MRC Myobrace Beginner Course 2014 Part 2

The Myobrace System
-A hammer for a houseSat-Sun, January 18-19, 2014
dr. barry raphael
the raphael center for integrative education
www.alignmine.com
drbarry@alignmine.com

Day 1 PM
Sunday, January 19, 14

Dinner Tonight?
$20 per person
To talk about whatever…


The Goals of Airway-centric
Myofunctional Orthodontics
1.
2.
3.
4.
5.
6.
7.
8.


Breathing through the nose
Lips together at rest
Correct tongue position
No facial muscles moving on swallowing
Optimal facial development
Class I occlusion
Straight teeth
Better Stability long term

Airway-focused Orthodontics
1.Airway-focused Diagnostics
2.Prevention
3.Undo the Damage
4. Establish Good Habits
5.Interdisciplinary Treatment


2. Prevention
3.Undo the Damage already done
Look for the source of the imbalance.
Look for the causes, not just the symptoms.

Lesson #3
Don’t be a Barker


So what’s this?


It’s a Forest


Can you see it now?


Must be a forest....


Let’s try a different approach


What’s this?


A Person!


A Tree Stump


The Tree


Trees...


Here’s the forest!


Lesson #3:
Don’t be a Barker
Step back from the teeth
Start by looking at the person
and work your way in.

Level 1: Screening
Chief Concern
Medical History
Body Form
Body Function
Facial Form
Facial Function
Intraoral Form
Intraoral Function


Level 1: Screening
Chief Concern Any Airway-related Craniofacial Dysfunction ARCD
Medical History Sleep: Snoring, Chronic tiredness,
Breathing: Loud breathing, URTI, allergy, asthma

Body Form
Body Function

Forward Head posture, Frontal asymmetry
Chest Breathing, BPM>14

Indicator Line excess,Venous pooling
Facial Form
Facial Function Open Mouth Posture, MFE movement on swallowing,
Gothic Arch with crowding, Swollen tonsils
Intraoral Form
Intraoral Function Limited tongue lift


Level 2: Exam
Chief Concern
Medical History
Age and Dental Age

URT

Asthma
Swollen T &/or A

Sleep:
Snoring
Restless
Tiredness
Hyperactivity
Hx sleep study

Body Form
Frontal Posture
Level of ears, eyes,
shoulders, hips
Ankle Pronation
Lateral Posture

Forward head
Winged scapula
Locked knees
Forward knuckles
Plumb line
Slouching

Body Function
Gait
Breathing mechanics
Breathing rate

Intraoral Function
Facial Form
Tongue: extension, frenum
Cranial
Tongue: resting posture
Symmetry
Tongue: thrust
Midface proﬁle
Mandibular proﬁle
Intraoral Form
Lips and indicator
Tongue:
U lip/L lip
Scalloping
Indicator line
Frenum
Incisal show
Arch Form
Posture at rest
Gothic (V-shaped)
Lip competence
Molar width <35
Lip shape
Deep Curve of Spee, bilevel
Chapping
Occlusion
Mentalis
Excess overbite
Facial Function
Openbite
MM palpation
Overjet
Joint function
Crossbite
Nasal patency
Wear faceting
Eyes
Angle Class
Venus pooling
Dental Alignment.
Scleral show
Crowding
Malar tangent
Impaction
Oral rest posture
Missing or extra
Swallow and articulation
Tooth size discrepancy
Facial muscle movement
Mentalis contraction
Cheeks
These are items to look for in
Head bob
addition to your normal dental exam

Level 2: Exam
Chief Concern
Medical History
Body Form
Body Function
Facial Form
Facial Function
Intraoral Function
Intraoral Form


Why are you here?
What have you seen in your child?
What do you know already?
What does your child want?
What do you want for your child?
How did you hear about us?
_____________________

Level 2: Exam
Chief Concern
Medical History
Body Form
Body Function
Facial Form
Facial Function
Intraoral Function
Intraoral Form


Age and Dental Age
URT
Asthma
Swollen T &/or A
Sleep:
Snoring
Restless
Tiredness or hyperactivity
HX Sleep Study
_____________________

Level 2: Exam
Chief Concern
Medical History
Body Form
Body Function
Facial Form
Facial Function
Intraoral Function
Intraoral Form


Frontal Posture
Level of ears, eyes,
shoulders, hips
Ankle Pro-, Supination
Lateral Posture
Forward Head
Winged Scapula
Locked Knees
Forward Knuckles
Plumb line
Slouching

Level 2: Exam
Chief Concern
Medical History
Body Form
Body Function
Facial Form
Facial Function
Intraoral Function
Intraoral Form


Body Function
Gait
Breathing mechanics
Breathing rate

Level 2: Exam
Chief Concern
Medical History
Body Form
Body Function
Facial Form
Facial Function
Intraoral Function
Intraoral Form


Facial Form
Cranial
Symmetry
Midface proﬁle
Mandibular proﬁle
Lips and indicator
U lip/L lip
Indicator line
Incisal show
Posture at rest
Lip competence
Lip shape
Chapping
Mentalis

Level 2: Exam
Chief Concern
Medical History
Body Form
Body Function
Facial Form
Facial Function
Intraoral Function
Intraoral Form


Facial Function
MM palpation
Joint function
Nasal patency
Eyes
Venus pooling
Scleral show
Malar tangent

Level 2: Exam
Chief Concern
Medical History
Body Form
Body Function
Facial Form
Facial Function
Intraoral Function
Intraoral Form


Intraoral Function
Tongue: extension, frenum
Tongue: resting posture
Tongue: thrust

Level 2: Exam
Chief Concern
Medical History
Body Form
Body Function
Facial Form
Facial Function
Intraoral Function
Intraoral Form


Intraoral Form
Tongue:
Scalloping
Frenum
Arch Form
Gothic (V-shaped)
Molar width <35
Deep Curve of Spee, bilevel
Occlusion
Excess overbite
Openbite
Overjet
Crossbite
Wear faceting
Angle Class
Dental Alignment.
Crowding
Impaction
Missing or extra
Tooth size discrepancy

Level 3 Exam: Complete Health History
(see notebook)


History Taking
• Medical/Myofunctional History
• Sleep Scale
• Home Observation
• Systems Review Worksheet


Home Observation
•Private Eye
sheet

Dr. Raphaelʼs Parentʼs Private-Eye Home Sheet
There are many things about your childʼs
health that are important to know, but that I
often donʼt get to see at the ofﬁce. Also, there
are signs to look for that you may not have
known were connected to your childʼs teeth or
health. By looking for and tracking these
“signs and symptoms”, we can get a better
handle on the problem and watch for
resolution.
You donʼt have to spend a lot of time with this.
Just watch for certain things at different times
of day. Try not to let your child know they are
being watched. You want to see the most
natural behaviors.
Check off what you see. If youʼre not sure,
check it anyway. Make comments if you want.

While sitting around (watching TV, in the
car), does your child:
put “things” in the mouth alot (toys,
sleeves, pencils, ﬁngernails, etc.)
______________________________
lick or suck on the lips
have the lips apart, even a little
stick or dart the tongue out of the
mouth
have the tongue resting between the
teeth
lean the cheek on a hand
breath with his mouth open, even a little
bit
make noises when breathing
have trouble sitting still

During a meal, does your child:
gasp for air while eating
stick his tongue between his teeth
when swallowing
stick the tongue out to meet the
drinking glass
drink alot while eating
make noises when chewing
eat sloppily
take a breath before drinking
puff the cheeks out when drinking
make the lips purse when swallowing
make the chin “crinkle” when
swallowing
bob the head when swallowing

While sleeping, does your child:
have the mouth open
snore
wet the bed
toss and turn
tilt the head back
wake up frequently
have frequent nightmares
have abnormal sleep issues
grind the teeth
have trouble waking up
wake with darker circles under eyes

While talking, does your child:
talk very fast
talk very slowly
gasp for air
have a lisp
take speech lessons

Raphael PES v1.1 2011


Home Observation

Dr. Raphaelʼs Parentʼs Private

•Private Eye
sheet

resolution.
natural behaviors.


During a

gasp
stick
whe
stick
drink
drink
mak
eat s
take
puff
mak
mak
swal
bob
have

While sle


Home Observation
•Private Eye
sheet

______________________________
mouth
teeth
bit

talk very fast
talk very slowly
gasp for air
have a lisp
take speech lessons

While s

ha
sn
we
tos
tilt
wa
ha
ha
gri
ha
wa

Home Observation

aelʼs Parentʼs Private-Eye Home Sheet

your childʼs
now, but that I
ofﬁce. Also, there
may not have Eye
Private
ur childʼs teeth or
sheet
acking these
an get a better
watch for

•

t of time with this.
at different times
ld know they are
see the most

uʼre not sure,
ments if you want.

when swallowing
drinking glass
eat sloppily
swallowing

ents if you want.

Home Observation

ching TV, in the

h alot (toys,
nails, etc.)
____________

•Private Eye

n a little
sheet
out of the

between the

nd
pen, even a little

athing

ild:



have the mouth open
snore
wet the bed
toss and turn
tilt the head back
wake up frequently
grind the teeth

Home Observation
•Private Eye
sheet

•Medical Hx
on backside

Dr. Raphaelʼs Parentʼs Private-Eye Home Sheet
resolution.
natural behaviors.

______________________________
mouth
teeth
bit

when swallowing
drinking glass
eat sloppily
swallowing

have the mouth open
snore
wet the bed
toss and turn
tilt the head back
wake up frequently
grind the teeth

talk very fast
talk very slowly
gasp for air
have a lisp
take speech lessons

Raphael PES v1.1 2011


Myofunctional History
STD Examination
Medical History Eating AgeEruption Early N Late Chewing Difficult Sloppy Digestive N Problems Food Allergies _______________ BreastFed _________ mos Paciﬁer to age _____ SippyCup
Habits Finger Thumb OralFixation Paciﬁer Nail Other___________
Airway recurrent ear infections Y recurrent sinus infections Y T&A Y Rx’d
Sleeping mouth posture open closed Snoring Y Apnea Dx’d
Allergies to____________________________ Tested? Y M.D. _________________________
Meds ____________________________
Symptoms Nasal Skin Breathing Family Hx
Asthma Y Dx’d M.D._________________________ Meds___________________
Precautions __________________________________________________________
Family Hx_____________________________________________________________
When things are "normal" do you have trouble breathing? Y N
Triggers _____________________ Last Episode date ______________________ Outcome _________
Intensity Mild Mod Severe Frequency Intermittent Persistent
Physical Exam: Height _______ Weight _________
Posture: Feet
Spinal curvature

Hips level R L High

Shoulders Level R L High

Head balance Forward Neutral Behind

Facial Shape Brachy Meso Dolico Ears N In Out Eyes Wide N Narrow RHigh LHigh Pooling
Nose Hump Crease Nares Flare Maxilla Full Flat OrbitalShow To bridge ______mm
Lower 1/3 Long N Short Lips At Rest Open Partial Closed LipsClosed Relaxed Tight Mentalis
Vermillion larger U Equal L Entrapment L Protrusion U L Interlabial Line Center Up Flat Down
Upper lip Short N Mand Retro N Prog Smile Display Incisor Gummy Narrow Corridors Cant


Sleep Scale
Pediatric Sleep Questionnaire: Sleep-Disordered Breathing Subscale
Licensed to: the raphael center for integrative orthodontics
070129

•© Regents of the
University of Michigan
2006
Score = #Y / (# Y + #N).
>.33 = significant

Child’s Name: ______________________________
Person completing form: _____________________

Study ID #: ___________
Date:
____/____/____

Please answer these questions regarding the behavior of your child during sleep and wakefulness. The
questions apply to how your child acts in general during the past month, not necessarily during the past few
days since these may not have been typical if your child has not been well. You should circle the correct
response or print your answers neatly in the space provided. A “Y” means “yes,” “N” means “no,” and
“DK” means “don’t know.”
WHILE SLEEPING, DOES YOUR CHILD:
Snore more than half the time?………………………………………...…. ……..Y
Always snore?
………………………………………………………………..Y
Snore loudly?
…………………………………………………………………Y
Have “heavy” or loud breathing? …………………………………….…………..Y
Have trouble breathing, or struggle to breathe? …………………….……………Y

N
N
N
N
N

DK
DK
DK
DK
DK

A3
A4
A5
A6

HAVE YOU EVER SEEN YOUR CHILD STOP BREATHING DURING
THE NIGHT? ……………………………………………………………………….Y

N

DK

A7

3. DOES YOUR CHILD:
Tend to breathe through the mouth during the day?…………………………….Y
Have a dry mouth on waking up in the morning? …..………………...Y
Occasionally wet the bed? ……………………………………………...Y

N
N
N

DK
DK
DK

A24
A25
A32

4. DOES YOUR CHILD:
Wake up feeling unrefreshed in the morning? ………………………………….Y
Have a problem with sleepiness during the day? ………………….……….…...Y

N
N

DK
DK

B1
B2

HAS A TEACHER OR OTHER SUPERVISOR COMMENTED THAT YOUR
CHILD APPEARS SLEEPY DURING THE DAY? …………………………….…Y

N

DK

B4

IS IT HARD TO WAKE YOUR CHILD UP IN THE MORNING? …………….…Y

N

DK

B6

7. DOES YOUR CHILD WAKE UP WITH HEADACHES IN THE MORNING?…..Y

N

1.

2.

5.
6.

A2

DK

B7

DID YOUR CHILD STOP GROWING AT A NORMAL RATE AT
ANY TIME SINCE BIRTH? …………………………………………………….….Y

N

DK

B9

9. IS YOUR CHILD OVERWEIGHT? ………………………………………………...Y

N

DK

B22

10. THIS CHILD OFTEN:
Does not seem to listen when spoken to directly. ……………………………....Y
Has difficulty organizing tasks and activities. …………………….…………...Y
Is easily distracted by extraneous stimuli. ………………………….…………...Y
Fidgets with hands or feet or squirms in seat. ……………………………….....Y
Is “on the go” or often acts as if “driven by a motor”. …………………………Y
Interrupts or intrudes on others (eg., butts into conversations or games). ………Y

N
N
N
N
N
N

DK
DK
DK
DK
DK
DK

C3
C5

8.

C8
C10
C14
C18

Thank you!
© Regents of the University of Michigan 2006
Score = #Y / (# Y + #N). >.33 = significant


Pediatric Sleep Questionnaire: Sleep-Disordered Breathing Subscale
Licensed to: the raphael center for integrative orthodontics
070129

Child’s Name: ______________________________
Person completing form: _____________________

Study ID #: ___________
Date:
____/____/____

Please answer these questions regarding the behavior of your child during sleep and wakefulness. The
questions apply to how your child acts in general during the past month, not necessarily during the past few
days since these may not have been typical if your child has not been well. You should circle the correct
response or print your answers neatly in the space provided. A “Y” means “yes,” “N” means “no,” and
“DK” means “don’t know.”
WHILE SLEEPING, DOES YOUR CHILD:
Snore more than half the time?………………………………………...…. ……..Y
Always snore?
………………………………………………………………..Y
Snore loudly?
…………………………………………………………………Y
Have “heavy” or loud breathing? …………………………………….…………..Y
Have trouble breathing, or struggle to breathe? …………………….……………Y

N
N
N
N
N

DK
DK
DK
DK
DK

A5
A6

HAVE YOU EVER SEEN YOUR CHILD STOP BREATHING DURING
THE NIGHT? ……………………………………………………………………….Y

N

DK

A7

3. DOES YOUR CHILD:
Tend to breathe through the mouth during the day?…………………………….Y
Have a dry mouth on waking up in the morning? …..………………...Y
Occasionally wet the bed? ……………………………………………...Y

N
N
N

DK
DK
DK

A24
A25
A32

4. DOES YOUR CHILD:
Wake up feeling unrefreshed in the morning? ………………………………….Y
Have a problem with sleepiness during the day? ………………….……….…...Y

N
N

DK
DK

B1
B2

1.

2.


A2
A3
A4

MFO Treatment Worksheet

Priority Issue: What I am Action for
looking
Trainer


Referral

MFO Treatment Worksheet


Clinical Exam*
Rough Order of Examination
•Body
•Breathing
•Head
•Face
•Mouth
•Teeth

*To be added to your
normal routine

Lateral Posture
Plumb Line Through...
1.Ext Aud Meatus
2.Shoulder
3.Hip (greater trochanter
4.Knee
5.Ankle

Forward Head Posture

Posture Analysis


Nasopharyngeal Obstruction
From
Kent Lauson
“Straight Talk about Crooked Teeth”


Nasopharyngeal Obstruction and its effects
Enlarged Tonsils
& Adenoids

Deviated Nasal
Septum

Nasal Constriction

Cysts, Polyps &
Tumors

Enlarged Turbinates

Allergic Rhinitis

NASOPHARYNGEAL OBSTRUCTION
Blockage of Eustachian Tubes

Accumulation of
Inﬂamed and
pathogens in
enlarged turbinates
Eustachian Tubes & nasal passages

Otitis media
(middle ear
infection)

Frequent colds &
sore throats,
respiratory
infections

Hearing Loss

Disease
Behavior
disorders
Reduced
energy
Reduced
mental
capacity
ADD
ADHD
SIDS

Mouth Breathing

Lowered Tongue Posture

Gingivitis, chapped
lips, bad breath,
dry mouth,
high decay rate

Hypertrophied
palatal tissues (no
tongue pressure)

Constricted nasal cavity
Lack of space for tongue

Airway Obstruction: dorsum of
tongue against oropharyngeal
wall or soft paltate

Obstructive
Sleep Apnea
Lowered O2
Intake

Snoring

Sleep Cycle
Dysfunction

Pulmonary
Hypertension

Daytime
Drowsiness

Cardiac
Hypertension

Reduced
Quality of Life

Mandible with lowered and retruded posture

Bucco-lingual
maxillary muscle
imbalance

Constricted and
underdeveloped maxilla

Constricted
nasal cavity

High V-shaped
palate

Mouth
breathing
increased

Lowered
tongue
posture

Poor self
image
Anti-social
behavior

Poor
Nutrition
Susceptibility
to disease

Bruxism

Craniomandibular
dysfunction

TMJ Dysfunction
TMJ condyle and
disc displacement
TMJ degeneration
and osteoarthritis


Anterior
open bite

Poor lip
seal

Neuro-muscular
dysfuntion

Neck muscle
strain

Gummy
smile

Loss of lordotic
curve of cervical
spine

Speech problems,
lisps, hyponasality

Malocclusion,
crowding, overbite,
crossbite, loss of
vertical dimension

Difﬁculty
eating

Excess vertical
development

Tongue Thrust

Constricted, retruded and
underdeveloped mandible

Poor facial
appearance

Forward head and shoulder posture

Malocclusion, open
bite, long face
syndrome,
prognathism
May result in lack
of skeletal muscle
strength and
coordination

Myofascial pain
dysfunction syndrome
Headaches, neck aches, ear pain,
ringing/fullness, hearing loss, visual
problems, limited or painful opening
of jaw, neurologic disorders such as
Parkinson’s, Tourette’s syndrome

Neck aches,
headaches

Checking Breathing
•Breathing
• Rate
• 10-14
• 15-20
• >22
• Movements
• Chest
• Diaphragm
• Sounds

This can be done by the
assistant , while the patient
isn’t watching

looking for chronic hyperventilation

looking for chronic hyperventilation

Facial Measurement Routine
1.Indicator line
2.Upper lip
3.Lower lip to chin
4.Competence at rest
5.Incisal show
6.Strain on lip closure


Indicator Line


Maxillary Height
• Indicator Line (Mew)
• Distance from most anterior point on nose to upper
incisal edge
• Age + 23
• A variable number, but important to watch over time.


From the tip of the Central...


...To the Forwardmost Tip of the Nose

41mm


Indicator Line
12 yo male
Ideal IL = 35mm

Watch during
growth for
>1mm increase /
year

35mm Watch during
42mm
treatment for
increase or
decrease

Take another look...
`


Indicator Line

Incisor falls faster than the nose
with vertical growth
and retractive/extrusive mechanics


1.Indicator Line
2.Upper lip
3.Lower Lip to chin
5.Incisal show
7.Maximum Opening
8.Tongue-to-Spot Opening

Norm =18-20mm

1.Indicator Line
2.Upper lip
3.Lower Lip to chin
5.Incisal show
7.Maximum Opening

Double Upper Lip

1.Indicator Line
2.Upper lip
3.Lower Lip to chin
5.Incisal show
7.Maximum Opening

1.Indicator Line
2.Upper lip
3.Lower Lip to chin
5.Incisal show


1.Indicator Line
2.Upper lip
3.Lower Lip to chin
5.Incisal show
7.Lip Condition


Soft Tissue Evaluation and
Diagnosis

Occlusion - CI CII CIII - normal overbite/Overjet open bite deep
bite.


Soft Tissue Evaluation and
Diagnosis
Tongue position - normal lowered between teeth.


What is wrong with these children?

Only correct diagnosis can lead to
correct treatment

Videos courtesy of Dr. John Flutter


Swallowing Styles...


What do you see?

12 things

• Open mouth posture
• Long lower third
• Eye shadows
• Allergic crease
• Anterior Tongue Thrust
• Anterior Open Bite
• Lisp
• Takes breath before

swallow
• Throws head back to
swallow
•Left ear high and rotated
out
• Dull eyes

Also look for:
T&A
Allergies
Lingual Frenum
Pronated Feet and Rotated Pelvis
Hypocapnia

What do you see?

10 things

• Shoulder Breathing
• Open mouth posture
• Facial muscles active on
swallow (woodpecker)
• Head dip on swallow
• Stuffy Nose
• Gothic Arch
• Breathing Before
drinking
• Anterior Tongue Thrust
•Right ear high


Also look for:
Frenum
Bruxism
T&A
Hypocapnia

What do you see?

11 things

• Open Mouth Posture
• Blows cheeks
• Lip activity on swallow
• Cheek activity
• Hypermentalis
• Anterior tongue thrust
• Larger lower lip
• Muscular deﬁnition

below lower lip border
• Temporal bone rotation
• Bigger, higher right eye
• Tiny nostrils


Also look for:
Frenum
T&A
Tongue between teeth on swallow

What do you see?

7 things

• Lips active on swallow
• Open Mouth Posture
• Mentalis action on
swallow
• Contraction of
Buccinator on swallow
• Lip Entrapment
• Left Ear rotation
• Muscular deﬁnition
around lips


Also look for:
Forward Head Posture
Scalloping on Tongue

What do you see?

6 things

• Blows out cheeks
• Hypermentalis
• Tight lip muscles on

swallow
• Lateral mandibular shift
• Bimaxillary Retrusion
• Concave proﬁle

Also look for:
Tongue between teeth
Class II div 2
Tongue Scalloping

What do you see?

10 things

• Lateral head tilt
• Temporal rotation
• Long lower 1/3
• Asymmetrical upper lip
movement
• Mentalis
• Eye shadows
• Midface deﬁciency
• Blows cheeks
• Lower lip eversion
• Small oral aperture


Also look for:
Tongue Scalloping
High Vault
Frenum
T&A

Face: Joints


Intraoral Measurement Routine
1.Maximum opening
2.Tongue-to-spot opening
3.Molar width
4.Palatal vault
1. Shape
2.Color
5.Malampati
6.Uvula
7.Tonsil grading

1.Maximum Opening
2.Tongue To Spot Opening
3.Molar Width
4.Palatal Vault
1. Shape
2.Color
5.Malampati
6.Uvula
7.Tonsil Grading

1.Maximum Opening
3.Molar Width
4.Palatal Vault
1. Shape
2.Color
5.Malampati
6.Uvula
7.Tonsil Grading

50% of Max Opening

Start “Clucks”, to Caves

From Paula Fabbie, COM

1.Maximum Opening
3.Molar Width
4.Palatal Vault
1. Shape
2.Color
5.Malampati
6.Uvula
7.Tonsil Grading

Modern Average: 35mm
Paleo Average:

50mm

1.Maximum Opening
3.Molar Width
4.Palatal Vault
1. Shape
2.Color
5.Malampati
6.Uvula
7.Tonsil Grading

Palatal Cyanosis
Proper contact of the tongue on the palate and the negative
pressure causes proper oxygenation of the palatal tissue.
Lack of pressure of the tongue and the positive air pressure inhibits
oxygenation and the palate will look cyanotic - yellowish/blueish in
a caucasian.

Functional Exams
• Lip tone testing
• Capnometry
• Sleep screening
• Videography and reading the face


2
CO

•Blood Gas
•Capnometer
•Pulse oximeter


Monitoring

Sleep Screening


Cardio-Pulmonary Coupling
Dr. Robert Thomas
Electrocortical Modulation
Heart Rate Variability

Respiratory rate

High Freq Coupling
Low Freq Coupling
Very Low Freq Coupling

Sleep Quality Index
Stable Sleep

Unstable Sleep

SQI = HFC:LFC

SleepImage M1 monitor
• Monitor
•Carry Case
• Software (PC)
• Reports
• Scheduling
• Help
• Cable
• Batteries supplied
• Patches supplied
• PhD reads reports
$185/month

www.sleepimage.com

Imaging
• Photography
• Videography
• Cephalometrics
• 3D Imaging


Tomorrow...
2.Prevention
Our ultimate goal is to keep children from getting sick.
By knowing the causes, we can prevent the disease.


Tomorrow...

2. Prevention
As much as possible, reverse the condition
TOWARD the genetically programmed ideal.

2. Prevention
Retraining Proper Oral-Rest Posture, Oral Function,
and other good health habits for a lifetime of stability


Arch Development in
conjunction with the
TRAINER System™

Recommended Age Group:
5-12 yrs


Trainer
Influence of Pre-Orthodontic Trainer
treatment on the perioral and
masticatory muscles in patients with
Class II division 1 malocclusion
1.

Tancan Uysal*,**, Ahmet Yagci*, Sadik Kara*** and Sukru Okkesim***

European Journal of Orthodontics ,2011, Volume 34, Issue 1 Pp. 96-101

“...POT appliance showed a positive
inﬂuence on the masticatory and
perioral musculature.”

3. The Myobrace System
1.History and Purpose
2.Types and uses
3.Clinical Protocols
4.Patient Education and Motivation
5.Follow-ups and Trouble shooting


Dr Chris Farrell
Dr Chris Farrell

BDS SYDNEY UNIVERSITY, AUSTRALIA
• Dr. Farrell graduated from Sydney University in 1971.
• Since that time he has been a clinician in private practice in
Australia and England.

• Was not comfortable with the excessive extraction of teeth
required by the orthodontists at the time.

• Received much education from Dr. John Mew (UK) and Dr. Harold
Gelb USA. Greatly inﬂuenced by Garliner, Prof. Hinz and Prof.
Frankel - All of whom were looking beyond the teeth and onto
faces, muscles and posture.

• Observation and extensive study of research over the years
showed that extraction of teeth did not resolve orthodontic
crowding and craniofacial discrepancies.

• He realised that newer techniques had to be developed to treat
these many patients more effectively.

• Now practices treating children and adults for Orthodontics and
TMJ exclusively.

• Dr. Farrell holds three worldwide patents for new dental

appliances and is developing other innovations in his practice in
Queensland, Australia, speciﬁc to the early treatment of
orthodontic problems in children and TMJ disorder in adults.


Dr Chris Farrell
BDS SYDNEY UNIVERSITY,

Dr Farrell produces the Ortho
TRAINER

The Ortho Trainer

World First use of 3D solid
modeling and stereo-lithography
on intra-oral appliance

MRC HEAD OFFICE AUSTRALIA


MRC MEGA CLINICS COOMERA
VISITING ORTHODONTISTS FROM JAPAN AND RUSSIA


MRC EUROPE
MRC EUROPE office
Waalwijk, NETHERLANDS


MRC USA
MRC USA office
Southern
CALIFORNIA


MRC USA


DR FARRELL presents 2012 LECTURE to
MYOFUNCTIONAL ORTHODONTICS
ORTHODONTISTS AND DENTISTS IN JAPAN


MRC CLINICS TRAINING CENTER
AUSTRALIA


MRC CLINICS ROBINA and SYDNEY

2.5 x 3.4

4.6 x 3.4
1.2 x 2.8

3.8 x 2.8
3.2 x 3.8
3.5 x 4.3

1.9
10.17
3.2 x 3.8
2.3

3.5 x 5.0

1.2
2.5 x 2.9

2.6

2.95 x 2.9

2.95 x 2.8

3.0 x 1.7
2.95 x 2.8

3.5 x 4

2.3 x 2.3
3.2 x 1.8

DESIGNED and CONSTRUCTED by MRC

MRC CLINICS ROBINA and SYDNEY

DESIGNED and CONSTRUCTED by MRC

the new approach to the diagnosis, treatment and clinical management of
malocclusion

Vanee Ganesaratnam
BOralH (Griffith Univ)
Oral Health Therapist
Orafacial Myologist

Dr Chris Farrell BDS Sydney

Dr Rohan Wijey
BOralH, Grad Dip Dent
(Griffith)

MRC CLINICS®

PRACTICE MANAGEMENT SYSTEM

MYOFUNCTIONAL RESEARCH CO
Goal over the last 20 years
“Improve the facial and dental
development of the growing child by
treatment and prevention of mouth
breathing and detrimental
myofunctional habits.”
Our goal is to have healthier children for
life.

PRIMARY DENTITION


MIXED DENTITION

DEVELOPING PERMANENT
DENTITION

PERMANENT
DENTITION

STAGE 1

HABIT CORRECTION

4-6 MONTHS

STAGE 2

ARCH EXPANSION

4-6 MONTHS

STAGE 3
FINAL ALIGNMENT
& RETENTION

4-6 MONTHS

THE MYOBRACE SYSTEM™
Myobrace® appliance group generally
consists of three appliances covering
three stages of treatment.
MIXED DENTITION - Kids SERIES
STAGE 1

HABIT CORRECTION

STAGE 2

ARCH EXPANSION

STAGE 3
FINAL ALIGNMENT
& RETENTION

Nasal Breathing
Lips Together
Tongue on the palate
4-6 MONTHS

4-6 MONTHS

4-6 MONTHS

MYOBRACE FOR

™
KIDS

- K1

Made of ﬂexible silicone to adapt
to any arch-form and poorlyaligned teeth.Its ﬂexible nature
means that it offers improved
retention for night-time use.

Breathing holes assist the
transition to correct nasal
breathing.

Extended lip bumper discourages
strong, overactive lip muscles.


MYOBRACE FOR

™
KIDS

- K2

Features Dynamicore™ with a
Frankel Cage which assists in
developing the arch-form and
improving the dental alignment.

Tongue tag, guard and elevators
train the tongue to position
properly.



MYOBRACE FOR

™
KIDS

- K3

Firm polyurethane construction
provides excellent tooth alignment
and retention.

Hollow tongue tag; tongue guard
and elevators train the tongue to
sit in ﬁnal correct position and
prevent thumb sucking.



STAGE 1

HABIT CORRECTION


STAGE 2

ARCH EXPANSION

STAGE 3
FINAL ALIGNMENT
& RETENTION

MYOBRACE FOR INTERCEPTIVE CLASS

™
III

- I3N

Flexible silicone adapts to any
arch-form and poorly-aligned
teeth. Its ﬂexible nature also
means that it offers improved
retention for night-time use.

properly.

Small breathing holes and dual
arch-form prevent mouth
breathing (a common problem in
Class III patients).



™
III

- I-3

Features Dynamicore™ with a
Frankel Cage which assists in
developing the arch-form and
improving the dental alignment.

properly.



I-3H

™
III

-

and retention.




®
MYOBRACE


INTERCEPTIVE CLASS III

Shields the soft tissue from
brackets.
Recommended Age Group:
12 - 15+ yrs
Most effective during the early
stages of permanent dentition
Improves stability
Speeds up orthodontic treatment


MYOFUNCTIONAL TREATMENT OF MALOCCLUSION

BRACES SERIES


STAGE 1

STAGE 2

HABIT CORRECTION

ARCH EXPANSION

4-6 MONTHS

4-6 MONTHS


STAGE 3

DENTAL ALIGNMENT

4-6 MONTHS

STAGE 4

RETENTION

4-6 MONTHS

®
MYOBRACE


FOR TEENS

MYOBRACE FOR

™
TEENS

- T3

Features Dynamicore™ to assist in
developing the arch-form which
provides more space for the
erupting dentition.

The tooth slots separate and
align the anterior teeth.

properly.


®
MYOBRACE


FOR LATE MIXED DENTITION

STAGE 1

HABIT CORRECTION

4-6 MONTHS


STAGE 2

ARCH EXPANSION

4-6 MONTHS

STAGE 3
FINAL ALIGNMENT
& RETENTION

4-6 MONTHS

MYOBRACE FOR

™
ADULTS

- A1

Soft and ﬂexible material adapts
to a wide range of arch-forms and
poorly aligned teeth.The soft
material allows for better
retention and comfort in the initial
stages of treatment.

Breathing holes assist the
transition to correct nasal
breathing.

Extended lip bumper trains the
lower lip.


MYOBRACE FOR

™
ADULTS

- A2

Medium-hardness polyurethane
provides arch development and
puts small force on the teeth for
improved dental alignment.

properly.



MYOBRACE FOR

™
ADULTS

- A3

and retention.




®
MYOBRACE


FOR ADULTS


the new approach to the diagnosis, treatment and clinical management of
malocclusion
WHAT IS MRC
CLINICAL
APPLICATION

PATIENT
EDUCATION

THE PROBLEM

HOW TO
START

THE CAUSES OF
MALOCCLUSION

RESEARCH
WHY IT WORKS


CURRENT
ORTHODONTIC
S

MYOFUNCTION
AL
ORTHODONTIC
S

MRC CLINICS CASE FILE

No 1
Permanent dentition
Blocked out Canine


Patient Name: MYOBRACE K1/BWS - K2 - K3 DOB 20.08.92
RHYS WADE - COOPER 21/04/2010
30 August 2005


21/04/2010
30 August 2005

RHYS WADE - COOPER 21/042010
30 August 2005


21/04/2010
30 August 2005

30 August 2005


26/10/10
30 August 2005

30 August 2005


28/09/2011
30 August 2005

MRC CLINICS CASE FILE

No 2
Mixed Dentition
Anterior Openbite


T4K - MYOBRACE K1
Patient Name: RHYS WADE - COOPER - DOB 20.08.92
10/11/2008
30 August 2005


10/11/2008
30 August 2005

T4K - MYOBRACE K1
12/07/10
30 August 2005


12/07/10
30 August 2005

T4K - MYOBRACE K1
10/11/2008
30 August 2005


12/07/10
30 August 2005

Pee Break


Read the Package...


2.1) Protocols: Trainers
1) Appliance Delivery
2) Comfort check
3) Routine visits
4) Post treatment maintenance


2.1.1) Protocols: Trainers: Appliance Delivery

1.The Try-on
2.“The Four Things”
1. Bite Down
2. Lips together
3. Breath through your nose
4. Tongue on Tag
3. “The Two Things”
1. Lips together
2. Tongue on Tag



1.The Try-on
2.The Two Things
3.Wearing Schedule

1.1hr/day plus sleeping
1.No “Two Things” while Sleeping
2.OK to Ramp up

5 min

10 min

20 min

30 min

5 min

10 min

20 min

30 min

5 min

10 min

20 min

5 min

10 min

5 min

60min

60+sleep


1.The Try-on
2.The Two Things
3.Wearing Schedule

1.1hr/day plus sleeping
1.No “Two Things” while Sleeping
2.OK to Ramp up
3.Choose activities and make calendar
4.OK to Split time
Sun

Activity 1
Activity 2

TV

Mon

Tue

Homework Homework

Wed
Ride to
Soccer

Gaming Reading Gaming Reading

Thu
Homework

Fri

Sat

TV

Movie

Laundary


1. The Try-on
2. The Four Things
3. Wearing Schedule
4. Score Card



1.The Try-on
2.The Four Things
3.Wearing Schedule
4.Score Card
5.Warnings

1.Don’t chew
2.Don’t let Dog chew
3.Fee to replace

$85-200


1. The Try-on
2. “The Four Things”
3. Wearing Schedule
4. Score Card
5. Warnings
6. Send them home


Follow-up Visits
• Activity Center
– Child observed in group setting wearing the trainer

• Exercise Review
– Therapist reviews and assigns exercises
– www.Trainerkids.com

• Wire Expander and Trainer Adjustment
– Seen by me at every visit

• Progress Records
– Photos, etc.


Length of Treatment
• Depends on Growth
• Depends on Cooperation
• Usually, 12 (to 24 months)
• Then monitor growth
• Re-evaluate for Further Treatment
–Braces???


What’s the benefit?
(especially if braces are needed anyway?)
•
•
•
•
•
•
•
•
•
•
•

Preventative rather than corrective
Addresses the cause of the problem
Better stability
Less extractions
Less stress on the jaw joints
Better looking facial appearance
Easier on the roots of the teeth
Less time in braces
Teeth are easier to clean
Myobrace stays at home
Better health through better breathing, posture,
nutrition, etc
• Reduced cost (if braces not needed)

What are the drawbacks?
• Child and family must be motivated
• For “perfection”, braces may be needed.


What’s the cost
• Depends on Age
• About 1/3-1/2 of braces
• Includes everything up until baby teeth
are lost
–Except lost or broken appliances

• My Guarantee


My Little-to-lose Proposition
• Not the right treatment? : 90 % credit
• Still need braces : 50% credit


3. The Myobrace System
1.History and Purpose
2.Types and Uses
3.Clinical Protocols
4.Patient Education and Motivation
5.Follow-ups and Trouble shooting


Trainers: Comfort Check
2. How is your daytime wear?
Great! Here’s my card
Too Busy
Education
Not Linking to other activities
Excuses
Encouragement,
• I was sick
Offer alternatives
• I told her she didn’t have to wear it.
• We had a family blah blah
• Sad Puppy Eyes
(Bite your tongue)
• Can’t Breathe, Gagging
•
•
•
•

Sun

Act
ivit
Act
y1
ivit
y2

Mo
n

TV

Rea
ding

Ga
min
g

Tue

Ho
me
wor
Ga
min
k
g

We
d
Rid
e to
Rea
Soc
ding
cer

Thu

Fri

Sat

Ho
me
wor
k

Spo
nge
bob
Lau
nda
ry

Mo
vie

Airway training


3. Nighttime wear
• Normally takes time

• Can’t fall asleep
• Falls Out At Night (FOAN)

Taping

Delay starting
15 Min before sleep,
Airway training

Check Daytime wear,
Airway training

Micro-pore, Paper Medical Tape



4. Motivation
• Attitude check
• Looking for results
• Encourage Patience
• Talk about alternatives



4. Motivation : The bicycle speech

7 out of 7



4. Motivation : The bicycle speech

5 out of 7


So, how does it feel? Is it comfortable?
1.Buccal gingiva, especially around erupting teeth
2.Retromolar pads
3.Incisive papilla
4. Doesn’t ﬁt over BWS
5.Unexplained apthous ulcers
6.Allergic Reactions
7.Unexpected results

2.1.2) Protocols: Trainers: Comfort Check

Comfort check
Buccal Gingiva blanching

1. Comfort: Common irritations
Buccal gingival, especially around erupting teeth
Retromolar pads
Incisive papilla
Unexplained apthous ulcers



Comfort check
Buccal gingival, especially around erupting teeth
Retromolar pads
Incisive papilla
Unexplained apthous ulcers



Comfort check


Retromolar Pads


Incisive Papilla


Doesn’t Fit over BWS


Apthous Ulcers

•Not related to contact with trainer
• Use oral ointment
• Restart use when sores gone
• Ramp up

time


Allergic Reactions

3 Days
of wear


Allergic Reactions


Allergic Reactions

Next: T4K Hard

Unexpected Results


Tomorrow...
2. Prevention
5. Interdisciplinary Treatment
Only by working together will we get to the root of
the problem.

MRC Myobrace Beginner Course 2014 Part 2

Recommandé

Recommandé

Contenu connexe

Tendances

Tendances (20)

En vedette

En vedette (18)

Similaire à MRC Myobrace Beginner Course 2014 Part 2

Similaire à MRC Myobrace Beginner Course 2014 Part 2 (20)

Plus de The Raphael Center for Integrative Education

Plus de The Raphael Center for Integrative Education (20)

Dernier

Dernier (20)

MRC Myobrace Beginner Course 2014 Part 2