review of orthodontic principles
TRANSCRIPT
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.
