Simon described the concept of ‘no retention’, the methodology and literature on the topic, with his expert option included.

Conclusion

· Controversial to not wear retainers

· Simon still asks patients to wear retainers

· Interproximal reduction helps but we don’t know why

Classic study

Riedel and Little

· 10 years out of retention

· 70% relapse – require retreatment, 30% no retainers and no treatment needed

· No identifiable factors – therefore to keep teeth straight require retainers

Treatment protocol and retrospective study of no retainers

Aasen EJO 2005

· During treatment

1. Respect lower archform

2. Maintain lower incisor position

3. Overcorrect of rotations

4. Heavy final wire 21x25 SS for 2-3 months

5. Relapse ‘test’: 4 weeks no archwire

· Results

1. After 3 years 1.1mm (Little’s Index)

§ Not significant clinical change

Randomised control trial Lower arch

Tynelius 2010, 2013

· Lower bonded retainer Vs IPR and no retainer

· 2 years = no difference in stability

Randomised control trial Upper arch

Naraghi 2020

· Upper VFR Vs no retainer

· 1 year follow up

o Relapse with retainer 0.4mm

o Relapse without retainer 1.3mm

· Not clinically significant

Post – treatment changes

1. Relapse

2. Age related changes

a. Abdulraheem 2020, 12 year follow up

i. Tooth displacement index

1. 25% = age related

2. 75% orthodontic relapse

Reference

Aasen, T.O. and Espeland, L., 2005. An approach to maintain orthodontic alignment of lower incisors without the use of retainers. The European Journal of Orthodontics, 27(3), pp.209-214.

Edman Tynelius, G., Bondemark, L. and Lilja‐Karlander, E., 2013. A randomized controlled trial of three orthodontic retention methods in C lass I four premolar extraction cases–stability after 2 years in retention. Orthodontics & craniofacial research, 16(2), pp.105-115.

Naraghi, S., Ganzer, N., Bondemark, L. and Sonesson, M., 2020. Comparison of post-treatment changes with and without retention in adolescents treated for maxillary impacted canines—a randomized controlled trial. European Journal of Orthodontics.

Tsiopas, N., Nilner, M., Bondemark, L. and Bjerklin, K., 2013. A 40 years follow-up of dental arch dimensions and incisor irregularity in adults. The European Journal of Orthodontics, 35(2), pp.230-235

Abdulraheem, S., Schütz-Fransson, U. and Bjerklin, K., 2020. Teeth movement 12 years after orthodontic treatment with and without retainer: relapse or usual changes?. European Journal of Orthodontics, 42(1), pp.52-59

Join me for a summary of the day 3 lectures from this year’s virtual IOC.

10 lectures covering: aligners, miniplates, root resorption, occlusion and bruxism.

Speakers: Benedict Wilmes, Hugo J.J. De Clerck, Anne Marie Kuijpers Jagtman, Ali H. Hassan, Zhihe Zhao, Carlalberta Verna, Glenn Sameshima, Ambra Michelotti, Shouichi Miyawaki, Mauro Farella

Individual lecture summaries will be available soon from the website www.orthoinsummary.com

Lectures titles:

1. Improving The Predictability Of Clear Aligner Therapy With Mini Implants Benedict Wilmes

2. The Defects, Risks And Countermeasures Of Clear Aligner Zhihe Zhao

3. Clear Aligner; How Predictable It Is Ali H. Hassan

4. The Influence Of Bone Density On Tooth Movement Biomechanics Carlalberta Verna

5. Miniplate Anchored Class Iii Orthopedics With Control Of Maxillary And Mandibular Rotations Hugo J.J. De Clerck

6. Orthodontic Root Resorption An Update For The Clinician Glenn Sameshima

7. An Evidence Based Approach To External Apical Root Resorption Anne Marie Kuijpers Jagtman

8. Occlusal Vulnerability Hypervigilance, Neuroplasticity And Adaptation Ambra Michelotti

9. Importance Of Occlusion And Physiological Significance Of Sleep Bruxism Shouichi Miyawaki

10. Bruxism An Orthodontist's Perspective Mauro Farella

Join me for a summary of the day 2 lectures from this year’s virtual IOC.

9 lectures covering: Retention, accelerated tooth movement, Airway, OSA, Patient expectations

Speakers: Padhraig Fleming,  Martyn T. Cobourne, Carlos Flores Mir, Leslie A. Will, Won Moon, Juan M. Palomo, Seung Hak Baek, Steven j. Lindauer, Susan J. Cunningham

Individual lecture summaries will be available at the end of the week, with written notes on each lecture!

Lectures titles:

Join me for a summary of the day 1 lectures from this year’s virtual IOC.

14 lectures covering: TADs, Facial aesthetics, Biomechanics, Class 2, Early treatment, Expansion, Impacted teeth, Self ligating brackets, Periodonics

Speakers: Chris Chang, David Sarver, James Mcnamara, Ravindra Nanda, Junji Sugawara, Noriaki Yoshida, Lorenzo Franchi, Peter Ngan, Sylvain Chamberland, Ewa M. Czochrowska, Yves G. Bolender, Chun-Hsi Chung, Dimitrios kloukos, Mitsuru Motoyoshi

Lectures titles:

1. Biomechanics Smart And Visible Biomechanics - Optimizing Treatment Mechanics Based On Prediction Strategy For Long-Term Tooth Movement Noriaki Yoshida

2. Relevancy Of Biomechanics In Clinical Orthodontics In 2020 Ravindra Nanda

3. Class 2 Patient Dependent Factors For The Efficient Treatment Of Class Ii Malocclusion Lorenzo Franchi

4. Early Treatment Of Class Iii Malocclusion With Tads Peter Ngan

5. Expansion In The Early Mixed Dentition Is It Worth The Effort James A

6. Facial Aesthetics Macro To Mini-Explore The Possibilities David M. Sarver, Dmd,Ms Birmingham, Alabama David M. Sarver

7. Facial Aesthetics Vertical Dimension And Facial Aesthetics Sylvain Chamberland

8. Impacted Teeth. Trans Alveolar Transplantation For Impacted Teeth Scientific Evidence And Clinical Practice Ewa M. Czochrowska

9. Is There Any Difference Between Conventional, Passive Self-Ligating And Active Edgewise Self Ligating Brackets A Systematic Review Of The Literature And Network Meta Analysis.Yves G. Bolender

10. Perio Periodontal Considerations In Orthodontic Treatment Chun-Hsi Chung

11. Periodontics And Orthodontics. Long-Term Development Of Gingival Recession In Orthodontically Treated Patients In Comparison To Untreated Individuals. Dimitrios Kloukos

12. Smile Gummy Smile Correction Chris Chang

13. Tads How Has Skeletal Anchorage Changed The Orthodontic Strategies For Class Iii Correction In Adults Junji Sugawara

14. Tads Safety Placement Of Orthodontic Anchoring Screws Mitsuru Motoyoshi

Join me for part 2, where Jae Park describes how to plan either extrusion or intrusion movements, the key evidence around AOB closure and TADs, aligners and orthognathic surgery.

Conclusion

How to plan intrusion posterior teeth  Vs extrusion of anterior teeth

CONSIDER EFFECTS ON OCCLUSAL PLANE WITH POSTERIOR INTRUSION

How to plan extrusion / intrusion:

Evidence of AOB closure with TADs

Aligners

Orthognathic surgery

Reduced stability due to Stylomandibular and medial pterygoid muscles.

Solution

Join me as I summarise Jay Park’s lecture looking at the anterior openbites and their management, with a focus on TADs, the good and the bad.

Part 1

Soft tissue aetiology and controversy

Dental-alveolar correction focus on posterior intrusion

Theories of tongue aetiology and AOB

· Tongue thrust = persistent visceral swallowing pattern for AOB Subtelny 1965

· Resting anterior tongue posture main factor Proffit 1993

Correct theory relates to resting tongue position:

· Anterior resting tongue position remains in between incisors many hours of the day, impedes incisor eruption and maintains AOB R.Juestus 2001

Anterior tongue posture correction

· Tongue anterior and high =  palatal crib.

· Tongue anterior in low = tongue spurs.

Indications for dental correction

1/ Posterior intrusion 2/ Intrusion of anterior teeth

· Intrusion posterior teeth

o Increased LAFH

o Excessive posterior gingiva

o Mild skeletal discrepancy

· Extrusion of anterior teeth

o Normal / decreased LAFH

o No excess gingival display

Posterior intrusion: Bite props as posterior bite plane affect

· 2-3mm of composite placed on the palatal cusp.

· Molar intrusion achieved =  1.5mm Hernandez 2017 17 months

TADS placed in the palate for intrusion

Jae Park combines bite plane effect with TADs

· RME bonded design acrylic capping on posterior teeth , 2 x TADs dento-alveolar region of the palate, between 5-6.

· Powerchain placed over the occlusal surface, from the palatal TAD to the buccal arm on the appliance

TADS with modified TPA

TPA placed with posterior hook for elastic traction

Position of TAD with modified TPA

Palatal dento-alveolar region of the 1st and 2ndmolars

· Ideal place for upper intrusion: Palatal U6-7, as intrusion vector ideal.

· Small interradicular space = challenge to place

· As molars intrude, space reduces in between molars Kuroda 2007

Palatal dento-alveolar region of the 2nd premolar / cuspid and 1st molar

· Easier location for placement

· However tipping of molars mesially occurs due to anterior vector from TAD

· Solution: Intrusion bend on 7s

Negative effects of palatal TADs and intrusion

Palatal cusp intrudes point of application, but buccal cusp doesn’t intrude / hangs down maintain occlusal vertical contact

Solution to negative effects

· Expand with QH and then palatal tad intrusion 2 stage approach, similar to QH, tipping movement then intrusion

· Approx. 300g per side for intrusion

Anterior extrusion

· Tads labially placed distal the upper and lower laterals with pt wearing elastics.

Orthodontics In Interview: NEAL KRAVITZ. USA

Join me as I interview Neal Kravitz, who is the associate editor for the Journal of Clinical Orthodontics, Edward Angle Society member NA and diplomate of the American Board of Orthodontics.

Neal Kravitz is an international speaker, he has published landmark papers, including a recent publication on the efficacy of aligners in the AJODO https://www.ajodo.org/article/S0889-5406(20)30303-6/

Neal discusses how his interest in aligners began, his thoughts on direct to consumer devices as well as more about Neal and his life.

We get to hear Neal’s one piece of advice to all orthodontists about a career in orthodontics.

Part 2: Nikhilesh explores the use of class 2 elastics, myobraces, growth and success.

Conclusions from part 1 and 2

o No advantage of early treatment

o No difference in self esteem with early treatment

o 20% failure of removable class 2 appliances

o Patients prefer fixed functional appliances

Question 9 Dento-alveolar correction worth it?

· If the results are stable = yes

· Drop outs for removable appliances 19%

Question 10 Use of class 2 elastics?

· Duration to achieve overjet correction

o 6.8/12 Vs Forsus 4.5/12 Arora 2018

o Side effects of class 2 elastics

§ Extrusion and palatal tipping of Ui

§ Clockwise rotation of occlusal plane (forsus anticlockwise rotation)

Question 11 Myobraces – off the shelf appliances?

· Activator appliances is more effective than Myobrace by 1.1mm Idris 2018

· Cost-benefit analysis however favours myobraces: Cirgic 2018

Question 12 Future growth

· No consensus about future growth prediction

· Relapse is unpredictable

o Nikhilesh recommends 1 year appliance use due to:

§ Minimising subnormal growth affects

§ Time for bone to mature

§ Minimise relapse

Question 13 Criteria for success:

o Cervical Spine Maturation 3 (CM3)

o CL2 molars

o CO-GO-ME 1250  - reduced vertical component Franchi & Bacetti

References

Arora, V., Sharma, R. and Chowdhary, S., 2018. Comparative evaluation of treatment effects between two fixed functional appliances for correction of Class II malocclusion: A single-center, randomized controlled trial. The Angle Orthodontist, 88(3), pp.259-266.

Idris, G., Hajeer, M.Y. and Al-Jundi, A., 2012. Acceptance and discomfort in growing patients during treatment with two functional appliances: a randomised controlled trial. European journal of paediatric dentistry, 13(3), pp.219-224.

Franchi, L. and Baccetti, T., 2006. Prediction of individual mandibular changes induced by functional jaw orthopedics followed by fixed appliances in Class II patients. The Angle Orthodontist, 76(6), pp.950-954.