FUNCTIONAL APPLIANCES

Dr. Rashid Mahmood Click to edit Master subtitle style

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GROWTH MODIFICATION
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Click icon to add picture

What? Why? Where ? When? 7/28/12

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Discrepancies
Skeletal Dental Soft-tissues
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Three dimensions
Transverse Sagittal Vertical

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Transverse Discrepancies

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Vertical Discrepancies

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Sagittal Discrepancies

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Sagittal Discrepancies

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II

III

Sagittal Discrepancies

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FUNCTIONAL APPLIANCES
In Orthodontics Click to edit Master subtitle style

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Definition:
Removable or fixed orthodontic appliances which use forces muscles, fascia and / or stretching of generated by the stretching Peridontium of muscles, fascia and / or Peridontium to alter skeletal and dental relationships.

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Form follows function

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Form follows function

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If compensatory, adaptive lip and tongue function could exacerbate excessive over-jet in class II-type malocclusions and if abnormal swallowing and prolonged finger-sucking habits could create anterior open-bite and narrow maxillary arches, could not the same muscles be used to correct these and other problem????

Background
Functional appliances are conceptually

based on Moss functional matrix theory

Functional matrix theory proposes that

functional matrices, tissues like muscles and glands influence skeletal units such as jaw bones and ultimately control their growth

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FUNCTIONAL APPLIANCES
The appliances used subtitle style Click to edit Masterto improve functional relationship of dento-facial structures by eliminating unfavorable developmental factors and improving the neuromuscular environment enveloping the developing occlusion

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Function

Muscular Action

Effect on dentoalveolar development 7/28/12

What they do..?

Alter the neuromuscular environment of oro-facial

region to improve occlusal development and/or craniofacial skeletal growth

Utilize muscle forces to effect bony and dental

changes

Disarticulate the teeth Encourage new mandibular position Require a tight lip seal during swallowing Selectively alter the eruptive path of teeth
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When???

When? ??
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When???
Functional appliance treatment should be

started before the pubertal growth spurt exhibit increased growth which may be influenced

This is the time when the mandible may

Duration---------------------------10-12 hours a day These appliances should be worn at night-

time as this is when growth takes place

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1. Growing ages (Mixed dentition and/or early permanent

INDICATIONS
a) b)

dentition)

2. Skeletal Considerations (Sagital correction of class II &III)

Skeletal Class II with Short mandible

Class II division 1 Class II division 2 (Convert div 2 to div 1) Normal to low angle cases

1. Vertical Considerations
a)

2. Dental Considerations
a) 7/28/12 Local irregularity & rotation of incisors especially

upper incisors

CONTRAINDICATIONS
1. Children with neuromuscular disorders
a.

Poliomyelitis

b. Cerebral palsy

2. Compliance 3. Hyperdivegent faces 4. Unfavorable growth 5. Protruded lower incisors 6. Severe crowding 7. Age

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Treatment Principles
Force Application: Compressive stress

and strain act on the structures involved resulting in primary alteration in form and secondary adaptation in function e.g all removable appliances destructive environmental influences are eliminated to allow optimum development

Force Elimination: Abnormal and

like lip bumpers and frankel buccal sheilds

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Mode of Action
Functional Appliances influence facial Goal is to
Use the functional stimulus of oro-facial

skeleton through condylar and sutural areas.

muscles , channeling this stimulus to the jaws, condyles and teeth to bring the change.
Purely functional and intermittent forces

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Limitations
Adult Age(Ineffective in adults) High Angle Cases(Increases vertical height of

patient)
Compliance Precise detailing of tooth position not possible Crowding (Cases with ALD are difficult to manage) Precise correction of Incisor inclination not possible
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Functional appliances if used properly & at right time then they help in improving the profile and eliminating the need for Orthognathic Surgery
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TYPES

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Active appliances reposition the mandible so

that the condyle is forced out of the glenoid fossa and this in turn is thought to stimulate the posterior/superior growth of the condyle.
Passive appliances act by repositioning the

musculature associated with the mandible so that the jaw bone itself responds by growing to the new equilibrium position

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SIMPLE FUNCTIONAL APPLIANCES Force elimination appliances e.g Oral shields, Tongue cribs , Habit breakers, Lip bumpers JAW ORTHOPEDICS APPLIANCES REMOVABLE FUNCTIONAL APPLIANCES FIXED FUNCTIONAL APPLIANCES 7/28/12

TYPES

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Simple functional appliances

Can be used for both mand

and maxilla

Uses the muscular force

from upper or lower lip to provide distal force specially to molars less acceptable so lip bumper is useful from labial aspect

Lip bumper

In lower arch headgear is Remove soft tissues forces Result increased lower

incisor inclination by influence of tongue

This can be reduced by placing it as low as possible

Simple functional appliances

Oral screens
Forerunner of functional

regulator
Consists

of vestibular shields which holds the lip away from all teeth except upper incisors b/c pressure from lips is transferred to U I and acts to move them palatally be used in mixed dentition and aids patient with digit sucking

Can

Jaw Orthopedic Functional Appliances

Removable Functional Appliances
TOOTH BORN

MONOBLOCK ACTIVATORS BIONATORS TWIN BLOCKS MAGNETIC APPLIANCE FRANKEL FUNCTIONAL APPLIANCE

TISSUE BORN

Fixed Functional Appliances

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Flexible Fixed Functional Appliances (FFFA)

Rigid Fixed Functional Appliances (RFFA)

TYPES
MYOTONIC
Depend upon displacement of mandible in AP

and vertical plane. e.g Activators

MYODYNAMIC
Not only translate the mandible AP & vertically

but also attempt to utilize and translate muscular movements e.g Bimler appliance

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Passive functional appliances

Frankel

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Active functional appliances

Bionator

Removable active functional appliances

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Active functional appliances

activator

Removable active functional appliances

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Active functional appliances

Twin-block appliance

Removable active functional appliances

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Active functional appliances

Herbst

Fixed active functional appliances

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Appliances
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Andresen Activator Viggo

Mono-block
together Andersen
As upper and lower plates appear joined

Activator Norwegian appliance

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Modified AndresenHupl-type activator

Class II cases Div I For better control of lower incisor

inclination,

the lower incisors are covered with acrylic, which is relieved on the lingual surface
Correct overjet, overbite and molar

relationship

during active growth

Labial bow to prevent incisors proclination Maximum extension of lower lingual
7/28/12 in order to redistribute the force flanges

Limitations
Difficulty in speech Needs removal during eating Arch expansion cannot be

carried out simultaneously

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Andresen

Labial view of the Andresen appliance. The picture shows labial Bow in 0.8mm S.S wire with tubing and lower incisal capping.

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Andresen

Models removed

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Andresen

Lingual or palatal view

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Andresen

Buccal Views

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Dr. Rolf Frankel

FRANKEL APPLIANCE FRANKEL CORRECTOR FUNCTIONAL REGULATOR

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Dr. Rolf Frankel

Passive functional appliance Essentially tissue borne

FRANKEL APPLIANCE Used in early mix dentition. FRANKEL CORRECTOR

Expands dental arches.

Appliance of choice in class II due to mandibular retrusion.

Has direct effect on neuromuscular system. Causes anterior advancement of mandible and increase in LAFH.

FUNCTIONAL REGULATOR

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FUNCTIONAL REGULATOR
Oral vestibule is used as operational

basis for the treatment of dentoalveolar discrepancies.

It combines the principles of

Andersons appliance and oral screen.

Mode of action depends upon the

relieving and lifting the pressure on teeth from lips and cheeks, so that the jaws can be allowed to grow and the teeth can be guided to move into 7/28/12 new more favorable position.

Frankel Applian ce

Click icon to add picture

Labial Bo w Can in e lo o p

Lip Pads/Pel ot s

Buccal V ie w The wire assembly anchors the appliance on the maxillary arch at the Buccal S h ie ld mesial embrasure of the of first molar.
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Labial and

Rolf Frankel

FrankelLip Pads/Pel Lower lin ots gual Applian wires Click icon Buccal ce to add shields
picture

Maxillary lo o p e d lingual a rch or protru s io n b ow

Lower Lingual Pad or Plate

A cross palatal stabilizing wire on the 7/28/12 maxillary

View w ith lower model rem

oved

FUNCTIONAL REGULATOR
FR I
a. Class I b. Class II div 1 <5mm c. Class II div 1 >7mm

FR II

Class II div 2

FR III Class III FR IV Open bite & mild bimax

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FUNCTIONAL REGULATOR
FR I
a. Class I

It is mainly used to treat cases of Class I malocclusion with minor to moderate crowding or arrested development of dental bases. It can also be used in class I malocclusion with deep bite.
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FR I Appliance

The components include: Upper Palatal wire 6 / 6 in 0.9mm S.S wire. Canine wires 3 / 3 in 0.9mm S.S wire. Labial Bow 2 / 2 in 0.9mm S.S wire. Lower Lip Pads and Joining wires in 0.9mm S.S wire.

Labial view

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FR I Appliance

Buccal view of the Frankel appliance.

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FR I Appliance

Frankel appliance - lingual / palatal view.

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FR I Appliance

Frankel appliance with upper model 7/28/12 removed.

FR I Appliance

Frankel appliance with lower model 7/28/12 removed.

FUNCTIONAL REGULATOR
FR I
b. Class II div 1 where over-jet is

<5mm
c. Class II div 1 where the over-jet is
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>7mm

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FUNCTIONAL REGULATOR
FR II Class II div 2

Prior to the functional therapy the incisor need to be aligned

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FR II Appliance 1. Flexible Appliance

2. The lingual and labial segments in lower portion

encourage holding the mandible in a postured position to alter the lip behavior.
3. By retraining the facial muscles & muscles of

mastication to occupy new position. into corrected position.

Labial Bow

Palatal Arch

Canine Clasps

4. The maxilla & mandible will be influenced to grow

Buccal Shields

5. Stretching of periosteum, osteoblastic activity & Occlusal Rests thus the bone formation.
Labial Pads 7/28/12

FUNCTIONAL REGULATOR
FR III Class III
Mild Class III cases

The correction of class III Malocclusion is by dento-alveolar means, not because of skeletal growth modification

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Registration of Bite
Varies with the type used. Move mandible forward by 4 6 mm. Or edge to edge contact of incisors 2.5 to 3.5 occlusal clearance. Correction of sagittal discrepancy in 2 or 3

stages.
3 dimensional effect of FR
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Bionator
1.Light Appliance 2.Better Compliance 3.Full Time Wear

Timing for Bionator Therapy

Effective and stable when it is initiated immediately before

the pubertal growth spurt. Optimal timing to start treatment with the Bionator is when a concavity is evident at the lower borders of both the second and the third cervical vertebrae (CVMS II).

In the long term, the amount of significant supplementary

elongation of the mandible in subjects treated with the 7/28/12 Bionator during the pubertal growth spurt is 5.1 mm more than that in untreated subjects with class-II malocclusion.

Used in mix dentition. Major indication is in extremely deep bite. Used to bring mandible in forward position and to increase LAFH by eruption of posterior teethCalifornia Bionator. Can be used to close bite and maintaining bite. Protusion springs may be used in class II div2

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Bionator
Facets in the acrylic which accepts maxillary & mandibular teeth & hold them in postured position Palatal spring (Reverse coffin spring)

Labial Bow

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Lingual horseshoe of acrylic

Twin Block
Indications
Class II div 1 Distal molar and canine relationship of at least half

premolar width Overjet more than or equal to 5mm Protrusion of maxillary incisors
Class II skelatal type ANB 4

Occlusal development ..late mixed dentition or

early permanenet dentition Normal & low angle cases

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Click to edit Master subtitle style

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Effects of twin block

Skeletal effects: mandibular length increses,during 1 yr,

restrains maxilla

Dentoalveolar change: upper incisors tip back Lower incisors move forward Overjet reduction.,.(correction achieved by skelatal and

dentoalveolar reduction

Correction of buccal segment achieved by combination of ANB reduction Increased vertical dimensions..(inc lower facial

distal movement of upper molars &forward movement lower molars

height)mandibular plane angle increases

Reduction of facial convexity

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Contraindications
TMJ problems Sk assymetries Syndromic pts

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Twin Block
ClarK 1988 Adams Clasp

In Function

Labial Bow Inclined Plane Modified Adams Clasp

Bite block 7/28/12

Expansion Screw

Bite block

Inclined Plane

where there is a will there is a way

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TREATMENT OF SKELETAL PROBLEMS IN CHILDREN Chapter 13 Click to edit Master subtitle style

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Jaw Orthopedic Functional Appliances

Removable Functional Appliances
TOOTH BORN

MONOBLOCK ACTIVATORS BIONATORS TWIN BLOCKS MAGNETIC APPLIANCE FRANKEL FUNCTIONAL APPLIANCE

TISSUE BORN

Fixed Functional Appliances

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Flexible Fixed Functional Appliances (FFFA)

Rigid Fixed Functional Appliances (RFFA)

Fixed functional. should be used in permanent dentition. Easily tolerated by the patient. Should be changed after some time .

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Fixed Functional Appliances

Advantages
Continuous stimulus for mandibular growth (24 hr use) They are smaller in size permitting better adaptation to

functions such as a mastication, swallowing, speech and breathing. Class II malocclusions successfully, overall treatment time.

Non-compliance Class II devices, which are able to treat while reducing the need for patient co-operation and Allows greater control by the orthodontist.

Disadvantages
Application of force is transmitted directly to the teeth

through a support system,

the main disadvantage that may be encountered is dental

7/28/12 movement that takes place during treatment

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APPLIANCE DISCRIPTION
Can be compared to the

artificial joint between maxilla & mandible. mechanism keeps the mandible in continuous anterior position.

A bilateral telescopic

Appliance consists of a tube

to which plunger fits. Tube is fixed to the distal end of maxillary molars & rod into the lower first premolars.

Herbst Appliance
The Herbst appliance consists of two tubes, two plungers, axles and

screws

Type I is characterized by a fixing system to the crowns or bands

through the use of screws.

It is necessary to weld the axles to the bands or crowns and then fix

the tubes and plungers with the screws through the use of screws Type III is for anchorage

Type II has a fixing system that fits directly onto the archwires Disadvantage is the fracture of archwires

Type IV has a fixation system with a ball attachment, which allows greater flexibility and freedom of mandibular movement.
Disadvanta ge in relation to other similar appliances is that it

needs brakes to stabilize the joint. The brakes are small and 7/28/12 sometime difficult to fit. When a fracture occurs or a brake is lost,

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FFF-Appliance
Jasper Jumper

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Herbst Appliance Jasper Jumper

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Indications of FFFA
Class I (An anchorage reinforcement) Class II division 1 and 2 Class III malocclusions Molar distalization Midline discrepancy
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Flexible Fixed Functional Appliances

Inter-maxillary torsion coils, or fixed springs.
Advanta ges

Elasticity

Flexibility Allow great freedom of movement of the mandible Lateral movements can be carried out with ease

Disadvanta ges
Fractures can occur both in the appliance itself (mainly in areas that have

more acute angles) and in the support system (mainly in the lower arch) produce fatigue in the springs breakage or damage.

If on one hand flexibility is an advantage, on the other hand it does tend to Tendency of the patient to chew on the appliance, possibly contributing to It is not possible for the patient to completely open his mouth, depending

on the way the system is fixed onto the lower arch, good opening can be achieved.

7/28/12 Expansive & replacement of broken parts adds cost

Mechanism of Action
FFFAs allow the patient to close in centric relation When the patient closes in centric relation, the contour of

the bow should be significantly increased

By slightly overactivating the appliance in centric relation,

the patient will automatically position the mandible forward. This is a natural response to decrease the force module and alleviate discomfort.

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Clinical Relevance
In brachyfacial cases, due to their strong musculature, it is

necessary to use more force (greater activation) than in dolicofacial cases.

If the patient has large cusps with good intercuspation, it will be

necessary to exert greater activation on the spring.

Greater force for orthopedic effects while lesser for dento-alveolar

movements

To maximize the dentoalveolar movements in the upper arch and

minimize any loss of anchorage in the lower, the upper archwire is not tied back.

It can be used to obtain maximum anchorage, holding upper molars

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back as the upper incisors are retracted.

Unwanted Effects
Due to the intrusive force on the upper molars, a posterior

open bite is common as well as posterior expansion due to the deflected force module.

Tendency for the lower molar to rotate mesiobuccally,

causing a mild posterior crossbite especially when the second molars have not been banded

Proclination of lower incisors..

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Jasper Jumper
Intrusion and distalization of the upper molars, with

occasional opening of the posterior bite similar to that seen with a Herbst ppliance.
Some indication of condylar growth.

Anterior migration of the mandibular teeth through alveolar

bone.

Intrusion of the lower incisors.

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Advantage
comfortable because of its covering.

Disadvantages
The large inventory that must be kept, the coating material may degrade Fractures
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Contd.
Canines can be retracted

against mandibular dentition.

As the force modules cause

asymmetric forces, it can be used to treat dental asymmetries.

Causes mandibular

advancement and increase in LAFH. surgical stabilization of class II patients.

Can be used in post

Indications.
Dental Class II malocclusion. Skeletal Class II with maxillary excess as opposed to

mandibular deficiency.

Deep bite with retroclined mandibular incisors. Midline Correction

Contra-indications.
Cases predisposed to root resorption. Dental and skeletal open bites. Vertical growth with high mandibular plane angle and excess

lower facial height. 7/28/12

Rigid Fixed Functional Appliances

RFFAs do not easily fracture but neither do they have elasticity or

flexibility.

After fitting and activation they do not allow the patient to close in

centric relation. This means that the mandible is in a forward position 24 hours a day creating greater stimulus for mandibular growth than with FFFAs.

Skeletal effects produced with this type of appliance are greater

than with FFFAs

Mechanism of Action Telescopic mechanism which encourages forward repositioning of

the lower jaw as the patient closes into occlusion

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Indications.
Dental Class II malocclusion due to retrognathic mandible Skeletal Class II mandibular deficiency.

Deep bite with retroclined mandibular incisors. They can be used as an anterior repositioning splinting patient with TMJ disorders.

Residual growth can be utilized in post adolescent patients. Can be used in mouth breathers.

Contra-indications.
Cases predisposed to root resorption. Dental and skeletal open bites.

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TYPES OF APPLIANCE
Bonded herbst (High Angle Cases) Banded herbs Flip locked herbst Crowned herbst

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The Flip-Lock Herbst Appliance

Reduced number of moving parts that can lead to breakage

or failure.
Easy to use Comfortable Instead of a screw attachment, it has a ball-joint connector

so it needs no retaining springs.

Less chairside time activation

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Bonded Herbst Appliance

It is a wire reinfofced acrylic splint.

High Angle Cases

The pivots are fixed to the wire framework at distobuucal aspect of the upper first molar mesial aspect of lower first premolar. Tube is fitted to the pivot in the upper molars & shaft is fixed to mandibular premolar region

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BANDED HERBST
Upper & lower first premolar & first

molars are banded.the tubes are fixed to pivots soldered to distobuccal aspect upper first molars. soldered to lower first premolar band.

The shaft or rods are fixed to pivots

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CROWNED HERBST

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Hybrid Functional Appliances

Hybrid appliances are specifically and individually tailored to exploit the natural processes of growth and development. These appliances blend several components designed to address specific problems

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Asymmetric mandibular deficiency or facial asymmetry in children

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Condylar fracture

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Fixed Version Of RFA

Dynamax Appliance Fixed Twin Block Magnetic Appliances

Elastics

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Fixed version of RFA

Clip-on Fixed Functional Appliance

Advantages of the Appliance

Patient co-operation is not required. It works for 24 hours a day. A full fixed appliance can be placed at the same time as the Class II

correction is being carried out.

Treatment time is short because of full time wear. There is no transitional phase between functional phase and the

fixed phase so treatment time reduced.

7/28/12 Overlap of the functional and fixed phase further reduces treatment

Fixed version of RFA

JO March 2001

Clip-on Fixed FA

Occlusal blocks with lingual tube attachments

Inclined Planes Occlusal blocks with palatal tube attachments.

Disadvantages of the Appliance

Breakage of the Appliance Construction of the Appliance

Oral Hygiene Problems Airways Clearance

Clip-on Fixed Functional Appliance

The results showed that this appliance was effective 7/28/12 in correcting Class II malocclusion; the

Head Gears
Extra-oral

force
Dento-facial

orthopedics

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Head Gears
Orthopedic appliance that control

growth of facial structures

Various designs. Used with growing patients.

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USES OF HEAD GEAR

CORRECTION OF SKELETAL CLASS II AND

REDIRECTION OF GROWTH ;(excess growth of maxilla/deficient growth of mandible)

Head gear restrain the forward and downward growth of maxilla by holding back the growth of upper jaw, allowing the lower jaw to catch up and thus the correction of class II.
MOLAR DISTILIZATION.

head gear may be used to distalize maxillary molar to correct the class II molar relation ship or to gain space for relief of crowding.
AS AN ANCHORAGE

orthodontist will not want the back teeth to come forward. The

In 7/28/12 some situations ,to maintain the bite, the

USES OF HEAD GEAR

REINFORCEMENT OF ANCHORAGE. head gear can be used to reinforce anchorage in high anchorage cases.

MOLAR ROTATION.
can also be brought about with the inner bow of headgear.

CORRECTION OF SKELETAL CLASS III.

(deficient growth of maxilla/excess growth of mandible).; by protraction or reverse pull head

gear that causes the anterior displacement 7/28/12 of maxilla.

CORRECTION OF SKELETAL CLASS II AND REDIRECTION OF GROWTH ;(excess growth of maxilla/deficient growth of mandible)

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CORRECTION OF SKELETAL CLASS II AND REDIRECTION OF GROWTH ;(excess growth of maxilla/deficient growth of mandible)

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CORRECTION OF SKELETAL CLASS III

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TYPES OF HEAD GEAR

High pull Cervical pull Combination pull Reverse pull

TYPES OF HEAD GEAR

TYPES OF HEADGEAR

High pull

Cervical Pull

Combination pull

Reverse pull

Asymmetric headgear

COMPONENTS PARTS OF HAEDGEAR

. Face bows; ( Inner and outer bow) . Release modules . Straps or cushions . Other items.

FACE BOW STYLES.

KLOEHN

Regular Cushion Loop

J-HOOK ASHER BITE PLATE

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FACEBOW STYLES
Kloehn style Bite plate Cushion loop Asher facebow

J -hook

BIOMECHANICS OF HEAD GEAR

CENTER OF RESISTANCE OF MAXILLA AND

MOLAR TOOTH.

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 The relation ship of line of action of force

BIOMECHANICS OF HEADGEAR

to the center of resistance of maxilla or first molar determines whether translation (bodily )or rotation (tipping) takes place.

When a force does not pass through the

center of resistance of the maxilla/molar, A moment is produced.

The direction of line of force can be

changed by adjusting the length and position of outer bow. 7/28/12

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High Pull Head Gear

Bodily movement of

molar (no tipping) when line of force is passing through the center of resistance of molar. upward movement of molar.

Both backward and

When line of force is

mesial tip of crown and distal tip of 7/28/12 root.

above CR ---

Low Pull/Cervical Head Gear

Bodily movement of

molar (no tipping) when line of force is passing through the center of resistance of molar, as determined by the outer bow length and position

Both backward and

downward 7/28/12 movements of molar.

BIOMECHANICS OF HEAD GEAR Similar

considerations apply to maxilla. Unless the line of force is through the center of resistance, rotation of maxilla occurs. Control of line of force is easier when face bow inserted into the splint covering all teeth. 7/28/12

RULE TO CHECK WHETHER THE LINE OF FORCE IS THROUGH THE CENTER OF RESISTANCE IN HIGH PULL AND CERVICAL PULL HEADGEAR
In order to determine the proper

position of outer bow. Use index finger to apply pressure in direction of head gear selected. move index finger below the outer bow, pushing up and back. As the finger is moved on the outer bow applying force. The bow will move up between the lips.

A)In case of high pull headgear we

B)In case of cervical pull headgear

we move index finger above the outer bow, pushing down and back. As the finger is moved on the outer bow applying force. The bow will move down between the lips.

BIOMECHANICS OF HEADGEAR
When the bow moves up, the

roots of maxillary first molar will move distally.

When the bow moves down, the roots of maxillary first molar will move mesially and crown distally.

. When the bow does not move.

The force is through the center of resistance of the maxillary first molar and molar will move bodily and not rotate.

BIOMECHANICS OF HEAD GEAR

EFFECT OF THE LENGTH OF OUTER BOW.

The longer outer bow bend up and

shorter bow bend down could produce the same line of force through the center of resistance of molar.

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High Pull Head Gear

Derives anchorage from parietal

region. It produces intrusion and distalization of teeth.

INDICATIONS.
Open bite cases. High mandibular plane angle. Long face cases with an increase in

lower anterior facial height.

High pull headgear can be used as.

HIGH PULL HEADGEAR TO

MOLARS.

CERVICAL HEAD GEAR

The anchor unit in this head

gear is nape of neck. It causes extrusion and distalization of molars along with distal movement of maxilla.

Indications:
short face,class II Anchorage conservation. early treatment of classII

Combination pull Headgear

Derives anchorage

from at least two regions ; the neck and occiput. It causes distal and slight superior force on maxilla and dentition.

Protraction head gear.

The rationale for protraction headgear is to apply

heavy force on the mid face in order to advance the maxilla anteriorly.

In this type inner bow is bent to achieve distal

insertion ,outer bow is modified to make hook in premolar region for elastic attachment. locate but most studies shows it 5-10mm below the orbit.

The center of resistance of mid face is difficult to

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Protraction head gear.

A line of force

closer to center of resistance of mid face will deliver a translatory force and line of force closer to occlusal plane has rotational force.

Petit Face Mask

For the protraction

of maxilla and maxillary dentoalveolar segments.

developing Class III

pattern.

Cleft lip and palate

patients.

Extra-oral elastics

Asymmetric head gear.

Asymmetic force is

achieved with a head gear by using an asymmetric outer bow,can be useful in regaining bilateral but asymmetric lost space.

Time, Duration and Force of Headgear Therapy.

FORCE.

500 TO 700gm(orthopedic )150200gm(orthodontic force). 12 -14hrs /Day, emphasis on wearing it from early morning.

DURATION

Treatment Duration. 12 TO 18 Months.

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TREATMENT EFFECTS
SKELETAL EFFECTS Frontomaxillary,zygomaticotemporal,zygo maticomaxillary n pterygopalatine r most imp growth sites for development of maxilla. head gears act by compressing the sutures thus restricting the normal downward n fowad growth of maxilla. DENTAL EFFECTS Distalization of molars. Extrusion and intrusion of molars 7/28/12

SIDE EFFECTS OF HEAD GEAR

Compensatory erruption of max And mand

molars but can be controlled by fixed lingual arch.

Distal tipping of max molars. Increased facial height.

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SIDE EFFECTS OF HEAD GEAR

LI P O O
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M P

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