بسم الله الرحمن الرحيم Dr: Hakam Husham

Myofunctional Appliance

Myofunctional appliances A removable or fixed appliance harnesses the natural forces (muscle , facia and periodontium) and transmits it to the teeth and alveolar bone in a predetermined direction to produce orthodontic and orthopedic effects

Theory of functional appliances functional appliances are conceptually based on Moss’ functional matrix theory. Functional matrix theory proposes that growth of the face occur as a response to function need and mediated by the soft tissue Soft tissue determination for growth

Mode of action of functional appliance Growth modification (skeletal) Mainly in the treatment of CL II malocclusion and Less commonly in CLIII (Orthopedic changes). Tipping tooth movement and expansion (Dento-alveolar changes). Removal of soft tissue pressures from the cheeks & lips or modification of soft tissue activity (Muscular and soft tissue changes)

Wear Time 1st week 2-3 hrs a day during day time. 2nd week onwards 3 hrs during day & while sleeping. (12-16 hrs , 12-18 month) ]

Ideal patient for functional appliance Age: only in growing patient. Patient behavior: cooperative Social Considerations: accepted Dental Considerations: well aligned dental arch Skeletal Considerations: Moderate to sever Class II malocclusion Mild Class III malocclusion with a reverse overjet & an average overbite

Ideal time for functional appliance before pubertal time????

Use functional appliance alone without fixed appliance Cases with mild skeletal discrepancy. Proclined upper incisors. No dental crowding. Use of functional in combination with fixed orthodontics appliance: used most commonly to improve the anteroposterior relationship before starting the fixed appliance treatment. reduce the amount of a comprehensive fixed therapy required. reduce need for orthognathic surgery.

Advantages of functional appliance Treatment can be started as early as in mix dentition stage. No said effects of mechanotherapy such as decalcification or root resorption ect. Less chair side time with less adjustment. Easier to maintain oral hygiene It acceptable to many patients because it is generally worn at night . Patient visit is less Less expensive

Disadvantages of functional appliance requires very good patient cooperation cannot produce a precise tooth movement or finishing of occlusion. May produce moderate mandibular rotation(hence contraindicated in excess lower facial height cases)

classification Passive tooth borne appliance like activator (monobloc) Group-I Passive tooth borne appliance like activator (monobloc) Group-II Active tooth borne appliances like modified activator Group-III Tissue borne appliance these appliance are located in the vestibule like frankel

Classification Mode of action Group-II Group-I Group-III The operating area is in the vestibule Transmit muscle force to the teeth Reposition the mandible eg: lip bumper eg: activator eg: Frankel

Types A- Bite planes B- Oral screen C- Activator D- frankel 90% 10% Fixed functional Removable functional Uncooperative. At terminal phase of growth. A- Bite planes B- Oral screen C- Activator D- frankel E- habit breaking eg: catalan s appliance cemented

COMMON APPLIANCES IN USE

Bite planes are extensions of acrylic base posterior Anterior

Anterior Bite planes flat inclined Used for correction of developing single cross bite Used for reduction of over bite

posterior Bite planes Un lack the occlusion to correct anterior cross bite

Activator or monobloc or Anderson Comprises upper and lower acrylic fused together. The labial bow lies against the upper incisors Indication: use mainly for correction of CLII division I malocclusion

Use to push the mandibular several mm to correct CL II Activator Use to push the mandibular several mm to correct CL II Wear Time: 1st week 2-3 hrs a day during day time 2nd week onwards 3 hrs during day & while sleeping

Activator the interdental acrylic is trimmed to form series of inclined planes to guide and control the tipping of the posterior teeth these plane called facets Facets

Modification of activator Activator with expansion screw

Modification of activator Herren modification of activator

Modification of activator Palate free actiator

Modification of activator

Bionator Developed by Balters in 1950’s. Modified activator less bulky & more elastic. Removed must of the bulk of activator consist of a lingual horseshoe of acrylic(Dose not interfere with the speech). The labial bow is extended distally that minimize cheek pressure on teeth. Palatal spring (reversed coffin spring)

Twin block Is a removable, orthodontic functional appliance with two section one on maxilla and the other on mandible carry inclined plans of acrylic on closure they meet and cause the mandibular arch to be postured forward

Advantages of twin block Dose not interfere with the speech. Can be worn during the day time. Patient can get adjusted easy. Easy activated. Less bulk than other functional appliance.

Herbest appliance Can be fix or removable consist from pin and tube that runs between the arch to force the mandible forward

Banded Herbst Appliance Bonded Herbst Appliance

Advantages of fix herbst 1-continuous action Advantages of fix herbst 1-continuous action. 2-duration of treatment is short. 3-can be use with un cooperation patients. 4-can be used in patients who are at the end of their growth. 5-can be used in patients with mouth breathing habit.

Oral screen Passive type It is a screen made up of acrylic which fits in the buccal and labial vestibule Passive type

Oral screen Active type

Frankel He makes oral vestibule as the operational basis for his treatment . Has acrylic buccal shields in the buccal side (cause expansion of the arches by holding the cheeks away and enlarge the alveolar process

Parts of frankel appliance 1-Lips pad. 2- BUCCAL SHIELDS. 3- palatal bow. 4- labial bow. 5- canine stopper.

Frankel Types Frankel I CL I and CL II Div I Frankel II CL II Div II Frankel III CL III Frankel III Frankel II Frankel I

End Dr: hakam

LIMITATIONS & COMPLICATIONS Discomfort, as both upper & lower teeth are joined together. Mainly depends on patient’s compliance Can be used only if a favorable horizontal growth pattern is present in cases of Class II correction. It has to be removed during masticaiton,particularly when strongest forces are applied. May interfere with speech. Treatment duration is often long

CONCLUSION The global demand for orthodontics without braces continues to grow.  It's an option that many parents and patients would prefer. Myofunctional orthodontics offers a viable alternative to traditional orthodontic methods. A functional appliance is an appliance that produces all or part of its effect by altering the position of the mandible/maxilla.

These appliances utilize the muscle action of the patient to produce orthodontic or orthopaedic forces to restore facial balance. The question that must be addressed in diagnosis is : “does the patient require orthodontic treatment or functional orthopedic treatment or a combination of both and to what degree? whether the patient requires functional appliance alone or need a orthognathic surgery or to what extend FA can reduce need for surgery?”