Myofnctionaapplbasics

MYOFUUNCTION
AL APPLIANCES
DEPARTMENT OF ORTHODONTICS
SUBHARTI DENTAL COLLEGE
SWAMI VIVEKANAND SUBHARTI UNIVERSITY
Presented By:
Dr Shalu Jain
 Functional therapy employs natural forces derived from the facial
and the masticatory musculature. This is accomplished either by
use of certain muscle exercises or by the means of an inert
appliance transmitting the muscle activity onto the teeth or jaws,
to be moved.
 A Functional appliance is designed in such a way that it guides

the forces arising from muscle activity to exert pressure upon a
tooth or teeth, thus effecting tooth movement.
Dr Shalu Jain, Subharti Dental College, SVSU
 Functional appliances also correct the antero-posterior skeletal
discrepancy stimulating the alveolar and condylar changes to
achieve the desired occlusion.
 For e.g: In a Class II div 1 malocclusion with mandibular

retrognathism, the mandible is brought forward to Class I molar
relation and held in that position by the functional appliance.
 All functional appliances have one common aspect, that of

inducing the forward positioning of the mandible as part of the
treatment effect (Jumping the bite).
Questions:
 Definition
 Advantages
 Disadvantages
 Classification – based on
1. use of muscle forces

2. type of retention
3. method of action
4. type of support

Definition
 A Functional appliance harnesses the natural
forces and transmits it to the teeth and alveolar
bone in a predetermined direction.

ADVANTAGES
It is possible to eliminate abnormal perioral muscle
functions which interfere with normal bone growth.
Treatment can be started during the growth period,
i.e as early as in the mixed dentition stage.
No side effects of mechano therapy.
Requires less chair side time with less frequent
adjustments.
Easier to maintain oral hygiene.
Frequency of patients visit is less.
Economic, cost effective.
LIMITATIONS
1. It is not useful in adults where growth is

completed.
2. It requires 2nd phase of fixed appliance

therapy
3. Results of treatment depends totally on

patients co-operation.

CLASSIFICATION OF FUNCTIONAL
APPLIANCES
F U N C T IO N A L A P P L IA N C E S
I] B a se d u p o n th e II] B a sed o n th e m e th od III] B a sed o n th e m e th od IV ] B a se d o n th e ty p e

u se of m u sc le fo r c es o f r e te n tion o f a c tion o f su p p o rt
A . G roup I A . R e m o v a b le A . M yo to n ic A p p lia n ce A . T o o th B o r n e
(w h ic h tr a n sm it m u sc le fu n ctio n a l a p p lian c es F u n c tio n a l ap p lia n ce
fo r c e d ir e ctly to te e th )
B . G ro u p II B . F ix ed B . M yo d y n a m ic a p p lia n ce B . T issu e b o r n e
(W h ich r e p o sitio n th e fu n ctio n a l a p p lian c es F u n c tio n a l ap p lia n ce
m a n d ib le fo rw a r d )
C . G r o u p III
(W h ich o p er a te o n th e
v e stib u le m a in ly)
I. Depending on the use of muscle
forces (Tom Graber)
 Group A: Functional appliances which transmit
muscle forces directly to the teeth.
 Eg: Inclined plane, oral screen.

 Group B: Consists of appliances which reposition
the mandible forward & downward activating the
attached and associated musculature.
 The resultant force is not only transmitted to the
teeth but also to the other structures both the
maxilla & mandible
 Eg: Activator and its modifications

 Group C: Appliances which brings out mandible
positional changes but major operating areas is in
the vestibule, outside the dental arches.
 Supporting bone & teeth are influenced by

changing the muscle balance through cheek
shields & lip pads.
 Eg: Frankle Functional regulator.

II. Depending on the type of
retention
1. Removable Functional appliances.
 They are myofunctional appliances that can be
removed and inserted by the patient
a) Bite plane
b) Oral screen
c) Activator
d) Bionator
e) Frankel appliance
f) Twin block
g) Lip bumper
 2. Fixed Functional Appliances
They are the functional appliances that are fitted on the
teeth by the operator and cannot be removed by the
patient at will
a) Herbst Appliance
b)Jasper Jumper
c) Cemented inclined plane.
d) Fixed twin block
e) Activator Headgear therapy

III. Depending on the method of
action
1. Myotonic Appliance – They are functional

appliances that depend upon the muscle mass &
resting pressure for their action. E.g.: Anderson-
Haupl Activator, Herrens Activator, Harvold &
Woodside Activator.
2. Myodynamic appliance – there are appliances

that make use of muscle activity or movement for
their function. It combines both active and
passiveDrforces. E.g.: Bimler Appliance.
Shalu Jain, Subharti Dental College, SVSU
IV. Depending on the type of
support
 Tooth Borne Functional appliances
a) Tooth borne active appliance: Modification of
activator and bionator design that include
expansion screws or springs to move teeth
b) Tooth borne passive appliances – these
appliances do not have intrinsic force
generation components such as springs &
screws. E.g.: Activator, Bionator, Herbst
appliance etc
 Tissue borne passive appliance
These appliances are mostly located in the
vestibule and have little or no contact with the
dentition
E.g.: Functional Regulator of Frankel.

Treatment principles
1. Force application – compressive stress and
strain – primary alteration in form with
secondary alteration in function
2. Force elimination – elimination of abnormal
and restrictive envoirnmental influences on
the dentition –function is rehabilitated with
secondary change in form

BITE PLANES
 They are simple functional appliances.

 Based on their position and shape they are
classified into different types.
 Anterior
 Posterior

Anterior Bite planes
 Anterior bite planes induce a forward posture

of the mandible in Class II div 1 malocclusion.
They are also useful in correcting deep bites.
 There are two types:
Maxillary (Upper)
Mandibular (Lower)

Upper anterior (flat) bite plane

Upper anterior inclined bite
plane

Posterior Bite plane

2. Lower anterior inclined Bite
plane
(CATALAN’S APPLIANCE)
Was introduced by Catalan in 1808.
Used in cases of developing anterior crossbite

It may be removable or cemented ( requires
less cooperation from the patient).
Should be limited to simple cases – those
involving one or two teeth at the most.
Sufficient space must be there.
The removable type of Catalan’s is made by
adding an inclined plane to the mandibular
Hawley type of retainer.
It is angulated at 450.
It can be used to retract labially malposed lower
incisors.
Used in cases where the bite is not too deep.
Has the characteristic of opening the bite by
allowing the supra-eruption of the posterior teeth.
Can be made of acrylic or cast metal when it is
to be cemented.
 It corrects anterior crossbites in a matter of days. It
should never be kept for more than 6 weeks.
 It is contra indicated if there is an end to end
overbite relationship or an open bite tendency.
 The state of development of the root apices must
also be determined before placing the appliance,
because early placement of the appliance may
cause for shortening of the roots.

 ADVANTAGES
 Ease of fabrication.
 Rapidity of correction.
 Lack of looseness or soreness of the teeth during
movement.
 Rarity of relapse.

 DISADVANTAGES
 Strong limitations on diet.
 Creation of a temporary speech defect.
 Tendency to create an anterior open bite if left
for too long.

SVED BITE PLANE
 Introduced in 1944.
 The inclined effect of
the upper anterior
inclined bite plane may
tend to cause the
proclination of the
upper incisors.

 Hence in addition to the upper anterior inclined
plane the acrylic is extended to the incisal 1/3
of the labial surfaces of the incisors to prevent
their proclination.
 This also reinforces the anchorage.

ORAL SCREEN
 Also known as the vestibular screen.

 Was introduced by Newell in 1912.
 It has no active components.
 Designed to produce its effect by redirecting
the pressures of the muscular curtain of the
cheeks and the lips.

INDICATIONS
1. Correction of thumb sucking, lip biting and

tongue thrusting.
2. For correction of mouth breathing when the
airways are open.
3. Mild disto-occlusions with premaxillary
protrusion and open bite in the deciduous and
mixed dentitions.
4. Flaccid, hypotonic orofacial musculature.
 The lips exert pressure through the plastic
shield against the anterior part of the dentition
and the bony support.
 Since the buccal portion of the oral screen is

away from the posterior teeth by 2 –3 mm, the
tongue's active function molds the posterior
segmentsDr Shalu
and helps to expand the narrow
Jain, Subharti Dental College, SVSU
 Thus the anterior segment is influenced
directly and the posterior segment indirectly by
keeping away cheek pressure.

MODIFICATIONS
A thick wire ring can be incorporated while

acrylizing the oral screen on the labial side to
aid in carrying out the muscle exercises
(Hotz)

 In patients with mouth breathing habit,
breathing holes are incorporated to
psychologically satisfy the patient.

In cases of tongue thrusting habit, Kraus
recommends a smaller lingual acrylic screen
attached to the oral screen, called the ‘Double
oral screen’.

 It includes an acrylic projection or a wire
extending onto the lingual aspect to keep the
tongue away.

MECHANISM OF ACTION
 When the oral screen is designed to contact

the labial surfaces of the incisors, then the
forces of the perioral musculature are
transferred onto it and this helps in their
retraction.

 The oral screen keeps the forces of the cheek
and lip musculature away from the incisors
during functional movements. Hence the
tongue is free to act on the lingual surface of
the posteriors resulting in the expansion of the
narrowed arches.

USAGE
 It should be worn by the patient every night and

also during the day when possible. The patient is
also instructed to perform lip exercises several
times in a day for a few minutes - 30 to 45 mins
over a 24 hour period.
 The upper and lower lips should be kept in

contact with each other at all the times to enhance
the effect of the appliance and to improve the lip
seal.
LIP BUMPER
 Used to eliminate the hyperactivity of the

mentalis muscle.
 Can also be used for correction of lip biting
and lip sucking habits.
 It may be removable or fixed.

 It can be fabricated for
both upper and lower
lips (arches). But
since the mentalis
causes the most
damage to the
mandibular dentition
by virtue of its
presence in the lower
lip, usually the lip
bumpers Drare
Shalu made for
Jain, Subharti Dental College, SVSU
FABRICATION
 FIXED LIP BUMPER

 The first permanent molar or the second
deciduous molar bands or crowns are placed
with buccal tubes to receive the wire or the
wire and acrylic assembly.
OR
 The wire may be directly soldered on the
buccal or lingual surfaces of the bands or
crowns of the anchor teeth.
 REMOVABLE LIP BUMPER
 It is retained by Adams clasps, eyelet clasps
etc and is used when the patients compliance
is assured.

MECHANISM OF ACTION
 The lip bumper keeps the lip away from the

lower incisors and also prevents the lower lip
from cushioning the upper incisors during
function.
 The tongue then force the lower incisors to

move labially leading to an increase in the arch
length and reduction of the increased overjet.
USES OF THE LIP BUMPER
To distalize the lower permanent first molars.
To prevent or correct the lower lip biting habit.
Can be used to reinforce the anchorage –

Muscular anchorage.

Dentoalveolar changes
 Sagittal – upper anteriors tip palatally and
lower anteriors labially
 Vertical- eruption of teeth
 Transverse- expansion of arches

Thank you !!!!
ACTIVATOR
 It was introduced by Anderson and Haupl.

 It is so called because of is ability to activate the
muscle forces.
 It is also called a the Norwegian appliance as it
was developed in Norway.
 It is a passive loose fitting appliance which
harnesses the orofacial muscular forces and
transmit them to the teeth and the alveolar
structures.

ACTIVATOR

INDICATIONS
1. It is used in growing patients (mixed and early

permanent dentition) with well aligned upper and
lower arches in the following conditions
2. A Class II div 1 malocclusion with a retrognathic
mandible.
3. Class III malocclusions.
4. Patients with horizontal growth pattern.
5. Patients with decreased lower facial height.
6. As retainers.
CONTRA-INDICATIONS
1. Non growing subjects.

2. Subjects with vertical growth pattern.
3. Patients with increased lower anterior facial
height.
4. Cases with severe crowding.

MECHANISM OF ACTION
 Depending on its construction, it can initiate myotactic

reflex activity, induce isometric muscle contractions or
relay the visco-elastic properties of the stretched soft
tissues.
 According to Anderson-Haupl concept the forces
generated in the activator therapy are caused by the
muscle contractions and the myotactic reflex activity. A
loose appliance stimulates the muscles and their
kinetic energy.
 The teeth are made to bite forcibly on the
appliance. The neuro-muscular adaptation to the
increased distance and the change in the direction is
the is the Drbasic requirement
Shalu Jain, for SVSU
Subharti Dental College, re-educating the
orofacial musculature.
 The condylar adaptation to the anterior
positioning of the mandible consists of growth
in an upward and backward direction to
maintain the integrity of the TMJ structures.At
the same time the glenoid fossa also readapts.
 According to Hansen, Harvold and
Woodside the visco-elastic properties of
muscle contraction induces skeletal
adaptation. There is stretching of the soft
tissues which stimulates the

 Skeletal and dental effects of the activator
 While the activator holds the mandible
forwards and stimulates mandibular
development, it has a restraining effect on the
mandibular growth and the maxillary dento
alveolar complex. The mandibular lower
incisors tend to tip labially. With proper
trimming of the appliance, different movements
can be performed and eruption of the teeth
can be guided.

CONSTRUCTION BITE
 The purpose of the construction bite is to

fabricate the appliance that induces the
following effects:
 To bring the lower jaw into a tolerable forward
position.
 To block the bite, depressing the lower
anterior teeth and stopping their eruption while
simultaneously allowing the eruption of the
lower posterior
 Before taking the construction bite the study casts
should have been examined for midline discrepancies
(as only only skeletal midline discrepancies can be
corrected). and curve of spee. Functional analysis for
the path of closure, respiration, occlusal prematurities
etc. Cephalometric analysis to determine the direction
of growth and the axial inclinations of the maxillary
and mandibular incisors.
 Later the amount of anterior positioning of the
mandible and the vertical opening is determined. Both
are intimately linked. Usually the horizontal or anterior
positioning of the mandible is 5 – 6 mm and the
vertical opening should be 2 – 3mm above the
freeway space in the molar and the premolar areas.
Steps in taking the construction
bite
1. Reproduce the maximum forward movement of the mandible
and
2. Determine the amount of forward movement of the the
mandible and vertical opening necessary. The amount of
mesial shift should be marked on the buccal surfaces of the
first molars.
3. Practice the forward mandibular movement by gently guiding
the mandible.
4. Register the true mandibular midline on the labial surfaces
of the upper and lower incisors on the casts.
5. Soften a sheet of bees wax and make a tight roll
approximately 1 cm in diameter.

6. Shape the roll to conform to the lower dental cast.
Press the softened roll of wax on the lower arch so
that only the buccal teeth are covered and the
anterior portion of the roll lies just lingual to the lower
incisors. Make a groove on the wax to indicate the
midline. Excess wax is removed in the retromolar
area.
7. Transfer the wax roll to the patients mouth fitting it
onto the lower arch. Move the mandible forward to
the previously determined horizontal position and ask
the patient to bite to the height previously
determined.
8. Remove the wax from the mouth and chill it. Place it
back on the casts and check the horizontal
movement of Jain,
Dr Shalu theSubharti
mandible.
Dental College, SVSU
CONSTRUCTION OF THE
ACTIVATOR
 The first step in the construction of the activator

appliance is the mounting of the working models with
the construction bite on an articulator. The articulator
allows the upper and lower parts of the activator to be
made separately and can later be united in the correct
construction bite.
 The activator consists of a combination of acrylic
and wire components. A labial bow is constructed for
the upper. It contacts the four upper incisors and is
usually passive and is made of 0.8 mm thick stainless
steel wire.
 Dr Shalu Jain, Subharti Dental College, SVSU
 The acrylic part consists of upper , lower and
interocclusal portions. The flanges for the upper
upper part are 8- 12 mm high in the gingival area
and cover the alveolar crest. The palate is not
covered.
 The lower acrylic plate is 5 – 10 mm wide. The

upper and lower acrylic portions are joined at the
interdental area with endothermic acrylic. After
polymerization the appliance is ground and
TRIMMING
 It is done with the patient in the chair, permitting

frequent spot checking to assess whether the
acrylic guide planes are functioning as desired.
Merely holding the mandible in a forward position
is not adequate to achieve the proper relationship
of the teeth in three dimensions. Selective
guidance of the eruption of teeth and development
of the arch form is necessary.
 This is done by carefully planned grinding and
trimming of the activator in the tooth contact
areas. After proper grinding the desired force acts
on pre determined areas of the teeth and applies
pressure in the direction of needed tooth
movement.Dr Shalu Jain, Subharti Dental College, SVSU
 Intrusion of the incisors can be achieved by
loading the incisal edges of the teeth, whereas
intrusion of the molars is achieved by loading
only the cusps of these teeth.

 Extrusion of the incisors require loading the
lingual surfaces gingival to the area of the
greatest convexity of the tooth (either maxillary
or mandibular).The labial bow can be placed
above the area of the greatest convexity.
Extrusion of the molars is facilitated by loading
the lingual surfaces of the molars gingival to
the area of the greatest convexity of the tooth .

 During selective trimming procedures only the
upper and lower molars are extruded. Also the
path of eruption of the molars must be
considered.

 The lower molars erupt in an upward and
slightly forward direction.The upper molars
erupt downwards and backwards. Thus an
impending Class II or Class III can be
converted into Class I interdigitations. By
allowing these selective movements.
 In general for a trimmed area of the
activator ill have a honey comb appearance.

 After the appliance is inserted the patient is
asked to open and close the mouth without
loosening the appliance. It is important to note
whether the labial bow slides automatically
into its proper place on the maxillary anterior
teeth with every closing movement of the
mandible.

 The patient is informed that the appliance may come
out the first several nights until tongue control helps in
holding it in place. The patient ho has trouble wearing
the appliance throughout the night in the beginning is
advised to wear it a few hours a day at first. Daytime
wear of about three hours when doing housework or
watching television is most important to speed up the
progress of the treatment.
 The patient is checked for every 4 – 8 weeks. The
fit of the appliance and the progress of the treatment
are observed during each visit.

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MYOFUUNCTION

SWAMI VIVEKANAND SUBHARTI UNIVERSITY

 A Functional appliance is designed in such a way that it guides

 For e.g: In a Class II div 1 malocclusion with mandibular

 All functional appliances have one common aspect, that of

1. use of muscle forces

Dr Shalu Jain, Subharti Dental College, SVSU

Dr Shalu Jain, Subharti Dental College, SVSU

1. It is not useful in adults where growth is

2. It requires 2nd phase of fixed appliance

3. Results of treatment depends totally on

Dr Shalu Jain, Subharti Dental College, SVSU

I] B a se d u p o n th e II] B a sed o n th e m e th od III] B a sed o n th e m e th od IV ] B a se d o n th e ty p e

Dr Shalu Jain, Subharti Dental College, SVSU

Dr Shalu Jain, Subharti Dental College, SVSU

 Supporting bone & teeth are influenced by

 Eg: Frankle Functional regulator.

Dr Shalu Jain, Subharti Dental College, SVSU

1. Myotonic Appliance – They are functional

2. Myodynamic appliance – there are appliances

Dr Shalu Jain, Subharti Dental College, SVSU

Dr Shalu Jain, Subharti Dental College, SVSU

 They are simple functional appliances.

Dr Shalu Jain, Subharti Dental College, SVSU

 Anterior bite planes induce a forward posture

Dr Shalu Jain, Subharti Dental College, SVSU

Dr Shalu Jain, Subharti Dental College, SVSU

Dr Shalu Jain, Subharti Dental College, SVSU

Dr Shalu Jain, Subharti Dental College, SVSU

Dr Shalu Jain, Subharti Dental College, SVSU

Dr Shalu Jain, Subharti Dental College, SVSU

Dr Shalu Jain, Subharti Dental College, SVSU

Dr Shalu Jain, Subharti Dental College, SVSU

Dr Shalu Jain, Subharti Dental College, SVSU

Dr Shalu Jain, Subharti Dental College, SVSU

 Also known as the vestibular screen.

Dr Shalu Jain, Subharti Dental College, SVSU

1. Correction of thumb sucking, lip biting and

 Since the buccal portion of the oral screen is

Dr Shalu Jain, Subharti Dental College, SVSU

A thick wire ring can be incorporated while

Dr Shalu Jain, Subharti Dental College, SVSU

Dr Shalu Jain, Subharti Dental College, SVSU

Dr Shalu Jain, Subharti Dental College, SVSU

Dr Shalu Jain, Subharti Dental College, SVSU

 When the oral screen is designed to contact

Dr Shalu Jain, Subharti Dental College, SVSU

Dr Shalu Jain, Subharti Dental College, SVSU

 It should be worn by the patient every night and

 The upper and lower lips should be kept in

 Used to eliminate the hyperactivity of the

Dr Shalu Jain, Subharti Dental College, SVSU

 FIXED LIP BUMPER

Dr Shalu Jain, Subharti Dental College, SVSU

 The lip bumper keeps the lip away from the

 The tongue then force the lower incisors to

To distalize the lower permanent first molars.

To prevent or correct the lower lip biting habit.

Can be used to reinforce the anchorage –

Dr Shalu Jain, Subharti Dental College, SVSU

Dr Shalu Jain, Subharti Dental College, SVSU

 It was introduced by Anderson and Haupl.