Clinical Continued » and study models.
• Orthodontic diagnosis: skeletal class III, Div 2, open bite, dental class II, Div 3. Neutral bite, tongue thrust; factor ı (position of premaxilla) is minus five degrees.
Treatment proposal • Upper r-n sagittal appliance to develop the arch.
• Lower TMD splint to reduce the TMD (Tourette’s) and retract the lower incisors.
• Fixed braces to level and align the teeth.
• Veneers on upper 2s • Retainers • Estimated treatment time: three years.
Treatment Henry started his treatment for Tourette’s on ı7 February 20ıı. He was fitted with an upper R-N sagittal appliance and a lower TMD splint to provide him with a more balanced mandibular position. His inter-incisal opening at this visit
was recorded as 44mm. At his second treatment visit two months later, his opening had improved to 5ımm. He was now off all his medication and his tics had mainly worsened, except for his eye tics which had reduced considerably. Muscle testing indicated the vertical dimension of the lower splint was correct. A month later, the patient was
much calmer since coming off the medication. Audiology tests noted his
hearing was now normal having been 20 per cent down previously. Dramatic improvement in his symptoms with no expletives and only one minor tic occasionally. Opening increased to 54mm. At this visit, Henry was filmed by
ITV for an episode of the documentary “My Child is not Perfect”. In June 20ıı, Henry reported only occasional tics when stressed; opening now 56mm. He was then referred to the podiatrist for a review of his orthotics. In July 20ıı, the upper fixed appliance
was fitted and the R-N sagittal was discontinued. The lower splint was being worn full time. In August 20ıı, Henry was being
treated by a cranial osteopath; orthotics were under construction to level his pelvis. Only one tic seen in the waiting room and one tic in the surgery. In October 20ıı, Henry’s neurologist
expressed an interest in his dental treatment. Appliances were checked and adjusted. Between November 20ıı and August
20ı4, Henry’s orthodontic treatment continued with a consistent and apparently permanent improvement
ABOUT THE AUTHOR
Dr André Hedger qualified from Guy’s Hospital in London in 1978 (GDC No. 52634). He holds a Bachelor in Dental Surgery and subsequently Licenciate in Dental Surgery degrees. He started his practice in Great Bookham in 1981. He is a fellow of the Hypnotherapy Society and a founder member of the British Society for the Study of Craniomandibular Disorders. André is also a member of the British Orthodontic Society and the International Association for Orthodontics. He is a member of the British Dental Acupuncture Society, the British Society for Clinical and Applied Hypnosis dental phobia certified, the American Academy of Craniofacial Pain, the International Academy of Oral Medicine and Toxicology and Patients Against Mercury Amalgams. He is in the British Society for Dental Sleep Medicine as well as several other specialist groups.
Post treatment Fig 6a
in his Tourette’s symptoms, in spite of suffering a severe physical assault while cycling in July 20ı3. Two months earlier, he passed his driving test. Now symptom-free, final occlusal
corrections were completed and retainers fitted in September 20ı4. At a three-month follow-up, Henry was symptom-free.
To see Henry’s final video please go to
www.openwide.biz (About us-Testimonials)
Posture before treatment Fig 7a
Posture before treatment Fig 7b
Posture post treatment Fig 7c
Posture post treatment Fig 7d
Ireland’s Dental magazine 37
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