MLADEN M. KUFFINEC, DMD (Harv.) Dstom, ScDb. Ortodoncia Prof. and Director Dept. of Orthodontics University of New York USA Member AAO. WFO. Chairman and Coordinator Congreso Euro-Americano de Ortopedia Dentofacial AMOM 2001, Nov.29-2 Dic. Ixtapa México USA AMOM

Improving Esthetics and Function of Dentition, Muscles and Joints through the Treatment with Preadjusted Orthodontic Fixed Appliances

The central theme of this Congress is the interaction, but also the difference between the two main treatment approaches or systems, the functional orthopedics and the fixed orthodontic appliances. For the third year we have demonstrated and discussed one of the modern techniques employing the preadjusted fixed appliances. Understanding the basic concepts, together with their advantages and disadvantages, of preadjusted appliances, then building on that with the Bidimensional approach and finally presenting the currently emerging techniques of using the self-ligating brackets, should give the clinician powerful tools in treating his patients who exhibit a variety of malocclusions.
One area of orthodontics that often does not receive adequate attention, is that of considering effects of various treatments on function of the temporo-mandibular joint [TMJ]. Several authors have been quite critical regarding the effects of orthodontic treatment on the TMJ. This, they claim, is particularly evident in, or as a result of the extraction therapy, in which the various arch dimensions and proportions are altered.
This, in turn, reportedly alters the function of the TMJ and may cause its pathology. A brief analysis and the reasoning behind these claims will be presented. The presentation will attempt to demonstrate that many of the claims of orthodontic culpability are wrong and that, in fact, in numerous cases our intervention may help normalize function of the TMJ. Recently published work by this presenter and his coworkers will support this conclusion. Furthermore, this may be the case in using both types of appliances or systems, functional and fixed.

Functional versus Preadjusted Orthodontic Fixed Appliances: Beliefs, Efficiency and Cultural Differences

Having presented many eloquent arguments, both pro and con the use of one form compared to the other during this Congress, one has to be questioning which side made a more convincing case.

Perhaps a better question is if there is a place for both of these systems to coexist in the armamentarium of a modern orthodontist.

The functional camp wins when the issue on hand is what can be done to normalize the altered function of the stomatognathic system found in great number of young children. It is the plain truth that if the role of orthodontics and dento-facial orthopedics is viewed as that of a discipline that restores the normal function, then the functional orthopedics wins. If, on the other hand, the role of orthodontics is perceived as that of a specialty that deals with and primarily improves cosmetics, then there is very little doubt that the fixed orthodontics wins. Both of these statements does not exclude the fact that the former also can and does improve esthetics of the face, the same as the fact that fixed orthodontics can and does improve altered function. The clinician best suited for the future of our field must understand both capabilities and limitations of both of these systems. He should be able to employ either or both as the specific situation or malocclusions requires. He should not, however, favor one over the other solely based on his inability, or limited ability, to use either one of the systems.

Demonstrating examples where one approach is better suited than the other will conclude this presentation. Also, examples will be given where the two systems are used together or successively.