Dr Sergio Sambataro describes the bioprogressive approach to managing the class 2 case

Class 2 aetiology: Sato 2008

· Upper molars less erupted

· Lower molars more erupted

Occlusal objective for class 2 in bioprogressive technique:

· Lower the posterior occlusal plane

Unlocking of growth:

·   Decompression theory

o Increased interarticular space = vertical growth at the condyle

· = mandible grows forwards

· = counterclockwise rotation of mandbile

Principles of treatment:

· Extrude upper molars – correct steep posterior occlusal plane

o = Decompress condyle through creating interarticular space

· Correct overbite

o = if not anterior interference prevents forward growth of mandible

Distalise

1. Utility arch with tip back bend

a. =  distally tip upper molars

2. Utility arch with activation:

a. By obtuse bend (instead of perpendicular band) – activate by compressing wire on insertion

i. distalisation force on posterior teeth

ii.  advance anterior teeth  - Counter affects by class 2 elastics

Utility arch: 16x16 Elgiloy =  low forces

Overall treatment entails the following:

· Diagnosis 75%

· Unlocking 20%

· Mechanics 5%

References

Occlusal plane and aetiology

Tanaka, E.M. and Sato, S., 2008. Longitudinal alteration of the occlusal plane and development of different dentoskeletal frames during growth. American Journal of Orthodontics and Dentofacial Orthopedics, 134(5), pp.602-e1.

Ricketts textbook

Ricketts, R.M., 1998. Orthodontic treatment in the growing patient. Vol. I, pp.16-21.

Cervial headgear = greater AP change in class 2

Zervas, E.D., Galang-Boquiren, M.T.S., Obrez, A., Viana, M.G.C., Oppermann, N., Sanchez, F., Romero, E.G. and Kusnoto, B., 2016. Change in the vertical dimension of Class II Division 1 patients after use of cervical or high-pull headgear. American Journal of Orthodontics and Dentofacial Orthopedics, 150(5), pp.771-781.

Orthodontics in interview!

Listen and enjoy the story of Flavia Artese: Associate Professor in orthodontics and editor-in-chief of Dental Press Journal of Orthodontics.

She describes her journey which led to a career in orthodontics and an interest in anterior open bites.

Flavia speaks of her role models and pet peeves. 

Flavia is looking forward to welcoming all to the 2025 WFO (World Federation of Orthodontics) 10th International Orthodontic Congress in Brazil

https://www.wfo.org/

Summary of Webinar: Simplified Orthodontic Biomechanics with Double Slot Bracket - Thaer Hamid Brazil

Conclusion

New bracket concept, could reduce anchorage demand for specific mechanics

What is it?

· Metal bracket with 2 conventional slots (1 passive, 1 active ligating) in a vertical arrangement

How does it work?

Passive incisal slot 022 x 028

· More liberty between archwire and slot

· Greater force (when compared to 018x025 slot)

Active gingival slot 018x030

· Better rotational control

· Quicker torque expression

Advantage in anchorage and less auxillaries

· Base archwire can be 19x25ss: high rigidity

o active wire can be larger:  16x22NiTi

Archwire sequence

012 CUNiTi initially 1 slot

012 CUNITI Both slots

016 CUNITI Both slots

16x22 CUNITI Both slots

17x25SS (working archwire) in 18x30 slot

Issues: Friction

Yes could be increased

Summary of webinar: Power2Reason - Orthodontics in periodontally compromised patients: Morten Laursen

Conclusion

orthodontic treatment can achieve:

Risk of not factoring in periodontal disease

1. Increased force  =  root resorption

2. Increased force  =  loss of anchorage

3. Active disease  = increase loss of periodontal tissue

1/ Treatment protocol: Anterior intrusion with mini implants with TADs

· TAD Where

o Distal to canine

· TAD How

o Indirect ligation to canine bracket

· Biomechanics

o Absolute intrusion of 2-2 = 3mm

2/ Treatment protocol: Lingual root torque of incisor with Auxiliary torqueing archwire

· Attachments x 3

o 1st molars R and L

o Affected lower incisor

· BASE ARCHWIRE  - prevent AP and vertical changes to lower incisor

o 020 ss

· AUXILIARY ARCHWIRE

o 19x25TMA

o Down bend or RCOS  = lingual root torque

· Biomechanics

o Lingual root torque to lower incisor

Simon Littlewood tells his story of orthodontics in his charismatic way.

Simon walks us through his achievement of the Cochrane Systematic Review on retention, what ideas led to the large body of work (link below).

Simon led the British Orthodontic Society's 'Hold that smile' campaign, and describes the process of how he did this, and also why he did it (link below).

We learn who Simon admires in orthodontics and outside the field.

We ask Simon your question on what retention regime he advises patient to use

And Simon gives his advise to a career in orthodontics

There were some light-hearted  outtakes which we hope you will enjoy!

Links below:

BOS hold that smile campaign

Cochrane Review in retention

Invisalign European Scientific Symposium Part 4- Data mining and new innervations   

Data and Science Based & Introducing the New Product Innovations Dr Mitra Derakhshan & John Morton 

How does Invisalign work?

Force driven system: Contact in certain location, another force for root movement

1. Smart force

· Allows controlled force to the tooth through:

o Changes shape of the tooth (attachments)

o Changes shape of aligner (power ridges , pressure areas)

2. Smart track

· Highly elastic material with high working range – LIKE NITI

3. Smart stage

· Calculation of force required to move tooth

· Staging of tooth movement to manage anchorage, ie 1st molars in expansion cases are moved first (greatest resistance due to surface area)

Data

Effectiveness of distalisation

· Sequential distalisation ( ½ movement achieved prior to next tooth moving) n= 2000

· Modified distalisation (1/3 movement achieved prior to next tooth moving n =) 4000 Simultaneous distalisation (all teeth move at the same time) n = 800

Bite ramps

· With bite ramps 30% greater intrusion of lower incisors in severe cases (1mm Vs 1.4mm)

New products

· Clincheck pro 6.0 cloud based

· In smile visualisation - smile integrates actual clincheck,

Summary of studies looking at expansion of aligners using invisalign First

Overall conclusions

· Greater expansion anteriorly

· Greater predictability of expansion anteriorly Vs posteriorly

· Greater predictability of expansion buccally, unpredictable palatally

Summary of webinar: Invisalign European scientific symposium part 3: Expansion

Arch expansion pattern using clear aligners: a three-dimensional retrospective study in paediatric subjects with posterior crossbite. Dr. Silvia Caruso

WHAT’S THE QUESTION?

How effective is the Invisalign system at expansion

Previous papers: not predicable but change in material to smart track since

WHO DID THEY TREAT?

N20

Age 6-10

Mod-severe crowding

WHAT DID THEY DO?

Retrospective

Maxillary dentition

Gingival width and buccal cusp width of teeth

WHAT DID THEY FIND?

Buccal expansion

· C-C expansion:   very predicable: 99% achieved (4mm)

· 1st permanent molar-molar expansion:  predicable  88% achieved (3.8mm)

· Primary molar expansion:  least predicable buccal and palatal

Palatal expansion

· Primary molar expansion:  unpredictable 42% achieved (1.9mm)

· 1st permanent molar-molar   unpredictable 38% achieved (1.4mm)

CONCLUSION

· Buccal expansion predictable with invisalign

· Palatal expansion predictable at C-C region, unpredictable Molar regions

Summary of webinar: Invisalign European scientific symposium part 3: Expansion

First maxillary expansion with aligners in growing patients. Dr. Tommaso Castroflorio & Dr. Francesco Garino

WHAT WAS THE QUESTION?

What expansion can be achieved with Invisalign first

WHO DID THEY TREAT?

N = 43

Age 8

Morphological superimposition

WHAT DID THEY DO?

Expansion using Invisalign protocols

WHAT DID THEY FIND?

· C-C expansion:   Greatest: 3mm +

· Primary molar expansion:  3mm

· Permanent molar-molar expansion:   Least: 2mm

· 19% area increased

· 38% volume increase

CONCLUSION?

1. Expansion greater anterior, less posterior

2. Increase in volume and area

CONCLUSIONS FROM DISTALISATION (AND CLASS 2 ELASTICS) AND MANDIBULAR ADVANCEMENT (MA) 

CRITIQUE:

Skeletal and dentoalveolar effects produced by Aligners and Elastics in Class II growing patients Federico Migliori

WHO

· 14 pts 13.6 years old

· Co-Go-Me 125 – hypodivergent

· Cervical spine C3

WHAT DID THEY DO IT

· Invisalign protocols for distalisation

o Sequential distalisation, ½ distalised, following tooth distalised - anchorage

o Class 2 elastics

WHAT DID THEY FIND

· Distalisation achieved in 15 months

· proclination of lowers did not occure IMPA: -2.2 – reduction

· Vertical control proportions FMA -1.7

· Co-Gn increased by 3mm

Correction of Class II malocclusion in growing patients with Aligners Dr. Simona Dianiskova

WHO

· Age 12, OJ 4mm, ANB 3

WHAT DID THEY DO IT

· De-rotate upper 1st molars – up to 2mm

o 85% of class 2 cases have rotated upper 1st molars

· Expansion – usually required

· Distalisation -2.5mm predictable Simon 2014 87%

· Class 2 from outset, no IPR

· Overcorrect upper inc by 5 degrees of palatal root torque – prevent undertorquing

analysis dolphin – Mcnamama

WHAT DID THEY FIND

Duration of tx 16-21 months

· Results no change ANB,

· Co-Gn 4 – stat sign

· Witts stat improve -1.8

· Ui and lLi 1-2 degrees change

· No vertical change FMA

II malocclusion treated with Invisalign with Mandibular advancement feature and twin block appliance compared with historical controls Dr. Sandra Tai

WHO

N32

Age 13

WHAT DID THEY DO IT

Outcome Ceph study

WHAT DID THEY FIND

SNB - stat sign for invisalign

Ui and Li procline 3.5 - stat sign t/b

No difference in vertical change both

Summary of the Invisalign European Scientific Symposium, with Dr Alessandro Mario and  Dr Dieter Brothag presenting their studies

Alessandro Mario 

Aligners resolve deep bites by

· Anterior bite turbos  - allow posterior extrusion, and progressively move incisal

· Anterior intrusion

· Pressure areas  - force through indentations into the aligner

WHO

·  N = 44 with complete OB of 7mm+

· hypodivergient SnGoGn less 25

WHAT DID THEY DO IT

· Prospective follow up

· Treatment protocol

o Anterior bite ramps, lingual pressure areas, class 2 / vertical elastics, extrusion 1mm of posterior teeth, Lower premolars - rectangular long attachments, Heavy posterior occlusal contacts

· No overcorrection

WHAT DID THEY FIND

· Overbite corrected in every case 3.5mm

· Average time 11 months. 26 aligners

CONCLUSION

· Aligners effective at correcting deep bites, if posterior extrusion is planned

IMPROVEMENTS / COMMENTS

· Did extrusion occur? –  Rossinia 2015 SR stated most difficult movement with aligners?

                                               Changing the paradigm of deepbite treatmentDieter Brothag

WHO

·  N = 50 with complete OB of 7mm+

· IOTN 3+

WHAT DID THEY DO IT

· Retrospective follow up

· Normal practie protocols for both treatments

· Fixed labial Vs Aligners

· Non-extraction

WHAT DID THEY FIND

Effectiveness - PAR changes

· Labial fixed:  20 – 4

· Invisalign:  18 – 3

NO STATISTICAL DIFFERENCE

Efficiency - duration

· Labial fixed:  30+ months

· Invisalign:  20 months

STATISTICALLY SIGNIFICAN DIFFERENCE

CONCLUSION

1. Aligners as effective at correcting deep bites as labial fixed

2. Aligners are more efficient than labial fixed

IMPROVEMENTS / COMMENTS

· Why did labial fixed cases take 30+ months non-extraction

· Retrospective study, RCT would be more robust

Dr Neal Kravitz gives the audience at the AAO advise from his clinical and professional mistakes

Clinical advise

1. 2 phase / early treatment - AVOID

a. It builds expectations of non-extraction treatment

2. All treatments none- extract - AVOID

a. If avoid due to patient pressures, can result in proclination, relapse, but most significantly impacted second molars

b. He extracts in 50% of adolescent cases

3. Inconsistent records - AVOID

a. Take photos every other visit

b. It will give opportunity for reflection on treatment

c. It will slow one down – therefore less mistakes

4. Only using bonded retainers - AVOID

a. consider temporary due to failure rates 20-50%

b. Always use a essix / VFR

Career advise

· Make your goal clinical, not financial

· Humility is the path to being a good clinician

· Focus on being better everyday

Conclusion

Take pride in your work, but stay humble