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CLINICAL CORNER

Stability in Orthodontics By Dr. Derek Bock

Stability in Orthodontics? What the hell is that? It’s an age old debate that continues today in every clinical forum and study group; Like The Pragmatic Orthodontist and The Pragmatic Orthodontist Elite groups that I run. I often hear younger practitioners claiming that nothing is stable and ignoring basic mechanics and biology. While it may be true that absolute stability is a farce, we should not use it as a cover to produce REALLY unstable results. I’m not going to sit here and pretend that my cases don’t relapse, because that wouldn’t be true, but I am going to explain how I like to see it coming WELL before it happens. There are many reasons that 35% of my case starts are Phase I. One of those reasons is that it allows me to have relapse transparency.

FIGURE 1

Another reason is that it allows for my 2nd phase to be treated in a shorter amount of time, most of the time with a digital treatment modality. Let’s talk about relapse transparency. I’ve executed thousands of 2-phase orthodontic cases in my career. I’ve come up with a systematic approach for efficient and impactful change. I routinely use Haas palatal expanders (yes even in the absence of crossbite) with Damon PSL brackets. I skeletally expand Phase I cases between 9-12 mm and coordinate the maxillary and mandibular arches with Damon PSL brackets to match the expansion. I create arch length for the un-erupted permanent teeth, overcorrect maxillary anterior torques and retain. I use bonded retainers for the maxillary

and mandibular incisors with nighttime Hawley retainer wear (FIGURE 1). The Hawley retainers are discontinued when the maxillary and mandibular permanent canines begin to erupt (FIGURE2). I remove the fixed retainers when the upper and lower 4-4 are fully erupted, and I sit back and WATCH for potential relapse. Every case shows me some relapse, I view this as an golden opportunity for overcorrection in the 2nd phase. We explain to the patients and parents that we do all the ‘heavy lifting’ in the first phase and that some movement in between phases is anticipated. We explain to them that we want to see what movements we’ll need to over-engineer in the 2nd phase so that we can provide a better, long term retention plan.

FIGURE 2 Q4 • 2017 | TheProOrtho.com 51

The Progressive Orthodontist  

Q4 2017

The Progressive Orthodontist  

Q4 2017