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Airway ortho 2 std and facial growth

A series of lectures by Dr. Barry Raphael on Airway-focused orthodontics from 2013.
Chapter 2: About Soft Tissue Dysfunction and how it affects the growth and adaptation of facial growth in children.

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Airway ortho 2 std and facial growth

  1. 1. Airway OrthodonticsA lecture series prepared byDr. Barry RaphaelOf theRaphael Center for Integrative OrthodonticsClifton,“Soft Tissue Dysfunction and Facial Growth” - 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. Soft TissueDysfunction isTHE etiologyin a majority ofmalocclusions3Thursday, June 6, 13
  4. 4. EgilHarvoldA History of Myofunctional OrthodonticsGeorgeCatlin1880 1890 1900 1910 1920 1930 1940 1950 1960 1970 1980 1990 2000 2010 2020NormanKingsleyJuliusWolffJ. SimWallaceEdwardH.AngleAndresenand HauplAlfred P.RogersChris Farrell,John FlutterYouAllan G.BrodieWestinPriceBimler,Balters,FrankelTomGraberMelvinMossDonaldEnlowCharlieTweedDanielGarlinerRobertLittleJohnMew4Thursday, June 6, 13
  5. 5. There is Nothing NewUnder the Sun5Thursday, June 6, 13
  6. 6. Norman William Kingsley•Stockholm, NewYork•“The Father of Orthodontics”• A Treatise on OralDeformities (1880),•The first to recommend thatetiology, diagnosis, andtreatment planning should be thefoundations of practice• The Bite Jumper•Vulcanite with “pull-forward”bite ramp1829-19136Thursday, June 6, 13
  7. 7. Julius Wolff•1892 :The Law of Bone Remodeling•Bone will adapt to the loads placed upon it. •Increased load leads to increasedtrabeculation internally and then increases inthe cortical thickness externally. •Converse: lack of use or stress leads to adiminution of bone strength and thickness dueto turnover.7Thursday, June 6, 13
  8. 8. George Catlin• Lawyer, artist, amateur anthropologist•Documented native populations in North andSouth America•1870•“Shut Your Mouth and Save Your Life”• Book recommended by Edward Angle in 19258Thursday, June 6, 13
  9. 9. George Catlin - 1870•The cause of modern man’s maladies is his lack of “a quiet and natural sleep”.•Proper breathing regulates digestion and circulation to every part of the body.•Improper breathing brings imbalance and disease.•The nostrils are intended to measure and temper the air in support of properbreathing.9Thursday, June 6, 13
  10. 10. George Catlin - 1870On mouth breathing at night:“That man knows not the pleasure of sleep; he rises in themorning more fatigued than when he retired to rest - takespills and remedies through the day, and renews his diseaseevery night.”10Thursday, June 6, 13
  11. 11. James Sim Wallace - 1904• Natural suckling and chewing exercises themuscles of the jaws and tongue.•The tongue stimulates the maxilla, the alveolus andthe teeth during growth.•A lack of spacing in the primary teeth is due to lack ofoutward pressure on the arches by a fully developedtongue.•Without primary spacing, permanent anterior teethwill surely be crowded, and the posterior teeth will beseen to “fall inwards”.11Thursday, June 6, 13
  12. 12. James Sim WallaceSoft food>lack of chewing>unopposed eruption>excess verticalheight> increased lip and muscleincompetence>mouthbreathing>deterioration of nasal airway>moremouth breathing>more verticalgrowth...12Thursday, June 6, 13
  13. 13. 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•All “TOOTH-CENTRIC” concepts, but...•“... more often than is recognized, thepeculiarities of lip function may have beenthe cause of forcing the teeth into themalpositions they occupy”.1855-193013Thursday, June 6, 13
  14. 14. 14Thursday, June 6, 13
  15. 15. Alfred P. Rogers•Angle School, 1903•taught at Harvard•private practice in Boston•past president of the ASO (AAO)•total-child approach and advocatedmuscular exercises to improve neck,head, and tongue posture andencourage nasal breathing•treated many “skeletal Class II”cases ONLY with exercise.1873-195915Thursday, June 6, 13
  16. 16. “Our teachers have recognized theimportance of muscular pressure in itsnormal conduct as well as in its abnormalconduct, but here we seem to havestopped, assuming that with the correctionof the faulty osseous formation and cusprelation, nature, somehow or other, wouldestablish the correct muscular tone andmuscular habits…”Alfred P. Rogers, 1918 to the A.S.OAlfred P. Rogers, 1918 to the A.S.O16Thursday, June 6, 13
  17. 17. Tom GraberAJO, 1963“The Three M’s:Muscles, Malformation, and MalocclusionThe Two Groups of Disciples:Edward Angle: Edgewise ExpansionistsCalvin Case: ExtractionistsThis tooth-focused battle rages oneven today.....Must take muscles into account...1917-200717Thursday, June 6, 13
  18. 18. Melvin Moss• Professor at Columbia U.•Functional Matrix Theory•AJO 1966 :“The Primary Role ofFunctional Matrices in FacialGrowth”•Periosteal Matrix: the pull of muscleon bone•Capsular Matrix: the function of aspace stimulates bone1923-200618Thursday, June 6, 13
  19. 19. Donald Enlow•U. Mich, Case Western•1975: Handbook of Facial Growth•“Area Displacement”Sutural and Bone growth inthe face is the RESPONSEto soft tissue displacement,not the CAUSE of it.19Thursday, June 6, 13
  20. 20. Egil Peter Harvold•Norwegian Orthodontist•Cleft Palate•Professor•Brought Functional Treatment to N.A.•1981 Primate experiments• Blocked nasal passage• Skeletal malocclusion resulted1912-1992Block the nose> posture changes and teeth get crooked20Thursday, June 6, 13
  21. 21. Plugged Nose changes Posture21Thursday, June 6, 13
  22. 22. Posture changes TeethLowered mandibular posture, tongue protrusion,and open biteOpen mouth posture retained for 1 year after nosereopened. Facial features retained22Thursday, June 6, 13
  23. 23. John Mew•“Orthotropics”•Normal growth of maxilla > Downand Forward•Dysfunctional growth > Down•BioBlock Therapy to reestablishForward componentwww.orthotropics.comwww.facefocused.com23Thursday, June 6, 13
  24. 24. The Tropic Premise“ If the tongue at rest is against thepalate with the lips lightly sealed andthe teeth in or near contact, there willbe ideal facial and dentaldevelopment.”“Something RARE in industrializedsocieties…”24Thursday, June 6, 13
  25. 25. The Tropic Premise“Because the genetic control of skeletalgrowth is not precise, the articulationof the teeth and jaws depends uponadditional guidance from oralposture.”25Thursday, June 6, 13
  26. 26. Normal Eruption•Tongue rest on palate•Erupting teeth slide into thespace between the tongue andcheeks/lips (path of leastresistance)•Cuspal contacts guide teethinto position26Thursday, June 6, 13
  27. 27. Dysfunctional Eruption•Tongue rests in between teeth• Maxillary alveolus collapses mediallyand fails to grow fully forward (changeof shape)•Teeth erupt without guidance or...•With poorly directed pressures fromhyperactive muscles• Cuspal contacts misdirect finalsettling of teeth27Thursday, June 6, 13
  28. 28. Orthodontics:Current Principles and Techniques (3rd ed.)Graber andVanarsdall• Equilibrium Theory: Stability is the sum total of forcesand lack of force over time.•Tongue Resting Posture is more important thantongue function.•Whatever determines resting tongue posture, forlong enough, will influence the position of the teeth.• Respiratory Pattern• Head posture• Jaw Function and posture28Thursday, June 6, 13
  29. 29. Homeostasis•The Body Seeks Balance•Against gravity•Temperature• Blood pH• Oxygen : CO2 balance• Dynamic Equilibrium•A System in a Steady State where loss is equal to gain•There is change, but no NET change•Blood glucose•Tooth Position29Thursday, June 6, 13
  30. 30. G. David Singh• Epigentic Orthodontics•Genetics is important inthe way genes react tostimuli"Malocclusion is one solution for the complex adaptiveorofacial system to be in equilibrium."30Thursday, June 6, 13
  31. 31. Epigenetics31Thursday, June 6, 13
  32. 32. How DNA works1. Direct protein synthesis2. Through switches that turn those genes on and off. (Histoneswitches and epigenetic factors)3.Through sequences of D.N.A.s chemicals that control thoseswitches.4. Gene switches can change a characteristic by changing thetiming, intensity or duration of the same thedifference between a fin or a limb.32Thursday, June 6, 13
  33. 33. Brian Palmer•From Kansas City•(Mal)occlusion begins at birth• Breast Feeding critical toformation of palate• Short Frena limit suckling andproper tongue postureGenetic response begins at birthAnd can be influenced.33Thursday, June 6, 13
  34. 34. •Open MouthPosture•Mouth breathing•Tongue Restingposition•Obstructive SleepApnea•Upper Airwayobstruction•Adenoids•Allergies•Nasal obstruction•URI•Recurrent OtitisMedia•Early Feeding• Breast vs Bottle•Hard vs soft•Tongue Thrust•Reverse swallow•Delayedmaturation ofinfantile suckling•Finger habits•Hypomobility•Short Frenum•Scarring•Premature ToothLoss•Stress•Overheated houses•Oxidative stress•NutritionalDeficiencies•Nutritional Excesses•Nutritional Toxins•Breathing Habits•CO2 stores•Posture•Birth Trauma•Cranial StrainsEnvironment Influences Homeostasis34Thursday, June 6, 13
  35. 35. PerpetuationForm FunctionMakes...Grows into...•Soft tissue dysfunctions cause malocclusion•Malocclusions encourage Soft Tissue dysfunctions.•The Spiral continues35Thursday, June 6, 13
  36. 36. The Stack of Blocks36Thursday, June 6, 13
  37. 37. The Stack of Blocks37Thursday, June 6, 13
  38. 38. The Stack of BlocksMalocclusion: onesolution to be inequilibrium38Thursday, June 6, 13
  39. 39. Soft TissueDysfunction isTHE etiologyin a majority ofmalocclusionsAs stated by Dr. John Flutter39Thursday, June 6, 13
  40. 40. “So why do some children developcrooked teeth and some children developstraight teeth?”40Thursday, June 6, 13
  41. 41. “For normal growth and developmentthe growing child needs to:1.breathe through the nose,2.have the lips together at rest, and3.have the tongue sitting in the roofof the mouth.”41Thursday, June 6, 13
  42. 42. “When the tongue rests in the roof of themouth the teeth erupt around the tongueforming a normal shaped and sized jaw.When this happens the teeth willerupt into a straight line.”42Thursday, June 6, 13
  43. 43. “Those children who breath through themouth or have the lips apart at rest will nothave the tongue in the roof of the mouth.All of these children will have anunderdeveloped upper jaw.It will not be big enough for all of the teeth and whenthe adult teeth erupt they will be crooked.”43Thursday, June 6, 13
  44. 44. Arch FormsThe Gothic Arch The Roman Arch44Thursday, June 6, 13
  45. 45. How do you build an arch?45Thursday, June 6, 13
  46. 46. Building a Stable ArchThe Roman Arch46Thursday, June 6, 13
  47. 47. When the tongue rests in the roof of themouth the teeth erupt around the tongueforming a normal shaped and sized jaw.The tongue is the scaffoldfor the upper jaw47Thursday, June 6, 13
  49. 49. Bones Adapt to Spaces49Thursday, June 6, 13
  50. 50. With Support of the Tongue50Thursday, June 6, 13
  51. 51. SOFT TISSUE DYSFUNCTIONWhen the palate is NOT supported by the tongue.51Thursday, June 6, 13
  52. 52. SOFT TISSUE DYSFUNCTIONComparison of Unsupported vs Supported Growth52Thursday, June 6, 13
  53. 53. SOFT TISSUE DYSFUNCTIONComparison of Unsupported vs Supported Growth53Thursday, June 6, 13
  54. 54. Everyday in my practice...54Thursday, June 6, 13
  55. 55. The Missing Link...It’s not justGrowth and DevelopmentIt’sGrowth, Development andAdaptation55Thursday, June 6, 13
  56. 56. If Malocclusion is caused byGrowth and DevelopmentGenotype PhenotypeTotal Growth56Thursday, June 6, 13
  57. 57. If Malocclusion is caused byGrowth and Development andAdaptationGenotype PhenotypeTotal Growth57Thursday, June 6, 13
  58. 58. The Missing Link…The Moral of the StoryThe Face you haveMay not be the faceThat Genetics intended for you58Thursday, June 6, 13
  59. 59. The Missing Link…The Moral of the StoryCrouzon’s59Thursday, June 6, 13
  60. 60. The Missing Link…The Moral of the Story60Thursday, June 6, 13
  61. 61. Is this the face her genetics gave her?What is the appropriate question to ask?The Missing Link…The Moral of the Story61Thursday, June 6, 13
  62. 62. Do any of us have the face that we were intended to have?The Missing Link…The Moral of the Story62Thursday, June 6, 13