review of orthodontic principles

1st Principle

• The same brackets, bands, and wires may

(and probably will) result in different

treatment responses in different patients

• Most of the differences in response center

on vertical changes

• It is possible (and, in fact necessary) to

predict the treatment response

Case 1-Mario age 14

Case 1, continued

Case 2- Oscar age 14

Case 2, continued

Comparison

Comparison

Example #2 Case 1

Case #1 Ceph

Example #2 Case 2

Case #2 Ceph

Comparison

Ceph comparison

Back to #1

• The same brackets, bands, and wires may

(and probably will) result in different

treatment responses in different patients

• Most of the differences in response center

on vertical changes

• It is possible (and, in fact necessary) to

predict the treatment response

Conclusion

• Even though molar relationship and

crowding are similar, every aspect of

treatment should be different in these

cases.

-bracket positioning

- extraction/non-extraction decision

- arch wires and mechanics

- retention

2nd Principle

• The worst mistake an orthodontic

practitioner can make is to cause

excessive bite opening in open bite

patients

• Not treating open bite patients make it

impossible to violate this rule

-Case selection

Look at this 12

year old patient

Questions

• What will happen

during initial leveling

and aligning?

Month 2

Questions

• What will happen

during initial leveling

and aligning?

• Could anything have

been done to prevent

this?

3rd Principle

• Every treatment decision you make is

based on the vertical needs of the patient

-Bracket position, what teeth are

bracketed, what wires to use, extraction

vs. non-extraction, mechanics used, and

retainers used are all greatly influenced by

a patient’s vertical needs.

What is different?

• Extraction case • Non-extraction

case

What is different?

• Bracket positioning

-gingival in anterior

-occlusal in posterior

• Bracket positioning

-incisal in anterior

-gingival in posterior

What is different?

• 7’s not bracketed • 7’s probably

bracketed

What is different?

• Retention

- clear plastic full

coverage retainers

(Essix)

• Retention

• Hawley with a bite

plane

Which is more difficult?

This one. Why?

This one. Why?

Which is tougher. This…

Strong or weak muscled?

Strong or weak muscled?

4th Principle

• Decalcification is the number one reason

orthodontic practitioners get sued. Make

sure all your patients have excellent oral

hygiene. If hygiene is not up to par,

consider early removal of the braces.

Now look at this.

Now look at this.

Prevention

• Good brushing

• Oral hygiene instruction and monitoring

• Fluoride mouth rinse

• Early braces removal

Special situations-white spot

lesions

• Studies show up to a third of all ortho

patients have some white spot lesions

• About half of all lesions remineralize in

6mo without any specific treatment

What NOT to do

• High concentration fluoride treatment

• This arrests remineralization

What to do

• Polish with casein calcium phosphate

materials (CPP)

-CPP is thought to stabilize and localize

calcium, fluoride, and phosphate at the

tooth surface in a slow-release amorphous

form, thus enhancing deeper

remineralization of white spot lesions

GC America

1-800-323-7063

• MI Paste™ and MI

Paste Plus™

Calcium, Phosphate

and Fluoride Tooth

Treatment

GC America-MI Paste

• MI Paste with RECALDENT™ (CPP-ACP)

has a proven clinical success record for

patients with increased caries risk and

white spot lesions. These include

orthodontic appliances, bleaching,

consumption of sports drinks and medical

therapies causing low salivary flow or

xerostomia.

5th Principle

• Check your patient’s molar relationship at

every appointment. This is the first thing

done at every orthodontic appointment.

• If the patient does not have a Class I

molar relationship, know how you are

going to get there, or have a reason why

the case will not finish with Class I molars.

Class II Malocclusion : Class II malocclusion occurs when the mesio-buccal cusp of the

upper first permanent molar interdigitates mesial to the buccal groove or fossa of the lower

first permanent molar.

Ideal Occlusion

Look at this 12 year old

• She is a growing

patient. Will she finish

in Class I?

Yes

Look at this18 year old

Continued

Comments

• Full Cusp (8mm) Class II

• Non-grower

• Significant lower arch crowding

Post treatment

Treatment time was 20 months

Why are the molars ClassII?

• Upper bicuspid

extractions

Why was this treated this way?

• It is tough to fight

molar relationship in a

non-grower.

• That is the “good

reason” not to finish

with Class I molars.

6th Principle

• Before initiating orthodontic treatment,

each patient should have a complete set

of records and a signed informed consent.

Records

• Models (digital is acceptable)

• Photos

• Panorex or full mouth series

• Ceph

7th Principle

• The most important mechanical

considerations in all cases are proper

bracket positioning and proper arch width

control.

8th Principle

• Overbite correction precedes overjet

correction.

Look at this11

year old patient

Diagnosis

• 7mm Class II

• Deep bite

• Moderate (4mm)

lower arch crowding

4 Months of Treatment

Waiting for permanent teeth to erupt.

Class II still 7mm.

1 Year Later- Mechanics

• Bite not opened

enough to begin

Class II correction

• Discrepancy may be

too great for Class II

elastics

Remember, do not attempt overjet correction until overbite is adequate.

Removal

Comments

• Not enough finishing

– Poor interdigitation

• Midline discrepancy

– Left side still in Class II

• Bite still too deep

– Not handled properly during wire progression

• Poor anterior torque control

– Side effects of excessive Class II elastics

Removal, Continued

Before/After

6 Months Later

Why?

• Poor torque control

– Interincisal contact does not aid retention

• Overjet, midline discrepancy allow rotation

• Overbite problem was never resolved

9th Principle

• Make sure all teeth are aligned before

progressing out of nickel titanium arch

wires.

10th Principle

• Standard of care dictates that a panorex

should be done on every patient 6-9

months into treatment. This x-ray is used

to check for root resorption. Failure to

discover root resorption is the 2nd most

common reason that orthodontic

practitioners get sued.