Apparently the best clinical guide for a beginner orthodontist

I want to start this year with a review of a wonderful textbook which is a great help for many orthodontists, especially those freshly out of school. 

The 20 principles of the Alexander Discipline is the first part of a trilogy by a famous American orthodontist, Richard Wick Alexander. It was published by Quintessence in 2008.

I bought my copy on the 3rd year after graduation. This is a landmark period in a young specialist’s life: you have just finished several dozens of your first cases and, hence, have a possibility to look back at the results, documentation and biomechanics used. And if you are quite honest with yourself, you are not too excited about how this all looks. “I need more structure in what I do”, – said I to myself then. And luckily, the book was right there at my disposal.

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A very short blog post on apathy

According to Wikipedia, apathy is a lack of feeling, emotion, interest, or concern about something. Last year, most people around the globe experienced this in one form or another because of the COVID crisis. I was one of the affected. I had spent about 2 months without seeing the patients and this distraction from the regular routine coupled with inability to travel was psychologically challenging. 

Here are three measures I find feasible to fight the miserable state of apathy. At least, these work for me.

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An antidote to orthodontic fantasies

Orthodontic fantasies – just as many other gimmicks of modern-day snake oil salesmen – are continuing to spread. We constantly see people online promising to grow children’s mandibles, avoid extractions at all costs with magical appliances or even treat malocclusions with extravagant tongue exercises. 

Of course, in countries with developed orthodontic infrastructures such nonsense is objected by powerful orthodontic organisations (national societies, orthodontic boards), academia or even advertising authorities. However, developing countries, such as Russia, are left alone to suffer from the insatiable appetite of dental charlatans. And it seems that no-one is in charge of this chaos.

About two years ago, I started doing video reviews of orthodontic textbooks. These silent paperback agents are one of few sources that could resist the utter ignorance of market at the outskirts of orthodontic civilisation. The first video I recorded was dedicated to a wonderful book titled Evidence-Based Orthodontics. Today I want to have a fresh look on the text. I think it is still my favourite orthodontic book.

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On Kevin O’Brien’s orthodontic blog

Impartiality is a rare quality. Especially in a competitive, market-driven and technologically advanced field of orthodontics. Today I decided to review one of the most valuable online resources about the specialty. In my view, it provides the most impartial information on the most important orthodontic topics.

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Class II functionals under scrutiny

Is there one source from which I can learn about the whole spectrum of functional appliances? This is a prudent and expected question a resident or a young orthodontist would ask. Luckily, I have a positive answer!

Today I would like to draw my readers attention to an interesting book that aims to provide a thorough and evidence-based assessment of the most popular Class II functional appliances: Twin Block, Herbst, Forsus, Jasper Jumper, etc. It also briefly covers the use of functional appliances in the correction of Class III malocclusion.

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An ultimate guide to the modern-day fixed appliances mechanics

Contemporary fixed orthodontic appliances are deceptively simple. Wire bending is minimised and bonding techniques are enhanced. Moreover, some manufacturers claim that premolar extractions are almost unnecessary implying the role of an orthodontist is just to change a few wires.

Such delusions usually disappear the moment a young orthodontist steps into the real clinical environment. And at this very moment it is imperative to have a reliable guide which will help to wrap the mind around the incredibly simple and uniquely sophisticated tool: the modern-day day fixed orthodontic appliances.

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Never be at crossroads about the mixed dentition again

I can’t help feeling that many young orthodontists often find mixed dentition cases quite tricky. I think this is partly due to the fact that these patients are growing so it takes years to fully appreciate the process of dentition development, and partly because of the constant flow of unscientific and erroneous claims heated by the market.

I had spent almost four years after the residency working exclusively with children and teenagers, so I know this confusion first hand. It whittles down with experience… or with the help of a good book.

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Don’t we need some education? A look from the East.

It was a breezy afternoon in the middle of the week, April 2018. I popped out from the Russian Healthcare Ministry building located in the very center of Moscow. I had just handed to the authorities the Young Russian Orthodontists’ Manifesto and been through a useless debate on if we need any improvements in the orthodontic education in the country. The authorities made it quite clear to me: they are not going to move a finger to make any change.

Few months ago, I made a promise to myself not to write anything more on the post-Soviet orthodotniya. This steals my time and ruins my mood. However, the topic of orthodontic education is a global and critical issue which affects the most vulnerable in the community: the young specialists. This probably excuses me for writing this piece.

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Troublesome laterals: the elephant is in the front!

“Lateral incisors were found to be among the most incorrectly angulated teeth.”

Lawrence Andrews

Despite our tremendous efforts to correct occlusion in all three dimensions, idealise interdigitation and finish without much proclination, our patients are commonly focus their most attention on the upper front teeth. As a result, we have to be very vigilant not to make mistakes in this esthetically sensitive area. 

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Should we rapidly expand children in the absence of cross-bite?

When I just started working as a specialist orthodontist, I would provide a lot of rapid maxillary expansion (RME) to my mixed dentition patients. Even in the absence of posterior cross-bite. I would tell the parents that this will help the teeth to erupt in a better position. I would especially emphasise the potential problems with the permanent canines that I was hoping to prevent with the RME.

I would say and do this because I hadn’t had enough clinical experience and wasn’t familiar with the research data on the subject. I also would probably want to impress the parents with my “comprehensive approach” expecting them to return for the second phase of treatment in a few years. 

Today I still do RME in children in the absence of cross-bite. But in the very particular situations. In this blog post, I want to look at some brilliant papers which helped me better understand the topics of the mixed dentition RME and canine impaction. Hopefully, it will be of benefit for some of my readers…

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