Doctors Program - 2018 Annual Session Conference

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Early Treatment of Transverse Problems: Is it Worth the Effort?

May 5, 2018 8:00am ‐ May 5, 2018 8:45am

Two-phase treatment has been a controversial topic for decades. The speaker will give his perspective on the role of rapid maxillary expansion in early mixed dentition patients. Bonded RME is used in Class I patients to increase available arch space, spontaneously improve Class II problems, improve eruption of impacted canines, and facilitate Class III correction. Indications and contraindications will be discussed.

Learning Objectives:

• Analyze the long-term stability of early arch expansion, with and without the use of the lower Schwarz appliance.
• Familiar themselves with spontaneous sagittal improvement of Class II relationships following RME.
• Identify several ways of using a bonded expander in the correction of Class III issues.

• Dr. James A. McNamara, DDS, PhD

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The Contemporary Blend of Esthetic Smile Design: The Role of the Case Presentation

May 5, 2018 8:00am ‐ May 5, 2018 8:45am

Designing a smile has accepted norms and ideals, but contemporary orthodontic treatment planning requires tailoring a treatment plan to the individual needs and desires of the individual patient. This requires us to treat the case presentation as a two-way street. Digital technology helps us tailor the clinical examination into the visual presentation of treatment options for both the patient and doctor to visualize the treatment goals as well as quantify what movements are needed to achieve the proposed outcome. This technology continues to evolve in both orthodontics and esthetic dentistry yielding even closer collaboration in interdisciplinary treatment.

Learning Objectives:

• Comprehend the psychological impact of image modification to describe Macroesthetic treatment goals.
• Identify the fundamental philosophical approach of visualization and quantification in treatment planning.
• Utilize a flowchart of information management to treatment implementation.

• Dr. David M. Sarver, DMD, MS

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Drastic Plastic: Improving the Predictability of Clear Aligners

May 5, 2018 8:00am ‐ May 5, 2018 8:45am

Once limitations of clear aligner treatments were identified, conceptualizing techniques to improve the predictability in producing desired results was the next logical step. A variety of concepts, methods, and adjuncts have subsequently been introduced to enhance the efficacy and effectiveness of clear aligners. As a consequence, the scope of biomechanics and type of malocclusions that can be more predictably treated has increased, much like adjuncts have improved traditional fixed appliances. As one example, the inclusion of miniscrew temporary skeletal anchorage has permitted the addition of direct and indirect anchorage to support and control more predictable programmed tooth movements with aligners.

Learning Objectives:

• Identify the purpose and advantages of individualizing clear aligners and applying adjunctive forces to increase treatment predictability.
• Familiarize themselves with a variety of applications and uses for adjuncts to aligners such as miniscrew anchorage, the addition of buttons/elastics, and enhancement instruments.
• Prepare a streamlined process for enhancing the clear aligner treatment planning process to incorporate individualized modifications for each patient.

• Dr. S. J. Bowman, DMD, MSD

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Sleep Apnea: Diagnostic Challenges, Treatment Strategies & New Concepts

May 5, 2018 8:00am ‐ May 5, 2018 8:45am

This discussion will update the practitioner on the current concepts regarding the purpose of sleep including a, brief cutting edge review of fascinating new information about sleep physiology. The focus will then shift to the specific diagnosis of sleep apnea, reviewing the changing face of the prototype sleep apnea patient, the appropriate use of portable diagnostic screening tests and their accuracy. Treatment options will be discussed with an algorithm to help determine the most appropriate intervention for the individual patient. Lastly, new innovations in the treatment of obstructive and central sleep apnea will be reviewed.

Learning Objectives:

• Provide a brief overview of the 2018 concepts of the purpose of sleep, the impact of sleep disorders and the ever expanding at-risk population.
• Update on the appropriate (and inappropriate) use of apnea screening devices… when is more data needed?
• Identify treatment options: old concepts and new innovations for obstructive and central sleep apnea.

• Dr. Helene A. Emsellem, MD

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Ortho-Prosthodontic Reconstruction of Dentition in Patients with Massive Abrasion

May 5, 2018 8:00am ‐ May 5, 2018 8:45am

The lecture deals with a complex issue of interdisciplinary cooperation in patients with erosive tooth surface changes in enamel or dental abrasion caused by bruxism. The authors describe the features of individual erosive and abrasive changes and they propose their possible solutions. Orthodontic therapies in these patients form a preparatory stage before the prosthodontic reconstruction. The lecture describes which situations can be solved without the orthodontic therapy and which with the therapy, so that the teeth would be in the best possible position before the prosthodontic reconstruction. Of course, the aim is that the prosthodontist could work in the minimally invasive protocol. The authors also present here the use of dental implants as anchorage units for tooth movement, the use of anchorage mini-implants for molar intrusion from supraocclusion, and last but not least they deal with tissue changes during intrusive tooth movement.

Learning Objectives:

• Identify the difference between abrasive and erosive changes.
• Evaluate the use of dental implant as an anchorage feature.
• During intrusion, evaluate whether the tooth be inserted into the bone and therefore bone support be augmented as a result.

• Dr. Ivo Marek, PhD

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Compromised Occlusal Outcome in Favor of Facial Esthetics

May 5, 2018 8:50am ‐ May 5, 2018 9:35am

Treatment to Class I occlusion has prevailed as the gold standard, but the occlusal outcome does not necessarily correspond to favorable or enhanced facial esthetics. Discrepancies among hard structures (bone and teeth) in relation to soft tissue variation in thickness and proportion indicate that in such malocclusions, limited compensation short of a Class I occlusion may be appropriate as the severity of skeletal discrepancy increases. This concept will be illustrated with treatment reports and research findings.

Learning Objectives:

• Recognize the scope of dentoalveolar compensation.
• Recognize the constitutional and therapeutic limitations to attaining neutroclusion.
  
• Determine how to reach an educated decision to balance individual outcome and expectations with the side effects of “ideal” treatment (e.g compromised esthetics, lengthy treatment).

• Dr. Joseph Ghafari, DMD

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Managing the Posterior Vertical Dimension with Aligners in Anterior Open Bite and High Mandibular Plane Angle Case Types

May 5, 2018 8:50am ‐ May 5, 2018 9:35am

No anterior open bite or high angle case has gotten worse when treated with aligner therapy. The advent of aligner therapy in orthodontics has allowed cases once thought of as challenging to manage now be looked upon as easy as a simple class 1 mild crowding case. Traditional cases once reserved for surgery and/or TADs are now more efficiently managed with aligners only while effectively managing the posterior vertical dimension without the routine side effects and concerns of traditional fixed appliances. Shift your mindset from a traditional analogue mode of thinking and delivery care to the newer digital approach of CAD-CAM-odontics with customized plastic aligners.

Learning Objectives:

• Identify proper design of digital tooth movement and attachments to impart the necessary forces based on a proper differential diagnosis.
• Recognize the ease of delivery of such care without surgery or TADS.
• Apply these principals in Phase 1 and growing teens as well as non growing adults.

• Dr. Jonathan L. Nicozisis, DMD, MS

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Lions and Tigers and Bears, Oh My? Orthodontists Serve on Sleep Teams?!

May 5, 2018 8:50am ‐ May 5, 2018 9:35am

Sleep related breathing disorders in both; the adult and pediatric population have been discussed for several years. There are a myriad of medical diagnoses as well as a broad range of treatment approaches. With medical, dental, surgical, behavioral, pharmacological, and other treatment options available, how does the provider know what form of care will work best? Is each discipline wearing a blindfold, palpating part of an elephant and prescribing treatment accordingly? Comprehensive sleep teams comprised of medical, dental, and allied health professionals may offer the best opportunity for every aspect of the sleep related breathing disorder to be treated. Inter-professional teams sit at the table to discuss the risks/benefits of the currently available treatment options to develop individualized, evidence based treatment options for each patient. Diligent follow up will enable each team to use their outcomes to enhance not only current but also future patient treatment options. The presentation will highlight the influential role an orthodontist can play on comprehensive sleep teams. With training and experience in sleep medicine orthodontists can truly provide life-altering care.

Learning Objectives:

• Investigate and understand characteristics of adult and pediatric obstructive sleep apnea.
• Comprehend the importance of an interdisciplinary and inter-professional team based approach to obstructive sleep apnea care.
• Comprehend the range of adult and pediatric obstructive sleep apnea treatment options and the benefits of team based treatment.

• R. S. Conley, DMD

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Early Treatment for Class II Malocclusions

May 5, 2018 8:50am ‐ May 5, 2018 9:35am

A comprehensive and effective method of Class II malocclusions in the early mixed dentition will be discussed based on a recent publication in the Angle Orthodontist. The presentation will demonstrate the method for Class II correction and how to maintain stability of the correction. The presenter will show how approximately 40% of Class II malocclusions treated early can avoid later Phase II full bonded therapy.

Learning Objectives:

• Identify concepts of comprehensive early orthodontic treatment.
• Preform effective correction of Class II malocclusions with Phase I therapy.
• Handle arch length deficiencies in the early mixed dentition.

• Steven A. Dugoni, DMD, MSD

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New Midpalatal Suture Maturation Grading System Using Panoramic Radiographs

May 5, 2018 9:40am ‐ May 5, 2018 10:25am

The purpose of this presentation is to demonstrate a system for individual assessment of midpalatal suture maturation using panoramic radiographs. The new grading system may enhance clinician’s ability to predict if rapid maxillary expansion is possible for late adolescent and young adult patients.

Learning Objectives:

• Fairly predict palatal expansion by using panoramic radiograph features.
• Recognize the reliability of the new grading system.
• Immediately apply the new grading system in your private practice.

• Dr. Jose A. Bosio, BDS, MS