Functional appliances: A review

doi:10.1016/0889-5406(89)90055-3

American Journal of Orthodontics and Dentofacial Orthopedics

Volume 95, Issue 3, March 1989, Pages 250-258

https://doi.org/10.1016/0889-5406(89)90055-3 Get rights and content

Abstract

The purpose of this review was to evaluate the scientific studies that describe the effects of functional appliances on the dentofacial structures in the treatment of Class II malocclusions. The review is limited to two appliances: the activator and the functional regulator.

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Cited by (122)

Comparison of masticatory myofunctional rehabilitation combined with conventional functional appliances for the treatment of class Ⅱ, division 1 malocclusion. A retrospective cohort study
2023, Journal of Stomatology, Oral and Maxillofacial Surgery
To estimate the clinical efficacy of early masticatory myofunction rehabilitation combined with conventional functional appliances for the treatment of class Ⅱ, division 1 malocclusion in orthodontic children during the growing phase.
A comparative retrospective cohort study, enrolled patients diagnosed with class Ⅱ/1 in the stage of late mixed or early permanent dentition. Patients were divided into a TBA group (Cohort 1): receiving Twin-block appliance treatment; and a MMR group (Cohort 2): receiving either early masticatory myofunction rehabilitation as adjunctive therapy combined with the same conventional functional appliances. The study variables were active (Phase 1) treatment duration, oral esthetic subjective impact score (OASIS), several cephalometric indices calculated from X-ray photographs, the maximum voltage (mV) and asymmetry index (AsI) of anterior temporalis (TA) and masseter muscles (MM) before and after treatment. Complications were also recorded.
A total of 424 cases were enrolled. The mean treatment duration in the MMR group was 168.33 days (SD: 25.43) and 215.00 days (SD: 28.81) in the TBA group; mean difference: -46.67 days (95% CI: [-81.62, -11.71]), P<0.001. For the OASIS outcome measure, there was no statistically significant difference between the mean total scores for the MMR group (18.83±7.73) or TBA group (17.67±6.47) groups adjusted to include pre-treatment OASIS scores (P = 0.783). After treatment, sella-nasion-B point (SNB), mandibular incisor angle, maxillary base and mandibular base in both two groups were significantly increased, while AB plane angle (ANB), maxillary incisor angle, overjet and overbite were significantly decreased. The mV and AsI of TA and MM were also improved following treatment. However, no significant differences were observed between two groups.
Our results confirmed that early masticatory myofunction rehabilitation in combination with conventional TBA for patients in the growing phase was significantly effective in the management of class Ⅱ/1 in orthodontic treatment, which could significantly shorten the treatment duration and had the similar improvement in the cephalometry data, OASIS scores and masticatory muscles function when comparing to conventional TBA alone.
Twin-block and mandibular anterior repositioning appliances effects in Class II malocclusion correction
2023, American Journal of Orthodontics and Dentofacial Orthopedics
The objective of this study was to compare the cephalometric changes in Class II Division 1 malocclusion patients treated with the Twin-block (TB) and the mandibular anterior repositioning appliance (MARA).
This retrospective study was performed with 132 lateral cephalograms of patients with Class II malocclusion divided into 3 groups: a TB group comprised 21 patients with mean initial and final ages of 10.59 and 11.97 years, respectively, treated for a mean period of 1.38 years; a MARA group comprised 21 patients with mean initial and final ages of 11.98 and 13.20 years, respectively, treated for a mean period of 1.22 years; and a control group included 24 subjects with untreated Class II malocclusion with mean initial and final ages of 10.55 and 12.01 years, respectively, observed for a mean period of 1.46 years. Cephalometric intergroup comparisons regarding the treatment changes (T2 − T1) were performed with the analysis of covariance, followed by Tukey tests.
Both appliances demonstrated significant restriction of the maxilla and improvement of the maxillomandibular relationship. The MARA produced a significantly greater amount of labial tipping and protrusion of the mandibular incisors than the other groups. The TB showed significant extrusion of the mandibular incisors and molars compared with MARA and control, respectively. Both treated groups reduced the overjet and overbite. The MARA presented a significantly greater reduction in the molar relationship than the other groups.
The appliances showed a headgear effect on the maxilla and effectively changed Class II cephalometric parameters through a combination of skeletal and dentoalveolar effects. TB showed a greater increase in LAFH. MARA promoted greater labial tipping and protrusion of the mandibular incisors.
Effects of the Forsus fatigue-resistant device and mandibular anterior repositioning appliance in Class II malocclusion treatment
2022, American Journal of Orthodontics and Dentofacial Orthopedics
Fixed functional appliances have been used to treat Class II malocclusion by a huge number of professionals. This retrospective study aimed to analyze the effects of the Forsus fatigue-resistant device and compare the findings with a well-matched group treated with the mandibular anterior repositioning appliance (MARA).
The Forsus group was composed of 14 patients at an initial mean age of 12.4 ± 1.3 years, treated with the Forsus fatigue-resistant device followed by a fixed orthodontic appliance. The MARA group comprised 18 patients at an initial mean age of 12.1 ± 1.3 years, treated with MARA followed by fixed orthodontic appliances. The untreated control group consisted of 14 patients matched with the other groups. Posttreatment changes were calculated as T1 − T2. Intergroup comparisons regarding treatment changes were performed using repeated-measures analysis of variance followed by Tukey’s test.
During treatment, the Forsus group showed a statistically significant decrease in maxillary protrusion and maxillomandibular sagittal discrepancy in the control group. The MARA group showed significantly greater retrusion of maxillary incisors than the Forsus and the control group. Overjet decreased significantly more in the treated groups in relation to the control group. Molar relationship improved significantly more in both treated groups, and both showed more correction than the untreated control group.
The Forsus and MARA associated with fixed appliances effectively corrected the Class II malocclusion, mostly using dentoalveolar changes and maxillary growth restriction.
Effects of miniplate anchored Herbst appliance on skeletal, dental and masticatory structures of the craniomandibular apparatus: A finite element study
2021, International Orthodontics
To analyze the stress distribution in the hard and soft tissue structures of craniomandibular complex during mandibular advancement with miniplate anchored rigid fixed functional appliance (FFA) using Finite Element Analysis (FEA).
The virtual model consisting of all the maxillofacial bones (up to calvaria), the mandible and temporomandibular joint (TMJ) was generated using the volumetric data from pre-treatment CBCT-scan of a growing patient. The masticatory muscles, other soft tissues, Herbst appliance and plate geometry were modelled mathematically. Force vectors simulating muscle contraction at rest and advanced mandibular positions, with protraction force of 8 N were applied. The final model was imported into ANSYS for analysis after assigning material properties.
The maximum von Mises stress of 11.69 MPa and 11.96 MPa magnitude was observed in the region of pterygoid plates and at the bone-miniplate interface respectively, with the mandibular advancement of 7 mm. Stress patterns were also noted at the condylar neck. The stress values observed in the medial and lateral pterygoid muscles were of 10.42 MPa and 4.16 MPa magnitude, respectively. Stress was noted in the bucco-cervical region of the upper posterior teeth, but negligible change was seen on the lower anterior teeth and periodontal ligament.
Miniplate Anchored Herbst Appliance brought about Class II skeletal correction in growing children as it was accompanied by minimal changes in the inclination of the lower incisors. Soft tissue structures like pterygoid muscles and discal ligaments exhibited increased stress whereas masseter muscle displayed reduction in stresses.
Effects of a fixed functional appliance on upper airway volume: A 3-dimensional cone-beam computed tomography study
2020, American Journal of Orthodontics and Dentofacial Orthopedics
Although functional appliances (FAs) are primarily used to treat Class II malocclusions, their effects on the upper airway have generally been reported in studies involving 2-dimensional analysis of cephalometric radiographs. This study aimed to use 3-dimensional cone-beam computed tomography to (1) determine the effects on upper airway volume and minimum cross-sectional area (MCA) when an FA is used for orthodontic treatment and (2) identify pretreatment markers for airway changes.
Pre- and posttreatment cone-beam computed tomography scans were selected from 73 children whose orthodontic treatment involved using a fixed FA (37 girls and 36 boys; mean age 12.0 years); a control group was constituted and included the scans of 73 children who were matched for chronological age, skeletal age, sex, and mandibular inclination and who received orthodontic treatment for minor malocclusions without an FA. Changes in upper airway volume and MCA were evaluated by a standardized, previously validated method analyzed with mixed-effects linear regression.
Upper airway volume and MCA increased over time for both the FA and the matched control groups (P <0.05). The FA caused an additional significant increase in upper airway volume and MCA (P <0.0001) when compared with the control group. An increased ANB angle, a reduced mandibular inclination, and a reduced skeletal age pretreatment had a positive effect on upper airway volume and MCA (P <0.05).
A fixed FA was associated with a significant increase in upper airway volume and MCA in children when compared with controls. Pretreatment ANB angle, skeletal age, and mandibular inclination may be predictors for positive changes in the upper airway. The results may prove valuable in treating children with Class II malocclusions with compromised upper airways.
Three-dimensional computed tomography analysis of airway volume in growing class II patients treated with Frankel II appliance
2024, Head and Face Medicine

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Review articleFunctional appliances: A review

Abstract

Am J Orthod

Am J Orthod

Am J Orthod

Am J Orthod

Am J Orthod

Angle Orthod

J Prosthet Dent

Angle Orthod

Am J Orthod

J Clin Orthod

Am J Orthod

Am J Orthod

Am J Orthod

Am J Orthod

Am J Orthod

Am J Orthod

Am J Orthod

Angle Orthod

Rev Stomatol

Am J Orthod

Am J Orthod

Am J Orthod

Mandibular plane changes during maxillary retraction

Am J Orthod

Die elastischen Gebissformer

Zahnarztl Welt

Review article
Functional appliances: A review