Integrated Clinical Orthodontics E-Book

• Herausgeber: John Wiley & Sons
• Kategorie: Fachliteratur
• Sprache: Englisch

Seitenzahl: 1460

Veröffentlichungsjahr: 2011

Beschreibung

Integrated Clinical Orthodontics provides an important new resource on the clinical interactions between the practice of orthodontics and other areas of clinical dentistry and medicine. Having at its heart the paradigm of patient-centred care, the book not only integrates the knowledge, skills, and experience of all the disciplines of dentistry and medicine, but also eases the work of orthodontists in arriving at an accurate diagnosis and a comprehensive treatment plan. Presented in a highly visual and practical format, Integrated Clinical Orthodontics uses clinical case presentations to illustrate the rationale and application of the integrated approach to a variety of clinical scenarios. Integrated Clinical Orthodontics covers areas of complexity in clinical orthodontics, specifically the role of the orthodontist as a member of a multidisciplinary team. The book outlines and details the management of congenital orofacial deformities, sleep disorders, esthetic smile creation and temporomandibular joint problems, and additionally and importantly includes specific protocols for effective communication with experts in other specialties.

Leseprobe

Table of Contents

Cover

Title page

Copyright page

Dedicated to

Dedication

Laure Lebret and Anna-Marie Grøn: for lives committed to integrated orthodontic education

List of Contributors

Preface

1 The Increased Stature of Orthodontics

Introduction

The broadening scope of orthodontics

The orthodontic patient as a human being

The patient’s biological status – does it influence orthodontic treatment?

Conclusions

2 Effective Data Management and Communication for the Contemporary Orthodontist

Introduction

The role of information technology in the orthodontic practice

Computer-aided diagnosis and treatment planning to enhance communication

Other arenas of communication

Electronic data management

Virtual patient record for integration of specialties

Conclusion

3 Orthodontic Diagnosis and Treatment Planning: Collaborating with Medical and Other Dental Specialists

Introduction

The other side of the story

Orthodontic diagnosis from a broad perspective

The first interaction with the patient

The importance of the medical history in the orthodontic diagnosis and treatment planning

Identifying local dental abnormalities before attempting orthodontic treatment

Evaluation of the occlusion and the temporomandibular joint

Radiographic examination of the jaws

Conclusions

4 Psychosocial Factors in Motivation, Treatment, Compliance, and Satisfaction with Orthodontic Care

Introduction

Motivation for orthodontic care

Psychosocial variables influencing compliance

Conclusion

5 Nutrition in Orthodontic Practice

Introduction: the role of the orthodontist in nutrition

What is an adequate diet?

Nutrition and the orthodontic patient

Effective nutrition management of the orthodontic patient

Conclusions

6 Anomalies in Growth and Development: The Importance of Consultation with a Pediatrician

Introduction

Pervasive sucking habits and tongue thrusting

Growth-related problems

Trauma-related issues

Conclusions

7 The Benefits of Obtaining the Opinion of a Clinical Geneticist Regarding Orthodontic Patients

Introduction

Interaction with the clinical geneticist

Evolution of the clinical (medical) geneticist specialist

When to refer?

Radiographic signs

History of premature tooth exfoliation

Conditions in which premature tooth exfoliation may occur occasionally

Supernumerary teeth and hypodontia (oligodontia)

Syndromic hypodontia

Supernumerary teeth or hypodontia (oligodontia) and cancer

Failure of dental eruption

Soft and hard tissue asymmetry

Maxillary hypoplasia

Functional (neuromuscular) asymmetry

Mandibular retrognathism

Connective tissue dysplasia

Cleft lip and cleft palate

Conclusion

8 Multidisciplinary Team Management of Congenital Orofacial Deformities

Introduction

Otofacial malformations

Craniosynostoses

Achondroplasia/FGFR3 mutations

Holoprosencephalic disorders

Conclusion

9 Cleft Lip and Palate: Role of the Orthodontist in the Interdisciplinary Management Team

Introduction

Interdisciplinary team care

Members of the cleft lip and palate team and their task

Orthodontic management

Conclusions

10 What can Orthodontists Learn from Orthopaedists Engaged in Basic Research?

A common language

Bone adaptation to mechanical deformation and orthodontic tooth movement

Bone reaction to skeletal anchorage

Conclusions

11 When Should an Orthodontist Seek the Advice of an Endocrinologist?

Introduction

Growth hormone deficiency

Growth hormone excess

Thyroid disease

Hyperparathyroidism-jaw tumor syndrome

Hypophosphatasia

Rachitic disorders

Osteopetrosis

Fibrous dysplasia

Diabetes

Adrenal disorders

Turner syndrome

Conclusions

12 The Benefits of Consulting with an Ear, Nose, and Throat (ENT) Specialist Before and During Orthodontic Treatment

Introduction

The anatomical connection: the mouth in its relation with the nose, throat, and ear

Areas of interaction

Conclusion

Acknowledgments

13 Obstructive Sleep Apnea: Orthodontic Strategies to Establish and Maintain a Patent Airway

Introduction

The spectrum of obstructive sleep-disordered breathing

Decoding OSA

Respiration: effect of anatomy and sleep

OSA in children

OSA in adults

Conclusions

Acknowledgments

14 Acute and Chronic Infections Affecting the Oral Cavity: Orthodontic Implications

Introduction

Bacterial infections

Chronic infections with oral manifestations

Viral infections

Fungal infections

Parasitic infections

The oral cavity as a source for focal infections

Conclusions

15 Orthodontics and Pediatric Dentistry: Two Specialties, One Goal

Introduction

Coordinating orthodontic and pediatric dental appointments in a group or solo practitioner setting

Identifying orthodontic and pediatric dental problems earlier than later

Restoring form and function – revisiting the unilateral posterior crossbite with a functional mandibular shift

Congenitally missing maxillary lateral incisors – who does what, when, and how?

Retention considerations and beyond

Enamel demineralization during orthodontic treatment – who takes responsibility for prevention?

Conclusions

16 Dental Caries, Tooth Fracture and Exposed Dental Pulp: The Role of Endodontics in Orthodontic Treatment Planning and Mechanotherapy

Introduction

Pretreatment evaluation and early orthodontic treatment

Interactive collaboration during orthodontic treatment

Emergency orthodontic treatment in trauma cases

Immediate post-orthodontic period, and the long-term retention requirements for avoiding relapse

Conclusion

17 Pre-Prosthetic Orthodontic Tooth Movement: Interdisciplinary Concepts for Optimizing Prosthodontic Care

Introduction

Case 1: Orthodontic intrusion

Case 2: Use of dental implants for anchorage and orthodontic tooth extrusion for implant site development

Case 3: Minor tooth movement to gain canine guidance for full mouth rehabilitation

Orthodontic techniques in maxillofacial prosthodontics

Case 4: Restoration after a maxillectomy for osteomyelitis

Case 5: Prosthetic restoration of maxillectomy due to adenoid cystic carcinoma

Conclusions

Acknowledgments

18 Orthodontic Treatment in Patients Requiring Orthognathic Surgical Procedures

The importance of the sequence/checklist

Team preparation – Steps I and II

Diagnosis and patient care – Steps III–X

Presurgical – Steps XI and XII

Postsurgical – Steps XIII–XVI

Feedback – Steps XVII–XVIII

Conclusions

19 The Role of Biomedical Engineers in the Design and Manufacture of Customized Orthodontic Appliances

Introduction

Past research activities

Current research activities and potential future applications

Conclusions

20 Tissue Engineering in Orthodontics Therapy

Introduction

Tissue engineering principles

Impact of tissue engineering on orthodontics

Orthodontics and dentofacial orthopedics as clinical motivation for tissue engineering

Conclusions

Acknowledgments

21 Corticotomy and Stem Cell Therapy for Orthodontists and Periodontists: Rationale, Hypotheses, and Protocol

Introduction

Twentieth-century ‘OldThink’

Orthodontic ‘NewThink’: the age of the stem cell

Conclusions

Acknowledgment

22 The Application of Lasers in Orthodontics

Definition and laser physics

Historical perspective

Laser versus scalpel

Diode versus solid-state lasers

Choosing a proper anesthetic

Laser machine set-up

Procedures and surgical technique

Laser safety

Postsurgical management

Conclusion

23 Implant Orthodontics: An Interactive Approach to Skeletal Anchorage

Introduction

Interactive approaches

Holding the molar vertical position

Intrusion of molars

Molar uprighting

Forced eruption

Surgical placement of micro-implants

Conclusion

24 Temporomandibular Dysfunction: Controversies and Orthodontics

Temporomandibular disorders – the evolution of controversy

Orthodontics and TMD

Centric relation controversy

Functional occlusion and TMD

Asymptomatic internal derangements – need for treatment?

Controversies regarding TMD treatments

Contemporary multidisciplinary, evidence-based treatment options

Conclusion

25 Orthodontic Treatment for the Special Needs Child

Introduction

Therapeutic access

Patient management

Drawing up a tentative treatment plan

Relapse and retention

Case descriptions

Conclusion

Index

This edition first published 2012

© 2012 by Blackwell Publishing Ltd

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Library of Congress Cataloging-in-Publication Data

Integrated clinical orthodontics / edited by Vinod Krishnan, Ze’ev Davidovitch.

p. ; cm.

 Includes bibliographical references and index.

ISBN 978-1-4443-3597-2 (hardback)

 I. Krishnan, Vinod. II. Davidovitch, Zeev.

 [DNLM: 1. Orthodontics–methods. WU 400]

 LC classification not assigned

 617.6'43–dc23

2011034246

A catalogue record for this book is available from the British Library.

Wiley also publishes its books in a variety of electronic formats. Some content that appears in print may not be available in electronic books.

ISBN 978-1-4443-9860-1 (epdf)

ISBN 978-1-4443-9861-8 (epub)

ISBN 978-1-4443-9862-5 (mobi)

My ever-inspiring family, who supported me throughout this project

My children, Jithu and Malu

My mentors, Dr Jyothindra Kumar (orthodontist) and the late Dr Ponnuswamy (anatomist), who changed the way I looked at my profession

and

All those who would love to see advancement in the ‘Science of Orthodontics’

Vinod Krishnan

My wife, for her continuous support and advice; my children, for their compassion and constructive suggestions; and my grandchildren, for their excellence in computer science

Ze’ev Davidovitch

Dedication

Laure Lebret and Anna-Marie Grøn: for lives committed to integrated orthodontic education

It is fitting to dedicate a book titled Integrated Clinical Orthodontics to two teachers whose lives were committed to interactive and integrated education: Laure Lebret and Anna-Marie Grøn. Both were full-time faculty members in the Departments of Orthodontics at the Forsyth Dental Center (initially The Forsyth Infirmary for Children and now The Forsyth Institute) and the Harvard School of Dental Medicine. The two affiliated institutions co-sponsored the orthodontic postgraduate program in an unparalleled combination until 1990. Together with Dr Coenrad F A Moorrees, the Chairman of both departments for over 40 years, they were the pillars of a unique educational program. The fact that the three of them originated from three different countries stands as an important detail in the history of a program whose graduates have spread worldwide, carrying with them the notion that professional excellence requires constant curiosity, and a search for contributing factors derived from any reasonable source. Coenrad Moorrees was born in Holland, Laure Lebret in France, and Anna-Marie Grøn in Denmark. Each was touched with difficult experiences during the Second World War.

To many generations of Harvard/Forsyth orthodontic graduates, our education was nurtured with the indelible impact of these three teachers, who were role models of civility, collegiality, scientific thinking, and productivity. Dr Moorrees departed in 2003, Dr Lebret in 2009, and one year later, Dr Grøn joined them, leaving behind a legacy of goodness, along with the hard and patient work of educating hundreds of orthodontists, many of whom became academicians, among them an unconventional number of chairpersons or program directors.

Laure Lebret and Anna-Marie Grøn were pioneer women, as dentists, orthodontists, and postgraduate teachers. Known as the important cornerstones in Coenrad Moorrees’ team, both had solid and independent cores with sharp minds and caring dispositions. They were involved with Dr Moorrees in seminal studies on the dentition and various aspects of facial growth, the most important of which was a long-term study of over 400 sets of twins, investigating the relation of facial and dental development.

In addition to co-authoring papers with Dr Moorrees and other workers on dental development, natural head position, and the mesh diagram analysis, Laure Lebret worked and published on the growth of the human palate, the reproducibility of rating stages of tooth movement, and physiological tooth migration. While tackling with Dr Moorrees the principles of diagnosis and also dental development, Anna-Marie Grøn’s role was cut in the equally demanding and meticulous research of reproducibility of rating stages of osseous development, and the prediction of the timing of tooth emergence. The research that both women engaged in was not easy, for they mastered the intricacies of, and fully understood the variations in, clinical research, let alone longitudinal investigations with thousands of collected measurements per child. Their inquiry was clean, responsible, and painfully detailed. Their publications are, currently some 40 and 50 years later, having an impact on clinical decisions for thousands of children worldwide. One particular summary of much of the combined efforts of Lebret, Grøn, and Moorrees is embedded in a paper entitled ‘Growth studies of the dentition: a review’ (Moorrees CF, Grøn AM, Lebret LM, Yen PK, Fröhlich FJ, American Journal of Orthodontics 1969; 55: 600–16). Rarely is it not referenced in a paper or chapter on dental development.

Beyond the research and organized, clear didactics, the clinical teaching of Grøn and Lebret was in line with what today is labeled evidence-based practice and critical appraisal. ‘Justify the plan’, was their modus operandi, and ‘consider the alternatives’, before you decide. They were not necessarily unique in these requests. They simply transferred their research experience into daily clinical practice. They translated the central tendencies developed by research into the individual environment, to choose and deliver sound individualized treatment. That was the educational culture they helped us go through, and later propagate on our own as we became educators.

For all the gifts of knowledge and humanity they bestowed on their students worldwide, we dedicate this book to Laure Lebret and Anna-Marie Grøn. They deserve recognition in a book built around the idea of integrated sciences in the ever-expanding world of clinical orthodontics. By honouring their memory, we acknowledge that the explorations are going on, extending from theirs, for the benefit of mankind.

Joseph G Ghafari, DMD

Ze’ev Davidovitch, DMD

List of Contributors

Nina K Anderson PhD

Clinical Instructor

Department of Developmental Biology

Harvard School of Dental Medicine

Boston, Massachusetts

USA

Neslihan Arhun DDS, PhD, MSc

Associate Professor

Department of Conservative Dentistry

Baskent University, Faculty of Dentistry

Ankara

Turkey

Ayca Arman-Ozcirpici DDS, PhD

Associate Professor

Department of Orthodontics

Baskent University, Faculty of Dentistry

Bahcelievler, Ankara

Turkey

Adrian Becker BDS, LDS, DDO

Clinical Associate Professor Emeritus

Department of Orthodontics and Center for the Treatment of Craniofacial Disorders in Special Needs Individuals

The Hebrew University-Hadassah School of Dental Medicine

Jerusalem

Israel

Nabil F Bissada DDS, MSD

Professor and Chair

Department of Periodontics

Case Western Reserve University

School of Dental Medicine

Cleveland, Ohio

USA

William A Brantley PhD

Professor and Director

Graduate Program in Dental Materials Science

Division of Restorative and Prosthetic Dentistry, College of Dentistry

and

Department of Biomedical Engineering, College of Engineering

Ohio State University

Columbus, Ohio

USA

Stella Chaushu DMD, MSc

Associate Professor and Chair

Department of Orthodontics and Center for the Treatment of Craniofacial Disorders in Special Needs Individuals

The Hebrew University-Hadassah School of Dental Medicine

Jerusalem

Israel

George J Cisneros DMD, MMSc

Professor and Chair

Department of Orthodontics

New York University College of Dentistry

New York

USA

Adriana Da Silveira DDS, MS, PhD

Chief of Orthodontics

Dell Children’s Craniofacial & Reconstructive Plastic Surgery Center

and

Adjunct Assistant Professor

Department of Biomedical Engineering

University of Texas at Austin

Austin, Texas

USA

Gunnar Dahlén BSc, DDS, PhD (Dr Odont)

Professor and Chairman

Department of Oral Microbiology

Institute of Odontology

Sahlgrenska Academy at University of Gothenburg

Gothenburg

Sweden

Ze’ev Davidovitch DMD, Cert Ortho

Professor of Orthodontics, Emeritus

Harvard University, Boston

Massachusetts

USA

and

Clinical Professor

Department of Orthodontics

Case Western Reserve University

Cleveland, Ohio

USA

Linda A DiMeglio MD, MPH

Associate Professor Section of Pediatric Endocrinology and Diabetology Riley Hospital for Children Indiana University School of Medicine

Indianapolis, Indiana

USA

Theodore Eliades DDS, MS, Dr Med, PhD

Professor and Director

Graduate Program in Dental Materials Science

Center of Dental Medicine, University of Zurich

Zurich

Switzerland

Kaj Fried DDS, PhD

Professor of Neuroscience

Karolinska Institutet

Department of Dental Medicine

Huddinge

Sweden

Joseph G Ghafari DMD

Professor and Head

Division of Orthodontics and Dentofacial Orthopedics

American University of Beirut Medical Center

Beirut

Lebanon

Donald B Giddon MA, DMD, PhD, FACD

Associate Professor of Clinical Pediatrics

Department of Developmental Biology

Harvard School of Dental Medicine

Boston, Massachusetts

USA

Nadine G Haddad MD, FAAP

Associate Professor of Clinical Pediatrics

Indiana University School of Medicine

Riley Hospital for Children

Section of Endocrinology and Diabetology

Indianapolis, Indiana

USA

James K Hartsfield Jr DMD, MS, MMSc, PhD, FACMG, CDABO

Adjunct Professor

Department of Orthodontics and Oral Facial Genetics

Indiana University School of Dentistry

and

Department of Medical and Molecular Genetics

Indiana University School of Medicine

and

Department of Orthodontics

University of Illinois at Chicago College of Dentistry

Chicago, Illinois

USA

Mark S Hochberg DMD

Program Director

Emeritus, Pediatric Dentistry, Interfaith Medical Center

and

Attending, New York Presbyterian Hospital

New York

USA

Julie Holloway DDS, MS

Program Director

Graduate Prosthodontics Program

Ohio State University College of Dentistry

Columbus, Ohio

Ohio

USA

Sarandeep Huja DDS, PhD

Program Director

Graduate Orthodontics Program

Ohio State University College of Dentistry

Columbus, Ohio

USA

Sanjivan Kandasamy BDSc, BScDent, DocClinDent, MOrthRCS, MRACDS

Clinical Associate Professor

Dental School

University of Western Australia

and

Centre for Advanced Dental Education

St Louis University

St Louis, Missouri

USA

Nina Kaukua DDS

Post Doctoral Fellow

Columbia University Medical Center

Craniofacial Regeneration Center, College of Dental Medicine

New York

USA

O P Kharbanda BDS, MDS, MOrth RCS Ed, MMEd

Professor and Head

Department of Orthodontics and Dentofacial Deformities

Centre for Dental Education and Research

All India Institute of Medical Sciences

New Delhi

India

Neal D Kravitz DMD, MS

Faculty, Washington Hospital Center

Washington, DC

and

Baltimore College of Dental Surgery

Dean’s Faculty, University of Maryland

Baltimore, Maryland

USA

Vinod Krishnan BDS, MDS, MOrth RCS (Edin)

Professor

Department of Orthodontics

Sri Sankara Dental College

Trivandrum, Kerala

India

Simone Kucska BDS, MSD

Kucska Facial Orthopedics

Sao Paulo, Brazil

and

Post-Doctoral Scholar

Los Angeles, California

USA

Anne Marie Kuijpers-Jagtman DDS, PhD

Professor of Orthodontics

Head of Department of Orthodontics and Craniofacial Biology

Head of Cleft Palate Craniofacial Unit

Radboud University Nijmegen Medical Center

Nijmegen

The Netherlands

Maria J Kuriakose BDS, PhD, Cert Ortho

Associate Professor

Department of Cleft and Craniomaxillofacial Surgery

Amrita Institute of Medical Sciences

Kochi, Kerala

India

Anthony T Macari DDS, MS

Instructor/Clinical Director

Division of Orthodontics and Dentofacial Orthopedics

American University of Beirut Medical Center

Riad El Solh

Beirut

Lebanon

Jeremy J Mao DDS, PhD

Professor and Zegarelli Endowed Chair

Columbia University

Director, Center for Craniofacial Regeneration

Senior Associate Dean for Research

Columbia University College of Dental Medicine

New York

USA

Birte Melsen DDS, Dr Odont

Professor and Chairman

Department of Orthodontics, School of Dentistry

Faculty of Health Sciences, Aarhus University

Aarhus

Denmark

Elliott M Moskowitz DDS, MSd, CDE

Clinical Professor

Department of Orthodontics

New York University College of Dentistry

New York

USA

Neal C Murphy DDS, MS

Clinical Associate Professor

Departments of Orthodontics & Periodontics

Case Western Reserve University

School of Dental Medicine

Cleveland, Ohio USA

David R Musich DDS, MS

Clinical Professor of Orthodontics

University of Pennsylvania School of Dental Medicine

Philadelphia, Pennsylvania

and

Lecturer

Department of Orthodontics

University of Illinois, School of Dentistry

Chicago, Illinois

Private practice

Schaumburg, Illinois

USA

Omur Polat Ozsoy DDS, PhD

Associate Professor

Department of Orthodontics

Baskent University, Faculty of Dentistry

Ankara

Turkey

Carole A Palmer EdD, RD, LDN

Professor

Division of Nutrition and Oral Health Promotion

Department of Public Health and Community Service

Tufts University School of Dental Medicine

Boston, Massachusetts

USA

Hyo-Sang Park DDS, MSD, PhD

Professor and Chair

Department of Orthodontics, School of Dentistry

Kyungpook National University

and

Director, Orthodontic Research Center, Kyungpook National University Hospital

Daegu

Korea

Sherry Peter BDS, MDS, FRCS

Clinical Professor

Department of Cleft and Craniomaxillofacial Surgery

Amrita Institute of Medical Sciences

Kochi, Kerala

India

Ameet V Revankar BDS, MDS

Assistant Professor

Department of Orthodontics and Dentofacial Orthopedics

SDM College of Dental Sciences and Hospital

Dharwad, Karnataka

India

Donald J Rinchuse DMD, MS, MDS, PhD

Professor and Graduate Orthodontic Program Director

Seton Hill University

Greensburg, Pennsylvania

USA

Lauren Schindler MS, RD

Senior Bariatric Dietitian

St Alexius Hospital NewStart

St Louis, MO

USA

Joseph Shapira DMD

Professor and Chair

Department of Pediatric Dentistry

The Hebrew University-Hadassah School of Dental Medicine

Jerusalem

Israel

Mete Ungor DDS, PhD

Professor

Head of Department of Endodontics

Baskent University, Faculty of Dentistry

Ankara

Turkey

Meade C Van Putten Jr, DDS, MS

Director of Maxillofacial Prosthodontics

The AG James Cancer Hospital and Solove Research Institute

Ohio State University

Columbus, Ohio

USA

Carlalberta Verna DDS, PhD

Associate Professor

Department of Orthodontics, School of Dentistry

Faculty of Health Sciences, Aarhus University

Aarhus

Denmark

Neeraj Wadhawan BDS, MDS

Research Officer

Department of Orthodontics and Dentofacial Deformities

Centre for Dental Education and Research

All India Institute of Medical Sciences

New Delhi

India

Eric Lye Kok Weng BDS, MDS, FRA CDS, FAMS

Consultant

Department of Oral and Maxillofacial Surgery Singapore

and

Assistant Director

Integrated Sleep Service

Changi General Hospital

Singapore

Mimi Yow BDS, FDS RCS, MSc (Orthodontics), FAMS

Senior Consultant

Department of Orthodontics

National Dental Centre

Singapore

and Clinical Associate Professor

Faculty of Dentistry

National University of Singapore

Singapore

Preface

The subject of this book, integrated clinical orthodontics, seemed initially to be a straightforward topic. After all, we know that we depend on each other, in all walks of life, not excluding orthodontics. Therefore, we thought that it would be helpful to try to compose a publication that would reflect clearly each area where orthodontists interact with experts in other medical specialties, in an effort to upgrade their services to their patients.

Each individual who needs, seeks, or receives orthodontic care, differs from every other individual, molecularly, functionally, and esthetically. This natural variability is reflected in the orthodontic clinic, defining the identity of the specialty whose experts could be beneficial to the orthodontist and the patient alike. Our goal has been to learn from people engaged in clinical research in different medical fields, about their experience and advice on interactions with orthodontists. These interactions stem from the simple fact that none of us knows everything, and whether we like it or not, we depend on the professional opinions of our colleagues in other specialties, whose knowledge can remedy the voids in our own.

In planning the contents of this book, we immediately realized that there are many fields of knowledge that can augment the diagnostic and therapeutic capabilities of the orthodontist. In fact, we were amazed at the large number of these specialties, clearly reflected in the number of chapters in this book, 25, each dedicated to a specialty whose members interact with orthodontists. This increasingly widening scope of orthodontics is enabled by the availability and relative ease of electronic communication, and the expanding new findings in medicine and dentistry. It becomes increasingly difficult to command all relevant information about emerging new and exciting fields, such as tissue engineering and stem cells, and becoming aware of ongoing progress in seemingly traditional fields, such as genetics, psychology, and material science. Interaction with others seems to offer the means to clarify and confirm the identity of clinical findings in the diagnostic phase, and elucidate the road ahead, in terms of treatment plans and the choice of the most suitable mechanotherapy for the individual patient.

The concept emerging from this book is that orthodontics is not merely an exercise in wire bending, but rather a specialty leaning on many others. Interactions, whenever indicated, between the orthodontist and other medical specialists are a powerful tool on the way to excellence. In short, we would like to see each and every reader of this book to think like a healthcare professional and as a conscientious member of the dental profession who wishes to bring credit upon a high calling that has lifted itself from a questionable mechanical art to a most respected and esteemed health service to humankind.

We would like to extend our heartfelt thanks to all our contributing authors, who have generously shared their valuable knowledge and wisdom for the benefit of all those who are eager to learn about the advancements in ‘science of orthodontics’. We were excited to read the manuscripts and are hopeful that the response of our esteemed readers will be the same too. Although the chapters are based on the contributors’ own work and experiences, all the information can be applied to similar settings across the world.

We would also like to express our sincere gratitude to all the staff at Wiley-Blackwell, Oxford, UK, especially Sophia Joyce, Nick Morgan, Catriona Cooper, Lucy Nash, and James Benefield, as well as Lotika Singha (copyeditor), and Anne Bassett (project manager) whose relentless efforts helped us to accomplish this laborious, but fulfilling, task.

Vinod Krishnan

Ze’ev Davidovitch

Editors

1

The Increased Stature of Orthodontics

Ze’ev Davidovitch, Vinod Krishnan

Summary

Orthodontists treat patients with orofacial anomalies, including malocclusions, by applying mechanical forces to the crowns of teeth. These forces are transmitted to the tissues surrounding the roots of the teeth, enticing their cells to remodel these tissues, thereby enabling the teeth to move to new, preferred positions. Like any other tissues and organs in the human body, dental tissues and cells are controlled by the nervous, immune, vascular, and endocrine systems, as well as by factors such as psychological stress, nutrition, medications, and local and systemic diseases. Since the jaws are integral parts of the body as a whole, orthodontic diagnosis must include detailed information on any deviation from general health norms, and these data should be reflected in the treatment plan. Therefore, when specific pathologies are identified, an interaction with the appropriate healthcare provider who is treating the patient should occur, or a referral made to another specialist. The advice obtained from these experts can have a substantial impact on the orthodontic diagnosis and treatment plan. Continuing advances in medicine and dentistry increase the scope, importance, and value of these interactions. This introductory chapter discusses the need and rationale for interactions in specific situations, and this book includes details of conditions that require advice from specific specialists. The focus on this expanding scope is derived from the notion that biology plays a pivotal role in orthodontics, and that pertinent information regarding the health status of individual candidates for orthodontic treatment might have long-lasting effects on the course and outcomes of orthodontic treatment.

Introduction

Facial esthetics, balance, and harmony, and/or their absence, have attracted attention from time immemorial, by artist and art viewer alike. Facial expressions can readily reflect various moods, emotions, and feelings, thereby conveying unspoken messages from person to person. The mouth is an essential component of this anatomical–physiological–emotional complex, by virtue of its ability to participate actively in these functions, involving its soft (cheeks, lips, and tongue) and hard (jaws and teeth) tissues. Painters, sculptors, and photographers have noted these features, and frequently, when creating images of human faces, included the rest of the body, or at least the torso, in their art work, demonstrating acceptance of the principle that the face and the rest of the body are one unit. The specialty of orthodontics is taught predominantly as a field of endeavor dedicated to the improvement of orofacial esthetics and function. Consideration of biological principles and constraints is shadowed by the desire of both the patient and his/her orthodontist to achieve noticeable improvement in the position and location of the malpositioned crown(s), ignoring the fact that the crowns are anchored in the jaws by their roots, which are surrounded by tissues that act and react like any other organ to any local or systemic factor that comes their way. This situation is similar to an iceberg, visible partially above the water surface, but invisible under it.