McLaughlin Bennett 5.0 PDF

... the only philosophy which offers a comprehensive system – it includes a range of high quality brackets, precise information on where to place those brackets, and full information on arch form and force levels. All of this is backed up with best-selling textbooks. Contents:...

... the only philosophy which offers a comprehensive system – it includes a range of high quality brackets, precise information on where to place those brackets, and full information on arch form and force levels. All of this is backed up with best-selling textbooks. Contents: Changes and progress 3 The story so far 4 Important advances in 10 key areas 7 Q & As on mechanics 12 Continuing education 13 Brackets and tubes 14 Archwires 15  McLaughlin Changes and progress Bennett with FORESTADENT If we are not making changes, we are not making progress. The work of Dr. Lawrence F. Andrews in the 1970s changed everything. The emphasis moved away from wire ben- ding, and two things became essential for good treatment mechanics – bracket positioning and bracket quality. In the 1980s and 1990s we developed our treatment philosophy with Dr. Hugo Trevisi and we released it at the AAO in Philadelphia in 1997. In time, it became the most widely used treatment method in the world, but things have moved on since then. We have continued to develop and improve the treatment method and here we document some of the important changes we have made. It has been our life’s work to develop an ‘ideal’ treatment system. McLaughlin Bennett 5.0 is the latest version of this, and it is fully described in our recent textbook, ‘Fundamentals of Orthodontic Treatment Mechanics’. The aim has been to ‘keep the best and improve the rest’ and you will see important advances in 10 key areas: 1. Indirect bonding 2. Bracket accuracy 3. Better working wires 4. Reducing decalcification 5. Anchorage support 6. A focus on the airway 7. Efficiency in enamel reduction 8. Improved versatility 9. The ‘Progress Review’ 10. Finishing protocols You may want to consider introducing some of these improvements, and we look forward to the pleasure of working with you at the courses. John Bennett & Rick McLaughlin -3-  McLaughlin The story so far Bennett with FORESTADENT The 1970s and the work of Andrews Andrews released his landmark ‘Six Keys’ paper in 1972 and introduced the SWA, based on his research. The orthodontic world was changed forever. 1980 – 1989 The treatment mechanics years We described our work on light continuous forces and sliding mechanics in a series of papers, the first appearing in 1989. 1993 The start of book publishing Our first book – ‘Orthodontic Treatment Mechanics and the Preadjusted Appliance’ – explained the mechanics in more detail and included a selection of treated cases. 1990 – 1996 The bracket design years The SWA brackets were redesigned, keeping all the advantages, but dealing with the apparent shortcomings. This involved less tip, more torque control, and a mass of detail refinements. Also, versatility was recommended, to simplify mechanics in a range of treatment situations. 1997 The release of the second book ‘Orthodontic Management of the Dentition with the Preadjusted Appliance’ was released at the AAO meeting in Philadelphia. It defined the bracket specifications which have stood the test of time, and continue to be effective 20 years later. This practical, highly illustrated guide pre- sents an innovative, organized approach to essential topics in orthodontics such as crowding, spacing, tooth size discrepan- cies, and management of common ecto- pic eruption problems and impactions. Its unique approach focuses on the treatment mechanics of each individual tooth involved, rather than the dentition as a whole. -4-  McLaughlin The story so far Bennett with FORESTADENT 1997 – 2001 Refining the treatment system Hundreds more cases were treated during these four years, refining the recommended mechanics and brackets. 2001 The release of the third book The definitive Book 3 was published – ‘Systemized Orthodontic Treatment Mechanics’. There were more than 20,000 copies in English, and it was published in at least 12 other languages. It became the standard mechanics text in many universities. 2005 – 2008 The confused years This was a confused period in orthodontics, when arch expansion was once again being promoted as a method of managing crowding, with no clear evidence that this was beneficial for patients or orthodontists. For several years this undermined the values and fabric of the orthodontic specialty. 2014 The release of the fourth book and McLaughlin Bennett 4.0 ‘Fundamentals of Orthodontic Treatment Mechanics’ was released in March 2014 (See page 12). It clears away the confusion of recent years, and defines an improved treatment philosophy for a new generation of orthodontists. It is available in multiple languages. A valuable information source for orthodontists at all levels who are seeking to provide high quality care. For students, looking for a concise understanding of modern treatment methods, it offers a clear pathway forward. -5-  McLaughlin Bennett with FORESTADENT Simplicity – the ultimate sophistication. Leonardo da Vinci -6-  McLaughlin Important advances in 10 key areas Bennett with FORESTADENT 1. Indirect bonding The importance of accurate bracket positioning After the introduction of the SWA in the 1970s, based on Andrews’ research, everything changed. Suddenly bracket positioning became all-important. In the days of standard edgewise, the best results came from the best wire benders. With the pre-adjusted edgewise the best results came from those who could achieve the most accurate bracket positio- ning, because everything was built into the brackets. The original concept was to position the brackets in the middle of the clinical crown. However, it proved difficult to get vertical accuracy by ‘eyeballing’, and in the 1990s gauges were recom- mended.1 In the 2000s there has been a move to combine the use of gauges with indirect bonding systems (IDBS). This brings benefits to patients and orthodontists alike. Bracket positioning is more accurate, less ‘doctor time’ is needed, and the patient has a better experience when setting up the case. More details are on page 74 of ‘Fundamentals of Orthodontic Treatment Mechanics’. Picture: Indirect bonding 2. Bracket accuracy The need for excellent brackets In the early years with the treatment method, the ‘full-size’ development brackets were accurately manufactured in Munich. German technology was available, and a milling process was used as a precise manufacturing method, to create accurate brackets for proper tooth control. However, the brackets were rather large, and milling was not an efficient manufacturing process. Experience has shown that it is difficult to be cost effective when making brackets and tubes by milling. Accordingly, in the 1990s there came a demand for smaller brackets and an efficient manufacturing process. This brought a move to mid-size brackets, and a change to manufacture by metal injection moulding (MIM). Brackets need to be precisely manufactured, or treatment becomes less efficient and more wire bending will be required. MIM can be a good production method, but only if there is great attention to quality control. Technical expertise is needed, along with good quality control, and in the past, many bracket types have been shown to be inaccurate.2 Forestadent is at the forefront of MIM technology. The company has its origins in the watch industry and is renowned for precision. We have complete confidence in the Forestadent Mini Sprint range of high quality brackets and tubes, and have no hesitation in recommending them. We appreciate Forestadent’s support for dental education worldwide. Pictures: Accuracy and quality control are essential. 1 McLaughlin RP, Bennett JC. Bracket placement with the preadjusted appliance. J Clin Orth 1995; 29: 302-11. 2 Cash A C, Good S A, Curtis R V, McDonald F. 2004 An evaluation of slot size in orthodontic brackets – are standards as expected? Angle Orthod. 74: 450-453 -7-  McLaughlin Important advances in 10 key areas Bennett with FORESTADENT 3. Better working wires Control of overbite and torque In recent years there have been advances in the quality and accuracy of steel wires, which is a big step forwards. Wires with increased spring temper bring new standards of control for over- bite, torque, and arch form, and they are diamond drawn for a smooth finish. The soldered ball hooks perform better than the earlier ‘posts’. The new type of hook is of solid brass with a swaged ball end. It is more comfortable for the patient than the previous bare soldered hooks, and placement of elastics is easier. Picture: The latest wires help control of overbite, torque, and arch form. 4. Reducing decalcification Sealing and protecting enamel against white spot lesions (WSLs) Orthodontic treatment can cause plaque accumulation around the brackets and increase the risk of enamel white spot lesions3, but steps can be taken to reduce this risk. The whole labial surface of the tooth enamel can be etched, ins- tead of the traditional etching of a small area below the bracket base. After rinsing and drying, the whole labial surface can then be sealed, as a measure to reduce the risk of demineralisation. Several years of use indicate that there are benefits to using a sealant in this way, but it will be some time before the studies appear to confirm this. More details are on pages 72 and 73 of ‘Fundamentals of Orthodontic Treatment Mechanics’. Picture: Etching of the whole labial surface before sealing, to reduce the risk of enamel demineralization. 3 Sigurd Hadler-Olsen, Kristin Sandvik, Mohammad A. El-Agroudi, and Bjørn Øgaard 2012 The incidence of cariesand white spot lesions in ortho- dontically treated adolescents with a comprehensive caries prophylactic regimen— a prospective study Eur J Orthod 34(5): 633-639 -8-  McLaughlin Important advances in 10 key areas Bennett with FORESTADENT 5. Anchorage support TADs and plates It is easy to combine TADs or plates with the treatment method, and there is no need to change the appliance or the mechanics. Mini screws can be used at various stages in the treatment, if absolute anchorage is needed. They can serve to anchor molars during levelling and aligning, or they can support the use of elastics or coil springs during sliding mechanics, but there are concerns about failure rates, which have recently been reported as 22% (maxilla) and 31% (mandible).4 Surgical plates are an effective option. They are normally fitted by oral surgeons, because the placement technique is more invasive than with TADs, and a surgical flap is required. They are very relia- ble, with a failure rate which is less than TADs.5 Picture: Surgical plates are effective and reliable. 6. A new focus on the airway Functional appliances and RME As orthodontists we have a responsibility to maintain or improve the airway during treatment, and there is an increased focus on this. It is a service to the patient to maintain an awareness of air- ways and sleep disorders, and make enquiries about this during history taking and clinical examination. If there is a positive res- ponse to these questions, then referrals are made for evaluation. If rapid maxillary expansion or functional appliances6 are included in the treatment plan, this may be expected to produce some airway improvement, along with the orthodontic changes. Con- versely, airway consideration is needed to avoid adverse changes when planning Class III surgical cases. Picture: RME or functional appliances can help airway improvement. 4 Bearn DR, Alharbi F 2015 British Orthodontic Society national audit of TADs: report of the first thousand placed. J Orthod. 42 214-219 5 De Clerck EB, Swennen GRJ. 2011 Success rate of miniplate anchorage for bone anchored maxillary protraction. Angle Orthod. 81:6 1010-1013 6 Bennett J. 2006 Orthodontic management of uncrowded Class II division one malocclusions in children.Mosby ISBN-13 07234 34263 -9-  McLaughlin Important advances in 10 key areas Bennett with FORESTADENT 7. Efficiency in enamel reduction Relief of crowding in non-extraction cases. Managing situa- tions where the teeth do not fit. Inter proximal enamel reduction (IPR) is becoming increasingly important in orthodontics, and it is often the method of choice to deal with mild crowding, especially in adult cases. This brings a new focus on the need for efficiency. Chapter 9 in the new book discusses appropriate techniques and explains that the procedure is safe, if properly carried out.7 It gives recommendations for the amount of enamel which may be safely removed. Careful management of tooth size is needed in many cases to reach an ideal occlusion. In the closing stages, after correction of incisor torque, overbite and overjet, spacing is often seen in one arch (more frequently the upper) due to a tooth size discrepancy. This is managed by enamel reduction or composite build-up, or by a combination of these two procedures, and efficient IPR is needed. Picture: Interproximal enamel reduction. 8. Improved versatility New versatility options Versatility reduces the need for wire bending and improves treatment efficiency. New options are described in chapter five and these include: It can be helpful to invert lower incisor brackets (to give +6° torque) in some Class III cases to prevent unwanted retrocli- nation of lower incisors. This can also be useful in cases where molar anchorage loss is needed or where a single lower incisor is proclined. In some Class III treatments it is helpful to switch left and right lower canine brackets. This changes the tip from +3° to -3° and can make the mechanics easier. For good root control with buccally ectopic upper canines, the -7° torque bracket is not really suitable, and works better when inverted to give the +7° option, which guides the root into can- cellous bone. Picture: It is helpful to invert the lower incisor brackets in some cases. 7 Zachrisson BU, Nyøygaard L, Mobarak K 2007 Dental health assessed more than 10 years after interproximal enamel reduction of mandibular anterior teeth. Am J Orthod Dentofacial Orthop; 131:162-9 I Zachrisson BU, Minster L, Øgaard B, Birkhed D 2011 Dental health assessed after interproximal enamel reduction: Caries risk in posterior teeth. Am J Orthod Dentofacial Orthop 139:90-98 - 10 -  McLaughlin Important advances in 10 key areas Bennett with FORESTADENT 9. The ‘Progress Review’ Easier treatment in the closing stages During treatment, and after the main tooth movements have been achieved, a long ‘progress review‘ appointment is recommended. The timing of this varies from case to case, and it is informally known as ‘Clean up time’. Bracket positions and other aspects of the treatment are carefully checked, sometimes with the help of radiographs and / or a set of progress models. Errors are corrected as necessary, and the ongoing needs of the case are recorded. This simple step makes finishing easier and often shortens the treatment time. Picture: The Progress Review helps finishing. 10. Finishing protocols Settling the case The final stages of an orthodontic treatment can be a challenging time for the orthodontist, and this was recognised at an early sta- ge.8 To improve effectiveness, and avoid needless appointments, an improved protocol is recommended for the finishing stages. It can be managed in three steps: The correction of errors made before finishing Overcorrection of key features of the malocclusion Case settling When finishing the case, it is important to minimise negative changes while the teeth settle. ‘Frequent options’ are available and are described in detail, to be used for upper and lower arch settling. They are used in different combinations, depending upon the needs of the case. Picture: 'Up and Down' elastics during finishing. 8 McLaughlin RP, Bennett JC. Finishing and Detailing with the Preadjusted Appliance System. 1991 Journal of Clinical Orthodontics, Vol. 25, pp. 251- 264 - 11 -  McLaughlin Q & A on working with McLaughlin Bennett 5.0 Bennett with FORESTADENT Should I choose.018 or.022 slot size? The mechanics work better with.022. I like the idea of the ‘Progress Review’. At what stage is it done? There is no fixed stage. In routine non-extraction cases we often schedule the Progress Review when we are ready to move into working wires. In more challenging cases, where major tooth movements are needed, or in extraction cases, the Progress Review will often be helpful later in the treatment. This may be towards the end of space closure, or after the incisor relationship has been corrected. The lower incisor brackets seem a little thick. Is this OK? Most brackets currently available do not have the correct in-out. The in-out values of our brackets appear a little thick, but are based on Andrews’ research. In almost almost all cases they deliver ideal alignment without the need for first order bends, particularly in the lower labial segment. You are using very accurate brackets. Does the improved precision bring any disadvantages? It helps the progress of the treatment and the outcome to work with precise brackets! We find there is a need for care in three clinical situations. 1. In a few cases there may be a tendency for upper and lower incisor roots to be a little forward. 2. In cases with an instanding upper lateral incisor, where the bracket has been inverted, there is a risk of too much over-correction. In situations (1) and (2) the remedy is to drop down from.019/.025 to a smaller wire, such as.017/.022. 3. In some non extraction cases doctors choose to use zero torque brackets for the lower incisors. This is a useful option where patients decline to have IPR, or where it is not carried out adequately. I am planning to switch to indirect bonding system (IDBS). Are there any tips? It is definitely a good move to make the switch. It is best to work with a colleague who is experienced with IDBS, but there is some information on YouTube. There is no doubt that indirect bonding has become easier with the newer materials. Should I order brackets with hooks on canines and/or premolars? We are currently not advocating hooks on premolar brackets, but many orthodontists find hooks are useful on canine brackets. The -7° torque upper and -6° torque lower canine brackets are sometimes inverted, depending on the needs of the case, and in this situation it is necessary to cut off the hooks and smooth the metal after cutting. Do I need to order full size second molar tubes? Surprisingly, we find that the mini tubes work well in almost all clinical situations. I like to use the new high tensile steel working wires with ball hooks. Any advice about using them? They seem to perform better and bring advantages in torque control, sliding mechanics, and overbite correction. There is advice on pages 89 to 92 of the new book, including the five factors in overbite control. In cases with a deep bite the working wires are used ‘flat’ for the first two or three months and we find there is seldom a need to add ‘anti-Spee’ if the rules are followed. - 12 -  McLaughlin Continuing education Bennett with FORESTADENT The new book in nine editions Fundamentals of Orthodontic Treatment Mechanics John C. Bennett & Richard P. McLaughlin A hardcover textbook with 300 pages, 14 chapters, and more than 900 color illustrations and line drawings. This is a valuable information source for orthodontists at all levels who are seeking to provide high-quality care, and for students who are looking for a concise understanding of modern treatment methods. Available in: English, Romanian, Italian, Spanish, Japanese, Turkish, Korean, Ukrainian, Polish (Portuguese and Chinese in preparation) Please contact Forestadent for sources of the book. The two-year program The popular McLaughlin two-year program is held in San Diego, at an all-new and expanded facility in the new practice. There are six sessions (three per year) over a two year period www.mclaughlince.com. It teaches an accurate and efficient approach to patient care using diagnostics, treatment planning, and case management, and is intended for certified orthodontists who want to extend their know- ledge of the treatment method. Each session lasts 3 or 4 days and includes a case presentation, discussion, and hands-on segment. The international courses Our courses feature many stage-by-stage treated cases to pass on new ideas and show the ease of the mechanics. Through the courses we keep in touch with colleagues worldwide and receive feed-back and suggestions. This helps in the development of the concept, and we gratefully acknowledge the con- tributions from orthodontic colleagues. Courses are available at all levels, and this image shows a group of 200 orthodontists and postgraduate students attending Dr. Bennett’s program in Madrid, May 2014. Copyright © John Bennett and Richard McLaughlin 2017 - 13 -  McLaughlin Brackets and tubes Bennett with FORESTADENT Mini Sprint® II Brackets McLaughlin Bennett 5.0 Optimized arch form Better comfort through Anatomically curved through clinically proven lowered hooks with flatter hook base for optimal bracket values. Adjusted design and increased bonding results. In/Out values for better space between tie wings clinical results. and pad. Maxillary Slot.018“ Slot.022“ Order No. Order No. Tooth Torque Angulation In/Out Rotation Right Left Right Left 1 Centrals +17˚ +4˚ 1,05 – 780T0103 779T0103 780T0101 779T0101 2 Laterals +10˚ +8˚ 1,25 – 780T0203 779T0203 780T0201 779T0201 Cuspids -7˚ +8˚ 0,6 – 780T0313 779T0313 780T0311 779T0311 3 Cuspids + hook -7˚ +8˚ 0,6 – 780T0303 779T0303 780T0301 779T0301 Cuspids 0˚ +8˚ 0,6 – 780T0333 779T0333 780T0331 779T0331 3 Cuspids + hook 0˚ +8˚ 0,6 – 780T0323 779T0323 780T0321 779T0321 Bicuspids -7˚ 0˚ 0,8 – 780T0413 779T0413 780T0411 779T0411 4 Bicuspids + hook -7˚ 0˚ 0,8 – 780T0403 779T0403 780T0401 779T0401 Bicuspids -7˚ 0˚ 0,8 – 780T0413 779T0413 780T0411 779T0411 5 Bicuspids + hook -7˚ 0˚ 0,8 – 780T0403 779T0403 780T0401 779T0401 Mandibular Slot.018“ Slot.022“ Order No. Order No. Tooth Torque Angulation In/Out Rotation Right Left Right Left 1 Centrals -6˚ 0˚ 1,3 – 780T1203 780T1203 780T1201 780T1201 2 Laterals -6˚ 0˚ 1,3 – 780T1203 780T1203 780T1201 780T1201 Cuspids -6˚ +3˚ 0,6 – 780T1413 779T1413 780T1411 779T1411 3 Cuspids + hook -6˚ +3˚ 0,6 – 780T1403 779T1403 780T1401 779T1401 Cuspids 0˚ +3˚ 0,6 – 780T1433 779T1433 780T1431 779T1431 3 Cuspids + hook 0˚ +3˚ 0,6 – 780T1423 779T1423 780T1421 779T1421 Bicuspids -12˚ +2˚ 0,65 – 780T1513 779T1513 780T1511 779T1511 4 Bicuspids + hook -12˚ +2˚ 0,65 – 780T1503 779T1503 780T1501 779T1501 Bicuspids -17˚ +2˚ 0,65 – 780T1613 779T1613 780T1611 779T1611 5 Bicuspids + hook -17˚ +2˚ 0,65 – 780T1603 779T1603 780T1601 779T1601 Cases Maxillary Cuspids: 0° Torque; Mandibular Cuspids: 0° Torque Maxillary Cuspids: -7° Torque; Mandibular Cuspids: -6° Torque Variation Slot.018“ Slot.022“ Slot.018“ Slot.022“ Cases 1 5 10 1 5 10 1 5 10 1 5 10 706T1060 706T1061 706T1062 706T1069 706T1070 706T1071 706T1031 706T1032 706T1033 706T1046 706T1047 706T1048 3 706T1063 706T1064 706T1065 706T1072 706T1073 706T1074 706T1036 706T1037 706T1038 706T1051 706T1052 706T1053 3-5 706T1066 706T1067 706T1068 706T1075 706T1076 706T1077 706T1041 706T1042 706T1043 706T1056 706T1057 706T1058 Tulip buccal tubes McLaughlin Bennett 5.0 on large pad OK / Maxillary Tooth Torque Angulation Distal Offset Slot right left 76 67.018“ x.028“ 743T0744 742T0744 -14° – 10°.022“ x.028“ 743T0742 742T0742 UK / Mandibular.018“ x.028“ 743T1714 742T1714 -20° – 0° 6 6.022“ x.028“ 743T1712 742T1712.018“ x.028“ 742T0724 743T0724 -10° – 0° 7 7.022“ x.028“ 742T0722 743T0722 - 14 -  McLaughlin Archwires Bennett with FORESTADENT Archwires McLaughlin Bennett 5.0 Tapered-form Ovoid-form Square-form Order No. Order No. Order No. Order No. Order No. Order No. description profile ø inch Maxillary Mandibular Maxillary Mandibular Maxillary Mandibular 208H0835 208H0935 208H1835 208H1935 208H2835 208H2935.014“ 208H0840 208H0940 208H1840 208H1940 208H2840 208H2940.016“ McLaughlin Bennett 5.0 Nickel Titanium - 208H2040 208H2140 208H3040 208H3140 208H4040 208H4140 016“ x.022“ Heat Activated 208H2044 208H2144 208H3044 208H3144 208H4044 208H4144.017“ x.025“ 208H2048 208H2148 208H3048 208H3148 208H4048 208H4148.019“ x.025“ 202-0835 202-0935 202-1835 202-1935 202-2835 202-2935.014“ McLaughlin Bennett 5.0 Stainless Steel 202-0840 202-0940 202-1840 202-1940 202-2840 202-2940.016“ 202H0845 202H0945 202H1845 202H1945 202H2845 202H2945.018“ McLaughlin Bennett 5.0 Stainless Steel 202H0850 202H0950 202H1850 202H1950 202H2850 202H2950.020“ Heat Treated 202H2048 202H2148 202H3048 202H3148 202H4048 202H4148.019“ x.025“ All archwires are supplied as package of 10 pieces. Archwires Ball Posted McLaughlin Bennett 5.0 Tapered-form Ovoid-form Square-form Order No. Order No. Order No. Order No. Order No. Order No. description mm profile ø inch Maxillary Mandibular Maxillary Mandibular Maxillary Mandibular - 209T2448 - 209O2448 - 209S2448 24 - 209T2648 - 209O2648 - 209S2648 26 - 209T2848 - 209O2848 - 209S2848 28 209T3048 - 209O3048 - 209S3048 - 30 McLaughlin Bennett 5.0 Stainless Steel 209T3248 - 209O3248 - 209S3248 - 32.019“ x.025“ Ball Posted 209T3448 - 209O3448 - 209S3448 - 34 209T3648 - 209O3648 - 209S3648 - 36 209T3848 - 209O3848 - 209S3848 - 38 209T4048 - 209O4048 - 209S4048 - 40 - 209T2444 - 209O2444 - 209S2444 24 - 209T2644 - 209O2644 - 209S2644 26 - 209T2844 - 209O2844 - 209S2844 28 209T3044 - 209O3044 - 209S3044 - 30 McLaughlin Bennett 5.0 Stainless Steel 209T3244 - 209O3244 - 209S3244 - 32.017“ x.025“ Ball Posted 209T3444 - 209O3444 - 209S3444 - 34 209T3644 - 209O3644 - 209S3644 - 36 209T3844 - 209O3844 - 209S3844 - 38 209T4044 - 209O4044 - 209S4044 - 40 All archwires are supplied as package of 10 pieces. - 15 -  FORESTADENT (Germany) Bernhard Förster GmbH Westliche Karl-Friedrich-Str. 151 D-75172 Pforzheim Info No. 212/04.18 Phone: +49 (0) 7231 459-0 Fax: +49 (0) 7231 459-102 [email protected] www.forestadent.com