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ePaper created 2017-09-06, 09:11:22 | version 1.38.0
technique open bite closure Figs. 2a & b Lateral open bites commonly associated with skeletal maxillary constriction frequently have an ENT aetiology, producing secondary mouth breathing and a chronic imbalance between a lower tongue position and buccinator muscle activity (facial muscles). Figs. 3a & b The recommended positions of the tongues stars are mildly more gingival for the upper incisors (a). Figs. 4a & b Tongue Stars 2 with anterior box elastic, and active self-ligating brackets shown, and found to be a highly efective and eficient system for rapid open bite closure (ROC) of severe skeletal anterior and lateral open bites. Fig. 2a Fig. 2b Fig. 3a Fig. 3b Fig. 4a Fig. 4b generation tongue star was found to be efective in controlling the tongue for ROC. As a result, new modifications were then implemented by the author to improve the first generation tongue star (TS1). The second generation TS2 was made in Italy, by SIA Orthodontic Manufacturer, as a four-piece unit including: 1) Bracket body with nine rounded protrusions and six new, tie-wing undercuts. 2) Braze (for flexibility) to a bonding pad. 3) Separate 80-guage mesh for greater shear resistance and bond strength. The separate application of 80-gauge bonding mesh is used to improve bond strength during shearing forces on the lingual. TS2s are minia- turised in size similar to bondable buttons to be comfortable for patients and to facilitate oral hygiene. In addition, tie-wing like undercuts are designed into six of the nine protrusions to secure the placement of crossbite elastics. This is re- quired commonly in lateral open bite treatment that is associated with severe skeletal maxillary constriction (Figs. 2a & b). Where should TS2 be placed? Clinically, TS2s are bonded on the middle-third regions of the upper and lower canine-to-canine regions (Figs. 3a & b). The TS2 position recom- mended for the upper anteriors is just gingival to the middle third to prepare for the corrected upper incisors to approach contact with the lower inci- sors during rapid open bite closure. This provides a total of 12 TS2s on the day of first bonding of a full Siamese twin, active self-ligating appliance recommended with new .018” × .014” NiTi, iArch wires (SIA Orthodontic Manufacturer). In addi- tion, for each open bite treatment, TS2s are ap- 12 ortho 2/2017