•Dr shabeel”sDr shabeel”s

Functional applianceFunctional appliance• ADVANTAGESADVANTAGES• Helps to eliminate Helps to eliminate

abnormal perioral abnormal perioral muscle function which muscle function which interferes with muscle interferes with muscle growth growth

• No side effects of No side effects of mechanotherapymechanotherapy

• Less chair side timeLess chair side time• Easy to maintain oral Easy to maintain oral

hygienehygiene• Acceptable can be Acceptable can be

worn during nightworn during night

• DISADVANTAGESDISADVANTAGES• Not useful in adults Not useful in adults

where active growth where active growth completedcompleted

• Patient cooperation n Patient cooperation n wearing appliance wearing appliance important important

• Not possible to correct Not possible to correct rotation ,crowding etc rotation ,crowding etc

• Tendency to increase Tendency to increase lower facial height lower facial height therefore therefore contraindicated in contraindicated in patients with backward patients with backward rotating mandiblerotating mandible

Classification of functional Classification of functional appliancesappliances

• 1. a. tooth borne active appliance eg activator ,bionator 1. a. tooth borne active appliance eg activator ,bionator • b.tooth borne passive appliance eg springs ,screws b.tooth borne passive appliance eg springs ,screws . c. tissue borne passive appliance eg frankel functional . c. tissue borne passive appliance eg frankel functional

appliance appliance

• 2. a.myotonic appliance2. a.myotonic appliance• b.myodynamic appliance b.myodynamic appliance

• 3. Removable functional appliance eg activator and bionator3. Removable functional appliance eg activator and bionator• Fixed functional applianceFixed functional appliance• • 4. group 1 appliances --eg inclined plane ,oral screen 4. group 1 appliances --eg inclined plane ,oral screen • group 2 appliances --eg activator ,bionator group 2 appliances --eg activator ,bionator • group 3 appliances --eg frankel appliance group 3 appliances --eg frankel appliance •

TREATMENT TREATMENT PRINCIPLES PRINCIPLES

• FORCE APPLICATION FORCE APPLICATION • Compressive stress and strain act on the structures Compressive stress and strain act on the structures

involved and result in a primary alteration in form with a involved and result in a primary alteration in form with a secondary adaptation in function secondary adaptation in function

• FORCE ELIMINATION FORCE ELIMINATION • The principle involves the elimination of abnormal and The principle involves the elimination of abnormal and

restrictive environmental influences on the dentition restrictive environmental influences on the dentition thereby allowing optimum development thus function is thereby allowing optimum development thus function is rehabilitated with a secondary change in form. these rehabilitated with a secondary change in form. these components produce skeletal and dentoalveolar changes components produce skeletal and dentoalveolar changes by acting on the following by acting on the following

• 1. eruption 1. eruption • 2. linguofacial muscle balance 2. linguofacial muscle balance • 3. mandibular repositioning 3. mandibular repositioning •

Action of functional Action of functional applianceappliance

• Functional appliance can produce following changes Functional appliance can produce following changes • 1.Orthopedic changes1.Orthopedic changes• 2.dentoalveolar changes 2.dentoalveolar changes • 3.muscular changes3.muscular changes

• orthopedic changesorthopedic changes• Myofunctional appl are capable of accelerating growth in condylar region Myofunctional appl are capable of accelerating growth in condylar region • They bring about remodelling of glenoid fossa They bring about remodelling of glenoid fossa • They can change direction of growth of the jaws They can change direction of growth of the jaws • • dentoalveolar changesdentoalveolar changes• They can bring about changes in sagittal ,transverse,and vrtical directions most They can bring about changes in sagittal ,transverse,and vrtical directions most

MFA allow upper anteriors to tip labially MFA allow upper anteriors to tip labially • In tranverse direction they can bring about expansion of the dental arches by In tranverse direction they can bring about expansion of the dental arches by

incorporating screws in them incorporating screws in them • In vertical plane they allow selective eruption of teeth In vertical plane they allow selective eruption of teeth

• muscular changesmuscular changes• Functional appliance can improve tonicity of the oro facial musculatureFunctional appliance can improve tonicity of the oro facial musculature

Bite PlanesBite Planes

Upper anterior inclined bite Upper anterior inclined bite plane plane

• Used in case where there is severe retroclination of lower anteriorsUsed in case where there is severe retroclination of lower anteriors• UsesUses1.1. Guiding mandible forwardGuiding mandible forward2.2. Proclination of retroclined lower anteriorsProclination of retroclined lower anteriors3.3. Reduction of overbite Reduction of overbite

SVED BITE PLANE SVED BITE PLANE

It’s a modification of anterior bite plane where the acrylic base is extended on to the incisal one third of the labial surface of It’s a modification of anterior bite plane where the acrylic base is extended on to the incisal one third of the labial surface of the anteriors inorder to prevent proclination of the teeth which may be caused due to inclined plane effect of bite the anteriors inorder to prevent proclination of the teeth which may be caused due to inclined plane effect of bite plane plane

This helps to reinforce anchorage also This helps to reinforce anchorage also

POSTERIOR BITE PLANEPOSTERIOR BITE PLANE Extension of acrylic base plate over the occlusal surface of posterior teethExtension of acrylic base plate over the occlusal surface of posterior teeth

INDICATIONSINDICATIONS To give occlusal clearance for correction of cross bite To give occlusal clearance for correction of cross bite Diagnosis of occlusal prematuritiesDiagnosis of occlusal prematuritiesCases with tmj dysfunction Cases with tmj dysfunction

CATALANS APPLIANCECATALANS APPLIANCE• This appliance is used to correct cross bite of young This appliance is used to correct cross bite of young

patients whose permanent molars have not erupted and patients whose permanent molars have not erupted and decidous molars are also lost due to extractiondecidous molars are also lost due to extraction

• This is used on lower anteriors where appliance make use This is used on lower anteriors where appliance make use of muscle forces and guides erupting tooth into normal of muscle forces and guides erupting tooth into normal position position

• CONTRAINDICATIONCONTRAINDICATION• Lack of over bite Lack of over bite • Cross bite due to true mandibular prognathismCross bite due to true mandibular prognathism

• MODE OF ACTION MODE OF ACTION • When appliance is worn the teeth can come into contact When appliance is worn the teeth can come into contact

only in the anterior region during various functionsonly in the anterior region during various functions

ORAL SCREENSORAL SCREENS• Oral screen is a thin sheet of acrylic processed over the occluded waxed working cast extending deep into the Oral screen is a thin sheet of acrylic processed over the occluded waxed working cast extending deep into the

sulcus both labially and buccally which act as a screen between teeth and musculature sulcus both labially and buccally which act as a screen between teeth and musculature

• INDICATIONSINDICATIONS1.1. Mouth breathing Mouth breathing 2.2. Thumb sucking Thumb sucking 3.3. Tongue thrusting Tongue thrusting 4.4. Lip biting Lip biting 5.5. Muscle exerciserMuscle exerciser• CONTRAINDICATIONCONTRAINDICATION1.1. Patients with mouth breathing due to nasal obstructionPatients with mouth breathing due to nasal obstruction

• MECHANISM OF ACTION MECHANISM OF ACTION 1.1. Retraction of anteriors Retraction of anteriors 2.2. To keep perioral musculature away from exerting its force To keep perioral musculature away from exerting its force 3.3. Forms mechanical barrier and prevents mouth breathing ,thumb sucking ,lip biting etc Forms mechanical barrier and prevents mouth breathing ,thumb sucking ,lip biting etc

• APPLIANCES FOR THUMB SUCKING AND TONGUE THRUSTING APPLIANCES FOR THUMB SUCKING AND TONGUE THRUSTING 1.1. Hawleys plate with anterior bite plane Hawleys plate with anterior bite plane 2.2. Appliance with tongue guard Appliance with tongue guard 3.3. Appliance with a bead Appliance with a bead

• Tongue guard should be long enough to prevent tongue from thrusting on maxllary incisors short enough to Tongue guard should be long enough to prevent tongue from thrusting on maxllary incisors short enough to prevent I nterfering with lower incisorprevent I nterfering with lower incisor

• Antero posteriorly they should be placed between canines if not lateral thrust developsAntero posteriorly they should be placed between canines if not lateral thrust develops

•

Appliance for correcting lip Appliance for correcting lip bitingbiting

• A lip bumper is used to correct lip biting A lip bumper is used to correct lip biting • Can be used in maxilla or mandible to shield away the lipsCan be used in maxilla or mandible to shield away the lips• As lips are kept away the pt cant bite lipAs lips are kept away the pt cant bite lip

• APPLIANCE FOR MOUTH BREATHINGAPPLIANCE FOR MOUTH BREATHING

• VESTIBULAR SCREENS VESTIBULAR SCREENS • It is a simple FA that takes form of a curved shield of acrylic It is a simple FA that takes form of a curved shield of acrylic

placed in labial vestibuleplaced in labial vestibule• Vestibular screens can be used either to apply forces of the Vestibular screens can be used either to apply forces of the

circumoral musculature or to relieve force from teeth circumoral musculature or to relieve force from teeth • These can used for correction of mouth breathingThese can used for correction of mouth breathing

• HOTZ MODIFICATIONHOTZ MODIFICATION• The vestibular screen can be modified using a ring projecting The vestibular screen can be modified using a ring projecting

outwards which is used for exerciseoutwards which is used for exercise

Frankel functional Frankel functional regulatorregulator

• Devpd by Rolf Frankel Devpd by Rolf Frankel • Also called oral gymnastic appliance Also called oral gymnastic appliance

• It has two main treatment effects It has two main treatment effects • 1. It serves as a template against which the cranio facial muscle function 1. It serves as a template against which the cranio facial muscle function • 2. The appliance removes muscle forces in labial and buccal areas that restricts 2. The appliance removes muscle forces in labial and buccal areas that restricts

skeletal growth thereby providing an environment which enables skeletal growth skeletal growth thereby providing an environment which enables skeletal growth

• MODE OF ACTIONMODE OF ACTION

The following are effects of frankel appliance The following are effects of frankel appliance 1.1. Increase in saggital and transverse intra oral space Increase in saggital and transverse intra oral space 2.2. Increase in vertical space where appliance is kept free from posterior teeth Increase in vertical space where appliance is kept free from posterior teeth 3.3. Mandibular protraction Mandibular protraction 4.4. Muscle function adaptation the pads and shield massage the blood vessels Muscle function adaptation the pads and shield massage the blood vessels

increase circulation increase circulation 5.5. Shields loosen up the tight muscles and improve muscle tone Shields loosen up the tight muscles and improve muscle tone

• Frankels exercises or oral gymnasticsFrankels exercises or oral gymnastics• 1. lips closed at all times 1. lips closed at all times • 2. swallowing speaking etc becomes exercise while using the appliance 2. swallowing speaking etc becomes exercise while using the appliance

Types of frankel Types of frankel appliance appliance

• FR 1 : Class 1, class2 division 1 FR 1 : Class 1, class2 division 1 malocclusionmalocclusion

• FR2 :Class2 division 1&2FR2 :Class2 division 1&2• FR3 :class3FR3 :class3• FR4 :Open bite and bimaxillary protrusion FR4 :Open bite and bimaxillary protrusion • FR5 :They are functional regulator which FR5 :They are functional regulator which

incorporate head gear indicated in long face incorporate head gear indicated in long face patients having a high mandibular plane patients having a high mandibular plane angle and vertical maxillary excessangle and vertical maxillary excess

•

ACTIVATORS ACTIVATORS • Activators induces musculo skeletal adaptation by introducing a new pattern of mandibular closure Activators induces musculo skeletal adaptation by introducing a new pattern of mandibular closure • The appliance loosely fits in the mouth the pt has to move the mandible forward to engage the appliance this The appliance loosely fits in the mouth the pt has to move the mandible forward to engage the appliance this

result in stretching of elevator muscles of mastication which starts contracting thereby setting up a myotactic result in stretching of elevator muscles of mastication which starts contracting thereby setting up a myotactic reflex reflex

• This generates kinetic energy that cause This generates kinetic energy that cause

1.1. Prevention of further forward growth of the maxillary dento alveolar process Prevention of further forward growth of the maxillary dento alveolar process 2.2. Movt of maxillary dento alveolar process distallyMovt of maxillary dento alveolar process distally3.3. Reciprocal forward force on the mandible Reciprocal forward force on the mandible 4.4. force is generated while sleeping and swallowing force is generated while sleeping and swallowing

• INDICATIONS INDICATIONS 1.1. CLASS2 division 1&2 CLASS2 division 1&2 2.2. Class 3 malocclusionClass 3 malocclusion3.3. Class 1 open bite Class 1 open bite 4.4. Class1 deep bite Class1 deep bite 5.5. Before major fixed appliance therapy Before major fixed appliance therapy 6.6. For post treatment retentionFor post treatment retention7.7. Children with lack of vertical height Children with lack of vertical height

• CONTRAINDICATIONS CONTRAINDICATIONS 1.1. Not used in class 1 with crowding by disharmony between tooth size and jaw size Not used in class 1 with crowding by disharmony between tooth size and jaw size 2.2. In children with excess lower facial height In children with excess lower facial height 3.3. In children whose lower incisors are severely procumbent In children whose lower incisors are severely procumbent 4.4. In children with nasal stenosis \In children with nasal stenosis \

POST DELIVERY POST DELIVERY INSTRUCTION INSTRUCTION

1.1. Teach the patient to wear and remove Teach the patient to wear and remove the appliance in front of mirrorthe appliance in front of mirror

2.2. Should be worn 2-3 hours daily initially Should be worn 2-3 hours daily initially 3.3. When not in use keep in water When not in use keep in water 4.4. Any pain ,soreness etc report to the clinic Any pain ,soreness etc report to the clinic 5.5. If no pain also report the clinic after 2 If no pain also report the clinic after 2

wks wks 6.6. Pt advised to maintain lip seal by Pt advised to maintain lip seal by

conscious effort conscious effort 7.7. Time charts should be given to record Time charts should be given to record

duration of wearing the appliance duration of wearing the appliance

BIBLIOGRAPHYBIBLIOGRAPHY

• Orthodontics ,art and science byOrthodontics ,art and science by• S.I S.I

BalajiBalaji• Removable orthodontic appliance Removable orthodontic appliance • M.S M.S

RaniRani• Text book of orthodontics by Text book of orthodontics by

GraberGraber