2021 Conference Programme

In dentistry, the goals of treatment are often designed for what our patients wish for, even demand. We all see it - instant satisfaction, immediate outcomes. But when we are anticipating treatment for an adolescent, whether it be strictly orthodontics or including interdisciplinary care, we must often take into account the hard and soft tissue changes that occur over the lifetime of that patient. In other words, we commit ourselves to designing treatment with a longer-term view. In this presentation, Dr. Sarver will cover the principles and will present newly gathered data on how smiles change with time and how we adapt our treatment. We will cover the essential keys to achieve a comprehensive facial and smile appearance and its importance to the immediate and long-term needs of the patient.

Learning objectives:

1. Learn the principles of the craniofacial change from growth through maturational and aging
2. Learn the principles of soft-tissue changes from growth through maturational changes
3. Learn how these changes can be quantified and applied to implementation of treatment plans

Is orthodontic treatment a 2 year transaction, an experience in “braces”? Or is it an opportunity to have a major impact and greater value on overall appearance and all that it brings in life. In this presentation, Dr. Sarver will cover expanded vision and inclusion of multiple dental and medical professionals to be partners in planning and implementation of treatment well beyond a mere transaction.

Learning objectives:

1. Expand your professional vision of what the practice of orthodontics may encompass
2. Offer a systematic appraisal of hard and soft tissue relationships
3. Learn how these principles can be applied to the smile and the face in a transformational manner

In recent years there has been an increasing preoccupation amongst orthodontists in trying to reduce orthodontic treatment time. A variety of techniques have been described, which can be classified primarily as variations in appliance design, and the use of adjunctive surgical and non-surgical techniques. This lecture will discuss the reasons for wanting to reduce treatment time and the evidence-base that currently exists to support the different methods that are available. In particular, it will focus on the clinical evidence underlying supplemental vibrational force and present details of a large randomized clinical trial that has recently been carried out in the UK. It is important that orthodontists understand the quality of evidence when considering using these different techniques on their patients; in particular, the influence of potential bias in many studies and the reporting of changes that are unlikely to be clinically significant.

This lecture will not deal with young adults but focus on patients with degenerating dentitions. Recognizing the impact of the maintenance “own teeth” i.e. avoiding removable dentures in old age has led to a significant increase in the number of adult patients requiring orthodontics. But! “Alone we are limited - together we can”. Adult orthodontics has to be performed in healthy environments requiring frequent periodontal interventions before initiating the treatment Following the treatment most adult patients will need reconstruction including fixed prosthetics possibly supported by dental implants. Orthodontic displacement of teeth when performed with the correct force system can be applied to position the available teeth in the best possible position for a reconstruction and also to build-up bone for implantation. The application of temporary anchorage units facilitates the prevention of undesirable displacements of well-positioned teeth. A treatment result is, however, never stable and the post treatment maintenance will also be dealt with.

Arch widening may be performed for various reasons and is inversely related to the perceived need for extraction. The percentages of patients submitted to extraction treatment have been varying dramatically since the dawn of orthodontics. From Angle´s desire to accommodate all teeth in the arches to Tweeds wish to upright lower incisors, the need for extraction rose to comprise the majority of patients. The pendulum swung back when Damon introduced his “biozone“ approach and claimed that the teeth were moving with bone allowing for dramatic expansion without periodontal damage, thus not as claimed by Wennstrom that moved outside the alveolar envelope. The recent development has been focused on narrow airways which in the seventies was the indication for adenoidectomy. Whereas tooth born expanders do not contribute to improvement of nasal airways, this is attempted by bone borne expanders. Not only the presence of crowding and the possible need to upright lower incisor does now influence the rate of extractions which is now gradually increasing. The facial skeleton, the dentoalveolar relationship, the tongue posture and the breathing pattern will have to be taken into consideration when deciding whether and how to widen the arches.

The spectrum of aligner therapy seems to be limited if it comes to difficult tasks like bodily movement of teeth, forced eruption of impacted teeth, and molar intrusion. TAD borne appliances provide the opportunity of a pre-aligner therapy to modify a difficult case into an easy case that can be finished with aligners in a significantly shorter treatment time.

Their small size allows mini-implants to be inserted in a variety of sites. Currently, the alveolar process is the most preferred insertion site. However, due to the varying bone quality and the risk of root contact, the survival rate of implants inserted in the alveolar ridge still needs improvement. Other regions, such as the anterior palate, provide much better conditions for a TAD insertion, since the amount and quality of the available bone is far superior. Utilizing TAD´s in the anterior palate eliminates the risk of root injury and takes the implants out of the path of tooth movement.

Clinical disciplines with foundations in craniofacial biology have traditionally been concerned with the growth and development of the craniofacial complex from birth through adolescence. This period of time covers rapidly accelerating and dramatically obvious changes in the skeleton and is the period when treatment has been undertaken to correct problems of growth. In this time period, growth is considered one of the most important and powerful determinants of success in orthodontic treatment. It is also known that the craniofacial skeleton continues to grow in adulthood. Even though the tempo of growth is less, substantial changes are possible in both the adult male and female. It is often suggested that knowledge is the basis for treatment. As a result, knowledge of the processes and timing of growth can be of considerable importance to the clinician in managing patients whether in treatment or retention.

Objectives:

1. This lecture will describe aspects of growth and development from childhood through adulthood
2. Growth as it affects clinical practice will be described with regard to the timing, goals, and conduct of treatment and retention
3. This lecture will describe how treatment plans and treatment goals need to differ when considering an adolecent versus and adult

‘Biomechanics’ or ‘biology’ of tooth movement may sound pedantic unless it is viably incorporated in the clinical situation. Conventional biomechanical principles mainly focused on how to move tooth/teeth that are already erupted, which normally requires two-dimensional tooth movement in each spatial plane. In contrast, pathologic conditions during the formation and development of dentition such as impaction and/or non-eruption may lead to various three-dimensional tooth and alveolar bone relationships due to the undesired migration of adjacent teeth, when left untreated. Tooth movement and eruption in common are mediated by the intervening soft tissue and the related bone turnover. Accordingly surgical exposure and orthodontic forced eruption has been a routine practice for impacted tooth. However, the forced eruption of impacted tooth may demand more than biomechanical consideration, due to the fact that the eruption of tooth is under stage-specific regulation, unlike the conventional tooth movement. Hence a strategic and individualized treatment planning involving biological and biomechanical understanding on the eruption of the tooth is crucial. The ‘best’ treatment plan may be chosen depending on various factors, leading the situation into a ‘game’. This presentation is aimed to propose and summarize essential factors for the predictable treatment of impacted/non-erupting tooth, with attention to the (1) biologic factors – depth, angulation, root maturity and age (2) biomechanical factors – three-dimensional localization and application of TADs according to the force-driven approach. The orthodontic treatment overall should be considered a process which facilitate the underlying osteogenic potential of the peri-dental tissue and thereby restore the undesirable alveolar structure during and after the formation of dentition.

Sleep apnea patients, one phenotype of sleep disordered breathing, is a common condition characterized by obstructive apneas, hypopneas, and respiratory effort related arousals during sleep. The optimal treatment of the sleep apnea patients is crucial since untreated conditions may evoke the adverse medical outcomes of daytime sleepiness, metabolic dysfunction, cardiovascular disorders.

Orthodontists are standing at the frontline to become aware of these conditions when the patients come up to their practices without notice of latent condition related to sleep disordered breathing.

The treatment of sleep disordered condition such as obstructive sleep apnea in orthodontic avenue involves orthognathic maxillomandibular advancement, while the preliminary clinical procedure counts on CPAP continuous positive airway pressure. Oral appliances have been recommended as a treatment option for being simple to use and non-invasive since these treatment options are expected to expand the airway patency by mechanical action. One of the common type of oral appliance is the MAD, preferably custom made mandibular advancement device.

It is the aim of the presentation for the orthodontists who are involved in the treatment for the sleep disordered breathing patients to provide a comprehensive insight for the evaluation, management of these conditions.

Learning Objectives

1. To identify the specific craniofacial morphological characteristics of sleep apnea patients
2. To review the evidence-based treatment modalities through literature review
3. To understand orthodontic intervention of sleep disordered breathing patients

The aims of treatment of Class III patients should be improvement of both occlusion and facial profile. However, the current orthodontic techniques in treated patients with Class III malocclusion, either in growing or adult patients, are mostly focus on the improvement of occlusion in anteroposterior dimension but not on the facial profile. This is orthodontic camouflage. A new strategy called “orthognathic camouflage” has been developing for treating patients with Class III malocclusion. This strategy uses maxillary protraction, TADs in the lower dentition, or TADs in upper dentition for clockwise rotation of maxillomandibular complex (MMc). Clockwise rotation of MMc redirects the mandibular growth downward and backward in growing patients, and on the other hand, it repositions the mandible and decreases chin projection and chin throat length in Class III adult patients, which simulates the MMc rotation in orthognathic surgery. The purpose of this presentation is to illustrate the combined application of the above-mentioned techniques in treating patients with Class III malocclusion from teenage to adulthood.

Obesity is a state of chronic inflammation mediated through the presence of excess adipose tissue and is a significant healthcare problem in Western societies because of the known associations between raised body mass index (BMI) and multiple chronic diseases, including diabetes, cardiovascular disease and cancer. The relationship between obesity and oral health is only poorly understood but recently there have been some reports in the literature to suggest that the presence of obesity may have implications for orthodontic treatment. This lecture will focus on the results of prospective cohort study carried out in the UK investigating the effect of obesity on orthodontic tooth movement at the clinical and biochemical levels. It will discuss the findings of this study within the context of how this common condition might influence orthodontic treatment outcome.

The majority of facial deformities create  asymmetric problems in the mandible. A large contributing factor begins with issues arising from the temporomandibular joint (TMJ). Degeneration of the joint has a multifactorial etiology and this lecture will focus on the clinical diagnosis, management and rehabilitation of the TMJ. Management during growth and adulthood will be described and chronicled with case examples.

The gold standard of the treatment for the skeletal class III malocclusion and/or facial asymmetry which demonstrates severe skeletal discrepancies beyond the range of orthodontic camouflage is orthognathic surgery. The orthognathic double jaw surgeries have been addressed towards maxillary retrusion, mandibular prognathism, open bite with the posterior vertical maxillary excess, and facial asymmetry which may be accompanied by all these skeletal deformities. Regardless the type of the orthognathic treatment such as surgery-first or conventional treatment protocols, orthodontic treatment by mechano-therapy poses the crucial part of the comprehensive treatment procedures.

The indispensable demand for orthodontic treatment makes the patients seek for an aesthetic substitute for the conventional appliances which is conspicuously invisible and this can be achieved by the lingual system. The lingual orthodontic system brings about the uncompromised aesthetics and mechanical advantages by being completely invisible from outside, no appliance-induced labial decalcification which jeopardizes the longevity of the teeth, and tendency to bite opening particularly in case of deep over bite.

The purpose the presentation is aimed to share the information on the biomechanical principles of the Incognito® lingual system, discuss the pros and cons related to its clinical application, particularly for orthognathic treatment protocol.

Learning Objectives

1. To suggest the comprehensive diagnostic scales for the skeletal asymmetry
2. To understand the specific nature of lingual system in the course of orthognathic treatment.
3. To review the pros and cons of lingual system in orthognathic treatment.

Correction of Class III skeletal malocclusion continues to be a challenge for the clinician. The traditional approach has been to employ growth modification in the growing period, dento-alveolar camouflage in mild skeletal Class III in non-growing patients and orthognathic surgery in severe skeletal Class III patients. But, all the approaches have been shown to have limitations either in the outcome or in long term stability. With greater insight into the etiology, the advent of better diagnostic modality, improved methods of enhancing anchorage and more definitive surgical protocols there seems to be a better way to manage the skeletal Class III malocclusion. This presentation will highlight the newer strategies with illustrative cases.

This talk will aim to map out the journey of a young child which starts at the time the child suffers severe trauma to anterior teeth through to adulthood where lost anterior teeth are replaced biologically to give this patient a good and sustainable, long term outcome. There are several discussion points that are of interest to orthodontists regarding Traumatised Teeth.  How soon after trauma are teeth safe to be moved orthodontically?  What are the additional risks of root resorption and other complications?  Can and should teeth with a history of root fractures or post-trauma pulp canal obliteration be moved and what are the possible risks? What should be done about ankylosis?

The interdisciplinary approach including the use of autotransplantation which we have pioneered in the University of Leeds and continued here in NUS/NUHS will also be discussed. The versatility of autotransplantation will be discussed as it can be used for numerous complex indications, including trauma, replacement of dilacerated teeth, developmental anomalies, replacing developmentally missing teeth etc.

Objectives are to enable the participants:

1. To understand the impact of previous trauma
2. To understand the role of orthodontics in the treatment of Traumatised Teeth
3. The role of orthodontics in treatment of traumatized teeth of poor prognosis - the role in interdisciplinary care in Dental Traumatology
4. Management of bone when loss of tooth is inevitable
5. Rationale and outcomes for tooth transplantation in children

Certainly the call for evidence-based articles has produced information that should make a difference in the clinical practice of orthodontics. This presentation will introduce the audience to some of the most important and productive trends in the literature. At the same time, some of the literature may be leading us to unfounded conclusions and applications; the differences will be explored. Topics will include early treatment, third molar management, sleep apnea and others.

Objectives:

1. To review the levels of evidence that make a difference in terms of evaluating the literature
2. To describe the most important papers that have recently appeared in the literature
3. To describe articles whose significance is low

Like traditional orthodontic principals, the goal of the pre-surgical phase is to align and decompensate the dental units, and envision co-ordinated arches to the final post-surgical position planned.

Using the ClinCheck Software to simulate the surgical movement allows the orthodontist to immediately plan the tooth movements that are required to achieve the pre-surgical goals and modify the ClinCheck Treatment Plan that will affect those required tooth movements.

Special procedures are then planned with the oral surgeon, and required to help the patient through the surgical phase and the immediate post-surgical phase so that the tooth movements achieved are not lost during healing.

The final detailing of the case is then performed by the orthodontist with aligners once again.

Learning objectives:

1. Learn what principals remain the same with Invisalign Surgical Cases, and what is different.
2. Understand the special way of having the patient undergo orthognathic surgery without placing full braces and wires to maintain teeth positions.
3. Review the special instructions to the oral surgeon and patient that are important during the surgical and immediate post-surgical healing phase.