Copyright (c) Department of Orthodontics University of Dental Medicine, Yangon

1. Proclined Upper Incisors
Dr.Hla Hla Yee

2. Causes
■ Skeletal cause
■ Non-skeletal cause

3. – due to habits
▪ Thumb sucking / Finger sucking
▪ Tongue thrusting
▪ Lip biting
– Dental causes
▪ Supernumerary teeth
▪ Retained deciduous teeth
– Function
▪ Adaptive swallowing behaviour caused by
– Skeletal discrepancy ( Sk II )
– Short upper lip and Low lip line
Non-skeletal cause

4. Differential Diagnosis
– Differentiate skeletal from non-skeletal

5. Treatment
■ I .Treat / eliminate the causes
– For habits
▪ ( a ) Encourage to stop the habits
– Straight forward discussion between the child and the
dentist
▪ ( b ) The reward system
– that provides a small tangible reward daily for not
engaging in the habit.
– In some cases, a large reward must be negotiated for
complete cessation of the habit.

6. ▪ ( C ) Reminder therapy
– For sucking habit
▪ Adhesive bandage with waterproof tape on the finger /
thumb that is sucked
▪ Glove
▪ Mittens
▪ Solution with unpleasant ( bitter )
▪ An elastic bandage loosely wrapped around the elbow
prevent the arm from flexing and the fingers from being
suck.
▪ It is usually only at night and 6 to 8 weekly of intervention
should be sufficient.

7. – For tongue thrusting habit
▪ Orthodontic elastic or sugarless candy lozenge at the tip of
the tongue and asking the patient to place the tip of the
tongue in correct position on the palate for certain length of
time, several times each day.
– For lip biting habit
▪ Lip ballooning by holding air in the vestibule and making
sure the lip are closed tight.

8. ▪ ( D ) Use of habit training device
– For sucking habit
▪ Removable appliance
-oral screens
-Hawley appliances

9. ▪ ( 1 ) The anterior portion of quad helix appliance
Fixed appliance

10. ▪ ( 2 ) Cemented reminder appliance to actively
impede sucking. ( Tongue Cribs )
– The appliance consists of a maxillary lingual arch and a
crib constructed of soldered wire so that it is difficult to
insert the thumb / finger into the mouth when sucking
apparently ceases, the appliance should be retained in
place for approximately 6 months to ensure the habit has
truly stopped.

11. ▪ ( 3 )for tongue thrusting habit
▪ Tongue cribs
▪ ( 4 )for lip biting habit
▪ Lip bumper appliances

12. ■ II. Treat the condition
– In young individuals, spontaneous correction
occur after stoppage of habits
– In adult
▪ If there is adequate vertical clearance and
▪ space within the arch
– the maxillary incisors can be tipped lingually with a
removable appliance or fixed appliance.

13. ▪ If there is no space for retroclination of upper
incisors and deep bite exists.
– space analysis
– choice of teeth for extraction
– Type of tooth movement
– Choice of appliance and mechanotherapy
– Correction of overbite before retroclination of
upper incisors.

14. ■ III. In adult, corrective treatment should
be completed with habit training device to
prevent relapse.
( For the causes of habits. )

15. ■ For dental cause
– Extract retained / erupted supernumerary
teeth
– Surgical removal of unerupted supernumerary
teeth
– Treat the condition ( mention above )

16. – But the corrective treatment should be
completed with simple retention appliance
– For adaptive swallowing behaviours
▪ The lower lip should cover at least the incisal third
of the labial surface of the retracted upper incisors
when a lip seal is obtained
– If the lip seal is not obtained, relapse may
occur.

17. Bimaxillary dentoalveolar protrusion

18. Causes
■ Soft tissue pattern
▪ Full and everted lip, the tongue acts to mould the
dental arches as they erupt
▪ Large tongue
■ Habit
▪ Tongue thrusting habit

19. Treatment
■ Bimaxillary dentoalveolar protrusion should
be treated with caution because of its
potential instability.

20. ■ If it is due to habit
▪ Treat / eliminate the causes.
▪ Extraction of upper and lower teeth. ( usually 1st
premolar ) , thus provide enough space for full
retraction of the upper and lower incisors
▪ the lower lip should cover at least the incisal third
of the labial surface of the extracted upper incisors
when a lip seal is obtained.
▪ If the lip seal is not obtained, relapse may occur.