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Regular Treatment Plan

Indications for the
Pre-Orthodontic Trainer

Contra-Indications for the
Pre-Orthodontic Trainer

Uses of The Trainer to assist in Other Treatments

Patient Issue

Fitting and Adjustment

The Research


Regular Treatment Plan

Treatment for children from 6 to 10* years with a developing malocclusion

The optimal age to start treatment with the TRAINER is 6-8 years.

The TRAINER¨ is designed to be used in the mixed dentition stage, from the time the permanent anterior teeth are erupting. This is the optimum time to implement treatment, as the anterior dentition is most dynamic. It can be used prior to this stage* or after (up to permanent dentition stage).

*Can be used on younger patients before the anterior teeth have erupted. Trim 8-10mm from distal ends to accommodate lack of first molars. Disadvantage is that tooth guidance system is ineffective until permanent anteriors commence eruption.


The soft (blue) TRAINER¨ is the starting appliance and the hard (pink or red) version is the follow-up finishing appliance. While the soft version has greater flexibility for maximum compliance, but with less tooth aligning force, the hard version has optimum tooth aligning properties. The soft version optionally comes with a 2mm breathing hole in the front, to allow for some mouth breathing for treatment of children with chronic nasal obstruction. This improves compliance while attempting to stop mouth breathing and associated tongue thrusting in these children. You can put a hole in the hard TRAINER¨ yourself with a number eight round bur for mouth breathers.

The treatment starts with the soft (blue) TRAINER¨ . This gives maximum compliance, while primarily treating the myofunctional problems with some light tooth guidance. Then is followed after 6-8 months, with the hard version, as functional problems improve and continued dental alignment becomes the priority.

Use must be for 1 hour per day plus overnight every day. Use the blue TRAINER¨ for 6 months average. You are looking for an improvement in myofunctional habits, particularly mouth open posture and overactive mentalis activity associated with an incorrect swallowing pattern. Improvement in dental alignment should occur after 3-6 months.

Review the patient after one month and then every 1-2 months thereafter.


Correcting Tooth Alignment

Once myofunctional habits and dental alignment improve (6-8 months) the child progresses to the hard (pink) TRAINER¨ . This is much firmer and more elastic (same principle as orthodontic archwire). The child will initially experience tooth sensitivity with the hard (pink) TRAINER¨, as more force is placed on them. The Myofunctional characteristics are the same, but combined with a stiffer material. A phasing in period of alternating the Blue TRAINER¨ one night and the Pink TRAINER¨ another night for a few weeks is sometimes necessary.

Use the pink TRAINER¨ for a further 6-12 months. Use beyond this period is recommended depending on the outcome and the next phase of orthodontic treatment.

The final outcome of the treatment is not to eliminate the need for orthodontic treatment, although this does occur in some cases. The role of the pre-orthodontic treatment is to attempt to eliminate the myofunctional habits that cause malocclusion and interrupt normal craniofacial growth patterns. See following research.

The added bonus of treatment is a noticeable facial improvement, a decrease in need for extractions, decreased orthodontic treatment time and improved stability.

"The influence of the lips in modifying the form of the dental arches is an interesting study, and almost every case of malocclusion offers some noticeable and varying manifestation of it." In speaking of the upper and lower lips - "This force is exerted automatically in response to almost every emotion, and results in maintaining the teeth in harmony with the graceful and beautiful curve of the normal individual arch......In cases of malocclusion, strikingly, characteristic abnormalities in lip function are often noticeable, leading to the suspicion that more often than is recognised, the peculiarities of lip function may have been the cause of forcing the teeth into the malpositions they occupy."

Dr. E.H. Angle - The Treatment of Malocclusion of the Teeth Edition 7. Chapter 2. Philadelphia: 1907.

When to start Trainer treatment

All children in the mixed dentition stage presenting in the practice with signs of a developing malocclusion can be started on the TRAINER¨ program. The common malocclusions can all be helped by the TRAINER¨. From the children whose parents see the anterior dentition erupting incorrectly and want something done immediately, to the severe cases that you wish to treat to decrease the complexity of treatment, onto those you would normally start treatment with a functional appliance.

Remember, you are treating pre-othodontically, so any improvement will be better than the old "just wait and watch it get worse" approach. There is no scientific reason to wait. The typical malocclusions to start the TRAINER¨ program are detailed below. Correction of the myofunctional habits combined with Tooth and Jaw alignment is the goal. Correction of Myofunctional problems like mouth breathing and tongue thrusting are evident are most important to future orthodontic success. Elimination of these with some dental correction can eliminate the need for further treatment in some cases. Observe the face for signs of reverse swallowing, overactive mentalis and a mouth open posture and show the parents the significance of these habits on the developing dentition.

The optimal age to start treatment

It is preferable to commence TRAINER¨ treatment at the stage that 4-6 permanent anterior incisors have erupted, to obtain the maximum effect from the tooth guidance and myofunctional training. A younger child can start before the first permanent molars come in by using a soft TRAINER¨ and shortening of the distal ends to compensate for the lack of first permanent molars. The TRAINER¨ can be used up to the permanent dentition stage.

Cases for which the TRAINER¨ is most effective

At ages 6-10, the TRAINER¨ is particularly helpful with class II malocclusions 4 and "crowding cases". 3 Minimum treatment time is 6-12 months, up to 18 months or more. From 6-10 years, it is used as sole treatment for developing malocclusions, and for mouth breathing tongue thrusting and thumb sucking as a pre-orthodontic treatment. The majority of developing malocclusions will have myofunctional and/or jaw positioning components that can be helped with pre-orthodontic treatment with the TRAINER¨.

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