Fixed Functional Appliances Guide

FIXED FUNCTIONAL APPLIANCES

INDIAN DENTAL ACADEMY
Leader in continuing dental education
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Goals of Orthodontics and
Dentofacial Orthopedics
Achieve a good occlusion

Class I
malocclusions

Harmonize the basal structures


Skeletal
malocclusions

A skeletal Class II - fault with the maxilla

A skeletal Class II - fault with the mandible

Components of a growing skeletal Class
II malocclusion



Maxillary prognathism – 30%
Mandibular retrusion - 70%
----Mc’Namara (1981)

Mastorakos study( 1984) --- slight disagreement
with Mc’Namara’s values


Skeletal malocclusions
If your only instrument’s a hammer,
then every problem looks like a nail.
--- Maslow


Skeletal malocclusions
Skeletal Class II or Skeletal Class III
Treated by ---a) Functional appliances
b) Headgear
c) Combination
d) Camouflage
e) Surgical intervention

Growth
Modulation

Functional appliances
Factors essential to success:
a) Proper diagnosis and appliance
fabrication
b) Growth parameters
c) Appliance wear – Patient compliance


Patient compliance
Facts :
 Percentage of poor compliance --- 50%
 Both patients and families mis-represent
the extent of compliance
 Compliance decreases the longer the
patient is treated


Evolution of the Non-compliance
appliances
Subdivided into :
 Fixed functional Orthopedic appliances
 Fixed intra-arch appliances
 Fixed Inter-arch appliances


Fixed functional appliances
History :
 Kingsley’s bite jumping plate was a fixed one

 Emil Herbst read a paper on the ‘Herbst

appliance’ in 1905
 The Herbst was resurrected only in 1977
 Subsequent improvements within the Herbst

History :
 Inter-arch springs

started becoming popular

after the introduction of the Jasper Jumper in
1987
 As

many as 24 fixed functional appliances

could be traced !!

Classification :
 Rigid Fixed functionals – ‘Herbst’ like
 Flexible fixed functionals – ‘Jasper’ like
 Hybrid appliances


Rigid Fixed functionals
1.

Herbst and its modifications

2.

The Mandibular Anterior Repositioning splint (MARS)

3.

The Ventral Telescope

4.

The Magnetic telescopic device

5.

The Mandibular Protraction Appliance (MPA I – IV)


Rigid Fixed functionals – Essential characteristics

1.

Telescoping mechanism

2.

Very rigid and permit restricted movements

3.

Effects are usually skeletal (orthopedic)

4.

Usually indicated in Class II patients

Rigid Fixed functionals (Contd..)
6. The Universal Bite Jumper
7. The Biopedic appliance
8. The Mandibular anterior repositioining appliance
(MARA)
9. The Intra-oral Snoring Therapy Appliance (IST)
10. The Ritto Appliance

The Herbst appliance – Components


Tube and plunger assembly



Axle and screw assembly anchored onto the
upper molars and the lower bicuspids


Components of the Herbst


The Herbst with crowns – Langford design


The Herbst with Edgewise appliance –
Dischinger design or
The ‘Bioprogressive Herbst’


The Cantilever Herbst


The Acrylic Splint Herbst


Variations in the Herbst appliance
The MALU – Mandibular advancement
locking unit – Swadesh Kumar


Variations in the Herbst appliance
The Flip-Lock Herbst - Robert Miller


Indications of Conventional
Herbst
1.
2.

Mandibular retrusion
Post Surgical

3.

Prevention of Bruxism

4.

Diseases of TMJ


Duration of Treatment
 According to Herbst – 15months
 According to Pancherz – 6 - 9months
 According to Weislander – 6-9months + 2-

3yrs of retention using activator


Problems with Conventional
Herbst
1.

Difficulty in fabrication

2.

Breakages

3.

Restricted lateral movements

4.

Cost


Effects due to the Herbst appliances


Herbst like appliances
a) The Ventral telescope


b) The Biopedic appliance - GAC


c) The MPA – Filho -1995,97,98 and 2001


d) The Magnetic Telescope device – Ritto1997


e) The MARA appliance – Toll and Eckhart


d) The MARA appliance


Lateral views of superimposition of the 3D mandibles before and after treatment,
registered according to the anatomical landmarks of the brain (green, the 3D
mandible before treatment; pink, the 3D mandible after treatment)

Thank you
Leader in continuing dental education


Fixed Functional Appliances Guide

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