Orthodontics is more than just straight teeth

Many dentists and orthodontists treat only crowded and misaligned teeth, and don’t treat the underlying cause.

What is the most common underlying cause for malocclusion?

An underdeveloped upper jaw. Upwards of eighty percent of the modern population has an underdeveloped upper jaw and midface when comparing it to population groups not eating a modern diet and not exposed to modern pollulants. When the upper jaw is underdeveloped, the lower jaw is often retruded causing compression of the jaw joints, a decreased airway capacity, incorrect cervical spine alignment, poor body posture, and of course teeth misalignment.

How does this occur?

Development and growth of the upper and lower jaws occurs between ages 6-13 years. The jaws between these ages should be stimulated by proper tongue position and swallowing movements to stimulate the jaws to grow forward. Face forward growth is natural, healthy, physiological, and associated with beauty!

Face Forward Growth

Vertical Growth

Will I need jaw surgery or extractions?

For many years, dental bite problems were remedied by two methods. The first was extracting teeth. In a crowded mouth, removing teeth in an already underdeveloped jaw, and making it even smaller only increases potential problems. Once the teeth are extracted, the front teeth are moved or retracted backwards to close the space. The second method was an expensive and risky jaw surgery to reposition one or both jaws. Both of those methods are not physiological and may take years and can be quite painful. In our practice our philosophy of orthopedics and orthodontics means no jaw surgery and no extractions.

It is never too late to treat patients with an underdeveloped maxilla. Expansion of the dental arches is widely practiced by dentists and orthodontists, but most do not expand anteroposteriorly (maxillay advancement). Maxillary advancement will create more space for the tongue and will facilitate improvement in the airway, TMJ pain, and aesthetics, including a person’s profile.

Before

3 Months Fixed ARA

How can we fix underdeveloped Jaws?

There are two different types of anterior remodeling appliances, the fixed and removable.

Fixed(ARA) Anterior Remodeling Appliance

The fixed ARA is designed for patients with an adult dentition which is typically around 12 years of age. The fixed ARA cannot be taken out, and the patient has appointments monthly for simple adjustments. The upper arch expands anteriorly (forward) by approximately 1mm per month, and is typically worn for 5-7 months. Spaces will be created between the upper canines and the first premolars.

FARA model

Fixed FARA

Occlusal Pads

While the Fixed ARA is being worn, the patient will be wearing occlusal pads on the bottom teeth. The pads function to allow for reshaping of the mandible in a more forward direction, and to decompress the jaw joints. Once the desired space is created, the appliance is removed and ControlledArch Orthodontics is commenced.

What is ControlledArch Orthodontics?

It is a straight wire orthodontic system and technique of specific wires, stoplocks, elastics and FRLA’s(Fixed Removable Lingual Archwires). It looks like conventional orthodontics, but its mechanics are not. ControlledArch has excess archwire that exerts force anteriorly and laterally to develop the arches. Because the teeth are moved while maintaining the developed bone, the arch is “controlled“

What is the difference between conventional and ControlledArch™ Orthodontics?

Remodeling Orthodontics is physiological.

• Jaw development is 3 dimensional and precedes movement of the teeth.

Conventional Orthodontics is mechanical.

• The teeth are moved within the confines of the existing jaws
• Jaw development is 2 dimensional and occurs with tooth movement.

Following the Fixed ARA, a lingual wire (FRLA) is placed behind the teeth to avoid relapse or collapse of the teeth from the new anterior position to the original position. We will at the same time place braces on both the upper and lower teeth, and correct the midlines and a cant of the jaw. The braces, with the help of elastic bands, will move the back teeth forward to close the gaps, while maintaining the position of the front teeth. Meanwhile the lower braces will straighten the lower teeth, followed by coordination of the upper and lower teeth to ensure optimal function and aesthetics. Average treatment time is 10-16 months for ControlledArch Orthodontics.

The end result is the complete upper jaw being advanced forward by a few to many millimeter, and both jaws being expanded laterally in width. Both arches occlude into ideal bite harmony with the TMJ joints and the facial muscles. The result is an enlarged space in the mouth that allows the tongue to position itself in the roof of the mouth, and allowing proper swallowing patterns. The more anteriorly positioned upper and lower jaws have also created an enlarged airway space which improves breathing capacity and decreases risk of Obstructive Sleep Anea.

Removable(ARA) Anterior Remodeling Appliance

The Removable ARA appliance is a functional upper jaw, flat occlusal surface appliance, designed for children to accommodate the orofacial growth in the mixed dentition ages between 6-10 years old. The appliance is activated 1-2 times per week by the patient or their parent, and is worn all the time including when eating. The appliance is similar to the Fixed ARA in the growing mouth in that it expands the upper jaw in all dimensions, adding sufficient space to accommodate the eruption of the incoming permanent teeth. When the permanent teeth do erupt, there will be adequate space for them.

Removable ARA

• Optimal treatment ages 6-10 years
• Treatment time 8-12 months
• Worn all the time, and for eating
• Remodeling the upper jaw is redirected forward
• Re-angles lower jaw forward
• Followed by FRLA wires in both arches
• Both jaws remain in forward position for life (no relapse)
• Nearly elliminates all possible TMJ and airway issues

FRLA

Following removable ARA treatment, one third of these patients will never need orthodontic treatment again in life. The remaining two thirds will require a 6-9 month short orthodontic treatment. This appliance is a miracle appliance and will completely change a vertical growth pattern which is pathological, to a natural, physiological healthy and aesthetically desired horizontal growth pattern for life. No child with malocclusion should miss out on being treated with this appliance!

What can I expect from facial growth orthodontic treatment?

The goal is to create the environment that the oral facial structures re-establish proper working function and esthetics. This proper function will create a physiological relatonship between the muscles, joints and jaws, along with cervical vertebrae and the airway to be healthy and pain free for life. To achieve this goal, 3 important changes need to occur which will be imperative in achieving good treatment success and a lasting dental occlusion that does not relapse.

1. Return mouth breathing to nasal breathing.
2. Teach proper lip seal.
3. Train proper tongue and oral posture.

Before treatment commences we also assess the airway and determine if there is any airway obstuction. If so, we refer to an Ear Nose Throat Doctor (ENT) for treatment. Patients with allergy problems will be sent to an allergist and patients with dysfunctional tongue habits will be referred to a myologist.

Do I need facial growth orthodontic treatment?

We will need to take a series of photographs, X-rays and intra oral measurements to determine the position of the upper jaw and whether it is midface deficient or not. Patients with a midface deficincy will be recommended a Fixed ARA followed by ControlledArch Orthodontics for adults, or Removable ARA followed by FRLA arch wires for the upper and lower jaws for children. If there is only mild or no midface deficiency, only ControlledArch Orthodontics or no treatment is recommended.