Orthodontic Seminars
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Third Molar Management
Content of our current series of recorded seminars is based on data from peer-reviewed publications emanating from Third Molar Clinical Trials. Please review the Introduction for the format of the seminar series. The outlines include suggested readings, objectives for each seminar, and test questions to be used as applicable.
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- Discuss how data/evidence from current literature can be incorporated into advice for patients
- Relate biological models of caries and periodontal inflammatory disease to clinical findings
- Describe possible clinical outcomes associated with retained 3rd molars
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- Explain why prevalence periodontal inflammatory disease in young adults underestimated
- Relate periodontal inflammatory disease progression to the biological model
- Discuss how risk markers for periodontal disease explain disease progression with asymptomatic 3rd molars
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- Relate biofilm biology to periodontal inflammatory disease progression
- Discuss evidence for periodontal inflammatory disease progression in the 3rd molar region and more anterior regions of the mouth
- Weigh the risk markers for periodontal disease progression; which are more or less important
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- Relate 3rd molar symptoms to possible disease levels
- Discuss 3rd molar symptoms and the impact on Quality of Life; Pain, Lifestyle, Oral Function
- Are existing Clinical Guidelines for removal of symptomatic 3rd molars adequate? Evidence??
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- Relate effectiveness of mechanical debridement of biofilm to recurrent 3rd molar periodontal pathology
- Discuss why 3rd molar removal is the current treatment option
- Discuss future options based on the biology of the disease
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- Relate 3rd molar caries prevalence to biological model of disease
- Discuss 3rd molar caries
- Relationship to caries prevalence 1st/2nd molars
- Changes over time in disease incidence
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- Discuss differences in 3rd molar caries and periodontal pathology among clinical/population studies
- Relate NHANES US population data to 3rd molar data in other clinical/population studies
- Discuss how outcomes could improve by designing studies differently
- Include barriers to study completion in discussion
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- Explain how Clinical and Quality of Life Outcomes after 3rd molar surgery were assessed
- Explain how to Predict Delayed Clinical and Quality of Life Outcomes after 3rd molar surgery
- Discuss how Delay in Recovery for Quality of Life Outcomes results from Delayed Clinical Outcomes
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- Discuss pro and con of at least two adjunctive measures to improve Quality of Life and Clinical Recovery
- Propose a plan for a Multi-center Clinical Study for assessing adjunctive measures to improve
- Quality of Life and Clinical Recovery
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- Explain how clinical problems are solved with data
- Propose a plan to integrate new clinical research data in advice to patients
- Explain why biological models are useful in conducting clinical research
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Psychologic and Psychosocial Aspects of Treating Children and Adolescents
A discussion of psychosocial development in childhood and adolescence, of interview methodology and goals, and of how to change health-related behavior (like cooperation with dental treatment).
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Part 1: A discussion of good vs. bad interviews and how to manage difficult interview situations.
Part 2: Seminar participants are guided through an exercise in managing a difficult interview.
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Part 1: A review of major theories of health behavior and what is necessary to obtain the necessary cooperation for treatment of children and adolescents.
Part 2: Defensive strategies used by reluctant patients, and how to recognize and overcome them.
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Part 1: A discussion of the interrelationship of physical, cognitive and emotional changes during adolescence and the tasks of an adolescent that are necessary for normal development.
Part 2: The key concepts in understanding adolescent behavior from a Freudian perspective and the differences between ego under- and over-controllers.
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Part 1: Psychological development and educational theory, from the perspective of John Locke (300 years ago) and Jean-Jacques Rousseau (100 years ago).
Part 2: Systems theory looks at adolescent behavior as a consequence of the family environment; role-playing illustrates the interactions within a group and how understanding them can overcome clinical challenges.
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Oral-Pharyngeal Function
A discussion of topics related to function as a factor in the etiology of malocclusion and dentofacial deformity, and of functional adaptation as a determinant of treatment success and post-treatment stability.
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Evidence reviewed in this seminar supports the long-held view that mouth breathing is a factor in the long face pattern of growth, but indicates that most long-face individuals are not primarily mouth breathers.
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A discussion of front-to-back maturation of oral function, with a focus on lip and tongue posture and activity in suckling, swallowing and acquisition of speech.
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The effect of forces against the teeth is determined much more by the duration than the magnitude of force. The effect of soft tissues on the dentition in various conditions is discussed from this perspective.
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The seminar focuses on the characteristics of language, influences of the components of the vocal tract on sound production, maturation of speech, and speech therapy (especially for cleft patients) in relation to orthodontic treatment.
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Myofunctional therapy developed from the idea that teeth are easily displaced by soft tissue pressures, and evolved to specific procedures claimed to correct tongue thrusting to facilitate closure of anterior open bite. It survives despite a lack of evidence to support it.
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The physiologic response to orthognathic surgery offers a better understanding of the changes with both surgical and orthodontic treatment that would be expected to be stable and those that predictably would be unstable.
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Malocclusion has become more prevalent as human populations have grown and more individuals live in close contact. In this seminar, the reasons for this, and the evidence for genetic vs. environmental influences as etiologic factors for malocclusion are examined and placed in perspective.
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Skeletal bone constantly remodels, and the pattern of remodeling is determined largely by the pattern of stress. This seminar reviews the current biologic findings that outline why and how adaptation to stress occurs.
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Sleep apnea in adults now is recognized as a frequent problem with increasing age and obesity. Direct and indirect diagnostic procedures, and treatment possibilities including intraoral appliances and surgery, are reviewed.
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Sleep apnea in children also is viewed as a potential problem in children who have a compromised airway. Diagnostic and treatment procedures are considered in detail in this seminar.
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Biomechanics
Orthodontic mechanics in the context of the biologic response to force against the teeth, properties of orthodontic materials, the development of orthodontic appliance systems, and analysis of forces and moments in two-tooth systems.
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Analyzing the reaction to orthodontic force differs from analyzing the effect of force on a rigid structure (for instance, a highway bridge) because of the biologic component. Nevertheless, appropriate engineering mechanics can be helpful in understanding how the teeth and jaws behave when stressed.
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Analyzing the reaction to orthodontic force differs from analyzing the effect of force on a rigid structure (for instance, a highway bridge) because of the biologic component. Nevertheless, appropriate engineering mechanics can be helpful in understanding how the teeth and jaws behave when stressed.
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The mechanical properties of orthodontic archwires are affected by three major things: the material from which they are fabricated, the size of the wire, and the distance between supporting structures (brackets or tubes).
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This seminar uses Edward Angle’s letters and other personal records to review his ideas and illustrate how he became “the father of modern orthodontics”.
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From its inception, the edgewise appliance has been continuously modified. This seminar discusses the changes that occurred from the early days of edgewise to the present and their effect on orthodontic practice.
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This seminar focuses on analysis of the force systems created by use of continuous archwires to align malposed teeth.
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Analysis of changes created by expanded archwires, lingual arches, intermaxillary elastics and headgear follows the same logic as other free body diagrams, but must be thought about differently from alignment and arch form.
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When a force and a moment are created at more than one location when an archwire is tied into a bracket, it is impossible to calculate the amount of force on the teeth. Such a force system is most likely to be encountered when root torque is desired; using an appliance constructed so that only one group of teeth receives a moment allows precisely-known torque.
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Retention principles are based on the biologic response to tooth movement, and retention techniques for correction of various types of malocclusion are discussed from this perspective.
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Diagnosis / Treatment Planning
An overview of the goals of modern orthodontics as viewed from the perspective of the soft tissue paradigm, the problem-oriented approach to treatment planning, and 3D imaging and genetic analysis in evaluating potential orthodontic patients.
Note: psychosocial development and interview techniques are covered in the Psychosocial series.
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The soft tissue paradigm is the modern extension of Angle’s classification system to include soft tissue considerations (facial proportions, smile characteristics, display of incisors) in orthodontic diagnosis and treatment planning.
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In orthodontics as in other health-related areas, the diagnosis is a list of the patient’s problems, and the steps in treatment planning follow logically as solutions to the problems.
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In orthodontics as in other health-related areas, the diagnosis is a list of the patient’s problems, and the steps in treatment planning follow logically as solutions to the problems.
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3D photography, 3D surface imaging of the dentition and evaluation of cone-beam CT images are important new diagnostic tools in the evaluation of orthodontic patients. All are discussed in comparison to 2D methods in some detail, with the major focus on cone-beam CT.
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A primary application of 3D imaging in modern orthodontics is in the evaluation of skeletal asymmetries, and this seminar focuses on how 3D imaging can be applied to these patients in a way that facilitates the treatment planning they require.
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Genetic analysis for orthodontic patients is available now in the evaluation of unerupted permanent teeth, and is being extended to other problems, particularly Class III problems.
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Evaluating how treatment for a vertical problem might make A-P relationships worse (or better) is an important aspect of a modern diagnostic evaluation.
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Growth and Development
A sequence of seminars on important aspects of normal growth and development and on the impact of environmental effects and treatment on growth.
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Growth patterns, defined as growth directions over time, are important in understanding the development of skeletal malocclusions and the possibility of modifying growth. Growth patterns and jaw rotations related to malocclusion are reviewed in detail.
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Craniofacial growth has been evaluated largely by superimposition of cephalometric radiographs, with important insights from superimposition on implants. This seminar reviews the findings from 2D studies and current research using 3D imaging.
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A pediatrician involved in treatment of short stature in children discusses the causes of short stature, possible treatment methods, and shows illustrative case reports.
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Pre- and post-emergent eruption have different mechanisms and a different type of control. Mechanisms and control are presented in detail and discussed in the context of management of eruption problems.
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Distraction osteogenesis offers the possibility of creating new bone in areas of deficient development. The discussion focuses on indications and contra-indications for distraction in patients with deficient craniofacial growth.
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This seminar focuses on methods for therapeutic modification of a Class II growth pattern and the chance of success with various methods and times of treatment.
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UNC Surg-Ortho Course for Residents
These lectures offer an overview of modern surgical-orthodontic treatment and can be used as desired to supplement surg-ortho instruction. They were taken from the live presentation of the 2-day surg-ortho course for residents at UNC in 2016, to which residents at other schools were invited.
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Special aspects of surgical-ortho diagnosis and treatment planning.
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