The Effect of a Unique Pacifier on Anterior Open Bite and Overjet in the Primary Dentition: A Pilot Study

PURPOSES

Pacifiers are the most common device used by children to satisfy their sucking needs. Because of their design, reports of anterior open bite and increased overjet are common. The purposes of this pilot study were to measure the effects of a unique pacifier in toddlers who have existing open bites and increased overjets; and secondly to determine the feasibility of recruiting and retaining toddlers for a six-month study.

METHODS

Toddlers with existing open bite and increased overjet currently using a conventional pacifier were recruited from a university pediatric dental clinic. Baseline information was obtained. Visual examination and intraoral measurements were obtained. The study pacifier was introduced to replace the existing pacifier. Follow-up data was collected at three and six months post-intervention.

RESULTS

Eight of the 11 toddlers (73 percent) completed the study. Recruitment was challenging because of the inclusion criteria and transportation; retaining participants required numerous reminders to parents. There was a significant difference between initial and final open bite and overjet measurements.

CONCLUSION

It is feasible to recruit and retain toddlers but it required significant staff interventions. There was a significant improvement in reducing existing open bite and overjet with the pacifier after six months.

Case history: improved maxillary growth and development following digit sucking elimination and orofacial myofunctional therapy

Orofacial myologists are frequently called upon to address retained oral habit concerns. During this process, current I.A.O.M. recommended treatment includes addressing tongue, lip, and jaw rest posture concerns. Following digit sucking remediation, we may also be called upon to address these rest posture issues, and tongue thrust more aggressively together. In this process, facial growth and development and jaw structure may coincidentally improve as a result of 'nature taking its course' by addressing both swallow AND rest posture. In a select subset of clients, dramatic improvements may occur if the timing is right. This article discusses one such case that appears to have yielded a significant improvement in oral postures influencing improved facial and oral growth and development.

Effectiveness of appliance therapy in reducing overjet and open bite associated with thumb sucking habit

AIM

The aim of this paper was to compare the effectiveness of appliance therapy and reward therapy in reducing overjet and open bite associated with thumb sucking habit.

METHODS

Thirty nine subjects (17 males and 22 females) with chronic thumb sucking habit were allocated to three groups: group A (positive reinforcement), group B (modified triple loop corrector), and group C (control). Pre-treatment and post-treatment study casts were evaluated for changes in overjet and open bite. Data from measurements of the three groups were statistically analyzed using a non-parametric Kruskal-Wallis test and Mann-Whitney U tests. All statistical computation was performed with SPSS 15.0 software. Significance was set at 0.05 level.

RESULTS

Statistically significant reductions in mean overjet and open bite were seen for the group treated with appliance therapy when compared to other two groups (P<0.05).

CONCLUSION

Appliance therapy was significantly more superior in reducing the overjet and open bite associated with thumb sucking habit. Early interception of these habits is recommended to reduce the incidence of malocclusion in children.

Efficacy of a novel pacifier in the prevention of anterior open bite

PURPOSE

The purpose of this study was to test a novel pacifier (Dentistar) regarding the development of anterior open bite in infants.

METHODS

One hundred twenty-nine newborn children were randomly assigned to 2 experimental groups: NUK (N; N =73); and Dentistar (D; N=56. Children (N=42) who did not use a pacifier served as the control (C). At 10- to 26-months old, the children were re-examined (via a blind operator) regarding the existence of an anterior open bite.

RESULTS

One hundred twenty-one toddlers (66 females, 55 males) were included in the final analysis (N: N=42; D: N=43; C: N=36). The mean age was 15.9 (±3.9 SD) months. In Group N, 16 children (38%) showed an anterior open bite, 2 (5%) in Group D, and 0 in Group C. The incidence of open bites was significantly less in Groups D and C vs N (chi-square test, P<.001). No significant difference was found between D and C.

CONCLUSION

Pacifier use may promote open bites in 16-month-old infants. Compared to a commonly used pacifier, the Dentistar caused almost no anterior open bites and, therefore, can be recommended for children younger than 16 months old.

Preventive orthodontics for the 5- to 7-year-old with the Nite-Guide technique

This preventive orthodontic technique is applicable for the 5- to 7-year-old to prevent problems involving crowding, spacing, rotations, overbite, overjet, gummy smiles, Class II molar relations, and TMJ dysfunction from developing. The technique is based on accepted published research on the development of the dentition. Patients are typically started at 5 or 6 years of age and wear two preformed appliances only while sleeping. The active stage lasts about 2 years. The same appliance is used as a retainer until 12 years when the patient is dismissed About 75% to 80% do not require further orthodontics. The total procedure takes about 2 to 3 hours of total chair time.

Different geometric patterns of pacifiers compared on the basis of finite element analysis

AIM

This study was carried out with the purpose to show on a virtual model of oral cavity the mechanical behaviour of different kinds of pacifiers with different pressure levels that can be likened to a condition of rest and deglutition.

MATERIALS AND METHODS

Three different types of dummies, orthodontic- (A), cherry- (B) and drop- (C) shaped from an anatomical point of view, were inserted between the palate and the tongue in a virtual system by means of a finite element simulation. The palatal structure was recreated through tridimensional laser scanning, while the tongue structure was reconstructed by a software suitable for reproducing solids. Also the image of the pacifiers was developed by computer-aided scanning and reproduction. Suitable constraints were inserted and high and low pressure levels were exerted on these systems. FEA simulation allowed us to distribute the strain on the palate according to the different geometrical structures of the objects.

RESULTS

Dummy A shows a more uniform and wider crosswise stress distribution with also a lesser load on the anterior palatal crest. Dummy B and C, on the contrary, show a more dot-like behaviour inducing a higher stress due to contact on restricted points.

CONCLUSION

The characteristics of dummy A, although they have not been clinically investigated yet, seem to be the fittest ones to guarantee the maintenance of the transversal diameters of the premaxilla and reduce the risk of open bite.

Children with Down syndrome: oral development and morphology after use of palatal plates between 6 and 48 months of age

OBJECTIVE

The aim of this study was to describe the number of erupted teeth, sucking habits, tongue morphology, facial expression and speech in children with Down syndrome (DS) aged 48 +/- 6 months and treated from 6 months of age with palatal plates in combination with speech and language therapy.

METHODS

The research took the form of a multicentre, multidisciplinary, longitudinal study of children with DS followed from the age of 6 months. A total of 37 children with DS were included. One child could not cooperate at all and was excluded from the evaluations. In combination with speech and language intervention provided by speech and language therapists, the children used palatal plates provided by dentists from 6 months of age. In the evaluation, the children in the sample (n = 36) were compared with two similarly aged control groups: one group of children with DS who never had used palatal plates (n = 31) and one group of children with normal development (n = 36). The evaluation of oral parameters was performed by dentists after calibration. Registration of facial expression and speech was done by a speech and language therapist, and the evaluation was done by two speech and language therapists and one phonetician who were calibrated in joint discussions.

RESULTS

In contrast to the children with DS in the control group, the subjects in the study were found to have as many erupted teeth as the children with normal development. The prevalence of sucking habits did not differ between the three groups. Only children with DS sucked their tongue, a toy or other things in addition to a thumb or dummy. The prevalence of tongue diastase in the study group with DS was of the same magnitude as in the evaluation at the age of 18 +/- 3 months. The palatal plates were used by 57-65% of the children without any larger problems. In the study sample, the possible beneficial effects of palatal plate therapy were a lower prevalence of posterior cross-bite, a higher prevalence of frontal cusp-to-cusp relation and a lower prevalence of frontal open bite. Evaluation of facial expression and speech showed a higher score for facial expression and a better communicative capacity in the children in the study group than in the control children with DS.

CONCLUSIONS

In children with DS, palatal plate therapy between 6 and 48 months of age in connection with speech and language intervention had a positive effect on occlusion, oral motor function, facial expression and speech. No harmful effects were observed. Although this is a valuable method, however, it must be emphasized that palatal plate therapy puts additional demands on already burdened children and their caretakers.

A retrospective and prospective view of orofacial myology

Orofacial myofunctional disorders include specific conditions or behaviors that can have a negative impact on oral postures and functions. Historically, interest has focused on behaviors in the horizontal plane, highlighted by tongue thrusting. Currently, the scope of practice also includes tongue forward posturing, lip incompetence, open mouth rest posture, thumb and finger sucking, bruxism, and biting habits involving lips, fingers, tongue and cheeks. The common denominator for myofunctional conditions is a change in the inter-dental arch vertical rest posture dimension, the dental freeway space. The purposes of myofunctional therapy include normalizing the freeway space dimension by eliminating noxious habits or postures related to freeway space change. Improving cosmesis with a lips-together rest posture is also an important treatment goal. The clinical significance of the freeway space is explained in terms of the dental consequences of differential eruption patterns that can develop from postural modification of the freeway space. When the freeway space is opened for extended periods beyond the normal range, the tongue can act as a functional appliance and contribute to the development of anterior open bite or a Class II malocclusion. A clinical procedure is proposed for evaluating the freeway space dimension and incorporating the information into treatment planning and evaluation of treatment success. While dentistry/orthodontics has a primary focus on dental occlusion, or teeth-together relationships, orofacial myologists focus on teeth-apart behaviors and postures that can lead to, or have already resulted in malocclusion.

[Effect of the early intervention of oral habits on the development of dental occlusion]

BACKGROUND

Sucking habits are related to malocclusion.

AIM

To evaluate the effect of a counseling interview about inhibiting this oral habit and, its influence on dental occlusion and labial-lingual posture.

METHOD

40 children (mean age = three years), with a sucking habit and anterior open bite, received counseling aiming for the interruption of this habit. Measurements of the open bite were made, as well as a myofunctional evaluation, prior to counseling and, three and six months after it.

RESULTS

26 children stopped with the habit of sucking, with 25 children presenting a reduction of the open bite. No change was observed in labial-lingual posture.

CONCLUSION

The counseling interview favored the interruption of the oral habit and the correction of the open bite.

Three-Dimensional Surgical Planning for Maxillary and Midface Distraction Osteogenesis

Computerized surgical planning protocols for distraction osteogenesis are still in their rudimentary phase. The authors have developed a system to plan distraction osteogenesis in craniofacial and maxillofacial surgery that uses three-dimensional computed tomography scans and computer simulation in a virtual reality environment. This involves the creation of a three-dimensional bone model of the craniofacial skeleton, which incorporates virtual globes. Virtual osteotomies are performed on the bone model and the movements of the bone segments are simulated. The program generates a recipe for the linear and the angular changes necessary to achieve the desired outcome. The purpose of this article is to present this surgical planning process and discuss its use in maxillary and midface distraction.

Moulding of the generate to control open bite during mandibular distraction osteogenesis

Distraction osteogenesis of the craniofacial skeleton has become a widely accepted, safe, and effective means of craniofacial reconstructive surgery. Despite excellent results in general, there are still some uncertainties related to the procedure, such as development of an anterior open bite (AOB) during mandibular distraction. The aim of this study was to examine whether 'moulding of the generate', i.e. use of intermaxillary elastics during the active distraction phase is possible to close the mandibular plane angle and open bite. Three subjects, 13- and 15-year-old males and a 7-year-old female, underwent mandibular linear and angular bilateral distraction osteogenesis with moulding of the generate. Lateral cephalograms were obtained before the introduction of elastics and following distraction, once the activation was stopped and the patients were ready for the consolidation phase. Conventional cephalometric measurements were used to assess possible changes in the mandibular plane angle and incisor position. Three different anchorage systems (dental, orthopaedic, and skeletal) were used for placement of the intermaxillary elastics. Cephalometric examination showed that the mandibular plane angle was decreased during active distraction osteogenesis with the introduction of elastics and angulation of the distraction device. Depending on the type of elastic anchorage system, smaller or greater amounts of extrusion of the incisors were noted. Moulding of the generate during active distraction can be performed to reduce the mandibular plane angle and open bite. To prevent unwanted dentoalveolar changes from occurring during elastic traction, skeletal rather than dental fixation of the elastics is recommended. Intrusive mechanics may be incorporated into the orthodontic appliances to balance extrusive force by the moulding elastics.

Effects of a modified acrylic bonded rapid maxillary expansion appliance and vertical chin cap on dentofacial structures

The aim of this study was to determine the sagittal, transverse, and vertical effects of a modified acrylic bonded rapid maxillary expansion (RME) device used with a vertical chin cap on dentofacial structures. The study group consisted of 34 patients (25 girls and 9 boys) who were selected without regard to their skeletal class and gender. All subjects had permanent dentition (mean age, 12.7 years) and needed maxillary expansion. Study Group I (RME only) was composed of 17 subjects, and study Group II (RME with vertical chin cap) was composed of 17 subjects. Twenty-nine measurements were made on the patients' cephalometric films and plaster models. The means and standard deviations for linear and angular cephalometric measurements were analyzed statistically, and intra-group and inter group changes were evaluated by paired and Student's t-tests using SPSS 10.1 for windows. We found that the maxilla moved anteriorly relative to the anterior cranial base. The nasal width, maxillary width, intercanine width, mandibular intermolar width, maxillary intermolar width, and overjet all increased, while the upper molars tipped buccally in both groups. In Group I, the mandible rotated posteriorly, the lower anterior facial height increased, and the overbite decreased. These effects were reduced in Group II. We conclude that the vertical chin cap is an effective appliance for preventing the adverse vertical effects of RME in patients with a crossbite and a vertical growth pattern.

Effect of reverse curve mushroom archwire on lower incisors in adult patients: a prospective study

This prospective clinical study was undertaken to analyze adult skeletodental changes induced by a reverse curve mushroom archwire during the initial stage of treatment. Lateral cephalograms from before treatment and immediately after bite opening were evaluated from 8 female adult patients who were undergoing lingual orthodontic treatment. Before treatment the patients had a mean overbite of 3.9 mm. Six linear and 5 angular measurements were selected for cephalometric analysis. The mean change in the cephalometric parameters was subjected to paired t-tests to determine whether the change was significant. There was a highly significant overbite reduction (-1.9 mm, P < .001) leaving a postintrusion overbite of 2.0 mm. The lower incisors were intruded 1.5 mm (P < .001) and the lower incisor edge was in an approximately stable sagittal position (L1 to NPg = -0.2 mm, NS). Some lower incisor proclination (L1 to MP = 1.2 degrees) was seen, which was not of significance. The mandibular molars were not significantly extruded. After bite opening the mandibular plane angle was not significantly altered. Consequently, the lower anterior face height was not significantly increased. The results of this study revealed that the use of reverse curve mushroom archwire is capable of intruding the lower incisors with minimal side effects on the posterior teeth.

Vector control in lower jaw distraction osteogenesis using an extra-oral multidirectional device

PURPOSE

This cephalometric study describes structural changes in facial features and occlusion during distraction of the mandible.

PATIENTS

Seven patients aged 7-16 years with severely retrognathic lower jaws were treated by bilateral extra-oral distraction. The direction of the distraction was changed during the distraction period (mean 30 days) using the adjustable hinge in the distractor. Cephalometric follow-up documents were analysed for changes in facial and occlusal structures. The distraction therapy proceeded in two phases. First, horizontal distraction was undertaken to achieve a good incisor relationship. After this, the direction was changed to a more vertical plane with the use of a hinge axis, and the tips of the lower incisors were used as the axis of rotation.

RESULTS

The most remarkable changes were in the more anterior position of the lower jaw, the increase in ramus height and good dental overjet. The mandibular occlusal plane became more horizontal, creating a posterior open bite. By guiding the vector of distraction, no anterior open bite or lateral crossbite appeared.

CONCLUSION

This study points out the advantages of using extra-oral multidimensional distractors. Severe lower jaw deficiency requires not only a long working length of the device but also precise control of the vector during the active phase of distraction.