Skeletal Class II Malocclusion Treatment with Combined Twin Block and Lip Bumper Appliances: A Case Report

ABSTRACT@#Functional appliances have been used over a century in clinical orthodontic treatments for skeletal Class II malocclusion patients. Its popularity is attributed to its high patient adaptability and ability to produce rapid treatment changes. The twin block and lip bumper can be combined depending on the patient’s cases. The purpose of therapy with twin block is effective in mandibular growth deficiencies to induce supplementary lengthening of mandibular by stimulating increased growth at the condylar cartilage. The patient was a ten-year-old male patient with skeletal Class II malocclusion. He had a convex facial profile, SNA (sella, nasion, A point) angle of 77.5°, SNB (sella, nasion, B point) angle of 73.0°, ANB (A point, nasion, B point) angle of 4.5°, overjet of 6.5 mm, overbite of 11/41 = 5.0 mm, 21/31 = 4.5 mm, abnormal upper labial frenulum, crossbite in the second left premolar of maxilla, crowded anterior teeth of mandibular, deficiency of mandibular growth, lower lip sucking habit, anterior teeth of maxilla with diastema and proclination. Orthodontic treatment for patient is a combination of twin block and lip bumper appliances. After seven months, frenectomy is used to eliminate and correct the spacing in the frenulum. After 10 months, the patient’s skeletal and profile had improved to skeletal Class I malocclusion, SNA angle of 78.0°, SNB angle of 75.0°, ANB angle of 3.0°, overbite and overjet of 4.0 mm, and the lower lip sucking habit had stopped. Twin block and lip bumper appliances are particularly good alternative treatment in managing selected cases of skeletal Class II malocclusion.

Utilização da placa lábio ativa na dentadura mista – relato de caso / The use of lip bumper appliance in mixed dentition patient – case report

A placa lábio ativa é um aparelho mio-funcional utilizado frequentemente para terapia preventiva e interceptora de más oclusões. O objetivo deste trabalho foi relatar o uso clínico dessa placa na dentadura mista. O artigo é ilustrado com a sequência de tratamento do caso de um paciente em crescimento, que apresentava grande apinhamento anteroinferior e desvio de linha média. Os resultados alcançados demostraram que ocorreu verticalização dos molares inferiores e movimento para vestibular dos incisivos inferiores. A placa lábio ativa confirmou-se como uma alternativa eficaz na terapia de pacientes na dentadura mista que necessitam de ganhos de espaço para correção de apinhamento e coadjuvante aos aparelhos ortodônticos fixos para ajuste das linhas médias superior e inferior.

Lip bumper is a myofunctional appliance frequently used as preventive and interceptive therapy for malocclusions. The aim of the present work was to report the clinical use of a lip bumper appliance in mixed dentition stage of development. This article illustrates the treatment sequence carried out in a growing patient that presented great lower anterior crowding and dental midline shift. Treatment results showed verticalization of the lower molars and forward movement of lower incisors. The lip bumper appliance has been confirmed as an effective alternative to treat patients in the mixed dentition stage needing to regain arch space for dental crowding correction. In addition, this appliance may be a support to fixed orthodontics in the correction of upper and lower dental midline shifts.

Fuerzas producidas por el Lip Bumper

Uno de los objetivos primordiales de la Ortodoncia es interceptar y/o resolver el problema de la falta de espacio, que generalmente ocasiona apiñamiento anterior. Los procedimientos utilizados para aumentar el perímetro del arco y permitir un espacio adecuado para la correcta ubicación de todos los dientes, son variados y el Lip Bumper es uno de los aparatos ortodóncicos de que disponemos para lograrlo. Es relativamente sencillo de realizar y de adaptar, es bien tolerado por los pacientes y nos permite controlar no sólo los movimientos dentarios sino además intervenir sobre los fuerzas musculares que están alteradas y redirigirlas. Es una opción importante a tomar en cuenta en pacientes jóvenes, durante la etapa de dentición mixta, sin embargo, esto no es contraindicación en pacientes adultos. No podemos olvidar además que el Lip Bumper puede usarse sólo o en conjunción con aparatología fija y aunque por lo general de gran utilidad en el maxilar inferior, también es usado en el maxilar superior. Por lo anteriormente señalado consideramos al Lip Bumper una alternativa válida en el tratamiento de la discrepancia dentaria.

One of the main objectives of orthodontics is to intercept and/or resolve the lack-of-space problem that usually produces anterior overlapping. There are several procedures used to enlarge the arch perimeter and allow adequate space for the proper placement of all teeth. The Lip Bumper is one of the orthodontic braces we currently have to do it. It is quite simple to manufacture and adapt; patients tolerate it well and it allows us not only to control dental movements but also to make interventions on altered muscular forces in order to redirect them. It is a great option that should be beard in mind, especially for young patients, during the mixed dentition stage, and having no contraindications for adult patients. Moreover, we should not forget that the Lip Bumper can be used as a stand alone device or combined with fixed appliances. Though in most cases it is of great help in the lower mandible, it is also used in the upper maxilla. Therefore, based on the above information, we consider the Lip Bumper a valid alternative for the treatment of dental discrepancy.