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Orthodontic
Perspectives
Vol XVIII No. 1
Clinical Information for the Orthodontic Professional
Choices for Doctor
and Patient
Satisfaction
Dr. Clint Emerson
Dr. Michel
Di Battista
Dr. Hugo Trevisi
Featuring:
• Oklahoma Takes On the Incognito™ Appliance System
3
by Dr. Clint Emerson
Dr. Kirsten Nigul
Dr. Anoop Sondhi
Dr. Dietmar
Segner
• Pre-Prosthetic Treatment with the
Clarity™ SL Self-Ligating Appliance System
by Dr. Kirsten Nigul
14
• Class II Pushing Correctors and the Occlusal Plane
by Dr. Michel Di Battista
6
• The Forsus™ Fatigue Resistant Device
10 Years at Hard Labor (and still going strong)
by Jim Cleary, 3M Unitek
11
• Wire Selection for Optimal Biomechanic
Efficiency in the MBT ™ Versatile+ Appliance System
by Dr. Dietmar Segner
20
13
• Transbond™ IDB Pre-Mix Chemical Cure Adhesive
by David K. Cinader and Darrell S. James, 3M Unitek
• Second Molar Extraction:
Why Should Second Molars be Extracted?
by Dr. Hugo Trevisi
• Clarity™ SL Self-Ligating Brackets: The Choice is Clear
by Dr. Anoop Sondhi
17
24
• Now THAT'S a Winning Smile (Special Feature Article) 26
MAY 2011
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. 3M, AlastiK, APC,
Clarity, Forsus, iBraces, Incognito,
MBT, SmartClip, Sondhi,
Transbond 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
As I look through this issue of Orthodontic Perspectives, I note a common theme
among many of the authors: Change – where was I then; where am I now. We all know
that change can sometimes be a long and difficult process. But the potential effects of
the change may well be worth the effort.
Reading about the experience of colleagues, their decision processes, and the benefits
and results of changes they made can be valuable input for those also considering
change. Among the topics you will find inside, one author describes the reasons for
switching from traditional to aesthetic self-ligating brackets; another decides to try a
new way for Class II correction; and another takes an interesting look at the decision
to introduce lingual treatment into the aesthetic mix at his practice.
On a personal note, reading and hearing of the benefits of the customized
Incognito™ Appliance System led me to the decision to initiate treatment – a change
I realize is overdue. I’ve been told by many orthodontists out there that I have “English
teeth” and would be a great candidate for the Incognito System. And so this last February,
I decided to “put my money where my mouth is”, so to speak, and was bonded with the
Incognito System.
Like many people who didn’t have the benefit of having braces when they were young,
and a little self-conscious now at having braces fitted, the Incognito braces solution is just
perfect for me. They’re hidden, custom-made for my treatment, and invisible to others.
And while it did take me a while to get used to having them in my mouth, a short time
later I was able to make a presentation at a 3M Company event and no one could tell I had
them on. (You can get the whole story and follow my progress at HiddenBraces.com.)
The quest to improve processes and offer innovative treatment options for orthodontic
patients is ongoing at 3M Unitek. Consider where you and your practice are today
and where you want to be tomorrow. Do you have questions about the opportunities
presented by aesthetic lingual treatment, or the benefits of self-ligating brackets for your
patients? How about the efficiencies of APC™ Adhesive or Forsus™ Class II Correctors?
Ask a 3M Unitek representative for more information, and let us know when you are ready
to write your article for Orthodontic Perspectives.
Oklahoma Takes On the Incognito™ Appliance System
by Dr. Clint Emerson
Dr. Clint Emerson
has been
practicing
orthodontics in
the Tulsa area
since 2004
and opened his own practice in Broken
Arrow in 2008. Dr. Emerson is a 2002
dental graduate from the University
of Mississippi School of Dentistry and
completed his orthodontic training in
2004 at the Louisiana State University
Department of Orthodontics in
New Orleans.
In his practice, Dr. Emerson uses
innovative technology to deliver
comprehensive orthodontics to all ages
of patients. He has been using TADs
and a soft tissue laser since his practice
opened, and in 2008 he began treating
patients with the Incognito™ Appliance
System. He is currently treating over
100 patients with Incognito braces.
Dr. Emerson received the 2010 “Velocity
Award” from 3M Unitek for the largest
increase in case starts for that year.
The sun is slowly dipping into the late afternoon. A dense haze hangs over the city, trapping
the sun’s rays and setting the skyline on fire. It is 80 degrees with a warm breeze gently
blowing. Everyone is out in the city with one hand texting and the other holding a double
latte. A blonde co-ed flies by me on a Harley, probably off to get another tattoo. Ahhhhhh,
the L.A. life. But not L.A.; try B.A. – Broken Arrow, Oklahoma, to be exact. A quiet suburb
of Tulsa, Broken Arrow is a family town that consistently ranks high among best towns in
which to live in Oklahoma.
When I opened my practice doors in 2008,
my vision was to create a friendly, fun
atmosphere in which innovative technology
was utilized to give the community great
smiles. As people began filtering through our
door, I noticed that teens and adults routinely wanted to know
options for more aesthetic orthodontic treatment. Ceramic
braces weren’t hidden enough and aligner treatment was case
limited with difficulty predicting outcomes and treatment times.
I remembered hearing Dr. Cliff Alexander speak in 2003 about a lingual option called
iBraces™, now the Incognito™ Appliance System. I did what every American does when
they need information, I Googled the company. There were a number of questions that
I felt needed to be answered before devoting time and resources to Incognito Braces.
Questions such as: “Am I ready to take on a new, rather steep, learning curve?” “What will
I charge?” And most importantly, “In this Midwestern suburb, who will buy this product?”
After a certification process, I realized the value of Incognito Braces for my patients and
implementation of this product in my practice.
I quickly found that treatment plans and mechanics with Incognito Braces were the same as
those used to treat a labial case. For example, if you would extract, then extract. If the case needs
expansion, then expand; even rules such as, “don’t tackle AP correction until you are in wires large
enough to control unwanted side effects” applied. The major learning curve for Incognito Braces
turned out to be the sensitivity of the technique. There are some unique systems, and getting my
entire team to realize the importance of each step was my first goal. To name a few:
• The impression must be precise
• Immaculate tooth preparation for bonding is essential
• Complete wire engagement is crucial
• With a 100% customized appliance, any short cuts lead to an inferior result
3M purchased the company in 2007 and began making changes such as converting
the product name to the worldwide recognized “Incognito” brand and injecting a robust
amount of technology into the appliance. We received a myriad of training opportunities
from 3M, including great “hands-on” seminars. As our office accepted the challenge of
this new learning curve, our only limitation of honing our skills was educating patients to
3
make them aware of this new system. The learning curve wasn’t
as steep as I had feared and looking back, our team’s initial focus
on the details even helped improve our performance with our labial
appliances:
•We see less loose brackets due to our commitment to more
stringent bonding protocols
•Our patients are experiencing faster treatment results due to our
focus on a more intimate wire to slot interface
•We go to great lengths to ensure patient’s wires are comfortable
before they leave our office
If You Build It, Will They Come?
I struggled deciding what I would charge for Incognito™ Appliance
System. So, I made a few phone calls to find out what everyone
else was charging for Incognito treatment. I heard a range of
$9,500-$11,000. Let me tell you, in Broken Arrow, where the
mean family income is just over $60,000 a year, that’s a new truck!
I don’t personally charge that much, and to that point, if you are
considering bringing Incognito Braces into your practice, I would
find a number that is a comfortable starting point and then let that
number move as patient acceptance dictates.
I then kept coming back to the question of “who will buy this
product?” Was the Incognito system typodont going to sit on my
shelf and be merely a bookend or a topic of conversation? I thought
it would probably fit a narrow range of patients, like newscasters
and models; people for whom aesthetics was essential in their life
would buy Incognito Braces. I was wrong. Once offered, everyone
bought Incognito Braces. The cases in my office included a myriad
of types of patients including: housewives, band members, athletes,
sales reps, teachers, widows, singers, hygienists, and medical
students. Our patients range in age from 14 to 67. We have patients
from different countries who speak different languages; we have
males and females, brothers and sisters, and even a mom and her
son in treatment. In fact, the only common link our Incognito Braces
patients share is the desire for the smile they have always wanted.
Making Treatment Accessible
So how did they afford it? The same way they afford cellphones,
nice cars, vacations, homes, and flat screen TVs. We put value in
the product and the patients realize the benefits greatly outweigh
the sacrifice. For us, the product concept sells itself. I believe this
is true because when a patient sits down and holds the Incognito
Braces typodont or sees an advertisement or meets a patient who
wears Incognito Braces, they immediately want it for themselves.
The key is converting this boiling pot of excitement into a signed
contract with value, simplicity, and flexibility. Spend time putting
value in the treatment and aesthetic benefits, not the cost of the
appliance. Make your discussion simple about what appliances can
be used for a patient’s treatment. Most patients like to hear what
YOU think is appropriate for them, instead of receiving a laundry list
of appliances such as removable aligners, lingual or metal brackets,
4
ligature free or ceramic brackets. These are all products most
people aren’t even aware of, let alone know which one will get the
best result for them. Don’t be embarrassed about offering more
expensive, esthetic options. Let the patient make the decision if
Incognito is affordable for their budget. Lastly, be flexible with your
payment options. Make Incognito Braces accessible without being
burdensome. Develop creative ways to receive a down payment that
securely covers your overhead but is feasible enough for people to
sign their name and produce payment at that first appointment. For
my office, it is that easy; value, simplicity, flexibility.
A Perfect Example
I am writing this perspective from an airplane headed to the AAO
midwinter meeting in San Diego. I was seeing patients at the office
this morning and Mark was a walk-in who came in to ask if he could
make an appointment to have his old retainer checked. We had a
cancellation, so the front desk asked if he could stay and be seen.
Not the way you want to see your new patient room filled, right? An
adult wondering if you can just place a few bends in his 20 year old
Hawley retainer! We spent a few minutes talking about the small
spaces that have reopened from his previous 4-bicuspid extraction
treatment, a slight Class II bite, and the vertical step between his
anteriors and posteriors, all of which didn’t seem to be of much
concern to him. I held the Incognito Braces typodont and said, “If
these are things you would like to correct, then this would be a
great product for you.” Some time later, my treatment coordinator
popped in my office as I was gathering my bag and heading to the
airport. “Full upper and lower Incognito” – Mark had signed up!
Empty chair becomes a retainer exam, which transforms into full
treatment. Now that’s value, simplicity, flexibility.
A Case in Progress
Patient Samantha found my office through persistence. After
deciding to align her teeth, she had several consults looking for
a plan to align her teeth without anyone seeing her braces. As a
nursing student, she was not comfortable wearing braces and, in
her words, “looking like a teenager”.
She saw two general dentists who had recommended
Invisalign® Aligners, and one orthodontist who advised her that
Invisalign was not a good option for total correction and that fixed
ceramic braces would be needed for complete alignment and bite
correction. Not satisfied with the options, Samantha found our
office on the internet and was ecstatic to learn that the Incognito
Appliance System was a viable option for her case. Having to travel
45 miles each direction was a small sacrifice to Samantha in order
to receive the Incognito Braces treatment.
Patient Background
• 21.3 year old female
• No significant medical history
• Chief dental concern: “Missing tooth #29, bite, and alignment”
• Chief concern: “I don’t want braces”
1A
1B
1C
2A
2B
2C
1D
1E
1F
2D
2E
2F
Figure 1A-F: Initial case presentation.
Figure 2A-H: Case in
progress at 16 months.
Orthodontic Diagnosis
• Class II division 1
• Retroclined Maxillary incisors
• Missing tooth #29
•#7 and #10 slightly smaller mesial/distal than normal
• 80% overbite; 4 mm overjet
• Maxillary spacing, mild Mandibular crowding
•Maxillary midline centered; Mandibular midline 4 mm
right of center
Treatment Plan
•Extract ankylosed #T and obtain proper mesial/distal space for
future implant
• Full Maxillary and Mandibular fixed appliances
•Forsus™ Fatigue Resistant Device placed one side only for
correction of right Class II
•Patient elected not to open space #7 and #10 for cosmetic
restorations
When setting up her case, I requested a band placed on #3 with a
headgear tube for use with the Forsus corrector. I also asked for
increased lingual crown torque on the lower incisors to prevent
flaring during bite correction and increased palatal root torque on
the upper incisors to achieve proper Incisal inclination (Figure 1).
After initial alignment, I placed the stainless steel wires and
prepared Samantha for the Forsus corrector by placing a stop on
the upper and lower wires distal to the first molars and creating
a resting point in the anterior for the Forsus spring. This was
accomplished by bending a .045 steel lab wire and using bracket
adhesive to bond to #27 and #28. This was my first lingual case to
use Forsus correctors, and to this point in treatment, the bond
has not failed.
2G
2H
Samantha has been in treatment for 1.4 years and has completed
10 office adjustments. She is currently in 16×25 stainless steel
wires upper and lower. Her Forsus corrector has been activated
incrementally during the last three visits. Remaining treatment
includes completion of Class II correction with the Forsus Correctors
and the mesial/distal reduction of the space in the area of #29 for
final tooth restoration.
Samantha is the typical Incognito™ Braces patient in my office.
She wanted to get her orthodontic and dental problems corrected,
but was reluctant to use traditional appliances. Once the option
of hidden lingual treatment was presented, the decision to start
treatment was easy.
Great for My Practice
I believe aesthetic treatment is no longer a trend in orthodontic
treatment. It is what patients want and it is here to stay. They
prefer brackets over bands, clear over metal, aligners over braces,
and I believe lingual over labial. I made the prediction to myself
in 2008 that a new wave of public interest in lingual was coming.
Three years later, the market is brimming with lingual possibilities.
I opened my doors with the vision of innovative technology and
three years later, Broken Arrow, Oklahoma, is still reminding me that
people will spend their money on exactly what they desire.
We have been privileged to be part of the transformation of this
lingual appliance from iBraces™ to Incognito Appliance System as
3M began pouring its innovative resources into both the product and
practitioners who will deliver it. Thank you to 3M for a commitment
to develop and redevelop cutting edge technology. Thanks to my
staff for the hard work they put in each day and their desire to learn
new techniques, and to my patients who have entrusted their smiles
to our office.
Case photos provided by Dr. Clint Emerson.
5
Class II Pushing Correctors and the Occlusal Plane
by Dr. Michel Di Battista
Dr. Michel Di Battista
received his dental
(‘75) and Orthodontic
Certificate (‘79) at
the University of
Montreal and has
maintained a private practice in Saint-Bruno,
Quebec, Canada since 1979.
He is a member of The Angle East Society
of Orthodontists and has delivered
presentations at the AAO, NESO, CAO, QAO,
Angle Society and European meetings.
I would like to thank Dr. Stephan Tisseront for his remarkable article and case report in the
October issue of Orthodontic Perspectives: Forsus™ Class II Correctors: Is There an Age
Limit? It has stimulated my willingness to share what I have learned over the last 15 years
working with Class II pushing correctors.
It was back in 1996 that Dr. John P. De Vincenzo made Eureka Springs pushing Class II
correctors available. The first patients I tried them on were half- to almost fully-corrected
within 3 months. It was way too fast to be growth! It could only be a dento-alveolar
phenomena, although the first cases were growing patients.
Consequently, I was soon using them in cases way over the growth period with amazing
outcomes and very stable results (no dual-bite, no “postural orthodontics” and negligible
CR-CO discrepancies).
Ten years ago, 3M Unitek launched the Forsus™ Fatigue Resistant Device. It did then,
and still delivers, the same amazing results, but with significantly fewer breakages and
emergencies. I use them exclusively now.
As mentioned by Dr. Tisseront, the treatment options regarding most Class II deep bite
adult cases with mild to moderate crowding are: decompensation of the dental arches and
mandibular surgical advancement (with or without genioplasty), or extraction of two upper
premolars with a less favorable facial aesthetic outcome.
“Class II adult deep bite” is a very vague label. Periodontal status, lip seal, incisor showing,
transverse dimension, tongue size, and sleep apnea, to name just a few, are among the
individual data that weigh in the decision scale to elect either a combination of orthodontic
treatment and maxillo-facial surgery or an alternative.
The purpose of this article is to provide additional information to support Dr. Tisseront’s
article and confirm his findings that the treatment alternative employing Forsus Class II
Correctors is not just a second best alternative, but THE treatment of choice in selected
cases, all things and risks considered.
The following two case reports are adult Class II deep bite patients treated with the Forsus
Fatigue Resistant Device without extractions and without maxillo-facial surgical procedures.
Case #1
N.M. female 38 years old. She came in for a second opinion because she declined the surgery
suggested by the previous orthodontist. Chief complaint: “I am hurting myself at the palate”.
It is with reasonable confidence that I suggested a non surgical treatment with the use of
the Forsus Fatigue Resistant Device.
The patient was informed and agreed that a plan “B” would involve extraction of upper
5’s or surgical advancement of the mandible (Figure 1A-L).
6
2A
1A
1B
1C
1D
1E
1F
2B
2D
2F
1G
1H
2C
2E
2G
2H
Figure 2A-H
08-11-17:Forsus Correctors 32 mm rods each side,
compression 8.0 mm.
1I
1J
1K
Figure 1A-L
09-01-29:Reactivation with the addition of split crimps totalizing
148 g per side.
09-04-22:Forsus Correctors stopped when normal overbite and
overjet is achieved (Figure 3A-C).
1L
3A
3B
3C
Figure 3A-C
The treatment sequence was the following:
07-05-30:Bonding upper arch (centrals 12° torque, laterals
8° torque, Clarity™ Ceramic Brackets). Final wire size
.016×.022 SS.
The Class II correction is held and stabilized with a
decreasing wear of Class II elastics (6 mm – ¼") light
1.8 oz, latex per side from mesial of 3’s to lower 6’s.
09-08-10:Fixed appliances removal.
08-01-21:Bonding lower arch (-5° torque on incisors). Final wire
size .016×.022 SS.
Fixed lingual retainers .016 round SS on #13 to #23 and
#33 to #43.
08-05-27:Day of Forsus™ Correctors installation. 25 mm rods
on both sides. An .016×.022 SS wire was inserted on
lower arch. At this time the lower Curve of Spee is not
totally flattened. The Forsus Correctors will assist the
levelling of the lower Curve of Spee. Compression of the
springs at initial insertion: 6.0 mm×18.5 g = 111 g per
side (Figure 2A-H).
10-09-22:Insertion of occlusal splint Biteplane full coverage type
on the upper arch without occlusal contacts posterior
to the lower canines.1
08-08-17:Forsus Correctors 29 mm rods each side, compression
at 6.0 mm (111 g).
08-09-30:Measured activation; down to 4.5 mm per side as
some correction has taken place. Addition of Forsus
Correctors Universal split crimps on each side.
1.5 mm×18.5 g = +27.75 g additional per split crimp.
Activation brought back to 6.0 mm (111 g per side).
Active treatment time 3 years 3 months.
10-11-16:Final records; Upper incisors correction torque to
occlusal plane = +30°.
Lower incisors to occlusal plane change = none.
Clockwise occlusal plane rotation: 6.2° (orig: Op/Sn =
12.2°, final: Op/Sn = 19.8°, Normal = 14.4°)2 (Figure 4A-C).
4A
4B
4C
Figure 4A-C
7
11-03-23:Control visit: Overjet = 3.1 mm Slide CR-CO = 0.4 mm.
The treatment sequence was the following:
Patient very satisfied with results “The results are far
beyond my expectations” (Figure 5A-M).
06-08-22:Bonding upper only: Clarity™ Ceramic Brackets
Standard Edgewise (0° torque, 0° ang.) brackets on
#12 to #22.
07-08-16:Bonding lower teeth. (It has taken one year to
decompensate the upper teeth torque = +28.5°.
5A
5B
5C
5D
5E
08-05-13:Forsus Correctors 25 mm rod right, 29 mm rod left.
08-09-24:Class I correction achieved, stop Forsus Correctors,
start Class II elastics.
5F
5G
5H
5I
Restorations done during treatment by the restorative
dentist (Dr. Gilles Dulude) (Figure 7A-D).
5J
5K
5L
7A
7B
7C
7D
5M
Figure 5A-M
Case #2 LP
Female 53 years old. Chief complaint: “My teeth are crooked,
my mouth and lips are going backwards, deeper and deeper”.
She agreed upon a “long” 3½ year treatment involving the
Forsus™ Fatigue Resistant Device. Teeth missing: #18, #24, #36,
#37 and #46. Bridge on #35-#38 (Figure 6A-N).
Figure 7A-D
10-07-15: Removal of fixed appliances.
Lingual fixed retainers .016" round SS, from #13 to
#23 and from #33 to #43.
6A
6B
6C
6D
6E
Treatment time 3 years and 10 months.
10-11-10:Final records. No clockwise rotation of the occlusal
plane, Op/Sn original = 12°.
Op/Sn final = 14.40°, normal = 14.40°2 (Figure 8A-O,
9A-B).
6F
6G
6I
6H
6J
11-03-24:Insertion of occlusal splint Bite Plane type, full coverage
on the upper arch without occlusal contacts posterior
to the lower canines.1
Overjet = 2.7 mm, CR-CO Slide = 0.2 mm.
Patient totally satisfied, “The treatment did not seem long!”
Some Tips
6K
6L
6M
Among the factors that should be taken in consideration with the
pushing Class II correctors force system are:
Figure 6A-N
Case Selection
6N
8
Generally Class II deep bite cases are the ones that respond more
favorably to this force system. They exhibit a brachyfacial type and
a favorable chin component. They are often characterized by a
counter-clockwise canted occlusal plane and normally positioned or
retroclined lower incisors.
8A
8B
8C
8D
8E
8J
Figure 8A-O
8F
8G
8H
8I
Figure 9A-B
8K
8M
8L
8N
8O
Class II pushing correctors are powerful clockwise occlusal plane
rotators and upper arch distalizers. The less originally clockwise
rotated the occlusal plane, the better the potential to correct the
point A and point B to the occlusal plane relationship (Witts). Avoid,
or use with extreme care, Class II pushing correctors, especially on
patients who exhibit pronounced clockwise or canted occlusal plane
with much vertical excess, and of course, on those with moderate
to severe open bite.
Retroclined lower incisors and normal attached gingiva are
positive prerequisites. As a result of using Class II pushing
correctors, the lower incisors are being intruded (contributing to
gingival build up) and anchored in the thick chin symphysis bone.
(Use -5° prescription on lower incisors.)
The decompensation and three dimensional preparation of the
dental arches before using the Class II pushing correctors
Both arches should be prepared and coordinated as in preparation
for a surgery at the exception of the lower Curve of Spee. The
Forsus™ Fatigue Resistant Device will assist the levelling of the
lower Curve of Spee.
In Class II Div II cases, make sure the upper incisor's buccal torque
is properly normalized or slightly overcorrected. A little opening
of spaces mesial to the upper canines sometimes allows a good
interdigitation and overcorrection of the buccal segments without
anterior interferences (Figure 10). The mandibular arch should be
Figure 10:
Forsus™ Corrector spring
compressed 3 mm.
Spaces mesial to canines.
9A
9B
free to move to a Class I occlusion without any interference. I avoid
overcorrecting to an edge-to-edge position. This traumatic situation
may initiate root resorption and unnecessary attrition.
The minute magnitude calibration of the force system
The control of the level of force delivered by an appliance is of
paramount importance, not only with regard to treatment efficiency
and treatment time, but also “TO MINIMIZE ANY IAOTROGENIC
EFFECT OF TREATMENT FROM THE USE OF TOO HIGH FORCE”.3
I would add, “to minimize breakages and bulky mechanics”.
The Forsus Fatigue Resistant Device can be compressed about
12.0 mm at a linear constant deflection rate of about 18.5 g/mm.
ATTENTION: THE FORCE IS NOT CONSTANT, BUT INCREASES
CONSTANTLY BY 18.5 G FOR EACH MM OF COMPRESSION.
Ideally, I don’t have the Forsus springs compressed by more
than 9.0 mm. Initially 5.0 mm to 8.0 mm of compression is fine,
comfortable and efficient.
At each appointment, the activation of the springs compression
is measured and kept between about 5.0 mm to a maximum of
8.0 mm, according to the amount of correction needed. The
distance from the mesial part of the distal ring “A” to the mesial
part of the spring “B” is passive at 28.0 mm and fully active at
16.0 mm for 12.0 mm of total possible compression. The distance
is measured at 25.0 mm (Figure 10), so the compression is
3.0 mm. Activation of 3.0 mm to 4.0 mm is a good holding and
stabilizing activation.
At about 5.0 mm to 8.0 mm of activation every two months,
no upper lingual arch or RPE appliance is required to hold the
upper first molars.
10
9
However, the buccal inclination of the upper first molars has to
be carefully monitored. The Forsus™ Corrector activation and the
lingual crown torque expressed by the archwire on the first molars
have to be coordinated.
When the lower incisor torque changes, it is as a block with the
occlusal plane, not off of it.
Sometimes an additional -10° to -20° of lingual crown torque at
#16 and #26 level may be bent on the .016"×.022" archwire.
The lower wire preparation:
By no means should the maximum opening of the jaw dictate
the length of the push rods and thus the entire force system.
Should a patient open beyond the length of the push rods, he can
easily be instructed to re-insert them back into place.
Note: If the Forsus Corrector is compressed at 7.0 mm, it exerts
a distal action force on the first molar of about 130 g, and as a
reaction force, an equal amount of 130 g on the archwire hook stop
at the distal of the lower canine.
The Condyle to Fossae Relationship
I do not use Class II pushing correctors as functional appliances
in growing and non-growing patients. In my office, every time the
Forsus Springs are employed, the patient should always be able to
close back in centric relation and chew on his molars. The condyles
are never permanently forced out of the fossae.4 This means no
activation beyond 12.0 mm.
I always bond upper and lower 7’s when available.
•Crimped hook on the loop bend between the lower 7’s and 6’s to
tie the archwire back (Figure 12A)
•Temporary step down bend just about 1.0 mm distal of #33 and
#43 to stabilize the crimped hook acting as a bumper to the
pushing rod (Figure 12B)
•A bent forward and outward ‘S’ modified crimped stop links the
rod (modified) to the archwire (Figure 12B-C)
•An elastomeric ligature to stabilize the rod “elbow” buccolingually from flipping in the cheek or rubbing against the first
premolar bracket. The ‘S’ part of the crimped hook is angulated
bucco-lingually as required (Figure 12B-D)
12A
12B
12C
12D
Some Tricks
The fixed appliances I employ with the Forsus Fatigue Resistant
Device can be shortly described as follows:
• Bracket size: .018"×.025"
• Wire size: .016×.022 stainless steel
• Torque prescription on #16 and #26: -14°
(-14T/0° offset-/3M Unitek Victory Series™ Brackets)
• Torque prescription on #32 to #42 is -5°
Please Note: To prevent the lower incisors from flaring, the
usual recommendation is to fill the bracket slot with a full-size
stiff archwire. This may be good mechanics, but I’ve found it is
less compatible with low physiologic forces and comfort if more
adjustments are performed on the archwire during and after the use
of Forsus correctors.
The “elastomeric torque” delivered by an Alastik™ Easy-To-Tie
Ligature (3M Unitek, #406-884, silver) tied in an X-fashion, prevents
any “play” of the lingual face of the archwire (0.16"×0.22") from the
bottom of the bracket slot. This torque has been estimated at about
0.4 g-mm5 (Figure 11).
Figure 11
11
10
Figure 12A-D
Conclusions
Some Class II, full cusp adult cases can be treated without
extractions or surgical advancement of the mandible. The dentoalveolar changes induced by the Class II pushing correctors Forsus
Fatigue Resistant Device are largely sufficient to achieve superb and
stable results in selected cases.
Case photos provided by Dr. Michel Di Battista.
References
1.Peter M. Greco, Robert L. Vanarsdall Jr, Michael Levrini, and Richard Read,
An evaluation of anterior temporal and masseter muscle activity in appliance
therapy, The Angle Orthodontist 1999, 69: 141-46.
2.Riolo M.L., Moyers R.E., McNamara J.A., Hunter W.S., An Atlas of Craniofacial
Growth, 1974.
3.El-Sheikh, Moazz Mohamed. Force-Deflection characteristics of the fatigueresistant device spring: An in vitro study. World Journal of Orthodontics 2007;
8: 30-6.
4.Popovich, Kurt. Effect of Herbst treatment on temporomandibular joint
morphology. A systematic literature review. AM J Orthod Dentofacial Orthop
2003; 123: 388-94.
5.Michel Di Battista, The Elastomeric Torque and the Incisors, Lecture given at the
AAO 101th Annual Session, Toronto, 2001.
The Forsus™ Fatigue Resistant Device
10 Years at Hard Labor (and still going strong)
by Jim Cleary
Jim Cleary
is a Product
Development
Specialist and has
been with 3M Unitek
for over 28 years.
He is an inventor on 48 issued U.S. patents.
Over a decade ago, in response to customer input, 3M Unitek engineers began an
evaluation of intraoral Class II devices as an alternative to headgear. With devices of this
kind, a common issue was fatigue failure. Orthodontics is all about movement, but most
of it happens slowly enough that the mechanics and appliance components used can be
viewed as nearly static. A device that is connected between the upper and lower arches,
however, operates in the most dynamic situation encountered in orthodontics. Any solution
adopted must first and foremost be reliably fatigue resistant.
The result of the research also indicated that, besides fatigue failure, there were typically
additional trade-offs that limited satisfaction with products in this category, including the
need for lab work and varying degrees of installation difficulty.
The “FReD” project (Fatigue Resistant Device), as it was dubbed in the beginning, was
started since it seemed that an approach could be developed which would meet the
important 3M Unitek fatigue resistance goal. Developing this new product would also
provide an opportunity to create a flexible, easy-to-use system, and possibly reshape the
way Class II correction was done.
The result, as we know now, was the Forsus™ Fatigue Resistant Device introduced in 2001.
It has now completed ten years of service to orthodontists and their patients.
1
Figure 1: Forsus™ Fatigue Resistant Device EZ2 Module.
A Brief Development History
The spring module and the system built around it have evolved over that time. The
system as originally launched provided an L-pin for the upper distal attachment of the
spring module, and an assortment of auxiliary bypass wires for attachment on the lower.
A range of push rod lengths used for both left and right mounting completed the hookup
(Figure 2-3). The three part telescope design of the spring module with its push rod
provided enough travel for full jaw opening, so many clinicians simplified installation by
omitting the bypass wire, and connected the push rod directly to the lower archwire. This
11
2
3
Figure 2: Original Forsus Corrector
spring with L-pin.
™
Figure 3: Typical Forsus™ Corrector
installed using archwire bypass.
preference led to the first major addition to the system, the Direct
Push Rod, which was developed by Dr. William Vogt, Easton, PA
(Figure 4). The recurve design and attachment loop orientation
provided a more stable position of the push rod under load (Figure 5).
The original spring module was constructed with a cylindrical distal
end fitting brazed to the larger of the two tubes within the module.
To improve manufacturing, TIG (Tungsten Inert Gas) welding was
implemented to join these components. Redesign of the distal end for
this new process provided the opportunity to improve comfort as well
with a smoother, rounded end fitting. Assembly was later switched
to laser welding for greater productivity. Less visible improvements
were also incorporated into the attachment of the spring module
mesial end flange and the mesial end of the spring itself.
4
Figure 4:
Dr. William Vogt.
5
Figure 5: Forsus™ Fatigue Resistant Device with
Direct Push Rod design.
The Forsus™ Fatigue Resistant Device did its job well and has
gained an ever-increasing following. But even greater efficiency and
reduced chair time are constantly sought by clinicians, and users
told us that threading the L-pin from distal of the headgear tube and
bending the end could be a time consuming endeavor. Development
of a quick and easy distal connection began.
6
Figure 6: Forsus™ Fatigue Resistant Device EZ Module featuring a snap-fit
connection to the buccal tube. Note a 22 mm push rod installed distal to the first
bicuspid bracket.
3M Unitek had expanded MIM (Metal Injection Mold) capabilities
in house, so a one piece MIM snap-in connector was proposed.
Persistence and fabrication of working prototypes overcame the
initial skepticism, and the Forsus™ EZ Module was added to the
system (Figure 6). The L-pin still had its uses, such as with gingival
or non-standard headgear tubes, but the quick and easy snap-in
connector gained a strong following.
12
Creative clinicians have embraced the Forsus Fatigue Resistant
Device and have made it their own; they realized its versatility and
have devised alternative hookups and custom attachment devices.
For instance, reports from the field were coming back about the
growing popularity of attaching the push rod distal to the lower first
bicuspid bracket. Proponents of this method cited advantages such
as less visibility and less cheek irritation than connecting distal to
the cuspid bracket.
In many cases, however, an extra short push rod was required.
A 38 mm push rod could easily be cut down to provide the proper
length, but a push rod length one step down in the current size
assortment was a better, easier solution. A push rod one step
shorter would not allow space for a tubular stop, as used on the
25 through 35 mm rods, within the length limit of a fully activated
spring module. Rather than adding rod length to accommodate a
tubular stop, it was decided to evaluate a 22 mm push rod where
the recurve bend would function as a stop. The system expanded
again to include the 22 mm push rod, which has subtly modified
bend geometry to assure smooth telescoping action.
Close to the time the 22 mm push rod was introduced, the first
change to the spring itself was made. A second closed coil was
added to the mesial end of the spring. This provided a more
positive, solid seating of the spring on the mesial flange, and a more
durable attachment.
That very dynamic, and, as patients continue to demonstrate, the
often hostile environment in which the Forsus device operates
drove the desire to make the EZ Module more robust. With
the development and field experience of the original snap-in
attachment, design options were explored. The one clear message
in feedback from clinicians was to maintain the “easy part”. Armed
with that prior experience, a whole new module was designed to
increase the durability. Careful analysis was performed on CAD
models to assure a snap-in function similar to the original. The
new module was designed with integral posts on which to mount
the spring module, and an integral gusset that snaps in lingual to
the headgear tube to control buccal deflection of the assembly.
The Forsus EZ2 Module was introduced at the end of 2008, and
while still easy to install, is tougher against the many assaults
encountered in service.
As the saga enters year eleven, the story has not ended. Ways
of improving and expanding the system continue to be explored.
And it can be expected that those friends of the Forsus Device
within the orthodontic profession will continue to develop creative
new applications.
For additional reading, the quest to design a spring module that
would withstand the roughly half million cycles during the necessary
treatment time was presented in detail in Orthodontic Perspectives,
Vol. IX, No.1 which is available for review on www.3MUnitek.com.
– Editor
Second Molar Extraction:
Why Should Second Molars be Extracted?
by Dr. Hugo Trevisi
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,
A large proportion of the routine work of an orthodontist is treating sagittal Class II malocclusion,
which is the most common malocclusion among patients seeking orthodontic treatment.
Class II malocclusions are frequently accompanied by compromised facial aesthetics, which
is best dealt with in the mixed dentition. However, patients do not always seek treatment
in mixed dentition. Rather, they postpone treatment to adolescence, a period which is
often associated with poor patient cooperation. In such adolescent cases, second molar
extractions offer a valid alternative treatment option for Class II treatment.
The main goals of a second molar extraction treatment are preventing third molar impaction
and making it easier to upright first molars. These extractions create some space distal to
the archwire, isolating the third molar from the remaining teeth, enabling its anterocclusal
movement and its eruption in contact with the distalized first molar (Figure 1A-C, 2A-B).
A third molar of good shape and size is an ideal substitute for second molars.
Case photos provided by Dr. Hugo Trevisi.
Central America, Portugal and Spain and
has developed his own orthodontic teaching
facility in Presidente Prudente. Dr. Trevisi
has over 20 years of experience with the
1A
1B
1C
Figure 1A-C: Panoramic radiograph of a patient who underwent orthodontic treatment with upper second molar
extractions. The spaces created enabled optimal eruption of the third molars.
pre-adjusted appliance. He is a professor
Figure 2A-B: Occlusal view at the
end of the corrective treatment
with the third molars fully erupted,
showing perfect alignment and
establishment of the contact points
with the first molars.
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.
2A
2B
New Textbook Available: If this topic is of interest to you, second molar extractions are covered
in depth in a new textbook (available in June 2011), “State-Of-The-Art Orthodontics: Self-Ligating
Appliances, Mini-Screws and Second Molar Extractions” by Drs. Hugo Trevisi and Reginaldo Trevisi
Zanelato, published by Mosby Elsevier.
The section on second molar extractions includes the following topics:
•Development of second molars and third molars •Management of the distalizing mechanics in
second molar extraction cases
• The benefits of second molar extractions
• When second molars should be extracted
•Eruption of third molars after second
molar extraction
•Characteristics of patients who undergo second
• Clinical case examples
molar extractions
Contact your 3M Unitek representative for more information. – Editor
Dr. Hugo Trevisi
Dr. Reginaldo
Trevisi Zanelato
13
Pre-Prosthetic Treatment with the
Clarity™ SL Self-Ligating Appliance System
by Dr. Kirsten Nigul
Dr. Kirsten Nigul
is associated in
private practice
at “Kliinik 32”, an
interdisciplinary
dental clinic in
Tallinn, Estonia. She is a 1998 graduate of
the University of Tartu, Faculty of Medicine,
Dentistry, DDS, and also received her
Specialist in Orthodontics from there.
In 2005 she received the Royal College of
Surgeons Edinburgh, MOrth, Overseas Gold
Medal. Dr. Nigul has been working with the
MBT ™ Versatile+ Appliance System since
2005, and with 3M™ Self-Ligating Appliances
since 2007. Current interests focus on
interdisciplinary treatment, perio-ortho
patients, adult orthodontics and aesthetic
treatment with Clarity™ SL Self-Ligating
Appliance System and Incognito™ Appliance
Systems. She has lectured for orthodontists
and dentists in Estonia and at Baltic
Orthodontic Congresses.
Kliinik 32, Tallinn, Estonia, is a private dental clinic specialized in interdisciplinary dentistry.
The various specialists in the clinic include general dentists, periodontists, endodontists,
prosthodontists and an orthodontist. The close proximity of the specialists makes it easy for
patients and doctors to be involved in interdisciplinary dentistry.
About 50% of my orthodontic patients are adults who need treatment from different
specialists. I have been using bracket systems from 3M Unitek since 2005 and have
found that a majority of adults prefer aesthetic orthodontic appliances. I started to use
3M™ Self-Ligating Appliances when the Clarity™ SL Self-Ligating System was released
in 2007. Currently, I also use the SmartClip™ SL3 Self-Ligating Appliance System and
Incognito™ Appliance Systems in my treatment.
Orthodontic treatment is often a part of interdisciplinary care. Most patients who benefit
from interdisciplinary treatment usually first visit a prosthodontist or periodontist and come
to orthodontist on the recommendation from these specialists. Often times, the option of
orthodontic treatment comes as a surprise for them. However, orthodontic involvement
as part of interdisciplinary care allows for minimally invasive treatment, saving the
patient’s own tooth material, making less prosthetic work and reducing the need for
surgical treatment.
When choosing a bracket system, patients are interested in aesthetics, treatment time and
comfort. The Clarity SL system is aesthetic and remains so, even if the patient loves to
drink coffee and tea, due to the absence of discoloring elastics. Self-ligating brackets also
give the possibility to make longer intervals between visits during some treatment phases.
Additionally, brackets with variable prescriptions allow a more precise focus on a patient’s
individual problems, and give the possibility to reduce treatment time and wire bending.
Following is an example of a Kliinik 32 interdisciplinary case which I treated with the
Clarity SL appliance system.
Patient Case
Patient
Female, 40 years 10 months.
Chief Complaint and History
The patient was worried about wearing of her teeth and treatment aesthetics. She had
been in another dental clinic where an ‘instant smile’ treatment plan was offered with
crowning of all the teeth. She did not want to sacrifice healthy dental structure and looked
for other options.
Diagnosis
The patient had a convex profile with slightly distal lower jaw. She had a deep overbite.
The posterior occlusion on her left side was Angle Class 1; on the right side Class 2; the
mandibular center line had deviated 2 mm to the right side. This was due to a long time
missing lower second premolar which was replaced by an implant, but the implant is too
narrow for the space. Her maxillary incisors where lingually inclined. She had significant
wear of her maxillary anterior teeth and the central incisors where shorter than the lateral
incisors. The teeth had erupted and brought the gingival margins incisally (Figure 1-2).
14
2nd Visit at Week 14 (8 weeks later)
Inserted Stainless Steel .019×.025" into lower arch.
3rd Visit at Week 20 (6 weeks later)
2
1
Figure 1: Wear on maxillary anteriors;
midline deviation.
Figure 2: Mandibular arch with implant
in lower second premolar.
Inserted Nitinol Classic .019×.025" into upper arch.
4th Visit at Week 26 (6 weeks later)
Introduced open coil in lower arch to create room for implant crown.
Treatment Alternatives
The profile change and Class 1 bilateral occlusion would have
needed bilateral sagittal split osteotomy. Patient did not desire any
change in her profile and we decided to concentrate on the
patient’s main problem and restore the maxillary incisors to create
better aesthetics.
Treatment Plan
Advance upper incisors to allow for the advancement of lower
incisors. Procline lower incisors to help correct deep bite, retain
normal overjet and create more room to put normal size implant
crown. Intrude upper incisors to move the gingival margins apically
to the correct level with canines. This will create room in vertical
plane to restore abraded crowns with prosthetic work.
5th Visit at Week 34 (8 weeks later)
Inserted Stainless Steel .018" into upper arch with step bends to
correct gingival margin discrepancies. Self-ligating braces give the
possibility to make activation visits shorter and more comfortable.
Memory wires and exact positions of brackets allow working with
straight wires from start to finish. While treating worn dentition,
small teeth do not allow bonding the bracket into the ideal position,
therefore bending of wire is necessary to get teeth into ideal
positions. Clarity SL brackets allow easy and exact bending of
the wire. While keeping the wire engaged in some brackets, you
can freely see the activation amount of other teeth and easily add
activation when wire is steadily held by clips in other brackets. The
clip allows easy removal of the wire and reactivation. Activation
intervals during that period are usually 4-5 weeks (Figure 4).
Treatment Progress
Bonding Appointment
Clarity SL brackets in the upper arch, Clarity™ Ceramic Brackets in
the lower arch (Clarity SL lower arch brackets were not yet available
at the time of this case). APC™ II Adhesive pre-coated brackets,
MBT™ Appliance System prescription with .022 slot using a direct
bonding technique and Transbond™ Self-Etching Primer. Initial
archwires were .014" Nitinol SE on upper arch and Nitinol HA
.016" on lower arch.
4
1st Visit at Week 6 (6 weeks later)
Figure 4: Step bends in upper arch.
Inserted .016×.022" Nitinol SE into upper arch and Nitinol HA
.019×.025" into lower arch. Rectangular wires were used to correct
the inclination of upper front teeth. During alignment with Nitinol
archwires, it is possible to keep longer periods between activations,
usually 8 weeks (Figure 3).
6th Visit at Week 42 (8 weeks later)
Make temporary restorations with composite. Orthodontist removes
archwire while restorative dentist adds restorations. Orthodontist
will continue with archwire activation according to restorative
dentist’s goals.
Approximately 10 Months after Beginning Treatment
Brackets are removed from lower arch and fixed lingual retainer
was placed on lower 4-4 anteriors to keep even levelled Curve
of Spee.
3
Inserted Stainless Steel .018" into upper arch to create more room
for canine restorations. Next 4 months were used to detail the final
Figure 3: Wire change 6 weeks into treatment.
15
positions of teeth. Close cooperation between the restorative dentist
and orthodontist is very important during this period of treatment
(Figure 5).
8A
8B
Figure 8A-C: Full ceramic crowns
placed on upper 3-3 anterior teeth.
8C
5
Conclusions
Figure 5: Temporary restorations on upper incisors.
Approximately 14 Months after Beginning Treatment
Brackets are removed from upper arch and fixed lingual retainer
was placed on 3-3 anterior teeth. On the same day composite
restorations were detailed and impressions for new implant crown
were taken (Figure 6-7).
Bracket treatment often gives the possibility for minimally invasive
treatment and the chance to preserve the patient’s own healthy
tooth structure. There are many adult patients who would prefer not
to receive orthodontic treatment. However, with careful explanation
of benefits of orthodontics in interdisciplinary treatment, combined
with a convenient and aesthetic bracket choice, orthodontic
treatment acceptance increases dramatically. Kliinik 32 has seen
a lot of success in offering the Clarity SL appliance system in
interdisciplinary treatment as an aesthetic option.
Case photos provided by Dr. Kirsten Nigul.
7
6
Figure 6: Completion of treatment.
Figure 7: Open space for implant.
Six months later, upper fixed retainer was removed and final full
ceramic crowns were placed on upper 3-3 anterior teeth. Maxillary
nightguard use is required while sleeping to retain the position of
the teeth after final restorations. This helps to retain the vertical
relationship of front teeth and to prevent further abrasion
(Figure 8A-C).
Forsus™ Fatigue Resistant Device Users Meeting
September 23-24, 2011
Newport, Rhode Island
Dr. Lisa Alvetro
Dr. William Vogt
Register online at
www.3MUnitek.com
16
The 2011 Forsus™ Fatigue Resistant Device Users Meeting offers
learning opportunities for both new and advanced Forsus Corrector
users through the sharing of key clinical techniques, practical
hands-on applications and evidence-based literature.
Contact 3M Unitek for more information.
Clarity™ SL Self-Ligating Brackets: The Choice is Clear
by Dr. Anoop Sondhi
Dr. Anoop Sondhi
received his
dental degree
from the Indiana
University School
of Dentistry, and
his post-graduate certificate and MS in
Orthodontics from the University of Illinois
in 1977. Following his graduation, he was
on the graduate faculty of the Department
Introduction
A bracket is a bracket is a bracket (with apologies to Gertrude Stein), and as long as a
bracket helps move teeth the way we want it to, there is really not much point in getting
excited about one over the other. After all, we’re all orthodontists, and can move teeth with
bailing wire if we have to. How often have we heard that one?! True to a certain point, I
suppose, but such a misguided way of thinking.
You can certainly get from point A to point B in a Yugo (am I showing my age here?), or you
could traverse the distance using something more efficient, reliable, and speedy – one of
the spiffy crop of automobiles that I have been dreaming about. Sure, we’ll get from point A
to point B in both scenarios, but there is a huge difference in how reliably, how quickly, how
efficiently, and how comfortably we will get there.
of Orthodontics at Indiana University.
During his full-time academic appointment
Making the Choice
at Indiana University, he maintained a
As of January 1, 2010, the appliance of choice in our practice is the
aesthetic Clarity™ SL Self-Ligating Bracket for the maxillary arch.
While we also use Clarity SL brackets in the mandibular arch, we
frequently choose SmartClip™ SL3 Self-Ligating Brackets for the
mandibular arch.
part-time private practice. Since 1988, he
has been in full-time private practice in
Indianapolis, and continues to be a Visiting
Professor for several graduate programs in
Orthodontics. He has presented seminars
and continuing education courses to several
dental and Orthodontic organizations in
the United States, and has been invited to
give courses in Canada, Central America,
South America, Europe, Asia, South Africa,
Australia and New Zealand.
Now, anyone who has heard me lecture over the years, as well as long-term members
of my staff, will recall when I was not enthusiastic about using aesthetic brackets at all.
Indeed, I used the traditionally ligated Clarity™ Metal-Reinforced Ceramic Bracket quite
sparingly, although it was an extremely aesthetic bracket. My reasons, at the time, were
simple. While the Clarity bracket was definitely aesthetic, the increased inter-bracket
distance exacted a penalty in efficiency, and we incurred additional visits, more often
with adults, with a request that discolored elastic ties be changed. So while the bracket
was certainly effective in expressing tooth movement, it gave up some efficiency when
compared to metal brackets.
That is what has changed. With self-ligation, the Clarity SL bracket presents all of the
efficiencies that SmartClip brackets brings to our practice, and none of the penalties that
aesthetic brackets previously had.
The Impact on Our Practice
When we made the decision to make the Clarity SL bracket the appliance of choice in
treating our patients, that decision was coupled with our campaign to position our practice
as an “aesthetic practice”. While this would obviously have been desirable even earlier, we
had been reluctant to compromise on treatment efficiency in order to adopt that moniker.
Once we recognized that the Clarity SL bracket system was delivering treatment results as
efficiently as SmartClip brackets, the campaign to reposition our practice went into
full swing.
17
In marketing and positioning our practice in this community, we
have always eschewed the conventional marketing strategies that
most marketing consultants employ, and most doctors are familiar
with. Conventional strategies involve all of the standard variables
that have been used for years, such as location, hours, participation
in specific insurance plans, etc. My partner, Jeff Biggs, and I
have always operated on the understanding that patients will go
the distance if they are convinced that there is a difference in the
treatment that they will receive. Therefore, rather than following the
normal marketing mantras of location, evening and Saturday hours,
etc., our mantra has always been that “Choosing an Orthodontist is
a Serious Decision”.
We give patients the clear reasons why they should choose to be
treated in our office. The slogan, therefore, became “The Choice is
Clear”, and that dovetails very nicely into our conversion to aesthetic
appliances because of the obvious double entendre. The theme
now is: it is clear that they should choose our practice, and equally
apparent that they should choose “clear” braces. Patients, young and
old alike, are quite pleased when we show them the typodonts to
demonstrate the kinds of brackets that will be placed on their teeth.
1A
1B
1C
Figure 1A-E: Patient
bonded with Clarity™ SL
Appliances upper and
lower.
1D
1E
of the packaging and delivery system available in VPO with
Clarity SL appliances, we have found that the transition to the
Clarity SL appliance system was almost seamless. The same
familiar color codes that are being used with the SmartClip SL3
appliance system are also available with Clarity SL which makes
inventory management simple. Further, because of the packaging
and delivery developed for Clarity SL appliances, ordering and
restocking is literally a breeze (Figure 2).
Indirect Bonding and VPO
One of the questions we originally had involved the impact on our
bonding appointments, since all of our full arch bondings are done
exclusively with indirect bonding. It became very clear to us, as we
tracked our progress in this transformation, that the indirect bonding
system worked extremely well with Clarity SL brackets. Indeed, we
have not seen any increase in bond failures, bracket breakage, or
any of the other concerns that are sometimes mentioned.
At this point, I should explain our reasons for not using Clarity SL
brackets consistently in the mandibular arch. Although we are
treating several patients who are bonded completely with maxillary
and mandibular Clarity SL appliances (Figure 1A-E), the readers
of this article may be familiar with the fact that, over the past few
years, I have focused sharply on the concept of using Variable
Prescription Orthodontics (VPO) to enhance the effectiveness and
efficiency of treatment.
The Clarity SL system is available in the complete spectrum of
torques and angles that are a part of the VPO armamentarium in the
maxillary arch. While several of the mandibular Clarity SL brackets
are available, the entire spectrum is not currently available. For that
reason, and for that reason alone, we are incorporating the Clarity
SL appliance system into the mandibular arch gradually. Over time,
it is our intent to make Clarity SL appliances our choice for both the
maxillary and mandibular arches.
VPO and Inventory Management
Every orthodontist knows that any change in clinical inventory
causes some concern, because existing, tried and tested systems
sometimes get disturbed in the process, and the resulting
turbulence in the clinical protocol is undesirable. However, because
18
2
Figure 2: APC™ Adhesive Coated Appliance System inventory management system
with VPO color-coded bracket packaging.
Hygiene and Comfort
It is now well understood, of course, that eliminating elastomeric
ties decreases plaque retention, and all of the consequences
that come with it. While that has become one of the accepted
advantages of changing to self-ligation, there hasn’t been much
discussion on the issue of comfort.
It has long been understood, and well accepted, that tooth
movement should be achieved by forces that are as light as
possible. The literature is replete with data to support the use of
light forces to minimize root resorption, patient discomfort, etc.
However, reducing force levels is always a greater challenge in
ligated treatment systems, since some of the force is required to
overcome the friction introduced by the ligature. In the absence of
such friction, we are now able to initiate treatment with extremely
light archwires, and it is not uncommon for us to begin the initial
leveling with an .012 Nitinol archwire.
Our follow-up with our patients has indicated a definite reduction
in the overall level of pain and tenderness as a consequence of the
change to lighter forces. Likewise, we have recorded a substantial
reduction in the discomfort associated with removal and insertion of
archwires. Because of the significant reduction in the force required
for removal and insertion of archwires in the SmartClip SL3 clip
that is incorporated in the Clarity SL bracket, the actual archwire
appointments are simply not a source of discomfort in the way they
used to be. Debonding has also proved to be easy. We are perfectly
happy being recognized in our community as the guys whose
braces don’t seem to hurt as much!
Conclusion
Our decision to transition from ligation to self-ligation, and now
to Clarity SL brackets as the chosen instrument of self-ligation,
has proved to be extremely positive, and well received by our
patients. Indeed, the transition progressed so smoothly that we
almost surprised ourselves. It is gratifying to be able to let the
patients know that they have a choice and that, if they choose our
clear braces, there will be absolutely no compromise in either the
efficiency or the outcome of treatment.
Case photos provided by Dr. Anoop Sondhi.
3M Unitek Holds “Future of Intelligent Orthodontics –
Adult Orthodontics” Symposium in Dubai
The second 3M Unitek “Future of Intelligent Orthodontics”
Symposium took place March 4-5, 2011 in Dubai. Featuring
the topic “Adult Orthodontics”, the scientific agenda featured
a broad range of topics and workshops by highly renowned
speakers including Prof. Birte Melsen, Dr. Lars Christensen,
Dr. Davide Mirabella, Dr. Francesco Amato, Dr. Jean-Stephane
Simon, Dr. Jason Cope, Prof. Dietmar Segner, Dr. Dagmar Ibe,
Dr. Leandro Fernandez, Dr. Colin Melrose, Dr. John Scholey
and others.
Facilitated by Dr. Magali Mujagic, highly renowned speakers
like Dr. Julia Tiefengraber, Dr. Leandro Fernandez,
Dr. Robbie Lawson, Dr. Anna-Kari Hajati, Dr. Skander Ellouze
and Dr. Esfandiar Modjahedpour lectured about the latest
developments of the Incognito System.
Facilitated by Dr. Fredrik Bergstrand of 3M Unitek, more
than 550 participants from 48 countries participated. Venue
of the symposium was the Mina A'Salam hotel at Madinat
Jumeirah, and a gala dinner was held the evening of March
4 at Al Hadheerah, a famous camp in the middle of the desert.
More than 150 participants also attended an Incognito™ Appliance
System User Meeting, which followed the Symposium on March 6.
19
Wire Selection for Optimal Biomechanic
Efficiency in the MBT ™ Versatile+ Appliance System
by Dr. Dietmar Segner
Dr. Dietmar Segner
earned his specialty
in orthodontics
from Hamburg
University, Germany,
and also received
his PhD from that institution. He worked as
professor of orthodontics at the university
It is the wire that drives or guides the teeth, no matter how advanced the brackets may be,
or whether they are self-ligating or not. The sensible selection of the archwires during the
different treatment phases has therefore a major influence on the treatment efficiency.
This article will show the principle and give the clinician a guide to select the right wire
at the right time. It should be pointed out that due to the variety of malocclusions and
the variability of individual tissue reaction, it is not possible to give fixed time frames for
changing to the next archwire. Rather, it is an important clinical decision if the tasks of a
certain treatment stage are resolved and the treatment can progress to the next stage and
next archwire.
clinic and now works in his private practice
in Hamburg specializing in the treatment of
adults using aesthetic appliances. For two
decades he has lectured all over the world
on adult orthodontic treatment, and results
of his research into biomechanical and
ortho materials.
What is the Archwire’s Task?
The tasks of archwires during an orthodontic treatment can be split into two, which I
will call Mode 1 and Mode 2 (Figure 1-2). In the first mode, the wire is in its active state.
Activation of the wire is carried out by ligating the archwire to the irregularly positioned
teeth. Energy is stored by pushing the elastic wires into the bracket slots. After this
activation, the archwire uses this energy to move the teeth. Such an operating mode is
typical for the aligning and leveling stages. It would also be relevant in all situations where
the orthodontist inserts loops or other active elements into the archwire through bends, as
for example retraction loops. As these applications are not used on a regular basis in the
MBT™ Versatile+ Appliance System, they will be excluded from the further deliberations.
In the other application of an archwire (Mode 2), the archwire is used as a guiding track for
the mesial or distal movement of teeth along the arch. Here the archwire is initially passive
and its stiffness and elasticity only comes into play when the teeth start to show side
effects such as tipping or rotations. Then the wire creates corrective forces and moments
and assures that the teeth do not deviate from the intended track and angulations. The
activation is achieved by elastomeric chains, super-elastic springs, inter-maxillary elastics
or similar. These auxiliaries store the energy for the tooth movement. This application
mode is typical for the working and retraction phases. In this mode the wire should have a
significant stiffness in order to keep the undesired rotations or tipping to a minimum.
1
Figure 1: Wire in an active state.
2
Figure 2: Wire in a passive state.
Dimension
During the alignment phase there is no need for a tight fit of the archwire in the bracket
slot, as the differences between the archwire dimension and the slot dimension are up to
0.15 mm, while the positioning precision during the first alignment stage needs to be only
about 0.5 mm. For a number of reasons, it is even desirable to have undersized wires in the
alignment stage. The play between archwire and bracket slot reduces friction and potential
binding with severely irregularly positioned teeth. Also the force-deflection curves of thin
super-elastic wires are usually better because they show the correct force level immediately
20
at the beginning of the deactivation while thicker super-elastic
archwires can show rather high forces during the first days after
the ligation. It is also important to note that the slot dimension does
not play a major role in selecting the first aligning wire. The same
dimension is suitable for the 18 and 22 slot system.
During the leveling stage and also later in treatment the wire
dimension becomes important. For de-rotation in self-ligating
brackets and for effective torque effect, the wire dimension needs
to be adjusted to the slot size. To get the standard designed torque
effect the vertical dimension of the (rectangular) archwire needs
to be 16 in the 18 slot and 19 in the 22 slot. Another requirement
is that the horizontal slot dimension needs to be 25 in both the
18 and 22 slot systems for good rotational control. It is therefore
clear that in the MBT™ Versatile+ Appliance System, the standard
working wire as well as the finishing wires should be 16×25 in the
18 system and 19×25 in the 22 system.
It should be kept in mind that an increase in wire dimension results
in a stronger expression of the torque built into the prescription of
the MBT system, resulting in additional torque angulation. Using a
17×25 wire instead of a 16×25 in the 18 system or a 20×25 instead
of a 19×25 in the 22 system increases the torque value by about 3°.
Of course the same is true for undersized archwires: using a 14×25
wire instead of a 16×25 wire in the 18 system decreases the torque
angle by 6°, using a 17×25 instead of 19×25 in the 22 slot system
will decrease the torque effect by 7°.
Stiffness and Force Levels
In the active Mode 1 of archwires, the force acting on the teeth
depends mainly on the archwire used. Super-elastic archwires
have a major advantage in that the force is almost constant no
matter how irregularly the teeth are positioned or how short the
inter-bracket distance is, in clear contrast to the twisted wires,
braided wires or non super-elastic Nickel-Titanium wires. In the
graph (Figure 3) we compare a 16 super-elastic nickel-titanium
wire (Nitinol HA) and a 16 non super-elastic Nickel-Titanium wire
(Nitinol Classic). We easily see that the super-elastic wire develops
significantly less force. The difference is shown by the combination
of the red and yellow areas in the graph.
But even if we try to reduce the force of the non super-elastic
archwires by selecting a thinner wire (14 Nitinol Classic) we see
that for all deflections above 1.2 mm, the thicker but super-elastic
wire develops lower forces that are also constant over much of the
deflection range. Below 1.2 mm deflection, the force of the non
super-elastic wire, decreases so much that it becomes less than the
super-elastic wire, and eventually it would not move the teeth any
more, and an archwire change needs to be conducted. On the other
hand, the super-elastic archwire continues to exert constant forces
3
Figure 3: Force associated with 3 archwires.
4
Figure 4: Force characteristics of Nitinol HA (HANT) in dimension 14 round.
until the deflection falls below 0.35 mm, so with one single archwire
we achieve almost perfect leveling if we just leave the wire in and
give it a chance to express itself fully, which might take anywhere
from 5 weeks to 5 months.
In order to optimize the biological response, and avoid the risk of
force that is too high, the initial archwire should be super-elastic
and its force level should be significantly below 100 g of force. The
optimal wire therefore is the 14 Nitinol Heat Activated both for the
18 system and the 22 system (Figure 4).
After the alignment phase, the slots will be quite well aligned.
If a second archwire is necessary for the leveling stage, the
deflection of that archwire due to misaligned bracket slots will
be below 0.5 mm. Since none of the super-elastic archwires
has a plateau of constant force below 0.5 mm, the aspect of
superelasticity becomes unimportant for the second and all
following wires of the treatment. Now it becomes crucial that the
wire has the correct dimension to get full expression of the bracket
prescription as described above.
21
During the working stage the wires operate in the passive Mode 2.
They should have sufficient stiffness to counteract any undesired
movements or rotations. Since the leveling phase achieved perfect
alignment of the bracket slots, insertion of such a stiff archwire
should not present a problem. Only wires of Beta III Titanium or
stainless steel provide sufficient stiffness. Especially in extraction
cases, steel is to be given preference.
5
Making Bends
Although the philosophy of the MBT appliance system is to
avoid bending as much as possible, by achieving perfect bracket
positioning through indirect bonding and – if required – early
repositioning of brackets in the leveling phase, it sometimes might be
necessary to implement bends, especially during the finishing phase.
When a corrective bend is applied, it is usually to achieve a change
from the previous situation. This means that in this moment the
archwire is changing into Mode 1 again, the active mode. In
addition to the property of accepting precise bends, the archwire
material should also deliver the stored energy with physiologic
forces. Especially in the 22 system even small corrective bends in a
stainless steel wire exert significant amounts of force. To decrease
the force level and associated pain for the patient, it is of benefit
to use the lower modulus of elasticity of the Beta III Titanium
material. The same corrective bend in the same dimension archwire
will exert only 50% of the force in comparison to a stainless steel
wire. Therefore, the Beta III Titanium material is the recommended
material for finishing wires.
Self-Ligating Brackets
In principle, treatment with self-ligating brackets in the MBT system
can proceed with the same wires as with conventionally ligated
brackets. The only difference of significance is the rotational control
in the leveling phase. All self-ligating brackets have a fixed slot
depth of 0.0275" (0.027" for the lower anteriors) defined by the
clips or slides. In order to be able to effect de-rotation or control
undesired rotation, the archwire needs to fill this slot depth with a
play of not more than 0.0025". Therefore a single round wire will
not give perfect rotational control without adding a ligature on the
tooth in question.
Two options are available to the orthodontist: the first is to finish the
leveling with an archwire that has a 25 for the horizontal dimension.
For the 18 slot dimension, archwires of the dimension 14×25 and
16×25 were introduced, while in the 22 system 17×25, 18×25,
and 19×25 wires have been available for a long time. The second
option is to fill the slot in the buccolingual direction using two round
archwires, which is called the Tandem Archwire Technique. For the
18 slot system this would be two 14 Nitinol HA archwires, while in
the 22 slot system it could either be also two 14 dimension wires
or a 14 and a 16 Nitinol HA wire used in tandem. The latter variant
might activate the clip a bit, leading to some pressure of the clip on
the wire(s) (Figure 5).
22
Figure 5: Tandem Archwire Technique examples.
In many cases, the initial alignment wire from the upper jaw can
be transferred to the lower jaw and added to the alignment wire
already present there. Often it would also be possible to transfer a
lower alignment wire to the upper jaw and let this second wire run
only up to the first molar.
Special Treatment Objectives
If there are special tasks during the leveling stage, the use of
additional archwires may increase treatment efficiency. Typical
examples would be the leveling of a pronounced Curve of Spee.
Here round stainless steel archwires of the dimension 18 in the
18 slot system, or of the dimensions 18 or 20 in the 22 slot system,
might enhance the efficiency. A number of orthodontists like to
use a Nitinol SE reversed curve archwire of the dimension 16×22
(18 slot) or 19×25 (22 slot) for the same task. For transverse arch
form adaptations, stainless steel wires would also be beneficial.
If the special application of torque is required, the use of non
super-elastic nickel-titanium should be preferred over the superelastic nickel-titanium variant. With super-elastic rectangular wires,
the torsional moments are in the range of 200 to 500 gmm, which
is on the low side of effective torque application. With non superelastic wire materials, the torsional moment depends on the amount
of activation and can be adjusted to up to about 1500 gmm. For the
18 slot system, a 16×25 Nitinol Classic, and for the 22 slot system,
a 19×25 Nitinol Classic left in the mouth a sufficient amount of
time will effect the specific torque requirements efficiently. Up to
2.5° per month can be achieved.
Wire Selection
To make the selection of wires for an optimal biomechanic
efficiency easier, a table has been assembled that lists the
recommended wires for the different treatment stages in the
MBT appliance system (Table 1). The table has columns for the
18 system as well as the 22 system. Also, the special requirements
of self-ligating brackets in the MBT system are addressed in the
table. In the rightmost column, suggestions for special treatment
tasks are given. These wires are only needed in certain cases
to make the treatment easier and more efficient for the patient.
Listing a strict, non-negotiable order of archwires or recommended
time intervals for the archwires to reside in the mouth has been
purposely avoided. Such inflexible cookbook-style recommendations
violate clinical experience as well as common sense and would be
contrary to the philosophy of the MBT system.
MBT™ Versatile+ Appliance System
Treatment Phases and Wire Requirements
Treatment Stage
Aligning Stage
14 HANT
Tasks:
Requirements for Wire:
• Activating cellular
reaction
• Low forces, especially with large
irregularities
• Initial slot alignment
• Force limitation desirable (force
limitation by superelastic plateau)
• Initial de-rotation
Recommended Wire Products and Variations
MBT™ System Brackets 18 Slot
MBT™ System Brackets 22 Slot
Variations:
14 HANT
Variations:
14 NCL with push coil
and not all teeth ligated
then for
self-ligating only:
14 NCL with push coil and
not all teeth ligated
14+16 HANT
Tandem
• Avoid binding
• Torque effect initially usually
not desirable
Leveling Stage
Self-Ligating:
Variations:
Tasks:
Requirements for Wire:
• F inal de-rotation/
re-establishing correct
contact points
• Not too high forces
14×25 HANT
or
14+14 HANT
Tandem
If torque matters
• 16×25 NCL
• Establishing torque
• Correcting angulations
• Leveling Curve of Spee
• Elasticity to correct angulations/tip
• Good rotational control
• Dimension needs to fill slot height
for torque effect
• Stiffness to level Curve of Spee
Non-Self-Ligating:
16 Australian
then
16×25 Beta III
Titanium
Working Stage
Tasks:
Requirements for Wire:
•C
losing of extraction
spaces
• Enough stiffness to avoid vertical
and horizontal bowing
• Closing of other spaces
• Dimension needs to fill slot height
for torque effect
•R
etracting anterior teeth
with torque control
Self-Ligating +
Non-Self-Ligating:
19×25 HANT
For additional
vertical leveling:
• 18 SS
• 16×22 NSE
reversed curve
Variations:
If torque matters
• 19×25 NCL instead of
19×25 HANT
For additional
vertical leveling:
• 18 SS
• 20 SS
• 19×25 NSE
reversed curve
• 19×25 Beta III Titanium
Variations:
19×25 SS
Variations:
If no space closure
required:
• 16×25 Beta III
Titanium
(with crimp hooks)
Optional: 21×25 hybrid
16×25 Beta III
Titanium
Variations:
19×25 Beta III
Titanium
Variations:
16×22 Braided
Alternative would be
using a positioner
19×25 Braided
Alternative would be
using a positioner
16×25 SS
or
17×25 SS Hybrid
(with crimp hooks)
If no space closure
required:
• 19×25 Beta III Titanium
• Good rotational control
• Low friction
Finishing Stage
Tasks:
Requirements for Wire:
• Correct midlines
• Corrective bends possible without
too high forces
• Root alignment
• Overbite/overjet
• Functional occlusion
If already in place:
• 17×25 SS hybrid
• 16×25 SS
If already in place:
• 19×25 SS
• Good rotational control
• Dimension needs to fill slot height
for torque effect
• Enough stiffness to hold or
fine-tune arch form and overbite
Settling Stage
Tasks:
Requirements for Wire:
• Maximizing
intercuspidation
• Allows minor tooth movement by
occlusion and elastic traction
Table 1: Recommended wires by treatment phase, MBT™ Versatile+ Appliance System. Note: Wire selection should be made on a case-by-case basis.
NCL: Nitinol Classic; NSE: Nitinol Super-Elastic; HANT: Nitinol HA; SS: Stainless Steel.
23
Transbond™ IDB Pre-Mix Chemical Cure Adhesive
by David K. Cinader and Darrell S. James
David K. Cinader
received a BS
Degree in Chemical
Engineering from
Michigan Tech
University in 1994
and a PhD in Chemical Engineering in 1999
from Northwestern University. He joined
3M Unitek Research and Development in
September 1999 and has been involved in
orthodontic bonding development including
Transbond™ Plus Self-Etching Primer,
APC™ II and PLUS Adhesives, and
Transbond™ Supreme LV Adhesive.
Darrell S. James
is Senior Technical
Service Engineer
at 3M Unitek. He
has worked at
Introduction
Indirect bonding has been practiced for many years, beginning with the “clean base”
method of Silverman et al.1 and progressing to the “custom base” method of Thomas2.
These techniques have in common the pre-positioning of appliances on a working model of
the dentition and the use of a transfer tray to capture the appliances and convey them to the
patient’s mouth. The custom base method offers the advantage of reducing the amount of
excess adhesive flash by allowing the use of less highly filled adhesives.
The increased interest in lingual orthodontics has brought about more comfortable,
customized systems such as the Incognito™ Appliance System3,4. Indirect bonding is
especially attractive for lingual cases since the access is limited. In addition, the Incognito
system requires a robust bonding solution, able to cure under the relatively large bonding
bases where the curing light may not penetrate, and in the gaps between bonding base and
tooth that may arise from tooth movement between taking the initial impression and fitting
the transfer tray. In response to these needs, we have developed Transbond™ IDB Pre-Mix
Chemical Cure Adhesive (Figure 1).
Transbond IDB adhesive is delivered in vials for familiarity of use and for the ability to
adjust the dispensed amount. The dispensing tip was chosen to assure uniform, bubble-free
drops. A fumed silica filler imparts the ability to fill gaps as well as resist slumping, running,
or drifting from the bracket base prior to placement in the patient’s mouth.
To provide the strength associated with Transbond brand adhesives, its resin consists of the
dimethacrylate monomers Bis-GMA and TegDMA.
3M Unitek since
1985, primarily being involved in adhesive
development. He received his Bachelor of
Science Degree in Biology from Kent State
University in 1983.
1
Figure 1: Transbond™ IDB Adhesive is delivered in vials.
Laboratory Findings
The most important requirement of any adhesive product is bond strength, so Transbond
IDB Adhesive is designed to have equivalent bond strength to Sondhi™ Rapid-Set Adhesive
and Reliance Maximum Cure®, which are commonly used for indirect bonding (Figure 2).
24
Based on feedback from the first evaluation, Transbond IDB
Adhesive was reworked to further improve the viscosity and work
and set times. A new dispensing tip was identified and evaluated.
The second evaluation version of Transbond IDB Adhesive offered
more accurate dispensing.
Figure 2: Bond strengths of Maximum Cure®, Sondhi™ Rapid-Set, and
Transbond™ IDB Adhesive.
Another important aspect of an adhesive product is the set and
work times, especially for the finite values of a chemical cure
adhesive. The initiator concentrations were carefully chosen to offer
a long working time without unduly extending the cure time. The
work and set times are shown in Figure 3, and can be adjusted by
using the product at refrigerated or room temperature.
Adhesive
Refrigerated
Room Temperature
Work Time, Set Time, Work Time, Set Time,
sec
sec
sec
sec
The improved version of Transbond IDB was sent to a limited number
of evaluators in the U.S. and Europe and included both Incognito
system users as well as traditional labial bracket indirect bonders.
The evaluators found this version to be preferred over the first version.
The bond failure rate over a three month period was 3.3% overall
(1261 brackets bonded). Labial and lingual indirect bonders achieved
nearly the same bond failure rate at 3.5% (847 brackets bonded)
and 2.9% (414 brackets bonded) respectively.
Summary
Transbond IDB Adhesive is a new chemical cure adhesive with
work/set time, rheology, and delivery specifically designed for
indirect bonding. The low bond failure rate recorded in a customer
evaluation demonstrates its effectiveness.
References
Transbond™ IDB
Pre-Mix Chemical
Cure Adhesive
140
180
80
110
1.Silverman, E., M. Cohen, A.A. Gianelly, and V.S. Dietz, “A universal direct bonding
system for both metal and plastic brackets,” American Journal of Orthodontics
62, 236-244, 1972.
Maximum Cure®
Chemical Cure
Sealant System
90
150
65
115
2.Thomas, R.G., “Indirect Bonding: Simplicity in Action,” Journal of Clinical
Orthodontics 13, 93-106, 1979.
Sondhi™ Rapid-Set
Indirect Bonding
Adhesive*
N/A
30
3.Mujagic, M., Fauquet, C., Galletti, C., Palot, C., Wiechmann, D., and J. Mah,
“Digital Design and Manufacturing of the Lingualcare Bracket System,” Journal
of Clinical Orthodontics 39, 375-382, 2005.
Figure 3: Set and work times.
N/A
15
*No pre-mixing required.
Customer Evaluation
Customer Acceptance Testing of Transbond™ IDB Adhesive was
conducted in two phases. Initial samples of Transbond IDB Adhesive
were sent to Incognito Appliance System users in Chile, Europe
and the UK. Evaluators were asked for a wide range of feedback
including comments on viscosity, work and set time, bond strength,
bond failures, etc.
These users were comparing Transbond IDB Adhesive to their
experience with Maximum Cure® Sealant (Reliance Orthodontic
Products, Inc.) since that was the recommended adhesive for the
Incognito System at that time.
Initial evaluators were asked to track bond failures over a 6 month
time frame and to submit a satisfaction survey on Viscosity, Working
Time, Setting Time, Dispensing, Color and Overall Satisfaction. The
evaluators that continued to use the product and submit surveys
rated the Transbond IDB Adhesive more highly than Maximum Cure
Sealant in every category.
4.Stamm, T., Hohoff, A., and U. Ehmer, “A subjective comparison of two lingual
bracket systems,” European Journal of Orthodontics 27, 420-426, 2005.
2010 Energy
Excellence Award
3M Unitek has been recognized by 3M Energy
Management as a winner of the 2010 Energy
Excellence Award. 3M Unitek is one of only
four 3M facilities around the globe to win this
prestigious award in 2010.
The 3M Unitek Energy Team implemented several energy
reduction projects that saved over 8% of kWhrs of electrical
energy usage indexed to production compared to the previous
year. 3M Unitek also implemented an Energy Management System
to provide automated and remote control and monitoring of key
major energy consuming equipment. The Award recognizes
superior work that goes beyond the energy management program
and demonstrates continued significant energy reduction and
continuous improvement.
25
Now THAT’S a Winning Smile
Special Feature Article
May 2011
Dr. Sami Webb
received her
The case is completed; the braces are off. What criteria are on your checklist to determine if
the treatment should be considered a success?
Bachelor's degree
• Do the results meet your treatment objectives?
at the University of
• Is the patient’s satisfaction high?
Nebraska-Lincoln
• Are parents and friends happy with the result?
and her DDS from
• Does it meet Board standards?
the University of Nebraska Medical CenterCollege of Dentistry in Lincoln, NE. She
practiced general dentistry for one year
prior to attending The Ohio State University
in Columbus, Ohio, for her orthodontic
specialty training. She obtained her MS and
Certificate of Orthodontics after a three
These may be pretty high hurdles, but they’re common ones for many of today’s
practitioners. But consider adding yet another to the list, like Dr. Sami Webb of Scottsbluff,
Nebraska has done. Her checklist includes: “Does the patient go on to win a pageant?”
Not your typical expectation you say? There’s good reason for this additional category on
Dr. Webb’s list. Approximately ten of her patients have won pageant titles over the past
few years. And the latest is none other than Teresa Scanlan, winner of the Miss America
Competition for 2011.
year residency program at The Ohio State
University. She currently has offices in
1
Figure 1: Miss America 2011 Teresa Scanlan.
26
Erik Kabik/Retna Ltd./Corbis
Scottsbluff and Alliance, Nebraska.
2
3
Figure 2: Dr. Sami Webb with Kaelia Nelson, Miss
Chadron (Nebraska) 2011 Outstanding Teen.
Figure 3: Dr. Webb with Jessica Littlejohn (L),
Miss Scotts Bluff County (Nebraska) 2010, and
Sara Richter (R), Teen Miss Scotts Bluff County 2010.
Dr. Webb says it’s a matter of both personal and professional
pride that her patients have the confidence of a beautiful smile to
help them in their pageant quests. That’s partially because she
has pageants in her background too: she represented the State of
South Dakota as a teen and competed at the national Miss Teen of
America pageant in 1992.
Dr. Webb feels pageants are not just beauty pageants, but an
avenue to recognize talented young women and reward them for
their accomplishments and achievements. So she takes a personal
interest in patients who also pursue these goals. She was a judge
5A
5B
5C
Figure 4: Left to Right: Miss Scotts Bluff County
Jessica Littlejohn, former Miss Nebraska and current
Miss America Teresa Scanlan and Scotts Bluff County
Teen Sara Richter.
in one of Teresa Scanlan’s first pageants in 2007 and was
even there in the audience in Las Vegas when Teresa won the
Miss America title. She says she knew she just had to be there
to support Teresa and had a feeling something great was going
to happen.
Dr. Webb treated Teresa with Clarity™ Ceramic Braces. They are
aesthetic and she has found that their strength and predictable
debonding is important. For her practice, she uses a variety of
3M Unitek braces along with the APC™ Adhesive Coated Appliance
System for convenience and efficiency. Dr. Webb has also recently
included the Incognito™ Appliance System as an additional
aesthetic offering.
Why did Dr. Webb choose 3M Unitek as her supplier? “I appreciate
the quality built into the products and as a result, I can move teeth
predictably and to my expectations.” She along with her staff have
used other suppliers in the past and said there is just no comparison
in quality of products, service and support. She also says “The APC
adhesive system is the most reliable bonding I’ve found and if you
asked my staff if there was one thing they would never live without,
it would be Transbond™ Plus Self Etching Primer.”
Case photos provided by Dr. Sami Webb.
All photos used with permission.
5E
5D
4
For more information about Dr. Webb and her patients, visit
www.webbortho.com. – Editor
5F
5G
5H
Figure 5A-H: Final treatment photos, Teresa Scanlan.
27
Upcoming Events
Register Early!
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
Treating adolescents. 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 early 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.
012-257 1105