FUNCTIONAL APPLIANCES - ACTIVATOR

INTRODUCTION

• Functional Appliances :
Loose fitting or passive appliances, which harness natural forces of the oro-
facial musculature that are transmitted to the teeth and alveolar bone through
the medium of the appliance

• They aid in growth modification procedures by intercepting and treating jaw

discrepancies

• Theory : new pattern of function leads to new morphologic pattern

 TREATMENT PRINCIPLES OF FUNCTIONAL
APPLIANCES

FORCE APPLICATION FORCE ELIMINATION

 Force application Force elimination

• Primary alteration in form • Primary alteration in function

• Secondary alteration in function • Secondary alteration in form
 HISTORY OF FUNCTIONAL APPLIANCES
• 1879 – Norman Kingsley – Bite Jumping Appliance

• 1902 – Pierre Robin – Monoblock

• 1905- Emil Herbst – Herbst Appliance

• 1909- Viggo Andersen – Activator

• 1950- Wilhelm Balters – Bionator

• 1957- Rolf Frankel – Functional Regulator

CLASSIFICATIONS OF FUNCTIONAL APPLIANCES

• REMOVABLE : Activator, Frankel Regulator

• FIXED : Herbst appliance, Jasper jumper

• SEMI-FIXED : Den Holtz appliance

CLASSIFICATIONS OF FUNCTIONAL APPLIANCES

• TOOTH BORNE PASSIVE: Activator, Bionator ,Herbst

• TOOTH BORNE ACTIVE : Modified activator

• TISSUE BORNE : Frankel Regulator

CLASSIFICATIONS OF FUNCTIONAL APPLIANCES

• GROUP A / TOOTH SUPPORTED : Catalans, Inclined planes

• GROUP B/ TOOTH AND TISSUE SUPPORTED : Activator, Bionator

• GROUP C / VESTIBULAR POSITIONED : Oral screen , Frankel

CLASSIFICATIONS OF FUNCTIONAL APPLIANCES

• GROUP I : Transmit muscle forces directly onto teeth – Oral screen

• GROUP II : Transmit forces of mandibular repositioning onto teeth –

Activator

• GROUP III: Transmit forces of mandibular repositioning but area of action is

in vestibule – Frankel regulator
CLASSIFICATIONS OF FUNCTIONAL APPLIANCES

• MYOTONIC APPLIANCES : Depend on muscle mass for action – H

activator

• MYODYNAMIC APPLIANCES : Depend on muscle function for action – V

activator
ACTIVATOR
 ACTIVATOR HISTORY
1908- Denmark – Viggo Andersen
Andersen called it a biomechanical working retainer
In NORWAY , worked further on activator appliance , thus it is also
known as Norwegian Appliance

Named it ACTIVATOR due to its ability to activate muscle forces

PARTS OF ACTIVATOR

Wire Components
Construction Bite
INDICATIONS AND CONTRAINDICATIONS

1. Class II Div 1 and 2 1. Class 1 crowding

2. Class III
3. Class I open bite , deep
Bite
4. Children with decreased
lower facial height
2. Proclined lower incisors
3. Children with increased
lower facial height
4. Non growing patients
 MODE OF ACTION OF ACTIVATOR

Stretching of muscles
Contraction of muscles

MYOTACTIC REFLEX
MODE OF ACTION OF ACTIVATOR
Appliance –loose
fitting
Mandible move
forward

Stretching of muscles

Contraction of
elevator muscles

Mytotactic reflex

Kinetic energy
generated
MODE OF ACTION OF ACTIVATOR

Restrict maxillary forward growth and

causes slight distal movement

Reciprocal forward thrust on mandible

 TRIMMING OF ACTIVATOR

Vertical control Sagittal control Transverse control

INTRUSION EXTRUSION PROTRUSION RETRUSION ARCH

EXPANSION
 VERTICAL CONTROL
Intrusion of anteriors and posteriors

Loading at the incisal edges

Loading at cusp tips of posterior teeth

 VERTICAL CONTROL
Extrusion of anteriors and posteriors

Loading on lingual surfaces above the

area of greatest convexity in maxilla and
below in mandible

Loading on lingual surfaces above the

area of greatest convexity in maxilla and
below in mandible
 VERTICAL CONTROL
Extrusion of anteriors and posteriors Intrusion of anteriors and posteriors
 SAGITTAL CONTROL
Protrusion of anteriors

Load on entire
lingual surface or
loading only at the
incisal portion
 SAGITTAL CONTROL

Retrusion of anteriors

Acrylic is trimmed off from the

lingual surfaces of anterior teeth
 SAGITTAL CONTROL

Retrusion of anteriors Protrusion of anteriors

 SAGITTAL CONTROL

Mesial movement of posterior teeth

Loading of acrylic in the distolingual

portion of posterior teeth will cause
mesiobuccal movement
 SAGITTAL CONTROL
Distal movement of posterior teeth

Loading of acrylic in the mesiolingual

portion of posterior teeth will cause
distobuccal movement
 SAGITTAL CONTROL
Distal movement of posterior teeth Mesial movement of posterior teeth
TRANSVERSE CONTROL

Expansion buccally

Loading of acrylic on lingual

surfaces will lead to slight
expansion of the arches
 ADVANTAGES AND DISADVANTAGES

Disadvantages Advantages

Economical
Require fixed orth Shorter appointme
odontic nts and
therapy later longer inter appoin
tment
intervals
Requires patient c Minimal oral hygi
oo peration ene problems
Uses existing grow
th of jaws
 MODIFICATIONS OF ACTIVATOR

• Construction bite modifications:

1. Low construction bite with marked mandibular forward

advancement / H activator :

- Given in class II Div 1 malocclusion with horizontal growth pattern

- Vertical opening is minimum and within interocclusal clearance

 MODIFICATIONS OF ACTIVATOR
• Construction bite modifications:

2. High construction bite with slight mandibular forward advancement / V

activator :

- Given in class II Div 1 malocclusion with vertical growth pattern

- Vertical opening is maximum ranging between 4-6mm

 MODIFICATIONS OF ACTIVATOR
• Construction bite modifications:

3. Construction bite without mandibular forward positiong :

- Given in open bite and deep bite cases

- No forward positioning of mandible

 MODIFICATIONS OF ACTIVATOR
• Construction bite modifications:

4. Construction bite with opening and posterior position of mandible :

- Given in class III malocclusion

- Vertical opening of 5mm and retrusion of 2mm

 MODIFICATIONS OF ACTIVATOR

• Bow activator : by A.M Schwarz

 MODIFICATIONS OF ACTIVATOR

• Bow activator : by A.M Schwarz

• Maxillary and mandibular components

are split horizontally and connected by
an elastic bow

• For Step wise advancement of mandible

 MODIFICATIONS OF ACTIVATOR

• Propulsor/ hybrid appliance : By Muhlemann

- Monobloc + oral screen

- Eliminates functional
retrusion tendencies
 MODIFICATIONS OF ACTIVATOR

• Cut out / palate free activator : By Dr. Klaws Metzelder

- Similar to bionator

- Comfortable for patients to wear

 MODIFICATIONS OF ACTIVATOR

• Wunderer’s modification :
- Maxillary and mandibular component of
activator are connected anteriorly by a
screw

- This screw when opened produces

anterior movement of maxillary component
and reciprocal posterior thrust on mandible

- For class III cases

 MODIFICATIONS OF ACTIVATOR

• Reduced activator / Cybernator : By Schmuth

- Similar to bionator

- Acrylic from the palatal vault area is

removed and an omega shaped wire is
incorporated
 MODIFICATIONS OF ACTIVATOR

• Karwetzky modification:

- Maxillary and mandibular

components are joined by a U bow
in 1st molar region

- For step wise advancement

- U loop / U bow has one shorter arm

and one longer arm
 MODIFICATIONS OF ACTIVATOR

• Karwetzky modification: Type I

- Longer arm of U loop is placed

posteriorly

- For mandibular advancement in

class II Div 1 cases
 MODIFICATIONS OF ACTIVATOR

• Karwetzky modification: Type II

- Longer arm of U loop is placed

anteriorly

- For mandibular setback in class III

cases
 MODIFICATIONS OF ACTIVATOR

• Karwetzky modification: Type III

- U loop arms are placed vice versa

on opposite sides

- For assymetric advancements of

mandible
 MODIFICATIONS OF ACTIVATOR

• Herren’s modification :

- Arrowhead/triangular/ Jackson’s clasps

are incorporated

- Sagittal advancement of mandible is upto

feasible maximum
THANK YOU