Dental Asia May/June 2020
For more than two decades, Dental Asia is the premium journal in linking dental innovators and manufacturers to its rightful audience. We devote ourselves in showcasing the latest dental technology and share evidence-based clinical philosophies to serve as an educational platform to dental professionals. Our combined portfolio of print and digital media also allows us to reach a wider market and secure our position as the leading dental media in the Asia Pacific region while facilitating global interactions among our readers.
For more than two decades, Dental Asia is the premium journal in linking dental innovators
and manufacturers to its rightful audience. We devote ourselves in showcasing the latest dental technology and share evidence-based clinical philosophies to serve as an educational platform to dental professionals. Our combined portfolio of print and digital media also allows us to reach a wider market and secure our position as the leading dental media in the Asia Pacific region while facilitating global interactions among our readers.
You also want an ePaper? Increase the reach of your titles
YUMPU automatically turns print PDFs into web optimized ePapers that Google loves.
Clinical Feature<br />
Traditional techniques correcting Literature review<br />
overbite features in all Orthodontic literature had described<br />
malocclusions have been known myriad approaches for overbite correction.<br />
to be quite complicated, and<br />
challenging<br />
to orthodontists. Strong<br />
mechanical background,<br />
sophisticated appliance<br />
designs, diligent patient’s<br />
cooperation and multiple<br />
By Dr. Suhail Khouri and Dr. Derek Mahony<br />
adjustment visits over a long<br />
treatment time are crucial<br />
elements for successful<br />
treatment prognosis of this<br />
dento-alveolar deformity.<br />
Despite the overwhelming advances that Some approaches used fabricated loops,<br />
already modernised many orthodontic helices and springs made of stainlesssteel<br />
wires to create the bite-opening<br />
concepts, techniques, and practice,<br />
nonetheless modalities correcting overbites force system 3,10-14 . Others used functional<br />
did not witness significant advances. appliances with and without headgears 4,5 ;<br />
while severe skeletal cases were managed<br />
To date super elastic wires have only with surgical approaches 6-9 .<br />
been principally used in their straight<br />
prefabricated form for the sole purpose of Ever since the inception of their use in<br />
initial teeth levelling, until the Bendistal Pliers orthodontic practice, the impossibility<br />
demonstrated their unique ability to cinchback<br />
and bend NiTi wires, for the first time 1 . restricted orthodontists to use them only<br />
of bending super elastic archwires has<br />
The possibility of placing permanent V-bends in their prefabricated straight arch forms<br />
on super elastic archwires intraorally armed in initial teeth levelling. Subsequently they<br />
orthodontists with full control of super couldn’t use the superior elasticity of those<br />
elastic wires and resurrected their advanced wires in other orthodontic tooth moments.<br />
mechanical properties that were overlooked They could not even bend distal ends of<br />
after performing initial teeth alignment. By such wires without annealing that ruins<br />
providing light and consistent force, these the entire wire’s resiliency and defeats the<br />
bends could effectively move groups of only purpose of their use. Many researchers<br />
teeth in both transverse and vertical planes demonstrated the validity of using intrusion<br />
of space.<br />
appliances, helices and springs made of<br />
super elastic wires in their prefabricated<br />
Clinical application of this concept has forms 15-17 . Despite this success, however,<br />
resulted in evolution of new techniques that the inability to bend these wires made it<br />
showed efficiency in correcting a multitude of impossible to customise the costly intrusion<br />
major orthodontic dentoalveolar deformities appliances, and resulted in the limited use<br />
with unprecedented simplicity, convenience of prefabricated elastic appliances and even<br />
and time savings 2 . This article elaborates wires.<br />
on one new technique that corrects dental<br />
and skeletal deep overbite mostly featured Bending titanium wires without annealing<br />
in Class I and Class II malocclusions using or breakage requires specially designed<br />
simple routine wire adjustments during pliers. Khouri developed one such set of<br />
patient’s regular visits.<br />
pliers – Bendistal Pliers – and subsequently<br />
Part I: Correcting Excessive<br />
Overbites with V-Bend Activations<br />
of Super Elastic Wires<br />
This two-part article describes a simple, effective and clinically<br />
applicable alternative bite-opening technique using V-bends on<br />
super elastic wires that are created by new orthodontic pliers.<br />
showed how clinicians could use them<br />
for many intraoral sundry super elastic<br />
wire activations that moved segments of<br />
teeth and corrected overbites, crossbites,<br />
expanded and constricted<br />
dental arches, tip backs and<br />
rotate molars 2 .<br />
The mechanical principles<br />
underlying bite-opening<br />
techniques have been<br />
well established and<br />
appreciated in literature 3,<br />
16, 19, 20<br />
. Dake and Sinclair 13<br />
reported that intrusions<br />
and extrusions achieved by both Ricketts<br />
and modified Tweed techniques remained<br />
stable. Hans et al 18 compared the efficiency<br />
of the headgear and bionator with fixed<br />
appliances in bite opening and found that<br />
both approaches produced incisor intrusion<br />
combined with skeletal mandibular changes<br />
that contributed to the correction of deep<br />
overbites. Burstone 3 has advocated that not<br />
all patients with overbites require incisor<br />
intrusion exclusively; rather, some require<br />
posterior teeth extrusion to open their bite.<br />
He presented upright intrusion springs that<br />
intrude anterior teeth with minimal effect<br />
on posterior teeth. He recommended spring<br />
appliances with low load deflection rates<br />
to produce the optimal intrusive forces.<br />
Sander et al 16 described intrusion mechanics<br />
completed with NiTi uprighting springs with<br />
low load deflection rates that could intrude<br />
incisors a magnitude of 7mm.<br />
Shroff et al 11 found it difficult to correct<br />
deep overbites when accompanied with<br />
flared incisors by conventional orthodontic<br />
therapies. They subsequently recommended<br />
the Burstone segmented arch approach for<br />
achieving precise vertical and horizontal<br />
simultaneous moments of teeth. Davidovitch<br />
and Rebella 12 described an intrusion<br />
archwire that uses only tip back bends<br />
close to molars, to achieve bite opening.<br />
Nanda has also described appliance systems<br />
and biomechanical techniques for incisor<br />
32<br />
DENTAL ASIA MAY / JUNE <strong>2020</strong>