Author Topic: Class II patients and functional apliances  (Read 15065 times)

bluejay

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Class II patients and functional apliances
« on: July 19, 2013, 01:24:56 PM »
I know it is small sample group, but I'm curious.

When I was about 10 yrs old I had a severe overbite. The roof of my mouth was actually sore from biting it. The orthodontist wished my parents had brought me in sooner, but felt it wasn't too late act. I was given a functional twin block appliance.

from wiki: "Fixed Twin Block Appliance: The Twin Block appliance is a removable appliance, and its high comfort level allows you to wear it 24 hours a day. This appliance actually is made up of two separate appliances that work together as one. The upper plate includes an optional expansion screw to widen your upper arch, if needed, as well as pads to cover your molars. The lower plate includes pads to cover your lower bicuspids. These two appliances interlock at an angle, and they move your lower jaw forward and lock it into the ideal position when you bite together. This new position, while temporary, will eventually become the permanent corrected position."

Unfortunately, at about age 20 my jaw began to recess. It was also discovered that at some point I had active Degenerative Joint Syndrome. I eventually decided on splint therapy. My jaw recessed, and my bite opened up. My orthodontist in college informed me that he had used the appliance on 100s of patients, including his daughter. Many of these cases, particularly females, had their jaws recess between age 17-20 and required surgery.

Anyone else use this or another appliance, experience regression and/or still require surgery?

Tiny

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Re: Class II patients and functional apliances
« Reply #1 on: July 22, 2013, 07:36:13 AM »
You mention hitting the roof of the mouth - was this with the lower incisors?  Do you have a deep overbite?

bluejay

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Re: Class II patients and functional apliances
« Reply #2 on: July 22, 2013, 12:03:19 PM »
I did when I was 10. I had the appliance which "fixed" the problem, then began to recess 7-10 yrs later. Splint therapy brought me back to my natural (over)bite, then my bite ended up flying open. By that I mean about 100 microns a week.

I had corrective surgery, so I no longer have an over bite. My teeth would line up perfectly, bite function normally, if my open bite hadn't relapsed.

It was 18 years ago, but yes, I believe it was with the lower incisors.

Tiny

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Re: Class II patients and functional apliances
« Reply #3 on: July 22, 2013, 08:09:14 PM »
So you had a deep (overbite), when then turned into an open bite?  Interesting.  It's open at the front?

bluejay

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Re: Class II patients and functional apliances
« Reply #4 on: July 22, 2013, 08:49:03 PM »
Yes, it is anterior. It was quite a shock. My jaw had settled. It hadn't moved in weeks and we were beginning to talk about moving forward with planning the surgery. Then all of the sudden my bite just began to open quite dramatically, and certainly changed the entire course of the surgery.

ExtractionsRuinFaces

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Re: Class II patients and functional apliances
« Reply #5 on: July 23, 2013, 05:54:34 AM »
Hmmm...interesting.

If you relapsed after 7-10 years I would think it was the Osteoarthritis that caused it, no?


bluejay

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Re: Class II patients and functional apliances
« Reply #6 on: July 23, 2013, 08:14:12 AM »
Well, the orthodontist I saw in MI during college said he had done about 1500 cases using the twin block. Most of those patients ended up recessing and needing surgery, particularly females. There are tons of studies assessing the best time use the twin block and follow up results a couple of years later. I have yet to see any studies of the long term effects, stability, or whether the patients still required surgery. So, did the DJD cause the start of the recession, or did the twin block cause the DJD which resulted in the recession? I also have no idea if DJD had anything to do with the recession or if it was just a side effect of all the strain my jaw was under. Bottom line, I don't think the twin block solved the problem.

My lower teeth also went crooked within a year or so after braces. I was wearing my retainer most of the time. The orthodontist offered a spring retainer followed up with a permanent one. I turned it down, partially because I thought it was my fault and I didn't want to cost my parents any more money. I asked my current dentist, Dr. Mac, if my jaw would have recessed if I had gone through with this treatment plan. He informed me that my jaw likely would not have recessed.

He went on to tell me that my jaw still would not have been in a natural position, putting a lot of strain on the muscles. He asked me, "what happens if you just keep stretching an elastic waist band?" Eventually the band would lose its elasticity. Essentially, I would have been walking down the street one day, minding my business, and my jaw would have just dropped right open. Later, I met a co-worker who had friend that had that happen. The teeth will move if the upper and lower jaw are not in proper alignment.

Alue

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Re: Class II patients and functional apliances
« Reply #7 on: July 23, 2013, 08:56:38 PM »
I used to bite the roof of my mouth, ortho put me in headgear to prevent my maxilla from growing while my mandible "caught up".   I wound up with a normal bight but a very recessed jaw. 

I'm not sure about recessing further after orthodontics has completed.  Did you have bicuspids extracted? 

bluejay

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Re: Class II patients and functional apliances
« Reply #8 on: July 24, 2013, 09:09:01 AM »
I'm having trouble picturing a normal bite with a recessed jaw. What is recessed?

I never had any extractions, thankfully.

My lower jaw recessed because what the orthodontist attempted did not actually work. Essentially, my lower jaw was trained to posture forward. The idea was to encourage growth during puberty, but I don't know that it actually works. It certainly didn't in my case and several others.

I generally feel that the idea you can affect growth with an appliance, in any way, without some form of surgery, is incorrect. I feel it creates more problems further down the road.

ExtractionsRuinFaces

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Re: Class II patients and functional apliances
« Reply #9 on: July 24, 2013, 04:03:33 PM »
I'm having trouble picturing a normal bite with a recessed jaw. What is recessed?

I never had any extractions, thankfully.

My lower jaw recessed because what the orthodontist attempted did not actually work. Essentially, my lower jaw was trained to posture forward. The idea was to encourage growth during puberty, but I don't know that it actually works. It certainly didn't in my case and several others.

I generally feel that the idea you can affect growth with an appliance, in any way, without some form of surgery, is incorrect. I feel it creates more problems further down the road.

Sounds like bad nuwz for me >:( im getting non surgical expansion right now at 18.

CK

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Re: Class II patients and functional apliances
« Reply #10 on: July 24, 2013, 05:38:18 PM »
Quote
I generally feel that the idea you can affect growth with an appliance, in any way, without some form of surgery, is incorrect. I feel it creates more problems further down the road.

not a feeling, fact. confirmed by multiple studies and experiments. many orthodontists like to pretend they have same capabilities as surgeons. and the whole gimmicky appliances that obviously are never subject to rigorous testing remain unchallenged in spite of the overwhelming problems created by them.

i think someone mentioned a paper written in 1960 that explained how terrible headgear is for facial growth. yet i know orthodontists STILL use it 2013.




ExtractionsRuinFaces

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Re: Class II patients and functional apliances
« Reply #11 on: July 25, 2013, 03:59:21 AM »
not a feeling, fact. confirmed by multiple studies and experiments. many orthodontists like to pretend they have same capabilities as surgeons. and the whole gimmicky appliances that obviously are never subject to rigorous testing remain unchallenged in spite of the overwhelming problems created by them.

i think someone mentioned a paper written in 1960 that explained how terrible headgear is for facial growth. yet i know orthodontists STILL use it 2013.

Do you have any links to the studies? what problems do these appliances create?

CK

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Re: Class II patients and functional apliances
« Reply #12 on: July 25, 2013, 04:38:41 AM »
Do you have any links to the studies? what problems do these appliances create?

the study on headgear is on the forum somewhere. for the other appliances im not entirely sure, but considering how reckless the orthodontic community has been generally every kind of appliance that orthos say can inhibits abnormal growth or jaw deformities should be held with great suspicion.



Alue

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Re: Class II patients and functional apliances
« Reply #13 on: July 25, 2013, 05:51:40 PM »
You can absolutely modify growth if you put enough force on it.  I posted some specific links to studies a while back, it's just the abstracts.  Primitive cultures even modified cranial growth by a process called head binding https://en.wikipedia.org/wiki/Artificial_cranial_deformation.  There is also Chines foot binding https://en.wikipedia.org/wiki/Foot_binding.  Point being, if you put enough force anywhere on the body for long periods of time, you can modify growth patterns.   It just depends on how much force is used and for how much time. 

CK

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Re: Class II patients and functional apliances
« Reply #14 on: July 25, 2013, 05:58:06 PM »
sad. really really sad. because the damage isnt seen till adulthood orthos continue to get away with these kinds of treatment plans.