Early Orthodontic treatment withTrainer system

Justin J.C. Lee D.D.S., Ph.D

Seoul Children’s Dental Center

So many dentists just drill

and fill cavities without

considering the causes of

caries.

So many orthodontists just

use mechanics to align

teeth without considering

the causes of malocclusion.

JDent Res 74 (8) 1995 Guest Editorial 1437

Juha Varrela and Pentti Alanen

It is difficult to avoid the impression

that the better the mechanics of tooth

movement have been mastered, the

smaller has been the interest in etiological

or developmental aspects of the

malocclusions

Edward F. Harris, PhD, and Michelle G. Johnson, DDS, MS

(AM J ORTHOD DENTOFAC ORTHOP 1991;99:258-68.)

In contrast to craniometric variables,

which have high heritabilities, almost all of the

occlusal variability is acquired rather than inherited

取得 遗传 咬合 Occlusion

An epidemiologic transition in dental occlusion in world populations Robert S. Corruccini American Journal of Orthodontics November 1984 (Vol. 86, Issue 5, Pages 419-426)

The history of malocclusion gives an

interesting viewpoint on the development of contemporary

occlusal variation. Analyses of skull materials show that gross

malocclusions have been rare or nonexistent during most of

human history.

Minor malpositions or mild crowding was not infrequent, but

individuals who, by modern standards, would have needed

orthodontic treatment were uncommon.

3 hypothesis of etiology for increasing malocclusion

The increase in allergies and other

factors that might obstruct

nasopharyngeal airways and interfere

with normal breathing

Dietary changes and

alterations in

masticatory activity

The effects of

abnormal sucking

habits

To have good occlusion

Lips together,

Breathe though nose

Tongue place on the spot: “N”

Swallow with masticatory muscles

not with perioralmuscles

No parafunctions such as

thumb sucking, etc

Tongue

tag

Breathing T4K

2007.02.01

2007.06.22 4m

2008.05.24

2009.01.29

2004.03

2004.05

2004.11

2005.4

2006.7

2006.12

2007.4

2008.05.10

2009.10.09 2009.10.09

TRAINER system

• Designed by a general dentist in Australia

• Acts like lip bumper: nose breathing

• Like Frankel appliance: relieves buccinator m.

• Tongue tag : remind tongue posture

• Silicon, ready made, a number of modifications

avaliable

J.S.Kim 1996.5.15 / M

• Max. protrusion

C.C

• Deepbite caused by mentalis activity

Dx

• Establish normal swallowing pattern with T4K

Goal

2005.01.16

2005.10.19 9m

2006.03.04.14m

2006.10.08. 1y9m

2007.01.04. 2y

2007.08.26 2y 7m

2008.02.27.3y2m

2008.11.26 3y10m

• Lower ant. crowding

C.C

• Deepbite, rhinitis, mentalis action

Dx

• Establish nose breathing and normal swallowing

pattern with T4K

Goal

2006.06.07 2006.10.11 4m

2007.08.01 1y2m

2008.07.30.2y 2m, 2008.12.10.2y6m

2009.03.06 2y 9m

2009.07.08 3y 1m 2009.09.18 TPA

2009.10.22 3y 4m 2010.01.27. 4y 7m

2010.05.19 4y

1999.04.05/F

• Diastema, flattened lower ant.

C.C

• Mentalis action, heavy labial frenum

Dx

• Establish normal lip tone

Goal

2004.05.13 2006.02.08

2006.12.27 10m

2007.05.08 1y 3m

2008.07.30 2y 5m

2009. 02.18.3y

2009.08.11 3y6m

2010.06.15 4y4m

2012 02 01 out of Tr 2yr

1999.11.24 /F

• Ant. crossbite, crowding

C.C

• Incorrect tongue posture and mentalis action

Dx

• Establish normal tongue posture and swallowing

pattern

Goal

2006.09.07

2006.10.27 Start T4K

2007.02.02 4m

2008.01.13 1y 3m

2008.10.04 2y

2009.08.04 2y 10m

1999.05.26 /M

• Crooked teeth

C.C

• Lack of space caused by perioral muscle action

Dx

• Establish normal tongue posture and lip tone

with T4K

Goal

2005.08.27 .

2006.06.03

2006.11.18

2007.10.21 T4K start

2008.01.13 3m

2008.08.30 10m

2008.12.06 1y 2m

2009.05.05 1y 7m

2009.09.19 1y 11m

2010.02.26 2y 4m

1998.09.25/M

• Max. protrusion

C.C

• Mentalis action, incorrect tongue posture

Dx

• Establish perioral muscle tone and tongue

posture

Goal

2005.12.29

2008.07.01 Start T4K

2008.07.01

2009.06.23 1y

2009.06.23 1y

2010.06.27 2yr

2011 07 28

2012 03 20 out of Tr 2yr

1998 02 .24/ F

• Crooked upper ant.

C.C

• Lack of space

Dx

• Establish normal tongue posture

Goal

2005.01.07

2005.04..28 Tr start

2005.12.28 8m

2007.01.04 1y 8m

2007.07.27 2y3m

2008.05.10 3y

S.H. Jang 1999.10.14/M

• Max. protrusion

• Lower crowding

C.C

• Mouth breathing, retro-positioned tongue

Dx

• Lip seal(Adenoidectomy and Tonsilectomy)

• Establish tongue posture with T4K

Goal

2006.07.21

A &T 2008.01 Tr start

2007.11.21

2008.05.08 4m

2008.08.21 7m

2008.08.21 7m

2009.03.21 !y 2m stop T4K

2010.03.31 1yr later relapse

Limitations

Compliance Gingival

irritation Relapse

Difficult to

correct CIII

Difficult to

charge fees

• Excellent for deepbite, mentalis action,

• Good for collapsed arch

• Good for mild upper/lower crowding

• Useful as a retainer during growth

• Can be used for crossbite(local factor)

• Questionable for open bite

Conclusion

Must be accompanied

by muscle exercises

(swallowing, tongue posture, lip

competence)