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Helpful Hints for General Dentists Doing Orthodontics (Part II)

11. If space is created in a case initially, it makes the correction of crowding and rotations considerably easier.
12. The lower arch is usually the controlling arch in making orthodontic decisions. The reason for this is the cortical bony trough that limits the expansive or constrictive movements of the lower teeth. The upper arch is more cancellous and allows for more generous movement of the teeth.
13. It is much easier to obtain extra space for crowding corrections in the mixed dentition due to the larger deciduous molars (than the premolars that replace them). Once the second permanent molars erupt and close this additional space (the leeway space of Nance) in a forward direction, it locks the crowding in and becomes almost impossible to get an acceptable longlasting result without future relapse.
14. Doing orthodontics on a simple problem such as a single rotation, which might relapse, could result in a 100% failure. A complicated problem that has a similar relapse of a single tooth represents a small degree of failure when compared to the remaining successful correction. Minimal adult crowding corrections can be very problematic for this reason.
15. At all cost preserve the existing width and shape of the lower arch – to change it is to encourage relapse.
16. Don’t treat skeletal Class III cases (mandibular, prognathism), impacted upper canines, cases with ankylosed permanent teeth, multiple missing adult teeth, and don’t extract permanent teeth to correct crowding unless you can do fixed orthodontics yourself.
17. If you are referring cases to an orthodontist, have him write a letter explaining at what age he wants cases sent to him and let him be the judge as to when to start a case. Don’t tell a parent what you think the diagnosis will be.
18. Don’t start a case if you cannot complete the treatment properly yourself. Never get halfway through a case and then refer it to an orthodontist to complete what you can’t do yourself because of lack of knowledge or experience.
19. Don’t promise a result to the patient, and always provide yourself the option of discontinuing treatment if the patient is uncooperative.
20. Always take complete initial records prior to starting any form of orthodontic treatment including study models, panoramic and lateral cephalometric radiographs, TMJ analysis, facial photos, and measures of the free-way space, midline relations, inclination of incisors and the severity of a gummy smile, if one exists.


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