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ePaper created 2017-09-06, 09:11:22 | version 1.38.0
open bite closure technique types, anterior open bite located in the area of the anterior canine-to-canine area, and lateral open bites located at the premolars and molars. In open bite malocclusions, the tongue attempts to seal the oral cavity for efective swallowing (suction-efect) in an unnatural, anterior posi- tion. In addition, the tongue thrusts both supe- riorly and inferiorly. This results in progressive opening of the bite preventing eruption of the upper and lower incisors. It is significant that both the upper and lower incisors are not only intruded, but also proclined often by the unnatural ante- rior tongue position between the incisors. Sev- eral factors have been associated with open bites. Aetiology of open bite includes: 1) Primary anterior, superior and inferior tongue positioning in conjunction with lateral tongue thrusting. 2) Allergies, asthma, nasal obstruction from for example nasal septum deviation as a result of chronically inflamed turbinates, chronically enlarged tonsils and adenoids, etc. 3) Primary, habitual mouth breathing (or 2º), as- sociated often with anterior, superior and in- ferior tongue positioning. 4) Skeletal downward and backward growth of the mandible (dolichocephalic). 5) Muscle hypoactivity (an extreme pathological example is observed in muscular dystrophy patients). 6) Dental delay of incisor eruption and overerup- tion of the molars. 7) Habits such as thumb-sucking, finger- sucking, blanket-sucking, over-retention of soothers after the age of 6. Several appliances have been developed to con- trol the anterior tongue positioning including the traditional cemented tongue-cribs soldered to molar bands, and bondable tongue habit- breakers type brackets on the palatal of the upper incisors. These were often bulky, uncomfortable and cumber some for patients. What is TS2? The first tongue star was developed in 2014 with nine-reminder protrusions rounded at the tips to prevent anterior tongue positioning. It was man- ufactured as a one-piece bracket and tested clin- ically for two years by the author in his private orthodontic clinic in Toronto, Canada. This first Fig. 1 Fig. 1 Anatomy of the TS2: The seven characteristic features of the second generation tongue star 2 (TS2). ortho 2/2017 11