the present invention provides a method and an apparatus for use in orthodontics for increasing the biological response of the temporomandibular joints ( tmj ) in patients being treating for class ii malocclusion . in accordance with the invention , the condition of the components of the tmj , especially the condyle , is noninvasively altered to enhance the therapeutic effect of class ii orthodontic treatment modalities through more and faster growth and adaptation within the joint and surrounding muscles , disk , ligament , tendons , vascularization and / or innervation . in accordance with this embodiment , extracorporeal shock waves are used in and / or around the tmj tissues to increase the growth and adaptation of the mandible and tmj tissues , thus enhancing the treatment effect of orthodontic appliances for class ii correction . fig1 is a top view of an example of a shock wave generating apparatus that is suitable for delivering stimuli in the form of shock waves , to a patient &# 39 ; s body in and / or around the tmj tissues . the apparatus 1 comprises a shock wave reflector 2 that focuses shock waves generated by the apparatus 1 at a focal point 3 . the location of the focal point 3 is dictated by the geometry and dimensions of the reflector 2 . the shock waves 4 propagate through water surrounding an electrode 5 when a bias voltage or current is applied to the electrode 5 . the shock waves 4 are reflected by the surface 6 of the reflector 2 and converge at the focal point 3 . the apparatus 1 preferably is positioned such that the focal point 3 is coincident with the location or locations in and / or around the tmj tissues at which the shock waves are to be applied . a variety of shock wave generating apparatuses are currently available that are suitable for applying shock waves to a patient &# 39 ; s body in and / or around the tmj tissues . such apparatuses may be used , either with or without adaptation or reconfiguration , to treat patients using the method of the invention . such adaptations may include , for example , focus depth , focal area shape , changes in energy flux density , changes in the frequency of the shock waves used , and number of pulses delivered during a treatment session . suitable apparatuses for this purpose are offered by electromedical medical systems company of switzerland , by storz medical company of germany , and by mts company of germany . those skilled in the art will understand , in view of the description provided herein , the manner in which a suitable shock wave device , either focused or radial , may be selected to appropriately apply shock waves for the desired growth and adaptation changes in the mandible , tmj and / or related tissues . fig2 illustrates a flow chart that demonstrates the method 10 of the invention . in general , the method is made up of two steps . the first step is to install a suitable jaw orthopedic appliance in the patient &# 39 ; s mouth , as indicated by block 11 . for example , a removeable bionator apparatus may be used for this purpose , as is known in orthodontics . there are fixed orthodontic appliances used for this purpose as well , such as the herbst appliance and the mandibular anterior repositioning appliance ( mara ). after the orthodontic appliance has been installed , the apparatus 1 shown in fig1 is used to apply shock waves in and around the tmj area , as indicated by block 12 . the frequency of treatment sessions can be adjusted for optimum therapeutic effect . in the present embodiment , focus depth will typically be approximately 5 to approximately 25 millimeters ( mm ), with the focal area conforming to the shape of the head of the condyle . the treatment area will typically be the entire tmj area , excluding the auditory mechanism to avoid damage to sensitive tissues . the energy flux density will typically range from approximately 0 . 05 to approximately 0 . 4 milli - joules per squared millimeter ( mj / mm 2 ). a typical treatment session may involve applying 1000 to 3000 shock waves . the settings and ranges mentioned above are chosen because of the size of the tmj joint and the variety of tissues involved . also , the settings are adjusted to suit the size of the patient and the severity of the orthodontic problem . for smaller patients and less severe problems , lower settings and fewer treatment sessions are used . treatment sessions are typically provided in 2 to 8 week intervals depending of the therapeutic response . the anatomic and physiologic effects that the application of shock waves produce in the tmj and related tissues ( e . g ., mandible , condyle , disk , muscles , ligaments , tendons , vascularization and innervation ) include corrective growth and adaptation . the combined results of applying shock waves to the tmj region and the work performed by the orthopedic appliance is an accentuated and accelerated treatment response to malocclusion . it should be noted that the invention has been described with reference to preferred embodiments and that modifications may be made to the embodiments described herein . as will be understood by those skilled in the art in view of the description provided herein , all such modifications are within the scope of the invention .
a method for treating malocclusion by installing an orthodontic apparatus on a patient configured to treat malocclusion , and applying shock waves to one or both temporomandibular joint of the patient . the application of the shock waves in combination with the force exerted on the mandible by the orthodontic apparatus results in accentuated and accelerated corrective growth and adaptation of the mandible .