3D TECHNOLOGY IN ROUTINE ORTHODONTIC PRACTICE BJÖRN LUDWIG
Lower arch missing lower 2nd premolars
- Hemisection lower E – distal half – Old school
- Allow mesial drift of 6s, L4s do not distally tip, important in class 2 cases
- Use mesial aspect for anchorage if ankylosed
- Remove remaining
Other options
- TADs 30% failure in the mandible in Caucasian
- Herbst
- Mini-plates – very evasive
- But hemisection is simple
Gingivectomy
After extrusion of impacted tooth, need for gingivectomy
- Orthodontists should learn as common need
- Process
- Scan
- Plan a gingivectomy guide
- Laser or electrosurgery for gingivectomy
Cant and TADs
- adult cases are the future of orthodontics, more challenging
- RHS>> Gincevectomy
- LHS>> extrusion using TADs TAD – opencoil to bracket on the tooth, and aligner to guide the tooth, cover incisal edges only
- And few aligners
- Patient did not want perfect result
Space closure and TADs Georgios Kanavakis 2014
- Space closure and mesial slider
- 2 x palatal tads
- SS spring close
- Mesialization of molars
- High tech
- But Space closure can be achieved with timely extractions, such a smissing UEs and extractions with mesial drift..
- Less likely lower arch, miniplates used to mesialise
Expansion
Digital planning
- Digitally decompensate the lower arch.
MARPE
- Changes to the midface through MARPE
- Hard tissue changes to the midface and nasal complex
- Caution in use, for selective cases only, and critical in use
SARPE
- Indicated due to resistance for Maxillary expansion in adults from 3 potential structures
- Zygomatic buttress, Pterygoid plates, Sutures from the mid face Published 1984 by Andrew Glassman
- Using a finite element analysis programme, fusion 360, identify the resistance individual to patient
- Case: Surgical guide to do a small lateral osteotomy under local = future as it is individualized to each patient
CBCT guided autotransplantation
- CBCT assess site
- guided donor site preparation
- Guided restorative management of premolar as central incisor
Hybrid treatment brackets Vs aligners
- Class 2 correction
- Change from fixed to aligners with Onyx Ceph planned wings for class 2 correction – like functional appliance
Problems
- Distalisation with Miniscrews
- Later on posterior crowding of 2nd molars and risk anterior recession
- Fracture of palatal appliance
- Failure at welding point between expander and abutment
- Can stop people using designs
- Solution
- print 1 piece appliance CADCAM
- Overuse
TAKE HOME MESSAGE BY ME FROM THE LECTURE
- Sometimes effort is not equal the benefit so always evaluate your benefit
- Always assess your outcome and see if technology you invested in worth it
- Orthodontists are Dentists and should do some gingival contouring and temporaries ..etc
- Always match arch before and after treatment and maintain your arch form
- Future is Hybrid Therapy … using strength of both aligners and fixed braces
