A series of lectures by Dr. Barry Raphael on Airway-focused orthodontics. Chapter 7 : Some ways of changing the Form side of the facial growth and adaptation equation.

1. Airway Orthodontics
A lecture series prepared by
Dr. Barry Raphael
Of the
Raphael Center for Integrative Orthodontics
Clifton, NJ.
www.alignmine.com
www.myobracenj.com
“Intervening Form” - 2013
1Thursday, June 6, 13

2. •Animations are not included in this archive and may
affect the meaning or intent of the slide
•As the information in these presentations is
constantly evolving, please consider the date of creation
when reviewing the material.
2Thursday, June 6, 13

3. Airway-focused Orthodontics
for the Orthodontist
May 31, 2013
Dr. Barry Raphael
drbarry@alignmine.com
www.alignmine.com
Part 3:The Solution
Intervening Form
3Thursday, June 6, 13

4. Intervening Form
• Expansion
• Biobloc
• Orthodontics/Orthopedics
4Thursday, June 6, 13

5. Expansion
5Thursday, June 6, 13

6. Arch Expansion
1.To increase arch length for crowded teeth
2.To increase Alveolar/Basal Width
3.To Open the Airway
4.To Release Cranial Sutural Strains
5.Relieve TMJ strain due to mandibular entrapment
6.Give Room for Mandibular Development
7.To give room in the palate for the Tongue
8. To Return the Maxilla to its genetic potential
6Thursday, June 6, 13

7. Increase Arch Length
Arch Development
Arch Length Increase
Rounding out the arch
7Thursday, June 6, 13

8. 8Thursday, June 6, 13

9. Increase Alveolar/Basal Width
9Thursday, June 6, 13

10. Open the Nasal Airway
Increase is flow rate exponential to diameter
10Thursday, June 6, 13

11. Relieve Cranial Strain
11Thursday, June 6, 13

12. Relieve Joint Entrapment
12Thursday, June 6, 13

13. Mandibular freedom to grow
13Thursday, June 6, 13

14. *Make Room for the Tongue
* The most important of all
14Thursday, June 6, 13

15. Restore Genetic
Potential
15Thursday, June 6, 13

16. Rapid Maxillary Expansion
Rapid Palatal Expansion
Sutural Spliting
1/4 to 1/2mm expansion / day
Least amount of dental movement
16Thursday, June 6, 13

17. Rapid Palatal Expanders
Hyrax
Haas
Bonded
17Thursday, June 6, 13

18. Semi-Rapid Expansion
1/8mm per day
Allows fill without splitting suture
18Thursday, June 6, 13

19. Acrylic Removables
(Semi-rapid or Slow)
Schwarz
Transverse
BioBloc
For Intermittent Force Application
19Thursday, June 6, 13

20. Nickel Titanium
NiTi Expander D-Max 2000
For Continuous Force Application
20Thursday, June 6, 13

21. Slow Expansion
1/4 to 1/2mm per week
Sutural Adaptation
Higher percentage of dental movement
21Thursday, June 6, 13

22. Wire-based Slow
W-Lingual
Quad Helix
Crozat
Frozat
22Thursday, June 6, 13

23. Tongue-Friendly Slow
ALF
Advanced Lightwire Functional
23Thursday, June 6, 13

24. Adapted Wire Ideal Wire
Farrel Bent Wire System
24Thursday, June 6, 13

25. Advanced Lightwire Functional
25Thursday, June 6, 13

26. Pix band on study
model
Banded first molars or 2nd Primary molars
With lingual tubes
26Thursday, June 6, 13

27. BWS in molar tube, elastic ligation
27Thursday, June 6, 13

28. Weldable Lingual Tube
TP 036 tube with hook
• Easier insertion of Bent
Wire than 025 tube
• Easier ligation with e-chain
28Thursday, June 6, 13

29. E-chain placed over
hook
29Thursday, June 6, 13

30. 30Thursday, June 6, 13

31. Retention Nibs with “Pop and Flow”
Retention Stops : Composite
31Thursday, June 6, 13

32. 2.2) Protocols: Light Wire Expanders
Retention Nibs with “Pop and Flow”
Pop
Flow
Retention Stops : Composite
32Thursday, June 6, 13

33. Retention Nibs with “Pop and Flow”
2.2) Protocols: Light Wire ExpandersRetention Stops : Composite
33Thursday, June 6, 13

34. 1.Undo kinks
2.Advance Loops
3.Expand ALF
4.Rotate Molars
BWS Adjustments
34Thursday, June 6, 13

35. Adjustments: Undo Kinks
35Thursday, June 6, 13

36. Adjustments: Undo Kinks
Undo Kinks
36Thursday, June 6, 13

37. Adjustments: Advance Loops
For Lost C-space
37Thursday, June 6, 13

38. Adjustments: Advance Loops
For Lost C-space
38Thursday, June 6, 13

39. Adjustments: Advance Loops
For Lost C-space
39Thursday, June 6, 13

40. Adjustments: Advance Loops
For Lost C-space
40Thursday, June 6, 13

41. Adjustments: Advance Loops
For Lost C-space
41Thursday, June 6, 13

42. 2.2) Protocols: Light Wire Expanders:Adjustments
Thin C-space loop
42Thursday, June 6, 13

43. 2.2) Protocols: Light Wire Expanders:Adjustments
Thin C-space loop
43Thursday, June 6, 13

44. Adjustments:ALF Midline Loop
44Thursday, June 6, 13

45. Adjustments:ALF Midline Loop
45Thursday, June 6, 13

46. Adjustments:ALF Midline Loop
46Thursday, June 6, 13

47. Adjustments:ALF Midline Loop
47Thursday, June 6, 13

48. 2.2) Protocols: Light Wire Expanders:Adjustments
Rotate Molars
48Thursday, June 6, 13

49. Biobloc
49Thursday, June 6, 13

50. Biobloc
John Mew
Mike Mew
Bill Hang
50Thursday, June 6, 13

51. Treatment Goals
51Thursday, June 6, 13

52. Biobloc Orthotropics
The appropriate treatment for a Collapsed Maxilla…
Moves the Maxilla up and forward…
AND the Mandible rotates and moves forward
52Thursday, June 6, 13

53. Biobloc Orthotropics
Phase I : Maxillary Development
Phase II : Mandibular Protrusion
Phase III : Normalize the Muscles
53Thursday, June 6, 13

54. B. Hockel 2012
Back
Phase I. Maxillary Development
1.Maxillary Expansion
2. Maxillary Advancement
3. Maxillary Impaction
54Thursday, June 6, 13

55. Hang Expancer
=”Expanding Advancer”
Advancing Wire
Molar
Intrusion
Springs
Hang Clasps
Semi-rapid screw
Half turn/day
55Thursday, June 6, 13

56. Hang Clasp
032 heat treated stainless wire
56Thursday, June 6, 13

57. Hang Clasp
57Thursday, June 6, 13

58. Measuring Progress
Gap Ruler Turn Back
58Thursday, June 6, 13

59. Hang Expanser
59Thursday, June 6, 13

60. Hang Retainer
60Thursday, June 6, 13

61. Phase II. BB3 - Postural Appliance
61Thursday, June 6, 13

62. Biobloc 3
62Thursday, June 6, 13

63. Phase III. - Normalize the Muscles
Oral Myology
63Thursday, June 6, 13

64. Principles of Biobloc
1.Treat Early (before deciduous molars lost)
2.Over-treat
3.Long Retention
4.Myotherapy to establish neutral posture
64Thursday, June 6, 13

65. B. Hockel 2012Back
Thanks to Dr. Brian Hockel
65Thursday, June 6, 13

66. B. Hockel 2012Back
66Thursday, June 6, 13

67. B. Hockel 2012
67Thursday, June 6, 13

68. B. Hockel 2012
Reduce
Indicator
Line
68Thursday, June 6, 13

69. B. Hockel 2012
Reduce
Indicator
Line
69Thursday, June 6, 13

70. B. Hockel 2012
Reduce
Indicator
Line
70Thursday, June 6, 13

71. B. Hockel 2012
Reduce
Indicator
Line
71Thursday, June 6, 13

72. B. Hockel 2012
Reduce
Indicator
Line
72Thursday, June 6, 13

73. B. Hockel 2012
Reduce
Indicator
Line
73Thursday, June 6, 13

74. B. Hockel 2012
Reduce
Indicator
Line
74Thursday, June 6, 13

75. B. Hockel 2012
Reduce
Indicator
Line
75Thursday, June 6, 13

76. B. Hockel 2012
76Thursday, June 6, 13

77. B. Hockel 2012
Level Lower
(Reduce Lower IL)
77Thursday, June 6, 13

78. B. Hockel 2012
Level Lower
(Reduce Lower IL)
78Thursday, June 6, 13

79. B. Hockel 2012
Level Lower
(Reduce Lower IL)
79Thursday, June 6, 13

80. B. Hockel 2012
Level Lower
(Reduce Lower IL)
80Thursday, June 6, 13

81. B. Hockel 2012
Level Lower
(Reduce Lower IL)
81Thursday, June 6, 13

82. B. Hockel 2012
Level Lower
(Reduce Lower IL)
82Thursday, June 6, 13

83. B. Hockel 2012
Level Lower
(Reduce Lower IL)
83Thursday, June 6, 13

84. B. Hockel 2012
84Thursday, June 6, 13

85. B. Hockel 2012
Intrude 6
85Thursday, June 6, 13

86. B. Hockel 2012
Intrude 6
86Thursday, June 6, 13

87. B. Hockel 2012
Intrude 6
87Thursday, June 6, 13

88. B. Hockel 2012
Intrude 6
88Thursday, June 6, 13

89. B. Hockel 2012
Intrude 6
89Thursday, June 6, 13

90. B. Hockel 2012
Intrude 6
90Thursday, June 6, 13

91. B. Hockel 2012
Intrude 6
91Thursday, June 6, 13

92. B. Hockel 2012
Intrude 6
92Thursday, June 6, 13

93. B. Hockel 2012
93Thursday, June 6, 13

94. B. Hockel 2012
94Thursday, June 6, 13

95. B. Hockel 2012
DE
Extraction
95Thursday, June 6, 13

96. B. Hockel 2012
Close /
Advance
Mandible
96Thursday, June 6, 13

97. B. Hockel 2012
Close /
Advance
Mandible
97Thursday, June 6, 13

98. B. Hockel 2012
Close /
Advance
Mandible
98Thursday, June 6, 13

99. B. Hockel 2012
Close /
Advance
Mandible
99Thursday, June 6, 13

100. B. Hockel 2012
Close /
Advance
Mandible
100Thursday, June 6, 13

101. B. Hockel 2012
Close /
Advance
Mandible
101Thursday, June 6, 13

102. B. Hockel 2012
Close /
Advance
Mandible
102Thursday, June 6, 13

103. B. Hockel 2012
Close /
Advance
Mandible
103Thursday, June 6, 13

104. B. Hockel 2012
Close /
Advance
Mandible
104Thursday, June 6, 13

105. B. Hockel 2012
Close /
Advance
Mandible
105Thursday, June 6, 13

106. B. Hockel 2012
Close /
Advance
Mandible
106Thursday, June 6, 13

107. B. Hockel 2012
107Thursday, June 6, 13

108. B. Hockel 2012
108Thursday, June 6, 13

109. B. Hockel 2012
109Thursday, June 6, 13

110. B. Hockel 2012
110Thursday, June 6, 13

111. B. Hockel 2012
111Thursday, June 6, 13

112. B. Hockel 2012
112Thursday, June 6, 13

113. B. Hockel 2012Back
113Thursday, June 6, 13

114. Dr. Darin Ward
114Thursday, June 6, 13

115. Dr. John Mew
```
115Thursday, June 6, 13

116. Dr. Bill Hang
Initial Expancer Biobloc
116Thursday, June 6, 13

117. Orthodontics and
Orthopedics
117Thursday, June 6, 13

118. Low Force:Low Friction
Mechanics
• “…benefits of minimizing friction and binding…”
• The “Functional Effect” - light wire in large slot allows
muscles to guide the movements
• “to match each phase of treatment with the natural
force systems of normal growth and development…”
• “…higher level of care is about "face-driven ortho…”
118Thursday, June 6, 13

119. Functional Orthodontics
Functional Orthodontics
Maximize the Benefits
Acknowledge the Limitations
119Thursday, June 6, 13

120. Facial Treatment Rubric
• Purpose:A conceptual framework for thinking
through airway-conscious treatment planning
•A way for explaining the choices available in treatment
120Thursday, June 6, 13

121. ThreeVariables
1. Age
2.Skeletal Dysplasia and need for profile improvement
3. Breathing Dysfunctions and need for rebalancing
121Thursday, June 6, 13

122. Regarding Facial Profile
Question to be asked of patients and parents:
Regarding your facial profile:
1.I don’t care if it gets worse with treatment
2.I like my profile as it is.
3.I’d like to improve my profile a little
4.I’d like to improve my profile a lot.
5.My profile must be perfect
122Thursday, June 6, 13

123. Regarding Sleep Breathing
1. I have no trouble breathing at night and neither does
anyone in my family
2.I sleep with my mouth open
3.I snore regularly
4.I have trouble sleeping peacefully. I sleep fitfully, wake
up, pee, nightmares, etc.
5.I’ve been told I (may) have SDB and recommended to
have a sleep study.
123Thursday, June 6, 13

124. Profile
Sleep
Non-issue Like A Little A lot Perfect
No
Trouble
Open
Mouth
Snoring
Disturbed
SDB
124Thursday, June 6, 13

125. Age 4-6
Profile
Sleep
Non-issue Like A Little A lot Perfect
No
Trouble
Wait Wait
Wait
Myobrace
Myobrace
Myobrace
Biobloc
Open
Mouth
Myobrace
Myobrace Myobrace
Myobrace
Biobloc
Biobloc
Snoring
Myobrace
T&A
Myobrace Myobrace Biobloc Biobloc
Disturbed
Myobrace
T&A
Myobrace
Myobrace
Biobloc
Biobloc Biobloc
SDB
Myobrace
T&A
Myobrace Biobloc Biobloc Biobloc
125Thursday, June 6, 13

126. Age 7-10
Profile
Sleep
Non-issue Like A Little A lot Perfect
No
Trouble
Wait
Extraction
Non-x
Braces
Functional
Braces
Functional
Biobloc
Biobloc
Open
Mouth
Myobrace Braces
Myobrace
Myobrace Biobloc Biobloc
Snoring
Myobrace
Myobrace
Myobrace
Biobloc
Biobloc Biobloc
Disturbed
Myobrace
Biobloc
Myobrace
Biobloc
Biobloc Biobloc Biobloc
Orthognathics
SDB
Biobloc
T&A
Biobloc Biobloc Biobloc
Orthognathics
Orthognathics
126Thursday, June 6, 13

127. Age 11-14
Profile
Sleep
Non-issue Like A Little A lot Perfect
No
Trouble
Wait
Extraction
Non-x
Braces
Non-x
Braces
Functional
Braces
Functional
Braces
Open
Mouth
Non-x
Braces
Non-x
Braces
Non-x
Braces
Functional
Braces
Braces
Orthognathics
Snoring
Non-x
Braces
Braces
Myobrace
Braces
Myobrace
Functional
Braces
Orthognathics
Disturbed
Braces
Myobrace
Myobrace
Biobloc
Myobrace
Biobloc
Biobloc Orthognathics
SDB Myobrace Biobloc Biobloc Biobloc
Orthognathics
Orthognathics
127Thursday, June 6, 13