Topics of the day:
1. Tip-Edge - Edgewise
Dear Group -
Paul Thomas' point is well-taken regarding the use of the Begg/Tip-Edge bracket in the type of case he illustrates, i.e., recreating space for the missing lateral incisor. Unquestionably, the Tip-Edge bracket offers many advantages over its ribbon arch predecessor. For those who are interested, Richard Parkhouse's new text, Tip-Edge Orthodontics (Mosby), graphically and beautifully illustrates the extreme versatility and simplicity of this appliance. His book is reviewed in the November issue of AJO/DO .
I believe that knowledge of Tip-Edge can greatly simplify many of your treatment procedures. I maintain that the use of Angle's edgewise bracket in extraction cases particularly has placed an unnecessary burden on you and your patients. Nowhere in Angle's writing is there any discussion of moving teeth long distances mesio-distally. However, with extraction treatment, that is precisely what you are required to do. The increased friction produced by this movement has required a myriad of anchorage-bolstering devices, which you are well aware of. The fact that the Tip-Edge appliance can simultaneously retract the six anterior teeth and open the bite with less force than it takes just to overcome edgewise bracket friction in cuspid retraction makes it worthy of consideration. Parkhouse's text, in addition to being an excellent instruction manual, clearly illustrates the many advantages of the technique.
For the record, I have no financial interest in this text or in TP Orthodontics. As an inveterate teacher, my chief interest lies in presenting information. I welcome any feed-back.
The burgeoning interest in temporary anchorage devices has been interesting to watch. It's certainly not a new concept. LB Higley, first chairman of UNC orthodontic department co-authored a paper in 1945 describing the use of an orthopedic bone screw placed in the ramus for anchorage. The growth of interest and available devices is mirroring osseointegrated implant evolution except on a much smaller scale. There are multiple companies, all using variations of a similar design regardless of whether mini-plates or modified screws. (with the exception of the mid-palatal devices) Having worked on developing TADs (temporary anchorage devices) since 1997 (first with Walter Lorenz Surgical and subsequently with KLS Martin)it's been interesting to see the number of companies rushing a product to the marketplace. I guess we were a little foolish and did the animal research first which delayed things a bit. Over the last couple of years there have been multiple clones, first from the Far East and more recently an Italian clone of a device from the Far East. Interesting!!
Our original design was simply a modification of an existing device, the maxillomandibular fixation screw. These were double headed screws which were intended to be used for fixation rather than Erich arch bars. (see attached images of examples from Lorenz and Synthes) We started with this design since the CAD/CAM work had already been done. It was simply a matter of modifying an existing design in order to produce the prototypes. There certainly may be better designs, but it's interesting to note the number of clones of that first design.
I agree with E Mizrahi regarding the ease of use and flexibility of application. An anchorage screw is my first choice if applicable. The modified plates are a fall-back when there is inadequate bone to stabilise the anchorage screw. The screws to secure the plates are typically 3-4 mm and can be placed monocortically. Of course an incision and stitches are necessary (times two), but it's still a minor procedure with minimal morbidity. The midpalatal devices seem to hold the least promise since they are more expensive, involve (in most cases) more paraphrenalia, integration time (with the exception of screws placed in the palate) require two surgeries and are limited in application.
I agree that use of TADs will continue to increase. There will probably be over-application and then some settlement into a reasonable amount of use. Companies will fall by the way-side, as in the case of OI implants. It will be interesting to observe.
Paul M Thomas
(See attached pictures)
Obsessing about specific orthodontic "mousetraps" in the overall scheme of things is like watching "Nero fiddle, while Rome burns." Quite frankly, the modern orthodontic appliances (sometimes referred to as "smart arch wires and brackets") are frequently "smarter" than the people using them.
Charlie, you asked me about TipEdge. The TipEdge appliance was a welcome and positive evolutionary step in bringing Begg (and the 256 bracket) into more of a mainstream "EdgeWise" environment. This included the use of rectangular wire and offered the possibility of greater control and ability to more precisely finish cases.
Finally, over the years, I have had the opportunity (like many of us) to view other clinician's finished results. Spending some time viewing the ABO cases at constituent or annual AAO meetings (and CDABO presentations) will remind us that unless we were told which specific fixed appliances were utilized (.018, .022, Bi-dimensional, etc.), none of us would know.
If we all more profoundly understood the biology of what we are treating, and the biologic mechanisms (not gizmology) that are responsible for our successful (and unsuccessful) outcomes, we, and certainly our patients, would be better off. Until that day arrives, we are all, more or less, in the same boat, regardless of what appliance we seem to so passionately defend.
Recently I read a article about the pros and cons of OJW for weight control. One of the panelist said not to perform OJW because it is outside the scope of dentistry. I have been involved with oral appliances for sleep apnea and I work with the physicians. If you work with the physicians with OJW, how is it different than the oral appliances with sleep apnea?
Can anyone tell me which is the best commercially available Miniscrew Implant System?
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