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AL
APPLIANCES
Prepared By:
Shi--IV year Part I B.D.S
K.M.C.T. Dental College
Kozhikode,Kerala
CONTENTS
INTRODUCTION
-DEFINITION
-HISTORY
BASIS FOR FUNCTIONAL APPLIANCE
CLASSIFICATION
FORCES
TREATMENT PRINCIPLES
INDICATIONS
ACTION OF FUNCTIONAL APPLLIANCES
CASE SELECTION
VISUAL TREATMENT OBJECTIVE
COMMON APPLIANCES IN USE
WHEN TO TREAT WITH FUNCTIONAL APPLIANCE?
LIMITATIONS & COMPLICATIONS OF FAs
CONCLUSION
REFERENCES
DEFINITION
A removable or fixed appliance which favorably
changes the soft tissue environment
-Frankel,1974
A removable or fixed appliance which changes the
position of mandible so as to transmit forces
generated by the stretching of the muscles,fascia
&/or periosteum,through the acrylic and wirework to
the dentition and the underlying skeletal structures.
-Mills,1991
HISTORY
1879-Norman Kingsley-Forward positioning of
mandible in orthodontics-Bite plane/Bite-jumping
appliance(vulcanite).
Drawback-tendency to relapse even with bite
guide.
Ottolengui-removable plate
1902-Pierre Robin-first practitioner to use
functional jaw orthopedics to treat a
malocclusion-Monoblockin children with
glossoptosis syndrome.
Viggo Andresen
Karl Hupl
Andresen-Hupl associationACTIVATOR
Biomechanical Orthodontics Functional Jaw
Orthopedics Norwegian System.
1936-collaborated on a textbook
Funktionskieferorthopdie (Function orthodontics).
1906-Alfred P. Rogers- Father Of Myofunctional therapythe first to implicate the facial muscles for the
growth, development,and form of the
stomatognathic system.
Double
Plates
Prof.Dr.Wilhem Balters
Dr.Martin Schwarz
Prof.Rolf Frankel
Dr.William J. Clark
CLASSIFICATION
I. Classification by Tom Graber,when functional
appliances were removable:
(i) Group I-Teeth supported -Eg: catlans appliance,inclined
planes.etc.
(ii) Group II-Teeth/Tissue supported-Eg:activator,bionator,etc.
(iii) Group III-Vestibular positioned appliances with isolated
support from tooth/tissue-Eg:Frankels appliance,lip
bumpers,vestibular screen
FORCES
Mostly use tensile forces-cause stress & strain-alter
stomatognathic muscle balance.
Both external(primary) & internal(secondary)
forces observed in each force application.
External Forces-occlusal & muscle forces from
tongue,lips & cheeks.
Internal Forces-reactions of tissues to 10force
TREATMENT PRINCIPLES
Depending on the type of force applied,2
treatment principles can be differentiated:
I. Force Application
II. Force Elimination
INDICATIONS
Use of FA alone:
-cases with mild skeletal discrepancy
-proclined upper incisors
-no dental crowding
Use of FA in combination with fixed appliance:
-used most commonly to improve the anteroposterior
relationship before starting the fixed appliance
treatment.
Interceptive treatment
-early intervention indicated when one wishes to
utilize their growth enhancing effect.
-extremely effective in reducing the relative
prominence of the proclined upper incisors,which are
particularly susceptible to dentoalveolar trauma.
Orthopaedic Changes:
-Capable of accelerating the growth in the
condylar region.
-Can bring about remodeling of the glenoid
fossa.
-Can be designed to have a restrictive
influence on the growth of jaws.
-Can change the direction of growth in jaws.
Dento-alveolar Changes:
-can bring about changes in sagittal,transverse &
vertical directions.
-Inhibition of downward & forward eruption of the
maxillary teeth.
-Retroclination of the upper incisors.
-Proclination of the lower incisor.
-Lower labial segment intrusion.
-Levelling of the curve of Spee & tipping of the
occlusal plane.
CASE SELECTION
Age: only in growing patient. Opt. age for FA
therapy b/w 10 years & pubertal growth
phase
Social Considerations:
Dental Considerations: ideal caseone
devoid of gross local irregularities
Skeletal Considerations: Moderate to sever
Class II mo cases are ideal
Mild Class III mo with a reverse overjet & an
average overbite
COMMO
N
APPLIAN
CES IN
VESTIBULAR SCREEN
Introduced by Newell in 1912.
Takes the form of a curved shield of acrylic placed in the labial
vestibule.
Works on the principle of both force application & elimination.
Vestibular screen does not contact teeth as compared to oral
screen.
Indications:
-to intercept mouth breathing,thumb sucking,tongue trusting,lip
biting & cheek biting.
-mild disto-occlusions.
-to perform muscle exercises to help in correction of hypotonic
lip & cheek muscles.
-mild anterior proclination.
Modifications:
HOTz MODIFICATION
KRAUSS
MODIFICATION
LIP BUMPER
combined removal-fixed appliance.
Used in both maxilla & mandible to shield
the lips away from the teeth.
Maxillary appliance Denholtz appliance.
Uses:
-in lip sucking patients.
-hyperactive mentalis activity.
-to augment anchorage
-distalization of first molars
ACTIVATOR
Indicaitons: In actively growing individuals with
favorable growth patterns.
-class II div I mo
-class II div II mo
-class III
-class I open bite
-class I deep bite
-as a preliminary T/t before major fixed appliance therapy
to improve skeletal jaw relations.
-for post treatment retention
-children with lack of vertical development in lower facial
height.
Contraindications:
-correction of class I cases with crowded teeth
caused by disharmony b/w tooth size & jaw
size.
-in children with excess lower facial height.
-in children whose lower incisors are severely
procumbent.
-in children with nasal stenosis caused by
structural problems w/in the nose or chronic
untreated allergy.
-in non-growing individuals.
Advantages:
-uses existing growth of the jaws
-minimal oral hygiene problems
-intervals b/w appointments is long
-appoints are short,minimal
adjustments required
-hence,more economical
Disadvantages:
-requires very good patient cooperation
-cannot produce a precise detailing &
finishing of occlusion.
-may produce moderate mandibular
rotation(hence contraindicated in excess
lower facial height cases)
Modifications:
Herrens Modification
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Wear Time:
1st week 2-3 hrs a day during day
time
2nd week onwards 3 hrs during day
& while sleeping.
Types:
FR I-Class I & Class II Div I .
FR 1a-Class I with minor to moderate crowding.
FR 1b-Class II div I where overjet does not exceed 5mm
FR 1c-Class II div I ;overjet >7mm
FR III-Class III
FR IV-open bite & bimaxilliary protrusion
FR V- incorporate head gear. Indicated in long face
patients having high mandibular plane angle&
vertical maxillary excess.
FR III
FR IV
BIONATOR
Developed by Balters in 1950s.
Modified activator less bulky &
more elastic
3 types> Standard type-class II div I having
narrow dental arches
> Class III Appliance
>Open bite appliance
Standard type
Advantages:
-very good patient acceptance.
-bite planes offer greater freedom of
movement & lateral excursion.
-less interference with normal
function.
-significant changes in patients
appearance within 2-3 months.
HERBST APPLIANCE
Fixed functional appliance developed
by Emil Herbst in early 1900s.
Indications:
-correction of class II MO due to
retrognathic mandible.
-can be used as anterior
repositioning splint in patients having
TMJ disorders.
Specific indications
-Post adolescent patients: T/t
completed w/in 6-8 months,hence
possible to use the residual growth in
these patients.
-Mouth breathers
-Uncooperative patients
2 types:
-Banded Herbst
-Bonded Herbst
Advantages:
-continuous action
-T/t duration is short
-less pt cooperation needed
-can be used in pts who are at the
end of their growth
-can be used in pts with mouth
breathing habit.
Disadvantages:
-cause minor functional disturbances.
-increased risk of development of
dual bit,with TMJ dysfunction
symptoms as a possible
consequence.
-repeated breakage & loosening of
appliance occurs,esp. in lower
premolar area.
-plaque accumulation & enamel
decalcification can occur
-tendency for posterior open bite.
JASPER JUMPER
A relatively new flexible,fixed
,tooth borne FA.
Introduced by J.J.Jasper ,1980
Actions similar to Herbst
appliance but lack rigidity.
Basically indicated in skeletal
class II mo with max. excess &
mandibular deficiency.
Advantages:
-produce continuous force
-does not require patient compliance
-allows greater degree of mandibular
freedom than Herbst appliance
-oral hygiene is easier to manage.
CONCLUSION
The global demand for orthodontics without braces
continues to grow. It's an option that many parents
and patients would prefer.
Myofunctional orthodontics offers a viable
alternative to traditional orthodontic methods.
A functional appliance is an appliance that produces
all or part of its effect by altering the position of the
mandible/maxilla.
REFERENCES
1) Dentofacial Orthopedics with Functional Appliances by
Thomas M. Graber,Thomas Rakosi & Alexandre
G.Petrovic;2/e,2009
2) Orthodontics Diagnosis & Management of Malocclusion
& Dentofacial Deformities by Om Prakash
Kharbanda;2/e,2013
3) Orthodontics Principles & Practice by Basavaraj
Subhashchandra Phulari;1/e,2011
4) Textbook Of Orthodontics By Gurkeerat Singh;2/e,2007