15 Keys to Success

R.G. Wick Alexander, DDS, MSD Diplomate of the American Board of Orthodontics 840 W. Mitchell St. Arlington, Texas 76013 www.drsalexander.com www.alexanderdiscipline.com : 

R.G. Wick Alexander, DDS, MSD Diplomate of the American Board of Orthodontics 840 W. Mitchell St. Arlington, Texas 76013 www.drsalexander.com www.alexanderdiscipline.com Copyright 2006 by Dr. Richard G. Alexander. No part of this lecture may be used without permission of author.

Alexander Discipline 2006 International Symposium “FACTS vs FICTION in ORTHODONTICS May 11 & 12, 2006 Arlington Wyndham Hotel Arlington, Texas: 

Alexander Discipline 2006 International Symposium “FACTS vs FICTION in ORTHODONTICS May 11 & 12, 2006 Arlington Wyndham Hotel Arlington, Texas Copyright 2006 by Dr. Richard G. Alexander. No part of this lecture may be used without permission of author.

Slide 3: 

A A F O R E 15 KEYS TO SUCCESS

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Patient : J.W. # 8715 Age : 12 Yrs. 11 Mos.

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Class II OB: 5.5 mm OJ: 11 mm

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Pre - Treatment

Slide 8: 

86 79 7 123 25 16 127 85 Pre - TX

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Treatment Time : 25 months

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Post - Treatment

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81 78 3 107 30 127 16 96 Post - TX

25 Years Post- Treatment : 

25 Years Post- Treatment

Slide 16: 

J.W. 1/3/02 40 6 25 Yrs. Post - TX 81 77 4 103 33 16 130 94

Slide 17: 

Age : 40 Yrs. 6 Mos.

Case Comparison: 

Case Comparison

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Pre – TX 27.31 mm Post – TX 29.75 mm 25 Yrs. Post – TX 28.91 mm Mandibular Intercanine Width

Slide 20: 

Pre – TX 33.99 mm Post – TX 37.03 mm 25 Yrs. Post – TX 36.80 mm Maxillary Intermolar Width

Slide 21: 

Pre - TX Post - TX 25 Yrs. Post - TX Curve of Spee Correction & Stability

Slide 22: 

Pre - TX Post - TX 25 Yrs. Post - TX Arch Forms

Slide 23: 

Pre - TX Post - TX 25 Yrs. Post - TX

Slide 24: 

Occlusion Pre - TX Post - TX 25 Yrs. Post - TX

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Pre - TX Post - TX 25 Yrs. Post - TX

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Note : Initial Panoramic X-ray not available. Post - TX 25 Yrs. Post - TX

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86 79 7 123 25 127 85 81 78 3 107 30 127 96 Post - TX Pre - TX

Slide 28: 

JW – Composite

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Pre - TX Post - TX 25 Yrs. Post - TX

Slide 30: 

Post - TX Pre - TX 25 Yrs. Post - TX

BEGIN WITH THE END IN MIND: 

BEGIN WITH THE END IN MIND In orthodontics always …

GOAL : to place the teeth in a particular position that will produce the most: 

GOAL : to place the teeth in a particular position that will produce the most

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Healthy Functional Aesthetic Stable results possible !

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Archform template

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The FINISH

Are there not certain truths that experience has taught us where to best place these teeth?: 

Are there not certain truths that experience has taught us where to best place these teeth?

Are there fundamental requirements we can all agree on?: 

Are there fundamental requirements we can all agree on?

“The more things change … the more they stay the same.”: 

“The more things change … the more they stay the same.”

Today certain facts cannot be disputed.: 

Today certain facts cannot be disputed. They can be ignored – but not disputed.

Why can’t we apply new technology to create results that: 

Why can’t we apply new technology to create results that good science has already proven?

The benchmarks have been established!: 

The benchmarks have been established!

Until science changes the benchmarks, it is our responsibility as professionals to strive to achieve them.: 

Until science changes the benchmarks, it is our responsibility as professionals to strive to achieve them.

By combining the knowledge from:: 

By combining the knowledge from: Our forefathers Clinical experience Research

Specific benchmarks can be followed . . .: 

Specific benchmarks can be followed . . . to consistently produce quality, stable results .

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15 KEYS to SUCCESS GOALS for Orthodontic Treatment

“Nothing is new. . .”: 

“Nothing is new. . .” Socrates “We just discover for ourselves.”

A “New” Cephalometric Analysis is presented .: 

A “New” Cephalometric Analysis is presented . Putting certain established cephalometric measurements together CEPHALOMETRICS :

TETRAGON – PLUS Analysis : 

TETRAGON – PLUS Analysis Definition : Tetragon – four sided figure

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Tetragon

TETRAGON – PLUS : 

TETRAGON – PLUS Definition : Plus : ANB & soft tissue profile

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SNA SNB ANB U1-SN SN-MP U1-L1 IMPA the TETRAGON PLUS

What are the goals for these measurements ?: 

What are the goals for these measurements ?

CEPHALOMETRIC GOALS :: 

Measurement : Angle : Desired Result/ Change : 1. Mandibular Incisor Torque Control IMPA Within 3 degrees of original * *convex and concave profiles may require more changes CEPHALOMETRIC GOALS :

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1. Mandibular incisor torque – 5 degrees Mandibular incisor torque control initial rectangular archwire - 6 degrees tip lower 1 st molar

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MP IMPA Mandibular Incisor Torque Control L1

CEPHALOMETRIC GOALS :: 

Measurement : Angle : Desired Result/ Change: 2. Vertical Control SN TO MP 0 +/-3 degrees CEPHALOMETRIC GOALS :

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2. Vertical control – Headgear direction of force

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SN-MP SN MP Vertical Control

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Measurement : Angle : Desired Result / Change 3. Maxillary Incisor Torque Control U1 TO SN 101 - 105 degrees * * Will differ depending upon vertical skeletal pattern

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3. Maxillary incisor torque – 17 X 25 SS in .018 slot

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U1-SN Maxillary Incisor Torque Control

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Measurement : Angle : Desired Result / Change 4. Interincisal Angle U1 TO L1 130 –135 degrees * * Will differ depending upon vertical skeletal pattern

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4. Interincisal angle – 17 X 25 SS in .018 slot

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U1-L1 Interincisal Angle

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U1-SN U1-L1 Tetragon SN-MP IMPA

CEPHALOMETRIC GOALS:: 

Measurement : Angle : Desired Result/ Change: 5. Sagital Control SNA 1-3 degrees SNB ANB CEPHALOMETRIC GOALS: “PLUS”

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5. Sagittal control – Headgear and Class 2 Elastics

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SNA SNB ANB Sagital Control

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PLUS … add Soft Tissue Profile

Slide 74: 

SNA SNB ANB U1-SN SN-MP U1-L1 IMPA the TETRAGON PLUS

Study Model Goals: 

Study Model Goals Next :

Measurements obtained with an Electronic Digital Caliper …: 

Measurements obtained with an Electronic Digital Caliper …

Slide 77: 

Pre – TX 27.16 mm Post – TX 27.16 mm 25 Yrs. Post – TX 27.62 mm Mandibular Intercanine Width STUDY MODEL GOALS : 6. Mandibular Intercanine Width Within 1.0 mm of original

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6. Mandibular intercanine width – Final Archwire

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Evidence throughout the literature

Clinically …: 

Control Mandibular Intercanine Width with Final archwire Clinically …

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Pre – TX 34.33 mm Post – TX 37.63 mm 25 Yrs. Post – TX 36.37 mm Maxillary Intermolar Width STUDY MODEL GOALS : 7. Maxillary Intermolar Width Between 34-38 mm

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7. Maxillary intermolar width - RPE (if necessary) or archwire

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Pre - TX Post - TX 25 Yrs. Post - TX Arch Form STUDY MODEL GOALS : 8. Archform Ovoid

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8. Arch form – Alexander arch form

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Archform template

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Pre - TX Post - TX 25 Yrs. Post - TX … on lower arch use “small” archform .

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Pre - TX Post - TX 25 Yrs. Post - TX Curve of Spee Leveled mandibular Arch STUDY MODEL GOALS : 9. Leveled Mandibular Arch Flat Curve of Spee

Slide 90: 

9. Leveled mandibular arch – -6 degrees tip mandibular 1 st molar Reverse curve of Spee in the mandibular arch

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Occlusion Pre - TX Post - TX 25 Yrs. Post - TX STUDY MODEL GOALS : 10. Occlusion Good Intercuspation CR = CO Anterior Guidance Cuspid protection

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10. Occlusion – Bracket Height Placement

Panoramic X-Ray: 

Panoramic X-Ray Next :

PANORAMIC X-RAY :: 

11. Root Positioning Anterior roots spread apart Lower 1 st molars upright PANORAMIC X-RAY :

Slide 95: 

11. Root positioning – Angulation built into bracket

PANORAMIC X-RAY :: 

11. Root Positioning Extraction sites parallel PANORAMIC X-RAY :

Slide 97: 

11. Root positioning – Angulation built into bracket

PANORAMIC X-RAY :: 

PANORAMIC X-RAY : 12. Periodontal Health

Slide 99: 

12. Periodontal Health - Oral Hygiene Move teeth quickly to final positions and “Let it Cook”

PANORAMIC X-RAY :: 

PANORAMIC X-RAY : 13. Temporal Mandibular Joint (TMJ)

Slide 101: 

13. TMJ - Cuspid and anterior guidance: Bracket placement CR + CO: Headgear and Class 2 elastics

Facial Photos: 

Facial Photos Next :

FACIAL PHOTOS:: 

14. Soft Tissue Profile lips touching when relaxed aesthetic line touches chin & lips and bisects nose FACIAL PHOTOS:

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14. Soft tissue profile - Proper diagnosis (Extraction VS Non-Extraction)

FACIAL PHOTOS:: 

15. Smile symmetric midline smile line smile arc no dark buccal corridors FACIAL PHOTOS:

Slide 106: 

15. Smile – Proper use of curve in archwires with the Alexander archform

Does anybody agree with these GOALS ?: 

Does anybody agree with these GOALS ?

Slide 108: 

Then the question is …

How can the teeth be placed in the most healthy, functional, esthetic & stable positions possible …: 

How can the teeth be placed in the most healthy, functional, esthetic & stable positions possible …

in a consistent manner … in a : 

in a consistent manner … in a busy practice ?

Our answer is …: 

Our answer is …

The Alexander Discipline and the “Signature Line” Brackets : 

A A F O R E The Alexander Discipline and the “Signature Line” Brackets

Slide 113: 

A A F O R E The “Signature Line” is designed to reach the 15 GOALS !

Slide 114: 

Literature Review supporting the 15 KEYS :

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“A Comparative Study of Orthodontic Stability in Class I Extraction Cases” J. Moody Alexander Unpublished Master’s Thesis Baylor 1995 “Non-Extraction Approach to Tooth Size Arch Length Discrepancies with the Alexander Discipline” Buschang, P.H., Horton-Reuland S.J., Legler, L., and Nevant, C. Seminars in Orthodontics,Vol. 7 : No. 2, June 2001:117-131.

Slide 116: 

“Long-Term Post-Retention Stability of Combined RPE / Lip Bumper Therapy Followed by Full Fixed Appliances’’ Tyler Ferris, DDS, MS, Peter Buschang, PhD; Wick Alexander, DDS, MS; Jimmy Boley, DDS, MS, Baylor Dallas 2002 “An Arch Form Designed for use with a Specific Straight Wire Orthodontic Appliance” G.D. Mc Kelvain Baylor June 1982

Slide 117: 

“A Computerized Analysis of the Shape and Stability of Mandibular Arch Form.” Felton, J.M.; Sinclair, P.M.; Jones, D.L.; Alexander, R.G. American Journal of Orthodontics 1987; 92: 478-483. “Leveling the Curve of Spee with a Continuous Archwire Technique – A Long-Term Cephalometric Analysis.” Rael Bernstein Accepted by AJO State University of New York at Buffalo

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A Office : www.drsalexander.com AFORE : www.alexanderdiscipline.com A F O R E

Alexander Discipline 2006 International Symposium “FACTS vs FICTION in ORTHODONTICS May 11 & 12, 2006 Arlington Wyndham Hotel Arlington, Texas: 

Alexander Discipline 2006 International Symposium “FACTS vs FICTION in ORTHODONTICS May 11 & 12, 2006 Arlington Wyndham Hotel Arlington, Texas Copyright 2006 by Dr. Richard G. Alexander. No part of this lecture may be used without permission of author.