Two years of the blog: What do we know about functional appliance treatment?
In this post I am going to continue with the theme from last week and make this post a summary of some of the most popular and relevant posts on Class II treatment. This will be last post for a couple of weeks, as I am having a herniated cervical disc removed on later this week and I will not be allowed to type for a few weeks!
The treatment of young people with Class II malocclusion makes up about 40% of the case load of most orthodontists and we are fortunate in that it is one of the areas of orthodontic treatment that has been researched to a high level. These studies range from the “classic” early treatment RCTs to more recent trials of treatment that is carried out in adolescence. There has also been a Cochrane systematic review that has combined the findings of these studies.
I will start with a bullet point list of the current findings of this research
- There are limited advantages to providing early orthodontic treatment of Class II malocclusion. However, there may be reduction in the incidence of trauma. Early treatment could also be provided to reduce teasing and bullying, but only if a child is being teased or bullied.
- Most of the reduction in overjet is achieved by tooth movement. There is minimal skeletal change and this cannot be predicted.
- When we provide treatment in adolescence there is nothing wrong with extracting upper first premolars and reducing the overjet. This treatment is practiced all over the world in countries where functional appliances are not so extensively used.
- There are no differences in the treatment result of fixed and removable functional appliances
- There is greater patient co-operation with fixed functionals than removable
- The Twin Block is the most popular functional appliance in the UK.
- There is no point in putting on or leaving off the labial bow on a Twin Block.
- If headgear is used to “drive Class II molars distally” the average length of the “drive” is 1.6mm
- No one can grow a mandible!
I have provided many posts on this clinical problem and I have made a list of the most popular and relevant to this summary here:
This post is a summary of the most important points in our Cochrane review. I concentrated mostly on the findings that we reported on the prevention of incisal trauma. We concluded that early treatment did reduce the chance of incisal trauma, but that there was a degree of uncertainty in the data and that this should be explained to patients and their parents.
These posts were summaries of a presentation that I and Professor Jonathan Sandler did at the American Association of Orthodontists congress in May 2015. We addressed the issue of early treatment and rather bluntly stated that questions about this treatment had been answered and that there was not much to debate on this issue.
This was one of the first posts that I did that was really directed towards a clinical guide. Again, I did this with Jonathan and it includes examples of his excellent clinical work interspersed with evidence.
This was concerned with a review of a systematic review that provided more information that functional appliances do not change skeletal pattern.
This was one of my first posts and I reviewed an interesting small trial published in the excellent Orthodontics and Craniofacial research. This provided useful information on the effects of a removable functional appliance.
I hope that these posts provide a useful summary of our current knowledge on the treatment of Class II malocclusion. I also hope that in a few weeks, the blog will be back to normal. This style of post has been widely read and I will repeat them from time to time, as I think that it is useful to provide summaries.