Airway ortho 7 intervening form

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A series of lectures by Dr. Barry Raphael on Airway-focused orthodontics.
Chapter 7 : Some ways of changing the Form side of the facial growth and adaptation equation.

Airway ortho 7 intervening form

  1. 1. Airway OrthodonticsA lecture series prepared byDr. Barry RaphaelOf theRaphael Center for Integrative OrthodonticsClifton, NJ.www.alignmine.comwww.myobracenj.com“Intervening Form” - 20131Thursday, June 6, 13
  2. 2. •Animations are not included in this archive and mayaffect the meaning or intent of the slide•As the information in these presentations isconstantly evolving, please consider the date of creationwhen reviewing the material.2Thursday, June 6, 13
  3. 3. Airway-focused Orthodonticsfor the OrthodontistMay 31, 2013Dr. Barry Raphaeldrbarry@alignmine.comwww.alignmine.comPart 3:The SolutionIntervening Form3Thursday, June 6, 13
  4. 4. Intervening Form• Expansion• Biobloc• Orthodontics/Orthopedics4Thursday, June 6, 13
  5. 5. Expansion5Thursday, June 6, 13
  6. 6. Arch Expansion1.To increase arch length for crowded teeth2.To increase Alveolar/Basal Width3.To Open the Airway4.To Release Cranial Sutural Strains5.Relieve TMJ strain due to mandibular entrapment6.Give Room for Mandibular Development7.To give room in the palate for the Tongue8. To Return the Maxilla to its genetic potential6Thursday, June 6, 13
  7. 7. Increase Arch LengthArch DevelopmentArch Length IncreaseRounding out the arch7Thursday, June 6, 13
  8. 8. 8Thursday, June 6, 13
  9. 9. Increase Alveolar/Basal Width9Thursday, June 6, 13
  10. 10. Open the Nasal AirwayIncrease is flow rate exponential to diameter10Thursday, June 6, 13
  11. 11. Relieve Cranial Strain11Thursday, June 6, 13
  12. 12. Relieve Joint Entrapment12Thursday, June 6, 13
  13. 13. Mandibular freedom to grow13Thursday, June 6, 13
  14. 14. *Make Room for the Tongue* The most important of all14Thursday, June 6, 13
  15. 15. Restore GeneticPotential15Thursday, June 6, 13
  16. 16. Rapid Maxillary ExpansionRapid Palatal ExpansionSutural Spliting1/4 to 1/2mm expansion / dayLeast amount of dental movement16Thursday, June 6, 13
  17. 17. Rapid Palatal ExpandersHyraxHaasBonded17Thursday, June 6, 13
  18. 18. Semi-Rapid Expansion1/8mm per dayAllows fill without splitting suture18Thursday, June 6, 13
  19. 19. Acrylic Removables(Semi-rapid or Slow)SchwarzTransverseBioBlocFor Intermittent Force Application19Thursday, June 6, 13
  20. 20. Nickel TitaniumNiTi Expander D-Max 2000For Continuous Force Application20Thursday, June 6, 13
  21. 21. Slow Expansion1/4 to 1/2mm per weekSutural AdaptationHigher percentage of dental movement21Thursday, June 6, 13
  22. 22. Wire-based SlowW-LingualQuad HelixCrozatFrozat22Thursday, June 6, 13
  23. 23. Tongue-Friendly SlowALFAdvanced Lightwire Functional23Thursday, June 6, 13
  24. 24. Adapted Wire Ideal WireFarrel Bent Wire System24Thursday, June 6, 13
  25. 25. Advanced Lightwire Functional25Thursday, June 6, 13
  26. 26. Pix band on studymodelBanded first molars or 2nd Primary molarsWith lingual tubes26Thursday, June 6, 13
  27. 27. BWS in molar tube, elastic ligation27Thursday, June 6, 13
  28. 28. Weldable Lingual TubeTP 036 tube with hook• Easier insertion of BentWire than 025 tube• Easier ligation with e-chain28Thursday, June 6, 13
  29. 29. E-chain placed overhook29Thursday, June 6, 13
  30. 30. 30Thursday, June 6, 13
  31. 31. Retention Nibs with “Pop and Flow”Retention Stops : Composite31Thursday, June 6, 13
  32. 32. 2.2) Protocols: Light Wire ExpandersRetention Nibs with “Pop and Flow”PopFlowRetention Stops : Composite32Thursday, June 6, 13
  33. 33. Retention Nibs with “Pop and Flow”2.2) Protocols: Light Wire ExpandersRetention Stops : Composite33Thursday, June 6, 13
  34. 34. 1.Undo kinks2.Advance Loops3.Expand ALF4.Rotate MolarsBWS Adjustments34Thursday, June 6, 13
  35. 35. Adjustments: Undo Kinks35Thursday, June 6, 13
  36. 36. Adjustments: Undo KinksUndo Kinks36Thursday, June 6, 13
  37. 37. Adjustments: Advance LoopsFor Lost C-space37Thursday, June 6, 13
  38. 38. Adjustments: Advance LoopsFor Lost C-space38Thursday, June 6, 13
  39. 39. Adjustments: Advance LoopsFor Lost C-space39Thursday, June 6, 13
  40. 40. Adjustments: Advance LoopsFor Lost C-space40Thursday, June 6, 13
  41. 41. Adjustments: Advance LoopsFor Lost C-space41Thursday, June 6, 13
  42. 42. 2.2) Protocols: Light Wire Expanders:AdjustmentsThin C-space loop42Thursday, June 6, 13
  43. 43. 2.2) Protocols: Light Wire Expanders:AdjustmentsThin C-space loop43Thursday, June 6, 13
  44. 44. Adjustments:ALF Midline Loop44Thursday, June 6, 13
  45. 45. Adjustments:ALF Midline Loop45Thursday, June 6, 13
  46. 46. Adjustments:ALF Midline Loop46Thursday, June 6, 13
  47. 47. Adjustments:ALF Midline Loop47Thursday, June 6, 13
  48. 48. 2.2) Protocols: Light Wire Expanders:AdjustmentsRotate Molars48Thursday, June 6, 13
  49. 49. Biobloc49Thursday, June 6, 13
  50. 50. BioblocJohn MewMike MewBill Hang50Thursday, June 6, 13
  51. 51. Treatment Goals51Thursday, June 6, 13
  52. 52. Biobloc OrthotropicsThe appropriate treatment for a Collapsed Maxilla…Moves the Maxilla up and forward…AND the Mandible rotates and moves forward52Thursday, June 6, 13
  53. 53. Biobloc OrthotropicsPhase I : Maxillary DevelopmentPhase II : Mandibular ProtrusionPhase III : Normalize the Muscles53Thursday, June 6, 13
  54. 54. B. Hockel 2012BackPhase I. Maxillary Development1.Maxillary Expansion2. Maxillary Advancement3. Maxillary Impaction54Thursday, June 6, 13
  55. 55. Hang Expancer=”Expanding Advancer”Advancing WireMolarIntrusionSpringsHang ClaspsSemi-rapid screwHalf turn/day55Thursday, June 6, 13
  56. 56. Hang Clasp032 heat treated stainless wire56Thursday, June 6, 13
  57. 57. Hang Clasp57Thursday, June 6, 13
  58. 58. Measuring ProgressGap Ruler Turn Back58Thursday, June 6, 13
  59. 59. Hang Expanser59Thursday, June 6, 13
  60. 60. Hang Retainer60Thursday, June 6, 13
  61. 61. Phase II. BB3 - Postural Appliance61Thursday, June 6, 13
  62. 62. Biobloc 362Thursday, June 6, 13
  63. 63. Phase III. - Normalize the MusclesOral Myology63Thursday, June 6, 13
  64. 64. Principles of Biobloc1.Treat Early (before deciduous molars lost)2.Over-treat3.Long Retention4.Myotherapy to establish neutral posture64Thursday, June 6, 13
  65. 65. B. Hockel 2012BackThanks to Dr. Brian Hockel65Thursday, June 6, 13
  66. 66. B. Hockel 2012Back66Thursday, June 6, 13
  67. 67. B. Hockel 201267Thursday, June 6, 13
  68. 68. B. Hockel 2012ReduceIndicatorLine68Thursday, June 6, 13
  69. 69. B. Hockel 2012ReduceIndicatorLine69Thursday, June 6, 13
  70. 70. B. Hockel 2012ReduceIndicatorLine70Thursday, June 6, 13
  71. 71. B. Hockel 2012ReduceIndicatorLine71Thursday, June 6, 13
  72. 72. B. Hockel 2012ReduceIndicatorLine72Thursday, June 6, 13
  73. 73. B. Hockel 2012ReduceIndicatorLine73Thursday, June 6, 13
  74. 74. B. Hockel 2012ReduceIndicatorLine74Thursday, June 6, 13
  75. 75. B. Hockel 2012ReduceIndicatorLine75Thursday, June 6, 13
  76. 76. B. Hockel 201276Thursday, June 6, 13
  77. 77. B. Hockel 2012Level Lower(Reduce Lower IL)77Thursday, June 6, 13
  78. 78. B. Hockel 2012Level Lower(Reduce Lower IL)78Thursday, June 6, 13
  79. 79. B. Hockel 2012Level Lower(Reduce Lower IL)79Thursday, June 6, 13
  80. 80. B. Hockel 2012Level Lower(Reduce Lower IL)80Thursday, June 6, 13
  81. 81. B. Hockel 2012Level Lower(Reduce Lower IL)81Thursday, June 6, 13
  82. 82. B. Hockel 2012Level Lower(Reduce Lower IL)82Thursday, June 6, 13
  83. 83. B. Hockel 2012Level Lower(Reduce Lower IL)83Thursday, June 6, 13
  84. 84. B. Hockel 201284Thursday, June 6, 13
  85. 85. B. Hockel 2012Intrude 685Thursday, June 6, 13
  86. 86. B. Hockel 2012Intrude 686Thursday, June 6, 13
  87. 87. B. Hockel 2012Intrude 687Thursday, June 6, 13
  88. 88. B. Hockel 2012Intrude 688Thursday, June 6, 13
  89. 89. B. Hockel 2012Intrude 689Thursday, June 6, 13
  90. 90. B. Hockel 2012Intrude 690Thursday, June 6, 13
  91. 91. B. Hockel 2012Intrude 691Thursday, June 6, 13
  92. 92. B. Hockel 2012Intrude 692Thursday, June 6, 13
  93. 93. B. Hockel 201293Thursday, June 6, 13
  94. 94. B. Hockel 201294Thursday, June 6, 13
  95. 95. B. Hockel 2012DEExtraction95Thursday, June 6, 13
  96. 96. B. Hockel 2012Close /AdvanceMandible96Thursday, June 6, 13
  97. 97. B. Hockel 2012Close /AdvanceMandible97Thursday, June 6, 13
  98. 98. B. Hockel 2012Close /AdvanceMandible98Thursday, June 6, 13
  99. 99. B. Hockel 2012Close /AdvanceMandible99Thursday, June 6, 13
  100. 100. B. Hockel 2012Close /AdvanceMandible100Thursday, June 6, 13
  101. 101. B. Hockel 2012Close /AdvanceMandible101Thursday, June 6, 13
  102. 102. B. Hockel 2012Close /AdvanceMandible102Thursday, June 6, 13
  103. 103. B. Hockel 2012Close /AdvanceMandible103Thursday, June 6, 13
  104. 104. B. Hockel 2012Close /AdvanceMandible104Thursday, June 6, 13
  105. 105. B. Hockel 2012Close /AdvanceMandible105Thursday, June 6, 13
  106. 106. B. Hockel 2012Close /AdvanceMandible106Thursday, June 6, 13
  107. 107. B. Hockel 2012107Thursday, June 6, 13
  108. 108. B. Hockel 2012108Thursday, June 6, 13
  109. 109. B. Hockel 2012109Thursday, June 6, 13
  110. 110. B. Hockel 2012110Thursday, June 6, 13
  111. 111. B. Hockel 2012111Thursday, June 6, 13
  112. 112. B. Hockel 2012112Thursday, June 6, 13
  113. 113. B. Hockel 2012Back113Thursday, June 6, 13
  114. 114. Dr. Darin Ward114Thursday, June 6, 13
  115. 115. Dr. John Mew```115Thursday, June 6, 13
  116. 116. Dr. Bill HangInitial Expancer Biobloc116Thursday, June 6, 13
  117. 117. Orthodontics andOrthopedics117Thursday, June 6, 13
  118. 118. Low Force:Low FrictionMechanics• “…benefits of minimizing friction and binding…”• The “Functional Effect” - light wire in large slot allowsmuscles to guide the movements• “to match each phase of treatment with the naturalforce systems of normal growth and development…”• “…higher level of care is about "face-driven ortho…”118Thursday, June 6, 13
  119. 119. Functional OrthodonticsFunctional OrthodonticsMaximize the BenefitsAcknowledge the Limitations119Thursday, June 6, 13
  120. 120. Facial Treatment Rubric• Purpose:A conceptual framework for thinkingthrough airway-conscious treatment planning•A way for explaining the choices available in treatment120Thursday, June 6, 13
  121. 121. ThreeVariables1. Age2.Skeletal Dysplasia and need for profile improvement3. Breathing Dysfunctions and need for rebalancing121Thursday, June 6, 13
  122. 122. Regarding Facial ProfileQuestion to be asked of patients and parents:Regarding your facial profile:1.I don’t care if it gets worse with treatment2.I like my profile as it is.3.I’d like to improve my profile a little4.I’d like to improve my profile a lot.5.My profile must be perfect122Thursday, June 6, 13
  123. 123. Regarding Sleep Breathing1. I have no trouble breathing at night and neither doesanyone in my family2.I sleep with my mouth open3.I snore regularly4.I have trouble sleeping peacefully. I sleep fitfully, wakeup, pee, nightmares, etc.5.I’ve been told I (may) have SDB and recommended tohave a sleep study.123Thursday, June 6, 13
  124. 124. ProfileSleepNon-issue Like A Little A lot PerfectNoTroubleOpenMouthSnoringDisturbedSDB124Thursday, June 6, 13
  125. 125. Age 4-6ProfileSleepNon-issue Like A Little A lot PerfectNoTroubleWait WaitWaitMyobraceMyobraceMyobraceBioblocOpenMouthMyobraceMyobrace MyobraceMyobraceBioblocBioblocSnoringMyobraceT&AMyobrace Myobrace Biobloc BioblocDisturbedMyobraceT&AMyobraceMyobraceBioblocBiobloc BioblocSDBMyobraceT&AMyobrace Biobloc Biobloc Biobloc125Thursday, June 6, 13
  126. 126. Age 7-10ProfileSleepNon-issue Like A Little A lot PerfectNoTroubleWaitExtractionNon-xBracesFunctionalBracesFunctionalBioblocBioblocOpenMouthMyobrace BracesMyobraceMyobrace Biobloc BioblocSnoringMyobraceMyobraceMyobraceBioblocBiobloc BioblocDisturbedMyobraceBioblocMyobraceBioblocBiobloc Biobloc BioblocOrthognathicsSDBBioblocT&ABiobloc Biobloc BioblocOrthognathicsOrthognathics126Thursday, June 6, 13
  127. 127. Age 11-14ProfileSleepNon-issue Like A Little A lot PerfectNoTroubleWaitExtractionNon-xBracesNon-xBracesFunctionalBracesFunctionalBracesOpenMouthNon-xBracesNon-xBracesNon-xBracesFunctionalBracesBracesOrthognathicsSnoringNon-xBracesBracesMyobraceBracesMyobraceFunctionalBracesOrthognathicsDisturbedBracesMyobraceMyobraceBioblocMyobraceBioblocBiobloc OrthognathicsSDB Myobrace Biobloc Biobloc BioblocOrthognathicsOrthognathics127Thursday, June 6, 13

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