Pacific Coast Society of Orthodontists Bulletin Spring 2015 - (Page 42)

SUMMARY ANNUAL SESSION ORTHODONTICS: THE KEY TO SUCCESSFUL INTERDISCIPLINARY TREATMENT Presented by Dr. Robert Vanarsdall at PCSO Annual Session, October 3, 2014. Summarized by Dr. Shahram Nabipour, PCSO Bulletin Central Region Editor. D r. Vanarsdall touched on some of the most common situations that may arise for clinicians when treating interdisciplinary cases, and he provided insights on how these clinical conditions are affected by patients' periodontal condition. As one would expect, orthodontic treatment provides numerous periodontal health Dr. Vanarsdall benefits: Reformatting of the periodontium Reduction of pathogenic subgingival bacteria Elimination of important periodontal risk factors Recognition of susceptible periodontal patients Implant site development As Dr. Vanarsdall puts it, today's orthodontists are placing too many implants. We are taking out natural teeth and replacing them with implants, instead of planning treatment for natural tooth replacement. The Periodontal Prosthesis Program was started at The University of Pennsylvania in the 1950s; it included specific guidelines for the treatment of advanced periodontal disease, but the underlying principle of the program was the preservation of the natural dentition. This principle holds true today, as clinicians can't do anything that is better or more cost-effective for their patients than saving their natural teeth. Implants placed in periodontally susceptible patients (for example, in the case of a maxillary lateral incisor) are good for about seven to eight years, but eventually the tissue will turn gray and soon afterward, there will be bone loss and loss of attachment at a rate of about 0.1 to 0.2 mm/year. Nothing can be done to stop this bone loss. Clinicians must be very careful about implants in treatment planning for such patients. There won't be any 42 such issues with resistant patients, on the other hand, even when their implants are placed in what we would consider less than ideal sites. Forced eruption is a viable method to alter the gingival margins and provide better bone height, especially for the anterior teeth. We now commonly employ forced eruption of hopeless teeth to alter the hard and soft tissue prior to implant placement. Forced eruption to treat one and two walled bony defects has very predictable results. Orthodontic extrusion is used to relocate the interdental papilla. Also, esthetic enhancement through orthodontic extrusion can be combined with guided tissue regeneration (GTR) procedures in order to allow more predictable implant placement. DOES TOOTH MOVEMENT ALTER THE COMPOSITION OF THE SUBGINGIVAL BACTERIA? Crowding promotes accumulation of dental plaque. Supergingival plaque creates an environment conducive to formation of subgingival plaque, but the bacteria that causes loss of attachment is subgingival. When a tooth becomes mobile, it changes the composition of the bacteria and can lead to a loss of attachment. There is a significant difference between subgingival bacteria in partially banded cases versus full fixed appliances. FUNCTIONAL OCCLUSION A recent study of mandibular anterior teeth shows that crowding created an environment of susceptibility to periodontal breakdown. About 91% of patients showed more species of periodontal pathogens in crowded sites than in well-aligned sites. PCSO BULLETIN * SPRING 2015

Table of Contents for the Digital Edition of Pacific Coast Society of Orthodontists Bulletin Spring 2015

The Whole is Greater Than Its Parts
The Land of Opportunity
Donated Orthodontic Services Program — AAO-DOS
Trustee Report
AAO Council on Scientific Affairs (COSA) Report
Component Reports
AAOF Report
AAO Leaders Complete Terms in San Francisco: The End of an Era for PCSO
Preparing for the Unexpected: Your Emotional SOS Plan Part I
Resident Spotlight: Dr. Mona Afrand, Orthodontic Resident, University of Alberta Department of Orthodontics; Younger Member Spotlight: Dr. Mostafa Altalibi, Calgary, Canada
PCSO At A Glance
The AEODO Research Data Portal: Restructuring Workflow
The Aveolar Bone Housing — The Orthodontist’s World
Case Report Pre-Treatment
Smile and Appliance Esthetics — New Understandings
How to Remember Names and Places: A Dale Carnegie Program
The Latest Trends in Orthodontic Treatment: Part I
Training and Giving Feedback to The Clinical Staff to Ensure a Well-Tuned Team
Treatment Possibilities with Invisalign®
Class III Treatment: Timing and Protocol
Orthodontics: The Key to Successful Interdisciplinary Treatment
CBCT: Assessment of Anatomical Boundary Conditions Important to Orthodontists
Case Report Post-Treatment
Sectional Mechanics for Class II Correction
Dr. Donald Poulton

Pacific Coast Society of Orthodontists Bulletin Spring 2015