Download Orthodontic Aesthetic

Orthodontic
Perspectives
Vol XVIII No. 2
Clinical Information for the Orthodontic Professional
Aesthetic
Treatment
ADVANCED
Dr. Patrice
Pellerin
Dr. Adam
Schulhof
Dr. Haroutioun
Dedeyan
Featuring:
• Welcoming a New Addition to the
Clarity™ Brand Family of Aesthetic Brackets
by Dr. Patrice Pellerin3
• Clarity ADVANCED Ceramic Brackets
A Technical Perspective
by Nicole Wagner, Bill Wyllie,
and Glenys Thorstenson
6
• The Incognito Appliance System and
Successful “Limited” Treatment
by Dr. Adam Schulhof 9
™
™
SEPTEMBER 2011
Dr. Lars
Christensen
Dr. Hugo Trevisi
Sonja Alexander
• Why the Incognito™ System is My Choice
by Dr. Haroutioun Dedeyan16
• Accurate Vertical and Axial Bracket Positioning
by Dr. Lars Christensen and Dr. Hugo Trevisi 21
• Evaluation and Adoption of Transbond™ IDB
Chemical Cure Adhesive
by Sonja Alexander 24
Orthodontic Perspectives
is published periodically by
Message from the President
3M Unitek to provide information
to orthodontic practitioners about
3M Unitek products. 3M Unitek
welcomes article submissions or
article ideas. Article submissions
should be sent to Editor,
Orthodontic Perspectives,
3M Unitek, 2724 South Peck
Road, Monrovia, CA 91016-5097
or call. In the United States and
Puerto Rico, call (800) 852-1990
ext. 4399. In Canada call
(800) 443-1661 and ask for
extension 4399. Or, call
(626) 574-4399. Copyright
© 2011, 3M. All rights reserved.
No part of this publication may be
reproduced without the consent
of 3M Unitek. AlastiK, Clarity,
Forsus, iBraces, Incognito, MBT,
SmartClip, Transbond, Unitek and
Victory Series are trademarks
of 3M. Other trademarks are
property of their respective holders.
Visit our website at
www.3MUnitek.com
Bill Cruise
President
“Aesthetic Treatment Advanced.” This bold title has hopefully elicited your curiosity
about the articles herein, and has enticed you to read them to see what the excitement
is all about. As you go through the issue, I think you will see that we did not use the word
“advanced” lightly.
This edition begins with an introduction to the newest member of the Clarity™ brand
family of aesthetic treatment solutions: Clarity™ ADVANCED Ceramic Brackets.
This groundbreaking appliance uses new ceramic material and 3M technology to
expand on the Clarity brand heritage of aesthetics and performance. It features a new
small size along with enhanced comfort and a brilliant appearance. Dr. Patrice Pellerin,
who leads off this issue with a discussion of the new bracket, summed it up by simply
saying “wow.”
But “advanced” doesn’t apply only to the new Clarity brackets. Two articles follow
featuring the unique Incognito™ Appliance System. In his article, Dr. Adam Schulhof
says “the Incognito System …continues to be a driving force in my practice, setting us
apart and helping to grow us beyond all projections.” And Dr. Haroutioun Dedeyan says
of the system, “I have the choice to offer the most tolerable, secure, effective, invisible
treatment to my patients… and the freedom to treat, with high precision, all kinds of
orthodontic problems.”
Additional articles include a discussion of accurate bracket positioning within the
MBT™ Versatile+ Appliance System, and we hear one staff member’s account of the
adoption of the recently introduced Transbond™ IDB Chemical Cure Adhesive. Transbond
IDB adhesive is designed to offer advantages in indirect bonding applications and is
recommended for the Incognito System.
When you make the choice of treatment solutions you will use in your office, consider
the broad range of products available to you from 3M Unitek. They all carry the
3M commitment to quality and service that orthodontists around the world trust. We
think you (and your patients) will agree with us that, for many reasons, they deserve the
“advanced” designation.
Just an aside in closing, I am now in the ninth month of my own treatment with the
Incognito System, and the progress has been outstanding. Take a look at the story of
my treatment by visiting www.hiddenbraces.com.
2
Welcoming a New Addition to the Clarity™ Brand
Family of Aesthetic Brackets
by Dr. Patrice Pellerin
Dr. Patrice Pellerin
received his
post graduate
Certificate in
Orthodontics
in 1991 from
the University of Montreal. Before
orthodontics, he practiced general
dentistry for four years after earning
his dental degree from the University of
Montreal in 1985. Since 1991, he has
maintained a solo private practice in
Lachine, Quebec. In 1998, Dr. Pellerin
converted his practice to a fully aesthetic
practice. He has lectured in North
America, Europe and Mexico to share his
practice philosophy of highest aesthetics
without compromise to accomplish
treatment. He has been an active member
on the 3M Unitek Advisory Committee for
If this is not your first time going through an Orthodontic Perspectives magazine, you’ve
probably seen my name before. Or even better, you have read articles I have written related
to the use of Clarity™ Ceramic Brackets in my practice.
But if this is your first time, you should know that, since 1998, my goal has been to use
aesthetic appliances on 100% of the cases we start in my practice.
From the beginning, Clarity™ Metal-Reinforced Ceramic Brackets were our appliance of
choice. In 2007, we were able to offer an aesthetic self-ligating option with the introduction
of Clarity™ SL Self-Ligating Brackets. We still use both of these brackets in our practice.
And recently, we have been able to test the newest addition to the Clarity Bracket family,
Clarity™ ADVANCED Ceramic Brackets.
Taking a Closer Look
As you will notice, the new Clarity ADVANCED Bracket is a twin, ligated bracket. It would
be tempting at first to say, “Well, this is just another clear bracket.” But that would be a big
mistake, because the Clarity ADVANCED Brackets are a completely new, technologically
developed bracket.
The first new features of note are the material (ceramic) and the injection-molding process
used to fabricate the bracket. You will immediately notice the aesthetic advantages, a
translucent look which makes it discreet on the labial surface of the tooth. The other big
aesthetic factor that makes the new Clarity ADVANCED Bracket more discreet is that there
is no need for a metal liner (Figure 1-2).
Aesthetic Appliances since 2003, as well
as a 3M Unitek Advocate for the use of
their aesthetic appliances since 2004.
1
Figure 1 Upper Lateral Clarity™ ADVANCED
Ceramic Bracket.
2
Figure 2 Side profile of an Upper Cuspid
Clarity™ ADVANCED Ceramic Bracket.
3
Even more important for the clinician and for patient comfort is the
fact that the profile of the new Clarity™ ADVANCED Ceramic Bracket
is the same as the profile of a Victory Series™ Low Profile Bracket
(Figure 3, Table 1). On average, the profile of the new Clarity
ADVANCED Bracket is smaller than the profiles of its counterparts
in the Clarity™ Ceramic or Clarity™ SL Self-Ligating Bracket series.
In fact, all of our patients mentioned the comfort of the new Clarity
ADVANCED Bracket after their bonding appointment.
5
Figure 5
Figure 3 Victory Series™ Low
Profile Bracket.
I think that most will agree that, of the many benefits of Clarity
Brackets, the ease of debonding is paramount, and is a result of
the unique stress concentrator on the base. You will be happy to
see that this benefit is still in full force in the Clarity ADVANCED
Brackets (Figure 6).
3
Figure 6 Base of Clarity™ ADVANCED
Ceramic Bracket with stress concentrator.
In-Out Dimensions
Clarity
ADVANCED
Ceramic
Brackets
Victory
Series™
Low Profile
Brackets
Clarity™
Ceramic
Brackets
Clarity™ SL
Self-Ligating
Brackets
U Central
0.026
0.026
0.048
0.044
™
Tooth
U Lateral
0.035
0.035
0.058
0.058
U Cuspid
0.021
0.021
0.041
0.030
U Bicuspid
0.029
0.029
0.041
0.033
L Anterior
0.045
0.045
0.060
0.060
L Cuspid
0.020
0.020
0.031
0.029
L 1st Bicuspid
0.030
0.030
0.041
0.029
L 2nd Bicuspid
0.034
0.034
0.041
0.033
6
To ensure debonding success, it is important to use the
recommended debonding plier (Figure 7).
Figure 7 Recommended debonding
instrument (REF 804-170).
Table 1 Comparison of In-Out Dimensions of 3M Unitek brackets.
The redesigned shape of the tie-wings makes it easier to tie an
AlastiK™ Ligature or a power chain (Figure 4-5). There will be a
learning curve to use double auxiliaries (for example, a Kobayashi
hook and a power chain), because the space between the labial
surface of the tooth and the tie-wing is minimal due to the low
profile of the bracket. This is a minor compromise when compared
to the added comfort for the patient. However, as I always say,
“Anything you say beforehand will be perceived as information;
anything you say afterward will be perceived as excuses.”
7
If ever you experience a problem when debonding your Clarity or
Clarity SL brackets, take notice of the instrument you are using.
The recommended debonding plier is designed to apply pressure
at a specific point on the side of the bracket that makes debonding
child’s play.
Let’s also discuss ease of bonding. From a clinical standpoint, the
importance of precise bonding goes without saying.
From the abundance of articles published on the subject, one could
certainly argue the clinical benefits of indirect bonding versus direct
bonding technique. However, for this discussion to be as fair as
possible, your bracket needs to be easy to position. Are the axes of
your bracket easy to visualize?
4
Figure 4
4
The new Clarity ADVANCED Bracket includes easily-soluble
horizontal & vertical reference markers for easy bracket placement
(Figure 8). Your patient will only be required to brush his/her teeth
and rinse to remove these markers (Figure 9-10).
Figure 8 Water soluble horizontal
and vertical reference markers on the
Clarity™ ADVANCED Ceramic Bracket.
Figure 9 Before rinsing/brushing.
10
Figure 10 After rinsing/brushing.
You will also find on Clarity ADVANCED Brackets the glass gritbonding base that enhances the bond strength of Clarity Brackets.
In addition, the bonding base has been improved for optimal tooth
fit and the base flange is designed for easy placement and adhesive
flash clean-up, for both direct or indirect bonding use (Figure 11-12).
11
Figure 11 Direct bonding.
A new generation of beauty and performance has been introduced
into the Clarity bracket family, in the form of Clarity ADVANCED
Brackets. With its brilliant aesthetics, low profile design, predictable,
consistent debonding, and enhanced patient comfort, the Clarity
ADVANCED Bracket is one more option for your patients asking for
the best in the aesthetic/cosmetic orthodontic treatment.
As for the other members of the Clarity bracket family, they still
have their specific indication in my practice. A traditionally ligated
Clarity bracket is still my appliance of choice for Phase 1 interceptive
treatment when we align the four front incisors, or for younger kids
or teens that prefer using colored ligatures. Clarity SL Self-Ligating
brackets will be my choice for adult patients who are smokers or
heavy coffee or tea drinkers, to avoid elastomeric discoloration. It
will also be my appliance of choice for patients who live far from
the office, since it is easier to increase the time between their
adjustment visits with the Clarity SL Self-Ligating Brackets.
8
9
Conclusion
12
Figure 12 Indirect bonding.
As for the newest member of the family, Clarity ADVANCED
Brackets, I am very happy with what I have seen so far. The concept
is great and the aesthetics, without a doubt, are a “wow.” Although
early in our evaluation process, I can say that detailing will not be a
challenge (Figure 13). I can conclude that there are no flaws with
the new appliance.
13
Figure 13 Steps bends introduced into an intercept case using Clarity™ ADVANCED
Ceramic Bracket.
Case photos provided by Dr. Patrice Pellerin.
5
Clarity™ ADVANCED Ceramic Brackets
A Technical Perspective
by Nicole Wagner, Bill Wyllie, and Glenys Thorstenson
Nicole Wagner is a
Senior Technical Service
Engineer at 3M Unitek.
She received her B.S.
in Chemistry from the
State University of New
York at Stony Brook. Her M.S. and Ph.D. are
in Mechanical Engineering from the University
of Minnesota, where her research focused
on synthesis, characterization, and reaction
modeling of hard, wear-resistant ceramic
materials. She has been at 3M since 2007,
joining 3M Unitek in 2010.
Bill Wyllie is a
Product Development
Specialist at 3M Unitek.
Introduction
As more patients seek a more aesthetic orthodontic treatment,
orthodontists still demand functionality in their orthodontic
appliances. Through various discussions with orthodontists
and assistants, the 3M Unitek product development
team assessed that ceramic brackets need to maintain
the characteristics of aesthetics, small physical size,
strength, predictable debonding, and a design that is
comfortable to patients. New Clarity™ ADVANCED Ceramic
Brackets incorporate these features into a revolutionary design to
give orthodontists the aesthetics and efficiency they require.
Bracket Material and Design
Advances in materials, manufacturing technologies, and bracket design have enabled new
levels of performance in the Clarity brand of aesthetic brackets. Clarity ADVANCED Ceramic
Brackets are made of polycrystalline alumina, which consists of small crystals, called
“grains” (Figure 1A-B). As the size of these grains decreases, the strength of the ceramic
material increases (Figure 2). Clarity ADVANCED Brackets are made of the same material
He is active in the
development of new
aesthetic materials
for brackets, and has worked on a variety
of product development teams such as
SmartClip™ and Clarity™ SL Self-Ligating
Brackets and Forsus™ Class II Correctors.
He received his B.S. in Materials and
Metallurgical Engineering from the University
1A
1B
Figure 1A-B Average alumina grain size of (A) 15 μm (Clarity Metal-Reinforced Ceramic Bracket) and
(B) 0.9 μm (Clarity™ ADVANCED Ceramic Bracket).
™
of Michigan and his M.S. and Ph.D. in Materials
Engineering from Rensselaer Polytechnic
Institute. He has been at 3M Unitek since 1997.
Glenys Thorstenson
received her B.S. in
Materials Science
and Engineering
from Michigan State
University and her
Ph.D. in Biomedical Engineering from the
University of North Carolina at Chapel Hill.
Her dissertation focused on the resistance to
sliding of novel orthodontic bracket systems.
She has been at 3M Unitek since 2003.
6
2
Figure 2 As average grain size decreases, strength of material increases.
as that used in Clarity™ SL Self-Ligating Brackets, which is a finergrained ceramic than the leading polycrystalline ceramic brackets.
In addition, the finer grain size of the ceramic material in Clarity™
ADVANCED Ceramic Brackets improves its inherent material
strength as compared to the material used in Clarity brackets.
Therefore, as seen in tie-wing crush strength testing, while overall
smaller in size, the strength of the Clarity ADVANCED brackets
is comparable to Clarity brackets. Also, since the material is the
same as that used in Clarity SL brackets, the material is proven
to resist staining to various staining agents throughout the course
of treatment. In addition, the translucent material of the Clarity
ADVANCED brackets blends with the color of various tooth shades.
Clarity ADVANCED brackets are fabricated by an injection-molding
process. This method permits the creation of smooth, rounded
corners designed to reduce binding and notching at the bracket
slot corners. Binding is an element of friction that contributes to
the resistance to sliding when the archwire is in contact with the
corners of the bracket slot. It is impacted by the materials and
geometries of the archwires and brackets, and does not depend on
the force applied by the ligature1.
Another factor that contributes to friction is notching, which is
the resistance to sliding when the bracket permanently deforms
the archwire. Most often, notching is due to the ligature force and
occurs on the lingual side of the archwire. However, notching can
also occur on the occlusal or gingival sides2. Images of bracket slot
corners of Clarity ADVANCED brackets and other ceramic brackets
that are currently on the market are shown in Figure 3A-D. The
bracket slot corners of the Clarity ADVANCED brackets appear to be
more rounded and smooth compared to the other ceramic brackets.
3A
3B
3C
3D
To allow for an increased inter-bracket distance, Clarity ADVANCED
brackets are designed to have small mesio-distal dimensions. For
reduced occlusal interference, Clarity ADVANCED brackets have
small occlusal-gingival dimensions. In addition, Clarity ADVANCED
brackets feature a generous under-tie-wing area to allow for both
single- and double-ligation. Of the doctors surveyed during a
ligation study (3M Unitek), 91% found that the Clarity ADVANCED
brackets easily accommodate double-ligation.
Bonding Base and Predictable Debonding
The bonding base of Clarity ADVANCED brackets has been designed
with a tooth-specific anatomy, similar to Clarity and Clarity SL
brackets, to contour to the shape of patients' teeth and provide
a better fit to each tooth. Also, similar to Clarity and Clarity SL
brackets, Clarity ADVANCED brackets have a micro-crystalline
surface on the base to create a mechanical bond with the adhesive
(Figure 4).
Figure 4
Clarity™ ADVANCED
Ceramic Bracket bonding
base with stressconcentrator.
4
To maintain the predictable debonding that orthodontists are
accustomed to with the Clarity brand of brackets, the new Clarity
ADVANCED ceramic brackets also feature the proprietary stressconcentrator vertically along their bracket base (Figure 4). When
debonding a bracket, the adhesive first breaks at the edge of the
bracket, initiating a crack that continues through the adhesive
layer along the bracket base, after which the stress-concentrator
collapses the bracket vertically in half3. With a mesial-distal
‘rocking’ motion, first towards the half of the bracket where
the adhesive first broke, then towards the other half, the Clarity
ADVANCED bracket can be removed entirely from the tooth. The
recommended debonding tool is the same as that used for Clarity
SL brackets, namely the Unitek™ Self-Ligating Bracket Debonding
Instrument. To remove a bracket, this instrument is inserted in the
labial side of the bracket with the instrument blade along the vertical
Figure 3A-D Bracket slot corners of (A) 3M Unitek Clarity™ ADVANCED,
(B) American Radiance™, (C) GAC Mystique™, and (D) Ormco Inspire ICE™ Brackets.
7
center slot and its ledges seated on the tie-wings. Using the mesialdistal squeeze debonding technique, Clarity™ ADVANCED Ceramic
Brackets can be debonded on or off the archwire (Figure 5A-B).
When debonding on the archwire, the ligature supports the collapsed
bracket halves. Care should be taken to grasp and hold the collapsed
bracket when debonding off the archwire.
The low profile design of Clarity ADVANCED brackets aims to
provide patients with enhanced comfort. In addition, the low profile
of lower anterior Clarity ADVANCED brackets reduces occlusal
interference, giving orthodontists more flexibility to use ceramic
brackets on a patient’s lower arch. Clarity ADVANCED brackets have
an in/out dimension that is compatible with that of Victory Series™
Low Profile Brackets.
Conclusions
5A
5B
Figure 5A-B Debonding Clarity ADVANCED Ceramic Brackets using the
Unitek™ Self-Ligating Bracket Debonding Instrument either (A) on or (B) off the archwire.
™
Patient Comfort
Clarity ADVANCED brackets are a new generation of ceramic
brackets with both aesthetics and functionality. The aesthetics of
the bracket are enabled by its translucent fine-grained alumina
material and low-profile design. The smooth, rounded features of
the bracket can both reduce binding and notching during treatment
and assist with increasing patient comfort. With these features and
the predictable debonding that remains a key feature of the Clarity
brand, the Clarity ADVANCED bracket system provides an excellent
aesthetic solution for both patients and orthodontists.
References
Clarity ADVANCED brackets are designed to provide enhanced
patient comfort. By using an injection-molding process, smooth,
rounded corners are created. The dome-shaped design and
rounded bi-directional ball hooks are intended to further improve
patient comfort.
1.Thorstenson GA, Kusy RP, “Effect of archwire size and material on the resistance
to sliding of self-ligating brackets with second-order angulation in the dry state”
Am J Orthod Dentofacial Orthop 2002; 122: 295-305.
2.Articolo LC, Kusy K, Saunders CR, Kusy RP, “Influence of ceramic and stainless
steel brackets on the notching of archwires during clinical treatment” Eur J
Orthod 2000; 22: 409-425.
3.Hansen J. “Ceramic Orthodontic Bracket with Debonding Channel” US Patent
Number 5439379, 8 Aug 1995.
Save
the
Date!
Make plans to join us for the 15th Annual
3M Unitek Summit in Las Vegas
We will review the latest technology, techniques, and tools
designed to help practitioners provide efficient treatment
with healthy and aesthetic results.
8
Dr. Lars
Christensen
February 24-25, 2012
Wynn Las Vegas – Las Vegas, Nevada
Featuring:
Dr. Hugo
Trevisi
More Than Straight Teeth:
Healthy and Aesthetic Results
For Doctors and Staff – CE Credits Apply
Dr. Mark
Berkman
Dr. Fredrik
Bergstrand
Dr. John
McDonald
For More Information
and to Register visit
www.3MUnitek.com
The Incognito™ Appliance System and
Successful “Limited” Treatment
by Dr. Adam Schulhof
Dr. Adam Schulhof
is a board-certified
orthodontic
specialist who
runs a state
of the art
private practice in Oradell, NJ. He’s a
co-founder of Kindersmiles, a practice
that specializes in the use of advanced
aesthetic technologies, such as the
Clarity™ SL and Incognito™ Appliance
Systems. More recently, he established
the Center for Cosmetic Orthodontics,
a practice that uses digital imaging,
advanced computer graphics and other
cutting edge technologies to provide
aesthetic and customized solutions for
his patients. Dr. Schulhof is a recognized
leader in the field of lingual orthodontics
and lectures frequently in the United
States and Internationally. He’s actively
involved in research and development
“It was the best of times, it was the worst of times, it was the age of
wisdom, it was the age of foolishness…it was the spring of hope,
it was the winter of despair…”
I’ve often marveled at how accurately the opening paragraph of Charles Dickens famous
tome describes the infancy of lingual orthodontics. Although those early years were fraught
with problems, the dedication of those early pioneers has given way to the Incognito™
Appliance System, the truly viable lingual orthodontic appliance system we use successfully
in our practice today.
Opening a new start up practice the day after leaving the motherly embrace of my
residency program, I was in for quite a shock. Perhaps I did spend too many hours
watching James Earl Jones tell Kevin Costner “people will come, Ray.” Who can blame
me? The voice of Darth Vader set to an orchestra, building in the background, it’s enough
to make anyone believe.
Realistically though, “If you build it they will come” does not a practice make. Fortunately,
I recognized the impact of emerging markets on our profession. It was clear that the adult
market was a force to contend with. The problem was that as a profession, we were illequipped to handle them. We needed better tools to satisfy their needs as well as ours.
Having treated a large number of patients with clear aligners, it was “clear” to me that in
a majority of cases they did not perform to our standards. And so, off I went on a journey
through the land of lingual. Within two years, and multiple appliance systems, it was
apparent that the Incognito Appliance System (at that time called iBraces™) stood head and
shoulders above the pack. Even in its infancy, the customization and phenomenal wire/slot
interface allowed for wonderful results (see Case 1).
continuing to improve and evolve lingual
orthodontics. Dr. Schulhof earned his
DMD degree from the University of
Medicine and Dentistry of New Jersey
and was inducted into the Omicron
Kappa Upsilon dental honors society.
He attended Columbia University for his
Orthodontic specialty training. Dr. Schulhof
is currently in the process of creating a
Lingual Orthodontic Program for many
universities in the United States.
9
Case 1
1A
1B
1D
1C
1E
1F
Figure 1A-F: Our earliest Incognito™ (iBraces™) Appliance System case. Patient presented asking for Invisalign . Due to the anterior crossbite and crowding, without a
tremendous amount of IPR, Invisalign could not achieve a good result. This case requires torque control and expansion. IPR to these small narrow incisors is contraindicated.
®
2A
2B
2D
2C
2E
2F
Figure 2A-F: Treatment with Incognito Appliance System took 8 months and patient was ecstatic. Notice the amazing torque control of the lower incisors. No IPR was performed.
™
Looking back, I will say with confidence that the Incognito™
Appliance System has been and continues to be a driving force in
my practice, setting us apart and helping to grow us beyond all
projections. It takes diligence, effort, practice, continuing education
and passion, all a small price to pay for giving patients what they
truly desire while satisfying our own high standard of care.
As the years went on it soon became apparent that within our typical
practice we had created another entity, an adult practice. A very wise
man once said, “with great power comes great responsibility” (OK so
it was Spiderman). Well I was finding out with a great adult practice,
comes… a whole new set of rules. One of the most blatant was the
need to acquiesce to – I’ll dare to say it – “limited treatment.”
We are changing lives…truly. It’s easy in the course of our busy
days and lives to forget this. Seeing so many adults on a daily basis,
though, puts it front and center. When a patient turns to you with tears
in their eyes to thank you, nothing beats that feeling. Adolescents
barely acknowledge how you’ve helped turn them from the awkward
duckling into a swan. An adult patient however, who’s felt for years a
10
lack of confidence due to their smile, is a bird of a different feather.
There is no end to the difference we are making in their lives.
The one barrier to treatment with the Incognito System for some
patients is cost. Many adult patients can benefit from treatment
limited to the anterior six or eight teeth. The idea was to be able
to provide for these patients a less costly “limited” treatment, but
without the limitations we’ve had in the past from so called “limited
treatments.” In an effort to be able to provide that feeling to as many
patients as possible, I began using Incognito Braces in only a 3-3 or
4-4 setup rather than in a full arch configuration.
During my early forays into the land of lingual I had tried quite a few
social six and limited lingual systems. Unfortunately the results were
very…limited. These systems only allowed for two-dimensional
control. There was zero torque control and poor tip control. The cases
ended up similar to our clear aligner treatment. At the end we did
achieve an OK result (not perfect) but only after struggling and going
way over our predicted treatment time (see Case 2).
Case 2
3A
3B
3F
3C
3D
3G
3E
3H
Figure 3A-H: Patient requested diastema closure.
4A
4C
4B
4D
4E
Figure 4A-E: Initiated treatment with a two-dimensional social six system. It soon became apparent that although we were achieving space closure, the system provided limited
control. Notice the canine rollout on the lower left. It was necessary to add brackets for the bicuspids and to use auxiliaries on the labial.
5A
5F
5B
5C
5G
5D
5E
5H
Figure 5A-H: We achieved a satisfactory result at the cost of 13 months of treatment most of which was correcting “side effects” of tipping and rollout.
11
Finishing Incognito™ Appliance System cases with extremely
accurate torque control lead to a natural train of thought. Using
Incognito fully customized brackets and archwires as a limited
treatment appliance can give us the perfect solution to adult
cosmetic treatment. We have full three-dimensional control.
The archwire is bent to each patient’s needs, and so we don’t have
to worry about canine or bicuspid “rollout” which is common in
two-dimensional products. We can now be confident to finish these
cases to our usual high standard of care.
Case Reports
Case 3
6A
6B
6F
6C
6D
6G
6E
6H
Figure 6A-H: Patients presents for correction of upper and lower anterior crowding. He has a beautifully socked in class I occlusion. Lower incisors need torque control.
7A
7C
7B
7D
7E
Figure 7A-E: We bonded the patient with Incognito™ Braces 3-3. Bonding appointment was 45 minutes. Lower .014 NiTi was engaged behind the self retaining wings.
This increases interbracket distance and levels very efficiently. The upper arch was engaged in the archwire slot with .014 NiTi.
12
8A
8C
8B
8D
8E
Figure 8A-E: 4 weeks post bonding. The incisors leveled out so nicely we directly engaged the Upper and Lower .016×.022 NiTi in the slots to begin torque control.
9A
9C
9B
9D
9E
Figure 9A-E: Finishing up with an .0182×.0182 TMA for full slot filling torque control.
10A
10F
10B
10C
10G
10D
10E
10H
Figure 10A-H: Treatment was completed in 15 weeks. Notice the wonderful alignment, excellent torque control and retention of a perfect Class I molar and canine.
13
Case 4
11A
11B
11F
11C
11D
11G
11E
11H
Figure 11A-H: Patient presents with Hx of previous ortho and 4 Bi Exo, complaining of crowded anterior and “tipping of my teeth to the left.”
12A
12C
12B
12D
12E
Figure 12A-E: Due to canine rotations we bonded Incognito™ Braces 4-4.
13A
13C
13B
13D
Figure 13A-E: We worked our way up to the .0182x.0182 TMA.
14
13E
14A
14B
14F
14C
14D
14G
14E
14H
Figure 14A-H: Treatment was completed in 23 weeks. Patient was ecstatic and appreciated the “tip control” we achieved.
15A
15B
Figure 15A-B: Tip Control Comparison.
Incognito™ Braces 3-3 has been another boon for our office.
Even more impressive than the beautiful results is the minimal
chair time involved. The initial bonding appointment is so easy.
With the small anterior tray moisture control is simple. The entire
appointment can take as little as a half hour. Wire changes are
simple and quick. My assistants love it almost as much as the
patients do. Speech and discomfort are greatly minimized
compared to a mouthful of brackets and patients are acclimating
in two to three days or less. When we tell a patient their treatment
will take six months we mean it. There is no need for “reboots”
or multiple “finishing” appointments. This saves us an extreme
amount of aggravation and overhead. The patient’s experience is
extremely positive and we continue to turn out “raving fans.”
Most importantly we are providing our patients an amazing
service. We are addressing their chief complaint, doing it invisibly,
comfortably and easily while maintaining full control and treating to
amazing standards and results.
Case photos provided by Dr. Adam Schulhof.
15
Why the Incognito™ System is My Choice
by Dr. Haroutioun Dedeyan
Dr. Haroutioun
Dedeyan
maintains a
private
practice,
Bazilika
Eurodental, in Budapest, Hungary that
he started in 1998. He specializes in
adult aesthetic orthodontic treatment.
Dr. Dedeyan received his Dental degree
in 1988 from the Medical University of
Yervan, Armenia, and his Orthodontic
degree from René Descartes Medical
University, Paris in 1994. He has treated
more than 150 cases with the Incognito™
Appliance System.
Since the early days of my professional career, I was intrigued by the following questions:
•What would be the dream appliance for someone living in Paris, New York, Budapest,
Istanbul, Tokyo, or Dubai, who is seeking an aesthetic treatment?
•What kind of appliance could I offer them without compromising my professional
convictions about the facial aesthetic values, the appliance tolerances, the time spent
chairside, and the speaking and chewing impairment problems?
These questions, in one way or another, were addressed over time in a relative way,
working with the patient’s request for an aesthetic appliance that doesn’t fit with the
imagined one.
Finally, in 2005, I began to treat my patients with the Incognito™ Appliance System, and
since then, I now can:
•Offer clear communication to my patients wanting to know everything about their
treatment details, which also helps me to visualize the progress of their treatment.
•Guarantee 100% discretion for the total duration of their treatment, because the braces
are “invisible,” which helps me to propose a similar mode of treatment at any age.
•Provide the most low-profile lingual appliance, easily tolerated by everyone, thanks to the
computerized and customized design. The appliances are reliable, accurate and effective
at treating all kinds of malocclusions, including difficult ones like asymmetrical cross bite
problems (Case 3) and deep bite problems.
• Leverage the robotically-bent archwires and indirect bonding protocols to save a
maximum amount of chairside time and easily integrate my lingual patients into my
buccal orthodontic practice.
•Use the auxiliaries to have the freedom to choose treatment with (Case 2) or without
(Case 1) extraction by using TADs or bite-jumping appliances like the Herbst® device,
Forsus™ Class II Correctors, or self-retaining slots for lower frontal teeth.
Case Studies
Case 1
Patient
Beata, 31 years old
Total Treatment Time:
12 months
Chief Complaint:
A few years ago she was already treated labially with four first premolar extractions. She
noticed that since the first year after treatment, the rotated position of tooth no. 22 and the
recrowding process of lower incisors were becoming aggravated. Invisible treatment was
requested (Figure 1-7).
16
• Lower arch: stripping is allowed if necessary
Set-up details:
1
Figure 1: Pretreatment
Smile.
2
3
Figure 2: Pretreatment
Profile.
4
Figure 4: Pretreatment Right.
•Total of 1.2 mm stripping was proposed by the laboratory for
lower frontal teeth (Figure 10-13)
Figure 3: Pretreatment
Frontal View.
5
Figure 5: Pretreatment Left.
10
11
Figure 10: Set Up: Upper
6
Figure 6: Pretreatment Upper.
Figure 11: Set Up: Lower
7
Figure 7: Pretreatment Lower.
12
13
Figure 12: Set Up: Left
Figure 13: Set Up: Right
Diagnosis:
• Skeletal relationship: Class I, prognathic, mesiognathic
Treatment progression:
•Dental relationship: Class I canine bilateral, tooth no. 22 in
distomesial rotation, severe crowding between 33-43
•After leveling of both arches with .016× and .016×.022 Nitinol SE
archwires, the SS archwires were introduced and elastic power
chains were used to close spaces.
Lab order form main details (Figure 8-9):
• Upper and lower arches to be bonded with silicone hard tray
• Set-up of both arches requested, with photos
•The case was finished with .0182×.0182 TMA archwires
combined with intraoral detail bends for teeth no. 22 and 42
(Figure 14-20).
• Ribbonwise appliance for both arches selected
• Auxiliaries: Half Occlusal Pads (Op) for teeth no. 17, 27
14
Figure 14: Debonding
Smile.
8
Figure 8: Upper Bonding Template.
15
16
Figure 15: Debonding
Profile.
Figure 16: Debonding
Frontal View.
9
Figure 9: Lower Bonding Template.
17
Archwire sequence:
Figure 17: Debonding Right.
18
Figure 18: Debonding Left.
•For upper and lower arches: .016, .016×.022 Nitinol SE indiv. lat.,
.016×.024 SS indiv. lat., .0182×.0182 TMA indiv. lat.
Treatment plan indications:
•Upper arch: Moderate expansion, Class 1 canine bilaterally,
stripping is allowed if necessary
19
Figure 19: Debonding Upper.
20
Figure 20: Debonding Lower.
17
Case 2
Patient:
Tamás, 32 years old
Total Treatment Time:
19 months
28
Chief Complaint:
Crowding of upper frontal teeth. Invisible treatment was requested
(Figure 21-27).
Figure 28: Upper Bonding Template.
29
Figure 29: Lower Bonding Template.
Archwire sequence:
•Upper arch: .016×.022 Nitinol SE straight lat. sec., .016×.024 SS
straight lat. sec. .0182×.0182 TMA indiv. lat.
•Lower arch .016 SE NiTi, .016×.022 Nitinol SE indiv. lat.,
.016×.024 SS indiv. lat., .0182×.0182 TMA indiv. lat.
21
Figure 21: Pretreatment
Smile.
22
23
Figure 22: Pretreatment
Profile.
Figure 23: Pretreatment
Frontal View.
Treatment plan indications:
•Upper arch: Class 1 canine Right and Left, extraction of tooth
no. 24, extraction space to be closed, midline correction,
stripping allowed if necessary
•Lower arch: Space for teeth no. 45 and 46 to be kept, stripping
allowed if necessary
24
Figure 24: Pretreatment Right.
25
Figure 25: Pretreatment Left.
Set-up details:
• Total of 1.2 mm Stripping was proposed for lower frontal teeth
• Class 1 canine Right and Left
• Tooth no. 24 extracted, space closed
• Upper midline misalignment corrected
26
Figure 26: Pretreatment Upper.
27
Figure 27: Pretreatment Lower.
Diagnosis:
•Skeletal relationship: Class 2, prognathic
•Dental relationship: Class 2 canine right and left side, teeth
no. 17, 36, 45, 46 missing, 38 impacted, 35-37 pontic, upper
frontal teeth severely crowded
• Space for teeth no. 45, 46 was kept
Treatment progression:
•In the upper arch, with the help of .016×.022 Nitinol SE archwire
straight laterally and with two TADs placed labially and palatally
between teeth 26/27, within six months, a sufficient space was
created for tooth no. 21, by distalizing en-mass 11, 12, 13
(Figure 30-33).
Lab order form main details (Figure 28-29):
•Upper and lower arches to be bonded with silicone hard tray
•Set-up requested for both arches, plus photos
• Ribbonwise appliance was chosen for both arches
•Auxiliaries: Half occlusal pads for teeth no. 18, 27. Tubes with
easy insertion combined with hooks were indicated
30
Figure 30: 5/27/2009 Upper.
32
Figure 32: 12/02/2009 Upper.
18
31
Figure 31: 5/27/2009 Lower.
33
Figure 33: 12/02/2009 Lower.
•In lower arch within this period, the anterior teeth were aligned
and the leveling phase was finished.
•At this point, I decided to extract the tooth no. 14 to correct the
residual overjet problem persisting between 11-13. With the
agreement of my patient, the extraction was done, .016×.024 SS
straight lat. archwire was introduced, and the space was closed.
•In the final step, the TMA individualized archwires were
introduced in both arches and intermaxillary vertical elastics were
indicated for canines to enhance the intercuspidation between
canines. At the end, an extra intraoral bending was added for
tooth no. 22 (Figure 34-40).
41
Figure 41: Pretreatment
Smile.
42
Figure 42: Pretreatment
Profile.
44
Figure 44: Pretreatment Right.
34
Figure 34: Debonding
Smile.
35
43
Figure 43: Pretreatment
Frontal View.
45
Figure 45: Pretreatment Left.
36
Figure 35: Debonding
Profile.
Figure 36: Debonding
Frontal View.
46
Figure 46: Pretreatment Upper.
47
Figure 47: Pretreatment Lower.
Diagnosis:
37
Figure 37: Debonding Right.
38
Figure 38: Debonding Left.
• Skeletal relationship: Class 1 skeletal, mesiognathic, orthognathic
•Dental relationship: Class 2 canine right, class 1 canine left,
asymmetrical lateral crossbite right and left, lower arch midline
deviation to right combined with moderate crowding of frontal
teeth, deep bite.
Lab-order form main details:
39
Figure 39: Debonding Upper.
40
Figure 40: Debonding Lower.
• Both arches to be bonded
• Set-up requested for both arches with photos
• Hard silicone bonding trays for both arches
•Once the appliances were removed, two clear retainer splints were
given to the patient, and he was advised to see a dentist for the
problem of missing teeth in the lower arch. One implant was placed
at the level of 45-46 and a temporary crown was prepared.
• Ribbonwise appliance chosen for both arches
Case 3
•Upper arch: .016×0.22 Nitinol SE straight lat., .018×0.25 Nitinol
SE straight lat., .016×.024 SS straight lat., .0182×0.182 TMA
indiv. lat.
Patient:
Péter, 32 years old
Total Treatment Time:
22 months
Chief complaint:
Péter is the husband of one of my Hungarian dentist colleagues who
was complaining about the facial asymmetry of her husband
(Figure 41-47).
•Auxiliaries: Occlusal pads for 17 and 27. Tubes with easy insertion
and hooks for second molars
Archwire sequence:
•Lower arch: .016×0.22 Nitinol SE indiv. lat., .018×0.25 Nitinol SE
indiv. lat. .016×.024 SS indiv. lat. .0182×.0182 TMA indiv. lat.
Treatment plan indications:
•Teeth no. 14 and 24 to be extracted and spaces to be closed,
Class 1 canine right and left side, crossbite correction, stripping
is allowed if necessary in both arches.
19
Important notice: Having in mind a hope to resolve the crossbite
problem without extraction with the help of the customized
Incognito™ Appliance System, I asked the laboratory to fabricate
two brackets for teeth no. 14 and 24.
50
Set-up details:
•Class 1 canine Right and Left relationship, bilateral crossbite
corrected, lower arch midline shift corrected and a total of
2.2 mm stripping was proposed by the laboratory from 33 to 44
Figure 50: Debonding
Smile.
51
52
Figure 51: Debonding
Profile.
Figure 52: Debonding
Frontal View.
Treatment progression:
•As is typical, the lower arch was bonded in September 6, 2009,
and the upper arch was bonded three weeks later (14 and
24 were also bonded). After just 9 months of treatment
(March 24, 2010), and with the help of the ordered Nitinol SE
archwires, combined with bilateral vertical elastics, the bilateral
crossbite was totally corrected, and both the deep bite and the
lower midline deviation problems were corrected almost with
100% accuracy (Figure 48-49)!
53
Figure 53: Debonding Right.
55
Figure 55: Debonding Upper.
54
Figure 54: Debonding Left.
56
Figure 56: Debonding Lower.
Conclusion
48
Figure 48: Vertical Elastics Right.
49
Figure 49: Vertical Elastics Left.
•At this stage of treatment, SS archwires were introduced in
both arches and the patient was asked to wear Class 2 elastics
on the right side to eliminate a persisting 1 mm diastema
between 13/14.
•The final stage was accomplished with individualized TMA
archwires and intermaxillary vertical elastics. An extra vertical
intraoral bending was added for tooth no. 11 to eliminate a
vertical discrepancy of 0.4 mm (Figure 50-56). It’s important to
mention that, by modifying the treatment plan from extraction to
non extraction, the first order bending information was readjusted
between teeth no. 13-17 and 23-27.
20
We are living in a global world where millions of people are
connected by the Internet and Facebook. No matter where we live,
facial aesthetic values are becoming universal, and the potential
demand for invisible treatment is coming more and more a daily
reality. By using the customized Incognito™ Appliance System,
on one hand I have the choice to offer the most tolerable, secure,
effective invisible treatment to my patients, and on the other hand,
I have the freedom to treat, with high precision, all kinds of
orthodontic problems, from simple ones to those that are
very complicated.
Case photos provided by Dr. Haroutioun Dedeyan.
Accurate Vertical and Axial Bracket Positioning
by Dr. Lars Christensen and Dr. Hugo Trevisi
Dr. Lars Christensen
has employed the
MBT™ Versatile+
Appliance System in
his private practice in
Oxford, England for
over twelve years and has conducted
in-office courses plus seminars and lectures
on the topic around the world. Current
research pursuits focus on the clinical
application of modern bonding materials,
MBT Appliance System treatment mechanics,
adult orthodontics and aesthetic treatment.
Dr. Hugo Trevisi
received his dental
degree in 1974
at Lins College of
Dentistry in the
state of São Paulo,
Brazil. He received his orthodontic training
from 1979 to 1983 at that same college.
Since that time he has been involved in
the full time practice of Orthodontics in
Presidente Prudente, Brazil. Dr. Trevisi has
lectured extensively in South America,
Central America, Portugal and Spain and
has developed his own orthodontic teaching
The benefits of optimal torque, tip and in/out in a pre-adjusted appliance are completely
dependent on accurate appliance placement. These slot values are designed such that
the appliances will arrive at the end of treatment in relative alignment to one another,
with the teeth in proper occlusion in all three planes of space; an appliance that is not in
relative alignment to the others, then, results in an incorrect tooth position, be it torque,
angulation or labio-lingual positions. From the start, the MBT™ Versatile+ Appliance System
has offered a systematic method for accurate placement, and over time, the steps to this
method have evolved.
The most common bracket positioning errors are the vertical and
axial errors. Horizontal and rotational placement accuracy can be
achieved through reference of the mesial and distal tooth edges,
along with the measured horizontal center of the clinical crown.
But the reference for accurate vertical and axial placement – the
gingival, the incisal edge, and the perceived root position – are
highly variable and can give a false sense of the vertical center of
the clinical crown (Figure 1). Inflamed or receeded gingiva, worn
incisal edges, or displaced roots can be difficult to detect and
challenge estimates for proper vertical placement.
1
Figure 1: Upper left
lateral incisors displaying
wear of the distal part of
the incisal edge.
The MBT Appliance System offers a method, based on scientific
research and decades of experience, to measure correct vertical placement of appliances to
achieve more consistent relative alignment. Historically, the steps have been as follows:
1.Use dividers and a millimeter ruler to measure the clinical crown heights on the fully
erupted teeth in the patient’s study model.
2.Record these measurements, divide them in half and round to the nearest 0.5 mm.
This will provide the distance from the occlusal surface to the vertical center of the
clinical crown.
3.Review the MBT System Bracket Placement Chart (Figure 2). Select the row that has
the greatest number of the recorded measurements and use all values on that row for
bracket placement. Use the chart as a reference point: in cases of occlusal wear or
disproportionately-sized teeth, make the appropriate millimeter adjustments from the
chart’s reference value as necessary.
facility in Presidente Prudente. Dr. Trevisi has
over 20 years of experience with the preadjusted appliance. He is a professor at the
Department of Orthodontics at the University
of Cuiabá – UNIC, Brazil, and a member of
the Brazilian Society of Orthodontics and the
Brazilian College of Orthodontics.
21
orthodontic treatment. For example, even the smallest extrusion on
a molar or premolar tooth during the leveling and alignment phase
will cause an undesired bite opening more anteriorly. This is often
seen as an increase in the Class II relationship on the cuspids.
Whether direct or indirect bonding, the original steps of the MBT
System Bracket Placement Method can be adapted to include
marginal ridge consideration as follows:
1.For cuspid to cuspid, follow the original steps 1-3 in the
sequence described above, finding through measurement the
row on the Bracket Placement Chart that corresponds best to
the patient (Figure 4A).
2
Figure 2: MBT ™ Versatile+ Appliance System Bracket Placement Chart.
4.Place the brackets while visualizing the vertical long axis of the
clinical crowns for a vertical reference and the perceived center
of the clinical crown as a horizontal reference.
5.Use a bracket placement gauge to confirm the vertical height
of the appliances based on the values selected on the Bracket
Placement Chart. Adjust as necessary.
6.Ensure that the malocclusion does not create conflict between
maxillary teeth and mandibular appliances, and if there is conflict,
remove the appliance or adjust the treatment plan accordingly
(Figure 3A-B).
3A
Figure 3A
Figure 4A
2.On the patient’s study model, mark the 1st Molar marginal ridges
with a line along the buccal edge of the tooth (Figure 4B).
3B
Figure 3B
Over the years, doctors around the world employing the MBT™
Versatile+ Appliance System methodology have adapted the
above steps to follow a different procedure for vertical and axial
bracket placement on the posterior teeth1. As alignment of the
marginal ridge is an important objective in orthodontic treatment,
consideration of the marginal ridge at the time of bracket
placement, especially in the posterior, has shown to be practical.
Furthermore, even the smallest vertical placement error in the
posterior segment can result in occlusal interferences during the
22
4A
4B
Figure 4B
3.On the patient’s study model, mark the 1st and 2nd Bicuspid
marginal ridges with a line along the buccal edge of the tooth.
4.Using the row on the Bracket Placement Chart selected, choose
the value for the 1st Molar slot height and draw a line on the
buccal edge of the tooth that reflects that value from the occlusal
edge. Then measure the difference between the marginal ridge
line and the Chart’s measurement line (Figure 4C).
4E
Figure 4E
4C
Figure 4C
5.Apply the same difference measured on the molar to the marginal
ridge lines of the 1st and 2nd Bicuspid teeth to find the optimal
vertical placement for those teeth (Figure 4D).
As mentioned, the Bracket Placement Chart is intended as a
reference guide: consider using adjacent rows for anterior and
posterior teeth of a patient when treating deep bites or open
bites. In cases of 1st or 2nd Bicuspid extraction, consider the step
difference between the two remaining adjacent teeth and adjust
appliance placement to achieve optimal intercuspation2. In general,
use the Chart and associated method to assist accurate placement
effectively, while applying necessary measurement adjustments
to meet the specific requirements of each individual case. Tooth
wear and dental anatomy are the most common situations where
individualization is necessary for an optimal outcome.
The MBT System is a synchronized cooperation of tools and
techniques designed to achieve quality results efficiently, and as
new knowledge and technology emerges, it evolves to incorporate
the best of new innovations. Including the marginal ridge
assessment into the existing Placement Chart Technique is an
important example of this evolution, one that enhances the original
objective of accuracy and efficiency. Adopting these steps into the
placement and bonding sequence can assist the practitioner in
realizing the full benefit of the pre-adjusted appliance, arch form,
and archwire sequence used in each patient’s treatment.
4D
Figure 4D
6.Then for all teeth, follow steps 4-6 in the sequence described
above. Repeat step 4-5 for the other quadrants.
7.Position the brackets (Figure 4E).
This is the first of two articles on this subject. Watch for the second
in the series in the Spring 2012 issue of Orthodontic Perspectives.
– Editor
References
1.Kalange, “Ideal Appliance Placement with APC Brackets and Indirect Bonding.”
JCO, September 1999. P.516; Trevisi, “SmartClip Self-Ligating Appliance System:
Concept and Biomechanics.” New York: Elsevier, 2007, p. 87-100.
2.Trevisi, “SmartClip: Self-Ligating Appliance System: Concept and Biomechanics.”
New York: Elsevier, 2007, p.72-78.
23
Evaluation and Adoption of Transbond™ IDB
Chemical Cure Adhesive
by Sonja Alexander
Sonja Alexander
is an Orthodontic
Therapist at the
Brace Place,
Temple Terrace,
FL, under the
direction of Dr. David L. Leever. She has
been with the team since 1997.
Dr. David L. Leever's treatment area.
Our office offers the Incognito™ Appliance System for patients who want aesthetic
treatment. When 3M Unitek contacted us about a new bonding adhesive that was
designed to improve the indirect bonding process used to deliver the Incognito appliances,
we jumped at the chance to be one of the first evaluators. It seemed like a long time, but
finally the wait was over, and long anticipated Transbond™ IDB Chemical Cure Adhesive
arrived for our test and evaluation.
After reading the instructions, I had a
meeting with Dr. Leever to give him the
highlights, and we decided to do a trial run
before actually using it on a patient. My
objective was to incorporate a technique
that would work well with our particular
office procedure.
In the trial run, we found that using
the Transbond IDB Adhesive at room
temperature, instead of keeping it
refrigerated until just before use, worked
better for our practice. It shortened the
bonding time, patient chair time, as well as
doctor time per-patient, and didn’t compromise the bond
strength of the adhesive. I also discovered that Transbond IDB Adhesive was unusually oily,
but that didn’t seem to interfere with the bond strength. The results of our trial run were
encouraging, so we decided to go ahead and use it in treatment.
In practice, we used the original procedure we developed for indirect bonding with the
Incognito System. After preparing the patient’s teeth for bonding, we simply substituted
Transbond IDB Adhesive for Maximum Cure® Sealant, which we had been using. The
bonding procedure was very smooth, and not having to use it cold proved to be a very
effective method, reducing the bonding time.
Upon removing the indirect bonding trays, the excess material did not require the use of
a Cavitron®. Instead a scaler could be used to remove the excess material. This was an
improvement, as the use of the Cavitron was uncomfortable for the patient and caused
irritation to the gum tissue.
“Transbond™ IDB Adhesive is a
welcome addition to our practice.”
24
In our office we allot 45-60 minutes for a complete initial
Incognito™ bracket bonding, including oral hygiene instructions.
We’ve discovered that incorporating Transbond™ IDB adhesive in
our office technique reduces this time by at least 20% (Figure 1).
2
Figure 2: Observed bond failure rate on initial bonding of Incognito™ Appliances
using two different adhesives.
Conclusion
1
Figure 1: Typical bonding time and time savings in Dr. Leever's office for initial
bonding, when using Transbond™ IDB Adhesive.
The number of bond failures has also been drastically reduced as a
result of using Transbond IDB adhesive (Figure 2). However, when a
bond failure does happen, we’ve found that Transbond IDB adhesive
can be very difficult to remove from the base of the bracket. We use
50 micron aluminum oxide in a micro-etch handpiece, and it is still
a challenge and time consuming to prepare for rebond.
Transbond IDB adhesive was easy to incorporate into our practice
and is a better fit for our patients and the heavy patient schedule.
Since using Transbond IDB adhesive, we have less bond failures,
better bonding strength, easier clean up, and reduced chair time for
both our patients and our doctor.
Our practice has always been open to trying new and different
products that keep us innovative and which benefit our patient’s
treatment. Transbond IDB adhesive is a welcome addition to
our practice.
Keeping Up-to-Date is Easy with Online Training
3MUnitekTraining.com is the 3M Unitek free online education
portal that provides continuing education and product training for
orthodontists and professional staff. The site hosts monthly live
webinars featuring industry experts who present up-to-date on
clinical techniques and information on 3M Unitek products.
What’s more, the webinars offer CE units that can be earned
from the comfort of the home or office.
If you cannot attend a live webinar, all of the webinars are archived
on the site for 24/7 viewing within seven business days of the live
event. The archive currently includes eleven courses, nine product
tutorials, and 29 resource documents.
Have you found 3MUnitekTraining.com? In the last year more than
8600 people from 115 countries have attended the online courses.
Current topics include: Class II Correction; Variable Prescription
Orthodontics (VPO); Bonding; Practice Management; and the
Incognito™ Appliance System.
25
Incognito™ Appliance System
Smile
with
Confidence
Patient demand for invisible, convenient and comfortable orthodontic care continues to grow. At the same time,
orthodontic practices worldwide continue to search for appliance systems that can deliver predictable, effective
and efficient treatment results. Finally, there is a solution:
The Incognito™ Appliance System.
The Incognito System brings the option of lingual treatment to the next level.
2011 Day-and-a-Half Certification Courses
$895 for Doctors, $395 for Staff
The day-and-a-half Certification Course is designed to teach orthodontists how to use the Incognito™ Appliance System. A combination of
clinical lectures and hands-on training, the program introduces attendees to the materials used, the components of the system, treatment
mechanics and chairside techniques.
Friday, October 14, 2011 8:00 a.m. –
Saturday, October 15, 2011 12:00 p.m.
Loews Philadelphia Hotel
1200 Market Street
Philadelphia, Pennsylvania 19107
212-627-1200
Friday, October 28, 2011 8:00 a.m. –
Saturday, October 29, 2011 12:00 p.m.
Conrad Chicago Hotel
521 North Rush Street
Chicago, Illinois 60611
312-645-1500
Friday, November 4, 2011 8:00 a.m. –
Saturday, November 5, 2011 12:00 p.m.
The Westin San Francisco Market Street
50 Third Street
San Francisco, California 94103
415-974-6400
2011 One-Day Advanced Courses for Doctors and Staff
New!
$295 for Doctors, $95 for Staff
Certification as an Incognito™ Appliance System Provider is required. If you are currently not a provider, you will need to attend a certification
course. In addition, we strongly recommend having at least one case in treatment. Experienced Incognito System users will draw from their
case work to describe common clinical challenges and approaches to resolving them.
Friday, October 28, 2011
8:00 a.m. – 4:00 p.m.
Conrad Chicago Hotel
521 North Rush Street
Chicago, Illinois 60611
312-645-1500
Friday, November 4, 2011
8:00 a.m. – 4:00 p.m.
The Westin San Francisco Market Street
50 Third Street
San Francisco, California 94103
415-974-6400
Register today
at 3MUnitek.com
or 3MUnitekTraining.com
CE Credits apply.
26
Upcoming Events
Register Now!
Space is limited.
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Date!
MBT™ Versatile+ Appliance System Symposium:
Building the Healthy Smile
November 25-26, 2011
London, England
Quality, healthy, aesthetic
orthodontic treatment isn’t
limited to straightening teeth.
Attend this unique Symposium
to gain valuable insights on the periodontal, dental and
skeletal aspects of treatment – and the mechanics that
can be incorporated to achieve excellent results.
For more information and to register visit
www.3MUnitek.co.uk
Busy all the time?
Finding it hard to get your CEUs completed?
3M Unitek has the right solution: www.3MUnitekTraining.com.
Earn free CEU credits by taking the online courses. Registration
is free and easy. Visit 3MUnitekTraining.com today.
Registration
Now Open!
Incognito™ Appliance System:
2011 Users Meeting
December 2-3, 2011
Paradise Island, Bahamas
Managing complex cases. Finishing.
Predictable treatment results.
Treating Class II cases. Effective
patient communication. Handling
emergencies. Digital setup review and ordering. Archwire ligation
competition. These are a sampling of the exciting learning
objectives planned for the 2011 Incognito™ Appliance System
Annual Users Meeting. Led by an esteemed roster of orthodontic
professionals, this fun and flexible program offers multiple
options for advanced users, newer users, and staff members.
Register now to secure your preferred breakout sessions.
For more information and to register visit
www.3MUnitek.com
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3M Unitek
Orthodontic Products
2724 South Peck Road
Monrovia, CA 91016 USA
www.3MUnitek.com
In U.S. and Puerto Rico: 1-800-423-4588 • 626-574-4000
In Canada: 1-800-443-1661
Technical Helpline: 1-800-265-1943 • 626-574-4577
CE Hotline: 1-800-852-1990 x4649 • 626-574-4649
Outside these areas, contact your local representative.
Please recycle. Printed in USA.
© 2011, 3M. All rights reserved.
012-263 1109