Download - Spreecast 2014 whats an ro to do
Whatrsquos an RO to doA replay of the March 2014
IAFGG Annual SymposiumCalgary Alberta
dr barry raphaelthe raphael center for integrative orthodontics
the raphael center for integrative education
wwwalignminecombioblocnjcom
drbarryalignminecom
IAFGG 2014
SOFT TISSUE DYSFUNCTION
With Chronic Open Mouth Posture
Comparison of Unsupported vs Supported Growth
The End
The Beginning
Everyday in my practice
RO since1983 (30 yearsyikes)
Bucknell University 1974University of Pennsylvania 1978
(Three Years in General Practice)Fairleigh-Dickenson University 1983
14 Instructors 14 Techniques
RO since1983 (30 yearsyikes)
Bucknell University 1974University of Pennsylvania 1978
(Three Years in General Practice)Fairleigh-Dickenson University 1983
My Dream Office 2001
1Crooked teeth are THE PROBLEM
2The lower incisor must be upright
3Patients donrsquot want to cooperate
4Straightened teeth arenrsquot stable
In the ROrsquos Mind
1Crooked teeth are THE PROBLEM
2The lower incisor must be upright
3Patients donrsquot want to cooperate
4Straightened teeth arenrsquot stable
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
A Change of Mind
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
George Catlin
Are we developing the wayour genes program us to be
Westin Price
Kevin Boyd
Peter Gluckman
Neese and Williams
Scott Gilbert
Clark Spencer Larsen
Darwinian Dentistry
MeJames
Sim Wallace
Obesity
Metabolic SyndromeCeliac
Intestinal PermeabilityType 2 Diabetes
Fatty Liver Disease Cardiovascular Disease
HypertensionSome Cancers
The Results of the MismatchBetween Genes and the Environment
Chronic Non-Communicable Diseases of CivilizationWestern Lifestyle Diseases
Asthma
Autism
Aspergerrsquos
Alzheimers
ADDADHDDepression
Chronic Back Pain
Osteoporosis
Caries
Malocclusion
Sleep Apnea
The Toothberg
Airway-Related Craniofacial Dysfunctions
bullChronic Naso-pharyngeal Obstructionbull Tongue form aberrations (Frenum and tongue-tie)bullOpen Mouth Rest Posture bullMyofunctional disorders (Swallowing chewingetc)bullChronic Hyperventilation and Hypocapniabull Breathing Disordered Sleep (OSA UARS snoring)bull Bruxism and parafunctionsbull TMD and facial pain componentsbullCranial and postural issuesbull Malocclusion
Airway Orthodontics
bullEarly Feeding and Nutrition
bullAllergies Asthma URT infections
bullPosture
bullAirway Breathing and Sleep Disorders
bullSoft Tissue Dysfunctions (Tongue Thrust Open Mouth)
Instead of crooked teeth being The ProblemThey are just a SYMPTOM of something larger
Parentrsquos Private-eye Sheet
Parentrsquos Private-eye Sheet
ldquoThere are many things about your childrsquos health that are important to know but that I often donrsquot get to see at the office Also there are signs to look for that you may not have known were connected to your childrsquos teeth or health By looking for and tracking these ldquosigns and symptomsrdquo we can get a better handle on the problem and watch for resolution
You donrsquot have to spend a lot of time with this but donrsquot rush either Watch for certain things at different times of day Try not to let your child know they are being watched You want to see the most natural behaviors
Check off what you see If yoursquore not sure check it anyway and wersquoll talk about it Make comments if you wantrdquo
While sitting around
While sitting around (watching TV in the car) does your child
put ldquothingsrdquo in the mouth alot (toys sleeves pencils fingernails etc) ______________________________
lick or suck on the lips have the lips apart even a little stick or dart the tongue out of the mouth have the tongue resting between the teeth lean the cheek on a hand breath with his mouth open even a little bit make noises when breathing have trouble sitting still
While talking
While talking does your child talk very fast talk very slowly gasp for air have a lisp take speech lessons
During a meal
During a meal does your child gasp for air while eating stick his tongue between his teeth when swallowing stick the tongue out to meet the drinking glass drink a lot while eating make noises when chewing eat sloppily take a breath before drinking puff the cheeks out when drinking make the lips purse when swallowing make the chin ldquocrinklerdquo when swallowing bob the head when swallowing have trouble sitting still
While sleeping
While sleeping does your child have the mouth open snore wet the bed toss and turn tilt the head back wake up frequently have frequent nightmares have abnormal sleep issues grind the teeth have trouble waking up wake with darker circles under eyes
S R 10-10yo M
bullMissing 3242bullImpacted 1323bullLate mixed 25 eruptedbullSoft tissue dysfunctionbullIL = 40bullNot compliant
S Reardon 10-7yo M
Impacted 3s Missing 2s
Medical history
bull Reactive Airway Diseasebull ldquoBronchial Constrictionrdquo bullCare of Pulmonologistbull Preventil
bull Dad OSA CPAP for 11 years diabetesbull Grandfather OSA untreatedbull ETCO2 = 361 at 10 bpm (acceptable)bull Posture number - 18 (lt10 ideal)bull Father refuses sleep screening
Treatment Options1 Extract upper premolars Align2Open spaces for impacted canines Open spaces for lower lateral implants
Whatrsquos more importantEase of treatment
OrBreathing well at night
Bolton Standards15yo
The Maxilla is Down and Back
The Mandible is Retrognathic
Nasal Cartilage Collapse
Insufficient Facial Support
Bi-maxillary Retrusion
Bimaxillary Retrusion Forward Growth
Mouthbreathers have significantly smaller airway space
(measurements PAS-OccL PAS-UP airway volume area and minimum axial area)
Mouth breather Nasal breather
Three-dimensional assessment of pharyngeal airway in nasal- and mouth-breathing children
Alves M etal Int J Ped ORL 75 (2011) 1195ndash1199
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
B Hockel 2012
This is the profile Biobloc children start with long and retrusive
This is the profile Biobloc children finish with Forward with lips
together
B Hockel 2012
Herersquos the ldquoinsiderdquo look Notice how the upper front teeth are closer to the nose (yellow arrows)
Notice how the lower jaw rotates around the star so the chin comes up and forward (red arrow)How do we make this happen
From the tip of the Central
To the Forwardmost Tip of the Nose
41mm
Maxillary Heightbull Indicator Line (Mew)
bull Distance from most anterior point on nose to upper incisal edge
bull Age + 23bull A variable number but important to watch over time
B Hockel 2012
Herersquos the ldquoinsiderdquo look Notice how the upper front teeth are closer to the nose (yellow arrows)
Notice how the lower jaw rotates around the star so the chin comes up and forward (red arrow)How do we make this happen
Using IndicatorCosmetic Line
bull To define a starting pointbull To set treatment goalsbull To track treatment progressbull To gauge the effectiveness of treatment
Charting the InCos Line
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Incisor pulled away from noseNot ldquoundertorquedrdquo or ldquogummy smilerdquo
Hypothetical ClI OrthoMARA
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
OJ = 7mm
Starts Ortho
ldquoGreat Headgear
Effectrdquo
Class II Elastics
50
40
30
20mm
y J F M A M J J A S O N
boys
Start Non-x
Expansion UncrowdingFinished
Start Cl II elastics
OK thatrsquos
enough
Hypothetical Mouthbreather(Dr Mewrsquos Hamster Boy)
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Boy gets
hamster
MFT
Hypothetical BBO 7yoM
50
40
30
20
5 6 7 8 9 10 11 12 13 14 15
girlsboys
Initial
StartBB1
BB3
Night
bullLR 11-9yFbullMissing all 5s6s8s and upper 4sbullHad ortho to close diastemahellipbullInL = 39bullGP objects to deX plan equil
LR Tx Plan
1Preparation Hang Expanser2deX 3Training BB3 to advance mandible4Myofunctional Therapy5Orthopostural Training6Myobrace to hold7 Reevaluate for dental detailing
LR Spotty progress
50
40
30
20mm
y 313 4 5 6 7 8 9 10 11 12114
2 3
Expanser
Parents dragging30 turnsStart Adv
Rx deXGP
objects
After delays
Equil ersquosBB3
bullLR 12-3 yF (6mo in tx)bullInL = 37 (+2)bull ersquos equilibratedbull OJ =10bull Appliance OJ = 5bull Still accommodating to BB3
Is there a calculus for the Indicator Line
Treatment GoalsBased on Indicator Line
Incisor Goals
Type 1 Treatment Place U1 in ideal position
Biobloc Orthotropics Orthognathic Surgery Distraction Osteogenesis
Type 1 Ideal InCos line
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
YZ 9yo M
bullLost upper d-spacebullInL = 36(+4)bullOJ = 9mmbullLip entrapmentbullLip Incompetence
Y Z 9yo M
Y Z 9yo M9mm OJ
Y Z 9yo M
Treatment Options
1 Type 1 Reduce InL open lost space BB3 to advance mandible
2 Type 2 Open lost space Align
3 Type 4 Extract four premolars
YZ 9yoM
50
40
30
20mm
yM A M J J A S O N D J F M A
boys
Hang Expanser
Upper and Lower
Brackets Hang Retainer
BB3
Incisor Goals
Type 2 Treatment Develop arch just enough to uncrowd
Biobloc Myofunctional Ortho Myofunctional Therapy Crozat ALF Expansion Orthodontics
Type 2 Uncrowding
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
bullLip incompetencebullLip entrapmentbullHypermentalisbullMouthbreathing
Type 2 Uncrowding
12 month progress
12 month progress
12 month progress
After Treatment
Bent-wire6 monthsMyobrace12 months
Hey RaphaelWhat about that
profile
ZP 9-5yoM
i
After Expansion Phase
Incomplete profile improvement better breathing head posture and sleep
Incisor Goals
Type 3 Treatment Maintain UI
Functional Orthodontics Expansion Orthodontics Distalization Ortho or No Treatment
Type 3 Maintain
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Bimax retrusion
Successful dental result
Profile Unimproved
Incisor Goals
Type 4 Treatment RetractExtrude UI
Extraction Orthodontics Retraction Ortho Distalization Ortho
Type 4 Retraction
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Bimax retrusion
Successful dental result
Failed Profile Result
Changes of pharyngeal airway size and hyoid bone position following orthodontic treatment of
Class I bimaxillary protrusion
Qingzhu Wanga Peizeng Jiab Nina K Andersonc Lin Wangd Jiuxiang Line
Angle Orthodontist Vol 00 No 0 0000 (pre-publication 2012)
ldquothe dimension of the velopharynx glossopharynx and hypopharynx were decreased after maximal retraction of anterior teeth with extraction of four premolarshelliprdquo ldquoAny factors that can influence the posture and position of tongue and soft palate may displace them backward andencroach upon the pharynxrdquo
ldquothe more the incisors were retracted the more the pharyngeal airway was reducedrdquo
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Backed into a corner
bull
Moving teeth faster more efficientlyhellipin the wrong direction
Now that wersquove made smoking unacceptable
could we not do the same withbull Sugarbull Processed foodbull Cheap milk and meatbull Fast foodbull Pill popping for symptomatic reliefbull Looking for the cure instead of the causebull Surgery as a quick fixbull Thinking braces are a status symbol
Each industry thrives on the status quoConsumers must drive the change
NP 10yM
NP
Sisterrsquos non-x ortho
Shersquos happyhellipbut Irsquom not so
I make my pitch for BBO
The dilemma of progress
(I forgot the progress pictureshellip)
Dad sells prosthetic parts to orthopedic surgeons
I selling the case against my previous work they loved
It takes me 3 hours to sell the case
They fret until the BB3 goes in
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Connecting the dots
bull Adult SDB and OSA
bull Narrow jaws and faces
bull Soft tissue dysfunction
bull Early parafunctional habits ie open mouth posture
bull Environmental stressors
bull CPAP MARAUPPP SurgWherersquos the best
place to start treatment here
or here
1 Prevention 2 Undo the damage already done3 Establish good habits
When to start When damage from poor breathing is noticed and when bad habits are discovered
The strategies of Airway Orthodontics
Prevention
bull Remove ankyloglossiabull Promote breastfeedingbull Harden the dietbull Develop masticatory strengthbull Discourage oral habitsbull Promote whole-foods low sugar dietbull Reduce oropharyngeal obstructionbull Promote nasal breathing
Breathing retraining
bull Nasal rinsingbull Nasal clearingbull Decongesting
The goals of Airway Orthodontics
1 Breathing through the nose2 Lips together at rest3 Correct tongue position4 No facial muscles moving on swallowing5 Optimal forward facial development6 Class I occlusion7 Straight teeth8 Better stability long term
Myofunctional Trainers
Professors R Soulet and A Besombes
Dr Earl Bergeson
Dr Chris Farrell
The Multi ndash Family System
Orofacial MyofunctionalTherapy
Oral MyologyMyofunctional TherapyTongue Thrust Therapy
B Hockel 2012 Back
Undoing Bimaxillary Dysplasia
1 Maxillary deconstriction2 Maxillary advancement3 Maxillary impaction4 Mandibular advancement
1 Maxillary Expansion
Treatment for Bimaxillary Dysplasia
ALFCrozat
Bent Wire
HyraxHaas
Niti Exp BioBlocSchwartz
The Farrell BENT WIRE Systemtrade
Recommended Age Group 5-12 yrs
Arch Development in conjunction with the TRAINER Systemtrade
Dr John Mew
Establish Good Habits
1 Breathing through the nose2 Lips together at rest3 Correct tongue position4 No facial muscles moving on swallowing5 Stand and sit in balance6 Breath gently using the diaphragm7 Eat to nourish8 Sleep to rest
Ortho-Postural TrainingWorkshops
Breathing
Nutrition
Posture
Sleep
COPYRIGHTRoger L PriceOctober 2012
Posture Number
Forward head posturecan be a compensationfor a deficient airway
Sleep Screening and Hygiene
SQI = 10 SQI = 98
Integrative Healthcare
Function ProfessionalNasal clearing ENT Pulm MFT BreathingMuscle balance and tone MFT Myofunctional OrthoUndoing damage GP Pedo Ortho OMFSBreathing dynamics OPT MFT Breath PhysiologistPosture DC OPT PT OsteopathCranial balance OsteopathNutrition RDH Nutritionist Dietitian Sleep ENT Sleep Med DentNeurocognitive development Pedrsquon SLP Psych SpEd
The Interdisciplinary Center
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Now that I know
My personal missionTo create from what Irsquove
learned from the besta model for others to followhellipespecially the orthodontists
Myofunctional Orthodontics
Chris Farrell
John Flutter
German Ramierez
Damien OrsquoBrien
Myofunctional Research CoRancho Cucamonga
2008-2012
Oral Myology
Oral Myology Basic CourseJoy MoellerNYC 2011LA 2012
Oral Myology Levels 2 3Kim BenkertClifton 2012
Habit CessationShari GreenClifton 2013
Biobloc Orthotropics
BBO Mini-residencyBill Hang
Agora Hills2012-13
BBO IntensiveDrs John and Mike
MewLSFO2013
Breathing and Sleep
Buteyko MentorshipThe Breathing Center
Woodstock2010
Breathing Well ProgrammeJohn Flutter
2010 Ortho-Postural TrainingRoger Price
2013
Sleep DentistryMichael Gelb etal
NYU2012
ALF and Cranial
Jim Bronson2013 Tasha Turzo
Cranial Academy2014
Bucket Listbull ALF and Crozat (Bronsonrsquos course)bullMore on Biobloc (Hangrsquos Advanced London School)bull More Cranial (The Farm)bullChirodontics (Bob Walker)bull Airway Dentistry with Marc Cruz Jeff Rousebull Sleep Dentistrybull Less-than-Six with Kevin Boydbull Intra-mandibular Distraction Osteogenesis (IMDO)
Off My ListAnything that moves the teeth faster in the wrong direction
Whatrsquos an RO to do
To create from what Irsquove learned from the best
a model for others to followhellipespecially orthodontists
Teaching
Mt Sinai Pedo ResidencyAli Attaie
2010-2012
Montefiore Ortho ResidencyTony Maganzini
2012
2009-Present
Mt Sinai School of MedicinePedodontic Residency
Guest SpeakersJim BronsonMike MewKevin BoydSandra KahnJennifer TowRoger PricePaula Fabbie
Damien OrsquoBrien
First clinical program in myofunctional orthodontics
Airway and Facial DevelopmentCollaborative Webcast
Mark Cruz
AAPMD Symposium
wwwaapm
dorg
Annual MeetingApril 25-26 2014
Westin Chicago North Shore
the raphael center for integrative orthodontics
wwwalignminecomwwwbioblocnjcom
wwwmyobracenjcom
Integrative vs Conventional
Integrative vs Conventional
ldquoWith improvements in expansion orthodontics advances in myofunctional orthodontics and the growing recognition about sleep disordered breathing among children and adults it is time for orthodontics to expand its horizons There is now so much more we can oerrdquo
The Raphael name has been associated with high quality orthodontics in New Jersey for over 60 years Dr Barry Raphael has been a university trained orthodontic specialist and a member of the American Association of Orthodontists for 30 years
He has a wide range of techniques and services to offer He has studied oral myology applied kinesiology Buteyko breathing Biobloc Orthotropics and Myobrace as part of his integrative training He can offer Damon Invisalign Insignia and Incognito appliances designs as some of his many conventional orthodontic services too
Dr Raphael teaches his techniques at post-graduate residencies study clubs dental societies and for the Myofunctional Research Co He is available for presentations to any group interested in learning more about the benefits of integrative orthodontics
wwwalignminecomLearn about the choices you have in orthodontics
dr barry raphael Why its
too Early never
1425
bro
ad
str
ee
tc
lifto
n n
j 070
13
973-
778-
4222
fax
973-
778-
9625
nj s
pe
c
368
4
1425 broad street clifton nj 07013973-778-4222
wwwalignminecom
the raphael centerforintegrative orthodontics
the
raph
ael c
ente
r fo
rin
tegr
ativ
e or
thod
onti
cs
Learn about an important choice you need to make before starting braces
the raphael center for integrative education
the raphael center for integrative education
Ongoing Intro to Airway Orthodontics
April Biobloc Study Group
April Training Ortho-Postural Therapists w Roger Price
June MRC Myobrace Basic Series
August Airway Dentistry with Mark Cruz and company
October Advanced MFT with Sandy Coulson
October Less than Six with Kevin Boyd
(who else wants to play)
Mission to create a space for spreading the word about Airway and Orthotropic principles and practice
Orthodontics in the 21st Century
EstheticOrthodontics
AirwayOrthodontics
GeneticTooth-Focused
Dental PerfectionEsthetics Primary
Treating SymptomsAirway Ignorant
AdaptationMuscle-FocusedMedical Better
Esthetics SecondaryTreating Causes
Airway Conscious
The EndAnd
The Beginning
IAFGG 2014
SOFT TISSUE DYSFUNCTION
With Chronic Open Mouth Posture
Comparison of Unsupported vs Supported Growth
The End
The Beginning
Everyday in my practice
RO since1983 (30 yearsyikes)
Bucknell University 1974University of Pennsylvania 1978
(Three Years in General Practice)Fairleigh-Dickenson University 1983
14 Instructors 14 Techniques
RO since1983 (30 yearsyikes)
Bucknell University 1974University of Pennsylvania 1978
(Three Years in General Practice)Fairleigh-Dickenson University 1983
My Dream Office 2001
1Crooked teeth are THE PROBLEM
2The lower incisor must be upright
3Patients donrsquot want to cooperate
4Straightened teeth arenrsquot stable
In the ROrsquos Mind
1Crooked teeth are THE PROBLEM
2The lower incisor must be upright
3Patients donrsquot want to cooperate
4Straightened teeth arenrsquot stable
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
A Change of Mind
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
George Catlin
Are we developing the wayour genes program us to be
Westin Price
Kevin Boyd
Peter Gluckman
Neese and Williams
Scott Gilbert
Clark Spencer Larsen
Darwinian Dentistry
MeJames
Sim Wallace
Obesity
Metabolic SyndromeCeliac
Intestinal PermeabilityType 2 Diabetes
Fatty Liver Disease Cardiovascular Disease
HypertensionSome Cancers
The Results of the MismatchBetween Genes and the Environment
Chronic Non-Communicable Diseases of CivilizationWestern Lifestyle Diseases
Asthma
Autism
Aspergerrsquos
Alzheimers
ADDADHDDepression
Chronic Back Pain
Osteoporosis
Caries
Malocclusion
Sleep Apnea
The Toothberg
Airway-Related Craniofacial Dysfunctions
bullChronic Naso-pharyngeal Obstructionbull Tongue form aberrations (Frenum and tongue-tie)bullOpen Mouth Rest Posture bullMyofunctional disorders (Swallowing chewingetc)bullChronic Hyperventilation and Hypocapniabull Breathing Disordered Sleep (OSA UARS snoring)bull Bruxism and parafunctionsbull TMD and facial pain componentsbullCranial and postural issuesbull Malocclusion
Airway Orthodontics
bullEarly Feeding and Nutrition
bullAllergies Asthma URT infections
bullPosture
bullAirway Breathing and Sleep Disorders
bullSoft Tissue Dysfunctions (Tongue Thrust Open Mouth)
Instead of crooked teeth being The ProblemThey are just a SYMPTOM of something larger
Parentrsquos Private-eye Sheet
Parentrsquos Private-eye Sheet
ldquoThere are many things about your childrsquos health that are important to know but that I often donrsquot get to see at the office Also there are signs to look for that you may not have known were connected to your childrsquos teeth or health By looking for and tracking these ldquosigns and symptomsrdquo we can get a better handle on the problem and watch for resolution
You donrsquot have to spend a lot of time with this but donrsquot rush either Watch for certain things at different times of day Try not to let your child know they are being watched You want to see the most natural behaviors
Check off what you see If yoursquore not sure check it anyway and wersquoll talk about it Make comments if you wantrdquo
While sitting around
While sitting around (watching TV in the car) does your child
put ldquothingsrdquo in the mouth alot (toys sleeves pencils fingernails etc) ______________________________
lick or suck on the lips have the lips apart even a little stick or dart the tongue out of the mouth have the tongue resting between the teeth lean the cheek on a hand breath with his mouth open even a little bit make noises when breathing have trouble sitting still
While talking
While talking does your child talk very fast talk very slowly gasp for air have a lisp take speech lessons
During a meal
During a meal does your child gasp for air while eating stick his tongue between his teeth when swallowing stick the tongue out to meet the drinking glass drink a lot while eating make noises when chewing eat sloppily take a breath before drinking puff the cheeks out when drinking make the lips purse when swallowing make the chin ldquocrinklerdquo when swallowing bob the head when swallowing have trouble sitting still
While sleeping
While sleeping does your child have the mouth open snore wet the bed toss and turn tilt the head back wake up frequently have frequent nightmares have abnormal sleep issues grind the teeth have trouble waking up wake with darker circles under eyes
S R 10-10yo M
bullMissing 3242bullImpacted 1323bullLate mixed 25 eruptedbullSoft tissue dysfunctionbullIL = 40bullNot compliant
S Reardon 10-7yo M
Impacted 3s Missing 2s
Medical history
bull Reactive Airway Diseasebull ldquoBronchial Constrictionrdquo bullCare of Pulmonologistbull Preventil
bull Dad OSA CPAP for 11 years diabetesbull Grandfather OSA untreatedbull ETCO2 = 361 at 10 bpm (acceptable)bull Posture number - 18 (lt10 ideal)bull Father refuses sleep screening
Treatment Options1 Extract upper premolars Align2Open spaces for impacted canines Open spaces for lower lateral implants
Whatrsquos more importantEase of treatment
OrBreathing well at night
Bolton Standards15yo
The Maxilla is Down and Back
The Mandible is Retrognathic
Nasal Cartilage Collapse
Insufficient Facial Support
Bi-maxillary Retrusion
Bimaxillary Retrusion Forward Growth
Mouthbreathers have significantly smaller airway space
(measurements PAS-OccL PAS-UP airway volume area and minimum axial area)
Mouth breather Nasal breather
Three-dimensional assessment of pharyngeal airway in nasal- and mouth-breathing children
Alves M etal Int J Ped ORL 75 (2011) 1195ndash1199
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
B Hockel 2012
This is the profile Biobloc children start with long and retrusive
This is the profile Biobloc children finish with Forward with lips
together
B Hockel 2012
Herersquos the ldquoinsiderdquo look Notice how the upper front teeth are closer to the nose (yellow arrows)
Notice how the lower jaw rotates around the star so the chin comes up and forward (red arrow)How do we make this happen
From the tip of the Central
To the Forwardmost Tip of the Nose
41mm
Maxillary Heightbull Indicator Line (Mew)
bull Distance from most anterior point on nose to upper incisal edge
bull Age + 23bull A variable number but important to watch over time
B Hockel 2012
Herersquos the ldquoinsiderdquo look Notice how the upper front teeth are closer to the nose (yellow arrows)
Notice how the lower jaw rotates around the star so the chin comes up and forward (red arrow)How do we make this happen
Using IndicatorCosmetic Line
bull To define a starting pointbull To set treatment goalsbull To track treatment progressbull To gauge the effectiveness of treatment
Charting the InCos Line
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Incisor pulled away from noseNot ldquoundertorquedrdquo or ldquogummy smilerdquo
Hypothetical ClI OrthoMARA
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
OJ = 7mm
Starts Ortho
ldquoGreat Headgear
Effectrdquo
Class II Elastics
50
40
30
20mm
y J F M A M J J A S O N
boys
Start Non-x
Expansion UncrowdingFinished
Start Cl II elastics
OK thatrsquos
enough
Hypothetical Mouthbreather(Dr Mewrsquos Hamster Boy)
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Boy gets
hamster
MFT
Hypothetical BBO 7yoM
50
40
30
20
5 6 7 8 9 10 11 12 13 14 15
girlsboys
Initial
StartBB1
BB3
Night
bullLR 11-9yFbullMissing all 5s6s8s and upper 4sbullHad ortho to close diastemahellipbullInL = 39bullGP objects to deX plan equil
LR Tx Plan
1Preparation Hang Expanser2deX 3Training BB3 to advance mandible4Myofunctional Therapy5Orthopostural Training6Myobrace to hold7 Reevaluate for dental detailing
LR Spotty progress
50
40
30
20mm
y 313 4 5 6 7 8 9 10 11 12114
2 3
Expanser
Parents dragging30 turnsStart Adv
Rx deXGP
objects
After delays
Equil ersquosBB3
bullLR 12-3 yF (6mo in tx)bullInL = 37 (+2)bull ersquos equilibratedbull OJ =10bull Appliance OJ = 5bull Still accommodating to BB3
Is there a calculus for the Indicator Line
Treatment GoalsBased on Indicator Line
Incisor Goals
Type 1 Treatment Place U1 in ideal position
Biobloc Orthotropics Orthognathic Surgery Distraction Osteogenesis
Type 1 Ideal InCos line
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
YZ 9yo M
bullLost upper d-spacebullInL = 36(+4)bullOJ = 9mmbullLip entrapmentbullLip Incompetence
Y Z 9yo M
Y Z 9yo M9mm OJ
Y Z 9yo M
Treatment Options
1 Type 1 Reduce InL open lost space BB3 to advance mandible
2 Type 2 Open lost space Align
3 Type 4 Extract four premolars
YZ 9yoM
50
40
30
20mm
yM A M J J A S O N D J F M A
boys
Hang Expanser
Upper and Lower
Brackets Hang Retainer
BB3
Incisor Goals
Type 2 Treatment Develop arch just enough to uncrowd
Biobloc Myofunctional Ortho Myofunctional Therapy Crozat ALF Expansion Orthodontics
Type 2 Uncrowding
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
bullLip incompetencebullLip entrapmentbullHypermentalisbullMouthbreathing
Type 2 Uncrowding
12 month progress
12 month progress
12 month progress
After Treatment
Bent-wire6 monthsMyobrace12 months
Hey RaphaelWhat about that
profile
ZP 9-5yoM
i
After Expansion Phase
Incomplete profile improvement better breathing head posture and sleep
Incisor Goals
Type 3 Treatment Maintain UI
Functional Orthodontics Expansion Orthodontics Distalization Ortho or No Treatment
Type 3 Maintain
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Bimax retrusion
Successful dental result
Profile Unimproved
Incisor Goals
Type 4 Treatment RetractExtrude UI
Extraction Orthodontics Retraction Ortho Distalization Ortho
Type 4 Retraction
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Bimax retrusion
Successful dental result
Failed Profile Result
Changes of pharyngeal airway size and hyoid bone position following orthodontic treatment of
Class I bimaxillary protrusion
Qingzhu Wanga Peizeng Jiab Nina K Andersonc Lin Wangd Jiuxiang Line
Angle Orthodontist Vol 00 No 0 0000 (pre-publication 2012)
ldquothe dimension of the velopharynx glossopharynx and hypopharynx were decreased after maximal retraction of anterior teeth with extraction of four premolarshelliprdquo ldquoAny factors that can influence the posture and position of tongue and soft palate may displace them backward andencroach upon the pharynxrdquo
ldquothe more the incisors were retracted the more the pharyngeal airway was reducedrdquo
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Backed into a corner
bull
Moving teeth faster more efficientlyhellipin the wrong direction
Now that wersquove made smoking unacceptable
could we not do the same withbull Sugarbull Processed foodbull Cheap milk and meatbull Fast foodbull Pill popping for symptomatic reliefbull Looking for the cure instead of the causebull Surgery as a quick fixbull Thinking braces are a status symbol
Each industry thrives on the status quoConsumers must drive the change
NP 10yM
NP
Sisterrsquos non-x ortho
Shersquos happyhellipbut Irsquom not so
I make my pitch for BBO
The dilemma of progress
(I forgot the progress pictureshellip)
Dad sells prosthetic parts to orthopedic surgeons
I selling the case against my previous work they loved
It takes me 3 hours to sell the case
They fret until the BB3 goes in
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Connecting the dots
bull Adult SDB and OSA
bull Narrow jaws and faces
bull Soft tissue dysfunction
bull Early parafunctional habits ie open mouth posture
bull Environmental stressors
bull CPAP MARAUPPP SurgWherersquos the best
place to start treatment here
or here
1 Prevention 2 Undo the damage already done3 Establish good habits
When to start When damage from poor breathing is noticed and when bad habits are discovered
The strategies of Airway Orthodontics
Prevention
bull Remove ankyloglossiabull Promote breastfeedingbull Harden the dietbull Develop masticatory strengthbull Discourage oral habitsbull Promote whole-foods low sugar dietbull Reduce oropharyngeal obstructionbull Promote nasal breathing
Breathing retraining
bull Nasal rinsingbull Nasal clearingbull Decongesting
The goals of Airway Orthodontics
1 Breathing through the nose2 Lips together at rest3 Correct tongue position4 No facial muscles moving on swallowing5 Optimal forward facial development6 Class I occlusion7 Straight teeth8 Better stability long term
Myofunctional Trainers
Professors R Soulet and A Besombes
Dr Earl Bergeson
Dr Chris Farrell
The Multi ndash Family System
Orofacial MyofunctionalTherapy
Oral MyologyMyofunctional TherapyTongue Thrust Therapy
B Hockel 2012 Back
Undoing Bimaxillary Dysplasia
1 Maxillary deconstriction2 Maxillary advancement3 Maxillary impaction4 Mandibular advancement
1 Maxillary Expansion
Treatment for Bimaxillary Dysplasia
ALFCrozat
Bent Wire
HyraxHaas
Niti Exp BioBlocSchwartz
The Farrell BENT WIRE Systemtrade
Recommended Age Group 5-12 yrs
Arch Development in conjunction with the TRAINER Systemtrade
Dr John Mew
Establish Good Habits
1 Breathing through the nose2 Lips together at rest3 Correct tongue position4 No facial muscles moving on swallowing5 Stand and sit in balance6 Breath gently using the diaphragm7 Eat to nourish8 Sleep to rest
Ortho-Postural TrainingWorkshops
Breathing
Nutrition
Posture
Sleep
COPYRIGHTRoger L PriceOctober 2012
Posture Number
Forward head posturecan be a compensationfor a deficient airway
Sleep Screening and Hygiene
SQI = 10 SQI = 98
Integrative Healthcare
Function ProfessionalNasal clearing ENT Pulm MFT BreathingMuscle balance and tone MFT Myofunctional OrthoUndoing damage GP Pedo Ortho OMFSBreathing dynamics OPT MFT Breath PhysiologistPosture DC OPT PT OsteopathCranial balance OsteopathNutrition RDH Nutritionist Dietitian Sleep ENT Sleep Med DentNeurocognitive development Pedrsquon SLP Psych SpEd
The Interdisciplinary Center
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Now that I know
My personal missionTo create from what Irsquove
learned from the besta model for others to followhellipespecially the orthodontists
Myofunctional Orthodontics
Chris Farrell
John Flutter
German Ramierez
Damien OrsquoBrien
Myofunctional Research CoRancho Cucamonga
2008-2012
Oral Myology
Oral Myology Basic CourseJoy MoellerNYC 2011LA 2012
Oral Myology Levels 2 3Kim BenkertClifton 2012
Habit CessationShari GreenClifton 2013
Biobloc Orthotropics
BBO Mini-residencyBill Hang
Agora Hills2012-13
BBO IntensiveDrs John and Mike
MewLSFO2013
Breathing and Sleep
Buteyko MentorshipThe Breathing Center
Woodstock2010
Breathing Well ProgrammeJohn Flutter
2010 Ortho-Postural TrainingRoger Price
2013
Sleep DentistryMichael Gelb etal
NYU2012
ALF and Cranial
Jim Bronson2013 Tasha Turzo
Cranial Academy2014
Bucket Listbull ALF and Crozat (Bronsonrsquos course)bullMore on Biobloc (Hangrsquos Advanced London School)bull More Cranial (The Farm)bullChirodontics (Bob Walker)bull Airway Dentistry with Marc Cruz Jeff Rousebull Sleep Dentistrybull Less-than-Six with Kevin Boydbull Intra-mandibular Distraction Osteogenesis (IMDO)
Off My ListAnything that moves the teeth faster in the wrong direction
Whatrsquos an RO to do
To create from what Irsquove learned from the best
a model for others to followhellipespecially orthodontists
Teaching
Mt Sinai Pedo ResidencyAli Attaie
2010-2012
Montefiore Ortho ResidencyTony Maganzini
2012
2009-Present
Mt Sinai School of MedicinePedodontic Residency
Guest SpeakersJim BronsonMike MewKevin BoydSandra KahnJennifer TowRoger PricePaula Fabbie
Damien OrsquoBrien
First clinical program in myofunctional orthodontics
Airway and Facial DevelopmentCollaborative Webcast
Mark Cruz
AAPMD Symposium
wwwaapm
dorg
Annual MeetingApril 25-26 2014
Westin Chicago North Shore
the raphael center for integrative orthodontics
wwwalignminecomwwwbioblocnjcom
wwwmyobracenjcom
Integrative vs Conventional
Integrative vs Conventional
ldquoWith improvements in expansion orthodontics advances in myofunctional orthodontics and the growing recognition about sleep disordered breathing among children and adults it is time for orthodontics to expand its horizons There is now so much more we can oerrdquo
The Raphael name has been associated with high quality orthodontics in New Jersey for over 60 years Dr Barry Raphael has been a university trained orthodontic specialist and a member of the American Association of Orthodontists for 30 years
He has a wide range of techniques and services to offer He has studied oral myology applied kinesiology Buteyko breathing Biobloc Orthotropics and Myobrace as part of his integrative training He can offer Damon Invisalign Insignia and Incognito appliances designs as some of his many conventional orthodontic services too
Dr Raphael teaches his techniques at post-graduate residencies study clubs dental societies and for the Myofunctional Research Co He is available for presentations to any group interested in learning more about the benefits of integrative orthodontics
wwwalignminecomLearn about the choices you have in orthodontics
dr barry raphael Why its
too Early never
1425
bro
ad
str
ee
tc
lifto
n n
j 070
13
973-
778-
4222
fax
973-
778-
9625
nj s
pe
c
368
4
1425 broad street clifton nj 07013973-778-4222
wwwalignminecom
the raphael centerforintegrative orthodontics
the
raph
ael c
ente
r fo
rin
tegr
ativ
e or
thod
onti
cs
Learn about an important choice you need to make before starting braces
the raphael center for integrative education
the raphael center for integrative education
Ongoing Intro to Airway Orthodontics
April Biobloc Study Group
April Training Ortho-Postural Therapists w Roger Price
June MRC Myobrace Basic Series
August Airway Dentistry with Mark Cruz and company
October Advanced MFT with Sandy Coulson
October Less than Six with Kevin Boyd
(who else wants to play)
Mission to create a space for spreading the word about Airway and Orthotropic principles and practice
Orthodontics in the 21st Century
EstheticOrthodontics
AirwayOrthodontics
GeneticTooth-Focused
Dental PerfectionEsthetics Primary
Treating SymptomsAirway Ignorant
AdaptationMuscle-FocusedMedical Better
Esthetics SecondaryTreating Causes
Airway Conscious
The EndAnd
The Beginning
SOFT TISSUE DYSFUNCTION
With Chronic Open Mouth Posture
Comparison of Unsupported vs Supported Growth
The End
The Beginning
Everyday in my practice
RO since1983 (30 yearsyikes)
Bucknell University 1974University of Pennsylvania 1978
(Three Years in General Practice)Fairleigh-Dickenson University 1983
14 Instructors 14 Techniques
RO since1983 (30 yearsyikes)
Bucknell University 1974University of Pennsylvania 1978
(Three Years in General Practice)Fairleigh-Dickenson University 1983
My Dream Office 2001
1Crooked teeth are THE PROBLEM
2The lower incisor must be upright
3Patients donrsquot want to cooperate
4Straightened teeth arenrsquot stable
In the ROrsquos Mind
1Crooked teeth are THE PROBLEM
2The lower incisor must be upright
3Patients donrsquot want to cooperate
4Straightened teeth arenrsquot stable
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
A Change of Mind
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
George Catlin
Are we developing the wayour genes program us to be
Westin Price
Kevin Boyd
Peter Gluckman
Neese and Williams
Scott Gilbert
Clark Spencer Larsen
Darwinian Dentistry
MeJames
Sim Wallace
Obesity
Metabolic SyndromeCeliac
Intestinal PermeabilityType 2 Diabetes
Fatty Liver Disease Cardiovascular Disease
HypertensionSome Cancers
The Results of the MismatchBetween Genes and the Environment
Chronic Non-Communicable Diseases of CivilizationWestern Lifestyle Diseases
Asthma
Autism
Aspergerrsquos
Alzheimers
ADDADHDDepression
Chronic Back Pain
Osteoporosis
Caries
Malocclusion
Sleep Apnea
The Toothberg
Airway-Related Craniofacial Dysfunctions
bullChronic Naso-pharyngeal Obstructionbull Tongue form aberrations (Frenum and tongue-tie)bullOpen Mouth Rest Posture bullMyofunctional disorders (Swallowing chewingetc)bullChronic Hyperventilation and Hypocapniabull Breathing Disordered Sleep (OSA UARS snoring)bull Bruxism and parafunctionsbull TMD and facial pain componentsbullCranial and postural issuesbull Malocclusion
Airway Orthodontics
bullEarly Feeding and Nutrition
bullAllergies Asthma URT infections
bullPosture
bullAirway Breathing and Sleep Disorders
bullSoft Tissue Dysfunctions (Tongue Thrust Open Mouth)
Instead of crooked teeth being The ProblemThey are just a SYMPTOM of something larger
Parentrsquos Private-eye Sheet
Parentrsquos Private-eye Sheet
ldquoThere are many things about your childrsquos health that are important to know but that I often donrsquot get to see at the office Also there are signs to look for that you may not have known were connected to your childrsquos teeth or health By looking for and tracking these ldquosigns and symptomsrdquo we can get a better handle on the problem and watch for resolution
You donrsquot have to spend a lot of time with this but donrsquot rush either Watch for certain things at different times of day Try not to let your child know they are being watched You want to see the most natural behaviors
Check off what you see If yoursquore not sure check it anyway and wersquoll talk about it Make comments if you wantrdquo
While sitting around
While sitting around (watching TV in the car) does your child
put ldquothingsrdquo in the mouth alot (toys sleeves pencils fingernails etc) ______________________________
lick or suck on the lips have the lips apart even a little stick or dart the tongue out of the mouth have the tongue resting between the teeth lean the cheek on a hand breath with his mouth open even a little bit make noises when breathing have trouble sitting still
While talking
While talking does your child talk very fast talk very slowly gasp for air have a lisp take speech lessons
During a meal
During a meal does your child gasp for air while eating stick his tongue between his teeth when swallowing stick the tongue out to meet the drinking glass drink a lot while eating make noises when chewing eat sloppily take a breath before drinking puff the cheeks out when drinking make the lips purse when swallowing make the chin ldquocrinklerdquo when swallowing bob the head when swallowing have trouble sitting still
While sleeping
While sleeping does your child have the mouth open snore wet the bed toss and turn tilt the head back wake up frequently have frequent nightmares have abnormal sleep issues grind the teeth have trouble waking up wake with darker circles under eyes
S R 10-10yo M
bullMissing 3242bullImpacted 1323bullLate mixed 25 eruptedbullSoft tissue dysfunctionbullIL = 40bullNot compliant
S Reardon 10-7yo M
Impacted 3s Missing 2s
Medical history
bull Reactive Airway Diseasebull ldquoBronchial Constrictionrdquo bullCare of Pulmonologistbull Preventil
bull Dad OSA CPAP for 11 years diabetesbull Grandfather OSA untreatedbull ETCO2 = 361 at 10 bpm (acceptable)bull Posture number - 18 (lt10 ideal)bull Father refuses sleep screening
Treatment Options1 Extract upper premolars Align2Open spaces for impacted canines Open spaces for lower lateral implants
Whatrsquos more importantEase of treatment
OrBreathing well at night
Bolton Standards15yo
The Maxilla is Down and Back
The Mandible is Retrognathic
Nasal Cartilage Collapse
Insufficient Facial Support
Bi-maxillary Retrusion
Bimaxillary Retrusion Forward Growth
Mouthbreathers have significantly smaller airway space
(measurements PAS-OccL PAS-UP airway volume area and minimum axial area)
Mouth breather Nasal breather
Three-dimensional assessment of pharyngeal airway in nasal- and mouth-breathing children
Alves M etal Int J Ped ORL 75 (2011) 1195ndash1199
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
B Hockel 2012
This is the profile Biobloc children start with long and retrusive
This is the profile Biobloc children finish with Forward with lips
together
B Hockel 2012
Herersquos the ldquoinsiderdquo look Notice how the upper front teeth are closer to the nose (yellow arrows)
Notice how the lower jaw rotates around the star so the chin comes up and forward (red arrow)How do we make this happen
From the tip of the Central
To the Forwardmost Tip of the Nose
41mm
Maxillary Heightbull Indicator Line (Mew)
bull Distance from most anterior point on nose to upper incisal edge
bull Age + 23bull A variable number but important to watch over time
B Hockel 2012
Herersquos the ldquoinsiderdquo look Notice how the upper front teeth are closer to the nose (yellow arrows)
Notice how the lower jaw rotates around the star so the chin comes up and forward (red arrow)How do we make this happen
Using IndicatorCosmetic Line
bull To define a starting pointbull To set treatment goalsbull To track treatment progressbull To gauge the effectiveness of treatment
Charting the InCos Line
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Incisor pulled away from noseNot ldquoundertorquedrdquo or ldquogummy smilerdquo
Hypothetical ClI OrthoMARA
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
OJ = 7mm
Starts Ortho
ldquoGreat Headgear
Effectrdquo
Class II Elastics
50
40
30
20mm
y J F M A M J J A S O N
boys
Start Non-x
Expansion UncrowdingFinished
Start Cl II elastics
OK thatrsquos
enough
Hypothetical Mouthbreather(Dr Mewrsquos Hamster Boy)
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Boy gets
hamster
MFT
Hypothetical BBO 7yoM
50
40
30
20
5 6 7 8 9 10 11 12 13 14 15
girlsboys
Initial
StartBB1
BB3
Night
bullLR 11-9yFbullMissing all 5s6s8s and upper 4sbullHad ortho to close diastemahellipbullInL = 39bullGP objects to deX plan equil
LR Tx Plan
1Preparation Hang Expanser2deX 3Training BB3 to advance mandible4Myofunctional Therapy5Orthopostural Training6Myobrace to hold7 Reevaluate for dental detailing
LR Spotty progress
50
40
30
20mm
y 313 4 5 6 7 8 9 10 11 12114
2 3
Expanser
Parents dragging30 turnsStart Adv
Rx deXGP
objects
After delays
Equil ersquosBB3
bullLR 12-3 yF (6mo in tx)bullInL = 37 (+2)bull ersquos equilibratedbull OJ =10bull Appliance OJ = 5bull Still accommodating to BB3
Is there a calculus for the Indicator Line
Treatment GoalsBased on Indicator Line
Incisor Goals
Type 1 Treatment Place U1 in ideal position
Biobloc Orthotropics Orthognathic Surgery Distraction Osteogenesis
Type 1 Ideal InCos line
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
YZ 9yo M
bullLost upper d-spacebullInL = 36(+4)bullOJ = 9mmbullLip entrapmentbullLip Incompetence
Y Z 9yo M
Y Z 9yo M9mm OJ
Y Z 9yo M
Treatment Options
1 Type 1 Reduce InL open lost space BB3 to advance mandible
2 Type 2 Open lost space Align
3 Type 4 Extract four premolars
YZ 9yoM
50
40
30
20mm
yM A M J J A S O N D J F M A
boys
Hang Expanser
Upper and Lower
Brackets Hang Retainer
BB3
Incisor Goals
Type 2 Treatment Develop arch just enough to uncrowd
Biobloc Myofunctional Ortho Myofunctional Therapy Crozat ALF Expansion Orthodontics
Type 2 Uncrowding
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
bullLip incompetencebullLip entrapmentbullHypermentalisbullMouthbreathing
Type 2 Uncrowding
12 month progress
12 month progress
12 month progress
After Treatment
Bent-wire6 monthsMyobrace12 months
Hey RaphaelWhat about that
profile
ZP 9-5yoM
i
After Expansion Phase
Incomplete profile improvement better breathing head posture and sleep
Incisor Goals
Type 3 Treatment Maintain UI
Functional Orthodontics Expansion Orthodontics Distalization Ortho or No Treatment
Type 3 Maintain
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Bimax retrusion
Successful dental result
Profile Unimproved
Incisor Goals
Type 4 Treatment RetractExtrude UI
Extraction Orthodontics Retraction Ortho Distalization Ortho
Type 4 Retraction
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Bimax retrusion
Successful dental result
Failed Profile Result
Changes of pharyngeal airway size and hyoid bone position following orthodontic treatment of
Class I bimaxillary protrusion
Qingzhu Wanga Peizeng Jiab Nina K Andersonc Lin Wangd Jiuxiang Line
Angle Orthodontist Vol 00 No 0 0000 (pre-publication 2012)
ldquothe dimension of the velopharynx glossopharynx and hypopharynx were decreased after maximal retraction of anterior teeth with extraction of four premolarshelliprdquo ldquoAny factors that can influence the posture and position of tongue and soft palate may displace them backward andencroach upon the pharynxrdquo
ldquothe more the incisors were retracted the more the pharyngeal airway was reducedrdquo
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Backed into a corner
bull
Moving teeth faster more efficientlyhellipin the wrong direction
Now that wersquove made smoking unacceptable
could we not do the same withbull Sugarbull Processed foodbull Cheap milk and meatbull Fast foodbull Pill popping for symptomatic reliefbull Looking for the cure instead of the causebull Surgery as a quick fixbull Thinking braces are a status symbol
Each industry thrives on the status quoConsumers must drive the change
NP 10yM
NP
Sisterrsquos non-x ortho
Shersquos happyhellipbut Irsquom not so
I make my pitch for BBO
The dilemma of progress
(I forgot the progress pictureshellip)
Dad sells prosthetic parts to orthopedic surgeons
I selling the case against my previous work they loved
It takes me 3 hours to sell the case
They fret until the BB3 goes in
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Connecting the dots
bull Adult SDB and OSA
bull Narrow jaws and faces
bull Soft tissue dysfunction
bull Early parafunctional habits ie open mouth posture
bull Environmental stressors
bull CPAP MARAUPPP SurgWherersquos the best
place to start treatment here
or here
1 Prevention 2 Undo the damage already done3 Establish good habits
When to start When damage from poor breathing is noticed and when bad habits are discovered
The strategies of Airway Orthodontics
Prevention
bull Remove ankyloglossiabull Promote breastfeedingbull Harden the dietbull Develop masticatory strengthbull Discourage oral habitsbull Promote whole-foods low sugar dietbull Reduce oropharyngeal obstructionbull Promote nasal breathing
Breathing retraining
bull Nasal rinsingbull Nasal clearingbull Decongesting
The goals of Airway Orthodontics
1 Breathing through the nose2 Lips together at rest3 Correct tongue position4 No facial muscles moving on swallowing5 Optimal forward facial development6 Class I occlusion7 Straight teeth8 Better stability long term
Myofunctional Trainers
Professors R Soulet and A Besombes
Dr Earl Bergeson
Dr Chris Farrell
The Multi ndash Family System
Orofacial MyofunctionalTherapy
Oral MyologyMyofunctional TherapyTongue Thrust Therapy
B Hockel 2012 Back
Undoing Bimaxillary Dysplasia
1 Maxillary deconstriction2 Maxillary advancement3 Maxillary impaction4 Mandibular advancement
1 Maxillary Expansion
Treatment for Bimaxillary Dysplasia
ALFCrozat
Bent Wire
HyraxHaas
Niti Exp BioBlocSchwartz
The Farrell BENT WIRE Systemtrade
Recommended Age Group 5-12 yrs
Arch Development in conjunction with the TRAINER Systemtrade
Dr John Mew
Establish Good Habits
1 Breathing through the nose2 Lips together at rest3 Correct tongue position4 No facial muscles moving on swallowing5 Stand and sit in balance6 Breath gently using the diaphragm7 Eat to nourish8 Sleep to rest
Ortho-Postural TrainingWorkshops
Breathing
Nutrition
Posture
Sleep
COPYRIGHTRoger L PriceOctober 2012
Posture Number
Forward head posturecan be a compensationfor a deficient airway
Sleep Screening and Hygiene
SQI = 10 SQI = 98
Integrative Healthcare
Function ProfessionalNasal clearing ENT Pulm MFT BreathingMuscle balance and tone MFT Myofunctional OrthoUndoing damage GP Pedo Ortho OMFSBreathing dynamics OPT MFT Breath PhysiologistPosture DC OPT PT OsteopathCranial balance OsteopathNutrition RDH Nutritionist Dietitian Sleep ENT Sleep Med DentNeurocognitive development Pedrsquon SLP Psych SpEd
The Interdisciplinary Center
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Now that I know
My personal missionTo create from what Irsquove
learned from the besta model for others to followhellipespecially the orthodontists
Myofunctional Orthodontics
Chris Farrell
John Flutter
German Ramierez
Damien OrsquoBrien
Myofunctional Research CoRancho Cucamonga
2008-2012
Oral Myology
Oral Myology Basic CourseJoy MoellerNYC 2011LA 2012
Oral Myology Levels 2 3Kim BenkertClifton 2012
Habit CessationShari GreenClifton 2013
Biobloc Orthotropics
BBO Mini-residencyBill Hang
Agora Hills2012-13
BBO IntensiveDrs John and Mike
MewLSFO2013
Breathing and Sleep
Buteyko MentorshipThe Breathing Center
Woodstock2010
Breathing Well ProgrammeJohn Flutter
2010 Ortho-Postural TrainingRoger Price
2013
Sleep DentistryMichael Gelb etal
NYU2012
ALF and Cranial
Jim Bronson2013 Tasha Turzo
Cranial Academy2014
Bucket Listbull ALF and Crozat (Bronsonrsquos course)bullMore on Biobloc (Hangrsquos Advanced London School)bull More Cranial (The Farm)bullChirodontics (Bob Walker)bull Airway Dentistry with Marc Cruz Jeff Rousebull Sleep Dentistrybull Less-than-Six with Kevin Boydbull Intra-mandibular Distraction Osteogenesis (IMDO)
Off My ListAnything that moves the teeth faster in the wrong direction
Whatrsquos an RO to do
To create from what Irsquove learned from the best
a model for others to followhellipespecially orthodontists
Teaching
Mt Sinai Pedo ResidencyAli Attaie
2010-2012
Montefiore Ortho ResidencyTony Maganzini
2012
2009-Present
Mt Sinai School of MedicinePedodontic Residency
Guest SpeakersJim BronsonMike MewKevin BoydSandra KahnJennifer TowRoger PricePaula Fabbie
Damien OrsquoBrien
First clinical program in myofunctional orthodontics
Airway and Facial DevelopmentCollaborative Webcast
Mark Cruz
AAPMD Symposium
wwwaapm
dorg
Annual MeetingApril 25-26 2014
Westin Chicago North Shore
the raphael center for integrative orthodontics
wwwalignminecomwwwbioblocnjcom
wwwmyobracenjcom
Integrative vs Conventional
Integrative vs Conventional
ldquoWith improvements in expansion orthodontics advances in myofunctional orthodontics and the growing recognition about sleep disordered breathing among children and adults it is time for orthodontics to expand its horizons There is now so much more we can oerrdquo
The Raphael name has been associated with high quality orthodontics in New Jersey for over 60 years Dr Barry Raphael has been a university trained orthodontic specialist and a member of the American Association of Orthodontists for 30 years
He has a wide range of techniques and services to offer He has studied oral myology applied kinesiology Buteyko breathing Biobloc Orthotropics and Myobrace as part of his integrative training He can offer Damon Invisalign Insignia and Incognito appliances designs as some of his many conventional orthodontic services too
Dr Raphael teaches his techniques at post-graduate residencies study clubs dental societies and for the Myofunctional Research Co He is available for presentations to any group interested in learning more about the benefits of integrative orthodontics
wwwalignminecomLearn about the choices you have in orthodontics
dr barry raphael Why its
too Early never
1425
bro
ad
str
ee
tc
lifto
n n
j 070
13
973-
778-
4222
fax
973-
778-
9625
nj s
pe
c
368
4
1425 broad street clifton nj 07013973-778-4222
wwwalignminecom
the raphael centerforintegrative orthodontics
the
raph
ael c
ente
r fo
rin
tegr
ativ
e or
thod
onti
cs
Learn about an important choice you need to make before starting braces
the raphael center for integrative education
the raphael center for integrative education
Ongoing Intro to Airway Orthodontics
April Biobloc Study Group
April Training Ortho-Postural Therapists w Roger Price
June MRC Myobrace Basic Series
August Airway Dentistry with Mark Cruz and company
October Advanced MFT with Sandy Coulson
October Less than Six with Kevin Boyd
(who else wants to play)
Mission to create a space for spreading the word about Airway and Orthotropic principles and practice
Orthodontics in the 21st Century
EstheticOrthodontics
AirwayOrthodontics
GeneticTooth-Focused
Dental PerfectionEsthetics Primary
Treating SymptomsAirway Ignorant
AdaptationMuscle-FocusedMedical Better
Esthetics SecondaryTreating Causes
Airway Conscious
The EndAnd
The Beginning
The End
The Beginning
Everyday in my practice
RO since1983 (30 yearsyikes)
Bucknell University 1974University of Pennsylvania 1978
(Three Years in General Practice)Fairleigh-Dickenson University 1983
14 Instructors 14 Techniques
RO since1983 (30 yearsyikes)
Bucknell University 1974University of Pennsylvania 1978
(Three Years in General Practice)Fairleigh-Dickenson University 1983
My Dream Office 2001
1Crooked teeth are THE PROBLEM
2The lower incisor must be upright
3Patients donrsquot want to cooperate
4Straightened teeth arenrsquot stable
In the ROrsquos Mind
1Crooked teeth are THE PROBLEM
2The lower incisor must be upright
3Patients donrsquot want to cooperate
4Straightened teeth arenrsquot stable
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
A Change of Mind
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
George Catlin
Are we developing the wayour genes program us to be
Westin Price
Kevin Boyd
Peter Gluckman
Neese and Williams
Scott Gilbert
Clark Spencer Larsen
Darwinian Dentistry
MeJames
Sim Wallace
Obesity
Metabolic SyndromeCeliac
Intestinal PermeabilityType 2 Diabetes
Fatty Liver Disease Cardiovascular Disease
HypertensionSome Cancers
The Results of the MismatchBetween Genes and the Environment
Chronic Non-Communicable Diseases of CivilizationWestern Lifestyle Diseases
Asthma
Autism
Aspergerrsquos
Alzheimers
ADDADHDDepression
Chronic Back Pain
Osteoporosis
Caries
Malocclusion
Sleep Apnea
The Toothberg
Airway-Related Craniofacial Dysfunctions
bullChronic Naso-pharyngeal Obstructionbull Tongue form aberrations (Frenum and tongue-tie)bullOpen Mouth Rest Posture bullMyofunctional disorders (Swallowing chewingetc)bullChronic Hyperventilation and Hypocapniabull Breathing Disordered Sleep (OSA UARS snoring)bull Bruxism and parafunctionsbull TMD and facial pain componentsbullCranial and postural issuesbull Malocclusion
Airway Orthodontics
bullEarly Feeding and Nutrition
bullAllergies Asthma URT infections
bullPosture
bullAirway Breathing and Sleep Disorders
bullSoft Tissue Dysfunctions (Tongue Thrust Open Mouth)
Instead of crooked teeth being The ProblemThey are just a SYMPTOM of something larger
Parentrsquos Private-eye Sheet
Parentrsquos Private-eye Sheet
ldquoThere are many things about your childrsquos health that are important to know but that I often donrsquot get to see at the office Also there are signs to look for that you may not have known were connected to your childrsquos teeth or health By looking for and tracking these ldquosigns and symptomsrdquo we can get a better handle on the problem and watch for resolution
You donrsquot have to spend a lot of time with this but donrsquot rush either Watch for certain things at different times of day Try not to let your child know they are being watched You want to see the most natural behaviors
Check off what you see If yoursquore not sure check it anyway and wersquoll talk about it Make comments if you wantrdquo
While sitting around
While sitting around (watching TV in the car) does your child
put ldquothingsrdquo in the mouth alot (toys sleeves pencils fingernails etc) ______________________________
lick or suck on the lips have the lips apart even a little stick or dart the tongue out of the mouth have the tongue resting between the teeth lean the cheek on a hand breath with his mouth open even a little bit make noises when breathing have trouble sitting still
While talking
While talking does your child talk very fast talk very slowly gasp for air have a lisp take speech lessons
During a meal
During a meal does your child gasp for air while eating stick his tongue between his teeth when swallowing stick the tongue out to meet the drinking glass drink a lot while eating make noises when chewing eat sloppily take a breath before drinking puff the cheeks out when drinking make the lips purse when swallowing make the chin ldquocrinklerdquo when swallowing bob the head when swallowing have trouble sitting still
While sleeping
While sleeping does your child have the mouth open snore wet the bed toss and turn tilt the head back wake up frequently have frequent nightmares have abnormal sleep issues grind the teeth have trouble waking up wake with darker circles under eyes
S R 10-10yo M
bullMissing 3242bullImpacted 1323bullLate mixed 25 eruptedbullSoft tissue dysfunctionbullIL = 40bullNot compliant
S Reardon 10-7yo M
Impacted 3s Missing 2s
Medical history
bull Reactive Airway Diseasebull ldquoBronchial Constrictionrdquo bullCare of Pulmonologistbull Preventil
bull Dad OSA CPAP for 11 years diabetesbull Grandfather OSA untreatedbull ETCO2 = 361 at 10 bpm (acceptable)bull Posture number - 18 (lt10 ideal)bull Father refuses sleep screening
Treatment Options1 Extract upper premolars Align2Open spaces for impacted canines Open spaces for lower lateral implants
Whatrsquos more importantEase of treatment
OrBreathing well at night
Bolton Standards15yo
The Maxilla is Down and Back
The Mandible is Retrognathic
Nasal Cartilage Collapse
Insufficient Facial Support
Bi-maxillary Retrusion
Bimaxillary Retrusion Forward Growth
Mouthbreathers have significantly smaller airway space
(measurements PAS-OccL PAS-UP airway volume area and minimum axial area)
Mouth breather Nasal breather
Three-dimensional assessment of pharyngeal airway in nasal- and mouth-breathing children
Alves M etal Int J Ped ORL 75 (2011) 1195ndash1199
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
B Hockel 2012
This is the profile Biobloc children start with long and retrusive
This is the profile Biobloc children finish with Forward with lips
together
B Hockel 2012
Herersquos the ldquoinsiderdquo look Notice how the upper front teeth are closer to the nose (yellow arrows)
Notice how the lower jaw rotates around the star so the chin comes up and forward (red arrow)How do we make this happen
From the tip of the Central
To the Forwardmost Tip of the Nose
41mm
Maxillary Heightbull Indicator Line (Mew)
bull Distance from most anterior point on nose to upper incisal edge
bull Age + 23bull A variable number but important to watch over time
B Hockel 2012
Herersquos the ldquoinsiderdquo look Notice how the upper front teeth are closer to the nose (yellow arrows)
Notice how the lower jaw rotates around the star so the chin comes up and forward (red arrow)How do we make this happen
Using IndicatorCosmetic Line
bull To define a starting pointbull To set treatment goalsbull To track treatment progressbull To gauge the effectiveness of treatment
Charting the InCos Line
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Incisor pulled away from noseNot ldquoundertorquedrdquo or ldquogummy smilerdquo
Hypothetical ClI OrthoMARA
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
OJ = 7mm
Starts Ortho
ldquoGreat Headgear
Effectrdquo
Class II Elastics
50
40
30
20mm
y J F M A M J J A S O N
boys
Start Non-x
Expansion UncrowdingFinished
Start Cl II elastics
OK thatrsquos
enough
Hypothetical Mouthbreather(Dr Mewrsquos Hamster Boy)
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Boy gets
hamster
MFT
Hypothetical BBO 7yoM
50
40
30
20
5 6 7 8 9 10 11 12 13 14 15
girlsboys
Initial
StartBB1
BB3
Night
bullLR 11-9yFbullMissing all 5s6s8s and upper 4sbullHad ortho to close diastemahellipbullInL = 39bullGP objects to deX plan equil
LR Tx Plan
1Preparation Hang Expanser2deX 3Training BB3 to advance mandible4Myofunctional Therapy5Orthopostural Training6Myobrace to hold7 Reevaluate for dental detailing
LR Spotty progress
50
40
30
20mm
y 313 4 5 6 7 8 9 10 11 12114
2 3
Expanser
Parents dragging30 turnsStart Adv
Rx deXGP
objects
After delays
Equil ersquosBB3
bullLR 12-3 yF (6mo in tx)bullInL = 37 (+2)bull ersquos equilibratedbull OJ =10bull Appliance OJ = 5bull Still accommodating to BB3
Is there a calculus for the Indicator Line
Treatment GoalsBased on Indicator Line
Incisor Goals
Type 1 Treatment Place U1 in ideal position
Biobloc Orthotropics Orthognathic Surgery Distraction Osteogenesis
Type 1 Ideal InCos line
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
YZ 9yo M
bullLost upper d-spacebullInL = 36(+4)bullOJ = 9mmbullLip entrapmentbullLip Incompetence
Y Z 9yo M
Y Z 9yo M9mm OJ
Y Z 9yo M
Treatment Options
1 Type 1 Reduce InL open lost space BB3 to advance mandible
2 Type 2 Open lost space Align
3 Type 4 Extract four premolars
YZ 9yoM
50
40
30
20mm
yM A M J J A S O N D J F M A
boys
Hang Expanser
Upper and Lower
Brackets Hang Retainer
BB3
Incisor Goals
Type 2 Treatment Develop arch just enough to uncrowd
Biobloc Myofunctional Ortho Myofunctional Therapy Crozat ALF Expansion Orthodontics
Type 2 Uncrowding
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
bullLip incompetencebullLip entrapmentbullHypermentalisbullMouthbreathing
Type 2 Uncrowding
12 month progress
12 month progress
12 month progress
After Treatment
Bent-wire6 monthsMyobrace12 months
Hey RaphaelWhat about that
profile
ZP 9-5yoM
i
After Expansion Phase
Incomplete profile improvement better breathing head posture and sleep
Incisor Goals
Type 3 Treatment Maintain UI
Functional Orthodontics Expansion Orthodontics Distalization Ortho or No Treatment
Type 3 Maintain
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Bimax retrusion
Successful dental result
Profile Unimproved
Incisor Goals
Type 4 Treatment RetractExtrude UI
Extraction Orthodontics Retraction Ortho Distalization Ortho
Type 4 Retraction
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Bimax retrusion
Successful dental result
Failed Profile Result
Changes of pharyngeal airway size and hyoid bone position following orthodontic treatment of
Class I bimaxillary protrusion
Qingzhu Wanga Peizeng Jiab Nina K Andersonc Lin Wangd Jiuxiang Line
Angle Orthodontist Vol 00 No 0 0000 (pre-publication 2012)
ldquothe dimension of the velopharynx glossopharynx and hypopharynx were decreased after maximal retraction of anterior teeth with extraction of four premolarshelliprdquo ldquoAny factors that can influence the posture and position of tongue and soft palate may displace them backward andencroach upon the pharynxrdquo
ldquothe more the incisors were retracted the more the pharyngeal airway was reducedrdquo
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Backed into a corner
bull
Moving teeth faster more efficientlyhellipin the wrong direction
Now that wersquove made smoking unacceptable
could we not do the same withbull Sugarbull Processed foodbull Cheap milk and meatbull Fast foodbull Pill popping for symptomatic reliefbull Looking for the cure instead of the causebull Surgery as a quick fixbull Thinking braces are a status symbol
Each industry thrives on the status quoConsumers must drive the change
NP 10yM
NP
Sisterrsquos non-x ortho
Shersquos happyhellipbut Irsquom not so
I make my pitch for BBO
The dilemma of progress
(I forgot the progress pictureshellip)
Dad sells prosthetic parts to orthopedic surgeons
I selling the case against my previous work they loved
It takes me 3 hours to sell the case
They fret until the BB3 goes in
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Connecting the dots
bull Adult SDB and OSA
bull Narrow jaws and faces
bull Soft tissue dysfunction
bull Early parafunctional habits ie open mouth posture
bull Environmental stressors
bull CPAP MARAUPPP SurgWherersquos the best
place to start treatment here
or here
1 Prevention 2 Undo the damage already done3 Establish good habits
When to start When damage from poor breathing is noticed and when bad habits are discovered
The strategies of Airway Orthodontics
Prevention
bull Remove ankyloglossiabull Promote breastfeedingbull Harden the dietbull Develop masticatory strengthbull Discourage oral habitsbull Promote whole-foods low sugar dietbull Reduce oropharyngeal obstructionbull Promote nasal breathing
Breathing retraining
bull Nasal rinsingbull Nasal clearingbull Decongesting
The goals of Airway Orthodontics
1 Breathing through the nose2 Lips together at rest3 Correct tongue position4 No facial muscles moving on swallowing5 Optimal forward facial development6 Class I occlusion7 Straight teeth8 Better stability long term
Myofunctional Trainers
Professors R Soulet and A Besombes
Dr Earl Bergeson
Dr Chris Farrell
The Multi ndash Family System
Orofacial MyofunctionalTherapy
Oral MyologyMyofunctional TherapyTongue Thrust Therapy
B Hockel 2012 Back
Undoing Bimaxillary Dysplasia
1 Maxillary deconstriction2 Maxillary advancement3 Maxillary impaction4 Mandibular advancement
1 Maxillary Expansion
Treatment for Bimaxillary Dysplasia
ALFCrozat
Bent Wire
HyraxHaas
Niti Exp BioBlocSchwartz
The Farrell BENT WIRE Systemtrade
Recommended Age Group 5-12 yrs
Arch Development in conjunction with the TRAINER Systemtrade
Dr John Mew
Establish Good Habits
1 Breathing through the nose2 Lips together at rest3 Correct tongue position4 No facial muscles moving on swallowing5 Stand and sit in balance6 Breath gently using the diaphragm7 Eat to nourish8 Sleep to rest
Ortho-Postural TrainingWorkshops
Breathing
Nutrition
Posture
Sleep
COPYRIGHTRoger L PriceOctober 2012
Posture Number
Forward head posturecan be a compensationfor a deficient airway
Sleep Screening and Hygiene
SQI = 10 SQI = 98
Integrative Healthcare
Function ProfessionalNasal clearing ENT Pulm MFT BreathingMuscle balance and tone MFT Myofunctional OrthoUndoing damage GP Pedo Ortho OMFSBreathing dynamics OPT MFT Breath PhysiologistPosture DC OPT PT OsteopathCranial balance OsteopathNutrition RDH Nutritionist Dietitian Sleep ENT Sleep Med DentNeurocognitive development Pedrsquon SLP Psych SpEd
The Interdisciplinary Center
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Now that I know
My personal missionTo create from what Irsquove
learned from the besta model for others to followhellipespecially the orthodontists
Myofunctional Orthodontics
Chris Farrell
John Flutter
German Ramierez
Damien OrsquoBrien
Myofunctional Research CoRancho Cucamonga
2008-2012
Oral Myology
Oral Myology Basic CourseJoy MoellerNYC 2011LA 2012
Oral Myology Levels 2 3Kim BenkertClifton 2012
Habit CessationShari GreenClifton 2013
Biobloc Orthotropics
BBO Mini-residencyBill Hang
Agora Hills2012-13
BBO IntensiveDrs John and Mike
MewLSFO2013
Breathing and Sleep
Buteyko MentorshipThe Breathing Center
Woodstock2010
Breathing Well ProgrammeJohn Flutter
2010 Ortho-Postural TrainingRoger Price
2013
Sleep DentistryMichael Gelb etal
NYU2012
ALF and Cranial
Jim Bronson2013 Tasha Turzo
Cranial Academy2014
Bucket Listbull ALF and Crozat (Bronsonrsquos course)bullMore on Biobloc (Hangrsquos Advanced London School)bull More Cranial (The Farm)bullChirodontics (Bob Walker)bull Airway Dentistry with Marc Cruz Jeff Rousebull Sleep Dentistrybull Less-than-Six with Kevin Boydbull Intra-mandibular Distraction Osteogenesis (IMDO)
Off My ListAnything that moves the teeth faster in the wrong direction
Whatrsquos an RO to do
To create from what Irsquove learned from the best
a model for others to followhellipespecially orthodontists
Teaching
Mt Sinai Pedo ResidencyAli Attaie
2010-2012
Montefiore Ortho ResidencyTony Maganzini
2012
2009-Present
Mt Sinai School of MedicinePedodontic Residency
Guest SpeakersJim BronsonMike MewKevin BoydSandra KahnJennifer TowRoger PricePaula Fabbie
Damien OrsquoBrien
First clinical program in myofunctional orthodontics
Airway and Facial DevelopmentCollaborative Webcast
Mark Cruz
AAPMD Symposium
wwwaapm
dorg
Annual MeetingApril 25-26 2014
Westin Chicago North Shore
the raphael center for integrative orthodontics
wwwalignminecomwwwbioblocnjcom
wwwmyobracenjcom
Integrative vs Conventional
Integrative vs Conventional
ldquoWith improvements in expansion orthodontics advances in myofunctional orthodontics and the growing recognition about sleep disordered breathing among children and adults it is time for orthodontics to expand its horizons There is now so much more we can oerrdquo
The Raphael name has been associated with high quality orthodontics in New Jersey for over 60 years Dr Barry Raphael has been a university trained orthodontic specialist and a member of the American Association of Orthodontists for 30 years
He has a wide range of techniques and services to offer He has studied oral myology applied kinesiology Buteyko breathing Biobloc Orthotropics and Myobrace as part of his integrative training He can offer Damon Invisalign Insignia and Incognito appliances designs as some of his many conventional orthodontic services too
Dr Raphael teaches his techniques at post-graduate residencies study clubs dental societies and for the Myofunctional Research Co He is available for presentations to any group interested in learning more about the benefits of integrative orthodontics
wwwalignminecomLearn about the choices you have in orthodontics
dr barry raphael Why its
too Early never
1425
bro
ad
str
ee
tc
lifto
n n
j 070
13
973-
778-
4222
fax
973-
778-
9625
nj s
pe
c
368
4
1425 broad street clifton nj 07013973-778-4222
wwwalignminecom
the raphael centerforintegrative orthodontics
the
raph
ael c
ente
r fo
rin
tegr
ativ
e or
thod
onti
cs
Learn about an important choice you need to make before starting braces
the raphael center for integrative education
the raphael center for integrative education
Ongoing Intro to Airway Orthodontics
April Biobloc Study Group
April Training Ortho-Postural Therapists w Roger Price
June MRC Myobrace Basic Series
August Airway Dentistry with Mark Cruz and company
October Advanced MFT with Sandy Coulson
October Less than Six with Kevin Boyd
(who else wants to play)
Mission to create a space for spreading the word about Airway and Orthotropic principles and practice
Orthodontics in the 21st Century
EstheticOrthodontics
AirwayOrthodontics
GeneticTooth-Focused
Dental PerfectionEsthetics Primary
Treating SymptomsAirway Ignorant
AdaptationMuscle-FocusedMedical Better
Esthetics SecondaryTreating Causes
Airway Conscious
The EndAnd
The Beginning
The Beginning
Everyday in my practice
RO since1983 (30 yearsyikes)
Bucknell University 1974University of Pennsylvania 1978
(Three Years in General Practice)Fairleigh-Dickenson University 1983
14 Instructors 14 Techniques
RO since1983 (30 yearsyikes)
Bucknell University 1974University of Pennsylvania 1978
(Three Years in General Practice)Fairleigh-Dickenson University 1983
My Dream Office 2001
1Crooked teeth are THE PROBLEM
2The lower incisor must be upright
3Patients donrsquot want to cooperate
4Straightened teeth arenrsquot stable
In the ROrsquos Mind
1Crooked teeth are THE PROBLEM
2The lower incisor must be upright
3Patients donrsquot want to cooperate
4Straightened teeth arenrsquot stable
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
A Change of Mind
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
George Catlin
Are we developing the wayour genes program us to be
Westin Price
Kevin Boyd
Peter Gluckman
Neese and Williams
Scott Gilbert
Clark Spencer Larsen
Darwinian Dentistry
MeJames
Sim Wallace
Obesity
Metabolic SyndromeCeliac
Intestinal PermeabilityType 2 Diabetes
Fatty Liver Disease Cardiovascular Disease
HypertensionSome Cancers
The Results of the MismatchBetween Genes and the Environment
Chronic Non-Communicable Diseases of CivilizationWestern Lifestyle Diseases
Asthma
Autism
Aspergerrsquos
Alzheimers
ADDADHDDepression
Chronic Back Pain
Osteoporosis
Caries
Malocclusion
Sleep Apnea
The Toothberg
Airway-Related Craniofacial Dysfunctions
bullChronic Naso-pharyngeal Obstructionbull Tongue form aberrations (Frenum and tongue-tie)bullOpen Mouth Rest Posture bullMyofunctional disorders (Swallowing chewingetc)bullChronic Hyperventilation and Hypocapniabull Breathing Disordered Sleep (OSA UARS snoring)bull Bruxism and parafunctionsbull TMD and facial pain componentsbullCranial and postural issuesbull Malocclusion
Airway Orthodontics
bullEarly Feeding and Nutrition
bullAllergies Asthma URT infections
bullPosture
bullAirway Breathing and Sleep Disorders
bullSoft Tissue Dysfunctions (Tongue Thrust Open Mouth)
Instead of crooked teeth being The ProblemThey are just a SYMPTOM of something larger
Parentrsquos Private-eye Sheet
Parentrsquos Private-eye Sheet
ldquoThere are many things about your childrsquos health that are important to know but that I often donrsquot get to see at the office Also there are signs to look for that you may not have known were connected to your childrsquos teeth or health By looking for and tracking these ldquosigns and symptomsrdquo we can get a better handle on the problem and watch for resolution
You donrsquot have to spend a lot of time with this but donrsquot rush either Watch for certain things at different times of day Try not to let your child know they are being watched You want to see the most natural behaviors
Check off what you see If yoursquore not sure check it anyway and wersquoll talk about it Make comments if you wantrdquo
While sitting around
While sitting around (watching TV in the car) does your child
put ldquothingsrdquo in the mouth alot (toys sleeves pencils fingernails etc) ______________________________
lick or suck on the lips have the lips apart even a little stick or dart the tongue out of the mouth have the tongue resting between the teeth lean the cheek on a hand breath with his mouth open even a little bit make noises when breathing have trouble sitting still
While talking
While talking does your child talk very fast talk very slowly gasp for air have a lisp take speech lessons
During a meal
During a meal does your child gasp for air while eating stick his tongue between his teeth when swallowing stick the tongue out to meet the drinking glass drink a lot while eating make noises when chewing eat sloppily take a breath before drinking puff the cheeks out when drinking make the lips purse when swallowing make the chin ldquocrinklerdquo when swallowing bob the head when swallowing have trouble sitting still
While sleeping
While sleeping does your child have the mouth open snore wet the bed toss and turn tilt the head back wake up frequently have frequent nightmares have abnormal sleep issues grind the teeth have trouble waking up wake with darker circles under eyes
S R 10-10yo M
bullMissing 3242bullImpacted 1323bullLate mixed 25 eruptedbullSoft tissue dysfunctionbullIL = 40bullNot compliant
S Reardon 10-7yo M
Impacted 3s Missing 2s
Medical history
bull Reactive Airway Diseasebull ldquoBronchial Constrictionrdquo bullCare of Pulmonologistbull Preventil
bull Dad OSA CPAP for 11 years diabetesbull Grandfather OSA untreatedbull ETCO2 = 361 at 10 bpm (acceptable)bull Posture number - 18 (lt10 ideal)bull Father refuses sleep screening
Treatment Options1 Extract upper premolars Align2Open spaces for impacted canines Open spaces for lower lateral implants
Whatrsquos more importantEase of treatment
OrBreathing well at night
Bolton Standards15yo
The Maxilla is Down and Back
The Mandible is Retrognathic
Nasal Cartilage Collapse
Insufficient Facial Support
Bi-maxillary Retrusion
Bimaxillary Retrusion Forward Growth
Mouthbreathers have significantly smaller airway space
(measurements PAS-OccL PAS-UP airway volume area and minimum axial area)
Mouth breather Nasal breather
Three-dimensional assessment of pharyngeal airway in nasal- and mouth-breathing children
Alves M etal Int J Ped ORL 75 (2011) 1195ndash1199
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
B Hockel 2012
This is the profile Biobloc children start with long and retrusive
This is the profile Biobloc children finish with Forward with lips
together
B Hockel 2012
Herersquos the ldquoinsiderdquo look Notice how the upper front teeth are closer to the nose (yellow arrows)
Notice how the lower jaw rotates around the star so the chin comes up and forward (red arrow)How do we make this happen
From the tip of the Central
To the Forwardmost Tip of the Nose
41mm
Maxillary Heightbull Indicator Line (Mew)
bull Distance from most anterior point on nose to upper incisal edge
bull Age + 23bull A variable number but important to watch over time
B Hockel 2012
Herersquos the ldquoinsiderdquo look Notice how the upper front teeth are closer to the nose (yellow arrows)
Notice how the lower jaw rotates around the star so the chin comes up and forward (red arrow)How do we make this happen
Using IndicatorCosmetic Line
bull To define a starting pointbull To set treatment goalsbull To track treatment progressbull To gauge the effectiveness of treatment
Charting the InCos Line
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Incisor pulled away from noseNot ldquoundertorquedrdquo or ldquogummy smilerdquo
Hypothetical ClI OrthoMARA
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
OJ = 7mm
Starts Ortho
ldquoGreat Headgear
Effectrdquo
Class II Elastics
50
40
30
20mm
y J F M A M J J A S O N
boys
Start Non-x
Expansion UncrowdingFinished
Start Cl II elastics
OK thatrsquos
enough
Hypothetical Mouthbreather(Dr Mewrsquos Hamster Boy)
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Boy gets
hamster
MFT
Hypothetical BBO 7yoM
50
40
30
20
5 6 7 8 9 10 11 12 13 14 15
girlsboys
Initial
StartBB1
BB3
Night
bullLR 11-9yFbullMissing all 5s6s8s and upper 4sbullHad ortho to close diastemahellipbullInL = 39bullGP objects to deX plan equil
LR Tx Plan
1Preparation Hang Expanser2deX 3Training BB3 to advance mandible4Myofunctional Therapy5Orthopostural Training6Myobrace to hold7 Reevaluate for dental detailing
LR Spotty progress
50
40
30
20mm
y 313 4 5 6 7 8 9 10 11 12114
2 3
Expanser
Parents dragging30 turnsStart Adv
Rx deXGP
objects
After delays
Equil ersquosBB3
bullLR 12-3 yF (6mo in tx)bullInL = 37 (+2)bull ersquos equilibratedbull OJ =10bull Appliance OJ = 5bull Still accommodating to BB3
Is there a calculus for the Indicator Line
Treatment GoalsBased on Indicator Line
Incisor Goals
Type 1 Treatment Place U1 in ideal position
Biobloc Orthotropics Orthognathic Surgery Distraction Osteogenesis
Type 1 Ideal InCos line
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
YZ 9yo M
bullLost upper d-spacebullInL = 36(+4)bullOJ = 9mmbullLip entrapmentbullLip Incompetence
Y Z 9yo M
Y Z 9yo M9mm OJ
Y Z 9yo M
Treatment Options
1 Type 1 Reduce InL open lost space BB3 to advance mandible
2 Type 2 Open lost space Align
3 Type 4 Extract four premolars
YZ 9yoM
50
40
30
20mm
yM A M J J A S O N D J F M A
boys
Hang Expanser
Upper and Lower
Brackets Hang Retainer
BB3
Incisor Goals
Type 2 Treatment Develop arch just enough to uncrowd
Biobloc Myofunctional Ortho Myofunctional Therapy Crozat ALF Expansion Orthodontics
Type 2 Uncrowding
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
bullLip incompetencebullLip entrapmentbullHypermentalisbullMouthbreathing
Type 2 Uncrowding
12 month progress
12 month progress
12 month progress
After Treatment
Bent-wire6 monthsMyobrace12 months
Hey RaphaelWhat about that
profile
ZP 9-5yoM
i
After Expansion Phase
Incomplete profile improvement better breathing head posture and sleep
Incisor Goals
Type 3 Treatment Maintain UI
Functional Orthodontics Expansion Orthodontics Distalization Ortho or No Treatment
Type 3 Maintain
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Bimax retrusion
Successful dental result
Profile Unimproved
Incisor Goals
Type 4 Treatment RetractExtrude UI
Extraction Orthodontics Retraction Ortho Distalization Ortho
Type 4 Retraction
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Bimax retrusion
Successful dental result
Failed Profile Result
Changes of pharyngeal airway size and hyoid bone position following orthodontic treatment of
Class I bimaxillary protrusion
Qingzhu Wanga Peizeng Jiab Nina K Andersonc Lin Wangd Jiuxiang Line
Angle Orthodontist Vol 00 No 0 0000 (pre-publication 2012)
ldquothe dimension of the velopharynx glossopharynx and hypopharynx were decreased after maximal retraction of anterior teeth with extraction of four premolarshelliprdquo ldquoAny factors that can influence the posture and position of tongue and soft palate may displace them backward andencroach upon the pharynxrdquo
ldquothe more the incisors were retracted the more the pharyngeal airway was reducedrdquo
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Backed into a corner
bull
Moving teeth faster more efficientlyhellipin the wrong direction
Now that wersquove made smoking unacceptable
could we not do the same withbull Sugarbull Processed foodbull Cheap milk and meatbull Fast foodbull Pill popping for symptomatic reliefbull Looking for the cure instead of the causebull Surgery as a quick fixbull Thinking braces are a status symbol
Each industry thrives on the status quoConsumers must drive the change
NP 10yM
NP
Sisterrsquos non-x ortho
Shersquos happyhellipbut Irsquom not so
I make my pitch for BBO
The dilemma of progress
(I forgot the progress pictureshellip)
Dad sells prosthetic parts to orthopedic surgeons
I selling the case against my previous work they loved
It takes me 3 hours to sell the case
They fret until the BB3 goes in
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Connecting the dots
bull Adult SDB and OSA
bull Narrow jaws and faces
bull Soft tissue dysfunction
bull Early parafunctional habits ie open mouth posture
bull Environmental stressors
bull CPAP MARAUPPP SurgWherersquos the best
place to start treatment here
or here
1 Prevention 2 Undo the damage already done3 Establish good habits
When to start When damage from poor breathing is noticed and when bad habits are discovered
The strategies of Airway Orthodontics
Prevention
bull Remove ankyloglossiabull Promote breastfeedingbull Harden the dietbull Develop masticatory strengthbull Discourage oral habitsbull Promote whole-foods low sugar dietbull Reduce oropharyngeal obstructionbull Promote nasal breathing
Breathing retraining
bull Nasal rinsingbull Nasal clearingbull Decongesting
The goals of Airway Orthodontics
1 Breathing through the nose2 Lips together at rest3 Correct tongue position4 No facial muscles moving on swallowing5 Optimal forward facial development6 Class I occlusion7 Straight teeth8 Better stability long term
Myofunctional Trainers
Professors R Soulet and A Besombes
Dr Earl Bergeson
Dr Chris Farrell
The Multi ndash Family System
Orofacial MyofunctionalTherapy
Oral MyologyMyofunctional TherapyTongue Thrust Therapy
B Hockel 2012 Back
Undoing Bimaxillary Dysplasia
1 Maxillary deconstriction2 Maxillary advancement3 Maxillary impaction4 Mandibular advancement
1 Maxillary Expansion
Treatment for Bimaxillary Dysplasia
ALFCrozat
Bent Wire
HyraxHaas
Niti Exp BioBlocSchwartz
The Farrell BENT WIRE Systemtrade
Recommended Age Group 5-12 yrs
Arch Development in conjunction with the TRAINER Systemtrade
Dr John Mew
Establish Good Habits
1 Breathing through the nose2 Lips together at rest3 Correct tongue position4 No facial muscles moving on swallowing5 Stand and sit in balance6 Breath gently using the diaphragm7 Eat to nourish8 Sleep to rest
Ortho-Postural TrainingWorkshops
Breathing
Nutrition
Posture
Sleep
COPYRIGHTRoger L PriceOctober 2012
Posture Number
Forward head posturecan be a compensationfor a deficient airway
Sleep Screening and Hygiene
SQI = 10 SQI = 98
Integrative Healthcare
Function ProfessionalNasal clearing ENT Pulm MFT BreathingMuscle balance and tone MFT Myofunctional OrthoUndoing damage GP Pedo Ortho OMFSBreathing dynamics OPT MFT Breath PhysiologistPosture DC OPT PT OsteopathCranial balance OsteopathNutrition RDH Nutritionist Dietitian Sleep ENT Sleep Med DentNeurocognitive development Pedrsquon SLP Psych SpEd
The Interdisciplinary Center
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Now that I know
My personal missionTo create from what Irsquove
learned from the besta model for others to followhellipespecially the orthodontists
Myofunctional Orthodontics
Chris Farrell
John Flutter
German Ramierez
Damien OrsquoBrien
Myofunctional Research CoRancho Cucamonga
2008-2012
Oral Myology
Oral Myology Basic CourseJoy MoellerNYC 2011LA 2012
Oral Myology Levels 2 3Kim BenkertClifton 2012
Habit CessationShari GreenClifton 2013
Biobloc Orthotropics
BBO Mini-residencyBill Hang
Agora Hills2012-13
BBO IntensiveDrs John and Mike
MewLSFO2013
Breathing and Sleep
Buteyko MentorshipThe Breathing Center
Woodstock2010
Breathing Well ProgrammeJohn Flutter
2010 Ortho-Postural TrainingRoger Price
2013
Sleep DentistryMichael Gelb etal
NYU2012
ALF and Cranial
Jim Bronson2013 Tasha Turzo
Cranial Academy2014
Bucket Listbull ALF and Crozat (Bronsonrsquos course)bullMore on Biobloc (Hangrsquos Advanced London School)bull More Cranial (The Farm)bullChirodontics (Bob Walker)bull Airway Dentistry with Marc Cruz Jeff Rousebull Sleep Dentistrybull Less-than-Six with Kevin Boydbull Intra-mandibular Distraction Osteogenesis (IMDO)
Off My ListAnything that moves the teeth faster in the wrong direction
Whatrsquos an RO to do
To create from what Irsquove learned from the best
a model for others to followhellipespecially orthodontists
Teaching
Mt Sinai Pedo ResidencyAli Attaie
2010-2012
Montefiore Ortho ResidencyTony Maganzini
2012
2009-Present
Mt Sinai School of MedicinePedodontic Residency
Guest SpeakersJim BronsonMike MewKevin BoydSandra KahnJennifer TowRoger PricePaula Fabbie
Damien OrsquoBrien
First clinical program in myofunctional orthodontics
Airway and Facial DevelopmentCollaborative Webcast
Mark Cruz
AAPMD Symposium
wwwaapm
dorg
Annual MeetingApril 25-26 2014
Westin Chicago North Shore
the raphael center for integrative orthodontics
wwwalignminecomwwwbioblocnjcom
wwwmyobracenjcom
Integrative vs Conventional
Integrative vs Conventional
ldquoWith improvements in expansion orthodontics advances in myofunctional orthodontics and the growing recognition about sleep disordered breathing among children and adults it is time for orthodontics to expand its horizons There is now so much more we can oerrdquo
The Raphael name has been associated with high quality orthodontics in New Jersey for over 60 years Dr Barry Raphael has been a university trained orthodontic specialist and a member of the American Association of Orthodontists for 30 years
He has a wide range of techniques and services to offer He has studied oral myology applied kinesiology Buteyko breathing Biobloc Orthotropics and Myobrace as part of his integrative training He can offer Damon Invisalign Insignia and Incognito appliances designs as some of his many conventional orthodontic services too
Dr Raphael teaches his techniques at post-graduate residencies study clubs dental societies and for the Myofunctional Research Co He is available for presentations to any group interested in learning more about the benefits of integrative orthodontics
wwwalignminecomLearn about the choices you have in orthodontics
dr barry raphael Why its
too Early never
1425
bro
ad
str
ee
tc
lifto
n n
j 070
13
973-
778-
4222
fax
973-
778-
9625
nj s
pe
c
368
4
1425 broad street clifton nj 07013973-778-4222
wwwalignminecom
the raphael centerforintegrative orthodontics
the
raph
ael c
ente
r fo
rin
tegr
ativ
e or
thod
onti
cs
Learn about an important choice you need to make before starting braces
the raphael center for integrative education
the raphael center for integrative education
Ongoing Intro to Airway Orthodontics
April Biobloc Study Group
April Training Ortho-Postural Therapists w Roger Price
June MRC Myobrace Basic Series
August Airway Dentistry with Mark Cruz and company
October Advanced MFT with Sandy Coulson
October Less than Six with Kevin Boyd
(who else wants to play)
Mission to create a space for spreading the word about Airway and Orthotropic principles and practice
Orthodontics in the 21st Century
EstheticOrthodontics
AirwayOrthodontics
GeneticTooth-Focused
Dental PerfectionEsthetics Primary
Treating SymptomsAirway Ignorant
AdaptationMuscle-FocusedMedical Better
Esthetics SecondaryTreating Causes
Airway Conscious
The EndAnd
The Beginning
Everyday in my practice
RO since1983 (30 yearsyikes)
Bucknell University 1974University of Pennsylvania 1978
(Three Years in General Practice)Fairleigh-Dickenson University 1983
14 Instructors 14 Techniques
RO since1983 (30 yearsyikes)
Bucknell University 1974University of Pennsylvania 1978
(Three Years in General Practice)Fairleigh-Dickenson University 1983
My Dream Office 2001
1Crooked teeth are THE PROBLEM
2The lower incisor must be upright
3Patients donrsquot want to cooperate
4Straightened teeth arenrsquot stable
In the ROrsquos Mind
1Crooked teeth are THE PROBLEM
2The lower incisor must be upright
3Patients donrsquot want to cooperate
4Straightened teeth arenrsquot stable
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
A Change of Mind
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
George Catlin
Are we developing the wayour genes program us to be
Westin Price
Kevin Boyd
Peter Gluckman
Neese and Williams
Scott Gilbert
Clark Spencer Larsen
Darwinian Dentistry
MeJames
Sim Wallace
Obesity
Metabolic SyndromeCeliac
Intestinal PermeabilityType 2 Diabetes
Fatty Liver Disease Cardiovascular Disease
HypertensionSome Cancers
The Results of the MismatchBetween Genes and the Environment
Chronic Non-Communicable Diseases of CivilizationWestern Lifestyle Diseases
Asthma
Autism
Aspergerrsquos
Alzheimers
ADDADHDDepression
Chronic Back Pain
Osteoporosis
Caries
Malocclusion
Sleep Apnea
The Toothberg
Airway-Related Craniofacial Dysfunctions
bullChronic Naso-pharyngeal Obstructionbull Tongue form aberrations (Frenum and tongue-tie)bullOpen Mouth Rest Posture bullMyofunctional disorders (Swallowing chewingetc)bullChronic Hyperventilation and Hypocapniabull Breathing Disordered Sleep (OSA UARS snoring)bull Bruxism and parafunctionsbull TMD and facial pain componentsbullCranial and postural issuesbull Malocclusion
Airway Orthodontics
bullEarly Feeding and Nutrition
bullAllergies Asthma URT infections
bullPosture
bullAirway Breathing and Sleep Disorders
bullSoft Tissue Dysfunctions (Tongue Thrust Open Mouth)
Instead of crooked teeth being The ProblemThey are just a SYMPTOM of something larger
Parentrsquos Private-eye Sheet
Parentrsquos Private-eye Sheet
ldquoThere are many things about your childrsquos health that are important to know but that I often donrsquot get to see at the office Also there are signs to look for that you may not have known were connected to your childrsquos teeth or health By looking for and tracking these ldquosigns and symptomsrdquo we can get a better handle on the problem and watch for resolution
You donrsquot have to spend a lot of time with this but donrsquot rush either Watch for certain things at different times of day Try not to let your child know they are being watched You want to see the most natural behaviors
Check off what you see If yoursquore not sure check it anyway and wersquoll talk about it Make comments if you wantrdquo
While sitting around
While sitting around (watching TV in the car) does your child
put ldquothingsrdquo in the mouth alot (toys sleeves pencils fingernails etc) ______________________________
lick or suck on the lips have the lips apart even a little stick or dart the tongue out of the mouth have the tongue resting between the teeth lean the cheek on a hand breath with his mouth open even a little bit make noises when breathing have trouble sitting still
While talking
While talking does your child talk very fast talk very slowly gasp for air have a lisp take speech lessons
During a meal
During a meal does your child gasp for air while eating stick his tongue between his teeth when swallowing stick the tongue out to meet the drinking glass drink a lot while eating make noises when chewing eat sloppily take a breath before drinking puff the cheeks out when drinking make the lips purse when swallowing make the chin ldquocrinklerdquo when swallowing bob the head when swallowing have trouble sitting still
While sleeping
While sleeping does your child have the mouth open snore wet the bed toss and turn tilt the head back wake up frequently have frequent nightmares have abnormal sleep issues grind the teeth have trouble waking up wake with darker circles under eyes
S R 10-10yo M
bullMissing 3242bullImpacted 1323bullLate mixed 25 eruptedbullSoft tissue dysfunctionbullIL = 40bullNot compliant
S Reardon 10-7yo M
Impacted 3s Missing 2s
Medical history
bull Reactive Airway Diseasebull ldquoBronchial Constrictionrdquo bullCare of Pulmonologistbull Preventil
bull Dad OSA CPAP for 11 years diabetesbull Grandfather OSA untreatedbull ETCO2 = 361 at 10 bpm (acceptable)bull Posture number - 18 (lt10 ideal)bull Father refuses sleep screening
Treatment Options1 Extract upper premolars Align2Open spaces for impacted canines Open spaces for lower lateral implants
Whatrsquos more importantEase of treatment
OrBreathing well at night
Bolton Standards15yo
The Maxilla is Down and Back
The Mandible is Retrognathic
Nasal Cartilage Collapse
Insufficient Facial Support
Bi-maxillary Retrusion
Bimaxillary Retrusion Forward Growth
Mouthbreathers have significantly smaller airway space
(measurements PAS-OccL PAS-UP airway volume area and minimum axial area)
Mouth breather Nasal breather
Three-dimensional assessment of pharyngeal airway in nasal- and mouth-breathing children
Alves M etal Int J Ped ORL 75 (2011) 1195ndash1199
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
B Hockel 2012
This is the profile Biobloc children start with long and retrusive
This is the profile Biobloc children finish with Forward with lips
together
B Hockel 2012
Herersquos the ldquoinsiderdquo look Notice how the upper front teeth are closer to the nose (yellow arrows)
Notice how the lower jaw rotates around the star so the chin comes up and forward (red arrow)How do we make this happen
From the tip of the Central
To the Forwardmost Tip of the Nose
41mm
Maxillary Heightbull Indicator Line (Mew)
bull Distance from most anterior point on nose to upper incisal edge
bull Age + 23bull A variable number but important to watch over time
B Hockel 2012
Herersquos the ldquoinsiderdquo look Notice how the upper front teeth are closer to the nose (yellow arrows)
Notice how the lower jaw rotates around the star so the chin comes up and forward (red arrow)How do we make this happen
Using IndicatorCosmetic Line
bull To define a starting pointbull To set treatment goalsbull To track treatment progressbull To gauge the effectiveness of treatment
Charting the InCos Line
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Incisor pulled away from noseNot ldquoundertorquedrdquo or ldquogummy smilerdquo
Hypothetical ClI OrthoMARA
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
OJ = 7mm
Starts Ortho
ldquoGreat Headgear
Effectrdquo
Class II Elastics
50
40
30
20mm
y J F M A M J J A S O N
boys
Start Non-x
Expansion UncrowdingFinished
Start Cl II elastics
OK thatrsquos
enough
Hypothetical Mouthbreather(Dr Mewrsquos Hamster Boy)
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Boy gets
hamster
MFT
Hypothetical BBO 7yoM
50
40
30
20
5 6 7 8 9 10 11 12 13 14 15
girlsboys
Initial
StartBB1
BB3
Night
bullLR 11-9yFbullMissing all 5s6s8s and upper 4sbullHad ortho to close diastemahellipbullInL = 39bullGP objects to deX plan equil
LR Tx Plan
1Preparation Hang Expanser2deX 3Training BB3 to advance mandible4Myofunctional Therapy5Orthopostural Training6Myobrace to hold7 Reevaluate for dental detailing
LR Spotty progress
50
40
30
20mm
y 313 4 5 6 7 8 9 10 11 12114
2 3
Expanser
Parents dragging30 turnsStart Adv
Rx deXGP
objects
After delays
Equil ersquosBB3
bullLR 12-3 yF (6mo in tx)bullInL = 37 (+2)bull ersquos equilibratedbull OJ =10bull Appliance OJ = 5bull Still accommodating to BB3
Is there a calculus for the Indicator Line
Treatment GoalsBased on Indicator Line
Incisor Goals
Type 1 Treatment Place U1 in ideal position
Biobloc Orthotropics Orthognathic Surgery Distraction Osteogenesis
Type 1 Ideal InCos line
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
YZ 9yo M
bullLost upper d-spacebullInL = 36(+4)bullOJ = 9mmbullLip entrapmentbullLip Incompetence
Y Z 9yo M
Y Z 9yo M9mm OJ
Y Z 9yo M
Treatment Options
1 Type 1 Reduce InL open lost space BB3 to advance mandible
2 Type 2 Open lost space Align
3 Type 4 Extract four premolars
YZ 9yoM
50
40
30
20mm
yM A M J J A S O N D J F M A
boys
Hang Expanser
Upper and Lower
Brackets Hang Retainer
BB3
Incisor Goals
Type 2 Treatment Develop arch just enough to uncrowd
Biobloc Myofunctional Ortho Myofunctional Therapy Crozat ALF Expansion Orthodontics
Type 2 Uncrowding
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
bullLip incompetencebullLip entrapmentbullHypermentalisbullMouthbreathing
Type 2 Uncrowding
12 month progress
12 month progress
12 month progress
After Treatment
Bent-wire6 monthsMyobrace12 months
Hey RaphaelWhat about that
profile
ZP 9-5yoM
i
After Expansion Phase
Incomplete profile improvement better breathing head posture and sleep
Incisor Goals
Type 3 Treatment Maintain UI
Functional Orthodontics Expansion Orthodontics Distalization Ortho or No Treatment
Type 3 Maintain
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Bimax retrusion
Successful dental result
Profile Unimproved
Incisor Goals
Type 4 Treatment RetractExtrude UI
Extraction Orthodontics Retraction Ortho Distalization Ortho
Type 4 Retraction
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Bimax retrusion
Successful dental result
Failed Profile Result
Changes of pharyngeal airway size and hyoid bone position following orthodontic treatment of
Class I bimaxillary protrusion
Qingzhu Wanga Peizeng Jiab Nina K Andersonc Lin Wangd Jiuxiang Line
Angle Orthodontist Vol 00 No 0 0000 (pre-publication 2012)
ldquothe dimension of the velopharynx glossopharynx and hypopharynx were decreased after maximal retraction of anterior teeth with extraction of four premolarshelliprdquo ldquoAny factors that can influence the posture and position of tongue and soft palate may displace them backward andencroach upon the pharynxrdquo
ldquothe more the incisors were retracted the more the pharyngeal airway was reducedrdquo
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Backed into a corner
bull
Moving teeth faster more efficientlyhellipin the wrong direction
Now that wersquove made smoking unacceptable
could we not do the same withbull Sugarbull Processed foodbull Cheap milk and meatbull Fast foodbull Pill popping for symptomatic reliefbull Looking for the cure instead of the causebull Surgery as a quick fixbull Thinking braces are a status symbol
Each industry thrives on the status quoConsumers must drive the change
NP 10yM
NP
Sisterrsquos non-x ortho
Shersquos happyhellipbut Irsquom not so
I make my pitch for BBO
The dilemma of progress
(I forgot the progress pictureshellip)
Dad sells prosthetic parts to orthopedic surgeons
I selling the case against my previous work they loved
It takes me 3 hours to sell the case
They fret until the BB3 goes in
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Connecting the dots
bull Adult SDB and OSA
bull Narrow jaws and faces
bull Soft tissue dysfunction
bull Early parafunctional habits ie open mouth posture
bull Environmental stressors
bull CPAP MARAUPPP SurgWherersquos the best
place to start treatment here
or here
1 Prevention 2 Undo the damage already done3 Establish good habits
When to start When damage from poor breathing is noticed and when bad habits are discovered
The strategies of Airway Orthodontics
Prevention
bull Remove ankyloglossiabull Promote breastfeedingbull Harden the dietbull Develop masticatory strengthbull Discourage oral habitsbull Promote whole-foods low sugar dietbull Reduce oropharyngeal obstructionbull Promote nasal breathing
Breathing retraining
bull Nasal rinsingbull Nasal clearingbull Decongesting
The goals of Airway Orthodontics
1 Breathing through the nose2 Lips together at rest3 Correct tongue position4 No facial muscles moving on swallowing5 Optimal forward facial development6 Class I occlusion7 Straight teeth8 Better stability long term
Myofunctional Trainers
Professors R Soulet and A Besombes
Dr Earl Bergeson
Dr Chris Farrell
The Multi ndash Family System
Orofacial MyofunctionalTherapy
Oral MyologyMyofunctional TherapyTongue Thrust Therapy
B Hockel 2012 Back
Undoing Bimaxillary Dysplasia
1 Maxillary deconstriction2 Maxillary advancement3 Maxillary impaction4 Mandibular advancement
1 Maxillary Expansion
Treatment for Bimaxillary Dysplasia
ALFCrozat
Bent Wire
HyraxHaas
Niti Exp BioBlocSchwartz
The Farrell BENT WIRE Systemtrade
Recommended Age Group 5-12 yrs
Arch Development in conjunction with the TRAINER Systemtrade
Dr John Mew
Establish Good Habits
1 Breathing through the nose2 Lips together at rest3 Correct tongue position4 No facial muscles moving on swallowing5 Stand and sit in balance6 Breath gently using the diaphragm7 Eat to nourish8 Sleep to rest
Ortho-Postural TrainingWorkshops
Breathing
Nutrition
Posture
Sleep
COPYRIGHTRoger L PriceOctober 2012
Posture Number
Forward head posturecan be a compensationfor a deficient airway
Sleep Screening and Hygiene
SQI = 10 SQI = 98
Integrative Healthcare
Function ProfessionalNasal clearing ENT Pulm MFT BreathingMuscle balance and tone MFT Myofunctional OrthoUndoing damage GP Pedo Ortho OMFSBreathing dynamics OPT MFT Breath PhysiologistPosture DC OPT PT OsteopathCranial balance OsteopathNutrition RDH Nutritionist Dietitian Sleep ENT Sleep Med DentNeurocognitive development Pedrsquon SLP Psych SpEd
The Interdisciplinary Center
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Now that I know
My personal missionTo create from what Irsquove
learned from the besta model for others to followhellipespecially the orthodontists
Myofunctional Orthodontics
Chris Farrell
John Flutter
German Ramierez
Damien OrsquoBrien
Myofunctional Research CoRancho Cucamonga
2008-2012
Oral Myology
Oral Myology Basic CourseJoy MoellerNYC 2011LA 2012
Oral Myology Levels 2 3Kim BenkertClifton 2012
Habit CessationShari GreenClifton 2013
Biobloc Orthotropics
BBO Mini-residencyBill Hang
Agora Hills2012-13
BBO IntensiveDrs John and Mike
MewLSFO2013
Breathing and Sleep
Buteyko MentorshipThe Breathing Center
Woodstock2010
Breathing Well ProgrammeJohn Flutter
2010 Ortho-Postural TrainingRoger Price
2013
Sleep DentistryMichael Gelb etal
NYU2012
ALF and Cranial
Jim Bronson2013 Tasha Turzo
Cranial Academy2014
Bucket Listbull ALF and Crozat (Bronsonrsquos course)bullMore on Biobloc (Hangrsquos Advanced London School)bull More Cranial (The Farm)bullChirodontics (Bob Walker)bull Airway Dentistry with Marc Cruz Jeff Rousebull Sleep Dentistrybull Less-than-Six with Kevin Boydbull Intra-mandibular Distraction Osteogenesis (IMDO)
Off My ListAnything that moves the teeth faster in the wrong direction
Whatrsquos an RO to do
To create from what Irsquove learned from the best
a model for others to followhellipespecially orthodontists
Teaching
Mt Sinai Pedo ResidencyAli Attaie
2010-2012
Montefiore Ortho ResidencyTony Maganzini
2012
2009-Present
Mt Sinai School of MedicinePedodontic Residency
Guest SpeakersJim BronsonMike MewKevin BoydSandra KahnJennifer TowRoger PricePaula Fabbie
Damien OrsquoBrien
First clinical program in myofunctional orthodontics
Airway and Facial DevelopmentCollaborative Webcast
Mark Cruz
AAPMD Symposium
wwwaapm
dorg
Annual MeetingApril 25-26 2014
Westin Chicago North Shore
the raphael center for integrative orthodontics
wwwalignminecomwwwbioblocnjcom
wwwmyobracenjcom
Integrative vs Conventional
Integrative vs Conventional
ldquoWith improvements in expansion orthodontics advances in myofunctional orthodontics and the growing recognition about sleep disordered breathing among children and adults it is time for orthodontics to expand its horizons There is now so much more we can oerrdquo
The Raphael name has been associated with high quality orthodontics in New Jersey for over 60 years Dr Barry Raphael has been a university trained orthodontic specialist and a member of the American Association of Orthodontists for 30 years
He has a wide range of techniques and services to offer He has studied oral myology applied kinesiology Buteyko breathing Biobloc Orthotropics and Myobrace as part of his integrative training He can offer Damon Invisalign Insignia and Incognito appliances designs as some of his many conventional orthodontic services too
Dr Raphael teaches his techniques at post-graduate residencies study clubs dental societies and for the Myofunctional Research Co He is available for presentations to any group interested in learning more about the benefits of integrative orthodontics
wwwalignminecomLearn about the choices you have in orthodontics
dr barry raphael Why its
too Early never
1425
bro
ad
str
ee
tc
lifto
n n
j 070
13
973-
778-
4222
fax
973-
778-
9625
nj s
pe
c
368
4
1425 broad street clifton nj 07013973-778-4222
wwwalignminecom
the raphael centerforintegrative orthodontics
the
raph
ael c
ente
r fo
rin
tegr
ativ
e or
thod
onti
cs
Learn about an important choice you need to make before starting braces
the raphael center for integrative education
the raphael center for integrative education
Ongoing Intro to Airway Orthodontics
April Biobloc Study Group
April Training Ortho-Postural Therapists w Roger Price
June MRC Myobrace Basic Series
August Airway Dentistry with Mark Cruz and company
October Advanced MFT with Sandy Coulson
October Less than Six with Kevin Boyd
(who else wants to play)
Mission to create a space for spreading the word about Airway and Orthotropic principles and practice
Orthodontics in the 21st Century
EstheticOrthodontics
AirwayOrthodontics
GeneticTooth-Focused
Dental PerfectionEsthetics Primary
Treating SymptomsAirway Ignorant
AdaptationMuscle-FocusedMedical Better
Esthetics SecondaryTreating Causes
Airway Conscious
The EndAnd
The Beginning
RO since1983 (30 yearsyikes)
Bucknell University 1974University of Pennsylvania 1978
(Three Years in General Practice)Fairleigh-Dickenson University 1983
14 Instructors 14 Techniques
RO since1983 (30 yearsyikes)
Bucknell University 1974University of Pennsylvania 1978
(Three Years in General Practice)Fairleigh-Dickenson University 1983
My Dream Office 2001
1Crooked teeth are THE PROBLEM
2The lower incisor must be upright
3Patients donrsquot want to cooperate
4Straightened teeth arenrsquot stable
In the ROrsquos Mind
1Crooked teeth are THE PROBLEM
2The lower incisor must be upright
3Patients donrsquot want to cooperate
4Straightened teeth arenrsquot stable
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
A Change of Mind
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
George Catlin
Are we developing the wayour genes program us to be
Westin Price
Kevin Boyd
Peter Gluckman
Neese and Williams
Scott Gilbert
Clark Spencer Larsen
Darwinian Dentistry
MeJames
Sim Wallace
Obesity
Metabolic SyndromeCeliac
Intestinal PermeabilityType 2 Diabetes
Fatty Liver Disease Cardiovascular Disease
HypertensionSome Cancers
The Results of the MismatchBetween Genes and the Environment
Chronic Non-Communicable Diseases of CivilizationWestern Lifestyle Diseases
Asthma
Autism
Aspergerrsquos
Alzheimers
ADDADHDDepression
Chronic Back Pain
Osteoporosis
Caries
Malocclusion
Sleep Apnea
The Toothberg
Airway-Related Craniofacial Dysfunctions
bullChronic Naso-pharyngeal Obstructionbull Tongue form aberrations (Frenum and tongue-tie)bullOpen Mouth Rest Posture bullMyofunctional disorders (Swallowing chewingetc)bullChronic Hyperventilation and Hypocapniabull Breathing Disordered Sleep (OSA UARS snoring)bull Bruxism and parafunctionsbull TMD and facial pain componentsbullCranial and postural issuesbull Malocclusion
Airway Orthodontics
bullEarly Feeding and Nutrition
bullAllergies Asthma URT infections
bullPosture
bullAirway Breathing and Sleep Disorders
bullSoft Tissue Dysfunctions (Tongue Thrust Open Mouth)
Instead of crooked teeth being The ProblemThey are just a SYMPTOM of something larger
Parentrsquos Private-eye Sheet
Parentrsquos Private-eye Sheet
ldquoThere are many things about your childrsquos health that are important to know but that I often donrsquot get to see at the office Also there are signs to look for that you may not have known were connected to your childrsquos teeth or health By looking for and tracking these ldquosigns and symptomsrdquo we can get a better handle on the problem and watch for resolution
You donrsquot have to spend a lot of time with this but donrsquot rush either Watch for certain things at different times of day Try not to let your child know they are being watched You want to see the most natural behaviors
Check off what you see If yoursquore not sure check it anyway and wersquoll talk about it Make comments if you wantrdquo
While sitting around
While sitting around (watching TV in the car) does your child
put ldquothingsrdquo in the mouth alot (toys sleeves pencils fingernails etc) ______________________________
lick or suck on the lips have the lips apart even a little stick or dart the tongue out of the mouth have the tongue resting between the teeth lean the cheek on a hand breath with his mouth open even a little bit make noises when breathing have trouble sitting still
While talking
While talking does your child talk very fast talk very slowly gasp for air have a lisp take speech lessons
During a meal
During a meal does your child gasp for air while eating stick his tongue between his teeth when swallowing stick the tongue out to meet the drinking glass drink a lot while eating make noises when chewing eat sloppily take a breath before drinking puff the cheeks out when drinking make the lips purse when swallowing make the chin ldquocrinklerdquo when swallowing bob the head when swallowing have trouble sitting still
While sleeping
While sleeping does your child have the mouth open snore wet the bed toss and turn tilt the head back wake up frequently have frequent nightmares have abnormal sleep issues grind the teeth have trouble waking up wake with darker circles under eyes
S R 10-10yo M
bullMissing 3242bullImpacted 1323bullLate mixed 25 eruptedbullSoft tissue dysfunctionbullIL = 40bullNot compliant
S Reardon 10-7yo M
Impacted 3s Missing 2s
Medical history
bull Reactive Airway Diseasebull ldquoBronchial Constrictionrdquo bullCare of Pulmonologistbull Preventil
bull Dad OSA CPAP for 11 years diabetesbull Grandfather OSA untreatedbull ETCO2 = 361 at 10 bpm (acceptable)bull Posture number - 18 (lt10 ideal)bull Father refuses sleep screening
Treatment Options1 Extract upper premolars Align2Open spaces for impacted canines Open spaces for lower lateral implants
Whatrsquos more importantEase of treatment
OrBreathing well at night
Bolton Standards15yo
The Maxilla is Down and Back
The Mandible is Retrognathic
Nasal Cartilage Collapse
Insufficient Facial Support
Bi-maxillary Retrusion
Bimaxillary Retrusion Forward Growth
Mouthbreathers have significantly smaller airway space
(measurements PAS-OccL PAS-UP airway volume area and minimum axial area)
Mouth breather Nasal breather
Three-dimensional assessment of pharyngeal airway in nasal- and mouth-breathing children
Alves M etal Int J Ped ORL 75 (2011) 1195ndash1199
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
B Hockel 2012
This is the profile Biobloc children start with long and retrusive
This is the profile Biobloc children finish with Forward with lips
together
B Hockel 2012
Herersquos the ldquoinsiderdquo look Notice how the upper front teeth are closer to the nose (yellow arrows)
Notice how the lower jaw rotates around the star so the chin comes up and forward (red arrow)How do we make this happen
From the tip of the Central
To the Forwardmost Tip of the Nose
41mm
Maxillary Heightbull Indicator Line (Mew)
bull Distance from most anterior point on nose to upper incisal edge
bull Age + 23bull A variable number but important to watch over time
B Hockel 2012
Herersquos the ldquoinsiderdquo look Notice how the upper front teeth are closer to the nose (yellow arrows)
Notice how the lower jaw rotates around the star so the chin comes up and forward (red arrow)How do we make this happen
Using IndicatorCosmetic Line
bull To define a starting pointbull To set treatment goalsbull To track treatment progressbull To gauge the effectiveness of treatment
Charting the InCos Line
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Incisor pulled away from noseNot ldquoundertorquedrdquo or ldquogummy smilerdquo
Hypothetical ClI OrthoMARA
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
OJ = 7mm
Starts Ortho
ldquoGreat Headgear
Effectrdquo
Class II Elastics
50
40
30
20mm
y J F M A M J J A S O N
boys
Start Non-x
Expansion UncrowdingFinished
Start Cl II elastics
OK thatrsquos
enough
Hypothetical Mouthbreather(Dr Mewrsquos Hamster Boy)
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Boy gets
hamster
MFT
Hypothetical BBO 7yoM
50
40
30
20
5 6 7 8 9 10 11 12 13 14 15
girlsboys
Initial
StartBB1
BB3
Night
bullLR 11-9yFbullMissing all 5s6s8s and upper 4sbullHad ortho to close diastemahellipbullInL = 39bullGP objects to deX plan equil
LR Tx Plan
1Preparation Hang Expanser2deX 3Training BB3 to advance mandible4Myofunctional Therapy5Orthopostural Training6Myobrace to hold7 Reevaluate for dental detailing
LR Spotty progress
50
40
30
20mm
y 313 4 5 6 7 8 9 10 11 12114
2 3
Expanser
Parents dragging30 turnsStart Adv
Rx deXGP
objects
After delays
Equil ersquosBB3
bullLR 12-3 yF (6mo in tx)bullInL = 37 (+2)bull ersquos equilibratedbull OJ =10bull Appliance OJ = 5bull Still accommodating to BB3
Is there a calculus for the Indicator Line
Treatment GoalsBased on Indicator Line
Incisor Goals
Type 1 Treatment Place U1 in ideal position
Biobloc Orthotropics Orthognathic Surgery Distraction Osteogenesis
Type 1 Ideal InCos line
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
YZ 9yo M
bullLost upper d-spacebullInL = 36(+4)bullOJ = 9mmbullLip entrapmentbullLip Incompetence
Y Z 9yo M
Y Z 9yo M9mm OJ
Y Z 9yo M
Treatment Options
1 Type 1 Reduce InL open lost space BB3 to advance mandible
2 Type 2 Open lost space Align
3 Type 4 Extract four premolars
YZ 9yoM
50
40
30
20mm
yM A M J J A S O N D J F M A
boys
Hang Expanser
Upper and Lower
Brackets Hang Retainer
BB3
Incisor Goals
Type 2 Treatment Develop arch just enough to uncrowd
Biobloc Myofunctional Ortho Myofunctional Therapy Crozat ALF Expansion Orthodontics
Type 2 Uncrowding
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
bullLip incompetencebullLip entrapmentbullHypermentalisbullMouthbreathing
Type 2 Uncrowding
12 month progress
12 month progress
12 month progress
After Treatment
Bent-wire6 monthsMyobrace12 months
Hey RaphaelWhat about that
profile
ZP 9-5yoM
i
After Expansion Phase
Incomplete profile improvement better breathing head posture and sleep
Incisor Goals
Type 3 Treatment Maintain UI
Functional Orthodontics Expansion Orthodontics Distalization Ortho or No Treatment
Type 3 Maintain
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Bimax retrusion
Successful dental result
Profile Unimproved
Incisor Goals
Type 4 Treatment RetractExtrude UI
Extraction Orthodontics Retraction Ortho Distalization Ortho
Type 4 Retraction
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Bimax retrusion
Successful dental result
Failed Profile Result
Changes of pharyngeal airway size and hyoid bone position following orthodontic treatment of
Class I bimaxillary protrusion
Qingzhu Wanga Peizeng Jiab Nina K Andersonc Lin Wangd Jiuxiang Line
Angle Orthodontist Vol 00 No 0 0000 (pre-publication 2012)
ldquothe dimension of the velopharynx glossopharynx and hypopharynx were decreased after maximal retraction of anterior teeth with extraction of four premolarshelliprdquo ldquoAny factors that can influence the posture and position of tongue and soft palate may displace them backward andencroach upon the pharynxrdquo
ldquothe more the incisors were retracted the more the pharyngeal airway was reducedrdquo
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Backed into a corner
bull
Moving teeth faster more efficientlyhellipin the wrong direction
Now that wersquove made smoking unacceptable
could we not do the same withbull Sugarbull Processed foodbull Cheap milk and meatbull Fast foodbull Pill popping for symptomatic reliefbull Looking for the cure instead of the causebull Surgery as a quick fixbull Thinking braces are a status symbol
Each industry thrives on the status quoConsumers must drive the change
NP 10yM
NP
Sisterrsquos non-x ortho
Shersquos happyhellipbut Irsquom not so
I make my pitch for BBO
The dilemma of progress
(I forgot the progress pictureshellip)
Dad sells prosthetic parts to orthopedic surgeons
I selling the case against my previous work they loved
It takes me 3 hours to sell the case
They fret until the BB3 goes in
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Connecting the dots
bull Adult SDB and OSA
bull Narrow jaws and faces
bull Soft tissue dysfunction
bull Early parafunctional habits ie open mouth posture
bull Environmental stressors
bull CPAP MARAUPPP SurgWherersquos the best
place to start treatment here
or here
1 Prevention 2 Undo the damage already done3 Establish good habits
When to start When damage from poor breathing is noticed and when bad habits are discovered
The strategies of Airway Orthodontics
Prevention
bull Remove ankyloglossiabull Promote breastfeedingbull Harden the dietbull Develop masticatory strengthbull Discourage oral habitsbull Promote whole-foods low sugar dietbull Reduce oropharyngeal obstructionbull Promote nasal breathing
Breathing retraining
bull Nasal rinsingbull Nasal clearingbull Decongesting
The goals of Airway Orthodontics
1 Breathing through the nose2 Lips together at rest3 Correct tongue position4 No facial muscles moving on swallowing5 Optimal forward facial development6 Class I occlusion7 Straight teeth8 Better stability long term
Myofunctional Trainers
Professors R Soulet and A Besombes
Dr Earl Bergeson
Dr Chris Farrell
The Multi ndash Family System
Orofacial MyofunctionalTherapy
Oral MyologyMyofunctional TherapyTongue Thrust Therapy
B Hockel 2012 Back
Undoing Bimaxillary Dysplasia
1 Maxillary deconstriction2 Maxillary advancement3 Maxillary impaction4 Mandibular advancement
1 Maxillary Expansion
Treatment for Bimaxillary Dysplasia
ALFCrozat
Bent Wire
HyraxHaas
Niti Exp BioBlocSchwartz
The Farrell BENT WIRE Systemtrade
Recommended Age Group 5-12 yrs
Arch Development in conjunction with the TRAINER Systemtrade
Dr John Mew
Establish Good Habits
1 Breathing through the nose2 Lips together at rest3 Correct tongue position4 No facial muscles moving on swallowing5 Stand and sit in balance6 Breath gently using the diaphragm7 Eat to nourish8 Sleep to rest
Ortho-Postural TrainingWorkshops
Breathing
Nutrition
Posture
Sleep
COPYRIGHTRoger L PriceOctober 2012
Posture Number
Forward head posturecan be a compensationfor a deficient airway
Sleep Screening and Hygiene
SQI = 10 SQI = 98
Integrative Healthcare
Function ProfessionalNasal clearing ENT Pulm MFT BreathingMuscle balance and tone MFT Myofunctional OrthoUndoing damage GP Pedo Ortho OMFSBreathing dynamics OPT MFT Breath PhysiologistPosture DC OPT PT OsteopathCranial balance OsteopathNutrition RDH Nutritionist Dietitian Sleep ENT Sleep Med DentNeurocognitive development Pedrsquon SLP Psych SpEd
The Interdisciplinary Center
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Now that I know
My personal missionTo create from what Irsquove
learned from the besta model for others to followhellipespecially the orthodontists
Myofunctional Orthodontics
Chris Farrell
John Flutter
German Ramierez
Damien OrsquoBrien
Myofunctional Research CoRancho Cucamonga
2008-2012
Oral Myology
Oral Myology Basic CourseJoy MoellerNYC 2011LA 2012
Oral Myology Levels 2 3Kim BenkertClifton 2012
Habit CessationShari GreenClifton 2013
Biobloc Orthotropics
BBO Mini-residencyBill Hang
Agora Hills2012-13
BBO IntensiveDrs John and Mike
MewLSFO2013
Breathing and Sleep
Buteyko MentorshipThe Breathing Center
Woodstock2010
Breathing Well ProgrammeJohn Flutter
2010 Ortho-Postural TrainingRoger Price
2013
Sleep DentistryMichael Gelb etal
NYU2012
ALF and Cranial
Jim Bronson2013 Tasha Turzo
Cranial Academy2014
Bucket Listbull ALF and Crozat (Bronsonrsquos course)bullMore on Biobloc (Hangrsquos Advanced London School)bull More Cranial (The Farm)bullChirodontics (Bob Walker)bull Airway Dentistry with Marc Cruz Jeff Rousebull Sleep Dentistrybull Less-than-Six with Kevin Boydbull Intra-mandibular Distraction Osteogenesis (IMDO)
Off My ListAnything that moves the teeth faster in the wrong direction
Whatrsquos an RO to do
To create from what Irsquove learned from the best
a model for others to followhellipespecially orthodontists
Teaching
Mt Sinai Pedo ResidencyAli Attaie
2010-2012
Montefiore Ortho ResidencyTony Maganzini
2012
2009-Present
Mt Sinai School of MedicinePedodontic Residency
Guest SpeakersJim BronsonMike MewKevin BoydSandra KahnJennifer TowRoger PricePaula Fabbie
Damien OrsquoBrien
First clinical program in myofunctional orthodontics
Airway and Facial DevelopmentCollaborative Webcast
Mark Cruz
AAPMD Symposium
wwwaapm
dorg
Annual MeetingApril 25-26 2014
Westin Chicago North Shore
the raphael center for integrative orthodontics
wwwalignminecomwwwbioblocnjcom
wwwmyobracenjcom
Integrative vs Conventional
Integrative vs Conventional
ldquoWith improvements in expansion orthodontics advances in myofunctional orthodontics and the growing recognition about sleep disordered breathing among children and adults it is time for orthodontics to expand its horizons There is now so much more we can oerrdquo
The Raphael name has been associated with high quality orthodontics in New Jersey for over 60 years Dr Barry Raphael has been a university trained orthodontic specialist and a member of the American Association of Orthodontists for 30 years
He has a wide range of techniques and services to offer He has studied oral myology applied kinesiology Buteyko breathing Biobloc Orthotropics and Myobrace as part of his integrative training He can offer Damon Invisalign Insignia and Incognito appliances designs as some of his many conventional orthodontic services too
Dr Raphael teaches his techniques at post-graduate residencies study clubs dental societies and for the Myofunctional Research Co He is available for presentations to any group interested in learning more about the benefits of integrative orthodontics
wwwalignminecomLearn about the choices you have in orthodontics
dr barry raphael Why its
too Early never
1425
bro
ad
str
ee
tc
lifto
n n
j 070
13
973-
778-
4222
fax
973-
778-
9625
nj s
pe
c
368
4
1425 broad street clifton nj 07013973-778-4222
wwwalignminecom
the raphael centerforintegrative orthodontics
the
raph
ael c
ente
r fo
rin
tegr
ativ
e or
thod
onti
cs
Learn about an important choice you need to make before starting braces
the raphael center for integrative education
the raphael center for integrative education
Ongoing Intro to Airway Orthodontics
April Biobloc Study Group
April Training Ortho-Postural Therapists w Roger Price
June MRC Myobrace Basic Series
August Airway Dentistry with Mark Cruz and company
October Advanced MFT with Sandy Coulson
October Less than Six with Kevin Boyd
(who else wants to play)
Mission to create a space for spreading the word about Airway and Orthotropic principles and practice
Orthodontics in the 21st Century
EstheticOrthodontics
AirwayOrthodontics
GeneticTooth-Focused
Dental PerfectionEsthetics Primary
Treating SymptomsAirway Ignorant
AdaptationMuscle-FocusedMedical Better
Esthetics SecondaryTreating Causes
Airway Conscious
The EndAnd
The Beginning
RO since1983 (30 yearsyikes)
Bucknell University 1974University of Pennsylvania 1978
(Three Years in General Practice)Fairleigh-Dickenson University 1983
My Dream Office 2001
1Crooked teeth are THE PROBLEM
2The lower incisor must be upright
3Patients donrsquot want to cooperate
4Straightened teeth arenrsquot stable
In the ROrsquos Mind
1Crooked teeth are THE PROBLEM
2The lower incisor must be upright
3Patients donrsquot want to cooperate
4Straightened teeth arenrsquot stable
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
A Change of Mind
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
George Catlin
Are we developing the wayour genes program us to be
Westin Price
Kevin Boyd
Peter Gluckman
Neese and Williams
Scott Gilbert
Clark Spencer Larsen
Darwinian Dentistry
MeJames
Sim Wallace
Obesity
Metabolic SyndromeCeliac
Intestinal PermeabilityType 2 Diabetes
Fatty Liver Disease Cardiovascular Disease
HypertensionSome Cancers
The Results of the MismatchBetween Genes and the Environment
Chronic Non-Communicable Diseases of CivilizationWestern Lifestyle Diseases
Asthma
Autism
Aspergerrsquos
Alzheimers
ADDADHDDepression
Chronic Back Pain
Osteoporosis
Caries
Malocclusion
Sleep Apnea
The Toothberg
Airway-Related Craniofacial Dysfunctions
bullChronic Naso-pharyngeal Obstructionbull Tongue form aberrations (Frenum and tongue-tie)bullOpen Mouth Rest Posture bullMyofunctional disorders (Swallowing chewingetc)bullChronic Hyperventilation and Hypocapniabull Breathing Disordered Sleep (OSA UARS snoring)bull Bruxism and parafunctionsbull TMD and facial pain componentsbullCranial and postural issuesbull Malocclusion
Airway Orthodontics
bullEarly Feeding and Nutrition
bullAllergies Asthma URT infections
bullPosture
bullAirway Breathing and Sleep Disorders
bullSoft Tissue Dysfunctions (Tongue Thrust Open Mouth)
Instead of crooked teeth being The ProblemThey are just a SYMPTOM of something larger
Parentrsquos Private-eye Sheet
Parentrsquos Private-eye Sheet
ldquoThere are many things about your childrsquos health that are important to know but that I often donrsquot get to see at the office Also there are signs to look for that you may not have known were connected to your childrsquos teeth or health By looking for and tracking these ldquosigns and symptomsrdquo we can get a better handle on the problem and watch for resolution
You donrsquot have to spend a lot of time with this but donrsquot rush either Watch for certain things at different times of day Try not to let your child know they are being watched You want to see the most natural behaviors
Check off what you see If yoursquore not sure check it anyway and wersquoll talk about it Make comments if you wantrdquo
While sitting around
While sitting around (watching TV in the car) does your child
put ldquothingsrdquo in the mouth alot (toys sleeves pencils fingernails etc) ______________________________
lick or suck on the lips have the lips apart even a little stick or dart the tongue out of the mouth have the tongue resting between the teeth lean the cheek on a hand breath with his mouth open even a little bit make noises when breathing have trouble sitting still
While talking
While talking does your child talk very fast talk very slowly gasp for air have a lisp take speech lessons
During a meal
During a meal does your child gasp for air while eating stick his tongue between his teeth when swallowing stick the tongue out to meet the drinking glass drink a lot while eating make noises when chewing eat sloppily take a breath before drinking puff the cheeks out when drinking make the lips purse when swallowing make the chin ldquocrinklerdquo when swallowing bob the head when swallowing have trouble sitting still
While sleeping
While sleeping does your child have the mouth open snore wet the bed toss and turn tilt the head back wake up frequently have frequent nightmares have abnormal sleep issues grind the teeth have trouble waking up wake with darker circles under eyes
S R 10-10yo M
bullMissing 3242bullImpacted 1323bullLate mixed 25 eruptedbullSoft tissue dysfunctionbullIL = 40bullNot compliant
S Reardon 10-7yo M
Impacted 3s Missing 2s
Medical history
bull Reactive Airway Diseasebull ldquoBronchial Constrictionrdquo bullCare of Pulmonologistbull Preventil
bull Dad OSA CPAP for 11 years diabetesbull Grandfather OSA untreatedbull ETCO2 = 361 at 10 bpm (acceptable)bull Posture number - 18 (lt10 ideal)bull Father refuses sleep screening
Treatment Options1 Extract upper premolars Align2Open spaces for impacted canines Open spaces for lower lateral implants
Whatrsquos more importantEase of treatment
OrBreathing well at night
Bolton Standards15yo
The Maxilla is Down and Back
The Mandible is Retrognathic
Nasal Cartilage Collapse
Insufficient Facial Support
Bi-maxillary Retrusion
Bimaxillary Retrusion Forward Growth
Mouthbreathers have significantly smaller airway space
(measurements PAS-OccL PAS-UP airway volume area and minimum axial area)
Mouth breather Nasal breather
Three-dimensional assessment of pharyngeal airway in nasal- and mouth-breathing children
Alves M etal Int J Ped ORL 75 (2011) 1195ndash1199
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
B Hockel 2012
This is the profile Biobloc children start with long and retrusive
This is the profile Biobloc children finish with Forward with lips
together
B Hockel 2012
Herersquos the ldquoinsiderdquo look Notice how the upper front teeth are closer to the nose (yellow arrows)
Notice how the lower jaw rotates around the star so the chin comes up and forward (red arrow)How do we make this happen
From the tip of the Central
To the Forwardmost Tip of the Nose
41mm
Maxillary Heightbull Indicator Line (Mew)
bull Distance from most anterior point on nose to upper incisal edge
bull Age + 23bull A variable number but important to watch over time
B Hockel 2012
Herersquos the ldquoinsiderdquo look Notice how the upper front teeth are closer to the nose (yellow arrows)
Notice how the lower jaw rotates around the star so the chin comes up and forward (red arrow)How do we make this happen
Using IndicatorCosmetic Line
bull To define a starting pointbull To set treatment goalsbull To track treatment progressbull To gauge the effectiveness of treatment
Charting the InCos Line
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Incisor pulled away from noseNot ldquoundertorquedrdquo or ldquogummy smilerdquo
Hypothetical ClI OrthoMARA
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
OJ = 7mm
Starts Ortho
ldquoGreat Headgear
Effectrdquo
Class II Elastics
50
40
30
20mm
y J F M A M J J A S O N
boys
Start Non-x
Expansion UncrowdingFinished
Start Cl II elastics
OK thatrsquos
enough
Hypothetical Mouthbreather(Dr Mewrsquos Hamster Boy)
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Boy gets
hamster
MFT
Hypothetical BBO 7yoM
50
40
30
20
5 6 7 8 9 10 11 12 13 14 15
girlsboys
Initial
StartBB1
BB3
Night
bullLR 11-9yFbullMissing all 5s6s8s and upper 4sbullHad ortho to close diastemahellipbullInL = 39bullGP objects to deX plan equil
LR Tx Plan
1Preparation Hang Expanser2deX 3Training BB3 to advance mandible4Myofunctional Therapy5Orthopostural Training6Myobrace to hold7 Reevaluate for dental detailing
LR Spotty progress
50
40
30
20mm
y 313 4 5 6 7 8 9 10 11 12114
2 3
Expanser
Parents dragging30 turnsStart Adv
Rx deXGP
objects
After delays
Equil ersquosBB3
bullLR 12-3 yF (6mo in tx)bullInL = 37 (+2)bull ersquos equilibratedbull OJ =10bull Appliance OJ = 5bull Still accommodating to BB3
Is there a calculus for the Indicator Line
Treatment GoalsBased on Indicator Line
Incisor Goals
Type 1 Treatment Place U1 in ideal position
Biobloc Orthotropics Orthognathic Surgery Distraction Osteogenesis
Type 1 Ideal InCos line
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
YZ 9yo M
bullLost upper d-spacebullInL = 36(+4)bullOJ = 9mmbullLip entrapmentbullLip Incompetence
Y Z 9yo M
Y Z 9yo M9mm OJ
Y Z 9yo M
Treatment Options
1 Type 1 Reduce InL open lost space BB3 to advance mandible
2 Type 2 Open lost space Align
3 Type 4 Extract four premolars
YZ 9yoM
50
40
30
20mm
yM A M J J A S O N D J F M A
boys
Hang Expanser
Upper and Lower
Brackets Hang Retainer
BB3
Incisor Goals
Type 2 Treatment Develop arch just enough to uncrowd
Biobloc Myofunctional Ortho Myofunctional Therapy Crozat ALF Expansion Orthodontics
Type 2 Uncrowding
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
bullLip incompetencebullLip entrapmentbullHypermentalisbullMouthbreathing
Type 2 Uncrowding
12 month progress
12 month progress
12 month progress
After Treatment
Bent-wire6 monthsMyobrace12 months
Hey RaphaelWhat about that
profile
ZP 9-5yoM
i
After Expansion Phase
Incomplete profile improvement better breathing head posture and sleep
Incisor Goals
Type 3 Treatment Maintain UI
Functional Orthodontics Expansion Orthodontics Distalization Ortho or No Treatment
Type 3 Maintain
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Bimax retrusion
Successful dental result
Profile Unimproved
Incisor Goals
Type 4 Treatment RetractExtrude UI
Extraction Orthodontics Retraction Ortho Distalization Ortho
Type 4 Retraction
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Bimax retrusion
Successful dental result
Failed Profile Result
Changes of pharyngeal airway size and hyoid bone position following orthodontic treatment of
Class I bimaxillary protrusion
Qingzhu Wanga Peizeng Jiab Nina K Andersonc Lin Wangd Jiuxiang Line
Angle Orthodontist Vol 00 No 0 0000 (pre-publication 2012)
ldquothe dimension of the velopharynx glossopharynx and hypopharynx were decreased after maximal retraction of anterior teeth with extraction of four premolarshelliprdquo ldquoAny factors that can influence the posture and position of tongue and soft palate may displace them backward andencroach upon the pharynxrdquo
ldquothe more the incisors were retracted the more the pharyngeal airway was reducedrdquo
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Backed into a corner
bull
Moving teeth faster more efficientlyhellipin the wrong direction
Now that wersquove made smoking unacceptable
could we not do the same withbull Sugarbull Processed foodbull Cheap milk and meatbull Fast foodbull Pill popping for symptomatic reliefbull Looking for the cure instead of the causebull Surgery as a quick fixbull Thinking braces are a status symbol
Each industry thrives on the status quoConsumers must drive the change
NP 10yM
NP
Sisterrsquos non-x ortho
Shersquos happyhellipbut Irsquom not so
I make my pitch for BBO
The dilemma of progress
(I forgot the progress pictureshellip)
Dad sells prosthetic parts to orthopedic surgeons
I selling the case against my previous work they loved
It takes me 3 hours to sell the case
They fret until the BB3 goes in
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Connecting the dots
bull Adult SDB and OSA
bull Narrow jaws and faces
bull Soft tissue dysfunction
bull Early parafunctional habits ie open mouth posture
bull Environmental stressors
bull CPAP MARAUPPP SurgWherersquos the best
place to start treatment here
or here
1 Prevention 2 Undo the damage already done3 Establish good habits
When to start When damage from poor breathing is noticed and when bad habits are discovered
The strategies of Airway Orthodontics
Prevention
bull Remove ankyloglossiabull Promote breastfeedingbull Harden the dietbull Develop masticatory strengthbull Discourage oral habitsbull Promote whole-foods low sugar dietbull Reduce oropharyngeal obstructionbull Promote nasal breathing
Breathing retraining
bull Nasal rinsingbull Nasal clearingbull Decongesting
The goals of Airway Orthodontics
1 Breathing through the nose2 Lips together at rest3 Correct tongue position4 No facial muscles moving on swallowing5 Optimal forward facial development6 Class I occlusion7 Straight teeth8 Better stability long term
Myofunctional Trainers
Professors R Soulet and A Besombes
Dr Earl Bergeson
Dr Chris Farrell
The Multi ndash Family System
Orofacial MyofunctionalTherapy
Oral MyologyMyofunctional TherapyTongue Thrust Therapy
B Hockel 2012 Back
Undoing Bimaxillary Dysplasia
1 Maxillary deconstriction2 Maxillary advancement3 Maxillary impaction4 Mandibular advancement
1 Maxillary Expansion
Treatment for Bimaxillary Dysplasia
ALFCrozat
Bent Wire
HyraxHaas
Niti Exp BioBlocSchwartz
The Farrell BENT WIRE Systemtrade
Recommended Age Group 5-12 yrs
Arch Development in conjunction with the TRAINER Systemtrade
Dr John Mew
Establish Good Habits
1 Breathing through the nose2 Lips together at rest3 Correct tongue position4 No facial muscles moving on swallowing5 Stand and sit in balance6 Breath gently using the diaphragm7 Eat to nourish8 Sleep to rest
Ortho-Postural TrainingWorkshops
Breathing
Nutrition
Posture
Sleep
COPYRIGHTRoger L PriceOctober 2012
Posture Number
Forward head posturecan be a compensationfor a deficient airway
Sleep Screening and Hygiene
SQI = 10 SQI = 98
Integrative Healthcare
Function ProfessionalNasal clearing ENT Pulm MFT BreathingMuscle balance and tone MFT Myofunctional OrthoUndoing damage GP Pedo Ortho OMFSBreathing dynamics OPT MFT Breath PhysiologistPosture DC OPT PT OsteopathCranial balance OsteopathNutrition RDH Nutritionist Dietitian Sleep ENT Sleep Med DentNeurocognitive development Pedrsquon SLP Psych SpEd
The Interdisciplinary Center
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Now that I know
My personal missionTo create from what Irsquove
learned from the besta model for others to followhellipespecially the orthodontists
Myofunctional Orthodontics
Chris Farrell
John Flutter
German Ramierez
Damien OrsquoBrien
Myofunctional Research CoRancho Cucamonga
2008-2012
Oral Myology
Oral Myology Basic CourseJoy MoellerNYC 2011LA 2012
Oral Myology Levels 2 3Kim BenkertClifton 2012
Habit CessationShari GreenClifton 2013
Biobloc Orthotropics
BBO Mini-residencyBill Hang
Agora Hills2012-13
BBO IntensiveDrs John and Mike
MewLSFO2013
Breathing and Sleep
Buteyko MentorshipThe Breathing Center
Woodstock2010
Breathing Well ProgrammeJohn Flutter
2010 Ortho-Postural TrainingRoger Price
2013
Sleep DentistryMichael Gelb etal
NYU2012
ALF and Cranial
Jim Bronson2013 Tasha Turzo
Cranial Academy2014
Bucket Listbull ALF and Crozat (Bronsonrsquos course)bullMore on Biobloc (Hangrsquos Advanced London School)bull More Cranial (The Farm)bullChirodontics (Bob Walker)bull Airway Dentistry with Marc Cruz Jeff Rousebull Sleep Dentistrybull Less-than-Six with Kevin Boydbull Intra-mandibular Distraction Osteogenesis (IMDO)
Off My ListAnything that moves the teeth faster in the wrong direction
Whatrsquos an RO to do
To create from what Irsquove learned from the best
a model for others to followhellipespecially orthodontists
Teaching
Mt Sinai Pedo ResidencyAli Attaie
2010-2012
Montefiore Ortho ResidencyTony Maganzini
2012
2009-Present
Mt Sinai School of MedicinePedodontic Residency
Guest SpeakersJim BronsonMike MewKevin BoydSandra KahnJennifer TowRoger PricePaula Fabbie
Damien OrsquoBrien
First clinical program in myofunctional orthodontics
Airway and Facial DevelopmentCollaborative Webcast
Mark Cruz
AAPMD Symposium
wwwaapm
dorg
Annual MeetingApril 25-26 2014
Westin Chicago North Shore
the raphael center for integrative orthodontics
wwwalignminecomwwwbioblocnjcom
wwwmyobracenjcom
Integrative vs Conventional
Integrative vs Conventional
ldquoWith improvements in expansion orthodontics advances in myofunctional orthodontics and the growing recognition about sleep disordered breathing among children and adults it is time for orthodontics to expand its horizons There is now so much more we can oerrdquo
The Raphael name has been associated with high quality orthodontics in New Jersey for over 60 years Dr Barry Raphael has been a university trained orthodontic specialist and a member of the American Association of Orthodontists for 30 years
He has a wide range of techniques and services to offer He has studied oral myology applied kinesiology Buteyko breathing Biobloc Orthotropics and Myobrace as part of his integrative training He can offer Damon Invisalign Insignia and Incognito appliances designs as some of his many conventional orthodontic services too
Dr Raphael teaches his techniques at post-graduate residencies study clubs dental societies and for the Myofunctional Research Co He is available for presentations to any group interested in learning more about the benefits of integrative orthodontics
wwwalignminecomLearn about the choices you have in orthodontics
dr barry raphael Why its
too Early never
1425
bro
ad
str
ee
tc
lifto
n n
j 070
13
973-
778-
4222
fax
973-
778-
9625
nj s
pe
c
368
4
1425 broad street clifton nj 07013973-778-4222
wwwalignminecom
the raphael centerforintegrative orthodontics
the
raph
ael c
ente
r fo
rin
tegr
ativ
e or
thod
onti
cs
Learn about an important choice you need to make before starting braces
the raphael center for integrative education
the raphael center for integrative education
Ongoing Intro to Airway Orthodontics
April Biobloc Study Group
April Training Ortho-Postural Therapists w Roger Price
June MRC Myobrace Basic Series
August Airway Dentistry with Mark Cruz and company
October Advanced MFT with Sandy Coulson
October Less than Six with Kevin Boyd
(who else wants to play)
Mission to create a space for spreading the word about Airway and Orthotropic principles and practice
Orthodontics in the 21st Century
EstheticOrthodontics
AirwayOrthodontics
GeneticTooth-Focused
Dental PerfectionEsthetics Primary
Treating SymptomsAirway Ignorant
AdaptationMuscle-FocusedMedical Better
Esthetics SecondaryTreating Causes
Airway Conscious
The EndAnd
The Beginning
My Dream Office 2001
1Crooked teeth are THE PROBLEM
2The lower incisor must be upright
3Patients donrsquot want to cooperate
4Straightened teeth arenrsquot stable
In the ROrsquos Mind
1Crooked teeth are THE PROBLEM
2The lower incisor must be upright
3Patients donrsquot want to cooperate
4Straightened teeth arenrsquot stable
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
A Change of Mind
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
George Catlin
Are we developing the wayour genes program us to be
Westin Price
Kevin Boyd
Peter Gluckman
Neese and Williams
Scott Gilbert
Clark Spencer Larsen
Darwinian Dentistry
MeJames
Sim Wallace
Obesity
Metabolic SyndromeCeliac
Intestinal PermeabilityType 2 Diabetes
Fatty Liver Disease Cardiovascular Disease
HypertensionSome Cancers
The Results of the MismatchBetween Genes and the Environment
Chronic Non-Communicable Diseases of CivilizationWestern Lifestyle Diseases
Asthma
Autism
Aspergerrsquos
Alzheimers
ADDADHDDepression
Chronic Back Pain
Osteoporosis
Caries
Malocclusion
Sleep Apnea
The Toothberg
Airway-Related Craniofacial Dysfunctions
bullChronic Naso-pharyngeal Obstructionbull Tongue form aberrations (Frenum and tongue-tie)bullOpen Mouth Rest Posture bullMyofunctional disorders (Swallowing chewingetc)bullChronic Hyperventilation and Hypocapniabull Breathing Disordered Sleep (OSA UARS snoring)bull Bruxism and parafunctionsbull TMD and facial pain componentsbullCranial and postural issuesbull Malocclusion
Airway Orthodontics
bullEarly Feeding and Nutrition
bullAllergies Asthma URT infections
bullPosture
bullAirway Breathing and Sleep Disorders
bullSoft Tissue Dysfunctions (Tongue Thrust Open Mouth)
Instead of crooked teeth being The ProblemThey are just a SYMPTOM of something larger
Parentrsquos Private-eye Sheet
Parentrsquos Private-eye Sheet
ldquoThere are many things about your childrsquos health that are important to know but that I often donrsquot get to see at the office Also there are signs to look for that you may not have known were connected to your childrsquos teeth or health By looking for and tracking these ldquosigns and symptomsrdquo we can get a better handle on the problem and watch for resolution
You donrsquot have to spend a lot of time with this but donrsquot rush either Watch for certain things at different times of day Try not to let your child know they are being watched You want to see the most natural behaviors
Check off what you see If yoursquore not sure check it anyway and wersquoll talk about it Make comments if you wantrdquo
While sitting around
While sitting around (watching TV in the car) does your child
put ldquothingsrdquo in the mouth alot (toys sleeves pencils fingernails etc) ______________________________
lick or suck on the lips have the lips apart even a little stick or dart the tongue out of the mouth have the tongue resting between the teeth lean the cheek on a hand breath with his mouth open even a little bit make noises when breathing have trouble sitting still
While talking
While talking does your child talk very fast talk very slowly gasp for air have a lisp take speech lessons
During a meal
During a meal does your child gasp for air while eating stick his tongue between his teeth when swallowing stick the tongue out to meet the drinking glass drink a lot while eating make noises when chewing eat sloppily take a breath before drinking puff the cheeks out when drinking make the lips purse when swallowing make the chin ldquocrinklerdquo when swallowing bob the head when swallowing have trouble sitting still
While sleeping
While sleeping does your child have the mouth open snore wet the bed toss and turn tilt the head back wake up frequently have frequent nightmares have abnormal sleep issues grind the teeth have trouble waking up wake with darker circles under eyes
S R 10-10yo M
bullMissing 3242bullImpacted 1323bullLate mixed 25 eruptedbullSoft tissue dysfunctionbullIL = 40bullNot compliant
S Reardon 10-7yo M
Impacted 3s Missing 2s
Medical history
bull Reactive Airway Diseasebull ldquoBronchial Constrictionrdquo bullCare of Pulmonologistbull Preventil
bull Dad OSA CPAP for 11 years diabetesbull Grandfather OSA untreatedbull ETCO2 = 361 at 10 bpm (acceptable)bull Posture number - 18 (lt10 ideal)bull Father refuses sleep screening
Treatment Options1 Extract upper premolars Align2Open spaces for impacted canines Open spaces for lower lateral implants
Whatrsquos more importantEase of treatment
OrBreathing well at night
Bolton Standards15yo
The Maxilla is Down and Back
The Mandible is Retrognathic
Nasal Cartilage Collapse
Insufficient Facial Support
Bi-maxillary Retrusion
Bimaxillary Retrusion Forward Growth
Mouthbreathers have significantly smaller airway space
(measurements PAS-OccL PAS-UP airway volume area and minimum axial area)
Mouth breather Nasal breather
Three-dimensional assessment of pharyngeal airway in nasal- and mouth-breathing children
Alves M etal Int J Ped ORL 75 (2011) 1195ndash1199
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
B Hockel 2012
This is the profile Biobloc children start with long and retrusive
This is the profile Biobloc children finish with Forward with lips
together
B Hockel 2012
Herersquos the ldquoinsiderdquo look Notice how the upper front teeth are closer to the nose (yellow arrows)
Notice how the lower jaw rotates around the star so the chin comes up and forward (red arrow)How do we make this happen
From the tip of the Central
To the Forwardmost Tip of the Nose
41mm
Maxillary Heightbull Indicator Line (Mew)
bull Distance from most anterior point on nose to upper incisal edge
bull Age + 23bull A variable number but important to watch over time
B Hockel 2012
Herersquos the ldquoinsiderdquo look Notice how the upper front teeth are closer to the nose (yellow arrows)
Notice how the lower jaw rotates around the star so the chin comes up and forward (red arrow)How do we make this happen
Using IndicatorCosmetic Line
bull To define a starting pointbull To set treatment goalsbull To track treatment progressbull To gauge the effectiveness of treatment
Charting the InCos Line
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Incisor pulled away from noseNot ldquoundertorquedrdquo or ldquogummy smilerdquo
Hypothetical ClI OrthoMARA
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
OJ = 7mm
Starts Ortho
ldquoGreat Headgear
Effectrdquo
Class II Elastics
50
40
30
20mm
y J F M A M J J A S O N
boys
Start Non-x
Expansion UncrowdingFinished
Start Cl II elastics
OK thatrsquos
enough
Hypothetical Mouthbreather(Dr Mewrsquos Hamster Boy)
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Boy gets
hamster
MFT
Hypothetical BBO 7yoM
50
40
30
20
5 6 7 8 9 10 11 12 13 14 15
girlsboys
Initial
StartBB1
BB3
Night
bullLR 11-9yFbullMissing all 5s6s8s and upper 4sbullHad ortho to close diastemahellipbullInL = 39bullGP objects to deX plan equil
LR Tx Plan
1Preparation Hang Expanser2deX 3Training BB3 to advance mandible4Myofunctional Therapy5Orthopostural Training6Myobrace to hold7 Reevaluate for dental detailing
LR Spotty progress
50
40
30
20mm
y 313 4 5 6 7 8 9 10 11 12114
2 3
Expanser
Parents dragging30 turnsStart Adv
Rx deXGP
objects
After delays
Equil ersquosBB3
bullLR 12-3 yF (6mo in tx)bullInL = 37 (+2)bull ersquos equilibratedbull OJ =10bull Appliance OJ = 5bull Still accommodating to BB3
Is there a calculus for the Indicator Line
Treatment GoalsBased on Indicator Line
Incisor Goals
Type 1 Treatment Place U1 in ideal position
Biobloc Orthotropics Orthognathic Surgery Distraction Osteogenesis
Type 1 Ideal InCos line
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
YZ 9yo M
bullLost upper d-spacebullInL = 36(+4)bullOJ = 9mmbullLip entrapmentbullLip Incompetence
Y Z 9yo M
Y Z 9yo M9mm OJ
Y Z 9yo M
Treatment Options
1 Type 1 Reduce InL open lost space BB3 to advance mandible
2 Type 2 Open lost space Align
3 Type 4 Extract four premolars
YZ 9yoM
50
40
30
20mm
yM A M J J A S O N D J F M A
boys
Hang Expanser
Upper and Lower
Brackets Hang Retainer
BB3
Incisor Goals
Type 2 Treatment Develop arch just enough to uncrowd
Biobloc Myofunctional Ortho Myofunctional Therapy Crozat ALF Expansion Orthodontics
Type 2 Uncrowding
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
bullLip incompetencebullLip entrapmentbullHypermentalisbullMouthbreathing
Type 2 Uncrowding
12 month progress
12 month progress
12 month progress
After Treatment
Bent-wire6 monthsMyobrace12 months
Hey RaphaelWhat about that
profile
ZP 9-5yoM
i
After Expansion Phase
Incomplete profile improvement better breathing head posture and sleep
Incisor Goals
Type 3 Treatment Maintain UI
Functional Orthodontics Expansion Orthodontics Distalization Ortho or No Treatment
Type 3 Maintain
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Bimax retrusion
Successful dental result
Profile Unimproved
Incisor Goals
Type 4 Treatment RetractExtrude UI
Extraction Orthodontics Retraction Ortho Distalization Ortho
Type 4 Retraction
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Bimax retrusion
Successful dental result
Failed Profile Result
Changes of pharyngeal airway size and hyoid bone position following orthodontic treatment of
Class I bimaxillary protrusion
Qingzhu Wanga Peizeng Jiab Nina K Andersonc Lin Wangd Jiuxiang Line
Angle Orthodontist Vol 00 No 0 0000 (pre-publication 2012)
ldquothe dimension of the velopharynx glossopharynx and hypopharynx were decreased after maximal retraction of anterior teeth with extraction of four premolarshelliprdquo ldquoAny factors that can influence the posture and position of tongue and soft palate may displace them backward andencroach upon the pharynxrdquo
ldquothe more the incisors were retracted the more the pharyngeal airway was reducedrdquo
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Backed into a corner
bull
Moving teeth faster more efficientlyhellipin the wrong direction
Now that wersquove made smoking unacceptable
could we not do the same withbull Sugarbull Processed foodbull Cheap milk and meatbull Fast foodbull Pill popping for symptomatic reliefbull Looking for the cure instead of the causebull Surgery as a quick fixbull Thinking braces are a status symbol
Each industry thrives on the status quoConsumers must drive the change
NP 10yM
NP
Sisterrsquos non-x ortho
Shersquos happyhellipbut Irsquom not so
I make my pitch for BBO
The dilemma of progress
(I forgot the progress pictureshellip)
Dad sells prosthetic parts to orthopedic surgeons
I selling the case against my previous work they loved
It takes me 3 hours to sell the case
They fret until the BB3 goes in
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Connecting the dots
bull Adult SDB and OSA
bull Narrow jaws and faces
bull Soft tissue dysfunction
bull Early parafunctional habits ie open mouth posture
bull Environmental stressors
bull CPAP MARAUPPP SurgWherersquos the best
place to start treatment here
or here
1 Prevention 2 Undo the damage already done3 Establish good habits
When to start When damage from poor breathing is noticed and when bad habits are discovered
The strategies of Airway Orthodontics
Prevention
bull Remove ankyloglossiabull Promote breastfeedingbull Harden the dietbull Develop masticatory strengthbull Discourage oral habitsbull Promote whole-foods low sugar dietbull Reduce oropharyngeal obstructionbull Promote nasal breathing
Breathing retraining
bull Nasal rinsingbull Nasal clearingbull Decongesting
The goals of Airway Orthodontics
1 Breathing through the nose2 Lips together at rest3 Correct tongue position4 No facial muscles moving on swallowing5 Optimal forward facial development6 Class I occlusion7 Straight teeth8 Better stability long term
Myofunctional Trainers
Professors R Soulet and A Besombes
Dr Earl Bergeson
Dr Chris Farrell
The Multi ndash Family System
Orofacial MyofunctionalTherapy
Oral MyologyMyofunctional TherapyTongue Thrust Therapy
B Hockel 2012 Back
Undoing Bimaxillary Dysplasia
1 Maxillary deconstriction2 Maxillary advancement3 Maxillary impaction4 Mandibular advancement
1 Maxillary Expansion
Treatment for Bimaxillary Dysplasia
ALFCrozat
Bent Wire
HyraxHaas
Niti Exp BioBlocSchwartz
The Farrell BENT WIRE Systemtrade
Recommended Age Group 5-12 yrs
Arch Development in conjunction with the TRAINER Systemtrade
Dr John Mew
Establish Good Habits
1 Breathing through the nose2 Lips together at rest3 Correct tongue position4 No facial muscles moving on swallowing5 Stand and sit in balance6 Breath gently using the diaphragm7 Eat to nourish8 Sleep to rest
Ortho-Postural TrainingWorkshops
Breathing
Nutrition
Posture
Sleep
COPYRIGHTRoger L PriceOctober 2012
Posture Number
Forward head posturecan be a compensationfor a deficient airway
Sleep Screening and Hygiene
SQI = 10 SQI = 98
Integrative Healthcare
Function ProfessionalNasal clearing ENT Pulm MFT BreathingMuscle balance and tone MFT Myofunctional OrthoUndoing damage GP Pedo Ortho OMFSBreathing dynamics OPT MFT Breath PhysiologistPosture DC OPT PT OsteopathCranial balance OsteopathNutrition RDH Nutritionist Dietitian Sleep ENT Sleep Med DentNeurocognitive development Pedrsquon SLP Psych SpEd
The Interdisciplinary Center
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Now that I know
My personal missionTo create from what Irsquove
learned from the besta model for others to followhellipespecially the orthodontists
Myofunctional Orthodontics
Chris Farrell
John Flutter
German Ramierez
Damien OrsquoBrien
Myofunctional Research CoRancho Cucamonga
2008-2012
Oral Myology
Oral Myology Basic CourseJoy MoellerNYC 2011LA 2012
Oral Myology Levels 2 3Kim BenkertClifton 2012
Habit CessationShari GreenClifton 2013
Biobloc Orthotropics
BBO Mini-residencyBill Hang
Agora Hills2012-13
BBO IntensiveDrs John and Mike
MewLSFO2013
Breathing and Sleep
Buteyko MentorshipThe Breathing Center
Woodstock2010
Breathing Well ProgrammeJohn Flutter
2010 Ortho-Postural TrainingRoger Price
2013
Sleep DentistryMichael Gelb etal
NYU2012
ALF and Cranial
Jim Bronson2013 Tasha Turzo
Cranial Academy2014
Bucket Listbull ALF and Crozat (Bronsonrsquos course)bullMore on Biobloc (Hangrsquos Advanced London School)bull More Cranial (The Farm)bullChirodontics (Bob Walker)bull Airway Dentistry with Marc Cruz Jeff Rousebull Sleep Dentistrybull Less-than-Six with Kevin Boydbull Intra-mandibular Distraction Osteogenesis (IMDO)
Off My ListAnything that moves the teeth faster in the wrong direction
Whatrsquos an RO to do
To create from what Irsquove learned from the best
a model for others to followhellipespecially orthodontists
Teaching
Mt Sinai Pedo ResidencyAli Attaie
2010-2012
Montefiore Ortho ResidencyTony Maganzini
2012
2009-Present
Mt Sinai School of MedicinePedodontic Residency
Guest SpeakersJim BronsonMike MewKevin BoydSandra KahnJennifer TowRoger PricePaula Fabbie
Damien OrsquoBrien
First clinical program in myofunctional orthodontics
Airway and Facial DevelopmentCollaborative Webcast
Mark Cruz
AAPMD Symposium
wwwaapm
dorg
Annual MeetingApril 25-26 2014
Westin Chicago North Shore
the raphael center for integrative orthodontics
wwwalignminecomwwwbioblocnjcom
wwwmyobracenjcom
Integrative vs Conventional
Integrative vs Conventional
ldquoWith improvements in expansion orthodontics advances in myofunctional orthodontics and the growing recognition about sleep disordered breathing among children and adults it is time for orthodontics to expand its horizons There is now so much more we can oerrdquo
The Raphael name has been associated with high quality orthodontics in New Jersey for over 60 years Dr Barry Raphael has been a university trained orthodontic specialist and a member of the American Association of Orthodontists for 30 years
He has a wide range of techniques and services to offer He has studied oral myology applied kinesiology Buteyko breathing Biobloc Orthotropics and Myobrace as part of his integrative training He can offer Damon Invisalign Insignia and Incognito appliances designs as some of his many conventional orthodontic services too
Dr Raphael teaches his techniques at post-graduate residencies study clubs dental societies and for the Myofunctional Research Co He is available for presentations to any group interested in learning more about the benefits of integrative orthodontics
wwwalignminecomLearn about the choices you have in orthodontics
dr barry raphael Why its
too Early never
1425
bro
ad
str
ee
tc
lifto
n n
j 070
13
973-
778-
4222
fax
973-
778-
9625
nj s
pe
c
368
4
1425 broad street clifton nj 07013973-778-4222
wwwalignminecom
the raphael centerforintegrative orthodontics
the
raph
ael c
ente
r fo
rin
tegr
ativ
e or
thod
onti
cs
Learn about an important choice you need to make before starting braces
the raphael center for integrative education
the raphael center for integrative education
Ongoing Intro to Airway Orthodontics
April Biobloc Study Group
April Training Ortho-Postural Therapists w Roger Price
June MRC Myobrace Basic Series
August Airway Dentistry with Mark Cruz and company
October Advanced MFT with Sandy Coulson
October Less than Six with Kevin Boyd
(who else wants to play)
Mission to create a space for spreading the word about Airway and Orthotropic principles and practice
Orthodontics in the 21st Century
EstheticOrthodontics
AirwayOrthodontics
GeneticTooth-Focused
Dental PerfectionEsthetics Primary
Treating SymptomsAirway Ignorant
AdaptationMuscle-FocusedMedical Better
Esthetics SecondaryTreating Causes
Airway Conscious
The EndAnd
The Beginning
1Crooked teeth are THE PROBLEM
2The lower incisor must be upright
3Patients donrsquot want to cooperate
4Straightened teeth arenrsquot stable
In the ROrsquos Mind
1Crooked teeth are THE PROBLEM
2The lower incisor must be upright
3Patients donrsquot want to cooperate
4Straightened teeth arenrsquot stable
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
A Change of Mind
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
George Catlin
Are we developing the wayour genes program us to be
Westin Price
Kevin Boyd
Peter Gluckman
Neese and Williams
Scott Gilbert
Clark Spencer Larsen
Darwinian Dentistry
MeJames
Sim Wallace
Obesity
Metabolic SyndromeCeliac
Intestinal PermeabilityType 2 Diabetes
Fatty Liver Disease Cardiovascular Disease
HypertensionSome Cancers
The Results of the MismatchBetween Genes and the Environment
Chronic Non-Communicable Diseases of CivilizationWestern Lifestyle Diseases
Asthma
Autism
Aspergerrsquos
Alzheimers
ADDADHDDepression
Chronic Back Pain
Osteoporosis
Caries
Malocclusion
Sleep Apnea
The Toothberg
Airway-Related Craniofacial Dysfunctions
bullChronic Naso-pharyngeal Obstructionbull Tongue form aberrations (Frenum and tongue-tie)bullOpen Mouth Rest Posture bullMyofunctional disorders (Swallowing chewingetc)bullChronic Hyperventilation and Hypocapniabull Breathing Disordered Sleep (OSA UARS snoring)bull Bruxism and parafunctionsbull TMD and facial pain componentsbullCranial and postural issuesbull Malocclusion
Airway Orthodontics
bullEarly Feeding and Nutrition
bullAllergies Asthma URT infections
bullPosture
bullAirway Breathing and Sleep Disorders
bullSoft Tissue Dysfunctions (Tongue Thrust Open Mouth)
Instead of crooked teeth being The ProblemThey are just a SYMPTOM of something larger
Parentrsquos Private-eye Sheet
Parentrsquos Private-eye Sheet
ldquoThere are many things about your childrsquos health that are important to know but that I often donrsquot get to see at the office Also there are signs to look for that you may not have known were connected to your childrsquos teeth or health By looking for and tracking these ldquosigns and symptomsrdquo we can get a better handle on the problem and watch for resolution
You donrsquot have to spend a lot of time with this but donrsquot rush either Watch for certain things at different times of day Try not to let your child know they are being watched You want to see the most natural behaviors
Check off what you see If yoursquore not sure check it anyway and wersquoll talk about it Make comments if you wantrdquo
While sitting around
While sitting around (watching TV in the car) does your child
put ldquothingsrdquo in the mouth alot (toys sleeves pencils fingernails etc) ______________________________
lick or suck on the lips have the lips apart even a little stick or dart the tongue out of the mouth have the tongue resting between the teeth lean the cheek on a hand breath with his mouth open even a little bit make noises when breathing have trouble sitting still
While talking
While talking does your child talk very fast talk very slowly gasp for air have a lisp take speech lessons
During a meal
During a meal does your child gasp for air while eating stick his tongue between his teeth when swallowing stick the tongue out to meet the drinking glass drink a lot while eating make noises when chewing eat sloppily take a breath before drinking puff the cheeks out when drinking make the lips purse when swallowing make the chin ldquocrinklerdquo when swallowing bob the head when swallowing have trouble sitting still
While sleeping
While sleeping does your child have the mouth open snore wet the bed toss and turn tilt the head back wake up frequently have frequent nightmares have abnormal sleep issues grind the teeth have trouble waking up wake with darker circles under eyes
S R 10-10yo M
bullMissing 3242bullImpacted 1323bullLate mixed 25 eruptedbullSoft tissue dysfunctionbullIL = 40bullNot compliant
S Reardon 10-7yo M
Impacted 3s Missing 2s
Medical history
bull Reactive Airway Diseasebull ldquoBronchial Constrictionrdquo bullCare of Pulmonologistbull Preventil
bull Dad OSA CPAP for 11 years diabetesbull Grandfather OSA untreatedbull ETCO2 = 361 at 10 bpm (acceptable)bull Posture number - 18 (lt10 ideal)bull Father refuses sleep screening
Treatment Options1 Extract upper premolars Align2Open spaces for impacted canines Open spaces for lower lateral implants
Whatrsquos more importantEase of treatment
OrBreathing well at night
Bolton Standards15yo
The Maxilla is Down and Back
The Mandible is Retrognathic
Nasal Cartilage Collapse
Insufficient Facial Support
Bi-maxillary Retrusion
Bimaxillary Retrusion Forward Growth
Mouthbreathers have significantly smaller airway space
(measurements PAS-OccL PAS-UP airway volume area and minimum axial area)
Mouth breather Nasal breather
Three-dimensional assessment of pharyngeal airway in nasal- and mouth-breathing children
Alves M etal Int J Ped ORL 75 (2011) 1195ndash1199
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
B Hockel 2012
This is the profile Biobloc children start with long and retrusive
This is the profile Biobloc children finish with Forward with lips
together
B Hockel 2012
Herersquos the ldquoinsiderdquo look Notice how the upper front teeth are closer to the nose (yellow arrows)
Notice how the lower jaw rotates around the star so the chin comes up and forward (red arrow)How do we make this happen
From the tip of the Central
To the Forwardmost Tip of the Nose
41mm
Maxillary Heightbull Indicator Line (Mew)
bull Distance from most anterior point on nose to upper incisal edge
bull Age + 23bull A variable number but important to watch over time
B Hockel 2012
Herersquos the ldquoinsiderdquo look Notice how the upper front teeth are closer to the nose (yellow arrows)
Notice how the lower jaw rotates around the star so the chin comes up and forward (red arrow)How do we make this happen
Using IndicatorCosmetic Line
bull To define a starting pointbull To set treatment goalsbull To track treatment progressbull To gauge the effectiveness of treatment
Charting the InCos Line
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Incisor pulled away from noseNot ldquoundertorquedrdquo or ldquogummy smilerdquo
Hypothetical ClI OrthoMARA
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
OJ = 7mm
Starts Ortho
ldquoGreat Headgear
Effectrdquo
Class II Elastics
50
40
30
20mm
y J F M A M J J A S O N
boys
Start Non-x
Expansion UncrowdingFinished
Start Cl II elastics
OK thatrsquos
enough
Hypothetical Mouthbreather(Dr Mewrsquos Hamster Boy)
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Boy gets
hamster
MFT
Hypothetical BBO 7yoM
50
40
30
20
5 6 7 8 9 10 11 12 13 14 15
girlsboys
Initial
StartBB1
BB3
Night
bullLR 11-9yFbullMissing all 5s6s8s and upper 4sbullHad ortho to close diastemahellipbullInL = 39bullGP objects to deX plan equil
LR Tx Plan
1Preparation Hang Expanser2deX 3Training BB3 to advance mandible4Myofunctional Therapy5Orthopostural Training6Myobrace to hold7 Reevaluate for dental detailing
LR Spotty progress
50
40
30
20mm
y 313 4 5 6 7 8 9 10 11 12114
2 3
Expanser
Parents dragging30 turnsStart Adv
Rx deXGP
objects
After delays
Equil ersquosBB3
bullLR 12-3 yF (6mo in tx)bullInL = 37 (+2)bull ersquos equilibratedbull OJ =10bull Appliance OJ = 5bull Still accommodating to BB3
Is there a calculus for the Indicator Line
Treatment GoalsBased on Indicator Line
Incisor Goals
Type 1 Treatment Place U1 in ideal position
Biobloc Orthotropics Orthognathic Surgery Distraction Osteogenesis
Type 1 Ideal InCos line
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
YZ 9yo M
bullLost upper d-spacebullInL = 36(+4)bullOJ = 9mmbullLip entrapmentbullLip Incompetence
Y Z 9yo M
Y Z 9yo M9mm OJ
Y Z 9yo M
Treatment Options
1 Type 1 Reduce InL open lost space BB3 to advance mandible
2 Type 2 Open lost space Align
3 Type 4 Extract four premolars
YZ 9yoM
50
40
30
20mm
yM A M J J A S O N D J F M A
boys
Hang Expanser
Upper and Lower
Brackets Hang Retainer
BB3
Incisor Goals
Type 2 Treatment Develop arch just enough to uncrowd
Biobloc Myofunctional Ortho Myofunctional Therapy Crozat ALF Expansion Orthodontics
Type 2 Uncrowding
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
bullLip incompetencebullLip entrapmentbullHypermentalisbullMouthbreathing
Type 2 Uncrowding
12 month progress
12 month progress
12 month progress
After Treatment
Bent-wire6 monthsMyobrace12 months
Hey RaphaelWhat about that
profile
ZP 9-5yoM
i
After Expansion Phase
Incomplete profile improvement better breathing head posture and sleep
Incisor Goals
Type 3 Treatment Maintain UI
Functional Orthodontics Expansion Orthodontics Distalization Ortho or No Treatment
Type 3 Maintain
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Bimax retrusion
Successful dental result
Profile Unimproved
Incisor Goals
Type 4 Treatment RetractExtrude UI
Extraction Orthodontics Retraction Ortho Distalization Ortho
Type 4 Retraction
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Bimax retrusion
Successful dental result
Failed Profile Result
Changes of pharyngeal airway size and hyoid bone position following orthodontic treatment of
Class I bimaxillary protrusion
Qingzhu Wanga Peizeng Jiab Nina K Andersonc Lin Wangd Jiuxiang Line
Angle Orthodontist Vol 00 No 0 0000 (pre-publication 2012)
ldquothe dimension of the velopharynx glossopharynx and hypopharynx were decreased after maximal retraction of anterior teeth with extraction of four premolarshelliprdquo ldquoAny factors that can influence the posture and position of tongue and soft palate may displace them backward andencroach upon the pharynxrdquo
ldquothe more the incisors were retracted the more the pharyngeal airway was reducedrdquo
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Backed into a corner
bull
Moving teeth faster more efficientlyhellipin the wrong direction
Now that wersquove made smoking unacceptable
could we not do the same withbull Sugarbull Processed foodbull Cheap milk and meatbull Fast foodbull Pill popping for symptomatic reliefbull Looking for the cure instead of the causebull Surgery as a quick fixbull Thinking braces are a status symbol
Each industry thrives on the status quoConsumers must drive the change
NP 10yM
NP
Sisterrsquos non-x ortho
Shersquos happyhellipbut Irsquom not so
I make my pitch for BBO
The dilemma of progress
(I forgot the progress pictureshellip)
Dad sells prosthetic parts to orthopedic surgeons
I selling the case against my previous work they loved
It takes me 3 hours to sell the case
They fret until the BB3 goes in
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Connecting the dots
bull Adult SDB and OSA
bull Narrow jaws and faces
bull Soft tissue dysfunction
bull Early parafunctional habits ie open mouth posture
bull Environmental stressors
bull CPAP MARAUPPP SurgWherersquos the best
place to start treatment here
or here
1 Prevention 2 Undo the damage already done3 Establish good habits
When to start When damage from poor breathing is noticed and when bad habits are discovered
The strategies of Airway Orthodontics
Prevention
bull Remove ankyloglossiabull Promote breastfeedingbull Harden the dietbull Develop masticatory strengthbull Discourage oral habitsbull Promote whole-foods low sugar dietbull Reduce oropharyngeal obstructionbull Promote nasal breathing
Breathing retraining
bull Nasal rinsingbull Nasal clearingbull Decongesting
The goals of Airway Orthodontics
1 Breathing through the nose2 Lips together at rest3 Correct tongue position4 No facial muscles moving on swallowing5 Optimal forward facial development6 Class I occlusion7 Straight teeth8 Better stability long term
Myofunctional Trainers
Professors R Soulet and A Besombes
Dr Earl Bergeson
Dr Chris Farrell
The Multi ndash Family System
Orofacial MyofunctionalTherapy
Oral MyologyMyofunctional TherapyTongue Thrust Therapy
B Hockel 2012 Back
Undoing Bimaxillary Dysplasia
1 Maxillary deconstriction2 Maxillary advancement3 Maxillary impaction4 Mandibular advancement
1 Maxillary Expansion
Treatment for Bimaxillary Dysplasia
ALFCrozat
Bent Wire
HyraxHaas
Niti Exp BioBlocSchwartz
The Farrell BENT WIRE Systemtrade
Recommended Age Group 5-12 yrs
Arch Development in conjunction with the TRAINER Systemtrade
Dr John Mew
Establish Good Habits
1 Breathing through the nose2 Lips together at rest3 Correct tongue position4 No facial muscles moving on swallowing5 Stand and sit in balance6 Breath gently using the diaphragm7 Eat to nourish8 Sleep to rest
Ortho-Postural TrainingWorkshops
Breathing
Nutrition
Posture
Sleep
COPYRIGHTRoger L PriceOctober 2012
Posture Number
Forward head posturecan be a compensationfor a deficient airway
Sleep Screening and Hygiene
SQI = 10 SQI = 98
Integrative Healthcare
Function ProfessionalNasal clearing ENT Pulm MFT BreathingMuscle balance and tone MFT Myofunctional OrthoUndoing damage GP Pedo Ortho OMFSBreathing dynamics OPT MFT Breath PhysiologistPosture DC OPT PT OsteopathCranial balance OsteopathNutrition RDH Nutritionist Dietitian Sleep ENT Sleep Med DentNeurocognitive development Pedrsquon SLP Psych SpEd
The Interdisciplinary Center
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Now that I know
My personal missionTo create from what Irsquove
learned from the besta model for others to followhellipespecially the orthodontists
Myofunctional Orthodontics
Chris Farrell
John Flutter
German Ramierez
Damien OrsquoBrien
Myofunctional Research CoRancho Cucamonga
2008-2012
Oral Myology
Oral Myology Basic CourseJoy MoellerNYC 2011LA 2012
Oral Myology Levels 2 3Kim BenkertClifton 2012
Habit CessationShari GreenClifton 2013
Biobloc Orthotropics
BBO Mini-residencyBill Hang
Agora Hills2012-13
BBO IntensiveDrs John and Mike
MewLSFO2013
Breathing and Sleep
Buteyko MentorshipThe Breathing Center
Woodstock2010
Breathing Well ProgrammeJohn Flutter
2010 Ortho-Postural TrainingRoger Price
2013
Sleep DentistryMichael Gelb etal
NYU2012
ALF and Cranial
Jim Bronson2013 Tasha Turzo
Cranial Academy2014
Bucket Listbull ALF and Crozat (Bronsonrsquos course)bullMore on Biobloc (Hangrsquos Advanced London School)bull More Cranial (The Farm)bullChirodontics (Bob Walker)bull Airway Dentistry with Marc Cruz Jeff Rousebull Sleep Dentistrybull Less-than-Six with Kevin Boydbull Intra-mandibular Distraction Osteogenesis (IMDO)
Off My ListAnything that moves the teeth faster in the wrong direction
Whatrsquos an RO to do
To create from what Irsquove learned from the best
a model for others to followhellipespecially orthodontists
Teaching
Mt Sinai Pedo ResidencyAli Attaie
2010-2012
Montefiore Ortho ResidencyTony Maganzini
2012
2009-Present
Mt Sinai School of MedicinePedodontic Residency
Guest SpeakersJim BronsonMike MewKevin BoydSandra KahnJennifer TowRoger PricePaula Fabbie
Damien OrsquoBrien
First clinical program in myofunctional orthodontics
Airway and Facial DevelopmentCollaborative Webcast
Mark Cruz
AAPMD Symposium
wwwaapm
dorg
Annual MeetingApril 25-26 2014
Westin Chicago North Shore
the raphael center for integrative orthodontics
wwwalignminecomwwwbioblocnjcom
wwwmyobracenjcom
Integrative vs Conventional
Integrative vs Conventional
ldquoWith improvements in expansion orthodontics advances in myofunctional orthodontics and the growing recognition about sleep disordered breathing among children and adults it is time for orthodontics to expand its horizons There is now so much more we can oerrdquo
The Raphael name has been associated with high quality orthodontics in New Jersey for over 60 years Dr Barry Raphael has been a university trained orthodontic specialist and a member of the American Association of Orthodontists for 30 years
He has a wide range of techniques and services to offer He has studied oral myology applied kinesiology Buteyko breathing Biobloc Orthotropics and Myobrace as part of his integrative training He can offer Damon Invisalign Insignia and Incognito appliances designs as some of his many conventional orthodontic services too
Dr Raphael teaches his techniques at post-graduate residencies study clubs dental societies and for the Myofunctional Research Co He is available for presentations to any group interested in learning more about the benefits of integrative orthodontics
wwwalignminecomLearn about the choices you have in orthodontics
dr barry raphael Why its
too Early never
1425
bro
ad
str
ee
tc
lifto
n n
j 070
13
973-
778-
4222
fax
973-
778-
9625
nj s
pe
c
368
4
1425 broad street clifton nj 07013973-778-4222
wwwalignminecom
the raphael centerforintegrative orthodontics
the
raph
ael c
ente
r fo
rin
tegr
ativ
e or
thod
onti
cs
Learn about an important choice you need to make before starting braces
the raphael center for integrative education
the raphael center for integrative education
Ongoing Intro to Airway Orthodontics
April Biobloc Study Group
April Training Ortho-Postural Therapists w Roger Price
June MRC Myobrace Basic Series
August Airway Dentistry with Mark Cruz and company
October Advanced MFT with Sandy Coulson
October Less than Six with Kevin Boyd
(who else wants to play)
Mission to create a space for spreading the word about Airway and Orthotropic principles and practice
Orthodontics in the 21st Century
EstheticOrthodontics
AirwayOrthodontics
GeneticTooth-Focused
Dental PerfectionEsthetics Primary
Treating SymptomsAirway Ignorant
AdaptationMuscle-FocusedMedical Better
Esthetics SecondaryTreating Causes
Airway Conscious
The EndAnd
The Beginning
1Crooked teeth are THE PROBLEM
2The lower incisor must be upright
3Patients donrsquot want to cooperate
4Straightened teeth arenrsquot stable
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
A Change of Mind
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
George Catlin
Are we developing the wayour genes program us to be
Westin Price
Kevin Boyd
Peter Gluckman
Neese and Williams
Scott Gilbert
Clark Spencer Larsen
Darwinian Dentistry
MeJames
Sim Wallace
Obesity
Metabolic SyndromeCeliac
Intestinal PermeabilityType 2 Diabetes
Fatty Liver Disease Cardiovascular Disease
HypertensionSome Cancers
The Results of the MismatchBetween Genes and the Environment
Chronic Non-Communicable Diseases of CivilizationWestern Lifestyle Diseases
Asthma
Autism
Aspergerrsquos
Alzheimers
ADDADHDDepression
Chronic Back Pain
Osteoporosis
Caries
Malocclusion
Sleep Apnea
The Toothberg
Airway-Related Craniofacial Dysfunctions
bullChronic Naso-pharyngeal Obstructionbull Tongue form aberrations (Frenum and tongue-tie)bullOpen Mouth Rest Posture bullMyofunctional disorders (Swallowing chewingetc)bullChronic Hyperventilation and Hypocapniabull Breathing Disordered Sleep (OSA UARS snoring)bull Bruxism and parafunctionsbull TMD and facial pain componentsbullCranial and postural issuesbull Malocclusion
Airway Orthodontics
bullEarly Feeding and Nutrition
bullAllergies Asthma URT infections
bullPosture
bullAirway Breathing and Sleep Disorders
bullSoft Tissue Dysfunctions (Tongue Thrust Open Mouth)
Instead of crooked teeth being The ProblemThey are just a SYMPTOM of something larger
Parentrsquos Private-eye Sheet
Parentrsquos Private-eye Sheet
ldquoThere are many things about your childrsquos health that are important to know but that I often donrsquot get to see at the office Also there are signs to look for that you may not have known were connected to your childrsquos teeth or health By looking for and tracking these ldquosigns and symptomsrdquo we can get a better handle on the problem and watch for resolution
You donrsquot have to spend a lot of time with this but donrsquot rush either Watch for certain things at different times of day Try not to let your child know they are being watched You want to see the most natural behaviors
Check off what you see If yoursquore not sure check it anyway and wersquoll talk about it Make comments if you wantrdquo
While sitting around
While sitting around (watching TV in the car) does your child
put ldquothingsrdquo in the mouth alot (toys sleeves pencils fingernails etc) ______________________________
lick or suck on the lips have the lips apart even a little stick or dart the tongue out of the mouth have the tongue resting between the teeth lean the cheek on a hand breath with his mouth open even a little bit make noises when breathing have trouble sitting still
While talking
While talking does your child talk very fast talk very slowly gasp for air have a lisp take speech lessons
During a meal
During a meal does your child gasp for air while eating stick his tongue between his teeth when swallowing stick the tongue out to meet the drinking glass drink a lot while eating make noises when chewing eat sloppily take a breath before drinking puff the cheeks out when drinking make the lips purse when swallowing make the chin ldquocrinklerdquo when swallowing bob the head when swallowing have trouble sitting still
While sleeping
While sleeping does your child have the mouth open snore wet the bed toss and turn tilt the head back wake up frequently have frequent nightmares have abnormal sleep issues grind the teeth have trouble waking up wake with darker circles under eyes
S R 10-10yo M
bullMissing 3242bullImpacted 1323bullLate mixed 25 eruptedbullSoft tissue dysfunctionbullIL = 40bullNot compliant
S Reardon 10-7yo M
Impacted 3s Missing 2s
Medical history
bull Reactive Airway Diseasebull ldquoBronchial Constrictionrdquo bullCare of Pulmonologistbull Preventil
bull Dad OSA CPAP for 11 years diabetesbull Grandfather OSA untreatedbull ETCO2 = 361 at 10 bpm (acceptable)bull Posture number - 18 (lt10 ideal)bull Father refuses sleep screening
Treatment Options1 Extract upper premolars Align2Open spaces for impacted canines Open spaces for lower lateral implants
Whatrsquos more importantEase of treatment
OrBreathing well at night
Bolton Standards15yo
The Maxilla is Down and Back
The Mandible is Retrognathic
Nasal Cartilage Collapse
Insufficient Facial Support
Bi-maxillary Retrusion
Bimaxillary Retrusion Forward Growth
Mouthbreathers have significantly smaller airway space
(measurements PAS-OccL PAS-UP airway volume area and minimum axial area)
Mouth breather Nasal breather
Three-dimensional assessment of pharyngeal airway in nasal- and mouth-breathing children
Alves M etal Int J Ped ORL 75 (2011) 1195ndash1199
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
B Hockel 2012
This is the profile Biobloc children start with long and retrusive
This is the profile Biobloc children finish with Forward with lips
together
B Hockel 2012
Herersquos the ldquoinsiderdquo look Notice how the upper front teeth are closer to the nose (yellow arrows)
Notice how the lower jaw rotates around the star so the chin comes up and forward (red arrow)How do we make this happen
From the tip of the Central
To the Forwardmost Tip of the Nose
41mm
Maxillary Heightbull Indicator Line (Mew)
bull Distance from most anterior point on nose to upper incisal edge
bull Age + 23bull A variable number but important to watch over time
B Hockel 2012
Herersquos the ldquoinsiderdquo look Notice how the upper front teeth are closer to the nose (yellow arrows)
Notice how the lower jaw rotates around the star so the chin comes up and forward (red arrow)How do we make this happen
Using IndicatorCosmetic Line
bull To define a starting pointbull To set treatment goalsbull To track treatment progressbull To gauge the effectiveness of treatment
Charting the InCos Line
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Incisor pulled away from noseNot ldquoundertorquedrdquo or ldquogummy smilerdquo
Hypothetical ClI OrthoMARA
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
OJ = 7mm
Starts Ortho
ldquoGreat Headgear
Effectrdquo
Class II Elastics
50
40
30
20mm
y J F M A M J J A S O N
boys
Start Non-x
Expansion UncrowdingFinished
Start Cl II elastics
OK thatrsquos
enough
Hypothetical Mouthbreather(Dr Mewrsquos Hamster Boy)
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Boy gets
hamster
MFT
Hypothetical BBO 7yoM
50
40
30
20
5 6 7 8 9 10 11 12 13 14 15
girlsboys
Initial
StartBB1
BB3
Night
bullLR 11-9yFbullMissing all 5s6s8s and upper 4sbullHad ortho to close diastemahellipbullInL = 39bullGP objects to deX plan equil
LR Tx Plan
1Preparation Hang Expanser2deX 3Training BB3 to advance mandible4Myofunctional Therapy5Orthopostural Training6Myobrace to hold7 Reevaluate for dental detailing
LR Spotty progress
50
40
30
20mm
y 313 4 5 6 7 8 9 10 11 12114
2 3
Expanser
Parents dragging30 turnsStart Adv
Rx deXGP
objects
After delays
Equil ersquosBB3
bullLR 12-3 yF (6mo in tx)bullInL = 37 (+2)bull ersquos equilibratedbull OJ =10bull Appliance OJ = 5bull Still accommodating to BB3
Is there a calculus for the Indicator Line
Treatment GoalsBased on Indicator Line
Incisor Goals
Type 1 Treatment Place U1 in ideal position
Biobloc Orthotropics Orthognathic Surgery Distraction Osteogenesis
Type 1 Ideal InCos line
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
YZ 9yo M
bullLost upper d-spacebullInL = 36(+4)bullOJ = 9mmbullLip entrapmentbullLip Incompetence
Y Z 9yo M
Y Z 9yo M9mm OJ
Y Z 9yo M
Treatment Options
1 Type 1 Reduce InL open lost space BB3 to advance mandible
2 Type 2 Open lost space Align
3 Type 4 Extract four premolars
YZ 9yoM
50
40
30
20mm
yM A M J J A S O N D J F M A
boys
Hang Expanser
Upper and Lower
Brackets Hang Retainer
BB3
Incisor Goals
Type 2 Treatment Develop arch just enough to uncrowd
Biobloc Myofunctional Ortho Myofunctional Therapy Crozat ALF Expansion Orthodontics
Type 2 Uncrowding
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
bullLip incompetencebullLip entrapmentbullHypermentalisbullMouthbreathing
Type 2 Uncrowding
12 month progress
12 month progress
12 month progress
After Treatment
Bent-wire6 monthsMyobrace12 months
Hey RaphaelWhat about that
profile
ZP 9-5yoM
i
After Expansion Phase
Incomplete profile improvement better breathing head posture and sleep
Incisor Goals
Type 3 Treatment Maintain UI
Functional Orthodontics Expansion Orthodontics Distalization Ortho or No Treatment
Type 3 Maintain
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Bimax retrusion
Successful dental result
Profile Unimproved
Incisor Goals
Type 4 Treatment RetractExtrude UI
Extraction Orthodontics Retraction Ortho Distalization Ortho
Type 4 Retraction
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Bimax retrusion
Successful dental result
Failed Profile Result
Changes of pharyngeal airway size and hyoid bone position following orthodontic treatment of
Class I bimaxillary protrusion
Qingzhu Wanga Peizeng Jiab Nina K Andersonc Lin Wangd Jiuxiang Line
Angle Orthodontist Vol 00 No 0 0000 (pre-publication 2012)
ldquothe dimension of the velopharynx glossopharynx and hypopharynx were decreased after maximal retraction of anterior teeth with extraction of four premolarshelliprdquo ldquoAny factors that can influence the posture and position of tongue and soft palate may displace them backward andencroach upon the pharynxrdquo
ldquothe more the incisors were retracted the more the pharyngeal airway was reducedrdquo
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Backed into a corner
bull
Moving teeth faster more efficientlyhellipin the wrong direction
Now that wersquove made smoking unacceptable
could we not do the same withbull Sugarbull Processed foodbull Cheap milk and meatbull Fast foodbull Pill popping for symptomatic reliefbull Looking for the cure instead of the causebull Surgery as a quick fixbull Thinking braces are a status symbol
Each industry thrives on the status quoConsumers must drive the change
NP 10yM
NP
Sisterrsquos non-x ortho
Shersquos happyhellipbut Irsquom not so
I make my pitch for BBO
The dilemma of progress
(I forgot the progress pictureshellip)
Dad sells prosthetic parts to orthopedic surgeons
I selling the case against my previous work they loved
It takes me 3 hours to sell the case
They fret until the BB3 goes in
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Connecting the dots
bull Adult SDB and OSA
bull Narrow jaws and faces
bull Soft tissue dysfunction
bull Early parafunctional habits ie open mouth posture
bull Environmental stressors
bull CPAP MARAUPPP SurgWherersquos the best
place to start treatment here
or here
1 Prevention 2 Undo the damage already done3 Establish good habits
When to start When damage from poor breathing is noticed and when bad habits are discovered
The strategies of Airway Orthodontics
Prevention
bull Remove ankyloglossiabull Promote breastfeedingbull Harden the dietbull Develop masticatory strengthbull Discourage oral habitsbull Promote whole-foods low sugar dietbull Reduce oropharyngeal obstructionbull Promote nasal breathing
Breathing retraining
bull Nasal rinsingbull Nasal clearingbull Decongesting
The goals of Airway Orthodontics
1 Breathing through the nose2 Lips together at rest3 Correct tongue position4 No facial muscles moving on swallowing5 Optimal forward facial development6 Class I occlusion7 Straight teeth8 Better stability long term
Myofunctional Trainers
Professors R Soulet and A Besombes
Dr Earl Bergeson
Dr Chris Farrell
The Multi ndash Family System
Orofacial MyofunctionalTherapy
Oral MyologyMyofunctional TherapyTongue Thrust Therapy
B Hockel 2012 Back
Undoing Bimaxillary Dysplasia
1 Maxillary deconstriction2 Maxillary advancement3 Maxillary impaction4 Mandibular advancement
1 Maxillary Expansion
Treatment for Bimaxillary Dysplasia
ALFCrozat
Bent Wire
HyraxHaas
Niti Exp BioBlocSchwartz
The Farrell BENT WIRE Systemtrade
Recommended Age Group 5-12 yrs
Arch Development in conjunction with the TRAINER Systemtrade
Dr John Mew
Establish Good Habits
1 Breathing through the nose2 Lips together at rest3 Correct tongue position4 No facial muscles moving on swallowing5 Stand and sit in balance6 Breath gently using the diaphragm7 Eat to nourish8 Sleep to rest
Ortho-Postural TrainingWorkshops
Breathing
Nutrition
Posture
Sleep
COPYRIGHTRoger L PriceOctober 2012
Posture Number
Forward head posturecan be a compensationfor a deficient airway
Sleep Screening and Hygiene
SQI = 10 SQI = 98
Integrative Healthcare
Function ProfessionalNasal clearing ENT Pulm MFT BreathingMuscle balance and tone MFT Myofunctional OrthoUndoing damage GP Pedo Ortho OMFSBreathing dynamics OPT MFT Breath PhysiologistPosture DC OPT PT OsteopathCranial balance OsteopathNutrition RDH Nutritionist Dietitian Sleep ENT Sleep Med DentNeurocognitive development Pedrsquon SLP Psych SpEd
The Interdisciplinary Center
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Now that I know
My personal missionTo create from what Irsquove
learned from the besta model for others to followhellipespecially the orthodontists
Myofunctional Orthodontics
Chris Farrell
John Flutter
German Ramierez
Damien OrsquoBrien
Myofunctional Research CoRancho Cucamonga
2008-2012
Oral Myology
Oral Myology Basic CourseJoy MoellerNYC 2011LA 2012
Oral Myology Levels 2 3Kim BenkertClifton 2012
Habit CessationShari GreenClifton 2013
Biobloc Orthotropics
BBO Mini-residencyBill Hang
Agora Hills2012-13
BBO IntensiveDrs John and Mike
MewLSFO2013
Breathing and Sleep
Buteyko MentorshipThe Breathing Center
Woodstock2010
Breathing Well ProgrammeJohn Flutter
2010 Ortho-Postural TrainingRoger Price
2013
Sleep DentistryMichael Gelb etal
NYU2012
ALF and Cranial
Jim Bronson2013 Tasha Turzo
Cranial Academy2014
Bucket Listbull ALF and Crozat (Bronsonrsquos course)bullMore on Biobloc (Hangrsquos Advanced London School)bull More Cranial (The Farm)bullChirodontics (Bob Walker)bull Airway Dentistry with Marc Cruz Jeff Rousebull Sleep Dentistrybull Less-than-Six with Kevin Boydbull Intra-mandibular Distraction Osteogenesis (IMDO)
Off My ListAnything that moves the teeth faster in the wrong direction
Whatrsquos an RO to do
To create from what Irsquove learned from the best
a model for others to followhellipespecially orthodontists
Teaching
Mt Sinai Pedo ResidencyAli Attaie
2010-2012
Montefiore Ortho ResidencyTony Maganzini
2012
2009-Present
Mt Sinai School of MedicinePedodontic Residency
Guest SpeakersJim BronsonMike MewKevin BoydSandra KahnJennifer TowRoger PricePaula Fabbie
Damien OrsquoBrien
First clinical program in myofunctional orthodontics
Airway and Facial DevelopmentCollaborative Webcast
Mark Cruz
AAPMD Symposium
wwwaapm
dorg
Annual MeetingApril 25-26 2014
Westin Chicago North Shore
the raphael center for integrative orthodontics
wwwalignminecomwwwbioblocnjcom
wwwmyobracenjcom
Integrative vs Conventional
Integrative vs Conventional
ldquoWith improvements in expansion orthodontics advances in myofunctional orthodontics and the growing recognition about sleep disordered breathing among children and adults it is time for orthodontics to expand its horizons There is now so much more we can oerrdquo
The Raphael name has been associated with high quality orthodontics in New Jersey for over 60 years Dr Barry Raphael has been a university trained orthodontic specialist and a member of the American Association of Orthodontists for 30 years
He has a wide range of techniques and services to offer He has studied oral myology applied kinesiology Buteyko breathing Biobloc Orthotropics and Myobrace as part of his integrative training He can offer Damon Invisalign Insignia and Incognito appliances designs as some of his many conventional orthodontic services too
Dr Raphael teaches his techniques at post-graduate residencies study clubs dental societies and for the Myofunctional Research Co He is available for presentations to any group interested in learning more about the benefits of integrative orthodontics
wwwalignminecomLearn about the choices you have in orthodontics
dr barry raphael Why its
too Early never
1425
bro
ad
str
ee
tc
lifto
n n
j 070
13
973-
778-
4222
fax
973-
778-
9625
nj s
pe
c
368
4
1425 broad street clifton nj 07013973-778-4222
wwwalignminecom
the raphael centerforintegrative orthodontics
the
raph
ael c
ente
r fo
rin
tegr
ativ
e or
thod
onti
cs
Learn about an important choice you need to make before starting braces
the raphael center for integrative education
the raphael center for integrative education
Ongoing Intro to Airway Orthodontics
April Biobloc Study Group
April Training Ortho-Postural Therapists w Roger Price
June MRC Myobrace Basic Series
August Airway Dentistry with Mark Cruz and company
October Advanced MFT with Sandy Coulson
October Less than Six with Kevin Boyd
(who else wants to play)
Mission to create a space for spreading the word about Airway and Orthotropic principles and practice
Orthodontics in the 21st Century
EstheticOrthodontics
AirwayOrthodontics
GeneticTooth-Focused
Dental PerfectionEsthetics Primary
Treating SymptomsAirway Ignorant
AdaptationMuscle-FocusedMedical Better
Esthetics SecondaryTreating Causes
Airway Conscious
The EndAnd
The Beginning
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
George Catlin
Are we developing the wayour genes program us to be
Westin Price
Kevin Boyd
Peter Gluckman
Neese and Williams
Scott Gilbert
Clark Spencer Larsen
Darwinian Dentistry
MeJames
Sim Wallace
Obesity
Metabolic SyndromeCeliac
Intestinal PermeabilityType 2 Diabetes
Fatty Liver Disease Cardiovascular Disease
HypertensionSome Cancers
The Results of the MismatchBetween Genes and the Environment
Chronic Non-Communicable Diseases of CivilizationWestern Lifestyle Diseases
Asthma
Autism
Aspergerrsquos
Alzheimers
ADDADHDDepression
Chronic Back Pain
Osteoporosis
Caries
Malocclusion
Sleep Apnea
The Toothberg
Airway-Related Craniofacial Dysfunctions
bullChronic Naso-pharyngeal Obstructionbull Tongue form aberrations (Frenum and tongue-tie)bullOpen Mouth Rest Posture bullMyofunctional disorders (Swallowing chewingetc)bullChronic Hyperventilation and Hypocapniabull Breathing Disordered Sleep (OSA UARS snoring)bull Bruxism and parafunctionsbull TMD and facial pain componentsbullCranial and postural issuesbull Malocclusion
Airway Orthodontics
bullEarly Feeding and Nutrition
bullAllergies Asthma URT infections
bullPosture
bullAirway Breathing and Sleep Disorders
bullSoft Tissue Dysfunctions (Tongue Thrust Open Mouth)
Instead of crooked teeth being The ProblemThey are just a SYMPTOM of something larger
Parentrsquos Private-eye Sheet
Parentrsquos Private-eye Sheet
ldquoThere are many things about your childrsquos health that are important to know but that I often donrsquot get to see at the office Also there are signs to look for that you may not have known were connected to your childrsquos teeth or health By looking for and tracking these ldquosigns and symptomsrdquo we can get a better handle on the problem and watch for resolution
You donrsquot have to spend a lot of time with this but donrsquot rush either Watch for certain things at different times of day Try not to let your child know they are being watched You want to see the most natural behaviors
Check off what you see If yoursquore not sure check it anyway and wersquoll talk about it Make comments if you wantrdquo
While sitting around
While sitting around (watching TV in the car) does your child
put ldquothingsrdquo in the mouth alot (toys sleeves pencils fingernails etc) ______________________________
lick or suck on the lips have the lips apart even a little stick or dart the tongue out of the mouth have the tongue resting between the teeth lean the cheek on a hand breath with his mouth open even a little bit make noises when breathing have trouble sitting still
While talking
While talking does your child talk very fast talk very slowly gasp for air have a lisp take speech lessons
During a meal
During a meal does your child gasp for air while eating stick his tongue between his teeth when swallowing stick the tongue out to meet the drinking glass drink a lot while eating make noises when chewing eat sloppily take a breath before drinking puff the cheeks out when drinking make the lips purse when swallowing make the chin ldquocrinklerdquo when swallowing bob the head when swallowing have trouble sitting still
While sleeping
While sleeping does your child have the mouth open snore wet the bed toss and turn tilt the head back wake up frequently have frequent nightmares have abnormal sleep issues grind the teeth have trouble waking up wake with darker circles under eyes
S R 10-10yo M
bullMissing 3242bullImpacted 1323bullLate mixed 25 eruptedbullSoft tissue dysfunctionbullIL = 40bullNot compliant
S Reardon 10-7yo M
Impacted 3s Missing 2s
Medical history
bull Reactive Airway Diseasebull ldquoBronchial Constrictionrdquo bullCare of Pulmonologistbull Preventil
bull Dad OSA CPAP for 11 years diabetesbull Grandfather OSA untreatedbull ETCO2 = 361 at 10 bpm (acceptable)bull Posture number - 18 (lt10 ideal)bull Father refuses sleep screening
Treatment Options1 Extract upper premolars Align2Open spaces for impacted canines Open spaces for lower lateral implants
Whatrsquos more importantEase of treatment
OrBreathing well at night
Bolton Standards15yo
The Maxilla is Down and Back
The Mandible is Retrognathic
Nasal Cartilage Collapse
Insufficient Facial Support
Bi-maxillary Retrusion
Bimaxillary Retrusion Forward Growth
Mouthbreathers have significantly smaller airway space
(measurements PAS-OccL PAS-UP airway volume area and minimum axial area)
Mouth breather Nasal breather
Three-dimensional assessment of pharyngeal airway in nasal- and mouth-breathing children
Alves M etal Int J Ped ORL 75 (2011) 1195ndash1199
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
B Hockel 2012
This is the profile Biobloc children start with long and retrusive
This is the profile Biobloc children finish with Forward with lips
together
B Hockel 2012
Herersquos the ldquoinsiderdquo look Notice how the upper front teeth are closer to the nose (yellow arrows)
Notice how the lower jaw rotates around the star so the chin comes up and forward (red arrow)How do we make this happen
From the tip of the Central
To the Forwardmost Tip of the Nose
41mm
Maxillary Heightbull Indicator Line (Mew)
bull Distance from most anterior point on nose to upper incisal edge
bull Age + 23bull A variable number but important to watch over time
B Hockel 2012
Herersquos the ldquoinsiderdquo look Notice how the upper front teeth are closer to the nose (yellow arrows)
Notice how the lower jaw rotates around the star so the chin comes up and forward (red arrow)How do we make this happen
Using IndicatorCosmetic Line
bull To define a starting pointbull To set treatment goalsbull To track treatment progressbull To gauge the effectiveness of treatment
Charting the InCos Line
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Incisor pulled away from noseNot ldquoundertorquedrdquo or ldquogummy smilerdquo
Hypothetical ClI OrthoMARA
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
OJ = 7mm
Starts Ortho
ldquoGreat Headgear
Effectrdquo
Class II Elastics
50
40
30
20mm
y J F M A M J J A S O N
boys
Start Non-x
Expansion UncrowdingFinished
Start Cl II elastics
OK thatrsquos
enough
Hypothetical Mouthbreather(Dr Mewrsquos Hamster Boy)
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Boy gets
hamster
MFT
Hypothetical BBO 7yoM
50
40
30
20
5 6 7 8 9 10 11 12 13 14 15
girlsboys
Initial
StartBB1
BB3
Night
bullLR 11-9yFbullMissing all 5s6s8s and upper 4sbullHad ortho to close diastemahellipbullInL = 39bullGP objects to deX plan equil
LR Tx Plan
1Preparation Hang Expanser2deX 3Training BB3 to advance mandible4Myofunctional Therapy5Orthopostural Training6Myobrace to hold7 Reevaluate for dental detailing
LR Spotty progress
50
40
30
20mm
y 313 4 5 6 7 8 9 10 11 12114
2 3
Expanser
Parents dragging30 turnsStart Adv
Rx deXGP
objects
After delays
Equil ersquosBB3
bullLR 12-3 yF (6mo in tx)bullInL = 37 (+2)bull ersquos equilibratedbull OJ =10bull Appliance OJ = 5bull Still accommodating to BB3
Is there a calculus for the Indicator Line
Treatment GoalsBased on Indicator Line
Incisor Goals
Type 1 Treatment Place U1 in ideal position
Biobloc Orthotropics Orthognathic Surgery Distraction Osteogenesis
Type 1 Ideal InCos line
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
YZ 9yo M
bullLost upper d-spacebullInL = 36(+4)bullOJ = 9mmbullLip entrapmentbullLip Incompetence
Y Z 9yo M
Y Z 9yo M9mm OJ
Y Z 9yo M
Treatment Options
1 Type 1 Reduce InL open lost space BB3 to advance mandible
2 Type 2 Open lost space Align
3 Type 4 Extract four premolars
YZ 9yoM
50
40
30
20mm
yM A M J J A S O N D J F M A
boys
Hang Expanser
Upper and Lower
Brackets Hang Retainer
BB3
Incisor Goals
Type 2 Treatment Develop arch just enough to uncrowd
Biobloc Myofunctional Ortho Myofunctional Therapy Crozat ALF Expansion Orthodontics
Type 2 Uncrowding
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
bullLip incompetencebullLip entrapmentbullHypermentalisbullMouthbreathing
Type 2 Uncrowding
12 month progress
12 month progress
12 month progress
After Treatment
Bent-wire6 monthsMyobrace12 months
Hey RaphaelWhat about that
profile
ZP 9-5yoM
i
After Expansion Phase
Incomplete profile improvement better breathing head posture and sleep
Incisor Goals
Type 3 Treatment Maintain UI
Functional Orthodontics Expansion Orthodontics Distalization Ortho or No Treatment
Type 3 Maintain
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Bimax retrusion
Successful dental result
Profile Unimproved
Incisor Goals
Type 4 Treatment RetractExtrude UI
Extraction Orthodontics Retraction Ortho Distalization Ortho
Type 4 Retraction
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Bimax retrusion
Successful dental result
Failed Profile Result
Changes of pharyngeal airway size and hyoid bone position following orthodontic treatment of
Class I bimaxillary protrusion
Qingzhu Wanga Peizeng Jiab Nina K Andersonc Lin Wangd Jiuxiang Line
Angle Orthodontist Vol 00 No 0 0000 (pre-publication 2012)
ldquothe dimension of the velopharynx glossopharynx and hypopharynx were decreased after maximal retraction of anterior teeth with extraction of four premolarshelliprdquo ldquoAny factors that can influence the posture and position of tongue and soft palate may displace them backward andencroach upon the pharynxrdquo
ldquothe more the incisors were retracted the more the pharyngeal airway was reducedrdquo
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Backed into a corner
bull
Moving teeth faster more efficientlyhellipin the wrong direction
Now that wersquove made smoking unacceptable
could we not do the same withbull Sugarbull Processed foodbull Cheap milk and meatbull Fast foodbull Pill popping for symptomatic reliefbull Looking for the cure instead of the causebull Surgery as a quick fixbull Thinking braces are a status symbol
Each industry thrives on the status quoConsumers must drive the change
NP 10yM
NP
Sisterrsquos non-x ortho
Shersquos happyhellipbut Irsquom not so
I make my pitch for BBO
The dilemma of progress
(I forgot the progress pictureshellip)
Dad sells prosthetic parts to orthopedic surgeons
I selling the case against my previous work they loved
It takes me 3 hours to sell the case
They fret until the BB3 goes in
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Connecting the dots
bull Adult SDB and OSA
bull Narrow jaws and faces
bull Soft tissue dysfunction
bull Early parafunctional habits ie open mouth posture
bull Environmental stressors
bull CPAP MARAUPPP SurgWherersquos the best
place to start treatment here
or here
1 Prevention 2 Undo the damage already done3 Establish good habits
When to start When damage from poor breathing is noticed and when bad habits are discovered
The strategies of Airway Orthodontics
Prevention
bull Remove ankyloglossiabull Promote breastfeedingbull Harden the dietbull Develop masticatory strengthbull Discourage oral habitsbull Promote whole-foods low sugar dietbull Reduce oropharyngeal obstructionbull Promote nasal breathing
Breathing retraining
bull Nasal rinsingbull Nasal clearingbull Decongesting
The goals of Airway Orthodontics
1 Breathing through the nose2 Lips together at rest3 Correct tongue position4 No facial muscles moving on swallowing5 Optimal forward facial development6 Class I occlusion7 Straight teeth8 Better stability long term
Myofunctional Trainers
Professors R Soulet and A Besombes
Dr Earl Bergeson
Dr Chris Farrell
The Multi ndash Family System
Orofacial MyofunctionalTherapy
Oral MyologyMyofunctional TherapyTongue Thrust Therapy
B Hockel 2012 Back
Undoing Bimaxillary Dysplasia
1 Maxillary deconstriction2 Maxillary advancement3 Maxillary impaction4 Mandibular advancement
1 Maxillary Expansion
Treatment for Bimaxillary Dysplasia
ALFCrozat
Bent Wire
HyraxHaas
Niti Exp BioBlocSchwartz
The Farrell BENT WIRE Systemtrade
Recommended Age Group 5-12 yrs
Arch Development in conjunction with the TRAINER Systemtrade
Dr John Mew
Establish Good Habits
1 Breathing through the nose2 Lips together at rest3 Correct tongue position4 No facial muscles moving on swallowing5 Stand and sit in balance6 Breath gently using the diaphragm7 Eat to nourish8 Sleep to rest
Ortho-Postural TrainingWorkshops
Breathing
Nutrition
Posture
Sleep
COPYRIGHTRoger L PriceOctober 2012
Posture Number
Forward head posturecan be a compensationfor a deficient airway
Sleep Screening and Hygiene
SQI = 10 SQI = 98
Integrative Healthcare
Function ProfessionalNasal clearing ENT Pulm MFT BreathingMuscle balance and tone MFT Myofunctional OrthoUndoing damage GP Pedo Ortho OMFSBreathing dynamics OPT MFT Breath PhysiologistPosture DC OPT PT OsteopathCranial balance OsteopathNutrition RDH Nutritionist Dietitian Sleep ENT Sleep Med DentNeurocognitive development Pedrsquon SLP Psych SpEd
The Interdisciplinary Center
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Now that I know
My personal missionTo create from what Irsquove
learned from the besta model for others to followhellipespecially the orthodontists
Myofunctional Orthodontics
Chris Farrell
John Flutter
German Ramierez
Damien OrsquoBrien
Myofunctional Research CoRancho Cucamonga
2008-2012
Oral Myology
Oral Myology Basic CourseJoy MoellerNYC 2011LA 2012
Oral Myology Levels 2 3Kim BenkertClifton 2012
Habit CessationShari GreenClifton 2013
Biobloc Orthotropics
BBO Mini-residencyBill Hang
Agora Hills2012-13
BBO IntensiveDrs John and Mike
MewLSFO2013
Breathing and Sleep
Buteyko MentorshipThe Breathing Center
Woodstock2010
Breathing Well ProgrammeJohn Flutter
2010 Ortho-Postural TrainingRoger Price
2013
Sleep DentistryMichael Gelb etal
NYU2012
ALF and Cranial
Jim Bronson2013 Tasha Turzo
Cranial Academy2014
Bucket Listbull ALF and Crozat (Bronsonrsquos course)bullMore on Biobloc (Hangrsquos Advanced London School)bull More Cranial (The Farm)bullChirodontics (Bob Walker)bull Airway Dentistry with Marc Cruz Jeff Rousebull Sleep Dentistrybull Less-than-Six with Kevin Boydbull Intra-mandibular Distraction Osteogenesis (IMDO)
Off My ListAnything that moves the teeth faster in the wrong direction
Whatrsquos an RO to do
To create from what Irsquove learned from the best
a model for others to followhellipespecially orthodontists
Teaching
Mt Sinai Pedo ResidencyAli Attaie
2010-2012
Montefiore Ortho ResidencyTony Maganzini
2012
2009-Present
Mt Sinai School of MedicinePedodontic Residency
Guest SpeakersJim BronsonMike MewKevin BoydSandra KahnJennifer TowRoger PricePaula Fabbie
Damien OrsquoBrien
First clinical program in myofunctional orthodontics
Airway and Facial DevelopmentCollaborative Webcast
Mark Cruz
AAPMD Symposium
wwwaapm
dorg
Annual MeetingApril 25-26 2014
Westin Chicago North Shore
the raphael center for integrative orthodontics
wwwalignminecomwwwbioblocnjcom
wwwmyobracenjcom
Integrative vs Conventional
Integrative vs Conventional
ldquoWith improvements in expansion orthodontics advances in myofunctional orthodontics and the growing recognition about sleep disordered breathing among children and adults it is time for orthodontics to expand its horizons There is now so much more we can oerrdquo
The Raphael name has been associated with high quality orthodontics in New Jersey for over 60 years Dr Barry Raphael has been a university trained orthodontic specialist and a member of the American Association of Orthodontists for 30 years
He has a wide range of techniques and services to offer He has studied oral myology applied kinesiology Buteyko breathing Biobloc Orthotropics and Myobrace as part of his integrative training He can offer Damon Invisalign Insignia and Incognito appliances designs as some of his many conventional orthodontic services too
Dr Raphael teaches his techniques at post-graduate residencies study clubs dental societies and for the Myofunctional Research Co He is available for presentations to any group interested in learning more about the benefits of integrative orthodontics
wwwalignminecomLearn about the choices you have in orthodontics
dr barry raphael Why its
too Early never
1425
bro
ad
str
ee
tc
lifto
n n
j 070
13
973-
778-
4222
fax
973-
778-
9625
nj s
pe
c
368
4
1425 broad street clifton nj 07013973-778-4222
wwwalignminecom
the raphael centerforintegrative orthodontics
the
raph
ael c
ente
r fo
rin
tegr
ativ
e or
thod
onti
cs
Learn about an important choice you need to make before starting braces
the raphael center for integrative education
the raphael center for integrative education
Ongoing Intro to Airway Orthodontics
April Biobloc Study Group
April Training Ortho-Postural Therapists w Roger Price
June MRC Myobrace Basic Series
August Airway Dentistry with Mark Cruz and company
October Advanced MFT with Sandy Coulson
October Less than Six with Kevin Boyd
(who else wants to play)
Mission to create a space for spreading the word about Airway and Orthotropic principles and practice
Orthodontics in the 21st Century
EstheticOrthodontics
AirwayOrthodontics
GeneticTooth-Focused
Dental PerfectionEsthetics Primary
Treating SymptomsAirway Ignorant
AdaptationMuscle-FocusedMedical Better
Esthetics SecondaryTreating Causes
Airway Conscious
The EndAnd
The Beginning
George Catlin
Are we developing the wayour genes program us to be
Westin Price
Kevin Boyd
Peter Gluckman
Neese and Williams
Scott Gilbert
Clark Spencer Larsen
Darwinian Dentistry
MeJames
Sim Wallace
Obesity
Metabolic SyndromeCeliac
Intestinal PermeabilityType 2 Diabetes
Fatty Liver Disease Cardiovascular Disease
HypertensionSome Cancers
The Results of the MismatchBetween Genes and the Environment
Chronic Non-Communicable Diseases of CivilizationWestern Lifestyle Diseases
Asthma
Autism
Aspergerrsquos
Alzheimers
ADDADHDDepression
Chronic Back Pain
Osteoporosis
Caries
Malocclusion
Sleep Apnea
The Toothberg
Airway-Related Craniofacial Dysfunctions
bullChronic Naso-pharyngeal Obstructionbull Tongue form aberrations (Frenum and tongue-tie)bullOpen Mouth Rest Posture bullMyofunctional disorders (Swallowing chewingetc)bullChronic Hyperventilation and Hypocapniabull Breathing Disordered Sleep (OSA UARS snoring)bull Bruxism and parafunctionsbull TMD and facial pain componentsbullCranial and postural issuesbull Malocclusion
Airway Orthodontics
bullEarly Feeding and Nutrition
bullAllergies Asthma URT infections
bullPosture
bullAirway Breathing and Sleep Disorders
bullSoft Tissue Dysfunctions (Tongue Thrust Open Mouth)
Instead of crooked teeth being The ProblemThey are just a SYMPTOM of something larger
Parentrsquos Private-eye Sheet
Parentrsquos Private-eye Sheet
ldquoThere are many things about your childrsquos health that are important to know but that I often donrsquot get to see at the office Also there are signs to look for that you may not have known were connected to your childrsquos teeth or health By looking for and tracking these ldquosigns and symptomsrdquo we can get a better handle on the problem and watch for resolution
You donrsquot have to spend a lot of time with this but donrsquot rush either Watch for certain things at different times of day Try not to let your child know they are being watched You want to see the most natural behaviors
Check off what you see If yoursquore not sure check it anyway and wersquoll talk about it Make comments if you wantrdquo
While sitting around
While sitting around (watching TV in the car) does your child
put ldquothingsrdquo in the mouth alot (toys sleeves pencils fingernails etc) ______________________________
lick or suck on the lips have the lips apart even a little stick or dart the tongue out of the mouth have the tongue resting between the teeth lean the cheek on a hand breath with his mouth open even a little bit make noises when breathing have trouble sitting still
While talking
While talking does your child talk very fast talk very slowly gasp for air have a lisp take speech lessons
During a meal
During a meal does your child gasp for air while eating stick his tongue between his teeth when swallowing stick the tongue out to meet the drinking glass drink a lot while eating make noises when chewing eat sloppily take a breath before drinking puff the cheeks out when drinking make the lips purse when swallowing make the chin ldquocrinklerdquo when swallowing bob the head when swallowing have trouble sitting still
While sleeping
While sleeping does your child have the mouth open snore wet the bed toss and turn tilt the head back wake up frequently have frequent nightmares have abnormal sleep issues grind the teeth have trouble waking up wake with darker circles under eyes
S R 10-10yo M
bullMissing 3242bullImpacted 1323bullLate mixed 25 eruptedbullSoft tissue dysfunctionbullIL = 40bullNot compliant
S Reardon 10-7yo M
Impacted 3s Missing 2s
Medical history
bull Reactive Airway Diseasebull ldquoBronchial Constrictionrdquo bullCare of Pulmonologistbull Preventil
bull Dad OSA CPAP for 11 years diabetesbull Grandfather OSA untreatedbull ETCO2 = 361 at 10 bpm (acceptable)bull Posture number - 18 (lt10 ideal)bull Father refuses sleep screening
Treatment Options1 Extract upper premolars Align2Open spaces for impacted canines Open spaces for lower lateral implants
Whatrsquos more importantEase of treatment
OrBreathing well at night
Bolton Standards15yo
The Maxilla is Down and Back
The Mandible is Retrognathic
Nasal Cartilage Collapse
Insufficient Facial Support
Bi-maxillary Retrusion
Bimaxillary Retrusion Forward Growth
Mouthbreathers have significantly smaller airway space
(measurements PAS-OccL PAS-UP airway volume area and minimum axial area)
Mouth breather Nasal breather
Three-dimensional assessment of pharyngeal airway in nasal- and mouth-breathing children
Alves M etal Int J Ped ORL 75 (2011) 1195ndash1199
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
B Hockel 2012
This is the profile Biobloc children start with long and retrusive
This is the profile Biobloc children finish with Forward with lips
together
B Hockel 2012
Herersquos the ldquoinsiderdquo look Notice how the upper front teeth are closer to the nose (yellow arrows)
Notice how the lower jaw rotates around the star so the chin comes up and forward (red arrow)How do we make this happen
From the tip of the Central
To the Forwardmost Tip of the Nose
41mm
Maxillary Heightbull Indicator Line (Mew)
bull Distance from most anterior point on nose to upper incisal edge
bull Age + 23bull A variable number but important to watch over time
B Hockel 2012
Herersquos the ldquoinsiderdquo look Notice how the upper front teeth are closer to the nose (yellow arrows)
Notice how the lower jaw rotates around the star so the chin comes up and forward (red arrow)How do we make this happen
Using IndicatorCosmetic Line
bull To define a starting pointbull To set treatment goalsbull To track treatment progressbull To gauge the effectiveness of treatment
Charting the InCos Line
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Incisor pulled away from noseNot ldquoundertorquedrdquo or ldquogummy smilerdquo
Hypothetical ClI OrthoMARA
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
OJ = 7mm
Starts Ortho
ldquoGreat Headgear
Effectrdquo
Class II Elastics
50
40
30
20mm
y J F M A M J J A S O N
boys
Start Non-x
Expansion UncrowdingFinished
Start Cl II elastics
OK thatrsquos
enough
Hypothetical Mouthbreather(Dr Mewrsquos Hamster Boy)
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Boy gets
hamster
MFT
Hypothetical BBO 7yoM
50
40
30
20
5 6 7 8 9 10 11 12 13 14 15
girlsboys
Initial
StartBB1
BB3
Night
bullLR 11-9yFbullMissing all 5s6s8s and upper 4sbullHad ortho to close diastemahellipbullInL = 39bullGP objects to deX plan equil
LR Tx Plan
1Preparation Hang Expanser2deX 3Training BB3 to advance mandible4Myofunctional Therapy5Orthopostural Training6Myobrace to hold7 Reevaluate for dental detailing
LR Spotty progress
50
40
30
20mm
y 313 4 5 6 7 8 9 10 11 12114
2 3
Expanser
Parents dragging30 turnsStart Adv
Rx deXGP
objects
After delays
Equil ersquosBB3
bullLR 12-3 yF (6mo in tx)bullInL = 37 (+2)bull ersquos equilibratedbull OJ =10bull Appliance OJ = 5bull Still accommodating to BB3
Is there a calculus for the Indicator Line
Treatment GoalsBased on Indicator Line
Incisor Goals
Type 1 Treatment Place U1 in ideal position
Biobloc Orthotropics Orthognathic Surgery Distraction Osteogenesis
Type 1 Ideal InCos line
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
YZ 9yo M
bullLost upper d-spacebullInL = 36(+4)bullOJ = 9mmbullLip entrapmentbullLip Incompetence
Y Z 9yo M
Y Z 9yo M9mm OJ
Y Z 9yo M
Treatment Options
1 Type 1 Reduce InL open lost space BB3 to advance mandible
2 Type 2 Open lost space Align
3 Type 4 Extract four premolars
YZ 9yoM
50
40
30
20mm
yM A M J J A S O N D J F M A
boys
Hang Expanser
Upper and Lower
Brackets Hang Retainer
BB3
Incisor Goals
Type 2 Treatment Develop arch just enough to uncrowd
Biobloc Myofunctional Ortho Myofunctional Therapy Crozat ALF Expansion Orthodontics
Type 2 Uncrowding
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
bullLip incompetencebullLip entrapmentbullHypermentalisbullMouthbreathing
Type 2 Uncrowding
12 month progress
12 month progress
12 month progress
After Treatment
Bent-wire6 monthsMyobrace12 months
Hey RaphaelWhat about that
profile
ZP 9-5yoM
i
After Expansion Phase
Incomplete profile improvement better breathing head posture and sleep
Incisor Goals
Type 3 Treatment Maintain UI
Functional Orthodontics Expansion Orthodontics Distalization Ortho or No Treatment
Type 3 Maintain
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Bimax retrusion
Successful dental result
Profile Unimproved
Incisor Goals
Type 4 Treatment RetractExtrude UI
Extraction Orthodontics Retraction Ortho Distalization Ortho
Type 4 Retraction
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Bimax retrusion
Successful dental result
Failed Profile Result
Changes of pharyngeal airway size and hyoid bone position following orthodontic treatment of
Class I bimaxillary protrusion
Qingzhu Wanga Peizeng Jiab Nina K Andersonc Lin Wangd Jiuxiang Line
Angle Orthodontist Vol 00 No 0 0000 (pre-publication 2012)
ldquothe dimension of the velopharynx glossopharynx and hypopharynx were decreased after maximal retraction of anterior teeth with extraction of four premolarshelliprdquo ldquoAny factors that can influence the posture and position of tongue and soft palate may displace them backward andencroach upon the pharynxrdquo
ldquothe more the incisors were retracted the more the pharyngeal airway was reducedrdquo
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Backed into a corner
bull
Moving teeth faster more efficientlyhellipin the wrong direction
Now that wersquove made smoking unacceptable
could we not do the same withbull Sugarbull Processed foodbull Cheap milk and meatbull Fast foodbull Pill popping for symptomatic reliefbull Looking for the cure instead of the causebull Surgery as a quick fixbull Thinking braces are a status symbol
Each industry thrives on the status quoConsumers must drive the change
NP 10yM
NP
Sisterrsquos non-x ortho
Shersquos happyhellipbut Irsquom not so
I make my pitch for BBO
The dilemma of progress
(I forgot the progress pictureshellip)
Dad sells prosthetic parts to orthopedic surgeons
I selling the case against my previous work they loved
It takes me 3 hours to sell the case
They fret until the BB3 goes in
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Connecting the dots
bull Adult SDB and OSA
bull Narrow jaws and faces
bull Soft tissue dysfunction
bull Early parafunctional habits ie open mouth posture
bull Environmental stressors
bull CPAP MARAUPPP SurgWherersquos the best
place to start treatment here
or here
1 Prevention 2 Undo the damage already done3 Establish good habits
When to start When damage from poor breathing is noticed and when bad habits are discovered
The strategies of Airway Orthodontics
Prevention
bull Remove ankyloglossiabull Promote breastfeedingbull Harden the dietbull Develop masticatory strengthbull Discourage oral habitsbull Promote whole-foods low sugar dietbull Reduce oropharyngeal obstructionbull Promote nasal breathing
Breathing retraining
bull Nasal rinsingbull Nasal clearingbull Decongesting
The goals of Airway Orthodontics
1 Breathing through the nose2 Lips together at rest3 Correct tongue position4 No facial muscles moving on swallowing5 Optimal forward facial development6 Class I occlusion7 Straight teeth8 Better stability long term
Myofunctional Trainers
Professors R Soulet and A Besombes
Dr Earl Bergeson
Dr Chris Farrell
The Multi ndash Family System
Orofacial MyofunctionalTherapy
Oral MyologyMyofunctional TherapyTongue Thrust Therapy
B Hockel 2012 Back
Undoing Bimaxillary Dysplasia
1 Maxillary deconstriction2 Maxillary advancement3 Maxillary impaction4 Mandibular advancement
1 Maxillary Expansion
Treatment for Bimaxillary Dysplasia
ALFCrozat
Bent Wire
HyraxHaas
Niti Exp BioBlocSchwartz
The Farrell BENT WIRE Systemtrade
Recommended Age Group 5-12 yrs
Arch Development in conjunction with the TRAINER Systemtrade
Dr John Mew
Establish Good Habits
1 Breathing through the nose2 Lips together at rest3 Correct tongue position4 No facial muscles moving on swallowing5 Stand and sit in balance6 Breath gently using the diaphragm7 Eat to nourish8 Sleep to rest
Ortho-Postural TrainingWorkshops
Breathing
Nutrition
Posture
Sleep
COPYRIGHTRoger L PriceOctober 2012
Posture Number
Forward head posturecan be a compensationfor a deficient airway
Sleep Screening and Hygiene
SQI = 10 SQI = 98
Integrative Healthcare
Function ProfessionalNasal clearing ENT Pulm MFT BreathingMuscle balance and tone MFT Myofunctional OrthoUndoing damage GP Pedo Ortho OMFSBreathing dynamics OPT MFT Breath PhysiologistPosture DC OPT PT OsteopathCranial balance OsteopathNutrition RDH Nutritionist Dietitian Sleep ENT Sleep Med DentNeurocognitive development Pedrsquon SLP Psych SpEd
The Interdisciplinary Center
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Now that I know
My personal missionTo create from what Irsquove
learned from the besta model for others to followhellipespecially the orthodontists
Myofunctional Orthodontics
Chris Farrell
John Flutter
German Ramierez
Damien OrsquoBrien
Myofunctional Research CoRancho Cucamonga
2008-2012
Oral Myology
Oral Myology Basic CourseJoy MoellerNYC 2011LA 2012
Oral Myology Levels 2 3Kim BenkertClifton 2012
Habit CessationShari GreenClifton 2013
Biobloc Orthotropics
BBO Mini-residencyBill Hang
Agora Hills2012-13
BBO IntensiveDrs John and Mike
MewLSFO2013
Breathing and Sleep
Buteyko MentorshipThe Breathing Center
Woodstock2010
Breathing Well ProgrammeJohn Flutter
2010 Ortho-Postural TrainingRoger Price
2013
Sleep DentistryMichael Gelb etal
NYU2012
ALF and Cranial
Jim Bronson2013 Tasha Turzo
Cranial Academy2014
Bucket Listbull ALF and Crozat (Bronsonrsquos course)bullMore on Biobloc (Hangrsquos Advanced London School)bull More Cranial (The Farm)bullChirodontics (Bob Walker)bull Airway Dentistry with Marc Cruz Jeff Rousebull Sleep Dentistrybull Less-than-Six with Kevin Boydbull Intra-mandibular Distraction Osteogenesis (IMDO)
Off My ListAnything that moves the teeth faster in the wrong direction
Whatrsquos an RO to do
To create from what Irsquove learned from the best
a model for others to followhellipespecially orthodontists
Teaching
Mt Sinai Pedo ResidencyAli Attaie
2010-2012
Montefiore Ortho ResidencyTony Maganzini
2012
2009-Present
Mt Sinai School of MedicinePedodontic Residency
Guest SpeakersJim BronsonMike MewKevin BoydSandra KahnJennifer TowRoger PricePaula Fabbie
Damien OrsquoBrien
First clinical program in myofunctional orthodontics
Airway and Facial DevelopmentCollaborative Webcast
Mark Cruz
AAPMD Symposium
wwwaapm
dorg
Annual MeetingApril 25-26 2014
Westin Chicago North Shore
the raphael center for integrative orthodontics
wwwalignminecomwwwbioblocnjcom
wwwmyobracenjcom
Integrative vs Conventional
Integrative vs Conventional
ldquoWith improvements in expansion orthodontics advances in myofunctional orthodontics and the growing recognition about sleep disordered breathing among children and adults it is time for orthodontics to expand its horizons There is now so much more we can oerrdquo
The Raphael name has been associated with high quality orthodontics in New Jersey for over 60 years Dr Barry Raphael has been a university trained orthodontic specialist and a member of the American Association of Orthodontists for 30 years
He has a wide range of techniques and services to offer He has studied oral myology applied kinesiology Buteyko breathing Biobloc Orthotropics and Myobrace as part of his integrative training He can offer Damon Invisalign Insignia and Incognito appliances designs as some of his many conventional orthodontic services too
Dr Raphael teaches his techniques at post-graduate residencies study clubs dental societies and for the Myofunctional Research Co He is available for presentations to any group interested in learning more about the benefits of integrative orthodontics
wwwalignminecomLearn about the choices you have in orthodontics
dr barry raphael Why its
too Early never
1425
bro
ad
str
ee
tc
lifto
n n
j 070
13
973-
778-
4222
fax
973-
778-
9625
nj s
pe
c
368
4
1425 broad street clifton nj 07013973-778-4222
wwwalignminecom
the raphael centerforintegrative orthodontics
the
raph
ael c
ente
r fo
rin
tegr
ativ
e or
thod
onti
cs
Learn about an important choice you need to make before starting braces
the raphael center for integrative education
the raphael center for integrative education
Ongoing Intro to Airway Orthodontics
April Biobloc Study Group
April Training Ortho-Postural Therapists w Roger Price
June MRC Myobrace Basic Series
August Airway Dentistry with Mark Cruz and company
October Advanced MFT with Sandy Coulson
October Less than Six with Kevin Boyd
(who else wants to play)
Mission to create a space for spreading the word about Airway and Orthotropic principles and practice
Orthodontics in the 21st Century
EstheticOrthodontics
AirwayOrthodontics
GeneticTooth-Focused
Dental PerfectionEsthetics Primary
Treating SymptomsAirway Ignorant
AdaptationMuscle-FocusedMedical Better
Esthetics SecondaryTreating Causes
Airway Conscious
The EndAnd
The Beginning
Obesity
Metabolic SyndromeCeliac
Intestinal PermeabilityType 2 Diabetes
Fatty Liver Disease Cardiovascular Disease
HypertensionSome Cancers
The Results of the MismatchBetween Genes and the Environment
Chronic Non-Communicable Diseases of CivilizationWestern Lifestyle Diseases
Asthma
Autism
Aspergerrsquos
Alzheimers
ADDADHDDepression
Chronic Back Pain
Osteoporosis
Caries
Malocclusion
Sleep Apnea
The Toothberg
Airway-Related Craniofacial Dysfunctions
bullChronic Naso-pharyngeal Obstructionbull Tongue form aberrations (Frenum and tongue-tie)bullOpen Mouth Rest Posture bullMyofunctional disorders (Swallowing chewingetc)bullChronic Hyperventilation and Hypocapniabull Breathing Disordered Sleep (OSA UARS snoring)bull Bruxism and parafunctionsbull TMD and facial pain componentsbullCranial and postural issuesbull Malocclusion
Airway Orthodontics
bullEarly Feeding and Nutrition
bullAllergies Asthma URT infections
bullPosture
bullAirway Breathing and Sleep Disorders
bullSoft Tissue Dysfunctions (Tongue Thrust Open Mouth)
Instead of crooked teeth being The ProblemThey are just a SYMPTOM of something larger
Parentrsquos Private-eye Sheet
Parentrsquos Private-eye Sheet
ldquoThere are many things about your childrsquos health that are important to know but that I often donrsquot get to see at the office Also there are signs to look for that you may not have known were connected to your childrsquos teeth or health By looking for and tracking these ldquosigns and symptomsrdquo we can get a better handle on the problem and watch for resolution
You donrsquot have to spend a lot of time with this but donrsquot rush either Watch for certain things at different times of day Try not to let your child know they are being watched You want to see the most natural behaviors
Check off what you see If yoursquore not sure check it anyway and wersquoll talk about it Make comments if you wantrdquo
While sitting around
While sitting around (watching TV in the car) does your child
put ldquothingsrdquo in the mouth alot (toys sleeves pencils fingernails etc) ______________________________
lick or suck on the lips have the lips apart even a little stick or dart the tongue out of the mouth have the tongue resting between the teeth lean the cheek on a hand breath with his mouth open even a little bit make noises when breathing have trouble sitting still
While talking
While talking does your child talk very fast talk very slowly gasp for air have a lisp take speech lessons
During a meal
During a meal does your child gasp for air while eating stick his tongue between his teeth when swallowing stick the tongue out to meet the drinking glass drink a lot while eating make noises when chewing eat sloppily take a breath before drinking puff the cheeks out when drinking make the lips purse when swallowing make the chin ldquocrinklerdquo when swallowing bob the head when swallowing have trouble sitting still
While sleeping
While sleeping does your child have the mouth open snore wet the bed toss and turn tilt the head back wake up frequently have frequent nightmares have abnormal sleep issues grind the teeth have trouble waking up wake with darker circles under eyes
S R 10-10yo M
bullMissing 3242bullImpacted 1323bullLate mixed 25 eruptedbullSoft tissue dysfunctionbullIL = 40bullNot compliant
S Reardon 10-7yo M
Impacted 3s Missing 2s
Medical history
bull Reactive Airway Diseasebull ldquoBronchial Constrictionrdquo bullCare of Pulmonologistbull Preventil
bull Dad OSA CPAP for 11 years diabetesbull Grandfather OSA untreatedbull ETCO2 = 361 at 10 bpm (acceptable)bull Posture number - 18 (lt10 ideal)bull Father refuses sleep screening
Treatment Options1 Extract upper premolars Align2Open spaces for impacted canines Open spaces for lower lateral implants
Whatrsquos more importantEase of treatment
OrBreathing well at night
Bolton Standards15yo
The Maxilla is Down and Back
The Mandible is Retrognathic
Nasal Cartilage Collapse
Insufficient Facial Support
Bi-maxillary Retrusion
Bimaxillary Retrusion Forward Growth
Mouthbreathers have significantly smaller airway space
(measurements PAS-OccL PAS-UP airway volume area and minimum axial area)
Mouth breather Nasal breather
Three-dimensional assessment of pharyngeal airway in nasal- and mouth-breathing children
Alves M etal Int J Ped ORL 75 (2011) 1195ndash1199
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
B Hockel 2012
This is the profile Biobloc children start with long and retrusive
This is the profile Biobloc children finish with Forward with lips
together
B Hockel 2012
Herersquos the ldquoinsiderdquo look Notice how the upper front teeth are closer to the nose (yellow arrows)
Notice how the lower jaw rotates around the star so the chin comes up and forward (red arrow)How do we make this happen
From the tip of the Central
To the Forwardmost Tip of the Nose
41mm
Maxillary Heightbull Indicator Line (Mew)
bull Distance from most anterior point on nose to upper incisal edge
bull Age + 23bull A variable number but important to watch over time
B Hockel 2012
Herersquos the ldquoinsiderdquo look Notice how the upper front teeth are closer to the nose (yellow arrows)
Notice how the lower jaw rotates around the star so the chin comes up and forward (red arrow)How do we make this happen
Using IndicatorCosmetic Line
bull To define a starting pointbull To set treatment goalsbull To track treatment progressbull To gauge the effectiveness of treatment
Charting the InCos Line
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Incisor pulled away from noseNot ldquoundertorquedrdquo or ldquogummy smilerdquo
Hypothetical ClI OrthoMARA
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
OJ = 7mm
Starts Ortho
ldquoGreat Headgear
Effectrdquo
Class II Elastics
50
40
30
20mm
y J F M A M J J A S O N
boys
Start Non-x
Expansion UncrowdingFinished
Start Cl II elastics
OK thatrsquos
enough
Hypothetical Mouthbreather(Dr Mewrsquos Hamster Boy)
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Boy gets
hamster
MFT
Hypothetical BBO 7yoM
50
40
30
20
5 6 7 8 9 10 11 12 13 14 15
girlsboys
Initial
StartBB1
BB3
Night
bullLR 11-9yFbullMissing all 5s6s8s and upper 4sbullHad ortho to close diastemahellipbullInL = 39bullGP objects to deX plan equil
LR Tx Plan
1Preparation Hang Expanser2deX 3Training BB3 to advance mandible4Myofunctional Therapy5Orthopostural Training6Myobrace to hold7 Reevaluate for dental detailing
LR Spotty progress
50
40
30
20mm
y 313 4 5 6 7 8 9 10 11 12114
2 3
Expanser
Parents dragging30 turnsStart Adv
Rx deXGP
objects
After delays
Equil ersquosBB3
bullLR 12-3 yF (6mo in tx)bullInL = 37 (+2)bull ersquos equilibratedbull OJ =10bull Appliance OJ = 5bull Still accommodating to BB3
Is there a calculus for the Indicator Line
Treatment GoalsBased on Indicator Line
Incisor Goals
Type 1 Treatment Place U1 in ideal position
Biobloc Orthotropics Orthognathic Surgery Distraction Osteogenesis
Type 1 Ideal InCos line
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
YZ 9yo M
bullLost upper d-spacebullInL = 36(+4)bullOJ = 9mmbullLip entrapmentbullLip Incompetence
Y Z 9yo M
Y Z 9yo M9mm OJ
Y Z 9yo M
Treatment Options
1 Type 1 Reduce InL open lost space BB3 to advance mandible
2 Type 2 Open lost space Align
3 Type 4 Extract four premolars
YZ 9yoM
50
40
30
20mm
yM A M J J A S O N D J F M A
boys
Hang Expanser
Upper and Lower
Brackets Hang Retainer
BB3
Incisor Goals
Type 2 Treatment Develop arch just enough to uncrowd
Biobloc Myofunctional Ortho Myofunctional Therapy Crozat ALF Expansion Orthodontics
Type 2 Uncrowding
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
bullLip incompetencebullLip entrapmentbullHypermentalisbullMouthbreathing
Type 2 Uncrowding
12 month progress
12 month progress
12 month progress
After Treatment
Bent-wire6 monthsMyobrace12 months
Hey RaphaelWhat about that
profile
ZP 9-5yoM
i
After Expansion Phase
Incomplete profile improvement better breathing head posture and sleep
Incisor Goals
Type 3 Treatment Maintain UI
Functional Orthodontics Expansion Orthodontics Distalization Ortho or No Treatment
Type 3 Maintain
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Bimax retrusion
Successful dental result
Profile Unimproved
Incisor Goals
Type 4 Treatment RetractExtrude UI
Extraction Orthodontics Retraction Ortho Distalization Ortho
Type 4 Retraction
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Bimax retrusion
Successful dental result
Failed Profile Result
Changes of pharyngeal airway size and hyoid bone position following orthodontic treatment of
Class I bimaxillary protrusion
Qingzhu Wanga Peizeng Jiab Nina K Andersonc Lin Wangd Jiuxiang Line
Angle Orthodontist Vol 00 No 0 0000 (pre-publication 2012)
ldquothe dimension of the velopharynx glossopharynx and hypopharynx were decreased after maximal retraction of anterior teeth with extraction of four premolarshelliprdquo ldquoAny factors that can influence the posture and position of tongue and soft palate may displace them backward andencroach upon the pharynxrdquo
ldquothe more the incisors were retracted the more the pharyngeal airway was reducedrdquo
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Backed into a corner
bull
Moving teeth faster more efficientlyhellipin the wrong direction
Now that wersquove made smoking unacceptable
could we not do the same withbull Sugarbull Processed foodbull Cheap milk and meatbull Fast foodbull Pill popping for symptomatic reliefbull Looking for the cure instead of the causebull Surgery as a quick fixbull Thinking braces are a status symbol
Each industry thrives on the status quoConsumers must drive the change
NP 10yM
NP
Sisterrsquos non-x ortho
Shersquos happyhellipbut Irsquom not so
I make my pitch for BBO
The dilemma of progress
(I forgot the progress pictureshellip)
Dad sells prosthetic parts to orthopedic surgeons
I selling the case against my previous work they loved
It takes me 3 hours to sell the case
They fret until the BB3 goes in
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Connecting the dots
bull Adult SDB and OSA
bull Narrow jaws and faces
bull Soft tissue dysfunction
bull Early parafunctional habits ie open mouth posture
bull Environmental stressors
bull CPAP MARAUPPP SurgWherersquos the best
place to start treatment here
or here
1 Prevention 2 Undo the damage already done3 Establish good habits
When to start When damage from poor breathing is noticed and when bad habits are discovered
The strategies of Airway Orthodontics
Prevention
bull Remove ankyloglossiabull Promote breastfeedingbull Harden the dietbull Develop masticatory strengthbull Discourage oral habitsbull Promote whole-foods low sugar dietbull Reduce oropharyngeal obstructionbull Promote nasal breathing
Breathing retraining
bull Nasal rinsingbull Nasal clearingbull Decongesting
The goals of Airway Orthodontics
1 Breathing through the nose2 Lips together at rest3 Correct tongue position4 No facial muscles moving on swallowing5 Optimal forward facial development6 Class I occlusion7 Straight teeth8 Better stability long term
Myofunctional Trainers
Professors R Soulet and A Besombes
Dr Earl Bergeson
Dr Chris Farrell
The Multi ndash Family System
Orofacial MyofunctionalTherapy
Oral MyologyMyofunctional TherapyTongue Thrust Therapy
B Hockel 2012 Back
Undoing Bimaxillary Dysplasia
1 Maxillary deconstriction2 Maxillary advancement3 Maxillary impaction4 Mandibular advancement
1 Maxillary Expansion
Treatment for Bimaxillary Dysplasia
ALFCrozat
Bent Wire
HyraxHaas
Niti Exp BioBlocSchwartz
The Farrell BENT WIRE Systemtrade
Recommended Age Group 5-12 yrs
Arch Development in conjunction with the TRAINER Systemtrade
Dr John Mew
Establish Good Habits
1 Breathing through the nose2 Lips together at rest3 Correct tongue position4 No facial muscles moving on swallowing5 Stand and sit in balance6 Breath gently using the diaphragm7 Eat to nourish8 Sleep to rest
Ortho-Postural TrainingWorkshops
Breathing
Nutrition
Posture
Sleep
COPYRIGHTRoger L PriceOctober 2012
Posture Number
Forward head posturecan be a compensationfor a deficient airway
Sleep Screening and Hygiene
SQI = 10 SQI = 98
Integrative Healthcare
Function ProfessionalNasal clearing ENT Pulm MFT BreathingMuscle balance and tone MFT Myofunctional OrthoUndoing damage GP Pedo Ortho OMFSBreathing dynamics OPT MFT Breath PhysiologistPosture DC OPT PT OsteopathCranial balance OsteopathNutrition RDH Nutritionist Dietitian Sleep ENT Sleep Med DentNeurocognitive development Pedrsquon SLP Psych SpEd
The Interdisciplinary Center
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Now that I know
My personal missionTo create from what Irsquove
learned from the besta model for others to followhellipespecially the orthodontists
Myofunctional Orthodontics
Chris Farrell
John Flutter
German Ramierez
Damien OrsquoBrien
Myofunctional Research CoRancho Cucamonga
2008-2012
Oral Myology
Oral Myology Basic CourseJoy MoellerNYC 2011LA 2012
Oral Myology Levels 2 3Kim BenkertClifton 2012
Habit CessationShari GreenClifton 2013
Biobloc Orthotropics
BBO Mini-residencyBill Hang
Agora Hills2012-13
BBO IntensiveDrs John and Mike
MewLSFO2013
Breathing and Sleep
Buteyko MentorshipThe Breathing Center
Woodstock2010
Breathing Well ProgrammeJohn Flutter
2010 Ortho-Postural TrainingRoger Price
2013
Sleep DentistryMichael Gelb etal
NYU2012
ALF and Cranial
Jim Bronson2013 Tasha Turzo
Cranial Academy2014
Bucket Listbull ALF and Crozat (Bronsonrsquos course)bullMore on Biobloc (Hangrsquos Advanced London School)bull More Cranial (The Farm)bullChirodontics (Bob Walker)bull Airway Dentistry with Marc Cruz Jeff Rousebull Sleep Dentistrybull Less-than-Six with Kevin Boydbull Intra-mandibular Distraction Osteogenesis (IMDO)
Off My ListAnything that moves the teeth faster in the wrong direction
Whatrsquos an RO to do
To create from what Irsquove learned from the best
a model for others to followhellipespecially orthodontists
Teaching
Mt Sinai Pedo ResidencyAli Attaie
2010-2012
Montefiore Ortho ResidencyTony Maganzini
2012
2009-Present
Mt Sinai School of MedicinePedodontic Residency
Guest SpeakersJim BronsonMike MewKevin BoydSandra KahnJennifer TowRoger PricePaula Fabbie
Damien OrsquoBrien
First clinical program in myofunctional orthodontics
Airway and Facial DevelopmentCollaborative Webcast
Mark Cruz
AAPMD Symposium
wwwaapm
dorg
Annual MeetingApril 25-26 2014
Westin Chicago North Shore
the raphael center for integrative orthodontics
wwwalignminecomwwwbioblocnjcom
wwwmyobracenjcom
Integrative vs Conventional
Integrative vs Conventional
ldquoWith improvements in expansion orthodontics advances in myofunctional orthodontics and the growing recognition about sleep disordered breathing among children and adults it is time for orthodontics to expand its horizons There is now so much more we can oerrdquo
The Raphael name has been associated with high quality orthodontics in New Jersey for over 60 years Dr Barry Raphael has been a university trained orthodontic specialist and a member of the American Association of Orthodontists for 30 years
He has a wide range of techniques and services to offer He has studied oral myology applied kinesiology Buteyko breathing Biobloc Orthotropics and Myobrace as part of his integrative training He can offer Damon Invisalign Insignia and Incognito appliances designs as some of his many conventional orthodontic services too
Dr Raphael teaches his techniques at post-graduate residencies study clubs dental societies and for the Myofunctional Research Co He is available for presentations to any group interested in learning more about the benefits of integrative orthodontics
wwwalignminecomLearn about the choices you have in orthodontics
dr barry raphael Why its
too Early never
1425
bro
ad
str
ee
tc
lifto
n n
j 070
13
973-
778-
4222
fax
973-
778-
9625
nj s
pe
c
368
4
1425 broad street clifton nj 07013973-778-4222
wwwalignminecom
the raphael centerforintegrative orthodontics
the
raph
ael c
ente
r fo
rin
tegr
ativ
e or
thod
onti
cs
Learn about an important choice you need to make before starting braces
the raphael center for integrative education
the raphael center for integrative education
Ongoing Intro to Airway Orthodontics
April Biobloc Study Group
April Training Ortho-Postural Therapists w Roger Price
June MRC Myobrace Basic Series
August Airway Dentistry with Mark Cruz and company
October Advanced MFT with Sandy Coulson
October Less than Six with Kevin Boyd
(who else wants to play)
Mission to create a space for spreading the word about Airway and Orthotropic principles and practice
Orthodontics in the 21st Century
EstheticOrthodontics
AirwayOrthodontics
GeneticTooth-Focused
Dental PerfectionEsthetics Primary
Treating SymptomsAirway Ignorant
AdaptationMuscle-FocusedMedical Better
Esthetics SecondaryTreating Causes
Airway Conscious
The EndAnd
The Beginning
The Toothberg
Airway-Related Craniofacial Dysfunctions
bullChronic Naso-pharyngeal Obstructionbull Tongue form aberrations (Frenum and tongue-tie)bullOpen Mouth Rest Posture bullMyofunctional disorders (Swallowing chewingetc)bullChronic Hyperventilation and Hypocapniabull Breathing Disordered Sleep (OSA UARS snoring)bull Bruxism and parafunctionsbull TMD and facial pain componentsbullCranial and postural issuesbull Malocclusion
Airway Orthodontics
bullEarly Feeding and Nutrition
bullAllergies Asthma URT infections
bullPosture
bullAirway Breathing and Sleep Disorders
bullSoft Tissue Dysfunctions (Tongue Thrust Open Mouth)
Instead of crooked teeth being The ProblemThey are just a SYMPTOM of something larger
Parentrsquos Private-eye Sheet
Parentrsquos Private-eye Sheet
ldquoThere are many things about your childrsquos health that are important to know but that I often donrsquot get to see at the office Also there are signs to look for that you may not have known were connected to your childrsquos teeth or health By looking for and tracking these ldquosigns and symptomsrdquo we can get a better handle on the problem and watch for resolution
You donrsquot have to spend a lot of time with this but donrsquot rush either Watch for certain things at different times of day Try not to let your child know they are being watched You want to see the most natural behaviors
Check off what you see If yoursquore not sure check it anyway and wersquoll talk about it Make comments if you wantrdquo
While sitting around
While sitting around (watching TV in the car) does your child
put ldquothingsrdquo in the mouth alot (toys sleeves pencils fingernails etc) ______________________________
lick or suck on the lips have the lips apart even a little stick or dart the tongue out of the mouth have the tongue resting between the teeth lean the cheek on a hand breath with his mouth open even a little bit make noises when breathing have trouble sitting still
While talking
While talking does your child talk very fast talk very slowly gasp for air have a lisp take speech lessons
During a meal
During a meal does your child gasp for air while eating stick his tongue between his teeth when swallowing stick the tongue out to meet the drinking glass drink a lot while eating make noises when chewing eat sloppily take a breath before drinking puff the cheeks out when drinking make the lips purse when swallowing make the chin ldquocrinklerdquo when swallowing bob the head when swallowing have trouble sitting still
While sleeping
While sleeping does your child have the mouth open snore wet the bed toss and turn tilt the head back wake up frequently have frequent nightmares have abnormal sleep issues grind the teeth have trouble waking up wake with darker circles under eyes
S R 10-10yo M
bullMissing 3242bullImpacted 1323bullLate mixed 25 eruptedbullSoft tissue dysfunctionbullIL = 40bullNot compliant
S Reardon 10-7yo M
Impacted 3s Missing 2s
Medical history
bull Reactive Airway Diseasebull ldquoBronchial Constrictionrdquo bullCare of Pulmonologistbull Preventil
bull Dad OSA CPAP for 11 years diabetesbull Grandfather OSA untreatedbull ETCO2 = 361 at 10 bpm (acceptable)bull Posture number - 18 (lt10 ideal)bull Father refuses sleep screening
Treatment Options1 Extract upper premolars Align2Open spaces for impacted canines Open spaces for lower lateral implants
Whatrsquos more importantEase of treatment
OrBreathing well at night
Bolton Standards15yo
The Maxilla is Down and Back
The Mandible is Retrognathic
Nasal Cartilage Collapse
Insufficient Facial Support
Bi-maxillary Retrusion
Bimaxillary Retrusion Forward Growth
Mouthbreathers have significantly smaller airway space
(measurements PAS-OccL PAS-UP airway volume area and minimum axial area)
Mouth breather Nasal breather
Three-dimensional assessment of pharyngeal airway in nasal- and mouth-breathing children
Alves M etal Int J Ped ORL 75 (2011) 1195ndash1199
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
B Hockel 2012
This is the profile Biobloc children start with long and retrusive
This is the profile Biobloc children finish with Forward with lips
together
B Hockel 2012
Herersquos the ldquoinsiderdquo look Notice how the upper front teeth are closer to the nose (yellow arrows)
Notice how the lower jaw rotates around the star so the chin comes up and forward (red arrow)How do we make this happen
From the tip of the Central
To the Forwardmost Tip of the Nose
41mm
Maxillary Heightbull Indicator Line (Mew)
bull Distance from most anterior point on nose to upper incisal edge
bull Age + 23bull A variable number but important to watch over time
B Hockel 2012
Herersquos the ldquoinsiderdquo look Notice how the upper front teeth are closer to the nose (yellow arrows)
Notice how the lower jaw rotates around the star so the chin comes up and forward (red arrow)How do we make this happen
Using IndicatorCosmetic Line
bull To define a starting pointbull To set treatment goalsbull To track treatment progressbull To gauge the effectiveness of treatment
Charting the InCos Line
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Incisor pulled away from noseNot ldquoundertorquedrdquo or ldquogummy smilerdquo
Hypothetical ClI OrthoMARA
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
OJ = 7mm
Starts Ortho
ldquoGreat Headgear
Effectrdquo
Class II Elastics
50
40
30
20mm
y J F M A M J J A S O N
boys
Start Non-x
Expansion UncrowdingFinished
Start Cl II elastics
OK thatrsquos
enough
Hypothetical Mouthbreather(Dr Mewrsquos Hamster Boy)
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Boy gets
hamster
MFT
Hypothetical BBO 7yoM
50
40
30
20
5 6 7 8 9 10 11 12 13 14 15
girlsboys
Initial
StartBB1
BB3
Night
bullLR 11-9yFbullMissing all 5s6s8s and upper 4sbullHad ortho to close diastemahellipbullInL = 39bullGP objects to deX plan equil
LR Tx Plan
1Preparation Hang Expanser2deX 3Training BB3 to advance mandible4Myofunctional Therapy5Orthopostural Training6Myobrace to hold7 Reevaluate for dental detailing
LR Spotty progress
50
40
30
20mm
y 313 4 5 6 7 8 9 10 11 12114
2 3
Expanser
Parents dragging30 turnsStart Adv
Rx deXGP
objects
After delays
Equil ersquosBB3
bullLR 12-3 yF (6mo in tx)bullInL = 37 (+2)bull ersquos equilibratedbull OJ =10bull Appliance OJ = 5bull Still accommodating to BB3
Is there a calculus for the Indicator Line
Treatment GoalsBased on Indicator Line
Incisor Goals
Type 1 Treatment Place U1 in ideal position
Biobloc Orthotropics Orthognathic Surgery Distraction Osteogenesis
Type 1 Ideal InCos line
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
YZ 9yo M
bullLost upper d-spacebullInL = 36(+4)bullOJ = 9mmbullLip entrapmentbullLip Incompetence
Y Z 9yo M
Y Z 9yo M9mm OJ
Y Z 9yo M
Treatment Options
1 Type 1 Reduce InL open lost space BB3 to advance mandible
2 Type 2 Open lost space Align
3 Type 4 Extract four premolars
YZ 9yoM
50
40
30
20mm
yM A M J J A S O N D J F M A
boys
Hang Expanser
Upper and Lower
Brackets Hang Retainer
BB3
Incisor Goals
Type 2 Treatment Develop arch just enough to uncrowd
Biobloc Myofunctional Ortho Myofunctional Therapy Crozat ALF Expansion Orthodontics
Type 2 Uncrowding
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
bullLip incompetencebullLip entrapmentbullHypermentalisbullMouthbreathing
Type 2 Uncrowding
12 month progress
12 month progress
12 month progress
After Treatment
Bent-wire6 monthsMyobrace12 months
Hey RaphaelWhat about that
profile
ZP 9-5yoM
i
After Expansion Phase
Incomplete profile improvement better breathing head posture and sleep
Incisor Goals
Type 3 Treatment Maintain UI
Functional Orthodontics Expansion Orthodontics Distalization Ortho or No Treatment
Type 3 Maintain
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Bimax retrusion
Successful dental result
Profile Unimproved
Incisor Goals
Type 4 Treatment RetractExtrude UI
Extraction Orthodontics Retraction Ortho Distalization Ortho
Type 4 Retraction
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Bimax retrusion
Successful dental result
Failed Profile Result
Changes of pharyngeal airway size and hyoid bone position following orthodontic treatment of
Class I bimaxillary protrusion
Qingzhu Wanga Peizeng Jiab Nina K Andersonc Lin Wangd Jiuxiang Line
Angle Orthodontist Vol 00 No 0 0000 (pre-publication 2012)
ldquothe dimension of the velopharynx glossopharynx and hypopharynx were decreased after maximal retraction of anterior teeth with extraction of four premolarshelliprdquo ldquoAny factors that can influence the posture and position of tongue and soft palate may displace them backward andencroach upon the pharynxrdquo
ldquothe more the incisors were retracted the more the pharyngeal airway was reducedrdquo
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Backed into a corner
bull
Moving teeth faster more efficientlyhellipin the wrong direction
Now that wersquove made smoking unacceptable
could we not do the same withbull Sugarbull Processed foodbull Cheap milk and meatbull Fast foodbull Pill popping for symptomatic reliefbull Looking for the cure instead of the causebull Surgery as a quick fixbull Thinking braces are a status symbol
Each industry thrives on the status quoConsumers must drive the change
NP 10yM
NP
Sisterrsquos non-x ortho
Shersquos happyhellipbut Irsquom not so
I make my pitch for BBO
The dilemma of progress
(I forgot the progress pictureshellip)
Dad sells prosthetic parts to orthopedic surgeons
I selling the case against my previous work they loved
It takes me 3 hours to sell the case
They fret until the BB3 goes in
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Connecting the dots
bull Adult SDB and OSA
bull Narrow jaws and faces
bull Soft tissue dysfunction
bull Early parafunctional habits ie open mouth posture
bull Environmental stressors
bull CPAP MARAUPPP SurgWherersquos the best
place to start treatment here
or here
1 Prevention 2 Undo the damage already done3 Establish good habits
When to start When damage from poor breathing is noticed and when bad habits are discovered
The strategies of Airway Orthodontics
Prevention
bull Remove ankyloglossiabull Promote breastfeedingbull Harden the dietbull Develop masticatory strengthbull Discourage oral habitsbull Promote whole-foods low sugar dietbull Reduce oropharyngeal obstructionbull Promote nasal breathing
Breathing retraining
bull Nasal rinsingbull Nasal clearingbull Decongesting
The goals of Airway Orthodontics
1 Breathing through the nose2 Lips together at rest3 Correct tongue position4 No facial muscles moving on swallowing5 Optimal forward facial development6 Class I occlusion7 Straight teeth8 Better stability long term
Myofunctional Trainers
Professors R Soulet and A Besombes
Dr Earl Bergeson
Dr Chris Farrell
The Multi ndash Family System
Orofacial MyofunctionalTherapy
Oral MyologyMyofunctional TherapyTongue Thrust Therapy
B Hockel 2012 Back
Undoing Bimaxillary Dysplasia
1 Maxillary deconstriction2 Maxillary advancement3 Maxillary impaction4 Mandibular advancement
1 Maxillary Expansion
Treatment for Bimaxillary Dysplasia
ALFCrozat
Bent Wire
HyraxHaas
Niti Exp BioBlocSchwartz
The Farrell BENT WIRE Systemtrade
Recommended Age Group 5-12 yrs
Arch Development in conjunction with the TRAINER Systemtrade
Dr John Mew
Establish Good Habits
1 Breathing through the nose2 Lips together at rest3 Correct tongue position4 No facial muscles moving on swallowing5 Stand and sit in balance6 Breath gently using the diaphragm7 Eat to nourish8 Sleep to rest
Ortho-Postural TrainingWorkshops
Breathing
Nutrition
Posture
Sleep
COPYRIGHTRoger L PriceOctober 2012
Posture Number
Forward head posturecan be a compensationfor a deficient airway
Sleep Screening and Hygiene
SQI = 10 SQI = 98
Integrative Healthcare
Function ProfessionalNasal clearing ENT Pulm MFT BreathingMuscle balance and tone MFT Myofunctional OrthoUndoing damage GP Pedo Ortho OMFSBreathing dynamics OPT MFT Breath PhysiologistPosture DC OPT PT OsteopathCranial balance OsteopathNutrition RDH Nutritionist Dietitian Sleep ENT Sleep Med DentNeurocognitive development Pedrsquon SLP Psych SpEd
The Interdisciplinary Center
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Now that I know
My personal missionTo create from what Irsquove
learned from the besta model for others to followhellipespecially the orthodontists
Myofunctional Orthodontics
Chris Farrell
John Flutter
German Ramierez
Damien OrsquoBrien
Myofunctional Research CoRancho Cucamonga
2008-2012
Oral Myology
Oral Myology Basic CourseJoy MoellerNYC 2011LA 2012
Oral Myology Levels 2 3Kim BenkertClifton 2012
Habit CessationShari GreenClifton 2013
Biobloc Orthotropics
BBO Mini-residencyBill Hang
Agora Hills2012-13
BBO IntensiveDrs John and Mike
MewLSFO2013
Breathing and Sleep
Buteyko MentorshipThe Breathing Center
Woodstock2010
Breathing Well ProgrammeJohn Flutter
2010 Ortho-Postural TrainingRoger Price
2013
Sleep DentistryMichael Gelb etal
NYU2012
ALF and Cranial
Jim Bronson2013 Tasha Turzo
Cranial Academy2014
Bucket Listbull ALF and Crozat (Bronsonrsquos course)bullMore on Biobloc (Hangrsquos Advanced London School)bull More Cranial (The Farm)bullChirodontics (Bob Walker)bull Airway Dentistry with Marc Cruz Jeff Rousebull Sleep Dentistrybull Less-than-Six with Kevin Boydbull Intra-mandibular Distraction Osteogenesis (IMDO)
Off My ListAnything that moves the teeth faster in the wrong direction
Whatrsquos an RO to do
To create from what Irsquove learned from the best
a model for others to followhellipespecially orthodontists
Teaching
Mt Sinai Pedo ResidencyAli Attaie
2010-2012
Montefiore Ortho ResidencyTony Maganzini
2012
2009-Present
Mt Sinai School of MedicinePedodontic Residency
Guest SpeakersJim BronsonMike MewKevin BoydSandra KahnJennifer TowRoger PricePaula Fabbie
Damien OrsquoBrien
First clinical program in myofunctional orthodontics
Airway and Facial DevelopmentCollaborative Webcast
Mark Cruz
AAPMD Symposium
wwwaapm
dorg
Annual MeetingApril 25-26 2014
Westin Chicago North Shore
the raphael center for integrative orthodontics
wwwalignminecomwwwbioblocnjcom
wwwmyobracenjcom
Integrative vs Conventional
Integrative vs Conventional
ldquoWith improvements in expansion orthodontics advances in myofunctional orthodontics and the growing recognition about sleep disordered breathing among children and adults it is time for orthodontics to expand its horizons There is now so much more we can oerrdquo
The Raphael name has been associated with high quality orthodontics in New Jersey for over 60 years Dr Barry Raphael has been a university trained orthodontic specialist and a member of the American Association of Orthodontists for 30 years
He has a wide range of techniques and services to offer He has studied oral myology applied kinesiology Buteyko breathing Biobloc Orthotropics and Myobrace as part of his integrative training He can offer Damon Invisalign Insignia and Incognito appliances designs as some of his many conventional orthodontic services too
Dr Raphael teaches his techniques at post-graduate residencies study clubs dental societies and for the Myofunctional Research Co He is available for presentations to any group interested in learning more about the benefits of integrative orthodontics
wwwalignminecomLearn about the choices you have in orthodontics
dr barry raphael Why its
too Early never
1425
bro
ad
str
ee
tc
lifto
n n
j 070
13
973-
778-
4222
fax
973-
778-
9625
nj s
pe
c
368
4
1425 broad street clifton nj 07013973-778-4222
wwwalignminecom
the raphael centerforintegrative orthodontics
the
raph
ael c
ente
r fo
rin
tegr
ativ
e or
thod
onti
cs
Learn about an important choice you need to make before starting braces
the raphael center for integrative education
the raphael center for integrative education
Ongoing Intro to Airway Orthodontics
April Biobloc Study Group
April Training Ortho-Postural Therapists w Roger Price
June MRC Myobrace Basic Series
August Airway Dentistry with Mark Cruz and company
October Advanced MFT with Sandy Coulson
October Less than Six with Kevin Boyd
(who else wants to play)
Mission to create a space for spreading the word about Airway and Orthotropic principles and practice
Orthodontics in the 21st Century
EstheticOrthodontics
AirwayOrthodontics
GeneticTooth-Focused
Dental PerfectionEsthetics Primary
Treating SymptomsAirway Ignorant
AdaptationMuscle-FocusedMedical Better
Esthetics SecondaryTreating Causes
Airway Conscious
The EndAnd
The Beginning
Airway-Related Craniofacial Dysfunctions
bullChronic Naso-pharyngeal Obstructionbull Tongue form aberrations (Frenum and tongue-tie)bullOpen Mouth Rest Posture bullMyofunctional disorders (Swallowing chewingetc)bullChronic Hyperventilation and Hypocapniabull Breathing Disordered Sleep (OSA UARS snoring)bull Bruxism and parafunctionsbull TMD and facial pain componentsbullCranial and postural issuesbull Malocclusion
Airway Orthodontics
bullEarly Feeding and Nutrition
bullAllergies Asthma URT infections
bullPosture
bullAirway Breathing and Sleep Disorders
bullSoft Tissue Dysfunctions (Tongue Thrust Open Mouth)
Instead of crooked teeth being The ProblemThey are just a SYMPTOM of something larger
Parentrsquos Private-eye Sheet
Parentrsquos Private-eye Sheet
ldquoThere are many things about your childrsquos health that are important to know but that I often donrsquot get to see at the office Also there are signs to look for that you may not have known were connected to your childrsquos teeth or health By looking for and tracking these ldquosigns and symptomsrdquo we can get a better handle on the problem and watch for resolution
You donrsquot have to spend a lot of time with this but donrsquot rush either Watch for certain things at different times of day Try not to let your child know they are being watched You want to see the most natural behaviors
Check off what you see If yoursquore not sure check it anyway and wersquoll talk about it Make comments if you wantrdquo
While sitting around
While sitting around (watching TV in the car) does your child
put ldquothingsrdquo in the mouth alot (toys sleeves pencils fingernails etc) ______________________________
lick or suck on the lips have the lips apart even a little stick or dart the tongue out of the mouth have the tongue resting between the teeth lean the cheek on a hand breath with his mouth open even a little bit make noises when breathing have trouble sitting still
While talking
While talking does your child talk very fast talk very slowly gasp for air have a lisp take speech lessons
During a meal
During a meal does your child gasp for air while eating stick his tongue between his teeth when swallowing stick the tongue out to meet the drinking glass drink a lot while eating make noises when chewing eat sloppily take a breath before drinking puff the cheeks out when drinking make the lips purse when swallowing make the chin ldquocrinklerdquo when swallowing bob the head when swallowing have trouble sitting still
While sleeping
While sleeping does your child have the mouth open snore wet the bed toss and turn tilt the head back wake up frequently have frequent nightmares have abnormal sleep issues grind the teeth have trouble waking up wake with darker circles under eyes
S R 10-10yo M
bullMissing 3242bullImpacted 1323bullLate mixed 25 eruptedbullSoft tissue dysfunctionbullIL = 40bullNot compliant
S Reardon 10-7yo M
Impacted 3s Missing 2s
Medical history
bull Reactive Airway Diseasebull ldquoBronchial Constrictionrdquo bullCare of Pulmonologistbull Preventil
bull Dad OSA CPAP for 11 years diabetesbull Grandfather OSA untreatedbull ETCO2 = 361 at 10 bpm (acceptable)bull Posture number - 18 (lt10 ideal)bull Father refuses sleep screening
Treatment Options1 Extract upper premolars Align2Open spaces for impacted canines Open spaces for lower lateral implants
Whatrsquos more importantEase of treatment
OrBreathing well at night
Bolton Standards15yo
The Maxilla is Down and Back
The Mandible is Retrognathic
Nasal Cartilage Collapse
Insufficient Facial Support
Bi-maxillary Retrusion
Bimaxillary Retrusion Forward Growth
Mouthbreathers have significantly smaller airway space
(measurements PAS-OccL PAS-UP airway volume area and minimum axial area)
Mouth breather Nasal breather
Three-dimensional assessment of pharyngeal airway in nasal- and mouth-breathing children
Alves M etal Int J Ped ORL 75 (2011) 1195ndash1199
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
B Hockel 2012
This is the profile Biobloc children start with long and retrusive
This is the profile Biobloc children finish with Forward with lips
together
B Hockel 2012
Herersquos the ldquoinsiderdquo look Notice how the upper front teeth are closer to the nose (yellow arrows)
Notice how the lower jaw rotates around the star so the chin comes up and forward (red arrow)How do we make this happen
From the tip of the Central
To the Forwardmost Tip of the Nose
41mm
Maxillary Heightbull Indicator Line (Mew)
bull Distance from most anterior point on nose to upper incisal edge
bull Age + 23bull A variable number but important to watch over time
B Hockel 2012
Herersquos the ldquoinsiderdquo look Notice how the upper front teeth are closer to the nose (yellow arrows)
Notice how the lower jaw rotates around the star so the chin comes up and forward (red arrow)How do we make this happen
Using IndicatorCosmetic Line
bull To define a starting pointbull To set treatment goalsbull To track treatment progressbull To gauge the effectiveness of treatment
Charting the InCos Line
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Incisor pulled away from noseNot ldquoundertorquedrdquo or ldquogummy smilerdquo
Hypothetical ClI OrthoMARA
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
OJ = 7mm
Starts Ortho
ldquoGreat Headgear
Effectrdquo
Class II Elastics
50
40
30
20mm
y J F M A M J J A S O N
boys
Start Non-x
Expansion UncrowdingFinished
Start Cl II elastics
OK thatrsquos
enough
Hypothetical Mouthbreather(Dr Mewrsquos Hamster Boy)
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Boy gets
hamster
MFT
Hypothetical BBO 7yoM
50
40
30
20
5 6 7 8 9 10 11 12 13 14 15
girlsboys
Initial
StartBB1
BB3
Night
bullLR 11-9yFbullMissing all 5s6s8s and upper 4sbullHad ortho to close diastemahellipbullInL = 39bullGP objects to deX plan equil
LR Tx Plan
1Preparation Hang Expanser2deX 3Training BB3 to advance mandible4Myofunctional Therapy5Orthopostural Training6Myobrace to hold7 Reevaluate for dental detailing
LR Spotty progress
50
40
30
20mm
y 313 4 5 6 7 8 9 10 11 12114
2 3
Expanser
Parents dragging30 turnsStart Adv
Rx deXGP
objects
After delays
Equil ersquosBB3
bullLR 12-3 yF (6mo in tx)bullInL = 37 (+2)bull ersquos equilibratedbull OJ =10bull Appliance OJ = 5bull Still accommodating to BB3
Is there a calculus for the Indicator Line
Treatment GoalsBased on Indicator Line
Incisor Goals
Type 1 Treatment Place U1 in ideal position
Biobloc Orthotropics Orthognathic Surgery Distraction Osteogenesis
Type 1 Ideal InCos line
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
YZ 9yo M
bullLost upper d-spacebullInL = 36(+4)bullOJ = 9mmbullLip entrapmentbullLip Incompetence
Y Z 9yo M
Y Z 9yo M9mm OJ
Y Z 9yo M
Treatment Options
1 Type 1 Reduce InL open lost space BB3 to advance mandible
2 Type 2 Open lost space Align
3 Type 4 Extract four premolars
YZ 9yoM
50
40
30
20mm
yM A M J J A S O N D J F M A
boys
Hang Expanser
Upper and Lower
Brackets Hang Retainer
BB3
Incisor Goals
Type 2 Treatment Develop arch just enough to uncrowd
Biobloc Myofunctional Ortho Myofunctional Therapy Crozat ALF Expansion Orthodontics
Type 2 Uncrowding
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
bullLip incompetencebullLip entrapmentbullHypermentalisbullMouthbreathing
Type 2 Uncrowding
12 month progress
12 month progress
12 month progress
After Treatment
Bent-wire6 monthsMyobrace12 months
Hey RaphaelWhat about that
profile
ZP 9-5yoM
i
After Expansion Phase
Incomplete profile improvement better breathing head posture and sleep
Incisor Goals
Type 3 Treatment Maintain UI
Functional Orthodontics Expansion Orthodontics Distalization Ortho or No Treatment
Type 3 Maintain
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Bimax retrusion
Successful dental result
Profile Unimproved
Incisor Goals
Type 4 Treatment RetractExtrude UI
Extraction Orthodontics Retraction Ortho Distalization Ortho
Type 4 Retraction
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Bimax retrusion
Successful dental result
Failed Profile Result
Changes of pharyngeal airway size and hyoid bone position following orthodontic treatment of
Class I bimaxillary protrusion
Qingzhu Wanga Peizeng Jiab Nina K Andersonc Lin Wangd Jiuxiang Line
Angle Orthodontist Vol 00 No 0 0000 (pre-publication 2012)
ldquothe dimension of the velopharynx glossopharynx and hypopharynx were decreased after maximal retraction of anterior teeth with extraction of four premolarshelliprdquo ldquoAny factors that can influence the posture and position of tongue and soft palate may displace them backward andencroach upon the pharynxrdquo
ldquothe more the incisors were retracted the more the pharyngeal airway was reducedrdquo
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Backed into a corner
bull
Moving teeth faster more efficientlyhellipin the wrong direction
Now that wersquove made smoking unacceptable
could we not do the same withbull Sugarbull Processed foodbull Cheap milk and meatbull Fast foodbull Pill popping for symptomatic reliefbull Looking for the cure instead of the causebull Surgery as a quick fixbull Thinking braces are a status symbol
Each industry thrives on the status quoConsumers must drive the change
NP 10yM
NP
Sisterrsquos non-x ortho
Shersquos happyhellipbut Irsquom not so
I make my pitch for BBO
The dilemma of progress
(I forgot the progress pictureshellip)
Dad sells prosthetic parts to orthopedic surgeons
I selling the case against my previous work they loved
It takes me 3 hours to sell the case
They fret until the BB3 goes in
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Connecting the dots
bull Adult SDB and OSA
bull Narrow jaws and faces
bull Soft tissue dysfunction
bull Early parafunctional habits ie open mouth posture
bull Environmental stressors
bull CPAP MARAUPPP SurgWherersquos the best
place to start treatment here
or here
1 Prevention 2 Undo the damage already done3 Establish good habits
When to start When damage from poor breathing is noticed and when bad habits are discovered
The strategies of Airway Orthodontics
Prevention
bull Remove ankyloglossiabull Promote breastfeedingbull Harden the dietbull Develop masticatory strengthbull Discourage oral habitsbull Promote whole-foods low sugar dietbull Reduce oropharyngeal obstructionbull Promote nasal breathing
Breathing retraining
bull Nasal rinsingbull Nasal clearingbull Decongesting
The goals of Airway Orthodontics
1 Breathing through the nose2 Lips together at rest3 Correct tongue position4 No facial muscles moving on swallowing5 Optimal forward facial development6 Class I occlusion7 Straight teeth8 Better stability long term
Myofunctional Trainers
Professors R Soulet and A Besombes
Dr Earl Bergeson
Dr Chris Farrell
The Multi ndash Family System
Orofacial MyofunctionalTherapy
Oral MyologyMyofunctional TherapyTongue Thrust Therapy
B Hockel 2012 Back
Undoing Bimaxillary Dysplasia
1 Maxillary deconstriction2 Maxillary advancement3 Maxillary impaction4 Mandibular advancement
1 Maxillary Expansion
Treatment for Bimaxillary Dysplasia
ALFCrozat
Bent Wire
HyraxHaas
Niti Exp BioBlocSchwartz
The Farrell BENT WIRE Systemtrade
Recommended Age Group 5-12 yrs
Arch Development in conjunction with the TRAINER Systemtrade
Dr John Mew
Establish Good Habits
1 Breathing through the nose2 Lips together at rest3 Correct tongue position4 No facial muscles moving on swallowing5 Stand and sit in balance6 Breath gently using the diaphragm7 Eat to nourish8 Sleep to rest
Ortho-Postural TrainingWorkshops
Breathing
Nutrition
Posture
Sleep
COPYRIGHTRoger L PriceOctober 2012
Posture Number
Forward head posturecan be a compensationfor a deficient airway
Sleep Screening and Hygiene
SQI = 10 SQI = 98
Integrative Healthcare
Function ProfessionalNasal clearing ENT Pulm MFT BreathingMuscle balance and tone MFT Myofunctional OrthoUndoing damage GP Pedo Ortho OMFSBreathing dynamics OPT MFT Breath PhysiologistPosture DC OPT PT OsteopathCranial balance OsteopathNutrition RDH Nutritionist Dietitian Sleep ENT Sleep Med DentNeurocognitive development Pedrsquon SLP Psych SpEd
The Interdisciplinary Center
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Now that I know
My personal missionTo create from what Irsquove
learned from the besta model for others to followhellipespecially the orthodontists
Myofunctional Orthodontics
Chris Farrell
John Flutter
German Ramierez
Damien OrsquoBrien
Myofunctional Research CoRancho Cucamonga
2008-2012
Oral Myology
Oral Myology Basic CourseJoy MoellerNYC 2011LA 2012
Oral Myology Levels 2 3Kim BenkertClifton 2012
Habit CessationShari GreenClifton 2013
Biobloc Orthotropics
BBO Mini-residencyBill Hang
Agora Hills2012-13
BBO IntensiveDrs John and Mike
MewLSFO2013
Breathing and Sleep
Buteyko MentorshipThe Breathing Center
Woodstock2010
Breathing Well ProgrammeJohn Flutter
2010 Ortho-Postural TrainingRoger Price
2013
Sleep DentistryMichael Gelb etal
NYU2012
ALF and Cranial
Jim Bronson2013 Tasha Turzo
Cranial Academy2014
Bucket Listbull ALF and Crozat (Bronsonrsquos course)bullMore on Biobloc (Hangrsquos Advanced London School)bull More Cranial (The Farm)bullChirodontics (Bob Walker)bull Airway Dentistry with Marc Cruz Jeff Rousebull Sleep Dentistrybull Less-than-Six with Kevin Boydbull Intra-mandibular Distraction Osteogenesis (IMDO)
Off My ListAnything that moves the teeth faster in the wrong direction
Whatrsquos an RO to do
To create from what Irsquove learned from the best
a model for others to followhellipespecially orthodontists
Teaching
Mt Sinai Pedo ResidencyAli Attaie
2010-2012
Montefiore Ortho ResidencyTony Maganzini
2012
2009-Present
Mt Sinai School of MedicinePedodontic Residency
Guest SpeakersJim BronsonMike MewKevin BoydSandra KahnJennifer TowRoger PricePaula Fabbie
Damien OrsquoBrien
First clinical program in myofunctional orthodontics
Airway and Facial DevelopmentCollaborative Webcast
Mark Cruz
AAPMD Symposium
wwwaapm
dorg
Annual MeetingApril 25-26 2014
Westin Chicago North Shore
the raphael center for integrative orthodontics
wwwalignminecomwwwbioblocnjcom
wwwmyobracenjcom
Integrative vs Conventional
Integrative vs Conventional
ldquoWith improvements in expansion orthodontics advances in myofunctional orthodontics and the growing recognition about sleep disordered breathing among children and adults it is time for orthodontics to expand its horizons There is now so much more we can oerrdquo
The Raphael name has been associated with high quality orthodontics in New Jersey for over 60 years Dr Barry Raphael has been a university trained orthodontic specialist and a member of the American Association of Orthodontists for 30 years
He has a wide range of techniques and services to offer He has studied oral myology applied kinesiology Buteyko breathing Biobloc Orthotropics and Myobrace as part of his integrative training He can offer Damon Invisalign Insignia and Incognito appliances designs as some of his many conventional orthodontic services too
Dr Raphael teaches his techniques at post-graduate residencies study clubs dental societies and for the Myofunctional Research Co He is available for presentations to any group interested in learning more about the benefits of integrative orthodontics
wwwalignminecomLearn about the choices you have in orthodontics
dr barry raphael Why its
too Early never
1425
bro
ad
str
ee
tc
lifto
n n
j 070
13
973-
778-
4222
fax
973-
778-
9625
nj s
pe
c
368
4
1425 broad street clifton nj 07013973-778-4222
wwwalignminecom
the raphael centerforintegrative orthodontics
the
raph
ael c
ente
r fo
rin
tegr
ativ
e or
thod
onti
cs
Learn about an important choice you need to make before starting braces
the raphael center for integrative education
the raphael center for integrative education
Ongoing Intro to Airway Orthodontics
April Biobloc Study Group
April Training Ortho-Postural Therapists w Roger Price
June MRC Myobrace Basic Series
August Airway Dentistry with Mark Cruz and company
October Advanced MFT with Sandy Coulson
October Less than Six with Kevin Boyd
(who else wants to play)
Mission to create a space for spreading the word about Airway and Orthotropic principles and practice
Orthodontics in the 21st Century
EstheticOrthodontics
AirwayOrthodontics
GeneticTooth-Focused
Dental PerfectionEsthetics Primary
Treating SymptomsAirway Ignorant
AdaptationMuscle-FocusedMedical Better
Esthetics SecondaryTreating Causes
Airway Conscious
The EndAnd
The Beginning
Airway Orthodontics
bullEarly Feeding and Nutrition
bullAllergies Asthma URT infections
bullPosture
bullAirway Breathing and Sleep Disorders
bullSoft Tissue Dysfunctions (Tongue Thrust Open Mouth)
Instead of crooked teeth being The ProblemThey are just a SYMPTOM of something larger
Parentrsquos Private-eye Sheet
Parentrsquos Private-eye Sheet
ldquoThere are many things about your childrsquos health that are important to know but that I often donrsquot get to see at the office Also there are signs to look for that you may not have known were connected to your childrsquos teeth or health By looking for and tracking these ldquosigns and symptomsrdquo we can get a better handle on the problem and watch for resolution
You donrsquot have to spend a lot of time with this but donrsquot rush either Watch for certain things at different times of day Try not to let your child know they are being watched You want to see the most natural behaviors
Check off what you see If yoursquore not sure check it anyway and wersquoll talk about it Make comments if you wantrdquo
While sitting around
While sitting around (watching TV in the car) does your child
put ldquothingsrdquo in the mouth alot (toys sleeves pencils fingernails etc) ______________________________
lick or suck on the lips have the lips apart even a little stick or dart the tongue out of the mouth have the tongue resting between the teeth lean the cheek on a hand breath with his mouth open even a little bit make noises when breathing have trouble sitting still
While talking
While talking does your child talk very fast talk very slowly gasp for air have a lisp take speech lessons
During a meal
During a meal does your child gasp for air while eating stick his tongue between his teeth when swallowing stick the tongue out to meet the drinking glass drink a lot while eating make noises when chewing eat sloppily take a breath before drinking puff the cheeks out when drinking make the lips purse when swallowing make the chin ldquocrinklerdquo when swallowing bob the head when swallowing have trouble sitting still
While sleeping
While sleeping does your child have the mouth open snore wet the bed toss and turn tilt the head back wake up frequently have frequent nightmares have abnormal sleep issues grind the teeth have trouble waking up wake with darker circles under eyes
S R 10-10yo M
bullMissing 3242bullImpacted 1323bullLate mixed 25 eruptedbullSoft tissue dysfunctionbullIL = 40bullNot compliant
S Reardon 10-7yo M
Impacted 3s Missing 2s
Medical history
bull Reactive Airway Diseasebull ldquoBronchial Constrictionrdquo bullCare of Pulmonologistbull Preventil
bull Dad OSA CPAP for 11 years diabetesbull Grandfather OSA untreatedbull ETCO2 = 361 at 10 bpm (acceptable)bull Posture number - 18 (lt10 ideal)bull Father refuses sleep screening
Treatment Options1 Extract upper premolars Align2Open spaces for impacted canines Open spaces for lower lateral implants
Whatrsquos more importantEase of treatment
OrBreathing well at night
Bolton Standards15yo
The Maxilla is Down and Back
The Mandible is Retrognathic
Nasal Cartilage Collapse
Insufficient Facial Support
Bi-maxillary Retrusion
Bimaxillary Retrusion Forward Growth
Mouthbreathers have significantly smaller airway space
(measurements PAS-OccL PAS-UP airway volume area and minimum axial area)
Mouth breather Nasal breather
Three-dimensional assessment of pharyngeal airway in nasal- and mouth-breathing children
Alves M etal Int J Ped ORL 75 (2011) 1195ndash1199
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
B Hockel 2012
This is the profile Biobloc children start with long and retrusive
This is the profile Biobloc children finish with Forward with lips
together
B Hockel 2012
Herersquos the ldquoinsiderdquo look Notice how the upper front teeth are closer to the nose (yellow arrows)
Notice how the lower jaw rotates around the star so the chin comes up and forward (red arrow)How do we make this happen
From the tip of the Central
To the Forwardmost Tip of the Nose
41mm
Maxillary Heightbull Indicator Line (Mew)
bull Distance from most anterior point on nose to upper incisal edge
bull Age + 23bull A variable number but important to watch over time
B Hockel 2012
Herersquos the ldquoinsiderdquo look Notice how the upper front teeth are closer to the nose (yellow arrows)
Notice how the lower jaw rotates around the star so the chin comes up and forward (red arrow)How do we make this happen
Using IndicatorCosmetic Line
bull To define a starting pointbull To set treatment goalsbull To track treatment progressbull To gauge the effectiveness of treatment
Charting the InCos Line
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Incisor pulled away from noseNot ldquoundertorquedrdquo or ldquogummy smilerdquo
Hypothetical ClI OrthoMARA
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
OJ = 7mm
Starts Ortho
ldquoGreat Headgear
Effectrdquo
Class II Elastics
50
40
30
20mm
y J F M A M J J A S O N
boys
Start Non-x
Expansion UncrowdingFinished
Start Cl II elastics
OK thatrsquos
enough
Hypothetical Mouthbreather(Dr Mewrsquos Hamster Boy)
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Boy gets
hamster
MFT
Hypothetical BBO 7yoM
50
40
30
20
5 6 7 8 9 10 11 12 13 14 15
girlsboys
Initial
StartBB1
BB3
Night
bullLR 11-9yFbullMissing all 5s6s8s and upper 4sbullHad ortho to close diastemahellipbullInL = 39bullGP objects to deX plan equil
LR Tx Plan
1Preparation Hang Expanser2deX 3Training BB3 to advance mandible4Myofunctional Therapy5Orthopostural Training6Myobrace to hold7 Reevaluate for dental detailing
LR Spotty progress
50
40
30
20mm
y 313 4 5 6 7 8 9 10 11 12114
2 3
Expanser
Parents dragging30 turnsStart Adv
Rx deXGP
objects
After delays
Equil ersquosBB3
bullLR 12-3 yF (6mo in tx)bullInL = 37 (+2)bull ersquos equilibratedbull OJ =10bull Appliance OJ = 5bull Still accommodating to BB3
Is there a calculus for the Indicator Line
Treatment GoalsBased on Indicator Line
Incisor Goals
Type 1 Treatment Place U1 in ideal position
Biobloc Orthotropics Orthognathic Surgery Distraction Osteogenesis
Type 1 Ideal InCos line
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
YZ 9yo M
bullLost upper d-spacebullInL = 36(+4)bullOJ = 9mmbullLip entrapmentbullLip Incompetence
Y Z 9yo M
Y Z 9yo M9mm OJ
Y Z 9yo M
Treatment Options
1 Type 1 Reduce InL open lost space BB3 to advance mandible
2 Type 2 Open lost space Align
3 Type 4 Extract four premolars
YZ 9yoM
50
40
30
20mm
yM A M J J A S O N D J F M A
boys
Hang Expanser
Upper and Lower
Brackets Hang Retainer
BB3
Incisor Goals
Type 2 Treatment Develop arch just enough to uncrowd
Biobloc Myofunctional Ortho Myofunctional Therapy Crozat ALF Expansion Orthodontics
Type 2 Uncrowding
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
bullLip incompetencebullLip entrapmentbullHypermentalisbullMouthbreathing
Type 2 Uncrowding
12 month progress
12 month progress
12 month progress
After Treatment
Bent-wire6 monthsMyobrace12 months
Hey RaphaelWhat about that
profile
ZP 9-5yoM
i
After Expansion Phase
Incomplete profile improvement better breathing head posture and sleep
Incisor Goals
Type 3 Treatment Maintain UI
Functional Orthodontics Expansion Orthodontics Distalization Ortho or No Treatment
Type 3 Maintain
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Bimax retrusion
Successful dental result
Profile Unimproved
Incisor Goals
Type 4 Treatment RetractExtrude UI
Extraction Orthodontics Retraction Ortho Distalization Ortho
Type 4 Retraction
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Bimax retrusion
Successful dental result
Failed Profile Result
Changes of pharyngeal airway size and hyoid bone position following orthodontic treatment of
Class I bimaxillary protrusion
Qingzhu Wanga Peizeng Jiab Nina K Andersonc Lin Wangd Jiuxiang Line
Angle Orthodontist Vol 00 No 0 0000 (pre-publication 2012)
ldquothe dimension of the velopharynx glossopharynx and hypopharynx were decreased after maximal retraction of anterior teeth with extraction of four premolarshelliprdquo ldquoAny factors that can influence the posture and position of tongue and soft palate may displace them backward andencroach upon the pharynxrdquo
ldquothe more the incisors were retracted the more the pharyngeal airway was reducedrdquo
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Backed into a corner
bull
Moving teeth faster more efficientlyhellipin the wrong direction
Now that wersquove made smoking unacceptable
could we not do the same withbull Sugarbull Processed foodbull Cheap milk and meatbull Fast foodbull Pill popping for symptomatic reliefbull Looking for the cure instead of the causebull Surgery as a quick fixbull Thinking braces are a status symbol
Each industry thrives on the status quoConsumers must drive the change
NP 10yM
NP
Sisterrsquos non-x ortho
Shersquos happyhellipbut Irsquom not so
I make my pitch for BBO
The dilemma of progress
(I forgot the progress pictureshellip)
Dad sells prosthetic parts to orthopedic surgeons
I selling the case against my previous work they loved
It takes me 3 hours to sell the case
They fret until the BB3 goes in
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Connecting the dots
bull Adult SDB and OSA
bull Narrow jaws and faces
bull Soft tissue dysfunction
bull Early parafunctional habits ie open mouth posture
bull Environmental stressors
bull CPAP MARAUPPP SurgWherersquos the best
place to start treatment here
or here
1 Prevention 2 Undo the damage already done3 Establish good habits
When to start When damage from poor breathing is noticed and when bad habits are discovered
The strategies of Airway Orthodontics
Prevention
bull Remove ankyloglossiabull Promote breastfeedingbull Harden the dietbull Develop masticatory strengthbull Discourage oral habitsbull Promote whole-foods low sugar dietbull Reduce oropharyngeal obstructionbull Promote nasal breathing
Breathing retraining
bull Nasal rinsingbull Nasal clearingbull Decongesting
The goals of Airway Orthodontics
1 Breathing through the nose2 Lips together at rest3 Correct tongue position4 No facial muscles moving on swallowing5 Optimal forward facial development6 Class I occlusion7 Straight teeth8 Better stability long term
Myofunctional Trainers
Professors R Soulet and A Besombes
Dr Earl Bergeson
Dr Chris Farrell
The Multi ndash Family System
Orofacial MyofunctionalTherapy
Oral MyologyMyofunctional TherapyTongue Thrust Therapy
B Hockel 2012 Back
Undoing Bimaxillary Dysplasia
1 Maxillary deconstriction2 Maxillary advancement3 Maxillary impaction4 Mandibular advancement
1 Maxillary Expansion
Treatment for Bimaxillary Dysplasia
ALFCrozat
Bent Wire
HyraxHaas
Niti Exp BioBlocSchwartz
The Farrell BENT WIRE Systemtrade
Recommended Age Group 5-12 yrs
Arch Development in conjunction with the TRAINER Systemtrade
Dr John Mew
Establish Good Habits
1 Breathing through the nose2 Lips together at rest3 Correct tongue position4 No facial muscles moving on swallowing5 Stand and sit in balance6 Breath gently using the diaphragm7 Eat to nourish8 Sleep to rest
Ortho-Postural TrainingWorkshops
Breathing
Nutrition
Posture
Sleep
COPYRIGHTRoger L PriceOctober 2012
Posture Number
Forward head posturecan be a compensationfor a deficient airway
Sleep Screening and Hygiene
SQI = 10 SQI = 98
Integrative Healthcare
Function ProfessionalNasal clearing ENT Pulm MFT BreathingMuscle balance and tone MFT Myofunctional OrthoUndoing damage GP Pedo Ortho OMFSBreathing dynamics OPT MFT Breath PhysiologistPosture DC OPT PT OsteopathCranial balance OsteopathNutrition RDH Nutritionist Dietitian Sleep ENT Sleep Med DentNeurocognitive development Pedrsquon SLP Psych SpEd
The Interdisciplinary Center
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Now that I know
My personal missionTo create from what Irsquove
learned from the besta model for others to followhellipespecially the orthodontists
Myofunctional Orthodontics
Chris Farrell
John Flutter
German Ramierez
Damien OrsquoBrien
Myofunctional Research CoRancho Cucamonga
2008-2012
Oral Myology
Oral Myology Basic CourseJoy MoellerNYC 2011LA 2012
Oral Myology Levels 2 3Kim BenkertClifton 2012
Habit CessationShari GreenClifton 2013
Biobloc Orthotropics
BBO Mini-residencyBill Hang
Agora Hills2012-13
BBO IntensiveDrs John and Mike
MewLSFO2013
Breathing and Sleep
Buteyko MentorshipThe Breathing Center
Woodstock2010
Breathing Well ProgrammeJohn Flutter
2010 Ortho-Postural TrainingRoger Price
2013
Sleep DentistryMichael Gelb etal
NYU2012
ALF and Cranial
Jim Bronson2013 Tasha Turzo
Cranial Academy2014
Bucket Listbull ALF and Crozat (Bronsonrsquos course)bullMore on Biobloc (Hangrsquos Advanced London School)bull More Cranial (The Farm)bullChirodontics (Bob Walker)bull Airway Dentistry with Marc Cruz Jeff Rousebull Sleep Dentistrybull Less-than-Six with Kevin Boydbull Intra-mandibular Distraction Osteogenesis (IMDO)
Off My ListAnything that moves the teeth faster in the wrong direction
Whatrsquos an RO to do
To create from what Irsquove learned from the best
a model for others to followhellipespecially orthodontists
Teaching
Mt Sinai Pedo ResidencyAli Attaie
2010-2012
Montefiore Ortho ResidencyTony Maganzini
2012
2009-Present
Mt Sinai School of MedicinePedodontic Residency
Guest SpeakersJim BronsonMike MewKevin BoydSandra KahnJennifer TowRoger PricePaula Fabbie
Damien OrsquoBrien
First clinical program in myofunctional orthodontics
Airway and Facial DevelopmentCollaborative Webcast
Mark Cruz
AAPMD Symposium
wwwaapm
dorg
Annual MeetingApril 25-26 2014
Westin Chicago North Shore
the raphael center for integrative orthodontics
wwwalignminecomwwwbioblocnjcom
wwwmyobracenjcom
Integrative vs Conventional
Integrative vs Conventional
ldquoWith improvements in expansion orthodontics advances in myofunctional orthodontics and the growing recognition about sleep disordered breathing among children and adults it is time for orthodontics to expand its horizons There is now so much more we can oerrdquo
The Raphael name has been associated with high quality orthodontics in New Jersey for over 60 years Dr Barry Raphael has been a university trained orthodontic specialist and a member of the American Association of Orthodontists for 30 years
He has a wide range of techniques and services to offer He has studied oral myology applied kinesiology Buteyko breathing Biobloc Orthotropics and Myobrace as part of his integrative training He can offer Damon Invisalign Insignia and Incognito appliances designs as some of his many conventional orthodontic services too
Dr Raphael teaches his techniques at post-graduate residencies study clubs dental societies and for the Myofunctional Research Co He is available for presentations to any group interested in learning more about the benefits of integrative orthodontics
wwwalignminecomLearn about the choices you have in orthodontics
dr barry raphael Why its
too Early never
1425
bro
ad
str
ee
tc
lifto
n n
j 070
13
973-
778-
4222
fax
973-
778-
9625
nj s
pe
c
368
4
1425 broad street clifton nj 07013973-778-4222
wwwalignminecom
the raphael centerforintegrative orthodontics
the
raph
ael c
ente
r fo
rin
tegr
ativ
e or
thod
onti
cs
Learn about an important choice you need to make before starting braces
the raphael center for integrative education
the raphael center for integrative education
Ongoing Intro to Airway Orthodontics
April Biobloc Study Group
April Training Ortho-Postural Therapists w Roger Price
June MRC Myobrace Basic Series
August Airway Dentistry with Mark Cruz and company
October Advanced MFT with Sandy Coulson
October Less than Six with Kevin Boyd
(who else wants to play)
Mission to create a space for spreading the word about Airway and Orthotropic principles and practice
Orthodontics in the 21st Century
EstheticOrthodontics
AirwayOrthodontics
GeneticTooth-Focused
Dental PerfectionEsthetics Primary
Treating SymptomsAirway Ignorant
AdaptationMuscle-FocusedMedical Better
Esthetics SecondaryTreating Causes
Airway Conscious
The EndAnd
The Beginning
Parentrsquos Private-eye Sheet
Parentrsquos Private-eye Sheet
ldquoThere are many things about your childrsquos health that are important to know but that I often donrsquot get to see at the office Also there are signs to look for that you may not have known were connected to your childrsquos teeth or health By looking for and tracking these ldquosigns and symptomsrdquo we can get a better handle on the problem and watch for resolution
You donrsquot have to spend a lot of time with this but donrsquot rush either Watch for certain things at different times of day Try not to let your child know they are being watched You want to see the most natural behaviors
Check off what you see If yoursquore not sure check it anyway and wersquoll talk about it Make comments if you wantrdquo
While sitting around
While sitting around (watching TV in the car) does your child
put ldquothingsrdquo in the mouth alot (toys sleeves pencils fingernails etc) ______________________________
lick or suck on the lips have the lips apart even a little stick or dart the tongue out of the mouth have the tongue resting between the teeth lean the cheek on a hand breath with his mouth open even a little bit make noises when breathing have trouble sitting still
While talking
While talking does your child talk very fast talk very slowly gasp for air have a lisp take speech lessons
During a meal
During a meal does your child gasp for air while eating stick his tongue between his teeth when swallowing stick the tongue out to meet the drinking glass drink a lot while eating make noises when chewing eat sloppily take a breath before drinking puff the cheeks out when drinking make the lips purse when swallowing make the chin ldquocrinklerdquo when swallowing bob the head when swallowing have trouble sitting still
While sleeping
While sleeping does your child have the mouth open snore wet the bed toss and turn tilt the head back wake up frequently have frequent nightmares have abnormal sleep issues grind the teeth have trouble waking up wake with darker circles under eyes
S R 10-10yo M
bullMissing 3242bullImpacted 1323bullLate mixed 25 eruptedbullSoft tissue dysfunctionbullIL = 40bullNot compliant
S Reardon 10-7yo M
Impacted 3s Missing 2s
Medical history
bull Reactive Airway Diseasebull ldquoBronchial Constrictionrdquo bullCare of Pulmonologistbull Preventil
bull Dad OSA CPAP for 11 years diabetesbull Grandfather OSA untreatedbull ETCO2 = 361 at 10 bpm (acceptable)bull Posture number - 18 (lt10 ideal)bull Father refuses sleep screening
Treatment Options1 Extract upper premolars Align2Open spaces for impacted canines Open spaces for lower lateral implants
Whatrsquos more importantEase of treatment
OrBreathing well at night
Bolton Standards15yo
The Maxilla is Down and Back
The Mandible is Retrognathic
Nasal Cartilage Collapse
Insufficient Facial Support
Bi-maxillary Retrusion
Bimaxillary Retrusion Forward Growth
Mouthbreathers have significantly smaller airway space
(measurements PAS-OccL PAS-UP airway volume area and minimum axial area)
Mouth breather Nasal breather
Three-dimensional assessment of pharyngeal airway in nasal- and mouth-breathing children
Alves M etal Int J Ped ORL 75 (2011) 1195ndash1199
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
B Hockel 2012
This is the profile Biobloc children start with long and retrusive
This is the profile Biobloc children finish with Forward with lips
together
B Hockel 2012
Herersquos the ldquoinsiderdquo look Notice how the upper front teeth are closer to the nose (yellow arrows)
Notice how the lower jaw rotates around the star so the chin comes up and forward (red arrow)How do we make this happen
From the tip of the Central
To the Forwardmost Tip of the Nose
41mm
Maxillary Heightbull Indicator Line (Mew)
bull Distance from most anterior point on nose to upper incisal edge
bull Age + 23bull A variable number but important to watch over time
B Hockel 2012
Herersquos the ldquoinsiderdquo look Notice how the upper front teeth are closer to the nose (yellow arrows)
Notice how the lower jaw rotates around the star so the chin comes up and forward (red arrow)How do we make this happen
Using IndicatorCosmetic Line
bull To define a starting pointbull To set treatment goalsbull To track treatment progressbull To gauge the effectiveness of treatment
Charting the InCos Line
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Incisor pulled away from noseNot ldquoundertorquedrdquo or ldquogummy smilerdquo
Hypothetical ClI OrthoMARA
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
OJ = 7mm
Starts Ortho
ldquoGreat Headgear
Effectrdquo
Class II Elastics
50
40
30
20mm
y J F M A M J J A S O N
boys
Start Non-x
Expansion UncrowdingFinished
Start Cl II elastics
OK thatrsquos
enough
Hypothetical Mouthbreather(Dr Mewrsquos Hamster Boy)
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Boy gets
hamster
MFT
Hypothetical BBO 7yoM
50
40
30
20
5 6 7 8 9 10 11 12 13 14 15
girlsboys
Initial
StartBB1
BB3
Night
bullLR 11-9yFbullMissing all 5s6s8s and upper 4sbullHad ortho to close diastemahellipbullInL = 39bullGP objects to deX plan equil
LR Tx Plan
1Preparation Hang Expanser2deX 3Training BB3 to advance mandible4Myofunctional Therapy5Orthopostural Training6Myobrace to hold7 Reevaluate for dental detailing
LR Spotty progress
50
40
30
20mm
y 313 4 5 6 7 8 9 10 11 12114
2 3
Expanser
Parents dragging30 turnsStart Adv
Rx deXGP
objects
After delays
Equil ersquosBB3
bullLR 12-3 yF (6mo in tx)bullInL = 37 (+2)bull ersquos equilibratedbull OJ =10bull Appliance OJ = 5bull Still accommodating to BB3
Is there a calculus for the Indicator Line
Treatment GoalsBased on Indicator Line
Incisor Goals
Type 1 Treatment Place U1 in ideal position
Biobloc Orthotropics Orthognathic Surgery Distraction Osteogenesis
Type 1 Ideal InCos line
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
YZ 9yo M
bullLost upper d-spacebullInL = 36(+4)bullOJ = 9mmbullLip entrapmentbullLip Incompetence
Y Z 9yo M
Y Z 9yo M9mm OJ
Y Z 9yo M
Treatment Options
1 Type 1 Reduce InL open lost space BB3 to advance mandible
2 Type 2 Open lost space Align
3 Type 4 Extract four premolars
YZ 9yoM
50
40
30
20mm
yM A M J J A S O N D J F M A
boys
Hang Expanser
Upper and Lower
Brackets Hang Retainer
BB3
Incisor Goals
Type 2 Treatment Develop arch just enough to uncrowd
Biobloc Myofunctional Ortho Myofunctional Therapy Crozat ALF Expansion Orthodontics
Type 2 Uncrowding
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
bullLip incompetencebullLip entrapmentbullHypermentalisbullMouthbreathing
Type 2 Uncrowding
12 month progress
12 month progress
12 month progress
After Treatment
Bent-wire6 monthsMyobrace12 months
Hey RaphaelWhat about that
profile
ZP 9-5yoM
i
After Expansion Phase
Incomplete profile improvement better breathing head posture and sleep
Incisor Goals
Type 3 Treatment Maintain UI
Functional Orthodontics Expansion Orthodontics Distalization Ortho or No Treatment
Type 3 Maintain
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Bimax retrusion
Successful dental result
Profile Unimproved
Incisor Goals
Type 4 Treatment RetractExtrude UI
Extraction Orthodontics Retraction Ortho Distalization Ortho
Type 4 Retraction
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Bimax retrusion
Successful dental result
Failed Profile Result
Changes of pharyngeal airway size and hyoid bone position following orthodontic treatment of
Class I bimaxillary protrusion
Qingzhu Wanga Peizeng Jiab Nina K Andersonc Lin Wangd Jiuxiang Line
Angle Orthodontist Vol 00 No 0 0000 (pre-publication 2012)
ldquothe dimension of the velopharynx glossopharynx and hypopharynx were decreased after maximal retraction of anterior teeth with extraction of four premolarshelliprdquo ldquoAny factors that can influence the posture and position of tongue and soft palate may displace them backward andencroach upon the pharynxrdquo
ldquothe more the incisors were retracted the more the pharyngeal airway was reducedrdquo
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Backed into a corner
bull
Moving teeth faster more efficientlyhellipin the wrong direction
Now that wersquove made smoking unacceptable
could we not do the same withbull Sugarbull Processed foodbull Cheap milk and meatbull Fast foodbull Pill popping for symptomatic reliefbull Looking for the cure instead of the causebull Surgery as a quick fixbull Thinking braces are a status symbol
Each industry thrives on the status quoConsumers must drive the change
NP 10yM
NP
Sisterrsquos non-x ortho
Shersquos happyhellipbut Irsquom not so
I make my pitch for BBO
The dilemma of progress
(I forgot the progress pictureshellip)
Dad sells prosthetic parts to orthopedic surgeons
I selling the case against my previous work they loved
It takes me 3 hours to sell the case
They fret until the BB3 goes in
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Connecting the dots
bull Adult SDB and OSA
bull Narrow jaws and faces
bull Soft tissue dysfunction
bull Early parafunctional habits ie open mouth posture
bull Environmental stressors
bull CPAP MARAUPPP SurgWherersquos the best
place to start treatment here
or here
1 Prevention 2 Undo the damage already done3 Establish good habits
When to start When damage from poor breathing is noticed and when bad habits are discovered
The strategies of Airway Orthodontics
Prevention
bull Remove ankyloglossiabull Promote breastfeedingbull Harden the dietbull Develop masticatory strengthbull Discourage oral habitsbull Promote whole-foods low sugar dietbull Reduce oropharyngeal obstructionbull Promote nasal breathing
Breathing retraining
bull Nasal rinsingbull Nasal clearingbull Decongesting
The goals of Airway Orthodontics
1 Breathing through the nose2 Lips together at rest3 Correct tongue position4 No facial muscles moving on swallowing5 Optimal forward facial development6 Class I occlusion7 Straight teeth8 Better stability long term
Myofunctional Trainers
Professors R Soulet and A Besombes
Dr Earl Bergeson
Dr Chris Farrell
The Multi ndash Family System
Orofacial MyofunctionalTherapy
Oral MyologyMyofunctional TherapyTongue Thrust Therapy
B Hockel 2012 Back
Undoing Bimaxillary Dysplasia
1 Maxillary deconstriction2 Maxillary advancement3 Maxillary impaction4 Mandibular advancement
1 Maxillary Expansion
Treatment for Bimaxillary Dysplasia
ALFCrozat
Bent Wire
HyraxHaas
Niti Exp BioBlocSchwartz
The Farrell BENT WIRE Systemtrade
Recommended Age Group 5-12 yrs
Arch Development in conjunction with the TRAINER Systemtrade
Dr John Mew
Establish Good Habits
1 Breathing through the nose2 Lips together at rest3 Correct tongue position4 No facial muscles moving on swallowing5 Stand and sit in balance6 Breath gently using the diaphragm7 Eat to nourish8 Sleep to rest
Ortho-Postural TrainingWorkshops
Breathing
Nutrition
Posture
Sleep
COPYRIGHTRoger L PriceOctober 2012
Posture Number
Forward head posturecan be a compensationfor a deficient airway
Sleep Screening and Hygiene
SQI = 10 SQI = 98
Integrative Healthcare
Function ProfessionalNasal clearing ENT Pulm MFT BreathingMuscle balance and tone MFT Myofunctional OrthoUndoing damage GP Pedo Ortho OMFSBreathing dynamics OPT MFT Breath PhysiologistPosture DC OPT PT OsteopathCranial balance OsteopathNutrition RDH Nutritionist Dietitian Sleep ENT Sleep Med DentNeurocognitive development Pedrsquon SLP Psych SpEd
The Interdisciplinary Center
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Now that I know
My personal missionTo create from what Irsquove
learned from the besta model for others to followhellipespecially the orthodontists
Myofunctional Orthodontics
Chris Farrell
John Flutter
German Ramierez
Damien OrsquoBrien
Myofunctional Research CoRancho Cucamonga
2008-2012
Oral Myology
Oral Myology Basic CourseJoy MoellerNYC 2011LA 2012
Oral Myology Levels 2 3Kim BenkertClifton 2012
Habit CessationShari GreenClifton 2013
Biobloc Orthotropics
BBO Mini-residencyBill Hang
Agora Hills2012-13
BBO IntensiveDrs John and Mike
MewLSFO2013
Breathing and Sleep
Buteyko MentorshipThe Breathing Center
Woodstock2010
Breathing Well ProgrammeJohn Flutter
2010 Ortho-Postural TrainingRoger Price
2013
Sleep DentistryMichael Gelb etal
NYU2012
ALF and Cranial
Jim Bronson2013 Tasha Turzo
Cranial Academy2014
Bucket Listbull ALF and Crozat (Bronsonrsquos course)bullMore on Biobloc (Hangrsquos Advanced London School)bull More Cranial (The Farm)bullChirodontics (Bob Walker)bull Airway Dentistry with Marc Cruz Jeff Rousebull Sleep Dentistrybull Less-than-Six with Kevin Boydbull Intra-mandibular Distraction Osteogenesis (IMDO)
Off My ListAnything that moves the teeth faster in the wrong direction
Whatrsquos an RO to do
To create from what Irsquove learned from the best
a model for others to followhellipespecially orthodontists
Teaching
Mt Sinai Pedo ResidencyAli Attaie
2010-2012
Montefiore Ortho ResidencyTony Maganzini
2012
2009-Present
Mt Sinai School of MedicinePedodontic Residency
Guest SpeakersJim BronsonMike MewKevin BoydSandra KahnJennifer TowRoger PricePaula Fabbie
Damien OrsquoBrien
First clinical program in myofunctional orthodontics
Airway and Facial DevelopmentCollaborative Webcast
Mark Cruz
AAPMD Symposium
wwwaapm
dorg
Annual MeetingApril 25-26 2014
Westin Chicago North Shore
the raphael center for integrative orthodontics
wwwalignminecomwwwbioblocnjcom
wwwmyobracenjcom
Integrative vs Conventional
Integrative vs Conventional
ldquoWith improvements in expansion orthodontics advances in myofunctional orthodontics and the growing recognition about sleep disordered breathing among children and adults it is time for orthodontics to expand its horizons There is now so much more we can oerrdquo
The Raphael name has been associated with high quality orthodontics in New Jersey for over 60 years Dr Barry Raphael has been a university trained orthodontic specialist and a member of the American Association of Orthodontists for 30 years
He has a wide range of techniques and services to offer He has studied oral myology applied kinesiology Buteyko breathing Biobloc Orthotropics and Myobrace as part of his integrative training He can offer Damon Invisalign Insignia and Incognito appliances designs as some of his many conventional orthodontic services too
Dr Raphael teaches his techniques at post-graduate residencies study clubs dental societies and for the Myofunctional Research Co He is available for presentations to any group interested in learning more about the benefits of integrative orthodontics
wwwalignminecomLearn about the choices you have in orthodontics
dr barry raphael Why its
too Early never
1425
bro
ad
str
ee
tc
lifto
n n
j 070
13
973-
778-
4222
fax
973-
778-
9625
nj s
pe
c
368
4
1425 broad street clifton nj 07013973-778-4222
wwwalignminecom
the raphael centerforintegrative orthodontics
the
raph
ael c
ente
r fo
rin
tegr
ativ
e or
thod
onti
cs
Learn about an important choice you need to make before starting braces
the raphael center for integrative education
the raphael center for integrative education
Ongoing Intro to Airway Orthodontics
April Biobloc Study Group
April Training Ortho-Postural Therapists w Roger Price
June MRC Myobrace Basic Series
August Airway Dentistry with Mark Cruz and company
October Advanced MFT with Sandy Coulson
October Less than Six with Kevin Boyd
(who else wants to play)
Mission to create a space for spreading the word about Airway and Orthotropic principles and practice
Orthodontics in the 21st Century
EstheticOrthodontics
AirwayOrthodontics
GeneticTooth-Focused
Dental PerfectionEsthetics Primary
Treating SymptomsAirway Ignorant
AdaptationMuscle-FocusedMedical Better
Esthetics SecondaryTreating Causes
Airway Conscious
The EndAnd
The Beginning
Parentrsquos Private-eye Sheet
ldquoThere are many things about your childrsquos health that are important to know but that I often donrsquot get to see at the office Also there are signs to look for that you may not have known were connected to your childrsquos teeth or health By looking for and tracking these ldquosigns and symptomsrdquo we can get a better handle on the problem and watch for resolution
You donrsquot have to spend a lot of time with this but donrsquot rush either Watch for certain things at different times of day Try not to let your child know they are being watched You want to see the most natural behaviors
Check off what you see If yoursquore not sure check it anyway and wersquoll talk about it Make comments if you wantrdquo
While sitting around
While sitting around (watching TV in the car) does your child
put ldquothingsrdquo in the mouth alot (toys sleeves pencils fingernails etc) ______________________________
lick or suck on the lips have the lips apart even a little stick or dart the tongue out of the mouth have the tongue resting between the teeth lean the cheek on a hand breath with his mouth open even a little bit make noises when breathing have trouble sitting still
While talking
While talking does your child talk very fast talk very slowly gasp for air have a lisp take speech lessons
During a meal
During a meal does your child gasp for air while eating stick his tongue between his teeth when swallowing stick the tongue out to meet the drinking glass drink a lot while eating make noises when chewing eat sloppily take a breath before drinking puff the cheeks out when drinking make the lips purse when swallowing make the chin ldquocrinklerdquo when swallowing bob the head when swallowing have trouble sitting still
While sleeping
While sleeping does your child have the mouth open snore wet the bed toss and turn tilt the head back wake up frequently have frequent nightmares have abnormal sleep issues grind the teeth have trouble waking up wake with darker circles under eyes
S R 10-10yo M
bullMissing 3242bullImpacted 1323bullLate mixed 25 eruptedbullSoft tissue dysfunctionbullIL = 40bullNot compliant
S Reardon 10-7yo M
Impacted 3s Missing 2s
Medical history
bull Reactive Airway Diseasebull ldquoBronchial Constrictionrdquo bullCare of Pulmonologistbull Preventil
bull Dad OSA CPAP for 11 years diabetesbull Grandfather OSA untreatedbull ETCO2 = 361 at 10 bpm (acceptable)bull Posture number - 18 (lt10 ideal)bull Father refuses sleep screening
Treatment Options1 Extract upper premolars Align2Open spaces for impacted canines Open spaces for lower lateral implants
Whatrsquos more importantEase of treatment
OrBreathing well at night
Bolton Standards15yo
The Maxilla is Down and Back
The Mandible is Retrognathic
Nasal Cartilage Collapse
Insufficient Facial Support
Bi-maxillary Retrusion
Bimaxillary Retrusion Forward Growth
Mouthbreathers have significantly smaller airway space
(measurements PAS-OccL PAS-UP airway volume area and minimum axial area)
Mouth breather Nasal breather
Three-dimensional assessment of pharyngeal airway in nasal- and mouth-breathing children
Alves M etal Int J Ped ORL 75 (2011) 1195ndash1199
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
B Hockel 2012
This is the profile Biobloc children start with long and retrusive
This is the profile Biobloc children finish with Forward with lips
together
B Hockel 2012
Herersquos the ldquoinsiderdquo look Notice how the upper front teeth are closer to the nose (yellow arrows)
Notice how the lower jaw rotates around the star so the chin comes up and forward (red arrow)How do we make this happen
From the tip of the Central
To the Forwardmost Tip of the Nose
41mm
Maxillary Heightbull Indicator Line (Mew)
bull Distance from most anterior point on nose to upper incisal edge
bull Age + 23bull A variable number but important to watch over time
B Hockel 2012
Herersquos the ldquoinsiderdquo look Notice how the upper front teeth are closer to the nose (yellow arrows)
Notice how the lower jaw rotates around the star so the chin comes up and forward (red arrow)How do we make this happen
Using IndicatorCosmetic Line
bull To define a starting pointbull To set treatment goalsbull To track treatment progressbull To gauge the effectiveness of treatment
Charting the InCos Line
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Incisor pulled away from noseNot ldquoundertorquedrdquo or ldquogummy smilerdquo
Hypothetical ClI OrthoMARA
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
OJ = 7mm
Starts Ortho
ldquoGreat Headgear
Effectrdquo
Class II Elastics
50
40
30
20mm
y J F M A M J J A S O N
boys
Start Non-x
Expansion UncrowdingFinished
Start Cl II elastics
OK thatrsquos
enough
Hypothetical Mouthbreather(Dr Mewrsquos Hamster Boy)
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Boy gets
hamster
MFT
Hypothetical BBO 7yoM
50
40
30
20
5 6 7 8 9 10 11 12 13 14 15
girlsboys
Initial
StartBB1
BB3
Night
bullLR 11-9yFbullMissing all 5s6s8s and upper 4sbullHad ortho to close diastemahellipbullInL = 39bullGP objects to deX plan equil
LR Tx Plan
1Preparation Hang Expanser2deX 3Training BB3 to advance mandible4Myofunctional Therapy5Orthopostural Training6Myobrace to hold7 Reevaluate for dental detailing
LR Spotty progress
50
40
30
20mm
y 313 4 5 6 7 8 9 10 11 12114
2 3
Expanser
Parents dragging30 turnsStart Adv
Rx deXGP
objects
After delays
Equil ersquosBB3
bullLR 12-3 yF (6mo in tx)bullInL = 37 (+2)bull ersquos equilibratedbull OJ =10bull Appliance OJ = 5bull Still accommodating to BB3
Is there a calculus for the Indicator Line
Treatment GoalsBased on Indicator Line
Incisor Goals
Type 1 Treatment Place U1 in ideal position
Biobloc Orthotropics Orthognathic Surgery Distraction Osteogenesis
Type 1 Ideal InCos line
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
YZ 9yo M
bullLost upper d-spacebullInL = 36(+4)bullOJ = 9mmbullLip entrapmentbullLip Incompetence
Y Z 9yo M
Y Z 9yo M9mm OJ
Y Z 9yo M
Treatment Options
1 Type 1 Reduce InL open lost space BB3 to advance mandible
2 Type 2 Open lost space Align
3 Type 4 Extract four premolars
YZ 9yoM
50
40
30
20mm
yM A M J J A S O N D J F M A
boys
Hang Expanser
Upper and Lower
Brackets Hang Retainer
BB3
Incisor Goals
Type 2 Treatment Develop arch just enough to uncrowd
Biobloc Myofunctional Ortho Myofunctional Therapy Crozat ALF Expansion Orthodontics
Type 2 Uncrowding
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
bullLip incompetencebullLip entrapmentbullHypermentalisbullMouthbreathing
Type 2 Uncrowding
12 month progress
12 month progress
12 month progress
After Treatment
Bent-wire6 monthsMyobrace12 months
Hey RaphaelWhat about that
profile
ZP 9-5yoM
i
After Expansion Phase
Incomplete profile improvement better breathing head posture and sleep
Incisor Goals
Type 3 Treatment Maintain UI
Functional Orthodontics Expansion Orthodontics Distalization Ortho or No Treatment
Type 3 Maintain
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Bimax retrusion
Successful dental result
Profile Unimproved
Incisor Goals
Type 4 Treatment RetractExtrude UI
Extraction Orthodontics Retraction Ortho Distalization Ortho
Type 4 Retraction
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Bimax retrusion
Successful dental result
Failed Profile Result
Changes of pharyngeal airway size and hyoid bone position following orthodontic treatment of
Class I bimaxillary protrusion
Qingzhu Wanga Peizeng Jiab Nina K Andersonc Lin Wangd Jiuxiang Line
Angle Orthodontist Vol 00 No 0 0000 (pre-publication 2012)
ldquothe dimension of the velopharynx glossopharynx and hypopharynx were decreased after maximal retraction of anterior teeth with extraction of four premolarshelliprdquo ldquoAny factors that can influence the posture and position of tongue and soft palate may displace them backward andencroach upon the pharynxrdquo
ldquothe more the incisors were retracted the more the pharyngeal airway was reducedrdquo
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Backed into a corner
bull
Moving teeth faster more efficientlyhellipin the wrong direction
Now that wersquove made smoking unacceptable
could we not do the same withbull Sugarbull Processed foodbull Cheap milk and meatbull Fast foodbull Pill popping for symptomatic reliefbull Looking for the cure instead of the causebull Surgery as a quick fixbull Thinking braces are a status symbol
Each industry thrives on the status quoConsumers must drive the change
NP 10yM
NP
Sisterrsquos non-x ortho
Shersquos happyhellipbut Irsquom not so
I make my pitch for BBO
The dilemma of progress
(I forgot the progress pictureshellip)
Dad sells prosthetic parts to orthopedic surgeons
I selling the case against my previous work they loved
It takes me 3 hours to sell the case
They fret until the BB3 goes in
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Connecting the dots
bull Adult SDB and OSA
bull Narrow jaws and faces
bull Soft tissue dysfunction
bull Early parafunctional habits ie open mouth posture
bull Environmental stressors
bull CPAP MARAUPPP SurgWherersquos the best
place to start treatment here
or here
1 Prevention 2 Undo the damage already done3 Establish good habits
When to start When damage from poor breathing is noticed and when bad habits are discovered
The strategies of Airway Orthodontics
Prevention
bull Remove ankyloglossiabull Promote breastfeedingbull Harden the dietbull Develop masticatory strengthbull Discourage oral habitsbull Promote whole-foods low sugar dietbull Reduce oropharyngeal obstructionbull Promote nasal breathing
Breathing retraining
bull Nasal rinsingbull Nasal clearingbull Decongesting
The goals of Airway Orthodontics
1 Breathing through the nose2 Lips together at rest3 Correct tongue position4 No facial muscles moving on swallowing5 Optimal forward facial development6 Class I occlusion7 Straight teeth8 Better stability long term
Myofunctional Trainers
Professors R Soulet and A Besombes
Dr Earl Bergeson
Dr Chris Farrell
The Multi ndash Family System
Orofacial MyofunctionalTherapy
Oral MyologyMyofunctional TherapyTongue Thrust Therapy
B Hockel 2012 Back
Undoing Bimaxillary Dysplasia
1 Maxillary deconstriction2 Maxillary advancement3 Maxillary impaction4 Mandibular advancement
1 Maxillary Expansion
Treatment for Bimaxillary Dysplasia
ALFCrozat
Bent Wire
HyraxHaas
Niti Exp BioBlocSchwartz
The Farrell BENT WIRE Systemtrade
Recommended Age Group 5-12 yrs
Arch Development in conjunction with the TRAINER Systemtrade
Dr John Mew
Establish Good Habits
1 Breathing through the nose2 Lips together at rest3 Correct tongue position4 No facial muscles moving on swallowing5 Stand and sit in balance6 Breath gently using the diaphragm7 Eat to nourish8 Sleep to rest
Ortho-Postural TrainingWorkshops
Breathing
Nutrition
Posture
Sleep
COPYRIGHTRoger L PriceOctober 2012
Posture Number
Forward head posturecan be a compensationfor a deficient airway
Sleep Screening and Hygiene
SQI = 10 SQI = 98
Integrative Healthcare
Function ProfessionalNasal clearing ENT Pulm MFT BreathingMuscle balance and tone MFT Myofunctional OrthoUndoing damage GP Pedo Ortho OMFSBreathing dynamics OPT MFT Breath PhysiologistPosture DC OPT PT OsteopathCranial balance OsteopathNutrition RDH Nutritionist Dietitian Sleep ENT Sleep Med DentNeurocognitive development Pedrsquon SLP Psych SpEd
The Interdisciplinary Center
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Now that I know
My personal missionTo create from what Irsquove
learned from the besta model for others to followhellipespecially the orthodontists
Myofunctional Orthodontics
Chris Farrell
John Flutter
German Ramierez
Damien OrsquoBrien
Myofunctional Research CoRancho Cucamonga
2008-2012
Oral Myology
Oral Myology Basic CourseJoy MoellerNYC 2011LA 2012
Oral Myology Levels 2 3Kim BenkertClifton 2012
Habit CessationShari GreenClifton 2013
Biobloc Orthotropics
BBO Mini-residencyBill Hang
Agora Hills2012-13
BBO IntensiveDrs John and Mike
MewLSFO2013
Breathing and Sleep
Buteyko MentorshipThe Breathing Center
Woodstock2010
Breathing Well ProgrammeJohn Flutter
2010 Ortho-Postural TrainingRoger Price
2013
Sleep DentistryMichael Gelb etal
NYU2012
ALF and Cranial
Jim Bronson2013 Tasha Turzo
Cranial Academy2014
Bucket Listbull ALF and Crozat (Bronsonrsquos course)bullMore on Biobloc (Hangrsquos Advanced London School)bull More Cranial (The Farm)bullChirodontics (Bob Walker)bull Airway Dentistry with Marc Cruz Jeff Rousebull Sleep Dentistrybull Less-than-Six with Kevin Boydbull Intra-mandibular Distraction Osteogenesis (IMDO)
Off My ListAnything that moves the teeth faster in the wrong direction
Whatrsquos an RO to do
To create from what Irsquove learned from the best
a model for others to followhellipespecially orthodontists
Teaching
Mt Sinai Pedo ResidencyAli Attaie
2010-2012
Montefiore Ortho ResidencyTony Maganzini
2012
2009-Present
Mt Sinai School of MedicinePedodontic Residency
Guest SpeakersJim BronsonMike MewKevin BoydSandra KahnJennifer TowRoger PricePaula Fabbie
Damien OrsquoBrien
First clinical program in myofunctional orthodontics
Airway and Facial DevelopmentCollaborative Webcast
Mark Cruz
AAPMD Symposium
wwwaapm
dorg
Annual MeetingApril 25-26 2014
Westin Chicago North Shore
the raphael center for integrative orthodontics
wwwalignminecomwwwbioblocnjcom
wwwmyobracenjcom
Integrative vs Conventional
Integrative vs Conventional
ldquoWith improvements in expansion orthodontics advances in myofunctional orthodontics and the growing recognition about sleep disordered breathing among children and adults it is time for orthodontics to expand its horizons There is now so much more we can oerrdquo
The Raphael name has been associated with high quality orthodontics in New Jersey for over 60 years Dr Barry Raphael has been a university trained orthodontic specialist and a member of the American Association of Orthodontists for 30 years
He has a wide range of techniques and services to offer He has studied oral myology applied kinesiology Buteyko breathing Biobloc Orthotropics and Myobrace as part of his integrative training He can offer Damon Invisalign Insignia and Incognito appliances designs as some of his many conventional orthodontic services too
Dr Raphael teaches his techniques at post-graduate residencies study clubs dental societies and for the Myofunctional Research Co He is available for presentations to any group interested in learning more about the benefits of integrative orthodontics
wwwalignminecomLearn about the choices you have in orthodontics
dr barry raphael Why its
too Early never
1425
bro
ad
str
ee
tc
lifto
n n
j 070
13
973-
778-
4222
fax
973-
778-
9625
nj s
pe
c
368
4
1425 broad street clifton nj 07013973-778-4222
wwwalignminecom
the raphael centerforintegrative orthodontics
the
raph
ael c
ente
r fo
rin
tegr
ativ
e or
thod
onti
cs
Learn about an important choice you need to make before starting braces
the raphael center for integrative education
the raphael center for integrative education
Ongoing Intro to Airway Orthodontics
April Biobloc Study Group
April Training Ortho-Postural Therapists w Roger Price
June MRC Myobrace Basic Series
August Airway Dentistry with Mark Cruz and company
October Advanced MFT with Sandy Coulson
October Less than Six with Kevin Boyd
(who else wants to play)
Mission to create a space for spreading the word about Airway and Orthotropic principles and practice
Orthodontics in the 21st Century
EstheticOrthodontics
AirwayOrthodontics
GeneticTooth-Focused
Dental PerfectionEsthetics Primary
Treating SymptomsAirway Ignorant
AdaptationMuscle-FocusedMedical Better
Esthetics SecondaryTreating Causes
Airway Conscious
The EndAnd
The Beginning
While sitting around
While sitting around (watching TV in the car) does your child
put ldquothingsrdquo in the mouth alot (toys sleeves pencils fingernails etc) ______________________________
lick or suck on the lips have the lips apart even a little stick or dart the tongue out of the mouth have the tongue resting between the teeth lean the cheek on a hand breath with his mouth open even a little bit make noises when breathing have trouble sitting still
While talking
While talking does your child talk very fast talk very slowly gasp for air have a lisp take speech lessons
During a meal
During a meal does your child gasp for air while eating stick his tongue between his teeth when swallowing stick the tongue out to meet the drinking glass drink a lot while eating make noises when chewing eat sloppily take a breath before drinking puff the cheeks out when drinking make the lips purse when swallowing make the chin ldquocrinklerdquo when swallowing bob the head when swallowing have trouble sitting still
While sleeping
While sleeping does your child have the mouth open snore wet the bed toss and turn tilt the head back wake up frequently have frequent nightmares have abnormal sleep issues grind the teeth have trouble waking up wake with darker circles under eyes
S R 10-10yo M
bullMissing 3242bullImpacted 1323bullLate mixed 25 eruptedbullSoft tissue dysfunctionbullIL = 40bullNot compliant
S Reardon 10-7yo M
Impacted 3s Missing 2s
Medical history
bull Reactive Airway Diseasebull ldquoBronchial Constrictionrdquo bullCare of Pulmonologistbull Preventil
bull Dad OSA CPAP for 11 years diabetesbull Grandfather OSA untreatedbull ETCO2 = 361 at 10 bpm (acceptable)bull Posture number - 18 (lt10 ideal)bull Father refuses sleep screening
Treatment Options1 Extract upper premolars Align2Open spaces for impacted canines Open spaces for lower lateral implants
Whatrsquos more importantEase of treatment
OrBreathing well at night
Bolton Standards15yo
The Maxilla is Down and Back
The Mandible is Retrognathic
Nasal Cartilage Collapse
Insufficient Facial Support
Bi-maxillary Retrusion
Bimaxillary Retrusion Forward Growth
Mouthbreathers have significantly smaller airway space
(measurements PAS-OccL PAS-UP airway volume area and minimum axial area)
Mouth breather Nasal breather
Three-dimensional assessment of pharyngeal airway in nasal- and mouth-breathing children
Alves M etal Int J Ped ORL 75 (2011) 1195ndash1199
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
B Hockel 2012
This is the profile Biobloc children start with long and retrusive
This is the profile Biobloc children finish with Forward with lips
together
B Hockel 2012
Herersquos the ldquoinsiderdquo look Notice how the upper front teeth are closer to the nose (yellow arrows)
Notice how the lower jaw rotates around the star so the chin comes up and forward (red arrow)How do we make this happen
From the tip of the Central
To the Forwardmost Tip of the Nose
41mm
Maxillary Heightbull Indicator Line (Mew)
bull Distance from most anterior point on nose to upper incisal edge
bull Age + 23bull A variable number but important to watch over time
B Hockel 2012
Herersquos the ldquoinsiderdquo look Notice how the upper front teeth are closer to the nose (yellow arrows)
Notice how the lower jaw rotates around the star so the chin comes up and forward (red arrow)How do we make this happen
Using IndicatorCosmetic Line
bull To define a starting pointbull To set treatment goalsbull To track treatment progressbull To gauge the effectiveness of treatment
Charting the InCos Line
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Incisor pulled away from noseNot ldquoundertorquedrdquo or ldquogummy smilerdquo
Hypothetical ClI OrthoMARA
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
OJ = 7mm
Starts Ortho
ldquoGreat Headgear
Effectrdquo
Class II Elastics
50
40
30
20mm
y J F M A M J J A S O N
boys
Start Non-x
Expansion UncrowdingFinished
Start Cl II elastics
OK thatrsquos
enough
Hypothetical Mouthbreather(Dr Mewrsquos Hamster Boy)
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Boy gets
hamster
MFT
Hypothetical BBO 7yoM
50
40
30
20
5 6 7 8 9 10 11 12 13 14 15
girlsboys
Initial
StartBB1
BB3
Night
bullLR 11-9yFbullMissing all 5s6s8s and upper 4sbullHad ortho to close diastemahellipbullInL = 39bullGP objects to deX plan equil
LR Tx Plan
1Preparation Hang Expanser2deX 3Training BB3 to advance mandible4Myofunctional Therapy5Orthopostural Training6Myobrace to hold7 Reevaluate for dental detailing
LR Spotty progress
50
40
30
20mm
y 313 4 5 6 7 8 9 10 11 12114
2 3
Expanser
Parents dragging30 turnsStart Adv
Rx deXGP
objects
After delays
Equil ersquosBB3
bullLR 12-3 yF (6mo in tx)bullInL = 37 (+2)bull ersquos equilibratedbull OJ =10bull Appliance OJ = 5bull Still accommodating to BB3
Is there a calculus for the Indicator Line
Treatment GoalsBased on Indicator Line
Incisor Goals
Type 1 Treatment Place U1 in ideal position
Biobloc Orthotropics Orthognathic Surgery Distraction Osteogenesis
Type 1 Ideal InCos line
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
YZ 9yo M
bullLost upper d-spacebullInL = 36(+4)bullOJ = 9mmbullLip entrapmentbullLip Incompetence
Y Z 9yo M
Y Z 9yo M9mm OJ
Y Z 9yo M
Treatment Options
1 Type 1 Reduce InL open lost space BB3 to advance mandible
2 Type 2 Open lost space Align
3 Type 4 Extract four premolars
YZ 9yoM
50
40
30
20mm
yM A M J J A S O N D J F M A
boys
Hang Expanser
Upper and Lower
Brackets Hang Retainer
BB3
Incisor Goals
Type 2 Treatment Develop arch just enough to uncrowd
Biobloc Myofunctional Ortho Myofunctional Therapy Crozat ALF Expansion Orthodontics
Type 2 Uncrowding
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
bullLip incompetencebullLip entrapmentbullHypermentalisbullMouthbreathing
Type 2 Uncrowding
12 month progress
12 month progress
12 month progress
After Treatment
Bent-wire6 monthsMyobrace12 months
Hey RaphaelWhat about that
profile
ZP 9-5yoM
i
After Expansion Phase
Incomplete profile improvement better breathing head posture and sleep
Incisor Goals
Type 3 Treatment Maintain UI
Functional Orthodontics Expansion Orthodontics Distalization Ortho or No Treatment
Type 3 Maintain
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Bimax retrusion
Successful dental result
Profile Unimproved
Incisor Goals
Type 4 Treatment RetractExtrude UI
Extraction Orthodontics Retraction Ortho Distalization Ortho
Type 4 Retraction
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Bimax retrusion
Successful dental result
Failed Profile Result
Changes of pharyngeal airway size and hyoid bone position following orthodontic treatment of
Class I bimaxillary protrusion
Qingzhu Wanga Peizeng Jiab Nina K Andersonc Lin Wangd Jiuxiang Line
Angle Orthodontist Vol 00 No 0 0000 (pre-publication 2012)
ldquothe dimension of the velopharynx glossopharynx and hypopharynx were decreased after maximal retraction of anterior teeth with extraction of four premolarshelliprdquo ldquoAny factors that can influence the posture and position of tongue and soft palate may displace them backward andencroach upon the pharynxrdquo
ldquothe more the incisors were retracted the more the pharyngeal airway was reducedrdquo
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Backed into a corner
bull
Moving teeth faster more efficientlyhellipin the wrong direction
Now that wersquove made smoking unacceptable
could we not do the same withbull Sugarbull Processed foodbull Cheap milk and meatbull Fast foodbull Pill popping for symptomatic reliefbull Looking for the cure instead of the causebull Surgery as a quick fixbull Thinking braces are a status symbol
Each industry thrives on the status quoConsumers must drive the change
NP 10yM
NP
Sisterrsquos non-x ortho
Shersquos happyhellipbut Irsquom not so
I make my pitch for BBO
The dilemma of progress
(I forgot the progress pictureshellip)
Dad sells prosthetic parts to orthopedic surgeons
I selling the case against my previous work they loved
It takes me 3 hours to sell the case
They fret until the BB3 goes in
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Connecting the dots
bull Adult SDB and OSA
bull Narrow jaws and faces
bull Soft tissue dysfunction
bull Early parafunctional habits ie open mouth posture
bull Environmental stressors
bull CPAP MARAUPPP SurgWherersquos the best
place to start treatment here
or here
1 Prevention 2 Undo the damage already done3 Establish good habits
When to start When damage from poor breathing is noticed and when bad habits are discovered
The strategies of Airway Orthodontics
Prevention
bull Remove ankyloglossiabull Promote breastfeedingbull Harden the dietbull Develop masticatory strengthbull Discourage oral habitsbull Promote whole-foods low sugar dietbull Reduce oropharyngeal obstructionbull Promote nasal breathing
Breathing retraining
bull Nasal rinsingbull Nasal clearingbull Decongesting
The goals of Airway Orthodontics
1 Breathing through the nose2 Lips together at rest3 Correct tongue position4 No facial muscles moving on swallowing5 Optimal forward facial development6 Class I occlusion7 Straight teeth8 Better stability long term
Myofunctional Trainers
Professors R Soulet and A Besombes
Dr Earl Bergeson
Dr Chris Farrell
The Multi ndash Family System
Orofacial MyofunctionalTherapy
Oral MyologyMyofunctional TherapyTongue Thrust Therapy
B Hockel 2012 Back
Undoing Bimaxillary Dysplasia
1 Maxillary deconstriction2 Maxillary advancement3 Maxillary impaction4 Mandibular advancement
1 Maxillary Expansion
Treatment for Bimaxillary Dysplasia
ALFCrozat
Bent Wire
HyraxHaas
Niti Exp BioBlocSchwartz
The Farrell BENT WIRE Systemtrade
Recommended Age Group 5-12 yrs
Arch Development in conjunction with the TRAINER Systemtrade
Dr John Mew
Establish Good Habits
1 Breathing through the nose2 Lips together at rest3 Correct tongue position4 No facial muscles moving on swallowing5 Stand and sit in balance6 Breath gently using the diaphragm7 Eat to nourish8 Sleep to rest
Ortho-Postural TrainingWorkshops
Breathing
Nutrition
Posture
Sleep
COPYRIGHTRoger L PriceOctober 2012
Posture Number
Forward head posturecan be a compensationfor a deficient airway
Sleep Screening and Hygiene
SQI = 10 SQI = 98
Integrative Healthcare
Function ProfessionalNasal clearing ENT Pulm MFT BreathingMuscle balance and tone MFT Myofunctional OrthoUndoing damage GP Pedo Ortho OMFSBreathing dynamics OPT MFT Breath PhysiologistPosture DC OPT PT OsteopathCranial balance OsteopathNutrition RDH Nutritionist Dietitian Sleep ENT Sleep Med DentNeurocognitive development Pedrsquon SLP Psych SpEd
The Interdisciplinary Center
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Now that I know
My personal missionTo create from what Irsquove
learned from the besta model for others to followhellipespecially the orthodontists
Myofunctional Orthodontics
Chris Farrell
John Flutter
German Ramierez
Damien OrsquoBrien
Myofunctional Research CoRancho Cucamonga
2008-2012
Oral Myology
Oral Myology Basic CourseJoy MoellerNYC 2011LA 2012
Oral Myology Levels 2 3Kim BenkertClifton 2012
Habit CessationShari GreenClifton 2013
Biobloc Orthotropics
BBO Mini-residencyBill Hang
Agora Hills2012-13
BBO IntensiveDrs John and Mike
MewLSFO2013
Breathing and Sleep
Buteyko MentorshipThe Breathing Center
Woodstock2010
Breathing Well ProgrammeJohn Flutter
2010 Ortho-Postural TrainingRoger Price
2013
Sleep DentistryMichael Gelb etal
NYU2012
ALF and Cranial
Jim Bronson2013 Tasha Turzo
Cranial Academy2014
Bucket Listbull ALF and Crozat (Bronsonrsquos course)bullMore on Biobloc (Hangrsquos Advanced London School)bull More Cranial (The Farm)bullChirodontics (Bob Walker)bull Airway Dentistry with Marc Cruz Jeff Rousebull Sleep Dentistrybull Less-than-Six with Kevin Boydbull Intra-mandibular Distraction Osteogenesis (IMDO)
Off My ListAnything that moves the teeth faster in the wrong direction
Whatrsquos an RO to do
To create from what Irsquove learned from the best
a model for others to followhellipespecially orthodontists
Teaching
Mt Sinai Pedo ResidencyAli Attaie
2010-2012
Montefiore Ortho ResidencyTony Maganzini
2012
2009-Present
Mt Sinai School of MedicinePedodontic Residency
Guest SpeakersJim BronsonMike MewKevin BoydSandra KahnJennifer TowRoger PricePaula Fabbie
Damien OrsquoBrien
First clinical program in myofunctional orthodontics
Airway and Facial DevelopmentCollaborative Webcast
Mark Cruz
AAPMD Symposium
wwwaapm
dorg
Annual MeetingApril 25-26 2014
Westin Chicago North Shore
the raphael center for integrative orthodontics
wwwalignminecomwwwbioblocnjcom
wwwmyobracenjcom
Integrative vs Conventional
Integrative vs Conventional
ldquoWith improvements in expansion orthodontics advances in myofunctional orthodontics and the growing recognition about sleep disordered breathing among children and adults it is time for orthodontics to expand its horizons There is now so much more we can oerrdquo
The Raphael name has been associated with high quality orthodontics in New Jersey for over 60 years Dr Barry Raphael has been a university trained orthodontic specialist and a member of the American Association of Orthodontists for 30 years
He has a wide range of techniques and services to offer He has studied oral myology applied kinesiology Buteyko breathing Biobloc Orthotropics and Myobrace as part of his integrative training He can offer Damon Invisalign Insignia and Incognito appliances designs as some of his many conventional orthodontic services too
Dr Raphael teaches his techniques at post-graduate residencies study clubs dental societies and for the Myofunctional Research Co He is available for presentations to any group interested in learning more about the benefits of integrative orthodontics
wwwalignminecomLearn about the choices you have in orthodontics
dr barry raphael Why its
too Early never
1425
bro
ad
str
ee
tc
lifto
n n
j 070
13
973-
778-
4222
fax
973-
778-
9625
nj s
pe
c
368
4
1425 broad street clifton nj 07013973-778-4222
wwwalignminecom
the raphael centerforintegrative orthodontics
the
raph
ael c
ente
r fo
rin
tegr
ativ
e or
thod
onti
cs
Learn about an important choice you need to make before starting braces
the raphael center for integrative education
the raphael center for integrative education
Ongoing Intro to Airway Orthodontics
April Biobloc Study Group
April Training Ortho-Postural Therapists w Roger Price
June MRC Myobrace Basic Series
August Airway Dentistry with Mark Cruz and company
October Advanced MFT with Sandy Coulson
October Less than Six with Kevin Boyd
(who else wants to play)
Mission to create a space for spreading the word about Airway and Orthotropic principles and practice
Orthodontics in the 21st Century
EstheticOrthodontics
AirwayOrthodontics
GeneticTooth-Focused
Dental PerfectionEsthetics Primary
Treating SymptomsAirway Ignorant
AdaptationMuscle-FocusedMedical Better
Esthetics SecondaryTreating Causes
Airway Conscious
The EndAnd
The Beginning
While talking
While talking does your child talk very fast talk very slowly gasp for air have a lisp take speech lessons
During a meal
During a meal does your child gasp for air while eating stick his tongue between his teeth when swallowing stick the tongue out to meet the drinking glass drink a lot while eating make noises when chewing eat sloppily take a breath before drinking puff the cheeks out when drinking make the lips purse when swallowing make the chin ldquocrinklerdquo when swallowing bob the head when swallowing have trouble sitting still
While sleeping
While sleeping does your child have the mouth open snore wet the bed toss and turn tilt the head back wake up frequently have frequent nightmares have abnormal sleep issues grind the teeth have trouble waking up wake with darker circles under eyes
S R 10-10yo M
bullMissing 3242bullImpacted 1323bullLate mixed 25 eruptedbullSoft tissue dysfunctionbullIL = 40bullNot compliant
S Reardon 10-7yo M
Impacted 3s Missing 2s
Medical history
bull Reactive Airway Diseasebull ldquoBronchial Constrictionrdquo bullCare of Pulmonologistbull Preventil
bull Dad OSA CPAP for 11 years diabetesbull Grandfather OSA untreatedbull ETCO2 = 361 at 10 bpm (acceptable)bull Posture number - 18 (lt10 ideal)bull Father refuses sleep screening
Treatment Options1 Extract upper premolars Align2Open spaces for impacted canines Open spaces for lower lateral implants
Whatrsquos more importantEase of treatment
OrBreathing well at night
Bolton Standards15yo
The Maxilla is Down and Back
The Mandible is Retrognathic
Nasal Cartilage Collapse
Insufficient Facial Support
Bi-maxillary Retrusion
Bimaxillary Retrusion Forward Growth
Mouthbreathers have significantly smaller airway space
(measurements PAS-OccL PAS-UP airway volume area and minimum axial area)
Mouth breather Nasal breather
Three-dimensional assessment of pharyngeal airway in nasal- and mouth-breathing children
Alves M etal Int J Ped ORL 75 (2011) 1195ndash1199
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
B Hockel 2012
This is the profile Biobloc children start with long and retrusive
This is the profile Biobloc children finish with Forward with lips
together
B Hockel 2012
Herersquos the ldquoinsiderdquo look Notice how the upper front teeth are closer to the nose (yellow arrows)
Notice how the lower jaw rotates around the star so the chin comes up and forward (red arrow)How do we make this happen
From the tip of the Central
To the Forwardmost Tip of the Nose
41mm
Maxillary Heightbull Indicator Line (Mew)
bull Distance from most anterior point on nose to upper incisal edge
bull Age + 23bull A variable number but important to watch over time
B Hockel 2012
Herersquos the ldquoinsiderdquo look Notice how the upper front teeth are closer to the nose (yellow arrows)
Notice how the lower jaw rotates around the star so the chin comes up and forward (red arrow)How do we make this happen
Using IndicatorCosmetic Line
bull To define a starting pointbull To set treatment goalsbull To track treatment progressbull To gauge the effectiveness of treatment
Charting the InCos Line
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Incisor pulled away from noseNot ldquoundertorquedrdquo or ldquogummy smilerdquo
Hypothetical ClI OrthoMARA
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
OJ = 7mm
Starts Ortho
ldquoGreat Headgear
Effectrdquo
Class II Elastics
50
40
30
20mm
y J F M A M J J A S O N
boys
Start Non-x
Expansion UncrowdingFinished
Start Cl II elastics
OK thatrsquos
enough
Hypothetical Mouthbreather(Dr Mewrsquos Hamster Boy)
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Boy gets
hamster
MFT
Hypothetical BBO 7yoM
50
40
30
20
5 6 7 8 9 10 11 12 13 14 15
girlsboys
Initial
StartBB1
BB3
Night
bullLR 11-9yFbullMissing all 5s6s8s and upper 4sbullHad ortho to close diastemahellipbullInL = 39bullGP objects to deX plan equil
LR Tx Plan
1Preparation Hang Expanser2deX 3Training BB3 to advance mandible4Myofunctional Therapy5Orthopostural Training6Myobrace to hold7 Reevaluate for dental detailing
LR Spotty progress
50
40
30
20mm
y 313 4 5 6 7 8 9 10 11 12114
2 3
Expanser
Parents dragging30 turnsStart Adv
Rx deXGP
objects
After delays
Equil ersquosBB3
bullLR 12-3 yF (6mo in tx)bullInL = 37 (+2)bull ersquos equilibratedbull OJ =10bull Appliance OJ = 5bull Still accommodating to BB3
Is there a calculus for the Indicator Line
Treatment GoalsBased on Indicator Line
Incisor Goals
Type 1 Treatment Place U1 in ideal position
Biobloc Orthotropics Orthognathic Surgery Distraction Osteogenesis
Type 1 Ideal InCos line
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
YZ 9yo M
bullLost upper d-spacebullInL = 36(+4)bullOJ = 9mmbullLip entrapmentbullLip Incompetence
Y Z 9yo M
Y Z 9yo M9mm OJ
Y Z 9yo M
Treatment Options
1 Type 1 Reduce InL open lost space BB3 to advance mandible
2 Type 2 Open lost space Align
3 Type 4 Extract four premolars
YZ 9yoM
50
40
30
20mm
yM A M J J A S O N D J F M A
boys
Hang Expanser
Upper and Lower
Brackets Hang Retainer
BB3
Incisor Goals
Type 2 Treatment Develop arch just enough to uncrowd
Biobloc Myofunctional Ortho Myofunctional Therapy Crozat ALF Expansion Orthodontics
Type 2 Uncrowding
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
bullLip incompetencebullLip entrapmentbullHypermentalisbullMouthbreathing
Type 2 Uncrowding
12 month progress
12 month progress
12 month progress
After Treatment
Bent-wire6 monthsMyobrace12 months
Hey RaphaelWhat about that
profile
ZP 9-5yoM
i
After Expansion Phase
Incomplete profile improvement better breathing head posture and sleep
Incisor Goals
Type 3 Treatment Maintain UI
Functional Orthodontics Expansion Orthodontics Distalization Ortho or No Treatment
Type 3 Maintain
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Bimax retrusion
Successful dental result
Profile Unimproved
Incisor Goals
Type 4 Treatment RetractExtrude UI
Extraction Orthodontics Retraction Ortho Distalization Ortho
Type 4 Retraction
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Bimax retrusion
Successful dental result
Failed Profile Result
Changes of pharyngeal airway size and hyoid bone position following orthodontic treatment of
Class I bimaxillary protrusion
Qingzhu Wanga Peizeng Jiab Nina K Andersonc Lin Wangd Jiuxiang Line
Angle Orthodontist Vol 00 No 0 0000 (pre-publication 2012)
ldquothe dimension of the velopharynx glossopharynx and hypopharynx were decreased after maximal retraction of anterior teeth with extraction of four premolarshelliprdquo ldquoAny factors that can influence the posture and position of tongue and soft palate may displace them backward andencroach upon the pharynxrdquo
ldquothe more the incisors were retracted the more the pharyngeal airway was reducedrdquo
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Backed into a corner
bull
Moving teeth faster more efficientlyhellipin the wrong direction
Now that wersquove made smoking unacceptable
could we not do the same withbull Sugarbull Processed foodbull Cheap milk and meatbull Fast foodbull Pill popping for symptomatic reliefbull Looking for the cure instead of the causebull Surgery as a quick fixbull Thinking braces are a status symbol
Each industry thrives on the status quoConsumers must drive the change
NP 10yM
NP
Sisterrsquos non-x ortho
Shersquos happyhellipbut Irsquom not so
I make my pitch for BBO
The dilemma of progress
(I forgot the progress pictureshellip)
Dad sells prosthetic parts to orthopedic surgeons
I selling the case against my previous work they loved
It takes me 3 hours to sell the case
They fret until the BB3 goes in
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Connecting the dots
bull Adult SDB and OSA
bull Narrow jaws and faces
bull Soft tissue dysfunction
bull Early parafunctional habits ie open mouth posture
bull Environmental stressors
bull CPAP MARAUPPP SurgWherersquos the best
place to start treatment here
or here
1 Prevention 2 Undo the damage already done3 Establish good habits
When to start When damage from poor breathing is noticed and when bad habits are discovered
The strategies of Airway Orthodontics
Prevention
bull Remove ankyloglossiabull Promote breastfeedingbull Harden the dietbull Develop masticatory strengthbull Discourage oral habitsbull Promote whole-foods low sugar dietbull Reduce oropharyngeal obstructionbull Promote nasal breathing
Breathing retraining
bull Nasal rinsingbull Nasal clearingbull Decongesting
The goals of Airway Orthodontics
1 Breathing through the nose2 Lips together at rest3 Correct tongue position4 No facial muscles moving on swallowing5 Optimal forward facial development6 Class I occlusion7 Straight teeth8 Better stability long term
Myofunctional Trainers
Professors R Soulet and A Besombes
Dr Earl Bergeson
Dr Chris Farrell
The Multi ndash Family System
Orofacial MyofunctionalTherapy
Oral MyologyMyofunctional TherapyTongue Thrust Therapy
B Hockel 2012 Back
Undoing Bimaxillary Dysplasia
1 Maxillary deconstriction2 Maxillary advancement3 Maxillary impaction4 Mandibular advancement
1 Maxillary Expansion
Treatment for Bimaxillary Dysplasia
ALFCrozat
Bent Wire
HyraxHaas
Niti Exp BioBlocSchwartz
The Farrell BENT WIRE Systemtrade
Recommended Age Group 5-12 yrs
Arch Development in conjunction with the TRAINER Systemtrade
Dr John Mew
Establish Good Habits
1 Breathing through the nose2 Lips together at rest3 Correct tongue position4 No facial muscles moving on swallowing5 Stand and sit in balance6 Breath gently using the diaphragm7 Eat to nourish8 Sleep to rest
Ortho-Postural TrainingWorkshops
Breathing
Nutrition
Posture
Sleep
COPYRIGHTRoger L PriceOctober 2012
Posture Number
Forward head posturecan be a compensationfor a deficient airway
Sleep Screening and Hygiene
SQI = 10 SQI = 98
Integrative Healthcare
Function ProfessionalNasal clearing ENT Pulm MFT BreathingMuscle balance and tone MFT Myofunctional OrthoUndoing damage GP Pedo Ortho OMFSBreathing dynamics OPT MFT Breath PhysiologistPosture DC OPT PT OsteopathCranial balance OsteopathNutrition RDH Nutritionist Dietitian Sleep ENT Sleep Med DentNeurocognitive development Pedrsquon SLP Psych SpEd
The Interdisciplinary Center
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Now that I know
My personal missionTo create from what Irsquove
learned from the besta model for others to followhellipespecially the orthodontists
Myofunctional Orthodontics
Chris Farrell
John Flutter
German Ramierez
Damien OrsquoBrien
Myofunctional Research CoRancho Cucamonga
2008-2012
Oral Myology
Oral Myology Basic CourseJoy MoellerNYC 2011LA 2012
Oral Myology Levels 2 3Kim BenkertClifton 2012
Habit CessationShari GreenClifton 2013
Biobloc Orthotropics
BBO Mini-residencyBill Hang
Agora Hills2012-13
BBO IntensiveDrs John and Mike
MewLSFO2013
Breathing and Sleep
Buteyko MentorshipThe Breathing Center
Woodstock2010
Breathing Well ProgrammeJohn Flutter
2010 Ortho-Postural TrainingRoger Price
2013
Sleep DentistryMichael Gelb etal
NYU2012
ALF and Cranial
Jim Bronson2013 Tasha Turzo
Cranial Academy2014
Bucket Listbull ALF and Crozat (Bronsonrsquos course)bullMore on Biobloc (Hangrsquos Advanced London School)bull More Cranial (The Farm)bullChirodontics (Bob Walker)bull Airway Dentistry with Marc Cruz Jeff Rousebull Sleep Dentistrybull Less-than-Six with Kevin Boydbull Intra-mandibular Distraction Osteogenesis (IMDO)
Off My ListAnything that moves the teeth faster in the wrong direction
Whatrsquos an RO to do
To create from what Irsquove learned from the best
a model for others to followhellipespecially orthodontists
Teaching
Mt Sinai Pedo ResidencyAli Attaie
2010-2012
Montefiore Ortho ResidencyTony Maganzini
2012
2009-Present
Mt Sinai School of MedicinePedodontic Residency
Guest SpeakersJim BronsonMike MewKevin BoydSandra KahnJennifer TowRoger PricePaula Fabbie
Damien OrsquoBrien
First clinical program in myofunctional orthodontics
Airway and Facial DevelopmentCollaborative Webcast
Mark Cruz
AAPMD Symposium
wwwaapm
dorg
Annual MeetingApril 25-26 2014
Westin Chicago North Shore
the raphael center for integrative orthodontics
wwwalignminecomwwwbioblocnjcom
wwwmyobracenjcom
Integrative vs Conventional
Integrative vs Conventional
ldquoWith improvements in expansion orthodontics advances in myofunctional orthodontics and the growing recognition about sleep disordered breathing among children and adults it is time for orthodontics to expand its horizons There is now so much more we can oerrdquo
The Raphael name has been associated with high quality orthodontics in New Jersey for over 60 years Dr Barry Raphael has been a university trained orthodontic specialist and a member of the American Association of Orthodontists for 30 years
He has a wide range of techniques and services to offer He has studied oral myology applied kinesiology Buteyko breathing Biobloc Orthotropics and Myobrace as part of his integrative training He can offer Damon Invisalign Insignia and Incognito appliances designs as some of his many conventional orthodontic services too
Dr Raphael teaches his techniques at post-graduate residencies study clubs dental societies and for the Myofunctional Research Co He is available for presentations to any group interested in learning more about the benefits of integrative orthodontics
wwwalignminecomLearn about the choices you have in orthodontics
dr barry raphael Why its
too Early never
1425
bro
ad
str
ee
tc
lifto
n n
j 070
13
973-
778-
4222
fax
973-
778-
9625
nj s
pe
c
368
4
1425 broad street clifton nj 07013973-778-4222
wwwalignminecom
the raphael centerforintegrative orthodontics
the
raph
ael c
ente
r fo
rin
tegr
ativ
e or
thod
onti
cs
Learn about an important choice you need to make before starting braces
the raphael center for integrative education
the raphael center for integrative education
Ongoing Intro to Airway Orthodontics
April Biobloc Study Group
April Training Ortho-Postural Therapists w Roger Price
June MRC Myobrace Basic Series
August Airway Dentistry with Mark Cruz and company
October Advanced MFT with Sandy Coulson
October Less than Six with Kevin Boyd
(who else wants to play)
Mission to create a space for spreading the word about Airway and Orthotropic principles and practice
Orthodontics in the 21st Century
EstheticOrthodontics
AirwayOrthodontics
GeneticTooth-Focused
Dental PerfectionEsthetics Primary
Treating SymptomsAirway Ignorant
AdaptationMuscle-FocusedMedical Better
Esthetics SecondaryTreating Causes
Airway Conscious
The EndAnd
The Beginning
During a meal
During a meal does your child gasp for air while eating stick his tongue between his teeth when swallowing stick the tongue out to meet the drinking glass drink a lot while eating make noises when chewing eat sloppily take a breath before drinking puff the cheeks out when drinking make the lips purse when swallowing make the chin ldquocrinklerdquo when swallowing bob the head when swallowing have trouble sitting still
While sleeping
While sleeping does your child have the mouth open snore wet the bed toss and turn tilt the head back wake up frequently have frequent nightmares have abnormal sleep issues grind the teeth have trouble waking up wake with darker circles under eyes
S R 10-10yo M
bullMissing 3242bullImpacted 1323bullLate mixed 25 eruptedbullSoft tissue dysfunctionbullIL = 40bullNot compliant
S Reardon 10-7yo M
Impacted 3s Missing 2s
Medical history
bull Reactive Airway Diseasebull ldquoBronchial Constrictionrdquo bullCare of Pulmonologistbull Preventil
bull Dad OSA CPAP for 11 years diabetesbull Grandfather OSA untreatedbull ETCO2 = 361 at 10 bpm (acceptable)bull Posture number - 18 (lt10 ideal)bull Father refuses sleep screening
Treatment Options1 Extract upper premolars Align2Open spaces for impacted canines Open spaces for lower lateral implants
Whatrsquos more importantEase of treatment
OrBreathing well at night
Bolton Standards15yo
The Maxilla is Down and Back
The Mandible is Retrognathic
Nasal Cartilage Collapse
Insufficient Facial Support
Bi-maxillary Retrusion
Bimaxillary Retrusion Forward Growth
Mouthbreathers have significantly smaller airway space
(measurements PAS-OccL PAS-UP airway volume area and minimum axial area)
Mouth breather Nasal breather
Three-dimensional assessment of pharyngeal airway in nasal- and mouth-breathing children
Alves M etal Int J Ped ORL 75 (2011) 1195ndash1199
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
B Hockel 2012
This is the profile Biobloc children start with long and retrusive
This is the profile Biobloc children finish with Forward with lips
together
B Hockel 2012
Herersquos the ldquoinsiderdquo look Notice how the upper front teeth are closer to the nose (yellow arrows)
Notice how the lower jaw rotates around the star so the chin comes up and forward (red arrow)How do we make this happen
From the tip of the Central
To the Forwardmost Tip of the Nose
41mm
Maxillary Heightbull Indicator Line (Mew)
bull Distance from most anterior point on nose to upper incisal edge
bull Age + 23bull A variable number but important to watch over time
B Hockel 2012
Herersquos the ldquoinsiderdquo look Notice how the upper front teeth are closer to the nose (yellow arrows)
Notice how the lower jaw rotates around the star so the chin comes up and forward (red arrow)How do we make this happen
Using IndicatorCosmetic Line
bull To define a starting pointbull To set treatment goalsbull To track treatment progressbull To gauge the effectiveness of treatment
Charting the InCos Line
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Incisor pulled away from noseNot ldquoundertorquedrdquo or ldquogummy smilerdquo
Hypothetical ClI OrthoMARA
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
OJ = 7mm
Starts Ortho
ldquoGreat Headgear
Effectrdquo
Class II Elastics
50
40
30
20mm
y J F M A M J J A S O N
boys
Start Non-x
Expansion UncrowdingFinished
Start Cl II elastics
OK thatrsquos
enough
Hypothetical Mouthbreather(Dr Mewrsquos Hamster Boy)
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Boy gets
hamster
MFT
Hypothetical BBO 7yoM
50
40
30
20
5 6 7 8 9 10 11 12 13 14 15
girlsboys
Initial
StartBB1
BB3
Night
bullLR 11-9yFbullMissing all 5s6s8s and upper 4sbullHad ortho to close diastemahellipbullInL = 39bullGP objects to deX plan equil
LR Tx Plan
1Preparation Hang Expanser2deX 3Training BB3 to advance mandible4Myofunctional Therapy5Orthopostural Training6Myobrace to hold7 Reevaluate for dental detailing
LR Spotty progress
50
40
30
20mm
y 313 4 5 6 7 8 9 10 11 12114
2 3
Expanser
Parents dragging30 turnsStart Adv
Rx deXGP
objects
After delays
Equil ersquosBB3
bullLR 12-3 yF (6mo in tx)bullInL = 37 (+2)bull ersquos equilibratedbull OJ =10bull Appliance OJ = 5bull Still accommodating to BB3
Is there a calculus for the Indicator Line
Treatment GoalsBased on Indicator Line
Incisor Goals
Type 1 Treatment Place U1 in ideal position
Biobloc Orthotropics Orthognathic Surgery Distraction Osteogenesis
Type 1 Ideal InCos line
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
YZ 9yo M
bullLost upper d-spacebullInL = 36(+4)bullOJ = 9mmbullLip entrapmentbullLip Incompetence
Y Z 9yo M
Y Z 9yo M9mm OJ
Y Z 9yo M
Treatment Options
1 Type 1 Reduce InL open lost space BB3 to advance mandible
2 Type 2 Open lost space Align
3 Type 4 Extract four premolars
YZ 9yoM
50
40
30
20mm
yM A M J J A S O N D J F M A
boys
Hang Expanser
Upper and Lower
Brackets Hang Retainer
BB3
Incisor Goals
Type 2 Treatment Develop arch just enough to uncrowd
Biobloc Myofunctional Ortho Myofunctional Therapy Crozat ALF Expansion Orthodontics
Type 2 Uncrowding
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
bullLip incompetencebullLip entrapmentbullHypermentalisbullMouthbreathing
Type 2 Uncrowding
12 month progress
12 month progress
12 month progress
After Treatment
Bent-wire6 monthsMyobrace12 months
Hey RaphaelWhat about that
profile
ZP 9-5yoM
i
After Expansion Phase
Incomplete profile improvement better breathing head posture and sleep
Incisor Goals
Type 3 Treatment Maintain UI
Functional Orthodontics Expansion Orthodontics Distalization Ortho or No Treatment
Type 3 Maintain
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Bimax retrusion
Successful dental result
Profile Unimproved
Incisor Goals
Type 4 Treatment RetractExtrude UI
Extraction Orthodontics Retraction Ortho Distalization Ortho
Type 4 Retraction
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Bimax retrusion
Successful dental result
Failed Profile Result
Changes of pharyngeal airway size and hyoid bone position following orthodontic treatment of
Class I bimaxillary protrusion
Qingzhu Wanga Peizeng Jiab Nina K Andersonc Lin Wangd Jiuxiang Line
Angle Orthodontist Vol 00 No 0 0000 (pre-publication 2012)
ldquothe dimension of the velopharynx glossopharynx and hypopharynx were decreased after maximal retraction of anterior teeth with extraction of four premolarshelliprdquo ldquoAny factors that can influence the posture and position of tongue and soft palate may displace them backward andencroach upon the pharynxrdquo
ldquothe more the incisors were retracted the more the pharyngeal airway was reducedrdquo
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Backed into a corner
bull
Moving teeth faster more efficientlyhellipin the wrong direction
Now that wersquove made smoking unacceptable
could we not do the same withbull Sugarbull Processed foodbull Cheap milk and meatbull Fast foodbull Pill popping for symptomatic reliefbull Looking for the cure instead of the causebull Surgery as a quick fixbull Thinking braces are a status symbol
Each industry thrives on the status quoConsumers must drive the change
NP 10yM
NP
Sisterrsquos non-x ortho
Shersquos happyhellipbut Irsquom not so
I make my pitch for BBO
The dilemma of progress
(I forgot the progress pictureshellip)
Dad sells prosthetic parts to orthopedic surgeons
I selling the case against my previous work they loved
It takes me 3 hours to sell the case
They fret until the BB3 goes in
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Connecting the dots
bull Adult SDB and OSA
bull Narrow jaws and faces
bull Soft tissue dysfunction
bull Early parafunctional habits ie open mouth posture
bull Environmental stressors
bull CPAP MARAUPPP SurgWherersquos the best
place to start treatment here
or here
1 Prevention 2 Undo the damage already done3 Establish good habits
When to start When damage from poor breathing is noticed and when bad habits are discovered
The strategies of Airway Orthodontics
Prevention
bull Remove ankyloglossiabull Promote breastfeedingbull Harden the dietbull Develop masticatory strengthbull Discourage oral habitsbull Promote whole-foods low sugar dietbull Reduce oropharyngeal obstructionbull Promote nasal breathing
Breathing retraining
bull Nasal rinsingbull Nasal clearingbull Decongesting
The goals of Airway Orthodontics
1 Breathing through the nose2 Lips together at rest3 Correct tongue position4 No facial muscles moving on swallowing5 Optimal forward facial development6 Class I occlusion7 Straight teeth8 Better stability long term
Myofunctional Trainers
Professors R Soulet and A Besombes
Dr Earl Bergeson
Dr Chris Farrell
The Multi ndash Family System
Orofacial MyofunctionalTherapy
Oral MyologyMyofunctional TherapyTongue Thrust Therapy
B Hockel 2012 Back
Undoing Bimaxillary Dysplasia
1 Maxillary deconstriction2 Maxillary advancement3 Maxillary impaction4 Mandibular advancement
1 Maxillary Expansion
Treatment for Bimaxillary Dysplasia
ALFCrozat
Bent Wire
HyraxHaas
Niti Exp BioBlocSchwartz
The Farrell BENT WIRE Systemtrade
Recommended Age Group 5-12 yrs
Arch Development in conjunction with the TRAINER Systemtrade
Dr John Mew
Establish Good Habits
1 Breathing through the nose2 Lips together at rest3 Correct tongue position4 No facial muscles moving on swallowing5 Stand and sit in balance6 Breath gently using the diaphragm7 Eat to nourish8 Sleep to rest
Ortho-Postural TrainingWorkshops
Breathing
Nutrition
Posture
Sleep
COPYRIGHTRoger L PriceOctober 2012
Posture Number
Forward head posturecan be a compensationfor a deficient airway
Sleep Screening and Hygiene
SQI = 10 SQI = 98
Integrative Healthcare
Function ProfessionalNasal clearing ENT Pulm MFT BreathingMuscle balance and tone MFT Myofunctional OrthoUndoing damage GP Pedo Ortho OMFSBreathing dynamics OPT MFT Breath PhysiologistPosture DC OPT PT OsteopathCranial balance OsteopathNutrition RDH Nutritionist Dietitian Sleep ENT Sleep Med DentNeurocognitive development Pedrsquon SLP Psych SpEd
The Interdisciplinary Center
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Now that I know
My personal missionTo create from what Irsquove
learned from the besta model for others to followhellipespecially the orthodontists
Myofunctional Orthodontics
Chris Farrell
John Flutter
German Ramierez
Damien OrsquoBrien
Myofunctional Research CoRancho Cucamonga
2008-2012
Oral Myology
Oral Myology Basic CourseJoy MoellerNYC 2011LA 2012
Oral Myology Levels 2 3Kim BenkertClifton 2012
Habit CessationShari GreenClifton 2013
Biobloc Orthotropics
BBO Mini-residencyBill Hang
Agora Hills2012-13
BBO IntensiveDrs John and Mike
MewLSFO2013
Breathing and Sleep
Buteyko MentorshipThe Breathing Center
Woodstock2010
Breathing Well ProgrammeJohn Flutter
2010 Ortho-Postural TrainingRoger Price
2013
Sleep DentistryMichael Gelb etal
NYU2012
ALF and Cranial
Jim Bronson2013 Tasha Turzo
Cranial Academy2014
Bucket Listbull ALF and Crozat (Bronsonrsquos course)bullMore on Biobloc (Hangrsquos Advanced London School)bull More Cranial (The Farm)bullChirodontics (Bob Walker)bull Airway Dentistry with Marc Cruz Jeff Rousebull Sleep Dentistrybull Less-than-Six with Kevin Boydbull Intra-mandibular Distraction Osteogenesis (IMDO)
Off My ListAnything that moves the teeth faster in the wrong direction
Whatrsquos an RO to do
To create from what Irsquove learned from the best
a model for others to followhellipespecially orthodontists
Teaching
Mt Sinai Pedo ResidencyAli Attaie
2010-2012
Montefiore Ortho ResidencyTony Maganzini
2012
2009-Present
Mt Sinai School of MedicinePedodontic Residency
Guest SpeakersJim BronsonMike MewKevin BoydSandra KahnJennifer TowRoger PricePaula Fabbie
Damien OrsquoBrien
First clinical program in myofunctional orthodontics
Airway and Facial DevelopmentCollaborative Webcast
Mark Cruz
AAPMD Symposium
wwwaapm
dorg
Annual MeetingApril 25-26 2014
Westin Chicago North Shore
the raphael center for integrative orthodontics
wwwalignminecomwwwbioblocnjcom
wwwmyobracenjcom
Integrative vs Conventional
Integrative vs Conventional
ldquoWith improvements in expansion orthodontics advances in myofunctional orthodontics and the growing recognition about sleep disordered breathing among children and adults it is time for orthodontics to expand its horizons There is now so much more we can oerrdquo
The Raphael name has been associated with high quality orthodontics in New Jersey for over 60 years Dr Barry Raphael has been a university trained orthodontic specialist and a member of the American Association of Orthodontists for 30 years
He has a wide range of techniques and services to offer He has studied oral myology applied kinesiology Buteyko breathing Biobloc Orthotropics and Myobrace as part of his integrative training He can offer Damon Invisalign Insignia and Incognito appliances designs as some of his many conventional orthodontic services too
Dr Raphael teaches his techniques at post-graduate residencies study clubs dental societies and for the Myofunctional Research Co He is available for presentations to any group interested in learning more about the benefits of integrative orthodontics
wwwalignminecomLearn about the choices you have in orthodontics
dr barry raphael Why its
too Early never
1425
bro
ad
str
ee
tc
lifto
n n
j 070
13
973-
778-
4222
fax
973-
778-
9625
nj s
pe
c
368
4
1425 broad street clifton nj 07013973-778-4222
wwwalignminecom
the raphael centerforintegrative orthodontics
the
raph
ael c
ente
r fo
rin
tegr
ativ
e or
thod
onti
cs
Learn about an important choice you need to make before starting braces
the raphael center for integrative education
the raphael center for integrative education
Ongoing Intro to Airway Orthodontics
April Biobloc Study Group
April Training Ortho-Postural Therapists w Roger Price
June MRC Myobrace Basic Series
August Airway Dentistry with Mark Cruz and company
October Advanced MFT with Sandy Coulson
October Less than Six with Kevin Boyd
(who else wants to play)
Mission to create a space for spreading the word about Airway and Orthotropic principles and practice
Orthodontics in the 21st Century
EstheticOrthodontics
AirwayOrthodontics
GeneticTooth-Focused
Dental PerfectionEsthetics Primary
Treating SymptomsAirway Ignorant
AdaptationMuscle-FocusedMedical Better
Esthetics SecondaryTreating Causes
Airway Conscious
The EndAnd
The Beginning
While sleeping
While sleeping does your child have the mouth open snore wet the bed toss and turn tilt the head back wake up frequently have frequent nightmares have abnormal sleep issues grind the teeth have trouble waking up wake with darker circles under eyes
S R 10-10yo M
bullMissing 3242bullImpacted 1323bullLate mixed 25 eruptedbullSoft tissue dysfunctionbullIL = 40bullNot compliant
S Reardon 10-7yo M
Impacted 3s Missing 2s
Medical history
bull Reactive Airway Diseasebull ldquoBronchial Constrictionrdquo bullCare of Pulmonologistbull Preventil
bull Dad OSA CPAP for 11 years diabetesbull Grandfather OSA untreatedbull ETCO2 = 361 at 10 bpm (acceptable)bull Posture number - 18 (lt10 ideal)bull Father refuses sleep screening
Treatment Options1 Extract upper premolars Align2Open spaces for impacted canines Open spaces for lower lateral implants
Whatrsquos more importantEase of treatment
OrBreathing well at night
Bolton Standards15yo
The Maxilla is Down and Back
The Mandible is Retrognathic
Nasal Cartilage Collapse
Insufficient Facial Support
Bi-maxillary Retrusion
Bimaxillary Retrusion Forward Growth
Mouthbreathers have significantly smaller airway space
(measurements PAS-OccL PAS-UP airway volume area and minimum axial area)
Mouth breather Nasal breather
Three-dimensional assessment of pharyngeal airway in nasal- and mouth-breathing children
Alves M etal Int J Ped ORL 75 (2011) 1195ndash1199
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
B Hockel 2012
This is the profile Biobloc children start with long and retrusive
This is the profile Biobloc children finish with Forward with lips
together
B Hockel 2012
Herersquos the ldquoinsiderdquo look Notice how the upper front teeth are closer to the nose (yellow arrows)
Notice how the lower jaw rotates around the star so the chin comes up and forward (red arrow)How do we make this happen
From the tip of the Central
To the Forwardmost Tip of the Nose
41mm
Maxillary Heightbull Indicator Line (Mew)
bull Distance from most anterior point on nose to upper incisal edge
bull Age + 23bull A variable number but important to watch over time
B Hockel 2012
Herersquos the ldquoinsiderdquo look Notice how the upper front teeth are closer to the nose (yellow arrows)
Notice how the lower jaw rotates around the star so the chin comes up and forward (red arrow)How do we make this happen
Using IndicatorCosmetic Line
bull To define a starting pointbull To set treatment goalsbull To track treatment progressbull To gauge the effectiveness of treatment
Charting the InCos Line
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Incisor pulled away from noseNot ldquoundertorquedrdquo or ldquogummy smilerdquo
Hypothetical ClI OrthoMARA
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
OJ = 7mm
Starts Ortho
ldquoGreat Headgear
Effectrdquo
Class II Elastics
50
40
30
20mm
y J F M A M J J A S O N
boys
Start Non-x
Expansion UncrowdingFinished
Start Cl II elastics
OK thatrsquos
enough
Hypothetical Mouthbreather(Dr Mewrsquos Hamster Boy)
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Boy gets
hamster
MFT
Hypothetical BBO 7yoM
50
40
30
20
5 6 7 8 9 10 11 12 13 14 15
girlsboys
Initial
StartBB1
BB3
Night
bullLR 11-9yFbullMissing all 5s6s8s and upper 4sbullHad ortho to close diastemahellipbullInL = 39bullGP objects to deX plan equil
LR Tx Plan
1Preparation Hang Expanser2deX 3Training BB3 to advance mandible4Myofunctional Therapy5Orthopostural Training6Myobrace to hold7 Reevaluate for dental detailing
LR Spotty progress
50
40
30
20mm
y 313 4 5 6 7 8 9 10 11 12114
2 3
Expanser
Parents dragging30 turnsStart Adv
Rx deXGP
objects
After delays
Equil ersquosBB3
bullLR 12-3 yF (6mo in tx)bullInL = 37 (+2)bull ersquos equilibratedbull OJ =10bull Appliance OJ = 5bull Still accommodating to BB3
Is there a calculus for the Indicator Line
Treatment GoalsBased on Indicator Line
Incisor Goals
Type 1 Treatment Place U1 in ideal position
Biobloc Orthotropics Orthognathic Surgery Distraction Osteogenesis
Type 1 Ideal InCos line
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
YZ 9yo M
bullLost upper d-spacebullInL = 36(+4)bullOJ = 9mmbullLip entrapmentbullLip Incompetence
Y Z 9yo M
Y Z 9yo M9mm OJ
Y Z 9yo M
Treatment Options
1 Type 1 Reduce InL open lost space BB3 to advance mandible
2 Type 2 Open lost space Align
3 Type 4 Extract four premolars
YZ 9yoM
50
40
30
20mm
yM A M J J A S O N D J F M A
boys
Hang Expanser
Upper and Lower
Brackets Hang Retainer
BB3
Incisor Goals
Type 2 Treatment Develop arch just enough to uncrowd
Biobloc Myofunctional Ortho Myofunctional Therapy Crozat ALF Expansion Orthodontics
Type 2 Uncrowding
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
bullLip incompetencebullLip entrapmentbullHypermentalisbullMouthbreathing
Type 2 Uncrowding
12 month progress
12 month progress
12 month progress
After Treatment
Bent-wire6 monthsMyobrace12 months
Hey RaphaelWhat about that
profile
ZP 9-5yoM
i
After Expansion Phase
Incomplete profile improvement better breathing head posture and sleep
Incisor Goals
Type 3 Treatment Maintain UI
Functional Orthodontics Expansion Orthodontics Distalization Ortho or No Treatment
Type 3 Maintain
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Bimax retrusion
Successful dental result
Profile Unimproved
Incisor Goals
Type 4 Treatment RetractExtrude UI
Extraction Orthodontics Retraction Ortho Distalization Ortho
Type 4 Retraction
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Bimax retrusion
Successful dental result
Failed Profile Result
Changes of pharyngeal airway size and hyoid bone position following orthodontic treatment of
Class I bimaxillary protrusion
Qingzhu Wanga Peizeng Jiab Nina K Andersonc Lin Wangd Jiuxiang Line
Angle Orthodontist Vol 00 No 0 0000 (pre-publication 2012)
ldquothe dimension of the velopharynx glossopharynx and hypopharynx were decreased after maximal retraction of anterior teeth with extraction of four premolarshelliprdquo ldquoAny factors that can influence the posture and position of tongue and soft palate may displace them backward andencroach upon the pharynxrdquo
ldquothe more the incisors were retracted the more the pharyngeal airway was reducedrdquo
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Backed into a corner
bull
Moving teeth faster more efficientlyhellipin the wrong direction
Now that wersquove made smoking unacceptable
could we not do the same withbull Sugarbull Processed foodbull Cheap milk and meatbull Fast foodbull Pill popping for symptomatic reliefbull Looking for the cure instead of the causebull Surgery as a quick fixbull Thinking braces are a status symbol
Each industry thrives on the status quoConsumers must drive the change
NP 10yM
NP
Sisterrsquos non-x ortho
Shersquos happyhellipbut Irsquom not so
I make my pitch for BBO
The dilemma of progress
(I forgot the progress pictureshellip)
Dad sells prosthetic parts to orthopedic surgeons
I selling the case against my previous work they loved
It takes me 3 hours to sell the case
They fret until the BB3 goes in
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Connecting the dots
bull Adult SDB and OSA
bull Narrow jaws and faces
bull Soft tissue dysfunction
bull Early parafunctional habits ie open mouth posture
bull Environmental stressors
bull CPAP MARAUPPP SurgWherersquos the best
place to start treatment here
or here
1 Prevention 2 Undo the damage already done3 Establish good habits
When to start When damage from poor breathing is noticed and when bad habits are discovered
The strategies of Airway Orthodontics
Prevention
bull Remove ankyloglossiabull Promote breastfeedingbull Harden the dietbull Develop masticatory strengthbull Discourage oral habitsbull Promote whole-foods low sugar dietbull Reduce oropharyngeal obstructionbull Promote nasal breathing
Breathing retraining
bull Nasal rinsingbull Nasal clearingbull Decongesting
The goals of Airway Orthodontics
1 Breathing through the nose2 Lips together at rest3 Correct tongue position4 No facial muscles moving on swallowing5 Optimal forward facial development6 Class I occlusion7 Straight teeth8 Better stability long term
Myofunctional Trainers
Professors R Soulet and A Besombes
Dr Earl Bergeson
Dr Chris Farrell
The Multi ndash Family System
Orofacial MyofunctionalTherapy
Oral MyologyMyofunctional TherapyTongue Thrust Therapy
B Hockel 2012 Back
Undoing Bimaxillary Dysplasia
1 Maxillary deconstriction2 Maxillary advancement3 Maxillary impaction4 Mandibular advancement
1 Maxillary Expansion
Treatment for Bimaxillary Dysplasia
ALFCrozat
Bent Wire
HyraxHaas
Niti Exp BioBlocSchwartz
The Farrell BENT WIRE Systemtrade
Recommended Age Group 5-12 yrs
Arch Development in conjunction with the TRAINER Systemtrade
Dr John Mew
Establish Good Habits
1 Breathing through the nose2 Lips together at rest3 Correct tongue position4 No facial muscles moving on swallowing5 Stand and sit in balance6 Breath gently using the diaphragm7 Eat to nourish8 Sleep to rest
Ortho-Postural TrainingWorkshops
Breathing
Nutrition
Posture
Sleep
COPYRIGHTRoger L PriceOctober 2012
Posture Number
Forward head posturecan be a compensationfor a deficient airway
Sleep Screening and Hygiene
SQI = 10 SQI = 98
Integrative Healthcare
Function ProfessionalNasal clearing ENT Pulm MFT BreathingMuscle balance and tone MFT Myofunctional OrthoUndoing damage GP Pedo Ortho OMFSBreathing dynamics OPT MFT Breath PhysiologistPosture DC OPT PT OsteopathCranial balance OsteopathNutrition RDH Nutritionist Dietitian Sleep ENT Sleep Med DentNeurocognitive development Pedrsquon SLP Psych SpEd
The Interdisciplinary Center
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Now that I know
My personal missionTo create from what Irsquove
learned from the besta model for others to followhellipespecially the orthodontists
Myofunctional Orthodontics
Chris Farrell
John Flutter
German Ramierez
Damien OrsquoBrien
Myofunctional Research CoRancho Cucamonga
2008-2012
Oral Myology
Oral Myology Basic CourseJoy MoellerNYC 2011LA 2012
Oral Myology Levels 2 3Kim BenkertClifton 2012
Habit CessationShari GreenClifton 2013
Biobloc Orthotropics
BBO Mini-residencyBill Hang
Agora Hills2012-13
BBO IntensiveDrs John and Mike
MewLSFO2013
Breathing and Sleep
Buteyko MentorshipThe Breathing Center
Woodstock2010
Breathing Well ProgrammeJohn Flutter
2010 Ortho-Postural TrainingRoger Price
2013
Sleep DentistryMichael Gelb etal
NYU2012
ALF and Cranial
Jim Bronson2013 Tasha Turzo
Cranial Academy2014
Bucket Listbull ALF and Crozat (Bronsonrsquos course)bullMore on Biobloc (Hangrsquos Advanced London School)bull More Cranial (The Farm)bullChirodontics (Bob Walker)bull Airway Dentistry with Marc Cruz Jeff Rousebull Sleep Dentistrybull Less-than-Six with Kevin Boydbull Intra-mandibular Distraction Osteogenesis (IMDO)
Off My ListAnything that moves the teeth faster in the wrong direction
Whatrsquos an RO to do
To create from what Irsquove learned from the best
a model for others to followhellipespecially orthodontists
Teaching
Mt Sinai Pedo ResidencyAli Attaie
2010-2012
Montefiore Ortho ResidencyTony Maganzini
2012
2009-Present
Mt Sinai School of MedicinePedodontic Residency
Guest SpeakersJim BronsonMike MewKevin BoydSandra KahnJennifer TowRoger PricePaula Fabbie
Damien OrsquoBrien
First clinical program in myofunctional orthodontics
Airway and Facial DevelopmentCollaborative Webcast
Mark Cruz
AAPMD Symposium
wwwaapm
dorg
Annual MeetingApril 25-26 2014
Westin Chicago North Shore
the raphael center for integrative orthodontics
wwwalignminecomwwwbioblocnjcom
wwwmyobracenjcom
Integrative vs Conventional
Integrative vs Conventional
ldquoWith improvements in expansion orthodontics advances in myofunctional orthodontics and the growing recognition about sleep disordered breathing among children and adults it is time for orthodontics to expand its horizons There is now so much more we can oerrdquo
The Raphael name has been associated with high quality orthodontics in New Jersey for over 60 years Dr Barry Raphael has been a university trained orthodontic specialist and a member of the American Association of Orthodontists for 30 years
He has a wide range of techniques and services to offer He has studied oral myology applied kinesiology Buteyko breathing Biobloc Orthotropics and Myobrace as part of his integrative training He can offer Damon Invisalign Insignia and Incognito appliances designs as some of his many conventional orthodontic services too
Dr Raphael teaches his techniques at post-graduate residencies study clubs dental societies and for the Myofunctional Research Co He is available for presentations to any group interested in learning more about the benefits of integrative orthodontics
wwwalignminecomLearn about the choices you have in orthodontics
dr barry raphael Why its
too Early never
1425
bro
ad
str
ee
tc
lifto
n n
j 070
13
973-
778-
4222
fax
973-
778-
9625
nj s
pe
c
368
4
1425 broad street clifton nj 07013973-778-4222
wwwalignminecom
the raphael centerforintegrative orthodontics
the
raph
ael c
ente
r fo
rin
tegr
ativ
e or
thod
onti
cs
Learn about an important choice you need to make before starting braces
the raphael center for integrative education
the raphael center for integrative education
Ongoing Intro to Airway Orthodontics
April Biobloc Study Group
April Training Ortho-Postural Therapists w Roger Price
June MRC Myobrace Basic Series
August Airway Dentistry with Mark Cruz and company
October Advanced MFT with Sandy Coulson
October Less than Six with Kevin Boyd
(who else wants to play)
Mission to create a space for spreading the word about Airway and Orthotropic principles and practice
Orthodontics in the 21st Century
EstheticOrthodontics
AirwayOrthodontics
GeneticTooth-Focused
Dental PerfectionEsthetics Primary
Treating SymptomsAirway Ignorant
AdaptationMuscle-FocusedMedical Better
Esthetics SecondaryTreating Causes
Airway Conscious
The EndAnd
The Beginning
S R 10-10yo M
bullMissing 3242bullImpacted 1323bullLate mixed 25 eruptedbullSoft tissue dysfunctionbullIL = 40bullNot compliant
S Reardon 10-7yo M
Impacted 3s Missing 2s
Medical history
bull Reactive Airway Diseasebull ldquoBronchial Constrictionrdquo bullCare of Pulmonologistbull Preventil
bull Dad OSA CPAP for 11 years diabetesbull Grandfather OSA untreatedbull ETCO2 = 361 at 10 bpm (acceptable)bull Posture number - 18 (lt10 ideal)bull Father refuses sleep screening
Treatment Options1 Extract upper premolars Align2Open spaces for impacted canines Open spaces for lower lateral implants
Whatrsquos more importantEase of treatment
OrBreathing well at night
Bolton Standards15yo
The Maxilla is Down and Back
The Mandible is Retrognathic
Nasal Cartilage Collapse
Insufficient Facial Support
Bi-maxillary Retrusion
Bimaxillary Retrusion Forward Growth
Mouthbreathers have significantly smaller airway space
(measurements PAS-OccL PAS-UP airway volume area and minimum axial area)
Mouth breather Nasal breather
Three-dimensional assessment of pharyngeal airway in nasal- and mouth-breathing children
Alves M etal Int J Ped ORL 75 (2011) 1195ndash1199
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
B Hockel 2012
This is the profile Biobloc children start with long and retrusive
This is the profile Biobloc children finish with Forward with lips
together
B Hockel 2012
Herersquos the ldquoinsiderdquo look Notice how the upper front teeth are closer to the nose (yellow arrows)
Notice how the lower jaw rotates around the star so the chin comes up and forward (red arrow)How do we make this happen
From the tip of the Central
To the Forwardmost Tip of the Nose
41mm
Maxillary Heightbull Indicator Line (Mew)
bull Distance from most anterior point on nose to upper incisal edge
bull Age + 23bull A variable number but important to watch over time
B Hockel 2012
Herersquos the ldquoinsiderdquo look Notice how the upper front teeth are closer to the nose (yellow arrows)
Notice how the lower jaw rotates around the star so the chin comes up and forward (red arrow)How do we make this happen
Using IndicatorCosmetic Line
bull To define a starting pointbull To set treatment goalsbull To track treatment progressbull To gauge the effectiveness of treatment
Charting the InCos Line
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Incisor pulled away from noseNot ldquoundertorquedrdquo or ldquogummy smilerdquo
Hypothetical ClI OrthoMARA
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
OJ = 7mm
Starts Ortho
ldquoGreat Headgear
Effectrdquo
Class II Elastics
50
40
30
20mm
y J F M A M J J A S O N
boys
Start Non-x
Expansion UncrowdingFinished
Start Cl II elastics
OK thatrsquos
enough
Hypothetical Mouthbreather(Dr Mewrsquos Hamster Boy)
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Boy gets
hamster
MFT
Hypothetical BBO 7yoM
50
40
30
20
5 6 7 8 9 10 11 12 13 14 15
girlsboys
Initial
StartBB1
BB3
Night
bullLR 11-9yFbullMissing all 5s6s8s and upper 4sbullHad ortho to close diastemahellipbullInL = 39bullGP objects to deX plan equil
LR Tx Plan
1Preparation Hang Expanser2deX 3Training BB3 to advance mandible4Myofunctional Therapy5Orthopostural Training6Myobrace to hold7 Reevaluate for dental detailing
LR Spotty progress
50
40
30
20mm
y 313 4 5 6 7 8 9 10 11 12114
2 3
Expanser
Parents dragging30 turnsStart Adv
Rx deXGP
objects
After delays
Equil ersquosBB3
bullLR 12-3 yF (6mo in tx)bullInL = 37 (+2)bull ersquos equilibratedbull OJ =10bull Appliance OJ = 5bull Still accommodating to BB3
Is there a calculus for the Indicator Line
Treatment GoalsBased on Indicator Line
Incisor Goals
Type 1 Treatment Place U1 in ideal position
Biobloc Orthotropics Orthognathic Surgery Distraction Osteogenesis
Type 1 Ideal InCos line
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
YZ 9yo M
bullLost upper d-spacebullInL = 36(+4)bullOJ = 9mmbullLip entrapmentbullLip Incompetence
Y Z 9yo M
Y Z 9yo M9mm OJ
Y Z 9yo M
Treatment Options
1 Type 1 Reduce InL open lost space BB3 to advance mandible
2 Type 2 Open lost space Align
3 Type 4 Extract four premolars
YZ 9yoM
50
40
30
20mm
yM A M J J A S O N D J F M A
boys
Hang Expanser
Upper and Lower
Brackets Hang Retainer
BB3
Incisor Goals
Type 2 Treatment Develop arch just enough to uncrowd
Biobloc Myofunctional Ortho Myofunctional Therapy Crozat ALF Expansion Orthodontics
Type 2 Uncrowding
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
bullLip incompetencebullLip entrapmentbullHypermentalisbullMouthbreathing
Type 2 Uncrowding
12 month progress
12 month progress
12 month progress
After Treatment
Bent-wire6 monthsMyobrace12 months
Hey RaphaelWhat about that
profile
ZP 9-5yoM
i
After Expansion Phase
Incomplete profile improvement better breathing head posture and sleep
Incisor Goals
Type 3 Treatment Maintain UI
Functional Orthodontics Expansion Orthodontics Distalization Ortho or No Treatment
Type 3 Maintain
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Bimax retrusion
Successful dental result
Profile Unimproved
Incisor Goals
Type 4 Treatment RetractExtrude UI
Extraction Orthodontics Retraction Ortho Distalization Ortho
Type 4 Retraction
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Bimax retrusion
Successful dental result
Failed Profile Result
Changes of pharyngeal airway size and hyoid bone position following orthodontic treatment of
Class I bimaxillary protrusion
Qingzhu Wanga Peizeng Jiab Nina K Andersonc Lin Wangd Jiuxiang Line
Angle Orthodontist Vol 00 No 0 0000 (pre-publication 2012)
ldquothe dimension of the velopharynx glossopharynx and hypopharynx were decreased after maximal retraction of anterior teeth with extraction of four premolarshelliprdquo ldquoAny factors that can influence the posture and position of tongue and soft palate may displace them backward andencroach upon the pharynxrdquo
ldquothe more the incisors were retracted the more the pharyngeal airway was reducedrdquo
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Backed into a corner
bull
Moving teeth faster more efficientlyhellipin the wrong direction
Now that wersquove made smoking unacceptable
could we not do the same withbull Sugarbull Processed foodbull Cheap milk and meatbull Fast foodbull Pill popping for symptomatic reliefbull Looking for the cure instead of the causebull Surgery as a quick fixbull Thinking braces are a status symbol
Each industry thrives on the status quoConsumers must drive the change
NP 10yM
NP
Sisterrsquos non-x ortho
Shersquos happyhellipbut Irsquom not so
I make my pitch for BBO
The dilemma of progress
(I forgot the progress pictureshellip)
Dad sells prosthetic parts to orthopedic surgeons
I selling the case against my previous work they loved
It takes me 3 hours to sell the case
They fret until the BB3 goes in
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Connecting the dots
bull Adult SDB and OSA
bull Narrow jaws and faces
bull Soft tissue dysfunction
bull Early parafunctional habits ie open mouth posture
bull Environmental stressors
bull CPAP MARAUPPP SurgWherersquos the best
place to start treatment here
or here
1 Prevention 2 Undo the damage already done3 Establish good habits
When to start When damage from poor breathing is noticed and when bad habits are discovered
The strategies of Airway Orthodontics
Prevention
bull Remove ankyloglossiabull Promote breastfeedingbull Harden the dietbull Develop masticatory strengthbull Discourage oral habitsbull Promote whole-foods low sugar dietbull Reduce oropharyngeal obstructionbull Promote nasal breathing
Breathing retraining
bull Nasal rinsingbull Nasal clearingbull Decongesting
The goals of Airway Orthodontics
1 Breathing through the nose2 Lips together at rest3 Correct tongue position4 No facial muscles moving on swallowing5 Optimal forward facial development6 Class I occlusion7 Straight teeth8 Better stability long term
Myofunctional Trainers
Professors R Soulet and A Besombes
Dr Earl Bergeson
Dr Chris Farrell
The Multi ndash Family System
Orofacial MyofunctionalTherapy
Oral MyologyMyofunctional TherapyTongue Thrust Therapy
B Hockel 2012 Back
Undoing Bimaxillary Dysplasia
1 Maxillary deconstriction2 Maxillary advancement3 Maxillary impaction4 Mandibular advancement
1 Maxillary Expansion
Treatment for Bimaxillary Dysplasia
ALFCrozat
Bent Wire
HyraxHaas
Niti Exp BioBlocSchwartz
The Farrell BENT WIRE Systemtrade
Recommended Age Group 5-12 yrs
Arch Development in conjunction with the TRAINER Systemtrade
Dr John Mew
Establish Good Habits
1 Breathing through the nose2 Lips together at rest3 Correct tongue position4 No facial muscles moving on swallowing5 Stand and sit in balance6 Breath gently using the diaphragm7 Eat to nourish8 Sleep to rest
Ortho-Postural TrainingWorkshops
Breathing
Nutrition
Posture
Sleep
COPYRIGHTRoger L PriceOctober 2012
Posture Number
Forward head posturecan be a compensationfor a deficient airway
Sleep Screening and Hygiene
SQI = 10 SQI = 98
Integrative Healthcare
Function ProfessionalNasal clearing ENT Pulm MFT BreathingMuscle balance and tone MFT Myofunctional OrthoUndoing damage GP Pedo Ortho OMFSBreathing dynamics OPT MFT Breath PhysiologistPosture DC OPT PT OsteopathCranial balance OsteopathNutrition RDH Nutritionist Dietitian Sleep ENT Sleep Med DentNeurocognitive development Pedrsquon SLP Psych SpEd
The Interdisciplinary Center
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Now that I know
My personal missionTo create from what Irsquove
learned from the besta model for others to followhellipespecially the orthodontists
Myofunctional Orthodontics
Chris Farrell
John Flutter
German Ramierez
Damien OrsquoBrien
Myofunctional Research CoRancho Cucamonga
2008-2012
Oral Myology
Oral Myology Basic CourseJoy MoellerNYC 2011LA 2012
Oral Myology Levels 2 3Kim BenkertClifton 2012
Habit CessationShari GreenClifton 2013
Biobloc Orthotropics
BBO Mini-residencyBill Hang
Agora Hills2012-13
BBO IntensiveDrs John and Mike
MewLSFO2013
Breathing and Sleep
Buteyko MentorshipThe Breathing Center
Woodstock2010
Breathing Well ProgrammeJohn Flutter
2010 Ortho-Postural TrainingRoger Price
2013
Sleep DentistryMichael Gelb etal
NYU2012
ALF and Cranial
Jim Bronson2013 Tasha Turzo
Cranial Academy2014
Bucket Listbull ALF and Crozat (Bronsonrsquos course)bullMore on Biobloc (Hangrsquos Advanced London School)bull More Cranial (The Farm)bullChirodontics (Bob Walker)bull Airway Dentistry with Marc Cruz Jeff Rousebull Sleep Dentistrybull Less-than-Six with Kevin Boydbull Intra-mandibular Distraction Osteogenesis (IMDO)
Off My ListAnything that moves the teeth faster in the wrong direction
Whatrsquos an RO to do
To create from what Irsquove learned from the best
a model for others to followhellipespecially orthodontists
Teaching
Mt Sinai Pedo ResidencyAli Attaie
2010-2012
Montefiore Ortho ResidencyTony Maganzini
2012
2009-Present
Mt Sinai School of MedicinePedodontic Residency
Guest SpeakersJim BronsonMike MewKevin BoydSandra KahnJennifer TowRoger PricePaula Fabbie
Damien OrsquoBrien
First clinical program in myofunctional orthodontics
Airway and Facial DevelopmentCollaborative Webcast
Mark Cruz
AAPMD Symposium
wwwaapm
dorg
Annual MeetingApril 25-26 2014
Westin Chicago North Shore
the raphael center for integrative orthodontics
wwwalignminecomwwwbioblocnjcom
wwwmyobracenjcom
Integrative vs Conventional
Integrative vs Conventional
ldquoWith improvements in expansion orthodontics advances in myofunctional orthodontics and the growing recognition about sleep disordered breathing among children and adults it is time for orthodontics to expand its horizons There is now so much more we can oerrdquo
The Raphael name has been associated with high quality orthodontics in New Jersey for over 60 years Dr Barry Raphael has been a university trained orthodontic specialist and a member of the American Association of Orthodontists for 30 years
He has a wide range of techniques and services to offer He has studied oral myology applied kinesiology Buteyko breathing Biobloc Orthotropics and Myobrace as part of his integrative training He can offer Damon Invisalign Insignia and Incognito appliances designs as some of his many conventional orthodontic services too
Dr Raphael teaches his techniques at post-graduate residencies study clubs dental societies and for the Myofunctional Research Co He is available for presentations to any group interested in learning more about the benefits of integrative orthodontics
wwwalignminecomLearn about the choices you have in orthodontics
dr barry raphael Why its
too Early never
1425
bro
ad
str
ee
tc
lifto
n n
j 070
13
973-
778-
4222
fax
973-
778-
9625
nj s
pe
c
368
4
1425 broad street clifton nj 07013973-778-4222
wwwalignminecom
the raphael centerforintegrative orthodontics
the
raph
ael c
ente
r fo
rin
tegr
ativ
e or
thod
onti
cs
Learn about an important choice you need to make before starting braces
the raphael center for integrative education
the raphael center for integrative education
Ongoing Intro to Airway Orthodontics
April Biobloc Study Group
April Training Ortho-Postural Therapists w Roger Price
June MRC Myobrace Basic Series
August Airway Dentistry with Mark Cruz and company
October Advanced MFT with Sandy Coulson
October Less than Six with Kevin Boyd
(who else wants to play)
Mission to create a space for spreading the word about Airway and Orthotropic principles and practice
Orthodontics in the 21st Century
EstheticOrthodontics
AirwayOrthodontics
GeneticTooth-Focused
Dental PerfectionEsthetics Primary
Treating SymptomsAirway Ignorant
AdaptationMuscle-FocusedMedical Better
Esthetics SecondaryTreating Causes
Airway Conscious
The EndAnd
The Beginning
S Reardon 10-7yo M
Impacted 3s Missing 2s
Medical history
bull Reactive Airway Diseasebull ldquoBronchial Constrictionrdquo bullCare of Pulmonologistbull Preventil
bull Dad OSA CPAP for 11 years diabetesbull Grandfather OSA untreatedbull ETCO2 = 361 at 10 bpm (acceptable)bull Posture number - 18 (lt10 ideal)bull Father refuses sleep screening
Treatment Options1 Extract upper premolars Align2Open spaces for impacted canines Open spaces for lower lateral implants
Whatrsquos more importantEase of treatment
OrBreathing well at night
Bolton Standards15yo
The Maxilla is Down and Back
The Mandible is Retrognathic
Nasal Cartilage Collapse
Insufficient Facial Support
Bi-maxillary Retrusion
Bimaxillary Retrusion Forward Growth
Mouthbreathers have significantly smaller airway space
(measurements PAS-OccL PAS-UP airway volume area and minimum axial area)
Mouth breather Nasal breather
Three-dimensional assessment of pharyngeal airway in nasal- and mouth-breathing children
Alves M etal Int J Ped ORL 75 (2011) 1195ndash1199
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
B Hockel 2012
This is the profile Biobloc children start with long and retrusive
This is the profile Biobloc children finish with Forward with lips
together
B Hockel 2012
Herersquos the ldquoinsiderdquo look Notice how the upper front teeth are closer to the nose (yellow arrows)
Notice how the lower jaw rotates around the star so the chin comes up and forward (red arrow)How do we make this happen
From the tip of the Central
To the Forwardmost Tip of the Nose
41mm
Maxillary Heightbull Indicator Line (Mew)
bull Distance from most anterior point on nose to upper incisal edge
bull Age + 23bull A variable number but important to watch over time
B Hockel 2012
Herersquos the ldquoinsiderdquo look Notice how the upper front teeth are closer to the nose (yellow arrows)
Notice how the lower jaw rotates around the star so the chin comes up and forward (red arrow)How do we make this happen
Using IndicatorCosmetic Line
bull To define a starting pointbull To set treatment goalsbull To track treatment progressbull To gauge the effectiveness of treatment
Charting the InCos Line
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Incisor pulled away from noseNot ldquoundertorquedrdquo or ldquogummy smilerdquo
Hypothetical ClI OrthoMARA
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
OJ = 7mm
Starts Ortho
ldquoGreat Headgear
Effectrdquo
Class II Elastics
50
40
30
20mm
y J F M A M J J A S O N
boys
Start Non-x
Expansion UncrowdingFinished
Start Cl II elastics
OK thatrsquos
enough
Hypothetical Mouthbreather(Dr Mewrsquos Hamster Boy)
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Boy gets
hamster
MFT
Hypothetical BBO 7yoM
50
40
30
20
5 6 7 8 9 10 11 12 13 14 15
girlsboys
Initial
StartBB1
BB3
Night
bullLR 11-9yFbullMissing all 5s6s8s and upper 4sbullHad ortho to close diastemahellipbullInL = 39bullGP objects to deX plan equil
LR Tx Plan
1Preparation Hang Expanser2deX 3Training BB3 to advance mandible4Myofunctional Therapy5Orthopostural Training6Myobrace to hold7 Reevaluate for dental detailing
LR Spotty progress
50
40
30
20mm
y 313 4 5 6 7 8 9 10 11 12114
2 3
Expanser
Parents dragging30 turnsStart Adv
Rx deXGP
objects
After delays
Equil ersquosBB3
bullLR 12-3 yF (6mo in tx)bullInL = 37 (+2)bull ersquos equilibratedbull OJ =10bull Appliance OJ = 5bull Still accommodating to BB3
Is there a calculus for the Indicator Line
Treatment GoalsBased on Indicator Line
Incisor Goals
Type 1 Treatment Place U1 in ideal position
Biobloc Orthotropics Orthognathic Surgery Distraction Osteogenesis
Type 1 Ideal InCos line
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
YZ 9yo M
bullLost upper d-spacebullInL = 36(+4)bullOJ = 9mmbullLip entrapmentbullLip Incompetence
Y Z 9yo M
Y Z 9yo M9mm OJ
Y Z 9yo M
Treatment Options
1 Type 1 Reduce InL open lost space BB3 to advance mandible
2 Type 2 Open lost space Align
3 Type 4 Extract four premolars
YZ 9yoM
50
40
30
20mm
yM A M J J A S O N D J F M A
boys
Hang Expanser
Upper and Lower
Brackets Hang Retainer
BB3
Incisor Goals
Type 2 Treatment Develop arch just enough to uncrowd
Biobloc Myofunctional Ortho Myofunctional Therapy Crozat ALF Expansion Orthodontics
Type 2 Uncrowding
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
bullLip incompetencebullLip entrapmentbullHypermentalisbullMouthbreathing
Type 2 Uncrowding
12 month progress
12 month progress
12 month progress
After Treatment
Bent-wire6 monthsMyobrace12 months
Hey RaphaelWhat about that
profile
ZP 9-5yoM
i
After Expansion Phase
Incomplete profile improvement better breathing head posture and sleep
Incisor Goals
Type 3 Treatment Maintain UI
Functional Orthodontics Expansion Orthodontics Distalization Ortho or No Treatment
Type 3 Maintain
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Bimax retrusion
Successful dental result
Profile Unimproved
Incisor Goals
Type 4 Treatment RetractExtrude UI
Extraction Orthodontics Retraction Ortho Distalization Ortho
Type 4 Retraction
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Bimax retrusion
Successful dental result
Failed Profile Result
Changes of pharyngeal airway size and hyoid bone position following orthodontic treatment of
Class I bimaxillary protrusion
Qingzhu Wanga Peizeng Jiab Nina K Andersonc Lin Wangd Jiuxiang Line
Angle Orthodontist Vol 00 No 0 0000 (pre-publication 2012)
ldquothe dimension of the velopharynx glossopharynx and hypopharynx were decreased after maximal retraction of anterior teeth with extraction of four premolarshelliprdquo ldquoAny factors that can influence the posture and position of tongue and soft palate may displace them backward andencroach upon the pharynxrdquo
ldquothe more the incisors were retracted the more the pharyngeal airway was reducedrdquo
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Backed into a corner
bull
Moving teeth faster more efficientlyhellipin the wrong direction
Now that wersquove made smoking unacceptable
could we not do the same withbull Sugarbull Processed foodbull Cheap milk and meatbull Fast foodbull Pill popping for symptomatic reliefbull Looking for the cure instead of the causebull Surgery as a quick fixbull Thinking braces are a status symbol
Each industry thrives on the status quoConsumers must drive the change
NP 10yM
NP
Sisterrsquos non-x ortho
Shersquos happyhellipbut Irsquom not so
I make my pitch for BBO
The dilemma of progress
(I forgot the progress pictureshellip)
Dad sells prosthetic parts to orthopedic surgeons
I selling the case against my previous work they loved
It takes me 3 hours to sell the case
They fret until the BB3 goes in
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Connecting the dots
bull Adult SDB and OSA
bull Narrow jaws and faces
bull Soft tissue dysfunction
bull Early parafunctional habits ie open mouth posture
bull Environmental stressors
bull CPAP MARAUPPP SurgWherersquos the best
place to start treatment here
or here
1 Prevention 2 Undo the damage already done3 Establish good habits
When to start When damage from poor breathing is noticed and when bad habits are discovered
The strategies of Airway Orthodontics
Prevention
bull Remove ankyloglossiabull Promote breastfeedingbull Harden the dietbull Develop masticatory strengthbull Discourage oral habitsbull Promote whole-foods low sugar dietbull Reduce oropharyngeal obstructionbull Promote nasal breathing
Breathing retraining
bull Nasal rinsingbull Nasal clearingbull Decongesting
The goals of Airway Orthodontics
1 Breathing through the nose2 Lips together at rest3 Correct tongue position4 No facial muscles moving on swallowing5 Optimal forward facial development6 Class I occlusion7 Straight teeth8 Better stability long term
Myofunctional Trainers
Professors R Soulet and A Besombes
Dr Earl Bergeson
Dr Chris Farrell
The Multi ndash Family System
Orofacial MyofunctionalTherapy
Oral MyologyMyofunctional TherapyTongue Thrust Therapy
B Hockel 2012 Back
Undoing Bimaxillary Dysplasia
1 Maxillary deconstriction2 Maxillary advancement3 Maxillary impaction4 Mandibular advancement
1 Maxillary Expansion
Treatment for Bimaxillary Dysplasia
ALFCrozat
Bent Wire
HyraxHaas
Niti Exp BioBlocSchwartz
The Farrell BENT WIRE Systemtrade
Recommended Age Group 5-12 yrs
Arch Development in conjunction with the TRAINER Systemtrade
Dr John Mew
Establish Good Habits
1 Breathing through the nose2 Lips together at rest3 Correct tongue position4 No facial muscles moving on swallowing5 Stand and sit in balance6 Breath gently using the diaphragm7 Eat to nourish8 Sleep to rest
Ortho-Postural TrainingWorkshops
Breathing
Nutrition
Posture
Sleep
COPYRIGHTRoger L PriceOctober 2012
Posture Number
Forward head posturecan be a compensationfor a deficient airway
Sleep Screening and Hygiene
SQI = 10 SQI = 98
Integrative Healthcare
Function ProfessionalNasal clearing ENT Pulm MFT BreathingMuscle balance and tone MFT Myofunctional OrthoUndoing damage GP Pedo Ortho OMFSBreathing dynamics OPT MFT Breath PhysiologistPosture DC OPT PT OsteopathCranial balance OsteopathNutrition RDH Nutritionist Dietitian Sleep ENT Sleep Med DentNeurocognitive development Pedrsquon SLP Psych SpEd
The Interdisciplinary Center
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Now that I know
My personal missionTo create from what Irsquove
learned from the besta model for others to followhellipespecially the orthodontists
Myofunctional Orthodontics
Chris Farrell
John Flutter
German Ramierez
Damien OrsquoBrien
Myofunctional Research CoRancho Cucamonga
2008-2012
Oral Myology
Oral Myology Basic CourseJoy MoellerNYC 2011LA 2012
Oral Myology Levels 2 3Kim BenkertClifton 2012
Habit CessationShari GreenClifton 2013
Biobloc Orthotropics
BBO Mini-residencyBill Hang
Agora Hills2012-13
BBO IntensiveDrs John and Mike
MewLSFO2013
Breathing and Sleep
Buteyko MentorshipThe Breathing Center
Woodstock2010
Breathing Well ProgrammeJohn Flutter
2010 Ortho-Postural TrainingRoger Price
2013
Sleep DentistryMichael Gelb etal
NYU2012
ALF and Cranial
Jim Bronson2013 Tasha Turzo
Cranial Academy2014
Bucket Listbull ALF and Crozat (Bronsonrsquos course)bullMore on Biobloc (Hangrsquos Advanced London School)bull More Cranial (The Farm)bullChirodontics (Bob Walker)bull Airway Dentistry with Marc Cruz Jeff Rousebull Sleep Dentistrybull Less-than-Six with Kevin Boydbull Intra-mandibular Distraction Osteogenesis (IMDO)
Off My ListAnything that moves the teeth faster in the wrong direction
Whatrsquos an RO to do
To create from what Irsquove learned from the best
a model for others to followhellipespecially orthodontists
Teaching
Mt Sinai Pedo ResidencyAli Attaie
2010-2012
Montefiore Ortho ResidencyTony Maganzini
2012
2009-Present
Mt Sinai School of MedicinePedodontic Residency
Guest SpeakersJim BronsonMike MewKevin BoydSandra KahnJennifer TowRoger PricePaula Fabbie
Damien OrsquoBrien
First clinical program in myofunctional orthodontics
Airway and Facial DevelopmentCollaborative Webcast
Mark Cruz
AAPMD Symposium
wwwaapm
dorg
Annual MeetingApril 25-26 2014
Westin Chicago North Shore
the raphael center for integrative orthodontics
wwwalignminecomwwwbioblocnjcom
wwwmyobracenjcom
Integrative vs Conventional
Integrative vs Conventional
ldquoWith improvements in expansion orthodontics advances in myofunctional orthodontics and the growing recognition about sleep disordered breathing among children and adults it is time for orthodontics to expand its horizons There is now so much more we can oerrdquo
The Raphael name has been associated with high quality orthodontics in New Jersey for over 60 years Dr Barry Raphael has been a university trained orthodontic specialist and a member of the American Association of Orthodontists for 30 years
He has a wide range of techniques and services to offer He has studied oral myology applied kinesiology Buteyko breathing Biobloc Orthotropics and Myobrace as part of his integrative training He can offer Damon Invisalign Insignia and Incognito appliances designs as some of his many conventional orthodontic services too
Dr Raphael teaches his techniques at post-graduate residencies study clubs dental societies and for the Myofunctional Research Co He is available for presentations to any group interested in learning more about the benefits of integrative orthodontics
wwwalignminecomLearn about the choices you have in orthodontics
dr barry raphael Why its
too Early never
1425
bro
ad
str
ee
tc
lifto
n n
j 070
13
973-
778-
4222
fax
973-
778-
9625
nj s
pe
c
368
4
1425 broad street clifton nj 07013973-778-4222
wwwalignminecom
the raphael centerforintegrative orthodontics
the
raph
ael c
ente
r fo
rin
tegr
ativ
e or
thod
onti
cs
Learn about an important choice you need to make before starting braces
the raphael center for integrative education
the raphael center for integrative education
Ongoing Intro to Airway Orthodontics
April Biobloc Study Group
April Training Ortho-Postural Therapists w Roger Price
June MRC Myobrace Basic Series
August Airway Dentistry with Mark Cruz and company
October Advanced MFT with Sandy Coulson
October Less than Six with Kevin Boyd
(who else wants to play)
Mission to create a space for spreading the word about Airway and Orthotropic principles and practice
Orthodontics in the 21st Century
EstheticOrthodontics
AirwayOrthodontics
GeneticTooth-Focused
Dental PerfectionEsthetics Primary
Treating SymptomsAirway Ignorant
AdaptationMuscle-FocusedMedical Better
Esthetics SecondaryTreating Causes
Airway Conscious
The EndAnd
The Beginning
Impacted 3s Missing 2s
Medical history
bull Reactive Airway Diseasebull ldquoBronchial Constrictionrdquo bullCare of Pulmonologistbull Preventil
bull Dad OSA CPAP for 11 years diabetesbull Grandfather OSA untreatedbull ETCO2 = 361 at 10 bpm (acceptable)bull Posture number - 18 (lt10 ideal)bull Father refuses sleep screening
Treatment Options1 Extract upper premolars Align2Open spaces for impacted canines Open spaces for lower lateral implants
Whatrsquos more importantEase of treatment
OrBreathing well at night
Bolton Standards15yo
The Maxilla is Down and Back
The Mandible is Retrognathic
Nasal Cartilage Collapse
Insufficient Facial Support
Bi-maxillary Retrusion
Bimaxillary Retrusion Forward Growth
Mouthbreathers have significantly smaller airway space
(measurements PAS-OccL PAS-UP airway volume area and minimum axial area)
Mouth breather Nasal breather
Three-dimensional assessment of pharyngeal airway in nasal- and mouth-breathing children
Alves M etal Int J Ped ORL 75 (2011) 1195ndash1199
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
B Hockel 2012
This is the profile Biobloc children start with long and retrusive
This is the profile Biobloc children finish with Forward with lips
together
B Hockel 2012
Herersquos the ldquoinsiderdquo look Notice how the upper front teeth are closer to the nose (yellow arrows)
Notice how the lower jaw rotates around the star so the chin comes up and forward (red arrow)How do we make this happen
From the tip of the Central
To the Forwardmost Tip of the Nose
41mm
Maxillary Heightbull Indicator Line (Mew)
bull Distance from most anterior point on nose to upper incisal edge
bull Age + 23bull A variable number but important to watch over time
B Hockel 2012
Herersquos the ldquoinsiderdquo look Notice how the upper front teeth are closer to the nose (yellow arrows)
Notice how the lower jaw rotates around the star so the chin comes up and forward (red arrow)How do we make this happen
Using IndicatorCosmetic Line
bull To define a starting pointbull To set treatment goalsbull To track treatment progressbull To gauge the effectiveness of treatment
Charting the InCos Line
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Incisor pulled away from noseNot ldquoundertorquedrdquo or ldquogummy smilerdquo
Hypothetical ClI OrthoMARA
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
OJ = 7mm
Starts Ortho
ldquoGreat Headgear
Effectrdquo
Class II Elastics
50
40
30
20mm
y J F M A M J J A S O N
boys
Start Non-x
Expansion UncrowdingFinished
Start Cl II elastics
OK thatrsquos
enough
Hypothetical Mouthbreather(Dr Mewrsquos Hamster Boy)
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Boy gets
hamster
MFT
Hypothetical BBO 7yoM
50
40
30
20
5 6 7 8 9 10 11 12 13 14 15
girlsboys
Initial
StartBB1
BB3
Night
bullLR 11-9yFbullMissing all 5s6s8s and upper 4sbullHad ortho to close diastemahellipbullInL = 39bullGP objects to deX plan equil
LR Tx Plan
1Preparation Hang Expanser2deX 3Training BB3 to advance mandible4Myofunctional Therapy5Orthopostural Training6Myobrace to hold7 Reevaluate for dental detailing
LR Spotty progress
50
40
30
20mm
y 313 4 5 6 7 8 9 10 11 12114
2 3
Expanser
Parents dragging30 turnsStart Adv
Rx deXGP
objects
After delays
Equil ersquosBB3
bullLR 12-3 yF (6mo in tx)bullInL = 37 (+2)bull ersquos equilibratedbull OJ =10bull Appliance OJ = 5bull Still accommodating to BB3
Is there a calculus for the Indicator Line
Treatment GoalsBased on Indicator Line
Incisor Goals
Type 1 Treatment Place U1 in ideal position
Biobloc Orthotropics Orthognathic Surgery Distraction Osteogenesis
Type 1 Ideal InCos line
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
YZ 9yo M
bullLost upper d-spacebullInL = 36(+4)bullOJ = 9mmbullLip entrapmentbullLip Incompetence
Y Z 9yo M
Y Z 9yo M9mm OJ
Y Z 9yo M
Treatment Options
1 Type 1 Reduce InL open lost space BB3 to advance mandible
2 Type 2 Open lost space Align
3 Type 4 Extract four premolars
YZ 9yoM
50
40
30
20mm
yM A M J J A S O N D J F M A
boys
Hang Expanser
Upper and Lower
Brackets Hang Retainer
BB3
Incisor Goals
Type 2 Treatment Develop arch just enough to uncrowd
Biobloc Myofunctional Ortho Myofunctional Therapy Crozat ALF Expansion Orthodontics
Type 2 Uncrowding
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
bullLip incompetencebullLip entrapmentbullHypermentalisbullMouthbreathing
Type 2 Uncrowding
12 month progress
12 month progress
12 month progress
After Treatment
Bent-wire6 monthsMyobrace12 months
Hey RaphaelWhat about that
profile
ZP 9-5yoM
i
After Expansion Phase
Incomplete profile improvement better breathing head posture and sleep
Incisor Goals
Type 3 Treatment Maintain UI
Functional Orthodontics Expansion Orthodontics Distalization Ortho or No Treatment
Type 3 Maintain
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Bimax retrusion
Successful dental result
Profile Unimproved
Incisor Goals
Type 4 Treatment RetractExtrude UI
Extraction Orthodontics Retraction Ortho Distalization Ortho
Type 4 Retraction
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Bimax retrusion
Successful dental result
Failed Profile Result
Changes of pharyngeal airway size and hyoid bone position following orthodontic treatment of
Class I bimaxillary protrusion
Qingzhu Wanga Peizeng Jiab Nina K Andersonc Lin Wangd Jiuxiang Line
Angle Orthodontist Vol 00 No 0 0000 (pre-publication 2012)
ldquothe dimension of the velopharynx glossopharynx and hypopharynx were decreased after maximal retraction of anterior teeth with extraction of four premolarshelliprdquo ldquoAny factors that can influence the posture and position of tongue and soft palate may displace them backward andencroach upon the pharynxrdquo
ldquothe more the incisors were retracted the more the pharyngeal airway was reducedrdquo
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Backed into a corner
bull
Moving teeth faster more efficientlyhellipin the wrong direction
Now that wersquove made smoking unacceptable
could we not do the same withbull Sugarbull Processed foodbull Cheap milk and meatbull Fast foodbull Pill popping for symptomatic reliefbull Looking for the cure instead of the causebull Surgery as a quick fixbull Thinking braces are a status symbol
Each industry thrives on the status quoConsumers must drive the change
NP 10yM
NP
Sisterrsquos non-x ortho
Shersquos happyhellipbut Irsquom not so
I make my pitch for BBO
The dilemma of progress
(I forgot the progress pictureshellip)
Dad sells prosthetic parts to orthopedic surgeons
I selling the case against my previous work they loved
It takes me 3 hours to sell the case
They fret until the BB3 goes in
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Connecting the dots
bull Adult SDB and OSA
bull Narrow jaws and faces
bull Soft tissue dysfunction
bull Early parafunctional habits ie open mouth posture
bull Environmental stressors
bull CPAP MARAUPPP SurgWherersquos the best
place to start treatment here
or here
1 Prevention 2 Undo the damage already done3 Establish good habits
When to start When damage from poor breathing is noticed and when bad habits are discovered
The strategies of Airway Orthodontics
Prevention
bull Remove ankyloglossiabull Promote breastfeedingbull Harden the dietbull Develop masticatory strengthbull Discourage oral habitsbull Promote whole-foods low sugar dietbull Reduce oropharyngeal obstructionbull Promote nasal breathing
Breathing retraining
bull Nasal rinsingbull Nasal clearingbull Decongesting
The goals of Airway Orthodontics
1 Breathing through the nose2 Lips together at rest3 Correct tongue position4 No facial muscles moving on swallowing5 Optimal forward facial development6 Class I occlusion7 Straight teeth8 Better stability long term
Myofunctional Trainers
Professors R Soulet and A Besombes
Dr Earl Bergeson
Dr Chris Farrell
The Multi ndash Family System
Orofacial MyofunctionalTherapy
Oral MyologyMyofunctional TherapyTongue Thrust Therapy
B Hockel 2012 Back
Undoing Bimaxillary Dysplasia
1 Maxillary deconstriction2 Maxillary advancement3 Maxillary impaction4 Mandibular advancement
1 Maxillary Expansion
Treatment for Bimaxillary Dysplasia
ALFCrozat
Bent Wire
HyraxHaas
Niti Exp BioBlocSchwartz
The Farrell BENT WIRE Systemtrade
Recommended Age Group 5-12 yrs
Arch Development in conjunction with the TRAINER Systemtrade
Dr John Mew
Establish Good Habits
1 Breathing through the nose2 Lips together at rest3 Correct tongue position4 No facial muscles moving on swallowing5 Stand and sit in balance6 Breath gently using the diaphragm7 Eat to nourish8 Sleep to rest
Ortho-Postural TrainingWorkshops
Breathing
Nutrition
Posture
Sleep
COPYRIGHTRoger L PriceOctober 2012
Posture Number
Forward head posturecan be a compensationfor a deficient airway
Sleep Screening and Hygiene
SQI = 10 SQI = 98
Integrative Healthcare
Function ProfessionalNasal clearing ENT Pulm MFT BreathingMuscle balance and tone MFT Myofunctional OrthoUndoing damage GP Pedo Ortho OMFSBreathing dynamics OPT MFT Breath PhysiologistPosture DC OPT PT OsteopathCranial balance OsteopathNutrition RDH Nutritionist Dietitian Sleep ENT Sleep Med DentNeurocognitive development Pedrsquon SLP Psych SpEd
The Interdisciplinary Center
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Now that I know
My personal missionTo create from what Irsquove
learned from the besta model for others to followhellipespecially the orthodontists
Myofunctional Orthodontics
Chris Farrell
John Flutter
German Ramierez
Damien OrsquoBrien
Myofunctional Research CoRancho Cucamonga
2008-2012
Oral Myology
Oral Myology Basic CourseJoy MoellerNYC 2011LA 2012
Oral Myology Levels 2 3Kim BenkertClifton 2012
Habit CessationShari GreenClifton 2013
Biobloc Orthotropics
BBO Mini-residencyBill Hang
Agora Hills2012-13
BBO IntensiveDrs John and Mike
MewLSFO2013
Breathing and Sleep
Buteyko MentorshipThe Breathing Center
Woodstock2010
Breathing Well ProgrammeJohn Flutter
2010 Ortho-Postural TrainingRoger Price
2013
Sleep DentistryMichael Gelb etal
NYU2012
ALF and Cranial
Jim Bronson2013 Tasha Turzo
Cranial Academy2014
Bucket Listbull ALF and Crozat (Bronsonrsquos course)bullMore on Biobloc (Hangrsquos Advanced London School)bull More Cranial (The Farm)bullChirodontics (Bob Walker)bull Airway Dentistry with Marc Cruz Jeff Rousebull Sleep Dentistrybull Less-than-Six with Kevin Boydbull Intra-mandibular Distraction Osteogenesis (IMDO)
Off My ListAnything that moves the teeth faster in the wrong direction
Whatrsquos an RO to do
To create from what Irsquove learned from the best
a model for others to followhellipespecially orthodontists
Teaching
Mt Sinai Pedo ResidencyAli Attaie
2010-2012
Montefiore Ortho ResidencyTony Maganzini
2012
2009-Present
Mt Sinai School of MedicinePedodontic Residency
Guest SpeakersJim BronsonMike MewKevin BoydSandra KahnJennifer TowRoger PricePaula Fabbie
Damien OrsquoBrien
First clinical program in myofunctional orthodontics
Airway and Facial DevelopmentCollaborative Webcast
Mark Cruz
AAPMD Symposium
wwwaapm
dorg
Annual MeetingApril 25-26 2014
Westin Chicago North Shore
the raphael center for integrative orthodontics
wwwalignminecomwwwbioblocnjcom
wwwmyobracenjcom
Integrative vs Conventional
Integrative vs Conventional
ldquoWith improvements in expansion orthodontics advances in myofunctional orthodontics and the growing recognition about sleep disordered breathing among children and adults it is time for orthodontics to expand its horizons There is now so much more we can oerrdquo
The Raphael name has been associated with high quality orthodontics in New Jersey for over 60 years Dr Barry Raphael has been a university trained orthodontic specialist and a member of the American Association of Orthodontists for 30 years
He has a wide range of techniques and services to offer He has studied oral myology applied kinesiology Buteyko breathing Biobloc Orthotropics and Myobrace as part of his integrative training He can offer Damon Invisalign Insignia and Incognito appliances designs as some of his many conventional orthodontic services too
Dr Raphael teaches his techniques at post-graduate residencies study clubs dental societies and for the Myofunctional Research Co He is available for presentations to any group interested in learning more about the benefits of integrative orthodontics
wwwalignminecomLearn about the choices you have in orthodontics
dr barry raphael Why its
too Early never
1425
bro
ad
str
ee
tc
lifto
n n
j 070
13
973-
778-
4222
fax
973-
778-
9625
nj s
pe
c
368
4
1425 broad street clifton nj 07013973-778-4222
wwwalignminecom
the raphael centerforintegrative orthodontics
the
raph
ael c
ente
r fo
rin
tegr
ativ
e or
thod
onti
cs
Learn about an important choice you need to make before starting braces
the raphael center for integrative education
the raphael center for integrative education
Ongoing Intro to Airway Orthodontics
April Biobloc Study Group
April Training Ortho-Postural Therapists w Roger Price
June MRC Myobrace Basic Series
August Airway Dentistry with Mark Cruz and company
October Advanced MFT with Sandy Coulson
October Less than Six with Kevin Boyd
(who else wants to play)
Mission to create a space for spreading the word about Airway and Orthotropic principles and practice
Orthodontics in the 21st Century
EstheticOrthodontics
AirwayOrthodontics
GeneticTooth-Focused
Dental PerfectionEsthetics Primary
Treating SymptomsAirway Ignorant
AdaptationMuscle-FocusedMedical Better
Esthetics SecondaryTreating Causes
Airway Conscious
The EndAnd
The Beginning
Medical history
bull Reactive Airway Diseasebull ldquoBronchial Constrictionrdquo bullCare of Pulmonologistbull Preventil
bull Dad OSA CPAP for 11 years diabetesbull Grandfather OSA untreatedbull ETCO2 = 361 at 10 bpm (acceptable)bull Posture number - 18 (lt10 ideal)bull Father refuses sleep screening
Treatment Options1 Extract upper premolars Align2Open spaces for impacted canines Open spaces for lower lateral implants
Whatrsquos more importantEase of treatment
OrBreathing well at night
Bolton Standards15yo
The Maxilla is Down and Back
The Mandible is Retrognathic
Nasal Cartilage Collapse
Insufficient Facial Support
Bi-maxillary Retrusion
Bimaxillary Retrusion Forward Growth
Mouthbreathers have significantly smaller airway space
(measurements PAS-OccL PAS-UP airway volume area and minimum axial area)
Mouth breather Nasal breather
Three-dimensional assessment of pharyngeal airway in nasal- and mouth-breathing children
Alves M etal Int J Ped ORL 75 (2011) 1195ndash1199
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
B Hockel 2012
This is the profile Biobloc children start with long and retrusive
This is the profile Biobloc children finish with Forward with lips
together
B Hockel 2012
Herersquos the ldquoinsiderdquo look Notice how the upper front teeth are closer to the nose (yellow arrows)
Notice how the lower jaw rotates around the star so the chin comes up and forward (red arrow)How do we make this happen
From the tip of the Central
To the Forwardmost Tip of the Nose
41mm
Maxillary Heightbull Indicator Line (Mew)
bull Distance from most anterior point on nose to upper incisal edge
bull Age + 23bull A variable number but important to watch over time
B Hockel 2012
Herersquos the ldquoinsiderdquo look Notice how the upper front teeth are closer to the nose (yellow arrows)
Notice how the lower jaw rotates around the star so the chin comes up and forward (red arrow)How do we make this happen
Using IndicatorCosmetic Line
bull To define a starting pointbull To set treatment goalsbull To track treatment progressbull To gauge the effectiveness of treatment
Charting the InCos Line
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Incisor pulled away from noseNot ldquoundertorquedrdquo or ldquogummy smilerdquo
Hypothetical ClI OrthoMARA
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
OJ = 7mm
Starts Ortho
ldquoGreat Headgear
Effectrdquo
Class II Elastics
50
40
30
20mm
y J F M A M J J A S O N
boys
Start Non-x
Expansion UncrowdingFinished
Start Cl II elastics
OK thatrsquos
enough
Hypothetical Mouthbreather(Dr Mewrsquos Hamster Boy)
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Boy gets
hamster
MFT
Hypothetical BBO 7yoM
50
40
30
20
5 6 7 8 9 10 11 12 13 14 15
girlsboys
Initial
StartBB1
BB3
Night
bullLR 11-9yFbullMissing all 5s6s8s and upper 4sbullHad ortho to close diastemahellipbullInL = 39bullGP objects to deX plan equil
LR Tx Plan
1Preparation Hang Expanser2deX 3Training BB3 to advance mandible4Myofunctional Therapy5Orthopostural Training6Myobrace to hold7 Reevaluate for dental detailing
LR Spotty progress
50
40
30
20mm
y 313 4 5 6 7 8 9 10 11 12114
2 3
Expanser
Parents dragging30 turnsStart Adv
Rx deXGP
objects
After delays
Equil ersquosBB3
bullLR 12-3 yF (6mo in tx)bullInL = 37 (+2)bull ersquos equilibratedbull OJ =10bull Appliance OJ = 5bull Still accommodating to BB3
Is there a calculus for the Indicator Line
Treatment GoalsBased on Indicator Line
Incisor Goals
Type 1 Treatment Place U1 in ideal position
Biobloc Orthotropics Orthognathic Surgery Distraction Osteogenesis
Type 1 Ideal InCos line
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
YZ 9yo M
bullLost upper d-spacebullInL = 36(+4)bullOJ = 9mmbullLip entrapmentbullLip Incompetence
Y Z 9yo M
Y Z 9yo M9mm OJ
Y Z 9yo M
Treatment Options
1 Type 1 Reduce InL open lost space BB3 to advance mandible
2 Type 2 Open lost space Align
3 Type 4 Extract four premolars
YZ 9yoM
50
40
30
20mm
yM A M J J A S O N D J F M A
boys
Hang Expanser
Upper and Lower
Brackets Hang Retainer
BB3
Incisor Goals
Type 2 Treatment Develop arch just enough to uncrowd
Biobloc Myofunctional Ortho Myofunctional Therapy Crozat ALF Expansion Orthodontics
Type 2 Uncrowding
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
bullLip incompetencebullLip entrapmentbullHypermentalisbullMouthbreathing
Type 2 Uncrowding
12 month progress
12 month progress
12 month progress
After Treatment
Bent-wire6 monthsMyobrace12 months
Hey RaphaelWhat about that
profile
ZP 9-5yoM
i
After Expansion Phase
Incomplete profile improvement better breathing head posture and sleep
Incisor Goals
Type 3 Treatment Maintain UI
Functional Orthodontics Expansion Orthodontics Distalization Ortho or No Treatment
Type 3 Maintain
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Bimax retrusion
Successful dental result
Profile Unimproved
Incisor Goals
Type 4 Treatment RetractExtrude UI
Extraction Orthodontics Retraction Ortho Distalization Ortho
Type 4 Retraction
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Bimax retrusion
Successful dental result
Failed Profile Result
Changes of pharyngeal airway size and hyoid bone position following orthodontic treatment of
Class I bimaxillary protrusion
Qingzhu Wanga Peizeng Jiab Nina K Andersonc Lin Wangd Jiuxiang Line
Angle Orthodontist Vol 00 No 0 0000 (pre-publication 2012)
ldquothe dimension of the velopharynx glossopharynx and hypopharynx were decreased after maximal retraction of anterior teeth with extraction of four premolarshelliprdquo ldquoAny factors that can influence the posture and position of tongue and soft palate may displace them backward andencroach upon the pharynxrdquo
ldquothe more the incisors were retracted the more the pharyngeal airway was reducedrdquo
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Backed into a corner
bull
Moving teeth faster more efficientlyhellipin the wrong direction
Now that wersquove made smoking unacceptable
could we not do the same withbull Sugarbull Processed foodbull Cheap milk and meatbull Fast foodbull Pill popping for symptomatic reliefbull Looking for the cure instead of the causebull Surgery as a quick fixbull Thinking braces are a status symbol
Each industry thrives on the status quoConsumers must drive the change
NP 10yM
NP
Sisterrsquos non-x ortho
Shersquos happyhellipbut Irsquom not so
I make my pitch for BBO
The dilemma of progress
(I forgot the progress pictureshellip)
Dad sells prosthetic parts to orthopedic surgeons
I selling the case against my previous work they loved
It takes me 3 hours to sell the case
They fret until the BB3 goes in
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Connecting the dots
bull Adult SDB and OSA
bull Narrow jaws and faces
bull Soft tissue dysfunction
bull Early parafunctional habits ie open mouth posture
bull Environmental stressors
bull CPAP MARAUPPP SurgWherersquos the best
place to start treatment here
or here
1 Prevention 2 Undo the damage already done3 Establish good habits
When to start When damage from poor breathing is noticed and when bad habits are discovered
The strategies of Airway Orthodontics
Prevention
bull Remove ankyloglossiabull Promote breastfeedingbull Harden the dietbull Develop masticatory strengthbull Discourage oral habitsbull Promote whole-foods low sugar dietbull Reduce oropharyngeal obstructionbull Promote nasal breathing
Breathing retraining
bull Nasal rinsingbull Nasal clearingbull Decongesting
The goals of Airway Orthodontics
1 Breathing through the nose2 Lips together at rest3 Correct tongue position4 No facial muscles moving on swallowing5 Optimal forward facial development6 Class I occlusion7 Straight teeth8 Better stability long term
Myofunctional Trainers
Professors R Soulet and A Besombes
Dr Earl Bergeson
Dr Chris Farrell
The Multi ndash Family System
Orofacial MyofunctionalTherapy
Oral MyologyMyofunctional TherapyTongue Thrust Therapy
B Hockel 2012 Back
Undoing Bimaxillary Dysplasia
1 Maxillary deconstriction2 Maxillary advancement3 Maxillary impaction4 Mandibular advancement
1 Maxillary Expansion
Treatment for Bimaxillary Dysplasia
ALFCrozat
Bent Wire
HyraxHaas
Niti Exp BioBlocSchwartz
The Farrell BENT WIRE Systemtrade
Recommended Age Group 5-12 yrs
Arch Development in conjunction with the TRAINER Systemtrade
Dr John Mew
Establish Good Habits
1 Breathing through the nose2 Lips together at rest3 Correct tongue position4 No facial muscles moving on swallowing5 Stand and sit in balance6 Breath gently using the diaphragm7 Eat to nourish8 Sleep to rest
Ortho-Postural TrainingWorkshops
Breathing
Nutrition
Posture
Sleep
COPYRIGHTRoger L PriceOctober 2012
Posture Number
Forward head posturecan be a compensationfor a deficient airway
Sleep Screening and Hygiene
SQI = 10 SQI = 98
Integrative Healthcare
Function ProfessionalNasal clearing ENT Pulm MFT BreathingMuscle balance and tone MFT Myofunctional OrthoUndoing damage GP Pedo Ortho OMFSBreathing dynamics OPT MFT Breath PhysiologistPosture DC OPT PT OsteopathCranial balance OsteopathNutrition RDH Nutritionist Dietitian Sleep ENT Sleep Med DentNeurocognitive development Pedrsquon SLP Psych SpEd
The Interdisciplinary Center
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Now that I know
My personal missionTo create from what Irsquove
learned from the besta model for others to followhellipespecially the orthodontists
Myofunctional Orthodontics
Chris Farrell
John Flutter
German Ramierez
Damien OrsquoBrien
Myofunctional Research CoRancho Cucamonga
2008-2012
Oral Myology
Oral Myology Basic CourseJoy MoellerNYC 2011LA 2012
Oral Myology Levels 2 3Kim BenkertClifton 2012
Habit CessationShari GreenClifton 2013
Biobloc Orthotropics
BBO Mini-residencyBill Hang
Agora Hills2012-13
BBO IntensiveDrs John and Mike
MewLSFO2013
Breathing and Sleep
Buteyko MentorshipThe Breathing Center
Woodstock2010
Breathing Well ProgrammeJohn Flutter
2010 Ortho-Postural TrainingRoger Price
2013
Sleep DentistryMichael Gelb etal
NYU2012
ALF and Cranial
Jim Bronson2013 Tasha Turzo
Cranial Academy2014
Bucket Listbull ALF and Crozat (Bronsonrsquos course)bullMore on Biobloc (Hangrsquos Advanced London School)bull More Cranial (The Farm)bullChirodontics (Bob Walker)bull Airway Dentistry with Marc Cruz Jeff Rousebull Sleep Dentistrybull Less-than-Six with Kevin Boydbull Intra-mandibular Distraction Osteogenesis (IMDO)
Off My ListAnything that moves the teeth faster in the wrong direction
Whatrsquos an RO to do
To create from what Irsquove learned from the best
a model for others to followhellipespecially orthodontists
Teaching
Mt Sinai Pedo ResidencyAli Attaie
2010-2012
Montefiore Ortho ResidencyTony Maganzini
2012
2009-Present
Mt Sinai School of MedicinePedodontic Residency
Guest SpeakersJim BronsonMike MewKevin BoydSandra KahnJennifer TowRoger PricePaula Fabbie
Damien OrsquoBrien
First clinical program in myofunctional orthodontics
Airway and Facial DevelopmentCollaborative Webcast
Mark Cruz
AAPMD Symposium
wwwaapm
dorg
Annual MeetingApril 25-26 2014
Westin Chicago North Shore
the raphael center for integrative orthodontics
wwwalignminecomwwwbioblocnjcom
wwwmyobracenjcom
Integrative vs Conventional
Integrative vs Conventional
ldquoWith improvements in expansion orthodontics advances in myofunctional orthodontics and the growing recognition about sleep disordered breathing among children and adults it is time for orthodontics to expand its horizons There is now so much more we can oerrdquo
The Raphael name has been associated with high quality orthodontics in New Jersey for over 60 years Dr Barry Raphael has been a university trained orthodontic specialist and a member of the American Association of Orthodontists for 30 years
He has a wide range of techniques and services to offer He has studied oral myology applied kinesiology Buteyko breathing Biobloc Orthotropics and Myobrace as part of his integrative training He can offer Damon Invisalign Insignia and Incognito appliances designs as some of his many conventional orthodontic services too
Dr Raphael teaches his techniques at post-graduate residencies study clubs dental societies and for the Myofunctional Research Co He is available for presentations to any group interested in learning more about the benefits of integrative orthodontics
wwwalignminecomLearn about the choices you have in orthodontics
dr barry raphael Why its
too Early never
1425
bro
ad
str
ee
tc
lifto
n n
j 070
13
973-
778-
4222
fax
973-
778-
9625
nj s
pe
c
368
4
1425 broad street clifton nj 07013973-778-4222
wwwalignminecom
the raphael centerforintegrative orthodontics
the
raph
ael c
ente
r fo
rin
tegr
ativ
e or
thod
onti
cs
Learn about an important choice you need to make before starting braces
the raphael center for integrative education
the raphael center for integrative education
Ongoing Intro to Airway Orthodontics
April Biobloc Study Group
April Training Ortho-Postural Therapists w Roger Price
June MRC Myobrace Basic Series
August Airway Dentistry with Mark Cruz and company
October Advanced MFT with Sandy Coulson
October Less than Six with Kevin Boyd
(who else wants to play)
Mission to create a space for spreading the word about Airway and Orthotropic principles and practice
Orthodontics in the 21st Century
EstheticOrthodontics
AirwayOrthodontics
GeneticTooth-Focused
Dental PerfectionEsthetics Primary
Treating SymptomsAirway Ignorant
AdaptationMuscle-FocusedMedical Better
Esthetics SecondaryTreating Causes
Airway Conscious
The EndAnd
The Beginning
Treatment Options1 Extract upper premolars Align2Open spaces for impacted canines Open spaces for lower lateral implants
Whatrsquos more importantEase of treatment
OrBreathing well at night
Bolton Standards15yo
The Maxilla is Down and Back
The Mandible is Retrognathic
Nasal Cartilage Collapse
Insufficient Facial Support
Bi-maxillary Retrusion
Bimaxillary Retrusion Forward Growth
Mouthbreathers have significantly smaller airway space
(measurements PAS-OccL PAS-UP airway volume area and minimum axial area)
Mouth breather Nasal breather
Three-dimensional assessment of pharyngeal airway in nasal- and mouth-breathing children
Alves M etal Int J Ped ORL 75 (2011) 1195ndash1199
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
B Hockel 2012
This is the profile Biobloc children start with long and retrusive
This is the profile Biobloc children finish with Forward with lips
together
B Hockel 2012
Herersquos the ldquoinsiderdquo look Notice how the upper front teeth are closer to the nose (yellow arrows)
Notice how the lower jaw rotates around the star so the chin comes up and forward (red arrow)How do we make this happen
From the tip of the Central
To the Forwardmost Tip of the Nose
41mm
Maxillary Heightbull Indicator Line (Mew)
bull Distance from most anterior point on nose to upper incisal edge
bull Age + 23bull A variable number but important to watch over time
B Hockel 2012
Herersquos the ldquoinsiderdquo look Notice how the upper front teeth are closer to the nose (yellow arrows)
Notice how the lower jaw rotates around the star so the chin comes up and forward (red arrow)How do we make this happen
Using IndicatorCosmetic Line
bull To define a starting pointbull To set treatment goalsbull To track treatment progressbull To gauge the effectiveness of treatment
Charting the InCos Line
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Incisor pulled away from noseNot ldquoundertorquedrdquo or ldquogummy smilerdquo
Hypothetical ClI OrthoMARA
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
OJ = 7mm
Starts Ortho
ldquoGreat Headgear
Effectrdquo
Class II Elastics
50
40
30
20mm
y J F M A M J J A S O N
boys
Start Non-x
Expansion UncrowdingFinished
Start Cl II elastics
OK thatrsquos
enough
Hypothetical Mouthbreather(Dr Mewrsquos Hamster Boy)
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Boy gets
hamster
MFT
Hypothetical BBO 7yoM
50
40
30
20
5 6 7 8 9 10 11 12 13 14 15
girlsboys
Initial
StartBB1
BB3
Night
bullLR 11-9yFbullMissing all 5s6s8s and upper 4sbullHad ortho to close diastemahellipbullInL = 39bullGP objects to deX plan equil
LR Tx Plan
1Preparation Hang Expanser2deX 3Training BB3 to advance mandible4Myofunctional Therapy5Orthopostural Training6Myobrace to hold7 Reevaluate for dental detailing
LR Spotty progress
50
40
30
20mm
y 313 4 5 6 7 8 9 10 11 12114
2 3
Expanser
Parents dragging30 turnsStart Adv
Rx deXGP
objects
After delays
Equil ersquosBB3
bullLR 12-3 yF (6mo in tx)bullInL = 37 (+2)bull ersquos equilibratedbull OJ =10bull Appliance OJ = 5bull Still accommodating to BB3
Is there a calculus for the Indicator Line
Treatment GoalsBased on Indicator Line
Incisor Goals
Type 1 Treatment Place U1 in ideal position
Biobloc Orthotropics Orthognathic Surgery Distraction Osteogenesis
Type 1 Ideal InCos line
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
YZ 9yo M
bullLost upper d-spacebullInL = 36(+4)bullOJ = 9mmbullLip entrapmentbullLip Incompetence
Y Z 9yo M
Y Z 9yo M9mm OJ
Y Z 9yo M
Treatment Options
1 Type 1 Reduce InL open lost space BB3 to advance mandible
2 Type 2 Open lost space Align
3 Type 4 Extract four premolars
YZ 9yoM
50
40
30
20mm
yM A M J J A S O N D J F M A
boys
Hang Expanser
Upper and Lower
Brackets Hang Retainer
BB3
Incisor Goals
Type 2 Treatment Develop arch just enough to uncrowd
Biobloc Myofunctional Ortho Myofunctional Therapy Crozat ALF Expansion Orthodontics
Type 2 Uncrowding
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
bullLip incompetencebullLip entrapmentbullHypermentalisbullMouthbreathing
Type 2 Uncrowding
12 month progress
12 month progress
12 month progress
After Treatment
Bent-wire6 monthsMyobrace12 months
Hey RaphaelWhat about that
profile
ZP 9-5yoM
i
After Expansion Phase
Incomplete profile improvement better breathing head posture and sleep
Incisor Goals
Type 3 Treatment Maintain UI
Functional Orthodontics Expansion Orthodontics Distalization Ortho or No Treatment
Type 3 Maintain
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Bimax retrusion
Successful dental result
Profile Unimproved
Incisor Goals
Type 4 Treatment RetractExtrude UI
Extraction Orthodontics Retraction Ortho Distalization Ortho
Type 4 Retraction
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Bimax retrusion
Successful dental result
Failed Profile Result
Changes of pharyngeal airway size and hyoid bone position following orthodontic treatment of
Class I bimaxillary protrusion
Qingzhu Wanga Peizeng Jiab Nina K Andersonc Lin Wangd Jiuxiang Line
Angle Orthodontist Vol 00 No 0 0000 (pre-publication 2012)
ldquothe dimension of the velopharynx glossopharynx and hypopharynx were decreased after maximal retraction of anterior teeth with extraction of four premolarshelliprdquo ldquoAny factors that can influence the posture and position of tongue and soft palate may displace them backward andencroach upon the pharynxrdquo
ldquothe more the incisors were retracted the more the pharyngeal airway was reducedrdquo
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Backed into a corner
bull
Moving teeth faster more efficientlyhellipin the wrong direction
Now that wersquove made smoking unacceptable
could we not do the same withbull Sugarbull Processed foodbull Cheap milk and meatbull Fast foodbull Pill popping for symptomatic reliefbull Looking for the cure instead of the causebull Surgery as a quick fixbull Thinking braces are a status symbol
Each industry thrives on the status quoConsumers must drive the change
NP 10yM
NP
Sisterrsquos non-x ortho
Shersquos happyhellipbut Irsquom not so
I make my pitch for BBO
The dilemma of progress
(I forgot the progress pictureshellip)
Dad sells prosthetic parts to orthopedic surgeons
I selling the case against my previous work they loved
It takes me 3 hours to sell the case
They fret until the BB3 goes in
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Connecting the dots
bull Adult SDB and OSA
bull Narrow jaws and faces
bull Soft tissue dysfunction
bull Early parafunctional habits ie open mouth posture
bull Environmental stressors
bull CPAP MARAUPPP SurgWherersquos the best
place to start treatment here
or here
1 Prevention 2 Undo the damage already done3 Establish good habits
When to start When damage from poor breathing is noticed and when bad habits are discovered
The strategies of Airway Orthodontics
Prevention
bull Remove ankyloglossiabull Promote breastfeedingbull Harden the dietbull Develop masticatory strengthbull Discourage oral habitsbull Promote whole-foods low sugar dietbull Reduce oropharyngeal obstructionbull Promote nasal breathing
Breathing retraining
bull Nasal rinsingbull Nasal clearingbull Decongesting
The goals of Airway Orthodontics
1 Breathing through the nose2 Lips together at rest3 Correct tongue position4 No facial muscles moving on swallowing5 Optimal forward facial development6 Class I occlusion7 Straight teeth8 Better stability long term
Myofunctional Trainers
Professors R Soulet and A Besombes
Dr Earl Bergeson
Dr Chris Farrell
The Multi ndash Family System
Orofacial MyofunctionalTherapy
Oral MyologyMyofunctional TherapyTongue Thrust Therapy
B Hockel 2012 Back
Undoing Bimaxillary Dysplasia
1 Maxillary deconstriction2 Maxillary advancement3 Maxillary impaction4 Mandibular advancement
1 Maxillary Expansion
Treatment for Bimaxillary Dysplasia
ALFCrozat
Bent Wire
HyraxHaas
Niti Exp BioBlocSchwartz
The Farrell BENT WIRE Systemtrade
Recommended Age Group 5-12 yrs
Arch Development in conjunction with the TRAINER Systemtrade
Dr John Mew
Establish Good Habits
1 Breathing through the nose2 Lips together at rest3 Correct tongue position4 No facial muscles moving on swallowing5 Stand and sit in balance6 Breath gently using the diaphragm7 Eat to nourish8 Sleep to rest
Ortho-Postural TrainingWorkshops
Breathing
Nutrition
Posture
Sleep
COPYRIGHTRoger L PriceOctober 2012
Posture Number
Forward head posturecan be a compensationfor a deficient airway
Sleep Screening and Hygiene
SQI = 10 SQI = 98
Integrative Healthcare
Function ProfessionalNasal clearing ENT Pulm MFT BreathingMuscle balance and tone MFT Myofunctional OrthoUndoing damage GP Pedo Ortho OMFSBreathing dynamics OPT MFT Breath PhysiologistPosture DC OPT PT OsteopathCranial balance OsteopathNutrition RDH Nutritionist Dietitian Sleep ENT Sleep Med DentNeurocognitive development Pedrsquon SLP Psych SpEd
The Interdisciplinary Center
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Now that I know
My personal missionTo create from what Irsquove
learned from the besta model for others to followhellipespecially the orthodontists
Myofunctional Orthodontics
Chris Farrell
John Flutter
German Ramierez
Damien OrsquoBrien
Myofunctional Research CoRancho Cucamonga
2008-2012
Oral Myology
Oral Myology Basic CourseJoy MoellerNYC 2011LA 2012
Oral Myology Levels 2 3Kim BenkertClifton 2012
Habit CessationShari GreenClifton 2013
Biobloc Orthotropics
BBO Mini-residencyBill Hang
Agora Hills2012-13
BBO IntensiveDrs John and Mike
MewLSFO2013
Breathing and Sleep
Buteyko MentorshipThe Breathing Center
Woodstock2010
Breathing Well ProgrammeJohn Flutter
2010 Ortho-Postural TrainingRoger Price
2013
Sleep DentistryMichael Gelb etal
NYU2012
ALF and Cranial
Jim Bronson2013 Tasha Turzo
Cranial Academy2014
Bucket Listbull ALF and Crozat (Bronsonrsquos course)bullMore on Biobloc (Hangrsquos Advanced London School)bull More Cranial (The Farm)bullChirodontics (Bob Walker)bull Airway Dentistry with Marc Cruz Jeff Rousebull Sleep Dentistrybull Less-than-Six with Kevin Boydbull Intra-mandibular Distraction Osteogenesis (IMDO)
Off My ListAnything that moves the teeth faster in the wrong direction
Whatrsquos an RO to do
To create from what Irsquove learned from the best
a model for others to followhellipespecially orthodontists
Teaching
Mt Sinai Pedo ResidencyAli Attaie
2010-2012
Montefiore Ortho ResidencyTony Maganzini
2012
2009-Present
Mt Sinai School of MedicinePedodontic Residency
Guest SpeakersJim BronsonMike MewKevin BoydSandra KahnJennifer TowRoger PricePaula Fabbie
Damien OrsquoBrien
First clinical program in myofunctional orthodontics
Airway and Facial DevelopmentCollaborative Webcast
Mark Cruz
AAPMD Symposium
wwwaapm
dorg
Annual MeetingApril 25-26 2014
Westin Chicago North Shore
the raphael center for integrative orthodontics
wwwalignminecomwwwbioblocnjcom
wwwmyobracenjcom
Integrative vs Conventional
Integrative vs Conventional
ldquoWith improvements in expansion orthodontics advances in myofunctional orthodontics and the growing recognition about sleep disordered breathing among children and adults it is time for orthodontics to expand its horizons There is now so much more we can oerrdquo
The Raphael name has been associated with high quality orthodontics in New Jersey for over 60 years Dr Barry Raphael has been a university trained orthodontic specialist and a member of the American Association of Orthodontists for 30 years
He has a wide range of techniques and services to offer He has studied oral myology applied kinesiology Buteyko breathing Biobloc Orthotropics and Myobrace as part of his integrative training He can offer Damon Invisalign Insignia and Incognito appliances designs as some of his many conventional orthodontic services too
Dr Raphael teaches his techniques at post-graduate residencies study clubs dental societies and for the Myofunctional Research Co He is available for presentations to any group interested in learning more about the benefits of integrative orthodontics
wwwalignminecomLearn about the choices you have in orthodontics
dr barry raphael Why its
too Early never
1425
bro
ad
str
ee
tc
lifto
n n
j 070
13
973-
778-
4222
fax
973-
778-
9625
nj s
pe
c
368
4
1425 broad street clifton nj 07013973-778-4222
wwwalignminecom
the raphael centerforintegrative orthodontics
the
raph
ael c
ente
r fo
rin
tegr
ativ
e or
thod
onti
cs
Learn about an important choice you need to make before starting braces
the raphael center for integrative education
the raphael center for integrative education
Ongoing Intro to Airway Orthodontics
April Biobloc Study Group
April Training Ortho-Postural Therapists w Roger Price
June MRC Myobrace Basic Series
August Airway Dentistry with Mark Cruz and company
October Advanced MFT with Sandy Coulson
October Less than Six with Kevin Boyd
(who else wants to play)
Mission to create a space for spreading the word about Airway and Orthotropic principles and practice
Orthodontics in the 21st Century
EstheticOrthodontics
AirwayOrthodontics
GeneticTooth-Focused
Dental PerfectionEsthetics Primary
Treating SymptomsAirway Ignorant
AdaptationMuscle-FocusedMedical Better
Esthetics SecondaryTreating Causes
Airway Conscious
The EndAnd
The Beginning
Bolton Standards15yo
The Maxilla is Down and Back
The Mandible is Retrognathic
Nasal Cartilage Collapse
Insufficient Facial Support
Bi-maxillary Retrusion
Bimaxillary Retrusion Forward Growth
Mouthbreathers have significantly smaller airway space
(measurements PAS-OccL PAS-UP airway volume area and minimum axial area)
Mouth breather Nasal breather
Three-dimensional assessment of pharyngeal airway in nasal- and mouth-breathing children
Alves M etal Int J Ped ORL 75 (2011) 1195ndash1199
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
B Hockel 2012
This is the profile Biobloc children start with long and retrusive
This is the profile Biobloc children finish with Forward with lips
together
B Hockel 2012
Herersquos the ldquoinsiderdquo look Notice how the upper front teeth are closer to the nose (yellow arrows)
Notice how the lower jaw rotates around the star so the chin comes up and forward (red arrow)How do we make this happen
From the tip of the Central
To the Forwardmost Tip of the Nose
41mm
Maxillary Heightbull Indicator Line (Mew)
bull Distance from most anterior point on nose to upper incisal edge
bull Age + 23bull A variable number but important to watch over time
B Hockel 2012
Herersquos the ldquoinsiderdquo look Notice how the upper front teeth are closer to the nose (yellow arrows)
Notice how the lower jaw rotates around the star so the chin comes up and forward (red arrow)How do we make this happen
Using IndicatorCosmetic Line
bull To define a starting pointbull To set treatment goalsbull To track treatment progressbull To gauge the effectiveness of treatment
Charting the InCos Line
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Incisor pulled away from noseNot ldquoundertorquedrdquo or ldquogummy smilerdquo
Hypothetical ClI OrthoMARA
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
OJ = 7mm
Starts Ortho
ldquoGreat Headgear
Effectrdquo
Class II Elastics
50
40
30
20mm
y J F M A M J J A S O N
boys
Start Non-x
Expansion UncrowdingFinished
Start Cl II elastics
OK thatrsquos
enough
Hypothetical Mouthbreather(Dr Mewrsquos Hamster Boy)
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Boy gets
hamster
MFT
Hypothetical BBO 7yoM
50
40
30
20
5 6 7 8 9 10 11 12 13 14 15
girlsboys
Initial
StartBB1
BB3
Night
bullLR 11-9yFbullMissing all 5s6s8s and upper 4sbullHad ortho to close diastemahellipbullInL = 39bullGP objects to deX plan equil
LR Tx Plan
1Preparation Hang Expanser2deX 3Training BB3 to advance mandible4Myofunctional Therapy5Orthopostural Training6Myobrace to hold7 Reevaluate for dental detailing
LR Spotty progress
50
40
30
20mm
y 313 4 5 6 7 8 9 10 11 12114
2 3
Expanser
Parents dragging30 turnsStart Adv
Rx deXGP
objects
After delays
Equil ersquosBB3
bullLR 12-3 yF (6mo in tx)bullInL = 37 (+2)bull ersquos equilibratedbull OJ =10bull Appliance OJ = 5bull Still accommodating to BB3
Is there a calculus for the Indicator Line
Treatment GoalsBased on Indicator Line
Incisor Goals
Type 1 Treatment Place U1 in ideal position
Biobloc Orthotropics Orthognathic Surgery Distraction Osteogenesis
Type 1 Ideal InCos line
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
YZ 9yo M
bullLost upper d-spacebullInL = 36(+4)bullOJ = 9mmbullLip entrapmentbullLip Incompetence
Y Z 9yo M
Y Z 9yo M9mm OJ
Y Z 9yo M
Treatment Options
1 Type 1 Reduce InL open lost space BB3 to advance mandible
2 Type 2 Open lost space Align
3 Type 4 Extract four premolars
YZ 9yoM
50
40
30
20mm
yM A M J J A S O N D J F M A
boys
Hang Expanser
Upper and Lower
Brackets Hang Retainer
BB3
Incisor Goals
Type 2 Treatment Develop arch just enough to uncrowd
Biobloc Myofunctional Ortho Myofunctional Therapy Crozat ALF Expansion Orthodontics
Type 2 Uncrowding
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
bullLip incompetencebullLip entrapmentbullHypermentalisbullMouthbreathing
Type 2 Uncrowding
12 month progress
12 month progress
12 month progress
After Treatment
Bent-wire6 monthsMyobrace12 months
Hey RaphaelWhat about that
profile
ZP 9-5yoM
i
After Expansion Phase
Incomplete profile improvement better breathing head posture and sleep
Incisor Goals
Type 3 Treatment Maintain UI
Functional Orthodontics Expansion Orthodontics Distalization Ortho or No Treatment
Type 3 Maintain
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Bimax retrusion
Successful dental result
Profile Unimproved
Incisor Goals
Type 4 Treatment RetractExtrude UI
Extraction Orthodontics Retraction Ortho Distalization Ortho
Type 4 Retraction
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Bimax retrusion
Successful dental result
Failed Profile Result
Changes of pharyngeal airway size and hyoid bone position following orthodontic treatment of
Class I bimaxillary protrusion
Qingzhu Wanga Peizeng Jiab Nina K Andersonc Lin Wangd Jiuxiang Line
Angle Orthodontist Vol 00 No 0 0000 (pre-publication 2012)
ldquothe dimension of the velopharynx glossopharynx and hypopharynx were decreased after maximal retraction of anterior teeth with extraction of four premolarshelliprdquo ldquoAny factors that can influence the posture and position of tongue and soft palate may displace them backward andencroach upon the pharynxrdquo
ldquothe more the incisors were retracted the more the pharyngeal airway was reducedrdquo
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Backed into a corner
bull
Moving teeth faster more efficientlyhellipin the wrong direction
Now that wersquove made smoking unacceptable
could we not do the same withbull Sugarbull Processed foodbull Cheap milk and meatbull Fast foodbull Pill popping for symptomatic reliefbull Looking for the cure instead of the causebull Surgery as a quick fixbull Thinking braces are a status symbol
Each industry thrives on the status quoConsumers must drive the change
NP 10yM
NP
Sisterrsquos non-x ortho
Shersquos happyhellipbut Irsquom not so
I make my pitch for BBO
The dilemma of progress
(I forgot the progress pictureshellip)
Dad sells prosthetic parts to orthopedic surgeons
I selling the case against my previous work they loved
It takes me 3 hours to sell the case
They fret until the BB3 goes in
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Connecting the dots
bull Adult SDB and OSA
bull Narrow jaws and faces
bull Soft tissue dysfunction
bull Early parafunctional habits ie open mouth posture
bull Environmental stressors
bull CPAP MARAUPPP SurgWherersquos the best
place to start treatment here
or here
1 Prevention 2 Undo the damage already done3 Establish good habits
When to start When damage from poor breathing is noticed and when bad habits are discovered
The strategies of Airway Orthodontics
Prevention
bull Remove ankyloglossiabull Promote breastfeedingbull Harden the dietbull Develop masticatory strengthbull Discourage oral habitsbull Promote whole-foods low sugar dietbull Reduce oropharyngeal obstructionbull Promote nasal breathing
Breathing retraining
bull Nasal rinsingbull Nasal clearingbull Decongesting
The goals of Airway Orthodontics
1 Breathing through the nose2 Lips together at rest3 Correct tongue position4 No facial muscles moving on swallowing5 Optimal forward facial development6 Class I occlusion7 Straight teeth8 Better stability long term
Myofunctional Trainers
Professors R Soulet and A Besombes
Dr Earl Bergeson
Dr Chris Farrell
The Multi ndash Family System
Orofacial MyofunctionalTherapy
Oral MyologyMyofunctional TherapyTongue Thrust Therapy
B Hockel 2012 Back
Undoing Bimaxillary Dysplasia
1 Maxillary deconstriction2 Maxillary advancement3 Maxillary impaction4 Mandibular advancement
1 Maxillary Expansion
Treatment for Bimaxillary Dysplasia
ALFCrozat
Bent Wire
HyraxHaas
Niti Exp BioBlocSchwartz
The Farrell BENT WIRE Systemtrade
Recommended Age Group 5-12 yrs
Arch Development in conjunction with the TRAINER Systemtrade
Dr John Mew
Establish Good Habits
1 Breathing through the nose2 Lips together at rest3 Correct tongue position4 No facial muscles moving on swallowing5 Stand and sit in balance6 Breath gently using the diaphragm7 Eat to nourish8 Sleep to rest
Ortho-Postural TrainingWorkshops
Breathing
Nutrition
Posture
Sleep
COPYRIGHTRoger L PriceOctober 2012
Posture Number
Forward head posturecan be a compensationfor a deficient airway
Sleep Screening and Hygiene
SQI = 10 SQI = 98
Integrative Healthcare
Function ProfessionalNasal clearing ENT Pulm MFT BreathingMuscle balance and tone MFT Myofunctional OrthoUndoing damage GP Pedo Ortho OMFSBreathing dynamics OPT MFT Breath PhysiologistPosture DC OPT PT OsteopathCranial balance OsteopathNutrition RDH Nutritionist Dietitian Sleep ENT Sleep Med DentNeurocognitive development Pedrsquon SLP Psych SpEd
The Interdisciplinary Center
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Now that I know
My personal missionTo create from what Irsquove
learned from the besta model for others to followhellipespecially the orthodontists
Myofunctional Orthodontics
Chris Farrell
John Flutter
German Ramierez
Damien OrsquoBrien
Myofunctional Research CoRancho Cucamonga
2008-2012
Oral Myology
Oral Myology Basic CourseJoy MoellerNYC 2011LA 2012
Oral Myology Levels 2 3Kim BenkertClifton 2012
Habit CessationShari GreenClifton 2013
Biobloc Orthotropics
BBO Mini-residencyBill Hang
Agora Hills2012-13
BBO IntensiveDrs John and Mike
MewLSFO2013
Breathing and Sleep
Buteyko MentorshipThe Breathing Center
Woodstock2010
Breathing Well ProgrammeJohn Flutter
2010 Ortho-Postural TrainingRoger Price
2013
Sleep DentistryMichael Gelb etal
NYU2012
ALF and Cranial
Jim Bronson2013 Tasha Turzo
Cranial Academy2014
Bucket Listbull ALF and Crozat (Bronsonrsquos course)bullMore on Biobloc (Hangrsquos Advanced London School)bull More Cranial (The Farm)bullChirodontics (Bob Walker)bull Airway Dentistry with Marc Cruz Jeff Rousebull Sleep Dentistrybull Less-than-Six with Kevin Boydbull Intra-mandibular Distraction Osteogenesis (IMDO)
Off My ListAnything that moves the teeth faster in the wrong direction
Whatrsquos an RO to do
To create from what Irsquove learned from the best
a model for others to followhellipespecially orthodontists
Teaching
Mt Sinai Pedo ResidencyAli Attaie
2010-2012
Montefiore Ortho ResidencyTony Maganzini
2012
2009-Present
Mt Sinai School of MedicinePedodontic Residency
Guest SpeakersJim BronsonMike MewKevin BoydSandra KahnJennifer TowRoger PricePaula Fabbie
Damien OrsquoBrien
First clinical program in myofunctional orthodontics
Airway and Facial DevelopmentCollaborative Webcast
Mark Cruz
AAPMD Symposium
wwwaapm
dorg
Annual MeetingApril 25-26 2014
Westin Chicago North Shore
the raphael center for integrative orthodontics
wwwalignminecomwwwbioblocnjcom
wwwmyobracenjcom
Integrative vs Conventional
Integrative vs Conventional
ldquoWith improvements in expansion orthodontics advances in myofunctional orthodontics and the growing recognition about sleep disordered breathing among children and adults it is time for orthodontics to expand its horizons There is now so much more we can oerrdquo
The Raphael name has been associated with high quality orthodontics in New Jersey for over 60 years Dr Barry Raphael has been a university trained orthodontic specialist and a member of the American Association of Orthodontists for 30 years
He has a wide range of techniques and services to offer He has studied oral myology applied kinesiology Buteyko breathing Biobloc Orthotropics and Myobrace as part of his integrative training He can offer Damon Invisalign Insignia and Incognito appliances designs as some of his many conventional orthodontic services too
Dr Raphael teaches his techniques at post-graduate residencies study clubs dental societies and for the Myofunctional Research Co He is available for presentations to any group interested in learning more about the benefits of integrative orthodontics
wwwalignminecomLearn about the choices you have in orthodontics
dr barry raphael Why its
too Early never
1425
bro
ad
str
ee
tc
lifto
n n
j 070
13
973-
778-
4222
fax
973-
778-
9625
nj s
pe
c
368
4
1425 broad street clifton nj 07013973-778-4222
wwwalignminecom
the raphael centerforintegrative orthodontics
the
raph
ael c
ente
r fo
rin
tegr
ativ
e or
thod
onti
cs
Learn about an important choice you need to make before starting braces
the raphael center for integrative education
the raphael center for integrative education
Ongoing Intro to Airway Orthodontics
April Biobloc Study Group
April Training Ortho-Postural Therapists w Roger Price
June MRC Myobrace Basic Series
August Airway Dentistry with Mark Cruz and company
October Advanced MFT with Sandy Coulson
October Less than Six with Kevin Boyd
(who else wants to play)
Mission to create a space for spreading the word about Airway and Orthotropic principles and practice
Orthodontics in the 21st Century
EstheticOrthodontics
AirwayOrthodontics
GeneticTooth-Focused
Dental PerfectionEsthetics Primary
Treating SymptomsAirway Ignorant
AdaptationMuscle-FocusedMedical Better
Esthetics SecondaryTreating Causes
Airway Conscious
The EndAnd
The Beginning
Bimaxillary Retrusion Forward Growth
Mouthbreathers have significantly smaller airway space
(measurements PAS-OccL PAS-UP airway volume area and minimum axial area)
Mouth breather Nasal breather
Three-dimensional assessment of pharyngeal airway in nasal- and mouth-breathing children
Alves M etal Int J Ped ORL 75 (2011) 1195ndash1199
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
B Hockel 2012
This is the profile Biobloc children start with long and retrusive
This is the profile Biobloc children finish with Forward with lips
together
B Hockel 2012
Herersquos the ldquoinsiderdquo look Notice how the upper front teeth are closer to the nose (yellow arrows)
Notice how the lower jaw rotates around the star so the chin comes up and forward (red arrow)How do we make this happen
From the tip of the Central
To the Forwardmost Tip of the Nose
41mm
Maxillary Heightbull Indicator Line (Mew)
bull Distance from most anterior point on nose to upper incisal edge
bull Age + 23bull A variable number but important to watch over time
B Hockel 2012
Herersquos the ldquoinsiderdquo look Notice how the upper front teeth are closer to the nose (yellow arrows)
Notice how the lower jaw rotates around the star so the chin comes up and forward (red arrow)How do we make this happen
Using IndicatorCosmetic Line
bull To define a starting pointbull To set treatment goalsbull To track treatment progressbull To gauge the effectiveness of treatment
Charting the InCos Line
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Incisor pulled away from noseNot ldquoundertorquedrdquo or ldquogummy smilerdquo
Hypothetical ClI OrthoMARA
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
OJ = 7mm
Starts Ortho
ldquoGreat Headgear
Effectrdquo
Class II Elastics
50
40
30
20mm
y J F M A M J J A S O N
boys
Start Non-x
Expansion UncrowdingFinished
Start Cl II elastics
OK thatrsquos
enough
Hypothetical Mouthbreather(Dr Mewrsquos Hamster Boy)
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Boy gets
hamster
MFT
Hypothetical BBO 7yoM
50
40
30
20
5 6 7 8 9 10 11 12 13 14 15
girlsboys
Initial
StartBB1
BB3
Night
bullLR 11-9yFbullMissing all 5s6s8s and upper 4sbullHad ortho to close diastemahellipbullInL = 39bullGP objects to deX plan equil
LR Tx Plan
1Preparation Hang Expanser2deX 3Training BB3 to advance mandible4Myofunctional Therapy5Orthopostural Training6Myobrace to hold7 Reevaluate for dental detailing
LR Spotty progress
50
40
30
20mm
y 313 4 5 6 7 8 9 10 11 12114
2 3
Expanser
Parents dragging30 turnsStart Adv
Rx deXGP
objects
After delays
Equil ersquosBB3
bullLR 12-3 yF (6mo in tx)bullInL = 37 (+2)bull ersquos equilibratedbull OJ =10bull Appliance OJ = 5bull Still accommodating to BB3
Is there a calculus for the Indicator Line
Treatment GoalsBased on Indicator Line
Incisor Goals
Type 1 Treatment Place U1 in ideal position
Biobloc Orthotropics Orthognathic Surgery Distraction Osteogenesis
Type 1 Ideal InCos line
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
YZ 9yo M
bullLost upper d-spacebullInL = 36(+4)bullOJ = 9mmbullLip entrapmentbullLip Incompetence
Y Z 9yo M
Y Z 9yo M9mm OJ
Y Z 9yo M
Treatment Options
1 Type 1 Reduce InL open lost space BB3 to advance mandible
2 Type 2 Open lost space Align
3 Type 4 Extract four premolars
YZ 9yoM
50
40
30
20mm
yM A M J J A S O N D J F M A
boys
Hang Expanser
Upper and Lower
Brackets Hang Retainer
BB3
Incisor Goals
Type 2 Treatment Develop arch just enough to uncrowd
Biobloc Myofunctional Ortho Myofunctional Therapy Crozat ALF Expansion Orthodontics
Type 2 Uncrowding
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
bullLip incompetencebullLip entrapmentbullHypermentalisbullMouthbreathing
Type 2 Uncrowding
12 month progress
12 month progress
12 month progress
After Treatment
Bent-wire6 monthsMyobrace12 months
Hey RaphaelWhat about that
profile
ZP 9-5yoM
i
After Expansion Phase
Incomplete profile improvement better breathing head posture and sleep
Incisor Goals
Type 3 Treatment Maintain UI
Functional Orthodontics Expansion Orthodontics Distalization Ortho or No Treatment
Type 3 Maintain
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Bimax retrusion
Successful dental result
Profile Unimproved
Incisor Goals
Type 4 Treatment RetractExtrude UI
Extraction Orthodontics Retraction Ortho Distalization Ortho
Type 4 Retraction
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Bimax retrusion
Successful dental result
Failed Profile Result
Changes of pharyngeal airway size and hyoid bone position following orthodontic treatment of
Class I bimaxillary protrusion
Qingzhu Wanga Peizeng Jiab Nina K Andersonc Lin Wangd Jiuxiang Line
Angle Orthodontist Vol 00 No 0 0000 (pre-publication 2012)
ldquothe dimension of the velopharynx glossopharynx and hypopharynx were decreased after maximal retraction of anterior teeth with extraction of four premolarshelliprdquo ldquoAny factors that can influence the posture and position of tongue and soft palate may displace them backward andencroach upon the pharynxrdquo
ldquothe more the incisors were retracted the more the pharyngeal airway was reducedrdquo
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Backed into a corner
bull
Moving teeth faster more efficientlyhellipin the wrong direction
Now that wersquove made smoking unacceptable
could we not do the same withbull Sugarbull Processed foodbull Cheap milk and meatbull Fast foodbull Pill popping for symptomatic reliefbull Looking for the cure instead of the causebull Surgery as a quick fixbull Thinking braces are a status symbol
Each industry thrives on the status quoConsumers must drive the change
NP 10yM
NP
Sisterrsquos non-x ortho
Shersquos happyhellipbut Irsquom not so
I make my pitch for BBO
The dilemma of progress
(I forgot the progress pictureshellip)
Dad sells prosthetic parts to orthopedic surgeons
I selling the case against my previous work they loved
It takes me 3 hours to sell the case
They fret until the BB3 goes in
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Connecting the dots
bull Adult SDB and OSA
bull Narrow jaws and faces
bull Soft tissue dysfunction
bull Early parafunctional habits ie open mouth posture
bull Environmental stressors
bull CPAP MARAUPPP SurgWherersquos the best
place to start treatment here
or here
1 Prevention 2 Undo the damage already done3 Establish good habits
When to start When damage from poor breathing is noticed and when bad habits are discovered
The strategies of Airway Orthodontics
Prevention
bull Remove ankyloglossiabull Promote breastfeedingbull Harden the dietbull Develop masticatory strengthbull Discourage oral habitsbull Promote whole-foods low sugar dietbull Reduce oropharyngeal obstructionbull Promote nasal breathing
Breathing retraining
bull Nasal rinsingbull Nasal clearingbull Decongesting
The goals of Airway Orthodontics
1 Breathing through the nose2 Lips together at rest3 Correct tongue position4 No facial muscles moving on swallowing5 Optimal forward facial development6 Class I occlusion7 Straight teeth8 Better stability long term
Myofunctional Trainers
Professors R Soulet and A Besombes
Dr Earl Bergeson
Dr Chris Farrell
The Multi ndash Family System
Orofacial MyofunctionalTherapy
Oral MyologyMyofunctional TherapyTongue Thrust Therapy
B Hockel 2012 Back
Undoing Bimaxillary Dysplasia
1 Maxillary deconstriction2 Maxillary advancement3 Maxillary impaction4 Mandibular advancement
1 Maxillary Expansion
Treatment for Bimaxillary Dysplasia
ALFCrozat
Bent Wire
HyraxHaas
Niti Exp BioBlocSchwartz
The Farrell BENT WIRE Systemtrade
Recommended Age Group 5-12 yrs
Arch Development in conjunction with the TRAINER Systemtrade
Dr John Mew
Establish Good Habits
1 Breathing through the nose2 Lips together at rest3 Correct tongue position4 No facial muscles moving on swallowing5 Stand and sit in balance6 Breath gently using the diaphragm7 Eat to nourish8 Sleep to rest
Ortho-Postural TrainingWorkshops
Breathing
Nutrition
Posture
Sleep
COPYRIGHTRoger L PriceOctober 2012
Posture Number
Forward head posturecan be a compensationfor a deficient airway
Sleep Screening and Hygiene
SQI = 10 SQI = 98
Integrative Healthcare
Function ProfessionalNasal clearing ENT Pulm MFT BreathingMuscle balance and tone MFT Myofunctional OrthoUndoing damage GP Pedo Ortho OMFSBreathing dynamics OPT MFT Breath PhysiologistPosture DC OPT PT OsteopathCranial balance OsteopathNutrition RDH Nutritionist Dietitian Sleep ENT Sleep Med DentNeurocognitive development Pedrsquon SLP Psych SpEd
The Interdisciplinary Center
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Now that I know
My personal missionTo create from what Irsquove
learned from the besta model for others to followhellipespecially the orthodontists
Myofunctional Orthodontics
Chris Farrell
John Flutter
German Ramierez
Damien OrsquoBrien
Myofunctional Research CoRancho Cucamonga
2008-2012
Oral Myology
Oral Myology Basic CourseJoy MoellerNYC 2011LA 2012
Oral Myology Levels 2 3Kim BenkertClifton 2012
Habit CessationShari GreenClifton 2013
Biobloc Orthotropics
BBO Mini-residencyBill Hang
Agora Hills2012-13
BBO IntensiveDrs John and Mike
MewLSFO2013
Breathing and Sleep
Buteyko MentorshipThe Breathing Center
Woodstock2010
Breathing Well ProgrammeJohn Flutter
2010 Ortho-Postural TrainingRoger Price
2013
Sleep DentistryMichael Gelb etal
NYU2012
ALF and Cranial
Jim Bronson2013 Tasha Turzo
Cranial Academy2014
Bucket Listbull ALF and Crozat (Bronsonrsquos course)bullMore on Biobloc (Hangrsquos Advanced London School)bull More Cranial (The Farm)bullChirodontics (Bob Walker)bull Airway Dentistry with Marc Cruz Jeff Rousebull Sleep Dentistrybull Less-than-Six with Kevin Boydbull Intra-mandibular Distraction Osteogenesis (IMDO)
Off My ListAnything that moves the teeth faster in the wrong direction
Whatrsquos an RO to do
To create from what Irsquove learned from the best
a model for others to followhellipespecially orthodontists
Teaching
Mt Sinai Pedo ResidencyAli Attaie
2010-2012
Montefiore Ortho ResidencyTony Maganzini
2012
2009-Present
Mt Sinai School of MedicinePedodontic Residency
Guest SpeakersJim BronsonMike MewKevin BoydSandra KahnJennifer TowRoger PricePaula Fabbie
Damien OrsquoBrien
First clinical program in myofunctional orthodontics
Airway and Facial DevelopmentCollaborative Webcast
Mark Cruz
AAPMD Symposium
wwwaapm
dorg
Annual MeetingApril 25-26 2014
Westin Chicago North Shore
the raphael center for integrative orthodontics
wwwalignminecomwwwbioblocnjcom
wwwmyobracenjcom
Integrative vs Conventional
Integrative vs Conventional
ldquoWith improvements in expansion orthodontics advances in myofunctional orthodontics and the growing recognition about sleep disordered breathing among children and adults it is time for orthodontics to expand its horizons There is now so much more we can oerrdquo
The Raphael name has been associated with high quality orthodontics in New Jersey for over 60 years Dr Barry Raphael has been a university trained orthodontic specialist and a member of the American Association of Orthodontists for 30 years
He has a wide range of techniques and services to offer He has studied oral myology applied kinesiology Buteyko breathing Biobloc Orthotropics and Myobrace as part of his integrative training He can offer Damon Invisalign Insignia and Incognito appliances designs as some of his many conventional orthodontic services too
Dr Raphael teaches his techniques at post-graduate residencies study clubs dental societies and for the Myofunctional Research Co He is available for presentations to any group interested in learning more about the benefits of integrative orthodontics
wwwalignminecomLearn about the choices you have in orthodontics
dr barry raphael Why its
too Early never
1425
bro
ad
str
ee
tc
lifto
n n
j 070
13
973-
778-
4222
fax
973-
778-
9625
nj s
pe
c
368
4
1425 broad street clifton nj 07013973-778-4222
wwwalignminecom
the raphael centerforintegrative orthodontics
the
raph
ael c
ente
r fo
rin
tegr
ativ
e or
thod
onti
cs
Learn about an important choice you need to make before starting braces
the raphael center for integrative education
the raphael center for integrative education
Ongoing Intro to Airway Orthodontics
April Biobloc Study Group
April Training Ortho-Postural Therapists w Roger Price
June MRC Myobrace Basic Series
August Airway Dentistry with Mark Cruz and company
October Advanced MFT with Sandy Coulson
October Less than Six with Kevin Boyd
(who else wants to play)
Mission to create a space for spreading the word about Airway and Orthotropic principles and practice
Orthodontics in the 21st Century
EstheticOrthodontics
AirwayOrthodontics
GeneticTooth-Focused
Dental PerfectionEsthetics Primary
Treating SymptomsAirway Ignorant
AdaptationMuscle-FocusedMedical Better
Esthetics SecondaryTreating Causes
Airway Conscious
The EndAnd
The Beginning
Mouthbreathers have significantly smaller airway space
(measurements PAS-OccL PAS-UP airway volume area and minimum axial area)
Mouth breather Nasal breather
Three-dimensional assessment of pharyngeal airway in nasal- and mouth-breathing children
Alves M etal Int J Ped ORL 75 (2011) 1195ndash1199
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
B Hockel 2012
This is the profile Biobloc children start with long and retrusive
This is the profile Biobloc children finish with Forward with lips
together
B Hockel 2012
Herersquos the ldquoinsiderdquo look Notice how the upper front teeth are closer to the nose (yellow arrows)
Notice how the lower jaw rotates around the star so the chin comes up and forward (red arrow)How do we make this happen
From the tip of the Central
To the Forwardmost Tip of the Nose
41mm
Maxillary Heightbull Indicator Line (Mew)
bull Distance from most anterior point on nose to upper incisal edge
bull Age + 23bull A variable number but important to watch over time
B Hockel 2012
Herersquos the ldquoinsiderdquo look Notice how the upper front teeth are closer to the nose (yellow arrows)
Notice how the lower jaw rotates around the star so the chin comes up and forward (red arrow)How do we make this happen
Using IndicatorCosmetic Line
bull To define a starting pointbull To set treatment goalsbull To track treatment progressbull To gauge the effectiveness of treatment
Charting the InCos Line
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Incisor pulled away from noseNot ldquoundertorquedrdquo or ldquogummy smilerdquo
Hypothetical ClI OrthoMARA
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
OJ = 7mm
Starts Ortho
ldquoGreat Headgear
Effectrdquo
Class II Elastics
50
40
30
20mm
y J F M A M J J A S O N
boys
Start Non-x
Expansion UncrowdingFinished
Start Cl II elastics
OK thatrsquos
enough
Hypothetical Mouthbreather(Dr Mewrsquos Hamster Boy)
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Boy gets
hamster
MFT
Hypothetical BBO 7yoM
50
40
30
20
5 6 7 8 9 10 11 12 13 14 15
girlsboys
Initial
StartBB1
BB3
Night
bullLR 11-9yFbullMissing all 5s6s8s and upper 4sbullHad ortho to close diastemahellipbullInL = 39bullGP objects to deX plan equil
LR Tx Plan
1Preparation Hang Expanser2deX 3Training BB3 to advance mandible4Myofunctional Therapy5Orthopostural Training6Myobrace to hold7 Reevaluate for dental detailing
LR Spotty progress
50
40
30
20mm
y 313 4 5 6 7 8 9 10 11 12114
2 3
Expanser
Parents dragging30 turnsStart Adv
Rx deXGP
objects
After delays
Equil ersquosBB3
bullLR 12-3 yF (6mo in tx)bullInL = 37 (+2)bull ersquos equilibratedbull OJ =10bull Appliance OJ = 5bull Still accommodating to BB3
Is there a calculus for the Indicator Line
Treatment GoalsBased on Indicator Line
Incisor Goals
Type 1 Treatment Place U1 in ideal position
Biobloc Orthotropics Orthognathic Surgery Distraction Osteogenesis
Type 1 Ideal InCos line
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
YZ 9yo M
bullLost upper d-spacebullInL = 36(+4)bullOJ = 9mmbullLip entrapmentbullLip Incompetence
Y Z 9yo M
Y Z 9yo M9mm OJ
Y Z 9yo M
Treatment Options
1 Type 1 Reduce InL open lost space BB3 to advance mandible
2 Type 2 Open lost space Align
3 Type 4 Extract four premolars
YZ 9yoM
50
40
30
20mm
yM A M J J A S O N D J F M A
boys
Hang Expanser
Upper and Lower
Brackets Hang Retainer
BB3
Incisor Goals
Type 2 Treatment Develop arch just enough to uncrowd
Biobloc Myofunctional Ortho Myofunctional Therapy Crozat ALF Expansion Orthodontics
Type 2 Uncrowding
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
bullLip incompetencebullLip entrapmentbullHypermentalisbullMouthbreathing
Type 2 Uncrowding
12 month progress
12 month progress
12 month progress
After Treatment
Bent-wire6 monthsMyobrace12 months
Hey RaphaelWhat about that
profile
ZP 9-5yoM
i
After Expansion Phase
Incomplete profile improvement better breathing head posture and sleep
Incisor Goals
Type 3 Treatment Maintain UI
Functional Orthodontics Expansion Orthodontics Distalization Ortho or No Treatment
Type 3 Maintain
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Bimax retrusion
Successful dental result
Profile Unimproved
Incisor Goals
Type 4 Treatment RetractExtrude UI
Extraction Orthodontics Retraction Ortho Distalization Ortho
Type 4 Retraction
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Bimax retrusion
Successful dental result
Failed Profile Result
Changes of pharyngeal airway size and hyoid bone position following orthodontic treatment of
Class I bimaxillary protrusion
Qingzhu Wanga Peizeng Jiab Nina K Andersonc Lin Wangd Jiuxiang Line
Angle Orthodontist Vol 00 No 0 0000 (pre-publication 2012)
ldquothe dimension of the velopharynx glossopharynx and hypopharynx were decreased after maximal retraction of anterior teeth with extraction of four premolarshelliprdquo ldquoAny factors that can influence the posture and position of tongue and soft palate may displace them backward andencroach upon the pharynxrdquo
ldquothe more the incisors were retracted the more the pharyngeal airway was reducedrdquo
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Backed into a corner
bull
Moving teeth faster more efficientlyhellipin the wrong direction
Now that wersquove made smoking unacceptable
could we not do the same withbull Sugarbull Processed foodbull Cheap milk and meatbull Fast foodbull Pill popping for symptomatic reliefbull Looking for the cure instead of the causebull Surgery as a quick fixbull Thinking braces are a status symbol
Each industry thrives on the status quoConsumers must drive the change
NP 10yM
NP
Sisterrsquos non-x ortho
Shersquos happyhellipbut Irsquom not so
I make my pitch for BBO
The dilemma of progress
(I forgot the progress pictureshellip)
Dad sells prosthetic parts to orthopedic surgeons
I selling the case against my previous work they loved
It takes me 3 hours to sell the case
They fret until the BB3 goes in
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Connecting the dots
bull Adult SDB and OSA
bull Narrow jaws and faces
bull Soft tissue dysfunction
bull Early parafunctional habits ie open mouth posture
bull Environmental stressors
bull CPAP MARAUPPP SurgWherersquos the best
place to start treatment here
or here
1 Prevention 2 Undo the damage already done3 Establish good habits
When to start When damage from poor breathing is noticed and when bad habits are discovered
The strategies of Airway Orthodontics
Prevention
bull Remove ankyloglossiabull Promote breastfeedingbull Harden the dietbull Develop masticatory strengthbull Discourage oral habitsbull Promote whole-foods low sugar dietbull Reduce oropharyngeal obstructionbull Promote nasal breathing
Breathing retraining
bull Nasal rinsingbull Nasal clearingbull Decongesting
The goals of Airway Orthodontics
1 Breathing through the nose2 Lips together at rest3 Correct tongue position4 No facial muscles moving on swallowing5 Optimal forward facial development6 Class I occlusion7 Straight teeth8 Better stability long term
Myofunctional Trainers
Professors R Soulet and A Besombes
Dr Earl Bergeson
Dr Chris Farrell
The Multi ndash Family System
Orofacial MyofunctionalTherapy
Oral MyologyMyofunctional TherapyTongue Thrust Therapy
B Hockel 2012 Back
Undoing Bimaxillary Dysplasia
1 Maxillary deconstriction2 Maxillary advancement3 Maxillary impaction4 Mandibular advancement
1 Maxillary Expansion
Treatment for Bimaxillary Dysplasia
ALFCrozat
Bent Wire
HyraxHaas
Niti Exp BioBlocSchwartz
The Farrell BENT WIRE Systemtrade
Recommended Age Group 5-12 yrs
Arch Development in conjunction with the TRAINER Systemtrade
Dr John Mew
Establish Good Habits
1 Breathing through the nose2 Lips together at rest3 Correct tongue position4 No facial muscles moving on swallowing5 Stand and sit in balance6 Breath gently using the diaphragm7 Eat to nourish8 Sleep to rest
Ortho-Postural TrainingWorkshops
Breathing
Nutrition
Posture
Sleep
COPYRIGHTRoger L PriceOctober 2012
Posture Number
Forward head posturecan be a compensationfor a deficient airway
Sleep Screening and Hygiene
SQI = 10 SQI = 98
Integrative Healthcare
Function ProfessionalNasal clearing ENT Pulm MFT BreathingMuscle balance and tone MFT Myofunctional OrthoUndoing damage GP Pedo Ortho OMFSBreathing dynamics OPT MFT Breath PhysiologistPosture DC OPT PT OsteopathCranial balance OsteopathNutrition RDH Nutritionist Dietitian Sleep ENT Sleep Med DentNeurocognitive development Pedrsquon SLP Psych SpEd
The Interdisciplinary Center
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Now that I know
My personal missionTo create from what Irsquove
learned from the besta model for others to followhellipespecially the orthodontists
Myofunctional Orthodontics
Chris Farrell
John Flutter
German Ramierez
Damien OrsquoBrien
Myofunctional Research CoRancho Cucamonga
2008-2012
Oral Myology
Oral Myology Basic CourseJoy MoellerNYC 2011LA 2012
Oral Myology Levels 2 3Kim BenkertClifton 2012
Habit CessationShari GreenClifton 2013
Biobloc Orthotropics
BBO Mini-residencyBill Hang
Agora Hills2012-13
BBO IntensiveDrs John and Mike
MewLSFO2013
Breathing and Sleep
Buteyko MentorshipThe Breathing Center
Woodstock2010
Breathing Well ProgrammeJohn Flutter
2010 Ortho-Postural TrainingRoger Price
2013
Sleep DentistryMichael Gelb etal
NYU2012
ALF and Cranial
Jim Bronson2013 Tasha Turzo
Cranial Academy2014
Bucket Listbull ALF and Crozat (Bronsonrsquos course)bullMore on Biobloc (Hangrsquos Advanced London School)bull More Cranial (The Farm)bullChirodontics (Bob Walker)bull Airway Dentistry with Marc Cruz Jeff Rousebull Sleep Dentistrybull Less-than-Six with Kevin Boydbull Intra-mandibular Distraction Osteogenesis (IMDO)
Off My ListAnything that moves the teeth faster in the wrong direction
Whatrsquos an RO to do
To create from what Irsquove learned from the best
a model for others to followhellipespecially orthodontists
Teaching
Mt Sinai Pedo ResidencyAli Attaie
2010-2012
Montefiore Ortho ResidencyTony Maganzini
2012
2009-Present
Mt Sinai School of MedicinePedodontic Residency
Guest SpeakersJim BronsonMike MewKevin BoydSandra KahnJennifer TowRoger PricePaula Fabbie
Damien OrsquoBrien
First clinical program in myofunctional orthodontics
Airway and Facial DevelopmentCollaborative Webcast
Mark Cruz
AAPMD Symposium
wwwaapm
dorg
Annual MeetingApril 25-26 2014
Westin Chicago North Shore
the raphael center for integrative orthodontics
wwwalignminecomwwwbioblocnjcom
wwwmyobracenjcom
Integrative vs Conventional
Integrative vs Conventional
ldquoWith improvements in expansion orthodontics advances in myofunctional orthodontics and the growing recognition about sleep disordered breathing among children and adults it is time for orthodontics to expand its horizons There is now so much more we can oerrdquo
The Raphael name has been associated with high quality orthodontics in New Jersey for over 60 years Dr Barry Raphael has been a university trained orthodontic specialist and a member of the American Association of Orthodontists for 30 years
He has a wide range of techniques and services to offer He has studied oral myology applied kinesiology Buteyko breathing Biobloc Orthotropics and Myobrace as part of his integrative training He can offer Damon Invisalign Insignia and Incognito appliances designs as some of his many conventional orthodontic services too
Dr Raphael teaches his techniques at post-graduate residencies study clubs dental societies and for the Myofunctional Research Co He is available for presentations to any group interested in learning more about the benefits of integrative orthodontics
wwwalignminecomLearn about the choices you have in orthodontics
dr barry raphael Why its
too Early never
1425
bro
ad
str
ee
tc
lifto
n n
j 070
13
973-
778-
4222
fax
973-
778-
9625
nj s
pe
c
368
4
1425 broad street clifton nj 07013973-778-4222
wwwalignminecom
the raphael centerforintegrative orthodontics
the
raph
ael c
ente
r fo
rin
tegr
ativ
e or
thod
onti
cs
Learn about an important choice you need to make before starting braces
the raphael center for integrative education
the raphael center for integrative education
Ongoing Intro to Airway Orthodontics
April Biobloc Study Group
April Training Ortho-Postural Therapists w Roger Price
June MRC Myobrace Basic Series
August Airway Dentistry with Mark Cruz and company
October Advanced MFT with Sandy Coulson
October Less than Six with Kevin Boyd
(who else wants to play)
Mission to create a space for spreading the word about Airway and Orthotropic principles and practice
Orthodontics in the 21st Century
EstheticOrthodontics
AirwayOrthodontics
GeneticTooth-Focused
Dental PerfectionEsthetics Primary
Treating SymptomsAirway Ignorant
AdaptationMuscle-FocusedMedical Better
Esthetics SecondaryTreating Causes
Airway Conscious
The EndAnd
The Beginning
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
B Hockel 2012
This is the profile Biobloc children start with long and retrusive
This is the profile Biobloc children finish with Forward with lips
together
B Hockel 2012
Herersquos the ldquoinsiderdquo look Notice how the upper front teeth are closer to the nose (yellow arrows)
Notice how the lower jaw rotates around the star so the chin comes up and forward (red arrow)How do we make this happen
From the tip of the Central
To the Forwardmost Tip of the Nose
41mm
Maxillary Heightbull Indicator Line (Mew)
bull Distance from most anterior point on nose to upper incisal edge
bull Age + 23bull A variable number but important to watch over time
B Hockel 2012
Herersquos the ldquoinsiderdquo look Notice how the upper front teeth are closer to the nose (yellow arrows)
Notice how the lower jaw rotates around the star so the chin comes up and forward (red arrow)How do we make this happen
Using IndicatorCosmetic Line
bull To define a starting pointbull To set treatment goalsbull To track treatment progressbull To gauge the effectiveness of treatment
Charting the InCos Line
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Incisor pulled away from noseNot ldquoundertorquedrdquo or ldquogummy smilerdquo
Hypothetical ClI OrthoMARA
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
OJ = 7mm
Starts Ortho
ldquoGreat Headgear
Effectrdquo
Class II Elastics
50
40
30
20mm
y J F M A M J J A S O N
boys
Start Non-x
Expansion UncrowdingFinished
Start Cl II elastics
OK thatrsquos
enough
Hypothetical Mouthbreather(Dr Mewrsquos Hamster Boy)
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Boy gets
hamster
MFT
Hypothetical BBO 7yoM
50
40
30
20
5 6 7 8 9 10 11 12 13 14 15
girlsboys
Initial
StartBB1
BB3
Night
bullLR 11-9yFbullMissing all 5s6s8s and upper 4sbullHad ortho to close diastemahellipbullInL = 39bullGP objects to deX plan equil
LR Tx Plan
1Preparation Hang Expanser2deX 3Training BB3 to advance mandible4Myofunctional Therapy5Orthopostural Training6Myobrace to hold7 Reevaluate for dental detailing
LR Spotty progress
50
40
30
20mm
y 313 4 5 6 7 8 9 10 11 12114
2 3
Expanser
Parents dragging30 turnsStart Adv
Rx deXGP
objects
After delays
Equil ersquosBB3
bullLR 12-3 yF (6mo in tx)bullInL = 37 (+2)bull ersquos equilibratedbull OJ =10bull Appliance OJ = 5bull Still accommodating to BB3
Is there a calculus for the Indicator Line
Treatment GoalsBased on Indicator Line
Incisor Goals
Type 1 Treatment Place U1 in ideal position
Biobloc Orthotropics Orthognathic Surgery Distraction Osteogenesis
Type 1 Ideal InCos line
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
YZ 9yo M
bullLost upper d-spacebullInL = 36(+4)bullOJ = 9mmbullLip entrapmentbullLip Incompetence
Y Z 9yo M
Y Z 9yo M9mm OJ
Y Z 9yo M
Treatment Options
1 Type 1 Reduce InL open lost space BB3 to advance mandible
2 Type 2 Open lost space Align
3 Type 4 Extract four premolars
YZ 9yoM
50
40
30
20mm
yM A M J J A S O N D J F M A
boys
Hang Expanser
Upper and Lower
Brackets Hang Retainer
BB3
Incisor Goals
Type 2 Treatment Develop arch just enough to uncrowd
Biobloc Myofunctional Ortho Myofunctional Therapy Crozat ALF Expansion Orthodontics
Type 2 Uncrowding
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
bullLip incompetencebullLip entrapmentbullHypermentalisbullMouthbreathing
Type 2 Uncrowding
12 month progress
12 month progress
12 month progress
After Treatment
Bent-wire6 monthsMyobrace12 months
Hey RaphaelWhat about that
profile
ZP 9-5yoM
i
After Expansion Phase
Incomplete profile improvement better breathing head posture and sleep
Incisor Goals
Type 3 Treatment Maintain UI
Functional Orthodontics Expansion Orthodontics Distalization Ortho or No Treatment
Type 3 Maintain
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Bimax retrusion
Successful dental result
Profile Unimproved
Incisor Goals
Type 4 Treatment RetractExtrude UI
Extraction Orthodontics Retraction Ortho Distalization Ortho
Type 4 Retraction
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Bimax retrusion
Successful dental result
Failed Profile Result
Changes of pharyngeal airway size and hyoid bone position following orthodontic treatment of
Class I bimaxillary protrusion
Qingzhu Wanga Peizeng Jiab Nina K Andersonc Lin Wangd Jiuxiang Line
Angle Orthodontist Vol 00 No 0 0000 (pre-publication 2012)
ldquothe dimension of the velopharynx glossopharynx and hypopharynx were decreased after maximal retraction of anterior teeth with extraction of four premolarshelliprdquo ldquoAny factors that can influence the posture and position of tongue and soft palate may displace them backward andencroach upon the pharynxrdquo
ldquothe more the incisors were retracted the more the pharyngeal airway was reducedrdquo
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Backed into a corner
bull
Moving teeth faster more efficientlyhellipin the wrong direction
Now that wersquove made smoking unacceptable
could we not do the same withbull Sugarbull Processed foodbull Cheap milk and meatbull Fast foodbull Pill popping for symptomatic reliefbull Looking for the cure instead of the causebull Surgery as a quick fixbull Thinking braces are a status symbol
Each industry thrives on the status quoConsumers must drive the change
NP 10yM
NP
Sisterrsquos non-x ortho
Shersquos happyhellipbut Irsquom not so
I make my pitch for BBO
The dilemma of progress
(I forgot the progress pictureshellip)
Dad sells prosthetic parts to orthopedic surgeons
I selling the case against my previous work they loved
It takes me 3 hours to sell the case
They fret until the BB3 goes in
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Connecting the dots
bull Adult SDB and OSA
bull Narrow jaws and faces
bull Soft tissue dysfunction
bull Early parafunctional habits ie open mouth posture
bull Environmental stressors
bull CPAP MARAUPPP SurgWherersquos the best
place to start treatment here
or here
1 Prevention 2 Undo the damage already done3 Establish good habits
When to start When damage from poor breathing is noticed and when bad habits are discovered
The strategies of Airway Orthodontics
Prevention
bull Remove ankyloglossiabull Promote breastfeedingbull Harden the dietbull Develop masticatory strengthbull Discourage oral habitsbull Promote whole-foods low sugar dietbull Reduce oropharyngeal obstructionbull Promote nasal breathing
Breathing retraining
bull Nasal rinsingbull Nasal clearingbull Decongesting
The goals of Airway Orthodontics
1 Breathing through the nose2 Lips together at rest3 Correct tongue position4 No facial muscles moving on swallowing5 Optimal forward facial development6 Class I occlusion7 Straight teeth8 Better stability long term
Myofunctional Trainers
Professors R Soulet and A Besombes
Dr Earl Bergeson
Dr Chris Farrell
The Multi ndash Family System
Orofacial MyofunctionalTherapy
Oral MyologyMyofunctional TherapyTongue Thrust Therapy
B Hockel 2012 Back
Undoing Bimaxillary Dysplasia
1 Maxillary deconstriction2 Maxillary advancement3 Maxillary impaction4 Mandibular advancement
1 Maxillary Expansion
Treatment for Bimaxillary Dysplasia
ALFCrozat
Bent Wire
HyraxHaas
Niti Exp BioBlocSchwartz
The Farrell BENT WIRE Systemtrade
Recommended Age Group 5-12 yrs
Arch Development in conjunction with the TRAINER Systemtrade
Dr John Mew
Establish Good Habits
1 Breathing through the nose2 Lips together at rest3 Correct tongue position4 No facial muscles moving on swallowing5 Stand and sit in balance6 Breath gently using the diaphragm7 Eat to nourish8 Sleep to rest
Ortho-Postural TrainingWorkshops
Breathing
Nutrition
Posture
Sleep
COPYRIGHTRoger L PriceOctober 2012
Posture Number
Forward head posturecan be a compensationfor a deficient airway
Sleep Screening and Hygiene
SQI = 10 SQI = 98
Integrative Healthcare
Function ProfessionalNasal clearing ENT Pulm MFT BreathingMuscle balance and tone MFT Myofunctional OrthoUndoing damage GP Pedo Ortho OMFSBreathing dynamics OPT MFT Breath PhysiologistPosture DC OPT PT OsteopathCranial balance OsteopathNutrition RDH Nutritionist Dietitian Sleep ENT Sleep Med DentNeurocognitive development Pedrsquon SLP Psych SpEd
The Interdisciplinary Center
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Now that I know
My personal missionTo create from what Irsquove
learned from the besta model for others to followhellipespecially the orthodontists
Myofunctional Orthodontics
Chris Farrell
John Flutter
German Ramierez
Damien OrsquoBrien
Myofunctional Research CoRancho Cucamonga
2008-2012
Oral Myology
Oral Myology Basic CourseJoy MoellerNYC 2011LA 2012
Oral Myology Levels 2 3Kim BenkertClifton 2012
Habit CessationShari GreenClifton 2013
Biobloc Orthotropics
BBO Mini-residencyBill Hang
Agora Hills2012-13
BBO IntensiveDrs John and Mike
MewLSFO2013
Breathing and Sleep
Buteyko MentorshipThe Breathing Center
Woodstock2010
Breathing Well ProgrammeJohn Flutter
2010 Ortho-Postural TrainingRoger Price
2013
Sleep DentistryMichael Gelb etal
NYU2012
ALF and Cranial
Jim Bronson2013 Tasha Turzo
Cranial Academy2014
Bucket Listbull ALF and Crozat (Bronsonrsquos course)bullMore on Biobloc (Hangrsquos Advanced London School)bull More Cranial (The Farm)bullChirodontics (Bob Walker)bull Airway Dentistry with Marc Cruz Jeff Rousebull Sleep Dentistrybull Less-than-Six with Kevin Boydbull Intra-mandibular Distraction Osteogenesis (IMDO)
Off My ListAnything that moves the teeth faster in the wrong direction
Whatrsquos an RO to do
To create from what Irsquove learned from the best
a model for others to followhellipespecially orthodontists
Teaching
Mt Sinai Pedo ResidencyAli Attaie
2010-2012
Montefiore Ortho ResidencyTony Maganzini
2012
2009-Present
Mt Sinai School of MedicinePedodontic Residency
Guest SpeakersJim BronsonMike MewKevin BoydSandra KahnJennifer TowRoger PricePaula Fabbie
Damien OrsquoBrien
First clinical program in myofunctional orthodontics
Airway and Facial DevelopmentCollaborative Webcast
Mark Cruz
AAPMD Symposium
wwwaapm
dorg
Annual MeetingApril 25-26 2014
Westin Chicago North Shore
the raphael center for integrative orthodontics
wwwalignminecomwwwbioblocnjcom
wwwmyobracenjcom
Integrative vs Conventional
Integrative vs Conventional
ldquoWith improvements in expansion orthodontics advances in myofunctional orthodontics and the growing recognition about sleep disordered breathing among children and adults it is time for orthodontics to expand its horizons There is now so much more we can oerrdquo
The Raphael name has been associated with high quality orthodontics in New Jersey for over 60 years Dr Barry Raphael has been a university trained orthodontic specialist and a member of the American Association of Orthodontists for 30 years
He has a wide range of techniques and services to offer He has studied oral myology applied kinesiology Buteyko breathing Biobloc Orthotropics and Myobrace as part of his integrative training He can offer Damon Invisalign Insignia and Incognito appliances designs as some of his many conventional orthodontic services too
Dr Raphael teaches his techniques at post-graduate residencies study clubs dental societies and for the Myofunctional Research Co He is available for presentations to any group interested in learning more about the benefits of integrative orthodontics
wwwalignminecomLearn about the choices you have in orthodontics
dr barry raphael Why its
too Early never
1425
bro
ad
str
ee
tc
lifto
n n
j 070
13
973-
778-
4222
fax
973-
778-
9625
nj s
pe
c
368
4
1425 broad street clifton nj 07013973-778-4222
wwwalignminecom
the raphael centerforintegrative orthodontics
the
raph
ael c
ente
r fo
rin
tegr
ativ
e or
thod
onti
cs
Learn about an important choice you need to make before starting braces
the raphael center for integrative education
the raphael center for integrative education
Ongoing Intro to Airway Orthodontics
April Biobloc Study Group
April Training Ortho-Postural Therapists w Roger Price
June MRC Myobrace Basic Series
August Airway Dentistry with Mark Cruz and company
October Advanced MFT with Sandy Coulson
October Less than Six with Kevin Boyd
(who else wants to play)
Mission to create a space for spreading the word about Airway and Orthotropic principles and practice
Orthodontics in the 21st Century
EstheticOrthodontics
AirwayOrthodontics
GeneticTooth-Focused
Dental PerfectionEsthetics Primary
Treating SymptomsAirway Ignorant
AdaptationMuscle-FocusedMedical Better
Esthetics SecondaryTreating Causes
Airway Conscious
The EndAnd
The Beginning
B Hockel 2012
This is the profile Biobloc children start with long and retrusive
This is the profile Biobloc children finish with Forward with lips
together
B Hockel 2012
Herersquos the ldquoinsiderdquo look Notice how the upper front teeth are closer to the nose (yellow arrows)
Notice how the lower jaw rotates around the star so the chin comes up and forward (red arrow)How do we make this happen
From the tip of the Central
To the Forwardmost Tip of the Nose
41mm
Maxillary Heightbull Indicator Line (Mew)
bull Distance from most anterior point on nose to upper incisal edge
bull Age + 23bull A variable number but important to watch over time
B Hockel 2012
Herersquos the ldquoinsiderdquo look Notice how the upper front teeth are closer to the nose (yellow arrows)
Notice how the lower jaw rotates around the star so the chin comes up and forward (red arrow)How do we make this happen
Using IndicatorCosmetic Line
bull To define a starting pointbull To set treatment goalsbull To track treatment progressbull To gauge the effectiveness of treatment
Charting the InCos Line
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Incisor pulled away from noseNot ldquoundertorquedrdquo or ldquogummy smilerdquo
Hypothetical ClI OrthoMARA
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
OJ = 7mm
Starts Ortho
ldquoGreat Headgear
Effectrdquo
Class II Elastics
50
40
30
20mm
y J F M A M J J A S O N
boys
Start Non-x
Expansion UncrowdingFinished
Start Cl II elastics
OK thatrsquos
enough
Hypothetical Mouthbreather(Dr Mewrsquos Hamster Boy)
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Boy gets
hamster
MFT
Hypothetical BBO 7yoM
50
40
30
20
5 6 7 8 9 10 11 12 13 14 15
girlsboys
Initial
StartBB1
BB3
Night
bullLR 11-9yFbullMissing all 5s6s8s and upper 4sbullHad ortho to close diastemahellipbullInL = 39bullGP objects to deX plan equil
LR Tx Plan
1Preparation Hang Expanser2deX 3Training BB3 to advance mandible4Myofunctional Therapy5Orthopostural Training6Myobrace to hold7 Reevaluate for dental detailing
LR Spotty progress
50
40
30
20mm
y 313 4 5 6 7 8 9 10 11 12114
2 3
Expanser
Parents dragging30 turnsStart Adv
Rx deXGP
objects
After delays
Equil ersquosBB3
bullLR 12-3 yF (6mo in tx)bullInL = 37 (+2)bull ersquos equilibratedbull OJ =10bull Appliance OJ = 5bull Still accommodating to BB3
Is there a calculus for the Indicator Line
Treatment GoalsBased on Indicator Line
Incisor Goals
Type 1 Treatment Place U1 in ideal position
Biobloc Orthotropics Orthognathic Surgery Distraction Osteogenesis
Type 1 Ideal InCos line
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
YZ 9yo M
bullLost upper d-spacebullInL = 36(+4)bullOJ = 9mmbullLip entrapmentbullLip Incompetence
Y Z 9yo M
Y Z 9yo M9mm OJ
Y Z 9yo M
Treatment Options
1 Type 1 Reduce InL open lost space BB3 to advance mandible
2 Type 2 Open lost space Align
3 Type 4 Extract four premolars
YZ 9yoM
50
40
30
20mm
yM A M J J A S O N D J F M A
boys
Hang Expanser
Upper and Lower
Brackets Hang Retainer
BB3
Incisor Goals
Type 2 Treatment Develop arch just enough to uncrowd
Biobloc Myofunctional Ortho Myofunctional Therapy Crozat ALF Expansion Orthodontics
Type 2 Uncrowding
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
bullLip incompetencebullLip entrapmentbullHypermentalisbullMouthbreathing
Type 2 Uncrowding
12 month progress
12 month progress
12 month progress
After Treatment
Bent-wire6 monthsMyobrace12 months
Hey RaphaelWhat about that
profile
ZP 9-5yoM
i
After Expansion Phase
Incomplete profile improvement better breathing head posture and sleep
Incisor Goals
Type 3 Treatment Maintain UI
Functional Orthodontics Expansion Orthodontics Distalization Ortho or No Treatment
Type 3 Maintain
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Bimax retrusion
Successful dental result
Profile Unimproved
Incisor Goals
Type 4 Treatment RetractExtrude UI
Extraction Orthodontics Retraction Ortho Distalization Ortho
Type 4 Retraction
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Bimax retrusion
Successful dental result
Failed Profile Result
Changes of pharyngeal airway size and hyoid bone position following orthodontic treatment of
Class I bimaxillary protrusion
Qingzhu Wanga Peizeng Jiab Nina K Andersonc Lin Wangd Jiuxiang Line
Angle Orthodontist Vol 00 No 0 0000 (pre-publication 2012)
ldquothe dimension of the velopharynx glossopharynx and hypopharynx were decreased after maximal retraction of anterior teeth with extraction of four premolarshelliprdquo ldquoAny factors that can influence the posture and position of tongue and soft palate may displace them backward andencroach upon the pharynxrdquo
ldquothe more the incisors were retracted the more the pharyngeal airway was reducedrdquo
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Backed into a corner
bull
Moving teeth faster more efficientlyhellipin the wrong direction
Now that wersquove made smoking unacceptable
could we not do the same withbull Sugarbull Processed foodbull Cheap milk and meatbull Fast foodbull Pill popping for symptomatic reliefbull Looking for the cure instead of the causebull Surgery as a quick fixbull Thinking braces are a status symbol
Each industry thrives on the status quoConsumers must drive the change
NP 10yM
NP
Sisterrsquos non-x ortho
Shersquos happyhellipbut Irsquom not so
I make my pitch for BBO
The dilemma of progress
(I forgot the progress pictureshellip)
Dad sells prosthetic parts to orthopedic surgeons
I selling the case against my previous work they loved
It takes me 3 hours to sell the case
They fret until the BB3 goes in
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Connecting the dots
bull Adult SDB and OSA
bull Narrow jaws and faces
bull Soft tissue dysfunction
bull Early parafunctional habits ie open mouth posture
bull Environmental stressors
bull CPAP MARAUPPP SurgWherersquos the best
place to start treatment here
or here
1 Prevention 2 Undo the damage already done3 Establish good habits
When to start When damage from poor breathing is noticed and when bad habits are discovered
The strategies of Airway Orthodontics
Prevention
bull Remove ankyloglossiabull Promote breastfeedingbull Harden the dietbull Develop masticatory strengthbull Discourage oral habitsbull Promote whole-foods low sugar dietbull Reduce oropharyngeal obstructionbull Promote nasal breathing
Breathing retraining
bull Nasal rinsingbull Nasal clearingbull Decongesting
The goals of Airway Orthodontics
1 Breathing through the nose2 Lips together at rest3 Correct tongue position4 No facial muscles moving on swallowing5 Optimal forward facial development6 Class I occlusion7 Straight teeth8 Better stability long term
Myofunctional Trainers
Professors R Soulet and A Besombes
Dr Earl Bergeson
Dr Chris Farrell
The Multi ndash Family System
Orofacial MyofunctionalTherapy
Oral MyologyMyofunctional TherapyTongue Thrust Therapy
B Hockel 2012 Back
Undoing Bimaxillary Dysplasia
1 Maxillary deconstriction2 Maxillary advancement3 Maxillary impaction4 Mandibular advancement
1 Maxillary Expansion
Treatment for Bimaxillary Dysplasia
ALFCrozat
Bent Wire
HyraxHaas
Niti Exp BioBlocSchwartz
The Farrell BENT WIRE Systemtrade
Recommended Age Group 5-12 yrs
Arch Development in conjunction with the TRAINER Systemtrade
Dr John Mew
Establish Good Habits
1 Breathing through the nose2 Lips together at rest3 Correct tongue position4 No facial muscles moving on swallowing5 Stand and sit in balance6 Breath gently using the diaphragm7 Eat to nourish8 Sleep to rest
Ortho-Postural TrainingWorkshops
Breathing
Nutrition
Posture
Sleep
COPYRIGHTRoger L PriceOctober 2012
Posture Number
Forward head posturecan be a compensationfor a deficient airway
Sleep Screening and Hygiene
SQI = 10 SQI = 98
Integrative Healthcare
Function ProfessionalNasal clearing ENT Pulm MFT BreathingMuscle balance and tone MFT Myofunctional OrthoUndoing damage GP Pedo Ortho OMFSBreathing dynamics OPT MFT Breath PhysiologistPosture DC OPT PT OsteopathCranial balance OsteopathNutrition RDH Nutritionist Dietitian Sleep ENT Sleep Med DentNeurocognitive development Pedrsquon SLP Psych SpEd
The Interdisciplinary Center
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Now that I know
My personal missionTo create from what Irsquove
learned from the besta model for others to followhellipespecially the orthodontists
Myofunctional Orthodontics
Chris Farrell
John Flutter
German Ramierez
Damien OrsquoBrien
Myofunctional Research CoRancho Cucamonga
2008-2012
Oral Myology
Oral Myology Basic CourseJoy MoellerNYC 2011LA 2012
Oral Myology Levels 2 3Kim BenkertClifton 2012
Habit CessationShari GreenClifton 2013
Biobloc Orthotropics
BBO Mini-residencyBill Hang
Agora Hills2012-13
BBO IntensiveDrs John and Mike
MewLSFO2013
Breathing and Sleep
Buteyko MentorshipThe Breathing Center
Woodstock2010
Breathing Well ProgrammeJohn Flutter
2010 Ortho-Postural TrainingRoger Price
2013
Sleep DentistryMichael Gelb etal
NYU2012
ALF and Cranial
Jim Bronson2013 Tasha Turzo
Cranial Academy2014
Bucket Listbull ALF and Crozat (Bronsonrsquos course)bullMore on Biobloc (Hangrsquos Advanced London School)bull More Cranial (The Farm)bullChirodontics (Bob Walker)bull Airway Dentistry with Marc Cruz Jeff Rousebull Sleep Dentistrybull Less-than-Six with Kevin Boydbull Intra-mandibular Distraction Osteogenesis (IMDO)
Off My ListAnything that moves the teeth faster in the wrong direction
Whatrsquos an RO to do
To create from what Irsquove learned from the best
a model for others to followhellipespecially orthodontists
Teaching
Mt Sinai Pedo ResidencyAli Attaie
2010-2012
Montefiore Ortho ResidencyTony Maganzini
2012
2009-Present
Mt Sinai School of MedicinePedodontic Residency
Guest SpeakersJim BronsonMike MewKevin BoydSandra KahnJennifer TowRoger PricePaula Fabbie
Damien OrsquoBrien
First clinical program in myofunctional orthodontics
Airway and Facial DevelopmentCollaborative Webcast
Mark Cruz
AAPMD Symposium
wwwaapm
dorg
Annual MeetingApril 25-26 2014
Westin Chicago North Shore
the raphael center for integrative orthodontics
wwwalignminecomwwwbioblocnjcom
wwwmyobracenjcom
Integrative vs Conventional
Integrative vs Conventional
ldquoWith improvements in expansion orthodontics advances in myofunctional orthodontics and the growing recognition about sleep disordered breathing among children and adults it is time for orthodontics to expand its horizons There is now so much more we can oerrdquo
The Raphael name has been associated with high quality orthodontics in New Jersey for over 60 years Dr Barry Raphael has been a university trained orthodontic specialist and a member of the American Association of Orthodontists for 30 years
He has a wide range of techniques and services to offer He has studied oral myology applied kinesiology Buteyko breathing Biobloc Orthotropics and Myobrace as part of his integrative training He can offer Damon Invisalign Insignia and Incognito appliances designs as some of his many conventional orthodontic services too
Dr Raphael teaches his techniques at post-graduate residencies study clubs dental societies and for the Myofunctional Research Co He is available for presentations to any group interested in learning more about the benefits of integrative orthodontics
wwwalignminecomLearn about the choices you have in orthodontics
dr barry raphael Why its
too Early never
1425
bro
ad
str
ee
tc
lifto
n n
j 070
13
973-
778-
4222
fax
973-
778-
9625
nj s
pe
c
368
4
1425 broad street clifton nj 07013973-778-4222
wwwalignminecom
the raphael centerforintegrative orthodontics
the
raph
ael c
ente
r fo
rin
tegr
ativ
e or
thod
onti
cs
Learn about an important choice you need to make before starting braces
the raphael center for integrative education
the raphael center for integrative education
Ongoing Intro to Airway Orthodontics
April Biobloc Study Group
April Training Ortho-Postural Therapists w Roger Price
June MRC Myobrace Basic Series
August Airway Dentistry with Mark Cruz and company
October Advanced MFT with Sandy Coulson
October Less than Six with Kevin Boyd
(who else wants to play)
Mission to create a space for spreading the word about Airway and Orthotropic principles and practice
Orthodontics in the 21st Century
EstheticOrthodontics
AirwayOrthodontics
GeneticTooth-Focused
Dental PerfectionEsthetics Primary
Treating SymptomsAirway Ignorant
AdaptationMuscle-FocusedMedical Better
Esthetics SecondaryTreating Causes
Airway Conscious
The EndAnd
The Beginning
B Hockel 2012
Herersquos the ldquoinsiderdquo look Notice how the upper front teeth are closer to the nose (yellow arrows)
Notice how the lower jaw rotates around the star so the chin comes up and forward (red arrow)How do we make this happen
From the tip of the Central
To the Forwardmost Tip of the Nose
41mm
Maxillary Heightbull Indicator Line (Mew)
bull Distance from most anterior point on nose to upper incisal edge
bull Age + 23bull A variable number but important to watch over time
B Hockel 2012
Herersquos the ldquoinsiderdquo look Notice how the upper front teeth are closer to the nose (yellow arrows)
Notice how the lower jaw rotates around the star so the chin comes up and forward (red arrow)How do we make this happen
Using IndicatorCosmetic Line
bull To define a starting pointbull To set treatment goalsbull To track treatment progressbull To gauge the effectiveness of treatment
Charting the InCos Line
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Incisor pulled away from noseNot ldquoundertorquedrdquo or ldquogummy smilerdquo
Hypothetical ClI OrthoMARA
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
OJ = 7mm
Starts Ortho
ldquoGreat Headgear
Effectrdquo
Class II Elastics
50
40
30
20mm
y J F M A M J J A S O N
boys
Start Non-x
Expansion UncrowdingFinished
Start Cl II elastics
OK thatrsquos
enough
Hypothetical Mouthbreather(Dr Mewrsquos Hamster Boy)
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Boy gets
hamster
MFT
Hypothetical BBO 7yoM
50
40
30
20
5 6 7 8 9 10 11 12 13 14 15
girlsboys
Initial
StartBB1
BB3
Night
bullLR 11-9yFbullMissing all 5s6s8s and upper 4sbullHad ortho to close diastemahellipbullInL = 39bullGP objects to deX plan equil
LR Tx Plan
1Preparation Hang Expanser2deX 3Training BB3 to advance mandible4Myofunctional Therapy5Orthopostural Training6Myobrace to hold7 Reevaluate for dental detailing
LR Spotty progress
50
40
30
20mm
y 313 4 5 6 7 8 9 10 11 12114
2 3
Expanser
Parents dragging30 turnsStart Adv
Rx deXGP
objects
After delays
Equil ersquosBB3
bullLR 12-3 yF (6mo in tx)bullInL = 37 (+2)bull ersquos equilibratedbull OJ =10bull Appliance OJ = 5bull Still accommodating to BB3
Is there a calculus for the Indicator Line
Treatment GoalsBased on Indicator Line
Incisor Goals
Type 1 Treatment Place U1 in ideal position
Biobloc Orthotropics Orthognathic Surgery Distraction Osteogenesis
Type 1 Ideal InCos line
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
YZ 9yo M
bullLost upper d-spacebullInL = 36(+4)bullOJ = 9mmbullLip entrapmentbullLip Incompetence
Y Z 9yo M
Y Z 9yo M9mm OJ
Y Z 9yo M
Treatment Options
1 Type 1 Reduce InL open lost space BB3 to advance mandible
2 Type 2 Open lost space Align
3 Type 4 Extract four premolars
YZ 9yoM
50
40
30
20mm
yM A M J J A S O N D J F M A
boys
Hang Expanser
Upper and Lower
Brackets Hang Retainer
BB3
Incisor Goals
Type 2 Treatment Develop arch just enough to uncrowd
Biobloc Myofunctional Ortho Myofunctional Therapy Crozat ALF Expansion Orthodontics
Type 2 Uncrowding
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
bullLip incompetencebullLip entrapmentbullHypermentalisbullMouthbreathing
Type 2 Uncrowding
12 month progress
12 month progress
12 month progress
After Treatment
Bent-wire6 monthsMyobrace12 months
Hey RaphaelWhat about that
profile
ZP 9-5yoM
i
After Expansion Phase
Incomplete profile improvement better breathing head posture and sleep
Incisor Goals
Type 3 Treatment Maintain UI
Functional Orthodontics Expansion Orthodontics Distalization Ortho or No Treatment
Type 3 Maintain
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Bimax retrusion
Successful dental result
Profile Unimproved
Incisor Goals
Type 4 Treatment RetractExtrude UI
Extraction Orthodontics Retraction Ortho Distalization Ortho
Type 4 Retraction
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Bimax retrusion
Successful dental result
Failed Profile Result
Changes of pharyngeal airway size and hyoid bone position following orthodontic treatment of
Class I bimaxillary protrusion
Qingzhu Wanga Peizeng Jiab Nina K Andersonc Lin Wangd Jiuxiang Line
Angle Orthodontist Vol 00 No 0 0000 (pre-publication 2012)
ldquothe dimension of the velopharynx glossopharynx and hypopharynx were decreased after maximal retraction of anterior teeth with extraction of four premolarshelliprdquo ldquoAny factors that can influence the posture and position of tongue and soft palate may displace them backward andencroach upon the pharynxrdquo
ldquothe more the incisors were retracted the more the pharyngeal airway was reducedrdquo
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Backed into a corner
bull
Moving teeth faster more efficientlyhellipin the wrong direction
Now that wersquove made smoking unacceptable
could we not do the same withbull Sugarbull Processed foodbull Cheap milk and meatbull Fast foodbull Pill popping for symptomatic reliefbull Looking for the cure instead of the causebull Surgery as a quick fixbull Thinking braces are a status symbol
Each industry thrives on the status quoConsumers must drive the change
NP 10yM
NP
Sisterrsquos non-x ortho
Shersquos happyhellipbut Irsquom not so
I make my pitch for BBO
The dilemma of progress
(I forgot the progress pictureshellip)
Dad sells prosthetic parts to orthopedic surgeons
I selling the case against my previous work they loved
It takes me 3 hours to sell the case
They fret until the BB3 goes in
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Connecting the dots
bull Adult SDB and OSA
bull Narrow jaws and faces
bull Soft tissue dysfunction
bull Early parafunctional habits ie open mouth posture
bull Environmental stressors
bull CPAP MARAUPPP SurgWherersquos the best
place to start treatment here
or here
1 Prevention 2 Undo the damage already done3 Establish good habits
When to start When damage from poor breathing is noticed and when bad habits are discovered
The strategies of Airway Orthodontics
Prevention
bull Remove ankyloglossiabull Promote breastfeedingbull Harden the dietbull Develop masticatory strengthbull Discourage oral habitsbull Promote whole-foods low sugar dietbull Reduce oropharyngeal obstructionbull Promote nasal breathing
Breathing retraining
bull Nasal rinsingbull Nasal clearingbull Decongesting
The goals of Airway Orthodontics
1 Breathing through the nose2 Lips together at rest3 Correct tongue position4 No facial muscles moving on swallowing5 Optimal forward facial development6 Class I occlusion7 Straight teeth8 Better stability long term
Myofunctional Trainers
Professors R Soulet and A Besombes
Dr Earl Bergeson
Dr Chris Farrell
The Multi ndash Family System
Orofacial MyofunctionalTherapy
Oral MyologyMyofunctional TherapyTongue Thrust Therapy
B Hockel 2012 Back
Undoing Bimaxillary Dysplasia
1 Maxillary deconstriction2 Maxillary advancement3 Maxillary impaction4 Mandibular advancement
1 Maxillary Expansion
Treatment for Bimaxillary Dysplasia
ALFCrozat
Bent Wire
HyraxHaas
Niti Exp BioBlocSchwartz
The Farrell BENT WIRE Systemtrade
Recommended Age Group 5-12 yrs
Arch Development in conjunction with the TRAINER Systemtrade
Dr John Mew
Establish Good Habits
1 Breathing through the nose2 Lips together at rest3 Correct tongue position4 No facial muscles moving on swallowing5 Stand and sit in balance6 Breath gently using the diaphragm7 Eat to nourish8 Sleep to rest
Ortho-Postural TrainingWorkshops
Breathing
Nutrition
Posture
Sleep
COPYRIGHTRoger L PriceOctober 2012
Posture Number
Forward head posturecan be a compensationfor a deficient airway
Sleep Screening and Hygiene
SQI = 10 SQI = 98
Integrative Healthcare
Function ProfessionalNasal clearing ENT Pulm MFT BreathingMuscle balance and tone MFT Myofunctional OrthoUndoing damage GP Pedo Ortho OMFSBreathing dynamics OPT MFT Breath PhysiologistPosture DC OPT PT OsteopathCranial balance OsteopathNutrition RDH Nutritionist Dietitian Sleep ENT Sleep Med DentNeurocognitive development Pedrsquon SLP Psych SpEd
The Interdisciplinary Center
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Now that I know
My personal missionTo create from what Irsquove
learned from the besta model for others to followhellipespecially the orthodontists
Myofunctional Orthodontics
Chris Farrell
John Flutter
German Ramierez
Damien OrsquoBrien
Myofunctional Research CoRancho Cucamonga
2008-2012
Oral Myology
Oral Myology Basic CourseJoy MoellerNYC 2011LA 2012
Oral Myology Levels 2 3Kim BenkertClifton 2012
Habit CessationShari GreenClifton 2013
Biobloc Orthotropics
BBO Mini-residencyBill Hang
Agora Hills2012-13
BBO IntensiveDrs John and Mike
MewLSFO2013
Breathing and Sleep
Buteyko MentorshipThe Breathing Center
Woodstock2010
Breathing Well ProgrammeJohn Flutter
2010 Ortho-Postural TrainingRoger Price
2013
Sleep DentistryMichael Gelb etal
NYU2012
ALF and Cranial
Jim Bronson2013 Tasha Turzo
Cranial Academy2014
Bucket Listbull ALF and Crozat (Bronsonrsquos course)bullMore on Biobloc (Hangrsquos Advanced London School)bull More Cranial (The Farm)bullChirodontics (Bob Walker)bull Airway Dentistry with Marc Cruz Jeff Rousebull Sleep Dentistrybull Less-than-Six with Kevin Boydbull Intra-mandibular Distraction Osteogenesis (IMDO)
Off My ListAnything that moves the teeth faster in the wrong direction
Whatrsquos an RO to do
To create from what Irsquove learned from the best
a model for others to followhellipespecially orthodontists
Teaching
Mt Sinai Pedo ResidencyAli Attaie
2010-2012
Montefiore Ortho ResidencyTony Maganzini
2012
2009-Present
Mt Sinai School of MedicinePedodontic Residency
Guest SpeakersJim BronsonMike MewKevin BoydSandra KahnJennifer TowRoger PricePaula Fabbie
Damien OrsquoBrien
First clinical program in myofunctional orthodontics
Airway and Facial DevelopmentCollaborative Webcast
Mark Cruz
AAPMD Symposium
wwwaapm
dorg
Annual MeetingApril 25-26 2014
Westin Chicago North Shore
the raphael center for integrative orthodontics
wwwalignminecomwwwbioblocnjcom
wwwmyobracenjcom
Integrative vs Conventional
Integrative vs Conventional
ldquoWith improvements in expansion orthodontics advances in myofunctional orthodontics and the growing recognition about sleep disordered breathing among children and adults it is time for orthodontics to expand its horizons There is now so much more we can oerrdquo
The Raphael name has been associated with high quality orthodontics in New Jersey for over 60 years Dr Barry Raphael has been a university trained orthodontic specialist and a member of the American Association of Orthodontists for 30 years
He has a wide range of techniques and services to offer He has studied oral myology applied kinesiology Buteyko breathing Biobloc Orthotropics and Myobrace as part of his integrative training He can offer Damon Invisalign Insignia and Incognito appliances designs as some of his many conventional orthodontic services too
Dr Raphael teaches his techniques at post-graduate residencies study clubs dental societies and for the Myofunctional Research Co He is available for presentations to any group interested in learning more about the benefits of integrative orthodontics
wwwalignminecomLearn about the choices you have in orthodontics
dr barry raphael Why its
too Early never
1425
bro
ad
str
ee
tc
lifto
n n
j 070
13
973-
778-
4222
fax
973-
778-
9625
nj s
pe
c
368
4
1425 broad street clifton nj 07013973-778-4222
wwwalignminecom
the raphael centerforintegrative orthodontics
the
raph
ael c
ente
r fo
rin
tegr
ativ
e or
thod
onti
cs
Learn about an important choice you need to make before starting braces
the raphael center for integrative education
the raphael center for integrative education
Ongoing Intro to Airway Orthodontics
April Biobloc Study Group
April Training Ortho-Postural Therapists w Roger Price
June MRC Myobrace Basic Series
August Airway Dentistry with Mark Cruz and company
October Advanced MFT with Sandy Coulson
October Less than Six with Kevin Boyd
(who else wants to play)
Mission to create a space for spreading the word about Airway and Orthotropic principles and practice
Orthodontics in the 21st Century
EstheticOrthodontics
AirwayOrthodontics
GeneticTooth-Focused
Dental PerfectionEsthetics Primary
Treating SymptomsAirway Ignorant
AdaptationMuscle-FocusedMedical Better
Esthetics SecondaryTreating Causes
Airway Conscious
The EndAnd
The Beginning
From the tip of the Central
To the Forwardmost Tip of the Nose
41mm
Maxillary Heightbull Indicator Line (Mew)
bull Distance from most anterior point on nose to upper incisal edge
bull Age + 23bull A variable number but important to watch over time
B Hockel 2012
Herersquos the ldquoinsiderdquo look Notice how the upper front teeth are closer to the nose (yellow arrows)
Notice how the lower jaw rotates around the star so the chin comes up and forward (red arrow)How do we make this happen
Using IndicatorCosmetic Line
bull To define a starting pointbull To set treatment goalsbull To track treatment progressbull To gauge the effectiveness of treatment
Charting the InCos Line
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Incisor pulled away from noseNot ldquoundertorquedrdquo or ldquogummy smilerdquo
Hypothetical ClI OrthoMARA
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
OJ = 7mm
Starts Ortho
ldquoGreat Headgear
Effectrdquo
Class II Elastics
50
40
30
20mm
y J F M A M J J A S O N
boys
Start Non-x
Expansion UncrowdingFinished
Start Cl II elastics
OK thatrsquos
enough
Hypothetical Mouthbreather(Dr Mewrsquos Hamster Boy)
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Boy gets
hamster
MFT
Hypothetical BBO 7yoM
50
40
30
20
5 6 7 8 9 10 11 12 13 14 15
girlsboys
Initial
StartBB1
BB3
Night
bullLR 11-9yFbullMissing all 5s6s8s and upper 4sbullHad ortho to close diastemahellipbullInL = 39bullGP objects to deX plan equil
LR Tx Plan
1Preparation Hang Expanser2deX 3Training BB3 to advance mandible4Myofunctional Therapy5Orthopostural Training6Myobrace to hold7 Reevaluate for dental detailing
LR Spotty progress
50
40
30
20mm
y 313 4 5 6 7 8 9 10 11 12114
2 3
Expanser
Parents dragging30 turnsStart Adv
Rx deXGP
objects
After delays
Equil ersquosBB3
bullLR 12-3 yF (6mo in tx)bullInL = 37 (+2)bull ersquos equilibratedbull OJ =10bull Appliance OJ = 5bull Still accommodating to BB3
Is there a calculus for the Indicator Line
Treatment GoalsBased on Indicator Line
Incisor Goals
Type 1 Treatment Place U1 in ideal position
Biobloc Orthotropics Orthognathic Surgery Distraction Osteogenesis
Type 1 Ideal InCos line
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
YZ 9yo M
bullLost upper d-spacebullInL = 36(+4)bullOJ = 9mmbullLip entrapmentbullLip Incompetence
Y Z 9yo M
Y Z 9yo M9mm OJ
Y Z 9yo M
Treatment Options
1 Type 1 Reduce InL open lost space BB3 to advance mandible
2 Type 2 Open lost space Align
3 Type 4 Extract four premolars
YZ 9yoM
50
40
30
20mm
yM A M J J A S O N D J F M A
boys
Hang Expanser
Upper and Lower
Brackets Hang Retainer
BB3
Incisor Goals
Type 2 Treatment Develop arch just enough to uncrowd
Biobloc Myofunctional Ortho Myofunctional Therapy Crozat ALF Expansion Orthodontics
Type 2 Uncrowding
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
bullLip incompetencebullLip entrapmentbullHypermentalisbullMouthbreathing
Type 2 Uncrowding
12 month progress
12 month progress
12 month progress
After Treatment
Bent-wire6 monthsMyobrace12 months
Hey RaphaelWhat about that
profile
ZP 9-5yoM
i
After Expansion Phase
Incomplete profile improvement better breathing head posture and sleep
Incisor Goals
Type 3 Treatment Maintain UI
Functional Orthodontics Expansion Orthodontics Distalization Ortho or No Treatment
Type 3 Maintain
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Bimax retrusion
Successful dental result
Profile Unimproved
Incisor Goals
Type 4 Treatment RetractExtrude UI
Extraction Orthodontics Retraction Ortho Distalization Ortho
Type 4 Retraction
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Bimax retrusion
Successful dental result
Failed Profile Result
Changes of pharyngeal airway size and hyoid bone position following orthodontic treatment of
Class I bimaxillary protrusion
Qingzhu Wanga Peizeng Jiab Nina K Andersonc Lin Wangd Jiuxiang Line
Angle Orthodontist Vol 00 No 0 0000 (pre-publication 2012)
ldquothe dimension of the velopharynx glossopharynx and hypopharynx were decreased after maximal retraction of anterior teeth with extraction of four premolarshelliprdquo ldquoAny factors that can influence the posture and position of tongue and soft palate may displace them backward andencroach upon the pharynxrdquo
ldquothe more the incisors were retracted the more the pharyngeal airway was reducedrdquo
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Backed into a corner
bull
Moving teeth faster more efficientlyhellipin the wrong direction
Now that wersquove made smoking unacceptable
could we not do the same withbull Sugarbull Processed foodbull Cheap milk and meatbull Fast foodbull Pill popping for symptomatic reliefbull Looking for the cure instead of the causebull Surgery as a quick fixbull Thinking braces are a status symbol
Each industry thrives on the status quoConsumers must drive the change
NP 10yM
NP
Sisterrsquos non-x ortho
Shersquos happyhellipbut Irsquom not so
I make my pitch for BBO
The dilemma of progress
(I forgot the progress pictureshellip)
Dad sells prosthetic parts to orthopedic surgeons
I selling the case against my previous work they loved
It takes me 3 hours to sell the case
They fret until the BB3 goes in
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Connecting the dots
bull Adult SDB and OSA
bull Narrow jaws and faces
bull Soft tissue dysfunction
bull Early parafunctional habits ie open mouth posture
bull Environmental stressors
bull CPAP MARAUPPP SurgWherersquos the best
place to start treatment here
or here
1 Prevention 2 Undo the damage already done3 Establish good habits
When to start When damage from poor breathing is noticed and when bad habits are discovered
The strategies of Airway Orthodontics
Prevention
bull Remove ankyloglossiabull Promote breastfeedingbull Harden the dietbull Develop masticatory strengthbull Discourage oral habitsbull Promote whole-foods low sugar dietbull Reduce oropharyngeal obstructionbull Promote nasal breathing
Breathing retraining
bull Nasal rinsingbull Nasal clearingbull Decongesting
The goals of Airway Orthodontics
1 Breathing through the nose2 Lips together at rest3 Correct tongue position4 No facial muscles moving on swallowing5 Optimal forward facial development6 Class I occlusion7 Straight teeth8 Better stability long term
Myofunctional Trainers
Professors R Soulet and A Besombes
Dr Earl Bergeson
Dr Chris Farrell
The Multi ndash Family System
Orofacial MyofunctionalTherapy
Oral MyologyMyofunctional TherapyTongue Thrust Therapy
B Hockel 2012 Back
Undoing Bimaxillary Dysplasia
1 Maxillary deconstriction2 Maxillary advancement3 Maxillary impaction4 Mandibular advancement
1 Maxillary Expansion
Treatment for Bimaxillary Dysplasia
ALFCrozat
Bent Wire
HyraxHaas
Niti Exp BioBlocSchwartz
The Farrell BENT WIRE Systemtrade
Recommended Age Group 5-12 yrs
Arch Development in conjunction with the TRAINER Systemtrade
Dr John Mew
Establish Good Habits
1 Breathing through the nose2 Lips together at rest3 Correct tongue position4 No facial muscles moving on swallowing5 Stand and sit in balance6 Breath gently using the diaphragm7 Eat to nourish8 Sleep to rest
Ortho-Postural TrainingWorkshops
Breathing
Nutrition
Posture
Sleep
COPYRIGHTRoger L PriceOctober 2012
Posture Number
Forward head posturecan be a compensationfor a deficient airway
Sleep Screening and Hygiene
SQI = 10 SQI = 98
Integrative Healthcare
Function ProfessionalNasal clearing ENT Pulm MFT BreathingMuscle balance and tone MFT Myofunctional OrthoUndoing damage GP Pedo Ortho OMFSBreathing dynamics OPT MFT Breath PhysiologistPosture DC OPT PT OsteopathCranial balance OsteopathNutrition RDH Nutritionist Dietitian Sleep ENT Sleep Med DentNeurocognitive development Pedrsquon SLP Psych SpEd
The Interdisciplinary Center
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Now that I know
My personal missionTo create from what Irsquove
learned from the besta model for others to followhellipespecially the orthodontists
Myofunctional Orthodontics
Chris Farrell
John Flutter
German Ramierez
Damien OrsquoBrien
Myofunctional Research CoRancho Cucamonga
2008-2012
Oral Myology
Oral Myology Basic CourseJoy MoellerNYC 2011LA 2012
Oral Myology Levels 2 3Kim BenkertClifton 2012
Habit CessationShari GreenClifton 2013
Biobloc Orthotropics
BBO Mini-residencyBill Hang
Agora Hills2012-13
BBO IntensiveDrs John and Mike
MewLSFO2013
Breathing and Sleep
Buteyko MentorshipThe Breathing Center
Woodstock2010
Breathing Well ProgrammeJohn Flutter
2010 Ortho-Postural TrainingRoger Price
2013
Sleep DentistryMichael Gelb etal
NYU2012
ALF and Cranial
Jim Bronson2013 Tasha Turzo
Cranial Academy2014
Bucket Listbull ALF and Crozat (Bronsonrsquos course)bullMore on Biobloc (Hangrsquos Advanced London School)bull More Cranial (The Farm)bullChirodontics (Bob Walker)bull Airway Dentistry with Marc Cruz Jeff Rousebull Sleep Dentistrybull Less-than-Six with Kevin Boydbull Intra-mandibular Distraction Osteogenesis (IMDO)
Off My ListAnything that moves the teeth faster in the wrong direction
Whatrsquos an RO to do
To create from what Irsquove learned from the best
a model for others to followhellipespecially orthodontists
Teaching
Mt Sinai Pedo ResidencyAli Attaie
2010-2012
Montefiore Ortho ResidencyTony Maganzini
2012
2009-Present
Mt Sinai School of MedicinePedodontic Residency
Guest SpeakersJim BronsonMike MewKevin BoydSandra KahnJennifer TowRoger PricePaula Fabbie
Damien OrsquoBrien
First clinical program in myofunctional orthodontics
Airway and Facial DevelopmentCollaborative Webcast
Mark Cruz
AAPMD Symposium
wwwaapm
dorg
Annual MeetingApril 25-26 2014
Westin Chicago North Shore
the raphael center for integrative orthodontics
wwwalignminecomwwwbioblocnjcom
wwwmyobracenjcom
Integrative vs Conventional
Integrative vs Conventional
ldquoWith improvements in expansion orthodontics advances in myofunctional orthodontics and the growing recognition about sleep disordered breathing among children and adults it is time for orthodontics to expand its horizons There is now so much more we can oerrdquo
The Raphael name has been associated with high quality orthodontics in New Jersey for over 60 years Dr Barry Raphael has been a university trained orthodontic specialist and a member of the American Association of Orthodontists for 30 years
He has a wide range of techniques and services to offer He has studied oral myology applied kinesiology Buteyko breathing Biobloc Orthotropics and Myobrace as part of his integrative training He can offer Damon Invisalign Insignia and Incognito appliances designs as some of his many conventional orthodontic services too
Dr Raphael teaches his techniques at post-graduate residencies study clubs dental societies and for the Myofunctional Research Co He is available for presentations to any group interested in learning more about the benefits of integrative orthodontics
wwwalignminecomLearn about the choices you have in orthodontics
dr barry raphael Why its
too Early never
1425
bro
ad
str
ee
tc
lifto
n n
j 070
13
973-
778-
4222
fax
973-
778-
9625
nj s
pe
c
368
4
1425 broad street clifton nj 07013973-778-4222
wwwalignminecom
the raphael centerforintegrative orthodontics
the
raph
ael c
ente
r fo
rin
tegr
ativ
e or
thod
onti
cs
Learn about an important choice you need to make before starting braces
the raphael center for integrative education
the raphael center for integrative education
Ongoing Intro to Airway Orthodontics
April Biobloc Study Group
April Training Ortho-Postural Therapists w Roger Price
June MRC Myobrace Basic Series
August Airway Dentistry with Mark Cruz and company
October Advanced MFT with Sandy Coulson
October Less than Six with Kevin Boyd
(who else wants to play)
Mission to create a space for spreading the word about Airway and Orthotropic principles and practice
Orthodontics in the 21st Century
EstheticOrthodontics
AirwayOrthodontics
GeneticTooth-Focused
Dental PerfectionEsthetics Primary
Treating SymptomsAirway Ignorant
AdaptationMuscle-FocusedMedical Better
Esthetics SecondaryTreating Causes
Airway Conscious
The EndAnd
The Beginning
To the Forwardmost Tip of the Nose
41mm
Maxillary Heightbull Indicator Line (Mew)
bull Distance from most anterior point on nose to upper incisal edge
bull Age + 23bull A variable number but important to watch over time
B Hockel 2012
Herersquos the ldquoinsiderdquo look Notice how the upper front teeth are closer to the nose (yellow arrows)
Notice how the lower jaw rotates around the star so the chin comes up and forward (red arrow)How do we make this happen
Using IndicatorCosmetic Line
bull To define a starting pointbull To set treatment goalsbull To track treatment progressbull To gauge the effectiveness of treatment
Charting the InCos Line
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Incisor pulled away from noseNot ldquoundertorquedrdquo or ldquogummy smilerdquo
Hypothetical ClI OrthoMARA
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
OJ = 7mm
Starts Ortho
ldquoGreat Headgear
Effectrdquo
Class II Elastics
50
40
30
20mm
y J F M A M J J A S O N
boys
Start Non-x
Expansion UncrowdingFinished
Start Cl II elastics
OK thatrsquos
enough
Hypothetical Mouthbreather(Dr Mewrsquos Hamster Boy)
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Boy gets
hamster
MFT
Hypothetical BBO 7yoM
50
40
30
20
5 6 7 8 9 10 11 12 13 14 15
girlsboys
Initial
StartBB1
BB3
Night
bullLR 11-9yFbullMissing all 5s6s8s and upper 4sbullHad ortho to close diastemahellipbullInL = 39bullGP objects to deX plan equil
LR Tx Plan
1Preparation Hang Expanser2deX 3Training BB3 to advance mandible4Myofunctional Therapy5Orthopostural Training6Myobrace to hold7 Reevaluate for dental detailing
LR Spotty progress
50
40
30
20mm
y 313 4 5 6 7 8 9 10 11 12114
2 3
Expanser
Parents dragging30 turnsStart Adv
Rx deXGP
objects
After delays
Equil ersquosBB3
bullLR 12-3 yF (6mo in tx)bullInL = 37 (+2)bull ersquos equilibratedbull OJ =10bull Appliance OJ = 5bull Still accommodating to BB3
Is there a calculus for the Indicator Line
Treatment GoalsBased on Indicator Line
Incisor Goals
Type 1 Treatment Place U1 in ideal position
Biobloc Orthotropics Orthognathic Surgery Distraction Osteogenesis
Type 1 Ideal InCos line
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
YZ 9yo M
bullLost upper d-spacebullInL = 36(+4)bullOJ = 9mmbullLip entrapmentbullLip Incompetence
Y Z 9yo M
Y Z 9yo M9mm OJ
Y Z 9yo M
Treatment Options
1 Type 1 Reduce InL open lost space BB3 to advance mandible
2 Type 2 Open lost space Align
3 Type 4 Extract four premolars
YZ 9yoM
50
40
30
20mm
yM A M J J A S O N D J F M A
boys
Hang Expanser
Upper and Lower
Brackets Hang Retainer
BB3
Incisor Goals
Type 2 Treatment Develop arch just enough to uncrowd
Biobloc Myofunctional Ortho Myofunctional Therapy Crozat ALF Expansion Orthodontics
Type 2 Uncrowding
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
bullLip incompetencebullLip entrapmentbullHypermentalisbullMouthbreathing
Type 2 Uncrowding
12 month progress
12 month progress
12 month progress
After Treatment
Bent-wire6 monthsMyobrace12 months
Hey RaphaelWhat about that
profile
ZP 9-5yoM
i
After Expansion Phase
Incomplete profile improvement better breathing head posture and sleep
Incisor Goals
Type 3 Treatment Maintain UI
Functional Orthodontics Expansion Orthodontics Distalization Ortho or No Treatment
Type 3 Maintain
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Bimax retrusion
Successful dental result
Profile Unimproved
Incisor Goals
Type 4 Treatment RetractExtrude UI
Extraction Orthodontics Retraction Ortho Distalization Ortho
Type 4 Retraction
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Bimax retrusion
Successful dental result
Failed Profile Result
Changes of pharyngeal airway size and hyoid bone position following orthodontic treatment of
Class I bimaxillary protrusion
Qingzhu Wanga Peizeng Jiab Nina K Andersonc Lin Wangd Jiuxiang Line
Angle Orthodontist Vol 00 No 0 0000 (pre-publication 2012)
ldquothe dimension of the velopharynx glossopharynx and hypopharynx were decreased after maximal retraction of anterior teeth with extraction of four premolarshelliprdquo ldquoAny factors that can influence the posture and position of tongue and soft palate may displace them backward andencroach upon the pharynxrdquo
ldquothe more the incisors were retracted the more the pharyngeal airway was reducedrdquo
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Backed into a corner
bull
Moving teeth faster more efficientlyhellipin the wrong direction
Now that wersquove made smoking unacceptable
could we not do the same withbull Sugarbull Processed foodbull Cheap milk and meatbull Fast foodbull Pill popping for symptomatic reliefbull Looking for the cure instead of the causebull Surgery as a quick fixbull Thinking braces are a status symbol
Each industry thrives on the status quoConsumers must drive the change
NP 10yM
NP
Sisterrsquos non-x ortho
Shersquos happyhellipbut Irsquom not so
I make my pitch for BBO
The dilemma of progress
(I forgot the progress pictureshellip)
Dad sells prosthetic parts to orthopedic surgeons
I selling the case against my previous work they loved
It takes me 3 hours to sell the case
They fret until the BB3 goes in
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Connecting the dots
bull Adult SDB and OSA
bull Narrow jaws and faces
bull Soft tissue dysfunction
bull Early parafunctional habits ie open mouth posture
bull Environmental stressors
bull CPAP MARAUPPP SurgWherersquos the best
place to start treatment here
or here
1 Prevention 2 Undo the damage already done3 Establish good habits
When to start When damage from poor breathing is noticed and when bad habits are discovered
The strategies of Airway Orthodontics
Prevention
bull Remove ankyloglossiabull Promote breastfeedingbull Harden the dietbull Develop masticatory strengthbull Discourage oral habitsbull Promote whole-foods low sugar dietbull Reduce oropharyngeal obstructionbull Promote nasal breathing
Breathing retraining
bull Nasal rinsingbull Nasal clearingbull Decongesting
The goals of Airway Orthodontics
1 Breathing through the nose2 Lips together at rest3 Correct tongue position4 No facial muscles moving on swallowing5 Optimal forward facial development6 Class I occlusion7 Straight teeth8 Better stability long term
Myofunctional Trainers
Professors R Soulet and A Besombes
Dr Earl Bergeson
Dr Chris Farrell
The Multi ndash Family System
Orofacial MyofunctionalTherapy
Oral MyologyMyofunctional TherapyTongue Thrust Therapy
B Hockel 2012 Back
Undoing Bimaxillary Dysplasia
1 Maxillary deconstriction2 Maxillary advancement3 Maxillary impaction4 Mandibular advancement
1 Maxillary Expansion
Treatment for Bimaxillary Dysplasia
ALFCrozat
Bent Wire
HyraxHaas
Niti Exp BioBlocSchwartz
The Farrell BENT WIRE Systemtrade
Recommended Age Group 5-12 yrs
Arch Development in conjunction with the TRAINER Systemtrade
Dr John Mew
Establish Good Habits
1 Breathing through the nose2 Lips together at rest3 Correct tongue position4 No facial muscles moving on swallowing5 Stand and sit in balance6 Breath gently using the diaphragm7 Eat to nourish8 Sleep to rest
Ortho-Postural TrainingWorkshops
Breathing
Nutrition
Posture
Sleep
COPYRIGHTRoger L PriceOctober 2012
Posture Number
Forward head posturecan be a compensationfor a deficient airway
Sleep Screening and Hygiene
SQI = 10 SQI = 98
Integrative Healthcare
Function ProfessionalNasal clearing ENT Pulm MFT BreathingMuscle balance and tone MFT Myofunctional OrthoUndoing damage GP Pedo Ortho OMFSBreathing dynamics OPT MFT Breath PhysiologistPosture DC OPT PT OsteopathCranial balance OsteopathNutrition RDH Nutritionist Dietitian Sleep ENT Sleep Med DentNeurocognitive development Pedrsquon SLP Psych SpEd
The Interdisciplinary Center
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Now that I know
My personal missionTo create from what Irsquove
learned from the besta model for others to followhellipespecially the orthodontists
Myofunctional Orthodontics
Chris Farrell
John Flutter
German Ramierez
Damien OrsquoBrien
Myofunctional Research CoRancho Cucamonga
2008-2012
Oral Myology
Oral Myology Basic CourseJoy MoellerNYC 2011LA 2012
Oral Myology Levels 2 3Kim BenkertClifton 2012
Habit CessationShari GreenClifton 2013
Biobloc Orthotropics
BBO Mini-residencyBill Hang
Agora Hills2012-13
BBO IntensiveDrs John and Mike
MewLSFO2013
Breathing and Sleep
Buteyko MentorshipThe Breathing Center
Woodstock2010
Breathing Well ProgrammeJohn Flutter
2010 Ortho-Postural TrainingRoger Price
2013
Sleep DentistryMichael Gelb etal
NYU2012
ALF and Cranial
Jim Bronson2013 Tasha Turzo
Cranial Academy2014
Bucket Listbull ALF and Crozat (Bronsonrsquos course)bullMore on Biobloc (Hangrsquos Advanced London School)bull More Cranial (The Farm)bullChirodontics (Bob Walker)bull Airway Dentistry with Marc Cruz Jeff Rousebull Sleep Dentistrybull Less-than-Six with Kevin Boydbull Intra-mandibular Distraction Osteogenesis (IMDO)
Off My ListAnything that moves the teeth faster in the wrong direction
Whatrsquos an RO to do
To create from what Irsquove learned from the best
a model for others to followhellipespecially orthodontists
Teaching
Mt Sinai Pedo ResidencyAli Attaie
2010-2012
Montefiore Ortho ResidencyTony Maganzini
2012
2009-Present
Mt Sinai School of MedicinePedodontic Residency
Guest SpeakersJim BronsonMike MewKevin BoydSandra KahnJennifer TowRoger PricePaula Fabbie
Damien OrsquoBrien
First clinical program in myofunctional orthodontics
Airway and Facial DevelopmentCollaborative Webcast
Mark Cruz
AAPMD Symposium
wwwaapm
dorg
Annual MeetingApril 25-26 2014
Westin Chicago North Shore
the raphael center for integrative orthodontics
wwwalignminecomwwwbioblocnjcom
wwwmyobracenjcom
Integrative vs Conventional
Integrative vs Conventional
ldquoWith improvements in expansion orthodontics advances in myofunctional orthodontics and the growing recognition about sleep disordered breathing among children and adults it is time for orthodontics to expand its horizons There is now so much more we can oerrdquo
The Raphael name has been associated with high quality orthodontics in New Jersey for over 60 years Dr Barry Raphael has been a university trained orthodontic specialist and a member of the American Association of Orthodontists for 30 years
He has a wide range of techniques and services to offer He has studied oral myology applied kinesiology Buteyko breathing Biobloc Orthotropics and Myobrace as part of his integrative training He can offer Damon Invisalign Insignia and Incognito appliances designs as some of his many conventional orthodontic services too
Dr Raphael teaches his techniques at post-graduate residencies study clubs dental societies and for the Myofunctional Research Co He is available for presentations to any group interested in learning more about the benefits of integrative orthodontics
wwwalignminecomLearn about the choices you have in orthodontics
dr barry raphael Why its
too Early never
1425
bro
ad
str
ee
tc
lifto
n n
j 070
13
973-
778-
4222
fax
973-
778-
9625
nj s
pe
c
368
4
1425 broad street clifton nj 07013973-778-4222
wwwalignminecom
the raphael centerforintegrative orthodontics
the
raph
ael c
ente
r fo
rin
tegr
ativ
e or
thod
onti
cs
Learn about an important choice you need to make before starting braces
the raphael center for integrative education
the raphael center for integrative education
Ongoing Intro to Airway Orthodontics
April Biobloc Study Group
April Training Ortho-Postural Therapists w Roger Price
June MRC Myobrace Basic Series
August Airway Dentistry with Mark Cruz and company
October Advanced MFT with Sandy Coulson
October Less than Six with Kevin Boyd
(who else wants to play)
Mission to create a space for spreading the word about Airway and Orthotropic principles and practice
Orthodontics in the 21st Century
EstheticOrthodontics
AirwayOrthodontics
GeneticTooth-Focused
Dental PerfectionEsthetics Primary
Treating SymptomsAirway Ignorant
AdaptationMuscle-FocusedMedical Better
Esthetics SecondaryTreating Causes
Airway Conscious
The EndAnd
The Beginning
Maxillary Heightbull Indicator Line (Mew)
bull Distance from most anterior point on nose to upper incisal edge
bull Age + 23bull A variable number but important to watch over time
B Hockel 2012
Herersquos the ldquoinsiderdquo look Notice how the upper front teeth are closer to the nose (yellow arrows)
Notice how the lower jaw rotates around the star so the chin comes up and forward (red arrow)How do we make this happen
Using IndicatorCosmetic Line
bull To define a starting pointbull To set treatment goalsbull To track treatment progressbull To gauge the effectiveness of treatment
Charting the InCos Line
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Incisor pulled away from noseNot ldquoundertorquedrdquo or ldquogummy smilerdquo
Hypothetical ClI OrthoMARA
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
OJ = 7mm
Starts Ortho
ldquoGreat Headgear
Effectrdquo
Class II Elastics
50
40
30
20mm
y J F M A M J J A S O N
boys
Start Non-x
Expansion UncrowdingFinished
Start Cl II elastics
OK thatrsquos
enough
Hypothetical Mouthbreather(Dr Mewrsquos Hamster Boy)
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Boy gets
hamster
MFT
Hypothetical BBO 7yoM
50
40
30
20
5 6 7 8 9 10 11 12 13 14 15
girlsboys
Initial
StartBB1
BB3
Night
bullLR 11-9yFbullMissing all 5s6s8s and upper 4sbullHad ortho to close diastemahellipbullInL = 39bullGP objects to deX plan equil
LR Tx Plan
1Preparation Hang Expanser2deX 3Training BB3 to advance mandible4Myofunctional Therapy5Orthopostural Training6Myobrace to hold7 Reevaluate for dental detailing
LR Spotty progress
50
40
30
20mm
y 313 4 5 6 7 8 9 10 11 12114
2 3
Expanser
Parents dragging30 turnsStart Adv
Rx deXGP
objects
After delays
Equil ersquosBB3
bullLR 12-3 yF (6mo in tx)bullInL = 37 (+2)bull ersquos equilibratedbull OJ =10bull Appliance OJ = 5bull Still accommodating to BB3
Is there a calculus for the Indicator Line
Treatment GoalsBased on Indicator Line
Incisor Goals
Type 1 Treatment Place U1 in ideal position
Biobloc Orthotropics Orthognathic Surgery Distraction Osteogenesis
Type 1 Ideal InCos line
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
YZ 9yo M
bullLost upper d-spacebullInL = 36(+4)bullOJ = 9mmbullLip entrapmentbullLip Incompetence
Y Z 9yo M
Y Z 9yo M9mm OJ
Y Z 9yo M
Treatment Options
1 Type 1 Reduce InL open lost space BB3 to advance mandible
2 Type 2 Open lost space Align
3 Type 4 Extract four premolars
YZ 9yoM
50
40
30
20mm
yM A M J J A S O N D J F M A
boys
Hang Expanser
Upper and Lower
Brackets Hang Retainer
BB3
Incisor Goals
Type 2 Treatment Develop arch just enough to uncrowd
Biobloc Myofunctional Ortho Myofunctional Therapy Crozat ALF Expansion Orthodontics
Type 2 Uncrowding
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
bullLip incompetencebullLip entrapmentbullHypermentalisbullMouthbreathing
Type 2 Uncrowding
12 month progress
12 month progress
12 month progress
After Treatment
Bent-wire6 monthsMyobrace12 months
Hey RaphaelWhat about that
profile
ZP 9-5yoM
i
After Expansion Phase
Incomplete profile improvement better breathing head posture and sleep
Incisor Goals
Type 3 Treatment Maintain UI
Functional Orthodontics Expansion Orthodontics Distalization Ortho or No Treatment
Type 3 Maintain
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Bimax retrusion
Successful dental result
Profile Unimproved
Incisor Goals
Type 4 Treatment RetractExtrude UI
Extraction Orthodontics Retraction Ortho Distalization Ortho
Type 4 Retraction
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Bimax retrusion
Successful dental result
Failed Profile Result
Changes of pharyngeal airway size and hyoid bone position following orthodontic treatment of
Class I bimaxillary protrusion
Qingzhu Wanga Peizeng Jiab Nina K Andersonc Lin Wangd Jiuxiang Line
Angle Orthodontist Vol 00 No 0 0000 (pre-publication 2012)
ldquothe dimension of the velopharynx glossopharynx and hypopharynx were decreased after maximal retraction of anterior teeth with extraction of four premolarshelliprdquo ldquoAny factors that can influence the posture and position of tongue and soft palate may displace them backward andencroach upon the pharynxrdquo
ldquothe more the incisors were retracted the more the pharyngeal airway was reducedrdquo
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Backed into a corner
bull
Moving teeth faster more efficientlyhellipin the wrong direction
Now that wersquove made smoking unacceptable
could we not do the same withbull Sugarbull Processed foodbull Cheap milk and meatbull Fast foodbull Pill popping for symptomatic reliefbull Looking for the cure instead of the causebull Surgery as a quick fixbull Thinking braces are a status symbol
Each industry thrives on the status quoConsumers must drive the change
NP 10yM
NP
Sisterrsquos non-x ortho
Shersquos happyhellipbut Irsquom not so
I make my pitch for BBO
The dilemma of progress
(I forgot the progress pictureshellip)
Dad sells prosthetic parts to orthopedic surgeons
I selling the case against my previous work they loved
It takes me 3 hours to sell the case
They fret until the BB3 goes in
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Connecting the dots
bull Adult SDB and OSA
bull Narrow jaws and faces
bull Soft tissue dysfunction
bull Early parafunctional habits ie open mouth posture
bull Environmental stressors
bull CPAP MARAUPPP SurgWherersquos the best
place to start treatment here
or here
1 Prevention 2 Undo the damage already done3 Establish good habits
When to start When damage from poor breathing is noticed and when bad habits are discovered
The strategies of Airway Orthodontics
Prevention
bull Remove ankyloglossiabull Promote breastfeedingbull Harden the dietbull Develop masticatory strengthbull Discourage oral habitsbull Promote whole-foods low sugar dietbull Reduce oropharyngeal obstructionbull Promote nasal breathing
Breathing retraining
bull Nasal rinsingbull Nasal clearingbull Decongesting
The goals of Airway Orthodontics
1 Breathing through the nose2 Lips together at rest3 Correct tongue position4 No facial muscles moving on swallowing5 Optimal forward facial development6 Class I occlusion7 Straight teeth8 Better stability long term
Myofunctional Trainers
Professors R Soulet and A Besombes
Dr Earl Bergeson
Dr Chris Farrell
The Multi ndash Family System
Orofacial MyofunctionalTherapy
Oral MyologyMyofunctional TherapyTongue Thrust Therapy
B Hockel 2012 Back
Undoing Bimaxillary Dysplasia
1 Maxillary deconstriction2 Maxillary advancement3 Maxillary impaction4 Mandibular advancement
1 Maxillary Expansion
Treatment for Bimaxillary Dysplasia
ALFCrozat
Bent Wire
HyraxHaas
Niti Exp BioBlocSchwartz
The Farrell BENT WIRE Systemtrade
Recommended Age Group 5-12 yrs
Arch Development in conjunction with the TRAINER Systemtrade
Dr John Mew
Establish Good Habits
1 Breathing through the nose2 Lips together at rest3 Correct tongue position4 No facial muscles moving on swallowing5 Stand and sit in balance6 Breath gently using the diaphragm7 Eat to nourish8 Sleep to rest
Ortho-Postural TrainingWorkshops
Breathing
Nutrition
Posture
Sleep
COPYRIGHTRoger L PriceOctober 2012
Posture Number
Forward head posturecan be a compensationfor a deficient airway
Sleep Screening and Hygiene
SQI = 10 SQI = 98
Integrative Healthcare
Function ProfessionalNasal clearing ENT Pulm MFT BreathingMuscle balance and tone MFT Myofunctional OrthoUndoing damage GP Pedo Ortho OMFSBreathing dynamics OPT MFT Breath PhysiologistPosture DC OPT PT OsteopathCranial balance OsteopathNutrition RDH Nutritionist Dietitian Sleep ENT Sleep Med DentNeurocognitive development Pedrsquon SLP Psych SpEd
The Interdisciplinary Center
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Now that I know
My personal missionTo create from what Irsquove
learned from the besta model for others to followhellipespecially the orthodontists
Myofunctional Orthodontics
Chris Farrell
John Flutter
German Ramierez
Damien OrsquoBrien
Myofunctional Research CoRancho Cucamonga
2008-2012
Oral Myology
Oral Myology Basic CourseJoy MoellerNYC 2011LA 2012
Oral Myology Levels 2 3Kim BenkertClifton 2012
Habit CessationShari GreenClifton 2013
Biobloc Orthotropics
BBO Mini-residencyBill Hang
Agora Hills2012-13
BBO IntensiveDrs John and Mike
MewLSFO2013
Breathing and Sleep
Buteyko MentorshipThe Breathing Center
Woodstock2010
Breathing Well ProgrammeJohn Flutter
2010 Ortho-Postural TrainingRoger Price
2013
Sleep DentistryMichael Gelb etal
NYU2012
ALF and Cranial
Jim Bronson2013 Tasha Turzo
Cranial Academy2014
Bucket Listbull ALF and Crozat (Bronsonrsquos course)bullMore on Biobloc (Hangrsquos Advanced London School)bull More Cranial (The Farm)bullChirodontics (Bob Walker)bull Airway Dentistry with Marc Cruz Jeff Rousebull Sleep Dentistrybull Less-than-Six with Kevin Boydbull Intra-mandibular Distraction Osteogenesis (IMDO)
Off My ListAnything that moves the teeth faster in the wrong direction
Whatrsquos an RO to do
To create from what Irsquove learned from the best
a model for others to followhellipespecially orthodontists
Teaching
Mt Sinai Pedo ResidencyAli Attaie
2010-2012
Montefiore Ortho ResidencyTony Maganzini
2012
2009-Present
Mt Sinai School of MedicinePedodontic Residency
Guest SpeakersJim BronsonMike MewKevin BoydSandra KahnJennifer TowRoger PricePaula Fabbie
Damien OrsquoBrien
First clinical program in myofunctional orthodontics
Airway and Facial DevelopmentCollaborative Webcast
Mark Cruz
AAPMD Symposium
wwwaapm
dorg
Annual MeetingApril 25-26 2014
Westin Chicago North Shore
the raphael center for integrative orthodontics
wwwalignminecomwwwbioblocnjcom
wwwmyobracenjcom
Integrative vs Conventional
Integrative vs Conventional
ldquoWith improvements in expansion orthodontics advances in myofunctional orthodontics and the growing recognition about sleep disordered breathing among children and adults it is time for orthodontics to expand its horizons There is now so much more we can oerrdquo
The Raphael name has been associated with high quality orthodontics in New Jersey for over 60 years Dr Barry Raphael has been a university trained orthodontic specialist and a member of the American Association of Orthodontists for 30 years
He has a wide range of techniques and services to offer He has studied oral myology applied kinesiology Buteyko breathing Biobloc Orthotropics and Myobrace as part of his integrative training He can offer Damon Invisalign Insignia and Incognito appliances designs as some of his many conventional orthodontic services too
Dr Raphael teaches his techniques at post-graduate residencies study clubs dental societies and for the Myofunctional Research Co He is available for presentations to any group interested in learning more about the benefits of integrative orthodontics
wwwalignminecomLearn about the choices you have in orthodontics
dr barry raphael Why its
too Early never
1425
bro
ad
str
ee
tc
lifto
n n
j 070
13
973-
778-
4222
fax
973-
778-
9625
nj s
pe
c
368
4
1425 broad street clifton nj 07013973-778-4222
wwwalignminecom
the raphael centerforintegrative orthodontics
the
raph
ael c
ente
r fo
rin
tegr
ativ
e or
thod
onti
cs
Learn about an important choice you need to make before starting braces
the raphael center for integrative education
the raphael center for integrative education
Ongoing Intro to Airway Orthodontics
April Biobloc Study Group
April Training Ortho-Postural Therapists w Roger Price
June MRC Myobrace Basic Series
August Airway Dentistry with Mark Cruz and company
October Advanced MFT with Sandy Coulson
October Less than Six with Kevin Boyd
(who else wants to play)
Mission to create a space for spreading the word about Airway and Orthotropic principles and practice
Orthodontics in the 21st Century
EstheticOrthodontics
AirwayOrthodontics
GeneticTooth-Focused
Dental PerfectionEsthetics Primary
Treating SymptomsAirway Ignorant
AdaptationMuscle-FocusedMedical Better
Esthetics SecondaryTreating Causes
Airway Conscious
The EndAnd
The Beginning
B Hockel 2012
Herersquos the ldquoinsiderdquo look Notice how the upper front teeth are closer to the nose (yellow arrows)
Notice how the lower jaw rotates around the star so the chin comes up and forward (red arrow)How do we make this happen
Using IndicatorCosmetic Line
bull To define a starting pointbull To set treatment goalsbull To track treatment progressbull To gauge the effectiveness of treatment
Charting the InCos Line
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Incisor pulled away from noseNot ldquoundertorquedrdquo or ldquogummy smilerdquo
Hypothetical ClI OrthoMARA
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
OJ = 7mm
Starts Ortho
ldquoGreat Headgear
Effectrdquo
Class II Elastics
50
40
30
20mm
y J F M A M J J A S O N
boys
Start Non-x
Expansion UncrowdingFinished
Start Cl II elastics
OK thatrsquos
enough
Hypothetical Mouthbreather(Dr Mewrsquos Hamster Boy)
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Boy gets
hamster
MFT
Hypothetical BBO 7yoM
50
40
30
20
5 6 7 8 9 10 11 12 13 14 15
girlsboys
Initial
StartBB1
BB3
Night
bullLR 11-9yFbullMissing all 5s6s8s and upper 4sbullHad ortho to close diastemahellipbullInL = 39bullGP objects to deX plan equil
LR Tx Plan
1Preparation Hang Expanser2deX 3Training BB3 to advance mandible4Myofunctional Therapy5Orthopostural Training6Myobrace to hold7 Reevaluate for dental detailing
LR Spotty progress
50
40
30
20mm
y 313 4 5 6 7 8 9 10 11 12114
2 3
Expanser
Parents dragging30 turnsStart Adv
Rx deXGP
objects
After delays
Equil ersquosBB3
bullLR 12-3 yF (6mo in tx)bullInL = 37 (+2)bull ersquos equilibratedbull OJ =10bull Appliance OJ = 5bull Still accommodating to BB3
Is there a calculus for the Indicator Line
Treatment GoalsBased on Indicator Line
Incisor Goals
Type 1 Treatment Place U1 in ideal position
Biobloc Orthotropics Orthognathic Surgery Distraction Osteogenesis
Type 1 Ideal InCos line
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
YZ 9yo M
bullLost upper d-spacebullInL = 36(+4)bullOJ = 9mmbullLip entrapmentbullLip Incompetence
Y Z 9yo M
Y Z 9yo M9mm OJ
Y Z 9yo M
Treatment Options
1 Type 1 Reduce InL open lost space BB3 to advance mandible
2 Type 2 Open lost space Align
3 Type 4 Extract four premolars
YZ 9yoM
50
40
30
20mm
yM A M J J A S O N D J F M A
boys
Hang Expanser
Upper and Lower
Brackets Hang Retainer
BB3
Incisor Goals
Type 2 Treatment Develop arch just enough to uncrowd
Biobloc Myofunctional Ortho Myofunctional Therapy Crozat ALF Expansion Orthodontics
Type 2 Uncrowding
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
bullLip incompetencebullLip entrapmentbullHypermentalisbullMouthbreathing
Type 2 Uncrowding
12 month progress
12 month progress
12 month progress
After Treatment
Bent-wire6 monthsMyobrace12 months
Hey RaphaelWhat about that
profile
ZP 9-5yoM
i
After Expansion Phase
Incomplete profile improvement better breathing head posture and sleep
Incisor Goals
Type 3 Treatment Maintain UI
Functional Orthodontics Expansion Orthodontics Distalization Ortho or No Treatment
Type 3 Maintain
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Bimax retrusion
Successful dental result
Profile Unimproved
Incisor Goals
Type 4 Treatment RetractExtrude UI
Extraction Orthodontics Retraction Ortho Distalization Ortho
Type 4 Retraction
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Bimax retrusion
Successful dental result
Failed Profile Result
Changes of pharyngeal airway size and hyoid bone position following orthodontic treatment of
Class I bimaxillary protrusion
Qingzhu Wanga Peizeng Jiab Nina K Andersonc Lin Wangd Jiuxiang Line
Angle Orthodontist Vol 00 No 0 0000 (pre-publication 2012)
ldquothe dimension of the velopharynx glossopharynx and hypopharynx were decreased after maximal retraction of anterior teeth with extraction of four premolarshelliprdquo ldquoAny factors that can influence the posture and position of tongue and soft palate may displace them backward andencroach upon the pharynxrdquo
ldquothe more the incisors were retracted the more the pharyngeal airway was reducedrdquo
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Backed into a corner
bull
Moving teeth faster more efficientlyhellipin the wrong direction
Now that wersquove made smoking unacceptable
could we not do the same withbull Sugarbull Processed foodbull Cheap milk and meatbull Fast foodbull Pill popping for symptomatic reliefbull Looking for the cure instead of the causebull Surgery as a quick fixbull Thinking braces are a status symbol
Each industry thrives on the status quoConsumers must drive the change
NP 10yM
NP
Sisterrsquos non-x ortho
Shersquos happyhellipbut Irsquom not so
I make my pitch for BBO
The dilemma of progress
(I forgot the progress pictureshellip)
Dad sells prosthetic parts to orthopedic surgeons
I selling the case against my previous work they loved
It takes me 3 hours to sell the case
They fret until the BB3 goes in
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Connecting the dots
bull Adult SDB and OSA
bull Narrow jaws and faces
bull Soft tissue dysfunction
bull Early parafunctional habits ie open mouth posture
bull Environmental stressors
bull CPAP MARAUPPP SurgWherersquos the best
place to start treatment here
or here
1 Prevention 2 Undo the damage already done3 Establish good habits
When to start When damage from poor breathing is noticed and when bad habits are discovered
The strategies of Airway Orthodontics
Prevention
bull Remove ankyloglossiabull Promote breastfeedingbull Harden the dietbull Develop masticatory strengthbull Discourage oral habitsbull Promote whole-foods low sugar dietbull Reduce oropharyngeal obstructionbull Promote nasal breathing
Breathing retraining
bull Nasal rinsingbull Nasal clearingbull Decongesting
The goals of Airway Orthodontics
1 Breathing through the nose2 Lips together at rest3 Correct tongue position4 No facial muscles moving on swallowing5 Optimal forward facial development6 Class I occlusion7 Straight teeth8 Better stability long term
Myofunctional Trainers
Professors R Soulet and A Besombes
Dr Earl Bergeson
Dr Chris Farrell
The Multi ndash Family System
Orofacial MyofunctionalTherapy
Oral MyologyMyofunctional TherapyTongue Thrust Therapy
B Hockel 2012 Back
Undoing Bimaxillary Dysplasia
1 Maxillary deconstriction2 Maxillary advancement3 Maxillary impaction4 Mandibular advancement
1 Maxillary Expansion
Treatment for Bimaxillary Dysplasia
ALFCrozat
Bent Wire
HyraxHaas
Niti Exp BioBlocSchwartz
The Farrell BENT WIRE Systemtrade
Recommended Age Group 5-12 yrs
Arch Development in conjunction with the TRAINER Systemtrade
Dr John Mew
Establish Good Habits
1 Breathing through the nose2 Lips together at rest3 Correct tongue position4 No facial muscles moving on swallowing5 Stand and sit in balance6 Breath gently using the diaphragm7 Eat to nourish8 Sleep to rest
Ortho-Postural TrainingWorkshops
Breathing
Nutrition
Posture
Sleep
COPYRIGHTRoger L PriceOctober 2012
Posture Number
Forward head posturecan be a compensationfor a deficient airway
Sleep Screening and Hygiene
SQI = 10 SQI = 98
Integrative Healthcare
Function ProfessionalNasal clearing ENT Pulm MFT BreathingMuscle balance and tone MFT Myofunctional OrthoUndoing damage GP Pedo Ortho OMFSBreathing dynamics OPT MFT Breath PhysiologistPosture DC OPT PT OsteopathCranial balance OsteopathNutrition RDH Nutritionist Dietitian Sleep ENT Sleep Med DentNeurocognitive development Pedrsquon SLP Psych SpEd
The Interdisciplinary Center
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Now that I know
My personal missionTo create from what Irsquove
learned from the besta model for others to followhellipespecially the orthodontists
Myofunctional Orthodontics
Chris Farrell
John Flutter
German Ramierez
Damien OrsquoBrien
Myofunctional Research CoRancho Cucamonga
2008-2012
Oral Myology
Oral Myology Basic CourseJoy MoellerNYC 2011LA 2012
Oral Myology Levels 2 3Kim BenkertClifton 2012
Habit CessationShari GreenClifton 2013
Biobloc Orthotropics
BBO Mini-residencyBill Hang
Agora Hills2012-13
BBO IntensiveDrs John and Mike
MewLSFO2013
Breathing and Sleep
Buteyko MentorshipThe Breathing Center
Woodstock2010
Breathing Well ProgrammeJohn Flutter
2010 Ortho-Postural TrainingRoger Price
2013
Sleep DentistryMichael Gelb etal
NYU2012
ALF and Cranial
Jim Bronson2013 Tasha Turzo
Cranial Academy2014
Bucket Listbull ALF and Crozat (Bronsonrsquos course)bullMore on Biobloc (Hangrsquos Advanced London School)bull More Cranial (The Farm)bullChirodontics (Bob Walker)bull Airway Dentistry with Marc Cruz Jeff Rousebull Sleep Dentistrybull Less-than-Six with Kevin Boydbull Intra-mandibular Distraction Osteogenesis (IMDO)
Off My ListAnything that moves the teeth faster in the wrong direction
Whatrsquos an RO to do
To create from what Irsquove learned from the best
a model for others to followhellipespecially orthodontists
Teaching
Mt Sinai Pedo ResidencyAli Attaie
2010-2012
Montefiore Ortho ResidencyTony Maganzini
2012
2009-Present
Mt Sinai School of MedicinePedodontic Residency
Guest SpeakersJim BronsonMike MewKevin BoydSandra KahnJennifer TowRoger PricePaula Fabbie
Damien OrsquoBrien
First clinical program in myofunctional orthodontics
Airway and Facial DevelopmentCollaborative Webcast
Mark Cruz
AAPMD Symposium
wwwaapm
dorg
Annual MeetingApril 25-26 2014
Westin Chicago North Shore
the raphael center for integrative orthodontics
wwwalignminecomwwwbioblocnjcom
wwwmyobracenjcom
Integrative vs Conventional
Integrative vs Conventional
ldquoWith improvements in expansion orthodontics advances in myofunctional orthodontics and the growing recognition about sleep disordered breathing among children and adults it is time for orthodontics to expand its horizons There is now so much more we can oerrdquo
The Raphael name has been associated with high quality orthodontics in New Jersey for over 60 years Dr Barry Raphael has been a university trained orthodontic specialist and a member of the American Association of Orthodontists for 30 years
He has a wide range of techniques and services to offer He has studied oral myology applied kinesiology Buteyko breathing Biobloc Orthotropics and Myobrace as part of his integrative training He can offer Damon Invisalign Insignia and Incognito appliances designs as some of his many conventional orthodontic services too
Dr Raphael teaches his techniques at post-graduate residencies study clubs dental societies and for the Myofunctional Research Co He is available for presentations to any group interested in learning more about the benefits of integrative orthodontics
wwwalignminecomLearn about the choices you have in orthodontics
dr barry raphael Why its
too Early never
1425
bro
ad
str
ee
tc
lifto
n n
j 070
13
973-
778-
4222
fax
973-
778-
9625
nj s
pe
c
368
4
1425 broad street clifton nj 07013973-778-4222
wwwalignminecom
the raphael centerforintegrative orthodontics
the
raph
ael c
ente
r fo
rin
tegr
ativ
e or
thod
onti
cs
Learn about an important choice you need to make before starting braces
the raphael center for integrative education
the raphael center for integrative education
Ongoing Intro to Airway Orthodontics
April Biobloc Study Group
April Training Ortho-Postural Therapists w Roger Price
June MRC Myobrace Basic Series
August Airway Dentistry with Mark Cruz and company
October Advanced MFT with Sandy Coulson
October Less than Six with Kevin Boyd
(who else wants to play)
Mission to create a space for spreading the word about Airway and Orthotropic principles and practice
Orthodontics in the 21st Century
EstheticOrthodontics
AirwayOrthodontics
GeneticTooth-Focused
Dental PerfectionEsthetics Primary
Treating SymptomsAirway Ignorant
AdaptationMuscle-FocusedMedical Better
Esthetics SecondaryTreating Causes
Airway Conscious
The EndAnd
The Beginning
Using IndicatorCosmetic Line
bull To define a starting pointbull To set treatment goalsbull To track treatment progressbull To gauge the effectiveness of treatment
Charting the InCos Line
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Incisor pulled away from noseNot ldquoundertorquedrdquo or ldquogummy smilerdquo
Hypothetical ClI OrthoMARA
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
OJ = 7mm
Starts Ortho
ldquoGreat Headgear
Effectrdquo
Class II Elastics
50
40
30
20mm
y J F M A M J J A S O N
boys
Start Non-x
Expansion UncrowdingFinished
Start Cl II elastics
OK thatrsquos
enough
Hypothetical Mouthbreather(Dr Mewrsquos Hamster Boy)
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Boy gets
hamster
MFT
Hypothetical BBO 7yoM
50
40
30
20
5 6 7 8 9 10 11 12 13 14 15
girlsboys
Initial
StartBB1
BB3
Night
bullLR 11-9yFbullMissing all 5s6s8s and upper 4sbullHad ortho to close diastemahellipbullInL = 39bullGP objects to deX plan equil
LR Tx Plan
1Preparation Hang Expanser2deX 3Training BB3 to advance mandible4Myofunctional Therapy5Orthopostural Training6Myobrace to hold7 Reevaluate for dental detailing
LR Spotty progress
50
40
30
20mm
y 313 4 5 6 7 8 9 10 11 12114
2 3
Expanser
Parents dragging30 turnsStart Adv
Rx deXGP
objects
After delays
Equil ersquosBB3
bullLR 12-3 yF (6mo in tx)bullInL = 37 (+2)bull ersquos equilibratedbull OJ =10bull Appliance OJ = 5bull Still accommodating to BB3
Is there a calculus for the Indicator Line
Treatment GoalsBased on Indicator Line
Incisor Goals
Type 1 Treatment Place U1 in ideal position
Biobloc Orthotropics Orthognathic Surgery Distraction Osteogenesis
Type 1 Ideal InCos line
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
YZ 9yo M
bullLost upper d-spacebullInL = 36(+4)bullOJ = 9mmbullLip entrapmentbullLip Incompetence
Y Z 9yo M
Y Z 9yo M9mm OJ
Y Z 9yo M
Treatment Options
1 Type 1 Reduce InL open lost space BB3 to advance mandible
2 Type 2 Open lost space Align
3 Type 4 Extract four premolars
YZ 9yoM
50
40
30
20mm
yM A M J J A S O N D J F M A
boys
Hang Expanser
Upper and Lower
Brackets Hang Retainer
BB3
Incisor Goals
Type 2 Treatment Develop arch just enough to uncrowd
Biobloc Myofunctional Ortho Myofunctional Therapy Crozat ALF Expansion Orthodontics
Type 2 Uncrowding
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
bullLip incompetencebullLip entrapmentbullHypermentalisbullMouthbreathing
Type 2 Uncrowding
12 month progress
12 month progress
12 month progress
After Treatment
Bent-wire6 monthsMyobrace12 months
Hey RaphaelWhat about that
profile
ZP 9-5yoM
i
After Expansion Phase
Incomplete profile improvement better breathing head posture and sleep
Incisor Goals
Type 3 Treatment Maintain UI
Functional Orthodontics Expansion Orthodontics Distalization Ortho or No Treatment
Type 3 Maintain
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Bimax retrusion
Successful dental result
Profile Unimproved
Incisor Goals
Type 4 Treatment RetractExtrude UI
Extraction Orthodontics Retraction Ortho Distalization Ortho
Type 4 Retraction
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Bimax retrusion
Successful dental result
Failed Profile Result
Changes of pharyngeal airway size and hyoid bone position following orthodontic treatment of
Class I bimaxillary protrusion
Qingzhu Wanga Peizeng Jiab Nina K Andersonc Lin Wangd Jiuxiang Line
Angle Orthodontist Vol 00 No 0 0000 (pre-publication 2012)
ldquothe dimension of the velopharynx glossopharynx and hypopharynx were decreased after maximal retraction of anterior teeth with extraction of four premolarshelliprdquo ldquoAny factors that can influence the posture and position of tongue and soft palate may displace them backward andencroach upon the pharynxrdquo
ldquothe more the incisors were retracted the more the pharyngeal airway was reducedrdquo
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Backed into a corner
bull
Moving teeth faster more efficientlyhellipin the wrong direction
Now that wersquove made smoking unacceptable
could we not do the same withbull Sugarbull Processed foodbull Cheap milk and meatbull Fast foodbull Pill popping for symptomatic reliefbull Looking for the cure instead of the causebull Surgery as a quick fixbull Thinking braces are a status symbol
Each industry thrives on the status quoConsumers must drive the change
NP 10yM
NP
Sisterrsquos non-x ortho
Shersquos happyhellipbut Irsquom not so
I make my pitch for BBO
The dilemma of progress
(I forgot the progress pictureshellip)
Dad sells prosthetic parts to orthopedic surgeons
I selling the case against my previous work they loved
It takes me 3 hours to sell the case
They fret until the BB3 goes in
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Connecting the dots
bull Adult SDB and OSA
bull Narrow jaws and faces
bull Soft tissue dysfunction
bull Early parafunctional habits ie open mouth posture
bull Environmental stressors
bull CPAP MARAUPPP SurgWherersquos the best
place to start treatment here
or here
1 Prevention 2 Undo the damage already done3 Establish good habits
When to start When damage from poor breathing is noticed and when bad habits are discovered
The strategies of Airway Orthodontics
Prevention
bull Remove ankyloglossiabull Promote breastfeedingbull Harden the dietbull Develop masticatory strengthbull Discourage oral habitsbull Promote whole-foods low sugar dietbull Reduce oropharyngeal obstructionbull Promote nasal breathing
Breathing retraining
bull Nasal rinsingbull Nasal clearingbull Decongesting
The goals of Airway Orthodontics
1 Breathing through the nose2 Lips together at rest3 Correct tongue position4 No facial muscles moving on swallowing5 Optimal forward facial development6 Class I occlusion7 Straight teeth8 Better stability long term
Myofunctional Trainers
Professors R Soulet and A Besombes
Dr Earl Bergeson
Dr Chris Farrell
The Multi ndash Family System
Orofacial MyofunctionalTherapy
Oral MyologyMyofunctional TherapyTongue Thrust Therapy
B Hockel 2012 Back
Undoing Bimaxillary Dysplasia
1 Maxillary deconstriction2 Maxillary advancement3 Maxillary impaction4 Mandibular advancement
1 Maxillary Expansion
Treatment for Bimaxillary Dysplasia
ALFCrozat
Bent Wire
HyraxHaas
Niti Exp BioBlocSchwartz
The Farrell BENT WIRE Systemtrade
Recommended Age Group 5-12 yrs
Arch Development in conjunction with the TRAINER Systemtrade
Dr John Mew
Establish Good Habits
1 Breathing through the nose2 Lips together at rest3 Correct tongue position4 No facial muscles moving on swallowing5 Stand and sit in balance6 Breath gently using the diaphragm7 Eat to nourish8 Sleep to rest
Ortho-Postural TrainingWorkshops
Breathing
Nutrition
Posture
Sleep
COPYRIGHTRoger L PriceOctober 2012
Posture Number
Forward head posturecan be a compensationfor a deficient airway
Sleep Screening and Hygiene
SQI = 10 SQI = 98
Integrative Healthcare
Function ProfessionalNasal clearing ENT Pulm MFT BreathingMuscle balance and tone MFT Myofunctional OrthoUndoing damage GP Pedo Ortho OMFSBreathing dynamics OPT MFT Breath PhysiologistPosture DC OPT PT OsteopathCranial balance OsteopathNutrition RDH Nutritionist Dietitian Sleep ENT Sleep Med DentNeurocognitive development Pedrsquon SLP Psych SpEd
The Interdisciplinary Center
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Now that I know
My personal missionTo create from what Irsquove
learned from the besta model for others to followhellipespecially the orthodontists
Myofunctional Orthodontics
Chris Farrell
John Flutter
German Ramierez
Damien OrsquoBrien
Myofunctional Research CoRancho Cucamonga
2008-2012
Oral Myology
Oral Myology Basic CourseJoy MoellerNYC 2011LA 2012
Oral Myology Levels 2 3Kim BenkertClifton 2012
Habit CessationShari GreenClifton 2013
Biobloc Orthotropics
BBO Mini-residencyBill Hang
Agora Hills2012-13
BBO IntensiveDrs John and Mike
MewLSFO2013
Breathing and Sleep
Buteyko MentorshipThe Breathing Center
Woodstock2010
Breathing Well ProgrammeJohn Flutter
2010 Ortho-Postural TrainingRoger Price
2013
Sleep DentistryMichael Gelb etal
NYU2012
ALF and Cranial
Jim Bronson2013 Tasha Turzo
Cranial Academy2014
Bucket Listbull ALF and Crozat (Bronsonrsquos course)bullMore on Biobloc (Hangrsquos Advanced London School)bull More Cranial (The Farm)bullChirodontics (Bob Walker)bull Airway Dentistry with Marc Cruz Jeff Rousebull Sleep Dentistrybull Less-than-Six with Kevin Boydbull Intra-mandibular Distraction Osteogenesis (IMDO)
Off My ListAnything that moves the teeth faster in the wrong direction
Whatrsquos an RO to do
To create from what Irsquove learned from the best
a model for others to followhellipespecially orthodontists
Teaching
Mt Sinai Pedo ResidencyAli Attaie
2010-2012
Montefiore Ortho ResidencyTony Maganzini
2012
2009-Present
Mt Sinai School of MedicinePedodontic Residency
Guest SpeakersJim BronsonMike MewKevin BoydSandra KahnJennifer TowRoger PricePaula Fabbie
Damien OrsquoBrien
First clinical program in myofunctional orthodontics
Airway and Facial DevelopmentCollaborative Webcast
Mark Cruz
AAPMD Symposium
wwwaapm
dorg
Annual MeetingApril 25-26 2014
Westin Chicago North Shore
the raphael center for integrative orthodontics
wwwalignminecomwwwbioblocnjcom
wwwmyobracenjcom
Integrative vs Conventional
Integrative vs Conventional
ldquoWith improvements in expansion orthodontics advances in myofunctional orthodontics and the growing recognition about sleep disordered breathing among children and adults it is time for orthodontics to expand its horizons There is now so much more we can oerrdquo
The Raphael name has been associated with high quality orthodontics in New Jersey for over 60 years Dr Barry Raphael has been a university trained orthodontic specialist and a member of the American Association of Orthodontists for 30 years
He has a wide range of techniques and services to offer He has studied oral myology applied kinesiology Buteyko breathing Biobloc Orthotropics and Myobrace as part of his integrative training He can offer Damon Invisalign Insignia and Incognito appliances designs as some of his many conventional orthodontic services too
Dr Raphael teaches his techniques at post-graduate residencies study clubs dental societies and for the Myofunctional Research Co He is available for presentations to any group interested in learning more about the benefits of integrative orthodontics
wwwalignminecomLearn about the choices you have in orthodontics
dr barry raphael Why its
too Early never
1425
bro
ad
str
ee
tc
lifto
n n
j 070
13
973-
778-
4222
fax
973-
778-
9625
nj s
pe
c
368
4
1425 broad street clifton nj 07013973-778-4222
wwwalignminecom
the raphael centerforintegrative orthodontics
the
raph
ael c
ente
r fo
rin
tegr
ativ
e or
thod
onti
cs
Learn about an important choice you need to make before starting braces
the raphael center for integrative education
the raphael center for integrative education
Ongoing Intro to Airway Orthodontics
April Biobloc Study Group
April Training Ortho-Postural Therapists w Roger Price
June MRC Myobrace Basic Series
August Airway Dentistry with Mark Cruz and company
October Advanced MFT with Sandy Coulson
October Less than Six with Kevin Boyd
(who else wants to play)
Mission to create a space for spreading the word about Airway and Orthotropic principles and practice
Orthodontics in the 21st Century
EstheticOrthodontics
AirwayOrthodontics
GeneticTooth-Focused
Dental PerfectionEsthetics Primary
Treating SymptomsAirway Ignorant
AdaptationMuscle-FocusedMedical Better
Esthetics SecondaryTreating Causes
Airway Conscious
The EndAnd
The Beginning
Charting the InCos Line
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Incisor pulled away from noseNot ldquoundertorquedrdquo or ldquogummy smilerdquo
Hypothetical ClI OrthoMARA
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
OJ = 7mm
Starts Ortho
ldquoGreat Headgear
Effectrdquo
Class II Elastics
50
40
30
20mm
y J F M A M J J A S O N
boys
Start Non-x
Expansion UncrowdingFinished
Start Cl II elastics
OK thatrsquos
enough
Hypothetical Mouthbreather(Dr Mewrsquos Hamster Boy)
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Boy gets
hamster
MFT
Hypothetical BBO 7yoM
50
40
30
20
5 6 7 8 9 10 11 12 13 14 15
girlsboys
Initial
StartBB1
BB3
Night
bullLR 11-9yFbullMissing all 5s6s8s and upper 4sbullHad ortho to close diastemahellipbullInL = 39bullGP objects to deX plan equil
LR Tx Plan
1Preparation Hang Expanser2deX 3Training BB3 to advance mandible4Myofunctional Therapy5Orthopostural Training6Myobrace to hold7 Reevaluate for dental detailing
LR Spotty progress
50
40
30
20mm
y 313 4 5 6 7 8 9 10 11 12114
2 3
Expanser
Parents dragging30 turnsStart Adv
Rx deXGP
objects
After delays
Equil ersquosBB3
bullLR 12-3 yF (6mo in tx)bullInL = 37 (+2)bull ersquos equilibratedbull OJ =10bull Appliance OJ = 5bull Still accommodating to BB3
Is there a calculus for the Indicator Line
Treatment GoalsBased on Indicator Line
Incisor Goals
Type 1 Treatment Place U1 in ideal position
Biobloc Orthotropics Orthognathic Surgery Distraction Osteogenesis
Type 1 Ideal InCos line
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
YZ 9yo M
bullLost upper d-spacebullInL = 36(+4)bullOJ = 9mmbullLip entrapmentbullLip Incompetence
Y Z 9yo M
Y Z 9yo M9mm OJ
Y Z 9yo M
Treatment Options
1 Type 1 Reduce InL open lost space BB3 to advance mandible
2 Type 2 Open lost space Align
3 Type 4 Extract four premolars
YZ 9yoM
50
40
30
20mm
yM A M J J A S O N D J F M A
boys
Hang Expanser
Upper and Lower
Brackets Hang Retainer
BB3
Incisor Goals
Type 2 Treatment Develop arch just enough to uncrowd
Biobloc Myofunctional Ortho Myofunctional Therapy Crozat ALF Expansion Orthodontics
Type 2 Uncrowding
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
bullLip incompetencebullLip entrapmentbullHypermentalisbullMouthbreathing
Type 2 Uncrowding
12 month progress
12 month progress
12 month progress
After Treatment
Bent-wire6 monthsMyobrace12 months
Hey RaphaelWhat about that
profile
ZP 9-5yoM
i
After Expansion Phase
Incomplete profile improvement better breathing head posture and sleep
Incisor Goals
Type 3 Treatment Maintain UI
Functional Orthodontics Expansion Orthodontics Distalization Ortho or No Treatment
Type 3 Maintain
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Bimax retrusion
Successful dental result
Profile Unimproved
Incisor Goals
Type 4 Treatment RetractExtrude UI
Extraction Orthodontics Retraction Ortho Distalization Ortho
Type 4 Retraction
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Bimax retrusion
Successful dental result
Failed Profile Result
Changes of pharyngeal airway size and hyoid bone position following orthodontic treatment of
Class I bimaxillary protrusion
Qingzhu Wanga Peizeng Jiab Nina K Andersonc Lin Wangd Jiuxiang Line
Angle Orthodontist Vol 00 No 0 0000 (pre-publication 2012)
ldquothe dimension of the velopharynx glossopharynx and hypopharynx were decreased after maximal retraction of anterior teeth with extraction of four premolarshelliprdquo ldquoAny factors that can influence the posture and position of tongue and soft palate may displace them backward andencroach upon the pharynxrdquo
ldquothe more the incisors were retracted the more the pharyngeal airway was reducedrdquo
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Backed into a corner
bull
Moving teeth faster more efficientlyhellipin the wrong direction
Now that wersquove made smoking unacceptable
could we not do the same withbull Sugarbull Processed foodbull Cheap milk and meatbull Fast foodbull Pill popping for symptomatic reliefbull Looking for the cure instead of the causebull Surgery as a quick fixbull Thinking braces are a status symbol
Each industry thrives on the status quoConsumers must drive the change
NP 10yM
NP
Sisterrsquos non-x ortho
Shersquos happyhellipbut Irsquom not so
I make my pitch for BBO
The dilemma of progress
(I forgot the progress pictureshellip)
Dad sells prosthetic parts to orthopedic surgeons
I selling the case against my previous work they loved
It takes me 3 hours to sell the case
They fret until the BB3 goes in
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Connecting the dots
bull Adult SDB and OSA
bull Narrow jaws and faces
bull Soft tissue dysfunction
bull Early parafunctional habits ie open mouth posture
bull Environmental stressors
bull CPAP MARAUPPP SurgWherersquos the best
place to start treatment here
or here
1 Prevention 2 Undo the damage already done3 Establish good habits
When to start When damage from poor breathing is noticed and when bad habits are discovered
The strategies of Airway Orthodontics
Prevention
bull Remove ankyloglossiabull Promote breastfeedingbull Harden the dietbull Develop masticatory strengthbull Discourage oral habitsbull Promote whole-foods low sugar dietbull Reduce oropharyngeal obstructionbull Promote nasal breathing
Breathing retraining
bull Nasal rinsingbull Nasal clearingbull Decongesting
The goals of Airway Orthodontics
1 Breathing through the nose2 Lips together at rest3 Correct tongue position4 No facial muscles moving on swallowing5 Optimal forward facial development6 Class I occlusion7 Straight teeth8 Better stability long term
Myofunctional Trainers
Professors R Soulet and A Besombes
Dr Earl Bergeson
Dr Chris Farrell
The Multi ndash Family System
Orofacial MyofunctionalTherapy
Oral MyologyMyofunctional TherapyTongue Thrust Therapy
B Hockel 2012 Back
Undoing Bimaxillary Dysplasia
1 Maxillary deconstriction2 Maxillary advancement3 Maxillary impaction4 Mandibular advancement
1 Maxillary Expansion
Treatment for Bimaxillary Dysplasia
ALFCrozat
Bent Wire
HyraxHaas
Niti Exp BioBlocSchwartz
The Farrell BENT WIRE Systemtrade
Recommended Age Group 5-12 yrs
Arch Development in conjunction with the TRAINER Systemtrade
Dr John Mew
Establish Good Habits
1 Breathing through the nose2 Lips together at rest3 Correct tongue position4 No facial muscles moving on swallowing5 Stand and sit in balance6 Breath gently using the diaphragm7 Eat to nourish8 Sleep to rest
Ortho-Postural TrainingWorkshops
Breathing
Nutrition
Posture
Sleep
COPYRIGHTRoger L PriceOctober 2012
Posture Number
Forward head posturecan be a compensationfor a deficient airway
Sleep Screening and Hygiene
SQI = 10 SQI = 98
Integrative Healthcare
Function ProfessionalNasal clearing ENT Pulm MFT BreathingMuscle balance and tone MFT Myofunctional OrthoUndoing damage GP Pedo Ortho OMFSBreathing dynamics OPT MFT Breath PhysiologistPosture DC OPT PT OsteopathCranial balance OsteopathNutrition RDH Nutritionist Dietitian Sleep ENT Sleep Med DentNeurocognitive development Pedrsquon SLP Psych SpEd
The Interdisciplinary Center
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Now that I know
My personal missionTo create from what Irsquove
learned from the besta model for others to followhellipespecially the orthodontists
Myofunctional Orthodontics
Chris Farrell
John Flutter
German Ramierez
Damien OrsquoBrien
Myofunctional Research CoRancho Cucamonga
2008-2012
Oral Myology
Oral Myology Basic CourseJoy MoellerNYC 2011LA 2012
Oral Myology Levels 2 3Kim BenkertClifton 2012
Habit CessationShari GreenClifton 2013
Biobloc Orthotropics
BBO Mini-residencyBill Hang
Agora Hills2012-13
BBO IntensiveDrs John and Mike
MewLSFO2013
Breathing and Sleep
Buteyko MentorshipThe Breathing Center
Woodstock2010
Breathing Well ProgrammeJohn Flutter
2010 Ortho-Postural TrainingRoger Price
2013
Sleep DentistryMichael Gelb etal
NYU2012
ALF and Cranial
Jim Bronson2013 Tasha Turzo
Cranial Academy2014
Bucket Listbull ALF and Crozat (Bronsonrsquos course)bullMore on Biobloc (Hangrsquos Advanced London School)bull More Cranial (The Farm)bullChirodontics (Bob Walker)bull Airway Dentistry with Marc Cruz Jeff Rousebull Sleep Dentistrybull Less-than-Six with Kevin Boydbull Intra-mandibular Distraction Osteogenesis (IMDO)
Off My ListAnything that moves the teeth faster in the wrong direction
Whatrsquos an RO to do
To create from what Irsquove learned from the best
a model for others to followhellipespecially orthodontists
Teaching
Mt Sinai Pedo ResidencyAli Attaie
2010-2012
Montefiore Ortho ResidencyTony Maganzini
2012
2009-Present
Mt Sinai School of MedicinePedodontic Residency
Guest SpeakersJim BronsonMike MewKevin BoydSandra KahnJennifer TowRoger PricePaula Fabbie
Damien OrsquoBrien
First clinical program in myofunctional orthodontics
Airway and Facial DevelopmentCollaborative Webcast
Mark Cruz
AAPMD Symposium
wwwaapm
dorg
Annual MeetingApril 25-26 2014
Westin Chicago North Shore
the raphael center for integrative orthodontics
wwwalignminecomwwwbioblocnjcom
wwwmyobracenjcom
Integrative vs Conventional
Integrative vs Conventional
ldquoWith improvements in expansion orthodontics advances in myofunctional orthodontics and the growing recognition about sleep disordered breathing among children and adults it is time for orthodontics to expand its horizons There is now so much more we can oerrdquo
The Raphael name has been associated with high quality orthodontics in New Jersey for over 60 years Dr Barry Raphael has been a university trained orthodontic specialist and a member of the American Association of Orthodontists for 30 years
He has a wide range of techniques and services to offer He has studied oral myology applied kinesiology Buteyko breathing Biobloc Orthotropics and Myobrace as part of his integrative training He can offer Damon Invisalign Insignia and Incognito appliances designs as some of his many conventional orthodontic services too
Dr Raphael teaches his techniques at post-graduate residencies study clubs dental societies and for the Myofunctional Research Co He is available for presentations to any group interested in learning more about the benefits of integrative orthodontics
wwwalignminecomLearn about the choices you have in orthodontics
dr barry raphael Why its
too Early never
1425
bro
ad
str
ee
tc
lifto
n n
j 070
13
973-
778-
4222
fax
973-
778-
9625
nj s
pe
c
368
4
1425 broad street clifton nj 07013973-778-4222
wwwalignminecom
the raphael centerforintegrative orthodontics
the
raph
ael c
ente
r fo
rin
tegr
ativ
e or
thod
onti
cs
Learn about an important choice you need to make before starting braces
the raphael center for integrative education
the raphael center for integrative education
Ongoing Intro to Airway Orthodontics
April Biobloc Study Group
April Training Ortho-Postural Therapists w Roger Price
June MRC Myobrace Basic Series
August Airway Dentistry with Mark Cruz and company
October Advanced MFT with Sandy Coulson
October Less than Six with Kevin Boyd
(who else wants to play)
Mission to create a space for spreading the word about Airway and Orthotropic principles and practice
Orthodontics in the 21st Century
EstheticOrthodontics
AirwayOrthodontics
GeneticTooth-Focused
Dental PerfectionEsthetics Primary
Treating SymptomsAirway Ignorant
AdaptationMuscle-FocusedMedical Better
Esthetics SecondaryTreating Causes
Airway Conscious
The EndAnd
The Beginning
Incisor pulled away from noseNot ldquoundertorquedrdquo or ldquogummy smilerdquo
Hypothetical ClI OrthoMARA
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
OJ = 7mm
Starts Ortho
ldquoGreat Headgear
Effectrdquo
Class II Elastics
50
40
30
20mm
y J F M A M J J A S O N
boys
Start Non-x
Expansion UncrowdingFinished
Start Cl II elastics
OK thatrsquos
enough
Hypothetical Mouthbreather(Dr Mewrsquos Hamster Boy)
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Boy gets
hamster
MFT
Hypothetical BBO 7yoM
50
40
30
20
5 6 7 8 9 10 11 12 13 14 15
girlsboys
Initial
StartBB1
BB3
Night
bullLR 11-9yFbullMissing all 5s6s8s and upper 4sbullHad ortho to close diastemahellipbullInL = 39bullGP objects to deX plan equil
LR Tx Plan
1Preparation Hang Expanser2deX 3Training BB3 to advance mandible4Myofunctional Therapy5Orthopostural Training6Myobrace to hold7 Reevaluate for dental detailing
LR Spotty progress
50
40
30
20mm
y 313 4 5 6 7 8 9 10 11 12114
2 3
Expanser
Parents dragging30 turnsStart Adv
Rx deXGP
objects
After delays
Equil ersquosBB3
bullLR 12-3 yF (6mo in tx)bullInL = 37 (+2)bull ersquos equilibratedbull OJ =10bull Appliance OJ = 5bull Still accommodating to BB3
Is there a calculus for the Indicator Line
Treatment GoalsBased on Indicator Line
Incisor Goals
Type 1 Treatment Place U1 in ideal position
Biobloc Orthotropics Orthognathic Surgery Distraction Osteogenesis
Type 1 Ideal InCos line
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
YZ 9yo M
bullLost upper d-spacebullInL = 36(+4)bullOJ = 9mmbullLip entrapmentbullLip Incompetence
Y Z 9yo M
Y Z 9yo M9mm OJ
Y Z 9yo M
Treatment Options
1 Type 1 Reduce InL open lost space BB3 to advance mandible
2 Type 2 Open lost space Align
3 Type 4 Extract four premolars
YZ 9yoM
50
40
30
20mm
yM A M J J A S O N D J F M A
boys
Hang Expanser
Upper and Lower
Brackets Hang Retainer
BB3
Incisor Goals
Type 2 Treatment Develop arch just enough to uncrowd
Biobloc Myofunctional Ortho Myofunctional Therapy Crozat ALF Expansion Orthodontics
Type 2 Uncrowding
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
bullLip incompetencebullLip entrapmentbullHypermentalisbullMouthbreathing
Type 2 Uncrowding
12 month progress
12 month progress
12 month progress
After Treatment
Bent-wire6 monthsMyobrace12 months
Hey RaphaelWhat about that
profile
ZP 9-5yoM
i
After Expansion Phase
Incomplete profile improvement better breathing head posture and sleep
Incisor Goals
Type 3 Treatment Maintain UI
Functional Orthodontics Expansion Orthodontics Distalization Ortho or No Treatment
Type 3 Maintain
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Bimax retrusion
Successful dental result
Profile Unimproved
Incisor Goals
Type 4 Treatment RetractExtrude UI
Extraction Orthodontics Retraction Ortho Distalization Ortho
Type 4 Retraction
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Bimax retrusion
Successful dental result
Failed Profile Result
Changes of pharyngeal airway size and hyoid bone position following orthodontic treatment of
Class I bimaxillary protrusion
Qingzhu Wanga Peizeng Jiab Nina K Andersonc Lin Wangd Jiuxiang Line
Angle Orthodontist Vol 00 No 0 0000 (pre-publication 2012)
ldquothe dimension of the velopharynx glossopharynx and hypopharynx were decreased after maximal retraction of anterior teeth with extraction of four premolarshelliprdquo ldquoAny factors that can influence the posture and position of tongue and soft palate may displace them backward andencroach upon the pharynxrdquo
ldquothe more the incisors were retracted the more the pharyngeal airway was reducedrdquo
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Backed into a corner
bull
Moving teeth faster more efficientlyhellipin the wrong direction
Now that wersquove made smoking unacceptable
could we not do the same withbull Sugarbull Processed foodbull Cheap milk and meatbull Fast foodbull Pill popping for symptomatic reliefbull Looking for the cure instead of the causebull Surgery as a quick fixbull Thinking braces are a status symbol
Each industry thrives on the status quoConsumers must drive the change
NP 10yM
NP
Sisterrsquos non-x ortho
Shersquos happyhellipbut Irsquom not so
I make my pitch for BBO
The dilemma of progress
(I forgot the progress pictureshellip)
Dad sells prosthetic parts to orthopedic surgeons
I selling the case against my previous work they loved
It takes me 3 hours to sell the case
They fret until the BB3 goes in
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Connecting the dots
bull Adult SDB and OSA
bull Narrow jaws and faces
bull Soft tissue dysfunction
bull Early parafunctional habits ie open mouth posture
bull Environmental stressors
bull CPAP MARAUPPP SurgWherersquos the best
place to start treatment here
or here
1 Prevention 2 Undo the damage already done3 Establish good habits
When to start When damage from poor breathing is noticed and when bad habits are discovered
The strategies of Airway Orthodontics
Prevention
bull Remove ankyloglossiabull Promote breastfeedingbull Harden the dietbull Develop masticatory strengthbull Discourage oral habitsbull Promote whole-foods low sugar dietbull Reduce oropharyngeal obstructionbull Promote nasal breathing
Breathing retraining
bull Nasal rinsingbull Nasal clearingbull Decongesting
The goals of Airway Orthodontics
1 Breathing through the nose2 Lips together at rest3 Correct tongue position4 No facial muscles moving on swallowing5 Optimal forward facial development6 Class I occlusion7 Straight teeth8 Better stability long term
Myofunctional Trainers
Professors R Soulet and A Besombes
Dr Earl Bergeson
Dr Chris Farrell
The Multi ndash Family System
Orofacial MyofunctionalTherapy
Oral MyologyMyofunctional TherapyTongue Thrust Therapy
B Hockel 2012 Back
Undoing Bimaxillary Dysplasia
1 Maxillary deconstriction2 Maxillary advancement3 Maxillary impaction4 Mandibular advancement
1 Maxillary Expansion
Treatment for Bimaxillary Dysplasia
ALFCrozat
Bent Wire
HyraxHaas
Niti Exp BioBlocSchwartz
The Farrell BENT WIRE Systemtrade
Recommended Age Group 5-12 yrs
Arch Development in conjunction with the TRAINER Systemtrade
Dr John Mew
Establish Good Habits
1 Breathing through the nose2 Lips together at rest3 Correct tongue position4 No facial muscles moving on swallowing5 Stand and sit in balance6 Breath gently using the diaphragm7 Eat to nourish8 Sleep to rest
Ortho-Postural TrainingWorkshops
Breathing
Nutrition
Posture
Sleep
COPYRIGHTRoger L PriceOctober 2012
Posture Number
Forward head posturecan be a compensationfor a deficient airway
Sleep Screening and Hygiene
SQI = 10 SQI = 98
Integrative Healthcare
Function ProfessionalNasal clearing ENT Pulm MFT BreathingMuscle balance and tone MFT Myofunctional OrthoUndoing damage GP Pedo Ortho OMFSBreathing dynamics OPT MFT Breath PhysiologistPosture DC OPT PT OsteopathCranial balance OsteopathNutrition RDH Nutritionist Dietitian Sleep ENT Sleep Med DentNeurocognitive development Pedrsquon SLP Psych SpEd
The Interdisciplinary Center
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Now that I know
My personal missionTo create from what Irsquove
learned from the besta model for others to followhellipespecially the orthodontists
Myofunctional Orthodontics
Chris Farrell
John Flutter
German Ramierez
Damien OrsquoBrien
Myofunctional Research CoRancho Cucamonga
2008-2012
Oral Myology
Oral Myology Basic CourseJoy MoellerNYC 2011LA 2012
Oral Myology Levels 2 3Kim BenkertClifton 2012
Habit CessationShari GreenClifton 2013
Biobloc Orthotropics
BBO Mini-residencyBill Hang
Agora Hills2012-13
BBO IntensiveDrs John and Mike
MewLSFO2013
Breathing and Sleep
Buteyko MentorshipThe Breathing Center
Woodstock2010
Breathing Well ProgrammeJohn Flutter
2010 Ortho-Postural TrainingRoger Price
2013
Sleep DentistryMichael Gelb etal
NYU2012
ALF and Cranial
Jim Bronson2013 Tasha Turzo
Cranial Academy2014
Bucket Listbull ALF and Crozat (Bronsonrsquos course)bullMore on Biobloc (Hangrsquos Advanced London School)bull More Cranial (The Farm)bullChirodontics (Bob Walker)bull Airway Dentistry with Marc Cruz Jeff Rousebull Sleep Dentistrybull Less-than-Six with Kevin Boydbull Intra-mandibular Distraction Osteogenesis (IMDO)
Off My ListAnything that moves the teeth faster in the wrong direction
Whatrsquos an RO to do
To create from what Irsquove learned from the best
a model for others to followhellipespecially orthodontists
Teaching
Mt Sinai Pedo ResidencyAli Attaie
2010-2012
Montefiore Ortho ResidencyTony Maganzini
2012
2009-Present
Mt Sinai School of MedicinePedodontic Residency
Guest SpeakersJim BronsonMike MewKevin BoydSandra KahnJennifer TowRoger PricePaula Fabbie
Damien OrsquoBrien
First clinical program in myofunctional orthodontics
Airway and Facial DevelopmentCollaborative Webcast
Mark Cruz
AAPMD Symposium
wwwaapm
dorg
Annual MeetingApril 25-26 2014
Westin Chicago North Shore
the raphael center for integrative orthodontics
wwwalignminecomwwwbioblocnjcom
wwwmyobracenjcom
Integrative vs Conventional
Integrative vs Conventional
ldquoWith improvements in expansion orthodontics advances in myofunctional orthodontics and the growing recognition about sleep disordered breathing among children and adults it is time for orthodontics to expand its horizons There is now so much more we can oerrdquo
The Raphael name has been associated with high quality orthodontics in New Jersey for over 60 years Dr Barry Raphael has been a university trained orthodontic specialist and a member of the American Association of Orthodontists for 30 years
He has a wide range of techniques and services to offer He has studied oral myology applied kinesiology Buteyko breathing Biobloc Orthotropics and Myobrace as part of his integrative training He can offer Damon Invisalign Insignia and Incognito appliances designs as some of his many conventional orthodontic services too
Dr Raphael teaches his techniques at post-graduate residencies study clubs dental societies and for the Myofunctional Research Co He is available for presentations to any group interested in learning more about the benefits of integrative orthodontics
wwwalignminecomLearn about the choices you have in orthodontics
dr barry raphael Why its
too Early never
1425
bro
ad
str
ee
tc
lifto
n n
j 070
13
973-
778-
4222
fax
973-
778-
9625
nj s
pe
c
368
4
1425 broad street clifton nj 07013973-778-4222
wwwalignminecom
the raphael centerforintegrative orthodontics
the
raph
ael c
ente
r fo
rin
tegr
ativ
e or
thod
onti
cs
Learn about an important choice you need to make before starting braces
the raphael center for integrative education
the raphael center for integrative education
Ongoing Intro to Airway Orthodontics
April Biobloc Study Group
April Training Ortho-Postural Therapists w Roger Price
June MRC Myobrace Basic Series
August Airway Dentistry with Mark Cruz and company
October Advanced MFT with Sandy Coulson
October Less than Six with Kevin Boyd
(who else wants to play)
Mission to create a space for spreading the word about Airway and Orthotropic principles and practice
Orthodontics in the 21st Century
EstheticOrthodontics
AirwayOrthodontics
GeneticTooth-Focused
Dental PerfectionEsthetics Primary
Treating SymptomsAirway Ignorant
AdaptationMuscle-FocusedMedical Better
Esthetics SecondaryTreating Causes
Airway Conscious
The EndAnd
The Beginning
Hypothetical ClI OrthoMARA
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
OJ = 7mm
Starts Ortho
ldquoGreat Headgear
Effectrdquo
Class II Elastics
50
40
30
20mm
y J F M A M J J A S O N
boys
Start Non-x
Expansion UncrowdingFinished
Start Cl II elastics
OK thatrsquos
enough
Hypothetical Mouthbreather(Dr Mewrsquos Hamster Boy)
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Boy gets
hamster
MFT
Hypothetical BBO 7yoM
50
40
30
20
5 6 7 8 9 10 11 12 13 14 15
girlsboys
Initial
StartBB1
BB3
Night
bullLR 11-9yFbullMissing all 5s6s8s and upper 4sbullHad ortho to close diastemahellipbullInL = 39bullGP objects to deX plan equil
LR Tx Plan
1Preparation Hang Expanser2deX 3Training BB3 to advance mandible4Myofunctional Therapy5Orthopostural Training6Myobrace to hold7 Reevaluate for dental detailing
LR Spotty progress
50
40
30
20mm
y 313 4 5 6 7 8 9 10 11 12114
2 3
Expanser
Parents dragging30 turnsStart Adv
Rx deXGP
objects
After delays
Equil ersquosBB3
bullLR 12-3 yF (6mo in tx)bullInL = 37 (+2)bull ersquos equilibratedbull OJ =10bull Appliance OJ = 5bull Still accommodating to BB3
Is there a calculus for the Indicator Line
Treatment GoalsBased on Indicator Line
Incisor Goals
Type 1 Treatment Place U1 in ideal position
Biobloc Orthotropics Orthognathic Surgery Distraction Osteogenesis
Type 1 Ideal InCos line
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
YZ 9yo M
bullLost upper d-spacebullInL = 36(+4)bullOJ = 9mmbullLip entrapmentbullLip Incompetence
Y Z 9yo M
Y Z 9yo M9mm OJ
Y Z 9yo M
Treatment Options
1 Type 1 Reduce InL open lost space BB3 to advance mandible
2 Type 2 Open lost space Align
3 Type 4 Extract four premolars
YZ 9yoM
50
40
30
20mm
yM A M J J A S O N D J F M A
boys
Hang Expanser
Upper and Lower
Brackets Hang Retainer
BB3
Incisor Goals
Type 2 Treatment Develop arch just enough to uncrowd
Biobloc Myofunctional Ortho Myofunctional Therapy Crozat ALF Expansion Orthodontics
Type 2 Uncrowding
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
bullLip incompetencebullLip entrapmentbullHypermentalisbullMouthbreathing
Type 2 Uncrowding
12 month progress
12 month progress
12 month progress
After Treatment
Bent-wire6 monthsMyobrace12 months
Hey RaphaelWhat about that
profile
ZP 9-5yoM
i
After Expansion Phase
Incomplete profile improvement better breathing head posture and sleep
Incisor Goals
Type 3 Treatment Maintain UI
Functional Orthodontics Expansion Orthodontics Distalization Ortho or No Treatment
Type 3 Maintain
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Bimax retrusion
Successful dental result
Profile Unimproved
Incisor Goals
Type 4 Treatment RetractExtrude UI
Extraction Orthodontics Retraction Ortho Distalization Ortho
Type 4 Retraction
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Bimax retrusion
Successful dental result
Failed Profile Result
Changes of pharyngeal airway size and hyoid bone position following orthodontic treatment of
Class I bimaxillary protrusion
Qingzhu Wanga Peizeng Jiab Nina K Andersonc Lin Wangd Jiuxiang Line
Angle Orthodontist Vol 00 No 0 0000 (pre-publication 2012)
ldquothe dimension of the velopharynx glossopharynx and hypopharynx were decreased after maximal retraction of anterior teeth with extraction of four premolarshelliprdquo ldquoAny factors that can influence the posture and position of tongue and soft palate may displace them backward andencroach upon the pharynxrdquo
ldquothe more the incisors were retracted the more the pharyngeal airway was reducedrdquo
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Backed into a corner
bull
Moving teeth faster more efficientlyhellipin the wrong direction
Now that wersquove made smoking unacceptable
could we not do the same withbull Sugarbull Processed foodbull Cheap milk and meatbull Fast foodbull Pill popping for symptomatic reliefbull Looking for the cure instead of the causebull Surgery as a quick fixbull Thinking braces are a status symbol
Each industry thrives on the status quoConsumers must drive the change
NP 10yM
NP
Sisterrsquos non-x ortho
Shersquos happyhellipbut Irsquom not so
I make my pitch for BBO
The dilemma of progress
(I forgot the progress pictureshellip)
Dad sells prosthetic parts to orthopedic surgeons
I selling the case against my previous work they loved
It takes me 3 hours to sell the case
They fret until the BB3 goes in
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Connecting the dots
bull Adult SDB and OSA
bull Narrow jaws and faces
bull Soft tissue dysfunction
bull Early parafunctional habits ie open mouth posture
bull Environmental stressors
bull CPAP MARAUPPP SurgWherersquos the best
place to start treatment here
or here
1 Prevention 2 Undo the damage already done3 Establish good habits
When to start When damage from poor breathing is noticed and when bad habits are discovered
The strategies of Airway Orthodontics
Prevention
bull Remove ankyloglossiabull Promote breastfeedingbull Harden the dietbull Develop masticatory strengthbull Discourage oral habitsbull Promote whole-foods low sugar dietbull Reduce oropharyngeal obstructionbull Promote nasal breathing
Breathing retraining
bull Nasal rinsingbull Nasal clearingbull Decongesting
The goals of Airway Orthodontics
1 Breathing through the nose2 Lips together at rest3 Correct tongue position4 No facial muscles moving on swallowing5 Optimal forward facial development6 Class I occlusion7 Straight teeth8 Better stability long term
Myofunctional Trainers
Professors R Soulet and A Besombes
Dr Earl Bergeson
Dr Chris Farrell
The Multi ndash Family System
Orofacial MyofunctionalTherapy
Oral MyologyMyofunctional TherapyTongue Thrust Therapy
B Hockel 2012 Back
Undoing Bimaxillary Dysplasia
1 Maxillary deconstriction2 Maxillary advancement3 Maxillary impaction4 Mandibular advancement
1 Maxillary Expansion
Treatment for Bimaxillary Dysplasia
ALFCrozat
Bent Wire
HyraxHaas
Niti Exp BioBlocSchwartz
The Farrell BENT WIRE Systemtrade
Recommended Age Group 5-12 yrs
Arch Development in conjunction with the TRAINER Systemtrade
Dr John Mew
Establish Good Habits
1 Breathing through the nose2 Lips together at rest3 Correct tongue position4 No facial muscles moving on swallowing5 Stand and sit in balance6 Breath gently using the diaphragm7 Eat to nourish8 Sleep to rest
Ortho-Postural TrainingWorkshops
Breathing
Nutrition
Posture
Sleep
COPYRIGHTRoger L PriceOctober 2012
Posture Number
Forward head posturecan be a compensationfor a deficient airway
Sleep Screening and Hygiene
SQI = 10 SQI = 98
Integrative Healthcare
Function ProfessionalNasal clearing ENT Pulm MFT BreathingMuscle balance and tone MFT Myofunctional OrthoUndoing damage GP Pedo Ortho OMFSBreathing dynamics OPT MFT Breath PhysiologistPosture DC OPT PT OsteopathCranial balance OsteopathNutrition RDH Nutritionist Dietitian Sleep ENT Sleep Med DentNeurocognitive development Pedrsquon SLP Psych SpEd
The Interdisciplinary Center
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Now that I know
My personal missionTo create from what Irsquove
learned from the besta model for others to followhellipespecially the orthodontists
Myofunctional Orthodontics
Chris Farrell
John Flutter
German Ramierez
Damien OrsquoBrien
Myofunctional Research CoRancho Cucamonga
2008-2012
Oral Myology
Oral Myology Basic CourseJoy MoellerNYC 2011LA 2012
Oral Myology Levels 2 3Kim BenkertClifton 2012
Habit CessationShari GreenClifton 2013
Biobloc Orthotropics
BBO Mini-residencyBill Hang
Agora Hills2012-13
BBO IntensiveDrs John and Mike
MewLSFO2013
Breathing and Sleep
Buteyko MentorshipThe Breathing Center
Woodstock2010
Breathing Well ProgrammeJohn Flutter
2010 Ortho-Postural TrainingRoger Price
2013
Sleep DentistryMichael Gelb etal
NYU2012
ALF and Cranial
Jim Bronson2013 Tasha Turzo
Cranial Academy2014
Bucket Listbull ALF and Crozat (Bronsonrsquos course)bullMore on Biobloc (Hangrsquos Advanced London School)bull More Cranial (The Farm)bullChirodontics (Bob Walker)bull Airway Dentistry with Marc Cruz Jeff Rousebull Sleep Dentistrybull Less-than-Six with Kevin Boydbull Intra-mandibular Distraction Osteogenesis (IMDO)
Off My ListAnything that moves the teeth faster in the wrong direction
Whatrsquos an RO to do
To create from what Irsquove learned from the best
a model for others to followhellipespecially orthodontists
Teaching
Mt Sinai Pedo ResidencyAli Attaie
2010-2012
Montefiore Ortho ResidencyTony Maganzini
2012
2009-Present
Mt Sinai School of MedicinePedodontic Residency
Guest SpeakersJim BronsonMike MewKevin BoydSandra KahnJennifer TowRoger PricePaula Fabbie
Damien OrsquoBrien
First clinical program in myofunctional orthodontics
Airway and Facial DevelopmentCollaborative Webcast
Mark Cruz
AAPMD Symposium
wwwaapm
dorg
Annual MeetingApril 25-26 2014
Westin Chicago North Shore
the raphael center for integrative orthodontics
wwwalignminecomwwwbioblocnjcom
wwwmyobracenjcom
Integrative vs Conventional
Integrative vs Conventional
ldquoWith improvements in expansion orthodontics advances in myofunctional orthodontics and the growing recognition about sleep disordered breathing among children and adults it is time for orthodontics to expand its horizons There is now so much more we can oerrdquo
The Raphael name has been associated with high quality orthodontics in New Jersey for over 60 years Dr Barry Raphael has been a university trained orthodontic specialist and a member of the American Association of Orthodontists for 30 years
He has a wide range of techniques and services to offer He has studied oral myology applied kinesiology Buteyko breathing Biobloc Orthotropics and Myobrace as part of his integrative training He can offer Damon Invisalign Insignia and Incognito appliances designs as some of his many conventional orthodontic services too
Dr Raphael teaches his techniques at post-graduate residencies study clubs dental societies and for the Myofunctional Research Co He is available for presentations to any group interested in learning more about the benefits of integrative orthodontics
wwwalignminecomLearn about the choices you have in orthodontics
dr barry raphael Why its
too Early never
1425
bro
ad
str
ee
tc
lifto
n n
j 070
13
973-
778-
4222
fax
973-
778-
9625
nj s
pe
c
368
4
1425 broad street clifton nj 07013973-778-4222
wwwalignminecom
the raphael centerforintegrative orthodontics
the
raph
ael c
ente
r fo
rin
tegr
ativ
e or
thod
onti
cs
Learn about an important choice you need to make before starting braces
the raphael center for integrative education
the raphael center for integrative education
Ongoing Intro to Airway Orthodontics
April Biobloc Study Group
April Training Ortho-Postural Therapists w Roger Price
June MRC Myobrace Basic Series
August Airway Dentistry with Mark Cruz and company
October Advanced MFT with Sandy Coulson
October Less than Six with Kevin Boyd
(who else wants to play)
Mission to create a space for spreading the word about Airway and Orthotropic principles and practice
Orthodontics in the 21st Century
EstheticOrthodontics
AirwayOrthodontics
GeneticTooth-Focused
Dental PerfectionEsthetics Primary
Treating SymptomsAirway Ignorant
AdaptationMuscle-FocusedMedical Better
Esthetics SecondaryTreating Causes
Airway Conscious
The EndAnd
The Beginning
Class II Elastics
50
40
30
20mm
y J F M A M J J A S O N
boys
Start Non-x
Expansion UncrowdingFinished
Start Cl II elastics
OK thatrsquos
enough
Hypothetical Mouthbreather(Dr Mewrsquos Hamster Boy)
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Boy gets
hamster
MFT
Hypothetical BBO 7yoM
50
40
30
20
5 6 7 8 9 10 11 12 13 14 15
girlsboys
Initial
StartBB1
BB3
Night
bullLR 11-9yFbullMissing all 5s6s8s and upper 4sbullHad ortho to close diastemahellipbullInL = 39bullGP objects to deX plan equil
LR Tx Plan
1Preparation Hang Expanser2deX 3Training BB3 to advance mandible4Myofunctional Therapy5Orthopostural Training6Myobrace to hold7 Reevaluate for dental detailing
LR Spotty progress
50
40
30
20mm
y 313 4 5 6 7 8 9 10 11 12114
2 3
Expanser
Parents dragging30 turnsStart Adv
Rx deXGP
objects
After delays
Equil ersquosBB3
bullLR 12-3 yF (6mo in tx)bullInL = 37 (+2)bull ersquos equilibratedbull OJ =10bull Appliance OJ = 5bull Still accommodating to BB3
Is there a calculus for the Indicator Line
Treatment GoalsBased on Indicator Line
Incisor Goals
Type 1 Treatment Place U1 in ideal position
Biobloc Orthotropics Orthognathic Surgery Distraction Osteogenesis
Type 1 Ideal InCos line
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
YZ 9yo M
bullLost upper d-spacebullInL = 36(+4)bullOJ = 9mmbullLip entrapmentbullLip Incompetence
Y Z 9yo M
Y Z 9yo M9mm OJ
Y Z 9yo M
Treatment Options
1 Type 1 Reduce InL open lost space BB3 to advance mandible
2 Type 2 Open lost space Align
3 Type 4 Extract four premolars
YZ 9yoM
50
40
30
20mm
yM A M J J A S O N D J F M A
boys
Hang Expanser
Upper and Lower
Brackets Hang Retainer
BB3
Incisor Goals
Type 2 Treatment Develop arch just enough to uncrowd
Biobloc Myofunctional Ortho Myofunctional Therapy Crozat ALF Expansion Orthodontics
Type 2 Uncrowding
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
bullLip incompetencebullLip entrapmentbullHypermentalisbullMouthbreathing
Type 2 Uncrowding
12 month progress
12 month progress
12 month progress
After Treatment
Bent-wire6 monthsMyobrace12 months
Hey RaphaelWhat about that
profile
ZP 9-5yoM
i
After Expansion Phase
Incomplete profile improvement better breathing head posture and sleep
Incisor Goals
Type 3 Treatment Maintain UI
Functional Orthodontics Expansion Orthodontics Distalization Ortho or No Treatment
Type 3 Maintain
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Bimax retrusion
Successful dental result
Profile Unimproved
Incisor Goals
Type 4 Treatment RetractExtrude UI
Extraction Orthodontics Retraction Ortho Distalization Ortho
Type 4 Retraction
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Bimax retrusion
Successful dental result
Failed Profile Result
Changes of pharyngeal airway size and hyoid bone position following orthodontic treatment of
Class I bimaxillary protrusion
Qingzhu Wanga Peizeng Jiab Nina K Andersonc Lin Wangd Jiuxiang Line
Angle Orthodontist Vol 00 No 0 0000 (pre-publication 2012)
ldquothe dimension of the velopharynx glossopharynx and hypopharynx were decreased after maximal retraction of anterior teeth with extraction of four premolarshelliprdquo ldquoAny factors that can influence the posture and position of tongue and soft palate may displace them backward andencroach upon the pharynxrdquo
ldquothe more the incisors were retracted the more the pharyngeal airway was reducedrdquo
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Backed into a corner
bull
Moving teeth faster more efficientlyhellipin the wrong direction
Now that wersquove made smoking unacceptable
could we not do the same withbull Sugarbull Processed foodbull Cheap milk and meatbull Fast foodbull Pill popping for symptomatic reliefbull Looking for the cure instead of the causebull Surgery as a quick fixbull Thinking braces are a status symbol
Each industry thrives on the status quoConsumers must drive the change
NP 10yM
NP
Sisterrsquos non-x ortho
Shersquos happyhellipbut Irsquom not so
I make my pitch for BBO
The dilemma of progress
(I forgot the progress pictureshellip)
Dad sells prosthetic parts to orthopedic surgeons
I selling the case against my previous work they loved
It takes me 3 hours to sell the case
They fret until the BB3 goes in
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Connecting the dots
bull Adult SDB and OSA
bull Narrow jaws and faces
bull Soft tissue dysfunction
bull Early parafunctional habits ie open mouth posture
bull Environmental stressors
bull CPAP MARAUPPP SurgWherersquos the best
place to start treatment here
or here
1 Prevention 2 Undo the damage already done3 Establish good habits
When to start When damage from poor breathing is noticed and when bad habits are discovered
The strategies of Airway Orthodontics
Prevention
bull Remove ankyloglossiabull Promote breastfeedingbull Harden the dietbull Develop masticatory strengthbull Discourage oral habitsbull Promote whole-foods low sugar dietbull Reduce oropharyngeal obstructionbull Promote nasal breathing
Breathing retraining
bull Nasal rinsingbull Nasal clearingbull Decongesting
The goals of Airway Orthodontics
1 Breathing through the nose2 Lips together at rest3 Correct tongue position4 No facial muscles moving on swallowing5 Optimal forward facial development6 Class I occlusion7 Straight teeth8 Better stability long term
Myofunctional Trainers
Professors R Soulet and A Besombes
Dr Earl Bergeson
Dr Chris Farrell
The Multi ndash Family System
Orofacial MyofunctionalTherapy
Oral MyologyMyofunctional TherapyTongue Thrust Therapy
B Hockel 2012 Back
Undoing Bimaxillary Dysplasia
1 Maxillary deconstriction2 Maxillary advancement3 Maxillary impaction4 Mandibular advancement
1 Maxillary Expansion
Treatment for Bimaxillary Dysplasia
ALFCrozat
Bent Wire
HyraxHaas
Niti Exp BioBlocSchwartz
The Farrell BENT WIRE Systemtrade
Recommended Age Group 5-12 yrs
Arch Development in conjunction with the TRAINER Systemtrade
Dr John Mew
Establish Good Habits
1 Breathing through the nose2 Lips together at rest3 Correct tongue position4 No facial muscles moving on swallowing5 Stand and sit in balance6 Breath gently using the diaphragm7 Eat to nourish8 Sleep to rest
Ortho-Postural TrainingWorkshops
Breathing
Nutrition
Posture
Sleep
COPYRIGHTRoger L PriceOctober 2012
Posture Number
Forward head posturecan be a compensationfor a deficient airway
Sleep Screening and Hygiene
SQI = 10 SQI = 98
Integrative Healthcare
Function ProfessionalNasal clearing ENT Pulm MFT BreathingMuscle balance and tone MFT Myofunctional OrthoUndoing damage GP Pedo Ortho OMFSBreathing dynamics OPT MFT Breath PhysiologistPosture DC OPT PT OsteopathCranial balance OsteopathNutrition RDH Nutritionist Dietitian Sleep ENT Sleep Med DentNeurocognitive development Pedrsquon SLP Psych SpEd
The Interdisciplinary Center
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Now that I know
My personal missionTo create from what Irsquove
learned from the besta model for others to followhellipespecially the orthodontists
Myofunctional Orthodontics
Chris Farrell
John Flutter
German Ramierez
Damien OrsquoBrien
Myofunctional Research CoRancho Cucamonga
2008-2012
Oral Myology
Oral Myology Basic CourseJoy MoellerNYC 2011LA 2012
Oral Myology Levels 2 3Kim BenkertClifton 2012
Habit CessationShari GreenClifton 2013
Biobloc Orthotropics
BBO Mini-residencyBill Hang
Agora Hills2012-13
BBO IntensiveDrs John and Mike
MewLSFO2013
Breathing and Sleep
Buteyko MentorshipThe Breathing Center
Woodstock2010
Breathing Well ProgrammeJohn Flutter
2010 Ortho-Postural TrainingRoger Price
2013
Sleep DentistryMichael Gelb etal
NYU2012
ALF and Cranial
Jim Bronson2013 Tasha Turzo
Cranial Academy2014
Bucket Listbull ALF and Crozat (Bronsonrsquos course)bullMore on Biobloc (Hangrsquos Advanced London School)bull More Cranial (The Farm)bullChirodontics (Bob Walker)bull Airway Dentistry with Marc Cruz Jeff Rousebull Sleep Dentistrybull Less-than-Six with Kevin Boydbull Intra-mandibular Distraction Osteogenesis (IMDO)
Off My ListAnything that moves the teeth faster in the wrong direction
Whatrsquos an RO to do
To create from what Irsquove learned from the best
a model for others to followhellipespecially orthodontists
Teaching
Mt Sinai Pedo ResidencyAli Attaie
2010-2012
Montefiore Ortho ResidencyTony Maganzini
2012
2009-Present
Mt Sinai School of MedicinePedodontic Residency
Guest SpeakersJim BronsonMike MewKevin BoydSandra KahnJennifer TowRoger PricePaula Fabbie
Damien OrsquoBrien
First clinical program in myofunctional orthodontics
Airway and Facial DevelopmentCollaborative Webcast
Mark Cruz
AAPMD Symposium
wwwaapm
dorg
Annual MeetingApril 25-26 2014
Westin Chicago North Shore
the raphael center for integrative orthodontics
wwwalignminecomwwwbioblocnjcom
wwwmyobracenjcom
Integrative vs Conventional
Integrative vs Conventional
ldquoWith improvements in expansion orthodontics advances in myofunctional orthodontics and the growing recognition about sleep disordered breathing among children and adults it is time for orthodontics to expand its horizons There is now so much more we can oerrdquo
The Raphael name has been associated with high quality orthodontics in New Jersey for over 60 years Dr Barry Raphael has been a university trained orthodontic specialist and a member of the American Association of Orthodontists for 30 years
He has a wide range of techniques and services to offer He has studied oral myology applied kinesiology Buteyko breathing Biobloc Orthotropics and Myobrace as part of his integrative training He can offer Damon Invisalign Insignia and Incognito appliances designs as some of his many conventional orthodontic services too
Dr Raphael teaches his techniques at post-graduate residencies study clubs dental societies and for the Myofunctional Research Co He is available for presentations to any group interested in learning more about the benefits of integrative orthodontics
wwwalignminecomLearn about the choices you have in orthodontics
dr barry raphael Why its
too Early never
1425
bro
ad
str
ee
tc
lifto
n n
j 070
13
973-
778-
4222
fax
973-
778-
9625
nj s
pe
c
368
4
1425 broad street clifton nj 07013973-778-4222
wwwalignminecom
the raphael centerforintegrative orthodontics
the
raph
ael c
ente
r fo
rin
tegr
ativ
e or
thod
onti
cs
Learn about an important choice you need to make before starting braces
the raphael center for integrative education
the raphael center for integrative education
Ongoing Intro to Airway Orthodontics
April Biobloc Study Group
April Training Ortho-Postural Therapists w Roger Price
June MRC Myobrace Basic Series
August Airway Dentistry with Mark Cruz and company
October Advanced MFT with Sandy Coulson
October Less than Six with Kevin Boyd
(who else wants to play)
Mission to create a space for spreading the word about Airway and Orthotropic principles and practice
Orthodontics in the 21st Century
EstheticOrthodontics
AirwayOrthodontics
GeneticTooth-Focused
Dental PerfectionEsthetics Primary
Treating SymptomsAirway Ignorant
AdaptationMuscle-FocusedMedical Better
Esthetics SecondaryTreating Causes
Airway Conscious
The EndAnd
The Beginning
Hypothetical Mouthbreather(Dr Mewrsquos Hamster Boy)
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Boy gets
hamster
MFT
Hypothetical BBO 7yoM
50
40
30
20
5 6 7 8 9 10 11 12 13 14 15
girlsboys
Initial
StartBB1
BB3
Night
bullLR 11-9yFbullMissing all 5s6s8s and upper 4sbullHad ortho to close diastemahellipbullInL = 39bullGP objects to deX plan equil
LR Tx Plan
1Preparation Hang Expanser2deX 3Training BB3 to advance mandible4Myofunctional Therapy5Orthopostural Training6Myobrace to hold7 Reevaluate for dental detailing
LR Spotty progress
50
40
30
20mm
y 313 4 5 6 7 8 9 10 11 12114
2 3
Expanser
Parents dragging30 turnsStart Adv
Rx deXGP
objects
After delays
Equil ersquosBB3
bullLR 12-3 yF (6mo in tx)bullInL = 37 (+2)bull ersquos equilibratedbull OJ =10bull Appliance OJ = 5bull Still accommodating to BB3
Is there a calculus for the Indicator Line
Treatment GoalsBased on Indicator Line
Incisor Goals
Type 1 Treatment Place U1 in ideal position
Biobloc Orthotropics Orthognathic Surgery Distraction Osteogenesis
Type 1 Ideal InCos line
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
YZ 9yo M
bullLost upper d-spacebullInL = 36(+4)bullOJ = 9mmbullLip entrapmentbullLip Incompetence
Y Z 9yo M
Y Z 9yo M9mm OJ
Y Z 9yo M
Treatment Options
1 Type 1 Reduce InL open lost space BB3 to advance mandible
2 Type 2 Open lost space Align
3 Type 4 Extract four premolars
YZ 9yoM
50
40
30
20mm
yM A M J J A S O N D J F M A
boys
Hang Expanser
Upper and Lower
Brackets Hang Retainer
BB3
Incisor Goals
Type 2 Treatment Develop arch just enough to uncrowd
Biobloc Myofunctional Ortho Myofunctional Therapy Crozat ALF Expansion Orthodontics
Type 2 Uncrowding
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
bullLip incompetencebullLip entrapmentbullHypermentalisbullMouthbreathing
Type 2 Uncrowding
12 month progress
12 month progress
12 month progress
After Treatment
Bent-wire6 monthsMyobrace12 months
Hey RaphaelWhat about that
profile
ZP 9-5yoM
i
After Expansion Phase
Incomplete profile improvement better breathing head posture and sleep
Incisor Goals
Type 3 Treatment Maintain UI
Functional Orthodontics Expansion Orthodontics Distalization Ortho or No Treatment
Type 3 Maintain
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Bimax retrusion
Successful dental result
Profile Unimproved
Incisor Goals
Type 4 Treatment RetractExtrude UI
Extraction Orthodontics Retraction Ortho Distalization Ortho
Type 4 Retraction
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Bimax retrusion
Successful dental result
Failed Profile Result
Changes of pharyngeal airway size and hyoid bone position following orthodontic treatment of
Class I bimaxillary protrusion
Qingzhu Wanga Peizeng Jiab Nina K Andersonc Lin Wangd Jiuxiang Line
Angle Orthodontist Vol 00 No 0 0000 (pre-publication 2012)
ldquothe dimension of the velopharynx glossopharynx and hypopharynx were decreased after maximal retraction of anterior teeth with extraction of four premolarshelliprdquo ldquoAny factors that can influence the posture and position of tongue and soft palate may displace them backward andencroach upon the pharynxrdquo
ldquothe more the incisors were retracted the more the pharyngeal airway was reducedrdquo
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Backed into a corner
bull
Moving teeth faster more efficientlyhellipin the wrong direction
Now that wersquove made smoking unacceptable
could we not do the same withbull Sugarbull Processed foodbull Cheap milk and meatbull Fast foodbull Pill popping for symptomatic reliefbull Looking for the cure instead of the causebull Surgery as a quick fixbull Thinking braces are a status symbol
Each industry thrives on the status quoConsumers must drive the change
NP 10yM
NP
Sisterrsquos non-x ortho
Shersquos happyhellipbut Irsquom not so
I make my pitch for BBO
The dilemma of progress
(I forgot the progress pictureshellip)
Dad sells prosthetic parts to orthopedic surgeons
I selling the case against my previous work they loved
It takes me 3 hours to sell the case
They fret until the BB3 goes in
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Connecting the dots
bull Adult SDB and OSA
bull Narrow jaws and faces
bull Soft tissue dysfunction
bull Early parafunctional habits ie open mouth posture
bull Environmental stressors
bull CPAP MARAUPPP SurgWherersquos the best
place to start treatment here
or here
1 Prevention 2 Undo the damage already done3 Establish good habits
When to start When damage from poor breathing is noticed and when bad habits are discovered
The strategies of Airway Orthodontics
Prevention
bull Remove ankyloglossiabull Promote breastfeedingbull Harden the dietbull Develop masticatory strengthbull Discourage oral habitsbull Promote whole-foods low sugar dietbull Reduce oropharyngeal obstructionbull Promote nasal breathing
Breathing retraining
bull Nasal rinsingbull Nasal clearingbull Decongesting
The goals of Airway Orthodontics
1 Breathing through the nose2 Lips together at rest3 Correct tongue position4 No facial muscles moving on swallowing5 Optimal forward facial development6 Class I occlusion7 Straight teeth8 Better stability long term
Myofunctional Trainers
Professors R Soulet and A Besombes
Dr Earl Bergeson
Dr Chris Farrell
The Multi ndash Family System
Orofacial MyofunctionalTherapy
Oral MyologyMyofunctional TherapyTongue Thrust Therapy
B Hockel 2012 Back
Undoing Bimaxillary Dysplasia
1 Maxillary deconstriction2 Maxillary advancement3 Maxillary impaction4 Mandibular advancement
1 Maxillary Expansion
Treatment for Bimaxillary Dysplasia
ALFCrozat
Bent Wire
HyraxHaas
Niti Exp BioBlocSchwartz
The Farrell BENT WIRE Systemtrade
Recommended Age Group 5-12 yrs
Arch Development in conjunction with the TRAINER Systemtrade
Dr John Mew
Establish Good Habits
1 Breathing through the nose2 Lips together at rest3 Correct tongue position4 No facial muscles moving on swallowing5 Stand and sit in balance6 Breath gently using the diaphragm7 Eat to nourish8 Sleep to rest
Ortho-Postural TrainingWorkshops
Breathing
Nutrition
Posture
Sleep
COPYRIGHTRoger L PriceOctober 2012
Posture Number
Forward head posturecan be a compensationfor a deficient airway
Sleep Screening and Hygiene
SQI = 10 SQI = 98
Integrative Healthcare
Function ProfessionalNasal clearing ENT Pulm MFT BreathingMuscle balance and tone MFT Myofunctional OrthoUndoing damage GP Pedo Ortho OMFSBreathing dynamics OPT MFT Breath PhysiologistPosture DC OPT PT OsteopathCranial balance OsteopathNutrition RDH Nutritionist Dietitian Sleep ENT Sleep Med DentNeurocognitive development Pedrsquon SLP Psych SpEd
The Interdisciplinary Center
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Now that I know
My personal missionTo create from what Irsquove
learned from the besta model for others to followhellipespecially the orthodontists
Myofunctional Orthodontics
Chris Farrell
John Flutter
German Ramierez
Damien OrsquoBrien
Myofunctional Research CoRancho Cucamonga
2008-2012
Oral Myology
Oral Myology Basic CourseJoy MoellerNYC 2011LA 2012
Oral Myology Levels 2 3Kim BenkertClifton 2012
Habit CessationShari GreenClifton 2013
Biobloc Orthotropics
BBO Mini-residencyBill Hang
Agora Hills2012-13
BBO IntensiveDrs John and Mike
MewLSFO2013
Breathing and Sleep
Buteyko MentorshipThe Breathing Center
Woodstock2010
Breathing Well ProgrammeJohn Flutter
2010 Ortho-Postural TrainingRoger Price
2013
Sleep DentistryMichael Gelb etal
NYU2012
ALF and Cranial
Jim Bronson2013 Tasha Turzo
Cranial Academy2014
Bucket Listbull ALF and Crozat (Bronsonrsquos course)bullMore on Biobloc (Hangrsquos Advanced London School)bull More Cranial (The Farm)bullChirodontics (Bob Walker)bull Airway Dentistry with Marc Cruz Jeff Rousebull Sleep Dentistrybull Less-than-Six with Kevin Boydbull Intra-mandibular Distraction Osteogenesis (IMDO)
Off My ListAnything that moves the teeth faster in the wrong direction
Whatrsquos an RO to do
To create from what Irsquove learned from the best
a model for others to followhellipespecially orthodontists
Teaching
Mt Sinai Pedo ResidencyAli Attaie
2010-2012
Montefiore Ortho ResidencyTony Maganzini
2012
2009-Present
Mt Sinai School of MedicinePedodontic Residency
Guest SpeakersJim BronsonMike MewKevin BoydSandra KahnJennifer TowRoger PricePaula Fabbie
Damien OrsquoBrien
First clinical program in myofunctional orthodontics
Airway and Facial DevelopmentCollaborative Webcast
Mark Cruz
AAPMD Symposium
wwwaapm
dorg
Annual MeetingApril 25-26 2014
Westin Chicago North Shore
the raphael center for integrative orthodontics
wwwalignminecomwwwbioblocnjcom
wwwmyobracenjcom
Integrative vs Conventional
Integrative vs Conventional
ldquoWith improvements in expansion orthodontics advances in myofunctional orthodontics and the growing recognition about sleep disordered breathing among children and adults it is time for orthodontics to expand its horizons There is now so much more we can oerrdquo
The Raphael name has been associated with high quality orthodontics in New Jersey for over 60 years Dr Barry Raphael has been a university trained orthodontic specialist and a member of the American Association of Orthodontists for 30 years
He has a wide range of techniques and services to offer He has studied oral myology applied kinesiology Buteyko breathing Biobloc Orthotropics and Myobrace as part of his integrative training He can offer Damon Invisalign Insignia and Incognito appliances designs as some of his many conventional orthodontic services too
Dr Raphael teaches his techniques at post-graduate residencies study clubs dental societies and for the Myofunctional Research Co He is available for presentations to any group interested in learning more about the benefits of integrative orthodontics
wwwalignminecomLearn about the choices you have in orthodontics
dr barry raphael Why its
too Early never
1425
bro
ad
str
ee
tc
lifto
n n
j 070
13
973-
778-
4222
fax
973-
778-
9625
nj s
pe
c
368
4
1425 broad street clifton nj 07013973-778-4222
wwwalignminecom
the raphael centerforintegrative orthodontics
the
raph
ael c
ente
r fo
rin
tegr
ativ
e or
thod
onti
cs
Learn about an important choice you need to make before starting braces
the raphael center for integrative education
the raphael center for integrative education
Ongoing Intro to Airway Orthodontics
April Biobloc Study Group
April Training Ortho-Postural Therapists w Roger Price
June MRC Myobrace Basic Series
August Airway Dentistry with Mark Cruz and company
October Advanced MFT with Sandy Coulson
October Less than Six with Kevin Boyd
(who else wants to play)
Mission to create a space for spreading the word about Airway and Orthotropic principles and practice
Orthodontics in the 21st Century
EstheticOrthodontics
AirwayOrthodontics
GeneticTooth-Focused
Dental PerfectionEsthetics Primary
Treating SymptomsAirway Ignorant
AdaptationMuscle-FocusedMedical Better
Esthetics SecondaryTreating Causes
Airway Conscious
The EndAnd
The Beginning
Hypothetical BBO 7yoM
50
40
30
20
5 6 7 8 9 10 11 12 13 14 15
girlsboys
Initial
StartBB1
BB3
Night
bullLR 11-9yFbullMissing all 5s6s8s and upper 4sbullHad ortho to close diastemahellipbullInL = 39bullGP objects to deX plan equil
LR Tx Plan
1Preparation Hang Expanser2deX 3Training BB3 to advance mandible4Myofunctional Therapy5Orthopostural Training6Myobrace to hold7 Reevaluate for dental detailing
LR Spotty progress
50
40
30
20mm
y 313 4 5 6 7 8 9 10 11 12114
2 3
Expanser
Parents dragging30 turnsStart Adv
Rx deXGP
objects
After delays
Equil ersquosBB3
bullLR 12-3 yF (6mo in tx)bullInL = 37 (+2)bull ersquos equilibratedbull OJ =10bull Appliance OJ = 5bull Still accommodating to BB3
Is there a calculus for the Indicator Line
Treatment GoalsBased on Indicator Line
Incisor Goals
Type 1 Treatment Place U1 in ideal position
Biobloc Orthotropics Orthognathic Surgery Distraction Osteogenesis
Type 1 Ideal InCos line
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
YZ 9yo M
bullLost upper d-spacebullInL = 36(+4)bullOJ = 9mmbullLip entrapmentbullLip Incompetence
Y Z 9yo M
Y Z 9yo M9mm OJ
Y Z 9yo M
Treatment Options
1 Type 1 Reduce InL open lost space BB3 to advance mandible
2 Type 2 Open lost space Align
3 Type 4 Extract four premolars
YZ 9yoM
50
40
30
20mm
yM A M J J A S O N D J F M A
boys
Hang Expanser
Upper and Lower
Brackets Hang Retainer
BB3
Incisor Goals
Type 2 Treatment Develop arch just enough to uncrowd
Biobloc Myofunctional Ortho Myofunctional Therapy Crozat ALF Expansion Orthodontics
Type 2 Uncrowding
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
bullLip incompetencebullLip entrapmentbullHypermentalisbullMouthbreathing
Type 2 Uncrowding
12 month progress
12 month progress
12 month progress
After Treatment
Bent-wire6 monthsMyobrace12 months
Hey RaphaelWhat about that
profile
ZP 9-5yoM
i
After Expansion Phase
Incomplete profile improvement better breathing head posture and sleep
Incisor Goals
Type 3 Treatment Maintain UI
Functional Orthodontics Expansion Orthodontics Distalization Ortho or No Treatment
Type 3 Maintain
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Bimax retrusion
Successful dental result
Profile Unimproved
Incisor Goals
Type 4 Treatment RetractExtrude UI
Extraction Orthodontics Retraction Ortho Distalization Ortho
Type 4 Retraction
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Bimax retrusion
Successful dental result
Failed Profile Result
Changes of pharyngeal airway size and hyoid bone position following orthodontic treatment of
Class I bimaxillary protrusion
Qingzhu Wanga Peizeng Jiab Nina K Andersonc Lin Wangd Jiuxiang Line
Angle Orthodontist Vol 00 No 0 0000 (pre-publication 2012)
ldquothe dimension of the velopharynx glossopharynx and hypopharynx were decreased after maximal retraction of anterior teeth with extraction of four premolarshelliprdquo ldquoAny factors that can influence the posture and position of tongue and soft palate may displace them backward andencroach upon the pharynxrdquo
ldquothe more the incisors were retracted the more the pharyngeal airway was reducedrdquo
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Backed into a corner
bull
Moving teeth faster more efficientlyhellipin the wrong direction
Now that wersquove made smoking unacceptable
could we not do the same withbull Sugarbull Processed foodbull Cheap milk and meatbull Fast foodbull Pill popping for symptomatic reliefbull Looking for the cure instead of the causebull Surgery as a quick fixbull Thinking braces are a status symbol
Each industry thrives on the status quoConsumers must drive the change
NP 10yM
NP
Sisterrsquos non-x ortho
Shersquos happyhellipbut Irsquom not so
I make my pitch for BBO
The dilemma of progress
(I forgot the progress pictureshellip)
Dad sells prosthetic parts to orthopedic surgeons
I selling the case against my previous work they loved
It takes me 3 hours to sell the case
They fret until the BB3 goes in
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Connecting the dots
bull Adult SDB and OSA
bull Narrow jaws and faces
bull Soft tissue dysfunction
bull Early parafunctional habits ie open mouth posture
bull Environmental stressors
bull CPAP MARAUPPP SurgWherersquos the best
place to start treatment here
or here
1 Prevention 2 Undo the damage already done3 Establish good habits
When to start When damage from poor breathing is noticed and when bad habits are discovered
The strategies of Airway Orthodontics
Prevention
bull Remove ankyloglossiabull Promote breastfeedingbull Harden the dietbull Develop masticatory strengthbull Discourage oral habitsbull Promote whole-foods low sugar dietbull Reduce oropharyngeal obstructionbull Promote nasal breathing
Breathing retraining
bull Nasal rinsingbull Nasal clearingbull Decongesting
The goals of Airway Orthodontics
1 Breathing through the nose2 Lips together at rest3 Correct tongue position4 No facial muscles moving on swallowing5 Optimal forward facial development6 Class I occlusion7 Straight teeth8 Better stability long term
Myofunctional Trainers
Professors R Soulet and A Besombes
Dr Earl Bergeson
Dr Chris Farrell
The Multi ndash Family System
Orofacial MyofunctionalTherapy
Oral MyologyMyofunctional TherapyTongue Thrust Therapy
B Hockel 2012 Back
Undoing Bimaxillary Dysplasia
1 Maxillary deconstriction2 Maxillary advancement3 Maxillary impaction4 Mandibular advancement
1 Maxillary Expansion
Treatment for Bimaxillary Dysplasia
ALFCrozat
Bent Wire
HyraxHaas
Niti Exp BioBlocSchwartz
The Farrell BENT WIRE Systemtrade
Recommended Age Group 5-12 yrs
Arch Development in conjunction with the TRAINER Systemtrade
Dr John Mew
Establish Good Habits
1 Breathing through the nose2 Lips together at rest3 Correct tongue position4 No facial muscles moving on swallowing5 Stand and sit in balance6 Breath gently using the diaphragm7 Eat to nourish8 Sleep to rest
Ortho-Postural TrainingWorkshops
Breathing
Nutrition
Posture
Sleep
COPYRIGHTRoger L PriceOctober 2012
Posture Number
Forward head posturecan be a compensationfor a deficient airway
Sleep Screening and Hygiene
SQI = 10 SQI = 98
Integrative Healthcare
Function ProfessionalNasal clearing ENT Pulm MFT BreathingMuscle balance and tone MFT Myofunctional OrthoUndoing damage GP Pedo Ortho OMFSBreathing dynamics OPT MFT Breath PhysiologistPosture DC OPT PT OsteopathCranial balance OsteopathNutrition RDH Nutritionist Dietitian Sleep ENT Sleep Med DentNeurocognitive development Pedrsquon SLP Psych SpEd
The Interdisciplinary Center
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Now that I know
My personal missionTo create from what Irsquove
learned from the besta model for others to followhellipespecially the orthodontists
Myofunctional Orthodontics
Chris Farrell
John Flutter
German Ramierez
Damien OrsquoBrien
Myofunctional Research CoRancho Cucamonga
2008-2012
Oral Myology
Oral Myology Basic CourseJoy MoellerNYC 2011LA 2012
Oral Myology Levels 2 3Kim BenkertClifton 2012
Habit CessationShari GreenClifton 2013
Biobloc Orthotropics
BBO Mini-residencyBill Hang
Agora Hills2012-13
BBO IntensiveDrs John and Mike
MewLSFO2013
Breathing and Sleep
Buteyko MentorshipThe Breathing Center
Woodstock2010
Breathing Well ProgrammeJohn Flutter
2010 Ortho-Postural TrainingRoger Price
2013
Sleep DentistryMichael Gelb etal
NYU2012
ALF and Cranial
Jim Bronson2013 Tasha Turzo
Cranial Academy2014
Bucket Listbull ALF and Crozat (Bronsonrsquos course)bullMore on Biobloc (Hangrsquos Advanced London School)bull More Cranial (The Farm)bullChirodontics (Bob Walker)bull Airway Dentistry with Marc Cruz Jeff Rousebull Sleep Dentistrybull Less-than-Six with Kevin Boydbull Intra-mandibular Distraction Osteogenesis (IMDO)
Off My ListAnything that moves the teeth faster in the wrong direction
Whatrsquos an RO to do
To create from what Irsquove learned from the best
a model for others to followhellipespecially orthodontists
Teaching
Mt Sinai Pedo ResidencyAli Attaie
2010-2012
Montefiore Ortho ResidencyTony Maganzini
2012
2009-Present
Mt Sinai School of MedicinePedodontic Residency
Guest SpeakersJim BronsonMike MewKevin BoydSandra KahnJennifer TowRoger PricePaula Fabbie
Damien OrsquoBrien
First clinical program in myofunctional orthodontics
Airway and Facial DevelopmentCollaborative Webcast
Mark Cruz
AAPMD Symposium
wwwaapm
dorg
Annual MeetingApril 25-26 2014
Westin Chicago North Shore
the raphael center for integrative orthodontics
wwwalignminecomwwwbioblocnjcom
wwwmyobracenjcom
Integrative vs Conventional
Integrative vs Conventional
ldquoWith improvements in expansion orthodontics advances in myofunctional orthodontics and the growing recognition about sleep disordered breathing among children and adults it is time for orthodontics to expand its horizons There is now so much more we can oerrdquo
The Raphael name has been associated with high quality orthodontics in New Jersey for over 60 years Dr Barry Raphael has been a university trained orthodontic specialist and a member of the American Association of Orthodontists for 30 years
He has a wide range of techniques and services to offer He has studied oral myology applied kinesiology Buteyko breathing Biobloc Orthotropics and Myobrace as part of his integrative training He can offer Damon Invisalign Insignia and Incognito appliances designs as some of his many conventional orthodontic services too
Dr Raphael teaches his techniques at post-graduate residencies study clubs dental societies and for the Myofunctional Research Co He is available for presentations to any group interested in learning more about the benefits of integrative orthodontics
wwwalignminecomLearn about the choices you have in orthodontics
dr barry raphael Why its
too Early never
1425
bro
ad
str
ee
tc
lifto
n n
j 070
13
973-
778-
4222
fax
973-
778-
9625
nj s
pe
c
368
4
1425 broad street clifton nj 07013973-778-4222
wwwalignminecom
the raphael centerforintegrative orthodontics
the
raph
ael c
ente
r fo
rin
tegr
ativ
e or
thod
onti
cs
Learn about an important choice you need to make before starting braces
the raphael center for integrative education
the raphael center for integrative education
Ongoing Intro to Airway Orthodontics
April Biobloc Study Group
April Training Ortho-Postural Therapists w Roger Price
June MRC Myobrace Basic Series
August Airway Dentistry with Mark Cruz and company
October Advanced MFT with Sandy Coulson
October Less than Six with Kevin Boyd
(who else wants to play)
Mission to create a space for spreading the word about Airway and Orthotropic principles and practice
Orthodontics in the 21st Century
EstheticOrthodontics
AirwayOrthodontics
GeneticTooth-Focused
Dental PerfectionEsthetics Primary
Treating SymptomsAirway Ignorant
AdaptationMuscle-FocusedMedical Better
Esthetics SecondaryTreating Causes
Airway Conscious
The EndAnd
The Beginning
bullLR 11-9yFbullMissing all 5s6s8s and upper 4sbullHad ortho to close diastemahellipbullInL = 39bullGP objects to deX plan equil
LR Tx Plan
1Preparation Hang Expanser2deX 3Training BB3 to advance mandible4Myofunctional Therapy5Orthopostural Training6Myobrace to hold7 Reevaluate for dental detailing
LR Spotty progress
50
40
30
20mm
y 313 4 5 6 7 8 9 10 11 12114
2 3
Expanser
Parents dragging30 turnsStart Adv
Rx deXGP
objects
After delays
Equil ersquosBB3
bullLR 12-3 yF (6mo in tx)bullInL = 37 (+2)bull ersquos equilibratedbull OJ =10bull Appliance OJ = 5bull Still accommodating to BB3
Is there a calculus for the Indicator Line
Treatment GoalsBased on Indicator Line
Incisor Goals
Type 1 Treatment Place U1 in ideal position
Biobloc Orthotropics Orthognathic Surgery Distraction Osteogenesis
Type 1 Ideal InCos line
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
YZ 9yo M
bullLost upper d-spacebullInL = 36(+4)bullOJ = 9mmbullLip entrapmentbullLip Incompetence
Y Z 9yo M
Y Z 9yo M9mm OJ
Y Z 9yo M
Treatment Options
1 Type 1 Reduce InL open lost space BB3 to advance mandible
2 Type 2 Open lost space Align
3 Type 4 Extract four premolars
YZ 9yoM
50
40
30
20mm
yM A M J J A S O N D J F M A
boys
Hang Expanser
Upper and Lower
Brackets Hang Retainer
BB3
Incisor Goals
Type 2 Treatment Develop arch just enough to uncrowd
Biobloc Myofunctional Ortho Myofunctional Therapy Crozat ALF Expansion Orthodontics
Type 2 Uncrowding
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
bullLip incompetencebullLip entrapmentbullHypermentalisbullMouthbreathing
Type 2 Uncrowding
12 month progress
12 month progress
12 month progress
After Treatment
Bent-wire6 monthsMyobrace12 months
Hey RaphaelWhat about that
profile
ZP 9-5yoM
i
After Expansion Phase
Incomplete profile improvement better breathing head posture and sleep
Incisor Goals
Type 3 Treatment Maintain UI
Functional Orthodontics Expansion Orthodontics Distalization Ortho or No Treatment
Type 3 Maintain
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Bimax retrusion
Successful dental result
Profile Unimproved
Incisor Goals
Type 4 Treatment RetractExtrude UI
Extraction Orthodontics Retraction Ortho Distalization Ortho
Type 4 Retraction
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Bimax retrusion
Successful dental result
Failed Profile Result
Changes of pharyngeal airway size and hyoid bone position following orthodontic treatment of
Class I bimaxillary protrusion
Qingzhu Wanga Peizeng Jiab Nina K Andersonc Lin Wangd Jiuxiang Line
Angle Orthodontist Vol 00 No 0 0000 (pre-publication 2012)
ldquothe dimension of the velopharynx glossopharynx and hypopharynx were decreased after maximal retraction of anterior teeth with extraction of four premolarshelliprdquo ldquoAny factors that can influence the posture and position of tongue and soft palate may displace them backward andencroach upon the pharynxrdquo
ldquothe more the incisors were retracted the more the pharyngeal airway was reducedrdquo
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Backed into a corner
bull
Moving teeth faster more efficientlyhellipin the wrong direction
Now that wersquove made smoking unacceptable
could we not do the same withbull Sugarbull Processed foodbull Cheap milk and meatbull Fast foodbull Pill popping for symptomatic reliefbull Looking for the cure instead of the causebull Surgery as a quick fixbull Thinking braces are a status symbol
Each industry thrives on the status quoConsumers must drive the change
NP 10yM
NP
Sisterrsquos non-x ortho
Shersquos happyhellipbut Irsquom not so
I make my pitch for BBO
The dilemma of progress
(I forgot the progress pictureshellip)
Dad sells prosthetic parts to orthopedic surgeons
I selling the case against my previous work they loved
It takes me 3 hours to sell the case
They fret until the BB3 goes in
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Connecting the dots
bull Adult SDB and OSA
bull Narrow jaws and faces
bull Soft tissue dysfunction
bull Early parafunctional habits ie open mouth posture
bull Environmental stressors
bull CPAP MARAUPPP SurgWherersquos the best
place to start treatment here
or here
1 Prevention 2 Undo the damage already done3 Establish good habits
When to start When damage from poor breathing is noticed and when bad habits are discovered
The strategies of Airway Orthodontics
Prevention
bull Remove ankyloglossiabull Promote breastfeedingbull Harden the dietbull Develop masticatory strengthbull Discourage oral habitsbull Promote whole-foods low sugar dietbull Reduce oropharyngeal obstructionbull Promote nasal breathing
Breathing retraining
bull Nasal rinsingbull Nasal clearingbull Decongesting
The goals of Airway Orthodontics
1 Breathing through the nose2 Lips together at rest3 Correct tongue position4 No facial muscles moving on swallowing5 Optimal forward facial development6 Class I occlusion7 Straight teeth8 Better stability long term
Myofunctional Trainers
Professors R Soulet and A Besombes
Dr Earl Bergeson
Dr Chris Farrell
The Multi ndash Family System
Orofacial MyofunctionalTherapy
Oral MyologyMyofunctional TherapyTongue Thrust Therapy
B Hockel 2012 Back
Undoing Bimaxillary Dysplasia
1 Maxillary deconstriction2 Maxillary advancement3 Maxillary impaction4 Mandibular advancement
1 Maxillary Expansion
Treatment for Bimaxillary Dysplasia
ALFCrozat
Bent Wire
HyraxHaas
Niti Exp BioBlocSchwartz
The Farrell BENT WIRE Systemtrade
Recommended Age Group 5-12 yrs
Arch Development in conjunction with the TRAINER Systemtrade
Dr John Mew
Establish Good Habits
1 Breathing through the nose2 Lips together at rest3 Correct tongue position4 No facial muscles moving on swallowing5 Stand and sit in balance6 Breath gently using the diaphragm7 Eat to nourish8 Sleep to rest
Ortho-Postural TrainingWorkshops
Breathing
Nutrition
Posture
Sleep
COPYRIGHTRoger L PriceOctober 2012
Posture Number
Forward head posturecan be a compensationfor a deficient airway
Sleep Screening and Hygiene
SQI = 10 SQI = 98
Integrative Healthcare
Function ProfessionalNasal clearing ENT Pulm MFT BreathingMuscle balance and tone MFT Myofunctional OrthoUndoing damage GP Pedo Ortho OMFSBreathing dynamics OPT MFT Breath PhysiologistPosture DC OPT PT OsteopathCranial balance OsteopathNutrition RDH Nutritionist Dietitian Sleep ENT Sleep Med DentNeurocognitive development Pedrsquon SLP Psych SpEd
The Interdisciplinary Center
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Now that I know
My personal missionTo create from what Irsquove
learned from the besta model for others to followhellipespecially the orthodontists
Myofunctional Orthodontics
Chris Farrell
John Flutter
German Ramierez
Damien OrsquoBrien
Myofunctional Research CoRancho Cucamonga
2008-2012
Oral Myology
Oral Myology Basic CourseJoy MoellerNYC 2011LA 2012
Oral Myology Levels 2 3Kim BenkertClifton 2012
Habit CessationShari GreenClifton 2013
Biobloc Orthotropics
BBO Mini-residencyBill Hang
Agora Hills2012-13
BBO IntensiveDrs John and Mike
MewLSFO2013
Breathing and Sleep
Buteyko MentorshipThe Breathing Center
Woodstock2010
Breathing Well ProgrammeJohn Flutter
2010 Ortho-Postural TrainingRoger Price
2013
Sleep DentistryMichael Gelb etal
NYU2012
ALF and Cranial
Jim Bronson2013 Tasha Turzo
Cranial Academy2014
Bucket Listbull ALF and Crozat (Bronsonrsquos course)bullMore on Biobloc (Hangrsquos Advanced London School)bull More Cranial (The Farm)bullChirodontics (Bob Walker)bull Airway Dentistry with Marc Cruz Jeff Rousebull Sleep Dentistrybull Less-than-Six with Kevin Boydbull Intra-mandibular Distraction Osteogenesis (IMDO)
Off My ListAnything that moves the teeth faster in the wrong direction
Whatrsquos an RO to do
To create from what Irsquove learned from the best
a model for others to followhellipespecially orthodontists
Teaching
Mt Sinai Pedo ResidencyAli Attaie
2010-2012
Montefiore Ortho ResidencyTony Maganzini
2012
2009-Present
Mt Sinai School of MedicinePedodontic Residency
Guest SpeakersJim BronsonMike MewKevin BoydSandra KahnJennifer TowRoger PricePaula Fabbie
Damien OrsquoBrien
First clinical program in myofunctional orthodontics
Airway and Facial DevelopmentCollaborative Webcast
Mark Cruz
AAPMD Symposium
wwwaapm
dorg
Annual MeetingApril 25-26 2014
Westin Chicago North Shore
the raphael center for integrative orthodontics
wwwalignminecomwwwbioblocnjcom
wwwmyobracenjcom
Integrative vs Conventional
Integrative vs Conventional
ldquoWith improvements in expansion orthodontics advances in myofunctional orthodontics and the growing recognition about sleep disordered breathing among children and adults it is time for orthodontics to expand its horizons There is now so much more we can oerrdquo
The Raphael name has been associated with high quality orthodontics in New Jersey for over 60 years Dr Barry Raphael has been a university trained orthodontic specialist and a member of the American Association of Orthodontists for 30 years
He has a wide range of techniques and services to offer He has studied oral myology applied kinesiology Buteyko breathing Biobloc Orthotropics and Myobrace as part of his integrative training He can offer Damon Invisalign Insignia and Incognito appliances designs as some of his many conventional orthodontic services too
Dr Raphael teaches his techniques at post-graduate residencies study clubs dental societies and for the Myofunctional Research Co He is available for presentations to any group interested in learning more about the benefits of integrative orthodontics
wwwalignminecomLearn about the choices you have in orthodontics
dr barry raphael Why its
too Early never
1425
bro
ad
str
ee
tc
lifto
n n
j 070
13
973-
778-
4222
fax
973-
778-
9625
nj s
pe
c
368
4
1425 broad street clifton nj 07013973-778-4222
wwwalignminecom
the raphael centerforintegrative orthodontics
the
raph
ael c
ente
r fo
rin
tegr
ativ
e or
thod
onti
cs
Learn about an important choice you need to make before starting braces
the raphael center for integrative education
the raphael center for integrative education
Ongoing Intro to Airway Orthodontics
April Biobloc Study Group
April Training Ortho-Postural Therapists w Roger Price
June MRC Myobrace Basic Series
August Airway Dentistry with Mark Cruz and company
October Advanced MFT with Sandy Coulson
October Less than Six with Kevin Boyd
(who else wants to play)
Mission to create a space for spreading the word about Airway and Orthotropic principles and practice
Orthodontics in the 21st Century
EstheticOrthodontics
AirwayOrthodontics
GeneticTooth-Focused
Dental PerfectionEsthetics Primary
Treating SymptomsAirway Ignorant
AdaptationMuscle-FocusedMedical Better
Esthetics SecondaryTreating Causes
Airway Conscious
The EndAnd
The Beginning
LR Tx Plan
1Preparation Hang Expanser2deX 3Training BB3 to advance mandible4Myofunctional Therapy5Orthopostural Training6Myobrace to hold7 Reevaluate for dental detailing
LR Spotty progress
50
40
30
20mm
y 313 4 5 6 7 8 9 10 11 12114
2 3
Expanser
Parents dragging30 turnsStart Adv
Rx deXGP
objects
After delays
Equil ersquosBB3
bullLR 12-3 yF (6mo in tx)bullInL = 37 (+2)bull ersquos equilibratedbull OJ =10bull Appliance OJ = 5bull Still accommodating to BB3
Is there a calculus for the Indicator Line
Treatment GoalsBased on Indicator Line
Incisor Goals
Type 1 Treatment Place U1 in ideal position
Biobloc Orthotropics Orthognathic Surgery Distraction Osteogenesis
Type 1 Ideal InCos line
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
YZ 9yo M
bullLost upper d-spacebullInL = 36(+4)bullOJ = 9mmbullLip entrapmentbullLip Incompetence
Y Z 9yo M
Y Z 9yo M9mm OJ
Y Z 9yo M
Treatment Options
1 Type 1 Reduce InL open lost space BB3 to advance mandible
2 Type 2 Open lost space Align
3 Type 4 Extract four premolars
YZ 9yoM
50
40
30
20mm
yM A M J J A S O N D J F M A
boys
Hang Expanser
Upper and Lower
Brackets Hang Retainer
BB3
Incisor Goals
Type 2 Treatment Develop arch just enough to uncrowd
Biobloc Myofunctional Ortho Myofunctional Therapy Crozat ALF Expansion Orthodontics
Type 2 Uncrowding
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
bullLip incompetencebullLip entrapmentbullHypermentalisbullMouthbreathing
Type 2 Uncrowding
12 month progress
12 month progress
12 month progress
After Treatment
Bent-wire6 monthsMyobrace12 months
Hey RaphaelWhat about that
profile
ZP 9-5yoM
i
After Expansion Phase
Incomplete profile improvement better breathing head posture and sleep
Incisor Goals
Type 3 Treatment Maintain UI
Functional Orthodontics Expansion Orthodontics Distalization Ortho or No Treatment
Type 3 Maintain
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Bimax retrusion
Successful dental result
Profile Unimproved
Incisor Goals
Type 4 Treatment RetractExtrude UI
Extraction Orthodontics Retraction Ortho Distalization Ortho
Type 4 Retraction
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Bimax retrusion
Successful dental result
Failed Profile Result
Changes of pharyngeal airway size and hyoid bone position following orthodontic treatment of
Class I bimaxillary protrusion
Qingzhu Wanga Peizeng Jiab Nina K Andersonc Lin Wangd Jiuxiang Line
Angle Orthodontist Vol 00 No 0 0000 (pre-publication 2012)
ldquothe dimension of the velopharynx glossopharynx and hypopharynx were decreased after maximal retraction of anterior teeth with extraction of four premolarshelliprdquo ldquoAny factors that can influence the posture and position of tongue and soft palate may displace them backward andencroach upon the pharynxrdquo
ldquothe more the incisors were retracted the more the pharyngeal airway was reducedrdquo
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Backed into a corner
bull
Moving teeth faster more efficientlyhellipin the wrong direction
Now that wersquove made smoking unacceptable
could we not do the same withbull Sugarbull Processed foodbull Cheap milk and meatbull Fast foodbull Pill popping for symptomatic reliefbull Looking for the cure instead of the causebull Surgery as a quick fixbull Thinking braces are a status symbol
Each industry thrives on the status quoConsumers must drive the change
NP 10yM
NP
Sisterrsquos non-x ortho
Shersquos happyhellipbut Irsquom not so
I make my pitch for BBO
The dilemma of progress
(I forgot the progress pictureshellip)
Dad sells prosthetic parts to orthopedic surgeons
I selling the case against my previous work they loved
It takes me 3 hours to sell the case
They fret until the BB3 goes in
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Connecting the dots
bull Adult SDB and OSA
bull Narrow jaws and faces
bull Soft tissue dysfunction
bull Early parafunctional habits ie open mouth posture
bull Environmental stressors
bull CPAP MARAUPPP SurgWherersquos the best
place to start treatment here
or here
1 Prevention 2 Undo the damage already done3 Establish good habits
When to start When damage from poor breathing is noticed and when bad habits are discovered
The strategies of Airway Orthodontics
Prevention
bull Remove ankyloglossiabull Promote breastfeedingbull Harden the dietbull Develop masticatory strengthbull Discourage oral habitsbull Promote whole-foods low sugar dietbull Reduce oropharyngeal obstructionbull Promote nasal breathing
Breathing retraining
bull Nasal rinsingbull Nasal clearingbull Decongesting
The goals of Airway Orthodontics
1 Breathing through the nose2 Lips together at rest3 Correct tongue position4 No facial muscles moving on swallowing5 Optimal forward facial development6 Class I occlusion7 Straight teeth8 Better stability long term
Myofunctional Trainers
Professors R Soulet and A Besombes
Dr Earl Bergeson
Dr Chris Farrell
The Multi ndash Family System
Orofacial MyofunctionalTherapy
Oral MyologyMyofunctional TherapyTongue Thrust Therapy
B Hockel 2012 Back
Undoing Bimaxillary Dysplasia
1 Maxillary deconstriction2 Maxillary advancement3 Maxillary impaction4 Mandibular advancement
1 Maxillary Expansion
Treatment for Bimaxillary Dysplasia
ALFCrozat
Bent Wire
HyraxHaas
Niti Exp BioBlocSchwartz
The Farrell BENT WIRE Systemtrade
Recommended Age Group 5-12 yrs
Arch Development in conjunction with the TRAINER Systemtrade
Dr John Mew
Establish Good Habits
1 Breathing through the nose2 Lips together at rest3 Correct tongue position4 No facial muscles moving on swallowing5 Stand and sit in balance6 Breath gently using the diaphragm7 Eat to nourish8 Sleep to rest
Ortho-Postural TrainingWorkshops
Breathing
Nutrition
Posture
Sleep
COPYRIGHTRoger L PriceOctober 2012
Posture Number
Forward head posturecan be a compensationfor a deficient airway
Sleep Screening and Hygiene
SQI = 10 SQI = 98
Integrative Healthcare
Function ProfessionalNasal clearing ENT Pulm MFT BreathingMuscle balance and tone MFT Myofunctional OrthoUndoing damage GP Pedo Ortho OMFSBreathing dynamics OPT MFT Breath PhysiologistPosture DC OPT PT OsteopathCranial balance OsteopathNutrition RDH Nutritionist Dietitian Sleep ENT Sleep Med DentNeurocognitive development Pedrsquon SLP Psych SpEd
The Interdisciplinary Center
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Now that I know
My personal missionTo create from what Irsquove
learned from the besta model for others to followhellipespecially the orthodontists
Myofunctional Orthodontics
Chris Farrell
John Flutter
German Ramierez
Damien OrsquoBrien
Myofunctional Research CoRancho Cucamonga
2008-2012
Oral Myology
Oral Myology Basic CourseJoy MoellerNYC 2011LA 2012
Oral Myology Levels 2 3Kim BenkertClifton 2012
Habit CessationShari GreenClifton 2013
Biobloc Orthotropics
BBO Mini-residencyBill Hang
Agora Hills2012-13
BBO IntensiveDrs John and Mike
MewLSFO2013
Breathing and Sleep
Buteyko MentorshipThe Breathing Center
Woodstock2010
Breathing Well ProgrammeJohn Flutter
2010 Ortho-Postural TrainingRoger Price
2013
Sleep DentistryMichael Gelb etal
NYU2012
ALF and Cranial
Jim Bronson2013 Tasha Turzo
Cranial Academy2014
Bucket Listbull ALF and Crozat (Bronsonrsquos course)bullMore on Biobloc (Hangrsquos Advanced London School)bull More Cranial (The Farm)bullChirodontics (Bob Walker)bull Airway Dentistry with Marc Cruz Jeff Rousebull Sleep Dentistrybull Less-than-Six with Kevin Boydbull Intra-mandibular Distraction Osteogenesis (IMDO)
Off My ListAnything that moves the teeth faster in the wrong direction
Whatrsquos an RO to do
To create from what Irsquove learned from the best
a model for others to followhellipespecially orthodontists
Teaching
Mt Sinai Pedo ResidencyAli Attaie
2010-2012
Montefiore Ortho ResidencyTony Maganzini
2012
2009-Present
Mt Sinai School of MedicinePedodontic Residency
Guest SpeakersJim BronsonMike MewKevin BoydSandra KahnJennifer TowRoger PricePaula Fabbie
Damien OrsquoBrien
First clinical program in myofunctional orthodontics
Airway and Facial DevelopmentCollaborative Webcast
Mark Cruz
AAPMD Symposium
wwwaapm
dorg
Annual MeetingApril 25-26 2014
Westin Chicago North Shore
the raphael center for integrative orthodontics
wwwalignminecomwwwbioblocnjcom
wwwmyobracenjcom
Integrative vs Conventional
Integrative vs Conventional
ldquoWith improvements in expansion orthodontics advances in myofunctional orthodontics and the growing recognition about sleep disordered breathing among children and adults it is time for orthodontics to expand its horizons There is now so much more we can oerrdquo
The Raphael name has been associated with high quality orthodontics in New Jersey for over 60 years Dr Barry Raphael has been a university trained orthodontic specialist and a member of the American Association of Orthodontists for 30 years
He has a wide range of techniques and services to offer He has studied oral myology applied kinesiology Buteyko breathing Biobloc Orthotropics and Myobrace as part of his integrative training He can offer Damon Invisalign Insignia and Incognito appliances designs as some of his many conventional orthodontic services too
Dr Raphael teaches his techniques at post-graduate residencies study clubs dental societies and for the Myofunctional Research Co He is available for presentations to any group interested in learning more about the benefits of integrative orthodontics
wwwalignminecomLearn about the choices you have in orthodontics
dr barry raphael Why its
too Early never
1425
bro
ad
str
ee
tc
lifto
n n
j 070
13
973-
778-
4222
fax
973-
778-
9625
nj s
pe
c
368
4
1425 broad street clifton nj 07013973-778-4222
wwwalignminecom
the raphael centerforintegrative orthodontics
the
raph
ael c
ente
r fo
rin
tegr
ativ
e or
thod
onti
cs
Learn about an important choice you need to make before starting braces
the raphael center for integrative education
the raphael center for integrative education
Ongoing Intro to Airway Orthodontics
April Biobloc Study Group
April Training Ortho-Postural Therapists w Roger Price
June MRC Myobrace Basic Series
August Airway Dentistry with Mark Cruz and company
October Advanced MFT with Sandy Coulson
October Less than Six with Kevin Boyd
(who else wants to play)
Mission to create a space for spreading the word about Airway and Orthotropic principles and practice
Orthodontics in the 21st Century
EstheticOrthodontics
AirwayOrthodontics
GeneticTooth-Focused
Dental PerfectionEsthetics Primary
Treating SymptomsAirway Ignorant
AdaptationMuscle-FocusedMedical Better
Esthetics SecondaryTreating Causes
Airway Conscious
The EndAnd
The Beginning
LR Spotty progress
50
40
30
20mm
y 313 4 5 6 7 8 9 10 11 12114
2 3
Expanser
Parents dragging30 turnsStart Adv
Rx deXGP
objects
After delays
Equil ersquosBB3
bullLR 12-3 yF (6mo in tx)bullInL = 37 (+2)bull ersquos equilibratedbull OJ =10bull Appliance OJ = 5bull Still accommodating to BB3
Is there a calculus for the Indicator Line
Treatment GoalsBased on Indicator Line
Incisor Goals
Type 1 Treatment Place U1 in ideal position
Biobloc Orthotropics Orthognathic Surgery Distraction Osteogenesis
Type 1 Ideal InCos line
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
YZ 9yo M
bullLost upper d-spacebullInL = 36(+4)bullOJ = 9mmbullLip entrapmentbullLip Incompetence
Y Z 9yo M
Y Z 9yo M9mm OJ
Y Z 9yo M
Treatment Options
1 Type 1 Reduce InL open lost space BB3 to advance mandible
2 Type 2 Open lost space Align
3 Type 4 Extract four premolars
YZ 9yoM
50
40
30
20mm
yM A M J J A S O N D J F M A
boys
Hang Expanser
Upper and Lower
Brackets Hang Retainer
BB3
Incisor Goals
Type 2 Treatment Develop arch just enough to uncrowd
Biobloc Myofunctional Ortho Myofunctional Therapy Crozat ALF Expansion Orthodontics
Type 2 Uncrowding
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
bullLip incompetencebullLip entrapmentbullHypermentalisbullMouthbreathing
Type 2 Uncrowding
12 month progress
12 month progress
12 month progress
After Treatment
Bent-wire6 monthsMyobrace12 months
Hey RaphaelWhat about that
profile
ZP 9-5yoM
i
After Expansion Phase
Incomplete profile improvement better breathing head posture and sleep
Incisor Goals
Type 3 Treatment Maintain UI
Functional Orthodontics Expansion Orthodontics Distalization Ortho or No Treatment
Type 3 Maintain
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Bimax retrusion
Successful dental result
Profile Unimproved
Incisor Goals
Type 4 Treatment RetractExtrude UI
Extraction Orthodontics Retraction Ortho Distalization Ortho
Type 4 Retraction
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Bimax retrusion
Successful dental result
Failed Profile Result
Changes of pharyngeal airway size and hyoid bone position following orthodontic treatment of
Class I bimaxillary protrusion
Qingzhu Wanga Peizeng Jiab Nina K Andersonc Lin Wangd Jiuxiang Line
Angle Orthodontist Vol 00 No 0 0000 (pre-publication 2012)
ldquothe dimension of the velopharynx glossopharynx and hypopharynx were decreased after maximal retraction of anterior teeth with extraction of four premolarshelliprdquo ldquoAny factors that can influence the posture and position of tongue and soft palate may displace them backward andencroach upon the pharynxrdquo
ldquothe more the incisors were retracted the more the pharyngeal airway was reducedrdquo
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Backed into a corner
bull
Moving teeth faster more efficientlyhellipin the wrong direction
Now that wersquove made smoking unacceptable
could we not do the same withbull Sugarbull Processed foodbull Cheap milk and meatbull Fast foodbull Pill popping for symptomatic reliefbull Looking for the cure instead of the causebull Surgery as a quick fixbull Thinking braces are a status symbol
Each industry thrives on the status quoConsumers must drive the change
NP 10yM
NP
Sisterrsquos non-x ortho
Shersquos happyhellipbut Irsquom not so
I make my pitch for BBO
The dilemma of progress
(I forgot the progress pictureshellip)
Dad sells prosthetic parts to orthopedic surgeons
I selling the case against my previous work they loved
It takes me 3 hours to sell the case
They fret until the BB3 goes in
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Connecting the dots
bull Adult SDB and OSA
bull Narrow jaws and faces
bull Soft tissue dysfunction
bull Early parafunctional habits ie open mouth posture
bull Environmental stressors
bull CPAP MARAUPPP SurgWherersquos the best
place to start treatment here
or here
1 Prevention 2 Undo the damage already done3 Establish good habits
When to start When damage from poor breathing is noticed and when bad habits are discovered
The strategies of Airway Orthodontics
Prevention
bull Remove ankyloglossiabull Promote breastfeedingbull Harden the dietbull Develop masticatory strengthbull Discourage oral habitsbull Promote whole-foods low sugar dietbull Reduce oropharyngeal obstructionbull Promote nasal breathing
Breathing retraining
bull Nasal rinsingbull Nasal clearingbull Decongesting
The goals of Airway Orthodontics
1 Breathing through the nose2 Lips together at rest3 Correct tongue position4 No facial muscles moving on swallowing5 Optimal forward facial development6 Class I occlusion7 Straight teeth8 Better stability long term
Myofunctional Trainers
Professors R Soulet and A Besombes
Dr Earl Bergeson
Dr Chris Farrell
The Multi ndash Family System
Orofacial MyofunctionalTherapy
Oral MyologyMyofunctional TherapyTongue Thrust Therapy
B Hockel 2012 Back
Undoing Bimaxillary Dysplasia
1 Maxillary deconstriction2 Maxillary advancement3 Maxillary impaction4 Mandibular advancement
1 Maxillary Expansion
Treatment for Bimaxillary Dysplasia
ALFCrozat
Bent Wire
HyraxHaas
Niti Exp BioBlocSchwartz
The Farrell BENT WIRE Systemtrade
Recommended Age Group 5-12 yrs
Arch Development in conjunction with the TRAINER Systemtrade
Dr John Mew
Establish Good Habits
1 Breathing through the nose2 Lips together at rest3 Correct tongue position4 No facial muscles moving on swallowing5 Stand and sit in balance6 Breath gently using the diaphragm7 Eat to nourish8 Sleep to rest
Ortho-Postural TrainingWorkshops
Breathing
Nutrition
Posture
Sleep
COPYRIGHTRoger L PriceOctober 2012
Posture Number
Forward head posturecan be a compensationfor a deficient airway
Sleep Screening and Hygiene
SQI = 10 SQI = 98
Integrative Healthcare
Function ProfessionalNasal clearing ENT Pulm MFT BreathingMuscle balance and tone MFT Myofunctional OrthoUndoing damage GP Pedo Ortho OMFSBreathing dynamics OPT MFT Breath PhysiologistPosture DC OPT PT OsteopathCranial balance OsteopathNutrition RDH Nutritionist Dietitian Sleep ENT Sleep Med DentNeurocognitive development Pedrsquon SLP Psych SpEd
The Interdisciplinary Center
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Now that I know
My personal missionTo create from what Irsquove
learned from the besta model for others to followhellipespecially the orthodontists
Myofunctional Orthodontics
Chris Farrell
John Flutter
German Ramierez
Damien OrsquoBrien
Myofunctional Research CoRancho Cucamonga
2008-2012
Oral Myology
Oral Myology Basic CourseJoy MoellerNYC 2011LA 2012
Oral Myology Levels 2 3Kim BenkertClifton 2012
Habit CessationShari GreenClifton 2013
Biobloc Orthotropics
BBO Mini-residencyBill Hang
Agora Hills2012-13
BBO IntensiveDrs John and Mike
MewLSFO2013
Breathing and Sleep
Buteyko MentorshipThe Breathing Center
Woodstock2010
Breathing Well ProgrammeJohn Flutter
2010 Ortho-Postural TrainingRoger Price
2013
Sleep DentistryMichael Gelb etal
NYU2012
ALF and Cranial
Jim Bronson2013 Tasha Turzo
Cranial Academy2014
Bucket Listbull ALF and Crozat (Bronsonrsquos course)bullMore on Biobloc (Hangrsquos Advanced London School)bull More Cranial (The Farm)bullChirodontics (Bob Walker)bull Airway Dentistry with Marc Cruz Jeff Rousebull Sleep Dentistrybull Less-than-Six with Kevin Boydbull Intra-mandibular Distraction Osteogenesis (IMDO)
Off My ListAnything that moves the teeth faster in the wrong direction
Whatrsquos an RO to do
To create from what Irsquove learned from the best
a model for others to followhellipespecially orthodontists
Teaching
Mt Sinai Pedo ResidencyAli Attaie
2010-2012
Montefiore Ortho ResidencyTony Maganzini
2012
2009-Present
Mt Sinai School of MedicinePedodontic Residency
Guest SpeakersJim BronsonMike MewKevin BoydSandra KahnJennifer TowRoger PricePaula Fabbie
Damien OrsquoBrien
First clinical program in myofunctional orthodontics
Airway and Facial DevelopmentCollaborative Webcast
Mark Cruz
AAPMD Symposium
wwwaapm
dorg
Annual MeetingApril 25-26 2014
Westin Chicago North Shore
the raphael center for integrative orthodontics
wwwalignminecomwwwbioblocnjcom
wwwmyobracenjcom
Integrative vs Conventional
Integrative vs Conventional
ldquoWith improvements in expansion orthodontics advances in myofunctional orthodontics and the growing recognition about sleep disordered breathing among children and adults it is time for orthodontics to expand its horizons There is now so much more we can oerrdquo
The Raphael name has been associated with high quality orthodontics in New Jersey for over 60 years Dr Barry Raphael has been a university trained orthodontic specialist and a member of the American Association of Orthodontists for 30 years
He has a wide range of techniques and services to offer He has studied oral myology applied kinesiology Buteyko breathing Biobloc Orthotropics and Myobrace as part of his integrative training He can offer Damon Invisalign Insignia and Incognito appliances designs as some of his many conventional orthodontic services too
Dr Raphael teaches his techniques at post-graduate residencies study clubs dental societies and for the Myofunctional Research Co He is available for presentations to any group interested in learning more about the benefits of integrative orthodontics
wwwalignminecomLearn about the choices you have in orthodontics
dr barry raphael Why its
too Early never
1425
bro
ad
str
ee
tc
lifto
n n
j 070
13
973-
778-
4222
fax
973-
778-
9625
nj s
pe
c
368
4
1425 broad street clifton nj 07013973-778-4222
wwwalignminecom
the raphael centerforintegrative orthodontics
the
raph
ael c
ente
r fo
rin
tegr
ativ
e or
thod
onti
cs
Learn about an important choice you need to make before starting braces
the raphael center for integrative education
the raphael center for integrative education
Ongoing Intro to Airway Orthodontics
April Biobloc Study Group
April Training Ortho-Postural Therapists w Roger Price
June MRC Myobrace Basic Series
August Airway Dentistry with Mark Cruz and company
October Advanced MFT with Sandy Coulson
October Less than Six with Kevin Boyd
(who else wants to play)
Mission to create a space for spreading the word about Airway and Orthotropic principles and practice
Orthodontics in the 21st Century
EstheticOrthodontics
AirwayOrthodontics
GeneticTooth-Focused
Dental PerfectionEsthetics Primary
Treating SymptomsAirway Ignorant
AdaptationMuscle-FocusedMedical Better
Esthetics SecondaryTreating Causes
Airway Conscious
The EndAnd
The Beginning
bullLR 12-3 yF (6mo in tx)bullInL = 37 (+2)bull ersquos equilibratedbull OJ =10bull Appliance OJ = 5bull Still accommodating to BB3
Is there a calculus for the Indicator Line
Treatment GoalsBased on Indicator Line
Incisor Goals
Type 1 Treatment Place U1 in ideal position
Biobloc Orthotropics Orthognathic Surgery Distraction Osteogenesis
Type 1 Ideal InCos line
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
YZ 9yo M
bullLost upper d-spacebullInL = 36(+4)bullOJ = 9mmbullLip entrapmentbullLip Incompetence
Y Z 9yo M
Y Z 9yo M9mm OJ
Y Z 9yo M
Treatment Options
1 Type 1 Reduce InL open lost space BB3 to advance mandible
2 Type 2 Open lost space Align
3 Type 4 Extract four premolars
YZ 9yoM
50
40
30
20mm
yM A M J J A S O N D J F M A
boys
Hang Expanser
Upper and Lower
Brackets Hang Retainer
BB3
Incisor Goals
Type 2 Treatment Develop arch just enough to uncrowd
Biobloc Myofunctional Ortho Myofunctional Therapy Crozat ALF Expansion Orthodontics
Type 2 Uncrowding
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
bullLip incompetencebullLip entrapmentbullHypermentalisbullMouthbreathing
Type 2 Uncrowding
12 month progress
12 month progress
12 month progress
After Treatment
Bent-wire6 monthsMyobrace12 months
Hey RaphaelWhat about that
profile
ZP 9-5yoM
i
After Expansion Phase
Incomplete profile improvement better breathing head posture and sleep
Incisor Goals
Type 3 Treatment Maintain UI
Functional Orthodontics Expansion Orthodontics Distalization Ortho or No Treatment
Type 3 Maintain
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Bimax retrusion
Successful dental result
Profile Unimproved
Incisor Goals
Type 4 Treatment RetractExtrude UI
Extraction Orthodontics Retraction Ortho Distalization Ortho
Type 4 Retraction
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Bimax retrusion
Successful dental result
Failed Profile Result
Changes of pharyngeal airway size and hyoid bone position following orthodontic treatment of
Class I bimaxillary protrusion
Qingzhu Wanga Peizeng Jiab Nina K Andersonc Lin Wangd Jiuxiang Line
Angle Orthodontist Vol 00 No 0 0000 (pre-publication 2012)
ldquothe dimension of the velopharynx glossopharynx and hypopharynx were decreased after maximal retraction of anterior teeth with extraction of four premolarshelliprdquo ldquoAny factors that can influence the posture and position of tongue and soft palate may displace them backward andencroach upon the pharynxrdquo
ldquothe more the incisors were retracted the more the pharyngeal airway was reducedrdquo
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Backed into a corner
bull
Moving teeth faster more efficientlyhellipin the wrong direction
Now that wersquove made smoking unacceptable
could we not do the same withbull Sugarbull Processed foodbull Cheap milk and meatbull Fast foodbull Pill popping for symptomatic reliefbull Looking for the cure instead of the causebull Surgery as a quick fixbull Thinking braces are a status symbol
Each industry thrives on the status quoConsumers must drive the change
NP 10yM
NP
Sisterrsquos non-x ortho
Shersquos happyhellipbut Irsquom not so
I make my pitch for BBO
The dilemma of progress
(I forgot the progress pictureshellip)
Dad sells prosthetic parts to orthopedic surgeons
I selling the case against my previous work they loved
It takes me 3 hours to sell the case
They fret until the BB3 goes in
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Connecting the dots
bull Adult SDB and OSA
bull Narrow jaws and faces
bull Soft tissue dysfunction
bull Early parafunctional habits ie open mouth posture
bull Environmental stressors
bull CPAP MARAUPPP SurgWherersquos the best
place to start treatment here
or here
1 Prevention 2 Undo the damage already done3 Establish good habits
When to start When damage from poor breathing is noticed and when bad habits are discovered
The strategies of Airway Orthodontics
Prevention
bull Remove ankyloglossiabull Promote breastfeedingbull Harden the dietbull Develop masticatory strengthbull Discourage oral habitsbull Promote whole-foods low sugar dietbull Reduce oropharyngeal obstructionbull Promote nasal breathing
Breathing retraining
bull Nasal rinsingbull Nasal clearingbull Decongesting
The goals of Airway Orthodontics
1 Breathing through the nose2 Lips together at rest3 Correct tongue position4 No facial muscles moving on swallowing5 Optimal forward facial development6 Class I occlusion7 Straight teeth8 Better stability long term
Myofunctional Trainers
Professors R Soulet and A Besombes
Dr Earl Bergeson
Dr Chris Farrell
The Multi ndash Family System
Orofacial MyofunctionalTherapy
Oral MyologyMyofunctional TherapyTongue Thrust Therapy
B Hockel 2012 Back
Undoing Bimaxillary Dysplasia
1 Maxillary deconstriction2 Maxillary advancement3 Maxillary impaction4 Mandibular advancement
1 Maxillary Expansion
Treatment for Bimaxillary Dysplasia
ALFCrozat
Bent Wire
HyraxHaas
Niti Exp BioBlocSchwartz
The Farrell BENT WIRE Systemtrade
Recommended Age Group 5-12 yrs
Arch Development in conjunction with the TRAINER Systemtrade
Dr John Mew
Establish Good Habits
1 Breathing through the nose2 Lips together at rest3 Correct tongue position4 No facial muscles moving on swallowing5 Stand and sit in balance6 Breath gently using the diaphragm7 Eat to nourish8 Sleep to rest
Ortho-Postural TrainingWorkshops
Breathing
Nutrition
Posture
Sleep
COPYRIGHTRoger L PriceOctober 2012
Posture Number
Forward head posturecan be a compensationfor a deficient airway
Sleep Screening and Hygiene
SQI = 10 SQI = 98
Integrative Healthcare
Function ProfessionalNasal clearing ENT Pulm MFT BreathingMuscle balance and tone MFT Myofunctional OrthoUndoing damage GP Pedo Ortho OMFSBreathing dynamics OPT MFT Breath PhysiologistPosture DC OPT PT OsteopathCranial balance OsteopathNutrition RDH Nutritionist Dietitian Sleep ENT Sleep Med DentNeurocognitive development Pedrsquon SLP Psych SpEd
The Interdisciplinary Center
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Now that I know
My personal missionTo create from what Irsquove
learned from the besta model for others to followhellipespecially the orthodontists
Myofunctional Orthodontics
Chris Farrell
John Flutter
German Ramierez
Damien OrsquoBrien
Myofunctional Research CoRancho Cucamonga
2008-2012
Oral Myology
Oral Myology Basic CourseJoy MoellerNYC 2011LA 2012
Oral Myology Levels 2 3Kim BenkertClifton 2012
Habit CessationShari GreenClifton 2013
Biobloc Orthotropics
BBO Mini-residencyBill Hang
Agora Hills2012-13
BBO IntensiveDrs John and Mike
MewLSFO2013
Breathing and Sleep
Buteyko MentorshipThe Breathing Center
Woodstock2010
Breathing Well ProgrammeJohn Flutter
2010 Ortho-Postural TrainingRoger Price
2013
Sleep DentistryMichael Gelb etal
NYU2012
ALF and Cranial
Jim Bronson2013 Tasha Turzo
Cranial Academy2014
Bucket Listbull ALF and Crozat (Bronsonrsquos course)bullMore on Biobloc (Hangrsquos Advanced London School)bull More Cranial (The Farm)bullChirodontics (Bob Walker)bull Airway Dentistry with Marc Cruz Jeff Rousebull Sleep Dentistrybull Less-than-Six with Kevin Boydbull Intra-mandibular Distraction Osteogenesis (IMDO)
Off My ListAnything that moves the teeth faster in the wrong direction
Whatrsquos an RO to do
To create from what Irsquove learned from the best
a model for others to followhellipespecially orthodontists
Teaching
Mt Sinai Pedo ResidencyAli Attaie
2010-2012
Montefiore Ortho ResidencyTony Maganzini
2012
2009-Present
Mt Sinai School of MedicinePedodontic Residency
Guest SpeakersJim BronsonMike MewKevin BoydSandra KahnJennifer TowRoger PricePaula Fabbie
Damien OrsquoBrien
First clinical program in myofunctional orthodontics
Airway and Facial DevelopmentCollaborative Webcast
Mark Cruz
AAPMD Symposium
wwwaapm
dorg
Annual MeetingApril 25-26 2014
Westin Chicago North Shore
the raphael center for integrative orthodontics
wwwalignminecomwwwbioblocnjcom
wwwmyobracenjcom
Integrative vs Conventional
Integrative vs Conventional
ldquoWith improvements in expansion orthodontics advances in myofunctional orthodontics and the growing recognition about sleep disordered breathing among children and adults it is time for orthodontics to expand its horizons There is now so much more we can oerrdquo
The Raphael name has been associated with high quality orthodontics in New Jersey for over 60 years Dr Barry Raphael has been a university trained orthodontic specialist and a member of the American Association of Orthodontists for 30 years
He has a wide range of techniques and services to offer He has studied oral myology applied kinesiology Buteyko breathing Biobloc Orthotropics and Myobrace as part of his integrative training He can offer Damon Invisalign Insignia and Incognito appliances designs as some of his many conventional orthodontic services too
Dr Raphael teaches his techniques at post-graduate residencies study clubs dental societies and for the Myofunctional Research Co He is available for presentations to any group interested in learning more about the benefits of integrative orthodontics
wwwalignminecomLearn about the choices you have in orthodontics
dr barry raphael Why its
too Early never
1425
bro
ad
str
ee
tc
lifto
n n
j 070
13
973-
778-
4222
fax
973-
778-
9625
nj s
pe
c
368
4
1425 broad street clifton nj 07013973-778-4222
wwwalignminecom
the raphael centerforintegrative orthodontics
the
raph
ael c
ente
r fo
rin
tegr
ativ
e or
thod
onti
cs
Learn about an important choice you need to make before starting braces
the raphael center for integrative education
the raphael center for integrative education
Ongoing Intro to Airway Orthodontics
April Biobloc Study Group
April Training Ortho-Postural Therapists w Roger Price
June MRC Myobrace Basic Series
August Airway Dentistry with Mark Cruz and company
October Advanced MFT with Sandy Coulson
October Less than Six with Kevin Boyd
(who else wants to play)
Mission to create a space for spreading the word about Airway and Orthotropic principles and practice
Orthodontics in the 21st Century
EstheticOrthodontics
AirwayOrthodontics
GeneticTooth-Focused
Dental PerfectionEsthetics Primary
Treating SymptomsAirway Ignorant
AdaptationMuscle-FocusedMedical Better
Esthetics SecondaryTreating Causes
Airway Conscious
The EndAnd
The Beginning
Is there a calculus for the Indicator Line
Treatment GoalsBased on Indicator Line
Incisor Goals
Type 1 Treatment Place U1 in ideal position
Biobloc Orthotropics Orthognathic Surgery Distraction Osteogenesis
Type 1 Ideal InCos line
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
YZ 9yo M
bullLost upper d-spacebullInL = 36(+4)bullOJ = 9mmbullLip entrapmentbullLip Incompetence
Y Z 9yo M
Y Z 9yo M9mm OJ
Y Z 9yo M
Treatment Options
1 Type 1 Reduce InL open lost space BB3 to advance mandible
2 Type 2 Open lost space Align
3 Type 4 Extract four premolars
YZ 9yoM
50
40
30
20mm
yM A M J J A S O N D J F M A
boys
Hang Expanser
Upper and Lower
Brackets Hang Retainer
BB3
Incisor Goals
Type 2 Treatment Develop arch just enough to uncrowd
Biobloc Myofunctional Ortho Myofunctional Therapy Crozat ALF Expansion Orthodontics
Type 2 Uncrowding
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
bullLip incompetencebullLip entrapmentbullHypermentalisbullMouthbreathing
Type 2 Uncrowding
12 month progress
12 month progress
12 month progress
After Treatment
Bent-wire6 monthsMyobrace12 months
Hey RaphaelWhat about that
profile
ZP 9-5yoM
i
After Expansion Phase
Incomplete profile improvement better breathing head posture and sleep
Incisor Goals
Type 3 Treatment Maintain UI
Functional Orthodontics Expansion Orthodontics Distalization Ortho or No Treatment
Type 3 Maintain
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Bimax retrusion
Successful dental result
Profile Unimproved
Incisor Goals
Type 4 Treatment RetractExtrude UI
Extraction Orthodontics Retraction Ortho Distalization Ortho
Type 4 Retraction
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Bimax retrusion
Successful dental result
Failed Profile Result
Changes of pharyngeal airway size and hyoid bone position following orthodontic treatment of
Class I bimaxillary protrusion
Qingzhu Wanga Peizeng Jiab Nina K Andersonc Lin Wangd Jiuxiang Line
Angle Orthodontist Vol 00 No 0 0000 (pre-publication 2012)
ldquothe dimension of the velopharynx glossopharynx and hypopharynx were decreased after maximal retraction of anterior teeth with extraction of four premolarshelliprdquo ldquoAny factors that can influence the posture and position of tongue and soft palate may displace them backward andencroach upon the pharynxrdquo
ldquothe more the incisors were retracted the more the pharyngeal airway was reducedrdquo
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Backed into a corner
bull
Moving teeth faster more efficientlyhellipin the wrong direction
Now that wersquove made smoking unacceptable
could we not do the same withbull Sugarbull Processed foodbull Cheap milk and meatbull Fast foodbull Pill popping for symptomatic reliefbull Looking for the cure instead of the causebull Surgery as a quick fixbull Thinking braces are a status symbol
Each industry thrives on the status quoConsumers must drive the change
NP 10yM
NP
Sisterrsquos non-x ortho
Shersquos happyhellipbut Irsquom not so
I make my pitch for BBO
The dilemma of progress
(I forgot the progress pictureshellip)
Dad sells prosthetic parts to orthopedic surgeons
I selling the case against my previous work they loved
It takes me 3 hours to sell the case
They fret until the BB3 goes in
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Connecting the dots
bull Adult SDB and OSA
bull Narrow jaws and faces
bull Soft tissue dysfunction
bull Early parafunctional habits ie open mouth posture
bull Environmental stressors
bull CPAP MARAUPPP SurgWherersquos the best
place to start treatment here
or here
1 Prevention 2 Undo the damage already done3 Establish good habits
When to start When damage from poor breathing is noticed and when bad habits are discovered
The strategies of Airway Orthodontics
Prevention
bull Remove ankyloglossiabull Promote breastfeedingbull Harden the dietbull Develop masticatory strengthbull Discourage oral habitsbull Promote whole-foods low sugar dietbull Reduce oropharyngeal obstructionbull Promote nasal breathing
Breathing retraining
bull Nasal rinsingbull Nasal clearingbull Decongesting
The goals of Airway Orthodontics
1 Breathing through the nose2 Lips together at rest3 Correct tongue position4 No facial muscles moving on swallowing5 Optimal forward facial development6 Class I occlusion7 Straight teeth8 Better stability long term
Myofunctional Trainers
Professors R Soulet and A Besombes
Dr Earl Bergeson
Dr Chris Farrell
The Multi ndash Family System
Orofacial MyofunctionalTherapy
Oral MyologyMyofunctional TherapyTongue Thrust Therapy
B Hockel 2012 Back
Undoing Bimaxillary Dysplasia
1 Maxillary deconstriction2 Maxillary advancement3 Maxillary impaction4 Mandibular advancement
1 Maxillary Expansion
Treatment for Bimaxillary Dysplasia
ALFCrozat
Bent Wire
HyraxHaas
Niti Exp BioBlocSchwartz
The Farrell BENT WIRE Systemtrade
Recommended Age Group 5-12 yrs
Arch Development in conjunction with the TRAINER Systemtrade
Dr John Mew
Establish Good Habits
1 Breathing through the nose2 Lips together at rest3 Correct tongue position4 No facial muscles moving on swallowing5 Stand and sit in balance6 Breath gently using the diaphragm7 Eat to nourish8 Sleep to rest
Ortho-Postural TrainingWorkshops
Breathing
Nutrition
Posture
Sleep
COPYRIGHTRoger L PriceOctober 2012
Posture Number
Forward head posturecan be a compensationfor a deficient airway
Sleep Screening and Hygiene
SQI = 10 SQI = 98
Integrative Healthcare
Function ProfessionalNasal clearing ENT Pulm MFT BreathingMuscle balance and tone MFT Myofunctional OrthoUndoing damage GP Pedo Ortho OMFSBreathing dynamics OPT MFT Breath PhysiologistPosture DC OPT PT OsteopathCranial balance OsteopathNutrition RDH Nutritionist Dietitian Sleep ENT Sleep Med DentNeurocognitive development Pedrsquon SLP Psych SpEd
The Interdisciplinary Center
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Now that I know
My personal missionTo create from what Irsquove
learned from the besta model for others to followhellipespecially the orthodontists
Myofunctional Orthodontics
Chris Farrell
John Flutter
German Ramierez
Damien OrsquoBrien
Myofunctional Research CoRancho Cucamonga
2008-2012
Oral Myology
Oral Myology Basic CourseJoy MoellerNYC 2011LA 2012
Oral Myology Levels 2 3Kim BenkertClifton 2012
Habit CessationShari GreenClifton 2013
Biobloc Orthotropics
BBO Mini-residencyBill Hang
Agora Hills2012-13
BBO IntensiveDrs John and Mike
MewLSFO2013
Breathing and Sleep
Buteyko MentorshipThe Breathing Center
Woodstock2010
Breathing Well ProgrammeJohn Flutter
2010 Ortho-Postural TrainingRoger Price
2013
Sleep DentistryMichael Gelb etal
NYU2012
ALF and Cranial
Jim Bronson2013 Tasha Turzo
Cranial Academy2014
Bucket Listbull ALF and Crozat (Bronsonrsquos course)bullMore on Biobloc (Hangrsquos Advanced London School)bull More Cranial (The Farm)bullChirodontics (Bob Walker)bull Airway Dentistry with Marc Cruz Jeff Rousebull Sleep Dentistrybull Less-than-Six with Kevin Boydbull Intra-mandibular Distraction Osteogenesis (IMDO)
Off My ListAnything that moves the teeth faster in the wrong direction
Whatrsquos an RO to do
To create from what Irsquove learned from the best
a model for others to followhellipespecially orthodontists
Teaching
Mt Sinai Pedo ResidencyAli Attaie
2010-2012
Montefiore Ortho ResidencyTony Maganzini
2012
2009-Present
Mt Sinai School of MedicinePedodontic Residency
Guest SpeakersJim BronsonMike MewKevin BoydSandra KahnJennifer TowRoger PricePaula Fabbie
Damien OrsquoBrien
First clinical program in myofunctional orthodontics
Airway and Facial DevelopmentCollaborative Webcast
Mark Cruz
AAPMD Symposium
wwwaapm
dorg
Annual MeetingApril 25-26 2014
Westin Chicago North Shore
the raphael center for integrative orthodontics
wwwalignminecomwwwbioblocnjcom
wwwmyobracenjcom
Integrative vs Conventional
Integrative vs Conventional
ldquoWith improvements in expansion orthodontics advances in myofunctional orthodontics and the growing recognition about sleep disordered breathing among children and adults it is time for orthodontics to expand its horizons There is now so much more we can oerrdquo
The Raphael name has been associated with high quality orthodontics in New Jersey for over 60 years Dr Barry Raphael has been a university trained orthodontic specialist and a member of the American Association of Orthodontists for 30 years
He has a wide range of techniques and services to offer He has studied oral myology applied kinesiology Buteyko breathing Biobloc Orthotropics and Myobrace as part of his integrative training He can offer Damon Invisalign Insignia and Incognito appliances designs as some of his many conventional orthodontic services too
Dr Raphael teaches his techniques at post-graduate residencies study clubs dental societies and for the Myofunctional Research Co He is available for presentations to any group interested in learning more about the benefits of integrative orthodontics
wwwalignminecomLearn about the choices you have in orthodontics
dr barry raphael Why its
too Early never
1425
bro
ad
str
ee
tc
lifto
n n
j 070
13
973-
778-
4222
fax
973-
778-
9625
nj s
pe
c
368
4
1425 broad street clifton nj 07013973-778-4222
wwwalignminecom
the raphael centerforintegrative orthodontics
the
raph
ael c
ente
r fo
rin
tegr
ativ
e or
thod
onti
cs
Learn about an important choice you need to make before starting braces
the raphael center for integrative education
the raphael center for integrative education
Ongoing Intro to Airway Orthodontics
April Biobloc Study Group
April Training Ortho-Postural Therapists w Roger Price
June MRC Myobrace Basic Series
August Airway Dentistry with Mark Cruz and company
October Advanced MFT with Sandy Coulson
October Less than Six with Kevin Boyd
(who else wants to play)
Mission to create a space for spreading the word about Airway and Orthotropic principles and practice
Orthodontics in the 21st Century
EstheticOrthodontics
AirwayOrthodontics
GeneticTooth-Focused
Dental PerfectionEsthetics Primary
Treating SymptomsAirway Ignorant
AdaptationMuscle-FocusedMedical Better
Esthetics SecondaryTreating Causes
Airway Conscious
The EndAnd
The Beginning
Treatment GoalsBased on Indicator Line
Incisor Goals
Type 1 Treatment Place U1 in ideal position
Biobloc Orthotropics Orthognathic Surgery Distraction Osteogenesis
Type 1 Ideal InCos line
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
YZ 9yo M
bullLost upper d-spacebullInL = 36(+4)bullOJ = 9mmbullLip entrapmentbullLip Incompetence
Y Z 9yo M
Y Z 9yo M9mm OJ
Y Z 9yo M
Treatment Options
1 Type 1 Reduce InL open lost space BB3 to advance mandible
2 Type 2 Open lost space Align
3 Type 4 Extract four premolars
YZ 9yoM
50
40
30
20mm
yM A M J J A S O N D J F M A
boys
Hang Expanser
Upper and Lower
Brackets Hang Retainer
BB3
Incisor Goals
Type 2 Treatment Develop arch just enough to uncrowd
Biobloc Myofunctional Ortho Myofunctional Therapy Crozat ALF Expansion Orthodontics
Type 2 Uncrowding
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
bullLip incompetencebullLip entrapmentbullHypermentalisbullMouthbreathing
Type 2 Uncrowding
12 month progress
12 month progress
12 month progress
After Treatment
Bent-wire6 monthsMyobrace12 months
Hey RaphaelWhat about that
profile
ZP 9-5yoM
i
After Expansion Phase
Incomplete profile improvement better breathing head posture and sleep
Incisor Goals
Type 3 Treatment Maintain UI
Functional Orthodontics Expansion Orthodontics Distalization Ortho or No Treatment
Type 3 Maintain
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Bimax retrusion
Successful dental result
Profile Unimproved
Incisor Goals
Type 4 Treatment RetractExtrude UI
Extraction Orthodontics Retraction Ortho Distalization Ortho
Type 4 Retraction
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Bimax retrusion
Successful dental result
Failed Profile Result
Changes of pharyngeal airway size and hyoid bone position following orthodontic treatment of
Class I bimaxillary protrusion
Qingzhu Wanga Peizeng Jiab Nina K Andersonc Lin Wangd Jiuxiang Line
Angle Orthodontist Vol 00 No 0 0000 (pre-publication 2012)
ldquothe dimension of the velopharynx glossopharynx and hypopharynx were decreased after maximal retraction of anterior teeth with extraction of four premolarshelliprdquo ldquoAny factors that can influence the posture and position of tongue and soft palate may displace them backward andencroach upon the pharynxrdquo
ldquothe more the incisors were retracted the more the pharyngeal airway was reducedrdquo
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Backed into a corner
bull
Moving teeth faster more efficientlyhellipin the wrong direction
Now that wersquove made smoking unacceptable
could we not do the same withbull Sugarbull Processed foodbull Cheap milk and meatbull Fast foodbull Pill popping for symptomatic reliefbull Looking for the cure instead of the causebull Surgery as a quick fixbull Thinking braces are a status symbol
Each industry thrives on the status quoConsumers must drive the change
NP 10yM
NP
Sisterrsquos non-x ortho
Shersquos happyhellipbut Irsquom not so
I make my pitch for BBO
The dilemma of progress
(I forgot the progress pictureshellip)
Dad sells prosthetic parts to orthopedic surgeons
I selling the case against my previous work they loved
It takes me 3 hours to sell the case
They fret until the BB3 goes in
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Connecting the dots
bull Adult SDB and OSA
bull Narrow jaws and faces
bull Soft tissue dysfunction
bull Early parafunctional habits ie open mouth posture
bull Environmental stressors
bull CPAP MARAUPPP SurgWherersquos the best
place to start treatment here
or here
1 Prevention 2 Undo the damage already done3 Establish good habits
When to start When damage from poor breathing is noticed and when bad habits are discovered
The strategies of Airway Orthodontics
Prevention
bull Remove ankyloglossiabull Promote breastfeedingbull Harden the dietbull Develop masticatory strengthbull Discourage oral habitsbull Promote whole-foods low sugar dietbull Reduce oropharyngeal obstructionbull Promote nasal breathing
Breathing retraining
bull Nasal rinsingbull Nasal clearingbull Decongesting
The goals of Airway Orthodontics
1 Breathing through the nose2 Lips together at rest3 Correct tongue position4 No facial muscles moving on swallowing5 Optimal forward facial development6 Class I occlusion7 Straight teeth8 Better stability long term
Myofunctional Trainers
Professors R Soulet and A Besombes
Dr Earl Bergeson
Dr Chris Farrell
The Multi ndash Family System
Orofacial MyofunctionalTherapy
Oral MyologyMyofunctional TherapyTongue Thrust Therapy
B Hockel 2012 Back
Undoing Bimaxillary Dysplasia
1 Maxillary deconstriction2 Maxillary advancement3 Maxillary impaction4 Mandibular advancement
1 Maxillary Expansion
Treatment for Bimaxillary Dysplasia
ALFCrozat
Bent Wire
HyraxHaas
Niti Exp BioBlocSchwartz
The Farrell BENT WIRE Systemtrade
Recommended Age Group 5-12 yrs
Arch Development in conjunction with the TRAINER Systemtrade
Dr John Mew
Establish Good Habits
1 Breathing through the nose2 Lips together at rest3 Correct tongue position4 No facial muscles moving on swallowing5 Stand and sit in balance6 Breath gently using the diaphragm7 Eat to nourish8 Sleep to rest
Ortho-Postural TrainingWorkshops
Breathing
Nutrition
Posture
Sleep
COPYRIGHTRoger L PriceOctober 2012
Posture Number
Forward head posturecan be a compensationfor a deficient airway
Sleep Screening and Hygiene
SQI = 10 SQI = 98
Integrative Healthcare
Function ProfessionalNasal clearing ENT Pulm MFT BreathingMuscle balance and tone MFT Myofunctional OrthoUndoing damage GP Pedo Ortho OMFSBreathing dynamics OPT MFT Breath PhysiologistPosture DC OPT PT OsteopathCranial balance OsteopathNutrition RDH Nutritionist Dietitian Sleep ENT Sleep Med DentNeurocognitive development Pedrsquon SLP Psych SpEd
The Interdisciplinary Center
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Now that I know
My personal missionTo create from what Irsquove
learned from the besta model for others to followhellipespecially the orthodontists
Myofunctional Orthodontics
Chris Farrell
John Flutter
German Ramierez
Damien OrsquoBrien
Myofunctional Research CoRancho Cucamonga
2008-2012
Oral Myology
Oral Myology Basic CourseJoy MoellerNYC 2011LA 2012
Oral Myology Levels 2 3Kim BenkertClifton 2012
Habit CessationShari GreenClifton 2013
Biobloc Orthotropics
BBO Mini-residencyBill Hang
Agora Hills2012-13
BBO IntensiveDrs John and Mike
MewLSFO2013
Breathing and Sleep
Buteyko MentorshipThe Breathing Center
Woodstock2010
Breathing Well ProgrammeJohn Flutter
2010 Ortho-Postural TrainingRoger Price
2013
Sleep DentistryMichael Gelb etal
NYU2012
ALF and Cranial
Jim Bronson2013 Tasha Turzo
Cranial Academy2014
Bucket Listbull ALF and Crozat (Bronsonrsquos course)bullMore on Biobloc (Hangrsquos Advanced London School)bull More Cranial (The Farm)bullChirodontics (Bob Walker)bull Airway Dentistry with Marc Cruz Jeff Rousebull Sleep Dentistrybull Less-than-Six with Kevin Boydbull Intra-mandibular Distraction Osteogenesis (IMDO)
Off My ListAnything that moves the teeth faster in the wrong direction
Whatrsquos an RO to do
To create from what Irsquove learned from the best
a model for others to followhellipespecially orthodontists
Teaching
Mt Sinai Pedo ResidencyAli Attaie
2010-2012
Montefiore Ortho ResidencyTony Maganzini
2012
2009-Present
Mt Sinai School of MedicinePedodontic Residency
Guest SpeakersJim BronsonMike MewKevin BoydSandra KahnJennifer TowRoger PricePaula Fabbie
Damien OrsquoBrien
First clinical program in myofunctional orthodontics
Airway and Facial DevelopmentCollaborative Webcast
Mark Cruz
AAPMD Symposium
wwwaapm
dorg
Annual MeetingApril 25-26 2014
Westin Chicago North Shore
the raphael center for integrative orthodontics
wwwalignminecomwwwbioblocnjcom
wwwmyobracenjcom
Integrative vs Conventional
Integrative vs Conventional
ldquoWith improvements in expansion orthodontics advances in myofunctional orthodontics and the growing recognition about sleep disordered breathing among children and adults it is time for orthodontics to expand its horizons There is now so much more we can oerrdquo
The Raphael name has been associated with high quality orthodontics in New Jersey for over 60 years Dr Barry Raphael has been a university trained orthodontic specialist and a member of the American Association of Orthodontists for 30 years
He has a wide range of techniques and services to offer He has studied oral myology applied kinesiology Buteyko breathing Biobloc Orthotropics and Myobrace as part of his integrative training He can offer Damon Invisalign Insignia and Incognito appliances designs as some of his many conventional orthodontic services too
Dr Raphael teaches his techniques at post-graduate residencies study clubs dental societies and for the Myofunctional Research Co He is available for presentations to any group interested in learning more about the benefits of integrative orthodontics
wwwalignminecomLearn about the choices you have in orthodontics
dr barry raphael Why its
too Early never
1425
bro
ad
str
ee
tc
lifto
n n
j 070
13
973-
778-
4222
fax
973-
778-
9625
nj s
pe
c
368
4
1425 broad street clifton nj 07013973-778-4222
wwwalignminecom
the raphael centerforintegrative orthodontics
the
raph
ael c
ente
r fo
rin
tegr
ativ
e or
thod
onti
cs
Learn about an important choice you need to make before starting braces
the raphael center for integrative education
the raphael center for integrative education
Ongoing Intro to Airway Orthodontics
April Biobloc Study Group
April Training Ortho-Postural Therapists w Roger Price
June MRC Myobrace Basic Series
August Airway Dentistry with Mark Cruz and company
October Advanced MFT with Sandy Coulson
October Less than Six with Kevin Boyd
(who else wants to play)
Mission to create a space for spreading the word about Airway and Orthotropic principles and practice
Orthodontics in the 21st Century
EstheticOrthodontics
AirwayOrthodontics
GeneticTooth-Focused
Dental PerfectionEsthetics Primary
Treating SymptomsAirway Ignorant
AdaptationMuscle-FocusedMedical Better
Esthetics SecondaryTreating Causes
Airway Conscious
The EndAnd
The Beginning
Incisor Goals
Type 1 Treatment Place U1 in ideal position
Biobloc Orthotropics Orthognathic Surgery Distraction Osteogenesis
Type 1 Ideal InCos line
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
YZ 9yo M
bullLost upper d-spacebullInL = 36(+4)bullOJ = 9mmbullLip entrapmentbullLip Incompetence
Y Z 9yo M
Y Z 9yo M9mm OJ
Y Z 9yo M
Treatment Options
1 Type 1 Reduce InL open lost space BB3 to advance mandible
2 Type 2 Open lost space Align
3 Type 4 Extract four premolars
YZ 9yoM
50
40
30
20mm
yM A M J J A S O N D J F M A
boys
Hang Expanser
Upper and Lower
Brackets Hang Retainer
BB3
Incisor Goals
Type 2 Treatment Develop arch just enough to uncrowd
Biobloc Myofunctional Ortho Myofunctional Therapy Crozat ALF Expansion Orthodontics
Type 2 Uncrowding
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
bullLip incompetencebullLip entrapmentbullHypermentalisbullMouthbreathing
Type 2 Uncrowding
12 month progress
12 month progress
12 month progress
After Treatment
Bent-wire6 monthsMyobrace12 months
Hey RaphaelWhat about that
profile
ZP 9-5yoM
i
After Expansion Phase
Incomplete profile improvement better breathing head posture and sleep
Incisor Goals
Type 3 Treatment Maintain UI
Functional Orthodontics Expansion Orthodontics Distalization Ortho or No Treatment
Type 3 Maintain
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Bimax retrusion
Successful dental result
Profile Unimproved
Incisor Goals
Type 4 Treatment RetractExtrude UI
Extraction Orthodontics Retraction Ortho Distalization Ortho
Type 4 Retraction
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Bimax retrusion
Successful dental result
Failed Profile Result
Changes of pharyngeal airway size and hyoid bone position following orthodontic treatment of
Class I bimaxillary protrusion
Qingzhu Wanga Peizeng Jiab Nina K Andersonc Lin Wangd Jiuxiang Line
Angle Orthodontist Vol 00 No 0 0000 (pre-publication 2012)
ldquothe dimension of the velopharynx glossopharynx and hypopharynx were decreased after maximal retraction of anterior teeth with extraction of four premolarshelliprdquo ldquoAny factors that can influence the posture and position of tongue and soft palate may displace them backward andencroach upon the pharynxrdquo
ldquothe more the incisors were retracted the more the pharyngeal airway was reducedrdquo
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Backed into a corner
bull
Moving teeth faster more efficientlyhellipin the wrong direction
Now that wersquove made smoking unacceptable
could we not do the same withbull Sugarbull Processed foodbull Cheap milk and meatbull Fast foodbull Pill popping for symptomatic reliefbull Looking for the cure instead of the causebull Surgery as a quick fixbull Thinking braces are a status symbol
Each industry thrives on the status quoConsumers must drive the change
NP 10yM
NP
Sisterrsquos non-x ortho
Shersquos happyhellipbut Irsquom not so
I make my pitch for BBO
The dilemma of progress
(I forgot the progress pictureshellip)
Dad sells prosthetic parts to orthopedic surgeons
I selling the case against my previous work they loved
It takes me 3 hours to sell the case
They fret until the BB3 goes in
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Connecting the dots
bull Adult SDB and OSA
bull Narrow jaws and faces
bull Soft tissue dysfunction
bull Early parafunctional habits ie open mouth posture
bull Environmental stressors
bull CPAP MARAUPPP SurgWherersquos the best
place to start treatment here
or here
1 Prevention 2 Undo the damage already done3 Establish good habits
When to start When damage from poor breathing is noticed and when bad habits are discovered
The strategies of Airway Orthodontics
Prevention
bull Remove ankyloglossiabull Promote breastfeedingbull Harden the dietbull Develop masticatory strengthbull Discourage oral habitsbull Promote whole-foods low sugar dietbull Reduce oropharyngeal obstructionbull Promote nasal breathing
Breathing retraining
bull Nasal rinsingbull Nasal clearingbull Decongesting
The goals of Airway Orthodontics
1 Breathing through the nose2 Lips together at rest3 Correct tongue position4 No facial muscles moving on swallowing5 Optimal forward facial development6 Class I occlusion7 Straight teeth8 Better stability long term
Myofunctional Trainers
Professors R Soulet and A Besombes
Dr Earl Bergeson
Dr Chris Farrell
The Multi ndash Family System
Orofacial MyofunctionalTherapy
Oral MyologyMyofunctional TherapyTongue Thrust Therapy
B Hockel 2012 Back
Undoing Bimaxillary Dysplasia
1 Maxillary deconstriction2 Maxillary advancement3 Maxillary impaction4 Mandibular advancement
1 Maxillary Expansion
Treatment for Bimaxillary Dysplasia
ALFCrozat
Bent Wire
HyraxHaas
Niti Exp BioBlocSchwartz
The Farrell BENT WIRE Systemtrade
Recommended Age Group 5-12 yrs
Arch Development in conjunction with the TRAINER Systemtrade
Dr John Mew
Establish Good Habits
1 Breathing through the nose2 Lips together at rest3 Correct tongue position4 No facial muscles moving on swallowing5 Stand and sit in balance6 Breath gently using the diaphragm7 Eat to nourish8 Sleep to rest
Ortho-Postural TrainingWorkshops
Breathing
Nutrition
Posture
Sleep
COPYRIGHTRoger L PriceOctober 2012
Posture Number
Forward head posturecan be a compensationfor a deficient airway
Sleep Screening and Hygiene
SQI = 10 SQI = 98
Integrative Healthcare
Function ProfessionalNasal clearing ENT Pulm MFT BreathingMuscle balance and tone MFT Myofunctional OrthoUndoing damage GP Pedo Ortho OMFSBreathing dynamics OPT MFT Breath PhysiologistPosture DC OPT PT OsteopathCranial balance OsteopathNutrition RDH Nutritionist Dietitian Sleep ENT Sleep Med DentNeurocognitive development Pedrsquon SLP Psych SpEd
The Interdisciplinary Center
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Now that I know
My personal missionTo create from what Irsquove
learned from the besta model for others to followhellipespecially the orthodontists
Myofunctional Orthodontics
Chris Farrell
John Flutter
German Ramierez
Damien OrsquoBrien
Myofunctional Research CoRancho Cucamonga
2008-2012
Oral Myology
Oral Myology Basic CourseJoy MoellerNYC 2011LA 2012
Oral Myology Levels 2 3Kim BenkertClifton 2012
Habit CessationShari GreenClifton 2013
Biobloc Orthotropics
BBO Mini-residencyBill Hang
Agora Hills2012-13
BBO IntensiveDrs John and Mike
MewLSFO2013
Breathing and Sleep
Buteyko MentorshipThe Breathing Center
Woodstock2010
Breathing Well ProgrammeJohn Flutter
2010 Ortho-Postural TrainingRoger Price
2013
Sleep DentistryMichael Gelb etal
NYU2012
ALF and Cranial
Jim Bronson2013 Tasha Turzo
Cranial Academy2014
Bucket Listbull ALF and Crozat (Bronsonrsquos course)bullMore on Biobloc (Hangrsquos Advanced London School)bull More Cranial (The Farm)bullChirodontics (Bob Walker)bull Airway Dentistry with Marc Cruz Jeff Rousebull Sleep Dentistrybull Less-than-Six with Kevin Boydbull Intra-mandibular Distraction Osteogenesis (IMDO)
Off My ListAnything that moves the teeth faster in the wrong direction
Whatrsquos an RO to do
To create from what Irsquove learned from the best
a model for others to followhellipespecially orthodontists
Teaching
Mt Sinai Pedo ResidencyAli Attaie
2010-2012
Montefiore Ortho ResidencyTony Maganzini
2012
2009-Present
Mt Sinai School of MedicinePedodontic Residency
Guest SpeakersJim BronsonMike MewKevin BoydSandra KahnJennifer TowRoger PricePaula Fabbie
Damien OrsquoBrien
First clinical program in myofunctional orthodontics
Airway and Facial DevelopmentCollaborative Webcast
Mark Cruz
AAPMD Symposium
wwwaapm
dorg
Annual MeetingApril 25-26 2014
Westin Chicago North Shore
the raphael center for integrative orthodontics
wwwalignminecomwwwbioblocnjcom
wwwmyobracenjcom
Integrative vs Conventional
Integrative vs Conventional
ldquoWith improvements in expansion orthodontics advances in myofunctional orthodontics and the growing recognition about sleep disordered breathing among children and adults it is time for orthodontics to expand its horizons There is now so much more we can oerrdquo
The Raphael name has been associated with high quality orthodontics in New Jersey for over 60 years Dr Barry Raphael has been a university trained orthodontic specialist and a member of the American Association of Orthodontists for 30 years
He has a wide range of techniques and services to offer He has studied oral myology applied kinesiology Buteyko breathing Biobloc Orthotropics and Myobrace as part of his integrative training He can offer Damon Invisalign Insignia and Incognito appliances designs as some of his many conventional orthodontic services too
Dr Raphael teaches his techniques at post-graduate residencies study clubs dental societies and for the Myofunctional Research Co He is available for presentations to any group interested in learning more about the benefits of integrative orthodontics
wwwalignminecomLearn about the choices you have in orthodontics
dr barry raphael Why its
too Early never
1425
bro
ad
str
ee
tc
lifto
n n
j 070
13
973-
778-
4222
fax
973-
778-
9625
nj s
pe
c
368
4
1425 broad street clifton nj 07013973-778-4222
wwwalignminecom
the raphael centerforintegrative orthodontics
the
raph
ael c
ente
r fo
rin
tegr
ativ
e or
thod
onti
cs
Learn about an important choice you need to make before starting braces
the raphael center for integrative education
the raphael center for integrative education
Ongoing Intro to Airway Orthodontics
April Biobloc Study Group
April Training Ortho-Postural Therapists w Roger Price
June MRC Myobrace Basic Series
August Airway Dentistry with Mark Cruz and company
October Advanced MFT with Sandy Coulson
October Less than Six with Kevin Boyd
(who else wants to play)
Mission to create a space for spreading the word about Airway and Orthotropic principles and practice
Orthodontics in the 21st Century
EstheticOrthodontics
AirwayOrthodontics
GeneticTooth-Focused
Dental PerfectionEsthetics Primary
Treating SymptomsAirway Ignorant
AdaptationMuscle-FocusedMedical Better
Esthetics SecondaryTreating Causes
Airway Conscious
The EndAnd
The Beginning
Type 1 Ideal InCos line
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
YZ 9yo M
bullLost upper d-spacebullInL = 36(+4)bullOJ = 9mmbullLip entrapmentbullLip Incompetence
Y Z 9yo M
Y Z 9yo M9mm OJ
Y Z 9yo M
Treatment Options
1 Type 1 Reduce InL open lost space BB3 to advance mandible
2 Type 2 Open lost space Align
3 Type 4 Extract four premolars
YZ 9yoM
50
40
30
20mm
yM A M J J A S O N D J F M A
boys
Hang Expanser
Upper and Lower
Brackets Hang Retainer
BB3
Incisor Goals
Type 2 Treatment Develop arch just enough to uncrowd
Biobloc Myofunctional Ortho Myofunctional Therapy Crozat ALF Expansion Orthodontics
Type 2 Uncrowding
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
bullLip incompetencebullLip entrapmentbullHypermentalisbullMouthbreathing
Type 2 Uncrowding
12 month progress
12 month progress
12 month progress
After Treatment
Bent-wire6 monthsMyobrace12 months
Hey RaphaelWhat about that
profile
ZP 9-5yoM
i
After Expansion Phase
Incomplete profile improvement better breathing head posture and sleep
Incisor Goals
Type 3 Treatment Maintain UI
Functional Orthodontics Expansion Orthodontics Distalization Ortho or No Treatment
Type 3 Maintain
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Bimax retrusion
Successful dental result
Profile Unimproved
Incisor Goals
Type 4 Treatment RetractExtrude UI
Extraction Orthodontics Retraction Ortho Distalization Ortho
Type 4 Retraction
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Bimax retrusion
Successful dental result
Failed Profile Result
Changes of pharyngeal airway size and hyoid bone position following orthodontic treatment of
Class I bimaxillary protrusion
Qingzhu Wanga Peizeng Jiab Nina K Andersonc Lin Wangd Jiuxiang Line
Angle Orthodontist Vol 00 No 0 0000 (pre-publication 2012)
ldquothe dimension of the velopharynx glossopharynx and hypopharynx were decreased after maximal retraction of anterior teeth with extraction of four premolarshelliprdquo ldquoAny factors that can influence the posture and position of tongue and soft palate may displace them backward andencroach upon the pharynxrdquo
ldquothe more the incisors were retracted the more the pharyngeal airway was reducedrdquo
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Backed into a corner
bull
Moving teeth faster more efficientlyhellipin the wrong direction
Now that wersquove made smoking unacceptable
could we not do the same withbull Sugarbull Processed foodbull Cheap milk and meatbull Fast foodbull Pill popping for symptomatic reliefbull Looking for the cure instead of the causebull Surgery as a quick fixbull Thinking braces are a status symbol
Each industry thrives on the status quoConsumers must drive the change
NP 10yM
NP
Sisterrsquos non-x ortho
Shersquos happyhellipbut Irsquom not so
I make my pitch for BBO
The dilemma of progress
(I forgot the progress pictureshellip)
Dad sells prosthetic parts to orthopedic surgeons
I selling the case against my previous work they loved
It takes me 3 hours to sell the case
They fret until the BB3 goes in
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Connecting the dots
bull Adult SDB and OSA
bull Narrow jaws and faces
bull Soft tissue dysfunction
bull Early parafunctional habits ie open mouth posture
bull Environmental stressors
bull CPAP MARAUPPP SurgWherersquos the best
place to start treatment here
or here
1 Prevention 2 Undo the damage already done3 Establish good habits
When to start When damage from poor breathing is noticed and when bad habits are discovered
The strategies of Airway Orthodontics
Prevention
bull Remove ankyloglossiabull Promote breastfeedingbull Harden the dietbull Develop masticatory strengthbull Discourage oral habitsbull Promote whole-foods low sugar dietbull Reduce oropharyngeal obstructionbull Promote nasal breathing
Breathing retraining
bull Nasal rinsingbull Nasal clearingbull Decongesting
The goals of Airway Orthodontics
1 Breathing through the nose2 Lips together at rest3 Correct tongue position4 No facial muscles moving on swallowing5 Optimal forward facial development6 Class I occlusion7 Straight teeth8 Better stability long term
Myofunctional Trainers
Professors R Soulet and A Besombes
Dr Earl Bergeson
Dr Chris Farrell
The Multi ndash Family System
Orofacial MyofunctionalTherapy
Oral MyologyMyofunctional TherapyTongue Thrust Therapy
B Hockel 2012 Back
Undoing Bimaxillary Dysplasia
1 Maxillary deconstriction2 Maxillary advancement3 Maxillary impaction4 Mandibular advancement
1 Maxillary Expansion
Treatment for Bimaxillary Dysplasia
ALFCrozat
Bent Wire
HyraxHaas
Niti Exp BioBlocSchwartz
The Farrell BENT WIRE Systemtrade
Recommended Age Group 5-12 yrs
Arch Development in conjunction with the TRAINER Systemtrade
Dr John Mew
Establish Good Habits
1 Breathing through the nose2 Lips together at rest3 Correct tongue position4 No facial muscles moving on swallowing5 Stand and sit in balance6 Breath gently using the diaphragm7 Eat to nourish8 Sleep to rest
Ortho-Postural TrainingWorkshops
Breathing
Nutrition
Posture
Sleep
COPYRIGHTRoger L PriceOctober 2012
Posture Number
Forward head posturecan be a compensationfor a deficient airway
Sleep Screening and Hygiene
SQI = 10 SQI = 98
Integrative Healthcare
Function ProfessionalNasal clearing ENT Pulm MFT BreathingMuscle balance and tone MFT Myofunctional OrthoUndoing damage GP Pedo Ortho OMFSBreathing dynamics OPT MFT Breath PhysiologistPosture DC OPT PT OsteopathCranial balance OsteopathNutrition RDH Nutritionist Dietitian Sleep ENT Sleep Med DentNeurocognitive development Pedrsquon SLP Psych SpEd
The Interdisciplinary Center
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Now that I know
My personal missionTo create from what Irsquove
learned from the besta model for others to followhellipespecially the orthodontists
Myofunctional Orthodontics
Chris Farrell
John Flutter
German Ramierez
Damien OrsquoBrien
Myofunctional Research CoRancho Cucamonga
2008-2012
Oral Myology
Oral Myology Basic CourseJoy MoellerNYC 2011LA 2012
Oral Myology Levels 2 3Kim BenkertClifton 2012
Habit CessationShari GreenClifton 2013
Biobloc Orthotropics
BBO Mini-residencyBill Hang
Agora Hills2012-13
BBO IntensiveDrs John and Mike
MewLSFO2013
Breathing and Sleep
Buteyko MentorshipThe Breathing Center
Woodstock2010
Breathing Well ProgrammeJohn Flutter
2010 Ortho-Postural TrainingRoger Price
2013
Sleep DentistryMichael Gelb etal
NYU2012
ALF and Cranial
Jim Bronson2013 Tasha Turzo
Cranial Academy2014
Bucket Listbull ALF and Crozat (Bronsonrsquos course)bullMore on Biobloc (Hangrsquos Advanced London School)bull More Cranial (The Farm)bullChirodontics (Bob Walker)bull Airway Dentistry with Marc Cruz Jeff Rousebull Sleep Dentistrybull Less-than-Six with Kevin Boydbull Intra-mandibular Distraction Osteogenesis (IMDO)
Off My ListAnything that moves the teeth faster in the wrong direction
Whatrsquos an RO to do
To create from what Irsquove learned from the best
a model for others to followhellipespecially orthodontists
Teaching
Mt Sinai Pedo ResidencyAli Attaie
2010-2012
Montefiore Ortho ResidencyTony Maganzini
2012
2009-Present
Mt Sinai School of MedicinePedodontic Residency
Guest SpeakersJim BronsonMike MewKevin BoydSandra KahnJennifer TowRoger PricePaula Fabbie
Damien OrsquoBrien
First clinical program in myofunctional orthodontics
Airway and Facial DevelopmentCollaborative Webcast
Mark Cruz
AAPMD Symposium
wwwaapm
dorg
Annual MeetingApril 25-26 2014
Westin Chicago North Shore
the raphael center for integrative orthodontics
wwwalignminecomwwwbioblocnjcom
wwwmyobracenjcom
Integrative vs Conventional
Integrative vs Conventional
ldquoWith improvements in expansion orthodontics advances in myofunctional orthodontics and the growing recognition about sleep disordered breathing among children and adults it is time for orthodontics to expand its horizons There is now so much more we can oerrdquo
The Raphael name has been associated with high quality orthodontics in New Jersey for over 60 years Dr Barry Raphael has been a university trained orthodontic specialist and a member of the American Association of Orthodontists for 30 years
He has a wide range of techniques and services to offer He has studied oral myology applied kinesiology Buteyko breathing Biobloc Orthotropics and Myobrace as part of his integrative training He can offer Damon Invisalign Insignia and Incognito appliances designs as some of his many conventional orthodontic services too
Dr Raphael teaches his techniques at post-graduate residencies study clubs dental societies and for the Myofunctional Research Co He is available for presentations to any group interested in learning more about the benefits of integrative orthodontics
wwwalignminecomLearn about the choices you have in orthodontics
dr barry raphael Why its
too Early never
1425
bro
ad
str
ee
tc
lifto
n n
j 070
13
973-
778-
4222
fax
973-
778-
9625
nj s
pe
c
368
4
1425 broad street clifton nj 07013973-778-4222
wwwalignminecom
the raphael centerforintegrative orthodontics
the
raph
ael c
ente
r fo
rin
tegr
ativ
e or
thod
onti
cs
Learn about an important choice you need to make before starting braces
the raphael center for integrative education
the raphael center for integrative education
Ongoing Intro to Airway Orthodontics
April Biobloc Study Group
April Training Ortho-Postural Therapists w Roger Price
June MRC Myobrace Basic Series
August Airway Dentistry with Mark Cruz and company
October Advanced MFT with Sandy Coulson
October Less than Six with Kevin Boyd
(who else wants to play)
Mission to create a space for spreading the word about Airway and Orthotropic principles and practice
Orthodontics in the 21st Century
EstheticOrthodontics
AirwayOrthodontics
GeneticTooth-Focused
Dental PerfectionEsthetics Primary
Treating SymptomsAirway Ignorant
AdaptationMuscle-FocusedMedical Better
Esthetics SecondaryTreating Causes
Airway Conscious
The EndAnd
The Beginning
YZ 9yo M
bullLost upper d-spacebullInL = 36(+4)bullOJ = 9mmbullLip entrapmentbullLip Incompetence
Y Z 9yo M
Y Z 9yo M9mm OJ
Y Z 9yo M
Treatment Options
1 Type 1 Reduce InL open lost space BB3 to advance mandible
2 Type 2 Open lost space Align
3 Type 4 Extract four premolars
YZ 9yoM
50
40
30
20mm
yM A M J J A S O N D J F M A
boys
Hang Expanser
Upper and Lower
Brackets Hang Retainer
BB3
Incisor Goals
Type 2 Treatment Develop arch just enough to uncrowd
Biobloc Myofunctional Ortho Myofunctional Therapy Crozat ALF Expansion Orthodontics
Type 2 Uncrowding
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
bullLip incompetencebullLip entrapmentbullHypermentalisbullMouthbreathing
Type 2 Uncrowding
12 month progress
12 month progress
12 month progress
After Treatment
Bent-wire6 monthsMyobrace12 months
Hey RaphaelWhat about that
profile
ZP 9-5yoM
i
After Expansion Phase
Incomplete profile improvement better breathing head posture and sleep
Incisor Goals
Type 3 Treatment Maintain UI
Functional Orthodontics Expansion Orthodontics Distalization Ortho or No Treatment
Type 3 Maintain
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Bimax retrusion
Successful dental result
Profile Unimproved
Incisor Goals
Type 4 Treatment RetractExtrude UI
Extraction Orthodontics Retraction Ortho Distalization Ortho
Type 4 Retraction
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Bimax retrusion
Successful dental result
Failed Profile Result
Changes of pharyngeal airway size and hyoid bone position following orthodontic treatment of
Class I bimaxillary protrusion
Qingzhu Wanga Peizeng Jiab Nina K Andersonc Lin Wangd Jiuxiang Line
Angle Orthodontist Vol 00 No 0 0000 (pre-publication 2012)
ldquothe dimension of the velopharynx glossopharynx and hypopharynx were decreased after maximal retraction of anterior teeth with extraction of four premolarshelliprdquo ldquoAny factors that can influence the posture and position of tongue and soft palate may displace them backward andencroach upon the pharynxrdquo
ldquothe more the incisors were retracted the more the pharyngeal airway was reducedrdquo
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Backed into a corner
bull
Moving teeth faster more efficientlyhellipin the wrong direction
Now that wersquove made smoking unacceptable
could we not do the same withbull Sugarbull Processed foodbull Cheap milk and meatbull Fast foodbull Pill popping for symptomatic reliefbull Looking for the cure instead of the causebull Surgery as a quick fixbull Thinking braces are a status symbol
Each industry thrives on the status quoConsumers must drive the change
NP 10yM
NP
Sisterrsquos non-x ortho
Shersquos happyhellipbut Irsquom not so
I make my pitch for BBO
The dilemma of progress
(I forgot the progress pictureshellip)
Dad sells prosthetic parts to orthopedic surgeons
I selling the case against my previous work they loved
It takes me 3 hours to sell the case
They fret until the BB3 goes in
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Connecting the dots
bull Adult SDB and OSA
bull Narrow jaws and faces
bull Soft tissue dysfunction
bull Early parafunctional habits ie open mouth posture
bull Environmental stressors
bull CPAP MARAUPPP SurgWherersquos the best
place to start treatment here
or here
1 Prevention 2 Undo the damage already done3 Establish good habits
When to start When damage from poor breathing is noticed and when bad habits are discovered
The strategies of Airway Orthodontics
Prevention
bull Remove ankyloglossiabull Promote breastfeedingbull Harden the dietbull Develop masticatory strengthbull Discourage oral habitsbull Promote whole-foods low sugar dietbull Reduce oropharyngeal obstructionbull Promote nasal breathing
Breathing retraining
bull Nasal rinsingbull Nasal clearingbull Decongesting
The goals of Airway Orthodontics
1 Breathing through the nose2 Lips together at rest3 Correct tongue position4 No facial muscles moving on swallowing5 Optimal forward facial development6 Class I occlusion7 Straight teeth8 Better stability long term
Myofunctional Trainers
Professors R Soulet and A Besombes
Dr Earl Bergeson
Dr Chris Farrell
The Multi ndash Family System
Orofacial MyofunctionalTherapy
Oral MyologyMyofunctional TherapyTongue Thrust Therapy
B Hockel 2012 Back
Undoing Bimaxillary Dysplasia
1 Maxillary deconstriction2 Maxillary advancement3 Maxillary impaction4 Mandibular advancement
1 Maxillary Expansion
Treatment for Bimaxillary Dysplasia
ALFCrozat
Bent Wire
HyraxHaas
Niti Exp BioBlocSchwartz
The Farrell BENT WIRE Systemtrade
Recommended Age Group 5-12 yrs
Arch Development in conjunction with the TRAINER Systemtrade
Dr John Mew
Establish Good Habits
1 Breathing through the nose2 Lips together at rest3 Correct tongue position4 No facial muscles moving on swallowing5 Stand and sit in balance6 Breath gently using the diaphragm7 Eat to nourish8 Sleep to rest
Ortho-Postural TrainingWorkshops
Breathing
Nutrition
Posture
Sleep
COPYRIGHTRoger L PriceOctober 2012
Posture Number
Forward head posturecan be a compensationfor a deficient airway
Sleep Screening and Hygiene
SQI = 10 SQI = 98
Integrative Healthcare
Function ProfessionalNasal clearing ENT Pulm MFT BreathingMuscle balance and tone MFT Myofunctional OrthoUndoing damage GP Pedo Ortho OMFSBreathing dynamics OPT MFT Breath PhysiologistPosture DC OPT PT OsteopathCranial balance OsteopathNutrition RDH Nutritionist Dietitian Sleep ENT Sleep Med DentNeurocognitive development Pedrsquon SLP Psych SpEd
The Interdisciplinary Center
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Now that I know
My personal missionTo create from what Irsquove
learned from the besta model for others to followhellipespecially the orthodontists
Myofunctional Orthodontics
Chris Farrell
John Flutter
German Ramierez
Damien OrsquoBrien
Myofunctional Research CoRancho Cucamonga
2008-2012
Oral Myology
Oral Myology Basic CourseJoy MoellerNYC 2011LA 2012
Oral Myology Levels 2 3Kim BenkertClifton 2012
Habit CessationShari GreenClifton 2013
Biobloc Orthotropics
BBO Mini-residencyBill Hang
Agora Hills2012-13
BBO IntensiveDrs John and Mike
MewLSFO2013
Breathing and Sleep
Buteyko MentorshipThe Breathing Center
Woodstock2010
Breathing Well ProgrammeJohn Flutter
2010 Ortho-Postural TrainingRoger Price
2013
Sleep DentistryMichael Gelb etal
NYU2012
ALF and Cranial
Jim Bronson2013 Tasha Turzo
Cranial Academy2014
Bucket Listbull ALF and Crozat (Bronsonrsquos course)bullMore on Biobloc (Hangrsquos Advanced London School)bull More Cranial (The Farm)bullChirodontics (Bob Walker)bull Airway Dentistry with Marc Cruz Jeff Rousebull Sleep Dentistrybull Less-than-Six with Kevin Boydbull Intra-mandibular Distraction Osteogenesis (IMDO)
Off My ListAnything that moves the teeth faster in the wrong direction
Whatrsquos an RO to do
To create from what Irsquove learned from the best
a model for others to followhellipespecially orthodontists
Teaching
Mt Sinai Pedo ResidencyAli Attaie
2010-2012
Montefiore Ortho ResidencyTony Maganzini
2012
2009-Present
Mt Sinai School of MedicinePedodontic Residency
Guest SpeakersJim BronsonMike MewKevin BoydSandra KahnJennifer TowRoger PricePaula Fabbie
Damien OrsquoBrien
First clinical program in myofunctional orthodontics
Airway and Facial DevelopmentCollaborative Webcast
Mark Cruz
AAPMD Symposium
wwwaapm
dorg
Annual MeetingApril 25-26 2014
Westin Chicago North Shore
the raphael center for integrative orthodontics
wwwalignminecomwwwbioblocnjcom
wwwmyobracenjcom
Integrative vs Conventional
Integrative vs Conventional
ldquoWith improvements in expansion orthodontics advances in myofunctional orthodontics and the growing recognition about sleep disordered breathing among children and adults it is time for orthodontics to expand its horizons There is now so much more we can oerrdquo
The Raphael name has been associated with high quality orthodontics in New Jersey for over 60 years Dr Barry Raphael has been a university trained orthodontic specialist and a member of the American Association of Orthodontists for 30 years
He has a wide range of techniques and services to offer He has studied oral myology applied kinesiology Buteyko breathing Biobloc Orthotropics and Myobrace as part of his integrative training He can offer Damon Invisalign Insignia and Incognito appliances designs as some of his many conventional orthodontic services too
Dr Raphael teaches his techniques at post-graduate residencies study clubs dental societies and for the Myofunctional Research Co He is available for presentations to any group interested in learning more about the benefits of integrative orthodontics
wwwalignminecomLearn about the choices you have in orthodontics
dr barry raphael Why its
too Early never
1425
bro
ad
str
ee
tc
lifto
n n
j 070
13
973-
778-
4222
fax
973-
778-
9625
nj s
pe
c
368
4
1425 broad street clifton nj 07013973-778-4222
wwwalignminecom
the raphael centerforintegrative orthodontics
the
raph
ael c
ente
r fo
rin
tegr
ativ
e or
thod
onti
cs
Learn about an important choice you need to make before starting braces
the raphael center for integrative education
the raphael center for integrative education
Ongoing Intro to Airway Orthodontics
April Biobloc Study Group
April Training Ortho-Postural Therapists w Roger Price
June MRC Myobrace Basic Series
August Airway Dentistry with Mark Cruz and company
October Advanced MFT with Sandy Coulson
October Less than Six with Kevin Boyd
(who else wants to play)
Mission to create a space for spreading the word about Airway and Orthotropic principles and practice
Orthodontics in the 21st Century
EstheticOrthodontics
AirwayOrthodontics
GeneticTooth-Focused
Dental PerfectionEsthetics Primary
Treating SymptomsAirway Ignorant
AdaptationMuscle-FocusedMedical Better
Esthetics SecondaryTreating Causes
Airway Conscious
The EndAnd
The Beginning
Y Z 9yo M
Y Z 9yo M9mm OJ
Y Z 9yo M
Treatment Options
1 Type 1 Reduce InL open lost space BB3 to advance mandible
2 Type 2 Open lost space Align
3 Type 4 Extract four premolars
YZ 9yoM
50
40
30
20mm
yM A M J J A S O N D J F M A
boys
Hang Expanser
Upper and Lower
Brackets Hang Retainer
BB3
Incisor Goals
Type 2 Treatment Develop arch just enough to uncrowd
Biobloc Myofunctional Ortho Myofunctional Therapy Crozat ALF Expansion Orthodontics
Type 2 Uncrowding
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
bullLip incompetencebullLip entrapmentbullHypermentalisbullMouthbreathing
Type 2 Uncrowding
12 month progress
12 month progress
12 month progress
After Treatment
Bent-wire6 monthsMyobrace12 months
Hey RaphaelWhat about that
profile
ZP 9-5yoM
i
After Expansion Phase
Incomplete profile improvement better breathing head posture and sleep
Incisor Goals
Type 3 Treatment Maintain UI
Functional Orthodontics Expansion Orthodontics Distalization Ortho or No Treatment
Type 3 Maintain
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Bimax retrusion
Successful dental result
Profile Unimproved
Incisor Goals
Type 4 Treatment RetractExtrude UI
Extraction Orthodontics Retraction Ortho Distalization Ortho
Type 4 Retraction
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Bimax retrusion
Successful dental result
Failed Profile Result
Changes of pharyngeal airway size and hyoid bone position following orthodontic treatment of
Class I bimaxillary protrusion
Qingzhu Wanga Peizeng Jiab Nina K Andersonc Lin Wangd Jiuxiang Line
Angle Orthodontist Vol 00 No 0 0000 (pre-publication 2012)
ldquothe dimension of the velopharynx glossopharynx and hypopharynx were decreased after maximal retraction of anterior teeth with extraction of four premolarshelliprdquo ldquoAny factors that can influence the posture and position of tongue and soft palate may displace them backward andencroach upon the pharynxrdquo
ldquothe more the incisors were retracted the more the pharyngeal airway was reducedrdquo
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Backed into a corner
bull
Moving teeth faster more efficientlyhellipin the wrong direction
Now that wersquove made smoking unacceptable
could we not do the same withbull Sugarbull Processed foodbull Cheap milk and meatbull Fast foodbull Pill popping for symptomatic reliefbull Looking for the cure instead of the causebull Surgery as a quick fixbull Thinking braces are a status symbol
Each industry thrives on the status quoConsumers must drive the change
NP 10yM
NP
Sisterrsquos non-x ortho
Shersquos happyhellipbut Irsquom not so
I make my pitch for BBO
The dilemma of progress
(I forgot the progress pictureshellip)
Dad sells prosthetic parts to orthopedic surgeons
I selling the case against my previous work they loved
It takes me 3 hours to sell the case
They fret until the BB3 goes in
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Connecting the dots
bull Adult SDB and OSA
bull Narrow jaws and faces
bull Soft tissue dysfunction
bull Early parafunctional habits ie open mouth posture
bull Environmental stressors
bull CPAP MARAUPPP SurgWherersquos the best
place to start treatment here
or here
1 Prevention 2 Undo the damage already done3 Establish good habits
When to start When damage from poor breathing is noticed and when bad habits are discovered
The strategies of Airway Orthodontics
Prevention
bull Remove ankyloglossiabull Promote breastfeedingbull Harden the dietbull Develop masticatory strengthbull Discourage oral habitsbull Promote whole-foods low sugar dietbull Reduce oropharyngeal obstructionbull Promote nasal breathing
Breathing retraining
bull Nasal rinsingbull Nasal clearingbull Decongesting
The goals of Airway Orthodontics
1 Breathing through the nose2 Lips together at rest3 Correct tongue position4 No facial muscles moving on swallowing5 Optimal forward facial development6 Class I occlusion7 Straight teeth8 Better stability long term
Myofunctional Trainers
Professors R Soulet and A Besombes
Dr Earl Bergeson
Dr Chris Farrell
The Multi ndash Family System
Orofacial MyofunctionalTherapy
Oral MyologyMyofunctional TherapyTongue Thrust Therapy
B Hockel 2012 Back
Undoing Bimaxillary Dysplasia
1 Maxillary deconstriction2 Maxillary advancement3 Maxillary impaction4 Mandibular advancement
1 Maxillary Expansion
Treatment for Bimaxillary Dysplasia
ALFCrozat
Bent Wire
HyraxHaas
Niti Exp BioBlocSchwartz
The Farrell BENT WIRE Systemtrade
Recommended Age Group 5-12 yrs
Arch Development in conjunction with the TRAINER Systemtrade
Dr John Mew
Establish Good Habits
1 Breathing through the nose2 Lips together at rest3 Correct tongue position4 No facial muscles moving on swallowing5 Stand and sit in balance6 Breath gently using the diaphragm7 Eat to nourish8 Sleep to rest
Ortho-Postural TrainingWorkshops
Breathing
Nutrition
Posture
Sleep
COPYRIGHTRoger L PriceOctober 2012
Posture Number
Forward head posturecan be a compensationfor a deficient airway
Sleep Screening and Hygiene
SQI = 10 SQI = 98
Integrative Healthcare
Function ProfessionalNasal clearing ENT Pulm MFT BreathingMuscle balance and tone MFT Myofunctional OrthoUndoing damage GP Pedo Ortho OMFSBreathing dynamics OPT MFT Breath PhysiologistPosture DC OPT PT OsteopathCranial balance OsteopathNutrition RDH Nutritionist Dietitian Sleep ENT Sleep Med DentNeurocognitive development Pedrsquon SLP Psych SpEd
The Interdisciplinary Center
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Now that I know
My personal missionTo create from what Irsquove
learned from the besta model for others to followhellipespecially the orthodontists
Myofunctional Orthodontics
Chris Farrell
John Flutter
German Ramierez
Damien OrsquoBrien
Myofunctional Research CoRancho Cucamonga
2008-2012
Oral Myology
Oral Myology Basic CourseJoy MoellerNYC 2011LA 2012
Oral Myology Levels 2 3Kim BenkertClifton 2012
Habit CessationShari GreenClifton 2013
Biobloc Orthotropics
BBO Mini-residencyBill Hang
Agora Hills2012-13
BBO IntensiveDrs John and Mike
MewLSFO2013
Breathing and Sleep
Buteyko MentorshipThe Breathing Center
Woodstock2010
Breathing Well ProgrammeJohn Flutter
2010 Ortho-Postural TrainingRoger Price
2013
Sleep DentistryMichael Gelb etal
NYU2012
ALF and Cranial
Jim Bronson2013 Tasha Turzo
Cranial Academy2014
Bucket Listbull ALF and Crozat (Bronsonrsquos course)bullMore on Biobloc (Hangrsquos Advanced London School)bull More Cranial (The Farm)bullChirodontics (Bob Walker)bull Airway Dentistry with Marc Cruz Jeff Rousebull Sleep Dentistrybull Less-than-Six with Kevin Boydbull Intra-mandibular Distraction Osteogenesis (IMDO)
Off My ListAnything that moves the teeth faster in the wrong direction
Whatrsquos an RO to do
To create from what Irsquove learned from the best
a model for others to followhellipespecially orthodontists
Teaching
Mt Sinai Pedo ResidencyAli Attaie
2010-2012
Montefiore Ortho ResidencyTony Maganzini
2012
2009-Present
Mt Sinai School of MedicinePedodontic Residency
Guest SpeakersJim BronsonMike MewKevin BoydSandra KahnJennifer TowRoger PricePaula Fabbie
Damien OrsquoBrien
First clinical program in myofunctional orthodontics
Airway and Facial DevelopmentCollaborative Webcast
Mark Cruz
AAPMD Symposium
wwwaapm
dorg
Annual MeetingApril 25-26 2014
Westin Chicago North Shore
the raphael center for integrative orthodontics
wwwalignminecomwwwbioblocnjcom
wwwmyobracenjcom
Integrative vs Conventional
Integrative vs Conventional
ldquoWith improvements in expansion orthodontics advances in myofunctional orthodontics and the growing recognition about sleep disordered breathing among children and adults it is time for orthodontics to expand its horizons There is now so much more we can oerrdquo
The Raphael name has been associated with high quality orthodontics in New Jersey for over 60 years Dr Barry Raphael has been a university trained orthodontic specialist and a member of the American Association of Orthodontists for 30 years
He has a wide range of techniques and services to offer He has studied oral myology applied kinesiology Buteyko breathing Biobloc Orthotropics and Myobrace as part of his integrative training He can offer Damon Invisalign Insignia and Incognito appliances designs as some of his many conventional orthodontic services too
Dr Raphael teaches his techniques at post-graduate residencies study clubs dental societies and for the Myofunctional Research Co He is available for presentations to any group interested in learning more about the benefits of integrative orthodontics
wwwalignminecomLearn about the choices you have in orthodontics
dr barry raphael Why its
too Early never
1425
bro
ad
str
ee
tc
lifto
n n
j 070
13
973-
778-
4222
fax
973-
778-
9625
nj s
pe
c
368
4
1425 broad street clifton nj 07013973-778-4222
wwwalignminecom
the raphael centerforintegrative orthodontics
the
raph
ael c
ente
r fo
rin
tegr
ativ
e or
thod
onti
cs
Learn about an important choice you need to make before starting braces
the raphael center for integrative education
the raphael center for integrative education
Ongoing Intro to Airway Orthodontics
April Biobloc Study Group
April Training Ortho-Postural Therapists w Roger Price
June MRC Myobrace Basic Series
August Airway Dentistry with Mark Cruz and company
October Advanced MFT with Sandy Coulson
October Less than Six with Kevin Boyd
(who else wants to play)
Mission to create a space for spreading the word about Airway and Orthotropic principles and practice
Orthodontics in the 21st Century
EstheticOrthodontics
AirwayOrthodontics
GeneticTooth-Focused
Dental PerfectionEsthetics Primary
Treating SymptomsAirway Ignorant
AdaptationMuscle-FocusedMedical Better
Esthetics SecondaryTreating Causes
Airway Conscious
The EndAnd
The Beginning
Y Z 9yo M9mm OJ
Y Z 9yo M
Treatment Options
1 Type 1 Reduce InL open lost space BB3 to advance mandible
2 Type 2 Open lost space Align
3 Type 4 Extract four premolars
YZ 9yoM
50
40
30
20mm
yM A M J J A S O N D J F M A
boys
Hang Expanser
Upper and Lower
Brackets Hang Retainer
BB3
Incisor Goals
Type 2 Treatment Develop arch just enough to uncrowd
Biobloc Myofunctional Ortho Myofunctional Therapy Crozat ALF Expansion Orthodontics
Type 2 Uncrowding
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
bullLip incompetencebullLip entrapmentbullHypermentalisbullMouthbreathing
Type 2 Uncrowding
12 month progress
12 month progress
12 month progress
After Treatment
Bent-wire6 monthsMyobrace12 months
Hey RaphaelWhat about that
profile
ZP 9-5yoM
i
After Expansion Phase
Incomplete profile improvement better breathing head posture and sleep
Incisor Goals
Type 3 Treatment Maintain UI
Functional Orthodontics Expansion Orthodontics Distalization Ortho or No Treatment
Type 3 Maintain
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Bimax retrusion
Successful dental result
Profile Unimproved
Incisor Goals
Type 4 Treatment RetractExtrude UI
Extraction Orthodontics Retraction Ortho Distalization Ortho
Type 4 Retraction
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Bimax retrusion
Successful dental result
Failed Profile Result
Changes of pharyngeal airway size and hyoid bone position following orthodontic treatment of
Class I bimaxillary protrusion
Qingzhu Wanga Peizeng Jiab Nina K Andersonc Lin Wangd Jiuxiang Line
Angle Orthodontist Vol 00 No 0 0000 (pre-publication 2012)
ldquothe dimension of the velopharynx glossopharynx and hypopharynx were decreased after maximal retraction of anterior teeth with extraction of four premolarshelliprdquo ldquoAny factors that can influence the posture and position of tongue and soft palate may displace them backward andencroach upon the pharynxrdquo
ldquothe more the incisors were retracted the more the pharyngeal airway was reducedrdquo
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Backed into a corner
bull
Moving teeth faster more efficientlyhellipin the wrong direction
Now that wersquove made smoking unacceptable
could we not do the same withbull Sugarbull Processed foodbull Cheap milk and meatbull Fast foodbull Pill popping for symptomatic reliefbull Looking for the cure instead of the causebull Surgery as a quick fixbull Thinking braces are a status symbol
Each industry thrives on the status quoConsumers must drive the change
NP 10yM
NP
Sisterrsquos non-x ortho
Shersquos happyhellipbut Irsquom not so
I make my pitch for BBO
The dilemma of progress
(I forgot the progress pictureshellip)
Dad sells prosthetic parts to orthopedic surgeons
I selling the case against my previous work they loved
It takes me 3 hours to sell the case
They fret until the BB3 goes in
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Connecting the dots
bull Adult SDB and OSA
bull Narrow jaws and faces
bull Soft tissue dysfunction
bull Early parafunctional habits ie open mouth posture
bull Environmental stressors
bull CPAP MARAUPPP SurgWherersquos the best
place to start treatment here
or here
1 Prevention 2 Undo the damage already done3 Establish good habits
When to start When damage from poor breathing is noticed and when bad habits are discovered
The strategies of Airway Orthodontics
Prevention
bull Remove ankyloglossiabull Promote breastfeedingbull Harden the dietbull Develop masticatory strengthbull Discourage oral habitsbull Promote whole-foods low sugar dietbull Reduce oropharyngeal obstructionbull Promote nasal breathing
Breathing retraining
bull Nasal rinsingbull Nasal clearingbull Decongesting
The goals of Airway Orthodontics
1 Breathing through the nose2 Lips together at rest3 Correct tongue position4 No facial muscles moving on swallowing5 Optimal forward facial development6 Class I occlusion7 Straight teeth8 Better stability long term
Myofunctional Trainers
Professors R Soulet and A Besombes
Dr Earl Bergeson
Dr Chris Farrell
The Multi ndash Family System
Orofacial MyofunctionalTherapy
Oral MyologyMyofunctional TherapyTongue Thrust Therapy
B Hockel 2012 Back
Undoing Bimaxillary Dysplasia
1 Maxillary deconstriction2 Maxillary advancement3 Maxillary impaction4 Mandibular advancement
1 Maxillary Expansion
Treatment for Bimaxillary Dysplasia
ALFCrozat
Bent Wire
HyraxHaas
Niti Exp BioBlocSchwartz
The Farrell BENT WIRE Systemtrade
Recommended Age Group 5-12 yrs
Arch Development in conjunction with the TRAINER Systemtrade
Dr John Mew
Establish Good Habits
1 Breathing through the nose2 Lips together at rest3 Correct tongue position4 No facial muscles moving on swallowing5 Stand and sit in balance6 Breath gently using the diaphragm7 Eat to nourish8 Sleep to rest
Ortho-Postural TrainingWorkshops
Breathing
Nutrition
Posture
Sleep
COPYRIGHTRoger L PriceOctober 2012
Posture Number
Forward head posturecan be a compensationfor a deficient airway
Sleep Screening and Hygiene
SQI = 10 SQI = 98
Integrative Healthcare
Function ProfessionalNasal clearing ENT Pulm MFT BreathingMuscle balance and tone MFT Myofunctional OrthoUndoing damage GP Pedo Ortho OMFSBreathing dynamics OPT MFT Breath PhysiologistPosture DC OPT PT OsteopathCranial balance OsteopathNutrition RDH Nutritionist Dietitian Sleep ENT Sleep Med DentNeurocognitive development Pedrsquon SLP Psych SpEd
The Interdisciplinary Center
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Now that I know
My personal missionTo create from what Irsquove
learned from the besta model for others to followhellipespecially the orthodontists
Myofunctional Orthodontics
Chris Farrell
John Flutter
German Ramierez
Damien OrsquoBrien
Myofunctional Research CoRancho Cucamonga
2008-2012
Oral Myology
Oral Myology Basic CourseJoy MoellerNYC 2011LA 2012
Oral Myology Levels 2 3Kim BenkertClifton 2012
Habit CessationShari GreenClifton 2013
Biobloc Orthotropics
BBO Mini-residencyBill Hang
Agora Hills2012-13
BBO IntensiveDrs John and Mike
MewLSFO2013
Breathing and Sleep
Buteyko MentorshipThe Breathing Center
Woodstock2010
Breathing Well ProgrammeJohn Flutter
2010 Ortho-Postural TrainingRoger Price
2013
Sleep DentistryMichael Gelb etal
NYU2012
ALF and Cranial
Jim Bronson2013 Tasha Turzo
Cranial Academy2014
Bucket Listbull ALF and Crozat (Bronsonrsquos course)bullMore on Biobloc (Hangrsquos Advanced London School)bull More Cranial (The Farm)bullChirodontics (Bob Walker)bull Airway Dentistry with Marc Cruz Jeff Rousebull Sleep Dentistrybull Less-than-Six with Kevin Boydbull Intra-mandibular Distraction Osteogenesis (IMDO)
Off My ListAnything that moves the teeth faster in the wrong direction
Whatrsquos an RO to do
To create from what Irsquove learned from the best
a model for others to followhellipespecially orthodontists
Teaching
Mt Sinai Pedo ResidencyAli Attaie
2010-2012
Montefiore Ortho ResidencyTony Maganzini
2012
2009-Present
Mt Sinai School of MedicinePedodontic Residency
Guest SpeakersJim BronsonMike MewKevin BoydSandra KahnJennifer TowRoger PricePaula Fabbie
Damien OrsquoBrien
First clinical program in myofunctional orthodontics
Airway and Facial DevelopmentCollaborative Webcast
Mark Cruz
AAPMD Symposium
wwwaapm
dorg
Annual MeetingApril 25-26 2014
Westin Chicago North Shore
the raphael center for integrative orthodontics
wwwalignminecomwwwbioblocnjcom
wwwmyobracenjcom
Integrative vs Conventional
Integrative vs Conventional
ldquoWith improvements in expansion orthodontics advances in myofunctional orthodontics and the growing recognition about sleep disordered breathing among children and adults it is time for orthodontics to expand its horizons There is now so much more we can oerrdquo
The Raphael name has been associated with high quality orthodontics in New Jersey for over 60 years Dr Barry Raphael has been a university trained orthodontic specialist and a member of the American Association of Orthodontists for 30 years
He has a wide range of techniques and services to offer He has studied oral myology applied kinesiology Buteyko breathing Biobloc Orthotropics and Myobrace as part of his integrative training He can offer Damon Invisalign Insignia and Incognito appliances designs as some of his many conventional orthodontic services too
Dr Raphael teaches his techniques at post-graduate residencies study clubs dental societies and for the Myofunctional Research Co He is available for presentations to any group interested in learning more about the benefits of integrative orthodontics
wwwalignminecomLearn about the choices you have in orthodontics
dr barry raphael Why its
too Early never
1425
bro
ad
str
ee
tc
lifto
n n
j 070
13
973-
778-
4222
fax
973-
778-
9625
nj s
pe
c
368
4
1425 broad street clifton nj 07013973-778-4222
wwwalignminecom
the raphael centerforintegrative orthodontics
the
raph
ael c
ente
r fo
rin
tegr
ativ
e or
thod
onti
cs
Learn about an important choice you need to make before starting braces
the raphael center for integrative education
the raphael center for integrative education
Ongoing Intro to Airway Orthodontics
April Biobloc Study Group
April Training Ortho-Postural Therapists w Roger Price
June MRC Myobrace Basic Series
August Airway Dentistry with Mark Cruz and company
October Advanced MFT with Sandy Coulson
October Less than Six with Kevin Boyd
(who else wants to play)
Mission to create a space for spreading the word about Airway and Orthotropic principles and practice
Orthodontics in the 21st Century
EstheticOrthodontics
AirwayOrthodontics
GeneticTooth-Focused
Dental PerfectionEsthetics Primary
Treating SymptomsAirway Ignorant
AdaptationMuscle-FocusedMedical Better
Esthetics SecondaryTreating Causes
Airway Conscious
The EndAnd
The Beginning
Y Z 9yo M
Treatment Options
1 Type 1 Reduce InL open lost space BB3 to advance mandible
2 Type 2 Open lost space Align
3 Type 4 Extract four premolars
YZ 9yoM
50
40
30
20mm
yM A M J J A S O N D J F M A
boys
Hang Expanser
Upper and Lower
Brackets Hang Retainer
BB3
Incisor Goals
Type 2 Treatment Develop arch just enough to uncrowd
Biobloc Myofunctional Ortho Myofunctional Therapy Crozat ALF Expansion Orthodontics
Type 2 Uncrowding
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
bullLip incompetencebullLip entrapmentbullHypermentalisbullMouthbreathing
Type 2 Uncrowding
12 month progress
12 month progress
12 month progress
After Treatment
Bent-wire6 monthsMyobrace12 months
Hey RaphaelWhat about that
profile
ZP 9-5yoM
i
After Expansion Phase
Incomplete profile improvement better breathing head posture and sleep
Incisor Goals
Type 3 Treatment Maintain UI
Functional Orthodontics Expansion Orthodontics Distalization Ortho or No Treatment
Type 3 Maintain
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Bimax retrusion
Successful dental result
Profile Unimproved
Incisor Goals
Type 4 Treatment RetractExtrude UI
Extraction Orthodontics Retraction Ortho Distalization Ortho
Type 4 Retraction
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Bimax retrusion
Successful dental result
Failed Profile Result
Changes of pharyngeal airway size and hyoid bone position following orthodontic treatment of
Class I bimaxillary protrusion
Qingzhu Wanga Peizeng Jiab Nina K Andersonc Lin Wangd Jiuxiang Line
Angle Orthodontist Vol 00 No 0 0000 (pre-publication 2012)
ldquothe dimension of the velopharynx glossopharynx and hypopharynx were decreased after maximal retraction of anterior teeth with extraction of four premolarshelliprdquo ldquoAny factors that can influence the posture and position of tongue and soft palate may displace them backward andencroach upon the pharynxrdquo
ldquothe more the incisors were retracted the more the pharyngeal airway was reducedrdquo
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Backed into a corner
bull
Moving teeth faster more efficientlyhellipin the wrong direction
Now that wersquove made smoking unacceptable
could we not do the same withbull Sugarbull Processed foodbull Cheap milk and meatbull Fast foodbull Pill popping for symptomatic reliefbull Looking for the cure instead of the causebull Surgery as a quick fixbull Thinking braces are a status symbol
Each industry thrives on the status quoConsumers must drive the change
NP 10yM
NP
Sisterrsquos non-x ortho
Shersquos happyhellipbut Irsquom not so
I make my pitch for BBO
The dilemma of progress
(I forgot the progress pictureshellip)
Dad sells prosthetic parts to orthopedic surgeons
I selling the case against my previous work they loved
It takes me 3 hours to sell the case
They fret until the BB3 goes in
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Connecting the dots
bull Adult SDB and OSA
bull Narrow jaws and faces
bull Soft tissue dysfunction
bull Early parafunctional habits ie open mouth posture
bull Environmental stressors
bull CPAP MARAUPPP SurgWherersquos the best
place to start treatment here
or here
1 Prevention 2 Undo the damage already done3 Establish good habits
When to start When damage from poor breathing is noticed and when bad habits are discovered
The strategies of Airway Orthodontics
Prevention
bull Remove ankyloglossiabull Promote breastfeedingbull Harden the dietbull Develop masticatory strengthbull Discourage oral habitsbull Promote whole-foods low sugar dietbull Reduce oropharyngeal obstructionbull Promote nasal breathing
Breathing retraining
bull Nasal rinsingbull Nasal clearingbull Decongesting
The goals of Airway Orthodontics
1 Breathing through the nose2 Lips together at rest3 Correct tongue position4 No facial muscles moving on swallowing5 Optimal forward facial development6 Class I occlusion7 Straight teeth8 Better stability long term
Myofunctional Trainers
Professors R Soulet and A Besombes
Dr Earl Bergeson
Dr Chris Farrell
The Multi ndash Family System
Orofacial MyofunctionalTherapy
Oral MyologyMyofunctional TherapyTongue Thrust Therapy
B Hockel 2012 Back
Undoing Bimaxillary Dysplasia
1 Maxillary deconstriction2 Maxillary advancement3 Maxillary impaction4 Mandibular advancement
1 Maxillary Expansion
Treatment for Bimaxillary Dysplasia
ALFCrozat
Bent Wire
HyraxHaas
Niti Exp BioBlocSchwartz
The Farrell BENT WIRE Systemtrade
Recommended Age Group 5-12 yrs
Arch Development in conjunction with the TRAINER Systemtrade
Dr John Mew
Establish Good Habits
1 Breathing through the nose2 Lips together at rest3 Correct tongue position4 No facial muscles moving on swallowing5 Stand and sit in balance6 Breath gently using the diaphragm7 Eat to nourish8 Sleep to rest
Ortho-Postural TrainingWorkshops
Breathing
Nutrition
Posture
Sleep
COPYRIGHTRoger L PriceOctober 2012
Posture Number
Forward head posturecan be a compensationfor a deficient airway
Sleep Screening and Hygiene
SQI = 10 SQI = 98
Integrative Healthcare
Function ProfessionalNasal clearing ENT Pulm MFT BreathingMuscle balance and tone MFT Myofunctional OrthoUndoing damage GP Pedo Ortho OMFSBreathing dynamics OPT MFT Breath PhysiologistPosture DC OPT PT OsteopathCranial balance OsteopathNutrition RDH Nutritionist Dietitian Sleep ENT Sleep Med DentNeurocognitive development Pedrsquon SLP Psych SpEd
The Interdisciplinary Center
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Now that I know
My personal missionTo create from what Irsquove
learned from the besta model for others to followhellipespecially the orthodontists
Myofunctional Orthodontics
Chris Farrell
John Flutter
German Ramierez
Damien OrsquoBrien
Myofunctional Research CoRancho Cucamonga
2008-2012
Oral Myology
Oral Myology Basic CourseJoy MoellerNYC 2011LA 2012
Oral Myology Levels 2 3Kim BenkertClifton 2012
Habit CessationShari GreenClifton 2013
Biobloc Orthotropics
BBO Mini-residencyBill Hang
Agora Hills2012-13
BBO IntensiveDrs John and Mike
MewLSFO2013
Breathing and Sleep
Buteyko MentorshipThe Breathing Center
Woodstock2010
Breathing Well ProgrammeJohn Flutter
2010 Ortho-Postural TrainingRoger Price
2013
Sleep DentistryMichael Gelb etal
NYU2012
ALF and Cranial
Jim Bronson2013 Tasha Turzo
Cranial Academy2014
Bucket Listbull ALF and Crozat (Bronsonrsquos course)bullMore on Biobloc (Hangrsquos Advanced London School)bull More Cranial (The Farm)bullChirodontics (Bob Walker)bull Airway Dentistry with Marc Cruz Jeff Rousebull Sleep Dentistrybull Less-than-Six with Kevin Boydbull Intra-mandibular Distraction Osteogenesis (IMDO)
Off My ListAnything that moves the teeth faster in the wrong direction
Whatrsquos an RO to do
To create from what Irsquove learned from the best
a model for others to followhellipespecially orthodontists
Teaching
Mt Sinai Pedo ResidencyAli Attaie
2010-2012
Montefiore Ortho ResidencyTony Maganzini
2012
2009-Present
Mt Sinai School of MedicinePedodontic Residency
Guest SpeakersJim BronsonMike MewKevin BoydSandra KahnJennifer TowRoger PricePaula Fabbie
Damien OrsquoBrien
First clinical program in myofunctional orthodontics
Airway and Facial DevelopmentCollaborative Webcast
Mark Cruz
AAPMD Symposium
wwwaapm
dorg
Annual MeetingApril 25-26 2014
Westin Chicago North Shore
the raphael center for integrative orthodontics
wwwalignminecomwwwbioblocnjcom
wwwmyobracenjcom
Integrative vs Conventional
Integrative vs Conventional
ldquoWith improvements in expansion orthodontics advances in myofunctional orthodontics and the growing recognition about sleep disordered breathing among children and adults it is time for orthodontics to expand its horizons There is now so much more we can oerrdquo
The Raphael name has been associated with high quality orthodontics in New Jersey for over 60 years Dr Barry Raphael has been a university trained orthodontic specialist and a member of the American Association of Orthodontists for 30 years
He has a wide range of techniques and services to offer He has studied oral myology applied kinesiology Buteyko breathing Biobloc Orthotropics and Myobrace as part of his integrative training He can offer Damon Invisalign Insignia and Incognito appliances designs as some of his many conventional orthodontic services too
Dr Raphael teaches his techniques at post-graduate residencies study clubs dental societies and for the Myofunctional Research Co He is available for presentations to any group interested in learning more about the benefits of integrative orthodontics
wwwalignminecomLearn about the choices you have in orthodontics
dr barry raphael Why its
too Early never
1425
bro
ad
str
ee
tc
lifto
n n
j 070
13
973-
778-
4222
fax
973-
778-
9625
nj s
pe
c
368
4
1425 broad street clifton nj 07013973-778-4222
wwwalignminecom
the raphael centerforintegrative orthodontics
the
raph
ael c
ente
r fo
rin
tegr
ativ
e or
thod
onti
cs
Learn about an important choice you need to make before starting braces
the raphael center for integrative education
the raphael center for integrative education
Ongoing Intro to Airway Orthodontics
April Biobloc Study Group
April Training Ortho-Postural Therapists w Roger Price
June MRC Myobrace Basic Series
August Airway Dentistry with Mark Cruz and company
October Advanced MFT with Sandy Coulson
October Less than Six with Kevin Boyd
(who else wants to play)
Mission to create a space for spreading the word about Airway and Orthotropic principles and practice
Orthodontics in the 21st Century
EstheticOrthodontics
AirwayOrthodontics
GeneticTooth-Focused
Dental PerfectionEsthetics Primary
Treating SymptomsAirway Ignorant
AdaptationMuscle-FocusedMedical Better
Esthetics SecondaryTreating Causes
Airway Conscious
The EndAnd
The Beginning
Treatment Options
1 Type 1 Reduce InL open lost space BB3 to advance mandible
2 Type 2 Open lost space Align
3 Type 4 Extract four premolars
YZ 9yoM
50
40
30
20mm
yM A M J J A S O N D J F M A
boys
Hang Expanser
Upper and Lower
Brackets Hang Retainer
BB3
Incisor Goals
Type 2 Treatment Develop arch just enough to uncrowd
Biobloc Myofunctional Ortho Myofunctional Therapy Crozat ALF Expansion Orthodontics
Type 2 Uncrowding
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
bullLip incompetencebullLip entrapmentbullHypermentalisbullMouthbreathing
Type 2 Uncrowding
12 month progress
12 month progress
12 month progress
After Treatment
Bent-wire6 monthsMyobrace12 months
Hey RaphaelWhat about that
profile
ZP 9-5yoM
i
After Expansion Phase
Incomplete profile improvement better breathing head posture and sleep
Incisor Goals
Type 3 Treatment Maintain UI
Functional Orthodontics Expansion Orthodontics Distalization Ortho or No Treatment
Type 3 Maintain
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Bimax retrusion
Successful dental result
Profile Unimproved
Incisor Goals
Type 4 Treatment RetractExtrude UI
Extraction Orthodontics Retraction Ortho Distalization Ortho
Type 4 Retraction
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Bimax retrusion
Successful dental result
Failed Profile Result
Changes of pharyngeal airway size and hyoid bone position following orthodontic treatment of
Class I bimaxillary protrusion
Qingzhu Wanga Peizeng Jiab Nina K Andersonc Lin Wangd Jiuxiang Line
Angle Orthodontist Vol 00 No 0 0000 (pre-publication 2012)
ldquothe dimension of the velopharynx glossopharynx and hypopharynx were decreased after maximal retraction of anterior teeth with extraction of four premolarshelliprdquo ldquoAny factors that can influence the posture and position of tongue and soft palate may displace them backward andencroach upon the pharynxrdquo
ldquothe more the incisors were retracted the more the pharyngeal airway was reducedrdquo
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Backed into a corner
bull
Moving teeth faster more efficientlyhellipin the wrong direction
Now that wersquove made smoking unacceptable
could we not do the same withbull Sugarbull Processed foodbull Cheap milk and meatbull Fast foodbull Pill popping for symptomatic reliefbull Looking for the cure instead of the causebull Surgery as a quick fixbull Thinking braces are a status symbol
Each industry thrives on the status quoConsumers must drive the change
NP 10yM
NP
Sisterrsquos non-x ortho
Shersquos happyhellipbut Irsquom not so
I make my pitch for BBO
The dilemma of progress
(I forgot the progress pictureshellip)
Dad sells prosthetic parts to orthopedic surgeons
I selling the case against my previous work they loved
It takes me 3 hours to sell the case
They fret until the BB3 goes in
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Connecting the dots
bull Adult SDB and OSA
bull Narrow jaws and faces
bull Soft tissue dysfunction
bull Early parafunctional habits ie open mouth posture
bull Environmental stressors
bull CPAP MARAUPPP SurgWherersquos the best
place to start treatment here
or here
1 Prevention 2 Undo the damage already done3 Establish good habits
When to start When damage from poor breathing is noticed and when bad habits are discovered
The strategies of Airway Orthodontics
Prevention
bull Remove ankyloglossiabull Promote breastfeedingbull Harden the dietbull Develop masticatory strengthbull Discourage oral habitsbull Promote whole-foods low sugar dietbull Reduce oropharyngeal obstructionbull Promote nasal breathing
Breathing retraining
bull Nasal rinsingbull Nasal clearingbull Decongesting
The goals of Airway Orthodontics
1 Breathing through the nose2 Lips together at rest3 Correct tongue position4 No facial muscles moving on swallowing5 Optimal forward facial development6 Class I occlusion7 Straight teeth8 Better stability long term
Myofunctional Trainers
Professors R Soulet and A Besombes
Dr Earl Bergeson
Dr Chris Farrell
The Multi ndash Family System
Orofacial MyofunctionalTherapy
Oral MyologyMyofunctional TherapyTongue Thrust Therapy
B Hockel 2012 Back
Undoing Bimaxillary Dysplasia
1 Maxillary deconstriction2 Maxillary advancement3 Maxillary impaction4 Mandibular advancement
1 Maxillary Expansion
Treatment for Bimaxillary Dysplasia
ALFCrozat
Bent Wire
HyraxHaas
Niti Exp BioBlocSchwartz
The Farrell BENT WIRE Systemtrade
Recommended Age Group 5-12 yrs
Arch Development in conjunction with the TRAINER Systemtrade
Dr John Mew
Establish Good Habits
1 Breathing through the nose2 Lips together at rest3 Correct tongue position4 No facial muscles moving on swallowing5 Stand and sit in balance6 Breath gently using the diaphragm7 Eat to nourish8 Sleep to rest
Ortho-Postural TrainingWorkshops
Breathing
Nutrition
Posture
Sleep
COPYRIGHTRoger L PriceOctober 2012
Posture Number
Forward head posturecan be a compensationfor a deficient airway
Sleep Screening and Hygiene
SQI = 10 SQI = 98
Integrative Healthcare
Function ProfessionalNasal clearing ENT Pulm MFT BreathingMuscle balance and tone MFT Myofunctional OrthoUndoing damage GP Pedo Ortho OMFSBreathing dynamics OPT MFT Breath PhysiologistPosture DC OPT PT OsteopathCranial balance OsteopathNutrition RDH Nutritionist Dietitian Sleep ENT Sleep Med DentNeurocognitive development Pedrsquon SLP Psych SpEd
The Interdisciplinary Center
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Now that I know
My personal missionTo create from what Irsquove
learned from the besta model for others to followhellipespecially the orthodontists
Myofunctional Orthodontics
Chris Farrell
John Flutter
German Ramierez
Damien OrsquoBrien
Myofunctional Research CoRancho Cucamonga
2008-2012
Oral Myology
Oral Myology Basic CourseJoy MoellerNYC 2011LA 2012
Oral Myology Levels 2 3Kim BenkertClifton 2012
Habit CessationShari GreenClifton 2013
Biobloc Orthotropics
BBO Mini-residencyBill Hang
Agora Hills2012-13
BBO IntensiveDrs John and Mike
MewLSFO2013
Breathing and Sleep
Buteyko MentorshipThe Breathing Center
Woodstock2010
Breathing Well ProgrammeJohn Flutter
2010 Ortho-Postural TrainingRoger Price
2013
Sleep DentistryMichael Gelb etal
NYU2012
ALF and Cranial
Jim Bronson2013 Tasha Turzo
Cranial Academy2014
Bucket Listbull ALF and Crozat (Bronsonrsquos course)bullMore on Biobloc (Hangrsquos Advanced London School)bull More Cranial (The Farm)bullChirodontics (Bob Walker)bull Airway Dentistry with Marc Cruz Jeff Rousebull Sleep Dentistrybull Less-than-Six with Kevin Boydbull Intra-mandibular Distraction Osteogenesis (IMDO)
Off My ListAnything that moves the teeth faster in the wrong direction
Whatrsquos an RO to do
To create from what Irsquove learned from the best
a model for others to followhellipespecially orthodontists
Teaching
Mt Sinai Pedo ResidencyAli Attaie
2010-2012
Montefiore Ortho ResidencyTony Maganzini
2012
2009-Present
Mt Sinai School of MedicinePedodontic Residency
Guest SpeakersJim BronsonMike MewKevin BoydSandra KahnJennifer TowRoger PricePaula Fabbie
Damien OrsquoBrien
First clinical program in myofunctional orthodontics
Airway and Facial DevelopmentCollaborative Webcast
Mark Cruz
AAPMD Symposium
wwwaapm
dorg
Annual MeetingApril 25-26 2014
Westin Chicago North Shore
the raphael center for integrative orthodontics
wwwalignminecomwwwbioblocnjcom
wwwmyobracenjcom
Integrative vs Conventional
Integrative vs Conventional
ldquoWith improvements in expansion orthodontics advances in myofunctional orthodontics and the growing recognition about sleep disordered breathing among children and adults it is time for orthodontics to expand its horizons There is now so much more we can oerrdquo
The Raphael name has been associated with high quality orthodontics in New Jersey for over 60 years Dr Barry Raphael has been a university trained orthodontic specialist and a member of the American Association of Orthodontists for 30 years
He has a wide range of techniques and services to offer He has studied oral myology applied kinesiology Buteyko breathing Biobloc Orthotropics and Myobrace as part of his integrative training He can offer Damon Invisalign Insignia and Incognito appliances designs as some of his many conventional orthodontic services too
Dr Raphael teaches his techniques at post-graduate residencies study clubs dental societies and for the Myofunctional Research Co He is available for presentations to any group interested in learning more about the benefits of integrative orthodontics
wwwalignminecomLearn about the choices you have in orthodontics
dr barry raphael Why its
too Early never
1425
bro
ad
str
ee
tc
lifto
n n
j 070
13
973-
778-
4222
fax
973-
778-
9625
nj s
pe
c
368
4
1425 broad street clifton nj 07013973-778-4222
wwwalignminecom
the raphael centerforintegrative orthodontics
the
raph
ael c
ente
r fo
rin
tegr
ativ
e or
thod
onti
cs
Learn about an important choice you need to make before starting braces
the raphael center for integrative education
the raphael center for integrative education
Ongoing Intro to Airway Orthodontics
April Biobloc Study Group
April Training Ortho-Postural Therapists w Roger Price
June MRC Myobrace Basic Series
August Airway Dentistry with Mark Cruz and company
October Advanced MFT with Sandy Coulson
October Less than Six with Kevin Boyd
(who else wants to play)
Mission to create a space for spreading the word about Airway and Orthotropic principles and practice
Orthodontics in the 21st Century
EstheticOrthodontics
AirwayOrthodontics
GeneticTooth-Focused
Dental PerfectionEsthetics Primary
Treating SymptomsAirway Ignorant
AdaptationMuscle-FocusedMedical Better
Esthetics SecondaryTreating Causes
Airway Conscious
The EndAnd
The Beginning
YZ 9yoM
50
40
30
20mm
yM A M J J A S O N D J F M A
boys
Hang Expanser
Upper and Lower
Brackets Hang Retainer
BB3
Incisor Goals
Type 2 Treatment Develop arch just enough to uncrowd
Biobloc Myofunctional Ortho Myofunctional Therapy Crozat ALF Expansion Orthodontics
Type 2 Uncrowding
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
bullLip incompetencebullLip entrapmentbullHypermentalisbullMouthbreathing
Type 2 Uncrowding
12 month progress
12 month progress
12 month progress
After Treatment
Bent-wire6 monthsMyobrace12 months
Hey RaphaelWhat about that
profile
ZP 9-5yoM
i
After Expansion Phase
Incomplete profile improvement better breathing head posture and sleep
Incisor Goals
Type 3 Treatment Maintain UI
Functional Orthodontics Expansion Orthodontics Distalization Ortho or No Treatment
Type 3 Maintain
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Bimax retrusion
Successful dental result
Profile Unimproved
Incisor Goals
Type 4 Treatment RetractExtrude UI
Extraction Orthodontics Retraction Ortho Distalization Ortho
Type 4 Retraction
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Bimax retrusion
Successful dental result
Failed Profile Result
Changes of pharyngeal airway size and hyoid bone position following orthodontic treatment of
Class I bimaxillary protrusion
Qingzhu Wanga Peizeng Jiab Nina K Andersonc Lin Wangd Jiuxiang Line
Angle Orthodontist Vol 00 No 0 0000 (pre-publication 2012)
ldquothe dimension of the velopharynx glossopharynx and hypopharynx were decreased after maximal retraction of anterior teeth with extraction of four premolarshelliprdquo ldquoAny factors that can influence the posture and position of tongue and soft palate may displace them backward andencroach upon the pharynxrdquo
ldquothe more the incisors were retracted the more the pharyngeal airway was reducedrdquo
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Backed into a corner
bull
Moving teeth faster more efficientlyhellipin the wrong direction
Now that wersquove made smoking unacceptable
could we not do the same withbull Sugarbull Processed foodbull Cheap milk and meatbull Fast foodbull Pill popping for symptomatic reliefbull Looking for the cure instead of the causebull Surgery as a quick fixbull Thinking braces are a status symbol
Each industry thrives on the status quoConsumers must drive the change
NP 10yM
NP
Sisterrsquos non-x ortho
Shersquos happyhellipbut Irsquom not so
I make my pitch for BBO
The dilemma of progress
(I forgot the progress pictureshellip)
Dad sells prosthetic parts to orthopedic surgeons
I selling the case against my previous work they loved
It takes me 3 hours to sell the case
They fret until the BB3 goes in
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Connecting the dots
bull Adult SDB and OSA
bull Narrow jaws and faces
bull Soft tissue dysfunction
bull Early parafunctional habits ie open mouth posture
bull Environmental stressors
bull CPAP MARAUPPP SurgWherersquos the best
place to start treatment here
or here
1 Prevention 2 Undo the damage already done3 Establish good habits
When to start When damage from poor breathing is noticed and when bad habits are discovered
The strategies of Airway Orthodontics
Prevention
bull Remove ankyloglossiabull Promote breastfeedingbull Harden the dietbull Develop masticatory strengthbull Discourage oral habitsbull Promote whole-foods low sugar dietbull Reduce oropharyngeal obstructionbull Promote nasal breathing
Breathing retraining
bull Nasal rinsingbull Nasal clearingbull Decongesting
The goals of Airway Orthodontics
1 Breathing through the nose2 Lips together at rest3 Correct tongue position4 No facial muscles moving on swallowing5 Optimal forward facial development6 Class I occlusion7 Straight teeth8 Better stability long term
Myofunctional Trainers
Professors R Soulet and A Besombes
Dr Earl Bergeson
Dr Chris Farrell
The Multi ndash Family System
Orofacial MyofunctionalTherapy
Oral MyologyMyofunctional TherapyTongue Thrust Therapy
B Hockel 2012 Back
Undoing Bimaxillary Dysplasia
1 Maxillary deconstriction2 Maxillary advancement3 Maxillary impaction4 Mandibular advancement
1 Maxillary Expansion
Treatment for Bimaxillary Dysplasia
ALFCrozat
Bent Wire
HyraxHaas
Niti Exp BioBlocSchwartz
The Farrell BENT WIRE Systemtrade
Recommended Age Group 5-12 yrs
Arch Development in conjunction with the TRAINER Systemtrade
Dr John Mew
Establish Good Habits
1 Breathing through the nose2 Lips together at rest3 Correct tongue position4 No facial muscles moving on swallowing5 Stand and sit in balance6 Breath gently using the diaphragm7 Eat to nourish8 Sleep to rest
Ortho-Postural TrainingWorkshops
Breathing
Nutrition
Posture
Sleep
COPYRIGHTRoger L PriceOctober 2012
Posture Number
Forward head posturecan be a compensationfor a deficient airway
Sleep Screening and Hygiene
SQI = 10 SQI = 98
Integrative Healthcare
Function ProfessionalNasal clearing ENT Pulm MFT BreathingMuscle balance and tone MFT Myofunctional OrthoUndoing damage GP Pedo Ortho OMFSBreathing dynamics OPT MFT Breath PhysiologistPosture DC OPT PT OsteopathCranial balance OsteopathNutrition RDH Nutritionist Dietitian Sleep ENT Sleep Med DentNeurocognitive development Pedrsquon SLP Psych SpEd
The Interdisciplinary Center
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Now that I know
My personal missionTo create from what Irsquove
learned from the besta model for others to followhellipespecially the orthodontists
Myofunctional Orthodontics
Chris Farrell
John Flutter
German Ramierez
Damien OrsquoBrien
Myofunctional Research CoRancho Cucamonga
2008-2012
Oral Myology
Oral Myology Basic CourseJoy MoellerNYC 2011LA 2012
Oral Myology Levels 2 3Kim BenkertClifton 2012
Habit CessationShari GreenClifton 2013
Biobloc Orthotropics
BBO Mini-residencyBill Hang
Agora Hills2012-13
BBO IntensiveDrs John and Mike
MewLSFO2013
Breathing and Sleep
Buteyko MentorshipThe Breathing Center
Woodstock2010
Breathing Well ProgrammeJohn Flutter
2010 Ortho-Postural TrainingRoger Price
2013
Sleep DentistryMichael Gelb etal
NYU2012
ALF and Cranial
Jim Bronson2013 Tasha Turzo
Cranial Academy2014
Bucket Listbull ALF and Crozat (Bronsonrsquos course)bullMore on Biobloc (Hangrsquos Advanced London School)bull More Cranial (The Farm)bullChirodontics (Bob Walker)bull Airway Dentistry with Marc Cruz Jeff Rousebull Sleep Dentistrybull Less-than-Six with Kevin Boydbull Intra-mandibular Distraction Osteogenesis (IMDO)
Off My ListAnything that moves the teeth faster in the wrong direction
Whatrsquos an RO to do
To create from what Irsquove learned from the best
a model for others to followhellipespecially orthodontists
Teaching
Mt Sinai Pedo ResidencyAli Attaie
2010-2012
Montefiore Ortho ResidencyTony Maganzini
2012
2009-Present
Mt Sinai School of MedicinePedodontic Residency
Guest SpeakersJim BronsonMike MewKevin BoydSandra KahnJennifer TowRoger PricePaula Fabbie
Damien OrsquoBrien
First clinical program in myofunctional orthodontics
Airway and Facial DevelopmentCollaborative Webcast
Mark Cruz
AAPMD Symposium
wwwaapm
dorg
Annual MeetingApril 25-26 2014
Westin Chicago North Shore
the raphael center for integrative orthodontics
wwwalignminecomwwwbioblocnjcom
wwwmyobracenjcom
Integrative vs Conventional
Integrative vs Conventional
ldquoWith improvements in expansion orthodontics advances in myofunctional orthodontics and the growing recognition about sleep disordered breathing among children and adults it is time for orthodontics to expand its horizons There is now so much more we can oerrdquo
The Raphael name has been associated with high quality orthodontics in New Jersey for over 60 years Dr Barry Raphael has been a university trained orthodontic specialist and a member of the American Association of Orthodontists for 30 years
He has a wide range of techniques and services to offer He has studied oral myology applied kinesiology Buteyko breathing Biobloc Orthotropics and Myobrace as part of his integrative training He can offer Damon Invisalign Insignia and Incognito appliances designs as some of his many conventional orthodontic services too
Dr Raphael teaches his techniques at post-graduate residencies study clubs dental societies and for the Myofunctional Research Co He is available for presentations to any group interested in learning more about the benefits of integrative orthodontics
wwwalignminecomLearn about the choices you have in orthodontics
dr barry raphael Why its
too Early never
1425
bro
ad
str
ee
tc
lifto
n n
j 070
13
973-
778-
4222
fax
973-
778-
9625
nj s
pe
c
368
4
1425 broad street clifton nj 07013973-778-4222
wwwalignminecom
the raphael centerforintegrative orthodontics
the
raph
ael c
ente
r fo
rin
tegr
ativ
e or
thod
onti
cs
Learn about an important choice you need to make before starting braces
the raphael center for integrative education
the raphael center for integrative education
Ongoing Intro to Airway Orthodontics
April Biobloc Study Group
April Training Ortho-Postural Therapists w Roger Price
June MRC Myobrace Basic Series
August Airway Dentistry with Mark Cruz and company
October Advanced MFT with Sandy Coulson
October Less than Six with Kevin Boyd
(who else wants to play)
Mission to create a space for spreading the word about Airway and Orthotropic principles and practice
Orthodontics in the 21st Century
EstheticOrthodontics
AirwayOrthodontics
GeneticTooth-Focused
Dental PerfectionEsthetics Primary
Treating SymptomsAirway Ignorant
AdaptationMuscle-FocusedMedical Better
Esthetics SecondaryTreating Causes
Airway Conscious
The EndAnd
The Beginning
Incisor Goals
Type 2 Treatment Develop arch just enough to uncrowd
Biobloc Myofunctional Ortho Myofunctional Therapy Crozat ALF Expansion Orthodontics
Type 2 Uncrowding
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
bullLip incompetencebullLip entrapmentbullHypermentalisbullMouthbreathing
Type 2 Uncrowding
12 month progress
12 month progress
12 month progress
After Treatment
Bent-wire6 monthsMyobrace12 months
Hey RaphaelWhat about that
profile
ZP 9-5yoM
i
After Expansion Phase
Incomplete profile improvement better breathing head posture and sleep
Incisor Goals
Type 3 Treatment Maintain UI
Functional Orthodontics Expansion Orthodontics Distalization Ortho or No Treatment
Type 3 Maintain
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Bimax retrusion
Successful dental result
Profile Unimproved
Incisor Goals
Type 4 Treatment RetractExtrude UI
Extraction Orthodontics Retraction Ortho Distalization Ortho
Type 4 Retraction
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Bimax retrusion
Successful dental result
Failed Profile Result
Changes of pharyngeal airway size and hyoid bone position following orthodontic treatment of
Class I bimaxillary protrusion
Qingzhu Wanga Peizeng Jiab Nina K Andersonc Lin Wangd Jiuxiang Line
Angle Orthodontist Vol 00 No 0 0000 (pre-publication 2012)
ldquothe dimension of the velopharynx glossopharynx and hypopharynx were decreased after maximal retraction of anterior teeth with extraction of four premolarshelliprdquo ldquoAny factors that can influence the posture and position of tongue and soft palate may displace them backward andencroach upon the pharynxrdquo
ldquothe more the incisors were retracted the more the pharyngeal airway was reducedrdquo
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Backed into a corner
bull
Moving teeth faster more efficientlyhellipin the wrong direction
Now that wersquove made smoking unacceptable
could we not do the same withbull Sugarbull Processed foodbull Cheap milk and meatbull Fast foodbull Pill popping for symptomatic reliefbull Looking for the cure instead of the causebull Surgery as a quick fixbull Thinking braces are a status symbol
Each industry thrives on the status quoConsumers must drive the change
NP 10yM
NP
Sisterrsquos non-x ortho
Shersquos happyhellipbut Irsquom not so
I make my pitch for BBO
The dilemma of progress
(I forgot the progress pictureshellip)
Dad sells prosthetic parts to orthopedic surgeons
I selling the case against my previous work they loved
It takes me 3 hours to sell the case
They fret until the BB3 goes in
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Connecting the dots
bull Adult SDB and OSA
bull Narrow jaws and faces
bull Soft tissue dysfunction
bull Early parafunctional habits ie open mouth posture
bull Environmental stressors
bull CPAP MARAUPPP SurgWherersquos the best
place to start treatment here
or here
1 Prevention 2 Undo the damage already done3 Establish good habits
When to start When damage from poor breathing is noticed and when bad habits are discovered
The strategies of Airway Orthodontics
Prevention
bull Remove ankyloglossiabull Promote breastfeedingbull Harden the dietbull Develop masticatory strengthbull Discourage oral habitsbull Promote whole-foods low sugar dietbull Reduce oropharyngeal obstructionbull Promote nasal breathing
Breathing retraining
bull Nasal rinsingbull Nasal clearingbull Decongesting
The goals of Airway Orthodontics
1 Breathing through the nose2 Lips together at rest3 Correct tongue position4 No facial muscles moving on swallowing5 Optimal forward facial development6 Class I occlusion7 Straight teeth8 Better stability long term
Myofunctional Trainers
Professors R Soulet and A Besombes
Dr Earl Bergeson
Dr Chris Farrell
The Multi ndash Family System
Orofacial MyofunctionalTherapy
Oral MyologyMyofunctional TherapyTongue Thrust Therapy
B Hockel 2012 Back
Undoing Bimaxillary Dysplasia
1 Maxillary deconstriction2 Maxillary advancement3 Maxillary impaction4 Mandibular advancement
1 Maxillary Expansion
Treatment for Bimaxillary Dysplasia
ALFCrozat
Bent Wire
HyraxHaas
Niti Exp BioBlocSchwartz
The Farrell BENT WIRE Systemtrade
Recommended Age Group 5-12 yrs
Arch Development in conjunction with the TRAINER Systemtrade
Dr John Mew
Establish Good Habits
1 Breathing through the nose2 Lips together at rest3 Correct tongue position4 No facial muscles moving on swallowing5 Stand and sit in balance6 Breath gently using the diaphragm7 Eat to nourish8 Sleep to rest
Ortho-Postural TrainingWorkshops
Breathing
Nutrition
Posture
Sleep
COPYRIGHTRoger L PriceOctober 2012
Posture Number
Forward head posturecan be a compensationfor a deficient airway
Sleep Screening and Hygiene
SQI = 10 SQI = 98
Integrative Healthcare
Function ProfessionalNasal clearing ENT Pulm MFT BreathingMuscle balance and tone MFT Myofunctional OrthoUndoing damage GP Pedo Ortho OMFSBreathing dynamics OPT MFT Breath PhysiologistPosture DC OPT PT OsteopathCranial balance OsteopathNutrition RDH Nutritionist Dietitian Sleep ENT Sleep Med DentNeurocognitive development Pedrsquon SLP Psych SpEd
The Interdisciplinary Center
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Now that I know
My personal missionTo create from what Irsquove
learned from the besta model for others to followhellipespecially the orthodontists
Myofunctional Orthodontics
Chris Farrell
John Flutter
German Ramierez
Damien OrsquoBrien
Myofunctional Research CoRancho Cucamonga
2008-2012
Oral Myology
Oral Myology Basic CourseJoy MoellerNYC 2011LA 2012
Oral Myology Levels 2 3Kim BenkertClifton 2012
Habit CessationShari GreenClifton 2013
Biobloc Orthotropics
BBO Mini-residencyBill Hang
Agora Hills2012-13
BBO IntensiveDrs John and Mike
MewLSFO2013
Breathing and Sleep
Buteyko MentorshipThe Breathing Center
Woodstock2010
Breathing Well ProgrammeJohn Flutter
2010 Ortho-Postural TrainingRoger Price
2013
Sleep DentistryMichael Gelb etal
NYU2012
ALF and Cranial
Jim Bronson2013 Tasha Turzo
Cranial Academy2014
Bucket Listbull ALF and Crozat (Bronsonrsquos course)bullMore on Biobloc (Hangrsquos Advanced London School)bull More Cranial (The Farm)bullChirodontics (Bob Walker)bull Airway Dentistry with Marc Cruz Jeff Rousebull Sleep Dentistrybull Less-than-Six with Kevin Boydbull Intra-mandibular Distraction Osteogenesis (IMDO)
Off My ListAnything that moves the teeth faster in the wrong direction
Whatrsquos an RO to do
To create from what Irsquove learned from the best
a model for others to followhellipespecially orthodontists
Teaching
Mt Sinai Pedo ResidencyAli Attaie
2010-2012
Montefiore Ortho ResidencyTony Maganzini
2012
2009-Present
Mt Sinai School of MedicinePedodontic Residency
Guest SpeakersJim BronsonMike MewKevin BoydSandra KahnJennifer TowRoger PricePaula Fabbie
Damien OrsquoBrien
First clinical program in myofunctional orthodontics
Airway and Facial DevelopmentCollaborative Webcast
Mark Cruz
AAPMD Symposium
wwwaapm
dorg
Annual MeetingApril 25-26 2014
Westin Chicago North Shore
the raphael center for integrative orthodontics
wwwalignminecomwwwbioblocnjcom
wwwmyobracenjcom
Integrative vs Conventional
Integrative vs Conventional
ldquoWith improvements in expansion orthodontics advances in myofunctional orthodontics and the growing recognition about sleep disordered breathing among children and adults it is time for orthodontics to expand its horizons There is now so much more we can oerrdquo
The Raphael name has been associated with high quality orthodontics in New Jersey for over 60 years Dr Barry Raphael has been a university trained orthodontic specialist and a member of the American Association of Orthodontists for 30 years
He has a wide range of techniques and services to offer He has studied oral myology applied kinesiology Buteyko breathing Biobloc Orthotropics and Myobrace as part of his integrative training He can offer Damon Invisalign Insignia and Incognito appliances designs as some of his many conventional orthodontic services too
Dr Raphael teaches his techniques at post-graduate residencies study clubs dental societies and for the Myofunctional Research Co He is available for presentations to any group interested in learning more about the benefits of integrative orthodontics
wwwalignminecomLearn about the choices you have in orthodontics
dr barry raphael Why its
too Early never
1425
bro
ad
str
ee
tc
lifto
n n
j 070
13
973-
778-
4222
fax
973-
778-
9625
nj s
pe
c
368
4
1425 broad street clifton nj 07013973-778-4222
wwwalignminecom
the raphael centerforintegrative orthodontics
the
raph
ael c
ente
r fo
rin
tegr
ativ
e or
thod
onti
cs
Learn about an important choice you need to make before starting braces
the raphael center for integrative education
the raphael center for integrative education
Ongoing Intro to Airway Orthodontics
April Biobloc Study Group
April Training Ortho-Postural Therapists w Roger Price
June MRC Myobrace Basic Series
August Airway Dentistry with Mark Cruz and company
October Advanced MFT with Sandy Coulson
October Less than Six with Kevin Boyd
(who else wants to play)
Mission to create a space for spreading the word about Airway and Orthotropic principles and practice
Orthodontics in the 21st Century
EstheticOrthodontics
AirwayOrthodontics
GeneticTooth-Focused
Dental PerfectionEsthetics Primary
Treating SymptomsAirway Ignorant
AdaptationMuscle-FocusedMedical Better
Esthetics SecondaryTreating Causes
Airway Conscious
The EndAnd
The Beginning
Type 2 Uncrowding
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
bullLip incompetencebullLip entrapmentbullHypermentalisbullMouthbreathing
Type 2 Uncrowding
12 month progress
12 month progress
12 month progress
After Treatment
Bent-wire6 monthsMyobrace12 months
Hey RaphaelWhat about that
profile
ZP 9-5yoM
i
After Expansion Phase
Incomplete profile improvement better breathing head posture and sleep
Incisor Goals
Type 3 Treatment Maintain UI
Functional Orthodontics Expansion Orthodontics Distalization Ortho or No Treatment
Type 3 Maintain
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Bimax retrusion
Successful dental result
Profile Unimproved
Incisor Goals
Type 4 Treatment RetractExtrude UI
Extraction Orthodontics Retraction Ortho Distalization Ortho
Type 4 Retraction
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Bimax retrusion
Successful dental result
Failed Profile Result
Changes of pharyngeal airway size and hyoid bone position following orthodontic treatment of
Class I bimaxillary protrusion
Qingzhu Wanga Peizeng Jiab Nina K Andersonc Lin Wangd Jiuxiang Line
Angle Orthodontist Vol 00 No 0 0000 (pre-publication 2012)
ldquothe dimension of the velopharynx glossopharynx and hypopharynx were decreased after maximal retraction of anterior teeth with extraction of four premolarshelliprdquo ldquoAny factors that can influence the posture and position of tongue and soft palate may displace them backward andencroach upon the pharynxrdquo
ldquothe more the incisors were retracted the more the pharyngeal airway was reducedrdquo
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Backed into a corner
bull
Moving teeth faster more efficientlyhellipin the wrong direction
Now that wersquove made smoking unacceptable
could we not do the same withbull Sugarbull Processed foodbull Cheap milk and meatbull Fast foodbull Pill popping for symptomatic reliefbull Looking for the cure instead of the causebull Surgery as a quick fixbull Thinking braces are a status symbol
Each industry thrives on the status quoConsumers must drive the change
NP 10yM
NP
Sisterrsquos non-x ortho
Shersquos happyhellipbut Irsquom not so
I make my pitch for BBO
The dilemma of progress
(I forgot the progress pictureshellip)
Dad sells prosthetic parts to orthopedic surgeons
I selling the case against my previous work they loved
It takes me 3 hours to sell the case
They fret until the BB3 goes in
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Connecting the dots
bull Adult SDB and OSA
bull Narrow jaws and faces
bull Soft tissue dysfunction
bull Early parafunctional habits ie open mouth posture
bull Environmental stressors
bull CPAP MARAUPPP SurgWherersquos the best
place to start treatment here
or here
1 Prevention 2 Undo the damage already done3 Establish good habits
When to start When damage from poor breathing is noticed and when bad habits are discovered
The strategies of Airway Orthodontics
Prevention
bull Remove ankyloglossiabull Promote breastfeedingbull Harden the dietbull Develop masticatory strengthbull Discourage oral habitsbull Promote whole-foods low sugar dietbull Reduce oropharyngeal obstructionbull Promote nasal breathing
Breathing retraining
bull Nasal rinsingbull Nasal clearingbull Decongesting
The goals of Airway Orthodontics
1 Breathing through the nose2 Lips together at rest3 Correct tongue position4 No facial muscles moving on swallowing5 Optimal forward facial development6 Class I occlusion7 Straight teeth8 Better stability long term
Myofunctional Trainers
Professors R Soulet and A Besombes
Dr Earl Bergeson
Dr Chris Farrell
The Multi ndash Family System
Orofacial MyofunctionalTherapy
Oral MyologyMyofunctional TherapyTongue Thrust Therapy
B Hockel 2012 Back
Undoing Bimaxillary Dysplasia
1 Maxillary deconstriction2 Maxillary advancement3 Maxillary impaction4 Mandibular advancement
1 Maxillary Expansion
Treatment for Bimaxillary Dysplasia
ALFCrozat
Bent Wire
HyraxHaas
Niti Exp BioBlocSchwartz
The Farrell BENT WIRE Systemtrade
Recommended Age Group 5-12 yrs
Arch Development in conjunction with the TRAINER Systemtrade
Dr John Mew
Establish Good Habits
1 Breathing through the nose2 Lips together at rest3 Correct tongue position4 No facial muscles moving on swallowing5 Stand and sit in balance6 Breath gently using the diaphragm7 Eat to nourish8 Sleep to rest
Ortho-Postural TrainingWorkshops
Breathing
Nutrition
Posture
Sleep
COPYRIGHTRoger L PriceOctober 2012
Posture Number
Forward head posturecan be a compensationfor a deficient airway
Sleep Screening and Hygiene
SQI = 10 SQI = 98
Integrative Healthcare
Function ProfessionalNasal clearing ENT Pulm MFT BreathingMuscle balance and tone MFT Myofunctional OrthoUndoing damage GP Pedo Ortho OMFSBreathing dynamics OPT MFT Breath PhysiologistPosture DC OPT PT OsteopathCranial balance OsteopathNutrition RDH Nutritionist Dietitian Sleep ENT Sleep Med DentNeurocognitive development Pedrsquon SLP Psych SpEd
The Interdisciplinary Center
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Now that I know
My personal missionTo create from what Irsquove
learned from the besta model for others to followhellipespecially the orthodontists
Myofunctional Orthodontics
Chris Farrell
John Flutter
German Ramierez
Damien OrsquoBrien
Myofunctional Research CoRancho Cucamonga
2008-2012
Oral Myology
Oral Myology Basic CourseJoy MoellerNYC 2011LA 2012
Oral Myology Levels 2 3Kim BenkertClifton 2012
Habit CessationShari GreenClifton 2013
Biobloc Orthotropics
BBO Mini-residencyBill Hang
Agora Hills2012-13
BBO IntensiveDrs John and Mike
MewLSFO2013
Breathing and Sleep
Buteyko MentorshipThe Breathing Center
Woodstock2010
Breathing Well ProgrammeJohn Flutter
2010 Ortho-Postural TrainingRoger Price
2013
Sleep DentistryMichael Gelb etal
NYU2012
ALF and Cranial
Jim Bronson2013 Tasha Turzo
Cranial Academy2014
Bucket Listbull ALF and Crozat (Bronsonrsquos course)bullMore on Biobloc (Hangrsquos Advanced London School)bull More Cranial (The Farm)bullChirodontics (Bob Walker)bull Airway Dentistry with Marc Cruz Jeff Rousebull Sleep Dentistrybull Less-than-Six with Kevin Boydbull Intra-mandibular Distraction Osteogenesis (IMDO)
Off My ListAnything that moves the teeth faster in the wrong direction
Whatrsquos an RO to do
To create from what Irsquove learned from the best
a model for others to followhellipespecially orthodontists
Teaching
Mt Sinai Pedo ResidencyAli Attaie
2010-2012
Montefiore Ortho ResidencyTony Maganzini
2012
2009-Present
Mt Sinai School of MedicinePedodontic Residency
Guest SpeakersJim BronsonMike MewKevin BoydSandra KahnJennifer TowRoger PricePaula Fabbie
Damien OrsquoBrien
First clinical program in myofunctional orthodontics
Airway and Facial DevelopmentCollaborative Webcast
Mark Cruz
AAPMD Symposium
wwwaapm
dorg
Annual MeetingApril 25-26 2014
Westin Chicago North Shore
the raphael center for integrative orthodontics
wwwalignminecomwwwbioblocnjcom
wwwmyobracenjcom
Integrative vs Conventional
Integrative vs Conventional
ldquoWith improvements in expansion orthodontics advances in myofunctional orthodontics and the growing recognition about sleep disordered breathing among children and adults it is time for orthodontics to expand its horizons There is now so much more we can oerrdquo
The Raphael name has been associated with high quality orthodontics in New Jersey for over 60 years Dr Barry Raphael has been a university trained orthodontic specialist and a member of the American Association of Orthodontists for 30 years
He has a wide range of techniques and services to offer He has studied oral myology applied kinesiology Buteyko breathing Biobloc Orthotropics and Myobrace as part of his integrative training He can offer Damon Invisalign Insignia and Incognito appliances designs as some of his many conventional orthodontic services too
Dr Raphael teaches his techniques at post-graduate residencies study clubs dental societies and for the Myofunctional Research Co He is available for presentations to any group interested in learning more about the benefits of integrative orthodontics
wwwalignminecomLearn about the choices you have in orthodontics
dr barry raphael Why its
too Early never
1425
bro
ad
str
ee
tc
lifto
n n
j 070
13
973-
778-
4222
fax
973-
778-
9625
nj s
pe
c
368
4
1425 broad street clifton nj 07013973-778-4222
wwwalignminecom
the raphael centerforintegrative orthodontics
the
raph
ael c
ente
r fo
rin
tegr
ativ
e or
thod
onti
cs
Learn about an important choice you need to make before starting braces
the raphael center for integrative education
the raphael center for integrative education
Ongoing Intro to Airway Orthodontics
April Biobloc Study Group
April Training Ortho-Postural Therapists w Roger Price
June MRC Myobrace Basic Series
August Airway Dentistry with Mark Cruz and company
October Advanced MFT with Sandy Coulson
October Less than Six with Kevin Boyd
(who else wants to play)
Mission to create a space for spreading the word about Airway and Orthotropic principles and practice
Orthodontics in the 21st Century
EstheticOrthodontics
AirwayOrthodontics
GeneticTooth-Focused
Dental PerfectionEsthetics Primary
Treating SymptomsAirway Ignorant
AdaptationMuscle-FocusedMedical Better
Esthetics SecondaryTreating Causes
Airway Conscious
The EndAnd
The Beginning
bullLip incompetencebullLip entrapmentbullHypermentalisbullMouthbreathing
Type 2 Uncrowding
12 month progress
12 month progress
12 month progress
After Treatment
Bent-wire6 monthsMyobrace12 months
Hey RaphaelWhat about that
profile
ZP 9-5yoM
i
After Expansion Phase
Incomplete profile improvement better breathing head posture and sleep
Incisor Goals
Type 3 Treatment Maintain UI
Functional Orthodontics Expansion Orthodontics Distalization Ortho or No Treatment
Type 3 Maintain
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Bimax retrusion
Successful dental result
Profile Unimproved
Incisor Goals
Type 4 Treatment RetractExtrude UI
Extraction Orthodontics Retraction Ortho Distalization Ortho
Type 4 Retraction
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Bimax retrusion
Successful dental result
Failed Profile Result
Changes of pharyngeal airway size and hyoid bone position following orthodontic treatment of
Class I bimaxillary protrusion
Qingzhu Wanga Peizeng Jiab Nina K Andersonc Lin Wangd Jiuxiang Line
Angle Orthodontist Vol 00 No 0 0000 (pre-publication 2012)
ldquothe dimension of the velopharynx glossopharynx and hypopharynx were decreased after maximal retraction of anterior teeth with extraction of four premolarshelliprdquo ldquoAny factors that can influence the posture and position of tongue and soft palate may displace them backward andencroach upon the pharynxrdquo
ldquothe more the incisors were retracted the more the pharyngeal airway was reducedrdquo
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Backed into a corner
bull
Moving teeth faster more efficientlyhellipin the wrong direction
Now that wersquove made smoking unacceptable
could we not do the same withbull Sugarbull Processed foodbull Cheap milk and meatbull Fast foodbull Pill popping for symptomatic reliefbull Looking for the cure instead of the causebull Surgery as a quick fixbull Thinking braces are a status symbol
Each industry thrives on the status quoConsumers must drive the change
NP 10yM
NP
Sisterrsquos non-x ortho
Shersquos happyhellipbut Irsquom not so
I make my pitch for BBO
The dilemma of progress
(I forgot the progress pictureshellip)
Dad sells prosthetic parts to orthopedic surgeons
I selling the case against my previous work they loved
It takes me 3 hours to sell the case
They fret until the BB3 goes in
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Connecting the dots
bull Adult SDB and OSA
bull Narrow jaws and faces
bull Soft tissue dysfunction
bull Early parafunctional habits ie open mouth posture
bull Environmental stressors
bull CPAP MARAUPPP SurgWherersquos the best
place to start treatment here
or here
1 Prevention 2 Undo the damage already done3 Establish good habits
When to start When damage from poor breathing is noticed and when bad habits are discovered
The strategies of Airway Orthodontics
Prevention
bull Remove ankyloglossiabull Promote breastfeedingbull Harden the dietbull Develop masticatory strengthbull Discourage oral habitsbull Promote whole-foods low sugar dietbull Reduce oropharyngeal obstructionbull Promote nasal breathing
Breathing retraining
bull Nasal rinsingbull Nasal clearingbull Decongesting
The goals of Airway Orthodontics
1 Breathing through the nose2 Lips together at rest3 Correct tongue position4 No facial muscles moving on swallowing5 Optimal forward facial development6 Class I occlusion7 Straight teeth8 Better stability long term
Myofunctional Trainers
Professors R Soulet and A Besombes
Dr Earl Bergeson
Dr Chris Farrell
The Multi ndash Family System
Orofacial MyofunctionalTherapy
Oral MyologyMyofunctional TherapyTongue Thrust Therapy
B Hockel 2012 Back
Undoing Bimaxillary Dysplasia
1 Maxillary deconstriction2 Maxillary advancement3 Maxillary impaction4 Mandibular advancement
1 Maxillary Expansion
Treatment for Bimaxillary Dysplasia
ALFCrozat
Bent Wire
HyraxHaas
Niti Exp BioBlocSchwartz
The Farrell BENT WIRE Systemtrade
Recommended Age Group 5-12 yrs
Arch Development in conjunction with the TRAINER Systemtrade
Dr John Mew
Establish Good Habits
1 Breathing through the nose2 Lips together at rest3 Correct tongue position4 No facial muscles moving on swallowing5 Stand and sit in balance6 Breath gently using the diaphragm7 Eat to nourish8 Sleep to rest
Ortho-Postural TrainingWorkshops
Breathing
Nutrition
Posture
Sleep
COPYRIGHTRoger L PriceOctober 2012
Posture Number
Forward head posturecan be a compensationfor a deficient airway
Sleep Screening and Hygiene
SQI = 10 SQI = 98
Integrative Healthcare
Function ProfessionalNasal clearing ENT Pulm MFT BreathingMuscle balance and tone MFT Myofunctional OrthoUndoing damage GP Pedo Ortho OMFSBreathing dynamics OPT MFT Breath PhysiologistPosture DC OPT PT OsteopathCranial balance OsteopathNutrition RDH Nutritionist Dietitian Sleep ENT Sleep Med DentNeurocognitive development Pedrsquon SLP Psych SpEd
The Interdisciplinary Center
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Now that I know
My personal missionTo create from what Irsquove
learned from the besta model for others to followhellipespecially the orthodontists
Myofunctional Orthodontics
Chris Farrell
John Flutter
German Ramierez
Damien OrsquoBrien
Myofunctional Research CoRancho Cucamonga
2008-2012
Oral Myology
Oral Myology Basic CourseJoy MoellerNYC 2011LA 2012
Oral Myology Levels 2 3Kim BenkertClifton 2012
Habit CessationShari GreenClifton 2013
Biobloc Orthotropics
BBO Mini-residencyBill Hang
Agora Hills2012-13
BBO IntensiveDrs John and Mike
MewLSFO2013
Breathing and Sleep
Buteyko MentorshipThe Breathing Center
Woodstock2010
Breathing Well ProgrammeJohn Flutter
2010 Ortho-Postural TrainingRoger Price
2013
Sleep DentistryMichael Gelb etal
NYU2012
ALF and Cranial
Jim Bronson2013 Tasha Turzo
Cranial Academy2014
Bucket Listbull ALF and Crozat (Bronsonrsquos course)bullMore on Biobloc (Hangrsquos Advanced London School)bull More Cranial (The Farm)bullChirodontics (Bob Walker)bull Airway Dentistry with Marc Cruz Jeff Rousebull Sleep Dentistrybull Less-than-Six with Kevin Boydbull Intra-mandibular Distraction Osteogenesis (IMDO)
Off My ListAnything that moves the teeth faster in the wrong direction
Whatrsquos an RO to do
To create from what Irsquove learned from the best
a model for others to followhellipespecially orthodontists
Teaching
Mt Sinai Pedo ResidencyAli Attaie
2010-2012
Montefiore Ortho ResidencyTony Maganzini
2012
2009-Present
Mt Sinai School of MedicinePedodontic Residency
Guest SpeakersJim BronsonMike MewKevin BoydSandra KahnJennifer TowRoger PricePaula Fabbie
Damien OrsquoBrien
First clinical program in myofunctional orthodontics
Airway and Facial DevelopmentCollaborative Webcast
Mark Cruz
AAPMD Symposium
wwwaapm
dorg
Annual MeetingApril 25-26 2014
Westin Chicago North Shore
the raphael center for integrative orthodontics
wwwalignminecomwwwbioblocnjcom
wwwmyobracenjcom
Integrative vs Conventional
Integrative vs Conventional
ldquoWith improvements in expansion orthodontics advances in myofunctional orthodontics and the growing recognition about sleep disordered breathing among children and adults it is time for orthodontics to expand its horizons There is now so much more we can oerrdquo
The Raphael name has been associated with high quality orthodontics in New Jersey for over 60 years Dr Barry Raphael has been a university trained orthodontic specialist and a member of the American Association of Orthodontists for 30 years
He has a wide range of techniques and services to offer He has studied oral myology applied kinesiology Buteyko breathing Biobloc Orthotropics and Myobrace as part of his integrative training He can offer Damon Invisalign Insignia and Incognito appliances designs as some of his many conventional orthodontic services too
Dr Raphael teaches his techniques at post-graduate residencies study clubs dental societies and for the Myofunctional Research Co He is available for presentations to any group interested in learning more about the benefits of integrative orthodontics
wwwalignminecomLearn about the choices you have in orthodontics
dr barry raphael Why its
too Early never
1425
bro
ad
str
ee
tc
lifto
n n
j 070
13
973-
778-
4222
fax
973-
778-
9625
nj s
pe
c
368
4
1425 broad street clifton nj 07013973-778-4222
wwwalignminecom
the raphael centerforintegrative orthodontics
the
raph
ael c
ente
r fo
rin
tegr
ativ
e or
thod
onti
cs
Learn about an important choice you need to make before starting braces
the raphael center for integrative education
the raphael center for integrative education
Ongoing Intro to Airway Orthodontics
April Biobloc Study Group
April Training Ortho-Postural Therapists w Roger Price
June MRC Myobrace Basic Series
August Airway Dentistry with Mark Cruz and company
October Advanced MFT with Sandy Coulson
October Less than Six with Kevin Boyd
(who else wants to play)
Mission to create a space for spreading the word about Airway and Orthotropic principles and practice
Orthodontics in the 21st Century
EstheticOrthodontics
AirwayOrthodontics
GeneticTooth-Focused
Dental PerfectionEsthetics Primary
Treating SymptomsAirway Ignorant
AdaptationMuscle-FocusedMedical Better
Esthetics SecondaryTreating Causes
Airway Conscious
The EndAnd
The Beginning
12 month progress
12 month progress
12 month progress
After Treatment
Bent-wire6 monthsMyobrace12 months
Hey RaphaelWhat about that
profile
ZP 9-5yoM
i
After Expansion Phase
Incomplete profile improvement better breathing head posture and sleep
Incisor Goals
Type 3 Treatment Maintain UI
Functional Orthodontics Expansion Orthodontics Distalization Ortho or No Treatment
Type 3 Maintain
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Bimax retrusion
Successful dental result
Profile Unimproved
Incisor Goals
Type 4 Treatment RetractExtrude UI
Extraction Orthodontics Retraction Ortho Distalization Ortho
Type 4 Retraction
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Bimax retrusion
Successful dental result
Failed Profile Result
Changes of pharyngeal airway size and hyoid bone position following orthodontic treatment of
Class I bimaxillary protrusion
Qingzhu Wanga Peizeng Jiab Nina K Andersonc Lin Wangd Jiuxiang Line
Angle Orthodontist Vol 00 No 0 0000 (pre-publication 2012)
ldquothe dimension of the velopharynx glossopharynx and hypopharynx were decreased after maximal retraction of anterior teeth with extraction of four premolarshelliprdquo ldquoAny factors that can influence the posture and position of tongue and soft palate may displace them backward andencroach upon the pharynxrdquo
ldquothe more the incisors were retracted the more the pharyngeal airway was reducedrdquo
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Backed into a corner
bull
Moving teeth faster more efficientlyhellipin the wrong direction
Now that wersquove made smoking unacceptable
could we not do the same withbull Sugarbull Processed foodbull Cheap milk and meatbull Fast foodbull Pill popping for symptomatic reliefbull Looking for the cure instead of the causebull Surgery as a quick fixbull Thinking braces are a status symbol
Each industry thrives on the status quoConsumers must drive the change
NP 10yM
NP
Sisterrsquos non-x ortho
Shersquos happyhellipbut Irsquom not so
I make my pitch for BBO
The dilemma of progress
(I forgot the progress pictureshellip)
Dad sells prosthetic parts to orthopedic surgeons
I selling the case against my previous work they loved
It takes me 3 hours to sell the case
They fret until the BB3 goes in
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Connecting the dots
bull Adult SDB and OSA
bull Narrow jaws and faces
bull Soft tissue dysfunction
bull Early parafunctional habits ie open mouth posture
bull Environmental stressors
bull CPAP MARAUPPP SurgWherersquos the best
place to start treatment here
or here
1 Prevention 2 Undo the damage already done3 Establish good habits
When to start When damage from poor breathing is noticed and when bad habits are discovered
The strategies of Airway Orthodontics
Prevention
bull Remove ankyloglossiabull Promote breastfeedingbull Harden the dietbull Develop masticatory strengthbull Discourage oral habitsbull Promote whole-foods low sugar dietbull Reduce oropharyngeal obstructionbull Promote nasal breathing
Breathing retraining
bull Nasal rinsingbull Nasal clearingbull Decongesting
The goals of Airway Orthodontics
1 Breathing through the nose2 Lips together at rest3 Correct tongue position4 No facial muscles moving on swallowing5 Optimal forward facial development6 Class I occlusion7 Straight teeth8 Better stability long term
Myofunctional Trainers
Professors R Soulet and A Besombes
Dr Earl Bergeson
Dr Chris Farrell
The Multi ndash Family System
Orofacial MyofunctionalTherapy
Oral MyologyMyofunctional TherapyTongue Thrust Therapy
B Hockel 2012 Back
Undoing Bimaxillary Dysplasia
1 Maxillary deconstriction2 Maxillary advancement3 Maxillary impaction4 Mandibular advancement
1 Maxillary Expansion
Treatment for Bimaxillary Dysplasia
ALFCrozat
Bent Wire
HyraxHaas
Niti Exp BioBlocSchwartz
The Farrell BENT WIRE Systemtrade
Recommended Age Group 5-12 yrs
Arch Development in conjunction with the TRAINER Systemtrade
Dr John Mew
Establish Good Habits
1 Breathing through the nose2 Lips together at rest3 Correct tongue position4 No facial muscles moving on swallowing5 Stand and sit in balance6 Breath gently using the diaphragm7 Eat to nourish8 Sleep to rest
Ortho-Postural TrainingWorkshops
Breathing
Nutrition
Posture
Sleep
COPYRIGHTRoger L PriceOctober 2012
Posture Number
Forward head posturecan be a compensationfor a deficient airway
Sleep Screening and Hygiene
SQI = 10 SQI = 98
Integrative Healthcare
Function ProfessionalNasal clearing ENT Pulm MFT BreathingMuscle balance and tone MFT Myofunctional OrthoUndoing damage GP Pedo Ortho OMFSBreathing dynamics OPT MFT Breath PhysiologistPosture DC OPT PT OsteopathCranial balance OsteopathNutrition RDH Nutritionist Dietitian Sleep ENT Sleep Med DentNeurocognitive development Pedrsquon SLP Psych SpEd
The Interdisciplinary Center
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Now that I know
My personal missionTo create from what Irsquove
learned from the besta model for others to followhellipespecially the orthodontists
Myofunctional Orthodontics
Chris Farrell
John Flutter
German Ramierez
Damien OrsquoBrien
Myofunctional Research CoRancho Cucamonga
2008-2012
Oral Myology
Oral Myology Basic CourseJoy MoellerNYC 2011LA 2012
Oral Myology Levels 2 3Kim BenkertClifton 2012
Habit CessationShari GreenClifton 2013
Biobloc Orthotropics
BBO Mini-residencyBill Hang
Agora Hills2012-13
BBO IntensiveDrs John and Mike
MewLSFO2013
Breathing and Sleep
Buteyko MentorshipThe Breathing Center
Woodstock2010
Breathing Well ProgrammeJohn Flutter
2010 Ortho-Postural TrainingRoger Price
2013
Sleep DentistryMichael Gelb etal
NYU2012
ALF and Cranial
Jim Bronson2013 Tasha Turzo
Cranial Academy2014
Bucket Listbull ALF and Crozat (Bronsonrsquos course)bullMore on Biobloc (Hangrsquos Advanced London School)bull More Cranial (The Farm)bullChirodontics (Bob Walker)bull Airway Dentistry with Marc Cruz Jeff Rousebull Sleep Dentistrybull Less-than-Six with Kevin Boydbull Intra-mandibular Distraction Osteogenesis (IMDO)
Off My ListAnything that moves the teeth faster in the wrong direction
Whatrsquos an RO to do
To create from what Irsquove learned from the best
a model for others to followhellipespecially orthodontists
Teaching
Mt Sinai Pedo ResidencyAli Attaie
2010-2012
Montefiore Ortho ResidencyTony Maganzini
2012
2009-Present
Mt Sinai School of MedicinePedodontic Residency
Guest SpeakersJim BronsonMike MewKevin BoydSandra KahnJennifer TowRoger PricePaula Fabbie
Damien OrsquoBrien
First clinical program in myofunctional orthodontics
Airway and Facial DevelopmentCollaborative Webcast
Mark Cruz
AAPMD Symposium
wwwaapm
dorg
Annual MeetingApril 25-26 2014
Westin Chicago North Shore
the raphael center for integrative orthodontics
wwwalignminecomwwwbioblocnjcom
wwwmyobracenjcom
Integrative vs Conventional
Integrative vs Conventional
ldquoWith improvements in expansion orthodontics advances in myofunctional orthodontics and the growing recognition about sleep disordered breathing among children and adults it is time for orthodontics to expand its horizons There is now so much more we can oerrdquo
The Raphael name has been associated with high quality orthodontics in New Jersey for over 60 years Dr Barry Raphael has been a university trained orthodontic specialist and a member of the American Association of Orthodontists for 30 years
He has a wide range of techniques and services to offer He has studied oral myology applied kinesiology Buteyko breathing Biobloc Orthotropics and Myobrace as part of his integrative training He can offer Damon Invisalign Insignia and Incognito appliances designs as some of his many conventional orthodontic services too
Dr Raphael teaches his techniques at post-graduate residencies study clubs dental societies and for the Myofunctional Research Co He is available for presentations to any group interested in learning more about the benefits of integrative orthodontics
wwwalignminecomLearn about the choices you have in orthodontics
dr barry raphael Why its
too Early never
1425
bro
ad
str
ee
tc
lifto
n n
j 070
13
973-
778-
4222
fax
973-
778-
9625
nj s
pe
c
368
4
1425 broad street clifton nj 07013973-778-4222
wwwalignminecom
the raphael centerforintegrative orthodontics
the
raph
ael c
ente
r fo
rin
tegr
ativ
e or
thod
onti
cs
Learn about an important choice you need to make before starting braces
the raphael center for integrative education
the raphael center for integrative education
Ongoing Intro to Airway Orthodontics
April Biobloc Study Group
April Training Ortho-Postural Therapists w Roger Price
June MRC Myobrace Basic Series
August Airway Dentistry with Mark Cruz and company
October Advanced MFT with Sandy Coulson
October Less than Six with Kevin Boyd
(who else wants to play)
Mission to create a space for spreading the word about Airway and Orthotropic principles and practice
Orthodontics in the 21st Century
EstheticOrthodontics
AirwayOrthodontics
GeneticTooth-Focused
Dental PerfectionEsthetics Primary
Treating SymptomsAirway Ignorant
AdaptationMuscle-FocusedMedical Better
Esthetics SecondaryTreating Causes
Airway Conscious
The EndAnd
The Beginning
12 month progress
12 month progress
After Treatment
Bent-wire6 monthsMyobrace12 months
Hey RaphaelWhat about that
profile
ZP 9-5yoM
i
After Expansion Phase
Incomplete profile improvement better breathing head posture and sleep
Incisor Goals
Type 3 Treatment Maintain UI
Functional Orthodontics Expansion Orthodontics Distalization Ortho or No Treatment
Type 3 Maintain
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Bimax retrusion
Successful dental result
Profile Unimproved
Incisor Goals
Type 4 Treatment RetractExtrude UI
Extraction Orthodontics Retraction Ortho Distalization Ortho
Type 4 Retraction
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Bimax retrusion
Successful dental result
Failed Profile Result
Changes of pharyngeal airway size and hyoid bone position following orthodontic treatment of
Class I bimaxillary protrusion
Qingzhu Wanga Peizeng Jiab Nina K Andersonc Lin Wangd Jiuxiang Line
Angle Orthodontist Vol 00 No 0 0000 (pre-publication 2012)
ldquothe dimension of the velopharynx glossopharynx and hypopharynx were decreased after maximal retraction of anterior teeth with extraction of four premolarshelliprdquo ldquoAny factors that can influence the posture and position of tongue and soft palate may displace them backward andencroach upon the pharynxrdquo
ldquothe more the incisors were retracted the more the pharyngeal airway was reducedrdquo
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Backed into a corner
bull
Moving teeth faster more efficientlyhellipin the wrong direction
Now that wersquove made smoking unacceptable
could we not do the same withbull Sugarbull Processed foodbull Cheap milk and meatbull Fast foodbull Pill popping for symptomatic reliefbull Looking for the cure instead of the causebull Surgery as a quick fixbull Thinking braces are a status symbol
Each industry thrives on the status quoConsumers must drive the change
NP 10yM
NP
Sisterrsquos non-x ortho
Shersquos happyhellipbut Irsquom not so
I make my pitch for BBO
The dilemma of progress
(I forgot the progress pictureshellip)
Dad sells prosthetic parts to orthopedic surgeons
I selling the case against my previous work they loved
It takes me 3 hours to sell the case
They fret until the BB3 goes in
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Connecting the dots
bull Adult SDB and OSA
bull Narrow jaws and faces
bull Soft tissue dysfunction
bull Early parafunctional habits ie open mouth posture
bull Environmental stressors
bull CPAP MARAUPPP SurgWherersquos the best
place to start treatment here
or here
1 Prevention 2 Undo the damage already done3 Establish good habits
When to start When damage from poor breathing is noticed and when bad habits are discovered
The strategies of Airway Orthodontics
Prevention
bull Remove ankyloglossiabull Promote breastfeedingbull Harden the dietbull Develop masticatory strengthbull Discourage oral habitsbull Promote whole-foods low sugar dietbull Reduce oropharyngeal obstructionbull Promote nasal breathing
Breathing retraining
bull Nasal rinsingbull Nasal clearingbull Decongesting
The goals of Airway Orthodontics
1 Breathing through the nose2 Lips together at rest3 Correct tongue position4 No facial muscles moving on swallowing5 Optimal forward facial development6 Class I occlusion7 Straight teeth8 Better stability long term
Myofunctional Trainers
Professors R Soulet and A Besombes
Dr Earl Bergeson
Dr Chris Farrell
The Multi ndash Family System
Orofacial MyofunctionalTherapy
Oral MyologyMyofunctional TherapyTongue Thrust Therapy
B Hockel 2012 Back
Undoing Bimaxillary Dysplasia
1 Maxillary deconstriction2 Maxillary advancement3 Maxillary impaction4 Mandibular advancement
1 Maxillary Expansion
Treatment for Bimaxillary Dysplasia
ALFCrozat
Bent Wire
HyraxHaas
Niti Exp BioBlocSchwartz
The Farrell BENT WIRE Systemtrade
Recommended Age Group 5-12 yrs
Arch Development in conjunction with the TRAINER Systemtrade
Dr John Mew
Establish Good Habits
1 Breathing through the nose2 Lips together at rest3 Correct tongue position4 No facial muscles moving on swallowing5 Stand and sit in balance6 Breath gently using the diaphragm7 Eat to nourish8 Sleep to rest
Ortho-Postural TrainingWorkshops
Breathing
Nutrition
Posture
Sleep
COPYRIGHTRoger L PriceOctober 2012
Posture Number
Forward head posturecan be a compensationfor a deficient airway
Sleep Screening and Hygiene
SQI = 10 SQI = 98
Integrative Healthcare
Function ProfessionalNasal clearing ENT Pulm MFT BreathingMuscle balance and tone MFT Myofunctional OrthoUndoing damage GP Pedo Ortho OMFSBreathing dynamics OPT MFT Breath PhysiologistPosture DC OPT PT OsteopathCranial balance OsteopathNutrition RDH Nutritionist Dietitian Sleep ENT Sleep Med DentNeurocognitive development Pedrsquon SLP Psych SpEd
The Interdisciplinary Center
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Now that I know
My personal missionTo create from what Irsquove
learned from the besta model for others to followhellipespecially the orthodontists
Myofunctional Orthodontics
Chris Farrell
John Flutter
German Ramierez
Damien OrsquoBrien
Myofunctional Research CoRancho Cucamonga
2008-2012
Oral Myology
Oral Myology Basic CourseJoy MoellerNYC 2011LA 2012
Oral Myology Levels 2 3Kim BenkertClifton 2012
Habit CessationShari GreenClifton 2013
Biobloc Orthotropics
BBO Mini-residencyBill Hang
Agora Hills2012-13
BBO IntensiveDrs John and Mike
MewLSFO2013
Breathing and Sleep
Buteyko MentorshipThe Breathing Center
Woodstock2010
Breathing Well ProgrammeJohn Flutter
2010 Ortho-Postural TrainingRoger Price
2013
Sleep DentistryMichael Gelb etal
NYU2012
ALF and Cranial
Jim Bronson2013 Tasha Turzo
Cranial Academy2014
Bucket Listbull ALF and Crozat (Bronsonrsquos course)bullMore on Biobloc (Hangrsquos Advanced London School)bull More Cranial (The Farm)bullChirodontics (Bob Walker)bull Airway Dentistry with Marc Cruz Jeff Rousebull Sleep Dentistrybull Less-than-Six with Kevin Boydbull Intra-mandibular Distraction Osteogenesis (IMDO)
Off My ListAnything that moves the teeth faster in the wrong direction
Whatrsquos an RO to do
To create from what Irsquove learned from the best
a model for others to followhellipespecially orthodontists
Teaching
Mt Sinai Pedo ResidencyAli Attaie
2010-2012
Montefiore Ortho ResidencyTony Maganzini
2012
2009-Present
Mt Sinai School of MedicinePedodontic Residency
Guest SpeakersJim BronsonMike MewKevin BoydSandra KahnJennifer TowRoger PricePaula Fabbie
Damien OrsquoBrien
First clinical program in myofunctional orthodontics
Airway and Facial DevelopmentCollaborative Webcast
Mark Cruz
AAPMD Symposium
wwwaapm
dorg
Annual MeetingApril 25-26 2014
Westin Chicago North Shore
the raphael center for integrative orthodontics
wwwalignminecomwwwbioblocnjcom
wwwmyobracenjcom
Integrative vs Conventional
Integrative vs Conventional
ldquoWith improvements in expansion orthodontics advances in myofunctional orthodontics and the growing recognition about sleep disordered breathing among children and adults it is time for orthodontics to expand its horizons There is now so much more we can oerrdquo
The Raphael name has been associated with high quality orthodontics in New Jersey for over 60 years Dr Barry Raphael has been a university trained orthodontic specialist and a member of the American Association of Orthodontists for 30 years
He has a wide range of techniques and services to offer He has studied oral myology applied kinesiology Buteyko breathing Biobloc Orthotropics and Myobrace as part of his integrative training He can offer Damon Invisalign Insignia and Incognito appliances designs as some of his many conventional orthodontic services too
Dr Raphael teaches his techniques at post-graduate residencies study clubs dental societies and for the Myofunctional Research Co He is available for presentations to any group interested in learning more about the benefits of integrative orthodontics
wwwalignminecomLearn about the choices you have in orthodontics
dr barry raphael Why its
too Early never
1425
bro
ad
str
ee
tc
lifto
n n
j 070
13
973-
778-
4222
fax
973-
778-
9625
nj s
pe
c
368
4
1425 broad street clifton nj 07013973-778-4222
wwwalignminecom
the raphael centerforintegrative orthodontics
the
raph
ael c
ente
r fo
rin
tegr
ativ
e or
thod
onti
cs
Learn about an important choice you need to make before starting braces
the raphael center for integrative education
the raphael center for integrative education
Ongoing Intro to Airway Orthodontics
April Biobloc Study Group
April Training Ortho-Postural Therapists w Roger Price
June MRC Myobrace Basic Series
August Airway Dentistry with Mark Cruz and company
October Advanced MFT with Sandy Coulson
October Less than Six with Kevin Boyd
(who else wants to play)
Mission to create a space for spreading the word about Airway and Orthotropic principles and practice
Orthodontics in the 21st Century
EstheticOrthodontics
AirwayOrthodontics
GeneticTooth-Focused
Dental PerfectionEsthetics Primary
Treating SymptomsAirway Ignorant
AdaptationMuscle-FocusedMedical Better
Esthetics SecondaryTreating Causes
Airway Conscious
The EndAnd
The Beginning
12 month progress
After Treatment
Bent-wire6 monthsMyobrace12 months
Hey RaphaelWhat about that
profile
ZP 9-5yoM
i
After Expansion Phase
Incomplete profile improvement better breathing head posture and sleep
Incisor Goals
Type 3 Treatment Maintain UI
Functional Orthodontics Expansion Orthodontics Distalization Ortho or No Treatment
Type 3 Maintain
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Bimax retrusion
Successful dental result
Profile Unimproved
Incisor Goals
Type 4 Treatment RetractExtrude UI
Extraction Orthodontics Retraction Ortho Distalization Ortho
Type 4 Retraction
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Bimax retrusion
Successful dental result
Failed Profile Result
Changes of pharyngeal airway size and hyoid bone position following orthodontic treatment of
Class I bimaxillary protrusion
Qingzhu Wanga Peizeng Jiab Nina K Andersonc Lin Wangd Jiuxiang Line
Angle Orthodontist Vol 00 No 0 0000 (pre-publication 2012)
ldquothe dimension of the velopharynx glossopharynx and hypopharynx were decreased after maximal retraction of anterior teeth with extraction of four premolarshelliprdquo ldquoAny factors that can influence the posture and position of tongue and soft palate may displace them backward andencroach upon the pharynxrdquo
ldquothe more the incisors were retracted the more the pharyngeal airway was reducedrdquo
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Backed into a corner
bull
Moving teeth faster more efficientlyhellipin the wrong direction
Now that wersquove made smoking unacceptable
could we not do the same withbull Sugarbull Processed foodbull Cheap milk and meatbull Fast foodbull Pill popping for symptomatic reliefbull Looking for the cure instead of the causebull Surgery as a quick fixbull Thinking braces are a status symbol
Each industry thrives on the status quoConsumers must drive the change
NP 10yM
NP
Sisterrsquos non-x ortho
Shersquos happyhellipbut Irsquom not so
I make my pitch for BBO
The dilemma of progress
(I forgot the progress pictureshellip)
Dad sells prosthetic parts to orthopedic surgeons
I selling the case against my previous work they loved
It takes me 3 hours to sell the case
They fret until the BB3 goes in
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Connecting the dots
bull Adult SDB and OSA
bull Narrow jaws and faces
bull Soft tissue dysfunction
bull Early parafunctional habits ie open mouth posture
bull Environmental stressors
bull CPAP MARAUPPP SurgWherersquos the best
place to start treatment here
or here
1 Prevention 2 Undo the damage already done3 Establish good habits
When to start When damage from poor breathing is noticed and when bad habits are discovered
The strategies of Airway Orthodontics
Prevention
bull Remove ankyloglossiabull Promote breastfeedingbull Harden the dietbull Develop masticatory strengthbull Discourage oral habitsbull Promote whole-foods low sugar dietbull Reduce oropharyngeal obstructionbull Promote nasal breathing
Breathing retraining
bull Nasal rinsingbull Nasal clearingbull Decongesting
The goals of Airway Orthodontics
1 Breathing through the nose2 Lips together at rest3 Correct tongue position4 No facial muscles moving on swallowing5 Optimal forward facial development6 Class I occlusion7 Straight teeth8 Better stability long term
Myofunctional Trainers
Professors R Soulet and A Besombes
Dr Earl Bergeson
Dr Chris Farrell
The Multi ndash Family System
Orofacial MyofunctionalTherapy
Oral MyologyMyofunctional TherapyTongue Thrust Therapy
B Hockel 2012 Back
Undoing Bimaxillary Dysplasia
1 Maxillary deconstriction2 Maxillary advancement3 Maxillary impaction4 Mandibular advancement
1 Maxillary Expansion
Treatment for Bimaxillary Dysplasia
ALFCrozat
Bent Wire
HyraxHaas
Niti Exp BioBlocSchwartz
The Farrell BENT WIRE Systemtrade
Recommended Age Group 5-12 yrs
Arch Development in conjunction with the TRAINER Systemtrade
Dr John Mew
Establish Good Habits
1 Breathing through the nose2 Lips together at rest3 Correct tongue position4 No facial muscles moving on swallowing5 Stand and sit in balance6 Breath gently using the diaphragm7 Eat to nourish8 Sleep to rest
Ortho-Postural TrainingWorkshops
Breathing
Nutrition
Posture
Sleep
COPYRIGHTRoger L PriceOctober 2012
Posture Number
Forward head posturecan be a compensationfor a deficient airway
Sleep Screening and Hygiene
SQI = 10 SQI = 98
Integrative Healthcare
Function ProfessionalNasal clearing ENT Pulm MFT BreathingMuscle balance and tone MFT Myofunctional OrthoUndoing damage GP Pedo Ortho OMFSBreathing dynamics OPT MFT Breath PhysiologistPosture DC OPT PT OsteopathCranial balance OsteopathNutrition RDH Nutritionist Dietitian Sleep ENT Sleep Med DentNeurocognitive development Pedrsquon SLP Psych SpEd
The Interdisciplinary Center
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Now that I know
My personal missionTo create from what Irsquove
learned from the besta model for others to followhellipespecially the orthodontists
Myofunctional Orthodontics
Chris Farrell
John Flutter
German Ramierez
Damien OrsquoBrien
Myofunctional Research CoRancho Cucamonga
2008-2012
Oral Myology
Oral Myology Basic CourseJoy MoellerNYC 2011LA 2012
Oral Myology Levels 2 3Kim BenkertClifton 2012
Habit CessationShari GreenClifton 2013
Biobloc Orthotropics
BBO Mini-residencyBill Hang
Agora Hills2012-13
BBO IntensiveDrs John and Mike
MewLSFO2013
Breathing and Sleep
Buteyko MentorshipThe Breathing Center
Woodstock2010
Breathing Well ProgrammeJohn Flutter
2010 Ortho-Postural TrainingRoger Price
2013
Sleep DentistryMichael Gelb etal
NYU2012
ALF and Cranial
Jim Bronson2013 Tasha Turzo
Cranial Academy2014
Bucket Listbull ALF and Crozat (Bronsonrsquos course)bullMore on Biobloc (Hangrsquos Advanced London School)bull More Cranial (The Farm)bullChirodontics (Bob Walker)bull Airway Dentistry with Marc Cruz Jeff Rousebull Sleep Dentistrybull Less-than-Six with Kevin Boydbull Intra-mandibular Distraction Osteogenesis (IMDO)
Off My ListAnything that moves the teeth faster in the wrong direction
Whatrsquos an RO to do
To create from what Irsquove learned from the best
a model for others to followhellipespecially orthodontists
Teaching
Mt Sinai Pedo ResidencyAli Attaie
2010-2012
Montefiore Ortho ResidencyTony Maganzini
2012
2009-Present
Mt Sinai School of MedicinePedodontic Residency
Guest SpeakersJim BronsonMike MewKevin BoydSandra KahnJennifer TowRoger PricePaula Fabbie
Damien OrsquoBrien
First clinical program in myofunctional orthodontics
Airway and Facial DevelopmentCollaborative Webcast
Mark Cruz
AAPMD Symposium
wwwaapm
dorg
Annual MeetingApril 25-26 2014
Westin Chicago North Shore
the raphael center for integrative orthodontics
wwwalignminecomwwwbioblocnjcom
wwwmyobracenjcom
Integrative vs Conventional
Integrative vs Conventional
ldquoWith improvements in expansion orthodontics advances in myofunctional orthodontics and the growing recognition about sleep disordered breathing among children and adults it is time for orthodontics to expand its horizons There is now so much more we can oerrdquo
The Raphael name has been associated with high quality orthodontics in New Jersey for over 60 years Dr Barry Raphael has been a university trained orthodontic specialist and a member of the American Association of Orthodontists for 30 years
He has a wide range of techniques and services to offer He has studied oral myology applied kinesiology Buteyko breathing Biobloc Orthotropics and Myobrace as part of his integrative training He can offer Damon Invisalign Insignia and Incognito appliances designs as some of his many conventional orthodontic services too
Dr Raphael teaches his techniques at post-graduate residencies study clubs dental societies and for the Myofunctional Research Co He is available for presentations to any group interested in learning more about the benefits of integrative orthodontics
wwwalignminecomLearn about the choices you have in orthodontics
dr barry raphael Why its
too Early never
1425
bro
ad
str
ee
tc
lifto
n n
j 070
13
973-
778-
4222
fax
973-
778-
9625
nj s
pe
c
368
4
1425 broad street clifton nj 07013973-778-4222
wwwalignminecom
the raphael centerforintegrative orthodontics
the
raph
ael c
ente
r fo
rin
tegr
ativ
e or
thod
onti
cs
Learn about an important choice you need to make before starting braces
the raphael center for integrative education
the raphael center for integrative education
Ongoing Intro to Airway Orthodontics
April Biobloc Study Group
April Training Ortho-Postural Therapists w Roger Price
June MRC Myobrace Basic Series
August Airway Dentistry with Mark Cruz and company
October Advanced MFT with Sandy Coulson
October Less than Six with Kevin Boyd
(who else wants to play)
Mission to create a space for spreading the word about Airway and Orthotropic principles and practice
Orthodontics in the 21st Century
EstheticOrthodontics
AirwayOrthodontics
GeneticTooth-Focused
Dental PerfectionEsthetics Primary
Treating SymptomsAirway Ignorant
AdaptationMuscle-FocusedMedical Better
Esthetics SecondaryTreating Causes
Airway Conscious
The EndAnd
The Beginning
After Treatment
Bent-wire6 monthsMyobrace12 months
Hey RaphaelWhat about that
profile
ZP 9-5yoM
i
After Expansion Phase
Incomplete profile improvement better breathing head posture and sleep
Incisor Goals
Type 3 Treatment Maintain UI
Functional Orthodontics Expansion Orthodontics Distalization Ortho or No Treatment
Type 3 Maintain
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Bimax retrusion
Successful dental result
Profile Unimproved
Incisor Goals
Type 4 Treatment RetractExtrude UI
Extraction Orthodontics Retraction Ortho Distalization Ortho
Type 4 Retraction
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Bimax retrusion
Successful dental result
Failed Profile Result
Changes of pharyngeal airway size and hyoid bone position following orthodontic treatment of
Class I bimaxillary protrusion
Qingzhu Wanga Peizeng Jiab Nina K Andersonc Lin Wangd Jiuxiang Line
Angle Orthodontist Vol 00 No 0 0000 (pre-publication 2012)
ldquothe dimension of the velopharynx glossopharynx and hypopharynx were decreased after maximal retraction of anterior teeth with extraction of four premolarshelliprdquo ldquoAny factors that can influence the posture and position of tongue and soft palate may displace them backward andencroach upon the pharynxrdquo
ldquothe more the incisors were retracted the more the pharyngeal airway was reducedrdquo
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Backed into a corner
bull
Moving teeth faster more efficientlyhellipin the wrong direction
Now that wersquove made smoking unacceptable
could we not do the same withbull Sugarbull Processed foodbull Cheap milk and meatbull Fast foodbull Pill popping for symptomatic reliefbull Looking for the cure instead of the causebull Surgery as a quick fixbull Thinking braces are a status symbol
Each industry thrives on the status quoConsumers must drive the change
NP 10yM
NP
Sisterrsquos non-x ortho
Shersquos happyhellipbut Irsquom not so
I make my pitch for BBO
The dilemma of progress
(I forgot the progress pictureshellip)
Dad sells prosthetic parts to orthopedic surgeons
I selling the case against my previous work they loved
It takes me 3 hours to sell the case
They fret until the BB3 goes in
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Connecting the dots
bull Adult SDB and OSA
bull Narrow jaws and faces
bull Soft tissue dysfunction
bull Early parafunctional habits ie open mouth posture
bull Environmental stressors
bull CPAP MARAUPPP SurgWherersquos the best
place to start treatment here
or here
1 Prevention 2 Undo the damage already done3 Establish good habits
When to start When damage from poor breathing is noticed and when bad habits are discovered
The strategies of Airway Orthodontics
Prevention
bull Remove ankyloglossiabull Promote breastfeedingbull Harden the dietbull Develop masticatory strengthbull Discourage oral habitsbull Promote whole-foods low sugar dietbull Reduce oropharyngeal obstructionbull Promote nasal breathing
Breathing retraining
bull Nasal rinsingbull Nasal clearingbull Decongesting
The goals of Airway Orthodontics
1 Breathing through the nose2 Lips together at rest3 Correct tongue position4 No facial muscles moving on swallowing5 Optimal forward facial development6 Class I occlusion7 Straight teeth8 Better stability long term
Myofunctional Trainers
Professors R Soulet and A Besombes
Dr Earl Bergeson
Dr Chris Farrell
The Multi ndash Family System
Orofacial MyofunctionalTherapy
Oral MyologyMyofunctional TherapyTongue Thrust Therapy
B Hockel 2012 Back
Undoing Bimaxillary Dysplasia
1 Maxillary deconstriction2 Maxillary advancement3 Maxillary impaction4 Mandibular advancement
1 Maxillary Expansion
Treatment for Bimaxillary Dysplasia
ALFCrozat
Bent Wire
HyraxHaas
Niti Exp BioBlocSchwartz
The Farrell BENT WIRE Systemtrade
Recommended Age Group 5-12 yrs
Arch Development in conjunction with the TRAINER Systemtrade
Dr John Mew
Establish Good Habits
1 Breathing through the nose2 Lips together at rest3 Correct tongue position4 No facial muscles moving on swallowing5 Stand and sit in balance6 Breath gently using the diaphragm7 Eat to nourish8 Sleep to rest
Ortho-Postural TrainingWorkshops
Breathing
Nutrition
Posture
Sleep
COPYRIGHTRoger L PriceOctober 2012
Posture Number
Forward head posturecan be a compensationfor a deficient airway
Sleep Screening and Hygiene
SQI = 10 SQI = 98
Integrative Healthcare
Function ProfessionalNasal clearing ENT Pulm MFT BreathingMuscle balance and tone MFT Myofunctional OrthoUndoing damage GP Pedo Ortho OMFSBreathing dynamics OPT MFT Breath PhysiologistPosture DC OPT PT OsteopathCranial balance OsteopathNutrition RDH Nutritionist Dietitian Sleep ENT Sleep Med DentNeurocognitive development Pedrsquon SLP Psych SpEd
The Interdisciplinary Center
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Now that I know
My personal missionTo create from what Irsquove
learned from the besta model for others to followhellipespecially the orthodontists
Myofunctional Orthodontics
Chris Farrell
John Flutter
German Ramierez
Damien OrsquoBrien
Myofunctional Research CoRancho Cucamonga
2008-2012
Oral Myology
Oral Myology Basic CourseJoy MoellerNYC 2011LA 2012
Oral Myology Levels 2 3Kim BenkertClifton 2012
Habit CessationShari GreenClifton 2013
Biobloc Orthotropics
BBO Mini-residencyBill Hang
Agora Hills2012-13
BBO IntensiveDrs John and Mike
MewLSFO2013
Breathing and Sleep
Buteyko MentorshipThe Breathing Center
Woodstock2010
Breathing Well ProgrammeJohn Flutter
2010 Ortho-Postural TrainingRoger Price
2013
Sleep DentistryMichael Gelb etal
NYU2012
ALF and Cranial
Jim Bronson2013 Tasha Turzo
Cranial Academy2014
Bucket Listbull ALF and Crozat (Bronsonrsquos course)bullMore on Biobloc (Hangrsquos Advanced London School)bull More Cranial (The Farm)bullChirodontics (Bob Walker)bull Airway Dentistry with Marc Cruz Jeff Rousebull Sleep Dentistrybull Less-than-Six with Kevin Boydbull Intra-mandibular Distraction Osteogenesis (IMDO)
Off My ListAnything that moves the teeth faster in the wrong direction
Whatrsquos an RO to do
To create from what Irsquove learned from the best
a model for others to followhellipespecially orthodontists
Teaching
Mt Sinai Pedo ResidencyAli Attaie
2010-2012
Montefiore Ortho ResidencyTony Maganzini
2012
2009-Present
Mt Sinai School of MedicinePedodontic Residency
Guest SpeakersJim BronsonMike MewKevin BoydSandra KahnJennifer TowRoger PricePaula Fabbie
Damien OrsquoBrien
First clinical program in myofunctional orthodontics
Airway and Facial DevelopmentCollaborative Webcast
Mark Cruz
AAPMD Symposium
wwwaapm
dorg
Annual MeetingApril 25-26 2014
Westin Chicago North Shore
the raphael center for integrative orthodontics
wwwalignminecomwwwbioblocnjcom
wwwmyobracenjcom
Integrative vs Conventional
Integrative vs Conventional
ldquoWith improvements in expansion orthodontics advances in myofunctional orthodontics and the growing recognition about sleep disordered breathing among children and adults it is time for orthodontics to expand its horizons There is now so much more we can oerrdquo
The Raphael name has been associated with high quality orthodontics in New Jersey for over 60 years Dr Barry Raphael has been a university trained orthodontic specialist and a member of the American Association of Orthodontists for 30 years
He has a wide range of techniques and services to offer He has studied oral myology applied kinesiology Buteyko breathing Biobloc Orthotropics and Myobrace as part of his integrative training He can offer Damon Invisalign Insignia and Incognito appliances designs as some of his many conventional orthodontic services too
Dr Raphael teaches his techniques at post-graduate residencies study clubs dental societies and for the Myofunctional Research Co He is available for presentations to any group interested in learning more about the benefits of integrative orthodontics
wwwalignminecomLearn about the choices you have in orthodontics
dr barry raphael Why its
too Early never
1425
bro
ad
str
ee
tc
lifto
n n
j 070
13
973-
778-
4222
fax
973-
778-
9625
nj s
pe
c
368
4
1425 broad street clifton nj 07013973-778-4222
wwwalignminecom
the raphael centerforintegrative orthodontics
the
raph
ael c
ente
r fo
rin
tegr
ativ
e or
thod
onti
cs
Learn about an important choice you need to make before starting braces
the raphael center for integrative education
the raphael center for integrative education
Ongoing Intro to Airway Orthodontics
April Biobloc Study Group
April Training Ortho-Postural Therapists w Roger Price
June MRC Myobrace Basic Series
August Airway Dentistry with Mark Cruz and company
October Advanced MFT with Sandy Coulson
October Less than Six with Kevin Boyd
(who else wants to play)
Mission to create a space for spreading the word about Airway and Orthotropic principles and practice
Orthodontics in the 21st Century
EstheticOrthodontics
AirwayOrthodontics
GeneticTooth-Focused
Dental PerfectionEsthetics Primary
Treating SymptomsAirway Ignorant
AdaptationMuscle-FocusedMedical Better
Esthetics SecondaryTreating Causes
Airway Conscious
The EndAnd
The Beginning
ZP 9-5yoM
i
After Expansion Phase
Incomplete profile improvement better breathing head posture and sleep
Incisor Goals
Type 3 Treatment Maintain UI
Functional Orthodontics Expansion Orthodontics Distalization Ortho or No Treatment
Type 3 Maintain
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Bimax retrusion
Successful dental result
Profile Unimproved
Incisor Goals
Type 4 Treatment RetractExtrude UI
Extraction Orthodontics Retraction Ortho Distalization Ortho
Type 4 Retraction
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Bimax retrusion
Successful dental result
Failed Profile Result
Changes of pharyngeal airway size and hyoid bone position following orthodontic treatment of
Class I bimaxillary protrusion
Qingzhu Wanga Peizeng Jiab Nina K Andersonc Lin Wangd Jiuxiang Line
Angle Orthodontist Vol 00 No 0 0000 (pre-publication 2012)
ldquothe dimension of the velopharynx glossopharynx and hypopharynx were decreased after maximal retraction of anterior teeth with extraction of four premolarshelliprdquo ldquoAny factors that can influence the posture and position of tongue and soft palate may displace them backward andencroach upon the pharynxrdquo
ldquothe more the incisors were retracted the more the pharyngeal airway was reducedrdquo
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Backed into a corner
bull
Moving teeth faster more efficientlyhellipin the wrong direction
Now that wersquove made smoking unacceptable
could we not do the same withbull Sugarbull Processed foodbull Cheap milk and meatbull Fast foodbull Pill popping for symptomatic reliefbull Looking for the cure instead of the causebull Surgery as a quick fixbull Thinking braces are a status symbol
Each industry thrives on the status quoConsumers must drive the change
NP 10yM
NP
Sisterrsquos non-x ortho
Shersquos happyhellipbut Irsquom not so
I make my pitch for BBO
The dilemma of progress
(I forgot the progress pictureshellip)
Dad sells prosthetic parts to orthopedic surgeons
I selling the case against my previous work they loved
It takes me 3 hours to sell the case
They fret until the BB3 goes in
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Connecting the dots
bull Adult SDB and OSA
bull Narrow jaws and faces
bull Soft tissue dysfunction
bull Early parafunctional habits ie open mouth posture
bull Environmental stressors
bull CPAP MARAUPPP SurgWherersquos the best
place to start treatment here
or here
1 Prevention 2 Undo the damage already done3 Establish good habits
When to start When damage from poor breathing is noticed and when bad habits are discovered
The strategies of Airway Orthodontics
Prevention
bull Remove ankyloglossiabull Promote breastfeedingbull Harden the dietbull Develop masticatory strengthbull Discourage oral habitsbull Promote whole-foods low sugar dietbull Reduce oropharyngeal obstructionbull Promote nasal breathing
Breathing retraining
bull Nasal rinsingbull Nasal clearingbull Decongesting
The goals of Airway Orthodontics
1 Breathing through the nose2 Lips together at rest3 Correct tongue position4 No facial muscles moving on swallowing5 Optimal forward facial development6 Class I occlusion7 Straight teeth8 Better stability long term
Myofunctional Trainers
Professors R Soulet and A Besombes
Dr Earl Bergeson
Dr Chris Farrell
The Multi ndash Family System
Orofacial MyofunctionalTherapy
Oral MyologyMyofunctional TherapyTongue Thrust Therapy
B Hockel 2012 Back
Undoing Bimaxillary Dysplasia
1 Maxillary deconstriction2 Maxillary advancement3 Maxillary impaction4 Mandibular advancement
1 Maxillary Expansion
Treatment for Bimaxillary Dysplasia
ALFCrozat
Bent Wire
HyraxHaas
Niti Exp BioBlocSchwartz
The Farrell BENT WIRE Systemtrade
Recommended Age Group 5-12 yrs
Arch Development in conjunction with the TRAINER Systemtrade
Dr John Mew
Establish Good Habits
1 Breathing through the nose2 Lips together at rest3 Correct tongue position4 No facial muscles moving on swallowing5 Stand and sit in balance6 Breath gently using the diaphragm7 Eat to nourish8 Sleep to rest
Ortho-Postural TrainingWorkshops
Breathing
Nutrition
Posture
Sleep
COPYRIGHTRoger L PriceOctober 2012
Posture Number
Forward head posturecan be a compensationfor a deficient airway
Sleep Screening and Hygiene
SQI = 10 SQI = 98
Integrative Healthcare
Function ProfessionalNasal clearing ENT Pulm MFT BreathingMuscle balance and tone MFT Myofunctional OrthoUndoing damage GP Pedo Ortho OMFSBreathing dynamics OPT MFT Breath PhysiologistPosture DC OPT PT OsteopathCranial balance OsteopathNutrition RDH Nutritionist Dietitian Sleep ENT Sleep Med DentNeurocognitive development Pedrsquon SLP Psych SpEd
The Interdisciplinary Center
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Now that I know
My personal missionTo create from what Irsquove
learned from the besta model for others to followhellipespecially the orthodontists
Myofunctional Orthodontics
Chris Farrell
John Flutter
German Ramierez
Damien OrsquoBrien
Myofunctional Research CoRancho Cucamonga
2008-2012
Oral Myology
Oral Myology Basic CourseJoy MoellerNYC 2011LA 2012
Oral Myology Levels 2 3Kim BenkertClifton 2012
Habit CessationShari GreenClifton 2013
Biobloc Orthotropics
BBO Mini-residencyBill Hang
Agora Hills2012-13
BBO IntensiveDrs John and Mike
MewLSFO2013
Breathing and Sleep
Buteyko MentorshipThe Breathing Center
Woodstock2010
Breathing Well ProgrammeJohn Flutter
2010 Ortho-Postural TrainingRoger Price
2013
Sleep DentistryMichael Gelb etal
NYU2012
ALF and Cranial
Jim Bronson2013 Tasha Turzo
Cranial Academy2014
Bucket Listbull ALF and Crozat (Bronsonrsquos course)bullMore on Biobloc (Hangrsquos Advanced London School)bull More Cranial (The Farm)bullChirodontics (Bob Walker)bull Airway Dentistry with Marc Cruz Jeff Rousebull Sleep Dentistrybull Less-than-Six with Kevin Boydbull Intra-mandibular Distraction Osteogenesis (IMDO)
Off My ListAnything that moves the teeth faster in the wrong direction
Whatrsquos an RO to do
To create from what Irsquove learned from the best
a model for others to followhellipespecially orthodontists
Teaching
Mt Sinai Pedo ResidencyAli Attaie
2010-2012
Montefiore Ortho ResidencyTony Maganzini
2012
2009-Present
Mt Sinai School of MedicinePedodontic Residency
Guest SpeakersJim BronsonMike MewKevin BoydSandra KahnJennifer TowRoger PricePaula Fabbie
Damien OrsquoBrien
First clinical program in myofunctional orthodontics
Airway and Facial DevelopmentCollaborative Webcast
Mark Cruz
AAPMD Symposium
wwwaapm
dorg
Annual MeetingApril 25-26 2014
Westin Chicago North Shore
the raphael center for integrative orthodontics
wwwalignminecomwwwbioblocnjcom
wwwmyobracenjcom
Integrative vs Conventional
Integrative vs Conventional
ldquoWith improvements in expansion orthodontics advances in myofunctional orthodontics and the growing recognition about sleep disordered breathing among children and adults it is time for orthodontics to expand its horizons There is now so much more we can oerrdquo
The Raphael name has been associated with high quality orthodontics in New Jersey for over 60 years Dr Barry Raphael has been a university trained orthodontic specialist and a member of the American Association of Orthodontists for 30 years
He has a wide range of techniques and services to offer He has studied oral myology applied kinesiology Buteyko breathing Biobloc Orthotropics and Myobrace as part of his integrative training He can offer Damon Invisalign Insignia and Incognito appliances designs as some of his many conventional orthodontic services too
Dr Raphael teaches his techniques at post-graduate residencies study clubs dental societies and for the Myofunctional Research Co He is available for presentations to any group interested in learning more about the benefits of integrative orthodontics
wwwalignminecomLearn about the choices you have in orthodontics
dr barry raphael Why its
too Early never
1425
bro
ad
str
ee
tc
lifto
n n
j 070
13
973-
778-
4222
fax
973-
778-
9625
nj s
pe
c
368
4
1425 broad street clifton nj 07013973-778-4222
wwwalignminecom
the raphael centerforintegrative orthodontics
the
raph
ael c
ente
r fo
rin
tegr
ativ
e or
thod
onti
cs
Learn about an important choice you need to make before starting braces
the raphael center for integrative education
the raphael center for integrative education
Ongoing Intro to Airway Orthodontics
April Biobloc Study Group
April Training Ortho-Postural Therapists w Roger Price
June MRC Myobrace Basic Series
August Airway Dentistry with Mark Cruz and company
October Advanced MFT with Sandy Coulson
October Less than Six with Kevin Boyd
(who else wants to play)
Mission to create a space for spreading the word about Airway and Orthotropic principles and practice
Orthodontics in the 21st Century
EstheticOrthodontics
AirwayOrthodontics
GeneticTooth-Focused
Dental PerfectionEsthetics Primary
Treating SymptomsAirway Ignorant
AdaptationMuscle-FocusedMedical Better
Esthetics SecondaryTreating Causes
Airway Conscious
The EndAnd
The Beginning
After Expansion Phase
Incomplete profile improvement better breathing head posture and sleep
Incisor Goals
Type 3 Treatment Maintain UI
Functional Orthodontics Expansion Orthodontics Distalization Ortho or No Treatment
Type 3 Maintain
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Bimax retrusion
Successful dental result
Profile Unimproved
Incisor Goals
Type 4 Treatment RetractExtrude UI
Extraction Orthodontics Retraction Ortho Distalization Ortho
Type 4 Retraction
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Bimax retrusion
Successful dental result
Failed Profile Result
Changes of pharyngeal airway size and hyoid bone position following orthodontic treatment of
Class I bimaxillary protrusion
Qingzhu Wanga Peizeng Jiab Nina K Andersonc Lin Wangd Jiuxiang Line
Angle Orthodontist Vol 00 No 0 0000 (pre-publication 2012)
ldquothe dimension of the velopharynx glossopharynx and hypopharynx were decreased after maximal retraction of anterior teeth with extraction of four premolarshelliprdquo ldquoAny factors that can influence the posture and position of tongue and soft palate may displace them backward andencroach upon the pharynxrdquo
ldquothe more the incisors were retracted the more the pharyngeal airway was reducedrdquo
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Backed into a corner
bull
Moving teeth faster more efficientlyhellipin the wrong direction
Now that wersquove made smoking unacceptable
could we not do the same withbull Sugarbull Processed foodbull Cheap milk and meatbull Fast foodbull Pill popping for symptomatic reliefbull Looking for the cure instead of the causebull Surgery as a quick fixbull Thinking braces are a status symbol
Each industry thrives on the status quoConsumers must drive the change
NP 10yM
NP
Sisterrsquos non-x ortho
Shersquos happyhellipbut Irsquom not so
I make my pitch for BBO
The dilemma of progress
(I forgot the progress pictureshellip)
Dad sells prosthetic parts to orthopedic surgeons
I selling the case against my previous work they loved
It takes me 3 hours to sell the case
They fret until the BB3 goes in
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Connecting the dots
bull Adult SDB and OSA
bull Narrow jaws and faces
bull Soft tissue dysfunction
bull Early parafunctional habits ie open mouth posture
bull Environmental stressors
bull CPAP MARAUPPP SurgWherersquos the best
place to start treatment here
or here
1 Prevention 2 Undo the damage already done3 Establish good habits
When to start When damage from poor breathing is noticed and when bad habits are discovered
The strategies of Airway Orthodontics
Prevention
bull Remove ankyloglossiabull Promote breastfeedingbull Harden the dietbull Develop masticatory strengthbull Discourage oral habitsbull Promote whole-foods low sugar dietbull Reduce oropharyngeal obstructionbull Promote nasal breathing
Breathing retraining
bull Nasal rinsingbull Nasal clearingbull Decongesting
The goals of Airway Orthodontics
1 Breathing through the nose2 Lips together at rest3 Correct tongue position4 No facial muscles moving on swallowing5 Optimal forward facial development6 Class I occlusion7 Straight teeth8 Better stability long term
Myofunctional Trainers
Professors R Soulet and A Besombes
Dr Earl Bergeson
Dr Chris Farrell
The Multi ndash Family System
Orofacial MyofunctionalTherapy
Oral MyologyMyofunctional TherapyTongue Thrust Therapy
B Hockel 2012 Back
Undoing Bimaxillary Dysplasia
1 Maxillary deconstriction2 Maxillary advancement3 Maxillary impaction4 Mandibular advancement
1 Maxillary Expansion
Treatment for Bimaxillary Dysplasia
ALFCrozat
Bent Wire
HyraxHaas
Niti Exp BioBlocSchwartz
The Farrell BENT WIRE Systemtrade
Recommended Age Group 5-12 yrs
Arch Development in conjunction with the TRAINER Systemtrade
Dr John Mew
Establish Good Habits
1 Breathing through the nose2 Lips together at rest3 Correct tongue position4 No facial muscles moving on swallowing5 Stand and sit in balance6 Breath gently using the diaphragm7 Eat to nourish8 Sleep to rest
Ortho-Postural TrainingWorkshops
Breathing
Nutrition
Posture
Sleep
COPYRIGHTRoger L PriceOctober 2012
Posture Number
Forward head posturecan be a compensationfor a deficient airway
Sleep Screening and Hygiene
SQI = 10 SQI = 98
Integrative Healthcare
Function ProfessionalNasal clearing ENT Pulm MFT BreathingMuscle balance and tone MFT Myofunctional OrthoUndoing damage GP Pedo Ortho OMFSBreathing dynamics OPT MFT Breath PhysiologistPosture DC OPT PT OsteopathCranial balance OsteopathNutrition RDH Nutritionist Dietitian Sleep ENT Sleep Med DentNeurocognitive development Pedrsquon SLP Psych SpEd
The Interdisciplinary Center
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Now that I know
My personal missionTo create from what Irsquove
learned from the besta model for others to followhellipespecially the orthodontists
Myofunctional Orthodontics
Chris Farrell
John Flutter
German Ramierez
Damien OrsquoBrien
Myofunctional Research CoRancho Cucamonga
2008-2012
Oral Myology
Oral Myology Basic CourseJoy MoellerNYC 2011LA 2012
Oral Myology Levels 2 3Kim BenkertClifton 2012
Habit CessationShari GreenClifton 2013
Biobloc Orthotropics
BBO Mini-residencyBill Hang
Agora Hills2012-13
BBO IntensiveDrs John and Mike
MewLSFO2013
Breathing and Sleep
Buteyko MentorshipThe Breathing Center
Woodstock2010
Breathing Well ProgrammeJohn Flutter
2010 Ortho-Postural TrainingRoger Price
2013
Sleep DentistryMichael Gelb etal
NYU2012
ALF and Cranial
Jim Bronson2013 Tasha Turzo
Cranial Academy2014
Bucket Listbull ALF and Crozat (Bronsonrsquos course)bullMore on Biobloc (Hangrsquos Advanced London School)bull More Cranial (The Farm)bullChirodontics (Bob Walker)bull Airway Dentistry with Marc Cruz Jeff Rousebull Sleep Dentistrybull Less-than-Six with Kevin Boydbull Intra-mandibular Distraction Osteogenesis (IMDO)
Off My ListAnything that moves the teeth faster in the wrong direction
Whatrsquos an RO to do
To create from what Irsquove learned from the best
a model for others to followhellipespecially orthodontists
Teaching
Mt Sinai Pedo ResidencyAli Attaie
2010-2012
Montefiore Ortho ResidencyTony Maganzini
2012
2009-Present
Mt Sinai School of MedicinePedodontic Residency
Guest SpeakersJim BronsonMike MewKevin BoydSandra KahnJennifer TowRoger PricePaula Fabbie
Damien OrsquoBrien
First clinical program in myofunctional orthodontics
Airway and Facial DevelopmentCollaborative Webcast
Mark Cruz
AAPMD Symposium
wwwaapm
dorg
Annual MeetingApril 25-26 2014
Westin Chicago North Shore
the raphael center for integrative orthodontics
wwwalignminecomwwwbioblocnjcom
wwwmyobracenjcom
Integrative vs Conventional
Integrative vs Conventional
ldquoWith improvements in expansion orthodontics advances in myofunctional orthodontics and the growing recognition about sleep disordered breathing among children and adults it is time for orthodontics to expand its horizons There is now so much more we can oerrdquo
The Raphael name has been associated with high quality orthodontics in New Jersey for over 60 years Dr Barry Raphael has been a university trained orthodontic specialist and a member of the American Association of Orthodontists for 30 years
He has a wide range of techniques and services to offer He has studied oral myology applied kinesiology Buteyko breathing Biobloc Orthotropics and Myobrace as part of his integrative training He can offer Damon Invisalign Insignia and Incognito appliances designs as some of his many conventional orthodontic services too
Dr Raphael teaches his techniques at post-graduate residencies study clubs dental societies and for the Myofunctional Research Co He is available for presentations to any group interested in learning more about the benefits of integrative orthodontics
wwwalignminecomLearn about the choices you have in orthodontics
dr barry raphael Why its
too Early never
1425
bro
ad
str
ee
tc
lifto
n n
j 070
13
973-
778-
4222
fax
973-
778-
9625
nj s
pe
c
368
4
1425 broad street clifton nj 07013973-778-4222
wwwalignminecom
the raphael centerforintegrative orthodontics
the
raph
ael c
ente
r fo
rin
tegr
ativ
e or
thod
onti
cs
Learn about an important choice you need to make before starting braces
the raphael center for integrative education
the raphael center for integrative education
Ongoing Intro to Airway Orthodontics
April Biobloc Study Group
April Training Ortho-Postural Therapists w Roger Price
June MRC Myobrace Basic Series
August Airway Dentistry with Mark Cruz and company
October Advanced MFT with Sandy Coulson
October Less than Six with Kevin Boyd
(who else wants to play)
Mission to create a space for spreading the word about Airway and Orthotropic principles and practice
Orthodontics in the 21st Century
EstheticOrthodontics
AirwayOrthodontics
GeneticTooth-Focused
Dental PerfectionEsthetics Primary
Treating SymptomsAirway Ignorant
AdaptationMuscle-FocusedMedical Better
Esthetics SecondaryTreating Causes
Airway Conscious
The EndAnd
The Beginning
Incomplete profile improvement better breathing head posture and sleep
Incisor Goals
Type 3 Treatment Maintain UI
Functional Orthodontics Expansion Orthodontics Distalization Ortho or No Treatment
Type 3 Maintain
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Bimax retrusion
Successful dental result
Profile Unimproved
Incisor Goals
Type 4 Treatment RetractExtrude UI
Extraction Orthodontics Retraction Ortho Distalization Ortho
Type 4 Retraction
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Bimax retrusion
Successful dental result
Failed Profile Result
Changes of pharyngeal airway size and hyoid bone position following orthodontic treatment of
Class I bimaxillary protrusion
Qingzhu Wanga Peizeng Jiab Nina K Andersonc Lin Wangd Jiuxiang Line
Angle Orthodontist Vol 00 No 0 0000 (pre-publication 2012)
ldquothe dimension of the velopharynx glossopharynx and hypopharynx were decreased after maximal retraction of anterior teeth with extraction of four premolarshelliprdquo ldquoAny factors that can influence the posture and position of tongue and soft palate may displace them backward andencroach upon the pharynxrdquo
ldquothe more the incisors were retracted the more the pharyngeal airway was reducedrdquo
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Backed into a corner
bull
Moving teeth faster more efficientlyhellipin the wrong direction
Now that wersquove made smoking unacceptable
could we not do the same withbull Sugarbull Processed foodbull Cheap milk and meatbull Fast foodbull Pill popping for symptomatic reliefbull Looking for the cure instead of the causebull Surgery as a quick fixbull Thinking braces are a status symbol
Each industry thrives on the status quoConsumers must drive the change
NP 10yM
NP
Sisterrsquos non-x ortho
Shersquos happyhellipbut Irsquom not so
I make my pitch for BBO
The dilemma of progress
(I forgot the progress pictureshellip)
Dad sells prosthetic parts to orthopedic surgeons
I selling the case against my previous work they loved
It takes me 3 hours to sell the case
They fret until the BB3 goes in
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Connecting the dots
bull Adult SDB and OSA
bull Narrow jaws and faces
bull Soft tissue dysfunction
bull Early parafunctional habits ie open mouth posture
bull Environmental stressors
bull CPAP MARAUPPP SurgWherersquos the best
place to start treatment here
or here
1 Prevention 2 Undo the damage already done3 Establish good habits
When to start When damage from poor breathing is noticed and when bad habits are discovered
The strategies of Airway Orthodontics
Prevention
bull Remove ankyloglossiabull Promote breastfeedingbull Harden the dietbull Develop masticatory strengthbull Discourage oral habitsbull Promote whole-foods low sugar dietbull Reduce oropharyngeal obstructionbull Promote nasal breathing
Breathing retraining
bull Nasal rinsingbull Nasal clearingbull Decongesting
The goals of Airway Orthodontics
1 Breathing through the nose2 Lips together at rest3 Correct tongue position4 No facial muscles moving on swallowing5 Optimal forward facial development6 Class I occlusion7 Straight teeth8 Better stability long term
Myofunctional Trainers
Professors R Soulet and A Besombes
Dr Earl Bergeson
Dr Chris Farrell
The Multi ndash Family System
Orofacial MyofunctionalTherapy
Oral MyologyMyofunctional TherapyTongue Thrust Therapy
B Hockel 2012 Back
Undoing Bimaxillary Dysplasia
1 Maxillary deconstriction2 Maxillary advancement3 Maxillary impaction4 Mandibular advancement
1 Maxillary Expansion
Treatment for Bimaxillary Dysplasia
ALFCrozat
Bent Wire
HyraxHaas
Niti Exp BioBlocSchwartz
The Farrell BENT WIRE Systemtrade
Recommended Age Group 5-12 yrs
Arch Development in conjunction with the TRAINER Systemtrade
Dr John Mew
Establish Good Habits
1 Breathing through the nose2 Lips together at rest3 Correct tongue position4 No facial muscles moving on swallowing5 Stand and sit in balance6 Breath gently using the diaphragm7 Eat to nourish8 Sleep to rest
Ortho-Postural TrainingWorkshops
Breathing
Nutrition
Posture
Sleep
COPYRIGHTRoger L PriceOctober 2012
Posture Number
Forward head posturecan be a compensationfor a deficient airway
Sleep Screening and Hygiene
SQI = 10 SQI = 98
Integrative Healthcare
Function ProfessionalNasal clearing ENT Pulm MFT BreathingMuscle balance and tone MFT Myofunctional OrthoUndoing damage GP Pedo Ortho OMFSBreathing dynamics OPT MFT Breath PhysiologistPosture DC OPT PT OsteopathCranial balance OsteopathNutrition RDH Nutritionist Dietitian Sleep ENT Sleep Med DentNeurocognitive development Pedrsquon SLP Psych SpEd
The Interdisciplinary Center
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Now that I know
My personal missionTo create from what Irsquove
learned from the besta model for others to followhellipespecially the orthodontists
Myofunctional Orthodontics
Chris Farrell
John Flutter
German Ramierez
Damien OrsquoBrien
Myofunctional Research CoRancho Cucamonga
2008-2012
Oral Myology
Oral Myology Basic CourseJoy MoellerNYC 2011LA 2012
Oral Myology Levels 2 3Kim BenkertClifton 2012
Habit CessationShari GreenClifton 2013
Biobloc Orthotropics
BBO Mini-residencyBill Hang
Agora Hills2012-13
BBO IntensiveDrs John and Mike
MewLSFO2013
Breathing and Sleep
Buteyko MentorshipThe Breathing Center
Woodstock2010
Breathing Well ProgrammeJohn Flutter
2010 Ortho-Postural TrainingRoger Price
2013
Sleep DentistryMichael Gelb etal
NYU2012
ALF and Cranial
Jim Bronson2013 Tasha Turzo
Cranial Academy2014
Bucket Listbull ALF and Crozat (Bronsonrsquos course)bullMore on Biobloc (Hangrsquos Advanced London School)bull More Cranial (The Farm)bullChirodontics (Bob Walker)bull Airway Dentistry with Marc Cruz Jeff Rousebull Sleep Dentistrybull Less-than-Six with Kevin Boydbull Intra-mandibular Distraction Osteogenesis (IMDO)
Off My ListAnything that moves the teeth faster in the wrong direction
Whatrsquos an RO to do
To create from what Irsquove learned from the best
a model for others to followhellipespecially orthodontists
Teaching
Mt Sinai Pedo ResidencyAli Attaie
2010-2012
Montefiore Ortho ResidencyTony Maganzini
2012
2009-Present
Mt Sinai School of MedicinePedodontic Residency
Guest SpeakersJim BronsonMike MewKevin BoydSandra KahnJennifer TowRoger PricePaula Fabbie
Damien OrsquoBrien
First clinical program in myofunctional orthodontics
Airway and Facial DevelopmentCollaborative Webcast
Mark Cruz
AAPMD Symposium
wwwaapm
dorg
Annual MeetingApril 25-26 2014
Westin Chicago North Shore
the raphael center for integrative orthodontics
wwwalignminecomwwwbioblocnjcom
wwwmyobracenjcom
Integrative vs Conventional
Integrative vs Conventional
ldquoWith improvements in expansion orthodontics advances in myofunctional orthodontics and the growing recognition about sleep disordered breathing among children and adults it is time for orthodontics to expand its horizons There is now so much more we can oerrdquo
The Raphael name has been associated with high quality orthodontics in New Jersey for over 60 years Dr Barry Raphael has been a university trained orthodontic specialist and a member of the American Association of Orthodontists for 30 years
He has a wide range of techniques and services to offer He has studied oral myology applied kinesiology Buteyko breathing Biobloc Orthotropics and Myobrace as part of his integrative training He can offer Damon Invisalign Insignia and Incognito appliances designs as some of his many conventional orthodontic services too
Dr Raphael teaches his techniques at post-graduate residencies study clubs dental societies and for the Myofunctional Research Co He is available for presentations to any group interested in learning more about the benefits of integrative orthodontics
wwwalignminecomLearn about the choices you have in orthodontics
dr barry raphael Why its
too Early never
1425
bro
ad
str
ee
tc
lifto
n n
j 070
13
973-
778-
4222
fax
973-
778-
9625
nj s
pe
c
368
4
1425 broad street clifton nj 07013973-778-4222
wwwalignminecom
the raphael centerforintegrative orthodontics
the
raph
ael c
ente
r fo
rin
tegr
ativ
e or
thod
onti
cs
Learn about an important choice you need to make before starting braces
the raphael center for integrative education
the raphael center for integrative education
Ongoing Intro to Airway Orthodontics
April Biobloc Study Group
April Training Ortho-Postural Therapists w Roger Price
June MRC Myobrace Basic Series
August Airway Dentistry with Mark Cruz and company
October Advanced MFT with Sandy Coulson
October Less than Six with Kevin Boyd
(who else wants to play)
Mission to create a space for spreading the word about Airway and Orthotropic principles and practice
Orthodontics in the 21st Century
EstheticOrthodontics
AirwayOrthodontics
GeneticTooth-Focused
Dental PerfectionEsthetics Primary
Treating SymptomsAirway Ignorant
AdaptationMuscle-FocusedMedical Better
Esthetics SecondaryTreating Causes
Airway Conscious
The EndAnd
The Beginning
Incisor Goals
Type 3 Treatment Maintain UI
Functional Orthodontics Expansion Orthodontics Distalization Ortho or No Treatment
Type 3 Maintain
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Bimax retrusion
Successful dental result
Profile Unimproved
Incisor Goals
Type 4 Treatment RetractExtrude UI
Extraction Orthodontics Retraction Ortho Distalization Ortho
Type 4 Retraction
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Bimax retrusion
Successful dental result
Failed Profile Result
Changes of pharyngeal airway size and hyoid bone position following orthodontic treatment of
Class I bimaxillary protrusion
Qingzhu Wanga Peizeng Jiab Nina K Andersonc Lin Wangd Jiuxiang Line
Angle Orthodontist Vol 00 No 0 0000 (pre-publication 2012)
ldquothe dimension of the velopharynx glossopharynx and hypopharynx were decreased after maximal retraction of anterior teeth with extraction of four premolarshelliprdquo ldquoAny factors that can influence the posture and position of tongue and soft palate may displace them backward andencroach upon the pharynxrdquo
ldquothe more the incisors were retracted the more the pharyngeal airway was reducedrdquo
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Backed into a corner
bull
Moving teeth faster more efficientlyhellipin the wrong direction
Now that wersquove made smoking unacceptable
could we not do the same withbull Sugarbull Processed foodbull Cheap milk and meatbull Fast foodbull Pill popping for symptomatic reliefbull Looking for the cure instead of the causebull Surgery as a quick fixbull Thinking braces are a status symbol
Each industry thrives on the status quoConsumers must drive the change
NP 10yM
NP
Sisterrsquos non-x ortho
Shersquos happyhellipbut Irsquom not so
I make my pitch for BBO
The dilemma of progress
(I forgot the progress pictureshellip)
Dad sells prosthetic parts to orthopedic surgeons
I selling the case against my previous work they loved
It takes me 3 hours to sell the case
They fret until the BB3 goes in
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Connecting the dots
bull Adult SDB and OSA
bull Narrow jaws and faces
bull Soft tissue dysfunction
bull Early parafunctional habits ie open mouth posture
bull Environmental stressors
bull CPAP MARAUPPP SurgWherersquos the best
place to start treatment here
or here
1 Prevention 2 Undo the damage already done3 Establish good habits
When to start When damage from poor breathing is noticed and when bad habits are discovered
The strategies of Airway Orthodontics
Prevention
bull Remove ankyloglossiabull Promote breastfeedingbull Harden the dietbull Develop masticatory strengthbull Discourage oral habitsbull Promote whole-foods low sugar dietbull Reduce oropharyngeal obstructionbull Promote nasal breathing
Breathing retraining
bull Nasal rinsingbull Nasal clearingbull Decongesting
The goals of Airway Orthodontics
1 Breathing through the nose2 Lips together at rest3 Correct tongue position4 No facial muscles moving on swallowing5 Optimal forward facial development6 Class I occlusion7 Straight teeth8 Better stability long term
Myofunctional Trainers
Professors R Soulet and A Besombes
Dr Earl Bergeson
Dr Chris Farrell
The Multi ndash Family System
Orofacial MyofunctionalTherapy
Oral MyologyMyofunctional TherapyTongue Thrust Therapy
B Hockel 2012 Back
Undoing Bimaxillary Dysplasia
1 Maxillary deconstriction2 Maxillary advancement3 Maxillary impaction4 Mandibular advancement
1 Maxillary Expansion
Treatment for Bimaxillary Dysplasia
ALFCrozat
Bent Wire
HyraxHaas
Niti Exp BioBlocSchwartz
The Farrell BENT WIRE Systemtrade
Recommended Age Group 5-12 yrs
Arch Development in conjunction with the TRAINER Systemtrade
Dr John Mew
Establish Good Habits
1 Breathing through the nose2 Lips together at rest3 Correct tongue position4 No facial muscles moving on swallowing5 Stand and sit in balance6 Breath gently using the diaphragm7 Eat to nourish8 Sleep to rest
Ortho-Postural TrainingWorkshops
Breathing
Nutrition
Posture
Sleep
COPYRIGHTRoger L PriceOctober 2012
Posture Number
Forward head posturecan be a compensationfor a deficient airway
Sleep Screening and Hygiene
SQI = 10 SQI = 98
Integrative Healthcare
Function ProfessionalNasal clearing ENT Pulm MFT BreathingMuscle balance and tone MFT Myofunctional OrthoUndoing damage GP Pedo Ortho OMFSBreathing dynamics OPT MFT Breath PhysiologistPosture DC OPT PT OsteopathCranial balance OsteopathNutrition RDH Nutritionist Dietitian Sleep ENT Sleep Med DentNeurocognitive development Pedrsquon SLP Psych SpEd
The Interdisciplinary Center
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Now that I know
My personal missionTo create from what Irsquove
learned from the besta model for others to followhellipespecially the orthodontists
Myofunctional Orthodontics
Chris Farrell
John Flutter
German Ramierez
Damien OrsquoBrien
Myofunctional Research CoRancho Cucamonga
2008-2012
Oral Myology
Oral Myology Basic CourseJoy MoellerNYC 2011LA 2012
Oral Myology Levels 2 3Kim BenkertClifton 2012
Habit CessationShari GreenClifton 2013
Biobloc Orthotropics
BBO Mini-residencyBill Hang
Agora Hills2012-13
BBO IntensiveDrs John and Mike
MewLSFO2013
Breathing and Sleep
Buteyko MentorshipThe Breathing Center
Woodstock2010
Breathing Well ProgrammeJohn Flutter
2010 Ortho-Postural TrainingRoger Price
2013
Sleep DentistryMichael Gelb etal
NYU2012
ALF and Cranial
Jim Bronson2013 Tasha Turzo
Cranial Academy2014
Bucket Listbull ALF and Crozat (Bronsonrsquos course)bullMore on Biobloc (Hangrsquos Advanced London School)bull More Cranial (The Farm)bullChirodontics (Bob Walker)bull Airway Dentistry with Marc Cruz Jeff Rousebull Sleep Dentistrybull Less-than-Six with Kevin Boydbull Intra-mandibular Distraction Osteogenesis (IMDO)
Off My ListAnything that moves the teeth faster in the wrong direction
Whatrsquos an RO to do
To create from what Irsquove learned from the best
a model for others to followhellipespecially orthodontists
Teaching
Mt Sinai Pedo ResidencyAli Attaie
2010-2012
Montefiore Ortho ResidencyTony Maganzini
2012
2009-Present
Mt Sinai School of MedicinePedodontic Residency
Guest SpeakersJim BronsonMike MewKevin BoydSandra KahnJennifer TowRoger PricePaula Fabbie
Damien OrsquoBrien
First clinical program in myofunctional orthodontics
Airway and Facial DevelopmentCollaborative Webcast
Mark Cruz
AAPMD Symposium
wwwaapm
dorg
Annual MeetingApril 25-26 2014
Westin Chicago North Shore
the raphael center for integrative orthodontics
wwwalignminecomwwwbioblocnjcom
wwwmyobracenjcom
Integrative vs Conventional
Integrative vs Conventional
ldquoWith improvements in expansion orthodontics advances in myofunctional orthodontics and the growing recognition about sleep disordered breathing among children and adults it is time for orthodontics to expand its horizons There is now so much more we can oerrdquo
The Raphael name has been associated with high quality orthodontics in New Jersey for over 60 years Dr Barry Raphael has been a university trained orthodontic specialist and a member of the American Association of Orthodontists for 30 years
He has a wide range of techniques and services to offer He has studied oral myology applied kinesiology Buteyko breathing Biobloc Orthotropics and Myobrace as part of his integrative training He can offer Damon Invisalign Insignia and Incognito appliances designs as some of his many conventional orthodontic services too
Dr Raphael teaches his techniques at post-graduate residencies study clubs dental societies and for the Myofunctional Research Co He is available for presentations to any group interested in learning more about the benefits of integrative orthodontics
wwwalignminecomLearn about the choices you have in orthodontics
dr barry raphael Why its
too Early never
1425
bro
ad
str
ee
tc
lifto
n n
j 070
13
973-
778-
4222
fax
973-
778-
9625
nj s
pe
c
368
4
1425 broad street clifton nj 07013973-778-4222
wwwalignminecom
the raphael centerforintegrative orthodontics
the
raph
ael c
ente
r fo
rin
tegr
ativ
e or
thod
onti
cs
Learn about an important choice you need to make before starting braces
the raphael center for integrative education
the raphael center for integrative education
Ongoing Intro to Airway Orthodontics
April Biobloc Study Group
April Training Ortho-Postural Therapists w Roger Price
June MRC Myobrace Basic Series
August Airway Dentistry with Mark Cruz and company
October Advanced MFT with Sandy Coulson
October Less than Six with Kevin Boyd
(who else wants to play)
Mission to create a space for spreading the word about Airway and Orthotropic principles and practice
Orthodontics in the 21st Century
EstheticOrthodontics
AirwayOrthodontics
GeneticTooth-Focused
Dental PerfectionEsthetics Primary
Treating SymptomsAirway Ignorant
AdaptationMuscle-FocusedMedical Better
Esthetics SecondaryTreating Causes
Airway Conscious
The EndAnd
The Beginning
Type 3 Maintain
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Bimax retrusion
Successful dental result
Profile Unimproved
Incisor Goals
Type 4 Treatment RetractExtrude UI
Extraction Orthodontics Retraction Ortho Distalization Ortho
Type 4 Retraction
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Bimax retrusion
Successful dental result
Failed Profile Result
Changes of pharyngeal airway size and hyoid bone position following orthodontic treatment of
Class I bimaxillary protrusion
Qingzhu Wanga Peizeng Jiab Nina K Andersonc Lin Wangd Jiuxiang Line
Angle Orthodontist Vol 00 No 0 0000 (pre-publication 2012)
ldquothe dimension of the velopharynx glossopharynx and hypopharynx were decreased after maximal retraction of anterior teeth with extraction of four premolarshelliprdquo ldquoAny factors that can influence the posture and position of tongue and soft palate may displace them backward andencroach upon the pharynxrdquo
ldquothe more the incisors were retracted the more the pharyngeal airway was reducedrdquo
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Backed into a corner
bull
Moving teeth faster more efficientlyhellipin the wrong direction
Now that wersquove made smoking unacceptable
could we not do the same withbull Sugarbull Processed foodbull Cheap milk and meatbull Fast foodbull Pill popping for symptomatic reliefbull Looking for the cure instead of the causebull Surgery as a quick fixbull Thinking braces are a status symbol
Each industry thrives on the status quoConsumers must drive the change
NP 10yM
NP
Sisterrsquos non-x ortho
Shersquos happyhellipbut Irsquom not so
I make my pitch for BBO
The dilemma of progress
(I forgot the progress pictureshellip)
Dad sells prosthetic parts to orthopedic surgeons
I selling the case against my previous work they loved
It takes me 3 hours to sell the case
They fret until the BB3 goes in
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Connecting the dots
bull Adult SDB and OSA
bull Narrow jaws and faces
bull Soft tissue dysfunction
bull Early parafunctional habits ie open mouth posture
bull Environmental stressors
bull CPAP MARAUPPP SurgWherersquos the best
place to start treatment here
or here
1 Prevention 2 Undo the damage already done3 Establish good habits
When to start When damage from poor breathing is noticed and when bad habits are discovered
The strategies of Airway Orthodontics
Prevention
bull Remove ankyloglossiabull Promote breastfeedingbull Harden the dietbull Develop masticatory strengthbull Discourage oral habitsbull Promote whole-foods low sugar dietbull Reduce oropharyngeal obstructionbull Promote nasal breathing
Breathing retraining
bull Nasal rinsingbull Nasal clearingbull Decongesting
The goals of Airway Orthodontics
1 Breathing through the nose2 Lips together at rest3 Correct tongue position4 No facial muscles moving on swallowing5 Optimal forward facial development6 Class I occlusion7 Straight teeth8 Better stability long term
Myofunctional Trainers
Professors R Soulet and A Besombes
Dr Earl Bergeson
Dr Chris Farrell
The Multi ndash Family System
Orofacial MyofunctionalTherapy
Oral MyologyMyofunctional TherapyTongue Thrust Therapy
B Hockel 2012 Back
Undoing Bimaxillary Dysplasia
1 Maxillary deconstriction2 Maxillary advancement3 Maxillary impaction4 Mandibular advancement
1 Maxillary Expansion
Treatment for Bimaxillary Dysplasia
ALFCrozat
Bent Wire
HyraxHaas
Niti Exp BioBlocSchwartz
The Farrell BENT WIRE Systemtrade
Recommended Age Group 5-12 yrs
Arch Development in conjunction with the TRAINER Systemtrade
Dr John Mew
Establish Good Habits
1 Breathing through the nose2 Lips together at rest3 Correct tongue position4 No facial muscles moving on swallowing5 Stand and sit in balance6 Breath gently using the diaphragm7 Eat to nourish8 Sleep to rest
Ortho-Postural TrainingWorkshops
Breathing
Nutrition
Posture
Sleep
COPYRIGHTRoger L PriceOctober 2012
Posture Number
Forward head posturecan be a compensationfor a deficient airway
Sleep Screening and Hygiene
SQI = 10 SQI = 98
Integrative Healthcare
Function ProfessionalNasal clearing ENT Pulm MFT BreathingMuscle balance and tone MFT Myofunctional OrthoUndoing damage GP Pedo Ortho OMFSBreathing dynamics OPT MFT Breath PhysiologistPosture DC OPT PT OsteopathCranial balance OsteopathNutrition RDH Nutritionist Dietitian Sleep ENT Sleep Med DentNeurocognitive development Pedrsquon SLP Psych SpEd
The Interdisciplinary Center
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Now that I know
My personal missionTo create from what Irsquove
learned from the besta model for others to followhellipespecially the orthodontists
Myofunctional Orthodontics
Chris Farrell
John Flutter
German Ramierez
Damien OrsquoBrien
Myofunctional Research CoRancho Cucamonga
2008-2012
Oral Myology
Oral Myology Basic CourseJoy MoellerNYC 2011LA 2012
Oral Myology Levels 2 3Kim BenkertClifton 2012
Habit CessationShari GreenClifton 2013
Biobloc Orthotropics
BBO Mini-residencyBill Hang
Agora Hills2012-13
BBO IntensiveDrs John and Mike
MewLSFO2013
Breathing and Sleep
Buteyko MentorshipThe Breathing Center
Woodstock2010
Breathing Well ProgrammeJohn Flutter
2010 Ortho-Postural TrainingRoger Price
2013
Sleep DentistryMichael Gelb etal
NYU2012
ALF and Cranial
Jim Bronson2013 Tasha Turzo
Cranial Academy2014
Bucket Listbull ALF and Crozat (Bronsonrsquos course)bullMore on Biobloc (Hangrsquos Advanced London School)bull More Cranial (The Farm)bullChirodontics (Bob Walker)bull Airway Dentistry with Marc Cruz Jeff Rousebull Sleep Dentistrybull Less-than-Six with Kevin Boydbull Intra-mandibular Distraction Osteogenesis (IMDO)
Off My ListAnything that moves the teeth faster in the wrong direction
Whatrsquos an RO to do
To create from what Irsquove learned from the best
a model for others to followhellipespecially orthodontists
Teaching
Mt Sinai Pedo ResidencyAli Attaie
2010-2012
Montefiore Ortho ResidencyTony Maganzini
2012
2009-Present
Mt Sinai School of MedicinePedodontic Residency
Guest SpeakersJim BronsonMike MewKevin BoydSandra KahnJennifer TowRoger PricePaula Fabbie
Damien OrsquoBrien
First clinical program in myofunctional orthodontics
Airway and Facial DevelopmentCollaborative Webcast
Mark Cruz
AAPMD Symposium
wwwaapm
dorg
Annual MeetingApril 25-26 2014
Westin Chicago North Shore
the raphael center for integrative orthodontics
wwwalignminecomwwwbioblocnjcom
wwwmyobracenjcom
Integrative vs Conventional
Integrative vs Conventional
ldquoWith improvements in expansion orthodontics advances in myofunctional orthodontics and the growing recognition about sleep disordered breathing among children and adults it is time for orthodontics to expand its horizons There is now so much more we can oerrdquo
The Raphael name has been associated with high quality orthodontics in New Jersey for over 60 years Dr Barry Raphael has been a university trained orthodontic specialist and a member of the American Association of Orthodontists for 30 years
He has a wide range of techniques and services to offer He has studied oral myology applied kinesiology Buteyko breathing Biobloc Orthotropics and Myobrace as part of his integrative training He can offer Damon Invisalign Insignia and Incognito appliances designs as some of his many conventional orthodontic services too
Dr Raphael teaches his techniques at post-graduate residencies study clubs dental societies and for the Myofunctional Research Co He is available for presentations to any group interested in learning more about the benefits of integrative orthodontics
wwwalignminecomLearn about the choices you have in orthodontics
dr barry raphael Why its
too Early never
1425
bro
ad
str
ee
tc
lifto
n n
j 070
13
973-
778-
4222
fax
973-
778-
9625
nj s
pe
c
368
4
1425 broad street clifton nj 07013973-778-4222
wwwalignminecom
the raphael centerforintegrative orthodontics
the
raph
ael c
ente
r fo
rin
tegr
ativ
e or
thod
onti
cs
Learn about an important choice you need to make before starting braces
the raphael center for integrative education
the raphael center for integrative education
Ongoing Intro to Airway Orthodontics
April Biobloc Study Group
April Training Ortho-Postural Therapists w Roger Price
June MRC Myobrace Basic Series
August Airway Dentistry with Mark Cruz and company
October Advanced MFT with Sandy Coulson
October Less than Six with Kevin Boyd
(who else wants to play)
Mission to create a space for spreading the word about Airway and Orthotropic principles and practice
Orthodontics in the 21st Century
EstheticOrthodontics
AirwayOrthodontics
GeneticTooth-Focused
Dental PerfectionEsthetics Primary
Treating SymptomsAirway Ignorant
AdaptationMuscle-FocusedMedical Better
Esthetics SecondaryTreating Causes
Airway Conscious
The EndAnd
The Beginning
Bimax retrusion
Successful dental result
Profile Unimproved
Incisor Goals
Type 4 Treatment RetractExtrude UI
Extraction Orthodontics Retraction Ortho Distalization Ortho
Type 4 Retraction
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Bimax retrusion
Successful dental result
Failed Profile Result
Changes of pharyngeal airway size and hyoid bone position following orthodontic treatment of
Class I bimaxillary protrusion
Qingzhu Wanga Peizeng Jiab Nina K Andersonc Lin Wangd Jiuxiang Line
Angle Orthodontist Vol 00 No 0 0000 (pre-publication 2012)
ldquothe dimension of the velopharynx glossopharynx and hypopharynx were decreased after maximal retraction of anterior teeth with extraction of four premolarshelliprdquo ldquoAny factors that can influence the posture and position of tongue and soft palate may displace them backward andencroach upon the pharynxrdquo
ldquothe more the incisors were retracted the more the pharyngeal airway was reducedrdquo
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Backed into a corner
bull
Moving teeth faster more efficientlyhellipin the wrong direction
Now that wersquove made smoking unacceptable
could we not do the same withbull Sugarbull Processed foodbull Cheap milk and meatbull Fast foodbull Pill popping for symptomatic reliefbull Looking for the cure instead of the causebull Surgery as a quick fixbull Thinking braces are a status symbol
Each industry thrives on the status quoConsumers must drive the change
NP 10yM
NP
Sisterrsquos non-x ortho
Shersquos happyhellipbut Irsquom not so
I make my pitch for BBO
The dilemma of progress
(I forgot the progress pictureshellip)
Dad sells prosthetic parts to orthopedic surgeons
I selling the case against my previous work they loved
It takes me 3 hours to sell the case
They fret until the BB3 goes in
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Connecting the dots
bull Adult SDB and OSA
bull Narrow jaws and faces
bull Soft tissue dysfunction
bull Early parafunctional habits ie open mouth posture
bull Environmental stressors
bull CPAP MARAUPPP SurgWherersquos the best
place to start treatment here
or here
1 Prevention 2 Undo the damage already done3 Establish good habits
When to start When damage from poor breathing is noticed and when bad habits are discovered
The strategies of Airway Orthodontics
Prevention
bull Remove ankyloglossiabull Promote breastfeedingbull Harden the dietbull Develop masticatory strengthbull Discourage oral habitsbull Promote whole-foods low sugar dietbull Reduce oropharyngeal obstructionbull Promote nasal breathing
Breathing retraining
bull Nasal rinsingbull Nasal clearingbull Decongesting
The goals of Airway Orthodontics
1 Breathing through the nose2 Lips together at rest3 Correct tongue position4 No facial muscles moving on swallowing5 Optimal forward facial development6 Class I occlusion7 Straight teeth8 Better stability long term
Myofunctional Trainers
Professors R Soulet and A Besombes
Dr Earl Bergeson
Dr Chris Farrell
The Multi ndash Family System
Orofacial MyofunctionalTherapy
Oral MyologyMyofunctional TherapyTongue Thrust Therapy
B Hockel 2012 Back
Undoing Bimaxillary Dysplasia
1 Maxillary deconstriction2 Maxillary advancement3 Maxillary impaction4 Mandibular advancement
1 Maxillary Expansion
Treatment for Bimaxillary Dysplasia
ALFCrozat
Bent Wire
HyraxHaas
Niti Exp BioBlocSchwartz
The Farrell BENT WIRE Systemtrade
Recommended Age Group 5-12 yrs
Arch Development in conjunction with the TRAINER Systemtrade
Dr John Mew
Establish Good Habits
1 Breathing through the nose2 Lips together at rest3 Correct tongue position4 No facial muscles moving on swallowing5 Stand and sit in balance6 Breath gently using the diaphragm7 Eat to nourish8 Sleep to rest
Ortho-Postural TrainingWorkshops
Breathing
Nutrition
Posture
Sleep
COPYRIGHTRoger L PriceOctober 2012
Posture Number
Forward head posturecan be a compensationfor a deficient airway
Sleep Screening and Hygiene
SQI = 10 SQI = 98
Integrative Healthcare
Function ProfessionalNasal clearing ENT Pulm MFT BreathingMuscle balance and tone MFT Myofunctional OrthoUndoing damage GP Pedo Ortho OMFSBreathing dynamics OPT MFT Breath PhysiologistPosture DC OPT PT OsteopathCranial balance OsteopathNutrition RDH Nutritionist Dietitian Sleep ENT Sleep Med DentNeurocognitive development Pedrsquon SLP Psych SpEd
The Interdisciplinary Center
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Now that I know
My personal missionTo create from what Irsquove
learned from the besta model for others to followhellipespecially the orthodontists
Myofunctional Orthodontics
Chris Farrell
John Flutter
German Ramierez
Damien OrsquoBrien
Myofunctional Research CoRancho Cucamonga
2008-2012
Oral Myology
Oral Myology Basic CourseJoy MoellerNYC 2011LA 2012
Oral Myology Levels 2 3Kim BenkertClifton 2012
Habit CessationShari GreenClifton 2013
Biobloc Orthotropics
BBO Mini-residencyBill Hang
Agora Hills2012-13
BBO IntensiveDrs John and Mike
MewLSFO2013
Breathing and Sleep
Buteyko MentorshipThe Breathing Center
Woodstock2010
Breathing Well ProgrammeJohn Flutter
2010 Ortho-Postural TrainingRoger Price
2013
Sleep DentistryMichael Gelb etal
NYU2012
ALF and Cranial
Jim Bronson2013 Tasha Turzo
Cranial Academy2014
Bucket Listbull ALF and Crozat (Bronsonrsquos course)bullMore on Biobloc (Hangrsquos Advanced London School)bull More Cranial (The Farm)bullChirodontics (Bob Walker)bull Airway Dentistry with Marc Cruz Jeff Rousebull Sleep Dentistrybull Less-than-Six with Kevin Boydbull Intra-mandibular Distraction Osteogenesis (IMDO)
Off My ListAnything that moves the teeth faster in the wrong direction
Whatrsquos an RO to do
To create from what Irsquove learned from the best
a model for others to followhellipespecially orthodontists
Teaching
Mt Sinai Pedo ResidencyAli Attaie
2010-2012
Montefiore Ortho ResidencyTony Maganzini
2012
2009-Present
Mt Sinai School of MedicinePedodontic Residency
Guest SpeakersJim BronsonMike MewKevin BoydSandra KahnJennifer TowRoger PricePaula Fabbie
Damien OrsquoBrien
First clinical program in myofunctional orthodontics
Airway and Facial DevelopmentCollaborative Webcast
Mark Cruz
AAPMD Symposium
wwwaapm
dorg
Annual MeetingApril 25-26 2014
Westin Chicago North Shore
the raphael center for integrative orthodontics
wwwalignminecomwwwbioblocnjcom
wwwmyobracenjcom
Integrative vs Conventional
Integrative vs Conventional
ldquoWith improvements in expansion orthodontics advances in myofunctional orthodontics and the growing recognition about sleep disordered breathing among children and adults it is time for orthodontics to expand its horizons There is now so much more we can oerrdquo
The Raphael name has been associated with high quality orthodontics in New Jersey for over 60 years Dr Barry Raphael has been a university trained orthodontic specialist and a member of the American Association of Orthodontists for 30 years
He has a wide range of techniques and services to offer He has studied oral myology applied kinesiology Buteyko breathing Biobloc Orthotropics and Myobrace as part of his integrative training He can offer Damon Invisalign Insignia and Incognito appliances designs as some of his many conventional orthodontic services too
Dr Raphael teaches his techniques at post-graduate residencies study clubs dental societies and for the Myofunctional Research Co He is available for presentations to any group interested in learning more about the benefits of integrative orthodontics
wwwalignminecomLearn about the choices you have in orthodontics
dr barry raphael Why its
too Early never
1425
bro
ad
str
ee
tc
lifto
n n
j 070
13
973-
778-
4222
fax
973-
778-
9625
nj s
pe
c
368
4
1425 broad street clifton nj 07013973-778-4222
wwwalignminecom
the raphael centerforintegrative orthodontics
the
raph
ael c
ente
r fo
rin
tegr
ativ
e or
thod
onti
cs
Learn about an important choice you need to make before starting braces
the raphael center for integrative education
the raphael center for integrative education
Ongoing Intro to Airway Orthodontics
April Biobloc Study Group
April Training Ortho-Postural Therapists w Roger Price
June MRC Myobrace Basic Series
August Airway Dentistry with Mark Cruz and company
October Advanced MFT with Sandy Coulson
October Less than Six with Kevin Boyd
(who else wants to play)
Mission to create a space for spreading the word about Airway and Orthotropic principles and practice
Orthodontics in the 21st Century
EstheticOrthodontics
AirwayOrthodontics
GeneticTooth-Focused
Dental PerfectionEsthetics Primary
Treating SymptomsAirway Ignorant
AdaptationMuscle-FocusedMedical Better
Esthetics SecondaryTreating Causes
Airway Conscious
The EndAnd
The Beginning
Successful dental result
Profile Unimproved
Incisor Goals
Type 4 Treatment RetractExtrude UI
Extraction Orthodontics Retraction Ortho Distalization Ortho
Type 4 Retraction
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Bimax retrusion
Successful dental result
Failed Profile Result
Changes of pharyngeal airway size and hyoid bone position following orthodontic treatment of
Class I bimaxillary protrusion
Qingzhu Wanga Peizeng Jiab Nina K Andersonc Lin Wangd Jiuxiang Line
Angle Orthodontist Vol 00 No 0 0000 (pre-publication 2012)
ldquothe dimension of the velopharynx glossopharynx and hypopharynx were decreased after maximal retraction of anterior teeth with extraction of four premolarshelliprdquo ldquoAny factors that can influence the posture and position of tongue and soft palate may displace them backward andencroach upon the pharynxrdquo
ldquothe more the incisors were retracted the more the pharyngeal airway was reducedrdquo
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Backed into a corner
bull
Moving teeth faster more efficientlyhellipin the wrong direction
Now that wersquove made smoking unacceptable
could we not do the same withbull Sugarbull Processed foodbull Cheap milk and meatbull Fast foodbull Pill popping for symptomatic reliefbull Looking for the cure instead of the causebull Surgery as a quick fixbull Thinking braces are a status symbol
Each industry thrives on the status quoConsumers must drive the change
NP 10yM
NP
Sisterrsquos non-x ortho
Shersquos happyhellipbut Irsquom not so
I make my pitch for BBO
The dilemma of progress
(I forgot the progress pictureshellip)
Dad sells prosthetic parts to orthopedic surgeons
I selling the case against my previous work they loved
It takes me 3 hours to sell the case
They fret until the BB3 goes in
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Connecting the dots
bull Adult SDB and OSA
bull Narrow jaws and faces
bull Soft tissue dysfunction
bull Early parafunctional habits ie open mouth posture
bull Environmental stressors
bull CPAP MARAUPPP SurgWherersquos the best
place to start treatment here
or here
1 Prevention 2 Undo the damage already done3 Establish good habits
When to start When damage from poor breathing is noticed and when bad habits are discovered
The strategies of Airway Orthodontics
Prevention
bull Remove ankyloglossiabull Promote breastfeedingbull Harden the dietbull Develop masticatory strengthbull Discourage oral habitsbull Promote whole-foods low sugar dietbull Reduce oropharyngeal obstructionbull Promote nasal breathing
Breathing retraining
bull Nasal rinsingbull Nasal clearingbull Decongesting
The goals of Airway Orthodontics
1 Breathing through the nose2 Lips together at rest3 Correct tongue position4 No facial muscles moving on swallowing5 Optimal forward facial development6 Class I occlusion7 Straight teeth8 Better stability long term
Myofunctional Trainers
Professors R Soulet and A Besombes
Dr Earl Bergeson
Dr Chris Farrell
The Multi ndash Family System
Orofacial MyofunctionalTherapy
Oral MyologyMyofunctional TherapyTongue Thrust Therapy
B Hockel 2012 Back
Undoing Bimaxillary Dysplasia
1 Maxillary deconstriction2 Maxillary advancement3 Maxillary impaction4 Mandibular advancement
1 Maxillary Expansion
Treatment for Bimaxillary Dysplasia
ALFCrozat
Bent Wire
HyraxHaas
Niti Exp BioBlocSchwartz
The Farrell BENT WIRE Systemtrade
Recommended Age Group 5-12 yrs
Arch Development in conjunction with the TRAINER Systemtrade
Dr John Mew
Establish Good Habits
1 Breathing through the nose2 Lips together at rest3 Correct tongue position4 No facial muscles moving on swallowing5 Stand and sit in balance6 Breath gently using the diaphragm7 Eat to nourish8 Sleep to rest
Ortho-Postural TrainingWorkshops
Breathing
Nutrition
Posture
Sleep
COPYRIGHTRoger L PriceOctober 2012
Posture Number
Forward head posturecan be a compensationfor a deficient airway
Sleep Screening and Hygiene
SQI = 10 SQI = 98
Integrative Healthcare
Function ProfessionalNasal clearing ENT Pulm MFT BreathingMuscle balance and tone MFT Myofunctional OrthoUndoing damage GP Pedo Ortho OMFSBreathing dynamics OPT MFT Breath PhysiologistPosture DC OPT PT OsteopathCranial balance OsteopathNutrition RDH Nutritionist Dietitian Sleep ENT Sleep Med DentNeurocognitive development Pedrsquon SLP Psych SpEd
The Interdisciplinary Center
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Now that I know
My personal missionTo create from what Irsquove
learned from the besta model for others to followhellipespecially the orthodontists
Myofunctional Orthodontics
Chris Farrell
John Flutter
German Ramierez
Damien OrsquoBrien
Myofunctional Research CoRancho Cucamonga
2008-2012
Oral Myology
Oral Myology Basic CourseJoy MoellerNYC 2011LA 2012
Oral Myology Levels 2 3Kim BenkertClifton 2012
Habit CessationShari GreenClifton 2013
Biobloc Orthotropics
BBO Mini-residencyBill Hang
Agora Hills2012-13
BBO IntensiveDrs John and Mike
MewLSFO2013
Breathing and Sleep
Buteyko MentorshipThe Breathing Center
Woodstock2010
Breathing Well ProgrammeJohn Flutter
2010 Ortho-Postural TrainingRoger Price
2013
Sleep DentistryMichael Gelb etal
NYU2012
ALF and Cranial
Jim Bronson2013 Tasha Turzo
Cranial Academy2014
Bucket Listbull ALF and Crozat (Bronsonrsquos course)bullMore on Biobloc (Hangrsquos Advanced London School)bull More Cranial (The Farm)bullChirodontics (Bob Walker)bull Airway Dentistry with Marc Cruz Jeff Rousebull Sleep Dentistrybull Less-than-Six with Kevin Boydbull Intra-mandibular Distraction Osteogenesis (IMDO)
Off My ListAnything that moves the teeth faster in the wrong direction
Whatrsquos an RO to do
To create from what Irsquove learned from the best
a model for others to followhellipespecially orthodontists
Teaching
Mt Sinai Pedo ResidencyAli Attaie
2010-2012
Montefiore Ortho ResidencyTony Maganzini
2012
2009-Present
Mt Sinai School of MedicinePedodontic Residency
Guest SpeakersJim BronsonMike MewKevin BoydSandra KahnJennifer TowRoger PricePaula Fabbie
Damien OrsquoBrien
First clinical program in myofunctional orthodontics
Airway and Facial DevelopmentCollaborative Webcast
Mark Cruz
AAPMD Symposium
wwwaapm
dorg
Annual MeetingApril 25-26 2014
Westin Chicago North Shore
the raphael center for integrative orthodontics
wwwalignminecomwwwbioblocnjcom
wwwmyobracenjcom
Integrative vs Conventional
Integrative vs Conventional
ldquoWith improvements in expansion orthodontics advances in myofunctional orthodontics and the growing recognition about sleep disordered breathing among children and adults it is time for orthodontics to expand its horizons There is now so much more we can oerrdquo
The Raphael name has been associated with high quality orthodontics in New Jersey for over 60 years Dr Barry Raphael has been a university trained orthodontic specialist and a member of the American Association of Orthodontists for 30 years
He has a wide range of techniques and services to offer He has studied oral myology applied kinesiology Buteyko breathing Biobloc Orthotropics and Myobrace as part of his integrative training He can offer Damon Invisalign Insignia and Incognito appliances designs as some of his many conventional orthodontic services too
Dr Raphael teaches his techniques at post-graduate residencies study clubs dental societies and for the Myofunctional Research Co He is available for presentations to any group interested in learning more about the benefits of integrative orthodontics
wwwalignminecomLearn about the choices you have in orthodontics
dr barry raphael Why its
too Early never
1425
bro
ad
str
ee
tc
lifto
n n
j 070
13
973-
778-
4222
fax
973-
778-
9625
nj s
pe
c
368
4
1425 broad street clifton nj 07013973-778-4222
wwwalignminecom
the raphael centerforintegrative orthodontics
the
raph
ael c
ente
r fo
rin
tegr
ativ
e or
thod
onti
cs
Learn about an important choice you need to make before starting braces
the raphael center for integrative education
the raphael center for integrative education
Ongoing Intro to Airway Orthodontics
April Biobloc Study Group
April Training Ortho-Postural Therapists w Roger Price
June MRC Myobrace Basic Series
August Airway Dentistry with Mark Cruz and company
October Advanced MFT with Sandy Coulson
October Less than Six with Kevin Boyd
(who else wants to play)
Mission to create a space for spreading the word about Airway and Orthotropic principles and practice
Orthodontics in the 21st Century
EstheticOrthodontics
AirwayOrthodontics
GeneticTooth-Focused
Dental PerfectionEsthetics Primary
Treating SymptomsAirway Ignorant
AdaptationMuscle-FocusedMedical Better
Esthetics SecondaryTreating Causes
Airway Conscious
The EndAnd
The Beginning
Profile Unimproved
Incisor Goals
Type 4 Treatment RetractExtrude UI
Extraction Orthodontics Retraction Ortho Distalization Ortho
Type 4 Retraction
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Bimax retrusion
Successful dental result
Failed Profile Result
Changes of pharyngeal airway size and hyoid bone position following orthodontic treatment of
Class I bimaxillary protrusion
Qingzhu Wanga Peizeng Jiab Nina K Andersonc Lin Wangd Jiuxiang Line
Angle Orthodontist Vol 00 No 0 0000 (pre-publication 2012)
ldquothe dimension of the velopharynx glossopharynx and hypopharynx were decreased after maximal retraction of anterior teeth with extraction of four premolarshelliprdquo ldquoAny factors that can influence the posture and position of tongue and soft palate may displace them backward andencroach upon the pharynxrdquo
ldquothe more the incisors were retracted the more the pharyngeal airway was reducedrdquo
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Backed into a corner
bull
Moving teeth faster more efficientlyhellipin the wrong direction
Now that wersquove made smoking unacceptable
could we not do the same withbull Sugarbull Processed foodbull Cheap milk and meatbull Fast foodbull Pill popping for symptomatic reliefbull Looking for the cure instead of the causebull Surgery as a quick fixbull Thinking braces are a status symbol
Each industry thrives on the status quoConsumers must drive the change
NP 10yM
NP
Sisterrsquos non-x ortho
Shersquos happyhellipbut Irsquom not so
I make my pitch for BBO
The dilemma of progress
(I forgot the progress pictureshellip)
Dad sells prosthetic parts to orthopedic surgeons
I selling the case against my previous work they loved
It takes me 3 hours to sell the case
They fret until the BB3 goes in
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Connecting the dots
bull Adult SDB and OSA
bull Narrow jaws and faces
bull Soft tissue dysfunction
bull Early parafunctional habits ie open mouth posture
bull Environmental stressors
bull CPAP MARAUPPP SurgWherersquos the best
place to start treatment here
or here
1 Prevention 2 Undo the damage already done3 Establish good habits
When to start When damage from poor breathing is noticed and when bad habits are discovered
The strategies of Airway Orthodontics
Prevention
bull Remove ankyloglossiabull Promote breastfeedingbull Harden the dietbull Develop masticatory strengthbull Discourage oral habitsbull Promote whole-foods low sugar dietbull Reduce oropharyngeal obstructionbull Promote nasal breathing
Breathing retraining
bull Nasal rinsingbull Nasal clearingbull Decongesting
The goals of Airway Orthodontics
1 Breathing through the nose2 Lips together at rest3 Correct tongue position4 No facial muscles moving on swallowing5 Optimal forward facial development6 Class I occlusion7 Straight teeth8 Better stability long term
Myofunctional Trainers
Professors R Soulet and A Besombes
Dr Earl Bergeson
Dr Chris Farrell
The Multi ndash Family System
Orofacial MyofunctionalTherapy
Oral MyologyMyofunctional TherapyTongue Thrust Therapy
B Hockel 2012 Back
Undoing Bimaxillary Dysplasia
1 Maxillary deconstriction2 Maxillary advancement3 Maxillary impaction4 Mandibular advancement
1 Maxillary Expansion
Treatment for Bimaxillary Dysplasia
ALFCrozat
Bent Wire
HyraxHaas
Niti Exp BioBlocSchwartz
The Farrell BENT WIRE Systemtrade
Recommended Age Group 5-12 yrs
Arch Development in conjunction with the TRAINER Systemtrade
Dr John Mew
Establish Good Habits
1 Breathing through the nose2 Lips together at rest3 Correct tongue position4 No facial muscles moving on swallowing5 Stand and sit in balance6 Breath gently using the diaphragm7 Eat to nourish8 Sleep to rest
Ortho-Postural TrainingWorkshops
Breathing
Nutrition
Posture
Sleep
COPYRIGHTRoger L PriceOctober 2012
Posture Number
Forward head posturecan be a compensationfor a deficient airway
Sleep Screening and Hygiene
SQI = 10 SQI = 98
Integrative Healthcare
Function ProfessionalNasal clearing ENT Pulm MFT BreathingMuscle balance and tone MFT Myofunctional OrthoUndoing damage GP Pedo Ortho OMFSBreathing dynamics OPT MFT Breath PhysiologistPosture DC OPT PT OsteopathCranial balance OsteopathNutrition RDH Nutritionist Dietitian Sleep ENT Sleep Med DentNeurocognitive development Pedrsquon SLP Psych SpEd
The Interdisciplinary Center
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Now that I know
My personal missionTo create from what Irsquove
learned from the besta model for others to followhellipespecially the orthodontists
Myofunctional Orthodontics
Chris Farrell
John Flutter
German Ramierez
Damien OrsquoBrien
Myofunctional Research CoRancho Cucamonga
2008-2012
Oral Myology
Oral Myology Basic CourseJoy MoellerNYC 2011LA 2012
Oral Myology Levels 2 3Kim BenkertClifton 2012
Habit CessationShari GreenClifton 2013
Biobloc Orthotropics
BBO Mini-residencyBill Hang
Agora Hills2012-13
BBO IntensiveDrs John and Mike
MewLSFO2013
Breathing and Sleep
Buteyko MentorshipThe Breathing Center
Woodstock2010
Breathing Well ProgrammeJohn Flutter
2010 Ortho-Postural TrainingRoger Price
2013
Sleep DentistryMichael Gelb etal
NYU2012
ALF and Cranial
Jim Bronson2013 Tasha Turzo
Cranial Academy2014
Bucket Listbull ALF and Crozat (Bronsonrsquos course)bullMore on Biobloc (Hangrsquos Advanced London School)bull More Cranial (The Farm)bullChirodontics (Bob Walker)bull Airway Dentistry with Marc Cruz Jeff Rousebull Sleep Dentistrybull Less-than-Six with Kevin Boydbull Intra-mandibular Distraction Osteogenesis (IMDO)
Off My ListAnything that moves the teeth faster in the wrong direction
Whatrsquos an RO to do
To create from what Irsquove learned from the best
a model for others to followhellipespecially orthodontists
Teaching
Mt Sinai Pedo ResidencyAli Attaie
2010-2012
Montefiore Ortho ResidencyTony Maganzini
2012
2009-Present
Mt Sinai School of MedicinePedodontic Residency
Guest SpeakersJim BronsonMike MewKevin BoydSandra KahnJennifer TowRoger PricePaula Fabbie
Damien OrsquoBrien
First clinical program in myofunctional orthodontics
Airway and Facial DevelopmentCollaborative Webcast
Mark Cruz
AAPMD Symposium
wwwaapm
dorg
Annual MeetingApril 25-26 2014
Westin Chicago North Shore
the raphael center for integrative orthodontics
wwwalignminecomwwwbioblocnjcom
wwwmyobracenjcom
Integrative vs Conventional
Integrative vs Conventional
ldquoWith improvements in expansion orthodontics advances in myofunctional orthodontics and the growing recognition about sleep disordered breathing among children and adults it is time for orthodontics to expand its horizons There is now so much more we can oerrdquo
The Raphael name has been associated with high quality orthodontics in New Jersey for over 60 years Dr Barry Raphael has been a university trained orthodontic specialist and a member of the American Association of Orthodontists for 30 years
He has a wide range of techniques and services to offer He has studied oral myology applied kinesiology Buteyko breathing Biobloc Orthotropics and Myobrace as part of his integrative training He can offer Damon Invisalign Insignia and Incognito appliances designs as some of his many conventional orthodontic services too
Dr Raphael teaches his techniques at post-graduate residencies study clubs dental societies and for the Myofunctional Research Co He is available for presentations to any group interested in learning more about the benefits of integrative orthodontics
wwwalignminecomLearn about the choices you have in orthodontics
dr barry raphael Why its
too Early never
1425
bro
ad
str
ee
tc
lifto
n n
j 070
13
973-
778-
4222
fax
973-
778-
9625
nj s
pe
c
368
4
1425 broad street clifton nj 07013973-778-4222
wwwalignminecom
the raphael centerforintegrative orthodontics
the
raph
ael c
ente
r fo
rin
tegr
ativ
e or
thod
onti
cs
Learn about an important choice you need to make before starting braces
the raphael center for integrative education
the raphael center for integrative education
Ongoing Intro to Airway Orthodontics
April Biobloc Study Group
April Training Ortho-Postural Therapists w Roger Price
June MRC Myobrace Basic Series
August Airway Dentistry with Mark Cruz and company
October Advanced MFT with Sandy Coulson
October Less than Six with Kevin Boyd
(who else wants to play)
Mission to create a space for spreading the word about Airway and Orthotropic principles and practice
Orthodontics in the 21st Century
EstheticOrthodontics
AirwayOrthodontics
GeneticTooth-Focused
Dental PerfectionEsthetics Primary
Treating SymptomsAirway Ignorant
AdaptationMuscle-FocusedMedical Better
Esthetics SecondaryTreating Causes
Airway Conscious
The EndAnd
The Beginning
Incisor Goals
Type 4 Treatment RetractExtrude UI
Extraction Orthodontics Retraction Ortho Distalization Ortho
Type 4 Retraction
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Bimax retrusion
Successful dental result
Failed Profile Result
Changes of pharyngeal airway size and hyoid bone position following orthodontic treatment of
Class I bimaxillary protrusion
Qingzhu Wanga Peizeng Jiab Nina K Andersonc Lin Wangd Jiuxiang Line
Angle Orthodontist Vol 00 No 0 0000 (pre-publication 2012)
ldquothe dimension of the velopharynx glossopharynx and hypopharynx were decreased after maximal retraction of anterior teeth with extraction of four premolarshelliprdquo ldquoAny factors that can influence the posture and position of tongue and soft palate may displace them backward andencroach upon the pharynxrdquo
ldquothe more the incisors were retracted the more the pharyngeal airway was reducedrdquo
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Backed into a corner
bull
Moving teeth faster more efficientlyhellipin the wrong direction
Now that wersquove made smoking unacceptable
could we not do the same withbull Sugarbull Processed foodbull Cheap milk and meatbull Fast foodbull Pill popping for symptomatic reliefbull Looking for the cure instead of the causebull Surgery as a quick fixbull Thinking braces are a status symbol
Each industry thrives on the status quoConsumers must drive the change
NP 10yM
NP
Sisterrsquos non-x ortho
Shersquos happyhellipbut Irsquom not so
I make my pitch for BBO
The dilemma of progress
(I forgot the progress pictureshellip)
Dad sells prosthetic parts to orthopedic surgeons
I selling the case against my previous work they loved
It takes me 3 hours to sell the case
They fret until the BB3 goes in
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Connecting the dots
bull Adult SDB and OSA
bull Narrow jaws and faces
bull Soft tissue dysfunction
bull Early parafunctional habits ie open mouth posture
bull Environmental stressors
bull CPAP MARAUPPP SurgWherersquos the best
place to start treatment here
or here
1 Prevention 2 Undo the damage already done3 Establish good habits
When to start When damage from poor breathing is noticed and when bad habits are discovered
The strategies of Airway Orthodontics
Prevention
bull Remove ankyloglossiabull Promote breastfeedingbull Harden the dietbull Develop masticatory strengthbull Discourage oral habitsbull Promote whole-foods low sugar dietbull Reduce oropharyngeal obstructionbull Promote nasal breathing
Breathing retraining
bull Nasal rinsingbull Nasal clearingbull Decongesting
The goals of Airway Orthodontics
1 Breathing through the nose2 Lips together at rest3 Correct tongue position4 No facial muscles moving on swallowing5 Optimal forward facial development6 Class I occlusion7 Straight teeth8 Better stability long term
Myofunctional Trainers
Professors R Soulet and A Besombes
Dr Earl Bergeson
Dr Chris Farrell
The Multi ndash Family System
Orofacial MyofunctionalTherapy
Oral MyologyMyofunctional TherapyTongue Thrust Therapy
B Hockel 2012 Back
Undoing Bimaxillary Dysplasia
1 Maxillary deconstriction2 Maxillary advancement3 Maxillary impaction4 Mandibular advancement
1 Maxillary Expansion
Treatment for Bimaxillary Dysplasia
ALFCrozat
Bent Wire
HyraxHaas
Niti Exp BioBlocSchwartz
The Farrell BENT WIRE Systemtrade
Recommended Age Group 5-12 yrs
Arch Development in conjunction with the TRAINER Systemtrade
Dr John Mew
Establish Good Habits
1 Breathing through the nose2 Lips together at rest3 Correct tongue position4 No facial muscles moving on swallowing5 Stand and sit in balance6 Breath gently using the diaphragm7 Eat to nourish8 Sleep to rest
Ortho-Postural TrainingWorkshops
Breathing
Nutrition
Posture
Sleep
COPYRIGHTRoger L PriceOctober 2012
Posture Number
Forward head posturecan be a compensationfor a deficient airway
Sleep Screening and Hygiene
SQI = 10 SQI = 98
Integrative Healthcare
Function ProfessionalNasal clearing ENT Pulm MFT BreathingMuscle balance and tone MFT Myofunctional OrthoUndoing damage GP Pedo Ortho OMFSBreathing dynamics OPT MFT Breath PhysiologistPosture DC OPT PT OsteopathCranial balance OsteopathNutrition RDH Nutritionist Dietitian Sleep ENT Sleep Med DentNeurocognitive development Pedrsquon SLP Psych SpEd
The Interdisciplinary Center
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Now that I know
My personal missionTo create from what Irsquove
learned from the besta model for others to followhellipespecially the orthodontists
Myofunctional Orthodontics
Chris Farrell
John Flutter
German Ramierez
Damien OrsquoBrien
Myofunctional Research CoRancho Cucamonga
2008-2012
Oral Myology
Oral Myology Basic CourseJoy MoellerNYC 2011LA 2012
Oral Myology Levels 2 3Kim BenkertClifton 2012
Habit CessationShari GreenClifton 2013
Biobloc Orthotropics
BBO Mini-residencyBill Hang
Agora Hills2012-13
BBO IntensiveDrs John and Mike
MewLSFO2013
Breathing and Sleep
Buteyko MentorshipThe Breathing Center
Woodstock2010
Breathing Well ProgrammeJohn Flutter
2010 Ortho-Postural TrainingRoger Price
2013
Sleep DentistryMichael Gelb etal
NYU2012
ALF and Cranial
Jim Bronson2013 Tasha Turzo
Cranial Academy2014
Bucket Listbull ALF and Crozat (Bronsonrsquos course)bullMore on Biobloc (Hangrsquos Advanced London School)bull More Cranial (The Farm)bullChirodontics (Bob Walker)bull Airway Dentistry with Marc Cruz Jeff Rousebull Sleep Dentistrybull Less-than-Six with Kevin Boydbull Intra-mandibular Distraction Osteogenesis (IMDO)
Off My ListAnything that moves the teeth faster in the wrong direction
Whatrsquos an RO to do
To create from what Irsquove learned from the best
a model for others to followhellipespecially orthodontists
Teaching
Mt Sinai Pedo ResidencyAli Attaie
2010-2012
Montefiore Ortho ResidencyTony Maganzini
2012
2009-Present
Mt Sinai School of MedicinePedodontic Residency
Guest SpeakersJim BronsonMike MewKevin BoydSandra KahnJennifer TowRoger PricePaula Fabbie
Damien OrsquoBrien
First clinical program in myofunctional orthodontics
Airway and Facial DevelopmentCollaborative Webcast
Mark Cruz
AAPMD Symposium
wwwaapm
dorg
Annual MeetingApril 25-26 2014
Westin Chicago North Shore
the raphael center for integrative orthodontics
wwwalignminecomwwwbioblocnjcom
wwwmyobracenjcom
Integrative vs Conventional
Integrative vs Conventional
ldquoWith improvements in expansion orthodontics advances in myofunctional orthodontics and the growing recognition about sleep disordered breathing among children and adults it is time for orthodontics to expand its horizons There is now so much more we can oerrdquo
The Raphael name has been associated with high quality orthodontics in New Jersey for over 60 years Dr Barry Raphael has been a university trained orthodontic specialist and a member of the American Association of Orthodontists for 30 years
He has a wide range of techniques and services to offer He has studied oral myology applied kinesiology Buteyko breathing Biobloc Orthotropics and Myobrace as part of his integrative training He can offer Damon Invisalign Insignia and Incognito appliances designs as some of his many conventional orthodontic services too
Dr Raphael teaches his techniques at post-graduate residencies study clubs dental societies and for the Myofunctional Research Co He is available for presentations to any group interested in learning more about the benefits of integrative orthodontics
wwwalignminecomLearn about the choices you have in orthodontics
dr barry raphael Why its
too Early never
1425
bro
ad
str
ee
tc
lifto
n n
j 070
13
973-
778-
4222
fax
973-
778-
9625
nj s
pe
c
368
4
1425 broad street clifton nj 07013973-778-4222
wwwalignminecom
the raphael centerforintegrative orthodontics
the
raph
ael c
ente
r fo
rin
tegr
ativ
e or
thod
onti
cs
Learn about an important choice you need to make before starting braces
the raphael center for integrative education
the raphael center for integrative education
Ongoing Intro to Airway Orthodontics
April Biobloc Study Group
April Training Ortho-Postural Therapists w Roger Price
June MRC Myobrace Basic Series
August Airway Dentistry with Mark Cruz and company
October Advanced MFT with Sandy Coulson
October Less than Six with Kevin Boyd
(who else wants to play)
Mission to create a space for spreading the word about Airway and Orthotropic principles and practice
Orthodontics in the 21st Century
EstheticOrthodontics
AirwayOrthodontics
GeneticTooth-Focused
Dental PerfectionEsthetics Primary
Treating SymptomsAirway Ignorant
AdaptationMuscle-FocusedMedical Better
Esthetics SecondaryTreating Causes
Airway Conscious
The EndAnd
The Beginning
Type 4 Retraction
50
40
30
20mm
y 5 6 7 8 9 10 11 12 13 14 15
girlsboys
Bimax retrusion
Successful dental result
Failed Profile Result
Changes of pharyngeal airway size and hyoid bone position following orthodontic treatment of
Class I bimaxillary protrusion
Qingzhu Wanga Peizeng Jiab Nina K Andersonc Lin Wangd Jiuxiang Line
Angle Orthodontist Vol 00 No 0 0000 (pre-publication 2012)
ldquothe dimension of the velopharynx glossopharynx and hypopharynx were decreased after maximal retraction of anterior teeth with extraction of four premolarshelliprdquo ldquoAny factors that can influence the posture and position of tongue and soft palate may displace them backward andencroach upon the pharynxrdquo
ldquothe more the incisors were retracted the more the pharyngeal airway was reducedrdquo
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Backed into a corner
bull
Moving teeth faster more efficientlyhellipin the wrong direction
Now that wersquove made smoking unacceptable
could we not do the same withbull Sugarbull Processed foodbull Cheap milk and meatbull Fast foodbull Pill popping for symptomatic reliefbull Looking for the cure instead of the causebull Surgery as a quick fixbull Thinking braces are a status symbol
Each industry thrives on the status quoConsumers must drive the change
NP 10yM
NP
Sisterrsquos non-x ortho
Shersquos happyhellipbut Irsquom not so
I make my pitch for BBO
The dilemma of progress
(I forgot the progress pictureshellip)
Dad sells prosthetic parts to orthopedic surgeons
I selling the case against my previous work they loved
It takes me 3 hours to sell the case
They fret until the BB3 goes in
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Connecting the dots
bull Adult SDB and OSA
bull Narrow jaws and faces
bull Soft tissue dysfunction
bull Early parafunctional habits ie open mouth posture
bull Environmental stressors
bull CPAP MARAUPPP SurgWherersquos the best
place to start treatment here
or here
1 Prevention 2 Undo the damage already done3 Establish good habits
When to start When damage from poor breathing is noticed and when bad habits are discovered
The strategies of Airway Orthodontics
Prevention
bull Remove ankyloglossiabull Promote breastfeedingbull Harden the dietbull Develop masticatory strengthbull Discourage oral habitsbull Promote whole-foods low sugar dietbull Reduce oropharyngeal obstructionbull Promote nasal breathing
Breathing retraining
bull Nasal rinsingbull Nasal clearingbull Decongesting
The goals of Airway Orthodontics
1 Breathing through the nose2 Lips together at rest3 Correct tongue position4 No facial muscles moving on swallowing5 Optimal forward facial development6 Class I occlusion7 Straight teeth8 Better stability long term
Myofunctional Trainers
Professors R Soulet and A Besombes
Dr Earl Bergeson
Dr Chris Farrell
The Multi ndash Family System
Orofacial MyofunctionalTherapy
Oral MyologyMyofunctional TherapyTongue Thrust Therapy
B Hockel 2012 Back
Undoing Bimaxillary Dysplasia
1 Maxillary deconstriction2 Maxillary advancement3 Maxillary impaction4 Mandibular advancement
1 Maxillary Expansion
Treatment for Bimaxillary Dysplasia
ALFCrozat
Bent Wire
HyraxHaas
Niti Exp BioBlocSchwartz
The Farrell BENT WIRE Systemtrade
Recommended Age Group 5-12 yrs
Arch Development in conjunction with the TRAINER Systemtrade
Dr John Mew
Establish Good Habits
1 Breathing through the nose2 Lips together at rest3 Correct tongue position4 No facial muscles moving on swallowing5 Stand and sit in balance6 Breath gently using the diaphragm7 Eat to nourish8 Sleep to rest
Ortho-Postural TrainingWorkshops
Breathing
Nutrition
Posture
Sleep
COPYRIGHTRoger L PriceOctober 2012
Posture Number
Forward head posturecan be a compensationfor a deficient airway
Sleep Screening and Hygiene
SQI = 10 SQI = 98
Integrative Healthcare
Function ProfessionalNasal clearing ENT Pulm MFT BreathingMuscle balance and tone MFT Myofunctional OrthoUndoing damage GP Pedo Ortho OMFSBreathing dynamics OPT MFT Breath PhysiologistPosture DC OPT PT OsteopathCranial balance OsteopathNutrition RDH Nutritionist Dietitian Sleep ENT Sleep Med DentNeurocognitive development Pedrsquon SLP Psych SpEd
The Interdisciplinary Center
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Now that I know
My personal missionTo create from what Irsquove
learned from the besta model for others to followhellipespecially the orthodontists
Myofunctional Orthodontics
Chris Farrell
John Flutter
German Ramierez
Damien OrsquoBrien
Myofunctional Research CoRancho Cucamonga
2008-2012
Oral Myology
Oral Myology Basic CourseJoy MoellerNYC 2011LA 2012
Oral Myology Levels 2 3Kim BenkertClifton 2012
Habit CessationShari GreenClifton 2013
Biobloc Orthotropics
BBO Mini-residencyBill Hang
Agora Hills2012-13
BBO IntensiveDrs John and Mike
MewLSFO2013
Breathing and Sleep
Buteyko MentorshipThe Breathing Center
Woodstock2010
Breathing Well ProgrammeJohn Flutter
2010 Ortho-Postural TrainingRoger Price
2013
Sleep DentistryMichael Gelb etal
NYU2012
ALF and Cranial
Jim Bronson2013 Tasha Turzo
Cranial Academy2014
Bucket Listbull ALF and Crozat (Bronsonrsquos course)bullMore on Biobloc (Hangrsquos Advanced London School)bull More Cranial (The Farm)bullChirodontics (Bob Walker)bull Airway Dentistry with Marc Cruz Jeff Rousebull Sleep Dentistrybull Less-than-Six with Kevin Boydbull Intra-mandibular Distraction Osteogenesis (IMDO)
Off My ListAnything that moves the teeth faster in the wrong direction
Whatrsquos an RO to do
To create from what Irsquove learned from the best
a model for others to followhellipespecially orthodontists
Teaching
Mt Sinai Pedo ResidencyAli Attaie
2010-2012
Montefiore Ortho ResidencyTony Maganzini
2012
2009-Present
Mt Sinai School of MedicinePedodontic Residency
Guest SpeakersJim BronsonMike MewKevin BoydSandra KahnJennifer TowRoger PricePaula Fabbie
Damien OrsquoBrien
First clinical program in myofunctional orthodontics
Airway and Facial DevelopmentCollaborative Webcast
Mark Cruz
AAPMD Symposium
wwwaapm
dorg
Annual MeetingApril 25-26 2014
Westin Chicago North Shore
the raphael center for integrative orthodontics
wwwalignminecomwwwbioblocnjcom
wwwmyobracenjcom
Integrative vs Conventional
Integrative vs Conventional
ldquoWith improvements in expansion orthodontics advances in myofunctional orthodontics and the growing recognition about sleep disordered breathing among children and adults it is time for orthodontics to expand its horizons There is now so much more we can oerrdquo
The Raphael name has been associated with high quality orthodontics in New Jersey for over 60 years Dr Barry Raphael has been a university trained orthodontic specialist and a member of the American Association of Orthodontists for 30 years
He has a wide range of techniques and services to offer He has studied oral myology applied kinesiology Buteyko breathing Biobloc Orthotropics and Myobrace as part of his integrative training He can offer Damon Invisalign Insignia and Incognito appliances designs as some of his many conventional orthodontic services too
Dr Raphael teaches his techniques at post-graduate residencies study clubs dental societies and for the Myofunctional Research Co He is available for presentations to any group interested in learning more about the benefits of integrative orthodontics
wwwalignminecomLearn about the choices you have in orthodontics
dr barry raphael Why its
too Early never
1425
bro
ad
str
ee
tc
lifto
n n
j 070
13
973-
778-
4222
fax
973-
778-
9625
nj s
pe
c
368
4
1425 broad street clifton nj 07013973-778-4222
wwwalignminecom
the raphael centerforintegrative orthodontics
the
raph
ael c
ente
r fo
rin
tegr
ativ
e or
thod
onti
cs
Learn about an important choice you need to make before starting braces
the raphael center for integrative education
the raphael center for integrative education
Ongoing Intro to Airway Orthodontics
April Biobloc Study Group
April Training Ortho-Postural Therapists w Roger Price
June MRC Myobrace Basic Series
August Airway Dentistry with Mark Cruz and company
October Advanced MFT with Sandy Coulson
October Less than Six with Kevin Boyd
(who else wants to play)
Mission to create a space for spreading the word about Airway and Orthotropic principles and practice
Orthodontics in the 21st Century
EstheticOrthodontics
AirwayOrthodontics
GeneticTooth-Focused
Dental PerfectionEsthetics Primary
Treating SymptomsAirway Ignorant
AdaptationMuscle-FocusedMedical Better
Esthetics SecondaryTreating Causes
Airway Conscious
The EndAnd
The Beginning
Bimax retrusion
Successful dental result
Failed Profile Result
Changes of pharyngeal airway size and hyoid bone position following orthodontic treatment of
Class I bimaxillary protrusion
Qingzhu Wanga Peizeng Jiab Nina K Andersonc Lin Wangd Jiuxiang Line
Angle Orthodontist Vol 00 No 0 0000 (pre-publication 2012)
ldquothe dimension of the velopharynx glossopharynx and hypopharynx were decreased after maximal retraction of anterior teeth with extraction of four premolarshelliprdquo ldquoAny factors that can influence the posture and position of tongue and soft palate may displace them backward andencroach upon the pharynxrdquo
ldquothe more the incisors were retracted the more the pharyngeal airway was reducedrdquo
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Backed into a corner
bull
Moving teeth faster more efficientlyhellipin the wrong direction
Now that wersquove made smoking unacceptable
could we not do the same withbull Sugarbull Processed foodbull Cheap milk and meatbull Fast foodbull Pill popping for symptomatic reliefbull Looking for the cure instead of the causebull Surgery as a quick fixbull Thinking braces are a status symbol
Each industry thrives on the status quoConsumers must drive the change
NP 10yM
NP
Sisterrsquos non-x ortho
Shersquos happyhellipbut Irsquom not so
I make my pitch for BBO
The dilemma of progress
(I forgot the progress pictureshellip)
Dad sells prosthetic parts to orthopedic surgeons
I selling the case against my previous work they loved
It takes me 3 hours to sell the case
They fret until the BB3 goes in
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Connecting the dots
bull Adult SDB and OSA
bull Narrow jaws and faces
bull Soft tissue dysfunction
bull Early parafunctional habits ie open mouth posture
bull Environmental stressors
bull CPAP MARAUPPP SurgWherersquos the best
place to start treatment here
or here
1 Prevention 2 Undo the damage already done3 Establish good habits
When to start When damage from poor breathing is noticed and when bad habits are discovered
The strategies of Airway Orthodontics
Prevention
bull Remove ankyloglossiabull Promote breastfeedingbull Harden the dietbull Develop masticatory strengthbull Discourage oral habitsbull Promote whole-foods low sugar dietbull Reduce oropharyngeal obstructionbull Promote nasal breathing
Breathing retraining
bull Nasal rinsingbull Nasal clearingbull Decongesting
The goals of Airway Orthodontics
1 Breathing through the nose2 Lips together at rest3 Correct tongue position4 No facial muscles moving on swallowing5 Optimal forward facial development6 Class I occlusion7 Straight teeth8 Better stability long term
Myofunctional Trainers
Professors R Soulet and A Besombes
Dr Earl Bergeson
Dr Chris Farrell
The Multi ndash Family System
Orofacial MyofunctionalTherapy
Oral MyologyMyofunctional TherapyTongue Thrust Therapy
B Hockel 2012 Back
Undoing Bimaxillary Dysplasia
1 Maxillary deconstriction2 Maxillary advancement3 Maxillary impaction4 Mandibular advancement
1 Maxillary Expansion
Treatment for Bimaxillary Dysplasia
ALFCrozat
Bent Wire
HyraxHaas
Niti Exp BioBlocSchwartz
The Farrell BENT WIRE Systemtrade
Recommended Age Group 5-12 yrs
Arch Development in conjunction with the TRAINER Systemtrade
Dr John Mew
Establish Good Habits
1 Breathing through the nose2 Lips together at rest3 Correct tongue position4 No facial muscles moving on swallowing5 Stand and sit in balance6 Breath gently using the diaphragm7 Eat to nourish8 Sleep to rest
Ortho-Postural TrainingWorkshops
Breathing
Nutrition
Posture
Sleep
COPYRIGHTRoger L PriceOctober 2012
Posture Number
Forward head posturecan be a compensationfor a deficient airway
Sleep Screening and Hygiene
SQI = 10 SQI = 98
Integrative Healthcare
Function ProfessionalNasal clearing ENT Pulm MFT BreathingMuscle balance and tone MFT Myofunctional OrthoUndoing damage GP Pedo Ortho OMFSBreathing dynamics OPT MFT Breath PhysiologistPosture DC OPT PT OsteopathCranial balance OsteopathNutrition RDH Nutritionist Dietitian Sleep ENT Sleep Med DentNeurocognitive development Pedrsquon SLP Psych SpEd
The Interdisciplinary Center
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Now that I know
My personal missionTo create from what Irsquove
learned from the besta model for others to followhellipespecially the orthodontists
Myofunctional Orthodontics
Chris Farrell
John Flutter
German Ramierez
Damien OrsquoBrien
Myofunctional Research CoRancho Cucamonga
2008-2012
Oral Myology
Oral Myology Basic CourseJoy MoellerNYC 2011LA 2012
Oral Myology Levels 2 3Kim BenkertClifton 2012
Habit CessationShari GreenClifton 2013
Biobloc Orthotropics
BBO Mini-residencyBill Hang
Agora Hills2012-13
BBO IntensiveDrs John and Mike
MewLSFO2013
Breathing and Sleep
Buteyko MentorshipThe Breathing Center
Woodstock2010
Breathing Well ProgrammeJohn Flutter
2010 Ortho-Postural TrainingRoger Price
2013
Sleep DentistryMichael Gelb etal
NYU2012
ALF and Cranial
Jim Bronson2013 Tasha Turzo
Cranial Academy2014
Bucket Listbull ALF and Crozat (Bronsonrsquos course)bullMore on Biobloc (Hangrsquos Advanced London School)bull More Cranial (The Farm)bullChirodontics (Bob Walker)bull Airway Dentistry with Marc Cruz Jeff Rousebull Sleep Dentistrybull Less-than-Six with Kevin Boydbull Intra-mandibular Distraction Osteogenesis (IMDO)
Off My ListAnything that moves the teeth faster in the wrong direction
Whatrsquos an RO to do
To create from what Irsquove learned from the best
a model for others to followhellipespecially orthodontists
Teaching
Mt Sinai Pedo ResidencyAli Attaie
2010-2012
Montefiore Ortho ResidencyTony Maganzini
2012
2009-Present
Mt Sinai School of MedicinePedodontic Residency
Guest SpeakersJim BronsonMike MewKevin BoydSandra KahnJennifer TowRoger PricePaula Fabbie
Damien OrsquoBrien
First clinical program in myofunctional orthodontics
Airway and Facial DevelopmentCollaborative Webcast
Mark Cruz
AAPMD Symposium
wwwaapm
dorg
Annual MeetingApril 25-26 2014
Westin Chicago North Shore
the raphael center for integrative orthodontics
wwwalignminecomwwwbioblocnjcom
wwwmyobracenjcom
Integrative vs Conventional
Integrative vs Conventional
ldquoWith improvements in expansion orthodontics advances in myofunctional orthodontics and the growing recognition about sleep disordered breathing among children and adults it is time for orthodontics to expand its horizons There is now so much more we can oerrdquo
The Raphael name has been associated with high quality orthodontics in New Jersey for over 60 years Dr Barry Raphael has been a university trained orthodontic specialist and a member of the American Association of Orthodontists for 30 years
He has a wide range of techniques and services to offer He has studied oral myology applied kinesiology Buteyko breathing Biobloc Orthotropics and Myobrace as part of his integrative training He can offer Damon Invisalign Insignia and Incognito appliances designs as some of his many conventional orthodontic services too
Dr Raphael teaches his techniques at post-graduate residencies study clubs dental societies and for the Myofunctional Research Co He is available for presentations to any group interested in learning more about the benefits of integrative orthodontics
wwwalignminecomLearn about the choices you have in orthodontics
dr barry raphael Why its
too Early never
1425
bro
ad
str
ee
tc
lifto
n n
j 070
13
973-
778-
4222
fax
973-
778-
9625
nj s
pe
c
368
4
1425 broad street clifton nj 07013973-778-4222
wwwalignminecom
the raphael centerforintegrative orthodontics
the
raph
ael c
ente
r fo
rin
tegr
ativ
e or
thod
onti
cs
Learn about an important choice you need to make before starting braces
the raphael center for integrative education
the raphael center for integrative education
Ongoing Intro to Airway Orthodontics
April Biobloc Study Group
April Training Ortho-Postural Therapists w Roger Price
June MRC Myobrace Basic Series
August Airway Dentistry with Mark Cruz and company
October Advanced MFT with Sandy Coulson
October Less than Six with Kevin Boyd
(who else wants to play)
Mission to create a space for spreading the word about Airway and Orthotropic principles and practice
Orthodontics in the 21st Century
EstheticOrthodontics
AirwayOrthodontics
GeneticTooth-Focused
Dental PerfectionEsthetics Primary
Treating SymptomsAirway Ignorant
AdaptationMuscle-FocusedMedical Better
Esthetics SecondaryTreating Causes
Airway Conscious
The EndAnd
The Beginning
Successful dental result
Failed Profile Result
Changes of pharyngeal airway size and hyoid bone position following orthodontic treatment of
Class I bimaxillary protrusion
Qingzhu Wanga Peizeng Jiab Nina K Andersonc Lin Wangd Jiuxiang Line
Angle Orthodontist Vol 00 No 0 0000 (pre-publication 2012)
ldquothe dimension of the velopharynx glossopharynx and hypopharynx were decreased after maximal retraction of anterior teeth with extraction of four premolarshelliprdquo ldquoAny factors that can influence the posture and position of tongue and soft palate may displace them backward andencroach upon the pharynxrdquo
ldquothe more the incisors were retracted the more the pharyngeal airway was reducedrdquo
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Backed into a corner
bull
Moving teeth faster more efficientlyhellipin the wrong direction
Now that wersquove made smoking unacceptable
could we not do the same withbull Sugarbull Processed foodbull Cheap milk and meatbull Fast foodbull Pill popping for symptomatic reliefbull Looking for the cure instead of the causebull Surgery as a quick fixbull Thinking braces are a status symbol
Each industry thrives on the status quoConsumers must drive the change
NP 10yM
NP
Sisterrsquos non-x ortho
Shersquos happyhellipbut Irsquom not so
I make my pitch for BBO
The dilemma of progress
(I forgot the progress pictureshellip)
Dad sells prosthetic parts to orthopedic surgeons
I selling the case against my previous work they loved
It takes me 3 hours to sell the case
They fret until the BB3 goes in
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Connecting the dots
bull Adult SDB and OSA
bull Narrow jaws and faces
bull Soft tissue dysfunction
bull Early parafunctional habits ie open mouth posture
bull Environmental stressors
bull CPAP MARAUPPP SurgWherersquos the best
place to start treatment here
or here
1 Prevention 2 Undo the damage already done3 Establish good habits
When to start When damage from poor breathing is noticed and when bad habits are discovered
The strategies of Airway Orthodontics
Prevention
bull Remove ankyloglossiabull Promote breastfeedingbull Harden the dietbull Develop masticatory strengthbull Discourage oral habitsbull Promote whole-foods low sugar dietbull Reduce oropharyngeal obstructionbull Promote nasal breathing
Breathing retraining
bull Nasal rinsingbull Nasal clearingbull Decongesting
The goals of Airway Orthodontics
1 Breathing through the nose2 Lips together at rest3 Correct tongue position4 No facial muscles moving on swallowing5 Optimal forward facial development6 Class I occlusion7 Straight teeth8 Better stability long term
Myofunctional Trainers
Professors R Soulet and A Besombes
Dr Earl Bergeson
Dr Chris Farrell
The Multi ndash Family System
Orofacial MyofunctionalTherapy
Oral MyologyMyofunctional TherapyTongue Thrust Therapy
B Hockel 2012 Back
Undoing Bimaxillary Dysplasia
1 Maxillary deconstriction2 Maxillary advancement3 Maxillary impaction4 Mandibular advancement
1 Maxillary Expansion
Treatment for Bimaxillary Dysplasia
ALFCrozat
Bent Wire
HyraxHaas
Niti Exp BioBlocSchwartz
The Farrell BENT WIRE Systemtrade
Recommended Age Group 5-12 yrs
Arch Development in conjunction with the TRAINER Systemtrade
Dr John Mew
Establish Good Habits
1 Breathing through the nose2 Lips together at rest3 Correct tongue position4 No facial muscles moving on swallowing5 Stand and sit in balance6 Breath gently using the diaphragm7 Eat to nourish8 Sleep to rest
Ortho-Postural TrainingWorkshops
Breathing
Nutrition
Posture
Sleep
COPYRIGHTRoger L PriceOctober 2012
Posture Number
Forward head posturecan be a compensationfor a deficient airway
Sleep Screening and Hygiene
SQI = 10 SQI = 98
Integrative Healthcare
Function ProfessionalNasal clearing ENT Pulm MFT BreathingMuscle balance and tone MFT Myofunctional OrthoUndoing damage GP Pedo Ortho OMFSBreathing dynamics OPT MFT Breath PhysiologistPosture DC OPT PT OsteopathCranial balance OsteopathNutrition RDH Nutritionist Dietitian Sleep ENT Sleep Med DentNeurocognitive development Pedrsquon SLP Psych SpEd
The Interdisciplinary Center
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Now that I know
My personal missionTo create from what Irsquove
learned from the besta model for others to followhellipespecially the orthodontists
Myofunctional Orthodontics
Chris Farrell
John Flutter
German Ramierez
Damien OrsquoBrien
Myofunctional Research CoRancho Cucamonga
2008-2012
Oral Myology
Oral Myology Basic CourseJoy MoellerNYC 2011LA 2012
Oral Myology Levels 2 3Kim BenkertClifton 2012
Habit CessationShari GreenClifton 2013
Biobloc Orthotropics
BBO Mini-residencyBill Hang
Agora Hills2012-13
BBO IntensiveDrs John and Mike
MewLSFO2013
Breathing and Sleep
Buteyko MentorshipThe Breathing Center
Woodstock2010
Breathing Well ProgrammeJohn Flutter
2010 Ortho-Postural TrainingRoger Price
2013
Sleep DentistryMichael Gelb etal
NYU2012
ALF and Cranial
Jim Bronson2013 Tasha Turzo
Cranial Academy2014
Bucket Listbull ALF and Crozat (Bronsonrsquos course)bullMore on Biobloc (Hangrsquos Advanced London School)bull More Cranial (The Farm)bullChirodontics (Bob Walker)bull Airway Dentistry with Marc Cruz Jeff Rousebull Sleep Dentistrybull Less-than-Six with Kevin Boydbull Intra-mandibular Distraction Osteogenesis (IMDO)
Off My ListAnything that moves the teeth faster in the wrong direction
Whatrsquos an RO to do
To create from what Irsquove learned from the best
a model for others to followhellipespecially orthodontists
Teaching
Mt Sinai Pedo ResidencyAli Attaie
2010-2012
Montefiore Ortho ResidencyTony Maganzini
2012
2009-Present
Mt Sinai School of MedicinePedodontic Residency
Guest SpeakersJim BronsonMike MewKevin BoydSandra KahnJennifer TowRoger PricePaula Fabbie
Damien OrsquoBrien
First clinical program in myofunctional orthodontics
Airway and Facial DevelopmentCollaborative Webcast
Mark Cruz
AAPMD Symposium
wwwaapm
dorg
Annual MeetingApril 25-26 2014
Westin Chicago North Shore
the raphael center for integrative orthodontics
wwwalignminecomwwwbioblocnjcom
wwwmyobracenjcom
Integrative vs Conventional
Integrative vs Conventional
ldquoWith improvements in expansion orthodontics advances in myofunctional orthodontics and the growing recognition about sleep disordered breathing among children and adults it is time for orthodontics to expand its horizons There is now so much more we can oerrdquo
The Raphael name has been associated with high quality orthodontics in New Jersey for over 60 years Dr Barry Raphael has been a university trained orthodontic specialist and a member of the American Association of Orthodontists for 30 years
He has a wide range of techniques and services to offer He has studied oral myology applied kinesiology Buteyko breathing Biobloc Orthotropics and Myobrace as part of his integrative training He can offer Damon Invisalign Insignia and Incognito appliances designs as some of his many conventional orthodontic services too
Dr Raphael teaches his techniques at post-graduate residencies study clubs dental societies and for the Myofunctional Research Co He is available for presentations to any group interested in learning more about the benefits of integrative orthodontics
wwwalignminecomLearn about the choices you have in orthodontics
dr barry raphael Why its
too Early never
1425
bro
ad
str
ee
tc
lifto
n n
j 070
13
973-
778-
4222
fax
973-
778-
9625
nj s
pe
c
368
4
1425 broad street clifton nj 07013973-778-4222
wwwalignminecom
the raphael centerforintegrative orthodontics
the
raph
ael c
ente
r fo
rin
tegr
ativ
e or
thod
onti
cs
Learn about an important choice you need to make before starting braces
the raphael center for integrative education
the raphael center for integrative education
Ongoing Intro to Airway Orthodontics
April Biobloc Study Group
April Training Ortho-Postural Therapists w Roger Price
June MRC Myobrace Basic Series
August Airway Dentistry with Mark Cruz and company
October Advanced MFT with Sandy Coulson
October Less than Six with Kevin Boyd
(who else wants to play)
Mission to create a space for spreading the word about Airway and Orthotropic principles and practice
Orthodontics in the 21st Century
EstheticOrthodontics
AirwayOrthodontics
GeneticTooth-Focused
Dental PerfectionEsthetics Primary
Treating SymptomsAirway Ignorant
AdaptationMuscle-FocusedMedical Better
Esthetics SecondaryTreating Causes
Airway Conscious
The EndAnd
The Beginning
Failed Profile Result
Changes of pharyngeal airway size and hyoid bone position following orthodontic treatment of
Class I bimaxillary protrusion
Qingzhu Wanga Peizeng Jiab Nina K Andersonc Lin Wangd Jiuxiang Line
Angle Orthodontist Vol 00 No 0 0000 (pre-publication 2012)
ldquothe dimension of the velopharynx glossopharynx and hypopharynx were decreased after maximal retraction of anterior teeth with extraction of four premolarshelliprdquo ldquoAny factors that can influence the posture and position of tongue and soft palate may displace them backward andencroach upon the pharynxrdquo
ldquothe more the incisors were retracted the more the pharyngeal airway was reducedrdquo
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Backed into a corner
bull
Moving teeth faster more efficientlyhellipin the wrong direction
Now that wersquove made smoking unacceptable
could we not do the same withbull Sugarbull Processed foodbull Cheap milk and meatbull Fast foodbull Pill popping for symptomatic reliefbull Looking for the cure instead of the causebull Surgery as a quick fixbull Thinking braces are a status symbol
Each industry thrives on the status quoConsumers must drive the change
NP 10yM
NP
Sisterrsquos non-x ortho
Shersquos happyhellipbut Irsquom not so
I make my pitch for BBO
The dilemma of progress
(I forgot the progress pictureshellip)
Dad sells prosthetic parts to orthopedic surgeons
I selling the case against my previous work they loved
It takes me 3 hours to sell the case
They fret until the BB3 goes in
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Connecting the dots
bull Adult SDB and OSA
bull Narrow jaws and faces
bull Soft tissue dysfunction
bull Early parafunctional habits ie open mouth posture
bull Environmental stressors
bull CPAP MARAUPPP SurgWherersquos the best
place to start treatment here
or here
1 Prevention 2 Undo the damage already done3 Establish good habits
When to start When damage from poor breathing is noticed and when bad habits are discovered
The strategies of Airway Orthodontics
Prevention
bull Remove ankyloglossiabull Promote breastfeedingbull Harden the dietbull Develop masticatory strengthbull Discourage oral habitsbull Promote whole-foods low sugar dietbull Reduce oropharyngeal obstructionbull Promote nasal breathing
Breathing retraining
bull Nasal rinsingbull Nasal clearingbull Decongesting
The goals of Airway Orthodontics
1 Breathing through the nose2 Lips together at rest3 Correct tongue position4 No facial muscles moving on swallowing5 Optimal forward facial development6 Class I occlusion7 Straight teeth8 Better stability long term
Myofunctional Trainers
Professors R Soulet and A Besombes
Dr Earl Bergeson
Dr Chris Farrell
The Multi ndash Family System
Orofacial MyofunctionalTherapy
Oral MyologyMyofunctional TherapyTongue Thrust Therapy
B Hockel 2012 Back
Undoing Bimaxillary Dysplasia
1 Maxillary deconstriction2 Maxillary advancement3 Maxillary impaction4 Mandibular advancement
1 Maxillary Expansion
Treatment for Bimaxillary Dysplasia
ALFCrozat
Bent Wire
HyraxHaas
Niti Exp BioBlocSchwartz
The Farrell BENT WIRE Systemtrade
Recommended Age Group 5-12 yrs
Arch Development in conjunction with the TRAINER Systemtrade
Dr John Mew
Establish Good Habits
1 Breathing through the nose2 Lips together at rest3 Correct tongue position4 No facial muscles moving on swallowing5 Stand and sit in balance6 Breath gently using the diaphragm7 Eat to nourish8 Sleep to rest
Ortho-Postural TrainingWorkshops
Breathing
Nutrition
Posture
Sleep
COPYRIGHTRoger L PriceOctober 2012
Posture Number
Forward head posturecan be a compensationfor a deficient airway
Sleep Screening and Hygiene
SQI = 10 SQI = 98
Integrative Healthcare
Function ProfessionalNasal clearing ENT Pulm MFT BreathingMuscle balance and tone MFT Myofunctional OrthoUndoing damage GP Pedo Ortho OMFSBreathing dynamics OPT MFT Breath PhysiologistPosture DC OPT PT OsteopathCranial balance OsteopathNutrition RDH Nutritionist Dietitian Sleep ENT Sleep Med DentNeurocognitive development Pedrsquon SLP Psych SpEd
The Interdisciplinary Center
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Now that I know
My personal missionTo create from what Irsquove
learned from the besta model for others to followhellipespecially the orthodontists
Myofunctional Orthodontics
Chris Farrell
John Flutter
German Ramierez
Damien OrsquoBrien
Myofunctional Research CoRancho Cucamonga
2008-2012
Oral Myology
Oral Myology Basic CourseJoy MoellerNYC 2011LA 2012
Oral Myology Levels 2 3Kim BenkertClifton 2012
Habit CessationShari GreenClifton 2013
Biobloc Orthotropics
BBO Mini-residencyBill Hang
Agora Hills2012-13
BBO IntensiveDrs John and Mike
MewLSFO2013
Breathing and Sleep
Buteyko MentorshipThe Breathing Center
Woodstock2010
Breathing Well ProgrammeJohn Flutter
2010 Ortho-Postural TrainingRoger Price
2013
Sleep DentistryMichael Gelb etal
NYU2012
ALF and Cranial
Jim Bronson2013 Tasha Turzo
Cranial Academy2014
Bucket Listbull ALF and Crozat (Bronsonrsquos course)bullMore on Biobloc (Hangrsquos Advanced London School)bull More Cranial (The Farm)bullChirodontics (Bob Walker)bull Airway Dentistry with Marc Cruz Jeff Rousebull Sleep Dentistrybull Less-than-Six with Kevin Boydbull Intra-mandibular Distraction Osteogenesis (IMDO)
Off My ListAnything that moves the teeth faster in the wrong direction
Whatrsquos an RO to do
To create from what Irsquove learned from the best
a model for others to followhellipespecially orthodontists
Teaching
Mt Sinai Pedo ResidencyAli Attaie
2010-2012
Montefiore Ortho ResidencyTony Maganzini
2012
2009-Present
Mt Sinai School of MedicinePedodontic Residency
Guest SpeakersJim BronsonMike MewKevin BoydSandra KahnJennifer TowRoger PricePaula Fabbie
Damien OrsquoBrien
First clinical program in myofunctional orthodontics
Airway and Facial DevelopmentCollaborative Webcast
Mark Cruz
AAPMD Symposium
wwwaapm
dorg
Annual MeetingApril 25-26 2014
Westin Chicago North Shore
the raphael center for integrative orthodontics
wwwalignminecomwwwbioblocnjcom
wwwmyobracenjcom
Integrative vs Conventional
Integrative vs Conventional
ldquoWith improvements in expansion orthodontics advances in myofunctional orthodontics and the growing recognition about sleep disordered breathing among children and adults it is time for orthodontics to expand its horizons There is now so much more we can oerrdquo
The Raphael name has been associated with high quality orthodontics in New Jersey for over 60 years Dr Barry Raphael has been a university trained orthodontic specialist and a member of the American Association of Orthodontists for 30 years
He has a wide range of techniques and services to offer He has studied oral myology applied kinesiology Buteyko breathing Biobloc Orthotropics and Myobrace as part of his integrative training He can offer Damon Invisalign Insignia and Incognito appliances designs as some of his many conventional orthodontic services too
Dr Raphael teaches his techniques at post-graduate residencies study clubs dental societies and for the Myofunctional Research Co He is available for presentations to any group interested in learning more about the benefits of integrative orthodontics
wwwalignminecomLearn about the choices you have in orthodontics
dr barry raphael Why its
too Early never
1425
bro
ad
str
ee
tc
lifto
n n
j 070
13
973-
778-
4222
fax
973-
778-
9625
nj s
pe
c
368
4
1425 broad street clifton nj 07013973-778-4222
wwwalignminecom
the raphael centerforintegrative orthodontics
the
raph
ael c
ente
r fo
rin
tegr
ativ
e or
thod
onti
cs
Learn about an important choice you need to make before starting braces
the raphael center for integrative education
the raphael center for integrative education
Ongoing Intro to Airway Orthodontics
April Biobloc Study Group
April Training Ortho-Postural Therapists w Roger Price
June MRC Myobrace Basic Series
August Airway Dentistry with Mark Cruz and company
October Advanced MFT with Sandy Coulson
October Less than Six with Kevin Boyd
(who else wants to play)
Mission to create a space for spreading the word about Airway and Orthotropic principles and practice
Orthodontics in the 21st Century
EstheticOrthodontics
AirwayOrthodontics
GeneticTooth-Focused
Dental PerfectionEsthetics Primary
Treating SymptomsAirway Ignorant
AdaptationMuscle-FocusedMedical Better
Esthetics SecondaryTreating Causes
Airway Conscious
The EndAnd
The Beginning
Changes of pharyngeal airway size and hyoid bone position following orthodontic treatment of
Class I bimaxillary protrusion
Qingzhu Wanga Peizeng Jiab Nina K Andersonc Lin Wangd Jiuxiang Line
Angle Orthodontist Vol 00 No 0 0000 (pre-publication 2012)
ldquothe dimension of the velopharynx glossopharynx and hypopharynx were decreased after maximal retraction of anterior teeth with extraction of four premolarshelliprdquo ldquoAny factors that can influence the posture and position of tongue and soft palate may displace them backward andencroach upon the pharynxrdquo
ldquothe more the incisors were retracted the more the pharyngeal airway was reducedrdquo
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Backed into a corner
bull
Moving teeth faster more efficientlyhellipin the wrong direction
Now that wersquove made smoking unacceptable
could we not do the same withbull Sugarbull Processed foodbull Cheap milk and meatbull Fast foodbull Pill popping for symptomatic reliefbull Looking for the cure instead of the causebull Surgery as a quick fixbull Thinking braces are a status symbol
Each industry thrives on the status quoConsumers must drive the change
NP 10yM
NP
Sisterrsquos non-x ortho
Shersquos happyhellipbut Irsquom not so
I make my pitch for BBO
The dilemma of progress
(I forgot the progress pictureshellip)
Dad sells prosthetic parts to orthopedic surgeons
I selling the case against my previous work they loved
It takes me 3 hours to sell the case
They fret until the BB3 goes in
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Connecting the dots
bull Adult SDB and OSA
bull Narrow jaws and faces
bull Soft tissue dysfunction
bull Early parafunctional habits ie open mouth posture
bull Environmental stressors
bull CPAP MARAUPPP SurgWherersquos the best
place to start treatment here
or here
1 Prevention 2 Undo the damage already done3 Establish good habits
When to start When damage from poor breathing is noticed and when bad habits are discovered
The strategies of Airway Orthodontics
Prevention
bull Remove ankyloglossiabull Promote breastfeedingbull Harden the dietbull Develop masticatory strengthbull Discourage oral habitsbull Promote whole-foods low sugar dietbull Reduce oropharyngeal obstructionbull Promote nasal breathing
Breathing retraining
bull Nasal rinsingbull Nasal clearingbull Decongesting
The goals of Airway Orthodontics
1 Breathing through the nose2 Lips together at rest3 Correct tongue position4 No facial muscles moving on swallowing5 Optimal forward facial development6 Class I occlusion7 Straight teeth8 Better stability long term
Myofunctional Trainers
Professors R Soulet and A Besombes
Dr Earl Bergeson
Dr Chris Farrell
The Multi ndash Family System
Orofacial MyofunctionalTherapy
Oral MyologyMyofunctional TherapyTongue Thrust Therapy
B Hockel 2012 Back
Undoing Bimaxillary Dysplasia
1 Maxillary deconstriction2 Maxillary advancement3 Maxillary impaction4 Mandibular advancement
1 Maxillary Expansion
Treatment for Bimaxillary Dysplasia
ALFCrozat
Bent Wire
HyraxHaas
Niti Exp BioBlocSchwartz
The Farrell BENT WIRE Systemtrade
Recommended Age Group 5-12 yrs
Arch Development in conjunction with the TRAINER Systemtrade
Dr John Mew
Establish Good Habits
1 Breathing through the nose2 Lips together at rest3 Correct tongue position4 No facial muscles moving on swallowing5 Stand and sit in balance6 Breath gently using the diaphragm7 Eat to nourish8 Sleep to rest
Ortho-Postural TrainingWorkshops
Breathing
Nutrition
Posture
Sleep
COPYRIGHTRoger L PriceOctober 2012
Posture Number
Forward head posturecan be a compensationfor a deficient airway
Sleep Screening and Hygiene
SQI = 10 SQI = 98
Integrative Healthcare
Function ProfessionalNasal clearing ENT Pulm MFT BreathingMuscle balance and tone MFT Myofunctional OrthoUndoing damage GP Pedo Ortho OMFSBreathing dynamics OPT MFT Breath PhysiologistPosture DC OPT PT OsteopathCranial balance OsteopathNutrition RDH Nutritionist Dietitian Sleep ENT Sleep Med DentNeurocognitive development Pedrsquon SLP Psych SpEd
The Interdisciplinary Center
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Now that I know
My personal missionTo create from what Irsquove
learned from the besta model for others to followhellipespecially the orthodontists
Myofunctional Orthodontics
Chris Farrell
John Flutter
German Ramierez
Damien OrsquoBrien
Myofunctional Research CoRancho Cucamonga
2008-2012
Oral Myology
Oral Myology Basic CourseJoy MoellerNYC 2011LA 2012
Oral Myology Levels 2 3Kim BenkertClifton 2012
Habit CessationShari GreenClifton 2013
Biobloc Orthotropics
BBO Mini-residencyBill Hang
Agora Hills2012-13
BBO IntensiveDrs John and Mike
MewLSFO2013
Breathing and Sleep
Buteyko MentorshipThe Breathing Center
Woodstock2010
Breathing Well ProgrammeJohn Flutter
2010 Ortho-Postural TrainingRoger Price
2013
Sleep DentistryMichael Gelb etal
NYU2012
ALF and Cranial
Jim Bronson2013 Tasha Turzo
Cranial Academy2014
Bucket Listbull ALF and Crozat (Bronsonrsquos course)bullMore on Biobloc (Hangrsquos Advanced London School)bull More Cranial (The Farm)bullChirodontics (Bob Walker)bull Airway Dentistry with Marc Cruz Jeff Rousebull Sleep Dentistrybull Less-than-Six with Kevin Boydbull Intra-mandibular Distraction Osteogenesis (IMDO)
Off My ListAnything that moves the teeth faster in the wrong direction
Whatrsquos an RO to do
To create from what Irsquove learned from the best
a model for others to followhellipespecially orthodontists
Teaching
Mt Sinai Pedo ResidencyAli Attaie
2010-2012
Montefiore Ortho ResidencyTony Maganzini
2012
2009-Present
Mt Sinai School of MedicinePedodontic Residency
Guest SpeakersJim BronsonMike MewKevin BoydSandra KahnJennifer TowRoger PricePaula Fabbie
Damien OrsquoBrien
First clinical program in myofunctional orthodontics
Airway and Facial DevelopmentCollaborative Webcast
Mark Cruz
AAPMD Symposium
wwwaapm
dorg
Annual MeetingApril 25-26 2014
Westin Chicago North Shore
the raphael center for integrative orthodontics
wwwalignminecomwwwbioblocnjcom
wwwmyobracenjcom
Integrative vs Conventional
Integrative vs Conventional
ldquoWith improvements in expansion orthodontics advances in myofunctional orthodontics and the growing recognition about sleep disordered breathing among children and adults it is time for orthodontics to expand its horizons There is now so much more we can oerrdquo
The Raphael name has been associated with high quality orthodontics in New Jersey for over 60 years Dr Barry Raphael has been a university trained orthodontic specialist and a member of the American Association of Orthodontists for 30 years
He has a wide range of techniques and services to offer He has studied oral myology applied kinesiology Buteyko breathing Biobloc Orthotropics and Myobrace as part of his integrative training He can offer Damon Invisalign Insignia and Incognito appliances designs as some of his many conventional orthodontic services too
Dr Raphael teaches his techniques at post-graduate residencies study clubs dental societies and for the Myofunctional Research Co He is available for presentations to any group interested in learning more about the benefits of integrative orthodontics
wwwalignminecomLearn about the choices you have in orthodontics
dr barry raphael Why its
too Early never
1425
bro
ad
str
ee
tc
lifto
n n
j 070
13
973-
778-
4222
fax
973-
778-
9625
nj s
pe
c
368
4
1425 broad street clifton nj 07013973-778-4222
wwwalignminecom
the raphael centerforintegrative orthodontics
the
raph
ael c
ente
r fo
rin
tegr
ativ
e or
thod
onti
cs
Learn about an important choice you need to make before starting braces
the raphael center for integrative education
the raphael center for integrative education
Ongoing Intro to Airway Orthodontics
April Biobloc Study Group
April Training Ortho-Postural Therapists w Roger Price
June MRC Myobrace Basic Series
August Airway Dentistry with Mark Cruz and company
October Advanced MFT with Sandy Coulson
October Less than Six with Kevin Boyd
(who else wants to play)
Mission to create a space for spreading the word about Airway and Orthotropic principles and practice
Orthodontics in the 21st Century
EstheticOrthodontics
AirwayOrthodontics
GeneticTooth-Focused
Dental PerfectionEsthetics Primary
Treating SymptomsAirway Ignorant
AdaptationMuscle-FocusedMedical Better
Esthetics SecondaryTreating Causes
Airway Conscious
The EndAnd
The Beginning
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Backed into a corner
bull
Moving teeth faster more efficientlyhellipin the wrong direction
Now that wersquove made smoking unacceptable
could we not do the same withbull Sugarbull Processed foodbull Cheap milk and meatbull Fast foodbull Pill popping for symptomatic reliefbull Looking for the cure instead of the causebull Surgery as a quick fixbull Thinking braces are a status symbol
Each industry thrives on the status quoConsumers must drive the change
NP 10yM
NP
Sisterrsquos non-x ortho
Shersquos happyhellipbut Irsquom not so
I make my pitch for BBO
The dilemma of progress
(I forgot the progress pictureshellip)
Dad sells prosthetic parts to orthopedic surgeons
I selling the case against my previous work they loved
It takes me 3 hours to sell the case
They fret until the BB3 goes in
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Connecting the dots
bull Adult SDB and OSA
bull Narrow jaws and faces
bull Soft tissue dysfunction
bull Early parafunctional habits ie open mouth posture
bull Environmental stressors
bull CPAP MARAUPPP SurgWherersquos the best
place to start treatment here
or here
1 Prevention 2 Undo the damage already done3 Establish good habits
When to start When damage from poor breathing is noticed and when bad habits are discovered
The strategies of Airway Orthodontics
Prevention
bull Remove ankyloglossiabull Promote breastfeedingbull Harden the dietbull Develop masticatory strengthbull Discourage oral habitsbull Promote whole-foods low sugar dietbull Reduce oropharyngeal obstructionbull Promote nasal breathing
Breathing retraining
bull Nasal rinsingbull Nasal clearingbull Decongesting
The goals of Airway Orthodontics
1 Breathing through the nose2 Lips together at rest3 Correct tongue position4 No facial muscles moving on swallowing5 Optimal forward facial development6 Class I occlusion7 Straight teeth8 Better stability long term
Myofunctional Trainers
Professors R Soulet and A Besombes
Dr Earl Bergeson
Dr Chris Farrell
The Multi ndash Family System
Orofacial MyofunctionalTherapy
Oral MyologyMyofunctional TherapyTongue Thrust Therapy
B Hockel 2012 Back
Undoing Bimaxillary Dysplasia
1 Maxillary deconstriction2 Maxillary advancement3 Maxillary impaction4 Mandibular advancement
1 Maxillary Expansion
Treatment for Bimaxillary Dysplasia
ALFCrozat
Bent Wire
HyraxHaas
Niti Exp BioBlocSchwartz
The Farrell BENT WIRE Systemtrade
Recommended Age Group 5-12 yrs
Arch Development in conjunction with the TRAINER Systemtrade
Dr John Mew
Establish Good Habits
1 Breathing through the nose2 Lips together at rest3 Correct tongue position4 No facial muscles moving on swallowing5 Stand and sit in balance6 Breath gently using the diaphragm7 Eat to nourish8 Sleep to rest
Ortho-Postural TrainingWorkshops
Breathing
Nutrition
Posture
Sleep
COPYRIGHTRoger L PriceOctober 2012
Posture Number
Forward head posturecan be a compensationfor a deficient airway
Sleep Screening and Hygiene
SQI = 10 SQI = 98
Integrative Healthcare
Function ProfessionalNasal clearing ENT Pulm MFT BreathingMuscle balance and tone MFT Myofunctional OrthoUndoing damage GP Pedo Ortho OMFSBreathing dynamics OPT MFT Breath PhysiologistPosture DC OPT PT OsteopathCranial balance OsteopathNutrition RDH Nutritionist Dietitian Sleep ENT Sleep Med DentNeurocognitive development Pedrsquon SLP Psych SpEd
The Interdisciplinary Center
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Now that I know
My personal missionTo create from what Irsquove
learned from the besta model for others to followhellipespecially the orthodontists
Myofunctional Orthodontics
Chris Farrell
John Flutter
German Ramierez
Damien OrsquoBrien
Myofunctional Research CoRancho Cucamonga
2008-2012
Oral Myology
Oral Myology Basic CourseJoy MoellerNYC 2011LA 2012
Oral Myology Levels 2 3Kim BenkertClifton 2012
Habit CessationShari GreenClifton 2013
Biobloc Orthotropics
BBO Mini-residencyBill Hang
Agora Hills2012-13
BBO IntensiveDrs John and Mike
MewLSFO2013
Breathing and Sleep
Buteyko MentorshipThe Breathing Center
Woodstock2010
Breathing Well ProgrammeJohn Flutter
2010 Ortho-Postural TrainingRoger Price
2013
Sleep DentistryMichael Gelb etal
NYU2012
ALF and Cranial
Jim Bronson2013 Tasha Turzo
Cranial Academy2014
Bucket Listbull ALF and Crozat (Bronsonrsquos course)bullMore on Biobloc (Hangrsquos Advanced London School)bull More Cranial (The Farm)bullChirodontics (Bob Walker)bull Airway Dentistry with Marc Cruz Jeff Rousebull Sleep Dentistrybull Less-than-Six with Kevin Boydbull Intra-mandibular Distraction Osteogenesis (IMDO)
Off My ListAnything that moves the teeth faster in the wrong direction
Whatrsquos an RO to do
To create from what Irsquove learned from the best
a model for others to followhellipespecially orthodontists
Teaching
Mt Sinai Pedo ResidencyAli Attaie
2010-2012
Montefiore Ortho ResidencyTony Maganzini
2012
2009-Present
Mt Sinai School of MedicinePedodontic Residency
Guest SpeakersJim BronsonMike MewKevin BoydSandra KahnJennifer TowRoger PricePaula Fabbie
Damien OrsquoBrien
First clinical program in myofunctional orthodontics
Airway and Facial DevelopmentCollaborative Webcast
Mark Cruz
AAPMD Symposium
wwwaapm
dorg
Annual MeetingApril 25-26 2014
Westin Chicago North Shore
the raphael center for integrative orthodontics
wwwalignminecomwwwbioblocnjcom
wwwmyobracenjcom
Integrative vs Conventional
Integrative vs Conventional
ldquoWith improvements in expansion orthodontics advances in myofunctional orthodontics and the growing recognition about sleep disordered breathing among children and adults it is time for orthodontics to expand its horizons There is now so much more we can oerrdquo
The Raphael name has been associated with high quality orthodontics in New Jersey for over 60 years Dr Barry Raphael has been a university trained orthodontic specialist and a member of the American Association of Orthodontists for 30 years
He has a wide range of techniques and services to offer He has studied oral myology applied kinesiology Buteyko breathing Biobloc Orthotropics and Myobrace as part of his integrative training He can offer Damon Invisalign Insignia and Incognito appliances designs as some of his many conventional orthodontic services too
Dr Raphael teaches his techniques at post-graduate residencies study clubs dental societies and for the Myofunctional Research Co He is available for presentations to any group interested in learning more about the benefits of integrative orthodontics
wwwalignminecomLearn about the choices you have in orthodontics
dr barry raphael Why its
too Early never
1425
bro
ad
str
ee
tc
lifto
n n
j 070
13
973-
778-
4222
fax
973-
778-
9625
nj s
pe
c
368
4
1425 broad street clifton nj 07013973-778-4222
wwwalignminecom
the raphael centerforintegrative orthodontics
the
raph
ael c
ente
r fo
rin
tegr
ativ
e or
thod
onti
cs
Learn about an important choice you need to make before starting braces
the raphael center for integrative education
the raphael center for integrative education
Ongoing Intro to Airway Orthodontics
April Biobloc Study Group
April Training Ortho-Postural Therapists w Roger Price
June MRC Myobrace Basic Series
August Airway Dentistry with Mark Cruz and company
October Advanced MFT with Sandy Coulson
October Less than Six with Kevin Boyd
(who else wants to play)
Mission to create a space for spreading the word about Airway and Orthotropic principles and practice
Orthodontics in the 21st Century
EstheticOrthodontics
AirwayOrthodontics
GeneticTooth-Focused
Dental PerfectionEsthetics Primary
Treating SymptomsAirway Ignorant
AdaptationMuscle-FocusedMedical Better
Esthetics SecondaryTreating Causes
Airway Conscious
The EndAnd
The Beginning
Backed into a corner
bull
Moving teeth faster more efficientlyhellipin the wrong direction
Now that wersquove made smoking unacceptable
could we not do the same withbull Sugarbull Processed foodbull Cheap milk and meatbull Fast foodbull Pill popping for symptomatic reliefbull Looking for the cure instead of the causebull Surgery as a quick fixbull Thinking braces are a status symbol
Each industry thrives on the status quoConsumers must drive the change
NP 10yM
NP
Sisterrsquos non-x ortho
Shersquos happyhellipbut Irsquom not so
I make my pitch for BBO
The dilemma of progress
(I forgot the progress pictureshellip)
Dad sells prosthetic parts to orthopedic surgeons
I selling the case against my previous work they loved
It takes me 3 hours to sell the case
They fret until the BB3 goes in
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Connecting the dots
bull Adult SDB and OSA
bull Narrow jaws and faces
bull Soft tissue dysfunction
bull Early parafunctional habits ie open mouth posture
bull Environmental stressors
bull CPAP MARAUPPP SurgWherersquos the best
place to start treatment here
or here
1 Prevention 2 Undo the damage already done3 Establish good habits
When to start When damage from poor breathing is noticed and when bad habits are discovered
The strategies of Airway Orthodontics
Prevention
bull Remove ankyloglossiabull Promote breastfeedingbull Harden the dietbull Develop masticatory strengthbull Discourage oral habitsbull Promote whole-foods low sugar dietbull Reduce oropharyngeal obstructionbull Promote nasal breathing
Breathing retraining
bull Nasal rinsingbull Nasal clearingbull Decongesting
The goals of Airway Orthodontics
1 Breathing through the nose2 Lips together at rest3 Correct tongue position4 No facial muscles moving on swallowing5 Optimal forward facial development6 Class I occlusion7 Straight teeth8 Better stability long term
Myofunctional Trainers
Professors R Soulet and A Besombes
Dr Earl Bergeson
Dr Chris Farrell
The Multi ndash Family System
Orofacial MyofunctionalTherapy
Oral MyologyMyofunctional TherapyTongue Thrust Therapy
B Hockel 2012 Back
Undoing Bimaxillary Dysplasia
1 Maxillary deconstriction2 Maxillary advancement3 Maxillary impaction4 Mandibular advancement
1 Maxillary Expansion
Treatment for Bimaxillary Dysplasia
ALFCrozat
Bent Wire
HyraxHaas
Niti Exp BioBlocSchwartz
The Farrell BENT WIRE Systemtrade
Recommended Age Group 5-12 yrs
Arch Development in conjunction with the TRAINER Systemtrade
Dr John Mew
Establish Good Habits
1 Breathing through the nose2 Lips together at rest3 Correct tongue position4 No facial muscles moving on swallowing5 Stand and sit in balance6 Breath gently using the diaphragm7 Eat to nourish8 Sleep to rest
Ortho-Postural TrainingWorkshops
Breathing
Nutrition
Posture
Sleep
COPYRIGHTRoger L PriceOctober 2012
Posture Number
Forward head posturecan be a compensationfor a deficient airway
Sleep Screening and Hygiene
SQI = 10 SQI = 98
Integrative Healthcare
Function ProfessionalNasal clearing ENT Pulm MFT BreathingMuscle balance and tone MFT Myofunctional OrthoUndoing damage GP Pedo Ortho OMFSBreathing dynamics OPT MFT Breath PhysiologistPosture DC OPT PT OsteopathCranial balance OsteopathNutrition RDH Nutritionist Dietitian Sleep ENT Sleep Med DentNeurocognitive development Pedrsquon SLP Psych SpEd
The Interdisciplinary Center
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Now that I know
My personal missionTo create from what Irsquove
learned from the besta model for others to followhellipespecially the orthodontists
Myofunctional Orthodontics
Chris Farrell
John Flutter
German Ramierez
Damien OrsquoBrien
Myofunctional Research CoRancho Cucamonga
2008-2012
Oral Myology
Oral Myology Basic CourseJoy MoellerNYC 2011LA 2012
Oral Myology Levels 2 3Kim BenkertClifton 2012
Habit CessationShari GreenClifton 2013
Biobloc Orthotropics
BBO Mini-residencyBill Hang
Agora Hills2012-13
BBO IntensiveDrs John and Mike
MewLSFO2013
Breathing and Sleep
Buteyko MentorshipThe Breathing Center
Woodstock2010
Breathing Well ProgrammeJohn Flutter
2010 Ortho-Postural TrainingRoger Price
2013
Sleep DentistryMichael Gelb etal
NYU2012
ALF and Cranial
Jim Bronson2013 Tasha Turzo
Cranial Academy2014
Bucket Listbull ALF and Crozat (Bronsonrsquos course)bullMore on Biobloc (Hangrsquos Advanced London School)bull More Cranial (The Farm)bullChirodontics (Bob Walker)bull Airway Dentistry with Marc Cruz Jeff Rousebull Sleep Dentistrybull Less-than-Six with Kevin Boydbull Intra-mandibular Distraction Osteogenesis (IMDO)
Off My ListAnything that moves the teeth faster in the wrong direction
Whatrsquos an RO to do
To create from what Irsquove learned from the best
a model for others to followhellipespecially orthodontists
Teaching
Mt Sinai Pedo ResidencyAli Attaie
2010-2012
Montefiore Ortho ResidencyTony Maganzini
2012
2009-Present
Mt Sinai School of MedicinePedodontic Residency
Guest SpeakersJim BronsonMike MewKevin BoydSandra KahnJennifer TowRoger PricePaula Fabbie
Damien OrsquoBrien
First clinical program in myofunctional orthodontics
Airway and Facial DevelopmentCollaborative Webcast
Mark Cruz
AAPMD Symposium
wwwaapm
dorg
Annual MeetingApril 25-26 2014
Westin Chicago North Shore
the raphael center for integrative orthodontics
wwwalignminecomwwwbioblocnjcom
wwwmyobracenjcom
Integrative vs Conventional
Integrative vs Conventional
ldquoWith improvements in expansion orthodontics advances in myofunctional orthodontics and the growing recognition about sleep disordered breathing among children and adults it is time for orthodontics to expand its horizons There is now so much more we can oerrdquo
The Raphael name has been associated with high quality orthodontics in New Jersey for over 60 years Dr Barry Raphael has been a university trained orthodontic specialist and a member of the American Association of Orthodontists for 30 years
He has a wide range of techniques and services to offer He has studied oral myology applied kinesiology Buteyko breathing Biobloc Orthotropics and Myobrace as part of his integrative training He can offer Damon Invisalign Insignia and Incognito appliances designs as some of his many conventional orthodontic services too
Dr Raphael teaches his techniques at post-graduate residencies study clubs dental societies and for the Myofunctional Research Co He is available for presentations to any group interested in learning more about the benefits of integrative orthodontics
wwwalignminecomLearn about the choices you have in orthodontics
dr barry raphael Why its
too Early never
1425
bro
ad
str
ee
tc
lifto
n n
j 070
13
973-
778-
4222
fax
973-
778-
9625
nj s
pe
c
368
4
1425 broad street clifton nj 07013973-778-4222
wwwalignminecom
the raphael centerforintegrative orthodontics
the
raph
ael c
ente
r fo
rin
tegr
ativ
e or
thod
onti
cs
Learn about an important choice you need to make before starting braces
the raphael center for integrative education
the raphael center for integrative education
Ongoing Intro to Airway Orthodontics
April Biobloc Study Group
April Training Ortho-Postural Therapists w Roger Price
June MRC Myobrace Basic Series
August Airway Dentistry with Mark Cruz and company
October Advanced MFT with Sandy Coulson
October Less than Six with Kevin Boyd
(who else wants to play)
Mission to create a space for spreading the word about Airway and Orthotropic principles and practice
Orthodontics in the 21st Century
EstheticOrthodontics
AirwayOrthodontics
GeneticTooth-Focused
Dental PerfectionEsthetics Primary
Treating SymptomsAirway Ignorant
AdaptationMuscle-FocusedMedical Better
Esthetics SecondaryTreating Causes
Airway Conscious
The EndAnd
The Beginning
Now that wersquove made smoking unacceptable
could we not do the same withbull Sugarbull Processed foodbull Cheap milk and meatbull Fast foodbull Pill popping for symptomatic reliefbull Looking for the cure instead of the causebull Surgery as a quick fixbull Thinking braces are a status symbol
Each industry thrives on the status quoConsumers must drive the change
NP 10yM
NP
Sisterrsquos non-x ortho
Shersquos happyhellipbut Irsquom not so
I make my pitch for BBO
The dilemma of progress
(I forgot the progress pictureshellip)
Dad sells prosthetic parts to orthopedic surgeons
I selling the case against my previous work they loved
It takes me 3 hours to sell the case
They fret until the BB3 goes in
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Connecting the dots
bull Adult SDB and OSA
bull Narrow jaws and faces
bull Soft tissue dysfunction
bull Early parafunctional habits ie open mouth posture
bull Environmental stressors
bull CPAP MARAUPPP SurgWherersquos the best
place to start treatment here
or here
1 Prevention 2 Undo the damage already done3 Establish good habits
When to start When damage from poor breathing is noticed and when bad habits are discovered
The strategies of Airway Orthodontics
Prevention
bull Remove ankyloglossiabull Promote breastfeedingbull Harden the dietbull Develop masticatory strengthbull Discourage oral habitsbull Promote whole-foods low sugar dietbull Reduce oropharyngeal obstructionbull Promote nasal breathing
Breathing retraining
bull Nasal rinsingbull Nasal clearingbull Decongesting
The goals of Airway Orthodontics
1 Breathing through the nose2 Lips together at rest3 Correct tongue position4 No facial muscles moving on swallowing5 Optimal forward facial development6 Class I occlusion7 Straight teeth8 Better stability long term
Myofunctional Trainers
Professors R Soulet and A Besombes
Dr Earl Bergeson
Dr Chris Farrell
The Multi ndash Family System
Orofacial MyofunctionalTherapy
Oral MyologyMyofunctional TherapyTongue Thrust Therapy
B Hockel 2012 Back
Undoing Bimaxillary Dysplasia
1 Maxillary deconstriction2 Maxillary advancement3 Maxillary impaction4 Mandibular advancement
1 Maxillary Expansion
Treatment for Bimaxillary Dysplasia
ALFCrozat
Bent Wire
HyraxHaas
Niti Exp BioBlocSchwartz
The Farrell BENT WIRE Systemtrade
Recommended Age Group 5-12 yrs
Arch Development in conjunction with the TRAINER Systemtrade
Dr John Mew
Establish Good Habits
1 Breathing through the nose2 Lips together at rest3 Correct tongue position4 No facial muscles moving on swallowing5 Stand and sit in balance6 Breath gently using the diaphragm7 Eat to nourish8 Sleep to rest
Ortho-Postural TrainingWorkshops
Breathing
Nutrition
Posture
Sleep
COPYRIGHTRoger L PriceOctober 2012
Posture Number
Forward head posturecan be a compensationfor a deficient airway
Sleep Screening and Hygiene
SQI = 10 SQI = 98
Integrative Healthcare
Function ProfessionalNasal clearing ENT Pulm MFT BreathingMuscle balance and tone MFT Myofunctional OrthoUndoing damage GP Pedo Ortho OMFSBreathing dynamics OPT MFT Breath PhysiologistPosture DC OPT PT OsteopathCranial balance OsteopathNutrition RDH Nutritionist Dietitian Sleep ENT Sleep Med DentNeurocognitive development Pedrsquon SLP Psych SpEd
The Interdisciplinary Center
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Now that I know
My personal missionTo create from what Irsquove
learned from the besta model for others to followhellipespecially the orthodontists
Myofunctional Orthodontics
Chris Farrell
John Flutter
German Ramierez
Damien OrsquoBrien
Myofunctional Research CoRancho Cucamonga
2008-2012
Oral Myology
Oral Myology Basic CourseJoy MoellerNYC 2011LA 2012
Oral Myology Levels 2 3Kim BenkertClifton 2012
Habit CessationShari GreenClifton 2013
Biobloc Orthotropics
BBO Mini-residencyBill Hang
Agora Hills2012-13
BBO IntensiveDrs John and Mike
MewLSFO2013
Breathing and Sleep
Buteyko MentorshipThe Breathing Center
Woodstock2010
Breathing Well ProgrammeJohn Flutter
2010 Ortho-Postural TrainingRoger Price
2013
Sleep DentistryMichael Gelb etal
NYU2012
ALF and Cranial
Jim Bronson2013 Tasha Turzo
Cranial Academy2014
Bucket Listbull ALF and Crozat (Bronsonrsquos course)bullMore on Biobloc (Hangrsquos Advanced London School)bull More Cranial (The Farm)bullChirodontics (Bob Walker)bull Airway Dentistry with Marc Cruz Jeff Rousebull Sleep Dentistrybull Less-than-Six with Kevin Boydbull Intra-mandibular Distraction Osteogenesis (IMDO)
Off My ListAnything that moves the teeth faster in the wrong direction
Whatrsquos an RO to do
To create from what Irsquove learned from the best
a model for others to followhellipespecially orthodontists
Teaching
Mt Sinai Pedo ResidencyAli Attaie
2010-2012
Montefiore Ortho ResidencyTony Maganzini
2012
2009-Present
Mt Sinai School of MedicinePedodontic Residency
Guest SpeakersJim BronsonMike MewKevin BoydSandra KahnJennifer TowRoger PricePaula Fabbie
Damien OrsquoBrien
First clinical program in myofunctional orthodontics
Airway and Facial DevelopmentCollaborative Webcast
Mark Cruz
AAPMD Symposium
wwwaapm
dorg
Annual MeetingApril 25-26 2014
Westin Chicago North Shore
the raphael center for integrative orthodontics
wwwalignminecomwwwbioblocnjcom
wwwmyobracenjcom
Integrative vs Conventional
Integrative vs Conventional
ldquoWith improvements in expansion orthodontics advances in myofunctional orthodontics and the growing recognition about sleep disordered breathing among children and adults it is time for orthodontics to expand its horizons There is now so much more we can oerrdquo
The Raphael name has been associated with high quality orthodontics in New Jersey for over 60 years Dr Barry Raphael has been a university trained orthodontic specialist and a member of the American Association of Orthodontists for 30 years
He has a wide range of techniques and services to offer He has studied oral myology applied kinesiology Buteyko breathing Biobloc Orthotropics and Myobrace as part of his integrative training He can offer Damon Invisalign Insignia and Incognito appliances designs as some of his many conventional orthodontic services too
Dr Raphael teaches his techniques at post-graduate residencies study clubs dental societies and for the Myofunctional Research Co He is available for presentations to any group interested in learning more about the benefits of integrative orthodontics
wwwalignminecomLearn about the choices you have in orthodontics
dr barry raphael Why its
too Early never
1425
bro
ad
str
ee
tc
lifto
n n
j 070
13
973-
778-
4222
fax
973-
778-
9625
nj s
pe
c
368
4
1425 broad street clifton nj 07013973-778-4222
wwwalignminecom
the raphael centerforintegrative orthodontics
the
raph
ael c
ente
r fo
rin
tegr
ativ
e or
thod
onti
cs
Learn about an important choice you need to make before starting braces
the raphael center for integrative education
the raphael center for integrative education
Ongoing Intro to Airway Orthodontics
April Biobloc Study Group
April Training Ortho-Postural Therapists w Roger Price
June MRC Myobrace Basic Series
August Airway Dentistry with Mark Cruz and company
October Advanced MFT with Sandy Coulson
October Less than Six with Kevin Boyd
(who else wants to play)
Mission to create a space for spreading the word about Airway and Orthotropic principles and practice
Orthodontics in the 21st Century
EstheticOrthodontics
AirwayOrthodontics
GeneticTooth-Focused
Dental PerfectionEsthetics Primary
Treating SymptomsAirway Ignorant
AdaptationMuscle-FocusedMedical Better
Esthetics SecondaryTreating Causes
Airway Conscious
The EndAnd
The Beginning
NP 10yM
NP
Sisterrsquos non-x ortho
Shersquos happyhellipbut Irsquom not so
I make my pitch for BBO
The dilemma of progress
(I forgot the progress pictureshellip)
Dad sells prosthetic parts to orthopedic surgeons
I selling the case against my previous work they loved
It takes me 3 hours to sell the case
They fret until the BB3 goes in
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Connecting the dots
bull Adult SDB and OSA
bull Narrow jaws and faces
bull Soft tissue dysfunction
bull Early parafunctional habits ie open mouth posture
bull Environmental stressors
bull CPAP MARAUPPP SurgWherersquos the best
place to start treatment here
or here
1 Prevention 2 Undo the damage already done3 Establish good habits
When to start When damage from poor breathing is noticed and when bad habits are discovered
The strategies of Airway Orthodontics
Prevention
bull Remove ankyloglossiabull Promote breastfeedingbull Harden the dietbull Develop masticatory strengthbull Discourage oral habitsbull Promote whole-foods low sugar dietbull Reduce oropharyngeal obstructionbull Promote nasal breathing
Breathing retraining
bull Nasal rinsingbull Nasal clearingbull Decongesting
The goals of Airway Orthodontics
1 Breathing through the nose2 Lips together at rest3 Correct tongue position4 No facial muscles moving on swallowing5 Optimal forward facial development6 Class I occlusion7 Straight teeth8 Better stability long term
Myofunctional Trainers
Professors R Soulet and A Besombes
Dr Earl Bergeson
Dr Chris Farrell
The Multi ndash Family System
Orofacial MyofunctionalTherapy
Oral MyologyMyofunctional TherapyTongue Thrust Therapy
B Hockel 2012 Back
Undoing Bimaxillary Dysplasia
1 Maxillary deconstriction2 Maxillary advancement3 Maxillary impaction4 Mandibular advancement
1 Maxillary Expansion
Treatment for Bimaxillary Dysplasia
ALFCrozat
Bent Wire
HyraxHaas
Niti Exp BioBlocSchwartz
The Farrell BENT WIRE Systemtrade
Recommended Age Group 5-12 yrs
Arch Development in conjunction with the TRAINER Systemtrade
Dr John Mew
Establish Good Habits
1 Breathing through the nose2 Lips together at rest3 Correct tongue position4 No facial muscles moving on swallowing5 Stand and sit in balance6 Breath gently using the diaphragm7 Eat to nourish8 Sleep to rest
Ortho-Postural TrainingWorkshops
Breathing
Nutrition
Posture
Sleep
COPYRIGHTRoger L PriceOctober 2012
Posture Number
Forward head posturecan be a compensationfor a deficient airway
Sleep Screening and Hygiene
SQI = 10 SQI = 98
Integrative Healthcare
Function ProfessionalNasal clearing ENT Pulm MFT BreathingMuscle balance and tone MFT Myofunctional OrthoUndoing damage GP Pedo Ortho OMFSBreathing dynamics OPT MFT Breath PhysiologistPosture DC OPT PT OsteopathCranial balance OsteopathNutrition RDH Nutritionist Dietitian Sleep ENT Sleep Med DentNeurocognitive development Pedrsquon SLP Psych SpEd
The Interdisciplinary Center
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Now that I know
My personal missionTo create from what Irsquove
learned from the besta model for others to followhellipespecially the orthodontists
Myofunctional Orthodontics
Chris Farrell
John Flutter
German Ramierez
Damien OrsquoBrien
Myofunctional Research CoRancho Cucamonga
2008-2012
Oral Myology
Oral Myology Basic CourseJoy MoellerNYC 2011LA 2012
Oral Myology Levels 2 3Kim BenkertClifton 2012
Habit CessationShari GreenClifton 2013
Biobloc Orthotropics
BBO Mini-residencyBill Hang
Agora Hills2012-13
BBO IntensiveDrs John and Mike
MewLSFO2013
Breathing and Sleep
Buteyko MentorshipThe Breathing Center
Woodstock2010
Breathing Well ProgrammeJohn Flutter
2010 Ortho-Postural TrainingRoger Price
2013
Sleep DentistryMichael Gelb etal
NYU2012
ALF and Cranial
Jim Bronson2013 Tasha Turzo
Cranial Academy2014
Bucket Listbull ALF and Crozat (Bronsonrsquos course)bullMore on Biobloc (Hangrsquos Advanced London School)bull More Cranial (The Farm)bullChirodontics (Bob Walker)bull Airway Dentistry with Marc Cruz Jeff Rousebull Sleep Dentistrybull Less-than-Six with Kevin Boydbull Intra-mandibular Distraction Osteogenesis (IMDO)
Off My ListAnything that moves the teeth faster in the wrong direction
Whatrsquos an RO to do
To create from what Irsquove learned from the best
a model for others to followhellipespecially orthodontists
Teaching
Mt Sinai Pedo ResidencyAli Attaie
2010-2012
Montefiore Ortho ResidencyTony Maganzini
2012
2009-Present
Mt Sinai School of MedicinePedodontic Residency
Guest SpeakersJim BronsonMike MewKevin BoydSandra KahnJennifer TowRoger PricePaula Fabbie
Damien OrsquoBrien
First clinical program in myofunctional orthodontics
Airway and Facial DevelopmentCollaborative Webcast
Mark Cruz
AAPMD Symposium
wwwaapm
dorg
Annual MeetingApril 25-26 2014
Westin Chicago North Shore
the raphael center for integrative orthodontics
wwwalignminecomwwwbioblocnjcom
wwwmyobracenjcom
Integrative vs Conventional
Integrative vs Conventional
ldquoWith improvements in expansion orthodontics advances in myofunctional orthodontics and the growing recognition about sleep disordered breathing among children and adults it is time for orthodontics to expand its horizons There is now so much more we can oerrdquo
The Raphael name has been associated with high quality orthodontics in New Jersey for over 60 years Dr Barry Raphael has been a university trained orthodontic specialist and a member of the American Association of Orthodontists for 30 years
He has a wide range of techniques and services to offer He has studied oral myology applied kinesiology Buteyko breathing Biobloc Orthotropics and Myobrace as part of his integrative training He can offer Damon Invisalign Insignia and Incognito appliances designs as some of his many conventional orthodontic services too
Dr Raphael teaches his techniques at post-graduate residencies study clubs dental societies and for the Myofunctional Research Co He is available for presentations to any group interested in learning more about the benefits of integrative orthodontics
wwwalignminecomLearn about the choices you have in orthodontics
dr barry raphael Why its
too Early never
1425
bro
ad
str
ee
tc
lifto
n n
j 070
13
973-
778-
4222
fax
973-
778-
9625
nj s
pe
c
368
4
1425 broad street clifton nj 07013973-778-4222
wwwalignminecom
the raphael centerforintegrative orthodontics
the
raph
ael c
ente
r fo
rin
tegr
ativ
e or
thod
onti
cs
Learn about an important choice you need to make before starting braces
the raphael center for integrative education
the raphael center for integrative education
Ongoing Intro to Airway Orthodontics
April Biobloc Study Group
April Training Ortho-Postural Therapists w Roger Price
June MRC Myobrace Basic Series
August Airway Dentistry with Mark Cruz and company
October Advanced MFT with Sandy Coulson
October Less than Six with Kevin Boyd
(who else wants to play)
Mission to create a space for spreading the word about Airway and Orthotropic principles and practice
Orthodontics in the 21st Century
EstheticOrthodontics
AirwayOrthodontics
GeneticTooth-Focused
Dental PerfectionEsthetics Primary
Treating SymptomsAirway Ignorant
AdaptationMuscle-FocusedMedical Better
Esthetics SecondaryTreating Causes
Airway Conscious
The EndAnd
The Beginning
NP
Sisterrsquos non-x ortho
Shersquos happyhellipbut Irsquom not so
I make my pitch for BBO
The dilemma of progress
(I forgot the progress pictureshellip)
Dad sells prosthetic parts to orthopedic surgeons
I selling the case against my previous work they loved
It takes me 3 hours to sell the case
They fret until the BB3 goes in
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Connecting the dots
bull Adult SDB and OSA
bull Narrow jaws and faces
bull Soft tissue dysfunction
bull Early parafunctional habits ie open mouth posture
bull Environmental stressors
bull CPAP MARAUPPP SurgWherersquos the best
place to start treatment here
or here
1 Prevention 2 Undo the damage already done3 Establish good habits
When to start When damage from poor breathing is noticed and when bad habits are discovered
The strategies of Airway Orthodontics
Prevention
bull Remove ankyloglossiabull Promote breastfeedingbull Harden the dietbull Develop masticatory strengthbull Discourage oral habitsbull Promote whole-foods low sugar dietbull Reduce oropharyngeal obstructionbull Promote nasal breathing
Breathing retraining
bull Nasal rinsingbull Nasal clearingbull Decongesting
The goals of Airway Orthodontics
1 Breathing through the nose2 Lips together at rest3 Correct tongue position4 No facial muscles moving on swallowing5 Optimal forward facial development6 Class I occlusion7 Straight teeth8 Better stability long term
Myofunctional Trainers
Professors R Soulet and A Besombes
Dr Earl Bergeson
Dr Chris Farrell
The Multi ndash Family System
Orofacial MyofunctionalTherapy
Oral MyologyMyofunctional TherapyTongue Thrust Therapy
B Hockel 2012 Back
Undoing Bimaxillary Dysplasia
1 Maxillary deconstriction2 Maxillary advancement3 Maxillary impaction4 Mandibular advancement
1 Maxillary Expansion
Treatment for Bimaxillary Dysplasia
ALFCrozat
Bent Wire
HyraxHaas
Niti Exp BioBlocSchwartz
The Farrell BENT WIRE Systemtrade
Recommended Age Group 5-12 yrs
Arch Development in conjunction with the TRAINER Systemtrade
Dr John Mew
Establish Good Habits
1 Breathing through the nose2 Lips together at rest3 Correct tongue position4 No facial muscles moving on swallowing5 Stand and sit in balance6 Breath gently using the diaphragm7 Eat to nourish8 Sleep to rest
Ortho-Postural TrainingWorkshops
Breathing
Nutrition
Posture
Sleep
COPYRIGHTRoger L PriceOctober 2012
Posture Number
Forward head posturecan be a compensationfor a deficient airway
Sleep Screening and Hygiene
SQI = 10 SQI = 98
Integrative Healthcare
Function ProfessionalNasal clearing ENT Pulm MFT BreathingMuscle balance and tone MFT Myofunctional OrthoUndoing damage GP Pedo Ortho OMFSBreathing dynamics OPT MFT Breath PhysiologistPosture DC OPT PT OsteopathCranial balance OsteopathNutrition RDH Nutritionist Dietitian Sleep ENT Sleep Med DentNeurocognitive development Pedrsquon SLP Psych SpEd
The Interdisciplinary Center
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Now that I know
My personal missionTo create from what Irsquove
learned from the besta model for others to followhellipespecially the orthodontists
Myofunctional Orthodontics
Chris Farrell
John Flutter
German Ramierez
Damien OrsquoBrien
Myofunctional Research CoRancho Cucamonga
2008-2012
Oral Myology
Oral Myology Basic CourseJoy MoellerNYC 2011LA 2012
Oral Myology Levels 2 3Kim BenkertClifton 2012
Habit CessationShari GreenClifton 2013
Biobloc Orthotropics
BBO Mini-residencyBill Hang
Agora Hills2012-13
BBO IntensiveDrs John and Mike
MewLSFO2013
Breathing and Sleep
Buteyko MentorshipThe Breathing Center
Woodstock2010
Breathing Well ProgrammeJohn Flutter
2010 Ortho-Postural TrainingRoger Price
2013
Sleep DentistryMichael Gelb etal
NYU2012
ALF and Cranial
Jim Bronson2013 Tasha Turzo
Cranial Academy2014
Bucket Listbull ALF and Crozat (Bronsonrsquos course)bullMore on Biobloc (Hangrsquos Advanced London School)bull More Cranial (The Farm)bullChirodontics (Bob Walker)bull Airway Dentistry with Marc Cruz Jeff Rousebull Sleep Dentistrybull Less-than-Six with Kevin Boydbull Intra-mandibular Distraction Osteogenesis (IMDO)
Off My ListAnything that moves the teeth faster in the wrong direction
Whatrsquos an RO to do
To create from what Irsquove learned from the best
a model for others to followhellipespecially orthodontists
Teaching
Mt Sinai Pedo ResidencyAli Attaie
2010-2012
Montefiore Ortho ResidencyTony Maganzini
2012
2009-Present
Mt Sinai School of MedicinePedodontic Residency
Guest SpeakersJim BronsonMike MewKevin BoydSandra KahnJennifer TowRoger PricePaula Fabbie
Damien OrsquoBrien
First clinical program in myofunctional orthodontics
Airway and Facial DevelopmentCollaborative Webcast
Mark Cruz
AAPMD Symposium
wwwaapm
dorg
Annual MeetingApril 25-26 2014
Westin Chicago North Shore
the raphael center for integrative orthodontics
wwwalignminecomwwwbioblocnjcom
wwwmyobracenjcom
Integrative vs Conventional
Integrative vs Conventional
ldquoWith improvements in expansion orthodontics advances in myofunctional orthodontics and the growing recognition about sleep disordered breathing among children and adults it is time for orthodontics to expand its horizons There is now so much more we can oerrdquo
The Raphael name has been associated with high quality orthodontics in New Jersey for over 60 years Dr Barry Raphael has been a university trained orthodontic specialist and a member of the American Association of Orthodontists for 30 years
He has a wide range of techniques and services to offer He has studied oral myology applied kinesiology Buteyko breathing Biobloc Orthotropics and Myobrace as part of his integrative training He can offer Damon Invisalign Insignia and Incognito appliances designs as some of his many conventional orthodontic services too
Dr Raphael teaches his techniques at post-graduate residencies study clubs dental societies and for the Myofunctional Research Co He is available for presentations to any group interested in learning more about the benefits of integrative orthodontics
wwwalignminecomLearn about the choices you have in orthodontics
dr barry raphael Why its
too Early never
1425
bro
ad
str
ee
tc
lifto
n n
j 070
13
973-
778-
4222
fax
973-
778-
9625
nj s
pe
c
368
4
1425 broad street clifton nj 07013973-778-4222
wwwalignminecom
the raphael centerforintegrative orthodontics
the
raph
ael c
ente
r fo
rin
tegr
ativ
e or
thod
onti
cs
Learn about an important choice you need to make before starting braces
the raphael center for integrative education
the raphael center for integrative education
Ongoing Intro to Airway Orthodontics
April Biobloc Study Group
April Training Ortho-Postural Therapists w Roger Price
June MRC Myobrace Basic Series
August Airway Dentistry with Mark Cruz and company
October Advanced MFT with Sandy Coulson
October Less than Six with Kevin Boyd
(who else wants to play)
Mission to create a space for spreading the word about Airway and Orthotropic principles and practice
Orthodontics in the 21st Century
EstheticOrthodontics
AirwayOrthodontics
GeneticTooth-Focused
Dental PerfectionEsthetics Primary
Treating SymptomsAirway Ignorant
AdaptationMuscle-FocusedMedical Better
Esthetics SecondaryTreating Causes
Airway Conscious
The EndAnd
The Beginning
Sisterrsquos non-x ortho
Shersquos happyhellipbut Irsquom not so
I make my pitch for BBO
The dilemma of progress
(I forgot the progress pictureshellip)
Dad sells prosthetic parts to orthopedic surgeons
I selling the case against my previous work they loved
It takes me 3 hours to sell the case
They fret until the BB3 goes in
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Connecting the dots
bull Adult SDB and OSA
bull Narrow jaws and faces
bull Soft tissue dysfunction
bull Early parafunctional habits ie open mouth posture
bull Environmental stressors
bull CPAP MARAUPPP SurgWherersquos the best
place to start treatment here
or here
1 Prevention 2 Undo the damage already done3 Establish good habits
When to start When damage from poor breathing is noticed and when bad habits are discovered
The strategies of Airway Orthodontics
Prevention
bull Remove ankyloglossiabull Promote breastfeedingbull Harden the dietbull Develop masticatory strengthbull Discourage oral habitsbull Promote whole-foods low sugar dietbull Reduce oropharyngeal obstructionbull Promote nasal breathing
Breathing retraining
bull Nasal rinsingbull Nasal clearingbull Decongesting
The goals of Airway Orthodontics
1 Breathing through the nose2 Lips together at rest3 Correct tongue position4 No facial muscles moving on swallowing5 Optimal forward facial development6 Class I occlusion7 Straight teeth8 Better stability long term
Myofunctional Trainers
Professors R Soulet and A Besombes
Dr Earl Bergeson
Dr Chris Farrell
The Multi ndash Family System
Orofacial MyofunctionalTherapy
Oral MyologyMyofunctional TherapyTongue Thrust Therapy
B Hockel 2012 Back
Undoing Bimaxillary Dysplasia
1 Maxillary deconstriction2 Maxillary advancement3 Maxillary impaction4 Mandibular advancement
1 Maxillary Expansion
Treatment for Bimaxillary Dysplasia
ALFCrozat
Bent Wire
HyraxHaas
Niti Exp BioBlocSchwartz
The Farrell BENT WIRE Systemtrade
Recommended Age Group 5-12 yrs
Arch Development in conjunction with the TRAINER Systemtrade
Dr John Mew
Establish Good Habits
1 Breathing through the nose2 Lips together at rest3 Correct tongue position4 No facial muscles moving on swallowing5 Stand and sit in balance6 Breath gently using the diaphragm7 Eat to nourish8 Sleep to rest
Ortho-Postural TrainingWorkshops
Breathing
Nutrition
Posture
Sleep
COPYRIGHTRoger L PriceOctober 2012
Posture Number
Forward head posturecan be a compensationfor a deficient airway
Sleep Screening and Hygiene
SQI = 10 SQI = 98
Integrative Healthcare
Function ProfessionalNasal clearing ENT Pulm MFT BreathingMuscle balance and tone MFT Myofunctional OrthoUndoing damage GP Pedo Ortho OMFSBreathing dynamics OPT MFT Breath PhysiologistPosture DC OPT PT OsteopathCranial balance OsteopathNutrition RDH Nutritionist Dietitian Sleep ENT Sleep Med DentNeurocognitive development Pedrsquon SLP Psych SpEd
The Interdisciplinary Center
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Now that I know
My personal missionTo create from what Irsquove
learned from the besta model for others to followhellipespecially the orthodontists
Myofunctional Orthodontics
Chris Farrell
John Flutter
German Ramierez
Damien OrsquoBrien
Myofunctional Research CoRancho Cucamonga
2008-2012
Oral Myology
Oral Myology Basic CourseJoy MoellerNYC 2011LA 2012
Oral Myology Levels 2 3Kim BenkertClifton 2012
Habit CessationShari GreenClifton 2013
Biobloc Orthotropics
BBO Mini-residencyBill Hang
Agora Hills2012-13
BBO IntensiveDrs John and Mike
MewLSFO2013
Breathing and Sleep
Buteyko MentorshipThe Breathing Center
Woodstock2010
Breathing Well ProgrammeJohn Flutter
2010 Ortho-Postural TrainingRoger Price
2013
Sleep DentistryMichael Gelb etal
NYU2012
ALF and Cranial
Jim Bronson2013 Tasha Turzo
Cranial Academy2014
Bucket Listbull ALF and Crozat (Bronsonrsquos course)bullMore on Biobloc (Hangrsquos Advanced London School)bull More Cranial (The Farm)bullChirodontics (Bob Walker)bull Airway Dentistry with Marc Cruz Jeff Rousebull Sleep Dentistrybull Less-than-Six with Kevin Boydbull Intra-mandibular Distraction Osteogenesis (IMDO)
Off My ListAnything that moves the teeth faster in the wrong direction
Whatrsquos an RO to do
To create from what Irsquove learned from the best
a model for others to followhellipespecially orthodontists
Teaching
Mt Sinai Pedo ResidencyAli Attaie
2010-2012
Montefiore Ortho ResidencyTony Maganzini
2012
2009-Present
Mt Sinai School of MedicinePedodontic Residency
Guest SpeakersJim BronsonMike MewKevin BoydSandra KahnJennifer TowRoger PricePaula Fabbie
Damien OrsquoBrien
First clinical program in myofunctional orthodontics
Airway and Facial DevelopmentCollaborative Webcast
Mark Cruz
AAPMD Symposium
wwwaapm
dorg
Annual MeetingApril 25-26 2014
Westin Chicago North Shore
the raphael center for integrative orthodontics
wwwalignminecomwwwbioblocnjcom
wwwmyobracenjcom
Integrative vs Conventional
Integrative vs Conventional
ldquoWith improvements in expansion orthodontics advances in myofunctional orthodontics and the growing recognition about sleep disordered breathing among children and adults it is time for orthodontics to expand its horizons There is now so much more we can oerrdquo
The Raphael name has been associated with high quality orthodontics in New Jersey for over 60 years Dr Barry Raphael has been a university trained orthodontic specialist and a member of the American Association of Orthodontists for 30 years
He has a wide range of techniques and services to offer He has studied oral myology applied kinesiology Buteyko breathing Biobloc Orthotropics and Myobrace as part of his integrative training He can offer Damon Invisalign Insignia and Incognito appliances designs as some of his many conventional orthodontic services too
Dr Raphael teaches his techniques at post-graduate residencies study clubs dental societies and for the Myofunctional Research Co He is available for presentations to any group interested in learning more about the benefits of integrative orthodontics
wwwalignminecomLearn about the choices you have in orthodontics
dr barry raphael Why its
too Early never
1425
bro
ad
str
ee
tc
lifto
n n
j 070
13
973-
778-
4222
fax
973-
778-
9625
nj s
pe
c
368
4
1425 broad street clifton nj 07013973-778-4222
wwwalignminecom
the raphael centerforintegrative orthodontics
the
raph
ael c
ente
r fo
rin
tegr
ativ
e or
thod
onti
cs
Learn about an important choice you need to make before starting braces
the raphael center for integrative education
the raphael center for integrative education
Ongoing Intro to Airway Orthodontics
April Biobloc Study Group
April Training Ortho-Postural Therapists w Roger Price
June MRC Myobrace Basic Series
August Airway Dentistry with Mark Cruz and company
October Advanced MFT with Sandy Coulson
October Less than Six with Kevin Boyd
(who else wants to play)
Mission to create a space for spreading the word about Airway and Orthotropic principles and practice
Orthodontics in the 21st Century
EstheticOrthodontics
AirwayOrthodontics
GeneticTooth-Focused
Dental PerfectionEsthetics Primary
Treating SymptomsAirway Ignorant
AdaptationMuscle-FocusedMedical Better
Esthetics SecondaryTreating Causes
Airway Conscious
The EndAnd
The Beginning
I make my pitch for BBO
The dilemma of progress
(I forgot the progress pictureshellip)
Dad sells prosthetic parts to orthopedic surgeons
I selling the case against my previous work they loved
It takes me 3 hours to sell the case
They fret until the BB3 goes in
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Connecting the dots
bull Adult SDB and OSA
bull Narrow jaws and faces
bull Soft tissue dysfunction
bull Early parafunctional habits ie open mouth posture
bull Environmental stressors
bull CPAP MARAUPPP SurgWherersquos the best
place to start treatment here
or here
1 Prevention 2 Undo the damage already done3 Establish good habits
When to start When damage from poor breathing is noticed and when bad habits are discovered
The strategies of Airway Orthodontics
Prevention
bull Remove ankyloglossiabull Promote breastfeedingbull Harden the dietbull Develop masticatory strengthbull Discourage oral habitsbull Promote whole-foods low sugar dietbull Reduce oropharyngeal obstructionbull Promote nasal breathing
Breathing retraining
bull Nasal rinsingbull Nasal clearingbull Decongesting
The goals of Airway Orthodontics
1 Breathing through the nose2 Lips together at rest3 Correct tongue position4 No facial muscles moving on swallowing5 Optimal forward facial development6 Class I occlusion7 Straight teeth8 Better stability long term
Myofunctional Trainers
Professors R Soulet and A Besombes
Dr Earl Bergeson
Dr Chris Farrell
The Multi ndash Family System
Orofacial MyofunctionalTherapy
Oral MyologyMyofunctional TherapyTongue Thrust Therapy
B Hockel 2012 Back
Undoing Bimaxillary Dysplasia
1 Maxillary deconstriction2 Maxillary advancement3 Maxillary impaction4 Mandibular advancement
1 Maxillary Expansion
Treatment for Bimaxillary Dysplasia
ALFCrozat
Bent Wire
HyraxHaas
Niti Exp BioBlocSchwartz
The Farrell BENT WIRE Systemtrade
Recommended Age Group 5-12 yrs
Arch Development in conjunction with the TRAINER Systemtrade
Dr John Mew
Establish Good Habits
1 Breathing through the nose2 Lips together at rest3 Correct tongue position4 No facial muscles moving on swallowing5 Stand and sit in balance6 Breath gently using the diaphragm7 Eat to nourish8 Sleep to rest
Ortho-Postural TrainingWorkshops
Breathing
Nutrition
Posture
Sleep
COPYRIGHTRoger L PriceOctober 2012
Posture Number
Forward head posturecan be a compensationfor a deficient airway
Sleep Screening and Hygiene
SQI = 10 SQI = 98
Integrative Healthcare
Function ProfessionalNasal clearing ENT Pulm MFT BreathingMuscle balance and tone MFT Myofunctional OrthoUndoing damage GP Pedo Ortho OMFSBreathing dynamics OPT MFT Breath PhysiologistPosture DC OPT PT OsteopathCranial balance OsteopathNutrition RDH Nutritionist Dietitian Sleep ENT Sleep Med DentNeurocognitive development Pedrsquon SLP Psych SpEd
The Interdisciplinary Center
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Now that I know
My personal missionTo create from what Irsquove
learned from the besta model for others to followhellipespecially the orthodontists
Myofunctional Orthodontics
Chris Farrell
John Flutter
German Ramierez
Damien OrsquoBrien
Myofunctional Research CoRancho Cucamonga
2008-2012
Oral Myology
Oral Myology Basic CourseJoy MoellerNYC 2011LA 2012
Oral Myology Levels 2 3Kim BenkertClifton 2012
Habit CessationShari GreenClifton 2013
Biobloc Orthotropics
BBO Mini-residencyBill Hang
Agora Hills2012-13
BBO IntensiveDrs John and Mike
MewLSFO2013
Breathing and Sleep
Buteyko MentorshipThe Breathing Center
Woodstock2010
Breathing Well ProgrammeJohn Flutter
2010 Ortho-Postural TrainingRoger Price
2013
Sleep DentistryMichael Gelb etal
NYU2012
ALF and Cranial
Jim Bronson2013 Tasha Turzo
Cranial Academy2014
Bucket Listbull ALF and Crozat (Bronsonrsquos course)bullMore on Biobloc (Hangrsquos Advanced London School)bull More Cranial (The Farm)bullChirodontics (Bob Walker)bull Airway Dentistry with Marc Cruz Jeff Rousebull Sleep Dentistrybull Less-than-Six with Kevin Boydbull Intra-mandibular Distraction Osteogenesis (IMDO)
Off My ListAnything that moves the teeth faster in the wrong direction
Whatrsquos an RO to do
To create from what Irsquove learned from the best
a model for others to followhellipespecially orthodontists
Teaching
Mt Sinai Pedo ResidencyAli Attaie
2010-2012
Montefiore Ortho ResidencyTony Maganzini
2012
2009-Present
Mt Sinai School of MedicinePedodontic Residency
Guest SpeakersJim BronsonMike MewKevin BoydSandra KahnJennifer TowRoger PricePaula Fabbie
Damien OrsquoBrien
First clinical program in myofunctional orthodontics
Airway and Facial DevelopmentCollaborative Webcast
Mark Cruz
AAPMD Symposium
wwwaapm
dorg
Annual MeetingApril 25-26 2014
Westin Chicago North Shore
the raphael center for integrative orthodontics
wwwalignminecomwwwbioblocnjcom
wwwmyobracenjcom
Integrative vs Conventional
Integrative vs Conventional
ldquoWith improvements in expansion orthodontics advances in myofunctional orthodontics and the growing recognition about sleep disordered breathing among children and adults it is time for orthodontics to expand its horizons There is now so much more we can oerrdquo
The Raphael name has been associated with high quality orthodontics in New Jersey for over 60 years Dr Barry Raphael has been a university trained orthodontic specialist and a member of the American Association of Orthodontists for 30 years
He has a wide range of techniques and services to offer He has studied oral myology applied kinesiology Buteyko breathing Biobloc Orthotropics and Myobrace as part of his integrative training He can offer Damon Invisalign Insignia and Incognito appliances designs as some of his many conventional orthodontic services too
Dr Raphael teaches his techniques at post-graduate residencies study clubs dental societies and for the Myofunctional Research Co He is available for presentations to any group interested in learning more about the benefits of integrative orthodontics
wwwalignminecomLearn about the choices you have in orthodontics
dr barry raphael Why its
too Early never
1425
bro
ad
str
ee
tc
lifto
n n
j 070
13
973-
778-
4222
fax
973-
778-
9625
nj s
pe
c
368
4
1425 broad street clifton nj 07013973-778-4222
wwwalignminecom
the raphael centerforintegrative orthodontics
the
raph
ael c
ente
r fo
rin
tegr
ativ
e or
thod
onti
cs
Learn about an important choice you need to make before starting braces
the raphael center for integrative education
the raphael center for integrative education
Ongoing Intro to Airway Orthodontics
April Biobloc Study Group
April Training Ortho-Postural Therapists w Roger Price
June MRC Myobrace Basic Series
August Airway Dentistry with Mark Cruz and company
October Advanced MFT with Sandy Coulson
October Less than Six with Kevin Boyd
(who else wants to play)
Mission to create a space for spreading the word about Airway and Orthotropic principles and practice
Orthodontics in the 21st Century
EstheticOrthodontics
AirwayOrthodontics
GeneticTooth-Focused
Dental PerfectionEsthetics Primary
Treating SymptomsAirway Ignorant
AdaptationMuscle-FocusedMedical Better
Esthetics SecondaryTreating Causes
Airway Conscious
The EndAnd
The Beginning
The dilemma of progress
(I forgot the progress pictureshellip)
Dad sells prosthetic parts to orthopedic surgeons
I selling the case against my previous work they loved
It takes me 3 hours to sell the case
They fret until the BB3 goes in
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Connecting the dots
bull Adult SDB and OSA
bull Narrow jaws and faces
bull Soft tissue dysfunction
bull Early parafunctional habits ie open mouth posture
bull Environmental stressors
bull CPAP MARAUPPP SurgWherersquos the best
place to start treatment here
or here
1 Prevention 2 Undo the damage already done3 Establish good habits
When to start When damage from poor breathing is noticed and when bad habits are discovered
The strategies of Airway Orthodontics
Prevention
bull Remove ankyloglossiabull Promote breastfeedingbull Harden the dietbull Develop masticatory strengthbull Discourage oral habitsbull Promote whole-foods low sugar dietbull Reduce oropharyngeal obstructionbull Promote nasal breathing
Breathing retraining
bull Nasal rinsingbull Nasal clearingbull Decongesting
The goals of Airway Orthodontics
1 Breathing through the nose2 Lips together at rest3 Correct tongue position4 No facial muscles moving on swallowing5 Optimal forward facial development6 Class I occlusion7 Straight teeth8 Better stability long term
Myofunctional Trainers
Professors R Soulet and A Besombes
Dr Earl Bergeson
Dr Chris Farrell
The Multi ndash Family System
Orofacial MyofunctionalTherapy
Oral MyologyMyofunctional TherapyTongue Thrust Therapy
B Hockel 2012 Back
Undoing Bimaxillary Dysplasia
1 Maxillary deconstriction2 Maxillary advancement3 Maxillary impaction4 Mandibular advancement
1 Maxillary Expansion
Treatment for Bimaxillary Dysplasia
ALFCrozat
Bent Wire
HyraxHaas
Niti Exp BioBlocSchwartz
The Farrell BENT WIRE Systemtrade
Recommended Age Group 5-12 yrs
Arch Development in conjunction with the TRAINER Systemtrade
Dr John Mew
Establish Good Habits
1 Breathing through the nose2 Lips together at rest3 Correct tongue position4 No facial muscles moving on swallowing5 Stand and sit in balance6 Breath gently using the diaphragm7 Eat to nourish8 Sleep to rest
Ortho-Postural TrainingWorkshops
Breathing
Nutrition
Posture
Sleep
COPYRIGHTRoger L PriceOctober 2012
Posture Number
Forward head posturecan be a compensationfor a deficient airway
Sleep Screening and Hygiene
SQI = 10 SQI = 98
Integrative Healthcare
Function ProfessionalNasal clearing ENT Pulm MFT BreathingMuscle balance and tone MFT Myofunctional OrthoUndoing damage GP Pedo Ortho OMFSBreathing dynamics OPT MFT Breath PhysiologistPosture DC OPT PT OsteopathCranial balance OsteopathNutrition RDH Nutritionist Dietitian Sleep ENT Sleep Med DentNeurocognitive development Pedrsquon SLP Psych SpEd
The Interdisciplinary Center
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Now that I know
My personal missionTo create from what Irsquove
learned from the besta model for others to followhellipespecially the orthodontists
Myofunctional Orthodontics
Chris Farrell
John Flutter
German Ramierez
Damien OrsquoBrien
Myofunctional Research CoRancho Cucamonga
2008-2012
Oral Myology
Oral Myology Basic CourseJoy MoellerNYC 2011LA 2012
Oral Myology Levels 2 3Kim BenkertClifton 2012
Habit CessationShari GreenClifton 2013
Biobloc Orthotropics
BBO Mini-residencyBill Hang
Agora Hills2012-13
BBO IntensiveDrs John and Mike
MewLSFO2013
Breathing and Sleep
Buteyko MentorshipThe Breathing Center
Woodstock2010
Breathing Well ProgrammeJohn Flutter
2010 Ortho-Postural TrainingRoger Price
2013
Sleep DentistryMichael Gelb etal
NYU2012
ALF and Cranial
Jim Bronson2013 Tasha Turzo
Cranial Academy2014
Bucket Listbull ALF and Crozat (Bronsonrsquos course)bullMore on Biobloc (Hangrsquos Advanced London School)bull More Cranial (The Farm)bullChirodontics (Bob Walker)bull Airway Dentistry with Marc Cruz Jeff Rousebull Sleep Dentistrybull Less-than-Six with Kevin Boydbull Intra-mandibular Distraction Osteogenesis (IMDO)
Off My ListAnything that moves the teeth faster in the wrong direction
Whatrsquos an RO to do
To create from what Irsquove learned from the best
a model for others to followhellipespecially orthodontists
Teaching
Mt Sinai Pedo ResidencyAli Attaie
2010-2012
Montefiore Ortho ResidencyTony Maganzini
2012
2009-Present
Mt Sinai School of MedicinePedodontic Residency
Guest SpeakersJim BronsonMike MewKevin BoydSandra KahnJennifer TowRoger PricePaula Fabbie
Damien OrsquoBrien
First clinical program in myofunctional orthodontics
Airway and Facial DevelopmentCollaborative Webcast
Mark Cruz
AAPMD Symposium
wwwaapm
dorg
Annual MeetingApril 25-26 2014
Westin Chicago North Shore
the raphael center for integrative orthodontics
wwwalignminecomwwwbioblocnjcom
wwwmyobracenjcom
Integrative vs Conventional
Integrative vs Conventional
ldquoWith improvements in expansion orthodontics advances in myofunctional orthodontics and the growing recognition about sleep disordered breathing among children and adults it is time for orthodontics to expand its horizons There is now so much more we can oerrdquo
The Raphael name has been associated with high quality orthodontics in New Jersey for over 60 years Dr Barry Raphael has been a university trained orthodontic specialist and a member of the American Association of Orthodontists for 30 years
He has a wide range of techniques and services to offer He has studied oral myology applied kinesiology Buteyko breathing Biobloc Orthotropics and Myobrace as part of his integrative training He can offer Damon Invisalign Insignia and Incognito appliances designs as some of his many conventional orthodontic services too
Dr Raphael teaches his techniques at post-graduate residencies study clubs dental societies and for the Myofunctional Research Co He is available for presentations to any group interested in learning more about the benefits of integrative orthodontics
wwwalignminecomLearn about the choices you have in orthodontics
dr barry raphael Why its
too Early never
1425
bro
ad
str
ee
tc
lifto
n n
j 070
13
973-
778-
4222
fax
973-
778-
9625
nj s
pe
c
368
4
1425 broad street clifton nj 07013973-778-4222
wwwalignminecom
the raphael centerforintegrative orthodontics
the
raph
ael c
ente
r fo
rin
tegr
ativ
e or
thod
onti
cs
Learn about an important choice you need to make before starting braces
the raphael center for integrative education
the raphael center for integrative education
Ongoing Intro to Airway Orthodontics
April Biobloc Study Group
April Training Ortho-Postural Therapists w Roger Price
June MRC Myobrace Basic Series
August Airway Dentistry with Mark Cruz and company
October Advanced MFT with Sandy Coulson
October Less than Six with Kevin Boyd
(who else wants to play)
Mission to create a space for spreading the word about Airway and Orthotropic principles and practice
Orthodontics in the 21st Century
EstheticOrthodontics
AirwayOrthodontics
GeneticTooth-Focused
Dental PerfectionEsthetics Primary
Treating SymptomsAirway Ignorant
AdaptationMuscle-FocusedMedical Better
Esthetics SecondaryTreating Causes
Airway Conscious
The EndAnd
The Beginning
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Connecting the dots
bull Adult SDB and OSA
bull Narrow jaws and faces
bull Soft tissue dysfunction
bull Early parafunctional habits ie open mouth posture
bull Environmental stressors
bull CPAP MARAUPPP SurgWherersquos the best
place to start treatment here
or here
1 Prevention 2 Undo the damage already done3 Establish good habits
When to start When damage from poor breathing is noticed and when bad habits are discovered
The strategies of Airway Orthodontics
Prevention
bull Remove ankyloglossiabull Promote breastfeedingbull Harden the dietbull Develop masticatory strengthbull Discourage oral habitsbull Promote whole-foods low sugar dietbull Reduce oropharyngeal obstructionbull Promote nasal breathing
Breathing retraining
bull Nasal rinsingbull Nasal clearingbull Decongesting
The goals of Airway Orthodontics
1 Breathing through the nose2 Lips together at rest3 Correct tongue position4 No facial muscles moving on swallowing5 Optimal forward facial development6 Class I occlusion7 Straight teeth8 Better stability long term
Myofunctional Trainers
Professors R Soulet and A Besombes
Dr Earl Bergeson
Dr Chris Farrell
The Multi ndash Family System
Orofacial MyofunctionalTherapy
Oral MyologyMyofunctional TherapyTongue Thrust Therapy
B Hockel 2012 Back
Undoing Bimaxillary Dysplasia
1 Maxillary deconstriction2 Maxillary advancement3 Maxillary impaction4 Mandibular advancement
1 Maxillary Expansion
Treatment for Bimaxillary Dysplasia
ALFCrozat
Bent Wire
HyraxHaas
Niti Exp BioBlocSchwartz
The Farrell BENT WIRE Systemtrade
Recommended Age Group 5-12 yrs
Arch Development in conjunction with the TRAINER Systemtrade
Dr John Mew
Establish Good Habits
1 Breathing through the nose2 Lips together at rest3 Correct tongue position4 No facial muscles moving on swallowing5 Stand and sit in balance6 Breath gently using the diaphragm7 Eat to nourish8 Sleep to rest
Ortho-Postural TrainingWorkshops
Breathing
Nutrition
Posture
Sleep
COPYRIGHTRoger L PriceOctober 2012
Posture Number
Forward head posturecan be a compensationfor a deficient airway
Sleep Screening and Hygiene
SQI = 10 SQI = 98
Integrative Healthcare
Function ProfessionalNasal clearing ENT Pulm MFT BreathingMuscle balance and tone MFT Myofunctional OrthoUndoing damage GP Pedo Ortho OMFSBreathing dynamics OPT MFT Breath PhysiologistPosture DC OPT PT OsteopathCranial balance OsteopathNutrition RDH Nutritionist Dietitian Sleep ENT Sleep Med DentNeurocognitive development Pedrsquon SLP Psych SpEd
The Interdisciplinary Center
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Now that I know
My personal missionTo create from what Irsquove
learned from the besta model for others to followhellipespecially the orthodontists
Myofunctional Orthodontics
Chris Farrell
John Flutter
German Ramierez
Damien OrsquoBrien
Myofunctional Research CoRancho Cucamonga
2008-2012
Oral Myology
Oral Myology Basic CourseJoy MoellerNYC 2011LA 2012
Oral Myology Levels 2 3Kim BenkertClifton 2012
Habit CessationShari GreenClifton 2013
Biobloc Orthotropics
BBO Mini-residencyBill Hang
Agora Hills2012-13
BBO IntensiveDrs John and Mike
MewLSFO2013
Breathing and Sleep
Buteyko MentorshipThe Breathing Center
Woodstock2010
Breathing Well ProgrammeJohn Flutter
2010 Ortho-Postural TrainingRoger Price
2013
Sleep DentistryMichael Gelb etal
NYU2012
ALF and Cranial
Jim Bronson2013 Tasha Turzo
Cranial Academy2014
Bucket Listbull ALF and Crozat (Bronsonrsquos course)bullMore on Biobloc (Hangrsquos Advanced London School)bull More Cranial (The Farm)bullChirodontics (Bob Walker)bull Airway Dentistry with Marc Cruz Jeff Rousebull Sleep Dentistrybull Less-than-Six with Kevin Boydbull Intra-mandibular Distraction Osteogenesis (IMDO)
Off My ListAnything that moves the teeth faster in the wrong direction
Whatrsquos an RO to do
To create from what Irsquove learned from the best
a model for others to followhellipespecially orthodontists
Teaching
Mt Sinai Pedo ResidencyAli Attaie
2010-2012
Montefiore Ortho ResidencyTony Maganzini
2012
2009-Present
Mt Sinai School of MedicinePedodontic Residency
Guest SpeakersJim BronsonMike MewKevin BoydSandra KahnJennifer TowRoger PricePaula Fabbie
Damien OrsquoBrien
First clinical program in myofunctional orthodontics
Airway and Facial DevelopmentCollaborative Webcast
Mark Cruz
AAPMD Symposium
wwwaapm
dorg
Annual MeetingApril 25-26 2014
Westin Chicago North Shore
the raphael center for integrative orthodontics
wwwalignminecomwwwbioblocnjcom
wwwmyobracenjcom
Integrative vs Conventional
Integrative vs Conventional
ldquoWith improvements in expansion orthodontics advances in myofunctional orthodontics and the growing recognition about sleep disordered breathing among children and adults it is time for orthodontics to expand its horizons There is now so much more we can oerrdquo
The Raphael name has been associated with high quality orthodontics in New Jersey for over 60 years Dr Barry Raphael has been a university trained orthodontic specialist and a member of the American Association of Orthodontists for 30 years
He has a wide range of techniques and services to offer He has studied oral myology applied kinesiology Buteyko breathing Biobloc Orthotropics and Myobrace as part of his integrative training He can offer Damon Invisalign Insignia and Incognito appliances designs as some of his many conventional orthodontic services too
Dr Raphael teaches his techniques at post-graduate residencies study clubs dental societies and for the Myofunctional Research Co He is available for presentations to any group interested in learning more about the benefits of integrative orthodontics
wwwalignminecomLearn about the choices you have in orthodontics
dr barry raphael Why its
too Early never
1425
bro
ad
str
ee
tc
lifto
n n
j 070
13
973-
778-
4222
fax
973-
778-
9625
nj s
pe
c
368
4
1425 broad street clifton nj 07013973-778-4222
wwwalignminecom
the raphael centerforintegrative orthodontics
the
raph
ael c
ente
r fo
rin
tegr
ativ
e or
thod
onti
cs
Learn about an important choice you need to make before starting braces
the raphael center for integrative education
the raphael center for integrative education
Ongoing Intro to Airway Orthodontics
April Biobloc Study Group
April Training Ortho-Postural Therapists w Roger Price
June MRC Myobrace Basic Series
August Airway Dentistry with Mark Cruz and company
October Advanced MFT with Sandy Coulson
October Less than Six with Kevin Boyd
(who else wants to play)
Mission to create a space for spreading the word about Airway and Orthotropic principles and practice
Orthodontics in the 21st Century
EstheticOrthodontics
AirwayOrthodontics
GeneticTooth-Focused
Dental PerfectionEsthetics Primary
Treating SymptomsAirway Ignorant
AdaptationMuscle-FocusedMedical Better
Esthetics SecondaryTreating Causes
Airway Conscious
The EndAnd
The Beginning
Connecting the dots
bull Adult SDB and OSA
bull Narrow jaws and faces
bull Soft tissue dysfunction
bull Early parafunctional habits ie open mouth posture
bull Environmental stressors
bull CPAP MARAUPPP SurgWherersquos the best
place to start treatment here
or here
1 Prevention 2 Undo the damage already done3 Establish good habits
When to start When damage from poor breathing is noticed and when bad habits are discovered
The strategies of Airway Orthodontics
Prevention
bull Remove ankyloglossiabull Promote breastfeedingbull Harden the dietbull Develop masticatory strengthbull Discourage oral habitsbull Promote whole-foods low sugar dietbull Reduce oropharyngeal obstructionbull Promote nasal breathing
Breathing retraining
bull Nasal rinsingbull Nasal clearingbull Decongesting
The goals of Airway Orthodontics
1 Breathing through the nose2 Lips together at rest3 Correct tongue position4 No facial muscles moving on swallowing5 Optimal forward facial development6 Class I occlusion7 Straight teeth8 Better stability long term
Myofunctional Trainers
Professors R Soulet and A Besombes
Dr Earl Bergeson
Dr Chris Farrell
The Multi ndash Family System
Orofacial MyofunctionalTherapy
Oral MyologyMyofunctional TherapyTongue Thrust Therapy
B Hockel 2012 Back
Undoing Bimaxillary Dysplasia
1 Maxillary deconstriction2 Maxillary advancement3 Maxillary impaction4 Mandibular advancement
1 Maxillary Expansion
Treatment for Bimaxillary Dysplasia
ALFCrozat
Bent Wire
HyraxHaas
Niti Exp BioBlocSchwartz
The Farrell BENT WIRE Systemtrade
Recommended Age Group 5-12 yrs
Arch Development in conjunction with the TRAINER Systemtrade
Dr John Mew
Establish Good Habits
1 Breathing through the nose2 Lips together at rest3 Correct tongue position4 No facial muscles moving on swallowing5 Stand and sit in balance6 Breath gently using the diaphragm7 Eat to nourish8 Sleep to rest
Ortho-Postural TrainingWorkshops
Breathing
Nutrition
Posture
Sleep
COPYRIGHTRoger L PriceOctober 2012
Posture Number
Forward head posturecan be a compensationfor a deficient airway
Sleep Screening and Hygiene
SQI = 10 SQI = 98
Integrative Healthcare
Function ProfessionalNasal clearing ENT Pulm MFT BreathingMuscle balance and tone MFT Myofunctional OrthoUndoing damage GP Pedo Ortho OMFSBreathing dynamics OPT MFT Breath PhysiologistPosture DC OPT PT OsteopathCranial balance OsteopathNutrition RDH Nutritionist Dietitian Sleep ENT Sleep Med DentNeurocognitive development Pedrsquon SLP Psych SpEd
The Interdisciplinary Center
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Now that I know
My personal missionTo create from what Irsquove
learned from the besta model for others to followhellipespecially the orthodontists
Myofunctional Orthodontics
Chris Farrell
John Flutter
German Ramierez
Damien OrsquoBrien
Myofunctional Research CoRancho Cucamonga
2008-2012
Oral Myology
Oral Myology Basic CourseJoy MoellerNYC 2011LA 2012
Oral Myology Levels 2 3Kim BenkertClifton 2012
Habit CessationShari GreenClifton 2013
Biobloc Orthotropics
BBO Mini-residencyBill Hang
Agora Hills2012-13
BBO IntensiveDrs John and Mike
MewLSFO2013
Breathing and Sleep
Buteyko MentorshipThe Breathing Center
Woodstock2010
Breathing Well ProgrammeJohn Flutter
2010 Ortho-Postural TrainingRoger Price
2013
Sleep DentistryMichael Gelb etal
NYU2012
ALF and Cranial
Jim Bronson2013 Tasha Turzo
Cranial Academy2014
Bucket Listbull ALF and Crozat (Bronsonrsquos course)bullMore on Biobloc (Hangrsquos Advanced London School)bull More Cranial (The Farm)bullChirodontics (Bob Walker)bull Airway Dentistry with Marc Cruz Jeff Rousebull Sleep Dentistrybull Less-than-Six with Kevin Boydbull Intra-mandibular Distraction Osteogenesis (IMDO)
Off My ListAnything that moves the teeth faster in the wrong direction
Whatrsquos an RO to do
To create from what Irsquove learned from the best
a model for others to followhellipespecially orthodontists
Teaching
Mt Sinai Pedo ResidencyAli Attaie
2010-2012
Montefiore Ortho ResidencyTony Maganzini
2012
2009-Present
Mt Sinai School of MedicinePedodontic Residency
Guest SpeakersJim BronsonMike MewKevin BoydSandra KahnJennifer TowRoger PricePaula Fabbie
Damien OrsquoBrien
First clinical program in myofunctional orthodontics
Airway and Facial DevelopmentCollaborative Webcast
Mark Cruz
AAPMD Symposium
wwwaapm
dorg
Annual MeetingApril 25-26 2014
Westin Chicago North Shore
the raphael center for integrative orthodontics
wwwalignminecomwwwbioblocnjcom
wwwmyobracenjcom
Integrative vs Conventional
Integrative vs Conventional
ldquoWith improvements in expansion orthodontics advances in myofunctional orthodontics and the growing recognition about sleep disordered breathing among children and adults it is time for orthodontics to expand its horizons There is now so much more we can oerrdquo
The Raphael name has been associated with high quality orthodontics in New Jersey for over 60 years Dr Barry Raphael has been a university trained orthodontic specialist and a member of the American Association of Orthodontists for 30 years
He has a wide range of techniques and services to offer He has studied oral myology applied kinesiology Buteyko breathing Biobloc Orthotropics and Myobrace as part of his integrative training He can offer Damon Invisalign Insignia and Incognito appliances designs as some of his many conventional orthodontic services too
Dr Raphael teaches his techniques at post-graduate residencies study clubs dental societies and for the Myofunctional Research Co He is available for presentations to any group interested in learning more about the benefits of integrative orthodontics
wwwalignminecomLearn about the choices you have in orthodontics
dr barry raphael Why its
too Early never
1425
bro
ad
str
ee
tc
lifto
n n
j 070
13
973-
778-
4222
fax
973-
778-
9625
nj s
pe
c
368
4
1425 broad street clifton nj 07013973-778-4222
wwwalignminecom
the raphael centerforintegrative orthodontics
the
raph
ael c
ente
r fo
rin
tegr
ativ
e or
thod
onti
cs
Learn about an important choice you need to make before starting braces
the raphael center for integrative education
the raphael center for integrative education
Ongoing Intro to Airway Orthodontics
April Biobloc Study Group
April Training Ortho-Postural Therapists w Roger Price
June MRC Myobrace Basic Series
August Airway Dentistry with Mark Cruz and company
October Advanced MFT with Sandy Coulson
October Less than Six with Kevin Boyd
(who else wants to play)
Mission to create a space for spreading the word about Airway and Orthotropic principles and practice
Orthodontics in the 21st Century
EstheticOrthodontics
AirwayOrthodontics
GeneticTooth-Focused
Dental PerfectionEsthetics Primary
Treating SymptomsAirway Ignorant
AdaptationMuscle-FocusedMedical Better
Esthetics SecondaryTreating Causes
Airway Conscious
The EndAnd
The Beginning
1 Prevention 2 Undo the damage already done3 Establish good habits
When to start When damage from poor breathing is noticed and when bad habits are discovered
The strategies of Airway Orthodontics
Prevention
bull Remove ankyloglossiabull Promote breastfeedingbull Harden the dietbull Develop masticatory strengthbull Discourage oral habitsbull Promote whole-foods low sugar dietbull Reduce oropharyngeal obstructionbull Promote nasal breathing
Breathing retraining
bull Nasal rinsingbull Nasal clearingbull Decongesting
The goals of Airway Orthodontics
1 Breathing through the nose2 Lips together at rest3 Correct tongue position4 No facial muscles moving on swallowing5 Optimal forward facial development6 Class I occlusion7 Straight teeth8 Better stability long term
Myofunctional Trainers
Professors R Soulet and A Besombes
Dr Earl Bergeson
Dr Chris Farrell
The Multi ndash Family System
Orofacial MyofunctionalTherapy
Oral MyologyMyofunctional TherapyTongue Thrust Therapy
B Hockel 2012 Back
Undoing Bimaxillary Dysplasia
1 Maxillary deconstriction2 Maxillary advancement3 Maxillary impaction4 Mandibular advancement
1 Maxillary Expansion
Treatment for Bimaxillary Dysplasia
ALFCrozat
Bent Wire
HyraxHaas
Niti Exp BioBlocSchwartz
The Farrell BENT WIRE Systemtrade
Recommended Age Group 5-12 yrs
Arch Development in conjunction with the TRAINER Systemtrade
Dr John Mew
Establish Good Habits
1 Breathing through the nose2 Lips together at rest3 Correct tongue position4 No facial muscles moving on swallowing5 Stand and sit in balance6 Breath gently using the diaphragm7 Eat to nourish8 Sleep to rest
Ortho-Postural TrainingWorkshops
Breathing
Nutrition
Posture
Sleep
COPYRIGHTRoger L PriceOctober 2012
Posture Number
Forward head posturecan be a compensationfor a deficient airway
Sleep Screening and Hygiene
SQI = 10 SQI = 98
Integrative Healthcare
Function ProfessionalNasal clearing ENT Pulm MFT BreathingMuscle balance and tone MFT Myofunctional OrthoUndoing damage GP Pedo Ortho OMFSBreathing dynamics OPT MFT Breath PhysiologistPosture DC OPT PT OsteopathCranial balance OsteopathNutrition RDH Nutritionist Dietitian Sleep ENT Sleep Med DentNeurocognitive development Pedrsquon SLP Psych SpEd
The Interdisciplinary Center
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Now that I know
My personal missionTo create from what Irsquove
learned from the besta model for others to followhellipespecially the orthodontists
Myofunctional Orthodontics
Chris Farrell
John Flutter
German Ramierez
Damien OrsquoBrien
Myofunctional Research CoRancho Cucamonga
2008-2012
Oral Myology
Oral Myology Basic CourseJoy MoellerNYC 2011LA 2012
Oral Myology Levels 2 3Kim BenkertClifton 2012
Habit CessationShari GreenClifton 2013
Biobloc Orthotropics
BBO Mini-residencyBill Hang
Agora Hills2012-13
BBO IntensiveDrs John and Mike
MewLSFO2013
Breathing and Sleep
Buteyko MentorshipThe Breathing Center
Woodstock2010
Breathing Well ProgrammeJohn Flutter
2010 Ortho-Postural TrainingRoger Price
2013
Sleep DentistryMichael Gelb etal
NYU2012
ALF and Cranial
Jim Bronson2013 Tasha Turzo
Cranial Academy2014
Bucket Listbull ALF and Crozat (Bronsonrsquos course)bullMore on Biobloc (Hangrsquos Advanced London School)bull More Cranial (The Farm)bullChirodontics (Bob Walker)bull Airway Dentistry with Marc Cruz Jeff Rousebull Sleep Dentistrybull Less-than-Six with Kevin Boydbull Intra-mandibular Distraction Osteogenesis (IMDO)
Off My ListAnything that moves the teeth faster in the wrong direction
Whatrsquos an RO to do
To create from what Irsquove learned from the best
a model for others to followhellipespecially orthodontists
Teaching
Mt Sinai Pedo ResidencyAli Attaie
2010-2012
Montefiore Ortho ResidencyTony Maganzini
2012
2009-Present
Mt Sinai School of MedicinePedodontic Residency
Guest SpeakersJim BronsonMike MewKevin BoydSandra KahnJennifer TowRoger PricePaula Fabbie
Damien OrsquoBrien
First clinical program in myofunctional orthodontics
Airway and Facial DevelopmentCollaborative Webcast
Mark Cruz
AAPMD Symposium
wwwaapm
dorg
Annual MeetingApril 25-26 2014
Westin Chicago North Shore
the raphael center for integrative orthodontics
wwwalignminecomwwwbioblocnjcom
wwwmyobracenjcom
Integrative vs Conventional
Integrative vs Conventional
ldquoWith improvements in expansion orthodontics advances in myofunctional orthodontics and the growing recognition about sleep disordered breathing among children and adults it is time for orthodontics to expand its horizons There is now so much more we can oerrdquo
The Raphael name has been associated with high quality orthodontics in New Jersey for over 60 years Dr Barry Raphael has been a university trained orthodontic specialist and a member of the American Association of Orthodontists for 30 years
He has a wide range of techniques and services to offer He has studied oral myology applied kinesiology Buteyko breathing Biobloc Orthotropics and Myobrace as part of his integrative training He can offer Damon Invisalign Insignia and Incognito appliances designs as some of his many conventional orthodontic services too
Dr Raphael teaches his techniques at post-graduate residencies study clubs dental societies and for the Myofunctional Research Co He is available for presentations to any group interested in learning more about the benefits of integrative orthodontics
wwwalignminecomLearn about the choices you have in orthodontics
dr barry raphael Why its
too Early never
1425
bro
ad
str
ee
tc
lifto
n n
j 070
13
973-
778-
4222
fax
973-
778-
9625
nj s
pe
c
368
4
1425 broad street clifton nj 07013973-778-4222
wwwalignminecom
the raphael centerforintegrative orthodontics
the
raph
ael c
ente
r fo
rin
tegr
ativ
e or
thod
onti
cs
Learn about an important choice you need to make before starting braces
the raphael center for integrative education
the raphael center for integrative education
Ongoing Intro to Airway Orthodontics
April Biobloc Study Group
April Training Ortho-Postural Therapists w Roger Price
June MRC Myobrace Basic Series
August Airway Dentistry with Mark Cruz and company
October Advanced MFT with Sandy Coulson
October Less than Six with Kevin Boyd
(who else wants to play)
Mission to create a space for spreading the word about Airway and Orthotropic principles and practice
Orthodontics in the 21st Century
EstheticOrthodontics
AirwayOrthodontics
GeneticTooth-Focused
Dental PerfectionEsthetics Primary
Treating SymptomsAirway Ignorant
AdaptationMuscle-FocusedMedical Better
Esthetics SecondaryTreating Causes
Airway Conscious
The EndAnd
The Beginning
Prevention
bull Remove ankyloglossiabull Promote breastfeedingbull Harden the dietbull Develop masticatory strengthbull Discourage oral habitsbull Promote whole-foods low sugar dietbull Reduce oropharyngeal obstructionbull Promote nasal breathing
Breathing retraining
bull Nasal rinsingbull Nasal clearingbull Decongesting
The goals of Airway Orthodontics
1 Breathing through the nose2 Lips together at rest3 Correct tongue position4 No facial muscles moving on swallowing5 Optimal forward facial development6 Class I occlusion7 Straight teeth8 Better stability long term
Myofunctional Trainers
Professors R Soulet and A Besombes
Dr Earl Bergeson
Dr Chris Farrell
The Multi ndash Family System
Orofacial MyofunctionalTherapy
Oral MyologyMyofunctional TherapyTongue Thrust Therapy
B Hockel 2012 Back
Undoing Bimaxillary Dysplasia
1 Maxillary deconstriction2 Maxillary advancement3 Maxillary impaction4 Mandibular advancement
1 Maxillary Expansion
Treatment for Bimaxillary Dysplasia
ALFCrozat
Bent Wire
HyraxHaas
Niti Exp BioBlocSchwartz
The Farrell BENT WIRE Systemtrade
Recommended Age Group 5-12 yrs
Arch Development in conjunction with the TRAINER Systemtrade
Dr John Mew
Establish Good Habits
1 Breathing through the nose2 Lips together at rest3 Correct tongue position4 No facial muscles moving on swallowing5 Stand and sit in balance6 Breath gently using the diaphragm7 Eat to nourish8 Sleep to rest
Ortho-Postural TrainingWorkshops
Breathing
Nutrition
Posture
Sleep
COPYRIGHTRoger L PriceOctober 2012
Posture Number
Forward head posturecan be a compensationfor a deficient airway
Sleep Screening and Hygiene
SQI = 10 SQI = 98
Integrative Healthcare
Function ProfessionalNasal clearing ENT Pulm MFT BreathingMuscle balance and tone MFT Myofunctional OrthoUndoing damage GP Pedo Ortho OMFSBreathing dynamics OPT MFT Breath PhysiologistPosture DC OPT PT OsteopathCranial balance OsteopathNutrition RDH Nutritionist Dietitian Sleep ENT Sleep Med DentNeurocognitive development Pedrsquon SLP Psych SpEd
The Interdisciplinary Center
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Now that I know
My personal missionTo create from what Irsquove
learned from the besta model for others to followhellipespecially the orthodontists
Myofunctional Orthodontics
Chris Farrell
John Flutter
German Ramierez
Damien OrsquoBrien
Myofunctional Research CoRancho Cucamonga
2008-2012
Oral Myology
Oral Myology Basic CourseJoy MoellerNYC 2011LA 2012
Oral Myology Levels 2 3Kim BenkertClifton 2012
Habit CessationShari GreenClifton 2013
Biobloc Orthotropics
BBO Mini-residencyBill Hang
Agora Hills2012-13
BBO IntensiveDrs John and Mike
MewLSFO2013
Breathing and Sleep
Buteyko MentorshipThe Breathing Center
Woodstock2010
Breathing Well ProgrammeJohn Flutter
2010 Ortho-Postural TrainingRoger Price
2013
Sleep DentistryMichael Gelb etal
NYU2012
ALF and Cranial
Jim Bronson2013 Tasha Turzo
Cranial Academy2014
Bucket Listbull ALF and Crozat (Bronsonrsquos course)bullMore on Biobloc (Hangrsquos Advanced London School)bull More Cranial (The Farm)bullChirodontics (Bob Walker)bull Airway Dentistry with Marc Cruz Jeff Rousebull Sleep Dentistrybull Less-than-Six with Kevin Boydbull Intra-mandibular Distraction Osteogenesis (IMDO)
Off My ListAnything that moves the teeth faster in the wrong direction
Whatrsquos an RO to do
To create from what Irsquove learned from the best
a model for others to followhellipespecially orthodontists
Teaching
Mt Sinai Pedo ResidencyAli Attaie
2010-2012
Montefiore Ortho ResidencyTony Maganzini
2012
2009-Present
Mt Sinai School of MedicinePedodontic Residency
Guest SpeakersJim BronsonMike MewKevin BoydSandra KahnJennifer TowRoger PricePaula Fabbie
Damien OrsquoBrien
First clinical program in myofunctional orthodontics
Airway and Facial DevelopmentCollaborative Webcast
Mark Cruz
AAPMD Symposium
wwwaapm
dorg
Annual MeetingApril 25-26 2014
Westin Chicago North Shore
the raphael center for integrative orthodontics
wwwalignminecomwwwbioblocnjcom
wwwmyobracenjcom
Integrative vs Conventional
Integrative vs Conventional
ldquoWith improvements in expansion orthodontics advances in myofunctional orthodontics and the growing recognition about sleep disordered breathing among children and adults it is time for orthodontics to expand its horizons There is now so much more we can oerrdquo
The Raphael name has been associated with high quality orthodontics in New Jersey for over 60 years Dr Barry Raphael has been a university trained orthodontic specialist and a member of the American Association of Orthodontists for 30 years
He has a wide range of techniques and services to offer He has studied oral myology applied kinesiology Buteyko breathing Biobloc Orthotropics and Myobrace as part of his integrative training He can offer Damon Invisalign Insignia and Incognito appliances designs as some of his many conventional orthodontic services too
Dr Raphael teaches his techniques at post-graduate residencies study clubs dental societies and for the Myofunctional Research Co He is available for presentations to any group interested in learning more about the benefits of integrative orthodontics
wwwalignminecomLearn about the choices you have in orthodontics
dr barry raphael Why its
too Early never
1425
bro
ad
str
ee
tc
lifto
n n
j 070
13
973-
778-
4222
fax
973-
778-
9625
nj s
pe
c
368
4
1425 broad street clifton nj 07013973-778-4222
wwwalignminecom
the raphael centerforintegrative orthodontics
the
raph
ael c
ente
r fo
rin
tegr
ativ
e or
thod
onti
cs
Learn about an important choice you need to make before starting braces
the raphael center for integrative education
the raphael center for integrative education
Ongoing Intro to Airway Orthodontics
April Biobloc Study Group
April Training Ortho-Postural Therapists w Roger Price
June MRC Myobrace Basic Series
August Airway Dentistry with Mark Cruz and company
October Advanced MFT with Sandy Coulson
October Less than Six with Kevin Boyd
(who else wants to play)
Mission to create a space for spreading the word about Airway and Orthotropic principles and practice
Orthodontics in the 21st Century
EstheticOrthodontics
AirwayOrthodontics
GeneticTooth-Focused
Dental PerfectionEsthetics Primary
Treating SymptomsAirway Ignorant
AdaptationMuscle-FocusedMedical Better
Esthetics SecondaryTreating Causes
Airway Conscious
The EndAnd
The Beginning
Breathing retraining
bull Nasal rinsingbull Nasal clearingbull Decongesting
The goals of Airway Orthodontics
1 Breathing through the nose2 Lips together at rest3 Correct tongue position4 No facial muscles moving on swallowing5 Optimal forward facial development6 Class I occlusion7 Straight teeth8 Better stability long term
Myofunctional Trainers
Professors R Soulet and A Besombes
Dr Earl Bergeson
Dr Chris Farrell
The Multi ndash Family System
Orofacial MyofunctionalTherapy
Oral MyologyMyofunctional TherapyTongue Thrust Therapy
B Hockel 2012 Back
Undoing Bimaxillary Dysplasia
1 Maxillary deconstriction2 Maxillary advancement3 Maxillary impaction4 Mandibular advancement
1 Maxillary Expansion
Treatment for Bimaxillary Dysplasia
ALFCrozat
Bent Wire
HyraxHaas
Niti Exp BioBlocSchwartz
The Farrell BENT WIRE Systemtrade
Recommended Age Group 5-12 yrs
Arch Development in conjunction with the TRAINER Systemtrade
Dr John Mew
Establish Good Habits
1 Breathing through the nose2 Lips together at rest3 Correct tongue position4 No facial muscles moving on swallowing5 Stand and sit in balance6 Breath gently using the diaphragm7 Eat to nourish8 Sleep to rest
Ortho-Postural TrainingWorkshops
Breathing
Nutrition
Posture
Sleep
COPYRIGHTRoger L PriceOctober 2012
Posture Number
Forward head posturecan be a compensationfor a deficient airway
Sleep Screening and Hygiene
SQI = 10 SQI = 98
Integrative Healthcare
Function ProfessionalNasal clearing ENT Pulm MFT BreathingMuscle balance and tone MFT Myofunctional OrthoUndoing damage GP Pedo Ortho OMFSBreathing dynamics OPT MFT Breath PhysiologistPosture DC OPT PT OsteopathCranial balance OsteopathNutrition RDH Nutritionist Dietitian Sleep ENT Sleep Med DentNeurocognitive development Pedrsquon SLP Psych SpEd
The Interdisciplinary Center
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Now that I know
My personal missionTo create from what Irsquove
learned from the besta model for others to followhellipespecially the orthodontists
Myofunctional Orthodontics
Chris Farrell
John Flutter
German Ramierez
Damien OrsquoBrien
Myofunctional Research CoRancho Cucamonga
2008-2012
Oral Myology
Oral Myology Basic CourseJoy MoellerNYC 2011LA 2012
Oral Myology Levels 2 3Kim BenkertClifton 2012
Habit CessationShari GreenClifton 2013
Biobloc Orthotropics
BBO Mini-residencyBill Hang
Agora Hills2012-13
BBO IntensiveDrs John and Mike
MewLSFO2013
Breathing and Sleep
Buteyko MentorshipThe Breathing Center
Woodstock2010
Breathing Well ProgrammeJohn Flutter
2010 Ortho-Postural TrainingRoger Price
2013
Sleep DentistryMichael Gelb etal
NYU2012
ALF and Cranial
Jim Bronson2013 Tasha Turzo
Cranial Academy2014
Bucket Listbull ALF and Crozat (Bronsonrsquos course)bullMore on Biobloc (Hangrsquos Advanced London School)bull More Cranial (The Farm)bullChirodontics (Bob Walker)bull Airway Dentistry with Marc Cruz Jeff Rousebull Sleep Dentistrybull Less-than-Six with Kevin Boydbull Intra-mandibular Distraction Osteogenesis (IMDO)
Off My ListAnything that moves the teeth faster in the wrong direction
Whatrsquos an RO to do
To create from what Irsquove learned from the best
a model for others to followhellipespecially orthodontists
Teaching
Mt Sinai Pedo ResidencyAli Attaie
2010-2012
Montefiore Ortho ResidencyTony Maganzini
2012
2009-Present
Mt Sinai School of MedicinePedodontic Residency
Guest SpeakersJim BronsonMike MewKevin BoydSandra KahnJennifer TowRoger PricePaula Fabbie
Damien OrsquoBrien
First clinical program in myofunctional orthodontics
Airway and Facial DevelopmentCollaborative Webcast
Mark Cruz
AAPMD Symposium
wwwaapm
dorg
Annual MeetingApril 25-26 2014
Westin Chicago North Shore
the raphael center for integrative orthodontics
wwwalignminecomwwwbioblocnjcom
wwwmyobracenjcom
Integrative vs Conventional
Integrative vs Conventional
ldquoWith improvements in expansion orthodontics advances in myofunctional orthodontics and the growing recognition about sleep disordered breathing among children and adults it is time for orthodontics to expand its horizons There is now so much more we can oerrdquo
The Raphael name has been associated with high quality orthodontics in New Jersey for over 60 years Dr Barry Raphael has been a university trained orthodontic specialist and a member of the American Association of Orthodontists for 30 years
He has a wide range of techniques and services to offer He has studied oral myology applied kinesiology Buteyko breathing Biobloc Orthotropics and Myobrace as part of his integrative training He can offer Damon Invisalign Insignia and Incognito appliances designs as some of his many conventional orthodontic services too
Dr Raphael teaches his techniques at post-graduate residencies study clubs dental societies and for the Myofunctional Research Co He is available for presentations to any group interested in learning more about the benefits of integrative orthodontics
wwwalignminecomLearn about the choices you have in orthodontics
dr barry raphael Why its
too Early never
1425
bro
ad
str
ee
tc
lifto
n n
j 070
13
973-
778-
4222
fax
973-
778-
9625
nj s
pe
c
368
4
1425 broad street clifton nj 07013973-778-4222
wwwalignminecom
the raphael centerforintegrative orthodontics
the
raph
ael c
ente
r fo
rin
tegr
ativ
e or
thod
onti
cs
Learn about an important choice you need to make before starting braces
the raphael center for integrative education
the raphael center for integrative education
Ongoing Intro to Airway Orthodontics
April Biobloc Study Group
April Training Ortho-Postural Therapists w Roger Price
June MRC Myobrace Basic Series
August Airway Dentistry with Mark Cruz and company
October Advanced MFT with Sandy Coulson
October Less than Six with Kevin Boyd
(who else wants to play)
Mission to create a space for spreading the word about Airway and Orthotropic principles and practice
Orthodontics in the 21st Century
EstheticOrthodontics
AirwayOrthodontics
GeneticTooth-Focused
Dental PerfectionEsthetics Primary
Treating SymptomsAirway Ignorant
AdaptationMuscle-FocusedMedical Better
Esthetics SecondaryTreating Causes
Airway Conscious
The EndAnd
The Beginning
The goals of Airway Orthodontics
1 Breathing through the nose2 Lips together at rest3 Correct tongue position4 No facial muscles moving on swallowing5 Optimal forward facial development6 Class I occlusion7 Straight teeth8 Better stability long term
Myofunctional Trainers
Professors R Soulet and A Besombes
Dr Earl Bergeson
Dr Chris Farrell
The Multi ndash Family System
Orofacial MyofunctionalTherapy
Oral MyologyMyofunctional TherapyTongue Thrust Therapy
B Hockel 2012 Back
Undoing Bimaxillary Dysplasia
1 Maxillary deconstriction2 Maxillary advancement3 Maxillary impaction4 Mandibular advancement
1 Maxillary Expansion
Treatment for Bimaxillary Dysplasia
ALFCrozat
Bent Wire
HyraxHaas
Niti Exp BioBlocSchwartz
The Farrell BENT WIRE Systemtrade
Recommended Age Group 5-12 yrs
Arch Development in conjunction with the TRAINER Systemtrade
Dr John Mew
Establish Good Habits
1 Breathing through the nose2 Lips together at rest3 Correct tongue position4 No facial muscles moving on swallowing5 Stand and sit in balance6 Breath gently using the diaphragm7 Eat to nourish8 Sleep to rest
Ortho-Postural TrainingWorkshops
Breathing
Nutrition
Posture
Sleep
COPYRIGHTRoger L PriceOctober 2012
Posture Number
Forward head posturecan be a compensationfor a deficient airway
Sleep Screening and Hygiene
SQI = 10 SQI = 98
Integrative Healthcare
Function ProfessionalNasal clearing ENT Pulm MFT BreathingMuscle balance and tone MFT Myofunctional OrthoUndoing damage GP Pedo Ortho OMFSBreathing dynamics OPT MFT Breath PhysiologistPosture DC OPT PT OsteopathCranial balance OsteopathNutrition RDH Nutritionist Dietitian Sleep ENT Sleep Med DentNeurocognitive development Pedrsquon SLP Psych SpEd
The Interdisciplinary Center
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Now that I know
My personal missionTo create from what Irsquove
learned from the besta model for others to followhellipespecially the orthodontists
Myofunctional Orthodontics
Chris Farrell
John Flutter
German Ramierez
Damien OrsquoBrien
Myofunctional Research CoRancho Cucamonga
2008-2012
Oral Myology
Oral Myology Basic CourseJoy MoellerNYC 2011LA 2012
Oral Myology Levels 2 3Kim BenkertClifton 2012
Habit CessationShari GreenClifton 2013
Biobloc Orthotropics
BBO Mini-residencyBill Hang
Agora Hills2012-13
BBO IntensiveDrs John and Mike
MewLSFO2013
Breathing and Sleep
Buteyko MentorshipThe Breathing Center
Woodstock2010
Breathing Well ProgrammeJohn Flutter
2010 Ortho-Postural TrainingRoger Price
2013
Sleep DentistryMichael Gelb etal
NYU2012
ALF and Cranial
Jim Bronson2013 Tasha Turzo
Cranial Academy2014
Bucket Listbull ALF and Crozat (Bronsonrsquos course)bullMore on Biobloc (Hangrsquos Advanced London School)bull More Cranial (The Farm)bullChirodontics (Bob Walker)bull Airway Dentistry with Marc Cruz Jeff Rousebull Sleep Dentistrybull Less-than-Six with Kevin Boydbull Intra-mandibular Distraction Osteogenesis (IMDO)
Off My ListAnything that moves the teeth faster in the wrong direction
Whatrsquos an RO to do
To create from what Irsquove learned from the best
a model for others to followhellipespecially orthodontists
Teaching
Mt Sinai Pedo ResidencyAli Attaie
2010-2012
Montefiore Ortho ResidencyTony Maganzini
2012
2009-Present
Mt Sinai School of MedicinePedodontic Residency
Guest SpeakersJim BronsonMike MewKevin BoydSandra KahnJennifer TowRoger PricePaula Fabbie
Damien OrsquoBrien
First clinical program in myofunctional orthodontics
Airway and Facial DevelopmentCollaborative Webcast
Mark Cruz
AAPMD Symposium
wwwaapm
dorg
Annual MeetingApril 25-26 2014
Westin Chicago North Shore
the raphael center for integrative orthodontics
wwwalignminecomwwwbioblocnjcom
wwwmyobracenjcom
Integrative vs Conventional
Integrative vs Conventional
ldquoWith improvements in expansion orthodontics advances in myofunctional orthodontics and the growing recognition about sleep disordered breathing among children and adults it is time for orthodontics to expand its horizons There is now so much more we can oerrdquo
The Raphael name has been associated with high quality orthodontics in New Jersey for over 60 years Dr Barry Raphael has been a university trained orthodontic specialist and a member of the American Association of Orthodontists for 30 years
He has a wide range of techniques and services to offer He has studied oral myology applied kinesiology Buteyko breathing Biobloc Orthotropics and Myobrace as part of his integrative training He can offer Damon Invisalign Insignia and Incognito appliances designs as some of his many conventional orthodontic services too
Dr Raphael teaches his techniques at post-graduate residencies study clubs dental societies and for the Myofunctional Research Co He is available for presentations to any group interested in learning more about the benefits of integrative orthodontics
wwwalignminecomLearn about the choices you have in orthodontics
dr barry raphael Why its
too Early never
1425
bro
ad
str
ee
tc
lifto
n n
j 070
13
973-
778-
4222
fax
973-
778-
9625
nj s
pe
c
368
4
1425 broad street clifton nj 07013973-778-4222
wwwalignminecom
the raphael centerforintegrative orthodontics
the
raph
ael c
ente
r fo
rin
tegr
ativ
e or
thod
onti
cs
Learn about an important choice you need to make before starting braces
the raphael center for integrative education
the raphael center for integrative education
Ongoing Intro to Airway Orthodontics
April Biobloc Study Group
April Training Ortho-Postural Therapists w Roger Price
June MRC Myobrace Basic Series
August Airway Dentistry with Mark Cruz and company
October Advanced MFT with Sandy Coulson
October Less than Six with Kevin Boyd
(who else wants to play)
Mission to create a space for spreading the word about Airway and Orthotropic principles and practice
Orthodontics in the 21st Century
EstheticOrthodontics
AirwayOrthodontics
GeneticTooth-Focused
Dental PerfectionEsthetics Primary
Treating SymptomsAirway Ignorant
AdaptationMuscle-FocusedMedical Better
Esthetics SecondaryTreating Causes
Airway Conscious
The EndAnd
The Beginning
Myofunctional Trainers
Professors R Soulet and A Besombes
Dr Earl Bergeson
Dr Chris Farrell
The Multi ndash Family System
Orofacial MyofunctionalTherapy
Oral MyologyMyofunctional TherapyTongue Thrust Therapy
B Hockel 2012 Back
Undoing Bimaxillary Dysplasia
1 Maxillary deconstriction2 Maxillary advancement3 Maxillary impaction4 Mandibular advancement
1 Maxillary Expansion
Treatment for Bimaxillary Dysplasia
ALFCrozat
Bent Wire
HyraxHaas
Niti Exp BioBlocSchwartz
The Farrell BENT WIRE Systemtrade
Recommended Age Group 5-12 yrs
Arch Development in conjunction with the TRAINER Systemtrade
Dr John Mew
Establish Good Habits
1 Breathing through the nose2 Lips together at rest3 Correct tongue position4 No facial muscles moving on swallowing5 Stand and sit in balance6 Breath gently using the diaphragm7 Eat to nourish8 Sleep to rest
Ortho-Postural TrainingWorkshops
Breathing
Nutrition
Posture
Sleep
COPYRIGHTRoger L PriceOctober 2012
Posture Number
Forward head posturecan be a compensationfor a deficient airway
Sleep Screening and Hygiene
SQI = 10 SQI = 98
Integrative Healthcare
Function ProfessionalNasal clearing ENT Pulm MFT BreathingMuscle balance and tone MFT Myofunctional OrthoUndoing damage GP Pedo Ortho OMFSBreathing dynamics OPT MFT Breath PhysiologistPosture DC OPT PT OsteopathCranial balance OsteopathNutrition RDH Nutritionist Dietitian Sleep ENT Sleep Med DentNeurocognitive development Pedrsquon SLP Psych SpEd
The Interdisciplinary Center
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Now that I know
My personal missionTo create from what Irsquove
learned from the besta model for others to followhellipespecially the orthodontists
Myofunctional Orthodontics
Chris Farrell
John Flutter
German Ramierez
Damien OrsquoBrien
Myofunctional Research CoRancho Cucamonga
2008-2012
Oral Myology
Oral Myology Basic CourseJoy MoellerNYC 2011LA 2012
Oral Myology Levels 2 3Kim BenkertClifton 2012
Habit CessationShari GreenClifton 2013
Biobloc Orthotropics
BBO Mini-residencyBill Hang
Agora Hills2012-13
BBO IntensiveDrs John and Mike
MewLSFO2013
Breathing and Sleep
Buteyko MentorshipThe Breathing Center
Woodstock2010
Breathing Well ProgrammeJohn Flutter
2010 Ortho-Postural TrainingRoger Price
2013
Sleep DentistryMichael Gelb etal
NYU2012
ALF and Cranial
Jim Bronson2013 Tasha Turzo
Cranial Academy2014
Bucket Listbull ALF and Crozat (Bronsonrsquos course)bullMore on Biobloc (Hangrsquos Advanced London School)bull More Cranial (The Farm)bullChirodontics (Bob Walker)bull Airway Dentistry with Marc Cruz Jeff Rousebull Sleep Dentistrybull Less-than-Six with Kevin Boydbull Intra-mandibular Distraction Osteogenesis (IMDO)
Off My ListAnything that moves the teeth faster in the wrong direction
Whatrsquos an RO to do
To create from what Irsquove learned from the best
a model for others to followhellipespecially orthodontists
Teaching
Mt Sinai Pedo ResidencyAli Attaie
2010-2012
Montefiore Ortho ResidencyTony Maganzini
2012
2009-Present
Mt Sinai School of MedicinePedodontic Residency
Guest SpeakersJim BronsonMike MewKevin BoydSandra KahnJennifer TowRoger PricePaula Fabbie
Damien OrsquoBrien
First clinical program in myofunctional orthodontics
Airway and Facial DevelopmentCollaborative Webcast
Mark Cruz
AAPMD Symposium
wwwaapm
dorg
Annual MeetingApril 25-26 2014
Westin Chicago North Shore
the raphael center for integrative orthodontics
wwwalignminecomwwwbioblocnjcom
wwwmyobracenjcom
Integrative vs Conventional
Integrative vs Conventional
ldquoWith improvements in expansion orthodontics advances in myofunctional orthodontics and the growing recognition about sleep disordered breathing among children and adults it is time for orthodontics to expand its horizons There is now so much more we can oerrdquo
The Raphael name has been associated with high quality orthodontics in New Jersey for over 60 years Dr Barry Raphael has been a university trained orthodontic specialist and a member of the American Association of Orthodontists for 30 years
He has a wide range of techniques and services to offer He has studied oral myology applied kinesiology Buteyko breathing Biobloc Orthotropics and Myobrace as part of his integrative training He can offer Damon Invisalign Insignia and Incognito appliances designs as some of his many conventional orthodontic services too
Dr Raphael teaches his techniques at post-graduate residencies study clubs dental societies and for the Myofunctional Research Co He is available for presentations to any group interested in learning more about the benefits of integrative orthodontics
wwwalignminecomLearn about the choices you have in orthodontics
dr barry raphael Why its
too Early never
1425
bro
ad
str
ee
tc
lifto
n n
j 070
13
973-
778-
4222
fax
973-
778-
9625
nj s
pe
c
368
4
1425 broad street clifton nj 07013973-778-4222
wwwalignminecom
the raphael centerforintegrative orthodontics
the
raph
ael c
ente
r fo
rin
tegr
ativ
e or
thod
onti
cs
Learn about an important choice you need to make before starting braces
the raphael center for integrative education
the raphael center for integrative education
Ongoing Intro to Airway Orthodontics
April Biobloc Study Group
April Training Ortho-Postural Therapists w Roger Price
June MRC Myobrace Basic Series
August Airway Dentistry with Mark Cruz and company
October Advanced MFT with Sandy Coulson
October Less than Six with Kevin Boyd
(who else wants to play)
Mission to create a space for spreading the word about Airway and Orthotropic principles and practice
Orthodontics in the 21st Century
EstheticOrthodontics
AirwayOrthodontics
GeneticTooth-Focused
Dental PerfectionEsthetics Primary
Treating SymptomsAirway Ignorant
AdaptationMuscle-FocusedMedical Better
Esthetics SecondaryTreating Causes
Airway Conscious
The EndAnd
The Beginning
Orofacial MyofunctionalTherapy
Oral MyologyMyofunctional TherapyTongue Thrust Therapy
B Hockel 2012 Back
Undoing Bimaxillary Dysplasia
1 Maxillary deconstriction2 Maxillary advancement3 Maxillary impaction4 Mandibular advancement
1 Maxillary Expansion
Treatment for Bimaxillary Dysplasia
ALFCrozat
Bent Wire
HyraxHaas
Niti Exp BioBlocSchwartz
The Farrell BENT WIRE Systemtrade
Recommended Age Group 5-12 yrs
Arch Development in conjunction with the TRAINER Systemtrade
Dr John Mew
Establish Good Habits
1 Breathing through the nose2 Lips together at rest3 Correct tongue position4 No facial muscles moving on swallowing5 Stand and sit in balance6 Breath gently using the diaphragm7 Eat to nourish8 Sleep to rest
Ortho-Postural TrainingWorkshops
Breathing
Nutrition
Posture
Sleep
COPYRIGHTRoger L PriceOctober 2012
Posture Number
Forward head posturecan be a compensationfor a deficient airway
Sleep Screening and Hygiene
SQI = 10 SQI = 98
Integrative Healthcare
Function ProfessionalNasal clearing ENT Pulm MFT BreathingMuscle balance and tone MFT Myofunctional OrthoUndoing damage GP Pedo Ortho OMFSBreathing dynamics OPT MFT Breath PhysiologistPosture DC OPT PT OsteopathCranial balance OsteopathNutrition RDH Nutritionist Dietitian Sleep ENT Sleep Med DentNeurocognitive development Pedrsquon SLP Psych SpEd
The Interdisciplinary Center
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Now that I know
My personal missionTo create from what Irsquove
learned from the besta model for others to followhellipespecially the orthodontists
Myofunctional Orthodontics
Chris Farrell
John Flutter
German Ramierez
Damien OrsquoBrien
Myofunctional Research CoRancho Cucamonga
2008-2012
Oral Myology
Oral Myology Basic CourseJoy MoellerNYC 2011LA 2012
Oral Myology Levels 2 3Kim BenkertClifton 2012
Habit CessationShari GreenClifton 2013
Biobloc Orthotropics
BBO Mini-residencyBill Hang
Agora Hills2012-13
BBO IntensiveDrs John and Mike
MewLSFO2013
Breathing and Sleep
Buteyko MentorshipThe Breathing Center
Woodstock2010
Breathing Well ProgrammeJohn Flutter
2010 Ortho-Postural TrainingRoger Price
2013
Sleep DentistryMichael Gelb etal
NYU2012
ALF and Cranial
Jim Bronson2013 Tasha Turzo
Cranial Academy2014
Bucket Listbull ALF and Crozat (Bronsonrsquos course)bullMore on Biobloc (Hangrsquos Advanced London School)bull More Cranial (The Farm)bullChirodontics (Bob Walker)bull Airway Dentistry with Marc Cruz Jeff Rousebull Sleep Dentistrybull Less-than-Six with Kevin Boydbull Intra-mandibular Distraction Osteogenesis (IMDO)
Off My ListAnything that moves the teeth faster in the wrong direction
Whatrsquos an RO to do
To create from what Irsquove learned from the best
a model for others to followhellipespecially orthodontists
Teaching
Mt Sinai Pedo ResidencyAli Attaie
2010-2012
Montefiore Ortho ResidencyTony Maganzini
2012
2009-Present
Mt Sinai School of MedicinePedodontic Residency
Guest SpeakersJim BronsonMike MewKevin BoydSandra KahnJennifer TowRoger PricePaula Fabbie
Damien OrsquoBrien
First clinical program in myofunctional orthodontics
Airway and Facial DevelopmentCollaborative Webcast
Mark Cruz
AAPMD Symposium
wwwaapm
dorg
Annual MeetingApril 25-26 2014
Westin Chicago North Shore
the raphael center for integrative orthodontics
wwwalignminecomwwwbioblocnjcom
wwwmyobracenjcom
Integrative vs Conventional
Integrative vs Conventional
ldquoWith improvements in expansion orthodontics advances in myofunctional orthodontics and the growing recognition about sleep disordered breathing among children and adults it is time for orthodontics to expand its horizons There is now so much more we can oerrdquo
The Raphael name has been associated with high quality orthodontics in New Jersey for over 60 years Dr Barry Raphael has been a university trained orthodontic specialist and a member of the American Association of Orthodontists for 30 years
He has a wide range of techniques and services to offer He has studied oral myology applied kinesiology Buteyko breathing Biobloc Orthotropics and Myobrace as part of his integrative training He can offer Damon Invisalign Insignia and Incognito appliances designs as some of his many conventional orthodontic services too
Dr Raphael teaches his techniques at post-graduate residencies study clubs dental societies and for the Myofunctional Research Co He is available for presentations to any group interested in learning more about the benefits of integrative orthodontics
wwwalignminecomLearn about the choices you have in orthodontics
dr barry raphael Why its
too Early never
1425
bro
ad
str
ee
tc
lifto
n n
j 070
13
973-
778-
4222
fax
973-
778-
9625
nj s
pe
c
368
4
1425 broad street clifton nj 07013973-778-4222
wwwalignminecom
the raphael centerforintegrative orthodontics
the
raph
ael c
ente
r fo
rin
tegr
ativ
e or
thod
onti
cs
Learn about an important choice you need to make before starting braces
the raphael center for integrative education
the raphael center for integrative education
Ongoing Intro to Airway Orthodontics
April Biobloc Study Group
April Training Ortho-Postural Therapists w Roger Price
June MRC Myobrace Basic Series
August Airway Dentistry with Mark Cruz and company
October Advanced MFT with Sandy Coulson
October Less than Six with Kevin Boyd
(who else wants to play)
Mission to create a space for spreading the word about Airway and Orthotropic principles and practice
Orthodontics in the 21st Century
EstheticOrthodontics
AirwayOrthodontics
GeneticTooth-Focused
Dental PerfectionEsthetics Primary
Treating SymptomsAirway Ignorant
AdaptationMuscle-FocusedMedical Better
Esthetics SecondaryTreating Causes
Airway Conscious
The EndAnd
The Beginning
B Hockel 2012 Back
Undoing Bimaxillary Dysplasia
1 Maxillary deconstriction2 Maxillary advancement3 Maxillary impaction4 Mandibular advancement
1 Maxillary Expansion
Treatment for Bimaxillary Dysplasia
ALFCrozat
Bent Wire
HyraxHaas
Niti Exp BioBlocSchwartz
The Farrell BENT WIRE Systemtrade
Recommended Age Group 5-12 yrs
Arch Development in conjunction with the TRAINER Systemtrade
Dr John Mew
Establish Good Habits
1 Breathing through the nose2 Lips together at rest3 Correct tongue position4 No facial muscles moving on swallowing5 Stand and sit in balance6 Breath gently using the diaphragm7 Eat to nourish8 Sleep to rest
Ortho-Postural TrainingWorkshops
Breathing
Nutrition
Posture
Sleep
COPYRIGHTRoger L PriceOctober 2012
Posture Number
Forward head posturecan be a compensationfor a deficient airway
Sleep Screening and Hygiene
SQI = 10 SQI = 98
Integrative Healthcare
Function ProfessionalNasal clearing ENT Pulm MFT BreathingMuscle balance and tone MFT Myofunctional OrthoUndoing damage GP Pedo Ortho OMFSBreathing dynamics OPT MFT Breath PhysiologistPosture DC OPT PT OsteopathCranial balance OsteopathNutrition RDH Nutritionist Dietitian Sleep ENT Sleep Med DentNeurocognitive development Pedrsquon SLP Psych SpEd
The Interdisciplinary Center
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Now that I know
My personal missionTo create from what Irsquove
learned from the besta model for others to followhellipespecially the orthodontists
Myofunctional Orthodontics
Chris Farrell
John Flutter
German Ramierez
Damien OrsquoBrien
Myofunctional Research CoRancho Cucamonga
2008-2012
Oral Myology
Oral Myology Basic CourseJoy MoellerNYC 2011LA 2012
Oral Myology Levels 2 3Kim BenkertClifton 2012
Habit CessationShari GreenClifton 2013
Biobloc Orthotropics
BBO Mini-residencyBill Hang
Agora Hills2012-13
BBO IntensiveDrs John and Mike
MewLSFO2013
Breathing and Sleep
Buteyko MentorshipThe Breathing Center
Woodstock2010
Breathing Well ProgrammeJohn Flutter
2010 Ortho-Postural TrainingRoger Price
2013
Sleep DentistryMichael Gelb etal
NYU2012
ALF and Cranial
Jim Bronson2013 Tasha Turzo
Cranial Academy2014
Bucket Listbull ALF and Crozat (Bronsonrsquos course)bullMore on Biobloc (Hangrsquos Advanced London School)bull More Cranial (The Farm)bullChirodontics (Bob Walker)bull Airway Dentistry with Marc Cruz Jeff Rousebull Sleep Dentistrybull Less-than-Six with Kevin Boydbull Intra-mandibular Distraction Osteogenesis (IMDO)
Off My ListAnything that moves the teeth faster in the wrong direction
Whatrsquos an RO to do
To create from what Irsquove learned from the best
a model for others to followhellipespecially orthodontists
Teaching
Mt Sinai Pedo ResidencyAli Attaie
2010-2012
Montefiore Ortho ResidencyTony Maganzini
2012
2009-Present
Mt Sinai School of MedicinePedodontic Residency
Guest SpeakersJim BronsonMike MewKevin BoydSandra KahnJennifer TowRoger PricePaula Fabbie
Damien OrsquoBrien
First clinical program in myofunctional orthodontics
Airway and Facial DevelopmentCollaborative Webcast
Mark Cruz
AAPMD Symposium
wwwaapm
dorg
Annual MeetingApril 25-26 2014
Westin Chicago North Shore
the raphael center for integrative orthodontics
wwwalignminecomwwwbioblocnjcom
wwwmyobracenjcom
Integrative vs Conventional
Integrative vs Conventional
ldquoWith improvements in expansion orthodontics advances in myofunctional orthodontics and the growing recognition about sleep disordered breathing among children and adults it is time for orthodontics to expand its horizons There is now so much more we can oerrdquo
The Raphael name has been associated with high quality orthodontics in New Jersey for over 60 years Dr Barry Raphael has been a university trained orthodontic specialist and a member of the American Association of Orthodontists for 30 years
He has a wide range of techniques and services to offer He has studied oral myology applied kinesiology Buteyko breathing Biobloc Orthotropics and Myobrace as part of his integrative training He can offer Damon Invisalign Insignia and Incognito appliances designs as some of his many conventional orthodontic services too
Dr Raphael teaches his techniques at post-graduate residencies study clubs dental societies and for the Myofunctional Research Co He is available for presentations to any group interested in learning more about the benefits of integrative orthodontics
wwwalignminecomLearn about the choices you have in orthodontics
dr barry raphael Why its
too Early never
1425
bro
ad
str
ee
tc
lifto
n n
j 070
13
973-
778-
4222
fax
973-
778-
9625
nj s
pe
c
368
4
1425 broad street clifton nj 07013973-778-4222
wwwalignminecom
the raphael centerforintegrative orthodontics
the
raph
ael c
ente
r fo
rin
tegr
ativ
e or
thod
onti
cs
Learn about an important choice you need to make before starting braces
the raphael center for integrative education
the raphael center for integrative education
Ongoing Intro to Airway Orthodontics
April Biobloc Study Group
April Training Ortho-Postural Therapists w Roger Price
June MRC Myobrace Basic Series
August Airway Dentistry with Mark Cruz and company
October Advanced MFT with Sandy Coulson
October Less than Six with Kevin Boyd
(who else wants to play)
Mission to create a space for spreading the word about Airway and Orthotropic principles and practice
Orthodontics in the 21st Century
EstheticOrthodontics
AirwayOrthodontics
GeneticTooth-Focused
Dental PerfectionEsthetics Primary
Treating SymptomsAirway Ignorant
AdaptationMuscle-FocusedMedical Better
Esthetics SecondaryTreating Causes
Airway Conscious
The EndAnd
The Beginning
1 Maxillary Expansion
Treatment for Bimaxillary Dysplasia
ALFCrozat
Bent Wire
HyraxHaas
Niti Exp BioBlocSchwartz
The Farrell BENT WIRE Systemtrade
Recommended Age Group 5-12 yrs
Arch Development in conjunction with the TRAINER Systemtrade
Dr John Mew
Establish Good Habits
1 Breathing through the nose2 Lips together at rest3 Correct tongue position4 No facial muscles moving on swallowing5 Stand and sit in balance6 Breath gently using the diaphragm7 Eat to nourish8 Sleep to rest
Ortho-Postural TrainingWorkshops
Breathing
Nutrition
Posture
Sleep
COPYRIGHTRoger L PriceOctober 2012
Posture Number
Forward head posturecan be a compensationfor a deficient airway
Sleep Screening and Hygiene
SQI = 10 SQI = 98
Integrative Healthcare
Function ProfessionalNasal clearing ENT Pulm MFT BreathingMuscle balance and tone MFT Myofunctional OrthoUndoing damage GP Pedo Ortho OMFSBreathing dynamics OPT MFT Breath PhysiologistPosture DC OPT PT OsteopathCranial balance OsteopathNutrition RDH Nutritionist Dietitian Sleep ENT Sleep Med DentNeurocognitive development Pedrsquon SLP Psych SpEd
The Interdisciplinary Center
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Now that I know
My personal missionTo create from what Irsquove
learned from the besta model for others to followhellipespecially the orthodontists
Myofunctional Orthodontics
Chris Farrell
John Flutter
German Ramierez
Damien OrsquoBrien
Myofunctional Research CoRancho Cucamonga
2008-2012
Oral Myology
Oral Myology Basic CourseJoy MoellerNYC 2011LA 2012
Oral Myology Levels 2 3Kim BenkertClifton 2012
Habit CessationShari GreenClifton 2013
Biobloc Orthotropics
BBO Mini-residencyBill Hang
Agora Hills2012-13
BBO IntensiveDrs John and Mike
MewLSFO2013
Breathing and Sleep
Buteyko MentorshipThe Breathing Center
Woodstock2010
Breathing Well ProgrammeJohn Flutter
2010 Ortho-Postural TrainingRoger Price
2013
Sleep DentistryMichael Gelb etal
NYU2012
ALF and Cranial
Jim Bronson2013 Tasha Turzo
Cranial Academy2014
Bucket Listbull ALF and Crozat (Bronsonrsquos course)bullMore on Biobloc (Hangrsquos Advanced London School)bull More Cranial (The Farm)bullChirodontics (Bob Walker)bull Airway Dentistry with Marc Cruz Jeff Rousebull Sleep Dentistrybull Less-than-Six with Kevin Boydbull Intra-mandibular Distraction Osteogenesis (IMDO)
Off My ListAnything that moves the teeth faster in the wrong direction
Whatrsquos an RO to do
To create from what Irsquove learned from the best
a model for others to followhellipespecially orthodontists
Teaching
Mt Sinai Pedo ResidencyAli Attaie
2010-2012
Montefiore Ortho ResidencyTony Maganzini
2012
2009-Present
Mt Sinai School of MedicinePedodontic Residency
Guest SpeakersJim BronsonMike MewKevin BoydSandra KahnJennifer TowRoger PricePaula Fabbie
Damien OrsquoBrien
First clinical program in myofunctional orthodontics
Airway and Facial DevelopmentCollaborative Webcast
Mark Cruz
AAPMD Symposium
wwwaapm
dorg
Annual MeetingApril 25-26 2014
Westin Chicago North Shore
the raphael center for integrative orthodontics
wwwalignminecomwwwbioblocnjcom
wwwmyobracenjcom
Integrative vs Conventional
Integrative vs Conventional
ldquoWith improvements in expansion orthodontics advances in myofunctional orthodontics and the growing recognition about sleep disordered breathing among children and adults it is time for orthodontics to expand its horizons There is now so much more we can oerrdquo
The Raphael name has been associated with high quality orthodontics in New Jersey for over 60 years Dr Barry Raphael has been a university trained orthodontic specialist and a member of the American Association of Orthodontists for 30 years
He has a wide range of techniques and services to offer He has studied oral myology applied kinesiology Buteyko breathing Biobloc Orthotropics and Myobrace as part of his integrative training He can offer Damon Invisalign Insignia and Incognito appliances designs as some of his many conventional orthodontic services too
Dr Raphael teaches his techniques at post-graduate residencies study clubs dental societies and for the Myofunctional Research Co He is available for presentations to any group interested in learning more about the benefits of integrative orthodontics
wwwalignminecomLearn about the choices you have in orthodontics
dr barry raphael Why its
too Early never
1425
bro
ad
str
ee
tc
lifto
n n
j 070
13
973-
778-
4222
fax
973-
778-
9625
nj s
pe
c
368
4
1425 broad street clifton nj 07013973-778-4222
wwwalignminecom
the raphael centerforintegrative orthodontics
the
raph
ael c
ente
r fo
rin
tegr
ativ
e or
thod
onti
cs
Learn about an important choice you need to make before starting braces
the raphael center for integrative education
the raphael center for integrative education
Ongoing Intro to Airway Orthodontics
April Biobloc Study Group
April Training Ortho-Postural Therapists w Roger Price
June MRC Myobrace Basic Series
August Airway Dentistry with Mark Cruz and company
October Advanced MFT with Sandy Coulson
October Less than Six with Kevin Boyd
(who else wants to play)
Mission to create a space for spreading the word about Airway and Orthotropic principles and practice
Orthodontics in the 21st Century
EstheticOrthodontics
AirwayOrthodontics
GeneticTooth-Focused
Dental PerfectionEsthetics Primary
Treating SymptomsAirway Ignorant
AdaptationMuscle-FocusedMedical Better
Esthetics SecondaryTreating Causes
Airway Conscious
The EndAnd
The Beginning
The Farrell BENT WIRE Systemtrade
Recommended Age Group 5-12 yrs
Arch Development in conjunction with the TRAINER Systemtrade
Dr John Mew
Establish Good Habits
1 Breathing through the nose2 Lips together at rest3 Correct tongue position4 No facial muscles moving on swallowing5 Stand and sit in balance6 Breath gently using the diaphragm7 Eat to nourish8 Sleep to rest
Ortho-Postural TrainingWorkshops
Breathing
Nutrition
Posture
Sleep
COPYRIGHTRoger L PriceOctober 2012
Posture Number
Forward head posturecan be a compensationfor a deficient airway
Sleep Screening and Hygiene
SQI = 10 SQI = 98
Integrative Healthcare
Function ProfessionalNasal clearing ENT Pulm MFT BreathingMuscle balance and tone MFT Myofunctional OrthoUndoing damage GP Pedo Ortho OMFSBreathing dynamics OPT MFT Breath PhysiologistPosture DC OPT PT OsteopathCranial balance OsteopathNutrition RDH Nutritionist Dietitian Sleep ENT Sleep Med DentNeurocognitive development Pedrsquon SLP Psych SpEd
The Interdisciplinary Center
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Now that I know
My personal missionTo create from what Irsquove
learned from the besta model for others to followhellipespecially the orthodontists
Myofunctional Orthodontics
Chris Farrell
John Flutter
German Ramierez
Damien OrsquoBrien
Myofunctional Research CoRancho Cucamonga
2008-2012
Oral Myology
Oral Myology Basic CourseJoy MoellerNYC 2011LA 2012
Oral Myology Levels 2 3Kim BenkertClifton 2012
Habit CessationShari GreenClifton 2013
Biobloc Orthotropics
BBO Mini-residencyBill Hang
Agora Hills2012-13
BBO IntensiveDrs John and Mike
MewLSFO2013
Breathing and Sleep
Buteyko MentorshipThe Breathing Center
Woodstock2010
Breathing Well ProgrammeJohn Flutter
2010 Ortho-Postural TrainingRoger Price
2013
Sleep DentistryMichael Gelb etal
NYU2012
ALF and Cranial
Jim Bronson2013 Tasha Turzo
Cranial Academy2014
Bucket Listbull ALF and Crozat (Bronsonrsquos course)bullMore on Biobloc (Hangrsquos Advanced London School)bull More Cranial (The Farm)bullChirodontics (Bob Walker)bull Airway Dentistry with Marc Cruz Jeff Rousebull Sleep Dentistrybull Less-than-Six with Kevin Boydbull Intra-mandibular Distraction Osteogenesis (IMDO)
Off My ListAnything that moves the teeth faster in the wrong direction
Whatrsquos an RO to do
To create from what Irsquove learned from the best
a model for others to followhellipespecially orthodontists
Teaching
Mt Sinai Pedo ResidencyAli Attaie
2010-2012
Montefiore Ortho ResidencyTony Maganzini
2012
2009-Present
Mt Sinai School of MedicinePedodontic Residency
Guest SpeakersJim BronsonMike MewKevin BoydSandra KahnJennifer TowRoger PricePaula Fabbie
Damien OrsquoBrien
First clinical program in myofunctional orthodontics
Airway and Facial DevelopmentCollaborative Webcast
Mark Cruz
AAPMD Symposium
wwwaapm
dorg
Annual MeetingApril 25-26 2014
Westin Chicago North Shore
the raphael center for integrative orthodontics
wwwalignminecomwwwbioblocnjcom
wwwmyobracenjcom
Integrative vs Conventional
Integrative vs Conventional
ldquoWith improvements in expansion orthodontics advances in myofunctional orthodontics and the growing recognition about sleep disordered breathing among children and adults it is time for orthodontics to expand its horizons There is now so much more we can oerrdquo
The Raphael name has been associated with high quality orthodontics in New Jersey for over 60 years Dr Barry Raphael has been a university trained orthodontic specialist and a member of the American Association of Orthodontists for 30 years
He has a wide range of techniques and services to offer He has studied oral myology applied kinesiology Buteyko breathing Biobloc Orthotropics and Myobrace as part of his integrative training He can offer Damon Invisalign Insignia and Incognito appliances designs as some of his many conventional orthodontic services too
Dr Raphael teaches his techniques at post-graduate residencies study clubs dental societies and for the Myofunctional Research Co He is available for presentations to any group interested in learning more about the benefits of integrative orthodontics
wwwalignminecomLearn about the choices you have in orthodontics
dr barry raphael Why its
too Early never
1425
bro
ad
str
ee
tc
lifto
n n
j 070
13
973-
778-
4222
fax
973-
778-
9625
nj s
pe
c
368
4
1425 broad street clifton nj 07013973-778-4222
wwwalignminecom
the raphael centerforintegrative orthodontics
the
raph
ael c
ente
r fo
rin
tegr
ativ
e or
thod
onti
cs
Learn about an important choice you need to make before starting braces
the raphael center for integrative education
the raphael center for integrative education
Ongoing Intro to Airway Orthodontics
April Biobloc Study Group
April Training Ortho-Postural Therapists w Roger Price
June MRC Myobrace Basic Series
August Airway Dentistry with Mark Cruz and company
October Advanced MFT with Sandy Coulson
October Less than Six with Kevin Boyd
(who else wants to play)
Mission to create a space for spreading the word about Airway and Orthotropic principles and practice
Orthodontics in the 21st Century
EstheticOrthodontics
AirwayOrthodontics
GeneticTooth-Focused
Dental PerfectionEsthetics Primary
Treating SymptomsAirway Ignorant
AdaptationMuscle-FocusedMedical Better
Esthetics SecondaryTreating Causes
Airway Conscious
The EndAnd
The Beginning
Recommended Age Group 5-12 yrs
Arch Development in conjunction with the TRAINER Systemtrade
Dr John Mew
Establish Good Habits
1 Breathing through the nose2 Lips together at rest3 Correct tongue position4 No facial muscles moving on swallowing5 Stand and sit in balance6 Breath gently using the diaphragm7 Eat to nourish8 Sleep to rest
Ortho-Postural TrainingWorkshops
Breathing
Nutrition
Posture
Sleep
COPYRIGHTRoger L PriceOctober 2012
Posture Number
Forward head posturecan be a compensationfor a deficient airway
Sleep Screening and Hygiene
SQI = 10 SQI = 98
Integrative Healthcare
Function ProfessionalNasal clearing ENT Pulm MFT BreathingMuscle balance and tone MFT Myofunctional OrthoUndoing damage GP Pedo Ortho OMFSBreathing dynamics OPT MFT Breath PhysiologistPosture DC OPT PT OsteopathCranial balance OsteopathNutrition RDH Nutritionist Dietitian Sleep ENT Sleep Med DentNeurocognitive development Pedrsquon SLP Psych SpEd
The Interdisciplinary Center
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Now that I know
My personal missionTo create from what Irsquove
learned from the besta model for others to followhellipespecially the orthodontists
Myofunctional Orthodontics
Chris Farrell
John Flutter
German Ramierez
Damien OrsquoBrien
Myofunctional Research CoRancho Cucamonga
2008-2012
Oral Myology
Oral Myology Basic CourseJoy MoellerNYC 2011LA 2012
Oral Myology Levels 2 3Kim BenkertClifton 2012
Habit CessationShari GreenClifton 2013
Biobloc Orthotropics
BBO Mini-residencyBill Hang
Agora Hills2012-13
BBO IntensiveDrs John and Mike
MewLSFO2013
Breathing and Sleep
Buteyko MentorshipThe Breathing Center
Woodstock2010
Breathing Well ProgrammeJohn Flutter
2010 Ortho-Postural TrainingRoger Price
2013
Sleep DentistryMichael Gelb etal
NYU2012
ALF and Cranial
Jim Bronson2013 Tasha Turzo
Cranial Academy2014
Bucket Listbull ALF and Crozat (Bronsonrsquos course)bullMore on Biobloc (Hangrsquos Advanced London School)bull More Cranial (The Farm)bullChirodontics (Bob Walker)bull Airway Dentistry with Marc Cruz Jeff Rousebull Sleep Dentistrybull Less-than-Six with Kevin Boydbull Intra-mandibular Distraction Osteogenesis (IMDO)
Off My ListAnything that moves the teeth faster in the wrong direction
Whatrsquos an RO to do
To create from what Irsquove learned from the best
a model for others to followhellipespecially orthodontists
Teaching
Mt Sinai Pedo ResidencyAli Attaie
2010-2012
Montefiore Ortho ResidencyTony Maganzini
2012
2009-Present
Mt Sinai School of MedicinePedodontic Residency
Guest SpeakersJim BronsonMike MewKevin BoydSandra KahnJennifer TowRoger PricePaula Fabbie
Damien OrsquoBrien
First clinical program in myofunctional orthodontics
Airway and Facial DevelopmentCollaborative Webcast
Mark Cruz
AAPMD Symposium
wwwaapm
dorg
Annual MeetingApril 25-26 2014
Westin Chicago North Shore
the raphael center for integrative orthodontics
wwwalignminecomwwwbioblocnjcom
wwwmyobracenjcom
Integrative vs Conventional
Integrative vs Conventional
ldquoWith improvements in expansion orthodontics advances in myofunctional orthodontics and the growing recognition about sleep disordered breathing among children and adults it is time for orthodontics to expand its horizons There is now so much more we can oerrdquo
The Raphael name has been associated with high quality orthodontics in New Jersey for over 60 years Dr Barry Raphael has been a university trained orthodontic specialist and a member of the American Association of Orthodontists for 30 years
He has a wide range of techniques and services to offer He has studied oral myology applied kinesiology Buteyko breathing Biobloc Orthotropics and Myobrace as part of his integrative training He can offer Damon Invisalign Insignia and Incognito appliances designs as some of his many conventional orthodontic services too
Dr Raphael teaches his techniques at post-graduate residencies study clubs dental societies and for the Myofunctional Research Co He is available for presentations to any group interested in learning more about the benefits of integrative orthodontics
wwwalignminecomLearn about the choices you have in orthodontics
dr barry raphael Why its
too Early never
1425
bro
ad
str
ee
tc
lifto
n n
j 070
13
973-
778-
4222
fax
973-
778-
9625
nj s
pe
c
368
4
1425 broad street clifton nj 07013973-778-4222
wwwalignminecom
the raphael centerforintegrative orthodontics
the
raph
ael c
ente
r fo
rin
tegr
ativ
e or
thod
onti
cs
Learn about an important choice you need to make before starting braces
the raphael center for integrative education
the raphael center for integrative education
Ongoing Intro to Airway Orthodontics
April Biobloc Study Group
April Training Ortho-Postural Therapists w Roger Price
June MRC Myobrace Basic Series
August Airway Dentistry with Mark Cruz and company
October Advanced MFT with Sandy Coulson
October Less than Six with Kevin Boyd
(who else wants to play)
Mission to create a space for spreading the word about Airway and Orthotropic principles and practice
Orthodontics in the 21st Century
EstheticOrthodontics
AirwayOrthodontics
GeneticTooth-Focused
Dental PerfectionEsthetics Primary
Treating SymptomsAirway Ignorant
AdaptationMuscle-FocusedMedical Better
Esthetics SecondaryTreating Causes
Airway Conscious
The EndAnd
The Beginning
Dr John Mew
Establish Good Habits
1 Breathing through the nose2 Lips together at rest3 Correct tongue position4 No facial muscles moving on swallowing5 Stand and sit in balance6 Breath gently using the diaphragm7 Eat to nourish8 Sleep to rest
Ortho-Postural TrainingWorkshops
Breathing
Nutrition
Posture
Sleep
COPYRIGHTRoger L PriceOctober 2012
Posture Number
Forward head posturecan be a compensationfor a deficient airway
Sleep Screening and Hygiene
SQI = 10 SQI = 98
Integrative Healthcare
Function ProfessionalNasal clearing ENT Pulm MFT BreathingMuscle balance and tone MFT Myofunctional OrthoUndoing damage GP Pedo Ortho OMFSBreathing dynamics OPT MFT Breath PhysiologistPosture DC OPT PT OsteopathCranial balance OsteopathNutrition RDH Nutritionist Dietitian Sleep ENT Sleep Med DentNeurocognitive development Pedrsquon SLP Psych SpEd
The Interdisciplinary Center
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Now that I know
My personal missionTo create from what Irsquove
learned from the besta model for others to followhellipespecially the orthodontists
Myofunctional Orthodontics
Chris Farrell
John Flutter
German Ramierez
Damien OrsquoBrien
Myofunctional Research CoRancho Cucamonga
2008-2012
Oral Myology
Oral Myology Basic CourseJoy MoellerNYC 2011LA 2012
Oral Myology Levels 2 3Kim BenkertClifton 2012
Habit CessationShari GreenClifton 2013
Biobloc Orthotropics
BBO Mini-residencyBill Hang
Agora Hills2012-13
BBO IntensiveDrs John and Mike
MewLSFO2013
Breathing and Sleep
Buteyko MentorshipThe Breathing Center
Woodstock2010
Breathing Well ProgrammeJohn Flutter
2010 Ortho-Postural TrainingRoger Price
2013
Sleep DentistryMichael Gelb etal
NYU2012
ALF and Cranial
Jim Bronson2013 Tasha Turzo
Cranial Academy2014
Bucket Listbull ALF and Crozat (Bronsonrsquos course)bullMore on Biobloc (Hangrsquos Advanced London School)bull More Cranial (The Farm)bullChirodontics (Bob Walker)bull Airway Dentistry with Marc Cruz Jeff Rousebull Sleep Dentistrybull Less-than-Six with Kevin Boydbull Intra-mandibular Distraction Osteogenesis (IMDO)
Off My ListAnything that moves the teeth faster in the wrong direction
Whatrsquos an RO to do
To create from what Irsquove learned from the best
a model for others to followhellipespecially orthodontists
Teaching
Mt Sinai Pedo ResidencyAli Attaie
2010-2012
Montefiore Ortho ResidencyTony Maganzini
2012
2009-Present
Mt Sinai School of MedicinePedodontic Residency
Guest SpeakersJim BronsonMike MewKevin BoydSandra KahnJennifer TowRoger PricePaula Fabbie
Damien OrsquoBrien
First clinical program in myofunctional orthodontics
Airway and Facial DevelopmentCollaborative Webcast
Mark Cruz
AAPMD Symposium
wwwaapm
dorg
Annual MeetingApril 25-26 2014
Westin Chicago North Shore
the raphael center for integrative orthodontics
wwwalignminecomwwwbioblocnjcom
wwwmyobracenjcom
Integrative vs Conventional
Integrative vs Conventional
ldquoWith improvements in expansion orthodontics advances in myofunctional orthodontics and the growing recognition about sleep disordered breathing among children and adults it is time for orthodontics to expand its horizons There is now so much more we can oerrdquo
The Raphael name has been associated with high quality orthodontics in New Jersey for over 60 years Dr Barry Raphael has been a university trained orthodontic specialist and a member of the American Association of Orthodontists for 30 years
He has a wide range of techniques and services to offer He has studied oral myology applied kinesiology Buteyko breathing Biobloc Orthotropics and Myobrace as part of his integrative training He can offer Damon Invisalign Insignia and Incognito appliances designs as some of his many conventional orthodontic services too
Dr Raphael teaches his techniques at post-graduate residencies study clubs dental societies and for the Myofunctional Research Co He is available for presentations to any group interested in learning more about the benefits of integrative orthodontics
wwwalignminecomLearn about the choices you have in orthodontics
dr barry raphael Why its
too Early never
1425
bro
ad
str
ee
tc
lifto
n n
j 070
13
973-
778-
4222
fax
973-
778-
9625
nj s
pe
c
368
4
1425 broad street clifton nj 07013973-778-4222
wwwalignminecom
the raphael centerforintegrative orthodontics
the
raph
ael c
ente
r fo
rin
tegr
ativ
e or
thod
onti
cs
Learn about an important choice you need to make before starting braces
the raphael center for integrative education
the raphael center for integrative education
Ongoing Intro to Airway Orthodontics
April Biobloc Study Group
April Training Ortho-Postural Therapists w Roger Price
June MRC Myobrace Basic Series
August Airway Dentistry with Mark Cruz and company
October Advanced MFT with Sandy Coulson
October Less than Six with Kevin Boyd
(who else wants to play)
Mission to create a space for spreading the word about Airway and Orthotropic principles and practice
Orthodontics in the 21st Century
EstheticOrthodontics
AirwayOrthodontics
GeneticTooth-Focused
Dental PerfectionEsthetics Primary
Treating SymptomsAirway Ignorant
AdaptationMuscle-FocusedMedical Better
Esthetics SecondaryTreating Causes
Airway Conscious
The EndAnd
The Beginning
Establish Good Habits
1 Breathing through the nose2 Lips together at rest3 Correct tongue position4 No facial muscles moving on swallowing5 Stand and sit in balance6 Breath gently using the diaphragm7 Eat to nourish8 Sleep to rest
Ortho-Postural TrainingWorkshops
Breathing
Nutrition
Posture
Sleep
COPYRIGHTRoger L PriceOctober 2012
Posture Number
Forward head posturecan be a compensationfor a deficient airway
Sleep Screening and Hygiene
SQI = 10 SQI = 98
Integrative Healthcare
Function ProfessionalNasal clearing ENT Pulm MFT BreathingMuscle balance and tone MFT Myofunctional OrthoUndoing damage GP Pedo Ortho OMFSBreathing dynamics OPT MFT Breath PhysiologistPosture DC OPT PT OsteopathCranial balance OsteopathNutrition RDH Nutritionist Dietitian Sleep ENT Sleep Med DentNeurocognitive development Pedrsquon SLP Psych SpEd
The Interdisciplinary Center
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Now that I know
My personal missionTo create from what Irsquove
learned from the besta model for others to followhellipespecially the orthodontists
Myofunctional Orthodontics
Chris Farrell
John Flutter
German Ramierez
Damien OrsquoBrien
Myofunctional Research CoRancho Cucamonga
2008-2012
Oral Myology
Oral Myology Basic CourseJoy MoellerNYC 2011LA 2012
Oral Myology Levels 2 3Kim BenkertClifton 2012
Habit CessationShari GreenClifton 2013
Biobloc Orthotropics
BBO Mini-residencyBill Hang
Agora Hills2012-13
BBO IntensiveDrs John and Mike
MewLSFO2013
Breathing and Sleep
Buteyko MentorshipThe Breathing Center
Woodstock2010
Breathing Well ProgrammeJohn Flutter
2010 Ortho-Postural TrainingRoger Price
2013
Sleep DentistryMichael Gelb etal
NYU2012
ALF and Cranial
Jim Bronson2013 Tasha Turzo
Cranial Academy2014
Bucket Listbull ALF and Crozat (Bronsonrsquos course)bullMore on Biobloc (Hangrsquos Advanced London School)bull More Cranial (The Farm)bullChirodontics (Bob Walker)bull Airway Dentistry with Marc Cruz Jeff Rousebull Sleep Dentistrybull Less-than-Six with Kevin Boydbull Intra-mandibular Distraction Osteogenesis (IMDO)
Off My ListAnything that moves the teeth faster in the wrong direction
Whatrsquos an RO to do
To create from what Irsquove learned from the best
a model for others to followhellipespecially orthodontists
Teaching
Mt Sinai Pedo ResidencyAli Attaie
2010-2012
Montefiore Ortho ResidencyTony Maganzini
2012
2009-Present
Mt Sinai School of MedicinePedodontic Residency
Guest SpeakersJim BronsonMike MewKevin BoydSandra KahnJennifer TowRoger PricePaula Fabbie
Damien OrsquoBrien
First clinical program in myofunctional orthodontics
Airway and Facial DevelopmentCollaborative Webcast
Mark Cruz
AAPMD Symposium
wwwaapm
dorg
Annual MeetingApril 25-26 2014
Westin Chicago North Shore
the raphael center for integrative orthodontics
wwwalignminecomwwwbioblocnjcom
wwwmyobracenjcom
Integrative vs Conventional
Integrative vs Conventional
ldquoWith improvements in expansion orthodontics advances in myofunctional orthodontics and the growing recognition about sleep disordered breathing among children and adults it is time for orthodontics to expand its horizons There is now so much more we can oerrdquo
The Raphael name has been associated with high quality orthodontics in New Jersey for over 60 years Dr Barry Raphael has been a university trained orthodontic specialist and a member of the American Association of Orthodontists for 30 years
He has a wide range of techniques and services to offer He has studied oral myology applied kinesiology Buteyko breathing Biobloc Orthotropics and Myobrace as part of his integrative training He can offer Damon Invisalign Insignia and Incognito appliances designs as some of his many conventional orthodontic services too
Dr Raphael teaches his techniques at post-graduate residencies study clubs dental societies and for the Myofunctional Research Co He is available for presentations to any group interested in learning more about the benefits of integrative orthodontics
wwwalignminecomLearn about the choices you have in orthodontics
dr barry raphael Why its
too Early never
1425
bro
ad
str
ee
tc
lifto
n n
j 070
13
973-
778-
4222
fax
973-
778-
9625
nj s
pe
c
368
4
1425 broad street clifton nj 07013973-778-4222
wwwalignminecom
the raphael centerforintegrative orthodontics
the
raph
ael c
ente
r fo
rin
tegr
ativ
e or
thod
onti
cs
Learn about an important choice you need to make before starting braces
the raphael center for integrative education
the raphael center for integrative education
Ongoing Intro to Airway Orthodontics
April Biobloc Study Group
April Training Ortho-Postural Therapists w Roger Price
June MRC Myobrace Basic Series
August Airway Dentistry with Mark Cruz and company
October Advanced MFT with Sandy Coulson
October Less than Six with Kevin Boyd
(who else wants to play)
Mission to create a space for spreading the word about Airway and Orthotropic principles and practice
Orthodontics in the 21st Century
EstheticOrthodontics
AirwayOrthodontics
GeneticTooth-Focused
Dental PerfectionEsthetics Primary
Treating SymptomsAirway Ignorant
AdaptationMuscle-FocusedMedical Better
Esthetics SecondaryTreating Causes
Airway Conscious
The EndAnd
The Beginning
Ortho-Postural TrainingWorkshops
Breathing
Nutrition
Posture
Sleep
COPYRIGHTRoger L PriceOctober 2012
Posture Number
Forward head posturecan be a compensationfor a deficient airway
Sleep Screening and Hygiene
SQI = 10 SQI = 98
Integrative Healthcare
Function ProfessionalNasal clearing ENT Pulm MFT BreathingMuscle balance and tone MFT Myofunctional OrthoUndoing damage GP Pedo Ortho OMFSBreathing dynamics OPT MFT Breath PhysiologistPosture DC OPT PT OsteopathCranial balance OsteopathNutrition RDH Nutritionist Dietitian Sleep ENT Sleep Med DentNeurocognitive development Pedrsquon SLP Psych SpEd
The Interdisciplinary Center
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Now that I know
My personal missionTo create from what Irsquove
learned from the besta model for others to followhellipespecially the orthodontists
Myofunctional Orthodontics
Chris Farrell
John Flutter
German Ramierez
Damien OrsquoBrien
Myofunctional Research CoRancho Cucamonga
2008-2012
Oral Myology
Oral Myology Basic CourseJoy MoellerNYC 2011LA 2012
Oral Myology Levels 2 3Kim BenkertClifton 2012
Habit CessationShari GreenClifton 2013
Biobloc Orthotropics
BBO Mini-residencyBill Hang
Agora Hills2012-13
BBO IntensiveDrs John and Mike
MewLSFO2013
Breathing and Sleep
Buteyko MentorshipThe Breathing Center
Woodstock2010
Breathing Well ProgrammeJohn Flutter
2010 Ortho-Postural TrainingRoger Price
2013
Sleep DentistryMichael Gelb etal
NYU2012
ALF and Cranial
Jim Bronson2013 Tasha Turzo
Cranial Academy2014
Bucket Listbull ALF and Crozat (Bronsonrsquos course)bullMore on Biobloc (Hangrsquos Advanced London School)bull More Cranial (The Farm)bullChirodontics (Bob Walker)bull Airway Dentistry with Marc Cruz Jeff Rousebull Sleep Dentistrybull Less-than-Six with Kevin Boydbull Intra-mandibular Distraction Osteogenesis (IMDO)
Off My ListAnything that moves the teeth faster in the wrong direction
Whatrsquos an RO to do
To create from what Irsquove learned from the best
a model for others to followhellipespecially orthodontists
Teaching
Mt Sinai Pedo ResidencyAli Attaie
2010-2012
Montefiore Ortho ResidencyTony Maganzini
2012
2009-Present
Mt Sinai School of MedicinePedodontic Residency
Guest SpeakersJim BronsonMike MewKevin BoydSandra KahnJennifer TowRoger PricePaula Fabbie
Damien OrsquoBrien
First clinical program in myofunctional orthodontics
Airway and Facial DevelopmentCollaborative Webcast
Mark Cruz
AAPMD Symposium
wwwaapm
dorg
Annual MeetingApril 25-26 2014
Westin Chicago North Shore
the raphael center for integrative orthodontics
wwwalignminecomwwwbioblocnjcom
wwwmyobracenjcom
Integrative vs Conventional
Integrative vs Conventional
ldquoWith improvements in expansion orthodontics advances in myofunctional orthodontics and the growing recognition about sleep disordered breathing among children and adults it is time for orthodontics to expand its horizons There is now so much more we can oerrdquo
The Raphael name has been associated with high quality orthodontics in New Jersey for over 60 years Dr Barry Raphael has been a university trained orthodontic specialist and a member of the American Association of Orthodontists for 30 years
He has a wide range of techniques and services to offer He has studied oral myology applied kinesiology Buteyko breathing Biobloc Orthotropics and Myobrace as part of his integrative training He can offer Damon Invisalign Insignia and Incognito appliances designs as some of his many conventional orthodontic services too
Dr Raphael teaches his techniques at post-graduate residencies study clubs dental societies and for the Myofunctional Research Co He is available for presentations to any group interested in learning more about the benefits of integrative orthodontics
wwwalignminecomLearn about the choices you have in orthodontics
dr barry raphael Why its
too Early never
1425
bro
ad
str
ee
tc
lifto
n n
j 070
13
973-
778-
4222
fax
973-
778-
9625
nj s
pe
c
368
4
1425 broad street clifton nj 07013973-778-4222
wwwalignminecom
the raphael centerforintegrative orthodontics
the
raph
ael c
ente
r fo
rin
tegr
ativ
e or
thod
onti
cs
Learn about an important choice you need to make before starting braces
the raphael center for integrative education
the raphael center for integrative education
Ongoing Intro to Airway Orthodontics
April Biobloc Study Group
April Training Ortho-Postural Therapists w Roger Price
June MRC Myobrace Basic Series
August Airway Dentistry with Mark Cruz and company
October Advanced MFT with Sandy Coulson
October Less than Six with Kevin Boyd
(who else wants to play)
Mission to create a space for spreading the word about Airway and Orthotropic principles and practice
Orthodontics in the 21st Century
EstheticOrthodontics
AirwayOrthodontics
GeneticTooth-Focused
Dental PerfectionEsthetics Primary
Treating SymptomsAirway Ignorant
AdaptationMuscle-FocusedMedical Better
Esthetics SecondaryTreating Causes
Airway Conscious
The EndAnd
The Beginning
COPYRIGHTRoger L PriceOctober 2012
Posture Number
Forward head posturecan be a compensationfor a deficient airway
Sleep Screening and Hygiene
SQI = 10 SQI = 98
Integrative Healthcare
Function ProfessionalNasal clearing ENT Pulm MFT BreathingMuscle balance and tone MFT Myofunctional OrthoUndoing damage GP Pedo Ortho OMFSBreathing dynamics OPT MFT Breath PhysiologistPosture DC OPT PT OsteopathCranial balance OsteopathNutrition RDH Nutritionist Dietitian Sleep ENT Sleep Med DentNeurocognitive development Pedrsquon SLP Psych SpEd
The Interdisciplinary Center
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Now that I know
My personal missionTo create from what Irsquove
learned from the besta model for others to followhellipespecially the orthodontists
Myofunctional Orthodontics
Chris Farrell
John Flutter
German Ramierez
Damien OrsquoBrien
Myofunctional Research CoRancho Cucamonga
2008-2012
Oral Myology
Oral Myology Basic CourseJoy MoellerNYC 2011LA 2012
Oral Myology Levels 2 3Kim BenkertClifton 2012
Habit CessationShari GreenClifton 2013
Biobloc Orthotropics
BBO Mini-residencyBill Hang
Agora Hills2012-13
BBO IntensiveDrs John and Mike
MewLSFO2013
Breathing and Sleep
Buteyko MentorshipThe Breathing Center
Woodstock2010
Breathing Well ProgrammeJohn Flutter
2010 Ortho-Postural TrainingRoger Price
2013
Sleep DentistryMichael Gelb etal
NYU2012
ALF and Cranial
Jim Bronson2013 Tasha Turzo
Cranial Academy2014
Bucket Listbull ALF and Crozat (Bronsonrsquos course)bullMore on Biobloc (Hangrsquos Advanced London School)bull More Cranial (The Farm)bullChirodontics (Bob Walker)bull Airway Dentistry with Marc Cruz Jeff Rousebull Sleep Dentistrybull Less-than-Six with Kevin Boydbull Intra-mandibular Distraction Osteogenesis (IMDO)
Off My ListAnything that moves the teeth faster in the wrong direction
Whatrsquos an RO to do
To create from what Irsquove learned from the best
a model for others to followhellipespecially orthodontists
Teaching
Mt Sinai Pedo ResidencyAli Attaie
2010-2012
Montefiore Ortho ResidencyTony Maganzini
2012
2009-Present
Mt Sinai School of MedicinePedodontic Residency
Guest SpeakersJim BronsonMike MewKevin BoydSandra KahnJennifer TowRoger PricePaula Fabbie
Damien OrsquoBrien
First clinical program in myofunctional orthodontics
Airway and Facial DevelopmentCollaborative Webcast
Mark Cruz
AAPMD Symposium
wwwaapm
dorg
Annual MeetingApril 25-26 2014
Westin Chicago North Shore
the raphael center for integrative orthodontics
wwwalignminecomwwwbioblocnjcom
wwwmyobracenjcom
Integrative vs Conventional
Integrative vs Conventional
ldquoWith improvements in expansion orthodontics advances in myofunctional orthodontics and the growing recognition about sleep disordered breathing among children and adults it is time for orthodontics to expand its horizons There is now so much more we can oerrdquo
The Raphael name has been associated with high quality orthodontics in New Jersey for over 60 years Dr Barry Raphael has been a university trained orthodontic specialist and a member of the American Association of Orthodontists for 30 years
He has a wide range of techniques and services to offer He has studied oral myology applied kinesiology Buteyko breathing Biobloc Orthotropics and Myobrace as part of his integrative training He can offer Damon Invisalign Insignia and Incognito appliances designs as some of his many conventional orthodontic services too
Dr Raphael teaches his techniques at post-graduate residencies study clubs dental societies and for the Myofunctional Research Co He is available for presentations to any group interested in learning more about the benefits of integrative orthodontics
wwwalignminecomLearn about the choices you have in orthodontics
dr barry raphael Why its
too Early never
1425
bro
ad
str
ee
tc
lifto
n n
j 070
13
973-
778-
4222
fax
973-
778-
9625
nj s
pe
c
368
4
1425 broad street clifton nj 07013973-778-4222
wwwalignminecom
the raphael centerforintegrative orthodontics
the
raph
ael c
ente
r fo
rin
tegr
ativ
e or
thod
onti
cs
Learn about an important choice you need to make before starting braces
the raphael center for integrative education
the raphael center for integrative education
Ongoing Intro to Airway Orthodontics
April Biobloc Study Group
April Training Ortho-Postural Therapists w Roger Price
June MRC Myobrace Basic Series
August Airway Dentistry with Mark Cruz and company
October Advanced MFT with Sandy Coulson
October Less than Six with Kevin Boyd
(who else wants to play)
Mission to create a space for spreading the word about Airway and Orthotropic principles and practice
Orthodontics in the 21st Century
EstheticOrthodontics
AirwayOrthodontics
GeneticTooth-Focused
Dental PerfectionEsthetics Primary
Treating SymptomsAirway Ignorant
AdaptationMuscle-FocusedMedical Better
Esthetics SecondaryTreating Causes
Airway Conscious
The EndAnd
The Beginning
Posture Number
Forward head posturecan be a compensationfor a deficient airway
Sleep Screening and Hygiene
SQI = 10 SQI = 98
Integrative Healthcare
Function ProfessionalNasal clearing ENT Pulm MFT BreathingMuscle balance and tone MFT Myofunctional OrthoUndoing damage GP Pedo Ortho OMFSBreathing dynamics OPT MFT Breath PhysiologistPosture DC OPT PT OsteopathCranial balance OsteopathNutrition RDH Nutritionist Dietitian Sleep ENT Sleep Med DentNeurocognitive development Pedrsquon SLP Psych SpEd
The Interdisciplinary Center
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Now that I know
My personal missionTo create from what Irsquove
learned from the besta model for others to followhellipespecially the orthodontists
Myofunctional Orthodontics
Chris Farrell
John Flutter
German Ramierez
Damien OrsquoBrien
Myofunctional Research CoRancho Cucamonga
2008-2012
Oral Myology
Oral Myology Basic CourseJoy MoellerNYC 2011LA 2012
Oral Myology Levels 2 3Kim BenkertClifton 2012
Habit CessationShari GreenClifton 2013
Biobloc Orthotropics
BBO Mini-residencyBill Hang
Agora Hills2012-13
BBO IntensiveDrs John and Mike
MewLSFO2013
Breathing and Sleep
Buteyko MentorshipThe Breathing Center
Woodstock2010
Breathing Well ProgrammeJohn Flutter
2010 Ortho-Postural TrainingRoger Price
2013
Sleep DentistryMichael Gelb etal
NYU2012
ALF and Cranial
Jim Bronson2013 Tasha Turzo
Cranial Academy2014
Bucket Listbull ALF and Crozat (Bronsonrsquos course)bullMore on Biobloc (Hangrsquos Advanced London School)bull More Cranial (The Farm)bullChirodontics (Bob Walker)bull Airway Dentistry with Marc Cruz Jeff Rousebull Sleep Dentistrybull Less-than-Six with Kevin Boydbull Intra-mandibular Distraction Osteogenesis (IMDO)
Off My ListAnything that moves the teeth faster in the wrong direction
Whatrsquos an RO to do
To create from what Irsquove learned from the best
a model for others to followhellipespecially orthodontists
Teaching
Mt Sinai Pedo ResidencyAli Attaie
2010-2012
Montefiore Ortho ResidencyTony Maganzini
2012
2009-Present
Mt Sinai School of MedicinePedodontic Residency
Guest SpeakersJim BronsonMike MewKevin BoydSandra KahnJennifer TowRoger PricePaula Fabbie
Damien OrsquoBrien
First clinical program in myofunctional orthodontics
Airway and Facial DevelopmentCollaborative Webcast
Mark Cruz
AAPMD Symposium
wwwaapm
dorg
Annual MeetingApril 25-26 2014
Westin Chicago North Shore
the raphael center for integrative orthodontics
wwwalignminecomwwwbioblocnjcom
wwwmyobracenjcom
Integrative vs Conventional
Integrative vs Conventional
ldquoWith improvements in expansion orthodontics advances in myofunctional orthodontics and the growing recognition about sleep disordered breathing among children and adults it is time for orthodontics to expand its horizons There is now so much more we can oerrdquo
The Raphael name has been associated with high quality orthodontics in New Jersey for over 60 years Dr Barry Raphael has been a university trained orthodontic specialist and a member of the American Association of Orthodontists for 30 years
He has a wide range of techniques and services to offer He has studied oral myology applied kinesiology Buteyko breathing Biobloc Orthotropics and Myobrace as part of his integrative training He can offer Damon Invisalign Insignia and Incognito appliances designs as some of his many conventional orthodontic services too
Dr Raphael teaches his techniques at post-graduate residencies study clubs dental societies and for the Myofunctional Research Co He is available for presentations to any group interested in learning more about the benefits of integrative orthodontics
wwwalignminecomLearn about the choices you have in orthodontics
dr barry raphael Why its
too Early never
1425
bro
ad
str
ee
tc
lifto
n n
j 070
13
973-
778-
4222
fax
973-
778-
9625
nj s
pe
c
368
4
1425 broad street clifton nj 07013973-778-4222
wwwalignminecom
the raphael centerforintegrative orthodontics
the
raph
ael c
ente
r fo
rin
tegr
ativ
e or
thod
onti
cs
Learn about an important choice you need to make before starting braces
the raphael center for integrative education
the raphael center for integrative education
Ongoing Intro to Airway Orthodontics
April Biobloc Study Group
April Training Ortho-Postural Therapists w Roger Price
June MRC Myobrace Basic Series
August Airway Dentistry with Mark Cruz and company
October Advanced MFT with Sandy Coulson
October Less than Six with Kevin Boyd
(who else wants to play)
Mission to create a space for spreading the word about Airway and Orthotropic principles and practice
Orthodontics in the 21st Century
EstheticOrthodontics
AirwayOrthodontics
GeneticTooth-Focused
Dental PerfectionEsthetics Primary
Treating SymptomsAirway Ignorant
AdaptationMuscle-FocusedMedical Better
Esthetics SecondaryTreating Causes
Airway Conscious
The EndAnd
The Beginning
Sleep Screening and Hygiene
SQI = 10 SQI = 98
Integrative Healthcare
Function ProfessionalNasal clearing ENT Pulm MFT BreathingMuscle balance and tone MFT Myofunctional OrthoUndoing damage GP Pedo Ortho OMFSBreathing dynamics OPT MFT Breath PhysiologistPosture DC OPT PT OsteopathCranial balance OsteopathNutrition RDH Nutritionist Dietitian Sleep ENT Sleep Med DentNeurocognitive development Pedrsquon SLP Psych SpEd
The Interdisciplinary Center
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Now that I know
My personal missionTo create from what Irsquove
learned from the besta model for others to followhellipespecially the orthodontists
Myofunctional Orthodontics
Chris Farrell
John Flutter
German Ramierez
Damien OrsquoBrien
Myofunctional Research CoRancho Cucamonga
2008-2012
Oral Myology
Oral Myology Basic CourseJoy MoellerNYC 2011LA 2012
Oral Myology Levels 2 3Kim BenkertClifton 2012
Habit CessationShari GreenClifton 2013
Biobloc Orthotropics
BBO Mini-residencyBill Hang
Agora Hills2012-13
BBO IntensiveDrs John and Mike
MewLSFO2013
Breathing and Sleep
Buteyko MentorshipThe Breathing Center
Woodstock2010
Breathing Well ProgrammeJohn Flutter
2010 Ortho-Postural TrainingRoger Price
2013
Sleep DentistryMichael Gelb etal
NYU2012
ALF and Cranial
Jim Bronson2013 Tasha Turzo
Cranial Academy2014
Bucket Listbull ALF and Crozat (Bronsonrsquos course)bullMore on Biobloc (Hangrsquos Advanced London School)bull More Cranial (The Farm)bullChirodontics (Bob Walker)bull Airway Dentistry with Marc Cruz Jeff Rousebull Sleep Dentistrybull Less-than-Six with Kevin Boydbull Intra-mandibular Distraction Osteogenesis (IMDO)
Off My ListAnything that moves the teeth faster in the wrong direction
Whatrsquos an RO to do
To create from what Irsquove learned from the best
a model for others to followhellipespecially orthodontists
Teaching
Mt Sinai Pedo ResidencyAli Attaie
2010-2012
Montefiore Ortho ResidencyTony Maganzini
2012
2009-Present
Mt Sinai School of MedicinePedodontic Residency
Guest SpeakersJim BronsonMike MewKevin BoydSandra KahnJennifer TowRoger PricePaula Fabbie
Damien OrsquoBrien
First clinical program in myofunctional orthodontics
Airway and Facial DevelopmentCollaborative Webcast
Mark Cruz
AAPMD Symposium
wwwaapm
dorg
Annual MeetingApril 25-26 2014
Westin Chicago North Shore
the raphael center for integrative orthodontics
wwwalignminecomwwwbioblocnjcom
wwwmyobracenjcom
Integrative vs Conventional
Integrative vs Conventional
ldquoWith improvements in expansion orthodontics advances in myofunctional orthodontics and the growing recognition about sleep disordered breathing among children and adults it is time for orthodontics to expand its horizons There is now so much more we can oerrdquo
The Raphael name has been associated with high quality orthodontics in New Jersey for over 60 years Dr Barry Raphael has been a university trained orthodontic specialist and a member of the American Association of Orthodontists for 30 years
He has a wide range of techniques and services to offer He has studied oral myology applied kinesiology Buteyko breathing Biobloc Orthotropics and Myobrace as part of his integrative training He can offer Damon Invisalign Insignia and Incognito appliances designs as some of his many conventional orthodontic services too
Dr Raphael teaches his techniques at post-graduate residencies study clubs dental societies and for the Myofunctional Research Co He is available for presentations to any group interested in learning more about the benefits of integrative orthodontics
wwwalignminecomLearn about the choices you have in orthodontics
dr barry raphael Why its
too Early never
1425
bro
ad
str
ee
tc
lifto
n n
j 070
13
973-
778-
4222
fax
973-
778-
9625
nj s
pe
c
368
4
1425 broad street clifton nj 07013973-778-4222
wwwalignminecom
the raphael centerforintegrative orthodontics
the
raph
ael c
ente
r fo
rin
tegr
ativ
e or
thod
onti
cs
Learn about an important choice you need to make before starting braces
the raphael center for integrative education
the raphael center for integrative education
Ongoing Intro to Airway Orthodontics
April Biobloc Study Group
April Training Ortho-Postural Therapists w Roger Price
June MRC Myobrace Basic Series
August Airway Dentistry with Mark Cruz and company
October Advanced MFT with Sandy Coulson
October Less than Six with Kevin Boyd
(who else wants to play)
Mission to create a space for spreading the word about Airway and Orthotropic principles and practice
Orthodontics in the 21st Century
EstheticOrthodontics
AirwayOrthodontics
GeneticTooth-Focused
Dental PerfectionEsthetics Primary
Treating SymptomsAirway Ignorant
AdaptationMuscle-FocusedMedical Better
Esthetics SecondaryTreating Causes
Airway Conscious
The EndAnd
The Beginning
Integrative Healthcare
Function ProfessionalNasal clearing ENT Pulm MFT BreathingMuscle balance and tone MFT Myofunctional OrthoUndoing damage GP Pedo Ortho OMFSBreathing dynamics OPT MFT Breath PhysiologistPosture DC OPT PT OsteopathCranial balance OsteopathNutrition RDH Nutritionist Dietitian Sleep ENT Sleep Med DentNeurocognitive development Pedrsquon SLP Psych SpEd
The Interdisciplinary Center
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Now that I know
My personal missionTo create from what Irsquove
learned from the besta model for others to followhellipespecially the orthodontists
Myofunctional Orthodontics
Chris Farrell
John Flutter
German Ramierez
Damien OrsquoBrien
Myofunctional Research CoRancho Cucamonga
2008-2012
Oral Myology
Oral Myology Basic CourseJoy MoellerNYC 2011LA 2012
Oral Myology Levels 2 3Kim BenkertClifton 2012
Habit CessationShari GreenClifton 2013
Biobloc Orthotropics
BBO Mini-residencyBill Hang
Agora Hills2012-13
BBO IntensiveDrs John and Mike
MewLSFO2013
Breathing and Sleep
Buteyko MentorshipThe Breathing Center
Woodstock2010
Breathing Well ProgrammeJohn Flutter
2010 Ortho-Postural TrainingRoger Price
2013
Sleep DentistryMichael Gelb etal
NYU2012
ALF and Cranial
Jim Bronson2013 Tasha Turzo
Cranial Academy2014
Bucket Listbull ALF and Crozat (Bronsonrsquos course)bullMore on Biobloc (Hangrsquos Advanced London School)bull More Cranial (The Farm)bullChirodontics (Bob Walker)bull Airway Dentistry with Marc Cruz Jeff Rousebull Sleep Dentistrybull Less-than-Six with Kevin Boydbull Intra-mandibular Distraction Osteogenesis (IMDO)
Off My ListAnything that moves the teeth faster in the wrong direction
Whatrsquos an RO to do
To create from what Irsquove learned from the best
a model for others to followhellipespecially orthodontists
Teaching
Mt Sinai Pedo ResidencyAli Attaie
2010-2012
Montefiore Ortho ResidencyTony Maganzini
2012
2009-Present
Mt Sinai School of MedicinePedodontic Residency
Guest SpeakersJim BronsonMike MewKevin BoydSandra KahnJennifer TowRoger PricePaula Fabbie
Damien OrsquoBrien
First clinical program in myofunctional orthodontics
Airway and Facial DevelopmentCollaborative Webcast
Mark Cruz
AAPMD Symposium
wwwaapm
dorg
Annual MeetingApril 25-26 2014
Westin Chicago North Shore
the raphael center for integrative orthodontics
wwwalignminecomwwwbioblocnjcom
wwwmyobracenjcom
Integrative vs Conventional
Integrative vs Conventional
ldquoWith improvements in expansion orthodontics advances in myofunctional orthodontics and the growing recognition about sleep disordered breathing among children and adults it is time for orthodontics to expand its horizons There is now so much more we can oerrdquo
The Raphael name has been associated with high quality orthodontics in New Jersey for over 60 years Dr Barry Raphael has been a university trained orthodontic specialist and a member of the American Association of Orthodontists for 30 years
He has a wide range of techniques and services to offer He has studied oral myology applied kinesiology Buteyko breathing Biobloc Orthotropics and Myobrace as part of his integrative training He can offer Damon Invisalign Insignia and Incognito appliances designs as some of his many conventional orthodontic services too
Dr Raphael teaches his techniques at post-graduate residencies study clubs dental societies and for the Myofunctional Research Co He is available for presentations to any group interested in learning more about the benefits of integrative orthodontics
wwwalignminecomLearn about the choices you have in orthodontics
dr barry raphael Why its
too Early never
1425
bro
ad
str
ee
tc
lifto
n n
j 070
13
973-
778-
4222
fax
973-
778-
9625
nj s
pe
c
368
4
1425 broad street clifton nj 07013973-778-4222
wwwalignminecom
the raphael centerforintegrative orthodontics
the
raph
ael c
ente
r fo
rin
tegr
ativ
e or
thod
onti
cs
Learn about an important choice you need to make before starting braces
the raphael center for integrative education
the raphael center for integrative education
Ongoing Intro to Airway Orthodontics
April Biobloc Study Group
April Training Ortho-Postural Therapists w Roger Price
June MRC Myobrace Basic Series
August Airway Dentistry with Mark Cruz and company
October Advanced MFT with Sandy Coulson
October Less than Six with Kevin Boyd
(who else wants to play)
Mission to create a space for spreading the word about Airway and Orthotropic principles and practice
Orthodontics in the 21st Century
EstheticOrthodontics
AirwayOrthodontics
GeneticTooth-Focused
Dental PerfectionEsthetics Primary
Treating SymptomsAirway Ignorant
AdaptationMuscle-FocusedMedical Better
Esthetics SecondaryTreating Causes
Airway Conscious
The EndAnd
The Beginning
1Crooked teeth are A SYMPTOM
2 The UPPER incisor directs treatment
3Patients donrsquot want to be exploited
4Teeth that grow straight are stable
Now that I know
My personal missionTo create from what Irsquove
learned from the besta model for others to followhellipespecially the orthodontists
Myofunctional Orthodontics
Chris Farrell
John Flutter
German Ramierez
Damien OrsquoBrien
Myofunctional Research CoRancho Cucamonga
2008-2012
Oral Myology
Oral Myology Basic CourseJoy MoellerNYC 2011LA 2012
Oral Myology Levels 2 3Kim BenkertClifton 2012
Habit CessationShari GreenClifton 2013
Biobloc Orthotropics
BBO Mini-residencyBill Hang
Agora Hills2012-13
BBO IntensiveDrs John and Mike
MewLSFO2013
Breathing and Sleep
Buteyko MentorshipThe Breathing Center
Woodstock2010
Breathing Well ProgrammeJohn Flutter
2010 Ortho-Postural TrainingRoger Price
2013
Sleep DentistryMichael Gelb etal
NYU2012
ALF and Cranial
Jim Bronson2013 Tasha Turzo
Cranial Academy2014
Bucket Listbull ALF and Crozat (Bronsonrsquos course)bullMore on Biobloc (Hangrsquos Advanced London School)bull More Cranial (The Farm)bullChirodontics (Bob Walker)bull Airway Dentistry with Marc Cruz Jeff Rousebull Sleep Dentistrybull Less-than-Six with Kevin Boydbull Intra-mandibular Distraction Osteogenesis (IMDO)
Off My ListAnything that moves the teeth faster in the wrong direction
Whatrsquos an RO to do
To create from what Irsquove learned from the best
a model for others to followhellipespecially orthodontists
Teaching
Mt Sinai Pedo ResidencyAli Attaie
2010-2012
Montefiore Ortho ResidencyTony Maganzini
2012
2009-Present
Mt Sinai School of MedicinePedodontic Residency
Guest SpeakersJim BronsonMike MewKevin BoydSandra KahnJennifer TowRoger PricePaula Fabbie
Damien OrsquoBrien
First clinical program in myofunctional orthodontics
Airway and Facial DevelopmentCollaborative Webcast
Mark Cruz
AAPMD Symposium
wwwaapm
dorg
Annual MeetingApril 25-26 2014
Westin Chicago North Shore
the raphael center for integrative orthodontics
wwwalignminecomwwwbioblocnjcom
wwwmyobracenjcom
Integrative vs Conventional
Integrative vs Conventional
ldquoWith improvements in expansion orthodontics advances in myofunctional orthodontics and the growing recognition about sleep disordered breathing among children and adults it is time for orthodontics to expand its horizons There is now so much more we can oerrdquo
The Raphael name has been associated with high quality orthodontics in New Jersey for over 60 years Dr Barry Raphael has been a university trained orthodontic specialist and a member of the American Association of Orthodontists for 30 years
He has a wide range of techniques and services to offer He has studied oral myology applied kinesiology Buteyko breathing Biobloc Orthotropics and Myobrace as part of his integrative training He can offer Damon Invisalign Insignia and Incognito appliances designs as some of his many conventional orthodontic services too
Dr Raphael teaches his techniques at post-graduate residencies study clubs dental societies and for the Myofunctional Research Co He is available for presentations to any group interested in learning more about the benefits of integrative orthodontics
wwwalignminecomLearn about the choices you have in orthodontics
dr barry raphael Why its
too Early never
1425
bro
ad
str
ee
tc
lifto
n n
j 070
13
973-
778-
4222
fax
973-
778-
9625
nj s
pe
c
368
4
1425 broad street clifton nj 07013973-778-4222
wwwalignminecom
the raphael centerforintegrative orthodontics
the
raph
ael c
ente
r fo
rin
tegr
ativ
e or
thod
onti
cs
Learn about an important choice you need to make before starting braces
the raphael center for integrative education
the raphael center for integrative education
Ongoing Intro to Airway Orthodontics
April Biobloc Study Group
April Training Ortho-Postural Therapists w Roger Price
June MRC Myobrace Basic Series
August Airway Dentistry with Mark Cruz and company
October Advanced MFT with Sandy Coulson
October Less than Six with Kevin Boyd
(who else wants to play)
Mission to create a space for spreading the word about Airway and Orthotropic principles and practice
Orthodontics in the 21st Century
EstheticOrthodontics
AirwayOrthodontics
GeneticTooth-Focused
Dental PerfectionEsthetics Primary
Treating SymptomsAirway Ignorant
AdaptationMuscle-FocusedMedical Better
Esthetics SecondaryTreating Causes
Airway Conscious
The EndAnd
The Beginning
Now that I know
My personal missionTo create from what Irsquove
learned from the besta model for others to followhellipespecially the orthodontists
Myofunctional Orthodontics
Chris Farrell
John Flutter
German Ramierez
Damien OrsquoBrien
Myofunctional Research CoRancho Cucamonga
2008-2012
Oral Myology
Oral Myology Basic CourseJoy MoellerNYC 2011LA 2012
Oral Myology Levels 2 3Kim BenkertClifton 2012
Habit CessationShari GreenClifton 2013
Biobloc Orthotropics
BBO Mini-residencyBill Hang
Agora Hills2012-13
BBO IntensiveDrs John and Mike
MewLSFO2013
Breathing and Sleep
Buteyko MentorshipThe Breathing Center
Woodstock2010
Breathing Well ProgrammeJohn Flutter
2010 Ortho-Postural TrainingRoger Price
2013
Sleep DentistryMichael Gelb etal
NYU2012
ALF and Cranial
Jim Bronson2013 Tasha Turzo
Cranial Academy2014
Bucket Listbull ALF and Crozat (Bronsonrsquos course)bullMore on Biobloc (Hangrsquos Advanced London School)bull More Cranial (The Farm)bullChirodontics (Bob Walker)bull Airway Dentistry with Marc Cruz Jeff Rousebull Sleep Dentistrybull Less-than-Six with Kevin Boydbull Intra-mandibular Distraction Osteogenesis (IMDO)
Off My ListAnything that moves the teeth faster in the wrong direction
Whatrsquos an RO to do
To create from what Irsquove learned from the best
a model for others to followhellipespecially orthodontists
Teaching
Mt Sinai Pedo ResidencyAli Attaie
2010-2012
Montefiore Ortho ResidencyTony Maganzini
2012
2009-Present
Mt Sinai School of MedicinePedodontic Residency
Guest SpeakersJim BronsonMike MewKevin BoydSandra KahnJennifer TowRoger PricePaula Fabbie
Damien OrsquoBrien
First clinical program in myofunctional orthodontics
Airway and Facial DevelopmentCollaborative Webcast
Mark Cruz
AAPMD Symposium
wwwaapm
dorg
Annual MeetingApril 25-26 2014
Westin Chicago North Shore
the raphael center for integrative orthodontics
wwwalignminecomwwwbioblocnjcom
wwwmyobracenjcom
Integrative vs Conventional
Integrative vs Conventional
ldquoWith improvements in expansion orthodontics advances in myofunctional orthodontics and the growing recognition about sleep disordered breathing among children and adults it is time for orthodontics to expand its horizons There is now so much more we can oerrdquo
The Raphael name has been associated with high quality orthodontics in New Jersey for over 60 years Dr Barry Raphael has been a university trained orthodontic specialist and a member of the American Association of Orthodontists for 30 years
He has a wide range of techniques and services to offer He has studied oral myology applied kinesiology Buteyko breathing Biobloc Orthotropics and Myobrace as part of his integrative training He can offer Damon Invisalign Insignia and Incognito appliances designs as some of his many conventional orthodontic services too
Dr Raphael teaches his techniques at post-graduate residencies study clubs dental societies and for the Myofunctional Research Co He is available for presentations to any group interested in learning more about the benefits of integrative orthodontics
wwwalignminecomLearn about the choices you have in orthodontics
dr barry raphael Why its
too Early never
1425
bro
ad
str
ee
tc
lifto
n n
j 070
13
973-
778-
4222
fax
973-
778-
9625
nj s
pe
c
368
4
1425 broad street clifton nj 07013973-778-4222
wwwalignminecom
the raphael centerforintegrative orthodontics
the
raph
ael c
ente
r fo
rin
tegr
ativ
e or
thod
onti
cs
Learn about an important choice you need to make before starting braces
the raphael center for integrative education
the raphael center for integrative education
Ongoing Intro to Airway Orthodontics
April Biobloc Study Group
April Training Ortho-Postural Therapists w Roger Price
June MRC Myobrace Basic Series
August Airway Dentistry with Mark Cruz and company
October Advanced MFT with Sandy Coulson
October Less than Six with Kevin Boyd
(who else wants to play)
Mission to create a space for spreading the word about Airway and Orthotropic principles and practice
Orthodontics in the 21st Century
EstheticOrthodontics
AirwayOrthodontics
GeneticTooth-Focused
Dental PerfectionEsthetics Primary
Treating SymptomsAirway Ignorant
AdaptationMuscle-FocusedMedical Better
Esthetics SecondaryTreating Causes
Airway Conscious
The EndAnd
The Beginning
Myofunctional Orthodontics
Chris Farrell
John Flutter
German Ramierez
Damien OrsquoBrien
Myofunctional Research CoRancho Cucamonga
2008-2012
Oral Myology
Oral Myology Basic CourseJoy MoellerNYC 2011LA 2012
Oral Myology Levels 2 3Kim BenkertClifton 2012
Habit CessationShari GreenClifton 2013
Biobloc Orthotropics
BBO Mini-residencyBill Hang
Agora Hills2012-13
BBO IntensiveDrs John and Mike
MewLSFO2013
Breathing and Sleep
Buteyko MentorshipThe Breathing Center
Woodstock2010
Breathing Well ProgrammeJohn Flutter
2010 Ortho-Postural TrainingRoger Price
2013
Sleep DentistryMichael Gelb etal
NYU2012
ALF and Cranial
Jim Bronson2013 Tasha Turzo
Cranial Academy2014
Bucket Listbull ALF and Crozat (Bronsonrsquos course)bullMore on Biobloc (Hangrsquos Advanced London School)bull More Cranial (The Farm)bullChirodontics (Bob Walker)bull Airway Dentistry with Marc Cruz Jeff Rousebull Sleep Dentistrybull Less-than-Six with Kevin Boydbull Intra-mandibular Distraction Osteogenesis (IMDO)
Off My ListAnything that moves the teeth faster in the wrong direction
Whatrsquos an RO to do
To create from what Irsquove learned from the best
a model for others to followhellipespecially orthodontists
Teaching
Mt Sinai Pedo ResidencyAli Attaie
2010-2012
Montefiore Ortho ResidencyTony Maganzini
2012
2009-Present
Mt Sinai School of MedicinePedodontic Residency
Guest SpeakersJim BronsonMike MewKevin BoydSandra KahnJennifer TowRoger PricePaula Fabbie
Damien OrsquoBrien
First clinical program in myofunctional orthodontics
Airway and Facial DevelopmentCollaborative Webcast
Mark Cruz
AAPMD Symposium
wwwaapm
dorg
Annual MeetingApril 25-26 2014
Westin Chicago North Shore
the raphael center for integrative orthodontics
wwwalignminecomwwwbioblocnjcom
wwwmyobracenjcom
Integrative vs Conventional
Integrative vs Conventional
ldquoWith improvements in expansion orthodontics advances in myofunctional orthodontics and the growing recognition about sleep disordered breathing among children and adults it is time for orthodontics to expand its horizons There is now so much more we can oerrdquo
The Raphael name has been associated with high quality orthodontics in New Jersey for over 60 years Dr Barry Raphael has been a university trained orthodontic specialist and a member of the American Association of Orthodontists for 30 years
He has a wide range of techniques and services to offer He has studied oral myology applied kinesiology Buteyko breathing Biobloc Orthotropics and Myobrace as part of his integrative training He can offer Damon Invisalign Insignia and Incognito appliances designs as some of his many conventional orthodontic services too
Dr Raphael teaches his techniques at post-graduate residencies study clubs dental societies and for the Myofunctional Research Co He is available for presentations to any group interested in learning more about the benefits of integrative orthodontics
wwwalignminecomLearn about the choices you have in orthodontics
dr barry raphael Why its
too Early never
1425
bro
ad
str
ee
tc
lifto
n n
j 070
13
973-
778-
4222
fax
973-
778-
9625
nj s
pe
c
368
4
1425 broad street clifton nj 07013973-778-4222
wwwalignminecom
the raphael centerforintegrative orthodontics
the
raph
ael c
ente
r fo
rin
tegr
ativ
e or
thod
onti
cs
Learn about an important choice you need to make before starting braces
the raphael center for integrative education
the raphael center for integrative education
Ongoing Intro to Airway Orthodontics
April Biobloc Study Group
April Training Ortho-Postural Therapists w Roger Price
June MRC Myobrace Basic Series
August Airway Dentistry with Mark Cruz and company
October Advanced MFT with Sandy Coulson
October Less than Six with Kevin Boyd
(who else wants to play)
Mission to create a space for spreading the word about Airway and Orthotropic principles and practice
Orthodontics in the 21st Century
EstheticOrthodontics
AirwayOrthodontics
GeneticTooth-Focused
Dental PerfectionEsthetics Primary
Treating SymptomsAirway Ignorant
AdaptationMuscle-FocusedMedical Better
Esthetics SecondaryTreating Causes
Airway Conscious
The EndAnd
The Beginning
Oral Myology
Oral Myology Basic CourseJoy MoellerNYC 2011LA 2012
Oral Myology Levels 2 3Kim BenkertClifton 2012
Habit CessationShari GreenClifton 2013
Biobloc Orthotropics
BBO Mini-residencyBill Hang
Agora Hills2012-13
BBO IntensiveDrs John and Mike
MewLSFO2013
Breathing and Sleep
Buteyko MentorshipThe Breathing Center
Woodstock2010
Breathing Well ProgrammeJohn Flutter
2010 Ortho-Postural TrainingRoger Price
2013
Sleep DentistryMichael Gelb etal
NYU2012
ALF and Cranial
Jim Bronson2013 Tasha Turzo
Cranial Academy2014
Bucket Listbull ALF and Crozat (Bronsonrsquos course)bullMore on Biobloc (Hangrsquos Advanced London School)bull More Cranial (The Farm)bullChirodontics (Bob Walker)bull Airway Dentistry with Marc Cruz Jeff Rousebull Sleep Dentistrybull Less-than-Six with Kevin Boydbull Intra-mandibular Distraction Osteogenesis (IMDO)
Off My ListAnything that moves the teeth faster in the wrong direction
Whatrsquos an RO to do
To create from what Irsquove learned from the best
a model for others to followhellipespecially orthodontists
Teaching
Mt Sinai Pedo ResidencyAli Attaie
2010-2012
Montefiore Ortho ResidencyTony Maganzini
2012
2009-Present
Mt Sinai School of MedicinePedodontic Residency
Guest SpeakersJim BronsonMike MewKevin BoydSandra KahnJennifer TowRoger PricePaula Fabbie
Damien OrsquoBrien
First clinical program in myofunctional orthodontics
Airway and Facial DevelopmentCollaborative Webcast
Mark Cruz
AAPMD Symposium
wwwaapm
dorg
Annual MeetingApril 25-26 2014
Westin Chicago North Shore
the raphael center for integrative orthodontics
wwwalignminecomwwwbioblocnjcom
wwwmyobracenjcom
Integrative vs Conventional
Integrative vs Conventional
ldquoWith improvements in expansion orthodontics advances in myofunctional orthodontics and the growing recognition about sleep disordered breathing among children and adults it is time for orthodontics to expand its horizons There is now so much more we can oerrdquo
The Raphael name has been associated with high quality orthodontics in New Jersey for over 60 years Dr Barry Raphael has been a university trained orthodontic specialist and a member of the American Association of Orthodontists for 30 years
He has a wide range of techniques and services to offer He has studied oral myology applied kinesiology Buteyko breathing Biobloc Orthotropics and Myobrace as part of his integrative training He can offer Damon Invisalign Insignia and Incognito appliances designs as some of his many conventional orthodontic services too
Dr Raphael teaches his techniques at post-graduate residencies study clubs dental societies and for the Myofunctional Research Co He is available for presentations to any group interested in learning more about the benefits of integrative orthodontics
wwwalignminecomLearn about the choices you have in orthodontics
dr barry raphael Why its
too Early never
1425
bro
ad
str
ee
tc
lifto
n n
j 070
13
973-
778-
4222
fax
973-
778-
9625
nj s
pe
c
368
4
1425 broad street clifton nj 07013973-778-4222
wwwalignminecom
the raphael centerforintegrative orthodontics
the
raph
ael c
ente
r fo
rin
tegr
ativ
e or
thod
onti
cs
Learn about an important choice you need to make before starting braces
the raphael center for integrative education
the raphael center for integrative education
Ongoing Intro to Airway Orthodontics
April Biobloc Study Group
April Training Ortho-Postural Therapists w Roger Price
June MRC Myobrace Basic Series
August Airway Dentistry with Mark Cruz and company
October Advanced MFT with Sandy Coulson
October Less than Six with Kevin Boyd
(who else wants to play)
Mission to create a space for spreading the word about Airway and Orthotropic principles and practice
Orthodontics in the 21st Century
EstheticOrthodontics
AirwayOrthodontics
GeneticTooth-Focused
Dental PerfectionEsthetics Primary
Treating SymptomsAirway Ignorant
AdaptationMuscle-FocusedMedical Better
Esthetics SecondaryTreating Causes
Airway Conscious
The EndAnd
The Beginning
Biobloc Orthotropics
BBO Mini-residencyBill Hang
Agora Hills2012-13
BBO IntensiveDrs John and Mike
MewLSFO2013
Breathing and Sleep
Buteyko MentorshipThe Breathing Center
Woodstock2010
Breathing Well ProgrammeJohn Flutter
2010 Ortho-Postural TrainingRoger Price
2013
Sleep DentistryMichael Gelb etal
NYU2012
ALF and Cranial
Jim Bronson2013 Tasha Turzo
Cranial Academy2014
Bucket Listbull ALF and Crozat (Bronsonrsquos course)bullMore on Biobloc (Hangrsquos Advanced London School)bull More Cranial (The Farm)bullChirodontics (Bob Walker)bull Airway Dentistry with Marc Cruz Jeff Rousebull Sleep Dentistrybull Less-than-Six with Kevin Boydbull Intra-mandibular Distraction Osteogenesis (IMDO)
Off My ListAnything that moves the teeth faster in the wrong direction
Whatrsquos an RO to do
To create from what Irsquove learned from the best
a model for others to followhellipespecially orthodontists
Teaching
Mt Sinai Pedo ResidencyAli Attaie
2010-2012
Montefiore Ortho ResidencyTony Maganzini
2012
2009-Present
Mt Sinai School of MedicinePedodontic Residency
Guest SpeakersJim BronsonMike MewKevin BoydSandra KahnJennifer TowRoger PricePaula Fabbie
Damien OrsquoBrien
First clinical program in myofunctional orthodontics
Airway and Facial DevelopmentCollaborative Webcast
Mark Cruz
AAPMD Symposium
wwwaapm
dorg
Annual MeetingApril 25-26 2014
Westin Chicago North Shore
the raphael center for integrative orthodontics
wwwalignminecomwwwbioblocnjcom
wwwmyobracenjcom
Integrative vs Conventional
Integrative vs Conventional
ldquoWith improvements in expansion orthodontics advances in myofunctional orthodontics and the growing recognition about sleep disordered breathing among children and adults it is time for orthodontics to expand its horizons There is now so much more we can oerrdquo
The Raphael name has been associated with high quality orthodontics in New Jersey for over 60 years Dr Barry Raphael has been a university trained orthodontic specialist and a member of the American Association of Orthodontists for 30 years
He has a wide range of techniques and services to offer He has studied oral myology applied kinesiology Buteyko breathing Biobloc Orthotropics and Myobrace as part of his integrative training He can offer Damon Invisalign Insignia and Incognito appliances designs as some of his many conventional orthodontic services too
Dr Raphael teaches his techniques at post-graduate residencies study clubs dental societies and for the Myofunctional Research Co He is available for presentations to any group interested in learning more about the benefits of integrative orthodontics
wwwalignminecomLearn about the choices you have in orthodontics
dr barry raphael Why its
too Early never
1425
bro
ad
str
ee
tc
lifto
n n
j 070
13
973-
778-
4222
fax
973-
778-
9625
nj s
pe
c
368
4
1425 broad street clifton nj 07013973-778-4222
wwwalignminecom
the raphael centerforintegrative orthodontics
the
raph
ael c
ente
r fo
rin
tegr
ativ
e or
thod
onti
cs
Learn about an important choice you need to make before starting braces
the raphael center for integrative education
the raphael center for integrative education
Ongoing Intro to Airway Orthodontics
April Biobloc Study Group
April Training Ortho-Postural Therapists w Roger Price
June MRC Myobrace Basic Series
August Airway Dentistry with Mark Cruz and company
October Advanced MFT with Sandy Coulson
October Less than Six with Kevin Boyd
(who else wants to play)
Mission to create a space for spreading the word about Airway and Orthotropic principles and practice
Orthodontics in the 21st Century
EstheticOrthodontics
AirwayOrthodontics
GeneticTooth-Focused
Dental PerfectionEsthetics Primary
Treating SymptomsAirway Ignorant
AdaptationMuscle-FocusedMedical Better
Esthetics SecondaryTreating Causes
Airway Conscious
The EndAnd
The Beginning
Breathing and Sleep
Buteyko MentorshipThe Breathing Center
Woodstock2010
Breathing Well ProgrammeJohn Flutter
2010 Ortho-Postural TrainingRoger Price
2013
Sleep DentistryMichael Gelb etal
NYU2012
ALF and Cranial
Jim Bronson2013 Tasha Turzo
Cranial Academy2014
Bucket Listbull ALF and Crozat (Bronsonrsquos course)bullMore on Biobloc (Hangrsquos Advanced London School)bull More Cranial (The Farm)bullChirodontics (Bob Walker)bull Airway Dentistry with Marc Cruz Jeff Rousebull Sleep Dentistrybull Less-than-Six with Kevin Boydbull Intra-mandibular Distraction Osteogenesis (IMDO)
Off My ListAnything that moves the teeth faster in the wrong direction
Whatrsquos an RO to do
To create from what Irsquove learned from the best
a model for others to followhellipespecially orthodontists
Teaching
Mt Sinai Pedo ResidencyAli Attaie
2010-2012
Montefiore Ortho ResidencyTony Maganzini
2012
2009-Present
Mt Sinai School of MedicinePedodontic Residency
Guest SpeakersJim BronsonMike MewKevin BoydSandra KahnJennifer TowRoger PricePaula Fabbie
Damien OrsquoBrien
First clinical program in myofunctional orthodontics
Airway and Facial DevelopmentCollaborative Webcast
Mark Cruz
AAPMD Symposium
wwwaapm
dorg
Annual MeetingApril 25-26 2014
Westin Chicago North Shore
the raphael center for integrative orthodontics
wwwalignminecomwwwbioblocnjcom
wwwmyobracenjcom
Integrative vs Conventional
Integrative vs Conventional
ldquoWith improvements in expansion orthodontics advances in myofunctional orthodontics and the growing recognition about sleep disordered breathing among children and adults it is time for orthodontics to expand its horizons There is now so much more we can oerrdquo
The Raphael name has been associated with high quality orthodontics in New Jersey for over 60 years Dr Barry Raphael has been a university trained orthodontic specialist and a member of the American Association of Orthodontists for 30 years
He has a wide range of techniques and services to offer He has studied oral myology applied kinesiology Buteyko breathing Biobloc Orthotropics and Myobrace as part of his integrative training He can offer Damon Invisalign Insignia and Incognito appliances designs as some of his many conventional orthodontic services too
Dr Raphael teaches his techniques at post-graduate residencies study clubs dental societies and for the Myofunctional Research Co He is available for presentations to any group interested in learning more about the benefits of integrative orthodontics
wwwalignminecomLearn about the choices you have in orthodontics
dr barry raphael Why its
too Early never
1425
bro
ad
str
ee
tc
lifto
n n
j 070
13
973-
778-
4222
fax
973-
778-
9625
nj s
pe
c
368
4
1425 broad street clifton nj 07013973-778-4222
wwwalignminecom
the raphael centerforintegrative orthodontics
the
raph
ael c
ente
r fo
rin
tegr
ativ
e or
thod
onti
cs
Learn about an important choice you need to make before starting braces
the raphael center for integrative education
the raphael center for integrative education
Ongoing Intro to Airway Orthodontics
April Biobloc Study Group
April Training Ortho-Postural Therapists w Roger Price
June MRC Myobrace Basic Series
August Airway Dentistry with Mark Cruz and company
October Advanced MFT with Sandy Coulson
October Less than Six with Kevin Boyd
(who else wants to play)
Mission to create a space for spreading the word about Airway and Orthotropic principles and practice
Orthodontics in the 21st Century
EstheticOrthodontics
AirwayOrthodontics
GeneticTooth-Focused
Dental PerfectionEsthetics Primary
Treating SymptomsAirway Ignorant
AdaptationMuscle-FocusedMedical Better
Esthetics SecondaryTreating Causes
Airway Conscious
The EndAnd
The Beginning
ALF and Cranial
Jim Bronson2013 Tasha Turzo
Cranial Academy2014
Bucket Listbull ALF and Crozat (Bronsonrsquos course)bullMore on Biobloc (Hangrsquos Advanced London School)bull More Cranial (The Farm)bullChirodontics (Bob Walker)bull Airway Dentistry with Marc Cruz Jeff Rousebull Sleep Dentistrybull Less-than-Six with Kevin Boydbull Intra-mandibular Distraction Osteogenesis (IMDO)
Off My ListAnything that moves the teeth faster in the wrong direction
Whatrsquos an RO to do
To create from what Irsquove learned from the best
a model for others to followhellipespecially orthodontists
Teaching
Mt Sinai Pedo ResidencyAli Attaie
2010-2012
Montefiore Ortho ResidencyTony Maganzini
2012
2009-Present
Mt Sinai School of MedicinePedodontic Residency
Guest SpeakersJim BronsonMike MewKevin BoydSandra KahnJennifer TowRoger PricePaula Fabbie
Damien OrsquoBrien
First clinical program in myofunctional orthodontics
Airway and Facial DevelopmentCollaborative Webcast
Mark Cruz
AAPMD Symposium
wwwaapm
dorg
Annual MeetingApril 25-26 2014
Westin Chicago North Shore
the raphael center for integrative orthodontics
wwwalignminecomwwwbioblocnjcom
wwwmyobracenjcom
Integrative vs Conventional
Integrative vs Conventional
ldquoWith improvements in expansion orthodontics advances in myofunctional orthodontics and the growing recognition about sleep disordered breathing among children and adults it is time for orthodontics to expand its horizons There is now so much more we can oerrdquo
The Raphael name has been associated with high quality orthodontics in New Jersey for over 60 years Dr Barry Raphael has been a university trained orthodontic specialist and a member of the American Association of Orthodontists for 30 years
He has a wide range of techniques and services to offer He has studied oral myology applied kinesiology Buteyko breathing Biobloc Orthotropics and Myobrace as part of his integrative training He can offer Damon Invisalign Insignia and Incognito appliances designs as some of his many conventional orthodontic services too
Dr Raphael teaches his techniques at post-graduate residencies study clubs dental societies and for the Myofunctional Research Co He is available for presentations to any group interested in learning more about the benefits of integrative orthodontics
wwwalignminecomLearn about the choices you have in orthodontics
dr barry raphael Why its
too Early never
1425
bro
ad
str
ee
tc
lifto
n n
j 070
13
973-
778-
4222
fax
973-
778-
9625
nj s
pe
c
368
4
1425 broad street clifton nj 07013973-778-4222
wwwalignminecom
the raphael centerforintegrative orthodontics
the
raph
ael c
ente
r fo
rin
tegr
ativ
e or
thod
onti
cs
Learn about an important choice you need to make before starting braces
the raphael center for integrative education
the raphael center for integrative education
Ongoing Intro to Airway Orthodontics
April Biobloc Study Group
April Training Ortho-Postural Therapists w Roger Price
June MRC Myobrace Basic Series
August Airway Dentistry with Mark Cruz and company
October Advanced MFT with Sandy Coulson
October Less than Six with Kevin Boyd
(who else wants to play)
Mission to create a space for spreading the word about Airway and Orthotropic principles and practice
Orthodontics in the 21st Century
EstheticOrthodontics
AirwayOrthodontics
GeneticTooth-Focused
Dental PerfectionEsthetics Primary
Treating SymptomsAirway Ignorant
AdaptationMuscle-FocusedMedical Better
Esthetics SecondaryTreating Causes
Airway Conscious
The EndAnd
The Beginning
Bucket Listbull ALF and Crozat (Bronsonrsquos course)bullMore on Biobloc (Hangrsquos Advanced London School)bull More Cranial (The Farm)bullChirodontics (Bob Walker)bull Airway Dentistry with Marc Cruz Jeff Rousebull Sleep Dentistrybull Less-than-Six with Kevin Boydbull Intra-mandibular Distraction Osteogenesis (IMDO)
Off My ListAnything that moves the teeth faster in the wrong direction
Whatrsquos an RO to do
To create from what Irsquove learned from the best
a model for others to followhellipespecially orthodontists
Teaching
Mt Sinai Pedo ResidencyAli Attaie
2010-2012
Montefiore Ortho ResidencyTony Maganzini
2012
2009-Present
Mt Sinai School of MedicinePedodontic Residency
Guest SpeakersJim BronsonMike MewKevin BoydSandra KahnJennifer TowRoger PricePaula Fabbie
Damien OrsquoBrien
First clinical program in myofunctional orthodontics
Airway and Facial DevelopmentCollaborative Webcast
Mark Cruz
AAPMD Symposium
wwwaapm
dorg
Annual MeetingApril 25-26 2014
Westin Chicago North Shore
the raphael center for integrative orthodontics
wwwalignminecomwwwbioblocnjcom
wwwmyobracenjcom
Integrative vs Conventional
Integrative vs Conventional
ldquoWith improvements in expansion orthodontics advances in myofunctional orthodontics and the growing recognition about sleep disordered breathing among children and adults it is time for orthodontics to expand its horizons There is now so much more we can oerrdquo
The Raphael name has been associated with high quality orthodontics in New Jersey for over 60 years Dr Barry Raphael has been a university trained orthodontic specialist and a member of the American Association of Orthodontists for 30 years
He has a wide range of techniques and services to offer He has studied oral myology applied kinesiology Buteyko breathing Biobloc Orthotropics and Myobrace as part of his integrative training He can offer Damon Invisalign Insignia and Incognito appliances designs as some of his many conventional orthodontic services too
Dr Raphael teaches his techniques at post-graduate residencies study clubs dental societies and for the Myofunctional Research Co He is available for presentations to any group interested in learning more about the benefits of integrative orthodontics
wwwalignminecomLearn about the choices you have in orthodontics
dr barry raphael Why its
too Early never
1425
bro
ad
str
ee
tc
lifto
n n
j 070
13
973-
778-
4222
fax
973-
778-
9625
nj s
pe
c
368
4
1425 broad street clifton nj 07013973-778-4222
wwwalignminecom
the raphael centerforintegrative orthodontics
the
raph
ael c
ente
r fo
rin
tegr
ativ
e or
thod
onti
cs
Learn about an important choice you need to make before starting braces
the raphael center for integrative education
the raphael center for integrative education
Ongoing Intro to Airway Orthodontics
April Biobloc Study Group
April Training Ortho-Postural Therapists w Roger Price
June MRC Myobrace Basic Series
August Airway Dentistry with Mark Cruz and company
October Advanced MFT with Sandy Coulson
October Less than Six with Kevin Boyd
(who else wants to play)
Mission to create a space for spreading the word about Airway and Orthotropic principles and practice
Orthodontics in the 21st Century
EstheticOrthodontics
AirwayOrthodontics
GeneticTooth-Focused
Dental PerfectionEsthetics Primary
Treating SymptomsAirway Ignorant
AdaptationMuscle-FocusedMedical Better
Esthetics SecondaryTreating Causes
Airway Conscious
The EndAnd
The Beginning
Whatrsquos an RO to do
To create from what Irsquove learned from the best
a model for others to followhellipespecially orthodontists
Teaching
Mt Sinai Pedo ResidencyAli Attaie
2010-2012
Montefiore Ortho ResidencyTony Maganzini
2012
2009-Present
Mt Sinai School of MedicinePedodontic Residency
Guest SpeakersJim BronsonMike MewKevin BoydSandra KahnJennifer TowRoger PricePaula Fabbie
Damien OrsquoBrien
First clinical program in myofunctional orthodontics
Airway and Facial DevelopmentCollaborative Webcast
Mark Cruz
AAPMD Symposium
wwwaapm
dorg
Annual MeetingApril 25-26 2014
Westin Chicago North Shore
the raphael center for integrative orthodontics
wwwalignminecomwwwbioblocnjcom
wwwmyobracenjcom
Integrative vs Conventional
Integrative vs Conventional
ldquoWith improvements in expansion orthodontics advances in myofunctional orthodontics and the growing recognition about sleep disordered breathing among children and adults it is time for orthodontics to expand its horizons There is now so much more we can oerrdquo
The Raphael name has been associated with high quality orthodontics in New Jersey for over 60 years Dr Barry Raphael has been a university trained orthodontic specialist and a member of the American Association of Orthodontists for 30 years
He has a wide range of techniques and services to offer He has studied oral myology applied kinesiology Buteyko breathing Biobloc Orthotropics and Myobrace as part of his integrative training He can offer Damon Invisalign Insignia and Incognito appliances designs as some of his many conventional orthodontic services too
Dr Raphael teaches his techniques at post-graduate residencies study clubs dental societies and for the Myofunctional Research Co He is available for presentations to any group interested in learning more about the benefits of integrative orthodontics
wwwalignminecomLearn about the choices you have in orthodontics
dr barry raphael Why its
too Early never
1425
bro
ad
str
ee
tc
lifto
n n
j 070
13
973-
778-
4222
fax
973-
778-
9625
nj s
pe
c
368
4
1425 broad street clifton nj 07013973-778-4222
wwwalignminecom
the raphael centerforintegrative orthodontics
the
raph
ael c
ente
r fo
rin
tegr
ativ
e or
thod
onti
cs
Learn about an important choice you need to make before starting braces
the raphael center for integrative education
the raphael center for integrative education
Ongoing Intro to Airway Orthodontics
April Biobloc Study Group
April Training Ortho-Postural Therapists w Roger Price
June MRC Myobrace Basic Series
August Airway Dentistry with Mark Cruz and company
October Advanced MFT with Sandy Coulson
October Less than Six with Kevin Boyd
(who else wants to play)
Mission to create a space for spreading the word about Airway and Orthotropic principles and practice
Orthodontics in the 21st Century
EstheticOrthodontics
AirwayOrthodontics
GeneticTooth-Focused
Dental PerfectionEsthetics Primary
Treating SymptomsAirway Ignorant
AdaptationMuscle-FocusedMedical Better
Esthetics SecondaryTreating Causes
Airway Conscious
The EndAnd
The Beginning
Teaching
Mt Sinai Pedo ResidencyAli Attaie
2010-2012
Montefiore Ortho ResidencyTony Maganzini
2012
2009-Present
Mt Sinai School of MedicinePedodontic Residency
Guest SpeakersJim BronsonMike MewKevin BoydSandra KahnJennifer TowRoger PricePaula Fabbie
Damien OrsquoBrien
First clinical program in myofunctional orthodontics
Airway and Facial DevelopmentCollaborative Webcast
Mark Cruz
AAPMD Symposium
wwwaapm
dorg
Annual MeetingApril 25-26 2014
Westin Chicago North Shore
the raphael center for integrative orthodontics
wwwalignminecomwwwbioblocnjcom
wwwmyobracenjcom
Integrative vs Conventional
Integrative vs Conventional
ldquoWith improvements in expansion orthodontics advances in myofunctional orthodontics and the growing recognition about sleep disordered breathing among children and adults it is time for orthodontics to expand its horizons There is now so much more we can oerrdquo
The Raphael name has been associated with high quality orthodontics in New Jersey for over 60 years Dr Barry Raphael has been a university trained orthodontic specialist and a member of the American Association of Orthodontists for 30 years
He has a wide range of techniques and services to offer He has studied oral myology applied kinesiology Buteyko breathing Biobloc Orthotropics and Myobrace as part of his integrative training He can offer Damon Invisalign Insignia and Incognito appliances designs as some of his many conventional orthodontic services too
Dr Raphael teaches his techniques at post-graduate residencies study clubs dental societies and for the Myofunctional Research Co He is available for presentations to any group interested in learning more about the benefits of integrative orthodontics
wwwalignminecomLearn about the choices you have in orthodontics
dr barry raphael Why its
too Early never
1425
bro
ad
str
ee
tc
lifto
n n
j 070
13
973-
778-
4222
fax
973-
778-
9625
nj s
pe
c
368
4
1425 broad street clifton nj 07013973-778-4222
wwwalignminecom
the raphael centerforintegrative orthodontics
the
raph
ael c
ente
r fo
rin
tegr
ativ
e or
thod
onti
cs
Learn about an important choice you need to make before starting braces
the raphael center for integrative education
the raphael center for integrative education
Ongoing Intro to Airway Orthodontics
April Biobloc Study Group
April Training Ortho-Postural Therapists w Roger Price
June MRC Myobrace Basic Series
August Airway Dentistry with Mark Cruz and company
October Advanced MFT with Sandy Coulson
October Less than Six with Kevin Boyd
(who else wants to play)
Mission to create a space for spreading the word about Airway and Orthotropic principles and practice
Orthodontics in the 21st Century
EstheticOrthodontics
AirwayOrthodontics
GeneticTooth-Focused
Dental PerfectionEsthetics Primary
Treating SymptomsAirway Ignorant
AdaptationMuscle-FocusedMedical Better
Esthetics SecondaryTreating Causes
Airway Conscious
The EndAnd
The Beginning
Mt Sinai School of MedicinePedodontic Residency
Guest SpeakersJim BronsonMike MewKevin BoydSandra KahnJennifer TowRoger PricePaula Fabbie
Damien OrsquoBrien
First clinical program in myofunctional orthodontics
Airway and Facial DevelopmentCollaborative Webcast
Mark Cruz
AAPMD Symposium
wwwaapm
dorg
Annual MeetingApril 25-26 2014
Westin Chicago North Shore
the raphael center for integrative orthodontics
wwwalignminecomwwwbioblocnjcom
wwwmyobracenjcom
Integrative vs Conventional
Integrative vs Conventional
ldquoWith improvements in expansion orthodontics advances in myofunctional orthodontics and the growing recognition about sleep disordered breathing among children and adults it is time for orthodontics to expand its horizons There is now so much more we can oerrdquo
The Raphael name has been associated with high quality orthodontics in New Jersey for over 60 years Dr Barry Raphael has been a university trained orthodontic specialist and a member of the American Association of Orthodontists for 30 years
He has a wide range of techniques and services to offer He has studied oral myology applied kinesiology Buteyko breathing Biobloc Orthotropics and Myobrace as part of his integrative training He can offer Damon Invisalign Insignia and Incognito appliances designs as some of his many conventional orthodontic services too
Dr Raphael teaches his techniques at post-graduate residencies study clubs dental societies and for the Myofunctional Research Co He is available for presentations to any group interested in learning more about the benefits of integrative orthodontics
wwwalignminecomLearn about the choices you have in orthodontics
dr barry raphael Why its
too Early never
1425
bro
ad
str
ee
tc
lifto
n n
j 070
13
973-
778-
4222
fax
973-
778-
9625
nj s
pe
c
368
4
1425 broad street clifton nj 07013973-778-4222
wwwalignminecom
the raphael centerforintegrative orthodontics
the
raph
ael c
ente
r fo
rin
tegr
ativ
e or
thod
onti
cs
Learn about an important choice you need to make before starting braces
the raphael center for integrative education
the raphael center for integrative education
Ongoing Intro to Airway Orthodontics
April Biobloc Study Group
April Training Ortho-Postural Therapists w Roger Price
June MRC Myobrace Basic Series
August Airway Dentistry with Mark Cruz and company
October Advanced MFT with Sandy Coulson
October Less than Six with Kevin Boyd
(who else wants to play)
Mission to create a space for spreading the word about Airway and Orthotropic principles and practice
Orthodontics in the 21st Century
EstheticOrthodontics
AirwayOrthodontics
GeneticTooth-Focused
Dental PerfectionEsthetics Primary
Treating SymptomsAirway Ignorant
AdaptationMuscle-FocusedMedical Better
Esthetics SecondaryTreating Causes
Airway Conscious
The EndAnd
The Beginning
Airway and Facial DevelopmentCollaborative Webcast
Mark Cruz
AAPMD Symposium
wwwaapm
dorg
Annual MeetingApril 25-26 2014
Westin Chicago North Shore
the raphael center for integrative orthodontics
wwwalignminecomwwwbioblocnjcom
wwwmyobracenjcom
Integrative vs Conventional
Integrative vs Conventional
ldquoWith improvements in expansion orthodontics advances in myofunctional orthodontics and the growing recognition about sleep disordered breathing among children and adults it is time for orthodontics to expand its horizons There is now so much more we can oerrdquo
The Raphael name has been associated with high quality orthodontics in New Jersey for over 60 years Dr Barry Raphael has been a university trained orthodontic specialist and a member of the American Association of Orthodontists for 30 years
He has a wide range of techniques and services to offer He has studied oral myology applied kinesiology Buteyko breathing Biobloc Orthotropics and Myobrace as part of his integrative training He can offer Damon Invisalign Insignia and Incognito appliances designs as some of his many conventional orthodontic services too
Dr Raphael teaches his techniques at post-graduate residencies study clubs dental societies and for the Myofunctional Research Co He is available for presentations to any group interested in learning more about the benefits of integrative orthodontics
wwwalignminecomLearn about the choices you have in orthodontics
dr barry raphael Why its
too Early never
1425
bro
ad
str
ee
tc
lifto
n n
j 070
13
973-
778-
4222
fax
973-
778-
9625
nj s
pe
c
368
4
1425 broad street clifton nj 07013973-778-4222
wwwalignminecom
the raphael centerforintegrative orthodontics
the
raph
ael c
ente
r fo
rin
tegr
ativ
e or
thod
onti
cs
Learn about an important choice you need to make before starting braces
the raphael center for integrative education
the raphael center for integrative education
Ongoing Intro to Airway Orthodontics
April Biobloc Study Group
April Training Ortho-Postural Therapists w Roger Price
June MRC Myobrace Basic Series
August Airway Dentistry with Mark Cruz and company
October Advanced MFT with Sandy Coulson
October Less than Six with Kevin Boyd
(who else wants to play)
Mission to create a space for spreading the word about Airway and Orthotropic principles and practice
Orthodontics in the 21st Century
EstheticOrthodontics
AirwayOrthodontics
GeneticTooth-Focused
Dental PerfectionEsthetics Primary
Treating SymptomsAirway Ignorant
AdaptationMuscle-FocusedMedical Better
Esthetics SecondaryTreating Causes
Airway Conscious
The EndAnd
The Beginning
AAPMD Symposium
wwwaapm
dorg
Annual MeetingApril 25-26 2014
Westin Chicago North Shore
the raphael center for integrative orthodontics
wwwalignminecomwwwbioblocnjcom
wwwmyobracenjcom
Integrative vs Conventional
Integrative vs Conventional
ldquoWith improvements in expansion orthodontics advances in myofunctional orthodontics and the growing recognition about sleep disordered breathing among children and adults it is time for orthodontics to expand its horizons There is now so much more we can oerrdquo
The Raphael name has been associated with high quality orthodontics in New Jersey for over 60 years Dr Barry Raphael has been a university trained orthodontic specialist and a member of the American Association of Orthodontists for 30 years
He has a wide range of techniques and services to offer He has studied oral myology applied kinesiology Buteyko breathing Biobloc Orthotropics and Myobrace as part of his integrative training He can offer Damon Invisalign Insignia and Incognito appliances designs as some of his many conventional orthodontic services too
Dr Raphael teaches his techniques at post-graduate residencies study clubs dental societies and for the Myofunctional Research Co He is available for presentations to any group interested in learning more about the benefits of integrative orthodontics
wwwalignminecomLearn about the choices you have in orthodontics
dr barry raphael Why its
too Early never
1425
bro
ad
str
ee
tc
lifto
n n
j 070
13
973-
778-
4222
fax
973-
778-
9625
nj s
pe
c
368
4
1425 broad street clifton nj 07013973-778-4222
wwwalignminecom
the raphael centerforintegrative orthodontics
the
raph
ael c
ente
r fo
rin
tegr
ativ
e or
thod
onti
cs
Learn about an important choice you need to make before starting braces
the raphael center for integrative education
the raphael center for integrative education
Ongoing Intro to Airway Orthodontics
April Biobloc Study Group
April Training Ortho-Postural Therapists w Roger Price
June MRC Myobrace Basic Series
August Airway Dentistry with Mark Cruz and company
October Advanced MFT with Sandy Coulson
October Less than Six with Kevin Boyd
(who else wants to play)
Mission to create a space for spreading the word about Airway and Orthotropic principles and practice
Orthodontics in the 21st Century
EstheticOrthodontics
AirwayOrthodontics
GeneticTooth-Focused
Dental PerfectionEsthetics Primary
Treating SymptomsAirway Ignorant
AdaptationMuscle-FocusedMedical Better
Esthetics SecondaryTreating Causes
Airway Conscious
The EndAnd
The Beginning
the raphael center for integrative orthodontics
wwwalignminecomwwwbioblocnjcom
wwwmyobracenjcom
Integrative vs Conventional
Integrative vs Conventional
ldquoWith improvements in expansion orthodontics advances in myofunctional orthodontics and the growing recognition about sleep disordered breathing among children and adults it is time for orthodontics to expand its horizons There is now so much more we can oerrdquo
The Raphael name has been associated with high quality orthodontics in New Jersey for over 60 years Dr Barry Raphael has been a university trained orthodontic specialist and a member of the American Association of Orthodontists for 30 years
He has a wide range of techniques and services to offer He has studied oral myology applied kinesiology Buteyko breathing Biobloc Orthotropics and Myobrace as part of his integrative training He can offer Damon Invisalign Insignia and Incognito appliances designs as some of his many conventional orthodontic services too
Dr Raphael teaches his techniques at post-graduate residencies study clubs dental societies and for the Myofunctional Research Co He is available for presentations to any group interested in learning more about the benefits of integrative orthodontics
wwwalignminecomLearn about the choices you have in orthodontics
dr barry raphael Why its
too Early never
1425
bro
ad
str
ee
tc
lifto
n n
j 070
13
973-
778-
4222
fax
973-
778-
9625
nj s
pe
c
368
4
1425 broad street clifton nj 07013973-778-4222
wwwalignminecom
the raphael centerforintegrative orthodontics
the
raph
ael c
ente
r fo
rin
tegr
ativ
e or
thod
onti
cs
Learn about an important choice you need to make before starting braces
the raphael center for integrative education
the raphael center for integrative education
Ongoing Intro to Airway Orthodontics
April Biobloc Study Group
April Training Ortho-Postural Therapists w Roger Price
June MRC Myobrace Basic Series
August Airway Dentistry with Mark Cruz and company
October Advanced MFT with Sandy Coulson
October Less than Six with Kevin Boyd
(who else wants to play)
Mission to create a space for spreading the word about Airway and Orthotropic principles and practice
Orthodontics in the 21st Century
EstheticOrthodontics
AirwayOrthodontics
GeneticTooth-Focused
Dental PerfectionEsthetics Primary
Treating SymptomsAirway Ignorant
AdaptationMuscle-FocusedMedical Better
Esthetics SecondaryTreating Causes
Airway Conscious
The EndAnd
The Beginning
Integrative vs Conventional
Integrative vs Conventional
ldquoWith improvements in expansion orthodontics advances in myofunctional orthodontics and the growing recognition about sleep disordered breathing among children and adults it is time for orthodontics to expand its horizons There is now so much more we can oerrdquo
The Raphael name has been associated with high quality orthodontics in New Jersey for over 60 years Dr Barry Raphael has been a university trained orthodontic specialist and a member of the American Association of Orthodontists for 30 years
He has a wide range of techniques and services to offer He has studied oral myology applied kinesiology Buteyko breathing Biobloc Orthotropics and Myobrace as part of his integrative training He can offer Damon Invisalign Insignia and Incognito appliances designs as some of his many conventional orthodontic services too
Dr Raphael teaches his techniques at post-graduate residencies study clubs dental societies and for the Myofunctional Research Co He is available for presentations to any group interested in learning more about the benefits of integrative orthodontics
wwwalignminecomLearn about the choices you have in orthodontics
dr barry raphael Why its
too Early never
1425
bro
ad
str
ee
tc
lifto
n n
j 070
13
973-
778-
4222
fax
973-
778-
9625
nj s
pe
c
368
4
1425 broad street clifton nj 07013973-778-4222
wwwalignminecom
the raphael centerforintegrative orthodontics
the
raph
ael c
ente
r fo
rin
tegr
ativ
e or
thod
onti
cs
Learn about an important choice you need to make before starting braces
the raphael center for integrative education
the raphael center for integrative education
Ongoing Intro to Airway Orthodontics
April Biobloc Study Group
April Training Ortho-Postural Therapists w Roger Price
June MRC Myobrace Basic Series
August Airway Dentistry with Mark Cruz and company
October Advanced MFT with Sandy Coulson
October Less than Six with Kevin Boyd
(who else wants to play)
Mission to create a space for spreading the word about Airway and Orthotropic principles and practice
Orthodontics in the 21st Century
EstheticOrthodontics
AirwayOrthodontics
GeneticTooth-Focused
Dental PerfectionEsthetics Primary
Treating SymptomsAirway Ignorant
AdaptationMuscle-FocusedMedical Better
Esthetics SecondaryTreating Causes
Airway Conscious
The EndAnd
The Beginning
Integrative vs Conventional
ldquoWith improvements in expansion orthodontics advances in myofunctional orthodontics and the growing recognition about sleep disordered breathing among children and adults it is time for orthodontics to expand its horizons There is now so much more we can oerrdquo
The Raphael name has been associated with high quality orthodontics in New Jersey for over 60 years Dr Barry Raphael has been a university trained orthodontic specialist and a member of the American Association of Orthodontists for 30 years
He has a wide range of techniques and services to offer He has studied oral myology applied kinesiology Buteyko breathing Biobloc Orthotropics and Myobrace as part of his integrative training He can offer Damon Invisalign Insignia and Incognito appliances designs as some of his many conventional orthodontic services too
Dr Raphael teaches his techniques at post-graduate residencies study clubs dental societies and for the Myofunctional Research Co He is available for presentations to any group interested in learning more about the benefits of integrative orthodontics
wwwalignminecomLearn about the choices you have in orthodontics
dr barry raphael Why its
too Early never
1425
bro
ad
str
ee
tc
lifto
n n
j 070
13
973-
778-
4222
fax
973-
778-
9625
nj s
pe
c
368
4
1425 broad street clifton nj 07013973-778-4222
wwwalignminecom
the raphael centerforintegrative orthodontics
the
raph
ael c
ente
r fo
rin
tegr
ativ
e or
thod
onti
cs
Learn about an important choice you need to make before starting braces
the raphael center for integrative education
the raphael center for integrative education
Ongoing Intro to Airway Orthodontics
April Biobloc Study Group
April Training Ortho-Postural Therapists w Roger Price
June MRC Myobrace Basic Series
August Airway Dentistry with Mark Cruz and company
October Advanced MFT with Sandy Coulson
October Less than Six with Kevin Boyd
(who else wants to play)
Mission to create a space for spreading the word about Airway and Orthotropic principles and practice
Orthodontics in the 21st Century
EstheticOrthodontics
AirwayOrthodontics
GeneticTooth-Focused
Dental PerfectionEsthetics Primary
Treating SymptomsAirway Ignorant
AdaptationMuscle-FocusedMedical Better
Esthetics SecondaryTreating Causes
Airway Conscious
The EndAnd
The Beginning
ldquoWith improvements in expansion orthodontics advances in myofunctional orthodontics and the growing recognition about sleep disordered breathing among children and adults it is time for orthodontics to expand its horizons There is now so much more we can oerrdquo
The Raphael name has been associated with high quality orthodontics in New Jersey for over 60 years Dr Barry Raphael has been a university trained orthodontic specialist and a member of the American Association of Orthodontists for 30 years
He has a wide range of techniques and services to offer He has studied oral myology applied kinesiology Buteyko breathing Biobloc Orthotropics and Myobrace as part of his integrative training He can offer Damon Invisalign Insignia and Incognito appliances designs as some of his many conventional orthodontic services too
Dr Raphael teaches his techniques at post-graduate residencies study clubs dental societies and for the Myofunctional Research Co He is available for presentations to any group interested in learning more about the benefits of integrative orthodontics
wwwalignminecomLearn about the choices you have in orthodontics
dr barry raphael Why its
too Early never
1425
bro
ad
str
ee
tc
lifto
n n
j 070
13
973-
778-
4222
fax
973-
778-
9625
nj s
pe
c
368
4
1425 broad street clifton nj 07013973-778-4222
wwwalignminecom
the raphael centerforintegrative orthodontics
the
raph
ael c
ente
r fo
rin
tegr
ativ
e or
thod
onti
cs
Learn about an important choice you need to make before starting braces
the raphael center for integrative education
the raphael center for integrative education
Ongoing Intro to Airway Orthodontics
April Biobloc Study Group
April Training Ortho-Postural Therapists w Roger Price
June MRC Myobrace Basic Series
August Airway Dentistry with Mark Cruz and company
October Advanced MFT with Sandy Coulson
October Less than Six with Kevin Boyd
(who else wants to play)
Mission to create a space for spreading the word about Airway and Orthotropic principles and practice
Orthodontics in the 21st Century
EstheticOrthodontics
AirwayOrthodontics
GeneticTooth-Focused
Dental PerfectionEsthetics Primary
Treating SymptomsAirway Ignorant
AdaptationMuscle-FocusedMedical Better
Esthetics SecondaryTreating Causes
Airway Conscious
The EndAnd
The Beginning
the raphael center for integrative education
the raphael center for integrative education
Ongoing Intro to Airway Orthodontics
April Biobloc Study Group
April Training Ortho-Postural Therapists w Roger Price
June MRC Myobrace Basic Series
August Airway Dentistry with Mark Cruz and company
October Advanced MFT with Sandy Coulson
October Less than Six with Kevin Boyd
(who else wants to play)
Mission to create a space for spreading the word about Airway and Orthotropic principles and practice
Orthodontics in the 21st Century
EstheticOrthodontics
AirwayOrthodontics
GeneticTooth-Focused
Dental PerfectionEsthetics Primary
Treating SymptomsAirway Ignorant
AdaptationMuscle-FocusedMedical Better
Esthetics SecondaryTreating Causes
Airway Conscious
The EndAnd
The Beginning
the raphael center for integrative education
Ongoing Intro to Airway Orthodontics
April Biobloc Study Group
April Training Ortho-Postural Therapists w Roger Price
June MRC Myobrace Basic Series
August Airway Dentistry with Mark Cruz and company
October Advanced MFT with Sandy Coulson
October Less than Six with Kevin Boyd
(who else wants to play)
Mission to create a space for spreading the word about Airway and Orthotropic principles and practice
Orthodontics in the 21st Century
EstheticOrthodontics
AirwayOrthodontics
GeneticTooth-Focused
Dental PerfectionEsthetics Primary
Treating SymptomsAirway Ignorant
AdaptationMuscle-FocusedMedical Better
Esthetics SecondaryTreating Causes
Airway Conscious
The EndAnd
The Beginning
Orthodontics in the 21st Century
EstheticOrthodontics
AirwayOrthodontics
GeneticTooth-Focused
Dental PerfectionEsthetics Primary
Treating SymptomsAirway Ignorant
AdaptationMuscle-FocusedMedical Better
Esthetics SecondaryTreating Causes
Airway Conscious
The EndAnd
The Beginning
The EndAnd
The Beginning