Orthotown November 2020 - 24

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Fenrisúlfr
Member Since: 02/25/09
Post: 3 of 15

Yep. Poor results can certainly occur as a result of misdiagnosis or shoddy mechanics, but
that is not the fault of the treatment modality. ■
9/22/2020

benzwire
Member Since: 04/25/12
Post: 4 of 15

Great post! What is your retention protocol, particularly with extraction of second premolars?
I've struggled with spaces opening at times on my second bi extraction cases. I prefer Essix to a
wraparound Hawley, but they aren't perfect either. Any tips? ■
9/22/2020

Dr-T
Member Since: 05/19/09
Post: 5 of 15

I feel like there were varied opinions on bicuspid extractions throughout the decades. In the
1960s-70s, extractions were sometimes performed to achieve ideal cephalometric goals, which
probably led to the dished-in look. In the '80s-90s, some orthos adapted a non-extraction only to
appeal to the public and counter the dished-in look. It seems like most of the more recent grads
(2000s to now) have a balanced approach of extraction vs. non-extraction based on many factors.
I still see some transfer cases, particularly from NY, that are treated non-extraction when they
should have had extractions. Is the public opinion there influencing the docs? ■
9/22/2020

Fenrisúlfr
Member Since: 02/25/09
Posts: 6 and 7 of 15

Benz, I provide an Essix and a Hawley with ball clasps for retention. If space closure was
protracted or complicated, I use a wraparound instead. The trick is to not debond immediately
after space closure. I stop inter- and intraarch traction for a visit or two, just to see if spaces
reopen. If they do not, we proceed toward debond. If they do, it is usually due to occlusion or
inadequate root parallelism.
Unfortunately, I still see way too many transfers and finished cases treated non-exo and with
crappy results. A lot of new grads seem to be very hesitant to proceed with extraction treatment.
Not sure if it is lack of training, or fear of patients refusing the recommendations. ■
9/23/2020

emac
Member Since: 11/21/11
Post: 8 of 15

Very nice case! At the beginning of treatment, you must decide on anchorage requirements.
Set the case up for max or min anchorage and stick with it throughout treatment, even if that
means actually bending an archwire! ■
9/23/2020

Fenrisúlfr
Member Since: 02/25/09
Post: 9 of 15

Absolutely. Also very important to take a progress ceph in the middle of space closure,
if needed, in order to alter the mechanics. ■
9/23/2020

fesdds
Member Since: 05/22/08
Post: 10 of 15

The great thing with second premolars over first premolars are that spaces don't tend to open
often. Not an excuse, but most don't mind a very small space between U4-6, but no one wants
a space U3-5.
One of the biggest reasons I do see a space open between U4-6 is incorrect tip. For me, it
is usually the U6. If I didn't get enough mesial root tip, that space will open a little. My most
common retainer is a regular ball-clasp Hawley. Easy to use and it holds well. If I extracted, I swap
out Adams clasps for the ball clasps. It locks in the distance between incisors and first molar. ■
9/23/2020

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Orthotown November 2020

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