Bio Adaptive Therapy Presentation

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Bio Adaptive Therapy Presentation

  1. 1. Bio-Adaptive Therapy A Breakthrough in Orthodontic Treatment
  2. 2. The Damon System is more than a new product – it’s an entirely new orthodontic concept. The Damon System delivers ideal tooth position and improved facial symmetry, usually without the need for rapid palatal expansion, extraction, or surgery.
  3. 3. Three Pillars of Damon System Bio-Adaptive Therapy • Passive Self-Ligating Brackets – Low friction, improved comfort, better hygiene • New Wire Technology – Lighter forces, fewer adjustments • Minimally Invasive Mechanics – Far fewer extractions and the near- elimination of headgear or rapid palatal expansion
  4. 4. Q: Why are we talking about a new system?
  5. 5. • Twin sisters • Similar malocclusions • Comparison of extraction vs. nonextraction
  6. 6. Traditional ceph and model analysis suggests extractions to achieve “correct” tooth positioning and jaw relationships. The nonextraction case was the experimental case.
  7. 7. One was treated with extractions. Which is which?
  8. 8. Extracted Not Extracted
  9. 9. Q: Is conventional orthodontics serving the needs of today’s patient?
  10. 10. “I wish I looked like my sister.”
  11. 11. Dr. Dwight Damon – the Pioneer in the Development of this Treatment Approach “Most extractions are done to make space to eliminate crowding. But what about the face, the roots of the teeth, and the soft tissue? With the Damon System, we use light forces to convert crowding into posterior arch width, yielding ideal tooth position AND better facial aesthetics. There is also a growing body of evidence that this approach yields less root resorption and a far better soft-tissue response.”
  12. 12. Force Management Why light forces? The following photos should challenge every clinician to lower their clinical force mechanics.
  13. 13. Force Management Why light forces? Q: What happens when roots are driven against the cortical plate with high forces?
  14. 14. Force Management Why light forces? Capillaries entering the foraminae of the cortical bone
  15. 15. Treatment goal: To achieve ideal tooth position and facial harmony while keeping the vascular integrity of the alveolar cortical plate.
  16. 16. Thought leaders have talked for decades about how light forces would stimulate rapid tooth movement. However, conventional appliances forced clinicians to use far higher forces due to wire alloys and friction. “Optimum force levels for orthodontic tooth movement should be just high enough to stimulate cellular activity without completely occluding blood vessels in the periodontal ligament” – Dr. William Proffit The new technology used in the Damon System now allows us to realize these goals.
  17. 17. Force Management Why light forces? Orthodontic Tooth Movement
  18. 18. Force Management Why light forces? Note the amount of blood flow in the PDL, and concentrated in the area of new bone deposition
  19. 19. Force Management Why light forces? Two Distinct Types of Pressure Side Dynamics • Undermining Resorption – Response to Heavier Forces • Frontal Resorption – Response to Light Forces
  20. 20. Force Management Why light forces? Tooth Movement And Oxygen  Oxygen is the trigger mechanism for remodeling of the periodontium.  If vascularity is interrupted in the periodontal space, oxygen is no longer available and cellular activity is slowed or stopped.
  21. 21. “If the applied force is great enough to totally occlude blood vessels and cut off the blood supply, a hyalinized avascular necrotic area is formed. This area must revascularize before teeth start to move.” – Dr. William Proffit
  22. 22. Force Management Why light forces? Pressure Side Traditional Heavy Forces Note how blood vessels are crushed in the necrotic PDL and how much bone must be eroded to cause movement with undermining resorption.
  23. 23. Force Management Why light forces? Pressure Side Characteristics of Light Forces capillaries
  24. 24. Force Management Why light forces? “Light continuous forces ensure more-effective tooth movement in areas with cortical bone or Conventional forces with necrotic PDL bone with few marrow spaces. Use forces that do not interrupt the vascular supply.” – Rygh Low forces with vascular PDL
  25. 25. Force Management Why light forces? Time Course of Tooth Movement: Frontal vs. Undermining Resorption Light (Damon) Heavy (conventional)
  26. 26. Friction Must Be Virtually Eliminated In Order To Achieve Lower, Biologically Optimal Forces The Significance of Self- Ligating Bracket Technology
  27. 27. New Low-Force, Low-Friction Orthodontic Therapy Passive Self-Ligation vs. Traditional Active Elastomeric Ligation
  28. 28. Older style braces require elastics Damon System braces use a slide to hold archwires in place. mechanism that eliminates the friction and binding. Elastics are like With the Damon bungee cords – System, teeth they cause friction move more freely and pressure , and comfortably. making treatment slower and less comfortable.
  29. 29. Passive Self-Ligation
  30. 30. Damon Difference Passive self-ligation Friction Comparison Conventional brackets with elastomerics produced 500 to 600 times more friction than Damon brackets.
  31. 31. Damon Difference Passive self-ligation Q: Why is low friction so important? A: By significantly reducing friction, now we can use “biologically sensible” forces with superior results
  32. 32. Damon Difference Passive self-ligation
  33. 33. Damon Difference Passive self-ligation Elastomerics and Hygiene • O-rings are extremely plaque retentive • Greatly increase the number of micro-organisms attached to appliances during treatment Forsberg, et al, Ligature Wires and Elastomeric Rings: Two Methods of Ligation and Their Association with Microbial Colonization, Eur J of Orth, pp416-20, Oct. 1991
  34. 34. What about other self- ligating brackets? Aren’t they all the same?
  35. 35. Self-Ligation Self-ligation is not a new concept • Dr. Jacob Stolzberg developed the “Russell” attachment in the 1930s • Dr. Jim Wildman developed the Edgelok bracket in 1971 – with limited commercial success
  36. 36. Self-Ligation SPEED * ® Time * ® * Speed is a trademark of Speed Orthodontics. Time is a trademark of American Orthodontics.
  37. 37. Damon Difference Passive Self-Ligation Most Self-Ligating Brackets Feature ACTIVE Clip Mechanisms • Wires are engaged or pressed into the In-Ovation® “R” bracket slot, producing greater FRICTION • Larger wires are needed to overcome the friction = heavier forces
  38. 38. Damon Brackets • Damon SL, 1996-1999 • Damon 2, 2001
  39. 39. Damon Difference Passive Self-Ligation 2005 2004
  40. 40. Damon Difference Passive Self-Ligation Damon brackets have a slot with four solid walls to allow the wire to slide freely in ALL PHASES OF TREATMENT
  41. 41. Frictional Resistance Comparison Even other self- ligating brackets have significantly more friction because they use an active clip to keep the wire pressed into the slot.
  42. 42. New Wire Technology Enhancing the Clinical Benefits of Passive Self- Ligation
  43. 43. Damon Difference High-Tech Archwires Mechanical Principles in Orthodontic Force Control
  44. 44. Damon Difference High-Tech Archwires • Very light forces • Faster tooth movement • Far greater spring- back properties • True heat activation
  45. 45. Treatment Time Comparison Compared with conventional treatment, the Damon System is proven to treat over 6 months faster on average…with lighter forces!
  46. 46. Patient Comfort Comparison Due to the lighter forces used in the Damon System, patients experience far less discomfort.
  47. 47. Damon braces are More Smaller Comfortable Faster Traditional Braces
  48. 48. Clinical Cases Harnessing the Power of Low Force and Low Friction
  49. 49. M.J. 14 yrs 6 mos Class I severe crowding, deep bite, all Initial cuspids blocked out.
  50. 50. Initial
  51. 51. Initial
  52. 52. Initial
  53. 53. Initial
  54. 54. Initial
  55. 55. Initial
  56. 56. Initial
  57. 57. Q: Why is this patient so crowded? Small jaws?
  58. 58. Q: What is your treatment plan for this case? Extraction?
  59. 59. Initial What would extractions do to the profile of this patient?
  60. 60. What is your treatment plan for this case? RPE? Surgery?
  61. 61. 2.5 Months 5 Months Initial 1 appointment st 2 appointment nd 7.5 Months 12 Months Final 3rd appointment 5th appointment 14.5 Months 7th appointment No extractions, RPE, headgear or surgery!
  62. 62. M.J. Final 14 months – 2 weeks 7 appts upper 5 appts lower
  63. 63. Initial 16 years – 5 months Class II, severe crowding, bilateral posterior crossbite
  64. 64. Treatment Planning • Ceph numbers • Model analysis • Pano X-rays • Facial analysis • Impact of growth/aging • Vestibular bone density • Tongue position/airway • How light a wire do I need to stimulate blood flow?
  65. 65. Initial
  66. 66. Initial
  67. 67. Initial
  68. 68. Initial
  69. 69. Initial
  70. 70. Initial
  71. 71. Initial
  72. 72. Why is the upper so crowded? Initial – Tongue position?
  73. 73. Initial – Tongue position?
  74. 74. What is your treatment plan? What is this patient going to look like at 50 years of age?
  75. 75. Damon Mechanics Dramatically simplified approach • No palatal expanders • No distalizers or headgear • No anchorage preparation (TPAs, Nance buttons, etc.)
  76. 76. A.H. 13 months Light forces – no extractions, RPE or surgery
  77. 77. 13 months
  78. 78. Initial 13 months
  79. 79. A.H. 13 months Light forces – no extractions, RPE or surgery
  80. 80. Initial Final
  81. 81. Final 22 months 3 weeks
  82. 82. Initial Final – 22 months 3 weeks
  83. 83. Initial Final Final 22 months 3 weeks
  84. 84. Note health of bone and tissue with tremendous alveolar change
  85. 85. Initial Final
  86. 86. Initial Final
  87. 87. Initial Final
  88. 88. Initial 1yr 3mo posttreatment
  89. 89. Final
  90. 90. “…way more than straight teeth! I can breathe through my nose and speak more clearly.”
  91. 91. Retention 1 year 3 months
  92. 92. Power of the Transverse Face-driven treatment by converting anterior crowding into posterior adaptation of bone, muscle, and soft tissues
  93. 93. Power of the Transverse • Low orthodontic forces do not “overpower” the lip musculature. • Incisors are prevented from “dumping” forward. • Teeth move laterally and distally.
  94. 94. Archwire adapted to initial and final arch form
  95. 95. Initial and final arch forms
  96. 96. Initial to final arch length increased 13 mm Arch width accounts for space gained
  97. 97. Skepticism of Bio-Adaptive Therapy Treatment Results • Buccal tipping of posterior teeth? • Compromising anterior labial bone support? Molar distalization? • Pushing roots through buccal plate?
  98. 98. Q: Were anteriors flared to resolve crowding?
  99. 99. Note final position of incisors in spite of extensive anterior crowding Composite
  100. 100. Q: Was the arch lengthened by molar distalization?
  101. 101. Distal of first molars to labial of incisors 37
  102. 102. Distal of first molars to labial of incisors 38 mm
  103. 103. Q: Was transverse development achieved by tipping?
  104. 104. Width Initial Final Change Cuspid 32 mm 34 mm 2 mm 1st bicuspid 32.5 mm 40.5 mm 8 mm 2nd bicuspid 37 mm 48 mm 11 mm 1st Molar 44 mm 53 mm 9 mm
  105. 105. Initial Final (Note tremendous palatal change with minimal tipping) First bicuspids changed 12 mm Second bicuspids changed 11 mm First molars changed 9 mm
  106. 106. Q: Have we blown teeth out of cortical bone?
  107. 107. The following CT scans have been provided courtesy of Dr. Damon
  108. 108. Maxillary Transpalatal Mandibular Transpalatal Maxillary Sagittal Mandibular Sagittal Transpalatal horizontal Reading CT Scans
  109. 109. Upper CT scans 7 mos in retention Note presence of bone on buccal and lingual sides of roots Upper first molars width change 9 mm
  110. 110. Upper CT scans 7 mos posttreatment Upper 2nd bicuspids width change 11 mm
  111. 111. Upper CT scans 7 mos posttreatment Upper 1st bicuspids width change 12 mm
  112. 112. Change: Cuspids 2 mm, 1st Bicuspids 12 mm, 2nd Bicuspids 11 mm, Molars 9 mm
  113. 113. Mid-Face Development Change: Cuspids 2 mm, 1st Bicuspids 12 mm, 2nd Bicuspids 11 mm, Molars 9 mm
  114. 114. Change: Cuspids 2 mm, 1st Bicuspids 12 mm, 2nd Bicuspids 11 mm, Molars 9 mm
  115. 115. Width Initial Final Change Cuspid 27 mm 27 mm 0 mm 1st bicuspid 34 mm 36.5 mm 2.5 mm 2nd bicuspid 40 mm 42 mm 2 mm 1st Molar 46.5 mm 47 mm .5 mm
  116. 116. Change: Cuspids 0 mm, 1st Bicuspids 2.5 mm, 2nd Bicuspids 2 mm, Molars .5 mm Lower CT scans 7 months post- treatment
  117. 117. Q: Can we achieve the same results with adults without surgery?
  118. 118. T.B. Initial 32 years – 9 months
  119. 119. Initial
  120. 120. Initial What is your treatment plan?
  121. 121. Initial
  122. 122. Initial
  123. 123. Initial (Note depth of palate) Q: Where does this patient’s tongue lay in the mouth?
  124. 124. Initial Q: In the palate, or….?
  125. 125. Initial A: In the lower arch.
  126. 126. Initial
  127. 127. Initial
  128. 128. Initial
  129. 129. Initial
  130. 130. Initial
  131. 131. Initial 10 weeks 7 months 1st Appt 3rd Appt 12 mos 2 wks 16 mos 2 wks Final 6th Appt 8th Appt How can teeth move this rapidly? With such light forces?
  132. 132. Initial 10 weeks 7 months 1st Appt 3rd Appt 12 mos 2 wks 16 mos 2 wks Final 6th Appt 8th Appt How can teeth move this rapidly? With such light forces?
  133. 133. Initial 32 years – 9 months
  134. 134. Final 18 Months – 2 weeks 10 appointments
  135. 135. Final 18 Months 2 weeks 10 Appointments
  136. 136. Final 18 Months 2 weeks 10 Appointments
  137. 137. Final 18 Months 2 weeks 10 Appointments
  138. 138. Initial Final
  139. 139. Initial Final
  140. 140. Composite
  141. 141. Width Initial Final Change Cuspid 32 mm 34.5 mm 2.5 mm 1st bicuspid 35 mm 43.5 mm 8.5 mm 2nd bicuspid 41 mm 48 mm 7 mm 1st Molar 48 mm 52 mm 4 mm
  142. 142. Initial Final Note change in shape of the palate – tongue can now move into balance
  143. 143. Q: Are we moving teeth through bone, or is the bone adapting and moving with the teeth with these light forces?
  144. 144. Change: Cuspids 2.5 mm, 1st Bi’s 8 mm, 2nd Bi’s 7 mm, Molars 4 mm 16 months post- treatment 1st Molars – 4 mm Transverse
  145. 145. Change: Cuspids 2.5 mm, 1st Bi’s 8 mm, 2nd Bi’s 7 mm, Molars 4 mm 16 months post- Roots are upright treatment in bone on both buccal and lingual side after significant transverse movement 2nd Bicuspids – 7 mm transverse Q: Does this image change your thinking on what is possible?
  146. 146. Change: Cuspids 2.5 mm, 1st Bi’s 8 mm, 2nd Bi’s 7 mm, Molars 4 mm 16 months post- treatment 1st Bicuspids – 8 mm transverse Q: Does this image change your thinking on what is possible?
  147. 147. Change: Cuspids 2.5 mm, 1st Bi’s 8 mm, 2nd Bi’s 7 mm, Molars 4 mm 16 months post- treatment Observe the presence of bone on the labial, buccal, and lingual of this adult
  148. 148. Evaluate bone and tissue contours 6 months posttreatment
  149. 149. Change: Cuspids 2.5 mm, 1st Bi’s 8 mm, 2nd Bi’s 7 mm, Molars 4 mm 16 months post- treatment Remember that the cuspids were out of the arch! Note the presence of bone on the labial, buccal, and lingual of this adult
  150. 150. Remember that the cuspids were out of the arch! Evaluate tissue 6 months retention
  151. 151. 2 years 1 month posttreatment
  152. 152. How Can Light Forces Cause Such a Dramatic Adaptation of the Alveolar Bone? Insights Gained By Observing Naturally Occurring Bodily Processes
  153. 153. Orthodontic Forces: How Low Can You Go?
  154. 154. 4-2-03 Q: Can a 3rd Molar move distal 2/3 width of 2nd Molar in 2-3 months?
  155. 155. 06-23-04 Cyst growth exerts a fraction of the forces used in traditional orthodontics, yet it can move teeth much more rapidly. A: It can when there is a growing cyst.
  156. 156. Note how cortical bone compensates for cyst growth
  157. 157. Should this be a wakeup call to our concepts of force? Once the cyst is removed, the alveolar bone moved back
  158. 158. Q: If the muscles of the face and tongue are helping to determine arch form, will the arch forms of all patients be different?
  159. 159. Standard Arch Form One Size Fits All?
  160. 160. Customizing Arch Form For Each Patient
  161. 161. K.M. Final C.B. Final UPPERS Two people, two very different arch forms.
  162. 162. Q: Is there ever a time when you need to extract?
  163. 163. Face-Driven Treatment Planning
  164. 164. There is a time to extract • Patient has very little crowding • Bi-max protrusion • Patient’s chief complaint is the protrusive nature of her profile. • This is a case where extraction will help to establish an improved facial profile.
  165. 165. With the Damon System we “Extract for the face, not for the space.”
  166. 166. Light elastics and/or springs are used to close space
  167. 167. Low-friction Damon brackets allow spaces to be closed far more quickly and easily.
  168. 168. Treatment time: 21 months
  169. 169. Treatment time: 21 months
  170. 170. Selective Application vs. All or None • This technology must be used in all cases to see the true efficiency gains • You never know who your best advocates will be • If you know it is better for patients, how do you choose?
  171. 171. Mom only sees diastema Note posterior teeth tipped lingual – dark triangles We could use brackets or aligners to make minor anterior corrections, but what about the facial impact?
  172. 172. A.M. Final
  173. 173. Final Note change in arch form
  174. 174. Initial Final Note change in mid-face support and smile vs. simple diastema closure
  175. 175. K.W. Initial
  176. 176. Initial
  177. 177. Initial
  178. 178. Initial
  179. 179. Initial K.W. at 53 years 3 months
  180. 180. 4 yrs 1 mo post- treatment No night retention for 2 yrs
  181. 181. 53 years 3 months 59 years 1 month
  182. 182. K.W. 59 years of age
  183. 183. “The interesting thing about the Damon System isn’t just the quality of the cases, it’s the consistent quality of the cases.” – Damon user
  184. 184. Before After
  185. 185. It’s More Than Just Straight Teeth.
  186. 186. It’s all about the face.
  187. 187. “As orthodontists we can do more for our patients, more quickly, and more comfortably than ever before.” – Dwight Damon
  188. 188. • Extraordinary Results • Shorter Treatment Time • Fewer Appointments • Greater Comfort • Most Cases Treated Without Extractions For more information, visit www.damonbraces.com
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