Publications: Dr. Vincent Kokich Jr.

Articles on interdisciplinary dentistry and orthodontics

Dr. Vincent Kokich Jr.
Our own Vincent Kokich Jr. is a published scholar and respected international lecturer on the subjects of interdisciplinary dentistry and orthodontics. You can read many of his papers right here.

Esthetics

Finishing

  • Excellence in Finishing: Modifications for the Ortho-Restorative Patient (in German)  Icon: PDF File
    This article identifies and describes the important occlusal factors that should be evaluated by clinical orthodontists to determine if their treatment objectives and goals have been fulfilled. Although ideal occlusal relationships are desirable for adolescents and children, these same goals may not be necessary or appropriate for adults. This review points out when and how posterior malocclusion should be addressed and treated in children, adolescents, and adult orthodontic patients. Special emphasis is directed toward those orthodontic patients who have periodontal or restorative needs that will be treated as a part of the orthodontic therapy.
  • Excellence in Finishing: Modifications for the Perio-Restorative Patient  Icon: PDF File
    This article identifies the occlusal, periodontal, and esthetic parameters for orthodontic finishing in the adolescent dentition, and provides useful guidelines for finishing in the adult perio-restorative patient.

Impactions

Implant Anchorage

  • Comprehensive Management of Implant Anchorage in the Multidisciplinary Patient  Icon: PDF File
    This chapter will discuss the interdisciplinary management of implants that are used for orthodontic anchorage and as restorative abutments. The chapter will also describe the indication for implant anchorage, methods of location the appropriate implant position, time of orthodontic loading, tipes of provisional restorations appropriate for attaching orthodontic brackets, and the effects of orthodontic loading on the integrity of osseointegration and final restoration.
  • Managing Complex Orthodontic Problems: The Use of Implants for Anchorage  Icon: PDF File
    This article will discuss the ramifications and requirements for using implants as anchors and abutments in adult orthodontic patients.
  • Osseointegrated titanium implants for maxillofacial protraction in monkeys  Icon: PDF File
    Titanium implants were placed surgically into the maxillary, zygomatic, frontal, and occipital bones of four pigtail monkeys. After a 4-month healing period, the implants were exposed and abutments were placed. Extraoral traction appliances were then attached to the abutments. The cranial implants were used to support the framework of the traction appliance; those in the facial bones were used to attach springs that delivered a protraction force. The application of force varied among animals. In animal A, the force was applied to the maxilla. In animal B, the force was applied to the zygomatic bones. Animals C and D had force applied to both the maxillary and zygomatic bones. A tensile force Iof 600 gm per side was maintained until approximately 8 mm of maxillary anterior displacement had olccurred. This amount of movement required 12 weeks of force application in animals A and B, and 18 weeks in animals C and D. Cephalometric and dry skull analyses showed that the amount of skeletal protraction was significant. The findings also demonstrated that it was possible to control the direction of maxillary protraction. The facial implants remained immobile throughout the experiment.

Interdisciplinary Treatment

  • Adult Orthodontics in the 21st Century: Guidelines for Achieving Successful Results  Icon: PDF File
    This article will describe a series of five guidelines to help manage the interrelationship of orthodontics with periodontics and restorative dentistry.
  • Clinical Options for Managing Congenitally Missing Mandibular Second Premolars (in German)  Icon: PDF File
    This article has described and illustrated several methods of managing the patient who is congenitally missing mandibular second premolars. In the past, orthodontists primarily made the treatment decisions in these types of patients. However, with the addition of newer solutions to restoring edentulous spaces, surgeons and restorative dentists may play a significant role in helping to manage these types of orthodontic patients. Although the orthodontist may see these patients at a young age, some of the decisions that are made at that time will affect the patient for a lifetime. This article has emphasized the interdisciplinary aspects of treating a patient who is congenitally missing their mandibular second premolars, in order to provide the patient with the best possible result that teamwork dentistry can offer.
  • Correcting Anterior Esthetic Dilemmas - Part 2: What and How? (in German)  Icon: PDF File
    This article attempts to accomplish two objectives. First of all, as clinicians, we should only recommend esthetic correction of tooth malposition, if it is truly unattractive to the lay public. Much of what dentists believe about esthetic relationships is simply theory. The study that is repeatedly referenced in this article actually gives the clinician some scientifically generated guidelines to assess the severity of specific esthetic relationships. The second objective of the article is to give the interdisciplinary team some guidelines to follow when determining the most appropriate solution for each particular unesthetic situation. The criteria given in this article may seem simplistic to some clinicians, but they are easy to understand by all members of the interdisciplinary team. This common diagnostic approach insures that no matter who on the team is evaluating the patient, the appropriate solution will be selected consistently. This is the interdisciplinary approach to esthetic dentistry.
  • Counterpoint: Congenitally missing maxillary lateral incisors: Restorative replacement  Icon: PDF File
    There are several restorative options for the replacement of congenitally missing lateral incisors, including resin-bonded bridge, cantilevered bridge, and conventional full-coverage bridge. Each of these restorative options has a high degree of success if used in the correct situation. However, in the United States today, the most common treatment alternative is the single-tooth implant. The main advantage of this type of restoration is conservation of tooth structure. It leaves the adjacent teeth intact. The orthodontist’s role is to provide the coronal and apical spacing necessary to facilitate any future restorative dentistry and implant placement. Therefore, it is imperative to manage these patients from an interdisciplinary diagnostic and treatment perspective. By creating that team, the orthodontist, restorative dentist, and surgeon can produce predictable and esthetic treatment results.
  • Early Management of Congenitally Missing Teeth  Icon: PDF File
    This article will discuss the importance of early diagnosis and intervention in order to preserve various treatment options in the future.
  • Esthetics: The Orthodontic-Periodontic-Restorative Connection  Icon: PDF File
    This article will discuss the solutions for managing these challenging orthodontic-periodontic-restorative situations to produce a more ideal esthetic result.
  • Inheriting the Unhappy Patient: An Interdisiplinary Case Report  Icon: PDF File
    A serious problem that challenges any interdisciplinary team is inheriting treatment that is already in progress but not proceeding appropriately in the eyes of the patient. The following case report illustrates the unfortunate consequences of uncoordinated and unplanned multidisciplinary treatment that was recognized by the patient and brought to the attention of the treating dentist. We demonstrate the steps that were necessary to treat this patient in an interdisciplinary manner and satisfy her functional and esthetic goals for her dentition.
  • Interdisciplinary Management of a Patient with a Skeletal Deformity  Icon: PDF File
    Patients with a skeletal aberration that results in a malocclusion are not uncommon in our patioent population. Several treatment options exist for these patients, from undertaking no treatment at all to performing complex orthodontics, orthognathic surgery, and restorative therapies.
  • Interdisciplinary Management of Congenitally Missing Lateral Incisors  Icon: PDF File
    Several treatment options exist for the replacement of congenitally missing maxillary lateral incisors. These options include canine substitution, resin-bonded fixed partial dentures, cantilevered fixed partial dentures, conventional fixed partial dentures, and single tooth implants.
  • Interrelationship of Orthodontics with Periodontics and Restorative Dentistry  Icon: PDF File
    This chapter will elucidate the dilemmas encountered in the orthodontic patient with multidisciplinary problems and describe a series of 10 guidelines to help manage the interrelationship of orthodontics with periodontics and restorative dentistry.
  • Managing Congenitally Missing Lateral Incisors Part 1: Canine Substitution  Icon: PDF File
    This article closely examines patient selection and illustrates the importance of interdisciplinary treatment planning to achieve optimal esthetics. This article is the first of a three-part series discussing the three treatment alternatives for replacing missing lateral incisors.
  • Managing Congenitally Missing Lateral Incisors, Part I: Canine Substitution  Icon: PDF File
    This article closely examines patient selection and illustrates the importance of interdisciplinary treatment planning to achieve optimal esthetics. It is the first in a three-part series discussing the three treatment alternatives for replacing missing lateral incisors.
  • Managing Congenitally Missing Lateral Incisors, Part III: Single-Tooth Implants  Icon: PDF File
    This is the final article of a three-part series discussing the three treatment alternatives for replacing congenitally missing lateral incisors.
  • Managing Congentally Missing Lateral Incisors, Part II: Tooth-Supported Restorations  Icon: PDF File
    This article is the second of a three-part series discussing the three treatment alternatives for replacing congenitally missing lateral incisors.
  • Maximizing Anterior Esthetics: An Interdisciplinary Approach  Icon: PDF File
    This chapter will illustrate the orthodontist's responsibility and role in maximizing dental esthetics for the restorative patient. The information will be divided into four parts based upon the esthetic perspective that is being evaluated: midline, mediolateral incisal angulation, incisal plane, and gingiva-to-lip relationship.
  • Point: Congenitally missing maxillary lateral incisors: Canine substitution ()
    A team approach combining carefully performed orthodontic space closure and esthetic porcelain veneers on several teeth will make it possible to treat patients with agenesis of at least 1 maxillary lateral incisor to a result that provides the look of an intact natural dentition. Advantages of such an approach are that (1) child patients will get the final result already as young teenagers, (2) the overall treatment can be completed after the orthodontic intervention, and (3) long-term adaptations of the teeth and supporting structures will appear natural.

Ortho-Perio

  • Adjunctive Role of Orthodontic Therapy  Icon: PDF File
    This chapter shows the ways in which adjunctive orthodontic therapy can enhance the periodontal health and restorability of teeth
  • Long-term effect of root proximity on periodontal health after orthodontic treatment  Icon: PDF File
    The present investigation was done (1) to evaluate the incidence and distribution of root proximity after orthodontic treatment and (2) to test the hypothesis that interproximal areas with thin interdental bone provide less resistance against marginal periodontal breakdown than areas with normal width of bone between the roots.
  • Managing Orthodontic Treatment for the Adult Patient with Periodontal Problems (in German)  Icon: PDF File
    This article discusses and illustrates the benefits of integrating orthodontics and periodontics in the management of adult patients with underlying periodontal osseous defects. The key to treating these types of patients is communication and proper diagnosis before orthodontic therapy as well as continued dialogue during orthodontic treatment. Not all periodontal problems are treated in the same way. Hopefully, this discussion of horizontal bone loss, intrabony defects, hemiseptal defects, furcation problems, root proximity, fractured teeth, and periodontally and restoratively hopeless teeth provides the clinician with a framework that will be helpful in treating these situations.
  • Managing Treatment for the Orthodontic Patient with Periodontal Problems  Icon: PDF File
    In this article, the diagnosis and management of several periodontal problems is discussed. The need for and timing of pre orthodontic periodontal surgery for these situations is elucidated. In addition, the types of tooth movement that will ameliorate these problematic situations is described. This information is valuable for the orthodontist who treats patients with underlying periodontal problems.
  • Orthodontic Therapy for the Periodontal-Restorative Patient  Icon: PDF File
    The purpose of this chapter is to illustrate how orthodontic therapy can enhance the periodontal health and restorability of teeth and implants.
  • The Esthetic Management of a Severe Isolated Periodontal Defect in the Maxillary Anterior  Icon: PDF File
    The purpose of this article is to describe how one patient who presented with a severe isolated periodontal defect in the anterior was treated. It is our hope that the readers will be aware of the benefits of interdisciplinary treatment planning in a patient such as this. Despite the progress in regenerative procedures and implants, patients such as this one would be very difficult to treat if the lateral incisor had been removed at the beginning of treatment.
  • The Role of Orthodontics as an Adjunct to Periodontal Therapy  Icon: PDF File
    This chapter shows the ways in which adjunctive orthodontic therapy can enhance the periodontal health and restorability of teeth.

Ortho-Restorative

  • Altering Vertical Dimension in the Perio-Restorative Patient: The Orthodontic Possibilities  Icon: PDF File
    Orthodontic tooth intrusion of severely abraded maxillary and mandibular incisors is a viable, realistic, and appropriate method for repositioning the maxillary and mandibular incisors into their original position, so they can be restored more conservatively by the restorative dentist. This is a perfect example of the value of interdisciplinary treatment in a challenging adult restorative case.
  • Guidelines for Managing the Orthodontic-Restorative Patient  Icon: PDF File
    This article will provide a series of eight guideline to help the interdisciplinary team manage treatment for the orthodontic-restorative patient.
  • Interdisciplinary Management of Anterior Guidance: A Case Report  Icon: PDF File
    This case report shows how orthodontics and restorative dentistry can accomplish treatment results that would not have been possible if either of these disciplines had been applied independently. Establishing anterior guidance, leveling gingival margins, restoring edentulous spaces, and establishing a balanced occlusion were only possible through the combined efforts of both disciplines. Through careful planning using diagnostic wax-ups, the various problems with this patient’s teeth could be treated effectively, efficiently, and conservatively.
  • Managing Orthodontic-Restorative Treatment for the Adolescent Patient  Icon: PDF File
    This chapter will use many examples to illustrate the key steps in managing the adolescent patient that requires orthodontic and restorative treatment.
  • Managing the patient with missing or malformed maxillary central incisors  Icon: PDF File
    This article has presented and discussed the early management and treatment of 5 patients, who were missing at least 1 maxillary central incisor at early ages. Several solutions were presented. Unfortunately, in these situations, bold decisions must often be made quickly, because the loss of a maxillary central incisor typically occurs accidentally or as the result of intentional extraction of a malformed tooth. This information should give the clinician some helpful guidelines for managing patients with missing maxillary central incisors.
  • Ortho-Restorative Management of the Patient With Missing or Malformed Maxillary Central Incisors - (in German)  Icon: PDF File
    This article presents and discusses the early management and treatment of five patients, who were missing one or more maxillary central incisors at an early age. Several solutions are presented. Unfortunately, in these situations bold decisions must often be made quickly, because the loss of a maxillary central incisor typically occurs accidentally or as the result of intentional extraction of a malformed tooth. Hopefully this information will provide the clinician with some helpful guidelines in the management of patients with missing maxillary central incisors.
  • Orthodontic and Nonorthodontic Root Resorption: Their Impact on Clinical Dental Practice  Icon: PDF File
    Occasionally, general dentists are challenged with providing restorative treatment for a postorthodontic patient who has had moderate to severe root resorption. When this happens, a number of questions about the cause of such resorption and the appropriate treatment arise in the dentist’s mind. This article will describe the orthodontic and restorative management of three patients with severe maxillary incisor root resorption, provide a thorough discussion of the currently available literature on the topic of root resorption, and answer clinical questions regarding this relatively infrequent but devastating sequel to orthodontic treatment.
  • Restoration and retention of maxillary anteriors with severe root resorption  Icon: PDF File
    The authors describe the treatment of three patients who had severe apical root resorption of maxillary lateral incisors caused by ectopically erupting canines. Ectopically erupting canines derive from a normal path of eruption and may cause resorption of the adjacent teeth.
  • Using orthodontic intrusion of abraded incisors to facilitate restoration: The technique's effects on alveolar bone level and root length  Icon: PDF File
    The authors examined the effects of orthodontic intrusion of abraded incisors in adult patients to facilitate restoration, focusing specifically on changes in alveolar bone level and root length.

Other

Single Tooth Implants

  • Determining the cessation of vertical growth of the craniofacial structures to facilitate placement of single-tooth implants  Icon: PDF File
    Single-tooth implants are commonly used to replace congenitally missing teeth in adolescent orthodontic patients. However, if implants are placed before cessation of facial growth, they will submerge relative to the adjacent erupting teeth. Therefore, it is important to know when facial growth is complete in postpubertal orthodontic patients. The purposes of this study were to determine and quantify the amount of vertical growth of the facial skeleton and the amount of eruption of the central incisors and the maxillary first molars after puberty.
  • Facial Development, Continuous Tooth Eruption, and Mesial Drift as Compromising Factors for Implant Placement  Icon: PDF File
    It is evident that jaw growth may compromise the outcome of oral rehabilitation using implant supported prostheses even if the implants are successfully integrated. Lack of proper occlusion and unesthetic situations can occur, especially in the anterior region. The timeframe for the development of the alveolar process can vary widely, especially in the case of long or short facial types. The risks posed by continuous tooth eruption in adulthood should also be considered. Too often, only the growing child and adolescent are considered challenges.
  • Interdisciplinary Management of Single-Tooth Implants  Icon: PDF File
    This article will discuss the many interdisciplinary issues that are involved in placing and restoring single-tooth implants in orthodontic patients.
  • Maxillary Lateral Incisor Implants: Planning With the Aid of Orthodontics  Icon: PDF File
    Implants are commonly used to replace congenitally missing lateral incisors in adolescent orthodontic patients. However, these restorations are often challenging for the orthodontist, surgeon, and restorative dentis. This article will use several clinical examples to discuss 6 potential problems and provide guidelines for their solutions.
  • Maxillary Lateral Incisor Implants: The Orthodontic Perspective  Icon: PDF File
    This article will use several clinical examples to discuss each of these six potential problems and provide guidelines for their solutions.
  • Temporary Restoration of Maxillary Lateral Incisor Implant Sites  Icon: PDF File
    This article describes two reasons why placing a miniscrew in an adolescent orthodontic patient who will eventually receive an implant restoration to replace a missing maxillary lateral incisor is not recommended.

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