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Bone creation and the power of orthodontics
16th Jun 2005
Three American specialists with the reputation of being, ‘the best act on the international dental circuit’ had much to live up to when they took the stage at Church House, Westminster, for the British Orthodontic Spring Conference. The title of the day was ‘Interdisciplinary management of missing teeth in the aesthetic zone’, which is precisely what these chaps are renowned for; orthodontist Vince Kokich, prosthodontist Frank Spear and periodontist Dave Mathews. They were welcomed by BOS president, Allan Thom, who told the sell-out audience they should ‘hang onto your seats’ while Nigel Harradine, who chaired the morning session and who had also heard them speak several times before, promised there would be plenty of virtuosity on display. Judging by the applause at the end of each session, the delegates were not disappointed. The three speakers took it in turns to go through some of the cases they had treated together, illustrating the value they, and their patients, get from their shared treatment planning. Vince Kokich, who has given over 600 presentations around the world, explained they began working together over 20 years ago when a general dentist and management guru in Washington decided to bring together a team of specialists. They still meet monthly and over time have become ever more innovative in their approach. Their trust in each other’s abilities and willingness to work under direction is unparalleled. Another factor that struck the audience was the truly outstanding quality of the ceramic laboratory work. Many of the studies they presented were of implant cases and the key components, said Dr Kokich, are: • Sufficient space • Accurate implant positioning • Adequate bone • Aesthetic gingival margins. The ability to place an implant following extraction is compromised by rapid bone loss. However, most impressive were the cases which showed that the bone created by orthodontic separation of adjacent teeth is maintained, even years later. This was described as ‘the power of orthodontics’. An application of this principle can be found in the management of patients with congenitally absent upper lateral incisors. It is preferable to allow the canines to erupt into the incisor positions and subsequently extract the deciduous canines and then recreate spaces. The bone thus created is of quantity and quality for the insertion of implants. The afternoon meeting was chaired by Dr Les Joffe, whose humorous introduction set the pace for the lively afternoon session. Dr Spear continued where the morning left off and discussed aesthetic gingival margins. He examined the implications of the biological width on papilla height in cases with single missing teeth and multiple missing teeth. Dr Spear highlighted the ability of the orthodontist to alter the bony level by forced eruption and controlled extraction, reinforcing the term ‘hopeless but not useless’. Such methods of controlled extraction are used where there are gingival level differences and bone level differences. Dr Mathews illustrated this with a remarkable case where a buccal dehiscence was treated with forced eruption and a pedicle connective tissue graft. The final part of the meeting was spent discussing options for avulsed teeth. Dr Kokich listed the three questions necessary to evaluate whether re-implantation is appropriate. Is the tooth retrievable? How long has the tooth been out of the mouth? Is RCT possible? The proceedings were brought to an end with a selection of inspiring cases showing multidisciplinary planning and treatment of the very highest standards. Dr Kokich and Dr Spear have made their research available on the internet, further details can be found from the following websites www.kokichorthodontics.com and www.seattleinstitute.com.
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