Pacific Coast Society of Orthodontists Bulletin Winter 2012 - (Page 39)

ANNUAL SESSION Comprehensive Mixed Dentition Approach Presented by Dr. Steven Dugoni (San Francisco, CA) at the PCSO Annual Session on October 5, 2012. Summarized by Dr. Gerald Nelson, PCSO Bulletin Editor. D Dr. Dugoni CLASS II MIXED DENTITION TREATMENT Dr. Dugoni presented cases treated with a protocol that he and his father have used for many decades. The goal of this protocol is to choose the case properly, and then to address all problems, including the class II, the alignment, and the arch length, prior to the permanent dentition. The vast majority of cases will not need a second phase of orthodontic treatment. In a case example, a class II moderate crowding in the early mixed dentition with fused LL 2 and 3, the treatment options were: 1. Use 2x4, headgear (HG), and LLA 2. Expand and use Herbst 3. Twinblock The UOP plan used was: 2x4, cervical HG, extract lower Cs and place active lingual arch. The objective was to reduce overjet by correcting the dental class II and reducing the skeletal class II, and to correct the crowding by maintaining E space and proclining incisors. r. Dugoni is the director of the Mixed Dentition Clinic at the Art Dugoni School of Dentistry in San Francisco. The Clinic began in 1971. The dental school and Orthodontic Department will move to a new location in downtown San Francisco in summer 2014. The case treated well, but Dr. Dugoni insists that an important part of the protocol is retention management. A Hawley will hold alignment, while the headgear is continued at night PRN. The lower lingual arch is retained until the full permanent dentition. When the permanent dentition arrived, the occlusion was good, but not perfect. Then the options were to employ full fixed appliances, use Invisalign, or accept the result. The patient chose a short period of FFA followed by bonded retention. CASE SELECTION Dr. Dugoni usually starts treatment in these cases around age 8, or when the laterals are emerging. He selects cases with more than 6mm overjet, deep bite, class II, and moderate crowding or spacing. He increases maxillary arch length while in the 2x4 appliance using push coil. Mandibular arch length is managed by holding E space, and in some cases proclining incisors, with LLA adjustments. No transverse expansion is attempted unless the maxillary arch is narrow. The active treatment is followed by an active retention phase, in which the molar relation, arch length and alignment is closely monitored and preserved. Dr. Dugoni avoids Phase I treatment when the canines are emerging, crowding is severe, skeletal relation is extreme, the parents are opposed, or the problem is mild to moderate. FINAL THOUGHTS Dr. Dugoni presented the protocol for mixed dentition class II cases as practiced at the Orthodontic Department in the Art Dugoni School of Dentistry. He emphasized setting comprehensive goals for such patients, and conducting close supervision of the retention period. S SUMMARIES W I N T E R 2 0 1 2 • P C S O B U L L E T I N 39

Table of Contents for the Digital Edition of Pacific Coast Society of Orthodontists Bulletin Winter 2012

Incremental Change
What a Time it Was!
Invisalign
AAO Trustee's Report
A need, A dream, A reality: A team approach produces an extraordinary outcome
PRECEDENT Orthodontists on Devices
The Complexities of Successful Herbst Treatment
Dr. Bryan Williams
Presentation Software
Treatment Planning: The Magic Step
Comprehensive Mixed Dentition Approach
Social Media 101 for Orthodontists
Update on Bonding 2012
Create the Future by Looking Back: 100 Years of PCSO
PCSO Business
Component Reports
AAOF Report
PCSO at a Glance
Case Report Pre-Treatment
Case Report Post-Treatment
In Memory

Pacific Coast Society of Orthodontists Bulletin Winter 2012