Evolution of occlusion and temporomandibular disorder in orthodontics: Past, present, and future.

Occlusion has been an important consideration in orthodontics since the beginning of the discipline. Early emphasis was placed on the alignment of the teeth, the stability of the intercuspal position, and the esthetic value of proper tooth positioning. These factors remain important to orthodontists, but orthopedic principles associated with masticatory functions must also be considered. Orthopedic stability in the masticatory structures should be a routine treatment goal to help reduce risk factors associated with developing temporomandibular disorders.

Combined surgical-orthodontic treatment: how did it evolve and what are the best practices now?

It has been 50 years since the landmark presentation by Hugo Obwegeser at Walter Reed Army Hospital. At that conference, Professor Obwegeser offered American surgeons techniques to correct facial skeletal deformities with access through intraoral incisions. As important advances in surgical technique and anesthesia evolved for the surgical procedures, a major contribution by American orthodontists in collaboration with surgeons was the creation of a common diagnostic, planning, and treatment scheme for use by both clinician groups in the treatment of dentofacial deformities, the skeletal and dental problems of the most severely affected 5% of the population. This article summarizes what American orthodontists and surgeons have learned in the late 20th and early 21st centuries, and forecasts what might be the future of treatment for patients with dentofacial deformities.

Motivations of orthodontic residents in Canada and the United States to treat patients with craniofacial anomalies, cleft lip/palate, and special needs.

OBJECTIVES: To determine the motivation of orthodontic residents in Canada and the United States to treat patients with cleft lip/palate (CLP), craniofacial anomalies (CFA), and special needs (SN). METHODS: In March 2009, an e-mail with a link to a 41-item survey was sent to all orthodontic residents in Canada and the United States (n  =  944). RESULTS: Of 944 residents contacted, 339 viewed and 208 completed the survey (22.03%). Using a seven-point Likert scale, residents recognized the importance of treating patients with CLP/CFA/SN. When asked if they plan to treat patients with CLP/CFA/SN, 54.48% responded yes, 13.46% no, and 36.06% were unsure. A total of 38.05% said they would charge the same fee as a typical multiarch case, while 58.05% would charge more, and 60% of fourth-year residents would charge twice the fee. Of the respondents, 43.00% were aware of the established fellowship programs in CLP/CFA/SN. Canadian residents (67.9%) were more enthusiastic about completing a fellowship than Americans were. Of the respondents, 29.33% would complete a 1-year fellowship, while 70.67% would not. A total of 78.4% of male respondents and 77.4% of American residents indicated they would not pursue a fellowship. CONCLUSIONS: Residents supported the importance of treating patients with CLP/CFA/SN, and more than 54% indicated they plan to treat these patients. Residents who indicated that they would not treat these patients sited limited experience and inadequate expertise as the reasons. Less than 30% indicated a willingness to pursue a fellowship program.

[From fundamental research to clinical development: a review of orthodontics].

In recent years, new approaches to the diagnosis and treatment of malocclusion have emerged. The diagnostic and therapeutic techniques of orthodontics have evolved from two dimensions to five dimensions with the development of computer technology, auto-machining and imaging. Furthermore, interdisciplinary study has become the driving force for the advancement of fundamental research in orthodontics. The mechanisms of malocclusion and orthodontic tooth movement have been extensively studied to the details at the level of cells and molecules.

Orthodontic dental patients and expenditures--2004.

INTRODUCTION: In this article, we describe recent trends in the age of patients receiving orthodontic services and look at how expenditures for these services are related to patient age and income level. METHODS: These findings are based on 3 national health expenditure surveys sponsored by the Agency for Healthcare Policy and Research conducted in 1987, 1996, and 2004. RESULTS: Recent increases in the number of patients receiving orthodontic services were largely due to an increase in the overall population. There has been a shift in the age distribution of patients receiving such services. Children 8 to 18 made up a greater percentage of all patients receiving orthodontic services, but there were fewer adult patients aged 19 years and older. CONCLUSIONS: Children 8 to 18 years old made up a larger percentage of patients who received orthodontic services in 2004 compared with 1996 and 1987. The percentage of total dental expenditures of children 8 to 18 for orthodontic services might increase in the future because of less need for restorative services among this segment of the population.

Orthodontic evolution: an update for the general dental practitioner. Part 1: recent advances, treatment need and demand, and benefits of treatment.

Like all specialties of dentistry, orthodontics has undergone considerable development and improvement in treatment techniques over the past four decades. The two articles in this series aim to inform the general dental practitioner about these developments, together with an update on orthodontics' relationship to dental health, TMJ dysfunction and other aspects.

Concepts, protocol, variations and current trends in surgery first orthognathic approach: a literature review.

In the current era of expedited orthodontics, among many clinicians, tertiary care hospitals and patients, surgery first orthognathic approach (SFOA) has gained popularity. The advantages of SFOA (face first approach) are the reduced overall treatment duration and the early improvement in facial esthetics. In SFOA, the absence of a presurgical phase allows surgery to be performed first, followed by comprehensive orthodontic treatment to achieve the desired occlusion. The basic concepts of surgery early, surgery last, SFOA and Sendai SFOA technique along with its variations are reviewed in the present article. The recent advancement in SFOA in the context of preoperative preparation, surgical procedures and post-surgical orthodontics with pertinent literature survey are also discussed.

[Perfecting smile esthetics: keep it pink!] / Comment parfaire l'esthétique du sourire : toujours en rose !

INTRODUCTION: Smile aesthetics is based on numerical, physical, physiological and psychological data regarding beauty, while taking into account the desires of the patient. It is determined by the shape, colour and position of the lips, teeth and gingival tissues. Periodontal examination in both the facial and labial settings supports analysis of the gingival display during natural and forced smiling, the health of the periodontium, the gingival contours, the aesthetic gingival line, and the presence of the papillae. MATERIALS AND METHODS: All these data will help establish a gingival aesthetic score to determine the causes of disharmony and possible treatment. DISCUSSION: During implementation of the global orthodontic treatment plan, periodontal plastic surgery can change the gingival appearance and morphology in order to restore the harmony of the smile. Subtractive periodontal plastic surgery treats biological space defects and excess tissue during incomplete passive eruption by gingivectomy or apically positioned flap, combined, or not, with osteoplasty or osteoectomy. Finally, injections of hyaluronic acid in the papillae can plump them up and minimize the size of any black holes.

[Adult orthodontics for a better prosthesis]. / L'orthodontie adulte pour une meilleure prothèse.

INTRODUCTION: Adult patients are seen more frequently in our orthodontic offices. Unlike the adolescent, the adult patient will often need a multidisciplinary approach due to tooth migrations secondary to extractions or periodontal disease. MATERIALS AND METHODS: This article will address the indications and orthodontic solutions to various restorative problems relative to the adult patient. Specific orthodontic mechanics aimed at facilitating and improving the prosthetic outcomes will be described and illustrated with clinical cases.

Secular trends in preadult orthodontic care in the United States: 1942-2002.

INTRODUCTION: The goals of this study were to describe secular trends in preadult orthodontic care for people in the United States born between 1942 and 1972, and to estimate the number of new preadult orthodontic treatment starts in 2006. METHODS: Orthodontic care experience in this group was ascertained by 2 questions in the Third National Health and Nutrition Examination Survey (NHANES III). RESULTS: Of those in the 1942 birth cohort, 4.6% (SE 1.5) and, of those in the 1972 birth cohort, 29.7% (SE 3.8) received preadult orthodontic care. These increasing secular trends were more pronounced for people of higher socioeconomic positions (P <.03) and girls (P = .04). If the orthodontic care prevalence continues to increase yearly by 0.7 percentage point (SE 0.08), there will be 1.62 million new preadult patient starts in 2006, an increase of 26,000 over 2005. CONCLUSIONS: The prevalence of preadult orthodontic care has steadily increased for successive birth cohorts between 1942 and 1972, particularly for girls and those at higher socioeconomic positions. Linear extrapolations extending to 2006 reasonably agree with survey data, suggesting linear growth in orthodontic treatment use by those born in the latter half of the 20th century.

Orthodontic materials research and applications: part 2. Current status and projected future developments in materials and biocompatibility.

The purpose of this 2-part opinion article was to project the developments expected to occur in the next few years in orthodontic materials research and applications. Part 1 reviewed developments in bonding to enamel. Part 2 looks at other orthodontic materials applications and explores emerging research strategies for probing the biological properties of materials. In the field of metallic brackets, expansion of the use of titanium alloys with improved hardness and nickel-free steels with better corrosion resistance and increased hardness is expected. Manufacturing techniques might be modified to include laser-welding methods and metal injection molding. Esthetic bracket research will involve the synthesis of high-crystallinity biomedical polymers with increased hardness and stiffness, decreased water sorption, and improved resistance to degradation. New plastic brackets might incorportate ceramic wings. Fiber-reinforced composite archwires, currently experimental, could soon be commercially available, and long-term applications of shape-memory plastics might become viable. Advancements in elastomeric materials will result in polymers with reduced relaxation, broader use of fluoride-releasing elastomers with decreased relaxation, and large-scale film coating of elastomers to decrease reactivity, water sorption, and degradation. Finally, biocompatibility assessments will incorporate testing of potential endocrinological action. New polymer formulations might be tested in adhesive and plastic bracket manufacturing, based on benzoic ring-free monomers to avoid the adverse effects of the estrogenic molecule bisphenol-A.