dr: hakam husham. a removable or fixed appliance harnesses the natural forces (muscle, facia and...

Dr: Hakam Husham

A removable or fixed appliance A removable or fixed appliance harnesses the natural forces harnesses the natural forces

(muscle , facia and (muscle , facia and periodontium) and transmits it periodontium) and transmits it to the teeth and alveolar bone to the teeth and alveolar bone

in a predetermined in a predetermined direction to produce direction to produce

orthodonticorthodontic and and orthopedic orthopedic effectseffects

Theory of functional Theory of functional appliancesappliances

• functional appliances are conceptually functional appliances are conceptually based on Moss’ functional matrix theory.based on Moss’ functional matrix theory.

• Functional matrix theory proposes that Functional matrix theory proposes that growth of the face occur as a response to growth of the face occur as a response to function need and mediated by the soft function need and mediated by the soft tissue tissue

1.1. Growth modification (skeletal) Mainly in the treatment of CL II Growth modification (skeletal) Mainly in the treatment of CL II malocclusion and Less commonly in CLIII malocclusion and Less commonly in CLIII (Orthopedic changes).(Orthopedic changes).

2.2. Tipping tooth movement and expansion Tipping tooth movement and expansion (Dento-alveolar (Dento-alveolar changes).changes).

3.3. Removal of soft tissue pressures from the cheeks & lips or Removal of soft tissue pressures from the cheeks & lips or modification of soft tissue activity modification of soft tissue activity (Muscular and soft tissue (Muscular and soft tissue changes) changes)

Wear TimeWear Time

11st st week week 2-3 hrs a day during day time.2-3 hrs a day during day time.

22ndnd week onwards week onwards 3 hrs during day & while 3 hrs during day & while sleeping.sleeping.

(12-16 hrs , 12-18 month) (12-16 hrs , 12-18 month)

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Ideal patient for functional Ideal patient for functional applianceappliance

• AgeAge: only in growing patient.: only in growing patient.

• Patient behaviorPatient behavior: cooperative : cooperative

• Social ConsiderationsSocial Considerations: accepted : accepted

• Dental ConsiderationsDental Considerations: well aligned dental : well aligned dental archarch

• Skeletal ConsiderationsSkeletal Considerations::

Moderate to sever Class II malocclusion Moderate to sever Class II malocclusion

Mild Class III malocclusion with a reverse Mild Class III malocclusion with a reverse overjet & an average overbiteoverjet & an average overbite

Ideal time for functional Ideal time for functional appliance before pubertal appliance before pubertal

timetime????????

Advantages of functional Advantages of functional applianceappliance1.1. Treatment can be started as early as in mix Treatment can be started as early as in mix

dentition stage.dentition stage.

2.2.No said effects of mechanotherapy such as No said effects of mechanotherapy such as decalcification or root resorption ect.decalcification or root resorption ect.

3.3. Less chair side time with less adjustment.Less chair side time with less adjustment.

4.4.Easier to maintain oral hygieneEasier to maintain oral hygiene

5.5. It acceptable to many patients because it is It acceptable to many patients because it is generally worn at night .generally worn at night .

6.6.Patient visit is lessPatient visit is less

7.7. Less expensive Less expensive

Disadvantages of functional applianceDisadvantages of functional appliance1.1. requires very good patient cooperationrequires very good patient cooperation

2.2. cannot produce a precise tooth movement or cannot produce a precise tooth movement or finishing of occlusion.finishing of occlusion.

3.3. May produce moderate mandibular May produce moderate mandibular rotation(hence contraindicated in excess lower rotation(hence contraindicated in excess lower facial height cases)facial height cases)

Group-I

Group-II

Group-III

Passive tooth borne appliance like activator (monobloc)

Active tooth borne appliances like modified activator

Tissue borne appliance these appliance are located in the vestibule

like frankel

Group-I Group-II Group-III

Transmit muscle force to the teeth

Reposition the mandibleThe operating area

is in the vestibule

eg: lip bumper eg: activator eg: Frankel

Mode of action

A- Bite planesA- Bite planes

B- Oral screenB- Oral screen

C- ActivatorC- Activator

D- frankelD- frankel

E- habit breakingE- habit breaking

Removable functional Fixed functional

Uncooperative.

At terminal phase of growth.

eg: catalan s appliance cemented

90% 10%

Bite planesBite planes

Anterior posterior

Anterior Bite planesAnterior Bite planes

Used for reduction of over bite

Used for correction of developing single cross bite

posterior Bite planesposterior Bite planes

Un lack the occlusion to correct anterior cross bite

Activator or monobloc or AndersonActivator or monobloc or AndersonComprises upper and lower acrylic fused together.The labial bow lies against the upper incisors

Indication: use mainly for correction of CLII division I malocclusion

ActivatorActivator

Wear Time:1st week 2-3 hrs a day during day time 2nd week onwards 3 hrs during day & while sleeping

ActivatorActivatorthe interdental acrylic is trimmed to the interdental acrylic is trimmed to form series of inclined planes to guide form series of inclined planes to guide and control the tipping of the posterior and control the tipping of the posterior

teeth these plane called facetsteeth these plane called facets

Modification of activatorModification of activator

Activator with expansion screw

Modification of activatorModification of activator

Herren modification of activator

Modification of activatorModification of activator

Palate free actiator

Modification of activatorModification of activator

• Developed by Balters in 1950’s.Developed by Balters in 1950’s.

• Modified activator Modified activator less bulky & more less bulky & more elastic.elastic.

• Removed must of the bulk of activator Removed must of the bulk of activator consist of a lingual horseshoe of consist of a lingual horseshoe of acrylic(Dose not interfere with the speech).acrylic(Dose not interfere with the speech).

• The labial bow is extended distally that The labial bow is extended distally that minimize cheek pressure on teeth.minimize cheek pressure on teeth.

• Palatal spring (reversed coffin spring)Palatal spring (reversed coffin spring)

BionatorBionator

Twin blockTwin block

Is a removable, orthodontic functional appliance with two section one on maxilla and the other on mandible carry inclined plans of acrylic on closure they meet and cause the mandibular arch to be postured forward

1.Dose not interfere with the speech.2.Can be worn during the day time.3.Patient can get adjusted easy.4.Easy activated.5.Less bulk than other functional appliance.

Herbest applianceHerbest applianceCan be fix or removable consist from pin and tube that runs between the arch to force the mandible forward

Banded Herbst Appliance

Bonded Herbst Appliance

Advantages of fix herbstAdvantages of fix herbst

11-continuous action.-continuous action.22-duration of treatment is short. -duration of treatment is short.

33-can be use with un cooperation -can be use with un cooperation patients. patients. 44-can be used in patients who are -can be used in patients who are at the end of their growth.at the end of their growth.55-can be used in patients with -can be used in patients with mouth breathing habit.mouth breathing habit.

Oral screenOral screen

Passive type

It is a screen made up of acrylic which fits in the buccal and labial vestibule

Oral screenOral screen

Active type

He makes oral vestibule as the operational basis for his treatment.

Has acrylic buccal shields in the buccal side (cause expansion of the arches by holding the cheeks away and enlarge the alveolar process

1-Lips pad.

2 -BUCCAL SHIELDS.

3 -palatal bow.

4 -labial bow.

5 -canine stopper.

Types

Frankel I CL I and CL II Div I

Frankel II CL II Div II

Frankel III CL III

Frankel IFrankel II

Frankel III

•Discomfort, as both upper & lower teeth are joined together.

•Mainly depends on patient’s compliance

•Can be used only if a favorable horizontal growth pattern is present in cases of Class

II correction.

•It has to be removed during masticaiton,particularly when strongest

forces are applied.

•May interfere with speechMay interfere with speech..

•Treatment duration is often longTreatment duration is often long

• These appliances utilize the muscle action of the patient These appliances utilize the muscle action of the patient to produce orthodontic or orthopaedic forces to restore to produce orthodontic or orthopaedic forces to restore

facial balancefacial balance..

•The question that must be addressed in diagnosis is : The question that must be addressed in diagnosis is : “does the patient require orthodontic treatment or “does the patient require orthodontic treatment or

functional orthopedic treatment or a combination of both functional orthopedic treatment or a combination of both and to what degree?and to what degree?

whether the patient requires functional appliance alone or whether the patient requires functional appliance alone or need a orthognathic surgery or to what extend FA can need a orthognathic surgery or to what extend FA can

reduce need for surgeryreduce need for surgery”?”?