The orthodontic appliances have undergone a phenomenal transformation since the speciality of Orthodontics got established. In the process, some good appliances were either ignored or were forgotten in the course of time. However, certain aspects of these appliances got incorporated in the present-day appliances. The first part of the presentation would review three such appliances viz. those of Dr Calvin Case, Dr Spencer Atkinson and Dr Joseph Johnson, and what they have contributed to the contemporary practice.
The second part of the presentation covers the Indian scene, mainly based on what I have seen over the past 50 plus years. Starting from the disorganized state of 1960s, how the pieces fell into the present well organized pattern, and who were the game changers that brought about this remarkable leap is an exciting chapter of history that the younger generation should be made aware of.
With the changing times and values, and rapid advances in technology, the oldest specialty of Dentistry seems to be drifting towards the “Business Of Orthodontics”. Extensive outsourcing, like CAD/CAM aligners, Robotic customised appliance systems, laboratory tailored lingual appliances, to quote a few examples, appears to be shifting the orthodontist off centre stage to sidelines?
Terms like ‘Conflict of Interest’, Plagiarism, Key Opinion Leaders, with reference to orthodontics will be discussed. Practical tips to sustain the pressures, both internal and external, within the ‘Leeway’ of ethical borders will be shared.
A great deal of research in craniofacial growth, newer treatment techniques and philosophies, and refined appliance systems have provided a more complete understanding of those aspects, which impact clinical orthodontics today. While orthodontic care offers a multitude of rewards and makes a significant and lasting impact on the many patients, it can also present a number of challenges due to the complexity of the malocclusion itself or those caused by inaccurate diagnosis, improper mechanics, inherent deficiencies in the appliance systems, and poor finishing. The need to understand and address these areas becomes an integral part of high-quality orthodontic practice. This clinical presentation will review a series of clinical techniques that can be utilized to address the above challenges observed during the management of orthodontic patients. It underlines the importance of accurate diagnosis, individualized treatment goals, efficient treatment mechanics and the use of precision appliance systems that are available today for optimal treatment outcome in diverse clinical situations.
The increased awareness about the issues of oral health and esthetics amongst the dental patients has led to a paradigm shift in our approach towards treatment planning of their problems. The orthodontist plays a pivotal role in addressing such problems by correctly diagnosing them and subsequently executing an appropriate treatment plan. The clinicians may differ greatly with respect to application of different treatment principles and methods as contemporary orthodontics has many ways of attaining its objectives. The variety of appliances and the swings in treatment philosophy have been dramatic, including the one from extraction to non-extraction therapy, the introduction of space-age wires, appliances that grow mandibles, the introduction and extraordinary growth of Invisalign and reduced friction brackets to reduce treatment time. Most of these 'advancements' represent what has been the 'juggernaut of technology’. A myriad of cases representing the various scenarios encountered in day to day orthodontic practice are discussed with emphasis on the identification of problem areas- dental/skeletal, complete work up and ultimately formulating the most suitable treatment plan based on the objectives to be achieved. Adjunct surgical, prosthetic and periodontal interventions for achieving the holistic results are also highlighted.
With the advent of technology I personally fear that our treatment approach has lost HUMAN TOUCH. The respect for biologic component and the possibility of eliciting wonderful response to light forces has become a diminishing art.
In my practice of three decades, now I have realized for the good twenty five years what I was practicing was not so biologically friendly. I have been using a bracket system to move teeth along an arch wire that was tightly tied. To overpower this binding and friction, I had to use forces that not in agreement with biologic principles of tooth movement. I would not hesitate to state that my interaction with Damon System was a chance. The journey for the last five years with Damon system following Damon Philosophy was quite rewarding. The system involves self- ligation brackets, super elastic wires and thoughtful patience by the Orthodontist. Damon philosophy is not about the bracket alone, it is about the System.... A low friction bracket, light force mechanics and respect for the biologic responses that allow tooth movement.
Vertical facial pattern recognized earlier than saggital and maintained through growth. To achieve esthetics profile and functional occlusion, vertical issue must be tackled in orthodontics. Adequate control of vertical facial outline is essential for successful outcome of malocclusion problems. Mostly vertical facial pattern having brachyfacial pattern with deep-bite malocclusion will have clinical features like hypodivergent face, low angle, europroscopic pattern etc. Dental compensations are mostly found in vertical problems. Correction of deep -bite is a prerequisite for retraction of anterior teeth and space closures. It can be achieved by anterior intrusion of teeth, posterior extrusion of molars or combinations of both. The choice of different biomechanics will depend upon nature of deep bite along with soft tissue and underlying skeletal relations. Different fixed orthodontic techniques have devised various concepts for management of deep bite having various biomechanical considerations. Treatment decisions are different for growing and non-growing vertical problems. Objective of present article highlighted characteristics of Deep bite and soft tissue along with biomechanical considerations for correction/management and their possible consequence on the dentition.
Impacted teeth are those with a delayed eruption or they are not expected to erupt on the basis of clinical examination and radiographic finding. Permanent canines are important for an attractive smile and are also essential for a functional occlusion. Maxillary canine are one of the most commonly impacted teeth after the third molar with the prevalence in the range of 0.8-2.8% . Frequency of palatally impacted canine is higher than the labially impacted canines and frequency of mandibular canine impaction is lower as compared to maxillary canine impaction. Because there is a high probability that palatally impacted maxillary canines may occur with other dental anomalies, the clinician should be alert to this possibility. Methods of accurate diagnosis that may allow for early detection should include a family history, visual and tactile clinical examinations by the age of 9-10 years and a thorough radiographic assessment. With early detection, interception and well managed surgical and orthodontic treatment , impacted canines can be guided to appropriate location in the dental arch.In this lecture I will discuss about the importance, diagnosis, surgical exposure and use of fixed orthodontic appliance to bring the tooth in the favourable position followed by cases of canine impaction.
Managing malocclusions efficiently calls for applications of sound mechanics; not just theoretical, but also adaptations of known concepts to suit a patient’s requirement. This may also lead to the discovery of a different regimen and treatment modality. When such new regimens make it simpler producing reproducible results, newer treatment alternatives emerge. In this presentation, the evolution of a new wire-bracket relationship, called the ‘Geometry-X’ will be presented. This has evolved from the understanding of the basic six geometries that Dr. Burstone had elaborated in his seminal article. Likewise, simple strategies of modifying V-bend mechanics is very useful for single tooth corrections in molar region as well as in case of entire anterior segment movement in open bite situations. Cases related to this new wire-bracket geometry and adoption of altered V-bend mechanics will be presented in this talk.
The maxillary anterior segment is indeed a “red zone” , a term borrowed form implant dentistry, in terms of attaining aesthetic objectives with functional and stability implications, within a critical window of leeway. When patients state their chief complaints for common orthodontic concerns like crowding, proclination, spacing, bite issues etc.., they often mean these concerns mainly with reference to their maxillary incisors. This scenario becomes further complicated for the orthodontist in terms of clinical management, when faced with complex maxillary incisor problems such as trauma, impaction, congenitally missing teeth, developmental alterations and periodontally compromised teeth. Treatment planning and subsequent execution truly becomes a challenge for the clinician, and entails interdisciplinary interaction. This presentation aims to elucidate principles in such situations based on contemporary scientific evidence and paradigms, aptly illustrated with clinical cases treated by the author.