Appliances
for functional jaw orthopedics
Last
update 01.07.2007
For
an impression of the art of functional jaw orthopedics with removable
appliances (German: FKO), see these 2 sentences which I found
elsewhere, in a materials research journal:
Nature
is still doing all the work in creating (..). We´re just
politely asking it to do it in a particular location with a defined
order and configuration.
FKO
utilizes exclusively the forces of the patient´s mouth muscles,
and it corrects the muscular functions. Particular non-rigid
appliances even stimulate jaw
movements by the so-called chewing gum effect.
These forces are controlled by the patient. Functional
appliances re-direct them for bite correction, for growing all teeth
in plane, and some special appliances also for gain of space by
stimulation of growth, or for correction of individual teeth.
Pain and possible damage, which threaten when applying artificial forces especially by fixed appliances, are prevented. It is emphasized that the somehow self-grown results of FKO are well stable against relapse. Some more English examples are in Weitere Info ... Naturheil-Spangen.
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Bite
jumper plates Another
kind of bite jumper plates are the green specimens below. The
upper has elastic bite jumper wings of silicone rubber, which
stimulate jaw movements, and can stimulate upper and lower
expansion, if the central screw elements are re-adjusted from time
to time. |
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Double and single (lightweight) bite back-shift plate Bite
back shift plates are intra-oral appliances in quite conventional
style to treat the rarer class III (progenic) cases. That
means, they do the opposite of the before-mentioned bite jumper
plates, and this is more difficult: try yourself, how far can you
shift your lower jaw forward, but how far only pull it
backward? The task of shifting back the lower jaw by small steps is solved in the double version by Sander´s commercial kit: in the upper plate a pair of downward directed lateral rods, and in the lower a pair of lateral supports which keep the upper rods in front of them. Or viewed from the lower jaw, this is held back by the upper plate. Some sideward distance permits the use of the expansion screws. Now the lower supports can be screwed forward, giving the lower jaw a back-shift little by little, whereas the counter-force acts on the upper jaw. The 4-element bite back shift single plate leaves much more space for the tongue. As the first element, a re-adjustable downward bow holds the lower jaw back (compare with expl. of cases> Early treatment of class III). Next, an expansion screw is for gain of jaw width. Then for gain of frontal jaw length, protrusion springs push the incisors from inside, and the outer shields, which are somewhat small here, stem from the FR 3 (see below) and are to stimulate the bone growth in the height of the roots. |
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Well-shaped activator The shown specimen reaches deep in the lower jaw, and snaps in there, for its sure guidance especially during sleep. In the upper jaw, however, the plastic body is largely reduced. By this, it hinders speech less than most upper plate appliances. It performs not only bite jumping, but allows also vertical equilibration of deep or open bite, if it is properly machined after casting. |
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Improved bionators of 2 types These are improved to stimulate jaw movements (chewing gum effect) and to convert their force to bite corrections. By this, even a treatment of children beyond their growth maximum remains promising. Silicone rubber is added on the sides of the first (upper) specimen, for more efficient correction of an open bite. The second specimen is a reverse Bionator modification, for class 3 treatment (back shift of lower jaw). Correction is enhanced here by silicone rubber for a full-contact forward shift of the upper front (set-up technique). The general shape of Bionators is intended to correct lip and tongue functions, and like all 1-piece appliances, to enhance nose breathing. Correct functions should lead to correct jaw development. |
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The
Biognathor, a functional appliance for adults The
Biognathor can also aim to achieve a functional bite shift, which
is done by influencing the jaw development, even in adult
treatment. This is vehemently doubted by protagonists of jaw
surgery, whereas manufacturers and protagonists of Herbst
appliances and likewise fetters nevertheless advertise their
success in adult treatment. |
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A
shoe tree in the cheeks: Between lips
and teeth, our cheeks have quite large pockets. The plastic of the
Fränkel appliances reaches into these pockets, up to their
top and bottom. There, it stands 2-3 mm away from the jaw. By
this, it makes our flesh pull at our jawbones. This stimulates
their growth, depending on age of the patient, but even for
difficult vertical face growth. With neither risk of
over-correction and subsequent relapse, nor risk of jaw joint
damages or tooth damages. High longtime stability of the results
has been reported. If treatment begins early, then not only
expansions of up to 6 mm and stretching of the jaws and vertical
correction can be achieved, but also space for the wisdom teeth
can be created. Function regulator 3 The FR3 is well-proven for
treatment of class 3 (progenic) children. It stretches and widens
only the upper jaw, where re-adjustment of the frontal
shields is also possible. It holds the lower jaw back and hinders
its growth (plastic fits tightly around it). |
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Muscle
force jaw shaper |
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Bimler
appliances (find more details under expl. of
cases) For Bimler treatment of children, the Bimler-A type is appropriate in 90% of these cases. The specimen shown here has an additional pair of springs in the upper cuspid region. |
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Bimler B appliance, against covered bite (class II-2) viewed
from above, so that the two long wires which hold the lower
frontal part are underneath it. For courses, pre-fabs and documentation, see http://www.bimler.com/. Addresses of manufacturers of custom-made Bimler appliances can also be obtained there. |
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Bimler C / progenic appliance (for class III cases) 5%
of the European population have a more or less progenic bite. The
Bimler C appliance, here viewed from above (find more under
expl. of cases), leaves for the tongue almost as much
space as the above-mentioned FR 3 does, but is much less bulky in
the cheeks and needs less of daily wearing time. In fact, daytime
wear is only required at the beginning of the treatment. |
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Hangl´s Maxillator Austrian
appliance which unifies advantages of Karwetzky´s
U-bow-activator in its lower part (simplicity, stability) and of
Bimler appliances in the upper part (gentle lateral and forward
expansion by chewing gum effect; open front = low
speech hindrance). |
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Stockfisch´s Kinetor This appliance is built from a pre-fabricated kit of replacable wire and tubing parts. It has a similar mode of action than the Bimlers, but is narrower inside. It stimulates chewing and demands moderate wear times (night + 2-3 hours per day). Jaw development can be influenced rapidly in 3 dimensions. |
Sources of the images: see German version of this chapter