ORIGINAL ARTICLE Patients’ and Parents’ Perception ?· ORIGINAL ARTICLE Patients’ and Parents’…

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  • TURKISH JOURNAL of DOI: 10.5152/TurkJOrthod.2017.17015

    ORIGINAL ARTICLE

    Patients and Parents Perception of Functional Appliances: A Survey Study

    ABSTRACT

    Objective: To evaluate patients and parents perception of removable, fixed rigid, and fixed hybrid functional appliances and to com-pare their impacts on anxiety and discomfort during treatment in different age groups and genders.

    Methods: Data were gathered by means of a questionnaire that included items presumed to be associated with orthodontic compli-ance. A self-administered questionnaire was used to quantify patients and parents perceptions. Three groups were formed regarding the type of functional appliance used: fixed rigid (Functional Mandibular Advancer, FMA), fixed hybrid (Forsus Fatigue Resistant De-vice, FRD), and removable (Twin Block, TB). Two separate questionnaires were used for the patients and their parents comprising the necessary context. Chi-square, Mann-Whitney U, and Kruskal-Wallis tests were used for data analysis.

    Results: Patients needed less time to adapt to the FRD appliance. Eating difficulties were encountered by patients in the FMA group. Adolescents who had completed functional orthodontic treatment with a removable appliance had difficulties in controlling their saliva. Patients and parents perceptions were found to be in accordance with each other.

    Conclusion: Adolescents who had completed functional orthodontic treatment with fixed appliances had more difficulty in their daily life. Orthodontists should be aware of this impact caused by functional orthodontic treatment and should regularly encourage patients by reminding them of the improvements to be had by fixing the malocclusion.

    Keywords: Orthodontic appliance, functional, questionnaire

    INTRODUCTION

    Class II malocclusion is a frequently seen discrepancy, and it occurs as a result of prognathic maxilla, retrognathic mandible, or a combination of both (1). The main aim of Class II treatment due to mandibular retrognathism is to en-hance mandibular growth in the sagittal direction during adolescence. Thus, various functional appliances have been developed targeting this effect. Fixed functional appliances such as fixed rigid (Herbst, FMA, MARA), fixed flexible (Jas-per Jumper), and fixed hybrid appliances (FRD) require much less patient cooperation compared to their removable forms (2-6). These appliances have advantages and disadvantages regarding oral hygiene, soft tissue irritations, and limitations of mandibular movements (7). Effects of the functional appliances on skeletal and dental tissues have been heavily investigated, whereas patients and parents perception of these appliances has not been questioned (8-10).

    During functional appliance treatment, patients may have pain and discomfort at various levels. It has been shown that the orthodontic appliances may lead to oral mucosa pressure, soft tissue tension, oral constriction, toothache, and pain (11,12). It has also been noted that removable appliances additionally may lead to fatigue or to functional speech and respiratory disorders, and they may affect the appearance of the face (13).

    Informing patients about possible problems and discomfort throughout functional treatment is beneficial in order to enhance the appliance efficiency and patient compliance (14). It is known that patient cooperation may

    Yamur Lena1, Aylin Paaolu Bozkurt2, Enver Yetkiner1

    1Department of Orthodontics, Ege University School of Dentistry, zmir, Turkey2Private Practice, stanbul, Turkey

    Corresponding Author: Dr. Yamur Lena, Department of Orthodontics, Ege University School of Dentistry, zmir, TurkeyE-mail: yagmurlena@hotmail.comCopyright 2017 by Turkish Orthodontic Society - Available online at www.turkjorthod.org

    Cite this article as: Lena Y, Paaolu Bozkurt A, Yetkiner E. Patients and Parents Perception of Functional Appliances: A Survey Study. Turkish J Orthod 2017; 30: 33-41.

    Received: 28 February 2017Accepted: 25 May 2017

    33

  • decline due to discomforts such as narrowing of the oral cavity and soft tissue irritation when orthodontic appliances are imple-mented (15,16). Speech difficulties can also be observed among patients, and the appearance of the appliances may be unpleas-ant in social interactions (16,14,17). All of these undesired conse-quences affect the patients degree of compliance in a negative manner, and it is necessary to explain possible discomforts and how to eliminate them (18,19). In this sense, it is vital that the orthodontists select the suitable appliance for the patient (20). While selecting the functional orthodontic appliances, accept-ability should be taken into consideration, in addition to the intraoral situations of the patients. One way of assessing the ac-ceptability of an appliance is to conduct surveys asking about the experiences of patients and their parents (21,22).

    To the best of the authors knowledge, there are no studies aim-ing to investigate patient and parent perception of removable, fixed rigid, and fixed hybrid functional appliances. Therefore, the aim of this study was to prepare and conduct a survey with the purpose of comparing the experiences of patient and their par-ents with reference to different appliance user groups.

    METHODS

    This study was approved by the Ethics Committee of Clinical Re-search of Medical School, Ege University (commission decision numbered 16-1.1/14). The study material comprised a question-naire given to patients who were undergoing functional ortho-dontic treatment at Ege University School of Dentistry, Depart-ment of Orthodontics and their parents. The participants were informed about the aim of the survey, and the subjects and their guardians signed an informed consent form.

    The survey questions were designed to be as simple as possible so that the participants could easily comprehend them. A total of 214 patients (mean age 13.25 years) and parents (mean age 44.23 years) participated in the study, and the outcomes were evaluated for three different groups. FRD (43 patients, mean age 14.47 years), FMA (42 patients, mean age 14 years), and TB (39 patients, mean age 11.10 years) were used as fixed hybrid, fixed rigid, and remov-able functional appliances, respectively (Table 1).

    The survey consisted of 30 multiple choice question and 1 rat-ing scale question (Apperdic 1). The questions covered issues re-

    garding the feeling of tension or pressure factors, tooth sensitiv-ity, pain, speech problems, difficulties in swallowing, and lack of confidence in public. The survey was presented to the patients 6 months after they had started the functional treatment and were filled out in the counseling room by patients and their parents separately. They answered the multiple choice questions as al-ways, often, sometimes, rarely, or never or as I totally agree, I agree, unsure, I do not agree, or I strongly disagree.

    The outcomes were interpreted through demographic distri-bution and chi-square analysis. The chi-square test was used to determine the differences in terms of pain, disorders, and the patients acceptance of the treatment among the three groups. The significance level for the p value was set at 0.05. Kolmogor-ov-Smirnov and Shapiro-Wilk tests were used to test the normal distribution of the data. When evaluating the adaptation peri-od for appliance usage, the Kruskal-Wallis non-parametric test was used. Because the data were not normally distributed, the Mann-Whitney U test was used in the intergroup analysis.

    RESULTS

    The adaptation periods to FRD and FMA were significantly differ-ent in the parents perception (p=0.004). According to the par-ents, the average adaptation periods to FMA, FRD, and TB were 3.33 weeks, 2.14 weeks, and 2.46 weeks, respectively, whereas the appliance with the longest adaptation period was FMA with 3.88 weeks (p

  • 35

    Turkish J Orthod 2017; 30: 33-41 Lena et al. Patients and Parents Perception

    Table 2. Percentages of patients and parents responses on the questionnaires

    PATIENT PARENT

    TB FRD FMA TOTAL TB FRD FMA TOTAL question n (% among n (% among n (% among n (% among n (% among n (% among n (% among n (% among number answers respondents) respondents) respondents) respondents) respondents) respondents) respondents) respondents)

    Q.01 yes 26 (66.7) 28 (65.1) 22 (52.4) 76 (61.3) 25 (64.1) 27 (62.8) 31 (73.8) 83 (66.9)

    no 13 (33.3) 15 (34.9) 20 (47.6) 48 (38.7) 14 (35.9) 16 (37.2) 11 (26.2) 41 (33.1)

    Q.02 strongly agree 23 (59.0) 29 (67.4) 27 (64.3) 79 (63.7) 26 (66.7) 27 (62.8) 29 (69) 82 (66.1)

    agree 10 (25.6) 11 (25.6) 12 (28.6) 33 (26.6) 9 (23.1) 12 (27.9) 10 (23.8) 31 (25)

    unsure 5 (12.8) 3 (7.0) 3 (7.1) 11 (8.9) 3 (7.7) 3 (7) 3 (7.1) 9 (7.3)

    disagree 1 (2.6) 0 (0.0) 0 (0.0) 1 (0.8) 1 (2.6) 1 (2.3) 0 2 (1.6)

    Q.03 strongly agree 26 (66.7) 30 (69.8) 26 (61.9) 82 (66.1) 23 (59) 24 (55.8) 24 (57.1) 71 (57.3)

    agree 10 (25.6) 13 (30.2) 11 (26.2) 34 (27.4) 12 (30.8) 19 (44.2) 15 (35.7) 46 (37.1)

    unsure 3 (7.7) 0 (0.0) 5 (11.9) 8 (6.5) 4 (10.3) 0 3 (7.1) 7 (5.6)

    Q.05 strongly agree 25 (64.1) 27 (62.8) 27 (64.3) 79 (63.7) 26 (66.7) 24 (55.8) 24 (57.1) 74 (59.7)

    agree 14 (35.9) 13 (30.2) 12 (28.6) 39 (31.5) 13 (33.3) 13 (30.2) 15 (35.7) 41 (33.1)

    unsure 0 (0.0) 1 (2.3) 3 (7.1) 4 (3.2) 0 3 (7) 3 (7.1) 6 (4.8)

    disagree 0 (0.0) 2 (4.7) 0 (0.0) 2 (1.6) 0 3 (7) 0 3 (2.4)

    Q.10 excellent 0 (0.0) 1 (2.3) 1 (2.4) 2 (1.6) 3 (7.7) 4 (9.3) 1 (2.4) 8 (6.5)

    good 20 (51.3) 25 (58.1) 30 (71.4) 75 (60.5) 22 (56.4) 28 (65.1) 24 (57.1) 74 (59.7)

    unsure 8 (20.5) 8 (18.6) 1 (2.4) 17 (13.7) 6 (15.4) 6 (14) 5 (11.9) 17 (13.7)

    poor 8 (20.5) 9 (20.9) 5 (11.9) 22 (17.7) 7 (17.9) 5 (11.6) 9 (21.4) 21 (16.9)

    very poor 3 (7.7) 0 (0.0) 5 (11.9) 8 (6.5) 1 (2.6) 0 3 (7.1) 4 (3.2)

    Q.11 never 10 (25.6) 28 (65.1) 9 (21.4) 47 (37.9) 11 (28.2) 28 (65.1) 9 (21.4) 48 (38.7)

    rarely 14 (35.9) 6 (14.0) 14 (33.3) 34 (27.4) 18 (46.2) 8 (18.6) 13 (31) 39 (31.5)

    sometimes 11 (28.2) 8 (18.6) 13 (31.0) 32 (25.8) 9 (23.1) 5 (11.6) 14 (33.3) 28 (22.6)

    often 4 (10.3) 1 (2.3) 5 (11.9) 10 (8.1) 1 (2.6) 2 (4.7) 4 (9.5) 7 (5.6)

    always 0 (0.0) 0 (0.0) 1 (2.4) 1 (0.8) 0 0 2 (4.8) 2 (1.6)

    Q.12 never 13 (33.3) 25 (58.1) 1 (2.4) 39 (31.5) 11 (28.2) 23 (53.5) 0 34 (27.4)

    rarely 7 (17.9) 10 (23.3) 9 (21.4) 26 (21.0) 7 (17.9) 11 (25.6) 9 (21.4) 27 (21.8)

    sometimes 18 (46.2) 7 (16.3) 21 (50.0) 46 (37.1) 19 (48.7) 8 (18.6) 24 (57.1) 51 (41.1)

    often 1 (2.6) 1 (2.3) 9 (21.4) 11 (8.9) 2 (5.1) 1 (2.3) 8 (19) 11 (8.9)

    always 0 (0.0) 0 (0.0) 2 (4.8) 2 (1.6) 0 0 1 (2.4) 1 (0.8)

    Q.13 never 14 (35.9) 22 (51.2) 3 (7.1) 39 (31.5) 8 (20.5) 22 (51.2) 3 (7.1) 33 (26.6)

    rarely 10 (25.6) 15 (34.9) 20 (47.6) 45 (36.3) 17 (43.6) 8 (18.6) 18 (42.9) 43 (34.7)

    sometimes 15 (38.5) 6 (14.0) 13 (31.0) 34 (27.4) 11 (28.2) 12 (27.9) 17 (40.5) 40 (32.3)

    often 0 (0.0) 0 (0.0) 5 (11.9) 5 (4.0) 3 (7.7) 1 (2.3) 2 (4.8) 6 (4.8)

    always 0 (0.0) 0 (0.0) 1 (2.4) 1 (0.8) 0 0 2 (4.8) 2 (1.6)

    Q.14 never 12 (30.8) 15 (34.9) 2 (4.8) 29 (23.4) 13 (33.3) 13 (30.2) 3 (7.1) 29 (23.4)

    rarely 12 (30.8) 13 (30.2) 16 (38.1) 41 (33.1) 11 (28.2) 10 (23.3) 19 (45.2) 40 (32.3)

    sometimes 11 (28.2) 5 (11.6) 20 (47.6) 36 (29.0) 10 (25.6) 12 (27.9) 15 (35.7) 37 (29.8)

    often 3 (7.7) 5 (11.6) 1 (2.4) 9 (7.3) 4 (10.3) 3 (7) 4 (9.5) 11 (8.9)

    always 1 (2.6) 5 (11.6) 3 (7.1) 9 (7.3) 1 (2.6) 5 (11.6) 1 (2.4) 7 (5.6)

    Q.15 never 4 (10.3) 9 (20.9) 0 (0.0) 13 (10.5) 2 (5.1) 8 (18.6) 0 10 (8.1)

    rarely 13 (33.3) 8 (18.6) 14 (33.3) 35 (28.2) 13 (33.3) 11 (25.6) 21 (50) 45 (36.3)

    sometimes 16 (41.0) 18 (41.9) 18 (42.9) 52 (41.9) 18 (46.2) 16 (37.2) 13 (31) 47 (37.9)

    often 4 (10.3) 5 (11.6) 7 (16.7) 16 (12.9) 5 (12.8) 5 (11.6) 6 (14.3) 16 (12.9)

    always 2 (5.1) 3 (7.0) 3 (7.1) 8 (6.5) 1 (2.6) 3 (7) 2 (4.8) 6 (4.8)

    FMA: functional mandibular advancer; FRD: forsus fatigue resistant device; TB: twin block

  • 36

    Turkish J Orthod 2017; 30: 33-41Lena et al. Patients and Parents Perception

    Table 3. Percentages of patients and parents responses on the questionnaires and p-values of significance tests of changes in relation to the three groups

    PATIENT PARENT

    TB FRD FMA TOTAL TB FRD FMA TOTAL n n n n n n n n question (% among (% among (% among (% among (% among (% among (% among (% among number answers respondents) respondents) respondents) respondents) p* respondents) respondents) respondents) respondents) p*

    Q.04 strongly agree 9 (23.1) 15 (34.9) 30 (71.4) 54 (43.5)

  • 37

    Turkish J Orthod 2017; 30: 33-41 Lena et al. Patients and Parents Perception

    Table 3. Percentages of patients and parents responses on the questionnaires and p-values of significance tests of changes in relation to the three groups

    PATIENT PARENT

    TB FRD FMA TOTAL TB FRD FMA TOTAL n n n n n n n n question (% among (% among (% among (% among (% among (% among (% among (% among number answers respondents) respondents) respondents) respondents) p* respondents) respondents) respondents) respondents) p*

    Q.08.09 never 2 (5.1) 5 (11.6) 1 (2.4) 8 (6.5) 0.014 2 (5.1) 4 (9.3) 0 6 (4.8) 0.027

    rarely 17 (43.6) 12 (27.9) 12 (28.6) 41 (33.1) 16 (41) 12 (27.9) 9 (21.4) 37 (29.8)

    sometimes 15 (38.5) 10 (23.3) 10 (23.8) 35 (28.2) 17 (43.6) 15 (34.9) 13 (31) 45 (36.3)

    often 3 (7.7) 16 (37.2) 15 (35.7) 34 (27.4) 3 (7.7) 10 (23.3) 16 (38.1) 29 (23.4)

    always 2 (5.1) 0 (0.0) 4 (9.5) 6 (4.8) 1 (2.6) 2 (4.7) 4 (9.5) 7 (5.6)

    Q.08.10 never 4 (10.3) 4 (9.3) 0 (0.0) 0 (0.0)

  • the TB appliance had difficulties in pronunciation. Displacement and breakage problems were mostly observed in the FMA group (57.1%) (p

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    5. Pancherz H. History, background, and development of the Herbst appliance. Semin Orthod 2003; 9: 3-11. [CrossRef]

    6. Pakshir H, Mokhtar A, Darnahal A, Kamali Z, Behesti MH, Jamilian A. Effect of bionator and farmand appliance on the treatment of mandibular deficiency in prepubertal stage. Turkish J Orthod 2017; 30: 15-20. [CrossRef]

    7. OBrien K, Wright J, Conboy F, Sanjie Y, Mandall N, Chadwick S, et al. Effectiveness of treatment for Class II malocclusion with the Herbst or twin-block appliances: a randomized, controlled trial. Am J Orth-od Dentofacial Orthop 2003; 124: 128-37. [CrossRef]

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