Dr David Sotomayor Z ď Ž The idea of being an Orthodontist goes beyond
straightening teeth, you have to be a philosopher, you have to have a certain perspective of life, you have to think that if we learned this art, it was to put it to work in favor of the most needy and not Only the richest. For these and many more reasons "Robert Ricketts" is considered by many "the best orthodontist in the world", and I consider myself fortunate to follow its guidelines and philosophy, which was taught to me by my teachers who had been a student of Ricketts. Below I will briefly explain his 10 philosophical principles.
Principles of therapy bioprogressive ď Ž 1 - Use of systematic access for diagnosis and treatment by
the application of VTO (Visual Treatment Objective) in the plane of treatment, anchor evaluation and results information. 2 - Torque control from the beginning to the end of the treatment. 3 - Muscle and cortical bone anchorage. 4 - Movement of any tooth in any direction with application of the right pressure. 5 - Orthopedic alteration. 6 - Treatment of vertical overbite (overbite) before correction horizontal (overjet). 7 - Treatment with sectioned arch. 8 - Concept of overtreatment. 9 - Correction of malocclusion in a progressive sequence of treatment, in order to restore or restore normal function. 10 - Efficiency in the treatment with quality results, using pre-fabricated devices.
1 - Use of systematic access for diagnosis and treatment by the application of VTO (Visual Treatment Objective) In the treatment plan, anchorage evaluation and information of results. It is not so simple, although it is absolutely viable. Requires full knowledge of the patient's current conditions, conditions that preceded the growth, and the professional must know deeply the specific effects of the treatment. Know the growth and take advantage of this. The opposite can aggravate the treatment.
2 - Torque control from the beginning to the end of the treatment. ď Ž The use of brackets .018 x .030 gives us the conditions for
that control, considering that the thread To be used it must be the Elgiloy .016 x .016. It should be noted that Dr. Ricketts was already aware and welcome in the 70s and 80s of the advent of new biomaterials, which today can perfectly replace the traditional Elgiloy. The importance of that is that during the treatment we meet different needs of mobilization of the roots. That is to say: 1- Keep roots in the trabecular bone for efficient mobilization. 2- Place the roots against the dense cortical bone for anchoring. 3- Remodeling of the cortical bone. Certain dental movements require the possibility of torque.
Torque control from the beginning and all of treatment
ď Ž a- Retraction of the upper and lower incisors.
b-Upper canines impacted on the palate or in the vestibule. c- Torque movement in the roots of the upper incisors. d-Intrusion of the lower incisors with roots in the cortex without the possibility of torque. e-Mesialization of the lower molars for closing existing spaces as consequence of retraction. 4- Placement of the teeth in the ideal occlusion. The correct position of the roots determines the best system operation and offers better stability
3 - Muscle and cortical bone anchorage. Muscle anchorage ď Ž The muscle anchorage in bioprogressive therapy is
observed and analyzed according to the biotype of the patient. It is necessary that previous analysis to know if we add or decrease the anchorage of the mechanics. The clinic, which is sovereign, shows us that brachifacial muscles have stronger muscles and dolichofacial weaker. Therefore, the former are better able to overcome the undesirable forces of mechanics.
Bone anchorage ď Ž Knowing that the teeth move more slowly in
the cortical bone, the bioprogressive one uses that knowledge to reinforce or even perform anchoring. The slow migration of the tooth in the Cortical bone is mainly due to the low blood supply, a key factor for the transport of the cellular elements that reabsorb and form
ď Ž Observe in the figures the thickness of the bony cortex
in the region of the first molar
4 -Mobilization of any tooth in any direction with application of adequate pressure. ď Ž The mobilization of a tooth in any direction can seem
difficult, mainly if the necessary movement was the intrusion. For some clinicians, up the intrusion of the incisors is a problem, judging from the impending recurrence. We discussed in the previous principle that the blood supply is the reason important for dental mobilization. Therefore, if the forces exerted were exaggerated, promote ischemia and, consequently, dental displacement will be harmed by the deficiency of osteoclastic actions and osteoblastic. In the bioprogressive, the forces can be absolutely measured.
Each tooth has its respective amount of force for an optimal and biological movement
5 -Orthopedic alteration ď Ž Bioprogressive therapy subscribes, anticipates and draws up a plan for orthopedic
alterations as part of of your treatment procedures. If there is an orthopedic alteration, there will be changes in the support structure of the maxilla, in as opposed to the movement of the tooth in the specific area of the alveolar process. In the last thirty years, research reports show alteration of the maxilla in the direction of growth through the use of extra-buccal devices that use a force of 450g. The palatal suture can be separated and expanded by several devices, promoting alterations orthopedic Mobile devices are also cited in recent reports as able to promote orthopedic changes. The understanding of the reaction of the supporting musculature is important in the planning of the alteration orthopedic In the construction of VTO and in its use, in the plane of treatment procedures, the orthopedic change is considered in the second overlap area, to analyze the point A and the modification of the palate decline. These influences also affect the decline of the nose and even the soft tissue profile
orthopedic appliances
6-Treat the intercross before the Overjet This stage of treatment and philosophical principle of ricketts explains that if we have a clinical situation and confirmed cephalometrically, where we have simultaneously increased overjet and increased overbite. We will first treat the overbite before the overjet or sagittal location (incisive protrusion).
7- Use of sectional arches ď Ž This principle intuits that not all dental
alterations appear bilaterally equal. That is, we indicate treating only the affected sector with non-continuous arcs until stabilizing or balancing the occlusion bilaterally.
8- Concept of overtreatment
ď Ž We basically over-treat certain malocclusions
due to their physiological and / or genetic tendency to recurrence after of the final treatment. This will depend on the initial diagnosis .
overtreatment
9- Treat the malocclusion, in a progressive sequence to reach the normal function. We will treat all the dental alterations in a hierarchical sequence and in order thus the present functional alterations and later the dental commitments guided by the aforementioned principles
10- Efficacy of the treatment by prefabrication of appliances Each diagnosis and patient is completely different and their malocclusions must be treated as such. A biomechanical appliance and plication will be preprogrammed for its effective and optimal result.
Dr Ricketts in some of the last conferencia. Buenos aires Argentina Nov 2001. ď Ž
In past years I had the good fortune to attend a course with Dr. Robert Ricketts, considered by many to be the father of Modern Orthodontics. Ricketts is essentially a researcher who has revolutionized the operative and diagnostic techniques in today's orthodontics. A native of the United States and an orthodontist since the 1940s, Ricketts learned orthodontics practically "from those who invented it" at the beginning of the century, and within a few years he had already found "failures" to the orthodontic principles of the orthodontics. discoveries made that over the years their same teachers ended up being ... their disciples. Ricketts had as teachers the gods of Orthodontics, Stainer, Nance, Brody, Tweed, who taught him his once famous cephalometries
Dr. Robert M. Ricketts (May 5, 1920 - June 17, 2003)