English

Abstract

Considering the large number of fixed functional appliances, choosing the best device for your patient is not an easy task. To describe the development of fixed functional appliances as well as our 20-year experience working with them. Fixed functional appliances are grouped into flexible, rigid and hybrid. They are different appliances, whose action is described here. Four clinical cases will be reported with a view in illustrating the different appliances. Rigid fixed functional appliances provide better skeletal results than flexible and hybrid ones. Flexible and hybrid appliances have similar effects to those produced by class II elastics. They ultimately correct class II with dentoalveolar changes. From a biomechanical standpoint, fixed functional appliances are more recommended to treat class II in dolichofacial patients, in comparison to class II elastics. The electromyographic (EMG) activity of masticatory muscles was monitored longitudinally with chronically implanted EMG electrodes to determine whether functional appliances produce a change in postural EMG activity of the muscles. Pre-appliance and post-appliance EMG levels in four experiments that had been fitted with functional appliances were compared against the background of EMG levels in controls without appliances. The insertion of two types of functional appliance to induce mandibular protrusion was associated with a decrease in postural EMG activity of the superior and inferior heads of the lateral pterygoid, superficial masseter, and anterior digastric muscles; the decrease in the first three muscles was statistically significant. This decreased postural EMG activity persisted for approximately 6 weeks, with a gradual return towards pre-appliance levels during a subsequent 6-week period of observation. Progressive mandibular advancement of 1.5 to 2 mm every 10 to 15 days did not prevent the decrease in postural EMG activity. KEY WORDS Orthodontics, Class II Malocclusion, Fixed Functional Appliance.