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Presentation and photo of a really complex case

alfio
(@alfio)
10+ Forum Posts

Hello everyone, I am an Italian boy of 24 years and I am here to show you my situation and my progress, all witnessed by clear and detailed photos.

 

I had bad oral habits since I was a child, I sucked my thumb and I had a short lingual frenum. In the midst of adolescence I wore both a night-time and a fixed mobile device, but he did nothing but straighten my upper teeth. Then I cut the short lingual frenulum, but my situation is not much improved. Now I find myself with a deep overbite,  head forward, and a wide palate more or less 35-36 mm.

 

These are my photos of my current situation:

IMG 20180724 164823
IMG 20180724 164921
IMG 20180724 165349
IMG 20180724 165507
IMG 20180724 165537
IMG 20180714 014101
These instead are my pictures that show my jaw when he consciously positioned it in the position where I presume it should be:
IMG 20180724 164753
 
IMG 20180724 164854
IMG 20180724 165145
IMG 20180724 165427
As you can see, the difference is abysmal; my face when I put the jaw in this position is quite harmonious, which I regret because I have good genes but I was completely ruined by my habits...
What I wonder is: why my jaw is not in the position where it should? How can I put it?
I've been mewing for 2 weeks, but I can not put the back third of my tongue on the palate because it completely stops my breath.I have also read that during the meowing the molars should touch lightly, but how can I make them touch with an overbite like that?
 
Well, that's all. I will be grateful to anyone who wants to help me, for my part I can say that I will report every little progress as my situation is complicated, and if I improve then it means that EVERYONE can do it. Thank you all.
Quote
Topic starter Posted : 24/07/2018 8:42 pm
Rockyp33
(@rockyp33)
500+ Forum Posts

https://www.youtube.com/watch?v=gcI8CvoFxfQ This video will teach you proper tongue posture and help your head posture as well. To get your body posture right you need pretend theres a string attached to the point part on the back of your skull (occiptial bone) and its being pulled upwards it should put you in a good position. other than that just focus hard on maintaining proper tongue posture DO the mike push swallow as often as you can go in the mirror for 10 minutes and do cheesy smiles just keep working at it and ittll get better over time.

ReplyQuote
Posted : 25/07/2018 3:50 pm
SUGR1
(@sugr1)
10+ Forum Posts

My assessment of your current situation is as follows: 

- Under developed mid face / maxilla, in both width and length. You can see the distance from the incisor to the nose is >38mm. When you smile you have dark buccal corridors. 
- Tipped backwards upper front teeth, seen by the backwards angle. 
- Vertical growth of the face seen by the gummy smile 
_The above causes the mandible to be entrapped backwards. Entrapped mandible then results in more vertical growth of the mandible. 
- There is an asymmetry in your lower face and some canting of the occlusal plane (hard to say what type of torsion/strain due to only lower face). 

It is hard to say exactly what caused this because factors can start from early as breast feeding, to childhood diet, to health, to breathing patterns and aberrant postures. 

Based on the information and current presentation I will try to make a guess based on similar cases to your. 
- Long standing tongue tie. You might still have a POSTERIOR tongue tie which has not been addressed with your tongue tie release.  This will have caused a low tongue posture and result in underdevelopment of the Maxilla. Low tongue posture with ties also often causes tightness on the mandible preventing it from forward traction. 
- Thumb sucking usually causes an anterior open bite. It actually tends to pull the front of the maxilla forward, but the act of thumb sucking also simultaneously pushes the mandible backwards. Thumb sucking also over stimulates the buccinator muscle (the cheek). This suction pressure puts force on the molars and pushes them in... causing a narrow maxilla. Often I see this carry forward in children into their chewing function. What I mean is they use their cheek to move food around when they chew rather than their tongue. 

 

I can not guess what the treatment you had in adolescence, but if it was only to straighten the front teeth then the bone and jaw position does not appear to have been treated or altered. 

When you bring your jaw forward, you are simulating the position your lower jaw should be. However in this position you would have no overbite, and your incisors would be touching edge to edge. This again reinforces the fact the midface/maxilla is very under developed. 

With the presentation currently, you are so entrapped in width and in length by the maxilla that you can not position your jaw in the correct position. 

The answer to your problems lies there. You need to develop your maxilla with whatever method you think appropriate. Your upper incisors then also need to tilt forward to a more protrusive/neutral position. Finally the mandible can slowly develop forward. 

As your teeth are acting as locks, my view is mewing alone will only achieve so much progress. But it is worth trying before looking at other options. 

 
ReplyQuote
Posted : 25/07/2018 6:20 pm
Apollo and alfio liked
alfio
(@alfio)
10+ Forum Posts
Posted by: SUGR1

My assessment of your current situation is as follows: 

- Under developed mid face / maxilla, in both width and length. You can see the distance from the incisor to the nose is >38mm. When you smile you have dark buccal corridors. 
- Tipped backwards upper front teeth, seen by the backwards angle. 
- Vertical growth of the face seen by the gummy smile 
_The above causes the mandible to be entrapped backwards. Entrapped mandible then results in more vertical growth of the mandible. 
- There is an asymmetry in your lower face and some canting of the occlusal plane (hard to say what type of torsion/strain due to only lower face). 

It is hard to say exactly what caused this because factors can start from early as breast feeding, to childhood diet, to health, to breathing patterns and aberrant postures. 

Based on the information and current presentation I will try to make a guess based on similar cases to your. 
- Long standing tongue tie. You might still have a POSTERIOR tongue tie which has not been addressed with your tongue tie release.  This will have caused a low tongue posture and result in underdevelopment of the Maxilla. Low tongue posture with ties also often causes tightness on the mandible preventing it from forward traction. 
- Thumb sucking usually causes an anterior open bite. It actually tends to pull the front of the maxilla forward, but the act of thumb sucking also simultaneously pushes the mandible backwards. Thumb sucking also over stimulates the buccinator muscle (the cheek). This suction pressure puts force on the molars and pushes them in... causing a narrow maxilla. Often I see this carry forward in children into their chewing function. What I mean is they use their cheek to move food around when they chew rather than their tongue. 

 

I can not guess what the treatment you had in adolescence, but if it was only to straighten the front teeth then the bone and jaw position does not appear to have been treated or altered. 

When you bring your jaw forward, you are simulating the position your lower jaw should be. However in this position you would have no overbite, and your incisors would be touching edge to edge. This again reinforces the fact the midface/maxilla is very under developed. 

With the presentation currently, you are so entrapped in width and in length by the maxilla that you can not position your jaw in the correct position. 

The answer to your problems lies there. You need to develop your maxilla with whatever method you think appropriate. Your upper incisors then also need to tilt forward to a more protrusive/neutral position. Finally the mandible can slowly develop forward. 

As your teeth are acting as locks, my view is mewing alone will only achieve so much progress. But it is worth trying before looking at other options. 

 

So, in your opinion, even from just changing the inclination of the upper incisors forward could I get a jaw advance?

 

To achieve this, could it be helpful to push with my tongue on the upper incisors, at least sometimes, or is it something that should never be done in any case?

ReplyQuote
Topic starter Posted : 26/07/2018 1:25 am
Rockyp33
(@rockyp33)
500+ Forum Posts

so theres more than one type of tongue tie? @SUGR1 please elaborate

ReplyQuote
Posted : 01/08/2018 12:50 pm
Rockyp33
(@rockyp33)
500+ Forum Posts

my ortho said thats the first step expand the front upper palate

ReplyQuote
Posted : 01/08/2018 12:50 pm
SUGR1
(@sugr1)
10+ Forum Posts

@rockyp33

Generally there are anterior and posterior tongue ties. The anterior is well understood compared to posterior - as it is harder to diagnose. There are groups who argue every anterior must also involve a posterior. Debatable... 

What I do believe though is in many we identify the anterior and manage it but miss the posterior and hence the problem continues.

Check out the below article. 

Defining ankyloglossia: a case series of anterior and posterior tongue ties.

Hong P, et al. Int J Pediatr Otorhinolaryngol. 2010
 
 
If you change the inclination of the upper incisors you will create room for the mandible to slide forward. However your other teeth may prevent you from having a comfortable bite in this position. You can use your tongue to push the teeth forward, but if the mandible can not freely slide forward then you will be left with an increased overjet. 
 
ReplyQuote
Posted : 01/08/2018 1:10 pm
EddieMoney and alfio liked
Rockyp33
(@rockyp33)
500+ Forum Posts

@sugr1 could you attempt to diagnose my case? could i email you?

ReplyQuote
Posted : 01/08/2018 1:31 pm
SUGR1
(@sugr1)
10+ Forum Posts

Please feel free to pm me

ReplyQuote
Posted : 01/08/2018 1:40 pm
Rockyp33
(@rockyp33)
500+ Forum Posts

@sugr1 i decided to just post it instead no point in hiding

ReplyQuote
Posted : 01/08/2018 1:49 pm
alfio
(@alfio)
10+ Forum Posts
Posted by: SUGR1

@rockyp33

Generally there are anterior and posterior tongue ties. The anterior is well understood compared to posterior - as it is harder to diagnose. There are groups who argue every anterior must also involve a posterior. Debatable... 

What I do believe though is in many we identify the anterior and manage it but miss the posterior and hence the problem continues.

Check out the below article. 

Defining ankyloglossia: a case series of anterior and posterior tongue ties.

Hong P, et al. Int J Pediatr Otorhinolaryngol. 2010
 
 
If you change the inclination of the upper incisors you will create room for the mandible to slide forward. However your other teeth may prevent you from having a comfortable bite in this position. You can use your tongue to push the teeth forward, but if the mandible can not freely slide forward then you will be left with an increased overjet. 
 

What do you mean exactly when you say"your other teeth may prevent you from having a comfortable bite in this position"? 

ReplyQuote
Topic starter Posted : 02/08/2018 3:26 am
EddieMoney
(@eddiemoney)
500+ Forum Posts

35-36mm is quite tight BUT if you can fit your tongue behind the rugae and on all the soft palate + half of the hard palate, you can see expansion happen this way without reaching the incisive papilla.

That is what I did. My tongue for many months didn't have much room in the front but expanding laterally eventually made this happen.  

ReplyQuote
Posted : 02/08/2018 5:02 am
alfio liked

THE GREAT WORK

Warning:
Your Cranial Sutures Need To Be open for CranioSacral / Jaw Development!