Orthotown March 2018 - 23

It'd be interesting to see examples of this treatment plan. Any concerns about exacerbating
the already compromised periodontal situation with additional proclination/expansion, or issues
with stability given the potential increase in IC width? I don't find closing spaces to be traumatic.
Would love to see an example or two that illustrates this point. ■

Fenrisúlfr
Member Since: 02/25/09
Post: 17 of 26

12/19/2017

For this patient I am concerned about the perio regardless of the treatment plan, but less
concerned with my current protocol as I outlined.
I was a longtime Damon user and now follow the Pitts protocols. My problem with treating
so many cases non-ex without an expansion appliance was flaring the upper incisors-not perio
issues. With my current protocol, proclination of the incisors is rarely an issue, but when it is
from the beginning, or develops, it can make sense to extract in both arches. I also warn patients
that if we do get proclination, due perhaps to inadequate elastic wear, we will have to consider
extractions. I am not doctrinaire about non-ex, only that it gives me the best results in most cases.
I will look for examples with good or at least half-decent photography. I am not always pleased
with the photos we get. ■

JohnnySS
Member Since: 10/18/13
Post: 18 of 26

12/19/2017

Based on the data below, it seems like there is still significant proclination and expansion
that tends to occur with SLBs or conventional brackets. In the attached CBCT study, the authors
also report loss of buccal bone.
Aside from the stability issues, in a case like this with a susceptible host, would non-surgical
expansion/proclination be advisable or beneficial, esp. given the data on the loss of buccal bone?
Something's gotta give, and the unfavorable changes may not be reversible. ■
[Editor's note: View this message board online to see the cited sources.]

Fenrisúlfr
Member Since: 02/25/09
Post: 19 of 26

12/19/2017

It's not the tool, it's how you use the tool. Most, if not all, of these studies are bogus in my
mind because they have such strict control protocols that they essentially use the PSL brackets
almost exactly as you would conventional brackets. I have spent 15 years learning PSL and
followed the developments closely. My current protocols are vastly different from my training in
school and my later changes.
In my school, which was excellent, we took out a lot of bicuspids for stability. In practice,
I started to use more and more fi xed expansion appliances to push the envelope and treat more
people non-ex. Then I jumped into Damon and I've gone through a major learning curve to use
that tool and later the Ortho Classic H4 bracket.
At one time bridges were made out of stone, and then iron came along. But initially of course,
the iron bridges were built more like stone bridges. It took time and experience to learn the
properties of the new material and take full advantage of it. All new developments work like this.
My current protocols have gradually evolved to the point where I practice very differently.
We all change. PSL is a huge part of that change for me, but so is disarticulation (bite turbos),
initial light elastics from Day 1, flipping brackets for torque control, super cable wire, bracket
placement for smile arc, and other things that I'm just not thinking of right now. So much of
our practice becomes intuitive.
A real study would have a look at very different protocols to compare approaches and outcomes.
PSL brackets are a small part or a big part of the effect depending upon the way they are used.
PSL is hardly the only way to achieve excellent results, but my personal experience is in no way
consistent with many of the studies that compare PSL to conventional brackets. We are all here
to learn, but the most compelling teacher is personal experience. ■

JohnnySS
Member Since: 10/18/13
Post: 20 of 26

12/20/2017

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