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Clinical Orthodontics

Clear Fixed Appliances Chosen over Aligner Treatment for Arch Development
Apr 4, 2015 | Orthodontics Middle East

Clear fixed appliances chosen over aligner treatment for arch development

by Dr. Stuart Frost, Phoenix, AZ

Pretreatment Diagnosis: Class I (end-to-end molar on right), female patient, 38, presented for clear aligner treatment. She had had orthodontic treatment years before. Given that her chief concerns were the crowding in her lower arch and widening her smile, I was able to convince her that passive self-ligation would offer her the results she wanted and could satisfy her need for esthetics since Damon Clear was then available in prototype. She had no jaw popping or clicking.

Facial/Soft Tissue/Macroesthetics: Mildly convex profi le and nasolabial angle. Slight lip strain at rest with lower midline shifted to the right.

Smile/Miniesthetics: Excessive upper gingival display, narrow arches with 3 to 4 mm of crowding in the lower arch and 1 to 2 mm of crowding in the upper arch. Consonant smile arc.

Teeth/Microesthetics: Esthetically-shaped teeth and excellent hygiene. Inconsistent gingival architecture in the lower anteriors and UR3.

Treatment objectives and Plan
Treat nonextraction, eliminating the crowding by widening the arches, using the Damon Clear prototype brackets U3-3 and Damon Q (DQ) elsewhere. Employ variable torque and bracket positioning to maintain the smile arc.

Damon Clear/DQ variable Torques Employed
U1s: Standard torque (+15)
U2s: Standard torque (+6°)
U3s: Standard torque (+7°)
L1-2s: Low torque (-11°)
LL3: Super torque (+13°)
LR3: Standard torque (+7°)

Treatment Sequence Bonding
U/L: Direct-bonded U/L arches, engaging .014 round Damon Optimal Force Copper Ni-Ti1 (Cu Ni-Ti) archwires. After 4 weeks, transitioned into .014 x .025 (upper) and .018 round (lower) Cu Ni-Ti archwires. Started shorty CL II elastics (bilaterally L6 to U4, full time with Quail, 3/16”, 2 oz.), maintaining them throughout treatment.

2 Months: Shorty CL II Elastics Maintained Throughout Treatment
U: Transitioned into .018 x .025 Cu Ni-Ti archwires. L: Transitioned to .014 x .025 Cu Ni-Ti archwires.

3-5 Months: Bracket Repositioning
U: Repositioned the UR3 and dropped the wire size to a .014 x .025 for 6 weeks before transitioning back to a .018 x .025 dimension. L: Maintained the .014 x .025 Cu Ni-Ti archwire over this period.
5.5 Months: Interim Panograph
U/L: Maintained the same archwires. Took interim panograph and repositioned UR4, LR1 and LR3. The repositionings were minor so did not have to reduce the wire dimensions.

6.5 Months: Torquing & StepUp Bends in TMA
U: Transitioned to a .019 x .025 TMA archwire, adding 10° of buccal crown torque to the UL3. L: Transitioned to a .017 x .025 TMA archwire with a step-up bend in the LR4. Maintained these archwires until debonding.

8.2 Months/7 Treatment Appointments: Treatment Complete
We achieved all treatment and patient objectives. Widening the transverse arch width, especially U2-2, also diminished the excess gingival display. While the patient had originally inquired about clear aligner treatment, the fee would have been substantially more and would not have allowed us to meet one of her chief objectives, which was transverse arch development. While clear aligner treatment can satisfy certain needs, esthetic fi xed appliance treatment allows us to achieve outstanding results.

What I Would Do Differently Today
The patient had a lateral tongue thrust at the UR3. Were I to treat the case today, I would place lingual tongue reminders on the LR3 that would likely have resulted in a more satisfactory Class I right cuspid relationship.

1. All Copper Ni-Ti wire used is Damon Optimal Force Copper Ni-Ti.

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