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From The CEO |
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"Extreme Class II
gets harder to correct
with age."
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When I read the Orthodontic journals and some of the dental literature, the term “early treatment” is so often cited with ridicule and misunderstanding.
What is early? And what is the treatment? More importantly, what is the diagnosis? The term is very open to misinterpretation. Dr. German Ramirez has contributed a great article this edition on what we are diagnosing and treating early, from a myofunctional rather than an orthodontic perspective. The point I would like to make is the concept that early treatment is so subjective. Is it from 9 years of age? From 5 years, as Dr. Rickets proposed? Or from birth as proposed by my good friend Dr. David Page?
Sorry to say, but the treatment is never early. I see children 8 years old and the parents do not like what I say. Every professional has told them to WAIT WAIT WAIT. I tell them, "If only you could have had treatment EARLIER - 5 years earlier."
I feel the dental profession has missed the point on early treatment. You can see even a 3 year old with a tongue thrust habit and mouth open posture. Age is irrelevant - treat it when you see it and the sooner the better.
Let us get clinical and give you an example. Just yesterday I saw some very extreme Class II’s from the same family. Too late to treat actually. What do you do? The oldest child was 9, the next was 8. The children's parents wanted treatment, so we started. During this, one of the parents asked, "What is the best age to start treatment then?" They had a 5 year old terrorising the waiting room... I said that age is a good start. So we started all the children simultaneously. The youngest now has an INFANT TRAINER™. These highly motivated parents had been treated with extraction Orthodontics themselves, and both had experienced relapse of course.
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"Extreme Class II from myofunctional causes."
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The point here is, it is never too early or too late. Unresolved myofunctional problems limit the growth of the 4 year old, cause orthodontics not to work and instil regret in adults (such as the example above) who have experienced the failure of fixed appliances with extractions. Treat what you see NOW. This is generally for the whole family.
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"Youngest child starts on INFANT TRAINER™."
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Routinely I see parents bringing in their eldest child (9 to 11 years of age). My therapist explains to both the child and their parent/s the MRC Clinics concept. If these parents have 3 children we INSTANTLY have not 1, but 3 patients. Often 5, as the parents so often want treatment too. One into five does go.
I have more patients than I have time to treat. However, you cannot help but be inspired to help these poor children with no face, crowding and eager parents. It takes little time to put all these children on the TRAINER program. The earlier the treatment starts for myofunctional habits, the sooner the child benefits from more favourable growth.
Regards,
Dr Chris Farrell BDS (Syd Uni)
CEO and Founder
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Scientifically Speaking |
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Early treatment is a controversial subject in orthodontics. Some authors claim it is not worth treating malocclusions at an early age, as further treatment may be required when the permanent dentition has come through. Other authors recommend treating malocclusions around a child’s pubertal spurt, as this is the time when a high release of hormones and growth factors occur in the body, and a better, quicker response can be produced with orthodontic appliances. It seems that my colleagues supporting those ideas do not have sufficient knowledge on the etiology of malocclusions, and how the biology of the Cranio-Cervico-Mandibular system works.
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"... the position of the teeth is a consequence of how the components of the Cranio-Cervico-Mandibular system are working ..."
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Malocclusions are not produced by a single factor. They are the result of multiple factors. The Cranio-Cervico-Mandibular system is not only composed of teeth, but from various structures with intertwined functions as follows:
(a) Muscular activity releases force on the jawbone, (b) mandibular movement loads the mandibular cartilage, (c) the impact produced by mastication loads the jawbone, (d) oral functions release force on teeth and jaws, and so, there would be enough (or reduced) alveolar bone to hold the teeth. As a result, the position of the teeth is a consequence of how the components of the Cranio-Cervico-Mandibular system are working and the biological response of the patient.
In my professional opinion, those authors claiming that a second phase of treatment is required when malocclusions are treated at an early age, probably focus their treatments on simply moving just the teeth. They forget that the principal factors causing those malocclusions are muscular and oral dysfunctions (For more information see Ramirez-Yañez, 2005). When those dysfunctions are not corrected by treatment, they then become the main cause of relapse. Also, those authors saying that the best age for orthodontic treatment is around a child’s pubertal spurt do not identify that human beings experience a higher rate of growing around 6-7 years of age - and sometimes even earlier. They do understand that the Cranio-Cervico-Mandibular system is ready to respond when it is properly stimulated at any age.
For these reasons, treatment of malocclusions at an early age is strongly recommended, but remember that the treatment has to aim at correcting ALL the factors causing the malocclusion - and not just moving teeth.
Regards,
Dr. German O. Ramirez-Yañez
Scientific Researcher for MRC
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MRC Global - A World Perspective |
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I am seeing an increasing number of doctors attending MRC’s Early Treatment Courses and seminars provided by local and international doctors. Across Asia, South America, India and the United States, (I would assess that) the number of participants is rapidly increasing by more than 50-60%. Clearly more and more doctors are seeing the need to better address early treatment within their clinics. It is amazing that over the last few years the number of extra conferences now running would be close to 300. These countries previously held only a couple of seminars each year, and now run many more. Numerous countries are starting support groups for doctors to swap cases, discuss information, and continue to grow in better clinic treatments. Not only have we seen the start of the International Symposiums on Myofunctional Correction and Cranio-Facial Development (ISMCCD) on the Gold Coast, but conferences across almost every country are now running multiple times each year to provide better education and awareness for doctors. Event details can be found on the MRC website on the Events and Education webpage.
Awareness has been growing globally, and it is exciting to see such enormous growth finally occurring across the United States, with so many more doctors, orthodontists and universities getting involved.
With scores of doctors across so many countries already having success in early treatment, there is no end to the number of doctors who are finding themselves more comfortable to begin this early treatment within their own clinics. Compared to when I began 11 years ago, it is now much easier to have a discussion with a doctor and help them to begin using early treatment appliances. People are now more receptive to treating early, and scepticism has certainly dropped enormously. Even speech therapists can see this concept supports their work.
Research articles provided at www.myoresearch.com have been a great help. Thank you Dr. Ramirez and all the doctors from universities around the world who have contributed.
Some great upcoming events I will be at include:
I hope some of these important events end up in your calendar. Please contact your local dealer for individual conference and seminar details.
 Events and Education
Regards,
Damien O'Brien
MRC Global Sales & Training Executive
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Guest Writer |
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At the 1st ISMCCD in September 07, Dr. John Mew said:
"The position of the maxillae is fixed in the cranium by the age of eight and a half."
We can expand the upper arch at any age by opening the mid-line suture but the ability to bring the maxillae forward reduces as the child becomes older. Why is this significant? In most malocclusions the maxillae is both small and retrognathic.
The position and the size of the maxillae is determined by the tongue. The tongue resting in the palate not only enables the width of the arch to develop correctly; it also allows the maxillae to grow forward to occupy the correct position. This produces an attractive face.
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"The correct tongue activity starts at birth.."
..when the child has to push the tongue into the palate and thrust it forward in order to feed at the breast.
A low tongue posture, often associated with mouth breathing and lips apart at rest, will cause the maxillae to be small and retrognathic within the cranium.
I see many children with an anterior cross bite. To call these children class 3, although accurate, is often misleading. It implies that the mandible is either large or positioned forwards or both.
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Many of the children I see with an anterior cross-bite have narrow, retrognathic maxillae and a retrognathic mandible as well! Hardly a class 3. This is often called the 'Pseudo Class III' but in reality the maxillae are small and set back within the cranium.
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"The treatment for these children is to develop and advance the maxillae"
I use a Biobloc (Stage 1) to develop the maxillae at a semi-rapid rate. The patient turns the screw 1/8 of a turn each day, which gives 7/8mm increase in the plate each week. This allows the maxillae to separate but not to snap the joint. I advance the catenary wires behind the upper incisors every two weeks. This will correct the anterior cross-bite. Once the width of upper arch is developed, I hold it for ninety days before proceeding with the treatment.
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I use a forward pull headgear if the lateral ceph shows that the posterior nasal spine or the back of the maxillae is retrognathic. When the back of the maxillae is not retrognathic, but we are just dealing with a short maxillae, I find that there is more tendency for the position of the maxillae to relapse if pulled forward.
Generally, within six months, I have developed the jaw and corrected both anterior and posterior cross-bites if they are also present. Once the arch is developed it is important to maintain the new arch form. This often means helping the child to establish nasal breathing when I see that as the aetiology.
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"Stability is established by training the muscles of the lip and tongue to support the new arch form."
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Whenever I expand an upper arch I expect the new form to be unstable. Stability is established by training the muscles of the lip and tongue to support the new arch form.
I use the tongue to support the new arch form and train the tongue into the palate with a TRAINER. Whenever I have corrected an anterior cross bite I have used the new i-3™ Interceptive Appliance. The large buccal flange in the anterior area works like the pads on a Frankel appliance holding the soft tissues away from the anterior teeth.
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"Whenever I have corrected an anterior cross bite I have used the new i-3™ Interceptive Appliance."
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Like all TRAINERs it is worn all night every night, and an hour a day every day, with the lips together for a minimum of one year. I take new records after one year and review the result.
Regards,
Dr John Flutter
Orthodontic Early Treatment Centre
Brisbane Queensland Australia
www.jfdental.com
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New at www.myoresearch.com |
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View the updated MYOBRACE® videos by clicking on the links below:
With the end of a successful 2007, MRC have now updated their Events and Education web page for 2008. Sift through event photos for 2005, 2006, 2007 and 2008 while keeping a watch on further updates to event dates and locations.
Chief Scientific Researcher for MRC, Dr. German O. Ramirez-Yañez has released his latest article on 'Dimensional Changes in Dental Arches After Treatment with a Prefabricated Functional Appliance' (2007). Download article via the MRC Academic Research Articles web page.
The INFANT TRAINER™ has recently featured in one of the most important TV news shows in Brazil, Jornal Nacional - Globo TV. View TV segment online.
The MRC Contact page now features a web support option. To contact the MRC Multimedia Dept. directly for any technical support related to www.myoresearch.com, choose the 'Website Support' from the 'Contact / Region' drop down list when filling out your contact details.
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Your Feedback
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This month's feedback comes from Dr. Masashi FUKUOKA. If you would like to share your comments, please contact the eNewsletter editor.
"The TRAINER is enjoying great popularity in my clinic. Thanks to the TRAINER, I've gained more than 570 (pre) orthodontic patients since I first started using the appliance in July 2001. It is my great joy and honour to see my patients (children) grow bright and charming without using braces or other orthodontic appliances. If used properly, the TRAINER almost never fails to prove successful." More Testimonials.
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