Removable Functional Appliances Research Articles

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.

Effects of Removable Functional Appliances on the Dentoalveolar Unit in Growing Patients.

Background and Objectives: The objective of this retrospective controlled study is to compare class II growing patients who underwent treatment with two different functional appliances: the Fraenkel regulator (FR-2), utilized as the control group, and the elastodontic device "Cranium Occluded Postural Multifunctional Harmonizers" (AMCOP), utilized as the test group. Materials and Methods: The study sample consisted of 52 patients with class II division I malocclusion (30 males, 22 females, mean age 8.6 ± 1.4 years) who were treated with the two different types of appliances: Group 1 (n = 27, mean age 8 [7.00, 9.00] years, 12 females, 15 males) received treatment with AMCOP, while Group 2 (n = 25, mean age 9.2 years [8.20, 10.00], 10 females, 15 males) received treatment with FR-2. The mean treatment duration for Group 1 was 28.00 [21.50, 38.00] months, while for Group 2 it was 23.70 [17.80, 27.40] months. Cephalometric analyses were performed on lateral cephalograms taken before treatment (T1) and after treatment (T2). Results: Significant intragroup differences were observed over time in Group 1 for 1^/PP. Similarly, significant intragroup differences were observed over time in Group 2 for SNB, ANB, and IMPA. Conclusions: Both treatment modalities resulted in the correction of class II malocclusion with dentoalveolar compensation, although the treatment duration with AMCOP tended to be longer on average.

Effect of Early Orthodontic Treatment on Long-Term Stability of Class II Malocclusions

ABSTRACT Background: Class II malocclusions are a common orthodontic problem, often requiring comprehensive treatment to achieve proper occlusion and facial harmony. Early orthodontic intervention in the mixed dentition phase has been advocated to address these issues. Materials and Methods: A retrospective analysis was conducted on a cohort of 150 patients with class II malocclusions who underwent early orthodontic treatment between the ages of 7 and 10 years. The treatment included fixed or removable appliances, headgear, and functional appliances, depending on individual needs. Records of their initial malocclusion severity, treatment modalities, and long-term follow-up data (mean follow-up duration of 10 years) were collected and analyzed. Stability was assessed by evaluating overjet and overbite changes from post-treatment to the long-term follow-up. Results: The initial mean overjet and overbite values were 8.5 mm and 4.0 mm, respectively. Following early orthodontic intervention, these values were significantly reduced to 3.0 mm and 1.5 mm, respectively (P < 0.001). At the long-term follow-up, the mean overjet and overbite remained stable at 3.2 mm and 1.6 mm, respectively. Analysis revealed that 85% of patients maintained their corrected class II occlusion within clinically acceptable limits, while 15% experienced minor relapse requiring minimal additional treatment. Conclusion: Early orthodontic treatment in class II malocclusions can lead to significant improvements in overjet and overbite, and these corrections tend to remain stable over the long term.

A Three-Dimensional Evaluation of Skeletal and Dentoalveolar Changes in Growing Class II Patients after Functional Appliance Therapy: A Retrospective Case-Control Study.

Background: The aim was to assess three-dimensionally mandibular and maxillary changes in growing Class II patients treated with removable functional appliances followed by fixed appliances. Methods: Twenty-four Class II patients (age range: 9 to 14, mean: 12.1 ± 1.1 years) treated with removable functional appliances followed by fixed appliances (functional appliance group-FAG) were retrospectively selected and compared to an age-matched control group (CG) treated with fixed appliances only. To be included in the study, pre- and post-treatment CBCT scans had to be available. The CBCTs were used to analyze, in 3D, the changes following treatment and growth. Results: Before treatment, overjet (FAG: 9 mm ± 2.8 (mean ± standard deviation); CG: 4 mm ± 1.7), ANB (FAG: 5.7° ± 2.0; CG: 3.2° ± 1.4), and effective mandibular length (FAG: 113.0 mm ± 4.1; CG: 116.6 mm ± 5.9) were statistically significantly different between the two groups. After treatment, overjet (FAG: -6.8 mm ± 2.8; CG: -1.8 mm ± 1.8) and effective mandibular length (FAG: 6.3 mm ± 2.6; CG: 3.9 mm ± 2.6) statistically significantly changed. There was a significant difference in the treatment effect between the FAG and the CG in overjet, ANB, and effective mandibular length. Conclusions: The results indicate that functional appliances are effective in correcting Class II malocclusions. The growth modification in the FAG resulted in an increase in mandibular length. Yet, the final length of the mandible in the FAG was smaller when compared to the CG.

Effect of orthodontic appliances on masticatory muscle activity

There is limited and conflicting evidence regarding the impact of orthodontic appliances on masticatory muscle activity (MMA), jaw function, and oral parafunctional behaviours. Investigations in this field frequently utilise surface electromyography (sEMG) to analyse changes in muscle contractile activity. Fixed orthodontics appliances have been associated with significant reductions in MMA post archwire activation. Conversely, elevations in masseter and digastric muscle activity have been reported in response to removable functional appliances. Research into the effect of clear aligner therapy (CAT) on MMA is still in its infancy with few studies published. There is a lack of agreement on whether MMA increases or diminishes in response to CAT though there is evidence this relationship may change over time due to muscle adaptation. The impact of CAT on temporomandibular disorder (TMD) symptoms is unclear, particularly how pre-existing risk factors for TMD may alter and individual's response.

Has the COVID-19 Pandemic Affected Orthodontists' Interest in Various Orthodontic Appliances?

To determine the changes in orthodontists' interest in various orthodontic appliances during the coronavirus disease-2019 (COVID-19) pandemic. A questionnaire probing respondents' interest in orthodontic appliances and techniques, including standard buccal metal brackets, self-ligating brackets, standard ceramic brackets, lingual brackets, clear aligners, orthodontic facemasks, removable functional appliances, fixed functional appliances, orthognathic surgery, orthodontic miniscrews, and lingual retainers, was prepared using Google Forms and then sent to the Turkish Orthodontic Society to invite all members of the society to participate in the survey. Of the 1903 members invited, 230 (response rate, 12.08%) orthodontists completed the questionnaire. The respondents' interest in brackets did not change among 70% of the respondents (standard buccal metal bracket 80%, self-ligating bracket 72.2%, standard ceramic bracket 77%, and lingual bracket 76.5%). A significant difference was observed between the genders only about the interest in standard metal brackets and fixed functional appliances (p<0.05 for both). Interest in standard metal brackets decreased as respondents' work experience increased (p<0.05). The interest in self-ligating brackets was higher among respondents with 1-5 years of experience than among other respondents (p<0.05). Interest in self-ligating brackets increased more among lecturers and residents than among clinicians (p<0.05). The interest of orthodontists in clear aligners showed the highest increase during the COVID-19 pandemic among all orthodontic appliances, whereas their interest in other appliances, particularly standard buccal metal brackets, did not change.

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).

Incline Correct: A Novel Device for Accurate Inclination of Twin Block Appliances

Retrognathic mandible is the most common feature in growing children with skeletal Class II malocclusion. This does not self-correct with growth. Functional appliances are known to exert beneficial effects to improve this skeletal pattern. Among several removable functional appliances, Twin Block is the most preferred. Twin Blocks are designed for full-time wear such that maximum benefit from functional forces can be obtained. The maxillary and mandibular bite blocks occlude at a 70° angle on complete closure. It is important to angulate the inclines at exactly 70°, as an increase in this angulation will require a conscious effort from the patient. Incline Correct is designed to accurately measure and construct inclines at 70° to the occlusal plane.

Early Treatment of Class II Division 1 Malocclusions with Prefabricated Myofunctional Appliances: A Case Report

Removable functional appliances (RFA) have long been employed to address Class II malocclusion, particularly in cases involving a significant overjet, a deep bite, and molar class 2 issues. Notably divergent from RFA, myofunctional appliances (PMA) offer several distinct advantages, including applicability in noncompliant patients, adaptability in cases of dental element scarcity, suitability for allergic patients, impression-free utilization, and reduced costs. Within the array of clinical cases treated with PMA, we chose to present an intricate case involving an 8-year-old girl. Our aim was to showcase the immediate effects of PMA and to track the progress over a two-year span. Following one year of PMA treatment, substantial improvements were observed in a large overjet, a deep bite, and lip incompetence—factors often associated with elevated risks of dental trauma. These improvements not only positively impacted dental aesthetics but also engendered normalized nasal respiration and diminished palatal impingement, thereby enhancing the overall quality of life. Upon reaching the two-year mark, the clinical status pertaining to Class II malocclusion remained stable. Further treatment was advised in a subsequent phase to refine imperfections in the dental arch form. Nonetheless, comprehensive data from the prolonged follow-up of patients treated with these appliances are essential to establish robust scientific evidence concerning their long-term efficacy.

Reflection on patients’ experience with orthodontic appliances wear and its impact on oral health related quality of life: observational comparative study

BackgroundThe objective of this study was to explore and compare patient’s experience with the use of a removable functional appliance or fixed orthodontic appliance and its influence on oral health-related quality of life.Material and methodsThis clinical trial included 81 participants having Class II Division 1 and age ranging between 10 and 16 years. The participants were included in any of a three equal groups according to the set inclusion and exclusion criteria; Group 1: patients treated with a Twin-Block functional appliance; Group 2: patients treated with a fixed orthodontic appliance only; and Group 3 (control group): patients not in orthodontic treatment yet. The COHIP SF-19 was used. Patients were given the questionnaire as follows: Group 1: (1) after at least 8 months from starting treatment; (2) after completing phase 1 by 2–3 months without wearing the appliance; Group 2: (1) just before debonding; (2) after finishing the treatment by 2–3 months without any appliances; and Group 3: (1) at the patient’s first visit to the orthodontic clinic; (2) after 2–3 months from the first visit to the orthodontic clinic and before starting any treatment.ResultsThe 81 participants were 31 males and 50 females with median age of 13 years. The total COHIP SF-19 scores at baseline were 57 (49–64), 67 (63–72), and 47 (42–53) for the Twin-Block, the fixed appliance, and the malocclusion groups, respectively. Two-month mean scores adjusted to the baseline scores were 64.82 ± 1.15, 65.65 ± 1.47, and 54.45 ± 1.44 for the Twin-Block, the fixed appliance, and the malocclusion groups, respectively.ConclusionsBoth at baseline and two-months (adjusted to the baseline scores), participants in the malocclusion group showed compromised socio-emotional quality of life and reported the poorest total OHRQoL. At the baseline, better socio-emotional and total OHRQoL was reported by the fixed appliance group compared to the Twin-Block group but, after two months both groups gave similar sores. Therefore; patients’ perceptions about their experience with the orthodontic appliance might change.

3D printed removable functional appliances for early orthodontic treatment – Possibilities and limitations

The early treatment of certain malocclusions, such as class II division 1, is recommended to decrease the likelihood of upper incisor trauma. However, the lack of skilled technicians and economic constraints prevent the availability of well-known removable functional appliances. The orthodontic profession is undergoing changes, and automation may offer a solution to these challenges. This article discusses the potential for automating the production of two commonly used removable orthodontic appliances. While CAD-CAM systems have streamlined dental manufacturing, 3D printing is a popular option for certain manufacturing processes. However, the adoption of 3D printing for orthodontic devices faces hurdles, such as redesigning devices for this new manufacturing process, material considerations, and necessary certifications. To showcase the potential design and manufacturing process of 3D printed devices that fall under the category of appliances similar in type and style to FR II and Sander II, the article centers on these two widely recognized appliances. As it is currently not possible to replicate all analog features in 3D, it may be appropriate to use a more general name for the FR II and Sander II appliances. In summary, the article examines the potential and limitations of automation in orthodontic appliance manufacturing.

A comparison of children’s experiences with fixed and removable functional appliances: A qualitative study

The objective of this study was to compare children's experiences and perceptions of treatment with Hanks-Herbst (HH) and modified Twin-block (MTB) functional appliances. A pragmatic nested qualitative study was undertaken in a single hospital setting. Participants from a randomized controlled trial (International Standard Randomised Controlled Trial Number 11717011) wearing HH and/or MTB appliances were interviewed using a topic guide in a one-to-one, semistructured format. Interviews were recorded and transcribed verbatim for framework methodology analysis until data saturation was reached. Eighteen participants (HH, 7: MTB, 4; switched group, 7) were interviewed. Thirteen codes were constructed and grouped into 3 themes: (1) functional impairment and symptoms, (2) psychosocial factors and impacts, and (3) feedback on appliances and patient care. Both appliances had a negative impact on quality of life, with disruption to children's daily routines and psychological well-being. Speaking was more problematic for MTB participants, whereas HH participants encountered mastication and breakage issues. HH was preferred by most participants, as its nonremovable feature meant less managing and self-discipline was required. MTB was considered a suitable option for children with good self-discipline and who preferred a versatile lifestyle. Feedback included wishes for the availability of multiple appliance options and a degree of autonomy in decision-making processes. HH and MTB can negatively affect children's quality of life. Participants preferred HH over MTB because of its nonremovable feature, and children requested to be empowered during decision-making processes.

Orthodontic Approaches in the Management of Mandibular Fractures: A Scoping Review.

Non-surgical approaches have been proposed in the management of mandibular fractures, especially in children, but there is a lack of clear guidelines on the clinical indications of conservative approaches. The aim of this scoping review is to provide the available evidence of the role of the orthodontist in the management of mandibular fractures. The PRISMA-ScR guidelines were followed to select eligible articles from the PubMed, Scopus, and Web of Science databases according to precise inclusion criteria. The research questions were formulated as follows: "what is the scientific evidence concerning the rule of orthodontists in the management of mandibular fractures" and "the preferential use of the direct bonding technique with orthodontic brackets rather than rigid arch bars"? Seventeen articles were included. Five articles presented the use of removable acrylic splints or functional appliances, six articles concerned the employment of cemented acrylic or rigid splints, and six articles described the management of mandibular fractures in adults and children using orthodontic brackets or mini-screws. Most of these techniques have been employed in children and growing subjects, while fewer data were available regarding conservative treatments in adults. Preliminary evidence suggests that condylar and some minor parasymphyseal fractures in children may be managed with conservative approaches. In adults, minor condylar and stable body mandibular fractures with minimal displacement have been reduced similarly. However, there are no sufficient elements that could suggest the preferential use of orthodontic brackets over rigid arch bars in adults. Further randomized and non-randomized clinical trials with long follow-ups will be needed to better define the clinical indications of the orthodontic approaches in the management of mandibular fractures based on severity, location, and age.

Evaluation of Local Application of Glucosamine Sulfate and Chondroitin Sulfate on Temporomandibular Joint Response and Alleviation of Pain and Tension During the Functional Treatment of Skeletal Class II Patients: A Randomized Control Clinical Trial.

This study was conducted to assess the effects of applying a gel ofcombined glucosamine sulfate and chondroitin sulfate on the temporomandibular joint (TMJ) area in patients with skeletal Class II malocclusion treated by removable functionalappliances in terms of TMJ internal proportions, levels of pain, and tension. The study included 36 patients aged 10-13 years with skeletal Class II malocclusion due to retrusion of the mandible characterized by:4-8 degrees of the sagittal skeletal discrepancy (ANB) angle,4-7 mm of overjet,72-76 degrees of the sagittal mandibular positioning (SNB) angle, and a bone maturity stage locatedat pubertal growth spurt. Patients were distributed to the experimental group (Twin-Block appliance + Jointance®gel)or thecontrol group (conventional treatment with the Twin-Block appliance). An allocation ratio of 1:1 was employed. Pre- and post-treatment digital lateral cephalometric radiograms were taken, and the TMJ joint spaces were measured using the Viewbox software (dHAL Software, Kifissia, Greece). The pain and discomfort levels were evaluated using a questionnaire with a four-point Likert scale at three assessment times. The anterior and posterior glenoid and anterior condylar distances to the pterygoid vertical (PTV) reference planesignificantly decreased after treatment (p<.001), and the anterior joint space decreased significantly (p<.001). In contrast, the superior distance of the condyle to the Frankfort horizontal reference planeincreased significantly after treatment, and the same results were found for the posterior and superior joint spaces (p<.05). There were no significant differences between the two groups in the evaluatedlinear variables. No significant differences were found when comparing pain and tension levels between the two groups at each assessment time. A gradual decrease in pain and tension levels was observed between the three evaluation times in both groups. A combinationof glucosamine sulfate and chondroitin sulfate did not affect the temporomandibular joint spaces, pain, and tension levelsin patients with skeletal Class II malocclusions treated by removable functional appliances.

Case report on pre-orthodontic trainer in a 9-year-old child with 12 months follow up

BACKGROUND: Pre-fabricated myofunctional appliances for early orthodontic therapy have been designed specifically for the care of children at the time of mixed dentition in growing adolescents with class II division 1 malocclusions. Sophisticated prefabricated removable functional appliances known as pre-orthodontic trainers have been shown to train the orofacial musculature, thus correcting malocclusions. CASE DESCRIPTION: This is a case report of 9-year-old boy diagnosed as Class II division 1 malocclusion with protruded upper anterior teeth, constricted upper arch, space loss in lower arch and Class 2 molar relation on side. Functional treatment approach was decided using pre orthodontic T4K trainer for 12 months. At the end of this phase of treatment, improvements have been evaluated with lateral cephalograms superimposition between T1 and T2. DISCUSSION: Class II orthopaedic treatment along with the use of functional appliances by early interception assist in addressing the concerns with soft tissues, muscles, mouth respiration, and bruxism. The pre orthodontic trainer allowed a good dento-skeletal result as it had a major effect on the masticatory muscles after 12 months application which helped in obtaining a good esthetic outcome for the patient. CONCLUSIONS: The use of prefabricated functional appliance in children can be an advantageous method for early treatment of class II malocclusions with functional patterns as these devices influences masticatory muscle which help in molding the facial tissues and a viable alternative to braces for treating malocclusions in children because it stimulates the development of the dental arches transversely to stop the progression of the malocclusion. Therefore, when a lack of transverse development is discovered at a young age, this appliance is an invaluable tool for enhancing dental arch development, interceptive management of malocclusion, and oral habits.

Comparison of the effects of removable functional appliance therapy applied in pubertal and postpubertal periods: A retrospective cephalometric and fractal analyses study

In this study, we compared the effects of functional treatment with Twin-block appliance on the bony architectures of the maxilla and mandible by fractal dimension (FD) analysis, and the skeletal and dentoalveolar effects by cephalometric analysis, in pubertal and postpubertal patients with Class II malocclusion. This study comprised 60 patients who underwent Twin-block treatment. Group 1 consisted of 30 patients in the pubertal period (6 boys and 24 girls; mean age 12.27 ± 1.35 years), whereas group 2 consisted of 30 patients in the postpubertal period (6 boys and 24 girls; mean age 13.73 ± 1.51 years). FD analysis was performed on the patients before and after Twin-block panoramic and lateral cephalometric radiographs. Cephalometric analysis was also conducted. Paired and Student t tests were used to compare the parametric data, and Wilcoxon signed rank and Mann-Whitney U tests were conducted to compare the nonparametric data. SNB, Pg-N, N-Me, ANS-Me, IMPA, L1/NB, Co-Gn, Go-Gn, S-Go, Co-Go, and Go-Me significantly increased in both groups after treatment. FD values of tuber, condyle, and molar regions significantly decreased in group 1, whereas no significant differences were observed in group 2 after treatment. In the pubertal period, the Twin-block appliance resulted in skeletal correction by causing bone remodeling and reshaping in both jaws along with the dentoalveolar correction. In the postpubertal period, Twin-block had no significant effect on the bone trabecular arrangement in the investigated areas but produced cephalometric improvement to a certain extent with lower skeletal and higher dental impact.

Smart Functional Appliance - A New Approach to Improve Patient Compliance

Aim To assess the patient compliance to removable functional appliances using TheraMonreg Microsensor.Method The study sample included 15 patients requiring removable functional appliances. Microsensors were incorporated in each of them. After three weeks of appliance delivery microsensor was activated T0 and patients were not informed that they were being monitored. After the activation T0 patients were evaluated at T1 and T2 intervals at three and six week intervals respectively to gain insight into further compliance of the subjects included in the study after they were made aware of the presence of sensor during T1 appointment.Results The mean overall wear time during the aware period of 21 days was significantly higher 239.568plusmn74.79 as compared to the non-aware period 145.03plusmn58.69 and the mean difference was statistically significant P0.001. The overall mean wear time during the aware period of 21 days among female patients was relatively higher compared to male patients. However the mean difference between the gender was not statistically significant P0.25.Conclusion Patients wore the appliance for longer duration during the aware period than the non-aware period. There was no statistically significant difference between male and female patients regarding overall compliance.

Management of Lip Sucking Habit Using Combination Therapy: A Case Report

Oral habits are those that are repeatedly performed thereby causing deleterious effects on the teeth and the adjoining oral tissues. In addition to or as a substitute for thumb sucking, lip sucking or biting is often observed. An orthodontic lip bumper, designed to intercept dental and occlusal problems, is a fixed or removable functional appliance. In this case report, the habit was treated using fixed lip bumper, lip exercises and habitual therapy conducted by both parents and the child. Parental encouragement and constant reminders combined with the child’s co-operation in wearing the appliance and performing the advised lip exercises regularly are significant factors in the success of this treatment.

Camouflage of Class III Malocclusion by the Maxillary Protrusion and Retrusion Of The Mandible Using a Removable Functional Appliance Model: Case Report

The objective of this case report was to present the camouflage of class III malocclusion with functional forces using a type 4 morpho-functional inducer. Methods: The patient was a 10-year-old Latin girl. Patient in front and profile was carried out. The position of the left and right superciliary arches, the position of the orbital cavities, and the position of both labial corners were evaluated. Similarly, the type of profile of the patient, the degree of concavity, the position of the lower lip concerning the upper lip, and the position of the chin concerning the nose and forehead were evaluated. In the lateral cephalometric analysis, the sagittal position of the maxilla and mandibular was evaluated through the SNA and SNB angles as well as the level of discrepancy obtained by the ANB angle. SNA before treatment was 79 degrees and SNB 87 and ANB -3 Results: after treatment, the SNA angle varied to 86 degrees, the SNB to 84, and ANB to 3 degrees. The linear measurement between the projection of points A and B to the Frankfort plane before treatment was - 2mm and after + 2 mm. The incisive angles changed to camouflage. The upper incisor angle before treatment was 122 degrees and after 118. The lower incisor angle before treatment was 96 degrees and suffered a decrease of 1 degree. Conclusion: The treatment of class III in skeletal using morpho-functional inducers in well-diagnosed cases and young patients is an alternative that allows obtaining favorable results that allow avoiding surgery.

The Use and Preference of Functional Appliances among a Sample of Iraqi Orthodontists: A Web-Based Survey.

Objectives This study evaluated the use and preference of different types of functional appliances among a sample of Iraqi orthodontists. Materials and Methods About 200 orthodontists were invited to fill out an online Google form questionnaire with multiple-choice questions. The questions were modified from previous England and Malaysian studies. The data were tabulated as frequency tables. Results The response rate was 61%. About 91.80% of the participants used functional appliances, with the removable type being the most used. The twin block was thought to be the best compliance one but not the most used functional appliance. About 62% depended on the clinical observations in determining the growth spurt and asked patients to wear the appliance full-time except at meal time. The majority preferred a period of retention of about 4–6 months and frequent visits for adjustments. Conclusions Removable functional appliances are the most frequently used among the studied sample.