Group 4 Created with Sketch.

‎orthodontics In summary

Play All
55 Subscribers
Share Path Report
rss rss .
Farooq brings the key points, references and understandings from keynote webinars and papers in a concise podcast.

Providing easy access to gain the most from our esteemed speakers and experts.

*Important to note the information is from our interpretation as individual professionals, and may incorporate our opinions* Continue Reading >>
Farooq brings the key points, references and understandings from keynote webinars and papers in a concise podcast.

Providing easy access to gain the most from our esteemed speakers and experts.

*Important to note the information is from our interpretation as individual professionals, and may incorporate our opinions* << Show Less
Featured Audio
Orthodontics In Interview: PROFESSOR CARLOS FLORES-MIR CANADA Join me for the next interview in orthodontics with Carlos Flores-Mir
Carlos is a Professor in orthodontics with an exceptional contribution to the field. He has published over 350 peer review papers and is an award winning educator within dentistry. He is an associate editor for the Angle Orthodontist journal and JWFO.
We get to hear of Carlos’ story of how he came to be a leading authority in orthodontics, his opinion on class 2 correction, why he chose to present clinical failures at this year’s AAO meeting, and his favourite hobbies.
Newest Audio
Orthodontics In Interview: PROFESSOR CARLOS FLORES-MIR CANADA Join me for the next interview in orthodontics with Carlos Flores-Mir
Carlos is a Professor in orthodontics with an exceptional contribution to the field. He has published over 350 peer review papers and is an award winning educator within dentistry. He is an associate editor for the Angle Orthodontist journal and JWFO.
We get to hear of Carlos’ story of how he came to be a leading authority in orthodontics, his opinion on class 2 correction, why he chose to present clinical failures at this year’s AAO meeting, and his favourite hobbies.
Class 2 Biomechanics with Aligners Join me for a summary of Dr Bing Fang’s lecture entitled: Biomechanical Research and clinical application of orthopaedic Treatment on Adolescent mandibular retrognathia. It was part of the first International Orthodontic Foundation online symposium, with Ravi Nanda: https://www.iofglobal.org
Intrusion with aligners
Clinical risk of anterior intrusion, can cause retroclination / proclination.

Plan with assessing lower incisor inclination relative to skeletal structure from a cephalogram
To figure out this problem they designed a finite element study to figure out what happens for different lower incisor inclinations
If the IMPA angle exceeded 100 the intrusive force will be in front of CR resulting in a moment causing lingual root torque and buccal crown torque
If the IMPA angle less than 100 the intrusive force will be behind the CR resulting in a moment causing buccal root torque and lingual crown torque
Plan intrusion:

Proclined teeth: intrusion and retraction at the same time with lingual crown torque
Retroclined teeth: Intrusion, with labial crown torque



Advanced Mandibular Spring AMS with aligner

Telescopic arm with spring.
Distalization of posterior and no movement in the anterior along with anterior bit turbos
Class II elastics are used day time, appliance at night
Inserts into connectors which are imbedded into the aligner
How does it work

Finite model analysis, favourable for advancing the mandible – PDL even stress, promote mandibular growth, stress on condylar anterior aspect and posterior glenoid fossa



#alignerorthodontics #class2 #Bingfang #farooqahmed
Early treatment (phase 1): Topic summary AAO meeting 2022 Join me for a summary of early treatment lectures from this years AAO meeting from May 2022. Topics will cover trauma, airway diagnosis and orthodontic treatment, and optimal timing of class 2 correction
Lectures:

Dental Trauma Eustaquio A. Araujo
Airway-centered Orthodontic Diagnosis & Treatment for Pediatric Patients Hong He
Predictors of Success for Early Mixed Dentition Treatment Heesoo Oh


Dental Trauma Eustaquio A. Araujo
Trauma protocol

Reposition with firm grip
16x22NT
Bite props to eliminate occlusal interference
Soft diet
Recall 2 weeks

Re-implantation of avulsion success

Less than 1hour 75%
Up to 24 hours 25%



Conclusion – look at the neighbours

Airway-centered Orthodontic Diagnosis & Treatment for Pediatric Patients Hong He
Nasal breathing Vs mouth breathing

NB = Tongue rests on the palate. MB = Tongue floor of the mouth
NB = Pressure of the cheeks is balanced with the tongue. MB Pressure of the cheeks is unopposed by tongue
NB = U shape upper arch (normal). MB = V shaped arch

Tonsillar hypertrophy

Oropharynx obstruction
Ventilation impaired
Occlusal effects

Tongue and mandible forwards Iwasaki 2017
Mandibular protrusion

Class 3 malocclusion




He’s study n=1776
Greater tonsillar hypertrophy in children with class 3

Caution as limited studies pre-pubertal and controls also improved in scores
Predictors of Success for Early Mixed Dentition Treatment Heesoo Oh
When is it best to treat class 2 cases
Study: optimal timing of the effectiveness and efficiency

Early class 2 equally effective not as efficient
BUT

Mean changes = mask individual response
Philosophy – correct some / all features of malocclusion

Reduce / eliminate need for phase 2




Angle orthodontist Oh 2017

Treatment protocol

7-9 years
Headgear night wear 11 hours
RME
2 x 4 fixed appliances
Lingual arch
Greater 33 months = unsuccessful (time only marker of success, as occlusal and skeletal the same at the end)

Results

15/54 (28%) phase 1 only
Comparison

No differences in occlusal and skeletal outcomes


Time

Total treatment times (phase 1 + phase 2):

67% less than 18 months in treatment active treatment
20% 4-5 years of total treatment time
Managing Complex Cases in Orthodontics. Kleber Meireles and Andre Machado Managing Complex Cases in Orthodontics. Kleber Meireles and Andre Machado
Join me for a summary of a dynamic conversation between Kleber and Andre, It was a lecture full of biomechanics and the podcast will focus on specific examples with fixed appliances and aligners.
Fixed appliance mechanics
1. Canine retraction in extraction case with buccal canine: sectional mechanics
o Conventional sliding mechanics retract canine but also distally tip and rotate distal in
o Loop mechanics
§ Mechanics = canine retraction – line of force buccal
§ Side effects = no distal in rotation due to line of the force buccal
§ Mechanics = sectional mechanics allows counter moment to increase as canine retracts = bodily retraction
§ Side effect = no distal tipping of the canine
2. Retraction of upper anterior teeth in extraction cases
o Loss of anterior torque on retraction,
o Torque mechanics:
§ Stop active space closure
§ Apply anterior buccal crown torque
§ When recovered, continue final space closure
Aligner biomechanics
Comment: Physics is physics & there is nothing magical appliance
Distalisation with aligners
· Not effective with aligners
· Mechanics: Distal tip
· Side effects: No root movement
Solution
· Attachments for molar distalisation:
o 6mm: horizontal requires 120g, 10mm from the CoR = 1200gm force required for counter moment, however no aligner material can deliver this force or provide retention to the force, therefore not effective tooth movement
o 4mm attachment requires greater force, 1200/4 = 300g
Issues with aligners
· Rely more on companies to do the treatment planning
o AI does not have knowledge of the roots and its angulation – which is difficult to correct even with conventional braces
· Lack of stiffness in the aligners make it difficult to apply counter moment
o For example incisor retraction in extraction cases
Thank you to our sponsors for supporting this episode
I hope to see you Porto for the Simply Ortho congress on the 9-11 of June
Dental Sleep Medicine and NICE guidelines Professor Ama Johal Join me for a summary looking at Dental Sleep Medicine and NICE guidelines. This summary describes obstructive sleep apnoea and the new guidelines of its management. There is a focus on the Mandibular Advancement Splint and the occlusal outcomes for patients using this appliance. This lecture was given by Professor Ama Johal. Ama is a member of the advisory committee to NICE sleep apnoea/hypopnoea syndrome
Introduction
Obstructive sleep apnoea –
· Sleep related breathing disorder
· Poorly understood
· 70% collapse retroglossal area
· Stops breathing
· Body movement occurs – body tries to wake patient up as suffocating
o = disturbed sleep
Health consequences
· Day time sleepiness
· Hypertension, heart disease, stroke – all stroke patients screened for OSA
Treatment
· Severe / mod- gold standard Continuous positive airway pressure CPAP
o Filters air and pushes at high force
o To be effective 4-6 hours, 7 days a week – NOT curative
o Compliance / adherence 30%
NICE guidelines 2021
· Symptomatic receive CPAP
· if not comply then if a person Mandibular Advancement Splint
· Require good dental and periodontal health
· Age 18 +
MAS appliance
1. Anatomical – increase size of pharyngeal airway
a. Mandible move forwards, tongue advances with it
i. Post lingual - Best impact of patients who have tongue contribution to collapse 70% of patients
2. Reduces airway collapsibility
3. Physiological role – stimulate dilation of upper airway muscle – improving muscle strength and control
MAS appliance
semi customised Vs customised
Johal 2018 S/R
o Overall effects better with customised Vs semi customised
§ AHI 3
§ Daytime sleepiness 1
§ Self reported wear: 7 Vs 3 nights per week
§ Pt preference 95% prefer customised to semi-customised
Ideal design features customised Johal 2018
· Good retention - customised
· Semi adjustable – incremental advancement
o Allowing for further advancement and slow increase in airway
· Full occlusal coverage
· Minimal vertical opening
In high angle cases clockwise rotation of mandible – compresses post-palatal area and worsens airway IF increase vertical opening. Minimal occlusal opening prevents clockwise rotation
Follow up long term
· Unwanted occlusal change
o Mesial molar movement
o Reduction of OJ and OB approx. 1mm
o Proclination of 1mm lower incisors
Thank you to the sponsors who have allowed the podcast to continue, Triple O, Orthocare and the Aligner Intensive Fellowship.
Subscribe to get summary podcasts and blogs in orthodontics
Orthodontics In Interview: STEFFEN DECKER UK Join me for the next interview in orthodontics with Steffen Decker
Steffen is a leading lingual an aligner provider and a Kois recognised specialist. He has been a global advisor for 3M and is a key opinion leader for Align technology.
We get to hear of Steffen’s story of how he came to use lingual appliances and aligners, his opinion on interceptive / phase 1 treatment and where he sees the future of orthodontics.

Facebook: @steffen.decker.503
Instagram @theorthodonticspecialist Instagram
MARPE - SARPE: Sense and NON-sense Björn Ludwig Join me for a summary of Björn Ludwig’s lecture exploring Miniscrew Assisted Rapid Palatal Expansion (MARPE) and Surgically Assisted Rapid Palatal Expansion (SARPE). Björn described how MARPE works, aspects of design and his clinical process.
Effects of MARPE

Parallel opening of suture 2mm greater at 6 region than RME (S/R Krusi 2019)
Facial changes

Widens Zygoma
Nasal base expands
Changes to the orbit – no significant but beware Brutally evasive!


No periodontal side effects with MARPE (limited evidence) S/R Vidalon 2021
RME Vs bone borne, hybrid = bone borne no dental side effects: Canan 2017

Age
MARPE Vs RME

Age up to 11, no difference in outcomes Bazargani 2021

Retention after MARPE
At 7 months: suture has not fully remodelled

Retention is needed for 1 year to allow full remodelling
Type of retainer

TPA does not maintain bony changes Prado 2014
TPA with TADs = prevent bony relapse



Expansion rate of MARPE

Fast Vs slow bone borne

Fast (2-3 x activation per day) Vs slow (2 activations per week)

Slow expansion MARPE: Sutural opening still occurs Pulver 2016 (Rabbit study)
No diastema





Activation process: Force controlled polycyclic activation

Activation occurs if the force is 500g, key indicates activation Winsauer 2021

Airflow

Increase in airflow with MARPE
White paper from AJODO on OSA – limited evidence

Our job is to get rid of crossbites NOT to resolve OSA


MARPE effective at resolving crossbite S/R: Kapetanović 2019

MSE reduce OSA: Brunetto and Moon 2022

Björn considered a good side effect, not the main cause





Class 3

RME most effective in class 3 cases
Alt-Ramec Eric Liou 2005
3 x day = maxilla moves downwards and forwards due to position of buttress
Facemask

Facemask in the night, and class 3 elastics in the day

A point advance 3mm: MARPE + facemask study: Maino 2018
Realistic ½ unit correction – borderline correction





SARPE Vs MARPE

SARPE mainly changes maxilla, maintains aspects of midface
MARPE changes to midface

Take home messages

Hi tech is good but low tech is key
No body said it was easy, and orthodontics is not easy

For more information see Benedict Wilmes guest blog on Kevin O’Brien’s Orthodontic Blog
Maxillary skeletal expansion using MARPE: Akram Alhuwaizi Join me for a summary of  Akram Alhuwaizi’s lecture on MARPE – Miniscrew assisted rapid palatal expansion. This summary explores MARPE from a clinical aspect, assessing the advantages and disadvantages, followed by a case discussion of success and failure, a discussion of MSE and lessons learned for designing MARPE.
The full lecture is available on Akram’s youtube channel:
Maxillary Skeletal Expansion using MARPE from A to Z (Updated) - YouTube
Introduction
Purpose of expansion

Correction of crossbite
Creating space
Pre myofunctional treatment
Widening smiles

Methods available

Removable appliance
Quad Helix
Rapid Maxillary Expander RME
Surgically assisted Rapid Palatal Expansion SARPE

Expansion methods
Ideal features of expansion appliances are to achieve bodily movement, minimal compliance required from the patient, applicable to a range of ages and straightforward for patients
MARPE experience
Case 1

Attended Peter Ngan lecture Arab conference
Surgical case requiring expansion – 2019
4 palatal TADs
FAILIURE – TADs moved, one got embedded into the palatal tissue, no significant expansion occurred

Cause of failure
Hyrax position:

Too posterior = near to Pterygo palatine suture and the zygomatic buttress which causes more resistance to the expansion
No guiding arms, greatert risk of dental movements but they help in seating of the appliance
Lack of guiding arm allowed rotation of the device by failure of only one TAD.

TADs

Length: Short: Ideally bi-cortical engagement to avoid bending and increase retention

Appliance design

There was a play between the TAD and the device
Lab fabricated loops, not precision fit

Case 2
Design

Used 2 TADs 2mm D/12mm L
Guiding arms to the 1st molars
Hyrax more anterior
Good fit abutment / screw and expander
Longer screws – bicortical engagement
Younger patient and female

Successful palatal expansion
Orthodontics In Interview: PROFESSOR RAVI NANDA Join me for the next interview in orthodontics with Ravi Nanda
Ravi is an authority in orthodontics, having authored 10 textbooks and published over 200 peer review publications, he is also the current editor-in-chief of Progress in Orthodontics
We get to hear of Ravi’s story of how he came in to orthodontics, his drive to ask research questions and how he has achieved so much. Ravi describes his mentors, and explains why he has never stopped learning, and why no orthodontist should either.

Facebook: @ravi.nanda.35
Instagram: @ravinanda

Textbooks
Esthetics and biomechanics in orthodontics
https://www.elsevier.com/books/esthetics-and-biomechanics-in-orthodontics/nanda/978-1-4557-5085-6
Principles and biomechanics or aligner treatment
https://www.elsevier.com/books/principles-and-biomechanics-of-aligner-treatment/nanda/978-0-323-68382-1
Load More Audio