Dr. Terrance J. Spahl is a world recognized authority and co-author of a triology of textbooks on Functional Orthodontics. The title of this three volume set is “The Clinical Management of Basic Maxillofacial Orthopedic Appliances.” These books deal with a newer and more advanced method of orthodontic treatment employing removable acrylic intra-oral devices that, for certain types of cases proves far superior to orthodontic treatments that rely on metal braces alone. The newer, more advanced method, employs not only metal braces, which are fine for precisely positioning individual teeth, but also uses what are now referred to as “European Functional Appliances”. These consist of removeable “retainer-like” intra-oral devices that do much more than merely move teeth. Many children, not all to be sure but nevertheless many, who suffer from “crooked teeth”, (technically referred to as a “malocclusion) also suffer from distorted, misshaped jaw bones, misaligned jaws, and even deeper-seated, improperly operating surrounding jaw muscles. We never really understood this in the “old days.” Improper jaw muscle function often results in improper or distorted jaw bone growth. One of the most common manifestions of this is an undersized, retruded lower jaw that bites during chewing way too far back. This type of problem not only makes for a weak looking retruded profile and less than attractive face, but it also is hard on the lower jaw joints and jaw sockets, (referred to as the temporomandibular jaw joints or “TMJ’s”.) Stress and damage of this type long term often results in the manifestation of TM joint pains, facial muscle pains, neck aches, and the big thing, chronic recurrent headaches, with the terrible migraine headache as the final stage of this progressive continuum.
+Who needs Functional Jaw Orthopedics?
Surprisingly a huge number of people; children, teens and adults need Functional Jaw Orthopedics. Anyone, young or old, could need Functional Jaw Orthopedic treatments.. Here is why?
- Children who have bad bites that trap and hold their lower jaws back too far, making their chins appear weak and making their upper teeth seem to stick too far out (buck teeth), often need some form of Functional Appliance treatment to make their faces appear normal and their smiles appear broader and more full.
- Children with chronic recurrent headaches, in the absence of any other known medical cause, (such as diabetes, lupus, etc.) definitely need to be evaluated for treatment with Functional Appliances There is a 95% chance that their chronic recurrent headaches are related to some form of bad bite (chronic headaches in children are defined as 1 per month or more!). This holds true even if their bite appears “perfect” i.e. looks normal to the untrained eye. It must be remembered that looking right and actually FITTING right are two different things. This is true even if the child has already had braces! Changes in jaw growth direction after traditional metal braces are taken off can change everything.
- Adults who have chronic recurrent headaches with or without jaw clicking during talking and chewing should definitely be evaluated (by someone who truly knows how to employ Functional Jaw Orthopedic techniques) for treatment with removable European-style Functional Appliances. Seldom will such techniques not provide the solution to chronic TMJ-based headache and facial pain problems, again even if braces have already been used once in the past.
- Adolescents and adults who have had four side teeth (“bicuspids” or “premolars” as they’re called) extracted as part of their orthodontic treatment with metal braces and who have frequent headaches DEFINITELY should be evaluated for “TMJ” and the possible need for treatment with Functional Appliances!
Here’s the big thing. People with chronic recurrent MIGRAINE HEADACHES absolutely must be evaluated for Functional Jaw Orthopedic treatments. Why? It is now firmly established that:
- Migraine Headaches come from “TMJ”, or “TMD” as they now refer to it in more recent times.
- Functional Jaw Orthopedics is the modern cure for dysfunctionally-induced TMJ/TMD problems.
- Therefore, Functional Jaw Orthodpedic Treatments (Functional Orthodontics) is the permanent cure for migraines!
…this represents an enormous breakthrough for headache sufferers in these modern times.
+Extracting teeth for Orthodontic treatment
A Better Way.
Do teeth need to be extracted for braces to work right?
Yes, sometimes teeth do need to be extracted to make room for the rest to be straightened properly.
Does extracting baby teeth help?
Usually not. It may be a “quick fix” temporarily that allows newly arrived or existing adult teeth to be straight, especially across the lower front, but this often causes entrapment or blocking out of other permanent teeth that have not arrived yet and still are forming down in the jaw bone. They get stuck in there. Then several years later these other trapped permanent teeth must be extracted too. Not good!
How does the new Functional Jaw orthopedics method deal with the issue of extracting permanent teeth?
Traditional American style orthodontics, utilizing fixed (glued on) metal braces usually favors extraction of bicuspid (premolar) teeth in the dental arches at the sides of the mouth to make room for realigning the remaining permanent teeth. This often makes the dental arches smaller, which retracts or “sinks in” the lip support making the smile appear smaller, more constricted and “older.” Many orthodontists insist it doesn’t happen but just look around at people who have had it done. The nickname for this flattened appearance of the lips and face, “the orthodontic look” didn’t come about by accident. It doesn’t happen everytime, just some of the time. The point is, it shouldn’t happen any of the time! Another problem in taking out 4 premolars, one in each quadrant of the dental arches of the mouth, is that it does nothing to help the “wisdom teeth” (3rd molars) get enough room to come into the mouth. Thus, these third molars are therefore also often extracted. This means 8 permanent teeth end up being taken out. Not good! Also, surgically removing wisdom teeth is a procedure fought with risk, difficulty, painful recovery, and high expense (and usually intravenous sedation). Also not good! Nevertheless, this is a frequent outcome for many patients who have had traditional American-style metal braces. A better way has been perfected by those of the Functional Jaw Orthopedics philosophy. The newer way to solve the tooth extraction problem as a part of orthodontic treatment, when teeth do in fact need to be removed, is to extract the 12 year (2nd) molars way in the back of the mouth instead of the traditional way of extracting bicuspids at the front corners of the mouth. This prevents the teeth remaining up in front of the extraction site gaps from being pulled inward or back too far thus preserving the lip support and fullness of the smile. It also is an easy and safe extraction from which young people recover very quickly. Finally, and here’s the big thing, once 2nd molars are extracted, and after the remaining teeth have been given the room to be subsequently unjumbled, realigned and straightened, the remaining 3rd molars (wisdom teeth) erupt right into the former site of the extracted 2nds, which conveniently eliminates the chances of the thirds ever becoming impacted. That means the patient will never have to endure the arduous and often painful procedure of having wisdom teeth surgically removed. Hence in the end the patient has 28 teeth, a full broad, beautiful smile and has had 4 less teeth extracted overall compared to former methods of 4 bicuspid extractions followed by 4 third molar extractions! That isn’t all; it also results in less retraction of all the upper front teeth. This in turn results in more room in the front part of the bite for the lower jaw to stay forward. This is turn prevents (or even cures) painful TMJ problems. That IS good!
Below is a patient case that shows second molar (12 year molars) replacement. Notice how the 3rd molars take the place of the second molars position.
Do many orthodontists extract 2nd molars this way?
Some do, but not many because it seems radical to the older, more traditional way of doing things. But it is a proven technique that gives superior results and it is a technique taught by some of the finest orthodontic specialists in the country. It is the modern way that is easy on the patient, better for their smile, better for their bite, and in the long run much better for the patient’s temporomandibular joints.
Special Note: Effects of Bicuspid Extractions on the Face:
Observe the effects of extracting four bicuspids (premolars) from the dental arches for orthodontic purposes. These identical twins had identical bad bites of crooked teeth (malocclusions). The twin labeled OE had four bicuspids extracted and orthodontic treatments of the traditional variety. Her twin sister, labeled OF, had her malocclusion treated the European Functional Jaw Orthopedics way using removable Functional Appliances as a part of her treatment plan, and most importantly, she did NOT have four bicuspids extracted as part of the treatment. Look Closely. Now remember, these photos are not repeats of the same person but individual pictures of two different persons, identical twins. After orthodontic treatment was completed, notice the difference in facial appearance of the girls’ faces. The girl on the left has had four bicuspids extracted and traditional American style metal braces. The girl on the right had her treatment done by means of European style removable Functional Appliances and did NOT have any teeth removed. Notice the wide face, the broader smile, the fuller appearance to the entire smile line, and the fullness and beauty of the lower facial structure!
These girls are from Manchester, England and were treated with the two different orthodontic methods; American metal braces style with bicuspid extraction vs European Functional Jaw Orthopedics style without extractions. In the past there was never anything to compare the posttreatment face to, i.e. the patient couldn’t be put back in their pretreatment bite and re-treated a different way. Because of this case of identical twins a true comparison of the final results of one method of treatment versus the other can now truly be made. Critics observing these results say it just shows that the twin with the four bicuspids extracted wasn’t skillfully treated by the treating orthodontist, i.e. the orthodontist who did the work didn’t know how to do braces very well. Nonsense! The orthodontic specialist who treated these twins was a close personal friend of yours truly. His name is Dr. Hans Eirew, a British orthodontic specialist who just happens to be the former president of the British Orthodontic Society and who is also a former member of the World Health Organization. He is a true expert and VERY knowledgeable. The results observed here are not a product of lack of skill by the operator but solely due to the extractions of the four teeth at the front corners of the mouth of the one twin, the old traditional way. That is why we used these photos in Volume I of a trilogy of text books I wrote for Dr. John Witzig on this subject back in the 1980’s, entitled The Clinical Management of Basic Maxillofacial Orthopedic Appliances, page 164-166. These now famous photographs are used by many clinicians on websites, in handout pamphlets and patient education materials etc, as an example that definitively shows prospective patients the effects of taking teeth (bicuspids) out the old way for orthodontics reasons. Many orthodontic specialists and academicians try to deny that taking bicuspids out for orthodontic treatment doesn’t shrink up the face or contribute in any way to TMJ damage. They try to do all sorts of experiments and studies measuring before and after plaster casts of bites of patients treated the American–style, metal braces way to show there’s no difference. They are only measuring plaster dental models of teeth however, not looking at true flesh and blood, three dimensional human faces. They just can’t seem to choke down the fact that, in this regard, they’ve been wrong for almost 100 years! So where does the slang term “orthodontic look” come from? You yourself may not be an orthodontic or dental expert, but I’ll bet you’re an expert on human faces. You look at them every day. You be the judge! Which of these two girls do you think has the more rounded, fuller more attractive smile?
Extreme Example: Note in this example how straight the teeth appear in this girl who had four bicuspids extracted and traditional American style metal braces as part of her orthodontic treatment. Yet look at how “sunken in” the lips are due to lack of dental lip support behind them. This is a result of shrunken dental arches that are a product of extracting the four bicuspids at the corners of the mouth to make room to realign the remaining teeth in undersized and misaligned jaws. Orthodontic specialists really resent people like me publishing photos like this (in our textbook p. 163 of Volume I) because they say no orthodontist would do this! Well somebody did. This photograph didn’t appear out of the thin air! Yes, it is an extreme example. The point is, when you see the extremes, like this, you better understand the means. Oh by the way, this girl in the photo is only 16 years old! Sometimes taking out 4 bicuspids the traditional way is acceptable and does not harm the facial appearance nor ultimately affect the TMJs. But only in certain types of cases, and the number of those cases that qualify for bicuspid-extraction technique are relatively few. Back in the “old days” it was all they had. Now we have better choices. But it is still a “hot issue”.