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CONTENTS. Common/general problems and management. Clinical management of functional appliances. PROBLEM WITH SPEECH. APPLIANCE LOOSE. MOUTH WATERING. CLASP FRACTURED. ACRYLIC FRACTURE. REDNESS ON ROOF OF MOUTH. SORE CRACKS AT SIDE OF MOUTH. CLINICAL MANAGEMENT OF FUNCTIONAL APPLIANCE.
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CONTENTS • Common/general problems and management. • Clinical management of functional appliances.
Preparing functional appliance • Upper and lower alginate impression are required. • Bite record with postured mandible in 3 dimension – anteroposteriorly, vertically and tranverse. • Degree of protrusion and overjet depend comfort patient. • Example – patient with large overjet, protruding mandible more than 75% of maximum protrusion can make difficult tolerance of the appliance.
Fitting functional appliance • Not painful but difficult to get used initialy. • Required to be worn sufficiently for adaptabiliy. Children adapt more faster. • Amout of hours appliance need to be worn each day depend on type apliance. • Twin block & herbs – worn full time.
Review functional appliance • Advisable to see patient 2 -3 weeks after fitting. Motivation every review is important, checking the appliance fitting and treatment progress. • Once clinician assure that the appliance worn as instructed, then review can be made 6-10 week interval. • No progress due to no. of factors: • Poor compliance. • Lack growth or unfavourable growth rotation. • Problems with the design or fit of the appliance. Poor compliance is most common problem with these appliance – failure rate 10-33%. Compliance better with younger patient .
End of functional appliance treatment. • At end stage of treatment, sensible to over correct overjet edge to edge due to risk of relapse. • Most functional appliance followed by fixed appliance and this transtition is complex best managed by specialist. • If arch is well alligned, second phase fixed apliance not required. Then patient is asked to wear functional apliance at night for period until growth complete.
Points about functional appliance • Used in growing patients. • Posture the mandible. • Used in late mixed dentition, provided patient still growing. • Can be used earlier for psychological reason if patient is being teased, overall treatments is increased. • Usually used for correction of mild to moderate class II skeletal problem. • Most cases followed by second phase fixed appliance. • Can be used alone to correct class II div 1 if arch is well aligned. • Produce predominantly dentoalveolar effect with small skeletal change. • Individual response to it is variable. • Can be difficult to wear initially and require encouragement and motivation from clinician.
