Pacific Coast Society of Orthodontists Bulletin Winter 2012 - (Page 39)
Presented by Dr. Steven Dugoni (San Francisco, CA) at the PCSO Annual Session on October 5, 2012.
Summarized by Dr. Gerald Nelson, PCSO Bulletin Editor.
Dr. Dugoni presented cases treated with a protocol that
he and his father have used for many decades. The goal
of this protocol is to choose the case properly, and then to
address all problems, including the class II, the alignment,
and the arch length, prior to the permanent dentition.
The vast majority of cases will not need a second
phase of orthodontic treatment.
In a case example, a class II moderate crowding in the
early mixed dentition with fused LL 2 and 3, the treatment
1. Use 2x4, headgear (HG), and LLA
2. Expand and use Herbst
The UOP plan used was: 2x4, cervical HG, extract lower
Cs and place active lingual arch. The objective was to
reduce overjet by correcting the dental class II and reducing
the skeletal class II, and to correct the crowding by
maintaining E space and proclining incisors.
r. Dugoni is the director of
the Mixed Dentition Clinic
at the Art Dugoni School
of Dentistry in San Francisco. The
Clinic began in 1971. The dental
school and Orthodontic Department
will move to a new location
in downtown San Francisco in
The case treated well, but Dr. Dugoni insists that an
important part of the protocol is retention management. A
Hawley will hold alignment, while the headgear is continued
at night PRN. The lower lingual arch is retained until
the full permanent dentition.
When the permanent dentition arrived, the occlusion was
good, but not perfect. Then the options were to employ
full fixed appliances, use Invisalign, or accept the result.
The patient chose a short period of FFA followed by
Dr. Dugoni usually starts treatment in these cases around
age 8, or when the laterals are emerging. He selects cases
with more than 6mm overjet, deep bite, class II, and moderate
crowding or spacing. He increases maxillary arch
length while in the 2x4 appliance using push coil. Mandibular
arch length is managed by holding E space, and
in some cases proclining incisors, with LLA adjustments.
No transverse expansion is attempted unless the maxillary
arch is narrow. The active treatment is followed by an
active retention phase, in which the molar relation, arch
length and alignment is closely monitored and preserved.
Dr. Dugoni avoids Phase I treatment when the canines
are emerging, crowding is severe, skeletal relation is
extreme, the parents are opposed, or the problem is mild
Dr. Dugoni presented the protocol for mixed dentition
class II cases as practiced at the Orthodontic Department
in the Art Dugoni School of Dentistry. He emphasized setting
comprehensive goals for such patients, and conducting
close supervision of the retention period.
W I N T E R 2 0 1 2 • P C S O B U L L E T I N
Table of Contents for the Digital Edition of Pacific Coast Society of Orthodontists Bulletin Winter 2012
What a Time it Was!
AAO Trustee's Report
A need, A dream, A reality: A team approach produces an extraordinary outcome
PRECEDENT Orthodontists on Devices
The Complexities of Successful Herbst Treatment
Dr. Bryan Williams
Treatment Planning: The Magic Step
Comprehensive Mixed Dentition Approach
Social Media 101 for Orthodontists
Update on Bonding 2012
Create the Future by Looking Back: 100 Years of PCSO
PCSO at a Glance
Case Report Pre-Treatment
Case Report Post-Treatment
Pacific Coast Society of Orthodontists Bulletin Winter 2012