COVERstory
Figure 4
Figure 5
Now, I utilize a Herbst appliance to stimulate growth of the mandible which helps improve both airway and skeletal asymmetries, and once again, 3D imaging helps to create more precision. By analyzing cone beam scans over the past four years, I found that growing patients who utilize the Herbst appliance average about 3-4 mm of additional growth of the mandible over the course of 12 to 18 months. This additional growth of the mandible helps open up the patient’s airway. With my CBCT scans and software, I am able to titrate the Herbst appliance properly by analyzing the condylar position. By achieving an accurate 3-4 mm stretch of the mandibular muscles, I can “repeatedly” obtain the necessary mandible growth. Before 3D imaging, I was like every other orthodontist receiving mixed results using the Herbst appliance. To the best of my ability, I would try to hand manipulate the patient’s lower jaw in an attempt to acquire the proper stretch of
Figure 6
the mandibular muscles to stimulate mandibular growth. By analyzing a CBCT scan taken in maximum intercuspation, I know exactly which muscles are being activated to achieve a particular condylar position. Several patients per year come to my office with Herbst appliances from orthodontists who do not use 3D imaging. The patients are in spasm because the orthodontist is not aware that the patient is already biting forward, and the Herbst appliance positions the jaw even further forward, throwing the lateral pterygoid into spasm and lockdown. Sarah E. is a typical eleven-year-old girl with a retruded lower jaw and a constricted airway (See Figure #4). Her initial CBCT scan showed her condylar position considerably forward on the eminence (See Figure #5), and yet her airway was still constricted as shown by utilizing the “airway tool” (See Figure #6). A second CBCT scan was taken one month later with Sarah biting in maxi-
Dr. Robert Kaspers received his DDS with honors from the University of Michigan Dental School. He then completed specialty training in orthodontics at the Northwestern University Dental School and earned a Master of Science degree in Radiology. While in Ann Arbor, Dr. Kaspers worked with Dr. Major Ash on research projects pertaining to temporomandibular dysfunction. Dr. Kaspers has lectured to hundreds of dentists and orthodontists on diagnosis and treatment for both orthodontic and TMD cases. Dr. Kaspers is the founder of the Five Condylar Positions which has helped make diagnosing and treatment planning easier for the practitioner. Dr. Kaspers is the founder of ProActive Orthodontics, and it is his desire to help the profession understand the advantages of the CBCT scan so that diagnosis of orthodontic cases can be made more easily and more accurately. Currently, Dr. Kaspers maintains a private orthodontic and TMD practice in Northbrook, Illinois.
8 DSP | Winter 2014