The use of functional appliances for class II malocclusions: a nation-wide cross-sectional survey of orthodontists in Australia

Background: If detected at the appropriate age, a Class II malocclusion can be improved or camouflaged by utilising functional appliances to manipulate a child’s skeletal growth spurt to advantage. Aim: The aim of this study was to evaluate the use of functional appliances by orthodontists currently practising in Australia. Methods: This was a cross-sectional study design that utilised a nation-wide online survey consisting of 22 questions related to: clinic/clinician demographics, appliance preference and treatment timing, the provision of first phase functional appliance treatment and treatment protocols for removable functional appliance therapy. The survey was distributed via the Australian Society of Orthodontists to its 428 members. Statistical analysis was conducted through Qualtrics XM® data analysis software, version 04/30/2023 (Qualtrics XM®, Provo, UT, USA. https://www.qualtrics.com) with a significance level set at P < 0.05. Results: A total of 166 responses were received representing a response rate of 38.8%. Ninety-nine per cent of survey respondents (n = 139) reported prescribing functional appliances to correct a Class II malocclusion with the Twin Block appliance as the most-commonly prescribed. It was found that a two phase, removable functional appliance followed by fixed appliances was the preferred choice for Class II treatment when utilising a functional appliance. The most common age to commence functional appliance therapy was between 10 and 12 years, incorporating 9 to 12 months of full-time wear, followed by a 4-to 6-month retention period. There appears to be a clear relationship between an orthodontist’s preferred choice of Class II treatment when employing functional appliances and their orthodontic training institution. Conclusion: It is common practice for orthodontists in Australia, to utilise functional appliances in the management of a Class II malocclusion. However, the prescribing patterns for functional appliance therapy are not uniform. Variations appear evidenced-based depending on the practice location and the institution from which the orthodontist graduated. (Aust Orthod J 2024; 40: 96-110. DOI: 10.2478/aoj-2024-0025).