SEMINAR ON

MYOFUNCTIONAL APPLIANCE
CHAIRPERSON
ASSOCIATE PROF. DR. MD MUKLESUR RAHMAN PINU
BDS,DDS,MCPS,FCPS
HEAD OF THE DEPARTMENT
DEPARTMENT OF ORTHODONTICS & DENTOFACIAL ORTHOPEDICS
DHAKA DENTAL COLLEGE HOSPITAL.

PRESENTED BY
DR. MALIHA KADER
DR. AZMERI SULTANA
DR. FARIHA RAHMAN DATE TIME VENUE
DR. SHARMIN AKTER
02 / 07 / 2019 11 AM SEMINAR HALL
DR. MUSTAHSINUL BARI ORTHO DEPT.
“ORTHODONTICS IS NOT ONLY THE APPLIANCE, BUT WHICH APPLIANCES,
WHY, WHEN AND FOR HOW LONG.”
-EDWARD HARTLEY ANGLE
 CONTENTS
 Introduction
 Basic principles
 Classification
 Indication
 Advantage
 Disadvantage
 VTO
 Common appliances
 ORTHODONTIC APPLIANCE
❖ They are device by means of which mild pressure (second degree
or optimum) may be applied to a tooth or group of tooth and their
surrounding structures so as to bring about changes within the
bone which will allow tooth movement.
❖ They are mainly of two groups:
➢ Mechanical:
■ Removable
■ Fixed
➢ Myofunctional:
■ Removable
■ Fixed
 MYOFUNCTIONAL APPLIANCE

❖ According to Bhalajhi,
“Functional appliances are defined as loose fitting or passive
appliances, which harness natural forces of the oro-facial
musculature that are transmitted to the teeth & alveolar bone
through the medium of the appliance.”
PIONEER OF MYOFUNCTIONAL APPLIANCE
 BASIC PRINCIPLES
❖ Functional appliances work on two broad treatment principles:
➢ Eliminates the pressure
(As in lip bumper)
➢ Application of the force
(As in the activator)
■ Primary/External force:
Occlusal & muscle forces from tongue, lip, cheek.
■ Secondary/Internal force:
Reactions of tissue to 1º forces.
 FUNCTIONAL COMPONENTS

 The currently used appliances are made of combinations from three basic
functional components.
 Bite planes
 Shields or Screens
 Construction or Working bites
 ACTION OF FUNCTIONAL APPLIANCES

❖ Functional appliances are capable of producing the following changes:

➢ Orthopaedic changes
➢ Dento-alveolar changes
➢ Muscular changes
 “ORTHOPAEDIC CHANGES”

❏ Myofunctional appliances are capable of accelerating the growth in the

condylar region.

❏ They can bring about remodelling of the glenoid fossa.

❏ They can be designed to have a restrictive influence on the growth of the jaw.

❏ They can change the direction of growth of the jaws.

 “DENTO-ALVEOLAR CHANGES”

❏ They can bring about dento-alveolar changes in the

sagittal, transverse & the vertical directions.
 “MUSCULAR CHANGES”

❏ Functional appliances can improve the tonicity of the

oro-facial musculature.
 CLASSIFICATION
❖ According to ‘Tom Graber’:
➢ Group A  Teeth supported appliances
■ Catlan’s appliances, Inclined planes

➢ Group B  Tissue / tooth supported appliances

■ Activator, Bionator etc.

➢ Vestibular positioned appliances with isolated support from tooth/tissue

■ Frankel appliance, Lip bumpers.
❖ Basic classification:

➢ Removable functional appliances

■ Activator, Bionator, Frankel etc.

➢ Fixed functional appliances

■ Herbst appliance, Jasper jumper etc.

➢ Semi-fixed functional appliances

■ Bass appliances, Den holtz etc.
 INDICATION
❖ Use of functional appliance alone:
➢ Cases with mild skeletal discrepancy
➢ Proclined upper incisors
➢ No dental crowding
❖ Use of functional appliance in combination with fixed appliance:
➢ Used most commonly to improve the anterior-posterior relationship
before starting the fixed appliance treatment
➢ Extremely useful in class-II cases
➢ Reduce the amount of a comprehensive fixed therapy required
➢ Reduce the need for orthognathic surgery
❖ Interceptive treatment:
➢ Early intervention indicated when one wishes to utilize their growth
enhancing effect.
➢ In reducing the relative prominence of the proclined upper incisors,
which are particularly susceptible to dento-alveolar trauma.
The difference between growth acceleration in response
to a functional appliance & true growth stimulation can
be represented by using a growth chart-
 ADVANTAGES
❖ Aiding in normal development
❖ Treatment can be initiated at early age
❖ As treatment started at early age psychological disturbances associated with
malocclusion can be avoided
❖ Mostly fabricated in lab; so less chair side time is needed
❖ Frequently visit is not needed
❖ Do not interfere with oral hygiene maintenance
❖ Mostly worn during the night, so patient acceptance is good
 LIMITATIONS

❖ Can’t be used in adult patients

❖ Can’t be used to bring about individual tooth movement

❖ Patient co-operation is essential as the appliance is needed to wear timely

❖ Fixed appliance therapy may be required at the termination of treatment

CASE SELECTION FOR MYOFUNCTIONAL
APPLIANCES

❖ Age of the patient

➢ Only in growing patient
➢ Pubertal growth phase:
■ Female: 8-12 yrs
■ Male: 10-14 yrs
❖ Social consideration
● Dental consideration:
Ideal case is one which is devoid of gross local irregularities like
rotations & crowding.
● Skeletal consideration
○ Moderate to severe skeletal class-II malocclusion are ideally suited
○ Mild class-III with a reverse overjet & an average overbite can be
corrected
● Patient’s co-operation
● Psychological disorder
○ Like epileptic disorder/hyperactive attention
CEPHALOMETRIC ANALYSIS FOR
FUNCTIONAL APPLIANCE THERAPY

❖ Cephalometric diagnosis for myofunctional appliance include 4 areas of

emphasis:

➢ Increment of growth direction vector

➢ Assessment of magnitude of growth change

➢ Assessment of constantly changing inclination of upper & lower incisors

➢ Radiographic cephalometrics
VISUAL TREATMENT OBJECTIVE (VTO)

❖ An important diagnostic test undertaken before making a

decision to use a functional appliance.
❖ Enables us to visualize how the patient’s profile would be
after FA therapy.
❖ Performed by asking the patient to bring the mandible
forward.
An improvement in profile positive indication.
Profile worsens negative-other Rx modalities
considered.
❖ Photographs taken with forward mandibular posture.
VISUAL TREATMENT OBJECTIVE (VTO)
 DURATION & TIMING OF WEAR

❖ Functional appliance treatment should be started

before the pubertal growth spurt.
This is the time when the mandible may exhibit
increased growth which may be influenced.
❖ Functional appliance should be worn for at least 10-12
hours a day.
❖ These appliances should be worn at night time as this
is when growth takes place.
 COMMON APPLIANCES IN USE:

⮚ Vestibular Screen
⮚ Lip bumper
⮚ Activator
⮚ Function regulator
⮚ Bionator
⮚ Twin block appliance
⮚ Some fixed appliance-
-Herbst appliance
-Jasper jumper
VESTIBULAR SCREEN
 VESTIBULAR SCREEN

❖ Vestibular screen was introduced by Newell in 1912

❖ It takes the form of a curved shield of acrylic placed in
the labial vestibule
❖ Works on the principle of both force application & force
elimination
 INDICATION

❖ Mostly used for interception of mouth breathing habit &

also be used in thumb sucking, tongue thrusting, lip
biting, cheek biting.
❖ Mild disto occlusion
❖ To perform muscle exercises to help in correction of
hypotonic lip & cheek muscles
❖ Mild anterior proclination
LIP BUMPER
 LIP BUMPER

❖ It is sometimes called is a “Combined removable-fixed

appliance
❖ It is also called modified vestibular screen
❖ It is used in both maxilla & mandible to shield the lips
away from the teeth
 INDICATION

❖ Used in lip sucking patients

❖ Used in patients exhibiting hyperactive mentalis activity
❖ Used to augment anchorage
❖ Distalization of 1st molars
❖ Used as space regainers if the lower molar have drifted
mesially due to early loss of deciduous molar
 ACTIVATOR

The activator (Frontal view) The activator (Superior view)

 ACTIVATOR

❖ It is primarily used in actively growing individuals

with favourable growth patterns.

❖ It is also known as Monoblock appliance/ Norweigian

appliance/ Andersen appliance/ Functional jaw
orthopaedics.
 PARTS OF ACTIVATOR

Basically activator have 3 parts-

● Labial Bow

● Jack screw

● Acrylic portion
 MODE OF ACTION OF
ACTIVATOR
 Activator induces musculo-skeletal adaptation by
introducing a new pattern of mandibular closure.
It stretches elevator muscles  Muscle contruction 
Myotactic reflex setup  Kinetic energy produces.
This energy causes prevention of maxillary dento-
alveolar process further forward growth & causes distal
movement & a reciprocal forward force to the mandible.

 In addition, a condylar adaptation by backward and upward

growth occurs.

 A third factor is the force generated while swallowing and

during sleeping.
STEPS OF FABRICATION

Impression taking

Model construction and analysis

Visual Treatment Objective

Adaptive bite

Bite registration

Articulation of the model

STEPS OF FABRICATION

Wire construction

Application of separating media

Fabrication of acrylic portion

Trimming of the activator

 INDICATION
❖ Class-II division 1 malocclusion
❖ Class-II division 2 malocclusion
❖ Class-III malocclusion
❖ Class-I open bite
❖ Class-I deep bite
❖ As a preliminary treatment for major fixed appliance
therapy to improve skeletal jaw relations
❖ For post treatment retention
❖ Children with lack of vertical development in lower facial
height
 CONTRAINDICATION

❖ Correction of class-III cases with crowded teeth caused

by disharmony between tooth size & jaw size
❖ In child with excess lower facial height
❖ In child whose lower incisors are severely procumbent
❖ In child with nasal stenosis caused by structural
problems within the nose or chronic untreated allergy
❖ In non growing individuals
 ADVANTAGES

❖ Uses existing growth of the jaws

❖ Minimal oral hygiene problem
❖ Intervals between appointments are long
❖ Appointments are usually short due to need for minimal
adjustments
❖ More economical
 DISADVANTAGE

❖ Requires very good patient co-operation

❖ Can’t produce a precise detailing & finishing of
occlusion
❖ May produce moderate mandibular rotation
(anteriorly downwards). Hence it is not used in case
of excessive lower facial height
 INSTRUCTION
●Timing of wearing

First week – 2 to 3 hours during day time

 Second week – 1 to 3 hours each day and while

sleeping.

 Third week – Visit for evaluation.

●Advice

 Patient should not slept alone during first trial.

 Clean up it regularly.
FUNCTION REGULATOR
 FUNCTION REGULATOR

❖ The function regulator is a myofunctional appliance developed by Prof.

Rolf Frankel of Germany.

❖ This appliance is also called:

➢ Frankel appliance
➢ Vestibular appliance and
➢ Oral gymnastic appliance
TREATMENT EFFECT OF FRANKEL
APPLIANCE

❖ Firstly, serves as a template against which the cranio-facial muscles

function. Framework of the appliance provide artificial balancing of
environment which promotes normal pattern of muscle activity.

❖ Secondly, it removes the muscle forces in the labial and buccal areas
thereby providing an environment which enables skeletal growth.
 MODE OF ACTION

❖ Effects of the Frankel appliance on the dento-alveolar structures are

following:

➢ Increase in transverse and sagittal intra-oral space

➢ Increase in vertical space

➢ Mandibular protraction

➢ Muscle function adaptation

 TYPES OF FUNCTIONAL REGULATORS

❖ FR1- is divided into 3 types:

➢ FR1a
■ Class-I with minor to moderate crowding
■ Class-I deep bite
➢ FR1b
■ Class-II div 1 where overjet <5mm
➢ FR1c
■ Class-II div 1 where overjet >7mm
❖ FR2
➢ Used for treatment of class-II div 1 and div 2
❖ FR3
➢ Used for treatment of class III
❖ FR4
➢ They are used for treatment of open bite & bimaxillary protrusion
❖ FR5
➢ They are functional regulators that incorporate headgear
➢ Indicated in-
■ Long face patients having a high mandibular plane angle and
vertical excess
■ Frankel 2 of Frankel is the most commonly used appliance
 PARTS

❖ Parts of FR1
■ Acrylic parts:
● 2 vestibular shields
● 2 lip pads
■ Wire components:
● Palatal bow
● Labial bow
● Labial support wire
● Lingual bow
● Canine loops
❖ Parts of FR2
➢ Acrylic components:
■ Buccal shields
■ Lip pads
■ Lower lingual pad
➢ Wire compounds:
■ Palatal bow
■ Labial bow
■ Canine extensions
■ Upper lingual wire
■ Lingual cross over wire
■ Support wire for lip pads
■ Lower lingual spring
❖ Parts of FR3
➢ 2 lip pads
➢ Buccal shields
➢ Labial support wire
➢ Labial bow
➢ Protrusion bow
➢ Palatal bow
❖ Parts of FR4
➢ It has same vestibular configuration a FR1 & FR2. It lacks-
■ Canine loops
■ Protrusion bows
➢ It consists of:
■ 4 occlusal rests on the maxillary 1st molars & 1st deciduous
molars
❖ Parts of FR5
● Their appliance consists of posterior acrylic bite blocks
that prevent molar eruption
● Headgear tubes are used for extra-oral traction
TWIN BLOCK APPLIANCE
 TWIN BLOCK APPLIANCE
❖ The Twin Block appliance is a removable, orthodontic functional appliance
that is used to help correct jaw alignment, particularly an underdeveloped
lower jaw.

❖ The appliance consists of an upper & lower plate having occlusally inclined
bite planes that induce favourably directed occlusal forces by causing a
functional mandibular movement.

❖ The appliance consists of an upper & lower plate having occlusally inclined
bite planes that induce favourably directed occlusal forces by causing a
functional mandibular movement.
❖ Upper block is retained by modified arrow head clasps and incorporate
with:

➢ A tube – for attachment of a face bow.

➢ Jackscrew – in case maxillary arch expansion required

❖ The upper block covers the lingual cusps of the upper posterior teeth,
extending anteriorly till the mesial ridge of the upper second premolar.
❖ The lower block is retained by interdental ball clasps and extends distally
up to the distal marginal ridge of the second premolar.

❖ The lower molars are kept free to help in their eruption if needed.

❖ The upper and lower bite blocks interlock at 45º angle

 INDICATIONS

 Class II division 1 in mixed dentition period

 .Class II division 1 with anterior open bite

 Class II division 1 with deep over bite.

 Class II division 2 malocclusion.

 Class III malocclusion.

 CONTRAINDICATIONS

 Cases with vertical growth pattern.

 Crowding that may require extraction.

 When VTO is not possible.

 ADVANTAGES

 Very good patient acceptance.

 Bite planes offer greater freedom of movement and lateral

extrusion.

 Less interference with normal function.

 Significant changes in patients appearance within 2-3 months.

 BIONATOR

Bionator (Anterior view) Bionator (Lateral

view)
 BIONATOR

❖ Bionator was first developed by Balter’s during the early 1950s.

❖ It differed from the conventional activation in that it was less bulky and
more elastic
 INDICATION
❖ In case of class-II division 1 malocclusion having following features:
➢ Well aligned dental arches
➢ Retruded mandible
➢ Not very severe discrepancy
➢ Labial tipping of upper incisors

❖ Class-III malocclusion where reverse bionator can be used

❖ Open bite cases where open bite bionator can be used

 TYPES OF BIONATOR

❖ There are 3 types of bionator:

➢ Standard appliance

➢ Class-III appliance

➢ The open bite appliance

 “STANDARD APPLIANCE”

❖ Standard appliance used for the treatment of class-II div-1 & class-!
Malocclusion having narrow dental arches.

❖ Standard appliance consists of:

➢ Relatively slender acrylic body fitted to the lingual aspects of
mandibular arch & part of maxillary arch.

➢ Wire components include:

■ Palatal arch
■ Vestibular wire
 “CLASS-III APPLIANCE”

❖ This appliance used in mandibular prognathism.

❖ Class-III appliance has the acrylic parts which are similar with
standard appliance.

❖ The palatal arch is placed in the opposite direction so that the rounded
arch is placed anteriorly.

❖ The vestibular wire runs over the lower incisors

 “OPEN BITE APPLIANCE”

❖ It is used in open bite cases.

❖ Maxillary acrylic portion is modified so that even the anterior area is

covered.

❖ It prevents the tongue from thrusting.

❖ The palatal & vestibular arch are same as the standard appliance
 FIXED APPLIANCES

❖ Some fixed appliances are:

➢ Herbst appliance
➢ Jasper jumper
HERBST APPLIANCE
 “HERBST APPLIANCE”

❖ Herbst is a fixed functional appliance that was developed by Emil Herbst

❖ Herbst appliances are 2 types:

➢ Banded herbst appliance
➢ Bonded herbst appliance
 INDICATIONS
❖ This appliance is indicated in class-II malocclusion due to retrognathic
mandible.

❖ It can be used as an anterior repositioning splint in temporomandibular

disorder patients.

❖ Specific indications of Herbst appliances are following:

➢ Post adolescent patient
➢ Mouth breathers
➢ Unco-operative patients
 ADVANTAGES

❖ Can not be removed by the patients.

❖ Treatment duration is short.

❖ Less patient co-operation needed.

❖ Can be used in mouth breather patients

 DISADVANTAGES
❖ It can cause minor temporary function disturbance in the masticatory
patients.

❖ Increased risk of development of dual bite.

❖ Repeated breakage & loosening of the appliance.

❖ Tendency of posterior open bite

JASPER JUMPER
 JASPER JUMPER

❖ A relatively new flexible, fixed tooth borne functional appliance.

❖ It was introduced by J. J. Jasper in 1980.

❖ Actions similar to Herbst appliance but lack of rigidity.

❖ Basically indicated in skeletal class-II malocclusion with maxillary

excess & mandibular deficiency
 ADVANTAGES

❖ Produce continuous force.

❖ Does not require patient compliance.

❖ Allows greater degree of mandibular freedom than Herbst appliance.

❖ Oral hygiene is easier to maintain

 LIMITATIONS & COMPLICATIONS

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

❖ May interfere with speech.

❖ Treatment duration is often too long

 RERERENCES
❖ Orthodontics-The Art & Science by S.I. Bhalajhi;3/e,2003

❖ Textbook Of Orthodontics by Gurkeerat Singh;2/e,2007

❖ Orthodontics Diagnosis & Management of Malocclusion & Dentofacial

Deformities by Om Prakash Kharbanda;2/e,2013

❖ Dentofacial Orthopedics with Functional Appliances by Thomas M.

Graber,Thomas Rakosi & Alexandre G. Petrovic;2/e, 2009

❖ Various Internet Sources