• Share
  • Email
  • Embed
  • Like
  • Save
  • Private Content
MRC Myobrace Beginner Course 2014 Part 1
 

MRC Myobrace Beginner Course 2014 Part 1

on

  • 730 views

Myofunctional Research Company presents Myobrace Beginner Course by Dr. Barry Raphael at the Raphael Center for Integrative Education, Clifton, New Jersey, January 2014: Part 1

Myofunctional Research Company presents Myobrace Beginner Course by Dr. Barry Raphael at the Raphael Center for Integrative Education, Clifton, New Jersey, January 2014: Part 1

Statistics

Views

Total Views
730
Views on SlideShare
730
Embed Views
0

Actions

Likes
1
Downloads
28
Comments
0

0 Embeds 0

No embeds

Accessibility

Upload Details

Uploaded via as Adobe PDF

Usage Rights

© All Rights Reserved

Report content

Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
  • Full Name Full Name Comment goes here.
    Are you sure you want to
    Your message goes here
    Processing…
Post Comment
Edit your comment

    MRC Myobrace Beginner Course 2014 Part 1 MRC Myobrace Beginner Course 2014 Part 1 Presentation Transcript

    • Myofunctional Research Company presents: The Myobrace System -As a Hammer for a HouseSat-Sun, January 18-19, 2014 dr. barry raphael the raphael center for integrative education www.alignmine.com drbarry@alignmine.com Sunday, January 19, 14
    • The Myobrace System -A hammer for a houseSat-Sun, January 18-19, 2014 dr. barry raphael the raphael center for integrative education www.alignmine.com drbarry@alignmine.com Day 1 AM Sunday, 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 1974 University of Pennsylvania 1978 (Three Years in General Practice) Fairleigh-Dickenson University 1983 Sunday, January 19, 14
    • Jim McNamara Sunday, January 19, 14
    • Functional Orthodontics Functional 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 Myofunctional Research Co. Rancho Cucamonga Damien O’Brien 2008-2012 Sunday, January 19, 14
    • Oral Myology Oral Myology Basic Course Joy Moeller NYC 2011 LA 2012 Oral Myology: Levels 2, 3 Kim Benkert Clifton 2012 Habit Cessation Shari Green Clifton, 2013 Sunday, January 19, 14
    • Biobloc Orthotropics BBO Mini-residency Bill Hang Agora Hills 2012-13 BBO Intensive Drs. John and Mike Mew LSFO 2013 Sunday, January 19, 14
    • Breathing and Sleep Buteyko Mentorship The Breathing Center Woodstock 2010 Breathing Well Programme John Flutter 2010 Sunday, January 19, 14 Sleep Dentistry Michael Gelb, et.al NYU 2012,2013 Ortho-Postural Training Roger Price 2013
    • Cranial Osteopathy Advanced Dento-cranial Orthopedics Bob Walker 2014 ALF, The Team Approach Jim Bronson 2013 Cranial Academy Soon Sunday, January 19, 14
    • Teaching Mt. Sinai Pedo Residency Ali Attaie 2010-2012 Montefiore Ortho Residency Tony Maganzini 2012 2009-Present Sunday, January 19, 14
    • Golf Handicap 2007 = 17 2013 = 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
    • Disclosure Honorarium and Travel Expenses for MRC No vested interest in Myofunctional Research Co. Chris told me to tell my truth. Director, Sunday, January 19, 14 raphael center for integrative education
    • 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
    • The Myobrace System -A hammer for a house1. The Perfect House: an overview of Myofunctional Orthodontics. 1. Airway and Breathing Dysfunction 2. Soft Tissue Dysfunction 3. Chronic Diseases of Lifestyle 4. Malocclusion and Retractive Orthodontics 2. Airway Focused Orthodontics 1.Diagnostics 2.Prevention 3.Undoing the Damage 4.Establishing Good Habits 1.The Myobrace System 1. Appliance Types 2.Clinical Protocols 3.Patient Education and Motivation 4.Follow-ups and troubleshooting 5.Interdisciplinary Treatment 3.... Sunday, January 19, 14
    • The Myobrace System Day 2 1.Case presentations and demonstrations 1.Case Results 2.Patient Assessment 3.Myobrace delivery 2.Starting your first case 1.Case selection checklist 2.Materials check list 3.Health History forms 4.Patient flow check list 5.Ordering Myobrace appliances 3.Course Review: Q&A 4.What comes next Sunday, January 19, 14
    • Paper clips…. 1. Level 1 Screening 2. Facial Measurement Routine 3. Treatment Goals 4. Demo: Myobrace Delivery 5. Starting your first case 6. What comes next? Sunday, January 19, 14
    • Feedback I agree I like Sunday, January 19, 14 I disagree I have a problem I have a question
    • The Perfect House Malocclusion “This place is Decor and and a mess!” Activity Orthodontics “Mommy, Family Living Soft Tissue Lisa’s hogging Dysfunction Together bathroom!” Airway-centric Pathology Shelter from Chronic “The Roof is Diseases of the Leaking” Lifestyle Storm Sunday, January 19, 14 “The A/C is Airway and HVAC Comfortable Breathing broken. I Environment can’t sleep.” Inefficiency
    • The Perfect House Malocclusion and Orthodontics Soft Tissue Dysfunction Airway-centric Pathology Chronic Diseases of Lifestyle Sunday, January 19, 14 Airway and Breathing Dysfunction
    • Spectrum of SDB Normal Prevalence: Snoring 8-10% UARS ? OSAS 1-3% 32 Sunday, January 19, 14
    • Anatomic Determinants of SleepDisordered Breathing Across the Spectrum of Clinical and Nonclinical Male Subjects* 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 CHEST September 2002 vol. 122no. 3 840-851 •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 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 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. • 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 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 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 • 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 Sunday, January 19, 14
    • Morphology and SDB in children Ikävalko, et.al.,Eur J Pediatr (2012) 171:1747–1752 “Abnormal craniofacial morphology, but not excess body fat, is associated with an increased risk of having SDB in 6–8-year-old children.” Sunday, January 19, 14
    • Morphology and SDB in children Ikävalko, et.al.,Eur J Pediatr (2012) 171:1747–1752 •491 Finnish children 6–8 years of age • studied: BMI, occlusion, sleep survey • Looked for: Frequent snoring, apeas, open-mouth posture Sunday, January 19, 14
    • Morphology and SDB in children Ikävalko, et.al.,Eur J Pediatr (2012) 171:1747–1752 Risk Factor Obesity 0 Tonsilar Hypertrophy 3.7x Crossbite 3.3x Convex Facial Profile Sunday, January 19, 14 Incidence 2.6x
    • 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 clinical examinations (i.e. facial profile, dental occlusion and tonsils) is recommended to recognize children with an increased risk of SDB.” Sunday, January 19, 14
    • Associations between sleepdisordered breathing symptoms and facial and dental morphometry, assessed with screening examinations Hyunh, et.al., AJODO, 2011, 140:762-70 SDB associated with: Dolicofacial shape High mandibular plane angle Narrow palate Severe crowding Sunday, January 19, 14 Swollen Tonsils and Adenoids Long and narrow face Allergies Frequent Colds and Infections Habitual Mouth Breathing
    • 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
    • Sleep-Disordered Breathing in a Population-Based Cohort: Behavioral Outcomes at 4 and 7 Years Karen Bonuck, PhD,a Katherine Freeman, DrPH,b Ronald D. Chervin, MD, MS,c and Linzhi Xu, PhDa PEDIATRICS Volume 129, Number 4, April 2012 “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.” Sunday, January 19, 14
    • Sleep-Disordered Breathing in a Population-Based Cohort: Behavioral Outcomes at 4 and 7 Years “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.” “...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 Sunday, January 19, 14 •Mouth breathing •Nocturnal migraine •Nocturnal sweating •Periodic Limb movement •Restless sleep •Sleep talking •Sleep terror •Sleep walking •Witnessed apnea
    • Daytime symptoms of SDB in kids •Morning headache •Mouthbreathing •Morning thirst •Excessive fatigue •Abnormal shyness, withdrawn, and depressive presentation •Behavioral problems Sunday, January 19, 14 •ADHD pattern •Aggressiveness •Irritability •Poor concentration •Learning difficulties •Memory impairment •Poor academic performance
    • Childhood Obstructive Sleep Apnea Associates with Neuropsychological Deficits and Neuronal Brain Injury Ann C. Halbower, et.al, PLoS Medicine,August 2006 | Volume 3 | Issue 8 | e301 •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.” Sunday, January 19, 14
    • Death, nasomaxillary complex, and sleep in young children Caroline Rambaud & Christian Guilleminault European Journal of Pediatrics DOI 10.1007/s00431-012-1727-3 Pub Online: April 11, 2012 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 visually recognizable abnormal high and narrow hard palate” Sunday, January 19, 14
    • Maxillary Dysplasia Is a major factor in Sleep Disordered Breathing Maxillary Retrusion Midface Deficiency Maxillary Hyperdivergency Long Face Syndrome Adenoid Facies Bimaxillary Retrusion What causes it? Sunday, January 19, 14
    • The Perfect House Malocclusion and Orthodontics Soft Tissue Dysfunction Airway-centric Pathology Chronic Diseases of Lifestyle Sunday, January 19, 14 Airway and Breathing Dysfunction
    • “….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 Sunday, January 19, 14 The Roman Arch
    • Chris Farrell Sunday, January 19, 14
    • Soft Tissue Dysfunction is THE etiology in Maxillary Dysplasia And 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 1912-1992 •Norwegian Orthodontist •Cleft Palate •Professor •Brought Functional Treatment to N.A. •1981 Primate experiments • Blocked nasal passage • Skeletal malocclusion resulted 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 The Tropic Premise “Because the genetic control of skeletal growth is not precise, the articulation of the teeth and jaws depends upon additional guidance from oral posture.” 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
    • With Chronic Open Mouth Posture SOFT TISSUE DYSFUNCTION Comparison of Unsupported vs Supported Growth Sunday, January 19, 14
    • With Chronic Open Mouth Posture SOFT TISSUE DYSFUNCTION 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
    • Bi-maxillary Retrusion Bolton Standards Insufficient Facial 15yo Support Nasal Cartilage Collapse The Maxilla is Down and Back The Mandible is Retrognathic Sunday, January 19, 14
    • Pharyngeal Airspace Three-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 tool Sunday, January 19, 14
    • Three-dimensional assessment of pharyngeal airway in nasal- and mouth-breathing children •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 Sunday, January 19, 14
    • Pharyngeal Airspace Mouth breather Nasal breather Mouthbreathers have significantly smaller airway space. (measurements PAS-OccL, PAS-UP, airway volume, area and minimum axial area) 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 Malocclusion and Orthodontics Soft Tissue Dysfunction Airway-centric Pathology Chronic Diseases of Lifestyle Sunday, January 19, 14 Airway and Breathing Dysfunction
    • Weston Price Nutrition and Physical Degeneration Weston A. Price, DDS, 1939 Price-Pottenger Nutrition Foundation www.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. 1870-1948 •Malocclusion is a product of the diet of industrialized societies Sunday, January 19, 14
    • Darwinian Dentistry Are we developing the way our genes meant us to be? Peter Gluckman Neese and Williams Sunday, January 19, 14 Clark Spencer Larsen Scott Gilbert Kevin Boyd Me...
    • The Results of the Mismatch Between Genes and the Environment Obesity Hypertension Cardiovascular Disease Caries Type 2 Diabetes Malocclusion Fatty Liver Disease Some Cancers Osteoporosis Sleep Apnea Metabolic Syndrome Asthma Autism Asperger’s Alzheimers ADD/ADHD Chronic Back Pain Depression Chronic Non-Communicable Diseases of Civilization Western Lifestyle Diseases Sunday, January 19, 14
    • There was a time... 5,000 years ago When caries and malocclusion were rare! Sunday, January 19, 14
    • The Missing Piece in Orthodontics Today... Its not just Growth and Development Its Growth, Development and Adaptation Sunday, January 19, 14
    • If Malocclusion is caused by Growth and Development... Genotype Total Growth Sunday, January 19, 14 Phenotype
    • If Malocclusion is caused by Growth and Development and Adaptation... Genotype Total Growth Sunday, January 19, 14 Phenotype
    • An example of “adaptation” Sunday, January 19, 14
    • An example of adaptation What do you notice about these boys? Sunday, January 19, 14
    • What do you notice about these boys? One of them has crooked teeth. Sunday, January 19, 14
    • RHYS - 10Y get How did these teeth 11M this way? 3 August 2003 3 August 2003 Different genes than his brother? Sunday, January 19, 14
    • RHYS - 14Y 5M Four years later, after successful MFO 1 March 2007 1 March 2007 Text (Treatment by Dr. Chris Farrell) Sunday, January 19, 14
    • RHYS & KYLE 13Y 8M Did genetics make the- teeth crooked? RHYS - 16 AUGUST 2007 KYLE - 16 AUGUST 2007 Did genetics make the teeth straight again? TRAINER BWS MYOBRACE MINIMAL SWA Sunday, January 19, 14
    • The Perfect House Malocclusion and Orthodontics Soft Tissue Dysfunction Airway-centric Pathology Chronic Diseases of Lifestyle Sunday, January 19, 14 Airway and Breathing Dysfunction
    • 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 •Based on the work of •George Crozat 1894 - 1966 •Albert Weibrecht • Arch development in harmony with natural growth and muscles •Light wire removable appliances Light intermittent forces can affect skeletal growth 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 1855-1930 Witzig vs McNamara NewConn 2009 Extraction vs Non-extraction Debate V. Kokich Sunday, January 19, 14 5-10% extraction rate F. Bogdan
    • Passive-Self Ligation The Damon System • “…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…” Sunday, January 19, 14
    • Non-extraction Sunday, January 19, 14
    • Light-wire, Low-force aaccnjpa@gmail.com 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 and encroach 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 Orthodontics Sunday, 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 Malocclusion and Orthodontics Soft Tissue Dysfunction Airway-centric Orthodontics Chronic Diseases of Lifestyle Sunday, January 19, 14 Airway and Breathing Dysfunction
    • John Mew “If it were possible to improve faces to the disadvantage of the teeth, where would our duty lie?” -AJODO, 1979 Esthetics? Sunday, January 19, 14 Proper Breathing?
    • Orthodontic treatment in children to prevent sleep-disordered breathing in adulthood Sleep and Breathing Published online: 17 November 2005© 10.1007/s11325-005-0028-8 Review Makoto Kikuchi “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.” Sunday, January 19, 14
    • Comparison case Older sister: Extract two upper premolars. Airway 14 to 10mm Younger 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 and encroach 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 Orthopedics Volume 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
    • Effect of mono- and bimaxillary advancement on pharyngeal airway volume: cone-beam computed tomography evaluation. Hernández-Alfaro F, Guijarro-Martínez R, Mareque-Bueno J. J Oral Maxillofac Surg. 2011 Nov;69(11):e395-400. Epub 2011 Jul 27 •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 Emine Kaygısız et.al., Angel Orthodontist, Volume 79, Issue 4 (July 2009) •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) “...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 be encouraged in pediatric OSAS, and an early approach may permanently modify nasal breathing and respiration, thereby preventing obstruction of the upper airway.” Yesss!!! Sunday, January 19, 14
    • Orthodontics in the 21st Century Conventional Orthodontics Airway Orthodontics Genetic Tooth-Focused Esthetics Primary Treating Symptoms Airway Ignorant Adaptation Muscle-Focused Esthetics Secondary Treating Causes Airway Concious Sunday, January 19, 14
    • A Pathology Cycle Swollen T&A Form Function Narrow Palate Form MouthBreathing and Low Tongue Crooked Teeth Declining Health Sunday, January 19, 14 Weak MMuscles Function Long Face Function Deviate Swallow Form Form
    • Breaking The Cycle Swollen T&A Form Function Narrow Palate Form Function Long Face Crooked Teeth Declining Health Sunday, January 19, 14 MouthBreathing and Low Tongue Weak MMuscles Form Form Swallowing with Active Function Facial Muscles Conventional Orthodontics
    • Backed into a corner... • Prevention is not mechanical! Sunday, January 19, 14
    • Breaking The Cycle Swollen T&A Form Function Narrow Palate Form Function Long Face Crooked Teeth Declining Health Sunday, January 19, 14 MouthBreathing and Low Tongue Weak MMuscles Form Form Swallowing with Active Function Facial Muscles Airway-Centric Orthodontist
    • Ortho and Ped OSA Chad 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 wellpositioned they are for the prevention of sleep-disordered breathing (SDB).” Sunday, January 19, 14
    • Ortho and Ped OSA Chad 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 Big -Pic tur rel e Is •Early Feeding and Nutrition (Mal) ated t sues Oc o clu •Allergies, Asthma, URT infections sio n •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 Sunday, January 19, 14
    • If the Cause is in the muscles, then treatment must be, too. Airway-Centered Orthodontics And Muscle-Centered Orthodontics Vs. Tooth-Centered Orthodontics Sunday, January 19, 14
    • The Perfect House Malocclusion Myofunctional and Orthodontics Orthodontics Myofunctional Soft Tissue Ortho-Postural Dysfunction Training Airway-centric Pathology Environmental Chronic Diseases of Holistic Medicine Lifestyle Sunday, January 19, 14 Airwayand Sleep and Breathing Dysfunction Dentistry