Glomerular Filtration and determinants of glomerular filtration .pptx
IAFGG 2014 What's an RO to Do?
1. What’s an RO to do?
March 15, 2014
IAFGG Annual Symposium
Calgary, Alberta
dr. barry raphael
the raphael center for integrative orthodontics
the raphael center for integrative education
www.alignmine.com
bioblocnj.com
drbarry@alignmine.com
Monday, March 17, 14
2. SOFT TISSUE DYSFUNCTION
With Chronic Open Mouth Posture
Comparison of Unsupported vs Supported Growth
Monday, March 17, 14
5. RO since1983 (30 years...yikes)
Bucknell University 1974
University of Pennsylvania 1978
(ThreeYears in General Practice)
Fairleigh-Dickenson University 1983
14 Instructors: 14 Techniques
Monday, March 17, 14
6. RO since1983 (30 years...yikes)
Bucknell University 1974
University of Pennsylvania 1978
(ThreeYears in General Practice)
Fairleigh-Dickenson University 1983
Monday, March 17, 14
7. My Dream Office, 2001
Clifton, NJ
Clifton
Empire
State
Building
Monday, March 17, 14
9. 1.Crooked teeth are THE PROBLEM.
2.The lower incisor must be upright.
3.Patients don’t want to cooperate.
4.Straightened teeth aren’t stable.
Monday, March 17, 14
10. 1.Orthotropics is the string theory of most
malocclusion
2. Biobloc is the gold standard
3. Biobloc cannot cover all cases or needs
4. I need other solutions
The Beginner’s Mind
Monday, March 17, 14
11. 1.Crooked teeth are THE PROBLEM.
2.The lower incisor must be upright.
3.Patients don’t want to cooperate.
4.Straightened teeth aren’t stable.
1.Crooked teeth are A SYMPTOM.
2. The UPPER incisor directs treatment.
3.Patients don’t want to be exploited.
4.Teeth that grow straight are stable.
A Change of Mind
Monday, March 17, 14
12. 1.Crooked teeth are A SYMPTOM.
2. The UPPER incisor directs treatment.
3.Patients don’t want to be exploited.
4.Teeth that grow straight are stable.
Monday, March 17, 14
14. Airway-Related Oral Dysfunctions (AROD)
• 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
Monday, March 17, 14
15. Airway Orthodontics
•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
Monday, March 17, 14
22. Medical history
• Reactive Airway Disease
•“Bronchial Constriction”
•Care of Pulmonologist
• Preventil
• Dad : OSA, CPAP for 11 years, diabetes
• Grandfather: OSA untreated
• ETCO2 = 36.1 at 10 bpm (acceptable)
• Posture number - 18 (<10 ideal)
• Father refuses sleep screening
Monday, March 17, 14
23. Treatment Options
1.Open spaces for impacted canines. Open spaces for
lower lateral implants.
2. Extract upper premolars. MFT. Align.
Patient chooses option 2. Goes elsewhere...
Monday, March 17, 14
24. 1.Crooked teeth are A SYMPTOM.
2. The UPPER incisor directs treatment.
3.Patients don’t want to be exploited.
4.Teeth that grow straight are stable.
Monday, March 17, 14
25. Using Indicator/
Cosmetic Line
•To define a starting point
•To set treatment goals
•To track treatment progress
•To gauge the effectiveness of treatment
Monday, March 17, 14
26. Charting the In/Cos Line
50
40
30
20
mm
y 5 6 7 8 9 10 11 12 13 14 15
girls
boys
Monday, March 17, 14
30. Guiding Type2 Tx
50
40
30
20
mm
y J F M A M J J A S O N
boys
Start
Non-x
Expansion
Uncrowding
Finished
Start Cl II
elastics
OK,
that’s
enough...
Monday, March 17, 14
31. Hypothetical Mouthbreather
(Dr. Mew’s Hamster Boy)
50
40
30
20
mm
y 5 6 7 8 9 10 11 12 13 14 15
girls
boys
Boy
gets
hamster
MFT
Monday, March 17, 14
33. •L.R. 11-9yF
•Missing all 5s,6s,8s and upper 4s
•Had ortho to close diastema…
•InL = 39
•GP objects to deX, plan equil
Monday, March 17, 14
34. L.R.Tx Plan
1.Preparation: Hang Expanser
2.deX
3.Training: BB3 to advance mandible
4.Myofunctional Therapy
5.Orthopostural Training
6.Myobrace to hold
7. Reevaluate for dental detailing
Monday, March 17, 14
35. L.R. : Spotty progress
50
40
30
20
mm
y 3/13 4 5 6 7 8 9 10 11 12
1/
14
2 3
Expanser
Parents
dragging.
30 turns.
Start Adv.
Rx deX.
GP
objects
After
delays,
Equil e’s,
BB3
Monday, March 17, 14
36. •L.R. 12-3 yF (6mo in tx)
•InL = 37 (+2)
• e’s equilibrated
• OJ =10
•Appliance OJ = 5
• Still accommodating to BB3
Monday, March 17, 14
37. Is there a calculus for the Indicator Line?
Monday, March 17, 14
39. Incisor Goals
Type 1 Treatment:
Place U1 in ideal position
Biobloc Orthotropics, Orthognathic Surgery, Distraction Osteogenesis
Monday, March 17, 14
40. Type 1: Ideal In/Cos line
50
40
30
20
mm
y 5 6 7 8 9 10 11 12 13 14 15
girls
boys
Monday, March 17, 14
45. Treatment Options
1. Type 1: Reduce InL, open lost space, BB3 to advance
mandible.
2. Type 2: Open lost space.Align.
3.Type 4: Extract four premolars.
Monday, March 17, 14
46. Y.Z. 9yoM
50
40
30
20
m
m
y
M A M J J A S O N D J F M A
boys
Hang
Expanser
Upper and
Lower
Brackets Hang
Retainer
BB3
Monday, March 17, 14
70. 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 and
encroach upon {the pharynx}.”
“the more the incisors were retracted, the more the
pharyngeal airway was reduced.”
Monday, March 17, 14
71. 1.Crooked teeth are A SYMPTOM.
2. The UPPER incisor directs treatment.
3.Patients don’t want to be exploited.
4.Teeth that grow straight are stable.
Monday, March 17, 14
72. Backed into a corner...
•
Moving teeth faster, more efficiently…
...in the wrong direction
Monday, March 17, 14
73. Now that we’ve made
smoking unacceptable,
could we not do the same with...
• Sugar?
• Processed food?
• Cheap milk and meat?
• Fast food?
• Pill popping for symptomatic relief?
• Looking for the cure instead of the cause?
• Surgery as a quick fix?
•Thinking braces are a status symbol?
Each industry thrives on the status quo.
Consumers must drive the change.
Monday, March 17, 14
80. The dilemma of progress.
(I forgot the progress pictures….)
Dad sells prosthetic parts to orthopedic surgeons.
I selling the case against my previous work they loved...
It takes me 3 hours to sell the case.
They fret until the BB3 goes in...
Monday, March 17, 14
81. 1.Crooked teeth are A SYMPTOM.
2. The UPPER incisor directs treatment.
3.Patients don’t want to be exploited.
4.Teeth that grow straight are stable.
Monday, March 17, 14
82. Connecting the dots...
• Adult SDB and OSA
• Narrow jaws and faces
• Soft tissue dysfunction
• Early parafunctional habits, ie. open mouth posture
• Environmental stressors
• CPAP, MARA,UPPP, Surg
Where’s the best
place to start
treatment? here?
orhere?
Monday, March 17, 14
83. 1. Prevention
2. Undo the damage already done
3. Establish good habits
When to start?
When damage from poor breathing is noticed and
when bad habits are discovered.
The strategies of
Airway Orthodontics
Monday, March 17, 14
86. The goals of
Airway Orthodontics
1. Breathing through the nose
2. Lips together at rest
3. Correct tongue position
4. No facial muscles moving on swallowing
5. Optimal forward facial development
6. Class I occlusion
7. Straight teeth
8. Better stability long term
Monday, March 17, 14
100. 3 August 2003 3 August 2003
RHYS - 10Y 11MHow did these teeth get this way?
Different genes than his brother?
Monday, March 17, 14
101. 1 March 2007 1 March 2007
RHYS - 14Y 5M
Four years later, after successful MFO
Text
(Treatment by Dr. Chris Farrell)
Monday, March 17, 14
102. RHYS - 16 AUGUST 2007 KYLE - 16 AUGUST 2007
TRAINER BWS MYOBRACE MINIMAL SWA
RHYS & KYLE - 13Y 8M
Did genetics make the teeth straight again?
Did genetics make the teeth crooked?
Monday, March 17, 14
104. Establish Good Habits
1. Breathing through the nose
2. Lips together at rest
3. Correct tongue position
4. No facial muscles moving on swallowing
5. Stand and sit in balance
6. Breath gently using the diaphragm
7. Eat to nourish
8. Sleep to rest
Monday, March 17, 14
110. Integrative Healthcare
Function Professional
Nasal clearing ENT, Pulm, MFT, Breathing
Muscle balance and tone MFT, Myofunctional Ortho
Undoing damage GP, Pedo, Ortho, OMFS
Breathing dynamics OPT, MFT, Breath Physiologist
Posture DC, OPT, PT, Osteopath
Cranial balance Osteopath
Nutrition RDH, Nutritionist, Dietitian
Sleep ENT, Sleep Med, Dent
Neurocognitive development Ped’n, SLP, Psych, Sp.Ed.
The Interdisciplinary Center
Monday, March 17, 14
111. 1.Crooked teeth are A SYMPTOM.
2. The UPPER incisor directs treatment.
3.Patients don’t want to be exploited.
4.Teeth that grow straight are stable.
Monday, March 17, 14
112. Now that I know...
My personal mission:
To create, from what I’ve
learned from the best,
a model for others to follow….
...especially the orthodontists.
Monday, March 17, 14
116. Breathing and Sleep
Buteyko Mentorship
The Breathing Center
Woodstock
2010
Breathing Well Programme
John Flutter
2010
Ortho-Postural Training
Roger Price
2013
Sleep Dentistry
Michael Gelb, et.al
NYU
2012
Monday, March 17, 14
117. ALF and Cranial
Jim Bronson
2013 Tasha Turzo
Cranial Academy
2014
Monday, March 17, 14
118. Bucket List
•ALF and Crozat (Bronson’s course)
•More on Biobloc (Hang’s Advanced, London School)
• More Cranial and Chirodontics (The Farm)
•Airway Dentistry with Marc Cruz, Jeff Rouse
• Sleep Dentistry
• Less-than-Six with Kevin Boyd
• Intra-mandibular Distraction Osteogenesis
Off My List
Anything that moves the teeth faster in the wrong direction...
Monday, March 17, 14
119. What’s an RO to do?
To create, from what I’ve
learned from the best,
a model for others to follow….
...especially orthodontists.
Monday, March 17, 14
120. Teaching
Mt. Sinai Pedo Residency
Ali Attaie
2010-2012
Montefiore Ortho Residency
Tony Maganzini
2012
2009-Present
Monday, March 17, 14
121. Mt. Sinai School of Medicine
Pedodontic Residency
Guest Speakers
Jim Bronson
Mike Mew
Kevin Boyd
Sandra Kahn
Jennifer Tow
Roger Price
Paula Fabbie
Damien O’Brien
First clinical program in myofunctional orthodontics
Monday, March 17, 14
122. Airway and Facial Development
Collaborative Webcast
Mark Cruz
Monday, March 17, 14
127. “With improvements in
expansion orthodontics,
advances in myofunctional
orthodontics, and the growing
recognition about sleep
disordered breathing among
children and adults, it is time for
orthodontics to expand its
horizons. There is now so
much more we can offer.”
The Raphael name has been associated with high
quality orthodontics in New Jersey for over 60 years.
Dr. Barry Raphael has been a university trained
orthodontic specialist and a member of the
American Association of Orthodontists for 30 years.
He has a wide range of techniques and services to
offer. He has studied oral myology, applied
kinesiology, Buteyko breathing, Biobloc Orthotropics
and Myobrace as part of his integrative training. He
can offer Damon, Invisalign, Insignia and Incognito
appliances designs as some of his many
conventional orthodontic services, too.
Dr. Raphael teaches his techniques at
post-graduate residencies, study clubs, dental
societies, and for the Myofunctional Research Co.
He is available for presentations to any group
interested in learning more about the benefits of
integrative orthodontics.
www.alignmine.com
Learn about the choices you have in orthodontics
dr barry raphael
Why it's
too Early...
never
1425broadstreet
clifton,nj07013
973-778-4222
fax973-778-9625
njspec#3684
1425 broad street, clifton, nj 07013
973-778-4222
www.alignmine.com
the
raphael center
for
integrative
orthodontics
theraphaelcenterfor
integrativeorthodontics
Learn about an important
choice you need to make
before starting braces.
Monday, March 17, 14
130. the raphael center for integrative education
Ongoing Intro to Airway Orthodontics
April Biobloc Study Group
April Training Ortho-Postural Therapists w Roger Price
June MRC Myobrace Basic Series
August Airway Dentistry with Mark Cruz and company
October Advanced MFT with Sandy Coulson
October Less than Six with Kevin Boyd
(who else wants to play?)
Mission: to create a space for spreading the word about
Airway and Orthotropic principles and practice.
Monday, March 17, 14
131. Orthodontics in the
21st Century
Esthetic
Orthodontics
Airway
Orthodontics
Genetic
Tooth-Focused
Dental: Perfection
Esthetics Primary
Treating Symptoms
Airway Ignorant
Adaptation
Muscle-Focused
Medical: Better
Esthetics Secondary
Treating Causes
Airway Conscious
Monday, March 17, 14