INDUSTRY

14 Ortho Tribune U.S. Edition | Summer 2012

Myofunctional orthodontics
and myofunctional therapy
By Chris Farrell, BDS, Sydney ‘Once a practitioner can
see the causes of a child’s
A brief history of orthodontics
More than 100 years ago, and before Ed- malocclusion, it is
ward Angle, dentists realized they could
move teeth into a more esthetic posi- possible to serve the
tion by applying various mechanical de-
vices to the teeth. This, in turn, caused growing demand from
apposition and deposition of bone in
areas where forces were increased or
parents who do not want
decreased. Teeth could be moved into a Begg bracket. (Photos/Provided
more esthetic position, and so the orth- by Dr. Chris Farrell)
to delay treatment ...’
odontic profession was born.
Angle clearly stated his view that it was
unethical to extract teeth for orthodon- correct their own dysfunctional habits
tic purposes and proved that, with his cause. Myofunctional therapy became (chronic mouth breathers, for example),
complex fixed appliances, he was able to the popular “adjunct to orthodontics” in correct dental alignment and arch devel-
expand the arches and align the teeth. the 1960s and 1970s, when Daniel Gar- opment is only possible if the patient ac-
The problem at this stage was that a lot liner created the Myofunctional Insti- cepts wire and glue for life. Occasionally,
of these cases (possibly most of them) tute in Florida. patients do accept this, and so sometimes
relapsed. Garliner trained thousands of myo- retainers are fitted under the direction
So Tweed, who was Angle’s student, functional therapists and wrote multi- of the patient or parent. This occurs for
suggested that the extraction of teeth ple books on the subject. The new etiol- only a minority of cases.
was the only way to get stability. In the ogy of malocclusion was confirmed by Once you can diagnose the causes of
1950s, extraction orthodontics became rapid success in treating malocclusion the malocclusion, you are capable of re-
the normal practice after the Australian with greater stability. Bonded retainer. solving the malocclusion, rather than
orthodontist Percy Raymond Begg de- Unfortunately, this success was not just treating its symptoms.
veloped the first straight wire appliance, evident in 100 percent of cases. Argu- Treating the causes of the malocclu-
which required less wire bending skills ably, the ensuing decades saw myofunc- sion, rather than just relying on me-
than previous methods. tional therapy diminish in popularity chanical forces to align teeth has great
Today, orthodontists revere self- because of the then time-consuming benefits for both patients and parents.
ligating brackets as the key to non-ex- treatment being seen as only an option- If you’d like to learn more, MRC offers
traction orthodontics. Angle would be al little adjunct for cases where the pa- myofunctional orthodontic training.
amused if he were around today. Has the tient exhibited tongue thrusting. Tooth-
stability of orthodontics changed? No. centered orthodontics with direct Benefits of myofunctional
The orthodontic profession has accepted bonded brackets and super-elastic wires orthodontics
that to expect case stability using fixed no longer warranted the “tongue thrust Myofunctional orthodontics produces
appliances without fitting permanent therapist” in all but the occasional cas- The tongue supports upper-arch healthier patients who are able to grow
retainers is both impractical and unre- es. development. without the detrimental habits that limit
alistic. facial growth. Patients who stop mouth
Progress in orthodontic stability is Myofunctional orthodontics breathing are healthier and get less al-
achieved by advances in flowable com- Myofunctional orthodontics put for- lergies and infections because of breath-
posite, rather than advances in orth- ward that the cause of malocclusion ing through their nose. Fixing incorrect
odontic technique. The Australian Soci- was muscle dysfunction. From an early swallowing patterns and improving poor
ety of Orthodontists (ASO) website is an age, mouth breathing, thumb sucking, nutrition allow correct downward and
example of the widespread acceptance tongue thrusting or swallowing incor- forward facial growth and development.
that stability is not possible with tooth- rectly can be observed in most children. Case after case using myofunctional
centred orthodontics.1 All will have a developing malocclusion. orthodontics produces stable maxillary
“Teeth may have a tendency to change The correction of these dysfunctional arch development and resolves lower
their positions after treatment. The long- habits not only corrects the malocclu- anterior crowding with little mechani-
term, faithful wearing of retainers should sion (if treated early enough), it also has Lower-crowding caused by poor cal effort. No braces are needed, and for
reduce this tendency.” (Source: www.aso. the potential to improve facial growth. myofunctional habits. the majority, no permanent retainers are
org.au/Docs/Orthodontics/Risks.htm) The problem with treating myofunc- required.
tional habits early is that the compliant
Myofunctional therapy patient will no longer need braces. This less fixed or removable retainers are Reference
Understanding how the oral muscles and is one of the biggest dilemmas facing an used in the long-term.1 Parents must be 1.) www.aso.org.au/Docs/Orthodontics/Risks.
the tongue influence the jaws and den- orthodontist today. Correct the causes made aware of this if they are to make htm
tal arches predates Angle by a long way. early and the market for braces can be an informed decision for their children.
The history of myofunctional therapy drastically decreased. However, treat- Should the problems be treated now, or
dates back to the 15th century in Italy. ing children earlier at their optimal should the patient wait? About the clinician
In 1906, American orthodontist Alfred growth stage (between ages 5-8 years) Myofunctional orthodontics is not just Chris Farrell, BDS, graduated from Sydney Universi-
Rodgers experimented with facial mus- using myofunctional orthodontic tech- about moving teeth. The first objective ty in 1971 with a comprehensive knowledge of tradi-
cle exercises and, in 1918, wrote a paper niques can make orthodontic treatment of myofunctional orthodontics is to have tional orthodontics using the BEGG technique.
titled “Living Orthodontic Appliances,” later easier and more stable. enough space for the tongue to sit in the Through clinical experience, he took an interest in
in which he cited that muscle function Once a practitioner can see the causes maxilla. The second objective is to have TMJ/TMD disorder and, after further research, Far-
alone would correct malocclusion. In of a child’s malocclusion, it is possible the patient breathing through their nose rell discovered that the etiology of malocclusion
1907, renowned orthodontist Edward H. to serve the growing demand from with their lips together. and TMJ disorder was myofunctional, contradicting
Angle’s textbook “Malocclusion of the parents who do not want to delay treat- If the patient is not breathing through the established views of his profession. Farrell
Teeth” detailed the effects of oral habits ment for their children. their nose, then correct arch develop- founded Myofunctional Research Co. (MRC) in 1989
on occlusion. We also now know that tooth- ment and correct dental alignment can- and has become the leading designer of intra-oral
Angle stated that in his view, every centered orthodontic treatment can not be achieved. appliances for orthodontics, TMJ disorder and
malocclusion has a myofunctional only achieve short-term results un- For patients unwilling or unable to sports mouthguards.