‫بسم الله الرحمن الرحيم‬

Functional Appliances
Ortho Lec # 6
26.03.09
You took fixed appliances and removable appliances which are
classified according to their state, if they can be removed from
the mouth by the pt or not. From these examples of these
appliances, we have a very special type of orthodontic appliances
that can be used only for growing pt to take the advantages
of growth to adjust certain malocclusion. Some old people think
that malocclusion in their ages isn’t correctable, but this isn’t true
because it can be adjusted by fixed or removable appliances, but
ofcausre not with functional appliances because they have been
passed the age of growth.

The idea of functional appliances has been started very early

from the last century (1912), and they said that if certain muscle
(like in case of short lip) can affect the teeth and cause
malocclusion and we opposite the action of this muscle, then we
can correct the malocclusion.

For the functional appliances we have a rational which is to

reduce the effect of certain muscles and promote or increase the
effect of other muscles, depending on that malocclusion.

There is a thought that has been published that said, if the

condyle present in the most protracted position without any load
on it, then it will enhance the growth of the condyle in an upward-

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backward direction, and that will increase the growth of the
mandible.

Now we will concentrate about our topic in this lecture, and we

have to know that with the help of the functional appliances we
can treat class II and class III malocclusion and even vertical
discrepancies.

We know that skeletal class II happens mostly due to small

mandible, or due to large maxilla, or due to the combination of
both.

Now we will talk about the classification of the functional

appliances:

1) According to the support:

a- Tissue born: which includes active and passive.

b- Tooth born.

1) According to the state:

a- Removable appliances: most of them are tooth born

and we have a lot of examples that correct class II
malocclusion like: Andresen and Twin block
appliances.

b- Fixed appliances: like herbst and jasper-jumper

appliances (all what we have to know is the name and
the shape).

Moveme
nt
direction

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 This is the herbst appliance, it consist of a metal rod that has
been inserted in a metal tube (stainless steal), and it forces the
mandible to move anteriorly (protrusion) to correct class II
malocclusion, it’s available commercially with different sizes and
only we have to put it in the pt mouth. Don’t think that the rod
that looks like the elastic in fixed appliances will do the same job,
elastic will pull the mandible backward, but herbst will push it
forward.

Removable Appliances:
1) Andresen appliance:
– Indications:

a- Used for class II dev I malocclusion.

b- Like all functional appliances, it’s used in a growing

pt, it’s a must.

c- Teeth should be well aligned.

d- Proclined upper teeth and retroclined lower teeth.

e- Normal or increased overbite.

This is the Andresen appliance (search about it in the slides)

which is used to treat class II dev I malocclusion with proclined
upper teeth and retroclined or normal lower teeth also with

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normal or increased overbite. We should have well aligned teeth
because if there is any crowding then we have to have a fixed
appliance after the functional one and that will make the pt tired
from the treatment, then we have to start with fixed appliance.

– Composition: it’s composed from a wire (0.9 mm) that

made as a labial bow to restrict the growth of the
maxilla and acrylic base plate.

– If we face a pt with all the conditions that make him

candidate for Andresen functional appliance like: class II
dev I, deep bite, well aligned teeth, proclined upper
incisors, retroclined lower incisors, and the most
important a growing pt, then we have a steps of
treatment that we have to follow, which are:
a- Impressions: either we take it twice, one for the
study model as a pretreatment record in addition to
the lateral cephalometric radiograph, and another
one which is a working model.
b- Normal bite in the centric occlusion.
c- The most important thing to make during the
treatment of this pt by which is “THE FUNCTIONAL
BITE”**, to achieve this bite we ask the pt to move
his mandible forward and to reach edge to edge
relationship of the incisors, then we insert a wax rim
between the teeth and behind the incisors (we have
to have an anterior open bite during taking the
functional bite) and take the bite, so we must have
an edge to edge relationship and anterior open bite
between the incisors. There is no need to make a
wax rim that covers all the posterior teeth, maybe 3
teeth are enough to guide you to put the upper and
lower casts together.

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 – You have to know the properties of the functional bite
because it’s a very important step in the treatment,
these properties are:
a- In the anterior-posterior plane: we ask the pt to
bring the mandible as forward as the pt can until he
reaches edge to edge, but if the overjet is very big
(>8-10mm) then the pt will face a difficulty in
reaching this relationship because that will be
beyond the tolerance of the facial muscles, in these
cases we ask the pt to bring the mandible forward
as much as he can and then we move it backward
about 2 mm to give the muscles a little freedom for
relaxation.
b- Vertical plane: it’s a must to have a separation
between the incisors about 2 mm (anterior open
bite) and posteriorly about 6 mm with the
maintenance of the midline unless if it’s shifted due
to functional shifting of the mandible, then we try to
correct it, but if the midline shifted due to dental
reason, then we have to maintain it.
c- Transverse plane.
**See the functional bite in the slides.
Note: in Andresen functional appliance we do capping on
the lower incisors to prevent their proclination, and a posterior
bite block to prevent supra-eruption of the lower and upper
molars. Another important note is that a pt with Andresen
functional appliance can’t eat while wearing the appliance, then
we instruct the pt to wear it 12-14 H/day from after the lunch
till the next morning.
You know that the teeth move 1 mm per month, then if we have a
case with 8 mm overjet and we want to reach a normal one (2

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mm) then we will have a 6 month treatment period, after that we
keep wearing the appliance for retention.

We said that we use Andresen functional appliance when we

have a deep bite, the question is:

Why we don’t remove the

posterior block to allow supre-
eruption of the posterior teeth to
correct the deep bite ??
Because first of all we correct the overjet to reach a normal
one, then we can correct the molar relationship by a process
called “CHANNELING”, we start trimming the acryl from the
occlusal surface in a special way to guide the eruption of upper
and lower molars, in this case we are talking about class II molar
relationship, then we have to cut the acryl in a way to force the
upper molars to move posteriorly by trimming the acryl from the
occlusal part and moving distaly and downward, on the other
hand we trim the lower part of the acryl and move upward and
mesialy to allow the lower molars to move forward, and that will
help in the correction of molar relation and canine relation. This
process is applicable in case of class II molar relationship, but
sometimes we may face a case of class II dev I incisor with a class
I molar relationship where we don’t need channeling.

Let’s assume that we construct a functional appliance and

How we can
gave it to the pt for a month and a half,

know that he wear it this

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period?? and how we can know
if the relation improved ??
1- We check the molar relationship.
2- The overjet should be reduced.
3- The overbite also should be reduced.
Note: if we notice a reduction in the overjet only with
unchanged molar relationship, then we reached only a dental
effect of retroclination of the upper teeth and maybe proclination
of the lower teeth. But if we notice changes in both the overjet
and the molar relationship, then we got a forward movement of
the mandible.

Can we move the maxilla

backward??
It doesn’t go back, it stops where it is because there is a lot of
structure behind it, but by the help of the wire from the functional
appliance (labial bow) we restrict its growth and prevent it from
coming forward, but the mandible is free to move anteriorly and
catch up with the maxilla.
The
inclined
1)Twin block :
surfeces

Moveme
nt
direction

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– It’s another common type of a removable functional
appliances.
– Has the same effect as Andresen functional appliance,
also has the same indications, the same bite
construction, and the same effect, but more tolerable
by the pt because it’s composed of two pieces and
easier for the pt to wear it, the upper piece has the same
labial bow as the one in Andresen but with thickness of
0.7 mm. Because it’s composed of two pieces, then we
can incorporate a screw between these pieces in
case of crossbite in addition to the class II.
– Each piece of the appliance has its own posterior bite
block, but they have a special configuration that force
the mandible to move forward when the pt wear it, both
of the bite blocks have an inclined surface (45°) that will
slide over the other surface, in the lower bite block, the
inclined surface is suited distaly and in the upper surface
it’s suited mesialy, by this the mandible will be forced to
slide forward.
– We know that if we have a sever overjet (12 mm), then
we construct an Andresen functional appliance for a 6-8
months until the overjet become 6 mm, then we
construct a new appliance according to the new overjet
to complete the treatment and correct the overjet to 2-3
mm. In case we want to us the twin block in sever
overjet, there is no need for two appliances, we only add
wax to the inclined surfaces, then the pt will be forced to
move the mandible more forward than what he use to do
before adding the wax.

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 – In Andresen functional appliance we did capping in the
lower arch, but in case of twin block, we will do a labial
bow with a wire of 0.6 mm thickness that will prevent
the proclination of the lower teeth as the cap will do.
– We said that the twin block is more tolerable by the pts
and they can speak and eat with it, then we instruct
them to wear it 24 H/day.

1)Bionator :
– It’s another removable functional appliance composed of
one piece without acryl in the palate, we have a caffen
spring there.
– It's similar to Andresen but without the acryl that cover
the palate.

Caffe
n
sprin

1)
Harvold:
– Has a high anterior open bite (about 7 mm), but with the
other functional appliances we have a 2 mm anterior
opening.

Now we will shift our talking to another type of functional

appliance which is the TISSUE BORN appliance, the only
example about this type is the Frankel appliance:

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 – Designed by the German professor frankel, and they
claim that it’s the best functional appliance for the
treatment of class III malocclusion, but also it’s used for
class II.

– The only disadvantage that its construction is very

difficult and very expensive, and because of that, plus
the fact that there is a substitutions for it in the
treatment, they aren’t used anymore although they are
very good appliances.

Bucc
al
shiel

Labi
lingu al
al shiel
shiel
– They promote the growth of the
maxilla in class III, and the growth of the
mandibular alveolar bone in class II.

– One of its components is the buccal shield which

prevents the effect of the cheeks on the teeth and
makes stretching to the mucosa, so they promote the
growth of the alveolar bone and causes increase in the
width of the maxilla. Also anteriorly it makes a kind of
expansion.

– Another component is the labial pads that prevent the

effect of the lip and make stretching to increase the

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 alveolar bone anteriorly, also we have a lingual shield
that prevents the effect of the tongue.

Now what
That all was about the functional appliances,

is the main effect of the functional

appliances?? From the most important to the least:
1- Retroclination of the maxillary incisors.

2- Proclination of the mandibular incisors.

3- Extrusion of the posterior teeth when needed by channeling.

4- Forward positioning of the mandible.

5- Might enhance the mandibular growth: according to some

studies they found that the mandible grows about 1-2
mm/year, put clinically, this 2 mm will do nothing to the
problem.

In the treatment of class II malocclusion, our aim is to stop the

growth of the maxilla, but after we finish the treatment and
Did the maxilla start
remove the appliance,

growing more than the mandible and

create a class II malocclusion again??
Ofcaurse that will happen, and to prevent that we have to have
the functional appliance as a retainer until the end of the growth.

That last topic in this lecture is the Extraoral

Appliances or HeadGears. We said that the functional
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appliances are under the category of growth modification, in
addition to these intraoral appliances, we have the headgears or
extraoral appliances, these extraoral appliances can be used
either to restrict the growth of the maxilla, or to distalize the
upper 1st molars, or to increase anchorage and to prevent the
forward movement of the upper 1st molar. There is a theory says
that the headgears has more effect on the maxilla than the
mandible, therefore, in class II malocclusion that happen due to a
large maxilla, it’s more convenient to use the extraoral
appliances, on the other hand, if this class II is due to small
mandible, then it’s more appropriate to use intraoral functional
appliances, but you have to keep in mind that most of the
skeletal class II malocclusions happen due to small or narrow
mandible (retrognathic).

There are a lot of types of headgears:

1) High pull headgear:
– For this appliance we cement bands on the upper 1st
molars (like the one that used for fixed orthodontic)
which has two tubes, a small one for the wire of the
fixed appliance, and a large one for the insertion of the
internal bow of the headgear, this internal bow is
attached to another external bow which is attached to
the head for support to hold the maxilla in its place or to
distalize the 1st molars. So keep in mind, we only restrict
the growth of the maxilla, we don’t bring it backward, to
allow the growth of the mandible and follow it.

– Also the headgear has to be worn 14 H/day.

– Since it takes the support from the head, then the

direction of the movement is backward and upward, so it
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Movement
direction
(backward-
 will cause intrusion of the 1st molars, and because of this
action, we can use it in class II malocclusion with
reduced overbite or with high angle cases (high MM
angle).

1)Low pull headgear (cervical):

– The same as the high pull headgear, but it gets the
support from the neck, then the direction of the
movement is backward and downward, in other wards, it
causes extrusion of the molars, so it’s used to correct
class II malocclusion with deep bite.

Movement
direction
(backward-

1)Medium pull
headgear:
– Also the same as the others, but it has a support from
the neck and the head at the same time, so the
direction of the movement will be only backward, so it

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 will help us if we want to move the teeth along the
arch without extrusion or intrusion.

Movement
direction
(backward)

1)J-hook headgear:
– It’s positioned in the canine region, and it will cause
intrusion and backward movement of the anterior teeth,
so it’s obvious that it’s used in a cases of class II
malocclusion with a gummy smile.

– Have to be worn about 14 H/day.

1)Reverse pull headgear:

– As the name implies, it cause forward and downward
movement of the maxilla instead of restricting its
movement, so it’s used in class III malocclusion in
very young pt (7-9 years).

– It has an intraoral piece (wire or acryl) that attached to

the teeth with hooks at the canine region that will be
tied to the extraoral appliance by elastic.

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– It will enhance forward and downward growth of
the maxilla, proclination of the maxillary teeth,
and retroclination of the
mandibular teeth.

THE END
Done by:
Abdallah Awadi .
All my greeting to my BEST friends: 7al7oli
bey, mimi (mo3ad’), mo7sn (mot3aded
almwaheb), OBU ALWALEED (the king of E-
mails), S.S.S (sale7 s3ed sale7-Da best), eyas,
3li al-2, m-rush, sha3bolaa, o aked altale
ll3’ale 7sen alshe5.

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And to the best girls: shahd, ruba, fara7,
amani 3fani, J-J-Z-S
(jumana,jumana,zinab,sanna), nor 7mdan.
To the Malaysian society: nor 7lem, zo-
al2rnyen, anjeleko, m-nazerol, and to all the
noors.
Lastly all my best wishes to all 4th year
dentistry student.
Good luck in the coming exams…….

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