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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. Save the 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 3 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