Quartz 4

L1 What Why How Orthodontics

12 min read

Integrated Dental Practice1

Orthodontics: Beyond Straightening Teeth

This presentation explores the what, why, and how of orthodontic practice, focusing on the fundamental principles of the field.

Academic Reference

  • Topic: Malocclusion and Dentofacial Deformity in Contemporary Society
  • Source: Chapter 1
  • Presenter: J. Mike Razza
  • Institution: UWA-OHCWA

Introduction to Orthodontics234

Presentation Overview

  1. What is Orthodontics and what do we do?
  2. Basic orthodontic procedures
  3. Orthodontics in a nutshell
  4. Rationale for orthodontic treatment
  5. Case studies

Defining the Scope of Practice

Orthodontics is often perceived through a narrow lens. To understand the profession, we must first address common public perceptions regarding what orthodontists actually do.

Common Perceptions

There is a widespread belief that the entirety of the profession is focused solely on the final aesthetic result.

Clinical Progression

The primary objective is to facilitate the transition and improvement of dental alignment, moving the patient’s dentition from its initial state to a corrected position.

Rationale for Intervention

  • ==Psychosocial Impact: Malocclusion can lead to social discrimination and reduced self-esteem; severe overjet may warrant early intervention due to psychosocial handicap.==
  • ==Trauma Susceptibility: Class II patients with large overjets face significantly higher risks of central incisor trauma; Phase 1 treatment is indicated to reduce this risk.==
  • ==Functional Disturbances: Unstable occlusions like crossbites or open bites can lead to TMD (10-16% of cases), periodontal trauma (recession), and speech or mastication issues.==

Basic Orthodontic Procedures5

Banding Tray Organization

A banding tray is utilized to organize various sizes of orthodontic bands. The tray compartments are typically labeled for easy identification:

  • Top Row Sizes: 4, 5, 6, 7, 8, 9
  • Middle Row Sizes: 13, 14, 15, 16, 17, 18

Banding and Separator Placement678

Separator Placement Overview

  • System: ORTHOSIGN AO Empower 2
  • Procedure: Placement of orthodontic separator(s) to create space for future banding

Separator Placement Details

  • Objective: Create interdental space (3-10 days) to accommodate orthodontic bands on molars.
  • Technique: Elastic rubber rings stretched and placed interdentally using dedicated pliers or dental floss.
  • Critical Safety: The ring must remain coronal to the contact point; if forced subgingivally, risk of periodontal abscess increases significantly.
  • Timeline: Removal occurs after 3-10 days (typically one week) when the ring loosens naturally. Delayed removal risks the separator falling out and space closure within 1-2 days. .

Band Fitting Using Mershon Band Seater9

Seating and Positioning Bands

  1. The operator tries the band onto the teeth using a Mershon band seater.
  2. The operator seats the band firmly onto the tooth using the Mershon band seater.
  3. Bands are positioned on all posterior teeth.
  • Sizing: Test bands of varying sizes until achieving tight retention on the molar.
  • Cementation: Bands are cemented using either glass ionomer or light-cure cement (light-cure preferred for easier removal and fluoride release).
  • Removal: Band remover pliers engage the band from the cervical margin and eject it occlusally; finger removal is impossible due to retention force.

Cleaning Teeth with Pumice and Water10

The teeth are cleaned thoroughly using a mixture of pumice and water to prepare the surface for bonding.

Tooth Preparation and Isolation11

Use of Lip and Cheek Retractors

Lip and cheek retractors are placed to ensure clear access and a dry field for the bonding procedure.

Rinsing and Drying Teeth12

Following cleaning, the teeth are rinsed and dried completely.

Application of Etching Solution13

Etching solution is applied to the tooth surfaces for a duration of 15–30 seconds.

  • 37% phosphoric acid etching gel is typically used to create micro-porosities in enamel.

Rinsing and Evaluating Etched Enamel1415

Rinsing Etched Teeth

  • All teeth are etched in preparation for brackets to be bonded to the entire arch.
  • Following the etching period, the teeth are rinsed.

Visual Evaluation

After etching, rinsing, and drying, the enamel should exhibit a uniform, dull, frosty appearance, indicating a successfully “etched” surface.

Application of Activator to Etched Areas1617

The activator is placed over the etched areas of the teeth.

The operator applies the activator specifically to the etched areas of the teeth to facilitate the bonding process.

  • The activator (bonding primer) is applied immediately prior to bracket placement to enhance adhesive flow and chemical bonding.

Bracket Bonding Procedure18

Adhesive Application

  • Bonding tweezers are used to remove the bond from the adhesive pad.
  • The adhesive is then placed onto the bracket base.
Positioning Bracket with Bonding Tweezers19
  1. The bracket is positioned on the tooth using bonding tweezers.
  2. Once the bond is correctly positioned, the bonding tweezers are removed.
Removing Excess Adhesive with Scaler

A scaler is used to remove any excess adhesive from around the bracket base.

Clinical Importance of Flash Removal

Residual adhesive creates plaque-retentive ledges leading to biofilm accumulation and white spot lesions (decalcification), which constitute professional liability regardless of patient hygiene compliance.

Curing Adhesive20

The procedure can utilize either chemical-cured or light-cured adhesive systems.

Indirect Bonding Technique

  • Laboratory Phase: Brackets are positioned on a stone cast using adhesive and a flexible transfer tray is fabricated.
  • Clinical Phase: Patient teeth are etched/primed, flowable resin is applied to bracket pads, and the tray is seated for curing from multiple angles.
  • Advantages: Significantly reduced chair time as all brackets are bonded simultaneously.

Archwire Insertion and Ligation21

The archwire is fitted into the individual bracket slots and the posterior buccal tubes.

Wire Selection and Properties

  • Nickel-Titanium (NiTi): Superelastic properties allow significant deflection.
  • Caution: Extraction of canines using superelastic wires can intrude adjacent lateral incisors due to differential root support.

Using Pliers to Fit Archwire into Brackets2223

Howe Pliers are used to accurately fit the archwires into the bracket slots.

Threading Archwire into Buccal Tube24

Instrumentation for Archwire Placement

  • Howe Pliers
  • Weingart Pliers

The archwire is fed or threaded into the buccal tube.

  • The terminal end of the archwire is inserted into the buccal tube to prevent soft tissue irritation from wire protrusion.
  • A distal end cutter with a holding mechanism is used to trim excess wire protruding from the tubes.

Securing Archwire with Alastik Ligatures25

Alastiks are used to secure the archwire onto the brackets. These ligatures are available in a wide variety of colors.

Using Artery Forceps to Pass Alastiks26

The dental assistant passes the Alastiks using artery forceps. The archwire is then tied into place with the Alastik ligatures attached to the artery forceps.

Self-Ligating Orthodontic Brackets27

As an alternative to traditional ligation, self-ligating orthodontic brackets may be utilized.

  • Mechanism: Brackets feature a sliding cap or clip that closes over the slot, eliminating the need for elastomeric or wire ligatures.
  • Efficiency: Reduces chair time as all brackets can be opened/closed in approximately 30 seconds.
  • Hygiene: The sliding mechanism can become obstructed by calculus, requiring excellent patient oral hygiene.

Indirect Bonding

  • you can also just transfer all the brackets to the patient mouth i fyou place them correctly using a cast

Advanced Procedures and Techniques282930313233

Comprehensive Patient Assessment

Before initiating advanced clinical procedures, a thorough diagnostic workup is essential. This ensures that the chosen intervention aligns with the patient’s overall oral health goals and systemic health status.

  • Clinical Examination: Detailed evaluation of hard and soft tissues.
  • Radiographic Analysis: Utilization of CBCT and digital periapical views to assess bone density and anatomical landmarks.
  • Risk Factor Identification: Assessment of smoking habits, glycemic control, and periodontal history.

Treatment Planning Integration

Advanced techniques should not be viewed in isolation but as part of a multidisciplinary approach. This includes coordination between restorative, surgical, and orthodontic considerations to achieve optimal functional and aesthetic outcomes.

Clear Aligner Therapy (Invisalign/Angel Align)

  • ==Mechanism: Sequential thermoplastic trays apply pressure through programmed tooth movements via material addition (compression) and relief (space creation).==
  • ==Attachments: Composite “buttons” bonded to tooth surfaces provide retention and specific force vectors for rotations, extrusions, or translations.==
  • ==Monitoring: Aligner fit indicates progress; if subsequent aligners do not seat properly, tooth movement has not occurred as simulated, requiring refinement.==

Digital Workflow and Guided Surgery

The integration of digital technologies has revolutionized the precision of advanced dental procedures. By utilizing virtual planning software, clinicians can predict outcomes with higher accuracy.

  • Intraoral Scanning: Capturing high-definition digital impressions to replace traditional putty-based methods.
  • Surgical Guide Fabrication: 3D-printed templates that dictate the exact position, depth, and angulation of implant placement.
  • Prosthetic-Driven Planning: Designing the final restoration virtually before the surgical phase begins to ensure ideal biomechanics

Hard Tissue Augmentation Techniques

When bone volume is insufficient for standard procedures, various augmentation strategies may be employed to create a stable foundation.

  • Guided Bone Regeneration (GBR): Use of barrier membranes and bone graft materials to promote osteogenesis.
  • Sinus Floor Elevation: Procedures to increase vertical bone height in the posterior maxilla.
    • Lateral Window Approach: Indicated for significant height deficiencies.
    • Crestal Approach: A less invasive technique for localized augmentation.
  • Ridge Expansion: Splitting or expanding the alveolar ridge to accommodate wider fixtures

Soft Tissue Management and Aesthetics

Achieving a natural appearance requires careful handling of the gingival architecture and soft tissue volume.

  • Connective Tissue Grafting: Enhancing tissue thickness and covering recession defects.
  • Free Gingival Grafts: Increasing the zone of keratinized tissue to improve long-term stability.
  • Suture Techniques: Utilization of microsurgical suturing to minimize trauma and promote primary intention healing.
  • Emergence Profile Development: Using provisional restorations to contour the soft tissue prior to final crown delivery

Advanced Endodontic Microsurgery

When conventional root canal therapy fails or is not feasible, microsurgical interventions provide a pathway to tooth retention.

  • Apicoectomy: Surgical removal of the root apex and associated periapical pathology.
  • Retrograde Filling: Sealing the root canal system from the apical end using biocompatible materials like MTA or bioceramics.
  • Operating Microscope Utilization: High magnification and illumination allow for the identification of accessory canals and micro-fractures that are otherwise invisible

Post-Operative Care and Long-Term Maintenance

The success of advanced procedures is heavily dependent on the healing phase and subsequent maintenance protocols.

  • Immediate Post-Operative Instructions: Management of swelling, pain, and oral hygiene during the initial 48 hours.
  • Pharmacological Support: Appropriate prescription of analgesics and, when indicated, prophylactic antibiotics.
  • Recall Intervals: Establishing a customized hygiene schedule to monitor the stability of the surgical site and restorative components.
  • Complication Management: Early identification and intervention for issues such as peri-implantitis or graft exposure

Why Orthodontics?

1. Protruding, Irregular and Maloccluded teeth

  1. Social discrimination because of facial appearance
  2. Problems with oral functoin, including difficulties in jaw movement (muscle incoordination or pain), TMD, and problems with mastication, swallowing, or speech
  3. Greater susceptibility to trauma, periodontal disease or tooth decay.

2. Problems with oral function

  1. Open bites and overjets affect speech and function
  2. tongue thrust swallow, anterior resting tongue posture lateral tongue thrust lead to open bites
  3. crossbites affect muscle function on opening and closing and occlusion

General Notes

  • It is tempting to consider that disoccluded teeth cause oral hygiene tisuses but this depends heavily on the patient!

Audio Appendix

Additional Audio Content

The following sections from the lecture audio did not correspond to any heading in the main document.

Course Introduction and Structure

Personnel and Coordination The course is coordinated by Professor Mike, with lectures and practical instruction delivered by Daniel Fernandez and additional staff, supported by postgraduate students who serve as instructors during practical reviews.

Core Materials Students are provided with two essential resources:

  • Roadmap Guidebook: A comprehensive PDF available on the Learning Management System (LMS) covering the semester’s curriculum from basic anatomy through to clinical facial analysis. This document contains all necessary slides, landmarks, and reference materials, negating the need for extensive note-taking during lectures.
  • Course Instructions: Detailed documentation covering learning strategies, assessment structures, and rules of engagement.

Online Learning Components Students receive access to the University of North Carolina (UNC) Orthodontics Department’s undergraduate curriculum (Level 2, Units A and B). This material complements—rather than replaces—textbook learning (recommended: Contemporary Orthodontics, 5th or 6th edition). Important Correction: The formative quiz scheduled for May covers Level 2 Units A and B, not Level 3 as indicated in some timetables.

Assessment Framework

  • Formative Quiz (May): 45-minute assessment with multiple-choice and short-answer questions.
  • Practical Exercises: Pass/fail assessment covering facial analysis, profile analysis, space analysis, and basic cephalometric tracing.
  • Final Examination: Two-hour exam (MCQs and short-answer questions).
  • Professionalism: Evaluated on a pass/fail basis.

Learning Sequence

  1. Seminars/Lectures: Mandatory sessions wrapping up online content and preparing students for assessments.
  2. Practical Activities: Hands-on exercises including facial analysis using patient photographs to predict malocclusion patterns prior to cephalometric confirmation.
  3. Clinical Preparation: The diagnostic tools taught in Semester 1 (facial analysis, model analysis) are prerequisites for Semester 2 clinical patient care.

Footnotes

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