Features
16 Impacted Incisors in Mixed Dentition
By Juan Carlos Echeverri, DDS
22
Departments
8 Ortho Industry News
12 Orthobites
Interceptive Orthodontics:
Early Treatment in Orthodontics 26
By David W. Jackson, DDS, FAGD
46 Patient’s Page 32
Oral Health and Diabetes
On the cover: Dr. James E. McIlwain provides
comprehensive pediatric dental care, specializing in
orthodontics. Dr. McIlwain explains to patient Samantha
Scott the Rapid Palatal Expander appliance and how it will
help her to achieve a beautiful smile. He has been in
This peer-reviewed journal is practice for more than 20 years and never has lost the
published as the official publication quest for new advancements in early patient treatment.
of the American Orthodontic Society Individual attention and comprehensive care for each
child are foremost priorities in his routine of treatment.
and the Academy of Gp Orthodontics. McIlwain Family Dentistry is located in Tampa, FL.
PUBLISHED BY
CONTRIBUTOR BIOGRAPHIES
Wright Publishing Group, Inc.
726 Pasadena Avenue South Dr. David W. Jackson graduated from Baylor College of
St. Petersburg, FL 33707 Dentistry in 1978. Dr. Jackson, a member of AOS and AGpO as
(727) 343-5600 well as other professional organizations, operates two highly
www.wrightgrp.com successful practices in Farmersville and Rowlett, Texas and
employs over 25 people. He lectures extensively for the American
ADVERTISING SALES & ANNUAL Orthodontic Society and the International Association for
MEETING EXHIBIT MANAGER Orthodontics. His insight to the real world of orthodontics in the
general practice is honest and informative. Find out about upcom-
Kimberly Price ing seminars at orthoplusseminars.com.
Integrity Media Group
4006 Majesty Palm Court
Tampa, FL 33624
Phone: 813-466-5521
Fax: 813-864-4454
E-mail: kprice@orthodontics.com
Dr. Juan Carlos Echeverri is the owner of Echeverri Dental
ADVERTISING & EDITORIAL POLICY Center in Houston, TX. Fluent in English and Spanish, he has made
The American Orthodontic Society presentations in Colombia, Venezuela, Spain and USA in prosthesis,
welcomes advertising in its publications as implants and orthodontics and dental education for patients.
an important means of keeping the Echeverri is the creator and director of the dental education
orthodontic practitioner informed of new outreach program for the schools surrounding his practice. He is a
and better products and services for the member of the Greater Houston Dental Society, Texas Dental
practice of orthodontics. Such advertising Society, American Orthodontic Society, American Dental Association
must be factual, dignified, tasteful and and Academy of General Dentistry.
intended to provide useful product and
service information. These standards apply
to all product-specific promotional mate-
rial submitted to the American Orthodon- Dr. Leonard Carapezza has over 25 years of clinical experience
tic Society. The publication of an advertise-
in pediatric orthodontics and operates a successful private practice in
ment is not to be construed as an endorse-
ment or approval by the American Wayland, MA. He has degrees from Brandeis University and the
Orthodontic Society unless the advertise- University of Medicine and Dentistry of New Jersey. He served as a
ment specifically includes an authorized Teaching Fellow at the Harvard School of Dental Medicine and
statement that such approval or endorse- received a certificate in Pediatric Dentistry from Children’s Hospital.
ment has been granted. The fact that an Dr. Carapezza is currently an Associate Clinical Professor at Tufts
advertisement for a product, service or University, School of Dental Medicine and a contributing editor to
company has appeared in an American the Journal of Clinical Pediatric Dentistry. His lecture experience
Orthodontic Society publication will not includes the Senior Certified Instructor for both the American
be referred to in collateral advertising. The Orthodontic Society (AOS) and International Association for
American Orthodontic Society reserves the
Orthodontics (IAO).
right to accept or reject advertising at its
sole discretion for any product or service
submitted for publication.
COPYRIGHT Dr. Jeffrey H. Ahlin has served on the Board of Directors and as
© 2009. Journal of the American an officer of the American Orthodontic Society and currently
Orthodontic Society. The material in serves on the Board of the AOS Foundation. He is a board certified
each issue of the JAOS is protected by diplomate of the AOS and of the American Academy of Pediatric
copyright. None of it may be duplicated, Dentistry. He has published over 50 papers in professional journals
reprinted or reproduced in any manner and two textbooks. He has taught at Harvard Schools of Dental
without express written consent from Medicine and Tufts Dental schools for 20 years and lives in
the publisher. All inquiries and/or
Gloucester, MA with his wife and two children.
requests should be submitted in writing
to Wright Publishing Group, Inc. or via
email at lisa@wrightgrp.com.
SUBSCRIPTIONS
The Journal of the American Orthodontic
Society is a benefit of membership for
Dr. Chris Baker, through her practice in pediatric dentistry
current American Orthodontic Society and and orthodontics in Lexington, KY, and as a national lecturer
Academy of Gp Orthodontics members. and author, enjoys her passions - connecting with the parents
Annual subscriptions to the quarterly jour- and child patients, educating professionals and parents in state-
nal (4 issues per year) are available at a rate of-the-art dental care and management to meet the needs of
of $40/year for US residents, $80 USD/year today’s parents and children. Dr. Baker’s greatest opportunities lie
for Canada and $100 USD/year interna- in providing diagnosis and treatment of poor craniofacial growth
tionally. Back issues are available at a rate patterns and airway obstructions in children as early as possible
of $5 per copy until supplies run out. to optimize each child’s beauty and aesthetics. Dr. Baker is an
To subscribe to the JAOS, please visit
AOS Board Examiner and Vice-president of the Society.
www.orthodontics.com.
ORTHOBITES
Interceptive
Orthodontics
E a r l y Tr e a t m e n t i n O r t h o d o n t i c s
By David W. Jackson, DDS, FAGD, IBO
FIG. 1 FIG. 2
ORTHOBITES
FIG. 5
FIG. 3
FIG. 6
ORTHOBITES
FIG. 7 FIG. 10
FIG. 11
FIG. 8
FIG. 12
FIG. 13
FIG. 9
ORTHOBITES
FIG. 14
FIG. 17
FIG. 18
Impacted Incisors
Mixed Dentition: in
Surgical & Orthodontic Management
By Dr. Juan Carlos Echeverri, D.D.S.
References:
Straight Wire Concepts: Diagnosis and Technique, by
Robert G. Gerety, 8th Edition,
September 2004
Class II Malocclusion
The Changing
Face of Growth
Modification
E
vidence-based clinical dentistry has become the Strategy & Protocol
new “paradigm”. Randomized clinical trials Do the benefits of early treatment as shown by this
(RCT) are considered to be the gold standard to specific treatment strategy and protocol justify the
acquire evidence. The first dental randomized intervention in the early mixed dentition stage of
clinical trials funded by The National Institute of development when compared with treatment in the
Dental and Craniofacial Research dealt with early late mixed or early permanent dentition? The comple-
Class II treatment. The results of these studies claim tion of this case report attempts to put into focus the
effectiveness of the early treatment Class II. The risk/benefit ratio of early versus late treatment.
lingering question posed by these studies was the effi-
ciency of treatment in a conventional specialized
orthodontic practice.
The case report presented in this article is the result
of the continuum of treatment of an early Class II Divi-
sion I case published in the Spring 2006 (Volume 6 Issue
2) of the Journal of the American Orthodontic Society.
Characteristics
An efficacious solution was found to this malocclu-
sion which displayed common Class II characteristics:
Fig. 1a: S.K. 8y 1m
Maxilla – narrow – tapered – constricted arch form 11-11-2004 pre tx.
orthodontic records
One-half to full Class II molar relationship facials and intra-orals
Mesial lingual rotation of the maxillary molars
Improper over-bite relationship
Improper over-jet relationship
Incompetent lip seal
Retruded position of the mandible
22 Winter 2009 JAOS
JAOSWin09 1/19/09 11:30 AM Page 23
Finishing Phase
The finishing phase with the continued use of a
fully programmed pre-adjusted straight arch appliance Fig. 4d: S.K. 11y 6m
4-24-08 post tx
began on 9-1-06. (Fig .2) The treatment continued with cephalometric tracing
leveling, aligning and rotation with proper attainment
of molar, cuspid and midline. Inclusion of bracketing
of the permanent second molars was accomplished
during that time period. Final tip, torque and bite
opening were completed on 4/15/08. (Fig.3 ) The case
was debracketed and retention records were then taken
on 4/24/08. (Fig.4 a,b,c,d,e)
Fig. 3: S.K. 11y 6m 4-15-08 F.T.T.B.O. Fig. 4e: S.K. 11y 6m 4-24-08 post tx study models
Experience-based Evidence
An on-going clinical research
project for the author has been
taking orthodontic records of the
parents of his pediatric orthodontic
patients. Most, if not all, of Fig. 9: Evidence based
these parents had conven- Fig. 6: M.K. 14y 8m 9th grade: decision
tional orthodontic treatment headgear, 4 bicuspid ext. making process
Proffit has stated that “clinical decisions such as the same playing field and allow the orthodontic practi-
optimal time to start treatment are inevitably difficult tioner and consumer to judge the risk/benefit ratio
because of the variability between patients and the of both of these approaches. The best clinical proto-
uncertainty about growth and treatment response.” cols should be based on the study of short term-long
The proposal from the author is to put fully docu- term treatment outcomes.
mented early treatment versus late treatment on the
References:
Tulloch JF, Phillips C., Proffit WR. Benefit of early Class II treatment: University of North Carolina. RCT Class II, NIDCR RO1 type
Progress report of a two-phase randomized clinical trial. Am J grant. DE-08708 (UNC owns Data – not Federal Gov). “Written
Orthod Dentofacial Orthop 1998; 113: 62-72. request from Tufts Department of Pediatric Dentistry for
specific data denied.” September 22, 2005.
Ghafari J, Shofer FS, Jacobsson-Hunt U, Markowitz DL, Laster LL.
Headgear versus functional regulator in the early treatment Class McNamara JA. The Dr. Herbert J. Margolis Memorial Lectureship.
II, Division I malocclusion: A randomized clinical trial. AMJ Tufts Dent. Cont. Ed. April 12, 2008
Orthod Dentofacial Orthop 1998: 113: 51-61.
Forrest, JL and Miller, S. A.: Evidence-Based Decision Making: A
Keeling SD, Wheeler TT, King GJ. et al. Anteroposterior skeletal and Translational Guide for Dental Professionals. Lippincott,
dental changes after early Class II treatment with bionators and Williams and Wilkins, Philadelphia, 2008.
headgear. Am J Orthod Dentofacial Orthop 1998: 113L 40-50.
Papadopoulos. MA and G Kiaouris, I.: A Critical evaluation of
Proffit WR. Tulloch JF. Preadolescent Class II problems: Treat now or meta-analysis in orthodontics, Am. J. Orthod. 131: 589-599,
wait? AM J Orthod Dentofacial Orthop 2002: 121: 560-562. 2007.
Andrews LF. The Straight-wire appliance. J Clin Orthod 10: Feb – Carapezza L.J. Objectifying treatment of Malocclusion.
Aug 1976. J Pedod 1990; 15: 5-12.
Gianelly, AA., One-phase versus Two-phase Treatment. Am J Orthod
Dentofacial Orthop 1995: 108: 556-9.
THE BENEFITS OF
Open Bite Dental
By Jeffrey H. Ahlin, DDS
EARLY TREATMENT
& Facial Deformity
patient.4 The obvious financial benefit to the patient or her daughter would most
parents is that a more serious surgical procedure could likely need a second
well be avoided. phase of therapy with
The patient presented here, Katie N. (Fig. 1), came full orthodontic brackets
to our office at age 7 with a history of pacifier use for when all of her perma-
over three years. There was a very evident deforma- nent teeth had erupted.
tion of the premaxilla. The patient had no other The Phase I treatment
medical considerations and was taking no medica- plan for Katie included
tions. In addition to her malocclusion, the patient’s maxillary expansion with
dental history included small occlusal incipient two removable appliances,
lesions on her first molars. (fig. 3) over 10 months
Katie’s anterior open bite was 9mm. with bilateral and eight maxillary brack-
Fig.4: Katie at age 10
posterior cross bite. Her mother stated that Katie “used ets for four months in
to love her pacifier” and was having some difficulty order to reduce the open bite
eating her food. Some of the patient’s school friends malocclusion and correct the cross bite. This phase of
were beginning to make derisive comments. Katie’s treatment lasted for 20 months. The second maxillary
mother was informed of a corrective course of action expansion appli-
and treatment plan. ance had poste-
Mrs. N. was initially reticent about committing to a rior occlusal
two-phase treatment plan. However, after a definitive coverage. A
two-phase plan of treatment was explained to the Hawley retention
patient’s mother, including the time period and the appliance was
stability of the results, she agreed to go ahead with placed and the
Katie’s treatment. Mrs. N. was assured that with good patient was re-
patient cooperation, Katie would have a beautiful result photographed at
Fig.5: Age 10 occlusion
with a full smile. The mother was also informed that age 10. (Fig. 4 & 5)
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JAOSWin09 1/19/09 1:37 PM Page 30
References:
1. Ahlin, J. H., Atkins, G., A screening procedure for differentiating tem-
poromandibular joint related headache. J. Headache 1984; 24: 216-221.
2. Ahlin, J. H., The theoretical and practical application of a remold-
able craniomandibular appliance. Int. J. Orthod. 1984: 22: 21-23.
3. Roux, F., D’Ambrosio, C., Mohsenin, V., Sleep related breathing
disorders and cardiovascular disease. Am J Med 2000; 108: 396-402.
4. Shoroog, A., Locker, D., Streiner, D.L., & Thompson, B., Impact of self-
esteem on the oral-health-related quality of life of children with
malocclusion. J Orthod. & Dentofacial Orthoped. 2008. 134: 484-489.
Early Transitional
Dentition Treatment
By Dr. Chris Baker, RN, DMD
It has been estimated that 50,000 patients are born in the U.S. every
year who will develop at least one impacted canine that will require
orthodontic attention by age 10.
Secondly, recommend extraction if the extended long Little, RM. Stability and relapse: Early treatment of arch length deficiency.
AJODO 121(6) 578-581. June 2002.
axis passes more than one adjacent crown width. (figure 2)
Shapiro P. Long term observation of orthodontically treated patients.
The extended long axis passes not only the lateral incisor Mandibular dental arch form and dimension treatment and post-treatment
at one crown width, but also into the central incisor changes. AJODO 1974: 66:411-430.
crown. Extended long axis evaluation may give us the abil- Turpin DL. Early treatment conference alters clinical focus. Am J Orthod
ity to predict the majority of unfavorable eruptive paths of Dentofacial Orthop. 2002
permanent canines earlier than previous analyses. This Turpin DL. Where has all the arch length gone? Editorial, AJODO March, 2001. 201.
analysis is done in the early rather than the late transi- Warren JJ, Bishara SE. Comparison of dental arch measurements in the
primary dentition between contemporary and historic samples. Am J Orthod
tional dentition and includes mid-alveolar paths that may Dentofacial Orthop. 2001 Mar;119(3):211
predispose laterals to root resorption. Treatment planning
Zachrisson BU. Important aspects of long-term stability. 1997 JCO
note: Always extract bilaterally to prevent midline shift! Sept;31(9): 562-583.
RENEW YOUR DUES TODAY AND ENSURE YOU ARE INCLUDED IN OUR 2009 MEMBERSHIP AND REFERAL
DIRECTORY. RENEW ONLINE AT WWW.ORTHODONTICS.COM or CALL THE AOS OFFICE AT 800-448-1601.
Board Examination
Fellowship Award Recipient
www.academygportho.com
Academy of
Gp Orthodontics
2009 Officers
President
Drew Ellenwood, DDS
President Elect
Marc Dandois, DDS
Vice President
Thomas Jacobsen, DDS
Secretary - Treasurer
Sam Gutovitz, DDS
Immediate Past-President
Keith Wilkerson, DDS
Board of Directors
This year, the Academy recognized Dr. Fred Der of Keswick, Ontario,
Eugene Boone, DDS Canada who achieved Fellowship status by passing the Fellowship Board
Greg Cannizzo, DDS Examination. Dr. Der is the host dentist of the comprehensive two-year,
hands-on orthodontic course taught in his office by Dr. Roy Holexa.
Corina Diaz- Bajsel, DDS
Fred Der, DDS
Kyle McCrea, DDS
Kurt Raack, DDS The Acacdemy of
Kurt Stodola, DDS
Helen Tran, DDS Gp Orthodontics
Advisory Board
Ron Austin, DDS
2009 Spring Referesher
Joe Fallin, DDS The Academy of Gp Orthodontics is pleased to present the 2009
Roy Holexa, DDS Spring Refresher Course featuring speakers on Tip-Edge Plus and
Orthodontic Appliances. This two day event will take place March 27th
Leslie R. Penley, DDS and March 28th at the Crowne Plaza Hotel in Addison Texas. Featured
Bob Shirley, DDS speakers and topics will include Dr. Richard Parkhouse on the Tip –
Barry Sockel, DDS Edge Plus Bracket. Dr. Edward Joneson will speak on The Tip – Edge
Experience – It makes more sense, and Paul Ruzicka of Ordent Laborato-
Walter L. Tippin, DDS ries speaking on Orthodontic Appliance Designs and Adjustments. To
register call the Academy headquarters at 800-634-2027. Don’t miss this
Executive Director
opportunity to improve and refresh your orthodontic skills and network
Cynthia Bordelon with other dentist and Pedodontists who practice orthodontics.
Your Practice:
A Safe Investment in Tumultuous Times
Recently, my parents were talking about the current sour times and their incredible, shrinking
retirement. I gave my mother a fright by telling her I was heavily invested in a small company
and that if it went bust, so would I. She anxiously said I needed to immediately diversify. Too late,
I told her, I was too entangled in this group. However, I knew the CEO, and I thought I’d still just
make it. My father had to tell her the small company was my dental practice.
This is our investment: Ourselves, our practices. Right now, that is probably the best place for Dr. Drew Ellenwood
money. I have to remind myself to take time to sit quietly and think on my goals, to look from afar AGpO President
and evaluate and then come close to organize and refine. During spring cleaning, I jettison the trash; in my practice, I
work to keep the fat trimmed and the weeds out. Though, it’s not all about building that better mousetrap. Investing in
becoming a better dentist means pressing to become a better me all around. I have to keep connected to my patients as
humans, to my staff as partners in service, and to my family as my touchstone. And remember, the one next to you. That
is, don’t take your spouse for granted as your spouse is the most valuable asset in your human portfolio.
My daughter, a sophomore in college, asked me recently about the economy and what to do. I told her the best
place to be during an economic bad time is in school. So it is with you and me. Now is not the time for panic –
and believe me I’m one to panic – but to invest in our education. I advise you, and it’s just as good as you’ll get
from any financial guru, to plan and save now to attend the joint annual meeting of the AGpO and the AOS in
Chicago, August 20-23, 2009. This will be a fantastic investment in honing your skills and becoming more effec-
tive in your orthodontic practice.
Even earlier in 2009 is the Academy’s Spring Refresher. It will be held in Dallas on March 27 and 28. On the
first day, the agenda includes Dr. Edward Jones who will lecture on Diagnosing the Maxilla and Paul Ruzicka, Pres-
ident of Ordont, who will lecture on Appliance Designs and Adjustments. On Saturday, Dr. Richard Parkhouse, our
Tip-Edge friend from Wales, will lecture on Tip-Edge Plus.
Hopefully, this can be an ongoing tradition to keep us connected to each other and the best in orthodontic
continuing education. Meanwhile, strap yourself in the roller coaster. Soon the ride will be over.
MEMBERSHIP RECIPIENTS
Mark Dandois, DDS
Hector Garza, DDS
Roy Holexa, DDS
Tom Jacobsen, DDS
Leslie Penley, DDS
Bob Shirley, DDS
Barry Sockel, DDS
FELLOWSHIP RECIPIENT
Fred Der
Oral Health
Diabetes
D
&
iabetes is a great concern for both the medical
and dental professions. Millions of Americans
are affected each year by this disease. Over
the last two decades there has been a thirty to
These patients also lose more teeth than patients who
have good control of their diabetes.
Diabetes can also affect the amount of saliva in the
mouth, leading to dry mouth and resulting in an
forty percent increase in diagnosed cases of diabetes, increased risk for cavities. Recurrent canker sores, white
especially among overweight children and adolescents, patches on the cheeks, and fungal infections can be an
since obesity is a major risk factor. But how can indication of poor glycemic control in a diabetic
diabetes affect your oral health? patient. Taste may also be altered in diabetic patients,
The Centers for Disease Control defines diabetes as a making it difficult to maintain a proper diet.
disease in which blood glucose levels are above normal. Patients with poorly controlled diabetes are at an
Most of the food we eat is turned into glucose-or sugar- increased risk of other complications, such as infections
for our bodies to use for energy. The pancreas produces and reduced healing. This may make it necessary for
a hormone called insulin to help glucose absorb into them to take antibiotics prior to certain dental procedures
the cells of our bodies. When you have diabetes, your including oral surgery. For patients taking insulin, it may
body either doesn’t make enough insulin or can’t use be necessary to consult with their physician in order to
its own insulin as well as it should. This causes sugar to increase the dosage in the case of an oral infection. It is
build up in your blood. also important for your dentist to know if you take
Diabetes can cause serious health complications, insulin because the use of local anesthetic can influence
including heart disease, blindness, kidney failure, and the effects of insulin and can result in hyperglycemia.
lower extremity amputations, and it is the sixth lead- So, if you have diabetes, make sure you take care of
ing cause of death in the United States. Some classic your teeth and gums. You may require more frequent
signs of diabetes are excessive appetite, excessive visits to the dentist and more rigorous follow-up treat-
thirst, and excessive urination, but the condition may ment to ensure optimum dental health. To offset the
also cause weight loss, irritability, drowsiness, and greater risk of gingival and periodontal problems, it is
fatigue. Diabetes, as well as any other medical condi- vital to control your blood glucose levels and to brush
tion, should be reported to your dentist so that and floss daily. Finally, seek regular dental care to help
proper care can be delivered. keep your mouth healthy and to obtain advice on how
When diabetes is not controlled it can lead to a to manage your diabetes.
number of dental complications because the high
glucose levels in saliva may help bacteria thrive in the
mouth. Diabetes also reduces the body’s resistance to
infection, and the body’s tissues, including the gums,
are likely to be affected. The most common and
potentially harmful oral health problems associated
with diabetes are gingivitis, periodontitis and rapid
loss of the bone that supports the teeth. According to
the American Dental Association periodontitis is often
linked to the control of diabetes. Patients who have
inadequate blood sugar control appear to develop
periodontitis more often and with greater severity.
This message is brought to you by your dentist, a proud member of the American Orthodontic Society and the AGpO.