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Orthodontic PerspectivesFal l 1997

A 3M Unitek Publication Volume IV No. 2

Newsworthy information for the orthodontic professional

3MU

nitek3M

Dental P

roducts Division

2724 South P

eck Road

Monrovia, C

A 91016 U

SA

Dr. McLaughlin Dr. Bennett Dr. Trevisi

Recent Develop

ments

The Ang

le Orthod

ontist on CD

-ROM

3M

Unitek

Products that m

ake yourlifeeasier

Have technical questions? 3M Unitek Technical Hotline, (800) 265-1943 or (626) 574-4475

Th

e A

ng

le O

rtho

do

ntis

t is n

ow

availa

ble

on

CD

-RO

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for th

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t time,g

ivin

g y

ou

the fo

llow

ing

ben

efits

.

•Fast and easy data access - saving you tim

e •

Full text and caption searchability - not just a journal index or library abstract search •

Complete portability - hom

e or office use •

Space saving - throw out those old journals

•Printability - for letters, presentations, referrals

In a

dd

ition

,th

e A

ng

le O

rtho

do

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t has th

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•The archive covers every issue from

1987 to 1996, 10 years worth

•In addition, there are 16 classic articles from

noted authors such as Drs. Broadbent, Brodie, Oppenheim

, Peck, Ricketts, Tweed, and m

ore •

The disk contains every figure, picture, diagram and table from

this period

Offered in Window

s (PC) and MAC version, as are its com

panion disks, the American Journal of Orthodontics - Dentofacial Orthopedics and

the Journal of Clinical Orthodontics. All are available on CD-ROM exclusively from

3M Unitek. MBT"It was determined that new

improvements in the pre-adjusted

appliance were needed."A Clinical Review of The

MBT™ Orthodontic Treatment ProgramMBT Treatment Philosophy – p. 3

Treatment Mechanics – p. 3MBT Appliance – p. 4

MBT Appliance Versatility – p. 8Bracket Placement – p. 14

Arch Form and Wire Sequencing – p. 15(An interview with Dr. Richard P. McLaughlin)

MBT Continuing Education Seminars – p. 17MBT Text Support – p. 19

Special EdVentures™ & Continuing Education Supplement – p. 9-12Recent Developments – back page

12-101 9710

3M Unitek is sad to say goodbye to ourPresident and General Manager, Mr. RichIverson, but we are happy for him as heassumes his new responsibilities in hisappointment to head up the MedicalResource Technology Division at 3M. Inhis 8 years with us, Rich has helped tosmooth the transition as we evolvedfrom Unitek into 3M Unitek and becamethe unquestionable leader in orthodonticsas well as the world's largest orthodonticmanufacturer. This growth has been due to our strategic goal of developing and maintaining the Best CustomerRelationships in the Orthodontic industry.Good luck Rich.

3M Unitek Now On The WebA further demonstration of 3M Unitek'scommitment to the future can be foundon our brand new web page. We inviteyou to stop by and browse.

3M DentalReceives '97Baldrige Award

3M Unitek congratulates 3M Dental forreceiving the 1997 Malcolm BaldrigeQuality Award. 3M Dental is the first divi-sion within 3M and only the secondcompany in health care to receive thiscoveted award, which certifies a com-pany's ongoing commitment to businessexcellence.

We are also very fortunate to be able tointroduce our new President andGeneral Manager, Mr. Patrick B. Ford.Pat is a seasoned manager with over 30years experience with 3M. Pat has astrong background in health care, salesoperations, international market devel-opment and subsidiary management.Both his track record and backgroundmake him well qualified to guide 3MUnitek's continued growth and marketleadership worldwide. He's extremelypleased to join us at this exciting time,as 3M Unitek launches innovative newproducts such as Clarity™ Metal-Reinforced Ceramic Brackets and theMBT ™ Appliance System. 3M Unitek isalso exclusive distributor for the AJO-DO, JCO, as well the Angle Orthodontiston CD-ROM. These, and other orthodonticproducts, will help usher in our upcom-ing 50th anniversary celebration in 1998.Pat has firmly endorsed and is commit-ted to 3M Unitek's credo of providingsuperior service to our customers.

Please join us in welcoming Pat Fordas the new leader of 3M Unitek, producerof orthodontic products and services tomake your life easier.

19

Into The Future

Good Luck Rich Iverson Welcome Pat Ford

"OrthodonticManagement of the Dentition

with the Preadjusted Appliance" wasreleased in 1997.

A book by orthodontists for orthodon-tists that blends research evidencewith long clinical experience, this newand innovative book considers eachtooth separately in the dentition.Entirely new, it looks at orthodontics ina fresh and organized way, that allowsyou to fine-tune your treatment man-agement strategies.

Easily readable with ultra-clear lay-outs and diagrams, it is a valuablesequel to the best selling "OrthodonticTreatment Mechanics and thePreadjusted Appliance".

Contents Include:1. General information on research

involved in bracket placement techniques as well as information on the use of the bracket placement chart.

2. Detailed information on research involved in bracket placement

techniques as well as information on the use of the bracket placement chart.

3. Individual information on each tooth in the dentition concerning general mechanical considera-tions and common clinical concerns.

Incisors - Information on various aspects of incisors such as trauma, tooth size discrepancy, congenital absence and malformation and shapeof these teeth.Cuspids - Information on the management of clinical situations such as cuspid impaction.First bicuspids - In this section of the text the controversy of first bicuspid extraction over the years is discussedin detail. There is also information which overlaps somewhat with Book Ion the mechanics of first bicuspid extraction.Second bicuspids - The problems of congenitally missing second bicuspids, retained deciduous secondmolars and second bicuspid extractionare discussed in this chapter.First molars - General considerations on first molars, including discussion of possible indications for extraction, are included in this chapter.Second molars - The vertical and horizontal anchorage aspects of second molars are discussed in this chapter as well as the very controversial subject of second molar extraction.Third molars - Research on the development, eruption and extraction timing of third molars is discussed in this chapter.

4. In each chapter a detailed discussion of the MBT bracket prescription and rational for use of these brackets is discussed in detail.

376 pages, 1050 color illustrations, 330 linedrawings, 31 case studies showing stage-by-stage treatment methods. Available worldwidethrough 3M Unitek, (REF 014-243).

"Orthodontic Treatment Mechanicsand the Preadjusted Appliance,"on the other hand, published in 1993,contains the following information:

1. Basic orthodontic mechanics on Class I extraction and non-extraction types of cases.

2. General information on bracket positioning and basic information on the pre-adjusted orthodontic appliance.

3. Information on the transition from Standard Edgewise to the pre-adjusted appliance

4. Information on anchorage control and leveling and aligning of the orthodontic case

5. Information on overbite control with emphasis on correction of deep overbites.

6. A limited amount of information on the very large subject of overjet reduction.

7. Information on the mechanics of space closure in extraction cases.

8. Some general information on the subject of finishing and detailing oforthodontic cases.

MBT™ Text SupportTwo text books, "Orthodontic Treatment Mechanics and the Preadjusted Appliance" & "Orthodontic Management ofthe Dentition with the Preadjusted Appliance," both co-authored by Dr. John Bennett and Dr. Richard McLaughlin,support the MBT philosophy, but are not Edition 1 and Edition 2 textbooks. Rather, each are textbooks on entirelydifferent subjects.

Orthodontic Perspectives is published periodically by 3M Unitek to provide information toorthodontic practitioners about 3M Unitek products. 3M Unitek welcomes article submissionsor article ideas. Article submissions should be sent to Editor, Orthodontic Perspectives, 3MUnitek, 2724 S. Peck Rd. Monrovia, CA 91016 or call. In the United States and Puerto Ricocall: 800 534-6300 ext. 4266. In Canada: 800 443-1661 and ask for extension 4266. Or call(626) 574-4266 or fax (626) 574-4892 or e-mail: rstoddard@mmm.com. Copyright ©1997 3M Unitek. All rights reserved. No part of this publication may be reproduced without theconsent of 3M Unitek.

18 3

MBT Treatment Philosophy

A Clinical Review of the MBT™

Orthodontic Treatment ProgramBy Dr. Richard McLaughlin, Dr. John Bennett and Dr. Hugo Trevisi

The MBT philosophy of orthodontictreatment has been developed over atwenty year period of time and hasinvolved the combined efforts of itsthree principle clinicians, along withthe help of numerous other cliniciancolleagues. Their philosophy placesemphasis on four critical areas oforthodontic treatment: 1. Treatmentmechanics, 2. The pre-adjusted appliance, 3. Bracket placement tech-nique, and 4. Arch form and archwiresequencing.

The MBT philosophy is supportednot only by a custom designed appli-ance, but also by worldwide continu-ing educational opportunities as wellas a long awaited textbook.

The MBT Philosophy ofOrthodontic Treatmentin Practice1. Treatment Mechanics

Emphasis on dento-alveolar changeThe major effect of orthodontic treat-ment is on the dento-alveolar struc-tures. Thus the term "growth modifica-tion" in growing patients consists primarily in the modification of thegrowth and development of the dento-alveolar processes. While other"orthopedic" changes may be occurringin some patients, the majority of changeis dento-alveolar, and, therefore,

emphasis is placed on the manage-ment of these structures.

Use of Light, Continuous ForcesIntermittent forces have proven to berelatively ineffective in bringing aboutdental tooth movement; on the otherhand, continuous forces are mosteffective in moving dental structures.Heavy forces have been shown tohave a detrimental effect on the rootstructure while lighter forces havebeen shown to maximize biologicresponse and efficacy in tooth move-ment. Therefore, treatment planning isdirected at providing light continuousforces on the teeth that need to bemoved at any given time during ortho-dontic treatment.

Anchorage ControlA combination of extra-oral (facebowsand "J" hooks) and intra-oral (palatalbars, lingual arches, Class II elastics,Class III elastics, Nance arches, Utilityarches, etc.) methods of anchoragecontrol are utilized in the MBT system.

Leveling and AligningThe leveling and aligning stage oftreatment consists of the followingtechniques:

• Use of Nitinol Heat-Activated nickel titanium wires during the aligning process

• The use of canine lace backs for cuspid control and retraction

• The use of bend backs to control forward movement of incisors

• The use of open coil springs to create space for blocked out teeth

• Early establishment and maintenance of arch form, followed by bringing malposed

teeth into the primary arch form without arch form distortion

Overbite ControlOverbite control is best accomplishedby using the following principles:

• Differentially controlling the eruption/extrusion (intrusive and extrusive forces) of the anterior and posterior segments

• Including second molars early in treatment for the opening of mostdeep bite cases

• Being aware that in most cases leveling and bite opening are not complete until rectangular wires have been in for one or two months

• Avoiding leveling of the posterior portion of the Curve of Spee in open bite cases

Space ClosureSpace closure control is best accom-plished by using the following principles:

• A .019 x .025" rectangular wire in the .022 bracket slot is preferred for effective sliding mechanics without major archwire deflection

• Sliding mechanics is accomplished with elastic module tie backs

• Incisor torque control is accomplished through bracket design and archwire bending

Overjet (Class II-Class III) CorrectionClass II and Class III correction isaccomplished by using a combinationof headgear, Class II and Class III elas-tics, and functional appliances. Theseappliances are used in combinationsthat bring about the best opportunityfor continuous forces on the dento-alveolar processes.

MBTText Book

MBT ContinuingEducation Seminars

MBTPhilosophy

MBT Appliance

Dr. Richard McLaughlin -San Diego, California

Dr. Richard McLaughlin completedhis orthodontic training at theUniversity of Southern California in1976. Since then he has been in the fulltime practice of orthodontics in SanDiego, California. While developing hisown practice, he was an associate ofDr. Lawrence F. Andrews for sevenyears. Dr. McLaughlin has lecturedextensively on the pre-adjusted appli-ance in the United States, Europe,South America, Asia and Australia withorthodontic colleagues from London,England, Dr. John Bennett, and fromSão Paulo, Brazil, Dr. Hugo Trevisi. Heis a member of the Pacific CoastSociety of Orthodontists, the AmericanAssociation of Orthodontists, aDiplomate of the American Board ofOrthodontics and a full member of theEdward H. Angle Society. In addition,Dr. McLaughlin is an associate clinicalprofessor at the University of SouthernCalifornia, Department of Orthodontics.

Dr. John Bennett -London, England

Dr. Bennett completed his ortho-dontic training at the Eastman DentalInstitute in London, England in 1972.Since that time he has been in the fulltime practice of orthodontics in London,England. For the past 20 years he hasworked exclusively with the pre-adjusted appliance system, and withDr. McLaughlin has held a particularinterest in evaluating and refiningeffective treatment mechanics utilizinglight forces. These concepts havedeveloped and have included the morerecent contribution from Dr. Trevisi.Their well tried and effective treatmentapproach has seen widespread accep-tance. Dr. Bennett has lectured inter-nationally on the pre-adjusted appli-ance for a number of years. Togetherwith Dr. McLaughlin he has publishednumerous articles and has co-authoredtwo orthodontic textbooks, both ofwhich have been well received. He iscurrently a part-time clinical instructorat the post-graduate orthodontic pro-gram at Bristol University in England.

Dr. Hugo Trevisi - São Paulo, Brazil

Dr. Hugo Trevisi received his dentaldegree in 1974 at Lins College ofDentistry in the state of São Paulo,Brazil. He received his orthodontictraining from 1979 to 1983 at that samecollege. Since that time he has beeninvolved in the full time practice oforthodontics in Presidente Prudente,Brazil. He is a Faculty Member at theUniversity of Odontology and Dentistryin Presidente Prudente. He has lec-tured extensively in South America andPortugal and has developed his ownorthodontic teaching facility inPresidente Prudente. Dr. Trevisi has 20years of experience with the pre-adjusted appliance. He is a member ofthe Brazilian Society of Orthodonticsand the Brazilian College of Orthodontics.

About the Authors

FinishingFinishing involves three main processes:

• The correction of mistakes made earlier in treatment (bracket positioning, torque control, anchorage control etc.)

• Over-correction as needed (periodontal, alveolar-sutural, muscular, and growth)

• Settling of cases in light wires for approximately six weeks (minimum) prior to debanding

RetentionRetention is accomplished using a com-bination of bonded retainers for thelower anterior segment, wrap aroundupper retainers to allow for continuedarch settling, and some positioners aswell as some clear acrylic full coverageretainers.

2. MBT ApplianceBracket SystemVictory Series™ Brackets – Figures 1, 2,3 show a good candidate for this smallsteel bracket, as evidenced by thepatient's short clinical crowns.

4 17

Clarity™ Brackets – Figures 4, 5, 6 show Clarity metal-reinforced ceramic brackets on herupper teeth, aesthetic brackets for anaesthetic appearance during treatment.

Full Size Twin Brackets – Figures 7, 8, 9 show a patient with large teeth, a difficult malocclusion and poor hygiene. The larger bracket willmaximize base surface area andincrease control.

APC™ SystemIn addition to the MBT Versatile+ appliance types available, our officesalso appreciate the option of APCadhesive coating on our brackets. Theefficiency and simplified inventorymanagement has been most beneficialfor staff and patients.

Fig. 1

Fig. 4

Fig. 5

Fig. 7

Fig. 8

Fig. 9

Fig. 3

Fig. 6

Editor: What role do the tapered,ovoid and square wire arch forms playin preventing relapse?

Dr. McLaughlin: With the edgewiseappliance, most orthodontists cus-tomized archwires to the patient's archform. When the pre-adjusted appliancewas developed, there seemed to be anunwritten assumption that one specificarch form needed to be used for thatsystem, and that arch form was themost appropriate.

After twenty years of using the pre-adjusted appliance, it is apparentthat customizing the arch form to theindividual patient is what is really mostimportant. Failure to do this will resultin relapse. In and out dimension coveredsome problems, but not all of them.What I would like to see is a return to acustomized arch form for each patientwithout the need to overstock officeinventory or waste time in unneededwire bending. This seems to be thebest method of efficiently achievingstable and esthetic end results.

REFERENCES1. Andrews LF. Straight Wire-The Concept and Appliance;

L. A. Wells Co., San Diego, Ca. 92107: 1989.

2. Sebata E. "An orthodontic study of teeth and dental arch form on the Japanese normal occlusion". Shikwa Gakuho1980; 80: 945-969. (In Japanese.)

3. Watanabe K, Koga M, Yatabe K, Motegi E, Isshiki Y. "A morphometric study on setup models of Japanese malocclusions". Shikwa Gakuho 1996. (Department of Orthodontics, Tokyo Dental College, Chiba 261, Japan).

4. Roth R. "Gnathologic concepts and orthodontic treatment goals". In: Technique and Treatment with Light Wire Appliances. Ed. Jarabak JR . St. Louis: CV Mosby, 1970, pp. 1160-1223.

5. McLaughlin, R.P. and Bennett, J.C.: "Bracket Placement with the Straight-Wire Appliance" Journal of Clinical Orthodontics, May 1995; 29: 302-311.

6. 'A' Company Orthodontics catalogue, 'A' Company Orthodontics, 9900 Old Grove Rd., San Diego, CA 92131-1683

Endo-Ice is a registered trademark of The Hygienic Corporation,Akron, OH 44310

_____________

Fig. 2

MBT™ Continuing Education Seminars

New Concepts in Orthodontic TreatmentMechanics - Available in 1997 and 1998This seminar presents a discussion ofthe McLaughlin, Bennett, Trevisi (MBT)philosophy of orthodontic treatment.State of the art mechanics using lightcontinuous force systems are describedin detail. The newly developed MBTVersatile+ Appliance, designed specifi-cally to coincide with and enhance thetreatment mechanics, is also presented.The six stages of orthodontic treatmentare reviewed using the sequentialdemonstration of a variety of case reports.This is a practical and very clinicallyoriented program, which will provideinformation that is immediately usefulfor the modern orthodontic practice.

Inter-Arch Treatment Mechanics -Available in 1998This seminar is a natural progression ofthe "New Concepts" seminar. The prin-ciples of intra-arch treatment mechan-ics are carried over and applied to themanagement of cases requiring atten-tion in the area of inter-arch manage-ment. It is the efficient management ofintra-arch factors that allows the ortho-dontist to focus on the challengingaspects of inter-arch management.

Considerations include the far moredifficult challenge of placing the upperand lower dentitions in three planes ofspace within the facial complex so thatthey are esthetic, fit properly duringstatic centric occlusion, allow thecondyles to be seated into a centric rela-tion position within the glenoid fossae inthis static position, and function fromthis static position without interfer-ences during lateral and protrusivemovements. Thus, inter-arch considera-tions include such factors as growth anddevelopment, and the management ofvertical, horizontal and transverse skeletaland dental discrepancies. The subjectsof Class II, Class III and Asymmetricaltreatment areas are also discussed.

Management of the Dentition -Available in 1999This seminar describes the manage-ment and correction of specific dental

problems involving each individualtooth. Thus, specific clinical situationsrelated to incisors, cuspids, 1st and 2ndbicuspids, and 1st, 2nd and 3rd molarsare discussed. The extraction versusnon-extraction issue is reviewed indetail. The seminar will also provide an in-depth review of the material in Dr.Bennett's and Dr. McLaughlin's newesttextbook, Orthodontic Management ofthe Dentition with the PreadjustedAppliance.

Occlusion and the TMJ in OrthodonticTreatmentCorrection of malocclusion to a positionin which the condyles are in the correctposition can be likened to the properconstruction of a house's foundation.Without it, the house is subject to futureinstability, as is the malocclusion treatedto the incorrect condyle position.

This seminar presents a compre-hensive review of the management oforthodontic patients with Temporo-Mandibular Disorders. The concept ofideal occlusion is discussed as well asits relationship to temporo-mandibulardisorders. The subjects of diagnosisand treatment planning, splint therapy,and post splint management with ortho-dontic appliances is discussed in detail.

Diagnosis, Treatment Planning andTreatment MechanicsThis seminar brings together the infor-mation from the previous four seminars byplacing emphasis on the all importantarea of diagnosis and treatment planning.The topics covered in previous programsare all relevant to this seminar, which looksat a wide variety of treatment situations.Each case is evaluated from a diagnosticpoint of view, and participants are invitedto make their own judgments concern-ing treatment planning. The treatmentwhich was completed is then reviewedin a step by step manner, with theresults being evaluated. Class I, II andIII and Asymmetrical treatment optionsare reviewed as well.

516

MBT™ Appliance Features

Reduced Upper and Lower Anterior Tip

Table 1 shows anterior tip measure-ments: Andrews' non-orthodontic normalstudy1, two Japanese studies 2, 3, theMBT Versatile+ Appliance, the OriginalStraight-Wire Appliance™ 6 and the RothAppliance6.

The anterior tip measurements forthe original Straight-Wire Applianceare all greater than those found inAndrews' research. This was presum-ably done to control what Andrewsreferred to as the “wagon wheel”effect* that torque places on anteriorcrown tip1. This is somewhat similar tothe compensating anti-tip, anti-rotationand power arms built into the extractionbrackets for the treatment of bicuspidextraction cases.

*As palatal root torque is added tothe anterior segment, mesial crown tipis reduced

It has been observed by the authorsthat with light continuous forcemechanics, tip is well controlled by thepre-adjusted appliance. Using “lace-backs” and “bendbacks” during level-ing and aligning, and elastic module“tie-backs” during space closure, verylittle adverse tipping occurs duringthese stages of treatment. By the finishing stage of treatment, completelylevelled upper and lower rectangularwires are normally in place, indicatingthat full expression of both anterior andposterior crown tip has occurred.Thus, additional tip is not seen to benecessary in the anterior segments.

Also, additional anterior tip creates asignificant drain on molar anchorage,Figure 10, 11. If the original research

values for tip are used, atotal of 10° less distal roottip in the upper anteriorsegment and 12° less distalroot tip in the lower anteriorsegment is needed (com-pared against the OriginalStraight-Wire Appliance). • Figures 10 and 11 showthe difference in root posi-

tions with MBT Versatile+ Applianceand two SWA.

• Figure 12. The MBT Appliance pro-vides anterior tip measurements thatcorrespond to Andrews' norms. Thisreduced tip provides a significantreduction in anchorage needs.

Also, reducing the tip on the cuspidsavoids the frequently observed problemof cuspid and bicuspid roots that finishin close proximity.

• Figure 13: This X-ray shows a casetreated with a bracket with excessivecuspid tip. This is what the MBT Versatile+bracket was designed against.

Thus reduced tip significantlyreduces the need for anchorage con-trol, which normally translates into areduced need for patient cooperation.Since the MBT Versatile+ measure-ments are identical to Andrews' originalresearch figures, there is no compro-mise in ideal static occlusion. And if thecondyles are in centric relation, there isno compromise in ideal functionalocclusion as described by Roth4.

Fig. 13

Upper Anterior Tip Lower Anterior Tip

Central Lateral Cuspid Central Lateral Cuspid

Andrews’ norms 3.59° 8.04° 8.4° 0.53° 0.38° 2.5°

Sebata’s data 4.25° 7.74° 7.7° -0.48° -1.2° 1.5°

Watanabe’s data 3.11° 3.99° 7.7° 1.98° 2.28° 5.4°

MBT Versatile+ 4.0° 8.0° 8.0° 0° 0° 3.0°

Original SWA 5.0° 9.0° 11.0° 2.0° 2.0° 5.0°

Roth SWA 5.0° 9.0° 13.0° 2.0° 2.0° 7.0°

choices for inter-molar width. Therefore,this area can be easily widened ornarrowed for each patient, particularlyin the rectangular wire stage of treat-ment and in the heavier wires just priorto this wire. This of course is mucheasier to do than constantly adjustingto the anterior aspect of the arch form,which is much more difficult and verytime consuming.

Editor: What other methods can beused to aid in the stability of the ortho-dontic case relative to arch form?

Dr. McLaughlin: Rather than pro-ceeding from rectangular wires toretainers, it is beneficial to allow casesto settle for a minimum of a month anda half in very light arch wires at the endof treatment. This allows for settling ofthe arch form to a more physiologicposition for the patient, based on thetongue and face musculature. It alsoallows for vertical settling of the denti-tion, which is most important. In addi-tion to this, the use of a bonded loweranterior retainer allows for some settling of inter-cuspid width withoutmovement in the incisor area.

Editor: You have recently devel-oped a more efficient system of arch-wire sequencing by taking advantageof major developments in wire technol-ogy. Was this sequence transitioneasy, and more important, how valu-able has it been in your practice?

Dr. McLaughlin: Figures 46 and 47illustrate the six wires replaced by onlytwo wires for the .022 slot MBT™

Versatile+ Appliance system.

• Figure 46 Nitinol Heat-Activated

.016" replacing .015" and .0175"

multi-strand steel and .014"

stainless steel.

The use of the .016" Nitinol Heat-Activated wire to replace multi-strandand the .014" round wire has been mostsatisfactory. This initial arch wire canbe placed with ease in most cases, andcan be retied one or two times at 4 to 6week intervals.

• Figure 47 Nitinol Heat-Activated .019 x .025" replacing .016", .018" and.020" round stainless steel.

The .019 x .025" Nitinol Heat-Activated can also be retied at thesame 4 to 6 week intervals.

As Figure 48, 49, 50, 51 illustrate,engagement of a Nitinol Heat-Activatedwire can be facilitated with use of EndoIce®, followed by tying in with a steelligature*. Because of rapid cooling, thisprocedure can be performed quicklyand comfortably.(*CF: Newswire article by Dr. JosephCaruso, Spring 1994)

The remaining wire used is an .019 x .025" rectangular stainless steel.

Use of Nitinol Heat-Activated wiresin my orthodontic practice has resultedin much less chair time involved ineach visit. Secondly, the intervalsbetween patient visits has been slightlyincreased. Thirdly, tooth movement isactually much more efficient, and as aresult, the aligning phase of treatmentis completed more rapidly. This in turnallows me to complete overbite control,overjet reduction and space closuresooner in treatment, which in turnallows more time for finishing anddetailing of the case, which enhancestreatment end result quality.

fig. 50

Table 1 Anterior Tip

Fig. 47

fig. 46

fig. 51

Fig. 10 Upper Arch Length

Total Arch Cuspid Lateral CentralLength Change Tip Tip Tip

MBT 0.0mm 8° 8° 4°

Andrews 1.7mm 11° 9° 5°

Roth 2.4mm 13° 9° 5°

Fig. 11 Lower Arch Length

Total Arch Cuspid Anterior AnteriorLength Change Tip Tip Tip

Roth 2.7mm 7° 2° 2°

Andrews 2.0mm 5° 2° 2°

MBT 0.0mm 3° 0° 0°

fig. 48

fig. 49

Fig. 12

6 15

Upper Posterior TipTable 2 shows posterior tip measure-ments for the upper bicuspids andmolars: Andrews' non-orthodontic normal study1, two Japanese studies2, 3,the MBT™ Versatile+ Appliance, theOriginal Straight-Wire Appliance™ 6

and the Roth Appliance6.

For the MBT Versatile+ Appliance,0° of tip, as opposed to 2° of tip, wasselected for all upper bicuspid bracketsto place the crowns in a slightly moreupright position, (in a Class I direction).It also provides for slightly reducedanchorage needs for the upper arch.

The buccal groove is the referencefor crown tip in the upper molars. Thisbuccal groove shows a 5° angulation toa line drawn perpendicular to theocclusal plane. There are two methodsof achieving 5° of effective tip in the upperfirst and second molars.

If a 5° bracket is used, the band mustbe seated more gingivally at the mesialaspect to position bracket wings parallel to buccal groove. (Fig 14a). Thismakes band positioning more difficult.When using these 5° brackets, it is fre-quently necessary to trim band materialfrom the distal of the band. If the 5°bracket is used and the band is placedparallel to the occlusal plane, it providesan excessive 10° of actual tip to theupper first and second molars (Fig. 14b).

Alternatively, the authors prefer touse a 0° crown tip bracket with the bandand bracket slots placed parallel to theocclusal plane. This introduces the correct5° of tip in the upper molars, as measuredfrom the buccal groove (Fig. 14c) and is easier to seat. The new Unitek™

Narrow Contoured Molar Bands havebeen extremely easy to use and are awelcome addition to the MBT system.

In summary, then, all of the upperposterior brackets are provided with 0°of crown tip for the reasons describedabove.

Lower Posterior Crown Tip Table 3 shows tip measurements forthe lower bicuspids and lower molars:Andrews' non-orthodontic normal study1,two Japanese studies2,3, the MBT Versatile+Appliance, the Original Straight-WireAppliance6 and the Roth Appliance6

The authors prefer to maintain 2° ofmesial crown tip in the lower bicuspids.Angling these teeth slightly forward inthis manner moves them more in a Class Idirection; 2° of tip is also preferred inthe lower first and second molars. Thisis accomplished in a manner similar to

the tip placed in the upper molars. Thelower buccal groove lies 2° off of a linedrawn perpendicular to the occlusalplane. As with the upper molars, intro-ducing this 2° of tip to the lower molarscan be accomplished by placing 0° tipbrackets parallel to the occlusal plane.In summary then, the lower bicuspidbrackets show 2° of mesial crown tipand the lower molar brackets show 0°of crown tip (2° effective tip) with thebands placed parallel to the occlusalsurface.

Incisor TorqueTable 4 shows anterior torque values:Andrews' non-orthodontic normalstudy1, two Japanese studies 2, 3, theMBT Versatile+ Appliance, the OriginalStraight-Wire Appliance6 and the RothAppliance6.

The authors observed that torque is rather poorly controlled with the pre-adjusted appliance system. This is dueto the fact that the torque movement isa difficult one since less than 1mm ofcontact between the bracket and thearchwire must bring about this move-ment. In general, here lies the greatestchallenge to bracket design in the pre-adjusted appliance. In the majority oforthodontic cases, because of this lackof torque control, torque tends to belost in the upper incisors during overjetreduction and space closure. The lowerincisors frequently tend to procline forward during Curve of Spee levelingand when eliminating lower incisorcrowding. This incisor torque factor,along with the tip and tooth size factors,frequently prevents posterior teethfrom fitting into a Class I relationship.

Upper Posterior Tip

1st 2nd 1st 2ndBi Bi Molar Molar

Andrews’ norms 2.7° 2.8° 5.7° 0.4°Sebata’s data 3.5° 6.2° 5.2° -0.3°Watanabe’s data 4.7° 5.2° 4.9° 4.1°MBT Versatile+ 0° 0° 0° * 0° * Original SWA 2.0° 2.0° 5.0° 5.0°Roth SWA 0° 0° 0° 0°

Table 2 Upper Posterior Tip * Effective tip is 5°

Anterior Torque

Upper Upper Lower LowerCentral Lateral Central Lateral

Andrews’ norms 6.11° 4.42° -1.71° -3.24°

Sebata’s data 9.42° 7.48° 3.55° 1.66°

Watanabe’s data 12.8° 10.4° 0.71° 0.53°

MBT Versatile+ 17.0° 10.0° -6.0° -6.0°

Original SWA 7.0° 3.0° -1.0° -1.0°

Roth SWA 12.0° 8.0° -1.0° -1.0°

Table 4 Anterior Torque

Lower Posterior Tip

1st 2nd 1st 2ndBi Bi Molar Molar

Andrews’ norms 1.3° 1.54° 2.0° 2.9°

Sebata’s data 2.5° 6.70° 5.7° 7.3°

Watanabe’s data 3.8° 3.91° 3.7° 3.9°

MBT Versatile+ 2.0° 2.0° 0° * 0° *

Original SWA 2.0° 2.0° 2.0° 2.0°

Roth SWA -1.0° 0° -1.0° -1.0°

Table 3 Lower Posterior Tip * Effective tip is 2°

Editor: Arch form and archwiresequencing are a very important part ofthe McLaughlin-Bennett-Trevisi philos-ophy of orthodontic treatment. Can youcomment in general on this importance?

Dr. McLaughlin: The proper selec-tion of an arch form for each patient aswell as the development of a generalarchwire sequencing system in theorthodontic practice can greatlyincrease treatment efficiency and alsoprovide greater stability in completedcases.

Editor: Can you offer an historicalperspective on the subject of arch form?

Dr. McLaughlin: A review of theorthodontic literature on the subject ofarch form reveals that there are threemain themes that run throughout thisinformation. The first is the search forthe ideal arch form (Bonwill-Hawley,caternary curve, Brader arch form, etc.).Second is the conflicting view thatthere is a great deal of variation inhuman arch form. The third is that whenarch form is significantly changed inthe patient, there is a great tendencytoward orthodontic relapse.

Editor: How should this informationaffect the choices an orthodontist mustmake when selecting an arch form foreach patient?

Dr. McLaughlin: This information,as well as treating patients over a 20year time period, indicates that the useof a single arch form in all patients isan unsatisfactory method of treatment.Some method of individualization mustbe carried out.

Editor: Does this then mean thatarchwires must be individually cus-tomized for each patient, or can somesystem of pre-formed arch wires be uti-lized?

Dr. McLaughlin: The arch form hasfour main components, 1) the anterior

curvature, 2) inter-cuspid width, 3) pos-terior curvature and 4) inter-molarwidth. Anterior curvature is primarilydetermined by inter-cuspid width, witha more tapered shape in patients withnarrow inter-cuspid width and widercurvature in patients with wider inter-cuspid width. The literature reveals thatinter-cuspid width is the most criticalaspect of arch form selection.

Figure 45 shows the super-impositionof three arch forms, tapered, square andovoid. (This designation was used by Dr. Robert Ricketts a number of years ago.)

Selecting one of these three archforms using a clear template over thelower study model provides a 6mmrange of inter-cuspid width, which isadequate for the great majority ofpatients in an orthodontic practice.These three arch forms are importantwith wires that are stiff enough to

affect arch form, such as the wires inFigure 47. For lighter force wires, suchas the wires in Figure 46, a single ovoidarch form is adequate, which simplifiesinventory requirements.

In the past, posterior arch formshape has varied from a straight line(Bonwill-Hawley) to a significant curva-ture (Brader). Figure 45 arch formsuper-impositions show a slight curva-ture in the posterior arch form, whichseems to be a practical approach. Theposterior arch form is slightly widenedin the bicuspid region to provide betterfunction during protrusive movement,(as described by Roth) and to decreasethe tendency for arches to collapse inthe bicuspid region in extraction cases.

Figure 45's inter-molar width isessentially the same. That is becauseit is impractical to maintain a largeinventory of arch forms with many

fig. 45

A Clinical Review of the MBT ™

Orthodontic Treatment Program

4. Arch Form and Wire SequencingInterview with Dr. Richard P. McLaughlin

Fig. 14a, b, c

_______________

"... inter-cuspid widthis the most critical aspect

of arch form selection"_______________

Fig. 42

14 7

Because of these factors there isgenerally a need for greater palatalroot torque of the upper incisors and labial root torque for more upright-ing of the lower incisors (Figure 15).For all these reasons, the authors rec-ommend +17° of torque for the uppercentral incisors, +10° of torque for theupper lateral incisors, and -6° of torquefor the lower incisors.

In Figure 16 the MBT™ Versatile+Appliance provides increased palatalroot torque for the upper incisors (a, b)and increased labial root torque for thelower incisors (c), the most commonrequirements in orthodontic cases.

Upper Cuspid, Bicuspid and Molar Torque Table 5 shows upper cuspid, bicuspidand molar torque values: Andrews'non-orthodontic normal study1, twoJapanese studies2, 3, the MBT Versatile+Appliance, the Original Straight-WireAppliance™ 6 and the Roth Appliance6.

The upper cuspid and bicuspidtorque values of -7° have proven to besatisfactory in most cases, and havetherefore been selected for the MBTVersatile+ Appliance. The uppermolars, on the other hand, frequentlyshow excessive buccal crown torquewith palatal cusps “hanging down”which creates centric, balancing side

and working side interferences. For thisreason the authors prefer -14° of buccal root torque in these teeth, asopposed to only -9° of buccal roottorque (Fig. 17a, b, c).

Lower Cuspid, Bicuspid and Molar Torque Table 6 shows torque values for lowercuspids, bicuspids and molars fromAndrews' non-orthodontic normalstudy1, two Japanese studies 2, 3, theMBT Versatile+ Appliance, the OriginalStraight-Wire Appliance6 and the RothAppliance6.

There are three reasonsfor reducing the amount of lin-gual crown torque in thelower cuspid, bicuspid andmolar areas: 1) Since lowercuspids and sometimes bicus-pids often show gingivalrecession, they benefit fromthe roots being moved closerto the center of the alveolarprocess; 2) many orthodonticcases demonstrate narrowingin the maxillary arch with

lower posterior segments that are com-pensated toward the lingual. These

cases benefit from buccal uprighting ofthe lower posterior segment. 3) It hasbeen consistently observed that lowersecond molars with -35° of torque con-sistently “roll in” lingually. Therefore,the authors have chosen to reduce thelingual crown torque, by 5° in the lowercuspids and bicuspids, by 10° in thelower first molars, and by 25° in thelower second molars (Fig. 18a, b and19a, b, c).

Lower PosteriorTorque

Cuspid 1st 2nd 1st 2ndBi Bi Molar Molar

Andrews’ norms -12.7° -19.0° -23.6° -30.7° -36.0°

Sebata’s data -4.7° -14.8° -22.6° -26.2° -31.0°

Watanabe’s data -11.1° -18.4° -21.8° -31.2° -32.9°

MBT Versatile+ -6.0° -12.0° -17.0° -20.0° -10.0°

Original SWA -11.0° -17.0° -22.0° -30.0° -35.0°

Roth SWA -11.0° -17.0° -22.0° -30.0° -30.0°

Table 6 Lower Posterior Torque

Table 5 Upper Posterior Torque

Upper PosteriorTorque

Cuspid 1st 2nd 1st 2ndBi Bi Molar Molar

Andrews’ norms -7.3° -8.5° -8.9° -11.5° -8.1°Sebata’s data 0.7° -6.5° -6.5° -1.7° -3.0°

Watanabe’s data -5.3° -6.0° -7.2° -9.8° -9.5°

MBT Versatile+ -7.0° -7.0° -7.0° -14.0° -14.0°

Original SWA -7.0° -7.0° -7.0° -9.0° -9.0°

Roth SWA -2.0° -7.0° -7.0° -14.0° -14.0°

3. Bracket PlacementPrior to the development of the pre-adjusted appliance, edgewise bracketswere placed using gauges which setthe bracket a specific number of mil-limeters from the incisal or occlusaltooth surface. When the pre-adjusted

appliance was developed, the center ofthe clinical crown became the verticalreference for bracket placement, andmost orthodontists discontinued theuse of gauges. The brackets weretherefore placed by visually selectingthe center of the clinical crown.Unfortunately, this method resulted insignificant errors relative to verticalplacement. For example:

• Gingival variations, such as partiallyerupted teeth, labially and lingually(palatally) displaced roots, and gingivalinflammation led to placement errors.• Large teeth (upper central incisors)and small teeth (upper lateral incisors)within the same patient led to obviouserrors when brackets were placed inthe center of the clinical crown.• Incisal or occlusal fractures andwear, as well as teeth with extremelytapered and pointed cusps, led tobracket placement errors. (Figure 36)

The use of a bracket placementchart (developed in 1994), as well aspre-adjusted Dougherty gauges,Figures 37 and 38, dramatically reducesbracket placement errors in the verticaldimension. Figures 39 though 44 showplacement technique. We have experi-enced approximately a 50 - 60% reduc-tion in the need to reposition brackets

during treatment using this very simplebut effective system.

Figure 39, 40, 41 illustrate measur-ing on the occlusal plane, burnishingthe band, and then light curing theband and tube in position.

Figure 42, 43 and 44 show checkingbracket height and tip, then curing.

Fig. 35

Fig. 40

Fig. 41

Fig. 43

Fig. 15 Labial Root Torque

Fig. 16a, b, c Anterior Root Torque

_______________

"In the past, the best resultswere achieved by the orthodontists

who were the best wire benders. In the future, the best results

will come from those orthodontistswho are the best bracket

positioners." –MBT______________________

Fig. 44

U7 U6 U5 U4 U3 U2 U1 Upper Arch

2.0 4.0 5.0 5.5 6.0 5.5 6.0 +1.0mm2.0 3.5 4.5 5.0 5.5 5.0 5.5 +0.5mm2.0 3.0 4.0 4.5 5.0 4.5 5.0 Average2.0 2.5 3.5 4.0 4.5 4.0 4.5 -0.5mm2.0 2.0 3.0 3.5 4.0 3.5 4.0 -1.0mm

3.5 3.5 4.5 5.0 5.5 5.0 5.0 +1.0mm3.0 3.0 4.0 4.5 5.0 4.5 4.5 +0.5mm2.5 2.5 3.5 4.0 4.5 4.0 4.0 Average2.0 2.0 3.0 3.5 4.0 3.5 3.5 -0.5mm2.0 2.0 2.5 3.0 3.5 3.0 3.0 -1.0mmU7 U6 U5 U4 U3 U2 U1 Lower Arch

A

B

C

D

E

A

B

C

D

E

MBT™ Versatile+ Appliance Bracket Placement Guide

Fig. 36

Fig. 17

Fig. 39

Fig. 38

Fig. 37

8 13

• Figure 19a, b, c Progressive buccalcrown torque in the lower posteriorsegments (cuspids through molars)provides uprighting of these areas,which are frequently inclined lingually.

• Figure 20 A patient in need of posteriorbuccal crown torque.

In-out Modifications of the MBT™

Versatile+ ApplianceIt has been observed by the authorsthat the in-out measurements (includingmolar rotation) for the original Straight-Wire Appliance™ have, for the mostpart, proven to be quite satisfactory. Withthe exception of severe rotations at theinitiation of treatment (best handled byspace opening in combination withfacial and lingual rotation elastics) minimal modifications in archwiresneed to be made until the finishingstage of treatment. At that time someteeth may need to be over-rotated forstability (using rotation wedges) andfirst molars may need archwire offsetsto complete their rotation.

One important in-out feature thathas been added to the MBT Versatile+appliance is because upper secondbicuspids are frequently smaller in sizethan upper first bicuspids. For this reason,an upper second bicuspid bracket hasbeen provided with an additional 0.5mmof in-out compensation. This will allowfor better alignment of central fossae in the upper arch and will also providefor relatively increased mesio-buccal rotation of the upper first molar. Whenupper second bicuspids are similar insize to the upper first bicuspids, anupper first bicuspid bracket can be usedon the upper second bicuspids.

• Figure 21 An upper second bicuspidbracket with an additional 0.5 mm of in-outcompensation is provided for the commonsituation in which upper second bicuspidsare smaller than upper first bicuspids.

• Figure 22 Patient with smaller 2ndbicuspid

MBT Appliance Versatility• Inversion of upper lateral incisorbrackets (Fig. 23, 24, 25). This is benefi-cial in cases with palatally displacedlaterals requiring labial root torque forproper stability.

• Same tip and torque in lower incisorbrackets. With the same lower incisorbrackets, inventory is simplified and thepossibility of confusion during bracketplacement is minimized.

Fig. 20

Fig. 24

Fig. 29

Fig. 30

Fig. 25

Fig. 26 Normal Bracket -7° Torque

Fig. 27 Inverted Bracket +7° Torque

Fig. 28 Optional Bracket 0° Torque With Hook

Fig. 21

Fig. 22

Fig. 31

Continued on page 13

Original SWA

MBT™ Appliance

Fig. 18a, b

Fig. 19a, b, c

Fig. 32

Fig. 33

Fig. 34

• Inversion of cuspid brackets withprominent cuspid roots. (Figure 26, 27).This adjustment allows for movement ofthe cuspid roots away from the corticalplate and into the center of the alveolarprocess.

• 0° cuspid brackets with hook forextraction cases. (Figure 28). Manyorthodontists prefer to have a hook ontheir cuspid bracket, and the zerodegree torque value also allows thecuspid to move away from the corticalplate for easier retraction.

• Inversion of upper cuspid bracketswhen cuspids are in the lateral position.(Figure 29, 30, 31). This adjustment allowsthe cuspid root to move palatally andassume a position and appearance thatmore closely resembles the lateral incisor.

• Same tip and torque in upper bicuspidbrackets. Thus, in most situations,onebracket is used for all four upper bicuspids.This simplifies inventory and provides forless confusion during placement.

• Additional 0.5mm of in-out in uppersecond bicuspid brackets. (Figure 32).Approximately 30% of upper secondbicuspids are smaller than upper firstbicuspids. This bracket is most beneficialin this situation. If all four bicuspids are thesame size, then first bicuspid bracketscan be placed on both first and secondbicuspids.

• Upper second molar bands andbrackets on upper first molars in non-headgear cases. (Figure 33). This adjust-ment provides greater comfort for thepatient, as opposed to the placement ofan unnecessary headgear tube.

• Lower second molar bands andbrackets on lower first molars. Whenthe buccal cusps of upper first molarsimpinge on the bracket of the lower firstmolar, the use of the lower secondmolar band with a much lower occlusalprofile bracket often eliminates thisproblem.

• Lower second molar brackets onupper first and second molars whenfinishing in a Class II molar relation-ship. (Figure 34, 35). The lower secondmolar bracket has zero rotation and 10°of torque which places the Class IIupper first molar in a correct relation-ship with the lower first molar.

• Inventory identification. This is vastlysimplified by the pre-labeled individualblister packs of the APC™ AdhesiveCoated brackets used in the operatory.

Fig. 23

November 8-13, 1997 JAGUAR REEF LODGE, BELIZE

February 12-16, 1998 HACIENDA DEL SOL RESORT, ARIZONA

February 14-21, 1998 POSADA DEL SOL RESORT, HONDURAS

March 22-26, 1998 GUNFLINT LODGE, MINNESOTA

April 4-8, 1998 LONE MOUNTAIN RANCH, MONTANA

May 19-26, 1998 GRAND CANYON, ARIZONA

June 6-13, 1998 YACUMAMA LODGE, AMAZON, PERU

June 22-28, 1998 KENAI SAFARI, ALASKA

July 3-8, 1998 PURCELL LODGE, BRITISH COLUMBIA

July 5-12, 1998 KING MOUNTAIN RANCH, COLORADO

July 27-31, 1998 WOLLASTON LAKE LODGE, SASKATCHEWAN

August 20-25, 1998 FORBES TRINCHERA RANCH, COLORADO

September 17-23, 1998 SALMON RIVER, IDAHO

October 7-16, 1998 GALAPAGOS CRUISE, ECUADOR

CONTACT INFORMATION

EdVenture International Inc

U.S. & Canada:

1-888-351-8494 Toll-Free

Local: 303-402-9455

Fax: 303-444-3999

Email: EdVentures@msn.com

A LIFETIME OF EDVENTURES™

Continuing EducationDATE PRESENTER LOCATION SPONSOR, SUBJECT

NOV. 7-8, 1997 Dr. Terry Dischinger Newport Beach, CA "Fixed Edgewise Herbst Appliance" Seminar

NOV. 13-17, 1997 Dr. Richard McLaughlin San Diego, CA In-Office Seminar

DEC. 4-7, 1997 Dr. Terry Sellke Amelia Island, FL Summit in the Sun

Dr. Anoop Sondhi

Ms. Rosemary Bray

JAN. 16-17, 1998 Dr. Terry Dischinger Orlando, FL "Fixed Edgewise Herbst Appliance" Seminar

JAN. 30, 1998 Dr. Richard McLaughlin Denver, CO "New Concepts in Treatment Mechanics and

the Pre-adjusted Appliance"

JAN. 30-31, 1998 Dr. Anoop Sondhi Omaha, NE "Current Concepts in the Orthodontic

Management of Temporomandibular Disorders"

JAN. 31 - FEB. 1, 1998 Dr. Richard McLaughlin Denver, CO "Inter-Arch Treatment Mechanics"

FEB. 6-7, 1998 Dr. Terry Dischinger Lake Oswego, OR “Fixed Edgewise Herbst Appliance” Hands-on program

FEB. 12-16, 1998 Dr. Richard McLaughlin San Diego, CA In-Office Seminar

FEB. 13, 1998 Dr. Daniel German Alaska Alaska State Society meeting

FEB. 19-21, 1998 Dr. Stephen Tracey Redlodge, MT Montana Orthodontic Society

FEB. 19-23, 1998 Dr. Richard McLaughlin San Diego, CA In-Office Seminar

FEB. 22-24, 1998 Dr. Terry Sellke Loma Linda "Zero Base - The West Side Story"

Dr. Carl Gugino University

Dr. Robert Ricketts Loma Linda, CA

Dr. Ruel Bench

MAR. 26-29, 1998 Dr. Richard McLaughlin Las Vegas, NV Summit in Las Vegas

Dr. Terry McDonald

Dr. Steve Hanks

MAR. 27, 1998 Dr. Gerald Samson Nebraska Nebraska Society of Orthodontists

APR. 17-18, 1998 Dr. Terry Dischinger Lake Oswego, OR “Fixed Edgewise Herbst Appliance” Hands-on program

APR. 18, 1998 Dr. Richard McLaughlin Chicago, IL "New Concepts in Treatment Mechanics and

the Pre-adjusted Appliance"

JUN. 26, 1998 Dr. Anoop Sondhi San Diego, CA San Diego State Society Meeting

JUN. 26-27, 1998 Dr. Terry Dischinger Lake Oswego, OR “Fixed Edgewise Herbst Appliance” Hands-on program

SEP. 25, 1998 Dr. Terry Dischinger Washington, DC "Fixed Edgewise Herbst Appliance" Seminar

OCT. 16-17, 1998 Dr. Terry Dischinger Lake Oswego, OR “Fixed Edgewise Herbst Appliance” Hands-on program

OCT. 23, 1998 Dr. Richard McLaughlin Boston, MA "New Concepts in Treatment Mechanics and

the Pre-adjusted Appliance"

OCT. 24-25, 1998 Dr. Richard McLaughlin Boston, MA "Inter-Arch Treatment Mechanics"

OCT. 29 - NOV. 2, '98 Dr. Richard McLaughlin San Diego, CA In-Office Seminar

NOV. 5-9, 1998 Dr. Richard McLaughlin San Diego, CA In-Office Seminar

3M UnitekProducts that make your lifeeasier.

To be what we are, and to become what we arecapable of becoming, is the only end in life.

—BARUCH SPINOZA

1110

For more information, please call the EdVentures HOTLINE 1-888-351-8494.

EDVENTURES

INTERNATIONAL

CONTINUING EDUCATION

AND ADVENTURE

PROGRAM

EdVenture International Inc(EVI) and 3M Unitek inviteyou to experience the headychallenges and rewards ofoutdoor adventure travel.

Our aim is to encouragepersonal growth and rejuvenation while participating in activitiesthat enrich all aspects ofone’s life. You derive thebenefits of a well-earnedvacation with the uniqueopportunity to participate incontinuing education seminars conducted bynoted orthodontists andother professionals. Wemanage all the details soyou get a no-hassle educational adventure ofrelaxation, learning, andrenewal.

Covering a wide range ofoutdoor activities andlocales, our trips providethe perfect professional/personal mix and areappropriate for individuals,study clubs, couples, andfamilies.

Come join us for yourEdVenture of a Lifetime!

SEMINAR COURSES AND

SPEAKERS

The EdVentures Internationalprogram features seminarsled by some of the mostnoted experts in theOrthodontic profession,including Terry Dischinger, D.D.S.,Daniel S. German, D.D.S.,Randall Moles, D.D.S., Terry Sellke, D.D.S., M.S.,Anoop Sondhi, D.D.S., M.S.,Stephen Tracey, D.D.S., M.S.,Patrick Turley, D.D.S.,John H. Walker, D.M.D.,and Thomas Ziegler, D.D.S.,M.S., J.D.

Our innovative andinvaluable courses fororthodontists cover issuessuch as leadership andpeak performance, thelatest technological,clinical, and businessaspects of orthodontics,and Tax & Estate planningfor Doctors and theirspouses.

For an EVI program catalogand seminar listing, contactour office toll free at 1-888-351-8494.

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EDVENTURES™

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Continuing EducationDATE PRESENTER LOCATION SPONSOR, SUBJECT

STAFF DEVELOPMENT

DEC. 4-7, 1997 Dr. Anoop Sondhi Amelia Island, FL Summit in the SunDr. Terry Sellke Ms. Rosemary Bray

MAR. 26-29, 1998 Dr. Richard McLaughlin Las Vegas, NV Summit in Las VegasDr. Terry McDonald

Dr. Stephen Hanks

Spring 1998 Dr. Randy Kunik Austin, TX In-Office Staff Development Program

Summer 1998 Dr. Randy Kunik Austin, TX In-Office Staff Development Program

Fall 1998 Dr. Randy Kunik Austin, TX In-Office Staff Development Program

Winter 1998 Dr. Randy Kunik Austin, TX In-Office Staff Development Program

INTERNATIONAL CALENDAR

OCT 14-15, 1997 Dr. Anoop Sondhi Bombay, India "Current Concepts in the Orthodontic Management of TMD"

JAN. 10-12, 1998 Dr. Carl Gugino Madrid, Spain "An Overview of The Zero Base Philosophy"

FEB 5-7, 1998 Dr. Anoop Sondhi Whistler, Canada 3M Unitek Ski Weekend '98

Dr. Stephen Tracey

JULY 18, 1998 Dr. Richard McLaughlin London, Ontario, CAN "New Concepts in Treatment Mechanics and the Pre-adjusted Appliance

ORTHODONTIC EVENTS

NOV. 2-5, 1997 __________ Atlantic City, NJ Middle Atlantic Society of OrthodonticsNOV. 3, 1997 __________ San Francisco, CA Pacific Coast Society of OrthodontistsNOV. 7-11 1997 __________ Marco Island, FL Southern Association of OrthodontistsDEC. 6-10, 1997 __________ New York, NY Northeast Society of OrthodontistsMAY 16-20, 1998 __________ Dallas, TX American Association of Orthodontists

For more information, please call the 3M Unitek CE HOTLINE at 1-800-852-1990 ext. 4649 or 626-574-4649. Or, visit the Professional Relations/Continuing Education Site on the 3M Unitek web page at http://www.3M.com/unitek.

3M Unitek

912

Dr. Thomas Creekmore Receives 1997 Martin E. Dewey Memorial AwardThe Martin E. Dewey Memorial Award was established by the Southwestern Society ofOrthodontics in 1953. This award immortalizes Dr. Martin Dewey, an honorary member ofthis society, founder of the Kansas City School of Orthodontics, first editor of the AmericanJournal of Orthodontics in 1911, President of the AAO, one of the first seven men elected toserve on the American Board of Orthodontics in 1922, and present of the ADA in 1932.

This award provides recognition to Southwestern Society of Orthodontics members for theircontributions to the field of orthodontics, especially in the areas of education, research orpublic relations. 3M Unitek is pleased to offer congratulations to the 1997 recipient of theMartin Dewey Award, Dr. Thomas D. Creekmore.

8 13

• Figure 19a, b, c Progressive buccalcrown torque in the lower posteriorsegments (cuspids through molars)provides uprighting of these areas,which are frequently inclined lingually.

• Figure 20 A patient in need of posteriorbuccal crown torque.

In-out Modifications of the MBT™

Versatile+ ApplianceIt has been observed by the authorsthat the in-out measurements (includingmolar rotation) for the original Straight-Wire Appliance™ have, for the mostpart, proven to be quite satisfactory. Withthe exception of severe rotations at theinitiation of treatment (best handled byspace opening in combination withfacial and lingual rotation elastics) minimal modifications in archwiresneed to be made until the finishingstage of treatment. At that time someteeth may need to be over-rotated forstability (using rotation wedges) andfirst molars may need archwire offsetsto complete their rotation.

One important in-out feature thathas been added to the MBT Versatile+appliance is because upper secondbicuspids are frequently smaller in sizethan upper first bicuspids. For this reason,an upper second bicuspid bracket hasbeen provided with an additional 0.5mmof in-out compensation. This will allowfor better alignment of central fossae in the upper arch and will also providefor relatively increased mesio-buccal rotation of the upper first molar. Whenupper second bicuspids are similar insize to the upper first bicuspids, anupper first bicuspid bracket can be usedon the upper second bicuspids.

• Figure 21 An upper second bicuspidbracket with an additional 0.5 mm of in-outcompensation is provided for the commonsituation in which upper second bicuspidsare smaller than upper first bicuspids.

• Figure 22 Patient with smaller 2ndbicuspid

MBT Appliance Versatility• Inversion of upper lateral incisorbrackets (Fig. 23, 24, 25). This is benefi-cial in cases with palatally displacedlaterals requiring labial root torque forproper stability.

• Same tip and torque in lower incisorbrackets. With the same lower incisorbrackets, inventory is simplified and thepossibility of confusion during bracketplacement is minimized.

Fig. 20

Fig. 24

Fig. 29

Fig. 30

Fig. 25

Fig. 26 Normal Bracket -7° Torque

Fig. 27 Inverted Bracket +7° Torque

Fig. 28 Optional Bracket 0° Torque With Hook

Fig. 21

Fig. 22

Fig. 31

Continued on page 13

Original SWA

MBT™ Appliance

Fig. 18a, b

Fig. 19a, b, c

Fig. 32

Fig. 33

Fig. 34

• Inversion of cuspid brackets withprominent cuspid roots. (Figure 26, 27).This adjustment allows for movement ofthe cuspid roots away from the corticalplate and into the center of the alveolarprocess.

• 0° cuspid brackets with hook forextraction cases. (Figure 28). Manyorthodontists prefer to have a hook ontheir cuspid bracket, and the zerodegree torque value also allows thecuspid to move away from the corticalplate for easier retraction.

• Inversion of upper cuspid bracketswhen cuspids are in the lateral position.(Figure 29, 30, 31). This adjustment allowsthe cuspid root to move palatally andassume a position and appearance thatmore closely resembles the lateral incisor.

• Same tip and torque in upper bicuspidbrackets. Thus, in most situations,onebracket is used for all four upper bicuspids.This simplifies inventory and provides forless confusion during placement.

• Additional 0.5mm of in-out in uppersecond bicuspid brackets. (Figure 32).Approximately 30% of upper secondbicuspids are smaller than upper firstbicuspids. This bracket is most beneficialin this situation. If all four bicuspids are thesame size, then first bicuspid bracketscan be placed on both first and secondbicuspids.

• Upper second molar bands andbrackets on upper first molars in non-headgear cases. (Figure 33). This adjust-ment provides greater comfort for thepatient, as opposed to the placement ofan unnecessary headgear tube.

• Lower second molar bands andbrackets on lower first molars. Whenthe buccal cusps of upper first molarsimpinge on the bracket of the lower firstmolar, the use of the lower secondmolar band with a much lower occlusalprofile bracket often eliminates thisproblem.

• Lower second molar brackets onupper first and second molars whenfinishing in a Class II molar relation-ship. (Figure 34, 35). The lower secondmolar bracket has zero rotation and 10°of torque which places the Class IIupper first molar in a correct relation-ship with the lower first molar.

• Inventory identification. This is vastlysimplified by the pre-labeled individualblister packs of the APC™ AdhesiveCoated brackets used in the operatory.

Fig. 23

Fig. 42

14 7

Because of these factors there isgenerally a need for greater palatalroot torque of the upper incisors and labial root torque for more upright-ing of the lower incisors (Figure 15).For all these reasons, the authors rec-ommend +17° of torque for the uppercentral incisors, +10° of torque for theupper lateral incisors, and -6° of torquefor the lower incisors.

In Figure 16 the MBT™ Versatile+Appliance provides increased palatalroot torque for the upper incisors (a, b)and increased labial root torque for thelower incisors (c), the most commonrequirements in orthodontic cases.

Upper Cuspid, Bicuspid and Molar Torque Table 5 shows upper cuspid, bicuspidand molar torque values: Andrews'non-orthodontic normal study1, twoJapanese studies2, 3, the MBT Versatile+Appliance, the Original Straight-WireAppliance™ 6 and the Roth Appliance6.

The upper cuspid and bicuspidtorque values of -7° have proven to besatisfactory in most cases, and havetherefore been selected for the MBTVersatile+ Appliance. The uppermolars, on the other hand, frequentlyshow excessive buccal crown torquewith palatal cusps “hanging down”which creates centric, balancing side

and working side interferences. For thisreason the authors prefer -14° of buccal root torque in these teeth, asopposed to only -9° of buccal roottorque (Fig. 17a, b, c).

Lower Cuspid, Bicuspid and Molar Torque Table 6 shows torque values for lowercuspids, bicuspids and molars fromAndrews' non-orthodontic normalstudy1, two Japanese studies 2, 3, theMBT Versatile+ Appliance, the OriginalStraight-Wire Appliance6 and the RothAppliance6.

There are three reasonsfor reducing the amount of lin-gual crown torque in thelower cuspid, bicuspid andmolar areas: 1) Since lowercuspids and sometimes bicus-pids often show gingivalrecession, they benefit fromthe roots being moved closerto the center of the alveolarprocess; 2) many orthodonticcases demonstrate narrowingin the maxillary arch with

lower posterior segments that are com-pensated toward the lingual. These

cases benefit from buccal uprighting ofthe lower posterior segment. 3) It hasbeen consistently observed that lowersecond molars with -35° of torque con-sistently “roll in” lingually. Therefore,the authors have chosen to reduce thelingual crown torque, by 5° in the lowercuspids and bicuspids, by 10° in thelower first molars, and by 25° in thelower second molars (Fig. 18a, b and19a, b, c).

Lower PosteriorTorque

Cuspid 1st 2nd 1st 2ndBi Bi Molar Molar

Andrews’ norms -12.7° -19.0° -23.6° -30.7° -36.0°

Sebata’s data -4.7° -14.8° -22.6° -26.2° -31.0°

Watanabe’s data -11.1° -18.4° -21.8° -31.2° -32.9°

MBT Versatile+ -6.0° -12.0° -17.0° -20.0° -10.0°

Original SWA -11.0° -17.0° -22.0° -30.0° -35.0°

Roth SWA -11.0° -17.0° -22.0° -30.0° -30.0°

Table 6 Lower Posterior Torque

Table 5 Upper Posterior Torque

Upper PosteriorTorque

Cuspid 1st 2nd 1st 2ndBi Bi Molar Molar

Andrews’ norms -7.3° -8.5° -8.9° -11.5° -8.1°Sebata’s data 0.7° -6.5° -6.5° -1.7° -3.0°

Watanabe’s data -5.3° -6.0° -7.2° -9.8° -9.5°

MBT Versatile+ -7.0° -7.0° -7.0° -14.0° -14.0°

Original SWA -7.0° -7.0° -7.0° -9.0° -9.0°

Roth SWA -2.0° -7.0° -7.0° -14.0° -14.0°

3. Bracket PlacementPrior to the development of the pre-adjusted appliance, edgewise bracketswere placed using gauges which setthe bracket a specific number of mil-limeters from the incisal or occlusaltooth surface. When the pre-adjusted

appliance was developed, the center ofthe clinical crown became the verticalreference for bracket placement, andmost orthodontists discontinued theuse of gauges. The brackets weretherefore placed by visually selectingthe center of the clinical crown.Unfortunately, this method resulted insignificant errors relative to verticalplacement. For example:

• Gingival variations, such as partiallyerupted teeth, labially and lingually(palatally) displaced roots, and gingivalinflammation led to placement errors.• Large teeth (upper central incisors)and small teeth (upper lateral incisors)within the same patient led to obviouserrors when brackets were placed inthe center of the clinical crown.• Incisal or occlusal fractures andwear, as well as teeth with extremelytapered and pointed cusps, led tobracket placement errors. (Figure 36)

The use of a bracket placementchart (developed in 1994), as well aspre-adjusted Dougherty gauges,Figures 37 and 38, dramatically reducesbracket placement errors in the verticaldimension. Figures 39 though 44 showplacement technique. We have experi-enced approximately a 50 - 60% reduc-tion in the need to reposition brackets

during treatment using this very simplebut effective system.

Figure 39, 40, 41 illustrate measur-ing on the occlusal plane, burnishingthe band, and then light curing theband and tube in position.

Figure 42, 43 and 44 show checkingbracket height and tip, then curing.

Fig. 35

Fig. 40

Fig. 41

Fig. 43

Fig. 15 Labial Root Torque

Fig. 16a, b, c Anterior Root Torque

_______________

"In the past, the best resultswere achieved by the orthodontists

who were the best wire benders. In the future, the best results

will come from those orthodontistswho are the best bracket

positioners." –MBT______________________

Fig. 44

U7 U6 U5 U4 U3 U2 U1 Upper Arch

2.0 4.0 5.0 5.5 6.0 5.5 6.0 +1.0mm2.0 3.5 4.5 5.0 5.5 5.0 5.5 +0.5mm2.0 3.0 4.0 4.5 5.0 4.5 5.0 Average2.0 2.5 3.5 4.0 4.5 4.0 4.5 -0.5mm2.0 2.0 3.0 3.5 4.0 3.5 4.0 -1.0mm

3.5 3.5 4.5 5.0 5.5 5.0 5.0 +1.0mm3.0 3.0 4.0 4.5 5.0 4.5 4.5 +0.5mm2.5 2.5 3.5 4.0 4.5 4.0 4.0 Average2.0 2.0 3.0 3.5 4.0 3.5 3.5 -0.5mm2.0 2.0 2.5 3.0 3.5 3.0 3.0 -1.0mmU7 U6 U5 U4 U3 U2 U1 Lower Arch

A

B

C

D

E

A

B

C

D

E

MBT™ Versatile+ Appliance Bracket Placement Guide

Fig. 36

Fig. 17

Fig. 39

Fig. 38

Fig. 37

6 15

Upper Posterior TipTable 2 shows posterior tip measure-ments for the upper bicuspids andmolars: Andrews' non-orthodontic normal study1, two Japanese studies2, 3,the MBT™ Versatile+ Appliance, theOriginal Straight-Wire Appliance™ 6

and the Roth Appliance6.

For the MBT Versatile+ Appliance,0° of tip, as opposed to 2° of tip, wasselected for all upper bicuspid bracketsto place the crowns in a slightly moreupright position, (in a Class I direction).It also provides for slightly reducedanchorage needs for the upper arch.

The buccal groove is the referencefor crown tip in the upper molars. Thisbuccal groove shows a 5° angulation toa line drawn perpendicular to theocclusal plane. There are two methodsof achieving 5° of effective tip in the upperfirst and second molars.

If a 5° bracket is used, the band mustbe seated more gingivally at the mesialaspect to position bracket wings parallel to buccal groove. (Fig 14a). Thismakes band positioning more difficult.When using these 5° brackets, it is fre-quently necessary to trim band materialfrom the distal of the band. If the 5°bracket is used and the band is placedparallel to the occlusal plane, it providesan excessive 10° of actual tip to theupper first and second molars (Fig. 14b).

Alternatively, the authors prefer touse a 0° crown tip bracket with the bandand bracket slots placed parallel to theocclusal plane. This introduces the correct5° of tip in the upper molars, as measuredfrom the buccal groove (Fig. 14c) and is easier to seat. The new Unitek™

Narrow Contoured Molar Bands havebeen extremely easy to use and are awelcome addition to the MBT system.

In summary, then, all of the upperposterior brackets are provided with 0°of crown tip for the reasons describedabove.

Lower Posterior Crown Tip Table 3 shows tip measurements forthe lower bicuspids and lower molars:Andrews' non-orthodontic normal study1,two Japanese studies2,3, the MBT Versatile+Appliance, the Original Straight-WireAppliance6 and the Roth Appliance6

The authors prefer to maintain 2° ofmesial crown tip in the lower bicuspids.Angling these teeth slightly forward inthis manner moves them more in a Class Idirection; 2° of tip is also preferred inthe lower first and second molars. Thisis accomplished in a manner similar to

the tip placed in the upper molars. Thelower buccal groove lies 2° off of a linedrawn perpendicular to the occlusalplane. As with the upper molars, intro-ducing this 2° of tip to the lower molarscan be accomplished by placing 0° tipbrackets parallel to the occlusal plane.In summary then, the lower bicuspidbrackets show 2° of mesial crown tipand the lower molar brackets show 0°of crown tip (2° effective tip) with thebands placed parallel to the occlusalsurface.

Incisor TorqueTable 4 shows anterior torque values:Andrews' non-orthodontic normalstudy1, two Japanese studies 2, 3, theMBT Versatile+ Appliance, the OriginalStraight-Wire Appliance6 and the RothAppliance6.

The authors observed that torque is rather poorly controlled with the pre-adjusted appliance system. This is dueto the fact that the torque movement isa difficult one since less than 1mm ofcontact between the bracket and thearchwire must bring about this move-ment. In general, here lies the greatestchallenge to bracket design in the pre-adjusted appliance. In the majority oforthodontic cases, because of this lackof torque control, torque tends to belost in the upper incisors during overjetreduction and space closure. The lowerincisors frequently tend to procline forward during Curve of Spee levelingand when eliminating lower incisorcrowding. This incisor torque factor,along with the tip and tooth size factors,frequently prevents posterior teethfrom fitting into a Class I relationship.

Upper Posterior Tip

1st 2nd 1st 2ndBi Bi Molar Molar

Andrews’ norms 2.7° 2.8° 5.7° 0.4°Sebata’s data 3.5° 6.2° 5.2° -0.3°Watanabe’s data 4.7° 5.2° 4.9° 4.1°MBT Versatile+ 0° 0° 0° * 0° * Original SWA 2.0° 2.0° 5.0° 5.0°Roth SWA 0° 0° 0° 0°

Table 2 Upper Posterior Tip * Effective tip is 5°

Anterior Torque

Upper Upper Lower LowerCentral Lateral Central Lateral

Andrews’ norms 6.11° 4.42° -1.71° -3.24°

Sebata’s data 9.42° 7.48° 3.55° 1.66°

Watanabe’s data 12.8° 10.4° 0.71° 0.53°

MBT Versatile+ 17.0° 10.0° -6.0° -6.0°

Original SWA 7.0° 3.0° -1.0° -1.0°

Roth SWA 12.0° 8.0° -1.0° -1.0°

Table 4 Anterior Torque

Lower Posterior Tip

1st 2nd 1st 2ndBi Bi Molar Molar

Andrews’ norms 1.3° 1.54° 2.0° 2.9°

Sebata’s data 2.5° 6.70° 5.7° 7.3°

Watanabe’s data 3.8° 3.91° 3.7° 3.9°

MBT Versatile+ 2.0° 2.0° 0° * 0° *

Original SWA 2.0° 2.0° 2.0° 2.0°

Roth SWA -1.0° 0° -1.0° -1.0°

Table 3 Lower Posterior Tip * Effective tip is 2°

Editor: Arch form and archwiresequencing are a very important part ofthe McLaughlin-Bennett-Trevisi philos-ophy of orthodontic treatment. Can youcomment in general on this importance?

Dr. McLaughlin: The proper selec-tion of an arch form for each patient aswell as the development of a generalarchwire sequencing system in theorthodontic practice can greatlyincrease treatment efficiency and alsoprovide greater stability in completedcases.

Editor: Can you offer an historicalperspective on the subject of arch form?

Dr. McLaughlin: A review of theorthodontic literature on the subject ofarch form reveals that there are threemain themes that run throughout thisinformation. The first is the search forthe ideal arch form (Bonwill-Hawley,caternary curve, Brader arch form, etc.).Second is the conflicting view thatthere is a great deal of variation inhuman arch form. The third is that whenarch form is significantly changed inthe patient, there is a great tendencytoward orthodontic relapse.

Editor: How should this informationaffect the choices an orthodontist mustmake when selecting an arch form foreach patient?

Dr. McLaughlin: This information,as well as treating patients over a 20year time period, indicates that the useof a single arch form in all patients isan unsatisfactory method of treatment.Some method of individualization mustbe carried out.

Editor: Does this then mean thatarchwires must be individually cus-tomized for each patient, or can somesystem of pre-formed arch wires be uti-lized?

Dr. McLaughlin: The arch form hasfour main components, 1) the anterior

curvature, 2) inter-cuspid width, 3) pos-terior curvature and 4) inter-molarwidth. Anterior curvature is primarilydetermined by inter-cuspid width, witha more tapered shape in patients withnarrow inter-cuspid width and widercurvature in patients with wider inter-cuspid width. The literature reveals thatinter-cuspid width is the most criticalaspect of arch form selection.

Figure 45 shows the super-impositionof three arch forms, tapered, square andovoid. (This designation was used by Dr. Robert Ricketts a number of years ago.)

Selecting one of these three archforms using a clear template over thelower study model provides a 6mmrange of inter-cuspid width, which isadequate for the great majority ofpatients in an orthodontic practice.These three arch forms are importantwith wires that are stiff enough to

affect arch form, such as the wires inFigure 47. For lighter force wires, suchas the wires in Figure 46, a single ovoidarch form is adequate, which simplifiesinventory requirements.

In the past, posterior arch formshape has varied from a straight line(Bonwill-Hawley) to a significant curva-ture (Brader). Figure 45 arch formsuper-impositions show a slight curva-ture in the posterior arch form, whichseems to be a practical approach. Theposterior arch form is slightly widenedin the bicuspid region to provide betterfunction during protrusive movement,(as described by Roth) and to decreasethe tendency for arches to collapse inthe bicuspid region in extraction cases.

Figure 45's inter-molar width isessentially the same. That is becauseit is impractical to maintain a largeinventory of arch forms with many

fig. 45

A Clinical Review of the MBT ™

Orthodontic Treatment Program

4. Arch Form and Wire SequencingInterview with Dr. Richard P. McLaughlin

Fig. 14a, b, c

_______________

"... inter-cuspid widthis the most critical aspect

of arch form selection"_______________

516

MBT™ Appliance Features

Reduced Upper and Lower Anterior Tip

Table 1 shows anterior tip measure-ments: Andrews' non-orthodontic normalstudy1, two Japanese studies 2, 3, theMBT Versatile+ Appliance, the OriginalStraight-Wire Appliance™ 6 and the RothAppliance6.

The anterior tip measurements forthe original Straight-Wire Applianceare all greater than those found inAndrews' research. This was presum-ably done to control what Andrewsreferred to as the “wagon wheel”effect* that torque places on anteriorcrown tip1. This is somewhat similar tothe compensating anti-tip, anti-rotationand power arms built into the extractionbrackets for the treatment of bicuspidextraction cases.

*As palatal root torque is added tothe anterior segment, mesial crown tipis reduced

It has been observed by the authorsthat with light continuous forcemechanics, tip is well controlled by thepre-adjusted appliance. Using “lace-backs” and “bendbacks” during level-ing and aligning, and elastic module“tie-backs” during space closure, verylittle adverse tipping occurs duringthese stages of treatment. By the finishing stage of treatment, completelylevelled upper and lower rectangularwires are normally in place, indicatingthat full expression of both anterior andposterior crown tip has occurred.Thus, additional tip is not seen to benecessary in the anterior segments.

Also, additional anterior tip creates asignificant drain on molar anchorage,Figure 10, 11. If the original research

values for tip are used, atotal of 10° less distal roottip in the upper anteriorsegment and 12° less distalroot tip in the lower anteriorsegment is needed (com-pared against the OriginalStraight-Wire Appliance). • Figures 10 and 11 showthe difference in root posi-

tions with MBT Versatile+ Applianceand two SWA.

• Figure 12. The MBT Appliance pro-vides anterior tip measurements thatcorrespond to Andrews' norms. Thisreduced tip provides a significantreduction in anchorage needs.

Also, reducing the tip on the cuspidsavoids the frequently observed problemof cuspid and bicuspid roots that finishin close proximity.

• Figure 13: This X-ray shows a casetreated with a bracket with excessivecuspid tip. This is what the MBT Versatile+bracket was designed against.

Thus reduced tip significantlyreduces the need for anchorage con-trol, which normally translates into areduced need for patient cooperation.Since the MBT Versatile+ measure-ments are identical to Andrews' originalresearch figures, there is no compro-mise in ideal static occlusion. And if thecondyles are in centric relation, there isno compromise in ideal functionalocclusion as described by Roth4.

Fig. 13

Upper Anterior Tip Lower Anterior Tip

Central Lateral Cuspid Central Lateral Cuspid

Andrews’ norms 3.59° 8.04° 8.4° 0.53° 0.38° 2.5°

Sebata’s data 4.25° 7.74° 7.7° -0.48° -1.2° 1.5°

Watanabe’s data 3.11° 3.99° 7.7° 1.98° 2.28° 5.4°

MBT Versatile+ 4.0° 8.0° 8.0° 0° 0° 3.0°

Original SWA 5.0° 9.0° 11.0° 2.0° 2.0° 5.0°

Roth SWA 5.0° 9.0° 13.0° 2.0° 2.0° 7.0°

choices for inter-molar width. Therefore,this area can be easily widened ornarrowed for each patient, particularlyin the rectangular wire stage of treat-ment and in the heavier wires just priorto this wire. This of course is mucheasier to do than constantly adjustingto the anterior aspect of the arch form,which is much more difficult and verytime consuming.

Editor: What other methods can beused to aid in the stability of the ortho-dontic case relative to arch form?

Dr. McLaughlin: Rather than pro-ceeding from rectangular wires toretainers, it is beneficial to allow casesto settle for a minimum of a month anda half in very light arch wires at the endof treatment. This allows for settling ofthe arch form to a more physiologicposition for the patient, based on thetongue and face musculature. It alsoallows for vertical settling of the denti-tion, which is most important. In addi-tion to this, the use of a bonded loweranterior retainer allows for some settling of inter-cuspid width withoutmovement in the incisor area.

Editor: You have recently devel-oped a more efficient system of arch-wire sequencing by taking advantageof major developments in wire technol-ogy. Was this sequence transitioneasy, and more important, how valu-able has it been in your practice?

Dr. McLaughlin: Figures 46 and 47illustrate the six wires replaced by onlytwo wires for the .022 slot MBT™

Versatile+ Appliance system.

• Figure 46 Nitinol Heat-Activated

.016" replacing .015" and .0175"

multi-strand steel and .014"

stainless steel.

The use of the .016" Nitinol Heat-Activated wire to replace multi-strandand the .014" round wire has been mostsatisfactory. This initial arch wire canbe placed with ease in most cases, andcan be retied one or two times at 4 to 6week intervals.

• Figure 47 Nitinol Heat-Activated .019 x .025" replacing .016", .018" and.020" round stainless steel.

The .019 x .025" Nitinol Heat-Activated can also be retied at thesame 4 to 6 week intervals.

As Figure 48, 49, 50, 51 illustrate,engagement of a Nitinol Heat-Activatedwire can be facilitated with use of EndoIce®, followed by tying in with a steelligature*. Because of rapid cooling, thisprocedure can be performed quicklyand comfortably.(*CF: Newswire article by Dr. JosephCaruso, Spring 1994)

The remaining wire used is an .019 x .025" rectangular stainless steel.

Use of Nitinol Heat-Activated wiresin my orthodontic practice has resultedin much less chair time involved ineach visit. Secondly, the intervalsbetween patient visits has been slightlyincreased. Thirdly, tooth movement isactually much more efficient, and as aresult, the aligning phase of treatmentis completed more rapidly. This in turnallows me to complete overbite control,overjet reduction and space closuresooner in treatment, which in turnallows more time for finishing anddetailing of the case, which enhancestreatment end result quality.

fig. 50

Table 1 Anterior Tip

Fig. 47

fig. 46

fig. 51

Fig. 10 Upper Arch Length

Total Arch Cuspid Lateral CentralLength Change Tip Tip Tip

MBT 0.0mm 8° 8° 4°

Andrews 1.7mm 11° 9° 5°

Roth 2.4mm 13° 9° 5°

Fig. 11 Lower Arch Length

Total Arch Cuspid Anterior AnteriorLength Change Tip Tip Tip

Roth 2.7mm 7° 2° 2°

Andrews 2.0mm 5° 2° 2°

MBT 0.0mm 3° 0° 0°

fig. 48

fig. 49

Fig. 12

FinishingFinishing involves three main processes:

• The correction of mistakes made earlier in treatment (bracket positioning, torque control, anchorage control etc.)

• Over-correction as needed (periodontal, alveolar-sutural, muscular, and growth)

• Settling of cases in light wires for approximately six weeks (minimum) prior to debanding

RetentionRetention is accomplished using a com-bination of bonded retainers for thelower anterior segment, wrap aroundupper retainers to allow for continuedarch settling, and some positioners aswell as some clear acrylic full coverageretainers.

2. MBT ApplianceBracket SystemVictory Series™ Brackets – Figures 1, 2,3 show a good candidate for this smallsteel bracket, as evidenced by thepatient's short clinical crowns.

4 17

Clarity™ Brackets – Figures 4, 5, 6 show Clarity metal-reinforced ceramic brackets on herupper teeth, aesthetic brackets for anaesthetic appearance during treatment.

Full Size Twin Brackets – Figures 7, 8, 9 show a patient with large teeth, a difficult malocclusion and poor hygiene. The larger bracket willmaximize base surface area andincrease control.

APC™ SystemIn addition to the MBT Versatile+ appliance types available, our officesalso appreciate the option of APCadhesive coating on our brackets. Theefficiency and simplified inventorymanagement has been most beneficialfor staff and patients.

Fig. 1

Fig. 4

Fig. 5

Fig. 7

Fig. 8

Fig. 9

Fig. 3

Fig. 6

Editor: What role do the tapered,ovoid and square wire arch forms playin preventing relapse?

Dr. McLaughlin: With the edgewiseappliance, most orthodontists cus-tomized archwires to the patient's archform. When the pre-adjusted appliancewas developed, there seemed to be anunwritten assumption that one specificarch form needed to be used for thatsystem, and that arch form was themost appropriate.

After twenty years of using the pre-adjusted appliance, it is apparentthat customizing the arch form to theindividual patient is what is really mostimportant. Failure to do this will resultin relapse. In and out dimension coveredsome problems, but not all of them.What I would like to see is a return to acustomized arch form for each patientwithout the need to overstock officeinventory or waste time in unneededwire bending. This seems to be thebest method of efficiently achievingstable and esthetic end results.

REFERENCES1. Andrews LF. Straight Wire-The Concept and Appliance;

L. A. Wells Co., San Diego, Ca. 92107: 1989.

2. Sebata E. "An orthodontic study of teeth and dental arch form on the Japanese normal occlusion". Shikwa Gakuho1980; 80: 945-969. (In Japanese.)

3. Watanabe K, Koga M, Yatabe K, Motegi E, Isshiki Y. "A morphometric study on setup models of Japanese malocclusions". Shikwa Gakuho 1996. (Department of Orthodontics, Tokyo Dental College, Chiba 261, Japan).

4. Roth R. "Gnathologic concepts and orthodontic treatment goals". In: Technique and Treatment with Light Wire Appliances. Ed. Jarabak JR . St. Louis: CV Mosby, 1970, pp. 1160-1223.

5. McLaughlin, R.P. and Bennett, J.C.: "Bracket Placement with the Straight-Wire Appliance" Journal of Clinical Orthodontics, May 1995; 29: 302-311.

6. 'A' Company Orthodontics catalogue, 'A' Company Orthodontics, 9900 Old Grove Rd., San Diego, CA 92131-1683

Endo-Ice is a registered trademark of The Hygienic Corporation,Akron, OH 44310

_____________

Fig. 2

MBT™ Continuing Education Seminars

New Concepts in Orthodontic TreatmentMechanics - Available in 1997 and 1998This seminar presents a discussion ofthe McLaughlin, Bennett, Trevisi (MBT)philosophy of orthodontic treatment.State of the art mechanics using lightcontinuous force systems are describedin detail. The newly developed MBTVersatile+ Appliance, designed specifi-cally to coincide with and enhance thetreatment mechanics, is also presented.The six stages of orthodontic treatmentare reviewed using the sequentialdemonstration of a variety of case reports.This is a practical and very clinicallyoriented program, which will provideinformation that is immediately usefulfor the modern orthodontic practice.

Inter-Arch Treatment Mechanics -Available in 1998This seminar is a natural progression ofthe "New Concepts" seminar. The prin-ciples of intra-arch treatment mechan-ics are carried over and applied to themanagement of cases requiring atten-tion in the area of inter-arch manage-ment. It is the efficient management ofintra-arch factors that allows the ortho-dontist to focus on the challengingaspects of inter-arch management.

Considerations include the far moredifficult challenge of placing the upperand lower dentitions in three planes ofspace within the facial complex so thatthey are esthetic, fit properly duringstatic centric occlusion, allow thecondyles to be seated into a centric rela-tion position within the glenoid fossae inthis static position, and function fromthis static position without interfer-ences during lateral and protrusivemovements. Thus, inter-arch considera-tions include such factors as growth anddevelopment, and the management ofvertical, horizontal and transverse skeletaland dental discrepancies. The subjectsof Class II, Class III and Asymmetricaltreatment areas are also discussed.

Management of the Dentition -Available in 1999This seminar describes the manage-ment and correction of specific dental

problems involving each individualtooth. Thus, specific clinical situationsrelated to incisors, cuspids, 1st and 2ndbicuspids, and 1st, 2nd and 3rd molarsare discussed. The extraction versusnon-extraction issue is reviewed indetail. The seminar will also provide an in-depth review of the material in Dr.Bennett's and Dr. McLaughlin's newesttextbook, Orthodontic Management ofthe Dentition with the PreadjustedAppliance.

Occlusion and the TMJ in OrthodonticTreatmentCorrection of malocclusion to a positionin which the condyles are in the correctposition can be likened to the properconstruction of a house's foundation.Without it, the house is subject to futureinstability, as is the malocclusion treatedto the incorrect condyle position.

This seminar presents a compre-hensive review of the management oforthodontic patients with Temporo-Mandibular Disorders. The concept ofideal occlusion is discussed as well asits relationship to temporo-mandibulardisorders. The subjects of diagnosisand treatment planning, splint therapy,and post splint management with ortho-dontic appliances is discussed in detail.

Diagnosis, Treatment Planning andTreatment MechanicsThis seminar brings together the infor-mation from the previous four seminars byplacing emphasis on the all importantarea of diagnosis and treatment planning.The topics covered in previous programsare all relevant to this seminar, which looksat a wide variety of treatment situations.Each case is evaluated from a diagnosticpoint of view, and participants are invitedto make their own judgments concern-ing treatment planning. The treatmentwhich was completed is then reviewedin a step by step manner, with theresults being evaluated. Class I, II andIII and Asymmetrical treatment optionsare reviewed as well.

18 3

MBT Treatment Philosophy

A Clinical Review of the MBT™

Orthodontic Treatment ProgramBy Dr. Richard McLaughlin, Dr. John Bennett and Dr. Hugo Trevisi

The MBT philosophy of orthodontictreatment has been developed over atwenty year period of time and hasinvolved the combined efforts of itsthree principle clinicians, along withthe help of numerous other cliniciancolleagues. Their philosophy placesemphasis on four critical areas oforthodontic treatment: 1. Treatmentmechanics, 2. The pre-adjusted appliance, 3. Bracket placement tech-nique, and 4. Arch form and archwiresequencing.

The MBT philosophy is supportednot only by a custom designed appli-ance, but also by worldwide continu-ing educational opportunities as wellas a long awaited textbook.

The MBT Philosophy ofOrthodontic Treatmentin Practice1. Treatment Mechanics

Emphasis on dento-alveolar changeThe major effect of orthodontic treat-ment is on the dento-alveolar struc-tures. Thus the term "growth modifica-tion" in growing patients consists primarily in the modification of thegrowth and development of the dento-alveolar processes. While other"orthopedic" changes may be occurringin some patients, the majority of changeis dento-alveolar, and, therefore,

emphasis is placed on the manage-ment of these structures.

Use of Light, Continuous ForcesIntermittent forces have proven to berelatively ineffective in bringing aboutdental tooth movement; on the otherhand, continuous forces are mosteffective in moving dental structures.Heavy forces have been shown tohave a detrimental effect on the rootstructure while lighter forces havebeen shown to maximize biologicresponse and efficacy in tooth move-ment. Therefore, treatment planning isdirected at providing light continuousforces on the teeth that need to bemoved at any given time during ortho-dontic treatment.

Anchorage ControlA combination of extra-oral (facebowsand "J" hooks) and intra-oral (palatalbars, lingual arches, Class II elastics,Class III elastics, Nance arches, Utilityarches, etc.) methods of anchoragecontrol are utilized in the MBT system.

Leveling and AligningThe leveling and aligning stage oftreatment consists of the followingtechniques:

• Use of Nitinol Heat-Activated nickel titanium wires during the aligning process

• The use of canine lace backs for cuspid control and retraction

• The use of bend backs to control forward movement of incisors

• The use of open coil springs to create space for blocked out teeth

• Early establishment and maintenance of arch form, followed by bringing malposed

teeth into the primary arch form without arch form distortion

Overbite ControlOverbite control is best accomplishedby using the following principles:

• Differentially controlling the eruption/extrusion (intrusive and extrusive forces) of the anterior and posterior segments

• Including second molars early in treatment for the opening of mostdeep bite cases

• Being aware that in most cases leveling and bite opening are not complete until rectangular wires have been in for one or two months

• Avoiding leveling of the posterior portion of the Curve of Spee in open bite cases

Space ClosureSpace closure control is best accom-plished by using the following principles:

• A .019 x .025" rectangular wire in the .022 bracket slot is preferred for effective sliding mechanics without major archwire deflection

• Sliding mechanics is accomplished with elastic module tie backs

• Incisor torque control is accomplished through bracket design and archwire bending

Overjet (Class II-Class III) CorrectionClass II and Class III correction isaccomplished by using a combinationof headgear, Class II and Class III elas-tics, and functional appliances. Theseappliances are used in combinationsthat bring about the best opportunityfor continuous forces on the dento-alveolar processes.

MBTText Book

MBT ContinuingEducation Seminars

MBTPhilosophy

MBT Appliance

Dr. Richard McLaughlin -San Diego, California

Dr. Richard McLaughlin completedhis orthodontic training at theUniversity of Southern California in1976. Since then he has been in the fulltime practice of orthodontics in SanDiego, California. While developing hisown practice, he was an associate ofDr. Lawrence F. Andrews for sevenyears. Dr. McLaughlin has lecturedextensively on the pre-adjusted appli-ance in the United States, Europe,South America, Asia and Australia withorthodontic colleagues from London,England, Dr. John Bennett, and fromSão Paulo, Brazil, Dr. Hugo Trevisi. Heis a member of the Pacific CoastSociety of Orthodontists, the AmericanAssociation of Orthodontists, aDiplomate of the American Board ofOrthodontics and a full member of theEdward H. Angle Society. In addition,Dr. McLaughlin is an associate clinicalprofessor at the University of SouthernCalifornia, Department of Orthodontics.

Dr. John Bennett -London, England

Dr. Bennett completed his ortho-dontic training at the Eastman DentalInstitute in London, England in 1972.Since that time he has been in the fulltime practice of orthodontics in London,England. For the past 20 years he hasworked exclusively with the pre-adjusted appliance system, and withDr. McLaughlin has held a particularinterest in evaluating and refiningeffective treatment mechanics utilizinglight forces. These concepts havedeveloped and have included the morerecent contribution from Dr. Trevisi.Their well tried and effective treatmentapproach has seen widespread accep-tance. Dr. Bennett has lectured inter-nationally on the pre-adjusted appli-ance for a number of years. Togetherwith Dr. McLaughlin he has publishednumerous articles and has co-authoredtwo orthodontic textbooks, both ofwhich have been well received. He iscurrently a part-time clinical instructorat the post-graduate orthodontic pro-gram at Bristol University in England.

Dr. Hugo Trevisi - São Paulo, Brazil

Dr. Hugo Trevisi received his dentaldegree in 1974 at Lins College ofDentistry in the state of São Paulo,Brazil. He received his orthodontictraining from 1979 to 1983 at that samecollege. Since that time he has beeninvolved in the full time practice oforthodontics in Presidente Prudente,Brazil. He is a Faculty Member at theUniversity of Odontology and Dentistryin Presidente Prudente. He has lec-tured extensively in South America andPortugal and has developed his ownorthodontic teaching facility inPresidente Prudente. Dr. Trevisi has 20years of experience with the pre-adjusted appliance. He is a member ofthe Brazilian Society of Orthodonticsand the Brazilian College of Orthodontics.

About the Authors

3M Unitek is sad to say goodbye to ourPresident and General Manager, Mr. RichIverson, but we are happy for him as heassumes his new responsibilities in hisappointment to head up the MedicalResource Technology Division at 3M. Inhis 8 years with us, Rich has helped tosmooth the transition as we evolvedfrom Unitek into 3M Unitek and becamethe unquestionable leader in orthodonticsas well as the world's largest orthodonticmanufacturer. This growth has been due to our strategic goal of developing and maintaining the Best CustomerRelationships in the Orthodontic industry.Good luck Rich.

3M Unitek Now On The WebA further demonstration of 3M Unitek'scommitment to the future can be foundon our brand new web page. We inviteyou to stop by and browse.

3M DentalReceives '97Baldrige Award

3M Unitek congratulates 3M Dental forreceiving the 1997 Malcolm BaldrigeQuality Award. 3M Dental is the first divi-sion within 3M and only the secondcompany in health care to receive thiscoveted award, which certifies a com-pany's ongoing commitment to businessexcellence.

We are also very fortunate to be able tointroduce our new President andGeneral Manager, Mr. Patrick B. Ford.Pat is a seasoned manager with over 30years experience with 3M. Pat has astrong background in health care, salesoperations, international market devel-opment and subsidiary management.Both his track record and backgroundmake him well qualified to guide 3MUnitek's continued growth and marketleadership worldwide. He's extremelypleased to join us at this exciting time,as 3M Unitek launches innovative newproducts such as Clarity™ Metal-Reinforced Ceramic Brackets and theMBT ™ Appliance System. 3M Unitek isalso exclusive distributor for the AJO-DO, JCO, as well the Angle Orthodontiston CD-ROM. These, and other orthodonticproducts, will help usher in our upcom-ing 50th anniversary celebration in 1998.Pat has firmly endorsed and is commit-ted to 3M Unitek's credo of providingsuperior service to our customers.

Please join us in welcoming Pat Fordas the new leader of 3M Unitek, producerof orthodontic products and services tomake your life easier.

19

Into The Future

Good Luck Rich Iverson Welcome Pat Ford

"OrthodonticManagement of the Dentition

with the Preadjusted Appliance" wasreleased in 1997.

A book by orthodontists for orthodon-tists that blends research evidencewith long clinical experience, this newand innovative book considers eachtooth separately in the dentition.Entirely new, it looks at orthodontics ina fresh and organized way, that allowsyou to fine-tune your treatment man-agement strategies.

Easily readable with ultra-clear lay-outs and diagrams, it is a valuablesequel to the best selling "OrthodonticTreatment Mechanics and thePreadjusted Appliance".

Contents Include:1. General information on research

involved in bracket placement techniques as well as information on the use of the bracket placement chart.

2. Detailed information on research involved in bracket placement

techniques as well as information on the use of the bracket placement chart.

3. Individual information on each tooth in the dentition concerning general mechanical considera-tions and common clinical concerns.

Incisors - Information on various aspects of incisors such as trauma, tooth size discrepancy, congenital absence and malformation and shapeof these teeth.Cuspids - Information on the management of clinical situations such as cuspid impaction.First bicuspids - In this section of the text the controversy of first bicuspid extraction over the years is discussedin detail. There is also information which overlaps somewhat with Book Ion the mechanics of first bicuspid extraction.Second bicuspids - The problems of congenitally missing second bicuspids, retained deciduous secondmolars and second bicuspid extractionare discussed in this chapter.First molars - General considerations on first molars, including discussion of possible indications for extraction, are included in this chapter.Second molars - The vertical and horizontal anchorage aspects of second molars are discussed in this chapter as well as the very controversial subject of second molar extraction.Third molars - Research on the development, eruption and extraction timing of third molars is discussed in this chapter.

4. In each chapter a detailed discussion of the MBT bracket prescription and rational for use of these brackets is discussed in detail.

376 pages, 1050 color illustrations, 330 linedrawings, 31 case studies showing stage-by-stage treatment methods. Available worldwidethrough 3M Unitek, (REF 014-243).

"Orthodontic Treatment Mechanicsand the Preadjusted Appliance,"on the other hand, published in 1993,contains the following information:

1. Basic orthodontic mechanics on Class I extraction and non-extraction types of cases.

2. General information on bracket positioning and basic information on the pre-adjusted orthodontic appliance.

3. Information on the transition from Standard Edgewise to the pre-adjusted appliance

4. Information on anchorage control and leveling and aligning of the orthodontic case

5. Information on overbite control with emphasis on correction of deep overbites.

6. A limited amount of information on the very large subject of overjet reduction.

7. Information on the mechanics of space closure in extraction cases.

8. Some general information on the subject of finishing and detailing oforthodontic cases.

MBT™ Text SupportTwo text books, "Orthodontic Treatment Mechanics and the Preadjusted Appliance" & "Orthodontic Management ofthe Dentition with the Preadjusted Appliance," both co-authored by Dr. John Bennett and Dr. Richard McLaughlin,support the MBT philosophy, but are not Edition 1 and Edition 2 textbooks. Rather, each are textbooks on entirelydifferent subjects.

Orthodontic Perspectives is published periodically by 3M Unitek to provide information toorthodontic practitioners about 3M Unitek products. 3M Unitek welcomes article submissionsor article ideas. Article submissions should be sent to Editor, Orthodontic Perspectives, 3MUnitek, 2724 S. Peck Rd. Monrovia, CA 91016 or call. In the United States and Puerto Ricocall: 800 534-6300 ext. 4266. In Canada: 800 443-1661 and ask for extension 4266. Or call(626) 574-4266 or fax (626) 574-4892 or e-mail: rstoddard@mmm.com. Copyright ©1997 3M Unitek. All rights reserved. No part of this publication may be reproduced without theconsent of 3M Unitek.