Functional Analysis

Functional analysis
Clinical importance of functional analysis 
1. To assess how a dysfunction contributes to the creation
&/or aggravation of a malocclusion. Correction of the
dysfunction is integral to the correction of the
malocclusion. 
2. Helps to assess the prognosis of treatment. All functional
problems cannot be corrected and in such cases the
orthodontist must realize his limits and build the
occlusion around the existing functional situation.
3. Helps in selecting the treatment modality (functional /
fixed) .
Functional analysis is of special significance in
treatment with functional appliances because of the
dynamic basis of functional therapy
 The three most important aspects of orthodontic
functional analysis are:
Examination of postural rest position and maximum
intercuspation
Examination of temporomandibular joint
Examination of orofacial dysfunctions
Examination Of The postural Rest
Position and maximum intercuspation
Determination of the postural rest position
Registration of the postural rest position
Evaluation of the relationship: postural rest position –
habitual occlusion in three planes of space
Determination of the postural rest
position
The rest position should
be determined with the
patient relaxed and sitting
upright
Head oriented by having
the patient look straight
ahead
Head can be positioned
with the frankfurt
horizontal parallel to the
floor
Musculature must be
relaxed(Tapping test)
When the mandible is in
the postural resting
position,it is usually 2-3
mm below and behind
the centric occlusion. it
is recorded in canine
area
Components affecting the rest position:
Short term influence:
Inconsistency in muscle tonicity
Respiration
Stress situations
Dysfunction of TMJ

Long term influences:

Attrition of dentition
Premature loss of teeth
Diseases of the neuromuscular system
The space between the teeth, when the mandible is at
rest, is referred to as the freeway space or interocclusal
clearance
Methods to determine the rest position during the
clinical examination:
Phonetic method
Command method
Non-command method
Combined methods
Phonetic method
Told the patient to pronounce certain consonants or
words repetitively(e.g. “M”, ”Mississippi”)
Mandible returns to the postural rest position 1-2
seconds after the exercise
Command method
Commanded to perform certain functions(e.g.
Swallowing)
After which the mandible spontaneously returns to
the rest position
Non-command method
The patient is distracted
While being distracted the patient relaxes causing the
musculature to relax as well, and the mandible reverts
to the postural rest position
Combined method
Most suitable for functional analysis in children
Patient is observed during swallowing and speaking
The patient is then distracted as non-command
method
The mandible must be checked extraorally to ensure
that it actually has assumed the rest position
Palpate the submental region: relaxed muscles in this
area indicate that the rest position has been attained

The lips are then carefully parted with the thumb and
forefinger – ensuring that the line of lip contact is not
opened completely to observe the maxillomandibular
relationship in the rest position
Registration of the postural rest position
Important in those orthodontic cases where the
functional analysis is significant for treatment planning
methods:
intraoral indirect method – registration with
impression material
Extraoral direct method – registration by means of
skin reference points
Extraoral indirect methods:
- Roentgenocephalometric registration
- Kinesiographic registration
Roentgenocephalometric registration
Two lateral or frontal radiograph
One in centric(habitual occlusion)
One with mandible in rest position
Rest position and freeway space can be determined by
comparing the radiographs
Kinesiographic registration
According to Jankelson(1984) allows
the mandibular rest position to be
registered three dimensionally
Recorded electronically by
A permanent magnet, which is fixed
with rapid setting acrylic to the
lower anterior teeth
A sensor system of six
magnetometers mounted on
spectacle frames
Every movement of the mandible
alters the strength of the magnetic
field
Changes recorded by sensors
processed and displayed on a
storage oscilloscope
Evaluation of the relationship: postural
rest position – habitual occlusion in
three planes of space
Movement is analyzed three dimensionally in the
saggital, vertical and frontal planes
Closing movement of the mandible can be divided into
two phases:
Free phase: mandibular path from the postural rest to
the initial or premature contact position
Articular phase: mandibular path from initial contact
position to centric or habitual occlusion
In case of functional equilibrium, the articular phase
doesnot occur(movement without tooth contact)
The following movements from the mandible from the
rest position to habitual occlusion must be
differentiated for orthodontic diagnosis:
Pure rotational movement(hinge movement)
Rotational movement with an anterior sliding
component
Rotational movement with a posterior sliding
component
Evaluation in saggital plane:
Due to different types of movement ,the class II
malocclusion can be divided into three functional types:
Rotational movement without a sliding component
The neuromuscular and morphologic relationships
correspond to each other
There is no functional disturbances
Rotational movement with posterior sliding movement
The mandible is slides backwards and is guided into a
posterior occlusal position
This reveals functional class II malocclusion and not a true
class II malrelationship
Rotational movement with anterior sliding movement
Starting from the relatively posterior rest position the
mandible slides forwards into habitual occlusion
The class II malocclusion is more pronounced than can be
seen in habitual occlusion
Evaluation in vertical plane:
This analysis is of particular importance to case with a deep
overbite
According to Hotz and Muhlemann(1952) one should
differentiate between two type:
True deep overbite – large freeway space caused by
infraocclusion of the molars
prognosis for successful therapy with functional method is
favorable
As the interocclusal clearance is large, sufficient freeway
space will remain after extrusion of the molars
Pseudo deep overbite – small freeway space caused by
overeruption of the incisors
prognosis for elevating the bite using functional method is
unfavorable
As the interocclusal clearance is small, extrusion of the
molars adversely affect the rest position and may create TMJ
problems or cause a relapse of the deep overbite
Evaluation in transverse plane:
The position of te midline is observed
Two type of skeletal mandibular deviation can be
differentiated:
Laterognathy
Lateroocclusion
Laterognathy – The center of
the mandible is not aligned
with the facial midline in rest
and in occlusion
These dysplasias constitute
the neuromuscular or
anatomical asymmetry
A lateral crossbite with
laterognathy is termed true
crossbite.
prognosis is unfavorable for
functional therapy
Laterocclusion – The
skeletal midline shift of
the mandible can be
observed only in
occlusion position; in
postural rest both
midlines are well aligned
The deviation is due to
tooth guidance(functional
non-true malocclusion)
Examination Of Temporomandibular Joint
Auscultation
Palpation
Functional analysis
Auscultation
Clinical examination is to assess the severity of the
clicking, pain, and dysfunction
Ausculatation carried out with a stethoscope
during anteroposterior and eccenric movements of
the mandible
Initial clicking- retruded condyle in relation to the
disc
Intermediate clicking- unevenness of the condylar
surface and of articular disc
Terminal clicking- condyle
being moved too far anteriorly,
in relation to the disc on
maximum jaw opening
Reciprocal clicking- expresses
an inco-ordination between
dispalcement of the condyle
and disc
Clicking of the joint is rare in
children

Crepitus- uncoordinated
movement of condyle
Palpation will reveal
possible pain on pressure
of the condyle areas and
checked for synchrony of
action
Palpation of
musculature
Lateral pterygoid
Masseter
temporalis
Functional analysis
Recording the maximum
interincisal distance
Opening and closing
movement of mandible
Lateral excursion,
retrusive and protrusive
movements
Examination Of Orofacial Dysfunction
Swallowing
Tongue
Speech
Lips
Respiration
Swallowing
Abnormal swallowing is caused by tongue thrust,
either as a simple thrusting action or as a tongue
thrust syndrome
Symptoms-protrusion of tip of tongue,no tooth
contact on molars, contraction of the perioral
muscle during deglutition cycle
Visceral swallowing persist after the fourth year of
age considered as a orofacial dysfunction
Tongue thrust may be considered primary or
secondary
Primary dysfunction causes malocclusion in which
treatment concentrate on eliminating the orofacial
dysfunction
Secondary dysfunction can be considered an
adaptive phenomenon to an existing skeletal or
dentoalveolar deviation in vertical development. This
abnormalities usually correct spontaneously while
the morphological discrepancies are being treated
Visceral(infantile) swallow somatic swallow
Horizontal growth pattern with tongue thrust habit results in
bimaxillary dental protrusion
Vertical growth pattern with tongue thrusting often causes lingual
inclination of lower incisor
Lip dysfunction
Competency of lips - competent, incompetent,
potentially competent,everted
Lip habits – lip-sucking, lip-thrust, lip insufficiency

Cheek dysfunction
Cheek sucking or cheek biting

Hyperactivity of mentalis muscle

Respiration
Mouth breathing
Symptoms-high palate,narrow upper arch,poor oral
hygiene,hyperplasia of gingiva
Extraoral-Adenoid faces
Impeded nasal breathing shows vertical growth
tendency
Hypertrophied tonsil
Examination of
breathing mode
Cotton pledget test
Mirror test
Observation of nostrils
References
Orthodontic diagnosis by THOMAS RAKOSI,
IRMTRUD JONAS, THOMAS M. GRABER
Dentofacial Orthopedics with Functional APPLIANCES-
GRABER, RAKOSI, PETROVIC
Contemporary orthodontics-WILLIAM PROFFIT
Principles and practice of Orthodontics - T.M.GRABER
Removable orthodontic appliances-GRABER & NEUMANN
Gottfried P. F. Schmuth. Milestones in the development
and practical application of functional appliances. Am J
Orthod Dentofacial Orthop 1983;84:48-53