Giovanna GARATTINI
Medical doctor and surgeon
Specialist in Odontostomatology
Specialist in Orthodontics
Associate Professor of Odontostomatology
General Coordinator of the Smile House at the San Paolo Hospital
in Milan giovanna.garattini@unimi.it
Elena BAZZINI
Graduate in Dentistry and Dental Prosthetics
Specialist in Orthodontics
Adjunct professor at the School of Specialisation in Orthodontics,
University of Milan elenabazzini@fastwebnet.it
Luca BOSCHIAN PEST
Graduate in Dentistry and Dental Prosthetics
Private practitioner in Milan lucaboschianpest@gmail.com
Presentation
Orthodontics is a field that was first pioneered
in Italy in the 1950s by masters such as Professors E. Muzi,
G. May and O. Hoffer. It subsequently grew and evolved, thanks
to the creation of the first Italian Orthodontics Study Group
(G.I.S.O. - 1967), the Italian Society of Orthodontics (S.I.D.O.
- 1968), and Italy’s Postgraduate Schools of Orthodontics,
beginning with Cagliari in 1973, but also as a result of the
setting up of advanced courses and Masters’ degree courses.
In this way, over several decades, having been launched by
a handful of early pioneers, it evolved into a field involving
several thousand professionals.
Hence there emerged the need for the present
series, made up entirely of monographs. In line with our approach,
it was decided that, in this volume, ample space should be
devoted to images, in order to facilitate its use as a reference
book/ atlas, and thus encourage its practical application.
The text, always concise, has been prepared with rigorous
attention to its scientific and bibliographic content, and
it is set out in an effective and logical way. It is easy
to consult, thus enabling the reader to use it to its greatest
advantage. To our deep satisfaction, a few years ago the series
reached its “silver jubilee” 25th volume, from
thereon advancing rapidly towards new milestones that were
certainly more than could have been envisaged when, in 1996,
the project tentatively got under way with the first volume.
The merit for this achievement must certainly go to all of
Italy’s various university schools of orthodontics and
to the independent professionals of proven experience, who,
over the years, have readily and enthusiastically supported
the initiative, being prepared to pour the best results obtained
in their specific fields of research into the highly significant
monographs that have made it such a valuable collection. In
more recent years, the series has been further enriched thanks
to the important decision, stemming from the vision and courage
of Dr Alfredo Martina and his children, Vincenzo and Nadia,
to publish these volumes in two languages contemporaneously:
English as well as Italian.
The tasks of an editor are numerous, ranging
from guaranteeing the scientific quality of the work published
to reminding authors to respect delivery/correction deadlines,
providing them with advice and help as they prepare their
volumes, and assisting the publisher in the decision-making
process. However, I feel that the editor’s main task
is, out of absolute respect for the reader, that of selecting
and coordinating the titles and ensuring that the order in
which they are published is exactly the right one.
Because the reader must be stimulated and
not allowed to become bored. Accordingly, the five most recent
volumes in the present series deliberately cover a range of
areas: classical clinical topics (No. 32 on functional therapy),
advanced research (No. 33 on genetics), specific situations
(No. 34 devoted to traumatic injuries), specific sectors (No.
35 on alignment of the back teeth), and appliances (No. 36
on the lip bumper). Thus, two and a half years on, it was
felt to be high time to return to a classic topic in our field:
orthodontics in adults. This is an area, encountered daily
in our clinical practice, in which we are becoming increasingly
involved on a technical level.
I make no secret of the pleasure and satisfaction
I feel each time we bring out a new volume in our series devoted
to orthodontics, and I am now delighted to present the 37th
volume, written by one of the leading professionals produced
by the Milan school of orthodontics.
It is often said that the pupil should surpass
the master; this is true, very true, but it is also very rare.
However, and I assure you that here I am speaking from direct
experience of various relationships (father/son, teacher/follower,
director/ intern), it is actually far better when masters
and pupils work together, each pouring all that he or she
has to offer into the final product, which thus becomes the
result of a coming together of experience, a balanced diagnostic
approach, new technologies, enthusiasm, intellectual fervour
and, most important of all, an EXCHANGING OF IDEAS. Certainly,
on reading the draft of this volume written by Prof. Giovanna
Garattini, together with her “pupils” Dr Elena
Bazzini and Dr Luca Boschian-Pest, I immediately found myself
imagining a group of people gathered around a table, or, if
you like, a dentist’s chair. This volume is divided
into eight chapters in which the reader will find evidence
and solutions relevant to the problems he or she may come
up against. The set of images, clear and precise, accompanies
a series of clinical cases and is supported by pertinent and
practically useful information. It is therefore a monograph
suitable not only for novices, but also for more experienced
orthodontists, who will find it to be a rich source of small
or sometimes more important tips that can help them to improve
in their work.
I wish, once again, to acknowledge and thank
our publisher, Dr Alfredo Martina, for the tireless energy
and enthusiasm that he continues to display. Finally, I wish
to congratulate the authors most sincerely on the work they
have done.
Prof. Alberto Caprioglio
Associate Professor of Orthodontics
Director of the School of Specialisation in Orthodontics
University of Insubria
alberto.caprioglio@uninsubria.it
PS: The idea of publishing the present
volume, “ORTHODONTICS IN ADULTS”, was very strongly
supported by my father Damaso, who has great respect and affection
for Prof. Garattini, with whom he shares many memories. In
recent years he “has really urged Giovanna to write”.
On more than one occasion, I have noted with admiration the
patience with which Prof. Garattini accepted my father’s
input, each time wondering about the source of the generous
dose of the cardinal virtues she possesses. But given the
outcome of this endeavour, I have to admit that, as has often
been the case, he was right!
Foreword
It is very unusual for the Director of a
series of scientific volumes to write the foreword to a monograph
included in the series.
I made an exception in the case of the monographs written
by two of my former pupils from the Parma school, with whom
I share a warm relationship based on decades of collaboration,
respect and gratitude.
I am now delighted to be making a second
exception; indeed, I felt honoured when Prof. Giovanna Garattini
and her excellent collaborators asked me to write the foreword
to this volume.
Prof. Garattini and I are bound by three
decades of deep friendship and mutual esteem, during which
we have frequently exchanged ideas in the course of our professional
activity (both clinical and research work) and shared the
joys and times of sadness that life’s ups and downs
have brought us – the emotions, fears, anxieties and
concerns, but also the moments of great satisfaction.
I first met her when she was the young pupil
of a dear friend of mine, whom I considered to be one of the
finest teachers of the early 1970s: Professor Giorgio Vogel.
Indeed, I held him in such high regard that when I left the
University of Pavia at the end of the 1960s, I decided, in
response to a warm and pressing invitation from him, to join
him, in my capacity as a freelance lecturer of clinical dentistry,
at the institute at the University of Milan which he directed.
I was fascinated by his school which was always holistic and
involved all the various dental disciplines.
I was impressed by his teaching method, which,
anticipating the concept of evidence-based medicine, was precise,
meticulous, always supported by the best international literature,
and based on scientific research always conducted as a team
endeavour according to a serious and rigorous approach that
involved lengthy and repeated verification and immediate and
direct comparison with the work done in the best foreign schools;
I was also struck by his clinical approach, which was thorough,
precise, passionate and extremely human, never conditioned
by factors such as social class and income, and in which the
priority was always the patient and his diagnosis and treatment.
In this remarkable school he trained some
excellent pupils, today themselves distinguished teachers
across all fields.
Giovanna Garattini was one such pupil – pragmatic, precise,
rigorous, passionate and also faithful to his teachings –
who, gradually, managed to grow and excel in her chosen discipline:
orthodontics.
We formed a friendship, strengthened by our
mutual regard for each other. Through our attendance of courses
and congresses we got to know each other better and even though
we differed in age, this was never a barrier; on the contrary
it made our friendship all the more precious.
As time went by, I came to appreciate all
the qualities that her teacher had instilled in her, which
she managed not only to assimilate and make her own, but also
to enhance, improve and, in turn, pass on to her own pupils.
Thus she formed her own school and her own
team, based at the San Paolo hospital in Milan. It is a close-knit
and enthusiastic team with a rigorous and precise approach,
which has created a stimulating and gratifying working environment.
I first asked her to write this monograph
years ago, aware of her great professionalism and that of
her pupils, especially in the field of orthodontics in adults.
It was a tough job convincing her.
The fact that she did not feel sufficiently
qualified for the task underlines her remarkable humility
and modesty, qualities that make her even more valuable and
reliable. “Vera Scientia Est Celare Scientiam”!
I think that her guiding motto has always
been to: “study, research, teach and treat, always with
care, consideration, diligence, great humanity and a sense
of responsibility towards students, staff and patients”!
Quietly and painstakingly she began to collect
and gradually verify, through rigorous follow ups, all the
documentation she had produced in the course of her decades
of clinical and research work.
Only after she had completed this careful
verification did she agree to prepare this monograph.
She has been flanked in the task by two excellent
collaborators, Dr Elena Bazzini and Dr Luca Boschian-Pest,
both of whom have, like her, gradually acquired the rigour
and methodology of their teacher.
The result is a monograph of enormous scientific
and practical value, as already stated in the presentation.
Every orthodontist, from the most expert
professional to the postgraduate student in training, will
find it to be a source of clinical and research knowledge
that can be readily applied in the multifaceted, varied, difficult
and insidious field of orthodontic treatment of adults, where,
once again, an interdisciplinary and multidisciplinary approach
can be seen to be vital and irreplaceable.
This is an aspect that clearly emerges from
the list of chapters, which show that diagnosis and orthodontic
problems are always addressed in relation to other disciplines
and areas: periodontics, restorative dentistry, prosthetics,
maxillofacial surgery and complex situations.
There is no doubt that this is one of the
most complex and challenging fields in the increasingly fascinating
discipline of orthodontics!
What emerges, on looking through the different
chapters, is the validity, practical importance and considerable
experience of Prof. Garattini’s school. Finally, it
should be pointed out that, together with all the different
treatments proposed, it is also necessary to add another special
ingredient. As the authors themselves point out in the conclusions:
We should always try to apply “clinical common sense”
!!
This monograph, number 37 in the series,
means a great deal to Prof. Giovanna Garattini and I am sure
that it will bring her much gratification and recognition!
For my part, I am delighted that the fruits
of her labours and her prestigious school have now become
a part of this series and that this experience has further
deepened and enriched our friendship.
Prof. Damaso Caprioglio
Professor and Former Chairman
Department of Orthodontics
University of Parma
Dean of Postgraduate Italians in Orthodontics
damaso.caprioglio@dentalchildren.net
Acknowledgements
Undertaking to write a monograph is a very
important and dangerous decision, loaded with responsibility:
“it takes courage” and also a measure of presumptuousness!
This book is intended to serve as a starting point for the
reader wanting to gain a more in-depth insight into the topics
covered. It is largely iconographic, with the many images
serving to illustrate the various types of treatment that
are possible in adults.
After working in the field of orthodontics
for more than 30 years, I came to the decision to write a
“summary” of this experience. The enormous encouragement
of Maso Caprioglio, to whom I certainly owe this undertaking
and who, for this and other reasons, I will never stop thanking,
was decisive!
I wish to express my profound gratitude to
my beloved mentor, Giorgio Vogel, whom I remember with real
affection and whose fundamental teachings and professional
example I guard jealously. I count myself extremely fortunate
to have had a teacher of such high intellectual and cultural
calibre! I remain deeply saddened by his death.
A fond and grateful mention also goes to
Misa Ferro, my first teacher of orthodontics.
I wish to say a special thank you to Roberto
Brusati, a great master of maxillofacial surgery, extraordinary
clinician and person of great determination and tenacity,
with whom I have shared years of intense work and great professional
satisfaction.
I warmly thank my co-authors – Elena
Bazzini who, as I often recall when introducing her, was once
an assiduous student of mine and is now not only my right
arm but also my left, and Luca Boschian-Pest, who represents
the complementary part or missing link of my profession –
for being by my side on a daily basis for so many years, both
in the clinical departments at the San Paolo Hospital in Milan
and in private practice.
A warm mention also goes to my longstanding
pupil and collaborator, Giacomo Grasso who, to his regret,
was unable to take part in the writing of this book.
Then, of course, I must mention all my former
pupils, most of whom are now fine and well-established professionals.
I may have been their teacher, but for me they have been a
source of innovative ideas, vital energy and enthusiasm: to
name just a few of them would mean leaving out many others,
therefore I extend my thanks to them all collectively.
In addition, how could I fail to thank all
the colleagues from other disciplines who have actively contributed
to the solution of many adult cases requiring an interdisciplinary
approach: Claudio Gatti, Paolo Crozzoli, Eugenio Romeo, Franco
Brenna, Matteo Chiapasco, Alessandro Rossi, Mauro Belluz,
Mario Pignanelli and many others besides.
Indeed, we have addressed numerous clinical
cases together, and have done so united by a common desire
and determination to do our very utmost for our patients.
Last but not least, as the saying goes, I
wish to extend my deep and loving thanks to the men in my
life: Carlo, Maurizio and Giò Rossi, who have been
deprived of so much of my time and my attention on account
of my day-to-day work.
And of course to my beloved parents.
Prof.ssa Giovanna Garattini
Associate Professor of Odontostomatology
General Coordinator of the Smile House
at the San Paolo Hospital in Milan
giovanna.garattini@unimi.it
Index
INTRODUCTION
PREFACE
ACKNOWLEDGEMENTS
CHAPTER 1
ORTHODONTIC TREATMENT AS A DECISIVE SOLUTION
CHAPTER 2
ORTHODONTIC TREATMENT IN PATIENTS WITH PERIODONTAL
DISEASE
