Topics of the day:
1. I like to hear some discussion about the self-ligating brackets specifically the Damon brackets
There has been a lot said on self-ligation and the Damon bracket. Here is how I see it
I practiced general dentistry with my father for 5 years before I went and did a TMJD fellowship and then my orthodontic residency. I really enjoyed general dentistry and the technology advances that I saw just in the few years I practiced. We were constantly going to courses to hear what was new and how we could do things more efficiently and all for the benefit to the patients. I have tried to model my orthodontic career after my father who practiced dentistry for 35 years and now is retired. 40 years ago he was fascinated about implants and he started attending implant courses from a Dr. Linkow who was putting screws in the jaws to help anchor dentures. My father was on the cutting edge of change and technology and he was scoffed and scorned for years by some of his peers. Now implants are 99 % successful and all of the individuals, who were so negative about them in the beginning, are using them routinely. I was on the golf course last week with a general dentist who said that he had one of my fathers old patients who had an implant placed by my dad 35 years ago and it is still there and functioning. He said how he admired my dad for his contribution to dentistry and implants.
Now that I am an orthodontist I see all the debates and negative comments on self-ligation am surprised at the reluctance of this branch of dentistry to embrace new technology and change. I have tried to step back and really see what is happening here, it is interesting to watch all of the debates and negative comments. We are a group of dentists that were taught and practice techniques that were developed 35 (or more) years ago. It is no wonder that when someone comes up with a more efficient, kinder on tissues, less painful way to move teeth we look for the negative instead of the positives that this can bring to our patients and their oral health. All of us tend to fight change because it is uncomfortable and requires more effort.
I have tried to be real with all of this new technology and not be one to just jump on the band wagon because someone says it is better. I am the first to raise my hand and say that no technique is perfect and that different self-ligating brackets all have some positives. What has attracted me to the Damon System is the Man behind the thinking. I personally know that Dwight Damon is genuinely concerned with treating his patients with the highest quality of care he can. It is not about the all mighty dollar for him. I know how expensive this system has been to develop. I have also witnessed him retreat 100 (if not more) of his former patients with the new Damon bracket because he knew he could give them a better smile with the new technology. He is always trying to make this whole self-ligation technology better. He is passionate about it and genuine in his motivation to make it better for all of us in this profession. Is the Damon bracket perfect, heavens no but it is a beautiful system that pays attention to all details of patient care.
I have been using the Damon System for 5 1/2 years now and have had an opportunity to really see for myself how the Damon System works. I realized when I started that I could not just dabble in this and see what it could do. I had to take a leap of faith and go full steam ahead with it to really see all the benefits it can offer. I am the first to admit that there is a steep learning curve with the Damon system but aren't we some of the brightest minds in dentistry. Just like any other new technology there is a process by which we see what we are comfortable with and what we are not. When I first started using the Damon system I still used hyrax expanders. It took trying some cases without expansion for me to really find out for myself if this can be done. For the majority of my cases that need upper expansion I do not use expanders. There are a few limited cases in which I choose to do a W arch expander. I will routinely use a W arch expander in a 9 year old that comes to my practice with bilateral cross bite and blocked out cuspids. I know that if you asked Dwight Damon he would tell you he uses some W arches in his practice. It is very limited though.
Let us all be reminded about what we are all trying to accomplish. I believe that we are in the practice of orthodontics because we love to help our patients have beautiful smiles in the least painful, shortest time, and the best possible way we can. I am amazed at the results I get with the Damon system and would have no problem sending pictures of before and after cases to any one who would like to see what results I find possible. I think that if we all took the time to evaluate or before and after cases and truly "look" at what we have done we might appreciate what the Damon system can do for our patients. I think it takes someone special to take their cases and put them up on a screen in front of thousands of people and have them scrutinized. If we all were doing this it would cause all of us to pay more attention to what we are doing and how we can change our profession for the better on behalf of our patients.
I had problems with the D3's not opening, etc... but, mine were from the very first batch and I would think they have probably improved them. It's the metal D2's that surprised me because I have had so much trouble keeping them on. I think I have figured out why: They probably had to make the bonding mesh weaker because otherwise, they are so stiff they will not flex when they are removed that they can be difficult to get off. When they bond, they really bond. You just can never know for sure when they will or not. You have to "pack" the adhesive into the base and use special methods to get them to work. I couldn't get them to re-bond after sand blasting and they wouldn't stay on with Fuji. I tried many cases. The concept is great and I really believe they could be the best way to move teeth, but I had too much trouble with the efficiency problem. I am waiting for the ideal Damon. I think the D3 may have a lot of potential. Innovation brackets don't seem to achieve the same movement and they tend to close before you can re-insert the archwires which can be very frustrating. I am experimenting with the Smart Clip and have one case of American's Time bracket to try. Self ligation is only part of the answer; it's the nearly frictionless movement that is the key. Self ligation with friction is useless. Damon and Bagdon show some impressive results as far as expansion of arches and they have some good bone scans to back it up. Time will tell.
I had many private responses to my first posting about the Damon. Some were strongly in favor of the Damon bracket and said they had no problem with bonding them, but many were having the same experience as me. For some reason, they chose to respond privately rather than publicly. I hope they will join in the conversation.
I have been using GAC's InOvation brackets for over 2 years and would never switch back to conventional edgewise brackets. The reason is my staff would kill me. I have found the InOvation brackets to be reliable (only one clip failure in over 10,000 brackets placed), easy to open and fast to close. I have no actual statistical data yet but my gut feeling is we save about one-third chair time for our patients - that translates into increased profitability for the practice. Most of the time if a tooth is not aligning properly it is because I have the bracket in an incorrect position. I am extremely pleased with our case results. Easier, quicker, reliable, and comfortable InOvation is a great bracket.
I am mostly an Ormco Orthos appliance person who uses multiple torque values depending upon the malocclusion, basically old A-Company stuff.
I have played with Damon SL, Inovation, Time, Speed. When these patients came in, only I would open and close them, so no assistants screwed them up. Damons were big, ugly, didn't like door mechanisms. Inovation I didn't feel the doors were 100% secure...I had one canine in particular that took forever to turn b/c the door would be secure close on a 16 thermal, but she would return with the door open (good adult patient otherwise). Ditto my feelings for Time and Speed.
I have been playing with the D3s and have been impressed. I have finally gotten the hang of opening and closing, but I had someone transfer into my office a month ago with D3s on and opening and closing them is next to impossible because, I believe, the assistants used explorers to open them and must have bent them up. Have not run into this with our own patients b/c we use the opening tool. I also find they close well and stay closed. Hygiene around them has been good and patients have reported minimal discomfort on 12 thermal wires followed by 16 thermals a month later. I like them and plan to increase their usage, but they're one appliance of many that I use. I feel their killer application is unraveling crowding, whereas for my easy mild crowdings their main value may be better hygiene. Finally, I have seen base/door failures, but not enough to make me concerned and my patients reported they were trauma induced, ie they ate the wrong stuff.
I really don't understand the whole "never needs expander" and such. Braces are merely a handle on the teeth by which we can apply force and create new equilibriums. They're just a tool, not a philosophy.
I am unsure of why some avoid expanders like they do. I use quad-helices, four-band RPEs, 2 band RPEs, bonded RPEs, whatever is the most appropriate appliance for a given patient. The RPEs all are the Forestadent screw with the NiTi spring dissipator built-in...we turn it 5/6/7 turns all at once in the office and patients tolerate it well. We ask alot of questions, and a patient who tolerates 8 turns one week will come in the next week and get to 4 turns and say to us that's enough. And we listen adn stop until the next visit. Sutural opening and expansion is very individualized and it is interesting to get the feedback about how the process is proceeding. For the space creation and crossbite correction that I get, I really cannot understand why I would park someone in self-ligating braces instead of doing the orthopedic correction I know we are capable of achieving. Of course, if you treat every expansion the same and just throw the RPE mechanism of 40 years ago into a four-banded appliance and tell 'em to go at it, I would be trying to find a way to avoid inducing that much pain in people too. Finally, I have seen no research showing stable crossbite corrections from just braces, but there is a wealth of research regarding RPE, so I will stick with what I can justify.
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