Therapy · Studies and science
What is supported by evidence.What remains a model.
Here you will find the studies on FaceFormer therapy with their figures and limitations, our own research since 1993 and the basic research on which the model is built. And an honest answer as to which of it is established.
At a glance
Four kinds of knowledge
Not every source carries the same weight. So that you can put what you read on this page into context, we distinguish between four kinds.
A randomised study
At the University Medical Center Hamburg-Eppendorf, 45 children and adolescents were randomly assigned to two groups and followed for six months. This is the strongest evidence available on FaceFormer therapy.
Smaller investigations
Pilot studies with few participants, conference contributions, a study on upper-body posture, a case report and an early book contribution from Mainz. They point in certain directions; they do not show established effects.
Basic research
Studies on the nose, tongue, swallowing, head balance and learning. They do not examine the FaceFormer, but the relationships on which the model is built.
A working model
The triadic functional circuit of breathing, swallowing and head balance organises these building blocks. It is testable; as a whole, it has not yet been tested.
The Hamburg study
Design of a randomised study
The study was carried out at the Department of Orthodontics of the University Medical Center Hamburg-Eppendorf. The examinations took place in 2002; the study was evaluated in M. Schwan’s dissertation (2007), and the journal version was published in 2004.
Who took part
45 children and adolescents aged between 3.9 and 16.9 years, with an average age of just over eight. All had several oral function disorders requiring treatment, had not previously been treated for them and received no other treatment during the study, such as braces, occupational therapy or physiotherapy.
Two randomly assigned groups
26 children trained with the FaceFormer. 19 children received myofunctional therapy without a device in speech therapy practices in the Hamburg area, following the approach of the respective practice. Age, sex and severity of findings were comparable in both groups.
What the FaceFormer group did
Pressing and holding the lip wedge, plus pull exercises, with the tip of the tongue behind the papilla incisiva. After three weeks, the FaceFormer was also used at night. The exercises were checked at the clinic every six weeks.
How measurements were taken
At the start, after three and after six months, an orthodontist and a speech therapist examined each child using a standardised assessment form. They checked the swallowing pattern by palatography and lip strength with a measuring device. During the examination, it was not apparent which group a child belonged to.
Results
What emerged after six months
Both groups improved. For mouth breathing and the swallowing pattern, the difference in favour of the FaceFormer group was statistically significant after six months.
Lip strength increased markedly in both groups, faster in the FaceFormer group. For the therapy, the pattern is what counts; strength was one measured value here. For lisping (sigmatism), no difference was seen within six months. The authors conclude from this that pronunciation needs to be practised additionally once breathing and swallowing have improved.
Mouth breathing with FaceFormer
Mouth breathing without device
Faulty swallowing pattern
Lisping after 6 months
Proportion of children examined. Before: 26 and 19 children; after three months: 19 and 14; after six months: 17 and 13. Source: Schwan M, dissertation, University of Hamburg 2007. Korbmacher et al., Int J Orofacial Myology 2004.
Limitations of the study
What the Hamburg study does not show
A study is only as good as what is known about its limitations. These six points belong with the figures.
Fewer children at the end
45 children started; after six months, 30 were examined, 17 with FaceFormer and 13 without a device. In groups this small, just a few children shift the percentages considerably.
Only six months
Whether the changes last was not investigated. The study itself points out that longer observation periods with more participants are needed for this.
Two treatment approaches
The FaceFormer group was checked regularly at the clinic and also trained at night. The comparison group was treated in various practices according to different approaches. So two approaches were compared, not a device alone.
An earlier exercise plan
In 2002, training was done with the FaceFormer of that time and according to the plan of that time: 20 repetitions four times a day. Today’s exercise plan is structured differently.
Close to the development
Sabine Berndsen, who co-developed the method, co-authored the journal version. The examinations were carried out by specialists at the university hospital who did not know which group the child was in. Replication by other research groups is still pending.
Only for this group
The study examined children and adolescents with oral function disorders. The figures cannot be transferred to adults, snoring, jaw joint complaints or other areas of application.
Mouth breathing was assessed during the examination, not measured with a device. The study itself states that the breathing pattern can change over the course of the day. And the results are not a verdict on speech therapy. The comparison group also improved, and the two can be combined well.
Further studies
A contribution from Mainz, upper-body posture and a case report
An independent study from Mainz. As early as 2001, Al-Nachef, Doll and Sergl of the Department of Orthodontics at the University of Mainz examined the effectiveness of the FaceFormer in a contribution to the edited volume “Prävention und Frühbehandlung” (Prevention and early treatment). It is the earliest study on the device known to us in which the developers were not involved. It was published as a book chapter, not in a peer-reviewed journal. We do not have details of the number of participants or the study design, so we cite the source here and no results.
Upper body posture. In 2012, Herget, Ohlendorf and Kopp examined upper body posture before and after six months of FaceFormer training in the journal Manuelle Medizin. This was preceded by a pilot study at the University of Frankfurt with five people whose backs were measured three-dimensionally during training (congress poster 2009). The authors saw this as an indication of a change in the alignment of the spine. Five people are a first indication, not proof.
Case report. In 2021, Booth and Kinzinger described in the journal Kieferorthopädie the treatment of an open bite with a combination of high-pull headgear and FaceFormer. A case report describes a single course. It shows how orthodontics and FaceFormer training can work together, not how often this succeeds.
Textbook and manual
Describing, contextualising, guiding
In the textbook “Zahnärztliche Schlafmedizin” (Dental Sleep Medicine) (eds. Langenhan and Kopp, Thieme 2023), Klaus and Sabine Berndsen describe FaceFormer therapy as a neurophysiological causal therapy for CCDS. A textbook chapter presents a method and puts it in context. It is not a study of effectiveness.
The methodology manual (2nd edition 2024) describes assessment, exercises and the training plan for use in practice. The book “Trust the Triad” by Klaus Berndsen, which brings together the foundations of the triadic functional circuit, is in preparation.
Our own research
More than thirty years in professional circles
Since 1993, Klaus and Sabine Berndsen have presented their work at professional conferences, often together with university hospitals.
- 1993
Orofacial muscle function
Talk at the conference “Down-Syndrom heute” (Down Syndrome Today) on functional disorders of the oral and facial muscles.
- 2000
The FaceFormer is introduced
Presented at the annual conference on myofunctional therapy in Hanover as a new technical therapy aid, together with a first study on its effectiveness.
- 2001
With the University of Jena
Poster contributions at the annual conference of the German Orthodontic Society on indications and treatment strategies and on the reliability of lip force measurement. In the same year, a contribution at the Dutch speech therapy congress.
- 2003
Hamburg study
Presentation at the congress of the European Orthodontic Society in Prague; the journal version was published in 2004, the dissertation in 2007.
- 2004
Jaw and sleep
An article with S. Kopp on muscle findings in the jaw system in the journal Manuelle Medizin, and a poster contribution on snoring and sleep apnoea.
- 2009
Bruxism and posture
Poster contributions at the annual conference of the German Orthodontic Society on teeth grinding and on spinal posture, both pilot studies with few participants.
- 2012
Upper body statics
Journal article by Herget, Ohlendorf and Kopp in Manuelle Medizin.
- 2018
The CCDS
Sabine and Klaus Berndsen describe craniocervical dysfunction syndrome as a working model.
- 2021
Case report
Booth and Kinzinger, open bite, orthodontics and FaceFormer combined.
- 2023
Textbook
Chapter on FaceFormer therapy in “Zahnärztliche Schlafmedizin” (Dental Sleep Medicine), Thieme. The second edition of the manual follows in 2024.
Congress contributions are abstracts, often with small groups and without review by independent experts. They show what was being worked on, not what is established. All publications are listed further down.
In detail
Every study with size, comparison and limitations
Since 1988, Sabine and Klaus Berndsen have published more than 50 contributions: congress posters, articles in professional journals and trade newspapers, book chapters and talks. Here you will find the studies among them, with what was actually measured in each, and the complete list below. Where a PDF is linked, you can read the original yourself.
For each study, the size, comparison group, duration and measurement method are given. The smaller the group and the more likely a comparison group is missing, the more cautiously you should read the result.
Indikation und Behandlungsstrategien myofunktioneller Therapie mit dem FaceFormer
Question. The abstract presents a concept for the assessment and treatment of functional disorders of the facial and masticatory muscles and compares a group treated with the FaceFormer with a comparison group.
Result. In this study, open lip closure (incompetent lip posture) improved compared with the comparison group (p = 0.008). Sucking habits decreased in the treated group over 3 to 6 months (p < 0,03). Den Tragekomfort bewerteten die Befragten besser als bei anderen Trainingsgeräten; Zahlen …
Limitations. Only an abstract of about a third of a page; no detailed article is known. It does not state who was in the comparison group, how participants were allocated or how old they were. No independent review. Klaus and Sabine Berndsen, who …
Original (PDF)Reliabilität der funktionsorientierten Messung perioraler Muskulatur mit dem FaceFormer
Question. Can lip force be measured reliably and repeatedly using the FaceFormer as a measuring attachment, and does it change with training?
Result. In this study, the measurements were readily repeatable: agreement κ = 0.81 with one examiner and κ = 0.76 with three examiners. The measured values clustered at 20, 45 and 70 mbar. The exercise group showed a training effect on lip force compared with the control group (p < 0,001).
Limitations. Abstract without mean values and without information on age, selection and allocation. Only lip force was measured, over six weeks; the study says nothing about symptoms or everyday functions. The measuring device and FaceFormer come from the co-authors Klaus and …
Original (PDF)Comparative evaluation of the effectiveness of the FaceFormer (original: Zur Wirksamkeit des neuen myofunktionellen Trainingsgerätes Face-Former)
Question. How does lip force change with the FaceFormer compared with other methods of myofunctional therapy and with untreated children?
Result. In this study, lip force improved most in the FaceFormer group (poster: p < 0,0005 für den Myoscanner, p < 0,0023 für die Federwaage). Jüngere Kinder verbesserten sich tendenziell stärker. Die Mehrheit akzeptierte das Gerät gut, Eltern und Jugendliche fanden die Übungen leichter zu …
Limitations. Congress contribution without independent review, no mean values in the text, allocation not described, only three months. The main outcome measure is lip force; mouth posture and tongue position are mentioned without figures. The age information is contradictory between …
Längerer Atem mit FaceFormer Therapie. Einfluss der FaceFormer Methode auf die Laufleistung
Question. Does additional FaceFormer training change the endurance performance of runners who follow the same training plan?
Result. According to the article, the FaceFormer group increased its speed at the aerobic threshold by 36.4 per cent, the comparison group by 1.08 per cent. Heart rate at this threshold fell by 6.56 per cent compared with 0.75 per cent.
Limitations. A short magazine report, not a scientific publication: no statistics, no individual values, no information on group allocation. The individual results were supposed to be published on a website of the organiser, which was not checked. An increase of just over a …
Wirkungen der Therapie mit dem FaceFormer auf Schnarchen und Schlafapnoe
Question. How do breathing pauses, oxygen supply, snoring and lip strength change in people with sleep apnoea who train with the FaceFormer for three months as instructed?
Result. In this study, the RDI before training was between 18 and 52, and between 1 and 14 afterwards; the mean reduction was 70.81 per cent (smallest 50, largest 88.89 per cent). The longest breathing pauses were 8 to 48 seconds before and 1 to 14 seconds afterwards; the oxygen level during sleep was 71 to 99 before, and afterwards …
Limitations. No comparison group: training, changes in weight, sleeping position, the switch from sleep laboratory to outpatient measurement and natural fluctuations cannot be separated. Only the 30 people with complete data were analysed; regarding the other 8, …
Original (PDF)Bruxism: Diagnosis and new ways of functional treatment by the FaceFormer Therapy (Neue Wege der funktionellen Bruxismus-Behandlung)
Question. Can observations from FaceFormer therapy for jaw and neck complaints be transferred to people with bruxism?
Result. After two weeks, six participants reported a marked improvement in pain. For eight weeks, the journal abstract gives an average improvement in ratings of 61.36 per cent (self-assessment) and 56.82 per cent (partner assessment). The poster gives the same figure as the proportion of …
Limitations. Twelve people, no comparison group, no follow-up beyond eight weeks. Only self- and partner assessment, no objective measurement of grinding such as a sleep laboratory or muscle recordings. No statistical tests reported. 61.36 per cent can, in the case of …
Original (PDF)Initiale Therapie myogener Befunde im kraniomandibulären System mit einem konfektionierten intra-/extraoralen Trainingsgerät
Question. Does muscle-related jaw pain change when those affected practise with the FaceFormer, compared with people who do not train?
Result. The mean pain score fell in both training groups but not in the group without training (read from Figure 14: coordination exercises 5.8 to 2.1, strengthening 6.2 to 1.6, without training about 6.1 to 6.4). According to the authors, the difference from the control group was statistically significant; the difference between the …
Limitations. Random allocation is not mentioned, and the control group is considerably smaller. p-values and measures of spread are missing from the text. No blinding, no observation beyond 12 weeks; the authors themselves point out the lack of long-term studies. Two developers are …
Original (PDF)Strategien myofunktioneller Therapie mit dem FaceFormer
Question. Do children accept the exercise programme, and do habits such as thumb-sucking change?
Result. 87.5 per cent of the children and 71 per cent of the parents stated that they had practised three times a day as instructed. 19 of 24 parents reported that sucking and other habits had become less frequent, 5 saw no change, and in no child did they become more frequent.
Limitations. The article mainly describes the exercise programme. No comparison group, survey only, no measurement of functions or complaints.
Original (PDF)Stillen und Schnulleranwendung als Ursache für Schnarchen und nächtliche Atemaussetzer
Question. How often were people receiving treatment for snoring breastfed as babies, and how often did they use dummies or their thumbs for a long time?
Result. 20 per cent stated that they had been breastfed for at least 6 months, 59 per cent knew that they had not been breastfed, and 21 per cent did not know. Among those who had been breastfed, 52 per cent had used dummies or their thumbs for a long time; among those who had not been breastfed, 77 per cent.
Limitations. Without a comparison with people who do not snore, no association can be shown, let alone a cause. Adults’ memories of breastfeeding and dummy use are unreliable. Short article in an association journal, without statistics.
Original (PDF)Publications
All publications since 1993
The complete list of publications by Sabine and Klaus Berndsen, sorted by topic. Where a PDF is linked, you can read the original.
FaceFormer therapy and orofacial function (18)
- Berndsen K (2009): “Das Cranio-Cervicale-Myo-Funktionsmodell (CCMF): Primäre und sekundäre Auswirkungen interaktiver Cranio-Cervicaler-Funktionsstörungen.” Continuing education conference of the e.V. für Morpho-Physiologische Therapie (MPL-Therapie), Kiel, 5 September 2009Talk
- Berndsen K, Berndsen S, van de Gehuchte C (2006): “En nieuwe therapie voor het corrigeren van arofaciale spierfuncties.” In: Signaal 56, Significant voor de professionele hulpverlener, vol. 15, 2006, pp. 20-33, Destelbergen (Belgium)Journal PDF
- Korbmacher HM, Schwan M, Berndsen S, Bull J, Kahl-Nieke B (2004): “Evaluation of a new concept of myofunctional Therapy in Children.” The International Journal of Orofacial Myology 30 (2004), pp. 39-52 (30th Anniversary Edition), PMID 15832861Journal PDF
- Berndsen K, Berndsen S (2004): “Effektiver trainieren: Myofunktionelle Störungen und viszerales Schlucken sind oft Ursachen für Dysgnathien.” In: KFO-Zeitung, issue 4, May 2004, pp. 14-15, udp-Verlagsgesellschaft, CologneTrade journal PDF
- Berndsen K (2004): “Auswirkungen der Face-Former Therapie auf extra- und intraorale Muskelaktivitäten.” In: Akuphon Kurier, issue 2/2004, UnnaTrade journal PDF
- Kopp S, Berndsen K, Berndsen S, Ifert F, Langbein U (2004): “Strategien myofunktioneller Therapie mit dem FaceFormer.” In: Quintessenz, Monatszeitschrift für die gesamte Zahnmedizin, vol. 55, January 2004, pp. 45-52, Quintessenz Verlag, BerlinJournal PDF
- Kahl-Nieke B, Korbmacher H, Berndsen S, Schwan M, Bull J (2003): “Evaluation of a new concept of functional Therapy supporting orthodontic treatment.” Poster demonstration, 79th Congress of the European Orthodontic Society, Prague, 10 to 14 June 2003Poster PDF
- Berndsen K, Berndsen S (2003): “FaceFormer-Therapie (FFT): Neue Hilfen zur Korrektur orofazialer Muskelfunktionen.” In: Logopädie (journal), no. 4/2003, pp. 7-8, ed. Verband der diplomierten Logopädinnen (Association of Qualified Speech Therapists), ViennaJournal PDF
- Berndsen K (2002): “Instrumento de Entreamiento de Fuctiones Orales. I Conbreso Internacional De Implantologia Oral.” El FaceFormer. I Congreso Internacional de Implantología Oral, Colegio Odontológico de Lima (Peru), 26 to 28 September 2002Talk
- Berndsen K (2001): “FaceFormer (FF): Een nieuwe myofunktionele therapie.” NVLF Jaarcongres (annual congress of the Dutch association of speech therapists), Ede, 3 November 2001Talk PDF
- Berndsen K, Kopp S, Berndsen S, Wangemann D, Ifert F (2001): “Indikation und Behandlungsstrategien myofunktioneller Therapie mit dem FaceFormer.” German Society of Orthodontics (Deutsche Gesellschaft für Kieferorthopädie), 74th Annual Scientific Meeting, poster demonstration P51, Friedrichshafen, 12 to 16 September 2001Poster PDF
- Kopp S, Berndsen K, Berndsen S, Wangemann D, Ifert F (2001): “Reliabilität der funktionsorientierten Messung perioraler Muskulatur mit dem FaceFormer.” German Society of Orthodontics (Deutsche Gesellschaft für Kieferorthopädie), 74th Annual Scientific Meeting, poster demonstration P52, Friedrichshafen, 12 to 16 September 2001Poster PDF
- Berndsen K, Berndsen S (2000): “Neuentwicklung zur Therapie orofazialer Dyskinesien im stomatognathen System – Ein einfaches Gerät und gezielte Übungen bringen Besserung” In: DZW, Die Zahnarztwoche, 1-2/2000 of 12 January 2000, p. 14, section “Praxis aktuell”Trade journal PDF
- Berndsen S (1998): “Das Kaugummi hat sich etabliert!?” MFT-Mitteilungen no. 16, Munich 1998, p. 12Journal
- Berndsen S (published under the name Heinemann) (1993): “MFT als funktionelles Übungsprogramm.” MFT workshop, Interlaken (Switzerland), 19 and 20 March 1993Talk
- Berndsen K (1992): “Frühes Erkennen verhindert teure Spätschäden.” 10th European Congress for Myofunctional Therapy, Lüneburg, 13 and 14 November 1992Talk
- Berndsen K, Berndsen S (1991): “Neuromotorische Koordinationsstörungen und Auswirkungen auf die orofaziale Muskulatur.” Peter Lang Verlag, Frankfurt 1991Book
- Berndsen S (published under the name Heinemann) (1988): “MFT in Kombination mit kieferorthopädischer und sprachtherapeutischer Behandlung, Video-Dokumentation einer Fallstudie.” European Congress for Myofunctional Therapy, Würzburg, 11 and 12 November 1988Talk
Sleep, snoring, sleep apnoea (7)
- Berndsen K, Berndsen S (2023): “FaceFormer-Therapie – Neurophysiologische Kausalterapie bei ‘Cranio-Cervikalem Dysfunktionssyndrom’ (CCDS) mit impliziten Symptomen von Schnarchen und Schlafapnoe.” In: Langenhan J, Kopp S (eds.): Zahnärztliche Schlafmedizin. Von Praktikern für Praktiker. Georg Thieme Verlag, Stuttgart, New York 2023, pp. 285-302Book chapter
- Berndsen K (2006): “FaceFormer: Die natürliche Therapie gegen Schnarchen” Lecture, “Schlaf Gut 2006” trade fair, Munich, 18 November 2006Talk
- Berndsen K, Berndsen S, Kopp S, Ifert F (2004): “Wirkungen der Therapie mit dem FaceFormer auf Schnarchen und Schlafapnoe.” German Society of Orthodontics (Deutsche Gesellschaft für Kieferorthopädie), 77th Annual Scientific Meeting, poster demonstration P73, Freiburg im Breisgau, 22 to 26 September 2004Poster PDF
- Berndsen K, Berndsen S (2004): “Atemaussetzer beim Schlafen.” In: Dental Magazin 1/2004 (March), pp. 128-131, Deutscher Ärzteverlag, CologneTrade journal PDF
- Berndsen K, Berndsen S (2004): “Die FaceFormer-Therapie. Ein neues funktionelles Behandlungskonzept bei Schnarchen und obstruktiver Schlafapnoe (Pilotstudie).” In: Somno Journal 2/2004, pp. 26-27Trade journal PDF
- Berndsen K, Berndsen S (2003): “Schnarchen und nächtliche Atemaussetzer jetzt einfach wegtrainieren.” In: Gero’s internationaler Medizin-Report, no. 9, September 2003, pp. 68-70, Gero Forschungs- und Dokumentationszentrum, Kreuzlingen (Switzerland)Trade journal PDF
- Berndsen K, Berndsen S (2002): “TAS, Trainingstherapie gegen Schlafapnoe und Schnarchen: Behandlung mit FaceFormer und OSP.” DZW, Die Zahnarztwoche 27/02 of 3 July 2002, special section on seminars and further training, p. 20Trade journal PDF
Children, breastfeeding, speech, LKGN malformations, OSP (16)
- Berndsen S (2009): “Funktionelle Habilitation bei Störungen des Essens, Trinkens, Schluckens sowie der Sprachentwicklung.” Training conference of the e.V. für Morpho-Physiologische Therapie (MPL-Therapie), Kiel, 5 September 2009Talk
- Berndsen K, Berndsen S (2007): “Myofunktionelle Behandlungen und ihr Einfluss auf die sprachliche Artikulation.” In: Schöler H, Welling A (eds.): Sonderpädagogik der Sprache, vol. 1 (handbook), Hogrefe, Göttingen 2007, pp. 866-890Book chapter PDF
- Berndsen K, Berndsen S (2006): “Neue Möglichkeiten zur Behandlung von Funktionsstörungen bei Lippen-, Kiefer-, Gaumen-, Nasenfehlbildungen (LKGN-Fehlbildungen): FaceFormer-Therapie (FFT) und Orale-Stimulations-Platten (OSP).” In: Gesichter, issue 1, vol. 18, April 2006, pp. 2-7. Ed. Wolfgang Rosenthal Gesellschaft (self-help association), HüttenbergJournal PDF
- Berndsen K, Berndsen S (2005): “Stillen und Schnulleranwendung als Ursache für Schnarchen und nächtliche Atemaussetzer.” Laktation und Stillen, journal of the Verband Europäischer Laktationsberaterinnen (VELB, Association of European Lactation Consultants), no. 2/2005, vol. 18, pp. 58-59Journal PDF
- Berndsen K, Berndsen S (2004): “Gestillte Kinder neigen als Erwachsene seltener zum Schnarchen: Stillen trainiert die Mund- und Rachenmuskulatur.” Die Zahnarztwoche (DZW), 1 December 2004, pp. 1 and 4, Zahnärztlicher Fachverlag, HerneTrade journal
- Korbmacher H, Berndsen K, Berndsen S, Kahl-Nieke B (2003): “Vorstellung eines modifizierten Stimulationsplattensystems bei Kindern mit Down Syndrom.” In: Forum Logopädie, journal of the Deutscher Bundesverband für Logopädie (German Federal Association for Speech and Language Therapy), issue 3, May 2003, pp. 14-16Journal PDF
- Berndsen K (2002): “Reflektieren und Motivieren. Schnittstelle einer Kooperation: Sprachtherapie und Logopädie” Dental Magazin 3/2002 (September), Deutscher Ärzteverlag, CologneTrade journal
- Berndsen K, Berndsen S (2001): “Orale Stimulationsplatten (OSP): Profil für Orale-Stimulations-Platten (POSP).” In: MFT-Mitteilungen, journal of the AK-MFT, for the 13th European Congress of the AK-MFT e.V., 2 and 3 November 2001, BrixenJournal PDF
- Berndsen K (2001): “Stillen – richtiges Verhalten verhindert Schäden fürs Leben” Specialist lecture of 19 September 2001, Malteser Krankenhaus St. Josef, Hamm-Bockum-HövelTalk
- Berndsen K (2001): “Orale-Stimulations-Platten (OSP).” In: MFT-Mitteilungen no. 1/2001, pp. 19-21, ed. AK-MFT e.V., Taufkirchen/MunichJournal
- Berndsen K (2001): “Anwendung und Herstellung von Oralen-Stimulations-Platten (OSP): Profil für Orale-Stimulations-Platten (POSP).” In: Tränkmann J, Lisson J (eds.): Prävention und Frühbehandlung mit Hilfe der Myofunktionellen Therapie in der logopädischen bzw. sprachheilpädagogischen, zahnärztlichen und kieferorthopädischen Praxis, Taufkirchen 2001, pp. 54-61Book chapter
- Berndsen K (1995): “Die Bedeutung prälingualer Fähigkeiten für die Sprachentwicklung:” In: Laktation und Stillen 4/1995, pp. 5-9Journal PDF
- Berndsen S (1994): “Allgemeine Hilfen und Übungen der professionellen Therapie bei Behinderungen der Eß-, Sprach- und Stimmentwicklung.” Conference “Down-Syndrom heute”, Dresden, 8 to 10 October 1993. In: Dokumentation der Vorträge, EDSA Deutschland e.V., 1994, pp. 56-58Talk PDF
- Berndsen K (1993): “Orofaziale Muskelfunktionsstörungen bei Menschen mit Down-Syndrom.” Conference “Down-Syndrom heute”, Dresden, 8 to 10 October 1993. In: Dokumentation der Vorträge, EDSA Deutschland e.V., pp. 19-24Talk
- Berndsen K (1993): “Die Bedeutung orofazialer Reflexentwicklung für die Lautbildung.” Die Sprachheilarbeit 3/1993 (vol. 38, June 1993), pp. 140-145Journal PDF
- Berndsen S (published under the name Heinemann) (1988): “Kombinierte Anwendungen von logopädisch-funktioneller und myofunktioneller Therapie bei sprachlichen Artikulationsstörungen und mögliche Auswirkung auf die Entwicklung von Zahnstellungsanomalien.” European Congress for Myofunctional Therapy, Würzburg, 11 and 12 November 1988Talk
Jaw joint and bruxism (3)
- Berndsen K, Berndsen S, Kopp S (2009): “Bruxism: Diagnosis and new ways of functional treatment by the FaceFormer Therapy.” Deutsche Gesellschaft für Kieferorthopädie (German Orthodontic Society), 82nd Annual Scientific Meeting, poster demonstration P19, Mainz, 16 to 19 September 2009Poster PDF
- Berndsen K, Berndsen S, Kopp S (2009): “Bruxism: Diagnosis and new ways of functional treatment by the FaceFormer Therapy.” Journal of Orofacial Orthopedics 70 (2009), issue 5, p. 430Poster PDF
- Kopp S, Berndsen K, Berndsen S, Ifert F, Langbein U (2004): “Initiale Therapie myogener Befunde im kraniomandibulären System mit einem konfektionierten intra-/extraoralen Trainingsgerät.” In: Manuelle Medizin 42 (2004), issue 1, pp. 55-61 (pp. 55-62 according to the article), Springer, Heidelberg, DOI 10.1007/s00337-004-0283-yJournal PDF
Posture and performance (1)
- Herget A, Ohlendorf D, Berndsen K, Kopp S (2009): “Die FaceFormer-Therapie und die Auswirkungen auf die Haltung der Wirbelsäule.” Deutsche Gesellschaft für Kieferorthopädie (German Orthodontic Society), 81st Annual Scientific Meeting, poster demonstration, Cologne (year as given in the ISST list: 9/2009)Poster PDF
Other works (hearing acoustics, communication aids, etc.) (12)
- Berndsen K (1997): “Die Adaption von Hörgeräten unter Berücksichtigung der Ergebnisse psychoakustischer Forschung.” In: Hörakustik no. 3, March 1997, pp. 40-45Trade journal PDF
- Berndsen K (1997): “Digitales Messverfahren zur Bestimmung von Ohrgeräuschen. Tinnitus-Hunter nach Berndsen.” In: Hörakustik No. 2, February 1997, pp. 64-68Trade journal PDF
- Berndsen K (1997): “Wir sprechen einfach so!” In: Dialog Rehabilitation, No. 1, January 1997, vol. 2, magazine of the Gehrmeyer-Schuchmann group of companiesTrade journal
- Berndsen K (1997): “Wen die Geräusche plagen.” In: Dialog Rehabilitation, No. 1, January 1997, vol. 2, pp. 1-2, magazine of the Gehrmeyer-Schuchmann group of companiesTrade journal
- Berndsen K (1997): “PFS-System für verbesserte Fußhaltung.” In: Haverich News, special edition for the Reha-Messe 1997, p. 2Trade journal PDF
- Berndsen K (1996): “VIVOCOM, Situations Communicator-System nach Berndsen.” In: Computergestützte Sprachtherapieprogramme und Kommunikationshilfen für Aphasiker. Workshop Computergestützte Sprachtherapie, 3rd International Aphasia Congress, Würzburg, 12 to 14 September 1996Talk PDF
- Berndsen K (1996): “VIVOCOM-ein neuentwickeltes Kommunikator- und Therapiesystem für Menschen mit Sprachbehinderungen.” Workshop Computergestützte Sprachtherapie, University of Leipzig, 13 September 1996Talk
- Berndsen K (1996): “Die Adaption von Hörgeräten unter Berücksichtigung der Ergebnisse psychoakustischer Forschung.” In: Impuls 96, 1st annual conference of Dreve-Otoplastik GmbH, 15 June 1996Talk PDF
- Berndsen K (1995): “Selektiver Lärmschutz für Zahnärzte. Zahnärzte sind beruflich extremen Geräuschen ausgesetzt.” In: DZW, Die Zahnarztwoche 13/95, correction in 14/95Trade journal
- Berndsen K (1995): “Gefährlicher Lärm in der Zahnarztpraxis. Lärmschutz für Zahnärzte.” In: ZWR, Das Deutsche Zahnärzteblatt 7/8 1995, vol. 104, pp. 586-589Journal PDF
- Berndsen K, Grebe RB (1992): “Sonderpädagogischer Förderunterricht mit neuen Technologien bei Kindern und Jugendlichen mit Sprachbehinderungen.” In: SOPÄD FuNT Sonderpädagogik. Eine schulformübergreifende Einführung in den sonderpädagogischen Förderunterricht mit neuen Informations- und Kommunikationstechnologien. Landesinstitut für Schule und Weiterbildung, Soest 1992, pp. 107-126Book chapter
- Berndsen K (1990): “Medienhandeln und Kommunikationslernen.” Verlag Peter Lang, Frankfurt am Main 1990Book
Most of these works were written or co-written by Sabine and Klaus Berndsen themselves, that is, by the people who developed the FaceFormer. Many are congress posters, abstracts or articles in trade journals without independent peer review, and most of the studies are small and have no comparison group. The peer-reviewed journal articles with a comparison group are the Hamburg study in children (2004) and the Jena study on jaw pain (2004). The remaining works show what was being worked on; they do not show established effects.
Check
How to test a training method fairly
A training method works through learning. It changes a coupled control pattern, and the effect can show up in very different complaints. Studies tailored to a single symptom and a few nights capture this poorly.
Was the training done correctly?
The effect comes about through learning. A study must document whether and how correctly the training was carried out. Otherwise it is testing a mixture of training and non-training.
Measuring intermediate steps
Nasal breathing, lip closure, swallowing pattern and head balance change before the symptom does. Without these intermediate steps, an improvement cannot be attributed to the training.
Enough time
A pattern that has become ingrained over years does not change in a few weeks. Observation must cover several months.
Passive aids
Splints, positioning pillows or breathing masks change the geometry of the airway, the position of the lower jaw or the sleeping position for as long as they are used. This can be effective and, in individual cases, necessary. The control behind it remains, which is why they have to be used on an ongoing basis.
Active training
The training addresses the control itself: breathing, swallowing and head balance are practised in the same sequence until they run without conscious attention. This takes time and cooperation, but it targets the pattern rather than the support.
The absence of a study does not mean that a connection does not exist. It means that it has not been tested.
We do not claim any effect that has not been studied, and we consider such studies necessary. A study funded by the manufacturer would not be independent. We are happy to support independent studies with devices and an introduction to correct use, without any influence on how they are carried out or evaluated.
Fundamentals
What the model is based on
FaceFormer therapy draws on findings that other research groups have obtained independently of the FaceFormer. None of these works examined the device or the training. They describe the physiology of the nose, tongue, swallowing, head balance and learning on which the model draws.
For each work, one sentence states what it shows. The links lead to the original source.
Nose and breathing
- Lundberg JO, Farkas-Szallasi T, Weitzberg E et al. (1995). High nitric oxide production in human paranasal sinuses. Nature Medicine 1(4):370–373. DOI
A large amount of nitric oxide is produced in the human paranasal sinuses, a gas that reaches the airways with nasal breathing. - Zipperer A, Konnerth MC, Laux C et al. (2016). Human commensals producing a novel antibiotic impair pathogen colonization (lugdunin, University of Tübingen). Nature 535:511–516. DOI
A natural inhabitant of the nose produces a previously unknown antibiotic substance, lugdunin, which makes it harder for pathogens to colonise. - Torres Salazar BO, Dema T, Schilling NA et al. (2023). Commensal production of a broad-spectrum and short-lived antimicrobial peptide polyene eliminates nasal Staphylococcus aureus (epifadin, University of Tübingen). Nature Microbiology. DOI
Another nasal bacterium produces epifadin, a short-lived substance that suppresses Staphylococcus aureus in the nose. - Harvold EP, Tomer BS, Vargervik K, Chierici G (1981). Primate experiments on oral respiration. American Journal of Orthodontics 79(4):359–372. PMID 6939331. PubMed
Animal study in primates on forced mouth breathing and its consequences for the development of the face and jaw. - Abdel Hadi LA, Aburahma SK (2022). Effect of mouth breathing on dentofacial morphology, systematic review. Full text
Systematic review of the relationship between mouth breathing and the shape of the teeth, jaw and face.
Tongue and swallowing
- Endo C, Sato T, Yajima T, Igarashi K, Ichikawa H (2018). Innervation of the human incisive papilla. Cells Tissues Organs 205(2). DOI
Describes the nerve supply of the incisive papilla, the small elevation behind the upper front teeth. - Caltenco HA, Lontis ER, Boudreau SA et al. (2012). Tip of the tongue selectivity and motor learning in the palatal area. IEEE Transactions on Biomedical Engineering 59(1):174–182. DOI
Examines how precisely the tip of the tongue can reach target points on the palate and how this improves with practice. - Hiiemae KM, Palmer JB (2003). Tongue movements in feeding and speech. Critical Reviews in Oral Biology & Medicine 14(6):413–429. PMID 14656897. PubMed
Overview of tongue movements during eating and speaking. - Gilbert RJ, Napadow VJ, Gaige TA, Wedeen VJ (2007). Anatomical basis of lingual hydrostatic deformation. PMID 18025008. PubMed
Describes how the fibre structure of the tongue makes its wide variety of shape changes possible. - Jean A (2001). Brain stem control of swallowing: neuronal network and cellular mechanisms. Physiological Reviews 81(2):929–969. DOI
Overview of how a network of nerve cells in the brainstem controls swallowing.
Jaw, head balance, craniomandibular dysfunction (TMD)
- Rocabado M (1983). Biomechanical relationship of the cranial, cervical, and hyoid regions. PMID 6586872. PubMed
Describes the biomechanical relationships between the skull, cervical spine and hyoid region. - Manfredini D et al. (2017). Temporomandibular disorders and dental occlusion. A systematic review of association studies: end of an era? PMID 28600812. PubMed
Systematic review of how closely jaw joint complaints are related to the way the teeth bite together. - Hansraj KK (2014). Assessment of stresses in the cervical spine caused by posture and position of the head. PMID 25393825. PubMed
Calculates how the load on the cervical spine increases the further the head is tilted forward. - Korbmacher H, Kahl-Nieke B (2005). Orofacial myofunctional disorders in children with asymmetry of the posture and locomotion apparatus. Int J Orofacial Myology 31:26–38. PMID 16739710. PubMed
Examines how often orofacial functional disorders are also present in children with asymmetries of posture and the musculoskeletal system.
Myofunctional therapy and sleep
- Camacho M, Certal V, Abdullatif J et al. (2015). Myofunctional therapy to treat obstructive sleep apnea: a systematic review and meta-analysis. Sleep 38(5):669–675. DOI
Systematic review and meta-analysis of myofunctional therapy for obstructive sleep apnoea. The exercise programmes studied were different from FaceFormer therapy; the results cannot be transferred. - Guilleminault C, Huang YS, Monteyrol PJ et al. (2013). Critical role of myofascial reeducation in pediatric sleep-disordered breathing. PMID 23522724. PubMed
Describes the role that targeted training of the mouth and facial muscles plays in children with sleep-related breathing disorders.
Learning and neuroplasticity
- Boutin A, Doyon J (2020). A sleep spindle framework for motor memory consolidation. PMID 32248783. PubMed
Theoretical framework for how sleep spindles, brief activity patterns during sleep, consolidate learned movements in memory. - Van den Steen L, Vanderwegen J, Guns C et al. (2019). Tongue-strengthening exercises in healthy older adults. PMID 30209561. PubMed
Examines strengthening exercises for the tongue in healthy older people.
An honest assessment
What is evidenced and what remains a model
There are no large, blinded studies with several comparison groups and predefined outcome measures on FaceFormer therapy. That is the current state, and we state it as it is.
The building blocks are evidenced
Basic research has described that breathing and swallowing are controlled in closely coupled ways in the brainstem, that the lips, tongue and palate are densely supplied with nerve endings, and that practice changes motor control in the oral cavity. For children with functional disorders in the oral cavity, there is also the Hamburg study.
The whole is a working model
That these building blocks combine into a therapeutic principle that guides breathing, swallowing and head balance back into their reference order together is a hypothesis. Klaus Berndsen calls it triadic pattern regulation. It can be tested; it has not yet been tested.
Our own terms
The Cranio-Cervical Functional Model (CCFM) and the Cranio-Cervical Dysfunction Syndrome (CCDS) were developed by Sabine and Klaus Berndsen. They organise findings that often occur together. They are not listed in any international classification, and the CCDS is not a diagnosis in the medical sense.
Observation is not evidence
Many courses observed in practice are encouraging. They are valuable because precise research questions arise from them. They do not replace a controlled study.
What is still missing
Data over several years, comparisons with other methods and larger follow-up studies with predefined measures such as nasal breathing, lip closure and swallowing pattern.
Not the only cause
Genetics, environment, infections and living circumstances carry their own weight. Not every complaint has a component in the triad, and the triad does not replace specialist treatment.
We still consider the training worthwhile. Breathing, swallowing and head balance are at the start of many causal chains, and many complaints can be connected with them. What comes of it depends on many factors. The training brings natural functions back to their original pattern, so you are not doing anything wrong.
For professionals
Original sources, the method in the seminar
For participants in our seminars, we have put together a source package with a reference list, the full text of the Hamburg dissertation and the conference contributions. The training courses cover assessment, how the exercises are structured and the limits of the method.
Questions
Frequently asked
Is the effect of FaceFormer therapy scientifically established?
In part. For children and adolescents with functional disorders in the oral area, there is a randomised study over six months showing clear differences in mouth breathing and swallowing pattern. For most other areas of application, there are pilot data, case reports and clinical experience, but no controlled studies.
Why aren’t there more large studies?
Large studies with several comparison groups and follow-up over years exceed what small-scale research embedded in a practice can do. Klaus and Sabine Berndsen therefore work mainly translationally. They combine findings from basic research with observations of patients. This does not replace formal proof, but it provides the questions that further studies should examine.
Do the Hamburg results also apply to adults?
Not automatically. The study examined children and adolescents aged between 3.9 and 16.9 years. The figures cannot be transferred to adults or to individual complaints such as snoring or jaw joint problems.
Where can I find the original studies?
The Hamburg dissertation is freely available as full text from the University of Hamburg. Journal articles can be accessed via the links in the sources, some only through the publisher.
Sources
- Schwan M (2007): Evaluation einer innovativen apparativen Therapie zur Harmonisierung der orofazialen Muskulatur und Funktion. Eine prospektive randomisierte klinische Studie bei Kindern. Doctoral thesis, Department of Orthodontics, University Medical Centre Hamburg-Eppendorf (Prof. B. Kahl-Nieke). Full text
- Korbmacher HM, Schwan M, Berndsen S, Bull J, Kahl-Nieke B (2004): Evaluation of a new concept of myofunctional therapy in children. International Journal of Orofacial Myology 30:39–52. PMID 15832861. PubMed
- Kahl-Nieke B, Korbmacher H, Berndsen S et al. (2003): Evaluation of a new concept of functional therapy supporting orthodontic treatment. 79th Congress of the European Orthodontic Society, Prague.
- Herget A, Ohlendorf D, Kopp S (2012): Auswirkungen der Face-Former-Therapie auf die Oberkörperstatik. Manuelle Medizin 50:204–210. DOI 10.1007/s00337-012-0911-x. DOI
- Booth D, Kinzinger G (2021): Behandlung eines offenen Bisses mit einer Kombination aus Highpull-Headgear und Face Former. Kieferorthopädie 35 (Quintessenz).
- Al-Nachef C, Doll GM, Sergl HG (2001): Zur Wirksamkeit eines neuen myofunktionellen Trainingsgerätes “FaceFormer”. In: Tränkmann J, Lisson J (eds.): Prävention und Frühbehandlung. Taufkirchen, pp. 62–69. ISBN 3-00-008757-5.
- Herget A, Ohlendorf D, Berndsen K, Kopp S (2009): Die Face-Former-Therapie und die Auswirkungen auf die Haltung der Wirbelsäule. Poster, Annual Meeting of the German Orthodontic Society (Deutsche Gesellschaft für Kieferorthopädie).
- Berndsen K, Berndsen S (2023): FaceFormer-Therapie. Neurophysiologische Kausaltherapie bei CCDS. In: Langenhan J, Kopp S (eds.): Zahnärztliche Schlafmedizin, Thieme, pp. 285–302. DOI 10.1055/b-006-163270.
- Berndsen K, Berndsen S (2023): FaceFormer Trainings-Therapie. Manual zur Methodik. Self-published (2nd edition 2024).
- Berndsen K (in preparation): Trust the Triad. Chapters “Triadic pattern regulation” and “Conclusion” (evidence base).
- Further publications: isst-unna.de, List of scientific publications. Foundational studies with links in the “Foundations” section.
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Knowledge on this topic
Where to go next
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The free FaceFormer app guides you through the basic exercises, counts along and reminds you of your sessions. If you wish, a practice from the practitioner directory can support you.
FaceFormer ZERO + ONE
Both material hardnesses for getting started, day and night. The set for adults.
FaceFormer ZERO
The softer FaceFormer for getting started, for children and for the night.
FaceFormer ZERO Children’s Set
ZERO with hygiene box, plush bag and success book with stamp.
FaceFormer training aims to restore the physiological setting of the basic functions of breathing, swallowing and head balance, with lip closure and the tongue reference position, thereby creating the conditions under which symptoms can improve. It does not replace a medical assessment. You can find practitioners near you in the practitioner directory.