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Farooq Ahmed에서 제공하는 콘텐츠입니다. 에피소드, 그래픽, 팟캐스트 설명을 포함한 모든 팟캐스트 콘텐츠는 Farooq Ahmed 또는 해당 팟캐스트 플랫폼 파트너가 직접 업로드하고 제공합니다. 누군가가 귀하의 허락 없이 귀하의 저작물을 사용하고 있다고 생각되는 경우 여기에 설명된 절차를 따르실 수 있습니다 https://ko.player.fm/legal.
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Interviews with mathematics education researchers about recent studies. Hosted by Samuel Otten, University of Missouri. www.mathedpodcast.com Produced by Fibre Studios
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orthodontics In summary
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Farooq Ahmed에서 제공하는 콘텐츠입니다. 에피소드, 그래픽, 팟캐스트 설명을 포함한 모든 팟캐스트 콘텐츠는 Farooq Ahmed 또는 해당 팟캐스트 플랫폼 파트너가 직접 업로드하고 제공합니다. 누군가가 귀하의 허락 없이 귀하의 저작물을 사용하고 있다고 생각되는 경우 여기에 설명된 절차를 따르실 수 있습니다 https://ko.player.fm/legal.
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*
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Manage series 2830917
Farooq Ahmed에서 제공하는 콘텐츠입니다. 에피소드, 그래픽, 팟캐스트 설명을 포함한 모든 팟캐스트 콘텐츠는 Farooq Ahmed 또는 해당 팟캐스트 플랫폼 파트너가 직접 업로드하고 제공합니다. 누군가가 귀하의 허락 없이 귀하의 저작물을 사용하고 있다고 생각되는 경우 여기에 설명된 절차를 따르실 수 있습니다 https://ko.player.fm/legal.
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*
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1 CBCT, what’s the harm and should it be routine? | 9 MINUTE SUMMARY 9:12
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좋아요9:12
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좋아요Join me for a summary of CBCT use inorthodontics, where I look into the current risk of cancer with CBCT use, the differenceit can make to treatment planning, and the 3 most common incidental findingsorthodontists should be aware of. This was one my highlight lectures from lastyears British Orthodontic Conference by Consultant Dental Radiologist, SimonHarvey. How much radiation comes from dentalCBCT, medicine? Effective dose of modern machines: · Dose from full DPT with adigital system = 20-25µSv · KAVO, MoritaX800 4 x 4cm =16uSv · FDA values of CT scans acrossthe boy from Lubar 1500uSv – Heart 16000uSv FACT 1 – effective dose in dental imagingare far below the rest of medicine Background radiation · Terrestrial radiation · Cosmic radiation o Flight London – New York 56uSv– cancer UK ‘does not effect risk of cancer, even for frequent flyers’, 4uSvper hour o Pilots do not have an increasedrisk of cancer UK 3000 uSv annually FACT 2 – EFFECTIVE DOSES IN DENTAL IMAGINGARE FAR BELOW THE NATURAL BACKGROUND RADIATION American Association of Physicist inMedicine AAPM “evidence supporting increased cancerincidence or mortality from radiation doeses below 100mSv is inconclusive” –cancer incidence and mortality from the use of diagnostic imaging are highlyspeculative, discourage these prediction of hypothetical harm FACT 3 EFFECTIVE DOSES IN DENTAL IMAGINGARE SO LOW, THEY DO NOT CAUSE CANCER Clinicians improved confidence andconsistency in treatment planning decisions. Impacted canine: · 3 radiographs - namely occlusal view, opg , periapical = still not confident about prognosis. · CBCT = clear follicle and impactedcanine proximity to adjacent tooth, = easily make up the decision estimatingprognosis o 22%-44% change of plans Hodges 2013 Stoustrup 2024 change in treatment plans ofimpacted teeth. The majority related to change in planning, with approximately10-20% a change in exposure Vs extraction. Keener 2023 · Cleft – quantification of bonedefect volume for grafting and localisation of ectopic teeth · Surgery – location of importantanatomical structures 3 Commonincidental findings for orthodontists · Dense bone island- o Radiopacity with no radiolucenthalo o Mandibular premolar region o Harmless, may resorb roots ifcontact it · Sinus mucosal thickening o Antrum floor intact o Only concern if 5mm+ · Trabecular pattern o Around inferior dento-alveolarcanal o No corticated boarder o normal in children, technicalreason is physiologic response as more RBC’s are developing surrounding thatarea. Pregnant women –yes as not irridating pelvic reason, CBCT beam is horizontal so no risk Conclusion 1. CBCT superior for resorption,material change to treatment plans and improve confidence of the orthodontists 2. No recommendation for takingfull mouth CBCT instead of DPT ahead of starting every orthodontic treatment asroutine and x rays should never go hand in hand 3. Small volume CBCT does is solow it doesn’t cause cancer…
1 Orthodontics In Interview: Aligners, Limited or Just Misunderstood? TOMMASO CASTROFLORIO 58:03
58:03 나중에 재생 나중에 재생 리스트 좋아요 좋아요58:03
나중에 재생 나중에 재생 리스트 좋아요 좋아요Orthodontics In Interview: Aligners, Limited or Just Misunderstood? tommaso castroflorio “The biggest difference in overcoming the limitation (of aligners) is to understand how to control aligner deformation” “We need to improve the available knowledge about aligners, because we need to control the companies, we do not need companies controlling us” “I think you can treat also complex cases, in my practice I treat extraction cases” “There are limitations in every technique, I think that the good orthodontist understands how to manage the limitation and how to overcome them” “Large mass 3D printing will represent an important evolution in orthodontics, aligners and braces” Tommaso explores the current understanding ofaligners, there limitations in terms of an appliance and scientific research. We explored the debate of aligners treating complex cases, why attachment designs still have limitations, and the role of aligners as functional appliances. We discuss emerging concerns of micro and nano-plastic toxicity andenvironmental concerns of aligners. TIMELINE 00:00:00 Introduction of Dr Tomasso Castroflorio 00:00:51 Tomasso's Early Experiences with Aligners 00:08:21 What are the Limitations of Aligners? 00:11:24 How do we Overcome Limitations with Aligners? 00:17:59 Should Aligners be Restricted to Mild to Moderate Cases? 00:20:22 Research IndicatesAligners Only Tip Teeth into Extraction Sites, Do you Agree? 00:25:50 Importance of Visualization in Orthodontics? 00:29:27 Are Functional Appliance Aligners Advantageous over Conventional Functional Appliances? 00:35:08 Has There Been Over-emphasis on Attachment Design? 00:44:18 What are the Consequences of Microplastics and Aligners? 00:50:32 What is the Future of Aligners? 00:53:54 Who do you Admire the Most in Orthodontics 00:55:36 Advice from Tomasso to all Orthodontists Click on the link below to view previous episodes, to refresh topics, pick up tricks and stay up to date. Please like and subscribe if you find it useful! Please visit the website for this interview podcast: https://orthoinsummary.com/orthodontics-in-interview-aligners-limited-or-misunderstood-tommaso-castroflorio/ #orthodontics #farooqahmed # tomassocastroflorio # aligners # clearalignertherapy #orthodonticsinsummary #orthodonticsininterview Farooq Ahmed…
Join me for a summary of recent long-term research of resorbed teeth due to impacted canines. This podcast is based on an excellent lecture by Julia Naoumova delivered at last year’s British Orthodontic Conference. Part 2 with focus on the prognosis of resorbed teeth from impacted canines, and follows on from part 1 with explored outcomes of open Vs closed exposures of impacted canines – see here for part 1. Root resorption of incisors reported at 19-67% Erikson 2000 Walker 2005, Mitsea 2022 Anna Dahlén and Julia Naoumova 2024 retrospective CBCT study n =27 incisors Mean Follow-up average 9 years (5.5-14.6) Patient reported outcomes Survival 100% Horizontal grade 3 moderate resorption n=17 (resorption inner dentine not involve pulp moderate) Horizontal grade 4 severe resorption n=12 (pulp exposed severe) Vertical grade 3+ severe resorption n=7 (resorption 2mm-1/3rd moderate)o Vertical grade 4 extreme resorption n = 1 (resorption 1/3rd +) No significant difference in any grade of resorption long term of the following: Symptoms Mobility and ankylosis Discolouration Increase gingival pocketing but not clinically significant RR horizontal changes with time No change 81% Worse 4% Improve 15% RR vertical changes with time No change 43% Worsen 57% Expected as had orthodontic treatment as well Previous research 1-23 years Survival 93-100% Falahat 2008 , Bjerklin 2011, Becker 2005, Jönsson 2007 Jönsson 2007 showed grade 1 mobility when root length < 10mm Conclusion: Extraction of asymptomatic based purely on root resorption should be routinely performed Paper by Anna Dahlén and Julia Naoumova 2024 Longitudinal study of root resorption on incisors caused by impacted maxillary canines—a clinical and cone beam CT assessment https://doi.org/10.1093/ejo/cjae052…
1 Impacted canines, what’s the latest? Part 1 | 6 MINUTE SUMMARY 6:30
6:30 나중에 재생 나중에 재생 리스트 좋아요 좋아요6:30
나중에 재생 나중에 재생 리스트 좋아요 좋아요Join me for a summary of the management of impacted canines, the latest evidence regarding different techniques for alignment. This podcast is based on an excellent lecture by Julia Naoumova delivered at last year’s British Orthodontic Conference. Part 1 will focus on recent findings of a modified open exposure technique Vs closed exposure, in terms of duration but also other key outcomes, health, pain, use of analgesics, time absent from school and costs. The next episode, part 2, will look at the prognosis of resorbed incisors related to impacted canines long term. Previous research no difference between closed Vs open exposure for alignment, aesthetics, treatment time, surgical success, treatment times. Limited to 2D views Parkin 2017, Sampaziotis 2018, Cassina 2018. Questionnaire of current decision making of open Vs closed: n=48 orthodontists = current clinical decision making by orthodontists based on preference Naoumova 2018 Multicentre RCT Margitha Björksved 2018, 2021 Modified open exposure with Glass ionomer OPen Exposure, first described by Nordenval 1999 6/12 of spontaneous eruption Traction with orthodontic appliances Results Total time: no difference 26 months (95% CI −3.2 to 2.9, P = 0.93) Canine eruption time: Open exposure quicker by 3 months 8.5 months Vs 11.5 months (95% CI 1.1 to 4.9, P = 0.002). With no traction in open exposure group No difference in periodontal status, root resorption, surgery time, complications, Pain: greater in closed group Greater pain with bilateral open exposure Closed exposure more painful applying traction Analgesics use (preliminary data): Day 1 nearly all patients use Day 5 drops to less than 50% of patients use Day 10 most have stopped taking analgesics Costs: – no difference €3,400 healthcare costs €6,300 including patient costs Missed days of school (preliminary data) Day 1 - 76% open Vs 65% closed exposure Day 2 - 3% open Vs 6% closed exposure Open exposure with GOPEX Not appropriate for: Close to adjacent tooth, to avoid material on adjacent teeth Very high canine position Older patient – start traction straight away, probability of ankylosis increases Cernochova 2024 1% at age 15 4% at age 20 14% at age 25 97% at age 45 Conclusion: Both open and closed techniques are viable, however with open exposure of GOPEX technique the canine erupts spontaneously and quicker Less pain with open exposure unless bilateral Most patient will miss 1-2 days from school Pain relief common for the first 5 days, but maybe used until day 10 Papers Open vs closed surgical exposure of palatally displaced canines: a comparison of clinical and patient-reported outcomes—a multicentre, randomized controlled trial Margitha Björksved Open and closed surgical exposure of palatally displaced canines: a cost-minimization analysis of a multicentre, randomized controlled trial Margitha Björksved…
1 Will dental monitoring change orthodontics? 6 MINUTE SUMMARY 7:10
7:10 나중에 재생 나중에 재생 리스트 좋아요 좋아요7:10
나중에 재생 나중에 재생 리스트 좋아요 좋아요Join me for a summary looking at remote monitoring in orthodontic clinical practice, and if it can improve, quicken and enhance orthodontic clinical practice. This podcast is based on an excellent webinar by Jonathan Sandler and Juan Carlos Varela, as part of the Angle-net webinar series. I discuss how Dental Monitoring works, the proposed advantages and a review of the emerging research on this innovation in orthodontics. What is Dental Monitoring? AI software which assesses occlusal and dental changes through a series of intra-oral photographs taken by the patient using their smartphone How does it work? Upload STL / digital study model Ai segmentation of teeth which maps digital study model to the photos Aligner fit analysis: Discrepancy between tooth surface and aligner fit Either proceed, continue wear or see clinician Fixed appliances Assess rate of movement and schedule appointment Other proposed benefits Oral hygiene assessment Breakages Retention changes What do patients think of it? Patients attitudes to remote monitoring 81% interested in reducing number of appointments due to telemonitoring – Dalessandri 2021 25% of patients found scans difficult to perform, with duration of scan 2-17 minutes Hansa 2020 Does it reduce appointments and make treatment quicker? Sangalli 2024 Decrease the number of in-office visits by 1.68–3.5 visits No difference in treatment duration No statistical reduction in emergency appointments Are treatment outcome better (aligners)? No difference in tooth movements Hansa 2021 No difference in number of refinements Hansa 2021 PAR changes – no difference in quality of outcomes Jarad Marks 2024 Is oral health better? DM reduced plaque scores Costi 2019 31% Improved hygiene Manzo white paper Other innovations with remote monitoring? Remote STL files Scan taken without patient attending the practice Scanbox Formulate STL file and fit aligner in surgery Is Dental Monitoring accurate? Ferlito 2022 80% repeatability from 2 scans 44.7% repeatability and reproducibility Discrepancy between scanbox and intra-oral scan varied between 0.5-1.9mm, angular measurements maximum error 8.9 degrees Conclusion 2-3 appointments less No difference in overall duration Some people struggle to use Accuracy and repeatability variable No difference in the quality of the outcome Areas which are of concern Unknown accuracy of occlusal assessments from a reliable retruded contact position Patient motivation maybe better delivered in person Ai environment cost 2-3% of energy used by data centres Other ways to reduce time? Diagnostic and treatment planning acumen Identify main aspect of malocclusion and address through efficient mechanics…
1 Overcorrection with aligners, when and how? 7 MINUTE SUMMARY 8:07
8:07 나중에 재생 나중에 재생 리스트 좋아요 좋아요8:07
나중에 재생 나중에 재생 리스트 좋아요 좋아요“We do not accept the weaknesses of out appliances as absolutes, but rather we adjust out treatment mechanics to account for them Mazyar Moshiri, “If you are not willing you use elastics – you are not able to get finishing like braces” Mazyar Moshiri “We cannot have a reasonable discussion of efficacy and accuracy until we study the appliance as orthodontic clinicians, and not as scientists Mazyar Moshiri Join me for the first summary of 2025, exploring finishing with clear aligners. Mazyar Moshiri explores overcorrection with aligners, when they should be used and his protocol. It was a lecture from last year’s AAO winter meeting.. This episode consists of overcorrection methods of 4 malocclusions: deep bite, anterior openbite, class 3, and expansion. Maz also shares his pearls on what to watch out for when using clear aligners with overcorrection. EXTRAS: Mazyar Moshiri has kindly given permission for the summary slide of his overcorrection protocol to be included in the podcast notes, please see the podcast website https://orthoinsummary.com/ Overcorrection Deep bite - achieve AOB Over-intrusion lower incisors to achieve a 50-100% of total movement predicted Favourable if proclaining teeth, unfavourable if retroclining Use of attachments on premolars, note the hierarchy of attachment design places anchorage for anterior intrusion 5th, “Drs have to doctor the Clincheck”. Anterior openbite Posterior intrusion – overcorrect with occlusal bite blocks class 3 triangular elastics canine and premolars Force down on posterior bite blocks May require controlled relapse following overcorrection, done in refinement NOTE – aligners continuous force system, reciprocal extrusion of anterior teeth is expected Class 3 case Retract lower incisors with retromolar tads and 6 Oz 3’16th Side effect – increase in curve of spee – similar to retraction on a NiTi wire, aligner is not stiff enough to resist Correction in refinement with anterior intrusion to eliminate premature contacts, DO NOT EXTRUDE POSTERIOR TEETH, as aetilogy is anterior iatrogenic extrusion Expansion Overcorrection of 1-2 mm, greater the further posterior Attachments, plan buccal attachments +/- palatal attachments, to account for likely buccal tipping, ensuring buccal root torque and preventing palatal cusp dropping Tip: for palatal cusp dropping place occlusal attachment on the palatal cusp to prevent extrusion during expansion Caution – if already in buccal version, consider limited correction…
1 Orthodontics In Interview: ALFRED GRIFFIN What can digital fixed appliances do better? LIGHTFORCE 40:26
40:26 나중에 재생 나중에 재생 리스트 좋아요 좋아요40:26
나중에 재생 나중에 재생 리스트 좋아요 좋아요“it's a platform for mass customization ” “I think Lightforce system has more friction than it should right now.” “We operationalize great outcomes.” “People that need to have a Cochrane review to prove to themselves the sky is blue, those are not the people that should be using Lightforce right now” Alfred and I discuss his digital bonding system, Lightforce, we explore the product as well as the strength of the claims around it. Alfred replies to criticisms of the product as we explore the emerging evidence of his digital bonding system. Alfred gives his opinion on the digital evolution within orthodontics, we have a candid discussion on the use of digital orthodontics and where there are still areas of significant improvement needed.…
1 Transverse assessment with a CBCT, is it the answer? 5 MINUTE SUMMARY 5:47
5:47 나중에 재생 나중에 재생 리스트 좋아요 좋아요5:47
나중에 재생 나중에 재생 리스트 좋아요 좋아요Join me for a look at CBCT and its use in the diagnosis of the transverse problem, and if it offers the solution to the debated topic. The podcast is based on a lecture by Chun Hsi Chung at this year’s AAO and appraises established methods of assessment, the Curve of Wilson and the WALA ridge line through the lens of a CBCT, as well as how to use a CBCT to assess the maxilla and mandible, which although revealed an ideal measurement, may not be telling the full story. What is ideal? inclination Curve of Wilson – CBCT study Vertical distance buccal and lingual cusp, 1mm vertical difference Buccal inclination upper 5 degrees Alkhatib 2017 Lingual inclination lower 12 degrees Alkhatib 2017 Andrews WALA ridge 2000 Bucco-lingual distance from crown ( FA point) to the most prominent portion of mandibular buccal alveolar bone (coincident with mucogingival junction) Hypothesised teeth over the basal bone , Glass 2019 1st molar = 2mm Ideal mandibular intermolar width FA – FA = WALA-WALA distance minus 4mm Normal width CBCT CBCT age 13 N = 79 Miner 2012 Maxilla slightly smaller mid point molar root on lingual bone -1.22 +/- 2.91mm CBCT Age 22.7 years Koo 2017 Measure CoR furcation 1st molar Mx – Mn = -0.39+/- 1.87mm CBCT 56 adults normal occlusion Lee 2022 PENN STUDY Buccal – buccal on crestal bone, furcation, 6s Lingual – lingual crestal furcation 6s Reliable reading on lingual aspect – buccal shelf bone prevents reliable readings Maxilla narrower than mandible -1 +/- 3mm Previous literature Tamburrino 2010 describes 5mm cortical plate level of furcation buccal aspect, however Lee 2022 showed for males 1.1mm +/- 4.5mm and 1.6mm +/- 2.9mm Without cbct can transverse diagnosis occur? Models = lingual surface at furcation level (4mm vertical below gingival margin) maxillary width slightly narrower than mandible -2+/- 3mm Issue with CBCT for diagnosis Standard Deviation is large = +/- 3mm, range from -4mm-+2mm falls into SD Issue with study model transverse analysis from 4mm at the gingiva Not validated…
1 Can Orthodontics Treat Paediatric Obstructive Sleep Apnoea? 8 MINUTE SUMMARY 8:13
8:13 나중에 재생 나중에 재생 리스트 좋아요 좋아요8:13
나중에 재생 나중에 재생 리스트 좋아요 좋아요Join me for a summary looking into the increasingly popular topic of paediatric obstructive sleep apnoea, a review of orthodontic treatments available, and how effective they are in this growing field of both medicine and dentistry. This episode is a summary of Alberto Capriglio’s lecture from the AAO and Carlos Flores Mir’s lecture at the IOF earlier this year. OSA - Defined upper airway dysfunction causing complete or partial airway obstruction during sleep Sleep = Slow wave sleep – constructive phase of sleep (recuperation of the mind) · Growth hormones secreted · Glial cells within brain restored · Cortical synapses increase in number – Moberget 2019 Outcomes to paediatric patients of SDB: (AASM) · delays in development, Poor academic performance, Aggressive behaviour, attention- deficit/hyperactivity disorder, , emotional problems in adolescence First line medical treatment – adenotonsillectomy · 40% residual OSA Effect palatal expansion 1. Roof the mouth = base of the nose - Increase in nasal airway volume - Reduction in OSA, if obstruction in naso-pharynx, 2. Short term reduction in OSA (not cure AASM) a. 20% improvement in AHI, 85% of cases Villa 2015 b. 15% got worse by 20% c. 57.5% residual AHI greater than 1 - not resolution 3. Caprioglio 2019 long term AHI return to initial scores, from 7 to 5 long term 4. Change in metabolism when combined with Vit D3 a. Vit D3 with RME increases reduction in AHI, sustained long term, Caprioglio 2019 AHI 61.9% Vs 35.5% long term Expansion other outcomes - school performance Bariani 2024 · AJODO – RME improves academic performance – o BEHAVOUR 1 of 8 parameters improved only for academic performance - change small 0.68 o COGNITIVE 1 in 8 improve Mandibular advancement Move mandible forwards and open space behind the tongue – oropharynx · Anatomical – increase size of oropharangeal airway · YAnyAn 2019 mandibular advancement for pOSA systematic review: 1.75 AHI reduction (CI) −2.07, −1.44) – modest change · However long term use required of the paediatric patient Orofacial features in children with obstructive sleep apnea. Fagundes Flores-Mir 2022 o No craniofacial features specific to pOSA – ANB, o However medical diagnosis through polysomnography may under-estimate incidence, o Broader diagnosis such as snoring, may over-estimate OSA AADSM 2024 – consensus statement · Expansion o Prevention: No consensus o Management: No consensus o Cure: Insufficient · Mandibular advancement o Prevention, management, cure – unclear More about OSA? To hear more about OSA, please check out the last interview on orthodontics in interview with Sanjivan Kandasamy, where we had a deep dive into OSA and where we are in our understanding today from the research Interview with Sanjivan Kandasamy on OSA…
1 Posterior Bolton’s Discrepancy. New Analysis To Solve Old Problems 5 MINUTE SUMMARY 5:35
5:35 나중에 재생 나중에 재생 리스트 좋아요 좋아요5:35
나중에 재생 나중에 재생 리스트 좋아요 좋아요Join me for a summary looking at The Posterior Bolton Discrepancy, a new take on the classic Bolton discrepancy. Wayne Bolton’s analysis has been critically appraised and the outcome from Patrick Foley and his team has been the formation of the posterior Bolton analysis, a new perspective on an established tool in orthodontics which seeks to give better insight into the location of tooth size discrepancies. He has also explored through his research the effects of premolar extractions and the likely outcomes of compromised occlusal outcomes, and where we should expect to see it within the posterior segment. Wayne Bolton established the Bolton’s ratio: · Mesial distal widths of teeth · Original study 55 well treated cases · Anterior – ideal 77.2% · Overall 91.3% - Anterior tooth size discrepancy maybe masked by a compensatory posterior discrepancy What is the posterior Bolton’s ratio · Not included in original study · Formular sum of mandibular 4s, 5s, 6s,/ maxillary 4s, 5s, 6s x 100 = 105.27% - data from original Bolton’s study Ratio confirmed by Mongillo 2021 · N=55 patients ideal outcomes · Digital casts (from plaster) · Posterior ratio 105.77% +/- 1.99% Vs Bolton’s data of 105.27% The effect of 4 premolar extractions on the posterior Bolton ratio Study: Mongillo 2021 (extraction of all 4s) Holton 2023 (extraction of upper 4s, lower 5s) · Posterior Bolton increases 107% +/- 2.23% (or U4s and L5s 106.52 +/- 2.52%), ideal digital removal of teeth · Observed Bolton’s was 110.48 % = 3.18% above Bolton’s ideal · Space of 1.1mm – 1.28mm remains in mandible when ideal arch – only 1 patient did not have space Clinical options i. compromise occlusion 1. slightly class 3 molar and class 1 canine 2. class 1 molar and slightly class 2 canine ii. IPR upper arch iii. Bonding · Anterior and posterior Bolton may be valuable in diagnosis and prediction than an overall Bolton…
1 What is Lightforce, will it change orthodontics? 6 MINUTE SUMMARY 7:06
7:06 나중에 재생 나중에 재생 리스트 좋아요 좋아요7:06
나중에 재생 나중에 재생 리스트 좋아요 좋아요Join me for a look into a recent digital innovation within orthodontics, Lightforce. I explore how the 3D printed labial bracket system works, the features and what the proposed advantages. Recent research exploring the advantages of Lightforce is discussed as well as my comparison to other digital innovations within orthodontic appliances. What is Lightforce · Manufacturing: 3D printed brackets Cad/Cam · Material: ceramic polycrystalline labial · Planning: Digital planning using Lightplan, visualisation of the outcome, alter both tooth position and bracket position, individualise prescription per bracket as a result of planned movements · Flexibility in positioning : Brackets do not have to be in the Facial Axis of the Clinical Crown, through altering the base thickness, the resulting moment can be achieved through the center of resistance · Torque expression is independent of the vertical position, for the same reasons · 0.018", 0.020", and 0.022", including combinations Stages 1. Submit records 2. Digital planning using lightplan, visualisation of the outcome, 3. Case approval 4. Indirect bonding tray – light-Tray, with brackets in situ Other advantages · Accuracy of 3D printed slot · Adapted base, less adhesive · Minitubes, biteturbos What are the proposed advantages and claims around Lightforce with evidence 1. Shorter duration of treatment due to precision a. JCO 2024 Wheeler 2024 Retropsectice study, 900 lightforces cases and over 300 conventional cases, 30% shorter and 30% fewer appointments. significant floors, with a lack of outcome measure and matching of controls Proposed advantages and claims around Lightforce ithout evidence 2. Reduced complications white spot lesions, dehiscences and root resorption as relate to duration 3. Remove issue of compliance or biomechanics as limitations to treatment outcomes 4. Saving Doctors time and money, remove repositions 5. Reduce or eliminate wire bends What are my thoughts? · Labial fixed appliances are catching up with aligners and lingual appliances · New possibilities of varying biomechanics, slot size, bracket position and customised prescription · Presence of Lighforce features within other appliances: o Customised brackets Insignia / Incognito o Digital planning: aligners, Insignia · No customisation of archwires with Lightforce · Not sure how Lightforce would reduce appointment intervals, ligation is conventional ligation through elastomeric modules, with plastic deformation Papers and videos on Lightforce https://www.jco-online.com/media/42415/2023_09_500_waldman.pdf JCO retrospective study https://www.jco-online.com/media/43897/2024_05_273_wheeler.pdf Youtube videos from Lightforce company, Alfred Griffin https://www.youtube.com/watch?v=zSNkYVgZ69I&t=2s&ab_channel=People%2BPractice Disclaimer 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. Contributions Contents and editing Farooq Ahmed…
1 What Happens To Adults When We Expand With Aligners? 6 MINUTE SUMMARY 6:57
6:57 나중에 재생 나중에 재생 리스트 좋아요 좋아요6:57
나중에 재생 나중에 재생 리스트 좋아요 좋아요Join me for a podcast summary looking at the effects of aligners when expansion occurs. In this podcast we will explore if bone loss occurs with expansion and why bone loss doesn’t necessarily cause recession. The podcast is based on the lecture and research by Greg Huang presented at this year’s AAO, and includes some more recent research on the topic PICO Population adults, 22 maxillary arches, 20 mandibular arches Intervention – expansion with aligners, average 3.7mm Control – minimal expansion, average 0.6mm Outcome – bone height and width from CBCT What was the bone loss? Maxilla · Minimal bone loss · Minimal bone height and width change Mandibular · Significant bone loss · 1.5mm height mandibular centrals · 1.4mm height premolars What movement took place of the incisors? Maxilla · Little change in bucco-lingual inclination Mandibular · Labial and buccal tipping increased What were the overall changes? Dental changes · 3-4mm of expansion · Mainly at premolars · Mainly buccal tipping, not bodily movement · Lower incisors procline Similar bone loss with aligners expansion from other studies, Zhang 2023 , Allahham 2023 Should CBCT’s debate within the literature regarding voxel size of a CBCT and false negatives. Accuracy of alveolar height CBCT 2019 Yuan Li BA systematic review showed · CBCT Vs skulls/patients · Bone height 0.03mm · Bone width 0.11mm My thoughts: no difference in cbct and gold standard, however the measurements were all of large structures, not bone height or thickness of less than the voxel size Predict bone loss · Upper arch no predictors as limited changes · Lower arch, same as for fixed appliances, but the quantity was missing o Proclination o Expansion o Buccal expansion and tipping Systematic review of orthodontics 48 articles de Llano-Pérula 2023 · Proclination · Less keratinised tissue · Thin biotype · Prior recession · Crossbite · Previous recession · Age Does bone loss = gingival recession? · Not generally found from Greg’s study · When significant bone loss of 3mm, far less than 3mm gingival recession Significant retraction of upper incisors and intrusion Kim 2024. Loss of Palatal bone however in retention palatal bone recovered Hypothesis · If PDL and periosteum are maintained epithelium is maintained · If the root moves back into the bone, the bone recovers – as PDL and periosteum osteogenic, and tension generated between PDL and periosteum · PDL-periosteum hypothesis – proposed by Greg Huang What I liked about Greg’s lecture was that he started with declaring his conflict of interest as an academic, both the royalties he receives for his books as well as research funding, which was great to hear and a trend I hope continues. Acknowledged the hard work of the research lead, his trainee and the time-consuming process of orientating CBCT slices of 1000s of images…
1 Orthodontics In Interview: SANJIVAN KANDASAMY Orthodontics and the airway, what does the evidence say? 1:15:54
1:15:54 나중에 재생 나중에 재생 리스트 좋아요 좋아요1:15:54
나중에 재생 나중에 재생 리스트 좋아요 좋아요“Airways are like TMD controversy on steroids ” “it amazes me we still think we can grow mandibles” “We have an appliance (expansion) and are trying to fit it into a diagnosis” “it is unethical to call yourself an airway orthodontist” Sanjivan describes why there is controversy in airways and orthodontics, where the research stands on treatment with expansion and mandibular advancement, can mouth breathing cause adverse development, the effects of extractions on the airway, as well as ethics within current practice of airway orthodontics. Click on the link below to view previous episodes, to refresh topics, pick up tricks and stay up to date. YouTube https://youtu.be/m2NIp1XhnxQ #orthodontics #farooqahmed # sanjivankandasamy # westaustralianorthodontics # airwayorthodontics # airway # OSA # SDB…
1 Can we grow mandibles with bone-anchored plates for class 2 correction? 6 MINUTE SUMMARY 6:44
6:44 나중에 재생 나중에 재생 리스트 좋아요 좋아요6:44
나중에 재생 나중에 재생 리스트 좋아요 좋아요Join me for a summary exploring an innovation of the use of bone-anchored plates in class 2 correction. This was a clinically novel idea presented by Hugo De Clerck, who has been an innovator in the use of bone-anchored plates and has published seminal papers on the topic for class 3 treatment. Hugo explores the use of bone-anchored plates in the mandible, combined with a Herbst appliance. He presents his data of 90 patients treated in Brussels by his research team. PROTOCOL Customised bone anchored plates in lower anterior mandible – digitally designed per patient with surgical guide Transmucosal between lower canine and 1st premolar Herbst: modified to attach from upper 1st molar to the lower bone anchored plates Procline upper incisors prior to fitting Bone anchored-Herbst Expansion of the upper arch 2-3 modifications to Herbst piston to lengthen during treatment Duration 10 months HOW DOES IT WORK Growth of the mandibular body: mainly, bone modelling. Average growth 5-7mm, whereas conventional herbst 2-2.5mm of chin projection. New growth of bone as ramus moves backwards, resulting in lengthening of the mandible Force generation: in similar to the conventional functional appliance, with contraction of medial and lateral pterygoid and stretching of the suprahyoid and temporalis muscle Lower incisor proclination: No lower incisor proclination: There is a distal force on the mandibular dentition instead of a forward force from conventional functional appliances, due to the appliance attaching to the mandibular body, not the dentition Condylar displacement: Longer duration, of up to 10 months which results in stimulation of growth of the body of the mandible, conventionally this stops with a herbst as the lower incisors procaine, resulting in only 2 months of condylar displacement and therefore less stimulation of growth Glenoid fossa remodelling. The glenoid fossa remodelled in a forwards direction, however it was small and unpredictable, with some posterior remodelling Rotation of mandible – similar to the conventional functional appliance, a posterior rotation reduces the effects, anterior rotation enhances, for every 1 degree 1.1mm increase projection. Achieve via expansion and removable appliance Upper molar distalisation: Hugo saw this as unfafourable and advised lengthening the herbst piston to reduce upper molar distalisation, therefore maximising mandibular lengthening Age 13-15 Not possible with miniscrews, due to the quantity of force Breakages of Herbst still occur Is growth maintained long term – unable to state No control as requirement for cbct of untreated patients. Contributions Contents: Farooq Ahmed Edited and produced: Farooq Ahmed…
1 How to extrude, intrude and expand with aligners reliably 8 MINUTE SUMMARY 9:06
9:06 나중에 재생 나중에 재생 리스트 좋아요 좋아요9:06
나중에 재생 나중에 재생 리스트 좋아요 좋아요Join me for a summary looking into difficult movements with aligners, why they are difficult, and a protocol derived from research on how to manage tooth movements with aligners. This lecture was given by Bill Layman at this year’s AAO, where he describes maxillary incisor extrusion, posterior intrusion, and controlled expansion. Introduction · Rate of refinement: 2.5 per patient Kravitz 2022 · 41% of aligner cases 3 refinements + · Switch to fixed appliances from aligners 1 in 6 Kravitz 2022 Staging and synergistic movements can reduce refinement rates Incisor extrusion Why is Incisor extrusion difficult? · Lack of undercut · Sqeeze teeth to engage, creating opposite effect due to V shape of a tooth – leading to loss of retention of the aligner · Interproximal binding through vertical contact point overlap or slipped contact points and a closed system of aligners Incisor extrusion staging steps: 1. Create undercut: Horizontal attachments are most effective, regardless of design Groody 2023 2. Create 0.1mm between teeth to relieve interproximal binding 3. First procline the incisors to increase surface contact 4. Then Extrude and retract Posterior intrusion Why is it difficult? · Multiple teeth and lack of anchorage, through anterior teeth · Crowns tip mesially during intrusion as an unwanted effect · What happens when we intrude: o Mesial tipping of posterior teeth Fan 2022 Finite element o Buccal and palatal attachments = less tipping buccal or lingual How to improve posterior intrusion · Sequential intrusion – 1st premolars · Tip posterior teeth 5-10 degrees distally · Horizontal attachment buccal / palatal · Consider attachment lingual Upper molars · Sequential intrusion · TADs not always needed, 5200 times bite on hard surface, enables posterior intrusion through masticatory forces Controlled expansion Why is it difficult · Aligners tip teeth buccally = creates occlusal interferences · Lack of rigidity of tray to exert forces = straight finish trays increase rigidity · Attempting to correct skeletal problems with dental solution · Greatest expansion in the premolar region · Expansion from the research showed progressive less posterior expansion o Molars expand less due to anchorage loss · Expansion through tipping How to improve posterior intrusion · Plan around premolar expansion · Expect 70% in premolar region, 55% molar and 46% canine · Overcorrection of canines 1.7mm (premolar region 3.4mm) Zhou 2020 · Maximum expansion seen is 4mm Conclusion: · Incisor extrusion: procline teeth with attachment, then extrude and retract o Include iPR · Posterior intrusion: Start with premolars and sequentially intrude posterior teeth o Add distal tip · Controlled expansion: Effective in premolar region o Plan with overcorrection Jay Bowman · “If you don’t build-in overcorrections you can’t get corrections” · “there many things that need improvement at the end that aren’t hard to do if start treatment with the overcorrections in mind” Contributions Contents: Shanyah Kapour Edited and produced: Farooq Ahmed…
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orthodontics In summary
1 Fixed or Removable, Which Functional Appliance Is Best?? 6 MINUTE SUMMARY 6:27
6:27 나중에 재생 나중에 재생 리스트 좋아요 좋아요6:27
나중에 재생 나중에 재생 리스트 좋아요 좋아요Join me for a summary looking at fixed versus removable functional appliances. This podcast sheds light on recent research comparing the main two types of functional appliances, which appliance offers the most advantages, and what patients think about the two appliance types. This was a lecture given by Ama Johal at last year’s British Orthodontic Conference, where the most recent evidence carried out by his PhD student Moaiyad Pacha. Moaiyad Pacha’s RCT 2023 – received Dewel 2024 clinical research award · Hanks Herbst Vs Modified Twinblock o Rollo bands o Expansion o No fixed appliances o Incremental advancement – no evidence to support but patient-centred · Overjet correction : More effective Herbst at 7mm Vs 5.8mm Twinblock , · Molar and skeletal changes : no difference o Twinblock = greater residual overjet after treatment p=0.2 · Dental changes : Herbst advance lower incisor greater 3mm Vs 1mm · Failure to complete : 17% Herbst Vs 37% twin block o 3 times greater likelihood of discontinue treatment OR 2.8 · Treatment duration: longer with Twinblock 1.5 months 8.8 Vs 10.3, and quicker rate of correction with Herbst · Chairside time : Greater than Twinblock 2.7 hours longer, 7.6 Vs 4.9 · Emergency appointments greater with Hanks Herbst 2.7 Vs 0.3 o Herbst mainly · Severe complications = same 0.5 o Severe complications – previously defined as involving lab work or break in appliance wear from Pasha’s SR 2020 Advantage of Hanks Herbst · Greater completion of treatment, 3 times less likely to discontinue · Quicker rate of correction, shorter duration, Disadvantages · Greater chairside time of nearly 3 hours · Greater emergency appointments, each patient needing 2-3 emergency appointments Qualitative · Both appliances – very negative to QoL and daily life · Aesthetic and self-image – worse with Twinblock · Patient preference – Herbst o Due to non-compliance and likely to get to the end · Positive Twinblock is flexible and easier to eat Conclusion was profound · Patients prefer Herbst, based on aesthetics, self image and non-compliance · Clinicians are likely to prefer Twinblock, quicker, easier, less emergencies Time to reconsider, and having both options, as well as both discussing of clinician Vs patient preferences, should decide which appliance…
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orthodontics In summary
Join me for a summary podcast exploring the topic of white spot lesions, and up-to-date research looking at how to manage lesions when they occur, when the right time is to treat the patient, and what minimally evasive options can be used in clinic. This was an excellent lecture from Gayle Glenn earlier this year at the AAO winter meeting. Four treatment options are discussed, Fluoride, CPPACP (Mi paste), resin infiltrate and microabrasion. Whitespot lesion background WSL Definition - subsurface deminieralization, intact outer layer, 1st sign of carious lesions Remineralisation – no additional agents Most rapid repair first 6 weeks without use of additional agents · Up to 6 months spontaneous improvement with good oral hygiene · Recommend 3-6 months monitor after debond: BEFORE consider additional treatment Fluoride · Decrease enamel dissolution · Increase reminerazation · Formation of fluorapatite · Products o Fl varnish reduce WSL occuring by 44%: § require plaque removal and wire removal § Not often used in clinical practice and requires repeat application · TREATMENT WSL o Fluoride low dose (toothpaste) o High Fluoride – hyperminerasied surface layer forms = seal off subsurface layer which remains demineralized. Bishara 2008 Resin infiltration Gray 2002 · Remove outer hypomineralised area with 15% HFL o Infiltrate with low viscosity o Improves aesthetics o Arrest lesion – however some demineralisation may remain o Lack long-term evidence o Most effective in research (RR:121.50, 95%CI: 51.45-191.55 Jiang 2023) MI paste (CPPACP) Frencken 2012 · Milk protein derived · Stabilizes Ca PO4 – ideal of for formed WSL · Creates Ca PO4 reservoir around bracket · Applied: o Brush above and below bracket or finger o Distributed by the tongue o Can be swallowed o Avoid eat and drink 30-60 minutes · Effectiveness for reminersation o Evidence unclear – conflicting sustematic reviews AlBukaiki 2023 no difference, same year Jiang 2023, it is effective, however exceptionally large range of values (RR:49.69, 95%CI: 0.87-98.51 and although RCTs, limited to assessing premolars only and different methods of assessment and duration of treatment. · TREATMENT FOR WSL o Wait 3-6 months following removal of braces o In retainer 3-5 minutes o Rinse out o Nothing to eat 30-60 minutes Microabrasion · Combination of acid and abrasive particles · Burinsh into enamel with slow speed handpiece · opalustre = 6% HCL + silica (low particle size, lower concentration with larger particle size than prophy paste = 12-160 particle size 1986 Krol) o 1 mm size of use o Burnished in using a polishing cup and slow handpiece o 1 minute · Not widely accepted o Partly due to variations in protocol o Use of rubber dam · Microabrasion and CPP-ACP proposed idea Ardu 2007 2022 Lammert · CPP-ACP both sides, with half of mouth also receiving 1 visit of microabrasion · After 6 months post debonding · Evaluate and repeat up to 8 times · Results o Mi paste group 9.3-8.1 size of lesion – statistically significant o Microabrasion and Mi paste group § 13.2 – 4.3 and reduce to 2.1 · Most improvement immediate after microabrasion o Compared difference of size of the initial lesion § 5.5 x reduction in CPPACP § 7.4 X reduction in microabrasion Clinical implication · Microabrasion = significant clinical time o Up to 8 minutes per tooth, can be up to 1 hour o Therefore clinical application § Perhaps isolated 1 or 2 teeth Conclusions: 1. Patients with WSL are usually not great compliers, giving additional products which require significant compliance, is practising research in isolation. 2. Microabrasion takes nearly 1 hour, role in clinical practice limited to isolated areas…
Join me for a summary exploring bullying and its relationship with malocclusion, with a contemporary review of evidence showing the psychological effects various malocclusions can cause young people. This podcast is a summary of Andrew DiBiase’s lecture last year at the British Orthodontic Conference. Andrew’s research explores what factors moderate bullying, and what factors can be protective against bullying. Introduction · Nearly 1 in 3 patients report teasing or fear of teasing as a motivating factor for orthodontic treatment Bauss 2023 AJODO · 1 in 7 patients attending our clinics are bullied Seehra et al., 2011 · Most upsetting feature of bullying teeth 60.7% Shaw · 13, 387 teenagers 25% report bullying o Around 7% related to teeth Definition of bullying: Olweus 1984 · Unprovoked and sustained campaign of aggression, towards someone in order to hurt them · Student exposed repeatedly to negative action on the part of one or more students o Harm, imbalance of power, organised, repetitive, harm experienced Who gets bullied and how? · Younger more – 10 year olds 22%, 15 year olds 7% · Girls are greater than boys by 5% · Boys low athletic competence o Judged on homour as well Langlois 2000 · Girls appearance o We do judge girls on physical appearance Langlois 2000 o 80% verbal - Cyber bullying – doest stop at the school gate Consequences of bullying · Short term and long term effects o Poorer academic performance o Crime o Self harm § 26% within young population and teeth occupying the reason in 1 in 5 young people Bitor 2022 AJODO o Low self esteem o Structural changes, medulla – related to fear (peer victimisation and its impact on adolescent brain) What features are more likely to result in bullying Dibiase, Jad Seehra 2014 · Greater rate of bullying · 2 div 1: 18% · Increased overjet 16% Tristão SR 2020 · Deep overbite · Missing teeth, anterior spacing · IOTN AC 9 and 10 · Regression – younger worse · Low athletic competence p 0.019 Conclusions · Relationship between bullying and severe malocclusion · Schoolchildren who report being bothered by their teeth report being lonelier at school and lower self-esteem · Malocclusion has a greater impact on females than males · Malocclusion and peer relations is moderated by self-esteem in girls, but not boys · Good peer relations protect against the negative impact of malocclusion in girls with low or average self-esteem…
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orthodontics In summary
Orthodontics and TMD, what is the role of orthodontics? “if you give a splint, it will not cure the TMD ” “It depends on the adaptability of the patient” “The role of the patient in the treatment is very, very important” Roxana describes her journey into TMD and orthodontics , what led her to attend courses worldwide and also set up her own course on TMD. Roxana describes what has created the controversy in TMD management , and answers recent questions from the literature of the role of both orthodontics and splints in TMD management To book onto Dr Roxana Petcu’s courses please visit www.lazarlearning.ro/cursuri/ or roxanapetcu_ (I have no financial interest) Click on the link below to view previous episodes, to refresh topics, pick up tricks and stay up to date. Please like and subscribe if you find it useful!…
Does whitening have a role in orthodontics? A popular cosmetic procedure which 1 in 4 adults partake in, and was proposed recently at a conference as part of finishing in orthodontics. So this podcast reviews whitening as a topic and the latest evidence in combining whitening with aligners. Reminder the podcast is an opinion piece and is the independent work of myself and the orthodontics in summary team. 24% of adults have whitening their teeth (dentalhealth.org) How does it work: Bleaching is the chemical changing of darker staining on teeth termed chromogens, with the active ingredient hydrogen peroxide. Hydrogen peroxide reacts to oxidize the chromogen, which becomes a lighter colored compound. Hydrogen Peroxide is not a stable chemical, so Carbamide peroxide is used, which roughly breaks down to 1/3 H2O2 when mixed with water. Hydrogen Peroxide UK limit 6%, or Carbamide peroxide 16% is used, USA, greater concentrations are used with 10% hydrogen peroxide for at home whitening, and 35% hydrogen peroxide for in office bleaching. Children UK guidelines GDC 2014 – no bleaching until 18, unless purpose of treating or preventing disease.’ USA: The AAPD 2023 s Safe and effective for whitening discolored teeth of children and adolescents. Avoid full-arch bleaching mixed dentition and primary dentitions Risks Sensitivity - about 80% of patient’s experience sensitivity Tooth sensitivity usually occurs at the time of treatment and can last several days Upper lateral incisors – greatest sensitivity Directly correlated with concentration Greater intensity if tooth was restored Bonafe 2013 Gingival irritation gingival irritation begins within a day of the treatment and can also last several days Susceptibility to demineralisation Suggested surface demineralization occurs as the pH of the whitening agent are acidic and hydrogen ions affect the enamel crystals, No difference when using manufacturers protocols including 35% H202 Tompkins 2014 However aggressive whitening: excessive use of in office whitening Shi 2012 How long does the whitening last Duration of correction, depends on lifestyle, with smoking and coffee reducing the correction. Expected 6-12 months of stable colour change. Wiegand 2008 Aligners Bleaching tray is different – reservoir for bleach, 1 or 1.5mm soft ethylene-vinyl acetate (EVA), Straight cut 2mm beyond gingiva or scalloped, with 2 mm extension onto the gingiva giving a better seal and greater patient comfort. Dosage dots to limit application beyond 2mm Aligners Usually gingival bevelled, but as effective as bleaching trays, Levrini 2020 improvement of 3.5 shades on average Seleem 2021 tooth sensitivity and gingival irritation does not disrupt of treatment 16% Carbamide peroxide Oliverio 2019, Levrini 2020 2 mm thick layer of gel is advised at incisal or facial central surface of the aligner Bleaching with attachments present, when bleaching complete attachments removed: hydrogen peroxide diffuses through spaces between enamel prisms The composite attachment was thought to affect pigment infiltration, however with enamel polishing after composite removal, color equalization occurs without discrepancies Staley 2004 Minimal change to aligner structure Oliverio 2019 Retainers as bleaching trays? Use of 0.8mm Zendura, no resivoir, effective bleaching with marked or extremely marked improvement in 78% of cases with 10% Carbamide peroxide, however but this changed the VFRs’ biomechanical properties, decrease in tensile strength and an increase in hardness and internal roughness, unclear what the medium and long term effects are .Jin 2024 Bond strength By Bleaching a tooth there is enamel bond strength reduction by 25 % Miguel 2006 Wait 2 weeks after bleaching for aligner attachment placement. Bonded retainer has not been researched…
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orthodontics In summary
1 Direct to Print Aligners, are they really different to normal aligners? 8 MINUTE SUMMARY Simon Graf 8:22
8:22 나중에 재생 나중에 재생 리스트 좋아요 좋아요8:22
나중에 재생 나중에 재생 리스트 좋아요 좋아요Join me for a summary of direct to print aligners. This lecture explores the application of a relatively new resin material which can be used for aligner fabrication, without the need of a 3D printed model. The lecture was given by Simon Graf who expertly compared the differences between conventional and direct to print aligners, as well as the clinical application of specific features of direct to print aligners. Limitations of current aligner material: 1. Only small undercuts 2. Limited aligner thickness to sheet thickness / no selective thickness 3. During the manufacturing process material can get thinner or thicker depending on heat distribution and stretch, 54% change in thickness of the aligner Lee 2022 4. Plastic and resin waste, (122 million aligners and models in 2022 Slaymaker 2024) Advantages of direct to print aligners · Select thickness, 0.5-0.7mm, conventional aligners 0.75mm+ · Gingival margin · Dentist in charge of design, not company Manufacturing steps of Direct to Print aligners (Tera Harz ‘Graphy’) 1. 3D printing of resin aligner 2. Centrifuge: Spin remove excess resin 3. UV Light cure in Nitrogen chamber 4. Washed twice, hot distilled water Characteristics of Direct to print aligners · Greater accuracy: (Zendura, Essix Ace and DTP were compared and DTP were 20-30% more accurate Koenig 2022) · Less with DTP (Hertan 2022) o DTP 50% less still (2.59 Vs 5.26 N) o DTP Less force as strain increases Shape memory effect · DTP Polymer chains crosslinked, not case in conventional aligners o The shape recovers in DTP when strain is removed, which does not occur to the same degree in conventional aligners Lee 2022 o Accelerated by placing in water Unknowns · How effective shape memory is remains unclear · Cytotoxicity – not enough data, although manufacturer protocols, lack of studies · Changing thickness, unclear how much of a difference in force it makes Clinical points Teeth extrusion Lateral incisors · Difficult to do with conventional aligners, · Create ‘wedging’ gingival pressure columns to squeeze the teeth to cause an extrusive force. Elastic Hooks without loss of force delivery on single tooth · Hook printed into aligner with DTP, instead of cut out which alters the force of the aligner instantly, maintain tooth control · Tip aligners and elastics: Still add attachment to tooth to prevent aligner displacing Mandibular advancement · Problem of mandibular advancement with aligners o Wings soft and not maintaining the AP position o Hard block many breakages · DTP choice of thickness of block Bite ramps Conventional bite ramps: limited length and often too short DTP no limit to size and thickness, and can be designed to not contact upper palatal surfaces, maintaining full tooth control I n the Transverse o Palatal coverage can be added as feature, similar to a TPA o Still being researched how much force can be delivered with palatal coverage Concluding statement Enjoy the variability of direct printed aligners. Contributions Contents: Abdallah Sharafeldin Edited and produced: Farooq Ahmed…
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orthodontics In summary
1 Think pink – orthodontics a problem or solution to gingival recession. 6 MINUTE SUMMARY 5:53
5:53 나중에 재생 나중에 재생 리스트 좋아요 좋아요5:53
나중에 재생 나중에 재생 리스트 좋아요 좋아요Join me for a summary looking at gingival recession in orthodontics, and whether it is detrimental or beneficial. This lecture was given by James Andrews, he explored the effect of orthodontics on the periodontium, an area under increasing interest within aesthetics to achieve the ideal ‘pink aesthetics’ with the increasing adult population receiving orthodontic treatment. His lecture was based on, is orthodontics good or bad for the gingiva? What is the starting point ? Increase in adult orthodontics from 1970 by 800% 50% of adults have some element of periodontal disease Untreated adult population 51% dehiscence 37% areas of fenestration Evangelista 2010 Facial type and bone morphology Tunis 2021 Dolichocephalic = narrow alveolus and elongated to compensate for vertical growth Brachycephalic = larger alveolus Dolichocephalic - Red flag patients Tooth movement: What happens when teeth move buccally? facial tooth movement Wennström 1996 Reduced bucco lingual width Therefore, reduced free gingiva Increased risk only if tooth is moved out of the alveolar housing What type of movement Tipping (uncontrolled) increase likelihood of recession Condo 2017 Proclination causes recession, but inconclusive Thickness more relevant than final inclination Yared 2006 How to decide what to do? WALA line – Will Andrews Larry Andrews ridge Andrews 2000 Limit of labial bone – shape is coincident with the mucogingival junction, coincident with centre of resistance Upper incisors – located anterior 1/3 of alveolus Mandibular incisors – cantered within the alveolus Gingival recession did not increase in treatment orthodontic population with segmental mechanics Melsen 2005 Aligners any different? Association between non-extraction clear aligner therapy and alveolar bone deficiency and fenestration Presence of both fenestration and dehiscence What do we do to correct extra-alveolar teeth? If teeth pushed outside of cortical plate then retracted, what happens Monkey – moved teeth outside of bone for 8 months, then reposition within bone with appliances = repair bony dehiscence and fenestration Morten Laursen and Melsen 12 consecutive patients 2020 Teeth moved towards the centre of the cortical plate = improvement in gingival height of depth decrease of 23%, the width with 38% Intrusion Use of intrusion arch increases the thickness of the periodontal fibres 0.7 to 2.3 mm Melsen 1988 Gingival graft when to move teeth Free gingival graft – 6 weeks Connective tissue graft – 12 weeks “Diagnose and treat each tooth no miracles shortcuts for good orthodontics” Peck 2017…
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orthodontics In summary
Join me for a summary looking at miniscrews, looking at where the answer to successful TAD placement lies, in research or clinical practice. The reasons for higher failure rates than others with TADs was explored through 3 key factors; insertion torque, site selection and root proximity. Evaluation of both scientific and clinical processes were described by Sebastian Baumgartel at the British Orthodontic Conference, as the Northcroft lecture. Is torque a factor in TAD success? Torque study – compression during insertion Motoyoshi 2006 · High torque – 60% · Low torque = 72% · Medium torque – 92% Understanding · Low torque = low compression, low primary stability - early failure as not engagement with screw · High torque = high compression, early success, but greater resorption after insertion, remodelling results in a resorption process · Medium = best of both = sufficient compression for primary stability, not high enough to cause resorption remodelling Ideal · Ideal torque range – 10 Ncm Shantavasinkal 2016 o Study of buccal tads · Sebastian’s empirical experience between 10-25Ncm depending on site Rules: · Aim for medium torque · Target 10Ncm · Exceed 10Ncm on palate acceptable What is the best site for TAD insertion? Keratinised gingiva · Evidence - states no difference Lim 2009, Chen 2008, Park 2006, Cheng 2004 · Non Keratlised – depends on mobile or non mobile, with non-mobile higher success rate Viwattanatipa 2009 · 2mm apical to muco-gingival junction o zone of opportunity Target zones and site o No roots o Consistent cortical bone o More tolerant to higher torque o Attached gingiva with low mobile mucosa Is there ideal bone? · = if ideal torque = ideal cortical plate thickness § 1-1.5mm cortical plate thickness · CBCT can be overkill, using research sites for average sites Ideal site: – 1st premolar region (transverse) Sebastian 2009 – 2 mm away from mid-palatal suture o = creates ideal zone ‘Mx1’ Evidence of site selection success · 98% Vs buccal 71% Houfar 2017 · 84% Trainee success Sebastian 2020 · Success of Sebastian anterior palate 100%, maxillary buccal lowest 85% Does root proximity influence TAD success? · Not just contact with roots, but proximity to root also causes failure Kuroda 2007, Asschericks 2008, Chen 2008 Understanding o Increase root and PDL proximity = bone stress increases = increase bone turnover = increase failure of TAD · 4mm interradicular distance needed (depending on size of tad) to achieve 1 mm clearance from roots · Most buccal sites have less than 4mm (resolve through diverging roots, or sites with no roots) What happens if TADs fail and we try again? – Secondary insertion success o 58% (reduced by 33%) Park 2006 o 44.2% (reduced by 36%) Uesugi 2017 o 58.1% buccal (reduced by 21%), 88.9% palatal (increased by 4%) Uesugi 2018 § Uesugi 2018 showed buccal failure increases for secondary insertion, but palatal insertion increases success For more education see Sebastian’s TAD course: https://tadchallenge.com/tad-certification-course I have no financial interest…
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orthodontics In summary
1 Aligners: do patients wear them and do attachments really work? 8:50
8:50 나중에 재생 나중에 재생 리스트 좋아요 좋아요8:50
나중에 재생 나중에 재생 리스트 좋아요 좋아요Join me for a summary of Tommaso’s lecture on aligner treatment, exploring questions on the use of aligners. Tommaso described how compliant patients are with the use of aligners, who is more likely to wear aligners well and methods to increase compliance. He critically reviewed the use of attachments, and revealed aligner deformation and staging as key areas of treatment. This podcast is a summary of the WFO online webinar from November patient compliance , biomechanics , rotation, distalisation and intrusion Patient Compliance Sample of over 200 patients treated with aligners under remote monitoring, Thirumoorthy 2021: 36% of the sample was fully compliant 25% has poor compliance 1st time Ortho patients are more compliant Conclusion: early detect non compliant patients with remote monitoring Patient factors which vary compliance of removable appliances Fleming 2019 The study came with some recommendations: Effective communication with our patients, with visual aid, pictures or movies. Using of tracking sensor included in the device Using some reminding tools – remote monitoring Biomechanics and material properties. Distalisation class 2 Incisors intrusion Conclusion We need to consider the lines of forces and aligner deformation not only on the attachments Any malocclusion that can be corrected by tipping has better predictability Add less activation Per aligner (to help flattening the steep decline in force over time and create consistent and continuous force system) Attachment driven mechanics are not always effective, aligner Activation is more effective Graphy is the trending technology in aligner activation…
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orthodontics In summary
Join me for a podcast summary looking at the grey topic of lower third molar management. The podcast explores the different guidelines of removal, factors for consideration for removal as well as the effect orthodontics can have on third molar pathology. The lecture was given by Flavia Artese at this year’s British Orthodontic Conference in my city London. Flavia Artese began with asking the clincal question we face, what would you do with an impacted 3rd molar? Difference in international practice · UK NICE guidelines 2000: Surgical removal of impacted third molars should be limited to patients with evidence of pathology · AAOMS White paper USA 2016: currently or likely to be non-functional associated with disease or at a high risk of developing disease What factors in decision making 1. Eruption path · Mandible = mesial, whereas Maxilla = distal o Rate of impaction Mandible 25%, maxilla 14% Worthington 2016 2. Mechanism of tooth eruption – explained by Frazier-Bowers · A pathway created by the dental follicle o Triggers eruption of intraosseous eruption o Genetic control of cell differentiation in dental follicle § Requires root elongation, vascular pressure and DL ise 2008 Orthodontic influence = SPACE · Decrease with distal movement of posterior teeth o Distalisation, elastics § Kim 2014 = limit of lower molar distalisation § 35% of cases already have contact with lingual cortical plate · Increase through mesial movement o 80% of 3rd molars erupted in premolar extraction cases Kim 2003 o Increase in retromolar area o 2nd molars – removal of guidance = unpredictable alignment of 3rd molars, tipped, therefore will likely require orthodontic alignment Gooris 1990 § Flavia suggested if 7s impacted, removal of 8s and 2nd molar uprighting, as no delay until full root development Prediction method · Mandibular morphology o Longer the mandible = greater chance of 3rd molar eruption: Begtrub 2012 · Retromolar space o OPG - size of crown and space available: If space greater then size of the tooth = 75% eruption, if less space available than the tooth size = 75% of impaction Olive Prediction of orthodontists and surgeons Bastos 2016 · Orthodontists 38% extract · Surgeons 50% extract · Surgeons extract more o Surgical morbidly 10% Yamada 2022 o Greater pathology: 82% when erupted, 74% in soft tissue, bone 33% Surveillance protocol · No complaints from patients Fully erupted · No consensus of protocol pathology Review of guidelines Gadiwalla 2021 Only 2 guidelines were recommended , RCS and SIGN · Recommended guidelines Conclusion · Limited evidence · Orthodontists can influence the space · If second molars require extraction, will require time to erupt as well as · CBCT should be used for diagnosis · Refer to oral surgeon for assessment of difficulty in removal Please join Flavia Artese at the 2025 International Orthodontic Conference in Rio De Janeiro Contributions Contents: AbdAllah Sharafeldin Contents edited and produced: Farooq Ahmed…
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orthodontics In summary
Join me for a podcast exploring the limits of orthodontic tooth movement. This podcast is a summary of two intriguing lectures, by Dr Yanqi Yang and Carlos Flores Mir from this year’s International Orthodontic Symposium by the IOF. This podcast explore the anatomical and periodontal boundaries of orthodontic tooth movement Anatomical boundary · Distalisation: Alveolar boundary lower molar distalization · Horizontal: Atrophic ridge. · Vertical: Maxillary sinus boundary for lower molar distalization. o Coronal level: Anterior border of mandibular ramus o Apex level: lingual plate o Variable – distance from second molar distal root and inner lingual cortex § Favourable Class 3 greater retromolar space, class 2 least Fan 2022 § Unfavourable High angle have shorter distance Kim 2021, Victoria 2022 Side effects of lower molar distalisation o Mainly tipping o Distalisation achieved at apical level approximately 1mm AJODO 2016 o Lingual plate contact 1/3 of cases Kim et al 2014 Horizontal movement: atrophic ridge · Change in width and height of extraction site o Loss of 40-60% width and height Pagni 2012 § Width 3.79mm Tao 2012 § Height 1.24mm Tao 2012 o Mostly within 6 months Schrepp 2003 · Changes when orthodontic tooth movement into atrophic edentulous site o Increase bone height 2.2-5.2mm, duration 24 months Elif 2004 o Increase in width 0.8-1.6mm Stokland 2011 o Greater height increase buccally, less lingually Dos Santos 2017 · Side effects o Root resorption – lateral § 0.7mm o Dehiscence § Slight in all cases, thinning of alveolar bone Patricia dos Santos 2017 o Reduced bone height compared to non-edentious area Vertical: · Maxillary sinus prevent tooth movement? o Increased tipping, slower rate of tooth movement · Side effects o Mild increase in RR o No difference in relapse, vitality or periodontal differences o 6 buccal roots closest . (Qin et al 2020) · Understanding o Maxillary sinus remodels itself with tooth movement o Increase in resistance to tooth movement, greater tipping. Periodontal boundaries Carlos Flores Mir started the topic with a thought proving question, that we are well aware of Proffit’s envelope of lower incisor dental movements; but the question of what is the periodontal limit, is still yet to be clearly defined. The difference between the gingival biotype and phylotype, there has been a focus on biotype but it · Biotype – thickness of gingiva in bucco-lingual direction · Phenotype – contour gingiva, underlying bony architecture, and width of keratinised tissue Thin gingival biotypes are likely to have more chances of recession . Factors to consider · Extraction Vs non-extraction: in both scenario the bone height decreases, but in different locations, anterior extraction treatment = 2mm reduction, non-extraction = 1.2mm. www.orthoinsummary.com/blog · Dehiscence exist pre treatment · Thicker the gingiva, the better Yared 2006 · Initial position of the tooth decides its periodontal future · Thickness varies in various areas of the mouth. · Oral hygiene major factor of recession Melsen 2005. CBCT · Aren’t really telling us the whole story – · Size of the image of a CBCT is limited by the radiation dose, and typically is 0.3-0.6mm3 of voxel size · Tissue less than 0.6mm appears as a absent in CBCT giving false positive results ( Redua 2020) Lower incisor proclination and recession: · Systematic review Kalina no correlation between proclination and gingival recession. (Kalina 2022) Understanding Recession = Thin gingiva + proclination + periodontitis Contents– Shanya Kapoor Editing and Production – Farooq Ahmed…
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orthodontics In summary
Orthodontics In Interview: RICHARD COUSLEY Digital orthodontics, miniscrews and aligners “Aligner set ups need to be orthodontically checked to make sure it is realistic, and an accurate representation of what you are trying to achieve” Richard describes his journey into digital orthodontics, what led him to create his own successful miniscrew system, and why he has continued to innovate in orthodontic with 3D printing. Richard describes what he thinks stifles innovation in orthodontics, as well as how CBCTs have improved his miniscrew success rates. Please like and subscribe if you find it useful! To book Dr Richard Cousley’s 3D orthodontic course, please see: https://www.3dorthodonticscourse.com (no financial interest) #orthodontics #farooqahmed #richardcousley #aligners #digitalorthodontics #infinitas #miniscrews #orthodonticsinsummary#orthodonticsininterview Farooq Ahmed…
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orthodontics In summary
Join me for a summary of two lectures from this year’s international orthodontic symposium (IOF), looking at mouth breathing and paediatric obstructive sleep apnoea, by Hong He and Carlos Flores Mir. The lectures explore this controversial area in both medicine and orthodontics and review the current understanding of the topic, the relationship with facial features and current recommendations for orthodontists. OSA is defined disruption to breathing American Academy of Sleep Medicine Adult > 5 apnoea/hour & 10 seconds Child apnoea for duration of 2 breaths 1 Defining mouth breathing at airflow over 25% through the mouth Evidence of craniofacial effects Mouth breathing Retrusive maxilla -1.33o (SNA -2.03 -0.63) Retrusive mandible -1.4 (SNB -2.20—0.6) Zhang 2020 SR Increased mandibular angle 3.38o (2.77-3.98) But is mouth breathing pathological? pOSA no craniofacial difference in pOSA vs controls SR Fagundes 2022 Recent study by Carlos Flores Mir, combine factors Demographics, lifestyle, craniofacial features and sleep features. Investigating effects of treatment on these categories Treatment Twinblock improves pOSA AHI 14.08 to 4.25 in the short term, severe to mild Zhang 2012 MARPE increases cross sectional area, by 40% oropharynx, 7% nasopharynx Zhao 2020 RME increases nasal airway volume initially of 1604 mm3, but reduce to 579mm3 after 3-5 months and non-significant SR Zhao 2021 Tonsillectomy Does not stop mouth breathing, even if OSA resolved Bae 2020 Conclusions Breathing involves complexity of 3D structures and fluid dynamics is not well understood Mouth breathing does seem to have craniofacial influence , however OSA does not Orthodontists role in OSA screening for OSA Refer to physician if risk factors present Refer adenoid hypertrophy to ENT Contributions Contents and video editing – Shanya Kapoor Editing and Production – Farooq Ahmed…
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orthodontics In summary
1 Orthodontics In Interview GUEST HOST BJÖRN LUDWIG WITH RALF RADLANSKI 10:13
10:13 나중에 재생 나중에 재생 리스트 좋아요 좋아요10:13
나중에 재생 나중에 재생 리스트 좋아요 좋아요Orthodontics In Interview GUEST HOST Björn Ludwig with Ralf Radlanski Guest podcast hosted by Dr Björn Ludwig, he interviews the anatomist and orthodontist Ralf Radlanski, he explores the career of the founder of the International Orthodontics Symposium (IOS) and president of the EurAsian Association of Orthodontists. The two questions close to Bjorn’s heart are explored: do you drink wine, and do you listen to music. YouTube https://youtu.be/vcAzjWa507Y #bjornjudwig #ralfradlanski #IOSmoselle23 #orthodonticsinsummary #orthodonticsininterview Instagram: https://www.instagram.com/bjoernludwig1 Facebook: https://www.facebook.com/bjorn.ludwig.961 @bjoernludwig1 @bjorn.ludwig.961…
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orthodontics In summary
Orthodontics and the airway “Lots of patients are struggling with the symptoms (of obstructive sleep apnoea) when a little kid doesn't sleep it's not just the child's problem, their parents and other family member who also become sleep deprived” Audrey describes her motivation in the young field of dental sleep medicine, the role of orthodontics in the management of paediatric obstructive sleep apnoea, the patient’s orthodontic treatment is appropriate in managing OSA, as well as those patients it is inappropriate for. Audrey explains her thoughts on why the field of airways and orthodontics is controversial, and answers critical questions regarding orthodontics and sleep medicine. We get to hear of Audrey’s take on the AAO White paper on obstructive sleep apnoea. Click on the link below to view previous episodes, to refresh topics, pick up tricks and stay up to date. Please like and subscribe if you find it useful! Instagram: www.instagram.com/draudreyyoonhappycamper Facebook: https://www.facebook.com/audrey.yoon @audrey.yoon @draudreyyoonhappycamper Farooq Ahmed…
Join me for a summary looking at impacted teeth and key components of timing which affect not only the success of alignment, but also root formation. This podcast also explores the occurrence of asymmetries of both dental and facial due to impacted teeth, and what can be done about it. This podcast is a summary of the AAO lecture by Stella Chaushu and Adrian Becker. Timing Role of timing to the impacted tooth, the adjacent teeth and alveolar and skeletal growth. Implications of timing on impacted teeth: Eruptive potential Root development 1/ Eruptive potential and timing Interceptive treatment Ideal time for spontaneous eruption is ½ to 2/3 of final root length. Orthodontic traction: Ideal time for active (orthodontic traction) eruption is 2/3 to ¾ final root length. Principle: Peak of eruptive potential is at 2/3 to ¾ of final root length Root completed within 2.5 to 3 yrs post eruption Timing of impacted maxillary canine interceptive treatment Dental age of 9-10 years Interceptive treatment includes: extraction C, D, distalisation molars, RME Prognosis of treatment of impacted canines is uncertain and reduces with age. Ideal early adolescence Timing of impacted maxillary incisor interceptive treatment Before age of eruption 7-8 years Likely spontaneous eruption, but risk of damage to permanent incisor in surgery After age of eruption > 8 years Spontaneous eruption not predictable, likely require active (orthodontic traction) Interceptive treatment Removal of obstruction, spontaneous eruption 36-75% Removal of obstruction + space creation spontaneous eruption 82-89% (Sun et al AJODO 2006) Root development Impacted incisor due to obstruction – ideal time =7-8 yrs Dilacerated upper incisors – ideal time – at ½ root or less = 6-7 yrs, as removal of root proximity to the anatomical barrier can reduce the dilaceration of the forming root Timing of impacted premolar interceptive treatment What to do when premolar root formation has not occurred in adolescent patient If apex is open = root formation occurring Timing of obstruction management Removal: As early as possible Orthodontic traction: Delay until bony infil, otherwise loss of gingivla and alveolar supoort 2/ Root development Canine root development Hooked apex 3-4 times more likely with impacted canines Shorter root impacted incisor 2.3mm shorter root Sun 2016, Impacted canine 2.3mm shorter roo Cao 2021 Total volume unaffected (length + hook) Prevalence and severity of dilaceration increase with age until apex closed Dilacerated root respond to traction/ Yes but increased treatment difficulty and duration , example of 2 years Arrested root development Can arrested root development be reversed? If root abuts with an anatomical barrier. Such as nasal floor, it is the cause of the arrested development Orthodontic traction and movement away from the barrier = continued root development Early exposure and orthodontic traction Implication of impacted tooth and asymmetry Impacted tooth can affect alveolar and skeletal growth Cases with asymmetry significantly higher in impacted group. Asymmetry index 27% Vs 3.4% Chin asymmetry 52% Vs 14% Occlusal cant 38% Vs 10% Timing of treatment, if delayed = occlusal cant increased with age. After treatment, asymmetry can persist = treat as early as possible to limit asymmetry (managing impaction will not correct asymmetry)…
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orthodontics In summary
Join me for the next interview in orthodontics with Dr Diego Peydro “The (aligner) protocols of the companies don’t work…my protocol shows expansion, the way I manage the roots, constriction of second molars…and have 95% predictability”. Diego explains his journey in orthodontics, the challenges with aligners and why he believes they are superior to fixed appliances now, also we hear his opinion on in-house aligners. We get to hear of Diego’s opinion on aligner research. Diego is the co-director of The clear aligner training programme “Clear Ortho International Program - Master COIP (I have no financial interest). Click on the link below to view previous episodes, to refresh topics, pick up tricks and stay up to date.…
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orthodontics In summary
Join me for a summary looking at the use of botox for deep bite management and bruxism. This was an interesting lecture by Dr Nan Hatch from Seattle, which was presented at this year’s AAO 2023. She explored the use of Botox for masseter hypertrophy and the evidence around it. Masseter hypertrophy when combined with bruxism can result in: o Long term changes in function o Fixation breakages o Orofacial pain, tmd, mobility How does it work? · Injection of neurotoxin into muscle · Temporary partial paralysis through chemical denervation · Most common Botulinum toxin or Botox · Mechanism of action o Block acetylcholine (neuromuscular transmission) release. o Also inhibit pain sensory neuron How to inject · Extra oral – use of facial landmarks · Intra-oral Use MRI / EMG guided injection What are the effects · Anticipate change facial aesthetics · Greater facial contouring achieved with higher dosage Review Wu 2023 · Last up to 180 days · Greater complications with greater dosage Anticipated change from botox · Treatment for masseteric hypertrophy o 35 units to masseter , two injections o 91% reported improvement headaches o Duration 25 months Decrease bite force Ahn 2007 · 25 units to each massenteric muscle · Mean bite force 51kg /cm using bite block attached to a transducer o Reduced to 30-36kg/cm for 8 weeks (29%-41% reduction) o After 41kg after 12 weeks , no longer statistically significant · Significantly reduced bite force up to 8 weeks Potential adverse effects · Chewing weakness · Sunken cheeks – high volume · Headaches · Sagging skin · Asymmetry · Paradoxical Bulging – miss masseter and affect other muscles · Distant spread of toxin · Speech disturbance · Muscle fiber atrophy 4-6 weeks, remover 4-6 weeks Chemical denervation protocol · 25 units per muscle, both masetter and temporalis · Interval 4-5 months and patient response · 3-5 serial injections o Some patients changes can be permanent…
Join me for a summary of a lecture by Ramesh Sabhlok, looking at one of the most popular sites for TAD placement, the maxillary buccal interradicular site. The most common site in maxilla for implant placement is between 2nd premolar and 1st molar in the keratinized gingiva. Two factors 1. Buccal bone thickness 2. Inter radicular distance Bone thickness: · Greatest bone width of bone is between 2nd premolar and 1st molar, and considered ‘safe zone’ thickness of bucco-palatal bone 10.2-11.4mm ( Pogio 2006 Angle orthodontics ) Inter-radicular distance · 2nd premolar and 1st molar: 3.2mm (SD 0.6mm)- 3.5mm (SD 0.8mm) when 4-6mm from the CEJ, largest clearance of interradicular space in the buccal aspect of maxilla Lee 2009 · Gradually decreases apically, therefore it is advised to place the mini implant at height of 4-6 mm from CEJ, at 2 mm height only 2.7mm interradicular · In the maxilla, the more anterior and the more apical, the safer the location becomes. · Increased after levelling and alignment, delay placing if possible ‘SAFE DEPTH’ proposed by Ramesh · depth of from the bone surface to the narrowest interradicular space at a given height which is safe = 3.2mm interradicular distance for 1.2mm width TAD AND 3.5mm for a 1.5mm TAD. · Safety depth (height) is 4mm. o 2mm depth the greatest inter radicular distance 2.4mm, not safe Angulation · A 20-30o angle, places the interradicular aspect of the miniscrw apically, where the interradicular is the greatest. This reduces root contact, increases retention with more cortical plate engagement, allows use of longer miniscrews as well as greater distalisation prior to relocation Deguchi 2006. Extraction of 3rd molars · Classic papers looking at the Pendulum appliance by Kinzinger 2004 showed extraction of 3rd molars resulted in greater bodily distalisation on the maxillary arch. · However recent CBCT paper by Lee 2019 show that with miniscrew distalisation there was no difference bodily movement with extraction of 3rd molars and non-extraction. Concept of biologic width 1-1.5mm of periodontium surrounding the implant, Lecture title Summary from AAO 2022 lecture: Non- compliance & Predictable class II correction with Micro implant Anchorage Dedication Episode is dedicated to the late Dr Anam Humdani, a London based dentist who tragically died aged 29 https://www.justgiving.com/fundraising/zayaan-humdani · Contents: Shanya Kapoor · Editing and Production: Farooq Ahmed…
Join me for a summary looking at accelerating orthodontic tooth movement, this podcast is a summary of two lectures from the AAO, by Ali Darendelier and Peter Buschang. Mechanical acceleration through vibration, photobiomodulation, minisurgery (Peizocision and Micro-Osteoperforation MOP) and Distraction. Vibrational mechanical Low magnitude / high frequency, used for 20 minutes per day 25g at 30Hz/ 50 Hz, Canine retraction: 30Hz NS, 50Hz 15% quicker, Significant but not clinically No increase in root resorption - split mouth study, except for 50Hz, reduced RRRR Tan 2011, Yilmaz 2021 Photobiomodulation (PBM) Low level laser therapy: LED device used for 20-30 minutes her day Tooth movement increase rate of 1.73mm over 2-3 months Yavagal 2021 SR Root resorption no difference Sambevski 2022 Minisurgery: Piezocision/ Micro-osteperforation(MOP) Piesocision – series of vertical bone cuts of 2-3mm depth vary lengths, Vs MOP – round punctures of 2-3mm depth. With or without flaps. The movements were twice as fast (Lino et al 2017, Cho et al 2007, Mostafa et al 2009) But limited duration of effect Buschang 2010 Peak at around 3-4 weeks No differences after 6 weeks - Similar to human trials: Aboul-Ela 2011 Root resorption Patterson 2017 Peizocision and MOP produced significantly (44% / 42%) MORE root resorption. Peizocision 36% additional iatrogenic damage (performed by periodontist) Distraction Mechanical removal of the bony obstruction Remove all or most of the bone in a way so that you can move teeth faster reliably Osteotomy, callus formation followed by Rapid separation of distal and proximal bone and healing with new bone formation. 1mm per day Moore 2011 Teeth vial with Dappler meter Vitality through histology as electronic pulp test not reliable during orthodontic treatment, Alomari 2011, increase in treatment but return to normal in retention. What do we know reliably extents treatment duration are 3: Wrong diagnosis Wrong mechanics Bracket position Conclusion: Distraction is the most reliable method at increasing tooth movement but the most invasive Peizocision / Micro-osteoperforation: Increases tooth movement but greatest risk of root resorption Photobiomodulation: Modest increase in tooth movement, no root resorption Vibration: No increase in tooth movement or root resorption Contributions Content creation: Shanya Kapoor Editing and production: Farooq Ahmed…
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orthodontics In summary
Join me for the next interview in orthodontics with Benedict Wilmes “Find a balance between clinical tips and evidence, if we only look at evidence there will be no innovation, if we only look at clinical tips we will make lots of clinical mistakes” Benedict describes his journey into mini-screws and what keeps him motivated to continue innovation in orthodontics. He describes his passion for sports and how he adopts these lessons in his work. We get to hear of Benedict’s thoughts on the future of orthodontics. Benedict is the pioneer behind the Benefit TAD system, the next annual user’s meeting will be the 2nd – 3rd June 2023 in Duesseldorf, I have no financial interest and am looking forward to attending this year’s meeting. Course details: https://www.benefit-user-meeting.de/ Click on the link below to view previous episodes, to refresh topics, pick up tricks and stay up to date. Please like and subscribe if you find it useful! #orthodontics #farooqahmed # BenedictWilmes # TADMAN # benefit # miniscrews #aligners #orthodonticsininterview #farooqahmed https://www.tadman.de/ \ Instagram: www.instagram.com/tadman.de/ Facebook: www.facebook.com/benedict.wilmes @tadman.de @benedict.wilmes Farooq Ahmed…
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orthodontics In summary
Join me for a summary of Oliver Liebl’s lecture looking at digital orthodontics, through both digital indirect bonding and in-house aligners. The workflow Oliver described was through Onyxceph in a step by step process, however the modules used are similar to other available software modules. Oliver described the ‘digital orthodontist’ who uses 1. Digital bracket positioning with Indirect Bonding Trays IDB 2. Finishing with in-house aligners Digital bracket positioning Advantages · Automatic placement of different heights, MBT, Andrews etc · Virtual simulation = visualise effects of changes Digital model, AI segments dentition, but requires some manual adjustment for the Gingival, occlusal and lingual aspects 1. Bracket selection · Bracket library of commercially available brackets 2. Bracket positioning · Select placement philosophy – automatically place brackets, MBT, Andrews, Alexander · Customise o Change bracket position o Change prescription · Visualise changes with automatic alignment on 3D pane · Select archform 3. Indirect bonding trays · Transfers virtual position through a 3D printed tray to the patient i. Change geometry of tray, thickness, cutting guide i. Values of the tray Oliver shared for the brackets he commonly uses – Experience SLB by GC · Active STL file export to 3D resin printer i. Resin – fits to each bracket system and printer, trial and error 4. Print IDB tray · Horizontal position · Remove IBT trays · Wash – isopropanol · Light cure – 50 minutes in glyceryl · Placement of brackets in tray · Use separator / releasing agent such as oven spray · Place bracket into IDB tray 5. Clinical steps · Etch, bond, conventional bonding · Use of acetone to remove finger prints on bracket base · Butter in adhesive to the mesh base · Light cure Finishing with aligners Virtual debonding, however not great results, better to debond and re-scan to plan Aligner 3D module set up Onyxceph · Modify tooth position · Settling process – like a Hawley a. Leave small occlusal gap for posterior settling Aligner attachment 3D · Select any available shape · Can add SARA wings, act as class 2 correctors, developed by Aladin Sabbagh Staging of aligner movement a. Parameters programmed per aligner i. Chose values which are predictable, depends on clinician and size of aligner Print working model b. Horizontal model 25 minutes or vertical 60-70 minutes c. Wash residual resin d. UV light Trimline choice e. Straight Vs scalloped f. Prefer straight. Cowley 2012 i. Less attachments ii. Greater force delivery iii. Greater predictability GET ORTHODONTIC SYMPOSIUM SEPT 8-9/2023, Aligners, bracket or both We are raising money worsening humanitarian crisis taking place in Turkey and Syria, please donate https://www.justgiving.com/fundraising/farooq-ahmed5…
Join me for a topic summary looking at anterior openbites from the AAO. This summary looks at the differences in key diagnostic criteria, the options for treatment planning, and the evidence to support time. The summary is taken from Roberto Carrillo, Flavia Artese and Ravi Nanda’s lectures. Separate treatment plan : · treatment of the aetiology · Treatment of mechanics Aetiology Tongue posture / thrust or mouth breathing, alter equilibrium of AP and vertical tooth position. · Tongue posture / thrust o Forwards position, not thrust / swallowing , as low intensity and duration o Different positions of tongue being forwards, results in different presentations of AOB, high = proclined uppers, horizontal bi-proclination, low procline lowers o See previous podcast on Flavia Artese in her Power2Reason lecture · Mouth breathing o Mouth breathing in itself is not considered factor for Tonsillectomy AAO-HNS guideline Treatment Extend of AOB does not determine treatment, Facial type and extent of AOB poor correlation r=0.2 Duplat 2016 o · Habit dissuader crib or spurs: o High tongue block tongue o Low tongue block and redirect o Removable – Aligner with lingual attachments, poke probe through and becomes uncomfortable · Adults like as removable, bonded is difficult to accept Voudouris 2022 o Cribs and spurs- relapse 17% Huang 1990 § Effective reduction in tongue forces and position at 1 year Taslan 2010 · Myofunctional therapy o Speech and language therapy – relapse 4% Smithpeter 2010 · Dental: o Incisor extrusion - relapse 38% Janson 2003 o Molar intrusion - relapse 27% Espinosa 2020 o Extractions – relapse 25% Janson 2006 · Skeletal: o Surgery – relapse 25% Greenlee 2011 Posterior intrusion · Screws / plates = depends on anatomical limitations Skeletal anchorage with aligners · Ct approach = C cuts and T-triangular elastics · C-cuts – through OCCLUSAL and buccal surface to prevent deflection premolar to molar · Pre-load elastics and then insert into the patients mouth · Posterior intrusion Lecture titles from AAO 2022 Key factors for vertical control with clear aligners Roberto Carrillo Game changers in open bite treatment – Dr Flavia Artese Biomechanic & Esthethic based management of open bite - Dr Ravi Nanda…
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orthodontics In summary
Join me for the next interview in orthodontics with Luis Carrière “The Carrière Motion Appliance is a story of simplicity, but not simplism” Luis describes how he conceived the Carrière Motion Appliance, and addresses in his own words addresses claims regarding changes to the occlusion, TMJ and airway. He describes the limited research regarding the appliance, as well as why he does not conduct the research himself. We get to hear of Luis thoughts on what he sees as the future of orthodontics. Click on the link below to view previous episodes, to refresh topics, pick up tricks and stay up to date. Please like and subscribe if you find it useful! www.carrieresystem.com/ Instagram @instagram.com/luiscarriere Facebook @luis.carriere.1 Farooq Ahmed…
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orthodontics In summary
Lower arch missing lower 2nd premolars Hemisection lower E – distal half – Old school Allow mesial drift of 6s, L4s do not distally tip, important in class 2 cases Use mesial aspect for anchorage if ankylosed Remove remaining Other options TADs 30% failure in the mandible in Caucasian Herbst Mini-plates – very evasive But hemisection is simple Gingivectomy After extrusion of impacted tooth, need for gingivectomy Orthodontists should learn as common need Process Scan Plan a gingivectomy guide Laser or electrosurgery for gingivectomy Cant and TADs adult cases are the future of orthodontics, more challenging RHS>> Gincevectomy LHS>> extrusion using TADs TAD – opencoil to bracket on the tooth, and aligner to guide the tooth, cover incisal edges only And few aligners Patient did not want perfect result Space closure and TADs Georgios Kanavakis 2014 Space closure and mesial slider 2 x palatal tads SS spring close Mesialization of molars High tech But Space closure can be achieved with timely extractions, such a smissing UEs and extractions with mesial drift.. Less likely lower arch, miniplates used to mesialise Expansion Digital planning Digitally decompensate the lower arch. MARPE Changes to the midface through MARPE Hard tissue changes to the midface and nasal complex Caution in use, for selective cases only, and critical in use SARPE Indicated due to resistance for Maxillary expansion in adults from 3 potential structures Zygomatic buttress, Pterygoid plates, Sutures from the mid face Published 1984 by Andrew Glassman Using a finite element analysis programme, fusion 360, identify the resistance individual to patient Case: Surgical guide to do a small lateral osteotomy under local = future as it is individualized to each patient Hybrid treatment brackets Vs aligners Class 2 correction Change from fixed to aligners with Onyx Ceph planned wings for class 2 correction – like functional appliance Problems Distalisation with Miniscrews Later on posterior crowding of 2nd molars and risk anterior recession Fracture of palatal appliance Failure at welding point between expander and abutment Can stop people using designs Solution print 1 piece appliance CADCAM Overuse TAKE HOME MESSAGE BY ME FROM THE LECTURE Sometimes effort is not equal the benefit so always evaluate your benefit Always assess your outcome and see if technology you invested in worth it Orthodontists are Dentists and should do some gingival contouring and temporaries ..etc Always match arch before and after treatment and maintain your arch form Future is Hybrid Therapy … using strength of both aligners and fixed braces…
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orthodontics In summary
Join me for the next interview in orthodontics with Padhraig Fleming “Innovation has made treatment more accessible, but has not necessarily translated into better outcomes” Padhraig is a Professor in Orthodontics based in Ireland. He has published over 150 peer review papers, 4 textbooks including the recent edition of Graber’s ‘Orthodontics: Current Principles and Techniques’. He won the 2021 Turpin Award from the AAO. He is an associate editor for the AJODO and Progress in Orthodontics. We get to hear of Padhraig’ story , what led him to pursue research and what pitfalls he sees ahead for orthodontics Professor Padhraig Fleming’s next course: Orthodontic Fundamentals: February 11-12 2023 http://www.orthodonticfundamentals.com/…
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orthodontics In summary
What goes wrong with MARPE? Audrey Yoon Join me for a lecture summary from this years AAO by Audrey Yoon. Don’t Make the Same Mistake I Did/ MARPE Complication. Success MARPE Overall separation: 87.8% Success rate of sutural separation: (Jeon 2021) · 61.05% in male · 94.17% in female · Average expansion: 7.8 ± 2.4 mm. Variation with age and gender MARPE efficacy = Achieved Vs planned expansion · Greater negative correlation with age in general o More male than female o Planned Vs achieved a. 20 years old = 1:1 M:F b. 30 years old = 0.5:1 : 0.8:1 c. 40 years old = 0! : 0.6:1 BUT NO DATA – extrapolation No relationship with bicortical engagement Asymmetric expansion · = 50% of cases ANS level greater than 1mm · 27% Greater than 2mm at ANS · Severe: Similar to tripod fracture · Causes of asymmetry Kim 2019 · Nasal-maxillary suture opening / remain closed · 30% of case unilateral opening of suture SARPE = 3-13% asymmetric expansion Williams 2012, Smeets 2020 Pain · 45% report pain · 19% Around band of 1st maxillary molar band · 10% headaches Gingival inflammation · 83.9% of patients · Design = flush o Change to 1mm from palate and arms 3mm from palate = reduce · Greater inflammation in retention o Possibly due to palatal vault relapse and therefore TADs imbed in palate Breakages · 10% · Usually guide rod / arm Rare: Loss of vitality 2% · Required RCT maxillary incisors (SARPE 4.5%) Fractures - potential tripod fracture Infra-orbital numbness · Temporary numbness 6 weeks · 3 cases · Management · Turn backwards slowly · Facial massage / myofascial · Folate, Vit b – aid nerve regeneration Hearing loss · Zygomatic arch = hearing loss temporary, tetanus, trismus Unexplained tears · Lateral orbital rim = sagging eyeball, lacrimal gland Popping in the ear Lateral pterygoid fracture · Click and popping to the ear – cheek shooting pain · Lateral pterygoid plate fracture – asymmetric expansion Consent Audrey Yoon – youtube patient instruction video / leaflet Growing consent Audrey Yoon paper AJODO clinical companion – open access A retrospective analysis of the complications associated with miniscrew-assisted rapid palatal expansion ` Audrey Yoon 2022…
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orthodontics In summary
Join me for a summary of this years American Association Meeting from the summer looking at AI and imaging. The topics covered at CBCT the facts, use in transverse and incidental findings. Other topics of facial imaging or 4D as a diagnostic tool. Finally looking at AI, its application currently and potential use of blockchain technology in orthodontics. CBCT Shaza Mardini Myths It is new developed 1990s, used 2001 Dose is too high – now just over the dosage of cephalogram and OPG, as low as 46uSv Buckley 2018 – 5 hour flight Children sensitive due to growth ALARA, ALADA to bear in mind Accuracy Small deviation of true size compared to 2D images Gregory 2004 Panoramic = not accurate and only screening tool Lione 2000 Asymmetry Accurate measurements for bilateral structure is possible Degenerative changes in condyle is often responsible for open bite which can be detected by Example of twins wherein one child with condylar degenerative issue had retro gnathic mandible leading to malocclusion CBCT and Transverse assessment Onur Kadioglu PA Ceph should not be utilized for transverse discrepancy. {Cheung et al Aust orthod 2013} CBCT as gold standard and compared PA ceph to it and has quoted that it has ↓False positives and high degree of sensitivity and specificity Correctly predicts 88.7% of crossbite; 91.25% no crossbites. landmark system for transverse measurements using CBCT images. Onur Kadioglu Maxillary teeth Trifurcation of molar (less likely to change in angulation changes) mandibular teeth midpoint of root 20 mm discrepancy = crossbite Used transverse discrepancy limit of 20mm to assess the outcomes of cases. Incidental findings with CBCT Onur Kadioglu Facial imaging William Harrell 2D Vs 3D Vs 4D 2D helps to precisely measure INACCURACY and its reproducible Accurate in 3D space; one needs to be careful in locating landmarks 4D imaging allows us to have shape analysis of a structure in dynamic state with aid of colour coding Study’s on facial imaging 3D AI Veerasathpurush Allareddy 1. Big data landscape – 2. Machine learning (subfield of Artificial Intelligence) – AI and craniofacial genomics – Blockchain Technology – Orthodontics in Review Blog: Direct to Print Aligners: Björn Ludwig www.orthodonticsinsummary/blog Contents: Shanya Kapoor Editing and Production: Farooq Ahmed…
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orthodontics In summary
Breathing disorders and orthodontics AAO 2022 Join me for a topic summary of breathing disorders and orthodontics, from this year’s American Association of Orthodontics meeting. Two lectures were covered, the first by Takashi Ono which looks at the issues surrounding mouth breathing and its consequences, the second lecture was by Martin Palomo looking at OSA and busy offices, our role and how new technologies are helping. Nasal breathing Vs mouth breathing · Nasal Vs mouth breathing, which is better: Nose = air is humidified, pressurized and filtered than the one come through mouth. · The tongue pressure is 10 times more with mouth breathing than nose breathing in sitting position · Even greater in supine position. = That means tongue pressure increases during mouth breathing especially while sleeping. Memory and Nasal breathing · Normal nasal breathing o = air flow stimulates sensory nerve ending via olfactory to prefrontal cortex and hippocampus region of brain = responsible for memory function. · Memory consolidation was better in subjects who breathe through nose Ribeiro 2016SR o 10 papers, largest paper non-validated questionnaire and half of studies no controls. Variety of outcome measures. · Takashi’s own study into rats showed less O2, and their opinion was this results in impairment in development Nasal obstruction and other consequences · Taste : Taste disturbed by breathing dysfunction, alters shape of lingual papillae Hsu 2017 o Mouth breathing group had increased threshold for sweet and sour taste · Muscles of mastication : Decreased in cross sectional area of masseter and temporalis muscle, with increase in type 2 muscle fiber. o Reduced muscle size and strength & decreased efficacy of masseter muscle strokes · Shape of palate § Altered shape of palatal shape, smaller volume Lione 2015 · Halitosis increased prevalence Motta 2011 · Actopic dermatitis Yamaguchi 2015 New technologies to manage OSA in busy orthodontic office Martin Palomo Prevalence of sleep obstructive sleep apnoea · 42 million adults USA · 1 in 5 mild OSA · 1 in15 moderate OSA · 75% severe sleep disorder = undiagnosed Diagnosis and the orthodontist · Orthodontists cannot diagnose: White paper from AJODO Rolf Behrents 2019 · CAN carry out a Risk assessment = onwards Risk assessment: Adults · STOPBang (Questionnaire for Risk assessment) : http://www.stopbang.ca/osa/screening.php · 8 questions, yes / no and physical details · 100% accurate for high risk apnoea patient · University of Toronto Canada Risk assessment: Children · Paediatric sleep questionnaire (PSQ). Available University of Michigan · Children who snores loudly = poor academic performance, . o Tools for tracking whether your child is snoring or not – 1. Apps Snorelab, Snoreclock a. Mobile apps that records fractions of snoring and categorizes into quite, light, loud and epic snoring - Validited = close to PSG b. Results vary with distance in which phone is kept, or microphone issues Please donate to the Flood Relief Charity for Pakistan https://www.justgiving.com/fundraising/farooqorthodontist1…
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orthodontics In summary
Join me for a summary of Dr Nikhilesh Vaid’s lecture entitled More Than Meets The EYE! Aligner Evidence Through Clinicians Eye It was part of the first International Orthodontic Foundation online symposium, with Ravi Nanda and co. Evidence available There are about 7000 papers available on clear aligner therapy 39 are prospective clinical trials 20 are systematic reviews What do the systematic review and meta-analysis conclude? Overall we don’t have sufficient good quality trials and there is a need of more such trials In addition to that ratio of prospective trials to systematic review is merely 2: 1. Systemic review topics Treatment outcomes Aligners work well for mild to moderate cases. Alignment with aligners is reasonably competent. In Vertical sagittal and transverse dimension possess a bit of challenge. If compared with fixed appliances – doesn’t fit well. *** Outcomes mainly depend on the measurement criteria . Deleterious effects Slight improvement in terms of periodontal effects Advantageous in external apical root resorption Some of periodontal indices improved, also no adverse effect was found Overall need for more studies. Other effects Force levels, only in vitro studies available with conflicting results. Pain level, it was initially lower, thereafter similar, short term QoL (Quality of life) there were less incidences of eating disturbances. Nikhilesh conclusion: Although stated in one of systematic review (Papageorgiou) the current evidence doesn’t supports the use of clear aligner therapy . That this doesn’t meant that it never worked. So according to Dr Vaid its on us to be able to gather some evidence. Nikhilesh’s research: Effectiveness, wear, refinement 1st study - Are aligner effective Does wear protocol makes a difference? Nadawi 2021 3rd study- Can we predict the number of refinements needed? Nikhilesh’s conclusion: Refinements are non-negotiable. Patients will be requiring nearly double the number of initially decided aligners. Planned Vs total aligners 108.11% Greater refinements class 3, deep bite, crowding, posterior crossbites Contributions Contents: Shanya Kapoor Editing and production: Farooq Ahmed…
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