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Saturday, June 9, 2012

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Orthodontics

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Orthodontics, formerly orthodontia (from Greek orthos "straight or proper or perfect"; and odous "tooth") is the first specialty of dentistry that is concerned with the study and treatment of malocclusions (improper bites), which may be a result of toothirregularity, disproportionate jaw relationships, or both. Orthodontic treatment can focus on dental displacement only, or can deal with the control and modification of facial growth. In the latter case it is better defined as "dentofacial orthopaedics". Orthodontic treatment can be carried out for purely aesthetic reasons with regards to improving the general appearance of patients' teeth. However, there are orthodontists who work on reconstructing the entire face rather than focusing exclusively on teeth.

[edit]
The use of digital models in orthodontics is rapidly increasing as the industry undergoes analog to digital conversions in record keeping. The University of Minnesota recently developed Three Dimensional Dental Models for Computer Automated Treatment Simulation that can be used to reduce the amount of human input needed for orthodontic treatment planning. This software tool has the ability to automatically segment teeth from one another and the gums. Digital laboratories are currently being used by many orthodontists, but can be very expensive. This software provides an efficient and cost-effective method for completing the segmentation process.^[1]Modern Orthodontics

[edit]Methods

For comprehensive orthodontic treatment, most commonly, metal wires (Juste) are inserted into orthodontic brackets (see dental braces), which can be made from stainless steel or a more aesthetic ceramic material. The wires interact with the brackets to move teeth into the desired positions. Other methods may include (1) invisalign. Invisalign consists of clear plastic aligners that 'level and align', but require more patient compliance than traditional braces. In most cases, invisalign is not a suitable replacement for traditional braces. (2) Suresmile, a dental treatment system that uses 3-D imaging and a robot to shorten the time to straight teeth.

Dental braces, with a powerchain, removed after completion of treatment.

Additional components—including removable appliances ("plates"), headgear, expansion appliances, and many other devices—may also be used to move teeth and jaw bones. Functional appliances, for example, are used in growing patients (age 5 to 14) with the aim of modifying the jaw dimensions and relationship if these are altered. This therapy, termed Dentofacial Orthopedics, is frequently followed by fixed multibracket therapy ("full braces") to align the teeth and refine the occlusion.

Hawley retainers are the most common type of retainers. This picture shows retainers for the top and bottom of the mouth.

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Orthodontics is the study of dentistry that is concerned with the treatment of improper bites, and crooked teeth. Orthodontic treatment can help fix your teeth and set them in the right place. Orthodontists usually use braces and retainers to set your teeth.^[2] There are, however, orthodontists who work on reconstructing the entire face rather than focusing exclusively on teeth. After a course of active orthodontic treatment, patients will typically wear retainers, which maintain the teeth in their improved positions while surrounding bone reforms around them. The retainers are generally worn full-time for a period, anywhere from just a few days to a year, then part-time (typically, nightly during sleep) for as long as the orthodontist recommends. It is possible for the teeth to stay aligned without regular retainer wear. However, there are many reasons teeth will crowd as a person ages, whether or not the individual ever experienced orthodontic treatment; thus there is no guarantee that teeth will stay aligned without retention. For this reason, many orthodontists prescribe night-time or part-time retainer wear for many years after orthodontic treatment (potentially for life).

[edit]Diagnosis and treatment planning

In diagnosis and treatment planning, the orthodontist must (1) recognize the various characteristics of a malocclusion or dentofacial deformity; (2) define the nature of the problem, including the etiology if possible;(3) design a treatment strategy based on the specific needs and desires of the individual; and (4) present the treatment strategy to the patient in such a way that the patient fully understands the ramifications of his/her decision.^[3]

The New York Times has recently written that orthodontists are using Cone Beam CT too much in the diagnosis and treatment of orthodontic patients, leading to an unnecessary increased risk of cancer.^[4]

[edit]Training

Orthodontics was the first recognized specialty field within dentistry. Many countries have their own systems for training and registering orthodontic specialists. A two to three year period of full-time post-graduate study is required for a dentist to qualify as an orthodontist.

[edit]United States of America

In order to be enrolled as a student or a resident in Advanced Education in Orthodontics approved by the Commission on Dental Accreditation (CODA), the dentist must have graduated with a DDS, DMD, BDS or equivalent. In the U.S., the orthodontics residency duration lasts between 24 -36 months long. The orthodontic residency typically award Certificate (non-degree) or Master of Science degree depending on its research requirements. The class size, tuition, stipend and number of patients seen and treated will all depend on the location of the program (hospital vs. university). Each training program has its own goals and treatment philosophy, however, most U.S. orthodontic programs focus on fixed straight wire appliances. All the graduates must also complete the written portion of the American Board of Orthodontics (ABO) examinations.

In order to become a Board Certified orthodontist, the practicing orthodontist must present six cases that have been treated entirely by the orthodontist to the ABO examiners. Once certified, the certificate is renewed every 10 years and the practitioner can add the following title, Diplomate, American Board of Orthodontics.

Similar to the ABO, the Canadian orthodontic specialist can take a two-part examinations (Written NDSE and Oral NDSE) offered by the Royal College of Dentists of Canada (RCDC) in their final year of the orthodontics training. Upon completion of the examinations, the orthodontist is admitted to the RCDC as a Fellow and can add the following title,FRCD(C).

Job outlook as a recent U.S. orthodontic graduates depend on the location of employment. Typically, more popular destinations (such as California, NYC, Seattle, Las Vegas and Texas) are heavily saturated with orthodontists. Traditional, practice transition situations (new orthodontist buying out the seller orthodontist) are becoming rare as the orthodontic market has been saturated with new and old practitioners, general dentists performing orthodontists, corporate clinics and older orthodontists delaying retirement.

[edit]Europe

In the United Kingdom, this training period lasts three years, after completion of a membership from a Royal College. A further two years is then completed to train to consultant level, after which a fellowship examination from the Royal College is sat. In other parts of Europe, a similar pattern is followed. It is always worth contacting the professional body responsible for registering orthodontists to ensure that the orthodontist you wish to consult is a recognised specialist.

[edit]Canada

A number of dental schools and hospitals offer advanced education in the specialty of Orthodontics to dentists seeking postgraduate education. The courses range from two to three years (with the majority being 3 years) of full-time classes in the theoretical and practical aspects of orthodontics together with clinical experience. Generally, admission is based on an application process followed by an extensive interviewing process by the institution, in order to select the best candidates. Candidates usually have to contact the individual school directly for the application process.

[edit]India

In India, many dental colleges affiliated to universities offer orthodontics as specialization in Master of Dental Surgery ( M.D.S ) programme.The minimum qualification for M.D.S isBachelor of Dental Surgery ( B.D.S ). The present course for MDS in Orthodontics stands at 3 years in all dental colleges in India which are recognised by the Dental Council of India.

The Indian Orthodontic Society was established in 1965. The Academy of Fixed Orthodontics, (AFO),^[5] established in 2004, represents GP's and members from other dental specialties(Non Orthodontists) who practices orthodontics. AFO offers certification courses in Fixed Orthodontics for General Practitioners in Dentistry.