ALF, Myobrace, Vivos DNA and Homeoblock appliances fix under bite, cross bite and deep bites.
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- Опубліковано 18 лис 2020
- Dr. Adams talks about how facial bone and jaw structure grows during appliance therapy. We use several different orthodontic expansion devices including Schwarz, Vivos DNA, Homeoblock, Twin Block and Crozat just to name a few. Anterior growth aka orthodontic expanders can help correct conditions including crowded teeth, TMJ and Sleep Apnea and mouth breathing.
Treatments can help adults and children. Expansion is easier with kids because they are still growing. But the DNA appliance is one example of a treatment that can stimulate bone to grow in adults. Kids appliances include ALF, Schwarz, Myobrace and Healthy Start. In fact 100s of growth appliances exist. The most important thing is to select an appliance that can stimulate the necessary growth and the patient can tolerate wearing the appliance. The AGGA or anterior growth guidance appliance is another adult appliance. But how does facial bone grow during appliance therapy?
Adult palatal expanders include Vivos DNA and Homeoblock devices.
Promoting optimal facial and jaw structure growth will optimize breathing and airway and balance the bite and occlusion. Most people also will notice better nasal breathing and less congestion in their nose. During expansion, the internal bony structure of the nose increases in diameter. And air will pass better through the nose.
TMJ Symptoms are a sign of Obstructive Sleep Apnea and UARS
77% of people with sleep apnea or UARS problems also report TMJ pain. TMJ symptoms are often caused by teeth clenching episodes at night time. Clenching occurs when the airway is blocked during sleep. Clenching is a reflex caused blockage or obstruction of the upper airway. Often times the obstruction is the tongue falling into the airway during deep sleep. The clenching is a defense mechanism to wake you up into a lighter sleep. In lighter sleep, the tongue will contract and come out of the throat and back into the mouth. The tongue displacement is caused by there not being enough room in the mouth for the tongue. Growth appliance therapy is the best non surgical treatment for TMJ, sleep apnea and UARS. Growth appliances can correct and sometimes cures TMJ and sleep apnea. Most treatments available for these conditions only address symptoms - night guards, occlusal splints and dental snore appliances. CPAP is a viable treatment option but it does not correct airway and sleep problems. Dr. Adams is a certified Vivoslife appliance provider. The power in this corrective treatment is pneumopedics and craniofacial epigenetics. The fancy terms you can forget, but basically what it means is you can stimulate new jaw and cranial bone growth in an adult. The result is more space for jaw and cranial balance, proper tongue spaces and function and a bigger upper airway for better sleep and night-time breathing.
Please keep publishing these videos! Fantastic information !
Just wanted to add on some additional research for you, which I found interesting. In 2006 in the Brazilian Journal of Otorhinolaryngology they used a "slow" maxillary / functional appliance to see what they could get in terms of expansion. It seems like it was a well-run experiment where they recruited a batch of patients, "blinded" the radiologist so they wouldn't know which patient was which, which was before/after images, and had frontal ceph images traced twice. In 5 months they got 2mm of maxillary expansion ... but more interesting than that, they got 2mm of mandibular expansion (no device was in the mandible), and they noticed about 2mm additional width between the zygomatic arches, and on nasal markers. I'm not sure how the nose and zygomas are getting wider if an appliance is just "tilting teeth" (as the Orthodonists will say). Oh, and they specifically noted in the report that the results did not appear to be due to "dental tilting."
Fascinating stuff -- www.sciencedirect.com/science/article/pii/S1808869415300513
That is very interesting and often what I see happen. It’s a secret. Don’t tell anybody. In all seriousness, we will read the article. Thanks for sharing
@@SereneOrthodontics Hi! Hope you are all doing great!
Dr. Do you recommend DNA appliances for crowding of teeth for a 12-year old kid? Is it best to use one device first and the one on the lower jaw later.in the treatment of both at the same.time?
Thank you so much
Very interesting. Thank you for sharing. I am not surprised in the results. I only expand my adult patients at 1/4mm per 2 weeks at the fastest.
@@SereneOrthodontics do you recommend traditional expanders ? Or DNA
sorry for the delay. It really depends on the patient. But we do several different kind of expanders@@eb4676
Korean subtitles, please.
I am a Korean who is interested in ALF.
Hi! Hope you are all doing great!
Dr. Do you recommend DNA appliances for crowding of teeth for a 12-year old kid? Is it best to use one device first and the one on the lower jaw later.in the treatment of both at the same.time?
Thank you so much
Thanks for asking. The DNA appliance or Schwarz appliance should work for a 12yo. And I definitely recommend both upper and lower appliances at the same time. Very important to have them grow proportionately.
I have very recessed jaw. Of only4 inch width. How many inches does it increase in width of maxilla
As an adult w/obstructive sleep apnea can you tell me if medical insurance covers this debra’s orthotic and treatment?
Adult with a child size bite and 24 teeth remaining after orthodontist treatment as a teen.
Almost 20 year old dental orthotic that holds my lower jaw out during sleep.
Your presentation answered an issue of why area under eyes and side of nose is flat.
every insurance is different. You'd need to check with your insurance company.
Hi Dr. Adams, do you know if the tongue is strong enough to move the craniofacial bones over a long period of time? I’m experiencing weird changes to my cognitive function (possibly because of a misaligned sphenoid) and my face has changed (wider cheekbones, more protruding mouth, higher palate, etc). Do you think it’s possible to revert these changes with orthodontics by applying the same pressure but in the opposite directions?
It all depends. I’d need to do an evaluation
At 5:04, Dr. Adams said that research shows that if you use an appliance that repositions the mandible more forward for a 3-month, that a structural change to the TMJ will occur so that the bottom mandible will align with the upper (I assume permanently). Is there anyway we could get those citations please? I've been looking for this exact piece of information for a while now and I am having trouble finding it. If he could share the source it would be an immense help and greatly appreciated.
Additionally, I have heard a few personal anecdotes regarding AGGA and FAGGA appliances where the forces from the appliances were anchored onto teeth, which actually moved the teeth through the alveolar bone to create space, not the maxilla itself, causing loose and unstable teeth. It looks like according to Dr. Singh (the creator of DNA appliances) was able to demonstrate/calculate growth to the maxilla in his study on DNA appliances. That being said, I am still concerned that maybe the DNA appliance too be in part anchored to the teeth and may push the teeth through the alveolar bone as well, leading to results as the anecdotes I described above regarding AGGA and FAGGA. When patients pursue the DNA appliance, is the position of the teeth in the alveolar bone monitored? And if so, have you seen patients teeth move through the bone into positions that are perhaps less stable? Your thoughts would be greatly appreciated!
The principles were brought by Dr. Gelb inventor of the Gelb appliance. The concept of “functional repositioning” is not a new one. Look up these items.
Nothing in life is a guarantee. It is the practitioner’s job to select an appropriate treatment and deliver and monitor care for a good outcome. There is no best appliance. The one that works, the doc knows how to use and the patient can tolerate, is the best to use. We have a blog post DNA vs AGGA that is a good read. Best of luck and thanks for the thoughtful comments
Hey John I have been wondering the same thing. My thoughts have been are we borrowing space from the alveolar bone and would this be the cause as to why some people then experience sensitivity? Anyway I have no idea but I'm supposed to get a schwarz and now I'm really confused and don't want to mess anything up cause I have never had any treatment done before. Let me know if you have found any more information too it would super appreciated. It's very easy to find me on IG or FB if you have more references/links in future. Thanks
John Lewis : The replies won't populate what was the answer, it's SOOO important.
Interested in replies to Doug Tombs and Pam May. How would this affect a teenager or adult with a cleft repair?
Thank you Dr. Adams! By chance, do you have some citations for the research you mentioned during this video? I don't necessarily need it for myself - I'm just waiting for my DNA appliance to come back from the lab at the moment - but I still talk with others regularly who don't believe it's possible. One of which, is actually my brother-in-law who is a retired oral surgeon and is understandably skeptical ... although he is trying to keep an open mind.
Thanks!
I always get this stuff from the manufacturer, Vivoslife.com But I’ve completed approximately 100 cases and I have at least another 50 in progress. It works quite well in most cases. Some get more growth than others, but I’ve never had a failed case. CBCTs don’t lie
@@SereneOrthodontics I've seen most of the research that Dr. Singh has published and/or cited in some of his presentations - just wasn't sure if there were some other notes you may have been referencing. Thanks for the prompt reply!
And I agree that it works well in many cases. Unfortunately, Vivos is absolutely abysmal at trying to get any of that information out there. There's an entire universe of people out there that I interact with regularly that are stuck on the fence of wanting to believe that it will work, but keep hearing the "it will just tilt your teeth / push them out of the bone" arguments from the traditional providers. So if you were ever so inclined to create a video with some of those CBCTs (anonymized of course) I think it would seriously rack up some views.
Thanks for what you've already done to try to advance knowledge in this space!
I’ll see what I can do. Speaking for us we are so busy “doing” we are not “selling” This community is also not friendly. You put stuff out there and you become a target
@@SereneOrthodontics Absolutely understood, and 100% agree. But the conversation IS happening out there, whether ALF and DNA/Homeoblock providers choose to participate or not. And in the absence of participation, the loudest voices in the room (typically Orthodontists and Oral Surgeons) end up getting to both define the playing field for discussion and then dominate the conversation within that field by limiting discussion to things like a 2D measurement of mid-palatal suture splits. It took me months of my own digging to feel comfortable with trying DNA as a first course of treatment.
One suggestion I've made to other Vivos-trained dentists before ... is if you're handy with CBCT software, perhaps a 3-measurement view of the movement in a maxillary tooth pair. Orthodontists will say "you're only tilting the crowns, measuring the cusps, and telling the patient they got expansion when they didn't." But Vivos training materials show that their Airway Intelligence Reports Vivos generates are measuring expansion at the CEJ, which is better because it's a bit lower. So why not 3 measurement points - cusp-tip-to-cusp-tip, CEJ-to-CEJ, and then apex-to-apex? If these things are all - as the Orthodontists say - just "tilting the crowns" then you'd probably expect to see maybe +3mm at the cusps but -3mm at the apex. But if all measurements are in the positive then you are getting bodily movement of a tooth due to bone growth (even though maybe some tilting/uprighting might be useful).
Alternately, showing an implant move along with the natural teeth - which seems to be a famous urban legend among Vivos providers ... they all say they know it's happened, have seen it happen ... but no one can ever seem to produce an image.
Again, thanks for all you have done so far to try to bring more knowledge into this space! It's a tough area to be wading into, no doubt!
Thanks Doug. Much agreed. And I have a ton of that data. We ust got a brand new hi-res 3D called an ICat Flex V17. I need about 6-12 mos to get some really good data. Orthodontists and Oral Surgeons are not specialists of sleep dentistry or TMD. But I’ve never met one that didn’t know everything.
One element often not measured btw is growth that occurs between the facial bones. Such as forward growth between the sphenoid and the maxilla. And forward growth/movement between the mandible and the cranial base.
I see that this expansion creates more space but is the actual mandible growing at all during this process? Thanks!
yes the lower appliance stimulates the lower jaw to grow wider. The lower actually moves forward in response to the upper jaw growing forward.
Can you see on X-ray or cbct that the growth comes from the bone and not the teeth? I’m very interested in getting a DNA (I’m in an ALF now), but people keep telling me that the growth is just from the teeth and not the palate because the maxillary palatal suture is ossified once someone is over 30. What are your thoughts on this?
The growth comes from all over and it can be seen in the X-rays if a comparable before and after images are taken with a high quality CBCT
Also much more growth is seen with DNA and Homeoblock vs ALF
Can the appliance stimulate vertical (downward) growth as well?
Yes. As facial growth proceeds forward/anteriorly, there is a vertical increase. That is a very important detail. The vertical increase occurs because the mandible grows down as it grows forward.
thoughts on MARPE? I absolutely hate my DNA appliance, my lower jaw hates moving forward, and my neck tightness up extremely. Any thoughts? I am a 37 year old female, already had the DNA for a year.
The appliance needs a different design if you are having those troubles. marylandholisticdentist.com/mse-sarpe-alternative-homeoblock-and-dna-appliance/
Also have you done any myofunctional
Therapy or tongue and lip releases?
I've just started treatment with the DNA appliance (haven't done the first adjustment yet) and I'm quite worried about the side effects this may cause in the long run. So far I've had headaches, teeth sensitivity, and light jaw soreness. Are there any major signs that I should discontinue treatment that I should be looking out for?
We’ve never had any cases not work, but as a gross average you should see you symptoms get consistently better and the bite should be comfortable
@@SereneOrthodontics I have been noticing that since I last commented. I have a bruxism issue that's been going on for the last 2 years. In your practice at least, have you observed this to help with that?
If the symptoms persist you need to go in for a bite adjustment. Normal stuff for initial treatment phase.
It is a very effective treatment for bruxism
@@zachyoung7733 Hi, could you please update how is your treatment going?
My Orthodontist hasn't had me adjust the bottom part of the Homeoblock device forward yet. My tongue still falls back and blocks my airway during the night. Maybe the reason for this is that the adjustment forward has not begun? I'm hoping this tongue issue begins to resolve itself after my Orthodontist instructs me to adjust the device forward and not only widthwise. I've been using the device for almost three months now.
Have you been doing any myofunctional therapy? Usually the top appliance can go wider and sometimes forward. The lower only goes wider.
@@SereneOrthodontics I can't afford myofunctional therapy. I'm on SSD because of severe sleep apnea. Dr. Belfore has written some papers that state the Homeoblock device is designed to train the tongue, so it is a form of myofunctional therapy on its own.
@@SereneOrthodontics Interestingly, when I work hard to get my body fat percentage down to around 10%, I sleep much better, even better than with the device, so far. The problem is it's very difficult to maintain that level of lean body mass consistently, year-round.
My dentist is only placing me in the upper DNA appliance and says I'll need braces, then restorative after. Is that a normal protocol?
We always use a bottom to control the growth of the top and bottom. Braces can be needed afterwards.
Wouldn’t the arch wire technically pull back the upper front teeth so that the lower back teeth can fit into the bite plane though?
We’re not really big fans of pulling anything backwards
Can DNA appliance be used by 7-8yr old with severe overbite and jaw thats not growing. underdeveloped lower jaw. Whats is the starting/earliest age at which DNA appliance can be used for growth.
Yes it can be used at any age. We also have many other appliances we use. Typically we will evaluate the case and select the bet appliance for the case. Great question and thanks for asking.
PAm May Maryland Holistic Dentist : the replies aren't visible
Hello doctor thank you for the video. May I know which appliance works better for six year old(ALF or DNA)? Please let me know
I like the Schwarz appliance for 6 year olds in most cases. marylandholisticdentist.com/schwarz-expander-appliance/
How much does this cost? The whole process
It depends on the appliance, how much growth the patient needs, whether it is a child or adult. Some people even need a combination of appliances. In general adult cases with one appliance all-in, take 1-2 years and cost $8 - $12K. Kids for the same $5500 - $6500.
do i have to wear VIVOs appliance after treatment for life?
We have our patients stop wearing it after a 30 day retainer period usually
Dr. Adams, have you used the DNA on yourself?
Yes I have :)
@@SereneOrthodontics that’s very helpful…thank you for letting us know you have used it on yourself 😎
I have a really narrow airway.. it looks like a thin straw.. 😳.. will vivos help me?? I have sleep apnea..
Absolutely. We have several more videos about DNA and Homeoblock appliances and how they work to correct obstructive airway conditions.
Is there chances of relapse in a 15yo?
The teeth positions can change, size and shape of the bone usually do not
Can any of these fix an occlusal cant? I’ve heard ALF fixes a lot of cranial distorsions
I find the Homeoblock most helpful in correcting cants
@@SereneOrthodontics got it if there is no one in my area that does it will ALF suffice?