Orthodontics

Dr. Maha Aly Ragab

Lecturer of Orthodontic
Faculty of Dentistry, Delta University
1 Examination & Diagnostic aids.

2 Removable Appliances.

3 Functional Appliances.

4 Growth Modification.

5 Fixed appliances.

6 Biology & mechanics of tooth movement.

7 Therapeutic Extraction.

8 Retention.
Functional appliance
1 Definition .

2 Indications for functional appliances

.
3 Contraindication for functional Appliances.

4 Advantages of functional appliances

.
5 Limitations.

6 Effect of treatment by functional appliance.

7 Classification and types.

8 Removable functional appliance.

9 Fixed functional appliances.

Group of removable (or
fixed) appliances which alter
the posture of mandible
,stretch the soft tissues
,change the tone of the
muscles creating pressures
which are transmitted to the
dental & skeletal structures
,moving teeth & modifying
growth.
 Why treat malocclusion?

01 Possible pre-disposition to 02 May lead to jaw dysfunction

disease (TMD, Speech, Mastication)

03 Facial esthetics with 04 Single or multiple

psychological implications tooth damage
implications
 Indications for functional
appliances

01 Well aligned dental arches 02 Posterior positioned

mandible

03 Non severe skeletal 04 Lingual tipping of mandibular

discrepancy incisors

05 Proper patient selection

 Contraindications

01 Class II skeletal by 02 Vertically directed grower

maxillary prognathism

03 Labial tipping of lower 04 Crowding

incisors
 Advantages of
functional appliances

01 Enlarge transverse width of

02 Tx of TMD
arches

03 04 Reduce or eliminate
Reduced time with braces
dysfunctional habits

05 Diminish adverse fixed appliance problems

(gingival proliferation, TMD,
decalcification, extractions)
 Limitations

Favorable horizontal growth Proprioceptive functional

01 02
pattern is required for a better stimulation to growth is lost if the
response appliance is removed for eating

03 Comfort & esthetics are crucial 04 Individual tooth movements are

in appliance design difficult to achieve

05 Limited use in non-growing 05 Results of treatment dependent

persons on patient cooperation
Effect of treatment by functional appliance

01 Optimizing mandibular 02 Redirection of maxillary

Growth growth

03 Lingual tipping of 04 Labial tipping of

maxillary incisors mandibular Incisors

05 Mesial & vertical eruption 05 Inhibition of mesial movement

of mandibular molars of maxillary molars

05 Orthodontic (60%-70%) &

orthopedic (30%-40%)
 Optimum timing

01
8-10 years for removable type

02
11-13 years fixed type
 Mostly interrupted force.
Duration

For movement of teeth should be consistent,

jiggling effects should be eliminated.
Direction

is small; if heavy forces used ,patient compliance will reduce .

Magnitude
 Classification
According to ‘’Tom Graber’’

Group A Group B Group C

Teeth supported Teeth\tissue Vestibular
appliances supported positioned
*Catlan’s appliances. appliances
appliance, *Activator, *Frankel
*Inclined planes *Bionator, appliance,
Twin block. *Lip bumpers.
Removable functional appliances

Activator Bionator

Frankel Twin block

Fixed functional appliances

Herbst Jasper jumper

Forsus
 Removable functional appliances
1 Activator Appliance

Large one piece of acrylic.

Advances mandibular jaw.
Teeth could be redirected during eruption.
Large vertical opening construction bite.
Could not speak or eat when worn.
Worn at night.
 Activator appliance
Contraindications
 Removable functional appliances
2 Bionator Appliance

Prototype of less bulky activator.

Mandibular advancement.
Allows more tongue action.
Speaking possible, yet difficult.
Worn day and night.
 Removable functional appliances
3 Frankel appliance

Vestibular arena of operation.

Restrains muscles and lips.
Periosteal pull by buccal shields& lip pads.
Exerciser.
Expands apical base.
Speaking possible, yet difficult.
Worn day and night.
 Removable functional appliances
4 Twin block appliance

Removeble
Separate upper/lower plates
Patient compliance required
Less airway blockage
Improved speech
Most popular removable type at present
 Removable functional appliances
4 Twin block appliance

Midline screws to expand the upper arch.

Occlusal bite blocks.
Adams clasps on the upper molars and premolars.
Adams clasps on lower premolars.
Interdental clasps on lower incisors.
 4 Twin block appliance

► Twin block appliances: occlusal inclined plane.

► Transmission of favourable occlusal forces to inclined planes
causing mandible to be displaced down ward and forward.
4 Twin block appliance

Lower block-angled from the mesial surface of

the second premolar / deciduous molar.

Upper block-angled from the mesial surface of

the upper second premolar
4 Twin block appliance

The angulations of bite blocks varied between

90°- 45°.

Drawbacks of 90° angulation - posterior open bite +

uncomfortable.
4 Twin block appliance

An angle of 45° - equal downward and forward

force on the mandibular dentition.

Finally changed to 70° - to apply a more horizontal

component of force + comfortable.
4 Twin block appliance

Twin blocks are worn full time. The objective is to correct arch
relationships in the anterior-posterior, vertical and transverse
dimensions.

Normally overjet and overbite are corrected within 6 months

The average time is 6 – 9 months.

Class II correction
 Advantages of fixed functional
appliance over removable appliance

01 Less dependent on patient Smaller in size permitting

02
cooperation better adaptation

03 Treatment time is less: approx. 04 Direction of force is

6-8 months more constant

05 Works 24 hrs a day, so there is continuous

stimulus for mandibular growth.
 Class II malocclusion due to retrognathic mandible in growing patients.
01
Postadolescent pt to utilize residual growth left.
02
Can be used in mouth breathers.
03
Uncooperative patients.
04
 Fixed functional appliances
1 Herbst appliance

Fixed to teeth.
Deep bite with retroclined incisors.
Restraining effect on maxillary growth.
Stimulating effect on mandibular growth.
Dentoalveolar changes include lower incisor proclination and
maxillary molar distalization and intrusion.
Contraindicated in dental & skeletal open bite cases.
Contraindicated to case prone to root resorption.
 1 Herbst appliance

Disadvantages

Expensive Breaks more significant

Restricted lateral movements Removal difficulty

Inability to incorporate arch expansion

Enamel decalcification during the functional phase