Myofunctional Devices in the Complex Treatment of Ankyloglossia and Short Lingual Tie: Implementation in the Healthcare Policy System

Abstract

Objective. To investigate the prevalence of tongue frenulum attachment anomalies among patients aged 6–9 years who presented for an initial orthodontic consultation. The study also aimed to examine the timing of normalization of swallowing patterns and tongue muscle function in patients who underwent frenuloplasty compared with those whose parents declined surgical intervention and instead followed a myofunctional therapy protocol using the Froggy Mouth appliance (FMA). Additionally, the study aims to justify the need for regulatory integration of such technologies into clinical practice as part of national health policy and legal frameworks supporting interdisciplinary approaches to surgical and orthodontic treatment.
Methods. This clinical study involved 1,236 patients aged 6–9 years attending their first orthodontic consultation. From this group, 36 patients with ankyloglossia and 38 patients with a short lingual frenulum were selected. A total of 74 patients were divided into four groups: Group I: 17 patients with ankyloglossia. Group II: 21 patients with a short lingual frenulum. Group III: 19 patients with ankyloglossia. Group IV: 17 patients with a short lingual frenulum. Patients in Groups I and II underwent frenuloplasty with primary wound healing, followed by myofunctional therapy using the Froggy Mouth appliance. Patients in Groups III and IV received only myofunctional therapy using the Froggy Mouth appliance. All participants underwent clinical and laboratory examinations.
Results and Discussion. Out of all examined patients, 420 individuals (34%) presented with ankyloglossia or a short lingual frenulum, along with atypical swallowing patterns. Most parents of these patients reported that they were informed of the tongue frenulum anomaly at birth, but 68% declined intervention, while 32% opted for surgical correction, which ensured effective suckling. These parents were later informed of the necessity of frenuloplasty during the mixed dentition phase to support the development of a normal swallowing pattern.
Scientific Novelty. Clinical and cephalometric studies of patients in Groups I and II confirmed that the primary therapeutic effect of FMA is the normalization of swallowing, but only after prior frenuloplasty in cases of ankyloglossia or short lingual ­frenulum. Cephalometric imaging (lateral teleradiographs) showed improved sublingual bone positioning and the absence of double-contouring of the mandible in these groups. No improvement in tongue posture was observed in Groups III and IV, and only 17.6% of patients in Group IV developed an automated swallowing reflex. We conclude that the use of the Froggy Mouth appliance is both appropriate and necessary as part of an interdisciplinary treatment strategy for patients with tongue frenulum anomalies, particularly when the tongue lies distally at the floor of the mouth. In such cases, frenuloplasty should be the initial step. The scientifically supported implementation of surgical correction (frenuloplasty) and myofunctional orthodontic technologies requires appropriate legal regulation at the legislative level. This includes the incorporation of relevant provisions into clinical protocols, standards of care, and medical professional accreditation requirements. The results of this study highlight not only the clinical effectiveness of these technologies but also the need for legal mechanisms that ensure an integrated, interdisciplinary approach to malocclusion treatment.
Conclusions. When the tongue rests on the floor of the mouth and lies distally during growth periods, it fails to stimulate maxillary development, leading to impaired upper jaw growth, reduced nasal breathing, and compensatory mandibular displacement. This results in the classic facial profile associated with Class II malocclusion, in line with Moss’s functional matrix theory. For orthodontists, the formation of a normal swallowing pattern is crucial, as it enhances treatment effectiveness, shortens treatment duration, and prevents relapse. Our results confirm the efficacy of Patrick Fellus’ labial therapy method: in the majority of patients, a normal swallowing pattern formed within 16 weeks following frenuloplasty. This study underscores the need for regulatory and legal support for incorporating myofunctional technologies into clinical practice. The integration of myofunctional appliances, such as the Froggy Mouth, into national health strategies requires an evidence-based interdisciplinary approach. Legislative recognition of these technologies will support the harmonization of dental, functional, and general medical practices.