All oro-facial functions, breathing, deglutition, chewing, mime and phonation can be partly educated.
The maturation of deglutition is slow, starting early in the child’s life and sometimes only ending with the appearance of permanent dentition. Bilabial contact during rest and during deglutition is an important factor for equilibrium.
Several factors may contribute to the appearance of an abnormal chewing/deglutition function (increased overjet, muscular atony, sucking habits, nighttime ventral position,…) causing a series of associated pathologies. When the tongue doesn’t work over the maxillary dental arch, limiting transversal development due to lack of stimulus on the inter maxillary suture can occur, favoring cross bites, gaining a low and protruding position and aggravating the clinical perspective.
The Lingual Pearl is a passive guiding appliance used in the reeducation of lingual function and can be seen both as an orthodontic therapeutic complement and as the main appliance for lingual reeducation. It can be used at any time during treatment, i.e. in the beginning, during or at the end of correction or even as retention device.
In order to work correctly, the following three factors in the construction of the lingual pearl need to be addressed:
- Size of Pearl;
- Mobility of Pearl;
- Type of exercises.
The size of the Pearl is very important. In the majority of appliances available on the market the Pearl is too big, or located too far back. With it’s in mind it is important that the Pearl shouldn’t be more than just a small reference allowing lingual exercises to be done. In this way, we can have not only a reduction in size of the appliance but also the possibility of having contact with the palatal mucus during the reeducation exercises.
The rotation and slide movements of the Pearl are necessary to allow the various types of lingual exercises.
Exercises vary depending on whether they are for deglutition reeducation or for speech therapy. In both of these cases it is important to have a first contact with the appliance for about 3 weeks. During this phase, the patient only carries the Pearl. Rotation and lateral slide exercises to increase muscular elasticity are precribed.
During the second stage of treatment, and if it is a case of deglutition reeducation, then the tip of the tongue will have to rest on the Pearl while deglutition is performed with the teeth closed and the lips together.
One of the principal rules for this therapy to be successful is that the patient may only exert light pressure on the Pearl. Should the patient apply excessive pressure then protrusion of incisors may occur.
Phonation education should be carried out by a speech therapist. The orthodontist should merely inform the therapist of the presence of the appliance, its advantages and applications.
The Lingual Pearl can be applied at any stage of treatment:
Beginning
Correction can be achieved with this appliance alone, only when the tongue is the principal etiological factor responsible for the malocclusion.
Nobody doubts that reeducating a complex muscular structure which has multiple and many faceted movements is an arduous and at times unrewarding task. Besides the inherent difficulties of the problem, there is a need for an almost daily monitoring of the patient, making it impossible for the orthodontist to achieve this at his or her practice.
During
In the majority of cases, the tongue is able to adapt itself to the new position of the dentition. However, given that it is a muscular force it will always be an obstacle to overcome. Sometimes it is necessary to remove this muscular force in order to close a space or open bite.
In these cases, the Lingual Pearl was applied to a transpalatal bar or to a quadhelix.
Final
Open bite cases, where vertical elastics were used to close the bite are the most obvious cases for the use of a Lingual Pearl in the final phase of treatment. By allowing lingual reeducation, the opening of spaces and consequent relapses, can be avoided.
Cases that have been dealt surgically are also good candidates, given the abrupt alteration to the amount of space available for the tongue, especially if there was an open bite.
In this final phase of treatment, the Lingual Pearl may be bonded to the palatal sides of the premolars and remain there until lingual movement has been normalized.
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Mark the distal palatine surface of the upper canines. The pearl should be placed in the midle area.
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The pearl should have the size of 1,5 to 3mm. Cut the excess of acrylic, polish, and bond the pearl with a composite to the palatine surface of the first premolars.