1. FUNCTIONAL APPLIANCES

2. INTRODUCTION Originated and developed in Europe Controversy
A group of orthodontic appliances

3. features Harness forces of muscles Construction bite
Only work in growing children
Can’t correct the teeth irregularity

5. Correction of Class Ⅱmalocclusion

6. Categories of functional appliances
Passive tooth-borne appliances: no active components
Active tooth-borne appliances:including expansive screw or springs to move teeth
Tissue-borne appliances: Functional Regulator-FR

7. Effects of functional appliances

8. Dento-alveolar changes
Antero-posterior: Anterior movement of lower teeth, posterior movement of upper teeth.
Vertical: lower posterior teeth erupt.

9. Modification of Maxillary growth
Restrain the forward growth of maxilla
Catch up growth occurs after treatment

10. Cephlomatric superimposition

11. Changes in mandibular growth
Stimulate mandible growth
Improve the growth direction of mandible

12. Cephlogram superimposition

13. Changes in glenoid fossae
Remolding of the glenoid fossa more anteriorly

14. Indications for functional appliances
The patient must still be growing,preferably approaching a phase of rapid growth.
The pattern and direction of facial growth should be favorable.
The profile improved immediately as the patient move mandible forward.
The patient must be well motivated.
Dentition are well aligned

15. The timing of treatment
Late stage of mixed dentition,1-2 years before the pubertal growth occur
Female: 9~10 year old
Male: 11~12 year old

16. Management of functional appliances

17. Diagnosis Skeletal or non-skeletal(dental)
Mandibular retrusion or maxillary protrusion
Degree of severity

18. Appliance Design No ideal appliance can be used in all situations
Exactly what is desired in the treatment
consideration of cost, complexity, acceptability
Vertical control
Mobile or exfoliating primary teeth

19. impression Differ with the diagnostic records
Areas where appliance components will contact soft tissues must clearly delineated
The impression must not stretch soft tissues in areas of contact with the appliance.

20. Bite registration
1.Anteroposterior dimension: for most patients: 4~6mm (edge to edge if no uncomfortable)
2.Vertical opening: 3~4mm in incisor region

21. Bite registration --methods
A horseshoe-shaped wax bite rim is prepared
Guiding the mandible into planned position
Forming the wax bite
Check and hardened

24. fabrication

25. Fit the appliance Instruction
Check the surface of roughness, adjust clasps, capping
How to insert and remove the appliances
Initially few hours, gradually increase the wearing time. At least 14 hours each day over 2 weeks

26. First review appointment
2 weeks later
Check and trim the appliance

27. Review appointment 1.Every 6~8 weeks 2.Check the appliance
3.Assess progress(improvement or no/slow improvement)

28. 4.Adjustment
Trimming of interocclusal elements to allow teeth erupt where desired
Adjustment of the labial bow: reduce its contact with the anterior teeth
Outward bending of buccal shields and lip pads,facilitate arch expansion

29. Retention
Gradually reduce the amount of wearing time till sleeping hours only
Period: the pubertal growth is over

30. Popular types of appliances

31. Activator Tu

32. construction Base plane Lip bow:transmit forces to upper incisors
Lower incisors capping:⑴minimize the tendency of lower incisors procline ⑵reducing overbite

34. principles
Muscles stretched-producing forces-retracting mandible-transmitted to maxilla through labial bow-restraining the maxillary growth

35. Rules for construction bite
In a forward positioning of the mandible of 7-8mm,the vertical opening must be slightly to moderated(2-4mm)
If the forward positioning is no more than 3-5mm,the vertical opening should be 4-6mm
The Activator can correct lower midline shift or deviation

36. Management Checkup appointments should be scheduled every 6 weeks:
1.observing shiny surface to determine whether the appliance be worn correctly
2.trimming and reshaping acrylic guild areas
3.Acrylic contact guild plane often must be resealed.
4.The labial bows must be checked
5.In expansion treatment the jackscrew are normally activated by the patients at 1-week interval. Check the screw

37. Trimming 1.vertical control
For dolichofacial patients:intrude molars, extrude incisors
For branchfacial patients: intrude incisors, extrude molars

38. Acrylic contour for extrusion of the molars
Acrylic contact Intrusion of the molars

39. Intrusion of the incisors

40. 2.sagittal control
Retrusion of the incisors

41. Distal movement of molars
Mesial movement of molars

42. 3.transverse movement

46. bionator

47. principles Less buckly Adjust the function of tongue
The working bite can’t be opened and must be positioned in an edge-to-edge relationship. If the overjet is too large,can be done step by step.

48. Types of Bionator Standard Bionator
Horseshoe-shaped acrylic lingual plate
Palatal bar
Labial bow extend buccally
No incisors capping

49. Open-bite Bionator

50. Class Ⅲ Bionator

51. Indications The dental are well aligned originally
The mandible is in a posterior position
The skeletal problem is not too severe
A labial tipping of the upper incisors is evident

52. Clinical management
The time interval between office visit is 3-5 weeks
Adjust labial bow to touch the teeth lightly
Trimming the interocclusal block to guild premolar into full occlusion

53. Frankel appliance(Functional Regulator-FR)

54. The large part of Frankel appliance is confined to the oral vestibule
The buccal shields and lip pads hold the buccal and labial soft tissue away from the teeth,eliminating restrictive influence
The manner in which the anteroposterior correction is different

55. tu

56. variation FR1:correction of class Ⅱdivision 1
FR2:correction of class Ⅱdivision 1 and 2
FR3:correction of class Ⅲ
FR4:correction of openbite
Among them, the FR2 and FR3 are often used

57. FR3
Acrylic parts:
Lip pads:eliminate restriction,stimulation of bone growth; transmitting forces to mandible
Buccal shields: maxillary expansion

58. Steel wire Lower labial bow:restrain mandible
Protrusion bow:stimulate forward movement of maxillary incisors
Palatal bar: stabling component
Occlusal rests:prevent lower molar erupt,open cross-overbite

59. Construction bite
Retruding mandible as much as possible, generally edge to edge
Vertical dimension: opened only enough to correct crossbite, allow wires to pass through, about 2mm in posterior region

60. Fabrication Working model trimming wax relief wire forming
fabrication of acrylic portion.

61. Clinical management All margins are checked smoothness
Fitting the appliance 1-2 weeks
First visit: extending wearing time to 4-6 hours
Second visit:exercises may be prescribed including speech and lip-seal
Upper molars rest will be cut

65. Twin block appliance tu

66. introduction Two pieces appliance
Giving greater freedom of movement in anterior and lateral excursion
The appliance can be worn full day
Harness all oral functional forces especially the forces of mastication
Correct the malocclusion rapidly

67. Construction bite
Overjet≤10mm,bite may be activated edge to edge on incisors if the patient can posture forward comfortable
Vertical dimension: 2mm interincisal clearance

68. Design and construction
Midline screw to expand the upper arch

69. Design and construction
retainer

70. Design and construction
Bite blocks

71. Design and construction
Inclined plane

72. Design and construction
Base plane

73. Design and construction
Labial bow

74. Stage 1: active phase:twin block
Stage of treatment
Stage 1: active phase:twin block

75. Stage 2: support phase-anterior plane

76. Vertical control
Dolichofacial patients:non-trimming, prevent second molars extrusion
Branchfacial patients:trimming
Timing:1-2 months after the appliance was inserted
Method:trimming the upper block to leave 1mm clearance between bite and lower molar

77. trimming

82. Herbst

88. Removable appliances Producing tilting movements of individual teeth
As an adjunct to fixed appliance treatment
retention

89. Anterior bite plane

90. management
The bite plane should be length enough to ensure the lower incisors bite on the bite plane.
Add to the height of the bite-plane during treatment

91. Buccal capping Eliminating occlusion interference
Dental incisors cross-bite
Unilateral posterior teeth crossbite

92. Bilateral block

93. Unilateral block