Orthodontic Seminer on

Myofunctional Appliances
Submitted To :
Dept. of Orthodontics
Dental Unit
Rajshahi Medical College

Prepared By :
Md. Tauhid Hossain
Batch: 21st BDS
Roll No : 32
Session: 2009-10

Definition
Funtional appliances are passive appliances
which harness natural forces of the oro-facial
musculature that are transmitted to the teeth
and alveolar bone in a predetermined
direction.

What they do..?

Function

Muscular Action

Effect on dentoalveolar development

Function

Muscular Action

Effect on dentoalveolar development

TREATMENT PRINCIPLES
FORCE APPLICATION
Compressive stress and strain act on the structures involved and
result in a primary alteration in form with a secondary adaptation in
function.

FORCE ELIMINATION
The principle involves the elimination of abnormal and restrictive
environmental influences on the dentition thereby allowing
optimum development thus function is rehabilitated with a
secondary change in form.

Action of functional appliance

Appliance can produce following changes
Orthopedic changes
Dento-alveolar changes
Muscular changes

Action of functional appliance

Orthopedic Changes
1.
2.
3.

Myofunctional appliances are capable of accelerating growth in condylar

region.
They bring about remodelling of glenoid fossa.
They can change the direction of growth of the jaws.

Dento-alveolar Changes
1. They can bring about changes in sagittal, transverse and vertical directions.
2. Most of them allow upper anteriors to tip palatally and lowers to tip labially.
3. In tranverse direction they can bring about expansion of the dental arches by
incorporating screws in them.
4. In vertical plane they allow selective eruption of teeth.

Muscular Changes
Functional appliance can improve tonicity of the oro-facial musculature.

Functional appliance treatment should be started before

the pubertal growth spurt.

This is the time when the mandible may exhibit

increased growth which may be influenced.

When???

Early treatment : 9-10 years.

Definitive treatment : 12-13 years.

These appliances should be worn at night-time as this

is when growth takes place. Duration: 10-12 hours a day.

Advantages of Functional Appliances

Helps to eliminate abnormal perioral muscle
function which interferes with muscle growth.
No side effects of mechanotherapy.
Less chair side time.
Easy to maintain oral hygiene.
Acceptable to many patients, can be worn
during night.
Frequency of the patients visit is less.

Basic Classification
Functional Appliances

Removable
Functional
Appliances.
Eg. Activator,
Frankel etc.

Fixed Functional
Appliances.
Eg. Jasper jumper

Semi-fixed
Functional
Appliances.
Eg. Den holtz, Bass
appliance etc.

Classification by Tom Graber

1. Group A Teeth supported appliances
Catalans appliances, Inclined planes etc.

2. Group B Teeth or tissues supported appliances

Activator, Bionator etc.

3. Group C Vestibular positioned appliances with

isolated support from tooth/tissue

Frankel appliance, Lip bumpers etc.

Classification by Proffit
1. Tooth borne passive appliance
Andersen activator
Harvold activator
Bionator

2. Tooth borne active appliance

Modified activator
Expansion activator
Orthopaedic corrector
Stockli headgear activator

3. Tissue borne appliance (passive)

Frankel appliance

Simple functional appliances

Lip Bumper

Used in patients exhibiting

lip habits such as lip
sucking. They can shield
the lip away.

Oral Screen

Consists of vestibular
shields which holds the lip
away from all teeth except
upper incisors
aids patient with digit
sucking

Upper Flat Bite Plane

It is an extension of acrylic base plate covering the region
behind the upper anterior teeth extending usually from
canine.
Uses

Deep bite
Cuspal interferences
Pain associated with Temporo-mandibular joint disturbances.
As a diagnostic splint- TMJ pain cases.
Decrease lower facial height.
Low(FMA) angle case

Upper Anterior Inclined Bite Plane

Used in case where there is severe retroclination of lower
anteriors.

Uses
Guiding mandible forward
Proclination of retroclined
lower anteriors
Reduction of overbite.

Posterior Bite Plane

Extension of acrylic base plate over the occlusal surface of
posterior teeth
INDICATION
To give occlusal clearance for correction of cross bite
Diagnosis of occlusal prematurities
Cases with TMJ pain dysfunction

Andresen Activator
Other Names
Mono-block
As upper and lower plates appear joined together.

Activator
Due to its ability to activate muscles.

Norwegian appliance

Indications
1.
2.
3.
4.
5.

Class II div-1
Class II div-2
Class III
Class I openbite
Class I deep bite

Frankels Functional Regulator

Passive functional appliance
Essentially tissue borne
Appliance of choice in class II due to mandibular retrusion.

Used in early mix dentition.

Has direct effect on neuromuscular system.
Expands dental arches.

A cross palatal
stabilizing wire on
the maxillary arch.

Acrylic
Bite Block

Lingual flange extensions

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

POST DELIVERY INSTRUCTION

1.
2.
3.
4.
5.
6.
7.

Teach the patient to wear and remove the appliance

in front of mirror
Should be worn 2-3 hours daily initially
When not in use keep in water
Any pain, soreness etc report to Dentist
If no pain also report the dentist after 2 weeks
Pt advised to maintain lip seal by conscious effort
Time charts should be given to record duration of
wearing the appliance

Limitations of Functional Appliances

Not useful in adults where active growth
completed
Patient cooperation and wearing appliance
important
Not possible to correct rotation, crowding etc
Tendency to increase lower facial height
therefore contraindicated in patients with
backward rotating mandible

BIBLIOGRAPHY
Orthodontics ,The art and science
by S.I Bhalajhi

Essentials of Orthodontics for Dental Students

by Mohammad Emadul Haq

Removable orthodontic appliances

by M.S Rani

Text book of orthodontics

by Graber