@ortho organizers的產品~MDA(multi-distalizing arch)大臼齒遠心移動的利器－崇愛牙醫診所(資料重建中,歡迎新舊朋友)

MDA是一種多功能的固定式裝置,主要的目的是被設計來當做大臼齒的遠心與整體移動,它可以雙側使用,也可以單側使用,也可以用在上顎或是下顎,在裝置被處於活化遠移階段,前牙區必須要有充裕的anchorage(支抗)來抵抗可能的反作用力,

上下顎的第一大臼齒必須上band,上顎的band上必須有0.045"的口外弓孔以便MDA的插入,若是使用在下顎的時候,一樣的0.045"的口外弓孔也是必須的 ,在遠移的過程,BUCCAL TUBE會有TIPPING的現象,

主線上的ANCHORAGE ARCH必須建立,且最小要有0.018X0.025"的不鏽鋼弓絲完全的ENGAGE進去

當使用的時候先取一塊BEEWAX或是BASEPLATE WAX來取得整個ARCH的蠟形印記
,

拿取整組所附的ORTHO ORGANIZERS的量尺,從一側的第一大臼齒近心量到對側的第一大臼齒近心,取得所需的SIZE(分成SIZE1,2,3,4,5,6,7),然後將取得的型號MDA插入試試大小是否可以,OMEGA LOOP的DISTAL LEG會約略落在頰面管近心2-3mm處,注意,omega loop不可以直接抵到口外弓孔的近心上面,這會影響到後方的open coil spring的充足放入的壓縮長度與活化,再一次將MDA與WAX IMPRESSION做一次確認形態,如果外型不夠好可以再RECONTOUR一下

犬齒的近心端MDA必須彎制一個OFFSET

其open coil spring所使用的size為0.010x0.045 nitanium或是不鏽鋼的材質,一般激活的長度為2mm左右,也就是buccal tube的近心與omega loop 的distal leg的距離+2mm,

接著將MDA的0.016X0.022的前牙段安放入bracket的slot裡,21/12的門牙區要用power chain(最好是長型的)來保持避免門牙翻出去(flaring),可以在2/2以結扎絲將之固定,再來將MDA上的hood(掛鉤)與第一小臼齒以結扎絲結扎起來

最重要的是要令patient 24小時帶用顎間的elastics,(除了吃飯與刷牙可以不戴外),橡皮筋的尺寸為第一周每側戴用3條1/4"
medium的皮筋來做活化,接下去的第2,3周減少為每側戴2條1/4"medium的皮筋,

所有戴用MDA的病人要每3周回診一次,

對於不配合的病人(non-compliant patient),必須採用固定式的顎間機制,來避免遠移的過程骯中,門牙外翻出去

MDA必須都放在上顎或是下顎的第一大臼齒上,若是第二大臼齒也存在的話,最好也上BAND,在激活的過程當中,必須在67/67以角線(0.018X0.025多股線的片段弓做連接),這樣可以防止在遠移的過程當中,第二大臼齒的不必要的伸長(extruding)或是推成crossbite

每次回診,都必須重新將omega loop做激活,也就是每次加力2mm,可以用omega loop plier來將distal leg做壓縮以抵到buccal tube的近心端,

激活後還是遵照上述的橡皮筋戴法繼續配掛,為了防止組織的回彈力,2mm的過矯正是必須的直到MDA被移除

注意:病人必須被告知,過程當中必須配掛橡皮筋來做MDA的支抗(anchorage),以免不必要的門牙外翻負作用產生(不戴橡皮筋的後果)

精彩幻燈片介紹(操作的方法) ,想了解MDA,務必點入慢慢學習體會題原理

A Fixed Appliance for Non-Extraction
Cases

Our Multi-Distalizing Arch™ (MDA) permits
non-extraction treatment even in severely crowded cases by allowing distal
movement for creating space. The teeth are moved bodily and do not
tip.

This distalizing arch is not phase dependent, so it is excellent for
mixed dentition cases. The appliance is also not dependent on age or growth for
producing dramatic results.

Virtually Eliminates Severe
Crowding
First and second molars can
be distalized up to 8 to 10 millimetres without tipping. This large gain in
space virtually eliminates severe crowding.

As a fixed appliance, the Multi-Distalizing Arch
greatly enhances treatment results by minimizing the need for patient
cooperation and the possibility of lost or broken appliances.

An Appliance with True
Multi-Treatment Capability
The Multi-Distalizing Arch is a true multi-treatment appliance.
Use it for bilateral, unilateral, maxillary or mandibular
distalization. The MDA can also correct asymmetrical malocclusions.

The
Pro Form Arch shape incorporates a rectangular .016 x .022 anterior wire that
activates torquing forces earlier in treatment. The length of active treatment
is more predictable because of the utilization of fixed interarch
mechanics.

Eliminates Functionals and
Headgear
The
Multi-Distalization Arch eliminates the need for functional appliances and/or
headgear to correct skeletal discrepancies.

case report ~molar distalization use with MDA