Join me for a
summary looking at fixed versus removable functional appliances. This podcast
sheds light on recent research comparing the main two types of functional
appliances, which appliance offers the most advantages, and what patients think
about the two appliance types. This was a lecture given by Ama Johal at last
year’s British Orthodontic Conference, where the most recent evidence carried
out by his PhD student Moaiyad Pacha.



Moaiyad Pacha’s
RCT 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 support
but patient-centred

·     
Overjet correction: More effective Herbst
at 7mm Vs 5.8mm Twinblock ,

·     
Molar and skeletal changes: no difference

o  
Twinblock = greater residual overjet after
treatment p=0.2

·     
Dental changes: Herbst advance lower
incisor greater 3mm Vs 1mm

·     
Failure to complete: 17% Herbst Vs 37%
twin block

o  
3 times greater likelihood of discontinue
treatment OR 2.8

·     
Treatment duration: longer with Twinblock
1.5 months 8.8 Vs 10.3, and quicker rate of correction with Herbst

·     
Chairside time : Greater than Twinblock
2.7 hours longer, 7.6 Vs 4.9

·     
Emergency appointments greater with Hanks
Herbst 2.7 Vs 0.3

o  
Herbst mainly

·     
Severe complications = same 0.5

o  
Severe complications – previously defined as
involving lab work or break in appliance wear from Pasha’s SR 2020

Advantage of Hanks Herbst

·     
Greater completion of treatment, 3 times less
likely to discontinue

·     
Quicker rate of correction, shorter duration,

Disadvantages

·     
Greater chairside time of nearly 3 hours

·     
Greater emergency appointments, each patient
needing 2-3 emergency appointments

Qualitative

·     
Both appliances – very negative to QoL and daily
life

·     
Aesthetic and self-image – worse with Twinblock

·     
Patient preference – Herbst

o  
Due to non-compliance and likely to get to the
end

·     
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 both
discussing of clinician Vs patient preferences, 
should decide which appliance