COMPONENTS OF FRANKELS

FUNCTION REGULATOR AND TWIN

BLOCK APPLIANCES

BY,
P.JEYARAM
I MDS
DEPT. OF ORTHODONTICS
FRANKEL FUNCTION REGULATOR
 Dr. Rolf Frankel
 Tissue borne passive appliance

SYNONYMS
 Frankel appliance
 vestibular appliance
 oral gymnastic appliance
 functional regulator
 TYPES OF FRANKEL APPLIANCE
TYPES USES
1)FR 1 ---- CL 1 AND CL 2 DIV 1 MALOCCLUSION.

A)FR1a ---- CL 1 MALOCCLUSION WITH MINOR

CROWDING, CLASS 2 DIV I
CL I WITH DEEP BITE.
B)FRI b ---- CL 2 DIV 1 MALOCCLUSION WITH OVERJET
LESS THAN 7mm.
C)FRI c ---- CL2 DIV 2 MALOCCLUSION WITH OVERJET
MORE THAN 7mm.

2)FR 2 ---- CL 2 DIV 1 AND DIV 2 MALOCCLUSIONS.

3)FR3 ---- CL 3 MALOCCLUSIONS.

4) FR4 ---- OPEN BITE AND BIMAXILLARY PROTRUSION.

5) FR5 ---- LONG FACE SYNDROME WITH HIGH MAND. PLANE ANGLE &
MAX. VERTICAL EXCESS
 GENERAL RULE

 All the wires should be bent with smooth curve.

 The vestibular wires are placed 1.5 mm from the

alveolar mucosa.

 Wires should follow the natural tissue contours.

 The distance between the wires and the wax

padding should be approximately 0.75mm.
FR1
 Acrylic components
1. Buccal shield
2. Lip pads
3. Lingual shield
 Wire components:

1. Palatal bow.
2. labial bow.
3. Labial support wire.
4. Lingual bow.
5. Canine loops
WIRE COMPONENTS OF FR 1

Palatal bow Canine loop

Labial bow

Cross over wire

WIRE COMPONENTS OF FR 1

Labial bow
Palatal bow Canine loop

Cross over wires

Lower lingual wires
DIFFERENCE BETWEEN FR-1A, FR-1B
AND FR-1C
 FR-1A : Has a lingual wire loop instead of acrylic
lingual mandibular pad

 FR-1B : Has a lingual acrylic pad

 FR-1C : Similar to Fr-1b except that L-shaped slit is

made in the buccal shield, the antero inferior portion can
be advanced
 FR1-A
 correction of class I deep bite cases with protruded
maxillary incisors and retruded mandibular incisors.

 correction of class II division 1 malocclusion in which

overjet does not exceed 5mm.

 class I malocclusion with minor to moderate crowding or

arrested development of buccal arches.
 MAXILLARY WIRES:

 The labial Bow ( 0.9mm)

 Lies in the middle of the labial surfaces of the upper incisors.

 It turns gingivally at right angles in the natural depression

between the maxillary lateral incisor and the canine to form the
canine loops.

 The canine loop is a gentle curve, the top of which approximates

the middle of the canine root
 THE PALATAL BOW ( 1MM)
 posterior appliance stability and inter maxillary anchorage.
 The bow has a slightly posterior curve

 extra wire length - lateral expansion adjustment-alveolar dental

area develops transversely - contact Buccal shields.
 arises from the central groove of the upper first molar

 forming an occlusal rest that is parallel to the occlusal plane.

 loop in the buccal shield -recurves to cross in the inter proximal

groove -cut between the maxillary first molar and second
premolar.
 deciduous dentition -the occlusal rests are bent -ends lying in the
second deciduous molars.
THE CANINE LOOP ( 0.9MM)
 Is embedded in the buccal shield at the level of the
occlusal plane.
 rises sharply- gingival margin maxillary first deciduous
molar
 fits- embrasure between the deciduous first molar and
the canine - lock the appliance
 guide the erupting canines
MANDIBULAR WIRES.
 Lower labial wires ( 0.9mm)
 support skeleton for the lip pads.

 emerge - buccal shields slightly inferior direction

-middle of the canine root( 1 ½ mm away from mucosa)
 wires -at least 7mm below the gingival margin.

 midline wire, or third element-the shape of an inverted

‘V’ -circumvent the labial muscle attachment.
LOWER LINGUAL WIRES ( 0.8 MM).
 These are recurved springs, contoured to the lingual
surfaces of the lower incisors, right above the cingula,
with the free ends about 3mm below the incisal margins.
 The primary objective is to prevent extrusion of the
lower incisors.
 provide a proprioceptive signal to the mandible
LOWER LINGUAL SUPPORT WIRE ( 1.2
MM).
 either three components soldered together or one continuous
wire.
 connects the lingual shield with the Buccal shields.

 The cross over wires pass between the occlusal surfaces at

the embrasure between the 1st and 2nd premolars between the
1st and 2nd deciduous molars.
 The lateral ends which enter into the buccual shield are bent
parallel to occursal plane because they will be used as guides
when the lower anterior section of the appliance is advanced
to change mandibular position step by step.
 A metal sheet (5 to 6mm) wide is used to make the split
easier in buccal shields when a step wise alteration of the
postural is needed.
THE BUCCAL SHIELDS
 Located on the buccal surfaces of the molars and
premolars
 relieve pressures from the buccinator mechanism

 WORKING MODEL: The upper sulcus depth

must be 10 to 12 mm above the gingival margin
of the posterior teeth.
 The anterosuperior margin of the vestibular
shield should extend past the canine-deciduous
first molar embrasure to the middle of the canine
 The posterior periphery of shield should exceed
beyond the distal of last erupted tooth
LIP PADS

 eliminate abnormal perioral muscle activity

 intercepting the lip trap

 form the labial boundary of the mandibular posturing trough


Lower labial wire: It forms the Skelton for the lip pads .
 WORKING MODEL:The lower relief should be at least
12mm below the gingival margin, according to Frankel, to
permit the wire framework for the lip pads to lie 7mm
below the incisor gingival margin
 The lip pads look somewhat like a parallelogram

 The superior periphery of the lip pads should be at least

5mm from the gingival margin
SEPARATION:
 separators are placed in the maxillary canine – deciduous
first molar and deciduous second molar – permanent first
molar contact areas 1 week before the impression taking
procedure.
 Provide space for palatal loop extension and canine loop
crossover wires
WAX RELIEF
 The buccal shields must stand away from the teeth and
tissues if the desired expansion is to be achieved,
 Thickness not exceed 4 or 5 mm in the tooth area or 2.5
to 3mm in the maxillary alveolar region.
 Lower arch waxing requires only a very thin layer over
the apical base (0.5mm)
FR1-B
 FR 1 (b) replaces FR 1 (a)
 a lingual acrylic pad for the lower anterior instead of
lower lingual loop
Lower lingual springs
 two passive recurved springs rest gently above the
cingula
 Prevent extrusion of lower incisors
FR1A AND FR1 B
Lower lingual loops
Overjet 5mm

Lower lingual shield

Overjet 7mm
FRI C

 The buccal shields are split horizontally and

vertically into 2 parts –
 Anteroinferior portion contains the wires for lingual
acrylic pressure pad and for the lower lip pads.
 The heavy through the bite hanger wire that connects the
lingual pad and buccal shields permits advancement of
the mandibular trough (formed by the lip pads on the
labial side and the lingual pad on the inside) to allow for
this maneuver.
FR 1C

Step by step opening in

the anterior and vertical
direction

Overjet > 7mm

FR2- MAX. OCCLUSAL VIEW
UPPER LINGUAL
WIRE CANINE
EXTN.

PALATAL OCCLUSAL
WIRE REST
 FR2- MAN. OCCLUSAL VIEW

BASE WIRE LOWER

CROSSOVER LINGUAL WIRE
WIRE

SUPPORT
WIRE CANINE
UPPER LABIAL
EXTN.
 Differs from the FR –1 by a modified canine loop and by adding an
upper lingual Bow.
 The upper lingual bow (0.9mm) Originates from the buccal shields
at the canine first deciduous molar embrasure, which has been
previously notched, in a lingual direction.
 The wire runs along the lingual surface of the upper incisors at the
level of the cingula to prevent their further eruption in the presence
of a deep bite.
 Canine loop function of supporting the appliances on the maxilla
has been taken over by the lingual bow, hence the canine loops are
modified.
 Canine loop emerging from the Buccal shields primarily acts as an
extension of the vertibular shield to eliminate perioral pressure
FR III
.
PALATAL BOW ( 1.0MM)
 Originates from the Buccal shields and has a shape
similar to that of the FR-1 and FR-2.
 It is important that the palatal Bow runs behind the last
molar tooth in each case, giving the molars freedom to
erupt and move mesially.
 The coffin spring- like loop at the palatal midline curves
anteriorly and can be adjusted slightly for expansion if
required.
 FR3- MAX OCCLUSAL VIEW
UPPER LINGUAL WIRE LOWER LABIA
SUPPORT WIRE

PALATAL WIRE

OCCLUSAL REST
PROTRUSION BOW ( 0.7MM)

 Is shaped like that of the FR-2.

 It is emphasized that the wire should not be allowed to
lodge interdentally.
 The wire should not contact the cingula as this will
impede the eruption.
 This wire connects the labial pads with the buccal
shields (0.9).
 They are formed similarly to that of the FR 1 or FR 2 but
on the maxilla.
THE OCCLUSAL REST ON THE LAST MAXILLARY
MOLAR. ( 0.7M)

 Used in class III cases associated with a deep reverse

over bite.
 It originates in the Buccal shields and runs distally to the
last molar, parallel to the palatal Bow. It is adapted to lie
beneath the palatal Bow and to form the occlusal rest in
the fissure of the last maxillary molar.
 FR3- MAN. OCCLUSAL VIEW
PALATAL WIRE

OCCLUSAL
REST

SUPPORT WIRE FOR

LABIAL PADS
 THE LOWER LABIAL BOW
( 1.0MM).

 The Bow is constructed to fit in the grooves

carved across the labial surface of the
mandibular incisors and canines at the height of
the Inter dental papillae.
 This low position of the wire is important as to
prevent lingual tipping of the mandibular
incisors.
 After giving a right angle bend downward at
distal edge of the canine, approximately 5mm
below the gingival margin it is made to run
parallel to the buccal teeth in the Buccal shields
THE MANDIBULAR OCCLSAL REST ( 0.9MM)

 Originates in the Buccal shield and is bent to lie in the

occlusal fissure of the last mandibular molar.
 These occlusal rests stabilize the appliance vertically,
which is necessary as the projecting maxillary labial
pads tend to displace the posterior portion of the FR –3
appliance inferiorly.
FR IV
USES
 Correction of open bite and bimaxillary protrusion.

 Reverses the unfavorable growth guidances, so its used

during active growth period
 mixed dentition is the optimal period
COMPONENTS.
 Same vestibular configuration as FR I and II with no
canine loops and protrusion bows.
 There are four occlusal rests on the maxillary first
molars, and first deciduous molars to prevent tipping
of the appliance.
 The palatal bow is like that of the FR –3 and is always
placed behind the last molar
 Has the same vertibular configuration as the FR I and the
FR II, but with no canine loops or protrusion Bow.
 There are four occlusal rests, on the maxillary 1st molass
and 1st deciduous molars, to prevent tipping of the
appliance.
 The palatal bow is like that of the FR –3 and is always
placed behind the last molar.
FRIV
BUCCAL
LABIAL BOW SHIELDS

LIP PADS
FR V
 Functional regulators with head gears
 Indicated in long face syndrome with high man. plane
angle and max. vertical excess
 ALBERT H OWEN incorporated interocclusal bite
block – prevent posterior teeth & Head gear tubes are
used for extraoral traction
TWIN BLOCK
 William J clark
 Simple removable appliances with interlocking occlusal
bites designed to position the mandible forward to
correct the malocclusion
 Both tissue and tooth borne appliance
TWIN BLOCK
 STANDARD APPLIANCE DESIGN
 Occlusal bite blocks

 Midline screw to expand the upper arch

 Clasps on upper molars and premolars.

 Clasps on lower premolars and incisors.

 Labial bow to retract the upper incisors.

 Springs to move individual teeth to improve the arch

form is required.
 Provision of extraoral traction in some cases.
INDICATION
 Treatment of class II DIV 1 DIV 2 malocclusion with
anterior open bite, deep bite, mixed dentition, uncrowded
permanent dentition

 Patient with growing age for favourable skeletal change

DESIGN
 Both tissue borne and tooth borne appliance.
 It links teeth together -anchor unit - limit individual
tooth movement & maximize orthopedic response
 In lower arch peripheral clasping combined with
Occlusal cover exerts a three dimensional control on
anchor teeth and limits tipping and displacement of
individual tooth.
LABIAL BOW
 In early stages was added to correct incisor angulation but
was found that the labial bow tends to overcorrect the
incisor angulation.
 Also the correction of incisors prematurely limits the
scope of mandible advancement thus the labial bow was
omitted unless incisors were severely proclined, even then
it is not activated till full functional correction is obtained.
 In twin block the lips usually achieve a good seal and act
as a labial bow uprighting the incisors.
 
CLASPS
 Delta clasps:- designed by Dr. Clark. Are similar to
Adams clasp in principle but incorporate a new feature
to improve retention reduce metal fatigue and minimize
need of adjustment. 
 Apart from delta clasp interdental clasp are also used
mesial to lower canine and in upper premolar or
deciduous molar region.
 Incase of mixed dentition C Clasps are used for
peripheral clasping of deciduous molars and canines
DELTA CLASP
 delta clasps -interdental tags, retentive loops and buccal
bridge
 the difference is that the retentive loops are shaped as a
closed triangle, later they were changed to circular shape.
 Due to the triangular shape the clasp does not open with
repetitive use and is less subjective to breakage.
 Also this type of clasp could be used in lower premolars and
all posterior teeth giving excellent retention.
CONSTRUCTION
 The clasp can be constructed by two methods:
 First like a Adams clasp with retentive loops angled to
follow the curvature of the tooth into mesial and distal
undercuts. This is used if the tooth is favorably shaped.
 Second method is shaping the loops to go directly
interdentally and the loop is at right angle to the bridge.
BASE PLATE
 Appliance can be made in heat cure or cold cure acrylic.
 The advantage of cold cure is speed and convenience
but it sacrifices on the strength and accuracy,
 using preformed blocks of good quality heat cure
acrylic-hence making the construction easier and with
highly accurate inclined planes.
 
OCCLUSAL INCLINED PLANES
 Early twin block- occlusal incined planes-90°
 Problem- posterior open bite- occlude old distal position
with bite blocks on top of each other
 Corrected - 45°- horizontal and vertical force equal

 Problem- vertical force undesirable

 steeper angle of 700 - apply a more amount of horizontal

force.
POSITION OF INCLINED PLANE
 position of the inclined plane -determined by lower
block
 inclined plane clear of the mesial surface of the lower
molar - not to obstruct in its eruption
 inclined from mesial surface of second premolar or
deciduous molar at 700 towards the mesial
 The lower inclined plane does not extend distally to the
marginal ridge on the lower second premolar or
deciduous molar
 inclined plane of the upper appliance to be positioned
mesial to the lower first molar so as to not obstruct its
eruption
OCCLUSAL VIEW
POSITION OF INCLINED PLANE
 Buccolingually the lower block covers the full thickness
of the premolars while getting tapered towards the
canine so as to improve the speech by allowing the free
movement of the tongue.
 The lingual flange of the appliance should be made thick
as is the most vulnerable part of the appliance to
breakage.
POSITION OF INCLINED PLANE
 The upper inclined plane is angled form the mesial
surface of the upper second premolar to the mesial
surface of the upper first molar.
 The flat surface then passes distal over the remaining
upper posterior teeth in a wedge shape.
 It is only necessary to cover only the lingual cusps of
upper teeth as the upper arch is wider, this allows the
clasps to be more flexible and the interdental wires of the
clasps accessible for adjustment
POSITION OF INCLINED PLANE
 The angulation of the blocks can be adjusted in two
ways:
1. Can be right angle to the line of arch in the same
pattern as the teeth are aligned
2. The lower block can be at right angle to the midline
and the upper block made according to this.
 Second method, block maintains the same angulation
relative to each other even if a midline screw is turned to
widen the archform.
SCREWS
 Used for arch development
 Upper arch- midline screw- accommodate
advancing lower arch
 Lower arch- screws- transverse devlopment

 Sagittal devlopment – screw anteroposteriorly in

palate( upper incisors retroclined with deep bite)
 Screw in palate placed horizontally

 Three dimensional screw – combined transverse

and sagittal devlopment
 Lower twin block

1. Curved screw- canine- labial segment

2. Straight screw- 2nd premolar- distalise molar

and open premolar spaces
REVERSE TWIN BLOCK
 Correction of class III malocclusion
 Position of bite block is reversed

 Upper appliance occlusal block- deciduous molar

 Lower appliance occlusal block- first permanent molar

 Addition of two saggital screw in palate- reciprocal force

 Contracted maxilla requires three way saggital design

MODIFICATIONS OF TWIN BLOCK
 FOR TRANSVERSE
DEVELOPMENT:-
 combination of Schwarz
appliance and twin block.
 Screws are incorporated in
the upper and lower twin
blocks to develop the
archfrom during the mixed
dentition.
 When screw is added in
lower plate the appliance is
also termed as BOWBEER
APPLIANCE.
MODIFICATION FOR TRANSVERSE
DEVLOPMENT
 Jackson design in the lower twin block.
  Twin block Crozat appliance.

 Adult treatment

 Minimum palatal and lingual coverage

 Disadvantage- careful adjustment- maintain symmetry  

TWIN BLOCK MC NAMARA
APPLIANCE

 placing two screws in the mid palatal region

 one in anterior region in line with premolars
 the other in posterior region in line with molar.
 The advantage -only anterior or only posterior expansion
as required
 
FOR SAGITAL DEVELOPMENT
 Sagital arch development is required when upper and
lower incisors are retroclined with deep overbite.
 Twin Block To Open The Bite

 Twin block sagital appliance

 Transverse and sagital appliance

TWIN BLOCK SAGITAL APPLIANCE
 twin block the anteroposterior arch development is
achieved by two screws which are aligned
anteroposteriorly in the palate.
 oblique movement - possible by offsetting the
angulation of the screws
 achieve a additional component of buccal expansion
TRANSVERSE AND SAGITAL APPLIANCE
 three way screw -the anterior part of the palate.
 disadvantage –bulk-impede the speech

 The midline screw can be placed anteriorly or

posteriorly in the palate.
 A midline screw combined with lingual wires to advance
and align the upper and lower incisors can also be used
to retrocline the incisors
MAGNETIC TWIN BLOCK
 In twin block therapy magnets can be added to increase
the occlusal contacts on the bite blocks so as to
maximize the functional forces in order to correct the
malocclusion. There are two types of magnets which are
used:-
 Samarium And Cobalt

 Neodymium And Boron (is more powerful)

 Both repelling and attracting magnets have been used in

twin blocks
 Attracting magnets- they basically encourage the
patient get the inclined planes in contact more often
stimulating the proprioceptive response more often,
hence leading to faster treatment result.
 It is especially useful in patients with weak muscular
tonicity who do not make any muscular effort to engage
the appliance.
 Repelling magnets- it acts in two ways :-
 Puts more pressure on the teeth when patients bite.

 Induce additional forward mandibular posture when the

patient bites without reactivation the blocks. The
disadvantage was that the amount of activation occurring
was not clear.
 Magnets are also used in cases of facial asymmetries.
The mandible responds faster on the side of correction
with attracting magnets on it, while on the other side
magnets with lesser force are used.
OTHER MODIFICATIONS

 Twin Block with a Spinner to control tongue thrust.

FIXED TWIN BLOCK:-
 is essentially used in cases where patient is not motivated
enough to wear the twin block twenty four hours.
 A fixed twin block has the following components

 Transpalatal Arch with occlusal inclined planes cemented on

both the sides. Occlusal inclined planes are held in place by
the wire tags which are nothing but extension of the
transpalatal arch.
 Lingual arch extends over the occlusal surface of the molars
premolars depending on the stage of development.
 Midline Screw a hyrax screw can be used in upper for
obtaining transverse expansion.
 Occlusal inclined planes are same as those for the normal twin
blocks.
CONCLUSION
 According to ideals of orthodontics- facial balance and
harmony are equal importance to ideal and occlusal
perfection
 Functional jaw orthopedic technique achieve this goal by
growth guidance during formative years
 Twin block is exteremely patient and operator friendly.
Has gift of versatility of design – correcting different
types of malocclusion
CONCLUSION
 A careful diagnosis, precise impression and bite
registration, adequate carving of models, diagnostic
monitoring during treatment, proper clinical
management are followed for predictable changes in
skeletal and dentoalveloar changes
 Regardless any appliances there is large or similiar
amount of variation in individual patient response to
treatment
 There is no universal or cook book formula available
REFERENCES
 Twin Block Functional Therapy, by William J Clark.
 Orthodontics & Dentofacial Orthopedics by McNamara
& Brudon.
 Dentofacial Orthopedics with Functional Appliances by
Graber , Rakosi & Petrovic.
 Removable Orthodontic Appliances by Graber &
Neumann
 Modified fuction regulator for vertical maxillary excess
by Albert H OWEN jco,inc volume 1985 oct(733-749)