Pacific Coast Society of Orthodontists Bulletin Spring 2018 - 44

Presentation Summary

Doctors

Myths, Dogma, Untruths, and
Unpredictability in Modern Orthodontics
Dr. Jae Hyun Park
PCSO Bulletin Editor-in-Chief

Dr. Elliot Moskowitz
Editor-in-Chief
Seminars in Orthodontics

Presented by Dr. Elliot Moskowitz, Arizona State
Orthodontic Association, Scottsdale, AZ, December
2017
Orthodontic Dogma
In this age of information via the Internet, the
dental profession is unable to regulate unsubstantiated orthodontic assertions, so it is becoming increasingly difficult to distinguish valid
evidence-based clinical information from manufacturers' claims. Dr. Moskowitz reminds the
orthodontic community to focus on the three
primary goals of treatment: esthetics, function,
and stability. These goals should be at the forefront of clinicians' minds as they tackle the ageold question of whether or not to extract. All too
often, clinicians find themselves in an "always" or
"never" mindset regarding extraction versus nonextraction treatment. No two orthodontic cases
are the same, however, so the orthodontist should
think critically, avoid empirical beliefs, and focus
on the optimal treatment plan for each patient.
Unfortunately, no burden of proof is placed on
manufacturers' claims that bracket systems and
specific appliances can drastically increase successful treatment outcomes. The real magic of
orthodontic treatment remains in the hands of
orthodontists, not in the unsubstantiated claims
from appliance manufacturers. Dr. Moskowitz
addressed a host of fallacies being put forth in
the current orthodontic climate, including claims
that extraction therapy causes sleep apnea and
temporomandibular joint disorders. He also
addressed the intensifying phenomenon of public-driven orthodontics and discussed the dangers of do-it-yourself orthodontic businesses.
Pseudo-Class III Malocclusion
Pseudo-Class III malocclusion is often associated
with a forward mandibular postural shift.
Patients with this type of occlusion often have
deficient midfacial length and maxillary arch
length, upper lip retrusion, excessive maxillomandibular anterior displacement, retroclined
maxillary incisors, and normal vertical development. Cephalometric values are usually less disparate than true Class III malocclusion. It is

44

frequently more challenging to differentiate from
true Class III malocclusions in the mixed dentition. Pseudo-Class III malocclusions are much
more amenable to orthodontic treatment than
are true Class III malocclusions.
There are obstacles to using cephalometrics to
differentiate between skeletal and pseudo-Class
III patients in the mixed dentition. Forward
mandibular posturing can falsely exaggerate
cephalometric values like SNB. Also, the A point is
often hard to locate with accuracy. Likewise, the
extent of any significant disparate relationship
between the maxilla and mandible has not been
clearly expressed in a young individual via
cephalometric analysis.
Early intervention for correcting pseudo-Class III
malocclusion provides simple, rapid, stable resolution and lowers the risk of developing skeletal
Class III malocclusions, at least as it might relate
to maxillary hypoplasia. The main goal during
Phase 1 is to reduce the functional shift of the
mandible and increase the maxillary arch length.
The Quick Fix device by Dr. Jay Bowman facilitates
advancement of the maxillary incisors, utilizing
a traditional 2ú4 edgewise appliance.1 With a
rectangular stainless steel archwire in place,
open-coil springs (OCS), arch locks, and Side Swipe
auxiliaries are used. The latter prevents soft-tissue
irritation resulting from the wire protruding past
the molar tube. Arch locks control the compression of the OCS.
When a facemask is used for enhancement of
maxillary protraction, it can be combined with
palatal expansion. However, whether there is
measurable benefit with maxillary expansion in
the absence of transverse deficiencies is controversial. For obvious transverse problems, rapid
maxillary expansion initially results in protraction, but ultimately it produces the same results
as a slow expander.2 When there is no transverse
deficiency, palatal expanders are usually unnecessary, and the lower molars must be uprighted
first. With minor deficiencies such as a mild
crossbite, palatal expansion is unnecessary. The

PCSO Bulletin  Spring 2018



Table of Contents for the Digital Edition of Pacific Coast Society of Orthodontists Bulletin Spring 2018

Pacific Coast Society of Orthodontists Bulletin Spring 2018 - 1
Pacific Coast Society of Orthodontists Bulletin Spring 2018 - 2
Pacific Coast Society of Orthodontists Bulletin Spring 2018 - 3
Pacific Coast Society of Orthodontists Bulletin Spring 2018 - 4
Pacific Coast Society of Orthodontists Bulletin Spring 2018 - 5
Pacific Coast Society of Orthodontists Bulletin Spring 2018 - 6
Pacific Coast Society of Orthodontists Bulletin Spring 2018 - 7
Pacific Coast Society of Orthodontists Bulletin Spring 2018 - 8
Pacific Coast Society of Orthodontists Bulletin Spring 2018 - 9
Pacific Coast Society of Orthodontists Bulletin Spring 2018 - 10
Pacific Coast Society of Orthodontists Bulletin Spring 2018 - 11
Pacific Coast Society of Orthodontists Bulletin Spring 2018 - 12
Pacific Coast Society of Orthodontists Bulletin Spring 2018 - 13
Pacific Coast Society of Orthodontists Bulletin Spring 2018 - 14
Pacific Coast Society of Orthodontists Bulletin Spring 2018 - 15
Pacific Coast Society of Orthodontists Bulletin Spring 2018 - 16
Pacific Coast Society of Orthodontists Bulletin Spring 2018 - 17
Pacific Coast Society of Orthodontists Bulletin Spring 2018 - 18
Pacific Coast Society of Orthodontists Bulletin Spring 2018 - 19
Pacific Coast Society of Orthodontists Bulletin Spring 2018 - 20
Pacific Coast Society of Orthodontists Bulletin Spring 2018 - 21
Pacific Coast Society of Orthodontists Bulletin Spring 2018 - 22
Pacific Coast Society of Orthodontists Bulletin Spring 2018 - 23
Pacific Coast Society of Orthodontists Bulletin Spring 2018 - 24
Pacific Coast Society of Orthodontists Bulletin Spring 2018 - 25
Pacific Coast Society of Orthodontists Bulletin Spring 2018 - 26
Pacific Coast Society of Orthodontists Bulletin Spring 2018 - 27
Pacific Coast Society of Orthodontists Bulletin Spring 2018 - 28
Pacific Coast Society of Orthodontists Bulletin Spring 2018 - 29
Pacific Coast Society of Orthodontists Bulletin Spring 2018 - 30
Pacific Coast Society of Orthodontists Bulletin Spring 2018 - 31
Pacific Coast Society of Orthodontists Bulletin Spring 2018 - 32
Pacific Coast Society of Orthodontists Bulletin Spring 2018 - 33
Pacific Coast Society of Orthodontists Bulletin Spring 2018 - 34
Pacific Coast Society of Orthodontists Bulletin Spring 2018 - 35
Pacific Coast Society of Orthodontists Bulletin Spring 2018 - 36
Pacific Coast Society of Orthodontists Bulletin Spring 2018 - 37
Pacific Coast Society of Orthodontists Bulletin Spring 2018 - 38
Pacific Coast Society of Orthodontists Bulletin Spring 2018 - 39
Pacific Coast Society of Orthodontists Bulletin Spring 2018 - 40
Pacific Coast Society of Orthodontists Bulletin Spring 2018 - 41
Pacific Coast Society of Orthodontists Bulletin Spring 2018 - 42
Pacific Coast Society of Orthodontists Bulletin Spring 2018 - 43
Pacific Coast Society of Orthodontists Bulletin Spring 2018 - 44
Pacific Coast Society of Orthodontists Bulletin Spring 2018 - 45
Pacific Coast Society of Orthodontists Bulletin Spring 2018 - 46
Pacific Coast Society of Orthodontists Bulletin Spring 2018 - 47
Pacific Coast Society of Orthodontists Bulletin Spring 2018 - 48
Pacific Coast Society of Orthodontists Bulletin Spring 2018 - 49
Pacific Coast Society of Orthodontists Bulletin Spring 2018 - 50
Pacific Coast Society of Orthodontists Bulletin Spring 2018 - 51
Pacific Coast Society of Orthodontists Bulletin Spring 2018 - 52
Pacific Coast Society of Orthodontists Bulletin Spring 2018 - 53
Pacific Coast Society of Orthodontists Bulletin Spring 2018 - 54
Pacific Coast Society of Orthodontists Bulletin Spring 2018 - 55
Pacific Coast Society of Orthodontists Bulletin Spring 2018 - 56
Pacific Coast Society of Orthodontists Bulletin Spring 2018 - 57
Pacific Coast Society of Orthodontists Bulletin Spring 2018 - 58
Pacific Coast Society of Orthodontists Bulletin Spring 2018 - 59
Pacific Coast Society of Orthodontists Bulletin Spring 2018 - 60
Pacific Coast Society of Orthodontists Bulletin Spring 2018 - 61
Pacific Coast Society of Orthodontists Bulletin Spring 2018 - 62
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