Functional Jaw Orthopaedics and Orthodontics

The study and treatment of the above cases necessitate an in depth knowledge of the development and growth of the various bony components, teeth and muscles that make up our face.

The bone of the upper jaw or maxilla develops from ectoderm and is called dermal bone. The growth and development of the maxilla is much more influenced by environmental factors such as breathing patterns (nasal compared to mouth breathing), object habits such as finger sucking, dummies or tongue thrusting. All the above cause the facial muscles to apply imbalanced mechanical and hydraulic pressures onto the jaws.

It is well known now that the UK is the area in the world with the highest concentration of asthma sufferers. Asthmatics, from a young age are predominantly mouth breathers with typically a narrow, high vaulted upper jaw, longish face and receding lower jaw.

Most of the long bones of our body develop from embryonic mesoderm and is called chondral bone, which is much more strictly growth guided by our genetically encrypted recipe. A person destined to grow to the height of 6ft will do just that no matter what outside influences he endures during his growth cycle.

Our lower jaw is a complex sandwich of both chondral bone (the body of the mandible) and dermal bone (the alveolar bone housing our teeth).

Functional jaw orthopaedics discovered that the growth imbalances of dermal bone could be greatly corrected by early use of functional appliances within the genetic limits of the individual. The ideal time to start treatment for the above patients is at the developmental age of eight, as we surf in on the growth curve or growth spurt and redirect growth back to normal. In cases of class III effect (overshot lower jaw) and other muscle driven imbalances such as anterior tongue thrust, lateral and anterior crossbites, treatment may even be indicated much earlier. If I may use the example of a new-born with a clubfoot. As soon as it is safe for a general anesthetic, the orthopaedic surgeon will surgically correct the above abnormality and splint the foot for more or less 6 weeks, after which the splint will be removed and the baby will grow up in to a healthy normal adult. If we were to wait until this child is 13 or 14 years of age before corrective surgery is attempted, the muscles and joints of the knee, pelvis and back would have misformed around the original abnormality and the individual would be crippled for life. Another example is the young growing child losing an eye. As soon as possible the eyeball will be replaced with a prosthesis the same size as the healthy eye or the face will deform and not develop fully on the affected side.

By the developmental age of fourteen years, 95% of our facial features are already formed and although orthopaedic facial correction can still be done to a large extent at this age or afterwards, it will take more time and will not be as effective as treatment performed during the growing period.

I must stress that in about 5% of facial or skeletal abnormalities such as a true class III (oversized lower jaw), corrective surgery will be needed.

Apart from wisdom teeth, we remove permanent teeth in less than 8% of cases to straighten out our patients smiles. This is only done where the problem of overcrowding is a dental one, as opposed to a skeletal or bony one. Examples of these cases are:- Macrodontia (affecting less than 2% of the population). Early loss of primary teeth which cause permanent teeth to drift forwards in the jaw and will not allow proper positional eruption of all permanent teeth.

Research has also shown that early loss or extraction of primary or permanent teeth will slow down development of alveolar bone housing our teeth and so prevent full bony and dental support for the cheeks and lips. This may result in a more sunken or dished-in face, smaller mouth and thinner lips. We see this most severely in cases where numerous permanent teeth are congenitally absent.

To the functional jaw orthopaedist the most important objective is for the patient to not only have a straight set of teeth, but a healthy temporo-mandibular joint, balanced face and a full smile supporting the lips, cheeks and housing the tongue comfortably in the vault of the maxillae.

The FJO practitioner will use a: Orthopaedic phase I treatment which take 12 - 18 months of wearing removable functional appliances followed by; Phase II of orthodontic correction, lasting on average 12 months using the newer bio-efficient thermally activated more gentle fixed braces. To the FJO practitioner, the use of fixed braces (train tracks) is almost just a finishing procedure. Most of the corrections are accomplished using functional appliances.

Our patients respect and pay for our time, skill, care and judegment.

Visit the Websites of Dr. Francois Rossouw B.Ch.D (Pret) & Associates
Member of

THE AMERICAN ASSOCIATION FOR FUNCTIONAL ORTHODONTICS

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