Orthodontics : current principles and techniques

Comprehensive, cutting-edge content addresses contemporary orthodontic practice! Orthodontics: Current Principles and Techniques, 7th Edition provides an evidence-based approach to orthodontic diagnosis, treatment planning, and clinical techniques, including esthetics, genetics, temporary anchorage devices, aligners, technology-assisted biomechanics, and much more. New to this edition are seven chapters, covering topics like AI, maxillary expansion in adults, Class II correctors, and autotransplantation. Newly authored chapters on orthognathic surgery and the craniofacial team, the periodontal-orthodontic interface, interdisciplinary treatment, and accelerated tooth movement, among others, address current perspectives. The 7 th edition comes with access to an enhanced eBook version, which includes videos and additional visuals to show concepts difficult to explain with words alone. Readers can also find additional, online-only chapters and a fully searchable version of the text. Respected editors Lee Graber, Katherine Vig, and Greg Huang are joined by new editor Pádhraig Fleming, along with expert contributors from around the world. This text provides the most current and comprehensive collection of orthodontic knowledge, making it the go-to book for orthodontic residents and practitioners! Comprehensive coverage provides a one-stop resource for the field of orthodontics, including foundational theory and the latest on the materials and techniques used in today's practice. Experienced, renowned editors lead a team of expert, international contributors to provide the most authoritative clinical practice and supporting science from the best and brightest in the industry. More than 3,400 images include a mixture of radiographs, full-color clinical photos, and anatomic or schematic line drawings, showing examples of treatment, techniques, and outcomes. Detailed, illustrated case studies show the decision-making process, highlighting the consequences of various treatment techniques over time. Extensive references make it easy to look up the latest in orthodontic research and evidence-based information, and all references also appear online. Enhanced ebook, included with every print purchase, features a fully searchable version of the text and bonus online-only chapters, instructional videos, and more. NEW! Seven chapters cover topics such as AI, maxillary expansion in adults, Class II correctors, and autotransplantation. Newly authored chapters on aligners, orthognathic surgery, the periodontal-orthodontic interface, interdisciplinary and computer-assisted treatment, temporary anchorage devices, and accelerated tooth movement, among others, address current perspectives. UPDATED! Relevant literature and evidence-based practices are featured throughout the text. NEW! Additional photos and illustrations visually reinforce key concepts and procedures. Front Cover Inside Front Cover Orthodontics: Current Principles and Techniques Copyright Dedication Contributors Preface Contents Part A Foundations of Orthodontics 1 The History of Orthodontics... From an Idea to a Profession Pre-1900 development of the orthodontic specialty The professionalization of orthodontics The American Board of Orthodontics, Albert Ketcham, and early 20th-century appliances More early 20th-century appliances and the extraction controversy The cephalometer takes its place in the orthodontic armamentarium Functional appliances to midcentury The golden age of orthodontics Two controversies: early treatment and occlusion The temporomandibular joint and orthognathic surgery Surgical adjuncts to orthodontics Skeletal anchorage Late 20th-century 2 Craniofacial Growth and Development Developing a Perspective Somatic Growth Differential Development and Maturation Variation in Rates of Growth during Maturation Craniofacial Complex Structural Units Desmocranium Chondrocranium Viscerocraniu Dentition Functional Units Neurocranium Face Oral Apparatus Molecular Basis of Craniofacial Development and Growth Cranial Vault Development of the Cranial Vault Mechanisms of Suture Growth Postnatal Growth of the Cranial Vault Cranial Base Development of the Cranial Base Mechanism of Synchondrosal Growth Postnatal Growth of the Cranial Base Midface/Nasomaxillary Complex Development of the Midface Postnatal Growth of the Midface Mandible Development of the Mandible Growth of the Mandibular Condyle Histomorphology of the Growing Condyle Articular layer Growth layer Age-Related Changes in the Mandibular Condyle Mechanisms of Condylar Growth Postnatal Growth of the Mandible Arch Development, Tooth Migration, and Eruption Adult Changes in Craniofacial Form Postnatal Interrelationships During Craniofacial Growth Significance of Understanding Craniofacial Growth for Orthodontics References 3 Genetics and Orthodontics Etiology Background and basic definitions Types of genetic effects and modes of inheritance Monogenic Traits Autosomal Dominant Traits and Penetrance Variable Expressivity Autosomal Recessive Traits X-Linked Traits and Lyonization (X-Inactivation) Complex Traits Nature versus nurture Heritability and Its Estimation Use of Family Data to “Predict” Growth Normal facial growth Growth Differences During Puberty Mandibular Prognathism/Class III Malocclusion Class II Division 2 Malocclusion Tooth size and agenesis Dental Crown Morphology Dental Agenesis Dental eruption problems Canine Impaction and/or Displacement Primary Failure of Eruption Environmental and genetic influences on bilateral symmetry Genetic factors and external apical root resorption Short root anomaly Personalized-precision orthodontics Summary References 4 The Biological Basis for Orthodontics Introduction Tooth-supporting tissues Gingiva Periodontal Ligament Root Cementum Alveolar Bone Biology of orthodontic tooth movement through bone Fundamental studies reveal tissue-level bone changes leading to tooth movement Bone cell modeling activity enables tooth movement through bone Mechanical orthodontic forces stimulate biochemical cell signals Local biological mediators of orthodontic tooth movement Neuropeptides and orthodontic tooth movement RANK/RANKL/OPG system for control of osteoclastogenesis and tooth movement Biological control of osteogenesis involved in orthodontic tooth movement Physical methods aimed at stimulating the biology of orthodontic tooth movement Injury-Facilitated Acceleration of Tooth Movement Vibration-Induced Acceleration of Tooth Movement Laser Irradiation–Induced Acceleration of Tooth Movement Types of Tooth Movements Physiologic Tooth Migration Tipping Bodily Movement Rotation Extrusion Intrusion Movements in the Labial/Buccal Direction Tissue Reactions Seen in Orthodontic Retention and Relapse Future directions References 5 Bone Physiology, Metabolism, and Biomechanics in Orthodontic Practice Osteology Differential Osteology of the Maxilla and Mandible Bone physiology Specific Assessment Methodology Classification of Bone Tissue Woven Bone Lamellar Bone Composite Bone Bundle Bone Skeletal adaptation: remodeling and modeling Bone Remodeling Bone Modeling Cortical bone growth and maturation Cutting and Filling Cones Structural and Metabolic Fractions Bone metabolism Biomechanics Sutures Orthodontic tooth movement Occlusal Trauma and Root Resorption Induction of the Tooth Movement Response Differential Anchorage Rate of Tooth Movement Periodontitis and Orthodontics Endosseous Implants Current status of miniscrew implants Osseointegration Bone-to-Implant Contact Bone Remodeling Failure of Miniscrew Implants—Design or Unique Biological Constraints? Rigidity of Miniscrew Implants Animal models for studying bone adaptation, remodeling, and modeling Novel Application of in vivo Micro-CT to Study Bone Adaptation in 3D Developing a Novel Animal Model for Orthodontic Tooth Movement 188 Expedited tooth movement Regional Acceleratory Phenomena Bone Remodeling Rate Current Evidence of Expedited Tooth Movement from Experimental Studies on Rodents and Canines Summary Acknowledgments References 6 Application of Bioengineering to Clinical Orthodontics Sign conventions Biomechanics of tooth movement Centers of Rotation and Centers of Resistance Bracket Path and the Required Force System Optimal Force and Stress The orthodontic appliance Active and Reactive Members Moment-to-Force Ratio Load-Deflection Rate Maximal Elastic Moment Manner of Loading Mechanical Properties of Metals Basic Behavior of Alloys Elastic Limit Modulus of Elasticity Shape-Memory Alloys Ideal Orthodontic Alloys Wire Cross-Section Selection of the Proper Wire (Alloy and Cross-Section) Wire Length Amount of Wire Stress Raisers Sections of Maximal Stress Direction of Loading Attachment Forces from a Continuous Arch Principles of Spring Design The Role of Friction Summary Acknowledgment References 7 Clinically Relevant Aspects of Dental Materials Science in Orthodontics Impact of appliance properties on mechanics Stainless Steel Brackets Stiffness Roughness Base-Wing Joint Hardness Friction Material Properties and Torque Titanium Brackets Ceramic Brackets Brittleness and Fracture Ceramics in Wet Environments Effect of Grain Size Archwires Clinical Impact of Nickel-Titanium Archwire Properties Superelastic and Non-superelastic Nickel-Titanium in Crowding Alleviation Photocuring and adhesives Photocuring Light Intensity Lamps Biological Properties of Blue Light and Adhesives Blue Light Effects Grinding of Adhesives: Production of Aerosol and Estrogenic Action Materials for fixed retainers Properties of Wires and Composite Resins Used for Fixed Retainers Wires Composite Resins Materials used in aligner treatment Properties Important to Their Clinical Performance Intraoral Alterations of Orthodontic Aligners Aspects of Composite Resin Attachments to the Tooth Summary Acknowledgments References 8 The Role of Evidence in Orthodontics Introduction The best scientific evidence Observational Studies Randomized Controlled Trials Critical Assessment and Interpretation of Randomized Controlled Trials 1 . Research Question Systematic Reviews Applying evidence-based orthodontics in clinical practice Example Integrating clinical expertise, the best evidence, and patient preferences/values Critique of Evidence-Based Orthodontics The future of evidence-based orthodontics References 9 Applications of Artificial Intelligence and Big Data Analytics in Orthodontics Introduction Applications of artificial intelligence in orthodontics Automated Cephalometric Analysis Three-Dimensional Cephalometric Analysis Orthodontic Treatment Planning Assessment of Treatment Outcomes Computer-Aided Design/Computer-Aided Manufacturing/Additive Manufacturing Classifying and Organizing Data Remote Treatment Monitoring Other Orthodontic Applications Artificial intelligences and genomics Conclusion References Part B Diagnosis and Treatment Planning 10 The Decision-Making Process in Orthodontics Background Concepts Quality of Life: The Modern Healthcare Paradigm Understanding Normal versus Ideal Occlusion Dental and Skeletal Compensations: Nature’s Way of Camouflaging Discrepancies Recognizing Orthodontic Problems Limitations of Orthodontic Treatment Patient evaluation: the diagnostic process in orthodontics Overview of the Problem-Oriented Approach Collection of Interview Data First Contact Interview at the First Appointment Meeting the Patient and Eliciting the Chief Concern Clinical Evaluation Facial Proportions and Appearance Intraoral Examination Health of hard and soft tissues Soft tissue function Jaw function Diagnostic Records What Records Are Needed? Virtual versus physical dental casts Head orientation for cephalograms Additional records Technologic Advances in Diagnosis Digital photography, videography, and three-dimensional photography Computer imaging Cone-beam computed tomography Intraoral scanning Analysis of Diagnostic Records Cast Analysis Cephalometric Analysis Development of clinical cephalometrics Goals of modern cephalometric analysis Evaluation of Class II malocclusion Evaluation of Class III malocclusion Vertical skeletal problems Vertical dental problems Classification: Organizing the Database Angle Classification Systematic Description: Ackerman-Proffit Classification Development of the classification scheme Application of systematic description Step 1: Evaluation of dentofacial appearance Step 2: Analysis of the dental alignment and intraarch symmetry Step 3: Lateral dimensions (Transverse Plane of Space) Step 4: Anteroposterior dimensions (Sagittal Plane of Space) Step 5: Vertical dimensions (Vertical Plane of Space) Summary of Diagnosis Treatment planning: the problem-oriented approach Prioritizing the Problem List Considerations in Evaluating Treatment Possibilities To Extract or Not to Extract? Management of crowding or protrusion Incisor repositioning for camouflage Visual treatment objectives in the extraction decision Therapeutic Modifiability Interaction among potential solutions to problems Patient cooperation Presenting the Tentative Treatment Plan, Finalizing It, and Obtaining Informed Consent The Patient-Parent Conference Informed Consent Informed consent sequence Computer image predictions Treatment response The Final Step: The Treatment Plan Details (Mechanotherapy Plan) Applications of skeletal anchorage Stereolithographic models and three-dimensional printing Custom milling of attachments and robotic wire bending References 11 Psychological Aspects of Diagnosis and Treatment Patient perceptions Patients with psychological disorders Attention-Deficit/Hyperactivity Disorder Obsessive-Compulsive Disorder Body Dysmorphic Disorder Bipolar Disorder Panic Disorder Depression Eating Disorders Personality Disorders Difficult” Patients Patients having orthognathic surgery Psychological Status and Motivation Expectations Satisfaction Patients with craniofacial deformities Psychological Issues Patients with Clefts of the Lip and Palate Patients with Acquired Deformities Summary References 12 Orthodontic Diagnosis and Treatment Planning with Cone-Beam Computed Tomography Imaging Introduction Strategies for assessment of radiation dose risk Factors that Influence Dose and Risk Estimation Biological Factors Technical Factors Receptor technology and field of view mAs kVp and beam filtration Resolution Clinical indications for the use of cone-beam computed tomography in orthodontics Tooth Morphology and Relative Position Within the Alveolar Bone Temporomandibular Joint Health and Disease Airway Assessment Skeletal Discrepancies and Craniofacial Anomalies Image analyses and the use of three-dimensional surface models and superimpositions Practical Challenges Image Acquisition Challenges Segmentation Challenges Image Registration Quantitative Measurements Volume Three-dimensional linear surface distances in triangular meshes Closest point measurements Shape correspondence measurements Three-dimensional angular measurements Step-by-Step Open-Source Three-Dimensional Image Analysis Procedures Acquisition of Three-Dimensional Diagnostic Records Head orientation Construction of 3D volumetric files that label with color the anatomic structures of interest Image registration Manual approximation of Time 1 and Time 2 scans Voxel-based registration for longitudinal assessments Placement of prelabeled landmarks on the segmentations Generation of three-dimensional surface models from the segmentations with prelabeled landmarks Quantitative measurements Three-dimensional linear surface distances in triangular meshes 3D angular measurements Visual analytics with graphic display of three-dimensional morphologic variability and/or changes over time Treatment planning with computer-assisted surgery Surgical Planning and Simulation Simulation of Soft Tissue Changes Intraoperative Guidance: Surgical Navigation Tracking Technology Final considerations References 13 Upper Airway, Cranial Morphology, and Sleep Apnea Introduction Airway complications have far-reaching effects Anatomy and growth Overview Hyoid Bone Position and Morphologic Features Relationship of Different Skeletal Patterns to Airway Morphologic Structure Airway measurements and imaging Overview Cone-Beam Computed Tomography Acoustic Rhinometry Pharyngometry Ultrasonography Influence of orthodontic treatment on the airway Treatment Including Extractions Rapid Maxillary Expansion Functional Orthopedic Appliances Orthognathic Surgery Summary of Orthodontic Treatment Effects on the Airway Sleep-disordered breathing: airway disorders and management Definitions and Testing Reports Classifications of Sleep-Disordered Breathing Obstructive Sleep Apnea Upper Airway Resistance Syndrome Central Sleep Apnea Syndrome Sleep Hypoventilation Syndromes Epidemiologic Factors Pathophysiologic Precipitants in Sleep Clinical Presentations Physical Risks in Wakefulness Clinical Prediction of Significant Sleep-Disordered Breathing Patient-Based Tests and Questionnaires Friedman Classification Modified Mallampati Classification Pediatric Sleep Questionnaire STOP-Bang Questionnaire Epworth Sleepiness Scale Nasal Obstruction Symptom Evaluation Scale Diagnostic Testing of Obstructive Sleep Apnea Treatment Modalities Treatment Options Lifestyle and Behavior Modification Positive Airway Pressure Oral Appliances Surgical Treatment Oropharyngeal Exercises Upper Airway Electrical Neurostimulation Management for Prevention of Harm Importance of a multidisciplinary approach Summary and conclusions Acknowledgment References 14 Orthodontic Therapy and the Patient with Temporomandibular Disorders Introduction The Concept of Orthopedic Stability Finding the Musculoskeletal Stable Position Evaluating the Patient for Temporomandibular Disorders A Temporomandibular Disorder Screen History A Temporomandibular Disorder Screen Examination Muscle Palpation Temporomandibular Joint Palpation Range of Mandibular Movement Occlusal Evaluation The Clinical Significance of Joint Sounds Developing the Orthodontic/Temporomandibular Disorder Treatment Plan Managing Temporomandibular Disorder Symptoms that Arise During Orthodontic Therapy Summary References 15 The Orthodontist’s Role and Collaboration in a Cleft Palate–Craniofacial Team The Team Approach Orthodontic Treatment and Team Collaboration Neonates and Infants (Birth to 2 Years of Age) Presurgical Infant Orthopedics Primary Alveolar Bone Grafting Speech Considerations for Infants and Toddlers Primary Dentition Stage (2 to 6 Years of Age) Speech Considerations for the Young Child Mixed Dentition Stage (7 to 12 Years of Age) Secondary Alveolar Bone Grafting Early secondary alveolar bone grafting (2 to 6 years of age) Intermediate or secondary alveolar bone grafting (7 to 15 years of age) Timing Interdisciplinary sequencing Orthodontic considerations associated with secondary alveolar bone grafting The transverse dimension Maxillary incisor alignment Position of the premaxilla in bilateral cleft cases Eruption of the maxillary canine Assessing the outcome of secondary alveolar bone grafting Speech Considerations for Older Children and Young Adolescents Permanent Dentition Stage Speech Considerations during Comprehensive Orthodontic Treatment Skeletofacial Growth Considerations Orthognathic Surgery Interdisciplinary treatment planning Role of the orthodontist Distraction osteogenesis Speech considerations AFTER orthognathic surgery Management of the Missing Lateral Incisor Space Canine substitution Fixed partial dentures Removable partial dentures Endosseous implants Current Issues in the Access of Orthodontic Care Barriers in the Access to Cleft Team Interdisciplinary Coordination and Specialty Care Barriers from United States Health Insurance Programs Other Barriers Encountered by Families References Part C Orthodontic Treatment 16 Principles of Treatment: Balancing Outcome and Efficiency Introduction Balancing risk and benefit Orthodontic planning and esthetics Orthodontic planning and dental health Treatment process, experience, and outcome Treatment duration and experience: association with outcome Optimizing efficiency: treatment planning and mechanics Fixed appliance attachments Nonsurgical and surgical adjunctive procedures Short-term” orthodontics Treatment principles: planning for stability Conclusion References 17 Optimizing Orthodontics and Dentofacial Orthopedics Part A: Patient Management and Motivation for the Child and Adolescent Patient Behavior guidance Pain Management First Impressions Differences in behavior management between pediatric dentistry and orthodontics Communication Guidance Patient at-home responsibilities Oral Hygiene and Diet Removable Orthodontic Appliances Extraoral Appliances Headgear for Class II Correction Removable Intraoral Appliances Orthodontic Appointments Intraoral Elastics Removable Retainers Summary Part B: Treatment Timing and Mixed Dentition Therapy The timing of treatment intervention Modification of Craniofacial Growth Patient Cooperation Practice Management The cervical vertebral maturation method When to intervene Treatment of tooth-size and arch-size discrepancy problems Space Maintenance During the Transition of the Dentition Transpalatal Arch Lingual Arch Serial extraction Arch expansion Types of Expansion Orthodontic Expansion Passive Expansion Orthopedic Expansion Rationale for Early Orthopedic Expansion Permanent Dentition Mixed Dentition Orthopedic Expansion Protocols Maxillary Adaptations Mandibular Dental Uprighting, Expansion, and Space Management Appliances Mandibular Adaptations The Schwarz Appliance Lip Bumper Spontaneous improvement of sagittal malocclusions Class II Patients Class III Patients The treatment of class II malocclusion Components of Class II Malocclusion Available Class II Treatment Strategies Maxillary Distalization Extraoral Traction Maxillary Molar Distalization Pendulum and Pendex Appliances Mandibular Enhancement: Functional Jaw Orthopedics Appliance Selection Herbst Appliance Mandibular Anterior Repositioning Appliance Treatment Timing for Class II Malocclusion Additional Comments Regarding Class II Treatment Treatment of class III malocclusion Components of Class III Malocclusion Available Class III Treatment Strategies Appliance Selection The Orthopedic Facial Mask The Fränkel FR-3 Appliance The Orthopedic Chin Cup Bone-anchored miniplates for maxillary protraction Additional Comments Regarding Class III Treatment Overview and summary Final remarks Acknowledgments References 18 Standard Edgewise: Tweed-Merrifield Philosophy, Diagnosis, Treatment Planning, and Force Systems 19 Contemporary Straight Wire Biomechanics Straight wire appliance design and values Straight wire appliance and self-ligation Optimal Bracket Placement Treatment Mechanics Stage 1: Leveling and Aligning Stage 2: Working Stage Arch coordination Overbite and overjet correction Closing extraction spaces Double keyhole loop activation Niti thermal-activated coil activation Minimum anchorage Medium Anchorage Maximum anchorage Intermaxillary elastics Stage 3: Finishing Stage Future directions Summary References 20 Self-Ligating Bracket Biomechanics The Historical Context of Self-Ligation Stainless Steel Ligatures Elastomeric Ligature Begg Pins Self-Ligation Factors that Hindered the Adoption of Self-Ligation Proposed Core Advantages of Self-Ligating Brackets Faster Archwire Removal and Ligation Less or No Chairside Assistance for Ligation Secure Archwire Engagement Friction and Self-Ligation Friction with Active Archwires: Thick, Stiff Wires Friction with Active Archwires: Thin, Flexible Wires Friction In Vivo: Occlusal and Masticatory Forces Secure Ligation and Low Friction as a Combination of Properties The Clinical Significance of Low Friction Active Clips and Passive Slides Thin Aligning Wires Smaller Than 0.018 -Inch in Diameter Wires Larger Than 0.018 Inch in Diameter Thick Rectangular Wires Aging of Spring Clips Self-Ligation and Treatment Efficiency Accuracy of Bracket Placement Initial Alignment Canine Retraction Transverse Development Space Closure Overall Treatment Duration Self-Ligation and Patient Comfort Self-Ligation and Effectiveness of Torque Control Self-Ligation and The Periodontium Self-Ligation and Root Resorption Force Levels with Self-Ligation and Conventional Ligation Does Self-Ligation Reduce the Need for Extractions? PRACTICAL CONSIDERATIONS AND CLINICAL TECHNIQUE TIPS Bracket Type Practical Tips Summary References 21 Lingual Appliance Treatment Introduction Customized Treatment Goals and Lingual Appliances Use of a Target Setup Model System Accurate Realization of Individual Treatment Goals Reduced Risk of Decalcification Main Differences Between Labial and Lingual Techniques Anatomic Variations of the Lingual Tooth Surfaces First-Order Compensations Torque Control Exposure of Bonding Area Innovation in Completely Customized Lingual Appliances Efficient Leveling and Aligning with Lingual Appliances Aligning Type 1 Aligning Type 2 Aligning Type 3 Summary Ref erences 22 Clear Aligner Treatment Introduction Materials Attachment design and other features Software Biomechanics of clear aligner treatment Clinical application References 23 New Frontiers in Fixed Class II Correctors Introduction Two-phase treatment with fixed class II correctors Interarch appliances Herbst Appliance and Variations: Clinical Use Herbst Appliance and Variations: Phase 1 Herbst and Variations: Comprehensive Treatment Mandibular Anterior Repositioning Appliance: Phase 1 Mandibular Anterior Repositioning Appliance: Comprehensive Treatment Xbow (Crossbow): Phase 1 Xbow (Crossbow): Comprehensive Treatment Intraarch appliances Pendulum Appliance: Phase 1 Pendulum Appliance: Comprehensive Treatment Other Intraoral Distalizers: Phase 1 Distal Jet: Phase 1 Distal Jet: Comprehensive Treatment Jones Jig: Phase 1 Jones Jig: Comprehensive Treatment Wilson Arch Carriere Motion Appliance: Phase 1 Carriere Motion Appliance: Comprehensive Treatment Jasper Jumper: Phase 1 Jasper Jumper: Comprehensive Treatment Forsus: Comprehensive Treatment Temporary anchorage devices anchored or bone-borne noncompliance appliances for molar distalization Overall Success Rates Insertion Sites Loading Force Effectiveness and Biomechanics Effectiveness of Different Nontooth/Tissue-Borne Distalization Variations Biomechanics: Palatal Versus Buccal Clinical Application Distal Jet as a Mainframe Pendulum-Type Distalizers Conclusion References 24 Temporary Anchorage Devices Part A: Biomechanical Considerations with Temporary Anchorage Devices Characteristics and clinical significance of temporary anchorage devices Characteristics of temporary anchorage device mechanics Rigid Anchorage Intrusive Mechanics High-Efficiency Mechanics Clinical significance of temporary anchorage device mechanics Easy and Simple Anchorage Preparation Increased Treatment Efficiency Expansion of the range of orthodontic and orthopedic treatment Shifting from a Mechanics-Centered Approach Considerations for temporary anchorage device mechanics Temporary Anchorage Device Stability Temporary Anchorage Device Positioning Load-Bearing Capacity of the Temporary Anchorage Device Biomechanical Considerations Biological Considerations Side effects related to temporary anchorage device mechanics and their management Clinical and biomechanical applications of temporary anchorage devices General Principles in Biomechanical Application of Temporary Anchorage Device Mechanics Diagnosis and Treatment Planning Selection of a Temporary Anchorage Device System and Insertion Site Anatomic factors Biomechanical factors Clinical factor Treatment Strategy Mechanotherapy Design Monitoring Molar Intrusion Decision-making Local factors General factors Factors for stability Biomechanics Mechanical efficiency Three-dimensional control Treatment Mechanics Maxillary molar intrusion Mandibular molar intrusion Considerations for Stability Molar Distalization Decision-making Required space Hard tissue conditions Soft tissue conditions Biomechanics Mechanical efficiency Three-dimensional control En masse distalization Molar Protraction Decision-making Biomechanics Anterior Retraction in Extraction Treatment Decision-making Biomechanics Case studies Prospective Insight Part B: The Use Of Palatal Mini-Implant Anchorage: Conventional Approaches Versus Computer-Aided Design and Computer-Aided ... Mini-implants in the anterior palate Mini-implant Placement Appliance Installation: Conventional Workflow Clinical Procedure: Digital Workflow Clinical Applications of Palatal Mini-implant Anchorage Upper Molar Distalization Maxillary Space Closure Molar Anchorage, En Masse Retraction Alignment of Impacted Teeth Molar Intrusion Rapid Maxillary Expansion Conventional Versus Digital Techniques? Conclusion Part C: Extraalveolar Bone Screw Anchorage Applied to Challenging Malocclusions Design and applications of orthobonescrews Mandibular buccal shelf Sagittal Anchorage: Retraction of the Lower Dentition Transverse Anchorage: Correction of Scissors Bite Mandibular Impaction Recovery: Three-Dimensional Lever Arm Anchored with an OrthoBoneScrew Protraction of Lower Posterior Teeth Ramus screw Application of a Ramus Screw to Treat Horizontally Impacted Molars Infrazygomatic crest bone screw Maxillary Impaction Recovery: Three-Dimensional Lever Arm Anchored with an OrthoBoneScrew Combined Incisal and Infrazygomatic Crest Screws for Arch Intrusion Combined Palatal and Infrazygomatic Crest Screws for Molar Intrusion Other Applications of Infrazygomatic Crest Screws Conclusions Acknowledgment Part D: Orthopedic Changes With Boneanchored Miniplates and Functional Jaw Orthopedics: Biological Basis and Practice Growth changes in the maxilla Class III Orthopedics Class II Orthopedics Growth changes in the mandible Class III Orthopedics Class II Orthopedics Gonial Angle Modifications Modification of Condylar Growth Direction Orthopedics in cleft patients Class III orthopedics and mandibular asymmetry Equilibrium of forces References Biomechanical Considerations with Temporary Anchorage Devices The Use of Palatal Mini-implant Anchorage: Conventional Approaches Versus Computer-Aided Design and Computer-Aided Manufact ... Extraalveolar Bone Screw Anchorage Applied to Challenging Malocclusions Orthopedic Changes with Bone-Anchored Miniplates and Functional Jaw Orthopedics: Biological Basis and Practice 25 Maxillary Expansion in Adults Traditional Tooth-Borne Expansion Appliances Surgically Assisted Rapid Maxillary Expansion Evolution of Bone-Borne Expansion Appliance Maxillary Skeletal Expander Fundamental Concept of Adult Expansion with Maxillary Skeletal Expander Expansion Protocols Midfacial Expansion with Maxillary Skeletal Expander Midfacial Protraction Surgically Assisted Maxillary Skeletal Expander Cortipuncture Surgery and Microimplant-Assisted Rapid Palatal Expansion (SMARPE) Future Consideration Less Invasive Surgical Options Airway Considerations Maxillary Skeletal Expander (MSE) Versus SURGERY AND MICROIMPLANT–Assisted Rapid Palatal Expansion (SMARPE) Versus Surgical ... The Microimplant-Assisted Rapid Palatal Expander and Orthodontics References 26 Orthodontic–Periodontal Interface Prevalence of Periodontal Disease and Conditions Periodontitis in Children and Adolescents The Problem of Different Case Definitions Increased Risk for Periodontitis Periodontal Health and Gingival Diseases and Conditions Forms of Periodontitis Periodontal Manifestations of Systemic Diseases and Developmental and Acquired Conditions Pathologic Tooth Migration Related to Periodontal Disease Prevalence Etiology Treatment of Pathologic Tooth Migration Gingival Recession Definition and Classifications Prevalence Etiology Traumatic Occlusion Gingival Recession and Planning of Orthodontic Treatment General Findings Proclination and Protrusion of Incisors Maxillary Arch Expansion Extraction Versus Nonextraction Treatment of Gingival Recession in Orthodontic Patients Increasing Gingival Thickness in Relation to Orthodontic Tooth Movement Indications for The Treatment of Gingival Recession in Orthodontically Treated Patients Timing of Soft Tissue Augmentation in Relation to Orthodontic Treatment Surgical Treatment of Gingival Recession in Orthodontic Patients Development of Gingival Recession in the Long-Term Following Orthodontic Treatment Orthodontic Fixed Retainers and Periodontal Health Studies Comparing Fixed Retainers to Orthodontically Treated or Untreated Controls Without Retainer Studies Comparing Fixed to Removable Retainers Studies Assessing Different Vertical Wire Positions Other Studies Studies Assessing Fixed Orthodontic Retainers and Gingival Recession Conclusions References 27 Orthodontic Aspects of Orthognathic Surgery Background Definition Prevalence of Dentofacial Deformities Objectives Esthetics Function Incising Food M