ORTHOPEDIC
(EXTRAORAL)
APPLIANCES
Functional
appliances
(myofunctional
appliances)
Presented by :
Dr.zahra abdelmalik
Extra-oral appliances
Appliance that worn outside the mouth to gain
force from head and neck to change the
differential growth rate.
Basis for extra-oral appliances: they used the
teeth as a handle to transmit the force to
underlying skeletal structures to produce skeletal
changes
Amount of force: greater than 400 grams per side
Duration of force: 12 to 14 hours per day (during
evening and night )
Orthopedic appliance
Why they worn evening and night?
Because growth hormone is released more
during evening and night
Age of the patient: effective during mixed
dentition period
Orthopedic appliances
Headgear
Facemask
Chin cap (cup)
Headgear
Most commonly used extra-oral
appliance, effective in prepubertal period
and is composed of:
1-force delivering unit(face bow)
2-force generating unit
3-Anchor unit (head cap , cervical strap)
Face bow
Metallic component that helps in delivering
extra-oral force to the posterior teeth
Consists of inner bow, outer bow and junction
Outer bow is made of 1.5 mm round stainless
steel wire, the distal end of outer bow is
curved to form a hook that gives attachment
to the force element
Outer bow is three types:
1-short: if the outer bow is lesser in length
than the inner bow
2-medium: the outer bow is equal to the
inner bow in length
3- long: the outer bow is longer than inner
bow in length
Inner bow is made of 1.25 mm round stainless
steel wire ,the inner bow is inserted into the
buccal tube fixed into maxillary first molar
Stops in the form of
U-loop,
bayonet bend or
friction stop are placed in the bow mesial to
the buccal tube to prevent it from sliding too far
distally
Junction is the point of attachment of
inner bow and outer bow which may be
soldered or welded
The junction is positioned in the midline of
two bows and sometimes is shifted to one
side in case of asymmetric face bow
Face bow
Headgear
Force element provides force , may be
spring, elastic or other stretchable
material
The force element connects the face bow
to headcap/neck strap
The appliance takes anchorage from rigid
bones of the skull or from back of the
neck by means of head cap or cervical
strap or combination of both
Headgear
Types of headgear
1-Cervical pull
2-Occipital pull
3-Parietal pull (high pull)
4- Combination
Cervical pull headgear: the anchor unit is
the tape of the neck(back of the neck),it
produces distal movement of first molar
and maxilla and extrusion of first
molar(contraindicated in anterior open bite)
Cervical headgear
Occipitalheadgear: the anchor unit is the back of the
head(occipital bone),it produces distal movement of
maxilla and first molar and slight intrusion of first
molar
Parietalheadgear: the anchor unit is the parietal
bone.It produces distal movement of maxilla and first
molar and intrusion of first molar(contraindicated in
deep bite cases)
Combination headgear: the anchor unit is at least two
region(i.e the neck and the occiput)
Occipital headgear
Combination headgear
Uses of headgear
1.Orthopedic changes-restrict downward and
forward growth of maxilla( the force in the
range of 350 gm-450 gm)
2.Distalization of molar
3.Anchorage augmentation: to reinforce
anchorage when intraoral anchorage is not
sufficient( the force is 300 gm per side for 10
hours per day)
4. Correction of molar rotation by
adjustment of inner bow so that to
produce rotational force on the molar
5.Space maintainer: by prevention of
mesial movement of first molar
Chin cap (cup)
An extra-oral appliance used in treatment of
skeletal class 111 malocclusion due to
prognathic mandible and normal maxilla
Components:
1. chin cap either custom made or prefabricated
2.force module(elastic or metal spring)
3.headcap :seated on posterior and superior
aspect of the cranium
Duration of wear: 12-14 hours per day
Types: 1- occipital pull 2-vertical pull
Chin cap
Occipital pull: derives anchorage from
occipital bone and is more commonly used
Used in skeletal class 111 cases with mild to moderate
mandibular prognathism and the patients can bring
their incisors into edge to edge bite at centric relation
Vertical pull: derives anchorage from parietal bone
Used in high angled cases or long face patients(steep
mandibular plane angle and excessive anterior facial
height, the patients are usually exhibiting anterior
open bite)
Chin cap
Effects of chin cap
1.Redirection
of mandibular growth in
downward and backward direction
2. Lingual tipping of lower incisors
3. Improvement of skeletal and soft tissue
profile
Facemask
Also known as reverse headgear or protraction
headgear
Used in patients with retrognathic maxilla and
prognathic mandible
Components:
1.Forehead pad(rest)
2.Chin cap
3.Metal famework
4.Elastic
5.Intra-oral appliance
Facemask
Facemask
Biomechanic : the amount of force is one
pound(450gm) per side
Direction of force :15- 20 degrees downward pull to
occlusal plane to produce pure forward translation of
maxilla
If the force is parallel to occlusal plane, a forward
translation as well as an upward rotation takes place
Duration of force: in low force (250 gm) takes 13
months to produce a desired result
In high forces(1600-3000gm) will reduce the
treatment time to 4-21 days
Frequency:12-14 hours per day
Types : according to the shape of metal
framework
facemasks classified into:
1-facemask of Delaire- the metal framework is
squarish in shape
2-Tubinger facemask - the metal framework in
the form two midline metal rods
3. Petit facemask- the metal framework in the
form a single midline rod
facemask of Delaire
Tubinger facemask
Petit facemask
Functional appliances
(myofunctional appliances)
Functional appliances
Appliances that utilize, eliminate, or guide
the forces of muscle function, tooth
eruption and growth to correct
malocclusion.
Why named functional? It was believed
that change in muscle function would
cause a change in growth response.
Timing of treatment: used in growing
patient best in late mixed dentition
Indications for functional appliance:
1-The patient must still be growing
2-The pattern and direction of facial growth
should be favorable
3-The patient must be well motivated
4-Dentition are well aligned
5-The profile improved immediately as the
patient moves the mandible forward( in
class 11) or
as the patient moves the mandible
backward( in class 111)
Changes produced by
functional appliances:
Orthopaedic changes.
Dento-alveolar changes
Muscular changes
1- Orthopaedic changes:
-Accelration the growth in the condylar region.
-Bring about remodelling of glenoid fossa.
-Can change direction of growth of the jaw.
-Can be designed to have restrictive influence on
the growth of the jaw
2-Dentoalveolar changes:
Changes occur in sagittal, transverse and
vertical directions
Sagittal change: most functional appliances
allow the upper anterior to tip palatally and
lower anterior to tip labially
Vertical change: to allow selective eruption of
teeth.
Transverse change: by shielding the buccal
muscle away from the dental arch.
3- muscular change: by improving tonicity
of oro-facial musculature
The components of functional appliances
produce skeletal and dento-alveolar
changes by acting on the:
1-eruption (bite planes)
2-linguofacial muscle balance (shield or
screen).
3-mandibular repositioning( construction or
working bite)
classification of functional
appliances
A- it can be removed by patient or not.
1-Removable functional appliance
(activator,bionator,twin block, frankel)
2- fixed functional appliance (herbst,jasper
jumper,mandibular anterior repositioning
appliance(MARA) )
B- if it is borne by tooth or soft tissue
1- tooth borne passive appliances- e.g
activator , herbst appliance , bionator
Classification of functional
appliances
2- tooth borne active appliances- include
modifications of activator and bionator
that include expansion screws or other
active components
3-tissue borne passive appliances- are
located in the vestibule and have little or
no contact with the dentition e.g Frankel
appliance
Activator Andresen:
Named activator because it has ability to
activate muscle force.
It is modified Hawley’s retainer on upper jaw
to which Andresen added a lower lingual
horse shoe shaped flange which helps in
positioning the mandible forward.
uses: for skeletal class 11,class 1 open bite
and deep bite malocclusion.
Wunderer’s appliance is a modification of
activator
Activator appliance
Wunderer ‘s Activator used for correction of
skeletal class 111 malocclusion.
Wunderer’s appliance is maxillary and
mandibular acrylic portion connected anteriorly
by screw.
Disadvantage of activator Andresen:
1- it is bulky
2- patient can not eat with it
3- patient can not speak accurately with it
Wunderer’s appliance
Bionator Balter
Developed by Balter
Although it is one unit( monoblock) but it is
less bulky.
TYPES:
1- Standard bionator used for correction of
class 11
2- class 111 appliance used for correction of
class 111 malocclusion
3- open bite appliance used for correction of
open bite
Bionator
Twin block appliance
Developed by William Clark
Consists of separate upper and lower
plates having occlusally inclined plane.
Patient can eat with the appliance
Twin block
Functional regulator(Frankel
appliance)
Developed by Rolf Frankel.
It is five types
Frankel 1 (FR1)used for correction of class
11 div 1.
Frankel 2(FR2) used for correction of class
11 div 2
Frankel 3 (FR3) used for correction of
class111
Frankel appliance
Frankel 4( FR4) used for correction of
Open bite and bimaxillary protrusion
Frankel 5( FR5) used for patient with long face
having high mandibular plane angle and vertical
maxillary excess
Frankel
Medium opening activator(MOA)
Itis one piece functional appliance, with
minimal acrylic to improve patient comfort
There is no buccal capping.
Used in class 11 deep bite
Medium opening activator
Herbst
Jasper jumper
