PRESENTED BY: Dr. SOURABH MADAANPRESENTED BY: Dr. SOURABH MADAAN

DEFINATIONDEFINATION Functional appliances are defined as loose Functional appliances are defined as loose

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

Force component are derived from the oro-Force component are derived from the oro-facial musculature.facial musculature.

Basis of functional treatment in general is the Basis of functional treatment in general is the principle that a principle that a ‘new pattern of function’‘new pattern of function’ dictated by the appliance, leads to the dictated by the appliance, leads to the development of a corresponding development of a corresponding ‘new ‘new morphologic pattern’.morphologic pattern’.

CLASIFICATIONCLASIFICATION

I.I. Tooth borne active appliancesTooth borne active appliances Tooth borne passive appliancesTooth borne passive appliances Tissue borne passive appliancesTissue borne passive appliancesII.II. Myotonic appliancesMyotonic appliances Myodynamic appliancesMyodynamic appliancesIII.III. Removable functional appliances Removable functional appliances Fixed functional appliances Fixed functional appliances IV.IV. Group I appliancesGroup I appliances Group II appliancesGroup II appliances

Group III appliancesGroup III appliances

TREATMENT PRINCIPLESTREATMENT PRINCIPLES

1.1. Force applicationForce application : Primary : Primary alteration in form with a secondary alteration in form with a secondary adaptation in function.adaptation in function.

2.2. Force elimination Force elimination : Elimination of : Elimination of abnormal and restrictive abnormal and restrictive environmental influences on the environmental influences on the dentition.dentition.

FUNCTIONAL COMPONENTSFUNCTIONAL COMPONENTS

- BITE PLANESBITE PLANES- SHIELDS OR SCREENS SHIELDS OR SCREENS - CONSTRUCTION OR WORKING BITECONSTRUCTION OR WORKING BITE

BITE PLANESBITE PLANES FLAT OR INCLINEDFLAT OR INCLINED ANTERIOR OR POSTERIORANTERIOR OR POSTERIOR CONTACTING SINGLE OR MULTIPLE TEETHCONTACTING SINGLE OR MULTIPLE TEETHFLAT ANTERIOR BITE PLANEFLAT ANTERIOR BITE PLANE It should be of sufficient dimensions to It should be of sufficient dimensions to

disocclude the posterior teeth .disocclude the posterior teeth .Following effects are seen:Following effects are seen:1.1. Differential eruption of posterior teeth.Differential eruption of posterior teeth.2.2. Non eruption, relative or absolute intrusion of Non eruption, relative or absolute intrusion of

incisors.incisors.3.3. Incisor overbite reductionIncisor overbite reduction4.4. Disocclusion with removal of intercuspation Disocclusion with removal of intercuspation

may well be responsible for any additional may well be responsible for any additional increments of mandibular growth.increments of mandibular growth.

5.5. Unimpeded posterior tooth eruption Unimpeded posterior tooth eruption may also result in a downward and may also result in a downward and backward mandibular rotation that backward mandibular rotation that tends to increase anterior vertical tends to increase anterior vertical lower height and reduces the lower height and reduces the prognathism of the mandible.prognathism of the mandible.

INCLINED PLANES INCLINED PLANES May be designed to May be designed to provide labiolingual mechanical provide labiolingual mechanical eruptive displacement of incisors or eruptive displacement of incisors or the buccolingual deflection of the the buccolingual deflection of the erupting posterior teeth.erupting posterior teeth.

ADVANTAGESADVANTAGES

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

maintainence.maintainence. Worn during night so good patient Worn during night so good patient

acceptance .acceptance .

LIMITATIONSLIMITATIONS

Cannot be used in adult patients.Cannot be used in adult patients.Cannot be used to bring about Cannot be used to bring about

individual tooth movement.individual tooth movement.Patient cooperation is required.Patient cooperation is required.Prefunctional orthodontic tooth Prefunctional orthodontic tooth

movement is required.movement is required.Fixed appliance therapy may be Fixed appliance therapy may be

required.required.

ACTIONS OF FUNCTIONAL ACTIONS OF FUNCTIONAL APPLIANCESAPPLIANCES

ORTHOPAEDIC CHANGESORTHOPAEDIC CHANGESDENTO-ALVEOLAR CHANGESDENTO-ALVEOLAR CHANGESMUSCULAR CHANGESMUSCULAR CHANGES

ORTHOPAEDIC CHANGESORTHOPAEDIC CHANGES

Acceleration of growth in the Acceleration of growth in the condylar region.condylar region.

Remodeling of glenoid fossa.Remodeling of glenoid fossa.Restrictive influence on the growth of Restrictive influence on the growth of

jaws.jaws.Change the direction of growth.Change the direction of growth.

DENTO-ALVEOLAR CHANGESDENTO-ALVEOLAR CHANGESThey can bring about dento-alveolar changes They can bring about dento-alveolar changes

in in

SaggitalSaggital transversetransverse Vertical Vertical directionsdirections

Upper ant. Expansion of selective Upper ant. Expansion of selective eruptioneruption

to tip palatally. dental arches. of teeth.to tip palatally. dental arches. of teeth.

MUSCULAR CHANGESMUSCULAR CHANGES::

Improve tonicity of oro-facial musculature.Improve tonicity of oro-facial musculature.

CASE SELECTIONCASE SELECTION

Suited to treat Class II, division 1 Suited to treat Class II, division 1 malocclusionmalocclusion

1.1. Age Age : only in a growing patient (b/w 10 yrs & : only in a growing patient (b/w 10 yrs & pubertal growth phase.pubertal growth phase.

2.2. Social considerationsSocial considerations: Results with minimum : Results with minimum supervision. Patients who live far away from supervision. Patients who live far away from clinic may benefit from these appliances.clinic may benefit from these appliances.

3.3. Dental considerationsDental considerations: Only the case devoid : Only the case devoid of gross local irregularities like rotations and of gross local irregularities like rotations and crowding.crowding.

4. Skeletal considerations4. Skeletal considerations

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

Increased overbite open biteIncreased overbite open bite

Successfully treated pose special Successfully treated pose special problemsproblems Class II , div 2 div 1 treated.Class II , div 2 div 1 treated. Mild class III malocclusions, which present with a Mild class III malocclusions, which present with a

reverse overjet .reverse overjet .

Visual treatment objective Visual treatment objective (VTO)(VTO)

DIAGNOSTIC TEST.DIAGNOSTIC TEST.

VESTIBULAR SCREENVESTIBULAR SCREEN Takes form of a curved Takes form of a curved

shield of acrylic placed shield of acrylic placed in the labial vestibule.in the labial vestibule.

Introduced by Newell Introduced by Newell in 1912.in 1912.

Principle: Both force Principle: Both force application and application and elimination.elimination.

Indications : Indications : 1.1. Habits interception.Habits interception.2.2. Mild distocclusions.Mild distocclusions.3.3. To perform muscle To perform muscle

exercises. exercises. 4.4. To correct mild To correct mild

anterior proclination.anterior proclination.

FABRICATIONFABRICATION

Impressions working models in Impressions working models in occlusion (correction bite for disto-occlusion (correction bite for disto-occlusions) should extend into sulcus occlusions) should extend into sulcus to the point mucosal tissue reflects to the point mucosal tissue reflects outwards.outwards.

2-3 mm of wax cover the labial surface 2-3 mm of wax cover the labial surface of the teeth and alveolar processof the teeth and alveolar process

Appliance fabricated with self cure or heat Appliance fabricated with self cure or heat cure acrylic.cure acrylic.

Smoothened using sand paper and Smoothened using sand paper and polished. polished.

MANAGEMENT AND MANAGEMENT AND MODIFICATIONSMODIFICATIONS

To be worn during To be worn during night and 2-3 hours night and 2-3 hours during daytime.during daytime.

Patient is instructed Patient is instructed to maintain lip seal.to maintain lip seal.

Modifications Modifications include :include :

1.1. Hotz modificationHotz modification

2.2. For tongue thrust For tongue thrust habithabit

3.3. For mouth For mouth breathers.breathers.

Lip bumperLip bumper

ACTIVATORACTIVATOR

Called so due to its ability to activate the Called so due to its ability to activate the muscle forces.muscle forces.

INDICATIONS:INDICATIONS:1.1. Class II, div 1Class II, div 12.2. Class II, div 2Class II, div 23.3. Class III malocclusionClass III malocclusion4.4. Class I open bite Class I open bite 5.5. Class I deep biteClass I deep bite6.6. Preliminary Rx before major fixed Preliminary Rx before major fixed

appliances therapy.appliances therapy.7.7. Post Rx retentionPost Rx retention

CONTRAINDICATIONSCONTRAINDICATIONS

Not used in correction of class I Not used in correction of class I problems of crowded teeth.problems of crowded teeth.

In children with excessive lower In children with excessive lower facial height.facial height.

In children in which lower incisors are In children in which lower incisors are procumbent.procumbent.

Nasal stenosis.Nasal stenosis. In non growing individuals.In non growing individuals.

MODE OF ACTION OF ACTIVATORMODE OF ACTION OF ACTIVATORPatient 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 distallyReciprocal forward force on mandible

CONSTRUCTION BITECONSTRUCTION BITE

Intermaxillary wax recordIntermaxillary wax recordBite registrationBite registration

forward positioning vertical openingforward positioning vertical openingRule of 10Rule of 10Stepwise positioning is performed.Stepwise positioning is performed.Low construction bite with marked mandibular Low construction bite with marked mandibular forward positioning (H-activator, Class II, div 1 forward positioning (H-activator, Class II, div 1 horizontal growers)horizontal growers)High construction bite with slight forward positioningHigh construction bite with slight forward positioningWithout mandibular forward positioningWithout mandibular forward positioningOpening & posterior positioningOpening & posterior positioning

FABRICATION OF ACTIVATORFABRICATION OF ACTIVATOR

Impression making Impression making Study & working Study & working models preparationmodels preparationBite registrationBite registrationArticulation of the Articulation of the modelmodelPreparation of wire Preparation of wire elementselementsFabrication of the Fabrication of the acrylic portionacrylic portion

- 3 parts:3 parts:- Maxillary part Maxillary part - Mandibular partMandibular part- Inter occlusal partInter occlusal part

Management Management

Wear time:Wear time:- 2-3 hours a day during first week.2-3 hours a day during first week.- Second week 3 hrs during day and Second week 3 hrs during day and

during sleeping.during sleeping.- Trimming plan is developed on the Trimming plan is developed on the

basis of individual needs of the basis of individual needs of the patient.patient.

TRIMMING OF THE TRIMMING OF THE ACTIVATORACTIVATOR

MODIFICATION OF MODIFICATION OF ACTIVATORACTIVATOR

MODIFICATION OF MODIFICATION OF ACTIVATORACTIVATOR

Function corrector is Function corrector is a myofunctional a myofunctional appliance developed appliance developed by prof. Rolf Frankel by prof. Rolf Frankel of Germany.of Germany.

Also called frankel’s Also called frankel’s applianceappliance

Vestibular applianceVestibular appliance Oral gymnastic Oral gymnastic

applianceappliance

THE FRANKEL PHILOSOPHYTHE FRANKEL PHILOSOPHY

VESTIBULAR ARENA OF VESTIBULAR ARENA OF OPERATIONOPERATION

SAGGITAL CORRECTION SAGGITAL CORRECTION VIA TOOTH BORNE VIA TOOTH BORNE MAXILLARY MAXILLARY ANCHORAGE.ANCHORAGE.

DIFFERENTIAL ERUPTION DIFFERENTIAL ERUPTION GUIDANCEGUIDANCE

MINIMAL MAXILLARY MINIMAL MAXILLARY BASAL EFFECTBASAL EFFECT

PERIOSTEAL PULL BY PERIOSTEAL PULL BY BUCCAL SHIELDS AND BUCCAL SHIELDS AND LIP PADSLIP PADS

MODE OF ACTION OF FRANKEL MODE OF ACTION OF FRANKEL APPLIANCEAPPLIANCE

INCREASE IN TRANSVERSE AND INCREASE IN TRANSVERSE AND SAGITTAL INTRAORAL SPACESAGITTAL INTRAORAL SPACE

INCREASE IN VERTICAL SPACEINCREASE IN VERTICAL SPACEMANDIBULAR PROTARCTIONMANDIBULAR PROTARCTIONMUSCLE ADAPTATIONMUSCLE ADAPTATION

TYPES OF FUNCTIONAL TYPES OF FUNCTIONAL REGULATORSREGULATORS

FR1: They are used for the treatment of FR1: They are used for the treatment of class I & class II, div 1: 3 typesclass I & class II, div 1: 3 types

FR1a: class I malocclusion with crowding or FR1a: class I malocclusion with crowding or deep bite cases.deep bite cases.

FR1b: class II , div 1 . Overjet less than 5mmFR1b: class II , div 1 . Overjet less than 5mmFR1c : overjet more than 7mm.FR1c : overjet more than 7mm. FR2: They are used in Rx of class II , div 1 & FR2: They are used in Rx of class II , div 1 &

22 FR3: Class IIIFR3: Class III FR4: open bite and bimaxillary protrusionFR4: open bite and bimaxillary protrusion FR5: long face patients with high mandibular FR5: long face patients with high mandibular

plane angle and vertical maxillary excess.plane angle and vertical maxillary excess.

FR 2 of FRANKELFR 2 of FRANKEL

Used in Rx of Used in Rx of Class II, div 1 and Class II, div 1 and div 2 div 2 malocclusion.malocclusion.

Acrylic Acrylic componentscomponents::

a.a. Buccal shieldsBuccal shields

b.b. Lip pads Lip pads

c.c. Lower lingual padLower lingual pad

Wire components Wire components

a.a. Palatal bow Palatal bow

b.b. Labial bowLabial bow

c.c. Canine extensionsCanine extensions

d.d. Upper lingual wireUpper lingual wire

e.e. Lingual crossover wireLingual crossover wire

f.f. Support wire for lip padsSupport wire for lip pads

g.g. Lower lingual springsLower lingual springs

Functional regulator 3 of Functional regulator 3 of frankelfrankel

Indicated in class III Indicated in class III malocclusions malocclusions characterized by characterized by maxillary skeletal maxillary skeletal retrusion and not retrusion and not mandibular mandibular prognathismprognathism

It has two upper lip It has two upper lip pads .pads .

Effects :Effects :

Wear timeWear time

First few weeks: 2-4 hours/day (day First few weeks: 2-4 hours/day (day time)time)

After 3 weeks : 4-6 hours/day (day time)After 3 weeks : 4-6 hours/day (day time)After 3After 3rdrd visit (2 months) : full time wear. visit (2 months) : full time wear.The patient is asked to perform oral The patient is asked to perform oral

gymnastics i.e. talking , reading, tightly gymnastics i.e. talking , reading, tightly grasping the appliance in the vestibulegrasping the appliance in the vestibule

BionatorBionator

Developed by Balter Developed by Balter in 1950in 1950

Had much in Had much in common to activatorcommon to activator

Less bulky and more Less bulky and more elasticelastic

3 types:3 types:

1.1. Standard applianceStandard appliance

2.2. Class III applianceClass III appliance

3.3. The open bite The open bite applianceappliance

Before and AfterBefore and After

Indications of bionatorIndications of bionator

In class II, div 1 malocclusion having In class II, div 1 malocclusion having following features:following features:

- Well aligned dental archesWell aligned dental arches- Retruded mandibleRetruded mandible- Not very severe dental discrepancyNot very severe dental discrepancy- Labial tipping of upper incisorsLabial tipping of upper incisors• Class III where reverse bionator can be Class III where reverse bionator can be

used.used.• Open bite casesOpen bite cases

Twin block applianceTwin block appliance

Combines inclined planes Combines inclined planes with extraoral and with extraoral and intraoral traction.intraoral traction.

Consists of u/l plates Consists of u/l plates having occlusally inclined having occlusally inclined planes that induce planes that induce favorably directed occlusal favorably directed occlusal forces by causing a forces by causing a functional mandibular functional mandibular displacement.displacement.

Upper plateUpper plate consist of: consist of:- Modified arrow head claspsModified arrow head clasps- Jack screwJack screw- Bite block covering lingual Bite block covering lingual

cusp of upper post. teeth.cusp of upper post. teeth.

Before

After

Lower plateLower plate

It is retained by interdental ball It is retained by interdental ball clasps.clasps.

Lower molars are kept free to help in Lower molars are kept free to help in their eruption if needed.their eruption if needed.

Upper and lower bite blocks interlock Upper and lower bite blocks interlock at a 45 degree angle.at a 45 degree angle.

Bite registrationBite registration : :

5-7mm 3-5mm5-7mm 3-5mm

ORTHOPAEDIC TRACTIONORTHOPAEDIC TRACTION

Extra oral traction required in case of Extra oral traction required in case of severe skeletal discrepancysevere skeletal discrepancy

Extra oral traction of 200 g for 8-10 Extra oral traction of 200 g for 8-10 hours a day.hours a day.

Herbst applianceHerbst appliance

Fixed functional applianceFixed functional appliance Developed by Emil Herbst in 1900’sDeveloped by Emil Herbst in 1900’s Reintroduced in 1979 by Hans PancherzReintroduced in 1979 by Hans Pancherz Indications :Indications :1.1. Class II malocclusion due to retrognathic Class II malocclusion due to retrognathic

mandible.mandible.2.2. As an ant. repositioning splint.As an ant. repositioning splint.3.3. Post adolescent patientsPost adolescent patients4.4. Mouth breathersMouth breathers5.5. Uncooperative patientsUncooperative patients

Description of applianceDescription of appliance Can be compared to an Can be compared to an

artificial joint working artificial joint working between maxilla and between maxilla and mandible.mandible.

A bilateral telescopic A bilateral telescopic mechanism keeps the mechanism keeps the mandible in continuous mandible in continuous ant. position ant. position

The device consist of a The device consist of a tube into which the tube into which the plunger fitsplunger fits

The tube is fixed into The tube is fixed into the distal ends of the the distal ends of the maxillary molar while maxillary molar while the rod is fixed to the the rod is fixed to the lower first premolars.lower first premolars.

Types Types

Bonded Bonded Banded Banded

TREATMENT EFFECTS :TREATMENT EFFECTS : Used in the Rx of Class II malocclusion. Used in the Rx of Class II malocclusion.

Following effects are seen:Following effects are seen: class I molar relationclass I molar relation Increase in mandibular growthIncrease in mandibular growth Distal driving of maxillary molarsDistal driving of maxillary molars Overjet reductionOverjet reduction Inhibitory influence on saggital maxillary Inhibitory influence on saggital maxillary

growthgrowth SNB & SNA SNB & SNA

JASPER JUMPERJASPER JUMPER Flexible , fixed tooth Flexible , fixed tooth

borne functional borne functional appliance that was appliance that was introduced by J.J Jasper introduced by J.J Jasper in the year 1980.in the year 1980.

Similar to Herbst but Similar to Herbst but lacks rigidity.lacks rigidity.

APPLIANCE DESIGNAPPLIANCE DESIGN: : consists of jasper consists of jasper module attached to module attached to fixed appliances that fixed appliances that are on the U/L arches are on the U/L arches and is analogous to and is analogous to herbst appliance.herbst appliance.

Indications Indications

Skeletal Class II with maxillary Skeletal Class II with maxillary excess and mandibular deficiency.excess and mandibular deficiency.

MECHANISM OF ACTION:MECHANISM OF ACTION:12 mm is added to distance 12 mm is added to distance

measured b/w mesial aspect of upper measured b/w mesial aspect of upper face bow tube and the distal aspect face bow tube and the distal aspect of the lexan ball distal to the of the lexan ball distal to the mandibular canine.mandibular canine.