Lip Bumper Research Articles

Orthodontic Management of a Mandibular Double-tooth Incisor: A Case Report

The presence of a double-tooth requires specific complex management due to the need for differential diagnosis and following treatment choices. The aim of this report was to present a rare case of a geminated mandibular lateral incisor, treated with an orthodontic approach. A Caucasian 10.9-year-old girl presented a lower right double-tooth incisor, with a class 1 molar and a class 2 cuspid tendency on both sides. The upper arch was constricted as shown by bilaterally tendencies to cross-bite, a slightly lower midline deviation was reported and a lack of space for all four permanent cuspids was confirmed also by the panoramic X-ray. In the lower arch, there was a severe crowding of about 14 mm and a buccally ectopic left canine. Overbite was normal and Overjet minimally increased. The double-tooth was identified like a geminated tooth, for the presence of one root and one pulp canal of increased size, as shown by the radiographic examinations. The anomalous tooth was managed with an orthodontic approach associated with a progressive stripping to reshape the crown. A two-phase treatment plan was performed, based on first maxillary expansion and lip bumper and then fixed appliances, in order to achieve a proper occlusion and a better aesthetic.

Evaluation of Lower Dental Arch Crowding and Dimension after Treatment with Lip Bumper versus Schwarz Appliance. A Prospective Pilot Study.

Aim: The treatment of patients with mixed dentition, with inferior moderate dental crowding (the so-called borderline cases, between extraction and expansion) is not yet clear. Two examples of widely used appliances for increasing lower dental arch dimensions are the Schwarz’s appliance and lip bumper. The aim of this prospective study was to compare dental crowding and arch dimensions from pre- to post-treatment with lip bumper versus Schwarz’s appliance. Subjects and Methods: Pre- and post-treatment orthodontic records of twenty subjects (10 males and 10 females) were analyzed in the present study. Inclusion criteria were: first/second molar class malocclusion; crowding of the mandibular arch, from mild to moderate (4–6 mm); mixed dentition; age ≤ 9 years at the beginning of the treatment; stage CS1 or CS2 of maturation of the cervical vertebrae analysis (CVM) at the beginning of the treatment. Ten subjects were treated with a lip bumper, and ten with the removable Schwarz appliance. The primary outcomes were the variations in dental crowding and arch dimensions from pre- to post-treatment. Results: Both the two appliances caused a statistically significant mean improvement/reduction in crowding, of 3.5 mm and 2.9 mm, for the Schwarz appliance and lip bumper, respectively. The Schwarz appliance resulted more effective in increasing arch dimension at the intercanine level, and arch perimeter, while the lip bumper achieves a higher increase in arch length. Conclusions: A lip bumper and Schwarz appliance are both useful in reducing crowding in mixed dentition. This improvement is due to the increase in dental arch dimensions, although the distribution of space resulted slightly differently between the two appliances.

Semi-Fixed Lip Bumper in Lesch-Nyhan Syndrome: An Interim Treatment Modality

Lesch-Nyhan syndrome is a rare X-linked, recessively inherited disorder of purine metabolism, caused by complete absence of the enzyme hypoxanthine-guanine phosphoribosyl transferase. This syndrome is characterized by 3 major features: neurological dysfunction, hyperuricemia, and cognitive and behavioral disturbances (e.g., self-mutilation, which begins at 2 to 3 years of age). Uncontrollable self-mutilation begins with biting of the perioral tissues and extends into patterns such as finger biting and head hitting. This report describes the case of a 31-month-old boy who was diagnosed with Lesch-Nyhan syndrome with severe lip injuries caused by self-mutilative behaviors. The behaviors were blocked with a semi-fixed lip bumper for a short period. The device was applied to the patient on the day of the visit without the requirement for an oral impression. It was easy to manage oral hygiene and adjust the device because it was detachable by clinicians and guardians. Therefore, a semi-fixed lip bumper may be useful as an interim appliance to block self-mutilative behaviors in children with Lesch-Nyhan syndrome.

Interim use of a maxillary lip bumper during interdisciplinary management of ectopically erupted incisor teeth.

Ectopic eruption, manifesting as an aberration in the normal path of eruption of a tooth, can adversely impact facial aesthetics, phonetics and psychosocial development. This case series describes the orthodontic management of two adolescent patients with different clinical presentations of ectopically erupted maxillary central incisors secondary to trauma during the primary dentition period. The therapy primarily included periodontal soft-tissue surgery accompanied by orthodontic traction to align the ectopic incisors. Frenectomy was performed in one patient and surgical excision of a hypertrophied pseudo-pouch in the second patient. A modified maxillary lip bumper was used concomitantly for management of associated soft-tissue trauma, thus facilitating healing and aiding orthodontic traction. Appropriately planned interdisciplinary management involving the interim use of a modified lip bumper allowed proper alignment of the ectopically positioned incisors with a stable outcome at three-year follow-up. Fixed orthodontic therapy with concurrent use of modified maxillary lip bumper is an effective approach to treat incisors erupted ectopically in relation to the upper lip and frenum.

Quad Helical U-Loop Lip Bumper

Lip bumpers have become an integral part of treatment regime in interceptive and corrective orthodontics. The triumph of it depends on the sturdiness without distortion and fracture during the course of treatment. Most often, excessive stress engendered by the patient triggers its breakage. This article presents a modified lip bumper that aims to diminish the undue stress in the wire, which makes the appliance more fracture resistant and effective.

The Use of Lip Bumper in Lip Sucking Treatment

<p><strong><em>Background: </em></strong><em>Oral habits include habit which are continuously done and has the potential to cause defects on teeth and perioral tissues.Lip sucking or biting habits are often found simultaneously or as a substitution of finger sucking. This habit may affect the labial and perioral structures. The habit may take </em><em>several</em><em> forms. Two extreme types are mild wetting</em><em> of</em><em> the lips with the tongue and pulling the lips into the mouth between the teeth. The lip bumper is a functional device that is used successfully to intercept developing dental and occlusal problems by allowing a proper development of the arch length and width for eruption of the permanent teeth.</em><strong><em>Purpos</em></strong><strong><em>e:</em></strong><em> This study aimed to re-validate the effectiveness of lip bumper application and habitual therapy in treating the bad habit of lip sucking. <strong>Case Report:</strong> The mother of a 9-year-old girl reported an upper front teeth protrusion and frequent occurrence of mouth ulcer. Further examination revealed that the patient had a habit of lip sucking. </em><strong><em>Case Management</em></strong><strong><em>:</em></strong><em> Removable Lip Bumper is used to control lip habits such as lip sucking and to improve mentalis muscle hyperactivity. Such habit was treated with the use of a removable lip bumper and habitual therapy conducted by both parents. Constants reminder and encouragement from the parent to wear the lip bumper is one of the key success factors in this treatment. <strong>Conclusion: </strong>Five months after the initial application of a lip bumper and habitual therapy, the patient overcame the habit of lip sucking.</em></p><p><strong><em>Keywords</em></strong><strong><em>:</em></strong><em> lip bumper, lip sucking, myofunctional therapy</em></p><p><strong><em>Correspondence</em></strong><strong><em>:</em></strong><em> YulieEmildaAkwan, </em><em>Department of Pediatric Dentistry</em><em>, Faculty of Dentistry, Hang TuahUniversity, Arif Rahman Hakim 150, Surabaya, Phone 031-5945864, Email: <span style="text-decoration: underline;">yulieemilda@yahoo.com.</span></em></p>

Early Treatment of Class II Division 1 Malocclusion by Modified Teuscher Activator with Lip Bumper: A Case Series

Early Treatment of Class II Division 1 Malocclusion by Modified Teuscher Activator with Lip Bumper: A Case Series

Treatment of Class II malocclusion with mandibular skeletal anchorage

The aim of this case report was to present the dentofacial changes obtained with bone anchorage in a Class II patient with moderate to severe crowding. A boy, aged 14.5years, with a dolichofacial type, convex profile, and skeletal and dental Class II relationships was examined. After evaluation, functional treatment with bone anchorage and 4 first premolar extractions was decided as the treatment approach. Miniplates were placed on the buccal shelves of the mandibular third molars. The hook of theanchor was revealed from the first molar level. After surgery, the 4 first premolars were extracted to retract the protrusive mandibular incisors. The maxillary and mandibular first molars were banded, and a lip bumper was inserted to apply elastics and to help distalize the maxillary first molars. Orthodontic forces of 300 to 500g were applied immediately after placement, originating from the miniscrews to the hooks of the appliance to advance the mandible. After 20months of treatment, the patient had a dental and skeletal Class I relationship, the mandible was advanced, the maxilla was restrained, and overjet was decreased. The combination of a bone anchor, Class II elastics, and an inner bow is a promising alternative to functional treatment, along with extractions, in Class II patients.

Soft tissue profile changes in growing patients having Class II Division 1 Malocclusion treated by Modified Activator with lip bumper

Objective: to evaluate the soft tissue profile changes induced by modified Teuscher activator with lip bumper on growing patients. Materials and Method: the present prospective clinical study consisted of fifteen subjects (8 girls and 7 boys) with skeletal class II division 1 malocclusion due to retrognathism of the mandible with mean age of (10.4 ± 0.6 years) years. Cases were selected to be treated for 14 months. Results: A significant difference of all soft tissue variables from T0-T1 was found for both angular and linear measurements on the cephalometric radiographs analysis. Conclusion: Treatment of Growing patients with Class II division 1 by Teuscher activator with lip bumper showed esthetic improvements due to significant changes in soft tissue profile, as a result of mandibular advancement. Keywords: Soft tissue, Class II division 1 malocclusion, Modified activator, Lip bumper, Growing patients

6 下顎リップバンパー治療における歯列の変化と下顎運動との関連について(第475回 大阪歯科学会例会)

6 下顎リップバンパー治療における歯列の変化と下顎運動との関連について(第475回 大阪歯科学会例会)

Early interception of mandibular shifting: A longitudinal approach from deciduous through mixed and permanent dentitions

AbstractA Class II malocclusion with a unilateral posterior crossbite in the late deciduous dentition is a challenging type of malocclusion to intercept. The objective is to analyze the long-term changes in a patient with a skeletal Class II division 1 malocclusion. A 5-year-old female child who was referred from a pediatric dentist came for consultation. Correction of posterior crossbite involves expansion of the maxillary arch with the aim of removal of occlusal interferences and elimination of the functional shift of the mandible. The treatment comprised three stages: (1) Expansion of the maxillary arch was performed with a modified Haas palatal expander and the clinical procedures thus resulted in improved facial symmetry and satisfactory functional occlusion in the mixed dentition (8 years 10 months). (2) Distalization of maxillary first molars was done with a Kloehn type headgear and a lip bumper was placed in the mandible to maintain the arch perimeter (12 years). (3) A 0.022 inch × 0.028 inch standard edgewise fixed appliance was used for comprehensive orthodontic treatment and the objectives were accomplished (14 years 5 months). The results showed great improvements in function and esthetics, and posttreatment stability was good after 7 years and 5 months.

Predictors of postretention stability of mandibular dental arch dimensions in patients treated with a lip bumper during mixed dentition followed by fixed appliances.

To identify which dental and/or cephalometric variables were predictors of postretention mandibular dental arch stability in patients who underwent treatment with transpalatal arch and lip bumper during mixed dentition followed by full fixed appliances in the permanent dentition. Thirty-one patients were divided into stable and relapse groups based on the postretention presence or absence of relapse. Intercuspid, interpremolar, and intermolar widths; arch length and perimeter; crowding; and lower incisor proclination were evaluated before treatment (T0), after lip bumper treatment (T1), after fixed appliance treatment (T2), and a minimum of 3 years after removal of the full fixed appliance (T3). Logistic regression analyses were performed to evaluate the effect of changes between T0 and T1, as predictive variables, on the occurrence of relapse at T3. The model explained 53.5 % of the variance in treatment stability and correctly classified 80.6 % of the sample. Of the seven prediction variables, intermolar and interpremolar changes between T0 and T1 (P = .024 and P = .034, respectively) were statistically significant. For every millimeter of increase in intermolar and interpremolar widths there was a 1.52 and 2.70 times increase, respectively, in the odds of having stability. There was also weak evidence for the effect of sex (P = .047). The best predictors of an average 4-year postretention mandibular dental arch stability after treatment with a lip bumper followed by full fixed appliances were intermolar and interpremolar width increases during lip bumper therapy. The amount of relapse in this crowding could be considered clinically irrelevant.

Management of space in the mixed dentition: The use of lip bumper

Management of dental space problems continues to play a substantial role in interceptive orthodontics. In the mixed dentition, moderate crowding problems can be resolved through preservation of the Leeway space, regaining space or producing limited expansion. The lip bumper is a functional device that is used successfully to intercept developing dental and occlusal problems by allowing a proper development of the arch length and width for eruption of the permanent teeth. A nine-year-old female patient with the chief complaint of delayed eruption and lack of space in the left mandibular quadrant for the eruption of the entire permanent teeth. She was successfully treated in duration of 9 months with a lip bumper and expansion therapy.

Short- and long-term evaluation of mandibular dental arch dimensional changes in patients treated with a lip bumper during mixed dentition followed by fixed appliances.

To evaluate short- and long-term mandibular dental arch changes in patients treated with a lip bumper during the mixed dentition followed by fixed appliances, compared with a matched control sample. Dental casts and lateral cephalograms obtained from 31 consecutively treated patients before (T0) and after (T1) lip bumper, after fixed appliances (T2), and a minimum of 3 years after fixed appliances (T3) were analyzed. The control group was matched as closely as possible. Arch width, arch perimeter, arch length, and incisor proclination were evaluated. Repeated measures ANOVA was used to analyze changes in measurements over all four time points between treatment and control groups. Arch widths and crowding were always significantly different except at T2-T1. At T1-T0, only crowding decreased 3.2 mm while intercanine, interpremolar, and intermolar widths increased by 3.8, 3.3, and 3.9 mm, respectively. Changes at T3-T2 showed a significant decrease of 2.1 mm for crowding and an increase of 3.5, 2.9, 2.7, and 0.8 mm for intercanine, interpremolar, and intermolar widths and arch perimeter, respectively. Finally, at T3-T0, the reduction in crowding of 5.03 mm was significant and clinically important in the treated group. The differences between intercanine, interpremolar, and intermolar widths were also significant (2.1, 3.8, and 3.6 mm, respectively). All those differences favored the treated group. Mandibular dental arch dimensions were significantly changed after lip bumper treatment. At follow-up, all arch widths were slightly decreased, generating an increase of 0.4 mm in crowding, considered clinically irrelevant. Overall changes remained stable after an average 6.3-year follow-up.

Comparison between rapid and mixed maxillary expansion through an assessment of arch changes on dental casts

BackgroundAim of this retrospective observational study was to compare upper and lower dental changes in patients treated with Rapid Maxillary Expansion (RME) and Mixed Maxillary Expansion (MME), assessed by dental cast analysis.MethodsTreatment groups consisted of 42 patients: the RME group (n = 21) consisted of 13 female and 8 male subjects with the mean age of 8.8 years ± 1.37 at T0 and 9.6 years ± 1.45 at T1; the MME group (n = 21) consisted of 12 female and 9 male patients with a mean age of 8.9 years ± 2.34 at T0 and 10.5 years ± 2.08 at T1. The upper and lower arch analysis was performed on four dental bilateral landmarks, on upper and lower casts; also upper and lower arch depths were measured. The groups were compared using independent sample t-test to estimate dental changes in upper and lower arches.ResultsBefore expansion treatment (T0), the groups were similar for all examined variables (p>0.05). In both RME and MME group, significant increments in all the variables for maxillary and mandibular arch widths were observed after treatment. No significant differences in maxillary and mandibular arch depths were observed at the end of treatment in both groups. An evaluation of the changes after RME and MME (T1) showed statistically significant differences in mandibular arch depth (p<0.001) and maxillary intercanine widths (p<0.05). Differences in maxillary arch depth and arch width measurements were not significant.ConclusionsRME and MME can be considered two effective treatment options to improve transverse arch dimensions and gain space in the dental arches. A greater lower arch expansion was observed in the MME group, which might be attributed to the “lip bumper effects” observed in the MME protocol.

Tratamiento temprano de maloclusión II division 2: Reporte de un caso

Se puede iniciar el tratamiento temprano de la maloclusión clase II división 2 en la dentición mixta, usando diferentes tipos de aparatología, el objetivo en esa fase es lograr una función muscular equilibrada, una relación molar clase I y mejorar el entrecruzamiento vertical y horizontal.Se reporta el caso de un niño de 9 años 4 meses, en dentición mixta primera fase con maloclusión clase II división 2 y discrepancia alveolo dentaria superior de -7,3 mm e inferior de -8,4mm. El tratamiento incluyó el uso de una placa de expansión con plano de mordida anterior, aparato extraoral ortodóntico de tracción cervical y lip bumper, obteniendo resultados satisfactorios en 18 meses.

Second molar impaction associated with lip bumper therapy.

INTRODUCTION: Although lip bumpers (LBs) provide significant clinical gain of mandibular arch perimeter in mixed-dentition patients, orthodontists are reluctant to use them due to the possibility of permanent second molar eruptive disturbances. OBJECTIVE: The present study was conducted to assess second molar impaction associated with the use of LBs, and to investigate how they can be solved. MATERIAL AND METHODS: Lateral and panoramic radiographs of 67 patients (34 females and 33 males) were assessed prior (T1) and post-LB treatment (T2). LB therapy lasted for approximately 1.8 ± 0.9 years. Concomitant rapid palatal expansion (RPE) was performed in the maxilla at LB treatment onset. Impaction of mandibular second molars was assessed by means of panoramic radiographs in relation to the position of first mandibular molars. Horizontal and vertical movements of first and second molars were assessed cephalometrically on lateral cephalometric radiographs based on mandibular superimpositions. RESULTS: Eight (11.9%) patients had impacted second molars at the end of LB therapy. Two patients required surgical correction, whereas five required spacers and one patient was self-corrected. Mandibular first molar tip and apex migrated forward 1.3 mm and 2.3 mm, respectively. Second molar tip showed no statistically significant horizontal movement. CONCLUSION: Although LB therapy increased the risk of second molar impaction, impactions were, in most instances, easily solved.

Class II 부정교합환자의 Trainer for Kids(T4K)를 이용한 조기치료 : 증례보고

T4K는 혼합치열기의 2급 부정교합 환자에게 사용되는 기능성, 가철성 교정장치이다. 기능성 교정장치의 경우 치열과 악골의 성장에 영향을 주는 구강안면부의 근육의 부조화를 개선시키는 역할을 한다. T4K에 포함된 lip bumper는 과도한 하순의 힘을 차단하여 주고, 하순 내측 전정을 자극하는 요소가 포함되어 있다. 부적절한 혀의 위치를 교정할 수 있는 요소는 환자들이 장치를 장착하는 동안 부가적인 혀 운동을 할 필요성을 감소시킨다. 2급 부정교합 환자의 경우 하악 열성장을 동반하는 경우가 대부분을 차지한다. 이 장치는 상악 치아를 고정원으로 하여, 하악을 전방으로 성장할 수 있도록 자극하여 부족한 하악 성장을 촉진하는 역할을 하고 있다. 이와 함께 부가적으로 Labial bow와 같은 역할을 하는 요소는 상악 치열의 개선에 도움을 준다. T4K는 기성품으로 작은 부피와 부드러운 질감으로 어린 환자들의 장착 동의율을 높이는 데 장점을 가진다. 원광대학교 치과대학 산본치과병원 소아치과에 내원한 혼합치열기의 2급 부정교합 환자에서 만족스러운 결과를 얻었기에 이를 보고하는 바이다. 요약 1. T4K를 혼합치열기의 2급 부정교합 환자에게 사용하여 안모의 개선을 얻었다. 2. 과도한 수직, 수평 피개교합이 개선되었다. 3. 하악 열성장 환자에서 T4K를 장착하여 하악 성장을 촉진하는 결과를 얻었다. 4. 구호흡 등과 같은 구강악습관의 개선을 얻었다. <TEX>$T4K^{TM}$</TEX>(Myofunctional Research Co, Australia) is one of the myofunctional appliance developed to be used in children of mixed dentition. Myofuncitonal appliance stimulate the facial, masticatory and tongue muscle and help to balance the muscular force. Labial bow included in the device exerts strength in excessively labial inclineded upper jaw, Lip bumper blocks strength of the mouth to prevent abnormal strength exerted in lower jaw, Tongue tag secures proper position of tongue, and additional exercise is not required for child patients. For the more, simpler design and softer texture of device prmoted cooperation of patients during use. This case report is to present the satisfactory results gained by using <TEX>$T4K^{TM}$</TEX> on Class II patients. Comment 1. <TEX>$T4K^{TM}$</TEX> was applied in Class II malocclusion patients of mixed dentition with expected space insufficient to gain facial improvement. 2. Excessive overjet, overbite were improved. 3. Main effects are regarded to have been achieved by development of lingual slant of upper jaw, labial slant of lower jaw, and lower part of jawbone. 4. Bad habits, such as mouth breathing, can also be adjusted.

Correction of bilateral impacted mandibular canines with a lip bumper for anchorage reinforcement

Multiple treatment options are available to patients with impacted manibular canines in addition to a retained deciduous canine. This article describes the treatment of a prepubertal girl, aged 10 years 6 months, with a skeletal Class I, dental Class II Division 1 malocclusion, retrognathic mandible, deep overbite, proclined maxillary incisors, midline diastema, and bilateral mandibular canine impaction. The orthodontic treatment plan included extraction of the deciduous canine and forced eruption of the impacted canines. A modified lip bumper appliance was used both for forced eruption and to reinforce anchorage. Through the collaborative efforts of an orthodontist and an oral surgeon, an excellent esthetic and functional outcome was achieved.

Mandibular lip bumper treatment and second molar eruption disturbances

Mandibular lip-bumper (LB) nonextraction treatment, usually started before complete second molar (M2) eruption, inevitably interacts with the development of the dentition. Yet, its effects on M2 eruption are still unknown. The first aim of this study was to retrospectively investigate whether LB therapy (260 patients) enhances the risk for M2 ectopic eruptions and impactions in comparison with 135 untreated subjects. The second aim was to assess, among treated patients (n = 197), the main potential determinants of M2 impaction and ectopic eruption. M2 eruption and impaction were determined on panoramic radiographs. To assess the predictive role of M2 inclination in relation to the first molar, a panoramic radiograph suitable for this measurement before treatment was required. The data were analyzed by using software (version 8.2, SAS, Cary, NC). LB treatment significantly enhanced M2 impaction and ectopic eruption. Negative prognostic factors were found. An initial inclination of the M2 greater than 30° was significantly associated with a higher impaction risk compared with an angulation less than 10°. LB treatment duration longer than 2 years increased the risk of ectopic eruptions. While gaining space in the anterior arch, unwanted effects might be produced in the posterior arch. To be informed about these unplanned events is necessary to better optimize treatment.