AAO Virtual Annual Session June 2021 Day 2

Join me for the summary of key lectures from this year’s American Association of Orthodontics Summer Meeting

14 key lectures are covered in this podcast from day 2 of the AAO meeting, on the topic of Maxillary Skeletal Expansion, TADs, Bone plates, Carriere appliance, Digital Orthodontics,  Phase 1 treatment, Facemask, Aligners,

Speakers: Hugo De Clerck, Jonathan Nicozisis , Carlos Flores-Mir, Jason Cope, James McNamara, Peter Ngan, Benedict Wilmes, Stella Chaushu, Brandon Owen, Juan Fernando Aristizabal, Roberta Lione, Tung Nguyen

Individual lecture podcasts are available in the description from the website www.orthoinsummary.com

Lectures titles:

1. Long-term evaluation of class 3 orthopedics using skeletal anchorage. Tung Nguyen

2. Growth Modulation by class 2 and class 3 orthopedics Hugo De Clerck

3. When you play the games of Thrones, you win, or you die. Is there a middle ground Carlos Flores-Mir

4. Can Changing the Transverse Dimension Improve the Quality of Orthodontic Treatment in Children? Dr. Roberta Lione

5. How To Become An In-House Aligner Power House. Jason Cope

6. Carriere 3 Treatment in minimally growing patients- How does it work? James McNamara Management of the Carriere Motion Appliance for Class III Correction in the Mixed and Permanent Dr. Laurie McNamara McClatchey

7. Treatment of maxillary deficiency with facemask and TADs Peter Ngan

8. Maxillary Expansion & Treatment of Class III Malocclusion in the Digital Age Dr. Benedict Wilmes

9. Clear Aligners in Orthognathic Surgery Flavio Uribe

10. Growing and Redirecting the Roots of Impacted Teeth Stella Chaushu

11. Surgery First Combined with CAD/CAM Brackets and 3D Predictions Juan Fernando Aristizabal

12. Clear Aligner Treatment- One Size Does NOT Fit ALL Dr. Clark Colville

13. Efficiencies of Aligner Treatment in Teens and Early Treatment Jonathan Nicozisis

14. The 'How to' Guide of Digital Braces/Teledentistry Brandon Owen

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Join me for the summary of key lectures from this year’s American Association of Orthodontics Summer Meeting

13 key lectures are covered in this podcast from day 1 of the AAO meeting, on the topic of Aligners, TADs, Miniscrew assisted expansion MSE, Biomechanics, AOB, 3D Metal printing, aging dentition, Forsus

Speakers: Chris Chang, Won Moon, Ravi Nanda, Daniela Garib, Brent Larson, Maz Moshiri, Lorenzo Franchi, Lorenzo Franchi, Kenji Ojima, William Dayan, Simon Graf, Lisa Alvetro, Flavia Artese, Jae Hyun Park

Individual lecture podcasts are available in the description from the website www.orthoinsummary.com

Lectures titles:

1. Simplified Mechanics for Aligners in Treating Complex Cases Dr. Chris

2. The Evolution of Mini-implant Assisted Midfacial Expansion, the Latest Developments and Advanced Applications Won Moon

3. Biomechanics and Force Delivery Systems- Wires to Screws to Plastic Ravi Nanda 2021 Edward H. Angle Award Lecture

4. Aging of the Occlusion- What Should We Know? Daniela Garib

5. Applying Science to Aligner Mechanics and Design Brent Larson

6. Suggestions for Systematic Treatment of Orthognathic Surgical Patients with Clear Aligners Maz Moshiri

7. Jacob A. Salzmann Award Lecture; Efficient and Effectively. Lorenzo Franchi

8. Type of Approach for Biomechanics of Aligner Orthodontics Kenji Ojima

9. Ideal Occlusion is Not Always the Ideal Treatment Plan William Dayan

10. 3D Metal-printed Bone Borne Appliances Simon Graf

11. Tips to Optimize Treatment Results Using Forsus Class II Corrector Dr. Lisa Alvetro

12. Key Factors to Consider when Correcting the Vertical Dimension Flavia Artese

13. Anterior Open Bite Correction- Conventional Treatment vs. TADs Jae Hyun Park

Join me as I summarise Ute Schneider’s lecture exploring early interceptive treatment. Part 1 explores signs of patients appropriate for interceptive treatment, the treatment options available with a focus on an adaptation of serial extractions which Ute is a proponent of.

Signs of hereditary tooth size jaw discrepancy in the younger patient

· Premature exfoliation of one or more deciduous lateral incisors

· Gingival recession on a prominent lower incisor

· Splaying of the maxillary or mandibular lateral incisors

· Ectopic eruption of U6, with premature exfoliation of E

· Impacted L7s

Treatment strategy for young patients

1. Wait for growth – natural skeletal discrepancy

2. Arch development: expansion , distalisation , proclination

3. Leeway space

4. Serial extractions

1/ Wait for growth

· Arch length and depth decreases with age, especially mandible decrease in arch length from age of 8 Bishara 1998

· Compare arch length 1930 Vs 1990s, smaller arch length and worse crowding in 1990s Bishara

2/ Arch development

· Rapid maxillary expansion

o Questionable stability

§ Meta analysis loss of RME 2.4mm Schiffman 2001

· Limited evidence of stability of RME

· Lip bumper, Quadhelix, 2 x 4, removable appliance

o 6 years severe relapse greater than other strategies

o 89% Significant relapse of mandibular anterior crowding Little et al

3/ Leeway space management

o Is crowding is equal or less than the leeway space Nance 1947

o Wide range of the leeway space available 0-8mm

o Lower premolars are larger now that 1930s – Evidence of reduced leeway space in 1930s Vs 1990s Allen 2017. Reduced 0.42mm per quadrant

· Lip bumper

o Impaction of 7s 10-20 x more prevalent than in the general population Sonis 2011

4/ Serial extractions

Advantages

· Immediate spontaneous improvement

· Reduces appliance time

· Reduces cost

· Reduces discomfort

Best candidates

· Severe hereditary tooth size discrepancy

· Orthognathic or bimax cases

· Minimal OJ and OB

· Class 1 malocclusion

Significant relief of crowding spontaneously?

· Extraction of Cs and 4s = Littles index improves from 11.8-2.74 Yoshihara 1999

Profile changes with serial extractions

· No evidence supporting adverse profile changes with serial extractions

· Non-extraction: consider possible negative aspects of non extraction Bowman 2000

Protocol for serial extraction

· Extraction of Cs

· Monitor every 6/12

· When 4s erupt, extract

Conclusions of serial extractions:

· Early non appliance orthodontic treatment

· Eruption guidance

· Limited to select group of patients

· Still has a place in orthodontic clinical practice

Invisalign: Virtual Orthodontic Summit 2021

Join me for the summary of key lectures from this year’s Invisalign UK Virtual Orthodontic Summit meeting

4 lectures are covered in this podcast on the topic of biomechanics and aligners, using tuberosity TADs and troubleshooting with aligners

Speakers: John Morton, Willy Dayan, Susana Palma, Graham Gardner

Individual lecture podcasts are available in the description from the website www.orthoinsummary.com

Lectures titles:

1. Biomechanics of the Invisalign system 2021 John Morton

2. Treating complex aligner biomechanics. Willy Dayan

3. Overcoming difficulties in class 2 correction with TADs in tuberosity and aligners. Susana Palma

4. Monitoring and troubleshooting Graham Gardner

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

#orthodontics #farooqahmed #almuzian #orthodonticsinsummary #aligners, #TADs #tracking

#orthodontics #farooqahmed

@farooqahmed_orthodontist

Join me for the next interview in orthodontic.

Kleber Meireles is a Professor in Orthodontics at the Instituto Prime Cursos, Salvador Brazil, he studied orthodontics at the HRAC/Centrinho University Sao Paulo Brazil. He is a visual educator in orthodontics with 500 + videos in orthodontics

We get to hear of Kleber’s commitment to education leading him to produced dynamic videos in orthodontics. I explore his treatment approach and his role models, as well as his one piece of advice to all orthodontists

Please find the link to Kleber’s Instagram and youtube where his videos are freely available

@klebermeirelesortodontia

Youtube channel: Kleber meireles 

Join me as I summarise Pater Miles lecture exploring myofunctional appliances and the literature of the appliance

Claims by some manufacturers of myofunctional appliances:

· incorrect breathing from 2 years of age

· Incompetent lips & mouth breathing – aesthetic effects

· Crooked teeth

· Long face

· Behavioural changes, tired / hyperactive

Claimed effects of appliances treatment

· Improve facial growth

· Skeletal growth

· Better alignment

· Stable

Myofunctional Appliances what are they?

Design – off the shelf design

· Monoblock Kesling positioner type appliance 1945:

· Double mouthguard postured into edge to edge position

· Postured edge to edge

· Example Occlus-o-guide, LM activator, Myobrace

Effects:

· Retrocline uppers, procline lowers

· Disocclusion posterior teeth = overeruption of posterior teeth, overbite improvement

Evidence

Occlusal changes with appliances

· Eruption Guidance Appliance, T4K, LM activator AJODO 2008 Angle 2019

· Overjet 2mm improvement

· Overbite 2mm improvement

· Crowding reduction 2mm

· Relapse towards baseline Janson, significant for OB crowding and 25% for OJ 2007

· Time 13-43 months

o Small changes over a long period, options to treat later Obrien 2003

Myobrace Vs Activator EJO 2015

· Poor compliance: PFA 70% non-compliance, 53% Activator non-compliance (Twinblock 84% compliance AJODO 2003)

· 2018 cost benefit analysis: PFA minimised costs

Airway evidence

Difficult to show direct changes, so related parameters are used.

Claimed issues with narrow airway and mouth breathing:

1. Dental: Crooked teeth and arches

2. Lip incompetence

3. Skeletal: long face

4. Behaviour tired and hyperactive

1: Crooked teeth and narrow arches

o Prevalence of malocclusion similar in Paediatric sleep disorder breathing in the population J den Sleep Medicine 2017

2: Lip incompetence

· Vig 1979

o Lip growth accelerate sand overtakes facial height 9-13

o Lip incompetence will improve with age

· Vig 1881

o Lip incompetence no difference in nasal airflow

§ Cannot conclude lip incompetence = mouth breather

o Proffit – long face still use nose to breath, but less than normal face type

3: Skeletal: long face

· Craniofacial morphology metal analysis: AJODO 2013

o Paediatric OSA statistically significant in class 2, 1.5-1.6o – NOT clinically significant or diagnostically useful

§ Direct casual relationship of craniofacial structure and paediatric sleep disorder is unsupported in meta analsysis

Myofunctional therapy

Oropharyngeal exercises

· Aim to improve tone of surrounding muscles, phalangeal muscles, soft palate,  airway – increase patency

o Reduce AHI index by half short term studies 3 months Am J resp Crit Car Med 2009, Sleep Med 2013

Orthodontists role in SDB

· We are not the primary care giver

· Main role: Screening / Assessment, questionnaire

o Paediatric sleep questionnaire

§ Effective ruling out OSA / SDB

Join me as I summaries 3 lectures from the mini-series by the EOS from 3 eminent professors in orthodontics. Topics covered include Aligners, TADs, Lingual appliances, trends in orthodontics.

Ravindra Nanda talking on the: Current clinical trends and evidence

Dirk Wiechmann talking on: Go east or go west- Non-surgical class 2 correction in adult patients

Theodore Eliades talking on: The future of Orthodontics going backwards with a fancy vehicle

Notes available from the website in the description

Join me for the second interview of 2021

Adith is a Consultant and Assistant Professor in Orthodontics at the University of Puthisastra South Korea, adjunct faculty Professor Chennai India, Co-editor of Kieferorthopaedie journal (International Orthodontics).  

We get to hear of Adith’s journey into using TADs, his one piece of advice to all orthodontists and what questions Adith hopes will be answered in orthodontics, as well as Hollywood Vs Bollywood!  

Please find the link to Adith’s up coming editorial in the AJODO entitled: ‘The Quagmire of Collegiality Vs. Competitiveness’ 

We hear of Adith’s thoughts on case reports and where evidence based practice fits in to the unique field of orthodontics

Join me as I describe Jassin Arnold’s lecture describing lower incisor extraction, its indications and management

Why should we use it?

o Reduces anchorage demand, entact posterior segments

o Improve dental occlusion in a shorter time frame

o Profile improves in mandibular protrusion cases Levin 1964

When should we use it? Systematic review Zhylich 2011

o Mild-moderate class 3

o Edge to edge anterior occlusion

o Crossbite with mild anterior mandibulae excess

o 4.5mm tooth size discrepancy of lower to upper Matsumoto 2010

When should we not use it?

o Severe OB

o Bimaxillary crowding

o Triangular lower incisor and minimal crowding 3mm less

o High insertion of labial frenum = gingival recession I removed

Risks of lower incisor extraction

o Black triangle

o Increased overjet and overbite

o Tendency for spaces to reopen an aesthetic zone

o Create tooth size discrepancy

Bolton’s anterior analysis

o Anterior ratio 77% 3-3 lower Vs 3-3 upper

Cases:

o Class 1

o 4mm of crowding of the lower incisors

o Bolton’s anterior analysis 87% - excess lower incisor tissue

§ = Extraction 1 lower incisor = 74.8% – TOO LOW (ideal 77%)

· = Solution strip upper 2-2 by 2mm = 78% Bolton’ ratio

o Case 2

o Molars ½ II, increased overjet 6mm, lower incisors 4mm of crowding

o Bolton’s anterior analysis 87% - excess lower incisor tissue

§ = Extraction 1 lower incisor and stripping of upper incisors = 77%

§ = Extraction of 2 upper premolars as well

· Stripping upper 2-2 to achieve ideal occlusion in the anterior 3-3 segment

· Extraction of Upper 4s to correct the increased overjet

References

Zhylich, D. and Suri, S., 2011. Mandibular incisor extraction: a systematic review of an uncommon extraction choice in orthodontic treatment. Journal of Orthodontics, 38(3), pp.185-195.

Join me for part 2 where we explore Mohammed’s rules on which teeth to extract, anchorage assessment and management, Bonding 2nd permanent molars, elastics and treatment planning adults Vs children

Which to extract 4 or 5

o CAT-V principle

§ C: Clinical condition of the teeth

§ A: Anterior crowding: 8mm + extract the 4s, 8mm – 5s or 4s

§ T: Transverse: Lower 5 will help narrow the arch

§ V: Vertical: Extraction of 5s for high angle cases will improve the overbite

Molar outcomes in treatment planning

o Non-extraction or extraction of 4 premolars = class 1

o Extraction of 2 upper premolars: Class 2

o Extraction of 2 lower premolars: Class 3

o Extraction of 1stmolars: Ignore them! Will not change the final molar relationship

o Type A (absolute) No movement of the posterior segment

o TADs – HG – extraction pattern

o Type B posterior movement moves mesially by 25%

o Nance, sectional archwires, intermaxillary elastics, HG

o Type C posterior movement moves mesially by 50%

o Reciprocal movement of anterior retraction

o Type D posterior movement moves mesially by 75%

o Anterior anchorage (reverse HG, TADS)

o Biomechanics: intermaxillary elastics – 2nd order bends – inverted lower brackets

Anchorage loss in the lower arch is less than upper arch

· Differential alveolar bone density

· differential root surface area

· differential Buccolingual width of molar

· differential anterior palatal root torques

o Don’t bond to for anchorage

o Bonding results in loss of anchorage due to 7s distally tipped, uprighting results in loss of anchorage

o Elastics =  rotation of mandible

o Overjet 0.5mm correction per month with class 2 elastics

o 1:3 ratio of vertical: horizontal effects

o Unilateral intermaxillary elastics in one side only =  cant

o = Use vertical part time elastics on the other side

o Elastic should be stretched 3 times its diameter to give the force

o Don’t expect you can distalize more than 2.5 mm unless you extract 7 OR 8

o Distalization lowers without TADS is very limited

Adults Vs growing patients

· Growing patient:

o Elastics +++

o Distalisation +++

o Functional appliances +++

o Extractions +++

· Adult

o Extractions +++

o Elastics ++

o Distalisation +