The aim of this shared presentation on “Efficiency in Early and Adolescent Treatment”, is to illustrate patient-related factors that potentially can improve the efficacy and efficiency of Class II and Class III treatment, specifically, the timing of treatment, and individual patient responsiveness. Also, to offer an alternative mechanism for administering fixed appliance therapy with the aim of improving treatment efficiency. This presentation will highlight that the treatment outcomes of this category of patients are often predicated on responsiveness to growth modification, which itself is related to specific individual pre-treatment skeletal features. For example, Class II patients with mandibular retrusion should be evaluated at the onset of the pubertal growth spurt to identify such indicators (i.e., mandibular angle), whereas Class III patients should be evaluated during the pre-pubertal growth period when circummaxillary sutures are potentially more responsive. Although it remains difficult to reliably predict the long-term treatment outcomes of early orthopedic treatment of Class III malocclusion, it can be stated that unsuccessful cases are characterized by pretreatment values of the inclination of the condylar axis to the mandibular plane greater than 148 degrees. Interestingly, mandibular morphology has also proven to be a reliable indicator of individual response to both Class II and Class III treatment in the growing patient. In addition to orthopedic treatment outcomes, tooth movement is also a component required to resolve malocclusions. For a century EH Angle's ingenious “Edgewise” appliance has been our method of choice. Although it has evolved together with other advances in orthodontics, it has retained its essential composition, thus explaining the lack of change in the duration of patient treatment. Presently, a “Wedgewise” bracket system will be described containing unique design features differentiating it biologically and mechanically from other bracket choices. Experimental and clinical evidence will be presented to explain the contribution of these features to enable a significant improvement in the short and long-term efficiency and duration in which orthodontic treatment can be delivered for the benefit of our patients.


Learning Objectives
After this lecture, you will be able to understand the advantages of pubertal treatment timing of Class II malocclusion with mandibular retrusion with an efficient one-phase therapy
After this lecture, you will be able to understand the advantages of prepubertal timing of Class III malocclusion with rapid maxillary expansion and face mask and that there is no difference between early prepubertal versus late prepubertal timing
After this lecture, you will be able to comprehend the differences between Edgewise and Wedgewise