Functional appliances

Dr: Hakam Husham

A removable or fixed appliance harnesses the natural forces (muscle , facia and periodontium) and transmits it to the teeth and alveolar bone in a predetermined direction to produce orthodontic and orthopedic effects

Theory of functional appliances

functional appliances are conceptually based on Moss’ functional matrix theory.Functional matrix theory proposes that growth of the face occur as a response to function need and mediated by the soft tissue

Growth modification (skeletal) Mainly in the treatment of CL II malocclusion and Less commonly in CLIII (Orthopedic changes). Tipping tooth movement and expansion (Dento-alveolar changes). Removal of soft tissue pressures from the cheeks & lips or modification of soft tissue activity (Muscular and soft tissue changes)

Wear Time1st week 2-3 hrs a day during day time. 2nd week onwards 3 hrs during day & while sleeping.(12-16 hrs , 12-18 month) ]

Ideal patient for functional appliance

Age: only in growing patient. Patient behavior: cooperative Social Considerations: accepted Dental Considerations: well aligned dental arch Skeletal Considerations: Moderate to sever Class II malocclusion Mild Class III malocclusion with a reverse overjet & an average overbite

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

Advantages of functional appliance
Treatment can be started as early as in mix dentition stage. No said effects of mechanotherapy such as decalcification or root resorption ect. Less chair side time with less adjustment. Easier to maintain oral hygiene It acceptable to many patients because it is generally worn at night . Patient visit is less Less expensive

Disadvantages of functional appliance

requires very good patient cooperation cannot produce a precise tooth movement or finishing of occlusion. May produce moderate mandibular rotation(hence contraindicated in excess lower 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 mandible
The operating area is in the vestibule
eg: lip bumper
eg: activator
eg: Frankel
Mode of action

A- Bite planes B- Oral screen C- Activator D- frankel E- habit breaking

Removable functional
Fixed functional
Uncooperative. At terminal phase of growth.
eg: catalan s appliance cemented
90%
10%

Bite planes

Anterior
posterior

Anterior Bite planes

Used for reduction of over bite
Used for correction of developing single cross bite

posterior Bite planes

Un lack the occlusion to correct anterior cross bite


Activator or monobloc or Anderson
Comprises upper and lower acrylic fused together. The labial bow lies against the upper incisors
Indication: use mainly for correction of CLII division I malocclusion

Activator

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

Activatorthe interdental acrylic is trimmed to form series of inclined planes to guide and control the tipping of the posterior teeth these plane called facets

Modification of activator

Activator with expansion screw

Modification of activator

Herren modification of activator

Modification of activator

Palate free actiator

Modification of activator

Developed by Balters in 1950’s.Modified activator less bulky & more elastic. Removed must of the bulk of activator consist of a lingual horseshoe of acrylic(Dose not interfere with the speech).The labial bow is extended distally that minimize cheek pressure on teeth.Palatal spring (reversed coffin spring) Bionator

Twin 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


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

Herbest appliance

Can 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 herbst 1-continuous action.2-duration of treatment is short. 3-can be use with un cooperation patients. 4-can be used in patients who are at the end of their growth.5-can be used in patients with mouth breathing habit.

Oral screen

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

Oral 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 I
Frankel II
Frankel III



Discomfort, as both upper & lower teeth are joined together.Mainly depends on patient’s complianceCan 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 speech.Treatment duration is often long


These appliances utilize the muscle action of the patient to produce orthodontic or orthopaedic forces to restore facial balance.The question that must be addressed in diagnosis is : “does the patient require orthodontic treatment or functional orthopedic treatment or a combination of both and to what degree?whether the patient requires functional appliance alone or need a orthognathic surgery or to what extend FA can reduce need for surgery?”