The use of a simple functional appliance as an adjunct to fixed appliance orthodontic treatment

Three clinical case studies are presented to demonstrate the use of a simple functional appliance in orthodontic situations not covered by traditionally-accepted dental and skeletal indications. In each case, the appliance was used to reduce the severity of the malocclusion, before a routine fixed-appliance detailing phase.     

Use of articulators in the United Kingdom by consultant orthodontists in planning orthognathic surgery

This questionnaire survey aimed to investigate articulator use in orthognathic surgical planning by consultant specialists in the United Kingdom (UK). A total of 205 questionnaires was sent to all consultant orthodontists in the UK. One hundred thirty questionnaires were completed, representing a 63.4% response rate. Consultants had been in their post for a median of 10.5 years (range 0 to 30 years) with a mean of 11.3 (SD 8.4) surgical cases per year. When asked which cases had been planned on a semiadjustable articulator, two thirds of consultants (67.7%) planned maxillary single-jaw procedures, 45.4% planned mandibular single-jaw procedures, and 77.7% planned bimaxillary procedures. While 98.5% of consultants reported access to at least one type of articulator, 14.6% of maxillary single-jaw and 5.4% of bimaxillary surgery was not planned on any articulator. Twice as many consultants who had been in their post fewer than 11 years had been trained on a semiadjustable articulator, compared to those who had more than 11 years of experience. Semiadjustable articulators were the most popular for planning orthognathic surgery. Consultants with less than 11 years of experience completed more surgical cases each year and were more likely to have been trained on a semiadjustable articulator than consultants with more than 11 years of experience. However, no link exists between the age of the consultant and the type of articulator selected for planning; this suggests that more mature consultants have received further training on contemporary articulator systems since receiving their accreditation.     

改良式摆型矫治器配合治疗伴牙列拥挤的功能性前牙反[牙合]

目的评价改良式摆型矫治器与固定矫治器结合治疗恒牙早期功能性反[牙合]伴牙列拥挤的治疗效果。方法选择恒牙早期功能性反[牙合]且上颌牙列拥挤的患者10例,上颌采用改良式摆型矫治器远中移动第一磨牙,同时下颌戴用活动式全牙列骀垫打开咬合,最后全口粘结固定矫治器完成治疗。分别于矫治前（T1）、改良式摆型矫治器治疗后（T2）、固定矫治器治疗后（T3）拍摄正中[牙合]位的X线头颅侧位定位片,进行头影测量分析。结果10例患者经改良式摆型矫治器治疗后上颌第一磨牙平均远中移动3．78mm,远中倾斜3．84°,上前牙平均唇向倾斜移动1．52mm;固定矫治器治疗后前牙反[牙合]解除,牙齿排列整齐,前牙覆[牙合]覆盖正常。结论改良式摆型矫治器能有效地远中移动上颌磨牙;与固定矫治器结合治疗恒牙早期功能性反[牙合]伴牙列拥挤疗效满意。     

Short term clinical effectiveness of a 0.07% cetylpyridinium chloride mouth rinse in patients undergoing fixed orthodontic appliance treatment

Objectives

To test the short term clinical effectiveness of commercially available 0.07%.cetylpyridinium chloride mouth rinse in patients undergoing fixed orthodontic treatment as compared to a placebo mouth rinse and patients using toothbrush and toothpaste.

Method

Forty-five subjects for this double blind study were assigned randomly into three groups of 15 each. Gingival inflammation, plaque accumulation, and bleeding on probing, were recorded at baseline (10 days after prophylaxis), and at the end of one month in all the three groups and compared.

Results

Paired t test showed significant differences in bleeding index for pre and post treatment recordings for cetylpyridinium group. Modified gingival index showed no significant difference in the cetylpyridinium group. For plaque index significant difference was found for cetylpyridinium and control groups.

Conclusion

Cetylpyridinium mouth rinse 0.7% was found to be effective in reducing the bleeding and plaque index scores. It was not effective in reducing the modified gingival index scores. Cetylpyridinium mouth rinse 0.07% improves the oral hygiene of orthodontic patients when used as an adjunct to normal oral hygiene measures.     

A cephalometric comparison of treatment with the Twin-block and stainless steel crown Herbst appliances followed by fixed appliance therapy.

This study compared the effects of 2 treatment protocols for correcting Class II disharmony. The first phase of treatment consisted of functional jaw orthopedics with either the Twin-block or the stainless-steel crown Herbst appliance; the second phase consisted of comprehensive fixed-appliance therapy in both protocols. Each of the 2 samples comprised 28 consecutively treated Class II patients. The mean age at the start of treatment was approximately 12 years, and the mean age at the end of the treatment was approximately 14.5 years in both groups. The duration of the treatment phase with the functional appliance was approximately 13 months, and the duration of fixed-appliance therapy was approximately 15 months in both groups. The sex distribution was identical in the 2 groups. Lateral cephalograms were analyzed at the start of treatment (T1) and at the end of the overall treatment protocol (T2). Nonparametric statistics were used for comparisons of starting forms and of the T1-T2 changes between the 2 treatment groups. The stainless-steel crown Herbst appliance and the Twin-block appliance produced very similar therapeutic modifications in Class II patients, although the Twin-block group exhibited almost 2 mm greater correction of the maxillomandibular differential than did the crown Herbst group. The treatment effects of both protocols led to a normalization of the dentoskeletal parameters at the end of the overall treatment period. Twin-block therapy also induced a greater increase in the height of the mandibular ramus (posterior facial height). Overall, only minor differences were detected in the treatment and posttreatment effects of a compliance-free (crown Herbst) and a noncompliance-free (Twin-block) appliance for correcting Class II disharmony.     

An audit of 'early debond' cases in the national outcomes audit of patients treated with upper and lower fixed appliances by Consultant Orthodontists in the UK

OBJECTIVE: To audit the outcomes of the 'early debond' cohort of the national outcomes audit carried out by the Consultant Orthodontic Group of the British Orthodontic Society. DESIGN: Multi-centre, retrospective national audit. STANDARDS: Seventy-five per cent of cases should exhibit a reduction in PAR greater than 70% with 3% or less with a PAR score reduction of less than 30% (i.e. worse/no different). METHOD: Analysis of consecutively completed cases treated by upper and lower fixed appliances that were noted by the operator as having discontinued treatment early. MAIN OUTCOME MEASURES: Incidence of early debond, PAR outcome. RESULTS: The 'early debond' cohort constituted 11% of the total 823 patients and fell below previously published standards for orthodontic treatment outcomes. They were less likely to be in the 'greatly improved' category, more likely to be in the 'improved' category and only slightly more likely to be in the 'worse/no different' category. There was a 67% reduction in PAR and 50% exhibited a reduction in PAR greater than 70%, with 6.5% having a reduction in PAR score lower than 30%. CONCLUSION: Discontinuation of orthodontic treatment is associated with a reduced level of treatment outcome.     

Predicting the outcome of twin block functional appliance treatment: a prospective study

A prospective study was undertaken to investigate the relationship between various measured pre-treatment parameters and the reduction in overjet achieved when using a twin block functional appliance. Forty-three subjects were fitted with a twin block functional appliance, and a number of pre-treatment clinical and radiographic morphological features were recorded. The functional appliance wear was monitored for 6 months and any individual who did not co-operate with wear was excluded from the subsequent analysis. Multiple regression analysis with stepwise inclusion was used to relate the percentage reduction in overjet achieved by functional appliance wear to any of the pre-treatment parameters. The data from 22 individuals was included in the final analysis. The overbite and SNB angle were the most strongly related variables to percentage reduction in overjet. These were then used to construct a predictive equation for the expected percentage reduction in overjet: Percentage reduction in overjet in 6 months = 132 + 4.9x1 - 1.4x2, where x1 = overbite and x2 = SNB. The pre-treatment overbite was, in isolation, the most influential feature in predicting the percentage of overjet reduction.     

改良固定反式TBA联合前牵矫治前牙反he

目的：评价改良固定反式双阻板矫治器(Twin-block appliance，TBA)联合前牵治疗AngleⅢ类骨性前牙反he的临床效果。方法：应用TBA联合前牵矫治骨性前牙反he15例，对治疗前后临床表现及X线硬组织测量进行分析，并与前牵组进行比较。结果：经过3～5个月的治疗，患者侧貌外型明显改善，反覆盖反覆he纠正。结论：反式TBA联合前牵引是矫治前牙反he的理想装置，对上下颌骨作用均较大。     

The use of myofunctional appliances in the UK: a survey of British orthodontists.

A questionnaire was sent out to members of the British Orthodontic Society in an attempt to establish how myofunctional appliances are currently used in the UK and to attempt to explain the differences between provider groups. This article reports the findings of this survey and that, of all the appliances currently available, British orthodontists prefer to use the Twin Block appliance. Furthermore, most of the sample questioned felt that the laboratory cost of many myofunctional appliances meant their provision under the General Dental Service was not practical.     

Simultaneous functional and fixed appliance therapy for growth modification and dental alignment prior to prosthetic habilitation in hypohidrotic ectodermal dysplasia: a clinical report

This clinical report describes the simultaneous use of functional and fixed appliances to modify the pattern of dentofacial development and align teeth in preparation for prosthodontic habilitation of a growing child with hypohidrotic ectodermal dysplasia. The treatment objective was to create a more favorable starting point for the prosthodontic phase of habilitation by improving the sagittal and vertical skeletal relationships and facial esthetics. This was accomplished through growth modification with functional appliances conducted simultaneously with eruption of maxillary and mandibular molars, dental arch expansion, alignment, and space management using fixed orthodontic appliances. Orthodontic retention was accomplished by means of removable partial dentures. A second phase of orthodontics conducted closer to the age of skeletal maturation will aim at definitive tooth alignment in preparation for dental implant-supported restorations.     

Impact of the first eight months of orthodontic treatment with a fixed appliance on the families of adolescent patients

Objective:To evaluate the impact of the first 8 months of orthodontic treatment with a fixed appliance on the families of adolescent patients and to examine the evaluative properties of the Family Impact Scale (FIS).Materials and Methods:The study involved a sample of 94 parents/caregivers of adolescents undergoing orthodontic treatment with a fixed appliance. The participants were asked to answer the Brazilian version of the FIS before treatment (T1) and 8 months after the bonding of the fixed appliance (T2). Statistical analysis was carried out using the Wilcoxon signed rank test and the Bonferroni correction for the overall score and FIS subscales. Responsiveness of the measure and the minimal clinically important difference (MCID) were also assessed.Results:Among the 94 participants initially admitted to the present study, two were excluded as a result of treatment dropout and failure to return the second questionnaire. Thus, a sample of 92 parents/caregivers participated (response rate: 97.8%). Among the 92 participants, 70 were the mothers of patients, 16 were fathers, and six were other family members. Statistically significant improvements were found in the overall score (P < .001) as well as in both parental activity and parental emotions subscales (P < .001). The reductions in scores were associated with effect sizes showing moderate clinically meaningful changes in the overall FIS and in the parental/family activity, parental emotions, and family conflict subscales. The MCID was 2.66 for the overall FIS.Conclusion:The first 8 months of orthodontic treatment with a fixed appliance had a positive impact on the families of adolescents.     

The influence of stabilisation appliance therapy and other factors on the treatment outcome in patients with temporomandibular disorders of arthrogeneous origin.

The aim of this study was to investigate if the difference in treatment outcome between patients provided with a stabilisation appliance and a control appliance was due to the treatment and/or other factors in patients with temporomandibular disorders (TMD) of arthrogeneous origin. Sixty patients were assigned to two equally sized groups: a treatment group, treated with a stabilisation appliance, and a control group given a control appliance. Thirteen possible background variables for the treatment outcome were correlated to changes in severity of temporomandibular joint (TMJ) pain on a verbal scale in the two patient groups. The logistic regression analyses revealed that, after correcting for the background variables, stabilisation appliance treatment was a strong explanatory factor for a positive treatment outcome, with a significance of P = 0.0013 compared to patients belonging to the control group. Background variables of significant importance for the treatment outcome were male sex (positive) (P = 0.0268), and severe or very severe TMJ pain (negative) (P = 0.0034). These findings indicate that not only the treatment with a stabilisation appliance but also sex and the intensity of the TMJ pain before treatment might influence the treatment outcome in patients with TMD of arthrogeneous origin.