1 – The Ritto-Appliance

All Class II malocclusions present a challenge to the orthodontist. The degree of difficulty for Class II treatment depends on the accompanying disorder. Early treatment for Class II malocclusion is frequently undertaken with the objective of correcting skeletal disproportion by altering the growth pattern.

From the experience gained after many years of using different techniques, a simplified approach to the best treatments will be presented. In addition to giving the patient the best treatment possible, the procedure adopted needs to be as easy as possible for all parties involved, including the patient. This approach not only gives the person undergoing treatment the best results, but also keeps patients happy, which is satisfying for everyone.

A number of fixed appliances have gained popularity in recent years due to the better results achieved on non-compliant patients. The author clinically tested all the available fixed functional appliances over a period of fifteen years. This evaluation enabled him to assess the advantages of each appliance and to merge them into a single appliance – The Ritto Appliance. It can be described as a miniaturised telescopic device.

The Ritto Appliance enables the correction of skeletal and dental Class II division 1 and 2, Class III malocclusions (mixed or permanent dentition), mandibular asymmetries, and is an excellent anchorage system in Class I and II treatment (extraction or non-extraction). It can also be used with lingual orthodontics to treat Class II discrepancies, or as an anchorage device in adult therapy.

2 – Why when an how to treat Class II malocclusions

The timing of early treatment involves intervention in primary dentition, early mixed dentition (permanent first molars and incisors present), and midmixed dentition (inter-transitional period, before the emergence of first premolars and permanent mandibular canines).

Early Class II treatment is a controversial debate. There has been considerable discussion in the orthodontic literature regarding the biological and clinical advantages and disadvantages of early orthodontic treatment.

On one hand, the public are increasingly asking for interceptive care, general dentists are alerted to orthodontic problems referring patients in deciduous or mixed dentition, while at the same time orthodontists know that some problems cannot be fully corrected until all teeth have erupted.

Some orthodontists have argued that early treatment of early or mixed dentition with Phase I orthodontics reduces the time needed for phase II treatment or can prevent such treatment altogether. Others have argued that phase I treatment has no long-term benefits.

This topic will discuss advantages and disadvantages of both approaches.

3 – Differences between rigid and flexible appliances

A variety of fixed appliances for Class II malocclusion correction of non-compliant patients appeared in the last decade.

Flexible appliances can be described as inter-maxillary torsion coils, or fixed springs. Rigid appliances, on the other hand, are based on inflexible fixed telescopic devices.

Both types have been designed to treat Class II malocclusions, although they produce different types of force. Following on from articles published to date we can state that flexible appliances produce greater dental movement during treatment than rigid appliances.

At present we distinguish a new group of appliances that has been classified as hybrid appliances because they represent nothing more than a mixture of a functional fixed rigid appliance with functional fixed flexible appliance. They could be described as rigid appliances with coil spring-type systems. The objective of these appliances is to move the teeth by applying 24-hour elastic continuous force that would replace the traditional use of elastics and extra-oral force.

4 – The lingual pearl

The correction of the tongue thrust should be an integral part of treatment in orthodontics.

The awareness of the problem of muscular dysfunction involving the dentition has been a grave problem for orthodontists for many decades.

The improper tongue thrust is reinforced with each succeeding feeding. Sometimes the degree of malocclusion or malformation depends upon the severity of the tongue thrust problem.

It must be remembered that although the muscles of the tongue, including the root of the tongue and muscles of the floor of the mouth, are the most important group of muscles that we contend with, other muscles, including the lips and cheeks, are of great importance as well.

THE GOAL of the treatment with the lingual pearl is to bring about normal function of those muscles surrounding the dentition that takes part in the masticatory process and deglutition. To make the treatment easier and the results more stable, regardless of what we use, either fixed or removable or functional methods, the cause must be dealt with and eliminated.

This condition of swallowing dysfunction is corrected by reinforcement of the exercise prescribed to bring about a new pattern of swallowing.


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