Orthodontic functional appliances: theory and practice

161 Pages·2016·0.36 MB·English

by  Padhraig S. Fleming

Orthodontic Functional Appliances

Orthodontic Functional
Appliances
Theory and Practice
Dr Padhraig Fleming BDent Sc. (Hons.), MSc, PhD,
MOrth RCS, FDS (Orth.) RCS, FHEA
Senior Clinical Lecturer/Hon. Consultant
Barts and The London School of Medicine and Dentistry
Queen Mary University of London
Institute of Dentistry
Whitechapel
London
UK
Professor Robert Lee BDS, MDS, FDS, MOrth RCS (Eng.)
Hon. Professor/Consultant
Barts Health NHS Trust
Barts and The London School of Medicine and Dentistry
Institute of Dentistry
Whitechapel
London
UK
This edition first published 2016
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Library of Congress Cataloging‐in‐Publication Data
Names: Fleming, Padhraig S., author. | Lee, Robert, 1947 July 26– , author.
Title: Orthodontic functional appliances: theory and practice / Dr. Padhraig Fleming, Professor Robert Lee.
Description: Chichester, West Sussex; Ames, Iowa : John Wiley & Sons, Inc., 2016. | Includes bibliographical references and index.
Identifiers: LCCN 2016007082 | ISBN 9781118670576 (hb) | ISBN 9781118670545 (Adobe PDF) | ISBN 9781118670569 (epub)
Subjects: MESH: Orthodontic Appliances, Functional | Malocclusion–therapy | Orthodontics, Corrective
Classification: LCC RK521 | NLM WU 426 | DDC 617.6/43–dc23
LC record available at http://lccn.loc.gov/2016007082
A catalogue record for this book is available from the British Library.
Wiley also publishes its books in a variety of electronic formats. Some content that appears in print may not be available in electronic books.
Set in 9.5/12pt Minion by SPi Global, Pondicherry, India
1 2016
Contents
List of contributors, vi 7 Flexible fixed functional appliances, 93
Peter Miles
Preface, vii
8 Transferring from functional to fixed appliances, 102
1 Biological basis for functional appliance therapy, 1
9 The use of functional appliances in the correction
2 Development of functional appliances, 10
of Class III malocclusion, 119
3 The role of genetics and environmental factors on Andrew DiBiase
the condyle in mandibular growth, 21
10 Functional appliances: A focused review
Peter A. Mossey and Colin Larmour
of the clinical evidence, 127
4 Functional appliance therapy: Indications
11 Cases, 135
and case selection, 28
Index, 160
5 Clinical use of the Twin Block appliance, 51
6 Rigid fixed functional appliances, 70
Peter Miles
v
List of contributors
Dr Andrew DiBiase Dr Peter Miles
BDS, MSc, MOrth RCS, FDS (Orth.) RCS BDSc, MDS, FCID
Consultant Orthodontist Senior Lecturer
East Kent Hospitals NHS University Foundation Trust University of Queensland School of Dentistry
Department of Orthodontics Queensland
William Harvey Hospital Australia
Kent
UK Visiting Lecturer
Seton Hill University Center for Orthodontics
Dr Colin Larmour Pennsylvania
BDS, MSc, FDS RCPS, MOrth RCS, FDS (Orth.) USA
Consultant Orthodontist
University of Aberdeen Dental School and Hospital Professor Peter A. Mossey
Aberdeen Royal Hospitals BDS, PhD, MOrth RCSEng, FDS RCSEd, FFD RCSI
Aberdeen Professor of Orthodontics
UK Division of Oral Health Sciences
Dundee Dental Hospital and School
Mr Kieran McLaughlin Dundee
MSc, Adv Dip Dent Tech UK
Orthodontic Technician
Barts Health NHS Trust
Barts and The London School of Medicine and Dentistry
Institute of Dentistry
London
UK
vi
Preface
Orthodontists are united in a quest to achieve functional, unapologetic in relation to our emphasis on the Twin Block, as
aesthetic and stable outcomes compatible with optimal health this has proven a reliable, effective and user‐friendly appliance
and stability of the dentition. While the focus on aesthetics has within our respective practices. However, we endeavour to
intensified in recent years, the scope to alter facial growth, and embody contemporary and universal approaches to functional
in particular aesthetics, with orthodontic appliances has been treatment in an unbiased fashion, particularly by devoting chap-
disputed. Functional appliance therapy offers the possibility of ters to both flexible and rigid fixed functional designs. We
modifying growth, producing potentially more meaningful therefore hope that a clinician without experience of either
facial as well as inter‐arch change. The skeletal and soft tissue removable or fixed functional appliances will be capable of iden-
variations in individuals are the main limiting factors in our tifying appropriate patients, designing a suitable appliance and
ability to achieve the perfection we desire. The use of functional managing the care of a functional case effectively on the basis of
appliances has been one of the more contentious areas within this textbook. To this end, we have documented a significant
orthodontics for decades. Paradoxically, these appliances have number of personally treated cases to augment the theory
been relied on to produce skeletal change, dental change or a behind the biological basis and indications for functional
combination of both in pre‐adolescent, adolescent and indeed treatment.
mature individuals for a century. While users of these appliances We would like to express our gratitude to a number of people
have often harboured inconsistent objectives, the popularity of who have influenced our lives and our professional careers. In
the appliances, while subject to regional variation, has been particular, we would like to pay tribute to our families, Caroline,
sustained and relatively consistent. Oliver, Sophie, Anne and Johnny Fleming, whose endless love
This book would not have been possible without the inspira- and support are always appreciated. We would also like to recog-
tion of early developers of functional appliance therapy and nize Norma Lee and her children for their unlimited patience
more recent innovators including the likes of William Clark, and understanding, and Dr Margaret Collins for encouraging
who have been integral in the refinement, simplification and and recommending this publication. We are indebted to Dr
popularity of functional appliances. The authors have used Peter Miles, Dr Andrew DiBiase and Professor Peter Mossey for
functional appliances successfully both throughout our training agreeing to write chapters within this book and for adding an
and within our orthodontic practices in growing Class II extra dimension to our efforts. Finally, we would like to acknowl-
patients. Our aim within this textbook has been to highlight the edge Mr Kieran McLaughln for his technical expertise and
rationale, indications and implications of this approach. While a p assion in fabricating and describing the technical aspects of a
number of chapters are intended to have a clinical and practical range of removable appliances.
focus, we hope to have maintained an evidence‐based under- Above all, we hope that you enjoy the book and that our
pinning throughout. In particular, while we are aware of the efforts and approach have a bearing either on your treatment
limitations of much of the evidence pertaining to appliance or on your expectations of treatment with functional
therapy, irrespective of design, we emphasize best available appliances.
e vidence in the form of randomized studies.
Allied to the research focus, however, we attempt to supple- Dr Padhraig Fleming
ment theoretical concepts with practical elements. We are Professor Robert Lee
vii