Join me for part 2 of Adith’s lecture looking at the vertical dimension in orthodontics and its management.

Part 2 looks at 6 cases with vertical management of impacted canines, the use of TADs including buccal shelf and infrazygomatic TADs.

4th case impacted canine

· Avoid continuous archwire as it can cause:

o Iatrogenic root resorption

o If stubborn canine = greater  occlusal side effects

· Resolution: TAD opposing arch

o Traction hook bonded to canine

o 150g elastic from lower TAD to traction hook on upper canine

o Providing intermittent forces

5th case scissor bite

· Buccal shelf TAD – placed vertically buccal to lower 6-7

· Anterior bite blocks to disocclude

· Mechanics:

o Buccal movement of molar with powerchain from BS TAD - molar

o Intrusion of molar with vertical vector to TAD

6th case cant

· TAD x 2, between U2-3 and U5-6 – placed high

· 19*25 NITI continuous

· Powerchain from TADs to brackets for intrusive force

7th case gummy smile

· Posterior TADs in conventional mucogingival junction with vertical vector not likely to achieve clinical improvement.

· Require TAD anterior region, and infrazygomatic TAD for retraction and intrusion

8th case class 3 with AOB

· Buccal shelf TADs

o Powerchain BS to hooks distal to lateral incisors on archwire:

§ Distalise lower molars

§ Intrude lower molars

§ Extrude lower anterior teeth – change to occlusal plane

· Extraction of 3rd molars

· TADs left in situ in retention in case of relapse.

9th case periodontally compromised patient

o 014NT, not all teeth ligated, alternate teeth ligated = increase inter-bracket distance = less force

References

Venugopal, A., Manzano, P. and Rengalakshmi, S., 2020. A Novel Temporary Anchorage Device Aided Sectional Mechanics for Simultaneous Orthodontic Retraction and Intrusion. Case Reports in Dentistry, 2020.

Venugopal, A., 2020. Interarch traction for impacted canines. APOS Trends in Orthodontics, 10(1), pp.60-61.

Venugopal, A., Manzano, P., Arnold, J., Ludwig, B. and Vaid, N.R., 2020. Treating a severe iatrogenic gingival exposure and lip incompetence–a challenge worthwhile. International orthodontics.