MAXILLARY ORTHOPEDICS

DEFINITION
Branch of Dentistry that deals with the study
from the Dysgnacies (anomalies of the apparatus
masticatory) and its treatment.
 MAXILLOFACIAL ORTHOPEDICS

Consider as 'unit', anatomic-physiological.

integrated, in structure and function to: teeth,
jawbones, TMJ, tongue, lips, gums, floor of
the mouth, palate and logically their functions of
mastication, swallowing, respiration, and phonation
among others.
 MAXILLOFACIAL ORTHOPEDICS

Correct the disorders through a modification.

functional of the dental-maxillary architectural complex
Facial more adapted to the shape and aesthetics
 OBJECTIVES
Balanced and stable occlusion

Optimal facial aesthetics

Temporomandibular joint

Dental and skeletal stability

 PURPOSE OF ORTHOPEDICS

Normalize the functions

Change the altered forms
 PURPOSE OF ORTHOPEDICS

Achieve a harmonious dental occlusion in

functional aesthetic balance.
 HISTORY

1741, Andry introduced the term 'ORTHOPEDICS'.

1880, Kingsley - 'Jumping the Bite'
1881, Roux - theory of 'functional adaptation'
1892, Wolff - 'transformation law'
•1902, Robin-'monoblock'
•1910, Andresen - "activator of containment"
•1936, Haülp introduced the term "FUNCTIONAL"
 HISTORY OF ORTHOPEDICS
FUNCTIONAL
•1860. Emerson Angell (USA) was one of the first, if not the first, to see the
great importance of the first permanent molars. 'it is a reliable guide and
infallible for the correct occlusion of the jaws." He was probably the first
in obtaining the separation of the suture to create space. I use a rod
transpalatal with nut and screw and bands on the premolars.
•1879. Norman Kingsley (USA.), Designed a bite plate that adapted to the
internal portion of the upper dental arch and at its anterior part it was projecting
downward and took the lower incisors. The aim was not to protrude the teeth.
inferior, but to change or make the bite jump in the case of a maxilla
excessively retracted. This method was unsuccessful.
•1881. Walter H. Coffin (France). Describes a method of expansion, which consisted of
on a rubber plate that covers the teeth divided along the midline into two
halves, joined by a piano string curved in the shape of a W. This string
acts like a spring.
•1888. John Nutting Farrar (USA.), Wrote the first complete and relevant text
dedicated to orthodontics. It focuses on observing physiological changes.
•1902. Pierre Robin (France) published an article describing a device, the 'Monoblock',
for the treatment of Glosoptosis Syndrome and to release the functional vital confluence, it is
to say, the throat, with its vital space, for the passage of air and food. This apparatus
it was also used for bimaxillary expansion.

•1907. Edward Angle, (USA.), Describes the dental classification of malocclusions and gives a
great boost to orthodontics as a scientific branch of medicine.
•
•1908. Viggo Andresen (Denmark), designs his first device, which consisted of a plate.
superior to which he added an extension behind the lower incisors and extensions
lateral covers for the lingual surfaces of the lower teeth.

•1909, A Pont (France), Publishes a system of analysis used to determine the width
from the arches, this is based on the sum of the mesiodistal widths of the four incisors
superiors.
• 1909, Emil Herbst (German), presented his fixed device for mandibular advancement.

• 1910. Viggo Andresen publishes and recommends the use of his device as a container after the
correction of the distocclusion of her own daughter. The 'biomechanical work container' was also
designed to prevent mouth breathing. The subsequent use of the 'retention activator', as Andrésen
later named this element, yields encouraging results.

• As was customary for many orthodontists of the time, he removed the fixed appliances from the patients.
for the summer holidays and containers were placed.

• Andresen found that the results of the previous treatment were not only preserved but also, in many
Cases really improved during that period. The novel element was different from any other.
removable device in use at that time. Totally inert and with freedom of movement in the cavity
oral, was set in motion by the tongue and the oral musculature. The correction of the malocclusion is
It was carried out through the transmission of muscular stimuli to the teeth, the supporting tissues, and the jaws.

• 1918, Alfred P Rogers (USA). Recommends exercises for the development of the facial muscles, with a view
to increase their functional activity and turn the facial muscles into our allies in the treatment
and the containment. There were exercises for the masseter, temporal, pterygoid, chin muscles, of the
tongue, orbicularis of the lips and facial muscles.
•1922, A. J. Paccini (Italy). He is the first to present a head positioner or
cephalostat

•1925. Andresen travels to Norway, and in 1927 he is appointed director of the Department of
Orthodontics from the Oslo school. There, he meets the Austrian pathologist and periodontist Kart.
Häupl, who is interested in the method used by his colleague and observes the similarities.
occurred between the headline changes induced by the activator and the dental migration that it
had studied.

1928. North (Holland), presents removable plates, which were made of rubber.

•1931. B.H. Broadbent (USA) and H. Hofrath (Germany) simultaneously publish the works
that convinced researchers of the benefits of using the cephalostat.

•1931. H. Linder and G. Harth (Germany), Modify the proportionality index of the width of
the arches given by Pont.
• 1936. Andresen and Häuplen Norway publish the conclusions of their studies based on Roux's theory (1885), who observed that
"stirring the bone substance" would increase the activity of osteoblasts, leading to greater bone formation. Andresen and Häupl
they maintained that the activator actually transmitted such stimuli to the bone. These theories were extensively supported and
persuasive so as to instruct the followers of the new method that the 'activator' was not only different from all the other devices but
at the same time very superior from a biological point of view.
• This treatment method was named by its authors as FUNCTIONAL ORTHOPEDICS OF THE JAWS. In Europe
it was also known as the 'Norwegian method'.

• Häupl has been appointed director of the Dental Clinic at the University of Prague in Germany. As one of the leading professionals
Influence in Central Europe is responsible for disseminating the method of Functional Orthopedics of the Jaws.
• Later, Häupl took a completely mistaken position on two important points. His total rejection of fixed devices leads
for a wrong path to the profession for a while. He also refused to accept any further development of the miofunctional devices.
Nevertheless, one of the greatest achievements of the activator is indeed that it gave rise to a wide variety of new constructions.
• At the end of the 1930s, acrylic emerged as a material that replaced vulcanite, thus facilitating construction.
of the O.F.M. devices

• l938 Martin Schwarz. (Austria), Introduces active plates, an expansion screw designed by its chief technician Mr. Tischler, Drives
a technique that is now known as "removable orthodontics".

• 1939, G. Korkhaus (Germany). Publishes the 'Volume IV of the German Dental School', which is considered a Treaty of the
specialty. It introduces a measure to the Pont Index, which it calls 'anterior length of the dental arch.' It facilitates the measurement of
Pont index, with the introduction of the 'orthometer' and the 'three-dimensional compass'.
• Despite World War II and the difficulties of the postwar period, the use of the new treatment method spread.
quickly, especially in Central Europe. The devices until this moment did not allow lateral movements, they were
called "Myotonics".
• 1949, Hans Peter Bimler (Germany), dedicated to the treatment of jaw traumas during the Second World War.
Deduce the possibility of expanding the upper arch through the cross-transmission of transverse mandibular movements. It
they designed several prototypes until in 1949 a definitive description of their method and the 'elastic modelers' was published.
The elasticity of the apparatus transmits muscle movements more efficiently to the dentition and to the supporting tissues, thus
way creates the Miodynamic devices.

• 1950, Martín Schwarz (Germany). Divide the activator and create the double plates or arc activator.

• 1950, Wilhelm Balters (Germany), Emphasizes the shaping role of the language in the form of the jaws and in the position of the teeth,
he designs his device which he calls "Bionator".

• 1951, Pedro Planas (Spain). Modifies the Schwarz plates and creates the 'Simple Indirect Tracks of Planas.' and advocates total freedom of
movements with the dental equipment in the mouth

• 1952. Hugo Stockfish (Germany). Continues with the development of the miodynamic devices and develops the 'kinetor', which is built with
prefabricated parts.

• 1953. George Klammt (Germany). Klammt, who was a disciple of Bimler, found his devices very fragile and combined some of his
elements with the trimmed activator at the front. I call this modification the 'elastic open activator'.

• 1954 A.F. Maccary (France). Studies the alterations that occur in mouth breathers, launches the gymnastics technique 'maxilo-
thoracic,

• 1955 Michelle Chateau (France). Makes various modifications to the activator and creates a metric analysis of the width of the arches.

• 1955 Ramón Torres (Argentina) introduces the O.F.M. technique in South America. He trains with European masters, especially with Dr.
Plans. Later on, Dr. Torres publishes two books on the specialty, giving a definitive boost to the specialty in South America.
• 1956 Rolf Fränkel (Germany). Describes a device that does not fit into either of the two groups of functional devices.
(miotonics and myodynamics). The Fränkel motor is that the oral vestibule and is the base of operations for treatment; the tongue
model the structures. The disturbance of the perioral muscle tone is the culprit of the orofacial alterations the 'Regulator of
function", reeducates the altered function of the muscles, thus correcting misalignments.

• 1957. Hans Peter Bimler, presenting his cephalometry, introduces the suborbital facial index, thus individualizing the patient according to their
facial biotype.

• 1960. Pedro Planas. Announces in the city of Paris his 'equilibrator', which allows for latero protrusive movements.

• In 1961, Pedro Planas created the 'Equiplan', which is a metallic element placed between the upper and lower incisors and serves
to promote vertical growth.

• 1961 A. J. Hass (USA), Scientifically demonstrates the therapeutic possibility (through histological studies in animals, in
cephalometric and clinical evaluations) of the repair of the connective tissue of the midpalatine suture during and after the phase
expansion and remineralization active.

• 1962 Pedro Planas. Reports on the importance of freedom of movement in the masticatory act. The lack of this inhibits the
development of the maxillae. It promotes dental wear in the temporary dentition as an early method to treat the
alterations of the stomatognathic system.

• 1962 Cid Benagg and Alex Osthoff (Brazil) design a hook with which dental pieces can be distalized. (Benagg hook)
• 1964 The Colombian Society of Maxillofacial Orthopedics is created.

• 1968. David Ordóñez (Colombia) Highlights the importance of psychology in the treatment of dignities, reveals the plaque.
psychofunctional, which is used in the treatment of thumb sucking.
• 1968. J. Delaire (France), creates the extraoral anterior traction mask. Boosts 'orthopedics'.
mechanics.

• 1971 G.Schmuth (Germany) Modifies the activator and creates the 'kibernetor'

• 1973. Alexandre Petrovic (France) Publishes results on experimental animals to which they
applies braces and demonstrates the importance of the lateral pterygoid muscle in growth
of the jaw.

• 1972. James McNamara (USA). Demonstrates neuromuscular and skeletal adaptations in monkeys.
What do orthopedic devices produce?

• 1975 The legal personality is recognized and the Colombian Society of Maxillofacial Orthopedics is legalized.

• 1977. Pedro Planas publishes a supplement to his early treatment method. The 'direct clues of
"Planas", which are resin aggregates placed on temporary teeth to facilitate freedom of
movements.

• 1979 Hans Pancherz (Germany), Takes over Herbst's device, and demonstrates the possibilities of
mandibular growth stimulation with this device.
1980 Donald Woodside. (Canada). Drastically increases the vertical distance in
the bite registration and says it is used to take advantage of the forces generated
when the lip muscles, skin, and other tissues are stretched. It also calls for its
activator device.

1983, Wilma Simoes (Brazil). Based on her clinical experience, she reveals the
concept of D.A. (Determined Area). Which results in treatments
faster.

•1988. Simoes publishes the results obtained with a mixture of philosophies such as
the Bimler and Planas ones. This series of devices are called Simoes Network or SNs

In 2003, the second edition of the book: Functional Orthopedics of the Maxillae was published.
view through neuro-occlusal rehabilitation
 Dysgenesis

Mordidas abiertas
Verticals Overbites or bites
deep
Thank you for your relationships
Sagittal Distortions

Narrowness
Transversals
Side deviations
mandibular
 Sagittal Relationships

MOLAR RELATION

CANINE RELATIONSHIP

INCISIVE HIGHLIGHT
OVERJET
 VERTICAL RELATIONS

CROSSBREEDING
Incisive
OPENBITE OR
PROFOUND
 TRANSVERSAL RELATIONS

CROSS BITE
Bilateral UNI
BACK

CROSSBITE
ANTERIOR
DENTOALVEOLARES OR
SKELETAL

Mandibular Deviation
 DIFFERENCES BETWEEN ORTHODONTICS AND
ORTHOPEDICS

Orthodontics can be performed at any age

•Orthopedics only during the growth period, since the

children's bones are more spongy, that is, more
moldable and we can handle them easily to obtain
favorable results avoiding more treatments
complicated later, such as Orthognathic surgeries
 DIFFERENCES BETWEEN ORTHODONTICS AND
ORTHOPEDICS

Corrective orthodontics is performed with fixed appliances, each of

they have their precise instruction and their appropriate age

Maxillary orthopedics or 'functional orthopedics of the maxilla' is

used when there are skeletal deficiencies, with devices a
a little more complex, most of them removable, that stimulate
muscular and/or skeletal changes, inhibiting or stimulating the
growth of the jaws

This type of device requires a lot of professional attention already

that a misguided growth will produce a malformation of by
life.
 MAXILLARY ORTHOPEDICS ORTHODONTICS
Correct the function to reset the form Correct the way to restore the function

Its foundations are of a Biological order Its foundations are of a physical nature.

It employs biological forces that determine reflexes. It employs mechanical forces that determine
neuromuscular on the teeth. displacement in the teeth

Produce dental movements through stimuli Produce dental movements through stimuli
tissue transformation through functional adaptation mechanisms of bone apposition and resorption

Uses removable devices that act on the Uses fixed appliances that act on the teeth in
teeth, lips, tongue, gums, palate, floor of the specifically, modifying individually their position in
mouth, ATM, modifying the functions of the the Occlusion
Mastication, Swallowing, Breathing, and Phonation of
Masticatory Apparatus.

It focuses its Biomechanical action on Kinematics, It focuses its Bio-mechanical action on the Statics of the
Static and Dynamic of the Masticatory Apparatus Teeth

Prioritize function over aesthetics Prioritizes aesthetics over function

CONSTITUENT ELEMENTS OF THE
ACTIVE PLATE AND DEVICES OF
MAXILLOFACIAL ORTHOPEDICS
 ACRYLIC
Maintains the change
therapeutic
 ACRYLIC
•Retain and or
connects parts
of the device.
 ACRYLIC

It is placed where
is needed
stimulate.
 PARTS OF THE ACRYLIC
Acrylic Tables
upper laterals (1)

Basins (2)
(3) (2)
Interproximal Wedges (3)
(2)
(2)
(1) (1)

Psychofunctional Plate of David Ordoñez - Digital Suction

WITHOUT SURFACE
Masticatory

Let extrude or move

freely the
teeth in direction
vertical
WITH SURFACE
Masticatory

Control of the teeth

later in Act. Klammt Open Elastic
vertical sense

Balters Bionator inverter

WITH SURFACE
Masticatory

Helps to lift the occlusion

in cases of bites
crusades.
Facilitates sagittal movement
WITH SURFACE
Masticatory

Allows to guide the

eruption process
if it wears out
gradually.
 WITH PLATFORM
Incisal

Control of the teeth

previous ones in the sense
vertical and labial
WITH SURFACE
Mastication and
INCISAL PLATFORM

Control vertical total

Maximum Anchor
ARCOS
ARCO HAWLEY.

It is used for
stabilize devices.
Help align or
to maintain
alignments
TYPE VESTIBULAR ARCH
BIMLER

Perioral muscle alley.

It can be used for purposes
orthodontics such as
lingualize incisors or align
teeth.

Open Elastic Activator of Klammt

TYPE VESTIBULAR ARCH
VEHICLES

Modified with Ansas

in U which facilitates the
activation.

Composite Flat Tracks with Equiplan

VESTIBULAR ARCH
BIMLER TYPE

Modified with Keys

Verticals

Facilitates doing
couplings for unthreading
teeth
ESCHLER TYPE ARCH

It is used for patients

with crossbite
anterior of origin
functional

http://www.o-atlas.de/esp/home.php
 MODIFIED HAWLEY ARCHES

With Horizontal Key

Sits in a Boot
 COFFIN

It gives elasticity to a
device.
By activating it, it helps to the
expansion
Increase the space
functional oral.
 LINGUAL CLIP
(THE BIONATOR OF
BALTERS)

Language re-educator
Guide for the language
It does not activate.
 SN 3
BARS
Wavy

They retrain the language

SN 2
 SCREWS
It helps us to move individual teeth,
to expand arches and palatine disjunction.

They vary in shape, size, and magnitude of

opening.

Width: Upper
Narrow: Inferior
 UPPER CENTRAL EXPANSION SCREW
BILATERAL

Helps to adjust the

device with it
growth of
patient, it can be used
for active expansion.
SCREW
UNIDIRECTIONAL

Move a tooth or
arcade segments.
It is only used on plates
individualis
TRIPLE SCREW

to do
movements in three
senses expansion
bilateral and increases
inter-canine distance
SCREW IN
FAN

To do
movements in three
senses expansion
bilateral and increases
intercanine distance
INTERCUSPAL GUMS

Control Vertical stimulates the

chewing helps with instruction
posterior sector, helps to
stabilize the jaw
for the tongue to
move to swallow
(linguistic reeducation).
PADS
ENTRANCE EXAMS
FRANKEL TYPE

While going to the bottom of the

saddle apply traction
periosteum that leads to
bone neoformation
VESTIBULAR SHIELDS
SCREEN TYPE

Muscle Alley
perioral
SPRINGS AND HOOKS
PROTRUSIVE SPRINGS

Control position of
teeth.

For
couples
RESORTS
PROTRUSIVE

Arms
 Retention hooks

Little ball
Arrow

Adams
Circumferential
Circumferential

Little ball
 Orthopedic Apparatus
BIMAXILAR FUNCTIONAL

Stimulate or redirect it
growth in the maxilla
superior or inferior
changing the pattern
neuromuscular to achieve
a bony response and
to produce changes
alveolodental type
vertical, sagittal and
transversal
 ORTHOPEDIC EQUIPMENT
BIMAXILLARY FUNCTIONAL
Functional appliances favor the
harmonious development of the maxillae and of the
dental arches using the force of the
swallowing.

At the moment of swallowing, the devices

they interpose between the dental arches and
they receive the force of the jaw that rises and
they return it to the whole mouth.
 ORTHOPEDIC APPARATUS
FUNCTIONAL BIMAXILAR
Transmit the force that derives from contraction
muscular (natural and intermittent forces) to
all elements of the system
stomatognathic (SE), since it generates a pathway
of information through the proprioceptors
of the central nervous system.
 OBJECTIVES
FUNCTIONAL APPARATUS
1- Change the function of the facial muscles and
maxillae.
2- Provide a more favorable environment for the
developmental dentition.
3- Optimize craniofacial skeletal growth and
change the addresses.
4- Selectively inhibit skeletal growth, and/or
guide the erupting teeth into more positions
favorable.
 CONSTRUCTIVE BITE

BITE BACK

PREPARATION OF TAKE THE PATIENT TO THE

PATIENT INDICATED POSITION
 WHEN TAKING THE BITE
CONSTRUCTIVE
Determine the type of stimulation
neuromuscular, the frequency of movements
mandibular and the duration of the forces
effective

•Take into account:

-Coincidence of dental midlines between each other and the
of these with the face in centric relation
Correct if the mismatch is a reflection of a
mandibular deviation
Transversal relation of the dental arches
 CONSTRUCTIVE BITE
Taking impressions in high-sided trays.
Emptying and cutting of the models.
It is carried out according to the type of malocclusion that is going to be
to deal with.

CLASS II

The crown is made of pink wax.

It is indented in the upper model
The patient is asked to push the jaw forward until a
comfortable position, without pain.
 CONSTRUCTIVE BRIBE
CLASS II

Single-step or phased advancement?

If the advance is large, minimum
increase in the vertical dimension of the record
and vice versa to avoid overstimulation
muscular
 CONSTRUCTIVE BRIBE
CLASS III

The bite registration is made in pink wax.

It is indented in the upper model and taken to

position, the patient is told to retract as much as possible
that I can.
 CLASSIFICATION OF DEVICES
FUNCTIONAL

Operational base in the lobby:

Frankel

The operational base in the linguistic space to the

dentition
Klammt
Bionator
Bimler
OPEN ACTIVATOR OF KLAMMT
 HISTORICAL REVIEW
Created by George Klammt in 1953 (Germany)

Bimler VS Andresen-Häupl
•Discípulo de Bimler, realizo modificaciones del
device due to its fragility.
Originating from the foundations of the apparatus created by

Andresen-Häupl
OPEN ACTIVATOR OF KLAMMT

Bimaxillary appliance that lacks

stabilization

Intimate interaction with the language.

It favors phonation and the tongue position.

ELEMENTS THAT CONSTITUTE IT

SUPERIOR AND INFERIOR LABIAL ARCHES.

It is done in 0.36 mm wire.

They are parallel and bend at the level of the first molar.
ansa. From there they are taken back to the mesial of the
canines to bend them towards palatal or lingual towards the
retention.

The main function of these arches is accommodation.

of the incisors.
LABIAL ARCHES
 PALATINO SPRING (COFFIN)

It serves to join both acrylic parts of the

device.

It is done in 0.40 mm wire.

It should not hinder the language.

It is located in the vicinity of the mucosa of the palate,

but without touching it.
PALATINO SPRING (COFFIN)
 LIP PADS
Acrylic Zones located in the area of
lobby.
Class III patients in the upper vestibule
Class II patients in the lower vestibule
PROTRUSIVE SPRINGS, HOOKS OF
DELIVER THE INCISIVE GUIDES
BIMMLER SPRINGS OR SCREENS
FOR PROTRUSION HABIT
LINGUAL
 PHILOSOPHY
Regulate the dental function

Correct the relationships

interarcade sagittals

Help with correction of

vertical alterations

Great utility in arches

Klammt Class II
narrow.
Klammt Class III

Klammt Open Bite

Klammt Deep Bite
 CONTROLS

First control 20 days

Schedule the patient monthly for evaluation

el manejo del aparato, activación y evolución
THE BIONATOR

.
 HISTORICAL REVIEW OF THE BIONATOR

Functional orthopedic appliance

bimaxillary

Created by Dr. Balter who

he attributed the malocclusions
dental to the tongue

Exerts its function in space

lingual, stimulating the
growth of the affected maxilla,
either upper, lower, or both.
 ELEMENTS OF THE BIONATOR

1. Language arch (also

language guide
2. Labial arch
3. Buccinator loop
4. Articulation plan
 LANGUAGE ARCH OR LANGUAGE GUIDE

Wire with a diameter of 1.0–1.5 mm

whose function is to stimulate the
lingual position.

It remains separated from the mucosa

1mm and has an egg shape.

The acrylic exits at the level of the premolars and directs towards the distal of the
first molar makes the omega and moves mesially until it reaches the
level of the premolars on the opposite side and enters the acrylic.
 LABIAL ARCH

0.9 mm diameter wire. Its function is to act as a presence indicator.

wire runs across the entire vestibular surface of the incisors
higher at the mid-level.
 BUCCINADOR'S LASSO

Its function is to separate the

muscles of the cheeks that
they want to interfere among the
occlusal spaces.
It exits distally from the canine and is a
continuation of the previous that is
direct distally through the vestibular
of the premolars and molars
inferiors
At the level of the first molar it rises to
reach the molars and premolars
superiors.
If necessary for the patient, it
some shields can be adapted.
 ARTICULATION PLAN

It is the acrylic body of the

device.
It extends from the
posterior lingual mucosa
until the previous one
traversing the entire maxilla
inferior and contacting
with the upper mucosa
until finding the
retentions of the lingual arch.
 TYPES OF BIONATOR
Standard bionator: (without alteration of vertical dimension)
Class II patients, their vestibular arch with the loops.
Buccinator muscles are positioned over the upper teeth.
Acrylic and wires in full contact with the teeth
 TYPES OF BIONATOR
Inverted Bionator:
Class III patients, the vestibular arch with its loops
Buccinator muscles are designed in the lower teeth.
 TYPES OF BIONATOR
Bionator for open bite
The design of the vestibular arch with the buccinator loops goes throughout
the center of space
Anterior zone covered with acrylic to prevent the tongue
I pushed the teeth and increased the patient's malocclusion.
Neither wire nor acrylic comes into contact with teeth.
 TYPES OF BIONATOR
Bionator for deep bite
•Construído de tal forma que permita el
vertical development of the posterior teeth
while keeping the previous segment in
position
 CONSTRUCTIVE BRIBE

A softened pink wax roll is used and placed on

all the occlusal surfaces of the upper jaw with its part
media behind the incisors and gently guiding with the
I adjust the lower jaw to the correct position.
watching the midline.

For the open bite, it is done in the same way, taking into account
make sure that the previous open space is filled with wax.
 INDICATIONS

Treatment of skeletal Class II producing a

mandibular advancement from class II to a
Class I.

Side effects:
Increase in vertical dimension, correcting the deep bite.
Vestibularization of anterior lower teeth that have tilted
linguistically.
Compression relief of the TMJ by removing the condyle from its position
retruded super posterior eliminating pain and discomfort and even the
dysfunction.
Bionator
Bionator
Developed in Germany by Dr. Rolf
Frankel.

Its effect is based on the interception of

problems of muscular function

It is not designed to move teeth by exerting

pressures on them, but frees them and their
basal structures of muscle pressures,
inducing therapeutic changes.
FUNCTIONS

Transversal, vertical, and increase

sagittal of the arches,

Previous Positioning of the

Jaw,
FUNCTIONS

Development of new patterns of

motor function,

Establishment of sealing
appropriate labial.
 PARTS OF THE FUNCTION REGULATOR OF
FRANKEL

SHIELDS OR VESTIBULAR SCREENS:

On the vestibular surfaces of the teeth

They separate the teeth from the buccinator muscles

so that they do not exert pressure
about teeth and facilitate growth
transversal of the maxillae in a manner
physiological
LIP BALMS:

They eliminate the pressure caused by hyperactivity.

of the mentalis muscle, providing support
mechanical to the lower lip, separating it from the
lower incisors and thus avoiding the
contact between both.
LINGUAL ARCH OR LINGUAL PLATE:

Part of the inner side of the side shields

passing behind the first premolar or first
temporal molar towards the lingual area of the incisors
to the opposite side.
Its function is to keep the jaw in its position.
adequate.
PROTRUSION ARCH
VESTIBULAR ARCH:

It is a passive arch that runs along the vestibular surfaces of

the upper incisors, slightly rises towards the
canine eminence, then introducing itself into the
acrylic of the shields.
 TRANSPALATIN ARCH:

It is used to join the back parts of the device,

cross in front of the first permanent molar towards
the shield, penetrating into this and coming out again
toward the occlusal surface of the molar, resting on the groove
between the mesovestibular peaks and
distovestibular
 FRANKELI

It is used in the treatment of malocclusion where the

molar ratio is class I
FRANKEL I

It is used in cases of mild or moderate crowding.

with delayed development of the basal arches, when
the molar ratio is in class I with:

Overbite.
Protruded upper incisors.
Retruded lower incisors.
 FRANKEL II

It has its application in class II-1 with protrusion.

extreme of the upper incisors and overbite
vertical like in class II-2 .
 COMPONENTS:

2 vestibular screens

2 lip pads
inferior

Lingual screen

Transpalatal arch

Occlusal support (MS)

Vestibular arch (Sup)

 FRANKEL III:

Early treatment of mild class misalignments

III of maxillary origin where there is no prognathism
mandibular.
 COMPONENTS

Two shields
entrance exams

Two lip pads

superiors

Protrusion arch

Palatine arch

Occlusal support (MI)

Vestibular arch (Inf)

FLAT TRACKS
DR. PEDRO PLANAS CASANOVA
(1912–1994)

Doctor in Medicine and Surgery.

Professor.
Dentist.
•Fundador y primer presidente de la sociedad
Spanish orthodontics.
President and founder of the club
neuro-occlusal rehabilitation (1964)
 PHILOSOPHY
It is based on occlusal balance.
masticatory as a condition for the
oral health maintenance of the patient.

The loss of this balance generates problems.

gingival and articular.
 TYPES OF FLAT TRACKS
Direct clues

Indirect clues
 FLAT STRAIGHT TRACKS
They are artificial tracks.
Built directly on teeth
temporals.
They release the movements of the jaw.
The anteroposterior slope of the tracks
they are the ones that induce a change of posture
therapeutic.
 DIRECT FLAT TRACKS OBJECTIVE
Allow the jaw to move freely to
right and left through the tracks,
allowing for proper chewing function
DIRECT RUNWAYS FOR CLASS II AND III
CLASS
II MESIAL DISTAL

CLASS
III Mesial DISTAL
 INDIRECT CLUES
They are fundamental bimaxillary action appliances for the
neuro occlusal rehabilitation, that is, to allow
aesthetic results and a perfect function of the system
chewing.
They are completely loose in the mouth, without exerting
pressure, force or good
retention
 INDIRECT CLUES
Its biological principle is to establish a plane
physiological occlusion with freedom of movement
of mandibular laterality without traumatizing the
periodontium and rehabilitating the joint
temporomandibular

These correct the maxillomandibular relationships.

with the entire system in harmony and the maximum
performance, with minimal effort, through
the law of minimal vertical dimension and of
nervous excitation.
 INDIRECT CLUES
The common components of the plates
the plans are:

Clues.
Occlusal stops
Stabilizers
 TRACES
They are two acrylic sliding surfaces.
at height, than when the child bites
they contact prematurely and do not let them
antagonistic teeth occlude with each other.
•
 INCLINATION OF THE RUNWAYS
Neutral tracks: they should be placed parallel to the
occlusion plan

M D
 Inclination of the slopes
Class II tracks: they are constructed upwards in direction
posteroanterior for the law of minimum to be fulfilled
vertical dimension and the jaw protrudes,
placing in neutroclusion.

M D
 Inclination of the slopes
Class III tracks or progeny: they are built upwards
in the anteroposterior direction and a smaller one is achieved
dimension backward, which hinders progress
mandibular.

M D
 FUNCTIONS OF THE TRACKS

They require contacting the lower plate with the upper one and
vice versa, without dental interferences.
They facilitate lateral movements.
They establish a physiological occlusal plane.
They rehabilitate the temporomandibular joint.
They correct distocclusions.
They stop monthly closures.
They help eliminate crossbites.
 Occlusal Stops

They are exclusively for the bottom plate,

They are attached to the occlusal surfaces of the
temporary molar seconds and in absence
of the first permanent molars.
They are built with half-round wire.
1.3 mm to 1.5 mm and an occlusal contact is left
of 2 mm.
They stabilize the lower plate vertically.
 STABILIZERS

They are made with 0.7 or 0.8 mm wire for canines and 0.9
mm for molars.

They are placed between the lateral and canine, sometimes between the canine and
first molar temporary or first premolar or between the
premolars.

They have their retaining part towards the lingual and contour the
proximal space towards vestibular until contacting the
papilla.

They provide stability to the apparatus and can serve to brake.

mesial and distal movements of a dental piece or of
the whole plate.
 top
Clues

Screw

standard

piers
Flat plates can be used with many
accessories such as towing hooks, bows
Eschler, arches Hawley arch Bimler.

Another device is the Equiplan, which is used to

balance the occlusal plane, usually in
patients with deep bite and distocclusion.
 EQUIPMENT
SIMOES NETWORKS
SN
It is a functional orthopedic device.
belonging to the group of hybrids.

It arises from the combination of the philosophy of two

devices that are basically the Bimler and
the flat plates.
SIMOES NETWORKS EQUIPMENT
SN
 ORTHOPEDICS
BIOMECHANICS
 DISJUNCTION OR RAPID EXPANSION
PALATINA
Its objective is

Separate the maxilla in 2 along its suture ½ palatine

2. It separates the sutures formed by the maxilla causing

an increase in the
bone size
maxilla in its
totality
 EFFECTS OF RAPID EXPANSION
PALATINA

AT THE SKELETAL LEVEL

Displacement of all the

craniofacial bones
directly articulated
with the max except the
sphenoid that presents >
resistance against the ERM
 EFFECTS OF RAPID EXPANSION
Palatine

The width of the nasal cavity

increases on average by 1.9
mm. but it can
widen to 8 to 10
mm. at the level of the turbinates
(Gray 1987)
 EFFECTS OF RAPID EXPANSION
PALATINE
MAXILLARY SUPERIOR

It tends to move towards

down and forward.
Rotation of its components
on the horizontal plane
The halves are separated into >
degree in the ant zone
In the frontal plane they are separated
the two halves in a pattern
triangular with its base facing
down.
 EFFECTS OF RAPID EXPANSION
PALATINA
JAW

It has a direct effect on positioning.

space of the jaw that rotates downward and backward it
that induces the opening of the bite, inclination of the
occlusal plane
 EFFECTS OF RAPID EXPANSION
PALATINA
At the Dentoalveolar Level
Lat. inclination of the teeth
Post sup.
Stretching and compression of
the periodontal soft tissues and
palatines.
IC divergence appearing a diastema
that confirms the disjunction
(Berlocher 1980).

Histological:
Mild root resorption due to
(Barber and Sims 1981).
EFFECTS OF MAXILLARY DISJUNCTION

Increase in arch length in dentition

temporary, mixed and permanent young.

Transversal expansion of the maxilla

It loosens the circummaxillary suture system.

facilitating the response of the maxilla to the
traction with facial mask
 INDICATIONS

Unilateral or bilateral crossbites

skeletal
Smile Enlargement
Patients with cleft lip and palate
maxillary collapse (with caution because
the scar can tear
 INDICATIONS
Correction of the axial tilt of the
posterior teeth in patients with
bone base deficiency.

Skeletal Class II correction with

maxillary compression, in order to then carry out the
mandibular orthopedic treatment.
 PRECAUTIONS
Maxillomandibular Hyperdivergence
open bite anterior, mandibular plane
retro-inclined convex profile and middle third
Augmented facial

Extrusion of the Palatal Cusps of Molars

superiors
EQUIPMENT
 FAST EXPANSION DEVICES
UPPER JAW WITH BANDS

Hyrax type expander

Haas type expander

 RAPID EXPANSION DEVICES
MAXILLARY WITH BANDS

HYRAX TYPE EXPANDER

 PARTS
BANDS
Preformed in 1 Pm and
1M sup
Disconnecting screw
(Hyrax):
6, 8, 10 and 12 mm for
10
 PARTS
SUPPORT WIRES
0.9 wire, on the V and P faces of Pm and M at level
remove
coronal third of the gingiva and soldered to the bands
with
the disconnecting screw.
This wire support must be extended to the area of
canines or seconds M sup.

WELDING AND FLUX

Universal welding is used.
 HASS TYPE EXPANDER
Band disconnect with acrylic in the vault
palatine, which produces intense forces.

The screw is covered with acrylic occupying

large part of the palate,
trying to get
a greater effect
orthopedic.
 PARTS
HASS TYPE EXPANDER

4 bands placed at 1Pm and 1M sup

Expansion screw in the middle part of the
two acrylic masses.
Wires extend before the M along
of the V and L surfaces of the posterior teeth,
to increase the rigidity of the device.
Acrylic cover P to support the device.
 ACRYLIC SPLINT EXPANDER
(McNamara)
Widen the jaw, separating the suture 1/2
palatine
Growing patients
Make changes in the transversal dimension,
ant/post and vertical
 ACRYLIC SPLINT EXPANDER
(McNamara)

WIRE FRAME
Wire 1.0
Around your V and P at 1 and 2 PM or AM
temp, 1M support in the gingival coronal third.
The wire crosses the occlusion at M of 1 PM 0
1M temporal and D of the 1st permanent M
 Acrylic Splint Expander
(McNamara)

DISJUNCTION SCREW

Place the screw arrow backwards.

 ACRYLIC SPLINT EXPANDER
(McNamara)
ACRYLIC PART
•Completely covers the clinical crown of the
1PM at a temperature of 1M per until its third
coronal gingival
The height is 2 to 3 mm
The thickness of the acrylic must be uniform in
all surfaces
Remain for a minimum of 3 months.
 ADVANTAGES
Anchoring surface and force distribution
orthopedic in the bone.

Adhesion surface, especially when

the occluso-gingival length of the crown is
reduced.
 ADVANTAGES
Inhibits the eruption of molars during the treatment
and allows its use with lower facial height
augmented.

The smooth occlusal surface allows for opening the

bite subsequently facilitating the
describe the bite
PALATINE EXPANSION
 Quad Helix
It is a device designed by Ricketts, it is a
palatal arch that holds wire from 0.9 to 1.25
with four helicoids and is welded to the
cemented bands on molars
 Quad Helix
The arms of the bow rest on the faces
palatines of the upper pieces, being able to
produce the expansion of the arch.
 QUAD HELIX
USES

Stabilize the molars

Rotate molars
Anchor
Expansion in the upper jaw, without tilting the
dental pieces
In cases of posterior crossbite
dentoalveolar etiology
APARATOLOGY
EXTRAORAL
 EXTRAORAL FORCES
Equipment that requires a system of
support on the head or neck, to apply a
strength to correct a certain
malocclusion.

They are transmitted through springs, elastics or

adjustable material that is supported by means of
hats on the head or around the neck
 FACIAL MASK

Anterior traction of the

maxilla

Stretching elastics
from the arms of the
support device

Parts: front support,

support bar, support
for elastics, support
Mentonian
 FACIAL MASK

Perform traction of the retracted upper jaw

through an orthopedic force

This effect targets the maxillary sutures and

create a reciprocal force on the jaw
taking her back, but without inhibiting her
growth
 FACIAL MASK
INDICATIONS:

Class III skeletal due to maxillary hypoplasia

Children under 8 years old: orthopedic effects
Ages 8 and older: dentoalveolar effects
 FACIAL MASK
MAIN EFFECTS

Anterior traction of the retruded maxilla

Posterior rotation of the mandible
Protrusion of upper incisors
Retrusion of lower incisors
Redirecting the upper maxilla in direction
vertical
 FACIAL MASK
First 8 days of use
8-ounce elastics
•After elastic bands of 14
ounces
Elastic bands attached to the support
from under the mask
from the occlusal plane from the
hooks welded to the
expansion device
It should be used between 12 and 14.
daily hours
 visor
Redirection of the
growth in the
lower jaw in
mild malocclusions
class III

Exert your strength in the

region
anteromandibular by
medium of tapes
elastic
 visor
USES

Pseudoprognathism: for mandibular restoration

while the etiological factor is eliminated

Open skeletal bites

True prognathism: Class III due to excess of

mandibular growth
 visor

Requires large orthopedic forces (400-

900g) and continuous for a prolonged period
Minors: orthopedic effect
Older age: dentoalveolar effect
Usage: 12-14 h/day
Use until after the growth peak
 CHANGES WITH THE USE OF THE
visor
•Reduces vertical condylar growth
Produce extrusion of molars and growth
vertical of the alveolar process
Posterior mandibular rotation
Modification of the goniac angle
Decreased SNB angle
Facial profile modification
Poor prognosis: Class III with vertical growth
Improvement of skeletal open bite
COMPONENTS OF THE CHIN GUARD

Sagittal suture
Vertical love
Brooch
Horizontal love

Elastic
Mental support
 TYPES OF CHIN STRAPS
Vertical Collar
Oblique Mento
-Through the condyle
-In front of the condyle
-Behind the condyle
 TYPES OF CHIN STRAPS

Oblique Chin Strap.

Through the condyle: Modifies condylar growth without
rotational component

In front of the condyle: It stimulates the anterior rotation of

the jaw and the reduction of the anterior facial height
worsening class III

–Behind the condyle: extrusion of molars which leads to

a posterior rotation of the jaw and increase of the
anterior facial height improving class III
 EXTRAORAL FORCES TYPE
TRACTION
It consists of an inner arch and an arch.
externally joined with welding at their centers
-Internal arch: Enters the mouth and is introduced
in the tubes in the molars
External arch
 Inner and outer arc
The joining point of the facial arc must allow the
natural closure of the lips, without tension.
 EXTRAORAL TRACTION
INDICATIONS
–Distal displacement of molars (effect
dentoalveolar
Maxillary redirection in protrusion
maxilla
Modification of the traction applied to molars
lower indicated in skeletal class III (action
similar to a chin guard
 EXTRAORAL TRACTION
CONTRAINDICATIONS
Hypoplasia of the maxilla
Mandibular prognathism
Open bite unless traction is used
parietal
Proximity of the second molar and that it is
using to distalize molars
 EXTRAORAL TRACTION
According to the direction of traction and the location
support is classified into:

LOW TRACTION OR HEADGEAR

CERVICAL
The support is at the nape, direction
from the flow-dorsal traction.
 CERVICAL TRACTION

The direction is transmitted downwards and backwards throughout the

upper jaw

Distalizes molars

Inhibits the growth of the upper jaw. (class II

skeletal). Intermittent forces of 400 to 900 grams

Extrusion of the first molar, lingualization of

crowns

It can be used in horizontal growth or deep bite.

The support is in the section
back of the head,
direction of the traction
cranial-dorsal
 HIGH TRACTION OR OCCIPITAL HEADGEAR

Produce distalization

Inhibits the growth of the upper jaw. (class II skeletal).

Forces from 400 to 900 grams

Intrusion of the first molar and coronal vestibularization

•Se puede usar cuando hay crecimiento vertical o

open bite.
 STRAIGHT TRACTION OR COMBINED HEADGEAR

The support is in the section

back of the head and
The nape, the direction of the
traction is dorsal along
From the occlusion plan.
 STRAIGHT TRACTION OR COMBINED HEADGEAR

Inhibits the growth of the upper jaw. (Class II

skeletal). Forces from 400 to 900 grams

Distalize molars, movement in body

In patients without vertical problems

Molar anchorage