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    Functional Appliances 2018

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    tonhanrhm
    Functional appliances are mainly used in orthodontics to redirect mandibular growth. They work by changing muscle and soft tissue pressures to modify bone growth. The most commonly used appliances today are the bionator and activator. Functional appliances are typically used to treat Class II malocclusions with a retrusive mandible. They work primarily through dentoalveolar changes rather than true mandibular growth modification. Patient compliance is important for success.

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    Functional Appliances 2018

    Uploaded by

    tonhanrhm
    97 views45 pages
    Functional appliances are mainly used in orthodontics to redirect mandibular growth. They work by changing muscle and soft tissue pressures to modify bone growth. The most commonly used appliances today are the bionator and activator. Functional appliances are typically used to treat Class II malocclusions with a retrusive mandible. They work primarily through dentoalveolar changes rather than true mandibular growth modification. Patient compliance is important for success.

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    Functional appliances are mainly used in orthodontics to redirect mandibular growth. They work by changing muscle and soft tissue pressures to modify bone growth. The most commonly used appliances today are the bionator and activator. Functional appliances are typically used to treat Class II malocclusions with a retrusive mandible. They work primarily through dentoalveolar changes rather than true mandibular growth modification. Patient compliance is important for success.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    97 views45 pages

    Functional Appliances 2018

    Uploaded by

    tonhanrhm
    Functional appliances are mainly used in orthodontics to redirect mandibular growth. They work by changing muscle and soft tissue pressures to modify bone growth. The most commonly used appliances today are the bionator and activator. Functional appliances are typically used to treat Class II malocclusions with a retrusive mandible. They work primarily through dentoalveolar changes rather than true mandibular growth modification. Patient compliance is important for success.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 45

    Functional Appliances

    Introduction and History

    • Functional appliances are mostly used in


    orthodontics to redirect the growth of the mandible
    to a more protrusive position.
    • The change in pressures created by stretching the
    muscles and soft tissues is used to modify growth in
    a desired direction.
    Introduction and History

    • Andresen in Norway developed the activator in 1920


    which became the first functional appliance to be
    widely accepted.
    • Functional appliances were introduced into
    American orthodontics in the 1960’s. Their use
    became widespread in North America in the 1970’s.
    • Nowadays the most commonly used functional
    appliances are the bionator and the activator
    Where are functional
    appliances mainly used?
    Cl II division 1

    • Proclined upper incisors


    • Micrognathic or retrusive mandible
    • Deep bite
    • Lower face height reduced patients
    Indications

    • Mainly typical Class II division 1


    presenting with large
    dentoalveolar compensations
    and a favorable growth pattern
    Mandibular plane
    Y axis
    What is a favorable growth pattern?
    What is a favorable growth pattern?
    • Functional matrix of Moss
    • Facial bone are responsive to functional needs .

    Concept of functional appliance therapy


    The functional matrix theory of Moss
    • Bone growth specially in the orofacial complex is dependent upon
    the needs of the neuro muscular system.
    • The neuro muscular system is itself dependent of the functional
    needs of the patient
    Maxillary growth
    Can we grow a mandible?
    • Yes and no!

    • McNamarra studies have shown that monkeys


    subjected to mandibular protractors 24 hours a day
    had longer mandibles than controls
    However..

    • In human, the difference between the groups is


    smaller .
    • Usually, the mandible is longer by about 1.5 mm
    after treatment than controls.
    So…

    • This difference does not explain the correction from


    Class II to Class 1 witnessed in clinical situations.
    Genetics

    • Functional appliances
    have no “effect” on true
    (genetic) micrognathic
    mandibles
    Different types of functional
    appliances
    The Bionator

    • An example of a passive tooth-borne appliance


    • One of the most commonly used functional
    appliances because of its simplicity, sturdiness, ease of
    fabrication, ability to be modified and patient acceptance
    • Palatal coverage may be eliminated to decrease
    bulkiness
    Bionator

    • Mandibular protractor.
    • Reposition the mandible in a more forward position
    • Increase mandibular length?
    • Allow for full mandibular growth expression?
    The Frankel Appliance

    •The only fully tissue-borne functional appliance


    •Modifies growth by displacing soft tissues and
    disrupting the equilibrium forces between the
    cheek muscles and the tongue
    •Requires more rigid design, fit, proper use and
    case selections as compared to the passive
    tooth-borne appliances for optimal results
    • If you alter the functional envelope, a different
    response from the growth sites of the orofacial
    bones is to be expected.
    • The use of a Frankl, a true functional appliance,
    should help express maximum response from the
    growth sites.
    Mode of action

    • Mandibular repositioning
    • Periosteal pull
    • Lip bumper effect
    • Suture stimulation?
    • Tongue pressure
    Indications for FA Therapy

    • FAs are mostly used to treat dental and skeletal


    Class II, div I malocclusions
    • They are particularly effective in treating cases with
    mandibular deficiency
    • Other indications for use of FAs may include
    prevention and correction of oral habits (thumb/lip
    sucking), mouth breathing and other oral functional
    aberrations
    Timing of Use

    • Functional Appliance Therapy should coincide with periods of active


    growth
    • Therapy should begin in middle to late mixed dentition
    • Therapy may be started earlier if patient is compliant
    • The success rate of FAs is very limited in non-growing persons
    Common Skeletal and Dental Effects of
    Functional Appliances

    • Redirection of mandibular growth into a more protrusive


    position
    • Restriction of maxillary growth
    • Proclination of lower incisors
    • Lingual tipping of upper incisors
    • Upper and lower molar extrusion
    • Mainly dentoalveolar effects and a small increase of
    mandibular length.
    Twin Block ( 9 months)
    Results
    Contraindications/
    Special considerations
    • FAs tend to open the bite and increase anterior
    lower face height (ALFH) and are not recommended
    in patients with minimum overbite and long ALFH
    • FAs are also contraindicated in patients with
    existing proclined lower incisors
    • FAs can create a dual bite therefore FA therapy
    requires careful evaluation and regular monitoring
    Special Considerations
    At times, pretreatment with fixed appliances may be
    needed in cases with crowded and irregular incisors to
    prepare for proper working bite registration and
    functional appliance position
    • Most often, a final phase fixed appliance therapy is
    indicated following FA therapy to establish optimal
    functional occlusion
    • Outcomes of treatment are totally dependent on
    patient compliance (with the usual removable FAs)
    Fabrication of functional appliance

    • Requires 2 appointments
    • First Appointment:
    • 1) Take accurate alginate impressions of both
    arches with good reproduction of teeth and soft
    tissues. Pour with yellow stone.
    • The impressions should not be overextended This
    will make it difficult to accurately locate the
    appliance components into the vestibule
    Fabrication

    • First Appointment:
    • 2) A “working wax bite” is taken
    - wax is softened and firmly seated on upper teeth
    - slowly guide the mandible forward, to the desired
    position (4-6mm of advancement recommended) and
    record the bite
    -vertically, the bite should be opened in the posterior
    region (amount of clearance depends on appliance type
    and patient’s existing overbite)
    - examine the bite record for maintenance of previous
    midline relationship and absence of dental and soft tissue
    interferences
    Instructions to Lab

    •Please fabricate... Specify type of


    functional appliance
    For most mandibular deficient cases, a bionator or activator-
    type is the most readily accepted appliance

    •Specify to include components of


    appliance most effective in solving
    patient’s problems
    If transverse expansion of the arches is desired, write “attach
    buccal shields to bionator/activator”, etc.
    Appliance Delivery
    • Inspect appliance and smooth out acrylic as needed
    • Check appliance fit on working cast first
    • Try appliance in patient’s mouth and make appropriate
    adjustments
    • Master insertion and removal techniques with patient
    • Give instructions to both the patient and parents
    • Include oral hygiene instructions
    Instructions to the Patient
    In courtesy of Dr. Shildkraut and Dr. Giambattistini
    It is very important to follow the instructions below for the best
    treatment outcomes.
    • You may start by wearing the appliance for 5-6 hours per day at
    home for the first week to get used to the appliance.
    • You may find your speech affected for a few days. Once your tongue
    has adjusted, you will be able to talk normally.
    • By the second week, the appliance should be worn all day.
    • From the 3rd week on, the appliance must always be in your mouth,
    day and night, except when eating or brushing your teeth.
    Instructions to the Patient
    In courtesy of Dr. Shildkraut and Dr. Giambattistini
    • When you remove your appliance, always place it in its
    box so as not to lose it or break it
    • It is very important to keep your mouth as well as your
    appliance clean at all times. To clean your appliance, use
    a toothbrush and rinse it under water. Never clean it
    under boiling water because you will distort the
    appliance.
    • You will be seen by us every 5-7 weeks for follow-up.
    However, if at any point the appliance becomes loose or
    irritating, do not hesitate to call us so we can see you
    the soonest possible to make the proper adjustments.
    • You will wear the appliance for a total of 1.5-2.0 years.
    Adjustment and Recall Schedule
    • Follow-up 2 weeks after appliance delivery for inspection of
    soft tissues and appliance fit and condition
    • Smooth out acrylic, trim back buccal shields and adjust lip pad as needed
    • Ideally see patient every 5-7 weeks to motivate patient,
    observe changes and assure for minimal dental side-effects
    • Re-evaluation in 8-10 months with new records to assess
    efficiency of therapy
    • Final evaluation in 1.5-2.0 years
    • Once FA therapy is completed, finalize treatment with fixed
    appliance
    References
    • Bishara, SE. Ziaja RR. Functional appliances: a review. American Journal of Orthodontics &
    Dentofacial Orthopedics. 95(3):250-8, 1989 Mar.

    • Caprioglio, Damaso. Aurelio Levrini. Interceptive Orthodontics. Bologna: Edizioni


    Martina Bologna s.r.l., 2002. Chapter 5.

    • Carels, C. van der Linden FP. Concepts on functional appliances' mode of action.
    American Journal of Orthodontics & Dentofacial Orthopedics. 92(2):162-8, 1987 Aug.

    • Collett, AR. Current concepts on functional appliances and mandibular growth stimulation.
    Australian Dental Journal. 45(3):173-8, 2000 Sep.

    • Frankel, R. Concerning recent articles on Frankel appliance therapy. American Journal of


    Orthodontics. 1984;85:441-4.

    • Graber, Thomas M. Orthodontics Current Principles and Techniques. Third Edition.


    St Louis: Mosby, Inc., 2000. Chapter 10.
    References
    • Macey-Dare, LV. Nixon F. Functional appliances: mode of action and clinical use.
    Dental Update. 26(6):240-4, 246, 1999 Jul-Aug.

    • Proffit, William R. Contemporary Orthodontics. Third Edition. St Louis: Mosby, Inc.,


    2000. Chapters 11 and 15.

    • Rudzki-Janson I. and Noachtar R. Functional appliance therapy with the Bionator.


    Seminars in Orthodontics. 4(1):33-45, 1998 Mar.

    • Schmuth, GP. Milestones in the development and practical application of functional


    appliances. American Journal of Orthodontics. 84(1):48-53, 1983 Jul.

    • Stratford, NM. Orthodontic treatment using functional appliances. Journal of the Irish
    Dental Association. 43(4):110-6, 1997.

    • Woodside, DG. Do functional appliances have an orthopedic effect? American Journal of


    Orthodontics & Dentofacial Orthopedics. 113(1):11-4, 1998 Jan.

    • http://images.search.yahoo.com/search/images?p=bionator

    • http://images.search.yahoo.com/search/images?p=functional+appliance

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