Transcript Frankel appliance

Dr. Hoori Mir Mohammad Sadeghi
Class III
Class II
Functional appliance side effects
The most desirable and variable effect is for the mandible to increase
in length as shown by the open possibly repositioning the TM
fossa by apposition.
The "headgear effect" restrains the maxilla and the maxillary teeth.
Mandibular repositioning often creates forces against the lower
teeth that cause anterior movement of the mandibular dentition.
The direction in which mandibular growth is expressed, forward
and/or inferiorly, is most related to the eruption of the molars.
If the molars erupt more than the ramus grows in height the forward
mandibular change will be negated and the Class ll malocclusion
will not improve.
To facilitate Class ll correction
Mesial and vertical eruption of the mandibular
molars. Upward and forward movement of the
mandibular posterior teeth will improve the
molar relationship.
Establish the posterior occlusal plane at the
higher level.
A poor response to Class ll functional
appliance treatment.
Cervical headgear which
uses a cervical neck-strap
and a face-bow to produce
distal force on the maxillary
teeth and maxilla, is aimed
at controlling maxillary size
and position but is only
effective if spontaneous
mandibular growth also
occurs.
Treatment Procedures
With Functional
Appliances
1.Pretreatment Alignment
 The incisor position and relationships should be
carefully examined.
 patient's ability to posture forward at least 4 to
6mm
 Most mandibular deficient children have a large
overjet and can do this readily but in some cases
incisor interferences prevent the mandible from
being advanced to the correct position for the bite
registration

1.
2.

The problem can be either:
Lingual displacement of the upper incisors (a
Class II, division 2 incisor pattern)
Irregular and crowded incisors in either arch.
Either fixed or removable appliances can be used
for this purpose, depending on the type and
magnitude of tooth movement required.
2.Impression
Impression technique depends on the appliance components :
1. Good reproduction of the teeth
2. An accurate representation of the area lingual pads or
flanges & If buccal shields or lip pads,
It is important not to overextend the impressions so that
tissue is displaced, location of the components leads tit
long-term soft tissue irritation, discomfort,
difficulty in appliance adjustment, and poor patient
compliance
Opening
1.
The minimal posterior opening to achieve the vertical
space is about 3 to 4 mm (Frankel appliance)
There must be enough space for the laboratory technician
to place wire and plastic between the teeth to connect
major components of the appliance and construct occlusal
& incisor stops.
2.
Interocclusal stops or facets to guide eruption, usually
require 4 to 5 mm of posterior separation (Activators and
Bionators)
3.
If eruption of upper and lower posterior teeth is to be
limited, 5 to 6 mm total opening in the molar region ( a
child with excessive vertical face height )
Components for Functional
Appliances
 Components to Advance the Mandible.
 Arch Expansion Components.
 Vertical Control Components.
 Stabilizing Components.
 Active Components.
Functional Components
Lingual flanges
Contact with mucosa ;most effective
Lingual pad
Contact with mucosa; less effective
Sliding pin and tube
contact with teeth ;variable tooth displacement
Tooth-supported ramps
Contact with teeth; tooth displacement likely
Lip pad
Secondary effect only on mandibular position
Arch Expansion
Buccal shields
Passive effective
Buccinator bow, wire shield
Passive less effective
Expansions crews
Must activates lowly;
questionable stability spring
Vertical Control
Occlusal or incisal stops
Prevent eruption in discrete area
Bite blocks
Prevent eruption fall posterior teeth
Lingual shield
Facilitate eruption
Stabilizing Components
Clasps
No effect on growh modification
Labial bow
Keep away from incisors lingual tipping
undesirable
Anterior torquing
Needed to control lingual tipping,
especially with headgear-activator
Tooth-Borne
Appliances.
1.Activator
The activator is also used to advance the mandible
 Incorporate anterior and posterior bite block
 A labial bow
 The lingual shields usually extend deeper along the mandibular alveolus
than other functional appliances,
 Displacing spring that engages the maxillary first molar s o that the
appliance requires a Closed and advanced mandibular posture to retain
the appliance in place.
2.Bionator
The bionator is borne on the teeth and advances
mandible.
 A buccal wire to maintain the lips off the teeth
 Bite blocks between the posterior teeth
 A tongue shield
 Major palatal connector to stabilize the posterior
segments
 Limited in bulk and relatively easy for the patient
to accommodate
3.Twin block
4.Herbst
Tissue-Borne Appliances
Frankel
The Frankel II appliance advances the mandible and fosters
expansion of the arches with the buccal shields .The lower lip
pad also moves the lower lip facially.
The appliance is largely tissue borne
This appliance is more bulky than the activator and bionator and
potentially uses more soft tissue irritation.
The appliance incorporate more wire and is more susceptible to
distortion.lt has wire as a major palatal connector and as stops
for the maxillary molars and incisors.
 A buccal shield holds the cheek a way from the
dentition and (B) facilitates posterior dental expansion
b y disrupting the tongue-cheek equilibrium.
 The shield is placed away from the teeth in areas where
arch expansion is desired).
 The lip pad holds the lower lip (or upper lip with a
Frankel ll appliance)a way from the teeth and forces he
lip to stretch to form a lip seal
 The pad must be carefully positioned a t the base o f
the vestibule to avoid soft tissue irritation.
Active tooth borne
 Expansion screws or springs
 During functional appliance treatment, every
millimeter of incisor tipping (camouflage) is a
millimeter of potential skeletal correction that has
been lost.
Headgear tubes can be incorporated into any tooth borne functional
appliance so that additional distal and vertical force can be applied with a
face bow and head cap.
Bionator
Activator
Buccal wire to
maintain he lips
off the teeth
and can
incorporate bite
blocks between
the posterior
teeth and a
tongue shield
as this one
does.
Hybrid functional
Asymmetric
patients