Date: Tuesday, December 11, 2007 12:14 AM
From: "ESCO automatic digest system" <LISTSERV@LISTSERV.UIC.EDU>
Subject: ESCO Digest - 6 Dec 2007 to 10 Dec 2007 (#2007-84)

There are 11 messages totalling 1364 lines in this issue.

Topics of the day:

1. Jack Fisher
2. Halterman appliance
3. Chelsea Clinton
4. Re: ectopic maxillary molar
5. Re: ectopic maxillary molar
6. Re: ectopic maxillary molar
7. Re: ectopic maxillary molar
8. Re: ectopic maxillary molar
9. Ectopic eruption of maxillary first molars
10. Ectopic maxillary molar
11. Faster Ortho

Date: Monday, December 10, 2007 9:33 AM
From: charles ruff <orthodmd@MAC.COM>
Subject: Jack Fisher

I've heard Jack Fisher lecture several times and I like his zygoma 
screw placement ideas.  He used a hand driver to make a purchase point 
on the zygomatic process so the TAD will catch as he starts to insert 
it.  He sells these hand drivers as part of his kit.  I already own 
five kits and really don't want to buy another right now.  Does anyone 
know of a source for these hand drivers separate from the kit?


charlie ruff


Date: Sunday, December 09, 2007 7:00 PM
From: charlie ruff <orthodmd@GMAIL.COM>
Subject: Halterman appliance

Hey Bob,

How's the Big Apple during the Holiday Season.  I always loved it there in December.
Are you concerned about leaving a space maintainer in for three years?  I might be a little but I would cement it with either Unitek dual cure or Fuji Ortho LC.  I know Fuji Ortho LC is supposed to be used for bonding brackets but it works great for cementing space maintainers in young kids especially where moisture might be a problem.  I would recall the patient yearly and plan on recementing after two years.  Real glass ionomer (powder liquid) is very protective of enamel.
I've used variations of the Halterman appliance.  The draw back other than age, might be that some authorities argue that ectopic 6s are really a crowding issue.  If they are right or partially right, correcting the problem now is harder because of inadequate maxillary growth.  Why not place a space maintainer off the 6s (if you can) and X the d's early.  When the 4s are down, reaccess for backing up the 6s before the 7s come in.
Didn't you just love the Patriots win over Pittsburgh today?  Time to go and watch the 1938 edition of the Christmas Carol (my favorite).

charlie ruff

Date: Sunday, December 09, 2007 5:52 PM
From: charlie ruff <orthodmd@GMAIL.COM>
Subject: Chelsea Clinton

When Bill Clinton had just started his first term as president, Chelsea was in braces.  She was bimax to the max and being treated nonextraction, according to the rumors, at her mother's decision.  I posted on ESCO at that time the following question: "Does anyone agree that Chelsea would have been better off with four on the floor?"  Joe Zernick, who was running ESCO then, bounced that back to me and refused to publish it with the comment that Chelsea Clinton was not a public person and he didn't feel we should make her one.  OK, I could live with that.
Now this weekend she makes a campaign appearance for her mother, the future president, and doesn't she look fabulous, I mean really nice.  
Is David Sarver right?  Did her bimax disappear with age & growth or did she have additional orthodontics as an adult with extractions on the sly.
Happy Holidays to all
charlie ruff

Date: Saturday, December 08, 2007 4:51 PM
From: Jean-Marc Retrouvey <jmretrouvey@VIDEOTRON.CA>
Subject: TMJ symptoms with Invisalign

I was just wondering if somebody had experienced patients developing TMJ symptoms with Invisalign. 2 of my patients complain of muscular pains and one of pain in the articular capsule.


Jean Marc Retrouvey


Date: Saturday, December 08, 2007 5:27 AM
From: Robert Kazmierski, D.M.D. <str8teeth1@VERIZON.NET>
Subject: ectopic maxillary molar

Had to look the Halterman appliance up. It looks like it should work. In the past, I have just bonded the permanent molar through to the primary canine on the same side. Worked my way up to a stainless steel wire with an open coil to distalize the 6. Nothing complicated in the mechanics and it works great. I try to keep the primary second molar as long as possible for anchorage during this and space maintenance afterward. If you loose the primary second molar, I would recommend a Nance after the 6 is uprighted and distalized. Happy Holidays.
Rob Kazmierski
Moorestown, NJ


Date: Friday, December 07, 2007 11:19 AM
From: drgscott@AOL.COM <drgscott@AOL.COM>
Subject: Re: ectopic maxillary molar

I have been able to take a small diamond bur or carbide and reshape the distal of the E in some cases where I could not place a separator to create a sloped shape on the E that would allow the 6 to erupt (with or without a seperator).  You can do this reshaping and still keep the overall occlusal size of the E the same.  I am not sure what the Halderman appliance is, but I find that a Pendulum works well for this situation followed by a Nance if necessary.

Greg Scott


Date: Friday, December 07, 2007 10:53 AM
From: mldabney@AOL.COM <mldabney@AOL.COM>
Subject: Re: ectopic maxillary molar

i have sucess with bonding a sectional TMA aw directly to the facial of the E, extending it to the distal & placing a loop so i can the place a chain or e-thread from the loop to a button bonded on the occlusal on the 6, assuming part of the 6 is erupted. fyi, i have also intruded U 7 similiarly after bonding to the lingual of the U6 w/ same type of aw & mechanics. get creative or read the jco and copy other creative docs like i do.     

good luck,

Date: Friday, December 07, 2007 7:51 AM
From: Oppenhuizen <doctoro@MACATAWA.COM>
Subject: Re: Ectopic eruption of maxillary first molars

Re: Ectopic maxillary molar

From: Dr. Robert W. Bruno" Orthos68@AOL.COM < mailto:Orthos68@AOL.COM >

I have had a run on these over the past summer. I probably saw 5-6 in
three months. Makes me wonder if there is something in the water?

I used to get aggressive with this problem. Now I don't.

I asked my self, "What is to be gained by doing anything at all right now?"

I concluded, "Nothing is gained. Nothing at all."

While I think it is possible that decay could develop on the mesial
aspect of the erupting first molar, it isn't very likely, but can be
somewhat predicted by an overall assessment of the decay issues in the
child's mouth. I haven't seen it happen yet even though there is a
resorptive / potential decay process on the primary molar.

Currently my approach is to buy time.

I fully explain that the primary molar will ultimately, inevitably be
lost, either because it will loosen and come out or it will develop an
abscess, or tooth ache. When this happens, step in and place the space
maintainer. In fact, I usually still wait a month or two to permit the
erupting first molar to erupt more fully so that we can more easily
place a band.

The parent needs to understand that when the tooth comes out, we need to
see the child back immediately. Explain the blocked out second premolar
problem. If it is a bilateral situation, I indicate that the opposite
primary molar should be removed when the problematic molar is removed.

I believe that the primary molar is still the best and easiest space
maintainer around in an ectopically erupting first molar, so use it as
long as you can. You can buy months or even years just watching and waiting.

Of course, you need to fully explain the situation and also you need to
place the child on an observation recall.

Making up lost arch length in the maxillary arch does not generally
prove to be difficult, so only rarely is there need for interceptive
intervention to regain space before a comprehensive phase of
orthodontics at a latter time.

I consider this 'watchful waiting' not 'supervised neglect'.

Also, fully explain that there absolutely is going to be a need for
comprehensive orthodontics latter - the parent can't ignore this and
hope it goes away. When the primary molar is lost, a space maintainer is
absolutely essential.

Parents appreciate being empowered to monitor a situation that they
understand, you create good will for future necessary care, and there
are no negative consequences.

If you have never done this before, it would be wise to speak to the
referring dentist to bring them on board with this thought process just
as it has been explained to the parents. Ask the dentist if they believe
this seems prudent and listen to what is said. There is always more to
be gained from working together. Generally the dentist simply wants to
know that the problem is being dealt with appropriately and reasonably
and that it doesn't become neglect.

It seems so often to me, that informed nothing is more appropriate than
doing something; immediately.

In the words of Groucho Marx:

*/ “Those are my principles, and if you don't like them... well, I have


Have a delightful holiday season everyone. :-)

Greg Oppenhuizen

Holland, MI

Date: Friday, December 07, 2007 7:03 AM
From: Barry Raphael <drbarry@ALIGNMINE.COM>
Subject: Re: Ectopic eruption of maxillary first molars

When I first learned this technique, I didn't believe it would work, but it does most of the time:  Bond brackets to the c, d and 6 with a sectional wire and open coil spring.  Most often the primary teeth will hold fast as an anchor for the two or three months it takes to back up the molar.   THEN do the retention and let the second primary molars be damned.

Barry Raphael

Clifton, NJ


Date: Friday, December 07, 2007 4:22 AM
From: David E. Paquette <davep@PAQUETTEORTHO.COM>
Subject: Re: ectopic maxillary molar


As a Pediatric Dentist and an Orthodontist, I used to try to recover these.  Now I simply allow the primary teeth to exfoliate and then distalize the molars when we start full treatment.  Easier on the kid and less frustrating for my staff and I in the long run.

Dave Paquette


Date: Friday, December 07, 2007 3:36 AM
Subject: Faster Ortho


OrthoAccel's proprietary technology accelerates the changes in bone
structure that result from orthodontic treatment. OrthoAccel said its
device cuts in half the treatment time required for braces, and can be used
with all existing orthodontic bracket technologies. To read the full news
go to , any one has idea what are they upto.

Prof Goel
Amazingly low bracket prices for bulk
Roth 022 in steel and Ceramic
email to