a team consists of - aao · pedo implants endo tmd ... •extractions ... side screw control s/c*%...
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Birte Melsen, DDS, Dr. Odont
Denmark
Orthodontics as an integrated Part of General Dentistry
Multidisciplinary
+ =
Interdisiplinary Top of the iceberg
Prostho
SurgeryPerio
Ortho
Pedo
Implants
Endo
TMD
DENTISTRY
•A periodontologist
•A gnathologist
•An orthodontist
•A prosthodontist
•A surgeon
A team consists of:
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Periodontal
diagnosis
Dental
diagnosis
Functional
diagnosis
Orthodontic
diagnosis
Treatment plan
Interdisciplinary discussion
Clinical
examination
Instrumental
examination
X-ray
examination
Problem list
Interdisciplinary discussion
Interdisciplinary discussion
The level of information can never be high enough !
One responsible !
Communication between colleagues is
important by meeting or?
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The sequence in the interdisciplinary
treatment
1. Preorthodontic periodontal treatment
Motivation - Instruction
Pocket elimination - Scaling/Surgery
The essential procedures
• Oral prophylaxis
• Restorative therapy
• Endodontics
• Extractions
• Temporary reconstructions
• Pocket illimination
Vertical PocketsGuided tissue regeneration
• More teeth against fewer teeth• Maximum rigidity
• Differentiated Force System• Free Anchorage
• Extra-Dental Intra-Oral - Zygoma wire
• Extraoral Anchorage (EOT)• Intermaxillary Elastic
• Occlusion
Conventional Orthodontic Anchorage Impossible Screw in the infrazygomatic ridge substituting a
zygoma ligature
Treated by A Costa and screw inserted by M Raffaini
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Lecture Outline :Back ground: Do the impossible
The surgeon didn't have the time
Indications: As anchorage and - for modelling of alveolar process- for rebuilding of alveolar process - for maintenance of bone- as bridge support - for displacement of bone
Initial photos - extraoral
With TADs!!
Initial photos -
intraoral
CBCT examination
Volumetric
Retroclined lower incisors
Date: 23/6-2010
Month in tx.: 1 weekUpper jaw: Bands 16,26. Q-helix
activated for expasion.
Date: 7/9-2012
Month in tx.: 3
5
Date: 28/6-2011
Month in tx.:12½
Final photos
3 appliances in the lower arch, 3 in the upper arch!!!!
Before and after
Initial – Final: Extraoral
Super imposition - total
Superimposition Stable structures
Anterior part of Sella
Anterior cranial base
Maxillary movement
No change
Maxillary rotation
No change
Mandibular movement
Minor movement
Mandibular rotation
Slight posterior rotation
InitialFinal
Super imposition – mandible
Superimposition Stable structures
Mandible Slight posterior rotation
Lower incisors Lingual root torque
Lower first molars
Slight extrusion
Lower arch Slight expansion
BeforeAfter
InitialFinal
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Initial – Final: IntraoralLecture Outline :
Back ground: Do the impossibleThe surgeon didn't have the time
Indications: As anchorage and - for modelling of alveolar process- for rebuilding of alveolar process
“ “
“
Treated by Johan K.Knudsen
Lecture Outline :Back ground: Do the impossible
The surgeon didn't have the time
Indications: As anchorage and - for modelling of alveolar process- for rebuilding of alveolar process - for maintenance of bone
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Maintenance of bone
Combined directand
indirect anchorage
2724T
Temporary retentionCompare bone density
Dog experiment:
Four dogs :Extraction of
first and second Incisors and Premolars
Six weeks later insertion of 2mm transcortical screws at
the extraction site on one side chosen at random
In collaboration with M.Dalstra and S. Huja
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animal ID 3605 3606 3607 3608
side screw control s/c*% screw control s/c*% screw control s/c*% screw control s/c*%
mesial screw-
ROI 44,9 40,8 110 48,2 43,3 111 42,9 37,1 116 42,3 37,5 113
distal screw-
ROI 44,5 34,3 130 41,1 39,4 104 36,3 35,1 104 41,9 35,2 119
Relative bone density
Virtual Implant
Note the difference in the height of the implant
TREATMENT OPTIONS in the case of
missing lateral incisors
Roberto Chairlatini
Removable plates:
compliance
pressure on the palatal mucosa
Adhesive bridges:
limited retention
invasive procedure on healthy teeth
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2724T
Temporary retention
MATERIALS AND METHODS
3 YEARS 15 cases studied
Two errors !
Lecture Outline :Back ground: Do the impossible
The surgeon didn't have the time
Indications: As anchorage and - for modelling of alveolar process- for rebuilding of alveolar process - for maintenance of bone- as bridge support
-
Fig. 2
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x Vno Vmes Vmid Vdis Mno Mmes Mmid Mdis
0,0 -338,6 -182,5 -218,0 -253,6 0,0 0,0 0,0 0,0
8,0 -338,6 -182,5 -218,0 -253,6 2708,8 1460,0 1744,0 2028,8
8,0 -47,6 -102,6 73,0 37,4 2708,8 1460,0 1744,0 2028,8
13,2 -47,6 -102,6 73,0 37,4 2956,3 1993,5 1364,4 1834,313,2 -47,6 -102,6 -138,1 37,4 2956,3 1993,5 1364,4 1834,3
18,4 -47,6 -102,6 -138,1 37,4 3203,8 2527,0 2082,5 1639,818,4 258,4 203,4 167,9 132,3 3203,8 2527,0 2082,5 1639,8
30,8 258,4 203,4 167,9 132,3 0,0 0,0 0,0 0,0
Are all “screws” loaded? Lecture Outline :Back ground: Do the impossible
The surgeon didn't have the time
Indications: As anchorage and - for modelling of alveolar process- for rebuilding of alveolar process - for maintenance of bone- as bridge support - for displacement of bone
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Dento alveolar retrognathism – prominent chinDento alveolar retrognathism– prominent chin
Treatment objective
Dento alveolar retrognathism – prominent chin
Dento alveolar retrognathism – prominent chin
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Surgical assisted rapid maxillary expansionTeeth serve as anchorage Satisfactory skeletal effect
Surgical assisted maxillary expansion
After six weeks Before
The teeth are maintained the bone moves back
Expansion skeletal anchorage – Pre-treatement
The maxilla is narrow in relation to the mandible.Mixed dentition – No anchorage possibilities
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Super imposition - maxillaSuperimposition Best fit
Maxilla A-point moved forward
Upper incisors Proclination and
forward translation
Upper first
molars
Slight mesial
movement
Upper arch Expansion
Final photos
Date:11/6-13Month in tx.: 18 months
Dott.ssa Susanna Botticelli Dott.ssa Monica CimadamoreDott.ssa Susanna Botticelli
Dott.ssa Monica Cimadamore
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Analog screws Insertion
Treatment demand ≠
Treatment need