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A clinical guide to orthodontics by Dai Roberts-Harry, Jonathan Sandy, British Dental

By Dai Roberts-Harry, Jonathan Sandy, British Dental Association

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Orthodontics has evolved from many years of clinical experience, in which the opinions of respected individuals during the birth of the speciality have determined how orthodontics should be practised. A problem with this form of teaching is that it is based on anecdotal experience rather than sound scientific evidence. New research often highlights inadequacies in these fundamental teachings, eventually leading to a change in clinical practice. A trend is emerging towards evidence-based rather than opinionbased decisions as more and more structured research is published.

Some cases, especially where the crowding is mild may not need tooth removal, and a more sensible approach based on the requirements of the individual case rather that the two extremes seen in the past century is advised. Interestingly, in a follow up study over a 15 year period in Fig. 1 Illustration of a macrodont tooth in the lower labial segment, which also exhibits a talon cusp. Alignment and arch co-ordination is hindered by the size of the tooth and the talon cusp. Some enamel reduction can be undertaken to reduce the width of the tooth but care must be taken not to breach the enamel.

For example, the impaction of a lower second premolar may be relieved by the removal of the first premolar or first molar, which only requires local analgesia and is less traumatic than the removal of the impacted tooth (Fig. 3). In Figure 4, eruption of the upper second premolars resulted in severe resorption of the roots of the upper first molars. Extracting these molars would be fairly atraumatic and allow the second premolars to erupt into the mouth. 13 CORRECTION OF OVERBITE Space closure with fixed appliances tends to increase the overbite and therefore extractions in the lower arch in deep bite cases should be undertaken with caution.

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