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Antonino Secchi, DMD, MS
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Dr. Secchi is Assistant Professor of Orthodontics-Clinician Educator and Clinical Director of the Department of Orthodontics at the University of Pennsylvania USA and Visiting Professor at the University of Los Andes, Chile. Dr. Secchi received his DMD, Certificate in Orthodontics, and a Master of Science in Oral Biology from the University of Pennsylvania. Dr. Secchi is a Diplomate of the American Board of Orthodontics and member of the Edward H. Angle Society of Orthodontists. At the University of Pennsylvania, he has developed and implemented courses on Orthodontic Treatment Mechanics, Straight Wire Appliance Systems and Functional Occlusion in Orthodontics. In addition, he maintains an active orthodontic practice at the Dental Care Center of the University of Pennsylvania. |
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Dear Dr. Gallardo,
Thank you for your question. Thanks to new information from articles and personal conversations with Dr. Robert Kusy, my use of cuspid movement archwires in the In-Ovation R bracket has changed. I published an article on this subject in Orthodontic Products entitled, “Complete Control.” Perhaps you can contact Chris Piehler for a reprint.
Dr. Kusy has shown and advises that more complete control of almost any tooth movement occurs when you fill the In-Ovation R bracket slot vertically.
I use the .018 slot. However, the same principles that I use will assist you with the .022 bracket slot. Because of the unique design of the .022 In-Ovation R bracket slot, the gingival arm and the vertical wall are approximately .0225 inches in length and the incisal or occlusal wall of the bracket is longer.
Now to answer your question precisely: I advise using a new Monacell.022 x .018 GAC BioForce wire with Ion Guard to retract cuspids. This wire will fill the slot vertically, giving you complete 3-D cuspid control. However, once the cuspid is aligned by the wire, the .022 x .018 wire will not touch the closing clip, so there will be no clip friction. In addition, BioForce is a unique temperature-sensitive nickel titanium wire. BioForce is a patented wire with individualized forces throughout the same arch wire, regardless of the size of the wire. Incisors receive approximately 90 g to 100 g of force. Cuspids receive 150 g of force, while molars receive approximately 350 gr of force. Thus, cuspid retraction occurs with the ideal forces for light, safe, rapid tooth movement.
If you also order BioForce with Ion Guard, the archwires arrive with a special ionic surface treatment that further reduces friction.
Using a BioForce with Ion Guard "Monacell" .022 x .018 arch wire, the cuspid begins to retract along the full 3-D controlled archwire. You can use elastic chain, sentalloy springs, or elastics. I normally expect to see 1 mm to 1. 5 mm of tooth movement per month.
As the cuspid glides along the arch wire, the tooth may drift slightly out of ideal position. Immediately, the closing clip will gently re-seat the cuspid bracket onto the archwire until the clip no longer touches the wire. I have referred to this technique as “pulsing” because the bracket attached to the cuspid will slide with minimal friction until it moves slightly out of alignment, then the clip will re-seat the bracket. This intermittent re-seating maintains maximum tip, torque, and in-out control with excellent bodily movement. Almost all human functions occur with a “pulsing” action.
I hope this answers you question. If you require additional information, please contact the Web site.
Best Personal Regards,
Michael C. Alpern, DDS, MS
Dear Dr. Gallardo,
Thank you for your question. Thanks to new information from articles and personal conversations with Dr. Robert Kusy, my use of cuspid movement archwires in the In-Ovation R bracket has changed. I published an article on this subject in Orthodontic Products entitled, “Complete Control.” Perhaps you can contact Chris Piehler for a reprint.
Dr. Kusy has shown and advises that more complete control of almost any tooth movement occurs when you fill the In-Ovation R bracket slot vertically.
I use the .018 slot. However, the same principles that I use will assist you with the .022 bracket slot. Because of the unique design of the .022 In-Ovation R bracket slot, the gingival arm and the vertical wall are approximately .0225 inches in length and the incisal or occlusal wall of the bracket is longer.
Now to answer your question precisely: I advise using a new Monacell.022 x .018 GAC BioForce wire with Ion Guard to retract cuspids. This wire will fill the slot vertically, giving you complete 3-D cuspid control. However, once the cuspid is aligned by the wire, the .022 x .018 wire will not touch the closing clip, so there will be no clip friction. In addition, BioForce is a unique temperature-sensitive nickel titanium wire. BioForce is a patented wire with individualized forces throughout the same arch wire, regardless of the size of the wire. Incisors receive approximately 90 g to 100 g of force. Cuspids receive 150 g of force, while molars receive approximately 350 gr of force. Thus, cuspid retraction occurs with the ideal forces for light, safe, rapid tooth movement.
If you also order BioForce with Ion Guard, the archwires arrive with a special ionic surface treatment that further reduces friction.
Using a BioForce with Ion Guard "Monacell" .022 x .018 arch wire, the cuspid begins to retract along the full 3-D controlled archwire. You can use elastic chain, sentalloy springs, or elastics. I normally expect to see 1 mm to 1. 5 mm of tooth movement per month.
As the cuspid glides along the arch wire, the tooth may drift slightly out of ideal position. Immediately, the closing clip will gently re-seat the cuspid bracket onto the archwire until the clip no longer touches the wire. I have referred to this technique as “pulsing” because the bracket attached to the cuspid will slide with minimal friction until it moves slightly out of alignment, then the clip will re-seat the bracket. This intermittent re-seating maintains maximum tip, torque, and in-out control with excellent bodily movement. Almost all human functions occur with a “pulsing” action.
I hope this answers you question. If you require additional information, please contact the Web site.
Best Personal Regards,
Michael C. Alpern, DDS, MS
Dear Dr. Groisser,
Thank you for your question.
My in-office, hands-on courses are only presented twice a year. The next two courses are October 19–22, 2006, and February 15–17, 2007. These courses are presented in my office in Port Charlotte , Fla. We are located 50 miles north of the Fort Myers airport and 60 miles south of the Sarasota airport. The course begins on a Thursday afternoon at 2:00 PM and lasts until 7:00 PM. On Friday we go from 8:00 AM until 6:00 PM, and on Saturday, from 8:00 AM until noon. This permits minimal time out of your office and allows you to fly home on Saturday to spend time with family.
This extensive course includes a complete syllabus with every article I published and includes all letters to patients and parents. The course covers ligatureless brackets, Mystique brackets with the new Neo-Clip, the complete Fixed/Functional/Splint orthodontic biomechanics system (including the "A SQUARED" three-wire approach), and a new series of invisible retainers which still have occlusal contact. These are just of few of the subjects covered, including digital imaging and 4 DVTO.
We limit each course to 20 attendees to make this a personal prescription for clinical, management, and marketing success.
Once you are registered, we will send complete directions, lodging and transportation information.
The course title is the ORTHOEVOLUTION or "How to Treat More Patients in Less Time With Superb Results: Preparation for Success Now and in the Future". Should you require additional information, please contact me at mcalpern@pci2.net .
Best Personal Regards,
Michael C. Alpern, DDS , MS
Dear Dr. Krug,
Thank you for your question.
We try to turn a negative into a positive. First, we challenge the patients who want colors to appear for two straight appointments with a very clean mouth. In this manner, they "earn" the right to have colors placed. If, at any time, the patient's oral hygiene diminishes, the colors are removed. Please inform your patients and parents of this policy in advance.
Second, we place colors on an angle. We attach the colored elastomerics from the mesial/gingival wing only to the distal/incisal wing of the "R" bracket. In this configuration, the colored elastomeric tie does not contact the archwire. Or, if it does contact the archwire, the contact is minimal.
Like many offices using cutting-edge technology, we educate patients and parents about the uniqueness and importance of the "R" ligatureless bracket. With spring in the clip joining the unique space-age wires, we use lighter, individualized forces to achieve faster, more comfortable tooth movement, yielding diminished treatment time. We explain to patients and parents that we are happy to place colors on braces. However, this request can potentially slow treatment progress. If they still insist on colors, we ask the patient and parents to sign the treatment card, verifying that we have informed them of the potential increase in treatment time due to the placement of colors. Very often, this request motivates the patient and parents to decide against colors and for technology.
Should you have additional questions, please e-mail me.
Best Regards,
Michael C. Alpern, DDS, MS
Thank you for your questions. Please inform me which bracket slot size you use. Are your .018 or .022? If you are .018, and you encounter significant tooth irregularities such as crowding or marked rotations, then my initial wire is a .016 x .016 Bioforce with Ion Guard in the Accu-arch form. This wire has individualized forces throughout the wire. Centrals and laterals receive approximately 90-100 grams of force. Cuspids receive approximately 150 grams of force and molars receive approximately 350 grams of force--all in the same wire regardless of the size of the wire. This may seem somewhat unconventional, but I have had tremendous success with this technique. Additionally, the InOvation R spring clip has an attenuated spring effect which at its narrowest opening has approximately 200 grams of force. The force is less in the wide-open position. This archwire is temperature-sensitive, so it can be iced and comfortably placed into the bracket slot. Only when it warms gradually up to mouth temperature does the wire exert the individualized forces.
My reasoning for using this wire rather than a standard .016 nickel titanium wire is that the NiTi wire may actually exert more than 100 grams of force on incisors and less than the required forces on the molars.
If there are not significant tooth irregularities such as crowding, then, my initial wire (in a .018 slot) is a .018 x .018 Bioforce with Ion Guard in the Accu-arch form. This unique combination of wire size and bracket-slot size I term "A Squared" biomechanics. The .018 x .018 Bioforce wire fills the .018 R bracket slot vertically, yet, once initial alignment has been achieved, the wire does not touch the clip. There is no clip friction. Therefore, it is a passive fit.
Once I have achieved a .018 x .018 Bioforce wire, my next wire is .018 x .018 beta titanium wire, followed by a .018 x .018 stainless-steel wire. Once the bracket slot is filled vertically, I have full, 3-D control with minimal clip friction. From then on, I only change the metallurgy, not the wire size.
In rare instances, such as curve of spee problems or maintaining expansion, I will use a final .017 x .025 stainless-steel wire.
If you use the .022 slot, my study club members usually begin with a .020 x .020 Bioforce with Ion Guard in the Accu-arch form. Next, they use a new .022 x .018 Monacell wire (again in Bioforce with Ion Guard in the Accu-arch form). Here again, all the previous principles apply. The next wires are .022 x .018 Monacell beta titanium wire and then a .022 x .018 stainless-steel wire to finish.
In answer to your other questions: Yes, I have a book, THE ORTHOEVOLUTION published by GAC, plus Orthodontic Products recently published my article, "COMPLETE CONTROL." Reprints should still be available. I am the process of completing a workbook that details more along these lines. I will hand these workbooks out at my courses. When it becomes available (Fall 2006) I will forward a copy to you.
Twice a year, I also offer an in-office, hands-on, three-day course with my patients available for observation.
Antonino Secchi,
DMD, MS
Straight Wire Appliance,
Self-ligation,
Treatment Mechanics
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Orthodontic Products, is your one-stop destination for orthodontists seeking practical solutions for their practices. We provide the latest product news and technique tips, as well as articles by experts on topics including efficient treatment, staff management, and marketing methods. A reader-friendly alternative to clinical journals, Orthodontic Products gives readers the tools they need to continue building successful practices.
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