I will be speaking to a group of orthodontists, some of whom refer to me. I know our position on rakes, cribs, etc. I looked in the literature and could not find any articles to tell me why orthodontists use these. Is it because they believe it is the best way to close the bite? Do they feel it is a more convenient and easy way to address open bites? Why do they opt for this? Is it based on research and training?
Orthodontists and other dentists who use such appliances might cite such studies as: Greg Huang and colleagues at the University of Washington; however, such studies do not report on the characteristics of patients being treated with appliances (such as the status of the airway) nor whether they have an anterior rest posture. They only focus on the thrusting, and show no data about whether the habit returns following the cessation of appliance use.
Orthodontists often focus on the thrusting action of the tongue, often never noting or recording if there is a forward rest posture of the tongue. When you are meeting with your referral sources, your primary message here is the importance of the rest posture and that thrusting itself does not move teeth, as was eloquently reported by Proffit and colleagues in many oral transducer studies. The references are all on the For Dentists and Physicians document on our website — as is the position statement on appliance use. Look under Position Papers, Guidelines, and Articles. Anytime you get stuck, just refer to that article and position statement — written by an orthodontist who has studied such issues and written more than anyone else. Disagreements and challenges are welcome, but only if they are ready to show the data rather than repeating long held beliefs that have no database.