|Date:||Tue, 17 Apr 2007 00:13:16 -0500|
|From:||"ESCO automatic digest system" <LISTSERV@LISTSERV.UIC.EDU>|
|Subject:||ESCO Digest - 13 Apr 2007 to 16 Apr 2007 (#2007-39)|
There are 3 messages totalling 5183 lines in this issue.
Topics of the day:
2. Class II molar finishing
3. Class 2 part 2
|Date:||Sun, 15 Apr 2007 12:51:01 -0400|
|From:||"Roy King" <rkking@BELLSOUTH.NET>|
When I use Peridex, it is use for only one week out of the month so to avoid the negative effects of Peridex. It seems that removing the wires and bringing the patient back in one week is the most effective way to improve oral hygiene.
|Date:||Sat, 14 Apr 2007 23:49:10 +1000|
|From:||"Mark Cordato" <markc@IX.NET.AU>|
|Subject:||Re: Class II molar finishing|
Orthodontic malocclusion is not necessarily pathological.
Your conceptual belief that just because a tooth arrangement is not as you have had defined to you by Angle then it is not correct is like saying that ALL whose ANB is greater than say 8 degrees requires orthognathic surgery to have normality (and to then perhaps they could lead a normal life, further implying that it is not possible for any person to lead a normal life with a large ANB angle).
If you have a mental image that molars may only be arranged with a Class I relationship then the range of treamtents you can deliver for your patients will be limited by this preconception. Extracting in one arch and even unilateral extractions do have their place in orthodontics and can simplify treatment and in well selected cases, produce fine results.
Personally, I agree with Brett Kerr and Paul Thomas that rigid concepts of occlusion and treatment goals can reduce what can be offered to patients. Even the American Board in its 1997 outline of objective treatment measures noted that its treatment goals could not be met in all patients. It is part of our skills as practitioners to determine the compromises required for the individual in the chair in front of us. I think this is where clinical experience can improve our decision making in reading our patients and how to treat them and when to follow dogma and when to discard it.
It is possible to finish a case with Class II and Class III molars with canine guidance, no protrusive and lateral interferences with good alignement and good aesthetics. A patient so treated may then have a problem if they then have a dentist whose teaching has altered their perceptions to see this as wrong (ugly or a malocclusion). Angle later regarded all extractions as unnatural and wrong yet Appolo Belvedere had a profile more retruded than many of us would treat to today. Begg's favourite skull demonstrating attritional occlusion and as his ideal occlusion had large dental protrusion, far more than many of us would accept today (I would be extracting if the patient suggested the teeth and lower facial soft tissue were too forward but then typically the Australian Aborigine is dental protrusive).
One of the challenges of our specialty is the need for judgement, the aesthetic aspect and the many paradoxes. Most of the treatments I would like to treat differently are those where I trusted numbers on a ceph alone without inputing the live patient features such as flesh thickness, gingival thickness, bone over the roots, soft tissue and how the teeth and lips work in speech and in smiling. (And of course those patients who grew differently or more than expected). We need the usual and our idealisations (which we perhaps inappropriately name as normal) to set our goals but we also need to know that deviation from such ideals is often required, however, the deviations should be foreseen noted and explained to the patient prior to treating.
firstname.lastname@example.org Bathurst Australia
|Date:||Sat, 14 Apr 2007 11:22:19 +0200|
|From:||"Dick Carter" <drdcarter@MAC.COM>|
|Subject:||class 2 part 2|
Here is the progress record at 5 months.? Now, we change the upper 3 brackets to standard Inspire 018 to take out the overcorrection built into the retraction brackets.? Notice the molar TUBES, which make tying and changing arches simple.? With titanium arches, there is rarely a need to have a bracket on a molar. Even displaced molars can be tied to a tube by threading the ligature wire through the tube first.
we want to avoid a heavy edgewise arch unless absolutely mandatory.? This is a growing child with delicate roots.
The last montage is at 7 months.? 4 appointments, 2 arches total in each arch: 016 round, then 016X022 edgewise titanium.
now, some minimal vertical elastics, and she'll finish easily in a year with no heavy forces.
I do not consider this a "compromise" treatment.? Au contraire, to subject this child to extreme forces and force teeth into positions off the basal bone is extreme.? Simply equilibrating the upper molar transverse ridges solve the problem of a class 2 molar relationship. This case will need little retention.
Dr Dick Carter Orthodontist Portland OR USA