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MYOFUNCTIONAL

APPLIANCES

CONTENTS

DEFINITION
HISTORY
CLASSIFICATION
MECHANISM OF CRANIO FACIAL GROWTH
ADVANTAGES AND DISADVANTAGES
CRITERIA FOR CASE SELECTION
PRINCIPLES OF MYOFUNCTIONAL APPLIANCE
ACCORDING TO TOM GRABERS
CLASSIFICATION

BITE PLANE
INCLINED PLANE
ORAL SCREEN
VESTIBULAR SCREEN

DEFINITION

Functional or myofunctional appliances are


defined as loose fitting or passive appliances,
whichharness natural forces of the oro-facial
musculature, that are transmitted to the teeth and
alveolar bone through the medium of the appliance.

HISTORYTHE PAST

History ..the past

ROUX 1883-Reported the influence of natural


forces and the functional stimulation on form
of tissues.
This hypothesis shaking of bone became
the background of both general and
functional dental orthopedic procedures.

HISTORY the past

History traced back


to 1879
Norman .w.
kingsley:introduced the
term jumping the
bitefor patients
with mandibular
retrusion-1880.

HISTORY.The past

He used a vulcanite palatal plate with an


anterior inclined plane, which guided the
mandible to a forward position when patient
closed on it.

His ideas influenced the development of

HISTORY.THE PAST

Pierre robin, -1902- developed the


monobloc appliance, used to influence
muscular activity by change in spatial
relationship of jaws.

Fore runner of all functional appliance.

HISTORY..The past

Alfred p.rogers
Sometimes called father of
myofunctinal therapy

Recognized the importance of whole


oro facialsystem in the problem of
orthodontic treatment.

HISTORY ..The past

Viggo andresen1920-ACTIVATOR
Not initially well
received .
Karl haupl:- became
enthusiastic, and
they together called
this the norwegian
system.

VIGGO ANDRESEN

HISTORY-----THE PAST
KARL HAUPL
HAUPL Applied roux concepts to the correction of
jaw and dental arch deformities.
Explained how functional appliances worked through
the activity of orofacial muscles.

the principle and their application lead to


development of orthodontics in Europe.
Crisis in orthodontics-Oppenheim showed
potential tissue damaging effect of heavy
orthodontic force.

HISTORY.The past

First functional appliance to be widely


accepted. universal appliance

HISTORY-----------THE PAST

schwarz, reitan and


other investigators
proved that any
force applied causes
hyalinization
changes in bone.

A. MARTIN SCHWARZ

HISTORY OF DEVELOPMENT OF
FUNCTIONAL APPLIANCE

ROBIN 1902-MONOBLOC
ANDRESEN 1920-ACTIVATOR
HERBST 1934-HERBST
BALTERS 1960-BIONATOR
BIMLER 1964-BIMLER
FRANKEL 1967-FRANKEL
CLARK 1977-TWIN BLOCK

CLASSIFICATION

1.

Stockfish

MYOTONIC APPLIANCES
Muscle mass
Activator, oral screen

MYODYNAMIC APPLIANCES
Muscle activity
Bimlers appliance

2. when functional appliances where still removable

TOM GRABER

GROUP A

TOOTH SUPPORTED

GROUP B

TOOTH/TISSUE SUPPORTED

GROUP C

TISSUE SUPPORTED

ORAL SCREEN
INCLINED PLANES

ACTIVATOR
BIONATOR

FRANKEL APPLIANCE
VESTIBULAR SCREEN

3. WITH THE ADVENT OF FIXED FUNCTIONALS

REMOVABLE
APPLIANCE
ACTIVATOR
BIONATOR

SEMI FIXED
APPLIANCE
DEN HOLTZ
BASS APPLIANCE

FIXED
APPLIANCE
HERBST JASPER
JUMBER
MARS

WITH THE AWARENESS AND


ACCEPTENCE OF CONCEPT OF HYBRIDISATION

PETER VIGI

CLASSIC FUNCTIONAL
APPLIANCE

ACTIVATOR
CATLANS APPLIANCE
FRANKELS APPLIANCE

HYBRID APPLIANCES

PROPULSOR
DOUBLE ORAL
SCREEN
HYBRID BIONATORS

PROFITT

TOOTH BORNE PASSIVE


ACTIVATOR
BIONATOR
HERBST

TOOTH BORNE ACTIVE


Modification of activator $
bionator .
ACTIVATOR AND EXPANSION
SCREWS.
ELASTIC OPEN ACTIVATOR

TISSUE BORNE PASSIVE


FRANKLES FUNCTIONAL
REGULATOR

FORCE ANALYSIS

TYPES OF FORCE

PRIMARY FORCE force applied by functional


appliance
SECONDARY FORCE reaction of tissues to primary
force

Types of forces

compressive
tensile
shearing

Force application and force elimination


Force application

Compressive stress and strain act on the structures


involved

Primary alteration in form with secondary adaptation in function

eg

All active fixed or removable appliance

Force elimination

Abnormal and restrictive influences eliminated

viscoelastic displacement of periosteum and bone forming response

Tensile strain

Optimal development

changes

Functional appliance can bring about


ORTHOPEDIC CHANGES
DENTAL CHANGES
MUSCULAR CHANGES

1 orthopedic changes
Accelerating growth in condylar
region.
Remodeling of glenoid fossa
Restrictive influences and changing
direction of growth of jaws

DENTAL CHANGES
sagittal direction
upper anterior tip palatally.
lower anterior tip labially

Transverse direction
Shielding the buccal muscles away from dental
arch.
Bring about expansion by screws

Vertical direction
Selective eruption of teeth

Muscular change: functional appliance can induce sensory


stimulation to trigger a neuromuscular
response.
Children with neuromuscular disease such as
poliomyelities and cerebral palsy cannot be
treated successfully with functional appliance
therapy.

MECHANISM OF CRANIO FACIAL GROWTH

Muscular hypothesis

Andersen-Haupl

MECHANISM OF CRANIO FACIAL GROWTH

Petrovic
and
McNamara

MECHANISM OF CRANIO FACIAL GROWTH

Viscoelastic hypothesis

Selmer-oslen
Harold
Woodside
Herren

Passive tension caused by stretching of muscles, soft


tissues, e.t.c applies a rigid stretch and create a
build up of potential energy.
Depending on the magnitude and direction,
viscoelastic reaction can be divided into
1 Emptying of vessels
2 Pressing out of interstitial fluid
3 Stretching of fibers
4 Elastic deformation of bone
5 Bioplastic adaptation

Divide $ synthesize matrix


Chondroblasts matures
$matrix undergo
endochondral ossification
Susceptable to gen
extrensic factors
(STH,thyroxin,sex
hormones)
Cartilagenous matrix
isolates them from local
factors
Functional appliance can
only mod direction of
growth.

Growth zone
Skeletoblasts$prechondrobla
st

Secondary cartilage

Primary cartilage

Growth zone
Functional chondroblast

Divide $do not synthesize


matrix
Once the prechondroblasts
matures and become
chondroblasts they become
surrounded by matrix and
they stop dividing
General $local factors
influence the growth

Amount of growth can be


modulated using appliances

MODUS OPERANDI OF FUNCTIONAL


APPLIANCE
FUNCTIONAL APPLIANCE

INCREASED CONTRACTILE ACTIVITY OF LATERAL


PTERYGOID MUSCLE

INTENSIFICATION OF RETRODISCAL PAD

INCREASE INGROWTH STIMULATING FACTORS


ENHANCEMENT OF LOCAL MEDIATORS

REDUCTION OF LOCAL REGULATORS

ADDITIONAL GROWTH OF CONDYLAR CARTILAGE

ADDITIONAL SUB PERIOSTEAL OSSIFICATION OF POSTERIOR BORDERTOF


MANDIBLE

SUPPLEMENTARY LENGTHENING OF MANDIBLE

ADVANTAGES
DISADVANTAGES

AND

ADVANTAGES
Helps in elimination of abnormal muscle function
aiding in normal development.
Less chair side time with less frequent adjustments.
Treatment can be started as early as mixed dentition
period, avoid psychological disturbance associated
with malocclusion
Worn during night, patient acceptance is good.
Do not interfere with oral hygiene maintenance.

LIMITATIONS

patients whose growth has ceased (adults)

Cannot bring about individual tooth movement.


Un cooperative patient
Fixed appliance therapy may be required at the
termination of treatment.
May require prefunctinal orthodontic treatment for
correction of minor local irregularities.
Severe crowding
Moth breathers

Criteria for case selection

Well aligned lower/upper arch.


Class I, mild class II skeletal pattern.
Forward posture of mandible will give a
satisfactory soft tissue profile.
Person undergoing active treatment(8-12yrs)

PRINCIPLE OF FUNTIONAL APPLIANCE

1.
2.
3.
4.
5.
6.
7.
8.
9.

Growth utilization
Correct diagnosis
Ideal and responsive type of malocclusion
Construction bite
Eruptive bite platform
Linguo facial screening
Force delivery/elimination
Patient cooperation
Patience

APPLIANCES

ORAL SCREEN/ VESTIBULAR SCREEN - Introduction

1912 Newell Introduced vestibular screen.


Before world war II it was used frequently in
England.
Recently, it is widely advocated by Kraus,
Hotz, Nord and Fingeroth.
Simple appliance in early interceptive
treatment of dental arch deformities.

According to Kraus
Vestibular screen Appliances that extent into the
vestibule in contact with alveolar process, but did
not contact tooth at all.

Oral screen Appliance with primary objective of


controlling tongue function.

PRINCIPLE
Force application as well as elimination.
Anterior segment influenced directly by appliance
-through muscle pressure.
Posterior segment influenced by keeping away of
cheek muscle allowing tongue posture and function
to expand posterior areas.

Oral screenprinciple $ indication

INDICATION:1.

Intercept habits:Mouth breathing [when airways

are open]
thumb sucking
tongue thrusting
lip and cheek biting

2, Mild disto occlusion with premaxillary


protrusion.

3, Perform muscle exercise-hypotonic lip and


cheek.

Oral screen ..construction


1 - Casts
Working casts that reproduce the depths of sulcus is
made.
2- Construction bite
Sagittal relationship normal-Casts are sealed in
occlusion using plaster.
Disto-occlusion case it is taken by moving mandible
forward by 1-3 mm and bite opened by 2mm.
After wax construction bite, it is transferred on the
models and articulated on a straight line articulator.

construction
3 Extension - Into the sulcus to the point where
mucosal tissue reflects outwards. Care not to
impinge on frenum and muscle attachment.
Posteriorly - up to distal margin of last erupted
molar.
4 , Models covered with 2-3mm wax over labial surface
of tooth and alveolar process.

Case of proclined teeth that is to retract, wax is


removed from incisal 1/3rd of tooth

construction
Ensure that screen contacts maxillary incisors only
and stands away 3mm on each side from buccal
segment.
Open bite case no need expansion appliance
allowed to rest on tissue.

5 Appliance fabricated using either self cure or heat


cure .

MANAGEMENT Patient should be asked to wear the appliance at


night and 2-3 hours during day time.
Instructed to maintain lip seal.
First few days certain areas of inflammation seen
that should be trimmed .
Best time for treatment is 3 - 4 years of age.
Duration 3-6 months

MODIFICATION OF ORAL SCREEN

HOTZ MODIFICATION - Oral screen with a


Metal ring projecting between lips .The ring
used to carry out various exercise.

MODIFICATION OF ORAL SCREEN


VESTIBULAR SCREEN WITH BREATHING HOLES:Fingeroth and Kraus.
Mouth breathers

3 small holes at the inter incisal angle .


Holes can be gradually reduced as the patient become
accustomed to the appliance, which will stimulate
nasal breathing.

COMBINED VESTIBULAR SCREEN AND


TONGUE CRIB:-

KRAUS

A crib of wire or acrylic can be placed in the


area of open bite and attached to screen by a
wire that extends around the last molar tooth
or passed through inter occlusal space in the
region of canine and first premolar.
In both cases it should not touch teeth even
in occlusion.

BITE PLANES

BITE PLANE
Thesearesimplefunctionalappliancesthat
bringaboutminor correctionsofthe
anteroposteriorrelationshipofthejaws.

Theycanbe: Anterior or Posterior


Inclined or flat

Bite Plate.flv

ANTERIOR BITE PLANE


Thickened platform of acrylic palatal to upper
incisors on which the lower incisor occlude leaving
the posterior tooth out of occlusion.
DESIGN
Caninetocanine

consists of Adams clasps on the molars retaining


the appliance.
A labial bow is incorporated to counter any forward

INDICATION
Class I deep bite with
low facial height

CONTRAINDICATION
High facial height
Skeletal deep bite

Class II div II
Severely protruded/
retruded lower
anteriors

CONSTRUCTION AND ADJUSTMENT


Correction of height Adjustment of bite
plane during treatment
Bite plane should be

high enough, so that


posteriors are
Appliance should be
separated by 2-3 mm
worn full time, If bite
opening requires again
bite is increased .
Horizontal adjustment
Before the upper
Surface of bite plane
incisors can be
should be parallel to
retracted to reduce the
occlusal plane and
overjet acrylic is
horizontal. The
trimmed from lingual
posterior limit of bite
surface but should be
plane should extent just
careful that lower
sufficiently to engage
incisors maintain
lower incisor
contact with it until

POSTERIORBITEPLANE
Indications:
Togiveocclusalclearanceforthecorrectionof
thecross
biteofeithertheanteriororposteriorteeth.
Fordiagnosisofocclusalprematurities

CONSTRUCTION:

covertheocclusalsurfaceofposteriorteet
h,
extendinganteriorlyfromfirstpremolartot
helast erupted toothposteriorly.
The thickness should be kept as minimum as
possible.
It is constructed as an extension of the

CLINICALMANAGEMENT
Whentheapplianceisdelivered,careistake
ntosee
thatthebiteplaneshouldcontactthebuccal
and
lingualcuspsoftheposteriorteethoftheopp
osingarchuniformlyonboththesides.
Thebiteplaneshouldbesufficientlythicktor
elievetheocclusalinterference.

Ifananteriorcrossbiteisbeingcorrect
ed,the
biteplaneneedsonlytobesufficiently
thickto
disengageocclusiononanteriorteeth.
Oncethecrossbiteiscorrected,themo

INCLINED PLANE/CATALANS APPLIANCE


Loweranteriorinclinedplane.
IntroducedbyCatalan more than 150years ago
Thisappliance guideseruptingtoothintonormal
position.
All inclined planes have characteristic of opening the
bite by allowing posterior teeth to erupt.So inclined
plane is contraindicated unless there is appreciable
amount of overbite.

INDICATION-
Where anterior cross bite(single tooth or a segment
of upper arch) is developing with a good degree of
overbite and there is sufficient space for the
erupting teeth.

DESIGN
Fabricated using self cure acrylic, designed to have
a 45 angulation, which forces teeth in crossbite to
more labial position

MANAGEMENT OF APPLIANCE
Must be worn continuously, If appliance is removed
during eating the tooth will be forced back towards
original malposition.

Correction will occur within 6 weeks.

After correction advise patient to wear appliance


during sleep to guard against the tendency to move
mandible forward .

DISADVANTAGES
1- Speech problem during therapy.
2- Anterior open bite if used for more than 6
weeks.
3-May need frequent recementation.

Thank you !