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Dentofacial Changes After Treatment with Prefabricated Functional Appliance T4CII

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Dentofacial Changes After Treatment with Prefabricated Functional Appliance T4CII 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 [1­4]. More recent studies have 14­year­old female patient using pre­fabricated 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 re­edu­ 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 mouth­breathing 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 Sli ka 4. Stu dij ski mo de li: uskost vi li ca i ne pra vi lan po lo žaj gor njih i do njih pred njih zu ba b Figure 1. Female patient age 14 with diagnosed malocclusion Class II, division 1 (a – profile view – right side; b – profile view – left side) Sli ka 1. Pa ci jent ki nja uz ra sta od 14 go di na sa di jag no sti ko va- nom ma lo klu zi jom II kla se 1. ode lje nja (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 Sli ka 5. Stu dij ski mo de li: sred nja li ni ja u do njoj vi li ci po me re na ude sno Figure 2. Deep bite (8 mm) and increased overjet (12 mm) a Sli ka 2. Du bok za gri žaj (8 mm) i dis tal ni za gri žaj (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) Sli ka 3. U cen tral noj oklu zi ji do nji se ku ti ći su u kon tak tu sa slu zo- Sli ke 6. Pre fa bri ko va ni funk ci o nal ni apa rat trej ner T4CII ko žom nep ca (a – prednja strana; b – gornja strana) Stomatološki glasnik Srbije. 2013;60(2):93-98 95 an alternative treatment with pre­fabricated functional appliance Trainer T4CII was suggested. The patient used the appliance during night and 2­3 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 Sli ka 7. Gor nja vi li ca po sle osam me se ci te ra pi je 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]. Post­treatment retention is needed for several years after treatment completion. In this period it is expected that soft tissues and entire cranio­mandibular system (CMS) adapt to new position of teeth and jaws. Therefore, for long­term stability it is important to establish normal functions of cranio­mandibular 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 Sli ka 8. Do nja vi li ca po sle osam me se ci te ra pi je 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 Sli ka 9. Ver ti kal ni i ho ri zon tal ni pre klop ko ri go va ni na 2 mm, od- aesthetics. no sno 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 1.5­2 years, Orthod Dentofac Orthop.
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