A note from Louisville, CO dentist Dr. Tracey Hughes: This is Part 3 of Camryn’s story. We previously posted Part 2 and Part 1, so be sure to check them out to learn more about Camryn’s journey. In the final part of this series, we will explore how non-surgical orthopedic forward face growth of the jaws cures eight years of headaches.
Camryn and her brother, Ben, enjoyed tagging along with me to Las Vegas during one of the LVI courses I attended in the summer.
It has been one year since I attended LVI’s Forward Face Orthodontics course in June 2018 to learn the skills necessary to help cure my now 15-year-old daughter of a lifetime of headaches, TMD and obstructive sleep apnea.
If you have not read Part 1 and Part 2 Blogs on Boulder Valley Dental’s website, I invite you to do so. The links are provided here.
- Case Study: The Cause of TMD, Headaches and Sleep Apnea
- Camryn’s Story Part 2: The bite’s relationship to TMD, Airway and Cranial Strain
I am thrilled to report, Camryn is 100% symptom-free since we began non-surgical, orthopedic forward face jaw development less than one year ago (she was headache free within one month of starting her treatment!) This blog explains the non-surgical TMJ treatment approach we used to cure her headaches.
She was suffering badly from allergies here in Colorado the week prior to her trip to the coast. She felt some instant relief at the beach…I guess the Vitamin Sea helped! Please see Part 1 for the significance of allergies, mouth breathing, and altered facial growth.
She began immunotherapy allergy shots a few short weeks after we returned home from our California trip and has been doing much better fairing allergy season this summer.
I had several treatment goals for Camryn’s treatment:
- Eliminate her lifetime of headaches by allowing her head and jaw muscles to lengthen to where they function and rest in a physiologic position.
- Overcome Camryn’s craniofacial deficiency and eliminate cranial strains by harnessing remodeling and growth potentials.
- Unlock the lower jaw from the teeth during treatment so the lower jaw could come forward as the upper jaw develops forward, decompressing her TMJs to allow them to remodel to proper anatomical form, preventing degenerative joint disease. Camryn already was showing signs of joint changes to that of a 30-year-old.
- Develop increase size of her upper airway as a result of growing her jaws forward, out of the back of her airway, preventing a lifetime of upper airway resistance and potentially obstructive sleep apnea.
- Improve neck posture and support her cervical vertebrae.
- Gain control of the Big 3 (nasal patency/allergy control, lip seal and absence of tongue thrust)
Non-Surgical Forward Face Remodeling of the jaws accomplishes all these goals in the following manner:
- Developing the size, shape, and position of her upper jaw to the intended genetic potential using fixed AGGA (Anterior Guided Growth Appliance)
- Orthopedic molar pads are placed on the lower molars and act as a mandibular “growth appliance,” in essence, which stimulates the lower jaw to remodel, accompanying the forward growth of the upper jaw.
- Once the upper jaw is in the correct position, then full transverse development (expansion) of the palate and dental arches are achieved.
- NOW that we have the jaws developed, there is enough space to level and align the teeth for a beautiful smile. No extractions are needed when jaw development orthopedics are utilized prior to aligning the teeth! Let me repeat that, please DO NOT ALLOW ANYONE TO EXTRACT YOUR CHILD’S TEETH FOR ORTHODONTIC PURPOSES!!! Orthopedic jaw development has eliminated the need to do that, EVER. Once that is done, the entire dental arch collapses and facial profile is retracted back into the airway, causing a lifetime of potential TMD, headaches, and obstructive sleep apnea.
Let’s take a look at what Forward Face Growth and Jaw Development look like mid-treatment In Camryn’s case:
Timeline for forwarding jaw growth is estimated at 1-2mm/mo of the maxilla, as measured in the space that develops behind the cuspids while in the AGGA appliance. Camryn’s Facial Beauty Institute Analysis indicated she would need 4-6mm forward growth, so we anticipated 3-4mos in AGGA for her. Hindsight, I wish I would have left her in her AGGA longer, which I will elaborate on more at the end of this blog.
What is AGGA?
Anterior Guided Growth Appliance remodels the entire nasomaxillary complex (midface and maxilla) 3 dimensionally, growing the face forward to it’s fully intended genetic potential.
This appliance is used in adolescents and adults of all ages, and a removable version is used in kids ages 6-10 years old to stimulate forward face jaw growth. This is a very comfortable alternative to orthognathic jaw surgery to treat underdeveloped jaws and midface deficiencies.
We Installed Camryn’s Fixed AGGA in August 2018; she was 14 at this time. The process is virtually painless, and the patient’s report very minimal to no discomfort with the process.
How does AGGA work?
Camryn was seen every four weeks for three adjustments of her appliance, which is activated by two springs on either side of the appliance. There is a pink acrylic pad that applies pressure to a particular spot on the palate behind the front teeth which stimulates a nerve, the nasopalatine nerve, to activate the growth and remodeling process of the upper jaw and entire midface forward, including her nasal sinuses. This growth and remodeling continue for up to 18 months after AGGA treatment.
Month 1- 2mm forward growth
Month 3- 5mm forward growth
The orthopedic molar pads are placed on the lower 1st and 2nd molars at the insertion of AGGA, which begins the remodeling process of the lower jaw to follow the upper jaw development forward.
Day 1 AGGA insertion
Notice how the lower jaw has tracked forward as the upper jaw has grown 5mm in 3 months. These orthopedic molar pads, as explained in Part 2, decompress the TMJs and support the muscles of the jaws, head, and neck in a balanced, physiologic rest position.
Three months in AGGA
While in AGGA, Camryn has been working on her myofunctional therapy exercises. She has not been 100% complaint, as they do take significant commitment to being successful. She’s a busy teenager, and tongue posture exercises aren’t a priority for her. Because of this, I have noticed a bit of vertical growth pattern of her face, even after AGGA. She is continuing to work on proper lip seal, nasal breathing, and proper tongue posture to help correct this. The robust growth stimulation of the orthopedic appliance continues for up to 18 mos after removal of the appliance, so we will continue to see improvement in her facial features with time.
Camryn’s 16-year-old brother, Ben, has also undergone AGGA Forward Face Jaw Development and here is a sneak peek at his progress… I plan to write a blog on his airway story. This is 10mm forward growth in just five months. AGGA is, by far, more profound and efficient than other growth/expansion type of appliances which all fail to stimulate three dimensional forward remodelings of the nasomaxillary complex.
I now have several adult and pediatric patients in treatment for Facial Orthopedics, and as we progress through their treatment, with their permission, I will share more cases on my website.
So what happens to those gaps behind the cuspid created during the forward growth?
After AGGA grows the face and jaw forward, we were the Controlled Arch Braces phase to protract the back teeth forward into the space created. Also, during this process, we expand the arches laterally using an FRLA wire (Fixed Removable Lingual Archwire). Controlled Arch Braces uses very different orthodontic mechanics from conventional retractive orthodontics, which have many limitations in what we are able to accomplish with Controlled Arch Braces. Special stop locks are used on the archwire to prevent ANY retractive forces that would pull the teeth back. Everything is moved forward!
Here’s how Controlled Arch Braces arch development and alignment look. The process involves blossoming the dental arch to a broad, wide Roman arch shape using controlled arch mechanics.
Because the archwire is “controlled” with an FRLA wire and stool locks, the teeth blossom outward, creating even more space for severely crowded teeth cases.
Each month, the elastic power chains are replaced until the 1st and 2nd bicuspids are protracted FORWARD into the space created by the forward jaw development. (Note, in conventional orthodontics, power chains are used to pull teeth back, but in Controlled Arch Braces, it is the opposite)
The green power chain is protracting the cuspids forward in the space created by the archwire.
Note how the bicuspids are moving forward in the spaces behind the cuspid, as space develops now in front of the molars.
Six months into CAB, look at this broad, beautiful arch form! So much room now for her tongue to be up and out of the back of her airway.
You can see, we are near completion of this step and once this is done, we will move the stop locks on the archwire from in front of the 1st molars, to behind the 2nd bicuspids that have been fully protracted forward…ALWAYS controlling the arch from any retractive forces. I plan to make an impression of her arch when treatment is complete and compare arch forms side by side. I expect it to be quite an impressive comparison.
Wait a minute…What is that crazy looking fixed appliance that lays across the roof of the mouth with that little blue ball you ask? Remember, Camryn’s cause of her midface deficiency and lack of forwarding face/jaw development is her low resting tongue posture and tongue thrust.
She has been doing this since she was six months old due to reasons discussed in Part 1, so it’s a difficult habit for her to break. This is a tongue habit appliance, and it corrected her tongue thrust and proper resting tongue posture within the first six months of Controlled Arch Braces.
The blue bead is a spinner bead. She plays with that all day with her tongue to remind her to keep her tongue up on the “spot.” The U shaped coffin spring in the back was there to correct her if she swallowed improperly. It provides a “negative” reminder to swallow with the front part of her tongue on the roof of her mouth. Happy to say, she had corrected her swallow pattern with myofunctional therapy prior to insertion of her tongue habit appliance, so she never developed a sore on the back of her tongue from the spring. However, for those people who do have an incorrect swallow, they will be reminded very quickly to swallow properly because their tongue will become quite sore until they change their reverse swallow.
I removed Camryn’s coffin spring this month because she has corrected her swallow pattern. Now all that’s left for her to master her lip seal! Don’t worry; we have negotiated an impressive reward once she masters lip competency.
*One of her myofunctional therapy exercises.
Don’t worry; she can still sing in the car. 😄
What is happening with Camryn’s lower jaw?
That opening of her bite when she started treatment is so big, how is that going to close?
Just look at what Camryn’s body is going in response to treatment: her lower jaw is remodeling as it decompresses the joints, bringing the teeth back into occlusion. The 2nd molar pads have not been reduced at all during the last ten months of treatment. This is profound remodeling of the entire lower jaw and joints, and this has cured her TMD/headaches for a lifetime.
🧐 Yes, we will be closing those spaces between her lower front teeth in the next few months.
We will continue her Controlled Arch Orthodontics treatment by protracting her upper molars forward once the bicuspids are fully protracted, expected in the next month or 2.
I am considering putting her in a 2nd AGGA once this is done. I will be attending Dr. Anne-Maree Cole’s Advanced Jaw Development course at LVI in September. I would like to see if we could correct more of Camryn’s vertical facial growth pattern and work more on her steep mandibular plane angle to try and drop the angle of her mandible down a bit more which would provide her a stronger, horizontal jawline.
This may be feasible after we allow time for the biology to catch up from the impressive remodeling she has already experienced. I will have more info then and post a follow-up blog of Camryn’s and my decision to use a 2nd AGGA to gain even more forward development.
In the meantime, this girl is thriving, pain-free, without the worries of migraine headaches. We grew her face and jaws without painful surgery! Best thing I have ever done is attended LVIs Jaw Development Orthodontic continuum.
A Special Thanks
I am so very grateful to my mentors teaching me this cutting edge advancement in orthodontics, Dr. David Buck, Dr. Timothy Gross, Dr. Anne- Maree Cole, Drs. Bill and Heidi Dickerson and Dr. Jill Taylor (my biggest cheerleader!)
And I owe a load of heartfelt gratitude to Drs. Conchi and Raul Garcia, who sat down one day at lunch with Camryn and me during an LVI course and discretely indicated to me, Cam and I would GREATLY benefit from me jumping in 100% to LVIs ortho program. We talked a lot about how she had been able to help her own daughters with these cutting edge orthopedic techniques. Conchi was right ♡ Forward Face Orthodontics has changed our lives!
I love instructing in the clinic at LVI courses with Drs. Conchi and Raul Garcia.
For my dental colleagues interested in more info on this course;
Stay Tuned for More Progress
This girl cannot afford for headaches to slow her down!
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