As the grade of tongue-tie increased, its association with Classes I and II malocclusion decreased. The lower grades of tongue-tie are associated with increased lower incisor crowding. Shorter, tight frenulums are more associated with maxillary constriction, anterior open bite, and spacing of the lower anteriors.

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Technological modifications of the elastomers using the Metafasix or OrthoShield Technology, is a definite improvement over the regular elastomers with regard to adhesion of S. mutans and Lactobacilli.

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