Dento Maxillo Facial Orthopedics: Proprioceptive Functional Mandibular Advancement Appliance
Main Article Content
Abstract
Brief historical/bibliographic review of Dentomaxillary Orthopedics, Classification of mandibular advancement appliances and their usefulness as orthopedic therapy in the correction of skeletal class II, with mandibular hypoplasia.
We also present a new device, which we call Proprioceptive Functional Appliance, AMARÔ, its physiological principles, design, manufacturing, clinical management and uses in the correction of class II with mandibular hypoplasia, and its improvement in the craniofacial development of growing patients. We report three clinical cases.
Keywords:
Functional dento maxillo facial orthopedics, skeletal class II, malocclusion, mandibular hypoplasia, Functional Proprioception, AMAR, Mandibular advancement, Clinical cases
Article Details
How to Cite
JC, Rivero; C, Rivero.
Dento Maxillo Facial Orthopedics: Proprioceptive Functional Mandibular Advancement Appliance.
Medical Research Archives, [S.l.], v. 13, n. 4, apr. 2025.
ISSN 2375-1924.
Available at: <https://esmed.org/MRA/mra/article/view/6444>. Date accessed: 15 may 2025.
doi: https://doi.org/10.18103/mra.v13i4.6444.
Section
Review Articles
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
References
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3. Gershater E, Li C, Ha P, Chung CH, Tanna N, Zou M, Zheng Z. Genes and Pathways Associated with Skeletal Sagittal Malocclusions: A Systematic Review. Int J Mol Sci. 2021 Dec 2;22(23):13037
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5. Bishara SE. Class II malocclusions: diagnostic and clinical considerations with and without treatment. Semin Orthod. 2006; 12:11-24
6. Angle EH. Classification of malocclusion. Dental Cosmos 1899;41:248-264
7. Thilander B. Basic mechanisms in craniofacial growth. Acta Odontol Scand. 1995 Jun;53(3):144-51
8. Williams RE, Ceen RF. Craniofacial growth and the dentition. Pediatr Clin North Am. 1982 Jun;29(3):503-22
9. Wroblewski ME, Bevington J, Badik C. Head Growth. Pediatr Rev. 2015 Sep;36(9):426-7.
10. Graber TM, Chung DD, Aoba JT. Dentofacial orthopedics versus orthodontics. J Am Dent Assoc. 1967 Nov;75(5):1145-66
11. Cleall JF. Dentofacial orthopedics. Am J Orthod. 1974 Sep;66(3):237-50
12. Schmuth GP. Considerations of functional aspects in dentofacial orthopedics and orthodontics: Sheldon Friel Memorial Lecture. Am J Orthod Dentofacial Orthop. 1999 Apr;115(4):373-81
13. Fränkel R. Functional orthopedics. Am J Orthod Dentofacial Orthop. 2001 May;119(5):11A
14. Meikle MC. Remodeling the dentofacial skeleton: the biological basis of orthodontics and dentofacial orthopedics. J Dent Res. 2007 Jan;86(1):12-24
15. Manlove AE, Romeo G, Venugopalan SR. Craniofacial Growth: Current Theories and Influence on Management. Oral Maxillofac Surg Clin North Am. 2020 May;32(2):167-175
16. Castaldo G, Cerritelli F. Craniofacial growth: evolving paradigms. Cranio. 2015 Jan;33(1):23-31
17. Kluemper GT, Spalding PM. Realities of craniofacial growth modification. Atlas Oral Maxillofac Surg Clin North Am. 2001 Mar;9(1):23-51
18. Cozza P, Baccetti T, Franchi L, De Toffol L, McNamara JA Jr. Mandibular changes produced by functional appliances in Class II malocclusion: a systematic review. Am J Orthod Dentofacial Orthop. 2006 May;129(5):599
19. Santamaría-Villegas A, Manrique-Hernandez R, Alvarez-Varela E, Restrepo-Serna C. Effect of removable functional appliances on mandibular length in patients with class II with retrognathism: systematic review and meta-analysis. BMC Oral Health. 2017 Feb 1;17(1):52
20. Vargervik K, Harvold EP. Response to activator treatment in Class II malocclusions. Am J Orthod. 1985; 88:242-251
21. Clark WJ. The twin block technique. A functional orthopedic appliance system. Am J Orthod Dentofacial Orthop. 1988 Jan;93(1):1-18
22. Pancherz H. Treatment of class II by jumping the bite with the Herbst appliance. A cephalometric investigation. Am J Orthod Dentofac Orthop. 1979;76:423-42.
23. Watted N, Witt E, Kenn W. The temporomandibular joint and the disc-condyle relationship after functional orthopaedic treatment: a magnetic resonance imaging study. Eur J Orthod. 2001 Dec;23(6):683-93
24. Rivero JC, et al. Hebst versus Twin-Block. V Simposio Internacional de Ortodoncia. 21-23 Febrero 2019. Madrid.
25. Foncatti CF, Castanha Henriques JFC, Janson G. Long-term stability of Class II treatment with the Jasper jumper appliance. Am J Orthod Dentofacial Orthop. 2017; 152:663-671
26. Bastiani C, Bellini-Pereira SA, Aliaga-Del Castillo A. Twin-block and mandibular anterior repositioning appliances effects in class II malocclusion correction. Am J Orthod Dentofacial Orthop. 2023; 163:181-190
27. Janson G, Castello Branco N, Aliaga-Del Castillo A. Soft tissue treatment changes with fixed functional appliances and with maxillary premolar extraction in Class II Division 1 malocclusion patients. Eur J Orthod. 2018; 40:214-222
28. Insabralde NM, de Almeida MR, de Almeida-Pedrin RR. Retrospective comparison of dental and skeletal effects in the treatment of Class II malocclusion between Herbst and Xbow appliances. Am J Orthod Dentofacial Orthop. 2021; 160:544-551
29. Bilgiç F, Başaran G, Hamamci O. Comparison of Forsus FRD EZ and Andresen activator in the treatment of Class II, Division 1 malocclusions. Clin Oral Investig. 2015; 19:445-451
30. Bozkurt AP, Aras I, Othman E. Comparison of 2 treatment protocols using fixed functional appliances in Class II malocclusion: treatment results and stability. Am J Orthod Dentofacial Orthop. 2020; 157:474-480
31. Pancherz H. Treatment of class II by jumping the bite with the Herbst appliance. A cephalometric investigation. Am J Orthod Dentofac Orthop. 1979;76:423-42.
32. Pancherz H, Bjerklin K. Mandibular incisor inclination, tooth irregularity, and gingival recessions after Herbst therapy: A 32-year follow-up study. Am J Orthod Dentofac Orthop. 2014;146:310-8.
33. Howe RP, McNamara J. Clinical management of the bonded Herbst appliance. J Clin Orthod. 1983;17(7):456-63
34. McNamara J, Howe RP. Clinical management of the acrylic splint Herbst appliance. Am J Orthod Dentofac Orthop. 1988;94(2):142-49.
35. Franchi L, Baccetti T, McNamara Jr J.A. Treatment and posttreatment effects of acrylic splint Herbst appliance therapy. Am J Orthod Dentofac Orthop. 1999;115:429-38.
36. Pancherz H, Ruf S. The Herbst appliance: Research-Based Updated Clinical Possibilities. World J Orthod. 2000;1:17-31.
37. Martin J, Pancherz H. Mandibular incisor position changes in relation to amount of bite jumping during Herbst/multibracket appliance treatment: A radiographic-cephalometric study. Am J Orthod Dentofac Orthop. 2009;136:44-51.
38. Pancherz H. The Herbst appliance- It´s biological effects and clinical use. Am J Orthod Dentofac Orthop. 1985;87:1-20.
39. Akan B, Veli I. Evaluation of soft-tissue changes in young adults treated with the Forsus fatigue-resistant device. Am J Orthod Dentofacial Orthop. 2020;157:481-489
40. Rivero JC, Roldòs L, Esteve B. Advansync®: otro tratamiento ortopédico de clases II. Ortod Esp. 2012;52(3-4):129-138
41. Rivero JC, Pereiro J, Sopeña M. Propulsor Oclusal Telescópico (POT®). Ortod Esp. 2021;59(1):23-43. ISSN 0210-1637.
42. Clark WJ. The twin block technique. A functional orthopedic appliance system. Am J Orthod Dentofacial Orthop. 1988 Jan;93(1):1-18
43. Vela A, Ponce de León JM, Lasagabaster F, Rico Lillo I. La “bisagra oclusal”: un nuevo aparato de avance mandibular. Rev Esp Ortod. 2002;32:43-7.
44. Fränkel R. The treatment of Class II, Division 1 malocclusion with functional correctors. Am J Orthod. 1969 Mar;55(3):265-75
45. Bimler HP. Dynamic functional therapy. The Bimler appliance. Trans Eur Orthod Soc. 1973:451-6
46. Bimler HP. Bimler therapy. Part 2. Bimler appliance. J Clin Orthod. 1985 Dec;19(12):880-8
47. Bass NM. Removable orthodontic appliance. Br Dent J. 1983 May 7;154(9):281
48. Armstrong SA, Herr MJ. Physiology, Nociception. 2023 May 1. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan. PMID: 31855389
49. Coghill RC. The Distributed Nociceptive System: A Framework for Understanding Pain. Trends Neurosci. 2020 Oct;43(10):780-794
50. Sharman MJ, Cresswell AG, Riek S. Proprioceptive neuromuscular facilitation stretching: mechanisms and clinical implications. Sports Med. 2006;36(11):929-39
51. Silva MC, Oliveira MT, Azevedo-Santos IF, DeSantana JM. Effect of proprioceptive neuromuscular facilitation in the treatment of dysfunctions in facial paralysis: a systematic literature review. Braz J Phys Ther. 2022 Nov-Dec;26(6):100454
2. Proffit WR, et al. Ortodoncia Contemporánea. 6ª Ed. Elsevier. ISBN-13-978-8491134770
3. Gershater E, Li C, Ha P, Chung CH, Tanna N, Zou M, Zheng Z. Genes and Pathways Associated with Skeletal Sagittal Malocclusions: A Systematic Review. Int J Mol Sci. 2021 Dec 2;22(23):13037
4. Riolo ML, Moyers RE, McNamara JA. An atlas of craniofacial growth: cephalometric standards from the University School Growth Study, University of Michigan Monograph 2 Craniofacial Growth Series Center for Human Growth and Development; University of Michigan, Ann Arbor, 1974; 106
5. Bishara SE. Class II malocclusions: diagnostic and clinical considerations with and without treatment. Semin Orthod. 2006; 12:11-24
6. Angle EH. Classification of malocclusion. Dental Cosmos 1899;41:248-264
7. Thilander B. Basic mechanisms in craniofacial growth. Acta Odontol Scand. 1995 Jun;53(3):144-51
8. Williams RE, Ceen RF. Craniofacial growth and the dentition. Pediatr Clin North Am. 1982 Jun;29(3):503-22
9. Wroblewski ME, Bevington J, Badik C. Head Growth. Pediatr Rev. 2015 Sep;36(9):426-7.
10. Graber TM, Chung DD, Aoba JT. Dentofacial orthopedics versus orthodontics. J Am Dent Assoc. 1967 Nov;75(5):1145-66
11. Cleall JF. Dentofacial orthopedics. Am J Orthod. 1974 Sep;66(3):237-50
12. Schmuth GP. Considerations of functional aspects in dentofacial orthopedics and orthodontics: Sheldon Friel Memorial Lecture. Am J Orthod Dentofacial Orthop. 1999 Apr;115(4):373-81
13. Fränkel R. Functional orthopedics. Am J Orthod Dentofacial Orthop. 2001 May;119(5):11A
14. Meikle MC. Remodeling the dentofacial skeleton: the biological basis of orthodontics and dentofacial orthopedics. J Dent Res. 2007 Jan;86(1):12-24
15. Manlove AE, Romeo G, Venugopalan SR. Craniofacial Growth: Current Theories and Influence on Management. Oral Maxillofac Surg Clin North Am. 2020 May;32(2):167-175
16. Castaldo G, Cerritelli F. Craniofacial growth: evolving paradigms. Cranio. 2015 Jan;33(1):23-31
17. Kluemper GT, Spalding PM. Realities of craniofacial growth modification. Atlas Oral Maxillofac Surg Clin North Am. 2001 Mar;9(1):23-51
18. Cozza P, Baccetti T, Franchi L, De Toffol L, McNamara JA Jr. Mandibular changes produced by functional appliances in Class II malocclusion: a systematic review. Am J Orthod Dentofacial Orthop. 2006 May;129(5):599
19. Santamaría-Villegas A, Manrique-Hernandez R, Alvarez-Varela E, Restrepo-Serna C. Effect of removable functional appliances on mandibular length in patients with class II with retrognathism: systematic review and meta-analysis. BMC Oral Health. 2017 Feb 1;17(1):52
20. Vargervik K, Harvold EP. Response to activator treatment in Class II malocclusions. Am J Orthod. 1985; 88:242-251
21. Clark WJ. The twin block technique. A functional orthopedic appliance system. Am J Orthod Dentofacial Orthop. 1988 Jan;93(1):1-18
22. Pancherz H. Treatment of class II by jumping the bite with the Herbst appliance. A cephalometric investigation. Am J Orthod Dentofac Orthop. 1979;76:423-42.
23. Watted N, Witt E, Kenn W. The temporomandibular joint and the disc-condyle relationship after functional orthopaedic treatment: a magnetic resonance imaging study. Eur J Orthod. 2001 Dec;23(6):683-93
24. Rivero JC, et al. Hebst versus Twin-Block. V Simposio Internacional de Ortodoncia. 21-23 Febrero 2019. Madrid.
25. Foncatti CF, Castanha Henriques JFC, Janson G. Long-term stability of Class II treatment with the Jasper jumper appliance. Am J Orthod Dentofacial Orthop. 2017; 152:663-671
26. Bastiani C, Bellini-Pereira SA, Aliaga-Del Castillo A. Twin-block and mandibular anterior repositioning appliances effects in class II malocclusion correction. Am J Orthod Dentofacial Orthop. 2023; 163:181-190
27. Janson G, Castello Branco N, Aliaga-Del Castillo A. Soft tissue treatment changes with fixed functional appliances and with maxillary premolar extraction in Class II Division 1 malocclusion patients. Eur J Orthod. 2018; 40:214-222
28. Insabralde NM, de Almeida MR, de Almeida-Pedrin RR. Retrospective comparison of dental and skeletal effects in the treatment of Class II malocclusion between Herbst and Xbow appliances. Am J Orthod Dentofacial Orthop. 2021; 160:544-551
29. Bilgiç F, Başaran G, Hamamci O. Comparison of Forsus FRD EZ and Andresen activator in the treatment of Class II, Division 1 malocclusions. Clin Oral Investig. 2015; 19:445-451
30. Bozkurt AP, Aras I, Othman E. Comparison of 2 treatment protocols using fixed functional appliances in Class II malocclusion: treatment results and stability. Am J Orthod Dentofacial Orthop. 2020; 157:474-480
31. Pancherz H. Treatment of class II by jumping the bite with the Herbst appliance. A cephalometric investigation. Am J Orthod Dentofac Orthop. 1979;76:423-42.
32. Pancherz H, Bjerklin K. Mandibular incisor inclination, tooth irregularity, and gingival recessions after Herbst therapy: A 32-year follow-up study. Am J Orthod Dentofac Orthop. 2014;146:310-8.
33. Howe RP, McNamara J. Clinical management of the bonded Herbst appliance. J Clin Orthod. 1983;17(7):456-63
34. McNamara J, Howe RP. Clinical management of the acrylic splint Herbst appliance. Am J Orthod Dentofac Orthop. 1988;94(2):142-49.
35. Franchi L, Baccetti T, McNamara Jr J.A. Treatment and posttreatment effects of acrylic splint Herbst appliance therapy. Am J Orthod Dentofac Orthop. 1999;115:429-38.
36. Pancherz H, Ruf S. The Herbst appliance: Research-Based Updated Clinical Possibilities. World J Orthod. 2000;1:17-31.
37. Martin J, Pancherz H. Mandibular incisor position changes in relation to amount of bite jumping during Herbst/multibracket appliance treatment: A radiographic-cephalometric study. Am J Orthod Dentofac Orthop. 2009;136:44-51.
38. Pancherz H. The Herbst appliance- It´s biological effects and clinical use. Am J Orthod Dentofac Orthop. 1985;87:1-20.
39. Akan B, Veli I. Evaluation of soft-tissue changes in young adults treated with the Forsus fatigue-resistant device. Am J Orthod Dentofacial Orthop. 2020;157:481-489
40. Rivero JC, Roldòs L, Esteve B. Advansync®: otro tratamiento ortopédico de clases II. Ortod Esp. 2012;52(3-4):129-138
41. Rivero JC, Pereiro J, Sopeña M. Propulsor Oclusal Telescópico (POT®). Ortod Esp. 2021;59(1):23-43. ISSN 0210-1637.
42. Clark WJ. The twin block technique. A functional orthopedic appliance system. Am J Orthod Dentofacial Orthop. 1988 Jan;93(1):1-18
43. Vela A, Ponce de León JM, Lasagabaster F, Rico Lillo I. La “bisagra oclusal”: un nuevo aparato de avance mandibular. Rev Esp Ortod. 2002;32:43-7.
44. Fränkel R. The treatment of Class II, Division 1 malocclusion with functional correctors. Am J Orthod. 1969 Mar;55(3):265-75
45. Bimler HP. Dynamic functional therapy. The Bimler appliance. Trans Eur Orthod Soc. 1973:451-6
46. Bimler HP. Bimler therapy. Part 2. Bimler appliance. J Clin Orthod. 1985 Dec;19(12):880-8
47. Bass NM. Removable orthodontic appliance. Br Dent J. 1983 May 7;154(9):281
48. Armstrong SA, Herr MJ. Physiology, Nociception. 2023 May 1. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan. PMID: 31855389
49. Coghill RC. The Distributed Nociceptive System: A Framework for Understanding Pain. Trends Neurosci. 2020 Oct;43(10):780-794
50. Sharman MJ, Cresswell AG, Riek S. Proprioceptive neuromuscular facilitation stretching: mechanisms and clinical implications. Sports Med. 2006;36(11):929-39
51. Silva MC, Oliveira MT, Azevedo-Santos IF, DeSantana JM. Effect of proprioceptive neuromuscular facilitation in the treatment of dysfunctions in facial paralysis: a systematic literature review. Braz J Phys Ther. 2022 Nov-Dec;26(6):100454