Bondable hyrax with split tongue crib appliance

Lijo John

doi:10.4103/jios.jios_256_17

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CLINICAL INNOVATION

Year : 2019 | Volume : 53 | Issue : 1 | Page : 77-78

Bondable hyrax with split tongue crib appliance

Lijo John
Assist. Prof., Department of Orthodontics and Dentofacial Orthopedics, Pushpagiri College of Dental Sciences, Thiruvalla, Kerala, India

Date of Submission	13-Dec-2017
Date of Acceptance	07-Mar-2018
Date of Web Publication	04-Feb-2019

Correspondence Address:
Dr. Lijo John
Room No. 6, Department of Orthodontics and Dentofacial Orthodontics, Pushpagiri College of Dental Sciences, Medicity, Perumthuruthy, Thiruvalla - 689 101, Kerala
India

Source of Support: None, Conflict of Interest: None

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DOI: 10.4103/jios.jios_256_17

Abstract

The main objective of this innovation was to combine and utilize the benefits of both hyrax appliance for rapid maxillary expansion and tongue crib for habit breaking. It is a very simple, easy to fabricate appliance which can be used for correction of posterior crossbite and tongue thrusting habit in a growing child.

Keywords: Anterior open bite, hyrax appliance, posterior crossbite, tongue crib

How to cite this article:
John L. Bondable hyrax with split tongue crib appliance. J Indian Orthod Soc 2019;53:77-8

How to cite this URL:
John L. Bondable hyrax with split tongue crib appliance. J Indian Orthod Soc [serial online] 2019 [cited 2019 Feb 21];53:77-8. Available from: http://www.jios.in/text.asp?2019/53/1/77/251550

Introduction

Routinely in orthodontic practice, we come across children with collapsed maxillary arch and tongue thrusting habit which could be primary or secondary to anterior open bite. When the posterior crossbite correction can be achieved by dental tipping alone and tongue thrusting habit needs to be checked, then modification of quad helix with soldered tongue rakes can be given, but when maxillary arch needs skeletal correction transversely and also a vertical growth control is needed, then bonded hyrax appliance with occlusal splint designed by McNamara and Brudon^[1] is preferred by most and it is followed by fixed tongue crib for tongue thrust habit correction. Tongue crib cannot be given along with hyrax expansion screw as it would not allow expansion to occur; therefore, to overcome this, I designed bondable hyrax with split tongue crib appliance to facilitate skeletal expansion along with correction of tongue thrust habit.

Fabrication

Appliance can be made with A2620 rapid expander (Leone orthodontic products, Sesto Fiorentino, Firenze, Italy) or hyrax (Dentaurum, Ispringen, Germany) or palatal split expansion screw (167-1326, Forestadent, Pforzheim, Germany).^[2]

Screw is soldered to 19-gauge wire framework surrounding the teeth from canine to distal most erupted molar. Anteriorly, on the mesiopalatal corner of wire framework near canine, split tongue crib is soldered. Split tongue crib has extended overlap to the opposite side tongue crib so that when expansion screw is activated, tongue crib just slides to each other maintaining continuity of tongue crib design, i.e., split ends are not separated away, thereby preventing tongue from protrusion [Figure 1].

Figure 1: (a) Wire framework of appliance (b) distal view of appliance (c) occlusal view of appliance (d) appliance intraoral view

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Acrylic occlusal splint covering all the posterior teeth extended anteriorly to include canine as suggested by McNamara and Brudon is made. Acrylic button below split tongue crib was given to prevent mucosal overgrowth or impingement.

Clinical Application

This appliance is used for treating posterior crossbite in a growing individual with an anterior open bite due to tongue thrust habit. Here, rapid maxillary expansion and tongue thrust habit corrections are achieved simultaneously with a single appliance, thereby reducing the duration of treatment, laboratory and chairside time.

Conclusion

This appliance is very simple, easy to fabricate. It not only reduces treatment time but also saves both laboratory and chairside time.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1.	McNamara JA Jr., Brudon WL, editors. Bonded rapid maxillary expansion appliances. In: Orthodontic and Orthopedic Treatment in Mixed Dentition. 5^th ed. Ann Arbor: Needham Press; 1995. p. 145-69.
2.	Paranhos Pinto FM, Pereira Abi-Ramia LB, Stuani AS, Sasso Stuani MB, Artese F. Vertical growth control during maxillary expansion using a bonded hyrax appliance. Dent Press J Orthod 2012;17:101-7.