The Orthodontist
Reality check: Who treats impacted canines?
Unfortunately, anyone. Anyone will take on impacted canines when the kid is 10-12. The odds are good. Of the 4 orthodontists we saw prior to starting treatment, no one shunned the prospect of dealing with impaction. They did imply that they could fail, it was not quite clear what would happen in that case, but extraction was mentioned. Nobody mentioned CBCT.
When a canine doesn't move by itself, what happens? Will there be a write a referral for 'expose and bond', see the patient after two weeks, grab the dangling chain and merrily start pulling, hoping for the best. It doesn't rhyme well with all the cautionary scientific studies on impacted canines, at least the ones that turn out to be problematic. The textbooks and scientific articles talk of the necessity of cooperation over all fields involved: dentist, surgeon, radiologist, endodontist...Careful diagnosis and planning, and discussions of options.
If you feel you need to change orthodontist you are in a much worse position. The impaction is already qualified as a difficult case, the orthodontist you interview with are likely to think that you are the problem rather than the orthodontist you are leaving. When it comes to transferring a case of complicated canines that have not resolved after an expose & bond, and you don't immediately want the canine extracted, you are more in the zone of looking for a needle in a haystack.
Unfortunately, anyone. Anyone will take on impacted canines when the kid is 10-12. The odds are good. Of the 4 orthodontists we saw prior to starting treatment, no one shunned the prospect of dealing with impaction. They did imply that they could fail, it was not quite clear what would happen in that case, but extraction was mentioned. Nobody mentioned CBCT.
When a canine doesn't move by itself, what happens? Will there be a write a referral for 'expose and bond', see the patient after two weeks, grab the dangling chain and merrily start pulling, hoping for the best. It doesn't rhyme well with all the cautionary scientific studies on impacted canines, at least the ones that turn out to be problematic. The textbooks and scientific articles talk of the necessity of cooperation over all fields involved: dentist, surgeon, radiologist, endodontist...Careful diagnosis and planning, and discussions of options.
If you feel you need to change orthodontist you are in a much worse position. The impaction is already qualified as a difficult case, the orthodontist you interview with are likely to think that you are the problem rather than the orthodontist you are leaving. When it comes to transferring a case of complicated canines that have not resolved after an expose & bond, and you don't immediately want the canine extracted, you are more in the zone of looking for a needle in a haystack.
Your orthodontist is a long term relationship.
You are not just buying something expensive, like a car, you are investing in your child's dental lifelong health.
When shopping around, hopefully you check out more than one office, you will not what the parking is like, what the office looks like, if the receptionist is nice and not, how knowledgeable the orthodontist seems. Is it a high tech place or more low key. Then the financial person takes over. You sign over your child and $ 6000 or so. When treatment starts you will know if you have come to a dental factory, conveyor belt style, or more hands-on orthodontia. Are frills important to you, do you really want an energy bar, gourmet coffee, a movie on a screen, healthy plants in pots. Does the orthodontist put on seasonal shows, have the whole dress up for Halloween...
The average treatment duration for a case with impacted canines is at least 2 years for the unilateral-
impacted group and almost 3 years for the bilateral-impacted group. (1)
...
In our recent article on the sample of cases in which treatment initially failed, the mean duration of the
first treatment from its initiation to the realization of failure was 26.2+/- 17.2 months, and the mean
duration of the new treatment in the successful cases were 14.4 +/- 7.2, meaning that these patients had
been treated for 41 months on average in the ultimately successful cases. The range of treatment duration
varied between 8 and 82 months, ie, there were patients who were in treatment for almost 7 years until
success or, more sorrowfully, admission of failure was declared.(1)
Orthodontics: business v. healthcare and science
Orthodontists seem to have a standard $ rate for all cases, complicated or not, around $ 6 000 (Bay Area). My daughter, with one lateral incisive slightly askew - where her dentist does not think she needs braces right now, or maybe ever, goes for basically the same price (we just asked, we didn't start her on braces, I frankly don't think I have the energy for more orthodontics) as my son with 3 impacted teeth - besides the canines, Sam had a molar that emerged after the surface over it was opened up-.)
Orthodontists seem to have a standard $ rate for all cases, complicated or not, around $ 6 000 (Bay Area). My daughter, with one lateral incisive slightly askew - where her dentist does not think she needs braces right now, or maybe ever, goes for basically the same price (we just asked, we didn't start her on braces, I frankly don't think I have the energy for more orthodontics) as my son with 3 impacted teeth - besides the canines, Sam had a molar that emerged after the surface over it was opened up-.)
Inside the head of an orthodontist
To understand the perspective of orthodontists confronted with difficult impacted canines I ease dropped on
some threads orthodontist conversations on some websites. It really gives a bit of pause to read that supposedly an orthodontist has to have 100 or so cases pass through his practice every day (I'm presuming that this is for the 200-300k income goal). You are already in debt with yearly tuition of tens of thousands of dollars after three years of dental school and then 2-3 years of orthodontics. You have to get your foot in, and then get going on a private practice if you don't want to stay on at the University.
After reading through some of these, I felt that, in my son's case, I was trying, rather naively, to find a health professional whose prime objective was going to be to help my son to the best possible outcome. In the real world I realized that complicated cases are not welcome in most places, someone spending time asking questions, is really not worth it if you look to the the business side of orthodontics. Clearly, some dental professionals is not viewing their patients as patients, but as customers.
From http://forums.studentdoctor.net/;
'Pedo [pediatric dentistry] is the new ortho' [as in 'where the money is']
'During our working careers, we will need to reach out to the Spanish speaking population and quite possibly the Islamic population. If you don't, you will run out of patients over the years because English-speaking people aren't reproducing sufficiently. It is also unclear whether the Spanish-speaking and the Islamic population will value orthodontics to the same degree that the English-speaking poplulation has valued it". ("Tooth"
, Jun 25, 2014)
Mexican patient rock! ("Silent Cool", Jun 25, 2014.)
'Hispanic patients rarely ask questions because they trust and respect their doctors. This helps the clinic flow better. Seeing 60-80 Hispanic patients a day requires a lot less effort than seeing 20 patients who demand the doctor and his staff to treat them like kings and queens. Hispanic patients don't mind the long wait because one of our staff members calls in sick. They don't mind the fact that my office is only opened a few days a month and only from 2 pm-6 pm on weekdays, 8 am-12 pm on Saturdays. They don't mind driving more than an hour in heavy traffic to see me. That's how I am able to run 4 of my own offices and still have free time to work part time as an associate. Unlike the rich kids' parents, the Hispanic parents don't get mad at their orthodontists when their kids have several broken brackets. Rich parents usually blame us for using "cheap glue". Hispanic parents, on the other hand, yell at their own kids for not being careful on what they eat. Hispanic parents apologize and promise to tell their kids not to eat hard food.("charlestweed", June 25, 2014.)
If I set up practice in the "upper 20%" area like yours, I wouldn't be able to survive because I know I am not very good at convincing the parents to pay $6-7k for a 24-month case. And personally, I don't feel I deserve to get paid that much for doing very simple procedures. The GPs get paid much less for doing much harder and more time consuming procedures. ("charlestweed", Jun 27, 2014)
Then you will have a hard time getting these upper/middle class patients to approve your treatment if you are a GP. Theses patients tend to be more educated than the average population. Not only do they know the difference between GP and ortho, they also know things like Damon brackets, lingual braces, RPE vs qwuad, Herbst vs BSSO advancement surgery et.chey usually google stuff on the internet before they come to see the dentsist/orthodontist. The reason that many orthos in SoCal are struggling now is that they all target the same top 25% income earners and largely ignore the other 75%.
That's why dental chains continue to do well because they chose to treat the other 75%. I know for the fact that most Hispanic and Asian patients would rather go see Asian doctors. They are actually afraid of the White doctors due to the perceived high fees and cultural differences. Yes it is worth spending more $$$ and years to do an ortho residency." ("charlestweed", Aug 14, 2013.)
Mothers talk faster than just about anything, and most of the time they just want to "fit in" with what everyone else is doing.
They may know what the difference between an ortho vs a GP doing braces, but given that they woudl be deling with a charming, good looking GP who would have a nice portfolio of cases and past patients to look at, I can tell you for a fact mother's don't care that GP does braces over an ortho. The ONLY problem, like many of you mentioned, is that first wave of clients that can begin "spreading the seed' if you will. After the seeds have spread, just cultivate them right and the moms will do a lot of the work for youo. "Ryanpoore" Apr 2, 2013
It also kinda sound bad saying this, but I'm tall, good looking, sociable, stero typical "good looking guy", and where I plan to settle down and practice 90% of the population are upper/middle calss white families. It also seems too easy to get the housewives to choose me over some of the other guys, who are mostly Asian/Indian
("Ryanpoore, )
I will start off by trying my luck in the saturated market targeting the high earners. Hopefully, I start slow and build up to the point I WILL, get referrrals from the moms who will be very pleased with not only my service but the general atmosphere of the office. One I get the new referral's, dependng on whether I went the GP doing ortho route or "orthodontist" route, I would need to base the 15-20 minute consultation meeting around eiterh 'Many schools teach outdated ortho methods and the fact of the matter is orthodontics aree trained to handle extreme cases, which obviously beautiful little Sara doesn't have" or "Orthodontists go through extensive training bla bla bla sell the fact that I spent 200k more and 2 years learning the trade." Either way, it's salesmanship and marketing.
If that DIDN'T work out for me, I woud take page out of my parents book and open a "value brand' orthodontic practice in a lower/middle class are. The office would be probably a lot like how yours are set up. What you see is what you get: Fast treatment (many patients a day) and run of the mill boing office (low overhead).
("Ryanpoore", Aug 14, 2013)
It's not perceived; it's a FACT and part of culture. White doctors won't budge but Asian doctors will give huge discounts plus free pickup/dropoff. Which White dentist in SoCal will do prophy for $5, composite for $20, full mouth SRP for $200, PFM for $300, ortho for $1000? Same concept apply to discount when dealing with masseuse, plumber, electrician, builder, wedding planner, restaurant, Macy's, Tiffany's, etc.
"Daurang,", Aug 22, 2013.
We, orthodontists, are notorious for charging outrageous fees for doing very little. If you think charging $6k a case and let the assistants do most of the work is a fair fee, then go ahead do it. I don't. My patients and my referring dentists view my low fee as being honest and hard working...
When you have to see 120+ patients a day, it's not because you start too many new cases but it's because you can't finish many of the cases on time. Most cases should be finished no longer than 24-30 months...I rarely have to see more than 80 patients a day....
("charlestweed", Jan 25, 2013)
My average case [for Invisalign] is 4-5 hours of chair time, my fee 3-6 k (depending on how difficult the case is or questions on compliance), after lab bill when you break down the production its $700/hour. Now, I don't think a GP [general practioner dentist], OMFS [oral maxillo facial surgeon], ENDO [endodontist], is going to bitch about that kind of hourly production. (OceanDMD, Apr 20, 2010).
The net profit is higher for convention braces. I pay less than $250 for 20 brackets + 4 bands + wires + ties +assistant salary 9 $20/hour salary. each RDA spends about 10-15 minutes per patient x 24 ortho visits). I believe the lab fee for invisalign is about $ 1000-1500. (charlestweed, Apr 19, 2010)
To understand the perspective of orthodontists confronted with difficult impacted canines I ease dropped on
some threads orthodontist conversations on some websites. It really gives a bit of pause to read that supposedly an orthodontist has to have 100 or so cases pass through his practice every day (I'm presuming that this is for the 200-300k income goal). You are already in debt with yearly tuition of tens of thousands of dollars after three years of dental school and then 2-3 years of orthodontics. You have to get your foot in, and then get going on a private practice if you don't want to stay on at the University.
After reading through some of these, I felt that, in my son's case, I was trying, rather naively, to find a health professional whose prime objective was going to be to help my son to the best possible outcome. In the real world I realized that complicated cases are not welcome in most places, someone spending time asking questions, is really not worth it if you look to the the business side of orthodontics. Clearly, some dental professionals is not viewing their patients as patients, but as customers.
From http://forums.studentdoctor.net/;
'Pedo [pediatric dentistry] is the new ortho' [as in 'where the money is']
'During our working careers, we will need to reach out to the Spanish speaking population and quite possibly the Islamic population. If you don't, you will run out of patients over the years because English-speaking people aren't reproducing sufficiently. It is also unclear whether the Spanish-speaking and the Islamic population will value orthodontics to the same degree that the English-speaking poplulation has valued it". ("Tooth"
, Jun 25, 2014)
Mexican patient rock! ("Silent Cool", Jun 25, 2014.)
'Hispanic patients rarely ask questions because they trust and respect their doctors. This helps the clinic flow better. Seeing 60-80 Hispanic patients a day requires a lot less effort than seeing 20 patients who demand the doctor and his staff to treat them like kings and queens. Hispanic patients don't mind the long wait because one of our staff members calls in sick. They don't mind the fact that my office is only opened a few days a month and only from 2 pm-6 pm on weekdays, 8 am-12 pm on Saturdays. They don't mind driving more than an hour in heavy traffic to see me. That's how I am able to run 4 of my own offices and still have free time to work part time as an associate. Unlike the rich kids' parents, the Hispanic parents don't get mad at their orthodontists when their kids have several broken brackets. Rich parents usually blame us for using "cheap glue". Hispanic parents, on the other hand, yell at their own kids for not being careful on what they eat. Hispanic parents apologize and promise to tell their kids not to eat hard food.("charlestweed", June 25, 2014.)
If I set up practice in the "upper 20%" area like yours, I wouldn't be able to survive because I know I am not very good at convincing the parents to pay $6-7k for a 24-month case. And personally, I don't feel I deserve to get paid that much for doing very simple procedures. The GPs get paid much less for doing much harder and more time consuming procedures. ("charlestweed", Jun 27, 2014)
Then you will have a hard time getting these upper/middle class patients to approve your treatment if you are a GP. Theses patients tend to be more educated than the average population. Not only do they know the difference between GP and ortho, they also know things like Damon brackets, lingual braces, RPE vs qwuad, Herbst vs BSSO advancement surgery et.chey usually google stuff on the internet before they come to see the dentsist/orthodontist. The reason that many orthos in SoCal are struggling now is that they all target the same top 25% income earners and largely ignore the other 75%.
That's why dental chains continue to do well because they chose to treat the other 75%. I know for the fact that most Hispanic and Asian patients would rather go see Asian doctors. They are actually afraid of the White doctors due to the perceived high fees and cultural differences. Yes it is worth spending more $$$ and years to do an ortho residency." ("charlestweed", Aug 14, 2013.)
Mothers talk faster than just about anything, and most of the time they just want to "fit in" with what everyone else is doing.
They may know what the difference between an ortho vs a GP doing braces, but given that they woudl be deling with a charming, good looking GP who would have a nice portfolio of cases and past patients to look at, I can tell you for a fact mother's don't care that GP does braces over an ortho. The ONLY problem, like many of you mentioned, is that first wave of clients that can begin "spreading the seed' if you will. After the seeds have spread, just cultivate them right and the moms will do a lot of the work for youo. "Ryanpoore" Apr 2, 2013
It also kinda sound bad saying this, but I'm tall, good looking, sociable, stero typical "good looking guy", and where I plan to settle down and practice 90% of the population are upper/middle calss white families. It also seems too easy to get the housewives to choose me over some of the other guys, who are mostly Asian/Indian
("Ryanpoore, )
I will start off by trying my luck in the saturated market targeting the high earners. Hopefully, I start slow and build up to the point I WILL, get referrrals from the moms who will be very pleased with not only my service but the general atmosphere of the office. One I get the new referral's, dependng on whether I went the GP doing ortho route or "orthodontist" route, I would need to base the 15-20 minute consultation meeting around eiterh 'Many schools teach outdated ortho methods and the fact of the matter is orthodontics aree trained to handle extreme cases, which obviously beautiful little Sara doesn't have" or "Orthodontists go through extensive training bla bla bla sell the fact that I spent 200k more and 2 years learning the trade." Either way, it's salesmanship and marketing.
If that DIDN'T work out for me, I woud take page out of my parents book and open a "value brand' orthodontic practice in a lower/middle class are. The office would be probably a lot like how yours are set up. What you see is what you get: Fast treatment (many patients a day) and run of the mill boing office (low overhead).
("Ryanpoore", Aug 14, 2013)
It's not perceived; it's a FACT and part of culture. White doctors won't budge but Asian doctors will give huge discounts plus free pickup/dropoff. Which White dentist in SoCal will do prophy for $5, composite for $20, full mouth SRP for $200, PFM for $300, ortho for $1000? Same concept apply to discount when dealing with masseuse, plumber, electrician, builder, wedding planner, restaurant, Macy's, Tiffany's, etc.
"Daurang,", Aug 22, 2013.
We, orthodontists, are notorious for charging outrageous fees for doing very little. If you think charging $6k a case and let the assistants do most of the work is a fair fee, then go ahead do it. I don't. My patients and my referring dentists view my low fee as being honest and hard working...
When you have to see 120+ patients a day, it's not because you start too many new cases but it's because you can't finish many of the cases on time. Most cases should be finished no longer than 24-30 months...I rarely have to see more than 80 patients a day....
("charlestweed", Jan 25, 2013)
My average case [for Invisalign] is 4-5 hours of chair time, my fee 3-6 k (depending on how difficult the case is or questions on compliance), after lab bill when you break down the production its $700/hour. Now, I don't think a GP [general practioner dentist], OMFS [oral maxillo facial surgeon], ENDO [endodontist], is going to bitch about that kind of hourly production. (OceanDMD, Apr 20, 2010).
The net profit is higher for convention braces. I pay less than $250 for 20 brackets + 4 bands + wires + ties +assistant salary 9 $20/hour salary. each RDA spends about 10-15 minutes per patient x 24 ortho visits). I believe the lab fee for invisalign is about $ 1000-1500. (charlestweed, Apr 19, 2010)
There is run-of-the-mill orthodontics and then there is Impacted Canines
Parents have to be aware that an orthodontist is not necessarily a specialist on the subject of impacted canines. It occurs in 1-3 % of the population, so it will take some time to gain experience for the individual orthodontist, and if you do not have the interest and inclination, the risk is that the impacted canine and whatever afflicts it, will be treated as what I call 'a unicorn' (see 'Sam's very long version'). The orthodontist will give it a go, not analyzing the complexities behind the cause of extraction. If pulling this way, and then that way, is ineffective, they will maybe pull harder, then declare it 'ankylosed!' (think Queen of Hearts and 'off with his head'), and the canine is history.
One orthodontist told me, (so it's not much of a statistic, but I don't know if anyone bothers keeping a record,
so it is not really clear where even the 1-2 % prevalence of impacted canines comes from) that he gets about 5 impacted canines a year, 3 canines in total over 15 years was not successfully brought in. It would be interesting to see what the real statistic is, if orthodontists had to report what actually happens to the impacted canines they take on, if the tooth had to be sent for a histological analysis, was it ankylosed or not.
Even though impacted teeth seem common enough that there should be enough collective experience to make more intelligent decisions about how to go about the treatment, medicine often fails collecting and analyzing all data that would be available if you could have everyone report cases, treatment and outcomes. I have a feeling that the orthodontists out there are their own islands. I don't think there is any reporting of good/bad outcomes that can identify who are the 'impact competent' orthodontists.
I've now looked at enough pictures and read plenty of case descriptions, where the authors describe dilemmas, technical manipulations and solutions, that I can see the art of it. Sadly, in reality, all orthodontist are not a Michelangelo.
Parents have to be aware that an orthodontist is not necessarily a specialist on the subject of impacted canines. It occurs in 1-3 % of the population, so it will take some time to gain experience for the individual orthodontist, and if you do not have the interest and inclination, the risk is that the impacted canine and whatever afflicts it, will be treated as what I call 'a unicorn' (see 'Sam's very long version'). The orthodontist will give it a go, not analyzing the complexities behind the cause of extraction. If pulling this way, and then that way, is ineffective, they will maybe pull harder, then declare it 'ankylosed!' (think Queen of Hearts and 'off with his head'), and the canine is history.
One orthodontist told me, (so it's not much of a statistic, but I don't know if anyone bothers keeping a record,
so it is not really clear where even the 1-2 % prevalence of impacted canines comes from) that he gets about 5 impacted canines a year, 3 canines in total over 15 years was not successfully brought in. It would be interesting to see what the real statistic is, if orthodontists had to report what actually happens to the impacted canines they take on, if the tooth had to be sent for a histological analysis, was it ankylosed or not.
Even though impacted teeth seem common enough that there should be enough collective experience to make more intelligent decisions about how to go about the treatment, medicine often fails collecting and analyzing all data that would be available if you could have everyone report cases, treatment and outcomes. I have a feeling that the orthodontists out there are their own islands. I don't think there is any reporting of good/bad outcomes that can identify who are the 'impact competent' orthodontists.
I've now looked at enough pictures and read plenty of case descriptions, where the authors describe dilemmas, technical manipulations and solutions, that I can see the art of it. Sadly, in reality, all orthodontist are not a Michelangelo.
How to find the right orthodontist for the job?
Good luck with that. It's the main flaw today, you have no clue and you don't know what to look for if you haven't read up on impacted canines.
Your friends might tell you that they have a 'nice' orthodontist who seems competent, but if you are dealing
with a complicated impacted canine, you are in a different league.
You can get a general idea if the orthodontist and his/her office is pleasant to deal with, but is is hard to get an idea of how problematic cases are dealt with from just 'yelps' or other review sites, and the smiles posted on the wall. Providers get a long way by just being generally pleasant, but what is their expertise? Do they take part in studies? Have a university position? Publish articles? Board Certified? Member of the Angle Society? Are they too busy with those things to focus on your child if he/she is not a run-of-the-mill case?
Ask about experience
Don't leave it vague. Ask for specifics. How many cases of impacted canines has the orthodontist handled. What was the outcome. There should be photos of the cases, and the orthodontist should be able to explain how he handles different cases and how he/she would handle your child's specific case. Who does your orthodontist collaborate with and/or take advice from? Is he/she part of a well functioning network?
Don't wait to get the name of the oral surgeon who would be involved if the treatment is not going to be
resolved without surgery. Actually, it could be worth having that talk, paying the $ 100 (Bay Area price), to
get the surgeon's take on things even before you know you need it. Maybe the surgeon can recommend you an
orthodontist instead of vice versa.
Get a treatment plan in writing.
If there is something in writing, I think it helps to bring a measure of thoughtfulness and gravitas into the equation. Sometimes I've found that strategies kind of change, spur of the moment. You don't want to be locked into a plan, but you want changes to be thought through and documented. If there are complications or new aspects, ask for a new treatment plan in writing. It is about hope for the best, plan for the worst.
At what point is surgery needed? When do you plan additional x-rays? If things do not go
in the right direction, what are the options? Get answers. For example, just to say that 'there's always dental implants' is not good enough. You can't put permanent implants in a 14-year-old boy (you need a full-grown bite), and the life time of implants is not unlimited, maybe 20-30 years, so it is not a final solution.
Does the orthodontist refer difficult cases?
Is there a specialist in impacted teeth that can be used as a resource? Is your orthodontist the end of the line,
and if that's the case, is he/she the best of the best? Or go straight to the specialist?
Is he/she really CBCT competent
Any mention of CBCT - Cone Beam Computer Tomography? I would be very suspicious of an orthodontist taking on a case of impacted canines without mentioning a CBCT, as I said...run! Next step would be to somehow make sure that they truly understand and can use CBCT, as in using the 3D program that allows you to look at everything from different angles combining the information from hundreds of slices through the teeth; not just use the 2D photo and is not just something they pretend to know and understand. Have them explain and demonstrate how they use CBCT in their practice.
Here's an excerpt from an email (with the person's permission, an adult in New York) I received through my contact page that illustrates the problem of CBCT competent posers:
My feeling is that every orthodontist wants to give it a go in treating impaction, but very few take the time
to understand this condition enough to have an initial treatment approach that provides a better success
rate. Many I’ve consulted with appear to have outdated approaches, are uninformed about success rates for
various approaches or never mentioned workarounds to ankylosed tooth such as cutting bone around or auto-
transplantation. None of the doctors were able to adequately use the 3D scan in front of me to demonstrate
my treatment options or to justify their approach or medical opinion. My orthodontist and one oral surgeon
didn't appear to know what to do with a CBCT I got – painful to watch them having a hard time opening up
the imaging software and properly navigating the 3D images, or to tell me on the spot whether my
impaction was buccal or palatal, if the tooth was healthy, of deep or angled the impaction and how this
correlates to treatment outcomes. There was disagreement between my previous oral surgeon and my
orthodontist on whether I needed a bone graft at the site of the impacted canine. At one point my previous
oral surgeon and my orthodontist discussed my case, but when I spoke with each independently a few weeks
later, they both had different next steps.
It is very sad that there are adults out there who have spent a big parts of their lives looking for a solution to their impacted canines without finding competent help.
(1) Chaushu S, Chaushu G. Skeletal Implant Anchorage in the Treatment of Impacted Teeth -
A Review of the State of the Art. Seminars in Orthodontics, Vol 16, No 3 (September),
2010: pp 234-241.
A Review of the State of the Art. Seminars in Orthodontics, Vol 16, No 3 (September),
2010: pp 234-241.