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Frankels Functional Regulator

Frankels functional regulator is a myofunctional appliance developed by professor Rolf Frankel of Germany. This appliance is also called as: Frankel appliance, vestibular appliance, oral gymnastic appliance, and functional regulator. It is classified as tissue borne passive appliance.

Treatment effects:
Serves as a template against which the cranio-facial muscles function. The framework of the appliance provides an artificial balancing environment, thereby promoting more normal pattern of muscle activity. The appliance removes the muscle forces in the labial and buccal areas that restrict skeletal growth thereby providing an environment which enable skeletal growth.

The Frankel philosophy

Frankel has based his appliance on the following principles Vestibular arena of operation: The dentition is influenced by perioral muscle function. Abnormal muscle function creates a barrier for optimal growth of the dentofacial complex. Thus Frankel appliance holds the perioral muscle forces (labial and buccal) away from the dentition so that the dentoalveolar complex are free to develop. In addition the appliance acts as an exercise device or oral gymnastic device that aids in correction of abnormal perioral muscle function. Sagittal correction via tooth borne maxillary anchorage: The appliance is anchored firmly in the maxillary arch by means of grooves in the molars and canine regions. The mandible is positioned anteriorly by means of an acrylic pad that contacts the alveolar bone behind the lower anterior segment. Thus lower acrylic pad acts more of a proprioceptive trigger for postural maintenance of the mandible. Differential eruption guidance: The appliance is free of maxillary teeth which allows selective eruption of the lower posterior teeth which aids in correction of the discrepancy in the vertical dimension and also helps in sagittal correction of classII malocclusions by allowing upward and forward movements of only the mandibular teeth.

Minimal maxillary basal effect: In most of the class II malcocclusion cases, it has been noted that maxillary position is normal while the mandible is retruded. The Frankel appliance has relatively little retrusive sagittal effect on the maxilla in contrast to marked protrusive change in mandible. Periosteal pull by buccals shields and lip pads: The buccal shields and lip pads are extednded to bring outward periosteal pull. This aids in formation of the bone at the apical base.

Mode of action of Frankel appliance

The following are the effects of the Frankel appliance on the dentoalveolar structures: Increase in transverse and sagittal intraoral space: Eliminates abnormal forces on the dentoalveolar structures from perioral region and at the same time favours lingual forces Constant outward pull on the connective tissue and muscles which is transmitted to the underlying bone by means of fibres inserted into the periosteum of the bone, resulting in apical bone formation. Increase in Vertical space: The appliance are free of mandibular teeth and selectively erutption of lower posterior teeth freely. Mandibular protraction Lingual pad guides the mandible to a more mesial position Training of protactor/retractor muscles of the mandible and condylar adaptation in course of time Whenever mandible is brought back the forces exerted by the lingual pads causes the protactor muscles to position the mandible mesially. Muscle function adaptation: Eliminates abnormal perioral muscle function Periosteal pull leading to apical bone formation Pads and shields massage soft tissues and improves blood circulation Improves tonocity of the muscles Lip pads prevents hyperactivity of the mentalis muscles , eliminates lip trap and establishes a proper lip seal.

Types of Frankels functional regulators

Frankels regulator 1: They are used for treatment of class I and class II division malocclusion. The FR1 is divided into following 3 types FR 1 a: Used for class I malocclusion where there is minor to moderate crowding. It is also for class I deep bite cases. All aspects for FR 1 is similar to FR 2 except for that it lacks the lingual shield, lingual springs, lingual crossover wire and the upper lingual bow seen in FR 2. The appliance consists of wire and acrylic components. The acrylic components includes 2 vestibular shields 2 lip pads The wire components includes Palatal bow Labial bow Labial support wire Lingual bow Canine loops The lingual pad is absent but a lingual bow is present which helps in forward positioning of the mandible FR 1 b: Used for class II, div 1 malocclusion where the overjet doesnt exceed 5mm. It differs from FR 1 in that it has a lingual pad. Among wire components, lower lingual springs are added to it. FR 1 c: Used for class II, div 1 malocclusion where the overjet is more than 7 mm. In FR1 c the buccal shields are split horizontally and vertically in two parts The antero inferior portion contains the wire wires for lingual acrylic pad and lip pads. This permits the forward movement of the anterior segment of thr appliance. The space created is filled with self cure acrylic Thus FR 1 c is used when multiple stage advancement is needed.

Frankels regulator 2: They are used for correction of class II, division 1 and 2 malocclusion. The FR 2 consist of acrylic and wire components. The acrylic component includes: Buccal shields Lip pads Lower lingual pad The wire component includes: Palatal bow Labial bow Canine extensions Upper lingual wire Lingual crossover wire Support wire for lip pads Lower lingual springs Acrylic components Lip pads The lower lip pads are also called as pellots Eliminates hyperactive mentalis activity Eliminates lower lip trap Exerts a periosteal pull which results in bone growth Buccal shields The buccal shields are also called as vestibular shields Removal of the forces exerted by the buccal musculature on the dentofacial complex Helps in unrestricted growth of dentofacial complex Cause periosteal bone deposition Wire components Palatal bow Palatal bow has its convexity facing distally and stands clear of the palate The lateral extension of the bow crosses the occlusal surface in the embrasure mesial to the first permanent molars and enters the acrylic buccal shield

The recurved ends of the bow ends as occlusal rest on the first molar which prevents the appliance from being dislodged superiorly and also prevents supra eruption of the first molars.

Canine loops Extensions of vestibular shields and are kept 2-3 mm away from the buccal surface of the canines They are also called as canine guards Eliminates restrictive muscle function thereby help in travnsverse development in the canine region. Labial bow The upper labial bow originates from the vestibular shields Runs in the middle 3rd of the labial surface of maxillay incisors Turns gingivally at right angles at the distal margins of the lateral incisors The bow is passive in nature Lingual stabilizing bow Also called as upper lingual wire or protrusion bow. Originates from the vestibular shields and passbetween the upper canines and first deciduous molars and curves along the lingual surface of the upper incisors at the level of the cingulum. Prevents lingual tipping of the incisors during treatment Lower lingual springs The wire component rests against the lingual surface of the lower anteriors. Helps to: Prevent supraeruption of the lower incisors To screen the tongue pressure from lower incisors To procline the lower incisors actively, when retroclined The spring gets embodied in the lingual pad; Lingual crossover wire Made of 1.25 mm stainleass stell wire, follows the contour of the lingual mucosa 3-4 mm below the lingual gingival margin of the lower incisors. It is placed 1-2 mm away from the mucosa. The wire crosses the occlusal surface between the deciduous molars and gets embedded in the buccal shields. Labial support wires Made of 0.9 mm stainless steel wire and offer support for the lip pads The wire should be atleast 7 mm below the gingival margin. The central wire is inverted v shaped to accommodate the lower ;abial frenum.

Another wire emerges from the lip pads and get embedded in the buccal shields

Frankels regulator 3: The FR 3 is indicated in class III malocclusion characterized by maxillary skeletal retrusion and not mandibular prognathism. The appliance should be used during deciduous dentition and early mixed dentition period. FR 3 has two upper lip pads. The lip pads are larger and more extended than the lower pads of FR 2. The pads appear teardrop shaped in the sagittal section and lie in the depth of vestibular sulcus parallel to the alveolus. The purpose of lip pads are: To eliminate the restrictive pressure of lip on the underdeveloped maxilla To exert tension on the tissues and periosteal attatchments in the depth of the sulcus to stimulate bone growth. To transmit the upper lip force to the mandible through the lower labial arch for a retrusive stimulus. Some forces are also transmitted to the vestibular shields. The buccal shields stands away form the maxillary posterior dentoalveolar structures by about 3 mm and are in contact with the mandibular apical bone. They eliminate the buccinator muscle force and also cause a periosteal pull leading to bone growth. Labial support wires connects the lip pads together and to the buccal shields. The labial bow is placed in the lower arch. Protrusion bow is seen behind upper incisors to stimulate forward movement of these teeth. The palatal bow lies slightly away from the mucosa to prevent irritation. It crosses the palate behind the last erupted molar. Frankel regulator 4: The FR 4 is used for correction of open bites and to a lesser exent bimaxillary protrusion. Its use is almost exclusively restricted to mixed dentition. The FR 4 has almost the same vestibular configuration as that of FR 1 and FR 2. It lacks canine loops and the protrusion bows. It consist of 4 occlusal rests on the maxillary first molars and first decidious molars to prevent tipping of the appliance.

The palatal bow is like FR 3 placed distal to the last molar.

Frankel regulator 5: They are functional regulators that incorporate head gear. They are indicated in patients with long face syndrome having high mandibular plane angle and vertical maxillary excess. The appliance consist of posterior acrylic bite blocks that prevent molar eruption due to the action of elevator muscles of mandible. Head gear tubes are incorporated that are used for extraoral traction.

Construction bite: For minor sagittal problems the construction bite is taken in an edge to edge incisal relationship making sure that there is no obvious strain of the facial muscles. Frankel has mentioned that the contruction bite should not move the mandible forward more than 2.5 to 3.0 mm. He recommends a small vertical opening large enough for the crossover wires to pass through the interocclusal area. In practice there must be at least 2.5 to 3 mm clearance in the buccal segments to allow the cross over wires to pass through. For an FR 3 the bite registration is taken with the the patients mandible in the most comfortable retruded position. In general the vertical opening is kept to a minmum to allow lip closure with minimal strain. Separation and seating grooves Before making the imressions, separators (heavy elastic separators) are placed in the maxillary canine-first deciduous molar embrasure and in the 2nd deciduous molar embrasure. This procedure is carried out to provide sufficient room for seating the crossover wires. If separations is ineffective in creating space, it is necessary to slice the distal contact of the upper second deciduous molar as well as the deciduous canine and first molar. Wear time 1st few weeks: 2-4 hours a day (day time) After 3 weeks: 4-6 hours a day (day time) After 3rd visit: (2 months), full time wear. The patient is asked to perform oral gymnastic appliance like talking, reading, tightly grasping the appliance in the vestibule.