PRESENTED BY: Dr.

SOURABH MADAAN

Functional appliances are defined as loose fitting or passive appliances which harness natural forces of the oro-facial musculature that are transmitted to the teeth and alveolar bone through the medium of the appliance.

DEFINATION

Force component are derived from the oro-facial musculature. Basis of functional treatment in general is the principle that a new pattern of function dictated by the appliance, leads to the development of a corresponding new morphologic pattern.

CLASIFICATION
I.

II. III. IV.

Tooth borne active appliances Tooth borne passive appliances Tissue borne passive appliances Myotonic appliances Myodynamic appliances Removable functional appliances Fixed functional appliances Group I appliances Group II appliances Group III appliances

TREATMENT PRINCIPLES
1.

2.

Force application : Primary alteration in form with a secondary adaptation in function. Force elimination : Elimination of abnormal and restrictive environmental influences on the dentition.

FUNCTIONAL COMPONENTS
-

BITE PLANES SHIELDS OR SCREENS CONSTRUCTION OR WORKING BITE

BITE PLANES
FLAT OR INCLINED ANTERIOR OR POSTERIOR CONTACTING SINGLE OR MULTIPLE TEETH FLAT ANTERIOR BITE PLANE It should be of sufficient dimensions to disocclude the posterior teeth . Following effects are seen: 1. Differential eruption of posterior teeth. 2. Non eruption, relative or absolute intrusion of incisors. 3. Incisor overbite reduction 4. Disocclusion with removal of intercuspation may well be responsible for any additional increments of

Unimpeded posterior tooth eruption may also result in a downward and backward mandibular rotation that tends to increase anterior vertical lower height and reduces the prognathism of the mandible. INCLINED PLANES May be designed to provide labiolingual mechanical eruptive displacement of incisors or the buccolingual deflection of the erupting posterior teeth.
5.

ADVANTAGES

Elimination of abnormal muscle function. Treatment can be initiated at early age. Psychological disturbances avoided. Less chair side time. Frequency of patient visit is reduced. Do not interfere with oral hygiene maintainence. Worn during night so good patient acceptance .

LIMITATIONS
Cannot be used in adult patients. Cannot be used to bring about individual tooth movement. Patient cooperation is required. Prefunctional orthodontic tooth movement is required. Fixed appliance therapy may be required.

ACTIONS OF FUNCTIONAL APPLIANCES

ORTHOPAEDIC CHANGES DENTO-ALVEOLAR CHANGES MUSCULAR CHANGES

ORTHOPAEDIC CHANGES
Acceleration of growth in the condylar region. Remodeling of glenoid fossa. Restrictive influence on the growth of jaws. Change the direction of growth.

DENTO-ALVEOLAR CHANGES
They can bring about dento-alveolar changes in Saggital transverse Vertical directions

Upper ant. Expansion of selective eruption to tip palatally. dental arches. of teeth.

MUSCULAR CHANGES: Improve tonicity of oro-facial musculature.

CASE SELECTION

1.
2.

3.

Suited to treat Class II, division 1 malocclusion Age : only in a growing patient (b/w 10 yrs & pubertal growth phase. Social considerations: Results with minimum supervision. Patients who live far away from clinic may benefit from these appliances. Dental considerations: Only the case devoid of gross local irregularities like rotations and crowding.

4. Skeletal considerations
Skeletal class II are ideally suited. Low angle cases: respond well. High angle cases:

Increased overbite Successfully treated

open bite

pose special problems Class II , div 2 div 1 treated. Mild class III malocclusions, which present with a reverse overjet .

Visual treatment objective (VTO)

DIAGNOSTIC TEST.

VESTIBULAR SCREEN

1.

2. 3.
4.

Takes form of a curved shield of acrylic placed in the labial vestibule. Introduced by Newell in 1912. Principle: Both force application and elimination. Indications : Habits interception. Mild distocclusions. To perform muscle exercises. To correct mild anterior proclination.

FABRICATION
Impressions working models in occlusion (correction bite for distoocclusions) should extend into sulcus to the point mucosal tissue reflects outwards. 2-3 mm of wax cover the labial surface of the teeth and alveolar process Appliance fabricated with self cure or heat cure acrylic. Smoothened using sand paper and polished.

MANAGEMENT AND MODIFICATIONS

1. 2. 3.

To be worn during night and 2-3 hours during daytime. Patient is instructed to maintain lip seal. Modifications include : Hotz modification For tongue thrust habit For mouth breathers.

Lip bumper

ACTIVATOR
Called so due to its ability to activate the muscle forces. INDICATIONS: 1. Class II, div 1 2. Class II, div 2 3. Class III malocclusion 4. Class I open bite 5. Class I deep bite 6. Preliminary Rx before major fixed appliances therapy. 7. Post Rx retention

CONTRAINDICATIONS
Not used in correction of class I problems of crowded teeth. In children with excessive lower facial height. In children in which lower incisors are procumbent. Nasal stenosis. In non growing individuals.

MODE OF ACTION OF ACTIVATOR

Patient has to move mandible forward to engage appliance

Streching of elevator muscles of mastication which starts contracting

Myotactic reflex
Kinetic energy produced

Prevent maxillary growth

Moves maxilla distally

Reciprocal forward force on mandible

CONSTRUCTION BITE
Intermaxillary wax record Bite registration forward positioning vertical opening Rule of 10 Stepwise positioning is performed. Low construction bite with marked mandibular forward positioning (H-activator, Class II, div 1 horizontal growers) High construction bite with slight forward positioning Without mandibular forward positioning Opening & posterior positioning

FABRICATION OF ACTIVATOR
Impression making Study & working models preparation Bite registration Articulation of the model Preparation of wire elements Fabrication of the acrylic portion - 3 parts: - Maxillary part - Mandibular part - Inter occlusal part

Management

Wear time: 2-3 hours a day during first week. Second week 3 hrs during day and during sleeping. Trimming plan is developed on the basis of individual needs of the patient.

TRIMMING OF THE ACTIVATOR

MODIFICATION OF ACTIVATOR

MODIFICATION OF ACTIVATOR

Function corrector is a myofunctional appliance developed by prof. Rolf Frankel of Germany. Also called frankels appliance Vestibular appliance Oral gymnastic appliance

THE FRANKEL PHILOSOPHY

VESTIBULAR ARENA OF OPERATION SAGGITAL CORRECTION VIA TOOTH BORNE MAXILLARY ANCHORAGE. DIFFERENTIAL ERUPTION GUIDANCE MINIMAL MAXILLARY BASAL EFFECT PERIOSTEAL PULL BY BUCCAL SHIELDS AND LIP PADS

MODE OF ACTION OF FRANKEL APPLIANCE

INCREASE IN TRANSVERSE AND SAGITTAL INTRAORAL SPACE INCREASE IN VERTICAL SPACE MANDIBULAR PROTARCTION MUSCLE ADAPTATION

TYPES OF FUNCTIONAL REGULATORS

FR1: They are used for the treatment of class I & class II, div 1: 3 types FR1a: class I malocclusion with crowding or deep bite cases. FR1b: class II , div 1 . Overjet less than 5mm FR1c : overjet more than 7mm. FR2: They are used in Rx of class II , div 1 & 2 FR3: Class III FR4: open bite and bimaxillary protrusion FR5: long face patients with high mandibular plane angle and vertical maxillary excess.

FR 2 of FRANKEL

a.
b. c.

Used in Rx of Class II, div 1 and div 2 malocclusion. Acrylic components: Buccal shields Lip pads Lower lingual pad

Wire components
a.

b.
c. d. e. f. g.

Palatal bow Labial bow Canine extensions Upper lingual wire Lingual crossover wire Support wire for lip pads Lower lingual springs

Functional regulator 3 of frankel

Indicated in class III malocclusions characterized by maxillary skeletal retrusion and not mandibular prognathism It has two upper lip pads . Effects :

Wear time
First few weeks: 2-4 hours/day (day time) After 3 weeks : 4-6 hours/day (day time) After 3rd visit (2 months) : full time wear. The patient is asked to perform oral gymnastics i.e. talking , reading, tightly grasping the appliance in the vestibule

Bionator

1.
2. 3.

Developed by Balter in 1950 Had much in common to activator Less bulky and more elastic 3 types: Standard appliance Class III appliance The open bite appliance

Before and After

Indications of bionator
-

In class II, div 1 malocclusion having following features: Well aligned dental arches Retruded mandible Not very severe dental discrepancy Labial tipping of upper incisors Class III where reverse bionator can be used. Open bite cases

Twin block appliance

Combines inclined planes with extraoral and intraoral traction. Consists of u/l plates having occlusally inclined planes that induce favorably directed occlusal forces by causing a functional mandibular displacement. Upper plate consist of: Modified arrow head clasps Jack screw Bite block covering lingual cusp of upper post. teeth.

Before

After

Lower plate
It is retained by interdental ball clasps. Lower molars are kept free to help in their eruption if needed. Upper and lower bite blocks interlock at a 45 degree angle. Bite registration : 5-7mm 3-5mm

ORTHOPAEDIC TRACTION
Extra oral traction required in case of severe skeletal discrepancy Extra oral traction of 200 g for 8-10 hours a day.

Herbst appliance
1. 2. 3. 4. 5.

Fixed functional appliance Developed by Emil Herbst in 1900s Reintroduced in 1979 by Hans Pancherz Indications : Class II malocclusion due to retrognathic mandible. As an ant. repositioning splint. Post adolescent patients Mouth breathers Uncooperative patients

Description of appliance
Can be compared to an artificial joint working between maxilla and mandible. A bilateral telescopic mechanism keeps the mandible in continuous ant. position The device consist of a tube into which the plunger fits The tube is fixed into the distal ends of the maxillary molar while the rod is fixed to the lower first premolars.

Types

Bonded Banded

TREATMENT EFFECTS : Used in the Rx of Class II malocclusion. Following effects are seen: class I molar relation Increase in mandibular growth Distal driving of maxillary molars Overjet reduction Inhibitory influence on saggital maxillary growth SNB & SNA

JASPER JUMPER
Flexible , fixed tooth borne functional appliance that was introduced by J.J Jasper in the year 1980. Similar to Herbst but lacks rigidity. APPLIANCE DESIGN: consists of jasper module attached to fixed appliances that are on the U/L arches and is analogous to herbst appliance.

Indications
Skeletal Class II with maxillary excess and mandibular deficiency. MECHANISM OF ACTION: 12 mm is added to distance measured b/w mesial aspect of upper face bow tube and the distal aspect of the lexan ball distal to the mandibular canine.