orthodontics In summary

Farooq Ahmed
  • 5.0 (7)
  • EDUCATION
  • UPDATED MONTHLY
orthodontics In summary

Farooq brings the key points, references and understandings from keynote webinars and papers in a concise podcast. Providing easy access to gain the most from our esteemed speakers and experts. *Important to note the information is from our interpretation as individual professionals, and may incorporate our opinions*

  1. Transverse assessment with a CBCT, is it the answer? 5 MINUTE SUMMARY

    NOV 13

    Transverse assessment with a CBCT, is it the answer? 5 MINUTE SUMMARY

    Join me for a look at CBCT and its use in the diagnosis of the transverse problem, and if it offers the solution to the debated topic. The podcast is based on a lecture by Chun Hsi Chung at this year’s AAO and appraises established methods of assessment, the Curve of Wilson and the WALA ridge line through the lens of a CBCT, as well as how to use a CBCT to assess the maxilla and mandible, which although revealed an ideal measurement, may not be telling the full story. What is ideal? inclination  Curve of Wilson – CBCT study  Vertical distance buccal and lingual cusp, 1mm vertical difference  Buccal inclination upper 5 degrees Alkhatib 2017 Lingual inclination lower 12 degrees Alkhatib 2017 Andrews WALA ridge 2000 Bucco-lingual distance from crown ( FA point) to the most prominent portion of mandibular buccal alveolar bone (coincident with mucogingival junction) Hypothesised teeth over the basal bone , Glass 2019 1st molar = 2mm Ideal mandibular intermolar width FA – FA = WALA-WALA distance minus 4mm Normal width  CBCT CBCT age 13 N = 79 Miner 2012 Maxilla slightly smaller mid point molar root on lingual bone -1.22 +/- 2.91mm CBCT Age 22.7 years Koo 2017 Measure CoR furcation 1st molar Mx – Mn = -0.39+/- 1.87mm CBCT 56 adults normal occlusion  Lee 2022 PENN STUDY Buccal – buccal on crestal bone, furcation, 6s Lingual – lingual crestal furcation 6s Reliable reading on lingual aspect – buccal shelf bone prevents reliable readings Maxilla narrower than mandible -1 +/- 3mm Previous literature  Tamburrino 2010 describes  5mm cortical plate level of furcation buccal aspect, however Lee 2022 showed for males 1.1mm +/- 4.5mm and 1.6mm +/- 2.9mm Without cbct can transverse diagnosis occur? Models = lingual surface at furcation level (4mm vertical below gingival margin) maxillary width slightly narrower than mandible -2+/- 3mm Issue with CBCT for diagnosis Standard Deviation is large = +/- 3mm, range from -4mm-+2mm falls into SD Issue with study model transverse analysis from 4mm at the gingiva Not validated

    6 min
  2. Can Orthodontics Treat Paediatric Obstructive Sleep Apnoea? 8 MINUTE SUMMARY

    OCT 23

    Can Orthodontics Treat Paediatric Obstructive Sleep Apnoea? 8 MINUTE SUMMARY

    Join me for a summary looking into the increasingly popular topic of paediatric obstructive sleep apnoea, a review of orthodontic treatments available, and how effective they are in this growing field of both medicine and dentistry. This episode is a summary of Alberto Capriglio’s lecture from the AAO and Carlos Flores Mir’s lecture at the IOF earlier this year.     OSA - Defined upper airway dysfunction causing complete or partial airway obstruction during sleep   Sleep = Slow wave sleep – constructive phase of sleep (recuperation of the mind) ·      Growth hormones secreted ·      Glial cells within brain restored ·      Cortical synapses increase in number – Moberget 2019   Outcomes to paediatric patients of SDB: (AASM) ·      delays in development,  Poor academic performance, Aggressive behaviour, attention- deficit/hyperactivity disorder, , emotional problems in adolescence   First line medical treatment – adenotonsillectomy  ·      40% residual  OSA       Effect palatal expansion 1.        Roof the mouth = base of the nose - Increase in nasal airway volume - Reduction in OSA, if obstruction in naso-pharynx, 2.        Short term reduction in OSA (not cure AASM) a.        20% improvement in AHI, 85% of cases Villa 2015 b.        15% got worse by 20% c.        57.5% residual AHI greater than 1 - not resolution 3.        Caprioglio 2019 long term AHI return to initial scores, from 7 to 5 long term 4.        Change in metabolism when combined with Vit D3 a.        Vit D3 with RME increases reduction in AHI, sustained long term, Caprioglio 2019 AHI 61.9% Vs 35.5% long term     Expansion other outcomes -  school performance  Bariani 2024 ·      AJODO – RME improves academic performance – o   BEHAVOUR 1 of 8 parameters improved only for academic performance  - change small 0.68 o   COGNITIVE 1 in 8 improve       Mandibular advancement Move mandible forwards and open space behind the tongue – oropharynx ·      Anatomical – increase size of oropharangeal airway ·      YAnyAn 2019 mandibular advancement for pOSA systematic review:  1.75 AHI reduction (CI) −2.07, −1.44) – modest change ·      However long term use required of the paediatric patient     Orofacial features in children with obstructive sleep apnea.  Fagundes Flores-Mir 2022 o   No craniofacial features specific to pOSA – ANB, o   However medical diagnosis through polysomnography may under-estimate incidence, o   Broader diagnosis such as snoring, may over-estimate OSA   AADSM 2024 – consensus statement ·      Expansion o   Prevention: No consensus o   Management: No consensus o   Cure: Insufficient ·      Mandibular advancement o   Prevention, management, cure – unclear   More about OSA? To hear more about OSA, please check out the last interview on orthodontics in interview with Sanjivan Kandasamy, where we had a deep dive into OSA and where we are in our understanding today from the research Interview with Sanjivan Kandasamy on OSA

    8 min
  3. Posterior Bolton’s Discrepancy. New Analysis To Solve Old Problems 5 MINUTE SUMMARY

    OCT 2

    Posterior Bolton’s Discrepancy. New Analysis To Solve Old Problems 5 MINUTE SUMMARY

    Join me for a summary looking at The Posterior Bolton Discrepancy, a new take on the classic Bolton discrepancy. Wayne Bolton’s analysis has been critically appraised and the outcome from Patrick Foley and his team has been the formation of the posterior Bolton analysis, a new perspective on an established tool in orthodontics which seeks to give better insight into the location of tooth size discrepancies. He has also explored through his research the effects of premolar extractions and the likely outcomes of compromised occlusal outcomes, and where we should expect to see it within the posterior segment.     Wayne Bolton established the Bolton’s ratio: ·      Mesial distal widths of teeth ·      Original study 55  well treated cases ·      Anterior – ideal 77.2% ·      Overall 91.3% - Anterior tooth size discrepancy maybe masked by a compensatory posterior discrepancy   What is the posterior Bolton’s ratio ·      Not included in original study ·      Formular sum of mandibular 4s, 5s, 6s,/ maxillary 4s, 5s, 6s x 100 = 105.27% - data from original Bolton’s study   Ratio confirmed by Mongillo 2021 ·      N=55 patients ideal outcomes ·      Digital casts (from plaster) ·      Posterior ratio 105.77% +/- 1.99%   Vs Bolton’s data of 105.27%     The effect of 4 premolar extractions on the posterior Bolton ratio   Study: Mongillo 2021 (extraction of all 4s) Holton 2023 (extraction of upper 4s, lower 5s)   ·      Posterior Bolton increases 107% +/- 2.23% (or U4s and L5s 106.52 +/-  2.52%),  ideal digital removal of teeth ·      Observed Bolton’s was 110.48 % =  3.18% above Bolton’s ideal ·      Space of 1.1mm – 1.28mm remains in mandible when ideal arch – only 1 patient did not have space       Clinical options                                                                                              i.         compromise occlusion 1.        slightly class 3 molar and class 1 canine 2.        class 1 molar and  slightly class 2 canine                                                                                           ii.         IPR upper arch                                                                                        iii.         Bonding   ·      Anterior and posterior Bolton may be valuable in diagnosis and prediction than an overall Bolton

    6 min
  4. What is Lightforce, will it change orthodontics? 6 MINUTE SUMMARY

    SEP 11

    What is Lightforce, will it change orthodontics? 6 MINUTE SUMMARY

    Join me for a look into a recent digital innovation within orthodontics, Lightforce. I explore how the 3D printed labial bracket system works, the features and what the proposed advantages. Recent research exploring the advantages of Lightforce is discussed as well as my comparison to other digital innovations within orthodontic appliances.   What is Lightforce   ·      Manufacturing: 3D printed brackets Cad/Cam ·      Material: ceramic polycrystalline labial ·      Planning: Digital planning using Lightplan, visualisation of the outcome, alter both tooth position and bracket position, individualise prescription per bracket as a result of planned movements ·      Flexibility in positioning:  Brackets do not have to be in the Facial Axis of the Clinical Crown, through altering the base thickness, the resulting moment can be achieved through the center of resistance ·      Torque expression is  independent of the vertical position,  for the same reasons ·      0.018", 0.020", and 0.022", including combinations   Stages 1.        Submit records 2.        Digital planning using lightplan, visualisation of the outcome,  3.        Case approval 4.        Indirect bonding tray – light-Tray, with brackets in situ   Other advantages ·      Accuracy of 3D printed slot ·      Adapted base, less adhesive ·      Minitubes, biteturbos   What are the proposed advantages and claims around Lightforce with evidence 1.        Shorter duration of treatment due to precision a.        JCO 2024 Wheeler 2024 Retropsectice study, 900 lightforces cases and over 300 conventional cases,  30% shorter and 30% fewer appointments. significant floors, with a lack of outcome measure and matching of controls Proposed advantages and claims around Lightforce ithout evidence   2.        Reduced complications white spot lesions, dehiscences and root resorption as relate to duration 3.        Remove issue of compliance or biomechanics as limitations to treatment outcomes   4.        Saving Doctors time and money, remove repositions 5.        Reduce or eliminate wire bends         What are my thoughts? ·      Labial fixed appliances are catching up with aligners and lingual appliances ·      New possibilities of varying biomechanics, slot size, bracket position and customised prescription ·      Presence of Lighforce features within other appliances: o   Customised brackets Insignia / Incognito o   Digital planning: aligners, Insignia ·      No customisation of archwires with Lightforce ·      Not sure how Lightforce would reduce appointment intervals, ligation is conventional ligation through elastomeric modules, with plastic deformation   Papers and videos on Lightforce https://www.jco-online.com/media/42415/2023_09_500_waldman.pdf   JCO retrospective study https://www.jco-online.com/media/43897/2024_05_273_wheeler.pdf   Youtube videos from Lightforce company, Alfred Griffin https://www.youtube.com/watch?v=zSNkYVgZ69I&t=2s&ab_channel=People%2BPractice   Disclaimer   The podcast is opinion and may not be 100% accurate or representative of the lecture / speaker, the podcast is not endorsed by an institute or the speaker and is the independent work of Farooq Ahmed and the Orthodontics in Summary team. It is not intended to over-ride or replace the requirement clinicians have in being familiar with the relevant training and guidelines for the treatment they provide.   Contributions Contents and editing Farooq Ahmed

    7 min
  5. What Happens To Adults When We Expand With Aligners? 6 MINUTE SUMMARY

    AUG 21

    What Happens To Adults When We Expand With Aligners? 6 MINUTE SUMMARY

    Join me for a podcast summary looking at the effects of aligners when expansion occurs. In this podcast we will explore if bone loss occurs with expansion and why bone loss doesn’t necessarily cause recession. The podcast is based on the lecture and research by Greg Huang presented at this year’s AAO, and includes some more recent research on the topic     PICO Population adults, 22 maxillary arches, 20 mandibular arches Intervention – expansion with aligners, average 3.7mm Control – minimal expansion, average 0.6mm Outcome – bone height and width from CBCT   What was the bone loss?   Maxilla ·      Minimal bone loss ·      Minimal bone height and width change   Mandibular ·      Significant bone loss ·      1.5mm height mandibular centrals ·      1.4mm height premolars   What movement took place of the incisors? Maxilla ·      Little change in bucco-lingual inclination   Mandibular ·      Labial and buccal tipping increased   What were the overall changes?   Dental changes ·      3-4mm of expansion ·      Mainly  at premolars ·      Mainly buccal tipping, not bodily movement ·      Lower incisors procline   Similar bone loss with aligners expansion from other studies, Zhang 2023 , Allahham  2023   Should CBCT’s debate within the literature regarding voxel size of a CBCT and false negatives. Accuracy of alveolar height CBCT 2019 Yuan Li BA systematic review showed ·      CBCT Vs skulls/patients ·      Bone height 0.03mm ·      Bone width 0.11mm   My thoughts: no difference in cbct and gold standard, however the measurements were all of large structures, not bone height or thickness of less than the voxel size   Predict bone loss ·      Upper arch no predictors as limited changes ·      Lower arch, same as for fixed appliances, but the quantity was missing o   Proclination o   Expansion o   Buccal expansion and tipping   Systematic review of orthodontics 48 articles de Llano-Pérula 2023 ·      Proclination ·      Less keratinised tissue ·      Thin biotype ·      Prior recession ·      Crossbite ·      Previous recession ·      Age     Does bone loss = gingival recession? ·      Not generally found from Greg’s study ·      When significant bone loss of 3mm, far less than 3mm gingival recession     Significant retraction of upper incisors and intrusion Kim 2024. Loss of Palatal bone however in retention palatal bone recovered   Hypothesis ·      If PDL and periosteum are maintained  epithelium is maintained ·      If the root moves back into the bone, the bone recovers – as PDL and periosteum osteogenic, and tension generated between PDL and periosteum ·      PDL-periosteum hypothesis – proposed by Greg Huang   What I liked about Greg’s lecture was that he started with declaring his conflict of interest as an academic, both the royalties he receives for his books as well as research funding, which was great to hear and a trend I hope continues. Acknowledged the hard work of the research lead, his trainee and the  time-consuming process of orientating CBCT slices of 1000s of images

    7 min
  6. Orthodontics In Interview: SANJIVAN KANDASAMY Orthodontics and the airway, what does the evidence say?

    JUL 31

    Orthodontics In Interview: SANJIVAN KANDASAMY Orthodontics and the airway, what does the evidence say?

    “Airways are like TMD controversy on steroids” “it amazes me we still think we can grow mandibles” “We have an appliance (expansion) and are trying to fit it into a diagnosis” “it is unethical to call yourself an airway orthodontist”     Sanjivan describes why there is controversy in airways and orthodontics, where the research stands on treatment with expansion and mandibular advancement, can mouth breathing cause adverse development, the effects of extractions on the airway, as well as ethics within current practice of airway orthodontics.       Click on the link below to view previous episodes, to refresh topics, pick up tricks and stay up to date.   YouTube https://youtu.be/m2NIp1XhnxQ     #orthodontics #farooqahmed #sanjivankandasamy #westaustralianorthodontics #airwayorthodontics #airway #OSA #SDB

    1h 16m
  7. Can we grow mandibles with bone-anchored plates for class 2 correction? 6 MINUTE SUMMARY

    JUL 3

    Can we grow mandibles with bone-anchored plates for class 2 correction? 6 MINUTE SUMMARY

    Join me for a summary exploring an innovation of the use of bone-anchored plates in class 2 correction. This was a clinically novel idea presented by Hugo De Clerck, who has been an innovator in the use of bone-anchored plates and has published seminal papers on the topic for class 3 treatment. Hugo explores the use of bone-anchored plates in the mandible, combined with a Herbst appliance. He presents his data of 90 patients treated in Brussels by his research team. PROTOCOL Customised bone anchored plates in lower anterior mandible – digitally designed per patient with surgical guide Transmucosal between lower canine and 1st premolar Herbst: modified to attach from upper 1st molar to the lower bone anchored plates Procline upper incisors prior to fitting Bone anchored-Herbst Expansion of the upper arch 2-3 modifications to Herbst piston to lengthen during treatment Duration 10 months HOW DOES IT WORK Growth of the mandibular body: mainly, bone modelling. Average growth 5-7mm, whereas conventional herbst 2-2.5mm of chin projection. New growth of bone as ramus moves backwards, resulting in lengthening of the mandible Force generation: in similar to the conventional functional appliance, with contraction of medial and lateral pterygoid and stretching of the suprahyoid and temporalis muscle Lower incisor proclination: No lower incisor proclination: There is a distal force on the mandibular dentition instead of a forward force from conventional functional appliances, due to the appliance attaching to the mandibular body, not the dentition Condylar displacement: Longer duration, of up to 10 months which results in stimulation of growth of the body of the mandible, conventionally this stops with a herbst as the lower incisors procaine, resulting in only 2 months of condylar displacement and therefore less stimulation of growth Glenoid fossa remodelling. The glenoid fossa remodelled in a forwards direction, however it was small and unpredictable, with some posterior remodelling Rotation of mandible – similar to the conventional functional appliance, a posterior rotation reduces the effects, anterior rotation enhances, for every 1 degree 1.1mm increase projection. Achieve via expansion and removable appliance Upper molar distalisation: Hugo saw this as unfafourable and advised lengthening the herbst piston to reduce upper molar distalisation, therefore maximising mandibular lengthening Age 13-15 Not possible with miniscrews, due to the quantity of force Breakages of Herbst still occur Is growth maintained long term – unable to state No control as requirement for cbct of untreated patients. Contributions Contents: Farooq Ahmed Edited and produced: Farooq Ahmed

    7 min

  8. JUN 19

    How to extrude, intrude and expand with aligners reliably 8 MINUTE SUMMARY

    Join me for a summary looking into difficult movements with aligners, why they are difficult, and a protocol derived from research on how to manage tooth movements with aligners. This lecture was given by Bill Layman at this year’s AAO, where he describes maxillary incisor extrusion, posterior intrusion, and controlled expansion. Introduction ·       Rate of refinement: 2.5 per patient Kravitz 2022 ·       41% of aligner cases 3 refinements + ·       Switch to fixed appliances from aligners 1 in 6 Kravitz 2022 Staging and synergistic movements can reduce refinement rates Incisor extrusion Why is Incisor extrusion difficult? ·       Lack of undercut ·       Sqeeze teeth to engage, creating opposite effect due to V shape of a tooth – leading to loss of retention of the aligner ·       Interproximal binding through vertical contact point overlap or slipped contact points and a closed system of aligners Incisor extrusion staging steps: 1.     Create undercut: Horizontal attachments are most effective, regardless of design Groody 2023 2.     Create 0.1mm between teeth to relieve interproximal binding 3.     First procline the incisors to increase surface contact 4.     Then Extrude and retract Posterior intrusion Why is it difficult? ·       Multiple teeth and lack of anchorage, through anterior teeth ·       Crowns tip mesially during intrusion as an unwanted effect ·       What happens when we intrude: o   Mesial tipping of posterior teeth Fan 2022 Finite element o   Buccal and palatal attachments = less tipping buccal or lingual How to improve posterior intrusion ·       Sequential intrusion – 1st premolars ·       Tip posterior teeth 5-10 degrees distally ·       Horizontal attachment buccal / palatal ·       Consider attachment lingual Upper molars ·       Sequential intrusion ·       TADs not always needed, 5200 times bite on hard surface, enables posterior intrusion through masticatory forces   Controlled expansion Why is it difficult ·       Aligners tip teeth buccally = creates occlusal interferences ·       Lack of rigidity of tray to exert forces = straight finish trays increase rigidity ·       Attempting to correct skeletal problems with dental solution ·       Greatest expansion in the premolar region ·       Expansion from the research showed progressive less posterior expansion o   Molars expand less due to anchorage loss ·       Expansion through tipping How to improve posterior intrusion ·       Plan around premolar expansion ·       Expect 70% in premolar region, 55% molar and 46% canine ·       Overcorrection of canines 1.7mm (premolar region 3.4mm) Zhou 2020 ·       Maximum expansion seen is 4mm   Conclusion: ·       Incisor extrusion: procline teeth with attachment, then extrude and retract o   Include iPR ·       Posterior intrusion: Start with premolars and sequentially intrude posterior teeth o   Add distal tip ·       Controlled expansion: Effective in premolar region o   Plan with overcorrection Jay Bowman ·       “If you don’t build-in overcorrections you can’t get corrections” ·       “there many things that need improvement at the end that aren’t hard to do if start treatment with the overcorrections in mind”   Contributions Contents: Shanyah Kapour Edited and produced: Farooq Ahmed

    9 min
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About

Farooq brings the key points, references and understandings from keynote webinars and papers in a concise podcast. Providing easy access to gain the most from our esteemed speakers and experts. *Important to note the information is from our interpretation as individual professionals, and may incorporate our opinions*

Information

  • Creator
    Farooq Ahmed
  • Years Active
    2020 - 2024
  • Episodes
    122
  • Rating
    Clean
  • Copyright
    © Farooq Ahmed

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