Month: November 2020

Orthotropics 14. Age for treatment.

Precis. What age should parents be advised about the cause of malocclusion and should treatment be started before the growth spurts at seven or twelve? My father was told it should be five I was taught thirteen and my son was taught when the permanent teeth had erupted. Which is correct? Certainly parents deserve sound advice so they can seek treatment at the appropriate time.

Lecture 14, My father who was also an orthodontist told me that when he trained in 1921 he was told to consider orthodontic treatment from the age of four onwards. If at the age of five there was not room for “Half a Crown” (a UK coin about 2mm thick) between each upper incisor, then you should expand. Why have orthodontists changed so much since then?

  

His teacher at Guys hospital was Harold Chapman who was probably the best known orthodontist in the UK. In 1936 I became a patient of Chapman at the age of 8 when he expanded my narrow jaw. I must now be one of the last of his patients still alive. Out of interest I looked up some of his lectures and found that the ‘correct age of treatment’ was his special interest.

At one meeting in America he said “it seemed to me not inappropriate to promote a new discussion on the age for orthodontic treatment at such a representative gathering as this”.

“Translated into practical terms, the reason age is a predominant factor is that at one period early treatment may give good results, and at another, the late period, good results may be an impossibility; in the intermediate period treatment looked at from every point of view gradually degenerate from good to very poor as the age increases”. Not everyone would agree with him today but few could prove him wrong.

 

Certainly I find expansion under the age of six quite simple and usually children at this age are very compliant. The thing that is difficult is changing their posture. I am sure that it was this last factor that persuaded orthodontists in the 1930s to delay treatment to the start of Puberty. Because if they could not change oral posture their cases quickly relapsed during the deciduous changeover. Therefore it made sense to them to wait until the changeover was complete. However by this age Maxillary change was very difficult.

I don’t think I can give a better example than my own son Mike. At the age of five his deciduous incisors were slightly crowded which is a sign that there will be severe crowding in the future. At that time I had not developed the Indicator Line but I could see that his face was growing vertically. So I expanded him at the semi-rapid rate with a Stage 1 Biobloc appliance.

After four months there was plenty of space and you can see the un-erupted central incisors had moved apart showing the central suture had widened. He subsequently had Stage 3 and 4 appliances which gave him an entirely different facial form compared to his father.

 

I should add that his mother’s maxilla was narrower than mine. I would recommend that either the Clinician or Parent measures the Indicator line around the age of three or four. If it is increased then efforts should be made to improve mouth posture and possibly commence treatment by five. Failure to do this can have severe consequences.

 

 

 

 

 

 

 

As a general rule neither Prof or Dr Mew have time to engage in the comments section, their focus must be to gain as much real change and scientific engagement as possible, and this would otherwise consume all their time. If you want to engage with Prof John Mew or Dr Mike Mew on this or other topics then follow these links (if you want a personal opinion on your situation then please book an on-line consultation at https://orthodontichealth.co.uk/book-…

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Orthotropics 13. Contrasting Orthodontic Concepts.

Precis. Most dental and orthodontic students attend university to learn how to treat patients, so they inevitably learn past methods. Some will stay with these all their life, others will change their ideas; maybe more than once. For many it has not been until near the end of their careers that experience teaches them that retracting ‘sticking out’ front truth may not improve appearance.

Lecture 13. Time does not always improve our knowledge.  As I said in my first lecture, Edward Angle stated “Orthodontic treatments are very unlikely to succeed, if the functional disorders are still going on”. Charles Tweed one of his more radical students suggested four premolars should be extracted and this concept was adopted by most orthodontists for the next 60 years. However at the end of his career Tweed said “in future the vast majority of orthodontic treatment will be carried out during the mixed dentition”. So ultimately both of them adopted concepts very similar to my own.

By the time many of us have realised the true nature of malocclusion it is too late to create a new paradigm. Today many orthodontists around the world still strive for perfectly straight teeth probably because they are all dentists. I was taught “if you treat correctly the teeth will stay straight, if they don’t, you have not done it correctly”, but now it is accepted that we have to retain the teeth for the rest of a patient’s life. Is this inevitable and are the patients getting a fair deal?

The constant theme of this lecture series is facial appearance.  In lecture 6 I described the ‘Indicator Line’ which I created in the 1970s to measure facial lengthening. It relates closely to facial attractiveness as well as malocclusion but I found that the Indicator Line almost always increased when fixed appliances were used, especially if this was coupled with extractions.

It was the Indicator Line that first convinced me that “sticking out incisors” are actually too far back and the rest of the face is even further back. See the illustration of an eight year old girl with a 14mm overjet. I proclined the incisors to reduce the Indicator Line which increased the overjet to 17mms before encouraging the rest of her face to grow forward. As a result her chin, the Gnathion came forward 27mm.

That was 50 years ago and I find it hard to believe that orthodontists are still retracting “sticking out” incisors. Even more concerning, few orthodontists appreciate the consequences of this. It routinely retracts the maxilla and mandible which not only spoils the face but reduces the arch length, therefore leaving less room for the teeth. Sadly this worsens Sleep Apnoea and Temporomandibular problems which are both related to retruded jaws, as well as many ear nose and throat issues. This is because none of the accepted treatments are able to make the mandible grow forward, so the maxilla is pulled back instead.

Many clinicians use ‘Functional’ appliances to bring forward the mandible in class II cases and the Twin Block is one of the most popular appliances in the world. However my experience is that these appliances only achieve one or two millimetres of forward growth and the rest of the overjet is corrected by facial lengthening and upper dental retraction with lower proclination.

Recently positioners such as Invisaline and Smile Direct have become popular, mainly because they are less work and therefore less expense. They usually align the teeth in class 1 cases very nicely as you can see, but are not so easy for class II or III cases. Frequently they lengthen the face, because the patient starts to swallow with their tongue between their teeth as can be seen here. Some cases lose lateral control while others Tip, Roll or Yaw. All these problems are difficult for orthodontics to control, although fairly easy for an Orthotropist.

As a general rule neither Prof or Dr Mew have time to engage in the comments section, their focus must be to gain as much real change and scientific engagement as possible, and this would otherwise consume all their time. If you want to engage with Prof John Mew or Dr Mike Mew on this or other topics then follow these links (if you want a personal opinion on your situation then please book an on-line consultation at https://orthodontichealth.co.uk/book-…

Professionals (of any medical/health discipline); https://www.facebook.com/groups/Ortho… or https://www.facebook.com/groups/Ortho…

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Please consider joining our Patreon Community: https://www.patreon.com/orthotropics Particularly if you have; 1) gained any benefit from the information that we have provided (usually for free). 2) wish to have the benefits of being a patreon member. 3) believe in, and wish to support our mission to gain full, free and fair debate (engagement) on these issues within the orthodontic and dental community.

Orthotropics 12. Measuring Facial Shape

Precis. Brodie and Bolton developed different ways to demonstrate facial form, especially of the profile. Most orthodontic super impositions are based on the Sphenoid bone but this may not be as stable as we have believed. The Gnathiometer uses the Frontal bone for superimpositions which enables the forward growth of the Gnathion to be measured to the nearest millimetre.

Lecture 12. I have been interested in facial form since I was an undergraduate and was impressed by the work of Allan Brodie who after a study of cephalometric X-rays in 1938, concluded “The most startling find was the apparent inability to alter anything beyond the alveolar process”. I think much of the work of orthodontists around the world is still based on this belief.

Subsequently I read the work of Charles Bolton, who had studied the facial profile of a large number of white Americans and created his famous ideal profile, but his work did not easily allow for variations in vertical height. At that time X-ray superimpositions were on the sphenoid bone which was assumed to be the fixed base of the skull. Naturally because everybody was superimposing on the Sphenoid they soon believed that it did not move.

However my own X-ray studies showed that during orthotropic treatment the angle between the Frontal bone and the Sphenoid bone increased, at the same time as the Saddle angle which reduced. As the Frontal bone showed little sign of change I assumed that the thin sphenoid wings had allowed the sphenoid itself to move up and down within the skull. This explained to me many of the other apparent changes in the face. It was also well supported by the research of Luzi in 1982.

As I discussed in my sixth lecture, I use the Indicator Line to measure the vertical drop of the face which is routinely caused by open mouth postures but because all the bones change shape it is not easy to assess forward growth, so I have created my Gnathiometer. With acknowledgment to Charles Bolton, this makes use of a point ‘F’ on the frontal bone 50mm above the Nasion. I found that a line dropped from ‘F’ through the Nasion should pass close to the ideal position of Gnathion.

Point ‘F’ is on the surface of the Frontal bone 50mm above the soft tissue cephalometric point ’N’, and the vertical line between them can be extended down to measure the amount of forward growth of Gnathion to the nearest millimetre. The Gnathiometer requires a full sized photographic print of the facial profile. The guide plus an APP which prints out the correct sized face is available from www.johnmeworthotropics.co.uk  price £50.

The amount of forward growth quickly distinguishes different types of treatment as many fixed appliances achieve little forward growth, indeed the Gnathion often falls back which may be why they are thought to increase TMD and OSA problems.

As a general rule neither Prof or Dr Mew have time to engage in the comments section, their focus must be to gain as much real change and scientific engagement as possible, and this would otherwise consume all their time. If you want to engage with Prof John Mew or Dr Mike Mew on this or other topics then follow these links (if you want a personal opinion on your situation then please book an on-line consultation at https://orthodontichealth.co.uk/book-…

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Orthotropics 11. Changing Facial Aesthetics

Precis. Orthodontists naturally focus on the teeth while most orthotropists think the face is more important. Most fixed appliances tend to retract the face while orthotropics moves it forward. Some illustrations are shown of different forms of treatment.

Lecture 11.This is the principal objective of Facial Orthotropics. I think I can fairly say that most orthodontists are more interested in dental alignment than facial change. In fact many of them claim and I am sure believe that there is no risk of facial damage provided the treatment is conducted correctly. I think they are wrong. I have spent many years studying facial change and in 1999 published the results of a study of Identical Twins treated by different methods. I know of no better way to research this subject and it surprises me the no one has ever repeated this. I believe that the one pair I show below demonstrates all we need to know about fixed orthodontics and orthotropics.

I had previously noticed that faces almost always lengthened slightly when fixed appliances were used. Often this was only a millimetre or two, but sometimes more and occasionally much more (see illustration below). This usually occurs with more severe malocclusions especially if much retraction had been used. Soon my post box began to fill with mail from distressed patients, often very upset about what they thought was damage caused by orthodontics.

                                   

 

I can understand that orthodontists are very irritated with these opinions and see me as a threat. As a result of my research with twins I concentrate on achieving as much forward growth as possible with all my patients and soon I had dozens of cases with obvious facial improvements (see below which orthodontics were not able to equal). By then I had been thrown out of my orthodontic society, but continued with my research. However I was dismayed to find that in the UK few were listening to me, although more and more orthodontists from around the world have become interested and I think my message is now being heard.

 

As a general rule neither Prof or Dr Mew have time to engage in the comments section, their focus must be to gain as much real change and scientific engagement as possible, and this would otherwise consume all their time. If you want to engage with Prof John Mew or Dr Mike Mew on this or other topics then follow these links (if you want a personal opinion on your situation then please book an on-line consultation at https://orthodontichealth.co.uk/book-…

Professionals (of any medical/health discipline); https://www.facebook.com/groups/Ortho… or https://www.facebook.com/groups/Ortho…

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For more general information please visit; https://orthotropics.suryawebsolution.com.np/

Please consider joining our Patreon Community: https://www.patreon.com/orthotropics Particularly if you have; 1) gained any benefit from the information that we have provided (usually for free). 2) wish to have the benefits of being a patreon member. 3) believe in, and wish to support our mission to gain full, free and fair debate (engagement) on these issues within the orthodontic and dental community.