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[Advice?] Cantedness, asymmetric cheekbones and midline discrepancies  

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Azrael
Estimable Member

I have a 9-11 tooth smile (since I show more teeth on one side) and my IMW is 40mm.

On my left side (the side I chewed with my whole life):

  1. ‌Upper dental arch is canted upwards more
  2. ‌Cheekbone is sunken and low
  3. Negatively Canthal tilted eye
  4. ‌Ramus is longer
  5. ‌Mandible is more developed

On my right side (the side I've been chewing with for the past 4 months):

  1. Upper dental arch is neutral
  2. ‌Cheekbone is pronounced and high
  3. Neutrally Canthal tilted eye
  4. Ramus is shorter
  5. ‌Mandible is less developed

I have a midline discrepancy as well and after taking EddieMoney's advice, I've mewed (and chewed) by coinciding the midlines.

How do you think this approach will affect the above mentioned asymmetries on my palate and face? I'm interested in hearing your thoughts.

Here is a recent (1 year old) X-ray:

Edit - included the X-ray and mentioned the Canthal tilt differences.

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Posted : 30/05/2020 9:00 am
Progress
Member Moderator
Posted by: @azrael

How do you think this approach will affect the above mentioned asymmetries on my palate and face? I'm interested in hearing your thoughts.

I think it depends on how much of your asymmetry is caused by asymmetric maxillary development vs asymmetric cranial structure, which of course is difficult to figure out without comprehensive medical imaging. It makes sense to assume that the more complicated the visible asymmetry is, the less likely the problem is to be localized to the maxilla. If it was a matter of one side of the palate being narrower than the other, I'd imagine simply expanding the narrower side with the tongue would be enough.

Yet in cranium-wide asymmetry the tongue and the mandible tend to function in separately asymmetric ways (along with a plethora of other muscles), both of which are likely to result in different kind of craniofacial asymmetries. For example, the tongue may be favoring one side and the mandible the opposite... or they may both favor the same side. So you would have to individually figure out your habitual functional imbalances in your tongue and jaw, then assume a posture that neutralizes each. That's how I'd approach asymmetry. That being said, I have been trying to figure out my facial asymmetry for years and I have not made much progress. Mine is something like this:

 

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Posted : 30/05/2020 11:31 am
Azrael liked
Azrael
Estimable Member
Posted by: @progress

I think it depends on how much of your asymmetry is caused by asymmetric maxillary development vs asymmetric cranial structure, which of course is difficult to figure out without comprehensive medical imaging. It makes sense to assume that the more complicated the visible asymmetry is, the less likely the problem is to be localized to the maxilla. If it was a matter of one side of the palate being narrower than the other, I'd imagine simply expanding the narrower side with the tongue would be enough.

Yeah, I guess the only obvious asymmetry I have at the moment is the mandibular one which has improved over the past four months by simply switching the side I chew stuff on. Almost all the other asymmetries are only observable when images of my face are horizontally flipped.

I don't seem to have any significantly widespread asymmetries in the overall cranial structure but I'm concerned about the possibility of my current asymmetries confined to the maxillary region (as you can see in the x-ray I just attached to the OP) having a cascading effect on other regions of the skull, if I don't address them early on.

Posted by: @progress

Yet in cranium-wide asymmetry the tongue and the mandible tend to function in separately asymmetric ways (along with a plethora of other muscles), both of which are likely to result in different kind of craniofacial asymmetries. For example, the tongue may be favoring one side and the mandible the opposite... or they may both favor the same side. So you would have to individually figure out your habitual functional imbalances in your tongue and jaw, then assume a posture that neutralizes each. That's how I'd approach asymmetry. That being said, I have been trying to figure out my facial asymmetry for years and I have not made much progress. Mine is something like this:

1582904061795

I noticed yesterday that when I place the tip of my tongue at the incissive papilla, the underside of my tongue sort of juts outwards to the left (as the tongue gets compressed with the jaws closing in) and that is probably what has caused the larger cantedness seen in my four upper incisors.

I have tried to neutralize certain behaviors (such as that) as you have said here by placing the tongue more towards the right but I stopped it since it could increase the asymmetric Canthal tilt and cheekbones even more as the upwards force/pressure is unlikely to be symmetric when the tongue is more aligned to one side (right, in this case).

The lesser cantedness in the overall upper dental arch could be:

Because a canted frontal occlusal plane is usually the result of unequal ramus length.

https://halligantmj.com/the-canted-plane-revisited-one-thing-you-must-check/
 
This could be true since I have unequal ramii as mentioned in the OP. If that is indeed the case, perhaps the switching of chewing side could help in that regard as well over time?
 
I should probably get such an image done to accurately gauge the asymmetries in the skull as it seems superior to an x-ray but from what I can see, my asymmetries hopefully aren't as severe as yours (yet). Still, I didn't notice any significant asymmetry even in your progress pics but that's probably because most of the pics were side profiles.
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Posted : 01/06/2020 10:26 am
Progress
Member Moderator

I'm inclined to think it's the other way around: unequal ramus length is the result of a canted occlusal plane, because the ramii are perhaps to most adaptable part of the jawbone. The maxillary cant in itself could still very well be caused by uneven mandible usage, as the article is suggesting. The outcome would be some sort of a feedback loop: mandibular function influences the maxillary shape, which in turn influences the mandibular functioning, which changes the mandibular shape, influencing the maxillary shape further and so on. In order to cut the loop, you'd probably have to figure out how to reverse the mandibular pattern.

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Posted : 01/06/2020 11:13 am
Adam liked
Apollo
Reputable Member

The right side of my maxilla is farther down and back than the left. On a panoramic x-ray, my right ramus is a little longer than the left. I intuitively chew in a left-to-right rotary pattern. For a while I was trying to exercise chewing gum in the counterintuative direction, but I haven't been consistent. I still try to remember to break the habit while eating, but if I'm not thinking about it I revert back to my old pattern. I think my occlusal cant might have improved very slightly in the past couple years, but I'm not sure what has helped. Maybe I should resume some moderate chewing exercises.    

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Posted : 01/06/2020 2:32 pm