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After 30 years in practice the overwhelming majority of patients can be treated with a certain routine. However, from time to time even the most experienced orthodontist is faces with issues which require brave and unorthodox treatment concepts. Four patients will illustrate these diagnostic and therapeutic challenges with special regard to finishing procedures.
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Congenitally missing lateral incisors or second premolars, extremely displaced canines, or severe trauma to the central incisors all result in a reduced upper dentition. The two most common treatment approaches are space closure or space opening to allow prosthodontic replacement with either a fixed prosthesis or single-tooth implants. Both of these approaches involve compromises in terms of esthetics, periodontal health, and function.
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With the introduction of new technologies such as the use of TADs and accelerated tooth movement the attention of clinicians has shifted from the growing to the non growing patient. While maintaining interest in early treatment, the increased ability to control anchorage without compliance in the second phase of treatment has given the idea of full control of biomechanics, while surgical intervention is proposed to control treatment time. Growing patients with Class II malocclusions are still the daily bread in clinical practice. Proposed timings of treatment are either related to skeletal maturation or stage of dental development. Skeletal timing tries to address the mandibular retrognathism which is a component of Class II malocclusion in a high number of patients. Dental timing aims to consistently achieve good occlusal results in non extraction treatment. Purpose of the presentation is to discuss skeletal and dental timings of treatment and their clinical significance relative to biomechanics, length of treatment and prognosis.
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Excessive gingival show is a leading candidate for one of the more unattractive features of the human smile. Patients want it fixed and dental providers are quick to offer a remedy. However, the success of our treatment depends directly on etiology. There can be many underlying reasons for the gummy smile. One of the more common, yet least understood etiologic factors is Altered Passive Eruption (APE). This presentation will attempt to define APE, review its multiple patterns and put the options for treatment into a proper and helpful perspective.
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Conventional orthodontic preparation of the dentition prior to surgery is often limited by the extent of required pre-surgical orthodontics. Temporary anchors may be used to assist in expanding the range of decompensation of the dentition prior to surgery or compensation of the dentition when surgery is performed prior to complete decompensation of the dentition. This lecture will discuss the rationale for selection of the appropriate pre and/or or post-surgically assisted application of temporary anchors.
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Oral appliances are an accepted first line of treatment for a wide range of adults with obstructive sleep apnea. As specialists in dentofacial orthopaedics, orthodontists are ideally suited to deliver this increasingly popular OSA treatment modality and should be well aware of both the associated benefits and complications. This presentation will focus on the latest evidence regarding the effectiveness of oral appliance treatment of OSA, as well as review the management of the most common side effects.
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The main Class II adult complaining is the typical facial profile aspect. Treatment can range since (1) Extractions, (2) Temporary Anchorage Devices, (3) Orthognathic Surgery or (4) Various Combinations. The decision-making processes must be founded on diagnostic tools, objectives to be achieved and patients decision. The objective is to diisplay significant outcome in the facial profile with simple and predictable treatment approaches with evidence that old procedures remain updated. A case series of facial profiles attractiveness judgment before and after treatment scores as very good/excellent, good, fair and poor. Presentation of clinical case series and approaches used. Resulting in significant improvement in facial profile aesthetics. The concepts assigned varied from deficient in all cases before treatment to very good/excellent after treatment. Concluding in simpler procedures can lead to higher results in shorter time and with predictable results.
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Treatment planning for the dental arch has often relied on interpretation of root position based on external factors; buccolingual position, torque and angulation of the crowns, or the shape of the alveolar crest have been used in various ways to develop bracket and wire systems that should put the roots of the teeth within the alveolar bone. Various shapes and methods of determining arch shapes have also been proposed. With the ready availability of CBCT imaging we now have the ability to look directly at the position of the root within the bone and to determine more precise relationships between the teeth and the bone. Combining this imaging technique with 3 dimensional shape analysis can now give us a different way to explore the relationship between coronal arch form and apical arch form. Morphometric techniques can also tell us what happens to the shape of the dental arch at various levels in the bone after treatment, which should inform our ability to more accurately predict and modify our treatment at the coronal level to anticipate outcomes at the apical level.
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A review of Merrifield-Gebeck's article "Analysis: Concepts and Values" gives us a chance to revisit the importance of the control of the occlusal plane and of the vertical dimension in order to facilitate a mandibular response in class II patients.
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Rotations of the occlusal plane not only affect the vertical dimension of the growing face but also the anteroposterior relation between upper and lower jaw. Conventional tooth born class III orthopedics often result in upper molar extrusion and posterior rotation of the mandible, with increase of the length and convexity of the face, which sometimes is wrongly interpreted as a restraint of mandibular growth. Furthermore, a counter clockwise rotation of the palatal plane, by the line of force passing below the center of resistance of the zygomatico-maxillary complex, may also result in a downward movement of the upper molars. These maxillary rotations can be altered by changing the angulation of the orthopedic force and it’s perpendicular distance to the center of resistance, or by adding an extra moment of force. Finally the moment-to-force ratio of the resulting orthopedic force system applied to the upper jaw will determine the direction of the maxillary rotation, and the subsequent rotations of the occlusal plane and the mandible.
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