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ePaper created 2017-03-08, 12:50:35 | version 1.38.0
E2 ◊Page E1 treating the patient. This tenant mandates a complete and thorough diagnostic evaluation (seeing eve- rything) from tempormandibular joint analysis to occlusal analysis to the elements that comprise a pleas- ing smile design; 2) Document specific treatment goals with specific assessment meas- urements, or the visualization of treatment outcomes for tooth and jaw joint positions and key aspects of facial balance and pleasing smile design; 3) Utilize skillfully engineered and exactingly manufactured orthodon- tic appliances and develop efficient mechanical systems—from bracket placement to debonding—that re- quire minimal patient cooperation, foster good hygiene and result in less chairtime (Figure 2); ORTHO TRIBUNE Dental Tribune Middle East & Africa Edition | 2/2017 Figure 2. Because of Ormco’s long history of engineering and production excellence, the instructors of the FACE Tx philosophy have partnered with Ormco for the de- livery of an appliance system that meets its requirements — Prodigy SL, an active- passive self-ligating appliance. 4) Undertake a never-ending quest for continued improvement in prac- tice efficiency. Finishing on time with predictable outcomes allows one to provide optimal results and meet or exceed patients’ expecta- tions. Conclusion The FACE Tx philosophy incorpo- rates comprehensive diagnosis and treatment planning, efficient treatment mechanics and the lat- est orthodontic advancements for treating each patient’s dental, facial and gnathological systems. Its aim is a collaboration between the goals of orthodontics and comprehensive dentistry that incorporates interdis- ciplinary coordination. This approach expands the network of professionals who share princi- ples of tooth positioning and jaw function. Such collaboration greatly strengthens one’s referral base as these colleagues understand the value of the orthodontic specialty and the specific value of FACE Tx. It promotes the viability of the or- thodontic specialty through the development and maintenance of viable practices that combine func- tion with beauty. The ultimate aim of FACE Tx is to foster excellence in orthodontic patient care and treat- ment through education, research and collaboration. Straty Righellis, DDS, Oakland Dr. Righellis graduated from UCLA Den- tal School and received his orthodontic specialty certifi cation from University of California, San Francisco. He maintains a private practice and serves as an associ- ate clinical professor at the University of the Pacific and University of California, San Francisco. Dr. Righellis is a diplomate of the American Board of Orthodontics, is on the editorial review board for the American Journal of Orthodontics and lectures domestically and internationally on excellence in clinical orthodontics. L. Douglas Knight, DMD, Louisville, KY Dr. Knight received his dental degree from the University of Kentucky and was awarded a certifi cate in orthodontics and dentofacial orthopedics from New York University. Dr. Knight completed a com- prehensive two-year clinical program in occlusion and orthodontics at the Roth- Williams Center for Functional Occlusion. In private practice, Dr. Knight is a diplo- mate of the American Board of Ortho- dontics, a fellow of the Academy of Gen- eral Dentistry, an active member of the American Association of Orthodontists, and lectures domestically and interna- tionally on new orthodontic techniques and interdisciplinary dentistry. Photograph: (Komsan Loonprom /Shutterstock) Avoiding common problems in tooth extractions By Dr Kamis Gaballah, UAE The last two decades have seen sig- nifi cant advances in restorative tech- niques and materials for dentistry. The latter, along with community- based preventive measures that aim to reduce the incidence of car- ies, have resulted in many patients living with functional teeth for a longer period. Yet, extraction of teeth forms the considerable bulk of the workload in oral surgeries owing to several factors, including the late presentation of patients with ad- vanced dental disease, the presence of symptomatic impacted teeth, such as third molars, and the need to extract teeth for orthodontic or orthognathic treatment. The extraction of teeth varies greatly based on the type of patient who is undergoing the procedure. For ex- ample, elderly patients with signifi - cant co-morbidities and on a com- plex combination of medications as compared with young healthy individuals render the procedure complicated and require much more preparation with modifi cations dur- ing and after patient management. Additionally, extractions can range from a single, fully erupted tooth with favourable morphology to mul- tiple misaligned, impacted teeth or teeth with challenging morphology. Local anatomy, such as tooth prox- imity to the nerve, maxillary sinus and tuberosity, also plays a signifi - cant role. These variations usually dictate who is to perform the extrac- tion, as many general practitioners deal with less complicated cases of dental extraction in individuals re- garded as healthy patients and may not feel comfortable operating on medically complex patients. Risk factors for IDN injury during LM3 extraction Overall risk factors for IDN injury Full bony impactions Horizontal impactions Use of burs for extraction Radiographic risk markers Radiographic signs of increased risk of IDN injury Apices of the LM3 located inferior to the lower border of the IDC Darkening of the root Abrupt narrowing of the root Interruption and loss of the white line representing the IDC Clinical observation of the bundle during surgery Displacement of the IDC by the roots Excessive bleeding into the socket during surgery Abrupt narrowing of one or both of the white lines Patient´s age Representing the IDC most of dentists and surgeons Table 1 Complex extraction cases have been linked to a higher rate of postop- erative complications; therefore, a cautious and systematic approach should be adopted that includes a detailed preoperative assessment to predict the potential diffi culties that might arise during extraction. The documentation of all complicat- ing risk factors along with their po- tential postoperative morbidities is crucial and should be included in the informed consent. In the following article, other useful tips will be pro- vided that are not usually included in traditional textbooks or lecture notes to help general practitioners to perform safer extractions. During clinical examination, it has been proven useful to observe the patient’s build. Tall and muscular in- dividuals tend to have a long ramus with a higher mandibular foramen, and this increases the possibility of failure of the inferior dental nerve block procedure if the former is not taken into account when determin- ing the height of the injection site. This can be aided by tracing the in- ferior dental canal (IDC) to the man- dibular foramen in the preoperative panoramic radiograph. The teeth of such individuals may also have ÿPage E3