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Name - Karen Boon

Age – 24 years old

Symptoms – Karen had been receiving pain for the last 2 ½ years after a 4 tooth pre-molar extraction, which was needed for the orthodontic treatment. She had a clicking jaw on the left when she opened and occasional ache´s come and go.

Her mandible was held of to the right and her teeth were very much crowded at the back.

Previous History – Karen has previously had orthodontic treatment starting from the age of 13 years and finally finishing when she was 19 years old.

Treatment –

Initial Cranial Osteopathy March 2004.
The first ALF appliance was fitted in April 2004 with monthly adjustment to expand the maxilla along with repeat monthly osteopath appointments.
In April 2004 we fitted upper and lower delta force fixed brackets increasing the tension from thermally activated wire to steel wire on a monthly basis.
Karen´s jaw was still deviated to the right so we fitted an appliance called a Rick-a-nator which brings the mandible forwards, this was fitted in April 2005 and was removed in May 2005 as it had pulled the mandible straight, on that same appointment composite bite guides were placed behind her upper right 1 and upper left 1 to make sure her closure was correct.
July 2005 Karen´s upper fixed brackets were removed and a retainer placed, the decision was taken to leave the lower fixed brackets on for the retention stage.

Duration of treatment – From first appliance fitting to the retention phase 15 months

Karen is still continuing with osteopathy to maintain a stable balance.

Osteopathic Report

Karen Boon presented with an audible click at the left TMJ and a deviation of the mandible to the right. She had also recurrent dislocation of the left shoulder joint. On examination the shoulder girdle pelvic and occipital levels were all up on the left and increased tone through the muscles in the left side of the neck and shoulder girdle. The muscles of the jaw on the right were tight and restricting some of the movement of the right TMJ. The mandible on the left was moving to far forward and to the right, partly as a result of the restrictions of the TMJ on the right.

The aim of the treatment before the appliance went in was to improve the movement at the base of the skull and upper neck, reduce the muscle tone in the neck and improve the movement in the right jaw joint. Once the appliance was in, it was important to balance the movement between the two jaw joints. This involved improving the movement between

the right temporal bone (the superior bone of the jaw joint)
the occiput (where the head meets the neck)
the front of the base of the skull (the sphenoid bone) from which many of the bones of the face hang including the upper jaw.

As the movement through the right TMJ improved it was important to get the two sides to match one another as much as possible, both functionally and anatomically. This was working with the changes the appliance was making to the bony length to the maxilla on the right and mandible on the left and the expansion and forward movement of the upper jaw (maxilla).

It was also important to ensure that the rest of the body was compensating for the changes and regular assessment of the levels in the pelvis, shoulder girdle and occiput was helpful in monitoring the balance between the two sides.