Date: Wed, 6 Sep 2006 00:15:21 -0500
From: "ESCO automatic digest system" <LISTSERV@LISTSERV.UIC.EDU>
Subject: ESCO Digest - 23 Aug 2006 to 5 Sep 2006 (#2006-24)
To: ESCO@LISTSERV.UIC.EDU

There are 4 messages totalling 3204 lines in this issue.

Topics of the day:
1. Bonded lower retainer wire
2. Tip edge tooth movement
3. Torquing with an 016 niti
4. Tip Edge

 

Date: Sat, 26 Aug 2006 10:16:25 EDT
From: "Dr. Robert W. Bruno" <Orthos68@AOL.COM>
Subject: Re: bonded lower retainer wire

Hi ESCO!

I would love to hear everyone's take on fixed retention. I practice in Manhasset, NY and it seems that many of the orthodontists in my area are bonding a fixed wire 3-3 upper and lower and that's it, no retainer. The patients are told that it can remain in place forever. The only time I use a bonded 3-3 is in adults and only the lower arch. I fabricate a standard retainer that overlays the wire that is worn at night. For the upper I use an Essix retainer. After 12-18 months  I remove the fixed lower wire and then it is just up to the patient to wear the retainers at night indefinitely. 1. In this type of retention 3-3/3-3 fixed, what happens to the posterior teeth, are they not involved in the retention too? 2. Who is going to maintain this type of retention for the life of the patient, the orthodontist or the general dentist? 3. If it is the general dentist (g.d.), wouldn't it be best that the g.d. place the fixed wire since they see patients on 6 month recalls? 4. Is this type of retention being used more often given the resistance to extraction therapy (therefore arch expansion) by parents and practitioners? I am eager to hear everyone's response.

Ciao,
Rob Bruno
Manhasset, NY

 

Date: Thu, 24 Aug 2006 03:20:59 EDT
From: JMer1997@AOL.COM
Subject: Re: ESCO Digest tip edge tooth movement

Hello all, I have enjoyed reading the tip edge comments from this technique very articulate supporters.  A couple thoughts from a 022 MBT guy and an observation on Mort's photos.  (Very high quality photos I might add) I did some pure Begg during my training at Penn 10 (I hated those pins!) years ago and what I took away from my experience is that Begg practitioners watch and analyze every tooth position every visit.  I suspect this approach is necessary in tip edge hence the thoughtful posts.  (I have no experience with tip edge)  Of course, all orthodontics should require thoughtful consideration of each tooth each visit.  I am an ardent MBT orthodontist and the MBT system builds this careful consideration of tooth position into diagnosis, bracket placement, tip and torque values, anchorage considerations, light force mechanics and arch form selection and coordination (to maintain initial arch form).  Because this attention to every tooth is built into the MBT system, and because the MBT system works within the known parameters of oral biology and also pays consideration to what we know tends to keep teeth stable, this is the system I use. I contrast that to what I see in many straight wire treatments, presentations, and transfer cases.  There seems to be a pick the right arch/wire size form from the box, see what you get, don't mind the anchorage, get what you can with elastics, type of approach in many cases.  This seem to have been taken to new heights by proponents of certain self ligating brackets that are claiming to have revolutionized bone biology as well by jiggling wire size and friction values.  I think many straight wire folks put to much faith in the brackets and wires and not enough thought into the process.  I enjoy the thoughtful articulate posts of the tip edge folks who seem to be dominating this discussion group of late but I must say that I am not convinced.  Tip and torque must be recovered and I find it harder to tip and recover rather than get proper tip and then maintain.  It is the same anchorage, I think my approach has fewer variables and surprises. Mort, your photo helps my point.  In the case of the canine substitution 2nd bi extraction, I would venture to say that there has been very little bodily movement of the first bi, only tipping of the bi and molar.  Palatal Rugae have been shown to be stable landmarks for evaluating tooth movement (part of my research project at Penn)  and if you look at the tooth positions relative to the Rugae, it doesn't  look like it has moved much, just tipped.  This means the molar is also quite tipped and forward since the space is gone.  This is OK if it is what you want, but I respectfully disagree that your photo shows that the extraction space has been closed by distal movement of the first bi.  (I have reattached the photo I am talking about.) Again, I appreciate all of the good posts.  I would like to see a more complete presentation of some tip edge cases but I never see them on the program at the AAO or in the table clinics.  Where are you all?  I am always open to a better way to do things but I think that MBT is a tough system to improve on.  Are there any programs or table clinics at the Seattle AAO?  I will make a point to seek them out. I look forward to the replies. John McDonald, Salem Oregon Disclaimer.  I speak for Unitek on the MBT system as well as some other non clinical topics.   Other than honorariums, I have no financial ties to Unitek.

 

Date: Thu, 24 Aug 2006 14:40:28 -0400
From: "charles ruff" <orthodmd@MAC.COM>
Subject: torquing with an 016 niti

Dear Charlie,

so how do you "torque" the incisors with 0.016 NiTi? 

Cheers,
Moanad Aker 

Date: Thu, 24 Aug 2006 14:31:57 -0400
From: "charles ruff" <orthodmd@MAC.COM>
Subject: Tip Edge

I also was trained at Columbia University like Dr. Bruno (Hi Bob!) in Edgewise, Begg and Tip-Edge by Dr. Meistrell and Graduated in 1991. Like most graduates, I went into practice using edgewise mechanics such as Jasper Jumpers, Herbst Appliances, Pendulums etc. I was most happiest with the Herbst in Class II corrections but did not enjoy all the hardware in my patient's mouths and the chair time cutting off the steel crowns. My cases also never quite had enough upper incisor torque and lower incisors were flared. Retention mandated fixed lower retainers.  I knew there was an easier way and remembered how nicely my Class 2 Tip-Edge cases went in my residency. About 6 years ago , I switched back to Tip-Edge and have never regretted it. Thanks Dr. Meistrell and Columbia!
I start my patients on the day of their banding with .016 wires and 2oz. Class II's attacking their overbite and overjet from Day 1 when they are motivated. I have never received a call that they are in pain. My cases typically use 4 sets of wires: .016,.022,.0215x.028 and 19x25 Braided. In Stage three we see patients every 8 to 12 weeks. My finished cases are superior to my edgewise by having nice upper incisor torque and lower incisor labial root torque and distal root tip. My staff enjoys the technique as well as wire changes are easier with the interbracket space and not having to cement in bulky devices. I also like the savings in lab costs.
In regards to the new plus ceramic bracket, I try to avoid them, but have not had bases delaminate. This is one of  the smallest ceramics on the market which makes it nice.
In regards to other comments about extractions, I have extracted upper 6's in Class II nongrowers with a good lower arch (no deep curve of spee or crowding). I have also extracted all 7's which works great because the slots allow everything to tip distally. I have also extracted lower 6's in Class III cases with great results. I also agree about removing the 5's in class II cases.
I really enjoy the technique and the esthetics of the small brackets and like others in this discussion do not understand why more orthodontists are not trying Tip-Edge. 
Regards,
Bradley Nirenblatt, D.M.D. drnirenblatt@mac.com Charleston, SC 

Brad,
Would you discuss how you transition out of 21 x 28 into 19 x25 braided for final finsihing.  Do you ever find that as soon as you remove the heavy wire and auxiliaries that you see the teeth rotate at little.  Not all the time but enough to make life less fun.
any comments on finishing would be appreciated.
charlie ruff