What is Development Orthodontics?
Hi, I'm Dr. Annissa.

I believe you deserve a
healthy, confident smile.

What is Development Orthodontics?

Posted .

Teens & Adults

Louisville, CO teens & adults benefit from developmental orthodontics, too!

Physiologic based dentistry establishes upper and lower jaws in a balanced position, with muscles of the head and neck relaxed and temporomandibular joints (TMJs) decompressed. Does that sound comfortable and healthy? It is! Developmental orthodontics is not just for kids. Teens & adults across the Boulder, Broomfield, and Lafayette region come to Boulder Valley Dental Center in Louisville, CO for Dr. Tracey Hughes’ expertise in this area.

Jaw development orthodontics in a nutshell

Jaw development orthodontics is a branch of physiologic based dentistry. It improves cervical neck alignment and posture, reduces pressure on TMJs, and improves the airway space. Treatment consists of a short-term, reversible, diagnostic phase using a physiologic, functional orthotic. No permanent changes are made to the bite during Phase 1.

TMJ treatments that make permanent changes to teeth or jaws should never be implemented without first establishing changes in jaw position with a reversible technique. Once symptoms have resolved, or new jaw position is confirmed to be comfortable for a patient without symptoms, then Phase 2 can begin. Phase 2 treatment is the long-term solution to correct bad bite position through non-surgical development of the nasomaxillary complex (mid-face and upper jaw). It is accomplished with AGGA orthopedics followed by protractive mechanics with ControlledArch braces.

How this is different from conventional orthodontics

Dr. Tracey Hughes trained in physiologic dentistry at the prestigious Las Vegas Institute. With this in-depth background, she has a wealth of experience successfully treating teens and adults. She starts by verifying proper at-ease jaw position with electromyography (EMG) using BioPak technology.

Conventional orthodontics utilizes lateral expansion and retractive mechanics to move teeth within the confines of the existing jaw size and position. When the upper jaw (maxilla) is underdeveloped or too far back (which current research determines is present in 85 of our population), the lower jaw and teeth are pulled back to compensate. Traditional orthodontic treatment disregards muscle position, joint compression, and airway health. Worse, bicuspids are sometimes extracted and remaining front teeth pulled back, leaving less room for the tongue. The airway is compromised because the tongue has nowhere else to go. TMJs are compressed and muscles are unhappy.

Please avoid extraction of permanent teeth for orthodontic purposes! It compromises facial esthetics significantly, and potentially causes a myriad of lifelong pain and suffering from TMD and OSA (obstructive sleep apnea) in adulthood.

Jaw development orthodontics addresses the connection of:

  • Body posture
  • Upper cervical alignment
  • Airway function
  • TMJ health
  • Muscular balance
  • Potential for enhanced facial skeletal remodeling
  • Proper coupling of teeth as an intimately integrated system

Common questions about developmental orthodontics for teens & adults in Louisville, CO

What is AGGA?

Anterior Guided Growth Appliance is a fixed orthopedic appliance developed nearly three decades ago. It is one of the safest orthopedic methods to remodel or grow face and jaws to their full genetic potential – without surgery. AGGA allows us to fully develop and relocate the entire nasomaxillary complex (including the upper jaw) to its ideal size, shape, and position, which in turn allows the trapped lower jaw to develop to its most relaxed, comfortable physiologic position. In addition, the nasal cavity, floor of the orbits, and cheek bones are reshaped. AGGA is all about facial orthopedics; not just straight teeth. We are developing faces, and straight teeth are part of the package.

What causes face or jaws to be underdeveloped?

Modern diets and environmental allergens contribute to inadequate face and jaw development in 85 percent of children today.

How does AGGA work?

AGGA stimulates growth in children, and three-dimensional remodeling of the nasomaxillary complex in adults. Unlike other expansion devices, AGGA is not a tooth borne appliance. The acrylic pad on the palate applies pressure on the nasopalatine neurovascular bundle. This creates a microtrauma response that induces bone to be laid down over the nerve as an insulating effect (to mitigate the irritation to the nerve). In this manner, AGGA stimulates optimal forward facial growth, correcting jaw size, shape, and location, which in turn creates space for crowded teeth.

Who benefits from AGGA?

The removable version (RAGGA) is recommended for children ages 6 to 10, while the fixed type is appropriate for teens and adults.

People with the following characteristics or symptoms may benefit from AGGA:

  • Craniofacial disharmony (facial asymmetry or cranial strain)
  • Severe dental crowding
  • Prior bicuspid extractions and now TMD symptoms or sleep disordered breathing – OSA
  • Underbite (lower jaw appears too large)
  • Overbites (lower jaw appears too small or too far back; upper teeth flare out)
  • Chin is too prominent
  • Chin looks too small
  • Mid-face deficiency – The upper jaw is typically 6 to 8mm too far back, causing the lower jaw to compensate (be pushed back) for chewing function.
  • Flat face
  • Poorly defined jaw line or “turkey neck”

What are the benefits of AGGA?

The benefits of jaw development orthodontics with AGGA and ControlledArch orthodontics include robust horizontal, face forward development, key to unraveling the entrapped mandible (lower jaw). This alleviates compressed TMJs and resolves most TMD symptoms.

With the mandible in the correct physiologic position, posture of the head over the cervical spine is dramatically improved, enhancing overall body posture. In addition, as the entire face develops forward and horizontally, the lower jaw comes forward. The airway at the back of the tongue opens significantly. This improvement can be measured before and after treatment using CBCT scans.

There can be remarkable changes in architecture of the nasal cavity, including remodeling of the palate which is the floor of the nose. Palatal remodeling creates more room for the tongue and better positioning/seal in the roof of the mouth. These changes improve nasal patency and improve nasal breathing.

Facial esthetics and profile are improved, as well. AGGA develops fuller definition of lips and cheeks like a non-surgical face lift!

How is the degree of necessary jaw development determined?

Dr. Hughes submits a 3-D CBCT scan and photographs to the Facial Beauty Institute. An oral maxillofacial radiologist and orthodontic specialists evaluate this information utilizing the OrthoMatrix Total Diagnostic and Treatment Design system. Recommendations are made by the Facial Beauty Institute and comprehensive treatment plan guidelines are provided based on the OrthoMatrix analysis.

IS AGGA an alternative to jaw surgery?

If you have been told you need jaw or TMJ surgery, please get a second opinion from Dr. Hughes before proceeding. With a jaw development orthopedics approach, there are very few indications for jaw surgery.

What happens to the lower jaw once the upper jaw is developed forward with AGGA?
The beauty of the AGGA growth appliance, when properly coupled with correctly placed lower physiologic molar pads, is synergistic activation of remodeling in the nasomaxillary complex (mid-face and upper jaw). This signals significant activation of the ramus and condylar remodeling centers in the lower jaw. The lower jaw follows the upper jaw beautifully as it is unlocked from being entrapped behind a deficient, retruded upper jaw.

The body goes where physiology dictates. The lower jaw wants to be in a position where muscles are relaxed and TMJs are decompressed. As the mid-face and upper jaw develops forward, the lower jaw remodels and follows, in most cases developing a desirable beautiful, strong jawline with improved function.

AGGA is the only appliance that stimulates remodeling of both upper and lower jaws to maximum genetic potential.

Does AGGA make room for crowded teeth in the lower arch?

Space is made in the lower jaw in three ways:

  • In response to AGGA, the lower jaw remodels, creating additional length and space for crowded teeth to align.
  • The lingual wire placed on lower teeth uprights molars that are tilted inward, and further alleviating crowding.
  • The ControlledArch braces anchorage system gently widens space available for the lower front teeth.

No other orthodontic system can do this much to create room for crowded lower teeth.

Conventional orthodontics involves IPR or interproximal reduction. Teeth are narrowed with sandpaper or extracted to make space. Jaw development orthodontics with AGGA and ControlledArch braces does not utilize these techniques.

What about an underbite – a lower jaw that looks too big?

The lower jaw is usually the correct size. Rather, the upper jaw is underdeveloped (too far back or too small). AGGA stimulates the midface and upper jaw to catch up to development of the mandible, which has already reached genetic potential. The result is a beautiful, physiologic balance of the face.

Does the face look different after treatment?

Yes, in a good way! Most AGGA patients have a:

  • Short, recessed mid-face
  • Step lower jaw
  • Long face
  • “Big nose” (it just looks large relative to the deficient midface)
  • Sunken facial appearance
  • Flattened face
  • Facial asymmetries
  • Prominent of a chin
  • Diminutive chin

These features are improved with forward face orthodontics using AGGA followed by ControlledArch braces. Forward maxilla and mandible position also support soft tissues of the face better, diminishing wrinkles for a more youthful appearance.

Does AGGA provide lateral expansion as well as forward development of the maxilla?

AGGA generates three-dimensional remodeling of the entire upper jaw, including additional bone outside molars. This allows molars to naturally move outward to their ideal physiology. Other methods of orthodontic expansion involve pushing on teeth which increases risk of recession. With AGGA, we can usually achieve full genetic potential width of the arch form.

What happens after AGGA creates space?

The ControlledArch phase of orthodontics following AGGA pulls back teeth forward into the space behind the canines, where there is newly developed bone. In the case of prior bicuspid extractions, teeth may be replaced with dental implants or fixed bridges.

Will teeth move or tip during AGGA treatment?

The front six teeth are bonded to a wire, which prevents movement. Teeth are relocated passively as bone remodels forward. The entire front segment of the upper jaw and the six front teeth move along with the remodeled bone. After AGGA development is complete, ControlledArch orthodontic alignment create ideal root torque to level and widen dental arches laterally for a beautiful smile.

Is AGGA orthopedics new?

Thousands of AGGA growth appliances have been used for the past 28 years with stunning success. It is one of the safest orthodontic systems ever developed. AGGA gained momentum in recent years, when the Las Vegas Institute for Advanced Dental Studies added it to their orthodontic training program. Now over 150 LVI trained dentists across the US, Canada, Australia, and the UK are providing this treatment option.

How does AGGA differ from other orthodontic expansion appliances?

Expanding the palate is only a minor part of a larger problem, mid-face deficiency, left un-addressed with other methods.

The stimulus of other types of orthodontic expansion appliances is transmitted from pressure on the teeth to bone. This does create a remodeling response and can have some benefits. However, it is a much slower process than the robust remodeling activation of AGGA. In contract, AGGA is not a tooth borne appliance. Rather, AGGA stimulates bone remodeling sites in the upper jaw from pressure on the palate.

Additionally, the expansion appliance approach uses conventional mechanics in braces after the expansion, which does not allow the mandible (lower jaw) to remodel properly. TMJs do not have maximum opportunity to heal, and there is no significant improvement to the airway.

You cannot compare AGGA’s full facial orthopedic rejuvenation with any other form of orthodontics. Face forward remodeling of both jaws is far more therapeutic and physiologic, with profound ability to heal TMD.

Does AGGA correct facial asymmetries/cranial strains?

Cranial strains impact the tough, outermost membrane of the brain and spinal cord. Resulting tension limits movement of fluid around the brain and spinal cord, creating a myriad of symptoms including facial asymmetries.

The remodeling response to AGGA stimulation incudes sutural activity in the Pterygoid plates behind the upper jaw which interface with the sphenoid bone. The induced dynamic state of actively remodeling the nasomaxillary complex allows for cranial release in the sphenoid even without osteopathic manipulation. However, it is more predictable with adjunctive treatment.

What does that mean to the patient? Once cranial release in the sphenoid occurs, the body is free to correct all kinds of distortions in the face and upper jaw, including width, twisting, and tilt in the upper jaw – naturally!

The AGGA patient who is being treated by an osteopath may experience further reduction in pain and symptoms as cranial strain patterns are reduced. Combining AGGA with craniosacral therapy or neurocranial restructuring unwinds these cranial strains, improving facial symmetry in a way no other type of orthodontic expansion appliance can accomplish.

Will AGGA cause gum recession?

AGGA does not move teeth. Rather it stimulates bone remodeling and teeth follow. AGGA encourages bone to build on the outer side the teeth. It is far safer than putting pressure on the teeth, as conventional orthodontics does. However, pre-existing recession or bone loss under the gum may not be visible at the start of treatment. When that situation is present, any orthodontic movement can increase degree of recession. Gum grafting can be performed to cover roots before orthodontics, or in some cases, after treatment.

How long does forward face orthodontics take?

That depends on how many millimeters of forward growth is prescribed by the Facial Beauty Institute evaluation and treatment plan report. Average growth occurs at a rate of 1mm per month for adults and 2mm per month for teens. For example, if you need the average 6 to 8mm of growth seen in most patients, it will take 6 to 8 months in AGGA treatment. When full forward development is complete, we transition into the protractive ControlledArch braces to torque roots to proper angulation, protract premolars and molars forward into the space developed behind the cuspids, and align teeth to a straight, appealing smile. Once forward development has taken place, there is plenty of space to move teeth where they need to be. They glide into position in the newly developed jaw quite easily. ControlledArch braces take much less time than conventional orthodontics. You can expect the braces phase to last 12 to 18 months after AGGA, to finalize forward face orthodontic treatment.

What about retainers and sleep appliances?

Once ControlledArch orthodontic treatment is complete, a fixed mesh wire is bonded to the back surface of the lower six teeth, and in some cases the upper six teeth.

A conventional nightguard or any other type of appliance that impedes tongue space is not recommended. Dr. Hughes provides a physiologic sleep appliance for any patient who has TMD (temporomandibular joint disorder) and/or OSA (obstructive sleep apnea). This thin nighttime appliance takes up very little tongue space. It stabilizes correct position of the lower jaw as muscles relax when sleeping on the back. It also acts as a retainer, preventing tooth movement during sleep.

How to explore the developmental orthodontics for teens & Adults further?

Your first visit is a 90-minute consultation with Dr. Hughes and her treatment coordinator. During this appointment:

  • Photos are taken
  • Computer EMG scans are run to evaluate muscle health
  • A T-scan computerized bite analysis is completed

Dr. Hughes reviews concerns and symptoms, and asks questions about your ultimate goals for treatment. She provides a tentative diagnosis and talks with you about preliminary treatment plan options. You receive an estimate of treatment cost. The consultation fee is $250, which is credited toward your treatment fee should you proceed with jaw development orthodontic treatment at Boulder Valley Dental Center.

If you decide to move forward with treatment, additional scans and testing may be needed for a definitive diagnosis and treatment plan. You may be referred to a radiologist for a CBCT scan (approximate fee $300 to $400) and sent home with a sleep testing device to rule out potential sleep disordered breathing issues (approximate fee $175). Dr. Hughes reviews the CBCT scan and uploads it to the Facial Beauty Institute for final evaluation, jaw tracings, airway assessment, and treatment plan recommendations for AGGA and/or ControlledArch Braces (approximate fee $475).

Are adjunct therapies or referrals to specialists needed during treatment?

It is crucial to have “The Big 3” in place for orthodontic treatment to be successful:

  • Nasal patency – unimpeded flow of air through the nose
  • Lip seal – absence of mouth breathing
  • Proper tongue position – absence of destructive tongue habits and improper swallow

If any of The Big 3 are compromised, you are given additional recommendations to correct the issues. If you have a tongue thrust or tongue tie, you may be referred to a myofunctional therapist to help retrain your tongue to the correct position during rest and swallowing. If tongue tie is severe, you may need to have it released; a minor procedure performed by an oral surgeon. If you have nasal patency issues, Dr. Hughes may refer you to an ENT to evaluate your nasal sinus including turbinates and nasal septum. Younger patients who snore may be referred for tonsillectomy and adenoidectomy, for optimal breathing and oxygenation.

If you have facial asymmetries, Dr. Hughes may ask you to see an osteopath for adjunct cranial therapies. If your scan shows issues with neck or posture, you may be referred to a chiropractor or physical therapist for adjustments and posture exercises. Dr. Hughes has excellent working relationships with many of these specialists, and is happy to send you in the right direction for optimum adjunctive care.

If you have read all the way to the end of this section, thank you for your interest in developmental orthodontics for teens & adults . . . and congratulations! You have taken the first important step in discovering how comfortable, functional, and attractive results of treatment can be. Now take the next step – call 303-666-8820 to schedule your consultation with Dr. Hughes at Boulder Valley Dental Center in Louisville, CO.