Orthotown October 2023 - 28

EARNED PLACEMENT
Fig. 4
Fig. 6
Fig. 5
Fig. 7
Ultima System is that when using
variable torque brackets, the
0.018-by-0.0275-inch wire has full
control in all three planes of space,
and first, second and third orders of
tooth movement are fully expressed
and controlled. When using light
intermaxillary elastics (2 ounces),
the resultant forces are expressed
in the anterior-posterior direction
but not so strong as to overpower
the torque couples protecting the
incisor facial angulations. Additionally,
once the tooth movement has
been expressed, the wire-bracket
interaction becomes passive.
At the end of this phase, all
was resolved through posterior
development to prevent unwanted
round-tripping of the lower anterior
teeth.
After six weeks, the patient returned
and the UR3 was engaged
while maintaining U/L archwires.
The patient was seen again after
six more weeks, and wires were
changed to 0.018-inch CuNiTi
extending to the U/L 7s. Wires were
again changed six weeks later
to 0.014-by-0.0275-inch CuNiTi
Ultima U/L. These were maintained
for eight weeks until the patient
returned for his Phase 1 evaluation
(Fig. 5).
Observations: Because the
Damon Ultima System was designed
to be a true full-expression
system, consistent attributes are
seen throughout treatment. At the
end of this phase, all rotations are
expected to be resolved, maxillary
arch development is seen along
with mandibular buccal uprighting
and axial inclinations are almost set.
All are seen here with the maxillary
arch development resulting in a
3 mm diastema and a significant improvement
in the Class 2 buccal relation.
There were only two simple
archwire changes, and this portion
of the treatment was completed in
about 7 months.
Phase 2 (7-10 months)
Upon returning, the wires were
changed to 0.018-by-0.0275-inch
CuNiTi Ultima U/L. A Generation 2
wide chain was placed from the
U3-3 to consolidate the anterior
spacing, and the elastics were
changed to 3.5-ounce, 3/16-inch
(rabbit) Class 2 full-time. A few
brackets were repositioned at
the six-week pan/repo appointment,
and the case was left for an
additional six weeks (Fig. 6) before
progressing to the final wires.
Observations: One of the most
remarkable attributes of the Damon
OCTOBER 2023 | 28 | ORTHOTOWN.COM
corrected rotations are expected to
be maintained, axial inclinations are
corrected, and anterior torque is fully
expressed and protected. Again,
the predictability of this system
is seen in these Phase 2 photographs.
Phase 2 is one of the most
straightforward in that it consists
of one archwire change, and the
overall time is an additional three
months, moving the total treatment
time to 10 months.
Phase 3 (10-13 months)
The final wires chosen in this case
were 0.018-by-0.0275-inch stainless
steel (SS) Ultima upper and
0.016-by-0.0275-inch SS Ultima
lower. The reason for the SS wires
was to have the proper stiffness to
allow for space closure between
the anterior and posterior segments
using a 125 g, 12 mm NiTi
coil spring and archwire shaping
for added arch development. The
lower SS wire was used for continued
buccal uprighting and final arch
leveling. The patient was seen for
two visits for shaping of wires, slight
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Orthotown October 2023

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