A Treatment Approach to Malocclusions Under the Consideration of Craniofacial Dynamics Sadao SatoPreface Orthodontics had been established for two decades now. My involvement in the field of orthodontics is not only limited t6 clinical orthodontics. In fact, from the very start I had been fascinated with bone biochemistry. [realized that the only possible rescarch field that will likely conduct a dynamic bone research is the specialized field of orthodontics. This is so since consideration of the bone cells, phosphoric acid calcium crystallization, collagen and other bone proteins is of great relevance during the initial stage of treatment The bone tissue used to be regarded as a very static tissue where the adaptational activity is low. However, with the development of molecular biology, results showed that the bone is a very active tissue with a high adaptational capacity to the environment. This renders tooth movement is possible, However, clespite its high adaptational capacity to the environment, we are still faced with the problem of abnormal growth, During the 70°s, research studies reveal the importance of environmental factors in the growth of craniofacial skeleton, The adaptational capacity of the bones to the environment was seen to be the possible key After nearly a decade of clinical orthodontic, treated patients, including my own, started coming back for re-treatment. These patients, unfortunately, had recurrence of malocclusion and I wondered what went wrong with the treatment. Surprisingly, most of these patients had open bite tendencies. So I concluded that this is not simply relapse but rather a recurrence of malocclusion, Besides, these changes usually appeared after the termination of the pubertal growth stage. If the relapse of malocclusion is attributed to hereditary factors, why then did the changes not appear during the active growth period? This question looms in our minds. ‘The answer to this question appeared after examining the cephalometric Tadiogram and oral cavity, which showed that there was a problem of posterior discrepancy and vertical dimension of the posterior teeth. However, even though the problem has already been identified, we were lost with respect to the proper approach for the management of these problems. With the timely lecture of Dr. Young H. Kim, Thad a chance encounter with the MEAW treatment. Afterwards, I had the intuition that this could be it. The day following that lecture of Dr. Kim, I could vividly remember that Ihad started bending MEAW in the treatment room. In this book, a new approach to the treatment of malocclusion was presented based on the experiments done on most of the patients who had recurrence of malocclusion, the researches of Dr. Kim and his clinical experience that gave rise to the idea of MEAW technique, and my concept and method as well. Dr. Sadao Sato Associate Professor Department of Orthodontics Kanagawa Dental College September 1991Editor’s Note Marubranshu, the pupil of Dekaruto by chance saw a dog while walking with a friend along the street and says, “this is a machine named dog” and left. The dog upon seeing Marubranshu wagged its tail and ran away. The rest is a joke. The teacher, Dekaruto recognized the importance of intracerebral process and attributes it to the humanlike response of mental activity. The anatomist, Prof, Yoro, made further studies on this matter and affirmed that it is the result of the peripheral nervous system’s domination over the central nervous system. The concept that the stimulation of the central nervous system comes from the peripheral nervous system was introduced for the first time, This correlates with the established and dominating structural concept of “Periphery as the Center”. For instance in a cultural society, development does not necessarily mean progress from an uncivilized to a civilized society but rather they co-exist. This also goes with the importance of stimulation of the periphery to the central nervous system, The founder of structuralism, Louie Strauss, also insisted that the world consists of people with a mental culture of equality. Prof. Yoro tried to correlate this equality in the realm of nerves, but it turned out to be the opposite. In recent years, the author of this book, Dr. Sato, started re-treating his patients with open bite and mandibular protrusion, He investigated the cause of the relapse and determined the mechanism behind it. One reason is that itis related to the cranial base growth due to the enormous effect of the vomer to the growth and position of the maxilla. This makes is necessary to manage the occlusal condition, too. Another aspect is the discrepancy that causes supra-eruption of the molars resulting to the displacement of the mandible, and stimulating the remaining growth capacity, thus expanding the mandibular ramus. Dr. Sato had excellently explained the remarkable mandibular growth during the pubertal growth spurt. The concept on the primary ‘guidance of jaw morphology claims that mandibular protrusion develops when the mandible enlarges. However there is the new explanation which states that there are changes in jaw morphology caused by abnormal occiusal function, Dr. Sato was fortunate to have met Dr. Kim who authored the treatment using a multi-loop appliance where this concept was based With the data that has captivated the development of orthodontics, the existing treatment approaches based on the established philosophy proves to be inadequate. There are still numerous patients who still cannot help but rely on surgical operations These are the patients whom Dr, Sato intends to help, It is indeed my great fortune to be part of that endeavor by making me the editor of this book. Prof. Yoshii. Suzuki Professor Department of Orthodontics Kanagawa Dental College September 1991