Vertical elastics talent

[danxnguyen]

Show us your vertical elastics talent here.   Everything from whimpy to wild.


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[Wilfred dG]

Month 10 [ Attachment: You are not allowed to view attachments ] Month 11 [ Attachment: You are not allowed to view attachments ]

[DMcGann]

Here is a skeletal anchorage (maxillary intrusion) case for gingival display on an adult patient (non-extraction).  This is really Nicassio's case that he shared with me...

Start
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Month 11: bite has opened as the coils have intruded the upper teeth...BUT the upper 7s were not bonded and there was no intrusion force applied to the molars (I believe the cause of the open bite...if the molars had been intruded, the mandible follows...autorotates)
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Month 21: patient is seen at 8 week intervals, the open bite has not closed, coils are still active for intrusion. The vertical elastics have been working in opposite direction of the intrusion coils, hopefully moving the "lower teeth to the upper". 
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[DMcGann]

The skeletal anchorage bone plates and coils were removed at month 20....just before you see the open bite is persistent at month 21 (coils are absent).  Two months later, the case was finished...yes, probably due to some extrusion of the upper teeth to the lowers, negating some of the maxillary intrusion
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Below are 3 cephs (Start, month 19, Final) ...no tracings...just look at the picture of the upper incisor as it relates to the upper [resting] lip on the cephs and you can see the dramatic impact of this treatment.  Nice work Ralph.
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[Unsalted]

This has inspired me to take the update course.  I didn't dream that kind of change was possible.

As a side note: how did you teach the patient to place those elastics herself?  make her a tutorial video?

[DMcGann]

This was Ralph Nicassio's case.  Bite opening when using skeletal anchorage intrusion of the maxillary teeth was common, but now I have identified the problems and how to reduce (not eliminate) them.  AT the update seminar this of course will be discussed, and NOW we feel that ALL pos students and graduates can use skeletal anchorage in any location (with update training)...previously limited to those with advanced training.   don

[skillz]

was there any surgery done to the upper lip ?

[DMcGann]

No surgery on the upper lip. The change was due to intrusion of the upper incisors and really the entire maxilla intruded. ONLY possible with skeletal anchorage or orthognathic surgery.

[sphun]

Took me some time to dig out these photos. This one is normal squeeze to tighten bite. [ Attachment: You are not allowed to view attachments ]

This case I am desperate.  Open bite case and the patient is leaving for over sea 5 months early. [ Attachment: You are not allowed to view attachments ]

[sphun]

Some comment on Ralph case: mini implant intrusion creating anterior open bite.

The mini implant intrusion is no doubt successful but the management of the resulting anterior open bite can be improve.
I ran across this data when I browse the Korean Orlus ortho implant system web. [ Attachment: You are not allowed to view attachments ]

This is ideal to close open bite by extruding the upper incisors (providing the initial reading of upper incisor to stomion is less than 0 indicating inadequate upper incisors showing to lip line).

Now flip it up side down and consider the principles below:

Dr Nicassio loss some of the intrusion when he ran the vertical elastic despite the retention wire attach between the upper arch wire to the Mx implant. The other better option will be to run the elastics from the LOWER arch wire to the Mx implant while maintaining the passive wire retention of the upper intrusion result. The net effect will be the extrusion of the lower incisors meeting up with the intruded upper incisors.

The question that need to be answer is can the Mx implant withstand the elastic stretch force to the lower arch wire without dislodging?
Has anyone done this and obtain a better or worse result?

It will be Dan's wild dream come true in this talent contest if one can attach both upper and lower arch wire to intrude (upper) and extrude (lower) at the same time!

Sphun.

[DMcGann]

If you apply an elastic (inter-arch or any elastic) to an ortho implant screw then you should DUCK YOU HEAD as the screw will predictably fail (too much force, especially when the patient opens their mouth) and when it does, close your mouth unless you want an ortho screw for lunch.  The picture is typical of what I see in the promotional materials for TADs, glad it stayed in long enough to get the photo taken

[sphun]

Thanks Dr McGann.

Sorry Dan. I have tried, may be the next posting.....TAD is evolving so fast, you will never know what is going to pop up next.

Still dreaming,

Sphun