REMOVABLE FUNCTIONAL

APPLIANCES
WHAT IS A FUNCTIOAL APPLIANCE
•The functional appliance achieves its effect through forces
arising from the masticatory and facial muscles.

•The goal of functional appliance is to advance the

mandible in case of class II with deficient mandible.
CLASSIFICATON OF FUNCTIONAL APPLIANCES
1. Tooth borne (present on teeth)
A. Active appliances è precence of active component like expansion
screws or springs produces intrinsc force ( Elastic open activator, Bimler’s
appliance )
B. Passive appliances è soft tissue stretch and muscle activity is used to
produce the desired result (Activator, Bionator)

2. Tissue borne (present on tissues)

A. Active appliances è precence of active component like expansion
screws or springs produces intrinsc force ( Frankel’s appiance)
B. Passive appliances è soft tissue stretch and muscle activity is used to
produce the desired result (Oral screen, lip bumper)
ACTIVATOR
DEFINITION
An Activator is a loosely fitting appliance designed by
Andreasen and Haupl to correct retrognathic mandible.
The appliance is used to open the bite and advance the
mandible for Class II correction.
INDICATIONS FOR USING AN ACTIVATOR
vClass II division I Malocclusion
vClass II division II Malocclusion after aligning the incisors
vClass I open bite Malocclusion
vClass I deep bite Malocclusion
vPost-treatment retention
vChildren with decreased facial height
CONTRAINDICATIONS FOR USING AN ACTIVATOR
vCannot be used in correction of Class I problems of
crowded teeth where there is disharmony between tooth
and jaw size
vCannot be used in children with excess lower facial
height.
vCannot be given in cases with lower proclination.
vIn non-growing patients.
ADVANTAGES OF ACTIVATOR
vUses existing growth.
vMinimal Oral Hygiene problems.
vAppointments are usually short.
DISADVANTAGES OF ACTIVATOR
vRequires good patient co-operation
vCannot produce precise detailing and finishing of
occlusion.
MODIFICATIONS OF ACTIVATOR
 ACTIVATOR
• Discribed by Andresen and Haupl

• Tooth borne passive appliance

• Consisting of large acrylic splint covering palate and teeth in both the
arches

• The acrylic guides the eruption of mandibular teeth mesially whereas

maxillary teeth are directed distally

• Wear only at night

MODIFICATIONS OF ACTIVATOR
Elastic open activator

Harvold or Woodside activator

Activators combined with headgear

­ Teuscher appliance

­ Van Beek appliance

­ Dynmax appliance

Medium opening activator

 ELASTIC OPEN ACTIVATOR
• Discribed by G. kalmet. Of Gorlitz (1960)

• The appliance consists of bilateral acrylic parts (an upper and lower
labial wire, a palatal arch, and guide wires for the upper and lower
anterior)

• Acrylic bulck is reduced and is replaced by wire è increas wear time &
increase flexibility of the appliance

• It can be used for various MO including extraction cases

• Flat acrylic surface permits closure of spaces created by extraction since

there is no interference in the interproximal area
 HARVOLD OR WOODSIDE ACTIVATOR
Discribed by Egil Harvold (Harvold & Vargervic, 1971) and Donald
Woodside (woodside, 1973)

In this type they have increased the Vertical opening greater than 10 mm
on protrusion of mandible because

­ They belived that the masticatory muscalture could not be stimulated

during sleep and for appliance to be effective it had to Strech orofacial
CT, including ligament and fascial sheet, and direct the force to the
teeth and supporting structures

­ However, this modification made it more difficult to tolerate & can affect
compliance
ACTIVATORS COMBINED WITH HEADGEAR

v The main adavantge of headgeaar combined with the functional appliance to treat cases
with

• Vertical maxillary excess (long face)

 ACTIVATORS COMBINED WITH HEADGEAR
1. Teuscher appliance (1978)
­ Anterior spurs to torque upper incisors & prevent their retroclination, allowing headgear to exert pull as far forward
as possiple and prevent the maxilla rotating downward & backward
 ACTIVATORS COMBINED WITH HEADGEAR
2. Van Beek appliance (1982)
­ Modified activator with a headgear directly incorporated into the acrylic

­ The patient wears at night & a few hours during the day
 DYNAMAX APPLIANCE (BASS, 2006)
Has two components:
­ the upper part is removable
­ the lower can be either removable or fixed as a lingual arch
with bands cemented to the first molars with “shoulders” bent
into wire mesial to bands.

Maxillary component
­ Adam clasp on 1st molar
­ Acrylic caping of buccal and anterior segment
­ Palatal spring (maxillary expansion)
­ Vertical spring in 1st molar area ( mandibular advancement by
engaging the lower shoulder in mandibular component)
­ Tube in the 2nd premolar region (for headgear)
­ Anterior torquing spring
­ Anterior bite plane
 DYNAMAX APPLIANCE (BASS, 2006)
Mandibular component (removable)
­ Adam clasp on 1st molar

­ Acrylic body extending as far as possible lingually

­ Acrylic shoulder

­ A lip bumber with addition buccal tube can added if needed

Fixed
­ Similar to a standard lingual arch, but with 3mm shoulder
bent mesial to the bands

­ The mandibular fixed orthodontic can be used

 MEDIUM OPENING ACTIVATOR(MOA)
Monoblock appliance with minimal acrylic to improve patient
comfort leaving breath hole anteriorly

The lower acrylic cover the lower anterior only with lingual
flanges to the lower labial segment

Cribs to maxillary 1st molar and 2nd premolar for retention

Mandibular protrusion achieved via lingual mandibular

guidance flanges

Useful in reduction of deep overbite

BIONATER
 PRINCIPLE OF BIONATOR
Bionator belong to which type of myofunctional appliance
• Tooth borne (designed to be present on teeth not on the tissue)
• Passive
• Removable
• Myodynamic (appliances which function using the muscular activity)
 PRINCIPLE OF BIONATOR
• The bionator, developed by Salters, is a functional jaw orthopedic appliance. Its primary
purpose is to stimulate growth of a deficient mandible, but it can also stimulate alveolar
growth in deep overbite cases, gain space in moderately crowded cases in mixed dentition,
as well as correction of open bite cases in mixed dentition.

• The essential part of robin's concept is function whereas for Baiter's it is the tongue (which is
the center of reflex activity in the oral cavity)

• It is similar in design to the activator but much less bulky, the bionator can be worn day and
night except during meals. Studies have shown greater orthopedic effect on the growing
jaws with full time wear, whereas part time wear results primarily in dental change.
Therefore, full time use of the bionator makes possible the improvement of deformed faces
and jaw structure in the growing child that was previously not possible with the use of fixed
appliances or part ti e orthopedic devices.
 TYPES OF BIONATORS
1. . THE STANDARD BIONATOR (Bionator I)

2. THE OPEN BITE BIONATOR (Bionator II)

3. Class Ill OR REVERSED BIONATOR (Bionator III)

Buccinator bend
Consists of
1. acrylic components
• lower horseshoe shaped acrylic lingual plate from distal of last erupted molar of one side
to other side
• Upper arch - lingual extension that cover molar & premolar region
2. Wire components
§ PALATAL BAR
• - 1.2 mm stainless steel wire
• extents from a line connecting distal surface and middle of upper 1st
permanent molars then follow the contour of palate 1mm away from palatal
mucosa then form a curve that reaches the distal surface of 1st permanent
molar
Function orients the tongue & mandible anteriorly by stimulating its dorsal
surface with palatal bar
§LABIAL BOW WITH BUCCAL EXTENSION
0.9 mm stainless steel wire
begins above contact point between canine and upper 1st premolar -runs
vertically and it bent at right angle to go distally along the middle of second
premolar crown mesial to molar , a rounded bend is made so that the wire run
at the level of lower papilla up to mandibular canine where it is bent to reach
the upper canine
labial portion of bow should be at a sheet of paper thickness away from
incisors surface
Lateral part - buccinator bends
• To keep soft tissue away from the cheeks -so the bite is leveled & eruption
proceed in buccal segment
• Moves cheeks laterally , which favor ex ans1on or transverse development
of dentition
 TYPES OF BIONATORS
1. . THE STANDARD BIONATOR (Bionator I)

2. THE OPEN BITE BIONATOR (Bionator II)

3. Class Ill OR REVERSED BIONATOR (Bionator III)

 2. THE OPEN BITE BIONATOR
(BIONATOR II)
• Acrylic part
oThe Bionator II is designed to correct anterior Open bites in
Class I and Class II malocclusions.
oThe posterior teeth are covered with acrylic to prevent their
eruption. The acrylic is kept away from the incisors to allow
closure of the open bite.
• Wire element
o Labial bow
runs between the upper and lower incisors at the height of lip closure.
Stimulating competent lip seal

o Palatal bar
•Has the same configuration of standard
•Moving the tongue to a more posteriorly
 TYPES OF BIONATORS
1. . THE STANDARD BIONATOR (Bionator I)

2. THE OPEN BITE BIONATOR (Bionator II)

3. Class Ill OR REVERSED BIONATOR (Bionator III)

 3. CLASS III OR REVERSED BIONATOR
(BIONATOR III)

Encourage development of max Bite opened 2mm for this purpose

• Acrylic portion
Extends incisally from canine to canine behind the upper incisors
Acrylic is trimmed away by 1mm behind the lower incisors
Wire elements :

• Palatal bar
The palatal configuration runs forward instead of posteriorly
Stimulate the tongue is in a retracted position in its normal functional space
extending as far as deciduous 1st molar or permanent premolars.
Function: tongue to contact anterior portion of palate , encouraging
forward growth of this area

• Labial bow
The labial bow runs along the lower incisors instead of upper.
similar to that of standard except that the labial bow does not bend obliquely
at the canine and runs through the lower incisors
 CONSTRUCTION BITE

• To achieve a class I relation

• Edge to edge relation of incisors - to provide maximum functional space for
tongue
• If overjet is too large step by step procedure is followed.

• In Open Bite Bionator

• Construction bite-is as low as possible with minimal vertical opening for
interposition of posterior bite blocks to prevent their eruption.
 CONSTRUCTION BITE
• The bite registration involves
• repositioning the mandible in a forward direction as well as opening the bite
vertically.
• In most cases the mandible is advanced by 4-5 mm and the bite is opened
to the extent of 2-3mm.
 CLINICAL MANGMENT

• Appliance must be worn day and night except while eating.

• Pt recalled after 1 week to check sore points Interval between visits 3-5
weeks based on the eruption of the teeth.
• It takes 1- 1and half yrs to achieve correction Labial bow away from
the incisors.
• Buccinator loops away from 1st & 2nd moler should not irritate mucosa.
 MODIFICATION OF BIONATOR
• Modification by Williamson & hamilton
• 3mm cover for max incisors from L.I to L.I
• This is to secure the position of maxillary incisors
• This modification made from construction bite
• This also prevents tipping of lower incisors
 MODIFICATION BY SCHMUTH

• Cybernator
• Normal labial bow in the max arch_ from canine to canine
• Mandibular incisors covered with thin 2mm acrylic
 BY ERICH & ANNETTE FLEISHER
BIO-M-S APPLIANCE

• MODIFICATIONS ARE-
• Acrylic body reduced in size
• Instead of long labial bow Maxillary buccolabial arch wire
and mandibular labial arch wire. Aid in correction of deep
bite.
• Transpalatal bar opens in distal direction as in Cl Ill
Bionator
• Wire spurs used to reinforce anchorage
 ORTHOPEDIC CORRECTOR I
• Side screws to permits forward repositioning of the front half
• INDICATION
• Cl II to cl I
• Excellent result in skeletal cl II cases
• Mixed dentition or permanent dentition treatment
• Upper incisors contact lower incisor acrylic
• capping
 ORTHOPEDIC CORRECTOR II

• Correct Cl II to cl I without vertical growth

• in mixed dentition
• Correct open bite
• enlarges dental arches in case of crowding
• In mixed dentition - TMJ pain patients repositions mandible without increasing
vertical height
To achieve forward growth of mandible in open bite tendency cases
 CALIFORNIA BIONATOR

• This type bionator helps i eruption of post teeth in patients with decreased
vertical dimension
INDICATION CONTRAINDICATION

• Dental arches well •Class II if caused

aligned Mandible in by maxillary
posterior position
Skeletal discrepancy not prognathism
severe . •Vertical growth
• Labial tipping of upper
incisors evident pattern
• Deep bite •Labial tipping of
• Class Ill where reverse
bionator can be used mandibular
• open bite incisors
advantages disadvantages
• Difficulty in managing it.
• Less bulky • Difficult to stabilize and
• It can be worn both day selective grinding of the
and night appliance.
• Action faster than • It is vulnerable to
activator -unfavorable distortion because less
forces are avoided support in the alveolar &
acting on dentition for incisal region
longer time
 http://www.free-powerpoint-templates-design.com

Frankel functional
regulator
 Frankel’s functional
regulator

• Orthodontic device introduced by Rolf Fränkel (Zwickau)

in 1961 in the form of a skeletonized oral shield

Functional Functional Vestibular Oral gymnastic Orofacial orthopedic

corrector regulator appliance appliances appliance
 Equilibrium theory
“When all the forces that act upon an object are balanced, then the object is said to be in a state of
equilibrium”

we can say the dentition is in equilibrium, when:

muscle forces of the tongue and those forces of
the lips and cheeks are balanced

except under certain cases of muscular

imbalances.
 Frankel’s philosophy
Vestibular area of operation Differential eruption guidance
Shields extend to vestibule to prevent 1 3
• Frankel is placed on the upper teeth.
abnormal muscle function • Mandibular posterior teeth are free to erupt
and their unrestricted upward and forward
movement contributes to both vertical as well
as horizontal correction of the malocclusion

Sagittal correction via tooth 2 4 Minimal maxillary base effect

borne maxillary anchorage Downward and forward growth of maxilla seems
Appliance is fixed on the upper arch by grooves to be restricted, even though lateral Maxillary
mesial to the 1st permanent molar and distal to expansion in seen
the canine in the mixed dentition period.
5
Presence of the lingual pad acts as stimulator and
helps in the forward posturing of the mandible
Periosteal pull by buccal shields and lip
pads
•Presence of buccal shields and lip pads exert à the periosteal pull
which helps in bone formation and lateral expansion of the
maxillary apical base
 Mode of action
1. Increase in transverse and sagittal direction
by use of buccal shields and lip pads.

2. Increase in vertical direction

by allowing the lower molar to erupt freely because appliance is fixed to the upper arch

3. muscle adaptation
Development of new patterns of motor function by buccal shields and lip pads
achieved by:
a) massaging the soft tissues
b) loosening the tight muscles
c) Improving the blood circulation
d) improving muscle tonicity
e) Providing new functional matrix for peri-oral muscle to act upon.

4. mandibular forward positioning

Position of mandible can be changed by gradual training of the protractor and retractor muscles followed by
condylar adaptation
Types of Frankel
§ Age Group (8-10 YEARS) (growth spurts) General
§ SKELETAL CL II ( protruded maxilla-retruded mandible)

§
SKELETAL CL III

Bimaxillary protrusion and open bite cases.

indications
Components
 Frankel

A. Acrylic B. Wire
components components

1. Vestibular component/ 1. Labial bow (upper and lower)

buccal shield 2. Labial support wires
2. Lower lip pads 3. Lower lingual support wires
3. Upper lip pads / labial pads 4. Maxillary lingual stabilizing bow
4. Lingual shields 5. Palatal bow
6. Lower lingual springs
7. Canine loops
8. Canine extension
9. Occlusal rest
1. Vestibular component/
Buccal shields stretches
buccal shield periosteum

Extension: Buccal to posterior teeth extends well

into the sulcus until the tolerated level.

Thickness:2.5mm

ACTION : Deposition of bone along

• Eliminates restrictive force of peri-oral muscles the lateral aspect of
maxilla
• Trains the cheek muscles to a more relaxed
level of tonicity
 2. Lower lip pads ACTION:

• Prevents action of
hyperactive mentalis

Two acrylic plate rhomboidal in shape. • prevents lip trap (Proper oral
seal)
• Present in FR II
• Eliminates retrusive muscular
function in sagittal direction

Extension:

• Labial sulcus of anterior region, lateral to

midline and medial to canine eminence,
parallel to alveolar process.
Forward growth of mandible
• Superior margin should be 5mm below
gingival margin prevents gingival stripping.
 3. Upper lip pads

• Similar to lower lip pad but larger in size:

• Absent in FR2
• present in FR3 appliance

• Upper lip pad buccal shield: Expansion of oral

functioning space.
 4. Lingual shield

• Lingual to mandibular alveolar bone

• Extends towards premolar region

Lateral pterygoid muscle
ACTION:
• Short of gingival margin superiorly and into functional
depth of sulcus
• Forward positioning of mandible
• Connected to buccal shields via connecting wires • Sensory input device reposition
mandible forward when patient fails to.
1. Labial bow (upper and lower)
2. Labial support wires
3. Lower lingual support wires
4. Maxillary lingual stabilizing bow
5. Palatal bow
6. Lower lingual springs
7. Canine loops
8. Canine extension
9. Occlusal rest
 Labial Bow
Upper labial bow:
• Found in FR1 and FR2
• Stabilizes the appliance
• interconnects the buccal shields
• acts as guide for positioning the appliance

Lower labial bow:

• used in FR3 appliance
• restricts anterior growth of mandible.
• prevents tipping of lower incisors .
 MAXILLARY PALATAL STABILIZING
BOW

• It is closely adapted to palatal surfaces

of the maxillary incisors above the
cingulum of the teeth

• In FRII its is mainly used to stabilize the

appliance prevents lingual tipping of
anterior teeth.

• In FRIII stimulates forward movement

of the teeth hence called protrusion
bow.
PALATAL BOW

§ Provides some extra wire length to

facilitate a lateral expansion
adjustment

§ Crosses the occlusal surface in the

embrasure, Mesial to 1st molar
CANINE LOOPS

• Wraps around the lingual

surface of canines

• Embedded in the buccal

shield at occlusal plane level
Types of Frankel
appliance
Types of Frankel
USES: CLASS I, CLASS II DIVISION
I MALOCCLUSION
FR-A Lack of Lingual shield

FR-B Has lingual shield + additional arch for protrusion of the lower incisors.

FR-C Has l lingual shield + screw for compensatory anterior movement of the
lower jaw.
USES:
correction of:
class II div.1 and div.2
malocclusion
In this appliance the lip pads are
used in the maxillary arch to allow
the maxilla to grow.

USES:
Class III malocclusion
• spontaneous change of growth of mandible
from downward & backward to upward &
forward direction àcorrection of skeletal
anterior open bite

USES:
correction of open bites and
bimaxillary protrusion.
 They incorporated
High pull headgear

Also, Addition of posterior

acrylic bite blocks (arrest
molar eruption)

USE:
For long face syndrome
with high Mandibular
plane angle and vertical
maxillary excess
Timing of treatment

Best therapeutic effect is achieved:

• during late mixed and transitional

dentition period (8-10 years)
(both soft & hard tissues are undergoing their
greatest transitional changes)

• Treatment of Class III & open bite cases

should usually start sooner than for Class II
problems
Instructions of wear:
• Worn all the time except for the meals
• 1st 2 weeks the appliance should be worn for 2 to 4 hours during the day
• Next 3 weeks the time is extended to 4 to 6 hours
• Usually takes 2 months before the appliance is worn at night
• Follow up visits every 4 weeks
THANK YOU