MRC Myobrace Beginner Course 2014 Part 4

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 2 PM
Sunday, January 19, 14

6. Starting your first case
1.Introduce the concept
2.Case selection checklist
3.Materials check list
4.Health history forms
5.Patient flow check list
6.Fees
7.Ordering Myobrace appliances


Introduce the Concept
(Elevator Speech)
• Your Elevator Speech
•“I notice your child has…”
• “Did you know that we can… “
• “There is a way that we can help…”
•“If you would like us to do an assessment of his/her problem, we

can sit and talk about how it will beneﬁt him/her. Can we make an
appointment?”
• Myobrace “Soft Tissue Dysfunction” card laminated
• Toothberg laminated
• Myobrace brochure
• Rubber dentoform (www.kilgoreinternational.com, Item I21D-400G, $174.)


Myobrace STD Card


Case Selection Checklist
Good Cases to Start with:
Age: a compliant 6-10 year old
Chief Concern: Crooked teeth. Wants alternative to braces.
Medical History: Mild airway-related dysfunctions. Use caution
with a major medical and respiratory history or refer ﬁrst.
Body Form: Avoid extreme postural deformity, eg. scoliosis
Body Function:
Facial Form: Indicator line less than 10mm excess
Facial Function: (That’s why you’re here!)
Intraoral Form: Avoid extreme crowding or overjet
Intraoral Function: Frenectomy? MFT back up.

Patient List
Name


Age

Date of Exam

Result

Informed Consent
• Informed Consent
• Myobrace is a good ﬁrst step
• May need further treatment
• Myofunctional therapy
• ENT/Allergy/Pulmonology
• Orthodontics
• Give options
• Have a back up plan...


Backup Plans
1. BE PATIENT - This is not a quick ﬁx. The body needs
time to readjust. Watch for positive signs. Keep dialogue
with patient and parent.
2. Find a Myofunctional Therapist. Just like school, some
kids need private tutoring.
3. Find an Airway-conscious Orthodontist. Or train one.
Or become one.
4. Be an airway-conscious Dentist. The more you identify
at the start, the more treatment options you’ll have.


Myobrace Materials
• Cheek retractors
• Camera with macro
• Hand mirror
• Ruler or Boley gauge
• Forms
• C&B or trimming scissors
• Lisko-S Polishing Disc (www.glidewelldirect.com)
• Myobrace inventory
• Optional:
•BWS supplies
•Biobloc supplies

Patient Flow Checklist
Introduce parent to concept
Appointment for assessment
Assessment
Consultation
Delivery of Myobrace and instructions
Comfort call (1week)
Comfort check appointment (2 weeks)
Myobrace check; review activities
Issue second Myobrace, take progress pictures
Issue third Myobrace; take progress records
Final records, plan observation, retention, further treatment

Fees
• Screening Exam
•Diagnostic Records
•Consultation
•Treatment Fees
• Age-related
• Appliance Fee
• Monthly Fee
• Additional Monthly after year 1
• Set Target Date


7. Course Review and Q&A
1.What I told you
2.Questions. Maybe some answers.
3.Your cases


8 Lessons
I’ve Learned
Subtitled:

“Plasticity is the capacity of the brain
to change with learning”


Lesson #1:
There is Nothing New
Under the Sun


A Not-so-brief History
of
Myofunctional
Orthodontics


A History of Myofunctional Orthodontics
George Edward
Catlin H. Angle

Westin
Price

J. Sim
Wallace

Andresen
and Haupl

Norman
Kingsley

1890


1900

1910

1920

Bimler,
Balters,
Frankel

1930

1940

1950

Melvin
Moss

1960

Chris Farrell,
John Flutter
Roger Price

Egil
Harvold

Tom
Graber

Alfred P.
Rogers

Julius
Wolff

1880

Daniel
Garliner
Charlie
Tweed

Allan G.
Brodie

1970

Robert
Little

John
Mew

Donald
Enlow

1980

1990

You

2000

2010

2020

George Catlin
• Lawyer, artist, amateur anthropologist
•Documented native populations in North and
South America

• The health of native tribes deteriorated after
introduction to modern ways
•Whisky and sugar

•1870
•“Shut Your Mouth and Save Your Life”

• Book recommended by Edward Angle in 1925


George Catlin

•The cause of modern man’s maladies is his lack of “a quiet and natural sleep”.
•Proper breathing regulates digestion and circulation to every part of the body.
•Improper breathing brings imbalance and disease.
•The nostrils are intended to measure and temper the air in support of proper
breathing.

George Catlin

On mouth breathing at night:
“That man knows not the pleasure of sleep; he rises in the
morning more fatigued than when he retired to rest - takes
pills and remedies through the day, and renews his disease
every night.”

Alfred P. Rogers

1873-1959


•Angle School, 1903
•taught at Harvard
•private practice in Boston
•past president of the AAO
•total-child approach and advocated
muscular exercises to improve neck,
head, and tongue posture and
encourage nasal breathing
•treated many so-called “skeletal
Class II” cases ONLY with exercise.

Alfred P. Rogers, 1918 to the A.S.O
Alfred P. Rogers, 1918 to the A.S.O

“Our teachers have recognized the
importance of muscular pressure in its
normal conduct as well as in its abnormal
conduct, but here we seem to have
stopped, assuming that with the correction
of the faulty osseous formation and cusp
relation, nature, somehow or other, would
establish the correct muscular tone and
muscular habits…”

Early works by Alfred P Rogers
“Exercises for the Development of the Muscles of the Face with
a View to Increasing Their Functional Activity. Dental Cosmos,
October, 1918.
“Muscle Training and Its Relation to Orthodontia.” Dental Items
of Interest, 1919, xli.
“Stimulating Arch Development by the Exercise of the MasseterTemporal Group of Muscles. International Journal of
Orthodontia, February, 1922, viii.
“Making Facial Muscles Our Allies in Treatment and Retention.”
Dental Cosmos, July, 1922.
“Coordinating Natural and Artiﬁcial Methods of Treatment. ”
International Journal of Orthodontia, February, 1924, x.
“ Simplifying Orthodontic Treatment. International Journal of
Orthodontia, June, 1926, xii.”

Tom Graber
AJO, 1963
“The Three M’s:
Muscles, Malformation, and Malocclusion
The Two Groups of Disciples:
Edward Angle: Edgewise Expansionists
Calvin Case: Extractionists
1917-2007


This tooth-focused battle rages on
even today.....
Must take muscles into account...

Tom Graber
•…they ignored “the balancing effect of

contiguous muscle on the role of growth and
development”

•“…muscle plays a dominant role, affecting our
manipulations whether we like it or not”.

•“controlling abnormal perio-oral muscle
1917-2007

function” crucial in treatment

•Homeostasis, postural rest position, the effect
of function on the teeth and bones.

Walter Straub
Daniel Garliner
Bernie Fogel
Walter J. Straub, orthodontist: Included speech therapists as the
best people to do myofuncitonal therpy for orthodontic
patients.
Daniel Garliner: created training and routine for MFT for
orthodontic patients
Bernie Fogel: First East Coast private practice of “Tongue
Thrust Therapy” in 1960

John Flutter
•Combines
•Posture
•Breathing
•Tongue
•Orthopedics/Orthotropics
•Tooth Movement

www.orthodonticearlytreatment.com

A History of Myofunctional Orthodontics
Edward
H. Angle

Andresen
and Haupl

Norman
Kingsley

1890


Tom
Graber

Alfred P.
Rogers

Julius
Wolff

1880

Daniel
Garliner

Westin
Price

J. Sim
Wallace

1900

1910

1920

Bimler,
Balters,
Frankel

1930

1940

Chris
Farrell,
John
Flutter

1950

Melvin
Moss

1960

1970

John
Mew
Donald
Enlow

1980

1990

You

2000

2010

2020

Published Studies:
Keywords: “Muscle” and “Orthodontics”
N=110

Meta-analyses or Theories

Clinical Trials

The Future
of
Myofunctional
Orthodontics
Subtitle:You Are Not Alone


Robert Corruccini
•Anthropologist
•Southern Illinois U
• Studies epidemiology of malocclusion
•Native populations all over the Earth

•Malocclusion a Modern Disease


Kevin Boyd
• Darwinian Dentistry
• Nutritionist, Pedodontist,

anthropologist
•Indiana U. Northwest
•The genetics of our mouths (and
bodies) were developed in a very
different world than the one we live
in now

We are leading our genetic potential astray

James Garry
Pedodontist
•airway affects the normal
formation of the jaws and face
•Breast feeding critical
•Wrote:
•The Role of Dentistry in Sleep
Apea
•Upper Airway Compromise
• Influences on Oro Facial
Development
•www.tmdataresources.com

Breast feeding, airway, and posture are critical factors

Brian Palmer
• Straight teeth begins at birth
•Importance of Breast Feeding
• Short Frena limit suckling and
proper tongue posture
• www.brianpalmerdds.com

•International Affiliation of
Tongue-tie Professionals
• www.tongue-tied.net

Tight frena limit breast feeding

David Page
•Wrote: Your

Jaws, Your Life
•Relates dental health, jaw
development and airway

•www.smilepage.com

Airway is a critical component for development

Gavin James and Dennis
Strokon
Cranial Strains and Malocclusion

•Strains on the cranial sutures

create rotations of the bones during
growth
• The maxilla is at the endpoint of
these rotations

Cranial and postural factors affect growth

Barbara Greene, Sandra Coulson
and Joy Moeller

•Oral Myology
•Certifying organization
•Exclusive for professionals
Oral postural and muscular issues affect growth

AAGO
American Association of Gnathologic Orthopedics

•Based on the work of
•George Crozat and
•Albert Weibrecht
• Arch development in harmony

with natural growth and muscles
•Light wire removable
appliances

Light intermittent forces can affect skeletal growth

Esther Gokhale
• “8 steps to a Pain Free Back”
•Poor posture is a cultural drift
away from our natural design

•“In the 1920’s, people began to

thrust their pelvises and necks
forward and hunch or round their
shoulders. It became fashionable
to slouch”

• Egwellness.com

Poor posture and back pain is another industrial disease

Robert Walker

•Chirodontics
• Merges
•Chiropractic
•Cranial mechanics
•TMJ mechanics
•Dental Orthopedics
•Nutrition
•exceptionaldentalcourses.com/

The chiropractor can help with postural issues

Darick Nordstrom
•ALF: Alternative wire functional
• Works with Sacro Occipital

Technique team
•Postural balance of whole body
affects jaw growth and alignment

Light intermittent force affects skeletal growth, too

G. David Singh
• Epigentic Orthodontics
• The “DNA Appliance”

•Genetics is important in
the way genes react to
stimuli

"Malocclusion is one solution for the complex adaptive
orofacial system to be in equilibrium."

Allen J. Moses
•Dentist in Sears Tower
• Childhood Sleep Apnea
• Reduce obstructions
• Reduce collapsability of airway
• Behavior re-education
• Reduce intermittent hypoxia
• www.kidsapnea.com
Cause-directed treatment, not Consequence-directed tx

Konstantin Buteyko (1923-2003)
• The Buteyko Breathing Method

•Russian Physiologist
• Worked with Asthmatics
• Mouth breathing LOWERS Carbon dioxide
blood levels too far. Oxygen not processed
properly.
•Reduced breathing relieves symptoms
•Variations
•Patrick McKeown
•Roger Price

•Artour Rakhimov

Hyperventilation affects everything

Dr. Steven Park
• ENT specializing in Sleep Medicine
• Wrote “Sleep Interrupted”
•Hosts weekly webcasts
•www.doctorstevenpark.com

Treating airway is critical

Michael Gelb
• This is not your father’s TMD
•TMD is a product of airway
distress

TMD is an airway issue

Jeff Rouse
•Prosthodontist
•Bruxism is relief for airway
problems.
•Treat biology ﬁrst, then do
mechanics

Bruxism and occlusal wear are airway issues

Jeffery Hindin
•Heart-rate Variability
• Proportional to health
• an indicator of inﬂammation,
• Signiﬁcance related to sleep
apnea, TMD and growth

“What we do to the mouth affects the rest of the body”


Etsuko Kondo
•Japanese RO
•Recognizes the importance of

muscle function in occlusion
•Nasal respiration is the key to
treatment and stability
The Three Goals of MFO
1) Create Adequate Tongue Space
2) Eliminate tongue habits
3) nasal respiration with lip closure


Bill Hang
• American BioBlock
•RO
• Focuses on Face, Jaws and

airway
•IAFGG : International
Association of Facial Growth
Guidance with John Mew

You must advance the maxilla AND the mandible

Ali Attaie
• Pedodontist
• Dept Chair Mt. Sinai Medical,

Pedodontics
• Developing ﬁrst MFO
curriculum in post-grad school
• Developing innovative teaching
methods for MFO

There is a future for MFO in the U. S.

Lesson #2:
Keep an Open Mind
“The mind is like a
parachute:
it’s best when it’s open”
- Frank Bogdan quoting...

Take half of 8 and you have...

4

Different Solutions
-Different Ways of
Looking at the Same
Thing


Lesson #3
Don’t be a Barker


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

Lesson #4:
The Missing Link...
It’s not just
Growth and Development
It’s
Growth, Development and
Adaptation

Regarding Adaptation:
The Maxilla is the key.


Lesson #5:
The Context Changes
If the Etiology is centered in the
muscles, then the treatment is, too.
Muscle-Centric
Vs.
Tooth-Centric

Lesson #5:
The Context Changes

Tooth-Centric Tx Goals
1.
2.
3.
4.
5.
6.
7.

Level and Align the Teeth
Correct the Bite
Match the Jaw Size or Position
Improve the Profile
Refer for Tongue Thrust Therapy
Relieve Joint Dysfunction
Permanent Retention


Lesson #5:
The Context Changes

Muscle-Centric Tx Goals
1.
2.
3.
4.
5.
6.
7.
8.

Breathing through the nose
Lips together at rest
Correct tongue position
No mentalis activity on swallowing
Optimal facial development
Class I occlusion
Straight teeth
No retainers required


Lesson #6:
Dentistry is Medicine
•The separation is political (for good

reason) but may be coming to an end
•The dentist as oral physician
•Broaden your view.....


Dentistry is Medicine
Big-Picture Issues
related to
(Mal)Occlusion

•Early Feeding, Nutrition and muscular development
•Tight Frena and Early Nutrition
•Posture, musculo-skeletal-cranial stress and facial growth
•Breathing, Airway and Apnea
•Soft Tissue Dysfunctions, Habits and malocclusion

Orthodontics in the
21st Century
Esthetic
Orthodontics

Airway
Orthodontics

Genetic
Tooth-Focused
Dental: Perfection
Esthetics Primary
Treating Symptoms
Airway Ignorant

Adaptation
Muscle-Focused
Medical: Better
Esthetics Secondary
Treating Causes
Airway Conscious


Lesson #7:

It’s NOT about the Trainer


It’s not about the
Trainer…
It’s about the Training


Lesson #7A:
It’s not about YOU
•11/5/10 Feedback from my office manager on MRC
“You’ve been getting a little tough on kids. I hear you losing your temper especially
with the MRC kids. I know you’re passionate about this technique, but it’s not sitting
well with the kids or their mothers especially.
You said “You have to wear it because it’s going to make you more beautiful and the
mother said but she’s already beautiful””

Problem > Cooperation is a major factor in the success of the case.
Solution > Encourage cooperation in a positive, upbeat way without offending the
kids or Mom’s.
It’s good to set expectations for cooperation from the beginning.
Have ways of evaluating cooperation without the judgementalness.


Lesson #8:
I have a mission
Our care of children is not complete until
we, as dentists, gain a broader view of
facial growth and help them achieve not
only straight teeth, but also beautiful faces,
which they have a right to enjoy.


Lesson #6:
I have a mission
“Our guardianship of little children is not complete
until we, as orthodontists, gain a broad conception
Our scope of our science, and minister until
of thecare of children is not completeto the
we, as dentists, gain a broader view of
young under our care until their faces represent
not only the ideal from the them achieve not
facial growth and help standpoint of the
function of mastication, butalso beautiful faces,
only straight teeth, but also the ideal of
perfection in contour and strength which it is their
which they have a right to enjoy.
right to enjoy.”

Alfred P. Rogers, 1918.

Lesson #1:
There is Nothing New
Under the Sun
“Our guardianship of little children is not complete
until we, as orthodontists, gain a broad conception
of the scope of our science, and minister to the
young under our care until their faces represent
not only the ideal from the standpoint of the
function of mastication, but also the ideal of
perfection in contour and strength which it is their
right to enjoy.”

Alfred P. Rogers, 1918.

8. What comes next?
1. Our Contest: First to assess 10 cases…
1. Patient List (gender, age)
2.Diagnosis and treatment recommended (in brief)
3.Picture of patient with Myobrace on
4. Prize: Mystery gift sent to your practice.
2.Learn about more about Myobrace and other modalities
3.Wire-bending primer
4.Online study club (ask Barry)
5.Myobrace advanced course
1.Bending and using BWS
2.Using removable expanders
3.Case presentations and discussion
4.Building systems that motivate
5.Improving your facility
6.Becoming an MRC Provider

GETTING STARTED STEPS
Basic clinic layout

1
SPACE
2
LAYOUT
3
STAFF TRAINING
4
IMPLEMENTATION
5
PATIENT SELECTION
6
PATIENT FEES
The system is easy to implement but requires good planning
and well deﬁned goals to succeed.
EDUCATION, MOTIVATION and COMPLIANCE
leads to SUCCESS

MYOBRACE CERTIFIED PROVIDER PROGRAM


What is the Myobrace Certiﬁed
Provider Program?
An exclusive network of Dentists or
Orthodontists who provide
myofunctional orthodontic treatment
using Myobrace®.
A provider can be certiﬁed at varying
levels - Bronze, Silver, Gold and
Platinum.


What to do next?
Step 1. Request an information pack from a Myofunctional Research Co. (MRC)
representative. The information pack will outline the eligibility, levels, inclusions
and terms of the certiﬁcation.
Step 2. Complete the application form and return to your MRC representative.
Step 3. Your application will be processed and you will then be contacted by MRC
in regards to the next steps you need to take to become a Myobrace Certiﬁed
Provider.
Contact MRC today for
access to these materials,
and for further training.
Visit
www.myoresearch.com
for more information.


MRC MEGA CLINICS COOMERA


MRC USA
MRC USA office
Southern
CALIFORNIA

Next Seminar Dates


More ways to get involved...
MFO in Education
Research
Study Clubs
The TriState Myofunctional
Study Club
TMFSC@googlegroups.com

MFO in Education
Picture of mt sinai


MFO in Education
•
•

The Mouth as part of the body

•

Soft Tissue Dysfunction deﬁned

•

STDys: Lingual Frenum

•

Examination and Diagnosis

•

Prevention and treatment in the Primary Dentition

•

Planas Direct Tracks

•

Lab: making Planas Tracks (2 hours)
The Importance of Nasal Breathing
Lightwire Expansion

•

Myofunctional Treatment: Trainer

•

Myofunctional Treatment: Clinical management

•

•

•

Lectures
Labs
Guests

The Etiology of Malocclusion

•

•
•
•

History of Myofunctional orthodontics

•

Mt. Sinai
Curriculum

Introduction to Preventive Orthodontics

Myofunctional Treatment: Exercises

More ways to get involved...

American Academy of Physiological Medicine and Dentistry g
or
Michael Gelb and Howard Hindin
D.

PM
A

.A
“...allowing for a healthy dialogue to take place between w
w orthodontists, ENTs,
physicians, dentists, physical therapists, and oromyologists. The focus of
//w
p: Performance, and
tt
the study club is the airway with impact on Potential,
h
Protection in children and adults.

the raphael center for
integrative education
www.learnairwayortho.com

Coming in 2014...
•Myobrace Advanced Course: BWS and Biobloc
•LTS (Less than 6years or 6 perm teeth) with Kevin Boyd
•Airway Dentistry Mini-residency with Mark Cruz
•Myofunctional Therapy Level 2 with Sandra Coulson
•Ortho-Postural Training for Trainers with Roger Price
•Airway Orthodontics with Barry Raphael

Join the Evolution!
www.myoresearch.com
www.slideshare.net/drbarry
drbarry.rcie@gmail.com

MRC Myobrace Beginner Course 2014 Part 4

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MRC Myobrace Beginner Course 2014 Part 4