260618 classone syllabus revised 010407 · retraction first, followed by anterior retraction. the...

Syllabus

FOR ORTHODONTIC POSITIONING

SYSTEM WITH CARRIERE SLB AND

CARRIERE DISTALIZER

“A Road Map for the Orthodontic Trip”

José Carrière, DDS, MD, PhD & Luis Carrière, DDS, MSD, PhD

ORTHODONTIC POSITIONING SYSTEM

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WITH CARRIERE SLB AND CARRIERE

DISTALIZER

Treatment Protocols and Arch wire Sequencing

(A Strategy for Orthodontic Space Management)

José Carrière, DDS, MD, PhD & Luis Carrière, DDS, MSD, PhD

Recent awards to Dr. Luis Carriere

CARRIERE DISTALIZER

Given the “AWARD OF DISTINCTION” at the 2005 International M/P Design Competition. Princeton, N.J., USA

SOFTLANDER PROJECT “JOSEPH E. JOHNSON AWARD” at the 1995 AAO Annual Meeting, San Francisco, CA, USA THE “GOLDEN MILIA” at the 1996 Milia Design Awards, Cannes, France

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“Simplicity is a unification around a purpose.”

Edward de Bono

INTRODUCTION

Self-Ligating Brackets have brought a new perspective to the biomechanics of fixed appliances, and by including superelastic wires have created an innovative, fast and comfortable way to align dental arches and correct malocclusions.

This system has spectacularly treated Class I malocclusions with

crowding and mild anteroposterior discrepancies in the opposing dental arches. Self-ligating brackets and low force superelastic wires treat these patients quickly, comfortably and efficiently.

Some malocclusions, especially Class IIs and Class IIIs require a

more deliberate protocol. In this Syllabus, we present a rational system together with the new armamentarium in orthodontics, which constitutes the ORTHODONTIC POSITIONING SYSTEM (OPS) – similar to the GLOBAL POSITIONING SYSTEM (GPS) used for navigation.

The purpose of orthodontics is the correct positioning of dento-

maxillo-facial structures in three planes of space. This syllabus will define some guidelines clinicians can use in the pursuit of those goals. The OPS works under the same principle by which boats navigate through waypoints while using the GPS. With this system, clinicians can avoid extractions, whereas in others they can minimize the removal of teeth and protect the profile.

This does not constitute the only or necessarily the best system of orthodontic therapy. However, over the years, its logic has proven reliable, simple and useful. This system offers orthodontists an empirically tested working hypothesis for the treatment of most malocclusions.

The OPS helps avoid maxillary premolar extractions in Class II

division 1 and Class II division 2 patients. Unilateral Class II malocclusions respond quite well when following this treatment protocol. Once Pseudo Class I malocclusions achieve a perfect Class I platform, they also treat conservatively.

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Some severe malocclusions obviously need extractions since

expansions of their arches even with superelastic wires will create more problems than they will solve. Some of the malocclusions that require extractions are:

• Class II div. 1 bimaxillary protrusions; • Class II div.2 with severe crowding, deep overbite, maxillary

prognathism with lingually inclined maxillary incisors and • Class III malocclusions that often need extractions for proper

relation of the arches. The ORTHODONTIC POSITIONING SYSTEM offers a protocol for

demanding malocclusions that require careful control. The morphological structures orthodontists deal with in the treatment of malocclusions will change with growth or treatment, but clinicians can measure and describe these changes with numbers and represent them with coordinates in three-dimensions.

Orthodontists need objective references to insure that the therapy

follows the projected plan. The Syllabus will show readers how to handle these measurements and will describe a system to control their relationships. A mathematical model or Equation will enable a morphological diagnosis and treatment plan that anticipates the continuous changes in these measurements and relationships from the beginning of therapy to the end.

“The clinical application of an Equation can be intriguing to the reader who does it for the first time. It many seem a complex and sophisticated concept, but, on the contrary, it is very simple. In reality it is the result of the application of logical thinking for the simplification of the treatment process.” José Carrière

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THE ORTHODONTIC POSITIONING SYSTEM (OPS)

The ORTHODONTIC POSITIONING SYSTEM provides a recent adaptation for the treatment of orthodontic malocclusions that incorporates the experience and treatment sequence from the book, Inverse Anchorage Technique, developed by Dr. José Carrière. The OPS combines the previous Carrière protocols with new appliances and, thus, produces a new process.

a) Appliances – The OPS has added the CARRIERE DISTALIZER and the CARRIERE SLB. DR. Luis Carrière designed and invented the two appliances in a 12 year R&D program using 3-D software, the SOFTLANDER PROJECT. Developed in 1995 for demonstration of the treatment process, it visualized different malocclusions in motion as treated with a library of appliances designed with Virtual Reality programs of high-resolution imagery. It has been used for the research and design of new appliances, educational purposes and demonstrations to patients and parents. The two new devices have the intention of producing a biological friendly response in the periodontium. A sequence of superelastic wires provides a third component for this new treatment protocol.

b) Process – this syllabus describes a basic mathematical model, the CARRIERE EQUATION, (C=Dc/2+R1), which when combined with the adequate protocols will permit the use of the proposed system in a simple but reliable manner. Too often orthodontic clinicians rely on their experiences as the bases for their diagnoses, treatment planning and therapies. At other times, they use therapeutic diagnoses that depend on a trial and error approach. The OPS defines the objectives of the treatment and eliminates experimentation by making use of anatomical landmarks and a simple Regressive Equation. All of them work under a clear protocol, which defines the treatment process and increases its level of predictability, precision and simplicity. The Equation offers a formula that shows the relationship and interactivity between three basic parameters. The three variables will change with growth and treatment. The Treatment Protocol offers a step-by-step application of the Equation and acts as a navigation system. Since this is not a diagnostic method, clinicians can use their own diagnostic preferences. Nevertheless, this equation presents orthodontists several advantages:

• Diminishes the number of extractions; • Shortens the treatment time by 40-50%; • Minimizes periodontium insult; • Increases patient comfort; • Diminishes treatment complications.

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FEATURES OF THE OPS

All orthodontists have a familiarity with terms maximum, medium and minimum anchorage. The Equation substitutes millimeter measurements for these concepts and thereby gives clinicians precise knowledge regarding the space needed to treat malocclusions. This treatment protocol depends on starting therapy in the maxilla, and it is known as the Maxillary Stage, and the Mandibular Stage follows it. Dental movement occurs in a Distomesial Sequence with posterior retraction first, followed by anterior retraction. The Equation (C=Dc/2+R1), where C is the distance the maxillary canine must move to achieve a Class I occlusion. Dc represents the mandibular anterior crowding as measured from the distal surfaces of the mandibular canines. Clinicians can make these measurements directly in the mouth with a pair of calipers or on study models. R1 equals the cephalometric planned position of the mandibular incisor. The combination of the protocol with the Equation allows clinicians:

• To know in millimeters the amount of anchorage needed before treatment;

• To monitor in millimeters the progress of treatment and detect any deviation from the proposed route;

• To evaluate the exactness of therapy at completion.

DIFFERENCES BETWEEN THE MAXILLA AND MANDIBLE

By considering the anatomical functional and histological differences between the maxilla and mandible, clinicians can safely conclude:

• The mandible anatomically provides a mobile and variable reference relative to the many positions it adopts and makes it an unstable frame of reference and renders it difficult to work with. Functionally, the mandible moves considerably and the surrounding muscles strongly influence it.

• The maxilla, anatomically, has a fixed or stationary anatomical relationship to the base of the skull. Functionally, the surrounding muscles influence it less than the mandible. Histologically, the maxilla has more plasticity than the mandible, and clinicians can better control its response to therapy. It offers a better response to orthodontic movement and is the preferred jaw in which treatment should start.

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TREATMENT PARAMETERS

The parameters that orthodontists change with treatment interrelate, i.e., a change in one of them changes the rest. Other influencing variables are the amount and direction of growth; treatment response; expansion of dental arches; correction of the curve of Spee; cooperation of the patient, etc. Clinicians can monitor the effects these variables cause and alter therapy so as to stay within the Equation parameters.

Repositioning the mandibular incisor “R1”

In the OPS, with the exception of patients with maxillary hypoplasia, cleft lip and palate and Class III malocclusions, the treatment goal rests on the basis of correct repositioning of the mandibular incisors. As previously said, the mandible presents more problems for orthodontic manipulation. At the same time, it remains the bone that limits treatment possibilities, especially in regards to the patients’ esthetic needs. The basis of orthodontic therapy depends on repositioning of the mandibular incisor represented by “R1” (Figure 1).

Some refer to this as cephalometric repositioning of the mandibular incisor since its value comes from the cephalometric analysis of the malocclusion.

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The repositioning of the mandibular incisor, in millimeters, indicates the amount of retraction or protraction necessary to relocate the mandibular incisors in an ideal position. Clinicians should multiply this millimeter value by two in order to consider both quadrants of the mandibular arch. In the Equation, repositioning of the mandibular incisors lingually has a positive algebraic value, whereas repositioning vestibularly has a negative value. In order to evaluate posttreatment results, clinicians should use three repositioning measurement for the mandibular incisor:

• The projected repositioning represents the number of millimeters necessary to achieve the ideal location;

• The accomplished repositioning represents the amount of repositioning in millimeters achieved by therapy;

• The differential repositioning represents the algebraic difference between the accomplished repositioning and the projected repositioning of the mandibular incisors.

These measurements serve as indicators that make possible a determination of the accuracy of final mandibular incisor positioning. If they have a positive value, treatment has gone beyond the anticipated position, i.e., the patient has had an excess of anchorage. On the other hand, if the differential repositioning has a negative value, then the mandibular incisors have suffered anterior slippage, which implies a loss of anchorage. The ideal differential between projected repositioning and accomplished repositioning should equal zero.

Arch Length Discrepancy, “Dc”

Clinicians should measure the intercanine arch length discrepancy (Dc) between the distal ridges of the mandibular canines in millimeters. Dividing this measurement by two gives the arch length discrepancy for one mandibular quadrant. (Figure 2)

Figure 2: Mandibular anterior arch length discrepancy, “Dc”, measured from the distal of both mandibular canines. It is measured with calipers directly in the mouth or indirectly

on study models.

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“C” Variable

The “C” variable is the horizontal distance that exists between the vertical line that passes through the center of the maxillary canine and the vertical line that passes through the distal ridge of the mandibular canine. Clinicians should move the maxillary canine to a predetermined “C” distance in relation the mandibular canine. (Figure 3)

Figure 3: “C” variable represents a distance in millimeters. Each malocclusion requires a different “C” distance in relation to the individual needs imposed by the application of the Carrière Equation. This determination is made during treatment planning and will vary with each patient. “C” can be calculated by substituting the values of Dc and R1 in the Equation. The “C” value derives from measurements in the mandibular arch. The mandibular canines serve as key teeth upon which the rest of the occlusion depends. The OPS treatment protocol proposes to position correctly the maxillary canines from the first. After correcting the maxillary canines, the mandibular canines then can be moved until they contact the maxillary canines in neutrocclusion. These movements will provide the space to correct the anterior crowding, “Dc” and to reposition properly the mandibular incisors “R1”.

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THE CARRIERE EQUATION, C= Dc/2+R1

With clinical patients, “C”, “D”, and “R1” variables interrelate. A

change in one will induce changes in the others, either positively or negatively. Their relationship can also be represented by the formula C-Dc/2-R1=0. When “C” is unknown, we can use the following formula. C=Dc/2+R1. The Carrière Equation correlates variables to one another and serves as a guideline for resolving analogous cases. The development of an equation makes it possible to progress from the level of repeated experimentation to a mathematical model that relates the variables and can be generalized. Two parameters are determined after the process of analysis of the cases where extraction of the first premolars is necessary. • Intercanine arch length discrepancy, “Dc”; (Figure 2) • Cephalometric repositioning of the mandibular incisor, “R1” (Figure 1)

By knowing both variables, we need to substitute Dc/2 and R1 for their

real values in millimeters in the mathematical expression. The result is the value of “C”, the distance that mandibular canines must move distally on each side to correct Dc and R1. This tells orthodontists how many millimeters the maxillary canines must move distally in respect to the mandibular canines to correct the occlusion, i.e., the “C” distance. (Figure 3)

When the mandibular arch is asymmetrical, the canine distance from the right side, “Cr”, and that of the left side, “Cl”, must be added together, and the values on each side of the formula also doubled as in the following formula.

Cr+Cl=Dc+2R1 The Equation has an empirical basis and is useful in therapy. As a

scientific matter, it is a product of experimentation, which provides an approximation to the truth, and we can predict the results on similar cases based on the evidence available. It also offers the possibility of refinement as research and experience enlarges.

This formula does not present a mathematical truth, such as an infallible theorem.

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The Equation in the treatment of severe malocclusions that need extraction of four premolars.

Figure 5: A malocclusion showing loss of anchorage. The extraction space has completely closed, but the occlusion remains Class II. The canines present a Class I occlusion, but this blocks the mandibular canines from moving distally and prevents the correction of “Dc” and “R1” in the mandibular arch. In this case, C< Dc/2+R1. A loss of equality in the equation indicates an irregular development in the treatment, and one that will require readjustment before proceeding.

Figure 6: A case of orthodontic treatment in which extractions have been performed with an ideal posterior occlusion. The maxillary and mandibular canines present a distance “C” = 0mm. Crowding of the mandibular incisors has corrected, and “Dc” = 0mm. The cephalometric repositioning of the mandibular incisor has also corrected, and “R1” = 0mm. With values of 0mm for the three variables, the posterior occlusion should also be correct, if there is no tooth size discrepancy.

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The Equation offers a valuable instrument in the treatment planning of

malocclusions that need extraction of four premolars. Combining the Equation with OPS, clinicians gain the following advantages.

• Prescribe anchorage – treatment planning enables clinicians to know the two variables in question in the malocclusion. The first evaluation concerns the arch length discrepancy between the mandibular canines, “Dc” and is measured by means of a precision caliper directly in the mouth or indirectly on study models. The second evaluation concerns the cephalometric repositioning of the mandibular incisor, “R1”. Clinicians can determine this by a preferred diagnostic procedure. R1 is made on the cephalometric tracing. The R1 variable must closely relate to the neuromuscular pattern and to the amount and direction of predicted growth. R1 also relates to the esthetic contour of the face, and the supramentalis curvature of the soft tissue profile of the patient. Once clinicians determine Dc and R1, they can arrive at a value for C by applying the Equation, C=Dc/2+R1. By way of example, suppose a patient needs four premolars removed. The patient presents with a mandibular intercanine arch length discrepancy, Dc, of 8mm (Figure 2). Moreover, the projected cephalometric repositioning of the mandibular incisors requires 2mm, or R1 =2mm (Figure 1). By applying the formula, we discover C=6mm.

C=Dc/2+R1 = 8/2+2=6mm The mandibular canine, thus, needs distal movement of 6mm. (Figure 4). Since therapy starts in the maxillary arch, clinicians realize the maxillary canines must also move 6mm distally to the lower canines. The orthodontic therapy will start with distal movement of the maxillary canines with a distomesial sequence. We call this the Maxillary Stage.

ANCHORAGE CONTROL

• Control anchorage throughout each stage of treatment – In four premolar extraction patients, the action starts with the extraction of the maxillary first premolars, followed by distal movement of the maxillary canines, while the mandibular arch remains undisturbed (Figures 10a – 10b). The maxillary canines continue moving distally until they achieve the correct “C” distance in reference to the mandibular canine. At the end of the distal movement of the maxillary canines, they will contact the maxillary second premolars.

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TREATMENT SEQUENCE

FIGURE 10A

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FIGURE 10B

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The Mandibular Stage, follows as the second part of the treatment protocol. After the maxilla, extractions are made in the mandible and treatment is started in this arch. After the extraction of mandibular premolars, lower canines start to be distalized by the action of Class III elastics. The values on both sides of the Equation begin to vary throughout the treatment. The discrepancy, “Dc” begins to decrease as the original crowding is being corrected. Repositioning of the lower incisor, “R1”, declines in value as it is functionally retruded by lip strain. The “C” variable should then become proportionately smaller as the correction takes place in “Dc” and “R1”. This is necessary condition in order to maintain sufficient space for the proper treatment of the case. It is essential to maintain a relationship of equality on both sides of the Equation as the values of “Dc” and “R1” decline. In the Mandibular Stage, the second part of the treatment, lower canines are distalized until they can occlude with the upper canines in a relation of neutrocclusion. When this is the case, the “C” distance will measure 0 mm. Mesial to the lower cuspids there are diastemas created.

Diastemas have a negative algebraic value, whereas the crowding of the lower incisors as well as the remaining cephalometric repositioning have a positive value that should compensate for the negative value of the diastema. At this stage of treatment, their algebraic addition and subtraction should equal zero. This would demonstrate that treatment is progressing correctly. If it is not and C<Dc/2+R1, a loss of anchorage has occurred, and the treatment should be stopped and redirected along the correct path with the treatment subroutine called complement of anchorage to recover the lost space. Growth, patient cooperation, expansion of dental arches, histological response to treatment, etc can induce changes in the variables and consequences in the Equation. Clinicians should detect and evaluate them in order to readjust the therapy. In summary, by applying the Equation clinicians can determine during treatment if the values of the completed therapy will conform to those proposed at the beginning and to know when remedial action is needed.

• Check the results of treatment – the occlusion of the arches should conform to a Class I, and the canines should have a neutrocclusion, which implies that “C”=0. Crowding will have been corrected and “Dc” = 0. When the mandibular incisors occupy their correct positions, the value reflected in “R1” should also equal zero. When the three values all equal zero, the treatment objectives have been met, C=Dc/2+R1 or 0=0/2+0. Summarizing, the formula helps determine if the values of the finished treatment conform to the ideals proposed at the beginning of treatment and to know that therapy has been applied correctly.

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The Equation in the treatment of patients without extractions The positions of the dental arches depend primarily on the muscular forces that act on them during the entire period of growth. The mandibular arch offers the best point of reference for studying the possibilities of therapy. The equation serves as a tool for controlling the treatment, whereas the decision to extract teeth or not develops during the treatment planning. When the diagnosis indicates extractions are not needed, clinicians will usually find the following conditions:

• The mandibular anterior teeth have only a slight or no misalignment and Dc approaches 0mm.

• The mandibular incisors have a correct position in relation to the symphysis and R1 = 0mm. They also remain in balance with the neuromuscular pattern, afford good esthetics in the lower anterior face height and present a harmonious supramentalis curve that requires no correction.

• The “C” distance to be accomplished is 0mm.

THE CARRIERE DISTALIZER A Class II malocclusion, after considering the amount and direction of

the growth potential of the mandible, can suggest a distal movement of the maxillary arch. The CARRIERE DISTALIZER treats these malocclusions nicely. In the mixed dentition, when the second primary maxillary molars exfoliate, the first permanent molars naturally migrate medially and consume the leeway space. They also rotate medially around the palatal root, incline medially and drift bodily. The recovery of lost maxillary space will correct this type of Class II malocclusion.

Distally rotating and uprighting the first permanent molars and their subsequent distal movement allow a nonextraction therapy for many patients who previously might have had two maxillary premolars extracted. The Distalizer provides recovery of the lost maxillary space and simultaneously moves the entire quadrant distally.

Pseudo Class I malocclusions with anterior crowding will also benefit by this approach. With these patients, the CARRIERE DISTALIZER will recover the lost space in the maxillary arch, derotate the first molars, upright them and place them in a firm Class I. This provides the ideal condition for easily finishing treatment with the CARRIERE SELF-LIGATING BRACKETS (SLB) and superelastic wires.

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Once the Distalizer has established a Class I Platform, the Carrière SLB system combined with superelastic nickel titanium wires will complete the correction (Figures 7A-B).

Figures 7A-B: Class II malocclusion with a good mandibular arch. It has no crowding, and “Dc” = 0mm. The anterior limit of the mandibular incisors is good, and “R1” = 0mm. The first orthodontic movement will occur with the CARRIERE DISTALIZER* to attain a Class One Platform with a “C” value of 0mm; i.e., a true neutrocclusion of the canines. The case is ready for the Maxillary Retraction of the anterior teeth with the CARRIERE SLB.

A

B

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CARRIERE SELF-LIGATING BRACKET Passive self-ligating brackets provide the most recent addition to the OPS protocol. The CARRIERE SLB (Figure 8a and 8b) offers an improved design for passive self-ligating brackets.

Figure 8a: CARRIERE SLB opens and closes with an explorer and will also close with finger pressure.

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Figure 8b: CARRIERE SLB assembled on an arch wire in position with the slides closed.

Traditional brackets ligated to the arch wire produce binding, which

induces a “global state of war” within the periodontal attachment, and this generates a slow, uncomfortable response to orthodontic movement. Competing vectors of forces do not interfere with the corrective forces applied to teeth through these new brackets. The passive ligation of the SLB allows osseous and periodontal response to ultra-light continuous forces provided by superelastic wires. This results in faster movement of teeth. Brackets slide easily on the arch wires, and the teeth freely express their movement under the light forces produced by the small superelastic wires. Orthodontic movement occurs easily, and is simultaneously controlled by the sliding wire-bracket interface and the progression of wires. Round superelastic wires provide the initial movements with minimal discomfort and maximum effect.

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Progressive edgewise superelastic wires follow the round wires and provide the precise fit that allows the tube like SLB to control teeth in three dimensions as well as enhance sliding mechanics through its rounded mesial and distal chamfers. The looseness of this appliance promotes a quick dental response aided by the vestibular neuromuscular function. The CARRIERE SLB has two parts – the base and the sliding wall. They match perfectly in form and function.

• The curved trajectory of the closing slide and the smooth rounded edges make it the most comfortable and smallest self-ligating bracket manufactured.

• This bracket displays the precision derived from computer design and modern technology.

• It opens with an explorer and closes with finger pressure. • The initial intention was to make it beautiful on the outside and useful

inside. • Its nickel free construction increases patient safety. • Its sliding wall opens occlusally in both arches, and this enlists the

forces of mastication in keeping it closed. • The occlusal slide does not interfere with malposed adjacent teeth.

The SLB offers several improvements over traditional appliances:

• Increased patient comfort; • Less complicated wire changes; • Diminished number of wire changes; • Faster changes of wires; • Shorter treatment times and longer intervals between visits; • Reduction in the number of extractions; • Faster alignment and leveling; • Easier cleaning with the sliding mechanism in the bracket face; • Promotes periodontal integrity with low forces and sliding mechanics; • Equally beneficial for adults and children. The Carrière SLB offers users and patients elegant technology and

precision. It gives doctors the most recent, advanced and simplified design for self-ligation brackets and has a general application for all edgewise techniques. Treatment forces can be reduced, as well as treatment time, and this delivers a biologically friendly action on the periodontium.

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83% of maxillary first permanent molars move mesially and rotate as they invade the leeway space in mixed dentition patients. Mesial migration of the maxillary first molars naturally occurs with the mesial rotation around the palatal root. This causes the rhomboid shape of the crown to occupy more space than it needs and creates an unbalanced occlusion with the opposing arch and suggests a tooth size discrepancy, which, of course, it isn’t. The CARRIERE DISTALIZER has a design that corrects the maxillary first molar rotation, mesial inclination and mesial migration, while simultaneously moving the two premolars and canine distally in a group movement. This appliance (Figure 9) as a new part of the OPS helps avoid extractions and efficiently and quickly corrects Class II malocclusions.

FIGURE 9

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By moving the entire quadrant into a Class I platform (Figure 7) the malocclusion is corrected efficiently and quickly. At this point, the Distalizer is discarded and the malocclusion can be finished with the CARRIERE SLB following a decided protocol. The second stage of treatment with the SLB involves retraction of the incisors and has the following patient benefits:

• Fewer activations; • Reduction of extractions; • Reduction in treatment time; • More patient comfort. The CARRIERE DISTALIZER offers efficiency in treating Class II

malocclusions without extractions when the diagnosis indicates such maxillary distal movement. Unilateral Class II malocclusions respond favorably. Pseudo Class I malocclusions, mixed dentition Class II malocclusions as well as Class II adult patients all benefit from this appliance.

One additional benefit of this appliance is that the patient’s profile stays

less challenged. Brachyfacial faces respond best to this treatment, followed by mesofacial and finally dolychofacial types. The appliance remains passive until activated by elastic traction. It offers a simple, noninvasive Class II therapy whose movement expresses automatically without the need of wire changes or regular activations.

Combining the Carrière Distalizer with SLB can diminish treatment time

for Class II malocclusions by 40-50%, while increasing quality and reducing cost.

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TREATMENT PROTOCOLS

Refer to Archwire Treatment Sequence Charts

The OPS finds usefulness in the treatment of most malocclusions and this syllabus offers a series of wires and protocols that divides into three parts:

• Left side represents the Maxillary Stage in red color; • Center describes the Anchorage for both arches as concerns the type

of elastics needed in blue color; • Right side represents the Mandibular Stage in green color.

The maxillary stage typically precedes the mandibular stage and treatment starts in the maxilla. The progress of dental movement proceeds from distal to mesial in a distomesial sequence and every stage has a preordained order:

• Leveling (with round and edgewise wires); • Posterior retraction; • Anterior retraction; • Finishing; • Settling This syllabus presents specific treatment protocols for different types of

malocclusions, which divide into two main groups. 1) Treatment protocols for eight types of malocclusions; 2) Treatment protocols for low compliance treatments using mini-implants as anchorage for six types of malocclusions.

This syllabus incorporates precise clinical details so that clinicians can easily follow each stage. The OPS offers a conceptual approach to orthodontic treatment that results from a theoretical reflection based on morphological and biological principles. Combined with the new advanced technological developments of Distal Movement, Self-ligation Brackets and superelastic wires, it constitutes a unified treatment system that opens new worlds of creativity and research in orthodontics.

ORTHODONTIC POSITIONING SYSTEM (OPS) WITH CARRIERE SLB AND CARRIERE DISTALIZER.

Treatment Protocols and Archwire Sequencing

(A Strategy for Orthodontic Space Manager)

CARRIERE SLB, WIRES LIST Leveling Round Wires: .012 SE Thermal .014 SE Thermal .016 SE Thermal .016 SE Thermal U Reverse .016 SE Thermal L Reverse Leveling Edgewise Wires : .014x.025 SE Thermal .016x.025 SE Thermal .016x.025 SE Thermal U 20º Ant Torque Reverse Posterior Retraction Edgewise Wires : .017x.025 SE Thernal .017x025 SE Thermal U 20º Ant Torque Reverse .019x.025 SE Thermal .019x.025 SE Thermal U 20º Ant Torque Reverse Anterior Retraction Edgewise Wires : .017x.025 SS Posted .017x.025 SS U 20º Ant Torque Reverse .019x.025 SS Posted Finishing Edgewise Wire: .017x.025 TMA .019x.025 TMA Settling Round Wire: .016 SS

OPS ARCHWIES SEQUENCING

T Y P E SIZE ACTION

LEVELING

Round : .012 Therm SE .014 Therm SE .016 Therm SE .016 Therm SE U Rev. .016 Therm SE L Rev.

Edgewise .014 x .025 Therm SE .016 x .025 Therm SE .016 x .025 Therm SE U 20º Ant T Rev.

Initiate dental movement with minimum parodontal reaction. For rotations, cross bites vertical and vestibulo lingual corrections (bracket alignement)

Once the case is leveled it starts the 3D Monitored Movements

in order to follow the OPS of space management

POSTERIOR RETRACTION

ANTERIOR RETRACTION

Edgewise .017X.025 Therm SE .017X.025 Therm SE U 20º Ant T Rev. .019X.025 Therm SE .019X.025 Therm SE U 20º Ant T Rev. Anterior .017X.025 SS Posted Retraction .017X.025 SS U Posted 20º Ant T Rev Edgewise .019X.025 SS Posted

To perform movements of intrusion translation and torque

FINISHING

.017X.025 TMA .019X.025 TMA

Finishing and detailing

SETTLING .016 SS Final adjustments for settling to a matching oclusion

General Protocol of Active Movements In the treatment with the Carriere SLB System

in severe cases with Crowding that request four premolars extraction

M A X I L L A R Y S T A G E ANCHORAGE MANDIBULAR STAGE

Xtr 4+4

Leveling

Posterior Retraction

Extraction 4-4

"C" Anterior Retraction

Leveling Anterior Retraction Posterior Retraction

Finishing Anterior Retraction

Settling Finishing

» Settling

General stages in the treatment of cases that request the extraction of four premolars. In these cases, the priority in the treatment

of the Maxillary Stage can be seen, with respect to the Mandibular Stage. In each one of two stages the sequence in the movement of teeth is repeated.

The order is from posterior to anterior regions, i.e., a Distomesial Sequence of movement. The “C” character in the Maxillary Stage informs that the projected distalization of the upper canines in relation to the lowers has been attained and treatment can progress starting the Mandibular Stage.

ORTHODONTIC POSITIONING SYSTEM Class I, dental arch compression and crowding

without extractions - .022x.028 Carrière Distalizer and SLB

MAXILLARY STAGE

ANCHORAGE MANDIBULAR STAGE

CARRIÈRE DISTALIZER Cl II 6 oz Cement 6-6 or 7-7

POSTERIOR RETRACTION TO A Class One Platform

Night except eating Lingual Arch Passive

“C” Bond 654321+123456 Remove Lingual Arch Bond 654321-123456 LEVELING ROUND WIRE .012 Therm SE or .014 Therm SE or .016 Therm SE

Midline and vertical adjustments with adequate use of elastics

LEVELING ROUND WIRE .012 Therm SE or .014 Therm SE or .016 Therm SE

LEVELING .014X.025 Therm SE or EDGEWISE .017x.025 Therm SE or WIRE .017x.025 Therm SE 20º T Rev

»

LEVELING EDGEWISE .014x.025 Therm SE or WIRE .017x.025 Therm SE or .019x.025 Therm SE

FINISHING .017x.025 TMA or

.019x.025 TMA » FINISHING .017x.025 TMA or

.019x.025 TMA

» SETTLING .016 SS SETTLING .016 SS

ORTHODONTIC POSITIONING SYSTEM Class II Division 1 w

thout extractions - .022 x .028 Carriere Distalizer and SLB


Cl II 6 oz CARRIERE DISTALIZER Cement 6-6 or 7-7 Night + Day except eating POSTERIOR RETRACTION TO A Class I Platform Lingual Arch Passive

"C" Bond 654321 + 123456 Lingual Arch or remove and

Full Bond 54321 - 12345 Cl II 3 oz (on 3+3) Figure 8 Metallic Ligature Base 6 to 3 LEVELING ROUND WIRE .012 or .014 or .016 Therm SE or

LEVELING ROUND WIRE

.016 Therm SE Rev .012 or .014 or .016 Therm SE Rev

Consolidate Elastic Chain Base 21+12 LEVELING EDGEWISE WIRE

Cl II 3 oz (on 3+3)

LEVELING EDGEWISE WIRE

.014 x .025 Therm SE or

Figure 8 Metallic Ligature Base 21+12 Optional ANTERIOR RETRACTION

Cl II 6 oz (on Posts) « «

FINISHING .017x.025 TMA or .019x.025 TMA


SETTLING .016 SS SETTLING .016 SS

.014 x .025 Therm SE or .017 x .025 Therm SE or

.017 x .025 Therm SE or .019 x .025 Therm SE or

.019 x .025 Therm SE or .019 x .025 Therm SE Rev

.019 x.025 Therm SE 20º T Rev

.017 x .025 SS Posted or Intrusion Torque .017 x .025 SS Posted 20º T Rev or

.019 x .025 SS Posted

ORTHODONTIC POSITIONING SYSTEM Class II Division 2 without extractions - .022 x .028 Carriere Distalizer and SLB


Cl II 6 oz CARRIERE DISTALIZER Cement 6-6 or 7-7 Night + day except eating POSTERIOR RETRACTION TO A Class I Platform Lingual Arch Passive

"C" Bond 654321 + 123456 Lingual Arch or remove and Bond 54321 - 12345 Figure 8 Metallic Ligature Base 6 to 3 Cl II 3 oz (on 3+3)

LEVELING ROUND WIRE .012 or .014 or .016 Therm Se Rev

LEVELING ROUND WIRE

Reverse Curve of Spee

.012 or .014 or .016 Therm SE or

.016 Therm SE Rev

Consolidate Elastic Chain Base 21+12 LEVELING EDGEWISE WIRE

Cl II 3 oz (on 3+3)


.014 x .025 Therm SE or .017 x .025 Therm SE or .017 x .025 Therm SE or

.017 x .025 Therm 20º T Rev .019 x .025 Therm SE or

.019 x .025 Therm SE or .019 x .025 Therm SE Rev

.019 x .025 Therm SE 20º T Rev

Figure 8 Metallic Ligature Base 21+12 Optional FINISHING .017x.025 TMA or ANTERIOR Intrusion RETRACTION Torque

Cl II 6 oz .019x.025 TMA (on Posts)

.017 x .025 SS Posted or .019 x .025 SS Posted


SETTLING .016 SS

SETTLING .016 SS « «

ORTHODONTIC POSITIONING SYSTEM Severe Class I Biprotrusion with extractions - .022 x .028 Carriere SLB


Xtr 4+4 Horizontal Elastic Chain or

Horizontal Coil or Cl II 3 oz (on 3+3) with EW Wire

Cement 6-6 or 7-7 Bond 65321+12356 Lingual Arch Passive LEVELING ROUND WIRE .012 or .014 or .016 Therm SE LEVELING EDGEWISE WIRE .016 x .025 Therm SE

Horizontal Elastic Chain or Horizontal Coil or Cl II 3

oz

Leveling POSTERIOR RETRACTION Edgewise Wire Consolidate Elastic Chain Base 21+12

(on 3+3)

Lingual Arch Passive

Figure 8 Metallic Ligature Base 21+12 Optional "C" Figure 8 Metallic Ligature Base 6 to 3 ANTERIOR RETRACTION

Horizontal Elastic Chain or Horizontal Coil or

Cl II 6 oz (on Posts)

« «

ANTERIOR RETRACTION Continued

Horizontal Elastic Chain or

Horizontal Coil or Cl II 6 oz

(on Posts)

Xtr 4-4

Bond 65321- 12356

LEVELING ROUND WIRE .012 or .014 or .016 Therm SE

LEVELING EDGEWISE WIRE .016 x .025 Therm SE


Horizontal Elastic Chain or Horizontal Coil or

Cl III 3 oz (on 3-3)

Consolidate Elastic Chain Base 21-12 POSTERIOR RETRACTION Edgewise Wire

« «


Horizontal Coil or Cl III 6 oz (on Posts)

Remove Lingual Arch Figure 8 Metallic Ligature Base 6 to 3 Figure 8 Metallic Ligature Base 21-12 Optional ANTERIOR RETRACTION

« «




.019 x .025 Therm SE

.017 x .025 SS Posted 20º T Rev or .019 x .025 SS Posted



.017 x .025 SS Posted or



Severe Class II Division 1 Biprotrusion with extractions - .022 x .028 Carriere SLB M A X I L L A R Y S T A G E ANCHORAGE MANDIBULAR STAGE

Xtr 4+4 Bond 65321+12356

Cl II 3 oz (on 3+3) with EW Wire

Cement 6-6 or 7-7 Lingual Arch Passive LEVELING ROUND WIRE .012 or .014 or .016 Therm SE




POSTERIOR RETRACTION Edgewise Wire Consolidate Elastic Chain Base 21+12

Cl II 3 oz (on 3+3) Lingual Arch Passive


Horizontal Elastic Chain or Coil or


« «


Horizontal Elastic Chain or Coil or Cl II 6 oz

(on Posts)

Xtr 4-4 Bond 65321- 12356

LEVELING ROUND WIRE LEVELING EDGEWISE WIRE

FINISHING .017 x .025 TMA or .019 x .025 TMA

Horizontal Elastic Chain or Coil or Cl III 3 oz

(on 3-3)

POSTERIOR RETRACTION

Edgewise Wire

« «


Coil orCl III 6 oz (on Posts)

Remove Lingual Arch Figure 8 Metallic Ligature Base 21-12 Optional Figure 8 Metallic Ligature Base 6 to 3 ANTERIOR RETRACTION

« «







.012 or .014 or .016 Therm SE or .016 Therm SE Rev

.014 x .025 ThermSE or




.019 x .025 Therm SE Rev




Severe Class II Division 2 with extractions - .022 x .028 Carriere SLB M A X I L L A R Y S T A G E ANCHORAGE MANDIBULAR STAGE

Xtr 4+4 Bond 65321+12356 Cl II 3 oz (on 3+3)

with EW Wire Cement 6-6 or 7-7

LEVELING ROUND WIRE


Lingual Arch Passive


Cl II 3 oz (on 3+3) Lingual Arch Passive

Figure 8 Metallic Ligature Base 21+12 Optional "C" Figure 8 Metallic Ligature Base 6 to 3 ANTERIOR Intrusion Torque RETRACTION Torque

Horizontal Elastic Chain or Coil or Cl II 6

oz (on Posts)

« «


« « « «



Xtr 4-4 Bond 5321- 1235

LEVELING ROUND WIRE


« «

Horizontal Elastic Chain or Horizontal

Coil or Cl III 3 oz (on 3-3)

Consolidate Elastics Chain Base 21-12 POSTERIOR RETRACTION Edgewise Wire

« «

Horizontal Elastic

Chain or Horizontal Coil or Cl III 6 oz

(on Posts)

Remove Lingual Arch Figure 8 Metallic Chain Base 21-12 Figure 8 Metallic Ligature Base 6 to 3 ANTERIOR RETRACTION

SETTLING .016 SS FINISHING .017x.025 TMA or .019x.025 TMA

« « SETTLING .016 SS

.012 or .014 or .016 Therm SE











.016 Therm Rev





ORTHODONTIC POSITIONING SYSTEM Class III with extraction of two lower premolars - .022 x .028 Carriere SLB


Bond 654321+123456 LEVELING ROUND WIRE .012 or .014 or .016 Therm SE

Xtr 4-4

"C" LEVELING EDGEWISE WIRE

Bond 65321- 12356

LEVELING ROUND WIRE .012 or .014 or .016 Therm SE





Horizontal Elastic Chain or Horizontal Coil or Consolidate Elastic Chain Base 21-12


Cl III 3 oz (on 3-3)

POSTERIOR RETRACTION Edgewise Wire .017 x .025 Therm SE or


Horizontal Elastic Chain or Horizontal Coil or Figure 8 Metallic Ligature Base 6 to 3

« « Figure 8 Metallic Ligature Base 21-12 Optional Cl III 6 oz (on Posts)

ANTERIOR RETRACTION



« « Horizontal Elastic Chain

or Horizontal Coil or FINISHING .017x.025 TMA or

Cl III 6 oz .019x.025 TMA (on Posts)


ORTHODONTIC POSITIONING SYSTEM Class II Division 1 without extractions

Maximum Anchorage - Low Compliance - .022 x .028 Carriere Distalizer and SLB


CARRIERE DISTALIZER Cl II 6 oz Cement 6-6 or 7-7 POSTERIOR RETRACTION TO A Class I Platform Night + day except eating Lingual Arch Passive

"C" Bond 654321 + 123456 Lingual Arch or remove and Full Bond 54321 – 12345 Maxillary Mini-Implant and Horizontal coil

(on 3+3) Figure 8 Metallic Ligature Base 6 to 3 LEVELING ROUND WIRE .012 or .014 or .016 Therm SE or LEVELING ROUND WIRE .012 or .014 or .016 Therm SE

.016 Therm Rev

Consolidate Elastic Chain Base 21+12

Maxillary Mini-Implant and Horizontal coil or Horizontal Elastic Chain


(on 3+3)


Figure 8 Metallic Ligature Base 21+12 Optional ANTERIOR RETRACTION


(on Posts)

« «












.017 x .025 SS Posted or Intrusion Torque .017 x .025 SS Posted 20º T Rev or


ORTHODONTIC POSITIONING SYSTEM Severe Class I Biprotrusion with extractions

Maximum Anchorage - Low Compliance - .022 x .028 Carriere SLB


Xtr 4+4 Maxillary Mini-Implant and Horizontal coil

or Horizontal Elastic Chain with EW Wire Bond 65321+12356 (on 3+3) LEVELING ROUND WIRE .012 or .014 or .016 Therm SE


Maxillary Mini-Implant and Horizontal coil

or Horizontal Elastic Chain Leveling POSTERIOR RETRACTION Edgewise Wire Consolidate Elastic Chain Base 21+12

(on 3+3)

.017 x .025 Therm SE or .019 x .025 Therm SE

Figure 8 Metallic Ligature Base 21+12 Optional "C" Figure 8 Metallic Ligature Base 6 to 3 Maxillary Mini-Implant and Horizontal coil

or Horizontal Elastic Chain (MANDIBULAR STAGE can start chronogically earlier in cases of less space requirement)

ANTERIOR RETRACTION

(on Posts)



(on Posts)

Xtr 4-4 Bond 65321-12356

LEVELING ROUND WIRE



Mandibular Mini-Implant and Horizontal coil or Horizontal Elastic Chain

(on 3-3)


.016 x .025 SS SE or .017 x .025 SS Posted 20º T Rev or .019 x .025 SS Posted

« «


(on Posts)

Figure 8 Metallic Ligature Base 21-12 Optional Figure 8 Metallic Ligature Base 6 to 3 ANTERIOR RETRACTION

« «





.012 or .014 or .016 Therm SE



ORTHODONTIC POSITIONING SYSTEM Class II Division 2 without extractions

Maximum Anchorage - Low Compliance - .022x .028 Carriere Distalizer and SLB


CARRIERE DISTALIZER Cl II elastics 6 oz Cement 6-6 or 7-7 POSTERIOR RETRACTION TO A Class I Platform Night + day except eating Lingual Arch Passive

"C" Bond 654321 + 123456 Lingual Arch or remove and

Bond 54321 - 12345 Maxillary Mini-Implant and Horizontal coil or Horizontal Elastic Chain Figure 8 Metallic Ligature Base 6 to 3

LEVELING ROUND WIRE .012 or .014 or .016 Therm SE Rev

(on 3+3)

LEVELING ROUND WIRE

Reverse Curve of Spee


.016 Therm Rev

Consolidate Elastic Chain Base 21+12



(on 3+3)



Figure 8 Metallic Chain Base 21+12 Optional ANTERIOR Intrusion RETRACTION Torque


(on Posts)

« «





.017 x .025 Therm SE 20º T Rev or






.017 x .025 SS Posted 20º T Rev or



Severe Class II Division 1 Biprotrusion with extractions Maximum Anchorage - Low Compliance - .022 x .028 Carriere SLB


Xtr 4+4 Bond 65321+12356 Cl II 6 oz with Edgewise W (on 3+3) LEVELING ROUND WIRE .012 or .014 or .016 Therm




POSTERIOR RETRACTION Edgewise Wire Consolidate Elastic Ligature Chain Base 21+12

Maxillary Mini-Implant and Horizontal coil or Horizontal Elastic Chain or

Cl II 6 oz (on 3+3)






(on Posts)


Maxillary Mini-Implant and Horizontal coil or Horizontal Elasti Chain

(on Posts)

Xtr 4-4 Bond 65321-12356

LEVELING ROUND WIRE


FINISHING .017 x .025 TMA or .019 x .025 TMA

Mandibular Mini-Implant and Horizontal coil or Horizontal Elastic

Chain (on 3-3)



« «

Mandibular Mini-Implant and Horizontal coil or Horizontal Elastic

Chain (on Posts)


« « «











ORTHODONTIC POSITIONING SYSTEM Severe Class II Division 2 with extractions

Maximum Anchorage - Low Compliance - .022 x .028 Carriere SLB M A X I L L A R Y S T A G E ANCHORAGE MANDIBULAR STAGE

Xtr 4+4 Bond 65321+12356 LEVELING ROUND WIRE


Cl II 6 oz with Edgewise W (on 3+3)


Maxillary Mini-Implant and Horizontal coil or Horizontal Elastic Chain or

Cl II 6 oz (on 3+3)

Figure 8 Metallic Ligature Base 21+12 Optional "C" Figure 8 Metallic Ligature Base 6 to 3 ANTERIOR Intrusion RETRACTION Torque


(on Posts)


Maxillary Mini-Implant and Horizontal coil or Horizontal

Elastic Chain (on Posts)

Xtr 4-4 Bond 5321-1235

LEVELING ROUND WIRE




(on 3-3)

POSTERIOR RETRACTION Edgewise Wire Consolidate Elastic Chain Base 21-12

« « Mandibular Mini-Implant and Horizontal

coil or Horizontal Elastic Chain (on Posts)


« «



.012 or .014 or .016 Therm SE






.017 x .025 SS Posted 20º T Rev or.019 x .025 SS Posted









CARRIERE SLB WIRES LIST NOMAD® ARCHWIRES

AVAILABLE FROM CLASSONE ORTHODONTICS

Leveling Round Wires:

.012 SE THERMAL

.014 SE THERMAL .014 REGENCY NNOMAD ULTRA THERMAL

.016 SE THERMAL .016 REGENCY NNOMAD ULTRA THERMAL

.016 SE THERMAL U Reverse .016U REGENCY NNOMAD ULTRA THERMAL Reverse Curve

.016 SE THERMAL L Reverse .016L REGENCY NNOMAD ULTRA THERMAL Reverse Curve

Leveling Edgewise Wires:

.014x.025 SE THERMAL .014X.025 REGENCY NOMAD ULTRA THERMAL

.016x.025 SE THERMAL .016x.025 REGENCY NNOMAD ULTRA THERMAL

.016x.025 SE THERMAL U 20° Ant Torque Reverse .016X.022 NNOMAD NITI U 20° Ant Torque Reverse

Posterior Retraction Edgewise Wires:

.017x.025 SE THERMAL .017X.025 UP & LOW REGENCY ULTRA THERMAL NATURAL


.019x.025 SE THERMAL .019X.025 REGENCY NNOMAD ULTRA THERMAL


Anterior Retraction Edgewise Wires:

.017x.025 SS Posted .017x.025 SOLDERED POST SS

.017x.025 SS U 20° Ant Torque Reverse N/A


Finishing Edgewise Wire:

.017x.025 TMA .017X.025U TITANIUM MOLYBDENUM ALLOY NATURAL FORM


Settling Round Wire:

.016 SS .016 SS NNOMAD

AND .016 BBLACK DIAMOND

5064 50th St. Lubbock, TX 79414

1-800-343-5291 Domestic1-806-797-1199 International

[email protected]

ADDITIONS ALSO RECOMMENDED

.012 NNITI, BLACK DIAMOND



BLACK DIAMOND WIRES

OFFER 30% LESS FRICTION

ALL NEW

RIBBON ARCHES

.018X.014

.022X.016

ADDITIONS ALSO RECOMMENDED




BLACK DIAMOND WIRES


ALL NEW

RIBBON ARCHES

.018X.014

.022X.016

CARRIERE SLB WIRES LIST NOMAD® ARCHWIRES ADDITIONS ALSO RECOMMENDED

AVAILABLE FROM CLASSONE ORTHODONTICS

Leveling Round Wires:

.012 SE THERMAL .012 NNITI, BLACK DIAMOND

.014 SE THERMAL .014 REGENCY NNOMAD ULTRA THERMAL .014 NNITI, BLACK DIAMOND

.016 SE THERMAL .016 REGENCY NNOMAD ULTRA THERMAL .016 NNITI, BLACK DIAMOND

.016 SE THERMAL U Reverse .016U REGENCY NNOMAD ULTRA THERMAL Reverse Curve

.016 SE THERMAL L Reverse .016L REGENCY NNOMAD ULTRA THERMAL Reverse Curve BBLACK DIAMOND WIRES


Leveling Edgewise Wires:

.014x.025 SE THERMAL .014X.025 REGENCY NOMAD ULTRA THERMAL

.016x.025 SE THERMAL .016x.025 REGENCY NNOMAD ULTRA THERMAL


Posterior Retraction Edgewise Wires:

.017x.025 SE THERMAL .017X.025 UP & LOW REGENCY ULTRA THERMAL NATURAL


.019x.025 SE THERMAL .019X.025 REGENCY NNOMAD ULTRA THERMAL


Anterior Retraction Edgewise Wires:

.017x.025 SS Posted .017x.025 SOLDERED POST SS AALL NEW

.017x.025 SS U 20° Ant Torque Reverse N/A RIBBON ARCHES


.018X.014

Finishing Edgewise Wire: .022X.016



Settling Round Wire:

.016 SS .016 SS NNOMAD

AND .016 BBLACK DIAMOND

5064 50th St. Lubbock, TX 79414

1-800-343-5291 Domestic1-806-797-1199 International

[email protected]

260618 classone syllabus revised 010407 · retraction first, followed by anterior retraction. the...

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