Date: Wed, 28 Mar 2007 00:14:30 -0500
From: "ESCO automatic digest system" <LISTSERV@LISTSERV.UIC.EDU>
Subject: ESCO Digest - 22 Mar 2007 to 27 Mar 2007 (#2007-32)

There are 2 messages totalling 225 lines in this issue.

Topics of the day:
1. Re: Finishing with Class II molars
2. Re: Finishing with Class II molars


Date: Thu, 22 Mar 2007 21:41:01 -0600
From: "SCOTT SMORON" <scottsmoron@COMCAST.NET>
Subject: Re: Finishing with Class II molars

Great question about molars brackets! I normally use 20 torque/20 offset molars on my upper molars (and stopped needing to ever put in offsets or fight hanging lingual cusps)...but situations where I expect to have a CII finish I place 20 torque/0 offset. This usually produces something very close to the natural mesial rotation of maxillary molars that you see in natural CIIs. Especially on patients with a solid CII to begin, the 0 offset molar tube is usually almost straight-wire to begin. I look forward to hearing what others are using.

Scott Smoron


Date: Thu, 22 Mar 2007 20:10:08 -0300
From: "philox" <philox@TERRA.COM.BR>
Subject: Re: Finishing with Class II molars


Some thoughts 1) Some companies offer molar tubes with less anti-rotation.

2) For mild class III cases, one thing you can do to avoid decompensation is to use bonded tubes with a resin offset on the mesial portion of the tube. If the second molar and premolar are fine, this can be done by placing the tube with excess resin in the archwire, placing the archwire in the adjacent brackets and then adjusting it to the buccal surface. In some cases, if the problem is just mild crowding, I can just bypass the molars and deal with them next to the finishing phase only.

3) For upper premolar extraction cases, if you place the molar tube inclined to bring the mesial cusp occlusally in the beginning like some people suggest, you usually see side effects such as eruption of the second molar and some intrusion of the premolars during leveling. That is annoying. I like to optimize the occlusion of the molar in the final stages of treatment. To accomplish this, in the finishing phase, I place a rigid SS archwire with an occlusal step bypassing the molars to form the anchorage unit. This has to be cinched back at the sec molar. Then, I use a 17x25 tma cantilever from the 1st molar tube to deliver an intrusive force to the anterior region and a moment to rotate the molar in second order. The effect on the molar will be mesial root movement and some small extrusion. I use a moment of ~2000cNmm for this type of movement. Small finishing bends can be done for fine tuning after that.

4) To correct molar first order rotations (move the mesial cusp lingually) I use a removable TPA with a symmetrical molar moment activation. I do this during finishing too. If you don't like TPAs you can do this Mulligan style using v bends mesial to the molars and distal to the canines.