MRC Myobrace Beginner Course 2014 Part 4

transcript

The Myobrace System-A hammer for a house-

Sat-Sun, January 18-19, 2014

dr. barry raphaelthe raphael center for integrative education

www.alignmine.comdrbarry@alignmine.com

Day 2 PMSunday, January 19, 14

6. Starting your first case

1.Introduce the concept2.Case selection checklist3.Materials check list4.Health history forms5.Patient flow check list6.Fees7.Ordering Myobrace appliances

Sunday, January 19, 14

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 oldChief 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. scoliosisBody Function:

Facial Form: Indicator line less than 10mm excessFacial Function: (That’s why you’re here!)

Intraoral Form: Avoid extreme crowding or overjetIntraoral 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 Myobrace check; review activities Issue second Myobrace, take progress pictures Myobrace check; review activities Myobrace check; review activities Issue third Myobrace; take progress records Myobrace check; review activities Myobrace check; review activities Final records, plan observation, retention, further treatment

• 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 you2.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 Historyof

Myofunctional Orthodontics

Egil Harvold

A History of Myofunctional Orthodontics

George Catlin

1880 1890 1900 1910 1920 1930 1940 1950 1960 1970 1980 1990 2000 2010 2020

Norman Kingsley

Julius Wolff

J. Sim Wallace

Edward H. Angle

Andresen and Haupl

Alfred P. Rogers

Chris Farrell, John FlutterRoger Price

Allan G. Brodie

Westin Price

Bimler, Balters, Frankel

Tom Graber

Melvin Moss

Donald Enlow

Charlie Tweed

Daniel Garliner

Robert Little

John Mew

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

•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.

1873-1959

“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…”

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

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 Masseter-Temporal 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

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

1917-2007

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 function” crucial in treatment

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

1917-2007

Walter StraubDaniel Garliner

Bernie FogelWalter 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

1880 1890 1900 1910 1920 1930 1940 1950 1960 1970 1980 1990 2000 2010 2020

Norman Kingsley

Julius Wolff

J. Sim Wallace

Edward H. Angle

Andresen and Haupl

Alfred P. Rogers

Westin Price

Bimler, Balters, Frankel

Tom Graber

Melvin Moss

Daniel Garliner

Donald Enlow

John Mew

Chris Farrell, John

Flutter

Published Studies: Keywords: “Muscle” and “Orthodontics”

Meta-analyses or Theories Clinical TrialsSunday, January 19, 14

The Futureof

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

• 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

Kevin Boyd

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

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

•www.smilepage.com

David Page

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

AAGOAmerican 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

• “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

Esther Gokhale

Poor posture and back pain is another industrial disease

•Chirodontics• Merges

•Chiropractic•Cranial mechanics•TMJ mechanics•Dental Orthopedics•Nutrition

•exceptionaldentalcourses.com/

Robert Walker

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...

Different Solutions

Take half of 8 and you have...

Different Ways of Looking at the Same

Lesson #3Don’t be a Barker

Lesson #3:Don’t be a Barker

Step back from the teeth

Start by looking at the personand work your way in.

Lesson #4:The Missing Link...

It’s not justGrowth and Development

It’sGrowth, Development and

AdaptationSunday, January 19, 14

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-CentricVs.

Tooth-Centric

1. Level and Align the Teeth2. Correct the Bite3. Match the Jaw Size or Position4. Improve the Profile5. Refer for Tongue Thrust Therapy6. Relieve Joint Dysfunction7. Permanent Retention

Tooth-Centric Tx Goals

1. Breathing through the nose2. Lips together at rest3. Correct tongue position4. No mentalis activity on swallowing5. Optimal facial development6. Class I occlusion7. Straight teeth8. No retainers required

Muscle-Centric Tx Goals

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

•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

Big-Picture Issuesrelated to

(Mal)Occlusion

Orthodontics in the 21st Century

EstheticOrthodontics

AirwayOrthodontics

GeneticTooth-Focused

Dental: PerfectionEsthetics Primary

Treating SymptomsAirway Ignorant

AdaptationMuscle-FocusedMedical: Better

Esthetics SecondaryTreating Causes

Airway ConsciousSunday, January 19, 14

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.

“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.”

Lesson #6:I have a mission

Alfred P. Rogers, 1918. Sunday, January 19, 14

Lesson #1:There is Nothing New

Under the Sun

Alfred P. Rogers, 1918.

“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.”

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 on4. Prize: Mystery gift sent to your practice.

2.Learn about more about Myobrace and other modalities3.Wire-bending primer4.Online study club (ask Barry)5.Myobrace advanced course

1.Bending and using BWS2.Using removable expanders3.Case presentations and discussion4.Building systems that motivate5.Improving your facility6.Becoming an MRC Provider

GETTING STARTED STEPS

EDUCATION, MOTIVATION and COMPLIANCE leads to SUCCESS

1 SPACE 2 LAYOUT 3 STAFF TRAINING 4 IMPLEMENTATION 5 PATIENT SELECTION6 PATIENT FEES

Basic clinic layout

The system is easy to implement but requires good planning and well defined goals to succeed.

MYOBRACE CERTIFIED PROVIDER PROGRAM

What is the Myobrace CertifiedProvider 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 USAMRC USA officeSouthern CALIFORNIA

Next Seminar Dates

GETTING STARTED STEPS

EDUCATION, MOTIVATION and COMPLIANCE leads to SUCCESS

1 SPACE 2 LAYOUT 3 STAFF TRAINING 4 IMPLEMENTATION 5 PATIENT SELECTION6 PATIENT FEES

Basic clinic layout

The system is easy to implement but requires good planning and well defined goals to succeed.

What is the Myobrace CertifiedProvider 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.

More ways to get involved...

MFO in EducationResearch

Study Clubs

The TriState Myofunctional Study Club

TMFSC@googlegroups.com

Picture of mt sinai

MFO in Education

Mt. SinaiCurriculum

• Lectures• Labs• Guests

• Introduction to Preventive Orthodontics

• History of Myofunctional orthodontics

• The Etiology of Malocclusion

• 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

• Myofunctional Treatment: Exercises

MFO in Education

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

American Academy of Physiological Medicine and DentistryMichael Gelb and Howard Hindin

More ways to get involved...

http://w

ww.AAPMD.org

the raphael center for integrative education

www.learnairwayortho.com

•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

Coming in 2014...

Join the Evolution!

drbarry.rcie@gmail.com

www.myoresearch.com

www.slideshare.net/drbarry

MRC Myobrace Beginner Course 2014 Part 4

Health & Medicine