Effectiveness of part-time vs full-time wear protocols of Twin-block appliance on dental and skeletal changes: A randomized controlled trial

Parekh, J.; Counihan, Kate; Fleming, Padhraig S.; Pandis, Nikolaos; Sharma, Pratik

doi:10.1016/j.ajodo.2018.07.016

Cited by 38 publications

(36 citation statements)

References 20 publications

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“…This was demonstrated recently in an RCT comparing part‐time and full‐time wear of the Twinblock appliance. Those authors used intraoral sensors to monitor patient compliance and found that the ‘full‐time’ group only wore the appliance 12 h a day on average . Although this study concluded that part‐time and full‐time wear were clinically equivalent, the poor compliance of the full‐time group meant that this study failed to answer this question.…”

Section: The Evidence Base Supporting Prefabricated Functional Appliamentioning

confidence: 82%

Myofunctional therapy and prefabricated functional appliances: an overview of the history and evidence

Wishney

Darendeliler

Dalci

2019

Australian Dental Journal

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Malocclusion represents the clinically observable endpoint of numerous genetic and environmental influences. Oral Myofunctional Therapy (OMT) aims to treat malocclusions by improving the oral environment through re-education of musculature and respiratory patterns. Although the concept of OMT has existed since the early part of the 20th Century, many of its purported benefits for the treatment of malocclusion remain undemonstrated in the scientific literature. However, a more recent application of OMT for the treatment of Obstructive Sleep Apnoea (OSA) suggests some benefits, although more research is needed to clarify this effect. Prefabricated functional appliances (PFAs) are sometimes advocated as part of myofunctional training programs. In the past decade, controlled clinical investigations have demonstrated that PFAs can improve Class II Division 1 malocclusions in compliant patients. Compared with traditional functional appliances, PFAs might be more cost effective; however, this must be balanced against compliance problems and evidence suggesting that other types of functional appliances might give better treatment results in a comparable time frame.Abbreviations and acronyms: OMT = Oral Myofunctional Therapy; PFA = prefabricated functional appliance; OSA = Obstructive Sleep Apnoea; AHI = apnoea hypopnoea index; RCT = randomised controlled trial.

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Section: The Evidence Base Supporting Prefabricated Functional Appliamentioning

confidence: 82%

Myofunctional therapy and prefabricated functional appliances: an overview of the history and evidence

Wishney

Darendeliler

Dalci

2019

Australian Dental Journal

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“…Patient compliance in terms of appliance wear might be checked qualitatively through interviews with the patient and treatment notes or checked quantitatively by dedicated microsensors embedded in the appliance (Schott and Ludwig, 2014), which have shown that most patients do not comply with given instructions for appliance wear time. However, criticisms about the accuracy of such sensors have been expressed (Brierley et al, 2017) and the exact amount of minimum wear time needed to produce adequate remains debatable (Parekh et al, 2019). In the present review, only two of the included trials assessed in any way patient compliance with appliance wear, but only through indirect means and this cannot be taken formally into account.…”

Section: Discussionmentioning

confidence: 99%

What evidence exists for myofunctional therapy with prefabricated appliances? A systematic review with meta-analyses of randomised trials

2019

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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.

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“…Therefore, the present case used a similar wear regime, 2 h during the day and overnight wearing, and this wear regime was coincident with most functional appliance treatments that do not require full time use. In addition, a recent study showed that there was no difference in either dental or skeletal changes achieved with part-time or full-time wear of a Twin-block appliance over 12 months (Parekh et al, 2019).…”

Section: Discussionmentioning

confidence: 99%

Elastodontic appliance assisted fixed appliance treatment: A new two-phase protocol for extraction cases

2019

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Elastodontic appliance (EA) is a type of removable appliance that has been widely used in interceptive orthodontics. The present case report describes a severe crowding case treated with a new two-phase protocol by using an EA and a fixed appliance. A 13-year-old patient with severe dental crowding, increased overjet and overbite on a skeletal Class II base was selected. The patient had four bicuspids extracted; during the first phase of treatment, she wore the EA for 2 h during the daytime plus overnight, combined with a myofunctional exercise. During the second phase of treatment, a fixed appliance was employed to close residual space and improve the teeth angulations. The total treatment time was 14 months, of which the second phase with fixed appliance lasted 10 months. Satisfactory improvements of the overjet and teeth alignment were achieved. This case report used a new two-phase treatment protocol which resulted in a favourable outcome after comparatively short treatment.

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Effectiveness of part-time vs full-time wear protocols of Twin-block appliance on dental and skeletal changes: A randomized controlled trial

Cited by 38 publications

References 20 publications

Myofunctional therapy and prefabricated functional appliances: an overview of the history and evidence

Myofunctional therapy and prefabricated functional appliances: an overview of the history and evidence

What evidence exists for myofunctional therapy with prefabricated appliances? A systematic review with meta-analyses of randomised trials

Elastodontic appliance assisted fixed appliance treatment: A new two-phase protocol for extraction cases

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