1. MANAGEMENT OF FUNCTIONAL APPLIANCE SAKINAH MASYITAH AISHAH FAIS ZULKHAIRI

2. Pre-functional Stage O a short period of treatment prior to fitting the appliance  optimize the benefits of a functional appliance. Eg: 1. Removable appliance with a midline expansion screw Maxillary arch expansion prevent a posterior maxillary lingual crossbite in saggital correction Not necessary in twin block 2. a removable appliance or a sectional fixed appliance prior to or parallel with the functional appliance class II division 2 incisor relationship  Proclination and alignment of the labial segments if they are retroclined or crowded

3. Impression and Bite Detailed impressions in alginateboth dental archesAdequate extension into the lingual and labial vestibules Particularly important in Fränkel functional regulator as buccal shields and labial pads are made to actively stretch the mucosa.

4. O Articulation in simple articulator O working models mounted to a postured bite taken in the mouth. O usually done in wax, with the mandible as far forwards as is comfortable

5. If the overjet is 10-mm or less postured bite can be taken with the incisors in an edge-to-edge relationship. If greater than 10-mm unlikely that full overjet reduction can be achieved with a single appliance appliance may need reactivating; either by adjusting it so the mandible is postured further forwards, or by fabricating a second appliance once the overjet has been partially reduced

6. O Vertically there should be approximately 2- mm of separation between the incisors. O But Harvold-type activators and twin -block are acception Constructed to open the bite beyond the freeway space Harvold-type activators which require at least 5-mm of vertical separation in the buccal segments to allow for the inclined occlusal planes Twin-Block

7. Appliance Fitting And Review O Appliance should be fitted within 2weeks O Show to the patient before fitting O Once fitted, full instructions be given – min wear required per day O Allow pt to practice insert and removing app O The use of calendar in record hours worn O Review 1/12, if no problem then bimonthly

8. Appliance Fitting And Review Each review visit: O Record OJ and buccal segment r/ship O OJ in max protrusion O If no change within 6 months, tx plan should be reviewed O Signs of poor wear: no change, continued problem with speech, a pristine app with no signs of wear and numerous breakage d/t repeated removal by pt

9. End of Treatment of Appliance and Retention O Once OJ corrected, cont using appliance on part-time basis O Further records (lat ceph) will aid in planning subsequent tx i.e. fixed appliance O Unless early tx was done in mixed dentition. Pt will be directly transfer for fixed app O Further tx should be planned to address any undeisrable effect

10. End of Treatment of Appliance and Retention O Retention should be continued until the end of adolescent skeletal growth O Incorporate a postural component to maintain the class II correction O This include:  Parttime wear of cut down app or  Removable app with inclined anterior bite plane

11. Reference O Handbook of orthodontic O Martyn T. Cobourne BDS(Hons) FDSRCS(Eng) FDSRCS(Edin) MSc MOrth RCS(Eng) FDSOrth RCS PhD (Author), Andrew T. DiBiase BDS(Hons) FDSRCS(Eng) MSc MOrth RCS(Eng) FDSOrth RCS (Author)