Orthodontic Pearls

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I acknowledge that the formal education provided by most dental schools as well as existing textbooks and journals equip the contemporary orthodontist with an excellent foundation in the science and art of orthodontics. However, I believe there is a pool of knowledge and information that is not provided by formal education and only becomes available and acquired with time and experience in clinical practice.

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Nội dung Text: Orthodontic Pearls

Orthodontic Pearls
Orthodontic Pearls A selection of practical tips and clinical expertise Edited by Eliakim Mizrahi BDS DOrthRCS FDSRCS MSc PhD Private Practice London, UK tucurie@passfans.com
© 2004 Taylor & Francis, an imprint of the Taylor & Francis Group First published in the United Kingdom in 2004 by Taylor & Francis, an imprint of the Taylor & Francis Group, 11 New Fetter Lane, London EC4P 4EE Tel.: +44 (0) 20 7583 9855 Fax.: +44 (0) 20 7842 2298 E-mail: info@dunitz.co.uk Website: http://www.dunitz.co.uk This edition published in the Taylor & Francis e-Library, 2004. All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording, or other- wise, without the prior permission of the publisher or in accordance with the provisions of the Copyright, Designs and Patents Act 1988 or under the terms of any licence permitting limited copy- ing issued by the Copyright Licensing Agency, 90 Tottenham Court Road, London W1P 0LP. Although every effort has been made to ensure that all owners of copyright material have been acknowledged in this publication, we would be glad to acknowledge in subsequent reprints or edi- tions any omissions brought to our attention. Although every effort has been made to ensure that drug doses and other information are presented accurately in this publication, the ultimate responsibility rests with the prescribing physician. Neither the publishers nor the authors can be held responsible for errors or for any consequences arising from the use of information contained herein. For detailed prescribing information or instruc- tions on the use of any product or procedure discussed herein, please consult the prescribing infor- mation or instructional material issued by the manufacturer. A CIP record for this book is available from the British Library. Library of Congress Cataloging-in-Publication Data Data available on application ISBN 0-203-50930-7 Master e-book ISBN ISBN 0-203-59580-7 (Adobe eReader Format) ISBN 1 84184 252 4 (Print Edition ) Distributed in the United States and Canada by: Thieme New York 333 Seventh Avenue New York, NY 10001, USA Distributed in the rest of the world by: Thomson Publishing Services Cheriton House North Way Andover Hampshire SP10 5BE, UK Composition by Wearset Ltd, Boldon, Tyne and Wear
CONTENTS viii List of contributors xi List of manufacturers xiii Introduction I ADMINISTRATION 3 Chapter 1 The practice Physical appearance and layout 3 Staff 8 Forms and stationery 9 II PRE-TREATMENT 13 Chapter 2 Management of the new patient First consultation 13 Treatment options 14 Correspondence 15 A perspective on the technological revolution 16 19 Chapter 3 Orthodontic investigations Clinical examination 19 Study models 19 Bite registration 22 Radiographs 23 Cephalometric tracing – Demetri Patrikios 27 31 Chapter 4 Orthodontic photography – P Jonathan Sandler and Alison M Murray Camera requirements 32 Other camera equipment required 33 Conventional 35 mm photography 36 Digital photography 36 Flash lighting 37 Improving image quality 38 41 Chapter 5 Case discussion Physical environment 41 Case discussion dialogue 42 Correspondence 45 Risk assessment regarding orthodontic communications – Laurence Jerrold 46
VI CONTENTS Chapter 6 Marketing an orthodontic practice and managing a new patient – 51 Winston B Senior External strategy 51 Internal strategy 55 The ﬁrst consultation 57 Carrying out a comprehensive investigation 59 The second consultation 60 Correspondence 61 My philosophy of orthodontic practice – Renton Tindall 62 65 Chapter 7 Psychology for patient compliance – Kees Booij Evaluating body language and patient attitudes 65 Clinical clues to patient compliance 66 Patient compliance with ﬁxed appliances 67 Parental inﬂuence 68 Adult patients and their motivation for treatment 68 III CLINICAL TREATMENT 75 Chapter 8 Fixed appliances Stainless steel bands 75 Brackets 79 Practical tips for self-ligating brackets – Nigel WT Harridine 80 Bonding procedure 86 Archwires 88 Intra-oral elastics 93 Oral hygiene 94 97 Chapter 9 Orthodontic auxiliaries Distal movement of ﬁrst or second molars 97 Lateral molar expansion 108 Aligning displaced second molar teeth 111 Displaced maxillary lateral incisor teeth 117 121 Chapter 10 Auxiliary springs for crown and root movement Correcting mesio-distal angulations 121 Correcting rotations 122 Torquing auxiliaries 124 Coil springs 128 Plastic tubing 129 Auxiliaries in orthodontics – André O Hugo 129 141 Chapter 11 Detailing the ﬁnal occlusion Anterior segments 141 Posterior segments 144 Functional evaluation 146 Final Records 147 149 Chapter 12 Removable appliances
CONTENTS VII 155 Chapter 13 Retention Interdental stripping 155 Types of retainers 156 Supervision and retention protocol 161 169 Chapter 14 Laboratory aids Polishing disc 169 Plaster 170 Models 171 Equipment 171 APPENDICES 175 Appendix A 189 Appendix B 213 Appendix C 223 Appendix D 227 Appendix E 229 Index
CONTRIBUTORS Simon Ash BDS MSc MOrth FDS RCS Lee W Graber DDS MS MS PhD Department of Orthodontics 450 Green Bay Road Whipps Cross University Hospital Kenilworth Whipps Cross Road IL 60043 Leytonstone, London E11 1NR USA UK Matie Grobler BchD DDO RFPS MchD Orth 1050 Schoeman Street Kees Booij Hatﬁeld Orthodontist Pretoria 0083 Gezellelaan 11 South Africa 9721 WJ Groningen The Netherlands Nigel WT Harradine LDS BDS MOrth RCS MSC FDS RCS MRCS LRCP Richard N Carter DMD MS 62 Woodstock Road 3250 NW 185th Redland Portland Bristol BS6 7ER Oregon UK OR 97229–3404 USA Jack Hickham DDS MSD PO Box 24129 Glen W Cooper BDS MOrth MSc Hilton Head Island 80 Southover SC 29925 Woodside Park USA London N12 7HB UK André O Hugo BDS MDent PO Box 3596 Luc Dermut DMD PhD Randburg Department of Orthodontics Gauteng 2125 Universiteit Gent South Africa De Pintelaan 185 B-9000 Gent Alec Jacobson DMD MS MDS PhD Belgium 3605 Dover Court Birmingham Gerald Gavron BDS HdipDent MDent(Orth) AL 35223–2865 Division of Orthodontics USA Faculty of Oral Health Sciences Laurence Jerrold DDS JD University of Witwatersrand School of Orthodontics Private Bag 3 Wits Jacksonville University Johannesburg 2050 2800 University Blvd South Africa North Jacksonville FL 32211 USA
CONTRIBUTORS IX Robert A Katz BDS MSc Demetri Patrikios BDS HdipDent MDent 165 Hale Lane 18 Cawarra Street Edgeware Carseldine Middlesex HA8 9QN Brisbane, Queensland 4034 UK Australia Brett Kerr BDS LDS RCS MDSc Efﬁe Patrikios BA 265 Waterworks Road 18 Cawarra Street Ashgrove Carseldine, Brisbane Queensland 4060 Queensland 4034 Australia Australia Victor Lalieu BDS MDent (Orth) Matthew Power BDS MSc FDS RCPS MOrth RCS 4 Westminister Road 13/14 Mary Rose Mall Indooroopilly, Brisbane Beckton District Centre Queensland 4068 Beckton Australia London E6 5LX UK Anthony GH McCollum BDS DOrth MDent (Orth) PO Box 67104 Adam A Ryan BDSc FDS MOrth MSc Bryanston 2021 Pond Cottage South Africa Rocky Lane Rotherﬁeld Ronald G Melville BDS DOrth FDS RCS Greys, Henley-on-Thames 39 Kloof Street Gardens Oxford RG9 4RD Cape Town 8001 UK South Africa P Jonathan Sandler BDS FDS RCPS MSc MOrth RCS Eliakim Mizrahi BDS DOrth RCS FDSRCS MSc PhD Woodstock Station Road 11 Dolphin Court Bakewell High Road Derbyshire DE45 1GA Chigwell UK Essex IG7 6XA UK Winston B Senior LDS RCS DDO RCPS Alison M Murray BDS DOrth MOrth RCS MSc FDS Northenden House Sale Road RCPS Woodstock Station Road Northenden Bakewell Manchester M23 0DF Derbyshire DE45 1GA UK UK John J Sheridan DDS MSD Brian Nebbe BDS MDent PhD Department of Orthodontics 1005 9717 111 Street Louisiana State University Edmonton 1100 Florida Avenue Alberta T5K 2M6 New Orleans Canada FL 70119-2799 USA Farah R Padhani LDS BDS FDS DOrth MOrth RCS 5 Sudbury Court Drive Harrow Middlesex HA1 3SZ UK
X CONTRIBUTORS Desmond Solomon LOTA Colin Wallis BDS LDS DOrth MOrth RCS Whipps Cross University Hospital Meadowside Orthodontic Laboratory Ravensmere Whipps Cross Road Epping Leytonstone Essex CM16 4PS London E11 1NR UK UK Ziegfried J Weber BDS MSc MDent PO Box 3596 Renton Tindall BDS MdentOrth Ground Floor Randburg 2125 St. Andrew’s House South Africa St. Mary’s Walk Maidenhead Tom Weinberger BDS FDS DOrth RCS Berkshire SL6 1QZ 43A Emek Refaim UK Jerusalem 93141 Israel Pieter van Heerden BChD MDent MChD 13 St. Peter’s Road St. Albans Herts AL1 3RU UK
MANUFACTURERS AJ Wilcock Fujiﬁlm Corporation Scientiﬁc and Engineering Equipment 26–30 Nishiazabu 45 Yea Road 2-Chome Whittlesea Minato-ku Victoria 3757 Tokyo 106-8620 Australia Japan GAC International Inc American Orthodontics 185 Oval Drive 1714 Cambridge Avenue Islandia Sheboygan NY 11749-1413 WI 53082 USA USA Great Lakes Orthodontics, Ltd DB Orthodontics 200 Cooper Avenue Acorn Business Park Tonawanda Keighley Road New York Skipton NY 14151-5111 North Yorkshire BD23 2UE USA UK Kerr Dental Products Dentronix Inc 1717 West Collins Orange 101 Steamwhistle Drive CA 92867 Ivyland USA PA 18974 USA Kyocera Corporation (Yashica) 5–22 Kitainoue-cho EM Natt Ltd Higashino 45–47 Friern Barnet Road Yamashima-ku London N11 3EG Yamashima UK Japan Erkodent Erich Kopp GmbH Masel Orthodontic Products Siemensstraße 3 2701 Bartram Road Postfach 1140 Bristol D-7293 Pfalzgrafenweiler PA 19007 Germany USA Forrestadent Ltd Nikon Corporation 21 Carters Lane Fuji Building Kiln Farm 12 2–3 Marunouchi 3-chome Milton Keynes MK11 3HL Chiyoda-ku UK Tokyo 100-8331 Japan
XII MANUFACTURERS Ormco Corporation Precision Orthodontics 1332 South Lone Hill Avenue Ashley House Glendora 58–60 Ashley Road CA 91740 Hampton USA Middlesex TW12 2HU UK OrthoCad Caldent Inc 8 Industrial Avenue Rocky Mountain Orthodontics Fairview Corporate Ofﬁce/Plant NJ 07022 PO Box 17085 USA Denver CO 80217-0085 USA Ortho-Care (UK) Ltd 5 Oxford Place Bradford TP Orthodontics Inc West Yorkshire BD3 0EF 100 Center Plaza UK LaPorte IN 46350-9672 USA Oscar Inc 8025 Castleway Drive Indianapolis 3M Unitek IN 46250 Dental Products Division USA 2724 South Peck Road Monrovia CA 91016 Plydentco Inc 325 Philmont Avenue USA Unit “A” Feasterville PA 19053 USA
INTRODUCTION I acknowledge that the formal education pro- and the concepts of straight wire and pre- vided by most dental schools as well as exist- formed arches, students over the last few ing textbooks and journals equip the years may not have been exposed to some of contemporary orthodontist with an excellent the intricacies and complexities of wire bend- foundation in the science and art of orthodon- ing. While it is commendable that clinical pro- tics. However, I believe there is a pool of cedures should continue to be simpliﬁed and knowledge and information that is not pro- streamlined, there are a number of occasions vided by formal education and only becomes in practice when the orthodontist is presented available and acquired with time and experi- with different malocclusions and individual ence in clinical practice. situations where additional wire bending or The administration and running of an the use of an additional auxiliary will facili- orthodontic practice is not an aspect of ortho- tate and improve the treatment and ﬁnal dontics that is taught extensively or formally result. This concept is well described in an in most schools; it is information that stu- editorial by Robert Rubin ‘Why we still have to bend wires’.1 He concludes in his last sen- dents, as well as young and old orthodontists glean with experience, from interchange with tence ‘In fact, in some areas of the arch, the professional colleagues and from general risk beneﬁt ratios suggest that wire bending reading. In time it comes to reﬂect the indi- will always be a wise choice’. vidual nature of a practice and becomes a With time and experience orthodontists component of the practice driven and learn many technique adjuncts that work for moulded by the personality of the individual them and which facilitate the clinical treat- orthodontist. ment of their patients. A number of these In this book I hope to present the reader adjuncts are published in different journals. with information on administrative and clini- In this book I tried to collate some of these cal aspects of practice sourced from experi- clinical tips and to present information from enced orthodontists worldwide; to show how an international selection of orthodontists they manage their patients and their prac- using varying techniques. I hope that this tices. What patterns do their conversations component of the book will be of value to the follow, what do they say to their patients at graduate student, the neophyte orthodontist different appointments and what do they say as well as the established orthodontist wher- to parents? It is important to know just how ever he or she may be practicing. much clinical information to give to patients This book is not intended to compete with and what information should be provided in the major texts on the theory and techniques correspondence to both the patient and the that form the basis of contemporary ortho- referring dentists. I hope the sample letters dontic teaching and practice. I hope that in an used by orthodontists in different parts of the informal style, more akin to a seminar or tuto- world will be of assistance and will reﬂect the rial, this book will provide the reader with varying nature of practices. information which will be helpful in both the With regard to the clinical aspect, current administrative and clinical components of teaching on the theory and technique of orthodontic practice. orthodontics continues to evolve and expand I concede that it has not been possible to and cannot be faulted. However, with the cover the complete orthodontic scenario; development of prescription-type brackets there are omissions particularly in the areas
XIV INTRODUCTION of non-compliance and functional appliances. of these makes for a happy orthodontist? I I have no doubt there are many clinicians don’t know. In our professional context, what who have ideas, tips and techniques that have is happiness, how do you deﬁne it? A simple not been included, perhaps these gaps could deﬁnition given to me by a friend states: be ﬁlled in future editions. ‘Happiness is when your earning power Much of the information submitted by dif- equals your yearning power’. By all means be ferent clinicians has been gleaned from expe- ambitious but above all be honest with your- rience, lectures, courses and journals; where self and with your patients. Be happy and con- possible references are listed at the end of tent with what you do. each chapter. Unfortunately, in certain cases I would like to acknowledge and thank the exact reference or source of an idea or a every contributor for his or her effort and technique cannot be recalled, in such cases, input. No matter how small or large their con- none of the contributing authors knowingly tribution, it takes time and effort to put pen to claim originality for any idea or technique paper, and for this I and I am sure our readers described. are grateful. I must also thank my colleagues The literary style varies with each contribu- and postgraduate students at the Department tion and I have tried not to alter this variation of Orthodontics, Whipps Cross Hospital, but rather to retain the individuality of each London, for their stimulus in the initiation of author. In certain sections the reader may this work, I hope the end result is worthy of encounter some repetition, once again this has their conﬁdence. been retained with the intent of maintaining Finally, let me say to every reader, the the integrity of each individual contributor. greatest appreciation you can demonstrate to A hallmark of our profession is the diver- your profession is to impart and pass on your sity of individual opinion on both clinical and knowledge and expertise to your students and administrative issues, this diversity on the fellow colleagues. To those of you already management of certain aspects of practice involved with teaching we acknowledge your may be apparent to the reader. I have made services. To the others, I encourage you to get no attempt to try to achieve consensus but involved with teaching to a level and extent have chosen, once again, to retain the individ- that suits you. I hope that, via this book, our uality of the contributor. I hope the reader colleagues who have put pen to paper are in will beneﬁt by being exposed to the different their way giving something back to the profes- views and will take from the text what suits sion they so enjoy. I leave you with what has his or her own circumstances, personality and probably been the best pearl in my career. practice environment. Pearl: For me the most satisfying profes- sional experience has been the mix of clinical orthodontic practice combined with part time Comment teaching. I believe that orthodontics is one of the ﬁnest professions; it combines the best of both the Invitation science and art of dentistry. We are privileged to treat a group of patients who actively seek I would like to take this opportunity to invite our services, and the general level of work any reader who believes that they have one or satisfaction and patient appreciation is high, I more pearls of information that could be have yet to meet an unhappy orthodontist. included in any possible future edition of this Whether you run an individual single practice book, to feel free to contact me. (My address is or a multiple surgery/operatory type of prac- included in the List of Contributors.) tice is an individual choice and I believe is more related to personality and character type Eliakim Mizrahi rather than to ﬁnancial consideration. Which
INTRODUCTION XV A LITTLE PHILOSOPHY life outside of their teeth. Consideration of their individual circumstances helps to form a bond between clinician and patient The following are a few experiences and early on in treatment. This individual con- lessons gleaned as I travelled as a practice sideration will also assist greatly in their manager for thirty-six years through the life cooperation during treatment. It is as well of an orthodontic ofﬁce. I learnt that: to remember that this ‘customer’ or ‘con- • Orthodontists hold in their hands a capac- sumer’ is going to share at least eighteen ity to generate ﬁnancial beneﬁts allowing months of their life’s experience with you. them to lead a comfortable and generous lifestyle. Pearl: Cultivate, as much as you can, to • That all of this is irrelevant if they do not share this experience on an individual basis acknowledge that their opportunity of with your patient and if possible without altering the position of the teeth should be another family member being present. joined with a positive experience in the lives of their patients. • That it is important to remember that as Efﬁe Patrikios each potential patient walks through the door they do not only bring misaligned teeth with them. They are part of a social REFERENCE structure interwoven with expectations and dreams of their own. They belong to a family, whether it is a nuclear or single par- 1. Rubin RM. Why we still have to bend wire. ent family. They belong to an educational The Editors Corner. J Clin Orthod (1996) 30: facility or the workforce. They each have a 541–542.
I Administration
1 THE PRACTICE PHYSICAL APPEARANCE AND LAYOUT Physical Layout It is important to appreciate and understand Remember, buildings and alterations are long- that for a new patient, or for that matter any term investments and physical structures that visitor, the external approach, the entrance, cannot easily be changed; you need to do the appearance and atmosphere of the recep- some careful research and plan well. tion and waiting area, all contribute to create Consideration of the physical design and lay- the ﬁrst and lasting impression of your out are important at the new surgery/ofﬁce practice. The whole environment should be planning stage, during the lifespan of the appealing to the eye and give the impression surgery/ofﬁce, and as the working life of the of being bright, clean and airy. Whether you clinician starts tailing off. The latter scenario prefer modern contemporary or older period is seldom given adequate consideration, style is your personal taste, but the overriding Hamula points out that when the time comes principle still holds, keep it bright and light. to either sell your practice or take in an associ- Lighting should be bright but not necessarily ate, a refurbished, modernized surgery/ofﬁce harsh. Bright areas help to elevate the mood of is more marketable and will attract a higher price.1 He believes that money spent in refur- both the staff and the patients. This theme of brightness and light should be carried through- bishing an old tired-looking practice will be out the entire practice. The choice of colours more than recovered in the ﬁnal sale. and decor once again is a matter of personal Two major issues will govern the physical taste and choice; try to select light as opposed layout. First, are you designing the practice to dark and oppressive colours and furniture. from scratch with an open area available to you, or are you limited by an existing physical structure? Second, and probably more impor- Pearl: Keep it bright, light and clean. tant, what is your available budget? Within the constraints of these limitations, there are some overriding principles that should be Cleanliness should be a given and not need to borne in mind. be mentioned but this issue is so important I feel it needs to be stressed. Both clinical and Patient ﬂow non-clinical areas need to be kept spotless. Whether in-house staff members are respons- A patient entering the reception room will ible for cleaning or you employ a cleaning generally be seen ﬁrst at the reception counter/ service, it is not always easy to get staff to desk and depending on the nature of the visit, clean to the standard that we would like. the new patient will either be guided to a seat in Unfortunately, it is an area of administration the waiting area, or directed through to a con- that needs constant monitoring. sulting ofﬁce or for patients under treatment, directed through to the surgery/operatory. Pearl: To make cleaning easier, try to keep Pearl: Access to these two areas should be the area uncluttered, use simple lightweight as direct as possible without the patient hav- furniture, easy to move and easy to clean ing to pass through any other rooms. under.