recent advances in surgical orthodontics /certified fixed orthodontic courses by indian dental...

INDIAN DENTAL ACADEMY

Leader in continuing dental education www.indiandentalacademy.com

www.indiandentalacademy.com

Recent advances in surgical orthodontics

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INDIA SHINES !!

THE MOOD IS UPBEAT ECONOMY GROWS DISPOSABLE INCOMES ON THE RISECONSUMERISM ON A HIGH

BEAUTY IS BIG BUSINESS THE INDIAN FACE SELLS ALL !!!

THE FEEL GOOD FACTOR +++++


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THE GOOD NEWS

•Increasing demand for orthodontics•A shift towards cosmetic dentistry•Mass Marketing ,consumer brandingStrategies – Invisalign • 54 % OF INDIANS BELOW 25 YEARS OF AGE !!


Indian Orthodontics: are we in a process of change ?

A period of turbulent global change • Books journals ,information•A profusion of appliances,space age materials•New diagnostics and Treatment modalities,•Distraction,MIA, •Craniofacial orthodontics•Age,no longer a consideration !!!Have our dimensions,horizons changed ?Are we looking beyond our mechanical preoccupation?


The Drivers for change in the 21st century

Biology / technology / evidencePatient centered approach

Efficient and effective orthodontics

•Convergence of technology•Materials•information

•Philosophies•Techniques•Comfort of status• quo/opinion


SO WHY DO PEOPLE SEEK ORTHODONTIC

TREATMENT ??


Orthodontics Justified

spirit

mindbody

“ If there is a defect on the soul, it cannot be corrected on the face, but if there is a defect on the face and one corrects it, it can correct a soul. “ - Jean Cocteau


Esthetics primarily responsible for Orthodontics

Appearance - The most important motivating factor for treatment.

Physically attractive people achieve higher levels of success in life than unattractive peopleBreece & Nieberg JCO 1986


Reasons for seeking orthodontic treatment : Malaligned teeth 84% Advice of dentist 52% Facial appearance 41%

©

Self concept in class II malocclusion and early treatmentDan C et al Angle Orthod. 65(6) 411, 1995Silver Platter Search


Information and AwarenessPatient empowermentA right to participate in the decisions and entitled to results

“Dentofacial Appearance is a significant predictor of orthodontic patients expectations of treatment”Am J Orthod Dentofacial Orthop 2003; 123-127

TimeSociety driven by speed !!Service on Demand,Instant gratification

+


The Face“A singular structure that teems with

subtletiesAn enchanted terrain,a zone of sensuality

A playground of secrets,a glory of function”

Daniel McNeill Facial Appearance :-The most important characteristic in relation to self image and self esteemPeople Dissatisfied with Facial appearance express more dissatisfaction with teeth than any other feature !!

Hershon LE, Giddon DB. Determinants of facial profile self-perception. Am J Orthod 1980;78:279-95. Berscheid E, Walster E, Bohrnstedt G. Body image. Psychol Today 1973;7:119-131v


ADULT ORTHODONTICS- A NEW VISTA Growing segment in orthodontic Practice

95.3 % of orthodontists in US into Surgical orthodontics !

70 75 80 85 90 97 02

10%

15%

20%

25%

5%

30%

JCO 1997-02www.indiandentalacademy.com

Three dimensional treatment goals

4th Dimension TIME !!The 5th Dimension Function

1. Do traditional strategies and goals in orthodontics still hold good ?

Is there a new paradigm in orthodontics ?


o Facial / Dental aesthetics decide successful outcome both may not correlateo Anterior Smile Aesthetics critical for the patiento Alteration of the skeletal bases needs to be harmonized with dentoalveolar modification

o Orthodontics and surgeons – a synergism !!

Success !!


ORTHODONTIC LIMITATIONS

Angle – Class 1 molar Relation ship 1925 – 1945

Tweed – Lower Incisor Position 1945 –1985

Surgical influence – Upper incisors/positioning anterior 6 teeth


Cephalometrics – What Value ?

Measurements based on cranial base landmarks –inaccurate in defining clinical profile Disconnect between hard & soft

tissues! No measurement is 100% accurate Soft tissue thickness / axial

inclination of incisors – the most important variables in inaccuracy

Michels & Tourne Int J Adult orthod orthog Surg 1990 5 (1) 43-52www.indiandentalacademy.com

JCO Survey 99 – traditional Ceph Analysis used by 94% orthodontistsIs it a Problem ?• Measure skeletal and dental relationships• Measure to cranial base • Soft tissue/ profile correlation ?•Did we forget to reintegrate soft and hard tissues ??

Face First – The Emerging Paradigm


NO CORRELATION BETWEEN NORMSAND PROFILE BALANCE !!OCCLUSAL /DENTOALVEOLAR CORRECTION BASED ON NORMS – LESS THAN OPTIMAL FACIAL RESULTS


PRE-TREATMENT

POST-TREATMENTwww.indiandentalacademy.com

Inheritance or mind set?Is Traditional Cephalometric and model diagnosis relevant towards a comprehensive treatment outcome ?Evidence :- Changes in facial profile during orthodontic treatment with extraction of first four premolars Am J Orthod Dentofac Orthop 95(3):220-30 Mar 89

Dobrocky and Smith found • 160 orthodontic patients treated to Class 1 models • 15% of lips excessively flat !• 30.6 % nasolabial angles excessively obtuse !!( >120)

ORTHODONTIC LIMITATIONS


A TIME FOR INTROSPECTION

Did a good occlusion match a good face at the end of treatment ??

Was Anchorage ever a problem ??

Was a special effort required to finish and detail your cases ?


OCCLUSION

AESTHETICS

180° turn around in conceptualOrthodontic thought !!!

OcclusionStatic recordsNon extnLower incisors

Face FirstSoft tissue and smile dynamics Skeletal modification

90’s paradig

m


“The winds of change are blowing in the face of time”Scorpions


Orthodontic Limitations

The Perceived Ideal Position not possible orthodontically Adverse Facial Changes if attempt to compromise is made .A Surgical /Orthodontic solution is essentialCompromised occlusions – a special challenge!

An entire new dimension in Orthodontics !!


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normalOrthodontics ++

Surgery

Defining orthodontic limitations


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Repositioning teeth can help the profile only that much !


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Color codes used with the Arnett soft tissuecephalometric analysis

Black = within 1 SDGreen = within 2 SDBlue = within 3 SDRed = more than 3 SD


FACE FIRST – A Paradigm change

Increasing focus on altering skeletal bases to achieve a positive outcome .

Growth modification

Compromise Orthodontics with malar augmentation, rhinoplasty ,genioplasty

Osteotomies – mandibular / maxillary for skeletal excessDeficiencies ?? Grafts


Right now my life is just one learning experience after another……By the end of the week I should be a genius!

Jeanette Osias


thank you


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