orthodontics In summary

By Farooq Ahmed

Farooq brings the key points, references and understandings from keynote webinars and papers in a concise podcast.

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The podcast currently has 129 episodes available.

orthodontics In summary episodes:

April 02, 2025 Orthodontics In Interview: Aligners, Limited or Just Misunderstood? TOMMASO CASTROFLORIO
Orthodontics In Interview: Aligners, Limited or Just Misunderstood? tommaso castroflorio

“The biggest difference in overcoming the limitation (of aligners) is to understand how to control aligner deformation”

“We need to improve the available knowledge about aligners, because we need to control the companies, we do not need companies controlling us”

“I think you can treat also complex cases, in my practice I treat extraction cases”

“There are limitations in every technique, I think that the good orthodontist understands how to manage the limitation and how to overcome them”

“Large mass 3D printing will represent an important evolution in orthodontics, aligners and braces”

Tommaso explores the current understanding ofaligners, there limitations in terms of an appliance and scientific research. We explored the debate of aligners treating complex cases, why attachment designs still have limitations, and the role of aligners as functional appliances. We discuss emerging concerns of micro and nano-plastic toxicity andenvironmental concerns of aligners.

TIMELINE
00:00:00 Introduction of Dr Tomasso Castroflorio
00:00:51 Tomasso's Early Experiences with Aligners
00:08:21 What are the Limitations of Aligners?
00:11:24 How do we Overcome Limitations with Aligners?
00:17:59 Should Aligners be Restricted to Mild to Moderate Cases?
00:20:22 Research IndicatesAligners Only Tip Teeth into Extraction Sites, Do you Agree? 00:25:50 Importance of Visualization in Orthodontics?
00:29:27 Are Functional Appliance Aligners Advantageous over Conventional Functional Appliances?
00:35:08 Has There Been Over-emphasis on Attachment Design?
00:44:18 What are the Consequences of Microplastics and Aligners?
00:50:32 What is the Future of Aligners?
00:53:54 Who do you Admire the Most in Orthodontics
00:55:36 Advice from Tomasso to all Orthodontists
Click on the link below to view previous episodes, to refresh topics, pick up tricks and stay up to date.

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Please visit the website for this interview podcast:
https://orthoinsummary.com/orthodontics-in-interview-aligners-limited-or-misunderstood-tommaso-castroflorio/

#orthodontics
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#aligners
#clearalignertherapy

#orthodonticsinsummary
#orthodonticsininterview

Farooq Ahmed

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59min
March 05, 2025Impacted canines, resorbed teeth Part 2 | 3 MINUTE SUMMARY
Join me for a summary of recent long-term research of resorbed teeth due to impacted canines. This podcast is based on an excellent lecture by Julia Naoumova delivered at last year’s British Orthodontic Conference. Part 2 with focus on the prognosis of resorbed teeth from impacted canines, and follows on from part 1 with explored outcomes of open Vs closed exposures of impacted canines – see here for part 1.
Root resorption of incisors reported at 19-67% Erikson 2000 Walker 2005, Mitsea 2022
Anna Dahlén and Julia Naoumova 2024 retrospective CBCT study n =27 incisors
Mean Follow-up average 9 years (5.5-14.6)
Patient reported outcomes
Survival 100%
Horizontal grade 3 moderate resorption n=17 (resorption inner dentine not involve pulp moderate)
Horizontal grade 4 severe resorption n=12 (pulp exposed severe)
Vertical grade 3+ severe resorption n=7 (resorption 2mm-1/3rd moderate)o
Vertical grade 4 extreme resorption n = 1 (resorption 1/3rd +)
No significant difference in any grade of resorption long term of the following:
Symptoms
Mobility and ankylosis
Discolouration
Increase gingival pocketing but not clinically significant
RR horizontal changes with time
No change 81%
Worse 4%
Improve 15%
RR vertical changes with time
No change 43%
Worsen 57%
Expected as had orthodontic treatment as well
Previous research
1-23 years Survival 93-100% Falahat 2008 , Bjerklin 2011, Becker 2005, Jönsson 2007
Jönsson 2007 showed grade 1 mobility when root length < 10mm
Conclusion:
Extraction of asymptomatic based purely on root resorption should be routinely performed
Paper by Anna Dahlén and Julia Naoumova 2024
Longitudinal study of root resorption on incisors caused by impacted maxillary canines—a clinical and cone beam CT assessment
https://doi.org/10.1093/ejo/cjae052
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4min
February 19, 2025Impacted canines, what’s the latest? Part 1 | 6 MINUTE SUMMARY
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
...more
7min
February 05, 2025Will dental monitoring change orthodontics? 6 MINUTE SUMMARY
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?
AI software which assesses occlusal and dental changes through a series of intra-oral photographs taken by the patient using their smartphone
How does it work?
Upload STL / digital study model

Ai segmentation of teeth which maps digital study model to the photos

Aligner fit analysis:
Discrepancy between tooth surface and aligner fit

Either proceed, continue wear or see clinician

Fixed appliances
Assess rate of movement and schedule appointment

Other proposed benefits
Oral hygiene assessment

Breakages

Retention changes
What do patients think of it?
Patients attitudes to remote monitoring
81% interested in reducing number of appointments due to telemonitoring – Dalessandri 2021

25% of patients found scans difficult to perform, with duration of scan 2-17 minutes Hansa 2020
Does it reduce appointments and make treatment quicker? Sangalli 2024
Decrease the number of in-office visits by 1.68–3.5 visits

No difference in treatment duration

No statistical reduction in emergency appointments
Are treatment outcome better (aligners)?
No difference in tooth movements Hansa 2021

No difference in number of refinements Hansa 2021
PAR changes – no difference in quality of outcomes Jarad Marks 2024
Is oral health better?
DM reduced plaque scores Costi 2019

31% Improved hygiene Manzo white paper
Other innovations with remote monitoring?
Remote STL files
Scan taken without patient attending the practice

Scanbox

Formulate STL file and fit aligner in surgery
Is Dental Monitoring accurate? Ferlito 2022
80% repeatability from 2 scans

44.7% repeatability and reproducibility

Discrepancy between scanbox and intra-oral scan varied between 0.5-1.9mm, angular measurements maximum error 8.9 degrees
Conclusion
2-3 appointments less

No difference in overall duration

Some people struggle to use

Accuracy and repeatability variable

No difference in the quality of the outcome
Areas which are of concern
Unknown accuracy of occlusal assessments from a reliable retruded contact position

Patient motivation maybe better delivered in person

Ai environment cost 2-3% of energy used by data centres
Other ways to reduce time?
Diagnostic and treatment planning acumen

Identify main aspect of malocclusion and address through efficient mechanics
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8min
January 15, 2025 Overcorrection with aligners, when and how? 7 MINUTE SUMMARY
“We do not accept the weaknesses of out appliances as absolutes, but rather we adjust out treatment mechanics to account for them Mazyar Moshiri,
“If you are not willing you use elastics – you are not able to get finishing like braces” Mazyar Moshiri
“We cannot have a reasonable discussion of efficacy and accuracy until we study the appliance as orthodontic clinicians, and not as scientists Mazyar Moshiri
Join me for the first summary of 2025, exploring finishing with clear aligners. Mazyar Moshiri explores overcorrection with aligners, when they should be used and his protocol. It was a lecture from last year’s AAO winter meeting..
This episode consists of overcorrection methods of 4 malocclusions: deep bite, anterior openbite, class 3, and expansion. Maz also shares his pearls on what to watch out for when using clear aligners with overcorrection.
EXTRAS: Mazyar Moshiri has kindly given permission for the summary slide of his overcorrection protocol to be included in the podcast notes, please see the podcast website https://orthoinsummary.com/
Overcorrection
Deep bite - achieve AOB
Over-intrusion lower incisors to achieve a 50-100% of total movement predicted
Favourable if proclaining teeth, unfavourable if retroclining
Use of attachments on premolars, note the hierarchy of attachment design places anchorage for anterior intrusion 5th, “Drs have to doctor the Clincheck”.
Anterior openbite
Posterior intrusion – overcorrect with occlusal bite blocks
class 3 triangular elastics canine and premolars
Force down on posterior bite blocks
May require controlled relapse following overcorrection, done in refinement
NOTE – aligners continuous force system, reciprocal extrusion of anterior teeth is expected
Class 3 case
Retract lower incisors with retromolar tads and 6 Oz 3’16th
Side effect – increase in curve of spee – similar to retraction on a NiTi wire, aligner is not stiff enough to resist
Correction in refinement with anterior intrusion to eliminate premature contacts, DO NOT EXTRUDE POSTERIOR TEETH, as aetilogy is anterior iatrogenic extrusion
Expansion
Overcorrection of 1-2 mm, greater the further posterior
Attachments, plan buccal attachments +/- palatal attachments, to account for likely buccal tipping, ensuring buccal root torque and preventing palatal cusp dropping
Tip: for palatal cusp dropping place occlusal attachment on the palatal cusp to prevent extrusion during expansion
Caution – if already in buccal version, consider limited correction
...more
9min
December 04, 2024 Orthodontics In Interview: ALFRED GRIFFIN What can digital fixed appliances do better? LIGHTFORCE
“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.

...more
41min
November 13, 2024Transverse assessment with a CBCT, is it the answer? 5 MINUTE SUMMARY
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
Vertical distance buccal and lingual cusp, 1mm vertical difference

Buccal inclination upper 5 degrees Alkhatib 2017

Lingual inclination lower 12 degrees Alkhatib 2017
Andrews WALA ridge 2000
Bucco-lingual distance from crown ( FA point) to the most prominent portion of mandibular buccal alveolar bone (coincident with mucogingival junction)

Hypothesised teeth over the basal bone , Glass 2019

1st molar = 2mm

Ideal mandibular intermolar width FA – FA = WALA-WALA distance minus 4mm
Normal width CBCT
CBCT age 13 N = 79 Miner 2012
Maxilla slightly smaller

mid point molar root on lingual bone -1.22 +/- 2.91mm
CBCT Age 22.7 years Koo 2017
Measure CoR furcation 1st molar Mx – Mn = -0.39+/- 1.87mm
CBCT 56 adults normal occlusion Lee 2022 PENN STUDY
Buccal – buccal on crestal bone, furcation, 6s

Lingual – lingual crestal furcation 6s

Reliable reading on lingual aspect – buccal shelf bone prevents reliable readings

Maxilla narrower than mandible -1 +/- 3mm
Previous literature Tamburrino 2010 describes 5mm cortical plate level of furcation buccal aspect, however Lee 2022 showed for males 1.1mm +/- 4.5mm and 1.6mm +/- 2.9mm
Without cbct can transverse diagnosis occur?
Models = lingual surface at furcation level (4mm vertical below gingival margin) maxillary width slightly narrower than mandible -2+/- 3mm
Issue with CBCT for diagnosis
Standard Deviation is large = +/- 3mm, range from -4mm-+2mm falls into SD
Issue with study model transverse analysis from 4mm at the gingiva
Not validated
...more
6min
October 23, 2024 Can Orthodontics Treat Paediatric Obstructive Sleep Apnoea? 8 MINUTE SUMMARY

Join me for a summary looking into the increasingly popular
topic of paediatric obstructive sleep apnoea, a review of orthodontic treatments available, and how effective they are in this growing field of both medicine and dentistry. This episode is a summary of Alberto Capriglio’s lecture from
the AAO and Carlos Flores Mir’s lecture at the IOF earlier this year.

OSA - Defined upper airway dysfunction causing complete or
partial airway obstruction during sleep

Sleep = Slow wave sleep – constructive phase of sleep
(recuperation of the mind)
·
Growth hormones secreted
·
Glial cells within brain restored
·
Cortical synapses increase in number – Moberget 2019

Outcomes to paediatric patients of SDB: (AASM)
·
delays in development, Poor academic performance, Aggressive behaviour,
attention- deficit/hyperactivity disorder, , emotional problems in adolescence

First line medical treatment – adenotonsillectomy
·
40% residual OSA

Effect palatal expansion
1.
Roof the mouth = base of the nose - Increase in
nasal airway volume - Reduction in OSA, if obstruction in naso-pharynx,
2.
Short term reduction in OSA (not cure AASM)
a.
20% improvement in AHI, 85% of cases Villa 2015
b.
15% got worse by 20%
c.
57.5% residual AHI greater than 1 - not
resolution
3.
Caprioglio 2019 long term AHI return to initial
scores, from 7 to 5 long term
4.
Change in metabolism when combined with Vit D3
a.
Vit D3 with RME increases reduction in AHI,
sustained long term, Caprioglio 2019 AHI 61.9% Vs 35.5% long term

Expansion other outcomes - school performance Bariani 2024
·
AJODO – RME improves academic performance –
o
BEHAVOUR 1 of 8 parameters improved only for
academic performance - change small 0.68
o
COGNITIVE 1 in 8 improve

Mandibular advancement
Move mandible forwards and open space behind the tongue – oropharynx
·
Anatomical – increase size of oropharangeal
airway
·
YAnyAn 2019 mandibular advancement for pOSA systematic review: 1.75 AHI reduction (CI) −2.07, −1.44)
– modest change
·
However long term use required of the paediatric patient

Orofacial features in children with obstructive sleep
apnea. Fagundes Flores-Mir 2022
o
No craniofacial features specific to pOSA – ANB,
o
However medical diagnosis through polysomnography
may under-estimate incidence,
o
Broader diagnosis such as snoring, may
over-estimate OSA

AADSM 2024 – consensus statement
·
Expansion
o
Prevention: No consensus
o
Management: No consensus
o
Cure: Insufficient
·
Mandibular advancement
o
Prevention, management, cure – unclear

More about OSA?
To hear more about OSA, please check out the last interview
on orthodontics in interview with Sanjivan Kandasamy, where we had a deep dive
into OSA and where we are in our understanding today from the research
Interview
with Sanjivan Kandasamy on OSA

...more
9min
October 02, 2024 Posterior Bolton’s Discrepancy. New Analysis To Solve Old Problems 5 MINUTE SUMMARY
Join me for a summary looking at The Posterior Bolton Discrepancy,
a new take on the classic Bolton discrepancy. Wayne Bolton’s analysis has been
critically appraised and the outcome from Patrick Foley and his team has been
the formation of the posterior Bolton analysis, a new perspective on an established
tool in orthodontics which seeks to give better insight into the location of tooth
size discrepancies. He has also explored through his research the effects of
premolar extractions and the likely outcomes of compromised occlusal outcomes,
and where we should expect to see it within the posterior segment.

Wayne Bolton established the Bolton’s ratio:
·
Mesial distal widths of teeth
·
Original study 55 well treated cases
·
Anterior – ideal 77.2%
·
Overall 91.3% - Anterior tooth size discrepancy maybe
masked by a compensatory posterior discrepancy

What is the posterior Bolton’s ratio
·
Not included in original study
·
Formular sum of mandibular 4s, 5s, 6s,/
maxillary 4s, 5s, 6s x 100 = 105.27% - data from original Bolton’s study

Ratio confirmed by Mongillo 2021
·
N=55 patients ideal outcomes
·
Digital casts (from plaster)
·
Posterior ratio 105.77% +/- 1.99%   Vs
Bolton’s data of 105.27%

The effect of 4 premolar extractions on the posterior
Bolton ratio

Study: Mongillo 2021 (extraction of all 4s) Holton 2023 (extraction
of upper 4s, lower 5s)

·
Posterior Bolton increases 107% +/- 2.23%
(or U4s and L5s 106.52 +/- 2.52%), ideal digital removal of teeth
·
Observed Bolton’s was 110.48 % = 3.18% above Bolton’s ideal
·
Space of 1.1mm – 1.28mm remains in mandible when
ideal arch – only 1 patient did not have space

Clinical options

i.
compromise occlusion
1.
slightly class 3 molar and class 1 canine
2.
class 1 molar and slightly class 2 canine

ii.
IPR upper arch

iii.
Bonding

·
Anterior and posterior Bolton may be valuable in
diagnosis and prediction than an overall Bolton

...more
6min
September 11, 2024 What is Lightforce, will it change orthodontics? 6 MINUTE SUMMARY

Join me for a look into a recent digital innovation within
orthodontics, Lightforce. I explore how the 3D printed
labial bracket system works, the features and what the proposed advantages. Recent
research
exploring the advantages of Lightforce is discussed as well as my comparison to
other digital innovations within orthodontic appliances.

What is Lightforce

·
Manufacturing: 3D printed brackets Cad/Cam
·
Material: ceramic polycrystalline labial
·
Planning: Digital planning using Lightplan,
visualisation of the outcome, alter both tooth position and bracket position,
individualise prescription per bracket as a result of planned movements
·
Flexibility in positioning: Brackets do not have to be in the Facial Axis
of the Clinical Crown, through altering the base thickness, the resulting
moment can be achieved through the center of resistance
·
Torque expression is independent of the vertical position, for the same reasons
·
0.018", 0.020", and 0.022",
including combinations

Stages
1.
Submit records
2.
Digital planning using lightplan, visualisation
of the outcome,
3.
Case approval
4.
Indirect bonding tray – light-Tray, with brackets
in situ

Other advantages
·
Accuracy of 3D printed slot
·
Adapted base, less adhesive
·
Minitubes, biteturbos

What are the proposed advantages and claims around Lightforce
with evidence
1.
Shorter duration of treatment due to precision
a.
JCO 2024 Wheeler 2024 Retropsectice study, 900 lightforces
cases and over 300 conventional cases, 30%
shorter and 30% fewer appointments. significant floors, with a lack of outcome
measure and matching of controls
Proposed advantages and claims around Lightforce ithout
evidence

2.
Reduced complications white spot lesions, dehiscences
and root resorption as relate to duration
3.
Remove issue of compliance or biomechanics as limitations
to treatment outcomes
4.
Saving Doctors time and money, remove
repositions
5.
Reduce or eliminate wire bends

What are my thoughts?
·
Labial fixed appliances are catching up with
aligners and lingual appliances
·
New possibilities of varying biomechanics, slot
size, bracket position and customised prescription
·
Presence of Lighforce features within other
appliances:
o
Customised brackets Insignia / Incognito
o
Digital planning: aligners, Insignia
·
No customisation of archwires with Lightforce
·
Not sure how Lightforce would reduce appointment
intervals, ligation is conventional ligation through elastomeric modules, with
plastic deformation

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
representative of the lecture / speaker, the podcast is not endorsed by an
institute or the speaker and is the independent work of Farooq Ahmed and the
Orthodontics in Summary team. It is not intended to over-ride or replace the
requirement clinicians have in being familiar with the relevant training and
guidelines for the treatment they provide.

Contributions
Contents and editing
Farooq Ahmed

...more
8min

FAQs about orthodontics In summary:

How many episodes does orthodontics In summary have?

The podcast currently has 129 episodes available.

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