Journal of the American Orthodontic Society • March

GEM #3: Mild & Moderate Crowding Expanding bicuspid and cuspid area will create EXPANSION EXPANSION Mild/Moderate Crowding: Expand, procline and then IPR. broad arch form initially. Evaluate the lingual crown torque of this area and decide if bone support is adequate to upright these teeth. By expanding this area (similar to our proform arch wires), we gain space in the anterior region. Request that any IPR will be completed after majority of crowding is resolved. The technicians will procline first, resolve rotations, intro- duce IPR, and then retrocline teeth back to position (in a sense, a mild round tripping). This technique helps with the accuracy of placing auxiliary tools to create space interproximal where needed. Additionally, instruct technicians to spread out IPR over many teeth as possible. Rarely accept .4mm-.5mm of IPR. GEM #4: Must-Have Tools The first simple tool that you have in large quantities will be the best product for aligner positive seating. The simple saliva ejector has easy handling; great chew force and low cost. Give patients two to three to help with firm seating, especially at aligner #2 when attachments are placed or during treatment when changing position of attachment. The second simple tool is the QwikStrip™ (Axis Sybron Dental Specialties, Coppell, TX). This hand-held system makes IPR safe and accurate. The color-coded system is noiseless, creates no danger to soft tissues and can fit between any overlapped teeth. Available as single sided/or double sided. Case outcome and predictablity are dependent on fit of aligners. The key to success is evaluating align- ers at every four- to six-week appointments. If align- ers are not seated, review IPR, check contacts with floss, and view attachment position. If attachments are not positioned directly under aligner space, remove and replace attachment with previous aligner. 20 March/April 2010 JAOS Use saliva ejector for positive seating. If tight contacts reappear in teeth that are not rotating, review IPR schedule, release contacts with QwikStrip™.