Topics of the day:

1. Gemination
2. Re: Help wanted in Hoo, Kent, Great Brittan. Or Who in Hoo?
3. Prepackage orthodontic plaster?
4. Computers
5. ESCO - The Electronic Study Club for Orthodontics

Dear Collegues,

I'm treating a 15 years old boy showing a Class II malocclusion generated chiefly (in my humble opinion) from two central upper incisor geminated ( or for that matters, fused with supernumerary elements. No tooth is missing) and severely rotated (the angle between the central incisor and the supernumerary is not flat but almost 120°). Roots fused.

Now I've corrected the canine and molar classes, aligned the arches but he still show of course a large OVJ. In order to finalize esthetically, I considered to split the centrals to normal size ( a tricky and harmfull procedure which can easy lead to root resorption and teeth loss). Or central incisors extraction and move laterals mesially, build up with veneer or crowns and implants for the laterals. Anyone of you have any idea for the final correction?

Thank you very much for any suggestion about a very unusual case. I can send pictures and model scanning to anyone would desire them.

Maurizio Fucci

Dear Dr. Heiber,

I read with interest your request for an orthodontist in Kent, England, who may follow  your comprehensive proposed treatment plan for a 13 year old patient who seems to be certain that she and her mother will be moving within 9 months or so.     There are several viable and prudent alternatives that you might want to consider in view of the impending relocation of this patient.

Firstly, you might want to inform the patient and her mother of some of the potential generic problems associated with transfer cases.  These might include additional costs of orthodontic treatment, possible dramatic midcourse changes in orthodontic appliance design and strategies, and lastly, treatment time estimates.    "Beating the growth spurt clock", notwithstanding, the disadvantages of beginning treatment (for the patient and parent) under these circumstances, might outweigh any well intended effort to begin treatment at this time. 

Another alternative might be to locate such an orthodontist now (check the AAO and World Directories), and fully discuss this case prior to beginning orthodontic treatment.  Will the new orthodontist feel comfortable with the nonextraction treatment plan that you propose and the use of the Herbst appliance?  As you have astutely noted, "as no treatment has started on this patient, a myriad of options are available, etc."  By consulting with an orthodontist who might be accepting this case prior to beginning orthodontic treatment, you would have the opportunity to minimize many of the potential problems that sometimes accompany transfer cases. 
This specialty (for better or worse) is as much of an art (perhaps more) than a science.  As such, different clinicians might propose different but reasonable treatment plans and/or designs of orthodontic appliances.  In most instances, we do not have the luxury of knowing which patients will transfer, and if they do, at what stage of orthodontic treatment this transfer will take place.   In this particular case, however, we do.  Therefore, as much care, thought, and concern as you might apply during the first 9 months of treatment for this patient must also be accompanied by the same level for the months following her transfer from your practice. 

Elliott Moskowitz
New York City    

To avoid waste, time, improper proportion, and clogging plaster trap, has anyone figured out weight or number of scoops of powder and water for an average set of study models?  Filling up little baggies might be a project for lab. assistant when  lull in schedule.    

Howard Tichler DDS

I have been running Orthotrac Unix for years and am now thinking of upgrading to the Windows version. Crazy? Please let me know.

Also, I looked at Dolphin practice management and found that they could only convert 60 days worth of financial date from Orthotrac so I would lose anything older than 60 days. Does that sound right?

Any other systems I should look at? thanks

charlie ruff

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