My case

I’m a 35 year old male (born February 1991).

Like many expansion patients, I had four healthy premolars extracted in childhood, in my case in order to make room for wisdom teeth.

Main symptoms

  • sleep disordered breathing

  • constant psoas tension (see psoas: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

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.

DateTripProviderDescription
22 Jun '231FFinitial assessment
22 Jun '231BIinitial assessment
18 Sep '232FFplace MARPE, install lower expander
19 Sep '232BIMIND, install MARPE
25 Sep '232FFfollow-up, first turn of MARPE (upper) and lower expander
26 Sep '232BIfollow-up
9 Jan '24--last turn on upper (total 65 turns = 5.42mm expansion)
17 Jan '243FFfollow-up, remove arms from MARPE, impression for upper invisalign, first invisalign tray in, install wire to upright impacted wisdom tooth
6 May '244FFMARPE and lower expander removal, new shorter wire on third molar
5 Aug '245FFimpressions for upper & lower Invisalign, tried new wire for third molar but it came out
16 Sep '246FFpicking up and installing Invisalign (new anchor placements)

That’s it for in-person appointments now for at least a year.

Once my teeth are stabilised and in the correct position, I aim to have MMA surgery with Dr Coppelson some time in 2025.