Dentistry Uncensored with Howard Farran
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379 Bone Screws with Chris Chang : Dentistry Uncensored with Howard Farran

379 Bone Screws with Chris Chang : Dentistry Uncensored with Howard Farran

4/29/2016 8:44:51 AM   |   Comments: 0   |   Views: 995

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Dr. Chris Chang received his PhD in bone physiology and Certificate in Orthodontics from Indiana University in 1996 and is a Diplomate of American Board of Orthodontics (ABO). He is the author of Jobsology, co-author of Orthodontics Vol I-IV, Clinical Implant Dentistry I-II, and publisher of International Journal of Orthodontics and Implantology (iJOI). Dr. Chang frequently lectures worldwide on non-surgical orthodontic treatment, implant-orthodontic combined treatment and effective presentations. As a private instructor since 2006, he has taught over 2,500 doctors from more than 30 countries. In addition to teaching and publishing, he also founded Newton’s A, Inc. and Beethoven Orthodontic Group, based in Hsinchu, Taiwan. His passion in digital learning has led him to produce a series of video courses on orthodontics and implantology and an App (iOS), Beethoven Dental Encyclopedia (BDE). He has been actively involved in the design of orthodontic bone screws and application on impaction treatment. His latest focus is implant and orthodontic combined treatment.

Howard Farran:

It is just a huge, huge, unbelievable honor for me to be podcast interviewing Dr. Chris Chang, DDS, PHD of the Beethoven Orthodontic Center, Newton's A, Inc.

 

 

How are you doing?

 

Chris Chang:

Good. Great.

 

Howard Farran:

Where are you at right now?

 

Chris Chang:

In Taiwan.

 

Howard Farran:

Taiwan. When I was lecturing, Ryan and I just went to Tokyo, Singapore, Malaysia, Indonesia and South Africa, and you are a household name. Not only in America but over there, they just spoke so highly of you. I just want to read your bio in case there's one dentist in the world who doesn't know who you are.

 

 

You're ABO-Certified Orthodontist. You're a member of the Angle Society Midwest Chapter. You're a publisher of the International Journal of Orthodontics and Implantology, founder of Newton's A and Beethoven Orthodontic Center in Taiwan, Executive producer of Podcast Encyclopedia in Orthodontics, author of Jobsology, co-author Orthodontics vol. 1-4, Clinical Implant Dentistry 1 and 2.

 

 

Dr. Chris Chang received his PHD in bone physiology and Certificate in Orthodontics from Indiana University in 1996 and is a Diplomat of the American Board of Orthodontics. He is the author of Jobsology, co-author Orthodontics vol. 1-4, Clinical Implant Dentistry 1 and 2 and publisher of International Journal of Orthodontics and Implantology. Dr. Chang frequently lectures worldwide on non-surgical orthodontic treatment, implant-orthodontic combined treatment and effective presentations. As a private instructor since 2006, he has taught over 2,500 doctors from more than 30 countries. In addition to teaching and publishing he also founded Newton's A, Inc. and Beethoven Orthodontic Group based in Taiwan. His passion in digital learning has lead him to produce a series of video courses on orthodontics and implantology and App (iOS) Beethoven Dental Encyclopedia (BDE). He has been actively involved in the design of orthodontic bone screws and application on impaction treatment. His latest focus is implant and orthodontic combined treatment.

 

 

How are you doing today?

 

Chris Chang:

Good. Great.

 

Howard Farran:

So it's 7 pm here, what time is it in Taiwan?

 

Chris Chang:

Uh, 10 am.

 

Howard Farran:

10 am?

 

Chris Chang:

Yeah.

 

Howard Farran:

So you have 3 presentations for us today, correct?

 

Chris Chang:

That's right.

 

Howard Farran:

I can't wait to see.

 

 

What made you start getting so interested in mini screws?

 

Chris Chang:

Well, because in Taiwan we have so many difficult and complex cases that I couldn't figure out how to fix it. When I get education in United States I find this mini screw is very powerful to solve those complicated cases.

 

Howard Farran:

Is that because United States is half European, 15% African American and only 6% Asian, and now you were in a totally Chinese-Asian-Taiwanese population?

 

Chris Chang:

That's right. Also the only problem is if you don't fix in childhood it will become more severe after they become adult. That is the situation in Taiwan. That's why those cases are so complicated.

 

Howard Farran:

Well you have combined orthodontics and implants and mini screws together like no one else ever thought it would happen. You have a huge YouTube channel with more than 6,000 followers. You're huge into publishing 3D e-books on Apple's iBooks store, talk about that.

 

Chris Chang:

Well.

 

Howard Farran:

How do they find you on YouTube? It's YouTube.com/ what?

 

Chris Chang:

You go to the YouTube and type Newton's A, A stands for apple, 0301. That's my YouTube address. I wish you luck in my presentation. Howard-

 

Howard Farran:

Okay. By the way, I gotta ask you, why did you pick Beethoven? Is it cause he mastered the earliest form of a piano? What was that, a harpsichord or what?

 

Chris Chang:

There are 3 reasons why I chose Beethoven. Number 1, I am fascinated and obsessed with classical music, especially Beethoven's music. That's number 1. Number 2, Beethoven in Chinese actually is 3 characters 'Bee' is money, 'tho' is a lot, 'ven' mean's share. So when you have a lot of money you want to share with your friend like Howard, I want to share my money with you, that's Beethoven. Number 3 because Beethoven is the one we present the people are trying to do perfect job. That's why I pick Beethoven.

 

Howard Farran:

When you lecture in Poland do you call this the Chopin?

 

Chris Chang:

That's good. I work I will try to let music of Chopin.

 

Howard Farran:

I think you should have an app in Polish and call it Chopin A, Inc. because they are so proud of their Chopin when you go to Warsaw, Poland. So let's start your presentations.

 

Chris Chang:

Great, great.

 

Howard Farran:

Before I go, you're a big fan of Beethoven, you're also a big fan of Steve Jobs.

 

Chris Chang:

That's right.

 

Howard Farran:

Why is that?

 

Chris Chang:

Because I use Apple computer and number 2 because when I study his history, his story, I find out we have a lot of similarities. I love to simplify everything, and because you simplify everything, such as your treatment[inaudible 00:06:21], that people can copy your treatment. Otherwise if your treatment [inaudible 00:06:26] is so complicated, how can people learn your technique? Steve Jobs did exactly like that in new work in his iPhone, iPad, and computer.

 

Howard Farran:

He was an amazing man. Did you read his book or see any of the 2 movies they made on his life?

 

Chris Chang:

I read his book several times and I saw those movies. Yes.

 

Howard Farran:

He was an amazing man. Let's start with your presentations.

 

Chris Chang:

Great, great.

 

 

Howard, I'm going to start with my background, which is where I practice. If you look at this screen, that's Chopin for sure, the video on the screen is my office Beethoven. If you have a chance to visit Taiwan, you are more than welcome to visit my practice. Because everybody straighten their teeth a little bit differently and sometimes it's quite interesting to look at how are other people play the game. Before I get in my topic today, I think it's quite appropriate that I show you where I practice.

 

 

I grew up in a small island by the name of Taiwan, which is surrounded by China, Korea, Japan and the Philippines. If you look at it from this perspective, Howard, you'll be surprised that my country Taiwan is growing in the center of the world. Can you imagine, I'm from the center of the world. Later on my friend told me, "Hey Chris, you can't [inaudible 00:08:22] this grow that every country can become the center of the world." Nevertheless, if you could call it the tallest building on Earth, it used to be right here by the name of Taipei 101. Taipei is the capital of Taiwan and 101 stands for 101 floors, [inaudible 00:08:48] 500 meters. It's a huge building. My office Beethoven is 40 miles south of Taipei 101. Finding this building should be easy, head to the south, you'll be able to catch me.

 

 

Let's start with question number 1. How would you fix a severe class 3 without surgery like a this? When we're talking about 11 mm discrepancy in the posterior area. In order to get into a good occlusion we need to move the molar 11 mm. How can you do that? Most people would guess, well in order to get 11 mm, and minus 5 mm overture, he was told that only surgery could solve his problem. 22. 22 [inaudible 00:09:58] That's the result. Neither surgery nor extraction. Can you believe it?

 

Howard Farran:

Very nice.

 

Chris Chang:

Hey Howard, that's 22 months. No surgery, no extraction. People say it seems photo-shopped. No, no, no, it's a real case. The key is whole arch move backwards with BS screw. BS stands for Buccal Shelf. Howard-

 

Howard Farran:

Yes?

 

Chris Chang:

BS stand for Buccal Shelf. Okay.

 

 

In fact, to correct this huge Class 3, you only need 4 months to convert negative overture to positive overture. Can you believe it? 4 months, with mini screws. Let me use this diagram to show you how that works. First you need to know where is the center of resistance for the lower arch. With that I put this mini screw and we trek backward that create a movement. This movement would locate the occlusal print and [inaudible 00:11:22] the whole [inaudible 00:11:23] backward. Let me rotate and describe for you like this. Can you see that?

 

Howard Farran:

Yes.

 

Chris Chang:

Alright, one more, and one more. Almost done, 22 months. Wow, that's huge. It used to be harder, this kind of case people would put on the table to do also lasik surgery, but today with this mini screw we can simplify the process and get non-surgical approach. I believe it is minimally invasive approach. I am obsessed with this minimally invasive approach.

 

 

When I showed this approach to my grandfather Charlie Burstone, Charlie Burstone is the most famous orthodontic today, he is [inaudible 00:12:12] the father of bio-mechanic in orthodontic. He looked at the way that we fixed this case, he punched the table and said, "Hey, Chris, I agree! This is a better way to treat this case" That's huge, but people who are skeptical were asking, "Hey, so what? It's not standard care because we don't see in textbook." Don't worry.

 

 

Howard, I published this case in this journal, International Journal of Orthodontics and Implantology, and the way I love to publish a case is I love to show people step-by-step. Especially key steps, because that's the only way that people can learn. If you only show pre-treatment, post-treatment and somewhere in between, how can people learn. So every single step that I fixed this case can by found in my journal. It is free! After that every single case I will evaluate the performance of this treatment. I also put all my presentation in YouTube and it's free so you go to the Newtonsa0301 and type Amazing Class lll, you'll be able to find this presentation. You are not the only one Howard, they are by far all the 900,000 people watch this case report. How can you attribute 900,000 people watch it also the presentation. I have no idea, you check that out.

 

 

This is interesting. People will still argue, "Hey, one case doesn't mean anything!" I agree. Last year, actually just 5 months ago we published 17 similar cases and we put them together and take a step further. 17 similar case and use finite evidence medicine to evaluate the full system that we used in this kind of treatment. If you look at this through this case report, this study, you'll be able to find the first time a human being will be able to identify how you rotate the entire dentition. It's quite interesting. This is the first time Howard, that we'll be able to know where is the center of resistance for the mandible, and where is the center of rotation that we can rotate the entire mandible backward, that sort of thing. First time in history, that's huge.

 

 

Finally, you might ask, "Hey Chris. What's special for this approach?" Howard, let me use a diagram to show you. The screw that I used is a BS screw versus most people will use a MIA which is a little bit smaller. My screw is bigger 2x12. Other people use 1.4x8. What's the difference between the BS screw and MIA? Let me use this diagram and my friend Dr. Rungsi would show a beautiful diagram to show you the difference between my screw and other peoples screw. The position is different. Let me blow that up for you. The screw actually sits outside the roots, while other people like to put between the roots, which is like this between the roots. My screw is outside the roots, because this screw is outside the roots we will be able to move the whole dentition backward. If you put a screw between the roots, then when you move backward this screw will be in the way, so you cannot move the whole dentition backward. This approach is huge to produce an entire arch [inaudible 00:16:40]. Furthermore, if you put screw like this way, horizontally, you might pop the soft tissue, that's why the failure rate is a little bit higher and our failure rate is much lower.

 

 

That reminds me the evolution of phone [inaudible 00:17:03]. How it used to be that people used rotary phone, but today if a young generation like us we never heard of rotary phone, we use iPhone. We don't use rotary phone, we use iPhone6. Howard, have you ever heard about rotary phones?

 

Howard Farran:

Yes, I grew up on one and it was nailed to the wall.

 

Chris Chang:

Howard, we are young generation, we never heard about rotary phone, remember? We only use iPhone. Did you get that?

 

Howard Farran:

I got that. The phone I grew up on was fixed to the wall with 4 bone screws.

 

Chris Chang:

Okay. Good job.

 

 

If you are interested in this approach we publish in The Angle Orthodontist, Nov. 2015 and the failure rate is just 7%, which is very, very small. That's the end of my first section. Howard, do you have any questions?

 

Howard Farran:

Yeah, do you ever use these on the upper maxilla?

 

Chris Chang:

Oh, you are so smart. Good. Before I get into that, I would love to give you the my educational background, so you know where I get an education. Then we continue to the lower first, and then we get to the upper.

 

 

Let me give you my education background. I was lucky. 30 years ago I learned also orthodontic from Dr. John Lin. Dr. John Lin is like the founding father of orthodontic in Taiwan. 5 years later I went to United States, I learned from Eugene Robert in Indiana University, and Eugene Robert became my godfather and my mentor. About 12 years ago I have a chance to know Dr. Damon, so ever since I know Dr. Damon I switched to the Damon process. I enjoy this process a lot. It was Dr. John Lin and Dr. Gene Robert, we later learn designed this BS screw. It was this BS screw and Damon process and we can solve a lot of complicated cases. With that, let me show you one more case.

 

 

The case number 2. How do you fix a severe post buccal cross bite like this? Did you see the Buccal cross bite?

 

Howard Farran:

Yes. That is severe.

 

Chris Chang:

You couldn't see the lower dentition. Wow. That's huge, and that's 10 months later. 10 months ago she was told by 4 doctors that only surgery could solve her problem. I was wondering, what kind of surgery you want to do with this girl. Are you going to cut the bone right here and cut the bone down below? No. We don't want to do it. What we did is we just used 1 BS screw. Then we pulled it back from here you have 6 mm from the screw to the molar tooth and 3 months later the molar tooth hit the screw. In other words, we moved 6 mm outward for this two molars. That's how we stopped this buccal [inaudible 00:20:40] molar. Wow. Is that wonderful? To avoid surgical approach.

 

 

Final one. This is the oh my God case. I would love to challenge you Howard how to fix this case. It's amazing dilacerated impaction. Dilacerated means the root is 90 degree curved like this. If you look at the [inaudible 00:21:11] you'll be able to see the situation is so complicated because about this dilacerated tooth they have [inaudible 00:21:22] right here. How would you fix this case Howard?

 

Howard Farran:

I would have zero idea.

 

Chris Chang:

You can never refer, you have to find a way by yourself. So if 7 mm down below and the root is dilacerated and actually the root is hooked in the nerve, nerve is right here, so it's very dangerous. So do you know how oral surgeon wanted to do? They wanted to remove all and put 2 dental implants. Let me tell you, if you do that you might run into a risk. You might break the entire mandible. You hear that, Howard?

 

Howard Farran:

I agree. I agree. That would be a very bad idea.

 

Chris Chang:

Well that is a bad idea. So what we did is we put this mini screw in the buccal shelf, BS screw and used this 3D lever like this and we be able to bring this 17 mm down below to the occlusal within 25 months. It is minimally invasive, is that cool Howard?

 

Howard Farran:

That is very cool. That is unbelievable.

 

Chris Chang:

I was so fascinated with this approach. 17 mm dilacerated root can be fixed with this simple, elegant approach.

 

Howard Farran:

Now does this change the position of the temporal mandibular joint? Is there any implications on the joint?

 

Chris Chang:

The beauty is no. The screw is just affixed there so it's nothing to do with the TMJ. That's the beauty of this approach.

 

Howard Farran:

Very nice.

 

Chris Chang:

You might ask, "Well this is a good approach. What is the failure rate for this screw?" As I mentioned before, I did 1680 buccal shelf screws for the past 3 years, and the failure rate is just 7%, which is very small.

 

 

Howard, let me show you the last case for the lower before we get into the upper. What would be your plan for this case?

 

 

Which ones would you take out? You want to take out the third molar or second molar?

 

Howard Farran:

I would probably uh...that is a hard case.

 

Chris Chang:

Let me tell you, the nerve is right here, so if you take out the second molar you might damage the nerve. If you take out the third molar how can you move the second molar outward and upward because it's so deep, it's a long way impacted. Let me give you a story.

 

 

About 4 years ago a famous doctor from United States, his name is Arnie Rosen, he told me he's very famous. He is Associate Dean from Tuft University. He told me the story, he has a case like this. The oral surgeon prescribed take out the second molar and when the surgeon take out the second molar it damaged the nerve, so it ended up a catastrophe result. Taking out the second molar is not the option. It's the complication is huge, so we don't want to take out the second molar. Instead we would love to take out the third molar.

 

 

A question is how can you upright this deep long impact second molar? Howard, do you have any idea?

 

Howard Farran:

No, but I bet you use a BS Buccal Shelf bone screw.

 

Chris Chang:

Way to go! You are a genius Howard! I can tell immediately.

 

 

They way I did it is I put a screw right here so with this screw I can hook up a [inaudible 00:25:34] I be able to upright it. Let me show you how I did it. That's the first month. Did you see any change? Look at it carefully.

 

Howard Farran:

Oh yes, yes.

 

Chris Chang:

No, no, no. You see nothing. We haven't started yet. In 2 months in treatment did you see any change? Right here, did you see the space between the second molar and the bone space? Did you see that?

 

Howard Farran:

Yes.

 

Chris Chang:

In 3 months, did you see that? In 4 months. Wow!

 

Howard Farran:

Wow.

 

Chris Chang:

How could that possible? If you only hook up the [inaudible 00:26:14] from this attachment to this screw it is similar to Buccal Shelf screw, right here. Now you can put braces along with the [inaudible 00:26:25] in 7 months. 7 months! How could that possible? Let me tell you, the most rewarding thing you do in life are often the ones that look like they can't be done, and this is the example Howard. Would you agree?

 

Howard Farran:

I would agree. That is an amazing case. That is an oh my God case!

 

Chris Chang:

Oh my God! Okay. Let me conclude.

 

 

It is indeed a revolutionary approach because the reason why people take out a second molar is because they have no idea how to upright the second molar and now with a simple screw you'll be able to upright within 7 months. Is that correct?

 

Howard Farran:

That is fantastic.

 

Chris Chang:

Thank you.

 

Howard Farran:

You should be very proud. This is a very amazing innovation.

 

Chris Chang:

Right. Howard, that is why I'm so excited everyday. Everyday I want to get up and [inaudible 00:27:30] away to work because there are so many things waiting for me to solve. You might ask, what is the failure rate for this ramus screw? What is it? It's just 5%. Can you imagine? Let me give you a summary of the failure rates in various approach. You'll be able to see the huge benefit.

 

 

When you have the screw that between the root, which is the old one, you get a 20% in the lower arch and 12% in the upper. When you put outside screw, like Buccal Shelf screw, it's only 7% and this Ramus screw is only 5%. This 5% is because the patient didn't brush well. If they can keep good oral hygiene and I don't have to take it out when they get inflammation and the failure rate would just zero. Can you believe it? 0%, because old screw is greater. If you are interested in this approach you can find it in a IJOI volume 41, published January 1st this year. Every single detail approach is why in this article. Can you believe it? Every step, and all the material I've published in YouTube is free for you too download and free for you too watch. Is that great?

 

Howard Farran:

That is fantastic. What about the age range of these patients? Does there come a time when you're too old for your bone to respond to this?

 

Chris Chang:

Wow, Howard! You are genius to ask the right question. I think for this case is 26. I think if the age is like your age, I guess you are about 30 okay? For under 30 I think is okay. Between 30 and 40 is questionable. Over 30 you might be too old. So you are pretty okay Howard.

 

Howard Farran:

Very good.

 

Chris Chang:

So I'm so excited to produce information YouTube to share my friend.

 

Howard Farran:

Very, very nice.

 

Chris Chang:

So what is your question?

 

Howard Farran:

Do you use these on the upper maxilla?

 

Chris Chang:

Yeah, that is the next. If we can fix the lower, we have the way to fix the upper. The most popular is the overture, overture means upper jaw and lower jaw have a big difference. Big gap, for example 10 mm overture which you can see is huge. In a textbook they say if you have over 8 mm that is considered surgery case. This man, 25 years old, with 10 mm overture Buccal cross bite like this is a huge Buccal cross bite. Can you see that?

 

Howard Farran:

Yes.

 

Chris Chang:

Second molar is Buccal cross bite. An adult patient, 10 mm overture, can you believe it? How can you fix it?

 

Howard Farran:

That is a lot.

 

Chris Chang:

That is a lot. He's humble request will be, no surgery, no extraction. Can you fix it Howard?

 

Howard Farran:

I could not.

 

Chris Chang:

You could not. You want to know how to fix it?

 

Howard Farran:

How?

 

Chris Chang:

That's the result. 26 months later. We solved the big overture, we solved the cross too, we solved the Buccal cross bite like this. Did you see the big difference?

 

Howard Farran:

That is an amazing difference.

 

Chris Chang:

No surgery. No extraction. Wow! How could this possible. The key is we put a screw on the top right here and moved the upper dentition backward. That's why, and because the screw is outside the root. That's why we can move the whole dentition backward like this. Is that amazing? It's similar to the lower. So let me tell you, again, it is indeed a revolutionary approach. To put a screw outside the root and you can move the whole dentition backward.

 

 

People will ask, "Hey Chris. It's not to stable." This is 3 years follow-up. Look at that overture holding pretty well, and look at the occlusal, solar occlusion it is stable. Give us 3 year follow-up for this adult patient.

 

 

So what is the 2nd application for the upper? Howard, how would you fix this severe gummy smile?

 

Howard Farran:

That is a very common cosmetic problem. Most Americans would treat that with surgery.

 

Chris Chang:

Ahhh, you are genius. I bet 100% people think this is a surgery case. When she come to my office looking for minimally invasive approach, I explain that this case is definitely surgery case. Would you agree?

 

Howard Farran:

I would agree.

 

Chris Chang:

So what is your plan? You want to do surgery?

 

Howard Farran:

No.

 

Chris Chang:

If not surgery, how can you fix it?

 

Howard Farran:

With a BS Buccal Shelf bone screw.

 

Chris Chang:

You are so good. I went ahead and explained how to fix this case. First we take a full fresh pre-mortar so when we close this pre-mortar space we be able to solve the bite [inaudible 00:33:50] That's step number one. You still cannot take away from the gummy smile. The second step is to cut a piece of bone like this. After we cut this piece of bone, about 5 mm, we impact the [inaudible 00:34:09] and glue secure with this [inaudible 00:34:13] That's a full 2 [inaudible 00:34:17] so it's full meaning [inaudible 00:34:19] with surgery. The surgery would take about 4 hours. After I explained this treatment this lady told me, "Hey Chris, this is ideal solution, but that simply doesn't fit into my personality. I would love to have minimally invasive approach. Is there any other way?"

 

 

I explained maybe we can use screw. I explained how I use the screw. Guess what? After I explained the screw, Howard.

 

Howard Farran:

Yes.

 

Chris Chang:

Do you know her response?

 

Howard Farran:

She loved the idea.

 

Chris Chang:

Yeah. Her immediate response is this, "Screw please!" Screw, you understand Howard?

 

Howard Farran:

Yes, a BS.

 

Chris Chang:

So I went ahead and put this screw on her right here and that's the result. The only word that I can describe this result is W-O-W. It's the same girl, can you believe it Howard?

 

Howard Farran:

That is an amazing difference. That's a life changing difference.

 

Chris Chang:

Life changing, definitely. So instead of one boyfriend, now she can enjoy many boyfriends.

 

Howard Farran:

If you turn that wow upside down it'd be mom and I bet her mom was just as ecstatic as she was.

 

Chris Chang:

Oh, Howard! You are such a genius! I need to turn it upside down?

 

Howard Farran:

Yeah because then it'd be mom. The wow would be mom, and I bet her mom was just, couldn't believe it either. I bet her mom was as excited as her daughter.

 

Chris Chang:

Howard. This is an inside story. After I fix her, her mother came in my office. She wanted me to use the same approach to fix her. Her mom is about 60 years old, I said, can you give me a break. Do you understand?

 

Howard Farran:

Yeah, so you thought she was too old. Did you try it or did you just say no she was too old?

 

Chris Chang:

A little bit too old. I love to fix young lady, you understand?

 

Howard Farran:

Yes.

 

Chris Chang:

That's a major benefit, so they can have a good life and look how through this case I think this approach is huge. This is a huge gummy smile and we can end up with a beautiful and soft smile. Beautiful. I really love this approach. So what else?

 

 

Third application. Howard-

 

Howard Farran:

Yes.

 

Chris Chang:

If the canine run into center like this so you need to have outward force system, then how would you fix this case?

 

 

The canine is between center and [inaudible 00:37:36] which is very difficult. I used this mini screw with 3D [inaudible 00:37:41] I be able to produce a backward, outward, downward force system and I would be able to solve this problem. Like this. Let me ask you Howard, my friend, is this really hard to fix?

 

Howard Farran:

Yes, it's incredibly difficult to fix.

 

Chris Chang:

Yeah. I bet you're right. It's very difficult. So between the roots of the center incisor and lateral incisor this too video show you exactly where that impacted cusp is located. It's between the center and lateral roots. With that let me ask you again, my dear friend Howard, is this really hard to fix?

 

Howard Farran:

Yes.

 

Chris Chang:

You're sure?

 

Howard Farran:

I have a feeling you fixed it with a bone screw.

 

Chris Chang:

Let me give you a quick review.

 

 

7 years ago I spent $300 to buy a book. $300. Are you getting this? $300 is a lot of money for poor doctor like me. $300 is very expensive. So what kind of book costs me $300? It is this book. Let me show you the canine is right here, let me pull that up for you, make it bigger. Bigger again. Did you see that?

 

Howard Farran:

Yes.

 

Chris Chang:

It's between the center and lateral roots. That's why I spent $300, I want to know how this expert fixed this case. I opened up this book I paid $300. I was so excited, I get this book and run home and try to figure it out. I turn to page 172 and the canine root is between center and lateral, the orthodontic resolution and alignment are often impassable. That is a lie. That's why I spent $300. I turn to the next page, there are 3 options for that.

 

 

Leave the canine in place. How can you do that? You will [inaudible 00:40:12] You can not pretend you didn't see it. Number 2 is refer to the oral surgeon to take it out. No. We are going to keep the canine. Number 3 is carefully planned directional orthodontic force, which I don't know what that means. I assume it's carefully planned directional force system. I was so excited. So I turned to the next page. That's the end of the discussion. Howard, what would you do? You pay $300.

 

Howard Farran:

I would want to see a case. I would want the discussion to show me how to do it.

 

Chris Chang:

But it's the end of the discussion. I run to the last page of the book. I couldn't see any discussion and didn't show any case to solve this problem. What would you do? $300, gone. Howard, are you [inaudible 00:41:19] to spend $300?

 

Howard Farran:

Yes.

 

Chris Chang:

I was so lucky. The next month I was lecturing in United States along with this author. His name is Adrian Becker. So we lectured together so I asked Dr. Becker, "Hey Dr. Becker, I spent $300 to buy your book. I couldn't get an answer. Can you tell me the answer?" Dr. Becker keeps smiling to I think about it, I believe this is an unsolved mystery. If Dr. Becker cannot figure out how to solve, I bet very few in the world know how to fix it. That's why you believe it's very difficult. Right, Howard?

 

Howard Farran:

Absolutely.

 

Chris Chang:

Absolutely. Let me ask you again. Is this really hard to fix? The answer is, no. No. With our screw and 3D lever arm, that's 5 months in treatment. Did you see the [inaudible 00:42:28] is in the press. It's ready to right here, just 5 months with this screw and 3D lever arm. It's over there. Wow. It's an unsolved mystery Howard, remember? If you ask my grandfather, Charlie Burstone, is this difficult to do? His answer will be with right mechanics, it is easy. The top teeth is screw with 3D lever arm. You'll be able to change in that direction and force this canine into the occlusion. It's so easy. So you select the right tool, you'll be able to fix this problem.

 

 

Howard, that's the scoop for the upper and the lower.

 

Howard Farran:

That is just simply amazing.

 

Chris Chang:

Thanks.

 

Howard Farran:

Simply amazing. You are as innovative as Steve Jobs. You're the Steve Jobs of ortho.

 

Chris Chang:

Thanks. Thank you, thank you.

 

Howard Farran:

You are just carrying this message around the world in person. You're carrying it around the world on YouTube, with eBooks, you're just sharing so much information. You're absolutely changing the face of orthodontics around the world.

 

Chris Chang:

That's why I invented this approach that I can invite, give lecture. For example I need to give a lecture over 22 countries. Can you believe it? I have to travel, I have a practice to see my patient, besides I need to travel 22 countries this year. That's why I come up to put all my presentation in the YouTube. I have by far 369 presentations in YouTube. I asked my friend, why not just watch my YouTube instead of inviting my to travel to your country. The more I put into YouTube the more invitations I got. That's why I needed to travel to so many place.

 

Howard Farran:

Well it's gonna be awhile before, it sounds strange that there's a physician or dentist today that's not on the internet, on social media, on YouTube and internet, but it's amazing how many I find every single day. I lived in a house with 5 dentists through dental school and 2 of them, they're never on the internet to this day, and we're all the same age, 53. You're gonna have to mix bricks and mortar and books along with the internet. The internet digital is the future, but there's still a lot of doctors out there that just do not embrace internet learning.

 

Chris Chang:

Howard, when I look at your internet stuff I find that we have a lot of similarities. To get this good information spread all over the world. I'm so happy I have the chance to know you. I was thinking about, what would be the best way to spread those great ideas.

 

 

The first obvious is to give a lecture in various countries so people get to know you. I was thinking about that would be too much to travel, so I put all my presentations in the YouTube so people won't be needing to invite me to give a lecture in their country. Later on I find out that it might be good that I write up those lecture cases and publish in the journal. The journal I would love to publish is International Journal of Orthodontic and Implantology, it's IJOI. Also AJO-DO, which is a premier journal in our profession, American journal.

 

 

Howard, I would love to update our publication 7 days ago. Which is April 1st. That's AJO-DO would publish a case in AJO-DO, AJO-DO is a premier journal in a word. Which you wanted to look at this premier journal?

 

Howard Farran:

Yes.

 

Chris Chang:

Let me ask you, how would you fix adult skeletal class 3 like this? It's a skeletal class 3. It's supposed to be very difficult. The A and B angle is minus 3, minus 3 means very very difficult to fix. On top of that how can you improve the profile like this? He has severe crowding with major, about 11 mm space. How can you invent a space to accommodate this arch? If you take the teeth out how can you [inaudible 00:47:56] low incisor. In this case you cannot take the teeth out. If you cannot take the teeth out how can you create a space, 11 mm space? It is difficult.

 

 

People was thinking about for this difficult case you need to take 4 bicuspid out and do also surgery. But unfortunately the patient refused to have surgery, so his humble request was no surgery, no extraction. How can you move this, solve this case with non-surgical and non-surgery. If you look at the public page on this issue they are using my picture as their cover page. After that the editor called me, "Hey Chris, can you get 4 minute video presentation so they can put in their website so people can understand how I fixed it?" Imagine, this is a complicated case. How can you use 4 minutes to explain a complicated case like this? It has to do with, you need to have effective teaching methods to do that. Do you agree?

 

Howard Farran:

Absolutely.

 

Chris Chang:

Howard, I would love to show you this 4 minute video and watch carefully. Look at the statement that I make which is called go inside with computer animation. Those are very difficult to make, so pay attention to that. You'll be able to enjoy this video.

 

 

"Ladies and Gentleman, this is Chris Chang from Taiwan along with my colleague Linda and my mentor Gene Roberts. We would love to present a conservative treatment of skeletal class 3.

 

 

How would you fix a case like this? In other words, how would you get from A to B? To be more precise, how would you increase A and B by 2 degrees? By doing this we'll be able to bring the front teeth forward and push the molar backward. His humble request was no surgery, no extraction. How can you fix this complicated case without surgery, without extraction? What would be your treatment plan?

 

 

Our minimally invasive approaches are; class 3 elastics, bite turbos, open coil springs and mini screws. There are 3 keys to this treatment.

 

 

Key number 1 is the key to deal with severe crowding with non-extraction, and it is the key to select proper torque. On the top we use low torque because severe crowding with non-extraction, down below we use standard torque. The idea behind this is whenever you have crowding with non-extraction, you normally will end up flaring the upper incisors. Low torque brackets can compensate this side effect. On the other hand, non-crowding with extraction, you'd end up uprighting the central incisors. High torque brackets come into play. Other than that we use standard torque.

 

 

Key number 2 is the key to unlock anterior cross bite. We use class 3 elastics in conjunction with bite turbos. This anterior bite turbo is so effective to open the bite and correct anterior cross bite.

 

 

Key number 3 is the key to create space and distalize the molars. We use IPR to reduce the tooth's mass and we also use open coil springs to gently open up the space. To distalize the molars we use mini screws. This mini screw is very effective to distalize the molars and also prevent anterior flaring.

 

 

With these 3 keys we'd be able to manage this difficult case into an acceptable result. Is that stable? 3 years follow-up. It is stable. Most importantly, this patient loves his new smile. He's showing more teeth, with full of confidence.

 

 

Even though 2 degrees sounds very small, the change in profile is huge. If you're interested in this case report, you can find it in AJODO 2016 edition.

 

 

To conclude my case presentation, I love minimally invasive approaches. My patient loves minimally invasive approaches, and who wouldn't?

 

 

Thank you."

 

Howard Farran:

That was amazing.

 

Chris Chang:

Thanks. Thanks.

 

Howard Farran:

Not only is your orthodontics and implant cases amazing, but your video presentation, your graphics, I mean, your presentation...it's like it comes from Hollywood or Bollywood, I don't know. It was an amazing presentation.

 

Chris Chang:

Thank you, thank you, thank you. So presentation, publication and finally is get everything together and put into iPad, a book so when people look in the book they can also look at the video of the presentation. Is that a great idea?

 

Howard Farran:

That is a great idea.

 

Chris Chang:

So we come up with 3D ibook. I'm going to show you this 3D ibook. Do you know, when people tell me their product is revolutionary, I always immediately think about, this guy tried to [inaudible 00:54:51] Let me tell you, this book is indeed revolutionary. I would love to show you. Do you want to see this?

 

Howard Farran:

Absolutely.

 

Chris Chang:

Okay, let me show you this 3D eBook. When you open up this iPad, and you find the ibook bookshelf and you open up the books you'll be able to find I have by far 10 3D eBooks on the app store, Apple bookstore. Let me give you an example. Volume 4 is right here so I open it up. Wow. So you can go to the case report that I have right here and I show you this case. On the first case I show you the open bite, how we fix this open bite like this. Look at the [inaudible 00:55:50] we also correct the [inaudible 00:55:52] correct the open bite. This case is too easy, so let me just skip this case. This is a good case. That's a case I show you. You are in the iPad, in the iPad you can mark, you can search, you can also have a dictionary there. Look at that, you can blow up the picture. That's the case I showed you, class 2 big 10 mm overture, supposed to have surgery and we did it non-surgically. Imagine, is that possible that we can hold this 3D model and look at this model in every single aspect, but it's in the book. Can you imagine Howard?

 

Howard Farran:

That is amazing.

 

Chris Chang:

It's in the book. You can hold a model and after that you can look at the treatment. All the treatment procedures can be found in here, so that's after the treatment. Wow. The picture is so big so you can study step-by-step. That's the finished model that show you every single aspect of this treatment. You might think about, do you have the step-by-step? Of course. If we are look at step-by-step I will show you right here. Step-by-step, when we put the braces, 6 months later and 11 months, 15 months we put a mini screw to distalize the whole dentition backwards. Every single step can be found in this book. Wow.

 

 

Finally I also put this Buccal Shelf screw if people want to know how to put a Buccal Shelf screw you get it. I have a video to show you how to put a screw. This is the regular paper I publish, which is good. The better way would be to have interactive which when people are sitting there in their room, they want to know how to put the mini screw. They can learn how to put a mini screw. This video shows how to put a mini screw.

 

 

Howard, imagine, you are sitting in your living room, watch the HBO and the same time you can study how to put a mini screw. If you are not comfortable, where is that Buccal Shelf, then I will show you this dry skull and every single aspect of the dry skull is right there, so before you put a mini screw you be able to know where you want to put your screw. Is that amazing?

 

Howard Farran:

That is beyond amazing.

 

Chris Chang:

That is so cool to have a book with content the text and also the video and the diagram. Let me conclude my interview today. I believe this approach, the mini screw, the publication and finally this 3D eBook is indeed revolutionary. It's a revolutionary product and if you want to know more about this, I also put my email right here. From the bottom of my heart I want to say thank you Howard. It's such a great honor to have a chance to talk with you today. Thank you.

 

Howard Farran:

The honor was all mine.

 

Chris Chang:

Any questions?

 

Howard Farran:

No, I just think what you've done is amazing. You're world renowned, you have 900,000 views on YouTube, if you ever want to push that over the million, for sure we have the Dental Town website and the Ortho Town website, I think if you put this presentation, this is a podcast, but I think if you did a presentation and put it on Ortho Town, our Ortho Town magazine goes to 10,500 American orthodontists and half of them are on OrthoTown.com. If you did an online CE course on there, if you put it in the magazine they'd all see it, if you put it on the website half would already be there, but I think that might be something. I'd really like to get the word out more to the American market.

 

Chris Chang:

Oh good. I would be happy to do that.

 

Howard Farran:

That would be a huge honor. That would raise the bar of Ortho Town single handedly. That would be amazing.

 

Chris Chang:

Okay, sure. Thank you, again.

 

Howard Farran:

Thank you, and hopefully the next time I see you it'll be in Taipei.

 

Chris Chang:

Okay. Enjoy the rest of your night.

 

 

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