Neural Mechnism and Physiologic Basis / Orthodontic Courses by Indian Dental Academy

Physiologic Basis & Neural
Mechanism Of Functional
Appliances

INDIAN DENTAL ACADEMY

Leader in continuing dental education
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Definition

Aims of Functional Appliance
Therapy
Functional Appliance Therapy aims to improve the
functional relationship of dentofacial structure by
eliminating the unfavorable factors and improving
muscle environment enveloping the developing
occlusion.
Through alteration of teeth and supporting
tissues,a new functional behavior pattern or
engram is established that can support a new
position of equilibrium.
An Increasing recognition of the interrelationship
of form and function
The realization of the neuromuscular
involvement
Recognition of the importance of airway
Recognition of the role of excessive
epipharyngeal lymphoid tissue on head posture
and accomplishment of dentofacial pattern
3M
Muscles
Malformation
Malocclusion
The physiologic basis of
functional Appliances
Role of Respiration
Role of tongue
Role of Deglutition
Role of Lips
Role of Temporomandibular Joints
Role of Respiration
The size and shape of the nasopharyngeal space must be adequate for functional
demands
Linder - Aronson Study I 1960
Mouth breathing was associated with crowding and narrow upper Jaws on patients with long and
narrow faces.

Study II 1970
Adenoidectomies were performed in 81 children with nasal obstruction problems
A comparison of mouth breathers was made with a equal number of nose breathers of similar gender
and age
Children with obstructed nasal breathing were characterized by increase in lower and total facial
heights
The greatest difference between the two groups was in the vertical development of face and not in
the anteroposterior jaw relation
The breathing changed from mouth breathing to nose breathing
The breathing pattern remained unchanged
Factors contributing to alteration in the
posture of Mandible
Frequent Respiratory
Infection
Nasal Septum Deviation Contracted Maxillary Arch
Swollen Nasal
Mucosa
Enlarged Adenoids
Reduced Nasal Breathing
Decrease In Nasal Width
Mouth Breathing
Lowered Tongue Position Extended Head Posture
Lowered Mandibular Posture
Role of Tongue
Abnormal Tongue posture and Function
Primary factor as a consequence of
Retained infantile deglutitional pattern
Abnormal oral habits

Secondary Factor
Adaptive to the unfavorable morphologic pattern

Functional Appliances are indicated when the role of the
tongue malfunction is primary

Role of Deglutition
Anterior Lip seal and a posterior oral seal

Tongue and soft palate

Creates negative pressure in the oral cavity

Cheeks are sucked in to the interocclusal space

Mandible returns to postural rest position

Constricts the dentoalveolar process

Prevents eruption of buccal segments

Offsets the intrinsic force potential of tongue
Role Of Lips
The configuration of the lips should be studied in relaxed position
for assessing incompetency
If there is slight contact or a small gap between the upper and
lower lips,they are said to be competent
If there is a wide gap , or if the lips are too short ,they can be
considered incompetent. Improvement with orthodontic treatment
and exercise is possible only in early stages
If the lips seems normally developed but the incisors are labially
tipped making closure difficult, Ballard And Tulley call this as
potential lip incompetence
Method Of Operation of
Functional Appliances
Theories of Cranio Facial Growth
Genetic Control Theory
Genotype supplies all information for phenotype
Cartilage Directed growth Theory
Scott ( Nasal septum ,condyle ,Synchonedroses )
Functional Matrix Theory
Melvin Moss
Periosteal Matrix
Capsular Matrix
Servosystem Theory
Primary Cartilage - General Extrinsic Factor ( STH, Thyroxinel )
Secondary Cartilage Local Extrinsic Factors ( Functional Orthopedic
Devices )

Control Of Maxillary Growth
Growth in length of
upper Jaw

Growth in width of
upper Jaw
Control Of Mandibular Growth

Servo System Theory
Gm - Lengthening of Maxilla

Gc + - Growth of condylar cartilage
after resection of LPM

Gc ++ Growth for minimal activity of
LPM

Gc+++ Growth for Maximal activity of
LPM
Morphogenetic Classification Of
Human Facial Development

Causal Interpretation of mode Of Operation
of Functional Appliances

Increased Contractile activity of LPM

Intensification of repetitive activity of retrodiscal pad

Increase in growth stimulating factors

Enhancement of local mediators
STH GROWTH HORMONE
TESTOSTERONE
INSULIN
THYROXIN
CALCITONIN
PARATHORMONE
GROWTH PROMOTING PEPTIDES
Reduction of local regulators

( Factors having negative feed back effects on cell multiplication )
CYCLIC AMP
PROSTAGLANDIN E2
SOMATOSTATIN LIKE SUBSTANCE

Change in condylar trabecular orientation

Additional growth of condylar cartilage

Additional subperiosteal ossification of the posterior border of the mandible

Supplementary lengthening of the mandible

Neural Pathway for reflex and Volitional
control of the Masticator Nucleus
Proprioceptive fibers arising from Periodontal membrane ,Muscles of Mastication,TMJ

Ascend Via Trigeminal nerve to the brain stem

Mesencephalic nucleus

Descends to the masticator nucleus on the ipsilateral side

Synapses with the lower motor neuron

Caries motor impulses to the muscles of mastication via Trigeminal Nerve
Reflex control of Skeletal Muscle contraction
Stretch of Muscle

Stimulus for Stretch Reflex

Stretch reflex elicited

Contraction of Stretched Muscle

Muscle stretch receptors muscle spindles proprioceptive nerve endings

Impulses from muscle spindle

Synapse with motor neurons

Supply extrafusal muscle fibers

Contraction of Stretched Muscle
Neural Control Of Skeletal
Muscle Contraction
Activation Of Gamma Efferents

Polar Contraction of Intrafusal Fibres

Non Contractile Nuclear Bag Tensed

Initiate spindle discharge in absence of
external discharge

Acts as a biasing Mechanism

Mechanism of Skeletal Muscle
Contraction
Functional Significance
Serves as a mechanism for
upright posture

Acts in the mandibular
musculature to maintain
Postural rest position of the
mandible in relation to maxilla
Clasp Knife reflex Or
Autogenic Inhibition
Functional Significance
Protects the overload by
preventing damaging
contractions against strong
stretching forces
Role of Lateral Pterygoid Muscle in Growth
Of Condylar Cartilage
Multiplication of Skeletoblasts in condylar cartilage

Skeletoblasts differentiate in to prechondroblasts

Resection of LPM

Significant slowing of condylar cartilage growth rate

Skeletobalsts no longer differentiate in to prechondroblasts

Percentage of skeletoblasts increases to the detriment of the prechodrobalsts

Prechondroblasts decreases in number

Skeletoblasts begin differentiating in to Preosteoblasts and Osteoblasts

The condyle then increases in size through periosteal type of growth

Prechondroblasts may have an inhibiting effect on the skeletoblasts
differentiating in to preosteoblasts

Role of Retrodiscal Pad
The retrodiscal pad controls the mandibular growth in two ways
Vascular Component
Controls the condylar cartilage growth rate and endochondral ossification rate
An increase in activity of the retrodiscal pad produces an increase in condylar
cartilage growth ossification
Biomechanic Component
Governs both bone apposition and condylar growth direction at posterior border
of the ramus
An increase in the interactivity of the retrodiscal pad produces an accentuation of
the ramus posterior concavity and a local increase in bone apposition and he
number of negative charges at the ramus posterior concavity surface
It also produces an accentuation of the ramus anterior convexity and a local
increase in bone resorption and the number of positive charges at the ramus
posterior convex surface

Interruption of the circulatory dependence on the blood supply originating
directly from LPM and directly through the retrodiscal pad may contribute to the
inhibited differentiation of skeletoblasts

Surgical excision of the retrodiscal pad and anteriorly displaced articular
disks,destroying intracapsular metabolism pump function of the retrodiscal pad,
dramatically demonstrates the mechanistic Iatrogenic potential of
nonphysiologic surgery

After surgical resection of the LPM the growth of the condylar cartilage and the
lengthening of the mandible continue but are significantly reduced.
Relationship of Retrodiscal Pad
and Lateral Pterygoid Muscle
Condylar Cartilage - Growth Direction
Mitosis distribution and
area of concentration a
sagittal section of
condylar cartilage.The
cartilage surface is
divided in to 4 sections
Endochondral Bone Trabeculae in
Mandibular Condyle
Diagram
Biologic Features of Primary & Secondary
Cartilages
Primary Cartilage
Epiphyseal ,Nasal
Septum,Spheno occipital
Synchondrosis
Secondary Cartilage
Condylar, Coroniod,Angular
cartilages
Intrinsic Regulation of condylar
Cartilage Growth Rate
The acceleration Maturation of
Chondroblasts
Growth Stimulating effect of
Thyroxinel

Chondroblasts Hypertrophy
Prechondroblasts Division
Restraining Signal
Growth Stimulating effect of


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