Asociación Mexicana de Ortopedia Maxilar A.C.
Dr. John Voudouris. DDS. Orth. M.Sc.
Condylar-Fossa Growth Relativity Theory, and Treatment-Retention Results
The first half of the presentation will review the growing interest and acceptance of the Growth Relativity mechanism for Condylar Growth and Glenoid Fossa Modification with Herbst Twin Block, and other “fybctuibak” appliance therapy. This will be supported by examining and comparing control condyles and fossae histologically followed by experimental subjects with the use of continuous orthopaedic displacement of the growing mandible. These histological results will be coordinated uniquely with electromyographic evidence in the experimental subjects following the use of orthopaedic displacement in the early mixed dentition stage of development. The results of this investigation will additionally be compared with adolescent subjects primarily in the permanent stage of development.
The growth relativity hypothesis attempts to answer using logic two critical questions in orthopaedic freatment. If “functional” appliances that advance the mandible do not elicit muscle hyperactivity to produce condylar and glenoid fossa modification, what then are the exact reasons for condylar’fossa bone formation with orthopaedic appliance therapy? Discovering the precise mechanism of growth modification provides better use of the emerging orthopaedic therapies, to be clinically significant to the patient. This will, in turn, provede more effective correction of severe Class II malocclusions characterized by severe mandibular retrognathism. In addition, attention to the mechanism of how condylar resorption and disk displacements occurs (shown by Ruf and Pancherz, AJO/DO, 1998) with Herbst appliances will be reviewed using the growth relativity concept.
Long-term Clinical and Schientific Evaluation of Pre-programmed interactive Self-Ligation and Orthopaedic Appliances.
The growing use of Interactive Self-ligation appliances is proving to be the future for orthodontics. Practitioners interested in effectively addressing daily orthodontics challenges should find the Clinical Advantages of pre-programmed appliances that Actively Self-ligate, extremely useful long-term:
1. Proven Higher Treatment Efficiency, (and completion) due to lower resistance.
2. Decalcification Reduction due to the potential for improved hygiene.
3. Root Resorption reduction potential by using optimal, light forces.
4. Interbracket Flexibility improvement with ligature-free appliances.
5. Aesthetic appliance improvement due to miniaturization.
6. Patient Comfort due to reduced moments of a force Mf, and couples Mc.
The new generation of pre-programmed interactive Self-ligating appliances have been designed to accept colour elastomers locally in patients with good oral hygiene while simultaneously providing the option not to ligate. They are today easier to open and close to integrate into daily pactise by the orthodontic team. This requires some training and care in the application procedures of these new appliances. Dr. Voundouris will demonstrate these and other techniques through patient presentations showing several of the new clinical advantages. These techniques are applicable to the majority of twint biomechanical techniques that are currently being used today.
Pre-programmed Interactive Self-ligation.
The Siamese Twing Pre-programmed appliance can ligate itself and most importantly simultaneously seart the arch wire actively to replace the functions of metal ligatures and elastomers.
1) Light and continuous forces were measured during synergistic interactions between the arch wire and the active bracket mechanism. This ligh seating force was found to be less than _ the magnitude of a conventionally ligated appliance while mainfaining absolute control. In the middle stages of treatment, retraction forces reached the capillary blood pressure forces of the periodontal ligament (25gm/sq mm). These appliances achieved reached Burstone,s optimal biolsogical force for tooth movement in an attempt to reduce the incidence of root resorption, found in a large number of fixed conventional orthodontic appliance treatments.
1) Interactive Self-ligating systems create using mathematics clinically significant lower moments of a force and couples with the elimination of extermal ligatures and lighter forces exerted by the energy clip.
1) Ligature-free appliances increase interbracket flexibility that was found clinically to assist compromised hypoactive muscle function particulary in open bite patients with a hugh FMA for finishing excellence. Conversely, new bonded Gnathological Bite Ramps and greater interbracket flexibility assist deep bite corrections with a hyperactive musculature.
1) For clinicians, Self-ligating appliances proved to be greater than 4X more time efficient for arch wire changes than conventionally ligated orthodontic appliances, in three independent and published studies to be reviewed. Earlier tratment completions is correctly perceived as one of the most significant advantages in a growing, and often over-scheduled patient base, that significantly improves the doctor´s time and quality of life.
1) Other advantages of Interactive Self-ligations appliances are that they have the potential to reduce oral bacteria levels. This improves the prognosis for preventing decalcification in conjunction with decay possibly during orthodontic treatment.
Clinical Practice Management.
Dr. Voudouris has developed and uses a Biolneractive Technique of Fluidity Mechanics with Orthopaedic appliances over the past 19 years. He will demonstrate the significant clinical advantages using several patient presentations, his clinical video recordings and personal graphic illustrations. Comprehensive Open bite and Deep bite treatment will be reviewed including combined Periodontic-Prosthodontic and Maxillofacial Surgical treatment using Interactive, Self-ligating appliances.
Often noted as one of the most useful components of the presentation Dr. Voudouris will demonstrate several simple-to-use new clinical tips and patient management approaches that are applied in daily practise with Interactive Self-ligation.