Transcript 矫治器 Appliance

Function appliance
Xi’an Jiao tong University
Stomatology Hospital
Orthodontic Division
Wang Xiaorong
1. The basic concept
• Function appliance：Itself does not
produce any mechanical power, its role is
changing the orofacial muscle function
together to promote development of
craniofacial growth, in order to correct the
mistake in the formation of malocclusion.
The features of function appliance
• The impact of the use of dental and skeletal
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muscle
Upper and lower dentition open bite separation
Lower jaw forward (or backward) shift
When swallowing, the lower lip close
Selective changes in the tooth eruption Road
Does not affect the eruption of permanent teeth
and replacement
The development of function appliance
• In 1726, the French doctor Fauchard first
use expansion.
• 1771 England surgeon Hunten, the first
analysis of the mandibular growth
• 1879, the United States, "the father of
Orthodontics" Kingsley, the design of a typical
occlusal appliance leaps and bounds, and guide
the mandibular forward, established the idea of
treatment of mandibular forward.
The development of function appliance
• 1880, published an article, the inclined plane
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treatment of mandibular retrusion deformities, carried
out functional appliance precedent.
1908-1936, Denmark and Germany Haupl of Andresen
long-term cooperation and invented activator system
1951, Stockfisch designed Kinetor appliance.
Functional appliance with the expansion of the
combination of helical spring. Function of the
maxillofacial region had a significant impact on
orthopedics.
The development of function appliance
• Balters designed Biology regulator in 1960.
• Frankel has designed functional regulator
in 1967.
• In late 80's our country are carrying out
the functional orthopedic treatment.
Principle of Functional appliance
• To the mouth and maxillofacial muscle
function to stimulate and guide the bone
growth of periodontal ligament receptors in
biological regulation, mobilization of the
growth potential, to achieve the purpose of
correction.
Principle of Functional appliance
• Correction does not in itself have any
power, but perioral muscle contractile
force, passing through the appliance to
the temporomandibular joint, jaw, teeth,
bone and other parts, so that deformities
have been corrected
Principle of Functional appliance
• Recoverable through the appliance and lip
cheek genioglossus muscle coordination
between the power to make happen and
maxillofacial soft tissue reconstruction, the
re-establishment of function and form a
balance between the power to the
treatment of dentofacial deformity
prevention purposes.
Muscle Change
• Treatment, change the tone of facial
muscles on the teeth and bones by the
application of force size, direction and
time, so I noodle region neuromuscular
jaw environment is conducive to
development and craniofacial growth.
• When caused by swallowing mandibular
muscle contraction contribute to the
establishment of normal swallowing tooth
contact.
Muscle Change
• Appliance because of retention in the
mouth lax, swallowing must rely on the
tongue to maintain its position, the
location of the tongue back to normal
• Emphasize the treatment of lip closure, lip
changed the location and activity
• Is a muscle training device.
Change of teeth and alveolar
• Selectively control the vertical height of
the teeth
• Inhibit anterior, promote eruption of
posterior teeth, to correct deep overbite
Change of teeth and alveolar
• Inhibition of posterior teeth, promoting
tooth eruption before the correction of
anterior open together.
• Vertical eruption of the teeth at the same
time, you can guide them in the near
distal direction, to do a small amount of
buccolingual movement.
Indication
• Before peak period of growth and
development (for the early permanent
dentition ）
• Upper and lower jaw development is not
transferred
• Functional types of malocclusion
Contraindication
• Crowding, misplaced teeth, extraction
cases
• Uncooperative patients
The advantages of functional appliance
• The unity of form and function, treatment
stability and time is short
• Exert the body growth and development
potential and development of the forces of
nature
• With fixed appliance used in conjunction,
can simplify the second phase of
treatment, to a certain extent to avoid
extract teeth and orthognathic surgery, so
that a more stable therapeutic effects
Treatment procedures
• Diagnosis
• Design
• Occlusal reconstruction
• Craft Room production
Clinical treatment
• Try to wear
• Treatment period
• Holding period
• Post-treatment
2. Categories
• easy：oblique derivative, lip block,
vestibular shield
• Activator Class：Activator、 Twin-block 、
Bionator、 Herbst .
• Frankel appliance
Commonly used functional appliance
• oblique derivative, lip block, vestibular
shield
• Activator
• Frankel
II III
Activator
Design by Andresen..
Advance the mandible
several millimeters for
Class Ⅱ correction.
Indication
Growth and development of children
Class Ⅱ bone (mandibular retrusion, mild
maxillary protrusion)
Patients with good cooperative
Appliance structure and production
• Maxillary component
Plastic part：baseplate
Metal parts: Transverse palatal bar
labial bow
• Mandibular component
One whole side of the tongue base,
enveloping the anterior labial to 2-3mm
baseplate
The original functional
appliance design was
a block of plastic
covering the teeth of
both arches and the
palate.
Wax Record Hop
The amount of mandibular advancement
overjet < 6mm，guide to cut to cut
overjet > 6mm，guide in several times
• Open vertical volume
Interest only on the basis of combined
space and continue to open 3 - 5mm
• On the mandibular midline to be
consistent
Wear appliance
• Wear appliance every day of not less than
12 - 14 hours in rest time and evening
8 - 10-month active treatment period
Maintain one and a half years
activator
• Angle II 1 Classification (wearing
appliance into) lower jaw forward and
downward (muscles by stretch and fatigue)
muscle reflex to pull back in situ
mandibular (upper and lower body
because of this backward force on
inhibition of maxillary dental arch forward
development) overlapped anterior occlusal
normal
Role and the principle
Mandibular protrusion
Tatsu neutral relations of posterior teeth
Front teeth overjet the normal occlusal
Referral should pay attention to
• Inspect influention second molar eruption
and primary and permanent teeth to
replace the plastic part
• Whether or not to loose bow lips
• Tooth surface and plastic noodle mediated
the relationship between the buffer
• Check active mandibular protrusion case
the function of Activator
• Improvement Class II molar relationship
• Reduce overbite and overjet.
• To improve the noodle type II category
• Backward upper anterior
• Forward under anterior
• Mandibular rotation after
function regulator，FR
• It was designed by German R. Frankel in
60's the 20th century, so is also known as
the Frankel appliance.
principle
• FR a major role at the oral part of the
vestibular area
• Used appliance retain lip, cheek screen
blocked lips, cheek muscle, so that the
developing dentition avoid abnormal
perioral muscle function
principle
• So that the dental arch, mandible length,
width and height on three bearings to
maximize development
• Lip shield, buccal vestibular sulcus screen
can pull Department periosteum to
stimulate the growth of the Department of
alveolar bone
FR I
• The appliance is utilized to
promote transverse arch
development both dentally and
skeletally.this is accomplished
by the vestibular shields
removing external muscle
pressure from both the
maxillary and mandibular
arches.Its also effective for
interruption of abnormal
mentalis function and promote
facial development.
FR II
• The FR II will also
accomplish transverse
and vertical development
of both the maxillary and
mandibular arches.
FR III
• This appliance is used
to aid in the correction
of Class III
malocclusions. This
can be achieved by
retarding further
development of the
mandible while
simultaneously
allowing for the
development of the
maxilla to its fullest
growth potential.
FR IV
• This appliance is used
exclusively in Class I
malocclusions where
skeletal open bite,arch
width deficiency,or
abnormal muscle
function are present.
FR V
• It is a modification of the FR
II and as such is intended for
Class II
malocclusion,particularly in
cases where an increase in
vertical dimension is
undesirable.It is often used in
conjunction with extraoral
traction devices.
FRⅢ
Indication
Functional Class Ⅲ is caused by such factors
as muscular disorders, bad habits, tongue,
or interference.
Mild skeletal class Ⅲ, maxillary hypoplasia,
normal or mild mandibular protrusion,
mandibular incisor to retreat to on the
edge, with a favorable growth pattern, no
obvious genetic history.
Bionator
Indication
Mixed dentition Class Ⅱ Division 1,
maxillary development of normal,
functional mandibular retrusion, position
on, the development of normal or mildly
inadequate Noodles 1 / 3 short or normal
mandibular advancement significantly
improved after the type
twin block
• It is plastic
• Upper and
lower
occlusal
contact pad
combined
into a 45
'angle
• All mattress covers on the second molars
and premolars together noodle, and in the
second premolar in the near edge of ridge
formed in the inclined plane to the near,
inclined plane and combined into a 45
'angle
• All coverage under the pad surface
premolar area together in the second
premolar distal marginal ridge formed in
the far 45 'of slope
• All pads in the upper and lower second
premolar area 45 'slope of the relationship
between occlusal contacts and keep guide
to the mandibular protrusion at the
location.
Forsus
Forsus appliance is a fixed appliance and
common use, rapid correction of
malocclusion Angle Ⅱ combined functional
appliance. It can be seen as a Herbst
appliance and the Jasper Jumper
appliance improvements, can produce
sustained, light elastic, so that the
mandibular oral function in a different
state at the protrusion, and mandibular
growth stimulation.
Indication
1）Functional and early bone malocclusion
2）Angle Ⅱ - maxillary protrusion and
normal or mildly, moderately incisor on the
lip following dump
3）Angle III - mandibular who can back on
the edge.
extraoral anchorage appliances
• To oral external head, pillow, neck, places,
submental extraoral structures such as the
anti-base
• Orthodontic tooth movement for threedimensional movement on the mandibular
inhibit or promote the growth and
development, to change the direction of
bone growth to provide sufficient
anchorage capacity
Categories
• Rear traction
• Vertical Traction
• Front traction
Rear traction appliance
• Backward force used to make teeth move
or inhibit distal alveolar, mandibular
forward growth of extraoral anchorage
appliance device
• Mainly include the face-bow, J-hook
headgear
reverseheadgear
To the amount of pads, chin pocket as
composite parts Anchorage
Traction stent as a mask to connect
components
Activity or as a fixed appliance within the
mouth piece
extraoralverticalpull
• Application of vertical traction to curb
dental, alveolar and mandibular vertical
growth direction and growth of extraoral
anchorage appliance-type devices
Extraoral traction type
• orthodonticforce：Are using face-bow
mobile teeth, and power range is 340 ~
450g
• orthopedicforce：Are mobile throughout
the dental arch, and even maxillary or
mandibular, maxillary on each side 8001lOOg, lower jaw on each side 12001700g
Traction power size and time
• reinforcement fmolaranchorage：
Traction on each side 200-300g, can be
every day with 8 hours, 10 hours or 12
hours.
• molardistalization
300 ~ 500g traction on each side, no less
than 12 hours every day.
Traction power size and time
• Canine rpremolar distalization
• Each side of the 150-300g. Not less than
12 hours every day.
• Intrusionandenmasseretraction
fupperanteriors
Each side of the 100-150g, not less than
12 hours every day.
• Inhibition of forward maxillary growth:
500 ~ 800g per side
• Stimulate maxillary growth :500-1000g,
not less than 12 hours every day
• Inhibition of mandibular growth: on each
side 500g, not less than 12 hours every
day
• Perpendicular to the growth inhibition: a
single molar down when each side of the
150-300g, down posterior teeth
paragraph ,300-500g
Commonly used extraoral
anchorage appliance
• Protraction appliance
• Outer bow appliance
（1） Protraction appliance
• Indication ：Shown deciduous, mixed
dentition maxillary hypoplasia caused by
anterior teeth / all teeth cross bite.
Protraction appliance
• Composition
Facial device
The amount of
board
Chin pocket
Metal stent
Intraoral devices
baseplate
Protraction appliance
• Clinical Application
• Intraoral devices: 24 hours / day wear,
removed when brushing their teeth
• Extraoral devices: 10 ~ 12 hours / day,
strength 300 ~ 500 g / side
Function
• Stimulate the growth of maxillary
forward
• Inhibit the growth of the mandibular
• Change the direction of mandibular
growth
Protraction appliance
• Other：If the solid potentiometer, to be
used in adhesive-type, base adhesive on
the teeth. If the maxillary arch narrow,
can be expansion, and then traction.
（2） Outer bow appliance
• 1）Indications ：Excessive maxillary
•
development, up near molar displacement,
maximum anchorage
2）Frame ：
Intraoral devices: on the first molar band.
Extraoral devices: Headgear high, medium and
low face-bow: bow inside and outside the 10 ~
30 degree angle
Outer bow appliance
• Device composed of
• head: headgear or neck
strap.
• Face device: face-bow
• Rubber band
Outer bow appliance
• 3）Clinical Application ：
Headgear ：In accordance with the
requirements of different locations (high,
medium and low)
Face-bow: long, medium and short.
Traction: tooth movement or increase the
anchorage 150 grams / lateral maxillary
development restrictions on 300 ~ 500 g /
side
Outer bow appliance
4）function：Pushed to the distal molar
movement; restrictions maxillary developmental;
increase anchorage
traction in the front (in the maxillary extraoral
arch welding on Hook, led by the lower jaw
forward)
J-hook headgear
• To neck strap or headgear as anchorage
components, J-shaped hook connected
components as the rear traction device
• Mechanism: J-shaped hook traction device
SHI main arch at the front to move far
from canine, premolar or incisor adduction
summary
• Functional appliance power source is the
correction of facial muscle strength, by
changing the mouth facial muscle function
together to promote development and
growth and the correction of malocclusion.
• Extraoral anchorage appliance is
characterized by greater access to
Anchorage, at the same time, the
application of orthopedic force to correct
mild deformity of the mandible