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15 Extra-oral traction applied via an Interlandii headgear Fig. 5 Nevertheless, dramatic occlusal changes are possible with these appliances and they can aid the correction of some quite severe malocclusions. Figures14a–f show a case treated with a functional appliance that had a marked effect not only on the occlusion but also on the patient's facial appearance. rior cross bite or in cases where the buccal segments are being moved forward to close spaces in the arches. Examples of extra oral traction devices are shown in Figures 15, 16a and b.

29 Pre-existence of TMD should be recorded, and the patient advised that treatment will not predictably improve their condition. Some patients may suffer with increased symptoms during treatment which must also be discussed at the beginning of treatment. Where patients experience symptoms during treatment, treatment should be directed at eliminating occlusal disharmony and joint noises whilst reassuring the patient. Standard Trauma Following a well publicised case of eye trauma in a patient wearing headgear28 a number of safety headgear products have been designed and explicit guidelines are now available.

I am strongly in favour of every dentist being a surgeon as well (if possible), but I protest against a revival of the “Association of Surgeons practising Dental Surgery” in this insidious form. Yours truly S. J. Hutchinson, M. R. C. Eng BR Dent J, 1903; 24: 828 18 BRITISH DENTAL JOURNAL VOLUME 196 NO. qxd 12/12/2003 11:58 Page 71 PRACTICE IN BRIEF ● ● ● Before any active orthodontic treatment is considered it is essential that the oral hygiene is of a high standard and that all carious leions have been dealt with Arch wires, headgears and brackets themselves may cause significant damage either during an active phase of treatment or during debonding.

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