A case study on myofunctional therapy and malocclusions created by oral habits

Purpose

To demonstrate the effect of an orofacial myofunctional therapy intervention by an interdisciplinary team composed of a registered dental hygienist who is also a certified orofacial myologist (COM^®), a general dentist, and an orthodontist on the elimination of oral habits and changes in dental malocclusion.

Method

This case study describes a 7-year-old female who underwent an individualized myofunctional therapy program and was given supervised education on a series of exercises targeting the muscles of mastication and facial expression over 5 months. Correct oral rest postures of the tongue and the lips were also established through therapy.

Results

The intervention enabled the client to eliminate multiple oral habits, which corrected oral rest postures of the lips and tongue. This correction consequently improved the client's malocclusion and further prepared the client for future orthodontic treatment.

Conclusion

Myofunctional therapy facilitated the elimination of unfavourable oral habits that led to malocclusion. Eliminating oral habits better prepared the client for orthodontic treatment and retention. Use of an interdisciplinary team facilitates optimal client care.

[Hypnosis and orthodontic treatments]

INTRODUCTION

After being discarded from hospitals due to its lack of scientific evidence, medical hypnosis is once more in the spotlight thanks to neuroscience and medical imaging, which have proven its specificity. Medical hypnosis is currently enjoying real enthusiasm, and now the doors are opening not only to medical and surgical units but also to our orthodontic clinics.

MATERIALS AND METHODS

This article defines hypnosis and its different levels of application and the required techniques. It also explores all the different fields in which it can be used in orthodontic treatment.

DISCUSSION

Hypnosis can be applied from the very first contact with the patient and can be useful and therapeutic at every step of the process. It is useful to think of it in our discipline as a treatment in its own right contributing to heal parafunctions and tongue disorders more efficiently.

Automatic Prompting to Reduce Persistent Tongue Protrusion in a Woman with Severe to Profound Mental Retardation

This study assessed whether an intervention approach relying on auditory prompting delivered automatically through a portable device was effective to reduce tongue protrusion in a woman with severe to profound mental retardation. The device involved (a) an optic sensor, i.e., a miniphotocell kept under the lower lip with medical tape, (b) a small signal transmission box, and (c) a Walkman for presenting the prompts. Initially, the automatic prompting condition was combined with occasional praise from a research assistant for having the tongue in the mouth. Analysis showed that the occurrence of tongue protrusion dropped from about 65% of the observation time during the initial baseline to less than 5% through the intervention. The study lasted 4.5 mo.

[Failures and tongue rehabilitation]

When confronted with difficult-to-eradicate dysfunctions and parafunctions, speech therapy most often proves a reliable ally to control the functional environment of the dental arches. However, a number of factors ranging from psychological issues to anatomical ENT obstructions, from genetic anomalies to iatrogenic procedures, account for the occasional mixed results achieved using this approach. In addition, our own treatment results can also be jeopardized or even obliterated by a recalcitrant tongue or one which has been inadequately provided for. The author will analyze the different factors involved through a series of clinical cases in order to outline her thinking regarding this organ, which can be either a driving force behind our treatments or a force for destruction.

[The tongue and ventilation: a recipe for failure?]

Since publication of the studies by the functionalist school (Ricketts, Linder-Aronson, Gola...), the role of function, and ventilation in particular, appears to be taken more widely into account. The close interconnection of ventilation / growth / lingual function and malocclusion is now evident to all. However, although an ENT diagnosis of a ventilation defect and its etiology is now standard practice, treatment of the condition is not always sufficient to ensure a functional environment conducive to orthodontic stability, even when rehabilitation is prescribed. In some instances, certain highly-invasive surgical treatments can even exacerbate the initial situation.

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.

[Orthodontic correction of a Brodie syndrome case related to oral habits]

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.

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.

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.

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.

[Dento-facial orthopedics and kinesthetic therapy: partners in patient management]

Orthodontic treatment alone, or combined with maxillo-facial surgery, can benefit from a kinesthetic therapy approach. This method of functional management, set in place as soon as the orthodontic diagnosis is made, will allow for a comprehensive therapeutic approach to patients, marked by a dialogue, between the different players involved in treatment, orthodontists and maxillofacial surgeons who intelligently work in concert.

Oral habits--part 2: beyond nutritive and non-nutritive sucking

In addition to sucking habits, a range of other habits have been associated with short- and long-term dental and orthodontic problems. These habits include tongue thrusting and atypical swallowing, lip sucking, oral self-mutilation, mouth breathing, and bruxism. Although the association between form and function continues to be controversial, if habits are of sufficient duration they may lead to dental malocclusion and impede successful management. Oral self-injury and bruxism can lead to significant problems, such as soft tissue trauma and infection. Accurate history taking and examination are essential steps in formulating a diagnosis and management plan. Although a range of treatment options are often available, clear guidelines for treatment are difficult to develop due to a lack of high quality clinical trials. Optimal management is likely to be dictated by patient and severity variability. The purpose of this paper is to review and discuss the management of tongue thrust and atypical swallowing, lip sucking, oral self-mutilation, mouth breathing and bruxism.

[How to push the limits in the transverse dimension? Facial asymmetry, palatal volume and tongue posture in children with unilateral posterior cross bite: a three-dimensional evaluation of early treatment]

Unilateral posterior crossbites have been reported to be one of the most prevalent malocclusions of the primary dentition in Caucasian children. Facial asymmetry due to lateral mandibular displacement in unilateral posterior crossbite, if not treated in the primary dentition period, may lead to an undesirable growth modification which results in facial asymmetry of skeletal origin. Irregular tongue function and posture have also been diagnosed as important etiological factors. Early orthodontic treatment seems to be profitable and desirable to create conditions for normal dental, functional and skeletal development of the orofacial region. Treatment success after correction of unilateral posterior crossbite in the primary dentition is highly questionable, as it is very difficult to objectively assess correction of facial asymmetry and irregular tongue function and posture in small, growing children. Although facial photography is an important diagnostic tool in orthodontics, its main disadvantage is that it represents a three dimensional subject in two dimensions. Tongue posture and function during clinical examination are difficult to assess and is therefore unreliable. Contemporary 3D diagnostics in unilateral posterior crossbite enables uninvasive, valid and objective assessment of facial morphology, palatal volume, tongue function and posture. It can, therefore, become in the future an important part of morphological and functional diagnostics in orthodontics and dentofacial orthopedics before, during and after orthodontic treatment.

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.

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.

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 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.

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.

The impact of spur therapy in dentoalveolar open bite

AIM

A longitudinal casecontrol study, designed to analyse the isolated effect of attached palatal spurs in patients displaying a dentoalveolar anterior open bite, is presented.

METHODS

Thirty-one patients (mean age of 13.3 years +/- 3.17 years) underwent a standardised treatment protocol with fixed anterior spurs for 8.3 months. Lateral cephalograms and plaster casts were analysed before (T1) and after spur therapy (T2). The data were tested using paired t-tests with a significance level of p < 0.05.

RESULTS

The cephalometric analysis showed significant elongation of the height of the maxillary (mean +1.22 mm) and the mandibular (mean +1.39 mm) alveolar processes, as well as uprighting of the lower anterior teeth. The plaster cast analysis showed an increase in maxillary intermolar width (mean +0.98 mm) and a decrease in intercanine distance (mean -0.96 mm). The mandibular anterior width and dental arch length reduced. Overall, spur therapy resulted in a significant increase in overjet and overbite.

CONCLUSION

The use of spurs produced a resolution of the open bite in all patients. Therefore, spurs could be considered an effective mechanism for the management of anterior open bite in selected adolescent patients.

Combining traditional techniques to correct anterior open bite and posterior crossbite

The treatment of anterior open bite often requires the use of skeletal anchorage to prevent excessive eruption of the posterior teeth and consequent downward rotation of the mandible. However, this procedure might not always be accomplished. This article reports the successful treatment of an anterior open bite and a posterior crossbite in a young boy, combining traditional techniques and involving high-pull maxillary traction to help growth to correct the skeletal Class II malocclusion without skeletal anchorage. The vertical dentoalveolar contribution of maxillary growth was also favorable to close the bite, whereas cross-elastics corrected the axial inclination of the mandibular posterior teeth, eliminating the inverted posterior crossbite. The open bite was completely closed with edgewise appliances, which also achieved normal overjet, intercuspation, and incisor exposure on smiling. Traditional mechanics for the treatment of open bite and crossbite remain a useful alternative when patients do not accept skeletal anchorage.

Research and clinical findings--a wholistic view

Valuable information is available to clinicians both from research articles, and reports from clinicians. Both sources have limitations. Research, with the exception of longitudinal studies, tends to isolate a variable or two from the whole, limiting its usefulness. Clinical techniques reported are sometimes biased, and perform well for certain therapists in certain settings, and not so well for others. Interrelationships are important among variables such as dentition, anatomy, physiology, oral muscle functions, oral rest postures, eating, and speech. Each affects the others. Equally important are interrelationships among all the specialists who treat patients with orofacial myofunctional disorders. A wholistic approach to the evaluation and treatment of orofacial disorders is advocated.

Patients treated with orthodontic-myofunctional therapeutic protocol

The aim of this study is to report three cases that needed myofunctional and orthodontic treatment and the good results achieved after the therapy. Orthodontic treatment alone, in presence of bad habits, is not enough to solve the orthodontic issues, so it needs to be combined with myofunctional treatment.

[Tongue retraining and occlusal stability in a young adult. Case report]

The clinical observation describes the case of a 20-year-old woman who has consulted for aesthetic and functional reasons. She presents a skeletal class III normodivergent, an occlusal class III with a lower proalveoli quite marked. In addition, a lingual dysfunction which manifests itself by important anterior diastema and dento-dental disharmony at the upper jaw complicates the case. The undertaken therapeutic project starts with a first step of a lingual praxis rehabilitation, followed by an orthodontic step and upper lateral incisors-plasty. The purpose of those results is the evaluation of the stability two years later, which was reported positive.

[Passive correction of an anterior open bite related to non-nutritive sucking habits: report of a case]

The term anterior open bite refers to a vertical space between the upper and lower front teeth in maximum intercuspation. This malocclusal trait can accompany many malocclusions of the Angle's classification. Two types of anterior open bite have been described: skeletal and dental open bite. The latter may have Non Nutritive Sucking Habits (NNSH) as causal factor and is deemed to aggravate without treatment. This article presents an interceptive approach based on the use of a fixed passive appliance interfering with sucking habit. It consists of a crib soldered to bands adjusted to the maxillary first permanent or temporary second molars. The device was globally well accepted by the patient and has been effective in breaking the sucking habit and subsequently in closing the bite after only 5 month. When psychological approach is not effective, a fixed deterrent device may be recommended for weaning children off nonnutritive sucking habits.

Influence of posture on swallowing

AIM

This study investigates the relationship between posture disorders and swallowing, either of infantile type or affected by the presence of a short lingual frenulum.

MATERIALS AND METHODS

The stabilometry examinations, taking into account the Romberg index and the LFS value, and when needed a frenectomy, showed positive variations in the recovery of a proper posture. The data were analysed by means of the Wilcoxon signed-rank test.

RESULTS AND CONCLUSION

This study showed that swallowing is able to modulate postural control and it can be a determining factor in postural syndromes that, if not promptly intercepted, may evolve into full-blown and irreversible musculoskeletal disorders for which treatment often proves ineffective.

The effect of mandibular tongue cribs on dentoskeletal changes in patients with Class II Division 1 malocclusions

AIM

To investigate the effect of a modified tongue crib appliance in Class II Division 1 patients with anterior tongue thrust and mandibular deficiency.

METHODS

Twenty-three patients (14 females, 9 males) with a mean age of 10.09 ± 1.02 years, a moderate Class II Division 1 occlusion due to a mandibular deficiency, and a mean overbite of -1.1 ± 0.8 mm were treated with a mandibular tongue crib device. Pre- and posttreatment lateral cephalograms were obtained and traced, and various angular and linear variables were measured. These measurements were compared using the paired t test.

RESULTS

The statistical assessment indicated that SNB, facial angle, B-VL, Pog-VL, and interincisal angle increased significantly. IMPA, 1-SN, ANB, and Wits appraisal were significantly decreased (P<.05). The changes of Jarabak Index, SN-MP, SNA, and Y-axis were not significant. In addition, the overjet was reduced.

CONCLUSION

During the mixed dentition phase, a tongue crib appliance in the mandible is helpful to impede tongue thrust and stimulate mandibular growth.

A single appliance for the correction of digit-sucking, tongue-thrust, and posterior cross bite

Clinical management of non-nutritive sucking habits and the resulting dentofacial changes often require multiple appliances to correct, leading to increased treatment time and costs. The aim of this paper was to introduce a single appliance combining a Teflon roller, a slow palatal expander, and a tongue crib appliance that is designed to correct the: (1) sucking habit; (2) anterior open bite; (3) posterior crossbite; (4) tongue thrust; and (5) molar relationships without the need for multiple treatment strategies. Moreover, the fixed-removable design ensures patient compliance, yet allows the appliance to be easily removed by the clinician for adjustments.

Moebius syndrome: clinical manifestations in a pediatric patient

Moebius syndrome is a congenital, nonprogressive disorder clinically characterized by loss of facial expression, impaired stomatognathic system functions, incapacity to close the eyelids, and several oral impairments. The purpose of this paper was to present the clinical manifestations and the dental treatment in a 5-year, 2-month-old male Moebius syndrome patient. The child presented with facial asymmetry, difficulty performing facial mimic movements and pronouncing some letters, and compromised suction, mastication, breathing, and deglutition. An intraoral examination revealed hypofunction of the perioral muscles, cheeks and tongue, ankyloglossia, anterior open bite, and absence of carious lesions and dental anomalies. The dental treatment consisted of frenectomy and further placement of a removable orthodontic appliance with a palatal crib for correction of the anterior open bite. After 12 months of follow-up, anterior open bite decreased and speech, deglutition, and mastication improved.

Amelogenesis imperfecta: report of a successful transitional treatment in the mixed dentition

The term amelogenesis imperfecta is applied to a clinically heterogeneous group of hereditary disorders that interfere with the normal development of dental enamel. These disorders cause a deficiency in the enamel's quantity and/or the quality that may result in poor dental esthetics. The purpose of this paper was to describe a case of hypoplastic amelogenesis imperfecta in an 8-year-old girl whose dissatisfaction with the appearance of her teeth led to impaired social functioning. Since the patient was in the mixed dentition stage, a temporary treatment aiming to improve dental esthetics, preserve oral function, and allow for the recovery of the patient's self-confidence was performed by a multidisciplinary team.

[Case of mandibular deviation with tongue habits treated with occlusal reconstruction]

PATIENT

A 36-year-old male is reported. He visited the clinic complaining of discomfort of the tongue due to attached prosthesis and dysmasesis by mandibular deviation. The occlusion was reconstructed for the original mandibular position to improve the oral environment.

DISCUSSION

Muscle tone was relieved, and the mandible was guided below. As a result, an adequate relationship could be established in the original mandibular position. Tongue habits were eliminated, and the patient was satisfied both functionally and aesthetically, suggesting that a stable condition had been maintained for a long period.

CONCLUSION

In this case, the long-term follow-up through reversible treatment with a splint corrected the mandibular position and improved the tongue habit, resulting in reconfiguration of occlusion in the whole jaw. No significant problem has occurred for three years after the treatment.

Dynamic MRI Evaluation of Tongue Posture and Deglutitive Movements in a Surgically Corrected Open Bite

Tongue thrust usually develops in the presence of anterior open bite in order to achieve anterior valve function. In the literature, tongue thrust is described both as the result and the cause of open bite. If it is an adaptation to malocclusion, then tongue posture and deglutitive tongue movements should change after treatment. In this case report, an adult who had skeletal open bite and Class II malocclusion caused by mandibular retrusion was treated surgically. The mandible was advanced in a forward and upward direction with a sagittal split osteotomy. The open bite and Class II malocclusion were corrected and an increase in the posterior airway space (PAS) was observed. Pretreatment and posttreatment dynamic magnetic resonance imaging (MRI) revealed that tongue tip was retruded behind the incisors and contact of the tongue with the palate increased. It was also determined that the anterior and middle portions descended, whereas the posterior portion was elevated at all stages. Advancement of the mandible, correction of open bite, and an increase in PAS affected not only the tongue posture and deglutitive movements, but also the breathing pattern of the patient.

Is tongue thrust that develops during orthodontic treatment an unrecognized potential road block?

The role of tongue thrust has often been suspected, long debated and largely dispelled as a primary etiological factor of malocclusion. However, tongue thrust may contribute to poor occlusal intercuspation both during and after treatment. A tongue thrust may also develop during orthodontic mechanotherapy as a result of the transient creation of intra and interarch spaces and this little recognized phenomenon was found to occur in many randomly followed cases. In many instances, this seemingly adaptive and secondary response of the tongue posture and function may persist and thereafter impede the resolution of intra and interarch problems.

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.