Combination Active Anteriors and Passive Posteriors (CAAPP)
Orthodontic Skating: Sliding with Control
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For those of you following my pursuit for efficiency, we finally have a self-ligating bracket system with a flat niti clip that is passive with round wire on incisors, active with rectangular wire on incisors, and passive with rectangular wire on canines and bicuspids. It's called Lotus Plus DS Hybrid. I am using it with the MBT prescription in an .018 slot. Thank you Dr. Lopes.
_______"C" Clip___________SS Passive__________Lotus Passive______Lotus Interactive____
The Lotus Interactive niti clip seats the archwire in the floor of the slot with a force that is perpendicular to the archwire and slot,
unlike a "C" clip.
CAAPP .018 with G&H Agility on canines and bicuspids,
The unique passive niti self-ligating clip can be removed and reinserted. This is ideal for engaging
the initial .012 niti archwire for severely rotated teeth or for archwire adjustments in the
.017X.025 beta titanium finishing archwire.
Root resorption increases as the force increases and as the length of treatment increases. The Xbow Treatment System focuses on phase one treatment goals to decrease the time in full braces to decrease decalcification and root resorption. Treatment begins with an .012 niti archwire in an .018 slot with ligatures on the incisors to seat the archwire in the base of the slot. A heavier archwire is only used for tooth movements that the lighter wire is unable to achieve.
CAAPP combines incisor control with ligated twin brackets and decreased resitance to sliding
with passive self-ligating brackets on canines and bicuspids, creating a "long buccal tube".
Ligated incisors also give young patients what they ask for, colored ligatures.
CAAPP minimizes "double ligation" when power chain is used to close space and hold it closed.
The .018 slot allows earlier incisor control with lighter forces. There is better torque control
with a .0175X.025 archwire in a .018 slot (4.5 degrees of play) compared to
a .019X.025 archwire in a .022 slot (10.5 degrees of play).
There are many claims for Passive Self-Ligating (PSL) brackets. Treatment time is the easiest variable to compare.
This author has concluded that by removing ligatures on canines and bicuspids there has been a decrease in treatment time
for incisor alignment and advancement, canine retraction, and space closure. Ligating canines, bicuspids, and molars
puts the brakes on. Ligating incisors does not slow down incisor alignment or require the use of heavier forces.
Ligating the archwire to the base of the incisor bracket slots allows the maximum deflection and activation
of the lightest archwires and the fastest incisor alignment with the lightest forces.
Initial placement of .012 niti_______________________________ After 2 months, day of change to .018 niti to lower second molars
In a group of 145 consecutively debonded patients from the author's practice, the average treatment time
from bonding to debonding was 16 months. 78% of patients had an average treatment time of 13.4 months.
This is the result of a combination of three key components: 1. The Higgins Xbow Class II Corrector,
2. Indirect (Precision) Bonding, and 3. CAAPP.
The part of treatment that the orthodontist has control over (other than the treatment plan) is
Alignment and Space Closure (ASC). The patient has control over elastic wear to coordinate
the arches and finish the occlusion. In a group of 42 consecutively treated patients where 34
were non-extraction and 8 were extraction cases, ASC took an average of 9 months to complete
for the non-extraction group and 11 months for the extraction group.
In the "race to fill the slot" we use an .018 slot and "shift gears" four times, from .012 nickel titanium
to .014 nickel titanium, then to .018 nickel titanium, then to .017X.025 nickel titanium,
and then to .016X.025 stainless steel. We don't pick up the second molars until the .018 niti.
Sometimes we skip the .014 and go right to .018 from .012. Fine tuning bends are done in a
.0175X.025 beta titanium archwire. This wire is stiff enough to maintain archform and space closure wth
elastic chain from first molar to first molar, but flexible enough to make adjustment bends in the lower incisors.
There is better torque control with a .0175X.025 archwire in a .018 slot (4.5 degrees of play) compared to
a .019X.025 archwire in a .022 slot (10.5 degrees of play).
The .018 technique uses lighter archwires and lower forces and fills the slot faster for control,
compared to the .022 technique.
In the CAAPP technique spaces lateral to lateral are closed with power chain on round wire in the first few appointments.
As soon as rectangular steel arch wires are placed we began closing space with first molar to first molar "over and under"
power chain and hold spaces closed for the rest of treatment with power chain. This means that we are "double ligating"
any tooth that has a self-ligating bracket. Even non-extraction cases require space closure after interproximal reduction
is done on incisors. When power chain is used there is no time saving for self-ligating brackets. It actually takes longer.
The goal is to reduce the total number of appointments and overall treatment time, not the actual chair time for each appointment.
"Over and Under" elastic chain space closure: 3 pieces of Ormco Generation II chain are used,
under the wire from the lateral incisor to first molar on each side, then over the wire from lateral incisor to lateral incisor.
CAAPP TwinLok 1997
The following are examples of rapid proclination and alignment of lower incisors with an .012" nickel titanium archwire in .018" slot CAAPP.
_____________________________________________After 2 months with .012 niti, day of .018 niti placement
After 1 month of .018 niti, day of .014X.025 niti placement
________________________________________________2 months with .012 niti and elastic chain to canine, day of change to .014X.025 niti
The following is a bicuspid extraction case showing rapid alignment with CAAPP.
1. Indirect bonding 2. Extractions 3. .012 niti archwires placed
3 weeks later. Begin light elastic chain under the .012 niti archwire.
6 weeks later. Day of change to .018 niti archwires
4 weeks later. 13 weeks total for initial alignment. Day of change to .014X.025 niti archwires.