Orthotown May 2017 - 20
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Is there a reason for the gingival position of the lower incisor brackets in the last picture? It's
hard for me to see the photos (on my iPhone) but it looked like first you were using an intrusion
arch then repositioned the brackets. Nice case! ■
1/17/2015
Fenrisúlfr
Member Since: 02/25/09
Post: 11 of 34
Thanks! Once the intrusion was completed, I repositioned the upper and lower 3-3.
I generally tend to do that in most cases to establish better vertical incisor display, smile
aesthetics and more optimal coupling and overbite. In her case, the lower canine brackets were
positioned a bit more incisal, so I reset the lower 3-3 to have the canines about 0.5mm above the
lower incisors (given their post-intruded position). Below is the image immediately after the resets.
Given the wire deflection, the incisors were still subjected to an intrusive force, but the
degree of deflection was minor enough to just use continuous low-modulus wires to complete
the leveling.
Toward the fi nishing stages, in several cases, I fi nd the anterior guidance to be shallow
(protrusive and balancing interferences), so a (slightly) deeper overbite tends to be functionally
better, IMO. Also, it is easier for me to add a slight RCOS/ACOS if the incisors are a bit overcoupled than to try to establish optimal incisor contact with step-bends, ELS and curved wires.
In addition (at least with these brackets and prescription), in several extraction cases (with a
more incisal placement of the brackets) the incisors appear detorqued (plausibly due to the greater
moment of the retraction force given the distance between the CR and the brackets).
I've also attached a couple of other cases that exemplify some of these issues. Sorry for the
thread derail! ■
1/17/2015
zxzxzx
Member Since: 02/28/03
Post: 12 of 34
Rick McLaughlin has his own way of doing second bicuspid extractions. The case he uses
is quite similar to the one NY Sent posted. If you look at the superimpositions, the upper first
molar comes forward a ton but the patient grows a ton so it all works out. I would not live that
dangerously. I would use the same basic approach but stabilize the upper 6s with palatal miniscrews
and remove them early if the patient started getting too Class III on me.
I'd also like to point out that this approach would allow you to treat with full braces or
Invisalign after the extraction spaces are closed. Rick's thinking is that he wants to take advantage
of the regional acceleratory effect and start closing spaces as soon as the teeth are gone and not
to have to wait some months while leveling to the full-sized arch wire. ■
1/17/2015
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