Join me as summarise this year’s Chapman Prize 2020 by Pratik and Padhraig
Lecture based on 2 studies published in the AJODO
- Effectiveness of part time Vs full time wear protocols of twin block appliance on dental and skeletal changes RCT AJODO 2019
- Understanding factors influencing compliance with removable functional appliances. A qualitative study AJODO 2019
Aim
Full time 22hrs, Vs 12 hours
Method
- Design, cribs 6s, 4s, ball clasps lowers, edge to edge bite
- Modification: Theramon sensor imbedded into the acrylic block 10mm x 7mm
- Detects changes in temperature – to assess compliance
- Patients seen 6-8 weeks
Results
- Part time Vs full time:
- Overjet change: 7mm Vs 6.5mm
- Pog increase : 3 Vs 3mm No difference
- ANB 1.5 Vs 1.25
- Compliance
- Part time
- Reporting 11 hrs
- Actual wear 8.8 hrs – statistically different to reported compliance
- Full time
- Reporting 20 hrs
- Actual wear 12.4 hrs – statistically different to reported compliance
- Part time
Conclusion
- No difference in skeletal and dental changes
- Part time wear 8-13 hours achieves dental and skeletal changes
- Patients over report wear
- Future research: re-activation of block can have more positive effects
Qualitative research Padhraig Fleming
Method
- 1 to 1 interview, 22 patients
- Full time and part time
- Topic guide: experience and compliance
Results
- Themes
- Self motivation
- Positive reinforcement from clinician or parents
- Social influence
- Teasing initially
- Quality of live impairment and adaptability
- Perceived treatment progress
- Pragmatic
- Forgetfulness
- Speech and effects on schooling
- Part time
- Possible confusion of time
- Self motivation
Timeline
- Initial 4 weeks – maximum social impairment, speech, forgetfulness
- After 4 weeks
- Positive parents
- Positive clinician
- Facial changes
First month
- Communication including parents
- Not wearing whilst eating
- Taper introduction
Timing / phasing school
- Part time wear during school
- Time fit in holidays
Overall treatment
- Full time after 4 weeks
- To maximise changes
Manage failure
- Night time wear only
Design consideration
- Minimise visible parts
- Simple
- Avoid labial bow, limit vertical opening
