8/3/2019 Ce 2008 m Lekic Use of Functional Appliances in Interceptive Orthodontics
1/20
Functional appliancesFunctional appliances
8/3/2019 Ce 2008 m Lekic Use of Functional Appliances in Interceptive Orthodontics
2/20
BackgroundBackground
Functional appliances are conceptually based on MossFunctional appliances are conceptually based on Mossfunctional matrix theoryfunctional matrix theory
Functional matrix theory proposes that functionalFunctional matrix theory proposes that functionalmatrices, tissues like muscles and glands influencematrices, tissues like muscles and glands influenceskeletal units such as jaw bones and ultimately controlskeletal units such as jaw bones and ultimately controltheir growththeir growth
8/3/2019 Ce 2008 m Lekic Use of Functional Appliances in Interceptive Orthodontics
3/20
Form follows functionForm follows function
8/3/2019 Ce 2008 m Lekic Use of Functional Appliances in Interceptive Orthodontics
4/20
8/3/2019 Ce 2008 m Lekic Use of Functional Appliances in Interceptive Orthodontics
5/20
8/3/2019 Ce 2008 m Lekic Use of Functional Appliances in Interceptive Orthodontics
6/20
Functional appliance typesFunctional appliance types
Orthodontic functional appliances may be active orOrthodontic functional appliances may be active orpassive:passive:
Active appliances reposition the mandible so that the condyleActive appliances reposition the mandible so that the condyle
is forced out of the glenoid fossa and this in turn is thoughtis forced out of the glenoid fossa and this in turn is thoughtto stimulate the posterior/superior growth of the condyleto stimulate the posterior/superior growth of the condyle
Passive appliances act by repositioning the musculaturePassive appliances act by repositioning the musculatureassociated with the mandible so that the jaw bone itselfassociated with the mandible so that the jaw bone itself
responds by growing to the new equilibrium positionresponds by growing to the new equilibrium position
8/3/2019 Ce 2008 m Lekic Use of Functional Appliances in Interceptive Orthodontics
7/20
Passive functional appliancesPassive functional appliances
FrankelFrankel
8/3/2019 Ce 2008 m Lekic Use of Functional Appliances in Interceptive Orthodontics
8/20
Active functional appliancesActive functional appliances
Fixed active functional appliancesFixed active functional appliances
HerbstHerbst
8/3/2019 Ce 2008 m Lekic Use of Functional Appliances in Interceptive Orthodontics
9/20
Active functional appliancesActive functional appliances
Removable active functional appliancesRemovable active functional appliances
BionatorBionator
8/3/2019 Ce 2008 m Lekic Use of Functional Appliances in Interceptive Orthodontics
10/20
Active functional appliancesActive functional appliances
Removable active functional appliancesRemovable active functional appliances
Woodside activatorWoodside activator
8/3/2019 Ce 2008 m Lekic Use of Functional Appliances in Interceptive Orthodontics
11/20
Active functional appliancesActive functional appliances
Removable active functional appliancesRemovable active functional appliances
TwinTwin--block applianceblock appliance
8/3/2019 Ce 2008 m Lekic Use of Functional Appliances in Interceptive Orthodontics
12/20
Duration and timing of wearDuration and timing of wear
Functional appliance treatment should be startedFunctional appliance treatment should be started
before the pubertal growth spurtbefore the pubertal growth spurt
This is the time when the mandible may exhibitThis is the time when the mandible may exhibitincreased growth which may be influencedincreased growth which may be influenced
Functional appliances should be worn for atFunctional appliances should be worn for at
least 10least 10--12 hours a day12 hours a day
These appliances should be worn at nighttime asThese appliances should be worn at nighttime asthis is when growth takes placethis is when growth takes place
8/3/2019 Ce 2008 m Lekic Use of Functional Appliances in Interceptive Orthodontics
13/20
Evidence of clinical effectivenessEvidence of clinical effectiveness
A Cochrane review, published in 2008, studiedA Cochrane review, published in 2008, studiedorthodontic treatment for prominent upper teeth inorthodontic treatment for prominent upper teeth inchildrenchildren
The study concentrated on primary outcomes including theThe study concentrated on primary outcomes including theprominence of upper front teeth and the relationshipprominence of upper front teeth and the relationshipbetween upper and lower jawsbetween upper and lower jaws
The secondary outcomes compared included selfThe secondary outcomes compared included self--esteem,esteem,
injury to teeth, joint problems, patient satisfaction and theinjury to teeth, joint problems, patient satisfaction and thenumber of appointments during active treatmentnumber of appointments during active treatment
8/3/2019 Ce 2008 m Lekic Use of Functional Appliances in Interceptive Orthodontics
14/20
Evidence of clinical effectivenessEvidence of clinical effectiveness
It has been shown that when front teeth stick out byIt has been shown that when front teeth stick out bymore than 3mm, they are twice as likely to be injuredmore than 3mm, they are twice as likely to be injured
The Cochrane review included eight clinical trials, basedThe Cochrane review included eight clinical trials, based
on data from 592 patients with Class II Division 1on data from 592 patients with Class II Division 1 Three trials, evaluating 432 patients, compared earlyThree trials, evaluating 432 patients, compared early
treatment (before the age of 10) with a functionaltreatment (before the age of 10) with a functionalappliance compared to no treatmentappliance compared to no treatment
It was found that functional appliance treatmentIt was found that functional appliance treatmentresulted in significant decreases in overjet and the ANBresulted in significant decreases in overjet and the ANBangleangle
8/3/2019 Ce 2008 m Lekic Use of Functional Appliances in Interceptive Orthodontics
15/20
Evidence of clinical effectivenessEvidence of clinical effectiveness
When the same patients received the second phase ofWhen the same patients received the second phase oftreatment (full fixed treatment) and when they weretreatment (full fixed treatment) and when they werecompared to patients who only received one phase ofcompared to patients who only received one phase of
treatment in adolescence, it was found that there weretreatment in adolescence, it was found that there wereno significant differencesno significant differences
Other reviews have also found that although the overallOther reviews have also found that although the overalleffect of early treatment was not significant, theeffect of early treatment was not significant, the
patients did have a milder malocclusion at the start ofpatients did have a milder malocclusion at the start offull fixed treatmentfull fixed treatment
8/3/2019 Ce 2008 m Lekic Use of Functional Appliances in Interceptive Orthodontics
16/20
Evidence of clinical effectivenessEvidence of clinical effectiveness
A systematic review by Cozza et.al. included 18A systematic review by Cozza et.al. included 18retrospective longitudinal controlled clinical trialsretrospective longitudinal controlled clinical trials
It was found that functional appliances did result in aIt was found that functional appliances did result in a
significant elongation of mandibular length (>2mm)significant elongation of mandibular length (>2mm)
It was concluded that the effect of growth modificationIt was concluded that the effect of growth modificationis the greatest during the pubertal growth peakis the greatest during the pubertal growth peak
8/3/2019 Ce 2008 m Lekic Use of Functional Appliances in Interceptive Orthodontics
17/20
What does this mean?What does this mean?
According to the evidence one should not useAccording to the evidence one should not usefunctional appliances as they are not necessarily morefunctional appliances as they are not necessarily moreefficient than one phase treatmentefficient than one phase treatment
Should we rely only on evidence in guiding our clinicalShould we rely only on evidence in guiding our clinicaldecisions?decisions?
I would argue that although sound scientific evidence isI would argue that although sound scientific evidence isthe most important aspect of clinical practice, it is notthe most important aspect of clinical practice, it is notthe only factor to considerthe only factor to consider
8/3/2019 Ce 2008 m Lekic Use of Functional Appliances in Interceptive Orthodontics
18/20
What does all this mean?What does all this mean?
Indeed, care for our patients extends beyond allIndeed, care for our patients extends beyond all
the evidence availablethe evidence available
True care also includes:True care also includes: HonestyHonesty
EmpathyEmpathy
Being genuineBeing genuine
Patient centered approachPatient centered approach
8/3/2019 Ce 2008 m Lekic Use of Functional Appliances in Interceptive Orthodontics
19/20
ReferncesRefernces
http://cache.virtualtourist.com/3709891http://cache.virtualtourist.com/3709891--Long_neck_Karen_in_Shan_state_of_BurmaLong_neck_Karen_in_Shan_state_of_Burma--Burma.jpgBurma.jpg
http://farm1.static.flickr.com/47/154578698_6011a485ce.jpghttp://farm1.static.flickr.com/47/154578698_6011a485ce.jpg http://www.sleepingtiger.org/blog/wphttp://www.sleepingtiger.org/blog/wp--
content/uploads/2007/08/maxyawns.jpgcontent/uploads/2007/08/maxyawns.jpg
http://imagecache2.allposters.com/images/146/PP0195.jpghttp://imagecache2.allposters.com/images/146/PP0195.jpg http://www.nimrodental.co.uk/appliances/media/functional5.jpghttp://www.nimrodental.co.uk/appliances/media/functional5.jpg http://coloradospringsortho.com/Web%20site/About%20braces_files/herbhttp://coloradospringsortho.com/Web%20site/About%20braces_files/herb
st_appliance.jpgst_appliance.jpg https://reader009.{domain}/reader009/html5/0507/5af0347b49a0d/5af03488b6152https://reader009.{domain}/reader009/html5/0507/5af0347b49a0d/5af03488b6152 http://www.tanos.co.uk/braces/bkb/images/activatorwoodside.jpghttp://www.tanos.co.uk/braces/bkb/images/activatorwoodside.jpg http://www.orthodentlab.com/products/images/photos/TwinBlock1.jpghttp://www.orthodentlab.com/products/images/photos/TwinBlock1.jpg
8/3/2019 Ce 2008 m Lekic Use of Functional Appliances in Interceptive Orthodontics
20/20
ReferencesReferences
Harrison JE, OBrien KD, Worthington HV. Orthodontic treatment for prominentHarrison JE, OBrien KD, Worthington HV. Orthodontic treatment for prominent
upper front teeth in children (review). The Cochrane Collaboration. John Wiley &upper front teeth in children (review). The Cochrane Collaboration. John Wiley &Sons, 2008.Sons, 2008.
Nguyen QV, Bezemer PD, Habets L, PrahlNguyen QV, Bezemer PD, Habets L, Prahl--Andersen B. A systematic review of theAndersen B. A systematic review of therelationship between overjet size and traumatic dental injuries. European Journal ofrelationship between overjet size and traumatic dental injuries. European Journal of
Orthodontics 1999;21(5):503Orthodontics 1999;21(5):503--515.515.
Pavlow SS, McGorray SP, Taylor MG, Dolce C, King GJ, Wheeler TT. Effect of earlyPavlow SS, McGorray SP, Taylor MG, Dolce C, King GJ, Wheeler TT. Effect of early
treatment on stability of occlusion in patients with Class II malocclusion. Americantreatment on stability of occlusion in patients with Class II malocclusion. AmericanJournal ofOrthodontics and Dentofacial Orthopedics 2008;133:235Journal ofOrthodontics and Dentofacial Orthopedics 2008;133:235--244.244.
Dolce C, McGorray SP, Brazeau L, King GJ, Wheeler TT. American Journal ofDolce C, McGorray SP, Brazeau L, King GJ, Wheeler TT. American Journal of
O
rthodontics and DentofacialO
rthopedics 2007;132:481O
rthodontics and DentofacialO
rthopedics 2007;132:481--489.489. Cozza P, Baccetti T, Franchi L, De Toffol L, McNamara JA. Mandibular changesCozza P, Baccetti T, Franchi L, De Toffol L, McNamara JA. Mandibular changes
produced by functional appliances in Class II malocclusion: a systematic review.produced by functional appliances in Class II malocclusion: a systematic review.
American Journal ofOrthodontics and Dentofacial Orthopedics 2006;129:599.e1American Journal ofOrthodontics and Dentofacial Orthopedics 2006;129:599.e1--599.e12.599.e12.