Functional Appliance Treatment Research Articles

Comparison of muscle response in patients treated with rigid and flexible fixed functional appliances.

The present study was undertaken to evaluate and compare muscle activity after the treatment with rigid and flexible fixed functional appliance. The study was conducted on 14 skeletal Class II malocclusion patients in the age group of 13-17 years, divided into two groups comprising 7 patients in each group. Group I was treated with a rigid fixed functional appliance (MPA IV), and Group II was treated with a flexible fixed functional appliance (Churro Jumper). Masseter and anterior temporalis muscle activities were recorded using needle electromyography (EMG) at postural rest, saliva swallowing, and clenching during five intervals (T0 to T4) during fixed functional appliance treatment. Unpaired t-test, Mann-Whitney U, and Wilcoxon sign rank test were applied for statistical analysis, and a P value of <.05 was considered statistically significant. Group I (MPA IV) showed a significant increase in EMG activity during postural rest position (P = 0.003, P = 0.001), swallowing (P = 0.013, P = 0.005), and clenching (P = 0.001, P = 0.002) in masseter and anterior temporalis muscle, respectively. Group II (Churro jumper) also showed a significant increase in EMG activity during postural rest position (P = 0.000, P = 0.000), swallowing (P = 0.001, P = 0.000), and clenching (P = 0.001, P = 0.000) in masseter and anterior temporalis muscle, respectively. Both rigid (MPA IV) and flexible (Churro Jumper) fixed functional appliances caused a significant increase in EMG activity of masseter and anterior temporalis muscle during postural rest position, swallowing, and clenching in 6 months of the observation period, but the flexible appliance (Churro Jumper) showed more significant increase.

The use of functional appliances for class II malocclusions: a nation-wide cross-sectional survey of orthodontists in Australia

Abstract Background If detected at the appropriate age, a Class II malocclusion can be improved or camouflaged by utilising functional appliances to manipulate a child’s skeletal growth spurt to advantage. Aim The aim of this study was to evaluate the use of functional appliances by orthodontists currently practising in Australia. Methods This was a cross-sectional study design that utilised a nation-wide online survey consisting of 22 questions related to: clinic/clinician demographics, appliance preference and treatment timing, the provision of first phase functional appliance treatment and treatment protocols for removable functional appliance therapy. The survey was distributed via the Australian Society of Orthodontists to its 428 members. Statistical analysis was conducted through Qualtrics XM® data analysis software, version 04/30/2023 (Qualtrics XM®, Provo, UT, USA. https://www.qualtrics.com) with a significance level set at P &lt; 0.05. Results A total of 166 responses were received representing a response rate of 38.8%. Ninety-nine per cent of survey respondents (n = 139) reported prescribing functional appliances to correct a Class II malocclusion with the Twin Block appliance as the most-commonly prescribed. It was found that a two phase, removable functional appliance followed by fixed appliances was the preferred choice for Class II treatment when utilising a functional appliance. The most common age to commence functional appliance therapy was between 10 and 12 years, incorporating 9 to 12 months of full-time wear, followed by a 4- to 6-month retention period. There appears to be a clear relationship between an orthodontist’s preferred choice of Class II treatment when employing functional appliances and their orthodontic training institution. Conclusion It is common practice for orthodontists in Australia, to utilise functional appliances in the management of a Class II malocclusion. However, the prescribing patterns for functional appliance therapy are not uniform. Variations appear evidenced-based depending on the practice location and the institution from which the orthodontist graduated.

Growth Evaluation After Costochondral Graft Combined With Functional Appliance in Children With Temporomandibular Joint Ankylosis.

The treatment of temporomandibular joint (TMJ) ankylosis in children is a great challenge for surgeons. Costochondral graft (CCG) is a common method of reconstructing the TMJ in children. However, the growth pattern of CCG is unpredictable. In this study, we introduced a surgical-orthodontic approach and evaluated the growth results of the mandible and maxilla in children with TMJ ankylosis through 3-dimensional computed tomography measurements. A prospective cohort study was conducted on child patients diagnosed as having TMJ ankylosis between September 1, 2018 and June 1, 2020. Computer-aided virtual mandibular position guided the CCG, and removable functional appliance was used after surgery. The maximal incisal opening (MIO), the maxilla height, and the length of mandibular ramus were determined. Paired t test was performed to analyze the differences among various stages. Six patients (3 females, 3 males; aged 6-9y) were included in this study. MIO was 12.4mm before surgery and improved to 36.8mm after 42.8 months' follow-up. Mandible length increased by 5.1mm in the affected side and by 5.3mm in the unaffected side, without significant difference. The affected maxilla height increased by 6.7mm, which was more than 5.0mm in the unaffected side. In conclusion, continued growth of mandible and maxilla can be achieved through CCG combined with functional appliance treatment for children TMJ ankylosis.

Three-dimensional spatial analysis of temporomandibular joint in adolescent Class II division 1 malocclusion patients: comparison of Twin-Block and clear functional aligner

BackgroundOur study aimed to use three-dimensional (3D) spatial morphological measurement methods to compare the influence of Twin-Block and clear functional aligners on the temporomandibular joint (TMJ) of adolescent Class II division 1 malocclusion mandibular retraction patients. We also aimed to explore the similarities and differences in the effects on the TMJ upon using Twin-Block and clear functional aligner.MethodsCone-beam computed tomography (CBCT) data of 49 patients with Class II division 1 malocclusion (Twin-Block group: 24; clear functional aligner group: 25) were collected before and after functional orthodontic treatment, and a 3D model of the TMJ was reconstructed using MIMICS 21.0 software. Eighteen measurement parameters, including the anterior, superior, and posterior joint spaces, were measured and compared using the 3D model.ResultsAfter the two groups underwent functional appliance treatment, the height, volume, and surface area of the condyle, length of the mandibular ramus and mandibular length increased; The retro-displaced condyle moved to the middle position of the articular fossa, while the rest of the condylar position did not change significantly. Remodeling of the articular fossa after treatment was not evident. The superior joint space of the clear functional aligner group increased, but there was no significant change after Twin-Block appliances treatment.ConclusionsBoth appliances promote condylar growth and sagittal and vertical development of the mandible in adolescent Class II division 1 malocclusion mandibular retraction patients. The length of the mandibular ramus showed a more significant increase following treatment with the Twin-Block appliances than with clear function aligners.

Vertical effects of cervical headgear in growing patients with Class II malocclusion: a systematic review and meta-analysis.

Cervical headgear (cHG) has been shown to be effective in Class II correction both with dental and orthopaedic effects but has traditionally been associated with vertical adverse effects in terms of posterior mandibular rotation. To assess the treatment effects of cHG treatment in the vertical dimension. Unrestricted literature search of five databases up to May 2023. Randomized/non-randomized clinical studies comparing cHG to untreated controls, high-pull headgear (hp-HG), cHG adjuncts, or other Class II treatment alternatives (functional appliances or distalisers). After duplicate study selection, data extraction, and risk-of-bias assessment according to Cochrane, random-effects meta-analyses of mean differences (MD)/standardized mean diffences (SMD) and their 95% confidence intervals (CIs) were performed, followed by meta-regressions, sensitivity analyses, and assessment of certainty on existed evidence. Two randomized/16 non-randomized studies (12 retrospective/4 prospective) involving 1094 patients (mean age 10.9 years and 46% male) were included. Compared to natural growth, cHG treatment was not associated on average with increases in mandibular (eight studies; SMD 0.22; 95% CI -0.06, 0.49; P = 0.11) or maxillary plane angle (seven studies; SMD 0.81; 95% CI -0.34, 1.95; P=0.14). Observed changes translate to MDs of 0.48° (95% CI -0.13, 1.07°) and 1.22° (95% CI -0.51, 2.94°) in the SN-ML and SN-NL angles, respectively. No significant differences were seen in y-axis, facial axis angle, or posterior face height (P > 0.05). Similarly, no significant differences were found between cHG treatment and (i) addition of a lower utility arch, (ii) hp-HG treatment, and (iii) removable functional appliance treatment (P > 0.05 for all). Meta-regressions of patient age, sex, or duration and sensitivity analyses showed relative robustness, while our confidence in these estimates was low to very low due to the risk of bias, inconsistency, and imprecision. cHG on average is not consistently associated with posterior rotation of the jaws or a consistent increase in vertical facial dimensions among Class II patients. PROSPERO registration (CRD42022374603).

A service evaluation of patients requiring growth modification in a public service setting.

Aim To conduct a service evaluation of patients who had functional appliance treatment to correct Class II malocclusions in a public orthodontic clinic. To evaluate the effect of prioritisation and earlier treatment of these patients on treatment duration and patient compliance. Methodology The prioritised treatment group (PTG) had twin block appliances fitted when they were 11 or 12 years old. In comparison, the routine treatment group (RTG) had twin block appliances fitted when they were 13 or 14. Electronic patient records were screened to find a sample of 100 patients from each cohort. The number of compliance issues, functional appliance treatment duration, fixed appliance treatment duration and total treatment duration was recorded retrospectively from patient charts. Results While mean total treatment time was similar across the two cohorts, the PTG did have significantly shorter fixed appliance treatment durations than the RTG. The PTG was also found to have better compliance than the RTG. Conclusion Prioritising patients who require functional appliance treatment does not reduce total treatment duration. A correlation between earlier treatment, improved patient compliance, and a shorter course of fixed appliance therapy can be seen, which may prove clinically beneficial. Further research in this area would be valuable.

Evaluation of Effects of Bimaxillary Anchored Fixed Functional Appliance on Temporomandibular Joint and Maxillomandibular Complex in Late Adolescents: An MRI Study

Objective To evaluate and assess changes in temporomandibular joint (TMJ), dental, skeletal and soft tissue changes following bimaxillary anchored fixed functional appliance (FFA) treatment of skeletal Class II malocclusion using Magnetic Resonance Imaging. Methods The prospective single-arm clinical trial included 15 patients (8 males, 7 females; mean age 15.71 + 1.81years) with Class II Division 1 malocclusion treated with bimaxillary anchored Forsus FRD. Four miniplates were placed bilaterally in maxilla and mandible. Then Forsus FRD L pin module was attached to miniplates without levelling of the arches. Pre-treatment (T1) and post-functional (T2) lateral cephalograms and MRI of TMJ were recorded. A total of 7 parameters were used to assess TMJ in all the 3 planes using MRI. Student’s t-test was carried out to compare pre- and post-treatment-induced changes. Results The mandible significantly moved forward (SNB, 3.71 + 0.91°; SND, 3.21 + 1.25°; Pg-OLp, 2.61 + 0.66 mm, p &lt; 0.001) and there was distalizing effect on maxilla (SNA, –0.79 + 0.89°; A-OLp, –0.57 + 0.47mm, &amp;lt;0.001). Mean overjet correction of 4.43mm was achieved, of which 71.8% were skeletal changes. 65% of skeletal changes contributed to molar relationship correction. The forward positioning of mandible seems to be because of condylar and glenoid fossa remodelling, with condyle moving in anterior position within glenoid fossa (3.28 + 2.29) and articular disc moved posteriorly relative to condylar head (2.27 + 1.62°). Conclusion Significant skeletal changes and TMJ remodelling were observed with bimaxillary anchored FFA in correcting skeletal Class II malocclusion.

Effects of Two-Phase Treatment with Functional Appliances Followed by Extraction versus One-Phase Treatment with Extraction in Class II Growing Patients: A Case-Control Study.

Objectives: Fixed appliance treatment with premolar extraction is often required after functional appliance treatment to relieve crowding and improve facial aesthetics in the Asian population. This study compared the treatment efficacy of two approaches for treating Class II division 1 malocclusion: functional appliance followed by fixed appliance treatment with extraction (two-phase) and fixed appliance treatment with extraction (one-phase). Methods: Growing skeletal Class II patients with an overjet of ≥6 mm treated with two- or one-phase orthodontics were included. The two groups consisted of 29 patients (mean age = 12.55) and 30 patients (mean age = 12.72), respectively. Pre- and post-treatment cephalograms were analysed and skeletal, dental, and soft tissue characteristics were compared using independent t-tests. Treatment changes were compared within and between groups using paired and independent t-tests, respectively. Stepwise discriminant analysis was performed to identify the variables that best predicted pre-treatment group allocations. Results: At baseline, there were no significant between-group differences in age, gender, cervical vertebral maturation, or overjet. The two-phase group had greater Class II skeletal discrepancies (ANB angle and Wits appraisal). During treatment, the two-phase group showed greater improvements in intermaxillary relationship and facial convexity compared with the one-phase group (p < 0.01). Following treatment, the two-phase group had a greater L1/APog distance (p < 0.05). Facial convexity and Wits appraisal were identified as parameters significantly influencing the clinicians’ decision to use a one- or two-phase approach. Conclusions: In patients requiring premolar extraction, two-phase (vs. one-phase) treatment produced greater improvements in the intermaxillary relationship and facial convexity.

Cost-effectiveness of orthodontics: a systematic review.

Health economic evaluation is a methodology to maximize health benefits and minimize opportunity costs and is of increasing importance in informing resource allocation decisions in healthcare. This systematic review aims to assess the availability and quality of economic evaluations of any orthodontic interventions and summarize the conclusions of these studies. A thorough search of the literature was carried out including terms related to orthodontic interventions and economic evaluation between January 2000 and February 2022. MEDLINE, EMBASE, SCOPUS, Web of Science, NHS Economic Evaluation Database, and Cochrane were searched. Grey literature was searched and further hand-searching was performed on the reference lists of relevant systematic reviews. Studies on cleft lip and palate surgery and sleep apnoea were excluded due to the multi-disciplinary nature of these conditions which might alter the applicability of the result to orthodontic interventions. Two independent reviewers selected studies for inclusion. Data extraction was carried out through full text analysis of included studies by two authors. The quality of each study was assessed according to the Drummond 10-point Checklist and the National Institute for Health and Care Excellence (NICE) Quality Appraisal Checklist for Economic Evaluations. Characteristics and conclusions of included articles were descriptively summarized. Sixteen articles met inclusion criteria. Most of the included articles were trial-based studies, with only one model-based study. Orthodontic interventions assessed included crossbite correction, functional appliance treatment and orthognathic surgery. Most studies were carried out in Europe and specifically in Sweden. The quality of included studies was generally low with 69% of studies reported as having serious limitations according to the NICE Checklist. This review highlighted a lack of economic evaluations for orthodontic interventions, and limitations of existing economic evaluations. Recommendations on future research are provided. The protocol for the systematic review was registered on the NIHR Database (www.crd.york.ac.uk/prospero, CRD42021220419).

Extraction Decision and Anchorage Consideration for Fixed Functional Appliance Treatment

Extraction Decision and Anchorage Consideration for Fixed Functional Appliance Treatment

A non-cephalometric two-dimensional appraisal of soft tissue changes by functional therapy in Class II patients: a systematic review and meta-analysis.

Facial attractiveness has social, psychological, and economic repercussions. Class II malocclusions are associated with a retroposition of the mandible, facial convexity, protruded upper lip, retruded lower lip, and pronounced mentolabial fold. Functional appliances (FA) try to increase mandibular length and normalize lip position, thereby decreasing the facial profile convexity and aesthetics. The aim of this review and meta-analysis is to investigate the effects of FA on the soft tissues in a non-cephalometric two-dimensional manner. Medline (via PubMed), Embase (via Ovid), Web of Science, and Cochrane Central were used to identify studies describing the soft tissue results of FA in a non-cephalometric way. The search was conducted up to July 2021. Prospective and retrospective studies investigating the effects of FA appliances on the soft tissues, with non-ionizing, two-dimensional imaging, including an attractiveness assessment based on Visual Analogue Scale or Likert scale, were considered eligible. Data extraction was performed separately by two authors. Risk of bias was assessed using the ROBINS-I tool. From the eight eligible studies, four were included in the meta-analysis to investigate the influence of assessors on facial attractiveness scores. Age range of the included studies varied from 8 to 21 years old including 313 Caucasian patients whereof 64% females. Six out of eight studies used growing patients as treatment group and only two studies reported follow-up after the end of treatment. Overall facial attractiveness increased after treatment with FA, resulting from a decrease in facial convexity and a normalization of the lip relationship. Orthodontists score higher aesthetic improvements after FA treatment as compared to laypeople. Current evidence suggests the positive effects of FA on the facial attractiveness in growing and non-growing patients. FA normalize the lip relationship. Furthermore, they tend to decrease facial convexity and advance the chin point. More pleasing results can be expected in growing patients. Orthodontists are more generous when assessing treatment changes as compared to laypeople. PROSPERO registration (CRD42021254835).

Airway changes after fixed functional appliance treatment in children with and without morphologic deviations of the upper spine: A 3-dimensional CBCT study

Functional appliances (FA) have a positive effect on the upper airway volume and minimal cross-sectional area (MCA) in children. An association between morphologic deviations of the upper spine (MDUS) and reduced treatment response was found in appliances used to treat adults with obstructive sleep apnea. This study aimed to: (1) compare airway changes after FA treatment in children with and without MDUS and controls; (2) identify if MDUS causes a smaller upper airway. Pretreatment and posttreatment cone-beam computed tomography scans were included from 21 children with MDUS and 42 without MDUS treated with a fixed FA, along with a pair-matched control group (matched for chronological age, skeletal age, gender, and mandibular inclination) who received orthodontic treatment for minor malocclusions without an FA. The influence of MDUS on changes in upper airway volume and MCA were evaluated with 3-dimensional cone-beam computed tomography scans using standardized, previously validated methods and mixed-effects linear regression. There was a significantly increased volume and MCA in the FA groups with and without MDUS compared with control (P= 0.003 and P= 0.049) and in the FA group without MDUS compared with the MDUS group (P= 0.008 and P= 0.011) after treatment. There was no significant pretreatment difference in airway dimensions between the MDUS and non-MDUS FA groups. The airway response with fixed FA is significantly reduced in MDUS children. MDUS caused no significant pretreatment airway differences in children. However, MDUS may be important in predicting airway changes in FA treatment.

Evaluation of architectural changes in mandibular trabecular and cortical bone pattern after functional treatment

Abstract Purpose: To assess the changes in mandibular trabecular and cortical bone following functional appliance treatment through fractal dimension (FD) and cortical thickness (CorT) measurements. Material and methods The study was performed on 45 mandibular retrognathia cases. While the treatment group (T) comprised 30 patients treated using a functional appliance for one year during puberty, the control group (C) consisted of 15 patients who did not receive any orthodontic treatment due to insufficient oral hygiene. FD and CorT analyses were bilaterally evaluated for each mandible. FD measurements were performed on the condylar process, the antegonial notch, and ramus regions on panoramic radiographs. A paired t-test was applied for group analysis, before (T1) and after treatment (T2) and, correspondingly, before (C1) and after (C2) controls. In addition, an independent t-test was used to determine differences between the treatment (∆T = T2−T1) and the control group (∆C = C2−C1). Results Statistically significant differences were found in the treatment group between the initial and post-treatment FD values of the right (p &lt; 0.05) and left condyles (p &lt; 0.05), and the CorT measurements on the right (p &lt; 0.01) and the left sides (p &lt; 0.05). There was no statistically significant difference in FD parameters in the control group and a significant difference was only found in the left CorT (p &lt; 0.05). A comparison of the treatment and control groups revealed that the changes in FD and CorT measurements were not statistically significantly different between the groups (p &gt; 0.05). Conclusion: Mandibular protraction appliances do not produce trabecular bone alteration in the mandibular condyles, the antegonial notch and ramus over a 12-month time period.

Late upper airway constriction and its prevention by interceptive functional appliance therapy- A review

Introduction: Sleep-disordered breathing (SDB) is one of the poorly diagnosed disorders which affects the quality of life of patients. The SDB is a spectrum of problems ranging from simple snoring to obstructive sleep apnoea (OSA) which involves complete collapse of the pharyngeal airway passage during sleep resulting in airflow cessation and consequent arousals. A noteworthy etiological factor of OSA is mandibular retrognathism. Imaging studies on craniofacial structures in OSA patients have shown decreased oropharyngeal and hypopharyngeal depth, elongated soft palate, altered tongue posture, and increased hyoid bone-to-mandible distance. The management modalities of OSA are positive airway pressure (PAP) and oral appliance therapy. The modus operandi of mandibular advancement devices (MADs) is the same as of myofunctional therapy instituted by orthodontists for the treatment of skeletal Class II malocclusions with mandibular retrusion in growing patients. By virtue of the increase in the mandibular length and advancement in mandibular position, pharyngeal airway space is enlarged along with favorable changes in the soft palate, tongue posture, and hyoid bone position. The focus of the present review is to consolidate the available literature on the long-term effects of functional appliance treatment. It is hypothesized that interceptive functional appliance therapy in the growing stage could be a viable strategy for the prevention of OSA development during adulthood. The review also highlights the importance of the need for more studies emphasizing the long-term impact of functional treatment to establish the role of the same in reducing the OSA treatment burden during adulthood.

Masseter muscle thickness and treatment outcomes in children with Class II division 1 malocclusion.

To investigate if treatment outcome in patients with Class II division 1 malocclusion treated by a variety of approaches is affected by masticatory muscle capacity. Seventy-four children with Class II division 1 malocclusion were included in the present study. These were divided into 54 children (10.4 ± 1.6 years of age) treated with fixed appliances including headgear and/or Class II intermaxillary elastics, 12 children (9.9 ± 1.9 years of age) treated with functional appliances and 8 children treated with fixed appliances and other means of treatment. Ultrasonographic masseter muscle thickness measurements were taken before treatment, while lateral cephalograms were taken before and after treatment. Multivariate linear regression analysis was used to assess the association between masseter muscle thickness and treatment outcomes, as well as the gonial angle and treatment outcomes. In children with Class II division 1 malocclusion treated by means other than functional appliances, treatment outcome is not associated with masseter thickness. This may be the case since the application of intermaxillary forces and torque application may offset the functional component in tooth movement. Outcomes following functional appliance treatment may be partly determined by the masticatory muscles. During functional treatment, children with a weaker masticatory system show greater dentoalveolar compensation. This is however not maintained during the second phase of fixed appliance treatment.

Effects of removable functional orthodontic apparatus on mandibular condyle bone quality

Aim: This study aims to compare the impact of dynamic functional orthodontic appliances on mandibular condyle bone density in patients with Class I, Class II, and Class III malocclusion during their growth and development phases.&#x0D; Methodology: The histories of patients with three separate malocclusions who received dynamic functional orthodontic appliance treatment were analyzed in this retrospective study. Twenty-eight patients met the inclusion criteria and were divided into four groups: maxillary expansion devices (Group A), twinblock/monoblock devices (Group B), face masks (Group C), and chincups (Group D). The fractal analysis approach was used to determine the mandibular condyle bone density by analyzing panoramic films taken from the patients at the beginning (T0) and end (T1) of treatment.&#x0D; Results: In Groups A and B, the results of the mandibular condyle bone fractal analysis decreased at the end of treatment compared with the pre-treatment results (p &lt; 0.05). In Groups C and D, the post-treatment results were better than the pre-treatment ones (p &lt; 0.05).&#x0D; Conclusion: Among the different malocclusion groups, some dynamic functional orthodontic appliances (maxillary expansion and twinblock/monoblock devices) enabled an increase in bone density in the mandibular condyle, while some (face masks and chincups) decreased the density. It is important to conduct orthodontic treatment by analyzing the results obtained with the use of these appliances.&#x0D; &#x0D; How to cite this article: Yüzbaşıoğlu Ertuğrul B. Effects of removable functional orthodontic apparatus on mandibular condyle bone quality. Int Dent Res 2021;11(Suppl.1):7-11. https://doi.org/10.5577/intdentres.2021.vol11.suppl1.2&#x0D; &#x0D; Linguistic Revision: The English in this manuscript has been checked by at least two professional editors, both native speakers of English.

Comparison of oropharyngeal airway dimensional changes in patients with skeletal Class II and Class III malocclusions after orthognathic surgery and functional appliance treatment: A systematic review

ObjectiveTo compare the dimensional changes in the oropharyngeal airway in patients with skeletal Class II and Class III malocclusion before and after orthognathic surgery and treatment with a functional appliance. MethodsThe protocol was developed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols (PRISMA-P) and was registered to the International Prospective Register of Systematic Reviews (PROSPERO) under the registration number CRD42020170901. Furthermore, the reporting of the present SR was performed based on the PRISMA checklist. ResultsThe use of removable functional appliances increased the volume of the oropharyngeal airway in patients with skeletal Class II malocclusion. Furthermore, the increase in the volume of the oropharyngeal airway following the removable functional appliance treatment was more than that observed after fixed functional appliance treatment in growing patients. For patients with skeletal Class III malocclusion, who underwent the bimaxillary orthognathic surgery, resulted in no change in the dimensions of the oropharyngeal airway. ConclusionGrowing patients who receive removable functional appliance treatment have a more favorable long-term prognosis with regard to the oropharyngeal airway when compared with those who receive fixed functional appliance. Alternatively, in patients aged from (18–22) years with skeletal class III malocclusion Bimaxillary orthognathic surgery was found to be the recomended and superior method of treatment.

Dentofacial changes following treatment with a fixed functional appliance and their three-dimensional effects on the upper airway

Abstract Background Proposed skeletal changes achieved by functional appliances (FA) with reference to stable structures (structural method) have received relatively little attention compared to conventional cephalometric measurements (conventional method). Using the two methods, the aims of this study were to (1) determine the skeletal changes as a result of FA treatment; and (2) identify the skeletal changes associated with upper-airway volume and minimum cross-sectional area (MCA). Methods Pre- and post-treatment CBCT scans were selected from 73 FA treated children (37 girls and 36 boys; mean age 12.0 years) and 73 children as a control group (matched for chronological age, skeletal age, gender, and mandibular inclination) who received orthodontic treatment using only fixed appliances (no FA). Skeletal, upper-airway volume, and MCA changes were analysed by applying both structural and conventional methods. Results The FA group had significant skeletal effects compared with the control group (both methods; p = 0.04 – p &lt; 0.001). The horizontal displacement of pogonion (both methods) and the hyoid bone, together with a forward mandibular rotation (structural method), had positive effects on upper-airway volume and MCA (p &lt; 0.05). Conclusions The horizontal changes in pogonion (both methods) and the hyoid bone, as well as a forward mandibular rotation (structural method), have a strong association with changes in the upper airway. The conventional method underestimates FA treatment effects. These results may influence the management of growing class II patients with compromised upper airways.

Functional appliance treatment for mandibular fractures: A systematic review with meta-analyses.

ObjectivesMandibular collum fractures among growing patients can lead to abnormal growth, function, esthetics and ultimately quality of life. Among the proposed treatment alternatives, orthopaedic treatment with functional appliances has been suggested, with encouraging results. Aim of the present systematic review was to critically appraise existing evidence on the outcome of functional appliance treatment among growing patients with mandibular collum fractures.Materials and methodsEight databases were searched up to October 2020 for randomised and non‐randomised clinical studies assessing functional appliance treatment outcome for children with mandibular fractures. After duplicate study selection, data extraction and risk of bias assessment, random effects meta‐analyses of mean differences (MD) and their 95% confidence intervals (CIs) were performed, followed by assessment of the quality of evidence with GRADE.ResultsA total of 8 unique studies (one prospective and nine retrospective non‐randomised) with 223 children could be identified. Functional appliance treatment was associated with greater anteroposterior condyle dimensions of the injured condyle compared with the contralateral healthy condyle (3 studies; MD = 0.87 mm; 95% CI = 0.30 to 1.45 mm; p = .003). No difference was found in the mesiodistal condyle size between the injured and the contralateral healthy joint (3 studies; MD = −0.05 mm; 95% CI = −1.05 to 0.95 mm; p = .92), but collum length was smaller at the injured side compared with the contralateral one (1 study; MD = −2.89 mm; 95% CI = −5.29 to −0.49 mm; p = .02). Treatment outcome might be influenced by patient age, patient sex and severity/localisation of the fracture, but the quality of evidence for all analyses was very low due to methodological limitations leading to bias.ConclusionsWhile some evidence exists that functional appliances might lead to good clinical rehabilitation of fractured mandibular condyles, including considerable bone remodelling, available studies are small and have methodological weaknesses.

Conservative Decompression Management with Functional Appliance in Pediatric Plexiform Ameloblastoma

Ameloblastoma is an infiltrative benign neoplasm in the mandible or maxilla that is locally aggressive with rare metastasizing capacity. This lesion is the most common tumor of the odontogenic epithelium. However, its occurrence in children is low, representing only 10–15% of all reported ameloblastoma cases. In treating such benign neoplasms in pediatric patients, the preservation of vital structures such as the inferior alveolar nerve (IAN), deciduous teeth, tooth buds, and nerves with proper post-operative management to maintain normal mandibular growth is imperative. A five-year-old boy with painless swelling and displaced teeth in the right mandible was diagnosed with plexiform ameloblastoma. Instead of a radical approach, the patient was treated conservatively using decompression and routine irrigation along with long-term follow-up. Functional appliance treatment was provided using a Frankel appliance to preserve and induce normal growth of the jaw. After eight years, there was no recurrence of the ameloblastoma, and normal mandibular growth of the patient was observed. Pediatric plexiform ameloblastoma should be treated with a conservative approach considering the preservation of important anatomic structures and further mandibular growth. Moreover, functional appliance therapy should be considered as an integral part of treatment for pediatric ameloblastoma and other tumors in children to maintain and induce normal growth of the mandible.