By hanif, azizul, dyana, laila

content  Growth graph  Timing of treatment

 Difficult to predict the magnitude and direction of future facial growth because of tremendous individual variation  Chronological age cannot be used to predict the onset of the adolescent growth spurt.  Some cephalometric features can help in predicting the likely directionof future mandibular growth rotations (not entirely reliable).

 Concerning timing, mandibular growth follows the general body pattern of skeletal growth which accelerates at puberty  Hence, serial statural height measurements and the presence of secondary sexual characteristics  can help determine the onset and stage of the pubertal growth spurt and associated acceleration in mandibular growth.

 Thus it is useful in determine the timing to start of functional appliance treatment.  The growth spurt (variable, both within and between populations)  Boys: 14 ± 2 years  Girls: 12 ± 2 years

Timing of Tx  Effective during active growth  The faster the growth, the faster the response, the shorter the tx time (theoretically)  Most common time for tx - pubertal growth spurt (difficult to predict accurately)  Early tx: 9-10 yrs  Definitive tx: 12-13yrs (late mixed)  Key factor : pt is actively growing

Early tx  Ideal tx time – when 4 upper incisors have erupted  Most common - correction of large OJ caused by retrognathic mandible  Tx - Reposition mandible forward  Tx discontinued once correction achieved  Some relapse will occur

Early tx  To intercept a developing problem  Improve aesthetics (improve self-esteem)  Decreased trauma risk to anterior teeth  Early correction of deleterious habit  Early tx might produces larger skeletal effects, but not supported by studies. In fact, more prolonged total tx time is reported.

Definitive tx  During pubertal growth spurt  Usually all permanent teeth have erupted  Correction of max-mand discrepancy  usually followed by fixed appliance tx  Functional appliance may also be used during fixed appliance tx

Tx Protocol  FullFull-time wear for first 6 months  Worn at all times including eating and sleeping  Removed only for brushing of teeth  Not to be worn during sporting activities  NightNight-time wear for next months  Finishing may be undertaken with fixed appliances fixed appliances