new castle curriculum

BDS Course Orthodontics

Study Guide

2002-2003

Teaching Staff Course Leader: Dr P H Gordon

Course compilation and development: Dr R S Hobson

Lecturers: The majority of teaching of orthodontics in the undergraduate dental curriculum is carried out from the Department of Child Dental Health. The orthodontic curriculum is delivered by: Dr Rye Mattick (Consultant Orthodontist) Mr Nigel Carter (Consultant Orthodontist) Mr Andrew Aw (Consultant Orthodontist) Dr Peter Gordon (Senior Lecture in Child Dental Health) Dr Ross Hobson (Senior Lecturer in Orthodontics) Miss Anne Sargison (Associate Specialist in Orthodontics) Other orthodontic related teaching is carried out within a number of other modules: Paediatric Dentistry (module leader: Dr A Maguire) Cranio-facial development course (module leader: Dr D Brown) Dental materials (module leader: Prof JF McCabe) Medicine and Surgery (module leader: Dr. S.J. Bourke) Occlusion (module leader: Dr R Wassell) Oral and maxillo facial surgery (module leader: Dr UJ Moore) Radiology (module leader: Mr DJ Lovelock)

___________________________________________________________________________ BDS COURSE Introduction • 1

Introduction From an administrative viewpoint, Orthodontics is part of the department of Child Dental Health, within the Dental School. The University appointed staff are listed in the BDS Degree Programme Handbook and the University Calendar. Photographs of the staff are in the CDH staff corridor. The orthodontic course is intended to engender an interest in orthodontics by exposing the student to a variety of different forms of orthodontic treatment in order to gain an appreciation of the use of different types of orthodontic appliances. This is different from most UK undergraduate orthodontic courses, where orthodontics is taught mainly as a postgraduate subject. We feel that gaining first hand experience of orthodontic appliances (you will treat patients using removable, fixed and functional appliances), assessment and diagnosis whilst learning the principles improves the learning experience.

Aim of the Orthodontic course The undergraduate orthodontic course at Newcastle aims to produce safe and effective dentists, who understand the principles of orthodontic treatment and can apply them in clinical practice. The general dental practitioner must be able to assess and manage limited occlusal abnormalities. To be able to provide this care, they must have the ability to:

• Independently assess the orthodontic needs of a patient - including the use of indices of orthodontic treatment need (IOTN).

• Provide an initial orthodontic diagnosis.

• Explain and discuss the nature of orthodontic treatment to the patient and parent, including the issues of compliance, and oral care.

• Make appropriate referrals based on the assessment.

• Understand the limitations of orthodontic treatment and what constitutes good and bad treatment outcome.

• Design, insert and adjust removable space maintainers.

• Design, insert and adjust an active removable appliance to move a single tooth or to correct a crossbite by movement of a segment of an arch.


Learning Outcomes Year 1:

Knowledge of facial anatomy and dental anatomy as they relate to the teeth and occlusion

Year 2 : Understand the principles of cranio-facial development and how it relates to clinical practice. Able to undertake a Cephalometric tracing, and a simple analysis, with interpretation of the results.

Year 3: Understand the basic elements of removable appliance construction and placement of a fixed appliance. Able to take impressions and bite registration for orthodontic study models.

Year 4: Able to fit and adjust a range of simple orthodontic appliances (removable, functional, fixed) under direct supervision. Understand the basic principles of the types of orthodontic appliances, the indications for their use and their advantages and disadvantages. Understand the principles of orthodontic assessment and the development of a problem list.

Year 5: Able to design, fit and adjust a removable appliance for either correction of a crossbite or as a space maintainer Able to undertake an orthodontic assessment (including the application of IOTN) and suggest possible outline treatment plans. Able to make appropriate referral of a patient, explain and discuss orthodontic appliance therapy and its implications. Able to assess the outcome of orthodontic treatment to the patient and parent.


Programme of Study The main methods of teaching orthodontics are:

Lectures

Seminars

Laboratory practicals

Clinical teaching The background to orthodontics, anatomy, facial development, and occlusion are taught in Years 1 and 2. Construction of removable appliances and principles of placement of fixed appliances are taught in Year 3. The majority of the orthodontic teaching occurs in Years 4 and 5. It is delivered through two lecture and two seminar series. A number of related lectures and seminars are given by Oral Surgery, Radiology, Child Dental Health, and Restorative Dentistry (see Appendix 1). The Year 4 orthodontic seminars have a shared framework used by all those delivering the teaching. In Year 5 patients referred by General dental Practitioners for an orthodontic opinion are seen for assessment and diagnosis.

Lectures

The orthodontic lectures are integrated into the Child Dental Health lecture program.

Seminars

Seminars in Orthodontics, during Stage 4, are held either at 1:00pm, or at 4:00pm at the end of your clinical session. A list of seminars and a detailed timetable are in the CDH study guide. While it is appreciated that, for any one of a number of reasons, clinical sessions may over-run their allotted time, you are encouraged to make every effort to finish your clinical work promptly, so that you are free to attend the seminar. The seminars form an important part of the Stage 4 course, supplementing and elaborating on the material presented in the lecture programme. Orthodontic seminars in Stage 5 are in 2 parts. In the first you will undertake an orthodontic assessment of a patient. The assessments are undertaken on the morning of your clinical attachment to Child Dental Health following the end of the treatment session i.e. between 11am and 12am. A fortnight later, a morning seminar (commencing at 9am) is led by one the orthodontic teaching staff. During this seminar you will present the assessment, diagnosis and outline treatment plan for the patient for discussion with your group and teaching staff. At the end of the morning you will present the diagnosis and treatment plan to the patient (and parents) under supervision of the Orthodontic staff.

___________________________________________________________________________ BDS COURSE Programme of Study • 4

Clinical Work

The allocation of time to orthodontic clinical work in Child Dental Health is one half-day per week in Years 4 and 5. In Year 3 you will be allocated to an orthodontic clinic as one of your specialist clinical attachments. The attachment in Year 3 is an opportunity to observe experienced clinicians on a one-to-one basis treating a variety of major malocclusions using complex orthodontic techniques. These attachments start at 10.00am and you should introduce yourself to the staff on the orthodontic clinic. These attachments are very much on a ‘what you put in – you get out’ basis - so asking questions and discussing cases you see is encouraged. In Years 4 and 5 your time is more or less equally divided, on an informal basis, between paediatric dentistry and orthodontics. Two members of staff, one a paediatric dentist and the other an orthodontist, run each clinic. You will be allocated a limited number of orthodontic patients to treat. Normally this will include one each of a removable, functional and fixed appliance case. You are required to keep good records of your clinical activity, both to facilitate audit of your work and to enable you to prepare the case presentations which form a feature of your Stage 5 course.

Directed Self Learning Computer-Assisted Learning

There are a number of computer assisted leaning programs and WWW pages (www.ncl.ac.uk/dental/ortho/), which set out to teach cephalometric analysis, orthodontic diagnosis and appliance design. These are available for use on the computer in the Tracing Room in the corridor leading to the Seminar Room and Teaching Laboratory in the Department of Child Dental Health and via the University computer clusters, available on the clinic and in the Faculty of Medicine Computing Centre. Videotapes / tape-slide sequences

There is also a collection of videotapes and tape-slide sequences, on a variety of topics related to Orthodontics, held in the seminar room together with a video cassette player. This collection is available for viewing by all clinical undergraduates. The seminar programme makes reference to some of the tapes that are relevant to individual topics. Recommended Textbooks

The essential texts are: Houston W.J.B., Stephens C.D. and Tulley W.J., A Textbook of Orthodontics, 2nd edition, Wright, 1992

Or Mitchell L., An Introduction to Orthodontics, 2nd Edition, O.U.P., 2001

The Chapters from these books that are relevant to the individual lectures and seminars are indicated in the commentary.


Summary of the Chronology of the Orthodontic Course Stage

1. Anatomy 2. Cranio-facial development

Dental materials 3. Orthodontic technique course

Clinical attachment, Introductory orthodontic lectures Occlusion Dental materials Radiology

4. Clinical orthodontic, orthodontic lectures and seminars Radiology Medicine and Surgery

5. Clinical orthodontics, lectures and case assessment seminars Radiology

Study Guides You will have already received guides for courses in Stages 1 and 2. You will now be receiving a study guide for the Stage 3 course in Child Dental Health. Study guides for the Child Dental Health courses in Stages 4 and 5 will be given to you in terms 10 and 13, respectively. Study guides for Stages 3, 4 and 5 will contain, inter alia, details of timetables and lists of lectures and seminars.


Orthodontic Lecture Programme Year 3

TERM 7 CDH 7.2 CRM Introduction to Orthodontics. What is malocclusion; what is orthodontics? CDH 7.3 PHG Diagnosis of Malocclusion.

The concept of malocclusion from the patients’ and the clinicians viewpoints. Things to ask about and look for.

TERM 9 CDH 9.1 PHG Occlusal Assessment.

A detailed discussion of the way in which the information collected in the course of an orthodontic examination should be integrated into a treatment plan.

CDH 9.2 PHG Design of Orthodontic Appliances. A review of the principles underlining the design and construction of removable orthodontic appliances. Retention, anchorage, active components and baseplate.

CDH 9.3 RSH Biomechanics of Tooth Movement. Histological description of tooth movement including effects of optimum and excessive forces. Types of tooth movement and the role of removable and fixed appliances in applying forces required to achieve movement.

Year 4 Term 10

CDH 10.1 PHG Orthodontic Assessment A discussion of the relevance of the various factors taken into account when carrying out an orthodontic assessment.

CDH 10.2 PHG Class I Malocclusion A discussion of the local causes of malocclusion.


CDH 10.3 RSH Treatment of Class II (div.1) Malocclusion, Part 1 This malocclusion is not a single entity -- the range of severity is illustrated, together with a two-stage planning procedure to determine whether treatment in general practice is appropriate.

CDH 10.4 RSH Treatment of Class II (div.1) Malocclusion, Part 2 Several cases treated by different methods are shown, including long-term follow-up.

CDH 10.5 PHG Treatment of Class II (div 2) Malocclusion. A discussion of the ways in which this malocclusion may be treated, if necessary, illustrated by the records of a series of treated cases.

CDH 10.6 NEC Class III Malocclusion Dentition, clinical features and aetiology of Class III. Principles of treatment planning, illustrated with clinical examples.

CDH 10.7 PHG Myo-Functional Orthodontic Appliances Principles and modes of action of functional appliances. The effects of functional appliances on facial growth. Types of functional appliances and the indications for their use. Illustrative clinical examples.

CDH 10.8 PHG Fixed Orthodontic Appliances A description of the components of fixed orthodontic appliances, not aimed at teaching the management of these appliances, but rather to impart some general knowledge regarding their mechanics.

CDH 10.9 PHG Disorders of Eruption Normal eruption times and the process of tooth eruption. The reasons for delayed eruption or failure of eruption together with their management.

Year 5 Term 13

CDH 13.1 PHG Orthodontic extractions A comprehensive account of the factors which must be considered when deciding which teeth, if any, should be removed as part of a course of orthodontic treatment.


CDH 13.4 RSH Missing teeth, extra teeth, mixed dentition

The aetiology and prevalence of disorders influencing the number of teeth, orthodontic management of problems arising in the mixed dentition.

CDH 13.8 NEC Anchorage and Headgear Definition of orthodontic anchorage; types and sources of anchorage; anchorage control and monitoring. Indication for extra-oral traction. Types of headgear, safety and headgear.

CDH 14.1 PHG Need and demand for orthodontic treatment. Cost-benefit analysis of orthodontic treatment as applied to a variety of malocclusions. The development and use of orthodontic indices.

CDH 14.2 CRM Severe malocclusion. Examples of severe malocclusions presented according to aetiology. Dental anomalies, e.g. severely ectopic canines, severe hypodontia. Management of very severe crowding. Severe malocclusion complicated by soft tissue habits. Management of skeletal discrepancy. Need for specialist management of severe malocclusion.

CDH 14.3 NEC Orthodontic - restorative interface. Overview of adult orthodontics - demand, assessment, treatment planning. Clinical examples of how tooth movement can assist the restorative dentist.

CDH 14.4 NEC Orthodontic/Surgical interface Overview of treatment planning in cases where the treatment is carried out with a combination of orthodontics and surgery.


Orthodontic Technique The aim of the course is to improve your manual dexterity skills and to give an insight into appliance construction prior to undertaking treatment on orthodontic patients in the 4th Year Two groups are scheduled to attend Child Dental Health each morning e.g. groups 1 and 6 on Mondays. See the 4th year course guide for details of the timetable. For each week of this term, with the exception of your attendance in Oral Surgery, group allocations to the orthodontic teaching laboratory or clinic are given in this table. One group will attend the Orthodontic Teaching Laboratory each morning at 10.00 a.m. The schedule of exercises for the Orthodontic Technique Course is given in below. During your allocation to the orthodontic teaching laboratory you will undertake a number of exercises:

1. Pin block wire bending exercise 2. Welding and soldering exercise 3. Construction of Adams clasps 4. Construction of a removable appliance to retract canines and incisors 5. Construction of a removable appliance to procline an incisor and expand

molar width 6. Construction of a fixed palatal or lingual arch 7. Placement of a fixed appliance, including bands and archwire

Each item of work you complete in the orthodontic laboratory will be graded on the scale A-F. The criteria are decided prior to appliance construction, and scoring corresponds to particular features of each appliance. Grades for each completed appliance are given to you and an overall grade will be awarded at the end of the year. This grade will be entered in your records. These are formative gradings.


Seminar Programme in Orthodontics Details of the recommended reading to accompany the seminar programme is given in appendix 2.

Year 3

S.7.3: Impressions in Children.

Purpose of impressions in children; importance of incisor teeth. Study model boxes and forms used. Discussion of materials and cross-infection control. Demonstration. The seminar programme relates to both orthodontics and Child Dental Health, it is aimed at teaching the clinical management of cases.

Year 4

SO1 (clinical demonstration): Fitting and Adjusting Upper Removable Orthodontic Appliances

A clinical demonstration including a laboratory demonstration of adjustment with a removable typodont and using the appliances you constructed in Year 3. On the first clinical session you will be allocated a patient for impressions etc and on the second you fit the appliance.

Objectives:

At the end of the seminar you should be able to undertake the fitting and adjustment of a removable appliance, namely adjustment of Adams clasps and springs.

SO2: Orthodontic Assessment and Treatment Planning (i)

How to undertake an orthodontic assessment. An exploration and discussion of the treatment planning of the orthodontic cases allocated to you. This will include the essentials on undertaking an orthodontic assessment and appliance design.

Objectives:

At the end of the seminar you should be able be able to undertake an orthodontic assessment. The seminar will give an insight into the diagnosis and planning that you underwent in preparing the treatment plans of your orthodontic patients.

SO3: Orthodontic Assessment and Treatment Planning (ii)

A continuation of SO2


SO4: Orthodontic Treatment Planning Class 1 Malocclusion

Orthodontic treatment planning of Class I malocclusions using case notes to illustrate, the problems and outcomes of treatment.

Objectives: At the end of the seminar you should have an understanding of the management of crowding, use of headgear and extraction patterns in Class I cases.

SO5 Treatment Planning – Class II Div1 Orthodontic treatment planning of Class II Div 1 malocclusions using case notes to illustrate, the problems and outcomes of treatment.

Objectives: To give an understanding of extraction and non-extraction treatment, including functional appliances, headgear and orthoganthic surgery for Class II Div 1.

SO6 Treatment Planning – Class II Div 2 Orthodontic treatment planning of Class II Div 2 malocclusions using case notes to illustrate, the problems and outcomes of treatment.

Objectives: To give an understanding of treatment, including functional appliances, headgear and orthoganthic surgery for Class II Div 2.

SO7 Treatment Planning – Class III Orthodontic treatment planning of Class III malocclusions using case notes to illustrate the problems and outcomes of treatment.

Objectives: To give an understanding of treatment, including functional appliances and orthoganthic surgery for Class III.

SO8 Treatment Planning – Supernumaries/Hypodontia Orthodontic treatment planning of supernumaries/hypodontia, focusing on the need for interdisciplinary management, using case notes to illustrate, the problems and outcomes of treatment.

Objectives: To give an insight to the interdisciplinary treatment planning, necessary for the management of supernumary teeth and hypodontia.


Year 5

Patient Assessment and Diagnosis Seminars Approximately fortnightly.

Objectives: To gain the ability to independently undertake an orthodontic assessment, provide an initial orthodontic diagnosis and explain and discuss the nature of orthodontic treatment to patient and parent.

Student Assessment Details of the BDS examinations are given in the general stage guides. The material described in this orthodontic course guide will be included in the following BDS examinations: Stage 2 Stage 3 - Part 3 Stage 5 In addition there is one class examination in Child Dental Health, which will include questions on orthodontics. This takes place in term 14 and is known as "mock finals" as its objective is to prepare you for the Final BDS examination (term 15).

Quality Assurance and Enhancement Each year, courses are evaluated and improvements agreed and implemented. Your views will be sought each year and are a most important part of the process - this is described in more detail in the general stage guides. This does not preclude you discussing matters with staff, particularly the stage co-ordinators and the head of department as, very often, prompt action is the most effective.

Student Conduct This matter is taken seriously. The department has a high reputation locally and nationally, and you can do much to enhance this by your professional attitude within and outside the Dental School. Further guidance is given in the BDS degree handbook and the general stage guides. We expect you to attend promptly when required and display a high standard of appearance.


Appendix 1

Detailed breakdown of orthodontic related teaching

Cranio-facial Development Whole course

Oral and Maxillofacial Surgery

Term 11

OS 11.5 Malpositioned Teeth Assessment: Pericoronitis, its features and management. Surgical anatomy of commonly malpositioned teeth.

OS 11.6 Malpositioned Teeth Surgical Management: Various options of treatment available (no treatment, removal, removal of adjacent tooth, exposure, transplant). Technique of removal. After care and complications.

Term 12

OS 12.2 Oral Surgery and Orthodontics: Management of teeth (impacted, embedded, supernumerary and supplemental teeth and odontomes). No treatment, removal of adjacent erupted teeth, exposure of unerupted teeth. Transplant surgery. Fraenectomy and fraenotomy. Reminder of maxillofacial techniques.

OS 12.5 Facial Deformity: Reasons for and against surgical interference. Pre-operative assessment. Slide presentation of surgical procedures.

Restorative Dentistry

Unit 2: Occlusion in the Adult

Lecture 1: Occlusion I The importance of occlusion to different dental specialities; physiological and pathological occlusion; definitions of jaw position.

Lecture 2: Occlusion II Normal occlusion; determinants of occlusion. Posselts border movements; interocclusal contact, duration and force; chewing cycle.


Lecture 3: Occlusion III Occlusion and Restorations Occlusion and plastic restorations; the ideal occlusal surface; “high restorations”; pre-operative assessment; adjusting the occlusion of restorations.

Dental Materials Science Term 5

2. Properties of Materials I Stress/strain, strength, toughness, hardness, rigidity, proportional limit. 4 Properties of Materials III Corrosion, erosion, abrasion, biocompatibility, aesthetics, adhesion. 7 Metals and Alloys Structure of metals and alloys, grain structure, work hardening, recrystallization, stress-relief. 8 Structure of Alloys Types of alloys, solution hardening, variation of structure with temperature. 9. Properties of Alloys The use of compositional diagrams to predict properties, coring, precipitation hardening, order hardening. 10. Properties of Alloys Wrought structures, steel compositional diagrams, stainless steel systems, hardening heat treatments, tempering.

Term 6

3.Composite Resins Factors controlling properties, classification of types, comparativeproperties. 5. Pinciples of Adhesion Clinical significance, wetting, bonding to enamel, bonding to dentine. 6. Adhesion Promoters Dentine bonding agents, bonding to metals, bonding to porcelain, factors controlling efficacy. 8. Resin Modified Glass Ionomers and Compomers Hybrids of composites and glass ionomers, properties relative to other materials. 16. Requirements of Impression Materials Classification, accuracy, dimensional stability, trays. 18. Hydrocolloid Impression Materials Agar, Alginates, composition, setting reactions, properties applications.


21. Gypsum Products Manufacture, different types, setting reaction, properties, uses.

Term 8

6.Wrought Alloys Stainless steel, denture base, wires.

Radiology Lectures:

7.5. Oblique Lateral jaw and occlusal technique 7.7 . Dental panoramic tomography 7.8. Skull views and localisation

Seminars:

3. Extra oral radiographic anatomy 4. Localisation 5. Abnormalities of tooth development 6. Impactions

Medicine and surgery

Module 8. PLASTIC AND RECONSTRUCTIVE SURGERY Session 4 Management of cleft lip and palate Session 7 Management of facial deformity


Appendix 2 Seminar programme reading list

SO1 Fitting/adjustment of removable appliances

Oxford Handbook of Clinical Dentistry Mitchell & Mitchell 174-179, 184-187 An Introduction to Orthodontics Mitchell 159 - 173; 186 - 196 A Textbook of Orthodontics Huston, Stephens & Tully 277 - 301, 323 - 345 The Design, Construction and use of Removable Appliances Adams & Kerr 6- 20 Functional Orthodontic Appliances Isaacson, Reed & Stephens

SO2/SO3 Treatment planning 1

Oxford Handbook of Clinical Dentistry Mitchell & Mitchell 125 - 137 An Introduction to Orthodontics Mitchell 1-17 A Textbook of Orthodontics Huston, Stephens & Tully 54 - 79 Practical Orthodontic Assessment Stephens & Isaacson (Good text with plenty of self assessment) Young Practitioners Guide Available from British Orthodontic Society. (020 7837 2193)

SO4 Treatment planning Class 1

Oxford Handbook of Clinical Dentistry Mitchell & Mitchell 136 - 145 An Introduction to Orthodontics Mitchell 21; 29-31; 68-81;138;146-151 A Textbook of Orthodontics Huston, Stephens & Tully 141 - 173 The extraction of permanent first molars during the mixed dentition period - a guide to treatment planning. Mackie, Blinkhorn & Davies Journal of Paediatric Dentistry


SO5 Treatment planning – class II div1

Oxford Handbook of Clinical Dentistry Mitchell & Mitchell 154 - 161 An Introduction to Orthodontics Mitchell 92 - 103 A Textbook of Orthodontics Huston, Stephens & Tully 223 - 240 Treatment of Class II malocclusions with removable appliances Rock Brit Dent J 1990, 168: Part 1 163-166 Part 2 206 - 209; Part 3; ? Part 4 298 -402 Functional Orthodontic Appliances Isaacson, Reed & Stephens

SO6 Treatment planning – class II div 2

Oxford Handbook of Clinical Dentistry Mitchell & Mitchell 158 - 161 An Introduction to Orthodontics Mitchell 104 - 113 A Textbook of Orthodontics Huston, Stephens & Tully 241 - 256 Functional Orthodontic Appliances Isaacson, Reed & Stephens

SO7 Treatment planning – class III

Oxford Handbook of Clinical Dentistry Mitchell & Mitchell 162 - 171 An Introduction to Orthodontics Mitchell 114 - 121 A Textbook of Orthodontics Huston, Stephens & Tully 257 - 265, 357 - 387 Functional Orthodontic Appliances Isaacson, Reed & Stephens


SO7 Treatment planning – Ectopic teeth

Oxford Handbook of Clinical Dentistry Mitchell & Mitchell 148 - 153, An Introduction to Orthodontics Mitchell 23-26; 137 - 145 A Textbook of Orthodontics Huston, Stephens & Tully 173 - 192 Management of the unerupted maxillary canine Ferguson Brit Dent J 1990 169: 11 - 17

SO8 Treatment planning – Supernumaries/Hypodontia

Oxford Handbook of Clinical Dentistry Mitchell & Mitchell 148 - 153, An Introduction to Orthodontics Mitchell 23-26; 137 - 145 A Textbook of Orthodontics Huston, Stephens & Tully 173 - 192


new castle curriculum

Documents

child dental health

initial orthodontic diagnosis

orthodontic teaching laboratory

general stage guides

fixed orthodontic appliances

including functional appliances

dental school

mixed dentition