To Compare The Post Treatment Effects of Fixed Palatal Crib and Bonded Lingual Spur in Reduction of Open Bite and Overjet Following Cessation of Digit Sucking Habit Among 8 To 11 - Year Old Children Attending A Tertiary Health Care Centre in Thiruvananthapuram

International Journal of Dental Science and Innovative Research (IJDSIR) IJDSIR : Dental Publication Service Available Online at:www.ijdsir.com Volume – 8, Issue – 4, August – 2025, Page No. : 168 - 183 Corresponding Author: Dr. Bukya Bharathi, ijdsir, Volume – 8 Issue - 4, Page No. : 168 - 183 Page168 ISSN: 2581-5989 PubMed - National Library of Medicine - ID: 101738774 To Compare The Post Treatment Effects of Fixed Palatal Crib and Bonded Lingual Spur in Reduction of Open Bite and Overjet Following Cessation of Digit Sucking Habit Among 8 To 11 - Year Old Children Attending A Tertiary Health Care Centre in Thiruvananthapuram 1Dr. Bukya Bharathi, Department of Pediatric and Preventive Dentistry, Government Dental College, Thiruvananthapuram 2Dr. Rita Zarina, Department of Pediatric and Preventive Dentistry, Government Dental College, Thiruvananthapuram 3Dr. Sabitha CP, Department of Pediatric and Preventive Dentistry, Government Dental College, Thiruvananthapuram 4Dr. Reshmi J, Department of Pediatric and Preventive Dentistry, Government Dental College, Thiruvananthapuram Corresponding Author: Dr. Bukya Bharathi, Department of Pediatric and Preventive Dentistry, Government Dental College, Thiruvananthapuram Citation of this Article: Dr. Bukya Bharathi, Dr. Rita Zarina, Dr. Sabitha CP, Dr. Reshmi J, “To Compare The Post Treatment Effects of Fixed Palatal Crib and Bonded Lingual Spur in Reduction of Open Bite and Overjet Following Cessation of Digit Sucking Habit Among 8 To 11 - Year Old Children Attending A Tertiary Health Care Centre in Thiruvananthapuram”, IJDSIRAugust – 2025, Volume – 8, Issue – 4, P. No. 168 – 183. Copyright: © 2025, Dr. Bukya Bharathi, et al. This is an open access journal and article distributed under the terms of the creative common’s attribution non-commercial License. Which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given, and the new creations are licensed under the identical terms. Type of Publication: Original Research Article Conflicts of Interest: Nil Abstract Aim: To compare the post treatment effects of Fixed palatal crib and Bonded lingual spur among 8 to 11 year old children with digit sucking habit attending a tertiary health care centre in Thiruvananthapuram. Methodology: A total of 60 subjects (41 girls and 19 boys) of age group 8 to 11 years children were consecutively selected and randomly assigned into two groups: Group - A (n=30) was treated with Bonded lingual spur (BLS) and Group - B (n=30) was treated with Fixed palatal crib (FPC). Data obtained from digit sucking diary (at intervals of every 10 days during the 1st month, every 2 weeks during the next three months and every 1 month during the following months), pre and post study models were assessed for the cessation of digit sucking habit and reduction of overjet & open bite. Statistical Analysis: The statistical analysis was performed by using a statistical software package SPSS version 20.0. Categorical and quantitative variables were expressed as frequency (percentage) and mean ± SD respectively. Independent t test was used to compare quantitative parameters between the categories. Wilcoxon Signed-rank test was carried out to compare ordinal parameters between two intervals of time and Mann-Whitney U test & Kruskal Wallis test was used to compare the ordinal parameters between two groups. Chi-square test was used to find the association between the categorical variables. Dr. Bukya Bharathi, et al. International Journal of Dental Science and Innovative Research (IJDSIR) ©2025 IJDSIR, All Rights Reserved Page169 Page169 Page169 Page169 Page169 Page169 Page169 Page169 Page169 Page169 Page169 Page169 Page169 Page169 Page169 Page169 Page169 Page169 Page169 Results: Socio demographic variables were equally distributed among the two groups (p > 0.05). Both FPC and BLS were effective in cessation of digit sucking habit and reduction of overjet and open bite (p < 0.001), but BLS was more effective in reduction of open bite (in 94.4 % of study subjects, p < 0.001) as compared to FPC (in 69.7 % of study subjects). However FPC was more effective in reduction of overjet (in 66.7 % of study subjects, p < 0.001) as compared to BLS (in 17.9 % of study subjects). The time taken for cessation of digit sucking habit was less with BLS than FPC (p < 0.001). Conclusion: Both FPC and BLS were effective in open bite and overjet reduction associated with digit sucking in children during mixed dentition period, with BLS being more advantageous than FPC in terms of the variables studied. Keywords: Digit sucking habit, Overjet & Open bite, Fixed palatal crib (FPC), Bonded lingual spur (BLS), Cessation of digit sucking habit Introduction Non-nutritive sucking habit (NNSHs) can be considered as the first step towards the development of a child’s selfregulation and the ability to control his/her emotions. Digit sucking habit or non-nutritive sucking, is considered to be the most prevalent of oral habit, with a reported incidence ranging from 13% to almost 100% at some time during infancy. Non-nutritive sucking in the form of digit sucking begins as early as the 29th week of gestation and continues through infancy and peaks at 18 to 21 months of age. Digit sucking habit considered to be normal during the first 2 or 3 years of life, may cause permanent damage if it continues beyond this age. The older the child and longer the duration of the habit, greater the likelihood that malocclusion will develop. (1) Fixed palatal crib is more effective and most commonly used interceptive appliance in the cessation of thumb sucking habit during mixed dentition as it works as an obstacle in continuing the non-nutritive sucking habit and maintains the tongue in a more retruded position thereby preventing its interposition between the incisors but it requires longer laboratory procedures for fabrication and is associated with low patient compliance, decalcification of teeth, food lodgement, calculus formation and gingivitis.(2) Bonded lingual spurs have been found to be effective in the cessation of thumb sucking and tongue thrusting habit. Smaller size of about 3 mm, low cost, better esthetics, lack of need for laboratory procedures, easy installation with reduced clinical time for bonding (about 2 minutes per spur) and less technique sensitive procedures are the advantages of the Bonded lingual spurs over Fixed palatal crib appliances. The absence of an anchorage unit on the molars eliminates the possibility of the mesial movement of those tooth due to the abnormal thrusting force of the tongue and is another notable advantage of the Bonded lingual spurs.(3) The simple design and smaller components of Bonded lingual spurs makes the maintenance of oral hygiene easier, especially in young children. Thus Bonded lingual spur is considered to be a better option as it eliminates the deleterious oral habit like digit sucking, tongue thrusting and associated abnormal tongue posture which allows the normal development of the dentoalveolar structures.(4) The main aim of our study was to observe if selfcorrection of malocclusion occurs with the early interruption of digit sucking habit during mixed dentition period by allowing the normal physiologic eruption of incisors. Very few studies could be found in the literature that compares the effectiveness of Bonded lingual spur (BLS) and Fixed palatal crib (FPC) in cessation of digit sucking habit and the correction of associated malocclusion during the mixed dentition period. The Dr. Bukya Bharathi, et al. International Journal of Dental Science and Innovative Research (IJDSIR) ©2025 IJDSIR, All Rights Reserved Page170 Page170 Page170 Page170 Page170 Page170 Page170 Page170 Page170 Page170 Page170 Page170 Page170 Page170 Page170 Page170 Page170 Page170 Page170 present study was done to compare the effectiveness of Bonded lingual spur and the Fixed palatal crib in terms of the post-treatment effects of a reduction in open bite and overjet following the cessation of digit sucking habit. Aim To compare the post-treatment effects of the Fixed palatal crib and Bonded lingual spur among 8 to 11-yearold children with digit sucking habit attending a tertiary health care centre in Thiruvananthapuram. Objectives Primary objectives To compare the post-treatment outcome of Bonded lingual spur over the Fixed palatal crib as assessed by the measurement of the reduction in open bite and overjet with Peer assessment rating (PAR) index ruler in millimetre by using pre and post-operative study models Secondary objectives To compare the reduction in digit sucking habit by the two deterrent methods as measured by the frequency of sucking episodes. Methodology Study Design Analytical Observational Study Study Setting Department of Paediatric and Preventive dentistry (Government Dental College, Thiruvananthapuram) Participants Children who had digit sucking habit with anterior open bite, who reported to Department of Pediatric and Preventive Dentistry at Government Dental College, Thiruvananthapuram, were selected for the study based on the inclusion and exclusion criteria. Inclusion criteria  Parents who were willing to give consent and children from whom assent could be obtained  Children having digit sucking with open bite, between 8 to 11 years of age, who could be reviewed for a period of 1, 3, 6 and 10 months interval, till the cessation of digit sucking.  Definitely positive and positive children with digit sucking habit during waking hours or sleep.  Angle’s class 1 malocclusion cases with overjet more than 4 mm and open bite more than 1 mm.  Children who had already undergone some form of home remedies to stop the habit, but need further professional assistance.  Fully erupted first permanent molars and incisors. Exclusion criteria  Physically and medically compromised children  Children with a previous history of professional intervention for habit cessation  Clinically missing anterior teeth  Patients having normal occlusion despite having digit sucking habit.  Known neurodevelopmental disabilities. Sampling Sample size Sample size was calculated using the formula n = ⌊2 𝑥 𝜎2 ∆2⌋ ⌊𝑍𝛼 +𝑍𝛽⌋2 Where n = Sample size Zα = False positive error (5%) Zβ = False negative error (20%) ∆ = 1 mm (clinically meaningful difference) σ = 1.25 (standard deviation of open bite)(5) n = 25 Minimum sample size for the study derived from the above formula is 25 in each group. For satisfying the power of efficiency, 20 % extra patients were added to Dr. Bukya Bharathi, et al. International Journal of Dental Science and Innovative Research (IJDSIR) ©2025 IJDSIR, All Rights Reserved Page171 Page171 Page171 Page171 Page171 Page171 Page171 Page171 Page171 Page171 Page171 Page171 Page171 Page171 Page171 Page171 Page171 Page171 Page171 the above number. Hence size of the sample was upsized to 30 patients. Sampling Procedure Children who had digit sucking habit with anterior open bite, who reported to Department of Pediatric and Preventive Dentistry at Government Dental College, Thiruvananthapuram, were selected for the study based on the inclusion and exclusion criteria. Children were consecutively selected and randomly assigned into two groups by the treating clinician till the sample size was achieved. Outcome Measurement Evaluation of the treatment outcomes were based on preoperative and post-operative measurements of overjet and open bite with PAR index ruler in millimetre by using study models. Outcome variables  Overjet and Open bite  Cessation of digit sucking habit Ethical Consideration  IEC clearance obtained from Government Dental College Institutional Ethics Committee IEC (IEC/E/23/2019/GDCT/dtd/12/11/2019)  Assent from children and verbal-informed consent from parents and care givers of the child were obtained. Methods of Data Collection Study participants were divided randomly into two groups based on the type of the appliance worn for correction of digit sucking habit. Group A: Subjects treated with Bonded lingual spur (BLS) Group B: Subjects treated with Fixed palatal crib (FPC) Armamentarium  Gloves and mask  Impression trays  Alginate impression material  Dental stone  Plaster of Paris  Pre and Post-operative study models  PAR index ruler The study subjects undergoing treatment in the Department were observed and recorded by the principal investigator and pre-operative study models were taken from the study participants just prior to the start of the treatment and post-operatively after cessation of the digit sucking habit. Both pre & post-operative overjet and open bite were measured from study models with the Peer assessment index ruler (PAR) in millimeter. Overjet and Open bite scoring was given according to PAR index ruler. Overjet and Open bite Score according to PAR ruler Scores Overjet in millimeter Open bite in millimeter 1 0 to 3 No open bite 2 1 to 5 Less than or equal to 1 3 5.1 to 7 1.1 to 2 4 7.1 to 9 2.1 to 4 5 > 9 > 4 The cessation of digit sucking habit was measured by the reduction in number of digit sucking episodes from the digit sucking diary, as recorded by follow-up calls made every 10 days during the 1st month, every 2 weeks during the next three months, every 1 month during the following months. Dr. Bukya Bharathi, et al. International Journal of Dental Science and Innovative Research (IJDSIR) ©2025 IJDSIR, All Rights Reserved Page172 Page172 Page172 Page172 Page172 Page172 Page172 Page172 Page172 Page172 Page172 Page172 Page172 Page172 Page172 Page172 Page172 Page172 Page172 Plan of Analysis  Statistical analysis was done using Statistical Package of Social Sciences (SPSS) software version 20.0.  Categorical and quantitative variables were expressed as frequency (percentage) and mean ± SD respectively.  Independent t-test was used to compare quantitative parameters between the categories.  Wilcoxon signed-rank test was carried out to compare ordinal parameters between two intervals of time.  Mann-Whitney U test & Kruskal Wallis test were used to compare ordinal parameters between the groups  Chi-square test was used to find an association between the categorical variables. Representative cases Case 1: Figure 1.1: Preoperative image of an 8-yearold female child with anterior Open bite and increased Overjet Figure 1.2: Intraoral image showing Fixed palatal crib appliance Figure 1.3: 12 weeks follow-up image showing improvement in anterior Open bite Figure 1.4: Post-operative image showing improvement in anterior Open bite following cessation of digit sucking habit Case 2 Figure 1.5: Preoperative image of a 9 and half-year-old female child showing anterior Open bite and increased Overjet Figure 1.6: Intraoral image showing Bonded lingual spurs/palatal spurs appliance Dr. Bukya Bharathi, et al. International Journal of Dental Science and Innovative Research (IJDSIR) ©2025 IJDSIR, All Rights Reserved Page173 Page173 Page173 Page173 Page173 Page173 Page173 Page173 Page173 Page173 Page173 Page173 Page173 Page173 Page173 Page173 Page173 Page173 Page173 Figure 1.7: 8 weeks follow-up image showing improvement in anterior Open bite Figure 1.8: Post-operative image showing achievement in normal over bite following cessation of digit sucking habit Results The present study was conducted to compare the posttreatment outcome of Bonded lingual spur and Fixed palatal crib in reduction of open bite and overjet following cessation of digit sucking habit. The study was done among 60 children in the age group of 8 to 11 years who reported to the outpatient Department of Pediatric and Preventive Dentistry, Government Dental College, Thiruvananthapuram and satisfied both the inclusion and exclusion criteria. This study evaluated effects on digit sucking episodes by two deterrent methods as measured by the change in frequency, duration and associated malocclusion. Out of the total 60 study participants, 8.3% of the study subjects, three subjects in the Fixed palatal crib group and two subjects in the Bonded lingual spur group were lost to follow up due to the unprecedented Covid-19 scenario. Hence post-treatment statistical analysis was done for the available 55 cases, though only 25 were required in each group as per the calculated sample size. The data collected were statistically analysed and the results are presented under the following categories: Post-treatment outcome of Bonded lingual spur (BLS) and Fixed palatal crib (FPC)  Treatment effects of the Bonded lingual spur in reduction of Overjet  Treatment effects of the Bonded lingual spur in reduction of Open bite  Treatment effects of the Fixed palatal crib in reduction of Overjet  Treatment effects of the Fixed palatal crib in reduction of Open bite  Comparison of treatment outcome of Bonded lingual spur and Fixed palatal crib in reduction of Overjet  Comparison of treatment outcome of Bonded lingual spur and Fixed palatal crib in reduction of Open bite Comparison of the cessation of digit sucking habit by the bonded lingual spur (BLS) and Fixed palatal crib (FPC)  Comparison of reduction in the frequency of digit sucking episodes by the two appliances  Comparison of the duration taken in weeks for cessation of digit sucking habit by the two appliances. Post-Treatment Outcome of Bonded Lingual Spur (BLS) and Fixed Palatal Crib (FPC)  Treatment effects of the Bonded lingual spur in reduction of Overjet Among the study participants, the mean difference in the pre and post-treatment overjet reduction was 4.71 mm in the Bonded lingual spur group and it was statistically significant (p < 0.001). Dr. Bukya Bharathi, et al. International Journal of Dental Science and Innovative Research (IJDSIR) ©2025 IJDSIR, All Rights Reserved Page174 Page174 Page174 Page174 Page174 Page174 Page174 Page174 Page174 Page174 Page174 Page174 Page174 Page174 Page174 Page174 Page174 Page174 Page174 Table 1: Distribution of Overjet in the study subjects during the pre and post-treatment period Overjet (in mm) Pre treatment Post treatment Z score ($) p value N % N % 0 to 3 0 0.0 5 17.9 4.71 < 0.001 3.1 to 5 0 0.0 19 67.9 5.1 to 7 13 43.3 4 14.3 7.1 to 9 13 43.3 0 0.0 > 9 4 13.3 0 0.0 Mean ± SD 6.6 ± 1.4 4.3 ± 0.8 Median 6.5 4.3 $ - Wilcoxon signed-rank test  Treatment effects of Bonded lingual spur in reduction of overjet Treatment effects of the Bonded lingual spur in reduction of Open bite Among the study participants, the mean difference in the pre and post-treatment open bite reduction was 4.76 mm in the Bonded lingual spur group and it was statistically significant (p < 0.001). Table 2: Distribution of Open bite in the study subjects during the pre and post-treatment period Open bite (-) (in mm) Pre treatment Post treatment Z score($) p value N % N % No open bite 0 0.0 20 71.4 4.76 < 0.001 ≤ 1 0 0.0 7 25.0 1.1 to 2 0 0.0 1 3.6 2.1 to 4 11 36.7 0 0.0 > 4 19 63.3 0 0.0 Mean ± SD - 4.7 ± 1.1 1.5 ± 0.7 Median - 4.5 2.0 $ - Wilcoxon signed-rank test  Treatment effects of Bonded lingual spur in reduction of open bite Treatment effects of the Fixed palatal crib in reduction of Overjet Among the study participants, the mean difference in the pre and post treatment overjet reduction was 4.63 mm in the Fixed palatal crib group and it was statistically significant (p < 0.001). Dr. Bukya Bharathi, et al. International Journal of Dental Science and Innovative Research (IJDSIR) ©2025 IJDSIR, All Rights Reserved Page175 Page175 Page175 Page175 Page175 Page175 Page175 Page175 Page175 Page175 Page175 Page175 Page175 Page175 Page175 Page175 Page175 Page175 Page175 Table 3: Distribution of Overjet in the study subjects during the pre and post-treatment period Overjet (in mm) Pre treatment Post treatment Z score ($) p value N % N % 0 to 3 0 0.0 18 66.7 4.63 < 0.001 3.1 to 5 1 3.3 8 29.6 5.1 to 7 10 33.3 1 3.7 7.1 to 9 15 50.0 0 0.0 > 9 4 13.3 0 0.0 Mean ± SD 7.3 ± 1.4 1.7 ± 0.5 Median 7.3 2.0 $ - Wilcoxon signed-rank test  Treatment effects of Fixed palatal crib in reduction of overjet Treatment effects of the Fixed palatal crib in reduction of Open bite Among the study participants, the mean difference in the pre and post-operative open bite reduction was 4.61 mm in the Fixed palatal crib group and was statistically significant (p < 0.001). Table 4: Distribution of Open bite in the study subjects during the pre and post-treatment period Open bite (-) ( in mm ) Pre treatment Post treatment Z score($) p value N % N % No open bite 0 0.0 3 11.1 4.61 < 0.001 ≤ 1 0 0.0 17 63.0 1.1 to 2 0 0.0 6 22.2 2.1 to 4 7 23.3 1 3.7 > 4 23 76.7 0 0.0 Mean ± SD - 4.4 ± 0.9 - 0.7 ± 1.4 Median - 4.5 -1.0 $ - Wilcoxon signed-rank test  Treatment effects of Fixed palatal crib in reduction of open bite Comparison of treatment effects of Bonded lingual spur and Fixed palatal crib in reduction of overjet Dr. Bukya Bharathi, et al. International Journal of Dental Science and Innovative Research (IJDSIR) ©2025 IJDSIR, All Rights Reserved Page176 Page176 Page176 Page176 Page176 Page176 Page176 Page176 Page176 Page176 Page176 Page176 Page176 Page176 Page176 Page176 Page176 Page176 Page176 Graph 1: Percentage distribution of overjet reduction with Bonded lingual spur and Fixed Palatal crib Among the study participants, the percentage of subjects who achieved a normal overjet of 0 - 3 mm in the Fixed palatal crib group was 18 (66.7%) whereas only 5 (17.9%) in the Bonded lingual spur group achieved the same Comparison of treatment effects of Bonded lingual spur and Fixed palatal crib in reduction of open bite Graph 2: Percentage distribution of open bite reduction with Bonded lingual spur and Fixed palatal crib  Among the study participants, the percentage distribution of the subjects who achieved normal overbite in the Bonded lingual spur group was 71.4% (20) whereas in the FPC it was only 11.1% (3).  Seventeen subjects (63.0%) in the Fixed palatal crib group and 7 subjects (25%) in the Bonded lingual spur group achieved a reduction in open bite of ≤ 1 mm. Dr. Bukya Bharathi, et al. International Journal of Dental Science and Innovative Research (IJDSIR) ©2025 IJDSIR, All Rights Reserved Page183 Page183 Page183 Page183 Page183 Page183 Page183 Page183 Page183 Page183 Page183 Page183 Page183 Page183 Page183 Page183 Page183 Page183 Page183 effects produced by different appliances on early treatment of anterior open bite: A randomized clinical trial. The Angle Orthodontist. 2018;88(6):684–91. 17. Giuntini V, Franchi L, Baccetti T, Mucedero M, Cozza P. Dentoskeletal changes associated with fixed and removable appliances with a crib in open-bite patients in the mixed dentition. American journal of orthodontics and dentofacial orthopedics. 2008;133(1):77–80. 18. Ferreira FPC, Almeida RR de, Torres FC, AlmeidaPedrin RR de, Almeida MR de, Santana Filho R. Evaluation of the stability of open bite treatment using a removable appliance with palatal crib combined with high-pull chincup. Dental Press Journal of Orthodontics. 2012;17(6):52–60. 19. Haryett RD, Hansen FC, Davidson PO. Chronic thumb-sucking: a second report on treatment and its psychological effects. American journal of orthodontics. 1970;57(2):164–78. 20. Bourne CO. The comparative effectiveness of two digit-sucking deterrent methods. West Indian Med J. 2005;54(4):257–60. 21. Justus R. Correction of Anterior Open Bite with Spurs: Long-Term Stability. World Journal of Orthodontics. 2001;2(3). 22. Villa NL, Cisneros GJ. Changes in the dentition secondary to palatal crib therapy in digit-suckers: a preliminary study. Pediatric dentistry. 1997;19(5):323–6.