Periodontal Rationale for Transverse Skeletal Normalization

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Authors: Dr. Shalin Raj Shah, Dr. Dan Fishel and Dr. Ryan Tamburrino

The goals of orthodontic treatment are well established for the sagittal and vertical dimensions in terms of how the teeth and jaws should relate, fit, and work together. Diagnostic and treatment strategies focusing on these dimensions are the topic of many orthodontic symposiums, conferences, and research papers. However, the transverse dimension is often missing from generally accepted and performed patient analyses and discussions. Additionally, well-defined criteria for determining if there is a need for correction based on objective means, instead of subjective, frequently are not used.

As there are treatment goals for the final tooth positions based on sagittal and vertical skeletal dimensions, there must be a set of defined goals for the transverse. For the posterior teeth, these would be to have them upright and centered in the alveolus in addition to being well-intercuspated with proper arch coordination, as shown in Figure 1.

Figure 1 – Ideal posterior dental treatment goals – teeth upright and centered in the alveolus, and well-intercuspated.
Figure 1 – Ideal posterior dental treatment goals – teeth upright and centered in the alveolus, and well-intercuspated.

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Orthodontics is a notoriously slow moving profession. Distances less than a single millimeter can take months to cover. It’s the ultimate in controlled, methodical movements.

The man behind the wheel depresses the clutch and plunges the gas pedal to the floor. The engine emits a throaty growl as the tachometer winds out a split second before his foot comes off the clutch, engaging the 800 horsepower engine. There’s so much torque unleashed, the inner portion of the tire has rotated 90 degrees before the outside of the tire even moves. In about ten seconds, the man and the car have moved a quarter mile away from where they started.

Orthodontics is a notoriously cerebral profession. It’s not enough that most doctors need to achieve a doctorate in dentistry, but they must also do so finishing near or at the top of their class. All of which earns them nothing more than the right to plunge head first into three more years of education. Continue reading No Label Required