1. Activator Appliance Components
2. Orthodontic Appliances Names
3. Functional Appliances Orthodontics Activator Free

Functional appliances have been used for over 100 years in orthodontics to correct Class II malocclusion. During this time numerous different systems have been developed often accompanied by claims of modification and enhancement of growth. Recent clinical evidence has questioned whether they really have a lasting influence on facial growth, their skeletal effects appearing to be short term. However, despite these findings, the clinical effectiveness of these appliances is acknowledged and they can be very useful in the correction of sagittal arch discrepancies. This article will discuss the clinical use of functional appliances, the underlying evidence for their use and their limitations.

Twin blocksAll the activator variations described above are essentially one-piece appliances. This means that they cannot be worn during eating. To overcome this, William Clark developed the Twin Block appliance , which consists of upper and lower removable appliances with bite blocks composed of bite ramps set at about 70 degrees. When occluding, the lower block bites in front of the upper to posture the mandible forwards. Generally, the Twin Block appliance is robust and well tolerated, and has become very popular in the UK. Fixed functional appliancesA major problem with any removable functional appliance is compliance, because they do not work unless they are worn for the required number of hours each day. This can be overcome by the use of a fixed functional appliance.

The most well-known and popular fixed functional appliance is the Herbst appliance. This was first described by Emil Herbst in 1905, which makes it almost as old as the speciality of orthodontics itself. However, it disappeared into obscurity until it was rediscovered and popularised by Hans Pancherz in the late 1970s. Since then, it has grown in popularity and is now one of the most widely used and researched functional appliances in the world.

It consists of separate superstructures cemented to the mandibular and maxillary dentition, and constructed from either orthodontic bands or cobalt chromium cap splints connected by telescopic pistons that provide the protrusive force to the mandible. Such is the prevalence of Class II malocclusion in developed countries and the desire for a predictable and compliance-free way of correction that numerous variations of the fixed Class II corrector based on the Herbst principle have been described. They usually have exciting and promising names but most are introduced without being properly clinically tested. A few persist and prove to be clinically useful.

An example of this is the FORSUS ® spring from 3M. This is similar in design to the Herbst, but attaches directly to the molar bands of a fixed appliance and the lower arch. It consists of a piston and nickel titanium spring that produces a protrusive force on the lower dental arch.

Aditya Chhibber. Flavio Uribe, in, 2015 IntroductionFixed functional appliances may be broadly classified as rigid, flexible and semirigid appliances. 1 The major difference between functional appliances and fixed functional appliances is probably that the mandible is forcefully postured in an anterior position with the latter, with the help of interarch anchorage using the maxillary denture base as the anchor unit.

As discussed in many chapters in this book, the use of temporary anchorage devices such as miniscrew implants (MIs) to provide the anchorage for fixed functional appliances avoids the unwanted effects of using teeth as the only anchorage. This chapter describes the use of the Twin Force Bite Corrector (TFBC), which is a hybrid type of fixed functional appliance, 2 together with direct and indirect anchorage supplied by MIs.

Functional appliances can also be used to achieve posterior extrusion to correct deep bites, especially in low angle Class II malocclusions. Functional appliances help in positioning the lower jaw forward to an edge-to-edge relationship, thereby disoccluding the posterior teeth, which are then free to erupt. Eruption can be augmented by using elastics during fixed appliance mechanotherapy.

However, for treatment to succeed, the appliance must be worn nearly full-time. Unfortunately, a significant number of patients do not cooperate fully and appliances are often worn only part-time and lost or broken while out of the mouth.

Many of these problems can be overcome by using fixed functional appliances, such as the Twin Force bite corrector ( Fig. Functional appliances can also be used to achieve posterior extrusion to correct deep bites, especially in low-angle Class II malocclusions. Functional appliances help in positioning the lower jaw forward to an edge-to-edge relationship, thereby disoccluding the posterior teeth, which are then free to erupt. Eruption can be augmented by using elastics during fixed-appliance mechanotherapy.

For treatment to succeed, however, the appliance must be worn almost full-time. Unfortunately, a significant number of patients do not fully comply, and appliances are often worn only part-time or may be lost or broken while out of the mouth. Many of these problems can be overcome by using fixed functional appliances, such as the Twin Force ( Fig. A to C, Clinical photographs of Class II, Division 1 patient with severe deep bite. D to F, The patient was treated with the Twin Force bite corrector (fixed functional appliance).

Note how the anterior positioning of the mandibular teeth in an edge-to-edge relationship with the maxillary incisors disoccludes the posterior teeth, which are then free to erupt. Alternatively, elastics can also be used to augment their eruption. G to I, Final treatment results showing Class I molar and canine relation with normal overbite. Brock Rondeau, Ingrid R.

Castellanos, in, 2012 Brief History of Functional AppliancesFunctional appliances are used to develop arches and to move mandibles or maxillae forward. They employ a non-extraction technique and were developed in Europe in the early 1900s. For over 100 years, clinicians worldwide have been using these appliances to improve facial esthetics in patients. Extracting teeth is very common in many countries, but when one extracts the bicuspid teeth, which are 8 mm wide, the upper arch is left 16 mm smaller, making for narrow smiles. Often if the teeth are retracted, the result is an un-esthetic retrognathic profile.

Functional appliances were originally used to bring the lower jaw forward and thereby improve the patient's esthetics. More recently, bringing the lower jaw forward has been shown to improve TMJ health as well as prevent snoring and sleep apnea later in life. Not only do the patients look better, but they are healthier, which should be one of the most important treatment objectives. Practitioners of esthetic dentistry, orthodontics, prosthodontics, or restorative dentistry should strive to improve patients’ health and their appearance.In orthodontics, one moves the teeth, originally mostly using metal brackets. In the 1980s clear brackets became available.

In the author's practice, 90% of the adults want clear brackets because of esthetic considerations. More recently, manufacturers have developed self-ligating clear brackets that do not stain and are highly esthetic.

Clear brackets have encouraged many adults to choose orthodontic treatment.About 20% of the orthodontists worldwide use functional appliances, with higher percentages in Europe and South America. In South America general dentists learn, in dental school, how to use functional appliances for treating children early while in dental school, then patients are referred to an orthodontist for tooth straightening and fixed braces. Dental schools in North America should start offering courses for general dentists regarding early orthodontic treatment for children. General dentists worldwide need to embrace the philosophy of developing arches at an early age.When the patient has dental crowding, there are two options: (1) view the teeth as too large for the size of the jaws and extract some teeth, or (2) view the upper or lower arches as too narrow and use an orthopedic appliance that moves the bone. Orthodontic clinicians alter the shape of the bone and the shape of the arch by expanding the arch. This is easily accomplished in children.

The mid-palatal suture widens and fills in with bone, it is a true orthopedic change that allows patients to keep all their teeth.As far as facial esthetics is concerned, the primary goal is a broad, attractive smile. The actors and actresses on TV are often the standard used to evaluate everyone's smile and smile width. When teeth are extracted, the result is a narrow smile, rather than the broad smile sought through esthetic dentistry. Some clinicians who do not do orthodontics can still create a broader smile by putting veneers on the bicuspids and cuspids, trying to widen the look of the arch. That is not quite the same as developing the arch early on.Techniques and appliances now exist that allow practitioners to develop adults’ arches. These include self-activating, nickel titanium coil springs that use 150 grams of force to develop adult arches.

Although it is amazing what can be accomplished, the key is improved health for the patient. First, practitioners should create a proper-sized maxillary arch without any extractions, and then relate the mandible properly to the maxilla.

That ensures a healthy TMJ and an improved appearance. Patients who have unstable TMJs have unstable occlusions, with the mandible often moving to a retrognathic position, which is not considered esthetically pleasing. A straight profile is preferred to either a retrognathic or a prognathic look.Functional appliances are the key to success in early orthodontic treatment.

Children should be seen before age 7 years to detect problems with the arches. These include arches that are too narrow, the lower jaw being too far back, the presence of a deep overbite, or habits such as thumb sucking or tongue thrusting. Those must be corrected early when patients are more cooperative.In Europe and South America, functional orthopedic appliances have been used to establish the correct relationship between the maxilla and mandible transversely, sagittally, and vertically.

In North America an increasing number of orthodontists and general dentists have used fixed and removable functional appliances to treat younger patients. A reason for this is that mothers are constantly asking general dentists to treat the orthodontic problems of their children at an early age, before the permanent teeth erupt. Another reason is that patients are more likely to cooperate when wearing fixed functional appliances. Clark, in, 2010 CONCLUSIONFunctional appliances have been criticized because of an unpredictable response and a lack of long-term influence on facial growth. Although it is not possible to encourage the mandible to grow beyond the individual's genetic potential, environmental factors play a major role in perpetuating a severe Class II malocclusion.

A distal occlusion exerts restraining occlusal forces on the mandibular dentition, and the maxillary dental arch is narrow from distal positioning of the lower dentition. These factors may not allow the mandible to grow to its full genetic potential. In severe class II malocclusion the tongue is back in the throat because it is contained within a retrusive lower dental arch. This pattern has negative effects on the health and metabolism of these patients.Expanding the maxilla and advancing the mandible unlock the malocclusion.

In functional terms, advancing the mandible advances the tongue and, as cephalometric records confirm, increases the airway. This is a fundamental physiological change with beneficial effects that can be seen clearly within 2 or 3 months of commencing treatment. In the hands of an experienced clinician, full-time functional appliances are more efficient in correcting severe Class II malocclusion than conventional fixed-appliance techniques without mandibular propulsion. This is especially true when treatment is timed to coincide with the pubertal growth spurt, but equally appropriate in early treatment.The goal of functional therapy is to elicit a proprioceptive response in the muscles and ligaments, and as a secondary response, to influence the pattern of bone growth to support a new functional environment for the developing dentition. The best results are obtained by combining orthodontic and orthopedic techniques, and the future for the orthodontic specialty lies in advancing orthopedic techniques toward a holistic approach to reduce skeletal discrepancies and restore normal function in promoting normal growth and development.A comprehensive description of the twin block technique is illustrated in the author's Twin block functional therapy: applications in dentofacial orthopaedics (ed 2, Edinburgh, 2002, Mosby Ltd.), with information on clinical management for the efficient use of the technique. Aditya Chhibber. Ravindra Nanda, in, 2015The term functional appliance refers to a group of appliances that posture the mandible forward in an attempt to stimulate mandibular growth.

Historically, the use of functional appliances began with Kingsley's vulcanite biteplate but probably was first propagated by Anderson with the use of the Activator appliance. 15 Since then, numerous functional appliances have been reported in the literature, with the most popular being the Activator, Bionator, and the Twin Block appliance. However, despite the use of functional appliances for more than a century, there is still considerable debate over the effectiveness of such mandibular anterior repositioning appliances in stimulating skeletal mandibular growth. 16 Studies 17–19 on experimental animals such as rats, mice, and primates depict a clear increased mandibular growth potential with the use of such appliances. However, similar experiments with these bite-jumping appliances to enhance mandibular skeletal growth in human subjects did not yield comparable results. The results of randomized clinical trials 20–22 have shown that with the use of functional appliances there is an initial increase in the mandibular growth response that is greater than that seen in the control sample; however, in the long-term, when patients treated with functional appliances were compared to untreated control subjects, the difference in the overall mandibular length was statistically insignificant. Nejat Erverdi.

Nazan Kucukkeles, in, 2015 IntroductionThe term functional appliance refers to a variety of appliances designed to transmit forces to the dentition and the basal bone in order to alter the function and position of the mandible. Typically this new sagittal and vertical muscular position results in orthodontic and orthopedic changes.

In spite of differences in design, all functional appliances rely on keeping the mandible in a forward position. The fixed functional appliances all act in the same way and their clinical consequences are similar.Approximately 30% of the Class II correction achieved using fixed functional appliances is attributed to skeletal response, with 70% to dentoalveolar response. 1 Dentoalveolar response is characterized by uncontrolled and unwanted tipping of the mandibular incisors. 2 True treatment of the skeletal malocclusion requires correction of the morphogenetic pattern. Consequently, condylar adaptation and mandibular skeletal growth have to be the main goal in functional treatment. Some investigators claim that rapid labial tipping of the mandibular incisors, which takes place in almost 6 months using functional appliances, limits the time needed to obtain more skeletal response.

It can be assumed that direct protrusive force application through the mandibular skeletal bone can prevent labial tipping of the mandibular incisors and, therefore, pure skeletal response of the functional treatment can be observed.This chapter describes the use of fixed functional appliances with symphyseal bone anchorage and discusses clinical results with three different designs. This chapter discusses the use of bone anchorage in treating patients with Class II, division 1 malocclusion of skeletal origin arising from mandibular deficiencies and the use of three-dimensional imaging for orthodontic diagnosis and treatment planning.

Activator Appliance Components

Cone beam CT (CBCT) allows quantitative evaluation of hard tissues with accuracy and ease, and at comparatively low effective radiation doses. 1 The chapter attempts to answer the following questions with regard to the use of MIs and miniplates in treating Class II, division 1 malocclusion: â–ªIs the approach beneficial for Class II, division 1 malocclusion arising from mandibular deficiency? â–ªWhat are the potential benefits, merits, problems of the approach? â–ªDoes three-dimensional evaluation of condylar growth and the maxillary restraining effect of fixed functional appliances provide useful information on changes in the maxillomandibular complex? Dandajena, in, 2010 Fixed Functional AppliancesThe fixed functional appliances can be classified into three groups: fixed rigid, fixed flexible, and fixed hybrid.

Orthodontic Appliances Names

5 The most used and historically prominent of the fixed rigid functional appliances is the Herbst. Herbst applianceThe Herbst appliance (Dentauram, Ispringen, Germany) was first introduced in the early twentieth century and gained popularity in the 1980s after work by Pancherz. Considerable debate surrounds how correction of Class II malocclusion is achieved during use of the Herbst. Users of the appliance have argued in favor of growth modification.

Functional Appliances Orthodontics Activator Free

Research has shown that the Herbst, as with other functional appliances, does not “grow� mandibles but produces a “headgear effect� by distalizing the maxillary molars and restricting maxillary growth. There is no evidence to support enhanced mandibular growth from use of the Herbst. The results obtained from the Herbst may be no different from Class II elastics.Interpretation of these studies requires caution. The basic tool used to assess changes in most studies is the lateral cephalogram, which has limited application in detecting condylar changes and is more suited to interpretation of large, gross changes. Computed tomography (CT) scans would be better suited for such assessment but are more expensive.The Herbst appliance was initially developed for the growing patient. However, its applications to correct Class II malocclusion have been extended to adult patients. Other appliances in the same category as the Herbst include the mandibular anterior repositioning appliance (MARA) (AOA Orthodontic Appliances, Sturtevant, Wis.) and fixed twin block.

Of the flexible fixed functional appliances, the most studied is the Jasper Jumper (American Orthodontics, Sheboygan, Wis.).