In August's Clinical Dentistry magazine, Specialist Orthodontist Dr Nikhil Gogna shared two of his his tips that strengthen his clinical practice. Nikhil kindly has given us permission to re post his article, revealing two different cases, and why he uses Infinitas Mini Implants and Reverse Curve Wires, from DB Orthodontics.
Case One: TADS
I have always had a fascination with skeletal anchorage and recognise it as an important component to my treatment planning and mechanics. Having worked with, and spoken to, many orthodontists with varying degrees of experience using temporary anchorage devices (TADs) I've noticed mixed reviews - usually due to their invasive nature and failure rate. The British Orthodontic Society's national TAD audit published in 2015 highlighted a 24.2% failure rate of 1000 TADs placed by orthodontists in the UK (Bearn and Alharbi, 2015).
With practice, I've become proficient in their use and prefer using them palatally and/or buccally with most of my failures occurring in the mandibular arch. Additionally, a challenge is to convince a patient to accept them. To overcome this, I commonly describe TADs as 'studs' or 'micro implants' rather than screws.
Fig 1. A case where Dr Nikhil Gogna would typically incorporate TADsFig 2. Photograph taken on 9/11/2020Fig 3. Photograph taken on 4/12/2020Fig 4. Photograph taken on 30/4/2021 shows progressive successful retraction of the UL3 using indirect anchorage over five months
Figure 1 shows a case where I would typically incorporate TADs. The malloclusion is complicated by hypodontia of the upper left lateral incisor resulting in mesial migration of the upper left canine thus becoming a full unit class II relationship. The treatment plan involved space redistribution for a pontic in the upper left lateral incisor space and therefore requiring canine retraction - an anchorage demanding movement.
Alternative methods can include the use of push coil between the upper left central incisor and left canine (but this will cause a centreline shift to the right, proclination of the upper incisors and subsequent round tripping) or class II elastics, which relies on patient compliance.
In such cases, I've found success placing TADs buccally as access is advantageous and have a choice of applying direct or indirect anchorage to the canine. Figures 2, 3, and 4 show progressive successful retraction of the UL3 using indirect anchorage over five months.
"The Infinitas Kit from DB Orthodontics is my go-to TADs kit. It offers simplicity, predictability, and a variety of kit types including the introduction, complete and stent guide kits"
Case Two: Counter Force Arch wires
Counter force wires are used for multiple reasons during orthodontic treatment, including overbite reduction, initial levelling, and maintenance of anterior torque.
Such wires have a reverse curve built in saving the clinician time of wire bending and preventing unwanted vectors having an influence on tooth movement.
Fig 5. Initial presentation - anterior open biteFigure 6. TreatmentFigure 7. Final result
An alternative use of such wires includes anterior open bite correction, which aim to extrude the upper incisors and intrude the posterior buccal segments.
"The super elastic nickel titanium Reverse Curve archwires (again from DB Orthodontics) offer a variety of choice. The reverse curves start as early as an 014 nickel titanium so overbite reduction or anterior overbite correction can begin immediately"
Figures 5, 6 and 7 demonstrate an anterior open bite case that utilised reverse curve of Spee nickel titanium wires (16x22 and 19x25), as well as settling elastics to reduce the lateral open bites created while using such wires. To aid extrusion of the upper incisors, anterior box elastics can be worn at night. However, stability of the corrected result is never guaranteed. Clinicians should access the incisal show during their examination to see if such mechanics are suitable.
BearnDR, Alharbi F (2015) British Orthodontic Society national audit of temporary anchorage devices (TADs): report of the first thousand TADs placed. J Orthod 42(3):214-219
About Nikhil Gogna
BDS (HONS) MFDS RCPS (GLASG) DCLINDENT (ORTH) MORTH RCS (ENG) FDS RCS (ENG)
Dr Nik Gogna is an orthodontist aiming to provide the highest standard of treatment and care to his patients. He has undertaken extensive amount of training in various cities within the United Kingdom enabling him to achieve his desired goal in becoming a specialist in the field of orthodontics.
After graduating from Cardiff Dental School in 2013, he went onto complete 1 year of ‘Dental Foundation Training’ in his home city of Wolverhampton. He gained a broad range of experience in a number of dental specialties by working as a Dental Core Trainee (DCT) in Oral & Maxillofacial Surgery, Community and Restorative dentistry in London and Cardiff. During this time he completed his Membership of Faculty in Dental Surgery (MFDS) associated with the Royal College of Physicians and Surgeons of Glasgow.
However the field of orthodontics was always his passion and in 2016, he was successful in gaining a place to study at the Royal London (Queen Mary’s University of London) & Southend University hospitals. In 2019, Nik completed his Doctorate in Clinical Dentistry (DClinDent) and passed the Membership in Orthodontics examination (MOrth), thereby recognising him as a fully qualified orthodontic specialist.
To compliment his clinical achievements, Nik has a strong academic background. He has participated in multiple audits, publications and presentations where he has had the honour of presenting his research internationally at the European Orthodontic Conference in Nice, France and the European Society of TMJ Surgeons in Bonn, Germany.
Nik is involved in management roles both as a leader and as a team player. He was elected as a committee member of the British Orthodontic Society Training Grades Group, British Lingual Orthodontic Society and participates within the West Midlands Consultant Orthodontic Group.
About DB Orthodontics
It is our company mission to become a global leader in orthodontic and laboratory supplies. With over 45 years of experience in orthodontics, we recognise the importance of quality, service and innovation. Working to ISO13485 standards we strive for perfection in all that we do, from unique product design to the excellent service provided by our dedicated customer service and sales teams. We are continually developing our product range, designing innovative products through consultation with leading orthodontists from the world, to ensure that our products meet the high standards expected by today’s practitioners.