auto-ligaturant:une experience

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Dernier message

15/07/2007 à 15h06

pour ceux qui utilisent les auto-ligaturants ou ceux qui sont interesses par le sujet,voici un temoignage assez interessant

je sais ,c'est long et c'est en anglais mais cette lettre(glanee sur un autre forum) resume assez bien l'interet et les problemes (decollement,torque...) rencontres avec la technique des auto-ligaturants
j'aime bien le ton aussi,si cela pouvait faire ecole.....

"When I think of the D3 bracket, I am reminded of the start of the old TV show, _Mission Impossible_. At the start of each episode just after Jim would get the mission the voice on the tape recorder would say, This tape will self destruct in 5 seconds. Good luck, Jim!
I say, D3 brackets will self destruct in 15 months Good luck Greg!

Thanks I need it. The race is on you better hustle.

There is not a D3 user anywhere that does not know (by hard knocks)that
the D3 bracket lacks the integrity to function anywhere except the
maxillary anterior even that is debatable. In my office the D3
bracket
has added 30% to the time to treat a case as well as the number of
visits. The reason: fundamentally they just self destruct. I was doing
very well with time and visits before D3. Worse than that, the bracket
has cost me personally thousands of dollars in time and materials to
fix
the problems associated with D3. I had one patient, early in the
process, with short clinical crowns (bad news) that simply left the
practice due to bond failure problems. That’s a problem that will shake
you to the bones.

Addressing Mark’s letter, I have not seen posterior bite opening as an
issue that is different from my experience with Innovation or any other
system I have used. I have not seen the posterior teeth tip buccally.
That, perhaps, may have to do with some nuance I employ to shape wires,
which is not standard Damon protocol.

I find a very slight increase in rotational issues in the lower
anterior
which I have solved completely with selective use of c-chain to resolve
the rotations mostly without wire bending.

I have seen no increase in torque problems in the lower anterior. The
perennial problem of upper anterior torque in any 22 system is due to
the wire size/slot size discrepancy. The problem is incisors that are
too upright. This can be accommodated by adding about 5° torque
(minimal) to the wire to eliminate the slop as well as anticipating the
issues and using increased torque NiTi wires earlier in alignment.

The biggest problem with the system is finishing wire stiffness and the
multiple wires to finish. If a bracket comes off (think second
premolar)
in finishing, the system lacks forgiveness. I attribute this problem
mostly to intrinsic issues with the 22 slot that are magnified by the
door. You just can’t cram a stainless steel or even a TMA wire into a
bracket that is too shifted. 1-3 month detours are possible. Of course,
occasionally it makes sense to use a ligature and some c-chain to save
the day in these specifics. But the wire stiffness/door issue is mostly
intrinsic and must be assessed in treatment planning. The system also
requires more wires than are necessary for many cases.

I have not had bond failure problems with the Dmx bracket that exceed
the norms. I bond with a modified L-Pop technique. I etch very briefly,
and then apply the L- pop as indicated in the directions. This works
very well since the strengths of both techniques appear to supplement
each other and counteract human errors applying either etch mechanism.

I applaud Ormco for finally doing the right thing and changing the mesh
on the Dmx bracket as well as offsetting the lower premolars. Why in
the
world didn’t you do that in the first place? Can’t figure that one -
classic Ormco.

Fortunately for me I was using Innovation before I entered the fray
with
D3. As I stated two years ago, I have not had problems with the
Innovation bracket. With thousands of brackets bonded, I have had less
than a dozen clip failures of any type. My worst situation ever, by
far,
was a patient this week where tartar immobilized 3 Innovation brackets
(really threw off the statistics).

My experience with both systems permits me to make comparisons that may
be unique.

I use the Damon system to this day and I grow more fond of it as my D3
cases fade away. I use Dmx 5 to 5 in the lower with selective torques.
I
am getting more creative this way every day. In the upper I use Dmx
exclusively on the 4’s and 5’s. I use D3 on 3 to 3 and am starting some
Dmx here as well.

You should ask yourself, why in the world would he use the Damon system
at all? The reason is simply this: for crowding cases with narrow
arches
it works best. My definition of a narrow arch may be different from
many
of my peers. It is clearly superior to my Innovation system (18x25
slot)
in this type of case. Cases unravel better and there is better incisor
control for torque. The disadvantage of finishing wire/door issues are
offset by advantages elsewhere. In extraction cases, it works best due
to easier sliding mechanics for whatever reason.

So today I triage my cases. Cases which are not so crowded are
Innovation R and Innovation C. I use fewer wires and I can be in
finishing in less than 6 months routinely in all but Herbst cases. I
can
use Class II or Class III elastics with better arch shape and torque
control earlier in treatment. I use Innovation on most Herbst cases.
Herbst cases can be in finishing in about a year. The reason is fewer
wires, earlier torque control, and a more linear start to finish
sequence using my approach to treating with the Herbst.

I find most cases can be treated easier and consequently faster with my
approach to using the Innovation system. I treat my 18x25 slot
Innovation cases in a manner like my D3/Dmx cases. I must applaud and
thank Dr Damon for improving my wire sequencing with self ligation
based
on what he teaches with the Damon system. I start with 013 or 014
Thermal NiTi wires. I think the data is getting better that there are
other wires with favorable attributes which are much less expensive
than
Copper NiTi or TMA and generate equal or better force loading and
unloading. My next wire is 16x22 thermal NiTi. This wire finishes
alignment and can be used to reposition as needed (I have much more to
say about this for some other time). I finish in a posted 16x22 ss wire
in the upper and a 16x22 TMA (Resolve) in the lower. If a bracket
breaks
in finishing rarely do you have to back off to 16x22 NiTi since all the
wires are smaller and can be comfortably inserted into a slot/clip
configuration. If I do have a greater displacement of a tooth in
finishing I can continue elastics with virtual impunity in the
Innovation system before going back to the finishing wire in a month or
less no detour.

Frankly the approach to treating cases in the Damon system is very
intelligent and I would recommend taking these classes to every
orthodontist. You will become an even better clinician if you can
expunge some of the dogma some hold so dear. These classes can help a
lot. The system is outstanding but has intrinsic flaws, just like
everything else.

As a clinician I am comfortable with using two systems in my office. I
use exclusively self ligation. I would recommend the lecture by Dr
Harradine from the 2007 AAO meeting as to why you really should be
using
self ligation exclusively. I use both systems in a very similar manner
so my staff does not need to shift their mindset to use one or the
other. Frankly, where I am at now I believe the two systems are better
than either one alone.

My opinion is never cast in stone so I will continue to evaluate and
re-evaluate until I ride off into the sunset (hopefully a long time
from
now). I do believe that there is a lot of nonsense that people believe
about the Damon system, mostly because they don’t know or care to
learn.
You should learn this information and also listen to others who have
gone down the road before you.

It is uncommon to see anything by Damon users that are negative. I
think
this is because there are so many positive things to be said about the
system. What’s going on in self ligation treatment is a major step
forward for our profession and for patient care. If a person does what
they have always done using a self ligating bracket then they will not
maximize the advantages that are available.

No other group has done more to demonstrate a better way than the Damon
users and the Damon system lecture series. If you cast aside learning
about the Damon system you are really cutting off your hand to spite
your arm. I encourage every orthodontist to learn what Dr Damon et. al.
are saying.

I started my letter here quite negative, because the D3 bracket is such
a flawed bracket and everybody needs to know this. But the system, at
the very least, has a lot for everyone one to learn and grow from."

un :) et un bravo pour ceux qui sont arrives jusqu'ici