My case
I’m a 33 year old male (born February 1991).
Like many expansion patients, I had four healthy premolars extracted in my childhood (in my case, in order to make room for wisdom teeth).
Main symptoms
sleep disordered breathing
constant psoas tension (see Releasing the Psoas by Neil Hallinan)
tinnitus
infrequent episodes of vertigo, or feeling like I’m on a ship that’s just rolled in heavy seas
forward head posture
tooth damage from grinding and traumatic occlusion
TMJ disorder
back, neck & shoulder tension
all the usual aesthetic issues: weak jawline; protruding nose; facial asymmetry; large buccal corridors; long and narrow face; dark circles under eyes; puffy-looking jowels
- in combination with misophonia, what I’ve called tooth rage: the physical feeling of the shape of my mouth causes intense anger.
Face Focused Assessment
Chief Complaints
Bite, TMJ issues, appearance of jaw
Signs & Symptoms
- Hx. of smoking (quit at 17)
- extraction of U/L 4’s
- snoring
- TMJ popping/discomfort
- ringing in ears
- daytime fatigue
- grinding during the day
- bite feels off/uncomfortable
Clinical Exam Conditions
- Head Posture: Forward Head Posture
- Facial Features: Allergic Eye Shiners, Excessive Buccal Corridors
- Vertical Upper Jaw Position: Mild Vertical Maxillary Excess
- TMJ Pain (R/L): Mild
- Masseter Pain (R/L): Moderate
- Anterior Temporalis Pain (R/L): None
- Posterior Digastric Pain: None
- SCM Pain: None
- Trapezius Pain: Moderate
- Maximum Opening: > 50 mm (55)
- TMJ Dysfunction: No Clicking/Popping
- Deviation/Deflection: No Deviation/Deflection on Opening
- Indicator Line: 42 mm
- Intermolar Width: 31 mm
- Mallampati: Class IV
- Tonsils: Grade 1
- Tori: None
- Exostosis : Mild
- Tongue Posture: Low rest posture
- Tongue Features: Scalloping
- TRMR - TIP: Grade 3 - < 50%
- LPS Overflow: Grade 4 - >50%
- Upper Arch Alignment: WNL
- Lower Arch Alignment: Mild Crowding
- Overjet: Mild
- Overbite: Moderate Dental Deep Bite
- Relative AP Molar Relationship: Class II Molars
- Transverse Dental Relationship: Edge to Edge Bite R to L
- Missing Teeth: Missing U&L 4’s
- Other Problems: Still has wisdom teeth, LR8 mesially inclined
- Airway MCA: 153.6mm2 (at risk for OSA less than 150mm2)
Portraits & 3D scan of arches
CBCT - airway
Panoramic x-ray
Assessment
- Sleep Disordered Breathing
- TMJ Dysfunction
- Ankyloglossia
- Hypotrophy - Maxilla
- Hypotrophy - Mandible
Treatment Recommendations
- Refer for Surgery Consult
- Refer for General Dentist Visit [root canal for discolored lower incisor]
- Comprehensive Orthodontic/Surgical Treatment
Treatment Timeline
FF = Face Focused; BI = The Breathe Institute.
| Date | Trip | Provider | Description |
|---|---|---|---|
| 22 Jun '23 | 1 | FF | initial assessment |
| 22 Jun '23 | 1 | BI | initial assessment |
| 18 Sep '23 | 2 | FF | place MARPE, install lower expander |
| 19 Sep '23 | 2 | BI | MIND, install MARPE |
| 25 Sep '23 | 2 | FF | follow-up, first turn of MARPE (upper) and lower expander |
| 26 Sep '23 | 2 | BI | follow-up |
| 9 Jan '24 | - | - | last turn on upper (total 65 turns = 5.42mm expansion) |
| 17 Sep '24 | 3 | FF | follow-up, remove arms from MARPE, impression for upper invisalign, first invisalign tray in, install wire to upright impacted wisdom tooth |
| May '24 | 4 | FF | next appointment |
I expect to have 1-3 more appointments with FF, including the one in May.
Once my teeth are stabilised and in the correct position, I aim to have MMA surgery with Dr Coppelson some time in 2025.