Okay, we’ve talked about the passive, self-ligating brackets – the D3’s and the D2’s – and we’ve talked about the high-tech alloy wires. I’m sure it all sounds great, but let’s take a look at what these technologies can do for our patients.
The first clinical case is M.J., a 14-year-old patient with extremely severe crowding. If you’ll notice, the upper and lower canines are completely blocked out of the arch. There can’t be much bone surrounding the labial surface of these roots. The upper lateral incisors are touching the first bicuspids. With traditional mechanics, this case would have had to be treated with four bicuspid extractions. With traditional elastomeric ties and high-force mechanics (if teeth were not removed) when you engaged the initial wire, two things would happen: 1. The incisors would dump forward 2. The canines would move laterally Moving the canines laterally is the last thing we would want to do in this case.
The point here is that most orthodontists who are focused solely on cephalometric numbers and intraoral photos would extract this case to make space. The anterior teeth are invariably retracted with four bicuspid extractions, which would produce flattening or “dishing-in” of the patient’s already flat profile. This would have the effect of making this patient look like he was 60 by the time he was 30! Wouldn’t it be nice to be able to treat this case nonextraction? With the Damon System, that’s exactly how it was treated. Damon System treatment planning is based on the face. Let’s take a look.
As you can see, the case started with upper braces only – due to the deep bite. In one appointment, the upper canines were beginning to align. Remember, we’re seeing the patients every 10 weeks at this point, so the first appointment back was at 2 months, 2 weeks. At 5 months, appointment #2, the lower braces were bonded and the upper arch was aligning nicely. In 3 appointments the upper arch was nearly finished, and without extractions! Look at the change in the arch form. We will see how that affects the facial result.
The case actually finished in 6 appointments in 13 months without removing teeth! Keep in mind that with traditional brackets, wires and heavy-force mechanics, we would have had to extract four bicuspids in a case like this and work hard for 24 to 30 months to finish. Furthermore, the profile would have been ruined.
Here’s the pre- and posttreatment facial photos. In the pretreatment photo, you can see how narrow the upper arch was by the dark triangles. You can only see from canine to canine when smiling (the six-tooth smile). Compare this with the posttreatment photo on the right. Look at how broad the smile is. You can almost see from mesial of first molar to mesial of first molar (the ten-tooth smile).
The lines shown help to confirm the Class II relationship of the occlusion.
Take into account that her nose and chin will grow as she matures. Retracting her teeth back with headgear or extractions would only make those features more prominent.
Progress photos show how quickly the Damon System moves teeth. This not only makes the total treatment time shorter, but it also gets patients excited about their treatment and keeps them motivated to maintain compliance (e.g.; rubber bands, hygiene, etc.). They look better faster, and they feel less self-conscious .
Notice how the posterior crossbite has been resolved, the high cuspid has dropped down, and the bite is coming together.
Notice the change in arch form. The original arch form was more triangular in shape. The new Damon arch form is more balanced and appealing.
Although this case was a bit longer than the average of 18 months, there was considerable movement required to correct the posterior crossbite. These are the toughest cases, since we need to establish a whole new orofacial muscular balance. Patients with this type of malocclusion may sometimes have to wear a retention split to help retrain the tongue to lift into the palate and stay in balance.
Okay, let’s look at an adult case. Patient T.B. was 32 years old at the time of treatment. The smiling facial photo shows a narrow smile. You can see only from canine to canine with “dark corners” at the commisures. The lateral photo shows a very flat profile with an obtuse nasolabial angle.
Note that both lower cuspids are outside the arch. This would normally have a major periodontal implication for treatment. The light forces used in the Damon System will play into this later.
With the severe crowding, no conventional orthodontist would dream of treating this case without extracting or using surgically assisted RPE (SARPE). Again, with the heavier forces they use, the lower anteriors would dump forward to create space. With the Damon System of light forces, we can create space using light wires and springs to allow the body to create space by increasing the transverse dimension.
You can see how even by the 3 rd appointment, this patient already had significant movement. There is already arch development to resolve the crowding, and teeth are mostly aligned. In a very short time and a startlingly low number of visits, the case was completed.
The lower is equally amazing. With all the severe crowding, the case unraveled and aligned quickly, and did not show excessive dumping of the anteriors as you would see if you tried to treat this case nonextraction with conventional treatment .
This would be a great result, even if he were a child. In a nongrowing adult with some periodontal concerns, it is remarkable!
Notice the number of appointments for this treatment time. Even busy adults can seek orthodontic care with greater convenience.
What would extraction have done to his face?
This patient is transformed. He feels more confident and more attractive. He also says his speech is clearer, which helps him in his job.
This shows the simple retraction mechanics used in the Damon System. (If asked about the ligature wire around the anterior brackets, make sure to let the viewer know that this is ligated UNDER the wire, so it does not introduce friction.) This ligation is meant to help consolidate the anteriors so the teeth can be moved back into place en masse. This is possible because of the low friction of the Damon System. In most conventional treatments, the orthodontist would retract the cuspid first, then pull back the centrals and laterals. We are now free to move teeth in groups, which also helps to distribute the same force between more teeth, and further reduce the force per tooth.
You can see how the spaces closed beautifully. There have been several head-to-head studies showing how Damon closes spaces faster. Alan Bagden conducted one such study in his own office when he was first dabbling with Damon, which is what convinced him to switch.
Dentally, this is a very nice result, but what about the face?
In this case, you can see how extraction helped to give this patient a much better profile and lip posture.
This patient is thrilled with her result. The picture tells it all!
This case shows the power of a naturally balanced arch form and its effect on the face.
The changes in the dentition are slight but clearly have a tremendous effect.
Although this case could have been treated conventionally or even with Invisalign by closing the diastema, you can clearly see how the Damon smile is an attractive 10-tooth smile, which provides great aesthetics and ideal facial support. You can see how the lip posture is improved and how there is reduction in the depth of nasolabial folds.
This case may also seem somewhat simple. However, examining the soft tissue, there are some periodontal concerns. Using heavier forces of conventional treatment or Invisalign may straighten teeth, but it may also exacerbate the periodontal dilemma.
With the Damon System, this case was treated to a beautiful result, and you can see the light forces used did not compromise the tissues. In fact, you can see that the tissue looks perhaps healthier that when she started.
As for the change, this is again a milder case, but you will see what a relatively minor transverse change in arch form will do for the patient’s face…
This patient’s result not only provides a more attractive smile but also improves the facial aesthetics, giving her a look that’s youthful and dynamic.
The natural, balanced arch form gives her a full smile and gives her improved facial support. She feels it makes her look younger.
Clinical Cases Harnessing the Power of Low Force and Low Friction
M.J. 14 yrs 6 mos Initial Class I severe crowding, deep bite, all cuspids blocked out.
<ul><li>Patient has very little crowding </li></ul><ul><li>Bi-max protrusion </li></ul><ul><li>Patient’s chief complaint is the protrusive nature of her profile. </li></ul><ul><li>This is a case where extraction will help to establish an improved facial profile. </li></ul>There is a time to extract
With the Damon System we “Extract for the face, not for the space.”
Light elastics and/or springs are used to close space
Low-friction Damon brackets allow spaces to be closed far more quickly and easily.