Frankel’s appliance

Frankles appliance Is a myofunctional appliance
Functional appliance are removable or fixed appliances that aim to utilize eliminate or guide the forces arising from muscle function,tooth eruption and growth inorder to alter skeletal and dental relationship

1. FRANKLE’S APPLIANCE DONE BY ASHWANTH DEEPAK cri

2. MYOFUCTIONAL APPLIANCE Frankles appliance Is a myofunctional appliance Functional appliance are removable or fixed appliances that aim to utilize eliminate or guide the forces arising from muscle function,tooth eruption and growth inorder to alter skeletal and dental relationship.

3. INTRODUCTION GIVEN BY Rolf frankle in 1967 at germany . Other names : 1.vestibular appliances 2. Oral gymnastic appliance Frankle’s appliance abnormal perioral muscle function Neither myotonic or myodynamic Worn full time REGULATES

4. Frankel philosophy influence E xtraorally I ntraorally 1

5. Potential restraining influence restricts Frankle’s appliance

6. C O R R E C T S

7. Moyer’s : “ alterting the condition that determine the pattern of occlusal development rather than altering the occlusion directly”

8. CLASSIFICATION OF FR FR 1 TYPES a,b and c FR 2 FR 3 FR4 MODIFICATION OF FR

9. COMPONENTS FR 2 is a prototype in comparing other types of frankel appliance Parts : 1.Acrylic component 2.wire component Acrylic component Wire component

10. vestibular component/ Buccal shield Lower lip pads Upper lip pads or labial pads Lingual shield Acrylic components

11. 1.Vestibular component or buccal shield Extension: Buccal to posterior teeth,extends well into the sulcus until the tolerable level. Thickness:2.5mm ACTION :Eliminates restrictive force of perioral muscles outward thrust of tongue. Trains the cheek musculature to a more relaxed level of tonicity. Correction of malocclusion.

12. Vestibular component

13. Premolar and tuberosity sheilds Strechs periosteum Deposition of bone along the lateral aspect of maxilla

14. 2.Lower lip pad Two acrylic plate rhomboidal in shape Extension: labial sulcus of anterior region,lateral to midline and medial to canine eminance,parallel to alveolar process. Superior margin should be 5mm below gingival margin prevents gingival stipping . LOWER LIP PAD

15. Prevents action of hyperactive mentalis prevents lip trap Proper oral seal Eliminates retrusive muscular function in sagittal direction Forward growth of mandible

16. 3.Upper lip pad Analogus to lower lip pad but larger in size Absent in FR2 but present in FR3 appliance Upper lip pad buccal shield Expansion of oral functioning space UPPER LIP PAD

17. 4.Lingual shield LOCATION :lingual to mandibular alveolar bone,extends towards premolar region,short of gingival marigin superioirly and into functional depth of sulcus Connected to buccal shields via connecting wires LINGUAL SHIELD

18. ACTION: Forward positioning of mandible Sensory input device reposition mandibe forward when patient fails to.

19. Labial bow- upper,lower labial support wires/lip pad support wires- upper,lower . Lower lingual support wire and crossoverwires /lingual stabilizing bow Maxillary lingual stabilizing bow/protrusion bow 5. Palatal bow 6.Lower lingual springs 7.Canine clasps/canine loops 8.Canine extension 9.Occlusal rest. Wire components

20. 1. Labial bow UPPER LABIAL BOW: Found in FR1 and FR2 Extension : between lateral incisors located along the middle third of labial surface of maxillary incisors from the distal surface of lateral incisors ,turns gingivally at rigth angles and about half a length of canine curves towards distal side. Labial bow should be bent in a ideal contour. FUNCTION: Stabilizes the appliance interconnects the buccal shields acts as guide for positioning the appliance UPPER LABIAL BOW Labial uses both upper and lower bow depending on the type of appliance.

21. LOWER LABIAL BOW: used in FR3 appliance EXTENSION: IN mandible extends between distal surface of canine and is located at the gingival third of lower anterior teeth. From distal surface wire moves vertically downwards,half through the depth of functional sulcus,curves distally and forms a tag,which is incorported in buccal shield FUNCTION: should be in tight contact with the lower anteriors restricts anterior growth of mandible,prevents tipping of lower incisors . LOWER LABIAL BOW

22. 2. Lip pad wires Made of 0.9mm wires EXTENSION: 7 mm below the gingival margin,inverted v in shape.another wire emerges from lip pad and gets embedded in the buccal shields. Lateral wires connect the lip pads to the buccal shields FUNCTION: They offer support to the lip pads LIP PAD WIRES

23. 3. Lingual stabilizing bow and lingual cross over wire Can be made form single piece of wire or in three segments. EXTENSION: Wire should be 1-2 mm away from the mucosa and about 4 mm below the lingual gingival margins of incisors to allow the addition of acrylic at later stage. cross over wire connects the lingula shield to buccal shield and pass between the first and second bicuspids or deciduous molars. FUNCTION: lingual support wire supports the lingual shield. cross over wire connects the lingual shield to buccal shield . LINGUAL CROSSOVER WIRE

24. 4.Maxillary lingual stabilizing bow It is closely adapted to palatal surfaces of the maxillary incisors and laterals above the cingulum of the teeth. At about distal surface of lateral incisors the bow takes a sharp bend to form a ‘ U’loop and crosses the contact point between canine and premolar and incorporated into buccal shield on either side. FUNCTION: In FRII its is mainly used to stabilize the appliance prevents lingual tipping of anterior teeth In FRIII stimulates forward movement of the teeth hence called protrusion bow. LINGUAL STABILIZING WIRE

25. 5. Palatal bow It is like a transpalatal arch The palatal bow should 1-2 mm away from the palatal tissue surface and has its convexity facing distally forming a small ‘U’ loop along the midline. The bow crosses the occlusal surface,mesial to first permanent molar tp enter the buccal shield. Palatal bow used in used in FRIII and FRIV is similar to FRI and FR II except the lateral ends of the bow cross distal to the last erupted tooth. FUNCTION: helps in connecting the buccal shields and supports the buccal shield from collapsing under the pressure of muscles pf the buccinator mucles Prevents supra eruption of permenant molars . PALATAL BOW

26. 6.Lower lingual springs Two separate wires are used for fabrication. EXTENSION: They rest against lingual surface of lower anteriors from canine to central incisors FUNCTION: prevent lingual tipping of lower anteriors Prevents supra eruption of lower anteriors Prevents muscular forces on lower anteriors Labial move retro clined incisors LOWER LINGUAL SPRING

27. 7. Canine loops Also called as canine guards Extension: kept 2-3 mm away drom the buccal surface of canines FUNCTION: Canine clasp along with palatal bow stabilizes appliance anteroposteriorly Corrects mandibular retrusion.guides erupting canines CANINE LOOPS

28. MODE OF ACTION Two main treatment effects : Serves as template against craniofacial muscles function Removes muscle force at the labial buccal areas that restrict skeletal growth,there by providing an environment which enables skeletal growth

29. Other important effects Increase in transverse and sagittal intraoral space(vestibular arena of operation) Increase in vertical space Sagittal correction Muscle function adaptation Periosteal bone formation

30. Oral gymnastic exercise The exercise recommended by: keep the lip closed all times,this can be aided by keeping a piece of between the lips Patient is asked to talk,read,swallow and tighly grasp the appliance in the vestibule.

31. FR I FR I is similar to FR II except it lacks lingual shield,lingual spring,lingual cross overwire and upper lingual bow. USES: CLASS I, CLASS II DIVISION I MALOCCLUSION

32. FR1 A AND FR1 B LOWER LINGUAL LOOPS OVERJET 5mm LOWER LINGUAL SHIELD OVERJET 7mm

33. FR 1 C STEP BY STEP OPENING IN THE ANTERIOR AND VERTICAL DIRECTION OVERJET >7mm

34. FR III COMPONENTS : It has two upper lip pads,which are tear drop shaped,larger . The buccal shields stand away from posterior dentoalveolar structures by about 3mm but are made to contact with the nadibular apical bone.

35. INDICATION: class III malocclusion characterised by maxillary retrusion without any mandibular prognathism . PERIOD: Decideous dentition USE: prevents restrictive force of lip over the under developed maxilla. They extened into periosteal attachment of sulcus depth and cause bone deposition Proturusion bow is seen behind the upper incisors to stimulate forward movement of these teeth.

36. FR IV COMPONENTS : same vestibular configuration as FR I and FR II but lacks canine loops and protrusion bows. It consists of IV occluusal rests on the maxillary first molars and first deciduous molars The palatal bow is like FR III placed distal to the last molar

37. AGE : Mixed dentition USES: correction of open bites and bimaxillary protrusion.

38. FR V They incorporate headgear COMPONENTS : consists of posterior acrylic bite blocks FUNCTION: prevents molar supraeruption . Indicated in cases of long face syndrome having mandibular plane angles and vertical maxillary excess.

39. construction Impression making Construction of wax bite Trimmin the casts Placement ofseating grooves/notching the teeth Mounting the casts Wax relief Fabrication of appliance

40. IMPRESSION TECHNIQUE REPREODUCE WHOLE ALVEOLAR PROCESS AND DEPTH OF THE SULCUS TRAY SELECTION ADEQUATE BASE

41. Contruction bite For minor sagittal problem : Edge to edge relationship Severe retrognathism : mandible should not be brought at once into edge to edge relation,should be advanced by about 4-6mm and incisors should be in edge to edge with aclearance of 2.5 mm to 3mm between occlusal surface of posterior teeth for FR I and FR II.

42. For FR III – Mandible should be in most retruded position. There should be a space of 1-2mm between the occlusal surface of posterior teeth for occlusal rest to be placed.

43. PREPARATIN OF THE CASTS GUAGE TO MEASURE THE DEPTH OF THE SULCUS PROPERLY CARVED MODEL

44. PREPARATION OF CASTS : SEATING GROOVES SEATING GROOVES ARE CUT IN THE MAXILLARY MODEL IN FR 1 AND FR 2 IN THE PERMANENT DENTITION

45. Trimming Maxillary tuberosity region Maxillary first premolar or first deciduous molar and anterior to buccal frenum Mandibular lip pad region Maxillary lip pad region

46. SULCUS TRIMMING AND POSTIONING LOWER LIP PAD EXTENSION OF LOWER LIP PAD

47. TREATMENT PHASES WITH FR INITIAL PHASE ACTIVE PHASE RETENTION PHASE

48. INITIAL PHASE APPLIANCE DELIVERY TO CHECK: SMOOTHNESS OF MARGINS LIP PAD – TEAR DROP SEPARATION b/w TEETH IN MIXED DENTITION MAKE NOTCHES APPLIANCE FIT OVER EXTENSION OF SHEILDS PALPATE FACE TO CHECK FOR SHARP EDGES

49. WEARING OF THE APPLIANCE SUCCESS OF TREATMENT –LIP SEAL EMPHASIS ON LIP EXERCISE DURATION OF WEAR 1 st WEEK 1-3 HRS IN AFTERNOON ONLY 2 ND WEEK 4-6 HRS 3-4 MONTHS –FULL TIME WEAR

50. ACTIVE PHASE CHECK AFTER EVERY 4 WEEKS: MUCOSAL IRRITATION STABILITY OF APPLIANCE IMPINGEMENT OF CROSS OVER WIRES APPLIANCE ADJUSTMENTS : CANINE LOOP- OCCCLUSALLY MOLAR RESTS- GINGIVALLY AFTER 3 MONTHS OF FULL TIME WEAR CHECK : EXPANSION OVERJET OVERBITE MOLAR RELATIONSHIP(6-8 MONTS) LEVELING OF CURVE OF SPEE DECREASE IN MENTALIS ACTIVITY

51. RETENTIVE PHASE DIFFERENT FROM FIXED APPLIANCE LABIAL AND LINGUAL WIRES CAN HOLD ALTERED TOOTH POSITIONS USED AS RETAINER IN PTS WHERE THE TRAINING EFFECT NOT SATISFACTORY FXED TREATMENT MAY BE REQUIRED 2HRS IN AFTERNOON 6 HRS IN NIGHT - SIX MONTHS ONLY NIGHT-ONE YEAR

52. MODIFICATION OF FR APPLIANCE CAPPED FRANKEL APPLIANCE0-OTTAN et al 1992 MODIFICATION FUNCTIONAL REGULATOR FOR VME –OWEN 1985 CHANGE IN ANGULATION OF CROSS OVER WIRE –CHATE 1986 KINGSTON MODIFIED BUCAAL SHIELDS HYBRID APPLIANCE – ACTIVATOR –FR COMBINATION 1986 FR WITH CONTIONOUS BUCOLABIAL SHIELD AND PALATAL ACRYLIC SUPPORT- HAYNES 1986

53. Wear time 1 st few weeks : 2-4hours/day (day time) After 3 rd weeks: 4-6 hours/day After 3 rd visit(2months): full time wear Patient is asked to perform oral gymnastics through reading,tightly grasping the appliance

54. ARTICLES BASED ON FRANKEL’S APPLIANCE

55. American Journal of Orthodontics Volume 83, Issue 3 , March 1983, Pages 200-217 Original article Morphologic changes in the transverse dimension using the Fränkel appliance Albert H. Owen III. Author links open the author workspace. D.D.S., M.S.D.Opens the author workspace Austin , Texas, USA Abstract Anthropologic studies have shown that the incidence of malocclusion increases as societies become urbanized. Crowding seems to be one of the most common findings. Possible explanations for this have been heredity, dietary changes, poor eruption patterns, and mouth breathing, among others. Many clinicians begin treatment early in order to minimize this maldevelopment . Various early-treatment approaches have included serial extraction, lingual holding arches, palatal expansion, functional appliances, partial fixed appliances, and headgear. Expansion with the functional regulator offers one solution to crowding. If this expansion can be shown to be significant in amount and stable, then the Fränkel appliance merits consideration regardless of the clinician's choice of fixed appliances. Fifty patients treated with the Fränkel appliance from the private practice of the author were analyzed to evaluate changes in the transverse dimension. The ages ranged from 5.9 to 13.8 years, with the average age 9.6 years (±1.54). Twenty-nine patients were girls and twenty-one were boys. The Angle molar relationships were distributed as follows: Class I-21 patients; Class II-27 patients; and Class III-2 patients. All patients were Caucasians and were selected for treatment on the basis of the presence of crowding, excessive overjet or overbite, or excessive open-bite. The presence of crowding was determined by a study model and Panorex analysis. All patients reported in this study were considered cooperative and wore their appliances for approximately 20 hours per day. Five cephalometric measurements were taken: nasal cavity width, maxillary width, mandibular width, intercanine width, and intermolar width. All cephalograms were originally traced by the same technician at Rocky Mountain Data Systems, Inc. When there was a discrepancy between the RMDS tracing and the author's tracing, the author's tracing was used. Data to serve as controls were provided by Rocky Mountain Data Systems, Inc. The sample is based on forty children measured over a 5-year period between the ages of 8 and 13 years. Twenty patients had an Angle Class I molar relationship, and twenty patients had an Angle Class II molar relationship. Two Student's t statistics were used to evaluate these measurements. Means, standard deviations, and standard errors are shown. The Bonferroni inequality method is used to determine if these five measurements are significant, and all five measurements were simultaneously significant at the 0.05 level. From the statistical results as well as the cephalometric descriptive analyses, it appears that the Fränkel appliance precipitates a limited but potentially significant increase in arch length which will benefit the patient if the results are stable.

56. American Journal of Orthodontics and Dentofacial Orthopedics Volume 104, Issue 2 , August 1993, Pages 153-161 Mandibular changes during functional appliance treatment ** Abstract: The purpose of this prospective trial was to determine the changes in position and size of the mandible in children treated with either the Fränkel function regulator or Harvold activator. Forty-two 10- to 13-year-old children with Class II, Division 1 malocclusions were matched in triads according to age and sex and randomly assigned to either control, Fränkel function regulator, or Harvold activator groups. There were no statistically significant differences between the groups at the beginning of the study. After 18 months, significant increases in gonial angle and articulare-pogonion length in the Harvold group were attributed to a change in the location of articulare because the condyles were positioned downward and forward at the end of treatment. The main effects of both appliances were to allow vertical development of the mandibular molars and increase the height of the face. The Harvold appliance also proclined the lower incisors and increased mandibular arch length. We could find no evidence to support the view that either appliance was capable of altering the size 

57. American Journal of Orthodontics Volume 82, Issue 1 , July 1982, Pages 10-22 Original article Arch width development in Class II patients treated with the Fränkel appliance workspace a Detroit , Mich., USA b Ann Arbor , Mich., USA Abstract: This article compares the arch development in growing Class II patients after Fränkel therapy with arch development in a similar group of untreated Class II subjects. Sixty treated and forty-seven untreated persons were compared for a 2- to 4-year period. Expansion of the maxillary and mandibular dental arches occurred to a much greater extent in patients undergoing Fränkel treatment than in the control subjects. The expansion was not limited to a particular region of the dental arch in the treated cases, although the largest expansion values were recorded in the premolar and molar regions. Lesser values were recorded in the canine region.

58. American Journal of Orthodontics and Dentofacial Orthopedics Volume 92, Issue 2 , August 1987, Pages 109-116 The uprighting effect of the Fränkel appliance on the mandibular canines and premolars during eruption Orthodontic Department of the District Hospital Heinrich Braun, Zwickau, German Democratic Republic Abstract: The effect of the Fränkel (FR) appliance on the eruptive path of the mandibular canines and premolars was evaluated in patients who were monitored from 8 to 13 years of age. The sample treated with the FR appliance consisted of 84 subjects with Class I or Class II malocclusion associated with crowding in the mandibular dental arch. Twenty-seven subjects of approximately the same age and with almost an indentical space deficiency in the mandibular arch not subjected to FR treatment served as a comparison group. Permanent teeth were not extracted during treatment in any cf the subjects in either group. The primary criterion of patient selection was based on the availability of standardized serial lateral and posteroanterior cephalograms , permitting an exact identification of the canine and premolar contours during eruption. Increases in width between the tips of the mandibular canines and the buccal tips of the mandibular premolars during eruption were significantly greater in the FR group than in the comparison group ( P  < 0.001). The expanding effect of the FR appliance was evidenced particularly in the region of the mandibular first premolars. The distance between the buccal tips of these teeth increased by an average of 3.5 mm more in the FR group than in the comparison group. Likewise, the width between the root landmarks of the first mandibular premolars increased during eruption in the FR group 212 times more than in the untreated sample, a difference that was statistically significant ( P  < 0.01). The analysis of the lateral cephalograms showed that the tips of the mandibular canines moved distally during eruption in the comparison group significantly more (mean = 2.2 mm) than in the FR group ( P  < 0.01). There was also a significant intergroup difference in the anteroposterior changes of point B, which moved posteriorly in the FR group less than in the untreated sample ( P  = < 0.01). This comparative study indicates that the eruptive path of the mandibular canines and premolars during treatment with the FR appliance can be significantly influenced in lateral, anteroposterior , and vertical dimensions. Since the FR appliance did not contact the mandibular teeth, it is suggested that the intercanine expansion in the treated group was the result of the vestibular shields that eliminated the restraining forces of the external muscular environment. The results of the study suggest that the size and shape of the external soft-tissue capsule are an important space factor controlling occlusal development, which should be considered when discussing the postretention recurrence of mandibular crowding.

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