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Pedodontics

Authors: Dr. Megha Rautela, Dr. Himanshu Aeron, Dr. Preeti Dhawan

Abstract

Many investigations have shown that inappropriate myofunctional habit leads to an orthodontic problem. So by preventing such habit like tongue thrusting, mouth breathing or lip sucking can prevent need for future orthodontic treatment. For the prevention of these habits various punitive appliance have been introduced which are very uncomfortable and as the name suggest they act as a punishment for habit correction. So to avoid such treatment myobrace have been introduced which are comfortable for the patient and also helpful in correction of minor orthodontic problem.

INTRODUCTION

Comprehensive research has been done on the impact of various incorrect myofunctional habit causing malocclusion like mouth breathing, tongue thrusting, reverse swallowing, and thumb sucking. These habits result in the restriction of the growth of craniofacial development which ultimately result in unappealing facial appearance.1

In mouth breathers, the saying ‘spring is in the air’ is quite factual. When the winter snow melts and vegetation bloom, pollen and other materials can inflict chaos on those suffering from seasonal allergies, usually causing a habit like mouth breathing.2 The other most common cause are various mechanical factors, including tonsil hyperplasia, hypertrophied turbinates, rhinitis, tumors, infectious or inflammatory diseases which resulted in changes in nasal architecture and due to the obstacles in the nasopharyngeal region, it increases nasal resistance which result in mouth breathing. However, even after these mechanical factors are removed, Mouth Breathing of the patient continues as it becomes a habit. Unbalanced facial musculature occurs as a result of Mouth Breathing, which causes changes in tooth positioning, lips, tongue, palate, and jaws, so as to counterbalance the new breathing pattern.3

Functional appliances have been extensively reported in the literature as an alternative for treating malocclusions, as they may stimulate jaw growth and development in preadolescent patients. Over the years series of functional appliances, which cause skeletal and dento-alveolar changes were used. Some of them are Activators, Bionator, Frankel’s regulator etc but due their bulkiness they were not very frequently used. In 1992 Myofunctional Research Co, Australia developed new concept for functional appliances, called Trainers ™. Nowadays Trainer System™ is one of the most effective appliances in early mixed dentition for tooth eruption guidance and correction of myofunctional habits4

Trainers i.e., Myobraces, they are preformed functional orthodontic device, especially used in interceptive orthodontic cases. Its mechanism of action is a combination of a functional device, positioners, and a myofunctional therapy device. These appliances straighten the teeth as well as correct the development of jaws and any adverse oral habits that are caused due to underdeveloped jaws.5 The purpose of this case report is to see the efficacy of myobrace in producing orthopaedic effect and correction of oral habit followed by the correction of malocclusion.

CASE REPORT

A 11 yr old male patient reported to the Department of Pedodontics and Preventive Dentistry, Seema Dental College and Hospital, with the chief complaint of spacing and protrusion of upper front tooth region and some dryness of mouth. The mother also gave the history that her son experienced nasal blockage due to seasonal allergies for which he had to undergo retreatment every year. On extraoral clinical examination, euryprosopic facial form, slightly convex facial profile with incompetent lips, hypotonic upper lip was noticed. (Fig 1,2). Intraoral examination revealed mixed dentition stage with teeth 11,12,13,14,55,16,21,22,23,24,65,26,31,32,33,34,75,36, 41.42,43,84,85,46. Assessment of occlusion revealed class 1 molar relation bilaterally, with an overjet of 2mm and presence of diastema with class 1 palatal form and normal oral mucous membrane. (Fig 3). A diagnosis of mouth breathing was made. ENT referral and consultation was taken and on that basis mouth breathing was classified to be anatomic as the lip morphology did not permit the boy to close his mouth completely.

 
 

The diagnostic cast were made by taking maxillary and mandibular impressions with irreversible hydrocolloid impression material. On the basis of records a myobrace was planned (fig 4). For selecting the proper myobrace the patient measurement from distal to right lateral incisor to distal of left incisor done by using scale provided by the company to determine the correct size of the myobrace (Fig 5). Myobraces are indicated as per the age group. For adolosent patient myobrace T are being used. On the basis of record myobrace T1 medium was selected for the patient.

 
 

The patient was instructed to just wear the appliance for 2 hours in a day and for whole night. The appliance was delivered and patient was recalled after a week and he got well adapted with the myobrace appliance, and then the myofunctional exercise were demonstrated which included lip exercise followed by water holding n tongue exercise which were gradually introduced in the interval of 2 weeks. The patient was recalled every month and treatment was carried out for 3 months. Since the desirable result were achieved the follow up had been done for another 3 month.

At the end of 3 months of treatment with the myobrace appliance, difference in patients profile and facial form was appreciable. Lip competency was also achieved and arch alignment was attained with the closure of diastema. (Fig 6 and 7). There was also a reduction of maxillary incisor proclination. The patient continued wearing the appliance for another 3 month as it acted as a retention appliance.

 
 
DISCUSSION

Myobrace (MB) is a most appropriate appliance for the correction of myofunctional habit in growing children and also proven to be effective in orthodontic correction without braces.1 It is preformed orthodontic device, designed for the treatment of malocclusions in patients in late mixed dentition (8-12 years). However, it can be used also in adult patients and, in any case, only for non-extractive cases and for mild or moderate malocclusions. It consists of a single block which contacts both arches, and it is built on a head-to-head incisal relation6. The purpose of its structural elements is to actively redirect the language and the perioral musculature, correct breathing, and align the anterior teeth. In early mixed dentition the device can also encourage the correct dental and facial development.

Trainer appliances have tooth channels and labial bows which guide the erupting teeth into the correct alignment. The Trainer’s tongue tag trains the tongue of the patient to stay in the roof of the mouth, improving myofunctional habits while the lip bumpers discourage overactive lip muscle activity. The soft, phase 1 appliance is more flexible in order to adapt to a wide range of malocclusions and the harder, phase 2 appliance, which usually follow after 6 to 9 months of Phase 1 use, achieves better tooth alignment.7 In our present case we just used the phase 1 appliance and not the phase 2 appliance as we did not require arch expansion.

Myobrace has been designed to combine the ability of dental alignment of the rigid appliances (such as Occlusal guide), and the properties of the soft and flexible ones (as the Multi-p). Its structure is therefore designed to simulate a fixed appliance: the soft outer part has the function of the orthodontic wire, while the inner rigid part simulates the function of the brackets, engaging the teeth individually. This double structure implies a better acceptance and increases the patient’s compliance. So its use is advocated in patients especially in mixed dentition phase due to its better compliance and desirable results.6

CONCLUSION

For the cases of habits like mouthbreathing various orthodontic treatments like fixed orthodontics, functional appliances like oral screen are indicated. The myobraces may be a simple and good choice of treatment option by this case we can reveal that the desired results could be achieved in a shorter duration with a comfortable treatment modality for the patient. The myobraces may be a good choice of orthodontic treatment option simple non extraction cases and oral habits.

REFERENCE
  1. Aggarwal I, Wadhawan M, Dhir V. Myobraces: Say No to Traditional Braces. Int J Oral Care Res 2016;4(1):82-85
  2. ain A, Bhaskar DJ, Gupta D, Yadav P, Dalai DR, Jhingala V, Garg Y, Kalra M. Mouth Breathing: A Menace to Developing Dentition. J Contemp Dent 2014;4(3):145-151.
  3. Pacheco MCT, Casagrande CF, Teixeira LP, Finck NS, Araújo MTM. Guidelines proposal for clinical recognition of mouth breathing children. Dental Press J Orthod. 2015 July-Aug;20(4):39-44.
  4. Dinkova m. Vertical control of overbite in mixed dentition by trainer system. J of imab. 2014 oct-dec;20(5):648-654.
  5. Sander FG. Functional processes when wearing the SII appliance during the day.J Orofac Orthop 2001; 62(4):264-74.
  6. Anastasi G, Dinnella A. Myobrace System: A no-braces approach to malocclusion and a myofunctional therapy device. Webmedcentral ORTHODONTICS 2014;5(1):WMC004492
  7. Usumez S, Uysal T, Sari Z, Basciftci FA, Karaman AI, Guray E. The effects of early preorthodontic Trainer treatment on Class II, division 1 patients. Angle Orthod, 2004