Pre-formed myofunctional appliances. If wishes were horses…

Once my grandpa said, “If wishes were horses, beggars would be riders.”
There have been a lot of claims about pre-formed myofunctional appliances. Personally, I feel that whenever we are considering adding anything new into our patient treatment regiment, it’s important to make sure that we know that the new treatment method is actually as effective as it is claimed to be.
I have read many claims about pre-formed myofunctional appliances correcting skeletal class III, class II, overjet, and crowding. I have to admit, it would be nice if our patients could just wear a pre-formed mouth piece and their retrognathic maxilla would be corrected in 6-8 months.
But do these pre-formed appliances really work effectively, and is there any evidence for these claims? We are all trying to help our patients, but I think it is crucial that we make sure that any appliance we use actually works effectively.
Let’s take the reverse-pull head gear or facemask as an example. It has been well established with research that it is a very effective appliance to correct retrognathic maxillary position in growing children. It works quickly and effectively.
Here is an example case we treated in just 5 months. You can see the significant skeletal correction of the maxillary position moving forward.

But, how about pre-formed myofunctional appliances? Well, the problem is that there are a lot of claims for their effectiveness, but there is little evidence to back it up in the scientific journals. So, as far as science is concerned, there is little that we know.

Actually, some of the recent research shows that a simple activator was more effective in reducing overjet, ANB, and wits then a pre-formed myofunctional appliance. See below link. (They did show in one study that the pre-formed myofunctional appliances were effective in reducing some dental crowding; however, there was no evidence for skeletal corrections.)
So, I think before we jump into using these “new” appliances, I think it’s important to make sure that we understand their effectiveness (or potential lack thereof), and we use appliances for our patients that will successfully and effectively correct their orthodontic problems beyond just wishful thinking.
Here is a good review of pre-formed myofunctional appliances.

In our seminars, we will cover what orthodontic appliances work effectively, and how you can get beautiful results with fundamental orthodontic treatments.



Clear aligners and posterior open bite – How to prevent it, and how to treat it.

One of the most common problems with clear aligner and Invisalign treatment is the development of posterior open bite. If you use clear aligner orthodontic treatment for your patients, at one point you will run into this problem.

Do you know how to recognize and deal with this problem?

During treatment

Often, the cause of posterior open bite with clear aligners is

  1. Lack of overjet, and/or
  2. Retroclined upper anterior teeth.

It’s important to recognize at the start of treatment that these problems may develop during clear aligner treatment.

Often, as the upper teeth retrocline and/or there is a lack of overjet, a premature anterior contact develops, resulting in posterior open bite.

How do we correct this problem?

The best is to prevent this problem from developing and to make efforts at the start of treatment to avoid this posterior open bite from occurring.

We can do this by adding extra upper torque to the upper anterior teeth.

Also, if there is a lack of overjet, lower IPR might be necessary to increase overjet.

It is also important to show 1-2mm overjet on the finish stage of the ClinCheck, to account for the thickness of the clear aligner material.

These steps often can reduce and/or eliminate the occurrence of posterior open bite.

After treatment
During treatment with posterior open bite

If you would like to know how to avoid problems with clear aligners and how to be more successful with clear aligner treatment, feel free to contact us to enroll in one of our upcoming orthodontic seminars.

We have an evening orthodontic seminar on Thursday 4/12/2018 in Cleveland Ohio.

We also have a Two Year Comprehensive Orthodontic Mini Residency for doctors who would like to master their orthodontic skills.

In addition, we have monthly webinars, most often on select Tuesday evenings at 8pm EST.

We hope to see you at our next orthodontic seminar.

Best wishes,

Dr. Attila Nagy DDS MS

Orthodontic Webinars

This is a new episode of our webinar series, on orthodontic diagnosis, and classification of orthodontic malocclusions.
The webinars will have a Q&A format at the end, so please send us your questions.
Also, the webinars are free to attend. If you’d like an ADA CERP seal 1CE certificate, please complete the post webinar 10 questions test, and pay $15 for the CE certificate.
To register, please email us at

April 5th, 8PM EST USA: Classifications of orthodontic malocclusion: Overview, records, and dental classifications.

I hope to see you soon.

Functional orthodontic pacifiers can reduce the incidence of open bite

I just saw this in a journal; Progress in Orthodontics.

For years we have know that poorly shaped pacifiers can give a poor support, and aid poor developments of an infant’s, or young child’s dental arches, and oral structures. 
This research article studied how pacifier use can effect the developing oral-facial musculature, and structure. They also examined how pacifier use effect open bite, and posterior cross bite.

They have found the the shape of the pacifier has a large impact on the prevalence of open bite, but the incidence of cross bite, is less well correlated. So, I would encourage parents to use an orthodontic pacifier for their children, for a better oral structural development. 


The effect of pacifier sucking on orofacial structures: a systematic literature review


Non-nutritive sucking habits may adversely affect the orofacial complex. This systematic literature review aimed to find scientific evidence on the effect of pacifier sucking on orofacial structures.


High level of evidence of the effect of sucking habits on orofacial structures is missing. The available studies show severe or moderate risk of bias; hence, the findings in the literature need to be very carefully evaluated.

There is moderate evidence that the use of pacifier is associated with anterior open bite and posterior crossbite, thus affecting the harmonious development of orofacial structures.

Functional/orthodontic pacifiers reduce the prevalence of open bite when compared to the conventional ones, but evidence is needed concerning the effects on posterior crossbite. Well-designed randomized controlled trials are needed to further analyze the effects of functional/orthodontic and conventional pacifiers on orofacial structures.

What can we tell from a Panorex? A mixed dentition case.

As more and more patients eat soft diet and soft processed food, arches and dental skeletal structures are getting smaller and smaller. Also, due to allergies, large tonsils and poor airway, many young patients develop a low and forward tongue position. This results in a high angle skeletal development and often an open bite, and or a long face appearance. As the jaw drops down as a result from the airway problems, large tonsillitis and the low and forward jaw position, the buccal cheek muscles exert a pressure inward on the upper and lower arches. This inward pressure creates an even more narrow upper and lower arches, resulting in more open bite and more narrow crowded arches.

So, many of the patients today, are becoming more and more crowded from the process descried above. Often we see patients during a hygiene exam with very little space for the erupting teeth, or with impacted, missing teeth. We used to see patients with erupted wisdom teeth, or at least second molars, but it is common today to see patients with totally impacted wisdom teeth, and even impacted lower and upper second molars. Many of our patients today have little room for second molars and often even the canines are blocked in. Unless, these problems are detected early, after the growth is complete very little can be done in cases of severe crowding and malocclusion but to do extractions and or surgery.
So, it is imperative that we all learn to identify, diagnose and learn to treat these mixed dentition problems early and effectively. So, let’s look at an example case here that exhibits some of the problems that we described above.
What can we tell from just a panorex? Let’s look at a mixed dentition case where such problems present.