Orthotown May 2018 - 15

I would give a couple options.
Ideal: Non-extraction, F/F in the maxillary advancement and posterior impaction
Compromises: 1. Extract UR5/5s and 8s. I like to extract the 8s here, because I worry about
anchorage concerns. As Fenrisúlfr stated, you need to burn anchorage (my choice if compromise
treatment plan is chosen.) 2. Consider extracting lower molars instead (first or second). I know
this may be "off the wall" for some, but now anchorage is less of a concern (than keeping 8s with
extraction of 4s) and only removing two lower teeth instead of four. Good luck. ■

srensch
Member Since: 03/12/09
Post: 12 of 14

4/16/2018

Fenrisúlfr, just curious, what are your methods for anterior anchorage when burning posterior
anchorage? Do you place moments? Torque the anteriors? ■

flourcity
Member Since: 10/02/09
Post: 13 of 14

4/17/2018

In general, sliding mechanics with full-sized arches in an 022-slot with MBT (or other hightorque straight-wire prescriptions) is set up to minimize anterior torque loss, or to burn anchorage.
As the slot is filled (19- or 21x25 SS), third-order moments are progressively generated (by
virtue of the wire-slot interaction) to increase the inclination of the tooth (frequently beyond
the desired end point), thus facilitating the desired anchorage loss/buccal segment protraction.
Once the optimal inclination and/or position is established, and depending on the remaining
space, COS/overbite, overjet, arch width, buccal segment inclination etc., the options could
include adding moments across the entire arch (V-bends or compensating curves to the arch wires
ACOS U/RCOS L) or localized third-order moments to the anterior section (torque).
Steel-ligating the anteriors minimizes loss of anterior activation or de-torquing during space
closure. In addition, adding els. to the prepared arch can speed up the process.
Closing loops in stiff wires (19x25 SS) with anterior torque or a curve added can also be
used to burn anchorage but can be very tricky in terms of activation. Overactivation (beyond a
millimeter or so) can lead to overretraction of the anteriors.
As an example, in the case below, following reciprocal space closure in flat 19x25 SS wires
(PC U 7-7/L 6-6) with Class II els., the linear position of the upper and lower incisors looks
pretty good. However, the inclination needs to be optimized.
Some bite-deepening and lingual/palatal tipping of the buccal segments is also evident. In this
case, upper and lower curves were added to 19x25 SS and the 3s steel-ligated to continue space
closure. The end point in her case would be lingual root torque of the incisors (5-8 degrees or
so), flattening the COS, root paralleling and uprighting the buccal segments. ■

Fenrisúlfr
Member Since: 02/25/09
Post: 14 of 14

4/17/2018

How do you deal with difficult cases?
Search: "Extraction Pattern"
A Class III case and a patient who has already had some extractions is
making this Townie wonder where to start the treatment. To view this
conversation online, and share your advice, go to orthotown.com and
search "extraction pattern." This message board will be the top result.

orthotown.com \\ MAY 2018

15


http://www.orthotown.com/messageboard/thread.aspx?a=11&s=6&f=693&t=310247&g=1 http://www.orthotown.com

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