detailed topic Frankle appliance

1. FRANKLE
APPLIANCE
• Guided by: Presented By:
Dr.Vijay Agarwal Dr. Niharika Samaga
Dr. Karamdeep Ahluwalia MDS-1
Dr. Hari Narayan Choudhary Dept. Of Orthodontics
Dr. Rekha Sharma

2. INTRODUCTION
• Functional appliances are defined as loose fitting or
passive appliances which harness or eliminates natural
forces of the oro-facial musculature that are transmitted
to the teeth and alveolar bone through the medium of
the appliance .

3. • The functional regulator is a removable orthodontic appliance developed by Professor
Rolf Frankel .
• The Frankel appliance has two main treatment effects.
It serves as a
template against
which the
craniofacial
muscles function.
Its influence on
skeletal and
dental
development

4. FRANKEL’S PHILOSOPHY
• A major tenet of the Frankel
philosophy is that the dentition
is heavily influenced by the
functional matrix, the buccinator
mechanism, and the orbicularis
oris complex.
• So any abnormal perioral muscle
function creates dynamic
barriers to optimal growth of
the dentoalveolar complex in
three dimensions of space.

5. PUSH-OUT-FROM-WITHIN
• Functional appliances before Frankel…….
• Exception being BIONATOR
“Aimed at pushing the dentition outward without
considering their restraning forces”

6. 6
Vestibular area of
operation
Sagittal correction
via tooth borne
maxillary anchorage
Differential eruption
guidance
Minimal maxillary
basal effect
Periosteal pull by buccal shields
and lip pad
Following are the Frankel’s philosophy:

7. VESTIBULAR ARENA OF
OPERATIONS
• Pushing the dental arch out from within
• Frankel’s appliance provides a positive framework and an
optimized supportive structure on which the muscles
that make the stomatognathic system can work correctly.
• By giving oral musculature a proper skeletal matrix on
which to function, normal function can be established.
Adverse pressures are relieved and the resultant
response is seen particularly with significant expansion of
the maxillary arch.

8. SAGITTAL CORRECTION VIA TOOTH
BORNE MAXILLARY ANCHORAGE
• FR has no tooth contact at all in the lower arch.
• The forward posturing of mandible is achieved by an
acrylic pad that contacts the alveolar bone only behind
the lower anterior segment making the lingual contact
more more of a proprioceptive trigger for postural
maintenance than a pressure bearing area.
• Appliance is anchored on the maxillary dentition both in
the molar and canine regions

9. DIFFERENTIAL ERUPTION GUIDANCE
• By being free of the mandibular teeth, selective differential eruption of lower posterior
is possible, which not only corrects vertical dimension deficiencies but also helps in
sagittal correction of Class II malocclusions.
• Maxillary teeth are withheld whereas mandibular teeth move upward and forward.

10. MINIMAL MAXILLARY BASAL EFFECT
• Restrictive effect possible on the maxillary arch through the labial wire and the
tension of the musculature that pulls the mandible back, but this is not a major
treatment objective.
• It is possible to activate the maxillary labial wire to close spaces, but this is usually a
secondary treatment objective.Too much labial pressure too early can produce
undesirable lingual tipping of the maxillary incisors or unseating of the appliance

11. BUCCAL SHIELDS, LIP PADS AND PERIOSTEAL PULL
• Pull on periosteal tissue enhances growth beneath it.
• Since the thin, bony shell beneath this area houses the erupting permanent teeth, an
outward growth of membranous bone, plus relief of any restrictive tissue pressure,
results in bodily transverse changes in the posterior segments and bone formation at
the apical base contiguous to the lip pads.

12. • The vestibular shield creates tension at the depth of the mucobuccal fold in a lateral
direction.This tension is directed at influencing the erupting permanent teeth to
erupt further laterally than normal, thereby resulting in arch expansion. Notice that
less influence is seen on fully erupted teeth, as shown by the open arrow.

13. CONDYLAR GROWTH
• The anterior repositioning of the mandible implies on
alteration in the TMJ area.Thus at right age , condylar
growth can be successfully stimulated.

14. INDICATIONS:
• Class I malocclusion (minor crowding)
• Functional Cl II malocclusion.
• Cl III malocclusios.
• Bimaxillary protrusion and open bite problems.
• Functional retrusion , deep over bite , and excessive interocclusal problems with a
normally positioned maxillae.
• Mixed dentition period with growth spurts.

15. CONTRAINDICATIONS
• Class I malocclusion with severe crowding
• Thumb sucking habit.
• Severe dentoalveolar problems in permanent dentition.
• Uncoperative patients

16. 1.Enables elimination of abnormal
muscle function thereby aiding in
normal development
2.Treatment can be initiated at
early age
3.Less chair side time is spent
4.Frequency of the patients visit is
less
5.Does not interfere with oral
hygiene status
6.Deals with skeletal as well as
dentoalveolar problems
1.Appliance is bulky and the
cooperation of the patient is
essential
2.Cannot be used in adult
patients were the growth
has ceased
3.Cannot be used to bring
about individual tooth
movement and in cases of
crowding
4.Fixed appliance therapy
may be required at the
termination of treatment for
final detailing of the
treatment.
ADVANTAGES &
DISADVANTAGES

17. VISUAL TREATMENT OBJECTIVE
DIAGNOSTIC TEST
• TheVTO for FR therapy is a simple but important clue as to the efficiency of the FR
appliance in any clinical case .
• It is a functional test,that also helps to establish whether a patient can tolerate a
protrusive bite, as well as whether satisfactory esthetic improvement occurs.
• The patient is asked to posture the mandible forward to the correct sagital relationship.
If the outcome of theVTO test is positive, the patient can be adjudged suitable for the
Frankel therapy.
• However a proper cephalometric analysis is the correct way to determine whether FR is
the appliance of choice.

18. Class II div I with
full occlusion
6mm of cuspal
advancement into
class I relation
After VTO

19. FR
FR I
FR I-
a
FRI-b
FR I-
c
FR II FR III FR IV FRV

20. TYPES OF FRANKEL APPLIANCE
TYPES USES
FR 1 CL I AND CL II DIV 1 MALOCCLUSION
FR1-a CL I MALOCCLUSION WITH MINOR CROWDING
CL I WITH DEEP BITE
FRI-b CL II DIV 1 MALOCCLUSION WITH OVERJET LESS THAN
5 mm
FRI-c CL II DIV 1 MALOCCLUSION WITH OVERJET MORE THAN
7mm
FR 2 CL II DIV 1 AND DIV 2 MALOCCLUSIONS.
FR 3 CL III MALOCCLUSIONS
FR 4 OPEN BITE AND BIMAXILLARY PROTRUSION.

21. FUNCTIONAL REGULATOR I
The FR I of Frankel has 3
modifications
• FRI- a
• FRI- b
• FRI- c
FR-I a - CL I malocclusion with mild
to moderate crowding
CL I deep bite cases .

22. COMPONENTS OF FR I-A
• Vestibular shields
• lip pads
Acrylic
parts
• Palatal bow
• labial bow
• Labial support
wire
• Lingual bow
• Canine loops
Wire
components

23. 23
COMPONENTS
ACRYLIC
BUCCAL SHEILD
LIP PADS
LOWER LINGUAL PAD
WIRE
PALATAL BOW
LABIAL BOW
CANINE EXTENSION
UPPER LINGUAL WIRE
LINGUAL CROSS OVER WIRE
SUPPORT WIRE
LOWER LINGUAL SPRINGS

24. BUCCAL SHIELDS
• Approximate the buccal surface of premolar and molar
• Carried deeply into the vestibular sulcus with the
patient comfort keeping in mind.
• Away from the dentition to relieve pressure from the
contiguous musculature
• Unrestricted dentoalveolar devlopment
• Periosteal pull
• Bodily tooth movement to buccal position

25. LIP PADS
• Eliminates hyperactive mentalis activity
• Prevents lip trap
• Periosteal pull
• Bone growth
• Reduce mentolabial sulcus
• Form a labial boundary for the forward
positioned mandible
5 mm

26. WIRE FORMING
• Stabilizing and connecting wire - 1.0mm or 1.25mm respectively
(palatal bow,occlusal rest)
• Tooth moving wire – 0.8mm
• Stabilizing and connecting wire – away from tissue surface
• Lingual side – 1-2 mm away from mucosa
• Wire bending should follow the natural tissue contour

27. PALATAL BOW
• Made up of 1mm thick SS wire
• Convexity facing distally with lateral extensions crossing the occlusal surface in the
embrasure mesial to the first molar.

28. • Curve provides some extra wire length to facilitate a lateral expansion adjustment.
• The wire should cross the occlusal surface in the embrasure mesial to the first
molar. Locking of the appliance on the maxillary arch is mainly due to this insertion
on the embrasure.

29. LABIAL BOW
• 0.9 mm thick wire
• The bow originates in the buccal shield and lies in the middle of the labial surfaces of
incisors , turning gingivally at right angles between maxillary lateral incisors and canines.
• Wire is straight,not adapted individual tooth malposition

30. LABIAL SUPPORT WIRE
• Made up of 0.9 mm thick SS wire
• It supports the Skelton for the lip pads
• Lateral wire and midline wire
• Should be atleast 7mm below gingival margin
• Midline wire is bent in an inverted “V” shape.

31. LINGUAL BOW
• In FR Ia a wire loop is used instead of an acrylic lingual pad that helps in the
forward position of the mandible forward. It extends downward to the floor of
the mouth which fit against the lingual tissue below the incisors.

32. CANINE LOOP
• 0.9mm thick
• Canine loops that passes through the embrasure mesial to the first decidous molar.This
helps to guide the erupting canine

33. FR I-B
• The FR Ib is quite similar to the FR I-a, the
difference being the use of lingual acrylic pad
instead of lingual bow or lingual wire loops, to
contact the lingual mucosa of the lower incisor
segment..
• Lower lingual support wire
• 3 components soldered together or 1
continuous wire.
• Wire member follows the contours of the
lingual apical base

34. LOWER LINGUAL SPRING
• 0.8 mm thick
• Contoured to the to the lingual surface of incisors above
cingula
• To prevent extrusion of incisors
• Passive
• If used for moving the incisors then a smaller gauge wire is
used (0.5 mmor 0.6 mm)

35. FR I- C
• The FR I c used in the more severe Class II division 1
malocclusions in which the overjet is more than 7mm.
• The mandibular advancement is planned for two or three
steps.

36. • Component parts
• The buccal shields are split horizontally and vertically into 2 parts –
• The antero inferior portion contains the wires for lingual acrylic pressure pad
or shield and for lower lip pads or pelots.
• This portion is then pulled forward with the wire moving in the posterior part
of the shield to accommodate the forward movement of the lingual shield and
labial lip pads.
• The vertical split is opened to the desired position by a 2mm to 3mm advancement and is then filled in
with self cure acrylic and polished.

37. FR II
• USES
• They are used for the treatment of CLII div I and II malocclusions.They
are the most widely used.

38. COMPONENTS
• Buccal shields
• Lip pads
Acrylic
parts
• Palatal bow
• labial bow
• Labial support
wire
• Canine extensions
• Protrusion bow
• Lingual cross over
wire
• Lower lingual
springs
Wire
components

39. • FR II is modified by adding a protrusion bow (0.8mm)
behind the maxillary incisors, which serve to maintain
the prefunctional appliance alignment that was
achieved and stabilizes the appliance by helping to
lock it on the maxillary arch.

40. CONSTRUCTION
• Separation :
• Separators are recommended 1 week before taking the impression. Placed between
maxillary canine and first deciduous molars & 2nd
deciduous molar and first
permanent molar embrasure.
• The slicing mechanism allows immediate seating of the appliance.

41. • Impression :
• Very important clinical procedure so that impression reproduces the whole alveolar
process up to the depth of the sulci.

42. CONSTUCTION BITE
• The purpose of this mandibular manipulation is to relocate
the jaw in the direction of treatment objectives.This
creates artificial functional forces and allows assessment of
the appliance's mode of action.
• Before taking the construction bite, the clinician must
prepare by making a detailed study of the plaster casts,
cephalometric and pan oral head films, and the patient's
functional pattern

43. • For minor sagital problems (2-4mm) the construction bite
is taken in an end to end incisal relationship.
• Horizontal and vertical requirements.
• Construction bite should not move the mandible forward
further than 2.5 mm to 3mm .
• End to end incisal relationship - no more than 6mm
forward.
• Positioning the edge to edge contact will determine the
vertical opening.

44.  Optimal prechondroblastic activity in the condyle is observed by staged construction
bite.
 In the frankel technique construction bite is not open any more than needed to allow
the cross over wires to pass through the interdental space. It is necessary for effective
lip seal exercises (atleast 2.5-3.5mm clearance in the buccal segments)

45. WORKING MODEL POUR UP AND TRIMMING
• Models should extend away from the alveolar
process at least 5mm to permit application of wax
• Cast carving :
• Casts are carved for accommodating the buccal
shield and lip pads with a pear shaped carbide bur
or carver
• Make sure that the models extend outward, away
from the alveolar process at least 5mm to permit
later application of wax relief

46. Lip pads :
• The stone of the mandibular model is carefully carved back
about 5mm from the greatest curvature of the alveolar base
with a pear-shaped carbide bur and office knife

47. • The lower relief be at least 12mm below the
gingival margin, so that the lower labial wire
framework will lie 7mm below the incisor
gingival margin.
• Parallelogram shape
• Upper edges of the lip pads should be atleast
5mm from the gingival margin
12 mm
5 mm

48. Buccal shields :
• The sulcus depth must be 10 mm to 12 mm above the gingival margin of the
posterior teeth.
• Trimming of the lower buccal vestibule is not -required.
• Total thickness of the shields and pad should not be greater than 2.5mm

49. • Work model mounting :
• Mount the models on the straight line fixators

50. WAX RELIEF :
• Wax padding under the buccal shield to establish space between the
tissue and the appliance.
• Wax is thicker in the maxillary sulcus than in the mandibular sulcus
• Thickness is determined individually by the amount of desired
expansion needed.
• It should not exceed 4mm to 5mm in the tooth area, nor 2.5mm to
3mm in the maxillary alveolar region.
• Lower arch waxing requires only a very thin layer over the apical
base (0.5mm), thinning out to a rounded knife edge in the lower
sulcus, in which transverse changes are usually not desired.

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

52. FR III
 The FR III is used for treatment of Class III malocclusions
and is similar to the FR I and the FR II.
Upper lip pads
Lower
labial wire
Occlusal
rests
Upper
lingual
wire

53. Buccal shields :
• They stand away 3mm from the maxillary posterior dentoalveolar structures but
they are in contact with the mandibular teeth and the mandibular apical base.

54. Lip pads
• Lip pads are situated in the maxillary, instead of the mandibular, labial vestibular sulcus.
• These pads stand away from mucosa and underlying alveolar bone in the depth of the
labial vestibular sulcus.
Upper lip pads

55. • The purposes of lip pads are
• To eliminate restrictive pressure of the upper lip on the under
developed maxilla.
• To exert tension on the tissue and periosteal attachments in the depth
of maxillary sulcus to stimulate bone growth.
• To transmit upper lip force to the mandible via the lower labial arch for
a retrusive stimulus

56. Labial bow :
• The labial bow rests against the
mandibular teeth and not the maxillary
incisors.
• There is definite contact with the
lower incisors by the 0.09mm
structural wire.
• In some instances a slight groove is cut
across the labial surface of the lower
incisors to make sure that a slight
tension exists in the wire when the
appliance is seated in patients mouth.
Lower labial wire

57. Protrusion bow
• There is protrusion bow behind upper incisors to stimulate forward movement
of these teeth.
Protrusion Bow

58. Palatal bow :
• The palatal bow approximates the palatal mucosa like FR I and FR
II.
• The ends pass distal instead of mesial to the last molar tooth.
• The palatal bow is capable of delivering a slight anterior stimulus
to the maxillary dentition by contacting the wire to the distal
surfaces of molars on the tuberosities.
• The appliance is not locked on the maxilla by cross-wires from
the protrusion bow and palatal bow.

59. • Occlusal rests :
• Occlusal rests originates in the vestibular shield and is adapted to lie in the occlusal
fissure of the last mandibular molar.
Occlusal rests

60. Construction bite :
• Procedure of taking the bite is done by retruding the mandible
as much as possible, with the condyle in the most posterior
position in the fossa.The bite is opened enough to let the
maxillary incisors move labially part the mandible incisors.
• In FR III maxillary cast must be carved for lip pads.The pads
are shaped more like a teardrop because of the midline muscle
attachment.

61.  Bite registration - most comfortable
retruded position

63. FR IV
• FR IV is used primarily in the correction of openbite, and to a lesser degree, in
bimaxillary protrusions. Its use is almost exclusively confined to the mixed dentition

64. • The FR IV has same vestibular configuration as the FRI and
FR II, but with no canine loops or protrusion bow.There
are four occlusal rests on maxillary I molars and I
deciduous molars, to prevent tipping of the appliance.
• The palatal bow is like a FR III and placed behind the last
molar.

65. CLINICAL HANDLING OF THE APPLIANCE
• Stabilizing the appliance at the delivery is absolutely essential
• Pre placement, all margins are checked for smoothness .
• Check vertical dimension.
• Over extension of the labial ,lingual, lip and buccal pads causes
tissue irritation . So the extension should be correct.
• The appliance should be inserted with a slight rotatory motion.

66. • Wearing time
• Although the Frankel appliance will be worn all the time except for the meals but the
treatment should be started slowly.
• First 2 weeks - 2 to 4 hours during the day.
• Next 3 weeks - Extended to 4 to 6 hours.
• It usually takes 2 months before the appliance is worn at night.
• The appliance and treatment progress should be checked at 4 weeks interval.
• An initial end to end molar relationship is corrected in 6 months.

67. Check after every 4 weeks :
• Mucosal irritation
• Stability of appliance
• Impingement of cross over wires
• Treatment timing :
• Optimum time to start the treatment is the mixed dentition period. (8 to 10 year
age)

68. INSTRUCTIONS FOR THE PATIENT:
• A little discomfort is to be expected initially.
• Salivation may be increased but it should not be a problem.
• Outline the duration of wear expected.
• Instruction on appliance care and oral hygiene maintenance .
• Demonstrate the lip seal exercise .
• Ask the patient to speak a few words and reassure that speech would
normalize.
• Wearing time should be correctly followed.

69. MODIFICATIONS OF
FR APPLIANCE

70. MODIFICATION OF FRANKEL BY
ALBERT H OWEN
• INDICATION
• Long face syndrome having a high mandibular plane angle and vertical maxillary
excess .

71. • The appliance consists of addition of posterior acrylic bite blocks to arrest molar
eruption.
• It also has head gear tubes that accept a face bow for an occipital pull headgear.

72. ADVANTAGES IN COMBINATION OF
FRANKEL WITH HEAD GEAR
• The vertical dimension can be decreased through intrusion
of the molars.
• Increased mandibular growth.
• Significant lateral expansion may reduce the need for
expansion.

73. MODIFICATION BY H S ORTON
• Capped Frankel appliance
• Vestibular shields have 3 -4mm less peripheral extension than the conventional appliance.
• Lower labial capping –The lingual acrylic of FR II is extended to cover the incisal 1/3 rd of
lower incisors and cuspids.

74. Advantages
• Controls tipping
• Indicated in deep bite cases
Disadvantages
• need of sufficient posterior separation
• capping may impinge on upper incisors as treatment progresses
• difficult to clean

75. MODIFIED FR WITH CONTINUOUS
BUCCOLABIAL SHIELD AND PALATAL
ACRYLIC SUPPORT
• Modified Function Regulator with palatal acrylic support
and continuous buccolabial acrylic construction, which
replaces conventional function regulator with separate
buccal shields and lip pads.
• The appliance is not "locked" into the mesial embrasure
of the maxillary first molars by a cross-palatal bar.
• To eliminate lip trap

77. HYBRID FUNCTIONAL APPLIANCE
• Components :
• Eruption (biteplanes)
• Linguofacial muscle balance (shields or screens)
• Mandibular repositioning (construction or working bite)

78. ARTICLES

79. ARCH WIDTH DEVELOPMENT IN CLASS II PATIENTS
TREATED WITH FRANKEL APPLIANCE
MCDOUGALL, MCNAMARA, AND DIERKES AJO
1982 JULY
• 60 treated and 47 untreated Class II Division 1 patients were
examined in this study.
• The patients in the former group were treated with the functional
regulator of Frankel (FR-1 or FR-2), while patients in the latter group
were not treated but were of similar ethnic and skeletal composition.
• Sequential dental casts of the treated and untreated groups were
examined, and the changes in lingual, buccal, and alveolar arch widths
were compared.

80. • The results of this study indicate that expansion of the maxillary and mandibular
dental arches and their supporting structure occurs routinely when a functional
regulator (FR-1 or FR-2) is continuously worn by the patient.
• The expansion is not limited to a particular region of the dental arch, although in
absolute terms the largest expansion values occur in the premolar and molar regions,
while lesser values were recorded in the canine region. In addition, this study indicates
that in the maxilla narrower arches tend to expand more than wider arches.

81. 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
• There is slight retrusion of maxilla
• U6 forward movement is reduced but not vertical movement
• U1 tipped lingually
• some tipping of L1
• Downward movement of mandible is noticed

82. THE EFFECT OF FR 4 IN CLASS 1 SKELETAL
ANTERIOR OPEN BITE
ELIT ERBAY AJO 1995
• 20 treated and 20 controls
• Treatment and observation periods were 2 years.
• Investigation was carried out on lateral cephalograms taken before
and after the study period
• The results indicate that a spontaneous downward and backward
growth direction of the mandible observed in the control group
could be changed to a upward and forward direction by FR-4
therapy

83. • The skeletal anterior open bite was successfully
corrected through upward and forward mandibular
rotation
• It was concluded that as a result of treatment of these
anomalies with the FR-4 appliance and lipseal training,
the growth and development pattern of the mandible
was altered

84. FRANKLE FR VS TWIN BLOCK
TOTH & MC NAMARA AJO 1999
Study Summary:
• 40 patients: Some treated with Twin Block, some with Frankel (FR), compared to a control group.
Key Results:
1. Mandibular Length Increase:
1. Twin Block: Increased by 3 mm compared to controls.
2. Frankel FR: Increased by 1.9 mm compared to controls.
3. So both appliances were effective, but Twin Block showed a greater increase.
2. Vertical Dimension & Dentoalveolar Changes:
1. Both appliances caused changes in vertical growth and tooth-alveolar position.
2. Twin Block > Frankel in terms of these effects.
3. TB tends to cause more extrusion of posterior teeth, leading to bite opening.
3. Type of Changes:
1. Twin Block: Induced a mix of skeletal and dentoalveolar changes. Mandible grew, but also a
lot of tooth movement.
2. Frankel: Changes were more skeletal and less dentoalveolar.

85. FR VS HERBST APPLIANCE
MC NAMARA ,HOWE AJO 1990
Study Overview:
•45 patients treated with the Herbst appliance
•41 patients treated with the Frankel appliance (FR)
•Compared with a control group (no appliance)
Key Results Explained:
1.Effect on Maxilla:
•Neither appliance had a significant effect on maxillary growth.
•So, these appliances mainly work by modifying mandibular position/growth, not restricting the
maxilla.
2.Herbst Appliance Specific Effects:
•Prevented vertical eruption of upper 6s (U6).
•Caused posterior movement of U6.
• Basically, the Herbst appliance exerts a more anchorage-heavy and restrictive effect on molars —
especially upper molars — which helps in correcting Class II malocclusion.
3.Incisor Effects (U1 and L1):
•U1 lingual tipping was seen in both appliances.
•Forward pull from lip musculature + appliance action contributes to that.
•Lower incisor proclination (L1) was more in Herbst than Frankel.
•That means Herbst caused more flaring of lower incisors — possibly due to its rigid, continuous
force delivery.
•FR, being softer in influence and more functional, had less flaring.
4.Mandibular Length Changes:
•Control group: ~2.1 mm/year (normal growth).
•Herbst: ~4.8 mm/year (more than double!).
•Frankel (FR): ~4.3 mm/year.
•Both appliances successfully stimulated mandibular growth, but Herbst showed a slightly higher
gain than Frankel.

86. CONCLUSION
• The results that maybe achieved with functional
orthopedics by means of FR are dramatic.These results can
be regularly achieved provided the FR appliance is properly
constructed and clinically handled has an exercise device.
Patient compliance is absolutely essential and exercise
routine is vital for treatment success.

87. REFERENCES
•Dentofacial orthopedics with functional appliances .Graber, Rakosi, Petrovic
•McNamara JA, Bookstein FL, Shaughnessy TG. Skeletal and dental changes following
functional regulator therapy on Class II patients.American journal of orthodontics. 1985
Aug 1;88(2):91-110
•Falck F, Fränkel R. Clinical relevance of step-by-step mandibular advancement in the
treatment of mandibular retrusion using the Fränkel appliance.American Journal of
Orthodontics and Dentofacial Orthopedics. 1989 Oct 1;96(4):333-41.
•McNamara JA, Howe RP, DischingerTG.A comparison of the Herbst and Fränkel
appliances in the treatment of Class II malocclusion.American Journal of Orthodontics
and Dentofacial Orthopedics. 1990 Aug 1;98(2):134-44.

88. THANK YOU :’)
“Frankel appliance: For when your face needs a gym membership.”