PubMed · 6940450
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W G Watson. 1981. Functional appliances--a perspective.. https://doi.org/10.1016/s0002-9416(81)90467-x
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PURPOSE: This study evaluates the skeletal response to functional orthodontic therapy in growing children with hemifacial microsomia (HM). A method of classification for mandibular growth subsequent to treatment is also suggested. MATERIALS AND METHODS: Sixteen growing children with unilateral HM were treated. Each patient was graded according to the skeletal, auricular, tissue (SAT) classification. Patients graded S4-S5 were excluded because the severity of the malformation made them unsuitable for functional orthodontic treatment. All patients initially underwent a period of treatment with an asymmetrical functional activator (AFA). RESULTS: In 7 of 16 cases (43.7%) classified as S1-S2/T1, regardless of the value of A, functional therapy brought about mandibular growth greater on the side of the malformation (G3-G4), re-establishing structural and functional harmony of the entire stomatognathic apparatus. Of the five cases (31.2%) classified as S2/T2, four required surgical intervention at about 10 years of age after an initial period of functional therapy that produced mandibular growth classified G1-G2. In the other case, functional treatment was sufficient to correct the malformation. In four patients (25%) classified as S3/T3 or S3/T2, it was necessary to combine surgical treatment with functional therapy. CONCLUSION: Use of the AFA in growing children with HM makes it possible to induce harmonious maxillomandibular growth. Statistically, in S1-S2/T2 cases, functional therapy brings about an overall resolution of the malformation whereas in more severe cases (S2/T2), it needs to be combined with orthodontics using fixed appliances and surgical intervention.
The purpose of this prospective study was to investigate the maxillary and the cranial base changes after treatment with the Harvold activator and the Fränkel function regulator appliances. Forty-two children, who are 10 to 13 years old, with Class II, Division 1 malocclusions were matched in triads according to age and sex and randomly assigned to either the control, Harvold activator, or Fränkel function regulator group. Lateral cephalometric radiographs were taken at the start of the study and 18 months later. Both appliances reduced the overjet by tipping the maxillary incisors palatally and, as a consequence, the length of the maxillary arch was reduced. The appliances had no effect on either the horizontal or vertical position of the maxillary molars. Small, but statistically significant, changes in the cranial base angle in the Fränkel function regulator group were attributed to relatively large changes at basion in several children, influencing the results because of the small size of the sample. The appliances had no effect on the position of the maxilla.
The orthodontic and orthopedic effects of the Activator, Activator-Headgear Combination (ACHG) and the Bass appliance systems were compared by analyzing the cephalometric records of 64 subjects, who were treated for skeletal Class II malocclusion, with both conventional and Pancherz's methods. Differences between observations on the different occasions (starting and ending values) were tested with Wilcoxon's matched pairs rank test. Kruskal-Wallis nonparametric analysis of variance was carried out in different situations among all three groups. If a level of significance less than 0.05 was observed, Scheffè's method of multiple comparisons was used to determine differences among groups. The results of this study showed that greater improvement in sagittal skeletal relationship (ANB angle) was obtained in both Bass and ACHG groups than in the Activator group. The differences between the groups were most pronounced for dental variables. The Bass appliance was found to be more effective in the control of the unwanted side effects (proclination of lower incisors, retroclination of upper incisors). Unfavorable labial tipping of the lower incisors was also prevented with the ACHG appliance.