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Dr Andrew Chang. Smiles & Faces
Orthodontics-Blacktown, Sydney, Australia.
Ph:02-8814-9941.
http://www.greatsydneysmiles.c...
1. Perceptions of dentistry
2. Trends In society
Dr Andrew Chang. Smiles & Faces Orthodontics-
Blacktown, Sydney, Australi...
Dr Andrew Chang. Smiles & Faces Orthodontics-
Blacktown, Sydney, Australia. Ph:02-8814-9941.
http://www.greatsydneysmiles....
Trend towards a health
conscious society
Trends in orthodontic treatment
Extraction (70’s, 80’s) Non-extraction or minimal...
Vs
Vs
Dr Andrew Chang. Smiles & Faces Orthodontics-
Blacktown, Sydney, Australia. Ph:02-8814-9941.
http://www.greatsydneys...
Many media types
Friends , family and
LIKES
Wikipedia
Dr Andrew Chang. Smiles & Faces Orthodontics-
Blacktown, Sydney, Aus...
Dr Andrew Chang. Smiles & Faces Orthodontics-
Blacktown, Sydney, Australia. Ph:02-8814-9941.
http://www.greatsydneysmiles....
Definite
non-
Extraction
4/5
Extraction
29%
Non-
Extraction
71%
Borderline Non-
extraction
1/5
Overview of orthodontic tre...
Outline
 Non extraction (arch expansion) and aesthetics
 Non extraction and gum recession
 Non extraction and protrusio...
Dr Andrew Chang. Smiles & Faces Orthodontics-
Blacktown, Sydney, Australia. Ph:02-8814-9941.
http://www.greatsydneysmiles....
AP
 21 year old
 Mild skeletal Class 3
 Marked upper right crowding
 Remove 4 premolar teeth or non extraction
 Treat...
Pre-treatment
Dr Andrew Chang. Smiles & Faces Orthodontics-
Blacktown, Sydney, Australia. Ph:02-8814-9941.
http://www.grea...
1 yr 2 months into treatment
Dr Andrew Chang. Smiles & Faces Orthodontics-
Blacktown, Sydney, Australia. Ph:02-8814-9941.
...
VZ
 18 year old male
 Concerned about teeth removal
 Mouthbreather
 Declined option of jaw surgery
Dr Andrew Chang. Sm...
Pre-treatment
 Had initial difficulty with expander- eating and speakingDr Andrew Chang. Smiles & Faces Orthodontics-
Bla...
8 mths into treatment
Dr Andrew Chang. Smiles & Faces Orthodontics-
Blacktown, Sydney, Australia. Ph:02-8814-9941.
http://...
RA
 15 years old
 Main concern: 2nd opinion, was previously informed
would need 4 premolars removed.
 ‘we would probabl...
Pre-treatment
Dr Andrew Chang. Smiles & Faces Orthodontics-
Blacktown, Sydney, Australia. Ph:02-8814-9941.
http://www.grea...
1 yr 4 mths into treatment
Dr Andrew Chang. Smiles & Faces Orthodontics-
Blacktown, Sydney, Australia. Ph:02-8814-9941.
ht...
Why did this treatment work?
 The incisors/ lips were NOT initially protrusive.
 Protrusion was NOT her main concern.
Dr...
 14 year old JL
 Apprehensive
Challenging the Limits
Dr Andrew Chang. Smiles & Faces Orthodontics-
Blacktown, Sydney, Au...
Pre-treatment
8 mths after (RPE+braces)
Dr Andrew Chang. Smiles & Faces Orthodontics-
Blacktown, Sydney, Australia. Ph:02-...
Arch expansion & aesthetics
 Arch expansion = broader smile
 Narrow smile – less inclined to extract
 Expander treatmen...
Outline
 Non extraction (arch expansion) and aesthetics
 Non extraction and gum recession
 Non extraction and protrusio...
Dr Andrew Chang. Smiles & Faces Orthodontics-
Blacktown, Sydney, Australia. Ph:02-8814-9941.
http://www.greatsydneysmiles....
Can the amount of arch expansion
determine recession?
 CP- adult
 MB- adult
 MC- teen
 TP- teen
Dr Andrew Chang. Smile...
CP
 19 year old
 Severe lower crowding
 Did not want teeth removed
 Gingival biotype- thin?
Dr Andrew Chang. Smiles & ...
Pre-treatment
Dr Andrew Chang. Smiles & Faces Orthodontics-
Blacktown, Sydney, Australia. Ph:02-8814-9941.
http://www.grea...
Post-treatment
Dr Andrew Chang. Smiles & Faces Orthodontics-
Blacktown, Sydney, Australia. Ph:02-8814-9941.
http://www.gre...
MB
 23 year old
 Moderate crowding in lower, severe crowding in upper
 Pre-existing recession on 31.
 Gingival biotype...
Pre-treatment
Dr Andrew Chang. Smiles & Faces Orthodontics-
Blacktown, Sydney, Australia. Ph:02-8814-9941.
http://www.grea...
Post-treatment
Dr Andrew Chang. Smiles & Faces Orthodontics-
Blacktown, Sydney, Australia. Ph:02-8814-9941.
http://www.gre...
MC
 13 year old
 Concerned about upper and lower teeth crowding
Dr Andrew Chang. Smiles & Faces Orthodontics-
Blacktown,...
Pre-treatment
Dr Andrew Chang. Smiles & Faces Orthodontics-
Blacktown, Sydney, Australia. Ph:02-8814-9941.
http://www.grea...
Post-treatment
Dr Andrew Chang. Smiles & Faces Orthodontics-
Blacktown, Sydney, Australia. Ph:02-8814-9941.
http://www.gre...
TP
 12 year old
 Recession present on 31
 Moderate lower arch crowding
Dr Andrew Chang. Smiles & Faces Orthodontics-
Bl...
Pre-treatment
Dr Andrew Chang. Smiles & Faces Orthodontics-
Blacktown, Sydney, Australia. Ph:02-8814-9941.
http://www.grea...
Post-treatment
Dr Andrew Chang. Smiles & Faces Orthodontics-
Blacktown, Sydney, Australia. Ph:02-8814-9941.
http://www.gre...
Challenging the limits of the
periodontium-summary
Predisposing factors
• Arch expansion &
crowding
• Inflammation
• Gingi...
Outline
 Non extraction (arch expansion) and aesthetics
 Non extraction and gum recession
 Non extraction and protrusio...
Dr Andrew Chang. Smiles & Faces Orthodontics-
Blacktown, Sydney, Australia. Ph:02-8814-9941.
http://www.greatsydneysmiles....
ET
 18 year old
 ET’s main concern was her upper front teeth are
forward
 Parents did not want teeth removal
Dr Andrew ...
Pre-treatment
Dr Andrew Chang. Smiles & Faces Orthodontics-
Blacktown, Sydney, Australia. Ph:02-8814-9941.
http://www.grea...
Progress treatment
Dr Andrew Chang. Smiles & Faces Orthodontics-
Blacktown, Sydney, Australia. Ph:02-8814-9941.
http://www...
Dr Andrew Chang. Smiles & Faces Orthodontics-
Blacktown, Sydney, Australia. Ph:02-8814-9941.
http://www.greatsydneysmiles....
AP
 26 year old
 Concerned with upper and lower crowding
 Would like a fuller smile
 Mild Class 3 skeletal
Dr Andrew C...
Pre-treatment
Dr Andrew Chang. Smiles & Faces Orthodontics-
Blacktown, Sydney, Australia. Ph:02-8814-9941.
http://www.grea...
Post-treatment
Dr Andrew Chang. Smiles & Faces Orthodontics-
Blacktown, Sydney, Australia. Ph:02-8814-9941.
http://www.gre...
Arch expansion and protrusion-
 Limiting factor is front teeth protrusion
 IPR limits incisor proclination
Summary
Dr An...
Outline
 Non extraction (arch expansion) and aesthetics
 Non extraction and gum recession
 Non extraction and protrusio...
Increased overjet non extraction
treatment
1. In growing children (before
pubertal growth spurt)
2.In teenagers (during or...
Adapted from J Korean
Med Assoc 2009
showing 3rd, 50th and
97th percentile
Dr Andrew Chang. Smiles & Faces Orthodontics-
B...
Identifying pubertal spurt
1. Ask parent: Height growth last 6 months?
Height compared with parents.
2. size change- when?...
BL
 13 year old male
 Late Mixed dentition, large 13mm overjet
 Missing tooth 45
 Had not commenced pubertal growth sp...
Pre-treatment
Dr Andrew Chang. Smiles & Faces Orthodontics-
Blacktown, Sydney, Australia. Ph:02-8814-9941.
http://www.grea...
Post-treatment
Dr Andrew Chang. Smiles & Faces Orthodontics-
Blacktown, Sydney, Australia. Ph:02-8814-9941.
http://www.gre...
JL
 13 year old male
 Permanent dentition
 Large 14mm overjet
 Had not commenced pubertal growth spurt
 Wore removabl...
Pre-treatment
Dr Andrew Chang. Smiles & Faces Orthodontics-
Blacktown, Sydney, Australia. Ph:02-8814-9941.
http://www.grea...
Post-treatment
Dr Andrew Chang. Smiles & Faces Orthodontics-
Blacktown, Sydney, Australia. Ph:02-8814-9941.
http://www.gre...
Increased overjet non extraction
treatment
1. In growing children (before
pubertal growth spurt)
2.In teenagers (during or...
Teenagers & adults
 TWM- teenager. Forsus
springs
 LD- teenager. Forsus
springs: 2nd opinion
 RA- adult. Forsus
springs...
TWM
 12 year old female
 Permanent dentition
 10mm anterior overjet
 Recently commenced pubertal growth spurt
Dr Andre...
Pre-treatment
Dr Andrew Chang. Smiles & Faces Orthodontics-
Blacktown, Sydney, Australia. Ph:02-8814-9941.
http://www.grea...
1 yr 6 months into treatment
Dr Andrew Chang. Smiles & Faces Orthodontics-
Blacktown, Sydney, Australia. Ph:02-8814-9941.
...
LD
 14 year old male
 Permanent dentition
 8mm anterior overjet
 Post pubertal growth peak
 2nd opinion: ‘My teeth ar...
Pre-treatment
Dr Andrew Chang. Smiles & Faces Orthodontics-
Blacktown, Sydney, Australia. Ph:02-8814-9941.
http://www.grea...
1 yr 6 months into treatment
Dr Andrew Chang. Smiles & Faces Orthodontics-
Blacktown, Sydney, Australia. Ph:02-8814-9941.
...
RA
 16 year old ‘adult’ female
 Deep bite
Dr Andrew Chang. Smiles & Faces Orthodontics-
Blacktown, Sydney, Australia. Ph...
Pre-treatment
Dr Andrew Chang. Smiles & Faces Orthodontics-
Blacktown, Sydney, Australia. Ph:02-8814-9941.
http://www.grea...
Post-treatment
Dr Andrew Chang. Smiles & Faces Orthodontics-
Blacktown, Sydney, Australia. Ph:02-8814-9941.
http://www.gre...
MP
• 22 years old female
• Deep bite, related to wear of her
upper incisal edges
Dr Andrew Chang. Smiles & Faces Orthodont...
Pre-treatment
Dr Andrew Chang. Smiles & Faces Orthodontics-
Blacktown, Sydney, Australia. Ph:02-8814-9941.
http://www.grea...
Post-treatment
Dr Andrew Chang. Smiles & Faces Orthodontics-
Blacktown, Sydney, Australia. Ph:02-8814-9941.
http://www.gre...
Increased overjet non-extraction
treatment
Restricted to deep
bite, moderate
overjets
Summary- treatment timing
>10mm over...
be identified &
intercepted at
an earlier age?
Can
Dr Andrew Chang. Smiles & Faces Orthodontics-
Blacktown, Sydney, Austra...
Outline
 Non extraction (arch expansion) and aesthetics
 Non extraction and gum recession
 Non extraction and protrusio...
Dr Andrew Chang. Smiles & Faces Orthodontics-
Blacktown, Sydney, Australia. Ph:02-8814-9941.
http://www.greatsydneysmiles....
The ectopically erupting 6
EARLY
1. E Mesial marginal ridge visibility
2. Angulation of 6- parallel
3. Width of impaction ...
The ectopically erupting 6
EARLY- Angulation of 6- parallelDr Andrew Chang. Smiles & Faces Orthodontics-
Blacktown, Sydney...
The ectopically erupting 6
EARLY- Width of impaction < ¼ MD width of EDr Andrew Chang. Smiles & Faces Orthodontics-
Blackt...
The ectopically erupting 6
EARLY- Depth of impaction < ¾ crown height of EDr Andrew Chang. Smiles & Faces Orthodontics-
Bl...
The ectopically erupting 6- mid
MID-STAGE
1. E Mesial marginal ridge not visible
2. Angulation of 6- not parallel
3. Width...
The ectopically erupting 6- late
LATE
1. E Mesial marginal ridge not visible
2. Angulation of 6- not parallel
3. Width of ...
Dr Andrew Chang. Smiles & Faces Orthodontics-
Blacktown, Sydney, Australia. Ph:02-8814-9941.
http://www.greatsydneysmiles....
Instruments
 2 mosquito forceps
 Elastic separator
 Vaseline
 Metal separator- for slightly deeper impactions
Dr Andre...
Summary
 Early stage impaction of 6 can be predictably managed
 Angulation of 6 and visibility of E marginal ridge are
k...
‘The success (of any outcome) lies
in the ability to get the other
person’s point of view and see
things from his angle as...
Dr Andrew Chang. Smiles & Faces Orthodontics-
Blacktown, Sydney, Australia. Ph:02-8814-9941.
http://www.greatsydneysmiles....
 Mesial drift- have a slide animation demonstrating this
and overeruption of opposing teeth
Dr Andrew Chang. Smiles & Fac...
Timeline sequence for loss of baby
teeth
Ectopically resorbing E’s
 David Lee
 Charlotte Vanderlinde
Prematurely lost 6 ...
Space maintainence – lingual
arches are best- be wary of
lingually erupting lower 4’s
Dr Andrew Chang. Smiles & Faces Orth...
Space regaining B4 U 6’s have
erupted
Andrew Amabile
Dr Andrew Chang. Smiles & Faces Orthodontics-
Blacktown, Sydney, Aust...
Distalization of upper molars early
for Class 2 patients
 Andrew Amabile
 Preferred method- U 2x4, LLA & Cl 2 els ie: Fa...
Dr Andrew Chang. Smiles & Faces Orthodontics-
Blacktown, Sydney, Australia. Ph:02-8814-9941.
http://www.greatsydneysmiles....
 Single tooth agenesis
 Survey the audience: For lower 5’s agenesis: if it was their
child, would they do exo of 4 teeth...
 Agenesis of E’s- Shannon Garland, Daniel Egan,
Teenage female- saw last Wed 27-3 or 26-3 or LEADS
during this time where...
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Examining the boundaries of non extraction orthodontic treatment

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Dr Andrew Chang,of Smiles & Faces orthodontics, explores the increasing prevalence of non extraction orthodontic treatment.

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Examining the boundaries of non extraction orthodontic treatment

  1. 1. Dr Andrew Chang. Smiles & Faces Orthodontics-Blacktown, Sydney, Australia. Ph:02-8814-9941. http://www.greatsydneysmiles.com.au
  2. 2. 1. Perceptions of dentistry 2. Trends In society Dr Andrew Chang. Smiles & Faces Orthodontics- Blacktown, Sydney, Australia. Ph:02-8814-9941. http://www.greatsydneysmiles.com.au
  3. 3. Dr Andrew Chang. Smiles & Faces Orthodontics- Blacktown, Sydney, Australia. Ph:02-8814-9941. http://www.greatsydneysmiles.com.au
  4. 4. Trend towards a health conscious society Trends in orthodontic treatment Extraction (70’s, 80’s) Non-extraction or minimal extractions(current) Dr Andrew Chang. Smiles & Faces Orthodontics- Blacktown, Sydney, Australia. Ph:02-8814-9941. http://www.greatsydneysmiles.com.au
  5. 5. Vs Vs Dr Andrew Chang. Smiles & Faces Orthodontics- Blacktown, Sydney, Australia. Ph:02-8814-9941. http://www.greatsydneysmiles.com.au
  6. 6. Many media types Friends , family and LIKES Wikipedia Dr Andrew Chang. Smiles & Faces Orthodontics- Blacktown, Sydney, Australia. Ph:02-8814-9941. http://www.greatsydneysmiles.com.au
  7. 7. Dr Andrew Chang. Smiles & Faces Orthodontics- Blacktown, Sydney, Australia. Ph:02-8814-9941. http://www.greatsydneysmiles.com.au
  8. 8. Definite non- Extraction 4/5 Extraction 29% Non- Extraction 71% Borderline Non- extraction 1/5 Overview of orthodontic treatment decisions Dr Andrew Chang. Smiles & Faces Orthodontics- Blacktown, Sydney, Australia. Ph:02-8814-9941. http://www.greatsydneysmiles.com.au
  9. 9. Outline  Non extraction (arch expansion) and aesthetics  Non extraction and gum recession  Non extraction and protrusion  Large overjets and non extraction treatment  Identifying & Intercepting the ectopic permanent 1st molar Dr Andrew Chang. Smiles & Faces Orthodontics- Blacktown, Sydney, Australia. Ph:02-8814-9941. http://www.greatsydneysmiles.com.au
  10. 10. Dr Andrew Chang. Smiles & Faces Orthodontics- Blacktown, Sydney, Australia. Ph:02-8814-9941. http://www.greatsydneysmiles.com.au
  11. 11. AP  21 year old  Mild skeletal Class 3  Marked upper right crowding  Remove 4 premolar teeth or non extraction  Treatment plan: U expander and U/L braces Dr Andrew Chang. Smiles & Faces Orthodontics- Blacktown, Sydney, Australia. Ph:02-8814-9941. http://www.greatsydneysmiles.com.au
  12. 12. Pre-treatment Dr Andrew Chang. Smiles & Faces Orthodontics- Blacktown, Sydney, Australia. Ph:02-8814-9941. http://www.greatsydneysmiles.com.au
  13. 13. 1 yr 2 months into treatment Dr Andrew Chang. Smiles & Faces Orthodontics- Blacktown, Sydney, Australia. Ph:02-8814-9941. http://www.greatsydneysmiles.com.au
  14. 14. VZ  18 year old male  Concerned about teeth removal  Mouthbreather  Declined option of jaw surgery Dr Andrew Chang. Smiles & Faces Orthodontics- Blacktown, Sydney, Australia. Ph:02-8814-9941. http://www.greatsydneysmiles.com.au
  15. 15. Pre-treatment  Had initial difficulty with expander- eating and speakingDr Andrew Chang. Smiles & Faces Orthodontics- Blacktown, Sydney, Australia. Ph:02-8814-9941. http://www.greatsydneysmiles.com.au
  16. 16. 8 mths into treatment Dr Andrew Chang. Smiles & Faces Orthodontics- Blacktown, Sydney, Australia. Ph:02-8814-9941. http://www.greatsydneysmiles.com.au
  17. 17. RA  15 years old  Main concern: 2nd opinion, was previously informed would need 4 premolars removed.  ‘we would probably have not proceeded with orthodontic treatment if RA had to have teeth removed’-- mother. Dr Andrew Chang. Smiles & Faces Orthodontics- Blacktown, Sydney, Australia. Ph:02-8814-9941. http://www.greatsydneysmiles.com.au
  18. 18. Pre-treatment Dr Andrew Chang. Smiles & Faces Orthodontics- Blacktown, Sydney, Australia. Ph:02-8814-9941. http://www.greatsydneysmiles.com.au
  19. 19. 1 yr 4 mths into treatment Dr Andrew Chang. Smiles & Faces Orthodontics- Blacktown, Sydney, Australia. Ph:02-8814-9941. http://www.greatsydneysmiles.com.au
  20. 20. Why did this treatment work?  The incisors/ lips were NOT initially protrusive.  Protrusion was NOT her main concern. Dr Andrew Chang. Smiles & Faces Orthodontics- Blacktown, Sydney, Australia. Ph:02-8814-9941. http://www.greatsydneysmiles.com.au
  21. 21.  14 year old JL  Apprehensive Challenging the Limits Dr Andrew Chang. Smiles & Faces Orthodontics- Blacktown, Sydney, Australia. Ph:02-8814-9941. http://www.greatsydneysmiles.com.au
  22. 22. Pre-treatment 8 mths after (RPE+braces) Dr Andrew Chang. Smiles & Faces Orthodontics- Blacktown, Sydney, Australia. Ph:02-8814-9941. http://www.greatsydneysmiles.com.au
  23. 23. Arch expansion & aesthetics  Arch expansion = broader smile  Narrow smile – less inclined to extract  Expander treatment in adults would be on dental basis ie: attaining space for the adult teeth Summary Dr Andrew Chang. Smiles & Faces Orthodontics- Blacktown, Sydney, Australia. Ph:02-8814-9941. http://www.greatsydneysmiles.com.au
  24. 24. Outline  Non extraction (arch expansion) and aesthetics  Non extraction and gum recession  Non extraction and protrusion  Large overjets and non extraction treatment  Identifying & Intercepting the ectopic permanent 1st molar Dr Andrew Chang. Smiles & Faces Orthodontics- Blacktown, Sydney, Australia. Ph:02-8814-9941. http://www.greatsydneysmiles.com.au
  25. 25. Dr Andrew Chang. Smiles & Faces Orthodontics- Blacktown, Sydney, Australia. Ph:02-8814-9941. http://www.greatsydneysmiles.com.au
  26. 26. Can the amount of arch expansion determine recession?  CP- adult  MB- adult  MC- teen  TP- teen Dr Andrew Chang. Smiles & Faces Orthodontics- Blacktown, Sydney, Australia. Ph:02-8814-9941. http://www.greatsydneysmiles.com.au
  27. 27. CP  19 year old  Severe lower crowding  Did not want teeth removed  Gingival biotype- thin? Dr Andrew Chang. Smiles & Faces Orthodontics- Blacktown, Sydney, Australia. Ph:02-8814-9941. http://www.greatsydneysmiles.com.au
  28. 28. Pre-treatment Dr Andrew Chang. Smiles & Faces Orthodontics- Blacktown, Sydney, Australia. Ph:02-8814-9941. http://www.greatsydneysmiles.com.au
  29. 29. Post-treatment Dr Andrew Chang. Smiles & Faces Orthodontics- Blacktown, Sydney, Australia. Ph:02-8814-9941. http://www.greatsydneysmiles.com.au
  30. 30. MB  23 year old  Moderate crowding in lower, severe crowding in upper  Pre-existing recession on 31.  Gingival biotype. Thin? Dr Andrew Chang. Smiles & Faces Orthodontics- Blacktown, Sydney, Australia. Ph:02-8814-9941. http://www.greatsydneysmiles.com.au
  31. 31. Pre-treatment Dr Andrew Chang. Smiles & Faces Orthodontics- Blacktown, Sydney, Australia. Ph:02-8814-9941. http://www.greatsydneysmiles.com.au
  32. 32. Post-treatment Dr Andrew Chang. Smiles & Faces Orthodontics- Blacktown, Sydney, Australia. Ph:02-8814-9941. http://www.greatsydneysmiles.com.au
  33. 33. MC  13 year old  Concerned about upper and lower teeth crowding Dr Andrew Chang. Smiles & Faces Orthodontics- Blacktown, Sydney, Australia. Ph:02-8814-9941. http://www.greatsydneysmiles.com.au
  34. 34. Pre-treatment Dr Andrew Chang. Smiles & Faces Orthodontics- Blacktown, Sydney, Australia. Ph:02-8814-9941. http://www.greatsydneysmiles.com.au
  35. 35. Post-treatment Dr Andrew Chang. Smiles & Faces Orthodontics- Blacktown, Sydney, Australia. Ph:02-8814-9941. http://www.greatsydneysmiles.com.au
  36. 36. TP  12 year old  Recession present on 31  Moderate lower arch crowding Dr Andrew Chang. Smiles & Faces Orthodontics- Blacktown, Sydney, Australia. Ph:02-8814-9941. http://www.greatsydneysmiles.com.au
  37. 37. Pre-treatment Dr Andrew Chang. Smiles & Faces Orthodontics- Blacktown, Sydney, Australia. Ph:02-8814-9941. http://www.greatsydneysmiles.com.au
  38. 38. Post-treatment Dr Andrew Chang. Smiles & Faces Orthodontics- Blacktown, Sydney, Australia. Ph:02-8814-9941. http://www.greatsydneysmiles.com.au
  39. 39. Challenging the limits of the periodontium-summary Predisposing factors • Arch expansion & crowding • Inflammation • Gingival biotype Initiating factors • Trauma- nailbiting/piercing • Deep bite • Toothbrush Recession Dr Andrew Chang. Smiles & Faces Orthodontics- Blacktown, Sydney, Australia. Ph:02-8814-9941. http://www.greatsydneysmiles.com.au
  40. 40. Outline  Non extraction (arch expansion) and aesthetics  Non extraction and gum recession  Non extraction and protrusion  Large overjets and non extraction treatment  Identifying & Intercepting the ectopic permanent 1st molar Dr Andrew Chang. Smiles & Faces Orthodontics- Blacktown, Sydney, Australia. Ph:02-8814-9941. http://www.greatsydneysmiles.com.au
  41. 41. Dr Andrew Chang. Smiles & Faces Orthodontics- Blacktown, Sydney, Australia. Ph:02-8814-9941. http://www.greatsydneysmiles.com.au
  42. 42. ET  18 year old  ET’s main concern was her upper front teeth are forward  Parents did not want teeth removal Dr Andrew Chang. Smiles & Faces Orthodontics- Blacktown, Sydney, Australia. Ph:02-8814-9941. http://www.greatsydneysmiles.com.au
  43. 43. Pre-treatment Dr Andrew Chang. Smiles & Faces Orthodontics- Blacktown, Sydney, Australia. Ph:02-8814-9941. http://www.greatsydneysmiles.com.au
  44. 44. Progress treatment Dr Andrew Chang. Smiles & Faces Orthodontics- Blacktown, Sydney, Australia. Ph:02-8814-9941. http://www.greatsydneysmiles.com.au
  45. 45. Dr Andrew Chang. Smiles & Faces Orthodontics- Blacktown, Sydney, Australia. Ph:02-8814-9941. http://www.greatsydneysmiles.com.au
  46. 46. AP  26 year old  Concerned with upper and lower crowding  Would like a fuller smile  Mild Class 3 skeletal Dr Andrew Chang. Smiles & Faces Orthodontics- Blacktown, Sydney, Australia. Ph:02-8814-9941. http://www.greatsydneysmiles.com.au
  47. 47. Pre-treatment Dr Andrew Chang. Smiles & Faces Orthodontics- Blacktown, Sydney, Australia. Ph:02-8814-9941. http://www.greatsydneysmiles.com.au
  48. 48. Post-treatment Dr Andrew Chang. Smiles & Faces Orthodontics- Blacktown, Sydney, Australia. Ph:02-8814-9941. http://www.greatsydneysmiles.com.au
  49. 49. Arch expansion and protrusion-  Limiting factor is front teeth protrusion  IPR limits incisor proclination Summary Dr Andrew Chang. Smiles & Faces Orthodontics- Blacktown, Sydney, Australia. Ph:02-8814-9941. http://www.greatsydneysmiles.com.au
  50. 50. Outline  Non extraction (arch expansion) and aesthetics  Non extraction and gum recession  Non extraction and protrusion  Increased overjets and non extraction treatment  Identifying & Intercepting the ectopic permanent 1st molar Dr Andrew Chang. Smiles & Faces Orthodontics- Blacktown, Sydney, Australia. Ph:02-8814-9941. http://www.greatsydneysmiles.com.au
  51. 51. Increased overjet non extraction treatment 1. In growing children (before pubertal growth spurt) 2.In teenagers (during or early post spurt) 3.In Adults Dr Andrew Chang. Smiles & Faces Orthodontics- Blacktown, Sydney, Australia. Ph:02-8814-9941. http://www.greatsydneysmiles.com.au
  52. 52. Adapted from J Korean Med Assoc 2009 showing 3rd, 50th and 97th percentile Dr Andrew Chang. Smiles & Faces Orthodontics- Blacktown, Sydney, Australia. Ph:02-8814-9941. http://www.greatsydneysmiles.com.au
  53. 53. Identifying pubertal spurt 1. Ask parent: Height growth last 6 months? Height compared with parents. 2. size change- when? 3. Sex characteristics- voice, breast development & onset of menarche, 4. Behavioural features: hair, nails, makeup etc Indicators Dr Andrew Chang. Smiles & Faces Orthodontics- Blacktown, Sydney, Australia. Ph:02-8814-9941. http://www.greatsydneysmiles.com.au
  54. 54. BL  13 year old male  Late Mixed dentition, large 13mm overjet  Missing tooth 45  Had not commenced pubertal growth spurt  Wore removable functional appliances, followed by upper and lower fixed braces Dr Andrew Chang. Smiles & Faces Orthodontics- Blacktown, Sydney, Australia. Ph:02-8814-9941. http://www.greatsydneysmiles.com.au
  55. 55. Pre-treatment Dr Andrew Chang. Smiles & Faces Orthodontics- Blacktown, Sydney, Australia. Ph:02-8814-9941. http://www.greatsydneysmiles.com.au
  56. 56. Post-treatment Dr Andrew Chang. Smiles & Faces Orthodontics- Blacktown, Sydney, Australia. Ph:02-8814-9941. http://www.greatsydneysmiles.com.au
  57. 57. JL  13 year old male  Permanent dentition  Large 14mm overjet  Had not commenced pubertal growth spurt  Wore removable functional appliances, followed by upper and lower fixed braces Dr Andrew Chang. Smiles & Faces Orthodontics- Blacktown, Sydney, Australia. Ph:02-8814-9941. http://www.greatsydneysmiles.com.au
  58. 58. Pre-treatment Dr Andrew Chang. Smiles & Faces Orthodontics- Blacktown, Sydney, Australia. Ph:02-8814-9941. http://www.greatsydneysmiles.com.au
  59. 59. Post-treatment Dr Andrew Chang. Smiles & Faces Orthodontics- Blacktown, Sydney, Australia. Ph:02-8814-9941. http://www.greatsydneysmiles.com.au
  60. 60. Increased overjet non extraction treatment 1. In growing children (before pubertal growth spurt) 2.In teenagers (during or early post spurt) 3.In Adults Dr Andrew Chang. Smiles & Faces Orthodontics- Blacktown, Sydney, Australia. Ph:02-8814-9941. http://www.greatsydneysmiles.com.au
  61. 61. Teenagers & adults  TWM- teenager. Forsus springs  LD- teenager. Forsus springs: 2nd opinion  RA- adult. Forsus springs  MP- adult. Forsus springs Image of Forsus spring. Adapted from 3M unitek website Dr Andrew Chang. Smiles & Faces Orthodontics- Blacktown, Sydney, Australia. Ph:02-8814-9941. http://www.greatsydneysmiles.com.au
  62. 62. TWM  12 year old female  Permanent dentition  10mm anterior overjet  Recently commenced pubertal growth spurt Dr Andrew Chang. Smiles & Faces Orthodontics- Blacktown, Sydney, Australia. Ph:02-8814-9941. http://www.greatsydneysmiles.com.au
  63. 63. Pre-treatment Dr Andrew Chang. Smiles & Faces Orthodontics- Blacktown, Sydney, Australia. Ph:02-8814-9941. http://www.greatsydneysmiles.com.au
  64. 64. 1 yr 6 months into treatment Dr Andrew Chang. Smiles & Faces Orthodontics- Blacktown, Sydney, Australia. Ph:02-8814-9941. http://www.greatsydneysmiles.com.au
  65. 65. LD  14 year old male  Permanent dentition  8mm anterior overjet  Post pubertal growth peak  2nd opinion: ‘My teeth are healthy teeth, I cannot see why they need to be removed’ Dr Andrew Chang. Smiles & Faces Orthodontics- Blacktown, Sydney, Australia. Ph:02-8814-9941. http://www.greatsydneysmiles.com.au
  66. 66. Pre-treatment Dr Andrew Chang. Smiles & Faces Orthodontics- Blacktown, Sydney, Australia. Ph:02-8814-9941. http://www.greatsydneysmiles.com.au
  67. 67. 1 yr 6 months into treatment Dr Andrew Chang. Smiles & Faces Orthodontics- Blacktown, Sydney, Australia. Ph:02-8814-9941. http://www.greatsydneysmiles.com.au
  68. 68. RA  16 year old ‘adult’ female  Deep bite Dr Andrew Chang. Smiles & Faces Orthodontics- Blacktown, Sydney, Australia. Ph:02-8814-9941. http://www.greatsydneysmiles.com.au
  69. 69. Pre-treatment Dr Andrew Chang. Smiles & Faces Orthodontics- Blacktown, Sydney, Australia. Ph:02-8814-9941. http://www.greatsydneysmiles.com.au
  70. 70. Post-treatment Dr Andrew Chang. Smiles & Faces Orthodontics- Blacktown, Sydney, Australia. Ph:02-8814-9941. http://www.greatsydneysmiles.com.au
  71. 71. MP • 22 years old female • Deep bite, related to wear of her upper incisal edges Dr Andrew Chang. Smiles & Faces Orthodontics- Blacktown, Sydney, Australia. Ph:02-8814-9941. http://www.greatsydneysmiles.com.au
  72. 72. Pre-treatment Dr Andrew Chang. Smiles & Faces Orthodontics- Blacktown, Sydney, Australia. Ph:02-8814-9941. http://www.greatsydneysmiles.com.au
  73. 73. Post-treatment Dr Andrew Chang. Smiles & Faces Orthodontics- Blacktown, Sydney, Australia. Ph:02-8814-9941. http://www.greatsydneysmiles.com.au
  74. 74. Increased overjet non-extraction treatment Restricted to deep bite, moderate overjets Summary- treatment timing >10mm overjets, B4 or during peak spurt Moderate overjets can still be managedDr Andrew Chang. Smiles & Faces Orthodontics- Blacktown, Sydney, Australia. Ph:02-8814-9941. http://www.greatsydneysmiles.com.au
  75. 75. be identified & intercepted at an earlier age? Can Dr Andrew Chang. Smiles & Faces Orthodontics- Blacktown, Sydney, Australia. Ph:02-8814-9941. http://www.greatsydneysmiles.com.au
  76. 76. Outline  Non extraction (arch expansion) and aesthetics  Non extraction and gum recession  Non extraction and protrusion  Large overjets and non extraction treatment  Identifying & Intercepting the ectopic permanent 1st molar Dr Andrew Chang. Smiles & Faces Orthodontics- Blacktown, Sydney, Australia. Ph:02-8814-9941. http://www.greatsydneysmiles.com.au
  77. 77. Dr Andrew Chang. Smiles & Faces Orthodontics- Blacktown, Sydney, Australia. Ph:02-8814-9941. http://www.greatsydneysmiles.com.au
  78. 78. The ectopically erupting 6 EARLY 1. E Mesial marginal ridge visibility 2. Angulation of 6- parallel 3. Width of impaction (horizontal) 4. Depth of impaction (vertical) Dr Andrew Chang. Smiles & Faces Orthodontics- Blacktown, Sydney, Australia. Ph:02-8814-9941. http://www.greatsydneysmiles.com.au
  79. 79. The ectopically erupting 6 EARLY- Angulation of 6- parallelDr Andrew Chang. Smiles & Faces Orthodontics- Blacktown, Sydney, Australia. Ph:02-8814-9941. http://www.greatsydneysmiles.com.au
  80. 80. The ectopically erupting 6 EARLY- Width of impaction < ¼ MD width of EDr Andrew Chang. Smiles & Faces Orthodontics- Blacktown, Sydney, Australia. Ph:02-8814-9941. http://www.greatsydneysmiles.com.au
  81. 81. The ectopically erupting 6 EARLY- Depth of impaction < ¾ crown height of EDr Andrew Chang. Smiles & Faces Orthodontics- Blacktown, Sydney, Australia. Ph:02-8814-9941. http://www.greatsydneysmiles.com.au
  82. 82. The ectopically erupting 6- mid MID-STAGE 1. E Mesial marginal ridge not visible 2. Angulation of 6- not parallel 3. Width of impaction (horizontal) 4. Depth of impaction (vertical) Dr Andrew Chang. Smiles & Faces Orthodontics- Blacktown, Sydney, Australia. Ph:02-8814-9941. http://www.greatsydneysmiles.com.au
  83. 83. The ectopically erupting 6- late LATE 1. E Mesial marginal ridge not visible 2. Angulation of 6- not parallel 3. Width of impaction (horizontal) 4. Depth of impaction (vertical) Dr Andrew Chang. Smiles & Faces Orthodontics- Blacktown, Sydney, Australia. Ph:02-8814-9941. http://www.greatsydneysmiles.com.au
  84. 84. Dr Andrew Chang. Smiles & Faces Orthodontics- Blacktown, Sydney, Australia. Ph:02-8814-9941. http://www.greatsydneysmiles.com.au
  85. 85. Instruments  2 mosquito forceps  Elastic separator  Vaseline  Metal separator- for slightly deeper impactions Dr Andrew Chang. Smiles & Faces Orthodontics- Blacktown, Sydney, Australia. Ph:02-8814-9941. http://www.greatsydneysmiles.com.au
  86. 86. Summary  Early stage impaction of 6 can be predictably managed  Angulation of 6 and visibility of E marginal ridge are key success factors Dr Andrew Chang. Smiles & Faces Orthodontics- Blacktown, Sydney, Australia. Ph:02-8814-9941. http://www.greatsydneysmiles.com.au
  87. 87. ‘The success (of any outcome) lies in the ability to get the other person’s point of view and see things from his angle as well as from your own’--- Henry Ford Dr Andrew Chang. Smiles & Faces Orthodontics- Blacktown, Sydney, Australia. Ph:02-8814-9941. http://www.greatsydneysmiles.com.au
  88. 88. Dr Andrew Chang. Smiles & Faces Orthodontics- Blacktown, Sydney, Australia. Ph:02-8814-9941. http://www.greatsydneysmiles.com.au
  89. 89.  Mesial drift- have a slide animation demonstrating this and overeruption of opposing teeth Dr Andrew Chang. Smiles & Faces Orthodontics- Blacktown, Sydney, Australia. Ph:02-8814-9941. http://www.greatsydneysmiles.com.au
  90. 90. Timeline sequence for loss of baby teeth Ectopically resorbing E’s  David Lee  Charlotte Vanderlinde Prematurely lost 6 and space maintainence Dr Andrew Chang. Smiles & Faces Orthodontics- Blacktown, Sydney, Australia. Ph:02-8814-9941. http://www.greatsydneysmiles.com.au
  91. 91. Space maintainence – lingual arches are best- be wary of lingually erupting lower 4’s Dr Andrew Chang. Smiles & Faces Orthodontics- Blacktown, Sydney, Australia. Ph:02-8814-9941. http://www.greatsydneysmiles.com.au
  92. 92. Space regaining B4 U 6’s have erupted Andrew Amabile Dr Andrew Chang. Smiles & Faces Orthodontics- Blacktown, Sydney, Australia. Ph:02-8814-9941. http://www.greatsydneysmiles.com.au
  93. 93. Distalization of upper molars early for Class 2 patients  Andrew Amabile  Preferred method- U 2x4, LLA & Cl 2 els ie: Fay Tang  Alternative setup- Zoe Wootton. Dr Andrew Chang. Smiles & Faces Orthodontics- Blacktown, Sydney, Australia. Ph:02-8814-9941. http://www.greatsydneysmiles.com.au
  94. 94. Dr Andrew Chang. Smiles & Faces Orthodontics- Blacktown, Sydney, Australia. Ph:02-8814-9941. http://www.greatsydneysmiles.com.au
  95. 95.  Single tooth agenesis  Survey the audience: For lower 5’s agenesis: if it was their child, would they do exo of 4 teeth or exo baby teeth and space closure or non exo and keep baby tooth there?  Agenesis of 3’s to discuss? Or too technical.  Use examples  Shannon Garland  Daniel Egan  Brandon Lacey- skeletal Class 2- unilateral E  Bilateral agenesis: Vanessa Edwards- started non extraction but had to go with extracting 2 upper premolar teeth due to overjet and poor elastic wear. Dr Andrew Chang. Smiles & Faces Orthodontics- Blacktown, Sydney, Australia. Ph:02-8814-9941. http://www.greatsydneysmiles.com.au
  96. 96.  Agenesis of E’s- Shannon Garland, Daniel Egan, Teenage female- saw last Wed 27-3 or 26-3 or LEADS during this time where seeing younger sister- Emma Rose Dale  Vanessa Edwards- with poor elastic wear- Forsus springs to boost lower anterior anchorage.  Brandon Lacey- Early treatment allowed use of CTB to boost lower anterior anchorage for space closure. Dr Andrew Chang. Smiles & Faces Orthodontics- Blacktown, Sydney, Australia. Ph:02-8814-9941. http://www.greatsydneysmiles.com.au

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