Dental Tribune India Issue

Nikodem springs (Fig. 9a). These flat coil springs made of NiTi were originally developed for the alignment of displaced canines. However, they have also since been found to be effective in intrusion and En Masse Retraction treatments (Fig. 9b). Elastic chains are widely used traction elements. In con- trast with NiTi springs, how- ever, these rapidly lose their effectiveness. For this reason, a chain is only placed around the head of a miniscrew so that it can be more easily re- moved later. Depending on head design and the direction of the force applied, it is poss- ible for the chain to become accidentally dislodged from the screw head. This problem can be avoided by the use of ready-made hooks (Table 3) that can be attached to the head of the screw. Sliding hooks Sliding hooks with a welded arm for attaching springs (Table 3) are an equally familiar piece of equipment. They are experi- encing something of a renais- sance in connection with the use of miniscrews. They are used for En Masse Retraction, mesialisation and distalisation. The effect of a sliding hook is determined by many different factors, which is why the value of attaching sliding hooks to the arch is disputed. Auxiliary elements for laboratory use All the elements discussed above can be prepared and inserted, with varying amounts of time expenditure, directly at the cha- irside. In recent years, the range of applications for miniscrews has also been extended to ske- letal adjustment treatments, such as palatine suture expan- sion (see Dental Tribune Asia Pacific, 5(2009): 24). The corre- sponding appliances require very careful preparation, and for this reason, the related tasks have been transferred to the laboratory. The principal procedure involves the inser- tion of the miniscrew(s) and the subsequent reshaping process. Once a working model has been prepared, the appliance is constructed and adjusted appro- priately. For connection to a minis- crew, a suitable abutment must be employed. In hybrid PSE, for example, two arms of the expan- sion screw are welded to the abutment. The laboratory abut- ments available from FORESTA- DENT fit the head of the Or- thoEasy screw. An adhesive is used for fixture after insertion. An innovative approach is theBENEFIT-System(Mondeal). Analogous to prosthetic impla- nts, an implant is placed in the bone. Instead of the widely known system where the head is firmly bonded to the threat, there are different abutments (Table 3) available. These will be threaded to the bone screw. This way, many installations can be prepared in the labora- tory, for example, distalisation, anchoring, and retention RPE, saving chair time. For many mechanisms, such as molar uprighting or intrusion, impres- sion is not necessary and the BENEFIT implant can be dire- ctly used. Conclusion Depending on the task at hand, it may be necessary to use vari- ous auxiliary elements. Most of the connection elements dis- cussed are not new and have already been used successfully in orthodontic treatment for some time. For this reason, most of them will already be available in every practice, but often not where they should be. In order to be effective and not waste time searching for tools, it is advisable to have the most important auxiliary elements to hand in a tray. You can either create a DIY version of the tray or purchase one of the ready-made trays available on the market. DT Element Device Application Characteristics Product name Available for Example applications Crimpa- ble hook “En Masse” Retraction Crimpabletubewithwel- ded-onhookforattach- mentofelasticelements (elasticchains,springs) tomas® -crimp hook Power arm crimpable Discopender Crimpable hook Crimpable hook tomas® -pin Ortho Easy® Orthodontic MiniImplantDual- TopTM AnchorScrew AbsoAnchor Compres- sion springs Distalisation, mesialisation Superelastic NiTi compression springs tomas® -compression spring Compression springs TruFlexTM Nickel Titanium Spring tomas® -pin Ortho Easy® Spider Pin Coil springs Mesialisation, distalisation, “En Masse” Retraction Superelastic NiTi coil spring with an eyelet that fits the pin head tomas® -coil spring tomas® -Nikodem spring Coil springs VectorTASTM Delta Spring Ortho Lok- king Closed Coil Springs NiTi closed springs NiTi closed coil spring Gentle NiTi closed coil spring Coil spring tomas® -pin tomas® -pin OrthoEasy® VectorTASTM Ortho Implant Dual-TopTM Anchor ScrewAbsoAnchor AbsoAnchor A-1 Hook for elastic chains or springs Mesialisation, distalisation, “En Masse” Retraction Hook compatible with pin head. Provides for secure attachment of elastic chains and springs tomas® -hook tomas® -monkey hook Monkey hook Screw hook tomas® -pin tomas® -pin M.A.S. A-1 Sliding hook Mesialisation, distalisation, “En Masse” Retraction Square tube with extension arm for attachment of elastic elements (elastic chains and springs) Power arm sliding VectorTASTM Powerarm Sliding hook OrthoEasy® VectorTASTM A-1 Stop elements e.g. for activation of compression springs without removing the appliance Tube with screws or open metal tube for attaching to appliance tomas® -stop screw tomas® -slotted stops Crimpable stop Crimpable stop tomas® -pin tomas® -pin OrthoEasy® AbsoAnchor Cross tube Indirect attachment Cross tube for the con- nection of two wires tomas® -cross tube cross tube tomas® -pin OrthoEasy® Abutments Distalisation, palatine suture expansion (PSE) Can be mounted on screw heads. They represent a crossover to laboratory-prepared appliances (eg for distalisation, PSE etc.) Labor Abutment BENEFIT-Standard abutment BENEFIT-Abutment with Slot BENEFIT-Abutment with bracket BENEFIT-Abutment with wire BENEFIT-Connecting plate with fixating screw OrthoEasy® BENEFIT BENEFIT BENEFIT BENEFIT BENEFIT Finished elements which can be directly used Table 3 (Graphics:DENTAURUM,FORESTADENT;Layout:DTI) trends &applications Dentaltribune|July-September, 201026 Dr Björn Ludwig can be reached at bludwig@kieferorthopaedie- mosel.de. About the author Figs. 9a, b: The Nikodem spring (a) is available with varying numbers of coils. It can be used for the alignment of displaced teeth, for intrusion and En Masse Retraction (b). (Photo 9b: Dr Nikodem, USA). Fig. 8: Use of crimpable hooks (tomas crimp hook, DENTAURUM) makes it possible to transfer the point at which force is applied to the level of the centre of resistance. The eyelet of the coil spring fits the mini-screw head exactly. (Photo: Dr Morea, Brazil)