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Functional Appliances

Functional appliances work by positioning the mandible forward, which transmits forces to the teeth and jaws. They are commonly used in growing patients to correct mild to moderate class 2 malocclusions. While functional appliances can modify jaw growth and change the spatial relationship of the jaws, they are more effective at changing the anteroposterior dental relationship and often require subsequent fixed appliance treatment to fully correct tooth irregularities.

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misbah Abid
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103 views

Functional Appliances

Functional appliances work by positioning the mandible forward, which transmits forces to the teeth and jaws. They are commonly used in growing patients to correct mild to moderate class 2 malocclusions. While functional appliances can modify jaw growth and change the spatial relationship of the jaws, they are more effective at changing the anteroposterior dental relationship and often require subsequent fixed appliance treatment to fully correct tooth irregularities.

Uploaded by

misbah Abid
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PPTX, PDF, TXT or read online on Scribd
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FUNCTIONAL APPLIANCES

Introduction:
• Functional Appliances are appliances that utilize natural forces
of orofacial and masticatory musculature for their action.
• They are conceptually based on Moss’s Functional Matrix
Theory.
• Pressure created by stretching of muscles then are transmitted to dental and skeletal
structures; moving teeth and modifying the growth.
• These appliances derive their forces from orofacial musculature.
• These appliances transmit forces, eliminate and guide the natural forces of musculature,
tooth eruption and growth to correct a malocclusion.
OVERVIEW

• There are many different types of functional appliances but most work
by principal of posturing the mandible forward in growing patients.
• Most effective at changing the anteroposterior relation between the
upper and lower arches, in patients with mild to moderate class 2
skeletal discrepancy.
• Not much effective at correcting tooth irregularities & malalignments
so often followed with a phase of fixed appliance treatment.
• Functional appliances can:
 Modify jaw growth
 Change spatial relationship of jaws
 Change direction of growth
 Change dental relations
FUNCTIONAL APPLIANCE

Definition:

It changes the posture of mandible and causes the patient to hold it opn
and/or forward. Pressures created by stretch of the muscles and soft
tissues are transmitted to the dental and skeletal structures through
function or through the appliances, moving teeth and modifying growth.
TREATMENT PRINCIPLES

1. Force Application: Compressive stress and strain


act on the structures involved and result in a primary
alteration in form with a secondary adaptation in
function.
2. Force Elimination: The principle involves the
elimination of abnormal and restrictive
environmental influences on the dentition and jaws
1. These components produce skeletal and dentoalveolar
changes by acting on the following
a. Guides Eruption pattern
b. Linguofacial muscle balance
c. Mandibular repositioning
TIMING OF TREATMENT

• Growing patients (late mixed dentition just before the growth spurt)
• Coincide with pubertal growth spurt
• CVMI: Cervical vertebral maturity indicators
CONSTRUCTION BITE
REGISTRATION
Advances the mandible in class II malocclusion and
rotates it downwards in class III malocclusion.
EXAMPLE: TWIN BLOCK
INDICATIONS:

• Class 2 malocclusions due to retrognathic mandible


• Growing patient
• Compliant patient
• Normal/low angle preferably
• Normally inclined or retroclined lower incisors
MECHANISM OF ACTION OF FUNCTIONAL
APPLIANCES

Functional appliances can produce following changes:


1. Orthopedic changes
2. Dentoalveolar changes
3. Muscular changes
MODE OF ACTION

• Most of functional appliances act by utilizing one or


more of the following:
1. A forced mandible posture which transmits forces to
the teeth and jaws.
2. Bite planes which produce differential eruption
• Modest change in size of the mandibular overall length
• Reorientation of maxilla and mandible , facilitated by clockwise
tipping of the occlusal plane and rotation of either of the jaws or both
• Reduction in forward growth of maxilla
ADVANTAGES OF FUNCTIONAL
APPLIANCES
1. Functional appliances are effective in vertical control of increased
over bite(class2 div 1 ,class2 div 2)
2. Can modify growth of patient
3. Can be used in mixed dentition
4. Minimal chair side adjustment
5. Can save the patient from the possibility of jaw surgery in future
if intervened at the right time and if the patient shows compliance
and favorable growth
6. Can correct curve of spee
7. Corrects class 2 dental relation
DISADVANTAGES:

1. Success of functional appliances depends on patient’s cooperation.


2. There is no precise tooth movement
3. Treatment duration is often prolonged.
4. Needs two phases of treatment to complete treatment and for
precision in tooth positioning
5. Increases vertical proportions of the face
6. Increases inclination of lower incisors
7. Have to be worn fulltime
8. Unesthetic, discomfort, breakages
DURATION AND 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 appliances should be worn fulltime except for
during brushing eating
• These appliances should be worn at nighttime as this is
when growth takes place
CLASSIFICATION:

• Removable Functional Appliance


• Tooth-borne appliances
• Active (modifications of appliances incorporating screws and springs)
• Passive (Bionator, Twinblock,Herbst)
• Tissue borne appliances (Frankel function regulator)
• Fixed Functional Appliance (Herbst, MARA)
FUNCTIONAL APPLIANCE
COMPONENTS
• Functional
• Tooth controlling
Functional component: The functional components generates forces
by altering posture of the mandible, changing soft tissue pressures
against the teeth, or both (mandible+teeth) components.
example: Lingual flanges
Sliding pins and tubes
Tooth supporting ramps
Lip pads
• Tooth controlling components:
• Arch expansion: Buccal shields
Buccinators bow and shield
Expansion screws /spring
• Vertical control:
Occlusal/incisal stops,
Bite blocks, lingual shield.

• Stabilizing :
Clasps, labial bow,
Anterior torquing springs
PASSIVE TOOTH BORNE

• They are tooth born appliances which have no intrinsic force generating
components such as springs or screws
• Depend only on soft tissues stretch and muscular activity to produce the
desired movement.
Examples:
 Bionator
 Activator
 Twin block
 Herbst (forces the mandible to be positioned forward not by pressure against
the mucosa, but by holding the teeth).
BIONATOR

• Stimulates forward posturing of mandible


• Vertical control of teeth(The lower anterior teeth are covered with
acrylic to act as a bite plane, to hold the bite open, and to
prevent anterior supraeruption).
ACTIVATOR

• Mandible is advanced for class II correction


• Opens the bite
TWIN BLOCK

• Mandible is postured forward


• Maxillary and mandibular portions configured
• Vertical bite control
• Often incorporates expansion screws and headgear tubes
MARA APPLIANCE
HERBST
• Holds the mandible forward
• Pin-and- tube device
• Fixed functional appliance
ACTIVE TOOTH BORNE

• Includes tooth moving mechanical components such as screws or


springs to provide intrinsic force for transverse or antero-posterior
changes.

Examples
 Expansion activator
TISSUE BORNE APPLIANCE

• Located in the vestibule and have little or no contact with the


dentition, holding the lips and cheeks away from the dentition.

Example
 Functional regulators of Frankel
FRANKEL FUNCTIONAL APPLIANCE
• Mandible repositioning
• Located mainly in vestibule
• Arch expansion appliance
SUMMARY/TAKE HOME

• Functional appliance postures the mandible forward & used in


growing patients(preadolescence and at adolescence).
• Used for correction of mild to moderate class 2 malocclusions.
• In most cases they are followed by 2nd phase of fixed appliance
treatment.
• They produce predominantly dentoalveolar changes with some
skeletal changes.
• Successful in 80% of cases,20 % failure is usually due to poor
compliance.

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