Orthodontics

O rthodontics Sept 2013

Lower Lip sucking habit treated with-

a Lip Bumper Appliance

Department of Orthodontics & Dentofacial Orthopaedics

Government Dental College P.G.I.M.S., University of Health Sciences,
Rohtak Haryana, India
Dr. Manisha Kamal Dr. Mahesh Goel
Associate Professor Associate Professor

INTRODUCTION
The position and stability of the dentition are influenced by the
equilibrium between their surrounding muscular forces. Extra
oral forces exerted by orbicularis oris and buccinator muscles are
balanced by opposing forces of tongue. Any prolonged change in
this balanced muscle function caused by para functions such as
lip sucking, lip biting , tongue thursting, can alter the equilibrium,
initiate morphologic change in the normal configuration of the teeth
and supporting bone, and result in a malocclusion1.
The manifestation of an acquired malocclusion varies according
to the type, localization, severity, frequency of the habit, but
elimination of the oral habit is fundamental for treatment and future
stability. In cases with a lip sucking habit the lip bumper appliance
is a good treatment alternative for breaking the habit and correcting
the resultant malocclusion2.
The purpose of this case report was to present the treatment for
a patient having a lower lip sucking habit with a mandibular lip
bumper appliance.
The 12 year old boy reported with increased overjet,
mandibular incisors irregularity, hyper active mentalis
muscle and deepening of mentolabial sulcus because
of the abnormal lower lip sucking habit. Orthodontic
treatment was started with a lip bumper appliance
to break the lip sucking habit and continued with
fixed orthodontic mechanotherapy. The lip bumper
appliance therapy resulted in elimination of lower lip
sucking habit and improvement in the lower incisors
inclination.
Key Words: lip sucking habit, mentalis hyperactivity,
lip bumper

CASE REPORT
A twelve year old boy with a class-II division 1 malocclusion and a
large overjet reported a chief complaint of lower lip sucking habit.
His medical history showed no contraindication to orthodontic
therapy. On extra oral examination, the patient had convex profile
with mentalis hyper activity and deep mento labial sulcus caused by
his abnormal habit (Fig1,2,3).
Fig 1: Pretreatment Extra Fig 2 : Pretreatment Extra Fig 3: Pretreatment Extra
Oral Frontal View Oral Right Profile View Oral Left Profile View

30 GUIDENT | Your Guide on the path of Dentistry

 Sept 2013
Fig 4: Pretreatment Intra Oral Frontal View Fig 5: Pretreatment Intra Oral Right Buccal View
On intra oral examination patient had Angles class-II molar
relationship with an over jet of 12 mm.The maxillary anteriors
were protruded (fig 4) and mandibular anterior teeth were lingually
collapsed. The molar relationship was class-II (Fig 5,6). Figure 7
shows patients lip sucking pattern.
Fig 7: Pretreatment Extra Oral Close Up View
Fig 8: Pre Treatment Lateral
Cephalogram
Radiological examination
The OPG revealed restored permanent first molars and buds of third
molars were present.
Cephalometric measurements showed average maxillary depth angle
of 89 degrees and facial depth angle of 90 degrees. Maxillary teeth
were inclined labially A1-Po angle was 26 degrees and mandibular
incisors were inclined lingually (B1-Po =11 degrees) (Fig 8).
Orthodontics
O rthodontics
Fig 6: Pretreatment Intra Oral Left Buccal View
Treatment plan
Treatment objectives included the elimination of lower lip sucking
habit and reduction of increased overjet to improve function
and facial esthetics for this purpose we planned to start phase I
orthodontic treatment with a lip bumper appliance. After the
elimination of the lower lip sucking habit, phase-II fixed orthodontic
therapy was indicated to align and level the dental arches.
Treatment progress
Phase-I
After banding of both lower first molars, a prefabricated lip bumper
appliance was placed at the level of the gingival 2-3 mm in front
of lower incisors and 4-5 mm away from the buccal segments. The
appliance was fixed to the molar tubes to eliminate any risk of
patient compliance and was removed for hygienic considerstions
weekly. This lip bumper appliance was adjusted in the successive
appointments to reactivate to its original position. After three
months , the lower lip sucking habit was completely eliminated.
Fig 9: Mid Treatment Intra Oral Frontal View With Lip Bumper Appliance
Fig 10: Mid Treatment Intra Oral Right Buccal View
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Your Guide on the path of Dentistry 31
Orthodontics
O rthodontics Sept 2013

Fig 11: Mid Treatment Intra Oral Left Buccal View

Phase-II
At the beginning of phase-II, the lip bumper was used for an
additional one month to intensify its effects. The patients orthodontic
therapy continued with fixed orthodontic appliances to align and Fig 13: Ppost Treatment Extra Oral Right Profile View
level the arches and eliminate the overbite. Upper and lower .
016 Niti (Fig 9,10,11) archwires were used for aligning the dental
arches. Levelling was done with .016x .O22 Niti and stainless steel
archwires applied sequentially. Fixed functional forsus appliance
was given for forward positioning of the mandible and reduction of
residual overjet and complete correction of the over bite.

Treatment results

Evaluation of phase-I

At the end of phase-I orthodontic therapy, lower lip sucking habit,

mentalis hyperactivity and labio mental strain were eliminated.
The lower incisors moved labially, and the lower arch crowding and
collapse of the lower anterior area were spontaneously resolved
with reduction of overjet. The lower canines moved forward.

Evaluation of phase-II
At the end of fixed appliance therapy a nice improvement in facial
esthetics and good facial balance was achieved (Fig 12,13,14) . A
Fig 14: Post Treatment Extra Oral Left Profile View
functional class- I with ideal overjet ( 3mm) and over bite (2mm)
was established. Lower dental arch crowding was eliminated (Fig
15,16,17).

Fig 15: Post Treatment Intra Oral Frontal View

Fig 12: Post Treatment Extra Oral Frontal View

32 GUIDENT | Your Guide on the path of Dentistry

Orthodontics
O rthodontics Sept 2013

In the present case study, a lip bumper appliance was used to

eliminate lower lip sucking habit and improve the mentalis and
labialis muscle forces in response to unopposed pressure from the
tongue. After this , fixed orthodontic mechano therapy was started
and forsus fixed functional appliance was given after shifting from
round to rectangular stainless steel wires to correct the over bite
and over jet.

REFRENCES
1. Germec D,Taner TU: Lower lip sucking habit with a lip bumper
appliance. Angle Orthodontist 2005;
Fig 16: Post Treatment Intra Oral Right Buccal View
2. Maroto RM etal : Open bite due to lip sucking a case report J Clin
Pediatr Dent: 1998; 22: 207-210

Fig 17: Post Treatment Intra Oral Left Buccal View

The post treatment cephalometric measurements showed that

upper incisors were uprighted and lower incisors were significantly
labially inclined (Fig 18). The patient also exhibited an increase in
labio mental angle and protrusion of the lower lip.

Fig 18: Post Treatment

Lateral Cephalogram

Discussion
Lip bumper is a simple functional appliance and usually well
tolerated by the patient. In orthodontics , lip bumper have been
used to gain arch length for the alignment of the mild to moderately Can
crowded dental arches, to correct rotations, to control anchorage
loss, to improve labialis muscle activity and to eliminate lower lip
sucking habit.

34 GUIDENT | Your Guide on the path of Dentistry

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