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© 2016 Ormco Corporation Order your Damon Clear2 brackets today! Visit ormcoeurope.com ClearPerformance. MoreControl. Offering the same crystal clear performance with more control,DamonClear2allowsyoutotreatawidevariety of cases with outstanding results so your practice and your patients can put their best face forward. *Variable torques for upper 3-3 brackets. **As compared to Damon Clear upper 3-3 brackets. Variable Torques* NEW! Actual Damon patients wearing Damon Clear. Treated by Dr. Todd Bovenizer. 100% CLEAR BRACKET BODY AND SLIDE for the supreme aesthetics patients demand SMOOTH, ROUNDED CORNERS for outstanding patient comfort INNOVATIVE SPINTEK™ SLIDE for easy and comfortable wire changes SELF-LIGATING BRACKET DESIGN eliminates the need for elastomerics which stain and collect bacteria FOUR SOLID WALLS with improved precision slot for 2x the rotational control** for meticulous finishing and efficient treatment Figure 6: Interim pano taken at 15 months. Figure 5: At 18 months, the upper .018” x .025” Copper Ni-Ti wires had been en- gaged for 11 months. The case would now transition to aTMA finishing wire in the upper arch and Reverse Curve wires in the lower arch before finishing in .018” stainlesssteelwireforfinalspaceclosure. Figure 7: Post-treatment records taken 2 months after appliance removal. Total treat- ment timewas25months. Figure 8: Post-treatment records taken at 30 months reveal effective stability. Note: Im- pactedUL8isbeingmonitoredbyoralsurgeonforpossiblefutureextraction. space closure, the lower arch fin- ishedina.018”stainlesssteelwirefor 3 months. The .018” x .025” Copper Ni-Tiwirethathadbeenengagedat7 months in the upper arch was maintained until the 20-month ap- pointment at which time the wire was switched to a .019” x .025” Da- mon™ Low-Friction TMA™ wire for 5 months. A few detail bends were made in the final 3 months of treat- ment for positioning, rotational, and smilearcrefinements. Interproximal reduction is an im- portant yet underutilized protocol for fine-tuning occlusions and smile aesthetics.Weliketotellpatientsthat I’m a tooth artist, not only putting teeth in the right positions for func- tion and aesthetics, but also looking closely at individual tooth shape (in this case, specifically the fan-shaped upper incisors) and how it affects overall aesthetics. In patients with blacktriangles,reshapinginterproxi- malcontactssothatthespacecanbe filled with the existing papilla is the best way to reduce the triangles and create better interproximal contact for stability. For this case, IPR was performed at several appointments (U/L3-3). Atthepre-debandevaluation,afixed lingual retainer wire was placed L3-3 and finishing V elastics (Moose 6 oz, 5/16”) were attached to settle the oc- clusion. When the appliances were removed at 25 months, the incisal edgesweremanicured(U/L3-3)and posterior segments equilibrated as needed. The post-treatment images are from the retainer follow-up appointment 2monthsaftertreatmentcompleted (Figure7). WhatIWouldDoDifferentlyToday Inretrospect,ClassIIIelasticsshould have been initiated at bonding (rath- er than 4 weeks later) to assist in up- righting the lower canines from the startoftreatment.Ratherthanbond- ing the lower laterals, using open coil springs between the L3s and L1s would have helped distalize the low- er canines and reduce the force on the anteriors, which can cause ante- rior flaring. Overuse of lower power chain caused lingual crown tipping of lower anterior teeth that then had to be recovered with Reverse Curve (lingualroottorque)wires. Using these wires, however, demon- strates the effective use of archwire selection tools available to the or- thodontist. There was also some me- sial rotation on both L7s from chain elastic use on light wires. Again, this would have been controlled more effectively if space closure had been able to be accommodated on rectan- gular stainless steel wire with Ni-Ti retractioncoils. In reviewing the pano at 15 months, theLL3couldhavebeenrepositioned formoredistalroottip,whichshould have completely prighted the root. This would help increase post- treatment stability. Despite this, her 30-month retention records (i-CAT FLX from Imaging Sciences Interna- tional) demonstrate good stability (Figure8). CaseDiscussion Thiscasedemonstratesanexcellent nonsurgical correction for a patient who refused surgery. Generally, there was good torque control al- thoughtheupperlateralscouldhave used a bit more facial root torque. Thecaseexhibitsgoodmanagement of the final occlusion and tooth shape with interproximal reduction for black triangles and manicuring for uneven incisal edges, a pleas- ing smile arc, and improvement of the gingival recession. Retraction and uprighting of the lower canines helped to improve the profile and facial aesthetics by reducing the prominence of the lower lip and introducing an aesthetically pleas- ing eversion. Treatment time was 25 months, only 1 month longer than estimated. Of course, it would have been preferable had treatment been 3 to 6 months shorter, but the patient’s periodontal condition and recession required a cautious ap- proach.OP References 1.AllCopperNi-Ti,ReverseCurve,and TMA archwires are Damon brand andarchformfromOrmcoCorp. 2.AllelasticslistedarepartoftheZoo PackbrandfromOrmcoCorp. Jeff Kozlowski, DDS is an internationally sought after lecturer and has presented on topics including clinical efficiency, digital orthodontics, early treatment, and passive selfligating mechanics. He graduated with a BS in economics from Syracuse University prior to re- ceiving his DDS and orthodontic specialty certificate from the State University of New York at Buffalo. He is the co-founder of OrthoFi, a company which helps quality-first orthodontists make treatment more af- fordable for patients. He has multiple practices in southeasternConnecticut. ◊Page2 Dental Tribune Middle East & Africa Edition | 4/2016 ORTHO TRIBUNE 3