Treatment Effects Produced by Frankel Appliance in Patients with Class II, Division 1 Malocclusion

Marcio Rodrigues de Almeida, DDS, MSc, PhDa; Jose´ Fernando Castanha Henriques, DDS, MSc, PhDb; Renato
Rodrigues de Almeida, DDS, MSc, PhDc; Weber Ursi, DDS, MSc, PhDd

Abstract:

The purpose of this investigation was to evaluate the dentoalveolar and skeletal cephalometric changes produced
by the Frankel appliance in individuals with a Class II, division 1 malocclusion. Lateral cephalograms of 44 patients of
both sexes were divided in two groups of 22 each. The control group was comprised of untreated Class II children
with an initial mean age of eight years and seven months who were followed without treatment for a period of 13
months. The Frankel group had an initial mean age of nine years and was treated for a mean period of 17 months.
Lateral cephalometric headfilms of each patient were obtained at the beginning and end of treatment. The Frankel
appliance produced no significant changes in maxillary growth during the evaluation period, while a statistically
significant increase in mandibular length was observed. The maxillomandibular relationship improved mostly
because of an increase in mandibular length. In addition, there were no statistically significant differences in the
craniofacial growth direction between the Frankel and the control group, both showing a slight downward rotation
of the palatal plane. The Frankel appliance produced a labial tipping of the lower incisors and a lingual inclination of
the upper incisors as well as a significant increase in mandibular posterior dentoalveolar height. It was concluded
that the main effects of the Frankel appliance during this time period were mostly dentoalveolar with a smaller but
significant skeletal mandibular effect. (Angle Orthod 2002;72:418–425.)

The effects of Frankel's function regulator (FR-4) therapy on the treatment of Angle Class I skeletal anterior open bite
malocclusion , AJODO 1995

Elif Erbay, DDS, MS , Türköz Ugur, DDS, DDO, Mustafa Ülgen, DDS, Dr.med.dent.

Abstract:

The present study attempts to evaluate cephalometrically the effects of Fränkel's function regulator (FR-4) appliance
on the treatment of Angle Class I skeletal anterior open bite malocclusion. Forty Turkish children (26 girls and 14
boys), with Angle Class I skeletal anterior open bite, were randomly divided into two groups of 20 (13 girls and 7
boys). Patients who had not undergone treatment served as the control group, whereas a second group was treated
with lip-seal training and the FR-4 appliance. Chronologic mean decimal age at initial period of the investigation was
8.7 years in the treated group, and 8.9 years in the control group. Treatment and observation periods were 2 years.
Investigation was carried out on lateral cephalograms taken before and after the study period. The results indicate
that a spontaneous downward and backward growth direction of the mandible observed in the control group could
be changed to a upward and forward direction by FR-4 therapy. The skeletal anterior open bite was successfully
corrected through upward and forward mandibular rotation. (AM J ORTHOD DENTOFAC ORTHOP 1995;108:9-21.)

Skeletal and dental changes following the use of the Frankel functional regulator

C. D. J. Rushforth, P. H. Gordon, and J. C. Aird

British Journal of Orthodontics 1999;26:127-34.

Abstract

The purpose of this study was to assess the relative contributions of skeletal and dental components in correction of
Class II Division 1 malocclusions when treated with Frankel’s function regulator (FR). This was a retrospective study
involving analyses of pretreatment and posttreatment cephalograms of 63 Class II Division 1 patients treated with
the FR to demonstrate the relative maxillary, mandibular, incisor, and molar movements during treatment compared
with normal growth within a control group of untreated 39 Class II Division 1 cases drawn from the same
demographic population. All cephalograms were digitized and subjected to a Pitchfork analysis, which measured
individual anteroposterior skeletal and dental changes during the period of study. It was shown that the FR was
effective in treating Class II Division 1 cases with the studied group being corrected to a clinically acceptable overjet
and overbite of 2 to 3 mm. The majority of the correction came from dental movements, the most significant being
the retroclination of the upper incisor teeth (mean 4.1 mm, 95% CI ± 0.44) and proclination of the lowers (mean 2.2
mm 95% CI ± 0.57). With respect to skeletal correction, the most significant contribution was the restraint of normal
maxillary forward growth (mean –0.2 mm, 95% CI ± 0.62) with forward mandibular growth not being a significant
factor.

Cranial base and maxillary changes in patients treated with Frankel’s functional regulator (1b)

Juan J. Alió-Sanz,Carmen Iglesias-Conde ,Jose Lorenzo-Pernía,Alejandro Iglesias-Linares

Med Oral Patol Oral Cir Bucal.2012 July

Abstract

Objectives: The purpose of this study was to assess cranial base and maxillary growth in patients with Class
II-type I malocclusions when treated with Frankel’s functional regulator (FR-1b). Study Design: The
treatment group was made up of 43 patients that were divided into two groups: prepubescent (n: 28), and
pubescent (n: 15). The control group included 40 patients who did not receive any kind of treatment and
were likewise divided into a prepubescent group (n: 19), and a pubescent group (n: 21). A computerized
cephalometric study was carried out and superimpositions were done in order to assess the antero-posterior,
vertical and rotational movement of the maxilla. Results: The results indicate that anterior cranial length is
not affected by the regulator but the cranial deflection of the treatment group was diminished. Although a
slight counterclockwise rotation effect on the upper jaw was observed due to treatment, no growth restriction
of the maxilla in a vertical or antero-posterior direction was observed compared to other non-treated Class
II-type I malocclusion patients. Conclusion: The functional regulator does not have any effect on anterior
cranial length, but it does affect the angulation of the cranial base. According to our results, the appliance
has demonstrated a flattening effect of the cranial base (p<0.05) in the treated sample. The functional
regulator induces counterclockwise rotation rather than vertical or sagittal changes in the maxilla.
Effectiveness of functional regulator II appliance in producing skeletal and dental changes and its
permanence in class II patients compared to a control group: A retrospective cephalometric study

S Divya, H C Kiran Kumar, K Sadashiva Shetty

Journal of International Oral Health , 2017
Abstract
Aims: Class II skeletal and dental disparities due to mandibular retrusion have been termed as a major type of facial eccentricity.
Functional appliance therapy is one of the treatment modalities aimed to correct the retrusive mandible during growth. We aimed at
comparing the treatment changes between patients treated with functional regulator (FR) II appliance of Frankel and untreated
class II control groups and to evaluate the permanence and long-term stability of this treatment in Indian population. 

Materials and Methods: The treatment group (FR II/study group) comprised 10 patients who were evaluated at three stages:
pretreatment (T1), immediate postfunctional (T2at 18 months), and long-term posttreatment (T3at 6 years). The control group
comprised 10 untreated class II patients under observation for >4 years. Intergroup comparison was done using Student's t-test, to
test for statistical significance.

 Results: The FR II group also showed a significant decrease in ANB value, indicating a strong normalization of sagittal jaw
discrepancy and increase in lower anterior facial height when compared with class II control group. Further, dentoalveolar changes
had significant differences between the two groups. 

Conclusions: This retrospective cephalometric study indicates that FR II appliance therapy in skeletal class II malocclusion with
retrognathic mandible during active growth phase brings about the correction of anteroposterior maxillo-mandibular relationship that
remains stable over long term.
Effects of the functional regulator III on profile changes in subjects with maxillary deficiency

Nihat Kilic et al

The European Journal of Orthodontics , May 2010

The aim of this study was to determine the hard and soft tissue profile changes in Class III malocclusion subjects
following functional regulator III (FR-3) treatment. The material comprised the cephalometric films of 15 patients
(11 males and four females; mean ages 10.22 and 10.44 years, respectively) with a Class III malocclusion and a
concave profile treated with the FR-3, and a control group of 15 subjects (11 males and four females; mean
ages 10.39 and 10.27 years, respectively) with a Class I malocclusion matched for chronological age and
observation period with the study group. Fourteen linear and seven angular measurements were measured on
the cephalometric films taken before (T1) and after (T2) treatment/observation. The results of the Student’s t-test
showed that the treatment group had a concave facial profile when compared with the controls. At the end of
treatment, the maxilla and surrounding soft tissues showed significant anterior movement (P < 0.001 and P <
0.01, respectively), whereas mandibular growth was restricted. The vertical dimensions increased, the upper
incisors proclined, and the lower incisors retroclined significantly (P < 0.001). The FR-3 appliance produced
significant improvements in the hard and soft tissues of Class III subjects with a concave profile.

Stability evaluation of occlusal changes obtained with Fränkel's Function Regulator-2

Tânia Gnecchi Tanaka, Fernanda Angelieri, Lylian Kazumi Kanashiro, Silvana Bommarito

Dental Press J. Orthod. vol.17 no.6 Maringá Nov./Dec. 2012

ABSTRACT

OBJECTIVE: To analyze the stability of occlusal changes promoted by the Frankel's Functional
Regulator 2 (FR-2), in a mean period of 7.16 years post treatment.
METHODS: Fifty-four pairs of models were evaluated, from 18 patients treated with FR-2. All patients
had Class II, division 1 malocclusion, with initial mean age of 10.77 years and were treated with FR-2
for 18 months. The models were evaluated at the beginning of treatment (T1), at the end (T2) and after
7.16 years post treatment (T3). For occlusal evaluation, the treatment priority index (TPI) was applied
on the three analyzed phases. The alterations that occurred between phases were verified with one
another through paired Student's t test, with critical value of 0.05.
RESULTS: A statistically significant reduction of TPI was verified, from the initial to the final phase of
the treatment, reflecting the efficiency of treatment performed with FR-2, specially due to
improvement in molar relation, overjet and overbite. Apart from this, the Class II correction remained
stable over time.
CONCLUSIONS: In this way, it is concluded that the FR-2 appliance showed to be efficient for the
dental correction of Class II malocclusion, with stable occlusal results after 7.16 years post treatment.

Treatment effects of Fränkel functional regulator III in children with class III malocclusions

Baik HS et al , AJODO 2004

The purpose of this study was to evaluate the skeletal and dental effects produced by the Fränkel
functional regulator III appliance in growing children with Class III malocclusions. Thirty preadolescents
(initial mean age, 8.0 +/- 1.2 years; mean treatment duration, 1.3 +/- 0.6 years) treated with the Fränkel
functional regulator III appliance were compared with 20 matched untreated Class III controls (initial
mean age 8.2 +/- 1.1 years; mean observation period, 1.5 +/- 0.6 years). The treatment effects were
mainly from backward and downward rotation of the mandible and linguoversion of the mandibular
incisors.
The use of Frankel -3 in Class III Malocclusion: Short term and Long term effects

Di Luzio C, Bellisario A, Caputo M, Favale M, Squillace F., WebmedCentral ORTHODONTICS 2017

Abstract

The aim of this article is to make a revision of literature to investigate the effectiveness of therapy with Frankel III in
children affected by class III malocclusion, differentiating between short-term and long-term effects.
FR-3 appliance can be the treatment of choice for children with mild or pseudo class III malocclusion caused by an
underdeveloped maxilla or by a retrusion of maxilla.
In preadolescent with severe skeletal class III malocclusion due to an overdevelopment of the mandible, the
recommended treatment is based on facemask and rapid palatal expansion appliance.
In the short term, the response of the craniofacial complex to treatment with the FR-3 appliance included significant
favorable changes in the maxilla (size and position). However, SNA's value didn't differ in the long term between the
FR-3 group and the untreated group in a significant way.
No significant long-term inhibition of mandibular growth is recorded. However, a significant mandibular shape change
is observed in the form of closure at the gonial angle and associated closure of the mandibular plane angle.
It is advantageous for children with class III malocclusion that the mandible is redirect downward and backward.
Considered the many different views on the effectiveness of Frankel 3 specially in long term, future investigations
related to observation with fulltime wear of the FR-3 are necessary to verify its effects, specially in the maxilla.