Date: Wed, 20 Sep 2006 00:14:37 -0500
From: "ESCO automatic digest system" <LISTSERV@LISTSERV.UIC.EDU>
Subject: ESCO Digest - 18 Sep 2006 to 19 Sep 2006 (#2006-28)

There are 2 messages totalling 2745 lines in this issue.

Topics of the day:
1. Torquing with TipEdge
2. Respones to Drs. Mcdonald and Viecilli; additional Tip-Edge


Date: Mon, 18 Sep 2006 17:54:06 +0200
From: "Marco Tribò" <marco.tribo@TRIBO.CH>
Subject: Torquing with TipEdge

Dear Dr. Viecelli and to the rest of you wondering about how you can torque with an .016 nitinol in tip edge. After stage II in tip edge treatment the incisors are not only tipped lingual but also distally. The .016 upright wire will correct this second order tipping and gradually force the rectangular wire from the .028 slot into the .025 slot. Included you will find the explanation how this works (taken from the fifth edition of the "TIP-EDGE-GUIDE" by Peter C. Kesling, D.D.S.. Sc.D.). Sometimes you still need to place an auxiliary torquing spring. Marco Tribò


Date: Mon, 18 Sep 2006 12:47:01 -0400
From: "Speck, Morton" <morton_speck@HSDM.HARVARD.EDU>
Subject: Respones to Drs. Mcdonald and Viecilli; additional Tip-Edge

Dear ESCO Folks,

I want to thank John MacDonald for keeping me honest. (My resident, who is treating the case, appreciated your comment about the quality of the photos.) Itâ€s hard to imagine that there has been much mesial movement of the molars when compared to the rugae since the molars were under a tip-back moment and no protraction force was applied. (Does rugae position change when anterior teeth are protracted?) Regardless, donâ€t lose sight of the fact that the bicuspid moved distally on its own with no force applied. Yes, of course it tipped as all teeth do initially in this technique. That is what makes it possible to simultaneously retract six, eight and even ten teeth with the lightest of forces, and at the same time affect bite opening. Why spend your anchorage assets retracting teeth that will readily move if you will only let them?

There is no doubt you pay the anchorage piper in the torquing and uprighting stage of Tip-Edge, but there is no question that total anchorage requirements are less than any edgewise system. This would be difficult to prove scientifically, but as Parkhouse states, the clinical evidence is unarguable. I was giving this message to a group of residents when I was challenged by a young man whose father was an ardent edgewise practitioner. In response, I asked the group to tell me who among them was treating a maximum anchorage edgewise extraction case without using either headgear, banded 2 nd molars, a transpalatal arch or palatal button, or any combination. Not one resident raised his or her hand and I rested my case. I can ask the same question of you, my edgewise colleagues.

It is in the really difficult cases that this technique shines. But John had it right when he wrote that you have to analyze every tooth position at every visit. As with any technique, problems do arise. This is particularly true with Tip-Edge because the teeth are free to move so rapidly that the operator must be continually alert.

I respect what John has written about MBT; the results the authors show in their book are outstanding. But I feel similar results can be achieved without resorting to anchorage auxiliaries. It is my view and that of my Tip-Edge colleagues that the 2 nd order finishing movements that are affected with the very first wire belong at the end of treatment, not at the start. And it is this action, as well as the apex first retraction of teeth that straight wire dictates, that readily depletes your anchorage bank account and necessitates the use of auxiliaries in those tough cases. The teeth look a lot neater during the course of straight wire treatment as compared to the untidy appearance (albeit temporary) of the Tip-Edge case, where the crowns are free to move along the path of least resistance. If this early control is important to you, than Tip-Edge is not your cup of tea.

Dr. Rodrigo Viecilli is right. There is little difference in the Tip-Edge bracket in the 3 rd order since two of the opposing corners have a straight wire design. The difference lies in how the torque is achieved. In straight wire, obviously the program in the bracket affects a twist in the wire that in turn reacts to torque the incisor. In Tip-Edge, the rectangular arch wire is a neutral and stable platform upon which the programmed portion of the bracket closes down to affect the torque. I had to smile when he referred to Tip-Edge as Begg 2.0. Thatâ€s like my calling his late model auto a Model T 2.0.

Incidentally, the AAO library, which is a wonderful and free resource, has at least one copy of the Parkhouse text available to anyone interested in borrowing it.

Mort Speck

Belmont , MA