tongue crib used in orthodontic therapy

1. ADJUSTABLE
TONGUE CRIB
Presenting by:
Dr. Ramya peteti
Post graduate
Dept of orthodontics
Guided by:
Dr. Raghu Ram
Dept of Orthodontics

2. Introduction
• Tongue thrust is an oral habit pattern related to the
persistence of an infantile swallow pattern during
childhood and adolescence, thereby producing an open
bite and protrusion of the anterior teeth.
• Deleterious habits such as thumb sucking and tongue
thrusting play a major role in causing malocclusion,
dental asymmetry and facial distortion (Meka and
Suryadevara, 2015).
A
B

3. Classification of tongue thrusting:
• Simple classification of Tongue thrust:
Simple tongue thrust Complex tongue

4. • Type I: Non- deforming tongue thrust
Classification by James S. Braner and Holt

5. • Type I: Non- deforming tongue thrust
• Type II: Deforming anterior tongue thrust

6. • Type I: Non- deforming tongue thrust
• Type II: Deforming anterior tongue thrust
sub group 1: Anterior open bite

7. • Type I: Non- deforming tongue thrust
• Type II: Deforming anterior tongue thrust
sub group 1: Anterior open bite
sub group 2: Anterior proclination

8. • Type I: Non- deforming tongue thrust
• Type II: Deforming anterior tongue thrust
sub group 1: Anterior open bite
sub group 2: Anterior proclination
sub group 3: Posterior crossbite

9. • Type III: Deforming lateral tongue thrust

10. • Type III: Deforming lateral tongue thrust
sub group 1: Posterior open bite

11. • Type III: Deforming lateral tongue thrust
sub group 1: Posterior open bite
sub group 2: Posterior crossbite

12. • Type III: Deforming lateral tongue thrust
sub group 1: Posterior open bite
sub group 2: Posterior crossbite
sub group 3: Deep overbite

13. • Type IV: Deforming anterior and lateral tongue thrust

14. • Type IV: Deforming anterior and lateral tongue thrust
sub group 1: Anterior and posterior open bite

15. • Type IV: Deforming anterior and lateral tongue thrust
sub group 1: Anterior and posterior open bite
sub group 2: Anterior proclination

16. • Type IV: Deforming anterior and lateral tongue thrust
sub group 1: Anterior and posterior open bite
sub group 2: Anterior proclination
sub group 3: Posterior crossbite

17. Treatment of tongue thrust:
• Myofunctional exercises,
• Fixed and removable appliances (cribs or rakes)
(Singaraju and Kumar, 2009).
A
B
C

18. • The tongue crib induces a change in the resting
position of the tongue, thus allowing tooth
eruption and closure of an anterior open bite.

19. • Most patients find it difficult to adapt and
discontinue the treatment.
A

20. • However, this is based on individual variation in the adaptive capacity
of the tongue (Epker and Fish, 1977; Subtelny and Sakuda, 1964).

21. Fixed tongue loops (Veis and Christian,
2004)
Tongue fence (Veis and Christian,
2004)
Upper hay rake (Veis and Christian,
2004)

22. TADs Supported Tongue Crib: A New Minimalistic Design
Journal of Contemporary Orthodontics, June 2018, Vol 2, Issue
2, (page 42-46)

23. Mittal R, Bapat SM, Garg N. Mittal bonded tongue thrusting
appliance. APOS Trends Orthod 2014;4:139-40.
Mittal bonded tongue thrusting appliance

24. • Modifications such as tongue crib with U-loops are
commonly practised for multiple corrections
(Abraham et al., 2013).
• However, when these U-loops are adjusted, as a
counter-effect, the height and angulation of the
crib are altered.
• To rectify these changes, counter-bends are given
in the crib to place it in the desired position.
• During these adjustments, the crib tends to break
due to its rigid nature and acute bends.
A
B

25. • Hence, we came up with a modification to the
conventional tongue crib which we call it as
“adjustable tongue crib”, by incorporating helices
at the acute bend areas, making them easy to
adjust without fracture.
• Most importantly, this design provides comfort
to the patient through a gradual adaptation of
the crib height and angulation.
A
B
C

26. Fabrication
A
• 0.8-mm round hard stainless-steel
wire

27. Fabrication
A
• 0.8-mm round hard stainless-steel
wire
• Universal plier

28. Fabrication • 3–4 cribs similar to a conventional tongue crib
(canine to canine (Miller, 1969).
A
• 0.8-mm round hard stainless-steel
wire
• Universal plier

29. Fabrication • 3–4 cribs similar to a conventional tongue crib
(canine to canine (Miller, 1969).
• Anterior helices (inner diameter 3 mm) facing the
occlusal side of the lateral cribs.
A
• 0.8-mm round hard stainless-steel
wire
• Universal plier

30. Fabrication • 3–4 cribs similar to a conventional tongue crib
(canine to canine (Miller, 1969).
• Anterior helices (inner diameter 3 mm) facing the
occlusal side of the lateral cribs.
• Adapt the connecting bar parallel to the lateral
surface of the palate, 2mm away from the soft
tissue.
A
• 0.8-mm round hard stainless-steel
wire
• Universal plier

31. Fabrication • 3–4 cribs similar to a conventional tongue crib
(canine to canine (Miller, 1969).
• Anterior helices (inner diameter 3 mm) facing the
occlusal side of the lateral cribs.
• Adapt the connecting bar parallel to the lateral
surface of the palate, 2mm away from the soft
tissue.
• Posterior helices (inner diameter 3 mm) opposite to
the occlusal side, 5mm before the lingual sheets.
A
• 0.8-mm round hard stainless-steel
wire
• Universal plier

32. Fabrication • 3–4 cribs similar to a conventional tongue crib
(canine to canine (Miller, 1969).
• Anterior helices (inner diameter 3 mm) facing the
occlusal side of the lateral cribs.
• Adapt the connecting bar parallel to the lateral
surface of the palate, 2mm away from the soft
tissue.
• Posterior helices (inner diameter 3 mm) opposite to
the occlusal side, 5mm before the lingual sheets.
• U-loops (width x height = 5 x 7 mm) near the
second premolar region.
A
• 0.8-mm round hard stainless-steel
wire
• Universal plier

33. Fabrication
• 3–4 cribs similar to a conventional tongue crib
(canine to canine (Miller, 1969).
• Anterior helices (inner diameter 3 mm) facing the
occlusal side of the lateral cribs.
• Adapt the connecting bar parallel to the lateral
surface of the palate, 2mm away from the soft
tissue.
• Posterior helices (inner diameter 3 mm) opposite to
the occlusal side, 5mm before the lingual sheets.
• U-loops (width x height = 5 x 7 mm) near the
second premolar region.
• Insert the distal extension into the lingual sheets
and lock.
A
• 0.8-mm round hard stainless-steel
wire
• Universal plier

34. Change of Crib Position in the Anteroposterior Direction
Compress the U-loop to retract the crib
A

35. Change of Crib Position in the Anteroposterior Direction
Compress the U-loop to retract the crib Expand the U-loop to protract the crib
A B

36. A
Change of Crib Position in the Vertical Direction
Open the posterior helices to increase the
height of the crib

37. A B
Change of Crib Position in the Vertical Direction
Open the posterior helices to increase the
height of the crib
Close the posterior helices to decrease the
height of the crib

38. A
Change of Crib Angulation
Open the anterior helices for anti-clockwise
rotation of the crib

39. A B
Change of Crib Angulation
Open the anterior helices for anti-clockwise
rotation of the crib
Close the anterior helices for the clockwise
rotation of the crib

40. Advantages
• The height, angulation and sagittal position of
the crib can be adjusted as and when required.
• Easy to adjust.
• Easily adaptable by the patients.
• Do not fracture during adjustments (due to the
incorporation of helices).

41. B
Case Application
• Bidental proclination
• Anterior open bite
• Tongue thrusting habit
• Adjustable semi-fixed tongue crib
A

42. A B
C D

43. A B C
U-loops were compressed to
retract the crib
Posterior helices were closed
to decrease the crib height
Anterior helices were closed
for a clockwise rotation of the
crib angulation

44. Discussion
• The tongue crib acts as a mechanical barrier against the thrusting tongue (Sayin et al.,
2006).
• Although the conventional tongue crib is rigid and restrains the tongue, it can not be
easily repositioned in its angulation and vertical position (Abraham R et al., 2013).
• Any attempt to adjust the position of the crib might lead to fracture. Moreover, the
patients feel uncomfortable in the initial phase with the crib and will not cooperate with
the treatment.

45. • With this modification, the patient’s discomfort level is initially reduced by positioning the
crib in a convenient height and angulation (parallel to the axial inclination of maxillary
anterior teeth and halfway to the overbite).
• Once the patient gets adjusted with the appliance, the crib height and angulation are
gradually adjusted to an ideal position in the subsequent visits.
• The incorporation of helices in the appliance design to a certain extend would increase the
flexibility of the overall appliance.
• However, this aspect is countered by incorporating anterior helices opposite to the tongue
force, which takes up the stress.

46. Conclusion
Adjustable tongue crib is a patient-friendly appliance
that is gradually adapted by adjusting the crib
position without fracture.

47. References
• Abraham R, Kamath G, Sodhi JS, Sodhi S, Rita C and Sai Kalyan S (2013) Habit breaking appliance for multiple
corrections. Case Reports in Dentistry 2013: 647649.
• Epker BN and Fish L (1977) Surgical-orthodontic correction of open bite deformity. American Journal of
Orthodontics 71: 278–299.
• Meka BP and Suryadevara S (2015) A simplified method of fabricating a habit breaking appliance. Journal of
Clinical and Diagnostic Research 9: ZH01.
• Miller H (1969) The early treatment of anterior open bite. International Journal of Orthodontics 7: 5–14.
• Singaraju GS and Kumar C (2009) Tongue thrust habit - a review. Annals and Essences of Dentistry 1: 14–23.
• Subtelny JD and Sakuda M (1964) Open bite: Diagnosis and treatment. American Journal of Orthodontics 50:
337–358.

48. Thank you…