The Frankel Appliance for Class II and Class III Bites

I. Introduction

  • Dr. Amanda from StraightSmile Solutions revisits an old-school myofunctional appliance, the Frankel appliance.
  • Developed around World War II, it remains a viable option for early Class II and Class III correction.
  • While not her go-to, she acknowledges it works when used correctly.

II. The Philosophy Behind It

  • Malocclusion exists because modern diets and habits lead to underdeveloped jaws.
  • Soft foods, pacifiers, bottles, and a lack of prolonged breastfeeding prevent proper jaw growth.
  • The Frankel appliance harnesses tongue pressure while reducing the negative forces of cheeks and lips.

III. How the Frankel Works

  • The appliance uses acrylic shields to keep lips and cheeks away from the dental arches.
  • This allows the tongue to expand the arches naturally.
  • The labial bow prevents front teeth from moving forward, while the lower pad sits a few millimeters away, acting like a lip bumper.
  • It places teeth in an edge-to-edge position, encouraging mandibular growth.

IV. Class II vs Class III Versions

  • Class II Frankel (Frankel II):
  • Labial bow at the upper front prevents proclination.
  • Acrylic pads keep cheeks and lips off the lower arch.
  • Encourages the lower jaw to grow forward.
  • Class III Frankel (Frankel III):
  • Pad is positioned in the upper vestibule, allowing upper incisors to flare.
  • Lower bow prevents lower incisors from moving forward.
  • Dr. Amanda still prefers reverse-pull headgear for Class III, but Frankel III remains an option.

V. Pros and Cons

Pros:

  • One-piece, no attachments to braces.
  • Cost-effective lab fee is around a few hundred dollars.
  • Minimal office visits; no adjustments or rescans needed.
  • Can achieve significant improvement in 6-9 months with compliance.

Cons:

  • Extremely bulky. Difficult to speak, smile, or make facial expressions.
  • Requires full-time wear for best results.
  • Not comfortable for all patients; best for motivated, young kids (ages 7-9).

VI. Patient Selection and Compliance

  • Ideal for homeschooled or younger children who may find the appliance “cool.”
  • Compliance contract is essential: “This only works if you wear it.”
  • Partial compliance yields partial results; finishing with braces is still an option.
  • No guarantees, but it rarely makes things worse.

VII. Cost-Effectiveness

  • Lab fee is roughly one-third that of Invisalign with MA.
  • No monthly office visits, no rescans, deliver and monitor.
  • A great option for budget-conscious families who need early intervention.

VIII. The Bottom Line

  • Everything old is new again. The Frankel still works.
  • Not the most comfortable or modern appliance, but for the right patient, young, compliant, and on a budget, it can deliver meaningful skeletal change
  • Consider adding it to your Phase 1 toolkit alongside expanders, facemasks, and functional appliances.