Palatal Crib Research Articles

Orthodontic treatment of children with anterior open bite and posterior crossbite: An analysis of the stomatognathic system.

Dental malocclusions are deviations from normalities due to the inadequate growth and development of the dental arch which provides functional changes to the stomatognathic system. The aim of this longitudinal study was to evaluate the electromyographic activity (EMG) the masseter and temporalis muscles, strength of the orofacial tissues and occlusal force of children with anterior open bite (n=15) and posterior crossbite (n=20), 7 days after the removal of the orthodontic apparatus. A fixed horizontal palatal crib was used in the treatment of anterior open bite and the fixed appliances Hyrax or MacNamara was used in the treatment of posterior crossbite. EMG of the masticatory muscles was recorded using an electromyograph with wireless sensors during mandibular tasks. Habitual chewing was assessed using the integral of the linear envelope of the electromyographic signal in the masticatory cycles. The strength of the tongue and facial muscles was measured using the Iowa Oral Pressure Instrument. T-Scan was used to analyze the force of occlusal contact. Molar bite force was measured by digital dynamometer. Significant differences (p<0.05) were found in the EMG data of the masseter and temporalis muscles in the static and dynamic mandibular tasks. There were no significant difference in strength of orofacial tissues, occlusal contact force and molar bite force 7 days after the removal of the orthodontic apparatus. The results of this study suggest that the orthodontic treatment of anterior open bite and posterior crossbite in children promoted functional alteration in the electromyographic activity of masseter and temporalis muscles.

Class II and anterior open bite malocclusion treated with mini-implants, intermaxillary elastics, speech therapy, and retained with a night-wear palatal crib wraparound

The teeth position in anterior open bite malocclusion depends on a balance of pressure between the tongue and lips and the treatment planning should include such variables. The objective of this study was to report an orthodontic case of an adult with maxillary protrusion and anterior open bite treated with skeletal anchorage and intermaxillary elastics. The patient presented a Class II malocclusion with anterior open bite, without a history of non-nutritive habits, and mandibular missing teeth at 54 years old. Mini-implants were inserted in the maxillary molars region to produce distal movement of the maxillary dentition while controlling molar extrusion, and in the mandibular anterior region on the left side to produce mesial movement of posterior teeth. Up and down intermaxillary elastics were worn in the area of the incisors to treat the open bite together with Class II intermaxillary elastics. Cleats were bonded in the lingual surface of the anterior teeth as spurs to the tongue posture. However, the best result on the anterior open bite treatment was coincident with the speech therapy. Normal relationships between the maxillary and mandibular occlusal plane of cusps, correct anterior overbite, and adequate proximal relationships were obtained at the end of treatment. The retention modality to the maxillary arch was daily wear of a removable standard wraparound and a night-time wraparound with the palatal crib. The new technology allows for more effective treatment in adults and speech therapy was helpful to achieve balanced pressure between the tongue and lips.

Use of a Posterior Bite Block Modified with TPA and Palatal Crib for Treating Open Bite in Growing Individual: A Case Report

Background: The aim of this paper is to illustrate the use of a Posterior bite block modified with TPA and Palatal crib to obtain the vertical control of maxillary molars, restrict tongue pressure as well as Intruding posterior molars thereby auto rotating mandible. Case Report: Use of posterior bite block modified with TPA and Palatal crib for correcting Anterior Open bite in growing individual is illustrated. Patient was successfully treated, and the open bite was fully corrected thanks to molar intrusion, following counter clockwise rotation of the mandible and tongue correction. Finishing of alignment was performed in phase II of the treatment with conventional appliances. Conclusion: Posterior bite block modified with TPA and Palatal crib proved to be effective in controlling the vertical position of maxillary molars promoting the counter-clockwise rotation of the mandible and stimulating a different tongue posture.

Use of a Posterior Bite Block Modified with TPA and Palatal Crib for Treating Openbite in Growing Individual: A Case Report

Use of a Posterior Bite Block Modified with TPA and Palatal Crib for Treating Openbite in Growing Individual: A Case Report

Influence of rapid maxillary expansion in the stability of anterior open bite treatment.

This study aimed to compare the stability of anterior open bite (AOB) in patients treated with and without rapid maxillary expansion (RME) before fixed palatal crib (PC) therapy in the mixed dentition. Expansion/palatal crib group (EPC) was comprised of 25 patients (10 male, 15 female, mean initial age of 7.8years) with AOB treated with RME before PC therapy. Palatal crib group (PC) included 25 patients with AOB (10 male, 15 female, mean initial age of 8.0years) treated only with PC therapy. Lateral cephalograms were analyzed at pre-treatment (T0), after PC therapy (T1), and 3years after PC removal (T2) in both groups. AOB relapse was considered when a negative overbite was observed at T2. Intergroup comparisons of interphase changes were performed using t and Mann-Whitney tests (p < 0.05). Treatment and post-treatment alterations showed similar changes in both groups for all cephalometric variables. Overall changes from T0 to T2 were similar between the groups except for the maxillary incisors that tipped lingually in PC group (1.PP = - 3.37°) and labially in EPC group (1.PP = 1.76°). The frequency of AOB relapse was 8% and 4% in the EPC and PC groups, respectively. Treatment time in the EPC group (9.7months) was shorter (p = 0.024) when compared to the PC group (11.0months). In the mixed dentition, stability of AOB treated with RME before fixed PC therapy was similar to PC therapy alone. However, treatment time with fixed PC was slightly shorter in the group treated with RME. This study aims to understand if RME performed previously to fixed palatal crib contributes to the index of stability of AOB treatment in the mixed dentition.

Functional orthopedic treatment for anterior open bite in children. Asystematic review of randomized clinical trials.

This systematic review aimed to assess the effects of orthopedic functional appliances for anterior open bite (AOB) in primary or mixed dentition children. A search for randomized controlled trials (RCT) was conducted in November 2020 in electronic databases with no data or language restrictions. Primary outcomes were skeletal cephalometric variables and adverse events. We used the Cochrane risk-of-bias tool to assess methodological quality and the GRADE approach to assess the certainty of the evidence. We identified five RCTs (220 participants). Very low certainty evidence showed an improvement in overbite (mean difference [MD] 3.60; 95% confidence interval [CI] 2.63-4.57) and in the angulation of the upper incisors to the palatal plane (MD 3.70; 95% CI 0.85-6.55) with Frankel's functional regulator, compared to no treatment. There was no difference in the measured cephalometric variables when comparing removable palatal crib to fixed palatal crib, bonded spurs, and chin cup. When comparing removable versus magnetic bite blocks, abeneficial effect was observed in overbite, overjet, skeletal anteroposterior angular measurements, and skeletal vertical linear measures in the magnetic group. No adverse events were reported. There was insufficient evidence to infer the effects of these treatments for AOB, and high-quality RCTs are needed to increase the estimated effects. CRD42020175634, prospectively registered (05July 2020).

Dental arch changes after anterior open bite treatment in the mixed dentition produced by miniscrew-supported palatal crib vs conventional fixed palatal crib.

To evaluate the dental arch changes produced by the miniscrew-supported palatal crib (MSPC) and the conventional fixed palatal crib (CFPC) after the treatment of patients with anterior open bite (AOB) attributed to the tongue-thrusting habit in the mixed dentition stage. A total of 26 children aged 8 to 11 years with an AOB were randomly distributed into two equal groups; the MSPC group was treated using a palatal crib supported by two miniscrews inserted paramedially, whereas the CFPC group was treated using a conventional fixed palatal crib soldered to bands. Digital models were obtained pretreatment and after a follow-up duration of 9 months. The MSPC group included 12 participants (9 girls and 3 boys; mean age, 9.4 ± 0.75 years), and the CFPC group included 12 participants (10 girls and 2 boys; mean age, 9.0 ± 0.73 years). The amount of AOB closure was similar in both groups: 3.97 ± 1.44 mm in the MSPC group and 3.97 ± 0.89 mm in the CFPC group. There was significant mesial movement of the maxillary first molar in the CFPC (-1.42 ± 0.99 mm) compared with the MSPC group (-0.53 ± 0.32 mm). Both appliances resulted in similar improvement in the amount of AOB closure. There was significantly more mesial movement of the maxillary first molars in the CFPC group compared with the MSPC group.

Multidisciplinary approach in the anterior open bite using a McNamara expander with palatal crib during mixed dentition stage: A case report

Open bite can be defined as an absence of occlusion, most frequently located in the anterior region of dental arches and its etiology is multifactorial. We present a clinical case of an 8 years and 10 months child presenting an anterior open bite (AOB) with transverse maxillary deficiency caused by tongue thrust during mixed dentition. The malocclusion was corrected by means of a McNamara expander with a palatal crib jointly with the association of speech therapy for tongue repositioning, and otolaryngology to treat adenoid hypertrophy due to its correlation with AOB. The multidisciplinary approach was effective in correcting the malocclusion with stable results after 2 years post-treatment.

Assessment of oral health literacy of principal caregivers and its association with dental caries in Mexican disabled pediatric patients

Open bite can be defined as an absence of occlusion, most frequently located in the anterior region of dental arches and its etiology is multifactorial. We present a clinical case of an 8 years and 10 months child presenting an anterior open bite (AOB) with transverse maxillary deficiency caused by tongue thrust during mixed dentition. The malocclusion was corrected by means of a McNamara expander with a palatal crib jointly with the association of speech therapy for tongue repositioning, and otolaryngology to treat adenoid hypertrophy due to its correlation with AOB. The multidisciplinary approach was effective in correcting the malocclusion with stable results after 2 years post-treatment.

Stability of early anterior open bite treatment: a 2-year follow-up randomized clinical trial.

This 2-year-follow up study compared and evaluated the stability of early anterior open bite (AOB) treatment based on different appliances. Children from 7 to 10 years with Angle Class I, AOB larger than 1.0 mm and fully erupted maxillary and mandibular permanent central incisors were eligible. The initial sample was 99 patients distributed, by simple randomization, into four groups: BS (bonded spurs), CC (chincup), FPC (fixed palatal crib) and RPC (removable palatal crib). Cephalometric analysis was performed at baseline (T1), final (T2) and 2-year post-treatment (T3) by taking the overbite measurements as the main outcome. Blinding was possible to cephalometric analysis. At T3, with dropouts, there were 63 individuals, being BS (n=15; overbite 0.19 mm; 11.54 years; 10 female (F)/5 male (M)); CC (n=11; overbite -0.19 mm; 11.41 years; 8 F/3 M); FPC (n=21; overbite 1.23 mm; 11.44 years; 15 F/6 M) and; RPC (n=16; overbite 0.73 mm; 11.67 years; 6 F/10 M). Changes in dentoskeletal variables and breaking deleterious oral habits during the follow up were statically analyzed with p<.05. Mandibular skeletal linear measurements and vertical dental components have gradually increased with age, manly at pubertal growth spurt and at the establishment of permanent dentition after treatment. Incisor teeth extrusion had impact on AOB correction and stability in 4 groups, which recorded a 1.15 mm-improvement of overbite after treatment (T3-T2). The experimental appliances were effective with stable results, being FPC the device recorded the highest AOB correction and the lowest patient withdrawal rate.

Clinical complications during early treatment of anterior open bite.

The object of this study was to compare the clinical complications of 4 different appliances used in the early treatment of anterior open bite (AOB), and to test the null hypothesis that there is no difference in the number of complications among the appliances. Records from 99 Class I malocclusion patients with AOB treated using bonded spurs, BS, n = 25; chin cup, CC, n = 25; fixed palatal crib, FPC, n = 25; and removable palatal crib, RPC, n = 24) were examined. The total number and frequency of clinical complications that occurred over 12 months were described and compared by using chi-square and Kruskal-Wallis tests (Dunn's post-test) (α = 5%, CI = 95%). The incidence of clinical complications was 66.7%, comprising: breakage, bond failure, maladjustment, allergy, soft-tissue lesion, loss of removable appliance and abandonment. Eighteen patients gave up treatment; this occurred more frequently in the groups with removable appliances. Regarding the total number of complications per patient, Group BS exhibited a significantly higher number than the other groups (p < 0.0001). A low frequency of complications (1 to 3) was found in the groups, except for Group BS, in which 8% of the patients presented moderate frequency (4 to 6). In terms of appliance types (fixed or removable), there was no difference in the incidence of complications (p > 0.094). The null hypothesis was rejected, since the BS group exhibited the highest total number and frequency of complications. There was no difference between fixed and removable appliances in terms of incidence of clinical complications, although more patients using removable appliances abandoned their treatment.

Treating the tongue thrusting: A case report

Presence of an infantile swallow during childhood and adolescence often leads to tongue thrusting which clinically presents a picture of an anterior open bite with protruted of anterior tooth segment. Tongue thrusting habit is the primary etiological factor in the development of an anterior open bite. Management of such abnormal habit includes removal of the underlying etiology, retraining exercises along with the support of mechanical restrictive orthodontic appliances. Palatal crib or palatal spurs are the most commonly used habit-breaking appliances. This case report discusses a case with anterior open bite caused due to tongue thrusting with dental proclination and spacing which was treated by a fixed tongue appliance in the form of a palatal crib for three months, which was followed up regularly in subsequent months.

Treating anterior open bite with a fixed palatal crib in children aged 8 to 10 years probably results in an important improvement in oral health–related quality of life

Treating anterior open bite with a fixed palatal crib in children aged 8 to 10 years probably results in an important improvement in oral health–related quality of life

Correction of Anterior Open Bite Malocclusion with the Association of Removable Palatal Crib and Chincup

AbstractAnterior open bite affects the child population by approximately 20%, with great aesthetic-functional impairment due to dental-skeletal changes, which may involve the presence of posterior crossbite. The objective was to present the anterior open bite correction associated with posterior crossbite with the use of a removable palatal crib. Patient during the mixed dentition phase presented an anterior open bite caused by a pacifier sucking habit and secondary lingual interposition. The treatment protocol consisted of the use of removable expander with palatal crib and nocturnal use of the chincup. The anterior open bite was corrected, and the best transverse relation of the arches was obtained. The precocious treatment using the palatal crib associated to the chincup allows to achieve favorable results in the resolution of the anterior open bite. Keywords: Open Bite. Malocclusion. Orthodontics, Interceptive. ResumoA mordida aberta anterior acomete a população infantil em aproximadamente 20%, com grande comprometimento estético-funcional em decorrência das alterações dentoesqueléticas, podendo envolver a presença de mordida cruzada posterior. O objetivo do estudo foi apresentar a correção da mordida aberta anterior associada à mordida cruzada posterior com a utilização de grade palatina removível. Paciente em fase de dentadura mista, apresentava mordida aberta anterior ocasionada por um hábito de sucção de chupeta e interposição lingual secundária. O protocolo de tratamento consistiu na utilização de expansor removível com grade palatina e uso noturno da mentoneira. A mordida aberta anterior foi corrigida e melhor relação transversal dos arcos foi obtida. O tratamento precoce utilizando grade palatina associada à mentoneira permite alcançar resultados favoráveis na resolução da mordida aberta anterior. Palavras-chave: Mordida Aberta. Má Oclusão. Ortodontia Interceptora.

Oral health-related quality of life of children before, during, and after anterior open bite correction: A single-blinded randomized controlled trial.

One of the goals of malocclusion treatment is to improve the oral health-related quality of life (OHRQoL) of patients. The aim of this trial was to assess the OHRQoL of children before, during, and after anterior open bite (AOB) correction, compared with nontreated children, in a 2-arm parallel single-blind randomized controlled trial. Eighty children with AOB aged 8-10years were randomly assigned to 2 groups (n=40 each): a group treated with the use of fixed palatal crib (FPC; TG) and a control group (nontreated; CG). Randomization was performed with the use of BioEstat software. The outcome (OHRQoL) was assessed with the use of the validated Brazilian Portuguese version of the Child Perceptions Questionnaire (CPQ8-10) applied before (baseline, phase 1), 3months after FPC placement (phase 2), and 1month after FPC removal (phase 3) in the TG. In the CG, CPQ8-10 was applied at baseline (phase 1), 3months (phase 2), and 12months (phase 3). Data were analyzed by means of a blinded statistic with the use of Friedman, Wilcoxon, and Mann-Whitney tests (α=0.05). All participants finished the RCT, and demographic characteristics were similar between groups. In phase 1, the TG had lower scores for the "social well-being" domain (P=0.02). In phase 2, the CG had higher scores than the TG for the "emotional well-being" and "social well-being" domains, but the opposite was observed for "oral symptoms" and "functional limitations" (P<0.001). In phase 3, the TG showed a lower impact on OHRQoL than the CG in all domains and in the overall score (P<0.001). In the 3 phases, the CG showed progressive increase (mean scores 70.37, 74.70, and 84.22, respectively; P<0.001) and the TG a decrease (mean scores 70.20, 70.80, and 6.05, respectively; P<0.001) in overall scores. The increase of scores in the CG was considered to represent a serious harm. Correction of AOB had a positive impact and failure to correct it had a negative impact on the OHRQoL of children. This trial was not registered. The protocol was not published before trial commencement.

Three-dimensional evaluation of soft tissue changes after fixed palatal crib application in anterior open-bite cases

Three-dimensional evaluation of soft tissue changes after fixed palatal crib application in anterior open-bite cases

Orthopedic and orthodontic treatment in a class 2 division 1 malocclusion for thumb sucking habit

In the treatment of a malocclusion class II division 1 to designate a specific treatment we have to take notice the age of the patient to consider a redirection of the maxilar complex also the use of appliances for nocive habits like thumb sucking. In this paper presents the case of a 9-year-old patient, with malocclusion II division 1, treated with headgear and a palatal crib.. Skeletal, facial and dental changes were observed.

Dentoalveolar effects produced by different appliances on early treatment of anterior open bite: A randomized clinical trial.

To compare different appliances for early anterior open bite (AOB) correction. This was a parallel, randomized clinical trial. A prospective sample of patients with AOB was recruited consecutively. Eligibility criteria included angle class I malocclusion with AOB equal to or greater than 1 mm. Participants were allocated by simple randomization to 4 groups: bonded spurs, chin cup, fixed palatal crib, and removable palatal crib. Dentoalveolar changes among the groups were assessed by blinded observers by comparing lateral cephalograms taken before (T1) and 12 months after treatment (T2; analysis of variance followed by Tukey test). Of the measurements, 30% were reassessed for reliability (intraclass correlation coefficient and Bland-Altman agreement test; α = 5%; 95% confidence interval). A total of 99 patients with a mean AOB of 3.7 mm (mean age 8.4 ± 0.8 years, both genders) were recruited. Dropouts occurred in all the groups, yielding a final sample size of 81 analyzed individuals. Intergroup comparisons of differences (T2-T1) showed significant differences for the incisor positioning variables (1.1, 1-PP, 6-PP, IMPA, 1.NB and 1-GoMe). However, there was no significant difference in AOB reduction among the groups, with an average correction of 3.1 mm. All of the tested devices promoted dental changes, especially in the anterior region, and contributed to AOB reduction during the study period. However, fixed palatal crib demonstrated greater impact on the positioning of the incisors.

VARIATION OF FIXED TONGUE CRIB FOR CORRECTING TONGUE THRUSTING HABIT

Background: Tongue thrusting is a behavior pattern in which the tongue protrudes through the anterior incisors and pushes the anterior teeth at rest position, during speech or swallowing. This bad habit causes malocclusion, but removable or fixed tongue crib appliance can be used to eliminate it. Purpose: To know various kinds of fixed tongue crib that can be used to overcome tongue thrust habit. Review: Habit is a repeated behavior pattern in the normal development stage. Tongue thrust makes oral muscle imbalance which eventually resulted in malocclusions such as incisor protruded and open bite. Several efforts can be done to overcome this habit including speech therapy, myofunctional therapy, tongue exercise and tongue crib orthodontic appliance usage. Tongue crib is used to returns the tongue to the normal position. Various forms of tongue crib are almost the same in the way they are made by soldering the crib to the maxillary first molar band. Conclusion: Tongue thrust habit can be corrected with fixed or removable tongue crib appliances such as hybrid habit correcting appliance, tongue crib with cold cured acrylic tongue shield, fixed palatal crib with transpalatal arch, fixed tongue loops, tongue fence, and upper hay rake.

Orthodontic Treatment Timing and Modalities in Anterior Open Bite: Case Series Study.

Objective:The purpose of this study was to present early and adult cases of anterior open bite that were treated efficiently using different treatment approaches and mechanics.Materials and Methods:Five patients of different age groups (from 7 to 27 years), suffering from a clear Anterior open bite deformity, were properly diagnosed and relevant treatment modality for each was selected.Results:Positive overbite was efficiently achieved for all patients.Conclusion:Patient compliance is a key factor in using removable habit breakers. However, fixed palatal crib gave the same results but in shorter time. Anterior open bite of skeletal components should be thoroughly evaluated before selecting camouflage or orthognathic surgery treatment modality.