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The Incognito Appliance System

Incognito Presentation
by

Pam Regimbal

on 24 March 2016

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Transcript of The Incognito Appliance System

Invisible Orthodontic Treatment
For Adults and Teens

Challenges in Lingual Bracket System

Why Introduce Incognito system?

Bracket Design

archwire design
Wire Selections & Objectives
Wire Materials

Ligation videos

Treatment Management Portal (TMP)

Case Presentations
Mock case work up
Non-extraction
Extraction
Summary of Presentation
There are a limited number of options for aesthetic treatment and each one has issues.

Clear brackets
Bracket visible on the teeth
Archwire visible
Enamel wear to upper incisors

Removable Aligners
Compliance
Limited range of cases
Problems with finishing

Lingual brackets



Individualized
Braces conform to the patients dental anatomy
Patient’s unique prescription is built into the brackets and wires

Intelligent and technology driven
Brackets and wires are engineered to deliver targeted results.
Each bracket is optimized to be as comfortable for the patient as possible.
Traditional Lingual Bracket
Each bracket is customized for that individual patient to be as small and as comfortable as possible.
Customized Bracket
Why Recommend
Incognito System to Patients?
UPPER
LOWER

SELF CLIPPING OR SELF RETAINING SLOT FEATURE
BRACKET DESIGNS
0.018
0.025
self retaining clip is to increase interbracket distance for rotational correction
RECTANGULAR ARCHWIRE DESIGN
Number of Arch wires
Each full case comes with 5 wires per arch
Incognito lite comes with 3 wires per arch

Three Wire Materials Available
SE NiTi (set-up wires - round and rectangular)
stainless Steel (Working wires)
Beta III Titanium (finishing wires)

Wire Sizes
Round – 0.012, 0.014, 0.016, 0.018
Rectangular – 16x 22, 17x25, 18.2x18.2, 18x25

Nonextraction Case
Individual for posterior lateral segment

Extraction Case
Straight for posterior lateral segment
Extra torque in anterior (in stainless steel AW)
Ordering Customized Wires
GOALS OF
WIRE SEQUENCING


Start IPR if access is available.
The upper wire (0.014, or 0.016) is tied into the main slot
Upper brackets do not have a self retaining clip because of the interbracket distance is increased due to large size incisors
The lower 0.014 niti wire is inserted into the self retaining clip behind the incisal wings

Resolve most of anterior crowding
Correct most rotational problems
Consolidate anterior spaces *
Most important – difficulty inserting next wire due to canine offsets present
Complete most if not all IPR
Possibly start to resolve angulation issues
Ligation is key (Double overtie)
Must be able to seat the wire to the base of the bracket slot


Complete IPR from 3-3
Complete space closure from 3-3
Complete angulation correction from 3-3 (2nd order)
some torque correction to move to the next rectangular aw
Ligation is key
Power overtie is tie of choice
Steel overtie is another method

Reason –Need to fully express the torque anteriorly. Otherwise, Stainless steel working wires and beta finishing aw will be Difficult to insert.

LIGATION
Double overties or power ties
O Rings
Steel ties
AP CORRECTION (non-extraction case)
Individualized lateral segment
AP correction is greater than 2 mm
CLII or III elastics is needed for extended amount of time
Forsus
Herbst

POSTERIOR SPACE CLOSURE (extraction)
Straight lateral segment
Order 16x24 SS with EXTRA TORQUE
WORKING WIRE
STAINLESS STEEL 16X24
It is slot filling torque to prevent torque loss during space closure
It is not designed to correct or add additional torque


Place figure “8” from 3-3 using 0.008 ligature wire before inserting AW
Must be very tight
Tie in 16x24 ss extra torque using double overties or steel overties
Canines tied in with steel overties – snug and tight
Premolars and molars are tied in using steel ligs – but backed off 1/2 turn
Place gray chain elastics from 3 to 7 – place chain under the premolar brackets
Ordering Beta Titanium finishing wires:
The lateral segments will come with detailing bends targeted for each individual tooth

18.2 x 18.2 or 18 x 25
When anterior torque control is needed
(ie, Final AP correction)

17.2 x 17.2 or 17 X 25
When posterior torque and angulation control is important
Beta III Titanium
Finishing or Detailing AW
SE NITI
Leveling of bracket slots
Aligning and derotating
complete IPR
Consolidate spaces 3-3

STAINLESS STEEL
Working wire for most AP correction (i.e, forsus usage,elastics,)
Posterior space closure (En Mass closure)

BETA III TITANIUM
Torque correction
Final AP correction
finishing with Detail bends
SUMMARY OF WIRE MATERIALS AND OBJECTIVES
Bracket Designs
Treatment Management Portal
VERTICAL SLOT ANTERIORLY
HORIZONTAL SLOT POSTERIORLY
Archwire Design
Recommended Second Wire is
0.016 x 0.022 NiTi
Reduced Size and Profile
Traditional vs. Incognito
Set up archwires
:
Round SE niti
Level and Align
Angulation Correction
Rectangular SE Niti:
Torque Correction

Working wires:
Rectangular Stainless steel
AP Correction
Space closure

finishing wires:
Beta titanium
Final detailing

First rectangle archwire insertion
allows for angulation and some
torque correction


OBJECTIVES of 16 X 22 NiTi
Congratulations
Dr. Babb
Dr. Eppright
Dr. Kelly
Dr. McEntire

You have set your sights and accomplished
First arrived wide eyed and eager to learn
wondered wistfully if it will ever end
Two years have gone by
It's time to leave MCV

a place of learning
a place of nurturing
a place of bonding
home away from home



WE WILL MISS YOU ALL!!!
Attached and engorged yourselves full of
bloody
orthodontic experiences!!!!!
Hang in there
and quit
monkeying
around!!!!!

Dr. Allen
Dr. Bibona
Dr. Nelson
Dr. Redford
November 2012
Initial Records
Problems

Class I dental malocclusion
severe crowding in both arches
impacted lower left second premolar
bimaxillary protrusive

Treatment Plan

Extract tooth #20 and 28
occlusal pad on lower first molars
do pick up impressions on lower arch
complete archwire selection
straight lateral segment
extra torque in 16x24 ss
October
2013
June 2013
May 2013
April 2013
Initial Records
problems

deep bite
overjet
moderate crowding
pt desires limited treatment
Treatment Plan

incognito lite
order terminal tubes on first premolars
IPR
December 2012
March 2013
February 2013
May 2013
Conventional Lasso
O Lasso
Powerchain Placement
Steel Overtie
Double Overtie
3 - link open chain
To the rest,

October 2012
Initial Records
June 2013
December 2012
October 2012
March 2013
June 2013
May 2013
March 2013
Problem

Skeletal cIII
Hyperplastic Mandible
Vertical growth

Class III dental malocclusion
Severe Lower crowding
Maximum anchorage on right side
Moderate anchorage on left side

Treatment pLan

Upper arch

Nonextraction
Wire selection:
Individual

Lower arch

Extract lower left first pm and lower right central incisor
Wire selection:
Straight
January 2012
May 2012
March 2012
June 2012
July 2012
Sept 2011
Initial Records
January 2013
May 2012
July 2012
March 2012
January 2013
December 2012
Problems

UPPER
Moderate crowding
Canine: Class I right and Class II Left
Maximum anchorage on left side
50% overbite

Lower
Moderate to severe crowding
Nonextraction upper
Extract lower left central incisor
3 lower incisor relationship
Finish to a class I canine and molar relationships
Some overjet
Ideal overbite
September 2011
November 2011
October 2011
February 2012
May 2011
Initial Records
December 2011
September 2012
June 2013


mushroom shaped archwire
canine offsets
individual bends
lateral segments
extraction
straight
non-extraction
individual
Rectangular archwire is a Ribbonwise VH wire

Vertical slot insertion anteriorly

Horizontal slot insertion posteriorly


0.018 X 0.025
.018
0.025
AW IS FORMED TO FINAL OCCLUSION

IN A severely CROWDED CASE, the segment from 3-3 offset may not be long enough to engage into every bracket.
January 2013
January 2013
September 2013
May 2013
April 2013
August 2012
October 2012
September 2012
November 2012
December 2012
May 2012
Initial Records
February 2013
Ligation videos

Incognito is a comprehensive lingual bracket system

Dr. prescribes and dictates treatment over TMP
Customized brackets with individual prescription values built-in for each patient
Indirect bonding trays for correct bracket placement
Series of customized arch wires to move teeth to target position-similar to Sure Smile concept
Comprehensive training and support throughout the treatment process to ensure success (Ie. Webinar sessions on 3Mtraining.com, courses available)

More and more patients are asking for nonvisible braces
General dentists are doing aligners
Aligners have limitations
Incognito system offers more control than removable aligners

Works like a bracket and wire system
Not compliance driven
Why the Extra Torque in the .016 x .024 ss ?
Set up for 16x24 SS AW En-Mass Space Closure
OBJECTIVES OF INITIAL ROUND NiTi WIRE
Rectangular SE Niti : Torque Correction
AP correction
Space closure
January 2013
Initial Records
February 2013
Initial Records
The initial aw is manufactured to the final occlusion
easy to forget about IPR - tape IPR card in front of box and mark off ones done
Recommended 3rd Wire is 0.018 x 0.025 NiTi
objectives of 3 wire types
Summarize
discuss future en-mass space closure
Don't worry if you can't engage into every bracket
Nov 2012
Jan 2013
March 1013
May 2013
Add crimpable stops mesial to the first premolars and continue to alleviate crowding.
Customize brackets to help with deep bite corrections.

include half occlusal pads
Chicane ligation
to close anterior 3-3 spacing and correct rotation at the canine.

Do not order brackets if tooth is crowded out of arch or if tooth is not fully erupted. Do a pick up impression and complete wire selection.
Ideal placement of bracket slot is in center of tooth or aligned with long axis of tooth.
easy to forget about IPR - tape IPR card in front of box and mark off ones done
Add flowable composites to end of wire to help with pokey wires.
Customize with tubes on terminal brackets when ordering incognito lite or full case.
Problems

Class I malocclusion
Uprighted upper and lower incisors
Deep overbite
Attrition on lingual of upper incisors
Modeate upper crowding
Moderate to severe lower crowding
Treatment Plan

Nonextraction
Flare upper and lower incisors
Build in bite opener
Design lower brackets with occlusal pads

Wire Selection:
Individual
O Lasso
to bring a tooth into position
Patient needs to have a thorough cleaning at the dentist's office one week before starting

Refer patient for extraction after placement of brackets
Set up wires in Round Niti
Demand for invisible braces is growing
incognito
traditional
not individualized
braces not customized
harder to rebond to exact position
wires difficult to bend
extended treatment time
Pt challenges:
* tongue irritations
* speech
* Chewing food
* longer chair time

* holds true for incognito
Initial round se niti
LEveling, Alignment, and angulation correction

First wire insertion

Initial upper Arch Wire
.012 (stock aw), 0.014, or 0.016 NiTi

Initial lower Arch wire
0.012 (stock aw), or 0.014 Niti only
only these wires can fit into the self retaining slot above the incisal wings. The design of the self clipping slot is to increase interbracket distance to help with rotation correction
Why offer aesthetic braces?
.
018


The Incognito™ Appliance System

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