Date: Wednesday, June 27, 2007 11:13 PM
From: "ESCO automatic digest system" <LISTSERV@LISTSERV.UIC.EDU>
Subject: ESCO Digest - 5 Jun 2007 to 27 Jun 2007 (#2007-56)

There are 6 messages totalling 669 lines in this issue.

Topics of the day:

  1. Scrubs v. ties and aligner satisfaction
  2. Damon
  3. canker sores
  4. Nickel allergy: suggestions?
  5. Photo Printer and Printer/Scanner in-one device
  6. Age as determinant of success with palatal cuspids

Date: Thursday, June 21, 2007 2:53 AM
From: SCOTT SMORON <scottsmoron@COMCAST.NET>
Subject: Scrubs v. ties and aligner satisfaction

I have two random questions that I would love to hear others' thoughts

1st, who out there practices in scrubs?  I normally wear a shirt/tie, but
have occasionally been working in scrubs on certain days.  The thing that I
am noticing is that my initial exams have a slightly different reaction on
scrubs days...there's more a doctor talking about treatment than a salesman
convincing me to spend money.  My actual approach has not changed, but I
swear the questions I get are more clinical instead of "Can I change my
colors at each visit?"  Has anyone else noticed this phenomenon?  Is it just
in my head?  But I actually am feeling more like a doctor, even if I'm not
as pretty.

2nd...and I hate to ask but I am curious...are any of the people who who
were unwilling to do Invisalign years ago doing it now...are there still
holdouts?  And for everyone doing aligner treatment...where is your
satisfaction level?  I still have those cases that are just great and the
patient refused to be treated any other way, but I personally just feel like
I have so much less control over results that it is professionally

Love to hear others' thoughts/ideas...

Scott Smoron


Date: Tuesday, June 19, 2007 9:20 AM
From: Lively Orthodontics, P.A. <mdlively@BELLSOUTH.NET>
Subject: Damon

Hi All: I want to apologize to all of you that have emailed me asking for information with regards to our issues with the appliance.  I have been hesitant to post to the group when information is negative but with all the emails I have decided that it would be easier to simply respond to ESCO.

I will preface this by saying that this has been my experience, as Ormco representatives let me know that my issues are isolated.  I would also like to point out that Damon bases his system on light forces which prevent hyalinization.   If you have read the most recent JCO article with respect to load forces, you will find that the Damon wires place the heaviest loads on the teeth of all wires tested, in some instances 3x-4x the force.  Kind of ironic.  Now, to my issues.

We started out with the D2 which we thought was great.  Root parallelism was excellent, patient acceptance was an issue but promises of quicker treatment times made the loss of colors more tolerable for the patient.  Shortly after starting with the D2, the D3 was introduced to my office. I believe that had I stuck with the D2 my life would have been fine with some issues noted below but not as many.   In retrospect, the D3 was my downfall. 

Unfortunately for us, the issues with the D3 did not begin to present until we were well into 15 months of treatment on patients, other than the posterior brackets constantly coming off.  We fixed the posterior breakage by simply limiting our placement of the D3 to the U3-3.  We had no idea that the bigger problem would be the anterior brackets. Starting around 15 months of treatment, little things like 2nd and 3rd order issues come into play.  This is when we began placing stainless steel wires with posts for tiebacks and ochain for space closure.  This is also when the D3 began to fall apart.  The metal would separate (delaminate)from the PLASTIC base.  Prior to this, the wings would disappear. 

Unfortunately, by this time, we had somewhere around 450 patients in D3 appliances.  Coming to work was a nightmare.  Both my front and back staff were stressed and tired of dealing with Damon issues.  Schedules were disrupted daily.  Usually, when we were ready to insert a 19x25 ss posted wire we would find that instead, we needed to replace one, two, or sometimes three brackets because of delamination issues or because of missing wings, requiring on the spot bondings.  And this was not on just one or two patients a day.  This was on multiple patients each day.  And it happened more than one time on the same patient.  In addition, if you look at the bracket base on the tooth using loops, it is quite common to see a plastic base that is shaped like a wedge, causing rotational discrepancies between the maxillary central incisors.

It gets better.  Posterior openbites starting popping up in the middle of treatment.  You know, the tongue was waking up.  This is another way of saying that there is a total lack of torque control in the posterior segments as the teeth were being "tipped to the buccal".  Never an issue for me in 15 years of practice until I starting waking up the tongue with the "Damon System."   We also started seeing 2nd and 3rd order discrepancies in the area of the incisors in both arches.  In addition the Mx was introduced to our practice.  Suddenly, we no longer knew how to bond braces.  We could not keep them on the teeth.  Patients were upset because of multiple rebondings.  We were able to address this issue by using Fuji as our bonding medium to make sure we had bonding adhesive in there new pad.  Not sure why they had to change the pad. Anyway, this helped considerably with the Mx bracket.

The last issue we discovered is with their molar hooks.  They went from the notoriously large "A Company" hook to a much smaller hook based on doctor complaints.  The problem is that when you place their brackets as gingivally as you must to avoid occlusal interferences, the hooks tend to get buried in the tissue.  When it comes time to use the hook, bending it out to allow for patient access results in a broken hook.  They are extremely weak and fracture with the smallest adjustment.  To fix this, we have to run the wire longer than usual to be used in place of the hook. 

So basically, using the Damon system we managed to break our p romises of treating patients in 25% less treatment time, could not longer keep our promises of seeing patients on time due to the disruption the D3 caused daily, keep my promise of a stress-free work environment to my staff, lost control of my schedule due to the number of emergency bonding appointments required, lost control of my overhead with regards to brackets, lost my enthusiasm for coming to work each day, and finally lost control of the results I had become accustomed to providing for my patients in a timely fashion.  So, how did I manage to keep my sanity, to keep my staff quitting and to keep my commitment to quality results?  We started by apologizing to our patients for making promises that it turned out we could not keep but guaranteed them that the finished results would be worth the wait.  We took down our sign in the lobby promising patients that they would not have to wait but also promised them this would change in the near future.  I also went back to my tried and true principles for diagnosing and treatment planning patients, including more extraction treatment plans. We started making all appointments 30 minutes long rather than 15 minutes long to address on-the-spot delamination issues. 

We started using Fuji on all metal Damon brackets which significantly reduced bracket breakage for those patients that were being bonded in the mandibular arch.  We ordered tons of OS Ortho Specialty pre-torqued wires to address a lack of torque in the anterior segments.  We started running vertical elastics as soon as possible in the posterior segments to reduce the number of posterior openbites we were seeing.  We started using elastomeric ties around all teeth on patients when we placed 18x25 CNT wires to introduce more torque control.  We rebonded delaminated maxillary canine brackets with Mx brackets for more control with hooks and used fewer 19x25 ss posted wires, helping to reduce some of our delaminations.  We also finish all patients in 19x25 TMA wires to allow for 2nd and 3rd order bends to finish cases correctly. 

Oh, we also stopped using the Damon system in July 2006 following an intervention with some buddies who convinced me that I was paralleling the life of a spouse in an abusive marriage and that I needed to leave.  I finally left that abusive marriage and went to the GAC Inovation-R system.  I am a much happier orthodontist as is my staff. 

As an aside, I am on vacation this week.  I took my boys to Boston to watch the RedSox sweep the Giants and saw Barry Bonds hit #748.  I leave tomorrow for Atlanta to watch my Sox beat the Braves.  In between, we are home for a day (today) and I advised my staff that I would drop by the office to check on the mail.  I arrived to 3 scheduled emergency bondings on patients that are supposed to be finishing up soon.   Do I need to tell you what the emergency bondings were for, probably not.   :)

With warmest personal regards,

Mark Lively
Lively Orthodontics, P.A.


Date: Tuesday, June 12, 2007 11:11 AM
From: charles ruff <orthodmd@MAC.COM>
Subject: canker sores

I recently had a 13 year old new patient present with significant crowding and multiple canker sores on the inside of the lips and cheeks. interestingly, these canker sores are more or less at the level of the occusion whether that has anything to do with anything. his mother had him to the pediatrician and was given the standard answer of maalox/benadryl or lidocaine as a paliative approach.

his mother feels this has effected his sleeping and his eating and he
quite frankly is short for 13. he is also a mouthbreather.

I'm wondering if any of you wizz kids know of any preventive approach
or systemic drug that can help this patient.


charlie ruff


Date: Saturday, June 09, 2007 6:36 AM
From: Ganesh Somayaji <ganeshsomayaji@YAHOO.COM>
Subject: Nickel allergy: suggestions?

Hello ESCO members,
We have a 14 yr old patient who has absolute allergy
to Nickel as per dermatology report and she requires
Orthodontic treatment.  I guess Invisalign would be
ideal in a situation like this, however, it is out of
the question since invisalign is not available in our
Any suggestions?
If anybody can provide details on how to go about it,
it would be very helpful. including product
details....(bracket kit, wires, molar tubes etc.)

Thank you
Dr Ganesh Somayaji.

P:S: It's an extraction case.

Date: Tuesday, June 19, 2007 5:58 PM
From: James N. Tsau <james_tsau@YAHOO.COM>
Subject: Photo Printer and Printer/Scanner in-one device

Hi everyone,

Any recommendations on brand/model of ink-jet printers for patient photos?

Also, recommendations on brand/model of Printer/Scanner in-one machines for documents?

Thanks in advance.


James Tsau
Fremont, CA

Date: Sunday, June 10, 2007 11:55 AM
From: Benton J. Runquist <davisdds@PACBELL.NET>
Subject: Age as determinant of success with palatal cuspids

Hey all,
I've got a 40 y.o. female, Class II div 2 with #c and #h present. History of
#h being mobile in the past, not presently.  Both #6 and #11 appear palatal
(root apices in pretty good location, crown tips just 'touching' over distal
surface of roots of centrals (i.e. both #6 and #11 have ~45° angle and are
symmetrical with each other...i.e. similarly inclined). Neither are palpable
in buccal vestibule.
My questions:
1. prognosis for being able to successfully bring #6 and #11 into place (age
2. possible 'long-term' side effects that should be mentioned
(relapse/intrusion; unesthetic gingival contours, etc.)
3. ability to distalize buccal segments to create room... to avoid excess
overjet by bringing her upper incisors forward (no wisdom teeth present)
4. value of cone-beam CT scan in making decisions

Also, if you have had success, or failure guiding impacted cuspids at this
age I'd like to hear about it!

B.J. Runquist, DDS, MS
Davis, CA