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FIXED FUNCTIONAL APPLIANCES

INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com www.indiandentalacademy.com


Goals of Orthodontics and Dentofacial Orthopedics Achieve a good occlusion

Class I malocclusions

Harmonize the basal structures

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Skeletal malocclusions


A skeletal Class II - fault with the maxilla www.indiandentalacademy.com


A skeletal Class II - fault with the mandible www.indiandentalacademy.com


A skeletal Class II - fault with the mandible www.indiandentalacademy.com


Components of a growing skeletal Class II malocclusion  

Maxillary prognathism – 30% Mandibular retrusion - 70% ----Mc’Namara (1981)

Mastorakos study( 1984) --- slight disagreement with Mc’Namara’s values

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Skeletal malocclusions If your only instrument’s a hammer, then every problem looks like a nail. --- Maslow

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Skeletal malocclusions Skeletal Class II or Skeletal Class III Treated by ---a) Functional appliances b) Headgear c) Combination d) Camouflage e) Surgical intervention www.indiandentalacademy.com

Growth Modulation


Functional appliances Factors essential to success: a) Proper diagnosis and appliance fabrication b) Growth parameters c) Appliance wear – Patient compliance

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Patient compliance Facts : ďƒž Percentage of poor compliance --- 50% ďƒž Both patients and families mis-represent the extent of compliance ďƒž Compliance decreases the longer the patient is treated

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Evolution of the Non-compliance appliances Subdivided into :  Fixed functional Orthopedic appliances  Fixed intra-arch appliances  Fixed Inter-arch appliances

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Fixed functional appliances History :  Kingsley’s bite jumping plate was a fixed one

 Emil Herbst read a paper on the ‘Herbst

appliance’ in 1905  The Herbst was resurrected only in 1977  Subsequent improvements within the Herbst www.indiandentalacademy.com


Fixed functional appliances History : ď‚Ż Inter-arch springs

started becoming popular

after the introduction of the Jasper Jumper in 1987 ď‚Ż As

many as 24 fixed functional appliances

could be traced !! www.indiandentalacademy.com


Fixed functional appliances Classification :  Rigid Fixed functionals – ‘Herbst’ like  Flexible fixed functionals – ‘Jasper’ like  Hybrid appliances

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Fixed functional appliances Rigid Fixed functionals 1.

Herbst and its modifications

2.

The Mandibular Anterior Repositioning splint (MARS)

3.

The Ventral Telescope

4.

The Magnetic telescopic device

5.

The Mandibular Protraction Appliance (MPA I – IV)

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Fixed functional appliances Rigid Fixed functionals – Essential characteristics

1.

Telescoping mechanism

2.

Very rigid and permit restricted movements

3.

Effects are usually skeletal (orthopedic)

4.

Usually indicated in Class II patients www.indiandentalacademy.com


Fixed functional appliances Rigid Fixed functionals (Contd..) 6. The Universal Bite Jumper 7. The Biopedic appliance 8. The Mandibular anterior repositioining appliance (MARA) 9. The Intra-oral Snoring Therapy Appliance (IST) 10. The Ritto Appliance www.indiandentalacademy.com


Fixed functional appliances The Herbst appliance – Components 

Tube and plunger assembly

Axle and screw assembly anchored onto the upper molars and the lower bicuspids

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Components of the Herbst

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Components of the Herbst

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The Herbst with crowns – Langford design

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The Herbst with Edgewise appliance – Dischinger design or The ‘Bioprogressive Herbst’

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The Cantilever Herbst

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The Cantilever Herbst

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The Acrylic Splint Herbst

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Variations in the Herbst appliance The MALU – Mandibular advancement locking unit – Swadesh Kumar

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Variations in the Herbst appliance The MALU – Mandibular advancement locking unit – Swadesh Kumar

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Variations in the Herbst appliance The Flip-Lock Herbst - Robert Miller

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Variations in the Herbst appliance The Flip-Lock Herbst - Robert Miller

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Indications of Conventional Herbst 1. 2.

Mandibular retrusion Post Surgical

3.

Prevention of Bruxism

4.

Diseases of TMJ

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Duration of Treatment  According to Herbst – 15months  According to Pancherz – 6 - 9months  According to Weislander – 6-9months + 2-

3yrs of retention using activator

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Problems with Conventional Herbst 1.

Difficulty in fabrication

2.

Breakages

3.

Restricted lateral movements

4.

Cost

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Effects due to the Herbst appliances

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Herbst like appliances a) The Ventral telescope

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Herbst like appliances b) The Biopedic appliance - GAC

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Herbst like appliances c) The MPA – Filho -1995,97,98 and 2001

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Herbst like appliances c) The MPA – Filho -1995,97,98 and 2001

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Herbst like appliances d) The Magnetic Telescope device – Ritto1997

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Herbst like appliances e) The MARA appliance – Toll and Eckhart

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Herbst like appliances d) The MARA appliance

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Lateral views of superimposition of the 3D mandibles before and after treatment, registered according to the anatomical landmarks of the brain (green, the 3D mandible before treatment; pink, the 3D mandible after treatment) www.indiandentalacademy.com


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Thank you www.indiandentalacademy.com Leader in continuing dental education

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Fixed functionals/ dental implant courses by Indian dental academy