Date: Friday, February 02, 2007 12:15 AM
From: "ESCO automatic digest system" <LISTSERV@LISTSERV.UIC.EDU>
Subject: ESCO Digest - 30 Jan 2007 to 1 Feb 2007 (#2007-13)

There are 5 messages totalling 1539 lines in this issue.

Topics of the day:

  1. Invisalign and elastics
  2. Invisalign and...ELASTICS!
  3. Invisalign and...ELASTICS!
  4. Bisphosphonate or hormones?
  5. Oral Bisphosphonates and Orthodontic treatment

Date: Wednesday, January 31, 2007 12:10 PM
From: Marco Tribò <marco.tribo@TRIBO.CH>
Subject: Re: Invisalign and elastics

Hi Barry

since I am a lazy guy I let my patients work for me! So I hand them an AMT ( Aligner Modifying Tool) and instruct them how to cut the aligners and allow for elastics to be hooked in to these cuts. It works well for me since many years and does not cut the elastics nor does it compromise the grip of the aligners. See the pictures.(It looks like a nail clip but I call it AMT ;-))

Marco Tribo

Date: Wednesday, January 31, 2007 4:54 AM
From: David E. Paquette <dave@PAQUETTEORTHO.COM>
Subject: Re: Invisalign and...ELASTICS!


I use a toe nail clipper to make opposing slits with the “points” bent in towards the tissue.  We cut one set and show the patient how to do the rest at home. They put the elastics (very light as if Begg or Damon tx) on the alingers and then insert in the mouth all together.  Variable effectiveness as in fixed…I suspect due to both patient variable response and compliance.  MUST have attachments to oppose aligner displacement.

I hope this helps.


Date: Friday, January 31, 2007 5:01 PM
From: Dr P. Miles <pmiles@BEAUTIFULSMILES.COM.AU>
Subject: Re: Invisalign and...ELASTICS!

I was wondering what the experience of the group was using elastics with Invisalign? What ways of attaching elastics do you find most predictable without rotating teeth or dislodging aligners and what sort of overjet correction can you comfortably handle and with what degree of predictably? Any input would be greatly appreciated.

kind regards
Peter Miles


Date: Friday, January 31, 2007 4:24 PM
From: Richard Crowder <drc@SMILESORTHO.COM>
Subject: Re: Bisphosphonates

I had an employee under treatment that we struggled for months to close a small lower anterior space.One day she walked in and the space was closed.When we were talking she related how she had just seen her physician recently and they had changed her estrogen dosage.Since that time I have had 3 other female patients that had similar space closure issues that I spoke with about their physicians evaluating their hormone levels.One discovered that she had an ovarian cyst the other two changed their birth control pills and the space closed.Has anyone else had similar experiences? Also I presently have a male that the lower incisor space is not closing---I'm not going there with him.



Date: Friday, January 31, 2007 12:01 PM
From: Martha Mejia-Maidl <maidls@HOTMAIL.COM>
Subject: Re: Oral Bisphosphonates and Orthodontic treatment

Re: Oral Bisphosphonates and Orthodontic treatment

Volume 19 #1 of the Practical Reviews in Orthodontics has an excellent discussion by Dr. John Helstein, on the orthodontic considerations in patients taking  ORAL bisphosphonates.  Here's a quick summary:

The main concern for orthodontists is that the balance between ostoblastic and osteoclastic activity (which is obviously key for tooth movement) is altered.  This means tooth movement is unpredictable, however, it doesn't mean orthodontic treatment is contraindicated.  A trial period to evaluate tooth movement on individual patients to assess their response, before proceeding to more complex treatment is recommended.  Extraction therapy can be done (following recommended protocols), but again, even if the extraction sites heal successfully, tooth movement being unpredictable still means you might be unable to close the extraction spaces.  Approx 200 cases of osteonecrosis have been reported on patients taking oral bisphosphonates, mostly related to tooth extraction.  No cases have been reported due to orthodontic treatment alone.
IV bisphosphonates are absorbed 50-60% while oral bisphosphonates <1%, however they both have a strongest affinity for bone with a high turnover rate (ie areas undergoing tooth movement).  Bisphosphonates incorporate themselves directly into into the crystalline structure of hydroxiapatite and have a half life of up to 12 years!  Therefore, there is NO benefit (in fact there could be serious risks), for orthodontic purposes, to have the patient suspend their bisphosphonate treatment.  Ortho treatment is contraindicated in ALL patients being administered INTRAVENOUS bisphosphonates, and on orthognathic surgery patients taking any kind of bisphosphonates, because of serious risks of extensive osteonecrosis. 

Martha Mejia-Maidl D.D.S., M.S.
El Paso, TX

P.S. Dr. John Helstein is a clinical professor at the department of oral pathology, radiology, and medicine, Univ. of Iowa, College of Dentistry. He's a curerent member of the ADA expert panel working on proposals on how to manage patients with oral bisphosphonate use.