Three-dimensional ultrasound evaluation of tongue posture and its impact on articulation disorders in preschool children with anterior open bite.

Background Tongue posture plays an important role in the etiology of anterior open bite (AOB) and articulation disorders, and is crucial for AOB treatment planning and posttreatment stability. Clinical assessment of tongue posture in children is unreliable due to anatomical limitations. The aim of the study was to present functional diagnostics using three-dimensional ultrasound (3DUS) assessment of resting tongue posture in comparison to clinical assessment, and the associations between the improper tongue posture, otorhinolaryngological characteristics, and articulation disorders in preschool children with AOB. Patients and methods A cross-sectional study included 446 children, aged 3-7 years, 236 boys and 210 girls, examined by an orthodontist to detect the prevalence of AOB. The AOB was present in 32 children. The control group consisted of 43 children randomly selected from the participants with normocclusion. An orthodontist, an ear, nose and throat (ENT) specialist and a speech therapist assessed orofacial and ENT conditions, oral habits, and articulation disorders in the AOB group and control group. Tongue posture was also assessed by an experienced radiologist, using 3DUS. The 3DUS assessment of tongue posture was compared to the clinical assessment of orthodontist and ENT specialist. Results The prevalence of AOB was 7.2%. The AOB group and the control group significantly differed regarding improper tongue posture (p < 0.001), and articulation disorders (p < 0.001). In children without articulation disorders from both groups, the improper tongue posture occured less frequently than in children with articulation disorders (p < 0.001). After age adjustment, a statistical regression model showed that the children with the improper tongue posture had higher odds ratios for the presence of AOB (OR 14.63; p < 0.001) than the others. When articulation disorders were included in the model, these odds ratios for the AOB became insignificant (p = 0.177). There was a strong association between the improper tongue posture and articulation disorders (p = 0.002). The 3DUS detected the highest number of children with improper resting tongue posture, though there was no significant difference between the 3DUS and clinical assessments done by orthodontist and ENT specialist. Conclusions The 3DUS has proved to be an objective, non-invasive, radiation free method for the assessment of tongue posture and could become an important tool in functional diagnostics and early rehabilitation in preschool children with speech irregularities and irregular tongue posture and malocclusion in order to enable optimal conditions for articulation development.

[Effects of breast-feeding duration, bottle-feeding duration and oral habits on the occlusal characteristics of primary dentition].

OBJECTIVE: To assess the effects of breast-feeding duration, bottle-feeding duration and oral habits on the occlusal characteristics of primary dentition in 3-6-year-old children in Beijing. METHODS: This cross sectional study was conducted via an examination of the occlusal characteristics of 734 children combined with a questionnaire completed by their parents/guardians. The examination was performed by a single, previously calibrated examiner and the following variables were evaluated: presence or absence of deep overbite, open bite, anterior cross bite, posterior cross bite, deep overjet, terminal plane relationship of the second primary molar, primary canine relationship, crowding and spacing. Univariate analysis and multiple Logistic regressions were applied to analyze the associations. RESULTS: It was found that a short duration of breast-feeding (never or ≤6 months) was directly associated with posterior cross bite (OR=3.13, 95%CI=1.11-8.82, P=0.031) and no maxillary space (OR=1.63, 95%CI=1.23-2.98, P=0.038). In children breast-fed for ≤6 months, the probability of developing pacifier-sucking habits was 4 times that for those breast-fed for >6 months (OR=4.21, 95%CI=1.85-9.60, P=0.000 2). The children who were bottle-fed for over 18 months had a 1.45-fold higher risk of nonmesial step occlusion and a 1.43-fold higher risk of class II canine relationship compared with those who were bottle-fed for 6-18 months. Non-nutritive sucking habits were also found to affect occlusion: a prolonged digit-sucking habit increased the probability of an anterior open bite, while a pacifier-sucking habit was associated with excessive overjet and absence of lower arch developmental space. Tongue-thrust habit was associated with anterior open bite (OR=4.21, 95%CI=1.85-9.60, P=0.000 2) and posterior cross bite (OR=7.24, 95%CI=1.30-40.13, P=0.024). Lower lip sucking habit was associated with deep overjet and had a negative association with class III canine relationship. Unilateral chewing was associated with spacing in mandibular (OR=1.57, 95%CI=1.03-2.41, P=0.037). Mouth breathing was associated with chronic rhinitis and adenoidal hypertrophy and had an association with spacing in maxillary. The chi-square test did not indicate a statistically significant association between upper lip sucking habit and any occlusal characteristics. CONCLUSION: Breast-feeding duration was shown to be associated with the prevalence of posterior crossbite, or no maxillary space in the deciduous dentition and development of a pacifier-sucking habit. Children who had a longer duration of bottle-feeding were more likely to develop class II canine relationship. Children who had an oral habit were more likely to develop abnormal occlusal characteristics.

One-step surgery and correction of the transverse dimension of the maxilla using the lingual technique: an original assisted transverse surgery method.

During orthodontic-surgical treatment, orthodontics must facilitate the surgery, and vice-versa. More specifically, surgical adjustment of the transverse dimension of the maxilla and its vertical and/or anteroposterior repositioning require orthodontic support. In addition to the orthodontic appliance, a palatal device is needed to guide and maintain the correction. In the lingual technique, this situation might appear to be difficult to manage since both the appliance and the auxiliaries are located on the same side. We demonstrate a removable tooth-supported expander as well as the use of dua-insertion palatal bands to solve a transverse maxillary deficit less than or equal to 5mm.

Midline diastema and its aetiology--a review.

Maxillary midline diastema is a common aesthetic complaint of patients. Treating the midline diastema is a matter of concern for practitioners, as many different aetiologies are reported to be associated with it. The appearance of midline diastema as part of the normal dental development makes it difficult for practitioners to decide whether to intervene or not at an early stage. The aim of this article is to review the possible aetiology and management options which will help the clinician to diagnose, intercept and to take effective action to correct the midline diastema. The available data shows that an early intervention is desirable in cases with large diastemas. Treatment modality, timing and retention protocol depends on the aetiology of the diastema. Therefore, priority needs to be given to diagnosing the aetiology before making any treatment decisions. Clinical Relevance: This article aims to determine and evaluate the aetiology and possible treatment options of midline diastema.

Asymmetrical distalization of maxillary molars with zygomatic anchorage, improved superelastic nickel-titanium alloy wires, and open-coil springs.

INTRODUCTION: In nongrowing patients with skeletal Class II malocclusion, premolar extraction or maxillary distalization can be used as camouflage treatment. Zygomatic anchorage enables distalization in uncooperative or noncompliant patients. We describe 1 such procedure in a 24-year-old woman. METHODS: We used novel improved superelastic nickel-titanium archwires combined with nickel-titanium open-coil springs to provide a constant and continuous low force to the dentition. RESULTS: We were able to successfully eliminate the protrusive profile and correct the Class II molar relationship using this system of zygomatic anchorage. The posterior occlusal relationships were improved to achieve Class I canine and molar relationships on both sides, and ideal overbite and overjet relationships were established. Facial esthetics was improved with decreased protrusion of the upper and lower lips. CONCLUSIONS: The method used here is a promising alternative to traditional distalization techniques and might offer an effective and simple means of distalizing maxillary molars in uncooperative patients.

Treatment and retreatment of a patient with a severe anterior open bite.

An 8-mm anterior and posterior open bite caused by a tongue rest posture habit was closed in a 25-year-old man by means of mandibular soldered tongue spurs and without orthognathic surgery. All maxillary and mandibular first molars were extracted, and the spaces were closed. Inappropriate retention protocol allowed for relapse in a 6-month period. A new 1-year orthodontic retreatment was conducted; after an appropriate retention protocol, the outcomes of treatment were significantly improved.

Pyogenic granuloma on the tongue: a pediatric case report.

Pyogenic granuloma (PG) is a rare, benign, vascular, hyperplasic, soft tissue lesion caused by diverse factors, including traumatic injuries. This article presents a case involving the surgical removal of PG on the tongue of a 4-year-old boy who had difficulty with speech and eating because of the tongue lesion. The parents reported that the child had the habit of nibbling on and sucking his tongue. The lesion was excised and histopathological analysis confirmed the diagnosis of PG; however, because the child continued to nibble and suck on his tongue, the lesion recurred. A second surgery was performed with the same histopathological diagnosis. At a one-year follow-up, the child had ceased his tongue habits, and no recurrence was seen.

Causal relationship between malocclusion and oral muscles dysfunction: a model of approach.

AIM: Bad habits result in altered functions which with time can cause anomalies of the orofacial morphology. To solve these problems, orthodontic treatment can be supported by myofunctional therapy in order to recover the normal functionality of the oral muscles. The aim of this study is to assess the need to treat patients with neuromuscular disorders, from both the occlusion and the muscles condition approach in order to obtain the balance needed for the stability of treatment. MATERIALS AND METHODS: A sample of 23 patients with atypical swallowing was included in this study, some of them presented thumb sucking and oral breathing. After case history collection, in order to make a correct orthodontic and functional diagnosis, correction of anomalies was carried out since they could compromise the success of the therapy (maxillary contraction, oral breathing, and short lingual fraenum). Then a different therapeutic approach was applied on the basis of the specific dental features. RESULTS: Both from the diagnostic and therapeutic point of view, important results were achieved especially through muscle analysis with dynamometer and surface electromyography. CONCLUSION: Orthodontic therapy, in the presence of bad habits, is not enough to solve orthodontic issues, it must be combined with a myofunctional treatment. The success of the therapy is granted only when patients and their family comply with the treatment and all factors which can prevent success of the therapy are removed.

[Effect of adverse oral habits on the development of the dentomaxillary system]. / Influenta obiceiurilor vicioase asupra dezvoltarii aparatului dento-maxilar.

UNLABELLED: Main features of the dentomaxillary system (breathing, chewing, swallowing) are provided by the rhythmic movements of the mandible, tongue, lips, mimic muscles, learned during ontogenesis and coordinated neuromusculary and largely automated. AIM: The aim of our study was to prove the role of oral habits in the development of dentomaxillary anomalies. We made experimental investigations--model studies, fotostatic test for face and side face, radiological examinations, clinical general and ENT exam for accurately assess of the factors which contribute to the emergence and development of dentomaxillary anomalies. MATERIAL AND METHODS: The study group consisted of 175 children (94 girls and 81 boys) aged between 7 and 14 years. We made individual sheets for recording neuromuscular and oropharyngeal balance starting from a patient's overall clinical appearance. RESULTS: The diagnosis of most teenagers was first Angle's class of malocclusion with tongue thrusting and mouth breathing. Oral habits disrupt the muscular balance and bone growth producing changes in the dental arch and ocllusal characteristics. The high prevalence of dentomaxillary anomalies (52.57%) and obvious interrelationship with functional imbalances of the dentomaxillary system (62.82% of subjects examined) supports the implication of functional factors in those etiology. CONCLUSIONS: Suppression of vicious habits by methods of awareness, myogymnastic and functional reducing exercises are the first steps of early functional treatment for dentomaxillary anomalies.

Deglución atípica y succión de dedos / Atypical swallowing and sucking toes

La deglución atípica corresponde a movimientos inadecuados de la lengua y/o otras estructuras que participan en el acto de deglutir. En general estas atipias ocurren por problemas de postura inadecuada de la cabeza, por alteraciones de torus, de la movilidad o la propiocepción de los órganos: lengua, labio mejilla y paladar blando. La deglución debe ser realizada con posición labial y lingual adecuada para no intervenir en el desarrollo óseo, en la dentición y en la oclusión. La succión digital se ha descrito como un hábito común en la infancia que se considera normal hasta la edad de los 3 a 4 años. Aunque la mayoría de los niños que comienzan a chuparse el pulgar interrumpen esta costumbre hacia los 2,5 a 3 años, en algunos casos este hábito permanece hasta edades entre los 6 y 12 años. Los riesgos asociados a la succión del pulgar dependen de la frecuencia, intensidad, duración y posición de la boca. La presencia de este hábito después de los 4años genera cambios en la tonicidad muscular de labio y bucinadores, retarda su maduración, dificulta la deglución normal y crea mecanismos nocivos que llevan a desarrollar una actividad muscular de compensación para lograr la deglución, todo lo cual también puede afectar otras acciones como la fonación y la respiración entre otras. Se parte de una breve exposición de la deglución normal y se analiza la atipia más frecuente, tipos y tratamientos de ambos hábitos. Se realizó una revisión exhaustiva de la literatura científica con los objetivos de describir las fases del mecanismo de la deglución normal, diferenciar la deglución infantil de la adulta, explicar los diferentes tipos de deglución, con el propósito de ofrecer una síntesis actualizada a la comunidad científica..

Tongue granulomatous lesion caused by mandibular primary incisors eruption.

The aim of this report was to present a case of granulomatous lesion on the ventral surface of the tongue in a 9-month-old, healthy, infant girl, caused by the habit of scraping the tongue on mandibular central incisors. Clinical treatment consisted of manual smoothing of the sharp edges of both incisors and excision of the 2-cm pediculate ulcerative granulomatous mass localized on the ventral surface of the tongue. After 3 weeks, the child could be properly fed and a complete healing of the lesion was observed.

Sublingual traumatic ulceration (a Riga-Fede disease): report of two cases.

Sublingual traumatic ulceration is rare and a benign, ulcerative and granulomatous process that occurs as a result of repetitive trauma of the oral mucosal surfaces by the teeth. Treatment should begin conservatively and should focus on eliminating the source of the trauma. In our cases, we chose the conservative treatment by grinding the teeth and placing composite resin over the offending teeth and applied orabase. At the follow-up, we confirmed that the lesion was resolved and infant was feeding normally.

An alternative for postorthodontic labial retention in an unusual case.

An integral part of sustaining long-term orthodontic results is a lingually bonded retainer. These retainers have been established as a standard retention protocol, as they combine efficiency and esthetics. Increasing patient demands for improved esthetics and maintenance of good health of dental and periodontal tissues have led to the development of new techniques and materials involving reinforced polyethylene fibers. In this case report, retention featuring the use of a reinforced polyethylene fiber retainer, placed labially to avoid irritating the tongue, is presented. Three-year posttreatment records indicated no relapse and that the integrity of soft and hard tissues had remained intact.

Vertical interincisal trespass assessment in children with speech disorders

Through a transversal epidemiological study, conducted with 333 Brazilian children, males (157) and females (176), aged 3 to 6 years old, enrolled in a public preschool, this study aimed to evaluate the prevalence of the different types of vertical interincisal trespass (VIT) and the relationship between these occlusal aspects and anterior lisping and/or anterior tongue thrust in the articulation of the lingua-alveolar phonemes /t/, /d/, /n/ and /l/. All children involved were submitted to a VIT examination and to a speech evaluation. Statistical significance was analyzed through the Qui-square test, at a significance level of 0.05 (95 percent confidence limit). The quantitative analysis of the data demonstrated the following prevalences: 1 - the different types of VIT: 48.3 percent for normal overbite (NO), 22.5 percent for deep overbite (DO), 9.3 percent for edge to edge (ETE) and 19.8 percent for open bite (OB); 2 - interdental lisping in relation to the different types of VIT: 42 percent for NO, 12.5 percent for DO, 12.5 percent for ETE, 32.9 percent for OB; and 3 - children with anterior tongue thrust in the articulation of lingua-alveolar phonemes in relation to the different types of VIT: 42.1 percent for NO, 14 percent for DO, 10.5 percent for ETE, 33.3 percent for OB. The results demonstrated that there was a significant relationship between open bite and anterior lisping and/or anterior tongue thrust in the articulation of the lingua-alveolar phonemes /t/, /d/, /n/ and /l/; and that there was a significant relationship between deep overbite and the absence of anterior lisping and anterior tongue thrust in the articulation of the lingua-alveolar phonemes.

Postura lingual: sua relação com a maloclusão / Tongue posture and its relationship with malocclusion

Objetivos: Através da análise de 40 modelos ortodônticos de indivíduos na dentição permanente completa, cuja imagem radiográfica da língua era visualizada na telerradiografia em norma lateral de cabeça, o objetivo desse trabalho foi correlacionar esta imagem radiográfica da língua com as características de maloclusão dos respectivos indivíduos. Métodos: Com auxílio de paquímetro digital e régua milimetrada foram realizadas aferições do trespasse horizontal, do trespasse vertical, das distâncias transversais intra-arcos entre os caninos superiores e inferiores, pré-molares superiores e inferiores e molares superiores e inferiores, a classificação molar de Angle e a discrepância de modelos no arco superior e inferior. O método da análise estatística constou de verificação do erro do método para averiguação da calibração do pesquisador e a análise estatística dos objetivos, valores observados através do teste “t”-Student. Resultados: Os resultados mostraram alterações significantes nos modelos analisados: trespasse horizontal e vertical aumentados (67,5% e 57,5%, respectivamente) a oclusão no sentido transversal foi normal em 95% da amostra. Conclusão: A postura lingual está intimamente ligada ao desenvolvimento das maloclusões, podendo influenciar na oclusão nos planos de espaço sagital e vertical

Remoção de hábitos e terapia miofuncional: restabelecimento da deglutição e repouso lingual / Removal of sucking habits and myofunctional therapy: establishing swallowing and tongue rest position

TEMA: hábitos prolongados de sucção de chupeta e mamadeira podem provocar distúrbios miofuncionais como o padrão incorreto de deglutição e repouso lingual. OBJETIVO: estudar os efeitos da associação da Terapia Miofuncional (TMF) e da remoção de hábitos (REM) de sucção na reabilitação da deglutição e repouso lingual. MÉTODO: dois grupos composto por dez crianças de quatro anos a quatro anos e oito meses de idade que inicialmente apresentavam hábitos de sucção de chupeta e mamadeira foram estudados. O grupo denominado REM foi submetido à REM pelo Método de Esclarecimento modificado, enquanto que o grupo denominado TMF também teve os hábitos de sucção removidos pelo mesmo método e foi associada a TMF. Foram realizados exames pré-tratamento, 60 e 180 dias pós-procedimentos. Os dados foram submetidos aos testes estatísticos de Mann-Whitney e Wilcoxon p < 0,05. RESULTADOS: os resultados evidenciaram que o grupo submetido à REM e TMF apresentou adequação dos padrões de deglutição aos 60 dias e 180 dias e correto posicionamento de língua em repouso aos 180 dias, enquanto que o grupo submetido apenas à REM demonstrou adequação do padrão de deglutição apenas aos 180 dias e não apresentou melhora significativa do correto padrão de posicionamento de língua em repouso durante os períodos de avaliação. CONCLUSAO: a TMF associada à REM de sucção de chupeta e mamadeira produziu melhor e mais rápida adequação do padrão de deglutição e de posicionamento lingual em repouso do que apenas a REM de sucção.

Mordida aberta anterior associada ao hábito de sucção de shupeta - relato de caso clínico / Anterior open bite associated tp pacidier use - alinical report

Os hábitos orais deletérios, como por exemplo a sucção de chupeta, podem gerar alterações no desenvolvimento de crianças na fase de crescimento, levando ao estabelecimento de maloclusões. Normalmente, quando interrompidos durante a dentadura decídua têm pouco ou nenhum efeito a longo prazo, contudo, quando persistem, pode se desenvolver maloclusão característica. O propósito deste artigo é descrever um caso clínico no qual uma menina portadora de mordida aberta anterior apresentou correção espontânea da maloclusão após a interrupção do hábito de sucção d chupeta