Korean J Orthod.  2014 Jul;44(4):203-216. 10.4041/kjod.2014.44.4.203.

Treatment and retention of relapsed anterior open-bite with low tongue posture and tongue-tie: A 10-year follow-up

• Seo YJ
• Kim SJ
• Munkhshur
• Chung KR
• Ngan P
• Kim SH

• KMID: 2273277
• DOI: http://doi.org/10.4041/kjod.2014.44.4.203

Abstract

The purpose of the current report is to present 6-year long-term stability and 10-year follow-up data for an adult patient who was treated with a tongue elevator for relapsed anterior open-bite. The 19-year-old male patient presented with the chief complaint of difficulty in chewing his food. Collectively, clinical and radiographic examinations revealed an anterior open-bite, low tongue posture, and tongue-tie. The patient opted for orthodontic treatment alone, without any surgical procedure. A lingual frenectomy was recommended to avoid the risk of relapse, but the patient declined because he was not experiencing tongue discomfort. Initial treatment of the anterior open-bite with molar intrusion and tongue exercises was successful, but relapse occurred during the retention period. A tongue elevator was used for retreatment, because the approach was minimally invasive and suited the patient's requirements regarding discomfort, cost, and time. The appliance changed the tongue posture and generated an altered tongue force, which ultimately resulted in intrusive dentoalveolar effects, and a subsequent counterclockwise rotation of the mandible. The results showed long-term stability and were maintained for six years through continual use of the tongue elevator. The results of this case indicated that a tongue elevator could be used not only as an alternative treatment for open-bite, but also as an active retainer.

Keyword

Open-bite; Tongue elevator; Relapse; Retention

MeSH Terms

Adult
Elevators and Escalators
Exercise
Follow-Up Studies*
Humans
Male
Mandible
Mastication
Molar
Posture*
Recurrence
Retreatment
Tongue*
Young Adult

Figure

• 

  Figure 1 Design of the tongue elevator. Occlusal view (A) and lingual view (B) of a conventional tongue elevator. The acrylic base occupies the entire mouth floor except for the region that can disturb the movement of the lingual frenum. The occlusal rests are placed on the lingual occlusal grooves of the posterior teeth. In a modified tongue elevator (C and D), the volume and height of the resin part are reduced for tongue-tie.

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  Figure 2 Mechanism of the tongue elevator. Tongue position is elevated after application of the tongue elevator (cross-sectional view). Arrows indicate the pressure generated by altered tongue posture with the tongue elevator.

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  Figure 3 Pretreatment facial and intraoral photographs.

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  Figure 4 Pretreatment dental casts.

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  Figure 5 Lateral cephalograms. From the left, initial (A); post-treatment (B); 3-year post-treatment showing relapse tendency (C); 8-year follow-up with 4-year application of tongue elevator (D); and 10-year follow-up with 6-year application of tongue elevator, indicating correction of anterior open-bite and good stability (E).

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  Figure 6 Initial treatment mechanics for molar intrusion. Four C-tubes installed in the each posterior area with a transpalatal arch in the upper dentition, and a lingual arch in the lower arch.

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  Figure 7 Post-treatment facial and intraoral photographs.

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  Figure 8 Post-treatment dental casts.

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  Figure 9 Superimpositions of lateral cephalograms. A, Pretreatment (solid line) and post-treatment (dotted line); B, Post-treatment (solid line) and 3-year post-treatment (dotted line) images showing relapse tendency; C, 3-year post-treatment (solid line) and 8-year follow-up (dotted line) with 4-year application of tongue elevator; D, 8-year follow-up (solid line) and 10-year follow-up (dotted line) with 6-year application of tongue elevator, showing good retention.

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  Figure 10 Facial and intraoral photographs of relapse after 3-year post-treatment.

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  Figure 11 Dental casts of relapse after 3-year post-treatment.

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  Figure 12 Re-treatment with a tongue elevator. After relapse occurred, a tongue elevator was used in the lower arch (A and B), and a wrap-around removable retainer with occlusal rests and reduced resin plate was used in the upper arch (C and D); Frontal view of the tongue while wearing the tongue elevator (E and F).

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  Figure 13 Facial and intraoral photographs at 8-year follow-up with 4-year application of tongue elevator.

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  Figure 14 Facial and intraoral photographs at 10-year follow-up with 6-year application of tongue elevator.

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  Figure 15 Dental casts at 10-year follow-up with 6-year application of tongue elevator.

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