Objective: To recommend unusual or new modalities to make Fixed Functionals (FFs) more effective and stable.
Methods: For the last 100 FF patients in our practice, new treatment suggestions were as follows:
1. Take an MRI with 6 to 9 sequences to see the position of the discs and condyles with various degrees of mandibular advancement.
2. At the delivery appointment, give a banana “chew-in” to the patients to test if they are able to accept this much protrusion.
3. Use mandibular TADs fixed to teeth so that no mandibular anterior tooth movement can take place.
4. Give loose up-and-down rubber bands right and left so that, at night, the patients cannot open their mouth wide enough to decrease mandibular protrusion effect.
5. Keep the appliance in for at least three months after speech centric appears to be stable.
6. After removal of the Fixed Functional Appliance, if any lack of stability is shown, use TADs from lower molar area to TADs in the upper cuspid area with rubber bands for anterior stability.
7. An MRI should be taken at end of treatment to check what effect treatment has had.
Results: Compared with the earlier group of patients wearing FFs, the last group of patients after three years of observation have shown 20 % more stable mandibular advancement.
Conclusions: FFs are still in the developmental stage to obtain optimal mandibular repositioning. The above listed suggestions have helped considerably. There will be more contributions in future from other investigators.