Patients travel from all corners of the planet to receive this state-of-the-art treatment from Dr. Yousefian, which he coins DAME™ (Distraction Assisted Mandibular Expansion). This proprietary treatment allows Dr. Yousefian to expand the upper jaw with his highly controlled and effective technique, DANE™ (Distraction Assisted Nasomaxillary Expansion), an additional 6 mm compared to traditional 2-4mm of total net expansion when doing MSE/MARPE alone, resulting in 10 mm of net upper and lower jaw expansion.
Distraction-assisted mandibular expansion (DAME)
Comprehensive Teledontic–Telegnathic Care for Pediatric Obstructive Sleep Apnea and TMJ Disorder
A 17-year-old female presented with jaw pain, popping, and locking, along with snoring, restless sleep, and frequent awakenings. She had undergone prior orthodontic treatment but continued to experience jaw asymmetry, headaches, and daytime fatigue. Imaging revealed bilateral temporomandibular joint (TMJ) degeneration, a narrow upper airway, and underdeveloped upper and lower jaws (maxillary and mandibular hypoplasia)—all contributing to pediatric obstructive sleep apnea (OSA).
Pre-treatment Extraoral and intraoral photographs. Lateral cephalometric X-ray. Panoramic X-ray.
A home sleep study (Nox T3) confirmed mild OSA (AHI 5.7/h, SpO₂ 82%). The patient declined CPAP therapy and chose treatment with the ApnoTX® oral appliance, a hybrid version of the ApnoDent® system designed by Dr. Joseph Yousefian to simultaneously manage OSA, TMJ disorders, and bruxism while coordinating with Invisalign® aligners.
Intraoral photographs showing the patient wearing ApnoTx on the top of the upper and lower Invisalign aligners to manage the temporomandibular joint symptoms and sleep apnea, and prepare the teeth and jaws for expansion
Using the teledontic–telegnathic protocol, her treatment included:
- ApnoTX® for nighttime airway support and TMJ stability
- Microimplant-Assisted Nasomaxillary Expansion (MANE) and Distraction-Assisted Mandibular Expansion (DAME) to widen both jaws and improve airway volume
- ApnoMed Expander System (AES-MISA and AES-RME) for non-surgical skeletal expansion
- Finishing and alignment with Invisalign®
Extraoral and intraoral photographs showing the ApnoMed Expander System/Micro-Implant-Spring Assisted (AES-MISA) was bonded to the upper teeth, and the ApnoMed Expander System-Rapid Mandibular Expander (AES-RME) was installed in the lower arch. The patient is wearing the ApnoTX between the upper and lower jaws on top of the expanders.
Following comprehensive therapy, her sleep study improved dramatically:
- Pre-treatment AHI: 5.4 → Post-treatment AHI: 0.5
- Minimum oxygen saturation: 82 % → 94 %
Clinically, her jaw pain, joint clicking, and morning headaches resolved completely, her facial balance and smile improved, and her airway expanded significantly on CBCT imaging.
This case illustrates how Teledontics and Telegnathics—developed by Dr. Yousefian—address not only crooked teeth, but also the underlying pharyngorofacial and airway deficiencies that cause sleep apnea and TMJ disorders, offering patients a comprehensive, non-CPAP solution to achieve healthy breathing, jaw function, and facial balance.
Posttreatment extraoral and intraoral photographs
Right photograph- Pre-treatment and left photograph- Post-treatment lateral view cephalometric CBCT X-rays.
Right, Pre-treatment and left, post-treatment frontal view, cephalometric, CBCT X-rays.
Right, post-expansion and left, post-treatment frontal view, cephalometric, CBCT X-rays. The site of expansion is properly healed, creating an enlarged upper airway to cure sleep apnea.
Right: pre-treatment; left: post-treatment frontal view photographs. The patient has a broader smile and an enlarged upper airway to treat sleep apnea with no temporomandibular joint symptoms.
