Use of EQ O.S.A. device in management of malocclusion: A clinical case

OBJECTIVES The objective of this clinical case is to describe a patient with a class I skeletal, molar class I, who exhibited increased overbite and dental overcrowding prior to treatment. This case was solved during mixed dentition by using only an activator. MATERIALS AND METHODS A healthy Caucasian girl of eight years was clinically examined at the Dental Clinic of the University of L’Aquila. The diagnosis was a skeletal class I, molar class I, exhibiting an overbite of 7 mm prior to treatment, atypical swallowing. The patient showed a medium grade of dental crowding in both dental arches. The patient was only treated with the EQ O.S.A. device, which was replaced two times after six months, during two years of orthopaedic-functional orthodontic therapy. This patient was under treatment until full permanent dentition was completed. After taking alginate impressions and developing cast stone models, the orthodontist uses an appropriate ruler to measure the distance between the palatal cusps of the first upper bicuspids (or the first upper deciduous molars) and will choose the correct size among the following:--O.S.A. 3, from 24 to 27 mm in mixed dentition;--O.S.A. 4, from 28 to 31 mm in mixed dentition;--O.S.A. 5, from 32 to 36 mm in permanent dentition. Three different materials are available based on hardness: white in natural rubber (soft), lavender in elastomeric resin (medi-um), and mint in elastomeric resin (hard). The patient inserts his or her teeth in the fitting upper and lower splints. This device is func-tionalized by biting it, through soft elastic forces led by muscle energy. The activator is worn all night long and for one hour during the day. Moreover, two exercises of 15 minutes each are executed, in the morning and in the evening. The basic exercise can be adapted to the patient’s features and characteristics. The orthodontist checks the patient every 30 days, to evaluate eventual modifications for execution on the device. The appliance must be replaced every 6 months, according to the ortho-dontist’s evaluations, until reaching the final orthodontic outcome. The patient completed the orthodontic treatment with a satisfactory alignment of both dental arches, and the tongue function was rehabilitated (final swallowing with the tongue in its position). RESULTS AND CONCLUSIONS This equilibrator yields several benefits: improving the chewing function, aligning the teeth, re-ed-ucating the tongue due to stimulation towards the retroincisal papilla spot, and modulating the muscular tone in occlusal-postural syn-drome; furthermore, it is ideal for treating obstructive sleep apnea syndrome. The examined device correctly employed allows a healthier posture and freer movements of the tongue. The apex of the tongue touching its spot during swallowing together with the centripetal force of perioral muscles act as an orthodontic device to enhance reduction of the overbite, improvement of tongue function and thereby an enhancement of breathing, with functional and aes-thetic improvements. CLINICAL SIGNIFICANCE This device, comfortable and easy to wear, can enhance the dynamic function, and thereby the cause of the malocclusion, makes orthodontic relapse much less likely and thus maintains stable occlusion over time. Proper use of the activator, in association with exer-cises and techniques for muscular balance, will allow the patient to gain benefits throughout the neu-romyofascial system with fewer concerns for the orthodontist.