Date: Tue, 12 Sep 2006 00:19:14 -0500
From: "ESCO automatic digest system" <LISTSERV@LISTSERV.UIC.EDU>
Subject: ESCO Digest - 5 Sep 2006 to 11 Sep 2006 (#2006-25)

There are 4 messages totalling 2279 lines in this issue.

Topics of the day:
1. Re: Tip edge tooth movement
2. Bonded lower retainer wire
3. Tip-Edge Torque Illustration


Date: Thu, 7 Sep 2006 09:14:31 -0400
From: "Roy King" <rkking@BELLSOUTH.NET>
Subject: Re: ESCO Digest tip edge tooth movement


To answer your question, Dr Parkhouse gives a course once a year on TipEdge. Because of all the chatter, I will attend a future course. The next one is in October 2006 so I will probably attend the following one. I tried Tip Edge before the underlay wire and I could not get the torque on the U12 that I wanted. Maybe I should say that I played with TipEdge. I was also a MBT at one time(for many years) and I have read the manual. I still use MBT techniques from time to time but I have converted over to the frictionless side(sine 1998). I have found that you can combine techniques and principles and do not believe everything that you hear. It will always be the practitioner and not the technique that will determine the case outcome( for the most part).

Roy King


Date: Thu, 7 Sep 2006 08:58:29 -0400
From: "Roy King" <rkking@BELLSOUTH.NET>
Subject: Re: bonded lower retainer wire

The answers are at the questions.

----- Original Message -----

From: Dr. Robert W. Bruno Sent: Saturday, August 26, 2006 10:16 AM Subject: Re: bonded lower retainer wire

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?I have rarely retained the lower posterior teeth in 9000 patients so settling is the magic word.

2. Who is going to maintain this type of retention for the life of the patient, the orthodontist or the general dentist?The patient is on the GP recall list for cleanings and if the GP notice that iit is loose, then the GP will refer the patient back for me to fix or replace with an appropriate retainer. It is very easy to fix.

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?Absolutely not in my opinion. The role of the GP is to recognize and refer back in post orthodontic cases. I do not expect the GP to treat my relapse cases.

4. Is this type of retention being used more often given the resistance to extraction therapy (therefore arch expansion) by parents and practitioners?That is a research question but I believe (graduated in 1979) that fixed retention has been taught for a very long time. I feel that you are more confused on the lingual bonding of the upper 123. Not everybody is doing lingual bonding on u123 and we should all have a reasonable explanation of why we do procedures. I do perform lingual bonding on U12 when I feel that relapse is a possiblity(midline diastema, rotated U12). I would not be opposed to bond U123 but have not found it necessary. Orthodontics is so much fun because there are so many ways to the same thing.  Yours truly, Roy King I am eager to hear everyone's response.

Rob Bruno
Manhasset, NY


Date: Wed, 6 Sep 2006 11:33:09 -0400
From: "Ernest McCallum" <emccallum@EMERALDIS.COM>
Subject: Re: bonded lower retainer wire

Rob (all),    

I place a lot of fixed lingual retainers. Here are a few of my thoughts. Personally, I find them invaluable in order to maintain certain corrections over a long period of time. They keep me from having a debate with parents over little Johnny's retainer wearing. Also, I have had patients seek me out b/c they have heard I do fixed or permanent retainers. I make Essix retainers over the top of the fixed retainers and call it a "belt and suspenders". I block out the model around the lingual with a  light cured material, prior to fabrication of the Essix. I tell patients if the fixed retainer breaks or comes loose wear the Essix full time and call for an appt.     I plan my retention the day I decide the treatment plan based on the position of the teeth. All diastemas get a lingual, lower crowding especially non exo cases get  a three/three lingual. If upper laterals are lingual and rotated  I like a upper two/two lingual. I rarely do an upper three/three. I have bonded an upper cuspid to a bi on the facial in a few adults that had an impacted or severely rotated cuspid. I leave these for a year or so.     I have tried several different types of wires. For me, I like to use an 018x025 braided wire. I bend/bond it chairside, one or two appts. before I debond. I use floss or 010 to hold it in place during bonding. I use a paste/paste self cure composite on each tooth.  I tried a dead soft braided rect wire and it was very easy to place, but I had a lot of breakage and several diastemas relapse (even with the wire still in place). I assume the wire fatigued and stretched.     I have placed tons of these over my 11 year career and see many in the practice that were placed 20+ years ago (my 1/1 being one of them).  Rarely, have I ever seen any dental problems caused by the lingual. I tell patients it may be harder to clean around it, and they need to see their dentist regularly. Their hygienist will probably frown upon it, but, if you aren't going to wear a removable retainer every day for the rest of your life, then this is the best way to maintain the correction. The fixed retainer should remain as long as it is not causing any problems. I have seen diastemas open after being held closed for over twenty years with a fixed lingual. A happy educated patient is a great referral source.     As for maintaining the lingual....I generally give about a two year "warranty" in which I will repair/replace them. After that I charge a small fee to add bond to them prn, or charge a replacement retainer fee to replace them. I would not leave it to the GD to place or maintain them. I really do not have that many problems with them, and I feel the benefit far outweighs the effort.     FWIW, if I have a patient that looses the bond on a 1/1 lingual and a small diastema opens, I place a wooden wedge (remember those things?) to squeeze the teeth together, replace the bond, let it set. If I cant get it closed with a wedge, I either try and close it with an Essix or bond a couple of brackets for a few  weeks. That is one advantage of the stiff braided is easier to repair if needed.     Probably, more info than you wanted...but I really like fixed retainers!

All the Best
Ernest Mccallum


Date: Wed, 6 Sep 2006 16:57:16 -0400
From: "Speck, Morton" <morton_speck@HSDM.HARVARD.EDU>
Subject: Tip-Edge Torque Illustration

Dear ESCO Members-

Richard Parkhouse (Tip-Edge Orthodontics, Mosby) generously provided me with the enclosed photos which illustrate the torquing and uprighting mechanism of the Tip-Edge appliance. The first slide shows the ni-ti wire in the deep tunnel prior to the placement of the .0215 X.028 base wire.  The design of the bracket with its cut-out corners allows the placement of the full size wire despite the tipping of the teeth. It is the uprighting of the teeth which causes the programmed surfaces of the bracket to close down on the rectangular wire which affects the tip and torque.  For the first time in the history of orthodontic there is 100% expression  of the programmed torque.  Because of the play in the traditional edgewise sytem, that technique compensates by increasing the torque prescription, which apparently works well. For those of you who might be interested, I recently learned that Parkhouse will be lecturing at the TP Tip-Edge course giiven On Oct. 26 - 28.  Once again, for the record, I have no commercial relationship with TP; only great appreciation for the Plus bracket and Tip-Edge technique, and it's inventor Peter Kesling.

Mort Speck