Later, brackets and bands were placed on the remain-ing maxillary teeth and a piggyback intrusion arch was used to maintain a light intrusion force on the incisors (Fig. 26). When intruding maxillary incisors, always reassess the smile to maintain correct incisor display. Do not intrude the maxillary incisors at the expense of a proper smile and possibly creating a reverse smile. 5 In this case, I have intruded the maxillary incisors enough before the above described negative effects have started to manifest (Fig. 26). Conventional 2x4 tip-back mechanics are being used on the mandibular arch to help level it before the remaining brackets are placed. Once both arches have been leveled, I will use a Bio-Finisher appliance (Fig. 27) to erupt the posterior dentition. 6,9 This will restore the insufficient skeletal vertical dimension and allow for proper overjet and overbite of the incisors. As another AOS colleague, Dr. Jim Prittinen says, “the same brackets, bands, and wires placed the same way produce different treatment responses on different patients.” 2 REFERENCES 1. 3M ESPE Dental Products. 2510 Conway Avenue, St. Paul, MN 55144-1000 USA. (TAD) 2. AOS Annual Meeting 2019. American Orthodontic Society Annual Meeting. September 19-22, 2019 3. Cope, Jason B., DDS, PhD; Fig. 9-2 Ortho TADs – The Clinical Guide and Atlas. Dallas, TX: Underdog Media, LP 2007. 4. Gerber, Jay W., D.D.S, Beistle, Richard T., D.D.S., Magill, Thomas S. Orthodontic Diagnostics: a Modified Sassouni + Cephalometric Analysis. http://www.orthodonticstud-ies.com/assets/documents/sassouni-plus-cephalometrics.pdf 5. www.navarrodentalgroup.com/reverse-smile/ 6. smlglobal.com/bio-finisher 7. www.thoughtco.com/introduction-to-the-bell-curve-3126337 8. Nicassio, Ralph, DDS. Differential Diagnosis of all Class II and Class III Cases for the Experienced Practitioner. An AOS Sponsored Education Series. 9. Witzig, John W., Spahl, Terrance J. The Clinical Manage-ment of Basic Maxillofacial Orthopedic Appliances. Volume II Diagnosics, 1989. 10.Wyatt, William, DDS, FACD, FICD and White, Larry, DDS, MSD. Orthodontics In Today’s Dental Practice. A Four Session AOS Sponsored Education Series. CONCLUSION Two cases were shown where traditional orthodon-tic mechanics would be difficult to resolve the issues they presented with. In one case, the dental and skele-tal vertical dimension opened rapidly, and in the other, the hoped-for opening proved difficult. Granted, both of these cases are atypical and exist on the extremes of the bell curve, 7 but they do exist and it behooves the practitioner to consider cases that present with: a clockwise or counter-clockwise growth pattern, an open or closed skeletal vertical dimension, and a deep dental bite. You’re invited to the American Orthodontic Society’s Annual Meeting in Atlanta, GA on Sept. 10-13, 2020 at the Crowne Plaza Atlanta Perimeter at Ravinia Hotel. All general and pediatric dentists can have the ultimate opportunity to expand their practices and further educate themselves on the latest in techniques, clinical advancements, practice management and products. 14 Winter 2020 JAOS
Journal of the American Orthodontic Society Winter 2020: Page 14
