FRANKEL’S FUNCTIONAL REGULATOR
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FRANKEL’S FUNCTIONAL REGULATOR
IntroductionFrankel’s philosophyFabrication of the applianceAppliance delivery & Clinical handlingFR in class 2 and class 3Modification of FRStudies on FRComparison b/w FR and other functional appliances
Rolf frankel
Zwichau- Germany
1967 functional regulator
FRANKEL’S PHILOSOPHYMossFunctional performance of the muscular portions of the capsule influence the developing functional spaces
Functional spaces also influence by atmospheric pressure
FRANKEL’S PHILOSOPHY
Pressure on soft tissue
Muscular forces
Sub atmospheric pressure
Studies of Mobius During swallowing Vacuum in oral cavity
FRANKEL’S PHILOSOPHY
‘ SPACE FACTOR’ important aspect of epigenetic regulation
FRANKEL’S PHILOSOPHY
Functional space deficiency in transverse and vertical planes
Perioral muscles had restraining effect on dental archesInsertion of appliance –expands capsule and allows for new functional adaptation of musclesActivator – ‘ push from within’FR – ‘ought to be matrix’All activities of oral cavity – muscle training
FRANKEL’S PHILOSOPHY
FRANKEL’S PHILOSOPHYBuccal shields and lip pads exert periosteal pull exp not verified this effect Graber (1988) exp- on primates showed that this effect is temporary
FRANKEL’S PHILOSOPHY The mechanical effect of the appliance directed to the capsular matrix and not to teeth / alveolar process.
MOYERS‘altering the condition that determine the pattern of occlusal development rather than altering the occlusion directly.’
Classification of FRFR1Types a , b and cFR 2 FR3FR4MODIFICATIONS OF FR
FR 1
Acrylic componentsBuccal shield Lip pads Lingual shield
Buccal shields
ExtensionThickness 2.5mmExpansion of the capsule
Lip padsextension and Tear drop shape Smoothen sulksLip posture and seal seal
5 mm
Lip pads and buccal shields
Concomitant action in mandibular retrusion
Lingual shieldsextensionOver comes the poor posture of mandibular musclesDifferent action from activatorAction only in step advancement
Labial bow
Canine loop
Palatal bow
Cross over wire
Wire components of FR 1
Wire components of FR 1
Lower lingual wires
Cross over wires
Labial bowPalatal bow Canine loop
Labial bowPosition and extensionStabilizingConnecting‘Function activated’
Palatal bowExtensionOcclusal rest on maxillary molarStabilizing action Intermaxillary anchorage
Canine loop
ExtensionGuide eruption of canineIntermaxillary anchorage
Lower lingual wires
ExtensionPrevent lingual movement of incisorsFunction activated element in deep bite and retruded anteriors
Cross over wiresRun b/w 1st and 2nd premolarsNot to be lodged interdentally Cause movement of buccal segmentsNo training effect
FR1a and FR1 b
Lower lingual loops
Overjet 5mm
Lower lingual shield
Overjet 7mm
FR 1CStep by step opening in the anterior and vertical direction
Overjet > 7mm
FR 2Canine loop and labial bow
Upper lingual wire
Upper lingual wireRuns b/w canine and lateralStabilizing effectPrevents lingual tipping of anteriors in div 2 cases corrected in pre fr phase
Upper lingual wirePreferred in class2 div 2 with horizontal growth patternBite opening action similar anterior bite plane/activatorBite opening effect also due to buccal shields
FR 3
Lower labial wire
Upper lingual wire
Upper lip pads
Occlusal rests
Buccal shields in FR 3Stand away from maxilla but not from mandible
Lip pads in FR 3
Larger in sizeStands away from alveolar processExpansion of capsule and correction of postural imbalance
Palatal bow and occlusal rests
Palatal bow not lodged interdentally
Additional occlusal rest on lower molar in deep bite
Upper lingual wire and lower labial bow
Upper wire not touch the anteriors but can be activated to protrude incisors
Lower labial bow must touch the incisors
FR 4
4 occlusal rests
Palatal bow
Lower labial pads and buccal shields
upper labial bow
Construction of the FR appliance
Impression techniqueReproduce whole alveolar process and depth of the sulcusTray selectionAdequate base
construction biteDiffers from other functional appliancesAdvancement only by 2-3mm in first step
Preparation of the casts
Gauge to measure the correct depth of the sulcus
Properly carved working models
Preparation of the castsseating grooves:
Seating grooves are cut in the maxillary model in FR 1 and FR 2 in the permanent dentition
Preparation of the castsseating grooves
Seating grooves in maxillary model for permanent dentition
Notching in the deciduous dentition
Preparation of the casts
Sulcus trimming and position of lower lip pads
12 mm
Extension of lower lip pads
Preparation of the castswax relief:
Maximum thickness of wax padding under buccal shield
Wax padding under the buccal shield to allow for dentoalveolar expansion
Wire fabrication
Correct position of wires on the maxillary work model
Labial bow 0.9mm , canine loop 0.8mm and palatal bow 1mm
Wire fabricationPalatal bow
Canine loop
Wire fabrication
Correct position of lip pads and lingual shields and wiresLo-la 0.9mmLo –li 0.8mm
Wire fabrication
Correct position b/w wires and wax up -0 .75mm
Wire fabrication
Lingual wires 0.8mm
Extension arm of cross over wire 1mm
Single piece 3 separate pieces
Wire fabricationFuture splitting of buccal shield with use of metal sheet
Wire fabrication – FR 2
Palatal bow and upper lingual bow (0.9mm) in FR 2 seated inter proximally for locking
Bite registration - most comfortable retruded position
Wire fabrication - FR 3
Preparation of models- FR 3
Trimming of maxillary casts
Wax relief – FR 3
FR 3
CORRECT POSITION OF THE UPPER LIP PADS
Wire fabrication - FR 3
Correct position of protrusion and palatal bow
Wire fabrication - FR 3
Occlusal rest below palatal bow
Mandibular labial bow
Timing of treatment7-8 ½ yearsBest therapeutic effect when mandibular lateral incisors eruptClass2 div I with mandibular retrusion- males till a 15-16 yearsNot start during circum pubertal growth period /late mixed dentition.
Treatment phases with FRInitial phase
Active phase
Retention phase
Initial phaseAppliance delivery
CheckSmoothness of marginsLip pad –tear dropSeparation b/w teeth In mixed dentition make notches
Initial phaseAppliance delivery
Check appliance fitOverextension of shieldsPalpate face to to check for sharp edges
Initial phaseWearing the appliance
Success of treatment – lip sealEmphasis on lip exercisesDuration of wearIst week – 1-3 hrs in afternoon only2nd week – 4-6 hrs3 – 4 months – full time wear
Active phaseCheck after every 4 weeks
Mucosal irritationStability of applianceImpingement of cross over wires
Appliance adjustmentsCanine loop -occlusally Molar rests – gingivally
Active phaseAppliance adjustmentsLabial bows & lingual wires-retract /close spacesLingual wires – towards cingula
Further advancement in severe cases
Active phaseAfter 3 months of full time wearCheck
ExpansionOverjet Overbite molar relationship-(6-8 months)Leveling of curve of speeDecrease in mentalis activity
Retentive phaseDifferent from fixed appliances Labial and lingual wires can hold altered tooth positionsUsed as retainer in pts where the training effect not satisfactoryFixed treatment may be required
2 hrs in afternoon6 hrs in nightOnly night – i year
6 months
FR in treatment of class IIMandible displaced anteriorly- retractor muscle force –600gmsActivator-force transmitted to single teethBjork : rapid reaction in the dental system TMJ unaffectedMajor dental changes – Proclination of lower incisors
FR in treatment of class IIActivator treatment
before after
FR in treatment of class IIMode of action of activator in the treatment of mandibular retrusion
FR in treatment of class IISuspending muscles relax during sleepMandible drops inferiorly and backwardsProclination of lower anteriors2-3mm advancement initial afternoon wear
FR in treatment of class IIPost –sup elongation of condyleRemodeling at ramal-corpus junction- elongation of corpus
The adjustive function of the ramus
FR in the treatment of class 2
Mandibular retrusion to be overcome byExpanding the oral spaceSuspending muscles of mandible provide dynamic forceCorrect immature patterns b/w protractors and retractorsKeep mandible forward but not mechanically
FR in the treatment of class 2
Change in position brought by lingual shieldsInitial bite 2-3 mm Advancement in small steps for biologic reasons.
FR in the treatment of class 2
Step by step advancement by splitting the buccal shieldsSuspending muscles are not overstrainedActivator –extreme alteration of mandibular position –occlusal instability & TMDFR advancement in steps stability in post retention periods
FR in the treatment of class 3
Characterized by diminished volume of the superior part of the oro-facial capsuleRelated to structural and postural imbalance of musclesLingual volume not to be diminished
FR in the treatment of class 3
Expansion of upper oral space
Tongue space not diminished
FR in the treatment of class 3
Septo premaxillary ligament pull translates upper incisors bodilyFR3 promotes max basal bone development and translates maxilla forwardAppliance should not be locked in the maxilla by wires
FR in the treatment of skeletal open bites
Aimed at correcting the poor lip valve mechanism.Marked activity of temporalis and masseter when lips are closedAcc to Frankel tongue thrust is compensatory
Modifications of FR appliance
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Modifications of FR appliance1. Capped frankel appliance-OTTON et al
19922. Modified functional regulator for VME -
Owen19853. Change in the angulation of cross over wire
–Chate 19864. Hybrid appliance –activator –FR
combination -19865. KINGSTON modified buccal shields6. Fr with continuous buccolabial shield and
palatal acrylic support – Haynes 1986
CAPPED FR controls tippingIndicated in deep bite cases
CAPPED FRDisadvantages- need of sufficient posterior separation- capping may impinge on U1 as treatment progresses- difficult to clean
Change in the angulation of cross over wire
Strictly horizontal advancement results in incisal movements of the lower wire and shields
Change in the angulation of cross over wire
Change in the angulation of cross over wire
Difficulty in establishing normal lip functions
Change in the angulation of cross over wire
In cases with step advancement FR to be constructed so that it be parallel to the downward and forward repositioning of the mandible
Modified FR for VME Posterior part of maxilla –important for vertical growth control ½ -1/3 mm posterior eruption increases AFH by 1mm.Molars intruded chin translated forward improving profile
Modified FR for VME
Modified FR for VME by adding posterior bite blocksAdded head gear tubes
Modified FR for VME25 pts av age 7 yrs 3 months,bite 3-4 mm assessed after 19 monthsU1 retractedNo proclination of L1Horizontal movement of the chinAFH decreasedGumminess of smile reduced
HYBRID FUNCTIONAL APPLIANCE (fr and activator
combination)Hybrid appliances are those that are specifically and individually tailored to exploit the natural process of growth and development
1. Bite planes2. Shields and screens3. Construction and working bite
HYBRID FUNCTIONAL APPLIANCE (fr and activator
combination)
HYBRID FUNCTIONAL APPLIANCE (fr and activator
combination)
FR with kingston modified buccaL SHIELDS
Modified Fr with continuous buccolabial shield and palatal acrylic support- haynes
ajo 1986To eliminate lip trapNo pressure on the gingival dentoalveolar tissues
Studies on Frankel‘s appliance
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N.R.E Robertson AJO 198312 cases with FR2 and FR3 using cephs and conclude the principle changes were dentoalveolarMC NAMARA AJO 19843 adult patients with class 2 malocclusion with mandibular retrusion Length of mandible not increased but vertical dimensions increasedAdaptation minimal not sufficient to overcome malocclusion
FACIAL GROWTH DURING TREATMENT WITH FR APPLIANCE
Leth Nielsen AJO 1984
10 pts treated with FR showed maxilla retrognaticNo indication that mandibular growth was promotedChanges more in vertical planeNot necessarily improved the profile
Skeletal and dental changes following FR therapy on class II patients
MC NAMARA AJO 1985
100 pts treated for 24 months and compared with controlsNo change in maxillaIf considered pt A then slight retrusion of maxillaU6 forward movement reduced but not verticalL6 vertical movement
Skeletal and dental changes following FR therapy on class II patients
MC NAMARA AJO 1985
U1 tipped posteriorly some tipping of L1Downward movement of mandible noticed Some forward movement noticed in some pts
The effect of FR 4 in class 1 skeletal anterior open bite
ELIT ERBAY AJO 199520 treated and 20 controlsUseful in treatment Diminished AFH ,growth rate of AFH (3.9 mm)decreased ,& PFH increased (4.5 mm).
Caused forward and upward rotation of mandibleReduction in mandibular plane angles i.e Sn-GoMe,AnsPns-GoMe
Frankel-post vestibular shields caused inferior translation of mandible,growth at condyle increase in ramal length
Anterior part of mandible rotated upward because of the lip seal
Erbay’s study noted FR inhibited posteriors and improved the axial inclination of U1
Comparison of FR with other functional
appliances
FR Vs twin blocktoth/mc namara AJO 1999
4O PTS WITH TWIN BLOCK AND FR COMPARED TO CONTROLSResultsIncrease in mandibular length
Twin block – 3mm > controlsFR – 1.9MM
Vertical dimension & dentoalveolar changes TB > FRTB -mandibular skeletal & dentoalveolar changesFR – more skeletal and less dentoalveolar
FR Vs herbst appliancemc namara ,howe ajo 1990
45 herbst and 41 FR pts compared with controlsResults Both appliance – no effect on maxillaherbst – prevented vertical eruption and caused posterior movement of u6U1 lingual tipping- bothLower proclination L1 – herbst > FR mandibular length
Control - 2.1mm/yrHerbst - 4.8mmFR – 4.3mm
FR Vs fixed mechanotherapy
CREEKMORE,RADNEY AJO 1983FR compared to edgewise with headgearEdgewise had greater retractive force on maxillaRetraction of u1 > FR Retraction of L1Backward growth of condyle But 1.2mm < FRPog forward 1mm< FR
Fr therapy in cleft palate patients
keere,welch ajo 1981
9 pts treated with Fr for 6-18 monthsTo treat collapsed maxilla and cross biteResultsNot clinically useful in cleft patients
Frankel’s functional regulator
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The occipital reference system
Orientation to the earth’s surface
The occipital reference system
The occipital reference system
Case 1Class2 Mandible retrudedNo lip seal+ VTOFR 1
8 yrs 4 months
1 1/2 year post retention
Case 1
Pre treatment After FR 1 ½ years post retention
Case 1bjork
Occipital reference system
Case 2
Class 2Mandibular retruded open bite no lip seal
8 yrs 5 months
22 yrs .9 years post retention
Case 2
Case 2
Case 312 yrs
16 yrs
Case 3
Case 3
Case 4Class 3Maxillary retrusion Mandibular prognatismNo lip seal Flaccid lips
6 yrs 5 months
7 yrs 3 months
Case 4
After FR 7 yrs post retention
Case 4
Case 5Class 3Incompetent lip valve retruded maxilla
5 years 7 months
Case 5
Case 5
Case 6Class 2 div 1 skeletal open biteLips habitually parted hypotonic
9 yrs 10 months
20 yrs
Case 64 yrs 11 months
9 yrs
After FR
At 20 yrs
Case 7
Stability of transverse dimensions in post retention periods
Pre FR Post FR 7 years post retention
Case 7
Case 8
Pre FR
8 yrsPost FR 17 yrs
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