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1. FRANKEL’S FUNCTIONAL
REGULATOR
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1

2. INDIAN DENTAL ACADEMY
Leader in continuing dental education
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2

3. FRANKEL’S FUNCTIONAL
REGULATOR
Introduction
Frankel’s philosophy
Fabrication of the appliance
Appliance delivery & Clinical handling
FR in class 2 and class 3
Modification of FR
Studies on FR
Comparison b/w FR and other functional
appliances
3

4. Rolf frankel
Zwichau- Germany
1967 functional
regulator
4

5. FRANKEL’S
PHILOSOPHY
Moss
Functional performance of the muscular
portions of the capsule influence the
developing functional spaces
Functional spaces also influence by
atmospheric pressure
5

6. FRANKEL’S
PHILOSOPHY
Pressure on soft tissue
Muscular
forces
Sub atmospheric
pressure
Studies of Mobius
During swallowing
Vacuum in oral
cavity
6

7. FRANKEL’S
PHILOSOPHY
‘ SPACE FACTOR’ important aspect
of epigenetic regulation
7

8. FRANKEL’S
PHILOSOPHY
Functional space deficiency in
transverse and vertical planes
8

9. FRANKEL’S
PHILOSOPHY
Perioral muscles had restraining effect on
dental arches
Insertion of appliance –expands capsule and
allows for new functional adaptation of
muscles
Activator – ‘ push from within’
FR – ‘ought to be matrix’
All activities of oral cavity – muscle training
9

10. FRANKEL’S
PHILOSOPHY
Buccal shields and lip pads exert
periosteal pull
exp not verified this effect
Graber (1988) exp- on primates
showed that this effect is temporary
10

11. FRANKEL’S
PHILOSOPHY
The mechanical effect of the appliance
directed to the capsular matrix and not
to teeth / alveolar process.
MOYERS
‘altering the condition that determine the pattern of
occlusal development rather than altering the
occlusion directly.’
11

12. Classification of FR
FR1
Types a , b and c
FR 2
FR3
FR4
MODIFICATIONS OF FR
12

13. FR 1
Acrylic components
Buccal shield
Lip pads
Lingual shield
13

14. Buccal shields
Extension
Thickness
2.5mm
Expansion of
the capsule
14

15. Lip pads
extension and
Tear drop shape
Smoothen sulks
Lip posture and seal
seal
5 mm
15

16. Lip pads and buccal
shields
Concomitant
action in
mandibular
retrusion
16

17. Lingual shields
extension
Over comes the
poor posture of
mandibular muscles
Different action from
activator
Action only in step
advancement
17

18. Wire components of FR 1
Palatal
bow
Labial
bow
Canine
loop
Cross
over wire
18

19. Wire components of FR 1
Cross
over
wires
Labial bow
Palatal bow
Canine loop
Lower lingual
wires
19

20. Labial bow
Position and
extension
Stabilizing
Connecting
‘Function
activated’
20

21. Palatal bow
Extension
Occlusal rest on
maxillary molar
Stabilizing action
Intermaxillary
anchorage
21

22. Canine loop
Extension
Guide eruption
of canine
Intermaxillary
anchorage
22

23. Lower lingual wires
Extension
Prevent lingual
movement of
incisors
Function activated
element in deep bite
and retruded
anteriors
23

24. Cross over wires
Run b/w 1st and 2nd
premolars
Not to be lodged
interdentally
Cause movement
of buccal
segments
No training effect
24

25. FR1a
and FR1 b
Lower lingual
loops
Overjet 5mm
Lower lingual
shield
Overjet 7mm
25

26. FR 1C
Step by step opening
in the anterior and
vertical direction
Overjet > 7mm
26

27. FR 2
Canine
loop and
labial
bow
Upper
lingual wire
27

28. Upper lingual wire
Runs b/w canine
and lateral
Stabilizing effect
Prevents lingual
tipping of anteriors
in div 2 cases
corrected in pre fr
phase
28

29. Upper lingual wire
Preferred in
class2 div 2 with
horizontal
growth pattern
Bite opening
action similar
anterior bite
plane/activator
Bite opening
effect also due
to buccal
shields
29

30. FR 3
Upper lip pads
Lower
labial wire
Upper
lingual
wire
Occlusal
rests
30

31. Buccal shields in FR 3
Stand away from
maxilla but not
from mandible
31

32. Lip pads in FR 3
Larger in size
Stands away from
alveolar process
Expansion of
capsule and
correction of
postural imbalance
32

33. Palatal bow and
occlusal rests
Palatal bow not
lodged
interdentally
Additional
occlusal rest on
lower molar in
deep bite
33

34. Upper lingual wire and
lower labial bow
Upper wire not
touch the anteriors
but can be
activated to
protrude incisors
Lower labial bow
must touch the
incisors
34

35. FR 4
Lower labial pads and
buccal shields
4 occlusal rests
upper labial bow
Palatal bow
35

36. Construction of the FR
appliance
36

37. Impression technique
Reproduce
whole alveolar
process and
depth of the
sulcus
Tray selection
Adequate base
37

38. construction bite
Differs from
other functional
appliances
Advancement
only by 2-3mm
in first step
38

39. Preparation of the
casts
Gauge to measure the
correct depth of the
sulcus
Properly carved
working models
39

40. Preparation of the
casts
seating grooves:
Seating
grooves are
cut in the
maxillary
model in FR
1 and FR 2 in
the
permanent
dentition
40

41. Preparation of the
casts
seating grooves
Seating grooves in
maxillary model for
permanent dentition
Notching in the
deciduous dentition
41

42. Preparation of the
casts
Sulcus
trimming and
position of
lower lip
pads
Extension of
lower lip pads
12 mm
42

43. Preparation of the casts
wax relief:
Wax padding under the
buccal shield to allow for
dentoalveolar expansion
Maximum
thickness of wax
padding under
buccal shield
43

44. Wire fabrication
Labial bow 0.9mm ,
canine loop 0.8mm and
palatal bow 1mm
Correct position of wires on the maxillary work
model
44

45. Wire fabrication
Palatal bow
Canine loop
45

46. Wire fabrication
Correct position of lip pads and lingual shields
and wires
Lo-la 0.9mm
Lo –li 0.8mm
46

47. Wire fabrication
Correct
position b/w
wires and wax
up -0 .75mm
47

48. Wire fabrication
Single piece
3 separate pieces
Lingual wires 0.8mm
Extension arm
of cross over
wire 1mm
48

49. Wire fabrication
Future splitting of buccal shield with use
of metal sheet
49

50. Wire fabrication – FR 2
Palatal bow and upper
lingual bow (0.9mm)
in FR 2 seated inter
proximally for locking
50

51. Wire fabrication - FR 3
Bite registration - most comfortable
retruded position
51

52. Preparation of modelsFR 3
Trimming of
maxillary casts
52

53. Wax relief – FR 3
53

54. FR 3
CORRECT POSITION OF THE UPPER LIP PADS
54

55. Wire fabrication - FR 3
Correct position of protrusion and
palatal bow
55

56. Wire fabrication - FR 3
Occlusal rest
below palatal bow
Mandibular
labial bow
56

57. Timing of treatment
7-8 ½ years
Best therapeutic effect when
mandibular lateral incisors erupt
Class2 div I with mandibular retrusionmales till a 15-16 years
Not start during circum pubertal growth
period /late mixed dentition.
57

58. Treatment phases with
FR
Initial phase
Active phase
Retention phase
58

59. Initial phase
Appliance delivery
Check
Smoothness of margins
Lip pad –tear drop
Separation b/w teeth
In mixed dentition make notches
59

60. Initial phase
Appliance delivery
Check
appliance fit
Overextension of shields
Palpate face to to check for sharp
edges
60

61. Initial phase
Wearing the appliance
Success of treatment – lip seal
Emphasis on lip exercises
Duration of wear
Ist week – 1-3 hrs in afternoon only
2nd week – 4-6 hrs
3 – 4 months – full time wear
61

62. Active phase
Check after every 4 weeks
Mucosal irritation
Stability of appliance
Impingement of cross over wires
Appliance adjustments
Canine loop -occlusally
Molar rests – gingivally
62

63. Active phase
Appliance adjustments
Labial bows & lingual wires-retract
/close spaces
Lingual wires – towards cingula
Further advancement in severe cases
63

64. Active phase
After 3 months of full time wear
Check
Expansion
Overjet
Overbite
molar relationship-(6-8 months)
Leveling of curve of spee
Decrease in mentalis activity
64

65. Retentive phase
Different from fixed appliances
Labial and lingual wires can hold altered tooth
positions
Used as retainer in pts where the training
effect not satisfactory
Fixed treatment may be required
2 hrs in afternoon
6 months
6 hrs in night
Only night – i year
65

66. FR in treatment of
class II
Mandible displaced anteriorly- retractor
muscle force –600gms
Activator-force transmitted to single teeth
Bjork : rapid reaction in the dental system
TMJ unaffected
Major dental changes – Proclination of lower
incisors
66

67. FR in treatment of
class II
Activator treatment
before
after
67

68. FR in treatment of
class II
Mode of action of
activator in the
treatment of
mandibular
retrusion
68

69. FR in treatment of
class II
Suspending muscles relax during sleep
Mandible drops inferiorly and backwards
Proclination of lower anteriors
2-3mm advancement
initial afternoon wear
69

70. FR in treatment of
class II
Post –sup
elongation of
condyle
Remodeling at
ramal-corpus
junction- elongation
of corpus
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71. The adjustive function
of the ramus
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72. FR in the treatment of
class 2
Mandibular retrusion to be overcome by
Expanding the oral space
Suspending muscles of mandible
provide dynamic force
Correct immature patterns b/w
protractors and retractors
Keep mandible forward but not
mechanically
72

73. FR in the treatment of
class 2
Change in position brought by lingual
shields
Initial bite 2-3 mm
Advancement in small steps for biologic
reasons.
73

74. FR in the treatment of
class 2
Step by step advancement by splitting the
buccal shields
Suspending muscles are not overstrained
Activator –extreme alteration of mandibular
position –occlusal instability & TMD
FR advancement in steps stability in post
retention periods
74

75. FR in the treatment of
class 3
Characterized by diminished
volume of the superior part of
the oro-facial capsule
Related to structural and
postural imbalance of
muscles
Lingual volume not to be
diminished
75

76. FR in the treatment of
class 3
Expansion of
upper oral
space
Tongue
space not
diminished
76

77. FR in the treatment
of class 3
Septo premaxillary ligament pull
translates upper incisors bodily
FR3 promotes max basal bone
development and translates maxilla
forward
Appliance should not be locked in the
maxilla by wires
77

78. FR in the treatment of
skeletal open bites
Aimed at correcting the
poor lip valve
mechanism.
Marked activity of
temporalis and
masseter when lips are
closed
Acc to Frankel tongue
thrust is compensatory
78

79. Modifications of FR
appliance
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80. Modifications of FR
appliance
1. Capped frankel appliance-OTTON et al
2.
3.
4.
5.
6.
1992
Modified functional regulator for VME
-Owen1985
Change in the angulation of cross over wire
–Chate 1986
Hybrid appliance –activator –FR
combination -1986
KINGSTON modified buccal shields
Fr with continuous buccolabial shield and
palatal acrylic support – Haynes 1986
80

81. CAPPED FR
controls tipping
Indicated in deep bite cases
81

82. CAPPED FR
Disadvantages
- need of sufficient posterior separation
- capping may impinge on U1 as
treatment progresses
- difficult to clean
82

83. Change in the angulation
of cross over wire
Strictly
horizontal
advancement
results in incisal
movements of
the lower wire
and shields
83

84. Change in the angulation
of cross over wire
84

85. Change in the angulation
of cross over wire
Difficulty in establishing normal lip functions
85

86. Change in the angulation
of cross over wire
In cases with
step
advancement
FR to be
constructed so
that it be
parallel to the
downward and
forward
repositioning of
the mandible
86

87. Modified FR for VME
Posterior part of maxilla –important for
vertical growth control
½ -1/3 mm posterior eruption increases
AFH by 1mm.
Molars intruded chin translated forward
improving profile
87

88. Modified FR for VME
Modified FR for VME
by adding posterior
bite blocks
Added head gear
tubes
88

89. Modified FR for VME
25 pts av age 7 yrs 3 months,bite 3-4
mm assessed after 19 months
U1 retracted
No proclination of L1
Horizontal movement of the chin
AFH decreased
Gumminess of smile reduced
89

90. HYBRID FUNCTIONAL
APPLIANCE (fr and
activator combination )
Hybrid appliances are those that are
specifically and individually tailored to
exploit the natural process of growth
and development
1. Bite planes
2. Shields and screens
3. Construction and working bite
90

91. HYBRID FUNCTIONAL
APPLIANCE (fr and
activator combination)
91

92. HYBRID FUNCTIONAL
APPLIANCE (fr and
activator combination)
92

93. FR with kingston modified
buccaL SHIELDS
93

94. Modified Fr with continuous
buccolabial shield and palatal
acrylic support- haynes ajo 1986
To eliminate lip
trap
No pressure on
the gingival
dentoalveolar
tissues
94

95. Studies on Frankel‘s
appliance
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96. N.R.E Robertson AJO 1983
12 cases with FR2 and FR3 using cephs
and conclude the principle changes were
dentoalveolar
MC NAMARA AJO 1984
3 adult patients with class 2 malocclusion
with mandibular retrusion
Length of mandible not increased but
vertical dimensions increased
Adaptation minimal not sufficient to
overcome malocclusion
96

97. FACIAL GROWTH DURING
TREATMENT WITH FR APPLIANCE
Leth Nielsen AJO 1984
10 pts treated with FR showed maxilla
retrognatic
No indication that mandibular growth was
promoted
Changes more in vertical plane
Not necessarily improved the profile
97

98. Skeletal and dental changes
following FR therapy on class II
patients
MC NAMARA AJO 1985
100 pts treated for 24 months and
compared with controls
No change in maxilla
If considered pt A then slight retrusion
of maxilla
U6 forward movement reduced but not
vertical
L6 vertical movement
98

99. Skeletal and dental changes
following FR therapy on class II
patients
MC NAMARA AJO 1985
U1 tipped posteriorly
some tipping of L1
Downward movement of mandible
noticed
Some forward movement noticed in
some pts
99

100. The effect of FR 4 in class 1 skeletal
anterior open bite
ELIT ERBAY AJO 1995
20 treated and 20 controls
Useful in treatment
Diminished AFH ,growth rate of AFH (3.9
mm)decreased ,& PFH increased (4.5 mm).
Caused forward and upward rotation of
mandible
Reduction in mandibular plane angles i.e SnGoMe,AnsPns-GoMe
100

101. Frankel-post vestibular shields caused
inferior translation of mandible,growth at
condyle increase in ramal length
Anterior part of mandible rotated upward
because of the lip seal
Erbay’s study noted FR inhibited
posteriors and improved the axial
inclination of U1
101

102. Comparison of FR with
other functional
appliances
102

103. FR Vs twin block
toth/mc namara AJO 1999
4O PTS WITH TWIN BLOCK AND FR COMPARED
TO CONTROLS
Results
Increase in mandibular length
Twin block – 3mm > controls
FR – 1.9MM
Vertical dimension & dentoalveolar changes TB > FR
TB -mandibular skeletal & dentoalveolar changes
FR – more skeletal and less dentoalveolar
103

104. FR Vs herbst appliance
mc namara ,howe ajo 1990
45 herbst and 41 FR pts compared with controls
Results
Both appliance – no effect on maxilla
herbst – prevented vertical eruption and caused
posterior movement of u6
U1 lingual tipping- both
Lower proclination L1 – herbst > FR
mandibular length
Control - 2.1mm/yr
Herbst - 4.8mm
FR – 4.3mm
104

105. FR Vs fixed
mechanotherapy
CREEKMORE,RADNEY AJO 1983
FR compared to edgewise with headgear
Edgewise had greater retractive force on
maxilla
Retraction of u1 > FR
Retraction of L1
Backward growth of condyle But 1.2mm < FR
Pog forward 1mm< FR
105

106. Fr therapy in cleft palate
patients
keere,welch ajo 1981
9 pts treated with Fr for 6-18 months
To treat collapsed maxilla and cross
bite
Results
Not clinically useful in cleft patients
106

107. Frankel’s functional
regulator
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107

108. The occipital
reference system
Orientation to
the earth’s
surface
108

109. The occipital
reference system
109

110. The occipital
reference system
110

111. Case 1
Class2
Mandible
retruded
No lip seal
+ VTO
FR 1
8 yrs 4
months
1 1/2
year post
retention
111

112. Case 1
Pre treatment
After FR
1 ½ years post
retention
112

113. Case 1
bjork
Occipital
reference
system
113

114. Case 2
Class 2
Mandibular
retruded
open bite
no lip seal
8 yrs 5
months
22 yrs .9 years
post retention
114

115. Case 2
115

116. Case 2
116

117. Case 3
12 yrs
16 yrs
117

118. Case 3
118

119. Case 3
119

120. Case 4
6 yrs 5
Class 3
months
Maxillary
retrusion
Mandibular
prognatism
7 yrs 3
No lip seal
months
Flaccid lips
120

121. Case 4
After FR
7 yrs post retention
121

122. Case 4
122

123. Case 5
Class 3
Incompetent lip
valve
retruded
maxilla
5 years 7
months
123

124. Case 5
124

125. Case 5
125

126. Case 6
Class 2
div 1
skeletal
open bite
Lips
habitually
parted
9 yrs 10
months
20 yrs
hypotonic
126

127. 4 yrs 11
months
9 yrs
Case 6
After FR
At 20 yrs
127

128. Case 7
Pre FR
Post FR
7 years post
retention
Stability of transverse dimensions in post retention periods
128

129. Case 7
129

130. Case 8
Pre FR
8 yrs
Post FR
17 yrs
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131. Thank you
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