Functional Appliances Indications & Contraindications Types Of Functional Appliances Medium Opening Activator Components Mechanism Uses Advantages

& Disadvantages

ORTHODONTIC FUNCTIONAL APPLIANCE

A functional appliance is an appliance that produces all or part of its effect by altering the position of the mandible It is one that changes the posture of the mandible, holding it open or open and forward.

Indications For Functional Appliances

Well aligned dental arches Posterior positioned mandible Non severe skeletal discrepancy Lingual tipping of mandibular incisors Proper patient selection (growing age)

Contraindications
Crowding Labial tipping of lower incisors Class ll skeletal by maxillary prognathism

Types Of Functional Appliances

Removable
(activator, bionator & Frankel II)

Passive Tooth-borne
Activator Bionator Herbst appliance

Fixed
(Herbst appliance)

Active Tooth-borne
Modifications of activator & bionator

Tissue-borne
Frankel appliance

Types Of Functional Appliances

TOOTH BORNE PASSIVE:
No intrinsic force generating component such as springs or screws Depend on soft tissue stretch & muscular activity

TOOTH BORNE ACTIVE:

Include expansion screws or other active components like springs to provides intrinsic force for transvers or AP changes

Types Of Functional Appliances

TISSUE BORNE PASSIVE:

Mostly located in vestibule Little or no contact with dentition

History Of Development Of Functional Appliances

Robin 1902- Monoblock Andresen 1908- Activator Herbst 1934- Herbst Balters 1960- Bionator Bimler 1964 Bimler Frankel 1967- Frankel Clark 1977-Twin Block

History Of Development Of Functional Appliances

Origin of activator Class II deep bite tendency Biomechanical Workng Retainer Norwegian Appliance ACTVATOR

Hawley Retainer

Activators
Loose-fitting removable orthodontic appliances redirect the pressures of the facial and masticatory muscles onto the teeth and their supporting structures to produce improvements in tooth arrangements and occlusal relations

Medium Opening Activators (Monoblock)

Removable, tooth-borne functional appliance One-piece functional appliance Made up of heat cured acrylic (minimal acrylic to improve patients comfort) Consists of upper and lower acrylic plates Lower plate extends only in the lingual portion Upper and lower plates are joined by two stout acrylic posts Breathing hole is left between them anteriorly

Medium Opening Activator with upper and lower models

MEDIUM OPENING ACTIVATOR

Medium Opening Activator with upper model removed Medium Opening Activator with lower removed

Components
Lower incisal capping 33-43 Anterior Palatal wire 13-23 Labial Bow 13-23 Adams clasps 15-16/25-26 (in upper buccal segment) Occlusal rests 15-16/25-26 Acrylic connecting 'struts' / posts

Labial bow 13-23 Lower incisal capping 33-43

Labial bow 13-23

Lower incisal capping 33-43

Double Adams Clasp 15-16/25-26

Lower incisal capping 33-43

Anterior Palatal Wire 13-23

Occlusal Rest 15-16/25-26

Double Adams Clasp 15-16/25-26

2 Rigid Acrylic Posts

Rigid Acrylic Post upper n lower parts are joined by these posts

Anterior breathing hole

Mechanism
When the patient bites the mandibular incisors contact the bite plane, thus disoccluding the posteriors that are free to erupt Adams clasps on the molars help in retaining the appliance Labial bow is also incorporated to counter any forward component of force on the upper anteriors The interocclusal acrylic is trimmed gradually to encourage the eruption of posterior teeth

Effects on Teeth in General

Tipping of mandibular incisors facially Retract maxillary incisors Allow eruption and mesial movements of mandibular molars This result in increase lower facial height

Use
Designed to translate a Class II division I incisor relationship into a Class I with a reduced overjet and overbite. Most effective treatment approaches available for the management of Class II deep bite malocclusion in growing subjects Deep bite cases diagnosed to be due to infraocclusion of molars can also be treated

Advantages
Breathing hole present anteriorly No molar capping; these teeth can erupt freely Less bulky and more comfortable Can be modified to fit around fixed braces

Disadvantages
Could not speak or eat when appliance is worn

Patients Compliance
Excellent rapport with the patient Convincing the patient about temporary inconveniences Compliant or non compliant appliances must be weighed and composed, keeping in mind the optional result.

PATIENCE

References
An introduction to orthodontics Laura Mtchell http://www.columbia.edu/itc/hs/dental/D5300/Functional%20Appl iances%20Slide%20Show%20with%20sounds_Mod6_04.ppt%2061_BW.pdf http://www.toteeth.com/html/y2010-297-what-is-a-functionalappliance.html http://faculty.ksu.edu.sa/Alkhadra/PublishingImages/Functional%2 0Appliances%20(2nd%20round)%20-%20Dr%20Khadra.pdf http://www.dentalcompare.com/litupdate.asp?ArticleID=6903 http://www.ncbi.nlm.nih.gov/pubmed/19641758 file:///F:/Medium_Opening_Activator.html http://www.learn-ortho.com/docs/intro%20to%20ortho.pdf