Category Archives: Orthodontic Techniques

Rethinking Bicuspid Extraction Patterns

 From: Morton Speck []
Sent: Monday, January 31, 2011 10:04 AM
Subject: Rethinking Bicuspid Extraction Patterns

Before I launch into one of my favorite topics, it’s great to see a refurbished ESCO as well as many of the usual suspects.  Thanks Huibi!

Now to cut to the chase!

Most of us consider extracting the four 1st bicuspids in a Cl. 1 crowded case a no-brainer because that tooth is closest to the crowding.  However, that is not always the best strategy in the maxillary arch for the following reasons: since the 1st bicuspid is generally larger than the 2nd, the presence of the 1st bicuspid makes the reopening of the extraction site less likely; furthermore, should the space reopen, it is less obvious because of its more distal position; equally important, the difference in the gingival heights of the cuspid and 2nd bicuspid can compromise smile esthetics.  The natural juxtaposition of the cuspid and 1st bicuspid results in a much more pleasing appearance.

Maxillary 1st bicuspids are also traditionally removed in single arch extraction cases, most notably in Cl. ll div. 1 cases.  For the reasons stated above, I would argue again that the maxillary 2nd bicuspid should be the tooth of choice in most cases.  The extraction of the maxillary first molar in single arch extraction cases is also a valid option, but that is the topic for another discussion.
With these considerations, I would ask ESCO readers why they would argue against the removal of maxillary 2nd bicuspids in the majority of cases, and in all cases where this size disparity exists, barring any periodontal considerations.
My guess is that most practitioners avoid removing maxillary 2nd bicuspids, either because they never gave it serious thought, or they were wary of the additional mechanics required and/or the anchorage-taxing problems this protocol entails.  But to trade a superior result for treatment expedience, in my view, does a disservice to your patient.  I respectfully suggest that if you have consistently favored 1st bicuspid extractions in the situations I have described, that you reconsider your options.

Attached are a couple of slides (click here ESCO) that illustrate the size and gingival height difference in a particular case.

Mort Speck
Lexington, MA

Self-Ligation bracket options

From: []
Sent: Tuesday, January 04, 2011 5:25 AM
Subject: Self-Ligation bracket options

Hi All

Does anyone have any experience or advice on GAC InOvation R v Forastedent BioQuick vs American Ortho EmPower brackets?

I have been using inOvation for many years and have generally been happy with them. I am thinking of changing from InOvation for various reasons and see the other 2 as being very similar. EmPower have a fishtail-locking clip whereas BioQuick have a centrally-locking clip. Empower seems to be made of standard stainless steel, while BioQuick is advertised as nickel free with a chrome cobalt clip. Both brackets are passive to 16×22 but EmPower has the option of deeper slots buccally for reduced friction on sliding, while BioQuick has an auxiliary slot. I have not yet looked at cost but I imagine they would be competitive.

Has anyone any thoughts on one system versus the others?

Owen Crotty

Case review

From: Roy King []
Sent: Saturday, January 01, 2011 12:17 PM
To: ‘The Electronic Study Club for Orthodontics’
Subject: Case review


I just reviewed a case that I did 8 years ago. She had multiple diastemas from the second premolar forward. About 8 mm of space in the upper and lower arches. I treated her with reciprocal closure(chains or s-coils) and then put an upper and lower fixed (u3-3 and l4-4) . She has broken the fixed and the spaces have reoccurred. I would not be so foolish to do the same type of treatment and expect different results. My question not only how would you handle the case now but in the future, should we all be dragging the molars forward using TADS on all cases that have large generalized spacing(6-8 mm). TADS has caused me to rethink my approach to these kind of cases. I can see that handling the maxilla would be best done by placing a palatal tad and changing theTPA  from the U6’s initially so to push U5-5 forward and then to place TPA on U4’s attached to the TAD and dragging u67 forward with indirect anchorage.  How would you drag the lower molars and premolars. I am thinking of doing a  chain l3-3 and place coils between L56  and drag l4-4 forward with chain and then drag L5-5 forward while ocoil is pushing L5’s. Then place the TAD distal to L3’s for direct or indirect and pull the L67 forward.  MY rational of using an ocoil between L56 is that I do not believe that I will get much distalization on L67 and especially if L8 is present. Any other advice.

Roy King

Protracting molars with or without TAD’S

From: allan sheridan [mailto:captainal_92865@YAHOO.COM]
Sent: Monday, December 07, 2009 10:25 PM
Subject: Protracting molars with or without TAD’S

I have over a 40 year period protracted10-15 second or first molars in to fully healed bone with fairly good results. The teeth moved very slow and very light pressure was used. Many times the general dentist did have to build up interproximal surfaces for adequate contact.

Today, I ask myself the question–how many of these patients would have been just as well off with bridgework or today implant/crowns??  The answer I think depends on the integrity of the adjacent teeth –do we still cut down healthy virgin teeth?? 

The patient should be given all the options as well as risks and rewards. Many times it is a decision between time and money.

Allan Sheridan DMD, MS 

Orange, California