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Oral Screen - An Effective Myofunctional Appliance: A case report

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J Clin Den Res Edu • October - December 2013

Received : 11/Jun/2013
Accepted : 28/Aug/2013
Oral Screen - An Effective Myofunctional
Appliance: Case Reports
† †† †††
Dr. Ankita Arora, Dr. Savitha Sathyaprasad, Dr. Prateek B Kariya,
Dr. Nilesh Deshpande *
† Senior Lecturer, Department of Pedodontics and Preventive Dentistry, K. M. Shah Dental College and Hospital, Vadodara, Gujarat, India
†† Professor & Head, Department of Pedodontics and Preventive Dentistry, KVG Dental College and Hospital, Sullia, Karnataka, India
††† Senior Lecturer, Department of Pedodontics and Preventive Dentistry, K. M. Shah Dental College and Hospital, Vadodara, Gujarat, India
* Assistant Professor, Department of Pedodontics and Preventive Dentistry, Government Dental College and Hospital, Nagpur, Maharashtra, India

Abstract: Development of dentition is influenced by balance of orofacial musculature and its function. Equilibrium of
opposing forces from buccal soft tissues and tongue maintain the dentition in pleasing form and function. Disruption of
this balance affects developing dentition and sets in malocclusion of varying degrees. Screening therapy works on the
principle of screening or eliminating abnormal muscle forces, thus preventing development of malocclusion and / or
intercepting it, if malocclusion has already set in. The following case report discusses effective correction of developing
malocclusion and orthopedic effects achieved with the use of oral screen.
KEY WORDS
Oral screen; Mouth breathing; Myofunctional exercises; Orthopedic effects; Interceptive orthodontics

INTRODUCTION CASE REPORTS

Functional appliances refer to a variety of appliances CASE 1
designed to alter the arrangement of various muscle An 8 year old girl reported to the department of
groups that influence the function and position of the Pedodontics and preventive dentistry, KVG Dental
mandible in order to transmit forces to the dentition College and Hospital, Sullia, with the chief complaint
and basal bone.[1] Their uniqueness is their mode of of forwardly placed upper front teeth. On eliciting
force application. They do not act on the teeth like parents revealed the history of mouth breathing habit.
conventional appliances, using mechanical elements On extraoral clinical examination, leptoprosopic facial
such as springs, elastics or ligatures, but rather form, convex facial profile with lower lip trap,
transmit, eliminate or guide natural forces (e.g. muscle hypotonic upper lip and hyperactive mentalis activity
activity, growth or tooth eruption). Cheney,[2,3] was noticed. Intraoral examination revealed mixed
introduced oral shield, a myofunctional appliance that dentition stage. Assessment of occlusion revealed
was designed to activate the lip and facial muscles to endon molar relation bilaterally, an overjet of 11mm
move the maxillary incisors into a more favorable was present with flared incisors. ENT referral and
position and to establish lip function that would consultation was taken and Mouth breathing was
counter balance the force of tongue against the teeth. classified to be anatomic as the lip morphology did not
Some clinicians,[4,5] explain this therapy using permit the girl to close her mouth completely.
functional matrix concept of Moss,[6] wherein screen TREATMENT PLAN
extends the capsular matrix to a more normal space, A custom - made acrylic oral screen was planned for
thus allowing musculature to function over an artificial interception of mouth breathing habit with a metal
dentoalveolar shell. Screen removes untoward holding loop modification to aid in myofunctional
deforming forces from the developing dentition, exercises for correction of malocclusion. Parents were
allowing the teeth and alveolar process to move down explained and educated about the treatment plan and
and out to matrix provided by acrylic screen. Proper consent taken.
morphology and function then combine to ensure the APPLIANCE FABRICATION
stability of acquired relationship.[4] The purpose of Upper and lower alginate impressions were recorded
following article is to present efficacy of oral screens giving special attention to accurate reproduction of the
in producing orthopedic effects and correction of depths of vestibular sulcus and labial fold and poured
malocclusion. with dental stone .A construction bite with modelling
wax was recorded, after guiding the patient to move

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Myofunctional Appliance Volume 2 • Number 5

Table 1: Pre-treatment and Post-treatment Cephalomatric Values of Case 1

Parameter Pre-treatment value Post-treatment value
0
SNA 80 810
0
SNB 72 770
0
ANB 8 40
U1 to NA(mm) 9mm 4mm
U1 to NA(angle) 400 250
U1 to NB(mm) 5mm 5mm
U1 to NB(angle) 230 270
0
Inter-incisal angle 109 1240
0
Nasolabial angle 84 900

Table 2: Pre-treatment and Post-treatment cephalometric values of case 2

Parameter Pre-treatment value Post-treatment value
SNA 770 770
0
SNB 73 740
0
ANB 4 30
U1 to NA(mm) 12mm 8mm
U1 to NA(angle) 420 340
U1 to NB(mm) 8mm 8mm
U1 to NB(angle) 320 320
0
Inter-incisal angle 102.5 1100
0
Nasolabial angle 84 900

the mandible forward to edge to edge incisor exercise regimen of half hour daily for another 3
Relationship.[4] Wax construction bite was chilled and months. Results were stable with no relapse.
replaced on casts and mounted on articulator. Fig. 1
Appliance was designed to contact only upper incisors
and shield lower lip away by blocking lower anterior
region with wax. Oral screen was outlined on the casts
and fabricated from self-cure acrylic resin with metal
ring incorporated; it was then finished and polished.
INSTRUCTIONS TO PATIENT
The patient was instructed to wear the appliance night
time along with daily half an hour of myofunctional
exercises. Child was instructed to improve lip
competence and tonicity by pulling on the holding ring
and closing lips against the pull, trying to retain the
appliance within mouth.
RESULTS ACHIEVED
At the end of 3 months of treatment with the screen,
difference in patients profile and facial form was
appreciable. Lip competency achieved with elimination
of lip trap. Overjet reduced by 7mm and arch
alignment attained (Fig. 1). The cephalometric analysis
(Table 1) after oral screen therapy demonstrates
favorable forward growth of the mandible. There was a
reduction of maxillary incisor proclination. The post
treatment value of SNB at 770 indicates reduction in
ANB due to advancement of mandible. Patient was
asked to continue wearing the appliance and follow
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J Clin Den Res Edu • Oct - Dec 2013 Arora A, Sathyaprasad S, Kariya PB, Deshpande N

CASE 2 maintaining contact with upper posterior teeth and

A 13-year-old male patient presented with the chief palatal tissue.[4] By treating this nonphysiologic reflex
complaint of more visibility of upper front teeth and pattern, by substituting screen for anterior lip seal,
inadequacy in closing the lips. Patient elicited history added benefit of an improved posterior oral seal is also
of mouth breathing habit. On various mouths breathing obtained. There is a negative air pressure within the
tests patient was diagnosed to be anatomic mouth mouth; that is, a pressure below that of the atmosphere.
breather secondary to his incompetent lip seal. The tongue is held back, so that its full bulk is
Extraoral examination revealed mesoprosopic facial available for spreading the dental arches, and for
form, convex facial profile with potentially competent increasing the height of the bite, If this perfectly
and protrusive lips, hypotonic upper lip and everted normal function is present throughout the entire period
lower lip. Intraoral examination revealed well aligned of the growth of the framework of the face, the whole
arch, with proclination and spacing of maxillary face will exhibit harmony of size and form in its
anterior teeth producing overjet of 9mm. On checking relation to the cranium, with larger dental arches and a
occlusion class 2 molar relation was noticed and class flatter palate.[8] Though it is important to examine
1 canine relationship was noticed. tongue posture in these habitual mouth breathing cases
TREATMENT PLAN as screening therapy is well indicated in tongue posture
Oral screen therapy for interception of mouth breathing that is retracted with humped dorsum and flat surface
habit and achieving lip competency by strengthening (as common in class II malocclusions). However, if
lips with lip exercises was planned. Impression, tongue is flat and anteriorly postured, the screen is
construction bite, fabrication procedure followed was contraindicated because of tendency for development
same as described above. Oral screen was delivered of class III malocclusion. [4] Another advantage of this
and similar instructions given to patient. treatment approach is that it is not likely to produce
RESULTS ACHIEVED iatrogenic damage.
On examining the patient three months later, Fig. 2
remarkable profile improvement was noticed with lip
competency established. On Intraoral examination,
overjet reduced by 4.5mm (Fig. 2). Post treatment
cephalograph showed marked reduction in upper
incisor proclination in distance as well as in angulation.
As skeletal relationship of patient was within normal
range, marked maxillary dental retraction was achieved
with minimum skeletal effects.
DISCUSSION
An oral screen is simple myofunctional appliance that
eliminates abnormal forces of lips and perioral
musculature on dentoalveolar structures and allows
forces of tongue to expand the lower arch.[4] It is
effective in treating acquired malocclusions due to
abnormal habits like lip sucking,[7] mouth breathing
and nasal blockage. Kraus defined this method as
“inhibition therapy” that is inhibiting the initial cause.
It forms artificial template for lips and cheek to mold
them, correcting the function of musculature
surrounding the developing dentition and thereby
correcting the form. Dickin HO attributes its mode of
action is to intercept mouth breathing, restoring natural
nasal breathing and hence bringing in to play variety of
important natural forces.[8] Due to habitual mouth
breathing, both the anterior and posterior seals are not
closed, the tongue lies low and flat, without

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 Myofunctional Appliance Volume 2 • Number 5

Results of therapy in the cases discussed are marvel in 7. Prasad VN, Utreja AK. An oral screen for early
reiterating interest in oral screen. Construction of intervention in lower-lip-sucking habits. J Clin
appliance by advancing the mandible forward in edge Orthod. 2005;39:97-100.
to edge incisor relationship and myofunctional 8. Dickin HO. Oral Screens in the Treatment of
exercises form working principle of this appliance in Certain Dental Irregularities. Proc R Soc Med.
producing esthetic results here. This is all the more 1934;27:1411-20.
indicated in so called functional retrusion cases (as in
Case 1 of our report), here mandible is guided up and
back from postural rest position to habitual occlusion,
establishing a new proprioceptive and functional
engram and hence normal form is established. As
success of any removable appliance therapy is
correlated to patient compliance, so is the case with
oral screens. Effective education and reinforcement of
children and parents help in gaining compliance. In
both above cases, treatment with oral screen not only
yielded effective clinical results but also had strong
influence on patients’ psychological bearing, instilling
in them confidence and positive attitude.
CONCLUSION
Oral screens are important in eliminating harmful or
deleterious muscle forces (primary / secondary to
habits) and facilitates reestablishment of normal
function and hence normal form ensues. As aptly said
an ounce of prevention is worth pounds of cure, Oral
screens may prove useful in timely intervention of
developing deleterious malocclusion.
CONFLICT OF INTEREST & SOURCE OF
FUNDING
The author declares that there is no source of funding
and there is no conflict of interest among all authors.
REFERENCE
1. Bishara SE, Ziaja RR. Functional appliances: a
review. Am J Orthod Dentofacial Orthop.
1989;95:250-8.
2. Cheney EA. Factors in the early treatment and
interception of malocclusion. Am J Orthod. 1958;
44:807-26.
3. Cheney EA. Treatment planning and therapy in
the mixed dentition. Am J Orthod. 1963;49:568-
80.
4. Rakosi T. Principles of functional appliances. In:
Graber TM, Rakosi T, Petrovic AG. Dentofacial
Orthopedics with Functional Appliances, 2nd ed.
St. Louis: Mosby;1997. p. 85-9.
5. McNamara JA. Neuromuscular and skeletal
adaptations to altered function in the orofacial
region. Am J Orthod. 1973;64:578-606.
6. Moss ML, Salentijn L. The capsular matrix. Am J
Orthod. 1969;56:474-90.

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