[Morphological and functional peri-oral changes during early treatment of Class II division 1 malocclusions using EF...

The aim of this article was to assess the impact of a flexible functional education splint for interceptive treatment of Class II division 1 dysmorphoses.

An observational, prospective, multi-center non-comparative EGIDYS study was conducted in 81 children with a Class II division 1 malocclusion presenting one or several functional disorders. Patients wore a flexible splint in the EF Line^® range for a minimum of two hours per day and all night over 12 months in combination with educational exercises depending on the case. Patients were followed at one month, four months and twelve months of treatment. Ventilation, lingual position, labial peri-oral muscle tension, arch forms and dentoskeletal cephalometric measurements were assessed at initiation and completion of the functional education.

Functional examination on inclusion showed that the majority of children displayed a low tongue position at rest, oral or mixed ventilation, abnormal labial and peri-oral muscle tone and, in many cases, a narrow maxilla. Initial cephalometric examination recorded the following parameters: overjet, deep bite, and inclination of the lower incisors relative to the A-Pog line, and the SNA, SNB and ANB angles. After twelve months of functional education with a flexible EF Line^® splint, improvement was observed in the orofacial functions as shown by correction of the tongue position at rest as well as the lingual index indicating the position of the tongue against the palate, reduced tension of both the lower lip and the buccinator muscles at rest and in function, increased nasal breathing ability and a more rounded maxillary arch form. In addition, a major reduction in overjet and deep bite were visible as well as a significant reduction of the ANB angle due to its increased SNB component. This first stage in the orthodontic treatment plan resulted in a 73% improvement of Class II division 1 malformations. Correction of the malocclusion and functional disorders correlates significantly with compliant wearing of the EF Line^® splints.

This study demonstrates that the design of EF Line^® flexible functional education devices effectively corrects functional disorders linked to poor tongue position and triggers positive dentoskeletal changes, as compared with no treatment. From the clinical viewpoint, flexible EF Line^® splints can contribute to orthopedic and orthodontic treatment of Class II division 1 malformations.