Date: Wednesday, April 04, 2007 11:31 PM
From: "ESCO automatic digest system" <LISTSERV@LISTSERV.UIC.EDU>
Subject: ESCO Digest - 3 Apr 2007 to 4 Apr 2007 (#2007-34)

There are 6 messages totalling 6860 lines in this issue.

Topics of the day: 

1. Re: open bite retention
2. TAD Intrusion retention and appliances
3. Re: growth hormone
4. Re: growth hormone
5. An Alternative to Max. Bicuspid Extraction

Date: Wednesday, April 04, 2007 10:05 AM
From: Dr. M.Jayaram <jmailankody@GMAIL.COM>
Subject: Re: open bite retention

Hullo Charlie,
I have two suggestions:
1. Keeping the labial bow slightly higher so as to stay at the level of
middle third or even junction of middle and cervical third of the upper
central incisor. This would provide an extrusion component to prevent
recurrence of open bite.
2. Considering the almost universal association of tongue thrust swallowing
habit (secondary/adaptive) with anterior open bite(adult-long standing), it
would be advisable to have a Tongue Guard(Crib) to serve as a reminder for
the tongue position and prevent continuation of the habit.

        In addition, some sort of counselling and tongue training practice
would further reinforce the retention plan.
Good Luck.
Jayaram Mailankody.
Calicut, India.

Date: Wednesday, April 04, 2007 1:23 AM
From: SCOTT SMORON <scottsmoron@COMCAST.NET>
Subject: TAD Intrusion retention and appliances


If anyone e-mails you directly regarding the retention of these open bite
closure cases when you have utilized TADs, let me know their thoughts.

Jason Cope, you out there?

I have given these posterior intrusion cases alot of thought and wonder what
will happen long term.  Amazing treatment results for the short run, for

Oh, and I just dug out a Seminars in Orthodontics issue for the comments
below and ran across the issue on managing the vertical dimension.  Dr.
Wheeler was the guest editor...any comments from you if you are out there?

As far as the 20/20 molars go, those are GAC (I am predominantly Ormco
Orthos).  I bond them.

Let me surprise you...I haven't used water or suction in my office (except
for laser surgeries) for years.  L-pops.  No retraction except via cotton
rolls.  But I was thinking of adding suction back in so I don't have to give
them a one-minute rinse mid-way.  I bond 7-7 regularly, and I have rebonds,
but it is not a problem.  And the tissues look SO much better than with
bands!  But I do band if I suspect future abuse ("uh, I dunno how it
happened").  If they understand why it happened, then I rebond.

The 20 torque/0 offset is a lower 1st molar tube that used on the
contra-lateral side.  I think MBT? and the Bioprogressive prescriptions hit
this.  If you buy Ormco, just ask them to make direct bond tubes like this
custom, like with bands.  My standard lower first molars are not
off-the-shelf...they are oversize contoured bonding pads that are less
likely to break than their off-the-shelf tubes.

As far as increased torque on the uppers and negative torque for the lowers
for CIII patients, Jayaram Mailankody,you are dead on.  I think Dr. Bob
Smith gets out and lectures on appliance design, but this goes back to the
old A Co. products of the 70s, was lost alot during the 80s/90s, and we're
rediscovering it.  I keep three prescriptions in my appliance for the
reasons you cite.  Beyond those modifications, I can get a negative 22
degrees on my lower incisors by taking my upper lateral incisor high torque
brackets and putting them on the lower incisors.  I think even a 17x25 in a
22 slot is engaging torque early in treatment.  On blocked out upper
laterals, I take those same high torques and put them upside down to get the
root out.  If you are into indirect bonding, you can really get creative
because you do not have any isolation to worry about.  Plus, you are better
able to pick up when the 2nd premolar torque would better match the 1st
premolars, vice-versa, and when you need alterations in your lower molar
torque.  The uppers I am strangely non-critical...just get the lingual cusps
up and out of the way and distally rotate them and they seem to settle into

Seminars in Orthodontics did a great issue finishing cases well and had some
articles on this topic of appliance design a couple of years ago...I think
Dr. Sondhi (sp?) was the lead editor on the issue.  He had some great
insights and once I read that issue it made me sit down and find a few
pieces of the puzzle that I now use, like the 20/20s.  If you want details,
Vol 8, No 3, September 2002.  Try the AAO library and they can xerox some of
it for you.

Date: Tuesday, April 03, 2007 3:54 PM
From: Lively Orthodontics, P.A. <mdlively@BELLSOUTH.NET>
Subject: Re: growth hormone

Hi Charlie:

You should consider yourself very lucky that you do not do Damon.  I am
still living the nightmare, but remember, now, after starting 600 cases, it
is OK to extract teeth and not ruin faces, according to Damon (not what his
video says).

As for the GH, I am not aware of any studies that would conclude an increase
in archlength secondary to it's use, especially posterior to the 2nd molars.
I have treated 2 kids on GH and though this is an anecdotal observation, one
would not have known the difference from their treatment versus any other
patients in treatment.

  With warmest personal regards,
Mark David Lively, DMD
Lively Orthodontics, P.A.

Date: Tuesday, April 03, 2007 10:43 AM
From: Dr.Kharsa <dr.kharsa@GMAIL.COM>
Subject: Re: growth hormone

Growth hormone will not relieve the dilemma of crowding, as even with growth hormone no tangible excess on arches width is expected for such an age. On the other hand, growth hormone has a potential impaction on the mandibular size, maybe more often than what's available on the maxillary one.

Best Regards
Dr.M.Azhar Kharsa  


Date: Wed 3/28/2007 3:30 PM
From: Speck, Morton
Subject: An Alternative to Max. Bicuspid Extraction

Dear Colleagues,

The several postings seeking to compensate for the compromised position of 1 st molars illustrate the accommodations that single arch bicuspid extraction cause us to make. This abnormal molar relationship that we tolerate is in addition to the tendency for loose contacts and/or the reopening of spaces, as well as the frequent poor appearance of the 2 nd bi cuspid relationship in 1 st bi extraction cases. Furthermore, the creation of the 1 st molar plunger cusp may concern our periodontal colleagues.

An alternative treatment I would have you consider is the extraction of the maxillary 1 st molars, as described by Raleigh Williams in his Oct.'79 AJO article, where third molars are well developed and positioned. This extraction procedure has the following advantages: 1. a reduced tendency for extraction spaces to reopen (and if they do, the spaces are less visible), 2. a minimized need for patient cooperation, 3. no need for extra-oral force, and 4. most important, the advantage of finishing with an ideal Cl. I occlusion. This strategy lends itself to straightforward treatment with the Tip-Edge technique.

The attached case (few slides included to keep the size small) was treated by Chris Kesling and illustrates the simplicity of Tip-Edge. The design of the bracket makes it possible to simultaneously retract 10 teeth and open the bite with an ounce and a half of force per side less force than it takes just to overcome the friction of sliding a single edgewise bracket along an arch wire. I want to stress the physiologic nature of this treatment, because the bracket allows for the natural tendency of the bicuspids to drift distally.

Can you imagine trying to perform the same task with the edgewise appliance: retract the 2 nd bi's, retract the 1 st bi's, retract the anterior teeth and at the same time try to affect overbite correction? What a Herculean task, even with extra-oral force!

After practicing and teaching this technique for many years, I still marvel at the ability of Tip-Edge to move teeth so freely and easily. And it continues to be a mystery to why more of you don't recognize the advantage this appliance can give you in many of your cases. (Ask Charlie Ruff!) It avoids so many of the problems inherent in the edgewise bracket.

The folks at Columbia Ortho recognize this fact, and more than 20% of their cases are treated Tip-Edge. And the graduates go on to use the technique in their practice.

TP (no financial interest) will sponsor a Tip-Edge Course this fall, and I encourage you to consider it. Most of you, not having been trained in Tip-Edge, don't yet realize how this technique can simplify your life. A look at Parkhouse's book, Tip-Edge Orthodontics , should convince you.

Mort Speck