After a long Xmas pause, I jump into 2018 full of energy and willing to share a lot of interesting stuff about 3D orthodontics.
Today I would like to start a mini-series of post concerning the digital-lab, and specifically my collaboration with Stefano Negrini, one of the very first technician who believed into 3D orthodontics in his field, beginning 10 years ago. I will talk about him in future post, but you can hold his name as he’s one of the world’s most renowned experts as a technician.
The collaboration between a 3D-digital orthodontist and a 3D-techinician has just one true limit: the imagination of both of them. In fact, the possibility of creating digital projects is almost limitless, and the clinical sense of the orthodontics can lead the technician to create very interesting custom-made appliances.
Let’s take the example of the Motion or Carriere appliance. I was exposed during a meeting to an enthusiastic lecture given by Luis Carriere (if you notice his name into a congress, don’t hesitate to go and listen to him!). I thereafter went into his office in Barcelona and could get a lot of inspiration from this great colleague. He’s trying to spread a philosophy that can be summarized into the motto “sagittal first”.
After applying his philosophy to CLII treatment, he recently published some very interesting material on CLIII treatment. His results are amazing. He treats even severe CLIII with a non-surgical approach, playing with the vertical dimension as a compensation for excessive sagittal projection of the chin. I have seen something similar only in the MEAW technique approach of Prof. Sadao Sato. It’s a super-interesting approach to CLIII treatment as it pushes forward the limit between orthodontic and ortho-surgical treatment. Worthless to say it’s a much more complex approach requiring good bending skills and a lot of patience to achieve great results. The Carriere/Motion CLIII approach is based on the same principles, but it’s much simpler.
I decided to test it on a CLIII patient of mine but I immediately faced to a clinical problem.
In fact, I was willing to have a long lever from lower 7 to lower 3, but such a size was not available into the market stock. I decided to try a 7 to 4 bar, after carefully measuring the distance for an appropriate selection, but the odd distal tip of my patient lower first premolar and the accentuated lingual torque of the lower 7 made the bonding of the stock appliance a quick failure.
I thus asked my technician to build a long bar, according to my original idea of going from 7 to 3, but as far as I judged the 5 as in need to some specific distal movement in order to unlock extrusion of the lower 4, I asked for an extra pad on the 5. In my mind, I was willing to cut the mesial part between 5 and 3, once canine correction was achieved.
By having a customized Carriere CLIII bar realized by my technician I could overcome the bonding problems linked to the special anatomy of the teeth.
I applied one month of Force1 elastics (1/4” 6,5oz) and two months of Force2 elastics (3/16” 8oz) on the right side from upper 6 – as 7 was not erupted yet – to the lower right canine. At the same time a standard motion appliance was bonded 7 to 4 on the left side (same force scheme).
In the upper arch I started an Invisalign treatment to enjoy alignement, while providing adequate anchorage for elastic traction.
I then cut the mesial part of the bar, leaving a small segment going from 7 to 5 and applied one extra-month of traction from upper right 6 to lower right 5 with Chipmunk elastics (1/8 3,5oz), and night use of Force2 elastics on the left side.
After 4 months of treatment, an annoying full CLIII on the right side was gone, together with partial flattening of the deep curve of Spee as a consequence of the spontaneous eruption of lower right first premolar after creating some distal space distal to it.
The case is now sagittally solved, with a slight overcorrection and an extra overjet that is more than welcome. The major change happened at the occlusal plan, with the typical anteroration that is expected when correcting a sagittal problem through a vertical compensation.
It can be now easily solved by a small further expansion of the upper arch coupled to retraction and extrusion of the upper incisors.
I wish this post could inspire you regarding:
- The Motion CLIII appliance of Luis Carriere and his simple and great sagittal first approach
- Collaboration and imagination into personalizing solutions together with your digital technician, who should be driven by an orthodontic having sound clinical ideas
As January is still not finished I am still on time to wish you a great 2018, full of smiles for you and your patients!
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