Q+A

 

COLLEGAUE QUERIES

What has changed, what do we need to consider?
  1. Gentle, nearly pain free treatments that do not encroach on the the day to day functions of the system and to not interfere with growth processes in children.
  2. Less is often more! The body needs time, particularly at the beginning of the treatment to remodel the bone structures and applying less force will aid this process and the body will not have to revert to a defensive reaction caused by too high forces.
  3. We need to consider the origin of the malocclusion and what led to the deformation more closely to be able to achieve long term stable results.
Who is a typically suitable patient for the passive orthodontic treatment method?
Every one of our patients. Any living tissue needs blood supply and providing orthodontic treatment which ensures this will benefit everybody.
When should this treatment not be done?
  1. In patients that smoke it is inadvisable to do orthodontic treatments. The periodontal ligament can be severely damaged by the influences of nicotine and this is amplified by the orthodontic treatment, thereby resulting in heavy bone loss.
  2. In patients that are heavy grinders or clenchers. The bone in these patients has adjusted to become very thick and hard to support the high forces that it is exposed to. In this orthodontic treatment the bone becomes much softer to accommodate tooth movement thereby exposing it to the bruxing forces.
  3. In patients with poor oral hygiene. It is far more difficult to control the oral hygiene with braces than without, so there should be good conditions when beginning.
  4. In patients with prior medical history or currently having an infection. This limitation may be of short duration, depending on the nature of the illness. The body will try to fight off the harming infection/pathology and may be less inclined to bear with the requirements of the orthodontic treatment. This will result in the patient experiencing unexpected severe pain from the treatment. Beware of cancer patients!
What are the typical errors in orthodontic thought processes when changing from conventional orthodontics?
  1. Too much, too fast: changing wires too quickly and forcing too strong wires into the bracket slots, will cause pain and prevent the passive effect.
  2. Elastic forces are stronger than the blood pressure and thereby counteract the forces of the musculature which often results in a reaction contrary to that which we are looking for.
  3. Using treatment tools that are ignorant of the natural forces will have a counter productive effect.
  4. In the diagnosis of our treatment cases we need to look at habits and functions more closely.
Why am I having problems with the finishing of my cases?

  1. The occlusion is disturbing the final tooth positioning.
  2. Bracket positioning has to be corrected with particular emphasis on angulation, torque and rotation.
  3. Occlusal disturbances most commonly on upper 2nd molars which are extruded.
  4. The centric relation and maximal intercuspidation do not coincide.
  5. Deviations in symmetry cause a forced bite relation , thereby preventing a decent finishing
Why can canine guidance not be achieved?
  1. Bracket position has to be corrected.
  2. Lower incisors are too strongly protruded.
  3. Upper incisors are too strongly retruded.
  4. The centric relation and maximal intercuspidation do not coincide.
  5. Occlusal disturbances most commonly on upper 2nd molars which are extruded.
What am I doing wrong, if the bite cannot be corrected?
  1. Occlusal disturbances most commonly on upper 2nd molars which are extruded.
  2. The dental morphology of the premolars and molars is probably so destroyed as to prevent a stable bite correction.
  3. Lower incisors are too strongly protruded.
  4. Elastic forces are too strong.
What is happening when my patient suddenly develops TMJ issues?
  1. Occlusal disturbances most commonly on upper 2nd molars which are extruded.
  2. The centric relation and maximal intercuspidation do not coincide.
  3. Deviations in symmetry cause a forced bite relation.
  4. Vertical support is insufficient, either bilaterally or unilaterally.
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