Orthodontics in the Vertical Dimension: A Case-Based Review PDF
Preview Orthodontics in the Vertical Dimension: A Case-Based Review
Orthodontics in the Vertical Dimension A Case‐Based Review Orthodontics in the Vertical Dimension A Case‐Based Review Thomas E. Southard, DDS, MS Steven D. Marshall, DDS, MS Laura L. Bonner, DDS, MS University of Iowa Iowa City, Iowa USA Copyright © 2015 by John Wiley & Sons, Inc. All rights reserved Published by John Wiley & Sons, Inc., Hoboken, New Jersey Published simultaneously in Canada No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, scanning, or otherwise, except as permitted under Section 107 or 108 of the 1976 United States Copyright Act, without either the prior written permission of the Publisher, or authorization through payment of the appropriate per‐copy fee to the Copyright Clearance Center, Inc., 222 Rosewood Drive, Danvers, MA 01923, (978) 750‐8400, fax (978) 750‐4470, or on the web at www.copyright.com. 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No warranty may be created or extended by any promotional statements for this work. Neither the publisher nor the author shall be liable for any damages arising herefrom. For general information on our other products and services or for technical support, please contact our Customer Care Department within the United States at (800) 762‐2974, outside the United States at (317) 572‐3993 or fax (317) 572‐4002. Wiley also publishes its books in a variety of electronic formats. Some content that appears in print may not be available in electronic formats. For more information about Wiley products, visit our web site at www.wiley.com. Library of Congress Cataloging‐in‐Publication Data: Southard, Thomas E., author. Orthodontics in the vertical dimension : a case‐based review / Thomas E. Southard, Steven D. Marshall, Laura L. Bonner. p. ; cm. Includes index. ISBN 978‐1‐118‐87021‐1 (cloth) I. Marshall, Steven D., author. II. Bonner, Laura L., author. III. Title. [DNLM: 1. Malocclusion–Case Reports. 2. Malocclusion–Problems and Exercises. 3. Orthodontics–methods–Case Reports. 4. Orthodontics–methods–Problems and Exercises. 5. Vertical Dimension–Case Reports. 6. Vertical Dimension–Problems and Exercises. WU 18.2] RK521 617.6′43–dc23 2015004424 Set in 9/11pt Minion by SPi Global, Pondicherry, India Printed in the United States of America 10 9 8 7 6 5 4 3 2 1 Contents Preface, vi 1 Foundations, 1 The Spectrum of Vertical, 1 Growth Foundations, 24 Diagnosis and Treatment Planning Principles, 31 2 Dental Deep Bites, 66 Introduction, 66 Case Andrew: Class II division 2, adolescent, 91 Case Emma: Class II division 2, impacted canines, missing premolar, adolescent, 125 3 Skeletal Deep Bites, 143 Introduction, 143 Case Adam: Class II division 1, adolescent, 169 Case Valerie: Class II division 1, dental asymmetry, adolescent, 182 Case Shawn: Class III, nearly complete lingual cross bite, late adolescent, 202 Case Megan: Class II division 2, left posterior cross bite, maxillary / mandibular cants, adult, 217 Case Connie: Class II division 2, severe anterior attrition, adult, 240 4 Dental Anterior Open Bites, 263 Introduction, 263 Case Sasha: Class II division 1 subdivision right, ADD with reduction and crepitus, small maxillary lateral incisors, adult, 276 Case Derrick: Class III, anterior and posterior cross bite, adolescent, 283 Case Steven: Class II division 1, minimal posterior overjet, adolescent, 297 5 Skeletal Anterior Open Bites, 309 Introduction, 309 Case Emma: Class II division 1, anterior cross bite, moderate to severe anterior crowding, child, 336 Case Rachael: Class II division 1, enlarged adenoids, child, 354 Case Kaylee: Class III, left posterior cross bite, late adolescent, 371 Case Greg: Class II division 1, bilateral posterior cross bite, multiple missing teeth, adult, 385 Case Ashley: Class II division 1 subdivision left, anterior cross bite, adult, 409 Case Alyson: Class II division 1, right posterior cross bite, mild adenoidal hypertrophy, adult, 429 6 Posterior Open Bites, 457 Introduction, 457 Case Mark: Class I, child, 472 Case George: Class II division 2 subdivision right, sleep apnea, adult, 484 Case Kreslyn: Class III right Class II left, bilateral posterior cross bite, adult, 495 Appendix, 512 Cephalometrics Primer, 512 Iowa AP Classification Primer, 522 Tables for Reference, 526 Abbreviations, 527 Appendix References, 528 Index, 529 v Preface The goal of this book is to teach—to provide students with a solid anteroposterior, and transverse dimensions. Many of the problems foundation in diagnosis, treatment planning, and “in‐treatment” that you will likely encounter in private practice will be examined decision‐making when managing malocclusions—with special and addressed in this text. emphasis on the vertical dimension. Problems in the vertical The answers we provide for the cases presented are based on our dimension can be especially challenging to manage, and a clinician many years of teaching, literature review, and clinical experience at must achieve a high level of proficiency in addressing these chal- the University of Iowa and in private practice. It does not mean, lenges. Careful study of our book will provide the foundation however, that our answers are necessarily “correct.” Everything for achieving this proficiency. taught in our specialty must be challenged and questioned. If our The practice of orthodontics and dentofacial orthopedics is ideas cannot withstand the rigor of scrutiny and the test of time, a cognitive discipline. Over 90% of what an orthodontist does is then we must modify our position. If you disagree with concepts in observe, reason, and make decisions. Treatment planning and this text, please discuss them with your colleagues, attending fac- treatment delivery for each patient essentially consist of your ability ulty, or us. Constructive dialogue makes us better orthodontists, to correctly answer a seemingly infinite series of questions related results in better care for our patients, and strengthens our specialty. to that patient’s care. During orthodontic residency, when you Our book contains important references for many clinical and examine a patient, the attending faculty asks what problems you scientific concepts, but was not written as a systematic review refer- observe, and you answer. The attending faculty asks how you would ence source. The treatment principles contained in this text will be treat these problems, you answer, and the faculty provides you with valid for your lifetime of clinical practice, but the specific scientific positive and constructive feedback. Whether in the classroom or and clinical study references may change over the years. clinic, we have found orthodontic residents mature fastest and best The spectrum of vertical problems encompasses deep bites and using this method of question–answer teaching. open bites of both skeletal and dental origin, and our book is orga- The format of our book is similarly based on this question– nized accordingly into the following chapters: Foundations, Dental answer style of teaching, as we view our book as an orthodontic Deep Bites, Skeletal Deep Bites, Dental Anterior Open Bites, miniresidency. We use the question–answer format in order to keep Skeletal Anterior Open Bites, Posterior Open Bites, and Appendix. you intellectually involved, to encourage critical thinking, to offer In Chapter 1, we provide an overview of the spectrum of vertical you the opportunity to reflect on our questions and your answers, dimension problems, important craniofacial growth concepts, and and to gauge the progress of your understanding. Using this format, fundamental principles of diagnosis and treatment planning. These we will coach you to address a very broad range of challenging principles are applied repeatedly with every case throughout the clinical problems and to formulate appropriate decisions. To grasp text. In Chapter 2, an introduction provides overall concepts of the principles upon which we focus, we recommend that you study dental deep bite diagnosis and treatment. The cases that follow each case from beginning to end at one sitting. Carefully think encompass comprehensive dental deep bite cases, which you will through answers to the questions we present (ideally, by writing work through from initial patient presentation to debond/deband down your answers), and make the best decisions you can. You and retention. The same chapter organization is repeated for should do this before you refer to the answers we have provided. subsequent chapters. The Appendix presents a cephalometric anal- Answer each question as thoughtfully as you would if the patient ysis primer, the Iowa AP Classification Primer, useful tables, and was sitting in front of you, and you had to make the right decision abbreviations. We wish to note that every case we present in the to care for him or her. Your orthodontic diagnostic, treatment book was painstakingly chosen from a cumulative clinical practice planning, and in‐treatment decision abilities will strengthen in of over one‐half century, with the intent of providing a broad range direct proportion to your efforts to work through each problem of problems. Our ultimate goal is your goal: to help you become a presented—before making your decision and reading our answers. superb orthodontist. As teachers, Steve, Laura, and I will always You will find certain principles are emphasized and applied strive to help you become a better orthodontist than we are. We repeatedly throughout this text. This is our objective—to instill experience no greater professional joy than when our students rise patterns of analysis and habits of rational decision making by repe- above us. If you learn from this book, then our years of teaching will tition and by presenting many different patients with a multitude of have been worthwhile. problems. Problems in the vertical dimension are inextricably You will find no mention of specific orthodontic bracket types related to problems in the anteroposterior and transverse dimen- or specific orthodontic bracket manufacturers in this text. Why? sions. The principles and cases presented comprehensively illustrate Excellent orthodontic care depends on the orthodontist’s intelli- these interrelationships and will strengthen your ability to treat gence, education, experience, skill, and desire. The specific appli- patients in all three dimensions. Also, as occurs with every patient ance used by each doctor is a matter of personal preference. When you will treat in your practice, each patient presented in this text has you first enter practice, you will be exposed to new brackets, wires, diverse problems apart from the primary problems in the vertical, appliances, and biomechanics that are purported to be “the answer” vi Preface vii to orthodontic treatment. Be skeptical. When someone announces use orthodontic clipart in developing many of the illustrations in they have the answer, or a panacea for treatment, demand that this text, and Drs. Nathan E. Holton, Veerasathpurush Allareddy, they provide you with evidence (independently confirmed from dif- and Ms. Chris White for their thorough review and many insightful ferent university studies in high impact, peer‐reviewed journals), that suggestions. Finally, we wish to thank Dr. James Vaden for providing clearly documents the efficacy of their claims of treatment superiority. us with material from the Charles H. Tweed International Foundation We wish to acknowledge the diagnostic skill, treatment out- for Orthodontic Research and Education. comes, and patient care provided by Dr. Karin A. Southard who This book is dedicated to every man or woman who strives daily kindly allowed us to include many of her cases in this book. Karin is to become proficient in the art and science of orthodontics and a clinician’s clinician and an educator’s educator. We thank her for dentofacial orthopedics, and who endeavors, uncompromisingly, her teaching and her many contributions to excellent patient care. to provide outstanding care to his or her patients. Doctor, we We also wish to thank Dr. Michael L. Swartz for his permission to salute you.
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