Dental public health
Dental Public Health is a non-clinical specialty of dentistry that deals with the prevention of oral disease and promotion of oral health. Dental public health is involved in the assessment of key dental health needs and coming up with effective solutions to improve the dental health of populations rather than individuals. Prevention is becoming important. Dental related diseases are preventable and there is a growing burden on health care systems for cure. Dental public health looks beyond the role of a dental practitioner in treating dental disease, seeks to reduce demand on health care systems by redirection of resources to priority areas. Countries around the world all face similar issues in relation to dental disease. Implementation of policies and principles vary due to available of resources. Similar to public health, an understanding of the many factors that influence health will assist the implementation of effective strategies. Public health dentistry, is practiced through government sponsored programs, which are for the most part directed toward public-school children in the belief that their education in oral hygiene is the best way to reach the general public.
The pattern for such programs in the past was a dental practitioners annual visit to a school to lecture and to demonstrate proper tooth-brushing techniques. The 1970s saw the emergence of a more elaborate program that included a week of one-hour sessions of instruction and questions and answers, conducted by a dentist and a dental assistant and aided by a teacher, given several hours of instruction. Use was made of televised dental health education programs, which parents were encouraged to observe. There seems to be a lot more that can be done to help individuals prevent tooth decay and gum disease based on what is known. With fluoridation and oral hygiene, tooth decay is still the most common diet–related disease affecting many people. Tooth decay has the economic impact of heart disease and diabetes. Dental decay is however prevented by reducing acid demineralisation caused by the remaining dental plaque left on teeth after brushing. Risk factors for tooth decay include physical, environmental and lifestyle-related factors such as high numbers of cariogenic bacteria, inadequate salivary flow, insufficient fluoride exposure, poor oral hygiene, inappropriate methods of feeding infants, poverty.'
Neutralising acids after eating and at least twice a day brushing with fluoridated toothpaste will assist prevention. Cavities can develop on any surface of a tooth, but are most common inside the pits and fissures in grooves on chewing surfaces; this is where the toothbrush fluoride toothpaste can not reach effectively. Gum diseases gingivitis and periodontitis are caused by certain types of bacteria that accumulate in remaining dental plaque; the extent of gum disease depends a lot on host susceptibility. Daily brushing must include brushing of gums. Effective brushing itself, will prevent progression of both dental decay and gum diseases. Neutralising acids after eating and at least twice a day brushing with fluoridated toothpaste will assist preventing dental decay. Stimulating saliva flow assists in the remineralisation process of teeth, this can be done by chewing sugar free gum. Using an interdental device once daily will assist prevention of gum diseases. Fissure sealants applied over the chewing surfaces of teeth, block plaque from being trapped inside pits and fissures.
The sealants make prevent acid demineralisation and tooth decay. A diet low in fermentable carbohydrates will reduce the buildup of plaque on teeth; the American Board of Dental Public Health have devised a list of competencies for dental public health specialists to follow. Dental public health specialists are a select group of certified dentists; the 10 competencies allow for growth and learning of individuals and set expectations for the future. An advantage of the design is; the list is updated periodically. Major areas of dental public health activity include: Oral health surveillanceNational Oral Health Surveillance system is designed to monitor the effects of oral disease on the population, as well as monitor how the oral care is delivered. Additionally the status of water fluoridation on both a state and a national level is continually supervised Assessing the evidence on oral health and dental interventions and services Policy and strategy development and implementation Oral health improvement Health and public protection Developing and monitoring quality dental services Dental public health intelligence Academic dental public health Role within health services Dental health is concerned with promoting health of an entire population and focuses on an action at a community level, rather than at an individual clinical approach.
Dental public health is a broad subject that seeks to expand the range of factors that influences peoples oral health and the most effective means of preventing and treating these oral health problems. To allow a health problem to be properly managed, it is important that there is a set of rules or criteria to follow which determines what is defined as a public health problem and what is the best way to manage health problems in communities; the following are questions should be considered when addressing public health problems: Once these questions have been answered, the way a public health problem is acted upon to protect a population can be determined. Water fluoridation is the implementation of artificial fluoride in public water supplies with the intentions to halt the progression of dental diseases. Fluoride has the ability to interfere with
Lucy Hobbs Taylor
Lucy Hobbs Taylor was a school teacher and a dentist, known for being the first American woman to graduate from dental school. She was denied admittance to the Eclectic Medical College in Cincinnati, Ohio due to her gender. Due to this, a professor in the college agreed to tutor her and encouraged her to practice dentistry. Once again, she applied to this time Ohio College of Dentistry, she was once again refused admittance due to her gender. From there, a college graduate agreed to tutor her, allowing her to continue her studies towards dentistry. In 1861, she decided to open her own practice instead of attempting to get into a college once again. After a year, Lucy Hobbs Taylor opened a dentistry practice; this allowed her to be accepted as a dentist without the diploma and become part of the Iowa State Dental Society. Being part of this society meant that she was serving as the group’s delegate to the American Dental Associate Convention, only 3 years after moving to Iowa. With great coincidence, that same year the Ohio College of Dentistry decided to waive the policy prohibiting women being admitted to the institution.
Taylor enrolled as a senior student thanks to her dentistry experience she had accumulated over the years. She graduated in 1866. Lucy Beaman Hobbs was born on March 1833 in Constable, New York, she was seventh out of ten children total. Both her parents passed away when she was 12, forcing her to obtain a job as a seamstress to support her siblings. Hobbs subsequently attended school and graduated from Franklin Academy in New York and began teaching for ten years in Michigan. In 1859, she applied to medical school at Eclectic Medical College. Hobbs was denied entrance because of her gender, but she was able to study under the supervision of a teacher from Eclectic. Subsequently, Hobbs applied to the Ohio College of Dentistry; when she was refused admission to dental school, she began a private program of study with a professor, Dr. Jonathan Taft, from the Ohio College of Dental Surgery. Hobbs was again rejected; as a response, she opened up her own practice, allowing her to practice dentistry without having to obtain a diploma.
After studying dentistry, Lucy Hobbs started her own practice in Cincinnati in 1861. She soon moved to Bellevue and McGregor, where she spent three years. In 1865, she gained all professional recognition and was allowed to join the Iowa State Dental Society, was sent as a delegate to the American Dental Association convention in Chicago; that November, she entered the Ohio College of Dental Surgery as a senior, where in February 1866, she earned her doctorate in dentistry, becoming the first woman in the United States to do so. She wrote, "People were amazed when they learned that a young girl had so far forgotten her womanhood as to want to study dentistry." Hobbs next moved to Chicago where she met James M. Taylor whom she married in April 1867, becoming Lucy Hobbs Taylor. Taylor convinced her husband to enter dentistry; the two moved to Lawrence, where they had a big and successful practice, until James Taylor died in 1886. After her husband's death, Lucy Taylor ceased to be an active dentist, but became more active in politics, campaigning for greater women's rights, until her own death on October 3, 1910.
In her time as a dentist, Lucy Hobbs Taylor opened up brand new doors to many women in the future the medical field doors. She believed that her journey was complete by "making it possible for women to be recognized in the dental profession on equal terms with men." By 1900 one thousand women had followed Lucy Taylor into dentistry, an increase many attribute to her accomplishments. In 1983, the American Association of Women Dentists honored Taylor by establishing the Lucy Hobbs Taylor Award, which it now presents annually to AAWD members in recognition of professional excellence and achievements in advancing the role of women in dentistry. Amalia Assur Rosalie Fougelberg Emma Gaudreau Casgrain Matlak, A. "Surfing for history: an annotated bibliography of select websites/pages on the history of dentistry". Journal of the History of Dentistry. 55: 26–9. PMID 17564149. "Women's role in dentistry celebrated". Dentistry Today. 19: 32, 40–1. 2000. PMID 12524757. Giangrego, E. "Looking back. Lucy Hobbs Taylor".
CDS Review: 42. PMID 11957833. Dees, L A. "Before we were created equally: the story of Lucy Hobbs Taylor, DDS". Journal of the History of Dentistry. 49: 105–10. PMID 11813374. Albert, S B. "It takes determination to be a dentist". The New York State Dental Journal. 65: 3–5. PMID 10079697. Hine, M K. "A look at women's contributions to dentistry". Journal of the Indiana Dental Association. 72: 36–8. PMID 8040726. "Lucy paved the way". The New York State Dental Journal. 59: 72. 1993. PMID 8247450. Davis, S. "Lucy Hobbs Taylor: the mixed blessing of being the first". Journal of the American Dental Association. 117: 443. PMID 3053854. Hewitt, D L. "Dentistry's first lady: Lucy Hobbs Taylor". The Ohio Dental Journal. 62: 28–31. PMID 3062517. Hofer, K. "Dr. Lucy Hobbs Taylor, first woman dentist". CAL. 45: 13–5, 18. PMID 7028217. Walker, J C. "Lucy had courage". CAL. 39: 29–30. PMID 795514. Edwards, R W. "The first woman dentist Lucy Hobbs Taylor, D. D. S.". Bulletin of the History of Medicine. 25: 277–83. PMID 14848611. Lucy Hobbs Taylor at Find a Grave
Dental braces
Dental braces are devices used in orthodontics that align and straighten teeth and help position them with regard to a person's bite, while aiming to improve dental health. Braces fix gaps, they are used to correct underbites, as well as malocclusions, open bites, deep bites, cross bites, crooked teeth, various other flaws of the teeth and jaw. Braces can be either structural. Dental braces are used in conjunction with other orthodontic appliances to help widen the palate or jaws and to otherwise assist in shaping the teeth and jaws. According to scholars and historians, braces date back to ancient times. Around 400-300 BC, Hippocrates and Aristotle contemplated ways to straighten teeth and fix various dental conditions. Archaeologists have discovered numerous mummified ancient individuals with what appear to be metal bands wrapped around their teeth. Catgut, a type of cord made from the natural fibers of an animal's intestines, performed a similar role to today’s orthodontic wire in closing gaps in the teeth and mouth.
The Etruscans buried their dead with dental appliances in place to maintain space and prevent collapse of the teeth during the afterlife. A Roman tomb was found with a number of teeth bound with gold wire documented as a ligature wire, a small elastic wire, used to affix the arch wire to the bracket. Cleopatra wore a pair. Roman philosopher and physician Aulus Cornelius Celsus first recorded the treatment of teeth by finger pressure. Due to lack of evidence, poor preservation of bodies, primitive technology, little research was carried out on dental braces until around the 17th century, although dentistry was making great advancements as a profession by then. Orthodontics began developing in the 18th and 19th centuries. In 1728, French dentist Pierre Fauchard, credited with inventing modern orthodontics, published a book entitled "The Surgeon Dentist" on methods of straightening teeth. Fauchard, in his practice, used a device called a "Bandeau", a horseshoe-shaped piece of iron that helped expand the palate.
In 1754, another French dentist, Louis Bourdet, dentist to the King of France, followed Fauchard's book with The Dentist's Art, which dedicated a chapter to tooth alignment and application. He perfected the "Bandeau" and was the first dentist on record to recommend extraction of the premolar teeth to alleviate crowding and to improve jaw growth. Although teeth and palate straightening and/or pulling was used to improve alignment of remaining teeth and had been practiced since early times, orthodontics, as a science of its own, did not exist until the mid-19th century. Several important dentists helped to advance dental braces with specific instruments and tools that allowed braces to be improved. In 1819, Delabarre introduced the wire crib, which marked the birth of contemporary orthodontics, gum elastics were first employed by Maynard in 1843. Tucker was the first to cut rubber bands from rubber tubing in 1850. Dentist, writer and sculptor Norman William Kingsley in 1858 wrote the first article on orthodontics and in 1880, his book, Treatise on Oral Deformities, was published.
A dentist named John Nutting Farrar is credited for writing two volumes entitled, A Treatise on the Irregularities of the Teeth and Their Corrections and was the first to suggest the use of mild force at timed intervals to move teeth. In the early 20th century, Edward Angle devised the first simple classification system for malocclusions, such as Class I, Class II, so on, his classification system is still used today as a way for dentists to describe how crooked teeth are, what way teeth are pointing, how teeth fit together. Angle contributed to the design of orthodontic and dental appliances, making many simplifications, he founded the first school and college of orthodontics, organized the American Society of Orthodontia in 1901 which became the American Association of Orthodontists in the 1930s, founded the first orthodontic journal in 1907. Other innovations in orthodontics in the late 19th and early 20th centuries included the first textbook on orthodontics for children, published by J.
J. Guilford in 1889, the use of rubber elastics, pioneered by Calvin S. Case, along with Henry Albert Baker; the application of braces moves the teeth as a result of pressure on the teeth. There are traditionally four basic elements that are used: brackets, bonding material, arch wire, ligature elastic; the teeth move when the arch wire puts pressure on the teeth. Sometimes springs or rubber bands are used to put more force in a specific direction. Braces have constant pressure; the process loosens the tooth after which new bone grows in to support the tooth in its new position. This is called bone remodeling. Bone remodeling is a biomechanical process responsible for making bones stronger in response to sustained load-bearing activity and weaker in the absence of carrying a load. Bones are made of cells called osteoblasts. Two different kinds of bone resorption are possible: direct resorption, which starts from the lining cells of the alveolar bone, indirect or retrograde resorption, which takes place when the periodontal ligament has been subjected to an excessive amount and duration of compressive stress.
Another important factor associated with tooth movement is bone deposition. Bone deposition occurs in the distracted periodontal ligament. Without bone deposition, the tooth will loosen and voids will occur distal to the direction of tooth movement. Traditional metal wired braces are stainless-steel and are sometimes used in combination with titanium. Traditional metal braces
Radiology
Radiology is the medical specialty that uses medical imaging to diagnose and treat diseases within the human body. A variety of imaging techniques such as X-ray radiography, computed tomography, nuclear medicine including positron emission tomography, magnetic resonance imaging are used to diagnose or treat diseases. Interventional radiology is the performance of minimally invasive medical procedures with the guidance of imaging technologies such as X-ray radiography, computed tomography, nuclear medicine including positron emission tomography, magnetic resonance imaging; the modern practice of radiology involves several different healthcare professions working as a team. The radiologist is a medical doctor who has completed the appropriate post-graduate training and interprets medical images, communicates these findings to other physicians by means of a report or verbally, uses imaging to perform minimally invasive medical procedures; the nurse is involved in the care of patients before and after imaging or procedures, including administration of medications, monitoring of vital signs and monitoring of sedated patients.
The radiographer known as a "radiologic technologist" in some countries such as the United States, is a specially trained healthcare professional that uses sophisticated technology and positioning techniques to produce medical images for the radiologist and nurse to interpret. Depending on the individual's training and country of practice, the radiographer may specialize in one of the above-mentioned imaging modalities or have expanded roles in image reporting. Radiographs are produced by transmitting X-rays through a patient; the X-rays are projected through the body onto a detector. Röntgen discovered X-rays on November 8, 1895 and received the first Nobel Prize in Physics for their discovery in 1901. In film-screen radiography, an X-ray tube generates a beam of X-rays, aimed at the patient; the X-rays that pass through the patient are filtered through a device called an grid or X-ray filter, to reduce scatter, strike an undeveloped film, held to a screen of light-emitting phosphors in a light-tight cassette.
The film is developed chemically and an image appears on the film. Film-screen radiography is being replaced by phosphor plate radiography but more by digital radiography and the EOS imaging. In the two latest systems, the X-rays strike sensors that converts the signals generated into digital information, transmitted and converted into an image displayed on a computer screen. In digital radiography the sensors shape a plate, but in the EOS system, a slot-scanning system, a linear sensor vertically scans the patient. Plain radiography was the only imaging modality available during the first 50 years of radiology. Due to its availability and lower costs compared to other modalities, radiography is the first-line test of choice in radiologic diagnosis. Despite the large amount of data in CT scans, MR scans and other digital-based imaging, there are many disease entities in which the classic diagnosis is obtained by plain radiographs. Examples include various types of arthritis and pneumonia, bone tumors, congenital skeletal anomalies, etc.
Mammography and DXA are two applications of low energy projectional radiography, used for the evaluation for breast cancer and osteoporosis, respectively. Fluoroscopy and angiography are special applications of X-ray imaging, in which a fluorescent screen and image intensifier tube is connected to a closed-circuit television system; this augmented with a radiocontrast agent. Radiocontrast agents are administered by swallowing or injecting into the body of the patient to delineate anatomy and functioning of the blood vessels, the genitourinary system, or the gastrointestinal tract. Two radiocontrast agents are presently in common use. Barium sulfate is given rectally for evaluation of the GI tract. Iodine, in multiple proprietary forms, is given by oral, vaginal, intra-arterial or intravenous routes; these radiocontrast agents absorb or scatter X-rays, in conjunction with the real-time imaging, allow demonstration of dynamic processes, such as peristalsis in the digestive tract or blood flow in arteries and veins.
Iodine contrast may be concentrated in abnormal areas more or less than in normal tissues and make abnormalities more conspicuous. Additionally, in specific circumstances, air can be used as a contrast agent for the gastrointestinal system and carbon dioxide can be used as a contrast agent in the venous system. CT imaging uses X-rays in conjunction with computing algorithms to image the body. In CT, an X-ray tube opposite an X-ray detector in a ring-shaped apparatus rotate around a patient, producing a computer-generated cross-sectional image. CT is acquired in the axial plane, with coronal and sagittal images produced by computer reconstruction. Radiocontrast agents are used with CT for enhanced delineation of anatomy. Although radiographs provide higher spatial resolution, CT can detect more subtle variations in attenuation of X-rays. CT exposes the patient to more ionizing radiation than a radiograph. Spiral multidetector CT uses 16, 64, 254 o
Surgeon
In modern medicine, a surgeon is a physician who performs surgical operations. There are surgeons in podiatry, dentistry maxillofacial surgeon and the veterinary fields; the first person to document a surgery was Sushruta. He specialized in cosmetic plastic surgery and had documented an operation of open rhinoplasty, his magnum opus Suśruta-saṃhitā is one of the most important surviving ancient treatises on medicine and is considered a foundational text of Ayurveda and surgery. The treatise addresses all aspects of general medicine, but the translator G. D. Singhal dubbed Suśruta "the father of surgical intervention" on account of the extraordinarily accurate and detailed accounts of surgery to be found in the work. After the eventual decline of the Sushruta School of Medicine in India, surgery had been ignored until the Islamic Golden Age surgeon Al-Zahrawi, reestablished surgery as an effective medical practice, he is considered the greatest medieval surgeon to have appeared from the Islamic World, has been described as the father of surgery.
His greatest contribution to medicine is the Kitab al-Tasrif, a thirty-volume encyclopedia of medical practices. He was the first physician to describe an ectopic pregnancy, the first physician to identify the hereditary nature of hæmophilia, his pioneering contributions to the field of surgical procedures and instruments had an enormous impact on surgery but it was not until the eighteenth century that surgery as a distinct medical discipline emerged in England. In Europe, surgery was associated with barber-surgeons who used their hair-cutting tools to undertake surgical procedures at the battlefield and for their employers. With advances in medicine and physiology, the professions of barbers and surgeons diverged. Surgeon continued, however, to be used as the title for military medical officers until the end of the 19th century, the title of Surgeon General continues to exist for both senior military medical officers and senior government public health officers. In 1950, the Royal College of Surgeons of England in London began to offer surgeons a formal status via RCS membership.
The title Mister became a badge of honour, today, in many Commonwealth countries, a qualified doctor who, after at least four years' training, obtains a surgical qualification is given the honour of being allowed to revert to calling themselves Mr, Mrs or Ms in the course of their professional practice, but this time the meaning is different. It is sometimes assumed that the change of title implies consultant status, but the length of postgraduate medical training outside North America is such that a qualified surgeon may be years away from obtaining such a post: many doctors obtained these qualifications in the senior house officer grade, remained in that grade when they began sub-specialty training; the distinction of Mr is used by surgeons in the Republic of Ireland, some states of Australia, New Zealand, South Africa and some other Commonwealth countries. In many English-speaking countries the military title of surgeon is applied to any medical practitioner, due to the historical evolution of the term.
The US Army Medical Corps retains various surgeon MOS' in the ranks of officer pay grades for military personnel dedicated to performing surgery on wounded soldiers. Some physicians who are general practitioners or specialists in family medicine or emergency medicine may perform limited ranges of minor, common, or emergency surgery. Anesthesia accompanies surgery, anesthesiologists and nurse anesthetists may oversee this aspect of surgery. Surgeon's assistant, surgical nurses, surgical technologists are trained professionals who support surgeons. In the United States, the Department of Labor description of a surgeon is "a physician who treats diseases and deformities by invasive, minimally-invasive, or non-invasive surgical methods, such as using instruments, appliances, or by manual manipulation". Sushruta al-Zahrawi, regarded as one of the greatest medieval surgeons and a father of surgery. ) Charles Kelman William Stewart Halsted Alfred Blalock C. Walton Lillehei Christiaan Barnard Victor Chang Australian pioneer of heart transplantation John Hunter Sir Victor Horsley Lars Leksell Joseph Lister Harvey Cushing Paul Tessier Gholam A. Peyman Ioannis Pallikaris Nikolay Pirogov Valery Shumakov Svyatoslav Fyodorov Gazi Yasargil Rene Favaloro (first surgeon to perform bypass
Orthodontics
Orthodontics and dentofacial orthopedics referred to as orthodontia, is a specialty of dentistry that deals with the diagnosis and correction of malpositioned teeth and jaws. The field was established by such pioneering orthodontists as Edward Angle and Norman William Kingsley. "Orthodontics" is derived from the Greek orthos and -odont. The history of orthodontics has been intimately linked with the history of dentistry for more than 2,000 years. Dentistry had its origins as a part of medicine. According to the American Association of Orthodontists, archaeologists have discovered mummified ancients with metal bands wrapped around individual teeth. Malocclusion is not a disease, but abnormal alignment of the teeth and the way the upper and lower teeth fit together; the prevalence of malocclusion varies, but using orthodontic treatment indices, which categorize malocclusions in terms of severity, it can be said that nearly 30% of the population present with malocclusions severe enough to benefit from orthodontic treatment.
Orthodontic treatment can focus on dental displacement only, or deal with the control and modification of facial growth. In the latter case it is better defined as "dentofacial orthopedics". In severe malocclusions that can be a part of craniofacial abnormality, management requires a combination of orthodontics with headgear or reverse pull facemask and/or jaw surgery or orthognathic surgery; this requires additional training, in addition to the formal three-year specialty training. For instance, in the United States, orthodontists get at least another year of training in a form of fellowship, the so-called'Craniofacial Orthodontics', to receive additional training in the orthodontic management of craniofacial anomalies. Treatment for malocclusion can take anywhere from 1 to 3 years to complete, with braces being altered every 4 to 10 weeks by the orthodontist. There are multiple methods for adjusting malocclusion, depending on the needs of the individual patient. In growing patients there are more options for treating skeletal discrepancies, either promoting or restricting growth using functional appliances, orthodontic headgear or a reverse pull facemask.
Most orthodontic work is started during the early permanent dentition stage before skeletal growth is completed. If skeletal growth has completed, orthognathic surgery can be an option. Extraction of teeth may be required to aid the orthodontic treatment. Starting the treatment process for overjets and prominent upper teeth in children rather than waiting until the child has reached adolescence has been shown to reduce damage to the lateral and central incisors; however the treatment outcome does not differ. The majority of Orthodontic Appliance Therapy is delivered using fixed appliances, with the use of removable appliances being reduced; the treatment outcome for fixed appliances is greater than that of removable appliances as the fixed type produces biomechanics that has greater control of the teeth under treatment: being able to move the teeth in dimensions therefore the subsequent final tooth positions are more ideal. Indications for Fixed Appliances Fixed appliances are used when orthodontic treatment involves moving teeth through 3 axis planes in the mouth.
These movements would include: 1) Rotations where the teeth are not conforming to the arch shape and there are contact displacements. 2) Multiple tooth movements where there may be crowding involved and the correction would involve the movement of numerous teeth in differing planes. 3) Bodily movement may be required to move a map-aligned tooth into the arch where the broad long axis of the tooth are correct but the tooth requires moving back into the arch maintaining the axial positions. 4) Tipping or changing the incline of the long axis of the tooth where the tooth may be proclined or retroclined and the tooth angulation is altered. 5) Root torquing - where the angle of the long axis of the tooth is changed with the position of the root being altered to facilitate a more positioned crown and root prominence. Contra-indications - Poor oral hygiene: this predisposes to decalcification, gingival hyperplasia, periodontal breakdown - Active caries - Poor motivation: treatment will last at least several months, patient needs to be committed to maintaining the highest levels of oral hygiene throughout this period.
- Mild malocclusions Risks DecalcificationPlaque accumulation around the margins of brackets and bands can result in areas of demineralisation of enamel. It is important that the patient maintains an excellent standard of oral hygiene throughout treatment. Root ResorptionThis occurs in orthodontic treatment, although it is small in amount, it is an irreversible outcome, difficult to predict. Fixed appliances cause more root resorption than removable appliances. Resorption occurs more in adults and with greater amounts of tooth movement. Root resorption stops as soon. Loss of periodontal support Loss of bone support Failed treatment Soft tissue traumaTypes of Fixed Appliances There are numerous fixed appliance systems that are in use today; these vary depending on personal preference. In basic terms, a bracket is bonded onto the center of the tooth and wires are placed in the bracket slot in order to control movement in all 3 dimensions; each individual bracket has a different shape and built in features for each particular tooth.
Chair-side fitted appliances include Edgewise, Lingual, Self-ligating bracket systems. Laboratory fabricated appliances include Herbst, Quadhelix and MIA, Lingual and Transpalatal arches and RME screw appliances
Sinus lift
Maxillary sinus floor augmentation is a surgical procedure which aims to increase the amount of bone in the posterior maxilla, in the area of the premolar and molar teeth, by lifting the lower Schneiderian membrane and placing a bone graft. When a tooth is lost the alveolar process begins to remodel; the vacant tooth socket collapses as it heals leaving an edentulous area, termed a ridge. This collapse causes a loss in both width of the surrounding bone. In addition, when a maxillary molar or premolar is lost, the floor of the maxillary sinus expands, which further diminishes the thickness of the underlying bone. Overall, this leads to a loss in volume of bone, available for implantation of dental implants, which rely on osseointegration, to replace missing teeth; the goal of the sinus lift is to graft extra bone into the maxillary sinus, so more bone is available to support a dental implant. While there may be a number of reasons for wanting a greater volume of bone in the posterior maxilla, the most common reason in contemporary dental treatment planning is to prepare the site for the future placement of dental implants.
Sinus augmentation is performed when the floor of the sinus is too close to an area where dental implants are to be placed. This procedure is performed to ensure a secure place for the implants while protecting the sinus. Lowering of the sinus can be caused by: Long-term tooth loss without the required treatment, periodontal disease, trauma. Patients who have the following may be good candidates for sinus augmentation. Lost more than one tooth in the posterior maxilla. Lost a significant amount of bone in the posterior maxilla. Missing teeth due to birth defect. Minus most of the maxillary teeth and need a strong sinus floor for multiple implants, it is not known if using sinus lift techniques is more successful than using short implants for reducing the number of artificial teeth or dental implant failures up to a year after teeth/implant placement. Prior to undergoing sinus augmentation, diagnostics are run to determine the health of the patient's sinuses. Panoramic radiographs are taken to map out the patient's upper jaw and sinuses.
In special instances, a computed tomography or CT scan is taken to measure the sinus's height and width, to rule out any sinus disease or pathology. There are several variations of the sinus lift technique. There are multiple ways to perform sinus augmentation; the procedure is performed from inside the patient's mouth where the surgeon makes an incision into the gum, or gingiva. Once the incision is made, the surgeon pulls back the gum tissue, exposing the lateral boney wall of the sinus; the surgeon cuts a "window" to the sinus, exposing the Schneiderian membrane. The membrane is separated from the bone, bone graft material is placed into the newly created space; the gums are sutured close and the graft is left to heal for 4–12 months. The graft material used can be either an autograft, an allograft, a xenograft, an alloplast, synthetic variants, or combinations thereof. Studies indicate that the mere lifting of the sinus membrane, creation of a void space and blood clot formation might result in new bone owing to the principles of guided bone regeneration.
The long-term prognosis for the technique is estimated to 94%. As an alternative, sinus augmentation can be performed by a less invasive osteotome technique. There are several variations of this technique and all originate from the original technique of Dr. Tatum, first published by Dr.s Boyne and James in 1980. Dr. Robert B. Summers described a technique, performed when the sinus floor that needs to be lifted is less than 4 mm; this technique is performed by flapping back gum tissue and making a socket in the bone within 1–2 mm short of the sinus membrane. The floor of the sinus is lifted by tapping the sinus floor with the use of osteotomes; the amount of augmentation achieved with the osteotome technique is less than what can be achieved with the lateral window technique. A dental implant is placed in the socket formed at the time of the sinus lift procedure and left to integrate with bone. Bone integration lasts 4 to 8 months; the goal of this procedure is to stimulate bone growth and form a thicker sinus floor, in order to support dental implants for teeth replacement.
Sinus dimensions and shape influence new bone formation after transcrestal sinus floor elevation: with this technique, the regeneration of a substantial amount of new bone is a predictable outcome only in narrow sinus cavities. During presurgical planning, bucco- palatal sinus width should be regarded as a crucial parameter when choosing sinus floor elevation with transcrestal approach as a treatment option. Dr. Bruschi and Scipioni described a similar technique, based on a partial thickness flap procedure; this technique increases the malleability of the crestal bone and uses not the bone directly below the sinus, but rather the bone on the medial wall, thus can be used in more extreme cases of bone resorption that would need to be treated with the lateral wall technique. The healing period is reduced to 1.5 to 3 months. An electrical mallet has been introduced to simplify the application of this and similar techniques. A major risk of a sinus augmentation is that the sinus membrane could be ripped.
Remedies, should this occur, include placing a patch over it. The sinus m
