MYOFUNCTIONAL APPLIANCES--
ACTIVATORS
INDIAN DENTAL ACADEMY
Leader in continuing dental education
www.indiandentalacademy....
Definition of Myofunctional appliances
• A myofunctional appliance is defined as a loose fitting
or passive appliance whic...
Classification
I] Acc. to Profitt
1. TOOTH BORNE
Active appliances - elastic open activator,
Bimler’s appliance
Passive ap...
III] Myotonic appliances – activator, bionator
Myodynamic appliances – elastic open activator,
Bimler’s appliance.
IV]Acc....
History of activators
• Normar Kingsley in 1879 devised
a vulcanite palatal plate to be
used in patients having a
retruded...
• One of the first known
functional appliance known
as ‘Monobloc’ was
introduced by Pierre Robin
in Paris in 1926 for t/t ...
• Viggo Andresen was not
satisfied with the orthodontic
treatment of his daughter, thus
tested the activator on her, who
w...
Indications
• Class II division 1
malocclusion.
• Class II division 2
malocclusion.
www.indiandentalacademy.com
• Class III
malocclusion.
www.indiandentalacademy.com
• Class I open bite
malocclusion.
• Class I deep bite
malocclusion.
www.indiandentalacademy.com
• As a preliminary
treatment before any
major fixed appliance
therapy.
• For post treatment
retention.
• Children with red...
Contraindications
• Correction of class I problems of crowded teeth
caused by disharmony between tooth size n jaw size.
• ...
Mode of action
• Acc. to Andresen & Haupl, the
activator induces a musculo-
skeletal adaptation by
introducing a new patte...
• This reflex generates a
kinetic energy which has a
restraining effect on the
maxillary skeletal & dento-
alveolar growth...
Effects of activator on masticatory muscles
• The muscle activity of temporalis,
masseter & digastric muscles is
lower dur...
• Although the activity of both
elevator muscles is
diminished by use of the
activator during sleep, some
subjects show an...
Advantages of the activator
• Provides incisal capping.
• Oral hygiene is kept simple,
the dental braces can be
cleaned th...
• Influencing the profile or
general harmony of the
face in a positive way by
steering growth and
working on the
musculatu...
Disadvantages of the activator
• The position of individual teeth
can hardly be changed
• Partly detrimental side effects
...
• In cases of marked growth
deficits, the treatment is not
always successful
• Are practically inapplicable
in male adoles...
Construction Bite
• Construction bite is an
intermaxillary wax record
used to relate the mandible
to the maxilla in the th...
• Degree of activation should
stretch the muscles of
mastication sufficiently to
provide a positive
proprioceptive respons...
General considerations for construction bite
• In case the overjet is too
large, forward positioning
is done in 2-3 phases...
Theories of bite registration
In the sagittal plane
• Single step advancement
• Progressive advancement
In the vertical pl...
• Characterised by marked
forward positioning of the
mandible but minimal vertical
opening
• As a rule of thumb anterior
a...
High construction bite with slight mandibular forward positioning
• Mandible is positioned
anteriorly by 3-5mm only and
th...
Construction bite without mandibular forward positioning
• Sometimes a
construction bite without
forward position of the
m...
Construction bite with opening and posterior positioning of
the mandible
• In class III malocclusion
a bite is taken after...
Fabrication of an activator
Impressions
• Impressions of upper &
lower arches are made to
construct 2 pairs of
models:-
1....
Bite registration
• The amount of sagittal &
vertical advancement is pre
planned.
• The patient is made to sit in an
uprig...
• Method 1
• Explain to the patient what is
required, that they posture the
lower jaw forward to the
required occlusion. D...
• Remove the wax
registration and chill the
wax under cold running
water & try it on the casts.
• Cut away the wax as show...
Method 2
• Use either a thick or thin 'bite
fork'. The thick (yellow) ones
are for when an overbite needs
reducing and thi...
• Soften a sheet of pink modeling
wax in hot water, folding them
into the bite fork.
• Place the bite fork and soft wax
in...
Articulation of the model
• The wax bite registration is
placed on the occlusal
surface between the upper
and lower models...
Preparation of wire elements
• Usual design requires an
upper labial bow made
with 0.8 or 0.9mm wire and
consists of horiz...
Fabrication of the acrylic portion
a. Maxillary part
b. Mandibular part
c. Inter-occlusal part
• The appliance can be
fabr...
Management of the appliance
• Patient should be sufficiently convinced about the
benefits of using the activator.
• The pa...
Trimming of the activator
• Planned trimming of the
appliance in tooth contact area
is carried out to bring about
dento-al...
For vertical control
• INTRUSION: In incisors it is
achieved by loading the incisal
edge of these teeth with
acrylic.
In c...
For sagittal control
• PROTRUSION: In case incisors are
to be protruded lingual surface of
the teeth is loaded with acryli...
Movement of posterior teeth in a
sagittal plane
• Teeth in the buccal segment
can be moved mesially or
distally to help tr...
TWIN BLOCK APPLIANCE
• Indicated for following
malocclusions: Class II Division
I; Class II Division 2; Class I
open bites...
• Versatile design allows
you to control and correct
upper and lower arch
width and length
independently, at the
same time...
• The Twin Block's high comfort
level allows it to be worn 24
hours a day - even while
eating. This versatile design
allow...
• The use of functional jaw
orthopaedics, at the
correct time during
growth, can ultimately
result in maloccluded
patients...
• Unlike bulky, one-piece
functional appliances, the
Twin Block has separate,
unattached upper and lower
bite block compon...
• The Twin Block Appliance has
been described as "the most
comfortable and the most
esthetic of all the functional
applian...
• The high comfort level allows
the appliance to be worn 24
hours a day. This harnesses
the forces of occlusion and
mastic...
Conclusion
• Functional appliances are
usually fitted to reduce the
prominence of upper incisors
and to improve the way th...
• Functional appliances should
be worn on a full-time basis,
day and night, for about 9
months. They must be removed
for c...
ONLY A
PERFECT
SMILE … …
MAKES A
PERFECT
PICTURE ! ! !
THANK - YOU
For more details please visit
www.indiandentalacademy.c...
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Myofunctional appliances -activators /certified fixed orthodontic courses by Indian dental academy

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The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.

Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078

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Myofunctional appliances -activators /certified fixed orthodontic courses by Indian dental academy

  1. 1. MYOFUNCTIONAL APPLIANCES-- ACTIVATORS INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com www.indiandentalacademy.com
  2. 2. Definition of Myofunctional appliances • A myofunctional appliance is defined as a loose fitting or passive appliance which harnesses the natural forces of the orofacial musculature that are transmitted to the teeth & alveolar bone in a predetermined direction through the medium of the appliance. • A functional appliance refers to a variety of appliances designed to alter the arrangement of various muscle groups that influence the function & position of the mandible in order to transmit forces to the direction of the basal bone. www.indiandentalacademy.com
  3. 3. Classification I] Acc. to Profitt 1. TOOTH BORNE Active appliances - elastic open activator, Bimler’s appliance Passive appliances - activator, bionator 2. TISSUE BORNE Active appliances - Frankel’s appliance Passive appliances - oral screen, lip bumper II] Removable appliances - activator, bionator Fixed appliances – Herbst appliance, Jasper Jumper Semifixed appliances – Denholtz appliancewww.indiandentalacademy.com
  4. 4. III] Myotonic appliances – activator, bionator Myodynamic appliances – elastic open activator, Bimler’s appliance. IV]Acc. to T.M. Graber, Group A : Tooth supported – Catlan’s appliance Group B : Tooth tissue supported – activator Group C : Vestibular positioned [Frankel appliance, vestibular oral screen]. V] Acc to Peter, Classical – activator, bionator Hybrid – double screen, Frankel’s hybrid appliance. www.indiandentalacademy.com
  5. 5. History of activators • Normar Kingsley in 1879 devised a vulcanite palatal plate to be used in patients having a retruded mandible. It consisted of an anterior incline which guided the mandible to a forward position when the patient closed on it. www.indiandentalacademy.com
  6. 6. • One of the first known functional appliance known as ‘Monobloc’ was introduced by Pierre Robin in Paris in 1926 for t/t of patients with Pierre Robin syndrome who suffered from extreme retrognathia of the mandible & as a result the tongue is so far back in the pharynx that there is risk of suffocation. www.indiandentalacademy.com
  7. 7. • Viggo Andresen was not satisfied with the orthodontic treatment of his daughter, thus tested the activator on her, who was of vacation departure, where she would remain for three months. This Activator, a modified Hawley device, with an extra layer of vulcanite, provoked a previous landslide of the jaw when in occlusion. After his daughter returned he found marked correction of her profile & class II malocclusion only on nocturnal use of the device. Andresen-Haupl appliance www.indiandentalacademy.com
  8. 8. Indications • Class II division 1 malocclusion. • Class II division 2 malocclusion. www.indiandentalacademy.com
  9. 9. • Class III malocclusion. www.indiandentalacademy.com
  10. 10. • Class I open bite malocclusion. • Class I deep bite malocclusion. www.indiandentalacademy.com
  11. 11. • As a preliminary treatment before any major fixed appliance therapy. • For post treatment retention. • Children with reduced lower facial height. REDUCED FACIAL HEIGHT POST T/T RETENTION www.indiandentalacademy.com
  12. 12. Contraindications • Correction of class I problems of crowded teeth caused by disharmony between tooth size n jaw size. • Children with excessive lower facial height & extreme vertical mandibular growth. • In children whose lower incisors are severely procumbent. • Children with nasal stenosis caused by structural problems within the nose or chronic untreated allergy. • Limited application in non growing individuals. www.indiandentalacademy.com
  13. 13. Mode of action • Acc. to Andresen & Haupl, the activator induces a musculo- skeletal adaptation by introducing a new pattern of mandibular closure. • Most changes are instigated by holding the mandible forward [hyperpropulsion] by stretching the muscles of mastication which contract & thereby set up a myotactic reflex. www.indiandentalacademy.com
  14. 14. • This reflex generates a kinetic energy which has a restraining effect on the maxillary skeletal & dento- alveolar growth & the alveolar process distally. • This in turn produces a reciprocal forward force on the mandible. • In addition a condylar adaptation by backward & upward growth occurs. • A 3rd factor is the force generated while swallowing & sleeping. ACTIVATOR www.indiandentalacademy.com
  15. 15. Effects of activator on masticatory muscles • The muscle activity of temporalis, masseter & digastric muscles is lower during sleep than during daytime, irrespective of the use of the activator. • In sleep-time, temporal and digastric muscle activity is significantly decreased, although masseter muscle activity presents no significant differences. • With the activator in use, the digastric muscle activity tends to increase in comparison with the elevator muscles during daytime and sleep. www.indiandentalacademy.com
  16. 16. • Although the activity of both elevator muscles is diminished by use of the activator during sleep, some subjects show an increase during daytime. • Activator should be used, not only during sleep, but also during daytime and clenched on consciously to obtain the adaptation and development of the masticatory muscles for the 're-training of the muscles' at a new favourable mandibular position. KARWETZKY’S ACTIVATOR www.indiandentalacademy.com
  17. 17. Advantages of the activator • Provides incisal capping. • Oral hygiene is kept simple, the dental braces can be cleaned thoroughly outside the mouth • Helps in early treatment of mixed dentition, especially in cases of large discrepancies between the upper and lower jaw ( reduces risk of damage to front teeth in the presence of strongly protruding front teeth or strongly layered front teeth) www.indiandentalacademy.com
  18. 18. • Influencing the profile or general harmony of the face in a positive way by steering growth and working on the musculature. • The growth of permanent teeth is not disturbed, the device can be ground for the purpose of steering the growth of permanent teeth. • Slow “switch in function” reduces the risk of recurrence. www.indiandentalacademy.com
  19. 19. Disadvantages of the activator • The position of individual teeth can hardly be changed • Partly detrimental side effects on the position of front teeth • Speech may be strongly impaired • The treatment takes longer than with fixed devices • Success depends on the patient’s cooperation (activators must be worn for 14 to 16 hours daily, sometimes even permanently, in order to achieve the optimum effect WOODSIDE ACTIVATOR www.indiandentalacademy.com
  20. 20. • In cases of marked growth deficits, the treatment is not always successful • Are practically inapplicable in male adolescents (aged 13 to 14 years) in the main phase of growth of the upper and lower jaw because of poor cooperation • Damage or loss of the fixture due to improper handling • Given the predisposition, the patient’s roots may be shortened www.indiandentalacademy.com
  21. 21. Construction Bite • Construction bite is an intermaxillary wax record used to relate the mandible to the maxilla in the three dimensions of space. • It is used to reposition the mandible in order to improve the skeletal inter jaw relation. • Bite registration involves repositioning the mandible in a forward direction as well as opening the bite vertically. www.indiandentalacademy.com
  22. 22. • Degree of activation should stretch the muscles of mastication sufficiently to provide a positive proprioceptive response. • Degree of activation should be within physiologic range of activity of muscles of mastication, ligamentous attachments & the TMJ. • In most cases the mandible is advanced by 4-5mm & the bite is opened to the extent of 2- 3mm beyond the freeway space www.indiandentalacademy.com
  23. 23. General considerations for construction bite • In case the overjet is too large, forward positioning is done in 2-3 phases. • In case of forward positioning of the mandible by 7-8mm, vertical opening should be slight to moderate, that is, 2-4mm. • If the forward positioning is not more than 3-5mm, then vertical opening can be 4-6mm. www.indiandentalacademy.com
  24. 24. Theories of bite registration In the sagittal plane • Single step advancement • Progressive advancement In the vertical plane • Minimal vertical opening • Moderate vertical opening • Extreme vertical opening www.indiandentalacademy.com
  25. 25. • Characterised by marked forward positioning of the mandible but minimal vertical opening • As a rule of thumb anterior advancement should not exceed more than 3 mm posterior to the most protrusive position. • This kind of an activator constructed with marked sagittal advancement but minimal vertical opening is a ‘H’ activator- indicated in class II div 1 patients having horizontal growth pattern. Low construction bite with marked mandibular forward positioning www.indiandentalacademy.com
  26. 26. High construction bite with slight mandibular forward positioning • Mandible is positioned anteriorly by 3-5mm only and the bite is opened vertically by 4-6mm or a max. of 4mm beyond the resting position. • This kind of an activator constructed with minimal sagittal advancement but marked vertical opening is a ‘V’ activator. • Indicated in class II division 1 malocclusion. V ACTIVATOR www.indiandentalacademy.com
  27. 27. Construction bite without mandibular forward positioning • Sometimes a construction bite without forward position of the mandible is made in cases such as deep bite and open bite. DEEP BITE OPEN BITE ACTIVATOR FOR OPEN & DEEP BITE www.indiandentalacademy.com
  28. 28. Construction bite with opening and posterior positioning of the mandible • In class III malocclusion a bite is taken after retruding the mandible to a more posterior position. • In addition the bite is opened sufficiently to clear the bite. • In general a vertical opening of 5mm & a retrusion of 2mm is required. Class III malocclusion www.indiandentalacademy.com
  29. 29. Fabrication of an activator Impressions • Impressions of upper & lower arches are made to construct 2 pairs of models:- 1. Study models 2. Working models Class II div 2 model Class III model Class II div 1 model www.indiandentalacademy.com
  30. 30. Bite registration • The amount of sagittal & vertical advancement is pre planned. • The patient is made to sit in an upright, relaxed & non strained position. • The mandible is guided to desired sagittal position merely by operator’s thumb & forefinger without force or pressure. • Practice this positioning a few times before registration of the bite. www.indiandentalacademy.com
  31. 31. • Method 1 • Explain to the patient what is required, that they posture the lower jaw forward to the required occlusion. Do not over posture the patient or place them into a class III relationship. • Soften 2-3 sheets of pink modeling wax in hot water, folding them into a horseshoe shape. • Place them into the patients mouth and get them to close into the postured position. You must ensure that the centre lines are correct. www.indiandentalacademy.com
  32. 32. • Remove the wax registration and chill the wax under cold running water & try it on the casts. • Cut away the wax as shown in the canine/premolar region. • Place back into the mouth to check the registration is correct - the lateral opening and that the centre lines are correct. www.indiandentalacademy.com
  33. 33. Method 2 • Use either a thick or thin 'bite fork'. The thick (yellow) ones are for when an overbite needs reducing and thin (blue) for normal or reduced overbites. • Explain to the patient what is required, that they posture forward to the required occlusion. • Place the bite fork into the mouth and ask the patient to practice biting into the required position. Do not over posture the patient or place them into a class III relationship. Bite forks www.indiandentalacademy.com
  34. 34. • Soften a sheet of pink modeling wax in hot water, folding them into the bite fork. • Place the bite fork and soft wax into the mouth asking the patient to close into the postured position. Excess wax can be moulded to aid location of the bite for the laboratory. You must ensure that the centre lines are correct. • Remove the bite fork and chill the wax under cold running water. Place back into the mouth to check the registration is correct. www.indiandentalacademy.com
  35. 35. Articulation of the model • The wax bite registration is placed on the occlusal surface between the upper and lower models. • The models are then articulated in a reverse direction so that the anterior teeth face the hinges. • This kind of articulation ensures sufficient access to the palatal surface of the upper and lingual surface of the lower models during fabrication of the appliance.www.indiandentalacademy.com
  36. 36. Preparation of wire elements • Usual design requires an upper labial bow made with 0.8 or 0.9mm wire and consists of horizontal section with two vertical loops. • Ends of the vertical loops enter the acrylic body between the canine and deciduous first molar (or first premolar). • Labial bow can be active or passive. www.indiandentalacademy.com
  37. 37. Fabrication of the acrylic portion a. Maxillary part b. Mandibular part c. Inter-occlusal part • The appliance can be fabricated either by using heat cure or cold cure resin. • In case of heat cure models are first waxed and then flasked. • Appliance consists of three parts:- ELASTIC OPEN ACTIVATOR www.indiandentalacademy.com
  38. 38. Management of the appliance • Patient should be sufficiently convinced about the benefits of using the activator. • The patient is taught how to use, place & remove the appliance by himself. • Usually the patient is asked to wear the appliance 2-3 hours a day during the day time for the first week. During the second week the patient is asked to wear it for three hours during the day as well as while sleeping. In case he has difficulty in using it whole night, more day time use is prescribed till he can use it for the entire night. • A trimming plan should be developed based on the individual needs of the patient. www.indiandentalacademy.com
  39. 39. Trimming of the activator • Planned trimming of the appliance in tooth contact area is carried out to bring about dento-alveolar changes so as to guide teeth into good relation in all three planes of space • The acrylic surfaces that transmit the desired force by contact with the teeth are alled guide planes. www.indiandentalacademy.com
  40. 40. For vertical control • INTRUSION: In incisors it is achieved by loading the incisal edge of these teeth with acrylic. In case intrusion of posteriors is needed then only cusp tips are loaded with acrylic. Fossae & fissures are free of acrylic. • EXTRUSION: In incisors & molars the lingual surface is loaded above the area of greatest convexity in the maxilla & below the area of greatest convexity in the mandible. FOR INTRUSION IN VERTICAL PLANE FOR EXTRUSION www.indiandentalacademy.com
  41. 41. For sagittal control • PROTRUSION: In case incisors are to be protruded lingual surface of the teeth is loaded with acrylic and a passive labial bow is given that is kept away from the teeth to provent perioral soft tissues contacting the teeth. It can be of two types: a. Entire lingual surface is loaded b. Only incisal portion of lingual surface is loaded • RETRUSION: The acrylic is trimmed away from the lingual surface & an active labial bow is used to bring about retrusion of the incisors. FOR PROTRUSION FOR RETRUSION www.indiandentalacademy.com
  42. 42. Movement of posterior teeth in a sagittal plane • Teeth in the buccal segment can be moved mesially or distally to help treat class II & III malocclusion. Movement of teeth in transverse plane • Stimulation of expansion of the buccal segment is done by allowing the contact of acrylic on the lingual surfaces of teeth to be moved transversely. • Jackscrew type activator provides better expansion. Jackscrew activator www.indiandentalacademy.com
  43. 43. TWIN BLOCK APPLIANCE • Indicated for following malocclusions: Class II Division I; Class II Division 2; Class I open bites; Class I closed bites; Class III; Lateral arch constriction and anterior/posterior arch length discrepancies (can also be used effectively in TMJ therapy). • Separate, unattached upper and lower components allow mandible to move normally in anterior and lateral excursions without being restricted by a bulky one-piece appliance UPPER TWIN BLOCK LOWER TWIN BLOCK www.indiandentalacademy.com
  44. 44. • Versatile design allows you to control and correct upper and lower arch width and length independently, at the same time that skeletal changes are being made. • Patient can eat and speak normally - movements of the tongue, lip and mandible are not restricted www.indiandentalacademy.com
  45. 45. • The Twin Block's high comfort level allows it to be worn 24 hours a day - even while eating. This versatile design allows you to take advantage of all the functional forces applied to the dentition during mastication (faster results and shorter treatment times). • Patient appearance and profile are noticeably improved immediately. This is an excellent patient motivator. www.indiandentalacademy.com
  46. 46. • The use of functional jaw orthopaedics, at the correct time during growth, can ultimately result in maloccluded patients achieving a broad, beautiful smile, an excellent functional occlusion, a full face with a beautiful jaw line and lateral profile and, most important of all, a stable and healthy temporomandibular joint www.indiandentalacademy.com
  47. 47. • Unlike bulky, one-piece functional appliances, the Twin Block has separate, unattached upper and lower bite block components - actually two appliances which work together as one. In function, these two appliances interlock at the 70 degree angle set into the bite blocks and posture the mandible forward into the ideal Class I position preset by your wax registration. www.indiandentalacademy.com
  48. 48. • The Twin Block Appliance has been described as "the most comfortable and the most esthetic of all the functional appliances." • The Twin Block does not contain anterior wires or cheek and lip pads. Lingual extensions are eliminated ensuring patient comfort. • The patient can eat and speak normally - movements of the tongue, lip and mandible are not restricted. Patient acceptance www.indiandentalacademy.com
  49. 49. • The high comfort level allows the appliance to be worn 24 hours a day. This harnesses the forces of occlusion and mastication, leading to faster results and shorter treatment times. • Patient appearance and profile are improved immediately. www.indiandentalacademy.com
  50. 50. Conclusion • Functional appliances are usually fitted to reduce the prominence of upper incisors and to improve the way the teeth bite together. • Two removable appliances, one over the top teeth and one over the bottom teeth, alter the bite of the teeth by holding the lower jaw forwards. • These braces may be in one piece (eg Medium opening activator) or in two separate parts (eg Twin Blocks). Before treatment www.indiandentalacademy.com
  51. 51. • Functional appliances should be worn on a full-time basis, day and night, for about 9 months. They must be removed for cleaning, swimming and contact sports. After this initial treatment period they are usually worn at night times for about a year. • Further orthodontic treatment with fixed braces may be needed after functional appliance treatment. In these cases headgear may be needed at night times and the total course of treatment may last 30 months. After treatment www.indiandentalacademy.com
  52. 52. ONLY A PERFECT SMILE … … MAKES A PERFECT PICTURE ! ! ! THANK - YOU For more details please visit www.indiandentalacademy.com www.indiandentalacademy.com

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