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Frankel’s functional regulator /certified fixed orthodontic courses by Indian dental academy
The document provides a comprehensive overview of Frankel's Functional Regulator (FR) appliance, detailing its philosophy, design, and clinical application for treating various dental malformations, primarily Class II and Class III cases. It explains the mechanisms of action, modifications of the appliance, and its comparative effectiveness against other functional devices. Numerous studies and case analyses are included to illustrate the appliance's efficacy and its impact on oral growth and development.
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Frankel’s functional regulator /certified fixed orthodontic courses by Indian dental academy
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- 2. INDIAN DENTAL ACADEMY Leaderin continuing dental education www.indiandentalacademy.com 2
- 3. FRANKEL’S FUNCTIONAL REGULATOR Introduction Frankel’s philosophy Fabricationof 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 1967functional regulator 4
- 5. FRANKEL’S PHILOSOPHY Moss Functional performance ofthe muscular portions of the capsule influence the developing functional spaces Functional spaces also influence by atmospheric pressure 5
- 6. FRANKEL’S PHILOSOPHY Pressure on softtissue 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 deficiencyin transverse and vertical planes 8
- 9. FRANKEL’S PHILOSOPHY Perioral muscles hadrestraining 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 andlip 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 effectof 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 Typesa , b and c FR 2 FR3 FR4 MODIFICATIONS OF FR 12
- 13. FR 1 Acrylic components Buccalshield Lip pads Lingual shield 13
- 14.
- 15. Lip pads extension and Teardrop shape Smoothen sulks Lip posture and seal seal 5 mm 15
- 16. Lip pads andbuccal shields Concomitant action in mandibular retrusion 16
- 17. Lingual shields extension Over comesthe poor posture of mandibular muscles Different action from activator Action only in step advancement 17
- 18. Wire components ofFR 1 Palatal bow Labial bow Canine loop Cross over wire 18
- 19. Wire components ofFR 1 Cross over wires Labial bow Palatal bow Canine loop Lower lingual wires 19
- 20.
- 21. Palatal bow Extension Occlusal reston maxillary molar Stabilizing action Intermaxillary anchorage 21
- 22. Canine loop Extension Guide eruption ofcanine Intermaxillary anchorage 22
- 23. Lower lingual wires Extension Preventlingual movement of incisors Function activated element in deep bite and retruded anteriors 23
- 24. Cross over wires Runb/w 1st and 2nd premolars Not to be lodged interdentally Cause movement of buccal segments No training effect 24
- 25. FR1a and FR1 b Lowerlingual loops Overjet 5mm Lower lingual shield Overjet 7mm 25
- 26. FR 1C Step bystep opening in the anterior and vertical direction Overjet > 7mm 26
- 27.
- 28. Upper lingual wire Runsb/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 Preferredin 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 lippads Lower labial wire Upper lingual wire Occlusal rests 30
- 31. Buccal shields inFR 3 Stand away from maxilla but not from mandible 31
- 32. Lip pads inFR 3 Larger in size Stands away from alveolar process Expansion of capsule and correction of postural imbalance 32
- 33. Palatal bow and occlusalrests Palatal bow not lodged interdentally Additional occlusal rest on lower molar in deep bite 33
- 34. Upper lingual wireand 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 labialpads and buccal shields 4 occlusal rests upper labial bow Palatal bow 35
- 36. Construction of theFR appliance 36
- 37. Impression technique Reproduce whole alveolar processand depth of the sulcus Tray selection Adequate base 37
- 38. construction bite Differs from otherfunctional appliances Advancement only by 2-3mm in first step 38
- 39. Preparation of the casts Gaugeto measure the correct depth of the sulcus Properly carved working models 39
- 40. Preparation of the casts seatinggrooves: Seating grooves are cut in the maxillary model in FR 1 and FR 2 in the permanent dentition 40
- 41. Preparation of the casts seatinggrooves Seating grooves in maxillary model for permanent dentition Notching in the deciduous dentition 41
- 42. Preparation of the casts Sulcus trimmingand position of lower lip pads Extension of lower lip pads 12 mm 42
- 43. Preparation of thecasts 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 bow0.9mm , canine loop 0.8mm and palatal bow 1mm Correct position of wires on the maxillary work model 44
- 45.
- 46. Wire fabrication Correct positionof lip pads and lingual shields and wires Lo-la 0.9mm Lo –li 0.8mm 46
- 47. Wire fabrication Correct position b/w wiresand wax up -0 .75mm 47
- 48. Wire fabrication Single piece 3separate pieces Lingual wires 0.8mm Extension arm of cross over wire 1mm 48
- 49. Wire fabrication Future splittingof 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 modelsFR3 Trimming of maxillary casts 52
- 53. Wax relief –FR 3 53
- 54. FR 3 CORRECT POSITIONOF 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 7-8½ 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 Initialphase Active phase Retention phase 58
- 59. Initial phase Appliance delivery Check Smoothnessof margins Lip pad –tear drop Separation b/w teeth In mixed dentition make notches 59
- 60. Initial phase Appliance delivery Check appliancefit Overextension of shields Palpate face to to check for sharp edges 60
- 61. Initial phase Wearing theappliance 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 afterevery 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 Labialbows & lingual wires-retract /close spaces Lingual wires – towards cingula Further advancement in severe cases 63
- 64. Active phase After 3months 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 fromfixed 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 treatmentof 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 treatmentof class II Activator treatment before after 67
- 68. FR in treatmentof class II Mode of action of activator in the treatment of mandibular retrusion 68
- 69. FR in treatmentof 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 treatmentof class II Post –sup elongation of condyle Remodeling at ramal-corpus junction- elongation of corpus 70
- 71. The adjustive function ofthe ramus 71
- 72. FR in thetreatment 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 thetreatment 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 thetreatment 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 thetreatment 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 thetreatment of class 3 Expansion of upper oral space Tongue space not diminished 76
- 77. FR in thetreatment 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 thetreatment 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.
- 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 Indicatedin deep bite cases 81
- 82. CAPPED FR Disadvantages - needof sufficient posterior separation - capping may impinge on U1 as treatment progresses - difficult to clean 82
- 83. Change in theangulation of cross over wire Strictly horizontal advancement results in incisal movements of the lower wire and shields 83
- 84. Change in theangulation of cross over wire 84
- 85. Change in theangulation of cross over wire Difficulty in establishing normal lip functions 85
- 86. Change in theangulation 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 forVME 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 forVME Modified FR for VME by adding posterior bite blocks Added head gear tubes 88
- 89. Modified FR forVME 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 (frand 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 (frand activator combination) 91
- 92. HYBRID FUNCTIONAL APPLIANCE (frand activator combination) 92
- 93. FR with kingstonmodified buccaL SHIELDS 93
- 94. Modified Fr withcontinuous buccolabial shield and palatal acrylic support- haynes ajo 1986 To eliminate lip trap No pressure on the gingival dentoalveolar tissues 94
- 95.
- 96. N.R.E Robertson AJO1983 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 TREATMENTWITH 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 dentalchanges 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 dentalchanges 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 ofFR 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 shieldscaused 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 FRwith other functional appliances 102
- 103. FR Vs twinblock 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 herbstappliance 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,RADNEYAJO 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 incleft 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.
- 108. The occipital reference system Orientationto the earth’s surface 108
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- 110.
- 111. Case 1 Class2 Mandible retruded No lipseal + VTO FR 1 8 yrs 4 months 1 1/2 year post retention 111
- 112. Case 1 Pre treatment AfterFR 1 ½ years post retention 112
- 113.
- 114. Case 2 Class 2 Mandibular retruded openbite no lip seal 8 yrs 5 months 22 yrs .9 years post retention 114
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- 116.
- 117. Case 3 12 yrs 16yrs 117
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- 120. Case 4 6 yrs5 Class 3 months Maxillary retrusion Mandibular prognatism 7 yrs 3 No lip seal months Flaccid lips 120
- 121. Case 4 After FR 7yrs post retention 121
- 122.
- 123. Case 5 Class 3 Incompetentlip valve retruded maxilla 5 years 7 months 123
- 124.
- 125.
- 126. Case 6 Class 2 div1 skeletal open bite Lips habitually parted 9 yrs 10 months 20 yrs hypotonic 126
- 127. 4 yrs 11 months 9yrs Case 6 After FR At 20 yrs 127
- 128. Case 7 Pre FR PostFR 7 years post retention Stability of transverse dimensions in post retention periods 128
- 129.
- 130. Case 8 Pre FR 8yrs Post FR 17 yrs 130
- 131. Thank you www.indiandentalacademy.com Leader incontinuing dental education 131