TRIBUNA BOOKS RIPANO
Nº 0 - 2013
Lingual Orthodontic Journal
Contents •
Advancements in the indirect bonding technique. Pablo Echarri DDS, Martín Pedernera DDS, Eng. Claus Schendell
•
cclusogram and occlusal Visual O Treatment Objective (occlusal VTO). Interrelation with lateral cephalogram. Pablo Echarri DDS, Martín Pedernera DDS
•
icroimplants use in Lingual OrM thodontics. Regina Bass, DDS.
Editor in Chief
Pablo Echarri, DDS
Editorial Committee Silvia Geron Ryoon-Ki Hong Hee-Moon Kyung Jean-François Leclerc Marcelo Marigó Martín Pedernera Rafi Romano Giusseppe Scuzzo Kyoto Takemoto Publish & Publicity:
Ripano S.A.
Ronda del Caballero de la Mancha, 135 28034 - Madrid, España Tel.: (+34) 913 721 377 Fax: (+34) 913 720 391 e-mail: ripano@ripano.es www.ripano.eu Nº 0 - 2013 ISSN: Solicited Official publication:
Ripano no asume ni se identifica, necesariamente, con las opiniones expresadas por sus redactores y colaboradores en el contenido de los artículos que publica. Queda prohibida la reproducción total o parcial del contenido de esta publicación en cualquier medio mecánico o electrónico, sin autorización previa y por escrito del editor.
5th WSLO MEETING
Paris France, 4 - 6 July 2013
Lingual Orthodontic Journal
Editorial Dear friends and colleagues, I am very glad to be able to announce you the first issue of Tribuna Books Ripano – Lingual Orthodontics Journal. After the successful 5th Congress of World Society of Lingual Orthodontics in Paris in July (my sincerest congratulations to its President, Didier Fillion, and to all members of Organizing Committee) we believed we should stay in touch with you through this journal while waiting the next world Congress in Seoul in 2016. I would also like to congratulate to already ex-president, Giusseppe Scuzzo, for his work as a leader of WSLO during the last years, and to new President, Hee-Moon Kyung, who, we are sure, will do excellent job in promoting and diffusion of Lingual Orthodontics. I would also like to wish all the best in organizing the 6th WSLO Congress in Seoul to its Chairman, Ryoon-Ki Hong. On the other hand, I would like to invite all the orthodontists who practice lingual orthodontics to send us articles for publishing in this journal. The Tribuna Books Ripano – Lingual Orthodontics Journal will be published on-line in English and Spanish, and it will have four issues per year. I would also appreciate any comments or suggestion you might have regarding the Journal, hoping it’ll be of your interest. Until next issue. Sincerely, Pablo Echarri, DDS echarri@centroladent.com
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Advancements in the indirect bonding technique Authors: Dr. Pablo Echarri Dr. Martín Pedernera Eng. Claus Schendell Keywords: Indirect bonding – Lingual Orthodontics – Set-up Model Maker – Occlusal Plane
Abstract / Introduction In this article, the authors perform an up-date of Class System Protocol using the laboratory appliances: Set-up Model Maker (SUM) and Occlusal Plane Reference (OPR). The brackets positioning protocol with this system is described step by step and the standardized results are obtained together with the reduced working time.
The Class System1 has been used by many specialists to position the lingual brackets in the indirect bonding technique. In this article, the working protocol revision of this system is carried out with the aim of obtaining the standardized
results, reducing the working time and making the technique easier.
Fig. 1. Models mounted in the articulator.
Fig. 2. Reference lines.
Fig. 3. SUM Base.
Fig. 4. Articulator plate with the set-up model in the SUM Base.
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When the models are mounted in the articulator (Fig. 1), the reference lines are traced (Fig. 2), which
Lingual Orthodontic Journal are: crown-root axes of the teeth, a horizontal line passing through LA point, a line marking the gingival margin of all teeth. All the teeth should be numbered to make its identification easier.
easier the positioning of set-up models in the articulator in the same initial position (Fig. 4).
To carry out the set-up models and their correction, a Set-up Model Maker (SUM) and the Occlusal Plane Reference (OPR), designed by Dr. Pablo Echarri and Eng. Claus Schendell2,3 will be used.
Take the impression of dento-alveolar zone in silicone using SUM (Fig. 5), and then cut horizontally the model to separate the dento-alveolar zone from the base. All the teeth are separated one by one and put back in the silicone impression (Fig. 6).
With the SUM (Fig. 3), the use of the models with the plate of any articulator is possible, which allows to maintain the interocclusal relationships, and to make
Vertical dimension, sagittal and transverse rotation of occlusal plane will be maintained when repositioning the teeth in the model base (Fig. 7).
Fig. 5. Silicone impression of dento-alveolar zone.
Fig. 6. Separation of the teeth in the silicone impression.
Fig. 7. Plate with the separated teeth in the SUM.
Fig. 8. The teeth are waxed to the set-up model.
Fig. 9. Fabrication of the set-up of finished model.
Fig. 10. Set-up models transferred to the articulator.
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Fig. 11. OPR.
Fig. 12. Occlusal Plane Plate adapted to the teeth.
Fig. 13. Superimposition of occlusal VTO over the teeth before the correction.
Fig. 14. Position of the corrected teeth matches with the VTO.
The teeth are waxed together with the model (Fig. 8), and in this way the set-up model is finished (Fig. 9).
The OPR uses the same base as SUM, only the upper part is replaced by Multidirectional Adaptation Appliance (MAA) and Occlusal Plane Plate (Fig. 11).
The SUM allows the fabrication of a set-up model in a quick and standardized way, maintaining the interocclusal relationships, and making easier the repositioning in the articulator (Fig. 10).
The MAA allows the adjustment of the height, antero-posterior position, sagittal and transverse rotation of occlusal plate. Adapt the Occlusal Plane Plate to the set-up model teeth (Fig. 12), and superimpose the occlusal VTO over the teeth of the set-up model (Fig. 13). In this way, it will be very easy to correct the teeth in the set-up model until they match with occlusal VTO (Fig. 14), making the
The OPR makes easier the set-up models correction and the brackets positioning in the model in indirect bonding technique.
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Fig. 15. Occlusal view of the set-up models after the correction.
Fig. 16. Corrected set-up models in the articulator.
Fig. 17. Adapted full size arch.
Fig. 18. Adapted full size arch and fixed to the OPR Plate.
Fig. 19. Anterior reference using the Blue Blokker.
Fig. 20. Full size arch.
correction to match exactly with the treatment plan (Fig. 15).
tor (Fig. 16). In the articulator, the functional occlusion will be checked: anterior guide, canine guides, etc.
The Occlusal Plane Plate allows to maintain the vertical dimension, and sagittal and transverse rotation of occlusal plane, and to level the Curve of Spee and the Curve of Wilson, and the MAA allows the modification of the vertical dimension, as well as the sagittal and/or transverse rotation of occlusal plane. Since the models are corrected maintaining the articulator plate, it is very easy to reposition the corrected set-up models in the articula-
Labial or lingual brackets will be positioned using the OPR with the plate for arch positioning. The ideal full size arch wire is adapted (Fig. 17), and the arch is fixed to the OPR plate with the resin or composite (Fig. 18). An anterior reference is carried out using the Blue Blokker (Fig. 19). In this way, it will be easy to reposition the arch on the model using the anterior reference, and the height, sagittal and transverse
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Fig. 21. Full size arch separated from the model.
Fig. 22. Bonding of the brackets to the model.
Fig. 23. Removal of the arch. Brackets bonded to the model.
Fig. 24. Transference trays using the Smart Cap System, posterior view.
Conclusions The SUM and the OPR allow maintaining or controlled modification of the occlusal plane position during the fabrication of set-up models, as well as their correction. Also, the steps of remounting of the set-up models in the articulator after their fabrication are eliminated.
Fig. 25. Transference trays using the Smart Cap System, anterior view.
rotation references of the MAA (Fig. 20). The full size arch is separated from the model (Fig. 21) and the brackets are ligated to the arch. The arch is positioned back to the model set-up together with the brackets, and the brackets are bonded to the model using the Light Bond (Fig. 22). Then, the arch is separated, leaving the brackets on the model (Fig. 23). In this case, the Evolution SLT lingual brackets have been used. The transfer trays are carried out using the Smart Cap System (Figs. 24 and 25).
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The OPR allows to correct the sagittal and transverse rotations of occlusal plane, and to level the Curve of Spee and the Curve of Wilson in a controlled way, to adjust the tooth movement to the treatment plan by means of occlusal VT superimposition in the model, and to reposition the ideal lingual arch in a precise and quick way for possible re-bonding of the brackets.
Bibliography Echarri P. TÊcnica de posicionamiento de brackets linguales Class System. Revista Iberoamericana de Ortodoncia 1997;16:1-17. Echarri P. In drei Schritten zum Erfolg. Kieferorthop Nachrichten 2013;4;6-7. Echarri P, Schendel C. Einfach und präzise. Kieferorthop Nachrichten 2013;6;14-16
Lingual Orthodontic Journal
Occlusogram and Visual Treatment Objective (occlusal VTO). Interrelation with lateral cephalogram Authors: Pablo Echarri, DDS MartĂn Pedernera, DDS Keywords: Occlusogram. Occlusal Visual Treatment Objective. Occlusal Plane Reference.
Abstract The authors of this article present a technique to obtain a 3D vision by putting the occlusogram into a relation with the lateral cephalogram. They also present a technique to transfer the dental movements carried out in Visual Treatment Objective in the cephalogram to the occlusogram, and later to set-up models to carry out the correction and treatment planning.
Introduction The realization of occlusogram and occlusal VTO allows to compare the results which could be obtained with different treatment plans, as well as to carry out safely the corrections on the set-up model, to visualize the interocclusal relationship, to relate the dental arches with the cephalometric tracing, and to customize the individual arch template.
cing, and with a simple technique, it is easy to obtain an occlusogram. Dr. Echarri’s cephalometric templates should be used (Scheu-Dental GmbH, Iserlohn, Germany).
Starting from the basic elements of orthodontic diagnosis, such as study models and cephalometric tra-
Make a photocopy of a model, and find three reference points, for example, mesial contact points of the first molars, and interincisal point. Measure the distance among these points in the model and in the photocopy (Figs. 1-4). If these measures match, this means that the photocopy is as the same size as the model, and that the process can be continued. If this
Fig. 1. Distance between the mesial points of the upper right and left first molar in the photocopy.
Fig. 2. Distance between the mesial points of the upper right and left first molar in the model.
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Fig. 3. Distance between the mesial point of the upper right first molar and the interincisal point in the photocopy.
Fig. 4. Distance between the mesial point of the upper right first molar and the interincisal point in the model.
Fig. 5. Upper midline tracing in the photocopy.
Fig. 6. Copy the contours of all teeth in black pencil (1).
Fig. 7. Copy the contours of all teeth in black pencil (2).
Fig. 8. Copy the contours of all teeth in black pencil (3).
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Lingual Orthodontic Journal is not a case, then the photocopy should be repeated using a size conversion factor for it. Trace the midline on the photocopy (Fig. 5) and copy the midline and the contours of all teeth over the acetate paper sheet in black pencil (Figs. 6-8). In this
way, the upper occlusogram is finished (Fig. 9). Follow the same procedure with the lower model (Figs. 10-16). Superimpose the upper and lower occlusogram respecting the occlusal relationships of the pa-
Fig. 9. Upper occlusogram.
Fig. 10. Lower midline tracing in the photocopy.
Fig. 11. Occlusogram fabrication: Copy the contours of all teeth in black pencil (1).
Fig. 12. Occlusogram fabrication: Copy the contours of all teeth in black pencil (2).
Fig. 13. Occlusogram fabrication: Copy the contours of all teeth in black pencil (3).
Fig. 14. Occlusogram fabrication: Copy the contours of all teeth in black pencil (4).
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Fig. 15. Occlusogram fabrication: Copy the contours of all teeth in black pencil (5).
Fig. 16. Lower occlusogram.
Fig. 17. Superimposition of upper and lower occlusogram.
Fig. 18. Place the lower occlusogram and relate the lower incisors of occlusogram with those of cephalogram.
tient to visualize the interocclusal relationship (Fig. 17).
7. Distal slope of the labial cusp in upper second bicuspids makes contact with the mesial slope of the mesiolabial cusp in lower first molars.
According to White, normal interocclusal relationships are: 1. Incisal overjet 0.7 mm.
8. Mesial slope of the labial cusp in upper second bicuspids makes contact with distal slope of labial cusp in lower second bicuspids.
2. Bicuspid overjet 1.9 mm. 3. Molar overjet 1.4 mm. 4. Distal or posterior overjet 2.3 mm. 5. Upper lateral incisors’ distal surface reaches the center of the lower canines. 6. Upper canines in Centric Occlusion make contact with the mesial slope of labial cusp in lower first bicuspids.
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Relationship between the occlusogram and cephalometric tracing According to different authors, the occlusogram can be related to cephalometric tracing, taking the Frankfort or occlusal plane as a reference. Place the lower occlusogram over the cephalogram relating the incisors from occlusogram with those from cephalogram, as indicated in the figure 18: place
Lingual Orthodontic Journal
Fig. 19. Trace a line perpendicular to the Frankfort plane, passing through mesial point of lower molars.
Fig. 20. Relationship between the lower occlusogram and cephalogram.
the template and trace a line perpendicular to the Frankfort plane, passing through the incisal edge of lower incisors (B1 Point) then place the occlusogram in a way that the incisors from it make contact with the perpendicular line. To determine the position of molars, trace another line perpendicular to the Frankfort plane, passing through the mesial point of lower molars of the cephalogram, and place the molars of the occlusogram adjusted to this line (Fig. 19). In the figure 20, the occlusogram fixed to cephalogram and with reference lines can be seen. Carry out the correction of lower incisor in the cephalogram according to the treatment plan (in red pencil), and transfer this position to the occlusogram (Fig. 21). In this case, a lower incisor proinclination of 1.5 mm has been carried out, and to transfer this movement to the occlusogram, a new line perpendicular to Frankfort plane has been traced in red pencil.
Fig. 21. Transfer the planned movement of lower incisor from the cephalogram to the occlusogram, using the line perpendicular to the Frankfort plane.
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Fig. 22. Determine the lower ideal arch line by superimposing the arch template over the midline and the new lower incisal point.
Fig. 23. Relationship between the lower occlusogram and the ideal arch line and the cephalogram.
Fig. 24. Lower occlusal VTO fabrication 1: draw the teeth over the ideal arch line, correcting the crowding and rotations.
Fig. 25. Lower occlusal VTO fabrication 2: draw the teeth over the ideal arch line, correcting the crowding and rotations. Continuation.
With this new interincisal point and using the arch template, select the final arch shape, which can be with or without expansion, depending on the treatment plan (Figs. 22-23). Then copy the teeth over the arch line in red pencil, correcting the crowding and rotations (Figs. 24-29). In the figure 30, the superimposition of lower occlusogram and lower occlusal VTO can be seen, and in the figure 31, the relationship between the occlusogram, occlusal VTO and cephalogram. The same procedure is followed with the upper occlusogram.
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Fig. 26. Lower occlusal VTO fabrication 3: draw the teeth over the ideal arch line, correcting the crowding and rotations. Continuation.
Lingual Orthodontic Journal
Fig. 27. Lower occlusal VTO fabrication 4: draw the teeth over the ideal arch line, correcting the crowding and rotations. Continuation.
Fig. 28. Lower occlusal VTO fabrication 5: draw the teeth over the ideal arch line, correcting the crowding and rotations. Continuation.
Fig. 29. Lower occlusal VTO fabrication 6: draw the teeth over the ideal arch line, correcting the crowding and rotations. Continuation.
Fig. 30. Superimposition of occlusogram and lower occlusal VTO.
Fig. 31. Relationship of a cephalogram, an occlusogram, and lower occlusal VTO.
Fig. 32. Relationship of the upper occlusogram and cephalogram. Position the incisors using the line perpendicular to the Frankfort plane as a reference.
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Fig. 33. Relationship of the upper occlusogram and cephalogram. Position the molars using the line perpendicular to the Frankfort plane as a reference.
Fig. 34. Relationship of upper occlusogram with the cephalogram.
Fig. 35. Observe the planned movement of the upper incisor in the cephalogram.
Fig. 36. Transfer the planned movement of upper incisor from cephalogram to occlusogram.
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Fig. 38. Select the upper ideal arch line using the midline, the new incisal point and the lower ideal arch line as a reference.
Fig. 37. Transfer the planned movement of upper incisor from cephalogram to occlusogram.
Transfer the incisal reference of the cephalogram to occlusogram (Fig. 32), as well as the molar reference (fig. 33). In the figure 34 the upper occlusogram can be seen in the relationship with the cephalometric tracing. Correct the upper incisor position in the cephalogram according to the treatment plan (Fig. 35), and transfer it to the occlusogram (Figs. 36-37). In this case, a treatment with upper incisors retrusion and upper right and left first bicuspid extraction will be carried out. Superimpose the template over the midline and interincisal point, and select the arch shape (Figs. 38-39). Correct the alignment and rotations (in this case, with extraction of both first bicuspids) to carry out the occlusal VTO of maxilla (Figs. 4043). The figure 44 shows the superimposition of occlusogram with occlusal VTO of the upper arch treatment, and the figure 45 shows the relationship among the cephalogram, occlusogram and occlusal VTO.
Fig. 39. Draw the midline of upper arch.
Fig. 40. Upper occlusal VTO fabrication 1: draw the teeth over the ideal arch line, correcting the crowding and rotations.
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Fig. 41. Upper occlusal VTO fabrication 2: draw the teeth over the ideal arch line, correcting the crowding and rotations. Continuation.
Fig. 42. Upper occlusal VTO fabrication 3: draw the teeth over the ideal arch line, correcting the crowding and rotations. Continuation.
Fig. 43. Upper occlusal VTO fabrication 4: draw the teeth over the ideal arch line, correcting the crowding and rotations. Continuation.
Fig. 44. Superimpose the upper occlusogram and the upper occlusal VTO, and carry out the extractions of both upper first bicuspids.
The figure 46 shows the occlusal VTOs of upper and lower treatment, and the figure 47 shows the interocclusal relationship among them.
the set-up model, which allows the maintaining or controlled modification of the vertical dimension, occlusal plane rotation, and the Spee Curve depth. The figure 49 shows the upper view of OPR with the occlusogram superimposed over the set-up model, making easier the correction of the teeth position so it can be adjusted according to the treatment plan.
The Occlusal Plane Reference (OPR) allows the superimposition of occlusal VTO of the treatment over the set-up model to carry out its correction according to the treatment plan. The figure 48 shows a lateral view of OPR, adjusting the occlusal plane on
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Fig. 45. Relationship of the upper cephalogram, occlusogram and occlusal VTO.
Fig. 46. Upper and lower occlusal VTO.
Fig. 47. Superimposition of upper and lower occlusal VTO.
Fig. 48. Occlusal Plane Reference (OPR). Lateral view.
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Fig. 49. Occlusal Plane Reference (OPR). Upper view.
Bibliography Marcotte MR. The use of the occlusogram in planning orthodontic treatment. Am J Orthod 1976;69:65567. Ricketts RM, Roth RH, Chaconas SJ, Schulhof RJ, Engel GA. Orthodontic diagnosis and planning 1982 Library of congress catalog card number: 82-62145, United States of America.
Bolton WA. Disharmony in tooth size and its relation to the analysis and treatment of the malocclusion. Angle Orthod 1958;28113-29. Chuck GC. Ideal arch form. Angle Orthod 1934;4:312-27. Musich DR, Ackerman JL. The catenometer: a reliable device for estimating dental arch perimeter. Am J Orthod 1973; 63:366-75. Scott JH. The shape of the dental arches. J Dental Research 1957;36:996-1003.
White LW. Individualized ideal arches. J Clin Orthod 1978;12:779-87.
Brader AC. Dental arch form related whith intraoral forces. Am J Orthod 1972;61:541-61.
White LW. The clinical use of occlusograms. J Clin Orthod 1982;16:92-103.
Currier JH. A computarized geometric analysis of human arch form. Am J Orthod 1969;56:164-79.
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Microimplants use in Lingual Orthodontics Author: Regina Bass, DDS* * Specialist in Orthodontics, Member of World Society of Lingual Orthodontics, Permanent lecturer at CREO Fundation, Córdoba, Argentina Key words: lingual orthodontics, microimplants, orthodontic mechanics.
Abstract After the appearance of microimplants, the orthodontic mechanics evolved to more efficient strategies in solving different issues. In case of Lingual Orthodontics, there is a special consideration concerning the mechanics because the force application is carried out from behind the resistance center of the tooth, with a consequent tendency to torque loss in space closure cases. In this article, the use of microimplants in sagittal, vertical, and transverse plane is described, as well as its use in orthognatic patients treated with lingual appliances.
Introduction There is no doubt that microimplants have revolutionized the orthodontic mechanics. The treatment efficiency has considerably increased thanks to the anchorage provided by microimplants. They have also allowed simpler and more predictable design of mechanotherapy. Different uses of microimplants in Lingual Orthodontics and in all three planes are going to be described in continuation.
Microimplants in Sagittal Plane Although it is true that the extraction space can be closed both in front-to-back and back-to-front direction, in this article the anchorage is defined as posterior teeth (molars and bicuspids) movement which closes the extraction spaces.
• Minimal anchorage: 75% or more of extraction space is occupied by posterior sector and towards with the minimum or zero anterior retrusion. Therefore, depending on anchorage requirements, different tools can be used in order to achieve our objective. Except for reciprocal anchorage, i.e. when the extraction space can be used both by anterior and posterior sector, microimplants can be used for maximal posterior anchorage and minimal posterior anchorage, which means, when the extraction space management is more compromised. Also, microimplants can be used directly or indirectly. Direct force is a force applied directly to microimplant (Fig. 1).
Therefore, there are: • Maximal or critical anchorage: Posterior sector practically remains in the same place until the end of treatment, because 75% or more of extraction space will be occupied by anterior sector. • Reciprocal anchorage: The extraction space is shared between the anterior and posterior sector.
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Fig. 1. Direct anchorage with microimplant.
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Fig. 2. Sectional SS or Chrome-Cobalt arch wire from auxiliary molar tube to microimplant. The elastics used for traction are inserted from canine hook to bicuspid hook, which is also fixed to molar by means of a figure 8 ligature made of reinforced wire.
Fig. 3. Retrusion with sliding mechanics and combined arch wire (rectangular in anterior sector, and round in posterior sectors, to reduce the friction). The arch wire is activated from canines to microimplants.
Fig. 4. Retrusion with loops mechanics. The traction is carried out with elastic chain from the loop of the arch wire to microimplants.
Fig. 5. Combined arch wire with crimpable hooks for better overbite and overjet control.
Indirectly, the microimplant is used when the teeth are anchored to microimplant and the force is applied from tooth to tooth (Fig. 2). In maximal posterior anchorage, the ideal place for microimplants is on palatal side, between the 2nd bicuspids and 1st molars. Space closure can be carried out by sliding mechanics in which the arch wire is inserted in posterior sectors as the anterior sector retrusion takes place (Fig. 3). Another way is loops mechanics, in which the loops are bent in the chrome-cobalt arch wires with different kinds of shapes, when it is necessary to manage vertically the anterior sector (Fig. 4). The arch wire can be clipped or welded with different types of hooks (Fig. 5) which also allow the orientation of traction in different heights with the consequent effect over the torque.
Fig. 6. Low friction system. Rectangular Chrome-Cobalt arch wire with closed helicoidal loops inserted in the auxiliary tube of first molar band. In this way, the space closure arch wire is less exposed to friction in closing procedure. The traction is carried out from the loop towards micro. The posterior sector remains consolidated with a sectional SS arch wire.
When the anterior torque loss is necessary during the retrusion, it is preferable to use low friction system, where the anterior arch wire passes through the 1st molar accessory tube (Fig. 6).
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Dental Tribuna Books Case Report With Extractions And Maximal Posterior Anchorage • Female 20-year old patient. • Bio type: dolichofacial, skeletal Class II, convex profile (Fig. 7). • Molar and canine Class II, right subdivision. Lower midline deviation to the right. Marked overjet (Fig. 8). • Occlusal photographs (Fig. 9).
Treatment plan: The following teeth were extracted: 14, 24, to resolve Class II, and 35 to center the lower midline, and to obtain the canine classes. Maximal posterior anchorage was carried out with microimplants and loops mechanics was used (Fig. 10). The case is finished with finishing 0.016” Chrome-Cobalt arches (Fig. 11). The canine classes are achieved, as well as the midline match and optimal overjet and overbite (Fig. 12).
Fig. 7. Observe convex profile.
Fig. 8. Right molar and canine Class II: Lower midline deviation to the right. Increased overjet.
Fig. 9. Mesiogresion to the right of the entire lower left quadrant is observed.
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Fig. 10. Space closure with the rectangular retrusion arch wire with closed helicoidal loops. Lower midline centered towards left.
Fig. 11. Finishing arches.
Fig. 12. Canine classes are obtained, upper and lower midline match, optimal overjet and overbite.
Fig. 13. Rhinoplasty and mentoplasty were carried out in order to improve convex profile.
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Dental Tribuna Books After the orthodontic treatment, advancing mentoplasty and Rhinoplasty were performed to achieve the harmony of the convex profile (Fig. 13).
Microimplants and Pendulum Appliance In some cases, the distalization is necessary, whether because of mesiogression of upper posterior sectors, or because the anchorage is lost after the extractions.
Fig. 14. Bilateral molar and canine Class II.
Fig. 15a. Pendulum Appliance anchored to microimplants.
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To do this, a good choice is the use of Pendulum or Hilgers Appliance. When anchored to microimplants, the protrusion is avoided, which can appear as a side effect of an acrylic button support of the appliance. This case report is about a female 19-year old patient with molar and canine Class II, the absence of first bicuspids due to previous orthodontic treatment (Figs. 14-17).
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Fig. 15b. Sagittal view of space generated by distalization.
Fig. 16. The microimplant parallel to the median raphe has been used together with the transpalatal bar to anchor the molars.
Fig. 17. Finished case. Molar and canine classes are obtained.
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Fig. 18. The improvement of smile esthetics can be seen thanks to the reduction of gummy smile.
Fig. 19. Skeletal open bite.
Microimplants in Vertical Plane In cases with gummy smile due to vertical excess, a dentoalveolar intrusion can be carried out by inserting the microimplants between the canines and lateral incisors, and carrying out traction with elastic chain from esthetic buttons (Fig. 18).
Microimplants and Open Bite In cases with open bite of mandibular origin with extruded upper posterior sectors, the microimplants can be used for their intrusion.
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A case report of a female 32-year old patient with skeletal open bite (Fig. 19). The patient chooses the lingual orthodontics treatment for maxilla, and labial orthodontic treatment with ceramic brackets in mandible. The decision is made to carry out the treatment with extractions and with posterior anchorage loss in order to reduce the fulcrum without compromising the facial profile. As one of the upper first molars presented an irreversible periapical process in maxilla, both first upper molars were extracted and second and third molars were mesialized. In mandible, the lower second bicuspids were extracted.
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Fig. 20. Microimplants positioned mesially from the extraction spaces. The traction is carried out from distal side of molars to minimize the distal tipping of molar roots.
Fig. 21. Finished case.
Microimplants in Transverse Plane In Lingual Orthodontics, it is better to treat uni or bilateral cross bites before bonding the brackets.
Fig. 22. Modified transpalatal bar with lateral arm in contact with the problematic side. The microimplant stops the activation of the expansion from the loop towards nonproblematic side.
In case of unilateral cross bite which includes one or two teeth, a Modified Transpalatal Bar will be used with the additional loops to generate less quantity of force. The microimplant is inserted on the side of cross bite, and it is anchored towards the loop of Transpalatal Bar so that the expansive force goes exclusively to the cross bite side without the risk of appearance of unnecessary overexpansion in the opposite side (Fig. 21). In case of skeletal cross bites the use of expanders anchored to four microimplants allows to challenge the age in skeletal expansion of maxilla (Fig. 23).
Maximal anterior anchorage is carried out with microimplants to mesialize the posterior sectors (Fig. 20). At the end of the treatment, the bite closure is achieved, as well as the molar and canine classes (Fig. 21).
Microimplants in Lingual Orthodontics patients treated with orthognatic surgery For patients who need an orthognatic surgery and present lingual orthodontics, microimplants present a beneficial option both in intrasurgical management and in post surgery use of intermaxillary elastics.
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Dental Tribuna Books A case report of a young adult patient with lateromentonism and mandibular prognatism, depression of the facial mid third and vertical excess of the chin (Fig. 24). In occlusion, a bilateral molar Class III and right canine Class III can be observed (Fig. 25). The patient’s treatment of choice is upper lingual orthodontics, and lower labial orthodontics.
After the presurgical orthodontic stage of decompensation (Fig. 26), the mandible is centered and moved backward surgically, as well as the vertical chin reduction (Fig. 27) and the cheek bone prosthesis is added to compensate the depression of the facial mid third. The ends of the cheek bone prosthesis were sectioned and fixed in the perinasal area, which also presented depression (Fig. 28).
Fig. 23. Better transverse dimension and increased arch length are achieved thanks to the separation.
Fig. 24. Patient with facial asymmetry due to the lateromentonism and vertical mandibular excess.
Fig. 25. Right canine and bilateral molar Class III. Lower midline deviation to the left.
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Fig. 26. The occlusion was decompensated in order to obtain more negative overjet.
Fig. 27. Vertical reduction of chin.
Fig. 28. Cheek-bone implants (porex) were used to compensate the depression of the mid facial third. A section of prosthesis was fixed in paranasal area, to fill the surface.
Microimplants were especially useful for intrasurgical blocking during the mandibular fixation (Fig. 29).
When the postsurgical orthodontic phase was finished, the both facial and occlusal esthetic and functional objectives could be achieved (Figs. 30-31).
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Dental Tribuna Books
Fig. 29. Microimplants allowed the hold of surgical splint, the fixation of mandible, and they were also useful with intermaxillary elastics in post-surgical phase.
Fig. 30. Final occlusion. Molar and canine classes and matching midlines.
Fig. 31. The improvement of symmetry and in general harmony of the face can be seen.
Conclusions After we have analyzed the use of microimplants in different space planes, we can draw a conclusion that
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they should be included in orthodontic planning to make the orthodontic mechanics easier and to reduce therapy time.
Lingual Orthodontic Journal Bibliography Biomecánica y Estética. Estrategias en Ortodoncia clínica. Ravindra Nanda Editorial Amolca; 20-26-194195, 2007 Diagnostico en Ortodoncia-Estudio Multidisciplinario. Dr Pablo Echarri Lobiondo- Editorial Quintesensse; 419-431, 1998 Ortodoncia y Microimplantes. Técnica completa paso a paso. Pablo Echarri, Lorenzo Favero. 2º Edición. Editorial Ripano Ortodoncia interdisciplinar. Margarita Varela. Editorial Oceano/ergon Optimización de Elásticos Ortodoncicos – Michel Langlade- Editado por GAC Intl.2000. Mecánica en el tratamiento de ortodoncia y la aparatología de arco recto- J.C. Bennett- R. P. McLaughlin – Editorial Wolfe Publishing. Microimplantes en Ortodoncia.Jae-Hyun Sung. HeeMoon Kyung.Seong-Min Bae. Hyo-Sang Park. OhWon Kwon. James A. McNamara Jr. Alfredo T Alvarez. Editorial Providence ,2007. Nuevo Enfoque en Ortodoncia Lingual. Echarri. Takemoto. Scuzzo. Fillion. Geron. Kyung. Paz. Leclerc. Marigo.Ripano, editorial médica.2010.
Yi-Jane Chen-American Journal of Orthodontics & Dentofacial Orthopedics- Volumen 134, Numero 5 , Pag 636-645, Noviembre 2008 Anchorage capacity of osseointegrated and conventional anchorage systems: A randomized controlled trial- Ingalill Feldmann, Lars Bondemark- American Journal of Orthodontics & Dentofacial OrthopedicsVolumen 133, Numero 3 , Pag 339.e19-339.e28, Marzo 2008 Three-dimensional finite element analysis of the craniomaxillary complex during maxillary protraction with bone anchorage vs conventional dental anchorage- Xiulin Yan, Weijun He, Tao Lin, Jun Liu, Xiaofeng Bai, Guangqi Yan -American Journal of Orthodontics & Dentofacial Orthopedics-Volumen 143, Numero 2 , Pag 197-205, Febrero 2013, Comparison of treatment outcomes between skeletal anchorage and extraoral anchorage in adults with maxillary dentoalveolar protrusion-Chung-Chen,Jane Yao, Eddie Hsiang-Hua Lai, Jenny Zwei-Chieng Chang, I. Chen,Yi-Jane Chen-American Journal of Orthodontics & Dentofacial Orthopedics Volumen 134, Numero 5 , Pag 615-624, Noviembre 2008
Ortodoncia Lingual. R.Romano .Espaxis.2000.
Case report: bimaxillary dentoalveolar protrusion treated with lingual appliances and temporary anchorage devices-Kiyoshi Tai, Jae Hyung Park, MasahiroTanino, Kazuhisa Ikeda, -Journal Clinic of Orthodontics -Volumen 46: Numero 12: Pag. 739: Diciembre 2012
The effectiveness of differential moments in establishing and maintaining anchorage.- Ari Hart, Leo Taft, Saul N. Greenber American Journal of Orthodontics and Dentofacial Orthopedics. -Volumen 102, Numero 5, pag. 434-442, Noviembre 1992
Lingual applications of the midpalatal absolute anchorage system- Ryoon-Ki Hong, Seung-Min Lim, Jung-Min Heo, Seung-Hak Baek, -Journal Clinic of Orthodontics Volumen 46: Numero 6: Pag 344: Junio 2012
Three-dimensional dental model analysis of treatment outcomes for protrusive maxillary dentition: Comparison of headgear, miniscrew, and miniplate skeletal anchorage.Eddie Hsiang-Hua Lai, ChungChen Jane Yao, Jenny Zwei-Chieng Chang, I. Chen,
Case Report adult class II treatment using a new lingual bracket and skeletal anchorage-Marcos Gabriel Do Lago Prieto, MS, Carla Maria Melleiro Gimenez, Lucas Tristao Prieto - Journal Clinic of OrthodonticsVolumen 46: Numero 3 : Pag. 175: Marzo 2012
Protocolos en Ortodoncia: diagnóstico, planeamiento y mecánica. Claudio R, Azenha. Eduardo Macluf Filho. Editorial Napoleao.
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L
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New approach to lingual Orthodontics Authors:
Dr. Pablo Echarri Lobiondo Dr. Kyoto Takemoto Dr. Giuseppe Scuzzo Dr. Didier Fillion Dra. Silvia Geron Dr. Hee Moon Kyung Dr. Mario Paz Dr. François Leclerc Dr. Marcelo Marigo
428 pages in full color Dimensions: 21x29.7 cm Luxurious hard cover binding ISBN: 978-84-937793-0-6 Price: 120 euros - Shipping price for Europe: 36 euros = 156 euros - Shipping price for America: 46 euros = 166 euros
OFFER: 80 euros (shipping included)* PROLOGUE Having had two our previous two WSLO Congresses in two different continents, in New York in 2006 and Seoul in 2007, we held our 3rd biennial Congress in March of this year at Buenos Aires with South America as our 3rd new continent. I’m very glad that so many orthodontists could attend this Congress and could see the newest and the highest level of treatments in lingual orthodontics in the world. I would especially like to say thank you for the efforts of the chairman Dr. Pablo Echarri, Dr. Adriana Pascual and Dr. Fernanda Elgoyhen, the Presidents of SAO and SAOL. Furthermore, I would like to say a very big thank you to all the staff and volunteers, too many to name individually here, who worked so hard to make the 2009 congress such a success. I think that everybody appreciates that putting together such a good event takes a great deal of work and dedication. In addition, I sincerely hope that everybody will appreciate that this book is the result of many hours of work and research by the speakers at the Congress who gave us so many excellent presentations. These speakers have greatly helped in our mission to advance the art and science of lingual orthodontics and to help us to promote the use of lingual orthodontics throughout the world. I hope everybody will make the best use of this book to understand current trends in lingual orthodontics. I hope everybody will take the opportunity to present their ideas and help extend the art and science of lingual orthodontics when we hold our next Congress which will be in Osaka, Japan in April 2011. The WSLO is always seeking to achieve the highest possible quality of lingual orthodontics. Let us look forward together to a promising future.
ORDERS: You can order the book, indicating the offer, by: • E-mail: ripano@ripano.eu • Phone: (+34) 91 372 13 77 • Fax: (+34) 91 372 03 91 • Mail: Ripano S.A. Ronda del Caballero de la Mancha, 135 - 28034 Madrid (Spain) • On-line: www.ripano.eu *Offer is valid while supplies last.
CONTENTS 1. Pascal Baron, Cristophe Gualano. Anchorage control performed with mini-screws and the LingualjetTM appliance 2. Regina Bass. Anchorage in lingual orthodontics 3. Germain Becker. Clinical pathways in lingual orthodontics 4. Tamar Brosh y col. Theoretical analysis of maxillary incisors movement due to antero-posterior force: labial vs. lingual orthodontics 5. Julio Cal-Neto. Advantages of the straight wire technique in lingual orthodontics 6. Asif Chatoo. Interdisciplinary management of adult patients with lingual braces 7. Claudia Correga Andreica y Dario Bertossi. Tissue reaction to light orthodontic forces – a comparison of STb versus Damon appliance 8. Juan Carlos Crespi y Marcos López Rubio. Study group of lingual orthodontics (SGLO). Starting the way 9. Antonio D’Alessandro y Livia Nastri. Advanced active retainer: fixed lingual orthodontics with no brackets 10. Rubens Demicheri. Leveling and systemized treatment mechanics with the Magic® Lingual system 11. Pablo Echarri. Skeletal anchorage in lingual orthodontics 12. Mª Fernanda Elgoyhen y José Carlos Elgoyhen. Therapeutic alternatives with lingual orthodontics 13. Ryuzo Fukawa. Lingual orthodontics in the new era: Treatment according to criteria for occlusion and aesthetics 14. Ricardo Gallardo. Retraction of lower anterior teeth with reduced anchorage loss without using miniscrews 15. José Gaspar y Vivian K. Granadino Gaspar. 20 years of lingual orthodontics in Brazil 16. Silvia Geron. Management of the vertical dimension in severe anterior open bite (AOB) 17. Alfredo Gilbert Reisman. A new in-house lingual bracket transfer system 18. Ana González Blanco. Clinical management of the lingual orthodontic appliance 19. Diana Grandi. Lingual orthodontics and speech – language therapy: the benefits of interdisciplinary team work 20. Julia Harfin. Paradigms in lingual orthodontics 21. Chiori Hashiba. Incisal embrasure and incisal edge: their efficacy of the aesthetic appearance of maxillary anterior teeth 22. Mª Esther Hidalgo. Clinical and laboratory evolution in lingual technique 23. Toru Inami. Clinical standards of the establishment for facial balance and harmony in lingual bracket orthodontic technique 24. Aurelio Jano Takane. Goodbye mushroom 25. Hee-Moon Kyung. Lingual plain wire appliance and microimplant anchorage 26. Hee-Moon Kyung. Microimplants as anchorage in orthodontics 27. Roberto Lapenta. How to obtain success with lingual orthodontics? 28. Jean François Leclerc y col. Partial case report: how to manage lingual treatment with an edentulous anterior teeth patient? 29. Christophe Lesage. Mini screws in orthodontics: contribution of the 3D cone beam in surgical technique 30. Hatto Loidl. Selfligation in lingual technique 31. Marcos López Rubio. From simple to complex 32. Marcelo Marigo y Valter Arima. A new concept for lingual bracket – a point of view 33. Francisco Martino. Lingual orthodontics FAQ 34. Isao Matsuno. Surgical orthodontic treatment in lingual orthodontics 35. Carla Melleiro y col. Evaluation of cephalometric alterations noted during the lingual orthodontic treatment 36. Eliakim Mizrahi. Miniscrews, auxiliaries and lingual orthodontics 37. Nayre Mondino. Class II. Treatment – lingual orthodontics 38. Ramiro Moreno. Small movements and laboratory procedures 39. Magali Mujagic. Lingual orthodontics for each patient: a reality in a daily practice 40. Christine Muller. Contribution of micro-screws to Class II treatment 41. Marino Musilli. The interdisciplinary approach with the bracketless fixed orthodontics 42. Manabu Nakagawa. Bracket “Evolution”: characteristics and case reports 43. Carlos Navarro y col. Development of the “In-Ovation-L” bracket from GAC 44. Thomas Örtendahl. Clinical experience of selfligated aesthetic directbond lingual bracket 45. Mª Giacinta Paolone y col. Lingual orthodontics: a means for osseous and tissue regeneration, conventional treatment and forced eruption 46. Mª Elsa Pavic. Vertical management in lingual technique: advantages and disadvantages 47. Mario Paz. Lingual and other accessory aesthetic techniques 48. Lucas Prieto. Prieto’s hygiene-friendly pendulum 49. Marcos Prieto. Prieto Lingual Straight-Wire Bracket (PSWb) 50. Caterina Pruzzo. Progress in lingual orthodontics, 8 years of clinical experience 51. Ronald Roncone. Lingual you will love 52. Florence Roussarie. Microscrews and the lingual system: an efficient working combination for the patient 53. Toru Shigeeda. Where is the best placement of micro implants, mid-palatal or alveolar bone or both? 54. Kyoto Takemoto y Giuseppe Scuzzo. New STb lingual straight wire method 55. Rita Thurler y col. Aluminum oxide – to use or not to use? 56. Henrique Valdetaro. Lingual orthodontics: problems and solutions 57. Emma Vila Manchó. Lingual orthodontics lesions vs. labial orthodontics lesions 58. Milena Zulic. Miniimplants as biomechanical auxiliaries in lingual orthodontics
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