Orthodontic and dentofacial orthopedic treatment PDF
Preview Orthodontic and dentofacial orthopedic treatment
Orthodontic and Dentofacial Orthopedic Treatment Thomas Rakosi, DDS, MD, MSD, PhD ProfessorEmeritusandFormerChairman DepartmentofOrthodontics SchoolofDentalMedicine AlbertLudwigsUniversity Freiburg,Germany Thomas M. Graber, DMD, MSD, PhD, † Odont Dr hc, DSc, ScD FormerClinicalProfessorofOrthodontics DepartmentofOrthodontics CollegeofDentistry UniversityofIllinoisatChicago Chicago,IL,USA Withcontributionsby R.G.“Wick”Alexander,WilliamJ.Clark,JasonB.Cope,JackG.Dale, M.AliDarendeliler,JohnDeVincenzo,MagdalenaKotova,Andrew Kuhlberg,MichaelR.Marcotte,Rainer-ReginaldMiethke,C.Brian Preston,JohnJ.Sheridan,AlexanderVardimon,BjørnZachrisson 1260illustrations Thieme Stuttgart·NewYork IV LibraryofCongressCataloging-in-PublicationData Importantnote:Medicineisanever-changingscienceundergoingcontinualdeve- isavailablefromthepublisher. lopment.Researchandclinicalexperiencearecontinuallyexpandingourknowledge, inparticularourknowledgeofpropertreatmentanddrugtherapy.Insofarasthis bookmentionsanydosageorapplication,readersmayrestassuredthattheauthors, editors,andpublishershavemadeeveryefforttoensurethatsuchreferencesarein accordancewiththestateofknowledgeatthetimeofproductionofthebook. 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PrintedinIndiabyReplikaPressLTD,Delhi ISBN978-3-13-127761-9 1 2 3 4 5 6 V In Memoriam ThomasM.Graber,DMD,MSD,PhD,OdontDrhc,DSc,ScD,MD,FDSRCS(Eng) *1917,†2007 VI Contributors R.G.“Wick”Alexander,DDS,MSD AndrewKuhlberg,DMD,MSD ProfessorofOrthodontics PrivatePractice BaylorCollegeofDentistry Avon,CT,USA TexasA&MHealthScienceCenter Dallas,TX MichaelR.Marcotte,DDS,MSD PrivatePractice PrivatePractice Arlington,TX,USA Bristol,CT,USA WilliamJ.Clark,BDS,DDO Rainer-ReginaldMiethke,Dr.med.dent.,PhD Orthodontist ProfessorandChair Fife,Scotland,UK DepartmentofOrthodontics,DentofacialOrthopedics andPedodontics JasonB.Cope,DDS,PhD Charité,CenterforDentalMedicine Diplomate,AmericanBoardofOrthodontics Berlin,Germany AdjunctAssociateProfessor DepartmentofOrthodontics C.BrianPreston,BDS,PhD,MSandCertificateinOrthodontics St.LouisUniversity DepartmentofOrthodontics St.Louis,MI,USA SchoolofDentalMedicine UniversityatBuffalo JackG.Dale,DDS TheStateUniversityofNewYork PrivatePractice Buffalo,NY,USA Toronto,Ontario,Canada JohnJ.Sheridan,DDS,ABO M.AliDarendeliler,DDS AssociateProfessor ProfessorandChair SchoolofOrthodontics DisciplineofOrthodontics JacksonvilleUniversity FacultyofDentistry Jacksonville,FL,USA UniversityofSydney Head,DepartmentofOrthodontics AlexanderVardimon,DDS SydneyDentalHospital AssociateProfessorandChairman Sydney,NSW,Australia DepartmentofOrthodontics TheMauriceandGabrielaGoldschlegerSchool JohnDeVincenzo,DDS,MS ofDentalMedicine ClinicalProfessor Head,TheInternationalPostgraduatePrograminOrthodontics UCSF,DivisionofOrthodontics TelAvivUniversity SanLuisObispo,CA,USA TelAviv,Israel MagdalenaKotova,DDS,PhD BjørnZachrisson,DDS,MSD,PhD ClinicalDepartmentofStomatology ProfessorII ThirdFacultyofMedicine DepartmentofOrthodontics CharlesUniversity FacultyofDentistry Prague,CzechRepublic UniversityofOslo Oslo,Norway VII A Clinical Roadmap for the New Orthodontics TomGraberoriginallypreparedthisprefacebutunfortunatelyhe whichwasprintedinmorelanguagesthananyotherorthodontic couldnotfinishit.Tomʼsinterestwasininternationalandnotna- text.“Droppingtheothershoe,”sotospeak,isthisnewtextOr- tional orthodontics—with no dogmatism but looking pragmati- thodonticandDentofacialOrthopedicTreatment.Forthiswehave callyinalldirectionsformethodsthathelpsolvevarioustypesof assembledanimpressivegroupofworld-classclinicianstocover treatmentproblemswithselectiveindication.Thiswasthenature thoseaspectsthatwefeelaremostimportantforrenderingthe ofTomandhisvision. highestlevelofserviceinthesafest,mostpractice-efficientway. AfterTomʼsdeath,itwasdecidedtodedicatethisbooktohis Chapter1(TomRakosi)recapitulatesthefundamentalsofor- memory.Asoriginallytheco-editorofthebook,Ihavecompleted thodonticdiagnosisaspreviouslypresentedinOrthodonticDiag- thisprefacebutmaintainedthespiritofTomaswellthecontentof nosis, with special emphasis on therapeutic diagnosis. Eachpa- theoriginal. tientvisitisadiagnosticexercise,assessingwhathasbeenaccom- Inwhatfollows,essentiallyTomisspeakingtous.First-person plished,possibleproblems,andwhatremainstobedoneinthe references convey his own experiences, enthusiasms, and wis- most time- and technique-efficient manner and with the most dom.Myowninterpolationswillbeobvious. tissue-consciousapproach. T.Rakosi Chapter2(BrianPreston)isonpreventiveorthodontics.Notall orthodontic patients havefull-blown malocclusions. Experience hasshownthatmanyproblemscanbeinterceptedearlyandfully Ninevolatileyearsintoamillenniumweareallacutelyawareof corrected,thuspreventingfurtherdamageorsmoothingtheway manychallengesthatconfrontusindiversefields.Everycountry forfullmechanotherapylater.Theexperienceddiagnosticianrec- in the world faces political, financial, and economic quicksand, ognizesthesepatientsandinstituteslimitedproceduresthathave andthefutureislesscertainthananyonewouldwish.Inamore adefinitecost–benefitratioforallconcerned.Someoftheseprob- professionallyparochialsurvey,thefieldoforthodonticsandden- lemsarecoveredinOrthodonticDiagnosis,butthischapterdelin- tofacialorthopedicshasseennocataclysmicevents,onlysteady eatessuchinstancesinmoredetail—withmoreofa“how-to”ap- progressbasedonextensiveresearcharoundtheworld.Thede- proach.Theoldsaying“Anounceofpreventionisworthapound mand for our services has encouraged the brightest minds to of cure” is most appropriate here. Such efforts are particularly comeintoourspecialty.Thefinancialreturnshaveattractedcom- worthwhileintheareaofabnormalperioralhabits,withtheirpo- mercialfirmstoprovidethearmamentariumweneed,andtech- tentialfordeformingthedevelopingdentition.Thesameistrue nicaldevelopmentshavekeptpacewithscientificprogress.Not for abnormalrespiration. Theway toapproacheachproblem is onlyaremorepatientsbeingtreated,but“service”isbetterthan to ask yourself “If this were my child, what would I think was everbefore.Long-termevidence-basedassessmentoftreatment bestforthechild?” resultsisnowavailable.Weknowprettywellwhatwecanand Chapter3(JackDale)coversinterceptiveguidanceofocclusion cannotdoindentofacialorthopedicsandorthodontics. andextraction:theraisond’être,thetechnique,andlong-termre- Ontheothersideofthecoin,thepotentialiatrogenicsequelae sults.JackDaleʼsmagnificentchaptersinotherbooks,hislectures ofourservicesarecommonknowledgebothwithinourspecialty aroundtheworld,andhisdedicationtoexcellencehaveearned and in the contingency-fee legal profession. The question “At him the preeminent status he now enjoys. His service on the whatpriceorthodontics?”isanswerednowinbiological,biome- American Board of Orthodontics has provided exemplary guid- chanical,andrisk-managementarenas.Someofthemostcompre- ancetoagenerationofyoungorthodontists,stimulatingthemto hensivesearchesinMedlineemanatefromlawoffices,asmotivat- become applied biologists, not merely good mechanics, which edyounglegalstaffsearchforallpossibleuntowardeffectsresult- earnedhimtheprestigiousAlbertH.KetchamAward.Thischap- ingfromourservices.Nolongeraresuchtermsas“crestalbone ter,liketheothers,mustbereadandre-readtoappreciatethefull loss,”“dehiscence,”“decalcification,”“fenestration,”“gingivalre- impactoftheprinciplesandpracticeofthebestpossiblecombi- cession,” “hypermobility,” “interseptal bone loss,” “periodontal nationofdiagnosticacumenandtherapeuticachievement. problems,” “root resorption,” “TMD,” and “traumatic occlusion” Chapter4(TomRakosi)discussesthescopeandlimitationsof exclusivetotheprofessionalorthodonticvocabulary! functionaltherapy.Itemphasizestheprinciplesofdifferentiation Itisimperativethatwepracticeevidence-basedorthodontics. and individualization. We can differentiate between functional Defensiveorthodonticsisimperativeforboththepatientandor- orthodonticandfunctional orthopedic treatment.The principle thodontist. This, of course, means proper diagnosis and patient ofthefunctionalorthodonticappliancescanbethatofforceappli- selectionbeforeanythingelse.ItwastothatendthatTomRakosi, cationorforceelimination.Thepreconditionforsuccessfultreat- IrmtrudJonas,andIproducedthewidelyusedOrthodonticDiag- mentisacomprehensivetreatmentprotocoltakingintoaccount nosisintheColorAtlasofDentalMedicineseries(Thieme,1993), theindividualrequirementsandpeculiaritiesofthepatient. VIII Preface Chapter5(WilliamClark)takesappliedbiologyastepfurther, thereismorebasalskeletalcorrectionasaresultofgrowthguid- utilizingtheTwinBlockapplianceforposturingthemandiblefor- ance,atleastintheshortrun,sinceuseoftheHerbstapplianceis wardandstimulatingtemporomandibularjointmetabolismand limitedto6–7monthsDeVincenzofeelsthatoverthelonghaul optimalgrowthresponse.TheBionatorhasthesamemandibular the response is essentially dental—i.e., tooth movement. Long- posturingapproach,andinadditionutilizesascreeningeffectto termstudiesbyPancherzandRufshowthatactualgrowthofthe preventdeleteriouspressuresonthedentitionbythescreening condyle achieved byadulthood is only1–2mm morethan nor- musculature.TheTwinBlockappliancemayhavestartedwithoc- mal.Buttwofactorsareoperativehere:Oneisthattheseappli- clusalguideplanesasrecommendedbyA.M.Schwartz,butithas ances are worn for onlya small portion of the growth period– comealongwayandisnowcapableoftreatingthree-dimension- only6–7months;butgrowthoccursover9–15years.Predomi- al problems (i.e., sagittal, vertical, and transverse deficiencies). nance of morphological pattern is likely to re-manifest itself in The reader is referred to Dr. Clarkʼs excellent textbooks for a suchcasesunlesssubsequentgrowth guidancethroughtheuse more comprehensive discussion of Twin Block therapy. Like so of activator/bionator/twin block continues the postural propul- manyofoureminentworld-classauthors,Dr.Clarkisindemand siontosomedegree.Thentoo,asUlrichPaulsenshowsinhisex- aroundtheworldtoexplainhisapproachtoClassIIproblems.As cellent CAT‑scan studies, the modification of the glenoid fossa withotherfunctionalappliances,thisdoesnotnegatetheuseof posteriorstructureissignificant,andmostresearchershavenot expansionscrewsorfixedattachmentsatoneormorephasesof measured this important area. Orthopedic surgeons correcting activetreatment.Buttheapproachmakessagittalcorrectioneas- scoliosisorlongbonedeformitieswouldneverlimittheirguid- ier,withlesspotentialiatrogenicdamage. anceto6monthsandstillexpectapermanentchange.Wecan Chapter6(AlexanderVardimon)employsmostoftheconcepts learn much from medical orthopedics as we resort to growth promulgatedbyDr.Clarkbutaddstheuseofrare-earthmagnets guidanceforlongerperiodsoftime,aswehavedonesuccessfully to help in the mandibular propulsion. Having done major withClassIIImalocclusions.Asanoften-quotedmaximhasit:“It NIH‑sponsoredresearchwithmeattheADAResearchInstitute, isnot thetoolthatyouuse,but when,why,forhowlong,with ProfessorVardimonwasabletoshowthetissue-consciousnature howmuchforce.” oftheseminusculeandpowerfulcoatedmagnets,inboththeat- Chapter9(MichaelMarcotte)isessentialforanyoneseekingto tractingandrepellingmodes,toachievejawpositioningaswellas understand the biomechanics of orthodontic therapy for both toothmovement(i.e.,bringingdownpalatallyimpactedcanines). fixed and removable appliances. Advertisements for newexotic JamesMosshasdonethesame. wiresandcomplexbracketsmaycreatetheimpressionthatthey Afullpictureofthebeneficialeffectsofthemagnetshasnot arelargelyautomatic,butthatisfarfromtrue.Orthodonticbio- beencompletelydetermined,butallevidencepointstofaster,po- mechanical principles were pretty elementary when I finished tentiallylessdamagingtoothmovement[1].Useinpalatalexpan- my specialty training. Learning by experience was not always sion appliances has proven quite successful, with less potential pleasant,asso-calledanchorageunitsmovedasmuchasthetar- iatrogenic damage such as root resorption, buccal plate dehis- get teeth. Fundamental concepts stressed appliances that pro- cence,andfenestration[2,3]. ducedsomuchfrictionthatheavyforceswererequiredtoover- Chapter 7 (Ali Darendeliler) on early maxillary expansion is cometheresistanceand,intheprocess,theyproduceddamage authoredbyatrulyinternationalorthodontist whohasworked intoomanypatients.Wewerehandedanedgewisebracketand at renowned universities all over the world; Istambul, Geneva, aseriesofthreeorfourarchwires,leadingtoa0.022×0.028wire NorthCarolina,andSouthernCaliforniahavebeenhisfieldsofac- thatsnuglyfitthebracket.Butevenheavyelasticshaddifficulty tivity.HeisnowtheheadoftheleadingOrthodonticDepartment movingteeth.Thedegreeofforceandlengthoftreatmentalmost of Australia, in Sydney. Within a very comprehensive research alwaysproducedsomerootresorptionandsoft-tissuedamage. program,researchinterestsincludethedentalandskeletaleffect Withleadersinthefieldsuchaswehavenow,ourspecialtyis oforthodonticappliancesandthescopeandpossibilitiesofmax- wellfoundedinbiomechanicalaspects,withtheemphasisonthe illaryexpansion.Aswellasthediagnosticpreconditionsoftheex- “bio.”Muchcreditforthisrevolutiongoestotheorthodonticde- pansion,thecontentsofhischapterincludetiming,typesofmax- partmentatIndianaUniversity,tosageclinicianslikeJamesBald- illaryexpanders,forcesproducedwithmaxillaryexpanders,and winandCharlesBurstone,andtotheirbrightyoungstudentslike theirskeletalanddentaleffects.Hestressestheimportanceofpa- MichaelMarcotteandThomasMulligan,whoareteachinggener- tientsʼagefortheindicationofvariousproceduresofexpansion ationsaroundtheworldthebasicsofmoments,couples,andvec- andgivesimportantguidelinestothepractitionerforsuccessful torsandofcontrolwithoutthesevereattendantdamagewepro- maxillaryexpansion. ducedbeforetheIndianainfluenceonthespecialty.Notonlyhas Chapter8(JohnDeVincenzo)recognizestheuseofmandibular Indiana been the font of biomechanical knowledge (all those propulsion,butusesafixedinter-archmechanism,similartothat mentioned above and many more are outstanding clinicians), ofHansPancherzandtheJasperJumper,withreciprocalanchor- buttheseeminentleadershavemadewhatappearstobeacom- ageinthemaxillaryarch.Theideaofcombiningmaxillarymolar plexaspectofphysicsveryunderstandableforall.Without this distalizationwithmandibularpropulsionandpotentialfavorable background,nocliniciandeservestocallhimselfanorthodontist. condylarandglenoidfossachangeswithfixedapplianceswasin- Admittedly, reading this chapter for thefirst time mayconfuse troduced by Emil Herbst in 1906 and expanded in his book of somenoviceorthodonticstudents,butlikeasacredtext,itmust 1910.Hisappliancesandconceptswereamazinglycontemporary, bereadagainandagain!Withtheinformationgained,theclini- as many orthodontists using the Herbst appliance can attest. cian canunderstand the raison d’être ofall appliances—the ad- WhereasPancherzandhisfollowers(TerryDischingeretal)feel vantages and disadvantages of specific problems. Too many or- Preface IX thodontic“piedpipers”whoneverreallyunderstoodtheunderly- inhisphilosophyandapplianceunitsashisexperiencesandthose ingprinciplesoftheappliancestheyused,the“set-up”theyap- ofhisstudentsanddisciplespointthewaytoevenbettercontrol. pliedtoallpatients,orthe“rulesofuse,”havetootedtheirhorns There is a common thread in the remaining chapters, though: toattractwillingfollowers.Thisistheuglysideofourhistory. light forces, the lowest possible level that moves teeth. We all Unfortunately, this lack of understanding still pervades our havelearnedthehardwaythatwithtoomuchforcewecausehy- specialty.Inaddition,manynonspecialistsreadonlytheadvertis- alinization,stopcellularactivitybyfrontalassault,reducemetab- ingclaimsandlearnthehardwaybymisuseandiatrogenicdam- olism,retain catabolicbyproducts,andmovethetoothor teeth age.Withthoseeager-beaverlegalvulturescirclingoverhead,we onlybyunderminingresorptionmechanotherapy. can no longer afford the luxury of learning by trial and error, ReaditinGraberandVanarsdall[4].Thereareotherchapters buryingcorrecteddentitionsunderpermanentretainers.Tome, ofvalue,butthisisanabsolutemustforperiodontics,etc.Their this is the most importantchapter in this book for orthodontic tissue work is, in myopinion, unexcelled, though European re- students. There are many roads to Rome,manyappliances that searchersarenotfarbehind.StartingwithSandstedtofNorway canaccomplishthesameresult,butonlyonesetoffundamental in1904,throughOppenheimofAustria,NoyesofChicago,Sicher tissue-consciousprinciples.Readandunderstandanddonʼtfeel and Weinmann of Austria and the USA, Kaare Reitan, Per Rygh handicapped if it takes three readings to get the full meaning andBirgit Thilander andAnnika Isbergof Norwayand Sweden, andimplications.Trytotakeshortcoursesgivenbytheseleaders wehave a fineheritage of research scientists that matches any if possible. Most graduate orthodontic resident programs have fieldintheworld. “in-house” teachers of biomechanics: Robert Isaacson, editor of Thelong-termresultsofAlexander,aswellasthoseofother TheAngleOrthodontistandlong-timedepartmentheadatMinne- authors in the light-wire chapters, are bound to be impressive, sota,California,andVirginia;leaderslikeRaviNandaatConnecti- butstandingthetestoftimeisparamount.Abalancedocclusion cut,Rohit SachdevaofBaylor,AndrewKuhlbergofConnecticut, isessential:balancedincontactwiththeopposingteeth,withthe StevenLindauerofVirginia,amongothers—andIknowIhaveleft neuromuscular envelope, with function and parafunction, and out some names. Most schools donʼt have these biomechanical withfacialesthetics.Thisisnotaneasyassignmentwiththemyri- gurusonstaff,butifyougotoIllinois,forexample,youwillhave adoffacialtypesweencounter.Studyofthecasereportsshould all the leaders giving seminars and guiding clinical units, from beaffordedconcentrationandconsiderabletime.Lookforcriteria JamesBaldwinandBillHohlt,throughCharlesBurstone,Michael ofstability,lookfortissuehealthaswellasestheticachievement. Marcotte,ThomasMulligan,andBobIsaacson.Learntheseprinci- Chapter 12 (Magdalena Kotova), authored by a well-known, plesearly,andallapplianceswillmakemoresense,ornonsense, leading orthodontist of the Orthodontic Department of the toyou.Noshortcutshere! Charles University Prague; deals with implants in orthodontics. Chapters9through11assiduouslyapplytheprinciplesofthe Czech orthodontics has had some internationally well-known biomechanicalBiblegiveninChapter9.Theearlychaptersinthis representatives such as Miroslav Adam, Frantisek Kraus, Ferdi- bookalsodo,ofcourse,buttheguidelinesaremoreimportantfor nandSkaloud, andBedrichNeumann.DuringWorld WarIIand fullfixedmechanotherapy.Atleast75%ofyourpracticeloadwill thefollowingIronCurtainperiod,communicationwiththeWest beinthiscategory,perhapsmore,asyouapplyfixedappliancesto wasinterruptedanditwasdifficulttoobtaineventhescientific fine-tune growth guidance cases. As you read the chapters by literature, let alone equipment or material. As soon as the Iron Marcotte,Kuhlberg,andAlexander,makeitapointtoreturnto Curtaindropped,thenewgenerationmadeupforthelosttime. theprofuseillustrationsinChapter9tohelpyouunderstandtheir Theyworkedenthusiastically,studyingthenewliterature,visit- implications. ing famous universities, organizing courses with leadingortho- Ifyouneedfurtherindoctrination,gototheoutstandingchap- dontistsandsoon,aimingtoliftCzechorthodonticstoaninter- ter by Burstone in the Graber–Vanarsdall graduate orthodontic nationallevel.Twoof theexponentsof thisnewgenerationare text[4],tothebooksbyBurstone,Marcotte,andMulligan,andto Magdalena Kotova and Milan Kaminek. Proof thatCzech ortho- theshortcoursesofferedbyallofthem. donticshascomeabreastofthetimesisfoundinDr.Kotovaʼsre- Chapter 10 (Andrew Kuhlberg) on the segmented arch tech- searchtopics.Implantsareoneofherresearchprioritiesandshe niquedealswiththeculminationofbiophysicalandbiomechani- hasmanyyearsofexperiencesinthisfield,publishingandlectur- cal design developed by Burstone and his staff. It is a popular ingon the subject. The qualityof her contribution tothis book choice,particularlyintheConnecticutarea.MarcotteandKuhl- demonstratesherreputationasanexpertinthefield. bergwereproductsofthisenvironmentandlearnedtheadvan- TomGraberwasalwaysbuildingbridgesbetweennationsand tagesofthesegmentedarchapproach.Theywilloftenmodifyit orthodontistsallovertheworld.Hewouldbehappyandproudto withcontinuousarchesatvariousstagesoftreatment.Thischap- havethiscontributioninhis“MemorialEdition.” tergivesyouafinedescriptionofthetechnique,itsbiomechanical Chapter 13 (Rainer-Reginald Miethke) describes treatment justification,andexamplesofthecorrectionpotentialifthetech- withtheInvisalignsystem.ProfessorMiethkeholdsthechairof niqueishandledproperly.Againcomparethesecaseswiththose the Charité University, Berlin. He was thefirst in Germanyand of the other fixed-appliance chapters and judge for yourself oneofthefirstinEuropetoincludethescopeandpossibilitiesof whetherthisisyour“cupoftea.”Thesegmentedarchtechnique treatment with the Invisalign system in his comprehensive re- maybethemostbiomechanicallyorientedapproach. searchprogram.Hecontributedtoimprovementof theefficacy Chapter11(WickAlexander)isagoodplacetoturnnext.Dr. ofthetreatmentwithnewideassuchas“ledtooth”orwaysofus- Alexanderisapioneerinlight-wiretechniquesandhasdevoted ingtheattachments.Heisactiveacrosstheworld,publishing,lec- hislifetoteachingothers.He,too,hasconstantlymadechanges turing,andteachingtreatmentwithInvisalign.
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