CE Course 1

ORTHODONTIC DIAGNOSTIC AND TREATMENT PLANNING FOR CLEAR ALIGNERs (1.5 CE)

Dr Jiachang Zhang

Software Hands on

Basic operations of Ortho Rx

个人的正畸学习经历

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Six Months Smile

My Patents on Orthodontics

正畸托槽系统

Teeth Adjustment Arrangement

Contemporary orthodontic Records

1. Patient’s history (Medical and dental)

Medical: Do you take any medication? Be careful to the systemic illnesses that might affect your decision in terms of treatment planning for the patient.

Dental history is very important to know if the patient had severe dental trauma, root canal treatment, maintaining regular checkup visits with his/her dentist or not.

2. Patient’s chief complaint

It is very important to investigate patients’ main concerns and address them during the consultation or during the treatment.

3. Clinical examination

Extra oral: profile to check if it is straight, convex or concave(skeletal class I, II or III)

Clinical examination of the patient’s facial symmetry is very important to differentiate between the patients that might require surgical intervention to improve patient’s asymmetric face/chin and consequently coordinated orthodontic-orthognathic treatment planning or patient that might have lateral mandibular shift due to dental interference or bilateral constricted upper arch.

Mouth breathers are usually have constricted upper arch and wide lower arch due to the unsupported upper posterior teeth from the lingual side against the inward forces of the cheek muscles.

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Intraoral examination includes centric relation-centric occlusion relationship and if there is any functional shift of the mandible upon closure (anterior, posterior or lateral shift).

4. Models

(plaster or digital)

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5. Radiographic evaluation

CBCT

Tomograms

Cephalometric

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Panaoramic X Ray

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A 15 year-old female that has skeletal Class II. A) Cephalometric x-ray shows mandibular retrognathism, however B) tomograms show distal shift of the mandible as indicated by the increased anterior disk space compared to posterior disk space. Without Tomograms, this case could have been set/planned for surgical orthodontics that may involve mandibular advancement utilizing bilateral sagittal split osteotomy.

This case was finished solely by orthodontic treatment within 12 months.

Cephalometric x-ray of an adult patient presented with anterior cross bite and she was set for two jaw surgeries by another orthodontist. However, tomograms show anterior functional shift which helped planning and finishing of the case using regular… — Cephalometric x-ray of an adult patient presented with anterior cross bite and she was set for two jaw surgeries by another orthodontist. However, tomograms show anterior functional shift which helped planning and finishing of the case using regular orthodontic treatment non-surgically.

A) Lateral cephalometric radiograph of a 15 years old male that shows severe mandibular retrognathism, however it is hard to confirm from the lateral cephalometric radiograph the shape and direction of the mandibular condyles to help predicting mand… — A) Lateral cephalometric radiograph of a 15 years old male that shows severe mandibular retrognathism, however it is hard to confirm from the lateral cephalometric radiograph the shape and direction of the mandibular condyles to help predicting mandibular growth direction. B) Tomograms showing forward directed mandibular condylar heads which can help predicting forward mandibular growth even at age 15 years old boy. It can also be seen that the patient is not in full centric occlusion which also can be confirmed by Tomogram where the condyles are positioned downward and slightly forward. In addition, estimating prediction of airway size and volume cannot be predicted from regular cephalometric radiographs. CBCT or tomograms can provide an estimation of nasal and oropharyngeal airway/volume for any patients. Without documentation of this information, major etiologic factors of malocclusion like mouth breathing can be overlooked and if not managed during orthodontic treatment, relapse is most likely to occur.

A) Lateral cephalometric radiograph that can hardly show the tongue position or airway. B) Same patient CBCT-generated airway screen clearly shows the low/back tongue position and constricted oropharyngeal airway.

Dental compensation for skeletal discrepancy

a. ANTEROPOSTERIOR (AP) DENTAL COMPENSATION

b. HORIZONTAL COMPENSATION:

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