Dentofacial orthopedics with functional appliances

内容摘要

The welter of clinical reports in the orthodontic literature and the profusion of short courses being given on so-called functional appliances (often featuring specialists from other countries) have engendered great interest in this approach to orthodontic and orthopedic treatment of malocclusion. The popularity and large of sales of the first edition of this book and of Removable Orthodontic Appliances by T.M. Graber are testimony to the enhanced desire to learn more about these appliances on the American side of the Atlantic. Functional jaw orthopedics has been used (and misused) for many years in Europe, ever since it was promulgated by Andresen of Norway. As in America, cultism, dogma, and the arbitrary follow-the-leader approaches have too often dominated the scene. The results have been spotty. There is an old aphorism It is not the tool but how you use it that counts. This can be rephrased to cover aspect of the topic at hand: although functional appliances may provide dramatic anecdotal examples of stable and balanced corrections of severe malocclusions, they also may show problems in which only partial correction was achieved or excessive lower incisor proclination was the result. Multiple factors may be responsible.It is unfortunate that the glowing functional appliance 'successes have been emphasized and oversold by some American proponents. Weekend motel and tailgate courses also have been given too often by inadequately trained  orthodontists, pediatric dentists, or would-be orthodontists who were interested more in the financial returns from these courses or the ego inflation that goes with standing behind a podium with a captive audience. Glitzy, glossy brochures promise as much as a $100,000 benefit to course attendees. Thus what has become a hot number for orthodontists and dentofacial orthopedists has effectively burned more than a few clinicians and patients who have been promised too much.Despite the admonitions in the previous edition of this book and other books and articles on the subject by superbly qualified leaders such as Rakosi, Frankel, Eirew, McNamara, Moss, Binder, Vardimon, Clark, Hamdton, and others, hundreds of clinicians have succumbed to the blandishments of the domestic gurus and used these appliances indiscriminately and in shotgun style on their patients. The inexorable unfavorable patient response from excessive use by inadequately trained orthodontists and unqualified pediatric dentists and general practitioners has produced a wave of frustration and backlash to functional appliances in many quarters.Yet if the clinician realizes that diagnosis is as demanding for functional orthopedics as it is for conventional fixed appliances, that case selection is critical, that construction bite details can make or break a treatment regimen (no matter how perfectly an appliance is constructed), that it takes time to learn how to manipulate these appliances, that mistakes will be made, that growth direction and growth amount as well as growth timing are major factors in the ultimate success or failure of a treatment regimen, and that patient compliance and motivation demand constant reinforcement after careful patient selection -- if all of these are absorbed into the clinician's modus cogitandi, they cannot help engendering a warm glow of success and pride in the beautiful results attained on many patients, results not possible from fixed appliances alone. This is not a recommendation for a one shot approach, nor does it diminish the importance of fixed appliances as needed.It is the purpose of this book to present those essential details on the Achilles' heel of functional appliances, or diagnosis, give detailed instructions on how to obtain a correct construction bite, describe fabrication and use of various types of functional appliances alone or in combination, and particularize specific treatment regimens for different malocclusion categories. We hope to be able to offset the antagonism engendered against functional appliances by the mixed experiences of the past 8 to 9 years.It might appear unseemly that the qualifications of the authors should be extolled. However, this aspect is vitally important if the objectives elaborated in the previous paragraph are to be achieved.