FORWARDONTIC PROTOCOL 52, 53 (in chronological order) Table 1 1. Functioning Nose -Turbinectomy, nasal vasodilators, T&A's etc. 54 2. Wide palate -(minimum of 38mm IMW – photo below) -orthodontic semi-rapid expansion or surgical implant supported expansion in adults, 55 etc. (Figs. 12–15) 3. Forward jaws -Bow bimaxillary protrusion appliance and MMA in adults. (Fig. 16) 4. Generate proper resting oral posture -use Vacuum activator to generate self-sustainable negative pressure Fig. 11: Stage 1 appliances based on Mew 51 and Wong designs for semi-rapid expansion. 5. Foster proper body posture 56 and diet-GOPex and GOFex programs sleep. 44,45 The effectiveness of the nose is represented by the constant and effortless breathing cycle all night long. Based on Engelke’s bio-functional model, when the 3 mouth valves (V1-V2-V3) and esophagus valve (V6) close, the entire negative pressure of the respi-ratory system is sent to the nose (V7) improving the strength of nasal breathing, allowing the air stream to be injected throughout the nasopharynx (V4), the larynx (V5) to the lungs, achieving the ideal parasympathetic mode, neces-sary to produce and consolidate a restful sleep. Doing this on “autopilot” allows the brain to carry out the mainte-Once our nose becomes clogged, we become congested and as a result we begin to breathe through our mouth. Oral breathing can be transient and limited only to the peak hay fever season, but unfortu-nately children tend to take the easy route and get used to mouth breathing. Even if nasal breathing recovers, there are habits that, once they are instilled, will not correct themselves. I'm talking about the habit of hanging your mouth open at rest. The growth of the naso-oro facial complex will be impacted by ignor-ing the nose. As corroborated by Wolff’s laws**** of bone growth, 41 proper maxillary development will happen through vigorous chewing and swallowing, facilitated by nasal breathing. In relation to our dental focus, there cannot be an effective rest position, chewing or swallowing without an adequate nasal passage. Also, as we mentioned before our current diet has become more and more soft, reducing the impact of chewing and appropriate swallow-ing. The remarks of Lustig, 42 already exposed, increases the levels of inflammation in the body. Let's remember that one of the key components of nasal congestion is inflammation. 43 Dr. Rangel-Chávez has developed the concept of “The nocturnal nose” that takes place during Fig. 12: Inter molar width IMW is measured between the mesiopalatal gingival point of the first maxillary molars. 57 Fig. 13: Early semi-rapid expansion. Photos by Simon Wong. 24 Winter 2021 JAOS
Journal of the American Orthodontic Society Winter 2021: Page 24
