DeNtal tribuNe | January-March, 2010 trends & applications 15 A clear, fixed pressure-formed, habit breaking appliance Dr. Deepak Rai, Dr. Gurkeerat Singh New Delhi Introduction Digit sucking habit, usually referred to as thumb or finger sucking habit, can cause adverse effect on normal pattern and direction of the skeletal and dentoalveolar growth.1 During thumb sucking, due to lowered position of the tongue in the oral cavity, maxilla tends to grow in an abnormal protrusive direction with the mandible growing in downward and backward direction.2 It causes maxillary anterior teeth protrusion while mandibular teeth are retroclined.3-5 The lowered position of tongue as well as the increased cheek pressure may also result in posterior cross bite. Moyers has concluded, that the thumb sucking habit creates undue pressure on immature highly malleable alveolar ridge, and can lead to malposition of the teeth, aberrant breathing pattern, speech abnormalities, facial muscular imbalances, and psychological problems.6 Graber, in his classic work, states that the muscle activity is normal in Class I malocclusion except in case of Class I malocclusion with the anterior open bite. The most common cause of anterior open-bite problems is thumb or finger sucking habit. It is considered normal for children to engage in nonnutritive sucking during infancy which mostly disappears spontaneously by 6-18 months of age. Proffit states that most of the dental changes resolve if sucking habit is discontinued before eruption of the permanent teeth erupt”. In cases of persistent thumb sucking habit with sufficient intensity, and frequency duration, maxillary anteHaskell and Mink introduced Blue-grass appliance having hexagonal teflon roller on the cross-palatal bar. 11 Fig. 1: Dental study models of patient with thumb sucking habit. Fig. 2: Working model, molar bands with soldered buccal and lingual buttons. Fig. 3: Working cast scored with three bur holes in palatal area. Fig. 4: Othodontic stone used to create spikes. Fig. 5: Wax relief for guidance to erupting incisors. Fig. 6: Working model in MinistarR *unit to form the appliance. Fig. 7: Labial view of vacuum-formed habit breaking appliance. Fig. 8: Inside view of appliance. Fig. 9: Spikes filled with wax, relief wax over incisors removed. pattern is achieved (Fig. 1). Habit breaking appliances make thumb sucking meaningless by breaking suction, preventing displacement of incisors and reposition the tongue. Habit breaking appliances, generally, have an associated problem of compliance wear, especially with the commonly used removable cribs with little success. 10 7 Appliance design and fabrication 1. Patient’s molar bands with soldered buccal and lingual buttons, on a working cast (Fig. 2). Button soldered to provide retention of molar bands into pressure-formed sheet. 2. The cast was scored with three deep bur holes along the line joining cuspid tips on the rugae area (Fig. 3). 3. Orthodontic white stone was used to create spikes with stone flowing and anchoring into retention holes on cast (Fig. 4). 4. Wax relief was given along erupting (Fig. 5). 5. Working model in Ministar R unit* & DuranR** pressure moulding foil were used to form the appliance (Fig. 6). 6. Labial view of the appliance (Fig. 7). 7. Inside view of the appliance with sheet cut out over molar band’s occlusal surincisor path To provide guidance, the nate thumb sucking habit before arch is deformed sufficiently, to require homeostatic muscle action during deglutition. This, new pressure-formed fixed clear appliance, helps in eliminating deleterious thumb sucking habit with passive guidance appliance can be cut back on lingual aspect of incisors, with a flowable composite flown into labial, for applying pressure on erupting incisors to be guided lingually. Discussion Graber mentioned fashion flourish in orthodontics as they do in interior decorating and clothes designing, with timelinked subject orientation.7 Current popularity of pressureformed appliances, after Sheridan’s 13 to incisors in eruption, allowing correction of the open bite, especially patients. *MINISTARR, SCHEU-DENTAL GmbH, P.O. BOX 7562 D-58613 ISERLOHN **DURANR, SCHEU-DENTAL GmbH, in noncompliant Chris Baker thermo-formed appli- modified Blue-grass appliance by replacing roller with two acrylic beads claiming more 12 ances for corrective orthodontics and retention purposes, have encouraged development of appliances which are easy to fabricate with no wire parts, and are less costly. Clear and transparent appearance of these appliances promotes early patient acceptance especially in the prepubertal children with low ego strength. 14 P.O. BOX 7562 D-58613 ISERLOHN DT References available on request. stimulation of tongue. All these modifications required some wire bending skills, with soldering procedures in some designs for cross-palatal bar-bearing cribs, spikes, beads or rollers, but without any passive guidance elements for labially deflected or erupted incisors. This article introduces a new clear, fixed pressureformed habit breaking appliance, which is easy to fabricate and is clear, for early patient acceptance, & overcomes noncompliance removable associated appliances with with rior segment is deformed leading to adaptive forward thrust of tongue, which accentuates open bite, preventing adequate eruption of maxillary incisors and forcing them labially.7 When maxillary incisors move labially, lip enters in to picture and joins the tongue in nature’s adaptive attempt to create oral seal during swallowing.8,9 Open bite is accentuated by this vicious cycle unless normal activity is restored and mature somatic About the authors The thumb sucking habit, leading to open bite malocclusion is, generally, the first assault on the integrity of dentition and the adaptive and compensatory activities of tongue and lip, which later may teamup to provide a more significant deforming mechanism. Thus, it is essential that an interceptive appliance is provided to elimiDr. Deepak Rai is an associate professor in the department of orthodontics at Sudha Rastogi College of Dental Sciences and Research, Faridabad, India. face, ready to be cemented in patients mouth (Fig. 8). 8. The spikes of pressure formed appliance can be filled with wax, cement, or colored acrylic to provide additional rigidity. 9. Wax relief over erupting incisors can progressively be removed (Fig. 9). passive eruption guidance to incisors. Co-author Dr . Gurkeerat Singh is a professor and heads the department of orthodontics at Sudha Rastogi College of Dental Sciences and Research, Faridabad, India.