New computer applications for the practice of clinical orthodontics - long a recurring theme in the pages of this journal - continue to amaze me. Although I jumped on the practice-management bandwagon early on, giving up my beloved pegboard accounting systems shortly after the first orthodontic computer software became available in the late 1980s and '90s, it took many more years before I finally gave in and adopted the programs designed to assist in performing cephalometric analysis, diagnosis, and treatment planning. I still have my tracing box, mechanical pencils, and cephalometric protractor, along with about a quarter-ton of tracing acetate, but these wonderful old tools have been relegated to the curiosity box. I confess to occasionally taking them out of the closet and doing a case workup the old-fashioned way, if for no other reason than mere nostalgia - much like the enjoyment I derive from driving a horse-drawn carriage now and then. In the modern age, though, computerized tracing and analysis have long since replaced the old manual diagnostic workhorses. In fact, given the development of intraoral scanners and virtual models, we don't even need our dental stone casts any longer. They still make excellent paperweights and conversation pieces, but there is no need to use them for orthodontic diagnosis and treatment planning.
Last month, the first article in this three-part report on the 2015 JCO Orthodontic Practice Study covered trends in the economics and administration of U.S. orthodontic practices since our first biennial survey in 1981. It also described the methodology used in this Study, the second to be conducted online. The full set of tables and the survey questionnaire are available to JCO subscribers in the Online Archive at www.jco-online.com; select the contents for the October 2015 issue and click on "Complete Tables". Part 2 will highlight a number of factors that appear related to practice success in terms of net income and case starts. For tests of statistical significance, we chose a significance level ("p") of .01, instead of the more usual .05, because the high number of variables in the Study increases the possibility that the results could be affected by chance. Any annual figures reported in the tables refer to the preceding calendar year (in this case, 2014).
The goal of orthodontic treatment is to move teeth from malocclusion to a functional, esthetic, and stable ideal occlusion in which all dental crowns and roots are in the correct three-dimensional positions. Mesiodistal, labiolingual, and occlusogingival positions and axial rotations can be determined solely from the crowns of the teeth, but mesiodistal angulations and faciolingual inclinations may be better assessed by viewing both the crowns and roots. Although most of the focus in orthodontic treatment is on crown positions as determinants of esthetic appearance and occlusal contacts, improper root positions may increase the risk of relapse, periodontal damage, and undesirable tooth movements under occlusal loads.
When the parents or the general dentist notices erupted upper lateral incisors and only one erupted central incisor in an 8-to-10-year-old child, it raises the possibility of an impacted upper central incisor - a significant esthetic concern. Treatment of such a patient in the mixed dentition requires an understanding of the eruption pattern of the permanent teeth. If the single central incisor had erupted six months previously, for example, or the lateral incisors had erupted before the central incisor, it would indicate a developmental problem requiring further investigation.
Autotransplantation of teeth, introduced by Slagsvold and Bjercke more than 40 years ago, is a proven option either for substitution of missing teeth or for replacement of avulsed and traumatized teeth when the original donor teeth are available. In cases of severely impacted teeth, it can avoid the need for complex traction mechanics and the risks of side effects on adjacent teeth while reducing overall treatment time. The procedure requires viable periodontal ligament cells around the tooth to be transplanted. It is also technique-sensitive, necessitating proper preparation of the recipient site, in the exact size and shape of the donor tooth and root, to minimize the time the donor tooth remains outside the oral cavity during surgery.
Torquing is a key consideration in finishing and detailing, and essential in the prevention of relapse. Many torquing auxiliaries apply force on two or more teeth and thus cannot be used for single-tooth correction; others apply force on the neighboring teeth, where it is not required. The spring shown here was designed to resolve both issues.
When a skeletal Class III malocclusion is diagnosed early enough, the preferred treatment is orthopedic, involving maxillary traction with facemasks - often combined with rapid maxillary expansion - followed by orthodontic correction using Class III elastics. If the problem is not diagnosed until the permanent dentition, however, the treatment options are limited to compensatory or surgical-orthodontic therapy. Surgical treatment may produce the most esthetic results, but is less commonly performed because of its risks and expense.
This expanded second edition, written by experts in dental public health and pediatric dentistry, discusses children's oral health within the overall context of health promotion. It provides useful tactics for preventing the oral-health problems that most commonly affect children, including chapters on epidemiology, methods for reducing oral-health inequalities, development of proper oral-health behaviors, public policies for healthy eating, oral-health education, and more.
Click here to download a PDF of the printed questions from the journal for reference. CE tests must be taken online. See the link to continuing education on the menu bar at the top of the screen.
Click here to download a PDF of the Product News column for November 2015. See also the Online Product News page of our website for a searchable data base of published Product News items for the past ...
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