Functional Appliances

Functional appliances are a form of removable appliances or plates.

This practice utilises functional appliances with some patients. However we always stress the following points prior to commencing:

1. Many patients want plates as they perceive plates to be easier than braces. This is often not the case. Functional appliances are usually more difficult for the patient than braces.
2. With functional appliances the control is often taken out of the hands of the operator, and put in the hands of the patient. This is successful if the patient cooperates well, but can also be the reason for failure. Unless the plates are worn virtually all of the time (to school, to bed, and around the house) the desired movements will not be achieved. Because of the level of cooperation required, older patients are more suited to functional appliances. The failure rate in patients under 12 years of age is unacceptably high.
3. Functional appliances are very good at correcting growth discrepancies, but are poor at aligning teeth. Consequently functional appliances usually do not remove the requirement for braces. However if braces are worn following functional appliances, keep in mind that much of the work has been achieved, and the braces should be on for a shorter time and be significantly cheaper. Generally if both braces and Functional Appliances are required, I prefer to use Functional Appliances following the braces treatment as they are then worn for a much shorter period.
4. A small number of patients will not achieve the desired growth, even with good cooperation.
5. Functional appliances require growth for their success. Consequently the more growth the patient experiences during treatment the greater the likelihood of success. The stage of greatest growth for most patients is after they have entered high school. This also coincides with a period that most children are having orthodontic treatment, and so peer pressure is reduced. This is the best stage to use Functional Appliances.

Many parents want early correction so their children do not have problems at high school. I caution against early treatment for the following reasons:

• Functional appliance treatment is required where the lower jaw does not grow as fast as the upper jaw. This growth pattern will continue. If treatment is too early then growth will undo the benefit of treatment and further treatment will be required.
• Functional appliances require a high level of cooperation. Younger patients have difficulty achieving this high standard. Consequently many treatments fail at a younger age due to lack of cooperation. If these treatments had been instigated later, the likelihood of success is much greater and less strain is placed on family relationships.