Science topic

Corrective Orthodontics - Science topic

The phase of orthodontics concerned with the correction of malocclusion with proper appliances and prevention of its sequelae (Jablonski's Illus. Dictionary of Dentistry).
Questions related to Corrective Orthodontics
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Different clinicians follow different aligner wear protocols for their patients such as, 7,10 or 14 day protocol. What are your views?
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This unique process works because each new tray is straight than the preceding tray Aligner wear protocol
It's worth noting that the clear aligners are only effective when they are in physical contact with the teeth
For that reason Invisalignly recommends that the tray bewor atlist 20-22hours per day
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Is there any effect on the airway and development of obstructive sleep apnoea after surgically setting the mandible back with a bilateral sagittal split osteotomy? Is there any evidence?
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Brritish Standard Institute 1983 (incisor classification).
E.H. Angle (molar classification)
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Incisor classification is more clinically acceptable and patients know more or particular about their front teeth than the posterior because of their aesthetics
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In response to this question, I can only find experience based recommendations in the literature that differed from as early as 3 weeks to as late as 12 weeks. There is a single animal experiment from Japan (Uji, 1996) in cats that compare one week and 8 weeks, but the experimental model does not really mimic that of a cleft. Recently, a couple of studies addressed the issue of moving teeth into the post distraction bone regenerate which may be considered quite similar. Does anybody know any research-based recommendations done on cleft material?
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Usually 6 months after grafting is the wait before the movement of teeth. Consulting with a periodontist is necessary to make sure that the graft has healed properly before tooth movement can be undertaken.
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I believe age is not really a limiting factor if cooperation is ok
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Skeletal age is more appropriate to formulate the treatment plan for growth modification rather than basing the treatment plan on chronological age. The peak growth occurs around stage CVS 3 which is when the functional appliances would be useful. Functional appliances used at a later age lead to mostly dentoalveolar effects, so should be used only when indicated
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1. if a person had an orthodontic treatment, would one could understand it, after the treathment? if Yes, what are the implications or traces to say so? Another question is, by looking  an individual's cephalometric radiograph or bitewing , panoramic etc. Can one understand this?
2. Are those materials (archwire, ligature, springs etc.) used for orthodontic treatment leave behind a trace or any deformation on tooth enamel?
3. can we understand this macroscopicly? And, after the orthodontic treatment, does it occur  a shift in size and morphology of teeth that has been to this treatment?
Thank you...
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I dont think by looking at the cephalogram, panoramic radiograph, it would be possible to identify whether orthodontic treatment has been performed. Unless the patient received extractions or surgery. Best way is to take proper history for the patients.
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There are numerous methods like using Ultrasonic scaler vibrations ,Propel, Acceldent, Surgical methods.
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Surgical and non surgical interventions can be done to speed up the tooth movement. however, there are negative effects of some treatment modalities. I have mentioned one of our article for your reference below.
Nanda A, Chen PJ, Mehta S, et al. The effect of differential force system and minimal surgical intervention on orthodontic tooth movement and root resorption [published online ahead of print, 2020 Dec 10]. Eur J Orthod. 2020;cjaa065. doi:10.1093/ejo/cjaa065
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Is this case better suited to be treated by posterior intrusion or anterior extrusion. The dental open bite of 5 mm has both a skeletal component and a dental component. How would you treat this case??
Is there any evidence from the literature than any of the above ttts is more stable than the other?
Edit : Thanks for all the info and the kind feed back . I added more records to obtain the right advice. Actually I have already treated this case, but the case was refused on grounds of stability. The claim was extrusion is less stable that intrusion, and that may not have been the best treatment option for this patient.
The etiologic cause of this case to me was unknown. I couldn't really pinpoint any tongue thrusting. He definitely had increased FMPA , but I still thought may be the open bite was due to low calcium levels during early stages of development !
The patient's medical history was : hypoparathyrodism , and he is on Calcium replacement now. I know that requires milder forces for the fear of root resorption. He had TMD symptoms and clicking. Stabilizing splint was fabricated before starting treatment.
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As the question pertains to stability, long term data on posterior intrusion is still deficient. However, for high angle cases, extraction approach does seem to provide higher stability for anterior open bite correction. Furthermore, if the patient has a poor tongue posture, or any other habits, it should be corrected for a stable result.
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Is there a danger on the path of canines eruption due to the change in the direction of the incisors Root during the treatment with 2*4 in the mixed dentition, which is considered the guide for the emergence of the canines? Or is it that on the contrary, the correction of the incisors root situation will play a role in guiding the emergence of the canine and preventing the impaction?
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it depends on the type of malocclusion. for eg., ugly duckling is self correcting and in case brackets are bonded, may harm the roots of the laterals. issues like crossbites need to be addressed asap. So, it may affect the canine eruption, but depends on what kind of malocclusion we are dealing with.
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Everyone talks about aesthetics, CAD CAM and Zirconia today... and the following questions remained unanswered:
1. Marginal fit of 20-30 microns with gold versus 50-80 with CAD CAM?
2. Ductility of gold versus Zirconia versus the natural tooth wear?
3. Minimalistic tooth preparation for gold onlays versus full ceramic preparation requirements?
I would like to invite you all to have a look at my recent case and leave your comments, thoughts, feedback. critique....
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Nice lot!
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is constriction of the maxilla common in all malocclusion classes (I, II and III) ?
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Almustafa just put out a great question and great questions require direct simple answers. The answer is YES. There is to much confusion on Class III... It's just that you see it more there....So if you refer to skeletal type the answer is yes. This is because many malocclusions are caused by OSA or change in diet/posture.
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Does keeping the same NITI wire inside the mouth more than 6 months change its strength or effectiveness?
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keeping it more than 2 months affect it's effectiveness...and of course it should be replaced if permanent deformation occurs.
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Orthognatic surgery
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So far never used final occlusion splints post operatively apart from some cases that soft elastics required post operatively almost for 2 weeks ( maybe more ) to correct some mal-allignment 
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There is complete non occlusion on left side with entire 3rd quadrant present lingually to the upper arch. On right side proper class I occlusion.
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Can you post a photograph of the cross bite?
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There seems to be no evidence how to successfully align a transmigrated mandibular canine.
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I think an important determinant of the treatment success is the position of the apex of the impacted canine. If the tooth is migrated from its origin position in the arch to a large distance then the treatment duration of morbidity will superced the expected outcome. A suitable alternative can be surgical autotransplantiion in the socket of decidious canine.
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Evidence based dentistry started 20 years ago (1). Most Cochrane Systematic Reviews still end with the conclusion that recommendations for clinical practice cannot be made based only on the results of these trials and that more randomised controlled trials are needed to elucidate the interventions for treating a certain kind of malocclusion. Turning the Cochrane reviews into a tool that is more relevant in clinical practice will require implementation of a methodology allowing inclusion of non-RCTs while controlling for possible bias.(2)
1.. Richards D, Lawrence A. Evidence based dentistry. Br Dent J. 1995;179(7):270–3.
2. Teich ST, Lang LA, Demko CA. Characteristics of the Cochrane Oral Health Gro up Systematic Reviews. J Dent Eduacation. 2015;79(1):5–15.
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Do you agree with Meikle`s statement that If one asks whether RCTs have achieved their objective, or provided knowledge not previously available from retrospective studies or animal experimentation, then the answer would have to be no; it is also hard to justify the cost. What is particularly interesting is that knowledge based on years of clinical experience has been disregarded and then announced as if it was something completely new?
1. Meikle MC. What do prospective randomized clinical trials tell us about the treatment of class II malocclusions? A personal viewpoint. Eur J Orthod. 2005;27(2005):105–14.
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How long does the 6 1/2 Oz or 3/8 " elastic band retain its orthopedic force of at least 400 grams per side when it is used in Reverse Pull head gear? Is it necessary to wear more than 2 elastics in some cases?
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If you assess the cranial rhythm of a patient undergoing reverse pull headgear, a 6 oz. elastic used on both sides will shut down the patient's cranial movement to nearly eliminate any sutural freedom at all.  Without sutural movement between the skull bones, maxillary advancement is almost not possible.  Working with osteopaths has demonstrated to me that forward traction forces on the headgear are tolerated by the cranium when the elastic force is 3 oz. per side or less.  This force tolerance varies from patient to patient and you need an osteopathic technique to tell you what force is appropriate.  I use a 2 and a half ounce elastic per side and find that this is suitable for most patients to achieve excellent results.  The rule is, "don't shut down the cranial movement" because the cranial rhythm is what is required for cranial change. The results are far greater the using heavy elastic force which actually prohibits movement in the cranial structures rather than induce movement as we think it should.   
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Dealing with a similar case and currently considering using this technique. Has anyone used this and reaped the benefits? Kindly share your thoughts and case details if any.
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Bracketless fixed treatmenet was introduced to the profession by Musilli in 2008. See attached papers for more details.
kind regards
Ulrich Kritzler
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A 15 years old girl with buccaly erupted, distally inclined canine above lateral incisor.
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If the crwon mesially and the root distally , laceback is a good choice from initial phase
tip in MBT is 8 in upper canine , and its root move distally
if the root mesially, overlay is agood choice and can you use bends in fishing.
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My clinical impression is that there are significant advantages in closing space in both arches simultaneously.
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Hi All,
Thanks for your replies. I use URA's with FABP to reduce the OB, as a consequence the lower arch is often aligned well before the upper arch. I now wait a little before closing spaces in both arches together. Overall treatment time is 24 months, but upper arch fixed perhaps only 16 months
Kind regards
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Can anyone tell me a safe pharmacological agent/ herbal or homeopathic drugs that reduces the bone density after local application? I would like to use it for faster tooth movement. Thank you.
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You could try using topical corticosteroids.
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Orthodontics, Class II malocclusion, root resorption.
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Root resorption is due to continuous forces that are heavy enough to lead to necrosis of the periodontal ligament and last long enough to prevent the root from recovering from damage inflicted on its surface. Despite the evidence that Weiland reported a greater amount of root resorption with the use of superelastic archwires  in the last 30 years I have encountered a greater amount of root resorption in my  private practice of orthodontics when using stainless steel archwires over a long period of time. This opinion seems to be supported by the following article: Janson, Guilherme RP, et al. "A radiographic comparison of apical root resorption after orthodontic treatment with 3 different fixed appliance techniques." American Journal of Orthodontics and Dentofacial Orthopedics 118.3 (2000): 262-273. As the use of fixed functional appliances depends on using big stainless steel archwires it could be advisable to use the technique with the least amount of time for correcting class II. Chhibber, Upadhay and Nanda report that the twin force bite corrector only needs 3 to 4 month for class II correction (Esthetics and Biomechanics ion Orthodontics 2.nd edition 2015 Chapter 13.
Best regards
U. Kritzler
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What are the total costs incurred to the system and to the patient as out of pocket expenses, where insurance does not fund dental care, especially in case of cleft lip and palate?
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A small report on some aspects of pre-surgical cost was put out by the Dutchcleft group (see below) which might be of interest to you. Obviously the cost to different parties will vary greatly depending on what type of funding situation exists in the location the treatment is being conducted, so the generalizability of this is limited.
1. Konst EM, Prahl C, Weersink-Braks H, et al. Cost-effectiveness of infant orthopedic treatment regarding speech in patients with complete unilateral cleft lip and palate: a randomized three-center trial in the Netherlands (Dutchcleft). Cleft Palate Craniofac J. 2004;41(1):71–77. doi:10.1597/02-069.
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In full dimension wires we can calculate the effective torque, but can we calculate how much torque would be expressed in 0.019x0.025 SS wire in MBT prescription in 0.022" slot?
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1. Archambault A, Lacoursiere R, Badawi H, Major PW, Carey J, Flores-Mir C. Torque expression in stainless steel orthodontic brackets. A systematic review. Angle Orthod. 2010 Jan;80(1):201–10.
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We all agree that FAs works as heavy Cl II elastics which make a combination of dentoalveolar and skeletal effects if used in the appropriate age. A direct desirable effect of the FAs is the combination of retroclination and destalization of the maxillary anterior teeth. For the RNA, how could the RNA achieve that with the acrylic button just palatal to the maxillary anterior teeth?
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Thank you, dr Khen -
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What accounts for the decrease of the distance measured on the dental arch, between the mesial surfaces of first permanent molars, when changing from mixed dentition to the permanent dentition?
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This refers to the so-called late mesial shift (Baume~1958). The second primary molar's mesial-distal dimension is greater than the premolar that replaces it. This residual space is loss with the mesial migration of the first permanent molar, thus a decrease in arch length between the permanent molars.
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Biology of tooth movement
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During the initial tipping phase (approximately 24hrs), significant compression and the associated ischemia and inflammation initiate the recruitment of chemo-kines and cytokines. Then there is a lag phase during which not much movement occurs, allowing for these to arrive at the site where bone resorption will occur (and the subsequent movement of the tooth thru the bone). There is not a continual state of severe compression or ischemia associated with the low forces used in modern orthodontics, in order to limit undesired side effects of root resorption. For additional information, you can access our chapter on "Neural Modulation of Orthodontic Tooth Movement" in the textbook "Principles in Contemporary Orthodontics". Hope this helps.
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Orthodontic
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The Distal Screw distalizes molars with no anterior anchorage loss, moreover the molars are distalized bodily, for more information:
Efficiency of the distal screw in the distal movement of maxillary molars.
Cozzani M, Zallio F, Lombardo L, Gracco A.
World J Orthod. 2010 Winter;11(4):341-5.