Our team was excited to help Melina begin her smile journey. Melina’s first visit was the result of a careful and deliberate investigative process in understanding her etiologic factors and subsequently determining her diagnosis and treatment plan options (a normal process among all orthodontists). As we often tell parents, a thorough understanding of why we are seeing what we are seeing helps us determine the answers for stable and predictable treatment.
Over the course of the next two years, we will combine our diagnostic findings along with Melina’s treatment to create a journey of information, dialogue, and smiles. Orthodontics enjoys the analysis of 3 planes of space, and our Facebook post of Melina’s first treatment appointment will focus on her transverse dimension and the TAD-supported expander she received. More detailed information on how we diagnosis the transverse dimension is available when Dr. Tamburrino lectures on February 20, 2015 at Dentsply GAC’s Orthodontic World Congress .
Melina’s transverse was measured by two methods: CBCT and casts/models. We routinely do two methods of transverse analysis and sometimes independent of each other to flush out mistakes that could unintentionally be generated by the technique of the processes. Recently, we also incorporated a third measurement method, and the intention is that all the three methods and all those taking measurements should be within +/- 1mm of each other. This ensures accuracy in our diagnosis of the transverse. Additionally, it helps provide critical insight allowing us to choosing the appropriate orthopedic expander design, determine the amount of expansion necessary at the level of the screw, and provide reasonable expected outcomes for Melina and our team.
We have uploaded Melina’s CBCT coronal and axial cuts relevant to the transverse diagnosis. The coronal slice shows the compensation of the posterior dentition in an untreated Melina. The middle image shows the maxillary measurement at the coronal portion of the basal bone. This is approximately 54.05mm across the first permanent molars. The image on the far right shows same basal bone position but of the mandible, and it measures approximately 56.67mm across the first permanent molars. To maintain the dentition between the buccal and lingual cortical plates on the maxilla and mandible, we want the maxillary transverse skeletal measurement to be 5mm larger than that of the mandible.
Therefore, if the mandible is 56.67mm then the ideal maxilla should be 61.67mm. Melina’s maxilla measured 54.05mm, which is approximately 7.62mm more narrow than ideal. This skeletal discrepancy is too large for us to overcome with dento-alveolar movement alone, so we intended to correct it via an orthopedic change at the level of the basal bone. We chose to use a TAD-supported expander as Melina was 12 years 7 months old at the time of her orthodontic records. The amount of expansion and her skeletal age required an expander design that would have the greatest influence on the maxillary bone change required.
Melina underwent what our team refers to as ‘family bonding’ for the next 44 days, with the expander being turned by mom/dad 1 time a day. Melina would end up with a large diastema between the teeth and 11mm at the level of the screw. When we took her post-expansion, limited FOV CBCT scan, the results were…stay tuned!
Shalin Raj Shah, DMD MS received his Certificate of Orthodontics and Masters of Science in Oral Biology from the University of Pennsylvania and is a Diplomate of the American Board of Orthodontics. He is also a graduate of the University of Pennsylvania College of Arts and Sciences and School of Dental Medicine. Currently, Shalin is Clinical Associate of Orthodontics at the University of Pennsylvania and is in private practice (Center for Orthodontic Excellence) in Princeton Junction, NJ and Philadelphia, PA.
Ryan K. Tamburrino, DMD, co-founder of the Center for Orthodontic Excellence, graduated from Duke University with a double major in biomedical engineering and mechanical engineering/materials science. He attended the University of Pennsylvania for dental school, as well as for specialty training in orthodontics. Dr. Tamburrino is on faculty as an attending clinician in the graduate orthodontic clinic at the University of Pennsylvania. Additionally, he is on faculty and lectures internationally/nationally with the Complete Clinical Orthodontics (CCO) courses.