In the last years, there has been an increasing request of orthodontic treatment from adult subjects who want to improve their smile. Between 12% and 49% of adults present a Class II division 1 malocclusion that, associated with patient's dental health, often dictates new challenges to both the general dental practitioner and the orthodontist. The aim of this presentation is to clarify how today a practitioner can improve the aesthetic, the smile and the occlusion of adult subjects by providing a correct interdisciplinary treatment plan with the aim of maintaining a good periodontal health and at the same time improve the smile with a good restorative intervention.
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This presentation deals with the concept that crestal bone loss is far more detrimental to the longevity of teeth than external root resorption. Orthodontic treatment may play a role in both of these conditions. With the help of supportive information and persuasive case reports, it will be demonstrated that elimination of malocclusion, with carefully coordinated orthodontic movements of teeth, can and does improve periodontal health.
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This lecture simplifies biomechanics by presenting just a few fundamental rules for tendencies produced by single forces and couples. Once you know these “rules”, simple treatment strategies can be devised to accomplish planned objectives. Moving teeth can be efficient and predictable.
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When treating patients with vertical skeletal discrepancies, orthodontists have had to be satisfied with occlusal corrections, hoping that the skeletal relationships do not worsen. For the longest time, surgery was the only way to correct vertical skeletal discrepancies. Based on our renewed understanding of growth, non-surgical orthopedic correction of growing patients with severe skeletal problems is now possible. This approach addresses both the AP and vertical skeletal discrepancies that affict many patients, producing positive changes in chin projection, mandibular plane orientation, gonial angulation, condylar growth direction, and lower facial height. To fully understand why this approach works, orthodontists must change the way they think about mandibular growth. Only by doing so will be able to truly grasp why it is possible to obtain substantial orthopedic changes in growing patients with vertical skeletal discrepancies, and why such corrections remain stable over the long-term.
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Ankyloses of dental structures offers challenges before, during and after orthodontic treatment. It refers to the fusion between the mineralized root surface and the alveolar bone, and it could be partial or total fusion. Different treatments have been proposed for the management of ankylosed teeth during and after orthodontic treatment, and orthodontic treatment alone most not be the treatment of choice. The options oscillate from no treatment, partial restorative procedures, extractions, to more invasive options of tooth mobilization. Alternatives should depend upon proper diagnosis, and decisions made depending on partial to full tooth ankyloses and treatment goals. Sometimes, a simple tooth mobilization through partial surgical procedures on the “fused” portion combined with orthodontic force application is enough to bring them to proper position. However, when the ankyloses involves a substantial portion of the root of a tooth, a total single tooth osteotomy might be necessary to bring it to proper position. And obviously, the prognosis of such treatment decision is related to the treatment of choice, based on proper diagnosis. There are also limitations for each treatment alternative, as well as retention protocols. Different options will be addressed during this presentation, with an established treatment protocol for each option.
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Many orthodontic appliances are used incorrectly, often leading to unexpected adverse side effects, such as anchorage loss, cuspid rotation during retraction, bite deepening by sliding mechanics, occlusal plane caning after leveling and so on. In cases like these, we have to treat not only the malocclusion of the patient but also the adverse side effects that we have made in the course of the treatment as well. Application of correct biomechanical principles is therefore key in obtaining predictable treatment results with minimal adverse side effects, or even in replacing such adverse side effect with beneficial side effects.
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Remote monitoring of patient care has gone on for decades in medicine. Witness pacemakers as just one obvious example. We all know that changes in the delivery of care, payment, reimbursement, and other activities in the medical model usually lead to changes in the dental model of delivery. Orthodontics has never had a way to remotely monitor patient care, compliance, or address emergencies until now. This program is about a paradigm shift that will change how orthodontics is practiced and delivered in the future.
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This lecture will present mechanics and step-by-step procedures to intrude upper posterior teeth. The following topics will be explained with cases: Single molar intrusion, maxillary posterior teeth intrusion, total maxillary intrusion, canting correction, four clinical tips (identifying the etiologic factors, tongue and muscle training, retainers and extraction of second molars).
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With the applications of skeletal anchorage system, genuine incisor intrusion is feasible to improve adult gummy smile, which was difficult to correct without orthognathic surgery in the past. Differential diagnosis and various treatment options should be fully discussed to decide the appropriate treatment modality. After significant amount of upper incisor intrusion, there might be an adverse effect on the crown height and width ratio. Esthetic periodontal surgery (gingivectomy, crown lengthening and/or alveoloplasty) would be indicated for restoring the appropriate crown height and width ratio and further reducing the excessive gingival display. Under the collaboration of anterior miniscrew anchorage and periodontal surgery, it greatly improves the possibility of orthodontic correction for gummy smile in adult patients.
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Transverse maxillary deficiencies and crowding are common problems often treated with archwire-assisted expansion. Well-documented negative effects of dentoalveolar expansion include dental tipping and loss of buccal alveolar bone. This presentation will answer the following questions: If excessive tipping can be avoided, will dehiscences be eliminated and will bone form along the buccal periosteal surface? The answers to these questions are fundamental for understanding the clinical effects and possible limitations of archwire expansion.
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