Myobrace® for Teens with BWS - T1BWS
Optimises BWS function while continuing habit correction
The T1BWS is designed to optimise the function of The Farrell Bent Wire System™ (BWS) to create more effective and efficient arch development. The T1BWS continues to improve breathing and myofunctional disorders while the BWS expands the arch form to create more room for the tongue. During times that the BWS isn’t being used, the patient is transitioned from the T1BWS appliance to the T2 appliance.
Design Features
The design features of the T1BWS are suited to optimise the function of the BWS, while simultaneously improving breathing and myofunctional disorders.
Flexible material
makes it a comfortable starting appliance, able to adapt to any arch form and malocclusion.
Tapered anterior section
of the appliance prevents over-flaring of the anterior teeth during BWS activation.
BWS channels
accommodate the BWS wire and composite stops on the lingual aspect of the teeth.
Small breathing holes
help to establish nasal breathing.
Lip bumper
discourages overactive lip muscles during a reverse swallow.
Tongue tag
encourages correct tip of the tongue positioning.
Tongue elevator
encourages the body of the tongue to rest in the roof of the mouth.
High sides
hold the soft tissues away, promoting arch development while optimising appliance retention.
Directions for Use
The Myobrace® appliance is to be used for one to two hours each day, plus overnight while sleeping. The patient's teeth may become slightly sensitive in the early stages of treatment. This is quite normal, however, if pain becomes excessive, decrease application time with the aim to build it back up once the appliance is accustomed to and sensitivity subsides.
Step 1
Hold the Myobrace® with the tongue tag facing up.
Step 2
Place the Myobrace® into your mouth.
Step 3
Keep your tongue positioned on the tongue tag.
Step 4
Close down on the Myobrace® and feel it working to align your front teeth and jaws.
Step 5
Keep your lips together and breathe through your nose.
Cleaning the Appliance
The Myobrace® appliance should be cleaned under warm running water every time the patient removes it from their mouth.
Use Myoclean™ tablets to thoroughly clean twice a week. Myoclean™ is the recommended cleaning agent for all MRC appliances.
Case Studies
Case Study 1
This 11-year-old female patient presented with the chief complaint of crowded teeth and wanting to avoid braces. After being presented with the various treatment options, the decision was made to undertake Myobrace® treatment. This involved the use of a series of Myobrace® appliances in conjunction with the BWS arch expansion appliance and Myobrace® Activities.
Pre-treatment
Conducting a Myofunctional Orthodontic Evaluation (MOE), we documented that this patient had moderate dental crowding with narrow and flattened arches, as well as a retruded mandible. There was also a deep overbite and moderate overjet. Her poor habits included mouth breathing with low tongue posture and a severe reverse swallow. She also had a history of thumb sucking as a child. Since she was in the developing permanent dentition, this patient was suited to the Myobrace®for Teens series.
Dental Progression
She started with the T1 appliance to establish nasal breathing and begin the correction of myofunctional habits. Two months later, her breathing function had improved, and she was consistently retaining the T1 overnight, so she progressed onto the T2 appliance to focus on arch development and continued habit correction. Since the patient was above the age of eight, the decision was made to use the BWS for extra arch development. Note that despite the overjet, we still developed the upper arch as the focus at this stage is on improving room for the tongue, not focused on the teeth. The BWS must be combined with a first stage appliance, so the T1 was reissued to the patient.
Dental Progression
The BWS generally requires four months of expansion, but due to rapid progress, only two months of expansion was needed. The wire was then removed and the patient was reissued the T2 appliance. A few months later, the patient was issued the T3 appliance for further dental alignment. As the upper arch was still slightly underdeveloped, the decision was made to enter a second round of BWS expansion to develop the upper arch and create more space for the tongue and the upper left canine. With the BWS back in, the patient was issued the T1BWS appliance, which is the preferred appliance to use with the BWS.
Dental Progression
Following the second round of BWS expansion, the patient was reissued the T2 appliance. Once the arches were nicely developed and her habits largely corrected, the patient was moved on to the T3 appliance for further dental alignment and, finally, the T4 appliance for retention.
Treatment Complete
This patient had less than two years of treatment. Once the goals of Myobrace® treatment had been achieved (correction of breathing and myofunctional habits, arch form and dental alignment), the patient entered into the retention phase. The T4 appliance was issued to retain the arch form, alignment and habits, allowing her to continue to develop correctly into the future.
Facial Progression
Once breathing and myofunctional disorders have been corrected, the development of the face continues in the correct downward and forward direction. The mandible has moved forward, which has positive effects on the breathing patterns, while the labiomental crease has shallowed as a result of correcting swallowing function.
Treatment Summary
Using the Myobrace® appliances in conjunction with BWS arch expansion and the Myobrace® Activities, we have helped the patient to establish nasal breathing, correct her myofunctional habits and, therefore, achieve natural alignment of the teeth. In Myobrace® treatment, we are not concerned with dental ‘perfection’ as we are looking for natural alignment, occurring with habit correction. With the correct breathing and myofunctional habits maintained, we can expect further improvements in the teeth and jaws as the patient continues to develop. For example, note that the overjet reduced further even after treatment was complete, as can be seen in the one-and-a-half-year retention photos.
Retention
The patient returned for a retention check appointment approximately one and a half years after treatment was complete and the result has been maintained without the use of any fixed retainers. The arches are broad and round, the deep bite has opened up and the overjet has reduced. With the correct breathing and muscle habits continued, we expect this stability to be maintained.
Case Study 2
This seven-year-old male patient presented with the chief complaint of crowded teeth, incorrect jaw development and nocturnal bruxism. His parents wanted to avoid extractions and braces after both having undergone this treatment themselves as teenagers, with poor long-term outcomes. After being presented with the various treatment options, the decision was made to undertake Myobrace® treatment, involving the use of a series of Myobrace® appliances in conjunction with the BWS arch expansion appliance, and the Myobrace® Activities.
Pre-treatment
Using the Myofunctional Orthodontic Evaluation (MOE) form, we documented that this patient had underdeveloped jaws with moderate dental crowding. There is a narrow upper arch, severely hourglass-shaped lower arch, deep bite and increased overjet. This patient was a mouth breather with a lip trap, low tongue posture and reverse swallow. Since he was in the mixed dentition, his treatment began with the Myobrace® for Kids series.
Dental Progression
He started with the K1 appliance to establish nasal breathing and begin the correction of myofunctional habits. Less than two months later, his breathing function had improved and he was consistently retaining his K1 overnight, so he progressed onto the K2 appliance to focus on arch development and continued habit correction. To enhance development of the upper arch, the decision was made to use the BWS arch expansion appliance, and the patient was issued the T1BWS appliance, which is the preferred appliance to use with the BWS. This was combined with Myolay™ to ‘unlock’ the upper teeth from the lower teeth and allow the narrow arches to develop to their fullest potential.
Dental Progression
This patient needed multiple rounds of BWS expansion, so the wire was removed for a few months to let the teeth settle. With the wire removed, the patient was issued the T2 appliance now that he was in the developing permanent dentition, before refitting the wire for a second round of expansion. Because the BWS must be combined with first stage appliance, the patient was reissued the T1BWS appliance. Once the second round of expansion was complete, the wire was once again removed, and the patient was issued the T4A® appliance.
Dental Progression
At this stage, the arch forms were broad and round and the crowding had resolved, however, occlusion was not ideal due to residual muscle dysfunction. The patient was issued the P-3® appliance while he continued working through the Myobrace® Activities to correct his poor myofunctional habits. Six months later, his muscle dysfunction was corrected, and a good occlusal relationship of the teeth was established, so he was issued the T4 appliance for retention. The patient returned for a retention check appointment more than a year later and the result had been maintained. At this point, we would normally start to wean the patient off the Myobrace®, however, this patient reported that he preferred to continue wearing an appliance as he had gotten used to it and found that he slept better when he wore his Myobrace®. So, the patient was issued the T4A® appliance, ideal for long-term wear.
Treatment Complete
Once the goals of Myobrace® treatment had been achieved (establish nasal breathing, correct the poor myofunctional habits and attain good arch forms), the patient was entered into the retention phase. This involved the use of the T4 appliance to retain the arch forms, alignment and corrected habits, allowing him to continue to develop correctly.
Facial Progression
Since the breathing and myofunctional disorders have been corrected, improvements can be seen in the development of the face. The lip trap has been corrected and the patient is now exclusively nasal breathing. As a result, the midface and lower face have developed forwards and the airway has also improved. The buccinators have reduced in size and the lips are resting together more comfortably as a result of correcting function.
Treatment Summary
Using the Myobrace® appliances in conjunction with BWS arch expansion and the Myobrace® Activities, we have helped this patient to establish nasal breathing, correct his poor myofunctional habits and, therefore, achieve natural alignment of the teeth. The arch forms have improved significantly and the deep bite and increased overjet have resolved. Most importantly, the patient is no longer bruxing during sleep. With the correct breathing and muscle habits established, we expect good stability of the result ahead.
Retention
The patient returned for a retention check appointment approximately one and a half years after treatment was complete and the result has been maintained. The permanent dentition has erupted into well-developed arches and the jaws have developed in the right direction, resulting in a much-improved facial profile. With the breathing and myofunctional habits corrected, the patient is also now breathing and sleeping better.
Resources
Appliance Instructions
Downloadable pdf document with instructions specifically for the T1BWS.
Download ResourceMyobrace® Appliance Catalogue
Downloadable pdf document detailing the Myobrace® appliance range.
Download Resource