Date: Thu, 12 Apr 2007 00:13:34 -0500
From: "ESCO automatic digest system" <LISTSERV@LISTSERV.UIC.EDU>
Subject: ESCO Digest - 9 Apr 2007 to 11 Apr 2007 (#2007-37)

There are 7 messages totalling 597 lines in this issue.

Topics of the day:
1. Re: first molar extraction
2. Class II molar finishing
3. Routine radiographs
4. daily peridex
5. Progress Pano, Cl2 molar, openbite retention, etc


Date: Tue, 10 Apr 2007 22:33:20 +0300
From: "Adrian Becker" <adrianb@CC.HUJI.AC.IL>
Subject: Re: first molar extraction

I guess everyone's experience is relatively limited in maxillary molar extraction cases - some more, some less. However, as a former Begg practitioner and subsequently reborn into TipEdge, I have found that these cases are neither all that rare nor are they difficult. In much the same way as the anatomical lining of the maxillary sinus recontours occlusally after loss of the tooth, the bone is quickly regenerated and recontoured back up again when the second molar is moved mesially and there is no reason for this movement to be inhibited or even slowed. Rather, the difficulty in moving the molar mesially using other methods may be due to the relative lack of a good sliding mechanism in the molar tube/archwire fit.

Adrian Becker


Date: Tue, 10 Apr 2007 19:30:56 +0100
From: "Paul M Thomas" <p.thomas@EARTHLINK.NET>
Subject: Re: Class II molar finishing

My goodness, Brett....

you have dared to suggest that the emperor is "not wearing clothes"?  You dare to suggest there is a paucity of scientific evidence supporting the sanctity and efficacy of a class I molar relationship.??  Did I feel the earth tremble??  Well-done, you!  Slightly eclipsing your 27 years of specialty practice, I have watched with amusement the ebb and flow of dogma regarding the necessity to finish to class I molar.  It is extremely difficult to put the wooden stake through the heart of that tenet.  And, the horror movie metaphor is appropriate since just when you think the "monster" is dead, it raises it's fearsome head once again.  I should add, parenthetically, that when serving on a search committee at a well-known US dental school seeking a chairman of occlusion, I submitted the name of John Rugh.  I thought he was the only person who could approach the issue objectively.  As a psychologist, I thought he would be perfect in the sense that he would bring no dental preconceptions (ie baggage) and had some basis in understanding the insanity exhibited by some of our colleagues SO focused on the paramount importance of occlusion.  Obviously someone elsewhere agreed since he, as a non-clinician (dental) is chairman of an orthodontics department. In managing adult orthodontic and orthognathic patients over the last 37 years, it is not unusual to have patients finish with class I canines and either class II or class III molars.  I will freely admit there can be a few issues related to contact on the terminal molars in the arch, but I will have to say I have never heard a SPONTANTEOUS patient complaint related to asymmetric molar/canine relationships. If there ever has been a complaint (and there has been the occasional) its genesis could be tracked to an over-zealous general dental practitioner who was indelibly "imprinted" with "the dogma" during the process of dental education.  Or if not in the course of pre-doctoral the process of attending a VERY expense post-doctoral "experience" with one of the various gurus preaching the sanctity of class I occlusion.  Although, in keeping with the reference listed by Dr. Kerr, I will agree that there is something to be said for "pretty teeth", but certainly not at the expense of good science and common sense. I am pleased to see that skepticism (and cricket) is alive and well "down under".     


Paul M Thomas

Date: Tue, 10 Apr 2007 15:16:00 +0530
From: "Dr. M.Jayaram" <jmailankody@GMAIL.COM>
Subject: Re: Class II molar finishing

Hi Brett,                

I am surprised by your seeking 'scientific evidence' for class I molar relationship! It is like physicians asking for evidence of normal temperature at 98.4 degree F or pulse rate of 72 per minute or normal blood cholesterol of 220 mgs%. Of course recent 'evidence and sponsored research' has been reducing the normal lipid level, thanks to the statin manufacturing firms! The very definition of malocclusion is 'deviation from normal occlusion'- and there can be no doubt about normal occlusion (class I)of the first molars. If deviated occlusion (class II) is better or as good as normal, and need not be corrected, one may need a new definition for the term 'malocclusion'! Why do you think only 'some articles' in JCO is freely accessible in the net, made so by sponsors? Is it sponsored research? Succumbing to commercial pressure and aggressive marketing oriented research and publication, one has to be cautious!  Your shift of paradigm would be welcome, if it is directed at appraisal of soft tissue, smile analysis,dynamics/function, transverse dimension, interdisciplinary possibilities, and so on. Not on the basis of commercial prescriptions, aligners, self ligating systems, MIS for anything and everything!

Jayaram Mailankody


Date: Mon, 9 Apr 2007 12:56:08 -0400
From: "Lively Orthodontics, P.A." <mdlively@BELLSOUTH.NET>
Subject: Re: Routine radiographs

We are (supposed to be) taking panos q6m on 18 mo tx plans, q8m on 24+ mo tx plans. Progress ceph and models on skeletal corrections or for verification of incisor inclination on extraction treatment plans. The first progress pano is usually taken at the visit we bond the mandibular arch and check for possible repositioning in the maxillary arch. Taking films more often is like watching grass grow, unless you are at the end of treatment and you are checking on 2nd order bends.

Mark Lively


Date: Mon, 9 Apr 2007 12:50:33 -0400
From: "Lively Orthodontics, P.A." <mdlively@BELLSOUTH.NET>
Subject: Re: daily peridex

I used Phosflur for years but have since gone to ACT as it is supported by both the AAO and ADA. I would think that one should be concerned about having a patient on chlorohexidine for an extended period of time. I have always considered it as an adjunct to treating gingivitis rather than a long-term solution.

Mark Lively


Date: Wed, 11 Apr 2007 11:34:28 -0400
From: "Roy King" <rkking@BELLSOUTH.NET>
Subject: Progress Pano, Cl2 molar, openbite retention, etc

Dear ESCO,

I take a progress pano on every patient and if they have risks to root resorption then that progress pano is planned at 6 months after braces. To retain openbites, I use a Damon Retainer( Did I say the D word). The rationale is that it locks all the teeth together and has a posterior bite block. As far as CL 2 molar, I would look into the same literature that describes missing upper laterals and replacing them with upper cuspids. The literatures states that even though their is no cuspid guidance that the mouths stayed healthy for a life time. I am sure that some of those cases were treated Cl 2. molar. I also ask myself what is the purpose of posterior occlusion and what do you want to avoid. If you satisfy that question then your posterior occlusion will be functional and healthy. I have basically never rotated a biscuspid 180 degrees. Those teeth appear to be healthy before treatment and the patients have not voiced a concern about the esthetics. As far as extractions of 1st molars for Cl 2 corrections, there are many ways to skin the cat . As long as the skinned cat is esthetically pleasing and functionally sound then do what is best in your hands. I have had a world of experience in growth hormones( 2 or 3 cases) and my concerns the unpredictale relationship of the skeletal components post orthodontics. The cases finished nice but the long term results deteriated. My only guess is that sutural and cartilage growth were affected differently. Sorry to bring up the I word but Invisalign is changing from a sequential staging to a simultaneous staging and asking us not to use our preferences. This sounds like Invisalign 101 of year 2000 where they said to send in the models and the computer knows all. What are your thoughts. I like the decrease in the velocity of the movements but I still have problems with not really seeing the staging editor so that I can see what velocity of movement for each order of movement.

Roy King


Date: Tue, 10 Apr 2007 09:34:27 -0700
Subject: Routine radiographs

Dear Leon,

I try to take the first update pan at 7-9 months into treatment to check for root resorption and root position. The logic for this time period is that I usually try to wait until the patient is in their maximum size archwire 2-3 months before taking the pan. Hopefully, this is enough time for the mistakes in my original bracket positioning to show themselves. Then I schedule rebonds for position. If I wait longer for the first pan then the rebonds are taking place much later in treatment and this can set the patients treatment behind. I believe that 7-9 months after the start is enough time to detect root resorption if the patient is prone. Then, unless the patient is almost done, a second update pan is taken 12 months later. Again checking for resorption and that my rebonds corrected any problems. Anyone have a better protocol? Sincerely, Rob Kazmierski Moorestown, NJ
How often are you taking routine progress radiographs on your
patients in fixed appliances?
Do you increase the frequency in patients with thin or tapered roots?
Panoramic or upper occlusal?

Leon Klempner
Port Jefferson, NY