Analysis of prefabricated myofunctional appliances with different overjet and bumper designs: a three-dimensional finite element analysis.

BACKGROUND: Prefabricated myofunctional appliance can guide tooth eruption, improve dentition alignment, correct myofunctional disorders and harmful oral habits. However, its application to skeletal discrepancy may result in unsatisfactory tooth inclination. This study aimed to construct a novel appliance with overjet design to avoid this side effect and investigated its shape and mechanical changes under occlusion using three-dimensional finite element method. METHODS: We established three samples of prefabricated myofunctional appliances. The first one was edge to edge without overjet, and the outer shield of both jaws were flattened. The second one was 3 mm overjet with stepped the outer shield. The last one was 3 mm overjet, and the outer shield of both jaws were flatted, which meant the front wall of lower jaw was strengthened with bumper, termed as lower bumper. A complete dentition model was applied to the study. 150 N occlusal force was applied to each type of appliance and the deformation displacement and the changes in stress was recorded. RESULTS: The deformation was significant in the incisors regions, especially in the vertical and lateral dimensions. The maximum displacements of 3 mm overjet with step shield group were 7.08 mm (vertical), 3.99 mm (lateral), and 2.90 mm (sagittal), while it decreased to 3.92 mm(vertical), 1.94 mm (lateral), and 1.55 mm (sagittal) in overjet with bumper group. Moreover, the upper molar regions exhibited higher vertical and sagittal displacement in 3 mm overjet with step shield group, which were 3.03 mm (vertical) and 1.99 mm (sagittal), and the bumper design could decrease the maximum displacement to 1.72 mm (vertical) and 0.72 mm (sagittal). In addition, the Von Mises stress of appliances was analyzed, and results indicated that 3 mm overjet with step shield generated higher stress than other groups, with the maximum Von Mises stress was 0.9387 MP, which were 0.5858 and 0.5657 MP in edge to edge group and 3 mm overjet with lower bumper group, respectively. CONCLUSION: The prefabricated myofunctional appliances may cause deformation during occlusion. Compared to step shield group, the application of lower bumper exhibited better resistance to occlusal force.

Tongue rehabilitation through the froggy mouth device: case series.

Based on the knowledge supporting the position of the tongue in relation to the palate to be the guiding factor of oro-dental growth and the key factor in long-term orthodontic stability after treatment, 6 different case reports show how the Froggy Mouth device changes treatment strategy in rehabilitation of dysfunctional swallowing by relying on the subcortical process, following the principles established by pioneering studies on memorization mechanisms conducted by Eric Kandel (year 2000 Nobel Prize winner in medical field for his research on memorization process).

Tongue Rehabilitation Device for Dysphagic Patients.

Dysphagia refers to difficulty in swallowing often associated with syndromic disorders. In dysphagic patients' rehabilitation, tongue motility is usually treated and monitored via simple exercises, in which the tongue is pushed against a depressor held by the speech therapist in different directions. In this study, we developed and tested a simple pressure/force sensor device, named "Tonic Tongue (ToTo)", intended to support training and monitoring tasks for the rehabilitation of tongue musculature. It consists of a metallic frame holding a ball bearing support equipped with a sterile disposable depressor, whose angular displacements are counterbalanced by extensional springs. The conversion from angular displacement to force is managed using a simple mechanical model of ToTo operation. Since the force exerted by the tongue in various directions can be estimated, quantitative assessment of the outcome of a given training program is possible. A first prototype of ToTo was tested on 26 healthy adults, who were trained for one month. After the treatment, we observed a statistically significant improvement with a force up to 2.2 N (median value) in all tested directions of pushing, except in the downward direction, in which the improvement was slightly higher than 5 N (median value). ToTo promises to be an innovative and reliable device that can be used for the rehabilitation of dysphagic patients. Moreover, since it is a self-standing device, it could be used as a point-of-care solution for in-home rehabilitation management of dysphasia.

Outcome of orthodontic palatal plate therapy for orofacial dysfunction in children with Down syndrome: A systematic review.

To evaluate the effects of orthodontic palatal plate therapy (OPPT) in the treatment of orofacial dysfunction in children with Down syndrome (DS). Indexed databases were searched. Clinical trials in DS allocated to test (treatment with palatal plates) versus control group (without palatal plates/special physiotherapy for orofacial stimulation) with follow-up of any time duration and assessing mouth closure, tongue position, active and inactive muscle function as outcomes. Study designs, subject demographics, frequency and duration of palatal plate therapy, method for assessment, follow-up period and outcomes were reported according to the PRISMA guidelines. Eight clinical studies were included. The risk of bias was considered high in three studies and moderate in 5 studies. The number of children with DS ranged between 9 and 42. The mean age of children with DS at the start of the study ranged between 2 months and 12 years. The duration of palatal plate therapy ranged between 4 months and 48 months. The follow-up period in all studies ranged from 12 to 58 months. All studies reported OPPT to be effective in improving orofacial disorders in children with DS. Most of the included studies suggest that palatal plate therapy in combination with physiotherapy/orofacial regulation therapy according to Castillo Morales/speech and language intervention seems to be effective in improving orofacial disorders in children with DS. However, the risk of bias of the included studies was high to moderate. Longitudinal trials with standardized evaluation methods, age of children at treatment initiation, treatment duration and standard orofacial outcomes are recommended.

Complete dentures for a patient after a stroke by means of orofacial myofunctional therapy: A clinical report.

After a stroke, patients frequently show compromised swallowing, mastication, and speech, as well as unfavorable motion and deviation of the tongue and mandible. The dentist can improve the oral rehabilitation of a patient with deteriorated facial and oral muscles after a stroke by incorporating orofacial myofunctional therapy. This report describes a method for tongue exercises and correction of mandible deviation in an edentulous patient after a stroke by using a pearl on a wire in the anteriomedian palatal part of the maxillary denture.

Efficacy of a Pre-Fabricated Myofunctional Appliance for the Treatment of Mild to Moderate Pediatric Obstructive Sleep Apnea: A Preliminary Report.

OBJECTIVE: The purpose of this study was to determine the efficacy of the Myobrace/MyOSA myofunctional appliance for the treatment of mild to moderate Obstructive Sleep Apnea (OSA) in children, by means of the Apnea/Hypopnea Index (AHI). STUDY DESIGN: Nine children with a diagnosis of mild to moderate OSA were included in the study. The subjects wore the Myobrace/MyOSA myofunctional appliance for a period of 90 days. The initial AHI, determined by means of a sleep test, was used as baseline (To), and a second AHI, computed at the end of the experimental period, was used as final data (T1). The differences between the AHIs at To and T1 were calculated (diff AHI) and used for statistical purposes. The level of Oxygen Saturation (SaO2) was also recorded before and after treatment, and their differences calculated as diff SaO2. Statistical analysis was performed with a paired-t- test and statistical significance was established at 95 per cent level of confidence. RESULTS: A statistical significant reduction in the AHI of the studied subjects was computed at the end of the experimental period (p = 0.0425). Although there was an improvement in the SaO2, it did not reach a statistically significant difference. CONCLUSIONS: The present results suggest that the Myobrace/MyOSA myofunctional appliance can be an alternative to treat mild to moderate OSA in children. However further studies are necessary to determine the stability of the results after treatment.

Correlation of Orthodontic Treatment by Fixed or Myofunctional Appliances and Periodontitis: A Retrospective Study.

INTRODUCTION: Malocclusion plays an important role in the development of periodontitis. Thus, by treating malocclusion, a good gingival health can be achieved. This study was conducted to establish the correlation between orthodontic tooth movement and periodontitis. MATERIALS AND METHODS: This is a retrospective study conducted on 220 patients who underwent orthodontic treatment for malocclusion. They were divided into two groups: Group I patients were treated with fixed orthodontics, while group II patients received myofunctional appliances. RESULTS: The value for plaque, gingival recession, and tooth mobility significantly increased in group I patients. However, the difference was statistically nonsignificant in group II patients. CONCLUSION: The authors concluded that there is correlation between malocclusion and periodontitis. Malocclusion leads to periodontitis. CLINICAL SIGNIFICANCE: Malocclusion is the main reason for the development of poor periodontal health. Combined effort has to be played by both periodontist and orthodontist for the treatment of various orthodontic-periodontal problems.

Dilemmas in Treatment of Recurrent Recalcitrant Dental Anterior Open Bite.

An anterior open bite is one of the most difficult occlusal abnormalities to treat. Quite often this aberration entails dental component and/or skeletal component. The skeletal open bite will require intrusion of the posterior sextants with the assistance of bite blocks, temporary anchorage devices, high pull headgear, and as a last resort - orthognathic surgery. The orthodontic treatment should be augmented with the orofacial myofunctional therapy. In this article, the author describes 3 different variations of treatment of the dental anterior open bite, first on acrylic models, and then on the actual patients. Consideration should be given to patients with a 'short upper lip," and in this case, surgical correction should be entertained.

Correction of a Overjet and Overbite In Class II Division 1 Malocclusion Using Twin Block Appliance Therapy: A Case Report.

Class II division 1 malocclusion is the most common malocclusion. It shows specific clinical characteristics such as large overiet and deep overbite resulting in a soft tissue profile imbalance. Majority of the patients with class II division 1 malocclusions have an underlying skeletal discrepancy between the maxilla and mandible. The treatment of skeletal class II division 1 malocclusion is done taking into consideration the age, growth potential, severity of malocclusion, and compliance of patient with treatment. Myofunctional appliances can be successfully used to treat growing patients with class II division 1 malocclusion. This article presents a discussion on successful treatment of class II division 1 malocclusion with growth modification approach using twin block appliances.

Thirty-year follow-up of a TMD case treated based on the neuromuscular concept.

AIM: Occlusal therapy is employed to alleviate the symptoms of a temporomandibular disorder (TMD) at times. However, the long-term effect of occlusal therapy in the masticatory system is not well understood. This case study aims to present a 30-year follow-up of a TMD case. METHODOLOGY: The patient developed TMD with intermittent closed lock of the left temporomandibular joint (TMJ). Chief complaints included trismus, pain, and noise of the left TMJ during function. The patient's occlusal disharmony was assessed with use of electronic instruments and corrected based on the neuromuscular concept. A minimum-invasive and reversible approach using adhesive occlusal restorations was used. RESULTS: The jaw movement and masticatory muscle activity assessed at the 7- and 23-year follow-ups revealed that the established occlusion was well adapted, and re-established the patient's functional occlusion system. The patient has been free from TMD symptoms with the corrected occlusion for 30 years. CONCLUSIONS: Occlusal reconstruction based on the neuromuscular concept can be stably integrated into the patient's functional occlusion system.

Early treatment with the ALF functional appliance.

The aim of this study is to report five cases of children treated with an interceptive technique utilizing ALF (Advanced Light Force) functional orthodontic appliances in anterior and/or posterior cross bites in primary and early mixed dentition.

Effectiveness of a fixed anterior bite plane in Class II deep-bite patients.

Orthodontic treatment of patients with distoclusion combined with dental deep bite and linguo version of the front upper teeth is one of the most difficult forms of malocclusion to treat to a functional and morphological optimum. Our objective was to analyze the efficacy of a fixed anterior bite plane appliance to disclude the teeth and correct this type of malocclusion. At the Department of Orthodontics MSUMD (Moscow State University of Medicine and Dentistry), we proposed the use of a fixed anterior bite plane for the effective treatment of patients with distoclusion combined to a dental deep bite. This appliance was used in 35 patients aged 11 to 15 years (13.2 +/- 1.2) with distoclusion combined with deep bite in a therapeutical approach that also involved an osteopathic correction. The appliance permitted the correction of the distoclusion by discluding the posterior teeth, allowing eruption of the molars and premolars which improved the occlusal plane line (Curve of Spee) and changed the inclination of the upper incisors which liberated the mandible from its retruded position. We also noted an effect on the postural status of the patient.

Validity based on the response processes of the MMBGR Protocol Infants and Preschoolers: Instructional and Orofacial Myofuncional Clinical History. / Validade baseada nos processos de respostas - Protocolo MMBGR Lactentes e Pré-escolares: Instrutivo e História Clínica Miofuncional Orofacial.

PURPOSE: Present the step of evidence of validity based on the responses to procedures of the MMBGR Protocol Infants and Preschoolers: Instructional and Orofacial Myofunctional Clinical History. METHODS: Study developed according to phonoaudiologic tests validations recommendations. Validity analysis performed based on the process of instrument response. Ten speech therapists, that work on phonoaudiology clinic and/or orofacial myofunctional research on the population with age between 6 to 71 months, participated and applied the MMBGR Protocol Infants and Preschoolers: Instructional and Orofacial Myofunctional Clinical History with those responsible for the children. The speech therapists appraised the instrument applicability via Google®ï¸ electronic forms, containing dichotic and/or multiple-choice questions, and likert scale with space to justify negative answers. The data was tabulated on Microsoft Excel 2016®ï¸ worksheets and analyzed by the content validity index (CVI). The software R Core Team 2022 (Versão 4.2.2) was used. RESULTS: All items from the MMBGR Protocol Infants and Preschoolers: Instructional and Orofacial Myofunctional Clinical History were valid when applied to real contexts. Orofacial Myofunctional Clinic history protocol- IVC 100% in terms of ease of application and filling and usage in professional practice; IVC 90% in terms of usefulness for phonoaudiology clinic. The instructional got IVC 80% in terms of clinic usefulness and 70% regarding to the prior reading necessity to fill the MMBGR Protocol Infants and Preschoolers. CONCLUSION: The Instrucional and Orofacial Myofunctional Clinical History, in the MMBGR Protocol Infants and Preschoolers had its validity proven based on the processes of responses to the usage on phonoaudiology clinic.

OBJETIVO: Apresentar a etapa da evidência de validade baseada nos processos de respostas do Protocolo MMBGR Lactentes e Pré-escolares: Instrutivo e História Clínica Miofuncional Orofacial. MÉTODO: Estudo desenvolvido conforme recomendações para validação de testes em Fonoaudiologia. Realizada análise da validade baseada nos processos de resposta do instrumento. Participaram dez fonoaudiólogos, que atuam em clínica e/ou pesquisa da Motricidade Orofacial com população entre 6 e 71 meses de idade, que aplicaram o Protocolo MMBGR Lactentes e Pré-escolares: Instrutivo e História Clínica Miofuncional Orofacial junto aos responsáveis pelas crianças. Os fonoaudiólogos emitiram apreciação sobre aplicabilidade do instrumento via formulário eletrônico do Google®, contendo questões dicóticas e/ou múltipla escolha, e escala likert com espaço para justificar respostas negativas. Os dados foram tabulados em planilhas Microsoft Excel 2016® e analisados pelo Índice de Validade de Conteúdo (IVC). Utilizado software R Core Team 2022 (Versão 4.2.2). RESULTADOS: Todos os itens do Protocolo MMBGR Lactentes e Pré-escolares: Instrutivo e História Clínica Miofuncional Orofacial foram válidos na aplicação em contexto real. Protocolo de História Clínica Miofuncional Orofacial - IVC 100% quanto à facilidade de aplicação e preenchimento, e uso na prática profissional; e IVC 90% quanto à utilidade para clínica fonoaudiológica. O Instrutivo obteve IVC 80% quanto à utilidade e 70% referente à necessidade de leitura prévia para preenchimento do Protocolo MMBGR Lactentes e Pré-escolares. CONCLUSÃO: O Instrutivo e o Protocolo História Clínica Miofuncional Orofacial, pertencentes ao protocolo MMBGR ­ Lactentes e Pré-escolares tiveram comprovada validade baseada nos processos de resposta, para uso na clínica fonoaudiológica.

Use of athletic tape in the speech-language-hearing treatment of post-stroke facial paralysis in the acute phase. / Utilização da bandagem elástica funcional no tratamento fonoaudiológico da paralisia facial pós-AVC na fase aguda.

PURPOSE: To verify the efficacy of using athletic tape associated with myofunctional therapy in the speech-language-hearing treatment of facial palsy after stroke in the acute phase. METHOD: Randomized controlled clinical study with 88 patients with facial palsy in the acute phase of stroke. The sample was allocated in: Group 1: rehabilitation with orofacial myofunctional therapy and use of athletic tape on the paralyzed zygomaticus major and minor muscles; Group 2: rehabilitation alone with orofacial myofunctional therapy on the paralyzed face; Group 3: no speech-language-hearing intervention for facial paralysis. In the evaluation, facial expression movements were requested, and the degree of impairment was determined according to the House and Brackmann scale. Movement incompetence was obtained from measurements of the face with a digital caliper. After the evaluation, the intervention was carried out as determined for groups 1 and 2. The participants of the three groups were reassessed after 15 days. The statistical analysis used was the generalized equations. RESULTS: The groups were homogeneous in terms of age, measure of disability and functioning, severity of neurological impairment and pre-intervention facial paralysis. Group 1 had a significant improvement in the measure from the lateral canthus to the corner of the mouth, with better results than groups 2 and 3. CONCLUSION: The athletic tape associated with orofacial myofunctional therapy had better results in the treatment of facial paralysis after stroke in the place where it was applied.

OBJETIVO: Verificar a eficácia do uso da bandagem elástica funcional associada à terapia miofuncional no tratamento fonoaudiológico da paralisia facial pós-acidente vascular cerebral na fase aguda. MÉTODO: Estudo clínico controlado randomizado com 88 pacientes com paralisia facial na fase aguda do acidente vascular cerebral. A amostra foi alocada em: Grupo 1: reabilitação com terapia miofuncional orofacial e utilização da bandagem elástica funcional nos músculos zigomáticos maior e menor paralisados; Grupo 2: reabilitação apenas com terapia miofuncional orofacial na face paralisada; Grupo 3: sem qualquer intervenção fonoaudiológica para paralisia facial. Na avaliação foram solicitados os movimentos de mímica facial e o grau do comprometimento foi determinado de acordo com a escala de House e Brackmann. A incompetência do movimento foi obtida a partir de medições da face com paquímetro digital. Após a avaliação, a intervenção foi realizada de acordo como determinado para os grupos 1 e 2. Os participantes dos três grupos foram reavaliados após 15 dias. A análise estatística utilizada foi das equações generalizadas. RESULTADOS: Os grupos foram homogêneos quanto à idade, medida de incapacidade e funcionalidade, gravidade do comprometimento neurológico e da paralisia facial pré-intervenção. O grupo 1 teve melhora significativa na medida canto externo do olho à comissura labial, com melhores resultados quando comparado aos grupos 2 e 3. CONCLUSÃO: A bandagem elástica funcional associada a terapia miofuncional orofacial apresentou melhor resultado no tratamento da paralisia facial após acidente vascular cerebral no local onde foi aplicado.

Atypical deglutition: diagnosis and interceptive treatment. A clinical study.

AIM: The aim of this study was to evaluate the early treatment of atypical deglutition, by analysing the efficacy of the eruptive guide appliance Habit Corrector™. MATERIALS AND METHODS: The pre- and post-treatment (T1 and T2) cephalometric data of 2 groups of patients (G1 and G2), both consisting of 25 patients each and treated with Habit Corrector™, were compared. The first group included 10 males and 15 females, aged between 4 and 7 years old, with average age 6.17 years, and therefore undergoing the last phase of primary dentition and the first phase of mixed dentition. The second group included 12 males and 13 females, aged between 8 and 12 years old, with average age 9.19 years old, undergoing the second phase of mixed dentition. The overall duration of the treatment was 12 months. RESULTS: The results showed significant differences between the two groups, with respect to overbite, overjet, molar relation, inclination of the upper and lower incisors, position of the jaw. A significant variation between the two groups at T2 was registered for the maxillomandibular relationships: the increase in the growth and degree of mandibular protrusion was of 4.66° in G1 and 2.44° in G2. Significant changes were registered for the position or growth of the upper jaw; the upper facial height almost remained unaltered, with 53.34° for G1 and with 53.96° for G2. A significant variation occurred with the increase in the sagittal relationship between the molars, improved in G1 by 3.14 mm and in G2 by 2.61 mm. A significant decrease of overjet was registered in G1 by 1.94 mm and in G2 by 0.76 m and an increase of overbite in G1 by 3.14 mm and in G2 by 0.88 mm. The inclination of the maxillary and mandibular incisors improved, with an inter-incisive angle of 123° in G1 and 124.2° in G2. CONCLUSION: The clinical results obtained suggest that early intervention in atypical deglutition with Habit Corrector™ is able to produce significant results in primary dentition and in the first phase of mixed dentition, rather than in the late phase of mixed dentition.

Appliance design and application.

Today's dental practice can increase patient satisfaction, as well as profitability, through the use of emerging technologies in the realm of dental appliances. Appliances can aid in an array of pathologies; however, many dentists struggle in their prescription of appliances due to a lack of scientific literature on the devices themselves. Blindly choosing an appliance can create a legal liability; therefore, undergirding selection with accurate information is critical for proper use and quality of care. The aim of this article is to serve as a quick reference for the practitioner in his selection of the appropriate dental device.

Accidental ingestion of a fractured Twin-block appliance.

Orthodontic appliances that become dislodged can cause problems in the airway or the gastrointestinal tract. Accidental ingestion of an appliance during a chair-side procedure or because of inadequate retention of the appliance can create a medical emergency with potentially serious complications, including death from aspiration of the foreign body. This article reports the accidental ingestion of a fractured Twin-block appliance. The ease with which removable appliances can become dislodged if retention is inadequate is discussed, and some serious complications that can arise are described. Precautions the orthodontist can take to prevent such accidents are presented.

Treatment of class II division 1 malocclusion with myofunctional trainer system in early mixed dentition period.

Dentofacial growth interferences, caused by abnormal lip and tongue function in the mixed dentition period are a common clinical condition. The main purpose of the treatment in such cases is to eliminate oral dysfunction, establish muscular balance and correct or diminish maxillary incisor protrusion. The position of the teeth is determined by the lip and tongue pressure. Lip function may have been the cause of forcing teeth in to malposition they occupy. The case report is presented where the myofunctional trainer T4K is used during growth phase.

Palatal training appliances in children with mild to moderate oral dysfunctions.

OBJECTIVE: The objective of the study was to evaluate the efficacy of palatal training appliances on speech articulation and orofacial functions in children undergoing speech therapy. STUDY DESIGN: The material consisted of 134 boys and 34 girls who were referred by speech and language therapists to the Public Dental Health Service in Vantaa due to mild to moderate problems with speech articulation or in oral motor skills. The mean age of the children at the start of the palatal plate therapy was 6.4 years (SD 1.9). The articulation assessment was performed by five speech and language therapist while the palatal plate therapy was carried out by an experienced dentist. The mean treatment time with the oral plates was 4.4 months (SD 2.3). RESULTS: An improvement in speech articulation was observed by the speech and language therapists in 51% of the children. Tongue movements improved in 47%, and lip closure in 38% of the participants. Drooling decreased in 54% of the cases. A multiple logistic regression model revealed that with respect to speech articulation the best improvement was found in children with /r/-disorder and in those with a crossbite. CONCLUSIONS: Palatal training appliances during speech therapy seemed to be an efficient way to improve speech articulation and tongue movements in children with mild to moderate problems in orofacial functions.