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Integrated Clinical Orthodontics, 2nd Edition

ISBN: 9781119870050



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Integrates orthodontic diagnosis and treatment into the wider healthcare of the patient to achieve the highest possible standards of care

Integrated Clinical Orthodontics offers an overview of clinical orthodontic theory and practice to equip clinicians to take an integrated approach to orthodontic practice. It presents the problems of orthodontics in an interdisciplinary context to describe how the potential complexity of dentofacial problems, the medical histories of patients, and a host of other factors contribute to orthodontic outcomes. The second edition has been expanded and thoroughly updated with new chapters and following an organized approach to the role of the orthodontist as part of a team. Cases in the book include orofacial deformities, sleep disorders, esthetic smile creation and temporomandibular joint problems.

Orthodontic diagnosis and treatment are integrated into the wider health of the patient, including orthopedics, neurology, pediatrics, genetics and psychology, and the result is a modern, adaptable approach that places the patient and their needs at its center to achieve the highest possible standard of patient care.

Readers of the second edition of Integrated Clinical Orthodontics will also find:

  • New chapters on neuromuscular disorders, customized orthodontics, artificial intelligence, ethics and patient data
  • Expanded content on special care in dentistry
  • Guidance for the clinical interactions between orthodontics and other areas of dentistry and medicine
  • Clinical implications and applications of the integrated approach in every chapter

Integrated Clinical Orthodontics is an essential resource for clinical orthodontists and specialists in related medical and dental fields who wish to take the holistic view of orthodontic practice.


Contributors xiii

Preface xvii

Acknowledgments xviii

Part I Diagnosis, Psychology, and Genetics 1

Chapter 1 The Increased Stature of Orthodontics 3

Vinod Krishnan, Ze’ev Davidovitch, and Anne Marie Kuijpers-Jagtman

The broadening scope of orthodontics 6

The orthodontic patient as a human being 7

The patient’s biological status: does it influence orthodontic treatment? 8

Conclusions 16

References 17

Chapter 2 Orthodontic Diagnosis and Treatment Planning: Collaborating

with Medical and Other Dental Specialists 18

Om P. Kharbanda, Neeraj Wadhawan, and Karthik Sennimalai

The other side of the story 19

Orthodontic diagnosis from a broad perspective 19

The first interaction with the patient 19

The importance of the medical history in orthodontic diagnosis and treatment planning 21

Overview of systemic disturbances in relation to orthodontic treatment planning 27

Identifying local dental abnormalities before attempting orthodontic treatment 32

Evaluation of the occlusion and the temporomandibular joint 42

Radiographic examination of the craniofacial region 43

Conclusion 46

References 47

Chapter 3 Psychosocial Factors in Orthodontics: Patient Perceptions, Motivation,

and Expectations 52

Leslie A. Will

Motivation for orthodontic treatment 52

Treatment expectations 53

Perception of malocclusion 53

Patients with psychological disorders 55

Orthognathic patients 57

Patients with orofacial clefts and craniofacial anomalies 59

Patients with acquired deformities 60

Conclusions 61

References 61

Chapter 4 Integrated Clinical Genetics/Syndromology for the Orthodontist 63

James K. Hartsfield, Jr., Lorri Ann Morford, and Aqib Muhammad Shafi

Interaction with the clinical geneticist 64

Evolution of the clinical geneticist specialist 64


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viii Contents

When to refer 65

Artificial intelligence and facial analysis 66

Selected syndromes and conditions 66

Radiographic signs 71

History of premature tooth exfoliation 73

Conditions in which premature tooth exfoliation may occur occasionally 74

Supernumerary teeth and hypodontia (oligodontia) 77

Syndromic hypodontia 80

Supernumerary teeth or hypodontia (oligodontia) and cancer 81

Failure of dental eruption 82

Soft and hard tissue asymmetry 83

Maxillary hypoplasia 84

Functional (neoromuscular) asymmetry 86

Mandibular retrognathism 86

Connective tissue dysplasia 87

Cleft lip and cleft palate 90

Additional resources 91

References 91

Part II The Growing Patient 97

Chapter 5 Endocrinological Conditions and Orthodontic Treatment 99

Athina Chatzigianni

Growth hormone disorders 99

Thyroid disease 101

Parathyroid gland disorders 103

Primary adrenal insufficiency 104

Fibrous dysplasia 104

Diabetes mellitus 105


endocrine disorders 106

Exogenous hormone administration 107

Conclusions 108

References 108

Chapter 6 Nutrition in Orthodontic Practice 111

Nadine Tassabehji and Jillian Kaye

The importance of diet and nutrition in oral health 111

Dietary habits 113

Nutrition and oral health 119

Orthodontic guide to performing nutrition risk assessments 124

Conclusion 126

References 127

Chapter 7 Cleft Lip and Palate: Role of the Orthodontist in the Interdisciplinary

Management Team 128

Anne Marie Kuijpers-Jagtman

and Mette A.R. Kuijpers

Interdisciplinary team care 129

Members of the cleft lip and palate team and their roles 129

Orthodontic management 133

Conclusion 146

References 146

Chapter 8 Multidisciplinary Management of Craniofacial Malformations 150

Latha P. Rao, Maria J. Kuriakose, and Sherry Peter

General principles in the diagnosis and management of craniofacial malformations 151

Otofacial malformations 157

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Contents ix

Craniosynostosis 169

Conclusion 175

References 175

Part III Enhancing the Envelope of Orthodontic Care: The Medical

Collaboration 179

Chapter 9 What Can Orthodontists Learn from Orthopedists Engaged

in Basic Research? 181

Carlalberta Verna and Birte Melsen

A common language 181

Bone adaptation to mechanical deformation and orthodontic tooth movement 189

Bone reaction to skeletal anchorage 190

Conclusion 192

References 193

Chapter 10 Acute and Chronic Infections Affecting the Oral Cavity: Orthodontic

Implications 195

Vinod Krishnan, Gunnar Dahlén, Ambili R. Kumar, and Ze’ev Davidovitch

Bacterial infections 196

Viral infections 206

Fungal infections 213

Parasitic infections 218

The oral cavity as a source for focal infections 219

Conclusions 221

References 221

Chapter 11 Unveiling and Managing Upper Airway Problems in the Orthodontic

Patient 225

Mimi Yow, Huiting Lynn Koh, and Shaun Loh

The spectrum of sleep-disordered

breathing 225

Decoding obstructive sleep apnea 226

Respiration: Effect of anatomy and sleep 228

The child with sleep-disordered

breathing 229

The adult with sleep-disordered

breathing 233

Cephalometrics and imaging 236

Orthodontic management 236

Surgical management 238

Conclusion 239

Acknowledgments 243

References 243

Chapter 12 Interaction between the Orthodontist and Medical Airway Specialists

on Respiratory and Nonrespiratory Disturbances 248

Joseph G. Ghafari and Anthony T. Macari

The mouth in relation to the nasopharyngeal airway: Anatomy overview 248

Common sources of airway dysfunction 250

Nonrespiratory areas of interaction with ENT specialists 261

State of interaction between orthodontists and medical airway specialists 269

References 269

Chapter 13 Neuromuscular Diseases and the Orthodontist 272

Gregory S. Antonarakis and Stavros Kiliaridis

Myotonic dystrophy 273

Duchenne muscular dystrophy 281

Conclusions 288

References 289

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x Contents

Chapter 14 Orthodontics for Children with Disabilities 291

Stella Chaushu, Yossi Shapira, and Adrian Becker

Therapeutic access 291

Pretreatment visits, patient assessment, and future management 292

Orthodontic records 294

Overall treatment plan 294

Relapse and retention 297

Case descriptions 298

Conclusion 308

References 308

Chapter 15 Orthodontic Care in the Adult Medically Compromised Patient 310

Ashok Kumar Jena and Jitendra Sharan

Cardiovascular disorders 311

Endocrine disorders 312

Infectious diseases 313

Skeletal system problems 315

Gastrointestinal disorders 316

Respiratory system problems 316

Nervous system disorders 317

Renal disorders 318

Allergy reactions 319

Conclusion 320

References 321

Part IV Orthodontics and Other Dental Specialties 323

Chapter 16 Comprehensive Periodontal Evaluation of the Orthodontic Patient:

The Role of a Periodontist in Orthodontic Practice 325

Giovanni E. Salvi, Andrea Roccuzzo, and Dimitrios Kloukos

Pathological tooth migration 325

Treatment plan 326

Goals of periodontal therapy 327

Comprehensive periodontal examination 327

Case presentations 328

Acknowledgments 342

References 344

Chapter 17 The Restorative Dentist and Orthodontist: Orthodontic Implications

of Dental Caries, Tooth Fracture, Exposed Dental Pulp, and Esthetic

Improvements 345

Neslihan Arhun, Ayca Arman-Özçırpıcı,

Sevi Burçak Çehreli, Kamran Gülşahı,

and Ömur Polat Özsoy

Pretreatment evaluation and early stages of the orthodontic treatment 346

Interactive collaboration during orthodontic treatment 356

Emergency orthodontic treatment in trauma cases 370

Immediate postorthodontic period 382

Esthetic improvements 384

Conclusion 396

References 398

Chapter 18 Orthodontics and Pediatric Dentistry: Two Specialties, One Goal 411

Elliott M. Moskowitz, George J. Cisneros, and Mark S. Hochberg

Coordinating orthodontic and pediatric dental appointments in a group or

solo practitioner setting 412

Identifying orthodontic and pediatric dental problems earlier rather than later 414

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Contents xi

Restoring form and function: Revisiting the unilateral posterior crossbite

with a functional mandibular shift 416

Congenitally missing maxillary lateral incisors: Who does what, when, and how? 419

Retention considerations and beyond 423

Enamel demineralization during orthodontic treatment: Who takes responsibility

for prevention? 425

Conclusions 426

References 426

Chapter 19 Optimizing Prosthodontic Care with Orthodontic Mechanotherapeutics 427

Hayam Alfallaj, Ruba Alkadhi, Samah Alfuriji, Fathima F. Farook, and Abdulaziz Alzaid


management of intraarch spaces 428


management of interarc spaces 435

Correction of ridge deformity though orthodontic tooth movement 443

Restorative treatment before orthodontics (means for tooth movement) 444

Conclusion 445

References 445

Chapter 20 Integrated Management of the Orthognathic Patient 447

Noura M. AlOtaibi, Philip C.M. Benington, and Ashraf F. Ayoub

Multidisciplinary Team 447

Systematic approach 448

Orthognathic surgery 488

Stability and relapse 489



Digital innovations in orthognathic surgery 490

Conclusion 490

References 491

Chapter 21 The Role of the Orthodontist in Managing Disorders

of the Temporomandibular Joint 493

Ambra Michelotti, Mauro Farella, and Roberto Rongo

Why should orthodontists deal with the temporomandibular joint? 493

Anatomy of the temporomandibular joint 494

Should orthodontists care about condylar position? 494

Temporomandibular joint disorders 496

Joint pain: Arthralgia 496

Disc disorders 502

Occlusal changes due to temporomandibular disorders 504

Congenital/developmental disorders 506

Conclusion 510

References 510

Part V The Biomedical Orthodontist 515

Chapter 22 The Role of Biomedical Engineers in the Design and Manufacture

of Orthodontic Appliances 517

William A. Brantley and Theodore Eliades

Past research activities 517

Current research activities and potential future applications 524

Conclusions 528

References 528

Chapter 23 Designing and Manufacturing Customized Orthodontic Appliances 531

Nearchos C. Panayi

Orthodontic imaging and analysis software 532

Surface and volume scanning 532

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xii Contents

Orthodontic computer-aided

design software 532


manufacturing 533

Customized orthodontic appliances 533

Clear aligners 534

Selective laser sintering and metallic orthodontic appliances 536

Customized orthodontic brackets 536

Conclusion 539

References 540

Chapter 24 Regenerative Medicine in Orthodontic Therapy 541

Nina Kaukua, Kaj Fried, and Jeremy J. Mao

Principles of tissue regeneration 543

Stem cell basics 543

Impact of regenerative medicine in dentistry and orthodontics 556

Orthodontics and dentofacial orthopedics as clinical motivation for tissue engineering 560

Conclusion 561

Acknowledgments 561

References 561

Chapter 25 Artificial Intelligence and Orthodontic Practice: The Future Unveiled 565

Mohammed H. Elnagar, Praveen Gajendrareddy, Min Kyeong Lee,

and Veerasathpurush Allareddy

Applications of artificial intelligence technology in orthodontics 566

Artificial intelligence–driven remote monitoring 570

Blockchain technology in healthcare 571

Ethical considerations in artificial intelligence 573

References 573

Chapter 26 The Seven Pillars of Professionalism 576

Peter M. Greco

The Seven Wonders of the World 576

The concept of professionalism 577

The seven pillars of professionalism 577

Our public image of professionalism 582

Now, what about those Seven Wonders of the World: Where are they now? 583

References 583

Index 000