A comparison of children's experiences with fixed and removable functional appliances: A qualitative study

The objective of this study was to compare children's experiences and perceptions of treatment with Hanks-Herbst (HH) and modified Twin-block (MTB) functional appliances.

A pragmatic nested qualitative study was undertaken in a single hospital setting. Participants from a randomized controlled trial (International Standard Randomised Controlled Trial Number 11717011) wearing HH and/or MTB appliances were interviewed using a topic guide in a one-to-one, semistructured format. Interviews were recorded and transcribed verbatim for framework methodology analysis until data saturation was reached.

Eighteen participants (HH, 7: MTB, 4; switched group, 7) were interviewed. Thirteen codes were constructed and grouped into 3 themes: (1) functional impairment and symptoms, (2) psychosocial factors and impacts, and (3) feedback on appliances and patient care. Both appliances had a negative impact on quality of life, with disruption to children's daily routines and psychological well-being. Speaking was more problematic for MTB participants, whereas HH participants encountered mastication and breakage issues. HH was preferred by most participants, as its nonremovable feature meant less managing and self-discipline was required. MTB was considered a suitable option for children with good self-discipline and who preferred a versatile lifestyle. Feedback included wishes for the availability of multiple appliance options and a degree of autonomy in decision-making processes.

HH and MTB can negatively affect children's quality of life. Participants preferred HH over MTB because of its nonremovable feature, and children requested to be empowered during decision-making processes.