I have been researching the Orthotropic Hybrid appliance for a while and I have finally reached a point where I understand it's unique abilities and advantages over other options. Dr. Mew was instrumental in this as he has kindly answered some of my questions. I am sharing his feedback here and plan to write an essay about the system sometime in the future.
Abdulrahman
The hybrid appliance is unique for it's ability to expand both the upper and lower arches in one appliance. If I understand correctly the expansion screw that's on the top pushes both arches where as other devices such as the old biobloc used two appliances one for the top and one for the bottom.This left the lower at an disadvantage because the expansion screw could never be placed in the middle area of the bi-cusps and molars, is that correct?
Dr. Mike Mew
More or less correct yes. The idea is that the upper appliance extends into the lower appliance and as such I can expand both arches without disturbing the way that the side teeth meet together. The more that I look at things the more that I think that the way that the side back teeth meet is essential. I think that the damage done (downswing) by fixed braces is usually due to the way that these braces artificially hold the teeth out of a good biting arraignment. Whenever someone attends my clinic wearing fixed braces, there maximum biting ability is greatly reduced. This is one of the main causes of a downswing in the first place.
Abdulrahman
The other thing that sets the hybrid appliance apart from other devices is that it's lingual bows can do decent forward (sagittal) expansion and can adjust the angulation of the front teeth, correct?
Dr. Mike Mew
The cat wire (upper) and nudge wires (lower) can gain sagittal expansion, the amount depends on the depth of the bite. If someone has an open bite then it is difficult to achieve much sagittal expansion, at least in the short term and unless they then upswing. Ultimately the lips gain the angulation of the front teeth. I usually push the teeth forwards and then the lips correct the angulation.
my story: http://www.aljabri.com/blog/my-story/
Is this a device that the Mews designed and only they use, or is it something available from other providers? I do like the idea that the upper expansion screw in the center of the roof of the mouth also expands the mandibular arch, rather than a separate screw behind the lower incisors.
Is this a device that the Mews designed and only they use, or is it something available from other providers? I do like the idea that the upper expansion screw in the center of the roof of the mouth also expands the mandibular arch, rather than a separate screw behind the lower incisors.
I am not sure. I know the hybrid appliance was developed recently to replace the more common biobloc. I will try to ask Dr. Mew if I get the chance, but there is a doctor that is big on Orthotropics in the States. His name is William Hang. He might be a good person to ask. His website is:
my story: http://www.aljabri.com/blog/my-story/
Abdulrahman, how long has this device been in the "market"?.
I would like they to develop more sophisticated devices that are able to expand the maxilla and zygomatic bones in order to actually expand the facial skeleton.
Abdulrahman, how long has this device been in the "market"?.
I would like they to develop more sophisticated devices that are able to expand the maxilla and zygomatic bones in order to actually expand the facial skeleton.
I don't know, but at least few years, as you can see it in some of Dr. Mew's head brace videos.
There are plenty of expanders for the palate and they do achieve decent results. A week ago a forum member from Italy posted an expansion device that is bolted right into the palate.
/community/community/main-forum/alt-ramec-protocol/
The problem is that even if you were able to achieve the full expansion desired it would often relapse.
my story: http://www.aljabri.com/blog/my-story/
Abdulrahman, how long has this device been in the "market"?.
I would like they to develop more sophisticated devices that are able to expand the maxilla and zygomatic bones in order to actually expand the facial skeleton.
If you look at anatomy, the zygoma and the maxilla are intimately attached to each other. They are also intimately attached to many other bones notably the base of the brain. Any changes in a bone of the skull will have a knock on effect on the rest of the head. However applying an expansion force to the zygoma is impossible without surgical intervention. Expanding the maxilla in whatever dimension or shape is possible with different appliances and now with implant anchorage we can do anything you can imagine. The issue is once you achieve your desired growth if the size and shape do not fit into your or humans physiologic envelop it will always regress to what your norm is. And the there is the huge issue of the impact of these changes to your cranium and then brain and neck.
High cheek bones etc are able to be developed in growth but there is also a limit to what is possible. Certain ethnicities such as Koreans have high prominent cheek bones.
I truely love the orthotropic premise in children but have to say in adults it’s use often results in less than ideal results. Most cases I have seen show a lot of tipping and problems with the dentoalveolar complex. Many famous clinicians in Ortho tropics would never dare use it in adults routinely. If you have certain bite which allow you to tip th teeth to achieve correction, say a class 2/1 then orthotropic appliances may work. Bill hang is as big in this as Dr Mew and he does not believe his expanders or appliances based off the bioblocs can correct many problems hence his propensity to do a LOT of surgeries maybe 50% of cases. So it is always intriguing to me that Dr Mew is so anti surgery when his greatest students and endorsed training institute (face focused by bill hang) are such pro surgery.
For me the hybrid is an improvement on the bio bloc but just new but same appliance. Not much to see here imo.
If you look at anatomy, the zygoma and the maxilla are intimately attached to each other. They are also intimately attached to many other bones notably the base of the brain. Any changes in a bone of the skull will have a knock on effect on the rest of the head. However applying an expansion force to the zygoma is impossible without surgical intervention. Expanding the maxilla in whatever dimension or shape is possible with different appliances and now with implant anchorage we can do anything you can imagine. The issue is once you achieve your desired growth if the size and shape do not fit into your or humans physiologic envelop it will always regress to what your norm is. And the there is the huge issue of the impact of these changes to your cranium and then brain and neck.
Exactly, but isn't there a way to determine weather expanding the maxilla at the suture will yield positive results in advance of the procedure? I know you use CBCT for pre FAGGA analysis, can't the same scan be used for determining weather maxilla expansion would work?
my story: http://www.aljabri.com/blog/my-story/
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