Tongue function correction appliances. The current state of knowledge and therapeutic possibilities including a device of own design – Review of the literature

Abstract

The appropriate scheme of the development and articulation of the whole dental system is determined by the right development of physiological functions. The subject of muscle homeostasis has been analyzed by many researchers. Forces exerted by the tongue, lips and cheeks influence occlusion. In terms of muscle balance, clinicians all agree, the lack of it leads to the development and consolidation of malocclusion. Moreover, it is stated that only treatments following a procedure which incorporates muscle activity in the oral-facial complex have a positive therapeutic effect and stable treatment results. The aim of this research was to describe the available fixed and removable appliances used for tongue dysfunction treatment. In addition to the presented, pre-existing tongue cribs, the authors’ original TPC (Tongue Position Changer) device was also included. In this article the devices used for the treatment of tongue malpositioning and tongue function correction were discussed and systematized. The shape, structure and application together with the treatment time and results were taken into consideration. Tongue cribs are the documented tongue dysfunction treatment method with special regard to partial anterior and lateral open bite at the time of late deciduous, mixed and permanent dentition.

Full text

REVIEWS
S   O A–D, M JB, C, E PE, F
Tongue Function Correction Appliances.
The Current State of Knowledge and Therapeutic
Possibilities Including aDevice of Own Design
– Review of the Literature
Aparaty korygujące funkcję języka.
Aktualny stan wiedzy iterapeutyczne możliwości
zuwzględnieniem aparatu własnego projektu – przegląd piśmiennictwa
1 Department of Orthodontics, Medical University of Łódź, Łódź, Poland
A–research concept and design; B–collection and/or assembly of data; C–data analysis and interpretation;
D–writing the article; E–critical revision of the article; F–final approval of article
Abstract
The appropriate scheme of the development and articulation of the whole dental system is determined by the right
development of physiological functions. The subject of muscle homeostasis has been analyzed by many research-
ers. Forces exerted by the tongue, lips and cheeks influence occlusion. In terms of muscle balance, clinicians all
agree, the lack of it leads to the development and consolidation of malocclusion. Moreover, it is stated that only
treatments following aprocedure which incorporates muscle activity in the oral-facial complex have apositive
therapeutic effect and stable treatment results. The aim of this research was to describe the available fixed and
removable appliances used for tongue dysfunction treatment. In addition to the presented, pre-existing tongue
cribs, the authors’ original TPC (Tongue Position Changer) device was also included. In this article the devices
used for the treatment of tongue malpositioning and tongue function correction were discussed and systematized.
The shape, structure and application together with the treatment time and results were taken into consideration.
Tongue cribs are the documented tongue dysfunction treatment method with special regard to partial anterior
and lateral open bite at the time of late deciduous, mixed and permanent dentition (Dent. Med. Probl. 2015,
52,2, 227–234).
Key words: open bite, dental spurs, tongue crib appliance, swallowing.
Słowa kluczowe: zgryz otwarty, aparaty korygujące funkcję języka, połykanie.
Dent. Med. Probl. 2015, 52, 2, 227–234
ISSN 1644-387X
© Copyright by Wroclaw Medical University
and Polish Dental Society
Tongue dysfunction (oral-facial dyskinesis), i.e.
inappropriate tongue rest position and its position
during swallowing, can be observed among 100%
of patients with partial anterior open bite and al-
so among those with anterior-posterior and vertical
dysfunctions [1–6]. As stated in scientific literature,
atongue dysfunction most often leads to open bite
in the frontal part. It is adistortion of complex etiol-
ogy, caused by both innate and environmental fac-
tors. It is developed by the above-mentioned tongue
dysfunctions as well as by genetic factors, the adverse
patient’sheight, the oral air tract connected with ton-
sillar hypertrophy, adeviated septum, narrowing of
upper airways, impaired neuromotor tongue func-
tion, finger or teat sucking and inappropriate posi-
tion [7–21]. The etiology of inappropriate tongue rest
position and its position during swallowing is com-
plex and requires further study.
Scientific grant number 502-03/2-043-02/502-24-021 awarded by the Medical University of Łódź.

S. Osiewacz, M. Jurecka, E. Pawłowska
228
Asucking habit is noticeable in the 14th week
of afetus’ life. During the first period of the in-
fant’slife this reaction is dominant. Its impairment
can be observed between the 6th and 7th month
of life, when it is gradually replaced by mastica-
tion movements. This should happen in parallel
to the changes in diet. It disappears between the
first and second year of life and transforms the in-
fantile (immature, visceral) swallowing type into
an adult one (somatic, mature)[22]. In the avail-
able academic literature, there are discrepancies
between the time of the change of infantile swal-
lowing into somatic. According to Masgutowa and
Regner[22], the change of swallowing type appears
in the 16th month of life. It is due to the eruption of
milk canines. The adult swallowing type, as Orlik-
-Grzybowska[23] states, is developed between the
2nd and 3rd year of life. Graber[24] claims that it
happens at the soonest between the 3rd and 4th year
of life, and most often between the 9th and10th. In
research conducted by Proffit et al. [25], it was
found that the adult swallowing type is formed
around the 3rd year in some children, but in the
6th among the majority. Author also observed that
among around 10–15% of children, the somatic
swallowing type is not developed at all.
The frequency of swallowing, according to dif-
ferent authors, varies between 1000 and 2000times
per day[8, 10]. The tongue apex, during the adult
swallowing type, is placed on the hard palate, next
to the papilla incisiva. It should not touch the pala-
tal/lingual surface of either the upper or the lower
incisors whilst during the infantile act of swallow-
ing the tongue is located in-between the incisors
and presses them for 1to 3seconds[8, 10, 11]. It
gives atotal contact time between 60 and 90min-
utes a day and, according to Justus, it is enough
to become the main factor leading to malocclu-
sion[8]. Feu et al. [17] adds that aforce of small
volume but frequent occurrence can contribute to
the creation of such deformations. Tongue thrust
during the swallowing act and also its frontal rest-
ing position can be the cause of anterior open bite.
That is why the modification of tongue position
may have a crucial influence on the stability of
therapy effects. Proffit et al.[25] presents aslight-
ly different approach, negating the influence of in-
appropriate swallowing tract on the formation of
orthodontic problems. This author points at lim-
ited contact time between the tongue and teeth
in the above-mentioned activity. However, he no-
ticed a deforming inf luence of incorrect resting
position. When atongue adjusts to existing condi-
tions, it creates an anterior seal. This prevents food
from coming out of the mouth while eating[25].
Despite some differences in opinions regard-
ing the etiology of open bite, clinicians are unan-
imous that this defect is difficult to treat and
long-term therapeutic effects cannot always be
achieved. Research results presenting a relapse in
treatment suggest that the described tongue dys-
function may cause the failure [26–28]. Cribs, de-
fined as appliances that change the position and
function of the tongue, are acknowledged to be
one of the effective methods of treating this abnor-
mality. Parker [29] and Rogers [30] were the first
who used tongue crib appliances. They proved
that, apart from their main usage, tongue cribs
also help fight the finger, lip and object sucking
habit. These appliances make the results of partial
open bite treatment stable and long-lasting.
The aim of this research was to describe the
available fixed and removable devices used in
tongue dysfunction treatment. In addition to
the presented, pre-existing tongue cribs, the au-
thor’s original TPC (Tongue Position Changer)
device was also included. The analyzed material
comes from the National Center for Biotechnol-
ogy Information (NCBI), Medline, Embase and
Pubmed. The sample contained 37 publications
issued between 2000 and 2014. The key words en-
tered to the browser were: tongue crib appliance,
dental spurs, open bite, orthodontics, swallow-
ing and their Polish equivalents: zgryz otwarty,
połykanie and ortodoncja.
With regard to the type of fixing in the oral
cavity, the appliances for tongue function correc-
tion can be divided as follows:
– Components of additional elements for plate
appliances such as: wire cribs, acrylic cribs
and tongue practice beads.
– Components of a self-standing element sol-
dered to orthodontic rings and placed perma-
nently on the first molars.
– Components of aself-standing element glued
directly to incisive upper and lower teeth.
Devices Composing
Additional Elements
of Appliances
The cribs made of metal or acrylic or in the
form of atongue bead are mounted in removable
appliances to an upper or lower plate of the de-
vice, depending on the patient’sneeds. It is nec-
essary to take detailed impressions so that the
crib is precisely adjusted by atechnician [2, 3, 19].
Acrib made of 0.8mm steel wire has an accordi-
on shape, stretching from the right canine to the
left one. There are usually 6–8 bends of heights
around 15–25 mm. The height depends on indi-
vidual conditions in the oral cavity. The crib can-

Tongue Function Correction Appliances 229
acrylic cribs can only be used as apart of the upper
plate of an appliance. Fixing rules, retention ele-
ments and additional elements do not differ much
from those applied with wire cribs. This type of
a crib is additionally bisected along the middle
line. Otherwise, the activation of ascrew would be
impossible. Therapy with the use of atongue prac-
tice bead is based on the everyday, several-minute
practice of putting the tongue apex on an acrylic
bead and, without disconnecting the tongue from
the bead, the patient should exercise swallowing
of saliva. Patients are instructed to wear the devic-
es presented above for 18 hours aday. It is advised
to remove them only for eating and brushing the
teeth. Minimal therapy time is around 14 months
(Fig. 1a–c).
TPC (Tongue Position Changer)
Appliance
This new device was created to correct tongue
malpositioning and tongue functions with mini-
mal engagement required by the patient. The aim
was also to eliminate placing the tongue over or
under the crib. This phenomenon was commonly
observed when wire or acrylic elements were used.
It happened due to the incommensurate length or
inappropriate shape of those elements. This led to
the continuity of ahabit – in the resting position,
the tongue was still placed between the teeth or the
touched surface of the lower incisors and held in
an anterior position. The therapy did not provide
any effective results despite long-term treatment.
The use of palatal plates with practice beads re-
quires agreat patient’sengagement. The treatment
includes afew steps and is based on everyday, sev-
eral minutes’ practice of putting the tongue apex
on an acrylic bead and without disconnecting the
tongue from the bead, a patient should exercise
swallowing of saliva. Speech therapy exercises are
also recommended (Fig. 2a, b).
The original concept of an additional ele-
ment relies on adding an acrylic tunnel (aramp)
to the upper, active palatal plate. It aims at direct-
ing the tongue position into the frontal part of the
palate, just behind the upper incisors. The tun-
nel from the outside has a half vertical course in
the direction of the lower molars. When viewed
from the side, the ramp stretches up to the pre-
molars. In the case of lateral open bite treatment,
there is apossibility of widening so that it embrac-
es molars. The ramp is designed is such away that
it touches the bottom of the oral cavity but at the
same time it does not touch the mucosa and does
not cause bedsores. In the upper part it finishes
next to a hole of diameter of 0.5–0.7mm cut in
the upper plate in the section of the papilla inci-
Fig. 1a. Crib made of metal
Fig. 1b. Acrylic crib
Fig. 1c. Bead for tongue exercise
not touch the palatal/lingual surfaces of either the
upper or the lower teeth. It runs up to 15 mm pos-
teriorly to the upper incisors. The crib should be
constructed in such away as to not distract oc-
clusion and to not cause bedsores on the mucosa
[19]. In the middle intersection of a crib, there is
ascrew to widen dental arches. Atongue bead and

S. Osiewacz, M. Jurecka, E. Pawłowska
230
siva. A TPC device can be fitted in an extension
screw located on the palate, with wire retention el-
ements and lip arch according to adentist’smea-
surements. It can also be equipped with addition-
al wire and acrylic elements depending on the in-
dividual treatment plan. Those elements include,
among others, springs, lip bumpers, slopes used to
correct crossbite, etc (Fig. 3a, b).
The tunnel for the tongue was mainly creat-
ed for the upper palatal plate, but can also be used
as apart of other removable devices. The results,
based on our observations, show that it can suc-
cessfully support a therapeutic effect in terms
of an appropriate tongue resting position, while
swallowing and re-education of speech. Addi-
tionally, the appliance is perceived by patients as
more comfortable in comparison to the devices
equipped with wire cribs that limit the freedom
of tongue movement. These tunnels create sup-
port for the device and shape anew posterior po-
sition. They do not require any modification dur-
ing treatment, contrary to wire cribs that need
to be cut or splayed to not limit extension of the
appliance during screw activation. Distinctively
from the above-mentioned devices, the appropri-
ate position is forced by the ramp from the mo-
ment of fixing the appliance in patient’smouth,
without his awareness of this fact. In the remain-
ing types of cribs, such apossibility does not ex-
ist. Undoubtedly, it can be considered as an enor-
mous advantage.
The appliance has been positively approved by
the Department of Orthodontics, Medical Univer-
sity of Łódź, Poland. It is claimed to fulfill its func-
tion properly and to be safe for the patients treated
in the Dentistry Institute. The device has also been
reported to the Office for Harmonization in the
Internal Market. It received aregistry certification
of Community Industrial Design named: Tongue
Positioner, medical tool no. RCD 002522268.
According to Meibodi et al. [2] as well as Ah-
rari et al. [3], aremovable appliance with built-in
wire crib is an effective method of malocclusion
treatment when this defect is caused by compli-
cated tongue dysfunction. Depending on the place
where the device is fixed, i.e. on the upper or lower
plate, it is possible to provoke anterior mandible or
dental complex movement as aresult of transfer-
ring the pressure which is produced by the tongue
in aresting position and being leaned against the
Fig. 2a. TPC appliance
Fig. 2b. TPC appliance
Fig. 3a. TPC appliance with lip bumpers
Fig. 3b. TPC appliance

Tongue Function Correction Appliances 231
crib. Meibodi et al. [2] treated 23 patients at the
average age of 10–11 years who had distoclusion
with incisor protrusion, tongue thrust and ante-
rior open bite with this type of appliance. These
authors achieved the following: correction of fa-
cial features, retraction of upper lip, decrease of lip
tension due to retraction of upper incisors and sig-
nificant anterior mandibular movement. Minimal
treatment time was 14 months and 6 days when
the appliance was worn for 18 hours aday [2].
Ahrari et al. [3] recommend reverse placing
of a crib, i.e. on the upper plate, to correct class
III with different intensity levels. They describe
a case of an 8-year-old patient with Angle class
III and anterior crossbite. A removable appliance
with this modification stimulated mandible move-
ment forward. It is especially recommended for
patients with primary teeth or early-mixed den-
tition. Stable treatment results were achieved af-
ter 15 months of active therapy. The device could
be removed only during eating and brushing the
teeth [3].
The models in place up to now had to be cut
along the middle line not to limit the extension of
dental arches and dental bases. It caused frequent
buckling and breaking of metal cribs. In the case
of the suggested solution, i.e. the TPC appliance,
there were no fractures. The appliance is more ef-
fective and durable. The tunnel element also pro-
vides the possibility of tongue muscle exercises by
putting the tongue apex together with its body into
the tunnel. It also enables exercises with astretch-
type spatula. The other objective of the TPC ap-
pliance is the opportunity to place the tongue in
a different plane running forward and upward
and different from the crease or muscle compres-
sion on awire crib. Such position is more comfort-
able and physiologically required due to the fact
that it is the actual tongue resting position, i.e. the
tongue apex touches the anterior part of the hard
palate [8–12, 17–19, 26–28].
Appliances Composing
aSelf-Standing Element Soldered
to Orthodontic Bands and Fixed
Permanently on the First Molars
of the Mandible or Maxilla
A tongue crib placed on bands is applied in
the lower or upper dental arch. In a standard ver-
sion, metal tailor-made bands are attached on the
second primary molars or the first permanent mo-
lars. An emerging steel wire of 0.6–0.8mm width
runs along the tooth necks of the molars and pre-
molars. From one canine to the opposing one, the
wire forms acombination of different types of cribs
varying from ashape of 6–8bended arches to adou-
ble arch with transverse spacing bars and a single
arch with spurs for the tongue. The crib should be
moved 1mm away from the palatal incisive surface
of the upper teeth. The upper edge of the crib placed
in apatient’smouth, when dental arches are closed,
reaches the mandibular teeth from the lingual side
and goes to the edge of the gingiva behind the low-
er incisors. The appliance should not impair occlu-
sion. To prevent this, awax occlusal record is taken
from the patient. In this type of adevice, it is advis-
able to place the tongue just behind the crib during
the act of swallowing as well as during the tongue
resting position [8–12, 17–19].
The therapy of such type usually lasts between
18–24 months and is divided into 2or 3 steps of
equal length, i.e. 6–8or 12 months: active therapy,
aretention phase in which the appliance is worn
for 24 hours a day, and a night retention phase
[8–12, 17–19].
Hybrid Habit Correcting Appliance (HH-
CA) is astandard wire crib in the shape of bend-
ed arches. In the middle part, i.e. next to the pa-
pilla incisiva, it has apractice tongue bead. In the
area of the molars there are U-shaped arches. The
approximate treatment time with this appliance is
12 months (6 months of active therapy and
6months of retention) [11] (Fig. 4a, b).
Fig. 4a. Hybrid Habit Correcting Appliance (HHCA)
Fig. 4b. Hybrid Habit Correcting Appliance (HHCA)

S. Osiewacz, M. Jurecka, E. Pawłowska
232
Mandibular Lingual Arch and Spurs (MASP)
is a crib attached to the first molars in the low-
er arch. There are 6 little metal pieces of differ-
ent thickness soldered to the lingual arch. Each of
these pieces after mounting is adjacent to the lin-
gual surface of 6mandibular teeth (from one ca-
nine to the opposing one). The approximate ther-
apy time is 14 months (8months of active therapy
and 6months of retention) [12].
Sohinderjit et al. [10] modification is com-
prised of adouble arch placed in the jaw. The ap-
proximate therapy time is 21 months. The active
therapy lasts between 6–8months and after that
there is aretention phase of the same length. Next,
the authors advise the patient to wear the appliance
only during the night for another 6–8months.
Appliances Composing
Self-Standing Elements
Bonded Directly to Upper
and Lower Incisors
Bondable Lingual Tongue Spurs (BLTS,
Tongue Tamers, Ortho Technology, Tampa, Flori-
da, USA) are bonded to the lingual/palatal side of
the incisors and the lateral mandibular and maxil-
lary teeth. The method of positioning and placing
cribs on the teeth is not very different from the one
used by placing orthodontic brackets in all types
of fixed appliances. The approximate therapy time
is 6.5month [14].
Lingual orthodontic (LO) are braces of 7th
generation (Ormco Company, Orange, Califor-
nia, USA) adjusted to be bonded in a lingual
method. They contain little hooks which prevent
the tongue from being placed anteriorly. During
the treatment, a patient is obliged to do postural
tongue exercises. The approximate treatment time
is 12 months [15].
The correction of the tongue dysfunction dur-
ing the swallowing and rest position as well as the
elimination of oral habits meanwhile leads to long-
term stabilization of the anterior open bite treat-
ment. Huang et al.[19], Justus[8] and McRea[14],
who treated tongue dysfunction with the use of
tongue cribs attached to the first permanent mo-
lars, confirmed these results. Huang et al.[19] ran
an observation among 33patients (26 at the age of
puberty, 7adults). All the adult patients kept the
correct overbite, 17% of pubertal patients lost the
appropriate contact between incisive teeth. Jus-
tus[8] applied the crib for 2young patients (8and
9years) with anterior open bite and 1adult patient
(34 years) with distoclusion and incisor protru-
sion caused by anterior open bite. After achieving
the appropriate tongue position, Justus observed
along-term stability in the frontal part of the an-
terior open bite treatment. He also presents apre-
dominance of acrib mounted to the rings over the
systems glued directly to the lingual/palatal sur-
face of the incisive teeth. In his opinion, the first
method makes it possible to correct adental arch
on the level of molars[8]. It also has grapples on
rings, among others, for headgear, it is cheap and
easy to perform in adental practice. McRea[14],
thanks to the BLTS, gained aright overlapping of
upper incisors over lower ones among 11 out of
12patients at the age of 7–18years with anterior
open bite. Cases of the same malocclusion with
tongue dysfunction treatment are also described
with the use of fixed appliances. 39patients aged
18–49 were observed during aperiod of 1–11years
after active therapy. Geron et al.[15] reported that
the effectiveness of this method is 87.5% after
12months. In her opinion, it gives better results
than anterior open bite correction with the use
of surgery or microimplants. On the other hand,
the results are worse in comparison to fixed wire
cribs[15]. The authors suggest that for the mainte-
nance of results, it is necessary to retain an appro-
priate transversal size as well as the overjet.
In the first stage of wearing tongue cribs, both
fixed and removable, patients feel adiscomfort of
different intensity. Araujo et al. [12] carried out
surveys among patients wearing fixed cribs at-
tached on aring in the lower dental arch and al-
so among patients’ caretakers. 98.6% accepted the
treatment method. Difficulty in speaking and
chewing were the main inconveniences at the time
of wearing the appliance. The esthetic aspect was
also important. Ametal part of the device is vis-
ible when the mouth is open. Over half of the pa-
tients described the procedure as too aggressive.
The majority of subjects felt pain of different in-
tensity lasting up to 10 days [12]. This is consistent
with McRea’sobservations [14]. When using BLTS,
patients felt discomfort up to a fortnight, but in
the survey the procedure was not perceived as ag-
gressive. There were also no problems with speak-
ing or esthetics, because the appliance is invisible
because of its position behind the dental arches. In
the rest of the studies, it was assessed that getting
used to the crib fixed on rings in the upper arch
took from 1to 3weeks [8, 18, 19]. Patients report-
ed some problems with speaking, eating and swal-
lowing. This is consisent with Gajanan et al.’sob-
servations [9]. He also reported tongue irritation
and difficulties with keeping proper oral hygiene.
Lopez-Gavito [26] and Remmers[34] noticed
a high percentage of anterior open bite relapse
when the tongue cribs were not used. The for-
mer claimed that when patients were treated with
the conventional fixed appliance, in 35% of cas-

Tongue Function Correction Appliances 233
es there was arelapse in the form of an overbite
decrease of 3mm after 10years from the end of
active therapy[26]. He suggested that this might
be caused by inappropriate muscle work, which
is why the restoration of correct tongue posi-
tion and the elimination of incorrect oral habits
are so important. Remmers et al. [34] achieved
the correct overbite in 71% (n = 52) at the end
of orthodontic treatment. In 44% of cases there
was arelapse within 5years after the procedure.
Smith and Covell compared the correction of an-
terior open bite in patients treated conventional-
ly and those with the support of myofunctional
therapy in the form of speech therapy exercises
(acc.[35]). Those exercises aimed at re-education
of swallowing and strengthening oral-facial mus-
cles. The clinicians stated that the therapy which
includes the correction of tongue malpositioning
and its functions, significantly influences the fi-
nal treatment results[35].
One may conclude that the reason for failure
in open bite treatment might be the untreated in-
fantile swallowing type and anterior tongue rest-
ing position [26–28, 36, 37].
Conclusions
Cribs are a documented tongue dysfunction
treatment method, especially with anterior open
bite and lateral open bite in the period of late de-
ciduous, mixed and permanent dentition. Perma-
nent fixation ensures that the therapeutic effect is
not dependent on the patient’s full cooperation.
It significantly increases the effectiveness of the
therapy and long-term stability results. The cribs
located in removable appliances, despite the fact
they require the patient’sengagement, also bring
positive results. The discomfort connected with
this type of an appliance is temporary and this al-
so constitutes an advantage of this method.
References
[1] F T., I M., M S., N T., T K., T-Y T.: Relationship between
maxillofacial morphology and deglutitive tongue movement in patients with anterior open bite. Am. J. Orthod.
Dentofacial. Orthop. 2004, 125, 16–21.
[2] M S.E., M S.A., M E.M.: The effect of mandibular tongue cribs on dentoskeletal changes in
patients with Class II Division 1malocclusions. World J. Orthod. 2010, 11, 23–26.
[3] A F., E N.: Nonsurgical treatment of maxillary deficiency using tongue guard appliance: acase report.
J. Dent. Res. Dent. Clin. Dent. Prospects 2011, 5, 4, 136–140.
[4] S E., H-D M., K M.: The relationship between breathing and swallowing, and
malocclusion and articulation in young children. Pediatr. Pol. 2005, 80, 895–898 [in Polish].
[5] T J., F A., F A.: Effect of tongue thrust swallowing on position of anterior teeth.
J. Dent. Res. Dent. Clin. Dent. Prospect 2009, 3, 3, 73–77.
[6] Y S., B Z., S M.: Changes of tongue position and oropharynx following treatment
with functional appliance. J. Clin. Pediatr. Dent. 2007, 31, 287–290.
[7] Ł J., S W., L B.W.: Relation between oral breathing and the frequency of malocclusions and
respiratory efficiency in adolescence. J. Stoma. 2012, 65, 714–728.
[8] J R.: Correction of anterior open bite with spurs: long-term stability. World J. Orthod. 2001, 2, 219–223.
[9] G V., K W., L D.: Asingle appliance for the correction of digit-sucking, tongue-thrust, and pos-
terior crossbite. Pediatr. Dent. 2010, 32, 61–63.
[10] S S., P A., P D., S J.: Habit breaking appliance for tongue thrusting – amod-
ification. Indian J. Dent. Sci. 2011, 3, 3, 10–12.
[11] R A., G K., S S.J., S S., C R., K S.S.: Habit breaking appliance for multiple correc-
tions. 2013, http://dx.doi.org/10.1155/2013/647649.
[12] A E.A., A J., D M B G., G L., H M.C.: Perception of discomfort during or-
thodontic treatment with tongue spurs. Art. Pract. Dent. Enhan. 2011, 12, 260–267.
[13] S A., A J.: Finger-Sucking: causes, consequences and interceptive methods – literature
review. Dent. Med. Probl. 2009, 46, 354–358 [in Polish].
[14] MR J.E.: Bondable lingual spur therapy to treat anterior open bite. Master’sTheses 2009, 2–45. http://epubli-
cations.marquette.edu/theses_open/25.
[15] G S., W S., G Z.: Stability of anterior open bite correction of adults treated with lingual ap-
pliances, 2012; http://ejo.oxfordjournals.org.
[16] K M., M-K A.: The role of the tongue in the etiology of anterior open bite. Dent.
Forum 2007, 35, 2, 41–43 [in Polish].
[17] F D., M  M L., A Q A.P., C A Q C.: Acustomized method for
palatal crib fabrication. J. Clin. Orthod. 2013, 67, 406–412.
[18] J G., V S.: Open-bite malocclusion: treatment and stability. John Wiley and Sons, Oxford 2014,1st
ed., 1–18, 23–37.
[19] H G.J., J R., K D.B., K V.G.: Stability of anterior open bite treated with crib therapy. An-
gle Orthod. 1990, 60, 17–26.

S. Osiewacz, M. Jurecka, E. Pawłowska
234
[20] K A., S A., G K., M-B T.: Nonsurgical treatment of skeletal open
bite with relapse during retention period – case report. Dent. Forum, 2006, 34, 2, 91–96 [in Polish].
[21] V  S C.A., A  S M., B F., S C C.A.: Electromyographic analysis of
the orbicularis oris muscle in youngsters with Class II, Division 1and normal occlusion. Dental Press J. Orthod.
2011, 16, 5, 54–61.
[22] M S., R A.: The child’sspeech development in the light of sensory integration Continuo, Wrocław
2009, 1st ed., 17– 23, 55–74 [in Polish].
[23] O-G A.: Basics of orthodontics. PZWL, Warszawa 2009, 3rd ed., 64–66 [in Polish].
[24] G T.M.: Orthodontics, principles and practice. WB Sauders Co, Philadelphia 1972, 3rd ed., 168.
[25] P W.R., F J., S D.M.: Contemporary orthodontics. Elsevier Urban & Partner, Wrocław 2007,
1st ed., 142–150 [in Polish].
[26] L-G G., W T.R., L R.M., J D.R.: Anterior open bite malocclusion: Alongitudinal
10-year postretention evaluation of orthodontically treated patients. Am. J. Orthod. 1985, 87, 175–186.
[27] K B., B T., C A.: The prevalence of dysfunctions, parafunctions and malocclusions in
preschool children. Dent. Med. Probl. 2003, 40, 319–325 [in Polish].
[28] K E., A T.J.: Nonsurgical and nonextraction treatment of skeletal Class III open bites: Its long-term sta-
bility. Am. J. Othod. Dentofac. Orthop. 2000, 117, 267–287.
[29] P J.: The interception of the open bite in the early growth period. Angle Orthod. 1971, 41, 24–44.
[30] R A.P.: Open bite cases involving tongue habits. Int. J. Orthod. 1927, 13, 837.
[31] T S., B S., C C.: Tongue pressure changes before, during and after crib appliance therapy.
Angle Orthod. 2010, 80, 533–539.
[32] H H., M T., N M., M A., K K.: Severe dental open bite malocclusion
with tongue reduction after orthodontic treatment. Angle Orthod. 2001, 71, 228–236.
[33] H J., K S.: Malocclusion associated with abnormal posture. Bull. Tokyo Dent. Call. 2003, 44, 2, 43–54.
[34] R D., V’H R., B E., B S., K C.: Treatment results and long-term
stability of anterior open bite malocclusion. Orthod. Craniofac. Res. 2008, 11, 32–42.
[35] S J., C D.: Relapse of anterior open bites treated with orthodontic appliances with and without
orofacial myofunctional therapy. Am. J. Orthod. 2010, 137, 605–614.
[36] M M., F L., G V., V A., MN J.A., C P.: Stability of quad-he-
lix/crib therapy in dentoskeletal open bite: Along-term controlled study. Am. J. Orthod. Dentofac. Orthop. 2013,
143, 695–703.
[37] G G.M., H G.J., C S.S., C J., K T., H P.: Stability of treatment for anterior
open-bite malocclusions: ameta-analysis. Am. J. Orthod. 2011, 139, 154–169.
Address for correspondence:
Sandra Osiewacz
Department of Orthodontics
Medical University of Łódź
Pomorska 251
92-213 Łódź
Poland
E-mail: osiewacz.sandra@gmail.com
Conflict of interest: None declared
Received: 18.11.2014
Revised: 17.12.2014
Accepted: 3.01.2015