Join me for asummary looking at fixed versus removable functional appliances. This podcastsheds light on recent research comparing the main two types of functionalappliances, which appliance offers the most advantages, and what patients thinkabout the two appliance types. This was a lecture given by Ama Johal at lastyear’s British Orthodontic Conference, where the most recent evidence carriedout by his PhD student Moaiyad Pacha.
Moaiyad Pacha’sRCT 2023 – received Dewel 2024 clinical research award
· Hanks Herbst Vs Modified Twinblock
o Rollo bands
o Expansion
o No fixed appliances
o Incremental advancement – no evidence to supportbut patient-centred
· Overjet correction: More effective Herbstat 7mm Vs 5.8mm Twinblock ,
· Molar and skeletal changes: no difference
o Twinblock = greater residual overjet aftertreatment p=0.2
· Dental changes: Herbst advance lowerincisor greater 3mm Vs 1mm
· Failure to complete: 17% Herbst Vs 37%twin block
o 3 times greater likelihood of discontinuetreatment OR 2.8
· Treatment duration: longer with Twinblock1.5 months 8.8 Vs 10.3, and quicker rate of correction with Herbst
· Chairside time : Greater than Twinblock2.7 hours longer, 7.6 Vs 4.9
· Emergency appointments greater with HanksHerbst 2.7 Vs 0.3
o Herbst mainly
· Severe complications = same 0.5
o Severe complications – previously defined asinvolving lab work or break in appliance wear from Pasha’s SR 2020
Advantage of Hanks Herbst
· Greater completion of treatment, 3 times lesslikely to discontinue
· Quicker rate of correction, shorter duration,
Disadvantages
· Greater chairside time of nearly 3 hours
· Greater emergency appointments, each patientneeding 2-3 emergency appointments
Qualitative
· Both appliances – very negative to QoL and dailylife
· Aesthetic and self-image – worse with Twinblock
· Patient preference – Herbst
o Due to non-compliance and likely to get to theend
· Positive Twinblock is flexible and easier to eat
Conclusion was profound
· Patients prefer Herbst, based on aesthetics,self image and non-compliance
· Clinicians are likely to prefer Twinblock,quicker, easier, less emergencies
Time to reconsider, and having both options, as well as bothdiscussing of clinician Vs patient preferences, should decide which appliance