The 'Missing Links' in Current Orthodontic

 Diagnosis and Treatment Procedures:

As aSpecialist Orthodontist in Melbourne- Australia for the past 30 years,ex-President of the Australian Society of Orthodontists and current member ofthe World Federation of Orthodontists, I was delighted to discover this year  two ' Missing Links' in my previous clinicaldiagnosis and treatment techniques after visiting the practice of Dr AriMasters.

The major 'MissingLink' in my diagnosis and treatment planning has been my reliance on the ratherlimited information available from OPG and lateral cephalometric radiographs incomparison with the wealth of diagnostic information provided by Dr Masters'use of Cone Beam Imaging.

The major 'Missing Link' in my clinical treatment mechanics is my failure to becomeinformed about the clinical use of the ' Myobrace' appliance thus depriving mypatients of a valuable treatment option to retrain and adapt the muscles of thetongue, cheeks and lips to the final position of the teeth at the end of activetreatment.

Over thepast 15 to 20 years of my professional practise in 'traditional' orthodonticdiagnosis, treatment planning and treatment mechanics with fixed appliances, Ihave become increasingly concerned about many of the concepts and treatmentprinciples of my University orthodontic training, such as the premise that tosignificantly change the lower inter-canine width will guarantee post-treatmentrelapse unless life-time retention is used after removal of the fixed appliances.

I have alsobeen concerned about the relatively high incidence of extraction of 2 upper,and sometimes also 2 lower premolars as a component of my own, and many of mySpecialist colleagues in orthodontic treatment plans.

Over thepast 20 years of my practise as a Specialist Orthodontist   I haveincreasingly been keen to commence active orthodontic treatment on my patients duringthe mixed dentition to correct Class 11 and Class 111 skeletal malocclusionsand to expand the dental arches to their maximum potential with my principleaims of avoiding the need for headgear, extraction of permanent teeth anddesire to avoid the need for a second stage of treatment with braces.

stage offixed appliance treatment, and in many cases I still felt the need to extracttwo or more premolars, to achieve my final correction of the  dental crowding and  reduction of large overjets, to produce  an ideal occlusion with good facial aesthetics in balance with the patient's facialmusculature.

I was  troubled by the development of significantposterior open bites after mixed dentition corrections with my removablefunctional orthopaedic appliances such as the bionator and twin block ,requiring me to place fixed appliances and use vertical elastics to close downthe open bites and to  achieve excellent interdigitationof all permanent teeth.

Over recentyears I was frustrated by my inability in many of my phase (1) treatment mixeddentition patients to avoid the extraction of permanent teeth to relieve thecrowding of erupting permanent canines and the reduction of large overjets, andmy inability for most patients to avoid the need for a second phase oftreatment with fixed appliances.

I couldnever find that elusive 'Missing Link' in treatment mechanics to predictablyguide the erupting permanent teeth into an ideal occlusion without the need formost of my mixed dentition patients to undergo phase (2) treatment with fixedappliances.

Over recentyears I heard from a number of  parentsof my own patients, of the high satisfaction level and increasing credibilityof Dr  Masters' ' No Braces' and 'NoExtractions' practice at The Nobrace Centre passed on to them by variousfriends, neighbours, relatives and fellow primary school parents of children who had undergone treatmentwith Dr Masters.

I wonderedif perhaps Dr Masters had discovered the ' Missing Link' in my ambition tosuccessfully treat the majority of my patients in the mixed dentition withonly  one phase of treatment without theneed for extraction of permanent teeth plus a second phase of braces treatment.

Severalmonths ago I telephoned Dr Masters to enquire whether he would allow me tovisit his practice for a few days to observe and learn the clinical techniqueshe has been using so successfully in avoiding the extraction of permanent teethand fitting of braces for the majority of his patients who present fortreatment at a young age, well before loss of all their deciduous teeth.

Dr Masterswas most welcoming and generous in sharing his sequence of treatment techniqueswith me. I was truly amazed at the high level of excellence of his patientexamination and diagnosis with use of the radiographic Cone Imagining   technology which makes the use of OPG and cephalometricradiographs seem almost obsolete.

I was alsoamazed by the sequence of clinical techniques that Dr Masters has evolved insignificantly expanding the maxillary and mandibular dental arches with aseries of removable appliances, with special focus on developing and advancingthe Pre-maxilla, so as to produce good upper lip support and open-up space inthe arches for eruption of crowded permanent canines, in combination with the 'Myobrace'appliance to guide the erupting permanent teeth into a zone of stability.

By utilizingthe 'Myobrace' to reprogram the oral musculature to accommodate and adjust tothe  position of the teeth in the finalcorrected occlusion over several years, during the transition from the mixeddentition to the permanent dentition, the teeth eventually finish in that zoneof improved stability.

I have observedthat the combination of Pre-maxillary advancement/ development, advancement oflower incisors and lateral expansion of upper and lower dental arches with aseries of removable appliances in combination with the 'Myobrace' technique,significantly improves the patient's final lip support enhancing facialaesthetics, thus avoiding a common observation of retruded lips and concave lipprofiles seen in many patients following 'traditional' fixedappliance treatments.

Furthermore,the treatment sequences used by Dr Masters in younger children, rather thanwaiting for the permanent canines to erupt prior to commencing activeorthodontic treatment,   providespredictable attractive full smiles and virtually eliminates the usual retentionproblems inherent in the current 'traditional' practise offixed appliance orthodontic treatment procedures, without the myofunctionalchanges achieved by using the 'Myobrace' appliance during the patient's activepubertal growth period during the transition from the mixed dentition to thepermanent dentition as the patient matures from a child to a teenager.

I have nowchanged my own mixed dentition orthodontic treatment diagnosis, treatmentplanning and treatment mechanics to follow the concepts and techniques I haveobserved in Dr Masters' practice.

Dr Peter J Horkin

BDSc ( MelbourneUniversity), LDS (DentalBoard-Victoria), MDSc-Orthodontics (MelbourneUniversity),   FRACDS-Honours {Children's Dentistry}                                                                                             

 SpecialistOrthodontist