Myofunctional therapy and prefabricated functional appliances: an overview of the history and evidence

Abstract

Malocclusion represents the clinically observable endpoint of numerous genetic and environmental influences. Oral Myofunctional Therapy (OMT) aims to treat malocclusions by improving the oral environment through re-education of musculature and respiratory patterns. Although the concept of OMT has existed since the early part of the 20th Century, many of its purported benefits for the treatment of malocclusion remain undemonstrated in the scientific literature. However, a more recent application of OMT for the treatment of Obstructive Sleep Apnoea (OSA) suggests some benefits, although more research is needed to clarify this effect. Prefabricated functional appliances (PFAs) are sometimes advocated as part of myofunctional training programs. In the past decade, controlled clinical investigations have demonstrated that PFAs can improve Class II Division 1 malocclusions in compliant patients. Compared with traditional functional appliances, PFAs might be more cost effective; however, this must be balanced against compliance problems and evidence suggesting that other types of functional appliances might give better treatment results in a comparable time frame.Abbreviations and acronyms: OMT = Oral Myofunctional Therapy; PFA = prefabricated functional appliance; OSA = Obstructive Sleep Apnoea; AHI = apnoea hypopnoea index; RCT = randomised controlled trial.

What evidence exists for myofunctional therapy with prefabricated appliances? A systematic review with meta-analyses of randomised trials

“…A recent systematic review, however, indicated that there is a lack of high-quality evidence in the existing literature regarding early orthodontic management and orofacial muscle training protocols on the correction of myofunctional and myoskeletal problems in the developing dentition (Koletsi et al, 2018). It is also important to note that Rogers considered myofunctional exercises as an aid in treatment and retention (Proffit and Mason, 1975) and not as a universal therapeutic approach for all orthodontic problems (Wishney et al, 2019).…”

Orofacial Myofunctional Therapy and Myofunctional Devices Used in Speech Pathology Treatment: A Systematic Quantitative Review of the Literature

“…T he use of orofacial myofunctional therapy (OMT) in orthodontic treatment dates back to the early to mid-1900s (Farrell & Darcy, 2018). Since this time, OMT has demonstrated improvements in orofacial function, including mandibular growth, malfunctions of the tongue, abnormal swallowing, nasal breathing, and facial appearance (Camacho et al, 2015;Wishney et al, 2019). Both Farrell and Darcy (2018) and Wishney et al (2019), in their reviews, discuss the establishment of OMT over 100 years ago by Alfred Rogers, who was a student of the influential orthodontist Edward Angle in the early 1900s.…”

“…Since this time, OMT has demonstrated improvements in orofacial function, including mandibular growth, malfunctions of the tongue, abnormal swallowing, nasal breathing, and facial appearance (Camacho et al, 2015;Wishney et al, 2019). Both Farrell and Darcy (2018) and Wishney et al (2019), in their reviews, discuss the establishment of OMT over 100 years ago by Alfred Rogers, who was a student of the influential orthodontist Edward Angle in the early 1900s. It was Angle who suggested that there was a myofunctional origin to dental malocclusions and that restoration of the muscles would lead to normal orofacial function (Farrell & Darcy, 2018;Wishney et al, 2019).…”

“…Both Farrell and Darcy (2018) and Wishney et al (2019), in their reviews, discuss the establishment of OMT over 100 years ago by Alfred Rogers, who was a student of the influential orthodontist Edward Angle in the early 1900s. It was Angle who suggested that there was a myofunctional origin to dental malocclusions and that restoration of the muscles would lead to normal orofacial function (Farrell & Darcy, 2018;Wishney et al, 2019). Following on from this earlier work, Mills (2011) described the influence of orthodontist Walter Straub in the 1950s and his use of OMT in deglutition and tongue thrust.…”

“…These deficits can affect the processes of swallowing such as mastication, poor bolus formation and positioning, premature spillage into the pharynx, difficultly with transit of the bolus and residue postswallow (Ibrahim et al, 2013), and breathing difficulties, including mouth breathing, snoring, and obstructive sleep apnea (Huang et al, 2018). The use of OMT has been reported to assist in providing the foundation for improving these functions (Homem et al, 2014;Wishney et al, 2019).…”