Controlled, rapid uprighting of molars: a surprisingly simple solution the pivot arm appliance.

In orthodontic cases where the regional anatomy provides limited room for eruption, there is etiologically a higher occurrence of tipped/impacted second molars. Although second molar extraction with third molar replacement is a useful option, the "Pivot Arm Appliance" encourages the uprighting of the second molar as a preferred treatment. The most unique and important attribute of the "Pivot Arm Appliance" is the rotating tube. In cases of access limitation, the disto-occlusal surface of the molar presents as one area that is accessible. Other features of the "Pivot Arm Appliance" include: The position of the rotator tube delivers optimal rotational force through the pivoting action of the tube/arm complex. The "Pivot Arm Appliance" takes advantage of the efficiency and simplicity of a Class I lever system. The anatomical fulcrum being the dense cortical bone located anterior to the ascending ramus. The vertical spring system is compact, reliable and delivers gentle controlled force in rotational direction. The lingual location of the "Pivot Arm Appliance" does not hinder the function of the tongue, impinge on the soft tissue or interfere with normal masticatory function. The ease of placement of the rotator tube and subsequent insertion of the spring. It is well to note the uprighting appliance provides a very useful and practical approach to the unique problem of severely tipped second molars with limited buccal access. The "Pivot Arm Appliance" does not function only in these situations but can be used in all cases of second molar uprighting of a moderate to severe nature.

The controlled arch system: a new method of straightwire treatment.

The "Controlled Arch System", coupled with a proper diagnosis and treatment plan, should produce excellent occlusion and esthetics for your patients from their Mixed Dentition growth period onward. The authors have offered a method of Phase I treatment for children of Mixed Dentition age that can be outlined as follows: 1. Fit maxillary and mandibular Functional Orthopedic appliances to produce whatever transverse expansion of the arches is needed, then distalize the maxillary 6 year molars to a super Class I relation, according the measurements assessed by the Sim Model Analysis. 2. On removal of the Functional Orthopedic appliances, upper and lower Fixed-Removable Lingual Arches are fitted to stabilize teeth and bone. 3. As needed, fit maxillary and mandibular 2 x 4 or 2 x 6 fixed Straightwire appliances with Nickel Titanium wires, utilizing pinched molar hook/stops to establish molar anchorage to level, align and rotate permanent incisors (and lower permanent canines, if erupted). 4. When alignment of the permanent incisors is completed, the FRLAs are left in place as "insurance" appliances to insure that no loss of arch width or arch length occurs. The FRLAs are left in place for up to two years as retainers. 5. Be sure to inform parents and patients that Phase II comprehensive fixed Straightwire treatment is almost certain to be needed during adolescence when the 28 permanent teeth have erupted. 6. Use of this "Controlled Arch System" not only simplifies and shortens the duration of orthodontic treatment, but also can dramatically lower the percentage of extraction cases in an orthodontic practice.

Inventing innovative orthodontic pliers.

Not everyone has been offered the rare opportunity to gather a group of "expert consultants" in orthodontics with the stated purpose of re-designing the instruments that orthodontic practitioners live with and practice with every day of their professional lives. This is what I feel we are doing by the designing and manufacturing of these special pliers that incorporate the Simplicity-Innovation-Motion-Saving characteristics that are represented in these remarkable instruments. Few dentists can point to others in the profession and say silently, "Those orthodontic practitioners are using instruments to treat patients that I had a part in bringing into our profession." If the plans for introducing these pliers to fellow professionals come to full fruition over the next few years, it will bring a warm, personal sense of success to all of those who have involved themselves in planning and carrying out this intricate and worthwhile project.