orthodontic lawsuit - orthodontics caused TMD

http://www.iosrjournals.org/iosr-jdms/papers/Vol13-issue10/Version-3/Q0131036366.pdf

 

On the other hand it was also claimed that orthodontic treatment might be effective in alleviating the

signs and symptoms of TMD.

The conflict became earnest when result of the famous

Michigan

orthodontic/

TMJ law suit was announced.

This litigation turned on the argument that a form of orthodontic

treatment had been the cause of the patient’s TMD, the six member jury were in

favor

of the patient

.

The patient

named

Susan Brimm

, when she was 16 years began treatment to correct a

Class II Div I malocclusion with a 7

mm of Overjet Her treatment included the removal of her upper first premolars, t

he use of headgear and bonding

of her upp

er and lower teeth.

At the time the treatment was initiated she exhibited no temp

o

romandibular symptoms. She

complained that when braces were removed she suffered a severe click

with

severe pain and limited opening.

Ultimately the matter was settled by a payment of a large sum of money to the patient. This litigious climate

stimulated the

American Association of Orthodontics to underwrite research concerning the relationship of

orthodo

ntic treatment to TMD.

The benefits of orthodontic treatment in the management of Temperomandibular

Disorder is questionable, since the occlusion is considered as having a limited role inthe cause of TMD

Effect of

headgear and/or class II elastics in

c

orrect

ion of Class II malocclusions with deep interlocking cusps

Can a Palatal Expander or Braces Cause TMJ?

•  5 years ago

There is a review titled "I now have TMJ for life" and several people have commented that they have TMJ problems, and also had palatal expanders and braces when they were younger. Is there a link between palatal expanders, braces, and TMJ?

• TMJ

Doctor Answers 3

Do Braces or Expanders Cause TMJ?

September 12th, 2011

 +2 

Following a landmark lawsuit in 1987 where a Michigan patient received a legal judgment against her orthodontist for giving her "TMJ," hundreds of studies and millions of dollars have been spent by the scientific community to find if there really is a relationship between orthodontic treatment and the health of the temporomandibular joint (TMJ). Obviously this would be an important finding for doctors and patients alike. These studies have examined the different types of bad bite as well as the various approaches to treatment to show any cause and effect relationships.

Time and time again scientific studies have supported the conclusion that orthodontics neither causes nor cures TMJ disorders. Except for two exceptions, malocclusion in general cannot be linked to a higher prevalence of joint problems. The two exceptions are a posterior cross bite that causes the jaw to shift to one side upon closure, and an anterior open bite where all the biting force is on the back teeth only and the front teeth do not touch at all. Scientific studies have been unable to uncover any links between the use of headgear, extractions, rubber bands, oral surgery, or any other treatments and TMJ problems

Having said that, although it is possible that an expander or braces could have been a factor in a patients joint problems, it is highly unlikely. Especially if the patient started with a crossbite that was actually corrected by the expander. There is scientific proof to show that leaving the crossbite is directly related to TMJ problems later on.

 SHOW LESS

Greg Jorgensen, DMD, MS 
Albuquerque Orthodontist 

Braces and TMJ

October 1st, 2011

 +1 

There is no scientific evidence that braces or expanders would cause TMJ problems,  Many patients that have TMJ problems have normal bite and never had braces before.  The answer can get more complicated than this, but I'm trying to stay with the scientific evidence.

Hasan Othman, DDS, MS, PhD 
Lombard Orthodontist 
5.0 out of 5 stars      1 review 

TMJ Dysfunction and braces

September 10th, 2011

 +1 

 Is there a link between palatal expanders, braces, and TMJ? The answer is that there can be.  In other words, braces can cause TMJ Dysfunction if the practitioner  is not knowlegable about the relationship of teeth to the TMJ.  Although there are multiple reasons for TMJ Dysfunction to occur, orthodontic tooth movement can be one of them.   Any treatment that causes the lower jaw to retrude can precipitate TMJ Dysfunction.  Therefore treatment should protect against this movement and encourage the jaw to be held in a forward position.  Repositioning splints, orthotics (mouth ones), bite plates, bite ramps can help this forward position and can all be used with braces, however the most important thing for you is to work with a competent dentist/orthodontist., i.e. one who has a great deal of experience with braces and  treating TMJ Dysfunctions.  Then he/she would create an appropriate plan, and explain it to you so it makes sense. TMJ Dysfunction is a solvable problem in the hands of an experienced TMJ dentist/orthodontist.  Good luck to you.

 SHOW LESS

Kent Lauson, DDS, MS 
Denver Orthodontist 
www.aotmj.com

42.9% of open-bite surgery cases relapse.

http://www.institutdentaire-alainlandry.com/english/functional.html
Orthodontics is a full mouth rehabilitation.

 Problems in conventional Orthodontics.

 Etiology of malocclusion.

 Anterior Crowding versus Posterior Discrepancy.

Key Factors for Successful Orthodontic
Treatment of Different Types of Malocclusion:

A.The Control of vertical dimension of Occlusion.
B.The Control of the inclination of Occlusal plane.

A.The Control of vertical dimension of Occlusion :

 Low angle cases

 High angle cases

 42.9% of open-bite surgery cases relapse.

 Open bite cases can be easily treated with Multiloop Edgewise Archwire (MEAW)

B. The Control of the inclination of Occlusal plane :

 The development of skeletal malocclusions such as Class II, Class III and Mandibular Lateral Deviation (MLD) cases are clearly dictated by their respective occlusal plane configurations.

 The Multiloop Edgewise Archwire (MEAW) easily controls the inclination of Occlusal plane.

MEAW - open bite, an under bite, or an asymmetric bite

MEAW (Multiloop Edgewise Archwire) Technique

Have you been told that you need surgery to correct an open bite, an under bite, or an asymmetric bite? If you answered yes to any of these questions, then you are likely to be a great candidate for MEAW (Multiloop Edgewise Archwire) Non Surgical Orthodontic Treatment. This technique is also indicated for younger patients not old enough for jaw surgery who wish to correct their bite and restore normal growth pattern.

The MEAW (Multiloop Edgewise Archwire) technique was introduced over 40 years ago by Dr. Young H. Kim, an Orthodontic Professor at Boston University School of Dental Medicine. Dr. Kim came up with the technique of using a multi-loop wire to close open bites.

At the same time, Dr. Sadao Sato, from the University of Kanagawa in Japan, was researching extensively regarding cranio-facial growth, physiology and anatomy of both human and animal bites (or occlusion), but did not yet have the right wire or instrument to move teeth in an efficient manner to achieve his ideas. It was right then when Professor Sato found out about Dr. Kim’s Multiloop Edgewise Archwire and incorporated it as a fundamental orthodontic tool. Professor Sato’s vision of orthodontics differs from many other traditional orthodontic technique such that it places special emphasis on masticatory (chewing) function, adaptation and compensation of craniofacial structures; hence the name of “Functional Orthodontics.”

The goal of “Functional Orthodontics” is to provide an ideal jaw function by correcting the etiology (diagnosis) of a bite problem rather than fixing the consequences of a misaligned bite. This philosophy utilizes braces, custom formed looped arch wires, and elastics to guide teeth into the correct position.

Dr. Chang at E Line Orthodontics is an advocate for Professor Sato’s “Functional Orthodontics”. With Professor Sato as his mentor, Dr. Chang’s unique treatment approach using Multiloop Edgewise Arch Wires gives him the ability to successfully treat many complex and dysfunctional cases without the need for jaw surgery. Dr. Chang is one of the few orthodontists personally trained under Professor Sato in the United States and the only orthodontist in the state of Texas.

http://elineortho.com/meaw/

MEAW Non-Surgical treatment for open bite

Do you have an open bite or an under bite? Have you been told that you need surgery to correct your bite? If your answer is yes to either of these questions, then you are likely a great candidate for MEAW Non-Surgical treatment! MEAW (Multiloop Edgewise Arch Wire) Non-Surgical treatment is a complex treatment technique that can allow for correction of severe bites in a short amount of time without orthognathic surgery. Or for a young patient who is not old enough for surgery with an open or under bite, MEAW can correct your bite and guide growth in a more normal pattern.

Few orthodontists offer MEAW Non-Surgical treatment because it is very technique sensitive, they have not been formally trained in it, and it takes extra time at the office visits. However, the benefits that MEAW Non-Surgical treatment can provide are astounding! Each MEAW wire starts as a 14 inch straight piece of wire that is hand shaped by Dr. Danny Bass to your specific arch form. Then Dr. Danny Bass bends the wire precisely between the teeth to form custom loops that make the MEAW wire so special. Dr. Danny Bass was trained for three years by an international MEAW expert, Dr. Jorge Coro, in mastering this technique. Dr. Bass loves providing this service for the appropriate patients because patients love the drastic change that happens so quickly! Call Family Orthodontics today for yourcomplimentary consultation to see if you are a good candidate for MEAW Non-Surgical treatment!

http://thefamilyorthodontist.com/treatment/meaw-treatment/

MEAW - bone remodeling instead of resorption

An experimental study by Lee and co-workers (1995) from Seoul National University using the MEAW on Rhesus monkeys showed that marked tooth movement occurred along with considerable bone remodeling cellular activity whereas a control monkey with a standard ideal arch wire of the same size showed insignificant cellular activity with signs of root resorption. 

http://www.intechopen.com/books/issues-in-contemporary-orthodontics/class-iii-high-angle-malocclusion-treated-with-orthodontic-camouflage-meaw-therapy-

Article (not public):

Evaluation of root resorption after the multiloop edgewise archwire (MEAW) appliance in patients with anterior open bites

Early in the 1970s, Young H. Kim, DDS, DMD, MS, developed the Multi-Loop Edgewise Archwire (MEAW) appliance in his Weston, Mass, practice. This appliance allowed him to treat open bites and other severe malocclusions with excellent clinical results.¹

Meanwhile, in the Department of Orthodontics at Kanagawa Dental College, Sadao Sato, DDS, DDSc, was investigating the etiology of different malocclusions and concluded that the posterior occlusal plane was the primary determinant of mandibular position. However, Sato could not find an appliance that would control the occlusal plane in the manner he wanted. When he attended a course in 1985 given by Kim in Tokyo, he realized that with the MEAW appliance he could apply his principles of occlusal plane control to influence mandibular position. Sato and his colleagues developed mechanics with the MEAW appliance in which they were able to efficiently treat even the most severe malocclusions by controlling the maxillary occlusal plane in three dimensions.²

<sup>http://www.orthodonticproductsonline.com/2012/11/meaw-therapy/ 


MEAW negatives:

We commend the authors for their efforts in documenting their technique and agree that MEAW therapy appears to be an effective and efficient method to treat open bite. However, we feel that their conclusion that “correction of open bite obtained by the MEAW therapy was proven to be very stable” is overstated. http://www.ajodo.org/article/S0889-5406(01)70164-3/fulltext</sup>

 

The prevalence of severe root resorption based on the number of teeth was significantly higher in the group with extractions (P < 0.01). Longer use of a MEAW appliance and elastics also produced a significantly higher prevalence of root resorption (P < 0.05). On the other hand, the prevalence of severe root resorption was not significantly different between the subjects treated with or without surgery, but there was a significant increase when treatment time was prolonged (P < 0.05). A significant difference was found in the amount of root movement of the upper central incisors and the distance from their root apices to the cortical bone surface (P < 0.05). These are regarded as essential factors in the onset of root resorption. These results indicate that orthodontic treatment with extractions, long-term use of a MEAW appliance and elastics, treatment time, and distance of tooth movement are risk factors for severe root resorption. http://www.jove.com/visualize/abstract/21811005/association-between-root-resorption-incident-to-orthodontic-treatment

 http://ebook.lib.cmu.ac.th/umi/v1/1406457.pdf

 

이갈이 예방법

□ 가나가와치과 이갈이 예방법

- 딱딱한 음식은 턱 근육을 더욱 긴장시켜 낮동안 턱에 긴장감과 자극을 주게 되어 이갈이 증상이 심해질 수 있기에 가급적 부드러운 음식을 섭취하는 것이 좋습니다.

- 이갈이 습관이 가장 큰 원인이 바로 스트레스 입니다. 긴장을 풀어주는 것이 가장 좋으며 하루 일과를 마친 뒤 가벼운 운동이 반신욕 등을 하는 것도 도움이 많이 됩니다.

- 잠을 잘 때 엎드려 자거나 옆으로 자게 되면 이갈이 증상이 더욱 심해지기 때문에 가능한 천장을 바라보는 바른 자세로 자는 것이 좋습니다.

[출처] <양재역_가나가와치과> 이갈이의 순기능|작성자 가나가와치과

patient must lead the treatment, not the doctors.

I’ve felt for a long time that the patient must lead the treatment, not the doctors.

Even the doctors that are practicing enlightened orthodontics, they still will not know the issues as well as you do.

If you leave it up to the doctors 100%, you may pay dearly months, years down the road.

When I went into my first orthodontic appointment at 18 years old, I was told by my doctor that the adult palate is fused and will not expand, so we have to take out 4 adult teeth. And this is not some distant past but in 2008.

and I believed him.

That was 8 years ago.

It has been a long road dealing with that initial assault.

I also learned a valuable lesson, never trust a doctor’s word even if they state it like a fact.

Even with my second treatment I had to push Dr. Gibbs to achieve more aggressive results than what he was willing to settle for, but he is an exception because he is open minded to listen & proceeded with my requests.

Doctors got bills to pay and a business to run, they can’t have the liberty to be so experimental.

Treating CFD (Cranial Facial Dystrophy) is a real challenge, & currently outside the scope of an orthodontist so they turn to jaw surgeons for the fix, but it is hard to trust if that is truly the best solution because these are the same guys that pull out bicuspids, & claim adult bones are set and the palate is fused.

-CP

no rubber bands, traditional braces - much tougher forces to align teeth

Bent Wire System (BWS)

Myobrace mentions that in severe cases they will use Bent Wire System (BWS) for expansion in conjunction with K1, which is light wire expansion appliance similar to ALF’s. Or they say they will use Biobloc, but I think most Myobrace doctors are using the BWS based on what I have seen.

This is the type of wire that remembers its original shape and tries to spring back to it no matter how long or how ever you try to bend it, so this is what is used in DAMON braces system as well as the wire will continually remodel the bone as it gently tries to return to its original shape that is shaped by the doctor. Each appointment the doctor may put in a wider wire in if the arch needs to get wider.

Also note that it does not have to be DAMON, but many doctors will still carry self-ligating bracket system which is the same thing but more economical as it hasn’t been branded by DAMON. Self-ligating bracket means that the wire is free to move through the bracket. No rubber bands to fix the wire onto the bracket like traditional braces which uses much tougher forces to align teeth and doesn’t allow for free & continual movement like the self-ligating (DAMON) system. It is noted that with traditional braces, the majority of the changes happen within the first week after monthly appointment, and causes much more sore teeth. Whereas with the self-ligating system the change will continue for the whole month and much more gentle forces mean less soreness. In my humble opinion, traditional braces should never be used and its a waste of money & time. Always opt for doctors that are using self-ligating system.

ALF which is placing the wire inside the teeth versus placing the wire outside with brackets, now is that better for expansion? is hard to say, I think they can both do the job but I have my speculation that having the wire inside the mouth might be better… Certainly there is still use for brackets especially in my case where you need to move teeth more, as in re-open extraction sites, which require coil springs in between brackets to move the teeth quite a ways and torquing of the teeth to move the roots by adjusting wire entry on certain brackets.

best ways to achieve expansion is Damon and ALF

It's great you have no extractions. So the critical thing is to find an ortho who doesn't believe in extractions, and rather believes in expansion. The two best ways to achieve natural expansion is with Damon and ALF. Do NOT get palatal expansion surgery or use a palatal expander!

I would start with this, and then if applicable, add face-pulling to your daily orthodontic regimen.

My friend bought one, and I was not impressed with what it did for him. It isn't that the homeoblock doesn't work, the problem is that for the money that is charged you can get something that blows it away. Many things "work" but you want something amazing for your money and suffering. If you aren't going to get Damon braces, the next best thing is upper/lower ALFs and wear them for 5 years. This will make real changes. The reason you need to wear them so long is because remodeling the bones of the jaw is a very slow process. The palate is easy.

The homeoblock is one of those half-assed solutions that gets pushed because people make lots of money from it.

http://jawpain-tmjtreatment.com/damon-braces.html

I recommend Dr. Seligman from NYC. He does all the stuff that Dr. Hang does he's just waaay cooler. lol

Surgery as a way to attain your goals is a bad idea for the following reasons:

1. Cost is over 2x the $$$!

2. End result looks simply awful.

3. Maybe would shave 1 year off your treatment time? But who cares if end result is crap. As I said on my site, a female friend took this path and result was a disaster.

The latest in Damon hardware will make all the changes you require in an aesthetically balanced fashion, and quickly and without pain.

Dr. Hang is most famous for using braces to re-create space where extraction was, then placing an implant in lieu of extracted tooth.

Dr. Seligman does this as well, should you need it.

light and comfortable headgear

http://www.facepulling.com/

The theory behind a facepulling headgear is rather simple. You want to apply constant forces on the palate to move it forward, upward and to expand it. Creating a headgear that is light enough to be worn for hours and that is comfortable enough to sleep with is the challenge.