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A series of lectures by Dr. Barry Raphael on Airway-focused orthodontics.
Chapter 4: How the basic assumption of Maxillary Dysplasia affects diagnosis and treatment planning in Airway-focused orthodontics.
Airway OrthodonticsA lecture series prepared byDr. Barry RaphaelOf theRaphael Center for Integrative OrthodonticsClifton, NJ.www.alignmine.comwww.myobracenj.com“Skeletal Treatment” - 20131Thursday, June 6, 13
•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
Skeletal RelationshipsBased on Bell, Proﬁt, and White, Surgical Correction of Dentofacial Deformities, 19803Thursday, June 6, 13
Skeletal RelationshipsCraniumNaso-maxillarycomplexMax dentitionMand dentitionMandible4Thursday, June 6, 13
Skeletal RelationshipsIdeal, Class I5Thursday, June 6, 13
Skeletal RelationshipsMaxillary Dental Protrusion6Thursday, June 6, 13
Skeletal RelationshipsClass II, Mandibular Retrusion7Thursday, June 6, 13
Skeletal RelationshipsSkeletal Open BiteMaxillary Protrusion with Mandibular Auto-rotation8Thursday, June 6, 13
Skeletal RelationshipsWhat’s This?9Thursday, June 6, 13
The Tropic PremiseMaxillary Growth is supported by Tongue Posture on the Palate10Thursday, June 6, 13
The Tropic PremiseBut if the tongue is chronically held away from the palate……the maxilla collapses in all three dimensions.11Thursday, June 6, 13
Then the Mandible AdaptsIf the mandible stay with maxilla: Class I Crowded12Thursday, June 6, 13
Then the Mandible AdaptsMouthbreathing and/or tongue thrust hinders growth : Class II13Thursday, June 6, 13
Then the Mandible AdaptsLow Tongue keeps mandible growing forward: Class III14Thursday, June 6, 13
The relationshipbetween retruded chinsand airway obstruction!Both infants andadults die fromobstructed airways!(Grant’s Atlas of Anatomy, Fifth Edition, 1962, Williams & Wilkins)18Thursday, June 6, 13
Kevin BoydMust treat early!19Thursday, June 6, 13
Predictive factors that puts anindividual at risk for OSA include:• Large body mass index (obese)• Large neck size• High palate• Narrow dental arches• Overjet (jaw back - retrognathic)IF the individual does not have a large neck and/or bodymass, then the predictive value for being at risk for OSA isbased on a high palate, narrow dental arches and overjet.From Kushia and Guilleminault, 199720Thursday, June 6, 13
Pharyngeal AirspaceThree-dimensional assessment of pharyngeal airwayin nasal- and mouth-breathing childrenAlves, M, et.al., Int J Ped ORL 75 (2011) 1195–1199Cone Beam and Airway analysis tool21Thursday, June 6, 13
Pharyngeal Airspace•Exam for Mouthbreathing•the habitual posture of the lips•size and shape of the nostrils•control reﬂex of the Alar Nasalis•Glatzel mirror test•Rhinoscopy•Adenoid hypertrophy25 Nasal breathers, 25 mouth breathers,Avg 8-9 y/o22Thursday, June 6, 13
Pharyngeal AirspaceMouthbreathers have signiﬁcantlysmaller airway space.(measurements PAS-OccL, PAS-UP, airway volume, area and minimum axial area)Mouth breather Nasal breather23Thursday, June 6, 13
Which is easier to breath through?24Thursday, June 6, 13
Which would you trust most?25Thursday, June 6, 13
Which would you rather have?26Thursday, June 6, 13
Big Problem!… except forbimaxillary advancement surgery,conventional orthodontics hasno workable protocols forcorrecting this type of malocclusionin the late mixed or permanent dentitions.27Thursday, June 6, 13
TreatmentThe one common feature of posture-related malocclusion isMaxillary Collapse28Thursday, June 6, 13
TreatmentWhat is the appropriate treatment for a Collapsed Maxilla?29Thursday, June 6, 13