Functional Appliances in Orthodontic treatment

Functional Appliances in Orthodontic Treatment

What are functional appliances

Functional appliances are used to treat malocclusion and teeth arrangement anomalies by restoring functions - muscle functions and other important functions such as breathing, swallowing correctly. Functional appliances combine the achievement of the maximum aesthetic result with the normalization of the function of the entire dentoalveolar system.

Functional appliances are designed to change the shape and position of the jaws, as well as some teeth during the period of active growth and formation of jaw tissues. They have a passive affect - their work is based on the contraction of the chewing and facial muscles. When the jaws are closed, the teeth are subjected to a certain load, which contributes to the restructuring of the tissues of the jaw system and a change in the position of the dentition.

Functional appliances are adapted for home use, they are worn by children, as a rule, at night and for several hours during the day. These appliances work in such a way that they eliminate excessive pressure on the lips, cheeks, tongue, and normalize the balance between the muscles

What are Functional Appliances made of?

Functional appliances are designed to regulate the growth of the jaws. They consist of various elements - a wire arch made of medical steel, an acrylic base, plastic plates for placement along the dentition in order to form the correct position of the teeth, as well as a number of active elements. This type includes the Klammt activator and the Twin Blok appliance (intended for the treatment of distal and mesial occlusion), the Frenkel function regulator (to eliminate anomalies of the anterior teeth) and others. Some models of orthodontic plates also belong to monoblock appliances.

Types Of Functional Appliances

Palatine clasps
A group of orthodontic appliances that are used to correct the shape and size of the upper jaw, as well as the position of the teeth - moving them forward or backward, fixing the position or correcting the inclination.

Palatine clasps can be in the form of an arc with hooks for positioning on 2 teeth (Gozhgarian's or Zeitlin's arch), on 4 teeth (Quadrohelix apparatus) with additional springs and spacers, using a button for additional fixation of the apparatus in the palate (Nance button), as well as with plastic plates and active screws (Pendulum-Pendex, Hyrex devices). Some models of orthodontic plates are also considered one of the varieties of palatine clasps.

Face bows and masks
External devices that are fixed on the teeth and on the head with the aim of affecting the lateral teeth. These are massive designs, which must be worn at home, as well as at night, since they do not differ in aesthetics. As a rule, face bows and masks implement the main orthodontic treatment, or can be used in combination with the simultaneous installation of braces.

Trainers & Lip Bumpers
Trainers are caps that are created from soft silicone. They are a type of lip bumpers (in these designs, metal elements can be added to target the front teeth). Trainers and lip bumpers are effective in correcting the bite, changing the position of the front teeth or consolidating the results of orthodontic treatment.

These devices are designed for both adult patients and children. In addition to correcting the bite, they additionally allow you to get rid of bad habits such as mouth breathing, dummy or thumb sucking. In addition, trainers reduce muscle pressure, reduce the force of impact on the front teeth from the lips or tongue, and restore diction in the child due to the incorrect position of the tongue. One of the most progressive brands of trainers is the Myobrace apparatus.

Monoblock appliances
They are focused on the functional treatment of both distal and mesial occlusion, and are also able to eliminate the anomalies that have arisen on the teeth located in front. These include some of the existing plate models with orthodontic properties.

Frenkel's apparatus
Treatment with such equipment takes about 1.5 years on average. It is important not to miss the active growth in such patients, as a rule, up to 13-14 years old, when it is possible to carry out the modification of the growth of the jaws with functional appliances. Upon completion of active growth, these patients have fully formed TMJ (temporomandibular joints) and treatment with functional appliances can lead to TMJ dysfunction.

Assistive appliances for braces
Braces are used to change the position of teeth, but they are not able to cope with malocclusion. Therefore, additional appliances can be used that will lengthen the dentition, accelerate the movement of some teeth, increase the pressure on the chewing teeth and even correct the position of the jaws relative to each other.

The auxiliary appliances that are used simultaneously with braces include the Sander alignment arch (allows you to change the inclination of the posterior teeth), as well as the Herbst appliances, Jasper Jumper, Distal Jet and Forsus (used to increase pressure on the teeth, contribute to the displacement of the dentition, which allows you to correct distal bite).

How Much To Wear Functional Appliances

The term of wearing orthodontic functional appliances depends only on the degree of bite pathology - during the day, their fixation on the teeth should be 3-4 hours or more. Since most designs are not very aesthetically pleasing, they must be worn mainly at home and at night.

However, due to the fact that the appliances are removable, discipline is required, especially in children - if the time of wearing them is not observed, the effectiveness is noticeably reduced, and the overall wearing period is noticeably stretched from several months to 2-3 years.

What are the indications for wearing removable devices, how to determine?

It is better, of course, to take the child to the orthodontist prophylactically every six months at least to understand whether he needs treatment or not. The classic indicator is a small jaw. Let's say the patient was at the dentist and he was told that the jaw is small, the teeth will erupt crookedly.

Or an incorrect bite - the upper jaw overlaps the lower jaw too much. Or the child has a bad habit - mouth breathing, which arises from problems with ENT organs. The ENT doctor also refers to the orthodontist with this problem.

What Is The Duration Of Orthodontic Treatment With Functional Appliance?

The treatment may last depending on the stage at which the patient came to us.
If he came to the orthodontist as a teenager, and the doctor got into the growth stage, when these functional appliances still work well, then the treatment can last about a year, followed by a retention period, when the patient is asked to wear the same appliance at night or another suitable one is prescribed so that the result the treatment did not go away.

If this is a small child, then the treatment can last long enough. Many parents now agree to start treatment as early as possible and prevent pathology, rather than wait for it to worsen and treat a more complex one.

Therefore, the muscles do not hinder the growth of the jaw, but rather help. With regular wearing of the functional device, the patient develops the correct bite. The ideal age to start treatment with a functional device is 7-8 years.

How to take care of your appliances?

Any appliances need to be cleaned, like teeth. If it is a plastic apparatus, it should be cleaned with a brush and paste or a brush and soap. You need to get a separate soft brush, you can use the child's former favorite brush. And clean theappliances for her.

You can't eat in functional appliances. This is unrealistic, they are two-jawed. Remove the appliance before eating. Then you need to put it on. It is better to rinse your mouth. Ideally brush your teeth.

Do not allow sugary drinks, soda to be consumed in them. If a child wants to drink a glass of Coca-Cola, he must take off the apparatus, have a drink, brush his teeth or at least rinse it, then put on the apparatus.

Because sugary drinks will then remain on the appliance, on all structures that are adjacent to the teeth, to the gums, which means bacteria will eat, the possibility of caries development increases - therefore, it is important to brush your teeth very well.

It happens when I see that a very dirty record comes, I show it to the child, to the parents, I say that we will now make soup from this! I bathe it in water, and a soup-like mass is formed. One such demonstration is enough so that next time they do not come with a dirty apparatus.


References

Functional appliances: mode of action and clinical use/ L V Macey-Dare, F Nixon
Early treatment with the ALF functional appliance James M Bronson, James Alexander Bronson
Importance of diagnosing and treating orthodontic and orthopedic problems in children Brock H M Rondeau
Class II correction-reducing patient compliance: a review of the available techniques P F McSherry, H Bradley

Den Tim


Practicing Dentistry for 20 years