| A. Demographics |
| 1. | Which age range do you fall into? |
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| A. 20–29 years old |
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| B. 30–39 years old |
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| C. 40–49 years old |
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| D. 50–59 years old |
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| E. >60 years old |
| 2. | Which institution did you obtain your orthodontic specialty qualification? |
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| A. Local |
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| B. Overseas |
| 3. | What is the name of the institution you obtained your orthodontic specialty qualification from? |
| 4. | What year did you graduate from your orthodontic specialty training? |
| 5. | Which state is your current primary practice? |
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| A. Melaka |
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| B. Selangor |
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| C. Johor |
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| D. Sabah |
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| E. Sarawak |
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| F. Pahang |
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| G. Perak |
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| H. Negeri Sembilan |
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| I. Kelantan |
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| J. Terengganu |
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| K. Pulau Pinang |
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| L. Perlis |
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| M. Kedah |
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| N. Putrajaya |
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| O. Kuala Lumpur |
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| P. Labuan |
| 6. | Which orthodontic service do you spend most of your clinical time? |
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| A. Private clinic/hospital |
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| B. Government clinic/hospital |
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| C. Government university hospital |
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| D. Private university dental facility |
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| E. Military clinic/hospital |
| B. Provision of interceptive functional treatment |
| 1. | Do you offer functional appliance therapy in your clinic? |
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| A. Yes |
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| B. No |
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| If yes, please answer Q2 and Q3 only of this section and complete section C, D and E. |
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| If no, please answer Q4 and Q5 only and end the questionnaire. |
| 2. | If yes, how many functional appliances have you prescribed in the last 12 months? |
| 3. | If yes, which malocclusions do you commonly treat with functional appliances? |
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| A. Class II |
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| B. Class III |
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| C. Anterior open bite |
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| D. Other (please specify: _____________________________________) |
| 4. | If not, would you refer a patient to another orthodontist for functional appliance therapy? |
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| A. Yes |
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| B. No |
| 5. | Why do you not offer functional appliance treatment? |
| C. Personal preferences in choice of functional appliance for Class II correction |
| 1. | There are several types of functional appliances currently available for the treatment of Class II malocclusion. Which do you commonly use? |
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| A. Fixed functional appliance |
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| B. Removable functional appliance |
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| C. Both fixed and removable functional appliance |
| 2. | What is the name of the appliance(s)? |
| 3. | Why is this your preferred choice of appliance(s)? |
| 4. | Is the cost of the functional appliance a factor in choosing your preferred appliance? |
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| A. Yes |
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| B. No |
| 5. | Is patient compliance a factor in choosing your preferred appliance? |
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| A. Yes |
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| B. No |
| 6. | Which appliance(s) would you ideally like to use and why? |
| 7. | Forsus for example, is a type of fixed functional appliance. Would you be willing to use this appliance if the production cost was the same as your current choice? |
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| A. Yes |
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| B. No |
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| C. Not sure |
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| D. I’m already using this appliance |
| D. Limitations with functional appliance laboratory service |
| 1. | Do you feel that your choice of functional appliance(s) is limited by the laboratory support available? |
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| A. Yes |
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| B. No |
| 2. | Are you satisfied with the standard of laboratory work you receive when prescribing a functional appliance? |
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| A. Yes |
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| B. No |
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| C. Not applicable as no laboratory work involved (e.g.: using fixed functional) or I do my own repairs |
| 3. | In the event of an appliance breakage, are you satisfied with the laboratory support available? |
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| A. Yes |
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| B. No |
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| C. Not applicable as no laboratory work involved (e.g.: using fixed functional) or I do my own repairs |
| E. Treatment protocol |
| 1. | What age range do you typically begin functional appliance treatment? |
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| A. <6 years old |
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| B. 6–9 years old 9 |
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| C. 10–14 years old |
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| D. >15 years old |
| 2. | Do you feel that potential growth modification cases are often referred to you at an ideal time? |
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| A. Often |
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| B. Sometimes |
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| C. Seldom |
| 3. | What is your typical functional appliance wear regime? |
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| A. Full time including mealtimes |
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| B. Full time NOT including mealtimes |
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| C. Part time |
| 4. | How long is your active functional appliance phase? |
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| A. <6 months |
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| B. 6–9 months |
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| C. 9–12 months |
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| D. >12 months |
| 5. | Do you prescribe a chart or diary to measure patient compliance with removable functional appliance therapy? |
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| A. Yes |
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| B. No |
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| C. Not applicable as using fixed functional appliance |
| 6. | Based on your experience in using functional appliances, which of the appliance(s) do you feel that you have the best compliance? |
| 7. | Following active removable functional appliance therapy, do you have a period of retention when the appliance is worn less? |
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| A. Yes |
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| B. No |
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| C. Not applicable as using fixed functional appliance |
| 8. | If so, how long does this period of retention last? |
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| A. 2–3 months |
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| B. 4–6 months |
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| C. 7–9 months |
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| D. >9 months |
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| E. Not applicable as using fixed functional appliance |
| 9. | Do you carry out any adjustment to the functional appliance during this retention phase? |
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| A. Yes |
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| B. No |
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| C. Not applicable as using fixed functional appliance |
