dr: hakam husham. a removable or fixed appliance harnesses the natural forces (muscle, facia and...
TRANSCRIPT
![Page 1: Dr: Hakam Husham. A removable or fixed appliance harnesses the natural forces (muscle, facia and periodontium) and transmits it to the teeth and alveolar](https://reader036.vdocuments.us/reader036/viewer/2022070414/5697c01e1a28abf838cd0ec5/html5/thumbnails/1.jpg)
Dr: Hakam Husham
![Page 2: Dr: Hakam Husham. A removable or fixed appliance harnesses the natural forces (muscle, facia and periodontium) and transmits it to the teeth and alveolar](https://reader036.vdocuments.us/reader036/viewer/2022070414/5697c01e1a28abf838cd0ec5/html5/thumbnails/2.jpg)
![Page 3: Dr: Hakam Husham. A removable or fixed appliance harnesses the natural forces (muscle, facia and periodontium) and transmits it to the teeth and alveolar](https://reader036.vdocuments.us/reader036/viewer/2022070414/5697c01e1a28abf838cd0ec5/html5/thumbnails/3.jpg)
A removable or fixed appliance A removable or fixed appliance harnesses the natural forces harnesses the natural forces
(muscle , facia and (muscle , facia and periodontium) and transmits it periodontium) and transmits it to the teeth and alveolar bone to the teeth and alveolar bone
in a predetermined in a predetermined direction to produce direction to produce
orthodonticorthodontic and and orthopedic orthopedic effectseffects
![Page 4: Dr: Hakam Husham. A removable or fixed appliance harnesses the natural forces (muscle, facia and periodontium) and transmits it to the teeth and alveolar](https://reader036.vdocuments.us/reader036/viewer/2022070414/5697c01e1a28abf838cd0ec5/html5/thumbnails/4.jpg)
Theory of functional Theory of functional appliancesappliances
• functional appliances are conceptually functional appliances are conceptually based on Moss’ functional matrix theory.based on Moss’ functional matrix theory.
• Functional matrix theory proposes that Functional matrix theory proposes that growth of the face occur as a response to growth of the face occur as a response to function need and mediated by the soft function need and mediated by the soft tissue tissue
![Page 5: Dr: Hakam Husham. A removable or fixed appliance harnesses the natural forces (muscle, facia and periodontium) and transmits it to the teeth and alveolar](https://reader036.vdocuments.us/reader036/viewer/2022070414/5697c01e1a28abf838cd0ec5/html5/thumbnails/5.jpg)
1.1. Growth modification (skeletal) Mainly in the treatment of CL II Growth modification (skeletal) Mainly in the treatment of CL II malocclusion and Less commonly in CLIII malocclusion and Less commonly in CLIII (Orthopedic changes).(Orthopedic changes).
2.2. Tipping tooth movement and expansion Tipping tooth movement and expansion (Dento-alveolar (Dento-alveolar changes).changes).
3.3. Removal of soft tissue pressures from the cheeks & lips or Removal of soft tissue pressures from the cheeks & lips or modification of soft tissue activity modification of soft tissue activity (Muscular and soft tissue (Muscular and soft tissue changes) changes)
![Page 6: Dr: Hakam Husham. A removable or fixed appliance harnesses the natural forces (muscle, facia and periodontium) and transmits it to the teeth and alveolar](https://reader036.vdocuments.us/reader036/viewer/2022070414/5697c01e1a28abf838cd0ec5/html5/thumbnails/6.jpg)
Wear TimeWear Time
11st st week week 2-3 hrs a day during day time.2-3 hrs a day during day time.
22ndnd week onwards week onwards 3 hrs during day & while 3 hrs during day & while sleeping.sleeping.
(12-16 hrs , 12-18 month) (12-16 hrs , 12-18 month)
]]
![Page 7: Dr: Hakam Husham. A removable or fixed appliance harnesses the natural forces (muscle, facia and periodontium) and transmits it to the teeth and alveolar](https://reader036.vdocuments.us/reader036/viewer/2022070414/5697c01e1a28abf838cd0ec5/html5/thumbnails/7.jpg)
Ideal patient for functional Ideal patient for functional applianceappliance
• AgeAge: only in growing patient.: only in growing patient.
• Patient behaviorPatient behavior: cooperative : cooperative
• Social ConsiderationsSocial Considerations: accepted : accepted
• Dental ConsiderationsDental Considerations: well aligned dental : well aligned dental archarch
• Skeletal ConsiderationsSkeletal Considerations::
Moderate to sever Class II malocclusion Moderate to sever Class II malocclusion
Mild Class III malocclusion with a reverse Mild Class III malocclusion with a reverse overjet & an average overbiteoverjet & an average overbite
![Page 8: Dr: Hakam Husham. A removable or fixed appliance harnesses the natural forces (muscle, facia and periodontium) and transmits it to the teeth and alveolar](https://reader036.vdocuments.us/reader036/viewer/2022070414/5697c01e1a28abf838cd0ec5/html5/thumbnails/8.jpg)
Ideal time for functional Ideal time for functional appliance before pubertal appliance before pubertal
timetime????????
![Page 9: Dr: Hakam Husham. A removable or fixed appliance harnesses the natural forces (muscle, facia and periodontium) and transmits it to the teeth and alveolar](https://reader036.vdocuments.us/reader036/viewer/2022070414/5697c01e1a28abf838cd0ec5/html5/thumbnails/9.jpg)
![Page 10: Dr: Hakam Husham. A removable or fixed appliance harnesses the natural forces (muscle, facia and periodontium) and transmits it to the teeth and alveolar](https://reader036.vdocuments.us/reader036/viewer/2022070414/5697c01e1a28abf838cd0ec5/html5/thumbnails/10.jpg)
Advantages of functional Advantages of functional applianceappliance1.1. Treatment can be started as early as in mix Treatment can be started as early as in mix
dentition stage.dentition stage.
2.2.No said effects of mechanotherapy such as No said effects of mechanotherapy such as decalcification or root resorption ect.decalcification or root resorption ect.
3.3. Less chair side time with less adjustment.Less chair side time with less adjustment.
4.4.Easier to maintain oral hygieneEasier to maintain oral hygiene
5.5. It acceptable to many patients because it is It acceptable to many patients because it is generally worn at night .generally worn at night .
6.6.Patient visit is lessPatient visit is less
7.7. Less expensive Less expensive
![Page 11: Dr: Hakam Husham. A removable or fixed appliance harnesses the natural forces (muscle, facia and periodontium) and transmits it to the teeth and alveolar](https://reader036.vdocuments.us/reader036/viewer/2022070414/5697c01e1a28abf838cd0ec5/html5/thumbnails/11.jpg)
Disadvantages of functional applianceDisadvantages of functional appliance1.1. requires very good patient cooperationrequires very good patient cooperation
2.2. cannot produce a precise tooth movement or cannot produce a precise tooth movement or finishing of occlusion.finishing of occlusion.
3.3. May produce moderate mandibular May produce moderate mandibular rotation(hence contraindicated in excess lower rotation(hence contraindicated in excess lower facial height cases)facial height cases)
![Page 12: Dr: Hakam Husham. A removable or fixed appliance harnesses the natural forces (muscle, facia and periodontium) and transmits it to the teeth and alveolar](https://reader036.vdocuments.us/reader036/viewer/2022070414/5697c01e1a28abf838cd0ec5/html5/thumbnails/12.jpg)
Group-I
Group-II
Group-III
Passive tooth borne appliance like activator (monobloc)
Active tooth borne appliances like modified activator
Tissue borne appliance these appliance are located in the vestibule
like frankel
![Page 13: Dr: Hakam Husham. A removable or fixed appliance harnesses the natural forces (muscle, facia and periodontium) and transmits it to the teeth and alveolar](https://reader036.vdocuments.us/reader036/viewer/2022070414/5697c01e1a28abf838cd0ec5/html5/thumbnails/13.jpg)
Group-I Group-II Group-III
Transmit muscle force to the teeth
Reposition the mandibleThe operating area
is in the vestibule
eg: lip bumper eg: activator eg: Frankel
Mode of action
![Page 14: Dr: Hakam Husham. A removable or fixed appliance harnesses the natural forces (muscle, facia and periodontium) and transmits it to the teeth and alveolar](https://reader036.vdocuments.us/reader036/viewer/2022070414/5697c01e1a28abf838cd0ec5/html5/thumbnails/14.jpg)
A- Bite planesA- Bite planes
B- Oral screenB- Oral screen
C- ActivatorC- Activator
D- frankelD- frankel
E- habit breakingE- habit breaking
Removable functional Fixed functional
Uncooperative.
At terminal phase of growth.
eg: catalan s appliance cemented
90% 10%
![Page 15: Dr: Hakam Husham. A removable or fixed appliance harnesses the natural forces (muscle, facia and periodontium) and transmits it to the teeth and alveolar](https://reader036.vdocuments.us/reader036/viewer/2022070414/5697c01e1a28abf838cd0ec5/html5/thumbnails/15.jpg)
![Page 16: Dr: Hakam Husham. A removable or fixed appliance harnesses the natural forces (muscle, facia and periodontium) and transmits it to the teeth and alveolar](https://reader036.vdocuments.us/reader036/viewer/2022070414/5697c01e1a28abf838cd0ec5/html5/thumbnails/16.jpg)
Bite planesBite planes
Anterior posterior
![Page 17: Dr: Hakam Husham. A removable or fixed appliance harnesses the natural forces (muscle, facia and periodontium) and transmits it to the teeth and alveolar](https://reader036.vdocuments.us/reader036/viewer/2022070414/5697c01e1a28abf838cd0ec5/html5/thumbnails/17.jpg)
Anterior Bite planesAnterior Bite planes
Used for reduction of over bite
Used for correction of developing single cross bite
![Page 18: Dr: Hakam Husham. A removable or fixed appliance harnesses the natural forces (muscle, facia and periodontium) and transmits it to the teeth and alveolar](https://reader036.vdocuments.us/reader036/viewer/2022070414/5697c01e1a28abf838cd0ec5/html5/thumbnails/18.jpg)
![Page 19: Dr: Hakam Husham. A removable or fixed appliance harnesses the natural forces (muscle, facia and periodontium) and transmits it to the teeth and alveolar](https://reader036.vdocuments.us/reader036/viewer/2022070414/5697c01e1a28abf838cd0ec5/html5/thumbnails/19.jpg)
posterior Bite planesposterior Bite planes
Un lack the occlusion to correct anterior cross bite
![Page 20: Dr: Hakam Husham. A removable or fixed appliance harnesses the natural forces (muscle, facia and periodontium) and transmits it to the teeth and alveolar](https://reader036.vdocuments.us/reader036/viewer/2022070414/5697c01e1a28abf838cd0ec5/html5/thumbnails/20.jpg)
Activator or monobloc or AndersonActivator or monobloc or AndersonComprises upper and lower acrylic fused together.The labial bow lies against the upper incisors
Indication: use mainly for correction of CLII division I malocclusion
![Page 21: Dr: Hakam Husham. A removable or fixed appliance harnesses the natural forces (muscle, facia and periodontium) and transmits it to the teeth and alveolar](https://reader036.vdocuments.us/reader036/viewer/2022070414/5697c01e1a28abf838cd0ec5/html5/thumbnails/21.jpg)
ActivatorActivator
Wear Time:1st week 2-3 hrs a day during day time 2nd week onwards 3 hrs during day & while sleeping
![Page 22: Dr: Hakam Husham. A removable or fixed appliance harnesses the natural forces (muscle, facia and periodontium) and transmits it to the teeth and alveolar](https://reader036.vdocuments.us/reader036/viewer/2022070414/5697c01e1a28abf838cd0ec5/html5/thumbnails/22.jpg)
ActivatorActivatorthe interdental acrylic is trimmed to the interdental acrylic is trimmed to form series of inclined planes to guide form series of inclined planes to guide and control the tipping of the posterior and control the tipping of the posterior
teeth these plane called facetsteeth these plane called facets
![Page 23: Dr: Hakam Husham. A removable or fixed appliance harnesses the natural forces (muscle, facia and periodontium) and transmits it to the teeth and alveolar](https://reader036.vdocuments.us/reader036/viewer/2022070414/5697c01e1a28abf838cd0ec5/html5/thumbnails/23.jpg)
Modification of activatorModification of activator
Activator with expansion screw
![Page 24: Dr: Hakam Husham. A removable or fixed appliance harnesses the natural forces (muscle, facia and periodontium) and transmits it to the teeth and alveolar](https://reader036.vdocuments.us/reader036/viewer/2022070414/5697c01e1a28abf838cd0ec5/html5/thumbnails/24.jpg)
Modification of activatorModification of activator
Herren modification of activator
![Page 25: Dr: Hakam Husham. A removable or fixed appliance harnesses the natural forces (muscle, facia and periodontium) and transmits it to the teeth and alveolar](https://reader036.vdocuments.us/reader036/viewer/2022070414/5697c01e1a28abf838cd0ec5/html5/thumbnails/25.jpg)
Modification of activatorModification of activator
Palate free actiator
![Page 26: Dr: Hakam Husham. A removable or fixed appliance harnesses the natural forces (muscle, facia and periodontium) and transmits it to the teeth and alveolar](https://reader036.vdocuments.us/reader036/viewer/2022070414/5697c01e1a28abf838cd0ec5/html5/thumbnails/26.jpg)
Modification of activatorModification of activator
![Page 27: Dr: Hakam Husham. A removable or fixed appliance harnesses the natural forces (muscle, facia and periodontium) and transmits it to the teeth and alveolar](https://reader036.vdocuments.us/reader036/viewer/2022070414/5697c01e1a28abf838cd0ec5/html5/thumbnails/27.jpg)
• Developed by Balters in 1950’s.Developed by Balters in 1950’s.
• Modified activator Modified activator less bulky & more less bulky & more elastic.elastic.
• Removed must of the bulk of activator Removed must of the bulk of activator consist of a lingual horseshoe of consist of a lingual horseshoe of acrylic(Dose not interfere with the speech).acrylic(Dose not interfere with the speech).
• The labial bow is extended distally that The labial bow is extended distally that minimize cheek pressure on teeth.minimize cheek pressure on teeth.
• Palatal spring (reversed coffin spring)Palatal spring (reversed coffin spring)
BionatorBionator
![Page 28: Dr: Hakam Husham. A removable or fixed appliance harnesses the natural forces (muscle, facia and periodontium) and transmits it to the teeth and alveolar](https://reader036.vdocuments.us/reader036/viewer/2022070414/5697c01e1a28abf838cd0ec5/html5/thumbnails/28.jpg)
Twin blockTwin block
Is a removable, orthodontic functional appliance with two section one on maxilla and the other on mandible carry inclined plans of acrylic on closure they meet and cause the mandibular arch to be postured forward
![Page 29: Dr: Hakam Husham. A removable or fixed appliance harnesses the natural forces (muscle, facia and periodontium) and transmits it to the teeth and alveolar](https://reader036.vdocuments.us/reader036/viewer/2022070414/5697c01e1a28abf838cd0ec5/html5/thumbnails/29.jpg)
1.Dose not interfere with the speech.2.Can be worn during the day time.3.Patient can get adjusted easy.4.Easy activated.5.Less bulk than other functional appliance.
![Page 30: Dr: Hakam Husham. A removable or fixed appliance harnesses the natural forces (muscle, facia and periodontium) and transmits it to the teeth and alveolar](https://reader036.vdocuments.us/reader036/viewer/2022070414/5697c01e1a28abf838cd0ec5/html5/thumbnails/30.jpg)
Herbest applianceHerbest applianceCan be fix or removable consist from pin and tube that runs between the arch to force the mandible forward
![Page 31: Dr: Hakam Husham. A removable or fixed appliance harnesses the natural forces (muscle, facia and periodontium) and transmits it to the teeth and alveolar](https://reader036.vdocuments.us/reader036/viewer/2022070414/5697c01e1a28abf838cd0ec5/html5/thumbnails/31.jpg)
Banded Herbst Appliance
Bonded Herbst Appliance
![Page 32: Dr: Hakam Husham. A removable or fixed appliance harnesses the natural forces (muscle, facia and periodontium) and transmits it to the teeth and alveolar](https://reader036.vdocuments.us/reader036/viewer/2022070414/5697c01e1a28abf838cd0ec5/html5/thumbnails/32.jpg)
Advantages of fix herbstAdvantages of fix herbst
11-continuous action.-continuous action.22-duration of treatment is short. -duration of treatment is short.
33-can be use with un cooperation -can be use with un cooperation patients. patients. 44-can be used in patients who are -can be used in patients who are at the end of their growth.at the end of their growth.55-can be used in patients with -can be used in patients with mouth breathing habit.mouth breathing habit.
![Page 33: Dr: Hakam Husham. A removable or fixed appliance harnesses the natural forces (muscle, facia and periodontium) and transmits it to the teeth and alveolar](https://reader036.vdocuments.us/reader036/viewer/2022070414/5697c01e1a28abf838cd0ec5/html5/thumbnails/33.jpg)
Oral screenOral screen
Passive type
It is a screen made up of acrylic which fits in the buccal and labial vestibule
![Page 34: Dr: Hakam Husham. A removable or fixed appliance harnesses the natural forces (muscle, facia and periodontium) and transmits it to the teeth and alveolar](https://reader036.vdocuments.us/reader036/viewer/2022070414/5697c01e1a28abf838cd0ec5/html5/thumbnails/34.jpg)
Oral screenOral screen
Active type
![Page 35: Dr: Hakam Husham. A removable or fixed appliance harnesses the natural forces (muscle, facia and periodontium) and transmits it to the teeth and alveolar](https://reader036.vdocuments.us/reader036/viewer/2022070414/5697c01e1a28abf838cd0ec5/html5/thumbnails/35.jpg)
He makes oral vestibule as the operational basis for his treatment.
Has acrylic buccal shields in the buccal side (cause expansion of the arches by holding the cheeks away and enlarge the alveolar process
![Page 36: Dr: Hakam Husham. A removable or fixed appliance harnesses the natural forces (muscle, facia and periodontium) and transmits it to the teeth and alveolar](https://reader036.vdocuments.us/reader036/viewer/2022070414/5697c01e1a28abf838cd0ec5/html5/thumbnails/36.jpg)
1-Lips pad.
2 -BUCCAL SHIELDS.
3 -palatal bow.
4 -labial bow.
5 -canine stopper.
![Page 37: Dr: Hakam Husham. A removable or fixed appliance harnesses the natural forces (muscle, facia and periodontium) and transmits it to the teeth and alveolar](https://reader036.vdocuments.us/reader036/viewer/2022070414/5697c01e1a28abf838cd0ec5/html5/thumbnails/37.jpg)
Types
Frankel I CL I and CL II Div I
Frankel II CL II Div II
Frankel III CL III
Frankel IFrankel II
Frankel III
![Page 38: Dr: Hakam Husham. A removable or fixed appliance harnesses the natural forces (muscle, facia and periodontium) and transmits it to the teeth and alveolar](https://reader036.vdocuments.us/reader036/viewer/2022070414/5697c01e1a28abf838cd0ec5/html5/thumbnails/38.jpg)
![Page 39: Dr: Hakam Husham. A removable or fixed appliance harnesses the natural forces (muscle, facia and periodontium) and transmits it to the teeth and alveolar](https://reader036.vdocuments.us/reader036/viewer/2022070414/5697c01e1a28abf838cd0ec5/html5/thumbnails/39.jpg)
![Page 40: Dr: Hakam Husham. A removable or fixed appliance harnesses the natural forces (muscle, facia and periodontium) and transmits it to the teeth and alveolar](https://reader036.vdocuments.us/reader036/viewer/2022070414/5697c01e1a28abf838cd0ec5/html5/thumbnails/40.jpg)
![Page 41: Dr: Hakam Husham. A removable or fixed appliance harnesses the natural forces (muscle, facia and periodontium) and transmits it to the teeth and alveolar](https://reader036.vdocuments.us/reader036/viewer/2022070414/5697c01e1a28abf838cd0ec5/html5/thumbnails/41.jpg)
•Discomfort, as both upper & lower teeth are joined together.
•Mainly depends on patient’s compliance
•Can be used only if a favorable horizontal growth pattern is present in cases of Class
II correction.
•It has to be removed during masticaiton,particularly when strongest
forces are applied.
•May interfere with speechMay interfere with speech..
•Treatment duration is often longTreatment duration is often long
![Page 42: Dr: Hakam Husham. A removable or fixed appliance harnesses the natural forces (muscle, facia and periodontium) and transmits it to the teeth and alveolar](https://reader036.vdocuments.us/reader036/viewer/2022070414/5697c01e1a28abf838cd0ec5/html5/thumbnails/42.jpg)
![Page 43: Dr: Hakam Husham. A removable or fixed appliance harnesses the natural forces (muscle, facia and periodontium) and transmits it to the teeth and alveolar](https://reader036.vdocuments.us/reader036/viewer/2022070414/5697c01e1a28abf838cd0ec5/html5/thumbnails/43.jpg)
• These appliances utilize the muscle action of the patient These appliances utilize the muscle action of the patient to produce orthodontic or orthopaedic forces to restore to produce orthodontic or orthopaedic forces to restore
facial balancefacial balance..
•The question that must be addressed in diagnosis is : The question that must be addressed in diagnosis is : “does the patient require orthodontic treatment or “does the patient require orthodontic treatment or
functional orthopedic treatment or a combination of both functional orthopedic treatment or a combination of both and to what degree?and to what degree?
whether the patient requires functional appliance alone or whether the patient requires functional appliance alone or need a orthognathic surgery or to what extend FA can need a orthognathic surgery or to what extend FA can
reduce need for surgeryreduce need for surgery”?”?