Key topics include practical applications of computer technology, alternative treatment approaches, the biomechanics of orthodontic appliances, the selection of efficient treatment procedures, and the treatment of complex problems in both children and adults. A wealth of case studies with photographs and illustrations highlight and reinforce key concepts.
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Authors: William R. Proffit, Henry W. Fields, Jr. The leading text for orthodontic education! With a world-renowned author team led by Dr. The fact that the young girl had a similar build as her father and other indications that she was going to experience a lot of growth had to be taken into account when planning her orthodontic treatment.
The goal of her orthodontic treatment was to improve the class II malocclusion, but at the same time maintain anterior incisor position for lip support. How this was discussed with her parents was fairly simple and did not require sophisticated technology or cephalometric analysis.
After bringing the profile image up on the computer screen, everything below the upper lip was blocked from view Figure 7. This demonstrated that the upper face and upper lip appeared to be quite normal in isolation and that her profile convexity was due to the moderate deficiency of the mandible and, in larger part, the chin.
The same exercise can be performed from the frontal view to visualize her lip support in that dimension. At the conclusion of the conversation, a treatment plan was selected that involved nonextraction treatment in combination with headgear for class II correction through growth modification.
In other words, the plan was to maintain the middle and upper soft-tissue position while improving the lower face. At the appropriate age usually 15 years or older in females when the soft tissue was appropriately mature, the patient would be reassessed for possible chin augmentation through an inferior border osteotomy. The maxillary incisor is a major determinant in cosmetic dental treatment plans as well as orthodontic treatment plans.
It is entirely appropriate in orthodontics to reshape teeth and close any remaining space as a part of treatment. Both of these procedures were performed by the orthodontist so that the sizes of the teeth could be visualized while the tooth movements were guided to achieve balanced maxillary incisor proportions Figure 9. After 20 months of orthodontic treatment and having attained the occlusal goals, the orthodontic appliances were removed and she was placed into retention.
Her profile demonstrated even more nasal growth, resulting in the increased facial convexity that was expected Figure At age 15 the appropriate time for 3rd molar removal , both the mother and the patient expressed their desire to have the chin augmentation via the inferior border osteotomy performed at the same time as the 3rd molar removal because the oral maxillofacial surgeon is required to perform both procedures.
After surgery, the resulting profile was well-balanced with a good lip and chin relationship and a pleasing labiomental sulcus Figure Furthermore, her frontal facial proportions were excellent and the lip support was ideal Figure Choosing to perform an inferior border osteotomy instead of using an implant to augment the chin results in an increase in bone thickness on the anterior aspect of the lower incisors, which is an additional periodontal benefit.
As an orthodontist, what is the take-home message? In contemporary orthodontics, it has become mandatory that practitioners incorporate the principals of smile design into their treatment planning and pay close attention to the many elements of function and esthetics.
Clin Orthod Res. Orthodontics about face: The re-emergence of the esthetic paradigm. Am J Orthod Dentofac Orthoped. Proffit WR. The soft tissue paradigm in orthodontic diagnosis and treatment planning: a new view for a new century.
J Esthet Dent. Morley J, Eubank J. Macroesthetic elements of smile design. J Am Dent Assoc. Video imaging: techniques for superimposition of cephalometric radiography and profile images.
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