Saad Al-Mozany
Contemporary Treatment of Class II Maxillary Deficiency Malocclusion in Growing Patients
Introduction: Temporary Anchorage devices (TADs) have opened up a new era in Orthodontics and Dentofacial Orthopaedics including maxillary protraction treatment. The introduction of maxillary plates in conjunction with Class III intermaxillary elastics by De Clerk has revolutionized the early treatment of the retrognathic maxilla by eliminating the need for the cumbersome extraoral protraction headgear appliance. The development of the alternate maxillary contraction and constriction (Alt-RAMEC) technique by Liou has also been to shown to reduce the duration of treatment of these malocclusions with a more pronounced maxillary protraction effect. The aim of this study was to evaluate the effectiveness of using Temporary Anchorage Devices (TADs) and intermaxillary Class III elastics in growing skeletal 3 patients with retrognathic maxillae whose maxillae were disarticulated using the Alt-RAMEC protocol.
Materials and Methods: 14 subjects (7 male and 7 female) with an average age of 12.42 years (range 11.2 – 14.4) were selected from the Sydney University waiting list whom exhibited Class III malocclusions with retrognathic maxillae and who were in the cervical maturation stage of CS2 to CS3. Two palatal TADs were inserted either side of the midpalatine suture and two TADs were inserted into the anterior mandible between the canines and lateral incisors. The palatal TADs were connected to a modified bonded palatal expander and the lower TADs were connected to a modified bonded lingual arch. The maxilla was then expanded at 1mm/day for a period of seven days followed by constriction of the maxilla at 1mm/day for 7 days. This protocol was repeated for nine weeks. Following this Alt-RAMEC protocol intermaxillary Class III elastics were worn 24 hours per day delivering 400gm force as measured by a Correx guage. Protraction was ceased when 2mm overjet was achieved. Cone Beam Computed Tomography (CBCT) scans were taken after TAD placement and at the end of active treatment. Rendered lateral cephalograms were then produced and cephalometric measurements were taken and compared.
Results: The aim of the study was achieved in all 14 subjects in 9 weeks of Alt-RAMEC followed by 8.57 weeks of protraction (range 8 – 9 weeks). The mean horizontal movement of point A was 3.28 1.54mm (p < 0.001). There was a mean increase in the ANB of 3.95o 0.57o (p < 0.001). The protraction led to a backward and downward rotation of the mandible with a mean change in the Y-axis of 1.95o 1.22o (p < 0.001). Dental effects included a proclination of the upper incisors coupled with a retroclination of the lower incisors. The UI to SN increased by a mean of 2.98o 2.71o (p < 0.05). The LI to MP decreased by mean of 3.2o 3.4o (p < 0.05). A mean increase in the overjet of 5.62 1.36mm (p < 0.001) was also observed.
Conclusion: The Alt-RAMEC protocol in conjunction with maxillary and mandibular TADs and Class III intermaxillary elastics is an efficient method of treatment maxillary deficient Class III patients eliminating the need for the protaction headgear appliance, however the long term stability of these changes need to be evaluated.
Key words:
Class III malocclusion; Temporary Anchorage Devices(TADs); maxillary protraction
Dr Rolf Behrents
Orthodontics and Age: Application of Knowledge
Clinical disciplines with foundations in craniofacial biology have traditionally been concerned with the growth and development of the craniofacial complex from birth through adolescence. This period of time covers rapidly accelerating and dramatically obvious changes in the skeleton and is the period when treatment has been undertaken to correct problems of growth. In this time period, growth is considered one of the most important and powerful determinants of success in orthodontic treatment. Growth can both enhance and detract from the intended result.
In recent time, evidence has emerged that suggests that the craniofacial skeleton continues to grow in adulthood. Even though the tempo of growth is less, numerous studies demonstrate continued growth of the craniofacial complex adulthood. Even though the tempo of growth was less, substantial changes are possible in both the adult male and female. Moreover, the skeletal changes effect predictable movements of the teeth.
It is often suggested that knowledge is the basis for treatment. As a result, knowledge of the processes and timing of growth can be of considerable importance to the clinician in managing patients whether in treatment or after.
Dr Jay Bowman
Just Face It Esthetics, Extraction, Expansion, and Early Orthodontics
Orthodontic treatment “philosophies” and appliance fashions have come and gone as rapidly as fads in the garment industry. Treatments featuring nonextraction, 2-stage, and “arch development have once again become de rigueur, but not because of convincing evidence of superiority, but rather due to clever, enthusiastic promotion combined with a relentless defamation of extraction treatments. Although orthodontists often wish to extract, they may instead relent for fear of reprisals. Making a claim is easy, producing evidence is not. Dr. Bowman will discuss the esthetic impact of both extraction and nonextraction strategies, based on a comprehensive exploration of the scientific literature, to provide evidence-based guidance in this contentious issue.
Learn:
1. Unmask the perpetuating myths of orthodontics in the face of evidence.
2. Investigate the esthetic effects of extraction, expansive, and nonextraction strategies.
3. Consideration of research conclusions when advising patients.
Orthodontic Items of Interest
Canine Obedience Training: So They’re Impacted, Now What?
Once cuspids are stuck, Dr. Bowman will present strategies for directing their eruption using a combination of Monkey Hooks and Kilroy Spring auxiliaries.
An Early Quick Fix Solution for Pseudo Class III
Research has demonstrated significant success with early resolution of Pseudo Class III anterior crossbite/functional shifts. Dr. Bowman will introduce a predictable method using the so-called Quick Fix device with a simple 2X4 appliance.
Scar Tactic: Strategies for Reducing Enamel Demineralization
Leaving lines or scars on enamel after the completion of orthodontics may mar, otherwise, beautiful smiles. The role of lasers, sealants, varnishes, and remineralizing agents will be discussed by Dr. Bowman.
Learn:
1. Biomechanics to direct the eruption of impacted cuspids.
2. Evaluate the evidence regarding early treatment of Pseudo Class IIIs.
3. Strategies to prevent white spot lesions.
A Spike in the Ice: Innovative Anchorage with Miniscrews
The advent of mini-screw anchorage has opened new avenues of treatment mechanics that were previously unpredictable or thought to be nearly impossible. These improvements come with associated costs and some surprises. A selection of innovative anchorage applications and auxiliaries for various malocclusions will be presented. In addition, concepts for reducing reliance upon compliance requirements for more predictable treatment success will be detailed including the Horseshoe Jet distalizer, TAD-bite opener, Ulysses Spring, and Propeller Arm auxiliaries.
[material to be covered: myths, basic patient recommendations, bite opening, openbite closure, midline correction, Class II strategies, Class III strategies, multi-tasking]
Learn:
1. Myths of miniscrews revealed by evidence in the literature
2. A multitude of multi-tasking options with miniscrews
3. The application of pure skeletal anchorage for molar distalization
Dr Robert Boyd
Improving Periodontal Health and TMD Through Orthodontic Treatment with Invisalign
It is well known that fixed appliances can exacerbate underlying periodontal problems due to the increased plaque and gingivitis usually seen during treatment, even if strict preventative measures are followed during treatment. However with Invisalign, clinical studies have shown the plaque and gingivitis are routinely reduced during Invisalign treatment. The doctor can use this periodontal advantage of Invisalign to manage patients with high susceptibility to periodontal disease such as those with moderate to advanced periodontitis with improved results than are possible with fixed appliances. Root resorption has now been shown in several studies to not exhibit the root resorption that is traditionally seen during fixed appliances. Dr Boyd (who is both an orthodontist and periodontist) will show numerous cases of patients with significant periodontal liability which were successfully managed with Invisalign and routine periodontal maintenance. In addition, other health benefits of Invisalign will be discussed such as the lack of occlusal abrasion during treatment and retention, the finding in several recent studies of no temporomandibular dysfunction (TMD) related to myofascial pain, less mucosal irritation, easier speech adjustments initially and the ease of periodontal maintenance compared to fixed appliances. The health advantages of doing a second phase with Invisalign of a two phase orthodontic treatment will also be discussed.
Paul Buchholz
TADS: Control of the Vertical and Beyond
A clinical perspective in controlling the vertical dimension using skeletal anchorage. Temporary Anchorage Devices have added a new perspective in Orthodontics and added a new dimension to our treatment planning and clinical treatment of patients with anterior openbites, which are probably the hardest malocclusions to treat and maintain. Surgical correction of these malocclusions has less that a 50% success rate with relapse prevalent. This clinical presentation will shed new light on how to treat adult cases using TADS, and enhance the clinical treatment of deep bite cases in patients with VME.
Dr Charles J. Burstone
Labial Esthetic Orthodontics – The New Translucent Wires
The major limitation in esthetic labial orthodontics with fixed edgewise appliances has been the unavailability of efficient esthetic wires. This presentation will discuss the clinical use of a new transparent wire that is esthetic and formable. Its high hardness leads to low friction applications. Unique properties for a polymer include both high spring back and high fracture resistance (ductility). Differences between optimal use of a polymeric wire and a metal wire will be emphasized including time dependent effects and low temperature heat treatments. Important clinical applications include how to select the proper cross section? When are round or rectangular wires used during leveling? Bends and torque are easy to place. What is the role of a simple heat treatment using a cup of hot water?
Dr Ali Darendeliler
Sleep Apnea – An Orthodontic Perspective
The cumbersome nature of continuous positive airway pressure (CPAP) makes tolerance and
compliance difficult for Obstructive Sleep Apnea (OSA) patients. Oral appliances, namely maxillary expanders, orthopedic appliances, mandibular advancement splints and tongue stabilizing devices, have been evaluated recently and showed promising results in the treatment of OSA in children and also as an alternative to CPAP in adults.
Dr Mithran Goonewardene
Periodontal Implications of Arch Expansion
One of the key objectives in orthodontic treatment is to leave the patient with stable and healthy periodontal tissues. There has also been a significant trend or “paradigm shift” to manage orthodontic arch length problems by arch expansion as clinicians aim to maintain or increase lip fullness in creating beautiful smiles. The impact of the aforementioned tooth movement strategies on the tissues of the periodontium in health and disease will be presented including aspects related to managing patients with significant periodontal problems.
1- Following this presentation delegates should know the following:
a. The relationship between tooth, bone and soft tissue after arch development.
b. The impact of periodontal biotype on the response on periodontal disease susceptibility.
c. The current methods to augment the tissues of the periodontium in conjunction with orthodontics
2- Following this presentation delegates should be able to:
a. Carefully consider the biological implications of expansion therapy and discuss this with their patients and colleagues.
b. Consider the indications for grafting in patients who might me susceptible to recession.
c. Appreciate the significant pressure from some sectors of the dental industry in promoting non-extraction expansion therapy without scientific support for this process.
Dr Johnathan Grove
The Effect of Mechanical Vibration (113 Hertz Applied to Maxillary First Premolars) on Root Resorption Associated with Orthodontic Force: A Micro-CT Study
Introduction: Recent research has suggested vibratory stimulation may enhance bone turnover, increase rate of tooth movement, and reduce root resorption. However to date there is little research investigating the influence of vibration on orthodontically induced inflammatory root resorption. This study was undertaken to examine the effect of mechanical vibration on the extent of root resorption craters associated with the application of a controlled orthodontic force.
Method: 14 patients (11 females and 3 males) aged 12.1 to 15.5 years, requiring premolar extraction as part of their orthodontic treatment, were used for this study. A controlled buccal tipping force of 150 grams was applied bilaterally to the maxillary first premolars of each patient for an experimental period of 4 weeks (28 days). Using a split-mouth procedure, each patient was randomly assigned a “vibration” and “non-vibration” side. Buccally directed vibration of 113Hz, using an Oral B HummingBird unit with a modified tip, was applied to the maxillary first premolar on the “vibration” side for 10mins/day for the experimental period. At the end of the experimental period, the maxillary first premolar teeth were extracted according to a strict protocol to avoid damage to the cementum and root surface. Each sample was imaged using a Micro-CT scan x-ray system (SkyScan 1172, SkyScan, Aartselaar, Belgium), and then analysed with specially designed software to determine the volumetric measurements of the resorption craters.
Results: Overall, there was a significant difference in the total root resorption volume between the vibration and non-vibration sides (p=0.003), with vibration reducing the amount of resorption by 33% on average. Except for the buccal surface, all other tooth surfaces and vertical thirds studied exhibited a reduction in root resorption volume with vibration, however only the palatal surface was significant (p=0.006) while the mesial surface and apical third were marginally significant (p=0.018, & p=0.019 respectively). Regression analyses of all regions studied showed the amount of reduction in resorption volume associated with vibration was correlated with the amount of resorption experienced by the control teeth. This was evident especially on the mesial and palatal surfaces (p<0.001 & p=0.006 respectively).
Conclusions: Mechanical vibration as applied in this study shows the potential of its use in preventing or reducing orthodontic root resorption. However the clinical significance of such application should be evaluated on a sample undergoing a complete course of orthodontic treatment.
Acknowledgement: This project was funded by the ASOFRE and the ADRF.
Dr Lysle E. Johnston, Jr.
Indecision is the Key to Flexibility: The Role of Controversy in Contemporary Orthodontic Practice
Some controversy apparently is not meant to be resolved. Would the World’s religious leaders be eager to be told, say, by a superior intelligence from outer space, whether or not there is a God and, if there is, which religion—if any—is the True Faith? Somehow I doubt it. I think a similar dynamic is at work in orthodontics. Now and for the foreseeable future, the major controversies, at least in theory, are extraction, “jaw-growing,” and the relationship between orthodontics and TMD. (I say “in theory” because I think the literature may already contain sufficient evidence to decide all three.) We really don’t want a resolution because a final answer threatens to brand some treatments—some popular treatments—as being inferior. Controversy is license. This seeming reluctance to reach conclusions has ignited a potentially more significant controversy: should contemporary treatment be evidence based? Amazingly, the argument surrounds the need for evidence, rather than the evidence, itself. Here then is our problem as I see it:
1. Evidence-based treatment won’t add to the “bottom line.” indeed, It may even cost money;
2. Evidence-based treatment probably would lead to better outcomes, no matter how “better” is defined;
3. The patient, however, will rarely know one way or another.
How are we to respond? Nobody dies from anchorage loss; everything works well enough to pay the bills. Orthodontics, the “thinking man’s specialty,” its practitioners, and its schools are facing an existential crisis. It will be my purpose to comment on the challenging dilemma we face.
Dr Om P Kharbanda
Mechanical and Biological Determinants for the Success of Miniscrews
This presentation will deal with our clinical experience and research findings in the treatment of severe cases of malocclusion where orthodontic anchorage has been reinforced with miniscrews. Presentation will dwell upon implant related factors on diameter, length, shape of the miniscrew, how they differentiate in the stress pattern on cortical and cancellous bone with varying force levels and two angulations of force direction. The effect of screw length, diameter and shape was also investigated for insertion and removal torque, insertion and removal thrust as these relates to stability. Findings of Finite Element Analysis relating to mini screw design with stress pattern on bone architecture will be corroborated to propose alternate design of the mini screw. Findings on host related factors showed that bone density at implant site may not be directly related to success or failure of miniscrews, while peri implant inflammation and root proximity could be significant contributors to failure of miniscrews. Above clinical and laboratory research is being carried out in collaboration with Indian Institute of Technology, New Delhi partly supported by Indian Council of Medical Research.
Dr James Mah
Evolution of Imaging and Radiation Safety
Although Cone-beam CT (CBCT) is generally accepted as a new technology, its origins are very familiar. This presentation describes the evolution of CBCT technology and explains how it is different from both conventional dental radiography and medical CT imaging. The diagnostic specificity and sensitivity of both conventional radiographs and CBCT imaging will be compared. Knowledge of the fundamentals of CBCT technology is a basis for understanding radiation dose. The effective absorbed dose from CBCT imaging will be compared with conventional and medical imaging as well as common human activities. Risk and benefit of CBCT imaging as well as diagnostic value will be presented.
Old Lessons in Orthodontics with New Imaging
Recent advances in 3-Dimensional imaging allow for exquisite anatomic detail and thoroughness not available with conventional orthodontic imaging. Computer software advances allow for viewing of the craniofacial complex from any chosen point of view as well as the colorized presentation of the data. The removal of superimposing structures, distortions and perspective errors provides for unparalleled quality and reliability of the images. This new information gives orthodontists much unique information about the patient but it also reinforces many of the “old lessons” in orthodontics. This presentation focuses on understanding the possibilities and limits of orthodontics using 3-dimensional imaging. Topics such as non-extraction vs. extraction, range of tooth movement, management of the temporomandibular joints, vertical facial patterns and airway obstructions will be discussed. In conclusion, current concepts in orthodontics will be reinforced with new imaging techniques.
Dr Birte Melsen
Advances in Bone Biology Research
The improved understanding of the tissue reaction related to orthodontic tooth movement has underlined that orthodontic tissue reaction cannot be separated from the general bone biology. As the general growth has an impact on the treatment of young patients, the general bone and local bone turnover has a significant impact on the tissue reaction generated by the force systems applied.
A differentiation between tooth movements “with” bone and “through” bone is crucial as teeth can generate bone when displaced “with” bone. The increasing numbers of adult patients requiring treatment have increased the prevalence of patients with variation from a normal bone turnover. The influence of chronicle diseases and their medication on the reaction to orthodontic forces are important factors when planning the orthodontic treatment. The treatment should only be performed in a healthy environment, with appliances that are custom made for the individual patient and based on limitations given both by the existing periodontium and the general medical status of the patients.
Fast Food Versus Slow Food Orthodontics. What are we Actually Serving Up?
Over the last few decades orthodontic treatment has been changing with respect to the treatment approach and the anchorage being used. Marketing of appliances is increasingly leading the orthodontist to out-source important aspects of treatment such as wirebending and bracket positioning. Brackets and wires are being presented as the solution to all problems and metaphysical terms such as “Intelligent Design,” “Working Brackets” and “Intelligent Wires” dominate advertising and reduce the impact of evidence-based knowledge.
The introduction of skeletal anchorage has changed the potential and widened the spectrum of orthodontics, allowing for treatments that could not be done with conventional appliances, but also reduced the need for compliance. Biomechanical knowledge is, however, mandatory if such systems should not be abused.
Due to the development of the “hard ware” the orthodontic world is being split between “appliance-driven fast-food orthodontics”, where the results to a large extent depend on both growth and function and, “orthodontist-driven” “slow-food” treatments attempting to push the limits of the possible in relation to complicated problems and reversal of degeneration in adult patients. The latter treatments are performed with individualized appliances adapting the force system to the patient. This lecture will attempt to summarize the bearing of these factors on present orthodontics.
TADs – Failures Related to the Patient, Doctor and Screws
The skeletal anchorage has now been an accepted part of orthodontics for more than ten years. The field is, however, still young and mainly based on case reports. Basic research supporting the use of skeletal anchorage is still missing.
Failures can be ascribed to the choice of anchorage unit, the handling by the doctor and the patient.
This presentation will address the design of the different anchorage systems on the market and indicate the characteristics of the various types. The handling of the doctors related to the insertion procedure and the biomechanical system applied. The biomechanical considerations when choosing skeletal anchorage for direct or indirect anchorage will be discussed as will the superfluous and detrimental use of these adjuncts to orthodontics. Failures related to patients may be caused by local or systemic factors and will be discussed in relation to factors influencing the bone turnover.
Ms Kathy Metaxas
Generation Talk
For the first time in history, four generations share the workplace. Not effectively managing generational differences can result in a clash of communication styles and work ethics. Employees from all generations must take on the responsibility to overcome generational differences and bridge the generation gap.
Do you scratch your head often and wonder why the younger or not so younger generations think and act differently? Come and hear why this happens and how to better communicate with the different generations in your practice.
Outline:
• The characteristics and traits of the Veterans, the Baby Boomers, Gen X and Gen Y
• Gen Ys are flooding the dental industry, learn how to train and maintain them
• Gen Xs are craving authority, use this to better your practice
• Gens X and Y communicate through social media what does this mean?
• Change is necessary for the Baby Boomers to survive!
• Market the practice to attract Gen X and Ys they are your future!
• Generation Talk for all Generations
• Ways to increase Case Acceptance for Baby Boomers and Gen X
Dr Peter Miles
Self Ligation – Slippery Marketing or Efficient Treatment?
Dr. Miles received his dental degree with honours from the University of Queensland in Australia and his MDS in orthodontics from the University of Pittsburgh in the USA. He is currently in private practice in Caloundra, Australia, and a senior lecturer in orthodontics at the University of Queensland. He is a reviewer for several journals and has published over 30 articles and book chapters pertaining to the efficiency and effectiveness of orthodontic treatment. This includes several prospective clinical trials involving self-ligating brackets. He lives in Caloundra, Australia with his wife Sharon and four children and enjoys tennis and astronomy.
Self-ligating brackets have enjoyed increasing popularity over the past decade concomitant with numerous claims proposed regarding their advantages – but what evidence is there to support these claims? Are self-ligating brackets a key element to efficient treatment? This lecture will examine the levels of evidence regarding self-ligation and other aspects of treatment and whether this may influence practice efficiency.
Dr Shazia Naser-ud-Din
SBLi 4 Orthodontics
SBLi (Scenario Based Learning interactive) has been in use with University of Queensland (UQ) for several years and is actively providing large web based learning packages. The concept of self learning, self motivation and self-assessment is well documented and to this end the package for Orthodontics is being developed to produce a comprehensive and clinical based assessment tool for both undergraduate and postgraduate Orthodontic teaching. Such learning packages are rare due to the intensive structure and delivery required to design. However, being a clinician provides us with wide range of cases that can be set up with interactive assessing scenarios. Modern andragogy is targeting the technology as a means of education delivery. This adds to yet another dimension of teaching which is very well accepted by the techno-savvy generation. Assessment is an essential component of all learning. With limited professional staff available it would be time and cost effective to put in place certain online learning tools that students could access to gauge their learning.
The aim of this project is to develop Orthodontic Clinical scenarios for assessments, provide an avenue to explore patient requirements, treatment options, treatment outcomes and long term retention strategies.
Every endeavour will be made to provide instant feedback to the learner.
Tracking the student assessment can add to both formative and summative assessment.
Our interest with long term retention of content, clarification of concepts and efficient swift evaluation with modern andragogy principles is in synch with this project.
Dr Sanjiv Ratneser
Effect of Different Orthodontic Adhesive Removal Techniques on Sound, Demineralised And Remineralised Enamel
Clinically it is often observed that white spot lesions around orthodontic appliances are susceptible to iatrogenic damage during the removal of orthodontic appliances. Recent research has shown that these white spot lesions can be remineralised with casein phosphopeptide stabilised-amorphous calcium fluoride phosphate (CPP-ACFP) prior to adhesive removal to reduce the amount of enamel damage. The purpose of this in vitro study was to examine the amount of enamel damage produced by four popular orthodontic adhesive removal techniques when the bracket was surrounded by sound enamel, a white spot or a white spot that has been remineralised with CPP-ACFP prior to adhesive removal.
Method: 100 teeth were divided into four adhesive removal technique groups: i) slow speed tungsten carbide bur (SS); ii) high speed tungsten carbide bur (HS); iii) aluminum oxide polishing discs (DC); iv) ultrasonic scaler (US). All teeth were bonded with a standardised amount of composite resin adhesive. Each experimental group contained five control teeth (not exposed to the demineralisation or remineralisation solutions) and 20 test samples subjected to 12 days of in vitro enamel demineralisation followed by 30 days of remineralisation of half of the demineralised window with 1% (w/v) CPP-ACFP. Damage following composite adhesive removal was quantified using white light profilometry (WLP), digital photography and scanning electron microscopy (SEM).
Results: All techniques produced quantifiable damage to sound, demineralised and remineralised enamel. The mean depth of damage with different techniques was DC < HS < US = SS. The sound enamel of the control teeth experienced the least amount of iatrogenic enamel area and depth damage. When the white spot around the adhesive was remineralised with CPP- ACFP prior to composite removal the amount of damage with all techniques was significantly reduced compared to the untreated white spots (ANOVA, p<0.014). Aluminum oxide discs produced the least damage to demineralised and remineralised enamel in both depth and area compared to the other adhesive removal techniques (ANOVA, p<0.021 and Mann-Whitney, p<0.001 respectively).
Conclusion: Remineralisation of white spot lesions around orthodontic adhesive with 1% CPP-ACFP significantly reduced iatrogenic enamel damage compared to untreated white spot lesions. However, damage experienced by remineralised and demineralised enamel with all removal techniques was greater than that experienced by sound enamel. Prevention of white spot lesions around brackets is paramount but when it has occurred these in vitro results suggest an aluminum oxide disc should be the removal method of choice and that remineralisation should be attempted prior to adhesive removal.
Dr Daniela Ribeiro
Increased Dental Crown Dimensions in Opposite-sex Dizygotic Twin Pairs as a Possible Result of Intrauterine Hormone Diffusion
Studies have suggested that masculinisation of females and feminisation of males can occur between fetuses prenatally due to hormonal diffusion. Opposite-sex twin pairs provide a valuable model to study prenatal hormone effects on tooth size. Serial dental models of primary and permanent dentitions of male and female twins from monozygotic same-sex (MZSS), dizygotic same-sex (DZSS) and dizygotic opposite-sex (DZOS) pairs were examined. Mesiodistal and buccolingual crown dimensions, crown height and intercuspal distances of all primary and selected permanent teeth were measured using a 2D image analysis system. OSDZ females were larger by approximately1-3% in mesiodistal and buccolingual dimensions of permanent teeth than other female groups. No systematic trend was found in either dentition of the male groups. This analysis shows a trend for permanent dental crown size to be larger in OSDZ females than in other female twins and this may be related to circulating male hormones in utero.
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Dr Emile Rossouw
Evidence-based Class II Treatment Considerations
Class II treatment is often considered the “bread-and-butter” treatment in the orthodontic office. The presence of this type of malocclusion evokes a vision of the problems encountered during the orthodontic correction of such malocclusion. Factors that easily compromise treatment include such issues as noncompliance; loss of anchorage; occlusion still remaining Class II following closure of spaces; loss of torque, especially upper and lower incisors; unwanted extrusion of teeth and open rotation of the mandibular plane. Anchorage control is mostly the link to success and this presentation will utilize laboratory and clinical research evidence to illustrate a method of achieving a successful outcome.
Evidence Based Bonding in Clinical Orthodontics
Bonding is regarded in most dental circles as one of the most significant contributions to the clinical practice of dentistry; in our field of orthodontics, this development revolutionized clinical practice as we evolved from banding to bonding of attachments. This presentation will provide an overview of this development; moreover, it will highlight how laboratory and clinical testing changed how we bond, re-bond or debond. Successful appliance placement forms a valuable adjunct to efficient practice management. The attendee will be updated as to efficient enamel preparation, management of the bracket-resin-enamel interface, preventing enamel decalcification, the light-cure era and successful debonding at completion of treatment to leave an unblemished enamel surface.
Evidence Based Retention and Stability Considerations
Long-term stability following orthodontic treatment is often referred to as an impossible goal. However, the literature provides information reassuring clinicians that with proper planning and adhering to established clinical standards that success is possible. This presentation will utilize clinical research evidence in an effort to encourage each clinician who seeks excellence in their treatment to think long-term planning right from the initial appointment. The intention is to ensure that the clinician is cognizant of the changes expected in untreated and treated dentitions over time; utilize the data to attain successful treatment outcomes and inform patients at the outset of treatment to be complaint not only during treatment but also during the important retention phase.
Dr Rohit Sachdeva
Reinventing Orthodontics Tabula Rasa
The hallmark of the Twentieth century orthodontic care delivery model was based upon nucleating patient care around the specialist. In a broad sense this was a strategy of containment. In this New Century our profession has been drawn into a healthcare ecosystem that is more global, open, complex and ever changing. The role of the Specialist Orthodontist as the primary provider of Orthodontic care is being challenged by the Generalist, Industry and care consumer. This has brought uncertainty into the profession. It is in this unsettling environment that, there lies opportunity and hope for forging our “New Look” with a strategy of Sustainability. This transformation will require, as Berwick says “crossing the boundaries of our own mind” and leadership.
A vision for the change required in our mental models to sustain the vitality of our specialty and better care for our patients will be presented.
Dr Paul Schneider
Orthodontics from the Lab to the Chair
Orthodontics at the University of Melbourne is positioning itself to become one of the links between the considerable research facilities and clinical teaching and service provisions at the University. The amount and quality of biomedical research being done at the University is unsurpassed in Australia and we wish to be a conduit for some of the thoughts about clinical problems to get to the researchers and for the researchers’ solutions to translate to the clinic.
One of the initiatives has been the setting up 10 years ago of the Melbourne Research Unit for Facial Disorders whose aim is to improve the health and well being of children with facial disorders (i.e. oral, dental and craniofacial malformations and diseases). The MRUFD supports scientists and clinicians investigating the causes, development and management of these disorders. It also aims to build teams and networks that foster translational research in these areas.
One of the significant teams that it has brought together is the Dental Developmental Defects group, which is making major progress in understanding molar incisor hypomineralisation, a condition that has a major impact in dental and orthodontic practice. We are investigating the extent of this impact on orthodontics and integrating our efforts with the entire group.
MRUFD has also spawned Proteomics and Metabolomics Victoria, which brings together world-class investigators in these disciplines. Interacting with these people is leading to exciting research opportunities for our students.
Orthodontics is also increasing its involvement with the Dental School’s Oral Health Cooperative Research Centre, which is at the forefront of bringing research to the clinic.
Dr Terry Sellke
Starting a Practice (From A to Z)
Residents coming out of orthodontic programs are traditionally unprepared to face the challenge of opening an office on their own. They usually get little training on choosing a location, designing an office, equipping the office, and financing the entire effort. They have little skill in cash flow analysis and budgeting. As a result, they make numerous very expensive mistakes that could have been avoided. This fast paced program teaches everything grads need to think about as they transition into private practice.
Maximizing Your Treatment Quality and Productivity Using Technology, Systems, and Common Sense
Are you working too hard? Are you inefficient? Do you finish the day exhausted, and wondering what went wrong as your well planned day exploded into chaos? There is a better way to not only thrive but also really enjoy orthodontics (to a degree you never thought possible). The key is maximizing delegation and technology through systems change. Oh by the way, your quality gets better too!
Dr Paul Sillifant
Crystal Ball Gazing: Can Obstructive Sleep Apnoea be Prevented with Early Airway Assessment in Patients with Dentofacial Deformity
The orthodontist sees patients usually in early teens and makes a treatment plan considering the current state of the patient and the likely effect of growth. In this way the patients will have the best long term aesthetic and functional outcome.
The new layer of difficulty comes as patients do not develop some of the problems associated with dentofacial deformity until they are in there 30s and 40s. One of these significant problems is Obstructive Sleep Apnea.
This presentation will examine the role of the orthodontist and surgeon in the longer term management of the airway in patients with dentofacial deformity.
The airway is a critical component of dentofacial deformity as both a driver of growth and the effect that facial anatomy has on the airway.
Obstructive sleep apnoea syndrome (OSAS) is a growing clinical problem, mainly due to the increase in body mass index in the community. The 2 most important contributors to OSAS are obesity and upper airway anatomy, and in many cases the biggest cause of obstruction is from the jaws.
The upper airway anatomy gives a baseline risk factor to the development of OSAS. A large airway can reduce the risk of OSAS even in patients with a high BMI. Whereas a patient with a small airway may develop OSAS at very low BMI.
A thorough history looking for risk factors and symptoms and thorough clinical evaluation of the airway and special investigations may be required in some patients.
Airway assessment is integral to the development of the orthodontic treatment plan. It should be comprehensive and should occur prior to commencement of orthodontic treatment.
Ms Cathy Sundvall
PRACTICE EUPHORIA – Improving Quality, Performance and Service
This program focuses on the role of team members and their relationship with patients, their individual roles in the practice and their ability to add value to the orthodontic practice.
Topics covered include:
- A full understanding of the steps they can take to improve their skills, knowledge and desire
- Learn how to increase their efficiency in the practice through evaluation of procedures and statistics.
- Learn effective steps to assist in organizing your work space, work day, prioritizing secondary duties based on the practice needs, and how to delegate to other team members.
- Understanding of the importance of how well you balance your responsibilities affects the practices effectiveness and the patient’s experience.
- Tips on improving patient service and customer service
David L Turpin
The Controversies of Orthodontic Practice — Stirred Anew by the Evidence
The additional effort required to develop an evidence-based practice is a viable and desired goal for the orthodontic practitioner. But flexibility and a good understanding of available research findings are essential. Clinicians are reminded that tomorrow’s practice includes recognition of patient needs as well as the doctor’s clinical expertise along with identification of the best available evidence.
One hundred years ago Edward H Angle was a major influence in a new specialty as it struggled to find a place in the healthcare profession. He found a supportive environment in what has been called the “Era of the Expert.” Fifty years later as the specialty of orthodontics became well established, research findings were more likely to be supported by our educational institutions — often called the “Scientific Era.” Now, another 50 years has passed and the basis of our specialty is changing again, — this time it is based on a study of treatment outcomes, as the evidence becomes king. We are now trying to become a part of the “Era of Evidence.”
A Multidisciplinary Approach to the Identification and Treatment of Dentoalveolar Asymmetries – from Adolescence to Maturity
The theme for this lecture highlights the multiple disciplines of orthodontic care focused on the treatment of dentoalveolar and skeletal asymmetries. How early can various forms of asymmetry be diagnosed and treated? How critical is it to determine the location of a developing asymmetry? What treatment alternatives are now available to achieve a stable correction of asymmetries? A discussion of treatment scenarios will help clarify what levels of evidence exist for resolving malocclusions characterized by asymmetry.
Evidence and the Future of Orthodontics
An evidence-based practice consists of three components or legs of support. First, treatment procedures are based on the ‘best available evidence.’ The second leg of support calls for doctors’ expertise to perform the required treatment. Qualifications and experience play a major role in an evidence-based practice. And lastly, your patient’s preferences and values form the third leg of support and must be fulfilled or the preferred treatment plan will not be accepted.
As creative product claims are made for each new fixed or removable appliance to enter the market, deciding how to discuss these claims with patients becomes even more frustrating. During this lecture we will review the latest studies on fixed and removable appliances, exploring together which claims are based upon published levels of evidence and which are based on ‘wishful thinking.’
Dr Tony Weir
The Accuracy of Posterior Dental Expansion Using Invisalign Appliances
While the Invisalign appliance has been in clinical use for almost 14 years now, little data has been published regarding the treatment effects of the appliance. Posterior dental expansion of the arches is one method for creating space to align teeth. This poster will present data, gained from sample sizes in excess of 30 patients, for each tooth type in both arches from canines to first molars, comparing the predicted expansion according to the initial ClinCheck treatment simulation to the achieved expansion as determined by PVS impressions. Statistical evidence thus determined allows the clinician to better understand the clinical performance of the Invisalign appliance and to adapt the ClinCheck treatment visualization to more accurately provide the desired clinical outcome for each patient for whom posterior dental expansion is part of the treatment plan.
Dr Chris Wholley and Dr Mark Walters
The Facial Profiling of Malocclusions: The Promise of Emerging 3-Dimensional Technologies
The assessment of facial profile, bite and underlying dental-skeletal discrepancies are critical in the diagnosis and treatment planning of malocclusions. In addition to the clinical evaluation, other records such as facial photography, dental impressions and cephalometry are routinely taken to provide subjective appraisal of facial profile, occlusal relationships and to quantify dental skeletal relationship.
The advent of three-dimensional (3D) surface acquisition modalities provides qualitatively detailed images for clinicians, researchers, and patients to assess facial profile. The promise of this technology is being facilitated by the power of the computer and engineered algorithms to provide an objective anlysis of form. The challenge is how to integrate this technology into orthodontic care so as to improve patient assesment and outcomes.
Michael Woods
Control of the Vertical Dimension: Its Relevance in Contemporary Orthodontic Practice
Over the past hundred years, the results of clinical orthodontic treatment have been assessed in all dimensions. Techniques for that assessment have evolved, as have plans and techniques promoted as being appropriate for controlling or predictably modifying the effects. While changes in all three dimensions of the face are important, it would seem that those occurring in the vertical dimension, with and without treatment, may most affect functional and aesthetic outcomes.
This presentation will draw on the results of collaborative research in Australia and abroad. Historical concepts of the vertical dimension and its potential control will be presented and discussed in the light of the current global use of contemporary diagnostic and treatment devices. Concepts will be illustrated and supported with clinical records taken over many years. While many contemporarily-available devices may show promise, especially with the introduction of a number of adjunctive procedures and digitally-based techniques, a strong argument will still be made in support of individualised treatment decisions and aims.
Dr Francis Wong
Treatment Outcome of Cleft Lip/Palate (CLP) Maxillary Surgery
Background: Maxillary hypoplasia is a common developmental problem in treated cleft lip/palate (CLP) patients and is attributed partly to the intrinsic reduction in growth potential due to the cleft defect itself and partly as a result of scar contracture following early surgical repair of the palate. In many cases, correction of the maxillary deficiency requires orthodontic treatment combined with orthognathic procedures; the basic procedure being the LeFort I osteotomy. If the skeletal discrepancy is severe, then gradual lengthening of the maxilla by distraction osteogenesis can facilitate a larger advancement, a combined maxillary advancement and mandibular reduction can be performed, or alternatively, a staged maxillary advancement can be considered. Recent studies comparing conventional LeFort I osteotomies and maxillary distraction of the cleft maxilla have shown that distraction can achieve better long-term skeletal stability1, although other important factors such as the magnitude of advancement required and vector control of the palatal plane also need to be considered.2
Aims: To evaluate the results of maxillary advancement surgery in a consecutive series of CLP patients treated in the Oral and Maxillofacial Surgery Unit at The Royal Children’s Hospital of Melbourne between 1995 and 2011, and to compare the treatment outcome between conventional LeFort I osteotomy and maxillary distraction procedures.
Methods: The sample consists of a maxillary advancement with LeFort I osteotomy group (N=98) and a maxillary distraction group (N=29). Lateral cephalograms taken at presurgery (T0), postsurgery (T1), and at longest follow-up (T2) will be used to assess changes in the vertical and horizontal position of the maxilla. Differences in cephalometric changes at T0-T1 and T1-T2 between the sample groups will be compared using independent t-test.
Dr Danny Yang
Investigation of Mechanobiology of Simulated Orthodontic Tooth Movement and Distraction Osteogenesis
Bone remodelling and modelling has always been intricately involved in the field of dentofacial orthopaedics. However, to date understanding is empirical. The aim of the project is to add to the overall understanding of orthodontic tooth movement and distraction osteogenesis which in particular has recently been the focus significant research endeavours. To date majority of the evidence are from in vivo animal model experiments. Understanding molecular pathways will further unravel the picture of bone remodelling and osteogenesis.
Materials and Methods: MC3T3 cell line were cultured until confluent and trypsinised into 6-well plates at 1 x10E6 for 24 hours prior to commencement of mechanical stimulation. Simulated parameters were derived from finite element models of orthodontic tooth movement and distraction osteogenesis. RNA were extracted and processed for DNA microarray analysis.
Results: DNA microarray have demonstrated that with simulated orthodontic tooth movement parameters, there is up-regulation of several remodelling genes whereas the genes regulated in distraction osteogenesis were more osteoconductive and osteotrophic in comparison.
Conclusion: The remodelling genes regulated were more prevalent in the simulated orthodontic tooth movement which is consistent with the bone remodelling process as teeth are translated through bone. Conversely, in simulated distraction osteogenesis there are molecular evidence supporting bone apposition in both osteotrophic and osteoconducive genes that are consistent with previous animal studies findings.