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Myofunctionals & airways – separating myth from reality: Peter Miles. Episode 79. April 4th 2021

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Hosted by
Farooq Ahmed

 

Join me as I summarise Pater Miles lecture exploring myofunctional appliances and the literature of the appliance

 

The following was covered

1.     Myofunctional appliances

2.     Evidence of Occlusal changes

3.     Airway influencing growth

4.     Myofunctional therapy

5.     Orthodontists role in Sleep disorder breathing

 

Claims by some manufacturers of myofunctional appliances:

·      Incorrect breathing from 2 years of age

·      Incompetent lips & mouth breathing – aesthetic effects

·      Crooked teeth

·      Long face

·      Behavioural changes, tired / hyperactive

 

 

Claimed effects of myofunctional appliances treatment

·      Improve facial growth

·      Skeletal growth

·      Better alignment

·      Stable

 

Myofunctional Appliances how do they work?

 

Design – off the shelf design

·      Monoblock Kesling positioner type appliance 1945:

·      Double mouthguard postured into edge to edge position

·      Postured edge to edge

·      Example Occlus-o-guide, LM activator, Myobrace

 

Effects:

·      Retrocline uppers, procline lowers

·      Disocclusion posterior teeth = overeruption of posterior teeth, overbite improvement

 

 

Evidence

Occlusal changes with appliances

 

 

·      Eruption Guidance Appliance, T4K, LM activator AJODO 2008 Angle 2019

·      Overjet  2mm improvement

·      Overbite 2mm improvement

·      Crowding reduction 2mm

·      Relapse towards baseline Janson, significant for OB crowding and 25% for OJ 2007

·      Time 13-43 months

o   Small changes over a long period, options to treat later Obrien 2003

 

Myobrace Vs Activator  EJO 2015

·      Poor compliance: PFA 70% non-compliance, 53% Activator non-compliance (Twinblock 84% compliance AJODO 2003)

·      2018 cost benefit analysis: PFA minimised costs

 

Airway evidence

 

Difficult to show direct changes, so related parameters are used.

 

Claimed issues with narrow airway and mouth breathing:

1.     Dental: Crooked teeth and arches

2.     Lip incompetence

3.     Skeletal: long face

4.     Behaviour tired and hyperactive

 

 

1: Crooked teeth and narrow arches

o   Prevalence of malocclusion similar in Paediatric sleep disorder breathing in the population J den Sleep Medicine 2017

 

2: Lip incompetence

 

·      Vig 1979

o   Lip growth accelerate sand overtakes facial height 9-13

o   Lip incompetence will improve with age

·      Vig 1881

o   Lip incompetence no difference in nasal airflow

§  Cannot conclude lip incompetence = mouth breather

o   Proffit – long face still use nose to breath, but less than normal face type

 

 

3: Skeletal: long face

 

·      Craniofacial morphology metal analysis: AJODO 2013

o   Paediatric OSA statistically significant in class 2, 1.5-1.6o – NOT clinically significant or diagnostically useful

§  Direct casual relationship of craniofacial structure and paediatric sleep disorder is unsupported in meta analsysis

 

 

Myofunctional therapy

 

 

 

Oropharyngeal exercises

·      Aim to improve tone of surrounding muscles, phalangeal muscles, soft palate,  airway – increase patency

o   Reduce AHI index by half short term studies 3 months Am J resp Crit Car Med 2009, Sleep Med 2013

 

Orthodontists role in Sleep Disorder Breathing

·      We are not the primary care giver

·      Main role: Screening / Assessment, questionnaire

o   Paediatric sleep questionnaire

§  Effective ruling out OSA / SDB

Join the discussion

3 comments
  • Interesting podcast. Thanks
    From what I hear, there is no real mention of the type of myofunctional appliances that were evaluated and how treatment assessment and planning was carried out. To posit that only 2mm of overjet and crowding resolution is possible really depends on the how treatment was carried out. It’s like saying that based on a study of car speeds it is not possible for a car to exceed 100mph (cars used in study were a nissan micra and a ford fiesta).
    I have been using these techniques for decades and have recently corrected a 13mm overjet and gained over 6mm in transverse arch development. Those of us who do this routinely know this not only achievable but actually pretty straightforward if you start treatment in the mixed dentition stage.
    Most orthodontic teaching in the UK, and probably elsewhere, is aimed at getting the teeth to fit into whatever jaw size we are presented with. Having set up a successful Orthodontic Diploma course, I know this to be the case, but as far I’m concerend, treatment at this stage has very little to do with teeth, which is why looking at occlusion is misleading. The reason I carry out myofunctional treatment is to optimise the development and relationship of the jaws as a child grows. Once this has been achieved tooth alignment is realtively straighforward and usually a lot quicker than waiting until all the adult teeth have erupted.
    Would be interesting to hear your thoughts.
    Regards
    Biju Krishnan

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