Nov 06

Facial Changes As A Result Of Palatal Expansion In Adult Patients Using The Homeoblock Appliance}

Submitted by: Theodore Belfor

Introduction

Palatal expansion in adult patients is a relatively new concept. Ever since Grays Anatomy the bible for dental students studying anatomy, we all believed that the cranial sutures fuse solid when we become non-growing adults. In an interview for Dental Press Magazine of Orthodontic and Facial Orthopedics in 2002, Donald H Enlow, author of three books on Cranium Facial Growth and 170 scientific articles, Dr Enlow, when queried Is there any craniofacial growth after 20 years of age? Answered,yes. Futhermore, he states, A capacity for facial remodeling in adults is retained throughout life. He also states,We must utilize three-dimensional evaluation based on an individuals actual growth and development. The Homeoblock functional appliance produces noticeable facial changes in adult patients in four to six months. We have viewed these changes in three-dimensions using stereophotogrammetry. In an article published Quantification of facial morphology using stereophotogrammetry–demonstration of a new concept. It is concluded that stereophotogrammetry is a suitable 3-D registration method for quantifying and detecting developmental changes in facial morphology. (1)

Abstract

Maxillary arch changes using the Homeoblock appliance have been reported and published in the Functional Orthodontist (2). The purpose of this paper is to look more closely at the facial changes that occur when we remodel the maxillary dental arch wider in the course of palatal expansion. To observe and understand these changes a review of the anatomy of the region is included.

Zygomatic bone (green)

Maxilla (orange)

Malar bone (in contact with the temporal frontal sphenoid and maxilla) (beige)

Four muscles from left to right

Zygomaticus majo

Zygomaticus mino

Levato Labii Superiorus

Obicularis Oris

Looking at the anatomy of the area we can see how the remodeling of the maxilla can easily affect the malar and the zygomatic bones. Since the muscle attachments are on the bone we can see how the muscles which insert into the muscle and soft tissue around the mouth can also affect the fullness of the lips. Optimal development of the lateral aspects of the face especially the malar and zygomatic bones make it easier for the patient to smile. The paper will examine three dimensional images of patients, pre and post treatment with the Homeoblock appliance. We choose the profile view to illustrate the changes most clearly. It is concluded that the Homeoblock appliance creates observable changes around the eyes, in the area of the cheekbone and around the mouth.

Case Reports

Patient A

The first patient is a sixty year old female that presented to the office for teeth straightening, and porcelain laminate veneers. A three-dimensional Stereophotogrammetry image was taken using a 3dMD facial capture system.

The pre and post photos clearly show changes around the eyes, at the area of the cheekbones and around the mouth consistent with remodeling the underlying maxillary and zygomatic bone structures wider.

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Patient B

The second patient a fifty year old female was treated six months with a Homeoblock appliance to reduce age lines in the face. Stereophotogrammetry images were taken pre and post treatment. The photos were then evaluated using the 3dMD facial capture software to evaluate the changes that occurred.

Pre and post profile

3dMD software was used to evaluate facial changes. An increase in facial width of almost 4 millimeters was observed.

Pre and post full face photos

Pre and post intra oral photos showing the Homeoblock appliance in place.

Patient C

The third patient is a thirty-six year old female that presented to the office for teeth straightening with the Homeoblock appliance. She was treated for thirty months wearing the appliance in the night time only to straighten her upper and lower teeth.

Pre and post profile after six months of treatment

A full face view that superimposes the post face over the pre face photos are used to illustrate where the development took place in the purple color.

Intra oral pre and post photos showing completed treatment with the Homeoblock appliance

Discussion

The issue of facial esthetics and functional orthodontics is very timely. There is a growing focus on esthetics, which needs to be balanced with good functional outcomes. The Homeoblock appliance has several components in combination, including a base-plate with a unilateral bite block and a mid-line expansion screw. We postulate that the unilateral bite block exerts cyclic, intermittent forces on the periodontium of the associated teeth during function (such as swallowing during sleep). These forces are detected by mechanoreceptors on the cell surfaces of the periodontal and periosteal cells. Due to signal transduction(3), a cascade of events is initiated, resulting in gene transcription and mRNA biosynthesis(4). Downstream, osteogenic cells are activated, and adapting to the axial forces, remodeling occurs. The change in vertical dimension (opening the bite) affects also the spatial relations of the contra-lateral teeth(5), which have lost their normal occlusal contacts. These changes are also detected by receptors in their periodontal and periosteal cells. Consequently, remodeling occurs due to signal transduction, adapting to decreased forces in accord with the functional matrix hypothesis(6-7).

The Homeoblock appliance has also a base-plate that does not contact the palatal vault. Consequently, swallowing of saliva creates a relative negative pressure between the palatal mucosa and the fitting surface of the device. As the dorsal surface of the tongue exerts forces on the polished surface of the device during swallowing, tension is exerted on the mucoperiosteum of the hard palate and the midpalatal suture is separated. Thus, the developmental mechanisms of sutural homeostasis are activated(8). Despite the fact that most osteogenic activity is normally observed during early to late childhood, it is now understood that palatal, maxillary and circum-maxillary sutures retain biosynthetic potential into late adulthood (9), and it is possible that mechanical stimuli up-regulate genes that are not typically expressed during normal development(10). It is postulated that the Homeoblock device maintains physiologic forces on the midpalatal suture, resulting in slow expansion (250m per week). Recent research suggests that a sutural width >300m results in bone deposition(11) while a sutural width

2. Singh GD, Diaz J, Busquets-Vaello C, Belfor TR. Soft tissue facial changes following treatment with a removable orthodontic appliance in adults. Funct Orthod. 2004;21(3):18-23.

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3. Sandy JR. Signal transduction. Br J Orthod 1998; 25:269-274.

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4. Mao JJ, Nah HD. Growth and development: hereditary and mechanical modulations. Am J Orthod Dentofacial Orthop 2004;125:676-689.

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5. Iscan HN, Sarisoy L. Comparison of the effects of passive posterior bite-blocks with different construction bites on the craniofacial and dentoalveolar structures. Am J Orthod Dentofacial Orthop 1997;112:171-178.

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6. Moss ML. The functional matrix hypothesis revisited: The role of mechanotransduction. Am J Orthod Dentofacial Orthop 1997;112:8-11.

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7. Singh GD. On Growth and Treatment: the Spatial Matrix hypothesis. In: McNamara JA Jr (ed). Growth and treatment. Craniofacial Growth Series. Monograph 41. Ann Arbor: University of Michigan, 2004.

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8. Mao JJ, Wang X, Mooney MP, Kopher RA, Nudera JA. Strain induced osteogenesis of the craniofacial suture upon controlled delivery of low-frequency cyclic forces. Front Biosci 2003;8:A10-17.

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9. Kokich VC. The biology of sutures. In: MM Cohen Jr (ed). Craniosynostosis: Diagnosis, evaluation and management. New York: Raven Press, 1986.

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10. Mao JJ, Nah HD. Growth and development: hereditary and mechanical modulations. Am J Orthod Dentofacial Orthop 2004;125:676-689.

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11. Borke JL, Yu JC, Isales CM, Wagle N, Do NN, Chen JR, Bollag RJ. Tension-induced reduction in connexin 43 expression in cranial sutures is linked to transcriptional regulation by TBX2. Ann Plast Surg 2003;51:499-504.

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12. Moss ML. The functional matrix hypothesis revisited: The role of mechanotransduction. Am J Orthod Dentofacial Orthop 1997;112:8-11.

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13. Singh GD. On Growth and Treatment: the Spatial Matrix hypothesis. In: McNamara JA Jr (ed). Growth and treatment. Craniofacial Growth Series. Monograph 41. Ann Arbor: University of Michigan, 2004.

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14. Lima AC. Spontaneous mandibular arch response following rapid palatal expansion: a long term study on Class I malocclusion. MS thesis, Marquette University, Milwaukee, Wisconsin, 2004.

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15. Belfor TR, Singh GD. Developing facial symmetry using an intra-oral device. J Cosmetic Dent 2004;20:76-80.

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16 Belfor TR, Singh GD. Developing dental arch symmetry using the Homeoblock device. Int J Orthod 2004;15(3), 27-30.

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17. Singh GD, Diaz J, Busquets-Vaello C, Belfor TR. Soft tissue facial changes following treatment with a removable orthodontic appliance in adults. Funct Orthod. 2004;21(3):18-23.

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18. Belfor TR, Singh GD. Treating malocclusions and improving orofacial form and function in adults. J Amer Acad Gnathol Orthop 2005;22(1), 14-17.

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About the Author: Dr. Theodore R. Belfor graduated from New York University College of Dentistry in 1966 and has been in private practice for 40 years.He has been published in CRANIO, The New York State Dental Journal, Philippine Journal of Orthodontics, Indian Dentist, Dental News (Lebanon), Novoe V Stomatologii (Russia), APEX (UK), The Journal of Cosmetic Dentistry, Aesthetic Dentistry Today, Dentistry Today, The Journal for the American Academy of Gnathologic Orthopedics, The Functional Orthodontist, International Journal for Orthodontics, Sleep Diagnosis and Therapy, Anti-Aging and Cosmetic Surgery Magazine. For more information visit website:

facialdevelopment.com/

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Oct 07

Very Good Reasons To Visit Your Dentist Evry Six Months

Submitted by: Dr. Pandya

While visiting your dentist once every six months may seem like a waste of time unless you have issues that need attention, these visits can actually prevent problems from occurring and can actually help guard against health issues much bigger than a toothache.

To begin with, good daily oral hygiene habits are crucial in keeping your teeth and gums healthy and regular trips to your dentist can ensure that you are doing everything you can in the way of oral hygiene. If not, your dental hygienist can instruct you on the proper ways of brushing and flossing to keep the bacteria in plaque from doing any damage to either your teeth or your gums.

While proper brushing and flossing removes a large percentage of the plaque that is consistently present in your mouth, some of the plaque gets into places where it can only be removed by a professional dental cleaning. And plaque that is not removed, overtime turns into tartar (also known as calculus) that can build up on your teeth both above and below the gum line. It takes special dental tools in the hands of a dental professional to remove tartar buildup. And tartar that is not removed can contribute to periodontal disease (also known as gum disease).

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During your six months checkup, your teeth will not only be professionally cleaned, they will also be examined for any issues that may be present from the beginning of tooth decay to periodontal disease. Having your dentist periodically check for periodontal disease is the best to prevent it or stop it in its early stages because gum disease has very few, if any, symptoms before it is at an advanced stage where bone loss is occurring. And studies show that 80 percent of adults in this country have some stage of gum disease most of it undetected.

While periodontal disease is an infection in the mouth and gums, it has far-reaching effects in that it has been linked to systemic diseases such as heart disease and diabetes. So keeping your gums healthy is an important part of your oral health, it is also important for maintaining good overall health.

Oral cancer screenings are also performed during regular dental checkups and this process could save your life. Each year worldwide, more than 300,000 new cases of oral cancer are diagnosed, and this disease causes more than 7,500 deaths annually.

During your dental appointment your dentist will also assess any treatments that might be necessary such as repairing a decaying tooth or performing scaling and root planing which is a non-surgical process for stopping gum disease in the early stages. Also, any current restorations that exist in your mouth such as fillings, veneers, inlay, onlays, crowns, implants, partials or dentures will be evaluated to ensure that they are strong and healthy and not causing any problems in your mouth.

Visiting your dentist at least every six months (more often if problems exist) will also save you money because problems that are found and treated in the early stages are much less costly than those that have not been found until they have developed into real issues.

Visiting your dentist at least twice a year should be high on your priority list simply because of the problems that these visits can prevent. Remember, a routine dental checkup can not only save your smile, your dental health and strain your pocketbook, it could also just possibly save your life.

About the Author: Dr. Pandya received his Doctor of Dental Surgery (D.D.S.) degree in 2001. He then completed additional training in Aesthetic at University of California Los Angeles. He also completed certificate in Boston Implant Institute for surgical implant and reconstructive surgeries.

Bay Dental Center

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Mar 07

Neck And Back Pain Treatment In Atlanta Types Of Treatment}

Submitted by: Deepa Dhingra

In the recent years, people complaining of back and neck pain problems have increased at an alarming rate. Also, it has been found that neck and back pain is one of the main causes of loss of work time, second to the common cold. Almost 70 percent to 80 percent people living in the United States of America suffer from it at one or the other point in their lives. Despite this, most of us just ignore it initially only to get worried later. Spasm, sprain and strain is the most common cause of back and neck pain. And, it happens because of improper posture, poor technique to lift things and unhealthy ergonomic environment. Disc problems which trigger because of age, wear or tear or injury is yet another cause. There are other causes as well as such, as osteoporosis, spinal stenosis and osteoarthritis.

Pain management is one of the most important parts of back and neck pain treatment in Atlanta. It is about a multidisciplinary approach for eliminating or minimizing pain. Some of the goals as part of pain management are eliminating intake of unsafe medicines, increase in physical activity and learning and adapting lifestyle promoting wellness.

Pain management therapies and treatments for back and neck pain treatment in Atlanta

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Antidepressant Medicines There are several evidences to prove that tricyclic anti-depressants make for an effective treatment for different type pain conditions like neuropathic pain and migraine headache.

Epidural InjectionsIt is one of the most effective ways of treating back and neck pain. In this, the physician or spinal surgeon feels the spine of patient for guiding needle placement between the spinal vertebrae. However, with new techniques, things have changed. Today, technique of X-ray fluoroscopy is used for administering the needle directly into the neural foramen. This is the point where the damaged nerve root exits the spinal canal.

Steroid injections into the lumbar epidural space are used for alleviating pain which radiates from the lower back and goes to the leg. The main cause of pain might be spinal stenosis or disc herniation which triggers inflammation, nerve root irritation and pain. In a similar way, Epidural injections are used for treating neck pain which extends till arm.

Nonsteroidal anti-inflammatory drugs These are pain relieving medications. Intake of these drugs does not alter or affect patients cognitive functions, cause nausea or respiratory depression. However, it is important for you to know that NSAIDs have significant side effects, particularly if taken for a long time.

Facet joint injectionsThey comprise of injection involving steroid medication into the damaged facet joint for alleviating pain and inflammation. Injections, when administered into these blocks or nerves of the joints can be of great help in relieving pain.

In addition to the above slated, there are several other treatment options for neck and back pain treatment in Atlanta. In order to know about the best available treatment, consult an experienced and an expert spinal surgeon like Dr. Erik Bendiks. He has been treating problems related to back, neck and spine for more than ten years, and thus recommends the best treatment.

About the Author: If you are suffering neck or back pain then consult a doctor who has expertise or specialization for the same. This will ensure you get the best neck pain treatment in Atlanta.

erikbendiksmd.com/cervical.html

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Dec 16

Experience Top Quality Dental Care In Plano}

Experience top quality dental care in Plano

by

davudobuya55

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We are the texas dental plano that offers dental services at prices that are unmatched and pocket-friendly as well. We are committed to providing finest quality family dentistry plano care in a relaxed, friendly and welcoming environment. We are open early in the mornings and late at night in order to offer you the finest quality dental care services at your convenience. We also offer our services on Saturdays and Sundays by appointment. Our rates are quite affordable and this is what has made numerous customers stick with us. We are known for accepting most of the dental insurances, which include CHIP and Medicaid. Do not worry that you do not have dental insurance; we offer texas dental plano services at 60% discount in addition to easy payment plans via our exclusive Shifa Dental Club membership.

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