Seminar 2: Expectations of the session Taking a Lateral Ceph



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Because these red lines are used to in the diagnosis of tooth rotations, which then is used to select brackets for each tooth.


  1. What are the problems if you make the teeth too small?

The dental vto then under-estimates the incisor advancement and you may make a non extraction diagnosis that finishes too protrusive. The other problem is that the 19x25 loops (keyhole and T) do not fit when the time comes to insert these archwires.


  1. Where are the archwires placed in permanent dentition?

On the incisal edges, slightly back from the center. Average the crowding


  1. Where are the archwires placed in the mixed dentition?

Just in front of the incisors.


  1. How do you rotate the archwire to center it on the model, correcting for non-vertical positioning of the model on the scanner?

Click on the archwire or shape of the mandible to turn it blue (selected), then on the “right end” of the wire or shape, drag the wire to rotate it.



  1. Where are the ‘buccal points” placed on the bicuspids and molars?

On the buccal surface where the archwire would pass if engaged into the bracket of that tooth.


  1. if there is a missing bicuspid, where do I place the dots for that tooth in the initial model measuring tracing?

Usually on the other bicuspid in that quadrant, or a similar bicuspid in the opposite quadrant, so as to get the size correct. Be sure to make a separate red line for the missing tooth so it is obvious you have 2 teeth represented on the one tooth.




  1. if there is a missing molar, where do I place the dots for that tooth in the initial model measuring tracing?

The distal dot generally goes where the distal of the molar “would be” if it was present. The mesial dot should be placed on the distal of the bicuspid (do not leave space or this will result in incisor retraction). The buccal point can be estimated or placed on the 2nd molars to measure transverse width. **if you use the 2nd molar for 36/46B point, then use 16/26C points on the upper second molar mesial-buccal cusp tips.
**missing bicuspid AND molar.

  1. What does the ‘shape of the mandible’ represent?

The cortical bone shape of the mandible. Otherwise known as the lingual shadow.
Editing cephs and model measuring

  1. How do you check the sublabial points on a lateral ceph for correct positioning?

Select the upper or lower profile and check that the 3rd point from the incisor (square point) is at the level of the upper or lower incisor apex. This is the point that the lips rotate on the dental vto.


  1. How do you check the points on a lateral ceph traced by another?

Turn off vectors, turn off drawing, turn back on points. Check points and move as needed, calculate and save.


  1. How do you check the points on a frontal ceph traced by another?

Leave on the vectors so you can see where the points are positioned. Move any points that need to be moved, then calculate and save.


  1. How do you check the points on a model measuring?

Lock the archwire, turn off the archwire, check the points and red lines to be sure they represent the widest mesial-distal width and represent the rotation of teach tooth. Turn back on the archwire, be sure the upper archwire and shape of the mandible are centered and in the correct position on the incisors. If not, turn on-off ‘lock’ the archwire, then move as needed, calculate and save.


  1. How do you change archwire shape and size in a previously completed model measuring?

Select the archwire or shape you want to change, turning it blue. Click F3 to move forward in the sequence of wires and shapes or F5 to move back through the sequence. Position the shape, rotate as needed, calculate and save.
Dental VTO, alignment and bicuspid extraction

  1. What does “vto” mean?

Visual treatment objective.


  1. How do you make an alignment vto and what does this represent in the permanent dentition?

Once you have completed model measuring and lateral ceph tracings, open the lateral ceph, click the VTO button. If you only have one model, the alignment vto will automatically appear. If there is more than one model measuring project, you need to select the start model measuring.

This represents where the incisors would be positioned if you simply straightened the teeth using the archwire shape and size selected. How much advancement or retraction.


  1. What does the alignment vto represent in the mixed dentition?

The final dental position if you straighten the teeth with the lower molar maintained in the current position (no shift into E space, use a Lower lingual arch?). note: if you want to represent the alignment vto without a lower lingual arch placed, then 36/46M points are placed 1.5mm more forward.


  1. How do you make an exact copy of the model measuring in preparation to make a class II elastic vto?

Open the model measuring you want to copy (start or alignment model measuring) then click the “paste analysis in new page” icon. Label Class II elastic model if non growing, class II elastic vto if growing.




  1. Which points do I move to make a class II elastic vto and what does this represent?

36/46M points are moved forward the amount of the class II. When class II elastics are used to correct class II, the lower arch moves forward to make the correction.


  1. Which points do I move to make a ‘distalization vto” and what does this represent?

16/26M points are moved back the amount of the class II. Distalization mechanics, such as the use of cervical headgear, would be applied to get this dot representation. The further the dots move back, the more you will need to extract molars to get the final picture(vto) represented by the model measuring.


  1. Which points do I move to make a “moderate anchorage” bicuspid extraction vto and what does this represent?

[lock the archwire], then move 34/44M points back ½ the bicuspid (moderate anchorage). Then move 14/24M points back ½ the bicuspid +the amount of class II (if there is any).

The space made on the mesial of the bicuspid is consumed by the anterior 6 teeth, aligning the crowding on the inside of the archwire shape, then if there is any remaining space, the anterior segment moves back to fill it up.

The space distal to the newly positioned mesial dots, with a red line still from the distal-to-mesial dots, represents the forward movement of the posterior segment.


  1. which points do I move to make a “moderate-maximum anchorage” vto and what does this represent?

[lock the archwire], then move 34/44M points back ¾ of the bicuspid (moderate-maximum anchorage). Then move 14/24M points back ¾ the bicuspid+the amount of class II (if there is any).

The space made on the mesial of the bicuspid is consumed by the anterior 6 teeth, aligning the crowding on the inside of the archwire shape, then if there is any remaining space, the anterior segment moves back to fill it up.

The space distal to the newly positioned mesial dots, with a red line still from the distal-to-mesial dots, represents the forward movement of the posterior segment.


  1. which points do I move to make a “maximum anchorage” vto and what does this represent?

14/24/34/44Mesial points are all moved back (after first locking the archwire) to be on top of the distal points. The front teeth are aligned, and any remaining space is consumed by the anterior segment moving back. The molars stay 100% stationary.

Note: if you move the mesial points further back than the distal points, then this represents less molar anchorage, the molars are then moving forward the amount of the red line between D-M points…do NOT do this.


  1. What is a ‘growth adjusted” vto and how is this made?

This is a visual estimate of the differential horizontal growth that this patient will experience during the treatment.

Step 1: growth adjusted ceph: A copy of the start ceph is made, and labeled “[non-extract]vto”. The mandible, lower incisor, lower molar, lingual symphysis, and lower profile are all moved forward the amount of the estimated differential horizontal growth.

Step 2: growth adjusted model measuring, label “non ext vto”. Make a copy of the start model measuring. For non extraction, move 16/26M points forward the amount of added growth (upper teeth follow the extra growth of the mandible).

Step 3: open the growth adjusted ceph, click the VTO button and select “nonext vto”. Label the resulting dental vto with “non ext vto” so you can see all these projects work together.


  1. If I do NOT like a dental vto and I want to throw it away, how do I do this WITHOUT losing my start ceph?

Click the ‘small x’ on the upper right hand corner, then cancel. Do NOT click the red X next to the save icon or you will lose the highlighted start ceph.

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Treatment plans: downloading and editing

  1. Why is it important to list all the treatment options that may be considered by the orthodontists in your community?

To protect yourself from criticism that you did not consider the treatment option that others might consider as the standard of care.


  1. Why is it important to list “orthognathic surgery” in the treatment options considered for all severe class II and all class III cases?

To show that you considered surgery when making your treatment decision, protecting yourself from attack from the legal community.


  1. How do I download a treatment plan? What happens if I do not have an active internet connection?

First select the links that you want to consider for this case. Then double click on the link while connected to the internet. A window should appear with the treatment plan you want. Click the lower left hand corner button to download the plan into your patient file.

If you do not have an active internet connection, you will not see the treatment plan you want, and you cannot download this into the patient file. In this case, you can use treatment plan 200 as a blank page to write your notes.

*** as of this writing, the 2011 treatment plans (with photos) are NOT available to directly download from the internet. These were made active, but many plans take a LONG time to download and during that time your computer is locked up. Until they can fix this problem, you will first download a treatment plan from the internet, and save. Then change patients to g6.section1 plans, a patient file, find the plan you want, single click to make it active, right click, select all, right click copy, change patients back to the one you are working on, single click to open the previous plan, right click select all, DELETE KEY, right click paste the new plan into place, save. (sorry!)


  1. How do I indicate the treatment decision?

Select the link of your treatment decision and ‘mark it in red” button. Note: when reopening a patient file, single click on the red link 1 time to reopen the plan.




  1. When reopening the patient file, there will not be a visible treatment plan, even though I am sure I downloaded and edited a plan. How do I get that treatment plan into view?

Single click on the link marked in red.


  1. What is the importance of the “consultation key points” in preparing and documenting the 2nd consultation.

If you prepare what you want to say to the patient/parent and how you want to say it, you will present yourself with more confidence, resulting in a higher percentage of successful consultations.
2nd consultation:

  1. How do you tell the patient “[the final decision] is exactly as we discussed at our last visit”. What is important about this statement?

By first recording what you told the patient at the first consultation when they made the decision to take records (and pay for them). If you stay within your estimate, then you can say these words, assuming the patient will start since they already approved the estimate. No surprises!


  1. Why is a contract important in orthodontics and where do you find this [draft] document?

Establishes what is included and not included in the fee. Establishes what happens if the patient does not complete the treatment. The draft document is at the end of the patient report.


  1. why is an informed consent important in orthodontics and where do you find this [draft] document?

Legally, the patient must be informed of what they are agreeing to in the treatment and contract. Complications must be explained in advance when they make the decision to start this treatment. The draft document is found at the end of the patient report.


  1. Who in your practice will review the informed consent and contract with the patient?

At first the doctor, but then hopefully a business manager to reduce doctor time in the case and separate the doctor from the financial issues.


  1. How long do you want to schedule your doctor time for the 2nd consultation?

If the doctor spends more than 10 minutes at a second consultation, the rate of refusals (have to think about it) will go way up!


  1. What appointments follow the 2nd consultation, what time intervals between appointments, and how long do you want for these?

Placing separators: should be done at the conclusion of the 2nd consultation. 5-10 minutes only.

Fitting bands: 2-3 days after separators are placed for kids, 1 week for adults. At the start, 15 minutes per band, after experience, 5 minutes per band.

Bonding brackets and archwire tie-in. Any time after the patient has accepted treatment, you have the brackets specific for that case, and you both have the time. At the start, 2 hours, after experience 1 hour with only 10 minutes doctor time.
Tutorials

  1. Where can I find the [free] tutorials for ceph tracing and model measuring?

On your memory stick, session 2 file folder, videos folder, or on www.posortho.com, current student, additional training, IPsoft instructions.


Administration

  1. What materials MUST I have at session 3?

Bonding light

Education kit.

Section 1 student book

Section 1-2 memory stick if not copied to your computer

optional instruments from your practice

  1. scaler (any type, to remove excess adhesive from around brackets)

  2. mosquito hemostat (locking)

  3. Bard parker blade handle
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