Description

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