the tweed profile - The Charles H. Tweed International Foundation

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the final result. Communication with the parent and/or the patient (if an adult) is paramount in order to impart an understanding of the process of treatment. We must keep in mind that some patients need extractions and some do not. If we apply these principles in our daily practice, we should be able to maintain and/or improve facials esthetics. The following case studies illustrate the importance of accurate diagnosis and treatment planning. CASE #1 Patient SK’s chief complaint was her “crooked teeth” and not being able to “get my front teeth together”. A review of her records showed a total discrepancy of approximately 15mm, which included 5mm of crowding, and 10 mm of cephalometric discrepancy. Skeletally she had an open bite tendency as well (Figure 6). With a history of previous orthodontic treatment and the obvious relapse due to the large discrepancy, an extraction treatment plan was chosen. The results (Figure 7) show nice soft tissue profile improvement into the esthetic zone due to the alignment and retraction of the anterior teeth. CASE #2 An African-American female presented to Dr. John Bilodeau as a transfer patient with partial appliances in place. The diagnostic records revealed a dentoalveolar protrusion with edentulous spaces in both arches (Figure 8). After discussing the problem and her desires for soft tissue profile improvement, she was retreated with the extraction of three premolars. Mini-anchors were used for absolute anchorage. The protrusion was reduced and all edentulous spaces were closed. The facial change was evident due to the reduction of the protrusion (Figure 9). Figure 8. Mulu Pretreatment Figure 6. SK Pretreatment Figure 9. Mulu Posttreatment Figure 7. SK Posttreatment CASE # 3 Patient CW’s chief complaint was her “crooked teeth”. Her diagnostic records revealed 6mm of TSAL and about 6mm of protrusion (Figure 10). Due to the low mandibular plane angle, the crowding and the protrusion and an already pleasing profile, a non-extraction treatment plan utilizing interproximal reduction was selected. The result reveals good tooth and dental arch alignment, a slight reduction in the dental protrusion and no change in the profile (Figure 11). 5
Figure 13. MT Posttreatment Figure 10. CW Pretreatment Figure 11. CW Posttreatment Figure 12. MT Pretreatment CASE #4 MT demonstrated a severe Class II division dento-skeletal problem. The profile was mandibular retrusive and there was an impinging overbite (Figure 12). Because of the low mandible plane angle, the impinging overbite and the severe skeletal retrusion, non-extraction treatment along with a fixed functional appliance for the skeletal correction was selected. The result (Figure 13) shows good improvement in the chin position and the overall profile as well as good dental correction. CONCLUSION “In Man, the lower face serves not only in the interests of digestion, speech and respiration, but it also influences to a large extent the social acceptance and psychological well being of the individual. Appearance, therefore, is one of the primary functions of the face”. Dr. Charles Burstone made this statement in 1958. We must realize that facial appearance must be a mandatory consideration in planning orthodontic treatment. In recent years there has been much discussion about the idea of evidenced based treatment. It has been touted as the direction of the future of our specialty as well as dentistry overall. It seems to me that there is a multitude of evidence available. Although some may say that it is merely clinical in nature, orthodontics is actually about clinical application of principals that work. It would appear that we are not listening. The direction of the future that I have seen is profit consideration, ease of treatment, marketing efforts, vicious competition and a downright lack of respect for scientific principles. I think that we need to get “back to the future” we had 30 years ago and stick to the basics given to us by clinical evidence. It appears that we have forgotten that orthodontics is both an art and a science. The use of science shows us what is possible and the application of art gives us the end result. 6
Page 1 and 2: THE TWEED PROFILE PUBLISHED BY THE
Page 3: CONTENTS 2 ORTHODONTICS IN THE AGE
Page 6 and 7: FACIAL ESTHETICS - A VALID TREATMEN
Page 10 and 11: VERTICAL CONTROL FOR THE CLASS II P
Page 12 and 13: The following records are those of
Page 14 and 15: This patient has crowding and is sl
Page 16 and 17: She was treated with Tweed-Merrifie
Page 18 and 19: This will Increase the Amount of In
Page 22 and 23: A .020 x .025 stainless steel T-loo
Page 24 and 25: for the other half (N=45) included
Page 26 and 27: tooth alignment. Long term stabilit
Page 28 and 29: RME ON PERMANENT VS RME ON DECIDUOU
Page 30 and 31: The “New REP” was retained for
Page 32 and 33: • Intercanine diameter: measured
Page 34 and 35: The second CBCT was repeated 10 mon
Page 36 and 37: 30. Ricketts RM, Roth RH, Chaconas
Page 38 and 39: DISCUSSION The described clinical a
Page 40 and 41: tion effect was created by the shif
Page 42 and 43: ceptable and favored by the Japanes
Page 45 and 46: CORRECTION OF ADULT SKELETAL CLASS
Page 47 and 48: applied for 10 to 12 hours a day an
Page 49 and 50: TREATMENT RESULT The patient was tr
Page 51 and 52: Cephalometrically, there was a good
Page 53 and 54: REFERENCES 1. Zachrisson B, Alnaes
Page 55 and 56: The panoramic X-ray (Fig 3) shows n
Page 57 and 58: Fig 15 Fig 18 Fig 16 Fig 19 SUMMARY
Page 59 and 60:
the rather short anterior-posterior
Page 61:
Figure16 correction which, in turn,
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