Topics of the day:

1. The 11th International Symposium on Dentofacial Development and Function
2. Re: Nickel allergy-palatal expansion
3. Re: Nickle allergy
4. Re: Ni allergy for expander
5. For Charlie and other responders; Tip-Edge, Damon etc.
6. Tack welder
7. Sealant to prevent white spot lesions
8. ESCO - The Electronic Study Club for Orthodontics

11TH INTERNATIONAL SYMPOSIUM ON DENTOFACIAL DEVELOPMENT AND FUNCTION

The 11th International Symposium on Dentofacial Development and Function, one of the most important events in the fields of craniofacial biology, orthodontics, and dentofacial orthopedics, to be held in Chicago at the Sheraton Chicago Hotel and Towers from June 18-22, 2006. We are requesting your sponsorship, participation, and friendship. HEADLINERS: Samir Bishara; Kurt Faltin, Jr.; N. Erverdi; Athanasios Athanasiou, Adrian Becker; Birte Melsen; Jose Dahan; Ennio Gianni; Abbas Zaher; Ram Nanda; Etsuko Kondo; Andrew Sonis; Stuart Goldman; Ronald Bell; Nolen Levine; Sergio Rubinstein; Eric Liou PRESYMPOSIUM: THE MEDICALLY COMPROMISED ORTHODONTIC PATIENT Andrew Sonis, Stuart Goldman, Ronald Bell POSTSYMPOSIUM: ENHANCING THE ORTHODONTIC RESULT Nolen Levine; Sergio Rubinstein; Eric Liou The meeting presents an opportunity for clinicians and researchers to meet dentofacial specialists from all over the world and gain exposure to the latest advances in research, techniques, and products through educational courses and a trade exhibition. An exciting interactive program has been assembled based around the following themes: Craniofacial Genetics, Bioengineering and Technology, Tooth Agenesis and Craniofacial Anomalies, Management of Functional and Behavioral Problems, Clinical Orthodontics, and Clinical Pediatric Dentistry. In addition to an exciting scientific and clinical program on the Chicago lakefront, an outstanding social program is planned to promote greater audience participation and communication with the speakers and exhibitors. Don't miss this opportunity to join your peers in one of the most exciting cities in North America-- Chicago . Network with dentofacial specialists from all over the world while gaining exposure to the latest advances in research and techniques through an extensive educational course and trade exhibit. Our 2006 highlights include oral presentations and posters on: Craniofacial Genetics Bioengineering and Technology Tooth Agenesis and Craniofacial Anomalies Management of Functional and Behavioral Problems Clinical Orthodontics Clinical Pediatric Dentistry

Don't miss out on all the glamour and excitement of the Windy City…

exceptional shopping and dining along Chicago's legendary Magnificent Mile world-class art, music and Frank Gehry architecture at the new Millennium Park waterfront thrills and fireworks at the inimitable Navy Pier nationally-renowned museums, jazz clubs, and theatre and much more!

REGISTRATION & ABSTRACT SUBMISSION: We invite registration and abstract submissions from clinicians, researchers, and graduate students in disciplines including craniofacial biology, orthodontics and dentofacial orthopedics, pediatric dentistry, as well as other clinicians interested in growth and development. Please visit the Symposium web site for submission guidelines, online submission and online registration: http://www.uic.edu/depts/dort/symposium.html Abstract submission deadline: April 15, 2006 Registration deadline: June 15, 2006 We look forward to seeing you in Chicago! Questions? E-mail: caevans@uic.edu Symposium Committee 2006 Department of Orthodontics University of Illinois at Chicago 801 S. Paulina St. , M/C 841 Chicago , IL 60612

PROUDLY SPONSORED BY: Quintessence, 3M Unitek, RMO, Palodex Group Instrumentarium, Dolphin Imaging, OraMetrix, TP Orthodontics, GAC, OrthoExpand, OrthoCAD, Raintree Essix

Hi John,

Regarding the Niti palatal expanders, I have been using them successfully since 1993. I have seen the cases (approx 200) at least 10 years past expansion treatment and only 2 with minor relapse. Many of the cases did not need to go onto braces so no retention was utilized and still no relapse. To my eyes, it appears like bodily movement not too much tipping but whatever the percentage of tipping to bodily movement- the results are great and appear to hold up. I believe there are some studies out of Conn that look into the Niti expander if I am not mistaken.

Regarding the nickel allergy, firstly, how do you know the patient is allergic to nickel? I did a literature search on nickel allergies in orthodontic patients last year (I will look for the articles and email you when I get a chance) and the mouth seems to have less of a response than cutaneous tissue so it may not be an issue with the palatal expander appliance.

I had a patient that was diagnosed with nickel allergy due to earings by the allergist. So I cemented one band and crossed my fingers, nothing. I cemented the other band, nothing. Fitted the Niti palatal expander (no financial ties to any company), nothing. No reaction, whatsoever.

Hope this helps.

Ciao,
Rob Bruno, Orthodontist (Woodside-Manhasset, NY)

Several points in answer to John McDonald's post on Nickle allergy in ESCO #2006-9

1.  I have had many patients claim they are allergic to Nickle.  We then bond a "test bracket" on an upper bi, on a Monday or time when we can remove it in a day or two.  Put it in the right position! We have never needed to remove one.  Ever. Even on a patient who couldn't wear jeans because of the metal buttons causing a terrible belly rash.  I discussed this with an internist who said most "nickle allergies" are allergic reactions to pot metals used in cheap jewelry and cheap castable buttons, fasteners, and zippers.  If your patient does have a true nickle allergy, how are you going to treat him after the expansion? 

2. Au contraire: NiTi expansion does not have to cause excessive tipping.  We use Ortho Organizers NiTi expanders inserted into Ormco lingual sheaths (because the Ormco sheaths are the smoothest and heaviest we have found).  In our hands, these cause less tipping than any other method, perhaps because the expanders have added buccal root torque?  One cannot place additional buccal root torque in a bonded or banded screw expander easily. We don't try to achieve all expansion in one week by placing excessively wide springs-stepping sizes avoids this. 

3.  In the one case where a true allergy existed, at the request of the allergist, we used Invisalign. Never bonded a test bracket.  The result was an Invisalign finish.  The patient was satisfied. We saw deficiencies.  The front teeth were straight. No irritation occurred from aligners. We won the battle but lost the war.  C'est-la guerre.
Good luck.  We are interested in what others will reply.

Dr Dick Carter
Orthodontist
Portland OR USA
drdcarter@mac.com

Re: ni allergy for expander

What I did was  to start with a Hyrex type expander until the palate separates (about 5-6 days) then immed switch to a Nitinol NPE type expander, which will work fabulously once the palate separates.  When the parents find out their nickel  allergy will cost thewm an extra few hundred dollars for the second expander, many confess the nickel allergy was only imaginary from the mother's reading too much (like latex and penicillin alllergies--most are developed by reading too much) and when they see the expander working well they decide to forget about the transition to the NPE.  Of course you do have the risk of coming across a real allergy, so I only put one in when I know I'm going to be available 24/7 to the kid for the 5 days the steel appliance is in! PS: How come none of these Ni sensitive kids are ever allergic to molar bands, only brackets?  Are the brackets made of a looser alloy  that leaches Ni ions faster?

Bill Koplin

Dear Readers,

Well, I'm looking forward to a future issue of ESCO to read the next installment of “This is My Life” by Charlie Ruff. I have to smile when Charlie writes of the dark side, because it was there that he finally saw the light! He deserves some recognition, and here it is:

There once was an ortho named Ruff
Who with friction had had quite enough.
He could no longer hack it
So he changed his bracket,
And now see him strut his stuff!

Ok, let's get serious. Charlie's point is well taken regarding the use of Tip-Edge where substantial movement is required. Additionally, his remarks about the non-extraction use of the appliance, an underestimated and little understood use, are right on. Tip-Edge utilizes tip back bends to hold the molars back, often with some accompanying distal tipping. This action, along with active growth, facilitates Cl. II correction. But this is nothing new. Mulligan wrote about this years ago in his discussion of tip back bends as they affect molar position in the correction of Cl. II malocclusions.

Ideally, we should all be pragmatists. However, because of premature biases we develop in school or under the influence of a particular guru, many of us become wedded to a certain technique and seek to apply this system to all varieties of malocclusions. To me it makes more sense to look for the most appropriate mechanotherapy to apply to the particular malocclusion.

There is a natural tendency among those of us who champion a particular technique to become somewhat uncritical when exposed to research which purportedly shows the superiority of our bracket over others.   W e may too willingly accept the conclusions because they feed into our bias. Specifically I'm referring to the article by Henao and Kusy, allud ed to by Brian Fryar, which appeared in the 2004 issue of the Angle Orthodontist, Vol. 74, no. 2. This article purportedly shows the frictional advantage of the Damon bracket over Tip-Edge and others. What the authors failed to explain was that the application of the Tip-Edge bracket to this experimental design in no way replicates any actual clinical situation, i.e., the bracket is never used in the manner they describe. Therefore, their Tip-Edge data are simply invalid. I can only surmise that the authors' lack of knowledge of Tip-Edge bracket mechanics led to its totally inappropriate inclusion.

Brian, I appreciate your remarks. I have studied Damon's workbook carefully, as well as his chapter in Graber's new text, and have been impressed with the quality of his presentation and many of his results. However, it's one thing to expand collapsed buccal segments and procline retroclined incisors. It's quite another to take a crowded but otherwise well positioned dentition and seek correction through buccal expansion and incisor proclination. As you know, Damon claims that the biological lightness of his forces causes the bone and tissue to move along with the teeth, and that the orofacial musculature will adapt to this new position. I appreciate that it would take some doing to back this up scientifically, even though some of his anecdotal results are impressive. I do question a universal application of his theory. The issue is whether the Damon technique is recreating the old world of expansion orthodontics, but this time with a completely different approach yielding stable results and esthetic faces. Or conversely, will some of the results you achieve with this technique add to the pool of patients who, once all retaining devices are removed, will relapse and become patients for the next generation of orthodontists?

Few will disagree with Damon's strong emphasis on final facial esthetics, and perhaps we are justified to impose lifetime retention on some of our patients for the sake of their appearance, so long as any expansion technique does not compromise the health and longevity of the periodontium. The practicality of “forever” retention is another matter.

Stan (Sokolow), I appreciate your thoughtful observations. However I don't quite see the analogy between anterior retraction, whether sequentially or en masse, and the effort to maintain anterior tooth position when posterior protraction is required. Perhaps this example, not previously mentioned, will make my statement clearer. If a 50 gm. coil is placed between the molar and 2 nd bicuspid, that tooth can easily be moved mesially, using a Tip-Edge bracket, with zero reactive force on the anterior teeth and essentially no distalizing force on the 1 st and 2 nd molars. Once the bicuspid is mesialized, the anterior section can then be “beefed up” with a rectangular wire augmented by an auxiliary wire in the deep tunnel. The rectangular wire would run through the larger round tube of the molar, rather than the rectangular tube, further reducing friction. Regarding your specific issue, I don't know if there is any scientific documentation regarding sequential retraction vs. en masse retraction. Perhaps one of you can enlighten us. However, I would think that maintaining bite opening during en masse retraction would be more difficult.

Mort Speck

Does anyone have a used "working" Orthodontic tack welder for sale?

Thanks,
Skip Hirsch

Someone please refresh my memory regarding the yellow colored sealant used to prevent white spot lesions/ caries. Who is manufacturer? What is product name?

Sincerely,
Joe Brenner

Dear Colleague:

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