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MYOFUNCTIONAL APPLIANCES

MYOFUNCTIONAL APPLIANCES. Dr. Muraleedhara Bhat Department of Orthodontics. Reviewed by Dr Vivek. CONTENTS. Definition Aim Classification of myofunctional appliance Treatment principles Advantages Limitation Action of myofunctional appliance Case selection

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MYOFUNCTIONAL APPLIANCES

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  1. MYOFUNCTIONAL APPLIANCES Dr. MuraleedharaBhat Department of Orthodontics Reviewed by Dr Vivek

  2. CONTENTS • Definition • Aim • Classification of myofunctional appliance • Treatment principles • Advantages • Limitation • Action of myofunctional appliance • Case selection • Visual treatment objective

  3. Vestibular screen • Lip bumper • Activator • Bionator • Frankel appliance • Twin block appliance • Herbst appliance • Jasper jumper • Conclusion • references

  4. DEFINTION • Definedas 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.

  5. AIM • Growth modification • Jaw size can be increased or decreased • Change spatial relationship of jaws • Change in direction of jaws • Acceleration of desirable growth

  6. CLASSIFICATION • A.Classification put forth byTom Grabber • Group 1 - transmit muscle forces to teeth • Eg: oral screen, inclined planes etc • Group II - reposition mandible, resultant force transmitted to teeth and other structures • Eg: Activator, bionator, etc. • Group III - reposition mandible, area of operation is vestibule , outside dental arch • Eg: Frankel appliance, lip bumpers, oral screen

  7. B.With advent of fixed functional appliances, a new classification evolved I.Removable functional, e.g. activator, bionator, frankel, etc. II.Fixed functional appliances, e.g. Herbst, Jasper jumper, Churrojumper,etc

  8. C.Classification put forth by Profitt I.Tooth borne passive appliances – no intrinsic force generating components, depends on soft tissue stretch & muscular activity e.g. activator,bionator etc. II. Tooth borne active appliances— include expansion screws and other active components e.g. Modification of activator bionator etc. III.Tissue borne passive appliance – mostly located in the vestibule little or no contact with the dentition e.g. Frankel

  9. Myotonic appliances – depend on the muscle mass Ex – Activator, twin block Myodynamic appliances – depend on muscle activity Ex – Functional regulator, Lip bumper

  10. TREATMENT PRINCIPLES • Force application -Compressive stress and strain act on the structures involved- Primary alteration in form with a secondary adaptation in function • Force elimination – Elimination of abnormal and restrictive environmental influences on dentition  optimal development • Ex- bite plans, screens, construction bite

  11. ADVANTAGES • Eliminates abnormal muscle function • Early age treatment • Psychological disturbances avoided • Less chair –side time • Frequency of visits is less • Oral hygiene maintenance • Patient acceptance is good

  12. LIMITATIONS • Cannot be used in adults • Single tooth movement cannot be done • Patient cooperation is essential • Pre-functional orthodontic tooth movement • Fixed appliance therapy for final detailing

  13. ACTION OF FUNCTIONAL APPLIANCES Orthopedic changes Dento-alveolar changes Muscular changes

  14. Orthopedic changes: • TMJ -capable of accelerating condylar growth, remodelling of glenoidfossa • Can be designed to have restrictive influence on growth of jaws • They can change the direction of growth of jaws

  15. 2. Dento-alveolar changes: • Sagittal, transverse & the vertical directions • Tipping of anteriors – upper palatally, lower labilally • Expansion of the arches • Vertically - Selective eruption of teeth • 3. Muscular changes: • Improve the tonicity

  16. CASE SELECTION • Age • Patient motivation • Dental consideration • Skeletal consideration

  17. CLINICAL PROCEDURE OF TREATING A PATIENT VISUAL TREATMENT OBJECTIVE Important diagnostic test undertaken before making a decision to use a functional appliance

  18. VESTIBULAR SCREEN • Curved shield of acrylic placed in the labial vestibule • Newell 1912 • Used either to apply the forces of circumoral musculature to certain teeth or to relieve those forces from the teeth • Indications: • Intercept mouth breathing habits • Mild disto-occlusion • Muscle exercises • Mild anterior proclination

  19. Fabrication • Impression, casts • Upper and lower casts occluded & sealed with plaster • Disto-occlusion - advance the bite • Covered with 2-3 mm wax over labial surface of teeth and alveolar process • Acrylisation using self or heat cure • Finishing & polishing

  20. Management • Night + 2 - 3 hrs day • Lip seal • Modifications • Hotz modification • Lingual screen • Mouth breather - Holes

  21. LIP BUMPER • Lip bumper / modified vestibular screen • Combined removable fixed appliance • Used for muscular force application or elimination • Uses: • Lip habits • Hyperactive mentalis • Augment anchorage • Distalization of molars • Space regainers

  22. Appliance design: • Thick S.S wire extending from one molar to another molar • Molar tubes - 0.93mm soldered to bands on Ist molar • Acrylic component • Modifications • Denholtz appliance

  23. ACTIVATOR • HISTORY • Kingsley, 1879 - vulcanite palatal plate • Hotz-‘Vorbissplatte’ • Pierre Robin, 1903 - Monobloc • Viggo Andresen, 1908 – Activator/ biomechanical working retainer/ Norwegian appliance • Activator – ability to activate the muscle function

  24. INDICATIONS • Class II div I cases • Class II div 2 cases • Class III cases • Open bite (dental / non skeletal) • Deep bite cases • Preliminary treatment • Post treatment anterior retention • Children with lack of vertical development

  25. CONTRAINDICATIONS • Cl 1 problems of Crowded teeth - tooth size & jaw size. • Excess lower facial height & extreme vertical mandibular growth. • Severely proclined lower incisors • Nasal stenosis • Non-growing individuals • Extreme hyperdivergent skeletal patterns

  26. ADVANTAGES • Uses existing growth of the jaws • Minimal oral hygiene problems • Appointments - short with long intervals • More economical • DISADVANTAGES • Patient cooperation • Post-treatment fixed therapy • Excess facial ht - cannot be used

  27. MODE OF ACTION • Andersen&Haupl -musculo-skeletal adaptation by introducing new pattern of mandibular closure • Myotactic reflex • Generates kinetic energy that : • Prevent further maxillary Growth • Movement of maxillary dentoalveolar process distally • Reciprocal forward force on mandible • Condylaradaptaion by backward and upward growth

  28. COMPONENTS: • Labial bow • Acrylic portion

  29. Wire elements • labial bow • Active or passive • 0.9mm - Active • 0.8mm - Passive • canine deciduous 1st molar embrasure • Fabrication of acrylic portions: • Maxillary part • Mandibular part • Interocclusal part

  30. CONSTRUCTION BITE • Intermaxillary wax record used to record maxilla to mandible in 3 dimensional plane • Advancement of the jaw by 4 – 5 mm • Opening the bite by 2 – 3 mm • Too large overjet : 2 – 3 stages • 7 - 8mm forward psn : 2 – 4 mm vertical opening. • 3 - 5 mm forward psn : 4- 6 mm vertical opening

  31. Types - Construction Bite A) Low construction with marked mandibular positioning B] High construction bite with slight anterior mandibular positioning C] Construction Bite without forward mandibular positioning D) Construction bite with opening & posterior positioning of mandible for class III malocclusion

  32. Low construction with Marked Mandibular Positioning • In class II div 1 - horizontal growth pattern • Characterized by marked forward positioning of mandible but minimal vertical opening • Within the limits of interocclusal clearance • ‘H ACTIVATOR’

  33. High construction bite with slight anterior mandibular positioning: • Minimal sagital advancement but with maximum vertical opening • 3 – 5 mm ahead of the habitual occlusal position • Vertical dimension is opened upto 4 – 6 mm • “V” ACTIVATOR • Class II, division 1 malocclusion - vertical growth pattern • Construction Bite without forward Mandibular positioning: • No sagital correction • Deep bite, open bite and on selected cases of crowding

  34. Construction bite with opening and posterior positioning of mandible for class III malocclusion: • Retruding the lower jaw • Open the bite sufficiently to allow clear the bite • Vertical opening - 5mm • Posterior psn - 2mm

  35. FABRICATION OF ACTIVATOR • Upper & lower impressions • 1] Study models • 2] Working models • Prepare the patient • Bite registration • Articulation of model

  36. Fabrication of Activator: Preparation of the wire elements Fabrication of acrylic portions Trimming of Activator

  37. TRIMMING OF THE ACTIVATOR • Planned trimming of the appliance in tooth contact area is carried out to bring about dentoalveolar changes so as to guide the teeth into good relation in all 3 planes of space • Trimming for vertical control • Trimming for sagittal control • Trimming for transverse control

  38. Trimming for vertical control • 2 movements are possible : intrusion and extrusion • Intrusion of Incisors - deep bite • b)Intrusion of Molars - open bite

  39. Extrusion of incisors - open bite Extrusion of molars - deep bite

  40. Trimming for sagital control • Protrusion of incisors • Retrusion of incisors

  41. Movement of posterior teeth in sagital plane Class II – Maxillary molars allowed to move distally and mandibular molars mesially by loading maxillary mesiolingul and mandibulardistolingual

  42. Trimming for transverse control • Trimming on lingual aspect , allowing the contact of the acrylic on the lingual surface of teeth to be moved transversely • Active plates • Jackscrews - anterior intermaxillary portion

  43. MANAGING THE APPLIANCE • Patient should be sufficiently convinced regarding benefits • 1st week – 2 to 3 hr day time • 2nd week – 3 hr day and night • 3 rd week evaluate for trimming

  44. MODIFICATIONS • The bow activator of A.M. Schwarz. • Wunderer’s modification • Cybernator of Schmuth - like bionator • The propulsor - Muhlemann, Hotz • Cutout or palate free activator -Metzelder • The Karwetzky modification. • Herrens modification of the activator

  45. BIONATOR • INTRODUCTION • Balters- early 1950’s • Less bulky and more elastic • Principle - not to activate but to • modulate muscle activity

  46. TYPES Standard appliance Open-bite appliance Class III or reverse bionator

  47. Standard appliance: • Class II, division 1 & class I malocclusion - narrow arches • Acrylic component • Lower horse shoe – distal of Ist Molar • Upper - open canine to canine • Gingival extension • Interocclusal extension • Wire components • Palatal arch - 1.2mm wire, middle area of the first pre molars, 1mm away from mucosa

  48. Vestibular wire - 0.9mm wire,extension, lateral portions of the wire are sufficiently away from the teeth to allow expansion of the arch

  49. Open bite appliance: • Inhibit abnormal posture & function of tongue • Maxillary acrylic portion is modified – anterior is covered • Vestibular wire - same • Palatal bar - same • Labial bow - incisal edges • Construction bite – edge to edge

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