Orthodontic Jungle

In 2017, Dr. D’Antò received the Italian national scientific qualification as full professor of Oral Sciences and He is currently working as associate professor at the School of Orthodontics of University of Naples Federico II.

Dr. D’Antò is member of SIDO, EHASO, EOS, AAO, WFO and IADR, and the Past President of the Italian Society for Biomechanics (SIBOS). He authored more than 130 papers and has given oral presentations in more than 40 countries and at the international congresses of EOS, AAO, IADR, SIDO, EAS, DGKFO, DGAO, NVvO, SFOPA, HOD. He serves as associate editor of AJO-DO, PIO and OCR. Dr. D’Antò received the Robert Frank Award (2004, 2005, 2009) and the Hatton Award (2006) of IADR, the SIDO award, the EOS Houston Award (2012) and the Tiziano Baccetti Award (2016) and FEO award for the best paper (2025).

Transverse maxillary deficiency is a frequently underdiagnosed component of malocclusion in adolescent and adult patients, with significant implications for facial aesthetics, airway function, and overall orthodontic treatment outcomes. While clear aligner therapy has demonstrated growing efficacy across a broad spectrum of malocclusions, its inherent limitations in producing true skeletal expansion in non-growing patients have driven the integration of Miniscrew-Assisted Palatal Expansion (MAPE) as a complementary intervention.
This presentation examines the clinical outcomes and efficacy of combining MAPE with clear aligner therapy, with particular emphasis on the distinction between skeletal and dental expansion, patient selection criteria. treatment protocols, failures and troubleshooting.

Class II malocclusion represents one of the most prevalent dentofacial discrepancies encountered in orthodontic practice, affecting both skeletal and dental components across a wide range of patient ages. The advent of clear aligner therapy has expanded treatment possibilities beyond traditional fixed appliances, offering clinicians a versatile tool for managing Class II correction from the mixed dentition through adulthood.
This presentation reviews clinical outcomes and efficacy of aligner-based Class II treatment, highlighting key differences in therapeutic approach between growing and adult patients.
In non-growing patients, treatment goals shift toward dentoalveolar compensation, achieved through a combination of upper molar distalization, lower arch development, strategic use of Class II elastics and skeletal anchorage.
A thorough understanding of growth potential, biomechanical principles, adequate vertical control and patient-specific variables enables clinicians to optimize outcomes and minimize treatment duration across the full Class II spectrum.

Treatment options for space closure, with a focus on hemisection of primary molars.
Synopsis:
„What do I do if I have aplasia of one or both lower 5s?” Orthodontists face this issue all the time. There are many solutions in the books, but a simple yet effective technique is often overlooked. This technique involves cutting off the distal half of the deciduous molar. It’s a clean and elegant way to fix the classic problem of space closure. In this lecture, we’ll talk about the technique through case studies and explore when and when not to use it. You’ll learn how to handle your next mandibular 5 aplasia case with a different approach.

A new interpretation of the most reliable mandibular retention concept by Bjørn Zachrisson.
Synopsis:
Over 50 years ago, Bjørn Zachrisson pioneered the creation of the first lingual retainer for the mandible. Since then, this classic and most reliable concept has remained largely unchanged. However, advancements in CAD/CAM technology have enabled the production of a completely new type of retainer that offers enhanced precision and reliability, comparable to Bjørn Zachrisson’s classic design.

While novel and sophisticated techniques have expanded the possibilities for space closure, the congenital absence of lateral incisors and second premolars continue to present a clinical challenge – requiring careful case selection, strategic biomechanical planning, and treatment monitoring.
This lecture will explore the potential of orthodontic space closure in agenesis, with a focus on anchorage management to prevent incisor over-retraction. Central to this discussion is the game-changing role of temporary anchorage devices (TADs), which have redefined the limits of tooth movement – making movements such as absolute minimum and ultra-minimum anchorage a clinical possibility.
However, it may be essential to Mind the Gap and question: When and how should we close spaces in agenesis? And can we predictably achieve space closure without risking incisor over-retraction in everyday clinical practice?

“Tissue is the issue, but bone sets the tone.” Roots positioned outside the alveolar bony housing can result in gingival recession. Conversely, orthodontic tooth movement into the alveolar envelope can facilitate improvement of gingival conditions and enhance the prognosis of periodontal plastic surgery. The presentation will focus on treatment planning, biomechanical considerations, and appliance design relevant to the interdisciplinary management of gingival recession. Clinical cases will illustrate how orthodontic interventions, in close collaboration with a periodontal specialist, can effectively reposition displaced roots and contribute to the management of gingival recession.

Orthodontic extractions are common sense in daily clinical practice and their indication is a diagnosis-based procedure. Common extraction protocols generally involve premolars and only in particular cases other teeth, nevertheless restorative issues can induce uncommon extraction protocols in order to eventually sacrifice compromised teeth instead of sound ones. The extraction of hopeless first molars opens to two possible options: orthodontic space closure vs. prosthetic restoration of the edentulous site. When this scenario develops in young adults, the first option has several advantages compared to the second one. The presentation will focus on the benefits of orthodontic treatment following compromised molar extractions, involving space closure and recovery of the wisdom teeth into the final occlusion. Cost/benefit issues, biomechanics and potential problems will be highlighted and discussed.

TADs are a common tool in modern orthodontics and their use has been  demonstrated to be clinically effective and extremely useful to treat several orthodontic daily challenges. Maxillary TADs have been associated to many treatment strategies including arch expansion, mesial and distal tooth movement, forced eruption of impacted teeth, vertical control and more, being used with specific protocols as anchorage both on the buccal and the palatal aspect of the maxillary bone. The mandible, on the contrary, is definitely less popular as a target of orthodontic TADs and generally not included in standard skeletal anchorage daily protocols. What is the reason for this? Why is the mandible the problem child? The lecture will analyse the use of TADs related to the lower jaw highlighting the positive and negative of the daily use of mandibular miniscrews.

Distalization has become an increasingly important component of modern orthodontic treatment, particularly in non-extraction approaches for managing Class II malocclusions and space deficiencies. The primary rationale behind distalization appliances is to achieve posterior tooth movement with controlled biomechanics while reducing dependence on patient compliance.
The development of skeletal anchorage systems, especially temporary anchorage devices (TADs), has significantly expanded the possibilities of distalization. By providing stable anchorage, these systems allow for more predictable and efficient tooth movement. However, their clinical use is associated with several potential complications, including screw loosening, soft tissue inflammation, anatomical limitations, and patient-related factors, all of which must be carefully considered during treatment planning.
This presentation will compare distalization mechanics using infrazygomatic crest (IZC) anchorage and palatal-based approaches, focusing on their biomechanical principles, advantages, and limitations. Special attention will be given to differences in force vectors, clinical applicability, and side effects.

Distalization is a well-established method in orthodontics for managing sagittal discrepancies and crowding without extractions. The integration of skeletal anchorage systems, particularly temporary anchorage devices (TADs), has significantly improved the predictability of distalization mechanics by minimizing unwanted reciprocal effects. Nevertheless, their clinical application is associated with potential complications, including anchorage failure, anatomical limitations, and biomechanical side effects etc.
This presentation will compare different distalization mechanics (infrazygomatic crest (IZC) anchorage and palatal-based approaches), focusing on their biomechanical principles, advantages, and limitations.

The integration of digital technologies into orthodontics has significantly transformed both the planning and execution of treatments involving temporary anchorage devices (TADs). This lecture is structured in two complementary parts, addressing key aspects of contemporary digital workflows.

The first part, “Digital planning of TAD insertion: successes and pitfalls,” focuses on the clinician-driven planning process. Emphasis is placed on CBCT-based assessment, identification of optimal insertion sites, and the use of digital guides to enhance accuracy and safety. While digital tools offer increased precision and predictability, their limitations must be clearly understood.

The second part, “Digital era of orthodontic appliance design,” explores the evolution of appliance design within a fully digital environment. Digital workflows enable the creation of highly individualized, TAD-supported mechanics.

Overall, this lecture underlines that, despite increasing digitalization, responsibility for diagnosis, planning, and execution remains firmly with the orthodontist. Understanding both the capabilities and limitations of digital tools is essential for achieving predictable and efficient clinical outcomes.

During the session, we will review the main clinical strategies for treating this malocclusion, taking into account key variables such as the patient’s age, the type of open bite (dental or skeletal), and the severity of the case. We will discuss how to adapt digital planning and treatment design to maximize the efficiency, predictability, and stability of the results.
Additionally, the session will delve into the specific clinical tools including the use of attachments, torque control, vertical management, movement staging, and refinement protocols. The characteristics of different aligner materials and their impact on biomechanics, patient comfort, and treatment adherence will also be addressed.
Finally, auxiliary techniques that can complement the use of aligners will be presented, such as intermaxillary elastics, micro-screws, myofunctional therapy, and other interdisciplinary strategies, with the aim of optimizing clinical results and reducing the risk of relapse.

Crossbite, beyond its dental or skeletal components, is a clinical manifestation of transverse imbalance that can influence orofacial development from an early age. In this lecture, we will review the diagnostic and therapeutic approach to crossbite in its various forms and developmental stages, from the primary and mixed dentition through adolescence and into adulthood. We will highlight the appropriate planning criteria for each growth phase and their impact on long-term stability.
We will analyze clinical cases treated with clear aligners as the sole tool for dentoalveolar expansion, as well as in combination with auxiliary techniques such as MARPE or orthognathic surgery in adult patients with severe skeletal discrepancies. The lecture will offer a practical, evidence-based approach to making effective therapeutic decisions tailored to each patient’s clinical and biological context.