For AGA Master Track Course April 24-26, 2020 (2 ½ days) Friday – Sunday
TMJ & Sleep Disorders Breathing in Children and Adults with a focus
on Airway-Orthodontics
William E. Harrell, Jr, DMD, C.DSM
Background
Dr. Harrell graduated from UAB Dental School in 1975 and did his specialty training in Orthodontics at the University of Pennsylvania School of Dental Medicine, graduated in 1977. He received his Orthodontic Board Certification in Orthodontics by the American Board of Orthodontics (ABO) in 1989. He has his private practice in Alexander City, Alabama and a satellite office in Auburn, Alabama. He diagnoses & treats early orthodontic & dento-facial orthopedic growth issues, “traditional” orthodontics, TMJD, and Dental Sleep Medicine. He also is an Adjunct Professor at UAB Orthodontic Dept. His passion for airway began in 1982, when Dr. Jim McNamara showed results from his time with Dr. Rolf Frankel and the monkey studies of Dr. Harvold that same year.
Dr. Harrell began his interest in 3D imaging in 1982 on an Atari computer. He also began working with the pioneers of TMD diagnosis and therapy, the late Dr. Bill Farrar and oral surgeon Dr. Bill McCarty in Montgomery, AL from 1979-1985 he also taught in their Normandie Study Group for TMJ Dysfunction. Dr. Farrar discovered the anatomic and orthopedic reasons of why TMJs clicks, pops and locks, “Internal Derangements such as: “The Anterior Disc Displacement with and without Reduction” (ADDwR, ADDwoR). Dr. Farrar also developed an occlusal concept of “Retrusive Braced Occlusion” for both splint therapy, natural and prosthetic occlusion which he felt was the more “TMJ Friendly” occlusion.
Dr. Harrell focuses on early screening and early diagnosis for children who present with certain “Facial Biomarkers” that relate to Sleep Related Breathing Disorders (SRBD) which has an anatomically obstructive origin for SRBD. Obstructive Sleep Apnea (OSA) is a one problem of SRBD and affects both children and adults. Most research on OSA has been in adults after they have developed the co-morbidities that effect their health.
Early screening and diagnosis for SRBD focuses on the altered growth and development associated with altered breathing during the day and night (ie. snoring, 4mouth breathing vs nasal breathing, narrowed maxillary and mandibular arches, retrognathic mandible AND/OR maxilla, small nasal valve opening, etc.
Objectives of Course:
1. Review the Pediatric Task Force Committee’s recommendations for screening exams for
Pediatric Sleep Related Breathing Disorders. The Reference Committee “C” and HOD of the ADA (San Francisco 2019) is recommending our Task Force’s work be adopted by the ADA.
2. To understand and document various facial biomarkers (3D Geometry and color)
related to SRBD.
3. To understand the difference between Adult OSA and Pediatric Sleep Disorders.
4. To understand how TMJ Disorders and Sleep Disorders may be related.
Bruxism as a part of Sleep Medicine is considered a movement disorder of sleep, like restless leg syndrome. Bruxism may be related to the patient trying to open up their airway at night.
5. Hands on Adjustment of Lower Splint TMJ Orthotic using Retrusive Bracing Occlusion.
6. Introduce the concept of occlusion put forward by Dr. Farrar of “Retrusive Braced
Occlusion” for both TMJ splints and natural dentition.
7. Early diagnosis and airway treatment alternatives in children is critical if
we are to have a chance of lessening or possibly even “curing” OSA and SRBD later in life. OSA and other obstructive sleep disorders may have their origins and signs (biomarkers) show up as early as 2 – 2 ½ years of age.
8. ConeBeam CT (CBCT) principals and uses in Airway focused therapy.
9. Is CR always the treatment position for all cases?
10. Presentation by 3dMD on future imaging of 3D and 4D imaging.
Course Outline:
Friday April 24, 2020
Day 1 AM Introduction to Pediatric Airway
Screening
Biomarkers
3D facial Imaging
CBCT
Case studies
PM TMJD
The work of Drs. Bill Farrar and Bill McCarty will be presented
Retrusive Braced Occlusion
Videos of fresh cadaver material of various types of Internal Derangements.
How TMJ Disorders and Sleep Disordered Breathing relate to each other
TMJ Splints. (I use mostly Lower splints that are equilibrated directly in the
mouth. Lowers are more amenable for Full Time Wear, speaking and are more comfortable).
Saturday April 25, 2020
Day 2 AM Case Studies and other material
PM Hands on TMJ splint therapy
Each Dr. is recommended to take a lower impression on themselves or a 3D IO scan. Send only lower to (a specific person at) Great Lakes Orthodontic Lab for fabrication of a lower 3 mm Biocryl splint to be trimmed but no occlusal adjustment. These splints will be mailed back to the Dr. to bring with them to the course. Must send in plenty of time to get them back for the course. Make sure they fit OK but do not adjust the occlusal as this will be done in the course. Articulation paper, slow speed hand pieces and acrylic burs will be provided.
Sunday April 26, 2020
Day 3 AM - 3dMD presentation Future of Imaging 3D and 4D
