Category Archives: Orthodontics

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

Allergic reactions to Invisalign materials

From: Charles J Ruff []
Sent: Thursday, January 06, 2011 7:56 AM
Subject: allergic reactions to Invisalign materials

I recently had a patient (45 yr old adult female) who complained of medical problems that started around the same time as she started Invisalign tx.  The chief complaint was vitamin D deficiency as well as being run down.  When I moved her from regular aligners to Invisalign retainers, her symptoms increased to the point she felt her tongue and throat were swollen and very sore.  When she removed the retainers she felt much better.

I then transitioned her to a fixed lower retainer and a true Essix retainer made from Ace material from Raintree.

The patient then did some research and found out about the FDA fine that Invisalign paid for not properly notifying the FDA about similar type complaints  that Invisalign was aware of.

Does anyone have any similar concerns or complaints from patients?


charlie ruff 

Here is a note from the patient about what she experienced

Class II correction and FORSUS

Hi ESCO friends,

Very happy with the come back of ESCO as a straight forward – FREE expession site for real clinicians, without academical or dognatic restrictions
or commercial interest in mind….Also about Class II correction and FORSUS:
I’ ve been using real HERBST tubes and plungers in combination with classic edgewise fixed appliances since 20 years.., thanks to the MALU system: “Mandibular Advancement Locking Unit” .
It is presented by a small company: SAGA co. from Norway. SAGA and the inventor of the system, Dr. Kumar Swadesch, is always present on AAO exhibition. It is an isometric system , without spring or helix:

I agree the learning curve is a bit difficult: you need strong bands, well adapted, etc.. Of course, there is some breakeage, especially of the lower arch wire, if the shape of the step bend was not smooth enough, but I can live with it. I almost never loose lower cuspid bracket’ s. WE must accept some technical failure, if we counteract muscles and nervous activity. This seems logic to me, especially for patiens with bruxomania extreme deep bite and a short and powerfull M. Masseter — sport activities – nervosity and stress…But witch alternative do we offer to this patient? elastics ? or a head gear ? or… Surgery !!
Of course, it is easier for the orthodontist to state from the beginning that there is no other way to correct the severe Class II of a given patient: you decide this – your patient accepts the treatment plan or not, and that’s up to him, – and you ‘ll sleep well… Of course, I present surgery as an option for cases that need an mandibular – pogonion – advancement for esthetical reasons.
It is difficult to “grow” the mandible on a long term basis with orthopedics, only the Herbst appliance can do it…a bit.( Aelbers and Dermaut – AJO 1996 ) The result is always individual and unpredictable, but for many cases there is some
skeletal change. For the Herbst appliance this skelettal change is about 22°. But it corrects nicely most Class II malocclusions. And not every patient wants or needs a radical profile change …
With the MALU – HERBST system, most cases work very well … it is relatively cheap , no lab work, (only cut the tube and plunger to the right
lenght with a diamond disk ), it is well tolerated by the patient.
Unilateral application is possible .
This system is not well known, due to the lack of interest of the mean companies … There are only few publications: J. C. O . 1996


Modified Edgewise herbst Appliance
VOLUME 30 : NUMBER 12 : PAGE 681 : Dec : 1996
This is my routine Class II correction procedure, I have always about 10 cases in treatment – respecting the Proffitt – and O ‘Brien studies, that proved efficacy and efficiency of a One stage treatment in the permanent dentition..
Hereby some pictures of the system — other pictures of many treated cases are available on request ..).
Good luck !

Marc Van Rossen 

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

Re: Doggy Dentistry Can Now Mean Braces

From: []
Sent: Monday, January 03, 2011 7:24 PM
Subject: Re: Doggy Dentistry Can Now Mean Braces 


To fellow ESCOERS  


During these difficult times, we are treating more adults and
canines(dogs) in greater numbers. We have certain criteria that must be met before agreeing to treat.  These are            
1- oral hygiene must be immaculate
2- all appointments are in the morning
3- wee wee pads accompany each visit  (seniors and dogs)
4- separate fee for prolonged elastic instructions 
5-  additional retainer fee if ” my dog chewed up HIS retainer” 
HAPPY NEW YEAR,  Glad that ESCO is returning!
Howard M. Tichler, DDS
Jenny E. Abraham, DDS
725 Montauk Hwy
West Islip, NY 11795

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

Periapical Cemental Dysplasia

Sent: Monday, January 03, 2011 9:23 AM
To: The Electronic Study Club for Orthodontics
Subject: Periapical Cemental Dysplasia

Has anyone had experience treating a patient with PCD.  No extractions are necessary but there is extensive space closure to be done.  There are lesions in and around the lower anteriors and approximately 50% bone loss due to periodontal disease, but the periodontist is satisfied that treatment can proceed.

Dr. Alan Bobkin

About Forsus/Twinforce

From: Marco Tribò []
Sent: Wednesday, December 22, 2010 2:53 AM
To: ‘The Electronic Study Club for Orthodontics’
Subject: About Forsus/Twinforce

Welcome back to the sleeping beauty Esco Digest!

About Forsus/Twinforce

We have been using both with the following results:

1. Both works
2. Twinforce is about 1.8 x more expensive (in Switzerland)
3. Considerably less breakage with forsus
4. Both are easy to handle
5. Twinforce offers a version that can be fixed to the upper and lower wire (no need of Bands on upper first molars)
6. Forsus slides on the lower wire and rests on the cuspid bracket. This can cause problems: rotation of cuspids and the brackets can be detached.

So finally it is a personal preference and depends also on the type of appliance/patient that you are treating. As we all know we have patients that are very careful and then we have others…

Merry Christmas and a Happy New Year to all out there!

Marco Tribò

Treating patients with periapcal cemental dysplasia

Sent: Monday, December 20, 2010 9:15 AM
To: The Electronic Study Club for Orthodontics
Subject: Treating patients with periapcal cemental dysplasia

Hello All

Does anyone have any experience treating patients with periapcal cemental dysplasia.  The patient has sen a periodontist who is satisfied that her periodontal condition is stable enough for tx.  The patient has large spaces which she would like closed.  No extractions are necessary for treatment (contraindicated for PCD).  I would like to know how the PCD would affedt space closure.  Literature is sparse.
Dr. Alan Bobkin

2 Questions: 1) ESCO still alive; 2) Twin-Force bite corrector springs

Date:         Sun, 12 Dec 2010 09:01:20 -0500
From:         “Dr. Blair Adams” <adams.blair@GMAIL.COM>
Subject:      Re: ESCO Digest – 27 Dec 2009 to 18 Apr 2010 (#2010-1)


I have 2 questions;

1; Is ESCO still alive? I haven’t had messages in about 12 months, but I
recently received some kind of test message that said; “do not reply”
How can I ensure I get the messages if I do not reply?

2; I have been using the Unitek Forsus springs with good success. What
about the “Twin-Force bite corrector springs? Has anyone used both
appliances? Is one better / cheaper / faster / less breakable than the

If Dr Nanda is using the twin force; there must be something to it.

Dr Blair Adams