European Society of Aesthetic Orthodontics: Foundation Course

Sorry for the silence loyal readers! Back with a bang with a recap of a day with the ESAO and their foundation course in London - talks from Prof Derrick Willmot and Dr Yvonne Shaw.

Despite a fun-filled Christmas party the evening before, I made it bright and early for the ESAO foundation course. The European Society of Aesthetic Orthodontics (ESAO) was set up to provide resources and support GDPs who practice orthodontics as well as offering information to patients. 

ESAO aims to educate GDPs and improve their general core orthodontic knowledge, no matter what 'system' they choose to use. 

The day was a good recap of our basic orthodontic knowledge without the bias of a particular brand. Here are just a few main points from the day:

Orthodontic Assessment and Treatment Planning

The crucial steps in assessing whether a patient may be suitable for orthodontic treatment. Some key points Prof Willmot explained to us were:

43% of missing or peg-shaped laterals are associated with palatally impacted canines. 

What is a compensating extraction?
Relating to molars, if there is a 6 that needs to be extracted due to caries/poor prognosis/peri-apical disease, then you may consider extracting the opposing tooth to prevent it over-erupting. If you extract a lower molar, then consider the extraction of the opposing upper tooth; however,  if an upper molar needs extracting you do not usually need to take out the lower molar as these do not tend to over-erupt. 

How can I analyse space? 

There are many ways to analyse space to help you assess how much space you may need to create, just a few examples include:
  • Qualitatively
  • Quantitatively i.e. mm
  • Royal London analysis
  • Ashley Howe analysis
  • Arch Perimeter analysis
  • Bolton analysis

Why do I need space?

There may be multiple reasons why you need to create space:
  • To relieve crowding
  • To decrease overjet
  • Levelling the Curve of Spee
  • To make incisor tip/tongue changes
  • To contract the arches

Ways to create space:

  • Extractions
  • Distal movement of molars
  • Expansion of the arch (1mm of expansion will create 0.5mm of space)
  • Enamel stripping i.e. IPR (interproximal reduction) - there is no evidence this creates any long term sequelae
Or a combination of the above

Once you've assessed the patient and made a diagnosis, you then need to make a problem list which you will address with your treatment plan. The list can be broken down into 4 components:
  1. Oral health
  2. Aesthetics e.g. lip competence
  3. Occlusion
  4. Future stability e.g. if changing intercanine width is this stable?

Dento-legal aspects of GDP orthodontics

Orthodontics is the 5th highest reason for claims against dentists and out of these claims 63% are against GDPs providing aesthetic orthodontics.

15% of patients with fixed appliances will get white spot demineralisation.

What do patients complain about with orthodontics?

  • Dissatisfied with outcome
  • Relapse
  • Collateral damage
  • Failure to refer
  • Unhappy with progress

More than 50% of claims are as a result of mistakes at diagnosis and treatment planning! This isn't surprising - as GDPs we are not specialists and therefore can be thrown by things not going to plan or failing to identify if a case is suitable for aesthetic orthodontics. 

It is important that we realise which cases are suitable for our treatments and which should be seen by a specialist. Always offering a referral to a specialist is advised although many patients will opt for your treatment as they may not want 2 years of fixed appliances etc. 

Obtaining valid consent is never as simple as getting the patient to sign one of the orthodontic system's proformas - you must explain risks of treatment especially things like root resorption, relapse, caries, pain etc. 

Thanks to ESAO for this informative day! If you want more information about GDP orthodontics, see the ESAO website.

Do you provide orthodontics as a GDP? Or attended the course on Saturday? Let me know your thoughts in the comments below!

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