We are updating a systematic review on Class II malocclusion. We could find differents approaches and some new evidence. We would like to know whether this reflects how the functional appliances have been used.
Hello Klaus,
I am using the Karwetzky U-Bow Activator to treat class II malocclusions for more than 30 years. The construction bite to advance the mandible is taken low and only a few millimeters, because this gives maxi-mum activation of the muscles. The sagittal activation is 2 to 3 mm and the vertical activation should be not beyond the freeway space. During treatment the u-bows can be activated to protude the maxilla again.
Kind regards
Ulrich
Hi Ulrich,
Thanks for your answer.
I don't know this appliance. Do you have any picture or link in which I could have a look?
Best wishes,
Klaus
We use Twin block appliance and some times activator in our department.
Dear Klaus,
I would like to recommend the Teuscher activator or Van Beek appliance (personally, I use Teuscher Activator). You can read more details about the both appliances hier: "Comparison of modified Teuscher and van Beek functional appliance therapies in high-angle cases. J Orofac Orthop. 2001 May;62(3):224-37". Moreover, there was a nice paper in AJODO, february 2017 about van Beek appliance and the wire time, "Overjet reduction in relation to wear time with the van Beek activator combined with a microsensor. Am J Orthod Dentofacial Orthop. 2017 Feb;151(2):277-283".
Finally, I would strongly recommend to take alook at Kevin O'Brien blog. You'll find nice reviews about the functional aplliances. You find hier
http://kevinobrienorthoblog.com/brief-guide-removable-functional-appliance-treatment/
Cheers
Ahmad
http://kevinobrienorthoblog.com/brief-guide-removable-functional-appliance-treatment/
https://www.ncbi.nlm.nih.gov/pubmed/?term=Van+Beek++wear+time
https://www.springermedizin.de/comparison-of-modified-teuscher-and-van-beek-functional-applianc/7946132?fulltextView=true
In South Korea, I uses Twin Block appliance. As I see, In Korea, some clinicians uses Herbst appliance.
Most of orthodontic specialist use head gear or screw through the maxillary premolar extraction, few of specialist use Herbst appliance. Many orthodontic specialists are not used to using functional appliance like Twin block appliance.
Hello Klaus, we are using Twin block in our department..but in few cases FORSUS is also used.
Many thanks for your answer Suchita Daokar.
Hello Klaus, i use twin block and Andreasn activator in adolscents, powerscope ( from American orthodontics) in adults.
For high divergent faces I used twin block combination with High pull headgear, but now I develop a new techniqe to do this.
Regards
ご回答いただきありがとうございました。しかし、どのようにブラケットとワイヤーを使用した後、前方の顎を持ってください。
actually i prefer fixing an orthodontic fixed appliance ,waiting till the eruption of permanent canines to resolve such a problem...
Thanks for your answer Herzallah. But how do you treat the Class II malocclusion after the eruption of permanent canines?
Hi Ghulam,
Thanks for your answer. Could you tell me which fixed appliance do you use?
Best wishes,
Klaus
for compliance pasien used bionator or twin block
non compliance used jumper or herbs
I use usually:
- Klammt (in some cases + Hg)
-Twin-block (in some cases + Hg)
- in some cases Lehmann
I used for compliance patient bionator and non compliance herbs or forays
Twin block treatment is described in two stages—active and support phases.
Stage 1: Active Phase
Twin blocks are used in the active phase to correct the anteroposterior relationship and establish the correct vertical
dimension. In all functional therapy, sagittal correction
is achieved before vertical development of posterior
teeth is complete. The vertical dimension is controlled by adjusting (trimming) the bite blocks. Throughout the
trimming phase, it is important to maintain the leading
edge of the inclined plane. Around 1–2 mm of acrylic is removed at each visit to allow the lower molar eruption,
more than which would encourage tongue thrusting.
In open bite and vertical growth patterns, bite blocks are not trimmed allowing an intrusive force to be delivered to the posteriors while the anterior teeth are free to
erupt. At the end of this phase, overjet, overbite and distal occlusion should be fully corrected. This phase
lasts for an average of 6–9 months.
Stage 2: Support Phase
The aim of this phase is to maintain the corrected incisor
relationship until the buccal segment occlusion is fully established. Once this phase is accomplished, twin blocks
are replaced with an upper Hawley-type appliance with
an anterior inclined plane to engage the lower incisors and canine. The lower twin block is left out at this stage;
this allows the posterior teeth to erupt freely. This helps
in settling the occlusion. Duration of this phase is usually
3–6 months.
Maxillary anteriors can be retracted with labial bow in removable functional appliances such as twin-block. However, if you are using a fixed functional appliance such as forsus, then you can control the inclination of maxillary anteriors with fixed braces.
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