Favorite Saved

THE EDITOR'S CORNER

Seeing the Light

Seeing the Light

When we think or talk about any new technology, we usually betray our preoccupation with related past experiences. In the 19th century, travelers named the locomotive the "iron horse" and subsequently called the automobile the "horseless carriage".

Today, we continue to view modern developments through rearview mirrors, having given the name "information superhighway" to the multimedia telecommunication phenomenon that is so much talked about today. Of course, this multifaceted technology hardly resembles a highway, which has predictable linearity, discrete boundaries, and carefully prescribed routes. Nevertheless, the inappropriate metaphor has taken hold, even if it has recently been shortened to "infoway" or "infobahn".

Were you to believe the hype delivered through our media by Wall Street, Hollywood, and cable-TV moguls, you would think the future lay with televisions topped by black boxes. But despite their best efforts to wed us to these outmoded and limited technologies, the heart and soul of the telecommunications revolution will be the computer. Therein lies the potential for rapid progress in orthodontics.

According to the 1993 JCO Orthodontic Practice Study, 73% of U.S. orthodontists had computers in 1992. For most of us, however, these remarkable machines are little more than administrative assistants that keep financial records, write letters, and help schedule our time. Even when we design and employ programs to do other tasks, such as cephalometric tracings and measurements, video imaging, occlusograms, and diagnoses, we seldom, if ever, make use of networks with useful data bases of orthodontic information and experience.

It's hard to imagine orthodontics remaining outside the communications explosion now exemplified by Internet: a confluence of thousands of giant computers around the world, linked together and available not only to each other, but to us as well. The digital technology to permit sharing of orthodontic skills and knowledge already exists, but no one seems to have had the vision or the drive to do much about it in a comprehensive way.

Recently, we've had some hopeful signs that our limited vision of computer use is ending and that, perhaps, an exciting new era of computer utilization has begun.

In the March issue of JCO, Melsen and Fiorelli described a system they developed to instruct orthodontic students and others in biomechanics, diagnosis, and treatment planning. Such Computer-Assisted Instruction (CAI) permits students to learn in a highly specific manner and at a pace that synchronizes with their individual personalities. A multimedia approach also enriches learning by using text and sound along with static and animated imagery. The interaction between user and computer offers enormous advantages in its ability to deliver immediate, accurate, and relevant feedback. Reinforcement is one of the hallmarks of great teaching and learning--regardless of the source.

In this issue of JCO, Doctors Yamada, Hassan, Yamaki, Hanada, Suzuki, and Hara of Japan illustrate how they have simulated orthodontic treatments by using the Macintosh program QuickTime, which creates the computer equivalent of motion pictures.

Orthodontists need this type of intellectual imagination to reach a critical mass of professional curiosity that will result in a cascade of shared ideas, experiences, and data.

In an age when telemedicine allows a physician to complete surgical procedures by robot while hundreds of miles from the operating room, surely orthodontists can use information technology to modernize and improve our profession. We need some universal system by which we can share data bases, exchange e-mail, solicit help for problem cases, access the literature, send and receive all kinds of information (images, text, and sound), stay current through electronic forums, and conduct high-tech research by searching worldwide for related topics.

I think we are just beginning to "see through a glass darkly". When the full light breaks through, I believe our computer screens will enlighten us in ways we can scarcely imagine. It's a great time to be an orthodontist.

Fig. 14 A. Adult male patient whose maxillary left central incisor had poor prognosis and more apical gingival margin (arrow) than on adjacent central incisor. B. Implant site development by extrusion of left central incisor, with bracket bonded apically, and initial leveling with superelastic wire. C. Interrupted continuous forces used to extrude incisor; incisal edge progressively ground out of occlusion with opposing arch. Increased root exposure (arrow) confirms that gingival tissue does not completely follow extruded tooth. D. Both labial soft tissue and alveolar bone followed extruded incisor enough to allow placement of implant-supported crown. (Reprinted by permission. [Ref. 41])
Fig. 15 A. 55-year-old female patient with labial gingival recession before treatment (arrows). B. Brackets bonded apically, and continuous force from superelastic wire used for extrusion of maxillary right lateral and central incisors. Incisal edges were ground with diamond bur to avoid occlusal interferences. C. Improvement in gingival levels after three months of treatment. D. After placement of six porcelain laminate veneers (courtesy of Dr. Roy Samuelsson, Oslo, Norway), note improved symmetry of anterior gingival levels. (Reprinted by permission. [Ref. 41])
Fig. 16 A. Adult female patient with severe local periodontal tissue breakdown (see Figure 17). Bone support for mandibular right first premolar was much better than that for canine and second premolar (arrows). B. Slow orthodontic extrusion of canine and second premolar used to improve vertical bone height prior to placement of implant-supported restorations. After removal of pulps, incisal edges of extruded teeth were ground to avoid jiggling with maxillary teeth. C. After 10 months of leveling, extruded teeth were extracted with forceps. Note even gingival and bone levels. D. Marked improvement in periodontal tissues around implant crowns one year after treatment. (Reprinted by permission. [Ref. 41])
Fig. 17 A. Same patient as in Figure 16, showing bone levels before treatment (arrows). B. Remarkable amount of bone build-up after 10 months of leveling (darker areas indicate immature bone). C. After placement of implants. D. Normal appearance one year after treatment, with bone levels up to first threads of Brånemark implants.
Fig. 18 A. 41-year-old female patient with agenesis of both mandibular central incisors, multiple spaces, thin periodontal tissues, and prominent root topography. Alveolar ridge was too thin labiolingually to allow implant placement in anterior region (arrow). B. Orthodontic movement used for implant site development mesial to mandibular left first molar. C. Wide area of bone on tension side provided ample space for titanium implant. Panoramic radiographs taken before (D) and after (E) treatment show placement of implant in area previously occupied by left second premolar. (Reprinted by permission. [Ref. 41])
Fig. 19 A. Adult female patient requiring implant in narrow area of alveolar bone, mesial to first molar (arrow). B. Horizontal implant site development by distal movement of mandibular right first premolar with continuous force from superelastic coil spring. C. Wide area of bone developing on tension side. D. Ample buccolingual space provided for implant.
Fig. 20 A. Adult female patient (same as in Figure 15) with buccolingually thin alveolar process, contraindicating implant placement without surgical ridge augmentation, especially on right side. Nonsurgical treatment was planned. B. Second premolars derotated and moved mesially into contact with first premolars, which were also derotated. C. Increased buccolingual width of alveolar bone on tension side, allowing placement of two implants. D. Radiographic evaluation confirms successful osseointegration of implants in newly regenerated alveolar bone, but shows pronounced lateral root resorption on pressure sides of both premolars (arrows). E. One year later, left first premolar had to be extracted, and long-term prognosis for right first premolar was poor due to resorption in marginal portion of root.
Fig. 21 A. Horizontal and vertical implant site development in 66-year-old female patient with severe periodontal tissue breakdown (see Figure 22). B. Brackets bonded apically on porcelain crowns of maxillary right lateral and left central incisors for orthodontic extrusion (arrows); right central incisor was moved mesially to correct midline deviation. C. Extruded crowns were ground incisally to avoid jiggling with mandibular teeth, and later rebonded onto roots.
Fig. 22 Same patient as in Figure 21, radiographs. Upper row: Right and left central incisors; lower row: right lateral and central incisors. A. Alveolar bone levels before treatment. B. After five months of extrusion. C. After 11 months of extrusion. D. Improved alveolar bone height for implants after 15 months of treatment.
Fig. 23 A. Low extension of sinus on left side made implant placement impossible without sinus-lift surgery in 66-year-old female patient whose crowns were all artificial. B. Non-osseointegrated Spider Screw inserted in tuberosity (arrow) and immediately loaded with light force for distal movement of left second premolar through maxillary sinus. C. After 12 months, space and alveolar bone were created for implant by 8mm distal movement of second premolar. Both premolar and bone were apparently moved into sinus, with immature bone (darker areas) forming on tension side.
Fig. 24 A. Patient with mesially rotated upper first molars in Class II malocclusion (arrows). B. Zachrisson transpalatal arch offers clinical advantages over conventional Goshgarian design, allowing simple and accurate molar derotation.

DR. BJORN U. ZACHRISSON DDS, MSD, PHD

DR. BJORN U. ZACHRISSON DDS, MSD, PHD

DR. ROBERT G. KEIM DDS, EDD, PHD

DR. ROBERT G. KEIM DDS, EDD, PHD

My Account

This is currently not available. Please check back later.

Please contact heather@jco-online.com for any changes to your account.