1. Xi’an Jiao tong University Stomatology Hospital
Function appliance
Xi’an Jiao tong University Stomatology Hospital
Orthodontic Division
Wang Xiaorong

2. 1. The basic concept
Function appliance：Itself does not produce any mechanical power, its role is changing the orofacial muscle function together to promote development of craniofacial growth, in order to correct the mistake in the formation of malocclusion.

3. The features of function appliance
The impact of the use of dental and skeletal muscle
Upper and lower dentition open bite separation
Lower jaw forward (or backward) shift
When swallowing, the lower lip close
Selective changes in the tooth eruption Road
Does not affect the eruption of permanent teeth and replacement

4. The development of function appliance
In 1726, the French doctor Fauchard first use expansion.
1771 England surgeon Hunten, the first analysis of the mandibular growth
1879, the United States, "the father of Orthodontics" Kingsley, the design of a typical occlusal appliance leaps and bounds, and guide the mandibular forward, established the idea of treatment of mandibular forward.

5. The development of function appliance
1880, published an article, the inclined plane treatment of mandibular retrusion deformities, carried out functional appliance precedent.
, Denmark and Germany Haupl of Andresen long-term cooperation and invented activator system
1951, Stockfisch designed Kinetor appliance. Functional appliance with the expansion of the combination of helical spring. Function of the maxillofacial region had a significant impact on orthopedics.

6. The development of function appliance
Balters designed Biology regulator in 1960.
Frankel has designed functional regulator in 1967.
In late 80's our country are carrying out the functional orthopedic treatment.

7. Principle of Functional appliance
To the mouth and maxillofacial muscle function to stimulate and guide the bone growth of periodontal ligament receptors in biological regulation, mobilization of the growth potential, to achieve the purpose of correction.

8. Principle of Functional appliance
Correction does not in itself have any power, but perioral muscle contractile force, passing through the appliance to the temporomandibular joint, jaw, teeth, bone and other parts, so that deformities have been corrected

9. Principle of Functional appliance
Recoverable through the appliance and lip cheek genioglossus muscle coordination between the power to make happen and maxillofacial soft tissue reconstruction, the re-establishment of function and form a balance between the power to the treatment of dentofacial deformity prevention purposes.

10. Muscle Change
Treatment, change the tone of facial muscles on the teeth and bones by the application of force size, direction and time, so I noodle region neuromuscular jaw environment is conducive to development and craniofacial growth.
When caused by swallowing mandibular muscle contraction contribute to the establishment of normal swallowing tooth contact.

11. Muscle Change
Appliance because of retention in the mouth lax, swallowing must rely on the tongue to maintain its position, the location of the tongue back to normal
Emphasize the treatment of lip closure, lip changed the location and activity
Is a muscle training device.

12. Change of teeth and alveolar
Selectively control the vertical height of the teeth
Inhibit anterior, promote eruption of posterior teeth, to correct deep overbite

13. Change of teeth and alveolar
Inhibition of posterior teeth, promoting tooth eruption before the correction of anterior open together.
Vertical eruption of the teeth at the same time, you can guide them in the near distal direction, to do a small amount of buccolingual movement.

14. Indication
Before peak period of growth and development (for the early permanent dentition ）
Upper and lower jaw development is not transferred
Functional types of malocclusion

15. Contraindication Crowding, misplaced teeth, extraction cases
Uncooperative patients

16. The advantages of functional appliance
The unity of form and function, treatment stability and time is short
Exert the body growth and development potential and development of the forces of nature
With fixed appliance used in conjunction, can simplify the second phase of treatment, to a certain extent to avoid extract teeth and orthognathic surgery, so that a more stable therapeutic effects

17. Treatment procedures Diagnosis Design Occlusal reconstruction
Craft Room production

18. Clinical treatment Try to wear Treatment period Holding period
Post-treatment

19. 2. Categories easy：oblique derivative, lip block, vestibular shield
Activator Class：Activator、 Twin-block 、 Bionator、 Herbst .
Frankel appliance

20. Commonly used functional appliance
oblique derivative, lip block, vestibular shield
Activator
Frankel II III

21. Activator Design by Andresen..
Advance the mandible several millimeters for Class Ⅱ correction.

22. Indication Growth and development of children
Class Ⅱ bone (mandibular retrusion, mild maxillary protrusion)
Patients with good cooperative

23. Appliance structure and production
Maxillary component
Plastic part：baseplate
Metal parts: Transverse palatal bar
labial bow

24. Mandibular component
One whole side of the tongue base, enveloping the anterior labial to 2-3mm

25. baseplate
The original functional appliance design was a block of plastic covering the teeth of both arches and the palate.

26. Wax Record Hop The amount of mandibular advancement
overjet < 6mm，guide to cut to cut overjet > 6mm，guide in several times

27. Open vertical volume
Interest only on the basis of combined space and continue to open 3 - 5mm
On the mandibular midline to be consistent

28. Wear appliance
Wear appliance every day of not less than hours in rest time and evening
month active treatment period    Maintain one and a half years

29. activator
Angle II 1 Classification (wearing appliance into) lower jaw forward and downward (muscles by stretch and fatigue) muscle reflex to pull back in situ mandibular (upper and lower body because of this backward force on inhibition of maxillary dental arch forward development) overlapped anterior occlusal normal

30. Role and the principle Mandibular protrusion
Tatsu neutral relations of posterior teeth
Front teeth overjet the normal occlusal

31. Referral should pay attention to
Inspect influention second molar eruption and primary and permanent teeth to replace the plastic part
Whether or not to loose bow lips
Tooth surface and plastic noodle mediated the relationship between the buffer
Check active mandibular protrusion case

32. the function of Activator
Improvement Class II molar relationship
Reduce overbite and overjet.
To improve the noodle type II category
Backward upper anterior
Forward under anterior
Mandibular rotation after

33. function regulator，FR
It was designed by German R. Frankel in 60's the 20th century, so is also known as the Frankel appliance.

34. principle FR a major role at the oral part of the vestibular area
Used appliance retain lip, cheek screen blocked lips, cheek muscle, so that the developing dentition avoid abnormal perioral muscle function

35. principle
So that the dental arch, mandible length, width and height on three bearings to maximize development
Lip shield, buccal vestibular sulcus screen can pull Department periosteum to stimulate the growth of the Department of alveolar bone

36. FR I
The appliance is utilized to promote transverse arch development both dentally and skeletally.this is accomplished by the vestibular shields removing external muscle pressure from both the maxillary and mandibular arches.Its also effective for interruption of abnormal mentalis function and promote facial development.

37. FR II
The FR II will also accomplish transverse and vertical development of both the maxillary and mandibular arches.

38. FR III
This appliance is used to aid in the correction of Class III malocclusions. This can be achieved by retarding further development of the mandible while simultaneously allowing for the development of the maxilla to its fullest growth potential.

39. FR IV
This appliance is used exclusively in Class I malocclusions where skeletal open bite,arch width deficiency,or abnormal muscle function are present.

40. FR V
It is a modification of the FR II and as such is intended for Class II malocclusion,particularly in cases where an increase in vertical dimension is undesirable.It is often used in conjunction with extraoral traction devices.

41. FRⅢ
Indication
Functional Class Ⅲ is caused by such factors as muscular disorders, bad habits, tongue, or interference.
Mild skeletal class Ⅲ, maxillary hypoplasia, normal or mild mandibular protrusion, mandibular incisor to retreat to on the edge, with a favorable growth pattern, no obvious genetic history.

42. Bionator
Indication
Mixed dentition Class Ⅱ Division 1, maxillary development of normal, functional mandibular retrusion, position on, the development of normal or mildly inadequate Noodles 1 / 3 short or normal mandibular advancement significantly improved after the type

43. twin block It is plastic
Upper and lower occlusal contact pad combined into a 45 'angle

44. All mattress covers on the second molars and premolars together noodle, and in the second premolar in the near edge of ridge formed in the inclined plane to the near, inclined plane and combined into a 45 'angle
All coverage under the pad surface premolar area together in the second premolar distal marginal ridge formed in the far 45 'of slope
All pads in the upper and lower second premolar area 45 'slope of the relationship between occlusal contacts and keep guide to the mandibular protrusion at the location.

45. Forsus
Forsus appliance is a fixed appliance and common use, rapid correction of malocclusion Angle Ⅱ combined functional appliance. It can be seen as a Herbst appliance and the Jasper Jumper appliance improvements, can produce sustained, light elastic, so that the mandibular oral function in a different state at the protrusion, and mandibular growth stimulation.

46. Indication 1）Functional and early bone malocclusion
2）Angle Ⅱ - maxillary protrusion and normal or mildly, moderately incisor on the lip following dump
3）Angle III - mandibular who can back on the edge.

47. extraoral anchorage appliances
To oral external head, pillow, neck, places, submental extraoral structures such as the anti-base
Orthodontic tooth movement for three-dimensional movement on the mandibular inhibit or promote the growth and development, to change the direction of bone growth to provide sufficient anchorage capacity

48. Categories
Rear traction
Vertical Traction
Front traction

49. Rear traction appliance
Backward force used to make teeth move or inhibit distal alveolar, mandibular forward growth of extraoral anchorage appliance device
Mainly include the face-bow, J-hook headgear

50. reverseheadgear
To the amount of pads, chin pocket as composite parts Anchorage   Traction stent as a mask to connect components   Activity or as a fixed appliance within the mouth piece

51. extraoralverticalpull
Application of vertical traction to curb dental, alveolar and mandibular vertical growth direction and growth of extraoral anchorage appliance-type devices

52. Extraoral traction type
orthodonticforce：Are using face-bow mobile teeth, and power range is 340 ~ 450g
orthopedicforce：Are mobile throughout the dental arch, and even maxillary or mandibular, maxillary on each side 800-1lOOg, lower jaw on each side g

53. Traction power size and time
reinforcement fmolaranchorage：
Traction on each side g, can be every day with 8 hours, 10 hours or 12 hours.
molardistalization
300 ~ 500g traction on each side, no less than 12 hours every day.

54. Traction power size and time
Canine rpremolar distalization
Each side of the g. Not less than 12 hours every day.
Intrusionandenmasseretraction fupperanteriors
Each side of the g, not less than 12 hours every day.

55. Inhibition of forward maxillary growth: 500 ~ 800g per side
Stimulate maxillary growth : g, not less than 12 hours every day
Inhibition of mandibular growth: on each side 500g, not less than 12 hours every day
Perpendicular to the growth inhibition: a single molar down when each side of the g, down posterior teeth paragraph , g

56. Commonly used extraoral anchorage appliance
Protraction appliance
Outer bow appliance

57. （1） Protraction appliance
Indication ：Shown deciduous, mixed dentition maxillary hypoplasia caused by anterior teeth / all teeth cross bite.

58. Protraction appliance
Composition
Facial device        The amount of board         Chin pocket         Metal stent
Intraoral devices         baseplate

59. Protraction appliance
Clinical Application
Intraoral devices: 24 hours / day wear,       removed when brushing their teeth
Extraoral devices: 10 ~ 12 hours / day, strength 300 ~ 500 g / side

60. Function Stimulate the growth of maxillary forward
Inhibit the growth of the mandibular
Change the direction of mandibular growth

61. Protraction appliance
Other：If the solid potentiometer, to be used in adhesive-type, base adhesive on the teeth. If the maxillary arch narrow, can be expansion, and then traction.

62. （2） Outer bow appliance
1）Indications ：Excessive maxillary development, up near molar displacement, maximum anchorage 2）Frame ：
Intraoral devices: on the first molar band. Extraoral devices: Headgear high, medium and low face-bow: bow inside and outside the 10 ~ 30 degree angle

63. Outer bow appliance Device composed of head: headgear or neck strap.
Face device: face-bow
Rubber band

64. Outer bow appliance 3）Clinical Application ：
Headgear ：In accordance with the requirements of different locations (high, medium and low) Face-bow: long, medium and short.
Traction: tooth movement or increase the anchorage 150 grams / lateral maxillary development restrictions on 300 ~ 500 g / side

65. Outer bow appliance
4）function：Pushed to the distal molar movement; restrictions maxillary developmental; increase anchorage
traction in the front (in the maxillary extraoral arch welding on Hook, led by the lower jaw forward)

66. J-hook headgear
To neck strap or headgear as anchorage components, J-shaped hook connected components as the rear traction device
Mechanism: J-shaped hook traction device SHI main arch at the front to move far from canine, premolar or incisor adduction

67. summary
Functional appliance power source is the correction of facial muscle strength, by changing the mouth facial muscle function together to promote development and growth and the correction of malocclusion.
Extraoral anchorage appliance is characterized by greater access to Anchorage, at the same time, the application of orthopedic force to correct mild deformity of the mandible