# Mandibular Advancement Techniques Explained

## Question:

Would you please provide some parameters on when we should consider MA.  If I understand correctly, CVMS/mostly adult dentition and how much of an OJ are we looking for?  I have had a case or two where I thought we should do MA but we only corrected the curve of spee.  Please advise.


## Answer:

[https://www.loom.com/share/c201f3773ddc4867b7f5eb2778eb738a?sid=e64b057c-b3d7-4f4d-a2a9-dc72385971ff](https://www.loom.com/share/c201f3773ddc4867b7f5eb2778eb738a?sid=e64b057c-b3d7-4f4d-a2a9-dc72385971ff)


### Use of Mandibular Advancement and Occlusal Blocks in Orthodontics

#### Overview

The decision to use mandibular advancement alone versus mandibular advancement with occlusal blocks in orthodontic treatment depends on various clinical factors, most notably the patient’s growth stage and degree of overjet. This topic is frequently discussed in the context of mixed dentition cases, where treatment strategies are tailored to the patient's stage of development.

#### Timing and Growth Considerations

In cases involving children around the ages of 7 to 10, the primary goal is not necessarily to correct the anterior-posterior relationship immediately. Instead, attention is given to the patient’s skeletal maturation, particularly by examining the cervical vertebrae. This helps determine how close the patient is to reaching their peak growth phase and how much time remains for effective orthopedic intervention.

When a patient is nearing the end of their growth phase, the urgency for corrective treatment increases. In such cases, occlusal blocks are often used in conjunction with mandibular advancement because waiting may no longer be an option. For patients who are nearly finished growing, elastics alone may not be sufficient—compliance can be an issue, and mandibular advancement wings may be damaged due to excessive bite force.

#### Advantages of Occlusal Blocks

Occlusal blocks offer several practical benefits:

* **Posterior Tooth Attachments**: They allow for attachments on all posterior teeth, which facilitates additional treatments such as intruding the curve of Spee or widening the dental arch.
* **Arch Expansion**: While using mandibular advancement trays with occlusal blocks, practitioners can work on expanding the maxillary arch, often employing buccal root torque.
* **Compliance**: Occlusal blocks ensure a higher degree of patient compliance due to their fixed nature, especially important in patients nearing the end of their growth period.

Given these advantages, occlusal blocks are typically employed when immediate intervention is needed, especially in patients presenting with a significant Class II malocclusion or large overjet.

#### Limitations in Younger Patients

Occlusal blocks are generally not recommended for younger patients—specifically those aged 7 to 9—during daytime wear. At that age, treatment priorities may differ, and there are often multiple concurrent issues that take precedence. In such cases, it is preferable to delay the use of occlusal blocks until nighttime wear becomes appropriate, as full-time wear may be uncomfortable for younger patients.

#### Target Overjet and Growth Implications

The ideal overjet target is approximately 2 to 2.5 millimeters. However, this can vary based on whether the patient is still in a growth phase and whether they still have primary teeth. For instance, as lower primary molars are lost, lower anterior teeth may drift forward, reducing the overjet. Similarly, the loss of upper primary molars may necessitate the use of Class II elastics to manage overjet.

For teenage or adult patients with fully erupted permanent dentition, the goal remains a 2-millimeter overjet.

#### Future of Occlusal Blocks

Occlusal blocks are increasingly seen as a superior alternative to traditional mandibular advancement wings. Unlike wings, occlusal blocks do not interfere with posterior attachments—an essential element in correcting the curve of Spee and facilitating transverse arch development. Given these benefits, occlusal blocks may soon replace mandibular advancement devices entirely in many treatment plans.