Date: Fri, 15 Sep 2006 00:11:35 -0500
From: "ESCO automatic digest system" <LISTSERV@LISTSERV.UIC.EDU>
Subject: ESCO Digest - 11 Sep 2006 to 14 Sep 2006 (#2006-26)

There are 4 messages totalling 2958 lines in this issue.

Topics of the day:
1. Fixed Retention
2. Tip-Edge Torque Illustration
3. Retention Protocol
4. Classification-nomenclature-reg


Date: Wed, 13 Sep 2006 00:45:11 EDT
From: Typodont@AOL.COM
Subject: Fixed Retention

Fixed Retention:

Dr. Ernest McCallum very accurately describes my own experience almost entirely.  I agree with his comments 100%.  Fixed retention resolves many of the annoying and nonproductive management issues associated with removable retention.  We have been using the OrthoFlex Tech wire from Reliance and we find that the placement of these wires (at least in the lower dental arch) is done effortlessly (See Moskowitz, et al, Direct Bonding of Ortho Flextech Lingual Retainers, JCO Vol. 38, No. 1, page 14, Jan. 2004) .  Well worth the extra time.  I am glad to see Dr. McCallum's comments about when he plans his retentive protocol.  Our office plans retention (naturally, it is revisited and revised, if appropriate, at the time of case completion or appliance removal) at the same time that we are diagnosing and treatment planning cases prior to orthodontic treatment.  I don't think that orthodontic retention is discussed as much as it should, both in postgraduate training programs and orthodontic forums (printed or electronic).  In my opinion, it has become the "forgotten phase of Orthodontics".  The number of "patient starts" (the obsessive hallmark of practice management courses) is far less important than the consistent quality of finishing and retaining of these same patients.  In the end, the latter qualities will be the most enduring practice builders of any of our practices.

Elliott Moskowitz, NYC


Date: Tue, 12 Sep 2006 23:35:21 -0300
From: "philox" <philox@TERRA.COM.BR>
Subject: Re: Tip-Edge Torque Illustration


Members of the group I have been following this discussion, but I must say I am also puzzled by the biomechanics of this appliance. In physics, moments in one plane are independent of moments in the other perpendicular planes (cannot cause a rotation in other planes). I do not see how uprighting of the teeth (rotation parallel to the buccal face) may lead to increased torque expression. Apparently this bracket design has increased play in 2nd order, but the dimensions are the same in 3rd order. So what makes it different from a regular edgewise bracket in 3rd order? (If you rotate a car tire wrench in one plane can you observe rotation in other planes?). The first impression I had was that torque with a "round wire" was referring to the old 60's Begg torque accessory. Not sure if the tip-edge guys (perhaps it could also be called Begg 2.0) still use this mechanism. Simple loops placed on the anterior region of a round archwire (loops bent on the same plane of the archwire, not perpendicular like we do for alignment) make the posterior region of the torquing auxiliary archwire go up or down posteriorly. When we make the loops parallel to the buccal surface of the anterior teeth, the posterior wire goes up or down. When the posterior extension is brought to the posterior bracket level, this loop archwire causes " torque" (3rd order moment) on the anterior teeth. You need to tie them back to restrain the rotation at the brackets, otherwise hey will just tip around a point close to the Cres. This mechanism has a few mechanical problems (soft wire deforms in second order due to the anterior and posterior vertical forces being in different planes- it's actually a 3D beam problem), but there are some ways around it even from the tip edge point of view (like using a stiffer round wire inside a second horizontal slot).

Rodrigo F. Viecilli

Date: Tue, 12 Sep 2006 16:41:13 -0400
From: "GJ/RR Oppenhuizen" <doctoro@MACATAWA.COM>
Subject: Retention Protocol

I will chime in on retention as Roy King has requested. I use a protocol very similar to that delineated by Ernest McCallum in the Sept 5 ESCO. I use the protocol outlined below because it holds the teeth better than anything else I have ever done with fewer side effects and problems of every type. I have used all manner of removable retainer and they simply don't hold the teeth as predictably even when used as indicated. Upper and lower incisors and lower cuspids shift frequently with removable retainers. I can't say it any easier. So why do it? I concluded a long time ago that the protocol for retention is a low priority in orthodontic training. It's seems like the residents are told; make a retainer. There are a million variations; choose something. Anything. Preferably make something that requires a lot of wire bending and plastic fussing so you can practice that too. After all, the more complex the better as a learning tool. Have patients wear it full time for a long time. Then go to nights. Deal with the inevitable lost retainers and shifting. When I was in school I had a patient swallow a fractured portion of a Hawley retainer while drinking water from a fountain. It required a visit to the ER to extricate. OH MY GOODNESS ! I knew that there had to be a better way. I routinely bond a cuspid to cuspid retainer in the lower onto each tooth with a posterior restoration composite filling material. I use a 0175 Wildcat wire that is adapted to a model made from a base plate wax impression of the lingual surfaces of the teeth prior to the removal appointment. In the upper, I routinely bond lateral to lateral with a 018 steel wire with a 90 degree bend in the wire on the laterals. If there is not a significant definite bend, space can open in a diastema situation and a braided wire can cause rotations of the centrals in some patients with tongue habits. I also make an upper polyvinyl clear retainer in the upper and occasionally in the lower if there is posterior spacing to begin. All retainers are delivered at the removal appointment so there is no chance of shifting from delayed delivery of the retainer. Patients are told to wear the removable retainer full time 3 days (to acclimate) then nights only. Removable retainers are almost never lost doing this. The removable upper retainer is somewhat redundant. I use Invisitain. It will not crack- ever. The removable retainer is to be brushed under running water immediately when it is removed in the morning, dried (the critical step) and stored in a drawer in a dry case. This keeps the retainer remarkably clean and fresh without additional cleaning agents. In patients with width problems, tongue issues, open bite problems, or significant AP problems to start, I place a fused intermaxillary upper and lower clear retainer (like Damon) along with the bonded wires. Most patients wear this well at night. If someone doesn't, there is less control. I instruct patients verbally and in writing that there is no perfect retainer and some change can occur. The system is not flawless and cannot be made that way. It is the /patient's responsibility/ to keep the retainer clean and to pay attention to its integrity on the teeth. I explain that I am here to repair or replace broken retainers but it is their responsibility to tell me. There is a fee for repair or replacement. It is the /patient's responsibility/ to keep their teeth the way they want them. A bonded retainer is like a bridge or any other dental restoration. My responsibility is to make it right and tell them what they must know to maintain it. I simply cannot understand orthodontists who think that bonding a retainer makes them more responsible for the alignment of the teeth over time than a removable appliance. Yet I have heard this many times. The roll of the general dentist is to tell the patient on routine recall if he sees dental health issues. The patient can see me or any orthodontist anytime if it is warranted. I also tell patients that they have a choice in their retention. The choice comes down to keeping their teeth aligned as simply as possible with a bonded wire which makes it harder to floss primarily. Or they can floss easier and not hold the teeth as simply or effectively. I respect their informed decision. My protocol is highly effective, yet not flawless. I re-align fewer teeth every year since I have used this approach. Patients are more satisfied and I have fewer retention problems. Retainer repair and replacement is a minor issue in our schedule. I have had only 2 out of thousands of patients with anterior decay issues. Both of these patients had chronic habitual sugar water (soda, Kool-Aid) consumption problems. Gingival inflammation is a slightly greater issue.

Greg Oppenhuizen
Holland MI


Date: Wed, 13 Sep 2006 15:31:29 +0530
From: "Dr. M.Jayaram" <jmailankody@GMAIL.COM>
Subject: Classification-nomenclature-reg

Hullo Group, I have patient(14-M)here whose molar relationship on left side is: Mesiobuccal cusp of upper second molar occluding with the mesio buccal groove of the lower first molar. The distal slope of the distal cusp of the upper first molar occludes with the mesial slope of the mesiobuccal cusp of the lower first molar.The photo is enclosed. What term shall we designate to his molar relationship ? Super class II Hyper class II Two cusp class II

Your views/suggestions welcome. Jayaram Mailankody. Calicut, INDIA. N.B: Other views of the patient are available on request.OPG and Lateral ceph was taken to confirm the identity of the teeth and presence of third molars in all quadrants.(also available on request)