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Tip of the week

Each week we’ll post up a new ‘Tip of the Week’ with practical advice from some of the most experienced myofunctional practitioners in the world.

You can improve patient compliance by adding Myobrace® usage into the patient's daily routine...

Common questions

Here is a collection of the most common questions we receive from professionals, defined into three main categories - Research, Appliances and Treatment.

If you find that your question hasn’t been answered, please use the 'Ask Your Question' feature to the left of this page and submit your own question.

Research

The Trainer and Myobrace® systems are used and recommended by Orthodontists and Dentists in virtually every major country in the world now. The time has come for us to remove the barriers and understand exactly what the Trainer and Myobrace® systems do. Many thousands of children need treatment for their myofunctional problems and complacency from many doctors is denying them the choice of treatment they need.

Research also shows that orthodontic structural changes, without corrected function, routinely fails. This is well documented.

There is no better and more cost effective method available to treat mouth breathing, incorrect tongue position and function, simultaneously with aligning the erupting dentition than the Trainer System™ - before, during and after orthodontic treatment. (T4K™,T4B™,T4A™) It is worth doing some simple cases and evaluating for yourself.

There are many references to the close association between myofunctional habits, facial growth and malocclusion. Just the references to mouth breathing and craniofacial growth are extensive enough to warrant more attention to the diagnosis of soft tissue dysfunction. (see the 'Your Resources' section on the website). Angle wrote that his observations would indicate "almost EVERY" malocclusion has some soft tissue case. It is important to look at the patient and see the close association between the myofunctional bad habits, arch form and tooth position.

Our courses will equip you with the ability to treat a wider range of cases and achieve better patient compliance - all while experiencing increased profitability. Attending one of our courses will give you a new and profitable technique that can be applied to any case.

Properly identifying soft tissue dysfunction and correctly treating these problems allows for better myofunctional orthodontic treatment and more stable long term treatment outcomes. You must treat the muscles even when there are other factors involved. MRC's appliances correct poor oral habits.

Dr Chris Farrell developed the Trainer System™ in 1990 in response to the need for an appliance system that was easy to use and would assist in the correction of myofunctional (muscle function) habits that cause malocclusion and TMJ problems.

Most of the dental and orthodontic profession were not recognising these problems at this time and few were treating them.

The ability to correct these soft tissue problems with the Trainer System™ has been shown to improve the facial growth, dental alignment, plus decrease the complexity and improve the stability of orthodontic treatment. See the case histories in the brochures, web and the other articles.

Orthodontists, dentists and paediatric dentists in over 100 countries use the Trainer System™ worldwide. The success that these practitioners experience on a daily basis combined with a wealth of research, confirm that the systems works.


Appliances

MRC's softer appliances offer good compliance and can adapt to any malocclusion. The Hard Trainer is best for teeth alignment, but too hard to use during initial stages of treatment.
Chewing on the ends can cause appliances to split. This happens over time, and is normal wear. Usually after 6 months some splitting will occur with the softer appliances.
No. They are not designed for protection and do not stay in during sporting activities. Myofunctional Research Co. has a range of mouthguards for this purpose. These are the world's most technically advanced mouthguard design. See POWRGARD® Sports for more information.
While the front section of MRC's appliances do incorporate design features that are similar to the oral screen, features which force the child to breathe through the nose,  The Trainer System™ has more features than the oral screen, features that re-train tongue position, function and lip bumpers that discourage overactive mentalis.
The Trainer System™ is not for teeth but it is for the muscles . It is for the correction of soft tissue dysfunction. There is no need for the individual tooth slots. The tooth channels and labial bows give a similar effect as well as the improvement in the myofunctional habits. Removal of aberrant muscular forces and the light forces on the teeth align the dentition. The Occluso-Guide® works more like braces and has the same relapse problem when treatment finishes. The amount of daily use is also much higher at 4 hours per day. However it is better for de-rotating anterior teeth if this is all that is required.
Myofunctional Research Co. pioneered the use of computer-aided design (CAD) to make single sized appliances. This allows one single size to be the only required for each product. The size and thickness vary between particular appliances like T4K™/T4A™ and the TMJ appliance. This makes the system easier than previous appliances. The focus is on myofunctional correction so individual tooth slots are not needed.
MRC has manufactured a unique cleaning system for our appliances called Myoclean™.  This is available through all doctors who prescribe MRC's appliances.  Please ask your doctor for Myoclean™, the official antibacterial cleaning solution for MRC's Trainer System™, Myobrace® and TMJ System™ appliances. Clean the appliance in running warm water each time the appliance is used. A toothbrush and toothpaste can be used if desired.

Treat the crossbite first then use the Trainer to stabilise and treat the myofunctional causes. See the T4K™ manual.

Autoclave on the lowest temperature cycle for the soft Trainers/TMJ Appliance™. The harder ones cold sterilization is better. Same with the T4F™ and T4U™.
Yes. However, heavy bruxers can destroy the T4K™ soft easily, so using the T4A™ with the distal ends cut off is often better in these cases. All our appliances help with bruxism.
The best effect is at the eruption of the permanent anteriors. At this stage you not only have a growth spurt, but also the T4K™ assists the guidance of the new teeth into position. This is in addition to the treatment of myofunctional habits. Between 6 and 8 years is optimum.
With open bite and class III you can start earlier if the patient is co-operative. Cut off the distal end if all first molars are not present.
The colour does not wash out of the material, but can fade with time and use.
The surface of the silicone material can also become dull from the effect of saliva. This makes the colour look less bright but presents no health hazard.
The colouring agents are vegetable based and similar to those approved for use in food. They have to go through the same certification process as the materials.
Yes. All of MRC's appliances, (Trainer System™, Myobrace System™ and TMJ System™) have been made from medical grade materials approved by USA and European health agencies for use in the mouth. The CE certification and FDA 510k in addition to other government approvals have been granted to the Myofunctional Research Co. products. Some allergy (Mucous) has been reported with a very small number of hyper- allergenic patients. This stops after suspended use. No reported problems with liability have occurred as these materials are in very common use in baby's dummies and medical infusion tubes plus many other medical applications.
There have been no reported harmful effects of the Trainer System™, Myobrace System and TMJ System.
As it is a passive and a very flexible appliance that assists in retraining the musculature and mode of breathing, there is little possibility of doing harm. However the recommendation is always to review patients regularly and ensure the soft tissue improvements are progressing, there is no irritation and that the dental changes are being supported by the surrounding structures.

Treatment

There are only a few. The two most common contraindications are non-motivated patients, or cases where the malocclusion is so extreme that the child cannot hold the appliance in their mouth. Another is when the patient suffers from complete nasal obstruction. See the manual for full information.
This varies so much with the selected group and the malocclusion.Generally patients aged 6-8 years old will be the most likely to have complete case resolution using only the T4K™ system.

Generally, about 50% of patients without severe problems will require no other treatment. All other cases will get the benefits of less complex treatment, better facial development, no extractions and better stability. The main advantage of the Trainer System™ is the correction of the soft tissues, which no other appliance system addresses.
Yes, it is better to follow the 2-phase system with both soft and hard appliances. There are, however, times when the malocclusion is minor and use of only the hard T4K™ is OK. When there is only a myofunctional problem just the soft T4K™ can be used. Experience has shown that the majority of cases do require the 2-phase system.
A minimum use of one hour during the day, for conscious habit retraining of the tongue position, keeping the lips together and breathing through the nose. Then use while asleep at night to have sufficient overall time to change these habits.
No. Some sensitivity is experienced in the first few days but after this, there is usually no pain.
The T4K™ is not particularly good at aligning teeth in the permanent dentition. The T4A™ is higher in the cuspid area and will bring them in but will not de-rotate cuspids.
The reverse is true. Many Orthodontists observe young children whose parents see the early signs of malocclusion. All too often nothing is done. Parents prefer to start some treatment at this stage. The Trainer System™ is ideal for maintaining the contact with the patient, instead of saying "go away and come back when all the permanent teeth are in." Parents also will understand that you are treating the causes of the problem as well as straightening the teeth later. See Trainer System™ video.

This is a common misconception, but the point is valid. Some children we find are really good and others do not persist with the program.
First you must understand that the Trainer System™ is more comfortable than acrylic appliances. It is an easy programme to follow. But the child needs to be organised and motivated, as does the parent. If this is the case, then compliance is good. It is important to understand that compliance is the duty of the child not the Dentist. However the results and improvements that are achieved are benefits for a lifetime. This is not an alternative form of orthodontics, it is a programme to treat myofunctional habits that cause poor facial growth, malocclusion and relapse.

The essentials are:

a. A good parent consultation that outlines what are the problems and goals.

b. Show the parent the patient video and/or have them take a copy home to show the whole family what it is about.

c. Ensure the child understands it is their responsibility. Have them read out the instructions for use inside the container box.

d. Discussing the required Trainer use for 12-18 months.

e. The Trainer will fall out at night in the first month, but persevere until it stays in all night. This is the first goal.

f. MINIMUM use is 1 hour daily plus overnight. Associate this with watching TV, playing games and bedtime routine. But even 10 minutes in a day is better than missing one day.

g. Understanding that money can be saved on future orthodontics, but this is not the real purpose. Facial growth will be improved (see parent brochure) and future orthodontics will be less complex (no extractions) and more stable.

h. Always give the parent the choice of the Trainer program. There is no reason not to present it as a treatment option.

i. Compliance is much better with these appliances in comparison to other functional appliances that are made of wire and/or acrylic.

If you would like to know more about how to improve patient compliance, please read Issue No.3 of the MRC Newsletter: 'Scientifically Speaking' by Dr. German O. Ramirez-Yañes.

Once the bad oral habits are corrected, they generally stay corrected, unless allergies reoccur. Since we swallow 2000 times a day, whatever habit is present will be constantly reinforced, just like any other training of the rest of the body. If correct lip seal and no perioral activity on the swallow are achieved, then the case will be stable.
The most important part of the myofunctional correction is that the lips are together at rest. So when the child is sitting down and not talking the lips should be together. When the child swallows, there should be no perioral activity; i.e. no mentalis contraction. Once this occurs, treatment is finished.

Yes. If the child is between 6 and 8 years of age, this is the best treatment to start. The improvement in tongue position and keeping the lips together assists the growing child to improve and widen arch form. If there is a posterior cross bite, it is best correct this first with a transverse expansion appliance or the Bent Wire System™ (BWS™). Older children (late mixed dentition) it is best to start with the TRAINER but also to do some simultaneous arch development with the BWS™ or other appliances.

Generally, if the patient can put the Trainer in their mouth and keep their lips together for 5 minutes or more, the Trainer System™ is the first choice for most cases of malocclusion . See manual for more details.

If the child cannot breathe through the nose and/or has a nasal obstruction, they need medical assistance first before commencing treatment. Extreme Class II and Class III cases may have a problem as well, physically fitting the Trainer to their mouth. These cases are the only ones the Trainer System™ cannot be readily used.

You will find usually the appliances last for the length of the case. It is important for the doctor to tell the child not to chew on the Trainer, as this will cause premature splitting. Reinforce this with the parent. As the soft T4K™ needs to be flexible and compliant, the silicone material is resilient but cannot withstand a lot of chewing or bruxing. If it gets chewed up, the doctor can issue another to the patient and charge them if they have been informed of this from the start .

Normally the T4K™ starting appliance will just last the 6-8 months and then the T4K™ harder (pink/red) will last longer. Sometimes it is OK to either issue another T4K™ soft or commence the T4K™ hard earlier than 6 months. Also the hard Trainer can be used initially for day use and continue the soft Trainer at night. This allows the Doctor to start the second phase earlier and still get good compliance and extending the life of the soft Trainer.

The T4A™ can be used with the distal ends cut off as an alternative for a T4K™ soft if the child is a heavy bruxer or chews through the T4K™ prematurely. It is a softer material than the T4K™ hard (red).

For malocclusion and soft tissue dysfunction use the Trainer until the patient has lips together at rest and correction of swallowing pattern. This is usually more than 12 months.

The key to Trainer success is the child's compliance. This should be established at the first consultation visit with the parent being told the importance of correcting bad myofunctional habits. This is not an alternative form of orthodontics. It is a treatment for the soft tissue causes of malocclusion and poor facial growth.

Therefore, the treatment is necessary for correct facial growth and stability of future orthodontic treatment.

If the child refuses to wear the T4K™ (which is rare to start) this is a contraindication for treatment. If the parent is not motivated, this is another contraindication. This is all in the manual.

When first starting treatment, the Trainer WILL fall out at night. The more there is a mouth breathing and tongue thrusting problem, the more likely there will be problems with falling out. A child with no myofunctional problems will keep the Trainer in at night easily. So this is the goal for the treatment . Increase daytime use if the night use is a problem. See manual.