Functional appliances Flashcards

1
Q

what are functional appliances?

A

Variety of appliances which alter the sagittal
and vertical position of the mandible (when
worn by the patient)
 This repositioning generates muscular forces
which result in orthodontic and possible
orthopaedic changes

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2
Q

What are the main functional appliances?

A

Clarktwin block
Andresen activator

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3
Q

Classification of functional appliances?

A

Fixed functional appliances
Removable functional appliances

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4
Q

Fixed functionals?

A

Fixed twin block
Herbst appliance

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5
Q

How does a Herbst appliance work?

A

 piston mechanism each side
 attached to fixed appliance
 +
◦ less cooperation required
◦ more effective??
◦ use simultaneously with FA
 -
◦ complex design
◦ time consuming to fit
◦ more frequent breakages

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6
Q

What are the removable functionals?

A

 Twin Block (Clark)*
 Andresen activator (Andresen)
 MOA
 Bionator (Balters)
 Dynamax (Bass)
 Functional regulator (Frankel)*

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7
Q

Theoretical advantages of functional appliances

A

improve facial aesthetics
 correct dental relationship
 reduce the need for extractions
 reduce the time needed for fixed appliance
therapy
 reduce chairside time
 reduce incidence of trauma
 reduce need for headgear
 removable – facilitates plaque control

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8
Q

Proven advantages
of functional appliances

A

do produce a clinically significant correction in
the A-P dental relationship
 do provide efficient anchorage reinforcement
prior to functional appliance treatment
 allows for full time wear – thereby more effective than headgear at correcting molar relationship
 can be used during mixed dentition phase
 can attach auxiliaries / expand upper arch etc

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9
Q

Disadvantages of functional appliances

A

 cannot produce detailed tooth movement
 do not produce a clinically significant effect on
skeletal bases
 can cause excessive proclination of lower
incisors
 may cause anterior open bite in patients with increased lower anterior face height / minimal overbite
 demand high level of patient cooperation

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10
Q

Advantages of clark twin block vs other functionals

A

 well tolerated (2 piece design)
 full-time wear possible
 eating possible (in theory)
 versatile appliance
◦ eg. elastics / sectional FA
 expansion of upper arch possible
 can add headgear
 can add fixed appliance
 possible to secure clark twin block to functional appliance

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11
Q

Example of what clark twin block does

A

Carries elastic traction to canine

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12
Q

How to functional appliances work

A

The subject of varying opinion,
but forces arising from the facial soft tissues are
undoubtedly the source of the main tooth
movements.

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13
Q

Mode of action

A

 Orthodontic effect…..dentoalveolar

 Orthopaedic effect…..? jaw growth

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14
Q

Mode of action orthodontic effect? upper and lower arch

A

 Upper arch
◦ retroclination of upper incisors
◦ distal movement of upper molars
 Lower arch
◦ mesial movement of lower teeth, including lower
incisors
◦ vertical movement of lower posterior teeth

this allows class I occlusion to be achieved

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15
Q

Mode of action- orthopaedic changes

A

 Controversial

 maxilla
◦ 1-2mm of long term restriction in growth possible
◦ may more long lasting than mandibular change
 mandible
◦ 1-2mm of extra short term growth possible
◦ evidence for long-term gain is limited

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16
Q

what patients are suitable?

A

Mild, uncrowded Class II with well aligned teeth
◦ uncommon in Western Europe
 As first phase in more severe Class II’s, with
second phase of functional appliance
 Anchorage reinforcement in Class II cases
◦ prior to functional appliance Tx
 Interceptive treatment
◦ early Tx to reduce very large overjet
◦ questionable use in certain countries (stiff private
competition)

17
Q

limitations and contraindications*

A

 poor cooperation*
 non-growing PTs*
 high angle cases*
 timing of treatment
 individual tooth movements…difficult
 variability of response

18
Q

Timing of treatment

A

 dental factors
◦ erupted permanent teeth
◦ trauma risk
 psychological factors
 growth
◦ difficult to predict
◦ may not make much difference in any case

19
Q

timing of treatment- growth

A

 Age
 Height
 Hand-wrist radiographs
 Hormone levels
 Secondary sex characteristics

20
Q

Timing of treatment- dental factors

A

 can start functional treatment in mixed dentition
phase
◦ await eruption of 1st premolars
 time start of functional phase to allow progression
straight into functional appliances
◦ avoid temptation to start functional Tx too early
◦ avoid significant pause between 2 stages
 aim in general to start functional treatment at
11/12 years of age

21
Q

Stages for a functional appliance
(CTB )

A

 Assessment
 treatment planning
 consent
 Imps & bite / laboratory prescription
 Fit appliance
 take baseline measurements
 Review visits
 review measurements
 Retention
 night time wear
 plan fixed appliances

22
Q

Bite registration for functional
appliance (CTB )

A

 Estimate amount of sagittal advancement of
mandible needed
 As rule of thumb this is edge to edge
 Ensure dental centrelines are coincident
 Select and try in ProJet jig
 Colour coded
 Insert with single slot to lower
 Demonstrate to patient
 Soften wax into horseshoe shape
 Wax bite should be 2-3mm thicker than planned vertical
opening
 Carefully apply to ProJet jig
 The softened wax bite and jig are placed against
the upper teeth
 Patient is asked to bite into desired position
 Ask patient to hold face mirror while recording bite
 Wax bite removed from the mouth
 Allow wax bite to cool / cool under running water
 The cooled wax bite is tried in again
 Critical to ensure accurate fit against upper & lower teeth
 If necessary soften and carefully any errors
 Consider retaking if not correct

23
Q

Prescription
- design appliance- upper and lower

A

upper
◦ clasp 4s and 6s
◦ split baseplate and screw
◦ labial bow?
◦ acrylic blocks
lower
◦ lower incisor capping or ball clasps
◦ clasp lower 4s +/- 6s
◦ acrylic blocks

24
Q

Review visits

A

 asses cooperation
◦ speech
◦ handling / ease swallowing / hypersalivation
◦ parent
 measure overjet
 record molar relationship
 adjust clasps as necessary
 check / start expansion
 update patient / parent on progress
◦ SMs

25
Advice to patients?
 parent present  full-time wear essential  remove appliance for  eating / cleaning / rough sports / swimming  use box  TLC  OHI  appliance and dentition  written instructions  to back up verbal instructions
26
What is important about retention?
 to assess stability  over-correct  night-time wear  review closely  explain rational carefully to PT and parent
27
most of the growth in children is
dentoalveolar there is inc mandibular growth in some children and perhaps reduced maxillary growth
28
functional appliance treatment integrated with fixed appliance treatment is classically used to treat
class II/i cases