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Functional appliances For general practitioners Prepared by Dr. M Alruby Functional appliances are large category of orthodontic appliances that used primarily to reposition of the mandible in order to alter the muscular forces against the teeth and craniofacial skeleton. Functional appliances are used for growth modification procedures that are aimed at intercepting and treating jaw discrepancies. They can bring about the following changes: 1- Change the relationship of the jaws. 2- Change the direction of the growth of the jaws. 3- Acceleration of desirable growth. 4- Provide more favorable environments foe developments of dentition through: a- Modify the muscle function. b- Relive abnormal muscle function. c- Selectively alter the eruptive path o the teeth. 5- Selectively inhibit the skeletal growth. Classification of functional appliances: 1- Myotonic appliances: they are functional appliances that depend on the muscle mass for their action. 2- Myodynamic appliances: they are functional appliances that depend on the muscle activity for their action. 3- Removable functional appliances: they are functional appliances that can remove and inserted into the mouth by the patient for example: activator and bionator. Uses and indications of functional appliances: 1- When the muscle dysfunction play a role in etiology of malocclusion. 2- Where alteration of muscle function may provides an optimum condition for normal dentofacial development. Functional appliances may be indicated in the following: 1- Anteroposterior discrepancies on mild disproportional bases as Class II, Class III. 2- Vertical discrepancies on mild disproportional skeletal bases (open bite or deep bite). Timing of treatment: All the functional appliances are probably most effective in the growing children to gain maximum benefits from pubertal growth spurt. Treatment principle: Functional appliances work on two broad principles: 1- Force application: comprehensive stress and strain act on the structures involved and result in a primary alteration in form with a secondary adaptation in function. Most of the fixed and removable appliances work on this principle. 2- Force elimination: this principle involves the elimination of abnormal and restrictive environmental influences on the dentition thereby allowing optimal development. Thus function is rehabilitated with secondary changes in form. All functional appliances are assemblies of a few simple components. Each component has a desired function and is generally incorporated for a specific purpose. The currently used appliances are made of combination from three basic functional components. They are bite planes, shields or screens and construction of working bites. These components produce skeletal and dentoalveolar changes by acting on the following: 1- Eruption (bite plane). 2- Linguofacial muscle balance (shields or screens). 3- Mandibular repositioning (construction of working bite).
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Functional appliances Prepared by: Dr Mohammed Alruby الوفاء غالي جدا فلا تتوقعه من رخيص Functional orthodontic appliances Definition: loose, usually removable intra-oral device which alter the muscle force against the teeth and cranio-facial skeleton. They are dynamic appliance depend on altered neuro-muscular action to affect bony growth and occlusal development and also in maxilla than mandible They are usually used in mixed dentition (ADA 1992) Growth modification: making limited change in size of the cranio-facial complex Time treatment: depend on growth spurt that differ in boys and girls = early treatment usually involves two phase of treatment: 1- Functional phase 2- Fixed phase =early start treatment can effect on the improvement of malocclusion so decrease the psychological impact Types of occlusion treatment with functional appliances - Class II div 1 - Class I div 2 - Class III - Open bite How functional appliance work Functional appliance influence four principle regions 1- Oro-facial soft tissue: Teeth sit between the tongue on one side and the lips and cheeks on the other side Correction can occur by improve the soft tissue environment surrounding the dentition Incorporating oral screens or shields constructed in wires or acrylic as part of appliance 2- Muscles of mastication: Forward positioning the mandible results in stretch and alteration in the activity of muscles of mastication, particularly involved in elevation and retraction of mandible The force transmitted to the dentition via the appliance electo-myographic studies shown hyperactivity of the lateral pterygoid on protrusion of the mandible ( Mac-Namara 1973) 3- Dentition and occlusion: Forward position of mandible also generate an inter-maxillary force directed between the maxillary and mandibular dentition = class II component force aid in reduction of overjet by tipping of teeth = change in mandibular position also associate with change in the vertical dimension, that facilitate eruption of buccal teeth = this eruption can be controlled by capping of the teeth in buccal segment 4- Jaw skeleton; The force affects the bone -------- remodeling The force affects the condyle ------- growth changes a- Additional over growth of the mandible b- Accelerate growth of the mandible c- Change the direction of growth d- Restricted growth of maxilla e- Change the position of condyle and glenoid fossa = studies of functional appliance like Herbest shown forward movement in the glenoid fossa through bony remodeling. The overall treatment time is usually in the region of 9 to 12 months depending on the size of initial overjet, the average overjet reduction is approximately 1mm / year Classification: 1- Myotonic: depend on the muscle mass for their action, large mandibular opening 8 – 10 mm worked by passive muscle stretch as Harvold 2- Myodynamic: depend on muscle activity for their function, median mandibular opening > 5mm Work by stimul
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