Ffa Esthetic
8
Hindawi Publishing Corporation Case Reports in Dentistry Volume , Article ID , pages http://dx.doi.org/.// Case Report The Hybrid Aesthetic Functional (HAF) Appliance: A Less Visible Proposal for Functional Orthodontics Christos Livas Department of Orthodont ics, University of Groningen, University Medical Center Gronin gen, Hanzeplein . Postb us ., RB Gronin gen, Te Nether lands Correspondence should be addressed to Christos Livas; [email protected] Received May ; Accept ed July Academic Editors: G. G´ omez-Moreno, M. A. de A. M. Machado, and U. Zilberman Copy right © Christos Livas . Tis is an openaccess artic le distribut ed underthe Crea tive Commons At tribu tionLicense, which permits unrestricted use, distribution, and reproductio n in any medium, provided the original work is properly cited. In moder n ortho don tics, aesth etics app ear to have a decis ive inue nce on ortho don tic app lian ce pre ere nces and acce ptab ility . Tis paper reports the early application o a newly emerged unctional device with enhanced aesthetics in a Class II treatment. Patient perspectives and technical considerations are discussed along with recommendations or urther design development. It can be assumed that the use o thermoplastic material-based appliances may meet both the therapeutic and aesthetic demands o young age groups. 1. Introduction Contempor ary ort hodontic tec hnology is und oubtedly driven by the growing interest o the public or aesthetically adva nced trea tment optio ns. Reecti ng this trend, alte rnati ve orthodontic systems, such as clear aligners and lingual appli- ances, have been perceived by patients as the most appealing in rel ation to diff ere nt type s o buc cal xe d at tac hme nts [ , ]. Acceptability and attractiveness o vacuum ormed aligners were rated also high in children and adolescents and showed an increase by age evolution pattern, resembling the con- cl usi onso adultstudies[ ]. Moreover, appliance nonvisibility has been attributed grea ter intellectual abili ty , a ndin g which,eve n in itsextre mit y , mayindic at e the imp acto ort ho- dontic appliance design on social perceptions [ ]. Clinicians are nowada ys enab led to select r om a wi de va ri et y o clear tray trademarks that guide gradual tooth movement by mea ns o a ser ieso cus tom-madere mov abl e dev ice s to sa tis y patient’ s aesthetic demands with respect to appliance appear- ance. o our knowledge, up to this date, thermoplastic mate- rials have not been engaged in the construction o unc- tional orthopaedic devices. Tis article describes the design and clinical application o the prototype o the novel HAF appliance, a concept, which may bridge the gap between aesthetic preerences o young patients and hitherto dento- acial orthopaedics. 2. Appliance Design and Fabrication As the title implies, HAF appliance is intended to integrate aesthetics in unctional orthodontic therapy. It is o double plate design, consisting o thermoplastic and acrylic parts (Figure ). Te upper component is a vacuum ormed plate, made o trans pare nt hard -elas tic polyet hylen e sheet with mm-thic kness , equi pped with an acrylic adva ncemen t bar positioned in the anterior midpalatal region. Similarly, the lower plate is constructed by thermoplastic material o the same width that covers totally the six anterior teeth. An acrylic guidance surace is placed over the plastic coverage on the lingual suraces o lower incisors and canines, aimed to t the upper bar. wo- sid ed arms are extended ro m the acrylic resin body up to second molars adapted to the morphology o lingual vestibule. o obtain optimal shape matching o the opposing attachments, the working casts are mounted on a semiadjustable articulator to contact in an end-to-end relationship, previously clinically registered with a construction bite. Posterior teeth are intentionally exposed to acilitate eruption and leveling o a deep curve o Spee. White colored acrylic resin is used or the abrication
Transcript of Ffa Esthetic
8112019 Ffa Esthetic
httpslidepdfcomreaderfullffa-esthetic 18
Hindawi Publishing CorporationCase Reports in Dentistry Volume 983090983088983089983091 Article ID 983090983097983096983094983095983089 983095 pageshttpdxdoiorg983089983088983089983089983093983093983090983088983089983091983090983097983096983094983095983089
Case Report The Hybrid Aesthetic Functional (HAF) Appliance A Less
Visible Proposal for Functional Orthodontics
Christos Livas
Department of Orthodontics University of Groningen University Medical Center Groningen Hanzeplein 983089 Postbus 983091983088983088983088983089983097983095983088983088 RB Groningen Te Netherlands
Correspondence should be addressed to Christos Livas clivasumcgnl
Received 983091983089 May 983090983088983089983091 Accepted 983090 July 983090983088983089983091
Academic Editors G Gomez-Moreno M A de A M Machado and U Zilberman
Copyright copy 983090983088983089983091 Christos Livas Tis is an openaccess article distributed underthe Creative Commons AttributionLicense whichpermits unrestricted use distribution and reproduction in any medium provided the original work is properly cited
In modern orthodontics aesthetics appear to have a decisive in1047298uence on orthodontic appliance preerences and acceptability Tispaper reports the early application o a newly emerged unctional device with enhanced aesthetics in a Class II treatment Patientperspectives and technical considerations are discussed along with recommendations or urther design development It can beassumed that the use o thermoplastic material-based appliances may meet both the therapeutic and aesthetic demands o youngage groups
1 Introduction
Contemporary orthodontic technology is undoubtedly driven by the growing interest o the public or aesthetically advanced treatment options Re1047298ecting this trend alternativeorthodontic systems such as clear aligners and lingual appli-ances have been perceived by patients as the most appealingin relation to different types o buccal 1047297xed attachments [983089 983090]Acceptability and attractiveness o vacuum ormed alignerswere rated also high in children and adolescents and showedan increase by age evolution pattern resembling the con-clusionso adultstudies[983091] Moreoverappliancenonvisibility
has been attributed greater intellectual ability a 1047297ndingwhich even in itsextremity mayindicate the impact o ortho-dontic appliance design on social perceptions [983090] Cliniciansare nowadays enabled to select rom a wide variety o clear tray trademarks that guide gradual tooth movement by means o a serieso custom-made removable devices to satisy patientrsquos aesthetic demands with respect to appliance appear-ance
o our knowledge up to this date thermoplastic mate-rials have not been engaged in the construction o unc-tional orthopaedic devices Tis article describes the designand clinical application o the prototype o the novel HAFappliance a concept which may bridge the gap between
aesthetic preerences o young patients and hitherto dento-acial orthopaedics
2 Appliance Design and Fabrication
As the title implies HAF appliance is intended to integrateaesthetics in unctional orthodontic therapy It is o doubleplate design consisting o thermoplastic and acrylic parts(Figure 983089) Te upper component is a vacuum ormed platemade o transparent hard-elastic polyethylene sheet with983090 mm-thickness equipped with an acrylic advancement barpositioned in the anterior midpalatal region Similarly the
lower plate is constructed by thermoplastic material o thesame width that covers totally the six anterior teeth Anacrylic guidance surace is placed over the plastic coverageon the lingual suraces o lower incisors and canines aimedto 1047297t the upper bar wo-sided arms are extended romthe acrylic resin body up to second molars adapted to themorphology o lingual vestibule o obtain optimal shapematching o the opposing attachments the working castsare mounted on a semiadjustable articulator to contact inan end-to-end relationship previously clinically registeredwith a construction bite Posterior teeth are intentionally exposed to acilitate eruption and leveling o a deep curve o Spee White colored acrylic resin is used or the abrication
8112019 Ffa Esthetic
httpslidepdfcomreaderfullffa-esthetic 28
983090 Case Reports in Dentistry
3
3
1
2
F983145983143983157983154983141 983089 Schematic diagram o HAF appliance design (983089) Advancement bar (983090) Guiding surace (983091) Buttons (in blue ink thermoplasticparts in red ink acrylic parts)
(a) (b)
(c) (d)
F983145983143983157983154983141 983090 Pretreatment records (a) extraoral pro1047297le photo (b) dental casts (c) panoramic radiograph and (d) cephalometric radiograph
8112019 Ffa Esthetic
httpslidepdfcomreaderfullffa-esthetic 38
Case Reports in Dentistry 983091
(a) (b)
F983145983143983157983154983141 983091 (a) Extraoral and (b) intraoral views o the HAF appliance used in this treatment
(a) (b)
F983145983143983157983154983141 983092 Intermediate records (a) extraoral pro1047297le photo and (b) intraoral photos
o acrylic parts to enhance esthetics By means o a specialplier buttons are ormed at the cervical third o upper andlower dental midlines to enable night-time wear o verticalelastics Alternatively light-cured composite resin combinedwith appropriate transparent matrices can be used or buttonconstruction
3 Case
983091983089 Diagnosis and reatment Plan An 983089983089983094-year-old emalewas diagnosed with bilateral ull cusp width Class II relation-ship overjet o 983089983089 mm overbite o 983093 mm and mild crowdeddental arches (Figure 983090) Extraorally the patient presented
8112019 Ffa Esthetic
httpslidepdfcomreaderfullffa-esthetic 48
983092 Case Reports in Dentistry
F983145983143983157983154983141 983093 Intraoral photos with 1047297xed appliances placed on both arches afer a 983089983088-month period in treatment
a convex pro1047297le with slightly prominent chin Radiographic
examination revealed signs o external apical root resorptionor maxillary incisors probably due to past occlusal traumaduring bruxism activity Te treatment plan included twophases an initial unctional appliance stage or sagittalcorrection through mandibular advancement ollowing by limited ull1047297xed mechanics to establishavorable tooth align-ment and intercuspation Appointments were determinedon 983092-week intervals as generally suggested or compliance-dependent appliances [983092]
983091983090 reatment Progress and Results Torough instructionswere given to the patient and her parents or appliance inser-tion removal and maintenance (Figure 983091) Te patient was
tutored in ront o a mirror to advance her mandible whileclosing the mouth in order to achieve matching o the acrylicsuraces A minimum o 983089983092 hours including bed time was pre-scribed or appliance wearing Vertical intermaxillary elasticuse was advised during sleeping to ensure mouth closure inthe desired end-to-end relationship Finally the patient wasasked to record hersel the daily appliance wear which waschecked by the specialist at the beginning o each session
Class I molar relationship was reached within eightmonths (Figure 983092) Immediately afer Quick System (Fore-stadent Porzheim Germany httpwwworestadentde)sel-ligating brackets (983088983090983090 slots Roth prescription) werebonded in the mandibular arch while the upper plate served
shortly as anterior bite plane Eight weeks later 1047297xed appli-
ances were also placed on maxillary teeth rom 1047297rst molarto 1047297rst molar (Figure 983093) Light orce application was practisedthroughout 1047297xed appliance phase to prevent aggravationo root resorption [983093] Without persisting on detailed rootpositioning appliances were debonded afer seven months(Figure 983094) Pretreatment overjet and overbite values werereduced to 983092 and 983090 mm respectively In total the two-stage treatment lasted seventeen months Canine-to-caninebonded 1047298exible spiral wire lingual retainers were placed onboth arches or permanent retention Additionally an upperHawley type retainer with anterior bite plane was prescribedor night-time wear aiming to prevent deep bite relapse
4 Discussion
Tis case report has demonstrated a successul 983090-phase treat-ment o a Class II division 983089 malocclusion including sequen-tial use o a new ldquojumping the biterdquo device and 1047297xed ortho-dontics As indicated by the superimposition o the pre-and posttreatment cephalometric radiographs (Figure 983095) theinitial anteroposterior discrepancy has been corrected by treatment and growth associated effects namely orward anddownward translation o the mandible in combination withreciprocal and opposite in direction maxillary and mandibu-lar incisor tooth movement Randomized clinical trials thatinvestigated potential skeletal outcomes o various unctional
8112019 Ffa Esthetic
httpslidepdfcomreaderfullffa-esthetic 58
Case Reports in Dentistry 983093
(a) (b)
(c) (d)
F983145983143983157983154983141 983094 Posttreatment records (a) extraoral pro1047297le photo (b) dental casts (c) panoramic radiograph and (d) cephalometric radiograph
appliances [983094ndash983096] demonstrated small but statistically signi1047297-cant differences in mandibular length and especially higher
effectiveness o ldquojumping the biterdquo appliances such as Herbstand win-Block compared to Andresen activator and relatedpassive devices [983097]
We were motivated to devise an aesthetically attractiveremovable appliance with complete lack o metal partslargely transparent appearance diminished bulkiness toavoid patient discomort and relatively less demanding labo-ratory abrication Ziuchkovski et al [983089] concluded thatappliance attractiveness is inversely affected by the amounto visibility o metal parts Likewise best accepted unctionalappliances have been ound to be the ones with reducedacrylic coverage occupying little space intraorally On thecontrary appliances o design and shape causing excessive
interocclusal opening with subsequent sof tissue tension andlip incompetence or constraining the tongue were the least
approved [983089983088]Patient compliance maniested as sufficient wear time o the removable appliance is a major prerequisite or treatmentsuccess Wear time prescription usually ranges rom 983089983091 to983089983094 hours per day and derives rom empirical nonevidence-based data owing to lack o objective measures and docu-mentation However when it comes to real lie 983096 out o 983089983088children may appear unwilling to extend plate use beyondnight span [983089983089] Under such conditions the actual wear timemight decline to 983097983093 hours daily and jeopardize a successultherapeutic outcome According to the case records thepatient appeared to wear the appliance or approximately 983089983090983093each day which practically proved to be sufficient to ul1047297ll
8112019 Ffa Esthetic
httpslidepdfcomreaderfullffa-esthetic 68
983094 Case Reports in Dentistry
F983145983143983157983154983141 983095 Superimposition o pre- and posttreatment cephalometric tracings
treatment requirements Interestingly she ound it difficultto keep the intermaxillary elastics in place while sleepingand eventually abandoned elastic use From a technicalperspective this act questions the number and location o buttons or even the presence o this eature per se in prospec-tive versions Modi1047297cations such as extension o the plasticcoverage o the lower plate in avour o retention radical
reduction o the acrylic resin and revision o matching o anterior attachments may be as well considered
Our initiative wasto demonstrate one o our 1047297rst attemptsto produce a less visible and patient riendly unctionaldevice Case reports inherently do not add rigorous sci-enti1047297c evidence Tus de1047297nite statements on the clinicalperormance o HAF appliance cannot be made Overall thedevelopment o a new appliance concept is a time-consumingprocess that necessitates meticulous observation and respec-tive structural adjustment Albeit the limited impact o ourcase presentation andearly developmental stage o the deviceHAF appliance treatment appeared to be bene1047297cial and may deserve urther research attention
o conclude usingsubsequently a novel unctional deviceand 1047297xed appliances the sagittal skeletal discrepancy o ayoung emale was corrected Auxiliary development andclinical testing are required to augment the technical eaturesand elucidate the treatment efficiency and effects o HAFappliance On the whole thermoplastic materials may bepotentially utilized in the abrication o unctional orthodon-tic appliances
Acknowledgment
Te author wishes to thank MSgt (D) Panagiotis Moura-tidis laboratory technician Department o Orthodontics 983090983093983089
Hellenic Air Force VA General Hospital Athens Greece ortechnical support
References
[983089] J P Ziuchkovski H W Fields W M Johnston and D Lindsey ldquoAssessmento perceived orthodonticappliance attrac-tivenessrdquo Te American Journal of Orthodontics and Dentofacial Orthopedics vol 983089983091983091 supplement 983092 pp S983094983096ndashS983095983096 983090983088983088983096
[983090] H G Jeremiah D Bister and J Newton ldquoSocial perceptionso adults wearing orthodontic appliances a cross-sectionalstudyrdquo European Journal of Orthodontics vol 983091983091 no 983093 pp 983092983095983094ndash983092983096983090 983090983088983089983089
[983091] D K Walton H W Fields W M Johnston S F RosenstielA R Firestone and J C Christensen ldquoOrthodontic appliancepreerences o children and adolescentsrdquo Te American Journal of Orthodontics and Dentofacial Orthopedics vol 983089983091983096 no 983094 pp983094983097983096e983089ndash983094983097983096e983089983090 983090983088983089983088
[983092] L Jerrold and N Naghavi ldquoEvidence-based considerationsor determining appointment intervalsrdquo Journal of Clinical
Orthodontics vol 983092983093 no 983095 pp 983091983095983097ndash983091983096983091 983090983088983089983089
[983093] B Weltman K W L Vig H W Fields S Shanker and EE Kaizar ldquoRoot resorption associated with orthodontic toothmovementa systematicreviewrdquo Te AmericanJournal of Ortho-dontics and Dentofacial Orthopedics vol 983089983091983095 no 983092 pp 983092983094983090ndash983092983095983094983090983088983089983088
[983094] H Pancherz ldquoTe mechanism o Class II correction in Herbstappliance treatment A cephalometric investigationrdquo Te Amer-ican Journal of Orthodontics vol 983096983090 no 983090 pp 983089983088983092ndash983089983089983091 983089983097983096983090
[983095] D I Lund and P J Sandler ldquoTe effects o twin blocks aprospective controlled studyrdquo Te American Journal of Ortho-dontics and Dentofacial Orthopedics vol 983089983089983091 no 983089 pp 983089983088983092ndash983089983089983088983089983097983097983096
8112019 Ffa Esthetic
httpslidepdfcomreaderfullffa-esthetic 78
Case Reports in Dentistry 983095
[983096] K OrsquoBrien J Wright F Conboy et al ldquoEffectiveness o early orthodontic treatment with the twin-block appliance a multi-center randomized controlled trialmdashpart 983089 dental and skeletaleffectsrdquo Te American Journal of Orthodontics and Dentofacial Orthopedics vol 983089983090983092 no 983091 pp 983090983091983092ndash983090983092983091 983090983088983088983091
[983097] M C Meikle ldquoRemodeling the dentoacial skeleton the biolog-ical basis o orthodontics and dentoacial orthopedicsrdquo Journal of Dental Research vol 983096983094 no 983089 pp 983089983090ndash983090983092 983090983088983088983095
[983089983088] H G Sergl andA Zentner ldquoA comparative assessment o accep-tance o different types o unctional appliancesrdquo European Journal of Orthodontics vol 983090983088 no 983093 pp 983093983089983095ndash983093983090983092 983089983097983097983096
[983089983089] C Schott and G Goz ldquoYoung patientsrsquo attitudes towardremovable appliance wear times wear-time instructions andelectronic wear-time measurementsmdashresults o a questionnairestudyrdquo Journal of Orofacial Orthopedics vol 983095983089 no 983090 pp 983089983088983096ndash983089983089983094 983090983088983089983088
8112019 Ffa Esthetic
httpslidepdfcomreaderfullffa-esthetic 88
Submit your manuscripts at
httpwwwhindawicom
8112019 Ffa Esthetic
httpslidepdfcomreaderfullffa-esthetic 28
983090 Case Reports in Dentistry
3
3
1
2
F983145983143983157983154983141 983089 Schematic diagram o HAF appliance design (983089) Advancement bar (983090) Guiding surace (983091) Buttons (in blue ink thermoplasticparts in red ink acrylic parts)
(a) (b)
(c) (d)
F983145983143983157983154983141 983090 Pretreatment records (a) extraoral pro1047297le photo (b) dental casts (c) panoramic radiograph and (d) cephalometric radiograph
8112019 Ffa Esthetic
httpslidepdfcomreaderfullffa-esthetic 38
Case Reports in Dentistry 983091
(a) (b)
F983145983143983157983154983141 983091 (a) Extraoral and (b) intraoral views o the HAF appliance used in this treatment
(a) (b)
F983145983143983157983154983141 983092 Intermediate records (a) extraoral pro1047297le photo and (b) intraoral photos
o acrylic parts to enhance esthetics By means o a specialplier buttons are ormed at the cervical third o upper andlower dental midlines to enable night-time wear o verticalelastics Alternatively light-cured composite resin combinedwith appropriate transparent matrices can be used or buttonconstruction
3 Case
983091983089 Diagnosis and reatment Plan An 983089983089983094-year-old emalewas diagnosed with bilateral ull cusp width Class II relation-ship overjet o 983089983089 mm overbite o 983093 mm and mild crowdeddental arches (Figure 983090) Extraorally the patient presented
8112019 Ffa Esthetic
httpslidepdfcomreaderfullffa-esthetic 48
983092 Case Reports in Dentistry
F983145983143983157983154983141 983093 Intraoral photos with 1047297xed appliances placed on both arches afer a 983089983088-month period in treatment
a convex pro1047297le with slightly prominent chin Radiographic
examination revealed signs o external apical root resorptionor maxillary incisors probably due to past occlusal traumaduring bruxism activity Te treatment plan included twophases an initial unctional appliance stage or sagittalcorrection through mandibular advancement ollowing by limited ull1047297xed mechanics to establishavorable tooth align-ment and intercuspation Appointments were determinedon 983092-week intervals as generally suggested or compliance-dependent appliances [983092]
983091983090 reatment Progress and Results Torough instructionswere given to the patient and her parents or appliance inser-tion removal and maintenance (Figure 983091) Te patient was
tutored in ront o a mirror to advance her mandible whileclosing the mouth in order to achieve matching o the acrylicsuraces A minimum o 983089983092 hours including bed time was pre-scribed or appliance wearing Vertical intermaxillary elasticuse was advised during sleeping to ensure mouth closure inthe desired end-to-end relationship Finally the patient wasasked to record hersel the daily appliance wear which waschecked by the specialist at the beginning o each session
Class I molar relationship was reached within eightmonths (Figure 983092) Immediately afer Quick System (Fore-stadent Porzheim Germany httpwwworestadentde)sel-ligating brackets (983088983090983090 slots Roth prescription) werebonded in the mandibular arch while the upper plate served
shortly as anterior bite plane Eight weeks later 1047297xed appli-
ances were also placed on maxillary teeth rom 1047297rst molarto 1047297rst molar (Figure 983093) Light orce application was practisedthroughout 1047297xed appliance phase to prevent aggravationo root resorption [983093] Without persisting on detailed rootpositioning appliances were debonded afer seven months(Figure 983094) Pretreatment overjet and overbite values werereduced to 983092 and 983090 mm respectively In total the two-stage treatment lasted seventeen months Canine-to-caninebonded 1047298exible spiral wire lingual retainers were placed onboth arches or permanent retention Additionally an upperHawley type retainer with anterior bite plane was prescribedor night-time wear aiming to prevent deep bite relapse
4 Discussion
Tis case report has demonstrated a successul 983090-phase treat-ment o a Class II division 983089 malocclusion including sequen-tial use o a new ldquojumping the biterdquo device and 1047297xed ortho-dontics As indicated by the superimposition o the pre-and posttreatment cephalometric radiographs (Figure 983095) theinitial anteroposterior discrepancy has been corrected by treatment and growth associated effects namely orward anddownward translation o the mandible in combination withreciprocal and opposite in direction maxillary and mandibu-lar incisor tooth movement Randomized clinical trials thatinvestigated potential skeletal outcomes o various unctional
8112019 Ffa Esthetic
httpslidepdfcomreaderfullffa-esthetic 58
Case Reports in Dentistry 983093
(a) (b)
(c) (d)
F983145983143983157983154983141 983094 Posttreatment records (a) extraoral pro1047297le photo (b) dental casts (c) panoramic radiograph and (d) cephalometric radiograph
appliances [983094ndash983096] demonstrated small but statistically signi1047297-cant differences in mandibular length and especially higher
effectiveness o ldquojumping the biterdquo appliances such as Herbstand win-Block compared to Andresen activator and relatedpassive devices [983097]
We were motivated to devise an aesthetically attractiveremovable appliance with complete lack o metal partslargely transparent appearance diminished bulkiness toavoid patient discomort and relatively less demanding labo-ratory abrication Ziuchkovski et al [983089] concluded thatappliance attractiveness is inversely affected by the amounto visibility o metal parts Likewise best accepted unctionalappliances have been ound to be the ones with reducedacrylic coverage occupying little space intraorally On thecontrary appliances o design and shape causing excessive
interocclusal opening with subsequent sof tissue tension andlip incompetence or constraining the tongue were the least
approved [983089983088]Patient compliance maniested as sufficient wear time o the removable appliance is a major prerequisite or treatmentsuccess Wear time prescription usually ranges rom 983089983091 to983089983094 hours per day and derives rom empirical nonevidence-based data owing to lack o objective measures and docu-mentation However when it comes to real lie 983096 out o 983089983088children may appear unwilling to extend plate use beyondnight span [983089983089] Under such conditions the actual wear timemight decline to 983097983093 hours daily and jeopardize a successultherapeutic outcome According to the case records thepatient appeared to wear the appliance or approximately 983089983090983093each day which practically proved to be sufficient to ul1047297ll
8112019 Ffa Esthetic
httpslidepdfcomreaderfullffa-esthetic 68
983094 Case Reports in Dentistry
F983145983143983157983154983141 983095 Superimposition o pre- and posttreatment cephalometric tracings
treatment requirements Interestingly she ound it difficultto keep the intermaxillary elastics in place while sleepingand eventually abandoned elastic use From a technicalperspective this act questions the number and location o buttons or even the presence o this eature per se in prospec-tive versions Modi1047297cations such as extension o the plasticcoverage o the lower plate in avour o retention radical
reduction o the acrylic resin and revision o matching o anterior attachments may be as well considered
Our initiative wasto demonstrate one o our 1047297rst attemptsto produce a less visible and patient riendly unctionaldevice Case reports inherently do not add rigorous sci-enti1047297c evidence Tus de1047297nite statements on the clinicalperormance o HAF appliance cannot be made Overall thedevelopment o a new appliance concept is a time-consumingprocess that necessitates meticulous observation and respec-tive structural adjustment Albeit the limited impact o ourcase presentation andearly developmental stage o the deviceHAF appliance treatment appeared to be bene1047297cial and may deserve urther research attention
o conclude usingsubsequently a novel unctional deviceand 1047297xed appliances the sagittal skeletal discrepancy o ayoung emale was corrected Auxiliary development andclinical testing are required to augment the technical eaturesand elucidate the treatment efficiency and effects o HAFappliance On the whole thermoplastic materials may bepotentially utilized in the abrication o unctional orthodon-tic appliances
Acknowledgment
Te author wishes to thank MSgt (D) Panagiotis Moura-tidis laboratory technician Department o Orthodontics 983090983093983089
Hellenic Air Force VA General Hospital Athens Greece ortechnical support
References
[983089] J P Ziuchkovski H W Fields W M Johnston and D Lindsey ldquoAssessmento perceived orthodonticappliance attrac-tivenessrdquo Te American Journal of Orthodontics and Dentofacial Orthopedics vol 983089983091983091 supplement 983092 pp S983094983096ndashS983095983096 983090983088983088983096
[983090] H G Jeremiah D Bister and J Newton ldquoSocial perceptionso adults wearing orthodontic appliances a cross-sectionalstudyrdquo European Journal of Orthodontics vol 983091983091 no 983093 pp 983092983095983094ndash983092983096983090 983090983088983089983089
[983091] D K Walton H W Fields W M Johnston S F RosenstielA R Firestone and J C Christensen ldquoOrthodontic appliancepreerences o children and adolescentsrdquo Te American Journal of Orthodontics and Dentofacial Orthopedics vol 983089983091983096 no 983094 pp983094983097983096e983089ndash983094983097983096e983089983090 983090983088983089983088
[983092] L Jerrold and N Naghavi ldquoEvidence-based considerationsor determining appointment intervalsrdquo Journal of Clinical
Orthodontics vol 983092983093 no 983095 pp 983091983095983097ndash983091983096983091 983090983088983089983089
[983093] B Weltman K W L Vig H W Fields S Shanker and EE Kaizar ldquoRoot resorption associated with orthodontic toothmovementa systematicreviewrdquo Te AmericanJournal of Ortho-dontics and Dentofacial Orthopedics vol 983089983091983095 no 983092 pp 983092983094983090ndash983092983095983094983090983088983089983088
[983094] H Pancherz ldquoTe mechanism o Class II correction in Herbstappliance treatment A cephalometric investigationrdquo Te Amer-ican Journal of Orthodontics vol 983096983090 no 983090 pp 983089983088983092ndash983089983089983091 983089983097983096983090
[983095] D I Lund and P J Sandler ldquoTe effects o twin blocks aprospective controlled studyrdquo Te American Journal of Ortho-dontics and Dentofacial Orthopedics vol 983089983089983091 no 983089 pp 983089983088983092ndash983089983089983088983089983097983097983096
8112019 Ffa Esthetic
httpslidepdfcomreaderfullffa-esthetic 78
Case Reports in Dentistry 983095
[983096] K OrsquoBrien J Wright F Conboy et al ldquoEffectiveness o early orthodontic treatment with the twin-block appliance a multi-center randomized controlled trialmdashpart 983089 dental and skeletaleffectsrdquo Te American Journal of Orthodontics and Dentofacial Orthopedics vol 983089983090983092 no 983091 pp 983090983091983092ndash983090983092983091 983090983088983088983091
[983097] M C Meikle ldquoRemodeling the dentoacial skeleton the biolog-ical basis o orthodontics and dentoacial orthopedicsrdquo Journal of Dental Research vol 983096983094 no 983089 pp 983089983090ndash983090983092 983090983088983088983095
[983089983088] H G Sergl andA Zentner ldquoA comparative assessment o accep-tance o different types o unctional appliancesrdquo European Journal of Orthodontics vol 983090983088 no 983093 pp 983093983089983095ndash983093983090983092 983089983097983097983096
[983089983089] C Schott and G Goz ldquoYoung patientsrsquo attitudes towardremovable appliance wear times wear-time instructions andelectronic wear-time measurementsmdashresults o a questionnairestudyrdquo Journal of Orofacial Orthopedics vol 983095983089 no 983090 pp 983089983088983096ndash983089983089983094 983090983088983089983088
8112019 Ffa Esthetic
httpslidepdfcomreaderfullffa-esthetic 88
Submit your manuscripts at
httpwwwhindawicom
8112019 Ffa Esthetic
httpslidepdfcomreaderfullffa-esthetic 38
Case Reports in Dentistry 983091
(a) (b)
F983145983143983157983154983141 983091 (a) Extraoral and (b) intraoral views o the HAF appliance used in this treatment
(a) (b)
F983145983143983157983154983141 983092 Intermediate records (a) extraoral pro1047297le photo and (b) intraoral photos
o acrylic parts to enhance esthetics By means o a specialplier buttons are ormed at the cervical third o upper andlower dental midlines to enable night-time wear o verticalelastics Alternatively light-cured composite resin combinedwith appropriate transparent matrices can be used or buttonconstruction
3 Case
983091983089 Diagnosis and reatment Plan An 983089983089983094-year-old emalewas diagnosed with bilateral ull cusp width Class II relation-ship overjet o 983089983089 mm overbite o 983093 mm and mild crowdeddental arches (Figure 983090) Extraorally the patient presented
8112019 Ffa Esthetic
httpslidepdfcomreaderfullffa-esthetic 48
983092 Case Reports in Dentistry
F983145983143983157983154983141 983093 Intraoral photos with 1047297xed appliances placed on both arches afer a 983089983088-month period in treatment
a convex pro1047297le with slightly prominent chin Radiographic
examination revealed signs o external apical root resorptionor maxillary incisors probably due to past occlusal traumaduring bruxism activity Te treatment plan included twophases an initial unctional appliance stage or sagittalcorrection through mandibular advancement ollowing by limited ull1047297xed mechanics to establishavorable tooth align-ment and intercuspation Appointments were determinedon 983092-week intervals as generally suggested or compliance-dependent appliances [983092]
983091983090 reatment Progress and Results Torough instructionswere given to the patient and her parents or appliance inser-tion removal and maintenance (Figure 983091) Te patient was
tutored in ront o a mirror to advance her mandible whileclosing the mouth in order to achieve matching o the acrylicsuraces A minimum o 983089983092 hours including bed time was pre-scribed or appliance wearing Vertical intermaxillary elasticuse was advised during sleeping to ensure mouth closure inthe desired end-to-end relationship Finally the patient wasasked to record hersel the daily appliance wear which waschecked by the specialist at the beginning o each session
Class I molar relationship was reached within eightmonths (Figure 983092) Immediately afer Quick System (Fore-stadent Porzheim Germany httpwwworestadentde)sel-ligating brackets (983088983090983090 slots Roth prescription) werebonded in the mandibular arch while the upper plate served
shortly as anterior bite plane Eight weeks later 1047297xed appli-
ances were also placed on maxillary teeth rom 1047297rst molarto 1047297rst molar (Figure 983093) Light orce application was practisedthroughout 1047297xed appliance phase to prevent aggravationo root resorption [983093] Without persisting on detailed rootpositioning appliances were debonded afer seven months(Figure 983094) Pretreatment overjet and overbite values werereduced to 983092 and 983090 mm respectively In total the two-stage treatment lasted seventeen months Canine-to-caninebonded 1047298exible spiral wire lingual retainers were placed onboth arches or permanent retention Additionally an upperHawley type retainer with anterior bite plane was prescribedor night-time wear aiming to prevent deep bite relapse
4 Discussion
Tis case report has demonstrated a successul 983090-phase treat-ment o a Class II division 983089 malocclusion including sequen-tial use o a new ldquojumping the biterdquo device and 1047297xed ortho-dontics As indicated by the superimposition o the pre-and posttreatment cephalometric radiographs (Figure 983095) theinitial anteroposterior discrepancy has been corrected by treatment and growth associated effects namely orward anddownward translation o the mandible in combination withreciprocal and opposite in direction maxillary and mandibu-lar incisor tooth movement Randomized clinical trials thatinvestigated potential skeletal outcomes o various unctional
8112019 Ffa Esthetic
httpslidepdfcomreaderfullffa-esthetic 58
Case Reports in Dentistry 983093
(a) (b)
(c) (d)
F983145983143983157983154983141 983094 Posttreatment records (a) extraoral pro1047297le photo (b) dental casts (c) panoramic radiograph and (d) cephalometric radiograph
appliances [983094ndash983096] demonstrated small but statistically signi1047297-cant differences in mandibular length and especially higher
effectiveness o ldquojumping the biterdquo appliances such as Herbstand win-Block compared to Andresen activator and relatedpassive devices [983097]
We were motivated to devise an aesthetically attractiveremovable appliance with complete lack o metal partslargely transparent appearance diminished bulkiness toavoid patient discomort and relatively less demanding labo-ratory abrication Ziuchkovski et al [983089] concluded thatappliance attractiveness is inversely affected by the amounto visibility o metal parts Likewise best accepted unctionalappliances have been ound to be the ones with reducedacrylic coverage occupying little space intraorally On thecontrary appliances o design and shape causing excessive
interocclusal opening with subsequent sof tissue tension andlip incompetence or constraining the tongue were the least
approved [983089983088]Patient compliance maniested as sufficient wear time o the removable appliance is a major prerequisite or treatmentsuccess Wear time prescription usually ranges rom 983089983091 to983089983094 hours per day and derives rom empirical nonevidence-based data owing to lack o objective measures and docu-mentation However when it comes to real lie 983096 out o 983089983088children may appear unwilling to extend plate use beyondnight span [983089983089] Under such conditions the actual wear timemight decline to 983097983093 hours daily and jeopardize a successultherapeutic outcome According to the case records thepatient appeared to wear the appliance or approximately 983089983090983093each day which practically proved to be sufficient to ul1047297ll
8112019 Ffa Esthetic
httpslidepdfcomreaderfullffa-esthetic 68
983094 Case Reports in Dentistry
F983145983143983157983154983141 983095 Superimposition o pre- and posttreatment cephalometric tracings
treatment requirements Interestingly she ound it difficultto keep the intermaxillary elastics in place while sleepingand eventually abandoned elastic use From a technicalperspective this act questions the number and location o buttons or even the presence o this eature per se in prospec-tive versions Modi1047297cations such as extension o the plasticcoverage o the lower plate in avour o retention radical
reduction o the acrylic resin and revision o matching o anterior attachments may be as well considered
Our initiative wasto demonstrate one o our 1047297rst attemptsto produce a less visible and patient riendly unctionaldevice Case reports inherently do not add rigorous sci-enti1047297c evidence Tus de1047297nite statements on the clinicalperormance o HAF appliance cannot be made Overall thedevelopment o a new appliance concept is a time-consumingprocess that necessitates meticulous observation and respec-tive structural adjustment Albeit the limited impact o ourcase presentation andearly developmental stage o the deviceHAF appliance treatment appeared to be bene1047297cial and may deserve urther research attention
o conclude usingsubsequently a novel unctional deviceand 1047297xed appliances the sagittal skeletal discrepancy o ayoung emale was corrected Auxiliary development andclinical testing are required to augment the technical eaturesand elucidate the treatment efficiency and effects o HAFappliance On the whole thermoplastic materials may bepotentially utilized in the abrication o unctional orthodon-tic appliances
Acknowledgment
Te author wishes to thank MSgt (D) Panagiotis Moura-tidis laboratory technician Department o Orthodontics 983090983093983089
Hellenic Air Force VA General Hospital Athens Greece ortechnical support
References
[983089] J P Ziuchkovski H W Fields W M Johnston and D Lindsey ldquoAssessmento perceived orthodonticappliance attrac-tivenessrdquo Te American Journal of Orthodontics and Dentofacial Orthopedics vol 983089983091983091 supplement 983092 pp S983094983096ndashS983095983096 983090983088983088983096
[983090] H G Jeremiah D Bister and J Newton ldquoSocial perceptionso adults wearing orthodontic appliances a cross-sectionalstudyrdquo European Journal of Orthodontics vol 983091983091 no 983093 pp 983092983095983094ndash983092983096983090 983090983088983089983089
[983091] D K Walton H W Fields W M Johnston S F RosenstielA R Firestone and J C Christensen ldquoOrthodontic appliancepreerences o children and adolescentsrdquo Te American Journal of Orthodontics and Dentofacial Orthopedics vol 983089983091983096 no 983094 pp983094983097983096e983089ndash983094983097983096e983089983090 983090983088983089983088
[983092] L Jerrold and N Naghavi ldquoEvidence-based considerationsor determining appointment intervalsrdquo Journal of Clinical
Orthodontics vol 983092983093 no 983095 pp 983091983095983097ndash983091983096983091 983090983088983089983089
[983093] B Weltman K W L Vig H W Fields S Shanker and EE Kaizar ldquoRoot resorption associated with orthodontic toothmovementa systematicreviewrdquo Te AmericanJournal of Ortho-dontics and Dentofacial Orthopedics vol 983089983091983095 no 983092 pp 983092983094983090ndash983092983095983094983090983088983089983088
[983094] H Pancherz ldquoTe mechanism o Class II correction in Herbstappliance treatment A cephalometric investigationrdquo Te Amer-ican Journal of Orthodontics vol 983096983090 no 983090 pp 983089983088983092ndash983089983089983091 983089983097983096983090
[983095] D I Lund and P J Sandler ldquoTe effects o twin blocks aprospective controlled studyrdquo Te American Journal of Ortho-dontics and Dentofacial Orthopedics vol 983089983089983091 no 983089 pp 983089983088983092ndash983089983089983088983089983097983097983096
8112019 Ffa Esthetic
httpslidepdfcomreaderfullffa-esthetic 78
Case Reports in Dentistry 983095
[983096] K OrsquoBrien J Wright F Conboy et al ldquoEffectiveness o early orthodontic treatment with the twin-block appliance a multi-center randomized controlled trialmdashpart 983089 dental and skeletaleffectsrdquo Te American Journal of Orthodontics and Dentofacial Orthopedics vol 983089983090983092 no 983091 pp 983090983091983092ndash983090983092983091 983090983088983088983091
[983097] M C Meikle ldquoRemodeling the dentoacial skeleton the biolog-ical basis o orthodontics and dentoacial orthopedicsrdquo Journal of Dental Research vol 983096983094 no 983089 pp 983089983090ndash983090983092 983090983088983088983095
[983089983088] H G Sergl andA Zentner ldquoA comparative assessment o accep-tance o different types o unctional appliancesrdquo European Journal of Orthodontics vol 983090983088 no 983093 pp 983093983089983095ndash983093983090983092 983089983097983097983096
[983089983089] C Schott and G Goz ldquoYoung patientsrsquo attitudes towardremovable appliance wear times wear-time instructions andelectronic wear-time measurementsmdashresults o a questionnairestudyrdquo Journal of Orofacial Orthopedics vol 983095983089 no 983090 pp 983089983088983096ndash983089983089983094 983090983088983089983088
8112019 Ffa Esthetic
httpslidepdfcomreaderfullffa-esthetic 88
Submit your manuscripts at
httpwwwhindawicom
8112019 Ffa Esthetic
httpslidepdfcomreaderfullffa-esthetic 48
983092 Case Reports in Dentistry
F983145983143983157983154983141 983093 Intraoral photos with 1047297xed appliances placed on both arches afer a 983089983088-month period in treatment
a convex pro1047297le with slightly prominent chin Radiographic
examination revealed signs o external apical root resorptionor maxillary incisors probably due to past occlusal traumaduring bruxism activity Te treatment plan included twophases an initial unctional appliance stage or sagittalcorrection through mandibular advancement ollowing by limited ull1047297xed mechanics to establishavorable tooth align-ment and intercuspation Appointments were determinedon 983092-week intervals as generally suggested or compliance-dependent appliances [983092]
983091983090 reatment Progress and Results Torough instructionswere given to the patient and her parents or appliance inser-tion removal and maintenance (Figure 983091) Te patient was
tutored in ront o a mirror to advance her mandible whileclosing the mouth in order to achieve matching o the acrylicsuraces A minimum o 983089983092 hours including bed time was pre-scribed or appliance wearing Vertical intermaxillary elasticuse was advised during sleeping to ensure mouth closure inthe desired end-to-end relationship Finally the patient wasasked to record hersel the daily appliance wear which waschecked by the specialist at the beginning o each session
Class I molar relationship was reached within eightmonths (Figure 983092) Immediately afer Quick System (Fore-stadent Porzheim Germany httpwwworestadentde)sel-ligating brackets (983088983090983090 slots Roth prescription) werebonded in the mandibular arch while the upper plate served
shortly as anterior bite plane Eight weeks later 1047297xed appli-
ances were also placed on maxillary teeth rom 1047297rst molarto 1047297rst molar (Figure 983093) Light orce application was practisedthroughout 1047297xed appliance phase to prevent aggravationo root resorption [983093] Without persisting on detailed rootpositioning appliances were debonded afer seven months(Figure 983094) Pretreatment overjet and overbite values werereduced to 983092 and 983090 mm respectively In total the two-stage treatment lasted seventeen months Canine-to-caninebonded 1047298exible spiral wire lingual retainers were placed onboth arches or permanent retention Additionally an upperHawley type retainer with anterior bite plane was prescribedor night-time wear aiming to prevent deep bite relapse
4 Discussion
Tis case report has demonstrated a successul 983090-phase treat-ment o a Class II division 983089 malocclusion including sequen-tial use o a new ldquojumping the biterdquo device and 1047297xed ortho-dontics As indicated by the superimposition o the pre-and posttreatment cephalometric radiographs (Figure 983095) theinitial anteroposterior discrepancy has been corrected by treatment and growth associated effects namely orward anddownward translation o the mandible in combination withreciprocal and opposite in direction maxillary and mandibu-lar incisor tooth movement Randomized clinical trials thatinvestigated potential skeletal outcomes o various unctional
8112019 Ffa Esthetic
httpslidepdfcomreaderfullffa-esthetic 58
Case Reports in Dentistry 983093
(a) (b)
(c) (d)
F983145983143983157983154983141 983094 Posttreatment records (a) extraoral pro1047297le photo (b) dental casts (c) panoramic radiograph and (d) cephalometric radiograph
appliances [983094ndash983096] demonstrated small but statistically signi1047297-cant differences in mandibular length and especially higher
effectiveness o ldquojumping the biterdquo appliances such as Herbstand win-Block compared to Andresen activator and relatedpassive devices [983097]
We were motivated to devise an aesthetically attractiveremovable appliance with complete lack o metal partslargely transparent appearance diminished bulkiness toavoid patient discomort and relatively less demanding labo-ratory abrication Ziuchkovski et al [983089] concluded thatappliance attractiveness is inversely affected by the amounto visibility o metal parts Likewise best accepted unctionalappliances have been ound to be the ones with reducedacrylic coverage occupying little space intraorally On thecontrary appliances o design and shape causing excessive
interocclusal opening with subsequent sof tissue tension andlip incompetence or constraining the tongue were the least
approved [983089983088]Patient compliance maniested as sufficient wear time o the removable appliance is a major prerequisite or treatmentsuccess Wear time prescription usually ranges rom 983089983091 to983089983094 hours per day and derives rom empirical nonevidence-based data owing to lack o objective measures and docu-mentation However when it comes to real lie 983096 out o 983089983088children may appear unwilling to extend plate use beyondnight span [983089983089] Under such conditions the actual wear timemight decline to 983097983093 hours daily and jeopardize a successultherapeutic outcome According to the case records thepatient appeared to wear the appliance or approximately 983089983090983093each day which practically proved to be sufficient to ul1047297ll
8112019 Ffa Esthetic
httpslidepdfcomreaderfullffa-esthetic 68
983094 Case Reports in Dentistry
F983145983143983157983154983141 983095 Superimposition o pre- and posttreatment cephalometric tracings
treatment requirements Interestingly she ound it difficultto keep the intermaxillary elastics in place while sleepingand eventually abandoned elastic use From a technicalperspective this act questions the number and location o buttons or even the presence o this eature per se in prospec-tive versions Modi1047297cations such as extension o the plasticcoverage o the lower plate in avour o retention radical
reduction o the acrylic resin and revision o matching o anterior attachments may be as well considered
Our initiative wasto demonstrate one o our 1047297rst attemptsto produce a less visible and patient riendly unctionaldevice Case reports inherently do not add rigorous sci-enti1047297c evidence Tus de1047297nite statements on the clinicalperormance o HAF appliance cannot be made Overall thedevelopment o a new appliance concept is a time-consumingprocess that necessitates meticulous observation and respec-tive structural adjustment Albeit the limited impact o ourcase presentation andearly developmental stage o the deviceHAF appliance treatment appeared to be bene1047297cial and may deserve urther research attention
o conclude usingsubsequently a novel unctional deviceand 1047297xed appliances the sagittal skeletal discrepancy o ayoung emale was corrected Auxiliary development andclinical testing are required to augment the technical eaturesand elucidate the treatment efficiency and effects o HAFappliance On the whole thermoplastic materials may bepotentially utilized in the abrication o unctional orthodon-tic appliances
Acknowledgment
Te author wishes to thank MSgt (D) Panagiotis Moura-tidis laboratory technician Department o Orthodontics 983090983093983089
Hellenic Air Force VA General Hospital Athens Greece ortechnical support
References
[983089] J P Ziuchkovski H W Fields W M Johnston and D Lindsey ldquoAssessmento perceived orthodonticappliance attrac-tivenessrdquo Te American Journal of Orthodontics and Dentofacial Orthopedics vol 983089983091983091 supplement 983092 pp S983094983096ndashS983095983096 983090983088983088983096
[983090] H G Jeremiah D Bister and J Newton ldquoSocial perceptionso adults wearing orthodontic appliances a cross-sectionalstudyrdquo European Journal of Orthodontics vol 983091983091 no 983093 pp 983092983095983094ndash983092983096983090 983090983088983089983089
[983091] D K Walton H W Fields W M Johnston S F RosenstielA R Firestone and J C Christensen ldquoOrthodontic appliancepreerences o children and adolescentsrdquo Te American Journal of Orthodontics and Dentofacial Orthopedics vol 983089983091983096 no 983094 pp983094983097983096e983089ndash983094983097983096e983089983090 983090983088983089983088
[983092] L Jerrold and N Naghavi ldquoEvidence-based considerationsor determining appointment intervalsrdquo Journal of Clinical
Orthodontics vol 983092983093 no 983095 pp 983091983095983097ndash983091983096983091 983090983088983089983089
[983093] B Weltman K W L Vig H W Fields S Shanker and EE Kaizar ldquoRoot resorption associated with orthodontic toothmovementa systematicreviewrdquo Te AmericanJournal of Ortho-dontics and Dentofacial Orthopedics vol 983089983091983095 no 983092 pp 983092983094983090ndash983092983095983094983090983088983089983088
[983094] H Pancherz ldquoTe mechanism o Class II correction in Herbstappliance treatment A cephalometric investigationrdquo Te Amer-ican Journal of Orthodontics vol 983096983090 no 983090 pp 983089983088983092ndash983089983089983091 983089983097983096983090
[983095] D I Lund and P J Sandler ldquoTe effects o twin blocks aprospective controlled studyrdquo Te American Journal of Ortho-dontics and Dentofacial Orthopedics vol 983089983089983091 no 983089 pp 983089983088983092ndash983089983089983088983089983097983097983096
8112019 Ffa Esthetic
httpslidepdfcomreaderfullffa-esthetic 78
Case Reports in Dentistry 983095
[983096] K OrsquoBrien J Wright F Conboy et al ldquoEffectiveness o early orthodontic treatment with the twin-block appliance a multi-center randomized controlled trialmdashpart 983089 dental and skeletaleffectsrdquo Te American Journal of Orthodontics and Dentofacial Orthopedics vol 983089983090983092 no 983091 pp 983090983091983092ndash983090983092983091 983090983088983088983091
[983097] M C Meikle ldquoRemodeling the dentoacial skeleton the biolog-ical basis o orthodontics and dentoacial orthopedicsrdquo Journal of Dental Research vol 983096983094 no 983089 pp 983089983090ndash983090983092 983090983088983088983095
[983089983088] H G Sergl andA Zentner ldquoA comparative assessment o accep-tance o different types o unctional appliancesrdquo European Journal of Orthodontics vol 983090983088 no 983093 pp 983093983089983095ndash983093983090983092 983089983097983097983096
[983089983089] C Schott and G Goz ldquoYoung patientsrsquo attitudes towardremovable appliance wear times wear-time instructions andelectronic wear-time measurementsmdashresults o a questionnairestudyrdquo Journal of Orofacial Orthopedics vol 983095983089 no 983090 pp 983089983088983096ndash983089983089983094 983090983088983089983088
8112019 Ffa Esthetic
httpslidepdfcomreaderfullffa-esthetic 88
Submit your manuscripts at
httpwwwhindawicom
8112019 Ffa Esthetic
httpslidepdfcomreaderfullffa-esthetic 58
Case Reports in Dentistry 983093
(a) (b)
(c) (d)
F983145983143983157983154983141 983094 Posttreatment records (a) extraoral pro1047297le photo (b) dental casts (c) panoramic radiograph and (d) cephalometric radiograph
appliances [983094ndash983096] demonstrated small but statistically signi1047297-cant differences in mandibular length and especially higher
effectiveness o ldquojumping the biterdquo appliances such as Herbstand win-Block compared to Andresen activator and relatedpassive devices [983097]
We were motivated to devise an aesthetically attractiveremovable appliance with complete lack o metal partslargely transparent appearance diminished bulkiness toavoid patient discomort and relatively less demanding labo-ratory abrication Ziuchkovski et al [983089] concluded thatappliance attractiveness is inversely affected by the amounto visibility o metal parts Likewise best accepted unctionalappliances have been ound to be the ones with reducedacrylic coverage occupying little space intraorally On thecontrary appliances o design and shape causing excessive
interocclusal opening with subsequent sof tissue tension andlip incompetence or constraining the tongue were the least
approved [983089983088]Patient compliance maniested as sufficient wear time o the removable appliance is a major prerequisite or treatmentsuccess Wear time prescription usually ranges rom 983089983091 to983089983094 hours per day and derives rom empirical nonevidence-based data owing to lack o objective measures and docu-mentation However when it comes to real lie 983096 out o 983089983088children may appear unwilling to extend plate use beyondnight span [983089983089] Under such conditions the actual wear timemight decline to 983097983093 hours daily and jeopardize a successultherapeutic outcome According to the case records thepatient appeared to wear the appliance or approximately 983089983090983093each day which practically proved to be sufficient to ul1047297ll
8112019 Ffa Esthetic
httpslidepdfcomreaderfullffa-esthetic 68
983094 Case Reports in Dentistry
F983145983143983157983154983141 983095 Superimposition o pre- and posttreatment cephalometric tracings
treatment requirements Interestingly she ound it difficultto keep the intermaxillary elastics in place while sleepingand eventually abandoned elastic use From a technicalperspective this act questions the number and location o buttons or even the presence o this eature per se in prospec-tive versions Modi1047297cations such as extension o the plasticcoverage o the lower plate in avour o retention radical
reduction o the acrylic resin and revision o matching o anterior attachments may be as well considered
Our initiative wasto demonstrate one o our 1047297rst attemptsto produce a less visible and patient riendly unctionaldevice Case reports inherently do not add rigorous sci-enti1047297c evidence Tus de1047297nite statements on the clinicalperormance o HAF appliance cannot be made Overall thedevelopment o a new appliance concept is a time-consumingprocess that necessitates meticulous observation and respec-tive structural adjustment Albeit the limited impact o ourcase presentation andearly developmental stage o the deviceHAF appliance treatment appeared to be bene1047297cial and may deserve urther research attention
o conclude usingsubsequently a novel unctional deviceand 1047297xed appliances the sagittal skeletal discrepancy o ayoung emale was corrected Auxiliary development andclinical testing are required to augment the technical eaturesand elucidate the treatment efficiency and effects o HAFappliance On the whole thermoplastic materials may bepotentially utilized in the abrication o unctional orthodon-tic appliances
Acknowledgment
Te author wishes to thank MSgt (D) Panagiotis Moura-tidis laboratory technician Department o Orthodontics 983090983093983089
Hellenic Air Force VA General Hospital Athens Greece ortechnical support
References
[983089] J P Ziuchkovski H W Fields W M Johnston and D Lindsey ldquoAssessmento perceived orthodonticappliance attrac-tivenessrdquo Te American Journal of Orthodontics and Dentofacial Orthopedics vol 983089983091983091 supplement 983092 pp S983094983096ndashS983095983096 983090983088983088983096
[983090] H G Jeremiah D Bister and J Newton ldquoSocial perceptionso adults wearing orthodontic appliances a cross-sectionalstudyrdquo European Journal of Orthodontics vol 983091983091 no 983093 pp 983092983095983094ndash983092983096983090 983090983088983089983089
[983091] D K Walton H W Fields W M Johnston S F RosenstielA R Firestone and J C Christensen ldquoOrthodontic appliancepreerences o children and adolescentsrdquo Te American Journal of Orthodontics and Dentofacial Orthopedics vol 983089983091983096 no 983094 pp983094983097983096e983089ndash983094983097983096e983089983090 983090983088983089983088
[983092] L Jerrold and N Naghavi ldquoEvidence-based considerationsor determining appointment intervalsrdquo Journal of Clinical
Orthodontics vol 983092983093 no 983095 pp 983091983095983097ndash983091983096983091 983090983088983089983089
[983093] B Weltman K W L Vig H W Fields S Shanker and EE Kaizar ldquoRoot resorption associated with orthodontic toothmovementa systematicreviewrdquo Te AmericanJournal of Ortho-dontics and Dentofacial Orthopedics vol 983089983091983095 no 983092 pp 983092983094983090ndash983092983095983094983090983088983089983088
[983094] H Pancherz ldquoTe mechanism o Class II correction in Herbstappliance treatment A cephalometric investigationrdquo Te Amer-ican Journal of Orthodontics vol 983096983090 no 983090 pp 983089983088983092ndash983089983089983091 983089983097983096983090
[983095] D I Lund and P J Sandler ldquoTe effects o twin blocks aprospective controlled studyrdquo Te American Journal of Ortho-dontics and Dentofacial Orthopedics vol 983089983089983091 no 983089 pp 983089983088983092ndash983089983089983088983089983097983097983096
8112019 Ffa Esthetic
httpslidepdfcomreaderfullffa-esthetic 78
Case Reports in Dentistry 983095
[983096] K OrsquoBrien J Wright F Conboy et al ldquoEffectiveness o early orthodontic treatment with the twin-block appliance a multi-center randomized controlled trialmdashpart 983089 dental and skeletaleffectsrdquo Te American Journal of Orthodontics and Dentofacial Orthopedics vol 983089983090983092 no 983091 pp 983090983091983092ndash983090983092983091 983090983088983088983091
[983097] M C Meikle ldquoRemodeling the dentoacial skeleton the biolog-ical basis o orthodontics and dentoacial orthopedicsrdquo Journal of Dental Research vol 983096983094 no 983089 pp 983089983090ndash983090983092 983090983088983088983095
[983089983088] H G Sergl andA Zentner ldquoA comparative assessment o accep-tance o different types o unctional appliancesrdquo European Journal of Orthodontics vol 983090983088 no 983093 pp 983093983089983095ndash983093983090983092 983089983097983097983096
[983089983089] C Schott and G Goz ldquoYoung patientsrsquo attitudes towardremovable appliance wear times wear-time instructions andelectronic wear-time measurementsmdashresults o a questionnairestudyrdquo Journal of Orofacial Orthopedics vol 983095983089 no 983090 pp 983089983088983096ndash983089983089983094 983090983088983089983088
8112019 Ffa Esthetic
httpslidepdfcomreaderfullffa-esthetic 88
Submit your manuscripts at
httpwwwhindawicom
8112019 Ffa Esthetic
httpslidepdfcomreaderfullffa-esthetic 68
983094 Case Reports in Dentistry
F983145983143983157983154983141 983095 Superimposition o pre- and posttreatment cephalometric tracings
treatment requirements Interestingly she ound it difficultto keep the intermaxillary elastics in place while sleepingand eventually abandoned elastic use From a technicalperspective this act questions the number and location o buttons or even the presence o this eature per se in prospec-tive versions Modi1047297cations such as extension o the plasticcoverage o the lower plate in avour o retention radical
reduction o the acrylic resin and revision o matching o anterior attachments may be as well considered
Our initiative wasto demonstrate one o our 1047297rst attemptsto produce a less visible and patient riendly unctionaldevice Case reports inherently do not add rigorous sci-enti1047297c evidence Tus de1047297nite statements on the clinicalperormance o HAF appliance cannot be made Overall thedevelopment o a new appliance concept is a time-consumingprocess that necessitates meticulous observation and respec-tive structural adjustment Albeit the limited impact o ourcase presentation andearly developmental stage o the deviceHAF appliance treatment appeared to be bene1047297cial and may deserve urther research attention
o conclude usingsubsequently a novel unctional deviceand 1047297xed appliances the sagittal skeletal discrepancy o ayoung emale was corrected Auxiliary development andclinical testing are required to augment the technical eaturesand elucidate the treatment efficiency and effects o HAFappliance On the whole thermoplastic materials may bepotentially utilized in the abrication o unctional orthodon-tic appliances
Acknowledgment
Te author wishes to thank MSgt (D) Panagiotis Moura-tidis laboratory technician Department o Orthodontics 983090983093983089
Hellenic Air Force VA General Hospital Athens Greece ortechnical support
References
[983089] J P Ziuchkovski H W Fields W M Johnston and D Lindsey ldquoAssessmento perceived orthodonticappliance attrac-tivenessrdquo Te American Journal of Orthodontics and Dentofacial Orthopedics vol 983089983091983091 supplement 983092 pp S983094983096ndashS983095983096 983090983088983088983096
[983090] H G Jeremiah D Bister and J Newton ldquoSocial perceptionso adults wearing orthodontic appliances a cross-sectionalstudyrdquo European Journal of Orthodontics vol 983091983091 no 983093 pp 983092983095983094ndash983092983096983090 983090983088983089983089
[983091] D K Walton H W Fields W M Johnston S F RosenstielA R Firestone and J C Christensen ldquoOrthodontic appliancepreerences o children and adolescentsrdquo Te American Journal of Orthodontics and Dentofacial Orthopedics vol 983089983091983096 no 983094 pp983094983097983096e983089ndash983094983097983096e983089983090 983090983088983089983088
[983092] L Jerrold and N Naghavi ldquoEvidence-based considerationsor determining appointment intervalsrdquo Journal of Clinical
Orthodontics vol 983092983093 no 983095 pp 983091983095983097ndash983091983096983091 983090983088983089983089
[983093] B Weltman K W L Vig H W Fields S Shanker and EE Kaizar ldquoRoot resorption associated with orthodontic toothmovementa systematicreviewrdquo Te AmericanJournal of Ortho-dontics and Dentofacial Orthopedics vol 983089983091983095 no 983092 pp 983092983094983090ndash983092983095983094983090983088983089983088
[983094] H Pancherz ldquoTe mechanism o Class II correction in Herbstappliance treatment A cephalometric investigationrdquo Te Amer-ican Journal of Orthodontics vol 983096983090 no 983090 pp 983089983088983092ndash983089983089983091 983089983097983096983090
[983095] D I Lund and P J Sandler ldquoTe effects o twin blocks aprospective controlled studyrdquo Te American Journal of Ortho-dontics and Dentofacial Orthopedics vol 983089983089983091 no 983089 pp 983089983088983092ndash983089983089983088983089983097983097983096
8112019 Ffa Esthetic
httpslidepdfcomreaderfullffa-esthetic 78
Case Reports in Dentistry 983095
[983096] K OrsquoBrien J Wright F Conboy et al ldquoEffectiveness o early orthodontic treatment with the twin-block appliance a multi-center randomized controlled trialmdashpart 983089 dental and skeletaleffectsrdquo Te American Journal of Orthodontics and Dentofacial Orthopedics vol 983089983090983092 no 983091 pp 983090983091983092ndash983090983092983091 983090983088983088983091
[983097] M C Meikle ldquoRemodeling the dentoacial skeleton the biolog-ical basis o orthodontics and dentoacial orthopedicsrdquo Journal of Dental Research vol 983096983094 no 983089 pp 983089983090ndash983090983092 983090983088983088983095
[983089983088] H G Sergl andA Zentner ldquoA comparative assessment o accep-tance o different types o unctional appliancesrdquo European Journal of Orthodontics vol 983090983088 no 983093 pp 983093983089983095ndash983093983090983092 983089983097983097983096
[983089983089] C Schott and G Goz ldquoYoung patientsrsquo attitudes towardremovable appliance wear times wear-time instructions andelectronic wear-time measurementsmdashresults o a questionnairestudyrdquo Journal of Orofacial Orthopedics vol 983095983089 no 983090 pp 983089983088983096ndash983089983089983094 983090983088983089983088
8112019 Ffa Esthetic
httpslidepdfcomreaderfullffa-esthetic 88
Submit your manuscripts at
httpwwwhindawicom
8112019 Ffa Esthetic
httpslidepdfcomreaderfullffa-esthetic 78
Case Reports in Dentistry 983095
[983096] K OrsquoBrien J Wright F Conboy et al ldquoEffectiveness o early orthodontic treatment with the twin-block appliance a multi-center randomized controlled trialmdashpart 983089 dental and skeletaleffectsrdquo Te American Journal of Orthodontics and Dentofacial Orthopedics vol 983089983090983092 no 983091 pp 983090983091983092ndash983090983092983091 983090983088983088983091
[983097] M C Meikle ldquoRemodeling the dentoacial skeleton the biolog-ical basis o orthodontics and dentoacial orthopedicsrdquo Journal of Dental Research vol 983096983094 no 983089 pp 983089983090ndash983090983092 983090983088983088983095
[983089983088] H G Sergl andA Zentner ldquoA comparative assessment o accep-tance o different types o unctional appliancesrdquo European Journal of Orthodontics vol 983090983088 no 983093 pp 983093983089983095ndash983093983090983092 983089983097983097983096
[983089983089] C Schott and G Goz ldquoYoung patientsrsquo attitudes towardremovable appliance wear times wear-time instructions andelectronic wear-time measurementsmdashresults o a questionnairestudyrdquo Journal of Orofacial Orthopedics vol 983095983089 no 983090 pp 983089983088983096ndash983089983089983094 983090983088983089983088
8112019 Ffa Esthetic
httpslidepdfcomreaderfullffa-esthetic 88
Submit your manuscripts at
httpwwwhindawicom
8112019 Ffa Esthetic
httpslidepdfcomreaderfullffa-esthetic 88
Submit your manuscripts at
httpwwwhindawicom
