Recent advances in surgical orthodontics /certified fixed orthodontic courses by Indian dental academy

INDIAN DENTAL ACADEMY
Leader in continuing dental education
www.indiandentalacademy.com
Recent advances in surgical
orthodontics

INDIA SHINES !!
THE MOOD IS UPBEAT
ECONOMY GROWS
DISPOSABLE INCOMES ON THE RISE
CONSUMERISM ON A HIGH
BEAUTY IS BIG BUSINESS
THE INDIAN FACE SELLS ALL !!!
THE FEEL GOOD FACTOR +++++

THE GOOD NEWS
•Increasing demand for orthodontics
•A shift towards cosmetic dentistry
•Mass Marketing ,consumer branding
Strategies – Invisalign
• 54 % OF INDIANS BELOW 25
YEARS OF AGE !!

Indian Orthodontics:
are we in a process of change ?
A period of turbulent global change
• Books journals ,information
•A profusion of appliances,space age materials
•New diagnostics and Treatment modalities,
•Distraction,MIA,
•Craniofacial orthodontics
•Age,no longer a consideration !!!
Have our dimensions,horizons changed ?
Are we looking beyond our mechanical preoccupation?

The Drivers for change in the 21st
century
Biology / technology / evidence
Patient centered approach
Efficient and effective orthodontics
•Convergence of
technology
•Materials
•information
•Philosophies
•Techniques
•Comfort of status
• quo/opinion

SO WHY DO PEOPLE
SEEK ORTHODONTIC
TREATMENT ??

Orthodontics Justified
spirit
mindbody
“ If there is a defect on the soul, it cannot be corrected on the face, but if there is a
defect on the face and one corrects it, it can correct a soul. “ - Jean Cocteau

Esthetics primarily responsible for
Orthodontics
Appearance - The most
important motivating factor for
treatment.
Physically attractive people achieve higher levels of success in life
than unattractive people
Breece & Nieberg JCO 1986

Reasons for seeking orthodontic
treatment :
 Malaligned teeth 84%
 Advice of dentist 52%
 Facial appearance 41%
©
Self concept in class II malocclusion and early treatment
Dan C et al Angle Orthod. 65(6) 411, 1995
Silver Platter Search

Information and Awareness
Patient empowerment
A right to participate in the
decisions and entitled to results
“Dentofacial Appearance is a significant predictor of
orthodontic patients expectations of treatment”
Am J Orthod Dentofacial Orthop 2003; 123-127
Time
Society driven by speed !!
Service on Demand,Instant gratification
+

The Face
“A singular structure that teems with subtleties
An enchanted terrain,a zone of sensuality
A playground of secrets,a glory of function”
Daniel McNeill
Facial Appearance :-The most important
characteristic in relation to self image and self
esteem
People Dissatisfied with Facial appearance express
more dissatisfaction with teeth than any other
feature !!
Hershon LE, Giddon DB. Determinants of facial profile self-perception. Am J Orthod
1980;78:279-95.
Berscheid E, Walster E, Bohrnstedt G. Body image. Psychol Today 1973;7:119-131v

ADULT ORTHODONTICS- A NEW VISTA
Growing segment in orthodontic Practice
95.3 % of orthodontists in US into
Surgical orthodontics !
70 75 80 85 90 97 02
10%
15%
20%
25%
5%
30%
JCO 1997-02

Three dimensional treatment goals
4th
Dimension TIME !!
The 5th
Dimension Function
1. Do traditional strategies and goals in
orthodontics still hold good ?
Is there a new paradigm in orthodontics ?

o Facial / Dental aesthetics
decide successful outcome
both may not correlate
o Anterior Smile Aesthetics critical for the
patient
o Alteration of the skeletal bases needs to
be harmonized with dentoalveolar modification
o Orthodontics and surgeons – a synergism !!
Success !!

ORTHODONTIC LIMITATIONS
Angle – Class 1 molar Relation ship
1925 – 1945
Tweed – Lower Incisor Position
1945 –1985
Surgical influence – Upper
incisors/positioning anterior 6 teeth

Cephalometrics – What Value ?
 Measurements based on
cranial base landmarks
–inaccurate in defining
clinical profile
 Disconnect between hard & soft tissues!
 No measurement is 100% accurate
 Soft tissue thickness / axial inclination
of incisors – the most important
variables in inaccuracy
Michels & Tourne Int J Adult orthod orthog Surg 1990 5
(1) 43-52

JCO Survey 99 – traditional Ceph
Analysis used by 94% orthodontists
Is it a Problem ?
• Measure skeletal and dental
relationships
• Measure to cranial base
• Soft tissue/ profile correlation ?
•Did we forget to reintegrate soft
and hard tissues ??
Face First – The Emerging Paradigm

NO CORRELATION BETWEEN
NORMSAND PROFILE BALANCE !!
OCCLUSAL /DENTOALVEOLAR
CORRECTION BASED ON NORMS –
LESS THAN OPTIMAL FACIAL
RESULTS

PRE-TREATMENT POST-TREATMENT

Inheritance or mind set?
Is Traditional Cephalometric and model
diagnosis relevant towards a comprehensive
treatment outcome ?
Evidence :- Changes in facial profile during orthodontic
treatment with extraction of first four premolars
Am J Orthod Dentofac Orthop 95(3):220-30 Mar 89
Dobrocky and Smith found
• 160 orthodontic patients treated to Class 1 models
• 15% of lips excessively flat !
• 30.6 % nasolabial angles excessively obtuse !!( >120)
ORTHODONTIC LIMITATIONS

A TIME FOR INTROSPECTION
Did a good occlusion match a good
face at the end of treatment ??
Was Anchorage ever a problem ??
Was a special effort required to
finish and detail your cases ?

OCCLUSION
AESTHETICS
180° turn around in conceptual
Orthodontic thought !!!
Occlusion
Static records
Non extn
Lower incisors
Face First
Soft tissue and smile
dynamics
Skeletal modification
90’s
paradigm

“The winds of change are
blowing in the face of
time”
Scorpions

Orthodontic Limitations
The Perceived Ideal Position not possible
orthodontically
Adverse Facial Changes if attempt to
compromise is made .
A Surgical /Orthodontic
solution is essential
Compromised occlusions – a special challenge!
An entire new dimension in Orthodontics !!

TVL TVL TVL
0
4
-5
-12
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57
64
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4
-1
-8
-6
57
64
normalOrthodontics ++Surgery
Defining orthodontic limitations

TVL TVL
64
57
0
3
-5
-12
-11
0
4
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57
Repositioning teeth can help the profile
only that much !

TVL TVL
0
4
7
1
3
57
64
0
4
2
-5
-3
57
64
Color codes used with
the Arnett soft tissue
cephalometric analysis
Black = within 1 SD
Green = within 2 SD
Blue = within 3 SD
Red = more than 3 SD

FACE FIRST – A Paradigm change
Increasing focus on altering skeletal bases to
achieve a positive outcome .
Growth modification
Compromise Orthodontics with malar
augmentation, rhinoplasty ,genioplasty
Osteotomies – mandibular / maxillary for
skeletal excess
Deficiencies ?? Grafts

Right now my life is just one learning
experience after another……
By the end of the week I should be a
genius!
Jeanette Osias

thank you

Recent advances in surgical orthodontics /certified fixed orthodontic courses by Indian dental academy

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Recent advances in surgical orthodontics /certified fixed orthodontic courses by Indian dental academy