Topics of the day:
1. Indirect bonding
2. Incisor Retraction; Canadian Wisdom; Re:En masse v. sequential retraction

Three more comments on indirect bonding that I've been wanting to add to the discussion:

1. if you haven't started doing indirect bonding, you owe it to yourself and your patients to look hard at the technique. it is better and does save tx time (in my humble opinion). While it does involve lab work in the beginning, you make that up with reduced doctor time at the bonding and definitely with less finishing at the other end.

2. if you can't place the bracket on the stone model exactly as necessary because the gingiva is high, it is OK to grind the bracket pad to make the bracket fit a tooth that is not fully erupted.

3. for those of you who are frustrated with trying to deal with a partially erupted tooth, don't feel like spending $10K of a laser, think electrosurgery (aka radiosurgery). The best unit on the market is the Ellman Radiosurgery (Ellman.com) unit for $1800 new but sometimes seen on eBay for less. You can teach yourself how to do it by using a p;iece of round steak (uhhh!)

charlie ruff

Perhaps a more critical question to incisor retraction should focus upon how orthodontists manage the reciprocal forces that are placed upon the posterior teeth during the retraction procedure regardless of whether en masse retraction or canine retraction followed by incisor retraction is used.  Stan more than alluded to this in his discussion.   Classic Edgewise instruction  included anchorage considerations throughout the course of the entire treatment.  I wonder, however, how much attention this is given by our colleagues in clinical practice?   The use of pre-adjusted appliances actually requires more, not less of such anchorage concerns.  Maintaining second order and third order spatial relationships during incisor retraction is anchorage taxing.  Expertly controlling the posterior segments during the incisor retraction phase of treatment is an important factor in the overall treatment effort.   The new so-called "smart appliances and archwires" are only as "smart" as the clinician using them. 

Elliott M. Moskowitz, D.D.S.,M.Sd New York City

Hi all,

Mort asked an interesting question about why many orthodontists retract canines first in severe anchorage cases even though clinical research suggests there is no anchorage benefit in doing so. In " severe anchorage" cases orthodontists are more likely to use adjuncts (elastics?  headgear?)  That means more variables As orthodontists part of what we do is apply forces to teeth but another part of the job is to monitor progress (and be prepared to modify treatment if progress is poor). This may seem trivial, but maybe the preference for canine retraction exists because it is easier for many of us to assess where we are and how the treatment is progressing when we do things this way.  The fact that most orthodontists do something a certain way may tell us more about human nature than about how teeth move.

Gerry Zeit Toronto, Canada

 Dear Gerry,

I am looking forward to meeting you soon at some meeting or the other.  Your last sentence tells it all.  You are one bright guy!  :-)

Best wishes

charlie ruff

Greetings:

I know that what is I'm writing is a debatable issue, and might be criticized by lots of "Escoians", nontheless, I followed both approaches (en mass and sequential) retractions, and I really did not find out such a big significant difference of "anchorage burden" in case of en masse retraction, than what had been in case of sequential one PROVIDED, usage of calculated forces insured by retraction springs and anchorage improvement, As I'm an "old fashioned" orthodontist, I use Nance in such cases in case of maxillary appliances. A recent photo has been attached for one of my cases where I used "In Mass Retarction", to retract the six anteriors, using retraction springs. Thank you,

Dr. Mohamed Azhar Kharsa, Ph.D. (Ortho)

(Photo attached)