Letters to Dr. Pedetta

On this page we collect some of the letters come with answers. At other points, Dr. Pedetta will try to respond privately. For some letters, we apologize, it will not be answered.

Serious problems in trying to recover a canine included

Sometimes it take a trip to Pisa instead of taking years of bad treatment ...

Expander expander mobile or fixed?

Extract or not extract, this is the dilemma

Three dentists in three different solutions ...

The dentist says that the cure for the third class is useless, so there is surgery!

The third class (cross bite) at 13 months: is it possible?

Abuse, and moral lessons of "physics mechanics" from conception of the Distal Jet  

The first of orthodontic implants: really?

The whiplash can lead to unrest temporomandibolari and all'artrosi?

Pain temporomandibolari treated with prosthetic reconstruction of the mouth: better not!

The jaw starts to "pop" and remains locked during orthodontics -

At first molar and canine Class ... curata with Frankel 2, and 13 years! --

pain that does not go after the extraction of premolars

Orthodontic autoleganti ... what do you think? --

Sublussazione of the jaw ... seeking help! --

The expander of the latest generation ... is 20 years old!

Treatment early (Issime) of the third class ... and the Posture? --

Which of the palate expander? --

OThe Orthodontics in London and early treatment? --

Distal Jet but does it work? --

What containment? --

Serious problems in the recovery of a dog included

Hello, I am a woman of 34 years with a very serious problem. From 2001 until today the port orthodontic appliance. The dentist who follows me for years continues to tell me to stay quiet and you must wait for the canine left including bait to raise the apparecchietto. Meanwhile, though the teeth incisors were taken over and moved all the premolars and molars of the right and that I was a tooth extracted cariato because I was the empty space, and yet your mouth I am always wrong, to suffer constant headaches, back pain, and I can not speak, chew, and I also difficulty in breathing from the left nostril (the side where the dog is included that your dentist tries in vain to exit). Physically destroy everything I can not nor eat, nor talk, nor sleep at night. Always take painkillers for the constant and severe headache and often suffer
also severe burns of the stomach. It is now 7 years who are under care, and instead of having the results I find with a mouth that is not mine, completely destroyed. I can not anymore. I do not know what to do. Who should I ask? I would like to hear a good doctor and not a charlatan. Unfortunately, here in my town seems that doctors do not want to work together to solve the problem because the doctor who follows me knows the different studies. Please help me! What should do?

Gent.le Madam,
his situation is quite serious. By X-rays that I sent you understand that your mouth is "distort" the whole side of the canine included. In practice, the teeth were in place that are moving while the dog that was out remains stationary. The recovery of the dogs involved are one of the most difficult treatments in orthodontics and requires a deep experience and the ability to immediately recognize any adverse reaction that may occur during your recovery. In his case, the conditional is a must as long as I can not visit in person, it "would be" checked one of those conditions which are called "dental ankylosis" and imposing immediately stop the forces applied to orthodontic tooth included. Indeed, there is no possibility that a tooth can be included to move while the other teeth are dragged inexorably toward him. This leads to continuous pain, the suffering of healthy teeth with extreme trauma of their roots, dell'occlusione upheaval that opens and deflects toward the tooth anchilosato. All these adverse reactions are difficult to resolve, once you begin and come to the point of his case. That is not the immediate recourse to the care of an orthodontist expert on that immediately suspend the tractions and may begin to bear its teeth in occlusion, ending his continuing pain. In the meantime we must establish a strategy for the canine anchilosato which, as explained in numerous articles by Robert Vanarsdall that was my teacher in the United States requires a new surgical techniques and appropriate lussative. His situation is so complicated that require a specific survey to assess the occlusion and well aware of the actual person dental ankylosis.
Yours sincerely,
Dr. Francis Pedetta

Sometimes it take a trip to Pisa instead of taking years of bad treatment ...

Dear Prof. Francesco Pedetta
I would kindly ask you disturb some information for me very important.
I have 34 years and I live in Genoa. For more than three years of suffering DCM / DTM, with various symptoms.
I state that I have a third class of malocclusion and the narrow palate. So far I have consulted, without a definitive solution: 3 other dentists, 2 ophthalmologists, 1 neurologist, 2 ENT, 1 osteopath, 1 speech. I have made 4 different bite, which I have, all, stringendoi broken teeth during the night, some have eliminated cmq headaches.
I performed various overviews, a CT (brain), a telecranio. The first dentist has tried to widen the palate through REP successo.Non can not be subjected to magnetic resonance xchè I have metal plates inserted in the chest. I have a strong visual fatigue (use glasses for myopia), mild pain in the area of the article and condili temporo mandibular, roar of noise and a sense of padded ears, my sternum muscle cleido mastoideo right side of the neck contract completely. What follows would undergo intervention to correct nasal septum, deviated slightly and then undergo a maxillo-facial speech. I read with particular interest on your site, especially for physiotherapy for the DTM, I want to know if in my area knows a therapist expert on these exercises. I would do one dell'ATM stratigraphy and address the issue of psychiatry (which I never approached), and seems a good choice? Aware that it can not make a diagnosis on-line, and that the evidence in itself is not sufficient, thank you for your attention and, when the next period, taking a appointment in his study in Pisa. FYI

Dear Mr ...,
I think in his case that needs a visit aimed to reorder all the information possible and to set a therapeutic protocol. I was struck by the fact that you did not specify a diagnosis .... only from a diagnosis, you can set up a treatment and if necessary correct it later. Unfortunately, in this way, trying to widen the palate or doing other things All-specific, do not get to much. Transcranial say that is not needed and that the MRI could only confirm that a diagnosis can be made clinically. We must see that the bite has been done but we must consider that it is only one of the principals and that treatment should be complemented by a number of other things. Her, asking the name of a physiotherapist in Genoa hit the mark: it is difficult to have people who deal in satisfactorily the DTM. We are finishing a couple of fisioterapistichiropratici here in the area, with a lot of effort and making them come to the courses that we take on dysfunction temporomandibolari. One of them, Erik Bergstrom, just last week he joined the National Football coronamneto in a career. So I do not have names that you can do. The council to come and visit us, the journey is certainly not impossible. This week we visited between others, a colleague of hematology S. Raffaele in Milan that he had not found help in his city. I think the journey that has taken has been largely repaid. Consider that if you decide to come and see us, will tell Francesca (050-9711094) to arrange an appointment for a visit in keeping Gnathology plus the full time to the treatment plan (photo, questionnaire etc.), which normally do in two visits but in his separate case, coming from afar, could do the same day. The greeting cordially.

Dr. Pedetta

Expander expander mobile or fixed?

In these days with my wife we are facing the dilemma "fixed palatal expander or mobile", recommended for our son for 8 years. With the mobile expander are obtained, even with more time, the same results / effects of the drive? What are the advantages and disadvantages of either choice? Thanks for your attention. Sincerely.

Regarding this question I can definitely recommend it to the expander fixed. It is not so much a matter of time (it is much faster than the fixed expander), the certainty of the outcome. Not least, it must consider that the expander is the only drive that can achieve an expansion of the palate. Mobile is not in a strong position to achieve it. If anything, the question that pops up is: what type of palate expander put fixed? Fact are not all equal and some are much more effective for others. At his son would not have doubts, to put an expander Mc Namara.

Regards. Dr. Pedetta

Extract or not extract, this is the dilemma ...

Dear Dr. Pedetta, suffer a crowding of the teeth from the tender age '. Between 8 and 12 years I have done a treatment of orthodontics, in the years following the situation and 'round slowly getting worse. My palate and 'Strictly speaking, the lower incisors are completely misaligned, overlapping and protrudes considerably higher than one on the right side. The bite on the right side and 'misaligned. I have also begun to suffer from disease and parodontal tomographic examination revealed loss of bone material. Despite that my teeth are still strong, I have 40 years. And a highly accredited in the country where I live (Chile) I was advised of orthodontic treatment with extraction of premolars. I tried alternative which allows me to avoid extractions in Italy and elsewhere, and I do study other orthodontics. One of these, I proposed the use of the method Demon zero or maybe a draw. Returned from the first doctor I was categorically not recommended in any solution that did not include extractions because 'too risky for the stability' of my teeth due to the bone at risk, finding no better treatment to a treatment without extractions. My questions then are as follows:
- There are cases where even today the extractions are necessary, I could be one, or abstractions can and should always be avoided?
- The main objective of the health of teeth and their longevity 'and' recommend an orthodontic extractions or with and 'better not do anything by merely a strict peridontale?

Thank you very much for your opinion.

Gent.le Mr. Leonardo,
from what I wrote, I believe that his is a case mining. The dental extractions should not be seen as escaping from the evil in absolute and sometimes the solution to a case difficult to address in a different way. So, I would not doubt to make them to solve a complex case like his. However, it is also true that recently appeared in the market for new appliances autoleganti that may allow the recovery of a lot of space in arch and for this reason, at times, are reported as inconclusive in cases like his. In this regard (including Damon are autoleganti) I must tell you that these devices last generation (I have already used more than ten years ago, first appeared on the market, the Speed) can, in skilled hands, and if not, you create a lot of damage to Parodont. In particular, can create an expansion dell'Arco (and therefore much room for the teeth), but at the expense of the tissues supporting the teeth. In your case, you should see what kind of suffering parondontopatia and see if it has spread of gingival recessions. In such cases, the extractions were the road. To try to cause less damage to Parodont, you can now apply a method of surgical osteotomy with piezosurgery. However, I believe that even if the roads for the "no mining" today are numerous and effective, sometimes you must resort to the old abstractions and simply solve a case that might not be controllable. I hope not to have created more questions, but if so, what to say my teacher, Professor Vanarsdall, used to say to me: "better this way!"
Sincerely
Dr. Francis Pedetta

three dentists in three different solutions ..

Unless, I would contact you because I have consulted three different dentists to solve my problem and I have given three different opinions. first into the top I have created a space between teeth and another tooth. The two incisors are slightly moved forward towards the left. Secondly I have the deep bite and crowding into the lower front teeth. I was diagnosed that it will get worse. A doctor I initially proposed a plate maintenance and repositioning, whose objective was to prevent me from making an unconscious movement which, in his opinion, was because of the space formed. Then she thought of a mobile device for the arch top (to wear for six months only at night) and no attention to the bottom, why did we come to the conclusion that space has created a fury of feathers chew on that side of the mouth The second dentist I had suggested a therapy sets up and down for about two years. The last doctor told me about Invisalign: applied above to put in place the 4 front teeth, making them turn back, and below to enlarge the arch and then solve the problem dell'affollamento.
I ask if could kindly give your opinion, taking into account my age (almost 17 years) and the fact that I have not yet checked the wisdom teeth.
Thank you in advance

Hello Clare,
try to answer your question, although that will include in his case would require a visit to try to understand the real situation. To explain: when you create a space between the upper teeth, which did not exist before, it might be a problem parodontal below. In fact a loss of support bone usually leads to that result, especially in the presence of a deep bite. However, whatever the cause, there is a need for fixed orthodontic therapy or to limit the Invisalign, although I see it less suitable. In fact, problems of overcrowding, is less effective for a number of reasons. The therapy that has been proposed, the bite, not the solution I see no need in his case. So, to summarize would recommend the therapy setting, not before he had well studied the health of your teeth parodontal higher (and X-ray survey).
Sincerely

The dentist says that the cure for the third class is useless, so there is surgery!

Egr. Dr. Pedetta,
I need your expert opinion on the issue of my son. He has already brought it to the problem of "third class" at the age of 9 years and everything seemed resolved. Now, at 12 years, my dentist has deemed necessary a second intervention and suggested that extraction of two upper premolars. I brought my son for a second opinion and was told that the treatment for the third class is not effective and therefore probably have to resort to surgery. I ask: Who should give a straight line? It 'just pull the upper teeth? The care will be really useful? Should I resign myself and think about the surgery when my son will be greater? Please help me.

Dear Mr.
when you listen to other professionals, always you get different answers, it is almost inevitable. Try to clarify the doubts expressed. His son did early therapy for the treatment of third class and has started this therapy 9 years. The third class, if possible, are treated first, even at the age of five years. I must assume then that his son was brought dall'ortodontista at that age and not before. The orthodontist, the study of telecranio certainly has done, could establish, measure where the third class was skeletal or dental. In any event, the early treatment for skeletal class third involves the use of face mask, to take at night for about a year. Other therapies, which provide for the more mobile devices are not effective in the third skeletal classes. So, if the face mask was applied to his son, I would say that so far the treatment has been set well. As for the extraction of premolars in the upper third class, I would say that is an eventuality to be avoided entirely, because the serious discrepancy between the upper and lower arch. I do not know what the orthodontist has moved in that direction ... even if it had been a serious problem of overcrowding, this could have been dealt very well into the top. Remains the question on the second phase of therapy. It 'really necessary? If your son is a third class skeletal (new telecranio for the diagnosis, before any decision) can surely benefit from a further orthopedic care, yet to be made with the face mask (this is the only effective presence in the third class). Only certain types of third class, do not benefit from orthodontic treatment and those with iperdivergenza (another feature that is revealed with a careful study cephalometric), certainly all the other may benefit from therapy. Finally, with regard to surgery, it is reserved for those cases or for the significant difference for the excessive growth in the pubertal peak and beyond, have become too marked to orthodontic treatment alone. It 'hard to predict which cases are certainly surgery at that age but if we intervene, we must implement efficient appliances otherwise all third grades worsen with age. I am sure that a prepared orthodontist can give you all the information and together you can make decisions most appropriate for your child.

The third class (cross bite) at 13 months: is it possible?

I have a girl of 13 months which has been "diagnosed" a third class of malocclusion. It 'been seen by a doctor, dentist and it seems to her the mask delaire .. for now has only four lower incisors and the two above, there is hope for change or a situation that can only worsen. . In our family there is no case of this type of malocclusion. Venice
Thank you, sincerely

Dear Madam,
is very rare to see a third class at the age of just 13 months. In fact, children are physiologically opposite condition (second class) and the chin seems very elusive. Then, with time, the chin is back on, until it assumed the final position. So, see a bit cross at that age, immediately raises doubts all'ortodontista: and in fact most of the time there is a sliding forward of the jaw, only during the closure of the mouth. The orthodontist has to verify the closure of the patient in centric and realize that any interference that force the child to close in the wrong way. So, I suggest to check the closure of the mouth, driving the jaw in centric position. In these cases, no facial mask is shown. Sincerely
Dr. Francis Pedetta

abuse, and moral lessons of "physics mechanics" from conception of the Distal Jet

Dear Dr. Pedetta,
I still wonder in the face of total lack of knowledge of physics and biomechanics.
It should be said that they are the creator of equipment that you have not properly described in 2006, the distal jet.
Unfortunately, just today I read his comments and would like some chiarigli concepts. Go to comments
Extraoral traction creates serious problems in the first section of the spine, especially in individuals growing.
The cervical lordosis to forces of 400-800 g may be amended and so you create much more serious damage of the solution of the problem which considers that it has obtained (ask your physiatrist if it has one).
Collaboration and the theory of 10 hours does not make it an effective and modern.
We have never said I will not Carano there would be loss of anchorage.
Sapevame we too 3A of Newton's Law!
But we have also explained how to minimize the problem, you probably do not know or did not or did not thoroughly read the book.
Compare the mechanics of Distal and the Pendulum would shiver anyone knows a bit of physical mechanics.
So my dear Doctor pontificate instead encourage you to investigate subjects before treating them.
I appreciate that sometimes someone does not agree with her.
Let me make a small lesson in morality, she is the esteemed representative of the mentality of the country in which they live (and which often complains about it), and in no other country like Canada is an evil things done by their own countrymen, in others you will like all the nationalistic protectionism.
Now in the case of the distal jet, not only in almost 15 years has proved its value but still remains the only device to represent her and my country abroad in orthodontics.
So when want to clarify one's ideas about the problems did not call me, I have my allgato the numbers, but have the good taste to respect the work that some of his country did for you who eat in them to make this dish, as Italian, most often beautiful that its ugly figure with the device with little knowledge she has not hesitated to brand almost alivello of a fraud made to his colleagues.
I believe that anyone who is really cheating is impersonating what he is not impersonating and that what is not and I will Carano we have ever done.
And because the poor Aldo can not answer the call more than and less presumption.

Cordialmente the greeting.
Professor Mauro Testa


Dear "Professor" Testa,

I believe that the presumption and prosopopea are all on their side and I am not surprised of how insulting that you wrote to me, just to the right criticism to your device. Finally, Dear "Professor", I would remind you that this title is usually reserved for tenured professors and professors not to contract, too, that I was a Professor and currently the contract is Clinical Professor at Pennsylvania University, I am the call himself a Doctor, but as you said, this is a matter of good taste.

Sincerely

Dr. Francis Pedetta

The first of orthodontic implants, really?

I am writing to you, if possible, a counselor, my dentist wants to put an orthodontic appliance before prosthesis. He says that the spaces are not adequate and the work would be compromised. It 'true that we must put the unit for force? I also more than fifty years and I fear that the device does not work on me. I will be grateful for his trial. Thank you

Your dentist has certainly given the right advice. For years, implants have been performed on teeth that malpractice had orthodontic adjustments you need. The work performed in this manner, presented a series of limitations, both aesthetic and functional, and the consequences inevitably paid the patient. Finally you are understanding the importance dell'occlusione, the pillars need to be corrected on the ease with you can obtain better cosmetic results, using only as an aid to orthodontic implants. Regards

The whiplash can lead to unrest temporomandibolari and all'artrosi?

GENT. DOTT.PEDETTA,
E 'FROM ABOUT 10 YEARS OF PAIN AND SUFFERING BLOCKS TEMPOROMANDIBOLARI. YEARS AGO I HAVE PERFORMED WITH TEMPOROMANDIBOLARI RX RESULT OF: ORLETTO sclerotic INITIAL AND Osteoarthritis. HAVE BEEN DALL'ODONTOSTOMATOLOGO VISTA, WHICH HAS ATTEMPTED TO DA treat TO PUT BYTE IN EXCESS OF TEETH, to relax muscles and relieve pain, Jaw ADDITION TO THAT EVEN headache still afflicts MI. TENGO A CLEAR THAT IN / 97 TAMPONATO HAVE BEEN ON THE SIDE WITH TRAVELER WITH CERVICAL COLPO birch, AND A CONTROL WITH MRI were diagnosed 2 ERNIE CERVICAL C-5 EC-6. TRAUMA DUE TO THE ROAD. SINCE THEN lot are worse. THE BYTE HAS NOT IMPROVED SINCE CHANGED IT, AND AFTER ABOUT 1 YEAR The ODONTOS. MI HAS NOT SAID PUT MORE 'IS VERY sorry I HAD SAID THAT IT COULD NOT DO MORE TO SOLVE MY PROBLEM. IN ALL THESE YEARS AND 'THE PAIN TO INCREASED jaw, I BLOCK, headache, dizziness and PAIN TO CERVICAL. CAN TO OPEN THE MOUTH NOT MORE 'TO CM 5 I DO NOT HAVE THE FORCE OF MASTIC OR Repeated yawning PERCHE' RISK TO REMAIN LOCKED IN THE OPEN MOUTH.
GENT. DOCTOR REQUEST HE CAN 'give me some COUNCIL, FARMI KNOW IF ALL THIS CAN' BE CAUSED BY THE STATE COLPO birch. ATTEND AN ANSWER HIS CORTESE, THANKS FOR THE HEART AND I extend my cordial greetings.

His story is very well articulated and temporomandibolari problems, there are muscle aches and a whiplash past that could have complicated the picture. Asks me if the whiplash can cause these problems in joints ... and I can tell you that the whiplash can only create pain in the areas relating to establishing temporomandibolare and therefore be wrong to consider the cause of disturbances temporomandibolari. In reality it is referred pain, which disappears if it is the actual site of pain. But if this is not recognized and if the patient is not treated properly (I am not making his case, I am just making an example that may clarify your ideas) and the pain persists, then, that pain could become the that the cause of problems temporomandibolari, through the mechanisms that regulate the transmission of pain and may involve other districts, other muscles and cause long term problems directly articulation. So the roads in this area are not easy to follow. The council strongly be seen by someone who might target in the treatment and that it can unravel a skein which currently looks very intricate.

Pain temporomandibolari treated with prosthetic reconstruction of the mouth: better not!

Gent. Dr.
I have severe articulation problems, I do not support totally and completely with all the teeth.
There are about 6 years that are followed by a famous dentist in Milan, I had orthodontic treatment in order to try to put teeth in the best position for me, trying to find the joints so as to relax the muscles of tension in the cheek, unfortunately without any results.
I still continue emicranee the maximum opening of the mouth is really minimal, and I feel like I have the spillini driven into condilo.
These articular problems are caused by a 'faulty orthodontic treatment done about 10 years ago, I have 2 teeth extracted above and their teeth at the bottom, therefore I can not find stability and are forced to take a day and night plate with some increases.
The dentist who is following me now crestfallen, proposes a byte in ceramics, namely an increase in ceramic on lower molars, hence mm offset those that are missing for me to find a good fit

I have a pleasure to have you think. Thank you in advance for your attention, I offer cordial greetings

Dear Ms
His story is similar to that of other patients who, after years and years care, continue to suffer from chronic pain. Sometimes facts are many different bite, sometimes they proposed to make occlusal reconstructions, prosthetic devices, so as to increase the bite, but in all cases, the symptoms do not improve.

As in his case, the "fault" of the disorder is attributed to the lack of some teeth, an orthodontic treatment effettuatao in the past or a deep bite (only for examples). The situation, of Usually, it is far more complex and requires a totally different approach. I can not enter further into the merits of his case, even if I have the feeling of what might have happened, because obviously you need to carry out an extremely thorough, I would say that the visit and the history of your problem, are usually the keys to reach a precise diagnosis and then a specific treatment.

I, before the visit, I complete a detailed questionnaire (you can do it from home) that gives me the key to making a visit focused. The advice that I can give, however, is surely to not proceed fully with prosthetic therapy and in this I can give the comfort of Professor Okeson, with whom I spoke recently (go to see the "news") and that is in complete agreement with me. The stress that we need a visit to set a therapy for reasons other than those that followed until now.

cordial greetings and e. .. I do know

the mandible begins to "pop" and remains locked during orthodontics -

I wanted an opinion on the case of my son of 14 aa. My son began orthodontic treatment with fixed appliance in gennaio2005 (boy with deep bite). In September 2007 he started to tell me to feel as stuck "at dell'ATM left to get rid of that feeling all the time causing a click opening the mouth (did it on purpose but to get rid immediately after he felt stuck again and drew).

The dentist from whom he was receiving treatment said it was not anything and make the elastics that do nothing but worsen the situazione.Gli captain now 3 episodes during which I am referring to not being able to Apiro good mouth.

The port in Milan by a Gnathology in a moment that tells me that a 'click'e must urgently put a bite. Him to do now dell'Atm plates with mouth open and closed report: no changes osteostrutturali, dislocation and retrusione bottom of condilo right retrusione of condilo dislocation with mild left lower extent tends to travel more in maximum mouth opening of a particular sin. After a week the two are ready to bite a sup for the night and one inf for the day which should take even while eating.

Rx is still made with bite against my opinion (I was not informed). Must take these bite that did not never taken away until around June and the end must make a plate of control (I think I will make him not to do) and then switch again to orthodontic therapy. If he had the patience to read all the message I would ask an opinion, we need all these plates, you can take the bite even while we eat?

Please if you saw that tour in Tuscany do not know anyone in Milan or Sydney to address warm thanks Regards GM (Cream)

Dear Madam,
I have carefully read your letter. From what I can infer he writes that his son, during orthodontic treatment, is suddenly faced signs and symptoms of dysfunction temporomandibolare (DTM).

As the literature has often demonstrated, the orthodontist is not the cause of the problem, which certainly was already there, at least in sub-clinical form and was then slatentizzato during therapy. The intraoral elastic, which was carrying his son, might just have been the cause of the manifestation of symptoms, because, when there is a problem articulate, they are poorly tolerated and should be discontinued as soon as possible. Given that things have now improved and that his son was even with the jaw locked, did well to take care Gnathology by a bite.

As I said, I think I I understood that his son has made of "radiography" mouth open and closed (transcranial) and that in the report have shown the position of condilo than the articular fossa (in particular, appears condilo moved down .....) . No survey instrument was made to make a diagnosis of this disorder temporomandibolare, that assumption should be a condilo-incoordination with meniscale reduction and occasional episodes lock joint, in closing (locking acute). This diagnosis is made, as well as the clinical and anamnestically, with the help of MRI, which remains to this day, the routine examination of the failures temporomandibolari, being able to highlight, in addition to bone structures, including soft tissues and in particular the articular meniscus.

To this has now supplanted the use of transcranial plates, which allow only highlight bone tissues without giving an overview of the situation intrarticolare, true theater dysfunction by incoordination meniscale. According to MRI, I said, will set a therapy, which will make use of bite. As you certainly read the site, in the section on disorders temporomandibolari, there are many types of bite, even according to the different schools, but very few are suited to his case and must be handled by hands experts. About your question if it ever bring the bite, even when we eat, the answer that this is done only in cases of locking (locking joints) acute when, not if you take the bite, the jaw block is again thus feeding the problem is exacerbated because much turns into chronic.

Even those patients who suffer from pain in the joints or muscles of mastication, always lead the bite, and the doctor asked to do so, without being bad bite. In other situations, I would say that it certainly can be less demanding and avoid bringing the bite during meals, and sometimes the night can be enough, but obviously has to be seen from case to case.

When a situation happens like what happened to his son, in the middle of an orthodontic therapy, it is sometimes to stop the use of rubber bands and see if the patient improves and then to complete the treatment without losing all the work done so far. You can also take a bite without releasing it and have it bring only until the critical stage. As you can see, based on experience of everyone, we can deal with the case in different ways.

The last of your questions, ie those who would advise to follow his son, so unfortunately not give you names, even on Milan, as the therapy Gnathology a very delicate area that requires both experience and knowledge and I would not commit itself on a name or the other. Take your research and do not hesitate to contact the best professional who can find and this will certainly satisfied.

Sincerely Dr. Francis Pedetta

Pain that does not go after the extraction of premolars

I ask help because I know not what more to do. My now 16-year-old daughter at the age of ten he was subjected to extraction of premolars, as had not sufficient space for the upper teeth, they were already very much out not so much with those below. Were subsequently placed fixed inf. and sup. followed by the elastic positioning the tensions created pain or not equal on both sides, all for a period of not less than 2 years after the installation of equipment and then shortly after the extraction of the teeth began to jaw pain, especially the right one, with constant headaches. Attensa have to remove the equipment to see if the situation improved, but unfortunately that has not happened even say that it is slightly worse. We turned to two specialists. The first has prescribed a lower bite she takes regularly for 3 months without any result, the following criticizing adversely the work above the bite required a higher course, my daughter has made and which now bears. 6 months have passed and we are in the same conditions. The headaches and jaw pain persist, creating a difficult situation especially for the psychological state of the girl taking behavior negative character (nervousness, aggressiveness, intolerance) dictated by the continued suffering. We are of course willing to come to her studio if she deems it necessary, what I ask is whether he should be bringing something specific examination such as a magnetic resonance imaging. In the event would make. For now I must apologize for the trouble and I am awaiting response.

At first molar and canine Class ... curata with Frankel 2, and 13 years! --

I ask advice about my patient who recently came to my observation. The patient you describe has 13 years, has completed the exchange and was treated for 18 months with a 2 Frankel even if you do not like wearing due, watching his patterns before they started treatment, I saw that the situation is almost the same now: Dental filed a molar and first-class dog class is on the right that left, had a severe crowding in the arch lower 43 is now out comletamente arch and 33 is 2 / 3 level of the upper edge is crowded of 12 and 22. The overjet is about 10 mm and 1mm overbite.
by cephalometric are:
ANB = 7 °
FMA = 30 °
IMPA = 97 °
SUM = 406 ° ANGLES
What should I do, continue with the Frankel? or start as soon as possible with the therapy setting, it is probably a mining case, what do you recommend to remove? how many teeth?
I thank you and send you my dearest greetings

Dr. Francesca Pucci francescapuccif@libero.it (Viareggio)

Dear Francesca,

you know that I can not get to discuss the cases of patients without complete documentation, from photography to cephalometric and as specimens. So for me it is very difficult to give advice on the case that I propose. I can make some considerations that may perhaps help in making your decisions. First, I find unusual Frankel put a 2 in a patient who has a first class molar and canine. In fact, the device requires the patient to close in the third class even without having a therapeutic effect. Furthermore, the cephalometric data that I provide, I can infer that the patient tends all'iperdivergenza Frankel, then the 2 is contraindicated, as well as for age, it is too late (it's better to put it to the eleven from 6 years maximum).

I think what might have happened to this patient (who has seen A second skeletal class), because this is a first class molar and canine, with an overjet of 10 mm and severe crowding, is that the posterior inferior (from canine to molar), are slipped on, reaching a ratio of first class with the upper teeth. The canines, from what I say, are even out of the difficult and now is recovering the space. The Frankel 2 is useless in a case like this. The distalizzazione below the arch, which recreate the space for the canines, it is not an option. So, it's almost mandatory to go through the extraction of two lower premolars. In the space that is created will be housed the canines and less crowding may be solved using the space freed by the canines. At this point, the road to the upper arch is marked, given that you have to remove by force, even here, the two premolars, in order to bring upper canine teeth in the back and end up with a first class dog.

Unfortunately, the case came to your comment too late and after a treatment that is not served to solve the problems.

I greet you, but from now on, I will only discuss mechanics and diagnostics in general, without analysis of individual cases. Hello

orthodontic autoleganti ... what do you think? --

Francesco dear, what do you think of autoleganti low friction?

Nicholas Di Dino, Monsummano Terme (didino.nicolo @ libero.it )

Dear Nicholas,

bentornato between us. I stimuli stringatissima with your question on autoleganti systems. For a long time, I used the first autoleganti systems on the market, the SPEED. At that time, able to build attacks with a door that could open and close it was not possible for the normal industry dell'Ortodonzia. In fact, the Speed, Canadian factory to high tech, building accessories for the aviation and his attacks are always a concentrate of technology and the only ones on the market. I am glad that now, after many years and after that the market had timidly tried to intrudurre other attacks autoleganti (the Activa for example), there are many companies that are proposing. My experience has always been exciting and I saw for myself how they were quick and efficient in moving the teeth. Now I'm trying attacks autoleganti that he made available to Target Orthodontics (Carriere LX). I can tell you is that certainly from the biomechanical point of view, systems are very efficient, which will certainly not regret the attacks traditional, but we must choose those that retain the qualities of simplicity and immediacy of use. The door should not be difficult to open or close and all operations related to the insertion of the wire must be fast and simple.

For what concerns the clutch, the speech is a bit complicated ... in fact it is the power that is exercised on a given surface. More strength increases, the more friction is determined. In Orthodontics, enhance the strength of the insert is always thicker wires, in order to fill the slot of the attacks and have more control over the teeth. So I think that things will change little between brackets traditional and autoleganti, especially when we put the rectangular wire. Perhaps, in the early stages of treatment, the same wire inserted, the systems allow autoleganti a "game" and increased the wire for this, a smaller clutch, along with lighter forces transmitted to the teeth. I do not know if it will spread in coming years, I believe that there is also a discourse of cost to be assessed. It certainly is a step towards orthodontics yet more modern and efficient.

Sublussazione of the jaw ... seeking help! --

Hello I would like to have an opinion on my case:
are a girl of 22 years and 4 months ago during a particularly stressful period, I was locked in the mandible irreversibly. Already suffering from several years of turmoil all'atm, or click and felt occasionally subivo short blocks alone sistemavo.Mi realize only now that he has neglected a disease that is quite serious. Returning Four months ago, I went by my dentist who diagnosed me a sublussazione and I did a manual repositioning, and then prescribed me medication and muscle relaxants the use of a bite p er 6 months to treat malocclusion by which they are affected.

I have taken this care with confidence but also with immense fear because I saw and I see that the situation of my mouth no signs of improvement and what I want if you know more than 2cm which is reduced now will never return to normal as prescribed 4cm. I want this factor especially since I have a passion that I have always grown up to 4 months ago and that is acting. My doctor tends to glisse on this and this worries me greatly because it gives me reason to believe that no more will come back to open the mouth normally. please give me advice!
thanks for the kind attention!

AR (Florence)

Dear Madam,
his is certainly an interesting case because the sublussazione she says that he has had, is a state of hypermobility of condilo and the maximum opening of the mouth, there is a feeling of blockage, but is easily overcome by the patient himself who is able to chiudela again. This is not a pathological condition and the patient is trained not to stretch your mouth to the maximum aperture.

What is in my opinion you have is a hypomobility of the jaw due to a dislocation of the disc without reduction. This is an intra-articular pathology that requires a specialized approach. The opening of the mouth is reduced to 25-30 mm. Each forcing open the mouth worsens the situation. Equipment repositioning of the anterior mandible, worsen the situation. In his case may go to a year before they can return to normal opening (even over 40 mm), but must follow an appropriate diet, put a plate for his specific case and not the joint efforts in any way. Obviously these are only general arguments and every consideration must be confirmed by a visit and request for diagnostic tests necessary to establish his case.

The expander of the latest generation ... is 20 years old!

But the expander of which speak in the orthodontic treatment early and that define the latest generation, which device is it? And 'something really innovative?

ME (Pisa)

Dear M.,

the debate we had on the palate expanders has prompted me to publish, albeit anonymously, as we said. I regret not having had your consent as every topic discussed, certainly leads to an increase in professional and often the different points of view enrich everyone. visat When you're on my site, I have pointed out that what I call expander of "next generation" which allows not to open the bite and that I use in mixed dentition, it is not just in the last generation .... It is of the rapid palatal expander shower with resin (also called Mc Namara expander or bite).

But I noticed that problem in Italy is still limited and therefore I said that is the last generation, although in reality, when I studied in Philadelphia, more than fifteen years ago, was the only one expander that is placed in mixed dentition and decidua. Then, after the exit of the last Graber Vanarsdall (Text prince of Orthodontics in the USA also translated into Italian by Piccin and edited by me same with Christian De Paoli) Chapter of early treatment was given to `el Mc Namara with shower expander is described in detail and has become the` official `` expander in the mixed dentition. Consider that at the regional SIDO upgrade the expansion of the palate, held in Siena a few months ago, I was the only one that the rapporteur has proposed, and should have been a refresher course on building!

However, prevents the opening of the bite because of the fact behaves like a bite back, covering the occlusal surface of molars and premolars, causing the intrusion of `posterior region and the closure of the bite. Using it is amazing to see how it is effective in that regard. Other types, including that of Haas, inevitably causing an opening of the bite as a result of the expansion, also documented by the opening angle of the FMA.
on this topic See also ...

Which of the palate expander? --

Dear Francesco,
I was impressed by your new site as orthodontic is full of useful and interesting information for my fellow dentists, both for orthodontic patients and ultimately for normal people who may have doubts about dental problems that affect them.
So I take this opportunity to have more news as to which of the palate expander is used well, and I referring to a number of models that you see around and, apart from the central screw, they differ in the number of bands and for design of the unit. Thanks for your possible answer.

Dr. Veronica Island (Mass) (veronica.isola @ libero.it )

Cara Veronica,

Thank you for the compliments but I urge you to make even the criticism that serve for the comparison and improvement, and now pass directly to your recent letter that appears to be in great demand, because I have just discussed sull'espansore type McNamara with another of our colleague.

The technique of rapid palatal expansion, requires a device that anchored on the teeth, sends all its power directly to the palate, to separate the suture palate. Do not go into the merits of whether or not to separate it according to the age of the patient but on the assumption that serve the largest possible anchorage to move out of the teeth (tipping) as little as possible and send all the strength on the palate. When you understand this simple principle, you understand immediately what expander should be used: prefer someone who has only two bands on the molars and the metal arms that go up to the canines or one that you prefer to have four bands? say that it is easy to see which has more anchorage. If mention of patients who have around 12 years, prefer one that has two bands (molars), four (molars and premolars) or four bands and the resin on the palate? In this case, the last unit is the best (Haas)

The literature is full studies on the effects that the expanders have a dental degree (side) and skeletal level (desired) and our efforts should go in the direction of using more efficient and to abandon those that give problems.

If we talk about mixed dentition, lately (last 20 years) has spread in the United States a new type of device that here is still not appreciated as it deserves: it is dell'espansore rapid palatal shower with resin (also called McNamara expander or bite). Practically has a block of resin holding a molar and molaretti milk and has a retention and anchoring distributed to all the back teeth of the sector (thus more than the others) and prevent the opening of the bite because of the fact behaves like a bite back , covering the occlusal surface of molars and premolars, causing the intrusion of the posterior and the closure of the bite.

Using it is amazing to see how it is effective in that regard. Other types, including that of Haas, inevitably provoke a bite as a result of expansion, also documented by the angle FMA.

So dear Veronica, the subject would be very long but we'll summarize the maximum McNamara uses the type in the mixed dentition and type in the Haas learning;

on this topic see also ... The Orthodontics in London and early treatment? --

Dear Francesco,
a few months ago I moved to London and I started working as a consultant for orthodontics, in several studies. One has an agreement with NHS, the British national health system, so I knew un'ortodonzia characterized by a very different approach.

The children began to be visited regularly once a year since 6 years, but no treatment, as is the severe malocclusion, begins before the final stage of the exchange dentale.
So well known that almost all cases are mining, typically the extraction of 4 premolars.
In fact, in my opinion, most of these cases, if they had been treated earlier in life, would have avoided the abstractions.

When I discuss with British colleagues the benefits of the treatments early, they say that NHS does not share this approach because they do not want to risk seeing compromise the result because of the growth of any remaining or problems at the last stage of tooth exchange.

However, I think the price of organic abstractions which these patients are charged too high, so in my private clinic I continue to insist on an approach to therapy and early correction of problems skeletal when it is still possible to exploit the growth of young patients.
What is your position on this?

Thank you for your attention.
Sincerely
Dr. Claudia Bortolaia (claudiabortolaia@virgilio.it )

Dear Claudia,
as you walk in London? I confess a certain envy where you live now. Of course, if London were at the same level as in Orthodontics in contemporary art (you have visited the Saatchi Collection? They finally opened in the new place?) Or in the finance .... Unfortunately, however, confirms what I already knew.

However, the dispute between early (or Phase 1) and treatment Phase 2 is also in fashion here. I had the opportunity to attend a presentation at the International Congress SIDO in Florence last November, in which he tried to pull the money to decide if it was better to make an initial phase of treatment at an early age (7-9anni) and a second to exchange completed (12 years), or one step in 12 years. As you know, you look for the evidence to see if what you can do a 7-9 years, is still viable even at 12. This is one of the nodal points, since the early supporters of therapy assume that the variations obtained on growth and development (see skeletal changes) can be better and to a greater extent at an early age. The second core issue is the duration (see also the cost) of treatment: it is right to subject patients to two phases of therapy, with more time than the single phase to 12 years and therefore cost more?

You know that I am an absolute advocate of early treatment, but will respond in the most objective possible: on the first core issue, the answer is that what you can do in 7-9 years, you can do the same by 12 to 14 years. Therefore say that the choice between the two approaches can not be dictated by the alleged superiority of therapy on early and late. In fact, you've seen the beautiful Cetlin cases or those of Haas? Both began their treatment only at the end of a dental exchange. None of them loved to draw, in fact were not convinced extraction.

You understand? Has nothing to do with anything the wire late treatment with extractions. There is no link. The abstractions, especially if done so in general, are only the result of an old way of doing orthodontics in England and certainly the low This level of quality. So if the first core issue is practically non-existent, we analyze the second: the time of treatment.

The British system seems to have made the decisions for everybody, not revising the treatment early, in fact makes them non-existent in that country. The assumption is that that last longer and serve to force the two phases of treatment, they cost too much. From this point of view would say that the view is almost unanimous, even from the ocean: the two phases, say, last longer. And 'Here we see how the old way of thinking, taken for granted, has caused the insurance to take those decisions, because there is a kind of early treatment (that you know have attended my courses), which very rarely leads to treatment Phase 2.

I almost exclusively early treatment, resolved in one, maximum two years and then simply, no step 2. You understand that this whole limelight: early treatment lasts less than the treatment of stage 2, probably leads to the same dento-skeletal changes (being higher) and requires no further stages of treatment. If we add that the kids today, at the age of 13 years, does not want to know of (and in my opinion they are right!) Because through a difficult phase of their growth, as I see it is absolutely a favor of early treatment. But under these conditions. I ask the insurance to pay only two years of treatment (time enough for most malocclusion) and then everyone decides to start when it wants, but without being able to prolong the time of treatment.

You, over there, you might begin to move the debate about not abstractions: spiegagli that these cases can be made without extractions, the battle over early, however, the British is lost.
Ti mando un saluto carissimo

Distal Jet but does it work? --

Dear Francesco,
advantage of our friendship for a question on the ports of distalizzazione upper molars. In recent years, I was widely suggested that a device is called Distal Jet and which on paper seems to have all the characteristics to be a good unit, in particular, are attracted by the need for non-cooperation by the patient and also its use seems be very simple. You do not appear to be a step forward not having to always ask the patient and parents to make extraoral traction? And the timing of treatment, should not shorten significantly if the molars are back on their own and in no time? I greet you and thank you.
Dr. Gianluigi Valentini gianluigivalentini@virgilio.it
 

Dear Luigi,
distalizzazione of the molars, the Distal Jet or similar devices (there are several on the market), is based on the idea of applying a spring that will push back when a button resin (type Nance) on the palate and a dental anchor object the forward movement of other teeth.

The idea is not new, I would say that is the same and its basic principles is the same Pendulum or the use of mobile devices with resin on the palate and finger springs for molars or in the arch of Nance as anchor while using the spring wire against the molars. Mechanical ones in the literature have been analyzed for years and the conclusion was always the same: they lose anchorage devices and also fail to distalizzare the molars, so I did not surprised to see that the Distal Jet poses the same problems the category of devices from which derives.

In fact, to think that a button of resin, although broader (and at present is that experts suggest to extend more and more), may represent anchoring, is wishful thinking. Did thirty years ago and it is not today. So if the button is not a resin anchor, what happens when the springs are trying to distalizzare the molars? The inevitable happens, ie loss of anchorage dependent of premolars and canines, which slide inexorably forward.

Just see the cases that were screened at the SIDO Congress for not having more doubts on the subject. The lack of quell'apparecchio, is not only insufficient anchorage underpinning, but also the fact that during the attempt to distalizzazione of molars, it is based on the premolars and canines. The result will be that premolars and canines will be pushed towards mesial rather than go back voluntarily, as happens with extraoral traction, compounding work for correction of Class II.

If the Distal Jet comparisons with extraoral traction, you'll see how this problem has no anchor, allowing the spontaneous distalizzazione premolars (instead of pushing in the opposite direction) and is effective in distalizzazione body of the molars. So the game is won 4 0. As I have always argued, the Distal Jet will not have the ability to see if the springs may or may not distalizzare in the molar body, until it leaves the system of "no" anchor (and thus substantially changes its structure ) for a mini anchor plants in the palate (safe). Not at random, until now, we have always seen to deal with first class or at most with one-second class (even the book that they printed) Dear Luigi greet you and urge you not to lower our guard but to always think about equipment you propose.

go to see the letter that we sent the creator of the Distal Jet What containment? --

Dear Pedetta,
with regard to containment, which equipment you use? Do you think the pre-masks (Essix type) can be a good choice? I think that the fact that they can produce in the studio, in a short time, is very beneficial and I noticed that the patients appreciated for their transparency.
Dr. Nicholas Di Dino (Monsummano Terme) didino.nicolò @ libero.it

Dino Di Caro,
I do not see templates essix type of equipment containment, if not very temporary (short periods, pending the actual containment) will explain the reasons for this choice: in the containment must be capable of teeth "accommodate" one another (interdigitarsi ), after being rigidly held by a steel wire and this is often impossible with the use of masks; occlusion, once removed Equipment shall be free and the mouth should be able to fold without the mediation of thickness between the teeth, masks, being about 1-1.5 mm thick, cause occlusal interference and the long run lead to intrusion of the teeth, are not indicated in cases with articular problems, and I believe can also slatentizzarli in asymptomatic subjects.

The best containment which is always the Hawley Retainer with vestibular arc from canine to canine and hooks Adams on sixths. If you are afraid of articular problems, then uses the modified Hawley Retainer type "wrap around", so you will not have even the wire hooks to interfere with the occlusion.

Treatment early (Issime) of the third class ... and the Posture?

Dear Francis, congratulations for your site and your profit ever disponibilita 'you ask for advice on what criteria rely on the decision of the cases of interception of third class with complete deciduous teeth when dealing with functional appliances or fixed appliances with Extraoral traction, and if ev recommendations. in this age 'and Posture dall'osteopata advice before proceeding with the treatment plan. Thanks and regards.

Dr. Helena Gay (helena.gay @ dentistinpinerolo.it )

Dear Helena, I'm glad felt after so long .. how's it going in your beautiful and huge study Pinerolo? You have many treatments in complete deciduous dentition? If so, congratulations. You know I love that early treatment and the third classes becomes an obligation on the part dell'ortodontista.

Want to know the criteria used? It 'a very broad but you carry out the following reasoning: If you feel that a child of 4 or 5 or 6 years, still deciduous dentition is a third class skeletal, then it means that you have a very difficult case before. In fact, normally the children at that age still have a convex profile and possibly a second-class "physiological" because the jaw is always a little behind with the growth and recovers later, the pubertal peak.

So, if you have before you a third class to that tender age, you absolutely need to make treatment with early orthodontic correction effective in orthopedic jaw bases. The choice falls on the strength of the face mask (very effective) rather than on functional appliances (Type III Frankel or similar) that have little effect on bone bases (see literature). CASOMAI you use the equipment only a functional purpose by as containment for the night.

You ask if send Posture dall'osteopata or a child of that age? Before the treatment? No, not inverei ... frankly I do not see the link. Hello and good skiing in Sestriere