SEMINAR ORTHODONTICS: TWIN BLOCK & FRANKEL APPLIANCE

GROUP 5:MASYITAH MUSTAFFA1090036SAKINAH MOHD SALEH1090041NURMARZURA ABDUL LATIF1090045SYAFIQAH NADHIRAH ISKANDAR1090049

SEMINAR ORTHODONTICS: TWIN BLOCK & FRANKEL APPLIANCEIntroductionFunctional appliance:removable or fixed orthodontic appliances that aim to utilise, eliminate or guide forces arising from muscle function, tooth eruption and growth in order to alter skeletal an dental relationships.

Types:Tissue-borne Frankel applianceTooth-borne (active) Twin blockTooth-borne (passive) Andresen applianceMyotonic Harvold activator

TWIN BLOCK removable functional appliance. made up of two components, an upper and lower plate, which works together to posture the lower jaw forward. frees up the locked-in lower jaw and encourages it to grow to its fullest potential. the upper (and sometimes lower) plate may also have an expansion screw to widen the arch. treatment with a Twin Block appliance typically takes 12 to 18 months.

MODE OF ACTIONworks on the philosophy of occlusal inclined planes and use of masticatory force throughout the day.

If the mandibular inclined planes are in a distal relation to that of maxilla then the force acting on the mandibular teeth will have a distal force vector leading to a Class II growth tendency.

The aim of the inclined planes of the bite blocks in twin block is to modify these inclined planes and cause more favorable growth pattern.

Hence the unfavorable cuspal contacts of the distal occlusion are replaced by favorable proprioceptive contacts on the inclined planes to correct the malocclusion and free the mandible from its locked distal position.Adjustment of the occlusal plane:deep overbite casethe upper block should be slightly trimmed occluso-distally to leave the lower molars 1 mm clear of the occlusion to allow for eruption This is usually done at the first visit, with subsequent reductions performed, as needed, until the proper vertical relationship is established.reduced overbite (or open bites) casevery important that NO trimming is done on the blocks.all posterior teeth must remain in contact with the blocks to PREVENT eruption of the posterior teeth.

Appointment Scheduling:First Appointment: Delivery of the appliance and patient instruction. Adjustment of the occlusal planes.One Week Later: Adjust the bite blocks if the lower molars have erupted into contact. For arch development, have the patient begin expansion screw activation at one turn per week.One months Interval:check adjustment. Watch for proper vertical, lateral and AP development.INDICATIONSBASIC USEClass II div I Malocclusion70% malocclusionMajority have Constricted maxillaRetrognathic mandibleN/short lower face height Large OJDeep OB12

13INDICATIONSClass II div IClass II div 2Class I OBClass I closed biteClass IIILateral arch constrictionAnterior/posterior arch length discrepanciesCan also be used in TMJ therapyINDICATIONSPermanent dentition and active growerUncrowded dentition with well developed arches10mm or less overjet with normal to deep overbiteImproved facial esthetics once the mandible is brought forward to class INormal growth direction

INDICATIONSNote:if patient is Class II div 2 with limited overjet or Class II div 1 with crowded and irregular incisors, you must align the upper incisors with a fixed or removable appliance before starting a twin bloc. It is recommended to hold the incisors in place for several months before delivering the applianceCONTRAINDICATIONSTx aim is to relate mandible to maxilla in 3DTransverse, AP and vertically.Requires Maxilla to be in correct position firstCONTRAINDICATIONSMaxilla must be in proper widthEnsure NO skeletal or facial asymmetryMaxilla incisors must be torqued correctlyMaxillary incisors should not be too vertical or lingually inclined (as in Class II div 2)Components

Standard Twin Blocks Class II Div I (with good arch arch form)Adams or Delta Clasps, and Anterior Ball Clasps for good retentionTwin Blocks at a 70 angle, to advance mandibleUpper Midline Screw: so upper arch can accomodate lower arch in advanced position C-TYPE 1Components

Standard Twin Blocks Class II Div I (with crowded lower arch) Adams or Delta Clasps, and Anterior Ball clasps for good retentionTwin Blocks, at a 70 angle, to advance mandible Upper and lower Midline Screws C-TYPE 2Components

Stage II Support PhaseAnterior Inclined Plane used to maintain the corrected AP and incisor relationship until buccal segments settle into full occlustion. *Molars must be in contact to begin Stage II C-TYPE 3Components

Class II Div II Twin Block Adams or Delta ClaspsTwin Blocks, at a 70 angle, to advance mandible Upper and lower Midline Screws Lingual Springs to move anterior forward To Open Bite: Reduce upper bite block as ilustrated above C-TYPE 4Components

Class II Div II Twin Block Saggital Adams or Delta Clasps, and Ball clasps Standard 70 Twin Blocks Adjust screws turn per week to advance anteriors To Open Bite: Reduce upper bite block as ilustrated above C-TYPE 5Components

Twin Block to close the Bite Adams or Delta Clasps Standard 70 Twin Blocks Tongue guard to prevent tongue thrust and act as Inclined plane to support the corrected incisor relationship Lower Acryclic extended to 6s with indicated clasps Acrylic relieved lingual to anteriors to encourage reduction of open bite C-TYPE 6FRANKEL APPLIANCE It is a tissue-borne type removable functional appliance developed by Rolf Frankel that aims to remove muscle forces in labial and buccal areas that restricts the skeletal growth

Also known as functional regulator (FR).Use during mixed and early permanent dentition stagesWidely used in Class II malocclusionIt produces changes in anteroposterior, transverse, and vertical jaw relationships Worn full-time basis for 18-24 months.Then, part-time basis until the fixed appliance are placed to align permanent teeth.

Indications Frankels regulator 1

FR-I a

FR-I b

FR-I cTo treat class I and class II division malocclusion

to treat Angles class I malocclusion with deep biteTo treat Angles class II division I malocclusion, OJ not exceed 5mmto treat Angles class II division I malocclusion, OJ more than 7 mmFR-IIto treat Angles class II malocclusion division I and class II malocclusionFR-IIIto treat Angles class III malocclusionFR-IVTo treat bimaxillary protrusion and open biteFR-VUsed with headgearComponents Frankel regulatorAcrylic componentsWire componentsFR I2 vestibular shields2 lip pads

Palatal bowLabial bowLabial support wireLingual bowCanine loops

Components Frankel regulatorAcrylic componentsWire componentsFR IIBuccal shieldsLip padsLower lingual padPalatal bowLabial bowCanine extensionsUpper lingual wireLingual crossover wireSupport wire for lip padsLower lingual springs

Frankel regulatorAcrylic componentsWire componentsFR III2 upper lip padsBuccal shieldsLabial support wireLabial bowProtrusion bowPalatal bow

Frankel regulatorAcrylic componentsWire componentsFR IV2 lower labial pads2 vestibular shieldsProtrusion bowOcclusal restsPalatal wire

Frankel regulatorAcrylic componentsWire componentsFR VPosterior acrylic bite blocksMode of actionMandibular protraction mandibular repositioning is provided by inferior border of vestibular shield, lower labial pad and lingual shield.Muscle function adaptation: pads and shields massage the blood vessels increase circulation.Lateral expansion Max;4-6mm. Mand;2-4mm. Due to vestibular shield inhibits cheek muscle from acting against occlusion. Thus allow the tongue to determine the lateral positioning of the teeth.

Increase in saggital and transverse intraoral space.Increase in vertical space where appliance is kept free from posterior teeth.Shields loosen up tight muscle and improve muscle toneReferencesTextbook Orthodontics Principles and Practice, Daljit S. Gill & Farhad B.Naini, 2011http://www.slideshare.net/shabeelpn/functional-applianceshttp://www.appliancetherapy.com/global_center/sml/pdf/PBBV5N2.pdfhttp://wikisites.mcgill.ca/Dentalpedia/index.php/Twin_Block#Indications:http://www.aurumgroup.com/files/removable/C882-Twin_Block_Ortho_4_Eng-web7-2.pdfhttp://jorthod.maneyjournals.org/content/28/4/271.full?sid=a959ab70-5056-4da6-917f-4cc22a3bfbbdhttp://www.appliancetherapy.com/global_center/sml/pdf/PBBV5N2.pdf

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