General Guidelines for Orthodontic Retention Protocol

Written By: Dr Rania AlRaddadi ..

As a continuation of the discussion we had today, I looked up some papers related to retention and it appears that no solid evidence is available up to date. The reason I believe is ofcourse the lack of well conducted trials and the huge variability in selecting the protocols among orthodontists.

Surgery First Approach

Written by : Dr. Rania Alraddadi ..

Surgery First Approach

Dear all,

I wanted to share this article discussing this approach which is a systematic review.

In summary:

As we are all aware of its limitations and of the importance of case selection, the two major advantages for this approach are:

1- The immediate facial and esthetic improvement which is reflected on the patient’s psychological status.

2- The accelerated postoperative tooth movement as explained by the “RAP” phenomenon.

I also wanted to add some selection criteria for this approach which were mentioned by the maxillofacial team in our school:

1- Class III

2- No crowding

3- Flat curve of Spee

Have a great weekend!

Click here to download the article !

 

Finishing Cases with Class III Molars

Comment by Dr. Rania AlRaddadi ..

I want to attach a paper of 3 case reports which discusses different scenarios which all finished with Class III molars.

I think that the paper is beneficial in terms of expanding our horizon when it comes to different treatment options, especially and as we all know that the introduction of extraction treatment by Tweed made Angle’s sagittal molar relationship less critical in orthodontics.

The paper will follow.

( PDF ) STRATEGIES TO FINISH ORTHODONTIC TREATMENT WITH A CLASS III MOLAR RELATIONSHIP:THREE PATIENT REPORTS

Download paper 1 here

UPDATE 29/11/2016 : A new article related to the same topic is shared by Dr. Khalid Zawawi and Dr.Ehdaa Elshawley . Thanks to them.

Download paper 2 here

Borderline Class III cases : Surgery vs. Camouflage.

Written by : Dr. Rania Alraddadi ..

Dear all,

I just wante d to summarize what we discussed today regarding the treatment decision in borderline Class III cases:

Surgery vs. Camouflage:

Factors to consider:

1- Extra oral exam including both profile and frontal views (is the mandible big? In AP? In transverse including the symmetry and In vertical?).

2- Family history.

Effect of rapid maxillary expansion on the vertical dimension.

Written by : Dr. Rania Alraddadi.

Dear all,

Another topic that we constantly discuss is the effect of rapid maxillary expansion on the vertical dimension.

It was shown that in the long term the  side effects on the vertical dimension are actually minimum.

Here is a systematic review:

http://libdigi.unicamp.br/document/?down=32604 that argues the real long term benefits claimed by bonded RPE users.

According to them, even after the use of bonded RPE, some vertical adverse effects are inevitable. They explained that the vertical change is not caused by buccal tipping of maxillary molars only (which can be controlled by using bonded RPE) but also caused by the whole maxilla being displaced downward. So it was suggested that in cases where vertical dimension is critically sensitive, the use of vertical pull chin cup (or I would also add high pull HG) might be an option.

Explanation of how mandibular expansion follows the Maxillary.

Written by : Dr. Rania Alraddadi .

Dear all,

Today we discussed expansion and mentioned that in most of the cases mandibular arch “follows” the expansion of the maxillary arch and so we rarely use expansion appliances in the mandible.

I just wanted to share the explanation to help the junior residents and refresh the info for the rest of us.

According to Hass, this happens due to several factors:

1- The forces of occlusion were altered by expansion so that the normal lingual vector on the mandibular teeth was lost and the lateral movement of maxilla widened the area of attachment of buccal musculature which caused change in balance between buccal surface and the tongue (a decrease in pressure from the cheeks as result of upper arch expansion will allow the tongue to exert more pressure thus uprighting and expanding lower arch).

2- Thickness of the appliance (3 quarters of an inch) might have caused the tongue to be in a lower position thus exerting even more lingual pressure on mandibular teeth.

Here is the original article:

http://www.angle.org/doi/pdf/10.1043/0003-3219(1961)031%3C0073:reotmd%3E2.0.co;2

Thank you.

Assessment of Lip Position

Written By : Dr. Rania AlRaddadi .

Dear all,

Here is a quick reminder & an illustration + some old but nonetheless classic references.

In ceph and photographic analysis there are many lines that have been introduced to assess lip position: Ricketts E line, Steiner’s S line, Holdaway’s H line, Burstone’s B line to name a few.. But actually the ones that are mostly used are the E line and the S line.

STCA (soft tissue cephalometric analysis)

Written by : Dr. Rania AlRaddadi ..

Dear all,

Attached is an article that discusses STCA (soft tissue cephalometric analysis).

I think some of us already came across it but I thought I would share it anyway.

Now I understand that we always say that ceph readings are only numbers and that we should always look at the patient clinically, but I still think that this is a good article because most of the time we rely on photographs to diagnose which are not always standard or accurate. Using the ceph (which we already take routinely for each patient) might aid in our diagnosis process.