Tatis jaos spring16prf1

1. This page is filler so pages line up as spreads

2. 32 Spring 2016 JAOS
THE ORTHOKINETIC
PHILOSOPHY:Preadjusted Straight Archwire
W
ith the completion of the 1990s innovations
in orthodontics involved, clearly defined
goals oriented toward technological changes
as a natural reflection of the technological
development of biomaterials and metallurgy that was
occurring. This lead to new materials for appliances,
self-ligation, technological approaches to dental move-
ment, etc. But little effort was made to find a solution
to the historical shortcomings observed in the integral
clinical practice of orthodontics.
Namely in the prescription of brackets, simplified
designs, biomechanics, and functional craniofacial inte-
gration. In addition the development of protocols for
diagnostics, therapy and the design of administrative
and management platforms for the clinical practice,
were important missed aspects.
For these reasons, Dr. Tatis, after years of training
and clinical testing of different techniques and treat-
ment modalities, plus years of clinical practice, and
basic clinical research applied with the highest stan-
dards of scientific background, and laboratory experi-
mental tests, arrived to the conclusions about the pros
and cons of the historical antecedents of orthodontics
evaluated with the rigor of scientific method. His
conclusion demands an interdisciplinary approach to
clinical practice to offer optimum outcomes in
contemporary orthodontics by the so called
ORTHOKINETIC PHILOSOPHY.® This word derives
from two etymologic components: Ortho from the
Greek stem of orthos meaning “straight”, “true" and
Kinesis also from the Greek meaning, “movement”,
“motion”. In short, the basic idea consolidated in this
new concept is the “dynamics of true movement in
contemporary orthodontics”.
The ORTHOKINETIC PHILOSOPHY® and its
approach is a new integrated view of orthodontic
dynamics in the 4th dimension. Through a radical
reduction of the level of force, time of treatment,
biological cost and financial cost for the patient, we
achieve the therapeutic goals of professional quality
and excellence with “efficiency and efficacy through
the principle of simplicity”.
This is the first of three articles about the ORTHOKI-
NETIC PHILOSOPHY® We talk about the fourth dimen-
Fig. 1a-c: A young man, 13 years old. Skeletal class II, with convex profile of soft and hard tissue. With dentoalveolar protrusión and dental
proclination. With macrodontia concomitant with several crowding upper and lower. Treatment plan: Extraction of 14, 24, 34 and 44,
Leveling, Retracction with máximum anchorage and Orthokinetics Mechanics and Retention.
By Diego F. Tatis, DDS
THE ORTHOKINETIC
PHILOSOPHY:Preadjusted Straight Archwire

3. www.orthodontics.com Spring 2016 33
sion in reference to time, when concerning the stages
involved in the exercise of orthodontics. We then add
this to the triple control normally used in orthodontic
techniques for the three dimensions of space.
Historically, the orthodontist dedicates a high
percentage of the treatment time to correct the errors
committed during the initial stages of the treatment.
The effects derived from the action-reaction process in
biomechanics, besides the biological cost for the
patient, almost always has an important impact in
terms of treatment duration and financial costs. Addi-
tionally, the increased chair time per patient, when we
employ complex biomechanic procedures, has
ergonomic consequences that can affect the systemic
health of the professional, who will be delivering the
continued treatment care.
Fundamental Principles of
the Orthokinetic Approach
The suggested dynamics of the ORTHOKINETIC
PHILOSOPHY® are expressed in the clinical practice of
orthodontics as well as in the scientific, technological and
administration levels of treatment. The following princi-
ples are fundamental fixed principles of Orthokinetics:
First principle: Design and prescription of
the appliances
í Minimum friction systems
í Reduction of treatment duration
í Optimization of the chair time
í Dynamics in dental movement
í Histogenetic Dental movement
Second principle: Biomechanical foundations
Innovative mechanics for sliding and minimal
forces, with self anchorage and self retraction systems.
Third principle: General cranio-
mandibular, cranio-cervical, and general
neuromuscular equilibrium, before tooth
movement.
Basic principle to treat the patient and primary
generator of the biomechanics, therapeutic results and
long term stability.
Fourth principle: Achieve therapeutic goals.
In the ORTHOKINETIC PHILOSOPHY®, the thera-
peutic goals are divided in two groups:
a) Static goals: Craniometric goals (hard tissue),
Photometric goals (soft tissue), dentoalveolar
(bone for dental movement and skeletal compen-
sations) , periodontal (dental support tissues).
b) Dynamic goals: Articular dynamics goals, occlusal
dynamics goals, and neuromuscular dynamic goals.
Fifth principle: Systematic management
of every orthodontic process
Absolutely demanded by the need to obtain immedi-
ate information to make decisions, inform the patient
during diagnostic and treatment, through the availabil-
ity of systematic information and informatics manage-
ment. With our ORTHOKINETOR software suite.
Sixth principle: Administrative management
with a system of control of the management
of all orthodontic processes.
The basic purpose in contemporary orthodontics is
to achieve excellence with the minimum effort. This
excellence is reflected at all levels of the practice: clini-
cal, scientific background, administration and results.
To bring about this purpose the Orthokinetic approach
offers an administrative platform oriented to the princi-
ples of total quality and permanent improvement in all
the clinical, paraclinic and administration processes
involved in orthodontic treatment.
The following is a clinical case highlighting the biome-
chanics of orthokinetics.
Extraction Case Study; 8-MoTreatment
Clinical Case
This 13-year-old young man presented to my clinic
with a Class II skeletal diagnosis with a convex profile of
both hard and soft tissues. This was combined with a
dento-alveolar protrusion and upper and lower dental
proclination. Due to Microdontia, a severe dento-alveolar
discrepency and severe crowding was present.(Fig.1a-c)
The patient was treatment planned for extraction of
all four first bicuspids (5-12-21 and 28) By following
through with this treatment we hope to elimate dental,
dental alveolar and facial esthetic problems.
The goals we will be working toward are grouped as
blocks are grouped as static and dynamic goals.
Fig. 2: 4R Orthokinetic Retraction System. Orthokinetic archwire with
hook (A) engaged distal on the canine and the retraction systems (B).

4. 34 Spring 2016 JAOS
Static Goals
a) Craniometric goals: hard tissue
í Develop a skeletal straight profile.
í Develop appropriate maxillo-mandibular
angular relationships horizontally
and vertically.
í Develop a correct tooth torque and tooth
position to produce smile harmony while
developing proper lip support for dentofacial
mini and macro esthetics
b) Photometric goals: soft tissue
í Develop a straight soft tissue profile.
í Obtain proper lip position both statically
and dynamically
í Develop adequate bilabial relationships with
spontaneous lip seal.
í Develop an adequate exposure of incisors in
the smile exercise.
í Develop correct chin position.
í Develop adequate soft tissue balance in
terms of symmetry and proportionallity in
both the sagittal and transverse direction.
c) Dentoalveolar goals: bone for dental movement
and skeletal compensations
í Develop both proper symmetry and
proportions of the heights of the alveolar
bone. This will allow for proper dental
support, and stability for masticatory
functions and a harmonious relationship
with TMJs, and with the Six Keys to
Normal Occlusion.
d) Periodontal: dental support tissues
í After dental movement is completed it will be
necessary to reach a final tooth position with
periodontal clinical attachment levels that are
ideal to allow for a quality and quanitity of
tissue support for long-term stability. Also it is
necessary to allow vertical distribution of
Fig. 3a-c: Initial intraoral photographs.
Fig. 4a-c: Initial leveling- Heat-activated 0.016 archwire for alignment and leveling. Initiating the stage.
Fig. 5a-c: Final leveling and Initial retraction- Heat-activated NiTi archwire 0.019 x 0.025 inch to prepare the slots of the
brackets to a friendly reception of the steel rectangular work archwire. Lower arch at retraction step.

5. www.orthodontics.com Spring 2016 35
forces to be directed to the long axis of the
teeth and periodontal tissues thus avoiding
horizontal forces that can cause occlusal trauma.
Dynamic Goals
a) Articular dynamic goals
í Develop comprehensive health for both
the intra- and extra-capsule of the TMJ
components by means of a dynamic joint
that is synchronous with the resulting
new occlusion.
b) Occlusal Goal dynamics:
í Develop a mutually protected dynamic
occlusion, that is compatible with all the
functionality and anatomy of the temporoZ
mandibular joints, cranio-cervical joints and
neuro-muscular and ligamentous system in
the sagittal, vertical and transverse dimensions.
c) Neuromuscular Dynamic goals:
í Develop proper load distribution with inter-
occlusal and inter-proximal contacts that
provide for proper muscle proprioception. The
proprioception of the muscles, including both
elevators and depressors of the jaw, are derived
from the periodontal ligament, due to
stimulating, clenching and chewing exercises.
Fig. 6a-c: Final Retraction : Orthokinetics Archwires. The activation of the Orthokinetic archwires is made by the retraction systems by stretching the
elastic module to 1/3 or ½ of its diameter until completing the space closure.
Fig. 7a-c: Final introral photographs.
Fig. 8a-c: Retention: Upper – removal; lower: 3x3 fix.
“Through a radical reduction
of the level of force, time of
treatment, biological cost
and financial cost for the
patient, we achieve the
therapeutic goals of
professional quality and
excellence with efficiency
and efficacy through the
principle of simplicity.”

6. 36 Spring 2016 JAOS
Treatment and Biomechanical
Sequence
The Orthokinetic philosophy, aims to optimize
chair-time as well as treatment time in general. It
divides the conventional management of an orthodon-
tic case into three basic steps:
ᕡ Bonding appliances
ᕢ Stage of alignment and leveling
ᕣ Work and finalization stage
Retention is taken in to consideration while perform-
ing all three basic steps. Bonding is carried out by the
cementing of appliances pre-set to an 0.22 slot, by the
method of indirect cementation. This guarantees the
minimum chair time and the correct location of the
brackets. By doing this, we reduce the maximum error in
final tooth position and also reduce the need for reloca-
tion of the brackets, while accelerating treatment.
Alignment & Leveling
Is initiated with an 0.016 archwire heat activated Niti-
nol. In cases of severe crowding lower diameter wires can
be used to begin alignment and leveling. The basic
purpose of the round superelastic wires used in Orthoki-
netics is only to eliminate rotations, so once they are
corrected, it is necessary to change immediately to the
next archwire, otherwise treatment time is wasted
because the effect of this archwire, to move further along,
is minimal once rotations are corrected. (see Figs. 4a-c).
After eliminating rotations, we continue with a heat-
activated 0.019 x 0.025 nitinol wire, whose basic
purpose is to prepare the slots of the brackets to receive
a working archwire. Because of this they are called tran-
sitional archwires. This wire generates the initial expres-
sion of the bracket prescription in terms of torque,
inclination and rotation, and prepares the slots of the
brackets and the coronal and radicular structures for
the final working archwire. This final working archwire
gives triple control for space closure using sliding
mechanics. (Figs.5a-c). The working archwire is made
of a high caliber rectangular stainless steel. It also
measures 0.019 x 0.025. This archwire is now able to
adapt to the bracket slot. due to work of the Nitinol
wire leveling and aligning all the teeth. Once this level-
ing and alignment stage is over the Orthokinetic stain-
less steel archwire will enter the bracket slots passively,
this indicates that we are ready to initiate the working
stage.
Working Stage and finalization
The Orthokinetic mechanics were developed by having
as their basic purpose the ability to avoid in any stage
undesired alterations or distortions of either the dental or
alveolar arch, and the archwire or root structures. Through
both this action and by applying the Orthokinetic biome-
chanic basis we perform a mechanotherapy that is more
physiologicly, friendly and highly effective.
This includes keeping the shape of the archwire in
size, form and coordination through out treatment.
Although movement mechanics are being conducted
the inter-arch relationship should be maintained at
the maximum occlusal harmony possible. This
harmony together with the neuromuscular equilib-
rium system. According to the initial shape of the
template selected for the patient's face shape the
dimension of the lower dental arch, will be
sequenced so that he arch wire will develop the lower
dental arch. (Figs.6a-c).
At the end of the space closure stage all structures
will be in their intended position and placement,
with adequate functional engagement having
Fig. 8a-c: Retention: Upper – removal; lower : 3x3 fix.
“Retention is an important
part of each treatment stage
and not addressed only at the
end of treatment. It is
important to initiate
treatment keeping in mind
how we will finalize the case.”

7. occurred. It is possible to avoid the extensive hard
work involved with the maneuvers of finalization
used in classic orthodontics, because with Orthoki-
netics it is usually not necessary to devote time to
correcting errors from the initial stages and from the
general sequence of treatment. By avoiding commit-
ting errors we can now reach the final stage quicker.
It is possible .to save up to 50 % of treatment time
by performing our treatment almost error free.
We are now ready to perform extraction space closure
or closure of any other space that has been generated as
a result of treatment. This is done through sliding
mechanics, with the Orthokinetic (O.K.) archwire. Made
of 0.019x0.025 inch stainless steel and with hooks
distally placed in canine teeth anchored to the retrac-
tion systems, as mentioned above.(Figs.6a-c)
The activation of the Orthokinetic retraction system
archwires is made by stretching the elastic module to 1/3 or
½ of its diameter until completing the space closure (Fig. 2)
The purpose of this stage is not just space closure
but to also find out and achieve the final position and
placement of all structures.
At the end of the space closure stage, we reestablish
both the intra and inter arch crown/root relationships
in space obtaining the static and dynamic therapeutic
goals. Now the case is finished (Figs.7a-c).
Retention
Retention is an important part of each treatment
stage and not addressed only at the end of treatment. It
is important to initiate treatment keeping in mind how
we will finalize the case.
The design of retention appliances must take into
account all the changes and corrections that have been
achieved during the treatment, including the elimina-
tion of the etiological factors that caused the original
malocclusion. The appliances used for retention are
adapted to the finished occlusion and both allow for
and facilitate any rebound from overcorrection that has
occurred. There is a certain amount of overcorrection
or overtreatment that can occur with the uprighting,
involved with restoring distal inclination and with the
unrotating of premolar and molar teeth to improve
their anchorage; hence during treatment the marginal
ridge height for posterior teeth becomes unequal.
After debanding a case, the rebound that occurs
from overcorrection helps to level the marginal ridges
and fix the desired occlusion. In addition there is also a
mild return of the curve of Spee and of the normal
meso-axial position of the posterior teeth (Figs.7a-c) For
upper arch retention, we placed splints with a continu-
ous contoured arch without occlusal additives. For the
lower arch we placed a 3x3 coax wire.(Figs.8a-c).
www.orthodontics.com Spring 2016 37