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1st Qatar International Orthodontic Conference By Dr. Khaled Abouseada, BDS, MS, Orthod. cert. A fter much planning and effort, the 1st Qatar International Orth- odontic Conference opened its doors to the delegates and par- ticipants on January 4, 2013, under the ban- ner ‘Stars of Excellence in Orthodontics.’ The Conference was the culmination of joint endeavours on the part of numerous dedicated members of the Department of Dentistry, Executives from Hamad Medical Corporation, and sponsors who contribut- ed generously to make this event the suc- cess that it was. The venue was the presti- gious Ritz Carlton Doha Hotel, renowned for hosting top-level gatherings in its state of the art facilities, beautifully located on the Arabian Gulf. The conference was preceded by two pre- congress courses. The first, entitled the “Skeletal Anchorage System” (SAS), was given by Professor Junji Sugawara who is the founder of the system. In contrast to the widely used mini-screws, the SAS makes use of titanium miniplates which are tem- porarily fixed to the zygomatic buttress and/or the mandibular body. Since there is no movement associated with the plates they can traverse the mobile oral muco- sa without causing any irritation. The fact that the anchorage arms are remote from the path of tooth movement gives the SAS an unbeatable advantage over other skel- etal anchorage systems. The required sur- gical intervention is regarded as minimal- ly traumatic and there are no more contra- indications than would be the case for any minimally invasive surgical procedure car- ried out under local anesthesia. The second pre-congress course entitled “Everything every aligner novice should know - an overview of 12 years of experi- ence” was given by Professor Rainer-Reg- inald Miethke, Chairman of the Depart- ment of Dentistry at Hamad Medical Cor- poration. He was the first orthodontist to use the Invisalign System outside of the Americas where it was developed. From his own experience with the system gained through trial and error he gave his audi- ence numerous recommendations on how to optimize this innovative invisible ap- proach to therapy. His course covered mul- tiple aspects of this system including treat- ment planning, ClinCheck evaluation, in- terproximal enamel reduction, attachment bonding, PVS-impression taking, and ac- cessories to name just a few. The conference itself started on January 5, 2013 with a recitation from the Holy Quran by Dr. Abdulmueen Al Qahtani following which Dr. Najat Al Sayed, Professor R.-R. Miethke, Dr. Shaymaa Ali and Dr. Khali- fa Al Ansari welcomed the invited speak- ers and the audience. The opening lecture on “The orthodontic- periodontic interface” was delivered by Professor Robert Boyd. In his lecture Dr. Boyd highlighted the close relationship be- tween Orthodontics and Periodontics and discussed the differing needs of patients being treated with traditional fixed braces versus contemporary invisible removable appliances. In all situations plaque con- trol is of the essence to ensure a caries and gingivitis-free environment. As an experi- enced clinician as well as a researcher Dr. Boyd gave many valuable tips for selecting toothpastes, dental floss and mouth rins- es. In closing Dr. Boyd showed examples of how restorative procedures can enhance orthodontic treatment outcomes. On the subject of decortication Professor Donald Ferguson delivered a lecture enti- tled “Decortication facilitated orthodon- tic treatment” during which he explained how even severe malocclusions could be corrected in a surprisingly short time span. The procedure involves raising a surgi- cal periodontal flap and making dot or slit shaped cuts into the alveolus, followed by augmentation grafting with dry-frozen or alloplastic bone material. The injury of the alveolar bone will alter its metabolism and initiate a regionally accelerated response whereby less mineralized bone will allow much faster yet physiologic tooth move- ment. Of great benefit is the finding that tooth movement is not only more rapid, but also more stable due to the dual effects of more comprehensive tissue turnover and increase in alveolar cortical bone thickness. In the course of his lecture “How do we cause root resorption? Can we avoid it?” Professor Ali Darendeliler took his audi- ence on a ‘virtual flight’ through root ca- nals and into resorption craters. This was done by combining technology from scan- ners and a flight simulator. For many years Dr. Darendeliler and his team of colleagues have systematically investigated the main problem of lateral root cementum resorp- tion in two and even three dimensions, with different appliance systems (fixed/re- movable) and different forces (light/heavy; intermittent/continuous). As expected, continuous forces caused the most severe root resorption, but even these were found to undergo a certain degree of repair, as Dr. Darendililer’s long-term observations indi- cate. He also pointed out that genetic back- ground plays a role, which gives hope to the possibility of identifying individuals who are at an increased risk of root resorp- tion. Though one would expect the topic of re- lapse to be of little or no interest to orth- odontic practitioners based upon their de- nial of its existence, the audience listened attentively to Dr. Simon Littlewood’s pre- sentation on “Retention and relapse in or- thodontics”! He pointed out how many of the existing retention protocols have been handed down from one orthodontic gener- ation to the next without any sound basis. What scarce evidence there is indicates that retention does not differ when a removable retainer (plate/splint-aligner type) is worn constantly or only during sleep. Care must be taken to ensure that fixed retainers are completely passive when bonded into po- sition. In summing up, Dr. Littlewood gave his answer to the frequently asked question ‘how long do I have to wear my retainer for?’ – His answer was ‘as long as you want to have straight teeth…’ The participants were shown impressive examples of lingual appliance therapy in Dr. Thomas Drechsler’s lecture entitled “Invisible first – lingual appliances for complex and combined treatments”. Con- temporary lingual braces are individual- ly customized i.e. cast in gold from a wax pattern, thus minimizing interference with oral tissues and function. Even the most difficult challenging cases (combined orth- odontic-orthognathic surgery therapy, par- tially edentulous patients) were shown to be successfully treated with lingual appli- ances. Of interest was that Dr. Drechsler sometimes combines treatment with lin- gual braces and Invisalign on opposing arches in the same patient. Professor Dieter Drescher gave the last presentation of the first day on “State of the art mini-implants for next genera- tion orthodontics”. His lecture dealt with the ‘Benefit System’ of intraoral anchor- age, a system comprised of various pre- fabricated components which can be in- serted with ease. What distinguishes this from other anchorage systems is the loca- tion of the screw in the anterior portion of the palate. This site ensures plentiful amounts of dense bone and does not inter- fere with tooth movements. Professor Dre- scher illustrated the superiority of the ‘Ben- efit System’ on patients in whom the poste- rior teeth were moved distally and/or me- sially, and where the maxilla was expand- ed skeletally or even protracted against an implant supported device in the mandible. The second day began with a lecture en- titled “How has skeletal anchorage im- proved orthodontic possibilities?” giv- en by Professor Birte Melsen. She showed numerous patients with sustained severe periodontal damage who were most suc- cessfully treated. Professor Melsen demon- strated how to utilize forces derived from cantilevers to overcome the less than ideal location of the implants in the interradicu- lar space. This, along with a segmented ap- proach, enabled the achievement of an out- come envisaged through expert application of digital models and occlusograms. “Goal orientated adult orthodontics us- ing a skeletal anchorage system (SAS)” was the title of Dr. Junji Sugawara’s pre- sentation which he started by explaining the development of his unique treatment approach over the past twenty years. Most impressive were the results he showed of treated open bites and advanced Class IIIs, both in terms of the quality of the outcome, and the relatively short treatment time tak- en to achieve it. Dr. Sugawara’s exception- al skills were also demonstrated in the Sen- dai Surgery First approach, whereby se- vere malocclusions can be corrected in a re- markably short period of time with much less effort and higher patient satisfaction. Professor Rainer-Reginald Miethke took a close look at treatment with clear align- ers in his lecture entitled “Invisalign – it all depends …”. He pointed out that the endless arguments favoring fixed brac- es over clear removable appliances are of- ten flawed since it is the particulars of each individual situation that determine the in- dications for using one mechanical system over another. There are malocclusions/ symptoms for which treatment with the In- visalign System results in at least as good, if not even better than that with fixed appli- ances. Professor Miethke emphasized that as the practitioner’s experience with the system grows coupled with an increased willingness of the part of the patient to ac- cept adjunct therapies – possibly even vis- ible appliances – the scope of manageable malocclusions grows. Dr. Saud Al Anezi spoke about “Intercep- tive orthodontics: an overview” in which he highlighted when early orthodontic in- tervention is desirable, and what it should consist of. He stressed the importance of general practitioners referring young pa- tients in a timely manner for specialty orth- odontic care. He supported his talk with multiple examples of situations where se- vere malocclusions were prevented by timely interceptive therapy. Dr. David Morris in his lecture “Surgical orthodontics – looking at the bigger pic- ture” warned the audience of the dramat- Dr. Khaled Abousada and Dr. Najat with Mr Sabahat (Clearpath) 34 DENTAL TRIBUNE Middle East & Africa Edition | Jan-Feb 2013EVENTS