Journal of general orthodontics最新文献

The patient presented with constriction of both arches, moderate crowding and an unerupted and impacted maxillary cuspid. The Crozat appliance therapy efficiently developed the arches, reduced skeletal asymmetry on the sagittal plane, and distalized the upper left posteriors although this was aided by the removal of the second molar. Alignment and the development of a good functional occlusion was accomplished efficiently with the straight wire appliance. Facial balance and good lip support was maintained. No stripping was present and the periodontal health remains excellent. A significant improvement was made in the patient's smile. The teeth have been stabler during the two-year period following the initial placement of retainers. And the patient is very pleased with the treatment results.

Many doctors think of orthotics or occlusal splints in connection with temporomandibular joint dysfunction patients and treatments. Few think of occlusal splints or intraoral orthotics in conjunction with orthodontics as diagnostic instruments. This article will demonstrate a close association between intraoral orthotics for diagnostic purposes to establish a functional mandibular-maxillary relationship before or during orthodontic treatment. Orthotics allow the practitioner to establish and maintain a harmony between the joint structures, the muscles and the dentition. Orthotics establish the stable orthopedic relationship prior to orthodontic intervention and thus, the end point of treatment established prior to irreversible corrections and a diagnosis of cause-effect relationships can be determined. Properly relating the mandible to the maxilla allows the opportunity to determine the arch developmental requirements necessary to maintain this functional relationship.

In random studies, some faces will deviate toward Type II skeletal and some toward Type III. Some will deviate toward a skeletally short vertical while some toward long. In their study, Langlois and Roggman digitized individual faces through a computer. As more and more faces were entered, the composite of these faces became more and more attractive. From this, they concluded that attractive faces are only average. The "average" face may very well conform to the divine proportion. However, some faces are strikingly beautiful, and Alley and Cunningham in their study attempted to explain these attributes. Individuals who are blessed with attractive features are treated differently in our society. Ackerman states, "Attractive people do better: in school, where they receive more help, better grades and less punishment; at work, where they are rewarded with higher pay, more prestigious jobs and faster promotions; in finding mates, where they tend to be in control of the relationship and make most of the decisions; and among strangers, who assume them to be more interesting, honest, virtuous and successful." Many would find this special treatment objectionable and unfair. The irony is that beautiful individuals make up a very small percentage of the population; they have very little power to dictate how society should act and behave. Various disciplines have studied the nature of facial beauty. Individually, they provide partial answers; however, when viewed together, they begin to weave provocative insights as to its biologic significance. It is intricately related to divine proportion, and all living creatures have the genetic potential to develop toward it. The appreciation for this proportion is primitive and inborn; it is a biologic mechanism by which all living creatures are attracted to potential mates who conform to this strict proportion because they are biologically strong, healthy, and fertile. To date, there is no other profession other than ours that has the knowledge and the expertise to treat facial problems. We have a keen interest in facial and dental esthetics. We understand occlusion, TMJ anatomy, and facial-skeletal relationship to soft tissue profile. Unlike plastic surgery, where the soft tissues are artificially recontoured for better esthetics, we can make real and substantial skeletal changes. We are able to correct the architectural framework of the face to its physiologically correct position. In so doing, we cannot only improve our patients' appearance, but improve their health as well. There are those in our profession who are afraid of changes. They will not accept what has been presented with the usual excuse that they are "anecdotal" and not supported in the scientific world with rat and monkey studies. Although the concepts presented are complicated and controversial, I have attempted to present them clearly and simply with many references. There will be those, however, who will stubbornly continue to disbelieve t

A good summary for the uses of TMJ radiographs was presented by Jeff Okeson in 1989 as follows: "Radiographs have limited use in the identification and treatment of TM disorders. Only through collaboration with clinical findings and history do they gain significance. When there is reason to believe that an organic joint pathosis exists, radiographs of the temporomandibular joints are obtained. Transcranial and panoramic views are used as screening devices for general assessment of bony abnormalities and osteoarthritic changes. Functional movements are also evaluated and correlated with clinical findings. Tomography is reserved for patients in whom the screening radiographs reveal a possible abnormality that needs closer visualization and investigation. Arthrography is a specialized diagnostic tool to be used only when significant doubt exists regarding the position of the articular disc. CT and MRI are reserved for when additional information will improve the adequacy of the diagnosis." I could not improve upon this summary but would like to point out that Jeff is labeling both panoramic imaging and transcranial imaging as screening devices to be later followed up with more definitive type imaging.