Always a high point of my year, this year's annual session of the AAO in Orlando, Florida, was another triumph for the profession. The lectures were stimulating, the exhibits were informative, and the social activities were enjoyable. One topic that seemed to be on everybody's mind was that of accelerated orthodontics (AO).
Anterior open bite has been considered a complex malocclusion to treat because of the initial difficulty in closing the bite and the subsequent challenge of retaining bite closure. Proper diagnosis is necessary to develop an effective treatment plan with appropriate retention of the newly established bite.
Maintenance after orthodontic treatment is often mistaken for stability of the post-treatment status. As stated by Oppenheim in 1934, "Retention is the most difficult problem in orthodontia; in fact, it is the problem". Bonded lingual retainers, which have become a standard part of retention protocol due to the relapse tendency of lower-incisor irregularity, have been shown to be effective in maintaining the alignment of the mandibular anterior region. Nevertheless, such retainers can loosen without being noticed or even be unintentionally activated, resulting in undesirable tooth displacement.
Clear-aligner therapy has gained popularity since the advent of Invisalign, to the point that it is often requested by potential patients. Although some practitioners still question the accuracy of the technique, this book offers a detailed protocol of diagnosis and treatment planning designed to improve the efficiency of aligner therapy.
Dental ankylosis is a cellular change in the periodontal ligament that results in continuity or fusion between the alveolar bone and cementum, making it impossible for a tooth to erupt completely. It is identified clinically by the failure of a tooth to erupt through the oral epithelium, by incomplete eruption, or by a lack of vertical movement compared with the adjacent teeth and the alveolar bone. Although ankylosis is more common in the primary dentition, it may also affect the permanent teeth, typically the molars. Bone defects are often associated, especially when ankylosis occurs during active vertical growth of the maxilla.
Lower second molars commonly erupt into a lingual crossbite or "scissor bite". Traditional treatment involves banding or bonding a lingual attachment and running crossbite elastics to the upper second molars, but that method is cumbersome and dependent on patient compliance. This month's Pearl describes a hairpin-spring appliance that can efficiently correct a second-molar crossbite without the need for brackets or elastics.
This month's Cutting Edge article describes accelerated orthodontic treatment using photobiomodulation (PBM), a low-level light therapy that has been shown to accelerate bone and connective-tissue metabolism for wound healing in medicine. One commercially available PBM device, OrthoPulse, uses light-emitting diodes (LEDs) that produce 850 nanometers of light (very near the infrared spectrum), offering a safer mode of treatment than with laser light.
Miniscrews are now routinely used as a source of skeletal anchorage in orthodontic practice, with a high reported success rate. One of the safest and easiest areas in the upper arch to place miniscrews is the anterior palate, which offers the thickest bone in the entire region. Although there are no anatomical structures that can be damaged during miniscrew placement, the nasopalatine bundle (NPB) is close enough to the upper incisors to be contacted by a miniscrew, leading to complications such as non-osseointegration or sensory dysfunction.
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