Myofunctional Appliance Research Articles

Powerscope Efficiency for Class II Malocclusion Correction: Case Reports

Abstract In day-to-day clinical practice, orthodontists face great challenges in the management of mild-to-moderate Class II malocclusion. Myofunctional appliances are usually used for Class II malocclusion correction having a mandibular deficiency in the growing phase. The fixed functional appliances evolved due to noncompliance of myofunctional and excellent results were achieved due to less patient cooperation in such cases. PowerScope, also called “noncompliance Class II correctors,” is the one innovation for such cases. Its one-size-fits-all design; offers the advantage of easy chairside installation, shortens the duration of treatment, gives predictable results, and is used in noncompliant patients. These case reports showed how PowerScope is efficient for correcting Class II division 1 malocclusion having a mandibular deficiency. Successful and stable results were achieved with improvement in mandible advancement, esthetic appearance, and facial profile.

Analysis of prefabricated myofunctional appliances with different overjet and bumper designs: a three-dimensional finite element analysis

BackgroundPrefabricated myofunctional appliance can guide tooth eruption, improve dentition alignment, correct myofunctional disorders and harmful oral habits. However, its application to skeletal discrepancy may result in unsatisfactory tooth inclination. This study aimed to construct a novel appliance with overjet design to avoid this side effect and investigated its shape and mechanical changes under occlusion using three-dimensional finite element method.MethodsWe established three samples of prefabricated myofunctional appliances. The first one was edge to edge without overjet, and the outer shield of both jaws were flattened. The second one was 3 mm overjet with stepped the outer shield. The last one was 3 mm overjet, and the outer shield of both jaws were flatted, which meant the front wall of lower jaw was strengthened with bumper, termed as lower bumper. A complete dentition model was applied to the study. 150 N occlusal force was applied to each type of appliance and the deformation displacement and the changes in stress was recorded.ResultsThe deformation was significant in the incisors regions, especially in the vertical and lateral dimensions. The maximum displacements of 3 mm overjet with step shield group were 7.08 mm (vertical), 3.99 mm (lateral), and 2.90 mm (sagittal), while it decreased to 3.92 mm(vertical), 1.94 mm (lateral), and 1.55 mm (sagittal) in overjet with bumper group. Moreover, the upper molar regions exhibited higher vertical and sagittal displacement in 3 mm overjet with step shield group, which were 3.03 mm (vertical) and 1.99 mm (sagittal), and the bumper design could decrease the maximum displacement to 1.72 mm (vertical) and 0.72 mm (sagittal). In addition, the Von Mises stress of appliances was analyzed, and results indicated that 3 mm overjet with step shield generated higher stress than other groups, with the maximum Von Mises stress was 0.9387 MP, which were 0.5858 and 0.5657 MP in edge to edge group and 3 mm overjet with lower bumper group, respectively.ConclusionThe prefabricated myofunctional appliances may cause deformation during occlusion. Compared to step shield group, the application of lower bumper exhibited better resistance to occlusal force.

Effects of modified twin block appliance in growing Class II high angle cases: A cephalometric study

Background Class II malocclusions represent anteroposterior dysplasia usually resulting from mandibular retrusion. Along with a retropositioned mandible, it can be associated with either upward or backward jaw rotation. High angle cases are often associated with a short ramal height, steeper mandibular plane, and large gonial angle. Twin block is a commonly used myofunctional appliance that incorporates bite planes that direct the occlusal forces in a more favorable direction for correction of the retrognathic mandible. We aimed to evaluate skeletal, dental, and soft tissue changes following modified twin block appliance therapy in high-angle cases. Methods A cephalometric study was performed on 15 growing (10-14 years) high angle (Frankfort mandibular angle 28-35°) Class II Division I malocclusion patients undergoing twin block therapy. Skeletal, dental, and soft tissue changes were evaluated by cephalometric analysis using Dolphin software. Results Pre- and post-treatment changes in cephalograms were assessed by analysis of variance and paired t-test. Significant changes in the position of the mandible (angle between Sella-Nasion-Point B [SNB] increased by 3.9 degrees, P=0.02), Wits appraisal (decreased by 1.54 mm, P=0.04), maxillo-mandibular relationship (angle between Point A-Nasion-Point B [ANB] decreased by 3.74 degrees, P=0.02) were observed. Soft tissue changes like the nasolabial angle were also significant, increasing by 3.8 degrees (P=0.04) and lower lip relation to E-line (reduction in lower lip protrusion) by 2 mm (P=0.04). Vertical parameters showed non-significant changes, like the Frankfort mandibular angle (FMA) increased by 0.07 degrees, (P=0.67), the angle between Sella-Nasion and Gonion-Gnathion (SN-Go-Gn) increased by 0.33 degrees, (P=0.67), Y-axis increased by 0.2 degrees, (P=0.32). The upper incisor inclination decreased non-significantly from 115.27±1.33 to 113.42±1.65 degrees, (P=0.12) and lower incisor increased non-significantly from 100.13±2.23 to 101.80 ±1.37 degrees, (P=0.08). Conclusions Modified twin block appliance can be used to successfully treat Class II Division I high angle cases with good vertical control.

Effects of Froggy Mouth Appliance in Pediatric Patients with Atypical Swallowing: A Prospective Study.

Atypical swallowing has a high incidence in growing subjects. Orthopedic treatment with orthodontic appliances and speech therapy are the main approaches to this problem. The aim of this prospective study was to evaluate the changes in the dental arches induced by one year of treatment with the Froggy Mouth myofunctional appliance designed to correct atypical swallowing. In total, 16 patients with atypical swallowing were instructed to use the Froggy Mouth appliance. A digital intraoral impression was taken at baseline (T0). The Froggy Mouth appliance had to be used for 15 min/day throughout the treatment period. At the end of the first year of treatment (T1), another impression was taken with the same intraoral scanner. Digital casts of the T0 and T1 impressions were obtained using software and the two casts were superimposed to record the following measurements: upper intercanine distance, upper arch diameter, upper arch width, overbite and overjet. The data were statistically analyzed (significance threshold: p < 0.05). Student's t-test was used to compare pre- and post-treatment measurements. Linear regressions were performed to assess the influence of arch width on anterior and posterior diameters. A significant increase was found for the upper arch diameters (p < 0.05), whereas no statistically significant difference was found for the incisor relationship (overjet/overbite) (p > 0.05). To date, the efficacy of this appliance has not been extensively studied. According to the present prospective study, the Froggy Mouth protocol could be a valuable method as a myofunctional therapy for atypical swallowing, but further studies are needed to confirm these preliminary results.

Knowledge, Attitude and Perception Regarding Myofunctional Appliance among Children—Prospective Study of Parents’ View

ABSTRACT Aim: The current purpose of the survey is to completely evaluate parents’ attitudes, knowledge, and perceptions of myofunctional appliances. Materials and Methods: Parents in Chennai participated in this cross-sectional web-based questionnaire survey. Pilot study was carried out to determine the sample size, and 500 individuals were the final sample size. The 10 organized, predesigned, and validated questions are on awareness of myofunctional appliance. Results: The result of the survey showed that in 500 subjects, 79.8% were aware of skeletal problems. The proportion of parents willing to recommend the use of such treatments is about 70%, while 69% believe that myofunctional appliances are important in correcting skeletal problems. Conclusion: The present study has established that most parents know about the functional appliance and have an understanding of how to distinguish between skeletal problems. In order to diagnose skeletal issues in an appropriate age range for the individual, more awareness about appliances is necessary and needs to be developed.

The analysis of the most common problems associated with wearing removable orthodontic appliances by patients attending dental clinics at the universities of Kerbala

Objective: To evaluate the problems patients perceive during orthodontic treatment with removable and myofunctional appliances. Study Design: Cross-sectional study. Place and Duration of Study: Prosthodontic Department, College of Dentistry, University of Kerbala, from March 2021 to July 2021. Methodology: A total of 210 orthodontic patients who had been wearing removable and myo-functional orthodontic appliances for at least four months were included in the study. Patients were divided into two groups aged between 10 to 40 years. A questionnaire comprising 11 items covering physical, functional, psychological, and social problems associated with wearing removable and myofunctional orthodontic appliances was used to analyze the outcome variables. Patients were interviewed at Kerbala University. Results: In this study, 107 (51%) patients were male, and 103 (49%) were female, with ages ranging from 10 to 40 years. Forty-four (21%) patients reported reeling pain after insertion of removable and myofunctional appliances. A relatively higher percentage of male patients (44.5%) believed the appliance was effective, and 40% found it comfortable. Difficulty in speaking (36.7%) was the most frequent problem reported by the patients in the studied population. Conclusion: Despite a few problems, wearing removable and myofunctional orthodontic appliances remained an effective and viable treatment option for uncomplicated malocclusions.

Significance of saddle angle in myofunctional therapy: A case series

Myofunctional appliances are highly effective in growing patients and are often used to correct jaw discrepancies and promote optimal growth. The twin block appliance is widely considered as the most efficacious myofunctional appliance for treating skeletal class II malocclusion in growing patients. The success of treatment with any myofunctional appliance depends on a variety of factors, including the patient's age, growth status, growth pattern, the specific malocclusion being treated, patient compliance, the type of appliance, and other case selection criteria, such as clinical examination and certain cephalometric parameters that are not typically considered in routine practice. Among cephalometric parameters, the saddle angle is of utmost importance and should always be considered before commencing myofunctional therapy. Patients with a large saddle angle may have a class II skeletal relationship, characterized by a posteriorly positioned mandible. These cases can be more challenging to treat with functional appliances alone and may require additional orthodontic or surgical interventions. This paper presents a detailed description of three cases illustrating the importance of the saddle angle in the success of myofunctional therapy.

Removable versus fixed myo-functional appliances in class II malocclusion among Indians.

It is of interest to compare two myofunctional appliances (frankal appliance and twin bloc) and two fixed orthodontic appliances (PowerScope and Forsus) in management of class II div 1 malocclusion. A total of 56 Class II division 1 malocclusion patients indicated for treatment with myofunctional appliances and fixed functional appliances were randomized. They were equally divided among frankal appliance (n=14), twin block appliance (n=14), PowerScope (American Orthodontics) (n=14), Forsus (3M Unitek Corp) groups (n=14). Skeletal and dentoalveolar effects of all appliances were compared. SNB increased remarkably by 4.2° in the Twin block group and it was high among all treatment groups. There was a significant decrease in vertical dimensions (SN-GoGn) in the Twin block (p = 0.002). Early treatment of Class II due to mandibular retrusion with Twin block functional appliance is recommended due to its favorable skeletal effect.

Cephalometric changes in pharyngeal airway dimensions after functional treatment with twin block versus myobrace appliances in developing skeletal class II patients: a randomized clinical trial

BackgroundSeveral appliances have been used for correction of developing skeletal Class II, including different myofunctional appliances as Twin block (TB)as well as the new pre-fabricated Myobrace (MB) appliance. However, the effects of these devices on the pharyngeal airways have not been compared in the literature. Thus, the aim of this study was to compare the effects of two Class II correction appliances; TB and MB on the sagittal pharyngeal airway dimension (SPAD), including the nasopharyngeal airway area (NPAA), the oropharyngeal airway area (OPAA), and the laryngopharyngeal airway area (LPAA).MethodsThis is a two parallel arms randomized comparative clinical trial. Twenty-six children of 9–12 years with Skeletal Class II malocclusion due to mandibular deficiency and normal maxillary growth as confirmed by lateral cephalometric X-ray readings (ANB angle > 4° and SNB angle < 78) and Cervical vertebral maturational index (CVMI) 1 or 2 were randomly assigned into two equal groups. Group I: TB, Group II: MB (prefabricated functional appliance, Myofunctional Research Co., Australia). Lateral cephalograms were taken for all patients in both groups before treatment (T1) and after treatment (6 months later) (T2). The primary aim was to assess pre and post treatment changes in the SPAD in each group, and compare between the two study groups. The secondary aim was to evaluate the sagittal skeletal measurements such as the SNA, SNB, ANB, Wits appraisal, as well as vertical skeletal measurements represented by the Frankfurt-mandibular plane angle (FMA) measured pre- and post-treatment. The independent samples t-test was used to compare the two study groups, and the mean difference and 95% confidence intervals (CI) were computed. The paired samples t-test was used to compare various parameters between T1 and T2 within each group. The cutoff for significance was p-value < 0.05. Data were analyzed using IBM SPSS for Windows (Version 26.0).ResultsBy Comparing changes in airway measurements within each group, it was found that NPAA, OPAA, and LPAA increased significantly after treatment within each group of MB and TB. TB group showed significantly higher mean difference (T2-T1) in both NPAA and OPAA than MB group with 28.39 (± 56.75) and 40.46 (± 52.16) respectively. The increase in LPAA values was not statistically significant at (T2-T1) between both groups. Regarding skeletal changes, there was a significant increase in the SNB values between T1 and T2 within each group with 2.82 (± 3.32) for MB group and 3.79 (± 3.06) for TB group Moreover, there was a significant decrease in the ANB values between T1 and T2 within each group by 2.42 (± 2.70) for MB group and 3.06 (± 1.14) for TB group. Similarly, there was a significant decrease in the ANB values between T1 and T2 within each group by -2.13 (± 0.62) for MB group and − 2.46 (± 0.72) for TB group. No significant differences were found between both groups in SNA, SNB, ANB and Wits appraisal at p = 0.06, p = 0.45, p = 0.43 and p = 0.22 respectively. FMA did not show significant difference between T1 and T2 within each group, nor showed a significant mean difference between both groups at T2-T1.ConclusionsTB was more effective than MB in improving the upper (NPAA) and middle (OPAA) airways, while no difference was found regarding the lower airway (LPAA). Both TB and MB reduced the severity of developing skeletal class II due to mandibular retrognathism by forward posturing of the mandible. Thus, patients with airway problems would benefit more from TB than MB.

Correction of Skeletal Class II Malocclusion in a Growing Child Using Standard Twin Block: A Case Report

Mandibular defiiency in a Class II malocclusion is a frequently encountered condition that can be managed with myofunctional appliance in a growing child. An 11-year-old patient presented with a complaint of forwardly placed upper front teeth. The patient had a convex facial profie, acute naso-labial angle, deep mento-labial sulcus with lip trap. Clinically the patient showed positive VTO. The clinical fidings and cephalometric analysis indicated skeletal Class II jaw bases owing to prognathic maxilla and retrognathic mandible with Angle’s Class II division 1 malocclusion. CVMIshowed that the patient was in his growth phase. The treatment was done with a standard twin block appliance for 9 months followed by fied orthodontic treatment. The post functional phase showed correction of skeletal class II jaw base and marked improvement in the facial profie from convex to straight. It was later followed by fixed orthodontic treatment in the second phase upon completion of which bonded lingual retainer and wrap around retainers were given in the upper and lower arch. The total duration of the treatment was 23 months.

Effect of pre-orthodontic trainer treatment on the masticatory and perioral muscles in patients with class II subdivision 1 malocclusion evaluated by surface EMG.

Myofunctional appliances have been shown to have a positive effect on the muscles in the facial area. Surface electromyography (sEMG) is one of the reliable methods used to investigate these effects.

Open Bite Treatment with Combined Aligners and Myofunctional Appliances: A Case Report

This case report describes an 18-year-old female patient with a skeletal class I pattern, mandibular asymmetry, a molar class III on the right side, a molar class II on the left side, and an anterior open bite (AOB). Treatment of AOB is often difficult for orthodontists and a multidisciplinary approach is sometimes required to rehabilitate the correct function and posture of the tongue. In this case the AOB was treated using the Nuvola® OP System: a treatment system that combines orthodontic aligners and a myofunctional elastodontic device called Freedom. An upper molar intrusion with miniscrews was performed during the first phase of the treatment programme, and then the aligner treatment began. The Nuvola® OP System ’s aligners are characterized by lingual pins that guide the tongue to the palatal spot position and take advantage of tongue function. The patient was instructed to wear the Freedom device for 30 min a day and to clench every 3 s with closed lips while wearing the aligners. These exercises improve the fitting of the aligners, improve the tongue’s posture, and take advantage of the masticatory forces to resolve the malocclusion. The patient was successfully treated, thus demonstrating that the Nuvola® OP System is a valid alternative for the treatment of AOB.

Early Treatment of Class II Division 1 Malocclusions with Prefabricated Myofunctional Appliances: A Case Report

Removable functional appliances (RFA) have long been employed to address Class II malocclusion, particularly in cases involving a significant overjet, a deep bite, and molar class 2 issues. Notably divergent from RFA, myofunctional appliances (PMA) offer several distinct advantages, including applicability in noncompliant patients, adaptability in cases of dental element scarcity, suitability for allergic patients, impression-free utilization, and reduced costs. Within the array of clinical cases treated with PMA, we chose to present an intricate case involving an 8-year-old girl. Our aim was to showcase the immediate effects of PMA and to track the progress over a two-year span. Following one year of PMA treatment, substantial improvements were observed in a large overjet, a deep bite, and lip incompetence—factors often associated with elevated risks of dental trauma. These improvements not only positively impacted dental aesthetics but also engendered normalized nasal respiration and diminished palatal impingement, thereby enhancing the overall quality of life. Upon reaching the two-year mark, the clinical status pertaining to Class II malocclusion remained stable. Further treatment was advised in a subsequent phase to refine imperfections in the dental arch form. Nonetheless, comprehensive data from the prolonged follow-up of patients treated with these appliances are essential to establish robust scientific evidence concerning their long-term efficacy.

Management of skeletal Class III malocclusion using two-phase therapy in young patient - A case report

Maxillary and mandibular skeletal discrepancies are one of the commonly prevailing malocclusion in the childhood. Many a time it is ignored by the parents as well as the clinicians. It can present itself with aesthetic, functional and psychological problems of the child. Proper identification, diagnosis and treatment planning at the proper age can lead to correction and improvement in the overall facial balance and psychological esteem of the child. Over the years orthopedic and myofunctional appliances has been used to correct Class II and Class III skeletal malocclusion in a growing child. Face mask therapy with RME has been used as treatment choice to treat a patient with skeletal Class III malocclusion. Orthopedic correction in the early stage of life can eliminate the severity and further complex treatment modalities in the later stages of life. This case report describes the treatment of male child aged 12 years who had skeletal Class III malocclusion with maxillary deficiency. The treatment was done in two phases; orthopedic correction was done initially using RME Facemask followed by fixed orthodontic correction. There was overall improvement in the facial profile and occlusion of the patient post treatment.

Comparison of Changes in Intraoral Dynamic Space (Donders Space) with Myofunctional Therapy in Skeletal Class II Division 1 Malocclusion: An In Vivo Study.

To evaluate the changes in the intraoral dynamic space with myofunctional therapy in skeletal class II division 1 malocclusion using three-dimensional digital volume tomography (3D-DVT). The study type is observational and the duration of intervention was 3 years. Dental casts obtained from 20 samples of 11-14 years age-group were collected and 3D-DVT scans were performed prior to and after the myofunctional therapy. The parameters depicting the arch perimeter, arch width, arch length, arch shape, and arch volume on dental cast were used in the study using several linear and volumetric measurements. All parameters were compared before and after myofunctional therapy using t-test. The Intraoral volume before myofunctional therapy (T0) was 5.59 mL and after myofunctional therapy (T1), it was 7.22 mL. Significant changes were seen in intraoral volume, arch perimeter, arch length, and intercanine and intermolar arch width and the arch shape. Linear and volumetric measurements were increased after myofunctional therapy. Myofunctional appliances lead to an expansion in the anteroposterior and sagittal direction thus increasing the Donders space and leading to proper formation of dental arches and proper positioning of the teeth. Myofunctional therapy is an effective method of increasing arch width, length, and volume. This therapy can be used in routine practices in young children with constricted arch and improvement in facial esthetic.

Cognitive awareness of online-sold prefabricated myofunctional appliances disadvantages among Bandung residents: cross-sectional study

Cognitive awareness of online-sold prefabricated myofunctional appliances disadvantages among Bandung residents: cross-sectional study

Bilateral Condylar Fracture: A 10-Year Case Report Follow-Up after a Conservative Myofunctional Approach

Mandibular condylar fractures can be approached with invasive techniques, such as surgical repositioning and fixation of the fractured condyle, or with conservative techniques using myofunctional appliances. Recent publications recommend non-invasive or conservative approaches when treating mandibular condylar fractures, as they may produce more stable results and fewer consequences. However, to the knowledge of the authors, there is no long-term follow up publications of clinical cases treated with a conservative approach. This report presents a ten-year follow-up of a case report published two years ago by the same authors. In the previous report, the authors showed an eleven year-old girl treated with a myofunctional appliance due to a bilateral mandibular condylar fracture. The treatment produced a stable result over the following ten years with the patient not using any appliance after the myofunctional treatment was completed. The benefits of a conservative treatment, as well as the consequences of mandibular condylar fracture, such as a heart shaped mandibular condyle, are discussed here by the authors.

Efficient way for correction of sagittal problems with powerscope – A case report

In orthodontics, the most prevalent sagittal problem is Class II malocclusion, which affects one-third of the population. During active growth, myofunctional appliances are usually used to address sagittal discrepancies associated with the retruded mandible. Due to non-compliance with traditional myofunctional appliances, fixed functional appliances have been developed.Powerscope appliance is used to successfully manage the growing skeletal class II malocclusion for the correction of skeletal and dental parameters. The patient's profile dramatically showed improvement with the reduction in ANB angle by 4 degrees.

The influence of obstructive sleep apnea syndrome on orthodontic treatment decisions in children and adolescents. Part 1: OSA phenotypes, treatment temporality and reciprocal effects on growth

Pediatric OSAS is a complex condition, comprising a plurality of clinical signs, complicated by the phenomena of growth. Its etiology is dominated by the hypertrophy of lymphoid organs, but obesity and certain craniofacial and neuromuscular tone abnormalities also contribute. The authors summarize the interrelations between pediatric OSAS endotypes, phenotypes and orthodontic anomalies. They report clinical practice recommendations on the multidisciplinary management of pediatric OSAS and define the place and timing of orthodontics. There is an indication for treatment of pediatric OSAS for an OAHI greater than 5/h, regardless of comorbidity, as well as for symptomatic children, whose OAHI is between 1-5/h. The first line of treatment is adenotonsillectomy, but it does not always normalize the OAHI. Complementary treatments are often necessary: early orthodontics (rapid maxillary expansion, myofunctional appliances), oral reeducation, as well as the management of obesity and allergies. Careful watching, without treatment is possible for mild cases with few symptoms, as pediatric OSAS tends to resolve naturally with growth. The therapeutic approach is stratified, depending on the severity of OSAS and the child's age. In terms of orthodontic repercussions, obesity is associated with earlier maturation and some facial morphological differences, while oral hypotonia and nasal obstruction can alter facial growth, promoting mandibular hyperdivergence and maxillary deficiency. Orthodontists are in a privileged position for the detection, follow-up and certain treatments of OSAS.

Case report on pre-orthodontic trainer in a 9-year-old child with 12 months follow up

BACKGROUND: Pre-fabricated myofunctional appliances for early orthodontic therapy have been designed specifically for the care of children at the time of mixed dentition in growing adolescents with class II division 1 malocclusions. Sophisticated prefabricated removable functional appliances known as pre-orthodontic trainers have been shown to train the orofacial musculature, thus correcting malocclusions. CASE DESCRIPTION: This is a case report of 9-year-old boy diagnosed as Class II division 1 malocclusion with protruded upper anterior teeth, constricted upper arch, space loss in lower arch and Class 2 molar relation on side. Functional treatment approach was decided using pre orthodontic T4K trainer for 12 months. At the end of this phase of treatment, improvements have been evaluated with lateral cephalograms superimposition between T1 and T2. DISCUSSION: Class II orthopaedic treatment along with the use of functional appliances by early interception assist in addressing the concerns with soft tissues, muscles, mouth respiration, and bruxism. The pre orthodontic trainer allowed a good dento-skeletal result as it had a major effect on the masticatory muscles after 12 months application which helped in obtaining a good esthetic outcome for the patient. CONCLUSIONS: The use of prefabricated functional appliance in children can be an advantageous method for early treatment of class II malocclusions with functional patterns as these devices influences masticatory muscle which help in molding the facial tissues and a viable alternative to braces for treating malocclusions in children because it stimulates the development of the dental arches transversely to stop the progression of the malocclusion. Therefore, when a lack of transverse development is discovered at a young age, this appliance is an invaluable tool for enhancing dental arch development, interceptive management of malocclusion, and oral habits.