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Orthodontic Cases. Braces, TADs, MARPE, Aligners
Case-driven teaching with step-by-step protocols for predictable orthodontic outcomes using braces, TADs, MARPE, and aligners.
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Kerolos Alhakeem
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Omar Fawzi Chawshli
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Complex orthodontic cases demand more than alignment—they require control over space, skeletal relationships, and vertical balance.
This course delivers a structured, biomechanically driven approach to managing challenging malocclusions using a combination of fixed appliances, aligners, skeletal anchorage, and digital planning.
The program explores how treatment decisions change across different spatial dimensions, with a strong focus on extraction logic, vertical correction strategies, and anteroposterior control.
During the course, you will learn about:
– Orthodontic space management and extraction decision-making strategies
– Control of the anteroposterior dimension in complex orthodontic cases
– Diagnosis and management of vertical plane malocclusions
– Hybrid aligner mechanics and clinical applications
– Digital workflow for palatal miniscrew appliances and MARPE systems
– Integrated case-based treatment planning for complex and challenging orthodontic cases.
Lezione 1.Orthodontic Space Management and Extraction Decision
– Orthodontic camouflage and anteroposterior problems: definitions and space management
– Strategies for space management in the dental arch
– The extraction vs. non-extraction dilemma
– Statistics on extraction therapy and reasons for the global decrease in extractions
– Evidence-based medicine (EBM) in the orthodontic decision-making process
– Facial aesthetics and soft tissue-centered treatment planning
– Clinical case presentations and methodology
– Detailed case analysis: proclined anterior teeth with an anterior open bite.
Lezione 2.The Anteroposterior Dimension in Complex Orthodontic Case Management
– Orthodontic camouflage and anteroposterior problems: definitions and space management
– Strategies for space management in the dental arch
– The extraction vs. non-extraction dilemma
– Statistics on extraction therapy and reasons for the global decrease in extractions
– Evidence-based medicine (EBM) in the orthodontic decision-making process
– Facial aesthetics and soft tissue-centered treatment planning
– Clinical case presentations and methodology
– Detailed case analysis: proclined anterior teeth with an anterior open bite
– Biomechanics: the drawbridge effect in vertical control
– Detailed case analysis: missing upper canines and reverse bite (anterior crossbite)
– Evaluation of gingival tissue: the Seibert and Lindhe classifications
– Detailed case analysis: congenitally missing lateral incisors and spacing
– Biomechanical dilemmas: space closure vs. space opening
– Analyzing the negative sequelae and risks of various treatment pathways
– Management and prevention of ""black triangles"" (loss of interdental papilla)
– Detailed case analysis: congenitally missing upper central incisor
– Treating growing patients: clinical nuances, growth prediction, and interceptive case analysis
– Detailed case analysis: overjet management and its effect on the soft-tissue profile
– Detailed case analysis: severe incisor proclination
– Molar distalization: the clinical efficiency of Temporary Anchorage Devices (TADs)
– Detailed case analysis: miniscrew-supported maxillary molar distalization
– Palatal anchorage concepts and mechanics
– Detailed case analysis: unilateral molar distalization
– Detailed case analysis: management of a transposed canine
– Simplified criteria for clinical decision-making.
Lezione 3.The Vertical Dimension in Complex Orthodontic Case Management
– The vertical control problem in orthodontics
– The 3 domains of vertical control
– Anterior vertical control: incisor intrusion and extrusion mechanics
– Posterior vertical control: molar intrusion and extrusion mechanics
– Mandibular rotation and skeletal vertical control
– Establishing a definitive vertical diagnostic framework
– Systematic diagnostic scheme for the evaluation of a gummy smile
– Assessment of gingival display at rest and during smiling
– Clinical assessment of upper lip length and mobility
– Evaluation of incisor width, height, and periodontal probing depth
– Determining upper incisor position in relation to the upper lip
– Assessment of the Curve of Spee (COS) and root parallelism
– Biomechanical scenarios: mesially tipped posterior segments
– Biomechanical scenarios: mesially tipped posterior segments combined with distally tipped anterior segments
– Fundamental biomechanical principles of vertical movement
– True vertical vs. relative vertical control mechanics
– Detailed clinical case analysis: anterior gummy smile with over-erupted upper incisors
– Detailed clinical case analysis: anterior gummy smile associated with maxillary excess
– Detailed clinical case analysis: anterior gummy smile associated with Vertical Maxillary Excess (VME) and protrusion
– Detailed clinical case analysis: anterior gummy smile with incisor extrusion, an increased Curve of Spee, and a deep bite
– Detailed clinical case analysis: deep bite management via an increased Curve of Spee and lower anterior intrusion
– Detailed clinical case analysis: deep bite management via an increased Curve of Spee and lower posterior intrusion
– Detailed clinical case analysis: open bite with average incisor inclination, decreased incisor exposure, and a tongue-thrust habit
– Detailed clinical case analysis: reduced incisal display – anterior open bite vertical control utilizing TAD mechanics
– Detailed clinical case analysis: increased Lower Anterior Facial Height (LAFH) and anterior open bite corrected via posterior intrusion
– Detailed clinical case analysis: over-erupted molar management using TAD-supported single molar intrusion
– Detailed clinical case analysis: occlusal plane canting correction utilizing TADs
– A simplified, systematic criteria for vertical decision-making.
Lezione 4.Hybrid Aligner Mechanics in Orthodontic Treatment
– Mechanical principles: how clear aligners move teeth
– The biomechanical concepts behind aligners: force delivery mechanisms
– Comparative analysis: clear aligners vs. fixed appliances
– Open vs. closed orthodontic systems and strategies for space gaining
– The clinical role of aligner attachments
– The tracking and engagement dilemma in aligner therapy
– Determining the force vectors and active push surfaces of an aligner
– Biomechanics of buccolingual tipping
– The 3 fundamental pillars of success in clear aligner therapy
– Aligner manufacturing: types of polymers
– Material science: physical characteristics of thermoplastic polymers
– Aligner biomechanics as dictated by material properties
– Evaluating movement type predictability
– Clinical efficacy: how effective are aligners at true tooth movement?
– Biomechanics of mesiodistal tipping
– What aligners can and cannot achieve
– Clinical guidelines for software overcorrection
– How to improve aligner predictability
– Hybrid mechanics: the synergy of buttons and elastics
– Strategic placement of elastic attachments for maximum efficiency
– Class 2 management: anchorage control in bilateral Class 2 Division 1 malocclusions (clinical case)
– Class 2 management: midline shift correction in unilateral Class 2 Division 1 malocclusions (clinical case)
– Class 3 management: anchorage control and mechanics in reverse overjet/anterior crossbite (clinical case)
– High-angle cases: managing vertical discrepancies, extrusion, and settling protocols (clinical case)
– The push-pull dynamic: mastering advanced directional forces (clinical case)
– Biomechanical limitations of rotational movements in aligner therapy
– Hybrid derotation techniques: integrating minitubes and sectional NiTi wires (clinical case).
Lezione 5.Digital Workflow for Palatal Miniscrew Appliances and MARPE
– The clinical and logistical benefits of transitioning to a digital orthodontic workflow
– Limitations of the conventional analog approach
– Complication analysis: a clinical case of incorrect palatal miniscrew positioning and its consequences
– Digital problem-solving: clinical challenges resolved by a completely digital workflow
– Limitations of maxillary expansion
– Architectural anatomy of the facial skeleton
– Identifying structures of resistance against skeletal maxillary expansion
– Biomechanical comparison: skeletal vs. conventional tooth-borne anchorage
– Midpalatal suture maturation: classification and the clinical decision-making hierarchy
– Comprehensive analysis of the stages of midpalatal suture maturation
– Clinical relevance of maturation stages: establishing age-appropriate treatment pathways
– Crucial intraoral clinical examination prior to skeletal expansion
– Diagnostic matrices for crowding cases
– Assessing and diagnosing functional mandibular shifts
– Utilizing the WALA Ridge for mandibular arch form diagnostics
– Classification of Miniscrew-Assisted Rapid Palatal Expansion (MARPE)
– Biomechanical differences: bone-borne (BB) vs. tooth-bone-borne (TBB) appliances
– Finite element analysis: stress distribution and displacement patterns of different palatal expanders
– The ""TAD-First"" vs. ""TAD-Last"" fabrication protocol
– Biomechanical stability: monocortical vs. bicortical skeletal anchorage
– Anatomical guidelines and safe zones for miniscrew insertion in palatal sites
– Core components and architecture of the digital orthodontic workflow
– Advanced imaging: segmentation, orientation, and fusion of cephalometric and CBCT data
– Three-dimensional anatomical evaluation and virtual placement of palatal TADs
– CAD/CAM software design for 3D-printed surgical guides
– Clinical protocol: placing palatal TADs using a 3D-printed surgical guide
– Laboratory and chairside protocols for bonding the skeletal appliance
– Comprehensive, step-by-step clinical case analyses and troubleshooting.
Lezione 6.Open Bite Treatment: Etiology, Mechanics, and Evidence-Based Strategies
– Classification of open bite etiologies: skeletal vs. dental
– Evidence-based treatment strategies for open bite correction
– Design and management of habit-breaking appliances
– Biomechanics of molar intrusion: foundational mechanics
– Utilizing Temporary Anchorage Devices (TADs) for molar intrusion: buccal vs. palatal configurations
– Strategic clinical placement of Transpalatal Arches (TPAs) and lingual arches
– Clinical applications of posterior bite turbos
– Introduction and comprehensive analysis of open bite clinical cases.
Lezione 7.Vertical Plane Malocclusion: Diagnosis and Management
– Classification of open bite etiologies: skeletal vs. dental
– Evidence-based treatment strategies for open bite correction
– Design and management of habit-breaking appliances
– Biomechanics of molar intrusion: foundational mechanics
– Utilizing Temporary Anchorage Devices (TADs) for molar intrusion: buccal vs. palatal configurations
– Strategic clinical placement of Transpalatal Arches (TPAs) and lingual arches
– Clinical applications of posterior bite turbos
– Introduction and comprehensive analysis of open bite clinical cases
– Biomechanical protocols for the incisor extrusion strategy
– Practical methods for incisor extrusion: V-bends, extrusion arches, and vertical elastics
– Interdisciplinary management: comprehensive case analysis of a cleft palate patient with a severe open bite
– Mechanics, rotational effects, and vectors of short Class 2 and Class 3 elastics
– Utilizing bite raisers to open the occlusion and manage vertical discrepancies
– Biomechanics and extraction protocols for open bite correction
– Mechanics of space closure in open bite cases: maximizing the drawbridge effect
– Strategic bonding of the second molar: clinical efficiency and vertical implications
– Classification of deep bite etiologies: skeletal vs. dental
– Comprehensive treatment planning and strategies for deep bite correction
– Absolute and relative extrusion of posterior teeth: anterior bite plates, bite bumpers, bite turbos, cervical headgear, and Class 2 elastics
– Controlling the intentional flaring of anterior teeth
– True intrusion of incisors utilizing anterior TADs
– Soft-tissue diagnostics: evaluating interlabial gap, smile line, lip length, and the incisor-gingival relationship
– Skeletal considerations in vertical diagnosis
– Clinical application of anterior bite turbos
– Introduction and comprehensive analysis of deep bite clinical cases
– Advanced mechanics of Temporary Anchorage Devices (TADs) in vertical correction
– Evaluating the rotational and vertical effects of short Class 2 and Class 3 elastics
– Biomechanics of intrusion: managing the Reverse Curve of Spee (RCS) archwire
– Mechanical principles of segmental intrusion arches
– Analysis and execution of Burstone's 6 principles of true intrusion
– Appliance engineering for incisor intrusion: utility intrusion arches and Burstone’s segmental mechanics
– Gummy smile: architectural correlation with open and deep bites, clinical case introduction
– Advanced anchorage setups: combining anterior TADs with posterior TADs for total arch vertical control
– Introduction and comprehensive analysis of complex gummy smile cases
– Occlusal plane canting: definition and clinical presentation
– Introduction and comprehensive analysis of occlusal plane canting correction cases
– The reciprocal effect of sagittal mechanics on the vertical dimension
– Comprehensive clinical case analysis: Class III malocclusion corrected via en-masse retraction using Infrazygomatic Crest (IZC) screws.
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