Pub Date : 2024-12-01DOI: 10.1053/j.sodo.2024.07.009
Francesco Caroccia DDS, MSD , Stefania Perrotta PHD, DDS, MSD , Veronica Giuntini PHD, DDS, MSD , Björn Ludwig PHD, DDS, MSD
Mandibular canine impaction and/or transmigration are rare, but how to diagnose and manage these conditions is essential knowledge for every orthodontist. There are several treatment strategies for mandibular canine impaction: orthodontic traction, trans-alveolar transplantation or surgical removal. Orthodontic traction is probably the most complicated solution and requires adequate planning in terms of anchorage control, adequate mechanics and space management. It also requires patient cooperation due to the significant treatment time. This article provides a brief literature review to introduce the management of displaced and impacted mandibular canines and the orthodontic dilemma in their approach. A series of clinical cases are used to illustrate the challenges, possible alternatives, and potential errors and failures.
{"title":"Mandibular displaced canines: Presenting clinical challenges, alternatives, errors, and failures","authors":"Francesco Caroccia DDS, MSD , Stefania Perrotta PHD, DDS, MSD , Veronica Giuntini PHD, DDS, MSD , Björn Ludwig PHD, DDS, MSD","doi":"10.1053/j.sodo.2024.07.009","DOIUrl":"10.1053/j.sodo.2024.07.009","url":null,"abstract":"<div><div>Mandibular canine impaction and/or transmigration are rare, but how to diagnose and manage these conditions is essential knowledge for every orthodontist. There are several treatment strategies for mandibular canine impaction: orthodontic traction, trans-alveolar transplantation or surgical removal. Orthodontic traction is probably the most complicated solution and requires adequate planning in terms of anchorage control, adequate mechanics and space management. It also requires patient cooperation due to the significant treatment time. This article provides a brief literature review to introduce the management of displaced and impacted mandibular canines and the orthodontic dilemma in their approach. A series of clinical cases are used to illustrate the challenges, possible alternatives, and potential errors and failures.</div></div>","PeriodicalId":48688,"journal":{"name":"Seminars in Orthodontics","volume":"30 5","pages":"Pages 719-726"},"PeriodicalIF":2.2,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142212655","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Controlling the occlusal plane in the three dimensions is essential for correcting complex functional imbalances and achieving proper smile aesthetics. Mini-implants have transformed modern orthodontics by providing enhanced anchorage control and improved predictability, thereby enabling novel treatment opportunities. These opportunities include the simultaneous distalization of all teeth in an arch, retraction of the anterior dental segment, non-surgical rapid palatal expansion in adults, correction of the gummy smile through entire maxillary arch intrusion, and modifications to the occlusal plane. The latter involves changes along the x-axis in the coronal plane, specifically addressing asymmetries in the frontal norm, as well as changes along the y-axis in the sagittal plane, which address inclinations of the occlusal plane such as anterior open bites. Additionally, modifications involve changes along the z-axis in the axial plane, correcting inclinations of the occlusal plane, including posterior sagittal discrepancies like Class II and III and midline corrections. This paper focuses on the latest and most accurate techniques, from diagnostic tools to detailed biomechanical execution of several treated clinical cases, with an emphasis on successful three-dimensional management of dental arches and occlusal planes.
{"title":"Occlusal Plane changes with mini-implants to solve complex cases","authors":"Sérgio Cury , Rogério Amaral Tupinambá , José Alexandre Alambert Kozel","doi":"10.1053/j.sodo.2024.06.007","DOIUrl":"10.1053/j.sodo.2024.06.007","url":null,"abstract":"<div><div><span><span>Controlling the occlusal<span> plane in the three dimensions is essential for correcting complex functional imbalances and achieving proper smile aesthetics. Mini-implants have transformed modern orthodontics by providing enhanced anchorage control and improved predictability, thereby enabling novel treatment opportunities. These opportunities include the simultaneous distalization of all teeth in an arch, retraction of the anterior dental segment, non-surgical rapid </span></span>palatal expansion in adults, correction of the gummy smile through entire maxillary arch intrusion, and modifications to the occlusal plane. The latter involves changes along the x-axis in the coronal plane, specifically addressing asymmetries in the frontal norm, as well as changes along the y-axis in the sagittal plane, which address inclinations of the occlusal plane such as anterior </span>open bites. Additionally, modifications involve changes along the z-axis in the axial plane, correcting inclinations of the occlusal plane, including posterior sagittal discrepancies like Class II and III and midline corrections. This paper focuses on the latest and most accurate techniques, from diagnostic tools to detailed biomechanical execution of several treated clinical cases, with an emphasis on successful three-dimensional management of dental arches and occlusal planes.</div></div>","PeriodicalId":48688,"journal":{"name":"Seminars in Orthodontics","volume":"30 5","pages":"Pages 673-683"},"PeriodicalIF":2.2,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141697294","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-01DOI: 10.1053/j.sodo.2024.07.007
D Martin Salvador MD, DDS, MS, J Aznar Arraiz DDS, MS, PhD, P Arias-Camisón DDS, MS, A. Canábez Berthet MD, DDS, MS
The use of skeletal anchorage for dentoalveolar compensations “camouflaging” in Class III malocclusions in borderline adult patients has become an important treatment alternative. In this article three different types of skeletal anchorage are presented: 1) retromolar miniscrews 2) miniplates with the use of Class III elastics and 3) osseointegrated implants. Furthermore, the three-dimensional nature of class III malocclusions implies that we not only have a sagittal problem but also a transverse and vertical alterations. To resolve transverse discrepancies in many instances we resort to corticotomies to be able to exceed the biological limits.
对于边缘型成人患者的 III 类错牙合畸形，使用骨骼固定装置进行牙槽骨补偿 "伪装 "已成为一种重要的治疗方法。本文介绍了三种不同的骨骼固定方式：1）后牙迷你螺钉；2）使用 III 类弹性体的迷你板；3）骨结合种植体。此外，III类错颌畸形的三维性质意味着我们不仅要解决矢状面的问题，还要解决横向和垂直方向的改变。为了解决横向差异，在很多情况下，我们会采用皮质切除术，以超越生物极限。
{"title":"Temporary Skeletal Anchorage for camouflaging Class III Malocclusions","authors":"D Martin Salvador MD, DDS, MS, J Aznar Arraiz DDS, MS, PhD, P Arias-Camisón DDS, MS, A. Canábez Berthet MD, DDS, MS","doi":"10.1053/j.sodo.2024.07.007","DOIUrl":"10.1053/j.sodo.2024.07.007","url":null,"abstract":"<div><div>The use of skeletal anchorage for dentoalveolar compensations “camouflaging” in Class III malocclusions in borderline adult patients has become an important treatment alternative. In this article three different types of skeletal anchorage are presented: 1) retromolar miniscrews 2) miniplates with the use of Class III elastics and 3) osseointegrated implants. Furthermore, the three-dimensional nature of class III malocclusions implies that we not only have a sagittal problem but also a transverse and vertical alterations. To resolve transverse discrepancies in many instances we resort to corticotomies to be able to exceed the biological limits.</div></div>","PeriodicalId":48688,"journal":{"name":"Seminars in Orthodontics","volume":"30 5","pages":"Pages 684-711"},"PeriodicalIF":2.2,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142212652","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-01DOI: 10.1053/S1073-8746(24)00122-1
{"title":"FMi --- Ed Board","authors":"","doi":"10.1053/S1073-8746(24)00122-1","DOIUrl":"10.1053/S1073-8746(24)00122-1","url":null,"abstract":"","PeriodicalId":48688,"journal":{"name":"Seminars in Orthodontics","volume":"30 5","pages":"Pages i-iv"},"PeriodicalIF":2.2,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142743583","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-01DOI: 10.1053/j.sodo.2023.11.014
Adith Venugopal , Paolo Manzano , Farooq Ahmed , Nikhillesh Vaiid , S. Jay Bowman
The phenomenon of a gummy smile, characterized by an excessive display of gingival tissue during smiling, is primarily a subjective clinical observation rather than a quantifiable cephalometric measurement. The variability in underlying causes, ranging from soft tissue to hard tissue origins, necessitates a nuanced approach for diagnosis and treatment. This communication offers a comprehensive overview of the multifaceted etiology of gummy smiles, highlighting the importance of distinguishing between soft and hard tissue origins. The focus is on orthodontic treatment approaches tailored to address moderate to severe gummy smiles. The communication aims to enhance clinicians' understanding of diverse orthodontic strategies applicable to correct gummy smiles stemming from different etiological factors, facilitating more precise and effective treatment outcomes aligned with patient expectations.
{"title":"Gummy smiles: Etiologies, diagnoses & formulating a clinically effective treatment protocol","authors":"Adith Venugopal , Paolo Manzano , Farooq Ahmed , Nikhillesh Vaiid , S. Jay Bowman","doi":"10.1053/j.sodo.2023.11.014","DOIUrl":"10.1053/j.sodo.2023.11.014","url":null,"abstract":"<div><div>The phenomenon of a gummy smile, characterized by an excessive display of gingival tissue during smiling, is primarily a subjective clinical observation rather than a quantifiable cephalometric measurement. The variability in underlying causes, ranging from soft tissue to hard tissue origins, necessitates a nuanced approach for diagnosis and treatment. This communication offers a comprehensive overview of the multifaceted etiology of gummy smiles, highlighting the importance of distinguishing between soft and hard tissue origins. The focus is on orthodontic treatment approaches tailored to address moderate to severe gummy smiles. The communication aims to enhance clinicians' understanding of diverse orthodontic strategies applicable to correct gummy smiles stemming from different etiological factors, facilitating more precise and effective treatment outcomes aligned with patient expectations.</div></div>","PeriodicalId":48688,"journal":{"name":"Seminars in Orthodontics","volume":"30 5","pages":"Pages 482-501"},"PeriodicalIF":2.2,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139423376","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-01DOI: 10.1053/j.sodo.2024.04.011
Johnny JL Liaw , Jae Hyun Park , Irene YH Shih , Stella YH Yang , Wendy WT Liao
Orthodontic biomechanics play a crucial role in achieving successful outcomes, especially in complex cases requiring precise control of tooth movements. This article explores force system analysis based on the moments and forces around the center of resistance and emphasizes traditional and contemporary approaches in orthodontic biomechanics, focusing on key tooth movements such as bite opening, space closure, retraction, protraction, intrusion, and extrusion.
In complex borderline cases involving nonsurgical treatment, this article addresses the significance of total arch distalization for maximum retraction, total arch intrusion for vertical control, total arch extrusion for enhancing maxillary incisor display, lever arm mechanics for achieving incisor torque control, and total arch protraction for improving the maxillary incisor show.
Patient-specific factors, efficient biomechanics, and a comprehensive understanding of the limitations of treatment modalities are emphasized in pursuit of optimal orthodontic outcomes.
{"title":"Creative biomechanics for complex cases","authors":"Johnny JL Liaw , Jae Hyun Park , Irene YH Shih , Stella YH Yang , Wendy WT Liao","doi":"10.1053/j.sodo.2024.04.011","DOIUrl":"10.1053/j.sodo.2024.04.011","url":null,"abstract":"<div><div><span>Orthodontic biomechanics play a crucial role in achieving successful outcomes, especially in complex cases requiring precise control of </span>tooth movements<span>. This article explores force system analysis based on the moments and forces around the center of resistance and emphasizes traditional and contemporary approaches in orthodontic biomechanics, focusing on key tooth movements such as bite opening, space closure, retraction, protraction, intrusion, and extrusion.</span></div><div>In complex borderline cases involving nonsurgical treatment, this article addresses the significance of total arch distalization for maximum retraction, total arch intrusion for vertical control, total arch extrusion for enhancing maxillary incisor display, lever arm mechanics for achieving incisor torque control, and total arch protraction for improving the maxillary incisor show.</div><div>Patient-specific factors, efficient biomechanics, and a comprehensive understanding of the limitations of treatment modalities are emphasized in pursuit of optimal orthodontic outcomes.</div></div>","PeriodicalId":48688,"journal":{"name":"Seminars in Orthodontics","volume":"30 5","pages":"Pages 591-601"},"PeriodicalIF":2.2,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141026459","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-01DOI: 10.1053/j.sodo.2024.03.001
Marcio Rodrigues de Almeida
The treatment with aligners is challenging especially because the overall accuracy of tooth movement is reported to be below 50 %. Moreover, dental anchorage provided by the Clear aligners (CA) is critical due to the third law of physics, where for every force action, there is an equal opposite reaction. CA associated with temporary skeletal anchorage devices (TSADs) are an effective treatment protocol for expanding the envelope of movement in complex cases. Extra-alveolar miniscrews associated with CA, are effective for retracting the maxillary (IZC) and mandibular dentition (MBS), while interradicular miniscrews provide excellent anchorage for incisor intrusion.
Objective: The objective of the paper was to discuss the current biomechanics principles related to the use of CA associated with TSADs showcasing the treatment of complex cases, such as Class II, Class III, as well as deepbite malocclusions.
{"title":"The Biomechanics of Clear Aligners associated with temporary skeletal anchorage devices (TSADs)","authors":"Marcio Rodrigues de Almeida","doi":"10.1053/j.sodo.2024.03.001","DOIUrl":"10.1053/j.sodo.2024.03.001","url":null,"abstract":"<div><div>The treatment with aligners<span><span> is challenging especially because the overall accuracy of tooth movement<span> is reported to be below 50 %. Moreover, dental anchorage provided by the Clear aligners (CA) is critical due to the third law of physics, where for every force action, there is an equal opposite reaction. CA associated with temporary skeletal anchorage devices (TSADs) are an effective treatment protocol for expanding the envelope of movement in complex cases. Extra-alveolar miniscrews associated with CA, are effective for retracting the maxillary (IZC) and mandibular dentition (MBS), while interradicular miniscrews provide excellent anchorage for </span></span>incisor intrusion.</span></div><div>Objective: The objective of the paper was to discuss the current biomechanics principles related to the use of CA associated with TSADs showcasing the treatment of complex cases, such as Class II, Class III, as well as deepbite malocclusions.</div></div>","PeriodicalId":48688,"journal":{"name":"Seminars in Orthodontics","volume":"30 5","pages":"Pages 514-526"},"PeriodicalIF":2.2,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140270673","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-01DOI: 10.1053/j.sodo.2024.03.002
Miguel Hirschhaut , Carol Weinstein , Carlos Flores-Mir
The introductory editorial comment succinctly presents different topics related to complex malocclusions covered in this Seminar in Orthodontics issue to inform clinicians on a reasonable path to solve their daily practice challenges. Complex malocclusions should not be underestimated. Many management steps can go sideways and potentially create patient complaints or claims that may raise significant regulatory or legal challenges. Careful steps, multiple interdisciplinary meetings during the planning stage, and continuous interactions within the interdisciplinary team are paramount and a good recipe for success. A continuous informed consent process is critical to remind these patients what is possible, what is working, and what is not developing as planned. At the same time, the outcome is one of the most rewarding experiences for the treating team. The remaining articles in this issue will delve into many details and tips that will help us better treat our complex malocclusion cases.
{"title":"An Introduction to the systematic evaluation and management of complex malocclusions","authors":"Miguel Hirschhaut , Carol Weinstein , Carlos Flores-Mir","doi":"10.1053/j.sodo.2024.03.002","DOIUrl":"10.1053/j.sodo.2024.03.002","url":null,"abstract":"<div><div>The introductory editorial comment succinctly presents different topics related to complex malocclusions covered in this Seminar in Orthodontics issue to inform clinicians on a reasonable path to solve their daily practice challenges. Complex malocclusions should not be underestimated. Many management steps can go sideways and potentially create patient complaints or claims that may raise significant regulatory or legal challenges. Careful steps, multiple interdisciplinary meetings during the planning stage, and continuous interactions within the interdisciplinary team are paramount and a good recipe for success. A continuous informed consent process is critical to remind these patients what is possible, what is working, and what is not developing as planned. At the same time, the outcome is one of the most rewarding experiences for the treating team. The remaining articles in this issue will delve into many details and tips that will help us better treat our complex malocclusion cases.</div></div>","PeriodicalId":48688,"journal":{"name":"Seminars in Orthodontics","volume":"30 5","pages":"Pages 475-481"},"PeriodicalIF":2.2,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140271715","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-01DOI: 10.1053/j.sodo.2024.06.004
Cheol Ho Paik , Mo Hyeon Lee , Jae Hyun Park
This comprehensive review investigates the treatment of vertical maxillary excess (VME) with and without anterior open bite (AOB) in seven unique case studies. These cases illustrate the implementation of advanced orthodontic techniques, such as miniscrew-assisted intrusion of the maxillary and mandibular arches. The multifaceted nature of AOB must be considered, highlighting the need for clear diagnostic criteria and an understanding of the long-term impacts of treatment strategies. The main goal of treatment is to reduce the vertical dimension of the maxillomandibular complex. A single miniscrew in the midpalatal region for the maxillary arch and two miniscrews in the buccal areas of the mandibular arch can be applied for the effective intrusion of the posterior teeth. The review then delves into the specific challenges and treatment modalities for managing VME without AOB, stressing the critical role of individualized intervention plans. Each case study demonstrates a different aspect of the treatment approach: from differential intrusion of molars to address esthetic concerns and functional issues to comprehensive strategies involving the intrusion of entire dental arches to correct severe malocclusions. The outcomes emphasize the importance of controlled orthodontic mechanics in achieving and maintaining optimal posttreatment stability. This review underscores the effectiveness of these treatment strategies in significantly improving facial profiles and dental function while highlighting the adjunctive use of myofunctional therapy and other retention techniques to prevent relapse. Collectively, these cases provide valuable insights into the tailored treatment of complex orthodontic conditions, offering guidance on achieving long-term success in clinical practice.
{"title":"Treatment strategies for vertical maxillary excess: Cases with and without anterior open bite","authors":"Cheol Ho Paik , Mo Hyeon Lee , Jae Hyun Park","doi":"10.1053/j.sodo.2024.06.004","DOIUrl":"10.1053/j.sodo.2024.06.004","url":null,"abstract":"<div><div>This comprehensive review investigates the treatment of vertical maxillary excess (VME) with and without anterior open bite (AOB) in seven unique case studies. These cases illustrate the implementation of advanced orthodontic techniques, such as miniscrew-assisted intrusion of the maxillary and mandibular arches. The multifaceted nature of AOB must be considered, highlighting the need for clear diagnostic criteria and an understanding of the long-term impacts of treatment strategies. The main goal of treatment is to reduce the vertical dimension of the maxillomandibular complex. A single miniscrew in the midpalatal region for the maxillary arch and two miniscrews in the buccal areas of the mandibular arch can be applied for the effective intrusion of the posterior teeth. The review then delves into the specific challenges and treatment modalities for managing VME without AOB, stressing the critical role of individualized intervention plans. Each case study demonstrates a different aspect of the treatment approach: from differential intrusion of molars to address esthetic concerns and functional issues to comprehensive strategies involving the intrusion of entire dental arches to correct severe malocclusions. The outcomes emphasize the importance of controlled orthodontic mechanics in achieving and maintaining optimal posttreatment stability. This review underscores the effectiveness of these treatment strategies in significantly improving facial profiles and dental function while highlighting the adjunctive use of myofunctional therapy and other retention techniques to prevent relapse. Collectively, these cases provide valuable insights into the tailored treatment of complex orthodontic conditions, offering guidance on achieving long-term success in clinical practice.</div></div>","PeriodicalId":48688,"journal":{"name":"Seminars in Orthodontics","volume":"30 5","pages":"Pages 648-672"},"PeriodicalIF":2.2,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141575199","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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