@2008.11.15DR. TOM PITTS(湯姆皮茲)來台演講記~3(演講筆記)－崇愛牙醫診所(資料重建中,歡迎新舊朋友)

FACIAL standard have changed(自1930年演變到1990年),不管從lip projection或是lip curl來看,

Sarver's classification of appearance &esthetics

Macroesthetics

↓

profile

vertical properties

lip fullness & vermillion arch

chin-nasal projection

facial widths

Miniesthetis

↓

incisor display

transverse smile

smile symmetry

crowding

smile arc

Microesthetics

↓

gingival shape & contour emergence profiles

tooth shade

tooth shape contacts ,connectors & embrassures

*MY BRACKET positioning depends on smile arc

*increasing vertical lower face ,high torque,proper torque,arch width,arch form

*it's not just the damon bracket,it is how you use it!!!!!!

incisal plane ,incisal cant,smile presentation

*it is not just about strengthening teeth,arch development is a major factor to more impressive mid-facial beauty and non-extraction treatment

*torque seems to come to a higher posture with the very light forces

*force level is extremely important to arch development

*natural expansion with light force

*mastery of damon finishing ,developing with 4 steps

1)learning how to use the appliance to fit the teeth together beautifully

2)learing how to create results with enhanced (highest &best) facial & smile esthetics

3)adding efficency to the process without diminishing the quality

-appliance placement/custom torque

-letting the system work

-early light elastics

-finishing elastics /cuspal continuing

4)learing how to retain the results

esthetic functional occlusion---esthetic facial balance

vertical is important to esthetics

vertical dimension

intrusion & extrusion of the posterior teeth without have to smile line

bracket positioning= 1st key to finishing

-very little flash of composites

-great adhesion

-great slot position

@ideal placement criteria

~smile arc

~matually protected occlusion

~marginal ridge & contacts point

~symmetry

~transition from the anteriors to the buccal segments/occlusion of buccal cusps

~torque control

DR. TOM PITTS在黏6與7的見解~~他的6會黏在CONTACT LINE的位置,而7會更靠OCCLUSIVE一點來黏,

look at the contact points

~more gingival on molars

1.out of occlusion

2.more torque control

~then find my best

@The key to my bracket positioning

upper cuspid to cuspid esthetics

smile arc & line

arch other tooth is set up for idealizing the occlusion

DR. TOM PITTS提到他在黏DEEP BITE(深咬)的CASE之前牙,會將bracket黏靠切端一點(more incisally),而open bite(開咬)的case會黏靠齦端一點(more gingivally)

其lower cuspids會黏在mesial to crown-long axis(height of contours)

DR. TOM PITTS的bracket似乎黏的位置較不同,他說是occlusal of wings about level with the height of contact points

@DR. TOM PITTS的MOLARS(6/7) & BI'S(4/5)的轉矩度與旋轉度

6 -18度的TORQUE/12度的ROTATION

7 -27度的TORQUE/10度的ROTATION

4/5 -7度的TORQUE

@COMMON ERRORS(常見的錯誤)

~bracket too mesial on upper 1st bicuspids/not mesial enough on the cuspids

@在deep bite 的case, 掛橡皮筋時採用上4下6的短皮圈牽引,使用3/16"(<2 oz) quail~~慢慢的變成kangerloo(4 oz)

@在gummy smile或是deep bite的case,bracket放較incisally的地方,可以產生intrusion的作用

@must achieve a great smile arc,#8(指的是右上1=中門牙) root is completely through the labial plate

@liabilities of non extraction treatment

~lack of papillae-pepper spots

~labial-gingival recession

~causing her to be too prortrusive

~procling the anterior teeth

~possibility of extracting

@ my case illustrated

~torque control

~arch will preformed

~patience

~peri-response to low forces

~finishing elastics

~slendering for tooth size

~bite adjusting retention

@ I left plenty of wire behind last engaged tooth~~如用013" cu niti wire時,DR. TOM PITTS是把WIRE在molar tooth前回折不入線到moalr tube裡,這樣可以產生proclination & anterior open bite,解決它的辦法是配戴lift up & down elastics 或是rebond anterior 3-3的brackets

@DR. TOM PITTS使用的方線有兩種wire size &sequence

019x025 SSW 016X025 SSW

019X025 TMA 016X025 TMA

always have posters or loops distal to lateral incisors on steel of TMA wire

1) never lose your way

2)tie backs +clearing(?) +stops

3)always know which side of the arch wire is up

4)easy to coordinate & gain symmetry

@ DR. TOM PITTS採用arch symmetry chart & DAMON SL universal arch form

@ don't overtorque the upper anteriors ,use steel on any CL II or space closing mechanics

if use TMA , I nose to incisal plane is important

@若是p't 有asymmetry的情況,其睡覺時很可能都是用另一側在睡,因此臉會偏向不對稱的那一側,這在CL III的案例裡常見到臉不對稱的情形

@ 3/3的口腔內位置是與INCISAL PLANE呈垂直

@DO'nt forget the pharyngeal airway!

@CL III

~reverse upper anterior brackets

~elastics or safe springs

~lower abterior guide plane (prn)

~after completing ,place in MT splint for retention

@ELE( EARLY LIGHT ELASTICS)的好處

1.controllary vertical dimension

2.controllary AP(前後) correction

3.influency higher torque posture

4.enhancing increased arch width

5.increased efficency

6.doesn't hurt the patient

must have full time (24 hrs)

saved them up to 12 mon of treatment time

3/16" 2 oz (Quails) from L 6(下6) TO U 4(上4)~~FULL time

@ CL I OPEN BITE 案例

~BONDING TEETH

~U & L 014 OR 013 CU NITI

~BITE TURBOS LOWER MOLARS

~SQUEEZE ERERCISES

~3/16" 2 oz (quails) U 3 to L 4 OR L3 (這個叫TENT ELASTICS,像帳蓬一樣的掛法)

@ CL II OPEN BITE 案例

~BONDING TEETH

~U & L 014 OR 013 CU NITI

~BITE TURBOS LOWER MOLARS

~SQUEEZE ERERCISES

~3/16" 2 OZ (QUAILS) U3 TO L5

@ CL III OPEN BITE 案例

~BONDING TEETH

~U & L 014 OR 013 CU NITI

~BITE TURBOS LOWER MOLARS

~SQUEEZE ERERCISES

~3/16" 2 OZ (QUAILS) L3 TO U5

@CROSSBITE : lingual kaplan hooks

posterior bite turbos (disarticulated)

014" CU NITI

5/16" 2 OZ PARROTS( U5-6 lingual to L 5-6 buccals)

switch to dolphins (5/16" 3 oz) at 2nd appointment

@ CL III OPEN-severe

posterior crossbite & anterior down & widen (?)=5/16"(parrots)

@dr. tom pitts不使用reverse curve of spee wire(也就是搖椅弓絲),原因是成型的搖椅弓容易產生形變,牙列的corrdination很容易變掉,對於torque control不利,所以他建議少用

@DEEP BITES

~keep the elastics more distally

except for openbite with good vertical ELE~~treatment works on adults

bite ramps at L 1's( CL III) U5~~L3/L3~~U5 2 oz 3/16"

@dr, tom pitts在黏前牙的時候提到一個訣竅~~就是將bracket的mesial wall與牙體的近心面端的wall平行,這是一個觀測法

@No torque rake Or glossectomy

no special anchorage or TADs

no headgear

LET'S look at extraction mechanics

revealled ~~only extract for the face

~bimaxillary protrusion with lip incompetence

~crowding with protrusion & very wide arches

~remember the more we widen, the arches with the proper torque on the

incisors ,the less we need to consider extraction

space closure on SSW(不鏽鋼),CONSOLIDATE space 3-3

lace upper or lower 3-3 with doing lifetimes end the SS behind 6's

I always close with 019x025 ssw on a straight wire,use posts or loops distal to laterals

+ 7度torque on U & L cuspids

place 019x025 preposted wires with lingual root torque form canine posteriorly with proper activation , one should expect about 1.2 mm closure per month

space closure with coil springs

I activate every 11 weeks

hice spring

medium NITI open coil spring retraction in children

niti coil or SS in adults

bend the end to a 90度 before hooking(把open coil spring的遠心端彎一個90度,來掛在wire上,而不是hook在buccal tube 上)

I end my SS wires at the 6's activates the spring about 9 mm or about 4~6 oz approximately 200 gm, tie the ligature on the bracket

closing maxillary space with medium niti coil springs(不放到7/7)

@DR. TOM PITTS不採用76/67連綁當ANCHORAGE用

@START WITH FINISHING IN MIND!!

@THE enamel plasty makes a big difference

@retainer(保持器的使用):