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Rules in orthodontic practice Mohammed Al Muzian Part 2
Join me for part 2 where we explore Mohammed’s rules on which teeth to extract, anchorage assessment and management, Bonding 2nd permanent molars, elastics and treatment planning adults Vs children
Which to extract 4 or 5
o CAT-V principle
§ C: Clinical condition of the teeth
§ A: Anterior crowding: 8mm + extract the 4s, 8mm – 5s or 4s
§ T: Transverse: Lower 5 will help narrow the arch
§ V: Vertical: Extraction of 5s for high angle cases will improve the overbite
Molar outcomes in treatment planning
o Non-extraction or extraction of 4 premolars = class 1
o Extraction of 2 upper premolars: Class 2
o Extraction of 2 lower premolars: Class 3
o Extraction of 1stmolars: Ignore them! Will not change the final molar relationship
Anchorage
o Type A (absolute) No movement of the posterior segment
o TADs – HG – extraction pattern
o Type B posterior movement moves mesially by 25%
o Nance, sectional archwires, intermaxillary elastics, HG
o Type C posterior movement moves mesially by 50%
o Reciprocal movement of anterior retraction
o Type D posterior movement moves mesially by 75%
o Anterior anchorage (reverse HG, TADS)
o Biomechanics: intermaxillary elastics – 2nd order bends – inverted lower brackets
Anchorage loss in the lower arch is less than upper arch
· Differential alveolar bone density
· differential root surface area
· differential Buccolingual width of molar
· differential anterior palatal root torques
Bonding upper 7s
o Don’t bond to for anchorage
o Bonding results in loss of anchorage due to 7s distally tipped, uprighting results in loss of anchorage
Elastics
o Elastics = rotation of mandible
o Overjet 0.5mm correction per month with class 2 elastics
o 1:3 ratio of vertical: horizontal effects
o Unilateral intermaxillary elastics in one side only = cant
o = Use vertical part time elastics on the other side
o Elastic should be stretched 3 times its diameter to give the force
Distalisation Rule
o Don’t expect you can distalize more than 2.5 mm unless you extract 7 OR 8
o Distalization lowers without TADS is very limited
Adults Vs growing patients
· Growing patient:
o Elastics +++
o Distalisation +++
o Functional appliances +++
o Extractions +++
· Adult
o Extractions +++
o Elastics ++
o Distalisation +
View all episodes
By Farooq Ahmed
5
77 ratings
Join me for part 2 where we explore Mohammed’s rules on which teeth to extract, anchorage assessment and management, Bonding 2nd permanent molars, elastics and treatment planning adults Vs children
Which to extract 4 or 5
o CAT-V principle
§ C: Clinical condition of the teeth
§ A: Anterior crowding: 8mm + extract the 4s, 8mm – 5s or 4s
§ T: Transverse: Lower 5 will help narrow the arch
§ V: Vertical: Extraction of 5s for high angle cases will improve the overbite
Molar outcomes in treatment planning
o Non-extraction or extraction of 4 premolars = class 1
o Extraction of 2 upper premolars: Class 2
o Extraction of 2 lower premolars: Class 3
o Extraction of 1stmolars: Ignore them! Will not change the final molar relationship
Anchorage
o Type A (absolute) No movement of the posterior segment
o TADs – HG – extraction pattern
o Type B posterior movement moves mesially by 25%
o Nance, sectional archwires, intermaxillary elastics, HG
o Type C posterior movement moves mesially by 50%
o Reciprocal movement of anterior retraction
o Type D posterior movement moves mesially by 75%
o Anterior anchorage (reverse HG, TADS)
o Biomechanics: intermaxillary elastics – 2nd order bends – inverted lower brackets
Anchorage loss in the lower arch is less than upper arch
· Differential alveolar bone density
· differential root surface area
· differential Buccolingual width of molar
· differential anterior palatal root torques
Bonding upper 7s
o Don’t bond to for anchorage
o Bonding results in loss of anchorage due to 7s distally tipped, uprighting results in loss of anchorage
Elastics
o Elastics = rotation of mandible
o Overjet 0.5mm correction per month with class 2 elastics
o 1:3 ratio of vertical: horizontal effects
o Unilateral intermaxillary elastics in one side only = cant
o = Use vertical part time elastics on the other side
o Elastic should be stretched 3 times its diameter to give the force
Distalisation Rule
o Don’t expect you can distalize more than 2.5 mm unless you extract 7 OR 8
o Distalization lowers without TADS is very limited
Adults Vs growing patients
· Growing patient:
o Elastics +++
o Distalisation +++
o Functional appliances +++
o Extractions +++
· Adult
o Extractions +++
o Elastics ++
o Distalisation +
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