When are you ready to start treating patients with ALF?

You have completed some ALF training and are familiar with the basic ALF design and adjustments. You are ready to put your skills to the test. What kind of cases should you start with?

Start with treating children

In my seminars, I recommend gathering experience with ALF by first treating children in the primary and early mixed dentition before treating adults. The reason is that adults have more complex treatment needs than children and are more likely to have unexpected reactions.

Recently I received feedback from a dentist who took my ALF seminar 10 months ago, has already experience with Crozat appliances but simply doesn’t see children in his practice. I see a huge potential of beneficial treatment not being delivered to patients if dentists in a similar situation don’t start treating adult patients. That’s why I’d like to give some guidelines of how to start with adult patients without jeopardizing the patients’ health or the dentist’s sleep.

Be aware of the challenges of adult treatment

Some of the challenges of adult treatment can be:

• Adults can have a harder time to deal with initial discomfort.
• They are less tolerant of food impactions.
• They are more bothered by speech impediments, and it takes them longer to overcome them.
• They often have a worn-in dentition with insufficient occlusal embrasure spaces to accommodate cribs.
• They tend to need more emergency visits, particularly if pain symptoms are present.
• Treatment time tends to be longer because:
  • Adults don’t have the advantage of growth anymore.
  • Their bodies have adjusted to the existing occlusion and compensatory mechanisms have been established for years.
  • All joints, particularly the facet joints of the spine, have wear patterns. This can limit how much postural and overall change can be achieved.
• Adults always need life-long retention.

Be competent

Don’t be fooled by the seemingly simple design of the ALF. You need to:

• Be proficient in diagnosis and treatment planning. (I highly recommend AAGO session 1 to achieve this.)
• Be comfortable with wire bending and adjusting an ALF.
• Understand and apply the principles of ALF treatment.

Know how to customize ALF treatment for patients in the permanent dentition

• If the basic ALF design causes occlusal interferences due to the cribs you have several options:
  • Place build-ups on the lower second bicuspids. This mostly works well for patients who are not symptomatic. Pain patients may not tolerate the build-ups.
  • Before taking the impression, perform enameloplasty of the occlusal embrasure spaces of the cribbed teeth.
  • If there is TMJ dysfunction full-time wear of a lower orthotic may be indicated which solves the problem of occlusal interferences.
• Alternative ALF designs are available, for example, the crescent retained Stealth.
  • Advantages of crescent retained appliances are that they eliminate the potential for occlusion interferences and are easily flossable.

Stay tuned for more information in one of my next newsletters about crescent retained appliances.

Use care when it comes to patient selection

Don’t strive for textbook results and perfection as in straight teeth. If this is what the patient wants ALF may not be the best option. Instead, examine whether there are areas where an ALF can improve function and overall well-being for the patient. Look for:

• cranial strains
• untoward myofunctional habits
• TMJ dysfunction
• pain symptoms.

If any of the above is present ALF treatment can help by

• freeing up the premaxilla and releasing cranial strains
• being an adjunct to myofunctional therapy
• developing the dental arches and the midface
• repositioning the mandible.

It is necessary to be upfront with our adult patients about what ALF can and cannot do. We need to be educators. Always strive to Under-promise and Over-deliver!

Case finishing

To finish treatment, it is often necessary to use segmental braces. As long as light, ROUND arch wires are used and the patient still wears the ALF appliances the cranial benefits of ALF treatment won’t be undone by the fixed appliances.

Your safety net

I would like to encourage dentists with ALF training to start treating adults if they don’t see children in their practice. It is wise to have a safety net in place:

• a mentor to ask questions about your cases
• colleagues who are already doing ALF treatment
• a multi-disciplinary approach working as a team with a cranial osteopathic physician and a myofunctional therapist.

Please share your thoughts in the comment box at the very bottom – Thank You!

Warm personal regards,
Ljuba Lemke

The ALF online seminar is now also available to osteopathic physicians and myofunctional therapists at a reduced price. Please inquire about discount coupons.

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