The Myobrace System-As a Hammer for a House-
Sat-Sun, January 18-19, 2014
dr. barry raphaelthe raphael center for integrative education
Myofunctional Research Company presents:
Sunday, January 19, 14
The Myobrace System-A hammer for a house-
Sat-Sun, January 18-19, 2014
dr. barry raphaelthe raphael center for integrative education
Day 1 AMSunday, January 19, 14
Can you hear me?
Let’s turn off ringers...
Sunday, January 19, 14
If all you have is a hammer...
Sunday, January 19, 14
In the news, March 2012
Sunday, January 19, 14
The House that
Sunday, January 19, 14
ADHD/Breastfeeding/Malocclusion/dental trauma/SDB
Understanding the relationships between breastfeeding, malocclusion, ADHD, sleep-disordered breathing and traumatic dental injuries.
Sabuncuoglu O., Med Hypotheses. 2013 Jan 7. pii: S0306-9877(12)00566-X. doi: 10.1016/j.mehy.2012.12.017. [Epub ahead of print]
Sunday, January 19, 14
RO since1983 (30 years...yikes)
Bucknell University 1974University of Pennsylvania 1978
(Three Years in General Practice)Fairleigh-Dickenson University 1983
Sunday, January 19, 14
Jim McNamara
Sunday, January 19, 14
Functional OrthodonticsFunctional Orthodontics
Sunday, January 19, 14
2008
Sunday, January 19, 14
Myofunctional Research Co.
Sunday, January 19, 14
Spring, 2009 MRC meeting, Chicago > Terry
September, 2009 MRC conference, Coral Gables, Fl.
Sunday, January 19, 14
Myofunctional Orthodontics
Chris Farrell
John Flutter
German Ramierez
Damien O’Brien
Myofunctional Research Co.Rancho Cucamonga
2008-2012Sunday, January 19, 14
Oral Myology
Oral Myology Basic CourseJoy MoellerNYC 2011LA 2012
Oral Myology: Levels 2, 3Kim BenkertClifton 2012
Habit CessationShari GreenClifton, 2013
Sunday, January 19, 14
Biobloc Orthotropics
BBO Mini-residencyBill Hang
Agora Hills2012-13
BBO IntensiveDrs. John and Mike
MewLSFO2013
Sunday, January 19, 14
Breathing and Sleep
Buteyko MentorshipThe Breathing Center
Woodstock2010
Breathing Well ProgrammeJohn Flutter
2010 Ortho-Postural TrainingRoger Price
2013
Sleep DentistryMichael Gelb, et.al
NYU2012,2013
Sunday, January 19, 14
Cranial Osteopathy
Advanced Dento-cranial OrthopedicsBob Walker
2014
ALF, The Team ApproachJim Bronson
2013
Cranial AcademySoon
Sunday, January 19, 14
Teaching
Mt. Sinai Pedo ResidencyAli Attaie
2010-2012
Montefiore Ortho ResidencyTony Maganzini
2012
2009-PresentSunday, January 19, 14
Golf
Handicap2007 = 172013 = 23
Sunday, January 19, 14
It’s about the Airway
“It’s all about Barry And
The World of Mouthbreathing”
BTW….I lost 30lbs
Sunday, January 19, 14
Honorarium and Travel Expenses for MRC
No vested interest in Myofunctional Research Co.
Chris told me to tell my truth.
Director, raphael center for integrative education
Disclosure
Sunday, January 19, 14
Represented today?
GP
Perio
Endo
Pedo
Ortho
OMS
Medical
TMD
Sleep Medicine
Sunday, January 19, 14
Schedule
Sunday, January 19, 14
Reading Assignment?
Sunday, January 19, 14
1. The Perfect House: an overview of Myofunctional Orthodontics.1. Airway and Breathing Dysfunction2. Soft Tissue Dysfunction3. Chronic Diseases of Lifestyle4. Malocclusion and Retractive Orthodontics
2. Airway Focused Orthodontics1.Diagnostics2.Prevention3.Undoing the Damage4.Establishing Good Habits
1.The Myobrace System1. Appliance Types2.Clinical Protocols3.Patient Education and Motivation4.Follow-ups and troubleshooting
5.Interdisciplinary Treatment3....
The Myobrace System-A hammer for a house-
Sunday, January 19, 14
The Myobrace SystemDay 2
1.Case presentations and demonstrations1.Case Results2.Patient Assessment3.Myobrace delivery
2.Starting your first case1.Case selection checklist2.Materials check list3.Health History forms4.Patient flow check list5.Ordering Myobrace appliances
3.Course Review: Q&A4.What comes next
Sunday, January 19, 14
Paper clips….
1. Level 1 Screening2. Facial Measurement Routine3. Treatment Goals4. Demo: Myobrace Delivery5. Starting your first case6. What comes next?
Sunday, January 19, 14
Feedback
I agree I like
I disagree I have a problem
I have a question
Sunday, January 19, 14
The Perfect House
Shelter from the
Storm
HVACComfortable Environment
Family Living Together
Decor and Activity
“The Roof is Leaking”
“The A/C is broken. I
can’t sleep.”
“Mommy, Lisa’s hogging bathroom!”
“This place is a mess!”
Chronic Diseases of
Lifestyle
Airway and Breathing
Inefficiency
Soft Tissue Dysfunction
Malocclusion and
Orthodontics
Airway-centricPathology
Sunday, January 19, 14
The Perfect House
Chronic Diseases of
Lifestyle
Soft Tissue Dysfunction
Malocclusion and
Orthodontics
Airway-centricPathology
Airway and Breathing
DysfunctionSunday, January 19, 14
Snoring 8-10%
NormalPrevalence:
OSAS 1-3%
UARS ?
32
Spectrum of SDB
Sunday, January 19, 14
Anatomic Determinants of SleepDisordered Breathing Across the Spectrum of Clinical and Nonclinical Male Subjects*
•Apnea occurs due to craniofacial morphology and obesity, each with their contributions
•The single most important cephalometric variable in predicting AHI severity was the horizontal dimension of the maxilla (ie, porion vertical to supradentale [PV-A] distance).
•SDB increased five- to seven-fold in non-obese subjects and threefold in obese subjects
CHEST September 2002 vol. 122no. 3 840-851
Jerome A. Dempsey, PhD; James B. Skatrud, MD; Anthony J. Jacques, BS;Stanley J. Ewanowski, PhD; B. Tucker Woodson, MD;
Pamela R. Hanson, DDS, MS; and Brian Goodman, PhD
Sunday, January 19, 14
Anatomic Determinants of SleepDisordered Breathing Across the Spectrum of Clinical and Nonclinical Male Subjects*
•It is the maxilla that determines the effective horizontal dimension of the pharynx, and in particular the upper pharynx.
•A constricted maxilla places the upper pharynx (pharyngeal isthmus) at increased risk of collapse with loss of muscle tone.
•differences in morphology explain susceptibility to AHI from weight gain
Sunday, January 19, 14
OSA Risk Factors
• 134 Japanese Males• PSG and various measures• Risk Factors for Increase AHI (Apnea-Hypopnea Index)
• Age• BMI• Position of Hyoid Bone• Size of Airway (and resistance to flow)• Neck Circumference
Analysis of anatomical and functional determinants of obstructive sleep apnea.
Aihara K, et. al ,Sleep Breath. 2012 Jun;16(2):473-81. Epub 2011 May 15.
Sunday, January 19, 14
Which is easier to breathe through?
Sunday, January 19, 14
Which would you trust most?
Sunday, January 19, 14
Which would you rather have?
Sunday, January 19, 14
Narrow Airway Dynamics
• Narrow, irregular airway > •> increased shear forces >•> negative pressure pulls on soft tissue >•> tissue pulling and trauma (snoring) >•> impairment of mechanoreceptors >•> uncoordinated diaphragm and upper airway muscle contraction >• >DISORDERED BREATHING
Powell N, Guilleminault C. “Abnormal pharyngeal airflow in obstructive sleep apnea using computational fluid dynamics: Feasibility study.” Proceeding of the 9th World Congress on Sleep Apnea (Seoul, Korea) 2009
Sunday, January 19, 14
Morphology and SDB in children
“Abnormal craniofacial morphology, but not excess body fat, is associated with an increased risk of having SDB in6–8-year-old children.”
Ikävalko, et.al.,Eur J Pediatr (2012) 171:1747–1752
Sunday, January 19, 14
Morphology and SDB in children
•491 Finnish children 6–8 years of age• studied: BMI, occlusion, sleep survey• Looked for: Frequent snoring, apeas, open-mouth posture
Ikävalko, et.al.,Eur J Pediatr (2012) 171:1747–1752
Sunday, January 19, 14
Morphology and SDB in children
Ikävalko, et.al.,Eur J Pediatr (2012) 171:1747–1752
Risk Factor Incidence
Obesity 0
Tonsilar Hypertrophy 3.7x
Crossbite 3.3x
Convex Facial Profile 2.6x
Sunday, January 19, 14
Morphology and SDB in children
Ikävalko, et.al.,Eur J Pediatr (2012) 171:1747–1752
Sunday, January 19, 14
Morphology and SDB in children
Ikävalko, et.al.,Eur J Pediatr (2012) 171:1747–1752
“A simple model of necessary clinicalexaminations (i.e. facial profile, dental occlusion and tonsils) is recommended to recognize children with an increased risk ofSDB.”
Sunday, January 19, 14
Associations between sleep-disordered breathing symptoms
and facial and dental morphometry, assessed with screening examinations
Hyunh, et.al., AJODO, 2011, 140:762-70
SDB associated with: Swollen Tonsils and AdenoidsLong and narrow face
AllergiesFrequent Colds and Infections
Habitual Mouth Breathing
Dolicofacial shapeHigh mandibular plane angle
Narrow palateSevere crowding
Sunday, January 19, 14
Of the 600 orthodontic patients...
•16% had long facial form
•86% had convex profiles (mandible set back from maxilla)
•Over 50% had daytime mouth open posture
Sunday, January 19, 14
“In this large, population-based, longitudinal study, early-life SDB symptoms had strong, persistent statistical effects on subsequent behavior in childhood.
Findings suggest that SDB symptoms may require attention as early as the first year of life.”
Sleep-Disordered Breathing in a Population-BasedCohort: Behavioral Outcomes at 4 and 7 Years
Karen Bonuck, PhD,a Katherine Freeman, DrPH,bRonald D. Chervin, MD, MS,c and Linzhi Xu, PhDa
PEDIATRICS Volume 129, Number 4, April 2012
Sunday, January 19, 14
“The 2 clusters with peak symptoms before 18 months that resolve thereafter still predicted 40% to 50% increased odds of behavior problems at 7 years.”
Sleep-Disordered Breathing in a Population-BasedCohort: Behavioral Outcomes at 4 and 7 Years
“...early childhood SDB effects may only become apparent years later.”
Sunday, January 19, 14
Nighttime symptoms of SDB in kids
•Abnormal sleeping position•Bruxism•Chronic, heavy snoring•Delayed sleep onset•Difficulty breathing•Difficulty waking up in AM•Drooling•Enuresis•Frequent awakenings•Insomnia•Bed Dread
•Mouth breathing•Nocturnal migraine•Nocturnal sweating•Periodic Limb movement•Restless sleep•Sleep talking•Sleep terror•Sleep walking•Witnessed apnea
Sunday, January 19, 14
Daytime symptoms of SDB in kids
•Morning headache•Mouthbreathing•Morning thirst•Excessive fatigue•Abnormal shyness, withdrawn, and depressive presentation
•Behavioral problems
•ADHD pattern•Aggressiveness•Irritability•Poor concentration•Learning difficulties•Memory impairment•Poor academic performance
Sunday, January 19, 14
Childhood Obstructive Sleep Apnea Associates with Neuropsychological Deficits
and Neuronal Brain Injury
•Childhood OSA is associated with •Deficits of IQ •Deficit of executive function •Possible neuronal injury in the hippocampus and frontal cortex.
•“...untreated childhood OSA could permanently alter a developing child’s cognitive potential.”
Ann C. Halbower, et.al, PLoS Medicine,August 2006 | Volume 3 | Issue 8 | e301
Sunday, January 19, 14
Caroline Rambaud & Christian GuilleminaultEuropean Journal of Pediatrics
DOI 10.1007/s00431-012-1727-3Pub Online: April 11, 2012
Death, nasomaxillary complex, and sleep in young children
Abrupt sleep associated death in seven children with good pre-mortem history
Sunday, January 19, 14
Findings in all 7 cases
•chronic indicators of abnormal sleep
•enlargement of upper airway soft tissues
•a narrow, small nasomaxillary complex, with or without mandibular retroposition
Sunday, January 19, 14
“all children present a visuallyrecognizable abnormal high and
narrow hard palate”
Sunday, January 19, 14
Maxillary DysplasiaIs a major factor in
Sleep Disordered Breathing
Maxillary RetrusionMidface Deficiency
Maxillary HyperdivergencyLong Face Syndrome
Adenoid FaciesBimaxillary Retrusion
What causes it?
Sunday, January 19, 14
The Perfect House
Chronic Diseases of
Lifestyle
Airway and Breathing
Dysfunction
Malocclusion and
Orthodontics
Airway-centricPathology
Soft Tissue Dysfunction
Sunday, January 19, 14
“….there is much circumstantial evidence that jaws and faces do not grow to the same size that they used to…”
Daniel E. Lieberman
Sunday, January 19, 14
Sunday, January 19, 14
The “Modern” Maxilla
The Gothic Arch The Roman Arch
Sunday, January 19, 14
Chris Farrell
Sunday, January 19, 14
Soft Tissue Dysfunction is THE etiology in
Maxillary DysplasiaAnd Malocclusion
Sunday, January 19, 14
How do you build an arch?
The Roman Arch
Sunday, January 19, 14
No scaffold?
Sunday, January 19, 14
When the tongue rests in the roof of the mouth the teeth erupt around the tongue forming a normally shaped and sized jaw.
The tongue is the scaffold for the upper jaw
Sunday, January 19, 14
Those children who breathe through the mouth or have the lips apart at rest will not have the
tongue in the roof of the mouth.
All of these children will have an underdeveloped upper jaw.
It will not be big enough for all of the teeth and when the adult teeth erupt they will be crooked.
Sunday, January 19, 14
Egil Peter Harvold
•Norwegian Orthodontist
•Cleft Palate
•Professor
•Brought Functional Treatment to N.A.
•1981 Primate experiments
• Blocked nasal passage
• Skeletal malocclusion resulted1912-1992
Block the nose> posture changes and teeth get crooked
Sunday, January 19, 14
Plugged Nose changes Posture
Sunday, January 19, 14
Posture changes Teeth
Lowered mandibular posture, tongue protrusion, and open bite
Open mouth posture retained for 1 year after nose reopened. Facial features retained
Sunday, January 19, 14
John Mew
•“Orthotropics”
•“Maxillary undergrowth is such a constant feature of modern malocclusion” - AJODO,1979
•Normal growth of maxilla > Down and Forward
•Dysfunctional growth > Down and Narrow
•Biobloc Therapy to reestablish Forward component
Sunday, January 19, 14
John Mew, 1981
“Because the genetic control of skeletal growth is not precise,
the articulation of the teeth and jaws depends upon additional guidance
from oral posture.”
The Tropic Premise
Sunday, January 19, 14
John Mew
“ If the tongue at rest is against the palate with the lips lightly sealed and
the teeth in or near contact, there will be ideal facial and dental
development.”“Something RARE in industrialized
societies…”
Sunday, January 19, 14
The Tropic Premise
If the tongue is chronically held away from the palate……the maxilla collapses in all three dimensions.
Sunday, January 19, 14
SOFT TISSUE DYSFUNCTION
With Chronic Open Mouth Posture
Comparison of Unsupported vs Supported Growth
Sunday, January 19, 14
SOFT TISSUE DYSFUNCTION
With Chronic Open Mouth Posture
Comparison of Unsupported vs Supported Growth
Sunday, January 19, 14
11y male vs Bolton norm
Sunday, January 19, 14
Male 8-3y
Sunday, January 19, 14
Male 10yo
Sunday, January 19, 14
11-7yF
Text
Sunday, January 19, 14
Everyday in my practice...
Sunday, January 19, 14
Bolton Standards15yo
The Maxilla is Down and Back
The Mandible is Retrognathic
Nasal Cartilage Collapse
Insufficient Facial Support
Bi-maxillary Retrusion
Sunday, January 19, 14
Pharyngeal AirspaceThree-dimensional assessment of pharyngeal airway
in nasal- and mouth-breathing children
Alves, M, et.al., Int J Ped ORL 75 (2011) 1195–1199
Cone Beam and Airway analysis toolSunday, January 19, 14
•Exam for Mouthbreathing•the habitual posture of the lips (apart, even slightly)•size and shape of the nostrils•control reflex of the Alar Nasalis •Glatzel mirror test•Rhinoscopy•Adenoid hypertrophy
25 Mouth breathers, 25 Nasal breathers, Avg 8-9 y/o
Three-dimensional assessment of pharyngeal airway in nasal- and mouth-breathing children
Sunday, January 19, 14
Pharyngeal Airspace
Mouthbreathers have significantly smaller airway space.
(measurements PAS-OccL, PAS-UP, airway volume, area and minimum axial area)
Mouth breather Nasal breather
Sunday, January 19, 14
Open Mouth Posture is the most common
and significant Soft Tissue Dysfunction
In children today.
Sunday, January 19, 14
The Perfect House
Chronic Diseases of
Lifestyle
Airway and Breathing
Dysfunction
Soft Tissue Dysfunction
Malocclusion and
Orthodontics
Airway-centricPathology
Sunday, January 19, 14
Weston Price
Nutrition and Physical DegenerationWeston A. Price, DDS, 1939
Price-Pottenger Nutrition Foundationwww.ppnf.org
1870-1948
Sunday, January 19, 14
Weston Price
•Dentist in Cleveland, OH•Traveled worldwide•“primitives” on their traditional diets
•freedom from decay, •stalwart bodies, •resistance to disease •fine characters •beautiful, straight teeth.
•Malocclusion is a product of the diet of industrialized societies
1870-1948
Sunday, January 19, 14
Kevin Boyd
Peter Gluckman
Neese and Williams
Scott Gilbert
Clark Spencer Larsen
Darwinian Dentistry Are we developing the wayour genes meant us to be?
Me...
Sunday, January 19, 14
Obesity
Hypertension
Cardiovascular Disease
Type 2 Diabetes
Fatty Liver Disease
Some Cancers
Osteoporosis
Depression
The Results of the MismatchBetween Genes and the Environment
Chronic Non-Communicable Diseases of CivilizationWestern Lifestyle Diseases
Metabolic Syndrome
Asthma
Autism
Asperger’s
Alzheimers
ADD/ADHD
Chronic Back Pain
Caries
Malocclusion
Sleep Apnea
Sunday, January 19, 14
There was a time...
5,000 years agoWhen caries and malocclusion
were rare!
Sunday, January 19, 14
The Missing Piece in Orthodontics Today...
Its not justGrowth and Development
ItsGrowth, Development and
AdaptationSunday, January 19, 14
If Malocclusion is caused byGrowth and Development...
Genotype Phenotype
Total Growth
Sunday, January 19, 14
If Malocclusion is caused byGrowth and Development and
Adaptation...
Genotype Phenotype
Total Growth
Sunday, January 19, 14
An example of “adaptation”
Sunday, January 19, 14
What do you notice about these boys?
An example of adaptation
Sunday, January 19, 14
What do you notice about these boys?
One of them has crooked teeth.Sunday, January 19, 14
3 August 2003 3 August 2003
RHYS - 10Y 11MHow did these teeth get this way?
Different genes than his brother?Sunday, January 19, 14
1 March 2007 1 March 2007
RHYS - 14Y 5M Four years later, after successful MFO
Text
(Treatment by Dr. Chris Farrell)
Sunday, January 19, 14
RHYS - 16 AUGUST 2007 KYLE - 16 AUGUST 2007
TRAINER BWS MYOBRACE MINIMAL SWA
RHYS & KYLE - 13Y 8MDid genetics make the teeth crooked?
Did genetics make the teeth straight again?Sunday, January 19, 14
The Perfect House
Chronic Diseases of
Lifestyle
Airway and Breathing
Dysfunction
Soft Tissue Dysfunction
Airway-centricPathology
Malocclusion and
Orthodontics
Sunday, January 19, 14
Edward H. Angle
•1898 Treatment of malocclusion of the teeth and fractures of the maxillae
•KNOWN for:•The Angle Classification•The Edgewise bracket and rectangular wire•Non-extraction orthodontics: “The Angle School”•Organizing the Specialty of orthodontics
•”... more often than is recognized, the peculiarities of lip function may have been the cause of forcing the teeth into the malpositions they occupy”.
1855-1930
Sunday, January 19, 14
From “Malocclusion” 1907
Sunday, January 19, 14
Crozat Appliance
Light intermittent forces can affect skeletal growth
•Based on the work of •George Crozat 1894 - 1966
•Albert Weibrecht• Arch development in harmony with natural growth and muscles•Light wire removable appliances
Sunday, January 19, 14
Crozat Philosophy
•Preserve the natural dentition and
•Develop the bony structures
•Assist the natural shape of the face and jaws to develop to their full biologic potential. •Overall health and well being of the patient
Sunday, January 19, 14
The Extraction Wars
Edward Angle vs Calvin Case
Witzig vs McNamara
NewConn 2009 Extraction vs Non-extraction Debate
1855-1930
5-10% extraction rateV. Kokich
F. Bogdan
Sunday, January 19, 14
Passive-Self Ligation
• “…benefits of minimizing friction and binding…”
• The “Functional Effect” - light wire in large slot allows muscles to guide the movements
• “to match each phase of treatment with the natural force systems of normal growth and development…”
• “…higher level of care is about "face-driven ortho…”
The Damon System
Sunday, January 19, 14
Non-extraction
Sunday, January 19, 14
Blocked out #26
Sunday, January 19, 14
18 Months
26 Months
Sunday, January 19, 14
Finding room for all the teeth is not a problem if you start early enough and try to mimic what
nature intended
Protractive vs. Retractive Orthodontics
Sunday, January 19, 14
Bimaxillary Dysplasia
Should treatment be based on the Angle Classification?
Sunday, January 19, 14
Bimax retrusion
Sunday, January 19, 14
Successful dental result
Sunday, January 19, 14
Failed Profile Result
Sunday, January 19, 14
Bimax retrusion
Sunday, January 19, 14
Successful dental result
Sunday, January 19, 14
Failed Profile Result
Sunday, January 19, 14
Treatment
What is the appropriate treatment for a Collapsed Maxilla?
Sunday, January 19, 14
Treatment
Headgear?
Sunday, January 19, 14
Treatment
Class II Elastics? Sunday, January 19, 14
Treatment
Mandibular Advancment Appliance?(Herbst, Twin Block,MARA with reciprocal anchorage)
Sunday, January 19, 14
Treatment
Extractions ?
Sunday, January 19, 14
Changes of pharyngeal airway size and hyoid bone position following orthodontic treatment of
Class I bimaxillary protrusion
Qingzhu Wanga; Peizeng Jiab; Nina K. Andersonc; Lin Wangd; Jiuxiang Line
Angle Orthodontist, Vol 00, No 0, 0000 (pre-publication 2012)
“the dimension of the velopharynx, glossopharynx, and hypopharynx were decreased after maximal retraction of anterior teeth with extraction of four premolars…” “Any factors that can influence the posture and position of tongue and soft palate may displace them backward andencroach upon {the pharynx}.”
“the more the incisors were retracted, the more the pharyngeal airway was reduced.”
Sunday, January 19, 14
Backed into a corner...
•
Retraction OrthodonticsSunday, January 19, 14
If Retraction Mechanics has the potential to
hinder the airway, how much retraction is OK?
Is it OK if I tie your tie just a little too
tight, son?
Sunday, January 19, 14
If snoring is likely to lead to obstruction someday,
how much snoring is “normal” for a child?
Sunday, January 19, 14
The Perfect House
Chronic Diseases of
Lifestyle
Airway and Breathing
Dysfunction
Soft Tissue Dysfunction
Malocclusion and
Orthodontics
Airway-centricOrthodontics
Sunday, January 19, 14
John Mew
“If it were possible to improve faces to the disadvantage of the teeth, where would our duty lie?” -AJODO, 1979
Esthetics?Proper
Breathing?
Sunday, January 19, 14
Orthodontic treatment in children to prevent sleep-disordered breathing in adulthood
“Consequently the most important missing diagnosis is the airway.
Nevertheless, breathing is the most important action for human beings to live; we forgot the airway to make
a diagnosis of the orthodontic patients.”
Sleep and BreathingPublished online: 17 November 2005©
10.1007/s11325-005-0028-8Review
Makoto Kikuchi
Sunday, January 19, 14
Comparison case
Older sister: Extract two upper premolars. Airway 14 to 10mmYounger sister: Non-extraction. Airway from 14-17mm
Sunday, January 19, 14
Comparison case
The result of the treatment looks almost the same from the appearance; however, there were big
differences between the sisters inside the face that was the most important structure for human beings:
the size of the airway.Sunday, January 19, 14
Changes of pharyngeal airway size and hyoid bone position following orthodontic treatment of
Class I bimaxillary protrusion
Qingzhu Wanga; Peizeng Jiab; Nina K. Andersonc; Lin Wangd; Jiuxiang Line
Angle Orthodontist, Vol 00, No 0, 0000 (pre-publication 2012)
“the dimension of the velopharynx, glossopharynx, and hypopharynx were decreased after maximal retraction of anterior teeth with extraction of four premolars…” “Any factors that can influence the posture and position of tongue and soft palate may displace them backward andencroach upon {the pharynx}.”
“the more the incisors were retracted, the more the pharyngeal airway was reduced.”
Sunday, January 19, 14
Setback at your Peril
Bilateral SSRO: “the pharyngeal airway was constricted significantly at the oropharyngeal and hypopharyngeal levels at both the short-term and the long-term follow-ups”
Lefort I plus SSRO: “bimaxillary surgery rather than only mandibular setback surgery is preferable to correct a Class III deformity to prevent narrowing of the pharyngeal airway space
American Journal of Orthodontics & Dentofacial OrthopedicsVolume 131, Issue 3 , Pages 372-377, March 2007
Effects of bimaxillary surgery and mandibular setback surgery on pharyngeal airway measurements in patients with Class III skeletal deformities
• Fengshan Chen, Kazuto Terada, Yongmei Hua, Isao Saito
Sunday, January 19, 14
J Oral Maxillofac Surg. 2011 Nov;69(11):e395-400. Epub 2011 Jul 27
Effect of mono- and bimaxillary advancement on pharyngeal airway volume: cone-beam computed
tomography evaluation.
Hernández-Alfaro F, Guijarro-Martínez R, Mareque-Bueno J.
•A statistically significant increase in the pharyngeal airway volume occurred systematically. •The average percentage of increase was:• 69.8% with MMA• 78.3% with Mandibular Advancement • 37.7% with Maxillary Advancement
Sunday, January 19, 14
Effects of Maxillary Protraction and Fixed Appliance Therapy on the Pharyngeal Airway
•25 x 11 year olds•Reverse Pull HG, 350 g, 14h/d for 6 months• Follow-up 4 years post-treatment• 2D analysis only (cephs)
Emine Kaygısız et.al., Angel Orthodontist, Volume 79, Issue 4 (July 2009)
“...the maxilla continued to grow forward after treatment, which was maintained in the long-term observation.”
“improved the nasopharyngeal and oropharyngeal airway dimensions initially, …. was maintained at long-term follow-up.”
Sunday, January 19, 14
Mandibular Advancement
Sleep Breath (2012) 16:971–976
“Orthodontic therapy should beencouraged in pediatric OSAS,
and an early approach maypermanently modify nasal breathing and respiration, thereby preventing obstruction of the upper airway.”
Yesss!!!
Sunday, January 19, 14
Orthodontics in the 21st Century
ConventionalOrthodontics
AirwayOrthodontics
GeneticTooth-Focused
Esthetics PrimaryTreating Symptoms
Airway Ignorant
AdaptationMuscle-Focused
Esthetics SecondaryTreating CausesAirway Concious
Sunday, January 19, 14
A Pathology Cycle
Declining Health
FunctionMouthBreathing and
Low Tongue
FormLong FaceFunction Weak MMuscles
FormNarrow Palate
Function Deviate Swallow
FormSwollen T&A
Crooked TeethForm
Sunday, January 19, 14
Breaking The Cycle
Declining Health
FunctionMouthBreathing and
Low Tongue
FormLong FaceFunction Weak MMuscles
FormNarrow Palate
FunctionSwallowing with Active
Facial MusclesCrooked
TeethForm
FormSwollen T&A
Conventional Orthodontics
Sunday, January 19, 14
Backed into a corner...
•
Prevention is not mechanical!
Sunday, January 19, 14
Breaking The Cycle
Declining Health
FunctionMouthBreathing and
Low Tongue
FormLong FaceFunction Weak MMuscles
FormNarrow Palate
FunctionSwallowing with Active
Facial MusclesCrooked
TeethForm
FormSwollen T&A
Airway-Centric Orthodontist
Sunday, January 19, 14
Ortho and Ped OSAChad M. Ruoff & Christian Guilleminault
Sleep Breath, 2011, pub online, May 11
“Although dentists and orthodontia recognize the importance of evaluating and treating OSA, they have yet to realize how well-positioned they are for the prevention of sleep-disordered breathing (SDB).”
Sunday, January 19, 14
Ortho and Ped OSAChad M. Ruoff & Christian Guilleminault
Sleep Breath, 2011, pub online, May 11
The “environment plays an important role in the development of SDB. Therefore, manipulation of environmental factors may decrease the development of OSA. There is a need to better define these environmental factors and predict those at risk for the development of OSA so that orthodontists and dentists can both treat and prevent OSA.”
Sunday, January 19, 14
Roger Price’ Toothberg
Sunday, January 19, 14
Airway-Related Craniofacial Dysfunctions
• Chronic Naso-pharyngeal Obstruction• Tongue form aberrations (Frenum and tongue-tie)• Open Mouth Rest Posture • Myofunctional disorders (Swallowing, chewing,etc.)• Chronic Hyperventilation and Hypocapnia• Breathing Disordered Sleep (OSA, UARS, snoring)• Bruxism and parafunctions• TMD and facial pain components• Cranial and postural issues• Malocclusion
Sunday, January 19, 14
Open Mouth Posture
•Early Feeding and Nutrition
•Allergies, Asthma, URT infections
•Posture
•Airway, Breathing, and Sleep Disorders
•Soft Tissue Dysfunctions (Tongue Thrust, Open Mouth)
Instead of crooked teeth being The Problem,They are just a SYMPTOM of something larger
Big-Picture Issuesrelated to
(Mal)Occlusion
Sunday, January 19, 14
If the Cause is in the muscles,then treatment must be, too.
Airway-Centered OrthodonticsAnd
Muscle-Centered OrthodonticsVs.
Tooth-Centered Orthodontics
Sunday, January 19, 14
The Perfect House
Chronic Diseases of
Lifestyle
Airway and Breathing
Dysfunction
Soft Tissue Dysfunction
Malocclusion and
Orthodontics
Airway-centricPathology
Environmental Holistic
Medicine
Sleep and Breathing Dentistry
Myofunctional Ortho-Postural
Training
Myofunctional Orthodontics
Sunday, January 19, 14
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