Asociación Mexicana de Ortopedia Maxilar A.C.
Malden M.Kuftinec, DMD,ScD
Minimizing Undesirable Effects of the Straight Wire Appliance Therapy
By far the most popular current edgewise technique in Orthodontics
is the so-called Straight Wire Appliance [SWA]. While the technique is widely
accepted and practiced, it is not without some inherent problems. Additionally,
many clinicians have not been adequately prepared for the changes and modifications
needed to overcome certain adverse effects of built-in adjustments.
The basic idea of the Bidimensional technique is in differential slot sizing of the attachmentsin different areas of the dental arch. This in turn allows the operator to set the anchorage in that portion of the arch which he wishes to make less likely to move. For instance, by establishing an anterior segment anchorage, one can protract the posterior segments without disturbing or moving the anterior or anchor segment.
From the philosophical standpoint, the bidimensional technique also varies from most of the other edgewise variations. It is a common procedure to set up posterior teeth occlusion in the proper Class I relation before any anterior retraction is attempted. As a part of the bidimensional therapy,early on during the treatment we bring the canines into their final or desired position. Changing incisors position, angulation and torque follows this step, and places the anterior segment into a well-aligned and esthetically desired position. It is only after this is accomplished that one addresses positions of the posterior segments and any residual space closure.
The technique could be easily modified for the purpose of addressing some other undesirable aspects of the SWA treatment, such as anchorage loss, round-tripping of certain teeth, transient deepening of the bite and resistance to rotation correction.
Note: This presentation will be particularly suitable for the participants of the pre-Congress course on the Bidimensional Technique. The Congress participants who do not attend the pre-Congress course will still be able to gain some basic concepts and advantages that the technique offers.
Orthodontics in the new Millennium
Orthodontics, the oldest recognized dental specialty, has recently celebrated its 100 Anniversary.
Beginning of its second century happens to coincide with the start of the new Millennium.
What will it bring us?
Lets briefly review what has been happening over the last few years in Orthodontics, because this will give us a preview of what we may expect in the near future. There are two areas where the most significant advances have been made.
The one is use of automation and computing, and the other advances in materials.
This does not exclude several other areas of progress, among them an expanded knowledge of bone and muscle physiology, advent of implants in variety of forms and purposes and substantial advances in orthodontic practice management.
This presentation will deal with the presenters forecast of what is likely to be occurring in orthodontics in the next decade or two. The first significant development was adoption of computers in both office management and in diagnostic procedures. Possibly the most significant contribution of automation in orthodontics is our new ability to store the records electronically.
This comes with an added bonus of unrestricted ability of record retrieval, this with no loss of quality or detail and essentially no danger of physical damage.
In the arena of new or improved dental materials one can make a convenient separation into advances in metals and synthetic materials. Of metals that have revolutionized the practice of orthodontics one must consider the importance of the various forms of NiTi alloys. It is fair to say that every practicing orthodontist modified his or her treatment protocol by incorporating some form of NiTi wires into his armamentarium. Other metals that show some significant promises for the future application include the noble metals [gold, platinum and palladium], that have been used with some degree of success in coating the orthodontic attachments and arch wires. Of significant synthetic materials one must consider various rubberized elastomeric chains and rings. These have largely replaced stainless steel ligatures, even though they cause some undesirable effects, chief among them increased friction and worsened oral hygiene.
This brings us to the prediction of increased use of self-ligating brackets. They come in various prescriptions and can be used in various techniques. Both, the encountered friction and the level of oral hygiene are substantially improved with their use.Lastly, numerous functional appliances have been refined and improved, their indications and limitations explained in more detail. The great divide between the fixed and the functional appliance treatments is gradually diminishing. One group is willingly learning from the other and we all, and particularly our patients are better for it.