A SINGLE APPLIANCE FOR THE CORRECTION OF

DIGIT-SUCKING, TONGUE-THRUST, AND POSTERIOR

CROSS BITE

Gajanan V. Kulkarni and D. Lau,

PEDIATRIC DENTISTRY, V 32, NO 1 JAN - FEB 10

Presented by:
Dr. Alok Avinash

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CONTENTS
 Introduction
 Appliance design

 Placement and clinical management

 Discussion

 References with other articles

 Conclusion

 Referencers

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INTRODUCTION
 Habits
 Definition

 Classification

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 Active sucking and pacifier habits in children frequently result
in changes to the orofacial structures and occlusion.
(1) Anterior open bite
(2) Anterior displacement of the maxilla
(3) Proclination of the upper incisors
(4) Unilateral or bilateral posterior crossbite
(5) Tongue thrusting during swallowing

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 Clinical management of sucking habits and the resulting
dentofacial changes, however, often requires multiple
appliances to correct.
 This can lead to increased treatment time and costs.

 For example, the use of a crib is effective at correcting sucking

habits but cannot effectively correct posterior crossbites.
 Additional appliances, such as the quad-helix, are necessary to
correct the posterior cross­bite, but alone they cannot prevent
the sucking habit or tongue thrusting.

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 Thus, combination or single appliances have been
implemented to simultaneously correct multiple dental
problems that frequently accompany non-nutritive
sucking habits.

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 This leads to introduce a single appliance combining a Teflon
roller, a slow palatal expander, and a tongue crib appliance that
is designed to correct the:
(1) Sucking habit
(2) Anterior open bite
(3) Posterior crossbite
(4) Tongue thrust
(5) Molar relationships
 Ideally, this appliance should be introduced to patients with
late primary or early mixed dentitions, at the earliest age
possible.

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 APPLIANCE DESIGN
 Accurate pretreatment
patient records should be
made, including
radiographic survey, study
models, and photographs.
 A single appliance is made
with a 0.036­inch Elgiloy
stainless steel wire arch with
a Teflon roller, with a crib or
rake, and wire.

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 The appliance is a fixed-removable type allowing for
easy removal of the appliance without removal of the
molar bands, which are cemented with glass ionomer
cement.
 The molar bands are located on the primary second
molars or the permanent first molars.

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PLACEMENT AND CLINICAL
MANAGEMENT.
 Placing the appliance first involves molar separation (24
hours or longer) with orthodontic separators, followed by
a try-in to ensure that the fit is optimal.
 The whole appliance is then cemented on with glass
ionomer cement.
 Treatment duration is typically 6 to 9 months, up to 1
year.
 The crib covering the roller should be continuously
monitored and removed soon after correcting the tongue
thrust habit. It also servers as an additional deter­rent for
the digit-sucking habit.
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 The appliance should be placed in the patient's mouth for
approximately 1 month before expansion to allow the child to
acclimatize to it.

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 The anterior open bite should correct spontaneously following
cessation of the habits.
 The posterior cross bite is corrected by incremental activa­tion
of the appliance.
 Only the wire portion of the appliance is removed outside the
mouth for activation and reinserted.
 The posterior cross bite is monitored and the appliance reacti­
vated until overcorrection is achieved. Typically, this can be
achieved in 2 to 3 months.

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 After overcorrection, the appliance is maintained for an
additional 2 to 3 months to retain the correction in the coronal
plane and the patient should be monitored with periodic recall
appropriate for the individual.

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DISCUSSION
 The multiple appliances arise due to the fact that no one
appliance can correct all the dentoskeletal complications
that result from sucking.
 One method of solving this problem is to use multiple
appliances sequentially to correct each of the problems
individually.
 This entails longer treatment times, however, as well as
additional expenses.

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 Thus, the single appliance introduced in this paper was
designed to reduce treatment time and cost and correct the:
(1) Sucking habit
(2) Anterior open bite
(3) Posterior crossbite
(4) Tongue thrust without the need for multiple treatment
strategies.

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 The sucking habit is stopped by the rake/crib.
 Once the tongue thrust habit is controlled, the rake/crib
portion of the appliance should be removed.
 Cessation of the habit and the alteration of the tongue
posture are maintained by the remaining portion of the
appliance along with repeated patient instructions.

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 Retroclination of the proclined maxillary anteriors usually
follows spontaneously after the habit is stopped.
 This is achieved by alleviating the labial pressure from the
digit being sucked and allowing natural lingual pressure from
the lip.
 Thrusting of the tongue primarily during swallowing is
checked by the rake/crib.
 The posterior cross bite is corrected by progressively activating
(expanding) the W arch laterally.

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 In this appliance uses a Teflon roller instead of a crib,
which is argued to be more humane compared to other
appliances and has better acceptance from patients and
parents.

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 Even with the prongs, the crib's effectiveness in stopping the
tongue thrusting-habit is questionable due to its close a­
daptation to the palate.
 Although the quad-helix structure may give the clinician more
control, it also lengthens the time needed during activation and
readjustments and oral hygiene can be difficult.
 The earlier in dental development that the single appliance is
used, the more ideal the results and the shorter the treatment
time.

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 Furthermore, compared to fixed appliances, the
appliance introduced in this paper is a fixed removable
design, making adjustments easier for the clinician and
patient.
 Achieving multiple treatment objectives with a single
appliance also reduces treatment cost.

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REFERENCE WITH OTHER ARTICLES
 Dentoskeletal changes associated with fixed and
removable appliances with a crib in open-bite patients in
the mixed dentition
 Veronica Giuntini et al

 Am J Orthod Dentofacial Orthop 2008;133:77-80

 They compare the effects of the quad-helix/crib (Q-H/C)

appliance and a removable plate with a crib (RP/C) in
patients with dentoskeletal open bite.

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METHODS
 Both samples consisted of 20 subjects. Lateral
cephalograms were analyzed before treatment (T1) and
after active treatment (T2).
 The average age at T1 was 8.4 years, and the mean
duration of treatment was 1.5 years in both groups.
 The T2-T1 changes in the 2 groups were compared with
a nonparametric test for independent samples.

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RESULT
 Both the Q-H/C and the RP/C appliances induced
favorable dental effects.
 However, a compliance-free appliance, such as the Q-
H/C appliance, produced more favorable vertical skeletal
changes.

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 Sucking habits in childhood and the effects on the
primary dentition
 Karen duncan et al

 International Journal of Paediatric Dentistry 2008; 18:

178–188

 Questionnaire data on non-nutritive sucking habits were

collected on the children at 15 months, 24 months, and
36 months of age.
 Dental examinations were performed on the same
children at 31 months, 43 months, and 61 months of age.

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RESULTS
 At 15 months, 63.2% of children had a sucking habit,
37.6% used just a dummy, and 22.8% used a digit.
 By 36 months, sucking had reduced to 40%, with similar
prevalence of dummy and digit sucking.
 Both habits had effects on the developing dentition, most
notably in upper labial segment alignment and the
development of anterior open bites and posterior
crossbites.

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CONCLUSION

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REFERENCES
 Text book of Pedodontics, Shobha Tandon 2nd edition
2008.
 Orthodontics the art and science, S. I. Bhalajhi, 3rd
edition 2006.
 Karen duncan et al International Journal of Paediatric
Dentistry 2008; 18: 178–188.
 Veronica Giuntini et al American Journal of
Orthodontics and Dentofacial Orthopedics 2008;133:77-
80.

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