Australasian Dentist Issue 92

CATEGORY 124 AUSTRALASIAN DENTIST Orthodontic Clinicians’ Corner... with Dr Geoff Hall Welcome to this edition of the Orthodontic Clinician’s Corner. This is where Dr Geoffrey Hall, specialist orthodontist, author, international lecturer and orthodontic myth buster answers your questions. If you have a question that you need answered in orthodontics, email geoff@orthoed.com.au Q1 Dear Geoff, I have just started inmy quest to learn more orthodontics, but I am scared that I will be treating more difficult cases than I should be. Can you please provide some guidance as to the cases that I should be starting. Dr PR, ACT Response 1 Dear Dr PR, I am so glad that you have raised this question – as it’s very important that we all provide clinical care to patients within our scope of practice and our level of knowledge. This is a very hard question to answer without a lot of orthodontic education – and I suppose my first recommendation to you is to learn as much as possible about orthodontics and orthodontic diagnosis, especially risk management from a qualified orthodontic specialist who is willing to teach you everything you need to know to protect yourself and your patients. In a summary to attempt to answer your question, I would recommend the following: a) If you are dealing with aligner cases predominantly, then I would prefer your initial starting cases to require minimal sagittal correction, minimal vertical problems and very mild alignment issues. In other words, I would limit your cases to initially Class I malocclusions with some mild crowding and a normal overbite and normal overjet. As you become more experiences with aligner cases, then you can push the boundaries further with up to 3mm sagittal corrections of mild Class II cases, further crowding cases up to 6mm of irregularity, or even spacing cases of greater than 4mm but less than 7mm. You can then also increase the range of patients to those with vertical issues greater than 3mmof overbite but less than 6mm of overbite. My recommendation though is to do at least 10-20 cases which are very easy and once you feel more confident and have mastered the basics of aligner therapy, then I suggest you proceed to those more moderate cases as discussed. b) If you are delving into the area of fixed orthodontics – you must understand that there can be far more side effects that occur due to the bracket /wire geometry and it is a great fallacy that using a straight wire appliance in every situation will correct the malocclusion. This doeswork however in about 70%of cases, where there may be a consistent force system but in 30% of patients, an inconsistent force system may prevail and hence cause significant unwanted side effects. These side effects may give rise to occlusal cants or increased bite opening and many other problems. Hence, once again, a really good understanding of orthodontic biomechanics is required to make sure that you do not have problems that you cannot correct – and unfortunately utilisation of fixed appliances is less forgiving than aligner therapy, as aligners do have a stop mechanism built into their system to control unwanted side effects far better than with fixed braces – but aligners may not track perfectly and hence significant tooth movement such as significant rotations on curved teeth and tipping of teeth are far less predictable with aligner therapy than with fixed braces. My guidelines to my students starting orthodontics in the area of fixed braces would be to once again commence cases which require minimal sagittal correction and mild crowding with at least a 3mm overbite – as I believe the worst scenario with fixed appliances is take a patient Dr Geoff Hall COLUMNISTS from an acceptable overbite initially to an anterior openbite – hence it is far better to start patients with at least a 3mm overbite if you are performing any fixed appliance therapy. u u u Q2 Dear Geoff, I have heard a lot of your webinars and have been to some of your lectures and I am really impressedwith your teaching and your help with orthodontics to the general dentist. I am now at the stage of increasing my staff, and I want to bring in to the practice an oral health therapist / hygienist and I was wondering what areas of orthodontics can I delegate to this type of auxiliary staff member. Dr RF, Queensland Response 2 Dear Dr RF, This is a fantastic question, and is a great passion of mine – as in our orthodontic practice we use various OHT/hygienists to perform just about every aspect of orthodontic care for our patients. These extended auxiliaries, for want of a better phrase, offer great scalability in providing orthodontic care for your patients. In our practice, our hygienist/OHT’s provide everything in orthodontics from obtaining high quality diagnostic records, setting up the procedures for bonding, placement of 98% of orthodontic arch wires andorthodontic auxiliaries, theorthodontic de-band appointment , placement of fixed and removable retainers, looking after orthodontic emergencies and in the area of aligner therapy – they also can place all of the attachments, they have been trained to monitor patients’ tracking and perform simple IPR using manual strips. In other words, the orthodontist or treating practitioner would be primarily