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9. FRANKEL’S
PHILOSOPHY
Perioral muscles had restraining effect on
dental arches
Insertion of appliance –expands capsule and
allows for new functional adaptation of
muscles
Activator – ‘ push from within’
FR – ‘ought to be matrix’
All activities of oral cavity – muscle training
9
10. FRANKEL’S
PHILOSOPHY
Buccal shields and lip pads exert
periosteal pull
exp not verified this effect
Graber (1988) exp- on primates
showed that this effect is temporary
10
11. FRANKEL’S
PHILOSOPHY
The mechanical effect of the appliance
directed to the capsular matrix and not
to teeth / alveolar process.
MOYERS
‘altering the condition that determine the pattern of
occlusal development rather than altering the
occlusion directly.’
11
28. Upper lingual wire
Runs b/w canine
and lateral
Stabilizing effect
Prevents lingual
tipping of anteriors
in div 2 cases
corrected in pre fr
phase
28
29. Upper lingual wire
Preferred in
class2 div 2 with
horizontal
growth pattern
Bite opening
action similar
anterior bite
plane/activator
Bite opening
effect also due
to buccal
shields
29
31. Buccal shields in FR 3
Stand away from
maxilla but not
from mandible
31
32. Lip pads in FR 3
Larger in size
Stands away from
alveolar process
Expansion of
capsule and
correction of
postural imbalance
32
33. Palatal bow and
occlusal rests
Palatal bow not
lodged
interdentally
Additional
occlusal rest on
lower molar in
deep bite
33
34. Upper lingual wire and
lower labial bow
Upper wire not
touch the anteriors
but can be
activated to
protrude incisors
Lower labial bow
must touch the
incisors
34
43. Preparation of the casts
wax relief:
Wax padding under the
buccal shield to allow for
dentoalveolar expansion
Maximum
thickness of wax
padding under
buccal shield
43
44. Wire fabrication
Labial bow 0.9mm ,
canine loop 0.8mm and
palatal bow 1mm
Correct position of wires on the maxillary work
model
44
57. Timing of treatment
7-8 ½ years
Best therapeutic effect when
mandibular lateral incisors erupt
Class2 div I with mandibular retrusionmales till a 15-16 years
Not start during circum pubertal growth
period /late mixed dentition.
57
61. Initial phase
Wearing the appliance
Success of treatment – lip seal
Emphasis on lip exercises
Duration of wear
Ist week – 1-3 hrs in afternoon only
2nd week – 4-6 hrs
3 – 4 months – full time wear
61
62. Active phase
Check after every 4 weeks
Mucosal irritation
Stability of appliance
Impingement of cross over wires
Appliance adjustments
Canine loop -occlusally
Molar rests – gingivally
62
64. Active phase
After 3 months of full time wear
Check
Expansion
Overjet
Overbite
molar relationship-(6-8 months)
Leveling of curve of spee
Decrease in mentalis activity
64
65. Retentive phase
Different from fixed appliances
Labial and lingual wires can hold altered tooth
positions
Used as retainer in pts where the training
effect not satisfactory
Fixed treatment may be required
2 hrs in afternoon
6 months
6 hrs in night
Only night – i year
65
66. FR in treatment of
class II
Mandible displaced anteriorly- retractor
muscle force –600gms
Activator-force transmitted to single teeth
Bjork : rapid reaction in the dental system
TMJ unaffected
Major dental changes – Proclination of lower
incisors
66
67. FR in treatment of
class II
Activator treatment
before
after
67
68. FR in treatment of
class II
Mode of action of
activator in the
treatment of
mandibular
retrusion
68
69. FR in treatment of
class II
Suspending muscles relax during sleep
Mandible drops inferiorly and backwards
Proclination of lower anteriors
2-3mm advancement
initial afternoon wear
69
70. FR in treatment of
class II
Post –sup
elongation of
condyle
Remodeling at
ramal-corpus
junction- elongation
of corpus
70
72. FR in the treatment of
class 2
Mandibular retrusion to be overcome by
Expanding the oral space
Suspending muscles of mandible
provide dynamic force
Correct immature patterns b/w
protractors and retractors
Keep mandible forward but not
mechanically
72
73. FR in the treatment of
class 2
Change in position brought by lingual
shields
Initial bite 2-3 mm
Advancement in small steps for biologic
reasons.
73
74. FR in the treatment of
class 2
Step by step advancement by splitting the
buccal shields
Suspending muscles are not overstrained
Activator –extreme alteration of mandibular
position –occlusal instability & TMD
FR advancement in steps stability in post
retention periods
74
75. FR in the treatment of
class 3
Characterized by diminished
volume of the superior part of
the oro-facial capsule
Related to structural and
postural imbalance of
muscles
Lingual volume not to be
diminished
75
76. FR in the treatment of
class 3
Expansion of
upper oral
space
Tongue
space not
diminished
76
77. FR in the treatment
of class 3
Septo premaxillary ligament pull
translates upper incisors bodily
FR3 promotes max basal bone
development and translates maxilla
forward
Appliance should not be locked in the
maxilla by wires
77
78. FR in the treatment of
skeletal open bites
Aimed at correcting the
poor lip valve
mechanism.
Marked activity of
temporalis and
masseter when lips are
closed
Acc to Frankel tongue
thrust is compensatory
78
85. Change in the angulation
of cross over wire
Difficulty in establishing normal lip functions
85
86. Change in the angulation
of cross over wire
In cases with
step
advancement
FR to be
constructed so
that it be
parallel to the
downward and
forward
repositioning of
the mandible
86
87. Modified FR for VME
Posterior part of maxilla –important for
vertical growth control
½ -1/3 mm posterior eruption increases
AFH by 1mm.
Molars intruded chin translated forward
improving profile
87
88. Modified FR for VME
Modified FR for VME
by adding posterior
bite blocks
Added head gear
tubes
88
89. Modified FR for VME
25 pts av age 7 yrs 3 months,bite 3-4
mm assessed after 19 months
U1 retracted
No proclination of L1
Horizontal movement of the chin
AFH decreased
Gumminess of smile reduced
89
90. HYBRID FUNCTIONAL
APPLIANCE (fr and
activator combination )
Hybrid appliances are those that are
specifically and individually tailored to
exploit the natural process of growth
and development
1. Bite planes
2. Shields and screens
3. Construction and working bite
90
94. Modified Fr with continuous
buccolabial shield and palatal
acrylic support- haynes ajo 1986
To eliminate lip
trap
No pressure on
the gingival
dentoalveolar
tissues
94
96. N.R.E Robertson AJO 1983
12 cases with FR2 and FR3 using cephs
and conclude the principle changes were
dentoalveolar
MC NAMARA AJO 1984
3 adult patients with class 2 malocclusion
with mandibular retrusion
Length of mandible not increased but
vertical dimensions increased
Adaptation minimal not sufficient to
overcome malocclusion
96
97. FACIAL GROWTH DURING
TREATMENT WITH FR APPLIANCE
Leth Nielsen AJO 1984
10 pts treated with FR showed maxilla
retrognatic
No indication that mandibular growth was
promoted
Changes more in vertical plane
Not necessarily improved the profile
97
98. Skeletal and dental changes
following FR therapy on class II
patients
MC NAMARA AJO 1985
100 pts treated for 24 months and
compared with controls
No change in maxilla
If considered pt A then slight retrusion
of maxilla
U6 forward movement reduced but not
vertical
L6 vertical movement
98
99. Skeletal and dental changes
following FR therapy on class II
patients
MC NAMARA AJO 1985
U1 tipped posteriorly
some tipping of L1
Downward movement of mandible
noticed
Some forward movement noticed in
some pts
99
100. The effect of FR 4 in class 1 skeletal
anterior open bite
ELIT ERBAY AJO 1995
20 treated and 20 controls
Useful in treatment
Diminished AFH ,growth rate of AFH (3.9
mm)decreased ,& PFH increased (4.5 mm).
Caused forward and upward rotation of
mandible
Reduction in mandibular plane angles i.e SnGoMe,AnsPns-GoMe
100
101. Frankel-post vestibular shields caused
inferior translation of mandible,growth at
condyle increase in ramal length
Anterior part of mandible rotated upward
because of the lip seal
Erbay’s study noted FR inhibited
posteriors and improved the axial
inclination of U1
101
103. FR Vs twin block
toth/mc namara AJO 1999
4O PTS WITH TWIN BLOCK AND FR COMPARED
TO CONTROLS
Results
Increase in mandibular length
Twin block – 3mm > controls
FR – 1.9MM
Vertical dimension & dentoalveolar changes TB > FR
TB -mandibular skeletal & dentoalveolar changes
FR – more skeletal and less dentoalveolar
103
104. FR Vs herbst appliance
mc namara ,howe ajo 1990
45 herbst and 41 FR pts compared with controls
Results
Both appliance – no effect on maxilla
herbst – prevented vertical eruption and caused
posterior movement of u6
U1 lingual tipping- both
Lower proclination L1 – herbst > FR
mandibular length
Control - 2.1mm/yr
Herbst - 4.8mm
FR – 4.3mm
104
105. FR Vs fixed
mechanotherapy
CREEKMORE,RADNEY AJO 1983
FR compared to edgewise with headgear
Edgewise had greater retractive force on
maxilla
Retraction of u1 > FR
Retraction of L1
Backward growth of condyle But 1.2mm < FR
Pog forward 1mm< FR
105
106. Fr therapy in cleft palate
patients
keere,welch ajo 1981
9 pts treated with Fr for 6-18 months
To treat collapsed maxilla and cross
bite
Results
Not clinically useful in cleft patients
106