Functional Appliance and The Mode of Action

By : Islam Yehia Raghed Michael

Functional appliances They do not act primarily on teeth like conventional appliances (springs, elastics) They transmits, eliminate or guide natural Forces Natural forces that can be controlled by functional appliances are: muscle activity from the tongue and check, tooth eruption, and growth and development The most favorable age for therapy 8-11 years for girls 10-13 years for boys

Why treat malocclusion? Possible pre-disposition to disease May lead to jaw dysfunction (TMD, Speech, Mastication) Facial esthetics with psychological effects Single or multiple tooth damage

Indications for functional Appliances

Well aligned dental arches Posterior positioned mandible Non severe skeletal discrepancy Lingual tipping of mand. incisors Proper patient selection

History of development of functional appliances

Robin 1902- monobloc Andresen 1908- Activator Herbst 1934- Herbst Balters 1960- Bionator Bimler 1964 Bimler Frankel 1967- Frankel Clark 1977-Twin Block

Historical biases of Europe and America on functional appliances

European Functional approach most biocompatible Mechanical force deemed unbiologic American European social system excluded extensive fixed appliance therapy Question of precision of results

Duration and timing of wear

Functional appliance treatment should be started before the pubertal growth spurt. This is the time when the mandible may exhibit increased growth which may be influenced. Functional appliances should be worn for at least 10-12 hours a day.

Night Time VS Day Time

Growth Theories
Scotts Cartilaginous Growth Theory

Sitchers Sutural Growth Theory

Mosss Functional Matrix Theory

Form follows function

Polyvinyle sialoxane bite registration material

Polyvinyle sialoxane bite registration material

Wax bite material preformed to arch shape

Activator

Woodside & harvold activator

Bionator

Herbst

Activator facts
Tooth borne passive appliance Original design worn at night Large one piece of acrylic Teeth could be redirected during eruption Large vertical opening construction bite Could not speak or eat when worn Advances mandibular jaw

 The original andersen activator was designed with angled flutes to guide the eruption of the molars for the upper molars distally and the lower molars mesially as they erupt

New design Lingual flanges contribute to its action Upper cant erupt Lower free to erupt Rotation of occlusion and correction of class II cases

Displacement springs

Bionater

Twin block

Frankel

( a.k.a. the shock absorber or "Bite Jumper") correction of ant-post relationships of upper and lower jaws. encourages mandibular growth, eliminate extractions and surgical corrections with headgears.

Herbst Appliance

The appliance is formed from a rod and tube (called the shock absorber) and actually connects the upper and lower jaws.
fully intraoraly and doesnt interfere with function.

Herbst facts

Fixed to teeth Patient compliance not required Works 24 hours Less airway blockage Most popular type at present time in U.S.

Arms guide the lower jaw forward to the ideal jaw position

Jasper Jumper
Upper Molars : Distalization /Intrusion / Expansion

Upper Incisors : Retrusion / Uprighting / Extrusion

Lower Molars : Mesialization / Extrusion Lower Incisors : Protrusion / Intsusion Reposition the Mandible

MARA Appliance (mandibular anterior repositioning appliance) Correction of anteroposterior relationships of upper and lower jaws. Works by guiding the mandible forward with occlusion. Completely intraorally so better compliance and aesthetics.

Indications for the MARA

The upper jaw is in good position and you want to advance the mandible. It is desirable to inhibit maxillary anterior growth and produce an increase in mandibular length. You want to recapture a prolapsed disc. Adult cases, when lower jaw surgery is not an option, needing a good compromise Class II correction. While the result is mostly dental, some mesial migration of the fossa may occur.

THE END
Special thanks for Assisst. Prof. Amjad Al-Taki