Figure 2 — Same patient 10 months into treatmentMany adult orthodontic treatment plans include interdisciplinary treatment such as implants and veneers. Patients who would never consider orthodontics due to the stigma associated with traditional orthodontics can now be treated “invisibly” and, in many cases, much quicker than ever before.Increased recallsPatients in active orthodontic care are told to return to their general dentists on a three-month recall program to better monitor their hygiene during this critical period. This adds four visits to the dentist over the course of 24 months of orthodontic treatment.New technologiesThe most talked about breakthrough in orthodontics is skeletal anchorage. Traditionally, orthodontists have struggled to attain anchorage in many situations. Temporary anchorage devices, known as TADs or miniscrews, have provided an absolute anchorage solution.In order to move an object, one needs a counter support to push or pull against. In orthodontics we pit the mass of a tooth or group of teeth against another tooth or group of teeth. Certain clinical situations, however, call for a point of anchorage that is beyond the dentition, or that will not cause any unintended movement of the anchor teeth.Miniscrews allow the orthodontist to attain absolute anchorage without affecting any other teeth. This allows movements that would have been impossible, or very difficult, with traditional means. It also allows for an appliance and treatment design specific to the target area without a full mouth of orthodontics.The following cases illustrate only one example of how skeletal anchorage is changing the face of not just orthodontics, but general and prosthetic dentistry as well.Case oneA 45-year-old patient presented to her general dentist requesting an implant to replace her lower left second molar. The dentist noted supereruption of the maxillary second molar and referred the patient to our office for full orthodontic appliances to intrude the maxillary left second molar, to avoid RCT and crown of No. 15.
This is a perfect example of how skeletal anchorage benefits general dentists as well as orthodontists.Case twoA 67-year-old female was being treated by her dentist for years but was extremely unhappy with her left posterior occlusion. She desperately wanted implants on the lower left. She had zero clearance due to supereruptions of her maxillary posterior. She was told that nothing could be done short of extraction and implants on the maxillary left, in addition to the implants on the mandibular left. She, therefore, decided to do nothing as that plan was too excessive.
Figure 6 — Supererupted posteriorAfter her dentist retired, the patient found herself in the office of a colleague who offered a new solution. He referred her to our office for posterior intrusion with miniscrew anchorage. Over the course of six months, we used one buccal and two palatal miniscrews to intrude the patient’s supererupted teeth.
Board-certified co-founder of KinderSmiles, a pediatric dentistry and orthodontic practice located in Oradell, N.J., Adam Schulhof, DMD, specializes in cosmetic solutions to orthodontics, such as Invisalign, iBraces, and other orthodontic treatment options. Dr. Schulhof is certified as a premier provider of iBraces. After receiving his DMD at the University of Medicine & Dentistry, where he graduated at the top of his class, Dr. Schulhof was inducted into the Omicron Kappa Upsilon Dental Honors Society. He was then accepted to the prestigious orthodontic program at Columbia University. Dr. Schulhof volunteers as a clinical instructor at the University and lectures for 3M. When not fixing smiles, Dr. Schulhof can be found snowboarding, riding his motorcycle, or at home in Bergen County with his wife, three children, and two dogs.