PabloEcharri,DDS

TreatmentofClassII Malocclusions

PabloEcharri,DDS

TreatmentofClassIIMalocclusion

2010CentrodeOrtodonciayATM,Ladent,SL Allrightsreserved Thisbookoranypartthereofmaynotbereproduced,storedinretrievalsystemortransmittedinanyformorby anymeans,electronic,mechanical,photocopyingorotherwise,withoutpriorwrittenpermissionofthepublishers.

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MODULEONE:TREATMENTOFCLASSII MALOCCLUSIONS APPLICATIONOFMODERNTREATMENT MODALITIESTOAVOIDOLDCOMPLICATIONS PabloEcharri,DDS

Index
ClaseII............................................................................................................................6 Treatment........................................................................................................15 ClassII.Earlytreatmentinmixeddentition............................................................20 DoubleTransferTraysforIndirect Bonding......................................................................................45 LingualTechnique.IndirectBonding:DoubleTransferTrayTechnique..50 SelfLigatingBrackets&SmartMechanics..56 StraightWireTratamentwithExtractions71 ExtractionCasesAbsoluteAnchorage..72 ExtractioncasesMinimumAnchorage...77 UnilateralExtractionCases..79 ExtractionsTreatment81 AModifiedPendulumApplianceforAnchorangeControl82 ModifiedPendulumwith4removablearms..90

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DistalizationwithPendulumMusingMicroimplantsafterthePendulumM99 DistalizationwithPendulumMIncreasingtheApplianceAnchoragewith Microimplants..101 Distalization..103 TwinForceTherapy..104 QuadHelix..122 AssymetricExpansion.124 NitaniumPalatalExpander.126 SeparationAndRapidExpansion.131 Bibliography139 Handson: Propermicroimplantinsertiontoachievedistalizationinextractioncases HowtoadaptandusetheTwinForceBiteCorrectordevice,crimpablehooks andbiteguides HowtoactivatePendulumsprings

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TreatmentofClassIIMalocclusion

ClaseII

DENTALDEFINITION
MolarClassIImalocclusionisarelationbetweentheupperandlowerfirst bicuspidswhenthemesiolabialvertexoftheupperfirstmolarcuspoccludes mesiallyfromthemesiolabialgrooveofthelowerfirstmolar. Orthodonticproblem.

CLASSIFICATION
ClassIIuniorbilateral(subdivisions). ClassII1stdivision(overjet). ClassII2nddivision(overbite). ClassII2nddivision,deckbisstype(overbiteandcrowding). ClassIIcamouflagedinClassI(advancedpositionofmandible).

MolarClassIImalocclusionveryrarelyoccursduetospontaneousdistalizingof lowermolar.Usuallyitisaresultofamesializing,mesialversionormesialrotation oftheuppermolar.

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CLASSII1STDIVISION
Proinclinationofupperincisors. Increasedoverjet. IncisalClassII.

CLASSII2NDDIVISION
Retroinclinationofupperincisors. Normaloverjet. Increasedoverbite.

CLASSII2NDDECKBISS
Retroinclinationof11and21withproinclinationof12and22. Anteriordeepbite.

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CLASSII1stDivisionLeftSubdivision

CLASSII
-

2nddivisionisalwaysaccompaniedbyanteriordeepbite. 1stdivisioncanhave: o Normaloverbite Anterioropenbite. Anteriordeepbite. ***Both1stand2nddivisionscanhaveposterioruniorbilateral crossbite.

Accordingtodentoalveolardiscrepancies,itcanbe: o Normal. o Withcrowding. o Withspacing.

SKELETALCLASSII
Themaincharacteristicofthismalocclusionisincreasedconvexity(Ricketts)or increasedANBangle(Steiner). Orthopaedicproblem(duringthegrowthperiod)orsurgical(afterthegrowth periodisfinished). Inmildcases,acompensationorcamouflageispossible.

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SKELETALCLASSIITYPES
Duetomaxillaryprognatia(increasedmaxillarydepth,anglebetweenFrancfort planeandNA). Duetomandibularretrognatia(decreasedfacialdepth,anglebetween FrancfortplaneandFacialplane. Combinationoftheprevioustwo. Biretrognathia,usuallyindolychofacialpatients. Biprognathia(morefrequentinAsiaticpatients).

SKELETALCLASSIITYPES CLASSIFICATION
SkeletalClassII(onlysagittalplaneisaffectedmesofacialandsymmetric patient). SkeletalClassII,inwhichaverticalplaneisaffected:braquifacialor dolychofacialClassII. SkeletalClassII,inwhichtransverseplaneisaffected:asymmetricalClassII. ClassIIwithallthreeplanesaffected. ClassIIcamouflagedinClassI: o TheApointcanberetrudedduetotheincreasedincisaltorque. o DuetoasymphisisshapewithadvancedPogonion. o DuetoanadvancedpositionofmandibleinrespecttoCR(forexample, caseswithcrossbiteoflateralincisors).

TreatmentofClassIIMalocclusion

CAUSESOFCLASSII
Heritage. Symptomofgeneralsyndromes. Softfoodwithoutdentalabrasioninmandibularadvanceintemporary dentition. Mouthbreathing(specialistsinPediatry,ORLorallegologistshouldbe consulted). Childswallowing(reeducationoftongueinterposition). Prolongeduseofapacifierandafeedingbottle(olderthantheageof2). Liporfingersuction,etc. Incompetentorshortupperlip.

CLASSIIPROGNOSIS
Persistenceofetiologicalfactors(themoreabnormalhabitsandfunctions,the lessfavourabletheprognosisis). MolarClassIIseriousness(ifthereismorethanonecusp,theprognosisisless favourable). IncisalClassIIseriousness(a4mmOJisnotthesameasa12mmOJ). Dentoalveolardiscrepancy(Themorecrowding,thelessfavourableprognosis). Anterioroverbite(ThegreaterOB,thelessfavourableprognosis.TheClassII mechanicstendstoincreaseoverbite). Posteriorcrossbite(lessfavourableprognosisbecauseanotherproblemis added). SkeletalClassIIseriousness. SkeletalClassIIduetomandibularretrognathiahaslessfavourableprognosis thanifitisduetomaxillaryprognathia.

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Iftherearemorethanoneaffectedplane:verticalandtransversehaveless favourableprognosis. Themoreanchoragerequirements,thelessfavourableprognosis(unless microimplantsareused).

CLASSIIANDMOUTHBREATHING(Dr.Durn) MOUTHBREATHINGCAUSES
-

Nasalcauses. Oralcauses.
Pharyngealcauses.NASALCAUSES

Hypertrophyofcornets. Septumdeviation. Polyposisandnasalallergy.

ORALCAUSES
Amigdalarhypertrophy. Increasedtonguesize.

PHARYNGEALCAUSES:
Adenoidalhypertrophy.

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MOUTHBREATHINGCONSEQUENCES
Posteriormandibularrotation. Lipincompetence. Tonguedescent. Hypertonicelevatingmuscles. Freespacebetweenjaws. Inhibitionofmandibulargrowth. Allabovementionedwillprovokeaseriesofdentalandorthopaediceffects, whichwillgetworseifthehabitpersists.

IMMEDIATEEFFECTS
Lipincompetencegenerateslabialversionofupperincisorsandlingualversion oflowerincisors. Freespacebetweenjawsfavoursuppermolarextrusion.Lowermolardoesnot extrudebecausethelowpositionofthetongueleansonthelowerincisors. Occlusalplanerotatesincounterclockwisedirection. Mandibularclockwiserotationdescendsandretrudesthechin. Muscularhypotoniainhibitsthegrowthofthecondyleandthemandibular ramus.

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MEDIUMTERMEFFECTS
Anterioroverbiteincreases. Lowerlipinterpositionisproduced,usuallyfollowedbyatypicaldeglutition. (onehabitmoreisadded). MolarClassIIismoreevidentduetothepersistencyofupperlateralsector extrusionandtheblockageofthelowerteetheruption. Thereisanalveolarremodellingwhichstabilizespostrotationandmandibular retrusion. Thereisalreadyskeletal(orthopaedic)ClassII(convexityisincreasedandfacial depthdescentinRickettsceph).

LONGTERMEFFECTS
Overbiteincreaseduetothelowerincisorsextrusionandtheblockageofthe upperincisorseruption,whichisaresultofalowerlipinterposition. StabilizingoftheAnglemolarClassII. Lowtonguepositionfavourstheappearanceofmaxillarycontraction(unio bilateralcrossbite). Hypertoniclowerlip.Shortandhypotonicupperlip. AllpreviouslymentionedresultsinAngleClassII1stdivision.
Thesoonerthecauseofmouthbreathingisresolved,thelessdentalandorthopaedic effectsshouldbedealtwith. Iforthodontictreatmentiscarriedoutinapatientmouthbreather,relapseis inevitable.

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Treatment

SKELETALCLASSIITREATMENT
DentalClassIIwithskeletalClassImalocclusiontreatmentisexclusivelyan orthodontictreatment. DentalClassIIwithskeletalClassIImalocclusiontreatmentrequiresa treatmentthatincludesbasalbones. Dependingontheage,anorthopaedictreatmentorsurgicaltreatmentwillbe carriedout.

TREATMENTOFSKELETALCLASSIIDUETOMAXILLARYCAUSE(1)
ClassIIduetoamaxillaryprognathiamalocclusioniseasiertotreat. Orthopaedicappliancesorsurgeryarenotusuallyusedformaxillaretrusion.It willbetreatedwithextractionsandupperanteriorgroupretrusion.

TREATMENTOFSKELETALCLASSIIDUETOMAXILLARYCAUSE(2)
ClassIIduetoaverticalmaxillaryhyperplasiamalocclusionismoredifficultto treat. Orthopaedicappliances(highpullheadgear)orsurgeryareusuallyusedto impactmaxilla,torotatemandibleinacounterclockwisedirection,withor withoutmandibularsurgery.

TREATMENTOFSKELETALCLASSIIDUETOMAXILLARYCAUSE(3)

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Inmanycases,ClassIIisaccompaniedbyatransversemaxillaryhypoplasia. Thiscontractionofmaxillakeepsthemandibleinaretrusiveposition (moccasinlikeeffectbyMcNamara).

TREATMENTOFSKELETALCLASSIIDUETOMANDIBULAR CAUSE(1)
Moredifficulttotreat. Themandibleismoresusceptiblebecauseitsgrowthisstimulated(duetothe condylarandtemporalcartilage(glenoidfossa)). Goodresultsareachievedonlyifthetreatmentiscarriedoutintheperiodof patientsgrowthpitch.

TREATMENTINMIXEDDENTITION(1)
Verticalmaxillaryhyperplasia:growthcontrolusinghighpullheadgear. Mandibularhypoplasia:mandibulargrowthstimulationusingfunctional appliances:TwinBlock. Ifdentoalveolardiscrepancyisverynegative,serialextractionsorexpansion shouldbecarriedout. OverbitecontrolusingFunctionalCplate. Anchoragecontrol:especiallyinextractioncases. Transverseexpansion:especiallyincasesinwhichisdetectedthatmaxilla contractioninhibitsmandibularadvance(moccasinlikeeffectbyMcNamara).

CLASSII1STDIVISIONMALOCCLUSIONTREATMENTWITH EXTRACTIONSINMAXILLA

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Themostfrequentlyextractedteethareupperfirstmolars. 1starch:.016NiTi(ALR) 2ndarch:.016x.022SSwithdistolateralTloopandsagittalandtransverse compensationcurves.Thisarchisusedfortorqueestablishing,canine distalizing,anteriorgroupretrusionandclosureoftheremnantspaces(STIR) 3rdarch:.017x.025SSwithantemolaromegaandastop,andsagittaland transversecompensationcurves(MID).

CLASSII1STDIVISIONMALOCCLUSIONTREATMENTWITHOUT EXTRACTIONSINMAXILLA
Itappearsonlyinfewcases. 1starch:.016NiTiwithdistalbend,toalignandtoprotrude. 2ndarch:.016x.022SSwithantecanineTloopandcompensationcurves. (orwithantemolaromegas,iftherearenospaces). 3rdarch:.018x.025SSwithantemolaromegaandsagittalandtransverse compensationcurves.

***Toretrudethewholemaxilla,butwithoutextractionsorspaces,enmasse retrusionofallupperteeth,oramandibularadvanceshouldbedone.

- UPPERRETRUSIONCANBECARRIEDOUTWITH:
o Headgear. o Distalmicroimplant(insertedinthetuberosity). o Distalizingtreatment(usingPendulumapplianceandwisdomteeth extraction). ***Ithasaneffectinmesofacialandbraquifacialpatients. o ClassIIelastics(upperretrusionandloweradvance).

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- MANDIBULARADVANCECANBECARRIEDOUTWITH:
o ClassIIelastics. o Fixedfunctionalappliances:Herbstappliance,TwinForce. **Themovementsarealwaysbimaxillary,maxillaisalittlebitretruded. **Ifthereisnoremnantgrowth,themovementwillbeof23mmindento alveolardirection,oritwillprovokeadoubleocclusion(maximalocclusion, advancedintercupationinrespecttothecentricrelation).

NONEXTRACTIONTREATMENTINMANDIBLE
Withcorrectmaxilla:Ideallingualarchforconsolidation,andClassIIelasticsas anchorage. Withonlyincisorscrowding:Utilityarchforalignmentandprotrusion. Withextrusionofloweranteriorgroup:Utilityarchforintrusion.

***Theseabovementionedcasesareexceptional. Withgeneralcrowding:Sequenceofarchesforalignment:.016NiTi,.016x .022NiTiorSS,and.018x.025SSwithomegas.

EXTRACTIONTREATMENTINMANDIBLE
Themostcommonextractionsaretheextractionsofthefirstandsecond bicuspids. 1starch:.016NiTi. 2ndarch:.016x.022SSwithdistolateralTloopsandcompensationcurves(to closespaces). 3rdarch:.0172x.025SSwithantemolaromegasandcompensationcurves.

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CLASSII2NDDIVISIONMALOCCLUSIONTREATMENT
ClassII2ndshouldbecomeClassII1stbeforeitiscorrected. Itisconvenienttheuseofa.016NiTi,toproinclinetheincisorsforwards.A utilityarchforproinclinationcanbeused,too. Apatientshouldbeinformedthatthetreatmenttimewillbelongerbecause ClassII1stdivisionmustbeachieved.Heshouldbealsowarnedofaesthetic changesthatwilltakeplaceduetotheupperprotrusion.

SIDEEFFECTSOFEXTRACTIONTREATMENT
Distalcaninemovementtendsto: A Distalinclinationofthecrown,whichiscompensatedbydistoradicularbonding ofthebracketsfor6. B Distalrotation,whichiscompensatedbyusingalingualbuttonandtractioning onbothlabialandlingualsides. Theretrusionmovementofincisorstendsto: A Torqueloss,whichiscompensatedbyincreasingthearchtorque,orindirect bondingwithmayorprescriptionofthetorqueorusingincisorsbracketswith extratorque. B Increasetheoverbite,whichiscompensatedwithasagittalcompensation curve. C Moreintrusionandpositivetorquecanbeactivatedbyactivatingahorizontal armofTloopusingTweedomegapliers. Mesialbicuspidsandmolarsmovementtendsto: A Mesialversionwhichiscompensatedbyasagittalcurve. B Mesialrotationwhichiscompensatedbyahorizontalcurve.

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ClassII.Earlytreatmentinmixeddentition
CPlateactive
Indications: IncreasedoverjetwithmolarClassIorClassII Increasedoverjetwithnormalorincreasedoverbite Increasedoverjetwithorwithoutposteriorcrossbite Increasedoverjetwithdiasthemasorcrowdingintheupperarch SkeletalclassIinmesofacial,mildbraquifacialormilddolicofacialpatients SkeletalclassIIconprognatismofmaxilla SkeletalclassIIwithmildretrognatismofmandible

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TheCPlateactiveincludes: 2Adamsretainerswithcircularloops XCmetallicplane Retainerspring Slidinglabialarchwire

Acrilicpalatalresin Elastics3,5oz,3/16

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TheexpansionCPlateactiveincludes: Planasexpansionscrew

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TheCPlateHawleychanges: TheslidinglabialarchwirebyaHawleylabialarchwire

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TreatmentofClassIIMalocclusion

Fig.A

Extractionoftemporaryupperrightandleftcuspids

Fig.B

UsetheCPlate1012hs/dayandchangetheelasticsevery45weeks

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Fig.C

Extractionoftemporaryupperrightandleftfirstmolars

Fig.D

Extractionofupperrightandleftfirstbicuspids.Changetheslidinglabialarchwirebya Hawleylabialarchwire

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Fig.E

Finishingwithfixedappliances.

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DuyzingsPlateActive

Indications: IncreasedoverjetwithmolarClassIorClassII Increasedoverjetwithnormalorreducedoverbite Increasedoverjetwithorwithoutposteriorcrossbite Increasedoverjetwithdiasthemasorcrowdingintheupperarch SkeletalclassIinmesofacial,mildbraquifacialormilddolicofacialpatients

SkeletalclassIIconprognatismofmaxilla SkeletalclassIIwithmildretrognatismofmandible

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TreatmentofClassIIMalocclusion

TheDuyzingsPlateactiveincludes: Palatalacrylicresinwithorwithoutexpansionscrew Labialacrylicshields Conexionspringsbetweenthelabialshieldsandthepalatalresin Lingualreference Loopsfortheslidinglabialarchwire

Stainlesssteeltubesfortheslidinglabialarchwire Slidinglabialarchwirewithcoilsprings

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Fig.A

Extractionoftemporaryupperrightandleftcuspids

Fig.B UsetheDuyzingsPlate1012hs/dayandactivatetheloopsfortheslidinglabialarchwireevery 45weeks

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Fig.C

Extractionoftemporaryupperrightandleftfirstmolars

Fig.D

Extractionofupperrightandleftfirstbicuspids.Changetheslidinglabialarchwirebya Hawleylabialarchwire

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Fig.E

Finishingwithfixedappliances.

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TreatmentofClassIIMalocclusion

TwinBlock
IndicationsSkeletalclassII:

Mandibularretrognatia MesofacialorBraquifacial DentalClassII,1;DentalclassII,2

Deepbite,openbite Growingpatient

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Figs.ABCD

DeepbiteTwinBlock

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TreatmentofClassIIMalocclusion

Figs.EFGH

OpenbiteTwinBlock

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Figs.IJKL

TwinBlockmodifiedwithlingualbuttonsandlabialshields

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Fig.M DeepbiteTwinBlock

Fig.N:

ClassII,1withdeepbite

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Fig.O

DeepbiteTwinBlock

Fig.P

Extrusionoffirstmolars

Fig.Q

TwinBlock2ndappliance

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Fig.R

Trimmingtheacrylicasaeruptionguidanceappliance

Fig.S

Trimmingtheacrylicasaeruptionguidanceappliance

Fig.T

Trimmingtheacrylicasaeruptionguidanceappliance

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Fig.V

Readyforfixedappliancesifnecessary

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TreatmentofClassIIMalocclusion

Fig.W ClassII,1withopenbite

Fig.X OpenbiteTwinBlock

Fig.Y

OpenbiteTwinBlock

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HighPullHeadgear(Orthopedics)
Indications: SkeletalClassII Verticalmaxillaryexcess Mandibularretrognathia(Postrotation) DentalClassII

Figs.AB

HeadgearwithloopsandHeadgearwithoutloops

Figs.CD

HeadgearwithCplane(Dr.Cervera)

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Figs.EF

CervicalPull

Figs.GH

HighPull

Figs.IJ

CombinationPull

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Fig.K

Dinamometer

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TreatmentofClassIIMalocclusion

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DoubleTransferTraysforIndirectBonding

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TreatmentofClassIIMalocclusion

LingualTechnique.IndirectBonding: DoubleTransferTrayTechnique

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TreatmentofClassIIMalocclusion

SelfLigatingBrackets&SmartMechanics

1BracketsandBuccalTubes

Carriere LX Self Ligating Bracket: Roth prescription in non-extraction cases. McLaughlin, Bennett and Trevisi in extraction cases.

CarriereLXSelfLigatingBracketdetails.

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SolsticeSelfLigating1stmolarbuccaltubesor Elite1stconvertiblemolartubesRothprescription Elite2ndMinimolarbuccaltubes.Rothprescription.

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TreatmentofClassIIMalocclusion

2ArchwiresSequence

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3Accesories

1ActionLigatureRotator

2MIMCrimpStops

3ArchwireStopLock(.018or.022)

4ArchwireStopLockwithHook(rightandleft)

5DoubleSidedArchwireStopLockWrench

6CrimplableBallHooks

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7CrimplableArchwirePowerHooks(rightandleft)

8HookCrimpingPlier

9TwinForceBiteCorrector

10NitaniumPalatalExpander2

11AncorProMicroimplants

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TreatmentofClassIIMalocclusion

4SmartMechanicsSLB&SM

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PASIVES 5RollingEffectControl

TheRollingEffectisthetendencyofthearchwirestoalateralsliding,especiallyinlow frictionsystems.Topreventthisundesireableeffectwecanusedimpledarchwiresor crimpablestopsbetweenthebracketsofthecentralincisors(2stopsintheupperarch and1stopinthelowerarch).Dependingonthecrowdingandrotationsofthecentral incisorswecannotusedimpledarchwires,butwecouldusecrimpablestopsin betweenthebracketsofotherteeth.ThismechanicsdonotpreventtheSlidingEffect.

6SlidingEffectControl

TheSlidingEffectinthetendencyofthearchwirestoaforwardsliding,especiallyin lowfrictionsystems.Thiseffectprovokesbothprotrusionandtorqueincreasingofthe incisors.Topreventthiseffect,whenitisnotindicated,wecanusemesialtomolar

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TreatmentofClassIIMalocclusion

crimpablehooksligatedtothemolartubes.ThismechanicsalsopreventstheRolling Effect.

7SpaceMaintainer

Tomaintainthespaceofanoneruptedoramissingtoothwecanuse2crimpable stops.ThismechanicsalsopreventstheRollingEffect.

8ExpansionCases

ToachievethetransverseexpansionofthearcheswecanusetheDLXexpansion archwires(seethearchwiressequenceonpage3).Togetmoreexpansion,wecanuse alsotheNitaniumPalatalExpander2andtogetaRapidPalatalExpansion,wecan useaBondedHyraxAppliance.

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9ExtractionCases

Intheextractioncases,wecanuseStainlessSteelrectangularwireswithcrimpable powerhooksandAncorProTADsforslidingmechanicsorCNAarchwiresforloops mechanics(seethearchwiresequenceonpage3).

10ClassII/ClassIIICases

Afteralignment,levellingandtorquecontrol,wecanusetheTwinForceBite CorrectortocorrectClassIIandClassIIIcaseswithbetterresultsthanClassIIandClass IIIelastics(seetheTwinForceTherapybyDr.Echarri).

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ACTIVES 11SpaceRegainer

ToregainaspacewecanuseaSuperelasticNitanium,orBioKinetixorBioKinetixPlus orBlackTiRoundArchwireswith2crimpablestopsinsteadofacoilspring.Thedistance betweenthe2stopsshouldbe2mmlargerthanthedistancebetweenthebrackets.

12StrippingCases

InStrippingCases,wecanuseaSuperelasticNitanium,orBioKinetixorBioKinetixPlus orBlackTiRoundArchwireswith2mesialtofirstbicuspidbracketscrimpablehooksligatedto thebicuspidbrackets.Thismechanicswillpreventboththeprotrusionandthetorque increasingoftheincisorsduringthestrippingandaligmentprocedure.

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13ProtrusionCases

InProtrusionCases,wecanuseaSuperelasticNitanium,orBioKinetixorBioKinetix PlusorBlackTiRoundArchwireswith2mesialtofirstbicuspidbracketscrimpablestopswith alargerdistancethanthedistancebetweenthefirstbicuspidbrackets.Thismechanicswill protrudeandincreasethetorqueoftheincisors.

14DistalizationCases

Incasesindicatingaminordistalizationofthemolarswecanuse2crimpablestops:one crimpablestopdistaltothefirstbicuspidandtheothercrimpablestopmesialtothefirstmolar tube.Thedistancebetweenthetwocrimpablestopsshouldbelargerthanthedistance betweenthebracketandthetube.Topreventthemesialmovementoftheanteriorteetha NancePalatalArchbondedorwelded(bands)tothefirstbicuspidisamust.Wecanuseother mechanicstoobtainamajordistalizationofthemolars.

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15CaseswithEctopicTeeth

Wecanuseadoublearchsystemwiththe.022brackets.Theanchoragearchwireisa.012 SuperelasticNitaniumArchwirewith2crimpablestopstomaintainthespace.Theectopic tootharchwireisasectionof.012BioKinetixarchwireligatedwithwireligaturetothe bracketsofthemesialanddistalteethtotheectopicone.Thisarchwireshouldhave2 crimpablestopstoavoidthelateralsliding.

16Tips

1OpenthecapforbondingusingtheBracketHeightGauge

2Openeasilywithascaler,awiredirectororanopeninginstrumentandapplyalight occusal/incisalpressure.
Closeeasilywiththefinger.

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3TheCarriereLXbracketsalsohavewingsforatraditionalwireligatureincaseswithteeth inextremepositions.

4Usetheligaturerotatortohelpforthecorrectionofrotatedteeth.

5Topreventthefrictionincreasingthe8figureligaturesortheelasticchainmustbeused underthearchwires.

6Aftertheactionoftherectangularwires,itisnecessarytotakeapanoramicXraytocheck therootsparallelism,andifnecessaryrebondsomebrackets.

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7Theintermaxillaryelasticstoimprovetheintercuspidationcanbefixedtothehooksofthe bracketsortocrimpableballhooksinthearchwire.

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StraightWireTratamentwithExtractions

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ExtractionCasesAbsoluteAnchorage

1Extractionoftherightandleft 2Bondthebracketstoalltheteeth.firstbicuspids.

3AlignmentandlevelingwithaNiTiRoundArchwire. 4Alignmentandlevelingcompleted.

5EstablishingtorquewithaNiTiRectangularArchwire. 6Torqueestablished.

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7StainlessSteelrectangulararchwirewithhooksweldedtothemolarbandsand figure8ligaturebetweensecondmolarandsecondbicuspid(onbothsides). 8Inserttwomicroimplants(68mm)rightonthedistalofthecuspids,oneontheleft andtheotherontherightside.

9Placeaclosingcoilspringoneachhook. 10Activateeachclosingcoilspringfromthehooktothemicroimplantonthesame side.

11Spaceclosurecompleted.

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ExtractioncasesMinimumAnchorage

1- Extraction on the right and left first bicuspids. 2- Bond the brackets to all the teeth.

3- Alignment and leveling with a NiTi Round Archwire. 4- Alignment and leveling completed.

5- Establishing torque with a NiTi Rectangular Archwire. 6- Torque established.

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7- Stainless Steel rectangular archwire with hooks welded to the molar bands and figure 8 ligature between second molar and second bicuspid (on both sides). 8- Insert two microimplants (6-8mm) right on the distal of the cuspids, one on the left and the other on the right side.

9- Place a closing coil spring on each hook. 10- Activate each closing coil spring from the hook to the microimplant on the same side.

12- Space closure completed.

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UnilateralExtractionCases

1Extractionoftherightorleftfirstbicuspid. 2Bondthebracketstoalltheteeth.

3AlignmentandlevelingwithaNiTiRoundArchwire. 4Alignmentandlevelingcompleted.

5EstablishingthetorquewithaNiTiRectangularArchwire. 6Torqueestablished.

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7StainlessSteelrectangulararchwirewithahookweldedtomolarband(on extractionside)andfigure8ligaturebetweensecondmolarandsecondbicuspid(on extractionside). 8Insertamicroimplant(68mm)rightonthedistalofcuspidonextractionside.

9Spaceclosingcoilspringonthehook. 10Activatetheclosingcoilspringfromthehooktothemicroimplant.

11Spaceclosurecompleted.

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ExtractionsTreatment

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AModifiedPendulumApplianceforAnchorange Control

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ModifiedPendulumwith4removable arms

1. FabricationoftheModifiedPendulumwith4removablearms:occlusalsupportin bicuspids,expansionscrewand4StainlessSteeltubestoinserttheremovablearms.

2. ModifiedPendulumwith4removablearms,occlusalview.

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3. ModifiedPendulumwith4removablearms,posteriorview.Observe4removable StainlessSteeltubes.

4. Pendulumforunilateraldistalizingofupperfirstandsecondrightmolar.Bonding technique1:bondingofthebandsand30acidetchingofocclusalsurfacesof bicuspids,and10rinsing.

5. Bondingtechnique2:InsertionofPendulumandbondingwithlightcuringcomposite.

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6. Bondingtechnique3:20lightcuring.

7. Bondingtechnique4:Checkingoftheocclusionusingarticulatingpaper.

8. Bondingtechnique5:Balancedocclusionofall4compositesurfacesshouldbe achieved,whichalsoshouldbesmoothandwithouttracesofantagonistcusps.

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9. TMAarmsforupperfirstandsecondrightmolar.

10. Insertionofthearmintothetubeinsidetheresinandinthelingualsheathofthe secondmolarbandfordistalizationofthesecondmolar.

11. Schemeofthesecondmolardistalization.

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12. Secondmolardistalization.

13. Xrayofsecondmolardistalization.

14. Schemeofthefirstmolardistalization.

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15. Firstmolardistalization.

16. Xrayoffirstmolardistalization.

17. Aftertheseparatedistalizationofthesecondandfirstmolar,Pendulumapplianceis removed,Nanceapplianceisinserted,andthesecondmolarisdistalizedusingelastic chain,andthemolaranchorageisincreasedwithfigure8ligaturebetweenthefirst andsecondmolar.

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18. Incontinuation,firstmolarisalsodistalizedusingelasticchain.

19. Incontinuation,canineisalsodistalizedusingelasticchainforthepurposeofaligning andlevelling.

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20. Activationfordistalizationfollowingthedesireddirectionofthemolar.Removable armsallowaverypreciseactivationofthearms,asitisexplainedincontinuation. 21.

22. Activationforexpansionorcontraction.

23. Activationfordistalormesialrotation.

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24. Activationfordistalormesialinclination.

25. Activationforintrusionorextrusion.

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DistalizationwithPendulumMusing MicroimplantsafterthePendulumM

1Bondbandsonfirstandsecondmolaronbothsides.BondPendulumMappliance. 2Insertthesecondmolarspringsinthependulumtube

3Insertsecondmolarspringinthelingualsheathsofsecondmolarbandstodistalize secondmolars. 4Insertthefirstmolarspringstodistalizethefirstmolars.

5Distalizationoffirstandsecondmolarscompleted. 6Bondthebracketsonfirstandsecondbicuspidsonbothsides.RemovePendulum appliance.Placefig8ligaturebetweenfirstandsecondmolaronbothsides.Insert microimplant(68mm)mesiallytofirstmolaronbothsides.LigateaStainlessSteel sectionalarchwireonbothsides.

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7Activateanelasticchainfromsecondbicuspidtomicroimplantonbothsidesfor distalizationofsecondbicuspids. 8Distalizationofsecondbicuspidscompleted.

9Ferulizefromsecondmolartosecondbicuspidusingfigure8. 10Distalizationoffirstbicuspidscompleted.

11Alignmentandlevelingofanteriorteeth(andretrusionsifindicated)using microimplantsifnecessary,iscompleted. 12Treatmentiscompleted.

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DistalizationwithPendulumMIncreasingthe ApplianceAnchoragewithMicroimplants

1Bondbandsonthefirstandsecondmolaronbothsides.BondthePendulumM appliance.ThePendulumMusedwithmicroimplantscanbesmallerandithastwo holestoinsertmicroimplants. 2Inserttwomicroimplants(8mm)throughacrylicplateofthependulum.

3Insertionofmicroimplantscompleted. 4Insertthesecondmolarspringsforsecondmolarsdistalization.

5Secondmolarsdistalizationcompleted. 6Insertthefirstmolarspringstodistalizethefirstmolars.

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7Distalizationofthefirstandsecondmolarscompleted. 8Distalizethesecondbicuspidswithelasticchain.

9CutthefirstbicuspidspringofthePendulumManddistalizethefirstbicuspidswith elasticchain. 10Distalizationofthefirstbicuspidscompleted.

11Bondthelingualorlabialbracketstoalltheteeth. 12Alignmentandlevelingcompleted.

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13Retrudetheanteriorteethwithcuspidtocuspidfigure8ligatureandelastic chainsfromcuspidstothePendulumMsprings. 14Retrusioncompleted.

Distalization

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Twin Force Therapy

ClassIItreatment
ClassIImalocclusionshouldbeconsiderednotonlyasasagittalplaneabnormality,but alsoastransverseandverticalplaneabnormalities,too. In sagittal plane, McNamara studies indicated that the majority of Class II malocclusions were characterized by mandibular retrusion and not maxillary protrusion, and therefore the most of the Class II malocclusion patients treated withoutextractionsimprovetheirprofiles. Apart from the sagittal plane, in majority of the cases a transverse plane is also affectedbymaxillarycontraction.Incasestreatedwithmandibularadvancementthe castsmustbeplacedinClassIinordertoevaluatethetransversemolarocclusionin advanced position of the mandible. If posterior cross bite is observed, an upper expansionmustbecarriedout. In many Class II malocclusion cases, the vertical plane is also affected, and patients present a vertical pattern with mandibular clockwise rotation that which worsens skeletalClassIImalocclusionandprofile. In short, many patients with skeletal Class II beneficiate from a treatment including mandibularadvancement,maxillaryexpansionandverticalcontrol.

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ClassIITreatmentSchemeusingCSWTechnique

Descriptionoftheappliance: TwinForceBiteCorrector(TFBC)DoubleLock

Twin Force Bite Corrector DoubleLock is an intraoral and intermaxillary appliance anditisusedinClassIImalocclusiontreatment.Itrequiresaminimalcooperation fromthepatient. The insertion and removal of the appliance is easy and rapid and there is no necessityforlaboratoryfabrication.ItisfixedtoSS.0172x.025archforthe.018 slotandtoSS.018x.025archforthe.022slot,adjustingthescrewwithaTwin Forcewrench.ItsNiTicomponentsofferaverysafeadjustmentsysteminthearch.

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Ballandsocketjointfastenerssituatedatitsends(nexttothewireclamps)allowa widerangeofjawmotionincludingthelateraljawmovements,whichincreasethe comfortofthepatient. The plunger/tube telescopic assemblies on each side contain NiTi coil springs that deliverconstantandlightforcestopositionthemandible.

Accessories: SpareAllenscrewsandTwinForcewrench

DeterminationoftheappropriatesizeoftheTwinForce

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A Twin Force Bite Corrector DoubleCheck is used and it is fixed directly to the arch usingitswireclamps. After aligning and levelling, and with a patient in habitual maximal occlusion, take measuresfromthemesialedgeoftheuppermolartubetothedistaledgeofthelower

Advantages:
Improvestheprofileofthepatient. Aminimalcooperationofthepatientisrequired. ItproducescontinuousandlightforcesduetoitsNiTicoilsprings Itallowslateraljawmovement,duetowhichismorecomfortableforthepatient. Resistant. Nolaboratoryworkisrequired(timeandcostsreduction).Itis inserteddirectlyattheclinicusingasimpleprocedure. Itiseasytoremoveitattheclinicinordertocheckthepositionofthemandible andinsertitagain,ifnecessary. Thepatientcanremoveitincaseofemergency. Itcanbeusedbothinextractionandnonextractioncases.

7mechanismsofTwinForceaction:
Growingpatientorwithfinishedgrowth:

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1. Complete maxillary distalization from 1mm to 1,5 mm Overjet and molar class correction.

2. Complete mandible protrusion from 1 mm to 1,5 mm Overjet and molar class correction.

3.Remodellingoftheglenoidcavityandcondyle(approx.1mm)Overjetandmolar classcorrection.

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4.MolardistalrotationMolarclasscorrection.

5. Intrusion of the upper molars and counter clockwise rotation of the mandible Overjet,molarclassandprofilecorrection(inanterioropenbitecases).

6.LowermolarsextrusiontofixthejawpositionOverjetandmolarclasscorrection (anteriordeepbitecases) *** In adult patients a 3 mm to 5 mm profile reduction can be expected due to orthodonticeffects.

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Growingpatient:

7.Condyleandglenoidcavitygrowth.

Indications:
1.SkeletalClassIImalocclusionwithmandibularretrognathia. 2.Facialtype: a.Braquifacial, b.Mesofacial, c.Moderatedolychofacial. 3.Permanentdentition. 4.Growingpatientorthopaediceffect. 5.Nongrowingpatientorthodonticeffect.

Limitations:
1.SkeletalClassIImalocclusionwithmaxillaryprotrusion. 2.Severeormediumdolychofacialpatient. Class II div. 2 malocclusion patients should become in Class II div, 1 malocclusion patientsinordertobeabletocarryoutmandibularadvancement.

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Preventionofsideeffects:
1.Topreventsolelytheuppermolarsdistalizationupperdistalclosureusingligated hookandligatedomega. 2.Topreventproinclinationoflowerincisorslowerdistalclosureusingligatedhook andomega,pluslingualsplintingfromlowercaninetolowercanine. 3.Toavoidexcessivedistalrotationofuppermolarstranspalatalbar.

Insertionandremovaloftheappliance

PlacearchwireclampoftheTwinForceat1mmmesialtotheupperfirstmolartube andtightentheAllenscrewusingaTwinForcewrench.Repeattheprocedureonthe oppositeside. WhentheleftandrightTwinForceBiteCorrectorsarefixedtoupperarch,placethe otherarchwireclamp1mmdistaltothecaninebracketonthelowerarchandtighten AllenscrewwiththeTwinForcewrench. Check if the appliance is well fixed on both ends, and ask the patient to make mandibularmovementsinalldirections.

Instructionsforthepatient:

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1.BrushtheTwinForceBiteCorrectoratthesametimewhenbrushingteeth. 2. In case of debonding of a bracket or a band, or if Twin Force moves from its position,rytoplaceitbackusingthewrench,orremovealsotheoppositeend,place ClassIIelasticsandcontacttheorthodontistassoonaspossible. 3.Trytolimittheexcessivemouthopeningmovements,suchasyawning. 4. If manipulating the Twin Force, do not remove completely the screws from wire clamps.

Biomechanicalsequence

BeforeinsertingtheTwinForceappliance,dentalocclusionshouldbebroughtintothe positionofmandibularadvancement: 1. Diagnosis. Correct diagnosis and Twin Force use checking (Indications; Limitationspage5)

2. ELITE OptiMiM MiniTwin brackets bonding with Roth prescription. In CSW technique a .018 slot is used, but .022 slot can also be used. In case you use the .022slot,archsizeshouldbeadaptedtoit.CarriereLXbracketscanbeused,too. 3. Align, level and correct rotations ALR .016 NiTi (Super elastic NITANIUM). Depending on the crowding level, a thermal .016 NiTi arch (BIOKINETIX) or .016 BlackTior..014NiTi(SuperelasticNITANIUM)canbeused.

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4. Torquecorrection.016x.022NiTi(SuperelasticNITANIUM)or thermal.016x .022NiTi(BIOKINETIX)or016x.022BlackTi.

5.LevelthecurveofSpee016x.022NiTi(SuperelasticNITANIUMRCS)orthermal NiTi(BioKinetixRCS)archwithreversecurve.

6. Transverse correction with plaster casts in Class I. Check it with the model casts positionedinClassI,expansionindication.

7.Correctrotationsinuppermolars.

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8..017x.025StainlessSteelarcheswithhooksandomegasligatedtomolarband. 9.IndicatetheuseofClassIIelastics3/62,5oz(TOUCAN)or3/64,5oz(ZEBRA)a monthbeforeinsertionofTwinForce,sothepatientgetusedtoadvancedmandible position.

10.TwinForce ChecklistoftheTwinForceuseincasesofdeepbite(seepage8). ChecklistoftheTwinForceuseincasesofopenbite(seepage9).

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HowlongmustIwearTwinForce?

It is recommended to use Twin Force during 1 month per each millimetre of the planned correction of overjet. As far as only orthodontics is concerned, it is used during3to4months.

CheckingtheeffectofTwinForce

RemovetheTwinForceandtrytoretractthemandible.Ifthemandiblemovesback, puttheTwinForceback.Ifthemandibledoesnotmove,taketheTwinforceoutand puttheClassIIelastics3/62,5oz(TOUCAN)or3/64,5oz(ZEBRA).

CaseFinishing
Finishintercuspationandmidlinecorrectionusingintermaxillaryelastics.

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TwinForceinClassIImalocclusioncaseswithanterior deepbite.Checklist.

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TwinForceinClassIImalocclusioncaseswithanterior openbite.Checklist.

Biomechanicalsequenceusing.018x.022slots

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Otheruses:

NiTiCoilSpring

Distalizationofuppermolars

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InverseuseinClassIIImalocclusiontreatment

Anchoragereinforcementinextractioncases

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Bibliography

Carlson D, Ribbens, K. Craniofacial growth during adolescence. Center for human growth anddevelopment,UniversityofMichigan,1987 Clark, W. Twin Block functional therapy. Applications in dentofacial orthopedics. Mosby Wolfe,1995,London,England ClarkW,EvansRD.Functionaloclusalrelationshipsinagroupofpostorthodonticspatients: preliminaryfindings.EuropeanJOrthod1998;20:10318 CorbettMC.DoublelockTwinForcebitecorrector.www.orthoorganizers.com Echarri P. Tratamiento ortodncico y ortopdico de primera fase en denticin mixta. EditorialRipano2edicin,2008,Madrid,Espaa EcharriP.TwinBlock.Diagnstico,registros,prescripcin,ajustesyresultados.Ortodoncia Clnica1999;4:2208 FrnkelR,FrnkelC.Orofacialorthopedicswiththefunctionregulador.Karger,1989 FrnkelR.Tcnicaymanejodelreguladordefuncin.EditorialCientficoMdica,1975 GraberT,SwainB.Ortodoncia:principiosgeneralesytcnicas.EdPanamericana,Argentina, 1991 Graber TM, Rakosi T, Petrovic AG. Dentofacial orthopedics with functional appliances. Mosby,1997,USA McNamaraJ,Brudon.Orthodonticsanddentofacialorthopedics.NeedamPressInc.,USA, January2002 Mc Namara J. Components of class II malocclusion in children 810 years of age. Angle Orthod1981;51:177202

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Mills CM, McCulloch KJ. Treatment effects of the Twin Block appliance: A cephalometric study.AmJOrthodDentofacialOrthop1998;114:1524 NandaR,PalaciosP,UribeF.TwinForcebitecorrector.Radiant2006;Ed.OrthoOrganizers; 1:24. Palacios P, Uribe F, Nanda R. Correction of an asymmetrical class II malocclusion using predictableforcesystems.JClinOrthod2007;41(4):2116 Pancherz H, Ruf S. The Herbst appliance. Researchbased clinical management. 1st Ed. QuintessencePublishingCo.,NewMalden,Surrey,2008 RittoK.FixedFunctionalAppliances.Aclassification.www.ocj.com/june01/Dr._Ritto.htm RothenbergJ,CampbellE,NandaR.ClassIIcorrectionwiththeTwinForcebitecorrector.J ClinOrthod2004;38(4):23240. http://www.centroladent.com http://www.orthoorganizers.com

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Quad Helix

RemovableQuadHelixwithelasticligature

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Preactivation

QuadHelixactivation

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AssymetricExpansion

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NitaniumPalatalExpander

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TreatmentofClassIIMalocclusion

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SeparationAndRapidExpansion

1. Hyraxappliancewith4bands.Tobondit,aparalelismofthefirstbicuspidsandthe firstmolarsisneeded.

2. FantypeHyraxappliance.Indicatedforthemayoranteriormovement,orifwelded backwards,forposteriormovement.

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TreatmentofClassIIMalocclusion

3. McNamaraappliancebondedwithresinsplints.Especiallyindicatedtobeusedin mixeddentitionandtobecombinedwithanteriortraction.

4. Separationappliancewithacompactscrew.Thesamemovement,butmuchmore comfortableforthepatient.

5. DirectBondingSeparatorusedbyauthorwithsheathsweldedinthefirstmolarbands, andbondedonlingualsurfacesofthebicuspids.

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6. Postexpansionandpostseparationretentionusingtranspalatalbarwithanterior arms.

7. Postexpansionandpostseparationretentioninextractioncases.Combinationof transpalatalbarwithanteriorarmsandNanceappliance.

8. Posteriorcrossbitecaseinanadultpatient.Surgicalseparationwillbecarriedout.

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9. Bondingofthebandswithlingualsheaths.

10. CheckingoftheDirectBondingSeparator.

11. Acidetchingoflingualsurfacesofbicuspids.

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12. Rinsingtoremoveacidanddrying.

13. InsertionoftheSeparator.

14. Bondingwithlightcuringcomposite.

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15. Lightcuringusingalightcuringlamp.

16. SeparatorbondedwithFermitonlingualsheathstoavoidtonguediscomfortandto increaseretentionoftheSeparator.

17. Progressinseparationprocess.Activationofthescrewfor2/4ofturnperdayduring thefirstweek,andofturnperdaytherestoftheweeks.Fortherapidexpansion, thescrewshouldbeactivatedeveryseconddayforoftheturn.

18. Separationisfinishedin30days.Frontalview.

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19. OcclusalXrayoftheseparation.

20. Separationfinished.Occlusalview.

21. TheSeparatorisremoved,butthebandsareleftbonded.Atranspalatalbarfor retentionisinsertedinthesamesheaths.

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22. Ligatingofthetranspalatalbarwithelastics.

23. Ligatingofthetranspalatalbarwithelastics.

24. Transpalatalbarisligated.

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Bibliography

Books

1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12.

EcharriP,editor.Diagnsticoenortodoncia.Estudiomultidisciplinario.Barcelona(Espaa): Quintessence;1998. EcharriP.Segmentallingualorthodonticsinmultidisciplinarycases.En:RomanoR,editor. LingualOrthodontics.Ontario(Canada):Ed.B.C.Decker;1998. EcharriP,LuceaA.OrtodonciaparaAsistenteseHigienistasDentales.Barcelona(Espaa): NexusEdicionesS.L.;2002. EcharriP.Diagnsticoenortodoncia.Estudiomultidisciplinario.2Ed.Barcelona(Espaa): NexusEdicionesS.L.;2003. EcharriP.OrtodonciaLingual.Tcnicacompletapasoapaso.Barcelona(Espaa):Nexus EdicionesS.L.;2003. EcharriP.Lingualorthodontics.Completetechnique,stepbystep.Barcelona(Spain):Nexus EdicionesS.L.;2003. EcharriP.OrtodonciaLingual.Tcnicacompletapasoapaso.Seoul(CoreadelSur):Public; 2003.(encoreano) EcharriP.Tratamientoortodncicoyortopdicodeprimerafaseendenticinmixta.Barcelona (Espaa):NexusEdicionesS.L.;2004. EcharriP,FernndezHerreraJM,GeliBurguesJ.MeseguerPlanasJR.Marketingparalaclnica ortodncica.Barcelona(Espaa):NexusEdicionesS.L.;2006. EcharriP,KimTW,FaveroL.ClearAligner.Aplicacionesclnicasypresentacindecasos. Madrid(Espaa):RipanoMdica;2007. EcharriP,KimTW,FaveroL,KimHJ.Ortodoncia&Microimplantes.Tcnicacompletapasoa paso,Madrid(Espaa):Ripano,Ed.Mdica;2007. EcharriP,KimTW,FaveroL,KimHJ.Orthodontics&Microimplants.Completetechnique,step bystep.Madrid(Spain):RipanoMdica;2007.

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13.

EchariP.Anclajeenortodoncia(captulo11).En:DranvonArx,coordinadordeseccin. Ortodoncia.En:EchaverraGarcaJJ,PumarolaSu,coordinadores.ElManualdeOdontologa.2 ed.Barcelona(Espaa):ElsevierMasson;2008. EchariP.Ortodonciaenadultosyortodonciaesttica(captulo14).En:DranvonArx, coordinadordeseccin.Ortodoncia.En:EchaverraGarcaJJ,PumarolaSu,coordinadores.El ManualdeOdontologa.2ed.Barcelona(Espaa):ElsevierMasson;2008. EcharriP.Tratamientoortodncicoyortopdicodeprimerafaseendenticinmixta.2ed. Madrid(Spain):RipanoMdica;2008. EcharriP.Microimplantes(captulo13).En:NappaA,editor.Arcorectoconvencionalalsistema Damon.Madrid(Espaa):RipanoMdica;2008. EcharriP.LaOrtodonciaLingualenelsigloXXI.En:LibrodeCongresodelaAIO2008,Madrid (Espaa):RipanoMdica;2008. EcharriP.LatcnicaCSWylaortodonciapreprotsicaconmicroimplantes.En:Librode ExpoOrtho2009.Madrid(Espaa):RipanoMdica;2009.pp.1527. EcharriP.TratamientoconClearAligner.10aosdeexperiencia.En:LibrodeExpoOrtho2009, Madrid(Espaa):RipanoMdica;2009.pp.2940. EcharriP,UribeRestrepoG.Captulo43.Ortodoncialingual.En:Ortodoncia.Teorayclnica. Medelln(Colombia):Corporacinparainvestigacionesbiolgicas;2010.pp.74252.

14.

15. 16. 17. 18. 19. 20.

ScientificArticles
1. 2. 3. 4. 5. 6.
EcharriP.Protectoresbucalesdeportivosparapacientesortodncicos.GacetaDental1990 Sept;55. EcharriP.LaOclusinDinmicaenOrtodoncia.GacetaDental1992;31:1779. EcharriP.Retenedorpermanentefijolingualdefibraptica.RevistaPortuguesadeOrtodoncia 1996;1:119. EcharriP.Procedimientoparaelposicionamientodebracketsenortodoncialingual.(ParteI). RevistaPortuguesadeOrtodoncia1996;3:7083. EcharriP.TcnicadeposicionamientodebracketslingualesClassSystem.Revista IberoamericanadeOrtodoncia1997;16:117. EcharriP.Carillaslingualesdeporcelanacomoretencinpermanenteencasosdemordida profunda.OrtodClin1998;1(1):313.

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7.

EcharriP,BacaA.Ortodoncialingual.Determinacindelaformadelarco.Revista IberoamericanadeOrtodoncia1998;17:18.

8. EcharriP.Tratamientomultidisciplinario:ortodonciaenpacientesdisfuncionales(resumendelaconferencia
en44ReunindelaSEDO,Oviedo,712dejuniode1998).OrtodEsp1998;38(2):12930.

9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. 21. 22. 23. 24.

EcharriP.Ortodoncialingual,ortodonciainvisible,estadoactualdelatcnica.Revistade Sonhiadent1998;12:1625. EcharriP.ProcedimientoparaelposicionamientodebracketsenOrtodonciaLingual.(ParteI). OrtodClin1998;1(2):6977. EcharriP.Procedimientoparaelposicionamientodebracketsenortodoncialingual.(ParteII). OrtodClin1998;1(3):10717. EcharriP.Segmentallingualorthodonticsinpreprostheticcases.JClinOrthod1998;32:7169. EcharriP.Ortodoncialingual.Puestaaldadelprocedimientoclnicodecementadoindirecto. (ParteIII).OrtodClin1999;2(1):2836. EcharriP.15clavesparaoptimizarlostratamientosdeortodoncialingual.Cspide1999;(2):610. EcharriP.Tcnicalingual(ParteIV).Preparacindelabocaen10pasos.OrtodClin 1999;2(2):7481. Echarri P. Twin Block Diagnstico, registros, prescripcin, ajustes, resultados. Ortod Clin 1999;2(4):2208. EcharriP.Ortodoncialingual.Vparte.Tratamientoconextracciones.OrtodClin2000;3(1):2231. EcharriP.Ortodoncialingual.VIAparte.Tratamientosinextracciones.OrtodClin2000;3(2):8693. EcharriP.Ortodoncialingual.VIBparte.Tratamientosinextracciones.OrtodClin 2000;3(3):13242. EcharriP.Ortodoncialingual.VIIparte.Terminacindecasos.OrtodClin2000;3(4):20612. EcharriP.Ortodoncialingual.VIIIAparte.Materialeseinstrumentalutilizadosyconfortdel paciente.OrtodClin2001;4(1):408. EcharriP.OrtodoncialingualVIIIBparte.Materialeseinstrumentalutilizadosyconfortdel paciente.OrtodClin2001;4(2):95102. BacaA,EcharriP.Ortodoncialingual.10aosdeexperienciaenelposicionamientoindirecto debrackets.OrtodClin2001;4(3):14250. EcharriP.ltimosavancesendiagnsticocontecnologa3D.Resumendelacomunicacinenel SimposioNuevasTecnologasen47ReunindelaSEDO,2001junio26;Granada,Espaa.OrtodEsp 2001;41(3):251253.

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EcharriP.Posibilidadesteraputicasdelaortodoncialingual.ProfesinDental2001;4:403. EcharriP.Introduccinalaortodoncialingual.Cspide2001noviembre;(5):414. LuceaMarchadorA,EcharriP.Mantenedoresyrecuperadoresdeespacio.OrtodClin 2002;5(2):8898. EcharriP.Sagittalandverticalcontrolinlingualorthodontics.JLingualOrthod2002;2:4856. EcharriP.ElasaderetrusinenLcerradahelicoidal.OrtodClin2002;5(3):14552. EcharriP.Fichaclnica1.SistemaWilsondetransferencia,Quadhlixyactivacin.OrtodClin 2002;5(3):14 EcharriP.Fichaclnica2.Elarcoextraoral.OrtodClin2002;5(4):58. EcharriP.Comparacindelostratamientosortodncicosrealizadosconortodonciavestibular yconortodoncialingual.RevEspOrtod2002;32:20732. EcharriP.Howtoobtainthemaximumbenefitsfromthelingualarchwires.JJapanLingOrthod Association(JJLOA)2002;13:213. EcharriP.Fichaclnica3.Traccinanterioryarcoutilitario.OrtodClin2003;6(1):912.

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PabloEcharri,DDS
echarri@centroladent.com

www.cantroladent.com www.ladentformacion.com www.clinicaecharri.com www.clearaligner.es

www.orthoorganizers.com

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