Professional Documents
Culture Documents
Functional Appliances
Ortho Lec # 6
26.03.09
You took fixed appliances and removable appliances which are
classified according to their state, if they can be removed from
the mouth by the pt or not. From these examples of these
appliances, we have a very special type of orthodontic appliances
that can be used only for growing pt to take the advantages
of growth to adjust certain malocclusion. Some old people think
that malocclusion in their ages isn’t correctable, but this isn’t true
because it can be adjusted by fixed or removable appliances, but
ofcausre not with functional appliances because they have been
passed the age of growth.
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backward direction, and that will increase the growth of the
mandible.
b- Tooth born.
Moveme
nt
direction
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This is the herbst appliance, it consist of a metal rod that has
been inserted in a metal tube (stainless steal), and it forces the
mandible to move anteriorly (protrusion) to correct class II
malocclusion, it’s available commercially with different sizes and
only we have to put it in the pt mouth. Don’t think that the rod
that looks like the elastic in fixed appliances will do the same job,
elastic will pull the mandible backward, but herbst will push it
forward.
Removable Appliances:
1) Andresen appliance:
– Indications:
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normal or increased overbite. We should have well aligned teeth
because if there is any crowding then we have to have a fixed
appliance after the functional one and that will make the pt tired
from the treatment, then we have to start with fixed appliance.
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– You have to know the properties of the functional bite
because it’s a very important step in the treatment,
these properties are:
a- In the anterior-posterior plane: we ask the pt to
bring the mandible as forward as the pt can until he
reaches edge to edge, but if the overjet is very big
(>8-10mm) then the pt will face a difficulty in
reaching this relationship because that will be
beyond the tolerance of the facial muscles, in these
cases we ask the pt to bring the mandible forward
as much as he can and then we move it backward
about 2 mm to give the muscles a little freedom for
relaxation.
b- Vertical plane: it’s a must to have a separation
between the incisors about 2 mm (anterior open
bite) and posteriorly about 6 mm with the
maintenance of the midline unless if it’s shifted due
to functional shifting of the mandible, then we try to
correct it, but if the midline shifted due to dental
reason, then we have to maintain it.
c- Transverse plane.
**See the functional bite in the slides.
Note: in Andresen functional appliance we do capping on
the lower incisors to prevent their proclination, and a posterior
bite block to prevent supra-eruption of the lower and upper
molars. Another important note is that a pt with Andresen
functional appliance can’t eat while wearing the appliance, then
we instruct the pt to wear it 12-14 H/day from after the lunch
till the next morning.
You know that the teeth move 1 mm per month, then if we have a
case with 8 mm overjet and we want to reach a normal one (2
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mm) then we will have a 6 month treatment period, after that we
keep wearing the appliance for retention.
How we can
gave it to the pt for a month and a half,
Moveme
nt
direction
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– It’s another common type of a removable functional
appliances.
– Has the same effect as Andresen functional appliance,
also has the same indications, the same bite
construction, and the same effect, but more tolerable
by the pt because it’s composed of two pieces and
easier for the pt to wear it, the upper piece has the same
labial bow as the one in Andresen but with thickness of
0.7 mm. Because it’s composed of two pieces, then we
can incorporate a screw between these pieces in
case of crossbite in addition to the class II.
– Each piece of the appliance has its own posterior bite
block, but they have a special configuration that force
the mandible to move forward when the pt wear it, both
of the bite blocks have an inclined surface (45°) that will
slide over the other surface, in the lower bite block, the
inclined surface is suited distaly and in the upper surface
it’s suited mesialy, by this the mandible will be forced to
slide forward.
– We know that if we have a sever overjet (12 mm), then
we construct an Andresen functional appliance for a 6-8
months until the overjet become 6 mm, then we
construct a new appliance according to the new overjet
to complete the treatment and correct the overjet to 2-3
mm. In case we want to us the twin block in sever
overjet, there is no need for two appliances, we only add
wax to the inclined surfaces, then the pt will be forced to
move the mandible more forward than what he use to do
before adding the wax.
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– In Andresen functional appliance we did capping in the
lower arch, but in case of twin block, we will do a labial
bow with a wire of 0.6 mm thickness that will prevent
the proclination of the lower teeth as the cap will do.
– We said that the twin block is more tolerable by the pts
and they can speak and eat with it, then we instruct
them to wear it 24 H/day.
1)Bionator :
– It’s another removable functional appliance composed of
one piece without acryl in the palate, we have a caffen
spring there.
– It's similar to Andresen but without the acryl that cover
the palate.
Caffe
n
sprin
1)
Harvold:
– Has a high anterior open bite (about 7 mm), but with the
other functional appliances we have a 2 mm anterior
opening.
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– Designed by the German professor frankel, and they
claim that it’s the best functional appliance for the
treatment of class III malocclusion, but also it’s used for
class II.
Bucc
al
shiel
Labi
lingu al
al shiel
shiel
– They promote the growth of the
maxilla in class III, and the growth of the
mandibular alveolar bone in class II.
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alveolar bone anteriorly, also we have a lingual shield
that prevents the effect of the tongue.
Now what
That all was about the functional appliances,
Movement
direction
(backward-
will cause intrusion of the 1st molars, and because of this
action, we can use it in class II malocclusion with
reduced overbite or with high angle cases (high MM
angle).
Movement
direction
(backward-
1)Medium pull
headgear:
– Also the same as the others, but it has a support from
the neck and the head at the same time, so the
direction of the movement will be only backward, so it
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will help us if we want to move the teeth along the
arch without extrusion or intrusion.
Movement
direction
(backward)
1)J-hook headgear:
– It’s positioned in the canine region, and it will cause
intrusion and backward movement of the anterior teeth,
so it’s obvious that it’s used in a cases of class II
malocclusion with a gummy smile.
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– It will enhance forward and downward growth of
the maxilla, proclination of the maxillary teeth,
and retroclination of the
mandibular teeth.
THE END
Done by:
Abdallah Awadi .
All my greeting to my BEST friends: 7al7oli
bey, mimi (mo3ad’), mo7sn (mot3aded
almwaheb), OBU ALWALEED (the king of E-
mails), S.S.S (sale7 s3ed sale7-Da best), eyas,
3li al-2, m-rush, sha3bolaa, o aked altale
ll3’ale 7sen alshe5.
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And to the best girls: shahd, ruba, fara7,
amani 3fani, J-J-Z-S
(jumana,jumana,zinab,sanna), nor 7mdan.
To the Malaysian society: nor 7lem, zo-
al2rnyen, anjeleko, m-nazerol, and to all the
noors.
Lastly all my best wishes to all 4th year
dentistry student.
Good luck in the coming exams…….
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