Pacific Coast Society of Orthodontists Bulletin Spring 2018 - 47

Presentation Summary

The treatment for altered passive eruption is
esthetic crown-lengthening surgery. A facial full
thickness flap is elevated one tooth distal to the
distal extent of the smile bilaterally. The alveolar
bone is moved 2 mm apical to the CEJ on each
tooth, and thinned. The tissue is then replaced
and sutured 3 mm coronal to the new alveolar
crest. The postop course is usually easy for the
patient and requires only mild analgesics for pain
management.
4. Alveolar bone
This is the most difficult global diagnosis -
dentoalveolar extrusion (DAE). The teeth
supererupt and bring bone and soft tissue with
them, resulting in a gingival line which is not
parallel with horizon. There are three reasons a
patient can present with DAE: first, due to lack of
opposing teeth; second, due to attrition and/or
erosion; third, due to a developmental cant. There
are nine treatment options for DAE, but the three
most commonly used are functional crown
lengthening, orthodontic intrusion, and restoring
at an increased vertical dimension.
5. Skeletal bone
The primary skeletal discrepancies that we treat
are vertical maxillary excess, vertical maxillary
deficiency, and A-P discrepancies, i.e., Class II and
Class III.
The 5 refers to the five core questions that are
necessary to a global diagnosis.
1. Face height: the middle third and lower third
of the face should be 1:1. Profile should be
straight.
2. Lip length: Average length of upper lip in young
female is 20 to 22 mm; in the young male, 22
to 24 mm. The lip will lengthen with age.

Spring 2018  PCSO Bulletin

Doctors

3. Gingival line in relation to the horizon should
be straight. If the teeth have supererupted,
the gingival line will not be parallel to the
horizon.
4. The average length of the maxillary central
incisor is 10 to 11 mm.
5. The clinician should be able to feel the CEJ in
the sulcus.
When the answers to the five core questions fall
outside the norm, the global diagnosis can then
be made.
The 6 refers to the six tools that we can use to
correct any landscape/tooth/gingiva problem.
1.
2.
3.
4.
5.
6.

Tissue graft
Crown lengthening
Orthodontic intrusion
Orthodontic extrusion
Surgery
Plastics (including Botox, filler, and plastic surgery procedures)

The primary purpose of adult orthodontics is to
decrease the restorative compromise. This occurs
in two ways:
1. The number of teeth requiring restorations is
commonly decreased when the teeth are
moved into their correct positions.
2. Decreased amount of tooth structure removed.
The restorations can commonly be more conservative enamel-bonded restorations.
Treatment goals for the adult orthodontic
patient:
 Maxillary dental midline coincident with
facial midline
 Ability to make proportional front teeth
 Good anterior guidance
 Back teeth touching 

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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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