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ARTÍCULOS CIENTÍFICOS

ORTOPEDIA MAXILAR

DR. MED. HANS-JOACHIM MULLER
Ortopedia Maxilar
Universidad de Hamburgo, Alemania
Asesor Asociación Mexicana de Ortopedia Maxilar, A.C.
Hamburgo, Alemania

27.) Is there more Funtional than Activators ?
Resumen Conferencia 4ta Reunión Anual AMOM 1999, Manzanillo. Col. 25-28 Nov.

When we discuss functional we commontly refer to treatment with bimaxillary appliances just like
AKTIVATORS, BIONATORS or similar construction.

However correct function in unsderstood as the harmony of movements of the lower jaw towards the maxila.
This harmony can be disturbed by more than a false mesial-and distal-bite-relation.
Funktional disturbances cat be caused by frontal or lateral open bites, by frontal or lateral cross-bites, by
nonocclusion or by extreme deep bites.

This brings us to a point where we consider all appliances which help to treat these disharmonies as
FUNCTIONAL APPLIANCES.

The least expensive: a wooden spoon to treat a frontal cross bite of one incisor.

We advise the patient to aply pressure to the palatinal surface of the upper incisor as often as possible in
oreder to move it labially.

If this does not work, we have to plan impressions in order to construct a plate with lateral plane for
disocluding the jaws and protrude the incisor with an aktive element like a spring.
Similar procedur has to be accepted when we have to treat a lateral cross-bite. These open the bite in a way
that allows us to move the teeth without being diturbed by the habitual occludion caused by the cross bite.

The same construction of active bite plate has to be planed when we have to treat a lateral non-occlusion.

Another form of disfunction l consider the open bite cases:
Both the frontal and the lateral open bite cases are either caused by heredity, by the lack of vitamin A (Richitis
is very rarely seen now days) or as in most cases by habits just like tongue-thrust or pencil chewing, by thumb-
sucking or by lip-biting.

In most case the frontal open bite is connected to a narrow maxila. An extending-plate is necessary to widen
the upper jaw. We normally add a tongue-fence to it to avoid the toungue-thrust at night. Sometimes a row of
spikes is used in the lower pate if extension of the upper is not obligatory.

Now we come what is normally understood when we talk about functional appliances. The question is how
can we differenciate which type of appliance suits which patient best?

To find out about this it is neccesary to evaluate the patients respective to their.
1. Direction of growth
2. State of Growth
3. Ability to keep the mouth closed (undisturbed nose breathing)
We use mainly 6 different types of bimaxillary funktional appliances to treat our patients referring to their
individual needs.
All of them can be comined with a high pull headgear if neccessary.

1. The classical AKTIVATOR with individual elements as springs or expensaion screws vertically open of with bite planes.

2. The Skeletal AKTIVATOR without a front shield leaving more free space for the tongue, again vertically open or with bite planes.

3. The BIONATOR similar to a scelered activator with a continuous labial wire which has two labial loops which are extended up to the first molars.

4. The spring AKTIVATOR a lower and an upper plate with the neccessary elements are connecte l with two safetypin-like springs.

5. The U-BOW AKTIVATOR (Bügelaktivator by Karwetzky)
Again a lower and an upper plate with specific elements are connected with a pair of U-shape I ware of a 1.2 mm stainless steel.

6. The VORSCHUB-DOPPEL-PLATTE (VDP by Karwetzky) is a combination of single ower and upper plates which slide on to
each other into the desired position when the mouth is closed. Two Spurs are welded together with the uppe expansion screw and
angulated to the bite plane.

Before we discuss what appliance suits best the specific malocclusion let me describe how they are produced.

After all this theory I would like to show you patients treated with aktivator. Not all of our patients cooperate that well and a great part of our work is to convince our patient that an aktivator in a box will not move teeth.

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