Adjustable tongue crib.

Thumb sucking and tongue thrusting habits are mostly counteracted and rehabilitated using a tongue crib. Most patients find the conventional crib difficult (due to its position and length) in the initial days of treatment and become uncooperative. Hence, few modifications are made to the traditional design of the tongue crib for easy adjustment of the crib height and angulation, which provides comfort to the patient.

Effect of Functional Chewing Training on tongue thrust and drooling in children with cerebral palsy: a randomised controlled trial.

Tongue thrust, which is an oral reflex associated with sucking behaviour, may cause problems in swallowing, speech, oro-facial development and also drooling. We aimed to examine the effect of Functional Chewing Training (FuCT) on tongue thrust and drooling in children with cerebral palsy. The study included 32 children with a mean age of 58·25 ± 9·58 months who had tongue thrust. Children were divided into two groups: the FuCT group and control group receiving classical oral motor exercises. Each group received training for 12 weeks. Oral motor assessment was performed. Chewing performance level was determined with the Karaduman Chewing Performance Scale. Tongue thrust severity was evaluated with the Tongue Thrust Rating Scale. The Drooling Severity and Frequency Scale was used to evaluate drooling severity and frequency. The evaluations were performed before and after treatment. Groups were well matched in age, gender and oral motor assessment. No significant difference was found between groups in terms of pre-treatment chewing function, tongue thrust severity, drooling severity and frequency (P > 0·05). The FuCT group showed improvement in chewing performance (P = 0·001), tongue thrust severity (P = 0·046) and drooling severity (P = 0·002), but no improvement was found in terms of drooling frequency (P = 0·082) after treatment. There was no improvement in chewing performance, tongue thrust, drooling severity and frequency in the control group. A significant difference was found between groups in favour of FuCT group in tongue thrust severity (P = 0·043). This study showed that the FuCT is an effective approach on the severity of tongue thrust and drooling in children with CP.

Open-bite treatment with vertical control and tongue reeducation.

An open-bite malocclusion with a tongue-thrust habit is a challenging type of malocclusion to correct. A 12-year-old girl came for orthodontic treatment with a severe anterior open bite, extruded posterior segments, a tongue-thrust habit, and lip incompetency. Her parents refused surgical treatment, so a nonextraction treatment plan was developed that used palatal temporary skeletal anchorage devices for vertical control and mandibular tongue spurs to reeducate the tongue. Interproximal reduction was also used to address the moderate to severe mandibular crowding. An abnormal Class I occlusion was achieved with proper overbite and overjet, along with a pleasing smile and gingival display.

Severe Anterior Open Bite during Mixed Dentition Treated with Palatal Spurs.

Deleterious oral habits, such as non-nutritive sucking or tongue thrusting, if not intercepted at an early stage can cause complex malocclusions. This manuscript describes a clinical case report of a successful interception of a severe anterior dental open bite caused by thumb sucking and tongue thrusting habits. The case involved a six-year-old female patient treated with the use of palatal spurs and maxillary removable crib followed by monitoring the development of dental occlusion. At the end of the interceptive phase acceptable results were achieved, showing the efficacy of the treatment undertaken as well the importance of an early intervention to remove harmful oral habits.

Interdisciplinary Management of Patient with Advanced Periodontal Disease.

This case report describes the interdisciplinary management of an adult patient with advanced periodontal disease. Treatment involved orthodontic and periodontal management. Good esthetic results and dental relationships were achieved by the treatment.

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.

Influence of non-orthodontic intervention on digit sucking and consequent anterior open bite: a preliminary study.

OBJECTIVES: This study aimed to assess behavioural and occlusal outcomes of non-orthodontic intervention (NOI) in a sample of children, 4-12 years of age, in Australia, in order to establish clinical relevance. MATERIALS AND METHODS: Data from 91 patient records of 4- to 12-year-old children reporting a habit of digit sucking, from two clinics in north-eastern Australia, were de-identified and used. Each patient had been examined at two visits, separated by an interval of 4 months, using standard clinical procedures. RESULTS: Of the 77 children who received a 4-month NOI, 69 (89.6%) had ceased their digit sucking habit by the end of the NOI period [χ2=67.0, degrees of freedom (d.f.)=1, P<0.001]. Of the 72 subjects who had front teeth, the number with anterior open bite decreased from 37 (51.4%) to 12 (16.7%) upon completion of NOI (χ2=21.3, d.f.=1, P<0.001). Among the 32 patients with a measurable overjet, the mean overjet was found to decrease from 4.2±2.4 mm to 3.1±1.9 mm after implementation of NOI (t=5.8, d.f.=31, P<0.001). Children who received NOI were more likely to quit the digit sucking habit in the 4-month period (P<0.001, OR=51.8, 95% CI: 9.8-273.9) and were more likely to appear without anterior open bite at a 4-month recall (P<0.001, OR=30.0, 95% CI: 5.9-151.6). CONCLUSIONS: This study demonstrated clinical relevance of NOI on the cessation of a digit sucking habit, closure of anterior open bite and reduction of overjet. Further investigations are indicated.

Nonsurgical approach to Class I open-bite malocclusion with extrusion mechanics: a 3-year retention case report.

Anterior open bite is one of the most challenging malocclusions for orthodontic treatment. The high incidence of relapse is a major concern. Therefore, accurate initial examination, diagnosis, treatment plan, and consideration of habitual risk factors are crucial for a successful outcome without unwanted sequelae. Excellent patient compliance for retainer wear is also a critical factor. This case report shows the 3-year stability of a nonsurgical and nonextraction orthodontic treatment of a 5-mm anterior open-bite malocclusion in a 12-year-old girl with extrusion mechanics and habit modification. After 2 years of orthodontic treatment, excellent outcomes were achieved. With an appropriate retention protocol, the long-term stability of the treatment was favorable.

Anterior open bite treated with myofunctional therapy and palatal crib.

This case report demonstrates the treatment effects of palatal crib combined with the myofunctional therapy in a child with anterior open bite (AOB) due to thumb sucking and habitual anterior and low tongue position. The patient, an 11-year-old boy, had an anterior open bite and flared and spaced upper and lower incisors. Palatal cribs in conjunction with myofunctional therapy were used to discourage sucking habit and to adapt normal tongue position. Successful correction of the AOB with adequate overjet and overbite were achieved with total treatment time of 7 months. The importance of myofunctional therapy in adopting normal tongue position and in maintaining the stability of open bite correction is emphasized.

[Orthodontic correction of a Brodie syndrome case related to oral habits]. / Traitement orthodontique d'un cas de syndrome de Brodie unilatéral d'origine dysfonctionnelle.

Unilateral Brodie bite, called also Scissor bite, is a form of transversal malocclusion that often leads to minor facial asymmetry. The prevalence of this form of malocclusion is rare, especially met in mixed denture. We report a case of 11-year-old girl who presents unilateral scissor bite related to oral habits, with a skeletal class II. Modified activation by contraction of a bi-helix appliance was used to treat the unilateral scissor bite occlusion, before approaching the correction of the sagittal relationship.

Orthodontic Treatment in Adult Patient with Reduced Periodontium: A Case Report.

Patients presenting reduced periodontium represent a major concern for orthodontists. The purpose of this article is to present the clinical case of an adult patient who presented sequel of periodontal disease (diastemas) compromising her dental aesthetics. She was subjected to an orthodontic treatment with the application of light forces distant from the teeth with reduced periodontium. A periodontal support therapy was successfully implemented. The final stage of the treatment indicated satisfactory occlusal and periodontal characteristics.

Molar distalization with the assistance of Temporary Anchorage Devices.

This article describes efficient techniques for distalization of maxillary and mandibular molars with the assistance of Temporary Anchorage Devices (TADs). There are numerous occasions where the distalization of molars is required in lieu of the odontectomy of bicuspids. In the past, extra-oral force has been used, (i.e. Cervical or Combination Head Gear, or intra-oral force, i.e. Posterior Sagittal Appliance, Modified Greenfield Appliance, Williams DMJ 20001, CD Distalizer, Magill Sagittal, Pendulum Appliance, etc.). All the intra-oral appliances have a common denominator the orthodontic clinician has to deal with, the undesirable expression of the Third Law of Newton. The utilization of TADs allows us to circumvent this shortcoming, establishing an absolute anchorage, and thus completely negate the expression of the Third Law of Newton.

The short-term effects of face mask and fixed tongue appliance on maxillary deficiency in growing patients--a randomized clinical trial.

BACKGROUND: The purpose of this single blind, prospective, parallel randomized trial study was to compare the effects of face mask and fixed tongue appliance in treatment of Class III malocclusion with maxillary deficiency in growing patients. METHODS: 88 patients with maxillary deficiency were selected. 60 fulfilled the study requirements. The patients were randomly assigned to 2 groups by computer generated tables. One group was treated with removable face mask and the other group was treated by fixed tongue appliance. 4 of the patients dropped out of study leaving a final number of 56 patients. Thus, the face mask group included 30 patients (13 males, 17 females) with the mean age of 8.5 (SD 1.4) years and the fixed tongue appliance group included 26 patients (13 males, 13 females) with the mean age of 8.9 (SD 1.7) years. The patients Lateral cephalograms obtained at the beginning and end of the study were analyzed. RESULTS: Paired t-tests showed that SNA increased by 1.3° (SD 1.1°) in face mask group (P<0.001) and it increased by 1.8° (SD 0.9°) in fixed tongue appliance group (P<0.001). T-test showed that there were no statistically significant differences between the two groups except for SNB. IMPA decreased significantly in both groups. CONCLUSIONS: Both treatment modalities were successful in moving the maxilla forward and improving the profile of the patients; however, the bulky size of face masks might reduce patients' compliance and make them less favorite choice of treatment.

THE ESSENTIAL ROLE OF THE COM IN THE MANAGEMENT OF SLEEP-DISORDERED BREATHING: A LITERATURE REVIEW AND DISCUSSION.

The origins of Orofacial Myofunctional Therapy began in the early 1960's by orthodontists who recognized the importance of functional nasal breathing, proper swallowing, and more ideal oral rest postures. Re-patterning these functions through myofunctional therapy assisted with better orthodontic outcomes and improved stability. Experts in orofacial myology have concluded that improper oral rest postures and tongue thrusting may be the result of hypertrophy of the lymphatic tissues in the upper airway. Orthodontists are aware of the deleterious effects these habits have on the developing face and dentition. Sleep disordered breathing is a major health concern that affects people from infancy into adulthood. Physicians who treat sleep disorders are now referring patients for orofacial myofunctional therapy. Researchers have concluded that removal of tonsils and adenoids, along with expansion orthodontics, may not fully resolve the upper airway issues that continue to plague patients' health. Sleep researchers report that the presence of mouth breathing, along with hypotonia of the orofacial muscular complex, has been a persistent problem in the treatment of sleep disordered breathing. Orofacial myofunctional disorders (OMDs) coexist in a large population of people with sleep disordered breathing and sleep apnea. Advances in 3D Cone Beam Computed Tomography (CBCT) imaging offer the dental and medical communities the opportunity to identify, assess, and treat patients with abnormal growth patterns. These undesirable changes in oral structures can involve the upper airway, as well as functional breathing, chewing and swallowing. Leading researchers have advocated a multidisciplinary team approach. Sleep physicians, otolaryngologists, dentists, myofunctional therapists, and other healthcare professionals are working together to achieve these goals. The authors have compiled research articles that support incorporating the necessary education on sleep disordered breathing for healthcare professionals seeking education in orofacial myology.

Conservative treatment for a growing patient with a severe, developing skeletal Class III malocclusion and open bite.

An 8-year-old Chinese girl sought treatment for a severe skeletal Class III malocclusion and open-bite skeletal pattern. Traditionally, patients with a skeletal Class III malocclusion are treated after they have stopped growing, and then they are treated with a combined orthodontic and orthognathic surgery approach. But the risks and expenses of this treatment plan are not acceptable to all patients. This young patient was treated with facemask therapy, a maxillary expansion device, and a molar occlusal splint for maxillary developmental stimulation with control of vertical jaw growth. After the completion of orthopedic therapy, 2 × 4 technology was used to adjust molar positions. A bonded tongue crib was used in the early permanent dentition to help the patient break her bad tongue habits. Straight-wire appliances were used for 16 months to adjust the occlusal relationship. This achieved significant improvement in anterior tooth relationships and facial profile esthetics. At the 2-year posttreatment follow-up, the results were satisfactory. The success of the sagittal relationship correction between the maxilla and the mandible for a skeletal Class III malocclusion depends on the coordination of transverse and vertical relationships combined with the growth potential of each patient.

Atypical swallowing: a review.

AIM: Atypical swallowing is a myofunctional problem consisting of an altered tongue position during the act of swallowing. High incidence in population, multifactorial etiology and the recurring connection with the presence of malocclusions made it a topic of strong interest and discussion in science. The purpose of this review is to illustrate the current orientation on the topic of atypical swallowing, trying in particular to answer two questions: 1) what kind of connection is there between atypical swallowing and malocclusion; 2) what kind of therapy should be used to solve it. METHODS: This review was conducted on the Medline database [www.ncbi.nim.nih.gov/pubmed] searching for the keywords "atypical swallowing" and "tongue thrust". We examined all the documents from the year 1990 onwards, excluding the ones about syndromic cases of the central motor system. RESULTS: The causal relation between the two problems seems to be biunique: some authors affirm that this oral habit starts as a compensation mechanism for a preexisting malocclusion (especially in case of open-bite); other texts show that it has a tendency to exacerbate cases of malocclusion; it is also proven that a non-physiological tongue thrust can negatively influence the progress of an ongoing orthodontic therapy. Thereby, the best therapeutic approach seems to be a multidisciplinary one: beside orthodontics, which is necessary to correct the malocclusion, it is essential to set up a myofunctional rehabilitation procedure to correct the oral habit, therefore granting long time permanent results. There is also proof of a substantial difference between the results obtained from early (deciduous or primary mixed dentition) or later treatments. CONCLUSION: The biunique causal relation between atypical swallowing and malocclusion suggests a multidisciplinary therapeutic approach, orthodontic and myofunctional, to temporarily solve both problems. An early diagnosis and a prompt intervention have a significantly positive influence on the therapy outcome.

NTRDC retainer: a novel approach for both retention and habit control--a follow up of 2 years.

Many methods have been used to correct abnormal tongue habits. A mechanical device such as tongue spurs or cribs offers help till they are in the mouth, but the habit often returns when the device is removed. Patients with tongue thrusting habits complain to their clinician, of reopening of spaces, proclination of anteriors and contraction of arch, though the clinician successfully treated the case.

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.

The development and benefits of vertical dimension primary molar buildup crowns.

This article describes the technique and advantages of vertical dimension-primary molar buildups (VD-PMB's). These primary molar buildups help correct the vertical dimension on overclosed children from 3 to 12 years old. The advantages of these VD-PMB's are enormous, with very little or no disadvantages when placed correctly. This is a very important procedure for the orthodontist because opening the bite on these children has many beneficial results. It changes the resting tongue position, changes the slope of the anterior border of the glenoid fossa from steep to normal on Class 2 div 2 patients, corrects overclosure and otitus media with effusion (ear infections). It is important for the orthodontist since it is very simple and an easy way to correct overclosure on class 2 patients, which is often not done in the correction of overclosed patients.

The Loudon Chateau repositioning appliance.

The LCR Appliance if fabricated and used properly, has many advantages over the Herbst and Twin Block appliances in solving tongue thrust, mandibular deficiency and repositioning with proper mandibular advancement and mandibular growth results. The regular Chateau appliance was named in 1904 after Dr. Chateau in Franc. It was originally used in Europe but was an uncomfortable removable appliance with wires used in the mandibular anterior lingual area to reposition the mandible.