Australasian Dentist Magazine May June 2021

Category 132 Australasian Dentist Q1 Dear Geoff, I am new to orthodontics and I am very interested in starting aligner therapy. Can you give me some ideas about how I should start and how do I implement that into my practice? Dr BF of Aspendale, Victoria Response 1 This is a great question and one that I am asked often. With any new product or system, the key is to understand it properly. This is no different even with aligner therapy, and it’s really important that one understands the correct diagnosis and treatment options in conventional orthodontic therapy – and then be able to transfer these if appropriate to performing aligner therapy. In other words, aligners are not a magical appliance system – it’s just another system to move teeth and you still need to understand how to correctly diagnose, formulate a problem list and finalise a treatment plan that is consistent with the problem list and the goals of therapy. Once you decide that this patient is a good candidate for aligner therapy – then you need to understand the intricacies of aligner treatment which involve the biomechanics of aligner therapy, the staging of aligner treatment, the correct placement of attachments for different orthodontic movements and the clinical techniques to ensure perfectly fitting and good clinical tracking of aligner therapy. In other words, there is so much more to know about aligner therapy than purely leaving it in thehands of adigital technician who provides you with what they believe is a good set up – as this very rarely works. As such, what I highly recommend, if you’re interested in starting any aligner therapy, you need to understand some orthodontics principles as well as the intricacies involved, specifically in aligner therapy. This requires the combination of sound training in aligner treatment and good mentorship with regards to your aligner cases. There are many good courses available – and through our OrthoED Institute we provide a three day “Essentials of Aligner Therapy” program, with a further optional two day “Advanced Aligner”program course. In addition, we can also optimise your Clear Aligner treatment plans through our dedicated CAPS service. Once you have had the training and you have established a good mentorship – then you are 80% on your way to implementing Aligner Therapy into your practice. I highly recommend that this area of orthodontic therapy (aligner treatments) can be fully delegated to a trained and registered auxiliary and can be a very profitable part of one’s practice. v v v Q2 Dear Geoff, I see a lot of orthodontic cases from Orthodontists come in and they have posterior build ups on their upper first molars as a routine – and when I question these orthodontists, they say that we need to do this because of the presenting dental deep bite. I have been asking many colleagues and some say this is good and other people say it is not so good. Could I please have your opinion on this? Dr RJ, Geelong Victoria Response 2 Thank you for this great question, and I have been told this many times by clients of mine. I have also seen this on many patients who have come to me for a second opinion. When one has a deep overbite, it is usually caused or definitely aggravated by a deep curve of spee. In order to level that curve of spee, we do so orthodontically by combining extrusion of the posterior teeth and intrusion of the anterior teeth. The concept of using bite ramps to help open the bite is a totally valid approach, as without it, the patient would be biting on the lower anterior brackets, causing destruction of these brackets. However, the concept remains to level that curve of spee – so any posterior build ups on the upper first molars would actually cause intrusion of the lower molar teeth and hence actually deepen the curve of spee – which is contraindicated in these deep bite cases. Hence, in a deep bite case, we either place the bite turbos anteriorly or we may place them on the second molars, if those second molars have over- erupted (which occurs very commonly in these patients with a deep curve of spee). So to answer your question – if a patient has a deep curve of spee associated with a deep overbite on initial presentation, I believe that it is a contradiction to place any posterior bite turbos on first molars as this will aggravate the problem by increasing the depth of the Curve of Spee and hence actually extend treatment time for that particular patient. So I believe that from a logical perspective and sound orthodontic principles this would not be the treatment of choice to correct a deep overbite. v v v Q3 Dear Geoff, I have a general dentist around the corner who basically places an expansion appliance in every patient and tells the patients that they are going to avoid dental extractions because of broadening the arch at an early age of approximately 9 or 10. What are your thoughts with regards to this one- eyed approach of expanding every child? Dr RW, Sunshine Coast Queensland Orthodontic Clinicians’ Corner Welcome to our first edition of Orthodontic Clinicians’ Corner. I welcome all questions related to orthodontics and look forward to answering them and hopefully breaking down many of the myths that have been taught in your undergraduate years or by other practitioners. Please feel free to email me with any of your questions (geoff@orthoed.com.au ). columnists By Dr Geoff Hall Dr Geoff Hall