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rapid overbite correction industry report | Fig. 4a Fig. 4b Fig. 4c the molars produced molar intrusion that was contraindicated. Bondable metal bracket type bite planes were more effective and efficient to apply chairside, however, they were often difficult to remove because of their solid form and design that made them rigid and uncomfortable during the debonding phase, particularly at the sensitive upper central incisors. The purpose of this clinical study was to develop and test a small bondable and curved bite plane device with a groove in the middle and whether it was more efficient and effective in application by being easier to place, had good gnathogical function and was easier to debond. The second objective was to develop a system whereby the bondable BT2 device could produce Rapid Bite Correction (RBC). What is a BiTurbo2? The first BiTurbo was developed in 2014 with a groove in the long-axis of the bondable bite opening device that was also curved to establish anterior guid- ance early in treatment. It was manufactured as a one-piece bracket and tested clinically for 2 years by one of the authors in his private orthodontic clinic in Toronto, Canada. This first generation BiTurbo was found to be effective in controlling the vertical di- mension by rapid deep bite correction. As a result, new modifications were implemented by Dr Voudouris to improve the first generation BiTurbo (BT1). The second generation BT2 was made by SIA Ortho- dontic Manufacturer, in Italy as a four-piece unit and included: 1. Bracket body with vertical groove (split), with in- cisal surface curvature 2. Braze (for flexibility) 3. Curved bonding pads to complement and adapt to the curved palatal anatomy of the upper central incisor for improved bond strength 4. Separate 80-guage mesh for greater bond strength. The vertical groove along the long axis of the BT2 permits the use of a periodontal probe or other in- strument to position and press-bond the BT2 to the enamel more efficiently and accurately. The separate application of 80-gauge bonding mesh is used to improve bond strength against palatal shearing forces. BT2s are miniaturised in size similar to bon- dable buttons but with a curved, shield shape bonding pad to be comfortable for patients and to facilitate oral hygiene. In addition, side dimples were developed to permit purchase points for tweezers during positioning on the palatal of the upper incisors. BT2s are required commonly in deep overbite treatment that is associated with severe CNS-muscle hyperac- tivity (Figs. 2a & b). Methods: Where to place BiTurbo2? Clinically, BT2s are bonded on the incisal-third region of the upper central incisors in Class II maloc- clusions. This provides a total of 2 BT2s on the day of first bonding of a full Siamese twin, active self-ligat- ing (SL) appliance. In addition, for each deep overbite treatment BT2s are applied in conjunction with 2 buc- cal box elastics (1/4”, 4.5 oz, see Fig. 6b) in rhomboid patterns for Class II correction. The elastics are applied from the labial aspects of the upper canine to the upper first molar, down to the lower second molar and first premolar bilaterally to facilitate rapid bite correc- tion. Results: Why apply BiTurbo2? It is well known from electromyographical studies that muscle activity of the masticatory muscles is generally reduced when the vertical dimension of the anterior lower face height is increased with overbite correction.7-9 In addition, adults with untreated deep overbite with CNS-muscle hyperactivity often suffer from generalised enamel wear that can then induce a cycle for further reductions in the vertical dimen- sion. When the vertical dimension is reduced, muscle hyperactivity increases further. This tends to set-off the destructive cycle of mutilation and collapse of the lower anterior face height characterised by progres- sively greater enamel wear with age. This reduction in enamel support produces further progressive increases in muscle hyperactivity leading to progres- sively deeper overbite (Figs. 4a & b). Progressive deep- ening of the overbite in children restricts skeletal eruption of the dentoalveolar structures of the buccal segments that is maintained for life without ortho- dontic treatment. Figs. 4a–c: Severity of the restriction of buccal segment eruption with the first CNS-muscle de-programmer (a & b). BiTurbos and active self-ligating brackets with rhomboid 1/4, 4.5 oz, combine with compensating curve in the upper arch and reverse curve of Spee in the lower arch for rapid bite correction from 120 % (Figs. a & b) to 50 % in 3.5 months (c). ortho 1 2017 33