Orthodontic Treatment Sequence

by Clayton A. Chan, DDS

Medical Versus Orthodontic Treatment Models
In disease-oriented disciplines such as medicine and dentistry, the idea of treatment planning and eventual treatment is based on the identification of disease; based on the information/data gathered, the disease that is identified and treatment options and approaches considered.

In the craniofacial aberrations called orthodontic malocclusions, one is not really describing a disease; Most malocclusion are the result of skeletal and dental variations that become extreme enough to disturb the patient’s esthetic or functional balance. In these circumstances orthodontic treatment is warranted.

Narrow Upper Arch - Before Treatment

Wider Upper Arch - After Treatment

Narrow Lower Arch Before Treatment

Wider Lower Arch - After Treatment

Orthodontic Treatment Sequencing
Properly sequencing an orthodontic treatment is crucial if one desires a successful outcome. Diagnosis is the key! Without a complete understanding of how cranio-mandibular complex develops and the surrounding neuromuscular system functions and operates will result in a need to rely on mechanical retention methods to hold together aspects of treatment that were not thoroughly understood and or acknowledged by the dentist.

Historically, there has been a tendency for orthodontist to treat to means and standards, but one must ask where does one position the bite physiologically?

One must synthesize the information to ask the relevant questions:

• Why is there a Class II retrusive jaw - retrognathic?
• Why is there a Class III protruding jaw - prognathic?
• Why does my child or patient present with a right side Class II and the left side Class III relationship?
• Why is there a deep overbite?
• What produces the crowding or spacing?

Perhaps the positioning of the patient’s maxilla or mandible is too far forward or too far backward …. ? These are questions that are not always adequately addressed within the common orthodontic teachings.

NEUROMUSCULAR ORTHODONTIC-ORTHOPEDICS

GNEUROMUSCULAR ORTHODONTICS

by Clayton A. Chan, D.D.S.

Over the past 42 years, neuromuscular dentistry has been steadily building its aesthetic orthodontic-orthopedic foundations based on sound bio-physiologic principles. Three key corners stones on which we have been building our foundations of clinical science and treatment philosophy has been in the disciplines of occlusion, TMD and orthodontics, all grounded on bio-medical science and neuromuscular principles.

The lower removable orthotic is used as an "Orthopedic Matrix" to transition the bite.

Verticalization of the teeth, ligaments and underly bone occurs with slow gentle forces.

KEY ONE - A strong occlusal philosophy based on biometric principles has been the first key on which we have built our teachings. Neuromuscular occlusion has effectively been shown to bring to the clinical dentist and team a whole new paradigm of thinking and understanding of what occlusion is really about. The traditional concepts have been further enhanced to realize that the teeth and supporting bone are not stand alone components in our dental health care arena, but rather the joints and muscles are an integral aspect in diagnosing cranial-mandibular orthopedic problems that relate to the complete masticatory postural system.

KEY TWO - The second corner stone that has been developed in our student’s clinical knowledge and skill has been the understanding of the musculoskeletal occlusal signs and symptoms in which the Advanced Orthopedic Dentist has been founded. These foundational concepts have brought to our students an in depth look at the fundamentals to effective diagnosis and clinical treatment skills in identifying the musculoskeletally compromised patient as well as treating these more challenging cases in their dental practices orthopedically.

KEY THREE - The third corner stone to enhance the aesthetic/ neuromuscular concepts has been the development of a strong orthodontic/orthopedic curriculum espousing the neuromuscular occlusion principles and advanced neuromuscular instrumentation to measure and record the bio-physiologic responses of muscle activity and cranio-mandibular relationships. These foundational disciplines have been the core to the understanding and clinical experience for the high-end general dentist and orthodontic specialist who have been searching for clinical answers to further their clinical experience.

Understanding the importance of airway breathing, intra oral cavity development, aberrant tongue containment and positioning along with sound cranio-mandibular orthopedic verticalization techniques allows our clinicians to excell in facial development and optimal occlusal stability of the stomatognathic neuromuscular system.
A NEED FOR NEUROMUSCULAR ORTHOPEDIC TREATMENTBased on the prevalence of malocclusion in the general population, it is easy to recognize that there is a large unmet need for orthodontic treatment. There has been no real change in the prevalence of malocclusions over time, or the need for care. However, the demand for care has increased significantly. Narrow arches, airway breathing problems, compromised vertical dimensions of occlusion and under developed smile profiles are just some of the problems that must be addressed in meeting the overall Neuromuscular Goal – facial cosmetics, dental aesthetics, and musculoskeletally balanced occlusion is best met with a complete skill set of knowledge, understanding and abilities to treat orthopedically.
The lower anteriors are now verticalized to the neuromuscular position replacing the orthosis. The first molars are the remain teeth to be verticalized to the myocentric position.
TRAINING THE DENTIST TO DIAGNOSE ORTHOPEDICALLY
A greater awarness among cosmetic dentists are recognizing that cranial and mandibular bone's can be systematically moved to more optimal relationships. Teeth can be rotated, leveled and aligned to increase occlusal stability. Teeth and surrounding periodontium can be orthopedically grown with light consistent forces, non surgically to establish proper crown to root ratio's with proper techniques. If the general dentist is treating 20-40% of the orthodontics patients in the U.S., many of them do not have the adequate training and capability to effectively diagnose and treat to the level of care possible today. "Our mission is to train dentist in diagnosis and treatment planning based upon sound anatomical/orthopedic concepts with a neuromuscular approach." No case can be diagnosed without adequate records for complete diagnosis:

• Detailed medical and dental history – evaluating for any airway obstruction, allergies, tongue function.
• Radiographs – panoramic, lateral cephlograms, submental vertex, tomograms of TMJ, lateral cervical spine, and AP cephlograms.
• Complete neuromuscular K6/K7 work up, EMG, Sonography, a complete series of scans including a scan 4/5 bite registration.
• Cephlogram with bite registration.
• Mounted casts to the neuromuscular physiologic position.
• Photos or images in color – intra oral and facial.

Diagnosis and treatment planning are made from these records. A written treatment plan is made up after careful study of records, identifying each visit and the fee for services at each visit.

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