有關dr. CARRIERE所發明的CARRIERE SLB自鎖式矯正器與CARRIERE DISTALIZER(遠心移動棒)的相關文章,請利用左下站內搜尋 鍵入 CARRIERE SLB 或是 CARRIERE DISTALIZER就可以找到過去PO過的文章與案例
w syllabus DR. CARRIERE Q&A AJO) American Journal of Orthopedics
AJO-DO(American Journal of Orthodontics and Dentofacial Orthopedics )
New Low-Friction Ligation System*(JCO)
●CL I PLATFORM~~to provide a rotation movement of the maxillary 1st molars around their palatal root & the same time receive a distalization impulse to achive distal movement
建立intercuspidation of canines & molars,同時C.O=C.R
●83%的MOLAR TOOTH本身有ROTATION
●CANINE MOVEMENT~~~~TRANSLATION
MOLAR MOVEMENT~~~~~ROTATION+UPRIGHTING+TRANSLATION
●CARRIERE提到牙周微血管的壓力為20~26gm/cm2,所以在矯正操作上,必須是以輕,持續力為主,若力量過大(overpower)則會產生ischemia~~造成necrosis tissue appear
●經過carriere distalizer的作用後,canine遠心端之fiber受到squeeze,近心端回拉,看似牙齒產生tipping,其時check panorex後,牙根是直立的,也就是說6543-3456是平行的產生位移,也就是牙根沒有偏斜
●sources of anchorage in the mandible~~
1)lingual arch
2)full bonded lower
3)lower essix with attachment in premolars & molars & CL II hooks
4)miniscrews in lower between 7-6/6-7,absolute orthodontic anchorage (1.8mm to 1.2mm diameter)
●ESSIX的製作是先戴上於口腔下顎後,再以剪刀剪去MOLAR BUCCAL TUBE位置留出窗口,再黏上BUCCAL TUBE
MINISCREW:ABSOLUTE ANCHORAGE
有打在上顎的ZYGOMATIC PROCESS,掛UNTRAMAXILLARY ELASTICS OR SPRINGS,主要是用在NON-COMPLIANCE PATIENT~~這是由DR. OJEDA -PERESTRELO提供的方法(用ZYGOMATIC PROCESS骨釘當支抗來拉CARRIERE DISTALIZER),處理上還要特別注意M-B ROOT在MOLAR 做ROTATION時會被骨釘卡住的可能,所以要注意植入點,D-B ROOT較不會有此情形
●ELASTICS的掛用:
STRENGTH:6 1/2 OUNCES 1/4 INCHES(或是8 OUNCES ,3/16")
WEARING TIME:
1)LOW ANGLE 案例: 24 HRS/EXCEPT EATING TIME
2)HIGH ANGLE案例:NIGHT TIME ,IF POSSIBLE 14 HR/INCLUDING PART OF DAY TIME
●當一邊是CL II CANINE ,另一邊是CL I CANINE,則ELASTIC一邊用大一點,另一邊會小一點
●不要同時用太多的矯正道具,比如HEADGEAR,FORSUS,TFBC與CARRIERE DISTALIZER併用,因為這樣作用會被干擾,產生支抗被偷走的現象
●unidirectional movement~~
wire with longer activation life makes possible to see patients every 8 weeks & to keep a more uniform direction
●friction~~static friction & kinetic friction
light aircrafts +90HP=180MILES/HR
boat+480HP=26 miles/hr
the ideal is to minimize friction
●"looseness" with precision,passive SLB enable clinician to keep control crowded case
●In general ,the biology of the body governs the response to the treatment,the orthodontist at the present can't change it
The only approach is to try to find the most biologic compatible system of applying force on the body structures
●carriere distalizer近心端在黏犬齒的時候,它的黏著位置是在靠牙齒中軸近心處,而非放在中軸上,此點要特別留意!!(這是順著morphology的形態來操作的)
●當第一階段carriere distalizer經由口腔內作用達到molar CL I PLATFORM後,可以看到上顎的CANINE剛好咬在下顎的3-4間,這時就是可以進入第二階段的流程,此時,採用的是PASSIVE LIGATION,也就是6543/3456是以PASSIVE的方式輕輕連綁住,而不是以加力(TWIST)的方式來綁,此點要注意,否則好不容易構建的MOLAR RELATION又會再一次的近心轉位
●其次,當進入上顎的LEVELING階段後,有一項操作要注意,那就是把5-4/4-5以連續皮鏈綁在3-2/2-3間的HOOK上, 其口訣為(2ND-1ST-HOOK On THE WIRE,,如下圖),這是為了HOLDING住3-4-5的關係,不可以HOOK到3/3的掛鉤上,會產生ROTATION的
●CARRIERE DISTALIZER本身有分左右,它會標示在MOLAR的關節(HINGE)下方,分別以R/L標示,使用上務必要注意,不要裝反了,在安裝前,可以使用廠商提供的量尺,分別去確認C/D的長度,本身有23,25,27MM三種尺寸,東方人大都以前2者為常用,後一種幾乎少用
●FROM THE side of the patient
~nickle free for patient protection
~size最小,locking mechanism in the face
~hygiene control easy & simple
~anatomically comfortable
●FROM THE side of orthodontists
~precise end gentle sliding locking mechanism
~can be opened with a simple explorer and be closed by a finger pressure audible"click"
~fact & easy wire changing closing direction of the slide
In severely crowded cases,the opening of the slide towards the incisal gives the possibility of opening the slide freely towards the incisal direction,pernitting an easy insertion of the wire
This, permits to place posts in the gingival side of the body of the bracket
MIM body gives max. precision & strength traditional wings for transforming it into an "active" bracket
●brainstorming
the truth is bearded by the patient a sound diagnosis gives us the clue
nobody has the intellectual property on how to treat cases!!
our obligation
mechanics with the following characteristics
1)body friendly
2)non-invasive
3)biominimalist
nautre gives us a response to our wishes for a respectful appliance design~~biomimetics & nature objectified design
dogmas are absolute ,they comes & go
●wire sequence(DR. CARRIERE在演講中的案例使用範例)
1) DISTALIZER 10 W(2.5月)
0.014THERMAL NITI 10W
0.014X0.025THERMAL NITI 8 W
0.017X0.025THERMAL NITI 8 W
0.019X0.025THERMAL NITI 8 W
0.019X0.025 S.S.W 10 W (讓TORQUE完全表現出來)
TOTAL 13 1/2 MONTHS
2)50YRS OLD LADY
DISTALIZER 20 W(5月)
0.014 THERMAL NITI 10 W
0.014X0.025THERMAL NITI 10 W
0.017X0.025 THERMAL NITI 8 W
0.019X0.025THERMAL NITI 8 W
0.019X0.025 S.S.W 10 W
TOTAL 16 1/2 MONTHS
3)29YRS OLD FEMALE PATIENT,DEEP BITE CL II FACIAL PATTERN OVERJET大
DISTALIZER 12 W
0.014THERMAL NITI 10W
0.014X0.025 THERMAL NITI 10 W
0.017X0.025THERMAL NITI 10 W
0.019X0.025THERMAL NITI 14 W
0.019X0.025 S.S.W 16 W
TOTAL 18 MONTHS
●DR. CARRIERE在課堂上特別注意到看病人的PROFILE時,需留意NASOLABIAL ANGLE與SUPERMENTALIS SULCUS TENSION,若原本病人PROFILE就相當不錯,儘量不去拔牙,維持其好的前牙關係,對PROFILE控制較能取得良好的結果
●若一邊是高位CANINE的一邊是正常的CANINE位置,DISTALIZER可以一邊黏7-4,另一邊黏3-6,採不對稱性的ELASTICS牽引
●CARRIERE DISTALIZER的使用原則
1)CANINE ERUPTED,,GOOD DIAGNOSIS
2)CL II CLINICAL CASES
3)BOND MOLAR ----CANINE
4)8,9歲的小孩可以黏C/C~6/6
●DR. CARRIERE 說,當1ST STAGE後,6543/3456採PASSIVE FIG 8 LIGATION主要是為了使後牙段穩定,ANTERIOR RETRACTION 應該MILD & GENTLE ,這是為了要得到良好的TORQUE,所以必須NOT VERY QUICK!!
●DR. CARRIERE曾在課間提到,市售的CARRIERE SLB矯正器有三家在販售,其來源都是出自同一廠家,並沒有甚麼差異性
●若您在使用CARRIERE SLB矯正器時,發覺有一兩個滑蓋不好打開,DR. CARRIERE告訴我他會用ETCHING AGENT,酸蝕一下,60秒或2分鐘,之後很好開,我自己的方法是用噴沙來做處理,把可能的雜質打掉,,,經驗告訴我這通常是廠商製作過程的滑蓋不夠精密
●我曾在課間建議DR. CARRIERE將來可以利用CB CT(cone beam CT)來取得CARRIERE SLB & CARRIERE DISTALIZER的三度空間變化表現,他也答應請廠商配合,我們拭目以待!!
●課間也有醫生問到,CARRIERE SLB矯正器有些滑蓋會自動打開一事,可能只是少數個案,我個人使用一年來,很少發現有此現象,通常我的經驗是,可能醫生在關的時候,沒有讓滑蓋完全關上,才會有此情形
●有關DR. CARRIERE 在上課裡有提到牙齒移動的那些數據,在去年的筆記我已整理出,請利用搜尋去找出來參閱即可,,,
syllabus on the carriere distalizer and its use
fast,effective treatment of the CL II malocclusions
ortho classic carriere SLB官方網站
The Carriere LX™Self-Ligating Bracket takes clinicalperformance and patient outcomes to a new level
留言列表
