Functional Orthodontic Appliances

These appliances are used to manage skeletal Class II and Class III malocclusions in growing patients. The studies of Class II treatment included adolescents, while Class III outcome studies included younger children as well.

Most patients in the reviewed studies reported mild, short-term discomfort or functional difficulty. Pain with appliances such as activators, twin blocks and trainers was usually low and decreased progressively during adaptation.

Reported patient concerns included pain, functional impairment, swallowing difficulty, speech difficulty and oral-health-related quality of life. The review found the appliances generally well tolerated, although the certainty of evidence was limited.

The long-term review assessed functional appliances worn for six months or longer, with active treatment completed by age 16 in its included criteria. Duration is therefore measured in months rather than a single appointment.

Functional appliances hold the mandible forward. Research compares incremental and maximal mandibular advancement in Class II treatment and also evaluates appliances used alone or together with multi-bracket therapy.

Adaptation was a consistent pattern in the patient-reported outcomes review. Early mild discomfort and functional difficulty generally eased over time, rather than remaining at the same level throughout treatment.

For Class II treatment, the research distinguishes removable and fixed functional appliances, and it includes appliances used alone or with multi-bracket therapy. The alternative in the comparison was an untreated Class II group.

The reviewed studies measured more than tooth and jaw changes. They also asked about pain, functional impairment, swallowing, speech and oral-health-related quality of life while growing patients used the appliances.

Functional-appliance treatment can involve a removable or fixed appliance. It may be used alone or combined with multi-bracket therapy in growing patients.