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What’s an RO to do?
March 15, 2014
IAFGG Annual Symposium
Calgary, Alberta
dr. barry raphael
the raphael center for integr...
SOFT TISSUE DYSFUNCTION
With Chronic Open Mouth Posture
Comparison of Unsupported vs Supported Growth
Monday, March 17, 14
The EndThe Beginning
Monday, March 17, 14
Everyday in my practice...
Monday, March 17, 14
RO since1983 (30 years...yikes)
Bucknell University 1974
University of Pennsylvania 1978
(ThreeYears in General Practice)
...
RO since1983 (30 years...yikes)
Bucknell University 1974
University of Pennsylvania 1978
(ThreeYears in General Practice)
...
My Dream Office, 2001
Clifton, NJ
Clifton
Empire
State
Building
Monday, March 17, 14
My Dream Office, 2001
Monday, March 17, 14
1.Crooked teeth are THE PROBLEM.
2.The lower incisor must be upright.
3.Patients don’t want to cooperate.
4.Straightened t...
1.Orthotropics is the string theory of most
malocclusion
2. Biobloc is the gold standard
3. Biobloc cannot cover all cases...
1.Crooked teeth are THE PROBLEM.
2.The lower incisor must be upright.
3.Patients don’t want to cooperate.
4.Straightened t...
1.Crooked teeth are A SYMPTOM.
2. The UPPER incisor directs treatment.
3.Patients don’t want to be exploited.
4.Teeth that...
The Toothberg
Monday, March 17, 14
Airway-Related Oral Dysfunctions (AROD)
• Chronic Naso-pharyngeal Obstruction
• Tongue form aberrations (Frenum and tongue...
Airway Orthodontics
•Early Feeding and Nutrition
•Allergies,Asthma, URT infections
•Posture
•Airway, Breathing, and Sleep ...
Monday, March 17, 14
•K.K 6-11y F
•Post XX with shift
• InL = 35 (+7)
•Tx plan: Expand for XX
correctiion, then reeval for BBO
Monday, March 17...
•K.K. 8-2y F
•Upper 2’s delayed, just bonded
•InL = 30 (+1)
•Dad opposes deX , until...
•SleepQualIndex = 1.3
Monday, Marc...
S. R. , 10-10yo M
•Missing 32,42
•Impacted 13,23
•Late mixed, 25 erupted
•Soft tissue dysfunction
•IL = 40
•Not compliant
...
S. Reardon, 10-7yo M
Monday, March 17, 14
Impacted 3s, Missing 2s
Monday, March 17, 14
Medical history
• Reactive Airway Disease
•“Bronchial Constriction”
•Care of Pulmonologist
• Preventil
• Dad : OSA, CPAP f...
Treatment Options
1.Open spaces for impacted canines. Open spaces for
lower lateral implants.
2. Extract upper premolars. ...
1.Crooked teeth are A SYMPTOM.
2. The UPPER incisor directs treatment.
3.Patients don’t want to be exploited.
4.Teeth that...
Using Indicator/
Cosmetic Line
•To define a starting point
•To set treatment goals
•To track treatment progress
•To gauge t...
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
Monday, March 17, 14
Incisor pulled away from nose.
Not “undertorqued” or “gummy smile”
Monday, March 17, 14
Hypothetical ClI Ortho/MARA
50
40
30
20
mm
y 5 6 7 8 9 10 11 12 13 14 15
girls
boys
OJ =
7mm
Starts
Ortho
“Great
Headgear
...
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
elastic...
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
hamste...
Hypothetical BBO, 7yoM
50
40
30
20
5 6 7 8 9 10 11 12 13 14 15
girls
boys
Initial
Start
BB1
BB3
Night
Monday, March 17, 14
•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
Mon...
L.R.Tx Plan
1.Preparation: Hang Expanser
2.deX
3.Training: BB3 to advance mandible
4.Myofunctional Therapy
5.Orthopostural...
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...
•L.R. 12-3 yF (6mo in tx)
•InL = 37 (+2)
• e’s equilibrated
• OJ =10
•Appliance OJ = 5
• Still accommodating to BB3
Monday...
Is there a calculus for the Indicator Line?
Monday, March 17, 14
Treatment Goals
Based on Indicator Line
Monday, March 17, 14
Incisor Goals
Type 1 Treatment:
Place U1 in ideal position
Biobloc Orthotropics, Orthognathic Surgery, Distraction Osteoge...
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
Y.Z., 9yo M
•Lost upper d-space
•InL = 36(+4)
•OJ = 9mm
•Lip entrapment
•Lip Incompetence
Monday, March 17, 14
Y. Z., 9yo M
Monday, March 17, 14
Y. Z., 9yo M
9mm OJ
Monday, March 17, 14
Y. Z., 9yo M
Monday, March 17, 14
Treatment Options
1. Type 1: Reduce InL, open lost space, BB3 to advance
mandible.
2. Type 2: Open lost space.Align.
3.Typ...
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
Mond...
Monday, March 17, 14
Incisor Goals
Type 2 Treatment:
Develop arch just enough to uncrowd
Biobloc, Myofunctional Ortho, Myofunctional Therapy, C...
Type 2: Uncrowding
50
40
30
20
mm
y 5 6 7 8 9 10 11 12 13 14 15
girls
boys
Monday, March 17, 14
H.G.
Monday, March 17, 14
50
40
30
20
mm
y S O N D J F M A M J J
Lower
Sweep
H.G. 9yo F
Expanser
Brackets
Hang Ret
Monday, March 17, 14
H. G. progress
Monday, March 17, 14
Monday, March 17, 14
H.G. progress
Next: Bond lowers to level and align
Revisit deX to decrease vertical.Also reduce InL to ideal.
Monday, Marc...
Z.P., 9-5yoM
i
Monday, March 17, 14
Monday, March 17, 14
After Expansion Phase
Monday, March 17, 14
Incomplete profile improvement...
better breathing, head posture and sleep.
Monday, March 17, 14
Monday, March 17, 14
Incisor Goals
Type 3 Treatment:
Maintain UI
Functional Orthodontics, Expansion Orthodontics, Distalization Ortho
or No Tre...
Type 3: Maintain
50
40
30
20
mm
y 5 6 7 8 9 10 11 12 13 14 15
girls
boys
Monday, March 17, 14
Bimax
retrusion
Monday, March 17, 14
Successful
dental result
Monday, March 17, 14
Failed Profile Result
Monday, March 17, 14
Incisor Goals
Type 4 Treatment:
Retract/Extrude UI
Extraction Orthodontics, Retraction Ortho, Distalization Ortho
Monday, ...
Type 4 : Retraction
50
40
30
20
mm
y 5 6 7 8 9 10 11 12 13 14 15
girls
boys
Monday, March 17, 14
Bimax
retrusion
Monday, March 17, 14
Successful
dental result
Monday, March 17, 14
Failed Profile Result
Monday, March 17, 14
Changes of pharyngeal airway size and hyoid bone
position following orthodontic treatment of
Class I bimaxillary protrusio...
1.Crooked teeth are A SYMPTOM.
2. The UPPER incisor directs treatment.
3.Patients don’t want to be exploited.
4.Teeth that...
Backed into a corner...
•
Moving teeth faster, more efficiently…
...in the wrong direction
Monday, March 17, 14
Now that we’ve made
smoking unacceptable,
could we not do the same with...
• Sugar?
• Processed food?
• Cheap milk and mea...
Nicholas Plaskon 10yM
Monday, March 17, 14
N.P.
Monday, March 17, 14
Monday, March 17, 14
Monday, March 17, 14
Sister’s non-x ortho
She’s happy….
but I’m not, so...
Monday, March 17, 14
I make my pitch for BBO
Monday, March 17, 14
The dilemma of progress.
(I forgot the progress pictures….)
Dad sells prosthetic parts to orthopedic surgeons.
I selling t...
1.Crooked teeth are A SYMPTOM.
2. The UPPER incisor directs treatment.
3.Patients don’t want to be exploited.
4.Teeth that...
Connecting the dots...
• Adult SDB and OSA
• Narrow jaws and faces
• Soft tissue dysfunction
• Early parafunctional habits...
1. Prevention
2. Undo the damage already done
3. Establish good habits
When to start?
When damage from poor breathing is n...
Prevention
• Remove ankyloglossia
• Promote breastfeeding
• Harden the diet
• Discourage oral habits
• Promote whole-foods...
Breathing retraining
• Nasal rinsing
• Nasal clearing
• Decongesting
Monday, March 17, 14
The goals of
Airway Orthodontics
1. Breathing through the nose
2. Lips together at rest
3. Correct tongue position
4. No f...
Myofunctional Trainers
Professors R. Soulet
and A. Besombes
Dr. Earl Bergeson
Dr. Chris Farrell
The Multi – Family System
...
Soft Tissue Dysfunctions
•Lip incompetence
•Lip entrapment
•Hypermentalis
•Mouthbreathing
Monday, March 17, 14
12 month progress
Monday, March 17, 14
12 month progress
Monday, March 17, 14
12 month progress
Monday, March 17, 14
After Treatment
Bent-wire
6 months
Myobrace
12 months
Hey,
Raphael...What
about that
profile?
Monday, March 17, 14
Orofacial Myofunctional
Therapy
Oral Myology
Myofunctional Therapy
Tongue Thrust Therapy
Monday, March 17, 14
B. Hockel 2012
Back
Undoing Bimaxillary Dysplasia
1. Maxillary deconstriction
2. Maxillary advancement
3. Maxillary impact...
1. Maxillary Expansion
Treatment for Bimaxillary Dysplasia
ALF
Crozat
Bent Wire
Hyrax
Haas
Niti Exp BioBloc
Schwartz
Monda...
The Farrell BENT WIRE System™
Monday, March 17, 14
Recommended Age Group:
5-12 yrs
Arch Development in
conjunction with the
TRAINER System™
Monday, March 17, 14
At age 16
Twin Study
Monday, March 17, 14
Four years earlier...
One of them has crooked teeth.
Monday, March 17, 14
3 August 2003 3 August 2003
RHYS - 10Y 11MHow did these teeth get this way?
Different genes than his brother?
Monday, Marc...
1 March 2007 1 March 2007
RHYS - 14Y 5M
Four years later, after successful MFO
Text
(Treatment by Dr. Chris Farrell)
Monda...
RHYS - 16 AUGUST 2007 KYLE - 16 AUGUST 2007
TRAINER BWS MYOBRACE MINIMAL SWA
RHYS & KYLE - 13Y 8M
Did genetics make the te...
Dr. John Mew
Monday, March 17, 14
Establish Good Habits
1. Breathing through the nose
2. Lips together at rest
3. Correct tongue position
4. No facial muscl...
Ortho-Postural Training
Workshops
Breathing
Nutrition
Posture
Sleep
Monday, March 17, 14
Monday, March 17, 14
COPYRIGHT
Roger L Price
October 2012
Monday, March 17, 14
Posture Number
Forward head posture
can be a compensation
for a deficient airway
Monday, March 17, 14
Sleep Screening and Hygiene
SQI = 10 SQI = .98
Monday, March 17, 14
Integrative Healthcare
Function Professional
Nasal clearing ENT, Pulm, MFT, Breathing
Muscle balance and tone MFT, Myofunc...
1.Crooked teeth are A SYMPTOM.
2. The UPPER incisor directs treatment.
3.Patients don’t want to be exploited.
4.Teeth that...
Now that I know...
My personal mission:
To create, from what I’ve
learned from the best,
a model for others to follow….
.....
Myofunctional Orthodontics
Chris Farrell
John Flutter
German Ramierez
Damien O’Brien
Myofunctional Research Co.
Rancho Cuc...
Oral Myology
Oral Myology Basic Course
Joy Moeller
NYC 2011
LA 2012
Oral Myology: Levels 2, 3
Kim Benkert
Clifton 2012
Hab...
Biobloc Orthotropics
BBO Mini-residency
Bill Hang
Agora Hills
2012-13
BBO Intensive
Drs. John and Mike
Mew
LSFO
2013
Monda...
Breathing and Sleep
Buteyko Mentorship
The Breathing Center
Woodstock
2010
Breathing Well Programme
John Flutter
2010
Orth...
ALF and Cranial
Jim Bronson
2013 Tasha Turzo
Cranial Academy
2014
Monday, March 17, 14
Bucket List
•ALF and Crozat (Bronson’s course)
•More on Biobloc (Hang’s Advanced, London School)
• More Cranial and Chirod...
What’s an RO to do?
To create, from what I’ve
learned from the best,
a model for others to follow….
...especially orthodon...
Teaching
Mt. Sinai Pedo Residency
Ali Attaie
2010-2012
Montefiore Ortho Residency
Tony Maganzini
2012
2009-Present
Monday, ...
Mt. Sinai School of Medicine
Pedodontic Residency
Guest Speakers
Jim Bronson
Mike Mew
Kevin Boyd
Sandra Kahn
Jennifer Tow
...
Airway and Facial Development
Collaborative Webcast
Mark Cruz
Monday, March 17, 14
AAPMD Symposium
www.aapmd.org
Annual Meeting
April 25-26, 2014
Westin Chicago North Shore
Monday, March 17, 14
the raphael center for integrative orthodontics
www.alignmine.com
www.bioblocnj.com
www.myobracenj.com
Monday, March 17, 14
Integrative vs Conventional
Monday, March 17, 14
Integrative vs Conventional
Monday, March 17, 14
“With improvements in
expansion orthodontics,
advances in myofunctional
orthodontics, and the growing
recognition about sl...
Monday, March 17, 14
the raphael center for integrative education
Monday, March 17, 14
the raphael center for integrative education
Ongoing Intro to Airway Orthodontics
April Biobloc Study Group
April Training...
Orthodontics in the
21st Century
Esthetic
Orthodontics
Airway
Orthodontics
Genetic
Tooth-Focused
Dental: Perfection
Esthet...
Monday, March 17, 14
The End
And
The Beginning
Monday, March 17, 14
Upcoming SlideShare
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IAFGG 2014 What's an RO to Do?

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Presented to the International Association for Facial Growth Guidance. Both Drs. Mew and Dr. Hang in attendance...a rare treat for us all.

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IAFGG 2014 What's an RO to Do?

  1. 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. 2. SOFT TISSUE DYSFUNCTION With Chronic Open Mouth Posture Comparison of Unsupported vs Supported Growth Monday, March 17, 14
  3. 3. The EndThe Beginning Monday, March 17, 14
  4. 4. Everyday in my practice... Monday, March 17, 14
  5. 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. 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. 7. My Dream Office, 2001 Clifton, NJ Clifton Empire State Building Monday, March 17, 14
  8. 8. My Dream Office, 2001 Monday, March 17, 14
  9. 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. 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. 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. 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
  13. 13. The Toothberg Monday, March 17, 14
  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. 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
  16. 16. Monday, March 17, 14
  17. 17. •K.K 6-11y F •Post XX with shift • InL = 35 (+7) •Tx plan: Expand for XX correctiion, then reeval for BBO Monday, March 17, 14
  18. 18. •K.K. 8-2y F •Upper 2’s delayed, just bonded •InL = 30 (+1) •Dad opposes deX , until... •SleepQualIndex = 1.3 Monday, March 17, 14
  19. 19. S. R. , 10-10yo M •Missing 32,42 •Impacted 13,23 •Late mixed, 25 erupted •Soft tissue dysfunction •IL = 40 •Not compliant Monday, March 17, 14
  20. 20. S. Reardon, 10-7yo M Monday, March 17, 14
  21. 21. Impacted 3s, Missing 2s Monday, March 17, 14
  22. 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. 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. 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. 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. 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
  27. 27. Monday, March 17, 14
  28. 28. Incisor pulled away from nose. Not “undertorqued” or “gummy smile” Monday, March 17, 14
  29. 29. Hypothetical ClI Ortho/MARA 50 40 30 20 mm y 5 6 7 8 9 10 11 12 13 14 15 girls boys OJ = 7mm Starts Ortho “Great Headgear Effect” Monday, March 17, 14
  30. 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. 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
  32. 32. Hypothetical BBO, 7yoM 50 40 30 20 5 6 7 8 9 10 11 12 13 14 15 girls boys Initial Start BB1 BB3 Night Monday, March 17, 14
  33. 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. 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. 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. 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. 37. Is there a calculus for the Indicator Line? Monday, March 17, 14
  38. 38. Treatment Goals Based on Indicator Line Monday, March 17, 14
  39. 39. Incisor Goals Type 1 Treatment: Place U1 in ideal position Biobloc Orthotropics, Orthognathic Surgery, Distraction Osteogenesis Monday, March 17, 14
  40. 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
  41. 41. Y.Z., 9yo M •Lost upper d-space •InL = 36(+4) •OJ = 9mm •Lip entrapment •Lip Incompetence Monday, March 17, 14
  42. 42. Y. Z., 9yo M Monday, March 17, 14
  43. 43. Y. Z., 9yo M 9mm OJ Monday, March 17, 14
  44. 44. Y. Z., 9yo M Monday, March 17, 14
  45. 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. 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
  47. 47. Monday, March 17, 14
  48. 48. Incisor Goals Type 2 Treatment: Develop arch just enough to uncrowd Biobloc, Myofunctional Ortho, Myofunctional Therapy, Crozat,ALF, Expansion Orthodontics Monday, March 17, 14
  49. 49. Type 2: Uncrowding 50 40 30 20 mm y 5 6 7 8 9 10 11 12 13 14 15 girls boys Monday, March 17, 14
  50. 50. H.G. Monday, March 17, 14
  51. 51. 50 40 30 20 mm y S O N D J F M A M J J Lower Sweep H.G. 9yo F Expanser Brackets Hang Ret Monday, March 17, 14
  52. 52. H. G. progress Monday, March 17, 14
  53. 53. Monday, March 17, 14
  54. 54. H.G. progress Next: Bond lowers to level and align Revisit deX to decrease vertical.Also reduce InL to ideal. Monday, March 17, 14
  55. 55. Z.P., 9-5yoM i Monday, March 17, 14
  56. 56. Monday, March 17, 14
  57. 57. After Expansion Phase Monday, March 17, 14
  58. 58. Incomplete profile improvement... better breathing, head posture and sleep. Monday, March 17, 14
  59. 59. Monday, March 17, 14
  60. 60. Incisor Goals Type 3 Treatment: Maintain UI Functional Orthodontics, Expansion Orthodontics, Distalization Ortho or No Treatment Monday, March 17, 14
  61. 61. Type 3: Maintain 50 40 30 20 mm y 5 6 7 8 9 10 11 12 13 14 15 girls boys Monday, March 17, 14
  62. 62. Bimax retrusion Monday, March 17, 14
  63. 63. Successful dental result Monday, March 17, 14
  64. 64. Failed Profile Result Monday, March 17, 14
  65. 65. Incisor Goals Type 4 Treatment: Retract/Extrude UI Extraction Orthodontics, Retraction Ortho, Distalization Ortho Monday, March 17, 14
  66. 66. Type 4 : Retraction 50 40 30 20 mm y 5 6 7 8 9 10 11 12 13 14 15 girls boys Monday, March 17, 14
  67. 67. Bimax retrusion Monday, March 17, 14
  68. 68. Successful dental result Monday, March 17, 14
  69. 69. Failed Profile Result Monday, March 17, 14
  70. 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. 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. 72. Backed into a corner... • Moving teeth faster, more efficiently… ...in the wrong direction Monday, March 17, 14
  73. 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
  74. 74. Nicholas Plaskon 10yM Monday, March 17, 14
  75. 75. N.P. Monday, March 17, 14
  76. 76. Monday, March 17, 14
  77. 77. Monday, March 17, 14
  78. 78. Sister’s non-x ortho She’s happy…. but I’m not, so... Monday, March 17, 14
  79. 79. I make my pitch for BBO Monday, March 17, 14
  80. 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. 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. 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. 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
  84. 84. Prevention • Remove ankyloglossia • Promote breastfeeding • Harden the diet • Discourage oral habits • Promote whole-foods, low sugar diet • Reduce oropharyngeal obstruction • Promote nasal breathing Monday, March 17, 14
  85. 85. Breathing retraining • Nasal rinsing • Nasal clearing • Decongesting Monday, March 17, 14
  86. 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
  87. 87. Myofunctional Trainers Professors R. Soulet and A. Besombes Dr. Earl Bergeson Dr. Chris Farrell The Multi – Family System Monday, March 17, 14
  88. 88. Soft Tissue Dysfunctions •Lip incompetence •Lip entrapment •Hypermentalis •Mouthbreathing Monday, March 17, 14
  89. 89. 12 month progress Monday, March 17, 14
  90. 90. 12 month progress Monday, March 17, 14
  91. 91. 12 month progress Monday, March 17, 14
  92. 92. After Treatment Bent-wire 6 months Myobrace 12 months Hey, Raphael...What about that profile? Monday, March 17, 14
  93. 93. Orofacial Myofunctional Therapy Oral Myology Myofunctional Therapy Tongue Thrust Therapy Monday, March 17, 14
  94. 94. B. Hockel 2012 Back Undoing Bimaxillary Dysplasia 1. Maxillary deconstriction 2. Maxillary advancement 3. Maxillary impaction 4. Mandibular advancement Monday, March 17, 14
  95. 95. 1. Maxillary Expansion Treatment for Bimaxillary Dysplasia ALF Crozat Bent Wire Hyrax Haas Niti Exp BioBloc Schwartz Monday, March 17, 14
  96. 96. The Farrell BENT WIRE System™ Monday, March 17, 14
  97. 97. Recommended Age Group: 5-12 yrs Arch Development in conjunction with the TRAINER System™ Monday, March 17, 14
  98. 98. At age 16 Twin Study Monday, March 17, 14
  99. 99. Four years earlier... One of them has crooked teeth. Monday, March 17, 14
  100. 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. 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. 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
  103. 103. Dr. John Mew Monday, March 17, 14
  104. 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
  105. 105. Ortho-Postural Training Workshops Breathing Nutrition Posture Sleep Monday, March 17, 14
  106. 106. Monday, March 17, 14
  107. 107. COPYRIGHT Roger L Price October 2012 Monday, March 17, 14
  108. 108. Posture Number Forward head posture can be a compensation for a deficient airway Monday, March 17, 14
  109. 109. Sleep Screening and Hygiene SQI = 10 SQI = .98 Monday, March 17, 14
  110. 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. 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. 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
  113. 113. Myofunctional Orthodontics Chris Farrell John Flutter German Ramierez Damien O’Brien Myofunctional Research Co. Rancho Cucamonga 2008-2012 Monday, March 17, 14
  114. 114. 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 Monday, March 17, 14
  115. 115. Biobloc Orthotropics BBO Mini-residency Bill Hang Agora Hills 2012-13 BBO Intensive Drs. John and Mike Mew LSFO 2013 Monday, March 17, 14
  116. 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. 117. ALF and Cranial Jim Bronson 2013 Tasha Turzo Cranial Academy 2014 Monday, March 17, 14
  118. 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. 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. 120. Teaching Mt. Sinai Pedo Residency Ali Attaie 2010-2012 Montefiore Ortho Residency Tony Maganzini 2012 2009-Present Monday, March 17, 14
  121. 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. 122. Airway and Facial Development Collaborative Webcast Mark Cruz Monday, March 17, 14
  123. 123. AAPMD Symposium www.aapmd.org Annual Meeting April 25-26, 2014 Westin Chicago North Shore Monday, March 17, 14
  124. 124. the raphael center for integrative orthodontics www.alignmine.com www.bioblocnj.com www.myobracenj.com Monday, March 17, 14
  125. 125. Integrative vs Conventional Monday, March 17, 14
  126. 126. Integrative vs Conventional Monday, March 17, 14
  127. 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
  128. 128. Monday, March 17, 14
  129. 129. the raphael center for integrative education Monday, March 17, 14
  130. 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. 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
  132. 132. Monday, March 17, 14
  133. 133. The End And The Beginning Monday, March 17, 14

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