The Masters of Functional Orthodontics
“It is only fitting, as we enter a new millennium, that we call attention to
an aspect of orthodontics that has been buried under the onslaught of brackets,
bands, exotic wires, efficient bonding media, and hoopla about how efficient
these devices are. . . . The book is a treasure trove of information and
historically based, time-tested, and proven techniques by world-class authors
and clinicians . . . [and] makes it abundantly clear that it is from the past
that we learn much about the present and the future of our specialty.”
—From the Foreword by Thomas M. Graber, editor-in-chief, World Journal of
Orthodontics
Contents
Preface
Acknowledgments
Presentation by Prof Guiseppe Armocida
Foreword by Dr Hans Peter Bimler
“Review and Outlook on Orthodontics” by Dr Hans Peter Bimler
Foreword by Dr Thomas M. Graber
Chapter 1 The Road to Discovery: Milestones in History
Chapter 2 Dentistry, Orthodontics, and the First Concepts of Functional Therapy
2.1 From Ancient Times to the Middle Ages
2.2 The Middle Ages to the 1700s: Pierre Fauchard, Le Chirurgien Dentiste
2.3 The 19th Century: The Birth of Scientific Orthodontics and the Discovery of
Rubber
2.4 Edward H. Angle: A Great Turn-of-the-Century Teacher
Chapter 3 The Advent of Functionalism: From the Pioneers’ Ideas to the 20th
Century Masters
3.1 The Origins of Functional Orthopedics: The Pioneering Years
3.2 Myofunctional Therapy
3.3 Pierre Robin (1867–1950): Dentofacial Orthopedics and the Eumorphic Method
3.4 The Golden Years: From Pre–World War II, to the Postwar Years, to the 1960s:
Andresen, Häupl, Muzj, Bimler, Balters, Klammt, Fränkel, Stockfisch, and Hoffer
3.5 The Contemporary Period
Chapter 4 The Masters of Functional Therapy
4.1 Viggo Andresen
4.2 Hans Peter Bimler
4.3 Wilhelm Balters
4.4 Georg Klammt
4.5 Rolf Fränkel
4.6 Hugo Stockfisch
4.7 Edmondo Muzj
4.8 Oscar Hoffer
Chapter 5 Functional Orthopedics and Prospects for the 21st Century: A Look at
the Future
Index of Names
Preface
“Form follows function.”
— Frank Lloyd Wright
This well-known aphorism could not help but relate to a highly biologic
discipline which, during therapy, has an important traveling companion: growth.
Functional orthopedics differs from other branches of orthodontics in various
and specific ways: from the etiologic bases of malocclusions to their diagnosis,
from the age of the patient to the techniques used. Basically, the
characteristic that distinguishes functional orthopedics is the maximum
attention it focuses on growth factors and the development of osseous bases and
their related neuromuscular structures. Therefore, we can properly speak of
functional orthopedics to delineate its specific field of action. The presence
of correct maxillomandibular relations and the optimal arrangement of dental
elements in the arch are the result of a balanced combination of many factors,
natural and environmental.
A rather important role is played by the neuromuscular complex of the
stomatognathic system, which is heavily responsible for the adequate development
of the osseous bases. In turn, these bases are fundamental to achieving the
correct dental-occlusal relations. The health of the dental-maxillofacial
complex thus originates in the delicate, early stages of growth and development;
it is in this sphere that functional orthopedics acts.
Functional orthodontic therapy was born between the end of the 19th century and
the start of the 20th century. Especially in Europe, functionalist schools and
philosophies grew and flourished, and even today research in this field never
ceases to make further progress and discoveries. More than a century from its
origin, the ideas, developments, and prospects of this fascinating discipline
are recorded in a single work that recognizes its maturity and scientific basis.
The Masters of Functional Orthodontics describes the broad therapeutic potential
of this discipline, in part through a critical review of its history, from birth
to the present day. The special design of the book, from the sequence of its
chapters to its illustrations and layout, is intended as a further stimulus to
learn more about this interesting and up-to-date orthodontic discipline.
There are many purposes of orthognathodontics, one of the newest dental therapy
specialties and one that, like other relatively new branches of medicine, is
destined for further development and scientific progress. To understand the
sphere of action of orthognathodontics in its entirety and complexity, it helps
to analyze the Greek etymology from which it derives: orthos, straight; gnathos,
jaw; and odontos, tooth. From this relationship emerges considerations of
extreme importance: If the ultimate aim is a regular arrangement of the dental
elements, with precise intra-arch and interarch relations, we must absolutely
not neglect the basic concept in which each individual dental element should be
considered within the global dental-maxillofacial complex. Often, for practical
reasons, the terms orthodontics and orthognathodontics are used interchangeably.
Without detracting value from the term orthodontics, the term orthognathodontics
is preferable, because there are many reasons for considering dental elements
and arches as part of the broader and more complex system that is the
stomatognathic apparatus. This reflection is a dutiful one: It is indisputable
that tooth arrangement and maxillomandibular relations are influenced by
supplementary factors, such as the size and position of the osseous bases,
muscle development and activity, and the function and parafunction of each
individual.
This point shows that the orthodontist—or better, the orthognathodontist—must
have in-depth knowledge of the dental-maxillofacial complex, which ranges from
embryology to histology, anatomy, biology, physiology, pathology, and therapy
and includes sufficiently solid knowledge of pediatrics, otorhinolaryngology,
auxology, anthropology, and, considering the young age of patients, some
fundamentals of child psychology.
The purpose of orthognathodontics is therefore to achieve correct occlusion,
optimal mastication and speech, and a satisfactory esthetic appearance. After
stressing the importance that anatomic and functional factors have on the
arrangement of teeth in the dental arch, the follower of orthognathodontics is
perfectly aware that the goal of correct occlusion can be reached not only
through strictly dental factors but also through other variables, the so-called
functional variables. The orthognathodontist therefore can work not only in the
mechanistic sense of correcting dental irregularities within the narrow context
of the arches but also in a broader sense: on the osseous bases, which influence
interarch relations, and on muscle functioning, of great importance in the
development and spatial positioning of the jawbones themselves. Essentially,
treatment can be dual: On the one hand, dysgnathia can be corrected by
regularizing intra-arch and interarch dental relations; in this case, the work
is limited to the anatomic sphere of the alveolar space, although doubtless
there are also repercussions on the reciprocal spatial relations of the osseous
bases. On the other hand, the therapy’s field of action also encompasses
extradental spaces and tissues: the oral cavity proper, the vestibule of the
mouth, and the extraoral zones. This is where functional orthopedics works.
Therefore, we can intuit how the goals of orthognathodontics can be basically
reached through two approaches: a mechanistic type that essentially acts on
individual teeth and the arches and a functional type that acts primarily on
bone and muscle structure, that is, on the individual’s function and
parafunction. This distinction in therapeutic approach is not meant to imply a
hierarchy of values between mechanical and functional orthodontics but rather to
show how closely they complement one another. The purpose of these reflections
is to be able to establish that the “mechanistic” orthodontist is —without
forcing the definition too much—a “functionalist”. If, in this treatise covering
the history of orthognathodontics from its dawn to the official birth of
functional orthopedics, we were to discover that functional concepts were
already present in work by authors classically defined as “mechanistic,” then we
could fairly confidently state that, even with their specific differences and
particularities, the divergence in the two trends was not so very great. To
facilitate our task, a clear definition of functional orthopedics is needed, to
give us a precise key for interpreting, from the functional standpoint, the
attempts, successes, and failures of the early orthognathodontic scholars.
The principle inspiring functional orthopedics came from new assumptions in the
study of the genesis of dysgnathia: Great importance was given to purely
myodynamic factors in the development of the stomatognathic apparatus (referring
to the influence intraoral and perioral musculature has on skeleton growth). A
necessary condition for optimal dental arrangement is an equally correct
relation of the osseous bases, both in the purely dimensional sense and in terms
of the reciprocal relations between maxilla and mandible in the three planes of
space.
We can intuit that the ultimate aim of functional orthopedics is to restore
correct function during the age of development: This concept is well expressed
by Eschler’s aphorism, “Modify the function to restore the shape.” Nonetheless,
in the sphere of diagnostics, the functional approach has always existed. In
fact, viewing myodynamic factors as responsible for malocclusions was, and is, a
common heritage of both the mechanistic and the functional schools, although
they differed in their more strictly therapeutic approaches. It was only in much
more recent times that we witnessed the birth and official development of
functional orthopedics as an operative and applicative technique. The spread of
this method in Europe, spurred by the validity of its diagnostic assumptions and
clear therapeutic results, in fact dates from the start of the last century, an
epoch in which classic American orthodontists had already dictated the
fundamental criteria for orthognathodontic treatment.
We shall now take a look at the differences (not the similarities) between the
functional and the mechanistic schools. Basically, they consist of the
corrective devices used and, as a consequence, the age of treatment. The forces
used in mechanical orthodontics originate in purely mechanical appliances:
arches, springs, bindings, and screws, devices made in the laboratory, while
functional orthopedics originates from sources intrinsic to the body: muscle
activity, structure, and tone. However, we should not forget how the action of
mechanical devices can, in reality, activate important functional reactions,
favoring corrective input and preventing negative situations, and how, vice
versa, functional appliances with particular construction specifications act
more closely on dentition, the skeleton, and the muscles themselves.
In even more general terms, it should be reiterated that, even making use of
fixed appliances, today’s expert orthodontist thinks of the functional elements
from the diagnostic as well as the therapeutic standpoint, considering broadly
and with every means everything—development, growth, musculature, soft tissues,
and joints—that is involved with and accompanies every dental movement.
It is therefore our opinion that, at the present time, differentiating between
the two techniques is relevant only for nosographic-classificatory and
historical purposes. This differentiation is significant only organizationally
and for systematic grouping.
In the course of our study, we will try to identify the “functional” aspects of
the history of orthognathodontics and to show that functional orthopedics has
always existed, developed, and progressed in step with orthognathodontics as a
whole.
Aurelio Levrini and Lorenzo Favero
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