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Indications for functional jaw orthopedic appliances
518 Reviews and abstracts ticular concern. A major requirement of any techique is its repeatability. Currently, much discussion exists about two different techniques. The one-handed push-back technique is intended to record the most retruded position of the condyles in their fossae. Despite claims of superior repeatability, some clinicians claim that this approach produces a downward and backward condylar displacement. However, an alternative technique of bimanual manipulation is claimed to produce the uppermost, rearmost position. Whether either is the more physiologic approach to centric relation is questionable. The bimanual adherents claim that their approach is better. However, the authors of this research project were concerned only with the repeatability of each technique. In this study, radiographic comparison of both condylar positions failed to reveal any significant difference. Clinically, however, the primary tooth contacts achieved with the bimanual technique tended to be more posterior, and most subjects could detect this difference. It is obvious that the clinician must determine which technique is most biologically compatible, and he should then stay with that one technique. T. M. Graber
A Laminagraphic Study of the Alterations in the Temporomandibular Joint Following Activator Treatment Liselot Birkebaek, Birte Melsen, and Sven Terp Eur. J. Orthod.
6: 257-266,
1984
The exact effect of activator treatment has been a subject of wide discussion and considerable controversy. Although most clinicians agree on the dentoalveolar changes, the exact effect on the temporomandibular joint (condyle, fossa, etc.) is still the subject of continuous debate and ongoing research. The purpose of the present study was to develop a standardized method of laminagraphy and to apply this to an evaluation of the changes in the temporomandibular joint following activator treatment. Twenty-three children (fifteen boys and eight girls) made up the sample. Metallic implants were inserted in both jaws before treatment. Fifteen of the patients, each of whom had a Class II molar relationship with a large overjet, were treated with a Harvold type of activator, worn I2 to 14 hours per day. Construction bite was taken edge-to-edge sagittally, and at least 2 mm beyond the freeway space vertically. One profile and two laminagraphic radiographs were taken before and after 10 ,months, via a standardized technique. TMJ changes were described according to a coordinate system related to the cranial base. Alveolodental as well
as condylar growth increments and direction were re lated to the metallic implants. It was shown that a major part of the activator effect could be ascribed to an anterior displacement of the mandible, caused by an increase in the amount and change in direction of condylar growth, as well as to remodeling of the articular fossa. This clinical study corroborates the extensive laboratory findings of Petrovic, Stutzmann, and associates. T. M. Graber
lndikation Funktionskieferorthoptidischer Geriite (Indications for Functional Jaw Orthopedic Appliances) G. P. F. Schmuth Fortschr.
Kieferorthop.
44: 428.437,
1984
Functional appliances are indicated primarily in cases of orofaciai dysfunction (abnormal perioral muscle activity, hyperactive mentalis function, hypofunction of upper lip, tongue posture and function abnormalities, sucking habits, bruxism). This applies to the deciduous and mixed dentition, as well as the adult dentition, when certain gnathologic procedures must take precedence. Functional appliances are indicated for the correction of a mesio- or distocclusion before and during the mixed-dentition period. In the adult they lead to a change in the habitual closing movement of the mandible which can be therapeutically beneficial. In cases of eccentric bruxism, functional appliances are particularly appropriate in preventing unilateral overload of the temporomandibular joint. Bite raising (stimulating eruption of selected teeth) can be achieved in conjunction with sagittal correction. In anterior open bite resulting from sucking habits, successful therapy is possible, provided there is not a marked skeletal component. When there is a question of tooth sacrifice, the capabilities of functional appliances for limited expansion must be considered. This is valid for both transverse and sagittal dimensions. Other criteria must also be taken into account. If marked mesial drift of the teeth cannot be controlled, then extraction therapy may be the only solution to the problem. Functional appliances that are used before or during the mixed-dentition period should be suspended as soon as the buccal occlusion and excessive overjet are corrected. Only a very small amount of relapse will occur at this time. Unfortunately, functional therapy previously has not always recognized the need for this interim cessation of active guidance and thus was correctly criticized because of the lengthy therapy and potential proclination of lower incisors. Artistic positioning on the teeth, par-
Reviews ad
Volume 87 Number 6
titularly in extraction cases in older persons, is not possible with functional appliances. However, prognosis for tooth guidance in early extraction cases with functional appliances is excellent when the eruption phenomenon is used. Long-term observation with the most efficient treatment at the appropriate time should be the goal for all orthodontists.
abstracts
519
Fr&kel appliances. Posttreatment growth increments and growth direction were comparable to the normal group-a testament to the effectiveness of the Frankel method in eliminating the original deficiencies. The results are quite similar in magnitude and degree to those reported by McNamara, who used a similar cast study but a different cephalometric analysis.
T. M. Graber
T. M. Graber
Analyse der Effektivitat der FrtinkelMethode zur Behandiung des Distaibisses (Analysis of the Effectiveness of the Frtinkei Method in the Treatment of Distal Bite [Class ii]) F. J. Choroschilkina and J. M. Malygin
Behandiungs und Wachstumsbedingte Veranderungen beim Profii der SpaitPatienten (Changes Due to Treatment and Growth in the Profile of the Cleft Palate and Cleft Lip Patient) G. Rehak
Fortschr.
Fortschr.
Kieferorthop.
45: 448-464,
1984
This article from the central dental institute of Moscow discusses the results of a study of 288 patients190 girls and 98 boys ranging in age from 5V’2to 17 years. Two hundred fifteen exhibited Angle Class II, Division 1 malocclusion and 73 Angle Class II, Division 2 malocclusion. The FR I was used in the treatment of 215 patients; the FR II was used in 73 subjects. For 29 patients early treatment by the authors, using the function regulator, corrected the problems. Modified function regulators were used for 61 patients with various contemporary modifications of the original appliance (FR Ia, FR Ib, FR Ic, etc.). Cephalometric and cast analyses were employed and a statistical analysis of before-and-after records, as compared with norm standards, was done. Treatment of 259 cases was deemed successful (90%). The cephalometric analysis showed that the most common characteristics of the patients were a deep bite and skeletal underdevelopment of the mandible. The Frankel function regulator was thus being used as a deficiency appliance. As a result of FR therapy, the mandible grew downward and forward along a vector that paralleled what would be expected from an orthognathic occlusion and normal facial development. This was in contradistinction to the more vertical growth pattern of untreated Class II malocclusions. There was little maxillary retraction. The original Class II malocclusion characteristics were largely eliminated by the functional appliance treatment. Normal function was established. To accomplish this morphologic and functional change, condylar bone growth was accelerated. This, along with the change in mandibular growth direction, established the efficacy of the Frankel appliances. The authors observed that the more pronounced the anomaly, the greater the change produced by the
Kieferorthop.
44: 468473,
1984
This article is based on a doctoral dissertation completed by the author in 1980. One hundred sixty-eight lateral cephalograms of 68 patients between 6 and 16 years of age were studied for the growth determination of the lower jaw. A chi-square test and the mandibular growth prediction cephalometric method of Bjork were employed. It was found that the Jarabak method of growth prediction gave a false value because of the greater anterior vertical growth in the cleft patient. Although various types of clefts (bilateral and unilateral) were studied, no clear correlation could be seen for any category as far as mandibular growth rotation was concerned. It was possible for the mandible to rotate anteriorly, grow down the Y axis, or rotate backward in all cleft categories. Employing the Bjork predictive technique gave a high level of growth prediction success for the mandible. Fifty-two cleft patients (averaging 11 years of age) were treated for approximately 1l/2 years with the Delair reverse face mask. The SNA angle was measured and a Student t test employed to assess significance. The results showed conclusively that the growth of the maxilla can be successfully stimulated as shown by an increased SNA angle after treatment. Successful treatment for the cleft-palate patient must thus take into consideration the probable growth direction of the mandible (which can be accurately determined with the Bjork technique for prediction of mandibular growth rotation) and the demands for protraction and stimulation of the maxilla-based on the original dysplasia and subsequent need for sag&al changes to harmonize the anteroposterior relationships in the cleft-patient profile. T. M. Graber
A Laminagraphic Study of the Alterations in the Temporomandibular Joint Following Activator Treatment Liselot Birkebaek, Birte Melsen, and Sven Terp Eur. J. Orthod.
6: 257-266,
1984
The exact effect of activator treatment has been a subject of wide discussion and considerable controversy. Although most clinicians agree on the dentoalveolar changes, the exact effect on the temporomandibular joint (condyle, fossa, etc.) is still the subject of continuous debate and ongoing research. The purpose of the present study was to develop a standardized method of laminagraphy and to apply this to an evaluation of the changes in the temporomandibular joint following activator treatment. Twenty-three children (fifteen boys and eight girls) made up the sample. Metallic implants were inserted in both jaws before treatment. Fifteen of the patients, each of whom had a Class II molar relationship with a large overjet, were treated with a Harvold type of activator, worn I2 to 14 hours per day. Construction bite was taken edge-to-edge sagittally, and at least 2 mm beyond the freeway space vertically. One profile and two laminagraphic radiographs were taken before and after 10 ,months, via a standardized technique. TMJ changes were described according to a coordinate system related to the cranial base. Alveolodental as well
as condylar growth increments and direction were re lated to the metallic implants. It was shown that a major part of the activator effect could be ascribed to an anterior displacement of the mandible, caused by an increase in the amount and change in direction of condylar growth, as well as to remodeling of the articular fossa. This clinical study corroborates the extensive laboratory findings of Petrovic, Stutzmann, and associates. T. M. Graber
lndikation Funktionskieferorthoptidischer Geriite (Indications for Functional Jaw Orthopedic Appliances) G. P. F. Schmuth Fortschr.
Kieferorthop.
44: 428.437,
1984
Functional appliances are indicated primarily in cases of orofaciai dysfunction (abnormal perioral muscle activity, hyperactive mentalis function, hypofunction of upper lip, tongue posture and function abnormalities, sucking habits, bruxism). This applies to the deciduous and mixed dentition, as well as the adult dentition, when certain gnathologic procedures must take precedence. Functional appliances are indicated for the correction of a mesio- or distocclusion before and during the mixed-dentition period. In the adult they lead to a change in the habitual closing movement of the mandible which can be therapeutically beneficial. In cases of eccentric bruxism, functional appliances are particularly appropriate in preventing unilateral overload of the temporomandibular joint. Bite raising (stimulating eruption of selected teeth) can be achieved in conjunction with sagittal correction. In anterior open bite resulting from sucking habits, successful therapy is possible, provided there is not a marked skeletal component. When there is a question of tooth sacrifice, the capabilities of functional appliances for limited expansion must be considered. This is valid for both transverse and sagittal dimensions. Other criteria must also be taken into account. If marked mesial drift of the teeth cannot be controlled, then extraction therapy may be the only solution to the problem. Functional appliances that are used before or during the mixed-dentition period should be suspended as soon as the buccal occlusion and excessive overjet are corrected. Only a very small amount of relapse will occur at this time. Unfortunately, functional therapy previously has not always recognized the need for this interim cessation of active guidance and thus was correctly criticized because of the lengthy therapy and potential proclination of lower incisors. Artistic positioning on the teeth, par-
Reviews ad
Volume 87 Number 6
titularly in extraction cases in older persons, is not possible with functional appliances. However, prognosis for tooth guidance in early extraction cases with functional appliances is excellent when the eruption phenomenon is used. Long-term observation with the most efficient treatment at the appropriate time should be the goal for all orthodontists.
abstracts
519
Fr&kel appliances. Posttreatment growth increments and growth direction were comparable to the normal group-a testament to the effectiveness of the Frankel method in eliminating the original deficiencies. The results are quite similar in magnitude and degree to those reported by McNamara, who used a similar cast study but a different cephalometric analysis.
T. M. Graber
T. M. Graber
Analyse der Effektivitat der FrtinkelMethode zur Behandiung des Distaibisses (Analysis of the Effectiveness of the Frtinkei Method in the Treatment of Distal Bite [Class ii]) F. J. Choroschilkina and J. M. Malygin
Behandiungs und Wachstumsbedingte Veranderungen beim Profii der SpaitPatienten (Changes Due to Treatment and Growth in the Profile of the Cleft Palate and Cleft Lip Patient) G. Rehak
Fortschr.
Fortschr.
Kieferorthop.
45: 448-464,
1984
This article from the central dental institute of Moscow discusses the results of a study of 288 patients190 girls and 98 boys ranging in age from 5V’2to 17 years. Two hundred fifteen exhibited Angle Class II, Division 1 malocclusion and 73 Angle Class II, Division 2 malocclusion. The FR I was used in the treatment of 215 patients; the FR II was used in 73 subjects. For 29 patients early treatment by the authors, using the function regulator, corrected the problems. Modified function regulators were used for 61 patients with various contemporary modifications of the original appliance (FR Ia, FR Ib, FR Ic, etc.). Cephalometric and cast analyses were employed and a statistical analysis of before-and-after records, as compared with norm standards, was done. Treatment of 259 cases was deemed successful (90%). The cephalometric analysis showed that the most common characteristics of the patients were a deep bite and skeletal underdevelopment of the mandible. The Frankel function regulator was thus being used as a deficiency appliance. As a result of FR therapy, the mandible grew downward and forward along a vector that paralleled what would be expected from an orthognathic occlusion and normal facial development. This was in contradistinction to the more vertical growth pattern of untreated Class II malocclusions. There was little maxillary retraction. The original Class II malocclusion characteristics were largely eliminated by the functional appliance treatment. Normal function was established. To accomplish this morphologic and functional change, condylar bone growth was accelerated. This, along with the change in mandibular growth direction, established the efficacy of the Frankel appliances. The authors observed that the more pronounced the anomaly, the greater the change produced by the
Kieferorthop.
44: 468473,
1984
This article is based on a doctoral dissertation completed by the author in 1980. One hundred sixty-eight lateral cephalograms of 68 patients between 6 and 16 years of age were studied for the growth determination of the lower jaw. A chi-square test and the mandibular growth prediction cephalometric method of Bjork were employed. It was found that the Jarabak method of growth prediction gave a false value because of the greater anterior vertical growth in the cleft patient. Although various types of clefts (bilateral and unilateral) were studied, no clear correlation could be seen for any category as far as mandibular growth rotation was concerned. It was possible for the mandible to rotate anteriorly, grow down the Y axis, or rotate backward in all cleft categories. Employing the Bjork predictive technique gave a high level of growth prediction success for the mandible. Fifty-two cleft patients (averaging 11 years of age) were treated for approximately 1l/2 years with the Delair reverse face mask. The SNA angle was measured and a Student t test employed to assess significance. The results showed conclusively that the growth of the maxilla can be successfully stimulated as shown by an increased SNA angle after treatment. Successful treatment for the cleft-palate patient must thus take into consideration the probable growth direction of the mandible (which can be accurately determined with the Bjork technique for prediction of mandibular growth rotation) and the demands for protraction and stimulation of the maxilla-based on the original dysplasia and subsequent need for sag&al changes to harmonize the anteroposterior relationships in the cleft-patient profile. T. M. Graber