1–4). Retardation in tooth eruption was visible with primary teeth beginning to erupt after 1 year of age and permanent teeth from 6 years of age. Various Gefitinib research buy types of malocclusions including maxillary hypoplasia, total mesiocclusion, pathological attrition of primary molar due to bruxism, total distocclusion with

primary crowdings were observed. Patients were cooperative, with medium degree of mental retardation, impaired physical development, poorly developed manual skills due to short fingers and wide hands. One of the patients underwent treatment due to hyperfunction of thyroid gland, was a habitual mouth breather and suffered from bruxism. The aetiology of bruxism is multifactorial with mouth breathing, emotional stress, release of histamine during stress, different levels of serotonine or even allergic rhinitis being mentioned as possible factors [24]. Additionally, dysfunction in form of persistent infantile type of swallowing was observed. Therefore, first phase of orthodontic treatment in both patients included a removable plate by Castillo Morales. According to Castillo Morales, such plate is used in cases with hypotonic, inactive upper lip and broad, hypotonic tongue, often positioned between dental arches. Plate by Castillo Morales enhances the position of lips and tongue due to lack of acrylic

material in the anterior part of palate (Fig. 5). It also has an influence on speech development [25]. One modification in upper palatal plate by Castillo Morales included posterior acrylic capping due to presence of bruxism in one of the patients. During BGB324 in vitro 2.5 years of treatment, the plate was changed three times because the

posterior acrylic capping was gradually being destroyed by bruxism. Other problems included lack of cooperation, therefore the first phase of orthodontic treatment was prolongated. Two IKBKE plates by Castillo Morales were used, each of them changed accordingly to occlusal conditions. At the end of treatment the dysfunction was successfully eliminated. The aim of orthodontic treatment in the second phase was to align the teeth in the upper arch. During intraoral examination, primary crowdings with lack of space for upper permanent canines were observed, II Angle class bilaterally and II canine class bilaterally. The upper canines were erupting buccally, with the left canine positioned less favorably than the right one (Figs. 6–9). The palate was “stair like” (“gothic”). Symmetric extractions of both I upper premolars (teeth 14 and 24) were made to allow the alignment of canines (teeth 13 and 23). Patient is now undergoing active orthodontic treatment with upper removable Schwarz plate. The design of Schwarz plate includes springs, which move both canines distally (Fig. 10). The oral hygiene was assessed using OHI Index by Green and Vermillon.