Some concepts were illustrated with clinical cases: 4 examples of negative consequences of lower incisor proclination and 2 examples were given of how to avoid lower incisor proclination (extractions and headgear).
- Incisor proclination may damage the periodontium and jeopardize stability.
- Arch length increase to alleviate crowding is the least stable orthodontic treatment.
- Avoid lower incisor proclination and still achieve ideal alignment.
- Maintain ideal alignment long-term.
- Early/timely Class II treatment helps to minimize incisor trauma and external apical root resorption.
- It’s important to prevent incisor tooth trauma to avoid its long-term consequences.
- Combination headgear is superior to functional appliances.
- It’s advantageous to utilize the three growth accelerations that occur in growing patients rather than just the adolescent growth acceleration.
- Maxillary sutural growth can be easily modified while mandibular growth cannot.
- Differential growth is the key to long-term stability.
- Four first bicuspids.
- Two mandibular second bicuspids and two maxillary first bicuspids.
Robert M. Little Richard A. Riedel Arthur Stein. Mandibular arch length increase during the mixed dentition: Postretention evaluation of stability and relapse. AJODO May 1990Volume 97, Issue 5, Pages 393–404.
Essam A. Al Yami, Anne M. Kuijpers-Jagtman, Martin A. van ‘t Hof. Stability of orthodontic treatment outcome: Follow-up until 10 years postretention. AJODO March 1999 Volume 115, Issue 3, Pages 300–304.
Brett C. Fidler, Jon Årtun, DDS Donald R. Joondeph Robert M. Little. Long-term stability of Angle Class II, Division 1 malocclusions with successful occlusal results at end of active treatment. AJODO March 1995 Volume 107, Issue 3, Pages 276–285.
C.L. Steyn, R.J. du Preez, A.M.P. Harris. Differential premolar extractions. AJODO November 1997 Volume 112, Issue 5, Pages 480–486.
Suwannee Luppanapornlarp and Lysle E. Johnston Jr. (1993) The effects of premolar-extraction: A long-term comparison of outcomes in “clear-cut” extraction and nonextraction Class II patients. The Angle Orthodontist: December 1993, Vol. 63, No. 4, pp. 257-272.
Bishara SE Justus R Graber TM. Proceedings of the CDABO Worskhop discussions on early treatment. AJODO 1998 113:5-6.
- Enamel is protected from white spot lesions when brackets are bonded with hybrid, fluoride-releasing, glass ionomer cement.
- Enamel de-proteinization with Clorox (5.25% Sodium Hypochlorite), prior to etching, increases bracket shear bond strength
- Incidence of bracket bond failure is diminished when the enamel surface is de-proteinized before etching and Type 1 Etching is achieved, not just a Tyupe 2 or 3 etching pattern, and bonding brackets, both with composite resin and also with glass ionomer cement.
- De-proteinize the enamel surface.
- Bond brackets with hybrid glass ionomer cement.
Roberto Espinosa, Roberto Valencia, Mario Uribe, Israel Ceja, Marc Saadia. Enamel deproteinization and its effect on acid etching: an in vitro study. The Journal of clinical pediatric dentistry January 2008; 33(1):13-19.
Leon M. Silverstone. Dental Caries: Aetiology, Pathology and Prevention. Macmillan Press. 1981
Samir E. Bishara, Adam W. Ostby. White Spot Lesions: Formation, Prevention, and Treatment. Seminars in Orthodontics September 2008Volume 14, Issue 3, Pages 174–182.
V. Angnes, G. Angnes, M. Batisttella, R. H. M. Grande, A. D. Loguercio, and A. Reis, “Clinical effectiveness of laser fluorescence, visual inspection and radiography in the detection of occlusal caries,” Caries Research, vol. 39, no. 6, pp. 490–495, 2005.
Greg J. Huang, Brie Roloff-Chiang, Brian E. Mills, Salma Shalchi, Charles Spiekerman, Anna M. Korpak, Jeri L. Starrett, Geoffrey M. Greenlee, Ross J. Drangsholt, Jack C. Matunas. Effectiveness of MI Paste Plus and PreviDent fluoride varnish for treatment of white spot lesions: A randomized controlled trial. AJODO January 2013 Volume 143, Issue 1, Pages 31–41. 2014 David L. Turpin Award for Best Evidence Based Research Article.
Benson PE1, Shah AA, Millett DT, Dyer F, Parkin N, Vine RS. Fluorides, orthodontics and demineralization: a systematic review. J Orthod. 2005 Jun;32(2):102-14.
Matheus M Pithon , Caio S Ferraz, Gabriel D Couto Oliveira and Adrielle M Dos Santos. Effect of different concentrations of papain gel on orthodontic bracket bonding. Progress in Orthodontics August 2013;14:22.
Topic 3 – Prevention of External Apical Root Resorption (EARR)
- Eruption guidance of maxillary canines,
- Early correction of anterior open bite with a spur appliance to establish normal tongue rest posture,
- Early correction of large overjets associated with Class II malocclusions using skeletal correction (growth modification) to minimize both incisor trauma and EARR.
- Orthognathic surgery (to avoid moving roots against cortical bone).
- EARR occurs.
- Genes are responsible for EARR.
- Treatment strategies to minimize EARR must be implemented in every orthodontic case.
- Detect EARR early in treatment. Recommend the taking of a periapical xray of the maxillary lateral incisor 6 months after start of treatment to assess.
- Root sparing treatment strategies include: Alleviating lower incisor crowding through timely extractions and subsequent driftodontics or guidance of eruption
- Driftodontics to prevent canine impactions and incisor root resorption.
- Close anterior open-bite malocclusions without brackets by allowing incisors to erupt unhindered by an anterior tongue rest posture using Fixed intraoral spurs to establish a normal tongue rest posture and also interrupt digit-sucking habits
- The anterior open-bite closes with spurs, without using brackets/wires.
- Long-term stability post-retention is achieved when spurs are used.
- Early correction of open-bite protects roots from resorbing
- Correct Class II, Div I malocclusions by growth modification instead of moving teeth with the risk of developing EARR.
- What the evidence recommends doing in case of timely detection of EARR.
Jon Årtun, Isolde Smale, Faraj Behbehani, Diane Doppel, Martin Van’t Hof, and Anne M. Kuijpers-Jagtman/ Apical Root Resorption Six and 12 Months After Initiation of Fixed Orthodontic Appliance Therapy. The Angle Orthodontist: November 2005, Vol. 75, No. 6, pp. 919-926.
Eva Levander , Olle Malmgren , Sören Eliasson. Evaluation of root resorption in relation to two orthodontic treatment regimes. A clinical experimental study. European J Orthodontics June 1994 16(3): 223-228.
Sune Ericson , Jüri Kurol. Early treatment of palatally erupting maxillary canines by extraction of the primary canines. Eur J Orthod March 1988 10 (4): 283-295.
Giulio Alessandri Bonetti, Matteo Zanarini, Serena Incerti Parenti, Ida Marini, Maria Rosaria Gatto Preventive treatment of ectopically erupting maxillary permanent canines by extraction of deciduous canines and first molars: A randomized clinical trial. AJODO March 2011Volume 139, Issue 3, 316–323
Huang JG Justus R Kennedy DB Kokich VG. Stability of Anterior Open Bite Treated with Crib Therapy. Angle Ortho. Spring 1990. Vol 60 (1) 17-24.
Roberto Justus. Correction of anterior open bite with spurs: long-term stability. World J. Orthod 2001 Vol 2(3): 219-231.
Roberto Justus. DNA analysis might provide a more accurate risk assessment for root resorption in the future. FDI News, Montreal, August 2005.
Topic 4 – Methods to Achieve Excellence in Orthodontic Treatment
The objective of this topic is to inform orthodontists on both how to increase their standard of orthodontic care by using the American Board of Orthodontics’ updated criteria for case approval, and also how to apply these criteria in daily practice.
- A “Discrepancy Index Form” to score the complexity of a case, using the initial orthodontic records.
- An Objective Grading System to score candidates´ finishing dental casts and panoramic radiographs.
- A Case Management Form to score candidates´ final skeletal, dental and facial results, including the quality of the orthodontic records.
For more information click on the icons to link and download the ABO Discrepancy Index and Case Management and Objective Grading Systems (bituin, I want them to be able to click to the image to get to the 3 attachments of Discrepancy Index, Case management form and Instructions.
- Lewis brackets are more efficient in rotating teeth, and also in over-correcting rotated teeth, than twin brackets.
- Fiberotomy is effective in minimizing/diminishing rotational relapse.
- Removable night-time retainers hold mandibular alignment better than fixed canine-to-canine retainers.
- Direct bonding of 2nd molar tubes is important to achieve ideal alignment.
- Glass ionomer cement is more effective for bonding second molar tubes than resin.
- 1st and 3rd order wire bends are essential to achieve excellence, even though pre-adjusted brackets are used.
- Ideal root parallelism is important, and how to achieve it.
- The ABO determines a cut-off score for approval/rejection of a candidate´s case.
- The ABO trains and calibrates its examiners.
- The ideal maxillary and mandibular retainers should be designed.
John S. Casko, James L. Vaden, Vincent G. Kokich, Joseph Damone, R.Don James, Thomas J. Cangialosi, Michael L. Riolo, Stephen E. Owens Jr., Eldon D. Bills. Objective grading system for dental casts and panoramic radiographs. AJODO November 1998 Volume 114, Issue 5, Pages 589–599
Thomas J Cangialosi, Michael L Riolo, S.Ed Owens Jr, Vance J Dykhouse, Allen H Moffitt, John E Grubb, Peter M Greco, Jeryl D English, R.Don James. The ABO discrepancy index: a measure of case complexity. AJODO March 2004 Volume 125, Issue 3, Pages 270–278