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27Dental Tribune Middle East & Africa Edition | May - June 2014 ortho tribune TwinsDigitalAuxiliariesPracticeDevelopmentEducation SelfLigationAlignersTubes/BandsArchwiresLabProducts Dig into the Numbers! ormco.com/insignia © 2014 Ormco Corporation * Weber II, Dennis J., Koroluk, Lorne D., Phillips, Ceib, Nguyen, Tung, Proffit, William R., “Clinical Effectiveness and Efficiency of Customized vs. Conventional Preadjusted Bracket Systems”, Journal of Clinical Orthodontics, Volume XLVII, No. 4 (2013): 261-266. Your All-inclusive Solution with customized brackets, wires and placement trays. The Proof is in the Numbers Reduced Treatment Time* Fewer Patient Visits* For more information please contact: Tarek Haneya – Area Sales Manager Tarek.haneya@ormcoeurope.com Tel: + 971 56 1746 575 Or contact your local distributor, list is available at ormcoeurope.com Optimize your practice with the award-winning Insignia™ Advanced Smile Design™ , providing the largest array of customized appliances including brackets, wires and even clear aligners. • Delivers Precise and Predictable Outcomes • No Inventory Costs • Combine with Lythos Digital Impression system for Greater Savings and More Streamlined Workflow • Grow your Practice with Digital Technology Insignia-Ad-2014-A4Size.indd 1 3/6/14 12:45 PM Complex dental problems and the contribution of adjunctive orthodontics ByProfessorAthanasiosE.Atha- nasiou,DSDM T he goal of contempo- rary dentistry is the maintenance of natu- ral dentition under biologically, functionally and esthetically optimal conditions, for the longest possible period. An increasing number of adult people present a variety of com- plex dental problems, which concern more than one clinical discipline or specialty. These include caries, periodontal diseases, dental trauma, eden- tulous sites, malocclusions, or their combination. This article outlines existing orthodontic therapeutic pos- sibilities for adjunctive dental work and emphasizes the im- portance of teamwork among the general dentist, the orth- odontic specialist, and other dental specialists. Principles of treatment plan- ning for complex dental prob- lems The need to formulate prob- lem-oriented treatment plans, which address patients’ chief complaint for complex cases necessitates consensus among the parties involved namely the general dentist, the specialist and the patient. Diagnosis must utilize patient’s data, derived from records interpreted by the clinician using strict sci- entific criteria. On the other hand, treatment planning con- stitutes an intellectual process where subjective elements are often involved. It is the path that the well-educated and ex- perienced clinician follows in order to maximize the benefits for the patient, which must be contrasted to the cost and risk involved when certain proce- dures are adopted (1). An essen- tial requirement for successful interaction is that both general practitioner and specialist are in agreement regarding the ad- vantages and limitations of the treatment chosen. Adjunctive orthodontics Adjunctive orthodontic treat- ment is tooth movement car- ried out to facilitate other den- tal procedures necessary to control disease and to restore function. It may be an alterna- tive adjunct to general dentist- ry by providing (a) rehabilita- tion following tooth migration due to pre-existing periodon- tal disease; (b) pre-prosthetic orthodontics; (c) treatment of periodontal defects; and (d) or- thodontics as an alternative to prosthodontics (2). Orthodontics and periodontics It has been documented that orthodontic treatment in pa- tients with severe periodon- tal destruction is no longer a contraindication (3). On the contrary such treatment might even enhance the possibilities of saving and restoring a dete- riorating dentition. During the orthodontic movement it is the entire periodontal unit (bone, periodontal ligament, and soft Figure 1. Extraction of the lower first molars has resulted several years later to a mesial tipping of the second and third molars (A). When orthodontic uprighting of tipped molars was undertaken the crestal bone exhibited considerable changes (B). tissues), which moves with the tooth (4). This all-embracing movement has been shown to be beneficial when orthodon- tic uprighting of tipped molars is undertaken since the crestal bone exhibits predictable and considerable changes (5) (Fig- ure 1). Forced eruption has also been reported to decrease the depth of isolated vertical in- frabony defects and to expose tooth structure, thus allowing the prosthetic management of > Page 33 (A) (B) subgingival fractures, caries and lateral root perforations (6) (Figure 2). Orthodontics and missing teeth In cases where lateral incisors are congenitally missing and other malocclusion co-exist, in most instances the treatment of choice is the orthodontic movement of the canines to-