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James Andrews Orthodontics

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25.01.2022 Mesially tipped lower canines are common in Adult lower crowding cases. Careful staged management is required to maintain healthy periodontal attachment. Staged aligner treatment with elastic adjuncts to upright align the canine before C-II correction #criticalthinkingrequired @ Perth, Western Australia

25.01.2022 The alveolar housing is delicate. We know from research we have approximately between 0.5 -0.8 mm wiggle room in bone in the anterior mandible. Consider where crowding goes during alignment. What happens when we breach of alveolar boundary conditions? Indiscriminate alignment of crowding likely occurs by blowing the anterior teeth forward or blowing the buccal segments laterally. While things may look good at the coronal level, the potential for dehiscences and extra-...alveolar root positioning is quite high. Please think beyond what a computer may tell you #gingivalgraftsdontlastforever See more

24.01.2022 Clear Aligner treatment with the #invisalign appliance. This is most definitely a borderline extraction case with the amount of lower incisor crowding. The patient was adamant to have aligner treatment and we decided to use maximum IPR utilising upto 9mm of interproximal tooth structure on the lower arch. Careful staged space management is required to try and prevent the inevitable proclination we will get when unraveling crowding. Aligners are very proficient in tipping mov...ements as you will notice, but inefficient in translation, rotations and intrusion. Research to date has shown that aligners are not as efficient as fixed braces and will require over correction to be planned along with adjuncts to provide a high standard of finish and acceptable outcomes for patients. Set your standards high and dont always believe the marketing. If you aim at nothing you will hit it every time! #invisalignnogo #CAT #orthodontics #Dentistry @ Perth, Western Australia See more

23.01.2022 Integrating analogue 2D DSD with 3D improves lab communication and increases predictablity of outcomes. This can be implicated in all aspects of cosmetic dentistry. #dsd #digitaldentistry @ Perth, Western Australia

23.01.2022 I feel this is very pertinent going forward and we as health professionals can help take control back from the money men....

22.01.2022 Finishing with aligners can be frustrating at times with further minor tooth movements required after several refinements. Using adjuncts such as dimple pliers and elastics combined with simple biomechanic principles can help achieve your objectives. @ Dentistry Ubc

22.01.2022 Impacted teeth retrieval requires patience. Growing CIII with impacted 11. phase 1 upper fixed appliance, RME and RPFM. Almost ready for holding pattern. Correction of Skeletal Anterior X bite is always successful 66% of the time

20.01.2022 What do functional appliances achieve? Long term Dento-skeletal changes with the Bionator, Herbst , Twin Block and Mara functional appliances Siara Olds et al 2010 Angle Orthodontist 2010; 80:18-29....Continue reading

20.01.2022 Indiscriminate non extraction treatment can be foolhardy. Teeth like to be in the centre of bone. Note the improvement in gingival tissue thickness and a reduction in recession in a case where the patient had been recommended non extraction aligner therapy. A straight smile isnt always a healthy smile. Dont let an appliance drive your treatment plan. #criticalthinking @ Perth, Western Australia

20.01.2022 Being red- green colourblind always made it difficult for me to ascertain certain shades. Probably a good reason why Im full on ortho now.... Tidying up wear and overhangs on old restorative can be a challenge, but satisfying .... @ Perth, Western Australia

20.01.2022 When maximum anchorage is required I likely using a micro-implant to simplify my planning. *please note video is speedx2

18.01.2022 During these times orthodontic care has been put on hold for most patients around the globe. This is devastating for us as clinicians and carers as we all want our patients not to suffer in this regard. There are some great videos on Facebook to help guide patients to manage any potential orthodontic emergencies. I suggest you check out some of these fab vids by the great orthodontist Dr Trista Felty https://www.facebook.com/pg/AbbotsfordOrtho/videos/?ref=page_internal

18.01.2022 Ortho-Perio treatment. Here is a case almost completed. Orthodontic treatment split over two phases due to the gingival and osseous recontouring procedure mid finishing. We debonded pre surgery. It was difficult to position brackets in the appropriate vertical positions due to the xs gingiva, and also felt surgery would be easier without any active appliances. ... We will start refinement with aligners 6 months post surgery, when the gingival fibres and new biological width is re-established. The most essential part of treatment is in the diagnostic phase. Only from the correct diagnosis can we plan and manage our cases appropriately. #increaseyourthinkingtime

18.01.2022 Marketing and spin are King #Trumped

17.01.2022 12 mm overjet treated with conventional orthodontic appliances. Patient helped out by growing.... #goodgrower @ Vancouver, British Columbia

17.01.2022 Is Fixed lingual retention better than removable retainers

17.01.2022 2nd and 3rd order control in finishing. How to manage the black triangle without creating a Bolton discrepancy? Pink - high /low /high ... #orthoresto

16.01.2022 Let’s take a moment... @ Dentistry Ubc

15.01.2022 Class III orthopedic treatments work in 60% patients according to the current evidence. protraction works we can get orthopedic change in older children side effects depend on level of force application and anchorage skeletal anchorage may protect from side effects Expansion should be reserved for transverse problems alt-RAMEC protocol may provide some advantages Future thinking involves 3D imaging, genetics (linkage analysis, association studies, SNPs, and mutations) and biomarkers. Precision orthodontic diagnosis and treatment planning to identify which therapies are appropriate for which patients.

15.01.2022 Progress. Mild C-III skeletal/ dental progressing nicely.

15.01.2022 Incisor liability is a term coined to describe the difference in size between the deciduous and permanent incisors . This is usually overcome by a combination of growth, increase in Intercanine width, spacing in the deciduous teeth, lingual eruption of the permanent incisors and a change in inclination. Careful management is required but we want to avoid over treatment at this age to prevent patient burn out and avoid parents paying for treatment that will need to be redone in the future. KISS principles apply. If in doubt refer to a critical thinker.... @ Perth, Western Australia

14.01.2022 If in doubt measure it.... @ Perth, Western Australia

14.01.2022 Come join myself and special guests for some informal discussions on treatment planning for the Ortho-Perio-Resto adult patient. https://us02web.zoom.us//register/WN_ZIqmBfrCSZuqnKvTQvgIqA

14.01.2022 Finishing. It’s great to look at the clinical photos for some extra time to examine what further minor tooth movements are required. This enables you to construct a biomechanical plan required to achieve a good result. crown lengthening to follow... #notblackbeltyet @ UBC Nobel Biocare Oral Health Centre

14.01.2022 In my mind the best text book for the discerning practitioner who wants to learn more about #clearaligners or #invisalign is Clear Aligner Technique by @drsandratai. Remember Clear aligners are an appliance that we use to carry out orthodontic treatment. The same principles apply to planning orthodontic therapy. Diagnosis and treatment planning are key which is nicely laid out in this excellent text. In my mind it is vitally important to assess the strengths and weakness of any appliance and choose the best and most appropriate appliance to treat the specific malocclusion. Critical thinking required at all times. Dont let the desire to make a sale get in the way of what is best for the patient. Look for independent research and education into all things Ortho. @ Perth, Western Australia

14.01.2022 My first step into the virtual orthodontic world which is on . We will try and compare our own training pathways amongst other things. Having been a general dentist for almost 17 years prior to starting my specialty training I have a pretty good insight into orthodontic education. From whats available for the general practitioner and how it compares to specialty training.... Maybe we will try and dispel the myths of the Ivory tower .... #orthodontics #orthodonticeducation #straighttalkaboutstraightteeth

14.01.2022 A nice visit from Prof Greg Huang from UW

13.01.2022 Finishing. I love taking the limited open shot which helps discern small 1st, 2nd and 3 order discrepancies. Note the torque on #22 and #23 in this instance. Can you spy any others? Tip > pay close attention to the gingival margins, incisal edges and tooth wear/deficient restorations. @ Vancouver, British Columbia

13.01.2022 Sometimes what seem relatively simple cases can be a #tad more challenging @ University of British Columbia

13.01.2022 Clinical pearl for those stubborn exfoliating deciduous (baby) teeth. Permanent incisors naturally erupt lingual to the deciduous teeth and delayed exfoliation can contribute to malposition. @ Perth, Western Australia

13.01.2022 Setting up for the segmented arch technique to level a deep impinging overbite. The technique was championed by Burstone whose techniques and writings should underpin all good orthodontic biomechanic planning. With this technique it has been shown to prevent molar extrusion, which is very important in adult treatments and will prevent face lengthening... #sciencebeforemarketing @ Perth, Western Australia

12.01.2022 Its important that you understand what actual tooth movements your appliance delivers. Dont just follow a cartoon blindly.... #orthodontics #criticalthinking #clearaligners #readtheresearch #dontbelievethehype @ Align Technology Costa Rica SRL

12.01.2022 All I want for Christmas is .. ... ..... ..... . .... #mytwofrontteeth @ Dentistry Ubc

12.01.2022 Extractions, retention and stability: the search for orthodontic truth. Sheldon Peck. Department of Orthodontics, University of North Carolina, Chapel Hill, NC, USA. Historian, The Edward H. Angle Society of Orthodontists European Journal of Orthodontics, 2017, 109115 A philosophy non-extraction only orthodontic treatment is a step back into Stone age orthodontics...Continue reading

09.01.2022 Removable Retainers. Hawley or Vacuum formed? Your retention protocol should relate to the starting malocclusion.... #criticalthinking #evidencebased

09.01.2022 The Peg.Plenty still to work on in this case Open space and restore. Restoration can be done before ortho if there is enough space between the adjacent teeth. This is rare. In most cases, the orthodontist and DMD must collaborate and the orthodontist opens extra space for the DMD to place the restoration during treatment and the orthodontist then replaces a bracket and closes the extra space. As space is opened, 4 questions arise: 1. How much space is required? Advanta...geous to create extra space for the DMD to contour and polish the interproximal surfaces of the temporary restoration so it matches the opposite one. If patient has an existing lateral of normal width on the opposite side, match this one. But the opposite lateral is often missing or is a peg as well. There are 3 other methods to determine space: a.) Golden proportion Each tooth should be 6.18 % wider than the tooth distal to it. Disadvantage: Derived from perceived size of teeth from a direct frontal view only and there is no relation to the actual measured widths of the teeth. Also, research shows there is no one single incisor width that is considered esthetic (ie it is a range) b.) Bolton analysis Sum of M-D widths of lower anterior 6 should be 0.78 of upper anterior 6 do the math! c.) Diagnostic wax-up Space is determined by the occlusion and esthetics. Most predictable way. Place canines for disclusion and the centrals for optimal esthetics, then fill in the rest with the laterals. 2. Where should the peg be placed M-D? Emergence profile on mesial of lateral and central incisors is flat, while the distal is more convex. Thus, the peg should be placed nearer the central incisor than the canine. 3. Where should the peg be placed B-Li? Depends on what the peg lateral is being restored withPorcelain crown centre the peg lateral B-Li, leaving 0.5-0.75mm of OJ to avoid further tooth preparation on the lingual Porcelain veneer peg lateral should be positioned lingually to contact the mandibular incisors in centric occlusion so that there is sufficient space on the labial for the veneer. 4. Where should the peg be placed inciso-gingivally? @ Perth, Western Australia See more

08.01.2022 C-III camouflage with extractions and Buccal shelf microimplants @ Dentistry Ubc

08.01.2022 3D printed Maxillary Expander by the excellent MotorCity Lab works #digitaldentistry #3dprinting #digitalorthodontics @ubcdentistry @ Perth, Western Australia

08.01.2022 I wanted to share my take on a case report by Professor Jae Hyun Sung. I had amazing fortune of being able to learn from Professor Sung, as he spent a year at our orthodontic program at UBC, in Vancouver. One of the original pioneers in the development of micro-implants, an amazing clinician, teacher and human, and he will forever be a huge influence on my career. I think his treatment approach is very clever to tackle this distinct malocclusion a it is good to have it in yo...Continue reading

08.01.2022 The Deep Bite. Because deep bite is a symptom, there are many causes and hence many solutions for correcting it. Sometimes incisor intrusion is indicated, and in other patients the extrusion of posterior teeth is required. Differential diagnosis must be followed by differential treatment mechanics. In C-II adults we must be careful not to extrude the posterior teeth which will lead to steepening of the mandibular plane. #levelup @ Dentistry Ubc

07.01.2022 #seeasmileshareasmile Thanks @drbvf for the tag. I have committed to #flattenthecurve, and am trying to help protect the happy curve that should never be flattened. ... Help keep that curve strong , share your smile and tag 10 friends, and keep the world smiling @iamdr.nik ... @mohamedalmuzian @draliouazzani.orthoclinic @orthofacultyassociates @jackandrews_86 @magic.orthodontist @dr.bharat.agrawal @dr.davidattia @dr.andrewcheng @bingshuangzou See more

07.01.2022 Making simple printable dental models on #meshmixer

07.01.2022 Well deserved Dr Kennedy.

06.01.2022 There is a common misconception that the thickness of the plastic in aligner treatment causes a posterior open bite. In the majority if cases it is poor management of the crowding, curve of spee and incisor relation/torque that result in an anterior occlusal interference. This can result in negative occlusal and functional side effects and even TMD in the susceptible patient. As always concise Orthodontic diagnosis and planning is key to excellent outcomes. Remember do no harm. #astraightsmileisntalwaysahealthysmile

05.01.2022 Interesting read https://kevinobrienorthoblog.com/clear-aligners-treatment/

04.01.2022 Prosthodontic -orthodontic work flow. This is a case I completed including my own pros... Not perfect but definite improvement. Analyzing your mistakes and being hyper critical is the only way to improve.... hiw do you manage these difficult cases. Ps I dont do the restorative in these cases anymore.... too hard for mere mortals like me. #failtoplanplantofail @ Perth, Western Australia

04.01.2022 One of the best mentors any resident could hope for....

03.01.2022 Improvement in alignment is fairly predictable. We must however understand what the functional and periodontal and aesthetic consequences will be from the particular tooth movement related to the chosen orthodontic appliance. #criticalthinkingrequired @ Perth, Western Australia

02.01.2022 Mild C-III skeletal with dental compensation expresses with upper incisors proclination which effects smile aesthetic. Uprighting of lower incisors can help in correction. The mandibular buccal shelf is a suitable site for or- thodontic miniscrews in most patients. Cortical bone thickness, buccal shelf bone width, and insertion appear to be the most favorable buccal to the second molar. Insertions buccal to the first molar will require 3D imaging or at least digital palpation to clarify whether the patient has sufficient bone. Elsie int et al 2018 @ Perth, Western Australia

02.01.2022 Dr Shuler is awesome check it

01.01.2022 Great Presentation by Dr Peter Miles separating the myth from reality in myofunctionsl therapy https://youtu.be/0isjaKX0Sz8

01.01.2022 Let’s make a moment...... @ University of British Columbia

01.01.2022 I use Removeable appliances very occasionally in the mixed dentition when there is something damaging occurring. The most critical factor is patient compliance combined with clever design....

01.01.2022 Sleep disordered breathing and Orthodontics.... What is our role as dentists/orthodontists? By Dr James Andrews Looking at the current evidence...Continue reading