Epigenetic Orthodontics / Orthotropics
Melanie L. Throne, DDS, PA - General Family Dentist located in Fort Worth, Texas
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Epigenetic or Functional Appliances are a group of fixed and removable appliances that are generally used to promote maxillary and mandibular growth in patients with a skeletal Class II malocclusion (overbite). They can be rigid, flexible, and semi-rigid. It is possible to use surgically placed mini-screw implants called TADs to anchor some appliances applying the forces to them instead of the teeth. They generally employ non-extraction techniques choosing instead to focus on growth and/or remodeling of the jaws, and in turn of the cranium as all bones of the head and neck complex then readjust to maintain overall systemic stasis. The appliance takes advantage of innate physiological growth and remodeling processes rather than using mechanical force to move teeth.
There has been a movement, recently brought on by research into disordered breathing and an understanding and identification of its contributing factors, to introduce a 4th Skeletal Orthodontic Classification where both jaws present as Dental Class I (Normal), but are in actuality pushed back in relation to the cranial base onto the airway decreasing its three-dimensional size. A team approach to facial bone growth and remodeling appliances can correct breathing issues, facial asymmetries, underbites, overbites, crossbites, alleviate nasal deviations, and correct less than esthetic facial and profile appearances without expensive and risky jaw surgery or unnecessary amputation of permanent teeth. A typical first premolar is 8 mm in width, and so when extraction of the first premolars occurs on both sides in one arch, it causes a 16 mm deficit in arch length resulting in smaller and narrower smiles, faces, and airways. Most patients look and feel like a healthier and often younger version of themselves at completion of the growth appliance phase.
It is critical to intervene as early as possible to take advantage of the chance to manipulate normal skeletal growth occurring in children. By the age of four, 60% of facial growth is complete. By the age of six, 80% of facial growth is complete. By the age of 11-12 90% of facial growth is completed and the second premolars have erupted. While orthodontic treatment in ages 6-11 often focuses on catching up to a normal healthy growth pattern that is supportive of the airway, traditional orthodontic treatment after the age of 12 will almost always ensure a relapse later in life with most assuredly airway compromise and associated health comorbidities.
There are a wide variety of appliances that are clumped together in this category despite having differences in treatment goals, mechanism of action, time-frame utilized, and long-term resolution and stability. It has been shown that promoting forward positioning of the mandible improves TMJ, neurologic, and airway health for a lifetime. It is also generally accepted that a more forward maxilla supports a larger and healthier nasopharyngeal airway. These appliances achieve dramatic forward and downward growth of the upper arch instead of just side-to-side growth as with other appliances. The appliances invoke a trauma response tapping into unrealized growth potential in the stem cells of various sutures in the jaws by pushing gently on bone and nerve mimicking a bone break and stimulating reparative growth/remodeling in all three dimensions.
Neuromuscular Orthodontics & Plastic Surgery WITHOUT Surgery
Once a TMJ is healthy and asymptomatic through positional appliance and various body-work therapies, we begin to remodel and/or grow the jaws to support a healthy airway. We align them in relation to a healthy and supportive TMJ, head, neck, spine, pelvis, and lower extremity posture. This involves a team of physiotherapists assembled by Dr. Throne in support of the best, longest-lasting outcomes for head to toe health and well-being. It is well known that as we age, the nose and chin actually enlarge in size, and facial asymmetries and growth discrepancies can become even more noticeable and dramatic. When the jaws are brought forward, they bring with them the surrounding soft tissues of the face, neck, and oral cavity, (tongue and pharynx). With these soft tissues being now properly supported and not sagging and collapsing, a patient will often look younger and healthier as wrinkles flatten out and the 2nd chin disappears over time with neuromuscular retraining and various body therapies.
Anterior Growth Guided Appliances (AGGA)
There are two types of anterior growth appliances:
Removable (RAGGA) – A removable anterior growth appliance is recommended for younger children with midface deficiencies, crowding, and small airways who do not yet have all their adult teeth. These appliances are worn all the time and work to expand the jaws in all directions. This has positive effects on breathing, alignment and spacing of the teeth, and on appearance. After the RAGGA has redirected bone growth and improved breathing and airway dimension verified by a sleep study and CBCT scan, specialized protraction orthodontic treatment is then utilized to straighten the now erupted adult teeth and close the spaces.
Fixed (FAGGA) – A fixed anterior growth appliance is recommended for older children, non-compliant younger children/parents, and adults who have crowding, breathing issues like snoring or sleep apnea, TMJ pain, neck pain, or are suffering with migraine headaches. Since these appliances work with total body dynamics, postural issues like hip and lower extremity joint pain and even scoliosis have improved after use of these appliances, sometimes in conjunction with oral tissue tether release. This appliance expands the upper jaw in three dimensions alleviating crowding, creating room for the tongue to sit up in the palate, enlarging the airway, and improving TMJ, migraine, and pain symptoms. It may also improve facial appearance of the eyes, nose, cheekbones, lower jaw, and throat (turkey throat). After adequate growth and remodeling are verified by a sleep study and CBCT scan, the teeth are straightened and spaces are closed using a special type of protraction orthodontics.
Controlled Arch System of Orthodontics
Dr. Throne utilizes the patented Controlled Arch System to reposition the teeth after a patient’s jaws have been moved to a physiologically balanced position. As described above, the jaw and airway are developed first followed by alignment of the upper and lower teeth using a protraction concept to maintain the healthy TMJ position and airway. Dr. Throne completed training with Dr. Steve Galella, the developer of the AGGA and Controlled Arch System, and uses his Facial Beauty Institute lab to oversee and make all of our appliances for every patient.
Other Functional Appliances
Habit Correctors: There are many types of habit correctors used with all sorts of goals in mind. Dr. Throne has been committed to learning and utilizing most all of them depending on the patient’s need. Many of these are age dependent and target different habits. Some even target and address multiple issues with only one appliance, so it is important to choose a dentist who has a full understanding of facial growth trends, orthodontic principles, soft tissue function, and support of a healthy airway.
ALF Appliance (Light Wire): This appliance is best utilized in younger children and takes advantage of light forces which manipulate skeletal growth occurring in earlier childhood. It consists of lightweight wire cribs that fit over the posterior teeth for stability and a wire with loops that can be enlarged over time to expand the arch moving teeth and bone. It benefits cranial support, proper tongue posture, a widened palate, an increased airway, better breathing and sleep, straighter teeth, and a better bite.
DNA Appliance: This appliance is a removable appliance that can be used in most all ages, but does require compliance in wear for it to work effectively. It attempts to gently expand the upper arch in three dimensions which increases the size of the nasal cavity in three dimensions. As the upper arch is widened, the lower jaw is able to move forward into a more natural position. It is worn 12-17 hours per day and is therefore removable. It corrects facial and jaw underdevelopment which can cause airway, TMJ, and orthodontic problems.
Dr. Throne is well-versed in the use of many of these functional appliances. After a full assessment of all the individual complex issues and after compiling a problem list, she presents options tailored specifically to each patient’s goals and challenges and chooses appliances best suited for optimal outcomes.
Adjunctive Therapies with Growth Appliances
Myofunctional Therapy: This therapy focuses on exercises designed to eliminate compensatory and abnormal tongue, lip, and cheek function. This also can involve swallow, tongue thrust, and speech difficulties so specially trained dental hygienists and speech pathologists are providing the therapy. At this time, this knowledge requires additional education and coursework on top of their regular degree plans and OMT certifications are attainable. Myofunctional therapy works to promote correction focused on the Goal of The Big Three: nasal breathing, lip seal, and tongue posture in contact with the palate front to back. Poor tongue function has been shown to be associated with midline shifts in the dentition. This component of therapy and treatment is critical in each and every orthotropic case to facilitate timely treatment and successful long term outcomes that hold and do not relapse.
Physiotherapy: It has been shown that posture, especially upper cervical alignment of the neck and head, effects mandibular positioning, craniofacial neurologic health, as well as TMJ function and pain issues. These treatments involve professionals like craniosacral therapists, chiropractors, osteopathic manipulative medicine physicians, physical therapists, myofascial massage therapists, pelvic floor therapists and lymphatic drainage massage therapists, and mental health specialists just to name a few. Dr. Throne has compiled a team of over 50 professionals across the North Texas area and panhandle to help assist with these therapies. She works specifically with physical therapists who have completed training at the renowned Postural Restoration Institute. Dr. Throne assesses posture and body alignment in all ages, infant to adult, and provides referrals for coordinated treatment for optimal outcomes that will last.
Is This Type of Appliance Right For Me?
You may be an ideal candidate for a functional growth appliance if you:
- Struggle with breathing and sleep difficulties
- Have asymmetrical facial structures
- Have TMJ pain or discomfort and/or ringing in the ears
- Have migraine headaches
- Have neck and back pain
- Have retruded facial structures and crowded teeth
- Have had premolar extractions and suffer from any of the above
An in-depth consultation to discuss your individual issues with Dr. Throne is the best place to begin your journey to a better and healthier pain-free version of you. If you have questions regarding any of the issues discussed above, please call Melanie L. Throne, DDS, PA at 817-735-4700 to schedule your time for an individual consultation.