Orthodontics

Department Chairperson

• Anthony A. Gianelly, DMD, Ph.D, MD, Professor Emeritus and Chair Ad Interim

Faculty

• Yael Frydman, DMD, Director, Predoctoral Clinical Orthodontics, yfrydman@bu.edu
  

Location

• Room G-613

Purpose

The orthodontic clinic will provide dentals student with the experience of providing oral health within the scope of general dentistry for the child, adolescent, adult, geriatric and/or medically compromised patient requiring minor tooth movement and space maintenance. Students will learn to incorporate orthodontics as a tool for comprehensive treatment planning. Students will be exposed to and will participate in single tooth or segmental tooth movement through utilization of active removable or fixed appliance therapy.


Suggested Reading

1. Gianelly, A.A.: Orthodontic Principles, Boston University, 1980.
2. Gianelly, A. and Goldman, H.: Biologic Basis of Orthodontics, Philadelphia, and Lea Febiger, 1971.
3. Goldman, H.M. and Cohen, D.W.: Periodontal Therapy, 4th Ed., St. Louis, C.V. Mosby Co., 1968.
4. Seide, L.J.,: A Dynamic Approach to Restorative Dentistry, 1st Ed., Philadelphia, W.B. Saunders Co., 1980.
   

Entry-level Requirements

1. Successful completion of the predoctoral dentistry courses: SDM Orthodontics 521, 530, 630 & 640.
2. Certification of eligibility by the second year promotions committee to treat patients.
   

Patient Care Times

• Consult Times: Fridays during Predoctoral Orthodontic Clinic Hours
• Treatment Times: Fridays between 8:30 am and 4:00pm.
• Summer clinic hours apply during the months of July and August.

Patient Assignment

1. Students will participate in the pre-doctoral orthodontic course on an elective basis. The students will be assigned a patient base to care for on a daily basis per the pre-doctoral orthodontic director. The course will run twice a year for six months.
2. On a predoctoral level, orthodontic treatment will encompass all patient types requiring minor tooth movement and/or space maintenance treated with removable, fixed or both types of orthodontic treatment.
3. The following are examples of limited orthodontic treatment:
   • Mandibular anterior crowding or spacing
   • Maxillary anterior crowding or spacing
   • Orthodontic treatment for prosthetic appliances
   • Opening space for prosthetic treatment
   • Closing space for prosthetic treatment
   • Minor tooth movement for prosthetic treatment (proclination, retroinclination, extrusion, intrusion)
   • Single tooth crossbites

Student Assignment

1. All predoctoral students will schedule patients requiring an orthodontic consultation through Dr. Frydman on the 6th floor, Room G-613. A comprehensive consult is required so that the student can demonstrate basic knowledge in identifying the type of patient malocclusion. A consult sheet is filled out, signed by the faculty member and photocopied. The original is placed in the patient’s chart and the copy is kept by the clinical director. The case is pending approval. (It is usually accepted or denied at the consult appointment. Occasionally, additional diagnostic records are required prior to a case’s approval for treatment in the predoctoral clinic. If the case is deemed too comprehensive for treatment in pre-doctoral orthodontics, then the patient will be referred to the post-graduate orthodontic program.)
2. After approval of the case by the clinical director, the patient will be assigned to an appointment for a standardized set of initial diagnostic records. Students participating in the pre-doctoral elective course will render all further care to the patient.

Equipment and Supplies

1. The students will be supplied with orthodontic instruments such as bands, brackets, wires, pliers, tracing paper and a camera.
2. The student is responsible for all other instruments including but not limited to handpieces and burs, mixing bowl & spatula, whip mix apparatus, etc.
3. Radiographs will be taken on the first floor - Radiology Department - under the supervision of the Pre-doctoral Orthodontic director. Cephalometric, panoramic and other films will be supplied.
   

Patient Management

1. At the consult appointment, the sequencing of treatment is discussed with the patient. If the case is deemed suitable for the Predoctoral clinic then an appointment for diagnostic records is scheduled.
2. Diagnostic Records include:
• Maxillary and mandibular alginate impressions required for model fabrication.
• Panoramic or FMX (full mouth series of radiographs) and a cephalometric radiograph required for tracing analysis.
• Intraoral and Extraoral photographs are taken in accordance to the American Association of Orthodontics’ positions.
3. A lab & film processing fee is collected at this appointment.
4. The photos will be sent out for developing and the impressions will be poured and trimmed in accordance with orthodontic standards. The cephalometric radiograph will be traced by the students which have taken the diagnostic records and a Steiner analysis will be completed.
5. Faculty Treatment Planning: The students which have taken the diagnostic records are responsible for speaking with the faculty member to review possible treatment options including interfacing with other clinical disciplines scheduling, on an individual basis.
6. NO MORE THAN TWO WEEKS should lapse from the date of initial record completion to the faculty treatment planning discussion. The patient’s TREATMENT PLAN is SIGNED by the FACULTY MEMBER and only after it is signed may treatment commence.
7. Patient Treatment Planning Appointment: At this visit, the treatment plan options and fees are discussed with the patient and separators are placed (where applicable) for fixed orthodontic treatment or an impression is taken for removable orthodontic appliance therapy. At this appointment:
• An Informed Consent Form MUST be signed.
• A Treatment Contract MUST be signed.
• A down payment is collected at this appointment if the treatment will require fabrication of a removable appliance. The down payment will be deferred until the day the fixed appliances are placed if this is the treatment strategy for the particular case.
  

Payment Procedures

1. Consults are $16.
2. Initial Records = $290
3. Limited Orthodontic Treatment will be broken down into the number of quadrants requiring treatment and their fees are located in the BUSDM fee schedule manual.
   

Orthodontic Emergencies

1. During normal daily school clinic hours, patients should present to the 1st floor department of orthodontics for emergency treatment by either the pre-doctoral orthodontic faculty (if available) or an available post graduate resident.
2. During evenings, weekends and school holidays, the patient should contact the post-doctoral orthodontic resident on call at (617) 638-4977.

Sterilization

Sterilization of orthodontic instruments are in compliance with the school’s infection control manual and a DRY HEAT STERILIZER will be located in Central Sterilization for its sterilizing.

Clinical Instruction Objectives

Students will:

1. Know what diagnostic records and information are necessary to evaluate a patient and be able to obtain them.
2. Understand the role of orthodontics in comprehensive dental care and be able to appropriately integrate orthodontic treatment into the patient’s treatment plan.
3. Apply clinical concepts learned in the preclinical laboratory and didactic courses
4. Distinguish between limited and comprehensive orthodontic treatment in children and adults.
5. Determine which occlusal problems are appropriate for treatment in general practice and be proficient in appropriate referral procedures for those patients with malocclusions requiring the services of a specialist.
6. Recognize the indications and contraindications for limited orthodontic treatment.
7. Demonstrate basic knowledge in diagnosis and sequential planning and treatment.
8. Design, fabricate and place appliances for limited orthodontic treatment.
9. Discuss with the patient, orthodontic treatment possibilities and the coordination of orthodontics with other disciplines of dentistry.
   
   
   

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