This presentation deals with all and all about orthotrainers and how to use myofunctional therapy to align teeth. For part 2 visit Myobraces

1. YOU ARE AWESOME !

5.  Relapse occurs in up to 90% of cases when
retainers are removed.
Little, R, et al. Vol 93, Issue5, American Journal of Orthodontics, May 1988.
SOLUTION
RETENTION - for life.
The only way to ensure continued
satisfactory alignment after treatment is
through the use of fixed retention for
life.

6. Not addressing the actual cause
What Actual cause ?
The teeth were mal-aligned, we aligned it.
So, it should be alright !

11. What determines your teeth position ?
1.Buccinator mechanism
2.Habits that alter normalcy
3. Functional matrix theory
4. Wolff’s law SPOILER ALERT !
BONE IS PLASTIC IN NATURE

12. Entire dentition & supporting structures
are surrounded by continuous bands of
musculature

13.  MUSCLES ACTING INWARD: Orbicularis
Oris, Buccinator , Superior constrictor of
pharynx
 MUSCLE ACTING OUTWARD : TONGUE
 Forces are neutralised
 Aids to maintain the position of teeth in the
arch & stability of dento-alveolar complex

14.  “ The Origin, form, position, growth and
maintenance of all skeletal tissues and organs is
always secondary, compensatory and
mechanically obligatory & necessary response to
chronologically & morphologically prior events or
process that occur in specifically related non-
skeletal tissues, organs or functioning spaces”
 BONES DONOT GROW, BONES ARE GROWN
 Skeletal unit | Functional matrix

16. Adds upon the fact that bone growth is
determined by functional needs
“Bone transforms its structure that is best
suited to bear the forces exerted upon it”
The direction of force acting upon a bone
is never a straight line but an
irregular,wavy one (trajectory)

19. Anatomical alteration eg.,
Macroglossia/microglossia
Hypertrophy/Atrophy of buccinators
Glossoptosis/Glossodynia
Hypotonicity of the constrictor muscles of pharynx
Deletarious habits :
Tongue thrusting /Changes in swallow pattern
Thumb/ digit sucking
Lip sucking
Mouth breathing

21. Orthotrainer

22.  The Trainer System™ appliances are single-
size, prefabricated dental appliances that
incorporate both myofunctional and tooth
positioning characteristics.
 Primary dentition
 Early mixed
 Late mixed
 Permanent dentition
 Speciality appliances

23.  an active exerciser that encourages patients to chew
correctly while using the jaw muscles. The Infant
Trainer helps patients breathe through their nose and it
also trains them to swallow and position their tongue
correctly.
 correct facial, jaw and dental growth depends strongly
on all of these factors.

24.  viable alternative for all parents with children 3 - 5
years old who are familiar with pacifiers but are
concerned about the possible negative dental impacts
associated with pacifier use.
 discourages all these poor habits, and stimulates
a child’s jaw to ensure that correct facial and jaw
growth is achieved.

25.  Air Spring - allows a gentle, active stimulation to the growing face.
 Tongue Tag - actively trains the child to position their tongue and swallow
correctly.
 Tongue Guard - prevents thumb sucking and subsequent tongue
thrusting.
 Strap-tether - ensures that the Infant Trainer is not lost when
spat out.

27.  1 hour each day and overnight while sleeping and always remember to follow these
few simple steps:
• Lips together - at all times except when speaking.
• Breathe through the nose - to assist the development of the upper and lower jaws,
and to achieve the correct bite.
• No lip activity when swallowing - which allows the front teeth to develop correctly.
 CLEANING & MAINTANANCE
should be cleansed under warm running water every time the
patient removes it from their mouth. Use Myoclean™ tablets to
correctly clean twice a week. Myoclean™ is the recommended
cleaning agent for MRC's appliances.

29.  “The patient needs to wear the functional
appliance for a brief time only during day-time
to influence the muscles in such a way that
the neuromuscular masticatory pattern is
improved” (Sander, 2001).
 Furthermore, “three hours of continuous
stimulation is enough to move the tooth in the
periodontium and to produce alveolar bone
remodeling” (Roberts, 1997).

30. • Exercising jaw muscles
• Encouraging correct chewing
• Training correct nasal breathing
• Correcting tongue position
• Good replacement of pacifier / dummy

31.  Introduced in 1992 (most successful product of MRC)
 Tooth channels and labial bows guide the
erupting/developing dentition into correct alignment,
while the tongue tag and lip bumpers treat
myofunctional habits.
 Starting is a soft (Silicone) Phase 1 appliance

32.  This is much stiffer Finishing or Phase 2 is harder
(Polyurethane).(same principle as orthodontic archwire).
As the teeth come into place, more force can be used to
encourage their alignment.
 The myofunctional characteristics are the same as the T4K
Phase 1.
 Use the finishing T4K Phase 2 for a further 6 to 12 months.
 NOTE : Use beyond this period is recommended depending on the outcome
and the next phase of orthodontic treatment.

33.  optimum patient age for the T4K is 6 - 8 years of
age.
 Although it is possible to use the T4K in patients
ranging from the primary right through to the
permanent dentition, (early & late mixed)
NOTE: As dentition progresses the effectiveness of the T4K as
the sole method of treatment is lessened..

35.  Tooth Channels and labial bows - guide erupting teeth
into correct alignment.
 Tongue Tag - trains the tongue to sit in the roof of the
mouth, improving myofunctional habits.
 Lip bumpers - discourage overactive lip muscle activity.


36.  1 hour each day and overnight while sleeping and always remember to
follow these few simple steps:
• Lips together - at all times except when speaking.
• Breathe through the nose - to assist the development of the upper and
lower jaws, and to achieve the correct bite.
• No lip activity when swallowing - which allows the front teeth to develop
correctly.
 CLEANING & MAINTANANCE
should be cleansed under warm running water every time the patient removes it
from their mouth. Use Myoclean™ tablets to correctly clean twice a
week. Myoclean™ is the recommended cleaning agent for MRC's appliances.

37. • Class II Division 1 + 2
• Anterior (upper + lower) crowding
• Deep bite
• Open bite

38. In more severe cases when the jaws are
underdeveloped, appliances such as
the Farrell Bent Wire System (BWS)
and/or Biobloc may be required for extra
widening of the dental archform.

39.  An advantage of using the BWS is that it
can be using in conjunction with the T4K.
 MRC have also developed a procedure for
composite build ups know as Myolay.

40. APPLIANCE IS SIMILAR TO EARLY
MIXED DENTITION STAGE.
Growth and development are slowing
down in the late-mixed dentition and as a
result, some patients may need extra arch
development in combination with MRC's
appliances.
 Viz., BWS

41.  It is similar in function to the T4K (for use
in the mixed dentition) and T4B (for use
with fixed appliances), and is ideal for
retention and minor relapse cases.

42. It has higher sides in the canine region to
align erupting canines and the distal ends
are longer to accommodate the second
molars.
The combination of labial bows and tooth
channels with the 2 phase hardness,
polyurethane material, give good
alignment of anterior teeth.

43.  The Phase 1 T4A (blue or clear) is a softer material with the
flexibility to adapt to misaligned anterior teeth.
 When used, light forces are applied to the anterior teeth to
assist their alignment into the correct arch form.
 The T4A Phase 1 can also be used simultaneously with
specific arch development appliances.
 Extra spacing in the palatal area means it can be used with
the BENT WIRE System (BWS) and also MRC's Myolay
arch-development system.
 NOTE: Combined with the myofunctional habit correction of the T4A, these light
intermittent forces produce dental alignment improvements within 3-6 months.

44.  Phase 2 T4A (red) is the same design but made in a harder
material putting more force on the anterior teeth.
 It is to be used after the phase 1 T4A once more aligning force
is required.
 This further improves the tooth and Class II correction (minor)
while continuing the myofunctional habit correction.
 It can be phased into use starting with 1-4 hours during the
day while continuing with the softer starting T4A at night.
Treatment period varies and can be a further 3-6 months plus
retention.

45. High sides - guide erupting canines.
Tongue tag - trains the tongue to sit in the
roof of the mouth, improving myofunctional
habits.
Tooth aligners - impart a light force on
misaligned teeth.

46.  The T4A is best suited to patients 12 - 15+
years of age in the early stages of the
permanent dentition.
 The T4A can be used as a myofunctional
retainer for patients who do not wish to have
permanent bonded retainers fitted.
 It is also useful for treating minor relapse
cases without re-fitting fixed orthodontics, and
for minor cosmetic alignment of the anterior
teeth.

47. The Trainer for Braces (T4B) is intended
for routine use with newly banded cases.
The T4B is highly flexible, providing
optimum patient comfort with minimum
appliance thickness.

48.  Braces Channels - accommodate brackets and
orthodontic archwire, and protect cheeks and
gums.
 Lip bumpers - discourage overactive lip muscle
activity, which can cause discomfort while
wearing braces.
 Tongue guard - stops tongue thrusting when in
place and encourages nose breathing.

49.  The T4B is perfectly suited to newly banded
patients who are feeling discomfort in the tongue,
cheeks and lips.
 USE
 Use with newly fitted fixed orthodontics cases.
Works in Conjunction With
 Fixed orthodontics
 Lingua

50.  The T4B2 is thicker and higher than the T4B making it a more
robust appliance specific for treatment of Class II cases before
and during fixed orthodontic treatment.
 The appliance's upper bracket channel and extended height
locks over braces for excellent retention and it can be used if
lower braces are fitted.
 Myofunctional habits associated with Class II malocclusion
are treated by the T4B2 pre-moulded in edge-to-edge/ class I
further assists the correction of class II malocclusion. Base
extends to cover second molars.

51.  Jaw Positioning - Correct jaw position is
produced when in place.
 Aerofoil-shaped Splint - reduces TMJ symptoms
by decompressing the temporo-mandibular joints.
 Braces Channels - accommodate brackets and
orthodontic archwire, and protect cheeks and
gums.
 Tongue Tag - for the correct positioning of the
tongue.

52.  Tongue guard - stops tongue thrusting when in place and
encourages nose breathing.
 Lip bumpers - discourage overactive lip muscle activity,
which can cause discomfort while wearing braces.
 Higher sides - for improved habit correction and better
retention.
 Robust construction - increases jaw development.

54.  Tancan Uysal et al., evaluated the influence of Pre-
Orthodontic Trainer treatment on the perioral and
masticatory muscles in patients with Class II division 1
malocclusion (The European Journal of Orthodontics Advance
Access published January 6, 2011)
 20 patients (10 males and 10 females)
 The ANB angles of all patients were greater than 4 degrees, and their
overjets were greater than 4.5 mm (mean ANB: 5.62 ± 1.46 degrees and
mean overjet: 6.0 ± 1.1 mm)
 None of the children in the test or control group had a thumb-sucking
habit.
 All were Caucasian and their ages ranged from 7.8 to 11.5 years (mean
age: 9.8 ± 2.2 years). All were treated exclusively with the POT
appliance (Myofunctional Research Co., Queensland, Australia).

55.  EMG of the peri-oral muscles
Muscles preferred : Anterior temporal muscles, mentalis,orbicularis oris, and
masseter
 EMG recordings of treatment group were taken at the beginning and
at the end of the POT therapy (mean treatment period: 7.43 ± 1.06
months).
 Follow-up records of the control group were taken after 8 months of
the first records.
 Recordings were taken during different oral functions: clenching,
sucking, and swallowing.
 Statistical analyses were undertaken with Wilcoxon and Mann–
Whitney U-tests.


56.  During the POT treatment, activity of anterior temporal, mental, and
masseter muscles was decreased and orbicularis oris activity was increased
during clenching and these differences were found statistically significant
when compared to control.
 Orbicularis oris activity during sucking was increased in the treatment group
 In the control group, significant changes were determined for anterior
temporal and masseter muscle at clenching and orbicularis oris muscle at
swallowing during observation period.
 Present findings indicated that treatment with POT appliance showed a
positive influence on the masticatory and perioral musculature.
 BOTTOM LINE :
 During sucking, EMG activity was decreased in treatment group and not
changed in controls.
 However, during clenching, EMG activity was decreased in treatment and
increased in control group.

57.  UM Das & D Reddy.,
 ” Orthotrainer for 15months “
 50 class II div. I patients (20 test patients and 30 controls) in
the age group of 8-12 years.
 Increase in Vertical height of face was seen in treatment
group.
 Concluded, class II corrections can be achieved with the
preorthodontic trainer appliance.
 This appliance appears to have mostly dentoalveolar effects
with smaller but significant skeletal effects
JISPPD Year : 2010 | Volume : 28 | Issue : 1 | Page : 30-33

58.  If untreated during the growing period, deep
overbite leads to serious functional disorders,
pathologic abrasion and myo-articular
problems.
 Myofunctional Trainer System is successfully
applied in the management of deep overbite
in growing kids with early mixed dentition.
 The design of appliances helps the right
positioning of tongue and jaws, removes bad
habits, harmonizes tooth arches, corrects the
vertical problems.

59. concluded that use of a Trainer
T4K myofunctional appliance results in
improved antero-postero dental
relationships and an improvement in oral
functioning. (Mastication & Deglutition)

60. Pallavi Pujar and Suryakanth M. Pai
eleven-year-old female
child(CDS,Karnataka)
patient was asked to wear the appliance
for 1-2 hours in the day and then overnight
for 6months.
The patient was followed up for every 15
days for first two months and later once in
every month.

63. Remember what buttersworth said
“Frequent or constant practice or acquired
tendency which has been fixed by frequent
repetition “
Mathewson, “ Oral habits are learned
pattern of muscular contractions”

64.  CHEAP
 Doesnot need impressions,models or tracings
 No wires, no brackets no bonding & Banding
 When selected correctly, results are superior
to fixed orthodontics
 Almost zero Periodontal issues
 No relapse
 Excellent tool to treat relapse

65. Compliance
Practice
Availability
Cannot be used in cases of severe
malocclusion.
Role of T4A is questionable.

66.  “The paucity of our present knowledge of etiology in
orthodontics compels us to attack the cause and effect
relationship from the wrong end - that of effect. By
working backward we shall undoubtedly arrive at the
beginning, someday. How nice it would be to approach
it from the other end.”
Graber, T. M. (1962) Orthodontics; Principles & Practice, Chapter 6, Etiology of Malocclusion - Extrinsic or General factors.
 “You start treatment when you discover the poor oral
habits that are going to create problems and you
address the habits, not the teeth.” Dr Barry Raphael –
Orthodontist (Clifton, New Jersey, USA)

67. If habits are nothing but a learned pattern
of muscle movements, Why can’t we use it
to our advantage ?
With proper and diligent patient selection
and little more awareness among the
public,
MRC appliances will play a role in our
clinics

69. YOU ARE THE BEST!

70.  Little, R, et al. Vol 93, Issue5, American
Journal of Orthodontics, May 1988.
 Textbook of Orthodontics- Sridhar premkumar
• Graber, T. M. (1962) Orthodontics; Principles & Practice,
Chapter 6, Etiology of Malocclusion - Extrinsic or
General factors.
 Textbook of orthodontics by S Gowri Shankar
 The European Journal of Orthodontics
Advance Access published January 6, 2011

71. UM Das & D reddy JISPPD Year :
2010 | Volume : 28 | Issue : 1 | Page :
30-33
Miroslava Dinkova(JIMAB Issue: 2014,
vol.20, issue 5)
 C.Boucher et al.,J Dentofacial Anom Orthod
Volume 11, Number 1, March 2008
VariaPage(s)30 – 44
 Textbook of Pediatric Dentistry – Nikhil
Marwah