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OF APPLIENCES TIMING OF TREATMENT ACTIVATOR Vs FRANKLE FR-VTO CONSTRUCTION BITE a. DIFFERENT TYPES b. TECHNIQUE 10.STUDIES 11.CONCLUSION 1. 2. 3. 4. 5. 6. 7. 8. 9.
Dr.Rolf Frankle of Zwickau, GDR, introduced the concept of Function correctors, to the field of orthodontics in 1986 through the publications in Trans. Euro Ortho society. Frankle based his philosophy upon HOTZ hypothesis. Other names for Frankle’s appliance 1. FUNCTION REGULATOR 2. VESTIBULAR APPLIANCE 3. ORAL GYMNASICS APPLIANCE
Schwartz classified orthodontic appliances According to degree of biologic efficiency (relationship between force magnitude & tissue response) I. Other similar appliances are 1. bionator. MUHLEMAN-HOTZ propulsor Frankle believed that full time wear was essential if any significant modification in orofacial musculature to be expected. Twin Block b. Tooth born active : Modification of activator with springs.It is basically an exercise devise with its base of operation in vestibule. Oral screen by Kraus 1956 2. II Removable Functional appliance.screws. outside the dental arch. First degree: Force below threshold of stimulation to activate orthodontic tooth movement.Bionator. Charles Nord of Europe called it a “Revolution in Orthodontic appliances”. Tissue born passive: Frankle Fr. CLASSIFICATION I a. III Group I : These appliances transmit muscle forces directly to the teeth for the purpose of correction of malocclusion. Eg: Activator. Eg: Frankle’s appliance. GroupIII : These appliances also reposition the mandible But their area of operation is vestibule. different from Activator. Group II : These appliances reposition the mandible & the resultant force is transmitted to the teeth & other structures. c. . Tooth born passive: Activator. Fixed Functional appliance. Eg: Inclined planes.
3.interrupted forces are conducive to resorption and deposition. • Functional performance of muscular portions of capsule is important It has space controlling potential Frankle has given importance to the important process of deglutition while formulating his philosophy.Forces are… 1. Too weak to provoke tooth movement. Third degree: These forces interrupt the blood circulation of periodontal ligament (20-50). Basis of Frankle’s Philosophy • Frankle recognizes the relationship between the form and function as the biologic axiom. Short duration.1mm (half the thickness of periodontal ligament) II. II. Balance by compensatory forces like from cheek. Fourth degree: Forces of such magnitude that tissues are crushed. Second degree: consider most favorable to achieve continuous tooth movement without root resorption. 2. Forces are weaker than blood pressure 15-20 gm/cm2 They are effective when exerted in same direction Pressure effective only over the distance of 0. Based on the experiments of Elekert Mobious (‘62) Frankle (‘67) and Pictone (‘75). . Forces of mastication are not artificially reinforced 4. • Establishment of functionally adequate space conditions in the orofacial area constitutes an important factor in skeletal growth. II. As mandible returns to rest position after swallowing. During vaccum is credited in oral cavity. he said 1. lip and tongue. Extensive necrosis is seen in them.due to anterior and posterior seal 2. Frankel comes in this category.
Important muscles in the region a. Orbicularis oris b. Vestibular construction an artificial “ough to be matrix allow muscles to exercise and adapt (not push out from within). Hyperactive mentalis. Abnormal perioral muscle deforming action on growth 4. the form of skeletal components can be redirected. Altering the function of soft tissue matrix. 2. 8. Mentalis d.Decrease in interocclusal space Buccal forces on dentoalveolar structures. Lip trap. . c. Tongue 3. Frankel’s Philosophy 1. 7. Promotes normal muscle function & eliminates a. 5. Buccinator c. Albert abnormal must be screened & modified. Frankel believed in full time wear. Aberrant buccinator/orbicularis oris. b. 6. Screening of “Constricting buccinator mechanism” Causes intercanine expansion Relieves lower anterior crowding. Unbalanced by tongue Great constricting effect on arches. Natural interplay of faces.
Create tension in the tissue Exerts tension on contagious Periosteal tissue. Mentalis activity is increased in compensation (hyperactive mentalis). vestibular shields and lip pad perform this important function. Maxillary bone widened. • Much of its function may be compensatory or adaptive. Mouth Breathing Patients: Air pressure conditions are beyond the physiological range. Apical bone widening. . Lower lip pads are provided to screen this hyperactivity & oral seal training is encouraged. Hypotonic Upper Lip: This may be due to severe Proclination of upper incisor. Role of Anterior Oral Seal In patient with mouth breathing habit due to any previous condition & in hypoactive orbicularis oris. • But also thinks that. Increase bone activity in the region. These structures extend into the depth of the buccal & labial vestibule.9. • Vaccum created during swallowing. Frankel believed the anterior oral seal training as indispensable. Incompetent lips are the pathophysiological condition at any rate. offset the intrinsic potential of the tongue. its role has been overstressed. • He thinks it plays significant role in the ultimate outward progression of the teeth & investing tissues. Role of Periosteal Pull: In addition to screening action. Roll of tongue. Bodily movement of buccal segment.
It prevents there eruption. • Mandibular molar are free to erupt upward and forward. Teeth are separated and wire pass below the contact area of this teeth. lower labial tipping may occur 2. Differential Eruption Guidance • Occlusal stops are given in Fr I &II in the maxillary molar region.Fr Ib These extend into floor of mouth to fit against lingual alveolar mucosa. Mesial contact point of both upper molars. For appliance is anchored positively to the maxillary Arch. Distal contact of both Upper canines. which gives proprioceptive stimulus. • 1-2 mm of total 6-7 mm of Sagittal advancement may be expected in terms of eruption. Injuring to labial gingival tissues in mandible may occur.Sagital Correction Via Tooth Born Maxillary Anchorage. • No wire contacts in the mandibular arch. FIGURE If not anchored in the embrasure 1. . Anchorage is determined through wire between 1. Sagittal correction Lingual bow with U loop – Fr Ia Lingual shield . 2.
In summery:. 3. Increase in transeverse & Sagittal intraoral space. 3. Frankel’s Philosophy Vestibular area of operation. Mandibular protraction. 4. 6. 4.mode of action of Fr 1. 2. 1. Swallowing.Effect on Maxilla It does have a restraining effect on maxilla and maxillary arch • McNamara indicates this is minimal. Full time wear. Increase in vertical space. 7. speaking with appliance in place. Sagittal correction via tooth born maxillary anchorage . Role of tongue Role of anterior oral seal Role of Periosteal pull. 5. • Lee Graber unpublished the study of 1993 • Labial wire not activated. Muscle function adaption Oral exercises recommended by Frankel 1. 2. Anterior oral seal 2. Screening of abnormal muscle function.
Sagittal correction – Lingual shields & U loops 10. Its inside the arch 2. Best time is late mixed dentition and transitional dentition greatest adaptational changes (but status of dentition) 2. Being in contact with dentoalveolar arch. 1. Effect on maxilla 11. 3. Frankel 1. For Fr IV Mixed dentition & continuing till permanent dentition. Role of muscles exercises Timing of FRANKEL APPLIANCE Treatment.Patient development psychological & physiological . 9. Important points: .Dentition status firm teeth needed to anchor. Harnesses the . For Fr III Early mixed dentition or deciduous dentition. Differential eruption guidance. (after eruption of all first molars. 4. McNamara indicated 1 year prior to exfoliation of deciduous molars. For Fr II After eruption of upper & lower anteriors 7 ½ . Becomes Effective by standing away from arch. If patient reports late wait for eruption of canine & premolars. 3.) 4.8.8 years or 8 ½ 9 yrs. Eliminate the muscular Activator 1. Operative by withholding pressure 4. Acrylic parts outside the arch 2. Operative by exerting pressure. 3.
.(muscle or appliance) 2. Frankel believes that activator is not a true functional appliance because 1. Fr Ib : Used for class II division 1 with overjet<7mm & molars upto endon relation 3. bone cells do not distinguish between source of pressure. Fr Ia : Used for treatment of class I deep bite & class II division 1 with overjet <5 mm 2. 3 PHOTOGRAPHS. Overjet is reduced. Fr 1 1. any appliance exerting pressure on dentoalveolar structure is outside the true definition of FUNCTIONAL STIMULI The Fr. DIAGRAMS OF EFFECT OF BUCCAL SHIELDS EFFECTD OF LIP PADS CONCOMITANT EFFECT OF LIPPADS & BUCCAL SHIELDS Types of Function Regulators I . A series of profile photographs are taken I Photograph: patient in postural rest position. II Photograph: patient in habitual occlusion with lips relaxed III Photograph: patient asked to protrude the mandible in correct Sagittal relationship. Instant print can be used to motivate the patient. II.forces muscular forces.VTO The clinical diagnostic test to determine whether functional appliance will be beneficial. Fr Ib : Used in class II division 1 with overjet<10 mm. Fr 2 : Used in treatment of class II division 1&2 III Fr 3 : Used for class III cases.
vertical opening is that at incisal edge to edge position. Vertical opening is still not beyond end-on bite. For minor Sagittal problems: (2-4mm) Take bite in end-on relation of incisors. Fr 4 : Used for openbite cases & some class II division I cases & bimaxillary protrusion cases. V. 3.5 to 3mm Vertical opening large enough to let cross over wires pass through At up to 6 mm advancement. If more than 6 mm of Sagittal advancement needed then 3 mm advancement is easily tolerated (step wise advancement). Classically Fr is given in non extraction cases but can be given in extraction cases also. VI. Vertical opening limited to allow crossbite correction Bite Registration For Fr Ia.c & Fr II .IV. Fr appliances in Adults(McNamara) Construction Bite Different opinion exert regarding the amount of horizontal and vertical opening. Fr appliances in cleft palate cases. For Frankel III appliance Clinically retruding the mandible as much as possible condyle occupying most posterior position in the fossa. 1. 2.b. Frankel recommends mandibular advancement up to 2.
Repeat maneuver several times. Thickness – 2-4 mm more than desired bite thickness 6. Bite removal. Replaced in mouth. Let patient hold mandible there for 1-2 minutes (proprioceptive learning process). Continue tapping gently and then ask patient to close slowly—guide the mandible posteriorly.chilled – placed on mould to check fit – excess removal with hot knife. 5. 4. 4. It is supposed to be an easier position to hold because of reproducible terminal position wax can be softer. 5. 2. 7. Ask the patient to protrude the mandible in desired position and hold it there for 3-5 mins 2.checked. 6. For Fr III 1. For final practice bite. Practice construction bite may be used. Clinician gently taps on the patient’s mandible with flexed knuckles while patient opens bite 1 cm. 8. Frankel IV Vertical opening is kept minimal with a wafer of acrylic interposed between upper & lower buccal segment. Keep Midline correct. 3. Bite opening is kept minimum to allow lip seal. Place the thumb against symphysis & forefinger under chin to guide.1. Technique of bite Registration Steps: . Taken in retruded position of mandible. warm water is used to soften beeswax or horseshoe wafer. Deep bite cases need greater bite opening. 3. Patient asked to bite to desired position – Guided by the operator.
Critical step & more demanding – will reduce cast trimming 2. Mesial to upper first molar. Thermal sensitive acrylic trays can be moulded. FIGURE. Clinical relevance of step by step mandibular advancement in treatment of mandibular retrusion using Fr appliance. Separation Space to be created 1. In case of inadequate space plan disking of deciduous upper canine & molars at the time of delivery of appliance. 3. Preformed Styrofoam (disposable)inadequate 6. 2. Sample: Group B 60 Children with Fr (step by step) Group A 60 children with Fr (edge to edge) . Special heavy separators should be placed 5-7 days before impression make. Custom trays should be fabricated on stock metal tray. AIM: To evaluate skeletal & dental changes occurring during the treatment with Fr and to compare the results achieved in patients in whom the initial construction bite was taken step by step Vs edge to edge advancement. Rebuilding of metal trays with utility wax. Distal to upper deciduous canine. Bite Registration. Impression making 3. Impression include whole alveolar process to the depth of sulci. 7. 5. 1. Separation 2. 4.1. Impression making. Care to be taken – not to distort soft tissues & muscle attachments.
Angular changes. Movement of pogonion Grp A 1. Patient A moved anteriorly 1 mm in untreated and Group b in group A 0. Positional changes in mandibular area.6mm GrpB 2.Ung 50 children with no treatment Skeletal class II malocclusion <ANB 5.1mm Fr B 0.2mm 2.36mm Position of Maxillary molar Fr A -0.6mm UNG 1. Dimensional changes of mandible Results 1.6mm .5mm UNG 1. Ventricaudal border of basal part & internal ridge of occipital bone. Pre & post treatment lateral cephalogram were taken. 2 FIGURE Measurements Positional changes of maxillary landmark.9º -6º Early mixed dentition Treatment time – 14 months. Occipital reference system for superimposition Mid Sagittal structures of occipital bone were taken as reference.
GPA – Maxillary molar distally moved. Restricting effect on maxilla can be eliminated or reduced in step by step advancement. Ramus length GPA – 0.46º)UNG GPA IMPA . MPA – GPA-1º GPB0. 3. GPB – only restricted. MPA. in corpus lengthening. 4. GPB IMPA – 2.Vertically both Grp A & Grp B 3.3. Greater dentoalveolar changes in edge to edge bite. 2. Gonial Angle Gonial Angle: 1.2mm UNG 1.3º UNG.-0. Angular changes : IMPA. significantly No significant inc.4 .52º) GPB (-0.4º increased.5º 4.11 (GPA) (0.4mm Discussion: 1.6mm GPB – 1.5.1mm Position of Condyle in Glenoid Fossa In Grp B maintained In Grp A anteriorly positioned 3. .2º Increased. UNGIMPA – 2. Dimentional Changes GPA & GPB distance between Co/Ar to Pog inc. Condyle fossae position maintained.0º Increased.
08mm) Speech affected in 1st week of wear but came back on long term wear. • Can be used as a retention appliance after primary expansion of maxilla. dental changes in maxilla or crossbite relationship • Not useful incase where treatment objective is primary expansion of collapsed maxillary segments.88± 1. Age 7-10 years with surgically repaired clefts of palate. HRXg. dental casts. . lateral & Frontal Ceph. Conclusion: • Minimal transeverse skeletal. Results: Interimplant distance was measured on PA Ceph. . Implants were placed prior to initial records Infrazygomatous implants Mandibular molar region.79mm (Greatest mean change) Interzygomatic implant 1. Records: Intraoral & Extraoral photographs.Function Regulator Therapy for Cleft Patients Kerr et al – AJODO 1981 A Clp children exhibiting maxillary segment collapse and crossbites were treated with Fr for 6-18 months.79mm(Greatest) -0. Speech evaluation. • No significant effect on spech on long term. Between Lower first molars 0.5 mm (least) Dental measurements Maxillary canine Change (0.
3 yrs) Angles class I molar relation Anterior open bite of atleast 1 mm Steep MPA(SN-GoMe>37º) 2 groups were made. Treated Group Treatment duration :. Lateral cephalogram analysis done by single investigation 14 linear. Material And Methods: 40 turkish children with angles class I skeletal open bite (13 girls & 17 boys) characteristics: Mixed dentition stage(7. 13 angular.2 years In treated Group – 18 hrs of appliance wear with lip seal training. 2 ratio were measured Important findings: .The effects of Fr 4 therapy on the treatment of angle class I skeletal anterior openbite malocclusion Erbay et al AJODO 1995 AIM: To study the effects cephalometrically.8-9. 1 Control Group 2. in the Sagittal & vertical planes of Fr 4 appliance and lip seal training for the treatment of angles class I skeletal anterior open bite malocclusion.
6º Angle IMPA 94º-95º Treatment time: about 2 years.little significant effect on AP Growth pattern .25º or less mean -19. Mandibular Rotation.Normal mandibular growth noted 2mm/yr. 25 cases with cephalographs. Mean ANB 5. dental casts and CTscan (Pre & post treatment) were taken.slight decrease in ANB . Changes were compared with normal subjects aaaaat University of Michigan. 10 boys & 15 girls. tomographic and dental cast evaluation of Frankel therapy. dental and condylar positional changes induced by Fr2 therapy.Slight decrease in ANB upto 1º than normal .4º) Facial height: . Cephalometric Data AP skeletal measurement: . AP Skeletal correction .6º & full dental classII MPA . Facial height. Hamilton et al AJODO 1987 Aim : To study skeletal.Normal mandibular growth of 2 mm/yrs was noted. 3.A cephalometric. 2. A small increase in MPA upto 1º was noted. Mandibular Rotation: Small increase in MPA(0. Results: 1.
7. Conclusion: Frankel believed in Moss therapy and a true “functional stimuli” concept.6mm) was noted. Bionator may resemble in some modes of action. 4. Lower incisors proclined 1. Between lower canines is1.5 mm & 2. 2. Believes in full time wear. 5. 1. Indicated in mixed dention for maximum adaptational change.No significant increase in facial height. 3. Incisor Position: Significantly Greater than normal retraction (angular) -4º and -1. His theory of appliance is quite different from activator. 6. Classically used for nonextraction cases. Between Upper canines is not statistically significantly inc as compared to control. Dental cast data: Intercanine width Dist. .2º Molar Position: Slight intrusion of maxillary alveolar height (-0.6 mm inc(significant & more than 1.0 mm (bodily) No significant upper incisor extension was noted.3m more than control) Dist. Step wise advancement of mandible Concentrates on expanding oral functioning space to let the mandible translate down & forward.
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