The Jasper Vektor appliance offers the most innovative, comfortable and efficient solution for Class II correction. Other common fixed appliances on the market tend to produce linear forces that result in frequent failure, unwanted tipping and patient discomfort.

The Jasper Vektor contains a unique spring design that produces curved vectors. The appliance flexes 25-45% of its overall length which results in the only appliance to deliver gentle, intrusive forces that do not tip the maxilla or produce unwanted extrusion. It provides just the right amount of force needed for efficient Class II correction. Many cases see results in as fast as 6 weeks.

They are made with a robust, nickel-titanium alloy that provides strength and flexibility. Installation is easy and the kit comes with the tools needed to place the appliance on patients.

The design keeps the appliance away from the “food zone” that allows the Vektor to remain clean and avoid any bacteria build up. Additionally, the design allows for natural lateral mandibular movement that enhances patient comfort. Jasper Vektor is also a compliance-independent appliance that ensures proper treatment is given and helps the doctor manage the overall treatment schedule.

Contact Kathy Kanellos via kathy.kanellos@tportho.com to discuss TP Orthodontics’ Jasper Vektor Class II Corrector Appliance^®. Alternatively call 1800 643 055 or click: www.tportho.com.

Dr. Derek Mahony
Registered Specialist in Orthodontics
BDS(Syd) MScOrth(Lon) DOrth RCS(Edin) MDOrth RCSP(Glas) MOrth RCS(Eng)
MOrth RCS(Edin) FRCD(Can) FICD FICCDE FACD FADFE GradDipDentalSleepMedicine (WA)

Summary

Overclosure is a common condition among patients seeking restorative and/or orthodontic rehabilitation.  By evaluating the patient for common signs and symptoms associated with overclosure, one can determine the need for re-establishing a physiologic vertical dimension.  Opening of the bite can be accomplished in a number of ways by following specific guidelines.  The use of objective diagnostic aids are extremely helpful by allowing the clinician to optimize TMJ and craniofacial muscle function at the new VDO.  The correction of the vertical dimension during a rehabilitative procedure should result in enhanced comfort and improved function in the finished case.

 Introduction

The term neuromuscular occlusion has become associated with certain limited methodologies that are used to obtain a muscle-compatible occlusal relationship.  In reality, there are several different approaches that can be used to determine a “neuromuscular” maxillo-mandibular relationship, even with a fully edentulous case. Within each method, however, the common basis for all muscle-oriented approaches involves first determining the resting length of the masticatory muscles.

 Historically, opening the bite has been considered hazardous and/or foolhardy by many dentists and with good reason.  Arbitrary opening of the bite, especially when accomplished strictly on an articulator, can result in a difficult, uncomfortable and unappreciative patient.  Some dentists have recommended against ever opening a bite, perhaps after an especially troublesome experience with a patient.

 In spite of the risks, there are some advantages associated with opening an over-closed bite. The identification can be traced back at least 70 years to an ENT physician, Dr. J. B. Costen.^1-3  Dr. Costen discovered, perhaps quite by accident after referring many of his symptomatic, edentulous patients to a local dentist for new dentures, that many returned with their head and ear pain symptoms greatly relieved.  His publications were positively received at the time and, in fact, what we refer to today as temporomandibular disorders (TMDs) were originally referred to as “Costen’s Syndrome.”  While we know today that many TMD patients are not over-closed, over-closed patients do often exhibit some of the signs and symptoms commonly associated with TMD.  Thus, although over-closure in and of itself is not pathognomonic of TMD, it should be considered as a risk factor.

 The use of the patient’s own muscles to determine the vertical dimension of occlusion was already being explored in the 1940s by people like orthodontist John R. Thompson.⁴   Sears⁵ introduced the concept of the “Pivot Appliance” in the 1950s, which was designed to open the bite enough to allow the patient’s muscles to reposition the mandible.  Following their lead, others^6-28 have subsequently evolved the current array of neuromuscular registration methods presently in use.  At the same time several studies^29-32 have demonstrated that a muscle-determined position, although similar, is not identical to centric relation.

Common signs and symptoms of over-closure

When asked, over-closed patients often report symptoms such as frequent headaches, dull pain of the elevator muscles and pain or stiffness in their neck muscles.  Ear stuffiness, tinnitus and/or vertigo are also commonly reported.  A more subtle symptom, less often reported, is frequent gastrointestinal distress in various forms that has no clear, identifiable cause.  This may also be accompanied by a report of difficulty in chewing and/or swallowing.  An overclosed patient will usually report several, but not all, of the following symptoms: 

1. Frequent headaches with no identifiable cause
2. Ear stuffiness with no indication of ear pathology
3. Difficulty in chewing tough foods
4. Difficulty or discomfort in swallowing
5. Frequent gastrointestinal distress
6. Vertigo
7. Tinnitus
8. Persistent dull pain in masticatory elevator muscles
9. Neck pain or stiffness
10. Possible increased wear of incisor teeth

Under examination, a number of signs indicating over-closure may appear.  These include; 1) a measured freeway space greater than 3 mm, 2) EMG or visual identification of a tongue-thrust swallow, 3) the appearance of less than fully erupted molars, 4) a deep curve of Spee, 5) one or more posterior edentulous spaces, 6) lingually tipped mandibular molars, 7) EMG identification of elevator muscle hyperactivity at rest of more than 2.0 microvolts average (or 2.2 microvolts RMS), 8) worn and shortened teeth (there is no scientific evidence that human teeth “grow out” in response to wear in the way that elephant’s teeth do), 9) horizontal skin creasing and saliva weeping at the corners of the mouth, 10) a so-called “Shimbashi” measurement (in centric occlusion) of less than 16 mm from the cemento-enamel junction of the maxillary central incisor to the cemento-enamel junction of its opposing mandibular tooth and 11) long-term chronic internal derangement of the TM Joint(s).  However, patients rarely seek dental treatment for any of these objective signs.  Instead, they are more likely to seek rehabilitative treatment for headache, jaw-ache, ear-ache, difficulty in chewing/swallowing or for purely aesthetic reasons.  In other cases, they are unaware of their condition, apparently due to their excellent adaptability.  In the over-closed patient, the “reason” for treatment either cosmetic or functional, is often dependent more on his/her individual adaptability than on the dental conditions present.  While some signs simply indicate the “progress of the destruction” that a pathological maxillo-mandibular relationship fosters, other signs may indicate a successful adaptation. 

1. Freeway space > 3 mm [if pain level is low, it is an adaptation, otherwise it is not]
2. Tongue thrust swallow [if full arch tongue thrust, usually a successful compensation]
3. The appearance of less than fully erupted molars [tongue inhibition of natural eruption]
4. A deep curve of Spee [often associated with one or more missing molars or a deep anterior overbite with retroclined upper incisors]
5. One or more posterior edentulous spaces [leads to deep curve of Spee]
6. Lingually tipped posterior teeth [tongue thrust during swallow, restricted maxillary arch]
7. Hyperactivity of elevator muscles at “rest.” [an adaptation, successful if no elevator muscle pain]
8. Worn/short teeth, abfractions (ground off) [not a successful adaptation]
9. Skin creasing at corners of mouth [may appear as aesthetic problem only, not an adaptation]
10. Saliva weeping at corners of mouth [an aesthetic and functional problem, not an adaptation]
11. CEJ (cemento-enamel junction) to CEJ in C.O. < 16 mm. [less than the normal adaptive range]
12. Internal derangement(s) of the TMJ [if no degeneration, may be a successful adaptation]

Maxillo-mandibular bite relationships

Centric occlusion (CO = habitual)

The maxillo-mandibular position of maximum intercuspation is most often the dental treatment position, primarily by default.  This is of necessity whenever single tooth preparations or small restorations are involved, since they must fit within the patients existing occlusal scheme.  It is only at times of major reconstructive, orthodontic and/or surgical treatments that the option of opening a bite or establishing a new maxillo-mandibular relation may present itself.  However, many clinicians still prefer to “play it safe” and retain the existing habitual (CO) maxillo-mandibular relationship, even during major rehabilitative procedures.  By definition, the use of centric occlusion as a treatment position excludes re-establishing a proper vertical dimension in an over-closed patient.  However, if the patient’s condition is actively deteriorating this may not be a safe option at all, as the continued physiologic breakdown may lead to failed dentistry and/or a flair up of craniofacial pain.

Centric relation (CR)

The concept of centric relation has a very long history and was originally devised, at least in part, to accommodate the use of articulators during prosthodontic treatment.  Although we now know that the jaw doesn’t function like a hinge, originally it was convenient to make that assumption when using articulators to make prostheses.  Today, one clear difference between centric relation procedures and strictly muscle-oriented methodologies is the priority given by CR methods to evaluating the function of the temporomandibular joints.  Typically, centric relation operators give first priority to establishing stable joint function, while muscle-oriented (neuromuscular) approaches tend to focus almost exclusively on muscle comfort.

 Muscle-related centric (MC)

Figure 1.  BioJVA testing for normal TM joints 

In general, muscle-oriented approaches consider joint position and/or stability secondary to muscle function.  In the extreme, it is simply assumed that creating “happy muscles” will automatically provide good or at least adequate joint function.  In a more practical view, both joint function and muscle function are seriously evaluated and, when indicated, a compromise is sought to provide both joint and muscle compatibility.  This represents an approach that bridges the gap between strict CR and rigid MC approaches.  Consequently, a variety of methods have evolved to capture and establish a muscle-related centric position, while maintaining favourable joint function. 

The requirements of proper neuromuscular occlusion (NMO)

Figure 2.   Bio-TENS, a ULF-TENS unit used for muscle relaxation 

The first step in all approaches to NMO requires inducing relaxation in the masticatory musculature, however, there is no rational excuse for not evaluating TM joint function prior to beginning the process.  This can be accomplished quickly and easily with Joint Vibration Analysis (JVA see figure 1.), or with more expensive and invasive imaging such as MRI.  Muscle relaxation can be aided by Ultra-Low Frequency TENS (ULF-TENS, see Figure 2.), an Aqualizer, soft music or any other technique that reduces the resting hyperactivity of the masticatory muscles.  

Surface electromyography (see Figure 3.) is useful for making a quantitative determination whether relaxation has occurred or whether resting muscle hyperactivity still exists.  Needles and/or fine wire electrodes not only make relaxation less likely, they record a more localized signal that is less representative of overall muscle activity.  However, needle EMG electrodes are required when one is seeking to differentiate a myopathy from a neuropathy.  Using the relaxed rest position of the mandible, with respect to the maxilla as a reference, a clinician can select a vertical dimension that allows adequate freeway space, yet avoids over-closing the bite.  There are several methods currently used for selecting the treatment vertical.  Each has its own rationale and advantages, but all of them benefit from objective diagnostic aids to ensure the best compromise between optimum joint, muscle, and tooth function.  

Figure 3.  BioEMG II for monitoring rest position and testing muscle function against the new bite 

Several muscle-oriented bite registration techniques

The wax swallow bite registration

A physiologic, muscle-oriented, vertical dimension can be obtained by means of the swallowing reflex technique originally proposed by the late Dr. Willie May.  Currently, the wax swallow bite technique, developed by James Carlson, is a simple, direct close approximation of a muscle-related bite registration.  Small pillars of soft wax are placed on the first molars, then the patient is instructed to swallow several times.  Subsequently, fast-curing impression material is injected around the arch to firmly establish the maxillo-mandibular relationship.  Since humans swallow thousands of times per day, it has been proposed that the swallow position should be compatible with the musculature.  This technique is recommended only after verification of good TM joint function with Joint Vibration Analysis or MRI. 

The ULF-TENS bite registration                                                                         

Ultra-low Frequency TENS, originally conceived by Bernard Jankelson, is often used to relax the masticatory muscles.  It can also be used to determine a bite registration position, sometimes referred to as myo-centric.  After a patient has been “pulsed” for relaxation, usually for about 40 minutes, bite registration material (a quick-cure acrylic) is placed over the mandibular occlusal surfaces and the ULF-TENS is re-applied to “close” the mandible about 1 – 2 mm above the rest position.  During this procedure the vertical dimension is usually monitored with a mechanic’s inside callipers between marks on the chin and nose.  There is a definite “technique sensitivity” to this procedure such that different operators tend to produce slightly to greatly different results.  However, once the skill is developed, an operator may produce good consistency.  These classic TENS bites ignored the TM joints function in the past, but this should no longer be the case. A final outcome with healthy TMJ’s and muscles is our goal today. 

The phonetic bite registration

As with the previously described muscle-oriented methods, this one begins with muscle relaxation.  Then the patient is instructed to speak specific sounds while the anterior teeth are observed by the clinician.  Based on the positions assumed by the teeth with specific phonetics, the clinician recognizes the vertical and antero-posterior requirements and records the position, typically also with impression material.  Admittedly, this technique requires subjective clinical judgment and the development of a skill without any objective support.

The EMG bite registration

To enhance the precision with which one can determine the optimum muscle-related position, some practitioners recommend monitoring the activity of the masseter, temporalis and anterior digastric muscles electromyographically.  Since the electrical muscle output levels involved are just a few microvolts, this measurement requires a high common mode noise rejection amplifier.  After relaxation has been verified electromyographically, the patient is instructed to open very gradually until the digastrics show a slight increase in activity (e.g. 0.5 microvolts average).  This establishes the limit to which opening the bite is permissible and is typically used as a position for constructing removable orthodontic appliances.  

Similar tests are done for closing or repositioning the bite antero-posteriorly while monitoring the elevator muscles.  The concept is to find the superior, inferior, anterior and posterior limits of muscle resting.  Then the new bite position is selected within these limits.  The exact relation chosen may be dependent on many factors, such as clinical findings and the clinician’s best judgment.  With this technique it is also possible to evaluate functional activity of the musculature with the bite registration in place to further evaluate the appropriateness of the new maxillo-mandibular relation. 

Figure.4. JT-3D Jaw Tracker used together with EMG to monitor a bite registration 

The instrument monitored bite registration

To maximize the precision with which one can determine the bite registration position, clinicians can actively monitor the position of the mandible using a magnetic jaw tracker while simultaneously recording EMG activity.  After the muscles are relaxed, a recording is made of the movement from rest to centric occlusion, light tapping in CO and protrusive guidance.  Next, the registration position is selected and targeted on the computer screen.  The treatment position chosen can reflect all of the information available regarding the patient’s current condition.  Finally, the registration material is placed in the mouth and the patient is instructed to close into it while the position of the mandible and the muscle activities are monitored on the computer screen.  (Figure 5).  This allows the clinician to immediately see the three-dimensional relationship between the old centric occlusal position and the new bite position.  The saved recording can be recalled later and utilized to evaluate an appliance, provisional restorations or the prosthesis at try-in. 

The position of the bite registration and the levels of muscle activity, are simultaneously visible in this combined EMG and jaw tracking recording, as shown in Figure 5.  The vertical dimension is increased 2.5 millimetres, the freeway space is reduced from 4.1 mm to 1.6 mm.  

Figure 5.  The position of the bite registration and the levels of muscle activity, are simultaneously visible in this combined EMG and jaw tracking recording. The vertical dimension is increased 2.5 millimetres, the freeway space is reduced from 4.1 mm to 1.6 mm. 

Figure 6. Example of a patient with an overclosed vertical dimension, due to previous loss of teeth, that has been successfully treated using Neuromuscular Principles. 

Predicting a patient’s response to correcting overclosure

The question is often asked, “How quickly will a patient adapt to a new bite registration?”  Even though the object is to “correct” a mal-relationship of the mandible to the maxilla, the patient’s current relationship still has familiarity.  The new relationship, no matter how “perfectly” established, will seem strange to the patient at first.  There are many factors that influence a patient’s adaptation to a new maxillo-mandibular relation.  It is possible to estimate a patient’s response by considering the following factors: 

• The age of the patient [younger = more adaptive, older = less adaptive]
• The amount of the change [a big change is more difficult to adapt to than a small change]
• The duration of the overclosed condition [a long-standing condition will be more difficult to “de-program” than one of short duration]
• The quality of bilateral TM joint function [good joint function makes adaptation easier]
• An overclosed bite, due to developmental abnormalities (if caught early) can be corrected easily and with rapid adaptation by the patient [children are much more adaptive]
• Overclosure resulting from parafunction typically coincides with a strong, healthy musculature. Strong, healthy muscles make adaptation easier, but require a treatment plan to protect the restored occlusion from destructive parafunctional forces.
• An overclosed bite due to caries, loss of teeth, etc. without evidence of parafunction, typically coincides with a weak musculature, making adaptation difficult. This is very often the case with complete removable prosthetics.  

References:

1. Costen JB: A syndrome of ear and sinus symptoms dependent upon disturbed function of the temporomandibular joint. Ann Otol Rhin and Laryngol 1934 Mar; 43:1-152
2. Costen JB: Glossodynia: Reflex irritation from the mandibular joint as the principal etiologic factor.  Arch Otolaryg 1935 Nov;22:554-564
3. Costen JB: Neuralgias and ear symptoms. J Am Med Assn 1936 Jul;107:252-255
4. Thompson JR: Concepts regarding the function of the stomatognathic system. JADA 1954 Jun; 48:626-637
5. Sears VH: Occlusal Pivots. J Prosthet Dent 1956 6:332-338
6. Gourion GR. [A new occlusal concept: myocentric relation and the Myo-monitor] Rev Fr Odontostomatol. 1971 Oct;18(8):995-1004. French.
7. Fujii H, Mitani H. Reflex responses of the masseter and temporal muscles in man. J Dent Res. 1973 Sep-Oct;52(5):1046-50
8. Vesanen E, Vesanen R. The Jankelson Myo-Monitor and its clinical use. Proc Finn Dent Soc. 1973 Dec;69(6):244-7.
9. Wessberg GA, Dinham R. The Myo-Monitor and the Myofacial Pain Dysfunction Syndrome. J Hawaii Dent Assoc. 1977 Aug;10(2):10-3.
10. Jankelson B, Radke JC. The myo-monitor: its use and abuse (I). Quintessence Int. 1978 Feb;9(2):47-52.
11. Jankelson B, Radke JC. The Myo-monitor: its use and abuse (II). Quintessence Int. 1978 Mar;9(3):35-9.
12. Kobayashi Y, Nakano Y, Komatsu Y, Ando N. [Clinical study of Myo-monitor. Part 1. An evaluation in the treatment of dysfunction of the masticatory system] 1978 Dec;66(4):539-47. Japanese.
13. Rogers Patient’s facial pain treated by Myo-monitor and dentures. Dent Surv. 1979 May;55(5):54.
14. Gernet W, Reither W, Gilde H. [Use of the Myo-Monitor in the functionally disturbed stomatognathic system] Dtsch Zahnarztl Z. 1980 Jun;35(6):595-8. German.
15. Shen WW. [A study of the myo-monitor and its clinical application] Zhonghua Kou Qiang Ke Za Zhi. 1982 Dec;17(4):193-6. Chinese.
16. Yoshida M, Higashi H, Yamauchi M, Takigawa H, Murakami M, Kawano J. [Effect of Myo-monitor pulsing on jaw opening in patients with trismus] Gifu Shika Gakkai Zasshi. 1983 Aug;11(1):157-69. Japanese.
17. Dinham Myocentric. A clinical appraisal. Angle Orthod. 1984 Jul;54(3):211-7.
18. Boschiero R, Fraccari F, Pagnacco O. [Analysis of the results of using the Myo-Monitor on patients with a reduced mouth opening] Minerva Stomatol. 1986 Sep;35(9):857-64
19. Allgood JP. Transcutaneous electrical neural stimulation (TENS) in dental practice. Compend Contin Educ Dent 1986 Oct;7(9):640, 642-4
20. Bremerich A, Wiegel W, Thein T, Dietze T. Transcutaneous electric nerve stimulation (TENS) in the therapy of chronic facial pain. Preliminary report. J Craniomaxillofac Surg 1988 Nov;16(8):379-81
21. Donegan SJ, Carr AB, Christensen LV, Ziebert GJ. An electromyographic study of aspects of ‘deprogramming’ of human jaw muscles. J Oral Rehabil 1990 Nov;17(6):509-18
22. Gomez CE, Christensen Stimulus-response latencies of two instruments delivering transcutaneous electrical neuromuscular stimulation (TENS). J Oral Rehabil 1991 Jan;18(1):87-94
23. Carr AB, Donegan SJ, Christensen LV, Ziebert GJ. An electrognathographic study of aspects of ‘deprogramming’ of human jaw muscles. J Oral Rehabil 1991 Mar;18(2):143-8
24. Michelotti A, Farella M, Vollaro S, Martina R. Mandibular rest position and electrical activity of the masticatory muscles. J Prosthet Dent. 1997 Jul;78(1):48-53
25. Rilo B, Santana U, Mora MJ, Cadarso CM. Myoelectrical activity of clinical rest position and jaw muscle activity in young adults. J Oral Rehabil. 1997 Oct;24(10):735-40
26. Sgobbi de Faria CR, Berzin F. Electromyographic study of the temporal, masseter and suprahyoid muscles in the mandibular rest position. J Oral Rehabil 1998 Oct;25(10):776-80
27. Eble OS, Jonas IE, Kappert HF. [Transcutaneous electrical nerve stimulation (TENS): its short-term and long-term effects on the masticatory muscles.] J Orofac Orthop 2000;61(2):100-11 [Article in English, German]
28. Kamyszek G, Ketcham R, Garcia R Jr, Radke J. Electromyographic evidence of reduced muscle activity when ULF-TENS is applied to the Vth and VIIth cranial nerves. Cranio 2001 Jul;19(3):162-8
29. Bessette RW, Quinlivan JT. Electromyographic evaluation of the Myo-Monitor. J Prosthet Dent. 1973 Jul;30(1):19-24.
30. Remien JC 2nd, Ash M Jr. “Myo-Monitor centric”: an evaluation. J Prosthet Dent. 1974 Feb;31(2):137-45.
31. Noble WH. Anteroposterior position of “Myo-Monitor centric”. J Prosthet Dent. 1975 Apr;33(4):398-402.

32. Azarbal M. Comparison of Myo-Monitor centric position to centric relation and centric occlusion.  J Prosthet Dent. 1977 Sep;38(3):331-7.

General dentists performing orthodontics is a touchy subject and Sydney orthodontist Derek Mahony has long been in the thick of it, controversially siding with GPs as well as putting his money where his mouth is: he runs his own mini-residencies and mentors hundreds of dentists. Now, with more orthodontic cases around the world initiated by general dentists than specialists, he says it’s time for the two sides to work together and, let’s face it, all make their businesses more profitable.

“I’m willing to share knowledge because it creates a good working relationship,” he says, “and when the GPs perform their own cases I know they will refer the tough ones to specialists. Given the state of dentistry now, you’ve got to work with them, not against them.”

From his state-of-the-art lecture centre at Alexandria, Dr Mahony and his staff of instructors teach about 100 dentists a year. The typical course participant is likely to have done a short introductory orthodontics course before realising they need a much better grounding. He now has 15 years of teaching behind him and 1500 alumni. Graduates who complete all theory and clinical requirements can apply for a MClinDent awarded by the BPP University in the UK, in conjunction with the City of London Dental School.

Dr Mahony’s main claim to fame is interceptive orthodontics, which minimises the need for extractions. This is a key part of his courses but they cover the full range of treatments, from the simple to the complex. The next mini-residency in Orthodontics and Dentofacial Orthopaedics starts in March 2017. The focus is on investigation as well as correct and thorough note taking, formulation of treatment plans and communicating those plans to the patient or parents.

“We teach dentists exactly what they need to know and provide a strong support network for when things go wrong. I have a number of co-instructors from specialties such as sleep medicine and Ear, Nose and Throat because my teaching is very much based on getting in early: nasal obstruction in children affects their upper jaw, which causes dental crowding. My programme is not just about putting braces on and extracting teeth, it’s also about how to prevent malocclusions from occurring.”

In the first two years, participants commit three days every two months to a program of face-to-face lectures – including live in-house procedures with full audio-visual, plus online tutorials, literature reviews and their own hands-on training with typodonts and live patients. There is a third year of clinical training, involving one day a week, in one of Dr Mahony’s own practices. “Unlike many courses where they can do two or three years of theory before they do one case, we ensure that each dentist will complete 15 closely supervised cases to a high standard. If you do the maths you’ll find that that more than pays for their tuition fees.” The courses also include more discussion in which the dentist’s’ cases are subject to group review. “It’s open learning and there’s a good camaraderie.”

Dr Mahony says his course not only makes the participants better dentists, it also generates a substantial “recession-proof” revenue stream. Graduates incorporate orthodontic techniques to permit less aggressive procedures, like moving teeth before doing veneers, or restoring a collapsed bite before doing a crown and bridge. On the revenue side, he says he knows from 30 years’ experience that parents will make great sacrifices to help pay for their children’s “essential” orthodontic work. One impediment is the fear of cost and inconvenience when the dentist says they need to refer to a specialist. “But if their own dentist does the orthodontics, patients are quite comfortable with it. It reminds them that they go to this dentist for a reason, and it says this practice offers more than the average treatment options. Of course, the more complex cases are referred to a specialist.”

Contact EODO Course Coordinator, Dr. Sakshi Arora, BDS on (02) 9398 8338 or courses@eodo.com

Over the past few years, there has been something of a paradigm shift in cosmetic dentistry to more minimally invasive protocols. The modern, preferred approach to enhance someone’s smile is to move their own teeth into a more favourable position, whiten the teeth and use cosmetic contouring, or bonding, to create a more appealing smile. The so-called ABC approach — Align, Bleach, Composite (or Contouring).

The ABC approach is well within the capability of the general dentist, and with the advent of companies such as Quick Straight Teeth, there are many more dentists offering ABC in preference to veneers. Awareness of orthodontics amongst patients has increased due to consumer advertising and the fact that more dentists are now offering cosmetic orthodontic solutions.

The stigma of ugly, metal, ‘train-track,’ braces is one that many people harbour from their teenage years, so there is something of a hurdle to overcome in providing orthodontics to grown-ups. Their fears generally comprise some, or all, of the following: price, discomfort, aesthetics and time.

It is the duty of the treating clinician to provide an option that overcomes all of these issues, however, this is often easier said than done. In cosmetic orthodontics, it is rare to find a solution that has no compromise – the very best quality, at realistic prices. Quick Straight Teeth is one example of a company that offer the very best, gold-standard components whilst maintaining the most realistic prices in the market, to ensure straight teeth are made available to a wider audience.

With companies such as 3M at the forefront of orthodontics, we are able to overcome any trepidation that grown-ups may have regarding the provision of orthodontics. Discomfort is kept to a minimum by using only small-gauge round wires, ceramic brackets and tooth-coloured wires allow for beautifully aesthetic, almost invisible braces, treatment times are short due to the focus being on anterior alignment, rather than comprehensive orthodontics and all this can be done at a fraction of the price of most aligners.

So, we know what’s stopping people having their teeth straightened, and how to overcome these issues – but what is stopping dentists providing orthodontic solutions to grown-up people? Many dentists are comfortable providing removable, clear aligners for patients but often refer out any cases requiring fixed solutions to their local orthodontist. To general dentists, fixed orthodontics is seen as something of a mystery. A complex world of angles and forces where they would rather not tread.

In the case of children, it does most definitely require a specialist orthodontist to see such cases due to the many factors at play in the growing jaw. However, in the case of grown-ups, who require minimal alignment of the front 6 or 8 teeth, this can be done safely and effectively in general practice with the close support and supervision of our learned specialist colleagues. If they work alongside a good quality orthodontic laboratory using the indirect-bonding method then the whole process becomes enjoyable, predictable and profitable.

Given the litigious nature of our times minimally invasive and conservative dentistry should always be the preferred approach of any clinician, and is almost always in the best interest of the patient.

Why not investigate the world of cosmetic orthodontics today? It’s as easy as ABC.

Alternatively, if you are a general dentist already offering simple orthodontics to your patients but are experiencing brackets de-bonding, long lead times for laboratory work, plastic or composite brackets and lack of local support, then why not make the switch to QST?

QST is a specialist designed, taught and supported orthodontic system design specifically for use by the general dentist. We offer gold standard products, training, mentoring, local support, marketing and clinical integration into your practice.

The good news is that the demand for adult orthodontics has never been higher, there will be many cases you can treat from the patients you see day to day. We have trained over 500 dentists in Australia over the past 8 months — don’t miss out on the chance to offer this fantastic service in your practice and help your patients to smile with confidence.

Book your course today and remember to quote promo code TDROFFER (limited to the first 25 course registrations due to high demand).

For more information download our Quick Straight Teeth information pack.

TP Orthodontics has added Nu-Edge^® Self-Ligating metal bracket with passive mechanics to their product line up.

Nu-Edge SL brackets offer several distinct features over competitor self-ligating brackets. 

Nu-Edge SL brackets feature a robust locking mechanism. Once the patented slide is locked in place, the archwire slot becomes a rigid tunnel preventing the bracket from becoming unseated. Our patented dumbbell mechanism provides audible assurance that the slide is completely closed. Additionally, Nu-Edge SL brackets do not require a special tool for ligating.

The sliding mechanism does not protrude like other self-ligating brackets. This gives a smoother surface that enhances patient comfort.

Nu-Edge SL brackets are made from Cobalt Chromium. They are ideal for nickel sensitive patients while offering superior strength to prevent slot collapse due to any occlusal forces.

The brackets feature nano-polishing technology which prevents bacterial adhesion, reduces friction and enhances surface smoothness for increased patient comfort. It has an extremely small footprint and profile design, making the bracket aesthetically pleasing for patients.

Nu-Edge SL also features deep undercuts and hidden tie wings allowing for traditional ligation when needed. Metal ties can also be used due to the strategically placed auxiliary wire slot.

The patented maze base design is metal injected molded and provides unparalleled bond strength and unmatched adhesive retention during debonding.

Contact Kathy Kanellos via kathy.kanellos@tportho.com to discuss TP Orthodontics’ Nu-Edge^®. Alternatively call 1800 643 055 or visit www.tportho.com.