THE TREATMETHE TREATMENT OF CLASS II, DIVISION 1 MALOCCLUSION WITH FUNCTIONAL CORRECTORS According to Hotz, the adjustment of teeth basically involves a modification of that "natural interplay of forces" which is responsible for the shape of the dentoalveolar arches. In this article certain problems of Class II, Division 1 cases which arise in connection with the use of skeletal vestibular screens are discussed. The figure illustrates the Frankel functional appliance that is used in the treatment of Class II cases. The mandible is repositioned in a forward direction to produce the so-called "construction bite," in which the incisors are in an end-to-end relation. The degree to which the buccal shields and the lip pads extend beyond the upper and lower arches corresponds to that of the normal dentition. This illustrates an occlusal view of a Class II malocclusion. The degree of expansion of the dental arches and of the palatal vault was achieved in this case with the functional appliance in 1 year and 7 months. These casts illustrate not only that good morphologic results can be obtained with functional correctors, but also the manner in which these results are obtained. The aim at bringing about a new equilibrium between the mechanical forces of the tongue and the cheeks with the aid of oral-seal exercises and a reorientation of the tongue position against the palate. This therapeutic principle corresponds to that applied in general orthopedics. The first objective is to modify the soft-tissue structures by physiotherapy, and the second is to reeducate motor functions and muscle tone by exercises.

1. THE TREATMETHE TREATMENT OF
CLASS II, DIVISION 1
MALOCCLUSION WITH FUNCTIONAL
CORRECTORS
ACHIEVED BY: Dr.Maen Dawodi

2. •According to Hotz, the adjustment of
teeth basically involves a modification of
that "natural interplay of forces" which is
responsible for the shape of the
dentoalveolar arches.
•In this article certain problems of Class II,
Division 1 cases which arise in
connection with the use of skeletal
vestibular screens are discussed.

3. The figure illustrates the Frankel functional
appliance that is used in the treatment of Class II
cases. The mandible is repositioned in a forward
direction to produce the so-called "construction
bite," in which the incisors are in an end-to-end
relation. The degree to which the buccal shields and
the lip pads extend beyond the upper and lower
arches corresponds to that of the normal dentition.

4. This illustrates an occlusal view of a Class II
malocclusion. The degree of expansion of the
dental arches and of the palatal vault was
achieved in this case with the functional
appliance in 1 year and 7 months. These casts
illustrate not only that good morphologic results
can be obtained with functional correctors, but
also the manner in which these results are
obtained.

5. The aim at bringing about a new equilibrium
between the mechanical forces of the
tongue and the cheeks with the aid of oral-
seal exercises and a reorientation of the
tongue position against the palate. This
therapeutic principle corresponds to that
applied in general orthopedics.
The first objective is to modify the soft-
tissue structures by physiotherapy, and the
second is to reeducate motor functions and
muscle tone by exercises.

6. Figure shows anterior and lateral views of the plaster casts.
The black arrows at the level of the root tips and at the
alveololabial sulcus indicate the expansion of the deeper
supporting structures. As the arrows show, a marked
expansion of 5 mm. is also demonstrable in the alveolar
process, in the premolar region. A comparison was made of
150 upper plaster casts, of which half had been treated with
palatal plates and the other half with functional correctors.
The results confirm the view that stretching of the soft
tissues in the alveololabial sulcus by means of the projecting
buccal shields stimulates bone apposition in the apical base
area.

7. Figure illustrates a functional appliance placed on a
lower plaster cast. It shows that bite shift with the
functional corrector is not achieved by the
functional corrector resting on the mandibular
molars or premolars, or on the incisors, either,
since the center part of the lingual arch has been
annealed.

8. Experiments have shown that, for the first 3
months at least, the bite correction is mainly
effected by the U-shaped loops. If the mandible
tries to fall back into its habitual distal position,
these U-shaped loops produce a reaction by
making contact with the mucosa at the lingual
surfaces of the alveolar process.
The appliance must not be worn longer than 1 or 2
hours daily during the initial treatment period.
There is no mesial movement of the lower molars
and premolars.

9. Shows the facial photographs of the patient shown.
These photographs were taken before treatment
began and after a treatment period of 2½ years. In
the upper photograph, note the marked
mentolabial fold and the high position of the soft
tissues of the chin which is caused by mentalis
muscle actvity. The lower photographs show the
effect of the lower lip pads. The over-all profile
correction is seen.

10. CONCLUSION
Form and function are interrelated in that
there is mutual influence and reciprocal
action between the two.
This discussion with functional correctors
indicates that by eliminating abnormal
perioral pressure, these appliances enable
us to effect significant changes in the
eruption of the teeth and hence in the
development of the alveolar process,
probably right up to the apical base. The
traction exerted on the buccal fold by the
lateral shields also seems to play an
important part in this process.

11. The practical procedures discussed are based on
the concept that abnormal mechanical factors
prevailing in the functional matrix, or in the
interplay of forces, must be located and
eliminated.
This should not be delayed until the permanent
teeth have erupted. The only measures deserving
the name of orthopedic treatment are those
taken during the first stage of development of
the permanent dentition and its supporting bone
structure. In this respect, the vestibule
constitutes a new base of operation for the
practical application of mechanical devices.

12.  AJODO Volume 1969 March (265 -
275)
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