2006

EXCELLENCE IN ORTHODONTICS
at The Royal College of Obstetricians and Gynaecologists, London

Excellence in
Orthodontics 2006
Lecture Course

DAVID BIRNIE
NIGEL HARRADINE
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EXCELLENCE IN ORTHODONTICS

Excellence in Orthodontics 2006

Lecture Course Manual
PRESENTED BY DAVID BIRNIE AND NIGEL HARRADINE

Published by EXCELLENCE IN ORTHODONTICS

© David Birnie and Nigel Harradine 1990-2006

© EXCELLENCE IN ORTHODONTICS 1990-2006

ISBN: 0-9542387-3-7

World rights reserved. No part of this publication may be stored in a retrieval system, transmitted, or
reproduced in any way, including but not limited to photocopy, photograph, magnetic or other record
without the prior agreement or written permission of the publishers

Eighteenth Edition 2006

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EXCELLENCE IN ORTHODONTICS

Courses
1987-2006

UK COURSES

Crest Hotel, York 1987

Regent Crest Hotel, London 1988
The Royal Society of Medicine, London 1989
The Royal Society of Medicine, London 1990
The Royal Society of Medicine, London 1991
The Royal Society of Medicine, London 1992
The Royal Society of Medicine, London 1993
The Royal Society of Medicine, London 1994
The Royal College of Physicians and Surgeons, Glasgow 1994
The Royal Society of Medicine, London 1995
The Royal Society of Medicine, London 1996
The Royal Society of Medicine, London 1997
The Royal Society of Medicine, London 1998
The Royal College of Surgeons of England (with Dr Dwight Damon) 1998
The Royal Society of Medicine, London 1999
The Royal Society of Medicine, London 2000
The Royal Society of Medicine, London 2001
The Royal Society of Medicine, London 2002
The Royal College of Physicians, London 2003
The Royal College of Physicians, London 2004
The Royal College of Physicians, London 2005
The Royal College of Obstetricians and Gynaecologists, London 2006

OVERSEAS COURSES

The Royal Academy of Medicine, Dublin, Ireland 1989

The University of Nijmegen, Nijmegen, The Netherlands 1991
Dorint Hotel, Leipzig, Germany 1994
SIDO, Hotel Royal, Milan, Italy 1996
The University of Erlangen, Erlangen, Germany 1997
The University of Bonn, Bonn, Germany (with Dr Dwight Damon) 1997
The University of Basle, Basle, Switzerland (with Dr Dwight Damon) 1997
Straight-Wire 97, Observatory Hotel, Sydney, Australia 1997
Queensland Section, Australian Orthodontic Society, Hilton Hotel, Brisbane, Australia 1997
Kuala Lumpur, Malaysia 1999
IDEC 2002, Durban, South Africa 2002
Orthodontic Society of Ireland, Dublin, Ireland 2004
th th
Pre-congress Course 7 Arab/4 Jordanian Orthodontic Congress, Amman Jordan 2005

FUTURE COURSES

Norwegian Orthodontic Society, Kristiansand, Norway 2006

th
The 18 Saudi International Dental Congress, Saudi Arabia 2007
The Royal College of Obstetricians and Gynaecologists, London 2007
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Lecturers
DAVID BIRNIE AND NIGEL HARRADINE

David Birnie
BDS Edin FDS DMI RCS Edin FDS MOrth RCS Eng

David Birnie graduated from Edinburgh Dental School in 1970 and

spent three years as a lecturer in periodontology before starting his
orthodontic training in 1975. Later that year he was appointed
registrar in orthodontics at Kingston Hospital, Surrey and at the
Royal Dental Hospital, London. In 1977 he moved to the Eastman
Dental Hospital as a senior registrar in orthodontics. Since 1982, he
has been a consultant orthodontist at Queen Alexandra Hospital,
Portsmouth, is a civilian consultant to the Royal Navy Dental
Service, a visiting consultant and senior clinical lecturer in
orthodontics at the University of Bristol Dental School and is in
private orthodontic practice.

Clinical interests include:

• clinical applications of computers and medical

informatics
• pre-adjusted edgewise appliances
• self-ligating brackets
• clinical application of biomaterials research
• orthognathic surgery

David has lectured extensively throughout the United Kingdom including invited presentations at the British
Orthodontic Conference, the Consultant Orthodontists Symposium, the British Dental Association’s Annual
and Scientific Meeting in addition to presenting lectures and papers in Cyprus, China, Belgium, Hong Kong,
the Republic of Ireland, South Africa and in the USA. During 2004, David gave courses on self-ligating
brackets in Denmark, The Netherlands, Spain, Sweden, and the United Kingdom.

With Nigel Harradine, David has co-presented Excellence in Orthodontics in the United Kingdom since the
first course in 1987 in York and at Excellence in Orthodontics overseas courses in the Australia, Germany,
Italy, Jordan, Malaysia, Norway, Republic of Ireland, Switzerland and The Netherlands.

David is Dean of the Faculty of Health Informatics at the Royal College of Surgeons of Edinburgh and sits
on College Council and the Council of the Faculty of Dental Surgery; he is also a member of the Specialist
Advisory Board in Orthodontics, Dental Examinations Committee and the Committee for the Diploma in
Medical Informatics. David has passed the Diploma in Medical Informatics of the Royal College of
Surgeons of Edinburgh in 2001, a part-time two-year course on health informatics delivered over the
internet. David represented the College on General Dental Council from 1998-2003 during which time he
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was a member of the Central Examining Board for Dental Hygienists, the Dental Auxiliaries Committee, the
Health Committee, the Professional Conduct Committee, the PCD Curricula Overview Group, the
Orthodontic Therapists Curriculum Working Group, the Registration Subcommittee of the Education
Committee and the Registration Review Group. David is a past chairman of the Specialist Advisory
Committee in Orthodontics and Paediatric Dentistry. At Queen Alexandra Hospital, David was Clinical
Director for Surgery, Trauma and Oncology from 1994 to 1999 and is currently Associate Medical Director
for Queen Alexandra Hospital’s £200 million Redevelopment Project funded through the government’s
Private Finance Initiative programme.

Nigel Harradine
BDS London FDS RCS Edin FDS MOrth RCS Eng MSc(Orth) MB BS London

Nigel Harradine qualified from Guys Hospital, London in 1971 and

was then a house surgeon at Guys before undertaking his
undergraduate medical training, qualifying again from Guys in 1975.
A medical house physician post followed at Guys and then a year as
an intern in London, Ontario before he settled on orthodontics as his
chosen speciality and returned to the United Kingdom. A year of full-
time general dental practice was followed by the two-year
orthodontic course at the Royal Dental Hospital, London and
Kingston Hospital, Surrey. In 1981, Nigel went to the Eastman
Dental Hospital, initially as a lecturer and then as a senior lecturer in
orthodontics. Since 1984 he has been a consultant at Bristol Dental
Hospital and School where he is in charge of the undergraduate
program and fully involved in the postgraduate teaching. Particular
clinical interests have included:

• the use of computers for planning and recording the effects of treatment and for storing
digital clinical records
• functional appliances
• the Straight-Wire Appliance pre-adjusted edgewise appliances
• self-ligating brackets
• the effects of orthognathic surgery

Nigel shares many of these particular interests with David and he has published on all these topics and on
others, including a random prospective trial of the effects of third molar extraction on later incisor crowding.

With David Birnie, Nigel Harradine has co-presented the annual Excellence in Orthodontics Course since
1987 and has lectured extensively throughout the United Kingdom including multiple presentations to the
British Orthodontic Conference and the Consultant Orthodontists Group Symposium, including the
Chapman Lecture and the Ballard Memorial Lecture.

In addition to Excellence in Orthodontics courses overseas, Nigel has delivered invited lectures and
courses in Holland, Switzerland, Israel, South Africa, Australia and the U.S.A., where he has given three
presentations to the annual session of the AAO and the keynote afternoon address to the Pacific Coast
Society.

Away from the chairside, Nigel’s roles have included being the President of the BDA hospitals group,
Chairman of the BOS scholarship committee, Chairman of the Royal College working party on Read
Coding, Secretary for seven years of the Royal College Orthodontic Audit working party, Secretary of the
BOC organising committee and a member of the British Orthodontic Society Council. He is a past
Chairman of the Consultant Orthodontists Group and a previous Clinical Director of Bristol Dental Hospital.
Nigel currently chairs the British Orthodontic Society Computer Users Group and was the inaugural
chairman of the British Orthodontic Society Foundation.
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Course Timetable
Friday 31 March 2006

9.15-9.30 Introduction DJB

9.30-10.30 The Development of Preadjusted Edgewise Appliances DJB

Where did they come from? How have they developed? What
have been the key technical advances? How have they changed
our practice?

10.30-11.00 COFFEE

11.00-12.00 Diagnosis and Treatment Planning NWTH

Diagnostic decisions, extraction and non-extraction dilemmas,
lower incisor position, facial profile and stability

12.00-1.00 Bonding and Debonding DJB

Bracket placement and adhesives, bonding to non-enamel
surfaces; debonding. Case presentation

1.00-2.00 LUNCH

2.00-2.45 Archwires DJB

Modern archwire technology; which archwires to use and why.
Case presentation.

2.45-3.30 Opening and Closing Spaces NWTH

An in-depth look at the most efficient ways of opening and
closing spaces. Problems and solutions.

3.30-4.00 TEA

4.00-5.00 Self-Ligating Brackets – Theory and Practice NWTH

A critical look at self-ligation; the Damon System (D2 and D3),
Opal and other bracket systems. Claims and evidence.
Treatment efficiency. Tips on treatment tactics

5.00-5.30 Questions and Discussion DJB/NWTH

5.30-7.00 DRINKS PARTY

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Course Timetable
Saturday 1 April 2006

9.15-9.45 Root Resorption DJB

What causes root resorption? Informed consent for the
orthodontic patient. Detecting and managing root resorption.

9.45-10.30 Anchorage NWTH

How do we measure anchorage? Maximising intra-oral
anchorage. Headgear compliance and usage. “Non-compliance”
appliances. Fixed class II traction devices.

10:30-11.00 Stability, Finishing and Retention DJB

Stability studies, finishing procedures and strategies for retention.
What is the best retainer to use?

11:00-11.30 COFFEE

11.30-12.15 Functional Appliances NWTH

Mode of action, choice of appliance, fixed versus removable
functionals, alternatives in appliance design; integration with fixed
appliances; choosing extractions. Timing treatment.

12:15-1.00 Class 3 Cases DJB

What should we treat without surgery? When should we treat?
Does reverse-pull headgear work?

1.00-2.15 LUNCH

2.15-3.15 Class 2 Division ii Malocclusions and Deep Overbites NWTH

Treating Class 2 division ii malocclusions: problems and
solutions. How should we reduce overbites?

3.15-4.15 Clinical Cases and Practical Tips DJB

Exploring the boundaries with self-ligating brackets; cases of
interest and clinical tips

4.15-5.15 Questions and Discussion DJB/NWTH

5.15 COURSE ENDS

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Table of Contents

Chapter 1 Introduction 1
Chapter 2 Occlusal Treatment Goals 7
Chapter 3 Diagnosis and Treatment Planning 23
Chapter 4 Facial Appearance, the Smile and Tooth Aesthetics 43
Chapter 5 Orthodontics and Oral Health 65
Chapter 6 Bracket Placement, Bonding and Debonding Techniques 85
Chapter 7 Bonding Adhesives and Band Cements 103
Chapter 8 Archwires and Archwire Technology 133
Chapter 9 The Classic Straight-Wire Appliance 157
Chapter 10 The Development of Preadjusted Edgewise Appliance Systems 175
Chapter 11 Self-Ligating Brackets – Theory and Practice 197
Chapter 12 Aesthetic Brackets and Archwires 223
Chapter 13 Anchorage 243
Chapter 14 Intraoral Auxiliaries 265
Chapter 15 Opening and Closing Spaces: Problems and Solutions 275
Chapter 16 Functional Appliances 285
Chapter 17 Managing Overbites 307
Chapter 18 Class 2 division ii Malocclusions 319
Chapter 19 Class 3 Malocclusions 325
Chapter 20 The Orthodontic Management of Open Bite Cases 347
Chapter 21 Unerupted Teeth 361
Chapter 22 Root Resorption 377
Chapter 23 Finishing 393
Chapter 24 Stability and Retention 405
Chapter 25 Transpositions 425
Chapter 26 Orthodontics and Orthognathic Surgery 433

Appendix 1 Excellence in Orthodontics 2006 on CD 447

Appendix 2 Reference Icons 449
Appendix 3 Questionnaire 453
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