3D TECHNOLOGY IN ROUTINE ORTHODONTIC PRACTICE BJÖRN LUDWIG

Lower arch missing lower 2nd premolars Hemisection lower E – distal half – Old school Allow mesial drift of 6s, L4s do not distally tip, important in class 2 cases Use mesial aspect for anchorage if ankylosed Remove remaining Other options TADs 30% failure in the mandible in Caucasian Herbst Mini-plates – very evasive But hemisection is simple Gingivectomy After extrusion of impacted tooth, need for gingivectomy Orthodontists should learn as common need Process Scan Plan a gingivectomy guide Laser or electrosurgery for gingivectomy Cant and TADs adult cases are the future of orthodontics, more challenging RHS>> Gincevectomy LHS>> extrusion using TADs TAD – opencoil to bracket on the tooth, and aligner to guide the tooth, cover incisal edges only And few aligners Patient did not want perfect result Space closure and TADs Georgios Kanavakis 2014 Space closure and mesial slider 2 x palatal tads SS spring close Mesialization of molars High tech But Space closure can be achieved with timely extractions, such a smissing UEs and extractions with mesial drift.. Less likely lower arch, miniplates used to mesialise Expansion Digital planning Digitally decompensate the lower arch. MARPE Changes to the midface through MARPE Hard tissue changes to the midface and nasal complex Caution in use, for selective cases only, and critical in use SARPE Indicated due to resistance for Maxillary expansion in adults from 3 potential structures Zygomatic buttress, Pterygoid plates, Sutures from the mid face Published 1984 by Andrew Glassman Using a finite element analysis programme, fusion 360, identify the resistance individual to patient Case: Surgical guide to do a small lateral osteotomy under local = future as it is individualized to each patient Hybrid treatment brackets Vs aligners Class 2 correction Change from fixed to aligners with Onyx Ceph planned wings for class 2 correction – like functional appliance Problems Distalisation with Miniscrews Later on posterior crowding of 2nd molars and risk anterior recession Fracture of palatal appliance Failure at welding point between expander and abutment Can stop people using designs Solution print 1 piece appliance CADCAM Overuse TAKE HOME MESSAGE BY ME FROM THE LECTURE Sometimes effort is not equal the benefit so always evaluate your benefit Always assess your outcome and see if technology you invested in worth it Orthodontists are Dentists and should do some gingival contouring and temporaries ..etc Always match arch before and after treatment and maintain your arch form Future is Hybrid Therapy … using strength of both aligners and fixed braces