A useful tool for impacted canines bonding technique:

Alberto R. Mazzocchi MD, DDS Note: The author has no financial interest in the products described in this article.

INTRODUCTION ctopic eruption and impaction of canines is a frequently encountered clinical problem. The incidence of impaction ran es bet!een "# and $#. %anine impaction can be the result of localized factor&s' or poly enic multifactorial inheritance in association !ith other dental anomalies. There are a number of possible sequelae to canine impaction, ran in from loss of space in the arch to resorption of the roots of the ad(acent teeth. Althou h the mana ement of the ectopically eruptin teeth necessitates the combined e)pertise of a number of clinicians, the orthodontist should ha*e the primary responsibility of coordinatin these efforts to pro*ide the patient !ith the optimal treatment options and the most stable and fa*orable outcome &"'. Ad*ances in bondin techniques and materials allo! for reliable brac+et placement on ectopically positioned teeth. The aim of this study is to present some clinical uses of the Transbond M,- primer &$M .nite+', a ne! product desi ned for bondin in a !et field. CAS ! R./. "$.0 12ARS 34D female, S+eletal class ,, Molar class ,, 35 6mm 37 "mm ,mpacted upper ri ht canine. A mucoperiosteal full thic+ness *estibular flap !as ele*ated bet!een the upper first premolar and the lateral ,ncisor. The dental follicle !as e)cised and a small area of the upper canine cro!n !as e)posed &8i ." '. After etchin for $9 seconds, the cro!n !as rinsed abundantly &fi .6 '. M,- primer !as applied immediately and a lin ual button !as bonded on the cro!n &Transbond li ht curin composite'. After :9 seconds of li ht curin &fi . $' clear po!er chain !as placed and the mucoperiosteal flap !as sutured &fi .: '

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fi . : S.A. ":.< 12ARS 34D female, S+eletal %lass ,, Molar class ,, 35 "mm 37 6mm 5ilateral palatally impacted canines &fi .; ' T!o palatal full thic+ness mucoperiosteal flaps !ere raised under local anaesthesia to e)pose the upper canines. 3n her upper ri ht, the canine !as located close to the lateral incisor root & fi .= ' ,n the upper left, the canine !as palatal to the lateral incisor root & fi .<' Due to the conspicuous bleedin , a complete dry field could not be achie*ed. After etchin a small portion of the canine cro!ns, M,primer !as placed and 6 palatal button !ere bonded &fi .0 '. -o!er chain !as placed on the steel li ature around the button after suturin the mucoperiosteal flaps &fi .>'

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fi . 0 DISCUSSION

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The palatally impacted canine requires a combination of both sur ical and orthodontic mana ement. The ad*ent of bonded brac+ets has allo!ed considerable fle)ibility in the e)posure technique. %omplete canine cro!n e)posure is not required yet, as a brac+et can simply be bonded to small e)posed surfaces. &6' T!o types of approaches are commonly used: simple e)posure, or e)posure !ith brac+etin at the time of sur ery &$'. 8orced orthodontic eruption of impacted ma)illary canines !ith a !ell bonded orthodontic traction hoo+ and li ation chain, used in con(unction !ith a palatal flap or an apically repositioned labial flap, results in predictable orthodontic eruption !ith fe! complications &:'. Durin sur ical e)posure and bondin procedures, the main problem is the control of blood, sali*a and fluid contamination to obtain stable and durable brac+etin of the impacted tooth.. Transbond M,- contains ?2MA to attain moisture insensiti*ity and 5is@MA for bond stren th and hydrophilic monomers, !hich are moisture friendly. Therefore, it is especially useful !here moisture control is troublesome, i.e. in the posterior re ion or on partially erupted teeth. ,t can be used in dry, !et or sali*a contaminated en*ironments, !hereas the usual bondin systems can only be used in dry en*ironments. 8or these reasons, Transbond M,- can be considered an effecti*e bondin system in the mana ement of impacted canines.

Intrusion of posterior teeth #ith magnets supported b$ osseointegrated implants

Alberto R. Mazzocchi MD, DDS 5er amo ,talia Note: The author has no financial interest in the products described in this article. INTRODUCTION Ma nets ha*e been used in dentistry for many years to push or pull teeth. ,n 3rthodontics they are used to intrude or to mo*e teeth alon arch!ires, to produce e)pansion or to pro*ide retention &",6,$'. Ma nets sho! predictable force le*els that do not decay o*er the time. Se*eral animal and clinical studies in human bein ha*e documented the reliability of usin ma netic forces for different orthodontic purposes &:,;'. ,ntrusion of posterior teeth seems to be one of the most promisin applications &='. 3sseointe rated implants may pro*ide ideal orthodontic anchora e since they are incapable of mo*ements !ithin bone. Animal studies and human trials ha*e demonstrated that endosseous implants can be efficiently used as anchora e in horizontal &mesioAdistal' orthodontic mo*ements &<,0,>'. The aim of this study is to present a case !here *ertical mo*ement &molar intrusion' !as obtained usin repellin ma nets positioned on natural teeth and reciprocally on implant abutments.

CAS R %ORT %.-. ;6,$ years old. 8emale This patient !as referred for an orthodontic consultation re ardin supraeruption of the ma)illary left second bicuspid and first molar. ,t !as determined that she necessitated intrusion of these teeth to establish adequate space for prosthetic reconstruction of the mandibular left quadrant &second bicuspid and first molar' &8i "'.

fi ." T!o osseointe rated implants &2TA 2)acta %/"' of ""Amm len th !ere placed in the lo!er arch. These implants !ould be used to support a repellin ma net durin orthodontics as !ell as the final prostheses.

8ollo!in healin and confirmation of osseointe ration, 6 plastic abutements &acrylic healin caps' !ere inserted on the implants. 3ne of the repellin ma nets !as attached to these abutments !ith coldAcure acrylic resin. &8i 6'

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,n the ma)illary arch, t!o orthodontic bands &Bashbone , 3rmco' !ere cemented around the second bicuspid and the first molar. The other repellin ma net !as bonded to the lin ual surface, a ain usin coldAcure acrylic resin &8i $'.

Due to the repellin forces of the ma nets, an openAbite !as present immediately follo!in their placement &fi :'. After $ months time, the ma nets produced effecti*e intrusion of the supraerupted teeth and the openA bite resol*ed &8i ;'.

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DISCUSSION Althou h ma nets are potentially useful, the force produced bet!een t!o ma nets falls dramatically !ith an increase in their distance or !ith an imperfect ali nment. ThreeAdimensional control is quite limited !hen ma nets are in a repulsi*e confi uration. ,mplants can be helpful in reducin treatment time and a*oidin any deleterious effects on natural teeth that !ould other!ise be used as anchora e durin orthodontic treatment. 2TA 2)acta is a dental rootAform implant made of pure titanium. ,t is a*ailable in : different diameters: $,$mm :.9mm :.<mm ;.=mm of : different len ths: >.9mm "".9mm "$.9mm and ";.9mm. -rosthodontic abutments

are connected to a he)a onal cylinder and secured !ith a transAabutment scre!. ,n addition to the usual metallic healin caps, 2TA 2)acta system an acrylic abutment is a*ailable. ,t can be adapted for orthodontic bands and con*erted to a temporary or definiti*e prosthetic restoration !ith simple and ine)pensi*e inAoffice procedures &"9'. 3ther ad*anta es for its use as an orthodontic anchor are: C it is comfortable and pro*ides con*enient anchora e, C the abutment is ine)pensi*e &it is made of acrylic resin', C it offers aesthetic results &temporary cro!ns can be cemented', C it reduces chances of brea+a e, C it requires ad(ustments appro)imately e*ery = !ee+s The main disad*anta es are the costs of the sur ical procedure &implant placement', the implant healin time &$A= months', and itDsD contraindication for use in youn patients: implants are recommended in patients o*er the a e of "0. This ine)pensi*e and simpleAtoAmana e tool pro*ides an efficient and comfortable solution to orthodontic anchora e. The compact sectional orthodontic mechanics sho!ed in the abo*e case !as quic+, con*enient, comfortable and effecti*e.

INDIR CT &ONDIN' a ne# impro(ed adhesi(e

Alberto R. Mazzocchi MD DDS Bergamo Italy INTRODUCTION Thou h fe!er than 69# of orthodontists use an indirect bondin technique &;', there is eneral a reement that brac+ets can be positioned more accurately e)traorally on a study model than intraorally on teeth &6,$'. This statement is e*en more important !hen it comes to usin preAad(usted brac+ets. ,ndirect bondin offers si nificant re!ards in term of quality of care and efficiency of treatment &:'. T!o main problems are usually related to indirect bondin : additional laboratory procedures and difficulty in achie*in consistent and rapid adhesion to teeth. The additional laboratory procedures can be dele ated to trained laboratory personnel a*oidin timeAconsumin operations by the orthodontist. Achie*in consistent and rapid adhesion can be brilliantly resol*ed !ith a ne! adhesi*e by $M .nite+. This product, The Sondhi Adhesi*e +ittm, is composed of t!o bottles of liquid resin de*eloped specifically for indirect bondin , !ith 6 main ob(ecti*es&"': "A*iscosity impro*ement &!ith the use of fine particle fumed silica filler' 6Ashort settin time of $9 seconds and completely cured in 6 minutes. )A&ORATOR* %ROC DUR S %lean !or+in models in orthodontic stone and eliminate any defects &bubbles, small *oids etc.'.Apply a thin coat of separatin medium to all the tooth surfaces and allo! to dry for " hour. -lace brac+ets precisely on the model casts usin your fa*orite composite. %oncise AE5 composite paste or Transbond li ht curin composite &$M .nite+' can be used. 2)cess composite should be remo*ed and the position of the brac+ets should be accurately chec+ed.

Barm up the study models to assure complete composite polymerization &$9 minutes'. ,f you use a li htAcurin composite, cure each brac+ets for $9 seconds.

-repare a *acuumAformed or a silicone impression tray. ,f you use a *acuumAformed tray, !e recommend 9.<mm. This type of tray is cheap, predictable and easy to prepare. Bhite &$' recommends a polymer of ethylene *inyl acetate &Surebond DTA 699tm dual temperature hotA lue un'. Falan e &:' uses 2safle)tm *ery *iscous -utty.

Remo*e the bondin tray from the cast, clean e)cessi*e material, and trim the tray lea*in less than "G$ of the buccal tooth cro!ns unco*ered. 2tch patientDs teeth !ith an etchin solution for $9 seconds. Rinse !ith !ater for "; seconds and air dry for $9 seconds. -aint resin A on the teeth !ith a small brush and resin 5 on the composite in the brac+ets tray.

-osition the tray o*er the teeth and apply equal pressure all o*er the tray for $9 seconds. 4et the adhesi*e set for 6 additional minutes and remo*e it usin a scaler or an orthodontic plier.The initial arch !ire can no! be inserted.

A thermoformed 6.9Amm dis+ can be prepared on the normal 9.<mm tray to obtain a ri id en*elope that can assure stable and uniform pressure.

Trim the 6.9Amm tray in a shape that co*ers only the occlusal ed e of the teeth. %orrect pressure on the tray is obtained by pushin on it !ith 6 fin ers. After the settin time, the 6.9mm tray can be easily remo*ed.