Ortodoncia Clínica

AFTER PASSING THIS SUBJECT, THE STUDENT SHOULD BE ABLE TO :
1- Establish a correct diagnosis and comprehensive treatment plan for the main malocclusions in the maxillary dentition.
2- Establish a correct diagnosis and comprehensive treatment plan for the main malocclusions in the young permanent dentition.
3- Establish a correct diagnosis and comprehensive treatment plan for the main malocclusions in the adult dentition.
4- Establish a correct diagnosis and comprehensive treatment plan for the main malocclusions in combined orthodontic and orthognathic surgery treatments.
5- To understand the concept and clinical application of orthodontic anchorage and its different types.
6- Know the aetiopathogenesis, establish a diagnosis and treatment plan, as well as the selection of the apparatus and biomechanics in the treatment of Class I malocclusions with dental crowding (osseo-dental discrepancy).
7- Know the aetiopathogenesis, establish a diagnosis and treatment plan, as well as the selection of the apparatus and biomechanics, in the treatment of Class II Malocclusions division 1.
8- Know the aetiopathogenesis, establish a diagnosis and treatment plan, as well as the selection of the apparatus and biomechanics, in the treatment of Class II malocclusions, 2nd division.
9- Understand the aetiopathogenesis, establish a diagnosis and treatment plan, as well as the selection of appliances and biomechanics in the treatment of Class III malocclusions.
10- Know the aetiopathogenesis, establish a diagnosis and treatment plan, as well as the selection of the apparatus and biomechanics in the treatment of malocclusions with overbite.
11- Understand the aetiopathogenesis, establish a diagnosis and treatment plan, as well as the selection of the apparatus and biomechanics in the treatment of malocclusions with an open bite.
12- Know the aetiopathogenesis, establish a diagnosis and treatment plan, as well as the selection of the apparatus and biomechanics, in the treatment of malocclusions that require orthognathic surgery.
13- Establish a correct treatment plan and sequence in cases requiring oral surgery and/or periodontal treatment.
14- Establish a correct treatment plan in the oral rehabilitation of adult patients.
15- Assess the importance of psychological and emotional aspects in orthodontic treatment.

THEORETICAL:
1.- Design of the current straight arch appliance. Bracket design: Biomechanical implications. Advanced biomechanics in multibracket techniques. Bracket design: marketing or scientific evidence?
Friction and tribology in orthodontic biomechanics. Friction formulas. Static and dynamic friction. Friction and orthodontic materials. Concept of cold welding and NOTCHING. BINDING. Techniques of controlled tooth-to-tooth friction. STRAIGHT WIRE LOW FRICTION (SWLF) technique.
Objectives, biomechanics and selection of wires in each phase of orthodontic treatment: Alignment. Levelling. Space closure. Twisting, detailing and finishing.
4.- Main class I malocclusions. Types. Aetiology. Diagnostic protocol. Diagnosis and treatment of mild and moderate incisor dental irregularity in class I in mixed and young permanent dentition.
Negative osseo-dental discrepancy or crowding. Aetiology. Pathogenesis. Treatment at different ages. Discrepancy in models and radiographs. Position of the lower incisor in cephalometry. The dilemma of expansion versus extraction throughout history. Evidence-based treatment: truths and false myths of therapeutic extraction therapy.
Risks of overexpansion. Therapeutic extraction. History. Indications and contraindications. Selection of the teeth to be extracted and consequences in the treatment. Treatment with aligners.
5.- Negative osseo-dental discrepancy or crowding. Aetiology. Pathogenesis. Treatment at different ages. Discrepancy in models and radiographs. Position of the lower incisor in cephalometry. The dilemma of expansion versus extraction throughout history. Evidence-based treatment: truths and false myths of therapeutic extraction therapy.
Risks of overexpansion. Therapeutic extraction. History. Indications and contraindications. Selection of the teeth to be extracted and consequences in the treatment. Treatment with aligners.
Treatment with therapeutic extractions: biomechanics of anchorage and space closure. Phases of treatment with multibracket technique. Treatment with aligners. Stripping or interproximal wear. Corticotomies and microsurgery. Included teeth and canines: aetiopathogenesis, diagnosis, prognosis, prevention, orthodontic-surgical treatment plan and the biomechanical sequence.
6.- Risks of overexpansion. Therapeutic extraction. History. Indications and contraindications. Selection of the teeth to be extracted and consequences in the treatment. Treatment with aligners.
Treatment with therapeutic extractions: biomechanics of anchorage and space closure. Phases of treatment with multibracket technique. Treatment with aligners. Stripping or interproximal wear. Corticotomies and microsurgery. Included teeth and canines: aetiopathogenesis, diagnosis, prognosis, prevention, orthodontic-surgical treatment plan and biomechanical sequence.
8.- Class II malocclusions. Aetiopathogenesis. Integral diagnosis. Treatment plan. Class II malocclusions. Maxillary dentoalveolar. Molar distalisation. Indications, limitations, biomechanics, appliances and techniques. Short and long term results.
9.- Class II malocclusions of mandibular origin. Is it possible to modify mandibular growth? A new approach to mandibular class II. Functional appliances. Combination with fixed appliances. Biomechanics. Treatment sequence. Maxillary class II malocclusions. Mandibular class II malocclusions in the growing child. Treatment with aligners.
10.- Class II malocclusions in adults: orthodontic treatment with extractions. Camouflage of class II malocclusion in adults. Class II division 2ª malocclusions: concept and differentiating characteristics. Possible genetic and functional etiopathogenesis. Diagnosis. Possible effects on dentition, TMJ and growth in the short and long term. Objectives and treatment plan. Control and treatment of overbite. Orthopaedic treatment Orthodontic treatment without extractions.
11.- Class III malocclusions. Concept. Classification, possible etiopathogenesis. Growth. Therapeutics based on scientific evidence. Class III malocclusions: new concepts. Maxillary disjunction and facial mask. Class III malocclusions: Orthodontic treatment of camouflage with extractions. Short and long term effects on occlusion, facial aesthetics and ATM.
12.- New treatments in Digital Orthodontics. Aligners. Digital flow. Programmes. Platforms. Basic planning. Attachments: types, design and biomechanics.
13.- Current integration of the different orthodontic techniques in children and adults. HYBRID DSQ technique. Biopolymeric aligners. Proopioceptive eruptive guides.
Orthodontics in the adult patient: special characteristics. Periodontal considerations. Biomechanical considerations.
14.- Orthodontics in the adult patient: special characteristics. Periodontal considerations. Biomechanical considerations.
15.- Orthodontic treatment in the dysfunctional patient/ATM. Orthodontics and dysfunctional and temporomandibular joint (TMJ) problems. Casual relationship between static and dynamic occlusion and craniomandibular dysfunction and pain. Effectiveness and efficiency of orthodontic treatment according to evidence-based therapeutics. Clinical and biomechanical considerations. Consequences of orthodontic treatment on TMJ and dysfunction.
16.-Combined orthodontic and orthognathic surgery treatment. Orthodontics, orthopaedics or orthognathic surgery? Treatment plan and sequence. Diagnostic and therapeutic protocols.
17.- Combined orthodontic and orthognathic surgery treatments in vertical skeletal malocclusions. Combined treatments in craniofacial syndromes and malformations.
18.-The role of the orthodontist in sleep and upper airway pathology. Bruxism. Obstructive Hypoarnea Sleep Apnoea Syndrome. Mandibular advancement devices (MAD). Combined orthodontic and orthognathic surgery treatments for cleft lip and palate and craniofacial syndromes. Orthodontics and speech therapy.
19.-Potential iatrogenic problems during orthodontic treatment. External root resorption of orthodontic origin. Possible aetiopathogenesis. Early detection and diagnosis. Guidelines and protocols for action. Short and long term consequences for the stability and survival of the dentition. Legal considerations. Periodontal problems secondary to orthodontic treatment.
20.-Retention and relapse. Short and long term stability. Retention techniques. Orthodontics based on scientific evidence. Future of orthodontic techniques: 3D design and printing. Shape-memory polymers. The RAP phenomenon. Electric and magnetic fields. Therapeutic ethics. Relationship of orthodontics with other medical and health specialities.
PRACTICE:
1.- Diagnostic-Therapeutic Protocols SIO-UDS da USC
2.- Diagnosis and integral treatment plan of clinical cases.
3.- Design and fabrication of: Lingual Arch. Palatal Bar.
4.- Design and manufacture of: Quadhelix and variants.
5.- Direct bonding of brackets. Alignment. Arch selection.
6.- By-pass archwires: Mulligan (CSM). Utility arch.
7.- Aligners.
7.- Aligners.

Basic bibliography

- Suárez-Quintanilla D (2022) Prácticas de Ortodoncia. Ed SIO-UDS / USC. Santiago de Compostela.

- David Suárez Quintanilla (2021) Prácticas clínicas de Ortodoncia. Amazon Media. Kindle version

- Bravo LA (2003) Manual de Ortodoncia. Ed Síntesis.

- Canut JA (2005) Clinical and Therapeutic Orthodontics. Masson. Barcelona.

- Uribe Restrepo, GA (2010) Ortodoncia: teoría y clínica. Ed Corporación para Investigaciones Biológicas. Medellín, Colombia.

- Suárez-Quintanilla D (2016) Orthodontics: Clinical Efficiency and Scientific Evidence. Ed DSQ. Santiago de C.

- Josep Maria Ustrell Torrent (2015) Diagnosis and treatment in Orthodontics. StudentConsult. Elsevier. Barcelona

- Echarri P et al. (2019) Diagnosis and Advanced Treatment Plan in Orthodontics. Ed Athenea Dental Institute. Barcelona

Complementary bibliography

- Proffit WR, Fields HW, Sarver D, Ackerman JL (2017) Contemporary Orthodontics. 6th Ed. Elsevier. St Louis (there is a Spanish edition in 2019).

- Farronato G and Nanda R (2019) Orthodontics (Volume I and II). Edi-Ermes. Milan

Knowledge
Con58: Drawing up prescriptions for custom-made medical devices ‘dental prostheses’ and ‘orthodontic and orthopaedic dento-facial appliances’.
Con60: Perform the oral and dental treatment of child patients and recognise their characteristics and peculiarities.
Con61: Identify and correct oral habits likely to cause or exacerbate malocclusions.
Con38: Determine and identify the aesthetic requirements of the patient and the possibilities of satisfying their concerns.
Con34: Perform basic treatment of oral-dental pathology in patients of all ages. Therapeutic procedures must be based on the concept of minimal invasion and on a global and integrated approach to oral treatment.
Con36: Take and interpret radiographs and other image-based procedures relevant to dental practice.
Con37: Make diagnostic models, mount them and take inter-occlusal recordings.
Competences
Comp06: Information management skills (ability to search for and analyse information from different sources).
Comp10: Teamwork.
Comp16: Ethical commitment.
Comp17: Ability to apply knowledge in practice.
Comp28: Achievement motivation.
Comp25: Project design and management.
Comp21: Ability to generate new ideas (creativity).
Comp29: Presentation and defence before a university examining board of a final degree project, consisting of an exercise of integration of the training content received and the competences acquired.
Abilities or skills
H/D23: Establish the diagnosis, prognosis and adequate therapeutic planning in all clinical areas of dentistry, being competent in the diagnosis, prognosis and elaboration of the dental treatment plan of the patient requiring care.
H/D25: Know and apply the basic treatment of the most common oral-dental pathology in patients of all ages. Therapeutic procedures must be based on the concept of minimal invasion and on a global and integrated approach to oral treatment.
H/D26: Know how to plan and carry out multidisciplinary, sequential and integrated dental treatment of limited complexity in patients of all ages and conditions and in patients requiring special care.
H/D27: Propose and propose preventive measures appropriate to each clinical situation.
H/D28: Acquire clinical experience under appropriate supervision.
H/D20: Obtain and draw up a clinical history containing all relevant information.
H/D21: Know how to carry out a complete oral examination, including appropriate radiographic and complementary exploratory tests, as well as obtaining appropriate clinical references.
H/D22: Be able to make an initial diagnostic judgement and establish a reasoned diagnostic strategy, being competent in recognising situations requiring urgent dental care.
H/D03: Know how to identify patient concerns and expectations, and communicate effectively and clearly, both orally and in writing, with patients, relatives, the media and others professionals.
H/D04: Understand and recognise the social and psychological aspects relevant to the treatment of patients.
H/D07: Promote autonomous learning of new knowledge and techniques, as well as motivation for quality.
H/D08: Know how to share information with other healthcare professionals and work in a team.
H/D09: Understand the importance of keeping and using patient information records for subsequent analysis, preserving the confidentiality of the data.
H/D01: Know the essential elements of the dental profession, including ethical principles and legal responsibilities.

Theoretical classes. Seminars. Clinical sessions on diagnosis and treatment.
Clinical practice with patients.

Learning assessment system in Clinical Orthodontics

- Continuous objective assessment (short question tests) during the attendance to theoretical classes (10%)
- A final theory exam with 10 questions (70%)
- Presentation of the comprehensive diagnostic notebook (10%) and the preclinical and clinical practice work (10%).

Attendance at classes and seminars is recommended. Four hours of study per week (for theory) and a further 2 hours to complete and improve the practicals are sufficient to pass the course.

STUDY by textbook is recommended. The exam will consist of asking for 50% of the information collected in the text ‘Contemporary Orthodontics’ by WR Proffit (2013) of those topics taught in class.