1. بسم الله الرحمن الرحيم
Dr: Hakam Husham

2. Myofunctional Appliance

3. 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

4. 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

5. 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)

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

7. 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

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

9. 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.

10. 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

11. 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)

12. 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

13. 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

14. 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

15. COMMON APPLIANCES IN USE

16. Bite planes are extensions of acrylic base
posterior
Anterior

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

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

20. 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

21. 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

22. 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

23. Modification of activator
Activator with expansion screw

24. Modification of activator
Herren modification of activator

25. Modification of activator
Palate free actiator

26. Modification of activator

27. 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)

28. 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

29. 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.

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

31. Banded Herbst Appliance
Bonded Herbst Appliance

32. 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.

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

34. Oral screen
Active type

35. 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

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

37. 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

39. End
Dr: hakam

41. 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

42. 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.

43. 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?”