This document discusses functional appliances used in orthodontic treatment. It describes the advantages and disadvantages of functional appliances, how they work to produce orthopedic, dentoalveolar and muscular changes, different types of functional appliances including activators and Frankel regulators, and guidelines for use and patient instruction.

1. Dr shabeel”s

2. Functional appliance ADVANTAGES Helps to eliminate abnormal perioral muscle function which interferes with muscle growth No side effects of mechanotherapy Less chair side time Easy to maintain oral hygiene Acceptable can be worn during night DISADVANTAGES Not useful in adults where active growth completed Patient cooperation n wearing appliance important Not possible to correct rotation ,crowding etc Tendency to increase lower facial height therefore contraindicated in patients with backward rotating mandible

3. Classification of functional appliances 1. a. tooth borne active appliance eg activator ,bionator b.tooth borne passive appliance eg springs ,screws . c. tissue borne passive appliance eg frankel functional appliance 2. a.myotonic appliance b.myodynamic appliance 3. Removable functional appliance eg activator and bionator Fixed functional appliance 4. group 1 appliances --eg inclined plane ,oral screen group 2 appliances --eg activator ,bionator group 3 appliances --eg frankel appliance

4. TREATMENT PRINCIPLES FORCE APPLICATION Compressive stress and strain act on the structures involved and result in a primary alteration in form with a secondary adaptation in function FORCE ELIMINATION The principle involves the elimination of abnormal and restrictive environmental influences on the dentition thereby allowing optimum development thus function is rehabilitated with a secondary change in form. these components produce skeletal and dentoalveolar changes by acting on the following 1. eruption 2. linguofacial muscle balance 3. mandibular repositioning

5. Action of functional appliance Functional appliance can produce following changes 1.Orthopedic changes 2.dentoalveolar changes 3.muscular changes orthopedic changes Myofunctional appl are capable of accelerating growth in condylar region They bring about remodelling of glenoid fossa They can change direction of growth of the jaws dentoalveolar changes They can bring about changes in sagittal ,transverse,and vrtical directions most MFA allow upper anteriors to tip labially In tranverse direction they can bring about expansion of the dental arches by incorporating screws in them In vertical plane they allow selective eruption of teeth muscular changes Functional appliance can improve tonicity of the oro facial musculature

6. Bite Planes

7. Upper anterior inclined bite plane Used in case where there is severe retroclination of lower anteriors Uses Guiding mandible forward Proclination of retroclined lower anteriors Reduction of overbite SVED BITE PLANE It’s a modification of anterior bite plane where the acrylic base is extended on to the incisal one third of the labial surface of the anteriors inorder to prevent proclination of the teeth which may be caused due to inclined plane effect of bite plane This helps to reinforce anchorage also POSTERIOR BITE PLANE Extension of acrylic base plate over the occlusal surface of posterior teeth INDICATIONS To give occlusal clearance for correction of cross bite Diagnosis of occlusal prematurities Cases with tmj dysfunction

8. CATALANS APPLIANCE This appliance is used to correct cross bite of young patients whose permanent molars have not erupted and decidous molars are also lost due to extraction This is used on lower anteriors where appliance make use of muscle forces and guides erupting tooth into normal position CONTRAINDICATION Lack of over bite Cross bite due to true mandibular prognathism MODE OF ACTION When appliance is worn the teeth can come into contact only in the anterior region during various functions

9. ORAL SCREENS Oral screen is a thin sheet of acrylic processed over the occluded waxed working cast extending deep into the sulcus both labially and buccally which act as a screen between teeth and musculature INDICATIONS Mouth breathing Thumb sucking Tongue thrusting Lip biting Muscle exerciser CONTRAINDICATION Patients with mouth breathing due to nasal obstruction MECHANISM OF ACTION Retraction of anteriors To keep perioral musculature away from exerting its force Forms mechanical barrier and prevents mouth breathing ,thumb sucking ,lip biting etc APPLIANCES FOR THUMB SUCKING AND TONGUE THRUSTING Hawleys plate with anterior bite plane Appliance with tongue guard Appliance with a bead Tongue guard should be long enough to prevent tongue from thrusting on maxllary incisors short enough to prevent I nterfering with lower incisor Antero posteriorly they should be placed between canines if not lateral thrust develops

10. Appliance for correcting lip biting A lip bumper is used to correct lip biting Can be used in maxilla or mandible to shield away the lips As lips are kept away the pt cant bite lip APPLIANCE FOR MOUTH BREATHING VESTIBULAR SCREENS It is a simple FA that takes form of a curved shield of acrylic placed in labial vestibule Vestibular screens can be used either to apply forces of the circumoral musculature or to relieve force from teeth These can used for correction of mouth breathing HOTZ MODIFICATION The vestibular screen can be modified using a ring projecting outwards which is used for exercise

11. Frankel functional regulator Devpd by Rolf Frankel Also called oral gymnastic appliance It has two main treatment effects 1. It serves as a template against which the cranio facial muscle function 2. The appliance removes muscle forces in labial and buccal areas that restricts skeletal growth thereby providing an environment which enables skeletal growth MODE OF ACTION The following are effects of frankel appliance Increase in saggital and transverse intra oral space Increase in vertical space where appliance is kept free from posterior teeth Mandibular protraction Muscle function adaptation the pads and shield massage the blood vessels increase circulation Shields loosen up the tight muscles and improve muscle tone Frankels exercises or oral gymnastics 1. lips closed at all times 2. swallowing speaking etc becomes exercise while using the appliance

12. Types of frankel appliance FR 1 : Class 1, class2 division 1 malocclusion FR2 :Class2 division 1&2 FR3 :class3 FR4 :Open bite and bimaxillary protrusion FR5 :They are functional regulator which incorporate head gear indicated in long face patients having a high mandibular plane angle and vertical maxillary excess

13. ACTIVATORS Activators induces musculo skeletal adaptation by introducing a new pattern of mandibular closure The appliance loosely fits in the mouth the pt has to move the mandible forward to engage the appliance this result in stretching of elevator muscles of mastication which starts contracting thereby setting up a myotactic reflex This generates kinetic energy that cause Prevention of further forward growth of the maxillary dento alveolar process Movt of maxillary dento alveolar process distally Reciprocal forward force on the mandible force is generated while sleeping and swallowing INDICATIONS CLASS2 division 1&2 Class 3 malocclusion Class 1 open bite Class1 deep bite Before major fixed appliance therapy For post treatment retention Children with lack of vertical height CONTRAINDICATIONS Not used in class 1 with crowding by disharmony between tooth size and jaw size In children with excess lower facial height In children whose lower incisors are severely procumbent In children with nasal stenosis \

14. POST DELIVERY INSTRUCTION Teach the patient to wear and remove the appliance in front of mirror Should be worn 2-3 hours daily initially When not in use keep in water Any pain ,soreness etc report to the clinic If no pain also report the clinic after 2 wks Pt advised to maintain lip seal by conscious effort Time charts should be given to record duration of wearing the appliance

15. BIBLIOGRAPHY Orthodontics ,art and science by S.I Balaji Removable orthodontic appliance M.S Rani Text book of orthodontics by Graber