TREATMENT OF THE FACE WITH BIOCOMPATIBLE ORTHODONTICS

DR. ALI WAQAR HASAN

FCPS-II RESIDENTORTHODONTICS

DAMON SYSTEM CONCEPT

• The philosophy is to approx. Biologically induced, Tooth moving forces in each phase of Orhodontic treatment

• Damon System achieves this by means of passive, virtually friction free, self locking, fixed appliance conduit that maximizes the full potential of arch wires

• It provides reliable & simple means of achieving best facial balance thru use of light forces = functional adaption of arch wire

• Functional Adaptation = FRANKEL EFFECT

• Traditional treatment planning based on maintaining original arch form for stability

• In patients with muscle imbalance & collapsed arch forms, tooth mass often had to be eliminated

• Extensive clinical results = clinicians can maintain complete dentitions even in severely crowded arches = using very light forces, high tech arch wires in passive Damon appliance = alter balance of forces of lips, tongue & muscles of face

• This alteration creates new force equilibrium that allows the arch form to reshape itself to accommodate teeth

• “the body not the clinician determines where the teeth be positioned”

• “PHYSIOLOGICALLY DETERMINED”

• CT scans of patients in retention ≥ 5 years = using light forces in a passive tube with small wire-lumen ratio enables teeth to be moved bodily, without tipping in all planes of space & alveolar bone will follow

• This compelling research calls for significant shift in thinking & treatment planning, eliminating need for molar distalization, extractions & rapid palatal expansion

EARLY OBSERVATIONS OF DAMON SYSTEM

• The system offers minimal negative impact on the arch form when aligning severely mal positioned teeth

• The appropriate force and wire to lumen ratio produces a frankel type effect, arch widening effect in posterior, whereas the lower canine width remains same

• The orbicularis oris & mentalis muscles create a lip bumper effect which minimizes anterior movement of incisors

• In cases treated with nonextraction, as the arch widens in the posterior, the tongue usually lifts & moves forward, creating a new force equilibrium between it & the lips & muscles of the face

• In bimaxillary protrusive cases treated through ectraction therapy, treatment mechanics are greatly simplified with the lip bumper and headgear effect of the facial muscles, thus minimizing the demand on posterior anchorage

CONTEMPORARY ORTHODONTIC PHILOSOPHIES

ACHIEVE FACIAL HARMONY via FACIAL TREATMENT PLANNING

• Most contemporary clinicians have expanded their primary focus toward creating beautiful & handsome faces

• Treatment planning is concentrated on developing a result that is conducive, rather than detrimental to long term maturation of face

• Treating a 13 year old with the future 50 year old in mind

USE OF NONEXTRACTION THERAPY WHERE POSSIBLE & LIGHT FORCE MECHANICS

• The principal means of gaining arch length were distalizing molars or high force palatal expanders

• Each has its drawbacks = fragile vascular architecture

• Some Damon system practitioners reluctant to relinquish rapid palatal expanders

• Author believes their use is unnecessary

• Clinicians can now maintain many complete dentitions by using very light force, high tech arch wires in passive tubes, thus gaining arch length

DAMON SYSTEM ESSENTIALSDAMON SYSTEM APPLIANCE

• Preadjusted Damon appliance is available in 0.022 & 0.018 inch slots

• 0.022 inch slot maximizes the potential for keeping forces in optimum zone

• Small wire in large lumen is favourable for tooth movement as it diminishes the divergence of angles in archwire slot, allowing free movement

• The greater play allows faster, unrestricted tooth movement

• Damon tube manufactured by metal injection molding, most precise process to manufacture metal brackets n tubes

• This process makes possible the manufacture of small, accurate parts that allow movement of slide & to provide close tolerances of arch wire slot

• Upper tubes open incisally while lower tubes open gingivally to provide best visibility when checking arch wire placement

DAMON STANDARD PRESCRIPTION

• Damon standard prescription is recommended for all molars, premolars and all incisors and canines in good position

• Careful selection of torque is essential before starting treatment

DAMON SYSTEM ARCHWIRES & ARCHWIRE SEQUENCING

• Damon system is designed to take advantage of play in mechanical system and yet maintain superb control of teeth in working and finishing of treatment

• Amount of play between the bracket tube and archwire is critical

• In early alignment phase, place a small high tech arch wire in a large lumen or tube of bracket

• Apply a force just high enough to stimulate cellular activity without crushing the lace like network of capillaries around the PDL & surrounding alveolar bone

• Key mistake = not allowing enough time for these light archwires to work

• Author encourages to resist temptation to change archwires frequently

• Too frequent archwire change can disrupt the repair process and cause damage to tissues and bone

• The first two high tech arch wire phases are intended to give the body a second chance of finding a new physiologically determined tooth position and arch form dictated by muscles of face and tongue, bone and soft tissue

LIGHT ROUND WIRE PHASE

• By the end of light round wire phase, the orthodontist will have achieved significant alignment and levelling, begun rotational control and arch development

• Use a 0.014 inch copper Ni-Ti initial archwire to start tooth movement, level, begin arch development & prepare for next arch wire

• Use a 0.016 inch copper Ni-Ti archwire for a second archwire in severly crowded adult patients

HIGH TECH EDGEWISE PHASE

• By end of high tech edgewise phase, the orthodontist will have completed levelling alignment, completed rotational control, begun torque control, begun space consolidation, and continued arch development

• Place 0.016 x 0.025 inch copper NiTi wires in primarily young patients

• Place 0.014 x 0.025 inch copper NiTi when archwire is too difficult to engage in upper arch

• Use a 0.018 x 0.025 inch copper NiTi after 0.014 x 0.025 inch copper NiTi archwire

• A 20 degree pretorqued reverse curve 0.017 x 0.025 inch copper NiTi archwire serves as a division 2 second wire

• Take a panoramic view to assess root positions to determine the need to reposition brackets

MAJOR MECHANICS PHASE

• By the end of major mechanics phase, the orthodontist will have completed or nearly completed torque control, completed space consolidation, corrected buccolingual discrepancies, and finalized the patient specific arch form

• 0.019 x 0.025 stainless steel arch wire is used to maintain arch integrity

FINISHING PHASE

• Final detailing

• In most cases working archwires are kept in place to finish the case

• If more bending & torqueing of archwires is needed then use 0.019 x 0.025 inch TMA archwire

TIEBACK USAGE WITH DAMON SYSTEM

• Once all spaces are closed, elastic chains, ligatures wires are used in major mechanics and in final stages of treatment to keep all spaces closed

• Available in variety of sizes n strengths

• These are extended intraarch from the hook on 0.019 x 0.025 inch archwire, occlusally passing beneath the 1st premolar to the hook on the 1st molar in the same arch

• Strongly recommended in low force, low friction systems

LINGUAL RETAINER WIRE & SPLINT RETAINER

• Using this tube technology, low friction, low force mechanics, clinicians have now been able to treat patients who in the past were destined for surgery

• To retain these challenging patients who have had severe muscle imbalance, the author recommends placement of upper temporary and lower permanent retainer wires with night time use of a splint

• Splint is an outstanding muscle trainer, not only maintains alignment of teeth and arches but it also helps maintain orientation of occlusion

Splints are recommended in patients with:

• Severe muscle dysfunction• Severe posterior cross bite• Herbst appliance• Severe class II or class III dentitions

corrected with elastics• Lateral tongue thrust• Sleep apnea• Temporomandibular Joint disorder

• For maximum retention, the orthodontist places lingual retention wires and bonds 0.016 x 0.025 inch Bond-a-Braid braided wire to each upper lateral to lateral incisor

• For the lower arch a canine to canine lingual retainer is made with a 0.026 inch round stainless steel wire