BSGDS Conference 2008 Dr Derek Mahony Jersey 4th Oct

The 2008 Conference speaker on “The Orthodontic/Restorative Interface” was Derek Mahony. He is an international lecturer in orthodontics and has delivered over 400 lectures in more than 30 countries.

There have been significant advances in orthodontics in recent years. It is, therefore, incumbent on dental practitioners to becomeacquainted with these changes as it is part of their responsibility for referrals. Furthermore, there are now some simple orthodontic techniques which can be used prior to restorative

treatment.

At the beginning of his presentation Derek demonstrated how wide dental arches and full lips enhance the smile. Extractions combined with retraction mechanics can, in some cases, result in a compromised facial appearance despite having well aligned teeth. As the nose and chin continue to grow through the teenage years and to a lesser extent during later decades, a maxillary deficiency will cause the face to age prematurely. Derek described a simple method of diagnosing whether a case required extractions. This was an imaginary line from the tip of the nose to the chin. Extractions are contra-indicated in any patient where the lips lie behind this line even when crowding

is present. Apart from causing crowding, narrow palates affect the nasal airway. Mouth breathing results in a far less efficient oxygen uptake and is often associated with the “long face” syndrome.

The public information section of the British Orthodontic Society website now states that “Extractions as part of orthodontic treatment are required somewhat less frequently than in the past on account of advances in orthodontic techniques. There has been widespread adoption of braces which take advantage of the growth of the patient’s jaw to correct the bite, possibly also creating small amounts of additional space in the dental arch. These braces, known as functional appliances, are routinely used now by most orthodontists and can often avoid the need for extractions.”

This website also suggests that screening of 7-8 year old children would be beneficial. Early interception, when appropriate, can reduce the overall length of treatment. Checking the position of unerupted upper canines on a dental pantomograph is important because of possible damage to the roots of the permanent incisors. Mini-implants can now be used in the treatment of ectopic canines resulting in a shorter time in fixed appliances. They are also useful for uprighting tilted teeth prior to fitting bridges or making space for implants.

There is evidence to show that the new low friction brackets systems combined with light biological forces results in dental arch development, faster treatment and less root resorption. For restorative treatment in adult patients there are many cases where a simple short-term fixed appliance using these brackets (3-3) could be used to improve alignment and so reduce tooth loss in preparation for veneers or crowns. In slightly more crowded cases the Advanced Lightwire Functional (ALF) appliance can develop a narrow maxilla before final alignment.

The day was extremely informative and also entertaining keeping everyone wide awake. Roy Dixon, in thanking Derek, drew attention to just how many different dental topics had been mentioned in the course of the day and were all linked to orthodontics.

Helen Jones