CASE REPORT / PRIKAZ IZ PRAKSE Serbian Dental Journal, vol. 60, No 2, 2013 93

UDC: 616.314.25/.26-085 DOI: 10.2298/SGS1302093A Dentofacial Changes after Treatment with Prefabricated Functional Appliance T4CII

Ema Aleksić1, Maja Lalić2, Jasmina Milić1, Mihajlo Gajić2, Zdenka Stojanović3 1Department of Orthodontics, Faculty of Stomatology Pančevo, University Business Academy Novi Sad, Pančevo, Serbia; 2Department of Paediatric Dentistry, Faculty of Stomatology Pančevo, University Business Academy Novi Sad, Pančevo, Serbia; 3Clinic of Dentistry, Military Medical Academy, Belgrade, Serbia

SUMMARY Introduction Functional maxillary orthodontics has a large number of different mobile devices with different effects on craniomandibular system and great capabilities in solving many orthodontic problems. The aim of this article was to show the effects of 9-month treatment of malocclusion class II, division 1 in a 14-year-old female patient using pre- fabricated functional appliance Trainer T4CII. Case Outline Skeletal distal relation, deep bite, increased overjet, narrowness and irregular position of upper and lower frontal teeth are indicated for orthodontic treatment with fixed appliance. After refusal of fixed appliance therapy, a female patient was proposed treatment with mobile orthodontic appliance. A pre-fabricated functional appliance Trainer T4CII was delivered to the patient. She was motivated and she was wearing appliance at night and 2-3 hours during the day. After 9 months of treatment there was a significant improvement in the position of upper and lower frontal teeth and reshaping of upper and lower dental arch, yet overbite and overjet were corrected. Conclusion Surprisingly good and fast improvement of all problems within class II, division 1 in a 14-year-old patient was achieved with prefabricated functional appliance Trainer T4CII. Keywords: Class II division 1;deep bite; myofunctional treatment; Trainer system

INTRODUCTION efficacy of the Trainer T4CII in the treatment of malocclu­ sion in permanent dentition [12, 13]. The influence of myofunctional habits on craniofacial The aim of the current study was to show the effects development and malocclusions has been reported in of the treatment of malocclusion Class II, division 1 in a numerous publications [1-4]. More recent studies have 14-year-old female patient using pre-fabricated functional shown that crowded teeth and jaw discrepancies are result appliance Trainer T4CII. of abnormal swallowing and breathing [5, 6]. Functional maxillary orthodontics (FMO) disposes with various removable appliances that produce different CASE REPORT effects on craniomandibular system (CMS). Some of them work by increasing masticatory muscles activity after pos­ In a female patient, age 14, Class II, division 1 malocclu­ itioning mandible forward (Monoblock and Bionator) sion (Figures 1a and 1b) with deep bite (8 mm) and in­ while others work on buccal area of mouth stimulating creased overjet (12 mm) was diagnosed (Figure 2). In transverse development of jaws and improving mandible central occlusion lower incisors were in contact with pal­ position (Fränkel’s Function Regulator) [7, 8, 9]. atal mucosa (Figure 3). From the medical history of the Appliances of the Trainer System have been developed patient it was found that she had adenoidectomy three to stimulate masticatory and facial muscles and re-edu­ years ago, when she was 11, and that she has never re­ cate the posture of tongue. They also have positive effects ceived orthodontic treatment. in mouth-breathing patients [10]. The effects of trainers The analysis of study models showed narrowness of are: physiological load of bones, growth stimulation and upper and lower jaw, increased arch height in the upper development of maxilla, mandible and dental arches, jaw and reduced arch height in the lower jaw. Narrowness and consequently better position and correct alignment and irregular position of upper and lower frontal teeth is of teeth [11]. Several studies have pointed out that the shown in Figure 4. Middle line of lower dental arch was Trainer T4K has been successfully used to treat Class II, moved to the right side (Figure 5). The analysis of lateral division 1 malocclusion and deep bite in early age (mixed cephalogram revealed skeletal distal relation (angle ANB = dentition). This paper is preliminary report of therapeutic 6 degrees), as a consequence of mandibular retrognatism

Address for correspondence: Ema ALEKSIĆ, Faculty of Stomatology Pančevo, Žarka Zrenjanina 179, 26000 Pančevo, Serbia; [email protected] 94 Aleksić E. et al. Dentofacial Changes after Treatment with Prefabricated Functional Appliance T4CII

a

Figure 4. Study models: narrowness and irregular position of upper and lower frontal teeth Sli­ka 4. Stu­dij­ski mo­de­li: uskost vi­li­ca i ne­pra­vi­lan po­lo­žaj gor­njih i do­njih pred­njih zu­ba

b

Figure 1. Female patient age 14 with diagnosed malocclusion Class II, division 1 (a – profile view – right side; b – profile view – left side) Sli­ka 1. Pa­ci­jent­ki­nja uz­ra­sta od 14 go­di­na sa di­jag­no­sti­ko­va­ nom ma­lo­klu­zi­jom II kla­se 1. ode­lje­nja (a – profil sa desne strane; b – profil sa leve strane) Figure 5. Study models: middle line of lower dental arch is moved to the right side Sli­ka 5. Stu­dij­ski mo­de­li: sred­nja li­ni­ja u do­njoj vi­li­ci po­me­re­na ude­sno

Figure 2. Deep bite (8 mm) and increased overjet (12 mm) a Sli­ka 2. Du­bok za­gri­žaj (8 mm) i dis­tal­ni za­gri­žaj (12 mm)

b

Figure 3. In central occlusion lower incisors are in contact with Figures 6. Pre-fabricated functional appliance Trainer T4CII palatal mucosa (a – front view; b – upper view) Sli­ka 3. U cen­tral­noj oklu­zi­ji do­nji se­ku­ti­ći su u kon­tak­tu sa slu­zo­ Sli­ke 6. Pre­fa­bri­ko­va­ni funk­ci­o­nal­ni apa­rat trej­ner T4CII ko­žom nep­ca (a – prednja strana; b – gornja strana) Stomatološki glasnik Srbije. 2013;60(2):93-98 95

an alternative treatment with pre-fabricated functional appliance Trainer T4CII was suggested. The patient used the appliance during night and 2-3 hours during the day for a period of 9 months (Figures 6a and 6b). After only 9 months of treatment there was a significant improve­ ment in the position of upper and lower frontal teeth and reshaping of upper and lower dental arch. Widths of upper and lower jaw were adjusted (Figures 7 and 8). Overbite was corrected to 2 mm, and overjet to 3 mm (Figure 9). The patient was very satisfied. She continued treatment with this appliance.

Figure 7. Upper dental arch after 8 months of treatment DISCUSSION Sli­ka 7. Gor­nja vi­li­ca po­sle osam me­se­ci te­ra­pi­je Orthodontic approach suggests that treatment or pre­ treatment of different malocclusions in mixed dentition is treated with different functional appliances whereas in permanent dentition the same malocclusion is usu­ ally treated with fixed appliance in order to achieve good alignment of teeth and improve jaw relationship [14]. Post-treatment retention is needed for several years after treatment completion. In this period it is expected that soft tissues and entire cranio-mandibular system (CMS) adapt to new position of teeth and jaws. Therefore, for long-term stability it is important to establish normal functions of cranio-mandibular system [15, 16]. Philosophy of the treatment with Trainer System is totally different: any malocclusion should be treated either by stimulating or inhibiting the activity of masticatory and/or facial muscles. Figure 8. Lower dental arch after 8 months of treatment That way jaws are stimulated and remodeled to allow bet­ Sli­ka 8. Do­nja vi­li­ca po­sle osam me­se­ci te­ra­pi­je ter teeth alignment [10]. It helps to correct and treat all functional problems associated with incorrect teeth pos­ itions in various malocclusions due to erroneous muscle force delivered on teeth [17]. Consequently, teeth tend to position better and to align correctly. Several clinical cases have confirmed that Trainer Sys­ tem appliances have been successfully used to treat many malocclusions in early age and mixed dentition [7, 18, 19]. The present case report showed that the Trainer T4CII may be useful in treating Class II, division 1 malocclu­ sion in later age (permanent dentition) similarly to the treatment of the same malocclusion in early age (mixed dentition) [13]. The results achieved in the present case report sug­ gest that T4CII used in permanent dentition can stimu­ late transversal development of dental arches, increase jaw Figure 9. Overbite and overjet corrected to 2 mm and 3 mm width, correct overbite and overjet and improve dental Sli­ka 9. Ver­ti­kal­ni i ho­ri­zon­tal­ni pre­klop ko­ri­go­va­ni na 2 mm, od­ aesthetics. no­sno 3 mm

REFERENCES (angle SNB = 74 degrees and angle SNA = 80 degrees), pro­ trusion of upper incisors (I/SpP = 62 degrees) and retrusion 1. Vargervik K. Morphologic evidence of muscle influence on the den- of lower incisors (i/MP = 92 degrees). The analysis also tal arch width. Am J Orthod. 1979; 76:21-8. showed posterior mandibular rotation and increased lower 2. Harradin NW, Kirschen RH. Lip and mentalis activity and its influ- ences on incisor position – a quantitative electromyographic stady. facial height. Br J Orthod. 1983; 10:114-27. These findings in 14 years old patient absolutely indi­ 3. Woodside DG, Linder-Aronson S, Lundstrom A, Mc William J. Man- cate orthodontic treatment with fixed appliance. Since the dibular and maxillar growth after changed mode of breathing. Am J patient refused fixed appliance treatment for 1.5-2 years, Orthod Dentofac Orthop. 1991; 100:1-18. 96 Aleksić E. et al. Dentofacial Changes after Treatment with Prefabricated Functional Appliance T4CII

4. Gross AM, Kellum GD, Michas C, Franz D, Foster M, Walker M, et al. 13. Usumez S, Uysal T, Sari Z, Basciftci FA, Karaman AI, Guray E. The Open-mouth posture and maxillary arch width in young children: a effects of early preorthodontic trainer treatment on class II, division three-year evaluation. Am J Orthod Dentofac Orthop. 1994; 106:635-40. 1 patients. Angle Orthod. 2004; 74:605-9. 5. Fricke B, Gebert HJ, Grabowski R, Hasund A, Serg HG. Nasal airway, 14. Proffit WR, Fields HW, Sarver MD. Contemporary Orthodontics. 4th lip competence and craniofacial morphology. Eur J Orthod. 1993; ed. Philadelphia, PA: Mosby Elsevier; 2007. 15:297-304. 15. Blake M, Bibbly K. Retention and stability: a review of the literature. 6. Flutter J. Horizontal growth: the key to facial beauty and optimal patient Am J Orthod Dentofacial Orthop. 1998; 114:299-306. health. Australasian Dental Practice. 2009; (7-8):146-50. 16. Graber TM, Vararsdall RL, Vig KWL, editors. Orthodontics: Current 7. Baccetti T, Franchi L, Toth LR, McNamara JA Jr. Treatment timing for Principle and Techniques. 4th ed. St. Louis: Mosby; 2005. Twin-block therapy. Am J Orthod Dentofac Orthop. 2000; 118:159-70. 17. Ramirez-Yanez GO, Farrell C. Soft tissue dysfunction: a missing clue 8. Faltin KJ, Faltin RM, Bacceti T, Franchi L, Ghiozzi B, McNamara JA Jr. when treating malocclusion. Int J Jaw Funct Orthop. 2005; 1:483-94. Long-term effectiveness and treatment timing for Bionator therapy. Angle Orthod. 2003; 73:221-30. 18. Ramirez-Yanez GO, Sidlauskas A, Junior E, Fluter J. Dimensional chan- 9. Owen AH 3rd. Morphologic changes in the transverse dimension ges in dental arches after treatment with a prefabricated functional using the Fränkel appliance. Am J Orthod. 1983; 83:200-17. appliance. J Clin Pediatr Dent. 2007; 31:279-83. 10. Myofunctional Research Co. Trainer SystemTM DVD, 2008. 19. Ramirez-Yanez GO, Jacira GA. A case study: Combining functional 11. Kanao A, Mashiko M, Kanao K. Application of T4K Trainer to “man- and fixed appliances to improve results in open bite treatment. The dibular retrusion syndrome”. J Clin Pediatr Dent. 2007; 12:45-58. Functional Orthodontist. 2007; 24:4-9. 12. Ramirez-Yanez GO, Faria P. Early treatment of a class II, division 2 malocclusion with the trainer for kids (T4K): a case report. J Clin Pediatr Dent. 2008; 32:325-9. Received: 12/02/2013 • Accepted: 26/04/2013 Stomatološki glasnik Srbije. 2013;60(2):93-98 97

Dentofacijalne promene nakon tretmana prefabrikovanim funkcionalnim aparatom T4CII

Ema Aleksić1, Maja Lalić2, Jasmina Milić1, Mihajlo Gajić2, Zdenka Stojanović3 1Klinika za ortopediju vilica, Stomatološki fakultet Pančevo, Univerzitet Privredna akademija Novi Sad, Pančevo, Srbija; 2Klinika za dečiju i preventivnu stomatologiju, Stomatološki fakultet Pančevo, Univerzitet Privredna akademija Novi Sad, Pančevo, Srbija; 3Vojnomedicinska akademija, Beograd, Srbija

KRATAK SADRŽAJ Uvod Funk­ci­o­nal­na mak­si­lar­na or­to­don­ci­ja ras­po­la­že ve­li­kim bro­jem raz­li­či­tih mo­bil­nih apa­ra­ta s raz­li­či­tim dej­stvom na kra­ni­o­man­ di­bu­lar­ni si­stem i ve­li­kim mo­guć­no­sti­ma u re­ša­va­nju broj­nih or­to­dont­skih pro­ble­ma. Cilj ra­da je da pri­ka­že efek­te de­ve­to­me­seč­nog le­če­nja če­tr­na­e­sto­go­di­šnje de­voj­či­ce sa ma­lo­klu­zi­jom II kla­se 1. ode­lje­nja pre­fa­bri­ko­va­nim funk­ci­o­nal­nim apa­ra­tom Tra­i­ner T4CII. Pri­kaz slu­ča­ja De­voj­či­ca sa ske­let­no-dis­tal­nim od­no­som, du­bo­kim za­gri­ža­jem, ve­li­kim ho­ri­zon­tal­nim pre­klo­pom, uskom vili­ ­com i ne­pra­vil­nim po­lo­ža­jem gor­njih i do­njih fron­tal­nih zu­ba ja­vi­la se na kli­ni­ku na­kon što je od­bi­la in­di­kova­ nu­ or­to­dont­sku te­rapi­ ­ju fik­snim apa­ra­tom. Raz­mo­tre­na je mo­guć­nost da se po­ku­ša le­če­nje ne­kim mo­bil­nim or­to­dont­skim apa­ra­tom. Od­lu­če­no je da se pri­me­ni pre­fa­bri­ko­va­ni funk­ci­o­nal­ni apa­rat Tra­i­ner T4CII, sa čim se pa­ci­jent­ki­nja sa­gla­si­la. Bi­la je ve­o­ma mo­ti­vi­sa­na, ta­ko da je no­ si­la apa­rat no­ću i dva-tri sa­ta u to­ku da­na. Po­sle de­vet me­se­ci le­če­nja do­šlo je do zna­čaj­nog po­bolj­ša­nja po­lo­ža­ja do­njih i gor­njih fron­tal­nih zu­ba, pre­o­bli­ko­va­nja gor­njeg i do­njeg zub­nog ni­za, du­bi­ne pre­klo­pa, kao i do sma­nje­nja in­ci­zal­nog ste­pe­ni­ka. Za­klju­čak Iz­ne­na­đu­ju­će do­bri i br­zi re­zul­ta­ti tret­ma­na svih pro­ble­ma u okvi­ru II kla­se 1. ode­lje­nja kod ove mla­de pa­ci­jent­ki­nje po­stig­nu­ti su ko­ri­šće­njem pre­fa­bri­ko­va­nog funk­ci­o­nal­nog apa­ra­ta Tra­i­ner T4CII. Ključ­ne re­či: II kla­sa 1. ode­lje­nje; du­bo­ki za­gri­žaj; mi­o­funk­ci­o­nal­ni tret­man; trej­ner (tra­i­ner) si­stem

UVOD da je de­voj­či­ca ima­la ope­ra­ci­ju ade­no­id­nih ve­ge­ta­ci­ja tri go­di­ne i da ni­ka­da ni­je bi­la or­to­dont­ski le­če­na. Uti­caj mi­o­funk­ci­o­nalnih­ na­vi­ka na raz­voj kar­ni­o­fa­ci­jalnog­ si­ Ana­li­za stu­dij­skih mo­de­la po­ka­za­la je te­skob­nost gor­njih i ste­ma i na­sta­nak ma­lo­klu­zi­ja pri­ka­zan je u ra­znim is­tra­ži­va­ do­njih zu­ba sa po­ve­ća­nom vi­si­nom lu­ka u gor­njoj vi­li­ci i sma­ nji­ma [1-4]. No­vi­ja is­tra­ži­va­nja po­ka­zu­ju da te­skob­nost zu­ba nje­nom vi­si­nom u do­njoj. Te­sko­ba i ne­pra­vi­lan po­lo­žaj gor­njih i vi­lič­ne dis­kre­pan­ci­je mo­gu bi­ti uzro­ko­va­ne na­či­nom gu­ta­nja i do­njih fron­tal­nih zu­ba pri­ka­za­ni su na sli­ci 4. Sre­di­na do­njeg i di­sa­nja [5, 6]. zub­nog ni­za po­me­re­na je bi­la u de­snu stra­nu (Sli­ka 5). Ana­li­za Funk­ci­o­nal­na mak­si­lar­na or­to­pe­di­ja ras­po­la­že raz­li­či­tim pro­fil­nog te­le­rend­gen­skog snim­ka po­ka­za­la je ske­let­no-dis­ta­ po­kret­nim apa­ra­ti­ma ko­ji ima­ju raz­li­či­to dej­stvo na kra­ni­o­ lan od­nos (ugao ANB bio je 6°) kao po­sle­di­cu man­di­bu­lar­nog man­di­bu­lar­ni si­stem. Ne­ki od njih ra­de na prin­ci­pu po­ve­ća­nja re­trog­na­ti­zma (ugao SNB bio je 74°, a ugao SNA 80°), pro­tru­ mu­sku­lar­ne ak­tiv­no­sti ma­sti­ka­tor­nih mi­ši­ća po­zi­ci­o­ni­ra­njem zi­je gor­njih se­ku­ti­ća (I/SpP=62°) i re­tru­zi­je do­njih se­ku­ti­ća man­di­bu­le an­te­ri­or­no (Mo­no­blok i Bi­o­na­tor), a dru­gi na prin­ (i/MP=92°). Ana­li­za je ta­ko­đe po­ka­za­la zad­nju ro­ta­ci­ju man­di­ ci­pu sti­mu­li­sa­nja tran­sfer­zal­nog raz­vo­ja mak­si­le, dok se po­lo­žaj bu­le i po­ve­ća­nu do­nju vi­si­nu li­ca. man­di­bu­le po­bolj­ša­va (Fren­ke­lov re­gu­la­tor funk­ci­je) [7, 8, 9]. Ovaj na­laz kod če­tr­na­e­sto­go­di­šnje de­voj­či­ce pot­pu­no je uka­ Apa­ra­ti si­ste­ma trej­ner (engl. tra­i­ner) su raz­vi­je­ni da sti­mu­ zi­vao na po­tre­bu or­to­dont­skog le­če­nja fik­snim apa­ra­tom. Ka­ko li­šu ma­sti­ka­tor­ne i fa­ci­jal­ne mi­ši­će i re­e­du­ku­ju po­lo­žaj je­zi­ka. je pa­ci­jent­ki­nja od­bi­la da no­si fik­sni apa­rat u na­red­nih go­di­nu Ta­ko­đe ima­ju po­zi­ti­van efe­kat kod oso­ba ko­je di­šu kroz usta i po da­na do dve go­di­ne, po­ku­ša­lo se s le­če­njem pri­me­nom [10]. Efek­ti ko­je pro­iz­vo­de trej­ne­ri su: fi­zi­o­lo­ško op­te­re­će­nje pre­fa­bri­ko­va­nog funk­ci­o­nal­nog apa­ra­ta T4CII. Bi­la je ve­o­ma ko­sti, sti­mu­la­ci­ja ra­sta i raz­vo­ja mak­si­le, man­di­bu­le i zub­nih lu­ mo­ti­vi­sa­na da no­si apa­rat no­ću i dva-tri sa­ta u to­ku da­na u ko­va, či­me zu­bi te­že da se bo­lje po­zi­ci­o­ni­ra­ju i pra­vil­no po­sta­ve na­red­nih de­vet mese­ ­ci (Sli­ke 6a i 6b). Po­sle tog pe­ri­o­da do­šlo [11]. Ne­ko­li­ko is­tra­ži­va­nja je is­ta­klo da se trej­ner T4K uspe­šno je do zna­čaj­nog na­pret­ka u po­lo­ža­ju gor­njih i do­njih fron­tal­ ko­ri­sti za le­če­nje ma­lo­klu­zi­je II kla­se 1. ode­lje­nja i du­bok za­ nih zu­ba, kao i u pre­o­bli­ko­va­nju gor­njeg i do­njeg zub­nog lu­ka. gri­žaj u ra­nom uzra­ ­stu (u me­šo­vi­toj den­ti­ci­ji). Pri­kaz ko­ji sle­di Ši­ri­ne gor­nje i do­nje vi­li­ce su pri­la­go­đe­ne (Sli­ke 7 i 8). Du­bi­na pred­sta­vlja pre­li­mi­nar­ni iz­ve­štaj o kli­nič­koj pro­ce­ni te­ra­pij­skog pre­klo­pa je is­pra­vlje­na na 2 mm, a ho­ri­zon­tal­na ste­pe­ni­ca na 3 efek­ta apa­ra­ta T4CII kod ma­lo­klu­zi­je u stal­noj den­ti­ci­ji [12, 13]. mm (Sli­ka 9). Pa­ci­jent­ki­nja je bi­la ve­o­ma za­do­volj­na po­stig­nu­ Cilj ra­da je bio da pri­ka­že dej­stvo funk­ci­o­nal­nog apa­ra­ta tim re­zul­ta­tom, te i da­lje no­si apa­rat. T4CII u le­če­nju ma­lo­klu­zija­ II kla­se kod če­tr­na­e­sto­go­di­šnje pa­ci­jent­ki­nje. DISKUSIJA

PRIKAZ SLUČAJA U or­to­dont­skom pri­stu­pu uobi­ča­je­no je da se le­če­nje ili pred­ tret­man raz­li­či­tih ma­lo­klu­zi­ja u me­šo­vi­toj den­ti­ci­ji re­a­li­zu­je Kod de­voj­či­ce uz­ra­sta od 14 go­di­na di­jag­no­sti­ko­va­na je ma­ raz­li­či­tim apa­ra­ti­ma, ali u stal­noj den­ti­ci­ji za iste ma­lo­klu­zi­je lo­klu­zi­ja II kla­se 1. ode­lje­nja (Sli­ke 1a i 1b) sa du­bo­kim pre­ naj­če­šće se pri­me­nju­je fik­sni apa­rat, ka­ko bi se obez­be­di­lo pra­ klo­pom (8 mm) i ve­li­kim ho­ri­zon­tal­nim pre­klo­pom (12 mm) vil­ni­je po­sta­vlja­nje zu­ba i po­bolj­ša­nje me­đu­vi­lič­nih od­no­sa [14]. (Sli­ka 2). U cen­tral­noj okluzi­ ­ji do­nji se­ku­ti­ći su bi­li u kon­tak­tu Po­sle te­ra­pi­je fik­snim apa­ra­tom ne­ko­li­ko go­di­na je neo­p­hod­na sa pa­la­ti­nal­nom mu­ko­zom (Sli­ka 3). Anam­ne­zom je utvr­đe­no pri­me­na re­ti­ne­ra. U ovom pe­ri­o­du se oče­ku­je da se me­ka tki­va 98 Aleksić E. et al. Dentofacial Changes after Treatment with Prefabricated Functional Appliance T4CII

i ceo kra­ni­o­man­di­bu­lar­ni si­stem adap­ti­ra­ju na no­vu po­zi­ci­ju Ne­ko­li­ko kli­nič­kih slu­ča­je­va je po­ka­za­lo da su apa­ra­ti si­ste­ zu­ba i vi­li­ca. Zbog to­ga je za du­go­roč­nu sta­bil­nost va­žno us­po­ ma trej­ner uspe­šno ko­ri­šće­ni u le­če­nju mno­gih ma­lo­klu­zi­ja u sta­vi­ti nor­mal­nu funk­ci­ju u kra­ni­o­man­di­bu­lar­nom si­ste­mu [15, ra­nom uz­ra­stu i me­šo­vi­toj den­ti­ci­ji [7, 18, 19]. Re­zul­ta­ti u ovom 16]. Fi­lo­zo­fi­ja or­to­dont­skog le­če­nja pri­me­nom si­ste­ma trej­ner je slu­ča­ju po­ka­zu­ju da trejner T4CII mo­že bi­ti ko­ri­stan za le­če­nje pot­pu­no dru­ga­či­ja, a osnov­na su­šti­na je da u le­če­nju ma­lo­klu­ ma­lo­klu­zi­je II kla­se 1. ode­lje­nja i u ka­sni­jim go­di­na­ma (stal­na zi­ja tre­ba pod­sti­ca­ti ili spre­ča­va­ti ak­tiv­no­sti ma­sti­ka­tor­nih i/ili den­ti­ci­ja), slič­no kao i za II kla­su 1. ode­lje­nja u ra­nom uz­ra­stu mi­ši­ća li­ca. Na taj na­čin se sti­mu­li­šu adap­ta­ci­ja i re­mo­de­lo­va­nje (me­šo­vi­ta den­ti­ci­ja) [13]. vi­li­ca i do­zvo­lja­va bo­lje po­sta­vlja­nje zu­ba [10]. To po­ma­že da se Do­bi­je­ni na­laz kod pri­ka­za­ne de­voj­či­ce uka­zu­je na to da is­pra­ve i re­še svi funk­ci­o­nal­ni pro­ble­mi ko­ji na­sta­ju kao po­sle­di­ T4CII, ko­ri­šćen u stal­noj den­ti­ci­ji, mo­že da pod­stak­ne tran­ ca ne­pra­vil­nog po­lo­ža­ja zu­ba u raz­li­či­tim ma­lo­klu­zi­ja­ma i zbog sfer­zal­ni raz­voj zub­nih lu­ko­va, po­ve­ća ši­ri­nu vi­li­ca, po­pra­vi ne­a­de­kvat­ne si­le na zu­be od stra­ne mi­ši­ća [17]. Shod­no to­me, ver­ti­kal­ni i ho­ri­zon­tal­ni pre­klop i uspe­šno po­bolj­ša estet­ski zu­bi te­že da se bo­lje po­zi­ci­o­ni­ra­ju i is­prav­no po­sta­ve. iz­gled pa­ci­jen­ta.