This is an example of why we segment the arch wire distal to the canine before placing springs.
We have just removed the springs after over-correcting the first bicuspid to a half cusp Class III
The lower incisors are overly proclined. They have been tipped forward, leaving the roots in bone.
The bicuspid crown relapses forward by tipping, leaving the root apex Class I. The lower incisor relapses
back by tipping, leaving it proclined 3 degrees on average.
Eruption mechanics with Class II elastics or intrusive mechanics with Class II springs? Springs support upper incisor intrusion.
1. RME X 6 2. Xbow with springs 3 months 3. Full Braces for 13 months
Impinging overbite. This is where you need Class II elastics. Class II springs cannot open the bite.
1. Upper 2X6 and posterior bite openers, 2. 6 months Xbow followed by compensatory maxillary expansion,
now hold expansion and test Cl II correction for 5 months
Day of bite opener switch from posterior to anterior (bite-turbo) 5 months into full braces
______________posterior bite openers______________________________bite openers removed_______________
We begin most cases with posterior bite openers. They remove occlusal interferences to prevent debonds as well as
allowing lower alignment with the lightest forces
_____________________bite turbo placed_____________________Class II elastics to erupt lower molars and correct overjet from bite opening
This is where patient cooperation is needed. Over-correct to incisal edge to edge
9 months progress with full braces
12 months braces
3 years post deband
The Bite-Turbo Story
In 1981 I became an associate of Dr. Michael Wainwright. We went to a course on lingual orthodontics sponsored by Ormco which manufactured the lingual
brackets. I had recently finished a master's degree involving research in orthodontic bracket bond strength. I had worked in the dental materials lab at Indiana
University that Ralph Phillips had made famous. At the Ormco course I met Dr. Craig Andreiko who had invented the pre-adjusted lingual bracket. This led to
me joining the Ormco Insiders, a think tank for orthodontic innovation, where Craig Andreiko did most of the innovating, and the other orthodontists did the
clinical testing. Many of the Insider orthodontists had noticed that Class II elastics seemed to work better with lingual treatment than labial treatment.
This was due to the anterior bite plane and bite opening effect of the upper incisor lingual brackets. Craig began using the upper incisor lingual bracket blanks
for labial treatment and called them "bite-turbos". He thought the best time to use them was with full size rectangular stainles steel arch wires when the overjet
had been reduced enough that the lingual of the upper incisors were hitting the lower incisor brackets. This was one of the "secret weapons" that I took away
from the Ormco Insiders meetings. Another was the use of the four crown cantilever bite-jumper Herbst appliance or CBJ. This and the Ormco Bite Fixer
Spring led to the Xbow Appliance.
The bite-turbo was used by some clinicians to treat TMD. It worked like a Lucia Jig by de-programming muscles and allowing the condyles to seat in the
most superior position. It also worked like an NTI splint to reduce muscle contraction in bruxers. Some clinicians used heavy 6 oz Class II elastics to
pull the mandible forward slightly which they claimed caused a "functional appliance effect", and even opened the airway slightly.
I was already using light cured adhesives for indirect bonding. I began using Ormco's Fluorobond lightly filled sealant with the custom base technique.
It worked so well it led to me giving many lectures on the technique. I also began using dentin bonding agents with hydrophillic monomers in an attempt
to decrease bond failures in high moisture situations. This led to moisture tolerant sealants used in orthodontic bonding and the product Ortho Solo.
Below are bond strength results from work I did with Ormco and Kerr.