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ePaper created 2017-09-06, 09:11:22 | version 1.38.0
technique open bite closure Tongue star 2 (TS2) – System for rapid open bite closure Author: Dr John Constantine Voudouris, Canada Introduction The aim of this article is to discuss a new system to treat severe skeletal open bite malocclusion using a new, miniaturised tongue star 2 (TS2) device. In the first part, the author will focus on clinical evaluation of TS2, the second part is devoted to tongue thrusting, open bite aetiology and its treatment. Clinical evaluation of TS2 Methods Clinical applications of the first generation of the tongue star devices with nine rounded protru- sions, initially manufactured as one-piece, were evaluated over a two year period in the private ortho dontic clinic of the author. Improvements were noted and implemented to develop a second generation tongue star 2. The new TS2 was made in Italy by SIA Ortho- dontic Manufacturer as a four-piece unit includ- ing a body with six tie-wing undercuts for cross- bite elastics, brazed to the bonding pad for greater flexibility, and 80-gauge mesh for higher bond strength against lingual shearing forces. For each orthodontic patient, 12 TS2s were bonded, including six tongue stars positioned on the palatal aspects of the gingival middle-third of the upper six anterior teeth from canine to canine, and six tongue stars were placed on the lingual middle-third of the lower anteriors from canine to canine. TS2s were the central device of a four com- ponent system to treat severe anterior, and lat- eral tongue positioning. The second component of the system included tongue stars bonded at the same time as a Siamese twin, active self- ligating appliance that employed the third com- ponent of new initial NiTi iArch wires for light force control. These specialised archwires with a higher vertical dimension than horizontal di- mension (for example .018” × .014”) acted closer to the canter of resistance of the root for earlier moments of incisor torque, and were incorpo- rated with curve of Spee for the lower arches, and reverse compensating curve on the upper arches to further facilitate incisor re-eruption. The fourth component of the system included a vertical box elastic from the upper lateral incisors to the lower canines (1/4”, 4.5 oz) that was addi- tionally applied on the labial aspects for light in- cisor re-eruption in conjunction with the TS2s. Clinical results and conclusion TS2s were found to be highly efective in restrict- ing anterior tongue positioning for rapid open bite closure (ROC). No clinically significant root resorp- tion was noted that appeared to be related to the light forces applied. Therefore tongue stars are recommended for rapid open bite closure since they cause the tongue to be retracted during treat- ment to permit anterior dental re-eruption. Multi-directional forces of anterior tongue positioning (tongue thrusting) The tongue afects the alignment of the dentition because it has one of the strongest sets of muscles in the human body capable of reflex.1 Malocclu- sions involving open bites are classified as two 10 ortho 2/2017