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Background: Elastodontics is a specific interceptive orthodontic treatment that uses removable elastomeric appliances. They are functional appliances that produce neuromuscular, orthopedic and dental effects. Thus, these devices are useful in the developmental age, when skeletal structures are characterized by important plasticity and adaptation capacity, allowing to remove factors responsible for malocclusions. Elastomeric devices are generally well tolerated by patients requiring simple collaboration and management. This work can be useful to update all orthodontists already adopting these appliances or for those who want to approach them for the first time. This study aimed to describe four cases treated with new elastomeric devices called AMCOP Bio-Activators and to provide an overview of elastodontics, its evolution, indications and limits. Methods: A total of four clinical cases were presented after a treatment period of 16–20 months to evaluate the clinical and radiological effects of the elastodontic therapy. Results: The effectiveness of Bio-Activators on clinical cases was evidenced with a significant improvement in skeletal and dentoalveolar relationship, and malocclusion correction in a limited treatment period (16–20 months). Conclusions: The Bio-Activators showed clinical effectiveness to achieve therapeutic targets according to a low impact on the patient’s compliance.

Background: The management of a hyperdivergent growth pattern is one of the most challenging in orthodontics and different treatments are advocated. The present study analyses the effectiveness of elastodontic therapy with AMCOP® devices in treating children with hyperdivergent class II malocclusion and the effect on the upper airway patency. Methods: The study group included 21 patients (10 males and 11 females, mean age 8.22 ± 1.17 years) with a hyperdivergent growth and a class II malocclusion treated with AMCOP® devices. Cephalometric analysis was performed before treatment (T0) and after treatment (T1). Results: After treatment, the cephalometric analysis revealed a correction of the class II malocclusion and a modification of the growth pattern with a divergence reduction. The improvement of the upper airway space was also observed. Conclusion: The elastodontic therapy effectively corrected hyperdivergent class II malocclusion in growing patients over a short period.

Scientific studies have shown that dysfunctional problems associated with dysmorphisms are the base of malocclusion. The position of the mouth and the head is a component of the general postural arrangement, so any head misalignment creates disharmonies and tensions among the neck muscles. Elastodontics is a treatment based on the use of removable elastomeric devices. These functional appliances are made of elastomeric material, acting tridimensionally on a neuromuscular system with orthopaedic and dental effects. Bioactivators have a vestibular and lingual flange with a free central area that permits them to position teeth without constraints. The flanges are linked by an occlusal plane that maintains the two skeletal bases and teeth in first-class normocclusion with propulsive and retropulsive effects on the maxilla and mandible. Elastomeric devices are generally well tolerated by patients requiring simple collaboration and management. This review aim is to describe the indications and limits of orthodontic therapy with elastomeric devices to provide an overview of elastodontics.

Background and Objectives: Elastodontic appliances made of medical-grade silicone are increasingly used in interceptive orthodontics, but prolonged intraoral exposure may affect their stability. This study evaluated structural changes in LM-ActivatorTM 2 appliances after clinical use, using Fourier-transform infrared (FTIR) spectroscopy. Materials and Methods: Eight appliances (one unused control and seven worn for 3–24 months) were analyzed by FTIR-ATR in the 4000–650 cm−1 range. Absorption bands characteristic of polydimethylsiloxane (PDMS) were quantified, and indices reflecting backbone crosslinking, side-group retention, hydrophilicity, and relative reduction in methyl-related spectral contributions were calculated. Results: The PDMS backbone remained chemically intact across all samples. However, progressive molecular reorganization was detected with wear duration. The Backbone Dominance Index increased significantly from control to 24 months, while side-group indices decreased, confirming apparent depletion of methyl-related FTIR bands. Hydrophilicity and crosslinking indices rose over time, particularly after 12 months, indicating increased surface polarity and network densification. Conclusions: LM-ActivatorTM 2 appliances undergo gradual intraoral aging, marked by backbone crosslinking and apparent reduction in methyl-associated vibrational contributions inferred from FTIR ratio side-groups. These changes, while not compromising the polymer identity, may influence surface properties, biofilm retention, and long-term mechanical behavior. Periodic replacement is recommended to ensure optimal clinical performance.

Background: Preformed elastodontic appliances (EAs) have been described as safe, cost-effective, and easy-to-use devices for interceptive orthodontic treatment in growing patients. This study aimed to assess the knowledge and the attitude of dentists toward the use of EAs and to compare the behaviors of orthodontists (Os) with those of general dental practitioners (GDPs). Methods: An anonymous survey was distributed among dentists through social media. Twenty-two items were divided as follows: characteristics of respondents; general knowledge about EAs; section for EA-users; and section for EA non-users. Chi-squared tests were used to analyze differences in responses between groups. Results: Participants included 226 Os and 168 GDPs. The majority in both groups reported having adequate knowledge about EAs and utilizing them in their practice. GDPs usually use EAs to treat children during the early phase of growth, while Os also use EAs to address orthodontic problems in different stages of dentition, experiencing a chair time reduction compared with traditional appliances. Regarding EA non-users, GDPs seem not to find an application among their patients, whereas Os reported not having enough patient compliance during treatment. Conclusions: Although treatment with EAs is common among all dentists, differences exist between Os and GDPs in the awareness and application, as well as in the reasons provided for not using EAs.

Objectives: This study aimed to compare the skeletal and dentoalveolar effects of a fully customized elastodontic appliance with those of the traditional Twin Block appliance in growing patients with Class II malocclusion during the mixed dentition phase. Methods: A total of 35 patients were included: 18 treated with a customized elastodontic appliance (C-Ela group) and 17 with a Twin Block appliance (TB group). Digital dental models and lateral cephalometric radiographs were obtained at baseline (T1) and after 12 months of treatment (T2). All patients were treated by experienced clinicians according to standardized appliance protocols. Data analysis was performed by a blinded operator using Ortho Analyzer and Dolphin Imaging software. The Shapiro–Wilk test was applied to verify the normal distribution of the data. Paired-sample t-tests were used to assess within-group changes between T1 and T2. For intergroup comparisons two-tail independent-sample t-tests were used, and chi-square tests were used for categorical variables. Statistical significance was set at p < 0.05. Results: Both groups showed significant intragroup improvements in overjet (C-Ela: −2.77 ± 2.07; TB: −2.30 ± 2.72 mm), overbite (C-Ela: −1.79 ± 1.95; TB: −1.40 ± 2.65 mm), and sagittal molar relationship (p < 0.05) after treatment. The C-Ela group exhibited a significantly greater reduction in anterior dental crowding (p < 0.05) and better control of upper (C-Ela: −4.93 ± 7.65°; TB: −1.80 ± 5.72°) and lower incisor inclination (C-Ela: +1.70 ± 4.80°; TB: +4.35 ± 6.22°). In intergroup comparisons, the TB group showed a significantly greater proclination of the lower incisors at T2 (L1/Go-Gn: +4.35°; L1/A-Pog: +1.44 mm), whereas the C-Ela more effectively limited these changes (L1/Go-Gn: +1.70°; L1/A-Pog: +1.18 mm). Skeletal analysis revealed an increase in ANB angle in both groups (C-Ela: −1.49 ± 2.62°; TB: −1.78 ± 2.78°), with no statistically significant intergroup differences, and no other skeletal parameters showed significant between-group changes. Conclusions: Both appliances effectively corrected Class II malocclusions. However, the customized elastodontic device provided better dentoalveolar control, particularly in managing anterior crowding and incisor inclination. Its individualized fit may enhance biomechanical precision and improve overall treatment outcomes in growing patients.

Background This study focused on the aging mechanism and degradation of mechanical and structural features of elastodontic appliances (EA) under artificial and intraoral aging to achieve oral myofunctional therapy with particular removable silicone elastomer devices. Materials and methods EAs artificially aged in saliva with different pH values were investigated through cyclic compression testing along with characterization techniques (Scanning electron microscopy, X-ray diffraction, and Fourier transform infrared spectroscopy), and characterization analysis was also performed on clinically retrieved EAs. Results Artificial aging was found to have minimal effect on the structural properties of EAs, and intraorally aged samples showed perceptible micro-morphology. The Mullins index and peak stress decreased ( P <0.01), while the compression set increased with prolonged aging time. Samples in alkaline saliva showed the largest Mullins effect ( P <0.05). Conclusions The aging mechanism of the elastomer was found to be the crosslinking of main chains and scission of side chains. The presence of OH- enhanced the rupture degree of side bonds. The decline in viscoelastic properties was shown to be more severe with longer service durations. Clinical relevance Research on how the salivary environment and pH affect the aging characteristics of EAs is vital for guiding clinical applications and future modifications to extend their clinical lifetime.

The aim of the current study was to assess patient and parental satisfaction following treatment during mixed dentition with two removable orthodontic devices: elastodontic appliances (EAs) and clear aligners (CAs). Consecutive patients below the age of 12 years who had completed the active phase of EA or CA therapy were recruited. A dedicated written questionnaire divided into four sections was used to measure parental and patient satisfaction regarding treatment experiences and treatment outcomes. The total sample included 56 subjects: 28 belonged to the EA group (7 girls and 21 boys; mean age 11 years); 28 belonged to the CA group (12 girls and 16 boys; mean age 9 years). Patients and parents of both the EA and CA groups were satisfied with the treatment experiences and outcomes. According to parental reporting, EA treatment was significantly more painful than CA therapy (p = 0.003), but this was not confirmed by the patients (p = 0.100). Both parents and patients reported EAs being significantly more difficult to wear than CAs (p < 0.001 and p = 0.001, respectively). Functional improvements were reported, including a reduction in grinding sounds in the CA group (p = 0.020) and breathing improvements in the EA group (p = 0.023). According to the parents, school life and social life were significantly improved in the CA group, as compared to the EA group (school life p < 0.001, social life p = 0.001). Finally, parents belonging to the CA group found that their child’s treatment was much shorter than expected (p = 0.003).

The aim of this study was to assess the skeletal and dentoalveolar changes obtained after 1 year of treatment with elastodontic appliances (EA) in a retrospective cohort of children reporting early signs of malocclusion. Also, a detailed description of the tested EAs was reported. The study sample included 20 subjects, 8 males and 12 females, with a mean age of 8.4 ± 0.6 years, and a control group consisting of 20 subjects, 9 males and 11 females, with a mean age of 8.1 ± 0.8 years. All subjects in the treated group received the AMCOP second class (SC) (Ortho Protec, Bari, Italy) device. Digital impressions were taken along with a digital bite registration in centric relation before treatment (T0) and after 1 year (T1). Lateral cephalograms were also taken at T0 and T1 and cephalometric analysis was performed to assess the skeletal sagittal changes of the maxilla and the mandible (sella, nasion, A point angle, SNA^; sella, nasion, B point angle, SNB^; and A point–nasion–B point angle, ANB^) as well as the changes of the inter-incisors angle (IIA^). In the treated group, the distribution of subjects according to the presence of crowding and the pattern of malocclusion changed at T1. In the same group, there was an increase of subjects showing no signs of crowding and a class I occlusal relationship, while in the control group, there was a small increase of subjects developing dental crowding and featuring a worse sagittal relationship (class II) compared to pre-treatment condition. A statistically significant reduction of the overjet and overbite was recorded in the treated group between T0 and T1 (p < 0.05); in the control group, a slight increase in the overjet and overbite was detected at T1, being this increment significanct only for the latter parameter. In the tested group, no significant differences were found between SNA^ values detected at T0 and T1 (p > 0.05), instead the SNB^, ANB^, and IIA^ showed a significant increase after 1 year of treatment (p < 0.05). From a clinical perspective, all clinical goals were reached since patients showed remarkable improvements in overjet, overbite, crowding, and the sagittal molar relationship. Within the limitations of the present study, EAs could be effectively used for the interceptive orthodontic in growing patients.

Background and Objectives: The objective of this retrospective controlled study is to compare class II growing patients who underwent treatment with two different functional appliances: the Fraenkel regulator (FR-2), utilized as the control group, and the elastodontic device “Cranium Occluded Postural Multifunctional Harmonizers” (AMCOP), utilized as the test group. Materials and Methods: The study sample consisted of 52 patients with class II division I malocclusion (30 males, 22 females, mean age 8.6 ± 1.4 years) who were treated with the two different types of appliances: Group 1 (n = 27, mean age 8 [7.00, 9.00] years, 12 females, 15 males) received treatment with AMCOP, while Group 2 (n = 25, mean age 9.2 years [8.20, 10.00], 10 females, 15 males) received treatment with FR-2. The mean treatment duration for Group 1 was 28.00 [21.50, 38.00] months, while for Group 2 it was 23.70 [17.80, 27.40] months. Cephalometric analyses were performed on lateral cephalograms taken before treatment (T1) and after treatment (T2). Results: Significant intragroup differences were observed over time in Group 1 for 1^/PP. Similarly, significant intragroup differences were observed over time in Group 2 for SNB, ANB, and IMPA. Conclusions: Both treatment modalities resulted in the correction of class II malocclusion with dentoalveolar compensation, although the treatment duration with AMCOP tended to be longer on average.