MYOFUNCTIONAL APPLIANCES

1. PRESENTED BY:
ARCHITA SRIVASTAVA
BDS FINAL PROF

2.  “ A removable or fixed appliance which favorably changes
the soft tissue environment”
-Frankel,1974
 “ A removable or fixed appliance which changes the position
of mandible so as to transmit forces generated by the
stretching of the muscles, fascia &/or periosteum, through
the acrylic and wirework to the dentition and the underlying
skeletal structures.
-Mills,1991
What are Myofunctional
Appliances ???

3. 
“Loose fitting or passive appliance which
harness natural forces of the oro-facial
musculature that are transmitted to the
teeth & alveolar bone through the
medium of the appliance.”

4. • Are used for growth modification procedures aimed at
intercepting and treating jaw discrepancies.
• They can bring about the following changes:
i. An increase and decrease in the jaw size.
ii. A change in the spatial relationship of the jaws.
iii.Change in direction of growth of jaws.
iv.Acceleration of desirable growth.

5. NEW PATTERN OF
FUNCTION
dictated by appliance
leads to
NEW MORPHOLOGICAL
PATTERN
• Functional appliances are conceptually based on
functional matrix theory given by Melvin Moss.
• Functional matrix theory proposes that functional
matrices, tissues like muscles and glands influence
skeletal units such as jaw bones and ultimately
control their growth
Theoretical basis of functional treatment in general is
the principle that:

6. HISTORY
• 1879-Norman Kingsley- Introduced “bite
jumping” appliance.
• Kingsley`s removable plate with molar clasps, might
be considered prototype of functional appliances, it
had a continuous labial wire and bite plane
extending posteriorly .
• Drawback-tendency to relapse even with bite guide.
1883- Wilhelm Roux-credited as the first
to study the influences of natural forces and
functional stimulation on form.

7. 1902-Pierre Robin-first practitioner to use
functional jaw orthopedics to treat a
malocclusion.
Monoblockinfluenced muscular activity by
changing the spatial relationship of jaws.
In children with glossoptosis syndrome.

8. • 1909-Viggo Andresen(Denmark)- introduced the
Activator.
Viggo Andresen Karl Häupl
1938-Karl Häupl(Germany)-saw the potential of Roux’s
hypothesis and explained how functional appliances work
through the activity of the orofacial muscles.

9. The Original Herbst Appliance
Prof. Emil Herbst
1905- Emil Herbst-  Herbst
Appliance, a fixed functional
appliance.

10. 1950-Wilhem Balters-modified
Andresen`s activator in an effort to treat
class II malocclusions characterized by
deficient mandibles. Bionator
Prof.Dr.Wilhem Balters
1957-Rolf Fränkel Function Regulator.
Appliance was designated as FR-1,FR-2 and FR-3 for treating Class I,
Class II and Class III malocclusions.

11. TREATMENT PRINCIPLES
Force
Application
Force
Elimination

12. I. BASIC CLASSIFICATION OF FUNCTIONAL
APPLIANCES:
(i) Removable Functional Appliances- can be removed
and inserted into mouth by patients at will.
Eg: Activator, Frankel’s.
(ii)Semi Fixed Functional Appliances-that have certain
components fixed.
Eg: Den Holtz, Bass Appliances.
(iii) Fixed Functional Appliances- that are fitted onto the
teeth by the orthodontist and cannot be removed at will by
the patient.
Eg: Herbst appliance,Jasper Jumper
CLASSIFICATION

13. II. CLASSIFICATION BY TOM GRABER
(i) Group A-Teeth supported appliances
-Eg: catlan’s appliance, inclined planes.etc.
(ii) Group B-Teeth or Tissue supported appliances
-Eg: activator,bionator,etc.
(iii) Group C-Vestibular positioned appliances with isolated
support from tooth/tissue
-Eg: Frankel’s appliance, lip bumpers,vestibular screen

14. III. CLASSIFICATION INTO MYOTONIC
AND MYODYNAMIC APPLIANCES
(i) Myotonic Appliances -depend on muscle mass for
their action.
(ii) Myodynamic appliances – depend upon muscle
activity for their function.

15. IV. CLASSIFICATION BY PROFITT
(i) Tooth borne passive appliances-have no intrinsic force
generating components . They depend upon the soft tissue
stretch and muscular activity to produce the desired results.
-Eg: Activator, Bionator and herbst appliance.
(ii) Tooth borne active appliances- they include
modifications of activator and bionator that includes
expansion screws or other active components like springs to
provide intrinsic force for transverse or antero-posterior
changes
(iii)Tissue borne appliances - mostly located in vestibule
and have a little or no contact with the dentition.
-Eg: Functional regulator of frankel.

16. • It enables elimination of abnormal muscle function
thereby aiding in normal development.
• T/t can be initiated at early age.
• As the T/T is started at early age, psychological
disturbance associated with malocclusion can be
avoided.
• Frequency of patient visit to orthodontist is less.
• They do not interfere with the oral hygiene
maintenance.
• Most FA are worn during night so patient acceptance
is good.

17. • They cannot be used in adult patients in whom
growth has ceased.
• They cannot be used to bring about an individual
tooth movement.
• Patients cooperation is essential for the success of
the treatment.
• Fixed appliance therapy may be required at the
termination of the treatment for final detailing of the
occlusion.

18. Functional appliances can bring about
the following changes:
i. ORTHOPAEDIC CHANGES
ii. DENTO-ALVEOLAR CHANGES
iii. MUSCULAR CHANGES
ACTION OF FUNCTIONAL
APPLIANCES

19.  -Capable of accelerating the growth in the condylar
region.
 -Can bring about remodeling of the glenoid fossa.
 -Can be designed to have a restrictive influence on the
growth of the jaws.
 -Can change the direction of growth of the jaws.

20.  Can bring about changes in sagittal, transverse & vertical
directions.
 Allow the upper anteriors to tip palatally and allow the
lower anteriors to tip labially.
 In transverse direction: can bring about expansion of
dental arches
 In vertical plane: can be designed to allow selective
eruption of teeth.

21.  Can improve the tonicity of the orofacial
musculature.

22. CASE SELECTION
• Age: Only in growing patient. Optimum age for
Functional Appliance therapy  b/w 10 years &
pubertal growth phase
• Social Considerations: Functional appliances
achieve their results with the minimum supervision.
Patient should exhibit high degree of motivation if
functional therapy is to be successful.
• Dental Considerations: ideal caseone devoid of
gross local irregularities like rotation and crowding.

23. Skeletal Considerations:
• Moderate to severe Class II malocclusions cases are ideal.
• Class II Division 1 malocclusion exhibiting a Class II
skeletal tendency due to short or retrognathic mandible
can be considered .
• Class II Division 2 malocclusions may be treated after
correcting the axial inclinations of the maxillary anteriors.
• Mild Class III malocclusion with a reverse overjet & an
average overbite can be regarded as potentially treatable.

24. VISUAL TREATMENT OBJECTIVE
• An imp. diagnostic test undertaken before
making a decision to use a functional
appliance.
• Enables us to visualize how the patient’s
profile would be after Functional
appliance therapy.
• Performed by asking the patient to bring
the mandible forward.
 An improvement in profile positive
indication.
 Profile worsensnegative indication-
other treatment modalities considered.
• Photographs taken with forward
mandibular posture are a valuable aid in
motivating the patient and parents.

26. VESTIBULAR SCREEN
• Introduced by Newell in 1912.
• Takes the form of a curved shield of acrylic
placed in the labial vestibule.

27. PRINCIPLE
Worksontheprincipleofbothforce
APPLICATION & ELIMINATION.
Apply the forces of
the circumoral
musculature to
certain teeth.
Relieve the forces of the
circumoral musculature
from the teeth thereby
allowing them to move
due to forces exerted by
the tongue.

28. (a) to intercept mouth breathing, thumb sucking, tongue trusting, lip
biting & cheek biting.
(b) to correct mild disto-occlusions.
(c) to perform muscle exercises to help in correction of hypotonic lip &
cheek muscles.
(d) to correct mild anterior proclination.
 Patient is instructed to
(i) wear the appliance at night and 2-3 hours during the day
(ii) maintain lip seal.
 Areas of irritation in sulcular and the frenal areas should be carefully
trimmed.

29. •MODIFICATIONS:
HOTz
MODIFICATION
DOUBLE ORAL SCREEN
(With additional tongue
shield)
KRAUS’S
MODIFICATION

30. LIP BUMPER
• “combined removal-fixed appliance”.
• Used in both maxilla & mandible to shield
the lips away from the teeth.
Maxillary appliance Denholtz appliance.

31. USES:
i. Patient exhibiting lower lip habits such as lip sucking. The lip bumper
shields the lower lip away.
ii. Patients exhibiting hyperactive mentalis activity.
iii. To augment anchorage.
iv. Distilization of molars.
v. As a space regainers.

32. APPLIANCE DESIGN

33. TWIN BLOCK APPLIANCE
 The Twin Block appliance is a removable, orthodontic
functional appliance that is used to help correct jaw
alignment, particularly an underdeveloped lower jaw.
 Effectively combines inclined planes with intermaxillary &
extraoral traction.

35. • Consists of upper and lower
plate having occlusally
inclined bite planes.
• The bite planes induce
favourably directed occlusal
forces by causing a
functional mandibular
displacement.
• The upper and lower bite
blocks interlock at
70°angle.
COMPONENTS.

36. Upper Plate.
Retained by modified
arrowhead clasps.
Upper bite block
covers lingual cusp of
the upper posterior
teeth extending till the
mesial ridge of the
upper second
premolar.
Lower Plate.
Retained by interdental
ball clasp.
Lower bite block
extends distally up to
the distal marginal
ridge of the second
premolar.
Lower molars are kept
free to help in their
eruption if needed.

37. works on the philosophy of occlusal
inclined planes and use of masticatory
force throughout the day.
The aim of the inclined planes of the bite
blocks in twin block is to modify these
inclined planes and cause more favorable
growth pattern.
MODE OF ACTION

39.  Orthopedic Traction can be added in cases of severe skeletal
discrepancies. This includes the use of a Concord Face bow that
combines the extra oral traction with intermaxillary traction.
• The Fixed Twin Block designed for direct fixation to
the teeth by bonding and can be used in non-
compliant patients. It is similar in design to the Herbst
appliance, however the telescopic tubes of the Herbst
appliance are replaced with two bite blocks.

40. Advantages:
-very good patient acceptance because:
(a) bite planes offer greater freedom of
movement in anterior & lateral excursion.
(b) interference with normal function.
(c) significant changes in patient’s appearance
within 2-3 months.

41. ACTIVATOR
It is an tooth borne passive appliance designed to move the mandible
forward for the correction of the Class II malocclusion and the open
bite.
It could also direct the erupting posteriors meaning it could change
dental relationships in all the three planes.

42. HISTORY AND EVOLUTION OF
ACTIVATOR
• KINGSLEY in 1879 devised a vulcanite palatal plate to be
used in patients having Retruded mandible. This vulcanite
plate consisted of an anterior incline that guided the
mandible to a forward position as the patient closed on it.
• HOTZ modified the kingsley's plate into a vorbissplatte
(used it for deep bite and retrognathism).
• From Kingsley's concept, VIGGO ANDRESEN 1908
developed a loose fitting appliance on his daughter as a
retainer during summer vacations which gave remarkable
results. He called it BIOMECHANICAL RETAINER.

43. • PIERRE ROBIN - monobloc to position the mandible
forward to prevent occluding the airway in patients of
GLOSSOPTOSIS.
• KARL HAUPL (a periodontist and histologist) became
convinced that appliance induced growth changes in a
physiological manner.
• Then the name ACTIVATOR was coined due to its ability
to activate muscle forces.

44. • Indicaitons:
• In actively growing individuals with favorable growth
patterns.
-class II, div I malocclusion
-class II div II malocclusion
-class III malocclusion
-class I open bite malocclusion
-class I deep bite malocclusion
-as a preliminary T/t before major fixed appliance
therapy to improve skeletal jaw relations.
-for post treatment retention
-children with lack of vertical development in lower
facial height.

45. • Contraindications:
-correction of class I cases with crowded teeth
caused by disharmony b/w tooth size & jaw
size.
-in children with excess lower facial height
and extreme vertical mandibular growth.
-in children whose lower incisors are severely
procumbent.
-in children with nasal stenosis caused by
structural problems w/in the nose or chronic
untreated allergy.
-in non-growing individuals.

46. • Advantages:
-uses existing growth of the jaws
-patient experiences minimal oral
hygiene problems
-intervals b/w appointments is long
-appoints are short,minimal adjustments
required
-hence,more economical

47. • Disadvantages:
-requires very good patient cooperation
-cannot produce a precise detailing &
finishing of occlusion. Thus post-
treatment fixed appliance therapy may be
needed.
-may produce moderate mandibular
rotation(hence contraindicated in excess
lower facial height cases)

48. 1. Acc. To Andresen & Haupl
 induce musculoskeletal adaptation by introducing a new
pattern of mandibular closure.
stretching of elevator muscles of
masticationcontractionmyotactic reflex set up
kinetic energy which causes:
-prevention of forward growth of max. dento-
alveolar process
-movement of max. dento-alveolar process
distally
-reciprocal forward force on mandible.
MODE OF ACTION:

49. • Another factor is force generated while swallowing and during
sleeping.
• According to Harvold, Woodside and Herren
Stretching of soft tissues,muscles and tendinous tissues
Passive tension
Responsible for action
• They called it viscoelastic property.

50. CONSTRUCTION BITE
• It is an intermaxillary wax record used to relate the
mandible to the maxilla in the three dimensions of space.
• Bite registration- repositioning the mandible in a forward
direction as well as opening the bite vertically.
• General consideration for construction bite are:
i. Overjet is too large-forward positioning done in stepwise
in 2-3 phases.
ii. If forward positioning of mandible is by 7-8 mm the
vertical opening should be slight to moderate i.e. 2-4 mm
iii. If forward positioning is not more than 3-5 mm then
vertical opening can be 4-6 mm.

51. Low Construction Bite With Marked
Mandibular Forward Positioning.
`H-ACTIVATOR`
• Characterized by marked forward positioning of mandible
but minimal vertical opening.
• ANTERIOR ADVANCEMENT: should not exceed more
than 3mm posterior to the most protrusive position.
• VERTICAL OPENING: is minimal and within the limits
of the inter-occlusal clearance.
• H activator is indicated in a patient with class II, division 1
malocclusion having a horizontal growth pattern.

53. HIGH CONSTRUCTION BITE WITH
SLIGHT MANDIBULAR FORWARD
POSITIONING
`V ACTIVATOR`
• ANTERIOR ADVANCEMENT: by 3-5 mm only.
• VERTICAL OPENING: by 4-6 mm or a max of 4
mm beyond the resting position.
• V activator is indicated in class II division 2
malocclusion having a vertical growth pattern.

54. CONSTRUCTION BITE WITHOUT
MANDIBULAR FORWARD
POSITIONING.
• Done in cases of Deep bite and Open bite.
CONSTRUCTION BITE WITH
OPENING AND POSTERIOR
POSITIONING OF MANDIBLE.
• Indicated in Class III malocclusion.
• Bite is taken after retruding the mandible to a more
posterior position. Bite is opened sufficiently to clear the
bite.
• VERTICAL OPENING: about 5 mm.
• POSTERIOR POSITIONING: about 2 mm.

55. FABRICATION OF ACTIVATOR
1. IMPRESSIONS
impressions of upper and lower arches are made
to construct 2 pairs of models:
i. Study Models
ii. Working Models.

56. 2. BITE REGISTRATION
• The amount of sagittal and vertical
advancement of mandible is
planned.
• Patient is made to sit in an upright
and non-strained position.
• Mandible is guided to desired
sagittal position.
• Patient is asked to practice
placement of mandible at desired
sagittal position.

57. • Horseshoe shaped wax is placed
over the occlusal surface of the
lower cast and is pressed gently
so as to form indentations of
lower buccal teeth.
• Wax block is placed on lower jaw
and patient is asked to bite at the
desired sagittal position.

58. • It is then removed and placed on models and
checked.
• It is then chilled and once again tried on cast . The
excess wax is trimmed off.
• The hardened wax block is again tried in patients
mouth.

59. 3.ARTICULATION OF THE
MODEL
• Wax bite registration is placed on occlusal surface
between upper and lower models
• Models are articulated in reverse direction so that
anterior teeth faces hinges
• It ensures sufficient access to palatal surface of
upper and lingual surface of lower models

60. 4.PREPARATION OF WIRE
ELEMENTS• Basic design requires an upper labial bow and the horizontal section
with two vertical loops
• End of vertical loops enter the acrylic body between canine and
deciduous first molar
• Labial bow can be active or passive

61. 5.FABRICATION OF ACRYLIC
PORTION
• The acrylic portion consists of three parts
1. Maxillary part
2. Mandibular Part
3. Inter occlusal part

62. MANAGEMENT OF APPLIANCE
• Patient should be taught how to use, place and remove the
appliance by himself.
• Wear Time:
1st week 2-3 hrs a day during day time
2nd week onwards 3 hrs during day & while sleeping.

63. TRIMMING OF ACTIVATOR
• Planned trimming of the appliance in the tooth contact
areas is carried out to bring about dento-alveolar changes
so as to guide the teeth into good relation in all the 3
planes of space.
• Selective trimming of acrylic is done in the direction of
tooth movement. The acrylic surfaces that transmit the
desired force by the contact with the teeth are called
guiding forces.

64. 1.VERTICAL PLANE
Intrusion:- Only limited intrusion is possible. Relative intrusion is
one of the objectives.
Incisor intrusion: brought about by
• Loading the incisal edge.
• Labial bow placed in the incisal third.
Molar intrusion brought about by
• Acrylic plate touching only the cusps.
• Acrylic plate ground away from fissures
and grooves.

65. • Extrusion: indicated in OPEN BITE problems.
• Incisor extrusion
– Labial bow is placed in the gingival 1/3 of
labial surface.
– Loading the lingual surface above and below
the area of greater convexity in maxilla and
mandible respectively./3 on the lingual
surface.
• Molar extrusion
• Enhancing eruption by grinding the acrylic plate
from the occlusal surface.
• Acrylic contacting the gingival 1/3 on the lingual
surface.

66. 2.SAGITTAL PLANE
• Protrusion of incisors:
─ Incisors can be protruded by loading their lingual
surface with acrylic and screening the lip strain by
the passive lip bow.
─ The acrylic loading of the lingual surface can be of
two types
i. Entire lingual surface is loaded.
ii. Only the incisal portion of the lingual surface is
loaded.

67. •Retrusion of incisors:
─Acrylic is trimmed away from the lingual surface.
─Active labial bow is incorporated.

68. • Movement Of Posterior Teeth In Sagittal Plane
─ Teeth in the buccal segment can be moved mesially or distally to help
in treating the Class II and Class III malocclusions.
─ In Class II malocclusions, MAXILLARY MOLARS are allowed to
move distally and the MANDIBULAR MOLARS are allowed to move
mesially.
─ Loading in MAXILLARY MOLARS is done on the mesio lingual
surface.
─ Loading in MANDIBULAR MOLARS is done on the disto lingual
surface.

69. • It is possible to produce expansion of the buccal segment
by trimming the activator.
• Acrylic loading is done on the lingual surface of the teeth
to be moved transversely.
• Most effective expansion can be achieved with the help
of the screws.
3. TRANSVERSE PLANE

70. • MODIFICATIONS:
1.BOW ACTIVATOR By A.M.Schwarz
a. A horizontally split activator.
b. Maxillary and mandibular portion
are connected by an elastic bow.
c. It allows step wise sagittal
advancement of the mandible by
adjustment of the bow.
d. It allows certain amount of
transverse mobility of mandible.

71. 2.WUNDERER’S MODIFICAITON
a. Mostly used in treatment of class III
malocclusion.
b. Maxillary and mandibular portions are
connected by an anterior screw.
Opening the screw
Maxillary portion moved anteriorly
Reciprocal backward thrust on mandibular
portion.

72. 3.REDUCED ACTIVATOR OR CYBERNATOR
By G.P.F.Schmuth
Appliance resembles bionator.
Acrylic portion of the activator reduced from the
maxillary anterior area.
The two halves may be connected by an omega
shaped palatal wire similar to bionator.

73. 4.THE KARWETZKY MODIFICATION.
a. Maxillary and mandibular plates joined by a ‘U’ bow in region of
first permanent premolar.
b. Allows mobility of mandible makes the activator more comfortable
to wear.
c. Allows gradual and sequential forward positioning of the lower jaw.
d. ‘U’ loop has a larger and shorter arm. Based on their placement
karwetzky activator has 3 types.

74. Type I – CLASS II, DIV 1
Larger lower leg placed posteriorly two arms of ‘U’ bow are squeezed
lower plate moves sagittaly forward.
Type II – CLASS III
Larger lower leg placed anteriorly U bow is squeezed madibular plate
moves posteriorly.

75. TYPE III
Bring asymmetric advancements of mandible.
U bow attached anteriorly on side and posteriorly on the other side to allow
asymmetric sagittal movement of mandible

76. 5.PROPULSOR by Muhlemann & Hotz
I. Hybrid appliance combining the features of both MONOBLOC and
ORAL SCREEN.
II. Devoid of any wire component.
III. Consists of acrylic that covers maxillary buccal portion like oral
screen.
IV. Acrylic portion extends into the inter-occlusion area and also a
lingual flange that helps position the mandible forward.

77. 6.HERREN’S MODIFICATION
• Modified the activator in two ways.
i. By over compensating the ventral
position of the mandible in the
construction wax bite.
ii. By seating the appliance firmly against
the maxillary dental arch by means of
clasps.
• Triangular or jackson`s clasp used to
firmly seat the appliance to the maxillary
dentition.
• Expansion screw can be used for
expansion.
Construction bite taken with
strong mandibular protrusion.
Retractor muscles try to bring
mandible back to original
position.
Causes a backwardly directed
force on upper teeth and mesial
directed force on the lower teeth.

79. 79
BIONATOR
 Developed by Wilhelm Balters in 1950’s.
 Modified activator less bulky & more
elastic
 Had much more in common with
activator.

80. 80
Advantages
Reduced size
It can be worn both day and night
Action faster than activator –unfavorable forces
are avoided acting on dentition for longer time
Constant wear so more rapid adjustment of
musculature

81. 81
Disadvantage
Difficulty in managing it.
Difficult to stabilize and selective grinding of the
appliance .
It is vulnerable to distortion – because less
support in the alveolar & incisal region

82. 82
INDICATIONS
In CLASS II, div 1 malocclusion having features
like:
a)Well aligned dental arches
b)Retruded mandible
c)Not very severe skeletal discrepancy
d)Labial tipping of upper incisors.
CLASS III malocclusion where reverse bionator
can be used.
Open bite cases where open bite bionator can be
used.

83. 83
TYPES OF BIONATOR
1. THE STANDARD BIONATOR
2. THE OPEN BITE BIONATOR
3. CI III OR REVERSED BIONATOR

84. 84
THE STANDARD APPLIANCE
Consists of
 acrylic components
- lower horse shoe shaped
acrylic lingual plate from distal
of last erupted molar of one
side to other side
- Upper arch - lingual
extension that cover molar &
premolar region

85. 85
WIRE COMPONENTS
 PALATAL BAR
 LABIAL BOW WITH BUCCAL EXTENSION
 PALATAL BAR
• Emerges opp of middle of first premolar and
follows contour of palate.
• On distal surface of molars forms a curve.
• Kept 1mm away from the mucosa.
Function- orients the tongue &
mandible anteriorly by stimulating its
dorsal surface with palatal bar

86. 86
WIRE COMPONENTS
VESTIBULAR
WIRE
• Emerges below the contact point of upper canine and first
premolar.
• Rises vertically and bent at right angle to go distally along
the middle of upper premolar crowns.
• Mesial to molar a rounded bend is made so the runs at level
of lower papilla up to the mandibular canine.
• Then it is bent to reach the upper canine.

87. 87
OPEN – BITE APPLIANCE
 Purpose of this appliance is to
close the anterior space
 Acrylic part-
 The lower lingual part extends
into the upper incisor region as a
lingual shield , closing the anterior
space without touching the upper teeth

88. 88
Wire elements
 Labial bow runs between the upper and
lower incisors at the height of lip
closure.

89. 89
REVERSED BIONATOR
 Used in mandibular prognathism.
 Bite opened 2mm for this
purpose
Acrylic portion
Extends incisally from canine to
canine behind the upper incisors
Acrylic is trimmed away by 1mm
behind the lower incisors

90. 90
Palatal bar
Labial bow
 In front of lower incisors
 Wire slightly touches the labial surface lightly / it is at a paper
thickness away
Palatal arch placed in opposite
direction so that the rounded arch
is placed anteriorly.

91. 91
CONSTRUCTION BITE
Objective
 To achieve a cIass I relation
 Edge to edge relation of incisors – to
provide maximum functional space for
tongue
 If overjet is too large – step by step
procedure is followed

92. FRANKEL’S FUNCTION
REGULATOR
• ‘ It is a tissue-borne type removable
functional appliance developed by Rolf
Frankel that aims to remove muscle forces
in labial and buccal areas that restricts the
skeletal growth’

93. 2 main T/t effects:
1) serves as a template against which craniofacial
muscles function. Framework of the appliance provide
an artificial balancing of environment.
2) removes the muscle forces in the labial & buccal
areas thereby providing an environment which enables
skeletal growth.

94. THE
FRANKEL
PHILOSOPHY
MINIMAL
MAXILLARY
BASAL EFFECT
DIFFERENTIAL
ERUPTION
GUIDANCE
VESTIBULAR
ARENA OF
OPERATION
SAGITTAL
CORRECTION
VIA TOOTH
BORNE
MAXILLARY
ANCHORAGE
PERIOSTEAL
PULL BY
BUCCAL
SHIELDS AND
LIP PADS.

95. VESTIBULAR ARENA OF OPERATION
 According to Frankel: dentition is influenced by perioral muscle
function
 Abnormal perioral muscle function barrier for the
optimal growth of dento alveolar complex
 Appliance design to hold away the muscles{buccal and labial}
from dentition dentoalveolar structures free to develop.
 Appliance acts as an exercise device that aids in correction of
abnormal perioral muscle function

96. SAGITTAL CORRECTION VIA TOOTH
BORNE MAXILLARY ANCHORAGE.
 Appliance anchored firmly to maxillary arch by
means of grooves in molar and canine region.
 Mandible is positioned anteriorly by means of
acrylic pad that contacts the alveolar bone behind
the lower anterior segment.
 Lower lingual pad acts as a proprioceptive trigger
for the postural maintenance of the mandible.

97. DIFFERENTIAL ERUPTION GUIDANCE.
 Appliance is free of mandibular teeth.
 Allows selective eruption of lower posteriors.
 Aids in correction of vertical dimension and sagittal
correction of class II malocclusion.

98. MINIMAL MAXILLARY BASAL EFFECT
 In most class II malocclusions, the maxillary
position is close to normal while the mandible is
retruded.
 Frankel appliance has relatively little retrusive
saggittal effect on maxilla in contrast to marked
protrusive change in mandible.

99. PERIOSTEAL PULL BY BUCCAL
SHELDS AND LIP PADS.
 Buccal shields and lip pads are extended
 Bring about outward periosteal pull
 Aids in bone formation at the apical base.

100. MODE
OF
ACTION
INCREASE IN
TRANSVERSE AND
SAGITTAL INTRA-
ORAL SPACE.
MANDIBULAR
PROTRACTION
MUSCLE FUNCTION
ADAPTATION
INCREASE IN
VERTICAL
SPACE

101. INCREASE IN TRANSVERSE AND SAGITTAL INTRA-
ORAL SPACE
 Buccal shields and lip pads Eliminates abnormal
forces of perioral
region acting on the
dento-alveolar
structures.
Favours the forces acting from
within the oral cavity (i.e.,
Tongue)
• Buccal shields and lip pads
• Constant outward pull on connective tissue
and muscles
• Transmitted to priosteum of bone
• Bone formation
• Aids in lateral movement of dento alveolar
shell.

102. INCREASE IN VERTICAL SPACE
 Frankel appliance kept free from posterior teeth
 Posterior teeth free to erupt
 Increase in vertical space is possible.

103. MANDIBULAR PROTRACTION
 Lingual pads place the mandible in more mesial position.
 By gradually training the protractor/ retractor muscles and by
condylar adaptation the position of mandible is changed.
 If mandible is brought back, lingual pads apply pressure on the
lingual alveolar process.
 Cause protractor muscles to position the mandible mesially.

104. MUSCLE FUNCTION ADAPTATION
 Appliance overcomes the abnormal muscle function
and rehabilitates the muscles that are causing
problem.
 Lip pads and buccal shield cause periosteal muscle
pull leading to bone formation.
 The shields loosen up the tighter muscles and
improve muscle tone.
 Lip pads prevent hyperactivity of the mentalis
muscles, eliminate lip trap and help in establishing
proper lip seal.

105. CONSTRUCTION BITE
 FOR MINOR SAGITTAL PROBLEMS, the
construction bite is taken in an edge-to-edge incisal
relationship.
 Mandible should not be moved forward further 2.5-3
mm.
 Vertical opening should be small, only large enough
to permit the crossover wires to pass through the
inter-occlusal area.
 FOR FR3 bite registration is taken with patients
mandible in the most comfortable retruded position.

106. Frankel’s regulator 1
FR-1 a
FR-1b
FR-1 c
To treat class I and class II division malocclusion
• to treat Angle’s class I malocclusion with minor
to moderate crowding. Also used in cases of deep
bite
•To treat Angle’s class II division I malocclusion,
OJ not exceed 5mm
•to treat Angle’s class II division I malocclusion,
OJ more than 7 mm
FR-2 •to treat Angle’s class II malocclusion division I and
class II malocclusion division 2
FR-3 •to treat Angle’s class III malocclusion
FR-4 •To treat bimaxillary protrusion and open bite
FR-5 •Used with headgear

107. FUNCTIONAL REGULATOR 2 OF FRANKEL.
Use for treatment of Class II division 1 and division 2
malocclusion.
COMPONENTS
ACRYLIC
a) BUCCAL SHIELDS
b) LIP PADS
c) LOWER LINGUAL
PAD
WIRE
a) PALATAL BOW
b) LABIAL BOW
c) CANINE EXTENSIONS
d) UPPER LINGUAL WIRE
e) LINGUAL CROSSOVER
WIRE
f) SUPPORT WIRE FOR LIP
PADS
g) LOWER LINGUAL SPRINGS.

109. 1. LIP PADS
• Also called PELLOTS.
• Help in elimination of abnormal perioral muscle activity.
• Helps in Elimination of lower lip trap which causes
proclination of upper incisors.
• Cause periosteal pull, resulting in bone growth.
2. BUCCAL SHIELDS
• Also called VESTIBULAR SHIELDS.
• Extended into the vestibule as deeply as
possible but within the confine of patients
comfort and tissue attachment.
• Stands away from dentition and basal
alveolar bone.
• Helps in unrestricted dento-alveolar
development.
• Also cause periosteal bone deposition.

110. 3. PALATAL BOW
• Stands clear of the palatal tissue.
• Has its convexity facing distally.
• Lateral extension of the bow crosses the occlusal surface in
the embrasure mesial to first permanent molar and enters the
acrylic buccal shield.
• Recurved ends of bow terminate
as occlusal rests of the first
permanent molars between the
mesio-buccal and disto-buccal
cusps.
• Occlusal rests prevent the
appliance from being dislodged
superiorly and also prevent
supraeruption of first permanent
molars.

111. 4. CANINE LOOPS
• Act as extensions of the vestibular shields and are kept 2-3
mm away from the buccal surface of the canines.
• Also called CANINE GUARDS
• Help in elimination of the restrictive muscle function thereby
helping in transverse development in the canine region.
5. LABIAL BOW
• Upper labial bow originates from the
vestibular shields.
• Wire runs in the middle one third of the
upper incisors.
• Turns gingivally at right angles at distal
margin of lateral incisors.
• Bow is passive in nature.

112. 6. LINGUAL STABILIZING BOW
• Also called UPPER LINGUAL WIRE or PROTRUSION BOW.
• Originates from the vestibular shields and passes by the
canines and first deciduous molars and curves along the
lingual surface of upper incisors at the level of the cingulum.
• It prevents the lingual tipping of the incisors during treatment.
7. LINGUAL CROSSOVER WIRE
• Follows the contour of lingual mucosa 3-4 mm below the
lingual gingival margin of the lower incisors.
• Placed 1-2 mm away from the mucosa.
• Crosses the occlusal surface between the deciduous molars
and gets embedded in the buccal shield.

113. 8. LOWER LINGUAL SPRINGS
• Rests against the lower lingual incisors.
• Main uses are:
a) To prevent the supra eruption of the lower incisors.
b) To screen the tongue pressure from lower incisors.
c) To procline the lower incisors actively.
9. LABIAL SUPPORT WIRES
• Offer support for the lip pads.
• Should be atleast 7mm below the gingival margin.
• Central wire is inverted`V` shape to accommodate
the lower labial frenum.

115. FUNCTIONAL REGULATOR 1 OF
FRANKEL.
FR1 a
• Used in Class I malocclusions with mild to moderate
crowding.
• Also used in cases of Class I deep bite.
• All aspects are same as that of FR2 except that it lacks the
lingual shield, lingual springs, lingual crossover wire, and the
upper lingual bow.
Frankel’ regulator Acrylic components Wire components
FR I 2 vestibular shields
2 lip pads
Palatal bow
Labial bow
Labial support wire
Lingual bow
Canine loops

117. FR1 b
• Used to treat Class II, div 1 malocclusion where the
overjet does not exceed 5 mm.
• Differs from FR1a in that it has lingual acrylic pad and
among the wire components the lingual springs are
added.
FR1 c
• Used in Class II , div 1 malocclusion where the overjet is
more than 7mm.
• Used when multiple stage advancement is needed.
• Buccal shields are split horizontally and vertically into 2
parts.
• The antero-inferior portion contains the wire for the lingual
acrylic pad and lip pads.
• This permits the forward movement of the anterior section
of the appliance.

119. FUNCTIONAL REGULATOR 3 OF
FRANKEL.
• Used in Class III malocclusions characterized by maxillary
retrusion and not the mandibular prognathism.
• Should be used during deciduous, mixed, and early
permanent dentition.
Frankel’ regulator Acrylic components Wire components
FR III 2 upper lip pads
Buccal shields
Labial support wire
Labial bow
Protrusion bow
Palatal bow

121. PURPOSE OF LIP PADS :
1.To eliminate the restrictive pressure of the upper lip on
the under developed maxilla.
2. To exert tension on the tissues and the periosteal
attachments in the depth of the maxillary sulcus to
stimulate bone growth.
3. To transmit the upper lip force to the mandible through
the lower labial arch for a retrusive stimulus.
• BUCCAL SHIELDS stand 3 mm away from the
maxillary posterior dentoalveolar structures.
• They are in contact with the mandibular apical
bone.
• They serve to eliminate buccinator muscle force
and cause a periosteal pull leading to bone growth.

122. FUNCTIONAL REGULATOR 4 OF FRANKEL.
• Used for correction of open bites and to a lesser
extent bimaxillary protrusion.
• Exclusively confined to the mixed dentition.
Frankel’ regulator Acrylic components Wire components
FR IV 2 lower labial pads
2 vestibular shields
Protrusion bow
Occlusal rests
Palatal wire

124. FUNCTIONAL REGULATOR 5 OF
FRANKEL.
• Functional regulators that incorporates headgear.
• Indicated in patients with long face syndrome having
a high mandibular plane angle and vertical maxillary
excess.
Frankel’ regulator Acrylic components Wire components
FR V Posterior acrylic bite
blocks

125. WEAR TIME
 1st few weeks: 2-4 hours/day (day time)
 After 3 weeks: 4-6 hours/day (day time)
 After 3rd visit(2 months): full time wear.
 Patient is asked to do oral gymnastics .i.e. talking,
reading, tightly grasping the appliance in vestibule.

126. *HERBST APPLIANCE
*Fixed functional appliance developed by Emil Herbst in
early 1900’s.

127. Indications:
-correction of Class II Malocclusion due to
retrognathic mandible.
-can be used as anterior repositioning splint in
patients having TMJ disorders.
Specific indications
-Post adolescent patients: Treatment
completed within 6-8 months, hence possible
to use the residual growth in these patients.
-Mouth breathers
-Uncooperative patients

128. Can be compared to an artificial joint working between
maxilla and mandible.

129. Banded Herbst Appliance
TYPES
Bonded Herbst Appliance

130. BANDED HERBST APPLIANCE
• Upper and lower first molars are banded.
• Tubes are fixed to pivots soldered to distobuccal
aspect of upper first molar bands.
• Shafts or rods are fixed to pivots soldered to the
lower first premolar bands.

131. BONDED HERBST APPLIANCE
• It is a wire reinforced acrylic
splint that covers the occlusal
and part of buccal and lingual
surfaces of all teeth except the
anteriors.
• Pivots are fixed to wire
framework at the distobuccal
aspect of the upper first molars
and the mesial aspect of the
lower first premolars.
• Tube is fitted to the pivots in
the maxillary molar area while
the shaft is fixed to pivots in
the mandibular premolar
region.

132. TREATMENT EFFECTS
1.Class I molar relation.
2.Increase in the mandibular growth.
3.Certain amount of distal driving of the maxillary
molars that helps in correction of the molar
relation.
4.Overjet reduction by increase in mandibular
length and proclination of mandibular incisors.
5.Inhibitory influence on the sagittal maxillary
growth.

133. *Advantages:
i. As it is a fixed appliance
-continuous action
-Treatment duration is short
-less pt cooperation needed
ii. Can be used in pts who are at the end of their
growth
iii. Can be used in pts with mouth breathing habit.

134. *Disadvantages:
(i) Cause minor functional disturbances.
increased risk of development of dual bit,with TMJ
dysfunction symptoms as a possible consequence.
(ii) Repeated breakage & loosening of appliance
occurs,esp. in lower premolar area.
(iii) Plaque accumulation & enamel decalcification
can occur.
(iv) Tendency for posterior open bite.

135. JASPER JUMPER
 A relatively new flexible,fixed ,tooth borne Functional
appliance.
 Introduced by J.J.Jasper ,1980
 Actions similar to Herbst appliance but lack rigidity.
 Basically indicated in skeletal class II mo with
maxillary excess & mandibular deficiency.

136. APPLIANCE DESIGN
• Uses a modular system known as jasper jumper.
• It can be attached to the fixed appliances that are placed on
upper and lower arches.
• Jasper jumper is constructed of stainless steel coil that is
attached at both the end to stainless steel end cap.
• The module is given in a opaque polyurethane covering for the
purpose of hygiene and comfort.
MAXILLA- attached posteriorly to the maxillary arch by a ball
pin.
MANDIBLE- attached distal to the mandibular canine by a small
bayonet bend and Lexan bead.

137. MECHANISM OF ACTION.
Force module is selected.
Distance is measured between the
mesial aspect of the upper face bow tube
and the distal aspect of the Lexan ball
distal to the mandibular canine.
To this length add ,12mm to get the
required length.
When teeth come in occlusion.
The force module being longer tends to
curve
produce a mesial force on the
mandibular arch and the distal force on
the maxillary arch.

138. EFFECTS OF JASPER JUMPER
1.Skeletal Effects
a. Holds and displaces
maxilla distally.
b. Clockwise rotation of
mandible.
c. Condyle moves forward.
2. Dental Changes
a. Posterior tipping and
intrusion of upper
molars.
b. Backward tipping of
maxillary incisors.
c. Intrusion of mandibular
incisors.

139.  Advantages:
-produce continuous force
-does not require patient compliance
-allows greater degree of mandibular freedom than
Herbst appliance
-oral hygiene is easier to manage.