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A comparison between the AA (Andresen Activator) and the PFA (Prefabricated Functional Appliance) in experiences of discomfort with these appliances reported after 6 months of treatment. No significant difference was found between groups.
Source publication
Background: The purpose of this study was to investigate the amount of functional and social discomfort experienced after 1 and 6 months of appliance wear, comparing a slightly modified Andresen Activator (AA) and a Prefabricated Functional Appliance (PFA).
Methods: Ninety-seven patients randomly selected by lottery in an AA (40 subjects), and a PF...
Contexts in source publication
Context 1
... oral pain, however, was reported as sig- nificantly higher in the AA group than in the PFA group (Figure 4). The results after 6 months of treatment showed no statistical significant differences between groups ( Figure 5). ...
Citations
... 18 When asked directly, Scandinavian adolescents pointed out several factors that helped them persevere in treatment, namely, receiving parental support and motivation and encouragement from the dentist and developing individual strategies such as using the thumb for measuring the change of OJ and using Post-it notes as a reminder to wear the appliance. 31 The current results showed that sex had no influence on compliance, which is in line with the findings of Bartsch et al. 32 in the German population. On the other hand, Sahm et al. 33 and Schäfer et al. 19 reported German girls to be more compliant with removable orthodontic appliances, which was also expected to be observed in the current study. ...
Objectives
To determine factors that could predict Class II/1 malocclusion patient compliance during functional treatment.
Materials and Methods
The sample consisted of 77 subjects (aged 11–13 years; 47% girls) presenting with Class II/1 malocclusion. Inclusion criteria were distal molar relationship, overjet greater than 5 mm, and confirmed pubertal growth spurt. Removable functional appliances (62% Twin Block [TB], 38% Sander Bite Jumping [BJ]) with built-in maxillary expansion screws were used. Follow-up period was 1 year. Patients and parents independently filled out the Child Perception Questionnaire, Parental/Caregiver Perception Questionnaire, and Family Impact Scale to assess emotional and social well-being, oral symptoms, functional limitations, parental emotions, family activities, conflicts, and financial burden as possible predictors of compliance during treatment. Sex, overjet, and appliance type were also analyzed.
Results
There were more noncompliant than compliant patients (55% vs 45%). Parental perception of altered emotional well-being of their children was the strongest predictor, increasing compliance odds 3.4 times (95% confidence interval [CI], 1.2–9.4; P = .017). Patients were 3.2 times (95% CI, 1.1–9.3; P = .033) more likely to cooperate with TB compared with BJ appliance. OJ ≥ 8 mm increased compliance odds 3.1 times (95% CI, 1.0–9.4; P = .044).
Conclusions
Parental perception of child's emotional well-being alteration, severity of malocclusion, and type of appliance are major predictors of compliance. Psychosocial issues and oral function limitations reported by children and family impact are of negligible influence.
... A total number of 461 studies were initially identified, with a further 19 articles obtained through other sources, of which 51 full-text articles were evaluated for inclusion (Fig 1). After evaluation, 22 full-text articles were excluded (Appendix II), whereas 29 articles met the selection criteria; however, 2 articles reported on data from the same study, 13,14 with an additional 2 articles related to the same cohort study. 15,16 Thus, 27 unique datasets were eventually included in the qualitative and quantitative synthesis. ...
Introduction
We aimed to explore the prevalence and nature of complications associated with Class II correctors in adolescents and their impact on the quality of life (QOL), completion of treatment, and success rate.
Methods
The review was registered in PROSPERO, and a comprehensive electronic search was performed without language or date restrictions. Randomized and nonrandomized trials, prospective cohort and cross-sectional studies, case series, and qualitative research were included. The Cochrane Collaboration's risk of bias tool and the Newcastle-Ottawa scale were used to assess the quality of included studies. Data were grouped according to appliances design: removable functional, fixed functional, hybrid functional, headgear, and fixed maxillary molar distalization appliances.
Results
Data from 27 studies were included, of which 11 were deemed eligible for meta-analysis. Overall, 1676 adolescents were included related to fixed functional (n = 682), removable functional (n = 682), hybrid functional (n = 84), headgear (n = 186), and Carriere (n = 42) appliances. The mean number of emergencies was 0.8 (95% confidence interval [CI], 1.1-2.1) and 2 (95% CI, 0.9-3.0) for removable and fixed designs, respectively. However, the rate of discontinuation was 35% (95% CI, 0.28-0.42) and just 1% (95% CI, 0.01-0.1) for removable and fixed designs, respectively. Other QOL dimensions such as eating, sleep, speech, and emotional domains were significantly impaired during treatment with removable functional appliances.
Conclusions
Removable Class II correctors were associated with a high rate of treatment discontinuation, most likely because of the negative impact on QOL and lack of compliance. More complications were observed with fixed designs, although this did not impact the overall success rates. Further prospective studies are needed to explore patient perceptions and cost-effectiveness to inform treatment decisions better.
... Depending on the development of the child, removable functional appliances are mostly used during the early and late mixed dentition era at age 8-13, while fixed functional appliances are used at age 11-16 (9,24,25). Therefore, to make a realistic comparison, the possible effects of the relatively wide age range were ignored. ...
... A total of six unique studies were identified. One large Swedish RCT was published in four parts and compared the Myobrace appliance to the Andresen activator (16)(17)(18)(19). Another large Syrian RCT was published in two parts and compared the Trainer to the Andresen activator appliance (6,20). ...
... Table 1 shows a summary of the characteristics of the included studies. We have managed to obtain raw data through communication with the Swedish RCT team (16)(17)(18)(19); however, we received no response regarding data and clarifications from other authors (21)(22)(23) ...
... Furthermore, two included RCTs (20,21) reported favorable overall experience with the activator appliances when it comes to the acceptance of the appliance, speech, oral constraint, and associated discomfort in comparison with the PMAs. In contrast, one RCT (17) reported no significant difference regarding patient-reported outcomes between both appliances; however, the activator appliance was associated with an increased level of pain during the first month of treatment. ...
Background
Prefabricated myofunctional appliances (PMAs) are widely advocated for correcting Class II division I malocclusion. However, their effectiveness is associated with a high amount of uncertainty within contemporary literature.
Objectives
The aim of this review was to systematically examine the available literature regarding the effectiveness of PMAs in treating Class II division 1 malocclusion in children and adolescents.
Search methods
Comprehensive unrestricted electronic searches in multiple databases as well as manual searches were conducted up to August 2018.
Selection criteria
Randomized controlled trials (RCTs) and non-randomized studies (NRS) matching the eligibility criteria.
Data collection and analysis
Two independent review authors were directly involved in study selection, data extraction, and bias assessment. The Cochrane risk of bias tool and the ROBINS-I tool were used for assessing the risk of bias. Quantitative pooling of the data was undertaken with a random-effects model with its 95% confidence interval (CI).
Results
Three RCTs comparing PMAs to activators and three NRS comparing PMAs to untreated controls met the inclusion criteria. On a short-term basis, exploratory quantitative synthesis indicated that the activators were more effective than the PMAs in correcting overjet with a mean difference of (1.1 mm; 95% CI: 0.44 to 1.77). On a long-term basis, there were no significant differences between the two appliances. Qualitative synthesis indicated less favorable soft tissue changes as well as patient experiences and compliance with the PMAs when compared to the activators. However, PMAs were associated with reduced costs compared to customized activators and modest changes when compared to untreated controls.
Conclusions
On a short-term basis, low quality of evidence suggests that PMAs were generally less effective than the activators in treating Class II division 1 malocclusion. The main advantage of PMAs seems to be their reduced costs. These results should be viewed with caution, as a definitive need for high-quality long-term research into this area is required.
Registration
PROSPERO (CRD42018108564).
... Besides the studies evaluating the satisfaction of the patient during the treatment process, there are studies evaluating the impact of doctorpatient and doctor-parent relationship that predict patient satisfaction. [6][7][8] Finally, studies comparing patient and parent expectations from orthodontic treatment have also been included in the literature. 9-11 Because a large majority of patients seeking orthodontic treatment are at a younger age and are still under the protection of their parents, the difference between patients' and parents' expectancies is gaining importance. ...
... Orthodontic pain and discomfort may negatively affect patient cooperation and discourage some patients from seeking treatment (7,8). Different studies have shown that 70-95% of patients complain of the pain caused by orthodontic appliances (9)(10)(11). ...
Objective: The aims of this study were to investigate the time at which pain started, the duration and intensity of the pain, the teeth affected in the mouth and whether sex was important in the perception of pain during the first week of rapid maxillary expansion (RME) treatment.
Materials and Methods: Sixty-two patients, 30 boys (mean age 12.91±0.70 years), 32 girls (mean age 13.16±0.52) undergoing RME treatment with an acrylic-bonded appliance was surveyed. The appliance was activated with two turns per day. The patient’s pain response was measured for each day in the morning and evening for a week using the Facial Pain Scale-Revised.
Results: Pain was reported by 66.12 per cent of patients after first activation of expansion appliance. No sex difference was found for percentage of patients reporting pain. At the posterior teeth, there were statistically significant results between the mean pain scores on days 2 and 6 in the morning and on days 1 and 6 in the evening for male patients.
Conclusion: Most of the patients undergoing RME treatment perceived pain, especially during the early phase of expansion. The maximum levels of pain were perceived during the first 5 days and showed variability among patients.
... It can be anticipated that the wide range of age is likely to affect the outcome in studies investigating perception. However, removable functional appliances are mostly used during the early and late mixed dentition period at the ages of 8-13 years depending on the child's development, whereas the fixed functional appliances are used at the ages of 11-16 years (9,24,25). Therefore, the possible effects of the relatively wide age range were ignored in order to make a realistic comparison. ...
... It can be concluded that the contact of the teeth and the acrylic parts of the appliance might have caused this discomfort. These findings were compatible with previous studies mentioning that the functional appliance may lead to tooth sensitivity (25,27). All patients suffered from a certain amount of pain due to use of the functional appliance. ...
Objective:
To evaluate patients' and parents' perception of removable, fixed rigid, and fixed hybrid functional appliances and to compare their impacts on anxiety and discomfort during treatment in different age groups and genders.
Methods:
Data were gathered by means of a questionnaire that included items presumed to be associated with orthodontic compliance. A self-administered questionnaire was used to quantify patients' and parents' perceptions. Three groups were formed regarding the type of functional appliance used: fixed rigid (Functional Mandibular Advancer, FMA), fixed hybrid (Forsus Fatigue Resistant Device, FRD), and removable (Twin Block, TB). Two separate questionnaires were used for the patients and their parents comprising the necessary context. Chi-square, Mann-Whitney U, and Kruskal-Wallis tests were used for data analysis.
Results:
Patients needed less time to adapt to the FRD appliance. Eating difficulties were encountered by patients in the FMA group. Adolescents who had completed functional orthodontic treatment with a removable appliance had difficulties in controlling their saliva. Patients' and parents' perceptions were found to be in accordance with each other.
Conclusion:
Adolescents who had completed functional orthodontic treatment with fixed appliances had more difficulty in their daily life. Orthodontists should be aware of this impact caused by functional orthodontic treatment and should regularly encourage patients by reminding them of the improvements to be had by fixing the malocclusion.
Objective: To determine treatment expectations of patients and parents, and the initial effects of fixed functional devices on oral health-related quality of life.
Materials and Method: The study comprised 50 patients (39 female, 11 male, mean age 16.24 years) with Angle Class II,1 malocclusion, who were planned to be treated with forsus fatigue resistant device (FFRD). Treatment expectations of the patients and their parents/legal guardians were assessed before the treatment. The Oral Health Impact Profile (OHIP-14) was assessed 1-month after bonding (T1), and repeated 1-month after placement of FFRD (T2). Statistical analysis included Wilcoxon Signed Rank test for the evaluation of the differences in scores between treatment periods and Mann-Whitney U test for the evaluation of gender differences. Results: Main motivation for seeking orthodontic treatment was to improve dental appearance for the patients, and facial esthetics for their parents. Results declared that girls took their orthodontic problems more seriously than boys (p<0.05). The highest mean scores in OHIP-14 were achieved for “difficulty in eating”, and “feeling pain”. No significant difference between treatment periods was noted.
Conclusion: This study highlighted the lack of serious adverse effects of the use of fixed functional devices on patients’ quality of life, and that patients might probably experience problems about physical status, mainly for functional limitations, rather than psychological status and social interactions. The findings may assist clinicians in understanding the concerns about these appliances.
Objective
To assess the treatment efficacy/efficiency with prefabricated myofunctional appliances (PMA) for children with malocclusion.
Data sources
Nine databases searched without limitations till July 2019.
Data selection
Randomised trials comparing PMAs to functional appliance treatment or no treatment.
Data extraction
Study selection, data extraction and risk of bias assessment were done in duplicate.
Data synthesis
Random-effects meta-analyses of mean differences (MDs) or relative risks (RRs) with their 95% confidence intervals (CIs) were conducted on seven publications (three published and one unpublished trials; 232 patients; 53% male; mean age 10.2 years). Compared to no treatment, one trial indicated that PMAs were somewhat effective in reducing overjet (MD −2.4; 95% CI −3.3 to −1.5), reducing overbite (MD −2.5; 95% CI −3.2 to −1.8), reducing mandibular crowding (RR 0.4; 95% CI 0.2–0.8) and establishing Class I canine relationship (RR = 2.3; 95% CI 1.1–4.9). However, compared to custom-made functional appliances, three trials indicated that PMAs were less effective in reducing the ANB angle (MD 0.9; 95% CI 0.5–1.4), increasing mandibular ramus length (MD −2.2; 95% CI −2.9 to −1.51), reducing overjet (MD 1.5; 95% CI 0.9–2.1), establishing a solid Class I molar relationship (RR 0.3; 95% CI 0.2–0.7), reducing the nasolabial angle (MD 5.8; 95% CI 0.8–10.8) and reducing facial convexity (MD −2.6; 95% CI −4.3 to −0.9). Finally, the quality of evidence was moderate to low due to risk of bias.
Conclusions
PMAs are more effective in reducing overjet, overbite, mandibular crowding and establishing Class I canine relationship than no treatment. However, compared to custom-made functional appliances, PMAs are less effective in producing dental, skeletal or soft-tissue changes, even though they are less costly.
Background:
Prominent upper front teeth are a common problem affecting about a quarter of 12-year-old children in the UK. The condition develops when permanent teeth erupt. These teeth are more likely to be injured and their appearance can cause significant distress. Children are often referred to an orthodontist for treatment with dental braces to reduce the prominence of their teeth. If a child is referred at a young age, the orthodontist is faced with the dilemma of whether to treat the patient early or to wait and provide treatment in adolescence.
Objectives:
To assess the effects of orthodontic treatment for prominent upper front teeth initiated when children are seven to 11 years old ('early treatment' in two phases) compared to in adolescence at around 12 to 16 years old ('late treatment' in one phase); to assess the effects of late treatment compared to no treatment; and to assess the effects of different types of orthodontic braces.
Search methods:
Cochrane Oral Health's Information Specialist searched the following databases: Cochrane Oral Health's Trials Register (to 27 September 2017), the Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library, 2017, Issue 8), MEDLINE Ovid (1946 to 27 September 2017), and Embase Ovid (1980 to 27 September 2017). The US National Institutes of Health Ongoing Trials Registry (ClinicalTrials.gov) and the World Health Organization International Clinical Trials Registry Platform were searched for ongoing trials. No restrictions were placed on the language or date of publication when searching the electronic databases.
Selection criteria:
Randomised controlled trials of orthodontic treatments to correct prominent upper front teeth (Class II malocclusion) in children and adolescents. We included trials that compared early treatment in children (two-phase) with any type of orthodontic braces (removable, fixed, functional) or head-braces versus late treatment in adolescents (one-phase) with any type of orthodontic braces or head-braces, and trials that compared any type of orthodontic braces or head-braces versus no treatment or another type of orthodontic brace or appliance (where treatment started at a similar age in the intervention groups).We excluded trials involving participants with a cleft lip or palate, or other craniofacial deformity/syndrome, and trials that recruited patients who had previously received surgical treatment for their Class II malocclusion.
Data collection and analysis:
Review authors screened the search results, extracted data and assessed risk of bias independently. We used odds ratios (ORs) and 95% confidence intervals (CIs) for dichotomous outcomes, and mean differences (MDs) and 95% CIs for continuous outcomes. We used the fixed-effect model for meta-analyses including two or three studies and the random-effects model for more than three studies.
Main results:
We included 27 RCTs based on data from 1251 participants.Three trials compared early treatment with a functional appliance versus late treatment for overjet, ANB and incisal trauma. After phase one of early treatment (i.e. before the other group had received any intervention), there was a reduction in overjet and ANB reduction favouring treatment with a functional appliance; however, when both groups had completed treatment, there was no difference between groups in final overjet (MD 0.21, 95% CI -0.10 to 0.51, P = 0.18; 343 participants) (low-quality evidence) or ANB (MD -0.02, 95% CI -0.47 to 0.43; 347 participants) (moderate-quality evidence). Early treatment with functional appliances reduced the incidence of incisal trauma compared to late treatment (OR 0.56, 95% CI 0.33 to 0.95; 332 participants) (moderate-quality evidence). The difference in the incidence of incisal trauma was clinically important with 30% (51/171) of participants reporting new trauma in the late treatment group compared to only 19% (31/161) of participants who had received early treatment.Two trials compared early treatment using headgear versus late treatment. After phase one of early treatment, headgear had reduced overjet and ANB; however, when both groups had completed treatment, there was no evidence of a difference between groups in overjet (MD -0.22, 95% CI -0.56 to 0.12; 238 participants) (low-quality evidence) or ANB (MD -0.27, 95% CI -0.80 to 0.26; 231 participants) (low-quality evidence). Early (two-phase) treatment with headgear reduced the incidence of incisal trauma (OR 0.45, 95% CI 0.25 to 0.80; 237 participants) (low-quality evidence), with almost half the incidence of new incisal trauma (24/117) compared to the late treatment group (44/120).Seven trials compared late treatment with functional appliances versus no treatment. There was a reduction in final overjet with both fixed functional appliances (MD -5.46 mm, 95% CI -6.63 to -4.28; 2 trials, 61 participants) and removable functional appliances (MD -4.62, 95% CI -5.33 to -3.92; 3 trials, 122 participants) (low-quality evidence). There was no evidence of a difference in final ANB between fixed functional appliances and no treatment (MD -0.53°, 95% CI -1.27 to -0.22; 3 trials, 89 participants) (low-quality evidence), but removable functional appliances seemed to reduce ANB compared to no treatment (MD -2.37°, 95% CI -3.01 to -1.74; 2 trials, 99 participants) (low-quality evidence).Six trials compared orthodontic treatment for adolescents with Twin Block versus other appliances and found no difference in overjet (0.08 mm, 95% CI -0.60 to 0.76; 4 trials, 259 participants) (low-quality evidence). The reduction in ANB favoured treatment with a Twin Block (-0.56°, 95% CI -0.96 to -0.16; 6 trials, 320 participants) (low-quality evidence).Three trials compared orthodontic treatment for adolescents with removable functional appliances versus fixed functional appliances and found a reduction in overjet in favour of fixed appliances (0.74, 95% CI 0.15 to 1.33; two trials, 154 participants) (low-quality evidence), and a reduction in ANB in favour of removable appliances (-1.04°, 95% CI -1.60 to -0.49; 3 trials, 185 participants) (low-quality evidence).
Authors' conclusions:
Evidence of low to moderate quality suggests that providing early orthodontic treatment for children with prominent upper front teeth is more effective for reducing the incidence of incisal trauma than providing one course of orthodontic treatment in adolescence. There appear to be no other advantages of providing early treatment when compared to late treatment. Low-quality evidence suggests that, compared to no treatment, late treatment in adolescence with functional appliances, is effective for reducing the prominence of upper front teeth.
