Ce diaporama a bien été signalé.
Nous utilisons votre profil LinkedIn et vos données d’activité pour vous proposer des publicités personnalisées et pertinentes. Vous pouvez changer vos préférences de publicités à tout moment.

Fixed applicance management of class II correction

4 641 vues

Publié le

Management of Class II correction device.
Lecture presented at McIntyre joint plenary program for doctors at the 66th Annual scientific session of the Canadian Association of Orthodontists, Montréal, september 2014
Class II correction devices are commonly used in orthodontics and exist in many declension. Literature reviews show that such devices do not appear to cause any significant changes in mandibular length and their effectiveness in correcting class II malocclusion can be explained by a combination of some skeletal (mainly maxillary) and dentoalveolar (maxillary and mandibular) modifications. The SUS2 corrector device will be presented using bondable head gear tube and self-ligating mandibular molar tube. A case presentaion will be used to explain how to use SUS2 device in a successful manner.

Publié dans : Santé
  • Hello! Get Your Professional Job-Winning Resume Here - Check our website! https://vk.cc/818RFv
       Répondre 
    Voulez-vous vraiment ?  Oui  Non
    Votre message apparaîtra ici

Fixed applicance management of class II correction

  1. 1. Fixed Appliance Management of Class II Malocclusion SUS2 Corrector ©Dr Sylvain Chamberland
 ©sylvainchamberland.com
  2. 2. Literature review
  3. 3. ©sylvainchamberland.com Xbow appliance •Sample of 69 consecutive cl II patients compared to 
 30 historical cl II controls. Retrospective study. •Xbow 4,5 months; T2 ceph : 6,5 months post Xbow removal •Therefore, T2 measurement include relapse of most side effect ✦ Skeletal change: ✓ Diminution of Mx protrusion, without md advancement ✓ Increase vertical dimension compare to untreated control Flores-Mir C, Barnett G, Higgins DW, Heo G, and Major PW. Short-term skeletal and dental effects of the Xbow appliance as measured on lateral cephalograms. AJODO; 2009;136(6):822-832. Flores-Mir, AJODO 2009
  4. 4. ©sylvainchamberland.com Xbow appliance ✦ Dental change ✓ Overjet ‣ Correction by increase incisor proclination (IMPA ➚ 4,7° ± 4,1°) ‣ No mx incisor movement ✓ Molar relationship ‣ U6 distalize 0,9 ± 1,2 mm ‣ L6 mesialize 1,1 ± 1,3 mm Flores-Mir C, Barnett G, Higgins DW, Heo G, and Major PW. Short-term skeletal and dental effects of the Xbow appliance as measured on lateral cephalograms. AJODO; 2009;136(6):822-832. Flores-Mir, AJODO 2009
  5. 5. ©sylvainchamberland.com Xbow vs Forsus •Sample of 38 consecutive xbow appliance tx compared to 
 36 Forsus appliance tx. Retrospective study. •T1 ceph at baseline. T2 ceph at the end of tx •Both appliance generate the same amount of incisors inclination •The older the patient, the more OJ and upper incisors inclination remain •The longer the tx time, the more the lower incisors procline •Total tx time for both appliance is about the same Flores-Mir et al AO 2013 Miller, Robert A, Long Tieu, and Carlos Flores-Mir. "Incisor Inclination Changes Produced by Two Compliance-free Class II Correction Protocols for the Treatment of Mild to Moderate Class II Malocclusions." Angle orthodontist 83, no. 3 (2013): doi:10.2319/062712-528.1.
  6. 6. ©sylvainchamberland.com Xbow appliance •Sample of 25 consecutive cl II patients. Mean age 11,1 ± 1,1 y. •Prospective study •CBCT at T0 and after debonding Xbow (T1). Tx time 6,0 m (5,0-8,0) •Skeletal effect ✦ Mild SNA decrease (0,67± 1,35°) Erbas, Banu, and Ilken Kocadereli. "Upper Airway Changes After Xbow Appliance Therapy Evaluated with Cone Beam Computed Tomography." Angle Orthod 2014; 84, no. 4: doi:10.2319/072213-533.1 Erbas, A0 2014
  7. 7. ©sylvainchamberland.com Xbow appliance •Dental effect ✦ U1: Palatal tipping (-3,58± 3,56°)+ extrusion (1,72 ± 1,87 mm) ✦ U6: No significant distal tipping or intrusion. Mesial mvt inhibited ✦ L1: Labial tipping (10,87± 4,91°) ✦ L6: Mesial mvt (2,07 ± 1,24 mm) + extrusion (1,52± 1,08 mm) Erbas, Banu, and Ilken Kocadereli. "Upper Airway Changes After Xbow Appliance Therapy Evaluated with Cone Beam Computed Tomography." Angle Orthod 2014; 84, no. 4:: doi:10.2319/072213-533.1 p< .001 p< .001 p< .001 Erbas, A0 2014
  8. 8. ©sylvainchamberland.com •♀, 12 a. 5 m. •End of Xbow •Lower incisor proclination is obvious (+21°) La.Sha 0807 La.Sha 0308
  9. 9. ©sylvainchamberland.com •Xbow undesirable side effect relapsed •Incisor proclination return to normal ✦ Sometimes, we pray for relapse La.Sha 0308. 5 month of Xbow
  10. 10. ©sylvainchamberland.com •Tx time 23 months •Outcome ✦ 82 weeks into retention La.Sha 22-03-11
  11. 11. ©sylvainchamberland.com Forsus vs Cl II elastic •Sample of 30 consecutive patients, 23 treated with Forsus (13,4 y), 7 with cl II elastics (14,3 y). Prospective. •Ceph T0 after alignment, ceph T1 at removal of Forsus. Tx time 6 m. •No difference in skeletal effect Mx or Md •Dental effect ✦ Forsus: ✓ 1/FH retroclined. /1-MP proclined ✓ Significant increase of occlusal plane to FH Dubois A, Rompré P, Rodrigue C, Remise C, Comparaison des effets sur la croissance des maxillaires de l’utilisation du Forsus versus celle des élastiques de classe II, Thèse de maîtrise Dubois, Master thesis U. MTL.
  12. 12. ©sylvainchamberland.com Forsus effectiveness •Retrospective study, 32 consecutive patients (12,7± 1,2 y) matched to 27 historical untreated controls (12,8 ± 1,3 y) •Ceph T0 prior tx and Ceph T1 at completion of ortho therapy. Tx time 2,4 ± 0,4 y ✦ Mean duration of FRD active phase: 5,2 ± 1,3 m ✦ Successful cl II correction in 87,5% of the patients ✦ Greater skeletal effect on maxillary structures by restraining sagittal advancement of the mx (SNA ➘ 1,6 ±1,4°) ✦ Effect on the mandible is mainly dentoalveolar: large amount of mesial mvt of L1 (6,1° ± 6,3°) and L6 (2,4 ± 1,6 mm), extrusion of L6 (3,6 ± 1,5 mm) Franchi L, Lisa Alvetro, Veronica Giuntini, Caterina Masucci, Efisio Defraia, and Tiziano Baccetti. "Effectiveness of Comprehensive Fixed Appliance Treatment Used wi Forsus Fatigue Resistant Device in Class II Patients." Angle orthodontist 2011; 81, no. 4: doi:10.2319/102710-629.1 Franchi, A0 2011
  13. 13. ©sylvainchamberland.com Forsus effectiveness •Follow-up at 2,3 ± 1,1 y post comprehensive tx. 36 consecutive patients/ 20 historical untreated controls. Retrospective study. ✦ Mean FRD duration 4,8 ± 2,4 m ✦ Outcome (retrospective study) ✓ T1-T2: Baseline to end of ortho ✓ T2-T3: End of ortho to end of retention ✓ T1-T3: Baseline to end of retention Cacciatore, Giorgio, Luis Tomas Huanca Ghislanzoni, Lisa Alvetro, Veronica Giuntini, and Lorenzo Franchi. "Treatment and Posttreatment Effects Induced by the Forsus Appliance A Controlled Clinical Study." Angle orthodontist (2014):doi:10.2319/112613-867.1 Cacciatore, A0 2014
  14. 14. ©sylvainchamberland.com Forsus effectiveness •Follow-up ✦ T1-T2 FRD vs untreated controls ✓ Significant skeletal effect on Mx (SNA ➘ 1,7 °) ✓ No significant effect on Md ✓ Significant improve of dental relationship ‣ OJ -5,1mm; OB -3,1 mm; molar relationship +3,5 mm ‣ U1 retruded 1,6 mm, L1 proclined 5,6°/ 1,5 mm. 
 L6 extruded 1.3 mm. U6: no vertical change Cacciatore, Giorgio, Luis Tomas Huanca Ghislanzoni, Lisa Alvetro, Veronica Giuntini, and Lorenzo Franchi. "Treatment and Posttreatment Effects Induced by the Forsus Appliance A Controlled Clinical Study." Angle orthodontist 2014 doi:10.2319/112613-867.1 Cacciatore, A0 2014
  15. 15. ©sylvainchamberland.com Forsus effectiveness •Follow-up ✦ T2-T3 FRD vs untreated controls ✓ Significant greater increase in sagittal position of Mx (SNA ➚ 1,4°) ✓ Significantly increase of both OJ (1,3 mm) and OB (1,5 mm) ✓ Significant intrusion of U1 (-1,2 mm) Cacciatore, Giorgio, Luis Tomas Huanca Ghislanzoni, Lisa Alvetro, Veronica Giuntini, and Lorenzo Franchi. "Treatment and Posttreatment Effects Induced by the Forsus Appliance A Controlled Clinical Study." Angle orthodontist 2014 doi:10.2319/112613-867.1 Cacciatore, A0 2014
  16. 16. ©sylvainchamberland.com Forsus effectiveness •Follow-up ✦ T1-T3 FRD vs untreated controls ✓ No significant sagittal or vertical skeletal change ✓ Significant reduction of OJ (-3,8 mm), OB (-1,5 mm) ✓ Significant improvement of molar relationship (+ 3,7 mm) ✓ Significant retrusion of U1 (-1,1 mm) ✓ Significant intrusion of L1 (-1,2 mm) ✓ Success rate of overall correction: 83,3% Cacciatore, Giorgio, Luis Tomas Huanca Ghislanzoni, Lisa Alvetro, Veronica Giuntini, and Lorenzo Franchi. "Treatment and Posttreatment Effects Induced by the Forsus Appliance A Controlled Clinical Study." Angle orthodontist 2014 doi:10.2319/112613-867.1 Cacciatore, A0 2014
  17. 17. ©sylvainchamberland.com Fatigue Resistant Device •29 subjects, prospective study, 15 prior growth peak; 14 post growth peak. •Tx time 9 months. Ceph + MRI study ✦ Palatal tipping + extrusion of mx incisors ✦ Protrusion + intrusion + labial tipping (5,5° - 6°) of md incisors ✦ Distal tipping of Mx molars ✦ Mesial movement + mesial tipping of Md molars ✦ No change in disk position Aras, Ada, Saracoglu, Gezer, and Aras. "Comparison of Treatments with the Forsus Fatigue Resistant Device in Relation to skeletal maturity: A cephalometric and magnetic resonance imaging study. AJODO 2011; 140: 616-25: doi:10.1016/j.ajodo.2010.12.018. Aras, AJODO 2011
  18. 18. ©sylvainchamberland.com •Class II div 1 •Constricted maxilla •Tx time: 99 weeks Gu.Ma. 0707 Gu.Ma. 0708 Gu.Ma.250811; 2 years out of ortho
  19. 19. ©sylvainchamberland.com •Side effects relapsed
  20. 20. ©sylvainchamberland.com Twin Force Bite Corrector •Sample of 23 patients before Pubertal Growth Spurt compared to 18 patients post PGS. Retrospective study. •Skeletal change ✦ Mx restriction SNA ➘ 1,22° •Dental change ✦ IMPA increased 4,4° to 5,5° Chhibber, Aditya, Madhur Upadhyay, Flavio Uribe, and Ravindra Nanda. "Mechanism of Class II Correction in Prepubertal and Postpubertal Patients with Twin Force Bite Corrector." Angle Orthod. 2013; 83, n718-727: doi:10.2319/090412-709.1 Chhibber, A0 2013
  21. 21. ©sylvainchamberland.com Twin Force Bite Corrector •At end of ortho ✦ No difference between skeletal and dental parameters of both groups ✦ Significant longer tx time for the youngest group (3,67 y vs 2,75 y) ✦ Tx efficiency is greater for the post pubertal group Chhibber, Aditya, Madhur Upadhyay, Flavio Uribe, and Ravindra Nanda. "Mechanism of Class II Correction in Prepubertal and Postpubertal Patients with Twin Force Bite Corrector." Angle Orthod. 2013; 83, n718-727: doi:10.2319/090412-709.1 Chhibber, A0 2013
  22. 22. ©sylvainchamberland.com SaAl180111 SaAl271009. male; 13y 10 m SaAl151112, 16y 11 m
  23. 23. ©sylvainchamberland.com •Tx plan: exo 4s/5s •Cl II correction device helped to maintain anchorage while retracting U1 and protracting L6
  24. 24. ©sylvainchamberland.com SUS2 vs Forsus FRD •Sample: 20 SUS2 , 20 Forsus, 19 controls. All post pubertal (~15 y±1 y) •Both appliances. Tx time 5 m ± 1 m. Prospective study. ✦ Dentoalveolar effect ✓ 1/: retrusion + extrusion ✓ /1: protrusion + intrusion ✦ No significant skeletal effect on Mx and Md. No vertical change ✦ Soft tissue profile improvement is limited Oztoprak MO, Nalbantgil D, Uyanlar A, and Arun T. A cephalometric comparative study of class II correction with Sabbagh Universal Spring. European journal of dentistry. 2012 Turkey;6(3):302-10 Oztoprak, Eur. J. Dent. 2012
  25. 25. ©sylvainchamberland.com SUS2 vs Forsus FRD •However: ✦ Lower incisors proclination more prominent with Forsus FRD ✓ SUS2 : ∆IMPA= 5,78° ± 3,91° ✓ Forsus: ∆IMPA = 10,8° ± 3,07° ✦ N-A-Pg: better reduction in facial convexity with SUS2 ✓ SUS2 : -2,13°± 2,85° ✓ Forsus: + 0,65° ± 3.04° p < .001 p < .05 Oztoprak MO, Nalbantgil D, Uyanlar A, and Arun T. A cephalometric comparative study of class II correction with Sabbagh Universal Spring. European journal of dentistry. 2012 Turkey;6(3):302-10 Oztoprak, Eur. J. Dent. 2012
  26. 26. ©sylvainchamberland.com Study Design Experimental groups Observation Time Point Sample size (>25) Untreated Controls T0 Baseline T1 Prior Cl II device T2 Post Cl II device T3 End of Ortho T4 Follow-up Flores-Mir AJODO 2009 R ✔ 69 ✔ 30 ✔ 6 m. post Xbow Miller AO 2013 R ✔ 38/36 ✔ ✔ Erbas AO 2014 P ✔ 25 ✔ ✔ Dubois et al P ✔ 23 / 7 ✔ ✔ Franchi AO 2011 R ✔ 32 ✔ 27 ✔ ✔ Cacciatore AO In press R ✔ 36 ✔ 20 ✔ ✔ ✔ Aras AJODO 2011 P ✔ 15 / 14 ✔ ✔ Chhibber AO 2013 R ✔ 23 / 18 ✔ ✔ Oztoprak EJD 2012 R ✔ 20 / 20 ✔ 19 ✔ ✔
  27. 27. ©sylvainchamberland.com Poor Study Design •Study about Cl II correction device are not at the level of RCT. •Evidences are below that level of confidence •Even meta-analysis should be interprete with caution Giuseppe Perinetti, Jasmina Primožič, Giovanna Furlani, Lorenzo Franchi, and Luca Contardo (2014) Treatment effects of fixed functional appliances alone or in combination with multibracket appliances: A systematic review and meta-analysis. The Angle Orthodontist In-Press.
  28. 28. SUS2 Corrector
  29. 29. ©sylvainchamberland.com SUS2 Telescope Element Telescope rod with ring Position for turbo spring or spacer Arch adaptor Fixing screw Middle telescope tube Inner spring 2,4 N Guide Tube Hexagon socket screw Eye
  30. 30. ©sylvainchamberland.com Inner Spring •At maximum activation ✦ Spring path of 6 mm ✦ 2,4 N at full compression •Deactivation with hexagon screw ✦ Spring path 2,1 mm ✦ 1,0 N at full compression Spring span Front stop Back stop Spring span
  31. 31. ©sylvainchamberland.com Turbo Spring •Place on the telescope element ✦ Force of 3,0 N •Spacer of 1 or 2 mm ✦ If required for reactivation, although seldom necessary
  32. 32. ©sylvainchamberland.com SPEED™ Convertible Tube • For class II correction devices! •Repeatably convertible •Facilitate insertion and removal of cinched back SS wire
  33. 33. ©sylvainchamberland.com SPEED™ Convertible Tube •Tips for bonding ✦ Adapt meshpad on the model ✦ Microetch enamel ✦ Use light bond adhesive or 2 paste system ✓ Extra care should be taken to ensure sufficient curing time
  34. 34. ©sylvainchamberland.com Tips for bonding •Etch enamel 15s •Wash, rince & dry •Apply Assure sealant on the tooth & light cure •Apply Assure sealant on the bracket base & light cure •Wipe the bracket base into Assure paste •Place on the tooth & light cure
  35. 35. ©sylvainchamberland.com •Large mesh pad needs slight adjustment to obtain best fit on the buccal surface •Good adaptation of the mesh pad is warrant of good bond strength ✦ Left side is not as nicely bonded than the right side
  36. 36. ©sylvainchamberland.com SPEED™
 Convertible Tube •Cinching a 20 x 25 SS wire in the gum and without debonding the tube is challenging •Convertible tube permits easy cinching outside the mouth •Insertion and removal of the SS wire takes seconds and done without fear of debonding
  37. 37. ©sylvainchamberland.com •Buccal offset of the L pin at 3-4 mm distal to the tube ✦ Longer extension may impinge over the bracket of the 7s ✦ The L ball-pin is bent gingivally or occlusally at the mesial ✓ After some trial and errors, I prefer occlusal bend of the L pin
  38. 38. ©sylvainchamberland.com L Pin •Inserted distally on the eye of the telescope •Inserted distally into the head gear tube •Buccal offset 3-4 mm long •The pin is bent gingivally or occlusally at the mesial of the tube ✦ With bonded convertible head gear tube, I prefer to bend occlusally •Distal buccal offset and mesial occlusal bend are at 90° each other
  39. 39. ©sylvainchamberland.com •SUS2 telescope is used without the outer turbo spring for the first 6 weeks AlLa110814
  40. 40. ©sylvainchamberland.com •SUS2 telescope is used without the outer turbo spring for the first 6 weeks •Turbo spring is added to maintain forward activation AlLa110814 LaShMa080813 This is not the same case as above
  41. 41. ©sylvainchamberland.com •L pin bent occlusally •SPEED™ convertible tube on lower molars for easier insertion
  42. 42. ©sylvainchamberland.com •Arch adaptor tightly screwed onto the arch wire distal to the offset •Buccal offset of the archwire distal to the lower canines
  43. 43. Case Presentation
  44. 44. ©sylvainchamberland.com •Class II div 1 •Deep overbite LaShMa160712
  45. 45. ©sylvainchamberland.com •Class II skeletal relationship ✦ ANB 7°, ABOP = 4 mm •Bimax protrusion 12y 0m
  46. 46. ©sylvainchamberland.com Tx plan •Comprehensive tx + SUS2 cl II corrector device •Alternative tx plan ✦ Comprehensive + Extractions 4s/5s
  47. 47. ©sylvainchamberland.com At 44 weeks •SUS2 corrector engaged in june 2013 at 36 weeks ✦ .020 X .025 SS wire U & L •Turbo spring added in august at 44 weeks LaShMa080813
  48. 48. ©sylvainchamberland.com At 52 weeks •E links from the molars to the canines LaShMa021013
  49. 49. ©sylvainchamberland.com At 62 weeks •SUS2 for 26 weeks LaShMa121213
  50. 50. ©sylvainchamberland.com •Tx time = 105 weeks •Class I relationship achieved •White spot lesion: !!! poor oral hygiene despite several warning MaLaSh270814
  51. 51. ©sylvainchamberland.com 14y
  52. 52. ©sylvainchamberland.com •/1 AP relationship nicely controlled •/1 intrusion obtained •/6 eruption occurred
  53. 53. ©sylvainchamberland.com •Class II div 1 •Deep curve of Spee. deep overbite EmEho121212
  54. 54. ©sylvainchamberland.com •Severe class II skeletal relationship ✦ ANB 6,4°; ABOP = 7.5 mm •Hypodivergent 13y 6m
  55. 55. ©sylvainchamberland.com Tx plan •Comprenhensive tx, RPE + Fixed cl II correctors ✦ Increase vertical dimension •Alternate tx plan ✦ Comprehensive tx+ Orthognathic surgery (BSSO)
  56. 56. ©sylvainchamberland.com At 32 weeks •SUS2 were engaged at 26 weeks •32 weeks ✦ E links 6-3 to distallize the canines EmEho190913
  57. 57. ©sylvainchamberland.com At 43 weeks •SUS2 removal (breakage occurred) •17 weeks of SUS2 cl II correctors •17x25 TMA mushroom loop EmEho021213
  58. 58. ©sylvainchamberland.com ! •At 71 weeks ✦ Rebond 16, 26. Mx: 20x20 niti. Cl II elastic nightime •At 81 weeks ✦ Mx: 21x25TMA, CE EmEho180614 EmEho170714EmEho260814
  59. 59. ©sylvainchamberland.com •Vertical dimension improved •/1 proclined 19° ✦ Not only because of SUS2 but also to arch leveling •1/ retroclined 11° 15y 1m ANB = 5,6° ABOP = 4,3 mm
  60. 60. ©sylvainchamberland.com •Some condylar growth and molar eruption + mesialisation helped to achieve cl II correction
  61. 61. ©sylvainchamberland.com •Improved facial profile 13y 6m 15y 1m
  62. 62. ©sylvainchamberland.com •Class II div 1 •Severe ALD, impacted 37 •Heavily restored 16, 46 •Md dental asymmetry KiLe250311
  63. 63. ©sylvainchamberland.com •Hyperdivergent •Convexe profile •Mild skeletal cl II (ANB = 6°; ABOP = 4 mm) 11y 8m
  64. 64. ©sylvainchamberland.com Tx plan •Extraction of 16, 24, 46, 38 •SUS2 corrector •Alternate tx plan ✦ Likely 14, 24, 35, 44
  65. 65. ©sylvainchamberland.com •SUS2 engaged at 30 weeks (march 2012) •E links to distalize the canines + protract 47 KiLe040612 43 w KiLe230412 37 w
  66. 66. ©sylvainchamberland.com •20 weeks of SUS2 corrector •#47 protracted •Arch symmetry achieved KiLe160712 50 w KiLe160712 50 w Bond #37
  67. 67. ©sylvainchamberland.com •Dentoalveolar protrusion •Lower lip procumbency •Unpleasant smile 12y 10m
  68. 68. ©sylvainchamberland.com •Class I canine relationship achieved KiLe160913 110 w
  69. 69. ©sylvainchamberland.com post SUS20712 •Lip incompetency •Strain of the mentalis muscle 14y 0m
  70. 70. ©sylvainchamberland.com End of Ortho KiLe091213 122W
  71. 71. ©sylvainchamberland.com •Functional genioplasty to ✦ Obtain lip competency ✦ Improve profile + smile display 14y 2m
  72. 72. ©sylvainchamberland.com
  73. 73. ©sylvainchamberland.com 11y 8m 12y 10m 14y 2m Initial Post SUS2 Pre genio Final 14y 0m Chamberland S, Proffit WR, Chamberland P-E, Genioplasty in growing patients, Angle Orthod, in press
  74. 74. ©sylvainchamberland.com •Cl II div 1 •Accentuated curve of Spee Mx + Md ElLa210812
  75. 75. ©sylvainchamberland.com 14y •Vertical maxillary excess •Gummy smile •Lip incompetency at repose 14y 5 m
  76. 76. ©sylvainchamberland.com Mini screw •Mx: ✦ Palatal side (one on the left failed) ✓ Replace by one paramedian •Md: Buccal ✦ The one on the left is too low and became 
 submerged ElLa221112
  77. 77. ©sylvainchamberland.com •Intrusion of mx posterior teeth help achieve some cl II correction •Posterior open bite •Deep overbite ElLa070313
  78. 78. ©sylvainchamberland.com •Posterior intrusion helped to improved AP relationship 14y 11 m
  79. 79. ©sylvainchamberland.com •Md forward rotation •Upper molar intrusion •Limited eruption of lower molars
  80. 80. ©sylvainchamberland.com •SUS2 corrector •E links were maintained for a few weeks ElLa100613
  81. 81. ©sylvainchamberland.com •Classe I relationship achieved ElLa190814
  82. 82. ©sylvainchamberland.com •Facial profile improve •Lip strain persist ✦ A functional genioplasty is indicated 16y 5 m
  83. 83. ©sylvainchamberland.com •Limited mx dentoalvolar growth •Favourable md growth •L6 extrusion •L1 proclination + intrusion
  84. 84. ©sylvainchamberland.com •Lip competency •Smile display 16y 5 m14y 5 m
  85. 85. ©sylvainchamberland.com •Anchorage for molar protraction ✦ Congenitally missing 35, 45 BiAu 190814 BiAu060513
  86. 86. ©sylvainchamberland.com Molar protraction + Cl II correction device •Classe II div 2 •Internal root resorption of #46 •Tx plan ✦ RPE, Cl II correction device. Exo 46. Protraction 47. MaHe220611
  87. 87. ©sylvainchamberland.com Molar protraction + Cl II correction device •Class I relationship + molar protraction achieved in 96 weeks MaHe220611 MaHe031012 MaHe040613
  88. 88. ©sylvainchamberland.com •Class II div 2, deep overbite •Hopeless 14, 36, 46 •Impacted 13 FrRo211111 16 y 2 m
  89. 89. ©sylvainchamberland.com •Tx plan ✦ Would usually not need extraction in the md arch ✦ How about exo 4s/6s + SUS2
  90. 90. ©sylvainchamberland.com •SUS2 were engaged ~ 1 years after tx was initiated because the above mentioned reasons •SUS2 was used 36 weeks FrRo041113 FrRo270114 The patient delayed extraction of U4 some 3 months and L6 some 9 months
  91. 91. ©sylvainchamberland.com • Reassessment of bracket position • Lower 7s protracted (3 mm to go for 47) FrRo260814 Patient didn’t show for 4 months (april to august)
  92. 92. ©sylvainchamberland.com •/1- maintained AP •1/ torque improved •Lip support maintained
  93. 93. ©sylvainchamberland.com •L7s protracted •/1s maintained AP
  94. 94. Discussion - Conclusion
  95. 95. ©sylvainchamberland.com Does the approach really matter? •Most studies showed ✦ Some restriction of Mx forward growth ✦ No significant increase of Md growth ✦ Significant dentoalveolar change at end of ortho ✦ Class II correction is maintained at 2 y follow-up (83%) ✦ No significant skeletal change at 2 y follow up.
  96. 96. ©sylvainchamberland.com Side effect •Incisor proclination occurred in spite of arch wire cinchback and -6° torque embed in the brackets (19x25 into .22 slot) •Wire-slot interplay should be reduce ✦ 20x25 or 21x25 SS wire + cinchback •TADs + Cl II correction device reduce lower incisors proclination ✦ /1 change 3,61° ± 5,07° vs 9,29° ± 3,81° •Extraction + cl II correction device: good marriage when space is necessary along cl II correction Cacciatore G, et al AO in press Aslan B, et al AO 2014;84;76-87
  97. 97. ©sylvainchamberland.com Cost •SUS2 : 135$ buy 3 get 1 (101$). One size fits all •Forsus: 260$, need large inventory for all different sizes. ✦ Must buy > 15000$ annually to get 50% discount… •TFBC: 239$ buy 4 get 1 (210$) ( 2 lenght sizes + double lock or anchor wire) •XBow: 220$ + 260$ =480$ •Esprit corrector : ~ 169$ 101/260 = 39%
  98. 98. ©sylvainchamberland.com Cost •If most appliances do about the same •Why should we pay >twice (257%) the price to get a Cl II corrector device?
  99. 99. ©sylvainchamberland.com Key points •SUS2 ✦ Easy to install and remove. ✦ Less expensive. ✦ Minimal breakage if any •U6 SPEED™ convertible tube’s headgear tube •L6 & L7 SPEED™ convertible tube Repeatably convertible Much easier to cinchback
  100. 100. Thank you

×