Sunday, December 19, 2010

What is Epigenetic Orthodontics?

I am only going to attempt a brief layman's explanation of Epigenetic Orthodontics here, which is simply my limited understanding of it. Googling the term will provide explanations more thorough and scientific for those seeking deeper knowledge.

I assume all readers know what standard orthodontics is. As we usually understand it, it is the technique of aligning teeth by forcing them into alignment using appliances or mechanical techniques (braces, Invisalign, etc)

Epigenetic orthodontics works differently, more subtly, and to my way of thinking, much more elegantly. It is based on the idea of activating bone stem cells that will grow into new bone tissue, thus changing the shape of the bones themselves in such a way that the teeth come into proper alignment naturally. (Stem cells are "generic starter cells" that do not yet have the characteristics of a particular type of body tissue, but will become a specific type of tissue, depending on where the stem cell is located in the body.)

In the photo above you can see lines that divide the bony plate of the upper palate. These lines are known as a sutures. There are many sutures in the skull such as can be seen in the illustration below.
The sutures are a very small gap between the bone plates, and they are where the bone stem cells exist. The sutures also allow a very small amount of movement between the plates. They are also where new bone growth occurs in a young growing body, and where new bone growth can occur in an adult body if the stem cells at the margins of the sutures become activated.


It was not known until recently that the adult stem cells at the margins of the sutures could be activated. It was always thought that once adulthood was reached, the bones stopped growing, the stem cells for the bones in the skull became dormant, and that, as they say, was that. You were stuck with what you had.

But we now know that the bone stem cells in the sutures of an adult can become active under special conditions and grow new bone. And if this new bone growth is directed in a planned and precise manner, it is then possible to achieve alterations of the shape and dimensions of the bones in such a way that the teeth will fall naturally into alignment, and/or that improvements in the airway can be achieved (eliminating snoring or sleep apnea), or that improvements to facial appearance can be achieved.

In Epigenetic Orthodontics, the sutures in the bone plate of the upper palate are of primary focus. The stem cells are activated by mechanical means- therefore no drugs or invasive techniques are involved. What has been discovered is that if the sutures can be spread just slightly more open, the dormant adult stem cells will "awaken" and produce new bone tissue at the site.

To achieve that  slight widening of the gap, an orthodontic appliance (Dr. Singh's  DNA Appliance) resembling an orthodontic retainer is worn. In order to direct the bone to grow in the desired manner to achieve the desired new shape, the appliance is outfitted with spring-like extensions that will place small  amounts of tension in specified ways against specified teeth. Which teeth are targeted depends on the patient's needs. This slight tension creates the signal to the stem cells in certain regions of the suture to become active and produce bone at the specific sites the doctor desires the bone to grow and the plate to expand.

And if the above weren't already interesting and exciting enough consider this: In expanding/reshaping the upper jaw (properly called the Maxilla), the lower jaw (AKA Mandible) also often follows into proper shape without the necessity of its own appliance. (I do not yet understand how that works but hope to learn.) Thus, both top and bottom teeth become aligned by using an appliance worn only on the top. However, I am told this is not always the case and that some patients will need to have an appliance made for their lower teeth as well.

Consider this as well: Since you are growing new bone, your improvements should last a lifetime- unlike, say, the braces I had as a kid, and from which I have suffered a gradual relapse such that I need orthodontia yet again, in middle age.

6 comments:

  1. This is the clearest explanation I have seen yet for how the DNA Appliance works. I wish I had seen/read this before I tried to explain the DNA Appliance to others. I'm looking forward to reading the rest of your blog. Thank you so much for writing it!

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  2. This is an in-depth data about orthodontics! Thanks for sharing your ideas.

    Emma | nj orthodontist

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  3. This is a very thorough article. Thank you for sharing this information.
    Braces Colorado Springs

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  4. Here is my understanding of how mandible (lower jaw) follows the maxilla (upper jaw) with these type of dental treatments: According to the functional matrix hypothesis (laid out by Columbia anatomy professor Melvin L. Moss), the mandible and mandibular teeth form a spatial matrix that is responsive to the maxillary complex. The upper appliance activates the lateral pterygoid muscles (muscles that move the mandible) which displace the mandible downward and forward, providing space for condylar remodeling. Therefore, it is conceivable that during the correction of palato-maxillary structures, these epigenetic appliances will produce spontaneous correction of the mandible due to neuromuscular activity.

    BigSmiles without Braces in Surrey, BC

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  5. So far, Dr. Singh has not presented any evidence in peer-reviewed journals that his appliance actually works like it claims to. Appliances like this have been around for decades. They line up teeth no problem. Dr. Singh is marketing his appliance as different and new (and charging a whole lot more for it) based on claims that are unsubstantiated.

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  6. The work was presented at the Asia-Pacific Orthodontic Congress where approx. 2000 Orthodontists heard the presentation. The speaker was invited by the organizers as a keynote speaker the following year but couldn't make it, so the paper was submitted to them for publication. Since that time, the speaker was awarded a prize at the International Association for Orthodontics in both 2013 and this year 2014 - two years in a row. It's taken a while for the paper to appear but here is the citation:

    Singh GD, Heit T, Preble D. Changes in 3D midfacial parameters after biomimetic oral appliance therapy in adults. J Ind Orthod Soc. 48(2), 104-108, 2014.

    The paper provides definitive evidence of increased bone volume in adults, using no surgery and no drugs. The second paper in this series, showing increased nasal airway volume was presented at the Sleep (medical) meeting. Here is that citation:

    Singh GD, Heit T, Preble D, Chandrashekhar R. Changes in 3D nasal volume after biomimetic oral appliance therapy in adults. Sleep (Abstract Suppl) 37:A150, 2014.

    The next paper in this series has been submitted to the World Association of Sleep Medicine. The findings are quite remarkable, but based on strong, scientific principles of Epigenetic orthodontics.

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