FRANKEL APPLIANCE

(also called: Functional regulators /

Functional corrector / Vestibular
appliances / Oral gymnastics)
Introduced by Dr. Rolf Frankel of
Germany
Treatment is not directed toward the
teeth or skeletal tissues, but to the
functional disorders responsible for
dentoskeletal malformation
Primary aim: to identify a faulty
postural performance of the orofacial
musculature and correct it by
functional appliance
Tissue-borne functional appliance
FRANKEL PHILOSOPHY
1. Vestibular area of operation
- shields extend to vestibuleto prevent
abnormal muscle function
2. Sagittal correction via tooth borne Mx
anchorage
- appliance is fixed on the upper arch
by grooves mesial to the 1st permanent
molar and distal to the canine in the mixed
dentition period
- presence of lingual pad acts as
proprioceptive stimulus and helps in the
forward posturing of the Mn.
3. Differential eruption guidance
- FR is placed on the Mx. teeth
- Mn. posterior teeth are free to erupt
(their unrestricted upward & forward
movement contributes to vertical &
horizontal correction of malocclusion)
4. Periosteal pull by buccal shields and lip
pad
- helps in bone formation and lateral
expansion of the Mx. apical base
5. Minimal maxillary basal defect
- downward & forward growth of
maxilla seems to be restricted, even though
lateral Mx. expansion is seen
Myodynamic (rely in muscle
movements or dynamic properties)
Maxillary restraining effect
Decrowding during eruption
Vestibular screens are extended
into the vestibular sulcus so
tension is created in the soft
tissues
causes outward bending of the
thin buccal plate, facilitating
outward drifting of teeth

Differential eruption prevent Mx

molars from downward and forward
movement
Differential eruptions of lower
molars contribute to establishment
of correct sagittal relationship by 12mm
Periosteal matrix stimulation
Buccal shields and lips are
extended into the vestibule causing
tension
elicits periosteal pull and bone
deposition
MODE OF ACTION OF FR
1. Increase transverse sagittal direction
- by use of buccal shields and lip pads
2. Increase in vertical direction
- by allowing the Mn. molar to erupt
freely
3. Muscle adaptation
- the form and extension of the buccal
shields and lip pads along with the
prescribed exercises corrects the abnormal
perioral muscle activity
The Functional Matrix and Frankel
Appliance

OO : Orbicularis Oris
B: Buccinator
PMR: Pterygomandibular raphe
SPC: Superior pharyngis constrictor
LP: Labial Pad
VS: Vestibular shield
FR provides a larger functional
matrix than the teeth.

The buccinator mechanism will

grow and adapt to whichever
functional matrix (soft-tissue
capsule) is present in the mouth.
This adaptation occurs primarily
during growth.
After growth is complete, very
little, if any, change can be
expected

ORAL EXERCISES WITH FR

Frankel worn full time
Lips to be closed at all times or to
keep a paper between the lips
Swallowing, speaking, etc. w/ the
appliance in mouth, itself serves as an
exercise
TYPES
FR I : used for correction of Class I and Class
II div.1 malocclusion
FR I a :
In class I malocclusion w/ minor
crowding
In delayed development of the basal
bone and dental structure
FR I b:
In class II div. 1 malocclusion w/ deep
bite and overjet <7mm
FR I c:
In severe class II div.1 w/ overjet
>7mm
FR II : used for correction of class II div.1
and div.2 malocclusion

FR III : used for treatment of class III due to

maxillary deficiency

FR IV : used for treatment of open bite and

bimaxillary protrusion
FR V: incorporate headgear, and is used in
high angle cases
INDICATIONS OF FR
Generally,
AGE GROUP OF 8-10 YEARS (MIXED
DENTITION PERIOD)WITH GROWTH
SPURTS.
SKELTAL CL II MALOCCLUSION WITH
PROGNATHIC MAXILLA AND
RETROGNATHIC MANDIBLE.
FUNCTIONAL CL II MALOCCLUSION.
IN A HORIZONTAL OR NETURAL
GROWTH VECTOR CASE.
CL III MALOCCLUSIOS.
BIMAXILLARY PROTRUSION AND OPEN
BITE PROBLEMS.
FUNCTIONAL RETRUSION , DEEP OVER
BITE , AND EXCESSIVE
INTEROCCLUSAL PROBLEMS WITH A
NORMALLY POSITIONED MAXILLAE
FR I
Class I
Early tx : discrepancy bet. tooth size &
arch size in px w/ normal overbite

Late tx : Mild crowding in the presence

of adequate apical base
Class II div. 1
Early tx : Mn. retrusion w/ normal
overbite
Late tx :
1. Mn. retrusion w/ normal overbite,
overjet >7mm
2. Mn. retrusion w/ crowding
3. Mn. retrusion w/ open bite

FR II
Class I
Early tx : deep bite assoc. w/ arch size
deficiency
Late tx : deep bite w/o irregularities

Class II div. 1 & 2

Early tx : Mn. retrusion w/ deep bite &
excessive overjet. Pre-tx
mechanotherapy to correct Mx.
incisors is required
Late tx :
1. Mn. retrusion w/ deep bite &
excessive overjet w/o arch
irregularities. Pre-tx mechanotherapy
to correct incisors is required
2. Mn. retrusion w/ arch irregularities.
Pre-tx mechanism to correct crowding
by extraction is required

FR III
Class III
Early & late tx of Mx. retrusion
Open bite assoc. w/ class III
FR IV
Early tx of skeletal open bite and
bimaxillary protrusion
FR V
High angle cases
Vertical growth pattern
CONTRAINDICATIONS OF FR
Class I malocclusion with severe
crowding
Thumb sucking habit
Severe dentoalveolar problems in
permanent dentition
Uncooperative patients
ADVANTAGES:
1. enables elimination of abnormal muscle
fxn aiding in normal development
2. Tx can be initiated at early age

3. Less chair side time is spent

4. The frequency of the patients visit is less
5. They do not interfere with oral hygiene
status
6. Duration of tx is comparatively less. They
deal with skeletal as well as dentoalveolar
problems.
DISADVANTAGES:
1. bulky and the cooperation of the patient is
essential. 2.They cannot be used in adult
patients were the growth has ceased.
3. Cannot be used to bring about individual
tooth movement and in cases of crowding.
4. Fixed appliance therapy may be required
at the termination of treatment for final
detailing of the treatment.
PARTS OF THE APPLIANCE
Acrylic part
Wire parts
Buccal shields
Palatal bow
Lip pads
Labial bow
Lower lingual pads
Canine extensions
Upper lingual wire
(FR II)
Lingual crossover
wire
Lip pads
Lower lingual springs
Buccal shields
Extend deep into the sulci in the apical
region of Mx. 1st PM and tuberosity region
Areas where expansion of dental arch
and alveolar process is required, the
shields stand away from the lateral
aspects of teeth and alveolus
In Mx. teeth & alveolus the gap bet.
the shield & teeth surface is 2x wax
thickness
In Mn., only 1 wax layer
Thickness: about 2.5mm
Functions:
1. Physiotherapy : by expanding the
circumoral capsule in transverse direction
soft tissues adapt new form
2. Forced training : of the muscles of the
cheek to adapt to fxnal performance
3. Correction of spatial disorder : by
stimulation of periosteal matrices
Labial pads / pelots

Vestibular wires
Connects labial pad and buccal shields
Made from 0.9mm wire
Serves as skeleton for lower lip pads

Rhomboid-shaped, fit the labial

surface of Mn. frontal alveolar process
Teardrop-shaped in x-section (permits
free seating of the lip pads in the
vestibule
5mm distance from upper edges of lip
pad to the gingival margin
Distal edge of lip pad should not
overlap the canine root protuberance
Functions:
1. Physiotherapy: supports the lower lip,
smoothens the mentolabial sulcus, improves
lip posture.
2. Forced training: main fxn is to prevent
hyperactive mentalis from raising the lower
lip

Maxillary Labial bow

Made from 0.9mm wire and usually
lies in the middle of the labial surfaces
of the maxillary incisors
Runs gingivally at 90 bet. lateral
incisor & canine
Forms a gentle curve distally at the
height of middle canine root and reembedded in the buccal shield

Palatal bow

Lingual shield

Below the gingival margin of Mn. teeth

Extends up to distal of 2nd PM
Positioned by the 2 connecting wires
to the buccal shield
Functions:
1. Forced training: in Mn. retrusion, it keeps
the mandible in advanced position.
Whenever the mandible tries to slide back to
its original position, it elicits a pressure
sensation on the lingual aspect of the
alveolar process stimulate protractors of
the mandible

Provides some extra wire length to

facilitate a lateral expansion
adjustment
Crosses the occlusal surface in the
embrasure
Mesial to 1st molar

Canine Loop
Wraps around the lingual surface of
canines
Embedded in the buccal shield at
occlusal plane level
Rises sharply to the gingival margin
Fits in the embrasure

Slicing mechanism allows immediate

seating of appliance

FR I

FR II

2 buccal shields
2 labial pads
1 lingual pad
Wire parts

Buccal shields
Lip pads
Lower lingual pad
Palatal bow, labial bow, canine
extensions, upper lingual wire, lingual
cross over wire, support wire for lip
pads, lower lingual springs

FR III

FR IV

Separators : recommended 1 week

before taking impression
Between Mx. canine & 1st deciduous
molar

FR V

Same vestibular config. as FR I & II w/o

canine loops and protrusion bows
4 occlusal rests on Mx. 1st molars, and
1st deciduous molars to prevent
tipping of the appliance
MOA: spontaneous change of growth
of mandible from downward &
backward to upward & forward
direction correction of skeletal
anterior open bite

For long face syndrome w/ high Mn.

plane angle and vertical Mx. excess

Addition of posterior acrylic bite blocks

(arrest molar eruption

Also has headgear tubes that accept

face bow for an occipital pull headgear

TREATMENT OBJECTIVES
1. INCREASE IN INTRA ORAL SPACE
achieved primarily through buccal
shields and lip pads which eliminate
the harmful mechanical forces on the
pressure sensitive membraneous
structures.
2. VERTICAL SPACE INCREASE
possible because the construction bite
is taken, so that the bite is opened in
the posterior segments as the
mandible is held forward
3. MANDIBULAR PROTACTION
The position of the mandible is
changed through the gradual training
of the protractor and retractor muscles
followed by condylar adaptation.
4. MUSCLE FUNCTION ADAPTATION
Development of new patterns of motor
function, improvement of muscle
tones and establishment of proper oral
seal.
The pads and shields massage the soft
tissues improving blood circulation .

Wearing time
worn all the time except for the meals
so the treatment should be started
slowly
For the first 2 weeks the appliance
should be worn for 2 to 4 hours during
the day
During the next 3 weeks the time is
extended to 4 to 6 hours
usually takes 2 months before the
appliance is worn at night
The appliance and treatment progress
should be checked at 4 weeks interval
An initial end to end molar relationship
is corrected in 6 months
TIMING OF TREATMENT
Best therapeutic effect is achieved
during late mixed and transitional
dentition period
(both soft & hard tissues are
undergoing their greatest transitional
changes) about 8-10 y/o
Tx of Class III & open bite cases should
usually start sooner than for Class II
problems
INSTRUCTIONS FOR THE PATIENT
> A little discomfort is to be expected
initially
> Salivation may be increased but it should
not be a problem
> Outline the duration of wear expected
> Instruction on appliance care and oral
hygiene maintenance
> Demonstrate the lip seal exercise
> Ask the patient to speak a few words and
reassure that speech would normalize
> Wearing time should be correctly followed
References:
Premkumar, S. Orthodontics: Prep Manual for
Undergraduates. Elsevier, 2008: Page 371378
nd
Singh, G. Textbook of Orthodontics, 2 Ed.
Jaypee Brothers, 2007: Page 523-529