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6 Keys to Derotational Success

Six Keys to Rotational Control (in MX)

Bracket Placement Variable Torques Archwire Bends TMA Tiebacks Closing Chain

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Finishing Cases with a Low-Friction Appliance

Finishing begins with good bracket placement l t This is a precision appliance
Errors show up early due to the rapidity in leveling to rectangular wires Reposition as needed Sl t size is .028, not .027 Slot i i 028 t 027 Because there is more play in the system, doctors may have to compensate for it

Most Common Issues with Bracket Placement

Brackets not placed more ginigivally Laterals and cuspids positioned too distally Upper and lower cuspid brackets not placed on the height of contour Upper and lower lateral brackets not placed more mesial to the height of contour Not viewing O-G reference points from the incisal/occlusal aspect using a mirror p g Position of the height of contour will look different! Maxillary bicuspids placed too mesially

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Maxillary Bracket Positioning

Damon
KEY OFF THE MAXILLARY CANINES! MD: Align bracket scribe line of upper anterior brackets with the crown long axis at the height of contour The OG positioning of the upper canine is slightly gingival to the mesial-distal contact line with the lateral and central incisor sequentially more gingival to the canine. Central: Slot is approx. .5 mm gingivally to slot of canine bracket. Lateral: Slot is approx. .25 mm incisally to slot of central bracket.

Conventional

M-D contact line is slightly canted

Bracket Slot Bracket Base

Denotes recontouring

Mandibular Bracket Positioning Cuspids

Damon
MD: Align scribe line with crown long axis at the height of contour VIEW FROM INCISAL SURFACE! IF VIEWED , FACIALLY, PLACEMENT WILL APPEAR MESIAL TO CROWN LONG AXIS!

Conventional

OG: Position incisal edge of wings s g ty slightly gingivally to mesialdistal contact line.

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Variable Bracket Torques

Get anterior torque control early in treatment by selecting proper bracket torques and using hightech archwires pre-torqued in the anterior

Variable Bracket Torques

Main reasons to use variable torque options:

1. Since the system is designed to incorporate play between the bracket and the slot throughout all p , q treatment phases, variable torque options help to maintain ideal anterior tooth position.

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Variable Bracket Torques

7-11 of play between slot and .019 x .025 Rectangular Wire
(factoring in both bracket and wire tolerances)

Variable Bracket Torques Main reasons to use torque options:

2. With so little friction and binding in the system, elastics and Class II correctors move teeth much more quickly. Torque selections are designed to maintain anterior position and avoid round tripping.

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Archwire Bends
.016 x .025 Damon stainless steel, typically used on the lower arch during major mechanics and finishing, is ti t i patient-specific, meaning that it is formed to the ifi i th t i f d t th patients archform prior to transitioning from .018 x .025 Damon Copper Ni-Ti. It is not uncommon however for Damon clinicians to remove play from the system by making appropriate torque bends to the archwire. Effectively, this maintains the desired amount of torque while introducing a minor degree of friction, which precludes undesired tooth movement near the end of treatment. At this stage of treatment, a certain amount of friction can be advantageous as long as the system remains passive.

TMA
Many clinicians favor .017 x .025 Damon TMA over steel in terms of making necessary bends because of its flexibility. Another important benefit is derived from its crosssection. Because the width of the wire is greater (.017 versus .016), the diagonal is also greater than .016 x .025 steel. This archwire occupies more space in the bracket lumen. This yields not only more effective torque, but more rotation control as well. Furthermore, this wire is manufactured at the higher end of the tolerance spectrum, which also aids in rotation control.

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Tiebacks
Tieback modules are intended to hold space, not to close it. When too much force is applied, it is not uncommon for lower cuspids to roll distal lingual, breaking contact with the lower laterals, and thus affecting lower anterior contacts. Lower laterals may then rotate mesial lingual. The aforementioned is a function of both heavy tieback forces and play in the bracket slot, which is inherent in passive self-ligating appliances.

Closing Chain
Chain is used on the lower anteriors 3-3 to close minor spacing. Once space is closed, it is imperative to remove it and hold space by either lacing L3-3 or crimping archwire stops distal to both lower cuspids. Chain that is not removed may continue to deliver an unwanted force, leading to rotations near the end of treatment. treatment