Functional Appliances in Orthodontics

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Questions and Answers

What is a key benefit of fixed functional appliances (FFAs)?

  • They provide continuous stimulation for mandibular growth. (correct)
  • They are easily removable for cleaning.
  • They require consistent patient cooperation.
  • They are only suitable for children.

Which appliance employs a telescopic mechanism for maintaining the mandible's position?

  • Herbst appliance (correct)
  • Jasper jumper
  • MARA appliance
  • Forsus appliance

What feature distinguishes the Forsus appliance from other functional appliances?

  • It is specifically designed for Class III malocclusion.
  • It is solely a removable device.
  • It uses metallic frameworks.
  • It incorporates flexible open coil springs. (correct)

Which of the following statements about the MARA appliance is incorrect?

<p>It is not suitable for vertical and transverse malocclusions. (A)</p> Signup and view all the answers

What determines the choice of functional appliance used for a patient?

<p>The age, malocclusion, and growth pattern of the patient. (D)</p> Signup and view all the answers

Which of the following is classified as a removable functional appliance?

<p>Bionator appliance (B)</p> Signup and view all the answers

What is the primary mechanism of action for removable functional appliances?

<p>Applying force to the dentition and basal bone (B)</p> Signup and view all the answers

What action does the Bionator appliance use to promote dental changes?

<p>Passive muscle stretch with a large movement (D)</p> Signup and view all the answers

Why is force elimination important in the function of removable appliances?

<p>It prevents abnormal forces affecting the dentition (D)</p> Signup and view all the answers

Which option describes the main focus of the Bionator appliance?

<p>To improve occlusal development through muscle stimulation (D)</p> Signup and view all the answers

In which circumstance would a removable functional appliance likely be ineffective?

<p>In cases of severe skeletal discrepancy (D)</p> Signup and view all the answers

How does a functional appliance achieve myodynamic action?

<p>By stimulating muscle activity with minimal opening (A)</p> Signup and view all the answers

What is the primary purpose of using a removable functional appliance like the Activator?

<p>To encourage the growth of cranio-facial structures (A)</p> Signup and view all the answers

What is the primary mode of action for the Lip Bumper?

<p>Changes muscle balance and stretches the perioosteum (D)</p> Signup and view all the answers

Which of the following descriptions matches the Bionator appliance?

<p>A passive appliance for regulating muscle activity and dental arch shape (A)</p> Signup and view all the answers

Which is NOT an indication for using a Lip Bumper?

<p>Severe dental crowding (A)</p> Signup and view all the answers

Which feature distinguishes the Bionator from the Andresen Activator?

<p>It includes a palatal loop to encourage forward posture (A)</p> Signup and view all the answers

What age group is indicated for Class II functional appliance treatment?

<p>11 to 13 years for girls, 12 to 14 years for boys (B)</p> Signup and view all the answers

Which effect does the Twin Block Appliance primarily aim to achieve?

<p>Encourage proper anterior positioning of the mandible (A)</p> Signup and view all the answers

What should the vertical opening of a wax bite for functional appliances be?

<p>2-6 mm (C)</p> Signup and view all the answers

In which scenario would the Intrusive Myofunctional Appliance be utilized?

<p>To retain space after premature loss of primary teeth (C)</p> Signup and view all the answers

What characteristic is true for the design of the Open-bite Bionator?

<p>Encourages a specific forward posture for the mandible (B)</p> Signup and view all the answers

What is one primary reason for using removable functional appliances?

<p>To allow for ease of cleaning and adjustment (A)</p> Signup and view all the answers

Flashcards

Herbst Appliance

A type of functional appliance that helps correct Class II malocclusions by continuously protracting the mandible, encouraging forward growth of the lower jaw.

Forsus Appliance

An FDA-approved flexible functional appliance that uses springs to protract the mandible, allowing for comfortable movement in all directions.

MARA Appliance

A fixed functional appliance designed to advance the mandible by using stainless steel crowns and tubing, with elbows guiding forward movement.

Fixed Functional Appliances (FFAs)

Fixed Functional Appliances (FFAs) are orthodontic appliances that are permanently attached to the teeth, providing constant forces to guide jaw growth and correct malocclusions.

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Functional Appliances

Functional appliances are used to correct malocclusions, especially Class II, by guiding jaw growth and improving the relationship between the upper and lower teeth.

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What are functional appliances?

Functional appliances are devices that aim to change the position of the jaw, usually by using gentle forces to encourage growth and development. They are customized to work with the muscles and tissues of the face.

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Lip Bumper Appliance

A removable appliance that aims to change muscle balance and stimulate bone growth by stretching the periosteum.

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Bite Registration for Functional Appliances

A method of taking a mold of the patient's bite to create a custom-fit appliance.

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How do functional appliances work?

Functional appliances work by applying gentle forces to the teeth and the base of the jaw bone, causing changes in the bones and tissues. The body then adapts to these changes, creating a better alignment of the teeth and jaw.

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Bionator Appliance

An appliance that influences the tongue and surrounding muscles to correct bite issues and promote proper growth.

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What's the purpose of functional appliances?

Functional appliances provide controlled forces to the teeth and jaws that encourage bone growth and movement. These forces promote a better alignment of the teeth, improving the bite and overall dental health.

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How does Proffit classify functional appliances?

Proffit classifies functional appliances based on how they hold the jaw in place. This classification includes tooth-borne passive appliances that use soft tissue stretch, tooth-borne active appliances with springs and screws, and tissue-borne appliances that use soft tissue pressure.

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Andresen Activator Appliance

The Andresen Activator is a removable appliance used to correct problems like an overbite by encouraging the lower jaw to move forward.

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Twin Block Appliance

A removable appliance that encourages forward tongue placement and promotes jaw growth.

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How are functional appliances classified according to Vig?

Vig's classification groups functional appliances based on how they affect muscle activity. This includes myotonic that uses muscle stretches, and myodynamic that stimulates muscle movement with a shorter opening of the jaw.

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Class II: Actively Growing Patient (Boys)

The age range when boys are typically experiencing a growth spurt.

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How does Hunt's classification categorize functional appliances?

Hunt's classification separates functional appliances based on how they are fixed to the teeth. This includes fixed appliances that are permanently attached, removable appliances that can be taken out, and semi-fixed appliances that have some parts that are permanently fixed and others that are removable.

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What is the principle of functional appliance therapy?

A key principle of functional appliance therapy is that changes in how the jaw works will lead to changes in its shape and structure. The body will adapt to the new way the jaw functions, leading to a better alignment and growth.

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Class II: Actively Growing Patient (Girls)

The age range when girls typically experience a growth spurt.

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What are the two principles behind functional appliance therapy?

Force application involves using gentle forces to encourage bone growth and movement. Force elimination involves removing forces that are causing problems with teeth or jaw alignment

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Removable Functional Appliances

These appliances are used to correct bite issues and help with the healthy growth of the jaw and teeth.

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Anchorage in Orthodontics

The ability of an appliance to control the movement of teeth, usually by using strong teeth for support.

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Myodynamic Passive Appliance

The concept that tongue posture and surrounding muscle activity influence jaw growth and the shape of the teeth.

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Study Notes

Functional Appliances

  • Functional appliances alter the mandible's position, aiming to improve occlusal development or craniofacial skeletal growth.

History

  • 1879: Kingsley first used removable appliances to alter bite.
  • 1900s: Pierre Robin developed a device for glossoptosis syndrome.
  • 1950s: Schwartz introduced a double plate for bite correction.
  • 1960s: Balther created the bionator, and Fränkel introduced a Frankel system for various malocclusions.
  • 1970s: Clark developed a twin block for Class II malocclusions.

Classification by Retention Mode

  • Tooth-borne passive appliances: Achieves antero-posterior or transverse changes through soft tissue and muscle activity.
  • Tooth-borne active appliances: Uses screws and springs for internal forces.
  • Tissue-borne appliances: Placed in the vestibule, avoiding direct forces on soft tissues, to allow jaw growth.

Classification by Action

  • Myotonic action: Produced by muscle mass, causing a passive muscle stretch, with large mandibular movement (8-10 mm).
  • Myodynamic action: Stimulates muscle activity with a medium opening (<5mm).

Classification by Calcification (Hunt)

  • Fixed appliances: Herbst, Jasper Jumper
  • Removable appliances: Bionator, Activator
  • Semi-fixed appliances: Lip bumper, Bass appliance

Principle of Functional Appliance Therapy

  • Adaptation between form and function is crucial.
  • Neuromuscular adaptation allows for form and function adjustment.
  • Two main principles:
    • Force application: Applied to dentition and basal bone to alter form and shape.
    • Force elimination: Prevents abnormal forces on dentition, leading to functional change.

Mechanism of Action

  • Redirection of musculature: Alters muscle patterns.
  • Lateral pterygoid muscle stimulation: Encourages active muscle participation.
  • Decreased biochemical feedback: Encourages condylar growth by inhibiting mitotic stem cell activity.
  • Unloading of mandibular condyle: Distraction allows for condyle growth.
  • Differential eruption of teeth: Modifies tooth eruption according to treatment needs.

Skeletel Changes

  • Changes in the growth and position of the various bones of the face and head are documented using models.

Dentoalveolar Changes

  • Changes in the teeth include proclination of lower incisors, retraction of upper incisors, differential eruption, and distalization/mesialization of molars.

Effect on Oropharyngeal Airway

  • Mandibular deficiency can reduce airway dimensions and respiratory function.
  • Changes in airway dimensions during treatment are measurable.

Full Potential of Functional Appliances

  • Patient cooperation, skeletal issue severity, and active growth are key factors.
  • Effective growth spurts vary based on the malocclusion type (Class II/III).

Advantages/Disadvantages of Functional Appliances

  • Advantages*:
  • Early intervention possible.
  • Aids normal bone growth.
  • Easier to maintain oral hygiene.
  • Disadvantages*:
  • Not suitable for all patients (adults).
  • Patient cooperation needed.
  • Cannot correct all dental issues.

Bite Registration for Fabrication of Functional Appliances

  • Procedures for registering the mandible's position are documented.
  • Different functional appliance types are mentioned.

Removable Functional Appliances

  • Information on specific appliance types (lip bumper, bionator, Activator, etc.) details their mode of action, indications, and contraindications.

Fixed Functional Appliances

  • Describes the concept of fixed functional appliances (FFAs), their advantages, and examples including Herbst and Forsus appliances (plus MARA).

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