Expanders, ALF, Bioblock & MSE

Homeoblock™ & DNA Appliance®
Myobrace® & Healthy Start™ For All Ages

Dr. Roca has spent many hours learning about all of the different expander methods to be able to provide you with a wide variety of treatment choices.

Not every patient fits into a perfect mold for one type of appliance.  Everyone has different symptoms and concerns and we work hard at Arlington Smile Center to make sure we help you pick which option would be the best fit for you.

Children

As early as age 4, removable or fixed expanders may be needed in children that do not have enough space between their baby teeth. Each child should have enough space to fit a nickel between each tooth. This space will give them the room they need for the adult teeth to have room to erupt as early as 5 years old.

Adults

There are seven sutures that connect the cranium to the maxilla and face that do not BEGIN to fuse until age 68 to 72. So the myth that adults are too old to expand is false. We use removable appliances on adults and turn once a week for adult cases.

Indications for Adult Removable Expanders:

  • Unilateral posterior crossbite
  • Bilateral posterior crossbite
  • High-vaulted roof of the mouth
  • Sleep apnea diagnosis
  • Severity of medical symptoms
  • Beyond Invisalign® capability

The purpose of the expander is for maxillary development, airway development, palatal vault remodeling and increasing tongue space. It can also help us with TMJ (temporamandibular joint) cases.

Epigenetic orthodontics can open and protect the airway, enhancing breathing both during sleep and waking activities. Dr. Roca practices a philosophy that integrates airway into all diagnosis and treatments. Dentistry has traditionally not considered the airway when planning dental treatments. Fortunately, today, there is a rapidly growing movement that now recognizes how dentistry can have an impact on the airway, which affects breathing during sleep. If dental treatments, including TMJ, orthopedics, and orthodontics are well planned, the result can be that the airway is protected or even enhanced. There is a clear link between underdeveloped and retruded jaws, and narrow dental arches that put a patient at risk for sleep-breathing disorders.

Please visit this site for more information: Airway Health

Example: Lower Expander
Example: Upper Expander

During expansion treatment or any orthodontic therapy we want to make sure we can keep your body from locking up and that we keep your sutures mobile and always in a neutral position.

What Is Orthotropics?

Orthotropics represents a new way of looking at crooked teeth. Instead of seeing them in isolation, they are viewed as part of the head and neck, and in relation to other problems in this system, such as breathing, body posture, jaw joint problems and most ENT.

Wider Airways
Healthier Jaw Joints
Stronger Profiles
Terrific Smiles

Orthotropics specializes in treating malocclusion by guiding the growth of the facial bones and correcting the oral environment. This treatment creates more space for the teeth and tongue. We use a variety of different fixed and removable appliances that help with expansion and correct posture. We also use myofunctional activities — exercises that teach correct swallowing and muscle function and help get the face to a symmetrical state.

Missing the bigger picture is a common problem within medicine, and orthodontics is no exception. Orthodontics was developed to make teeth straight. They do make teeth straight, but too many people need braces more than once, and we have finally learned why this is the case. Faces that grow correctly have straight teeth and are healthy, whereas faces that do not have crooked teeth and a list of other health problems. Attempting to force the teeth into alignment is ineffective in the long term and potentially damaging. However, attempting to redirect the growth pattern can align the teeth permanently, gain wide-ranging health benefits, especially for sleep apnea, and improving facial appearance.

Traditionally, an orthodontist uses an expander at the age of 8 and places a Hawley retainer for the patient to wear at night until the child loses the rest of their teeth and starts Phase II treatment. As you can see in the photo, the expander gives a lot more room for the patient to breathe, but as soon as the Hawley retainer is placed in the mouth, the tongue can’t live in the roof of the mouth and the habit of mouth breathing starts all over again. If the tongue was originally living in the roof of the mouth, they would not have needed an expander in the first place. Over time, we most usually see orthodontic relapse because it is common practice that the child stops wearing the retainer. Either they forget one night or it starts to bother them due to the incorrect swallow during the day when they don’t have the retainer in their mouth. Before we know it, the palate starts to move into its narrow shape again. In order for this not to happen, the tongue needs be suctioned to the roof of the mouth 24/7, except while chewing and talking, which is why it is an essential part of our treatment to teach your child the proper use of all facial muscles.

Below is an Upper Bioblock

There are many different methods of orthotropic treatment. It all depends on the patient’s chief complaint and age. There is not one correct way; it depends on many variables. Here is a video talking more about this:

Many Available Options

We can use fixed expanders, removeable expanders, ALF (Advanced Lightwire Functionals), BioBlock and more.

ALF: Advanced Lightwire Functional Appliance

Advanced Lightwire Functional Appliance

My gratitude goes out to Dr. Darick Nordstrom, who developed the ALF appliance over many years and who has shared his insights with us. His ingenious mind, as well as his warmth and modesty are reflected in this wonderful work. I also studied Alf under Dr Ljuba Lenke and Dr Angie Tenholder who both opened my eyes to the world of ALF.

What is the “magic” of the ALF, and is it all in the design?

While the design does indeed need to match the patient’s individual needs, the material used is equally important. The body wire of the ALF is made of elgiloy, a cobalt-based alloy; the blue elgiloy often selected for its natural flexibility. We need that springy sensation to enhance the body’s natural rhythmicity (created by the flow of cerebral spinal fluid).

Who can benefit from ALF treatment?

  • Children and adults who want to address misalignment of their teeth and jaws while improving health and well-being
  • Patients with pain in the head, neck, shoulder or back areas
  • People who has received previous orthodontic treatment, including tooth extractions and headgear
  • Individuals who experience TMJ disorders
  • Patients who clench or grind their teeth, snore, or suffer from obstructive sleep apnea
  • Patients who have an active sympathetic nervous system and need calming of their over active autonomic nervous system
  • Patients who have a lot of sensory overload or anger management concerns

Why isn’t ALF treatment more common?

  • ALF treatment is a multi-disciplinary approach and more complex than traditional braces. It requires the dentist to spend more time with the patient and the patient to spend more time in the chair. This more intensive treatment schedule can be difficult to integrate into busy lifestyles and busy practice schedules.
  • Providing ALF treatment requires additional training and expertise in cranial osteopathy and orofacial myology.
  • While the appliances may look simple, it requires knowledge and experience to adjust them appropriately.

What Dental Lab do we use for our ALF appliances?

ALF Internationals LLC is a small laboratory that specializes in the creation of Advanced Lightwire Functional appliances as developed by Dr. Darick Nordstrom. This novel approach to orthodontics works to integrate cranial mobility with the palate, tooth. tongue and jaw alignment which results in improved swallowing, breathing, speech and sleep. Alf International is an experienced top-notch certified ALF laboratory. Often, Karol Quiroga, the owner will even come to our office to deliver some cases with Dr. Roca so she can see and enjoy firsthand the profound impact the Alf will have on our patients.

What is the best time to start ALF treatment?

Beginning ALF treatment at a young age is ideal, as physical growth is the most important factor in receiving treatment. However, ALF treatment can begin at any ages as long as the teeth have sufficient supporting bone.

Can ALF treatment be used to undo problems created by previous orthodontic treatment?

Yes, ALF treatment is a good approach to undo the damage from tooth extractions and headgear wear.

How can Alf appliance therapy act as a preventive health measure?

Underlying issues that cause teeth to be misaligned can also significantly impact overall health:

Cranial strains or kinks between the bones of the head affect nerve function and blood circulation to and from the brain.

One cranial nerve that you may have heard about is the vagal nerve. It affects all of our inner organs. If it is irritated, a variety of different symptoms can occur: heart palpitations, breathing problems, irritable bowel syndrome, anxiety attacks, and other symptoms. Therefore, releasing cranial strains is a preventive health approach.

Functional breathing happens with the tongue is up against the roof of the mouth, the diaphragm engage and the breath travels along the spine all the way into the small of the back. Breathing is effortless.

One of the causes for asthma, allergies, high blood pressure and other diseases is over-breathing (we mostly expect the opposite). In a team approach to ALF treatment, good breathing habits are taught and habituated – a major asset for good health.

Oral posture and overall posture are important because:

Having the tongue up against the roof of the mouth stimulates important acupuncture points.

  • If the tongue, throat and neck muscles are toned it lessens the likeliness of snoring and developing OSA.
  • The teeth touching during swallowing stabilizes the cervical spine and allows muscles to relax. This is important to prevent muscle tension in the neck and shoulders
  • Unless the head is centered on top of the spine there will be huge forces present that tend to distort the back; the result can be spinal disk degeneration, joint problems, arthritic changes and more.

The things I just talked about are all very basic, very essential elements of good health. They can and should be addressed during ALF treatment.

What is Cranial Osteopathy?

Cranial osteopathy is a refined and subtle type of treatment that encourages the release of stresses and tensions throughout the body, including the head. It is a gentle yet extremely effective approach and may be used in a wide range of conditions for people of all ages. Our office needs each patient to be under the care of an osteopathic doctor or body worker.
https://cranialacademy.org/

Cranio-Sacral Therapy (CST)

While the training for cranio-sacral therapists is less involved than what is taught at osteopathic school, there are CST practitioners with outstanding skills who can support ALF treatment in powerful ways.

Can ALF treatment be used to undo problems created by previous orthodontic treatment?

Absolutely! In fac, ALF treatment is an excellent approach to undoing damage from tooth extractions, headgear and less effective orthodontic treatments.

How much does ALF treatment cost?

The fee for ALF treatment varies widely between practitioners. Factors that play a role are:

  • The length of treatment (2 to 4 years and sometimes longer)
  • The complexity of the treatment needs
  • Phase 1 treatment only: This involves early arch development with the need for Invisalign® later, OR Comprehensive treatment without the need for Invisalign.

In general, you can expect the fees to be at least as much as treatment with braces would be. In all practices that offer Alf treatment you will find that Alf fees are higher because the dentist will spend significantly more chair time with each patient and has many hours of extra education invested in the ALF appliances.

Why do patients in Alf treatment need to invest time in Orofacial Myology / Myofunctional Therapy?

Orofacial myofunctional therapy treats a variety of postural and functional disorders, including finger-sucking habits and inappropriate oral postures or functions of the tongue, lips, jaw and face. If not corrected these habits will negatively impact facial development, jaw alignment and teeth alignment.

Our office normally combines Alf treatment with Myobrace treatment. The idea being that when you finish Alf treatment, we will normally use Myobrace® as your retainer. Myobrace also works beautifully with Alf treatment, they compliment each other well.

Photos below provided By Dr. Ben Miraglia

3 Options to Fix the Class III Dental Maloclusion Growth Problem

IF a patient has a class III bite ( which means lower jaw is growing or has grown in front of upper jaw). Our office can provide three options in order to avoid jaw surgery to correct this malocclusion. To start with we can do removable or cemented-in-place expanders with many designs. Below, you can see three options we offer to correct the underbite depending on the patient’s age and degree of their Class III classification.

In our office, we will never want to retract the lower jaw since that would narrow the airway. We will never recommend removing permanent teeth.

Option 1

The ideal option is start at an early age with the Myobrace™ I-3 to move the upper jaw forward. Often, we do Myobrace alone or combine it with an Alf depending on child and their symptoms

Pros: This treatment guides newly erupting teeth into the proper position, naturally round out the arches, improving sleep and nose breathing. It also teaches the correct way swallow and a lip closed posture.

Cons: This treatment might not be enough and we may need to implement another treatment at the same time as Myobrace.

Photo of our patient

Option 2 may be a good choice depending on age of the child and the severity of the Class III skeletal classification.

The upper expander is connected to the back molars and is cemented in place using reverse pull headgear that should be worn 16 hours a day or longer.

Pros: No implants are needed and there is no pain. However there may be some  just very mild discomfort. It is less expensive than an MSE, expander and is easier for dentist to place. It is also easier for patient to tolerate and normally, they Myobrace is all they need at the end of the treatment to align the teeth.

Cons: This treatment takes longer. It will improve nasal breathing and sleep but not as quickly.  If we do this after age 10, the palatal suture does not split down the middle.  The expander is in mouth longer than with MSE. The facemask is used longer, and usually results in 1 millimeter of protraction a month in a child 10 years of age and under if the child wears reverse pull face mask 16 hours a day. If patient wears it less than 16 hours a day it takes much longer.  If the child is older than 10 we may only need to turn expander two to three times a week. Some dentists maintain that in a child over 10-12 the treatment may result in tipping the teeth. Depending on severity of the condition, more than one expander may be needed.

Early class III protraction facemask treatment reduces the need for orthognathic surgery: a multi-centre, two-arm parallel randomized, controlled trial

Our patient Bruno gives a testimonial and his photos

Option 3

The upper expander is connected to TAD implants (4 micro-assisted mini-implants). This placed in the roof of mouth to split palate with a fixed expander that connects to a reverse pull face mask.

 

Pros: This treatment may be quicker, depending on each patient and how often headgear is worn. It will improve nasal breathing and sleep. The palatal suture can create an even split. The appliance needs to be turned more often to open and close palatal suture. There is less chance of tipping the teeth.

 

Cons: This treatment more expensive and invasive, and could create more discomfort. The patient will need braces or Invisalign® to align teeth and we can use Myobrace at same time as braces or Invisalign.

Comparison of skeletal maxillary transverse deficiency treated by microimplant-assisted rapid palatal expansion and tooth-borne expansion during the post-pubertal growth spurt stage:A prospective cone beam computed tomography study

Below you can see an example of a lower expander and an upper MSE expander with hooks for the reverse pull face mask. You can learn more about MSE below.

What is Maxillary Skeletal Expansion (MSE)?

Maxillary transverse deficiency (narrow upper jaw) is a highly prevalent orthodontic problem present in all age groups. For children and early teens with this narrow upper jaw, it can easily be widened with a palatal expander, as their upper jaw is in two pieces and not fully fused in the middle. For mature patients and adults, however, a palatal expander often will result in unwanted flaring of posterior teeth instead of skeletal expansion. Typically, adults with a narrow upper jaw with bite problems were subjected to an invasive surgical procedure — surgically-assisted rapid palatal expansion (SARPE) — to correct this condition. Maxillary Skeletal Expander (MSE), it is a type of MARPE, and patients who use it can forgo surgery with the use of four TADs in the palate. Developed by one of Dr. Roca’s mentors, Dr. Won Moon, MSE offers a non-invasive way of correcting maxillary transverse deficiency for patients who were previously told that they would need surgical intervention. We can also attach a reverse pull facemask to try to get some saggital growth as well. Dr Roca has also studied Dr Richard Singh and Dr Rebecca Brokow’s MSE techinique as well. Dr. Roca says placing MSE is much easier than implants since no dangerous structures are in our way. Even corticopunture is surprisingly quick and painless.

MSE II ActivationEarly Teens: 6x/week (0.80mm/wk)

Late Teens: 2x/day (0.27mm/day)

Early to Mid 20’s: 4-6x/day (0.53-0.80mm/day)

Older: Min 4-6x/day

After Diastema: 2x/day (0.27mm/day)

Patient’s Biotype Must Be Considered!

  • Initial penetration with force
  • Relatively easier insertion after the first layer of cortical bone
  • Tighter insertion when the second layer of cortical bone is being penetrated
  • Slight release of tightness and tickling sensation in the nose
  • Complete insertion: no significant complications

MSE

Slow Expansion

  • Trans-septal fibers keep crowns together: No Diastema
  • V-shaped Expansion Minimized!
  • Less Peri-Maxillary Changes
  • Airway Treatment and FM: Rapid may be better
  • Lower Failure

Rapid Expansion

  • Trans-septal fibers get stretched by overwhelming force: Diastema
  • Parallel Expansion
  • Signficant Per-Maxillary Changes
  • Great for Airway Treatment and FM
  • More Breakage of MSE

Call for a consultation at 703-237-7622 to determine if you or anyone in your family is a candidate for any of our orthodontic options.