Patient dependent factors for the efficient treatment of class ii malocclusion Lorenzo Franchi Episode 30 IOC 2020

Timing of functional appliance treatment of class 2 correction

Meta analysis Perinetti  2015:

• Mandibular length increase:
  • Pre puberal: 9mm
  • Pubertal: 2.9mm

Ideal time for removable appliances CS3

• Approximately 3mm of mandibular growth
• Shorter duration of total therapy 2.5years Vs 4 years (pre pubertal) Tulloch 2004
• Less time in fixed appliances compared to fixed functional appliances
• Good stability, as ends at post pubertal stage

Compliance of removable functional appliance

• Part time Vs full time Parekh 2019 – No difference in skeletal or dento-alveolar changes

Individual responsiveness to functional appliance therapy

• Ideal timing of functional appliance still results in variation to functional appliances, 1-13mm at CS 13mm Baccetti 2001
• Good responders Vs bad responders Franchi 2006
  • Mandibular angle = Co-Go-Me
    • Poor responders =+128^o 
    • Good responders =123 ^o -128 ^o
    • Excellent responders =-123 ^o
  • Predictive variable: Gender, age, cephalomertric variables = Only Co-Go-Me predictive variable

What are the long term effects of functional appliance therapy Pavoni 2017

• Prepubertal treatment – showed acceleration of growth, but no long term (Age 9.4-17)
• Pubertal treatment – showed increased overall growth long term 5mm (Age 10-18)