Myofunctional Research Company Presents The Myobrace System

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

Can you hear me?

Let’s turn off ringers...

If all you have is a hammer...


In the news, March 2012


The House that


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]


RO since1983

(30 years...yikes)

Bucknell University 1974
University of Pennsylvania 1978
(Three Years in General Practice)
Fairleigh-Dickenson University 1983


Jim McNamara


Functional Orthodontics

Functional Orthodontics


Myofunctional Research Co.


Spring, 2009 MRC meeting, Chicago > Terry
September, 2009 MRC conference, Coral Gables, Fl.


Myofunctional Orthodontics

Chris Farrell
John Flutter
German Ramierez
Myofunctional Research Co.
Rancho Cucamonga
Damien O’Brien
2008-2012

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

Biobloc Orthotropics
BBO Mini-residency
Bill Hang
Agora Hills
2012-13
BBO Intensive
Drs. John and Mike
Mew
LSFO
2013

Breathing and Sleep
Buteyko Mentorship
The Breathing Center
Woodstock
2010

Breathing Well Programme
John Flutter
2010


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


Teaching
Mt. Sinai Pedo Residency
Ali Attaie
2010-2012
Monteﬁore Ortho Residency
Tony Maganzini
2012

2009-Present

Golf
Handicap
2007 = 17
2013 = 23


It’s about the Airway
“It’s all about
Barry
And
The World of
Mouthbreathing”

BTW….I lost 30lbs

Disclosure
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

Represented today?
GP
Perio
Endo
Pedo
Ortho
OMS
Medical
TMD
Sleep Medicine

Schedule


Reading Assignment?


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....

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

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?

Feedback

I agree
I like

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

“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

Airway and
Breathing
Dysfunction

Spectrum of SDB

Normal
Prevalence:

Snoring
8-10%

UARS
?

OSAS
1-3%
32


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

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


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


Which is easier to breathe through?


Which would you trust most?


Which would you rather have?


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

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.”


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


Morphology and SDB
in children
Risk Factor
Obesity

0

Tonsilar Hypertrophy

3.7x

Crossbite

3.3x

Convex Facial Proﬁle

Incidence

2.6x

Morphology and SDB
in children


Morphology and SDB
in children

“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.”

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

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


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.”


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.”

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

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

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.”

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


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


“all children present a visually
recognizable abnormal high and
narrow hard palate”


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?


“….there is much circumstantial evidence that jaws and
faces do not grow to the same size that they used to…”
Daniel E. Lieberman


The “Modern” Maxilla
The Gothic Arch


The Roman Arch

Chris Farrell


Soft Tissue Dysfunction
is THE etiology in
Maxillary Dysplasia
And Malocclusion


How do you build an arch?
The Roman Arch


No scaffold?


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

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.

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

Plugged Nose changes Posture


Posture changes Teeth

Lowered mandibular posture, tongue protrusion,
and open bite
Open mouth posture retained for 1 year after nose
reopened. Facial features retained

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


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.”

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…”

The Tropic Premise

If the tongue is chronically held away from the palate…
…the maxilla collapses in all three dimensions.

With Chronic Open Mouth Posture

SOFT TISSUE DYSFUNCTION
Comparison of Unsupported vs Supported Growth

11y male vs Bolton norm


Male 8-3y


Male 10yo


11-7yF

Text


Everyday in my practice...


Bi-maxillary Retrusion
Bolton Standards
Insufﬁcient Facial
15yo
Support
Nasal Cartilage
Collapse
The Maxilla is
Down and Back

The Mandible is
Retrognathic

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

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

Pharyngeal Airspace

Mouth breather
Nasal breather
Mouthbreathers have signiﬁcantly
smaller airway space.
(measurements PAS-OccL, PAS-UP, airway volume, area and minimum axial area)

Open Mouth Posture is
the most common
and signiﬁcant
Soft Tissue Dysfunction
In children today.

Weston Price
Nutrition and Physical Degeneration
Weston A. Price, DDS, 1939
Price-Pottenger Nutrition Foundation
www.ppnf.org

1870-1948


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

Darwinian Dentistry
Are we developing the way
our genes meant us to be?
Peter
Gluckman

Neese and
Williams

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

There was a
time...
5,000 years ago
When caries and malocclusion
were rare!


The Missing Piece in
Orthodontics Today...
Its not just
Growth and Development
Its
Growth, Development and
Adaptation

If Malocclusion is caused by
Growth and Development...

Genotype

Total Growth


Phenotype

If Malocclusion is caused by
Growth and Development and
Adaptation...
Genotype

Total Growth


Phenotype

An example of “adaptation”


An example of adaptation

What do you notice about these boys?

What do you notice about these boys?

One of them has crooked teeth.

RHYS - 10Y get
How did these teeth 11M this way?
3 August 2003

3 August 2003

Different genes than his brother?

RHYS - 14Y 5M

Four years later, after successful MFO
1 March 2007

1 March 2007

Text

(Treatment by Dr. Chris Farrell)

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

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


From “Malocclusion” 1907


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

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


The Extraction Wars
Edward Angle vs Calvin Case

1855-1930

Witzig vs McNamara

NewConn 2009 Extraction vs Non-extraction Debate

V. Kokich


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…”

Non-extraction


Light-wire, Low-force

aaccnjpa@gmail.com


Blocked out #26


18 Months

26 Months

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

Bimaxillary Dysplasia

Should treatment be based on the Angle Classiﬁcation?

Bimax
retrusion


Successful
dental result


Failed Proﬁle Result


Treatment

What is the appropriate treatment for a Collapsed Maxilla?


Treatment

Headgear?


Treatment

Class II Elastics?

Treatment

Mandibular Advancment Appliance?
(Herbst, Twin Block,MARA with reciprocal anchorage)

Treatment

Extractions ?


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.”

Backed into a corner...
•

Retraction Orthodontics

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?

If snoring is likely to lead
to obstruction someday,
how much snoring is
“normal” for a child?


The Perfect House
Malocclusion
and
Orthodontics

Soft Tissue
Dysfunction

Airway-centric
Orthodontics

Chronic
Diseases of
Lifestyle

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?


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.”


Comparison case
Older sister: Extract two upper premolars. Airway 14 to 10mm
Younger sister: Non-extraction. Airway from 14-17mm


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.

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


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


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.”

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!!!

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


A Pathology Cycle
Swollen T&A

Form
Function

Narrow Palate

Form

MouthBreathing and
Low Tongue

Crooked Teeth
Declining Health

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

MouthBreathing and
Low Tongue
Weak MMuscles

Form

Form

Swallowing with Active
Function
Facial Muscles
Conventional Orthodontics

Backed into a corner...
•

Prevention is not mechanical!

Breaking The Cycle
Swollen T&A

Form
Function

Narrow Palate

Form
Function

Long Face

Crooked
Teeth
Declining Health

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).”


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.”

Roger Price’ Toothberg


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

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

If the Cause is in the muscles,
then treatment must be, too.
Airway-Centered Orthodontics
And
Muscle-Centered Orthodontics
Vs.
Tooth-Centered Orthodontics

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


Airwayand
Sleep and
Breathing
Dysfunction
Dentistry

Myofunctional Research Company Presents The Myobrace System

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Myofunctional Research Company Presents The Myobrace System