One of the most popular topics in my series of Blogs has been on prefabricated #Myofunctional appliances and so I thought I would share the results of this randomized clinical trial from Sweden which was presented at the recent 8th International Orthodontic Congress in London. The complete abstract is below and follows on from their paper reported at the 7th IOC in Sydney in 2010 which I reported here.
The conclusions reinforce that the overjet/protrusion correction obtained with the prefabricated Myobrace was dental/tipping of teeth while the custom made #Activator appliance achieved a better molar correction, however compliance with both appliances was poor. This will affect the clinical choice of an appliance as in cases where simple tipping may be suitable then the cheaper prefabricated appliance may be appropriate. However if more molar bite correction is required then the custom-made appliance would be more suited.... as long as they wear it. The percentage of subjects in this study having unsuccessful treatment was very high at 70% with the Myobrace appliance and ~53% with the Activator which the authors attributed mainly to a lack of compliance. The patient and the family should therefore be involved in the appliance choice or alternatively appliances that do not require as much cooperation can be used (the subject of a future Blog). These authors are to be congratulated on a job well done in conducting this trial.
Update: The full paper is now available in the European Journal of Orthodontics.
Update: The full paper is now available in the European Journal of Orthodontics.
Authors
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E. Cirgic, K.
Hansen, H. Kjellberg.
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Abstract:
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TREATMENT EFFICACY OF PREFABRICATED FUNCTIONAL APPLIANCES AND
ANDRESEN ACTIVATORS IN CLASS II, DIVISION1 CASES: A RANDOMIZED CLINICAL TRIAL
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Aim: The
purpose of this study was to compare the clinical effectiveness in reducing large
overjet between a prefabricated functional appliance (PFA) and a slightly
modified Andresen activator (AA).
Methods: A
multicentre, prospective and randomized clinical trial was conducted in 12
general dental practices and an ethical committee approved the study. The
sample consisted of 97 subjects (44 girls, 53 boys) mean age 10.3 years with
a Class II, division 1 malocclusion and an overjet ≥ 6 mm. The study was
designed as intention to treat and the patients were randomly selected to
treatment with either a PFA or a AA. The PFA and AA group consisted of 57
subjects (28 girls, 29 boys) and 40 subjects (16 girls, 24 boys)
respectively. Overjet, overbite, lip seal and sagittal relation were recorded
before and at 3, 6 and 12 months after start of treatment. The endpoint of
treatment was set to overjet ≤ 3mm and after this a 6 months retention period
followed.
Results: No
significant difference was found in overjet, overbite and lip seal between
the two groups. Significant difference was found in sagittal molar correction
between the two groups. The treatment of 40 patients with PFA and 21 with AA
were considered unsuccessful mainly due to poor compliance.
Conclusions: Prefabricated
functional appliances are as effective as Andresen activators in correcting
overjet, overbite and lip seal. Andresen activators seem to be more effective
in sagittal molar correction than PFA. The success rate in treatment with
both appliances is however, low.
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Dr Peter Miles is the orthodontist at Newwave Orthodontics in Caloundra, Australia and teaches orthodontics part-time at the University of Queensland and is a visiting lecturer at Seton Hill University in the USA. Peter is one of the editors and authors of the orthodontic textbook, 'Evidence-Based Clinical Orthodontics'.
