Join me for a summary of the management of impacted canines, the latest evidence regarding different techniques for alignment. This podcast is based on an excellent lecture by Julia Naoumova delivered at last year’s British Orthodontic Conference. 

Part 1 will focus on recent findings of a modified open exposure technique Vs closed exposure, in terms of duration but also other key outcomes, health, pain, use of analgesics,  time absent from school and costs. The next episode, part 2, will look at the prognosis of resorbed incisors related to impacted canines long term. 

Previous research  no difference between closed Vs open exposure for alignment, aesthetics, treatment time, surgical success, treatment times. Limited to 2D views Parkin 2017, Sampaziotis 2018, Cassina 2018. 

Questionnaire of current decision making of open Vs closed: n=48 orthodontists = current clinical decision making by orthodontists based on preference Naoumova 2018

Multicentre RCT Margitha Björksved 2018, 2021

• Modified open exposure with Glass ionomer OPen Exposure, first described by Nordenval 1999

• 6/12 of spontaneous eruption

• Traction with orthodontic appliances

Results

• Total time: no difference 26 months (95% CI −3.2 to 2.9, P = 0.93)

• Canine eruption time: Open exposure quicker by 3 months 8.5 months Vs 11.5 months (95% CI 1.1 to 4.9, P = 0.002). With no traction in open exposure group 

• No difference in periodontal status, root resorption, surgery time, complications, 

• Pain:  greater in closed group

• Greater pain with bilateral open exposure

• Closed exposure more painful applying traction 

• Analgesics use (preliminary data):

• Day 1 nearly all patients use

• Day 5 drops to less than 50% of patients use

• Day 10 most have stopped taking analgesics

• Costs: – no difference 

• €3,400  healthcare costs

• €6,300 including patient costs

• Missed days of school (preliminary data)

• Day 1 -  76% open Vs 65% closed exposure 

• Day 2 -  3% open Vs 6% closed exposure

Open exposure with GOPEX Not appropriate for:

• Close to adjacent tooth, to avoid material on adjacent teeth

• Very high canine position 

• Older patient – start traction straight away, probability of ankylosis increases Cernochova 2024

• 1% at age 15

• 4% at age 20

• 14% at age 25

• 97% at age 45

Conclusion:

• Both open and closed techniques are viable, however with open exposure of GOPEX technique the canine erupts spontaneously and quicker

• Less pain with open exposure unless bilateral

• Most patient will miss 1-2 days from school 

• Pain relief common for the first 5 days, but maybe used until day 10

Papers

Open vs closed surgical exposure of palatally displaced canines: a comparison of clinical and patient-reported outcomes—a multicentre, randomized controlled trial 

Margitha Björksved

Open and closed surgical exposure of palatally displaced canines: a cost-minimization analysis of a multicentre, randomized controlled trial 

Margitha Björksved

Join me for a summary looking at remote monitoring in orthodontic clinical practice, and if it can improve, quicken and enhance orthodontic clinical practice. This podcast is based on an excellent webinar by Jonathan Sandler and Juan Carlos Varela, as part of the Angle-net webinar series. I discuss how Dental Monitoring works, the proposed advantages and a review of the emerging research on this innovation in orthodontics. 

What is Dental Monitoring?

How does it work?

What do patients think of it?

Patients attitudes to remote monitoring

Does it reduce appointments and make treatment quicker? Sangalli 2024

Are treatment outcome better (aligners)? 

Is oral health better? 

Other innovations with remote monitoring?

Remote STL files

Is Dental Monitoring accurate? Ferlito 2022

Conclusion

Areas which are of concern

Other ways to reduce time?

“We do not accept the weaknesses of out appliances as absolutes, but rather we adjust out treatment mechanics to account for them Mazyar Moshiri,

“it's a platform for mass customization”

“I think Lightforce system has more friction than it should right now.”

“We operationalize great outcomes.”

“People that need to have a Cochrane review to prove to themselves the sky is blue, those are not the people that should be using Lightforce right now”

Alfred and I discuss his digital bonding system, Lightforce, we explore the product as well as the strength of the claims around it. Alfred replies to criticisms of the product as we explore the emerging evidence of his digital bonding system. 

Alfred gives his opinion on the digital evolution within orthodontics, we have a candid discussion on the use of digital orthodontics and where there are still areas of significant improvement needed.

Join me for a look at CBCT and its use in the diagnosis of the transverse problem, and if it offers the solution to the debated topic. The podcast is based on a lecture by Chun Hsi Chung at this year’s AAO and appraises established methods of assessment, the Curve of Wilson and the WALA ridge line through the lens of a CBCT, as well as how to use a CBCT to assess the maxilla and mandible, which although revealed an ideal measurement, may not be telling the full story.

What is ideal?

inclination 

Curve of Wilson – CBCT study 

Andrews WALA ridge 2000

Normal width  CBCT

CBCT age 13 N = 79 Miner 2012

CBCT Age 22.7 years Koo 2017

CBCT 56 adults normal occlusion  Lee 2022 PENN STUDY

Without cbct can transverse diagnosis occur?

Issue with CBCT for diagnosis

Issue with study model transverse analysis from 4mm at the gingiva

Join me for a summary looking into the increasingly popular

OSA - Defined upper airway dysfunction causing complete or

Sleep = Slow wave sleep – constructive phase of sleep

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Outcomes to paediatric patients of SDB: (AASM)

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First line medical treatment – adenotonsillectomy 

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Effect palatal expansion

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Expansion other outcomes -  school performance  Bariani 2024

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Mandibular advancement

Move mandible forwards and open space behind the tongue – oropharynx

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Orofacial features in children with obstructive sleep

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AADSM 2024 – consensus statement

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More about OSA?

To hear more about OSA, please check out the last interview

Interview

Join me for a summary looking at The Posterior Bolton Discrepancy,

Wayne Bolton established the Bolton’s ratio:

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What is the posterior Bolton’s ratio

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Ratio confirmed by Mongillo 2021

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The effect of 4 premolar extractions on the posterior

Study: Mongillo 2021 (extraction of all 4s) Holton 2023 (extraction

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Clinical options

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 Join me for a look into a recent digital innovation within

What is Lightforce

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Stages

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Other advantages

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What are the proposed advantages and claims around Lightforce

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Proposed advantages and claims around Lightforce ithout

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What are my thoughts?

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Papers and videos on Lightforce

https://www.jco-online.com/media/42415/2023_09_500_waldman.pdf

JCO retrospective study

https://www.jco-online.com/media/43897/2024_05_273_wheeler.pdf

Youtube videos from Lightforce company, Alfred Griffin

https://www.youtube.com/watch?v=zSNkYVgZ69I&t=2s&ab_channel=People%2BPractice

Disclaimer

The podcast is opinion and may not be 100% accurate or

Contributions

Contents and editing

Farooq Ahmed

Join me for a podcast summary looking at the effects of

PICO

Population adults, 22 maxillary arches, 20 mandibular arches

Intervention – expansion with aligners, average 3.7mm

Control – minimal expansion, average 0.6mm

Outcome – bone height and width from CBCT

What was the bone loss?

Maxilla

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Mandibular

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What movement took place of the incisors?

Maxilla

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Mandibular

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What were the overall changes?

Dental changes

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Similar bone loss with aligners expansion from other studies,

Should CBCT’s debate within the literature regarding voxel

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My thoughts: no difference in cbct and gold standard,

Predict bone loss

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Systematic review of orthodontics 48 articles de

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Does bone loss = gingival recession?

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Significant retraction of upper incisors and intrusion Kim

Hypothesis

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What I liked about Greg’s lecture was that he started with

“Airways are like TMD controversy on steroids”

“it amazes me we still think we can grow mandibles”

“We have an appliance (expansion) and are trying to fit it into a diagnosis”

“it is unethical to call yourself an airway orthodontist”

Sanjivan describes why there is controversy in

Click on the link below to view previous episodes, to refresh topics,

YouTube

https://youtu.be/m2NIp1XhnxQ

#orthodontics

#farooqahmed

#sanjivankandasamy

#westaustralianorthodontics

#airwayorthodontics

#airway

#OSA

#SDB