Replies to This Discussion

Permalink Reply by cherie tschudi on March 4, 2010 at 7:58pm

Nice to hear from you Aquad! I have not come to use MYOBRACE is my profession as of yet, but tell us more about it's process and approach to orthodontic application ????

Permalink Reply by Ravi Kumar on March 5, 2010 at 1:29am

First of all, I do not believe in any kind of Phase I treatment with myofunctional appliances. My approach is always Phase II treatment with fixed orthodontics. Research and my experience has shown that the growth modifications effect purported to be achieved by myofunctional appliances are highly unstable.

Myobraces are a kind of positioner device which may lead to some tooth alignment in the mixed dentition stage if there is enough growth later and space for the all the teeth to erupt into. I prescribe these to patients whose parents insists on some treatment and cannot wait for all the teeth to erupt. This treatment is always provided with the advice that there is only a 50% chance that this may reduce the necessity for fixed orthodontics later.

Permalink Reply by tarik aouad on March 5, 2010 at 4:01pm

thanks dr Ravi Kumar for your response but see this link
http://www.myoresearch.com/cms/index.php?t4k
they supposed myobrace is effective in mixed dentition to solve the problem of overcrowding

Ravi Kumar said:

First of all, I do not believe in any kind of Phase I treatment with myofunctional appliances. My approach is always Phase II treatment with fixed orthodontics. Research and my experience has shown that the growth modifications effect purported to be achieved by myofunctional appliances are highly unstable.

Myobraces are a kind of positioner device which may lead to some tooth alignment in the mixed dentition stage if there is enough growth later and space for the all the teeth to erupt into. I prescribe these to patients whose parents insists on some treatment and cannot wait for all the teeth to erupt. This treatment is always provided with the advice that there is only a 50% chance that this may reduce the necessity for fixed orthodontics later.

Permalink Reply by Ravi Kumar on March 7, 2010 at 1:04am

The company will say many things to promote their products. Take it from me as I have been using this for quite some time now. The photograph shows one of my patients with the trainer in his mouth. I prescribed this when he was 8 years old. This patient came to me after 5 years for fixed orthodontic treatment. But as I had already told his parents about this possibility, there were no complaints.
1. And unquestionably this is a big practice builder. I get both the Phase I and Phase II treatment.
2. And this is way better than a functional appliance in patient compliance.

So go ahead and prescribe this to your patient and do tell him about the need (remember 50%) for later Phase II treatment.
:-)

Permalink Reply by Ravi Kumar on March 7, 2010 at 1:13am

Here is the study "only total facial height increase, lower incisor proclination, and overjet reduction
were significantly higher when compared with the changes observed in the control group. This study
demonstrates that the preorthodontic trainer application induces basically dentoalveolar changes that result
in significant reduction of overjet and can be used with appropriate patient selection. (Angle Orthod 2004;
74:605–609.)"

http://www.angle.org/doi/pdf/10.1043/0003-3219(2004)074%3C0605:TEOEPT%3E2.0.CO%3B2?cookieSet=1

The dentoalveolar changes achieved may give good results only in a few patients and only a very few need not go for Phase II treatment. Also many other studies have shown that the growth modifications achieved with myofunctional appliances are highly unstable.

Permalink Reply by Rohan Wijey on March 10, 2010 at 10:09pm

Hi Aouad, I actually work with the inventor of the MRC appliances, including the Myobrace in a clinic that uses only these myofunctional appliances in Australia (if you want to know more, go to lessbraces.com).

It is impossible to give you adivce on which appliance to use, because I have not seen the case in question; but judging by age alone, I would say that the I-2 Trainer would probably be best suited. If you want, you can e-mail me photos and an OPG of your pt and I may be able to help more.

As for Ravi Kumar's opinions, they are slightly misguided on a number of levels.

It seems he has mistaken myofunctional appliances for functional appliances. There is a clear distinction: functional appliances simply either widen the upper jaw or posture the mandible forward. Myofunctional appliances train the orofacial muscles to function correctly, thereby correcting the cause of underdeveloped jaws, faces and crooked teeth.

When the child is trained to eliminate its own myofunctional habits with the Trainers and myofunctional exercises, results are in fact more stable than anything else. Ravi's comment that 50% chance of relapse is simply false. I would like to see the research to back this up.

Ravi also quoted the Cochrane Review on how there is no much difference between Phase I and Phase II tx when it comes to tooth alignment. This Review only assessed functional, not myofunctional appliances, and the criteria only assess the teeth, not the face or jaws. It must be remembered that the range of Trainers are not concerned with aligning teeth at an early age - it is concerned with elimating myofunctional habits that have caused underdeveloped jaws, faces and crooked teeth. This is why our clinics regularly give pts a better face, better teeth and better stability.

Finally, I am rather troubled by Ravi's comment that "I do not believe in any kind of Phase I treatment with myofunctional appliances", but then says that "unquestionably this is a big practice builder. I get both the Phase I and Phase II treatment". Our appliances are not meant to be 'practice builders', especially for practitioners who don't believe in them. MRC appliances are used to give the patient the best, most stable result possible.

Permalink Reply by tarik aouad on March 11, 2010 at 6:30am

GREAT
we have now two schools in philosophy of treatment in orthodontics
dr RAVI KUMAR school dr ROHAN WIJEY school
but i think in early age we should use phase I of treatment :
- myobraces
-propulsor universal light
- quadhelix.................
if that is sufisent and give good result i ask why not to use it ?

Permalink Reply by Barry Raphael on March 12, 2010 at 3:26pm

There is a better way to describe the "schools of thought" here, though they are not mutually exclusive: the genetic vs the developmental schools. While we all would admit that both play a part, the myofunctional school is going out on (as I see it) a limb by saying that malocclusion is far more developmental than we have previously thought. Narrow maxillae with crowding and with normal or retrusive mandibles are ALWAYS due to a lack of stimulation of the upper arch by the tongue during post-natal development. Malocclusion, therefore, is not THE PROBLEM as much as it is a SYMPTOM of Soft Tissue Dysfunction. Soft Tissue Dysfunction itself is secondary to anything that hampers proper nasal breathing - asthma, allergies, T&A, recurrent URI - all of which are very common. Also, the method of infant feeding, quality of food chewed once teeth come in, the transition from infantile to mature swallowing patterns, and, of course, oral and finger habits, are all influential in the development of STDys.

Early treatment, then becomes CORRECTION of the STDys and INTERCEPTION of the malocclusion. The eventual need for orthodontic therapy depends on how early the STDys is corrected and how much of the dental and skeletal aberration has already occured at that time. Theoretically, it would be necessary to prevent the STDys itself to totally avoid orthodontics, and this means starting myofunctional work WAY BEFORE we are used to thinking about it - even for the early treatment people among us. Practically speaking, we need a patient's and parent's understanding and compliance with the trainer and excersizes. That usually puts us at an age where much of the problem has already occured. And, at least in my part of the world, (New Jersey), getting sufficient compliance over a long period of growth is the BIGGEST chanllenge of all. Despite what Dr. Farrell says, many kids will CHOOSE braces over something they have to be responsible for.

Nonetheless, I have joined the fray because I believe that a pound of prevention is better than a half-pound of cure (that's the way I see it....)

Sincerely, new WebDental member,
Barry Raphael

Permalink Reply by Dimple Sharma Rohilla on May 21, 2010 at 11:06am

hi Dr tarik.
i agree with dr ravi. moreover it depends on the case. does ur patient really need myobrace? is he the one indicated for arch expansion or the case is of tooth size arch length deficiency. because not all cases will benefit from myobraces. in fact sometimes u might end up worsening the the profile of the patient before fixed mechanotherapy. that is not wat u want.and personally speaking i do not feel using myobrace is anything more than a placebo.

Dr Dimple Rohilla.

Permalink Reply by Rohan Wijey on May 23, 2010 at 10:15pm

It is absolutely true to say that not every case needs arch expansion, although many do. It seems Dr Rohilla is slightly misguided on the mechanism of action of the Myobrace, as well as the definition of 'placebo'. We use the Myobrace not so much for expansion, but mainly for dental alignment. It must be said that braces are still the most efficient way to move teeth, however, the strong forces lead to root resorption and there is potential for enamel damage.

The MRC appliances are focussed mainly on helping the pt elimiate his/her own myofunctional habits, which are responsible for poor facial development and malocclusion.

Anyone who calls the Myobrace a 'placebo' firstly has never worked with one properly, and secondly, does not understand what a 'placebo' is.

Dimple Sharma Rohilla said:

hi Dr tarik.
i agree with dr ravi. moreover it depends on the case. does ur patient really need myobrace? is he the one indicated for arch expansion or the case is of tooth size arch length deficiency. because not all cases will benefit from myobraces. in fact sometimes u might end up worsening the the profile of the patient before fixed mechanotherapy. that is not wat u want.and personally speaking i do not feel using myobrace is anything more than a placebo.

Dr Dimple Rohilla.

Permalink Reply by Dimple Sharma Rohilla on May 24, 2010 at 2:34am

ok, u use myobrace for alignment and correction of myofunctional habits. how do u know this patient has some abnormal muscular function? and by the way if u try to align an arch with excess tooth material, u end up expanding the arch and worsening the profile, atleast initially. i very weel know wat a placebo is, and its a personal point of veiw, i still believe myobrace is nothing but a placebo. u better get off with the fixed mechanotherapy to get more stable and quick results without wasting time.

Permalink Reply by Barry Raphael on May 24, 2010 at 9:44am

How's this for a placebo affect? Study it carefully and tell me how this could have happened either with or without the placebo.

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