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Correction of skeletal Class II malocclusion with camouflage orthodontic treatment generally requires the extraction of the maxillary first premolars to provide space for retraction of the maxillary incisors. Retraction of incisors changes the position of the incisors and the dimensions of the dental arch, which can cause changes in tongue posture and affect the upper airway. The purpose of this study was to determine the relationship between premolar extraction on the dimensions of upper airway and tongue posture in skeletal Class II malocclusion. This study was designed as a retrospective cohort using lateral cephalometric radiographs before and after orthodontic treatment. The samples in this study consisted of 44 samples of adult patients (n = 44) aged 18-40 years, who were divided into 2 groups: 22 subjects treated without premolar extraction and 22 subjects treated with premolar extraction. Lateral cephalometric radiographic analysis were used to measure the dimensions of the upper airway by analyzing superior posterior airway space (SPAS), middle airway space (MAS), inferior airway space (IAS), vertical airway length (VAL), and tongue posture (tongue length and height tongue) using imageJ software. No Statistically significant different changes were observed as seen from the following results: SPAS (p = 0.709), MAS (p = 0.365), IAS (p = 0.562), (p = 0.401), tongue length (p = 0.578), tongue height (p = 0.086) in the sample group without extraction premolar. No significant alterations in the upper airway and tongue posture measurement were observed in the sample group with extraction premolar. Premolar extraction with retraction on upper incisors did not affect upper airway dimensions and toung posture in skeletal Class II malocclusion.

Objectives: The aim of the study is to determine and correlate the effects of anterior teeth retraction on tongue position, posture and pharyngeal airway dimensions, in Angle’s Class 1 bimaxillary dentoalveolar proclination cases treated with all first premolar extraction. Materials and Methods: Pre and post treatment lateral cephalogram of fifteen Class I bimaxillary dentoalveolar proclination patients in the age group of 15-25years treated orthodontically as maximum anchorage cases with Preadjusted Edgewise Appliances (MBT prescription) and extraction of all first premolars were compared. Results: Tongue position analysis showed significant decrease in tg1: 2.2 +/- 1.52 mm (p = 0.001) and TGL: 4.2 +/- 3.877 mm (p = 0.001). Tongue posture analysis showed a significant decrease in Point 1: 1.48 +/- 1.92 mm (p=0.028), Point 2: 1.44 +/- 1.46 mm (p=0.008) and Point 5: 1.92 +/- 2.45 mm (p=0.026).Pharyngeal airway analysis showed significant increase in PNS-Ad1: 1.2 +/- 1.69 mm (p=0.016) while V-LPW: 2.0 +/- 3.047 mm (p=0.023) was decreased. No significant correlation was found between changes in total tongue length and velopharyngeal and glossopharyngeal airway. Conclusions: A significant reduction in the total tongue length particularly in the posterior region was observed after retraction. Also there was a reduction in the distance between root of the tongue and uvula, dorsum of the tongue and the roof of mouth in the posterior and anterior part of palate respectively. There was an increase in the lower nasopharyngeal airway and a decrease in the hypopharyngeal airway.

Background The aim of the study was to analyze the morphology and position of the tongue and hyoid bone in skeletal Class II patients with different vertical growth patterns by cone beam computed tomography in comparison to skeletal Class I patients. Methods Ninety subjects with malocclusion were divided into skeletal Class II and Class I groups by ANB angles. Based on different vertical growth patterns, subjects in each group were divided into 3 subgroups: high-angle group (MP-FH ≥ 32.0°), average-angle group (22.0° ≤ MP-FH t‐test was used to compare the position and morphology of the tongue and hyoid bone between skeletal Class I and Class II groups. One-way analysis of variance (ANOVA) was used to compare the measurement indexes of different vertical facial patterns in each group. Results Patients in skeletal Class II group had lower tongue posture, and the tongue body was smaller than that of those in the Class I group (P P P P > 0.05). Conclusion Patients with skeletal Class II malocclusion have lower tongue posture, a smaller tongue body, and greater occurrence of posterior inferior hyoid bone position than skeletal Class I patients. The length of the mandibular body in skeletal Class I patients with a horizontal growth type is longer. The position and morphology of the tongue and hyoid bone were not greatly affected by vertical facial development in skeletal Class II patients.

Objectives: To investigate the relationship between head posture, hyoid bone, tongue position and lower incisor inclination. Materials and Methods: The study sample consisted of 98 subjects (35 males, 63 females), who had a mean age of 17.7 years in the permanent dentition and with a skeletal Class I relationship. Lower incisor inclination, craniovertical, craniocervical and craniohorizontal postural variables, tongue and hyoid position and airway measurements were evaluated on lateral cephalograms taken in natural head position. The study sample was divided into two groups according to lower incisor inclination (48 had IMPA90 ⁰ with a mean degree of 102.84) and a Student-t test was performed to compare and describe head posture, tongue and hyoid bone positions.Results: The subjects with upright incisors had a more posteriorly positioned hyoid bone relative to the mandibular symphysis compared with the subjects with flared incisors (p

Namen in cilji. Z namenom izdelati priporočilo za nacionalni preventivni program glede uporabe funkcionalne diagnostike v preprečevanju odprtega griza mlečnih sekalcev (OGS) in artikulacijskih motenj (AM) pri predšolskih otrocih, s poudarkom na preiskavi jezika s tridimenzionalnim ultrazvokom (3DUZ), smo sledili ciljem: ugotoviti pogostost OGS v mlečnem zobovju in AM v ciljni skupini opazovancev, oceniti povezanost OGS in AM z orofacialnimi in otorinolaringološkimi (ORL) odkloni, ovrednotiti lego jezika pri otrocih z in brez OGS in AM ter primerjati lego jezika pri otrocih z in brez OGS in AM ter pri otrocih brez teh nepravilnosti. Preiskovanci in metode. V epidemiološko in klinično raziskavo je bilo vključenih 446 predšolskih otrok, starih od 3 do 7 let, 236 dečkov in 210 deklic v raziskovalni in kontrolni skupini. Zgradba raziskave je bila razdeljena na štiri ločene študije. Otroci so bili ortodontsko pregledani v vrtcih v Posočju, starši so z odgovori v vprašalnikih podali podatke o orofacialnh in ORL odklonih, boleznih, razvadah in AM. Pri otrocih z OGS v mlečnem zobovju so bili v kliničnem delu opravljeni čeljustnoortopedski in ORL pregled z akumetrično preiskavo sluha ter logopedski pregled artikulacije. Naredili smo obrazne in intraoralne fotografije, registracijo zagriza v vosku ter odtise zobnih lokov za izdelavo mavčnih študijskih modelov. S 3DUZ je bila ovrednotena lega jezika pri otrocih z OGS in v kontrolni skupini brez OGS. Za posnetke je bil uporabljen 3DUZ sistem Voluson 730, za analize, obdelavo in rekonstrukcijo program 4D View verzija 5.0. Lego jezika so neodvisno pregledale specialistke radiologije, ORL ter čeljustne in zobne ortopedije. Za statistično analizo je bil uporabljen R-program, metode opisne statistike, Mann-Whitney in hi-kvadrat oz. Fisherjev eksaktni test za primerjave parametrov, McNemarjev test in metoda logistične regresije. Meja statistične značilnosti je bila na p=0.05. Rezultati. Pogostost OGS je bila 7,2 %, pogostost AM je bila 30,2 %. AM so bile prisotne pri večini otrok z OGS, predvsem sigmatizem in rotacizem ter njune kombinacije. Skupini otrok z OGS in kontrol sta se značilno razlikovali glede nepravilne lege jezika in glede AM. Pri otrocih brez AM iz obeh skupin je bila nepravilna lega jezika ugotovljena manj pogosto kot pri otrocih z AM. Po starostni prilagoditvi je regresijski model pokazal, da je pri otrocih z nepravilno lego jezika večja verjetnost za OGS kot pri drugih. Med nepravilno lego jezika in AM je močna povezanost. S 3DUZ vrednotenjem smo odkrili največje število otrok z nepravilno lego jezika, čeprav med kliničnimi pregledi ni bilo statistično značilne razlike. Zaključki. 3DUZ ovrednotenje lege jezika je otroku prijazna, hitra, neškodljiva, ponovljiva, zanesljiva in objektivna metoda za vrednotenje nepravilnosti ter zgodnje rehabilitacije. Interceptivni ukrepi za preprečevanje OGS in AM naj bodo vključeni v vse tri nivoje preventivnega ortodontskega programa in v publikacije NIJZ o ustnem zdravju. Starše je priporočljivo zgodaj seznaniti o pomenu drže zaprtih ust, dihanju skozi nos, pravilne lege jezika, zgodnji odpravi razvad, izboljševanju orofacialnih in ORL odklonov ter izvajanju miofunkcijskih vaj takoj po izrasti mlečnih zob. Priporočamo čeljustnoortopedski pregled, dosledno izvajanje logopedskega programa PLP 5 ob pregledih pred vstopom v šolo ter zgodnjo napotitev k zobozdravniku, specialistu čeljustne in zobne ortopedije ter logopedu, kadar so poleg funkcionalnih prisotni tudi morfološki odkloni in artikulacijske motnje. Background and aims. The aims of this study were to assess the prevalence of anterior open bite (AOB) and articulation disorders (AD) in deciduous dentition and their association with low tongue posture, orofacial disorders and impaired ENT condition. The aim was to assess the resting tongue posture in subjects with and without AOB and AD using a three-dimensional ultrasonography (3DUS) and to compare the method to orthodontic and ENT assessment. These findings would allow us to supplement basics of national preventative protocol for early developmental interception of both, AOB malocclusion and AD. Subjects and methods. The subjects were 446 children aged 3 - 7 years, 236 boys and 210 girls visiting local kindergartens in Posočje, Slovenia. The survey has 4 different studies. The subjects were orthodontically examined for AOB malocclusion, orofacial and ENT impairment, oral habits, AD and questionnaires were answered by their parents. Participants presenting AOB in deciduous dentiton were allocated to the research group, the rest were included to the control group (CG). Further orthodontic clinical examinations, facial and oral photographs and dental casts were obtained in AOB subjects only. An experienced ENT specialist the ENT condition and a speech therapist examined the AD. A 3DUS assessment of resting tongue posture was assessed by an experienced radiologist and an orthodontist independently. The device used was 3DUS Voluson 730 (General Electrics Healthcare). The 3DUS data were analysed by 4D View Programe 5.0. The R-Programe was used for collated data statistical analysis with descriptive statistic, Mann-Whitney, chi-square or Fisher's exact test, McNemar test and the multiple logistic regression model. Statistical significancy was set at p < 0.05. Results. The 32 preschool children aged 3.5 -7 years (mean 5.0 years ± 0.9 y) presented AOB in the deciduous dentition the prevalence of AOB was 7.2 % and the prevalence of AD was 30,2 %. The subjects with AOB presented higher occurrence of orofacial and ENT irregularities and AD, mostly sigmatism, rhotacism and their combinations. In children without AD from both groups, the improper tongue posture occured less frequently than in children with AD. The 3DUS detected the highest number of AOB subjects with low tongue posture and there was no significant difference among the three clinical assessments. Conclusions. The results confirmed a strong relationship among AOB, low tongue posture and AD. The 3DUS assessment is objective, reliable, non-invasive, radiation free, no time consuming and child-friendly method for functional assessment of the tongue posture in preschool children and should become a useful tool in everyday clinical practice for functional diagnostics, prevention of the development of dentofacial deformities, and for treatment planning of early rehabilitation in preschool children with AOB and AD. The child and his/her parents should get the early information about the proper resting tongue posture, lip closure and nasal breathing. In this way, an optimal condition in the oral cavity for proper orofacial and articulation development can be created. Preventative procedures for early AOB development interception should be included into all three levels of national preventative protocol to enhance early interception of sucking and non-sucking habits, orofacial or ENT impairment and a timely PLP 5 screening for referrals to orthodontists and speech therapists.

The aim of this study was to pinpoint the cerebral regions implicated during swallowing by comparing the brain activation areas associated with two different volitional movements: tongue protrusion and tongue elevation. Twenty-four healthy subjects (11&mdash, males 22 &plusmn, 2.9 y, 13&mdash, females 23 &plusmn, 4.1 y, were examined through functional magnetic resonance imaging (fMRI) while performing two different swallowing tasks: with tongue protrusion and with tongue elevation. The study was carried out with the help of fMRI imaging which assesses brain signals caused by changes in neuronal activity in response to sensory, motor or cognitive tasks. The precentral gyrus and the cerebellum were activated during both swallowing tasks while the postcentral gyrus, thalamus, and superior parietal lobule could be identified as large activation foci only during the protrusion task. During protrusion tasks, increased activations were also seen in the left-middle and medial frontal gyrus, right thalamus, inferior parietal lobule, and the superior temporal gyrus (15,592-voxels, Z-score 5.49 &plusmn, 0.90). Tongue elevation activated a large volume of cortex portions within the left sub-gyral cortex and minor activations in both right and left inferior parietal lobules, right postcentral gyrus, lentiform nucleus, subcortical structures, the anterior cingulate, and left insular cortex (3601-voxels, Z-score 5.23 &plusmn, 0.52). However, the overall activation during swallowing tasks with tongue elevation, was significantly less than swallowing tasks with tongue protrusion. These results suggest that tongue protrusion (on inferior incisors) during swallowing activates a widely distributed network of cortical and subcortical areas than tongue elevation (on incisor papilla), suggesting a less economic and physiologically more complex movement. These neuromuscular patterns of the tongue confirm the different purpose of elevation and protrusion during swallowing and might help professionals manage malocclusions and orofacial myofunctional disorders.

Background Tongue posture plays an important role in the etiology of anterior open bite (AOB) and articulation disorders, and is crucial for AOB treatment planning and posttreatment stability. Clinical assessment of tongue posture in children is unreliable due to anatomical limitations. The aim of the study was to present functional diagnostics using three-dimensional ultrasound (3DUS) assessment of resting tongue posture in comparison to clinical assessment, and the associations between the improper tongue posture, otorhinolaryngological characteristics, and articulation disorders in preschool children with AOB. Patients and methods A cross-sectional study included 446 children, aged 3–7 years, 236 boys and 210 girls, examined by an orthodontist to detect the prevalence of AOB. The AOB was present in 32 children. The control group consisted of 43 children randomly selected from the participants with normocclusion. An orthodontist, an ear, nose and throat (ENT) specialist and a speech therapist assessed orofacial and ENT conditions, oral habits, and articulation disorders in the AOB group and control group. Tongue posture was also assessed by an experienced radiologist, using 3DUS. The 3DUS assessment of tongue posture was compared to the clinical assessment of orthodontist and ENT specialist. Results The prevalence of AOB was 7.2%. The AOB group and the control group significantly differed regarding improper tongue posture (p < 0.001), and articulation disorders (p < 0.001). In children without articulation disorders from both groups, the improper tongue posture occured less frequently than in children with articulation disorders (p < 0.001). After age adjustment, a statistical regression model showed that the children with the improper tongue posture had higher odds ratios for the presence of AOB (OR 14.63; p < 0.001) than the others. When articulation disorders were included in the model, these odds ratios for the AOB became insignificant (p = 0.177). There was a strong association between the improper tongue posture and articulation disorders (p = 0.002). The 3DUS detected the highest number of children with improper resting tongue posture, though there was no significant difference between the 3DUS and clinical assessments done by orthodontist and ENT specialist. Conclusions The 3DUS has proved to be an objective, non-invasive, radiation free method for the assessment of tongue posture and could become an important tool in functional diagnostics and early rehabilitation in preschool children with speech irregularities and irregular tongue posture and malocclusion in order to enable optimal conditions for articulation development.

A 45-year-old woman presented with an anterior open-bite complaining chiefly of her unpleasant smile esthetics and masticatory and speech problems. Treatment included speech therapy initiated immediately after bonding. Lingual spurs were positioned on the mandibular incisors in order to help tongue rehabilitation. During the working phase, temporary anchorage devices (TADs) were used at the mandibular anterior segment to intrude the lower left premolars. A splint was used to ensure retention in the upper and lower arches; an enveloppe linguale nocturne (ELN) was provided. Non-surgical open-bite treatment could offer a valid alternative to orthognanthic surgery when cephalometric evaluation shows no vertical growth pattern; patient compliance is essential to prevent relapse.

Twelve young adults in a good general health were observed during habitual posture of tongue and jaw in different emotional conditions induced by watching three video sequences. The position of the mandible was tracked by the displacements of an electromagnetic sensor glued to the chin. The tongue-to-palate distance was obtained by 2-D location of three electromagnetic sensors placed on the tongue upper midline surface. Head displacements were evaluated with a sensor fixed to an upper central incisor and were subtracted from corresponding displacements of tongue and chin sensors to obtain the real tongue and mandible positions during continuous recording sequences. Emotional conditioning by a fear movie influenced the vertical position of the mandible: the mean interarch distances during the fear movie (2 center dot 34 +/- 0 center dot 24mm) were significantly different from those measured during the tender (3 center dot 13 +/- 0 center dot 35) and neutral (3 center dot 42 +/- 0 center dot 80) movies, respectively (anova repeated measure, SNK; P

The use of self-ligating brackets has gained popularity recently in orthodontic treatment. The Damon philosophy is a system that employs passive self-ligation with the use of light forces to achieve arch development and to relieve dental crowding. The philosophy of the system is that the use of light forces does not overpower the forces of the lips, tongue, and other peri-oral soft tissue thereby allowing for optimal equilibration of forces that is customized to every individual. If this actually occurs, changes in the posture of the tongue and hyoid would be expected as is seen after orthognathic surgery and rapid maxillary expansion. The purpose of this study was to evaluate if these postural adjustments do occur, and, if they do, to assess if there is a stratification of treatment effect based on dental classification. A customized cephalometric evaluation was designed from an amalgamation of previous cephalometric studies. This cephalometric study not only evaluated changes due to treatment but also assessed changes in cervical postural position to validate the quality of the measurements and to verify that radiographs were taken in a correct and repeatable head position. Cephalometric measurements were correlated with measurements of posterior dental expansion at the premolars and molars. Results of the study showed a correlation in tongue length and hyoid to mandible measurements. Lack of significance in the cervical posture cephalometric changes validated the cephalometric design and the quality of radiograph included in the study. Significant posterior dental expansion was documented although this expansion was limited to the premolar regions. Changes in tongue length correlated with dental expansion, particularly in the lower premolars. Lastly, increases in upper airway space correlated with dental expansion, particularly in Class III patients. This finding is very interesting and suggests the need for further research in this area. Additionally, replication of this study with more subjects may yield very interesting results. Overall, this study supports the fact that studies of soft tissue changes in relation to orthodontic treatment need further investigation as these tissues are involved in the equilibrium of forces and are directly related to the stability of orthodontic treatment.