FUNCTIONAL APPLIANCES

INTRODUCTION
Originated and developed in Europe
Controversy
A group of orthodontic appliances

features
Harness forces of muscles
Construction bite
Only work in growing children
Cant correct the teeth irregularity

Correction of Class malocclusion

Categories of functional appliances

Passive tooth-borne appliances: no active
components
Active tooth-borne appliances:including
expansive screw or springs to move teeth
Tissue-borne appliances: Functional
Regulator-FR

Effects of functional appliances

Dento-alveolar changes
Antero-posterior: Anterior movement of
lower teeth, posterior movement of upper
teeth.
Vertical: lower posterior teeth erupt.

Modification of Maxillary
growth
Restrain the forward growth of maxilla
Catch up growth occurs after treatment

Cephlomatric superimposition

Changes in mandibular growth

Stimulate mandible growth
Improve the growth direction of mandible

Cephlogram superimposition

Changes in glenoid fossae

Remolding of the glenoid fossa more

anteriorly

Indications for functional

appliances
The patient must still be growing,preferably
approaching a phase of rapid growth.
The pattern and direction of facial growth should
be favorable.
The profile improved immediately as the patient
move mandible forward.
The patient must be well motivated.
Dentition are well aligned

The timing of treatment

Late stage of mixed dentition,1-2 years before
the pubertal growth occur
Female: 9~10 year old
Male: 11~12 year old

Management of functional
appliances

Diagnosis
Skeletal or non-skeletal(dental)
Mandibular retrusion or maxillary
protrusion
Degree of severity

Appliance Design
No ideal appliance can be used in all
situations
Exactly what is desired in the treatment
consideration of cost, complexity,
acceptability
Vertical control
Mobile or exfoliating primary teeth

impression
Differ with the diagnostic records
Areas where appliance components will
contact soft tissues must clearly delineated
The impression must not stretch soft
tissues in areas of contact with the
appliance.

Bite registration
1.Anteroposterior dimension: for most
patients: 4~6mm (edge to edge if no
uncomfortable)
2.Vertical opening: 3~4mm in incisor
region

Bite registration
--methods
A horseshoe-shaped wax bite rim is
prepared
Guiding the mandible into planned
position
Forming the wax bite
Check and hardened

fabrication

Fit the appliance

Instruction
Check the surface of roughness, adjust
clasps, capping
How to insert and remove the appliances
Initially few hours, gradually increase the
wearing time. At least 14 hours each day
over 2 weeks

First review appointment

2 weeks later
Check and trim the appliance

Review appointment
1.Every 6~8 weeks
2.Check the appliance
3.Assess progress(improvement or no/slow
improvement)

4.Adjustment
Trimming of interocclusal elements to
allow teeth erupt where desired
Adjustment of the labial bow: reduce its
contact with the anterior teeth
Outward bending of buccal shields and lip
pads,facilitate arch expansion

Retention
Gradually reduce the amount of wearing
time till sleeping hours only
Period: the pubertal growth is over

Popular types of
appliances

Activator

Tu

construction
Base plane
Lip bow:transmit forces
to upper incisors
Lower incisors
capping:minimize
the tendency of lower
incisors procline
reducing overbite

principles

Muscles stretched-producing forces-retracting mandible-transmitted

to maxilla through labial bow-restraining the maxillary growth

Rules for construction bite

In a forward positioning of the mandible of
7-8mm,the vertical opening must be
slightly to moderated(2-4mm)
If the forward positioning is no more than
3-5mm,the vertical opening should be 46mm
The Activator can correct lower midline
shift or deviation

Management
Checkup appointments should be scheduled every 6 weeks:
1.observing shiny surface to determine whether the appliance be
worn correctly
2.trimming and reshaping acrylic guild areas
3.Acrylic contact guild plane often must be resealed.
4.The labial bows must be checked
5.In expansion treatment the jackscrew are normally activated by
the patients at 1-week interval. Check the screw

Trimming
1.vertical control
For dolichofacial patients:intrude molars,
extrude incisors
For branchfacial patients: intrude incisors,
extrude molars

Acrylic contact Intrusion of

the molars

Acrylic contour for

extrusion of the molars

Intrusion of the incisors

2.sagittal control

Retrusion of the incisors

Mesial movement of
molars

Distal movement of
molars

3.transverse movement

bionator

principles
Less buckly
Adjust the function of tongue
The working bite cant be opened and must
be positioned in an edge-to-edge
relationship. If the overjet is too large,can
be done step by step.

Types of Bionator
Standard Bionator
Horseshoe-shaped
acrylic lingual plate
Palatal bar
Labial bow extend
buccally
No incisors capping

Open-bite Bionator

Class Bionator

Indications

The dental are well aligned originally

The mandible is in a posterior position
The skeletal problem is not too severe
A labial tipping of the upper incisors is
evident

Clinical management
The time interval between office visit is 35 weeks
Adjust labial bow to touch the teeth lightly
Trimming the interocclusal block to guild
premolar into full occlusion

Frankel appliance(Functional
Regulator-FR)

 The large part of Frankel appliance is

confined to the oral vestibule
The buccal shields and lip pads hold the
buccal and labial soft tissue away from the
teeth,eliminating restrictive influence
The manner in which the anteroposterior
correction is different

tu

variation

FR1:correction of class division 1

FR2:correction of class division 1 and 2
FR3:correction of class
FR4:correction of openbite
Among them, the FR2 and FR3 are often
used

FR3
Acrylic parts:
Lip pads:eliminate
restriction,stimulation
of bone growth;
transmitting forces to
mandible
Buccal shields:
maxillary expansion

Steel wire
Lower labial bow:restrain
mandible
Protrusion bow:stimulate
forward movement of
maxillary incisors
Palatal bar: stabling
component
Occlusal rests:prevent
lower molar erupt,open
cross-overbite

Construction bite
Retruding mandible as much as possible,
generally edge to edge
Vertical dimension: opened only enough to
correct crossbite, allow wires to pass
through, about 2mm in posterior region

Fabrication
Working model trimming
wax relief
wire forming
fabrication of acrylic portion.

Clinical management
All margins are checked smoothness
Fitting the appliance 1-2 weeks
First visit: extending wearing time to 4-6
hours
Second visit:exercises may be prescribed
including speech and lip-seal
Upper molars rest will be cut

Twin block appliance

tu

introduction
Two pieces appliance
Giving greater freedom of movement in
anterior and lateral excursion
The appliance can be worn full day
Harness all oral functional forces
especially the forces of mastication
Correct the malocclusion rapidly

Construction bite
Overjet10mm,bite may be activated edge to
edge on incisors if the patient can posture
forward comfortable
Vertical dimension: 2mm interincisal clearance

Design and construction

Midline screw to expand the upper arch

Design and construction

retainer

Design and construction

Bite blocks

Design and construction

Inclined plane

Design and construction

Base plane

Design and construction

Labial bow

Stage of treatment
Stage 1: active phase:twin block

Stage 2: support phase-anterior plane

Vertical control
Dolichofacial patients:non-trimming, prevent second
molars extrusion
Branchfacial patients:trimming
Timing:1-2 months after the appliance was inserted
Method:trimming the upper block to leave 1mm
clearance between bite and lower molar

trimming

Herbst

Removable appliances
Producing tilting movements of individual
teeth
As an adjunct to fixed appliance treatment
retention

Anterior bite plane

management
The bite plane should be length enough to
ensure the lower incisors bite on the bite
plane.
Add to the height of the bite-plane during
treatment

Buccal capping
Eliminating occlusion interference
Dental incisors cross-bite
Unilateral posterior teeth crossbite

Bilateral block

Unilateral block