More Related Content Similar to Part II-Management of class ii malocclusion with speed appliance part ii (14) More from Dr Sylvain Chamberland (13) Part II-Management of class ii malocclusion with speed appliance part ii1. Management of Class II
Malocclusion with SPEED
Appliance
Part II
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2. Clinical Case presentation
ā¢ Class II div 1 and II
ā¢ Twin Force Bite Corretor
ā¢ Pendulum appliance and intrusive arch to level the
curve of spee
ā¢ Biomechanical approach for cl II div 2 (mx anterior
intrusive arch)
ā¢ TAD and extraction approach in hyperdivergent cases
Ā©Dr Sylvain Chamberland
4. ā¢ Class I proļ¬le
ā¢ Retroclined 1/
Ā©Dr Sylvain Chamberland
5. Cl II div 2
St.De 010210, 14y 10 m
ā¢ Maxillary constriction
ā¢ Left posterior Xbite
ā¢ Severe 1 molar mesial rotation
st
Ā©Dr Sylvain Chamberland
6. Tx plan
ā¢ RPE + exo 2 premolars?
ā¢ RPE, non exo + cl II correctors?
ā¢ RPE, non exo, molar derotation, mx anterior intrusive
arch
Ā©Dr Sylvain Chamberland
7. ā¢At 34 weeks
!TFBC are installed
Mx:.018 SCā¢
St.De 100111 Md:.020 x.020 SS
Mx:.016 X .016 Sent
St.De 140211 Md:.020 x.020 SS
ā¢At 52 weeks
!TFBC removed
!A Hilgers RPE design would have achieved derotation of the 1st molar while an Hyrax had maintained it.
Ā©Dr Sylvain Chamberland
8. At 58 weeks
St.De 280311
ā¢ Mx molar de-rotation is needed
ā¢ Class II elastic to wear during night
ā¢ Coordination of arch form is necessary
Ā©Dr Sylvain Chamberland
9. ā¢ Mx molars distalized
ā¢ /1-MP proclined by 17Ā°
ā¢ Rotation of occlusal plane noted
Ā©Dr Sylvain Chamberland
10. At 80 weeks
St.De 280311
ā¢ Finishing bends here and there
ā¢ Incisal recontouring
Ā©Dr Sylvain Chamberland
12. Ro.LĆ© 061009
ā¢ Class II div 1
ā¢ Constricted maxilla
Ā©Dr Sylvain Chamberland
13. ā¢ Skeletal class II
ā¢ Proclined lower incisors
ā¢ Lip trapping
ā¢ Low MPA
Ā©Dr Sylvain Chamberland
14. ā¢ Fixed class II correctors (Forsus, Twin force, Herbst, etc)
have a tendency to procline the lower incisors
ā¢ Therefore, maxillary molar distallization was preferred
for class II correction in this case
Ā©Dr Sylvain Chamberland
15. At 22 weeks
Mx:.018 SCā¢
ā¢
Ro.LĆ© 060410
Class I molar relationshipx.022 neost + 17x25 niti
Md:.016 obtained
ā¢ Elastomeric chain to distalize the U5'S
ā¢ 17x25 niti intrusive arch attached
at the canine to level the lower arch and
minimize /1 proclination
Ā©Dr Sylvain Chamberland
16. At 45 weeks
Mx:.016 SS, cinch back
Ro.LĆ© 160910 Md:.020 x.025 Niti
ā¢ Sliding mechanics on a .016 SS, cinch back
! Elastomeric chain attached to U4ās
ā¢ Class I canine relationship is obtained
Ā©Dr Sylvain Chamberland
17. At 60 weeks
Mx:.016 x .016 sent
ā¢ Bond 7's/
Ro.LĆ© 281010
! EC 12 to 22
! Anteriors will be retracted with .017 x .025 mushroom loop
ā¢ /7's will be bonded at next RV
Ā©Dr Sylvain Chamberland
18. At 67 weeks
Mx:.020 x .025 Nitisw
Ro.LĆ© 170211 Md:.020 x .025 Nitisw
ā¢ Mx: Elastomeric chain 6 to 6 to maintain
space closure
ā¢ .020 x .025 niti for leveling prior ļ¬nishing
ā¢ .020 x .025 SS for ļ¬nishing " 17 weeks
Ā©Dr Sylvain Chamberland
20. 6 weeks into retention
Ro.LĆ© 250811
Ā©Dr Sylvain Chamberland
24. Em.Be 250610
ā¢ Cl II div 2
ā¢ Deep overbite
ā¢ Mx molar mesially rotated
Ā©Dr Sylvain Chamberland
25. ā¢ Dished in proļ¬le
ā¢ Retroclined 1/-SN & /1-MP
ā¢ Increased 1/1 " 147Ā°
Ā©Dr Sylvain Chamberland
26. Tx objective
ā¢ Decreased interincisal angle
ā¢ Procline 1/ and /1
ā¢ Obtain class I molar and canine relationship
Ā©Dr Sylvain Chamberland
27. Tx Plan
ā¢ Forsus?
ā¢ RPE?
ā¢ Exo of 2 mx premolars?
Ā©Dr Sylvain Chamberland
28. ā¢ TPA .032 SS activated to de-rotate the molars
ā¢ Molars distalization
Em.Be 060710
ā¢ Mx 3 segments (016 x 022 niti) for alignment
ā¢ Overlay 17x25 niti intrusive arch
! Anterior intrusion
! Posterior extrusion
! Tip back at buccal segment
Ā©Dr Sylvain Chamberland
29. Why the intrusive arch is overlayed and not
engaged into the brackets of the incisors?
ā¢ The rectangular wire would create a torquing moment
ā¢ This would be balanced by anterior extrusion and posterior
intrusion
ā¢ That would substract from the anterior intrusive force and
posterior extrusive force
ā¢ The efļ¬cacy of the force sytem would be reduced
ā¢ Also the intrusive force would be in-line or lingual to the center
of resistance of the incisor negating the desired ļ¬airing effect
Ā©Dr Sylvain Chamberland
30. Do we need to understand
orthodontic mechanics
ā¢ Yes, because I said so
ā¢ Yes, because...
Ā«...when a case is challenging,
orthodontists know what to do.Ā»
Ā©Dr Sylvain Chamberland
31. At 6 weeks
Em.Be 190810 Md:.016 SCā¢
ā¢ Anterior mandibular teeth are bonded
ā¢ Unraveling the lower curve of Spee will
assist cl II correction
Ā©Dr Sylvain Chamberland
32. At 13 weeks
Mx:.016 SCā¢
Em.Be 051010 Md:.016 Sent
ā¢ Mx: 16 SCā¢ engaging the canines
ā¢ Derotation of mx molars noted
Ā©Dr Sylvain Chamberland
33. At 20 weeks
Mx:.016 Sent
Em.Be 221110 Md:.016 x .022 neosent
ā¢ Md: 016 x 022 neosent
ā¢ Mx: 016 sent + cl II elastics
ā¢ Intrusive arch is removed
Ā©Dr Sylvain Chamberland
34. At 27 weeks
Mx: 016 x .022 neosent
Em.Be 100111 Md:.020 x .020 neosent
ā¢ Remove the TPA
ā¢ Continue cl II eastics
ā¢ Class I relationship is almost achieved
Ā©Dr Sylvain Chamberland
35. At 40 weeks
Mx: .020 x .020 neosent
Em.Be 120411 Md:.020 x .020 neosent
ā¢ Reassessment of bk position
! Rebond 12, bond 16, 26, 47
ā¢ Continue cl II elastics
Ā©Dr Sylvain Chamberland
36. At 59 weeks
Em.Be 220811
Rebonded
ā¢ Mx: ! elastomeric chain
ā¢ Md: rebond #47 , #33,
.020 x .020 neost
Ā©Dr Sylvain Chamberland
37. ā¢ May be some improvement in lip support can be noted
ā¢ Incisors display is adequate
Ā©Dr Sylvain Chamberland
38. Wi.Ja. 270111
ā¢ Is such a treatment approach repeatable?
! Same mechanics: 28 weeks into treatment
3 Segments 16 x16 sent" 16x22 neo"16SC + cl II"16sent + cl II"16x22 neost + cl II
Wi.Ja. 260811 2 Segments 16sent"16sent continuous "20 x 20 neost + cl II"20x25 niti + cl II
Ā©Dr Sylvain Chamberland
41. El.Re 060510
ā¢ Cl II div 1
ā¢ Mx crowding
Ā©Dr Sylvain Chamberland
42. El.Re 060510, 9 y 7 m
ā¢ Slight vertical facial asymmetry
ā¢ Retrognathic mandible
ā¢ Low FMA, brachycephalic
Ā©Dr Sylvain Chamberland
43. ā¢ At 29 weeks
Cinch Mx:.020 x .025 sw Cinch
El.Re 201210 Md:.020 x .025 sw
! Forsus are engaged
! Md: .020 x .025 SW, loop distal to the canine, cinch back
ā¢ At 35 weeks
El.Re 310111
! E-links to sliding the canine distally on .020 x .025 SW
Ā©Dr Sylvain Chamberland
44. At 41 weeks
ā¢ Reassessment of bk position
! Rebond 12, 16, 26,
! Bond 37, 46, rebond 33, 35, 45
Ā©Dr Sylvain Chamberland
45. At 41 weeks
Md:.016 x .022 neosent
El.Re. 140311 Md:.016 sent
ā¢ Forsus and Hyrax removed
ā¢ Canines distalized and a space opened mesially
ā¢ Side effect: posterior intrusion
Ā©Dr Sylvain Chamberland
46. El.Re 140311
ā¢ Molar distallization and intrusion
ā¢ Increased smile display
ā¢ /1-PM was maintained at 109Ā°
Ā©Dr Sylvain Chamberland
47. At 64 weeks
El.Re. 220811
ā¢ Mx & Md: .020 SS SW
ā¢ Finishing bends, Cl II elastics
Ā©Dr Sylvain Chamberland
51. ā¢ Straight proļ¬le
ā¢ Lips to E-plane = normal ā¢Tx Plan
ā¢ Retroclined 1/ #Non extraction?
#Extraction?
ā¢ Proclined /1
Ā©Dr Sylvain Chamberland
52. At 61 weeks
ā¢ Mx: 21x21x20 x 38 mm, E-links #5 at 17 & 27
Ma.Ma 221110
ā¢ Md: 21x21x20 x 38 mm
! To include the canine in the rectangular
section
! Upright spring on 1st premolars, E-links #3
! Cl II elastics 3/6
Ā©Dr Sylvain Chamberland
53. At 74 weeks
Ma.Ma 240211
ā¢ Space closure is effective
ā¢ Lower curve of Spee remained ļ¬at
ā¢ Continue cl II elastics
Ā©Dr Sylvain Chamberland
54. At 81 weeks
ā¢ Mx: Continue en masse retraction
Ma.Ma 130411 Md:.020 x .025 sw
ā¢ Md: .020 x .025 SW + EC 6 to 6
! Continue cl II elastics
Ā©Dr Sylvain Chamberland
55. At 102 weeks
Mx:.020 x .025 sw
Ma.Ma 080911 Md:.020 x .025 sw
ā¢ Finishing bend
ā¢ Enamel recontouring
Ā©Dr Sylvain Chamberland
58. Ma.Co 250809, 10y 9 m
ā¢ Cl II div 1
ā¢ Md deviated to the right
ā¢ Deep overbite
ā¢ Mesially rotated 1st molar
Ā©Dr Sylvain Chamberland
59. ā¢ Proclined 1/ and /1 (1/-SN = 121Ā°; /1-MP = 104Ā°)
ā¢ Large overjet, 1/1 = 108Ā°
ā¢ Deep overbite
Ā©Dr Sylvain Chamberland
60. Tx plan
ā¢ Any cl II ļ¬xed corrector will procline lower incisors
ā¢ Lower incisor intrusion with a SW will procline /1
Ā©Dr Sylvain Chamberland
61. At 11 weeks
Ma.Co 011209
ā¢ .032 TMA TPA to derotate U6ās
ā¢ Md: 3 segments + lingual arch
ā¢ Intrusive arch 17x25 niti attached at /3ās (distal to C rot) to
intrude and retrocline /1
Ā©Dr Sylvain Chamberland
62. At 23 weeks
Ma.Co 230210
ā¢ Md: 20x20 neost + intrusive arch on /3ās
ā¢ Mx: 20x25 nitisw (to detorque U1ās)
ā¢ Cl II elastics
ā¢ Molars are derotated
Ā©Dr Sylvain Chamberland
63. At 29 weeks
Ma.Co 070410
ā¢ Mx: 21x21x20 to slide buccal segment distally
ā¢ TPA removed
ā¢ Md: 20x25 nitisw, LA + intrusive arch removed
ā¢ Unilateral FORSUS cl II corrector on the right side is installed
Ā©Dr Sylvain Chamberland
64. ā¢ 1/ SN = 102, retracted
to normal
ā¢ /1-MP = 105 maintained
ā¢ 1/1 = 125 = normal
Ā©Dr Sylvain Chamberland
65. At 53 weeks
Ma.Co 200910
ā¢ Remove Forsus on the right side
ā¢ Mx: 17x25 TMA mushroom loop
to retract anteriors (note the space mesial to U3ās)
ā¢ Md: 20x25 nitisw
ā¢ Class I molar and canine relationship achieved
Ā©Dr Sylvain Chamberland
66. At 59 weeks
Ma.Co 011110
ā¢ Mx: 20x25nitisw + elastomeric chain
ā¢ Continue cl II
Ā©Dr Sylvain Chamberland
67. At 78 weeks
Ma.Co 210311
ā¢ Mx: 20x25 sw + elastomeric chain
ā¢ Md: 20x25 nitisw
ā¢ Patient instructed to wear Cl II elastic during nightime
Ā©Dr Sylvain Chamberland
68. At 103 weeks
Ma.Co 070911
ā¢ Class I molar and canine relationship
Ā©Dr Sylvain Chamberland
72. Es.Gr 040609
ā¢ Class I, congenitally missing #45
ā¢ Xbite 22/33
Ā©Dr Sylvain Chamberland
73. ā¢ Bimax protrusion
ā¢ Mx midline to the left
ā¢ Tx plan
! Exo???
Ā©Dr Sylvain Chamberland
74. Md:.018 SCā¢
Es.Gr 231109, 20 weeks Md:.016 Sent
ā¢ Tx initiated with .016 SCā¢ for 12 weeks, then .018
SCā¢ for 8 weeks
ā¢ At 20 weeks:
! Mx: 18 SC; Md: .016 sent
ā¢ Followed by .016 x .022 neost, .020 x .020 neost, .020
x .025 niti, then .021 x .021 x .020 en masse retraction
Ā©Dr Sylvain Chamberland
75. Es.Gr 071210, 74 weeks #45 was protracted alone before engaging #46
ā¢ Sliding #13 on the round section of HDGW
ā¢ Note the slight curve of Spee in lower arch
! The squared anterior section is limited to lower incisors
! This reduce the stiffness of the anterior segment
! The canine and the 1st premolar have a tendency to tip lingually
as the E-links press on the labial surface
! When spaces are closed, it is most often not possible to engage
a .020 x .025 SS wire
Ā©Dr Sylvain Chamberland
76. Es.Gr 180111, 80 weeks
ā¢ Md: .021x.021x.020 x 58 mm
! Extended square anterior section include the 1st premolars
! This increased the wire stiffness in torsion
! Hence it help to maintain a ļ¬at curve of Spee
! Once the space are close, a .020 x .025 SS sw can be engage
ā¢ Mx: #13 distalized into cl I
Ā©Dr Sylvain Chamberland
77. Md: .020 SS
Es.Gr 010311, 86 weeks
ā¢ Mx cl I canine is achieved
! EC 7-6-5-3-o-2
! 6 weeks later (92w), the EC was changed and an active coil was added
Es.Gr 240511, 98 weeks Md: .020 x.025 nitisw
ā¢ 98 weeks: midline improved
! Sliding mechanics: Light force + round wire
Ā©Dr Sylvain Chamberland
78. At 110 weeks
Es.Gr 150811, 110 weeks
ā¢ Mx: rebond #22 to move the root mesially
! .020 x.025 nitisw + EC
ā¢ Md: .020 x .025 SSsw + EC
Ā©Dr Sylvain Chamberland
80. An.Gr. 160309, 14 y 4 m
ā¢ Cl II div 1
ā¢ Open bite
ā¢ Moderatle ALD
Ā©Dr Sylvain Chamberland
81. ā¢ Hyperdivergent
ā¢ Bimaxillary protrusion
ā¢ Lip incompetency
Ā©Dr Sylvain Chamberland
82. Tx plan
Tx initiated: July 15-2009
ā¢ Extraction?
ā¢ Surgery?
ā¢ Non-surgery
ā¢ TADs
Ā©Dr Sylvain Chamberland
83. At 13 weeks
An.Gr. 131009
ā¢ Mx:
! TADs 6 x 1,4 mm
! 3 segments .020 x.020 neost + TPA .032 x .032 activated mesial
out
ā¢ Md: .018SCā¢
Ā©Dr Sylvain Chamberland
84. At 21 weeks
An.Gr. 131009
ā¢ Mx: Replace TAD distal to 1 m, .016 sent
st
ā¢ Md: TADs 8 x 1,4 mm + .016 sent
An.Gr. 071209
Ā©Dr Sylvain Chamberland
85. At 26 weeks
An.Gr. 071209
ā¢ Mx: .016 x .022 neost, ! EC
ā¢ Md: .016 x .022 neost, ! EC
! .032 TMA LA
An.Gr. 15-01-10
Ā©Dr Sylvain Chamberland
86. At 34 weeks
An.Gr. 15-01-10
ā¢ Mx: .21 x .021 x .020 x 38 mm
-E5 7-3
ā¢ Md: .020 x .025 niti
Class 1I
An.Gr. 08-03-10
Ā©Dr Sylvain Chamberland
87. At 46 weeks
An.Gr. 08-03-10
ā¢ Mx: .E links: Hook to the TADs
ā¢ Md: ! E4
ā¢ TPA and LA removed
Class 1
An.Gr. 07-06-10 Md: .021 x .021 x .020
Ā©Dr Sylvain Chamberland
88. At 59 weeks
An.Gr. 15-07-10 Md: .021 x .021 x .020
ā¢ Mx: E links: Shep-Hk to the TAD
! EC 11-27
ā¢ Md: .020 x .025 niti
An.Gr. 02-09-10 Md: .020 x .025 niti + EC
Ā©Dr Sylvain Chamberland
89. At 66 weeks
An. Gr. 191010
! Mx: .021 x .021 x .020. Lig. tie
TAD-U3, E links
At 75 weeks
An. Gr. 231210 Md: .020 x .025 SS
! Mx: EC 6 to 6
! Md: .020 x .025 SW
Ā©Dr Sylvain Chamberland
90. At 94 weeks
Mx: .021 x .021 x .020 SS
An. Gr. 020511 Md: .020 x .025 SS
ā¢ After 2 missed rendez-vous: lost 12 weeks!
ā¢ Patients involved in a ļ¬ght!!!
! Luxation of 12, 11, 42, 41, 31
Mx: .016 x .022 neost
Md: .06 sent
Ā©Dr Sylvain Chamberland
92. ā¢ Condilar growth
ā¢ Almost no aveolar growth
ā¢ Finishing stages to improve
root parallelism
Ā©Dr Sylvain Chamberland
93. At 111 weeks
An. Gr. 290811
ā¢ TAD are removed
ā¢ Wire cut distal to lower 5ās
ā¢ Debond in 2 weeks
Ā©Dr Sylvain Chamberland
96. ā¢ Lip incompetency
ā¢ Bimaxillary protrusion
ā¢ Vertical maxillary excess (posterior)
Ā©Dr Sylvain Chamberland
97. Tx Plan
ā¢ Extraction
ā¢ Would usually involve bimaxillary surgery
! The patient was tx planned for surgery.
! Tx initiated: March 5, 2009
Ā©Dr Sylvain Chamberland
98. 52 weeks into treatment
ā¢ The patient and his father declined the surgery: No way!
ā¢ Pull out the TAD box!
ā¢ TAD: 8 x 1,8 mm
Md: .020 x .025 sw
Ma.An.Vo.Bo 030310 Md: .021 x .021 x .020 E-4
Ā©Dr Sylvain Chamberland
99. ā¢ Mx arch was treated in segments
Ā©Dr Sylvain Chamberland
100. At 67 weeks
Ma.An.Vo.Bo 150610
ā¢ Upper left TAD is replaced
ā¢ Lower expansion occurred because of the
absence absence of a lingual arch
Ā©Dr Sylvain Chamberland
101. At 110 weeks
Ma.An.Vo.Bo 190411
ā¢ Upper left TAD failed 3 times
ā¢ TFBC was used unilaterally on the left from
Dec. 2010 to April 2011
Ā©Dr Sylvain Chamberland
102. At 128 weeks
Ma.An.Vo.Bo 110811
ā¢ A compromised posterior occlusion was
accepted
ā¢ Mandibular asymetry to the left may
explain the cl II relationship
Ā©Dr Sylvain Chamberland
103. ā¢ Smile display improved
ā¢ Lip competency improved
ā¢ Mandibular dĆ©viation to the left is noted
Ā©Dr Sylvain Chamberland
105. ā¢ Forward rotation of the mandible
! Intrusion of mx molars
! Intrusion of md molars
! AFH !
Ā©Dr Sylvain Chamberland