Orthodontic Perspectives

Innova
News, Information, and Clinical Case Studies

Vol. XXIII, No. 1 • Global Edition • May 2016

Orthodontic Perspectives Innova

In my travels to meet with orthodontists, I hear from many that the current competitive
environment is increasingly difficult. Patients not only choose among providers, but now they also
choose by different treatment methods and claims about the final results available from each.
Patients hear about dental GPs placing brackets, and clear tray aligners, and better smiles promised
in just six months. It almost seems that comprehensive, quality treatment is under assault.

At 3M, we understand that lasting success in meeting this challenge comes from an unwavering
commitment to quality, clinical excellence, and treatment efficiency. As your partner, our goal is to
help you succeed in your practice, delighting the patient with a great treatment experience, and you
with your planned treatment results.
James Ingebrand
Vice President & To help you toward your goals, 3M Oral Care leverages a broad technology portfolio, extensive
General Manager manufacturing expertise and a global presence to deliver unique and differentiated products that
3M Oral Care help you succeed. 3M’s science background, applied to your needs, brings new ideas to you in the
form of products and services that enable excellence in treatment.

If you are at the AAO Annual meeting, visit us at the 3M booth. Learn how 3M’s aesthetic and
efficient orthodontic solutions are helping orthodontists differentiate their practices, grow case
starts and enjoy clinical, professional and personal success across the world.

I would also invite you to read further into this May 2016 issue of Orthodontic Perspectives Innova.
This issue brings together doctors from around the globe to share their experience and success with
3M Oral Care products.

Four cases highlight the wide breadth of treatment with aesthetic Clarity™ ADVANCED Ceramic
Brackets. We also look in depth into the SmartClip™ SL3 Appliance System, unique among
self-ligating bracket systems. It provides a high level of treatment efficiency with a design that
addresses problems experienced with more common self-ligating bracket designs. And it is now
even easier to use with an enhanced self-ligating clip.

You will also find interesting product news, treatment tips and important dates for upcoming
educational opportunities for you and your staff. Orthodontic Perspectives Innova is in its 23rd year
of continuous publication, providing industry news and information to orthodontists. I hope you find
the information in this issue of value to your practice. Please contact your 3M representative if you
have any questions or need any more information on any of the products included here.

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Orthodontic Perspectives Innova

Orthodontic Perspectives Innova is

Table of Contents
published periodically by 3M to
provide information to orthodontic News and Information
practitioners about 3M orthodontic
Product news and announcements. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
products and services. 3M welcomes
article submissions or article ideas. U.S. Education Events – 2016. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
Contact address: Editor, Orthodontic
Perspectives Innova, 3M Oral Care, Global Incognito™ Appliance System course schedule for 2016 . . . . . . . . . . . . . . . . 7
3M Center, 275-2W-08, St. Paul, MN
55144-1000. To call for more information:
In the United States and Puerto Rico,
3M Health Care Academy
SM

call (800) 852-1990 ext. 4399. In Canada

call (800) 443-1661 and ask for extension
Clinical Cases
4399. Or, call (651) 736-7690 (direct).
Clarity™ ADVANCED Ceramic Brackets and Incognito™ Appliance System
Copyright © 3M 2016. All rights reserved. Case Study
No part of this publication may be by Dr. Patrice Pellerin. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
reproduced without the consent of 3M.
Some of the doctors contributing to SmartClip™ SL3 Self-Ligating Appliance:
the Orthodontic Perspectives Innova A Case for Orthodontic Treatment Efficiency
publication may receive compensation by Dr. Moe Razavi . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
from 3M.
Eight Keys for Successful and Efficient Treatment with SmartClip™
3M, “3M Science. Applied to Life.”, and Clarity™ SL Appliances
APC, AlastiK, Clarity, Forsus, Incognito, by Dr. Gilad Har-Zion. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
MBT, SmartClip, Sondhi, Unitek, and
Victory Series are trademarks of 3M. Class I: Crooked teeth, crowding, midline discrepancy
3M Health Care Academy is a service by Dr. Patrice Pellerin. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
mark of 3M. Used under license in
Canada. All other trademarks are Class II: Aesthetic Treatment with Clarity™ ADVANCED Ceramic Brackets
property of their respective holders. Patient Experienced Failure in Treatment with Aligners
by Dr. Anoop Sondhi. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30
Visit our website at
[Link]/ortho Class III: Missing teeth, tight teeth, Class III cuspid relationship
by Dr. Patrice Pellerin. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34

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Orthodontic Perspectives Innova News and Information

Clarity™ ADVANCED Ceramic Brackets with

Forsus™ CIass II Correctors – the efficient
aesthetic treatment choice for your patients.

Clarity™ ADVANCED Ceramic Brackets have quickly become the Forsus™ Class II Correctors were the pioneer
traditional bracket of choice for aesthetic treatment. Small, strong, among intraoral Class II appliances. Proven in
easy to ligate, easy to debond, and amazingly aesthetic, treatment for more than a decade, they give
they offer a complete treatment solution for patients you a completely aesthetic treatment system
considering treatment options. Combined with APC™ for your patients who need Class II. Now with
Flash-Free Adhesive, this system is a practice differentiator the addition of the Forsus wire mount, the
in an ever more competitive treatment environment. system can be used with or without banded
molars, installed with no labs required. Even if Class II treatment
But when Class II Correction comes into the mix, non-aesthetic
was not in the initial treatment plan, it can be added at any time
options are still being offered to patients. Yes, headgear works. But what patient
with simple installation.
in today's market would choose headgear over an aesthetic solution that works
quickly, efficiently, comfortably, and importantly, unnoticeably. Read a case study where Clarity ADVANCED Ceramic Brackets have been
combined in treatment with the Incognito™ Appliance System..
Clarity™ ADVANCED Ceramic Brackets and Incognito™ Appliance System
Case Study by Dr. Patrice Pellerin

Read more about Clarity ADVANCED Ceramic Brackets and Forsus Class II
correctors by visiting [Link]/ortho.

Patient with headgear Patient wearing Forsus™ Correctors

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Orthodontic Perspectives Innova News and Information

Clarity™ ADVANCED Ceramic Efficiencies of SmartClip™

Brackets – Case Overview SL3 Self-Ligating Appliances
booklet released. enhanced with improved
ligating clip.
A new resource for doctors, featuring Clarity™ ADVANCED As part of an ongoing continuing improvement process for 3M products,
Ceramic Brackets in treatment, is now available on the 3M web site. 3M R&D engineers have responded to a call for improved engagement and
The Clarity™ ADVANCED Ceramic Brackets – Case Overview is an informative disengagement forces for the ligating clips on SmartClip™ SL3 Self-Ligating
compilation of many cases using Clarity ADVANCED Brackets for Class I, Class II Appliances. While visually the change is hardly noticeable, the improved clips
and Class III patients. change the forces needed to engage and disengage archwires, and in particular,
rectangular archwires. The result is an improved experience
The cases show the wide variety of requirements that these versatile brackets can
for both the doctor and patient. In the process, the shape
successfully treat, while providing an excellent aesthetic solution for the patient.
of the enhanced clip has also improved the rotation
There will be additional cases added over time, so feel free to check back for control characteristics of the brackets.
additional information.
There are also two articles featuring the SmartClip
appliance system in this issue. One includes Information on the SmartClip
For a sample of the cases covered in the new booklet, see the following articles:
Bracket’s aesthetic counterpart – Clarity™ SL Self-Ligating Appliances.
Class I: Crooked teeth, crowding, midline discrepancy
SmartClip™ SL3 Self-Ligating Appliance: A Case for Orthodontic Treatment
 lass II: Aesthetic Treatment with Clarity™ ADVANCED Ceramic Brackets
C
Efficiency, Dr. Moe Razavi, Canada
Patient Experienced Failure in Treatment with Aligners
Class III: Missing teeth, tight teeth, Class III cuspid relationship Eight Keys for Successful and Efficient Treatment with SmartClip™ and
Clarity™ SL Self-Ligating Appliances, Dr. Gilad Har-Zion, Israel

To view the entire Case Overview booklet,

visit the website at [Link]/ADVANCED and
see the listing under "Resources"

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Orthodontic Perspectives Innova News and Information

Unitek™ Miniature Twin Explore a world of color with

Brackets now available our “Paint Your Smile” web app.
in the MBT™ Appliance Paint Your Smile is a web-based program designed for teen patients to have a
System prescription. fun experience choosing their orthodontic braces and then selecting colorful
AlastiK™ Ligatures for their teeth. Teen patients like to experiment with colors,
and this tool allows them to express their individuality with Clarity™ ADVANCED
Treatment proven Unitek™ Miniature Twin Brackets provide the clinical Ceramic Braces or Victory Series™ Low Profile Braces.
treatment characteristics of a full-size twin bracket, but in a smaller size for
greater patient comfort and aesthetics. Now, you can choose these popular With this website application:
brackets in the MBT™ Versatile+ Appliance System prescription. • The braces and ligature choices are placed on an uploaded image
of themselves.
The MBT System is known worldwide for predictable outcomes, even in the
most difficult cases. Unitek Miniature Twin brackets are manufactured from • For the best outcome, be sure to recommend that they use a photo
sturdy 17-4 stainless steel, are metal injection molded (MIM), and feature both with a big full smile.
torque-in-base and a micro-etched base. Smooth bidirectional hooks on the • The final image that your patient creates with the
cuspids and bicuspids provide superior elastic engagement, and the ample application can be shared via social media sites
under tie-wing area means easier ligation. such as Twitter and Facebook, forwarded by
email or saved on their device.
For an easier and faster bonding process, you will also soon be able to choose
3M-exclusive APC™ II Adhesive Coating with your Unitek Miniature Twin MBT You can link to the application from your website, or
Brackets, giving you an efficient treatment combination. Contact your 3M Oral use this tool in the reception area or during the
Care sales representative today or vist [Link]/ortho for additional information. patient consult! Using a tablet, smartphone
or desktop computer, it can be a fun way to
show patients what they will look like with
ture
Unitek Minia
™

Twin Brackets braces on their teeth and help to close the

sale. With bold colors, whimsical imagery and
–
Performance
Outstanding
Smaller Size
e Twin Brackets
Unitek Miniatur
™
proven clinical
provide all the
of full size twin
characteristics greater
smaller size for
brackets, in a

upbeat language, [Link] is sure to

s.
improved aesthetic
comfort and
from sturdy 17-4
Manufactured molded
steel, metal injection
stainless
e Twin brackets
Unitek Miniatur base for
micro-etched
incorporate a mesh.
equivalent to
bond strength ead
are easy-to-r
Also featured

connect with any audience.

marks and tie-wing
permanent I.D.
addition, Unitek
ink marks. In
brackets include
Miniature Twin ional hook for
a smooth, bi-direct Unitek
engagement.
superior elastic
brackets promise
Miniature Twin nce for patients
outstanding performa
alike.
and practitioners

Torque-in-base
design with

For more information, ask your local

Appliance System compound base
Adhesive Coated
contour.

Appliance System
Adhesive Coated

ion, contact your

For more informat
today!

3M Oral Care representative.

3M representative
tie-wing
Ample under and
area means smoother
ed base features ligation.
A micro-etch e to mesh. more secure
strength comparabl

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Orthodontic Perspectives Innova News and Information

3M Health Care Academy

SM

U.S. Education Events – 2016

Franklin, TN Bellagio Dallas, TX

June 2-3, 2016 Las Vegas, NV September 30 – October 1, 2016
September 17-18, 2016
Ecstatic about Esthetics: MiniScrew Certification Course
The New Game in Orthodontics with Jason B. Cope, DDS, PhD
Esthetics and Your Bottom Line
Kemp Orthodontics In-Office Seminar
3M 2016 Orthodontic Summit This two-day certification course covers the placement
This unique in-office course will help you understand and use of miniscrew implants (MSIs) in specific cases.
how to increase practice profitability. 3M Oral Care invites you to attend the 3M 2016 For more information, contact
Orthodontic Summit! Learn how to get more patients Shannon Horton at info@[Link]
Register online! in your practice by exploring today’s orthodontic
[Link]/KempIOC landscape and the shift to esthetic appliances. Gain
insight and hear clinical pearls and tips from experienced Dallas, TX
orthodontists who have driven growth in their practices
Sidney, OH through esthetics and clinical excellence.
December 2-3, 2016
October 6-7, 2016 Advanced MiniScrew Treatment Mechanics
FEATURING…
Dr. Adam Schulhof Dr. Moe Razavi with Jason B. Cope, DDS, PhD
Creating Systems to Differentiate your
Practice in a Changing Market Dr. Paul Tran Dr. Mark Causey
Dr. Shane Langley This two-day advanced course covers the use of
Alvetro Two-Day Seminar miniscrew implants (MSIs) in advanced cases of the
sagittal and vertical dimension.
Mark your calendar! Register online!
[Link]/Vegas For more information, contact
Watch for additional information.
Shannon Horton at info@[Link]

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Orthodontic Perspectives Innova News and Information

3M Health Care Academy

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Global Incognito™ Appliance System

course schedule for 2016
London, UK Hiroshima, Japan Tokyo, Japan
May 20-21, 2016 September 7-8, 2016 October 12-13, 2016
Speakers Contact Speaker Contact Speakers Contact
Dr. Robbie Lawson cmm Dr. Shoji Sugiyama 3M Oral Care Japan Dr. Keizo Hirose 3M Oral Care Japan
Dr. Roberto Stradi [Link]/incognito Masaya Kawate Dr. Shoji Sugiyama Masaya Kawate
Language
+81-3-6409-5511 +81-3-6409-5511
Language Japanese Language
mkawate@[Link] mkawate@[Link]
English Japanese

Fukuoka, Japan Madrid, Spain Munich, Germany

May 25-26, 2016 September 9-10, 2016 October 21-22, 2016
Speaker Contact Speakers Contact Speakers Contact
Dr. Keizo Hirose 3M Oral Care Japan Dr. Leandro Fernandez cmm Dr. Lars Christensen cmm
Masaya Kawate Dr. Paul Ward [Link]/incognito Dr. Esfandiar Modjahedpour [Link]/incognito
Language
+81-3-6409-5511
Japanese Languages Languages
mkawate@[Link]
Spanish and English with simultaneous translations German and English with simultaneous translations

Advanced courses:
Visit [Link]/ortho for
Düsseldorf, Germany Tokyo, Japan more information!
March 11, 2016 September 15, 2016
Speaker Contact Speakers Contact
Dr. Esfandiar Modjahedpour 3M Oral Care Germany Dr. Keizo Hirose 3M Oral Care Japan
Brigitte Mader Dr. Toru Inami Masaya Kawate
Language
+49 8191-9474-5015 Dr. Shoji Sugiyama +81-3-6409-5511
German
[Link]@[Link] mkawate@[Link]
Language
Japanese

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Orthodontic Perspectives Innova

3M Health Care Academy

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Clinical Cases

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Orthodontic Perspectives Innova

3M Health Care Academy

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Clarity™ ADVANCED Ceramic Brackets and

Incognito™ Appliance System Case Study

Dr. Patrice Pellerin

Dr. Pellerin received his post graduate Certificate in Orthodontics He is referred to by his peers as the grandfather of the completely aesthetic
in 1991 from the University of Montreal. Before orthodontics, he practice. He has lectured worldwide to share his practice philosophy of
practiced general dentistry for four years after earning his dental highest aesthetics without compromise to accomplish treatment. Dr. Pellerin
degree from the University of Montreal in 1985. Since 1991, he has also currently teaches lingual and aesthetic orthodontics to the residents at
maintained a solo private practice in Lachine, Quebec. In 1998, the University of Montreal and University of Winnipeg. He has been an active
Dr. Pellerin converted his practice to a fully aesthetic practice. member of the 3M Unitek Advisory Committee for Aesthetic Appliances
since 2003, as well as a 3M Advocate for the use of aesthetic appliances
since 2004.

Introduction Having to talk a lot in her occupation, she

This case shows a typical situation when a busy/successful adult patient comes
was concerned with having a lower lingual
in the office for treatment. Most of the time, the treatment needed is more
appliance. For that reason, we presented
comprehensive, requiring more tooth movement than they may think, or worse,
the option of using Clarity™ ADVANCED
more than they read on the internet. Ceramic Brackets on the lower arch. It
turned out to be an excellent option and
This particular young woman wanted a treatment option as invisible as possible:
decision in her case. She was happy with
something fast, and nothing removable because it wouldn’t fit her busy schedule,
the appearance and the comfort of the
and because in the end something removable would possibly make her treatment
appliances was to her satisfaction. From a Initial Final
far longer and potentially not as successful.
clinical perspective, we were very satisfied
with the efficiency of the appliances chosen
for this case.

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Orthodontic Perspectives Innova

Patient
Female (S.D.); 32 years, 1 month

Patient's Main Concern

Doesn’t like the position of her upper front teeth that are sticking out

X-ray Findings
• Permanent dentition
• Evidence of formation of 1 wisdom tooth (LL8)
• Condyles asymmetrical and irregular

Dental Analysis
• Class II 7 mm
1
• Important constriction of the maxilla
Figure 1: Initial X-ray.
• Lower midline discrepancy
• Excessive OJ (11 mm)
• Accentuated lower curve of Spee and Wilson
Cephalometric Analysis
• Lower lip trapping SNA (°) 89.5 82.0 3.5 2.1 **
SNB (°) 79.3 80.9 3.4 -0.5
Treatment Plan ANB (°) 10.2 1.6 1.5 5.8 *****
• Upper Incognito™ Brackets Maxillary Depth (FH-NA) (°) 93.9 90.0 3.0 1.3 *
• Lower – Clarity™ ADVANCED Ceramic Brackets 0.018 slot – MBT™ System Facial Angle (FH-NPo) (°) 83.4 88.6 3.0 -1.7 *
FMA (MP-FH) (°) 30.0 23.9 4.5 1.4 *
prescription (APCFF)
UFH:LFH, Upper (N-ANS/N-Gn) (%) 42.7 45.0 1.0 -2.3 **
• Bonding charts: MBT System standard 4.5 mm U-Incisor Protrusion (U1-APo) (mm) 6.6 6.0 2.2 0.3
• Extraction of UR4, UL4 (composite pontics to hide the extraction sites) U1 – Palatal Plane (°) 117.8 110.0 5.0 1.6 *
L1 Protrusion (L1-APo) (mm) -5.4 2.7 1.7 -4.8 ****
• Class II elastics on both sides +++ and control molar anchorage
IMPA (L1-MP) (°) 87.3 95.0 7.0 -1.1 *
Interincisal Angle (U1-L1) (°) 128.2 130.0 5.0 -0.4
Treatment 17 months (October 2012 – March 2014) Upper Lip to E-Plane (mm) -0.2 -6.0 2.0 2.9 **
Lower Lip to E-Plane (mm) -1.8 -2.0 2.0 0.1
14 SE (5s), 18 SE (6s), 16x22 SE (5s), Nasolabial Angle (Col-Sn-UL) (°) 110.4 102.0 8.0 1.0 *
Mx October 2012 Indirect
18x25 TMA (9s), 16x22 SS to the end2 Maxillary length (ANS-PNS) (mm) 50.1 51.6 4.3 -0.3
2 Mandibular length (Go-Gn) (mm) 76.2 65.9 5.5 1.9 *
14 SE (5s), 16 SE (5s), 16x16 SE (4s), Facial Convexity (G'–Sn-Po') (°) 163.6 154.0 5.6 1.7 *
Md January 20131 Direct 16x22 SE (9s), 17x25 Classic (21s), Figure 2: Initial cephalometric Wits Appraisal (mm) 12.3 -1.0 1.0 13.3 ******
16x22 SS to the end2 analysis. SUMMARY ANALYSIS
Class II Molar Relationship
# of visits 21
Skeletal Class II (A-Po)
Emergencies 0 Skeletal Class II (ANB)
Protrusive Maxilla (A-N)
Retrusive Mandible (Pg-N)
Retention Deep Overbite
Excessive Overjet
• Fixed lingual wires 0.018 TMA
Table 1: Cephalometric analysis.
• Upper canine to canine/Lower first bicuspid to first bicuspid
• Upper Hawley retainer nighttime use only to control the spaces of the
extraction sites
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Orthodontic Perspectives Innova

Initial

3A 3B 3C
4A 4B 4C

4D 4E 4F

3D 3E 3F

Figure 3A-F: Initial dental analysis.

4G 4H 4I

Figure 4A-I: Initial photos.

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Orthodontic Perspectives Innova

Treatment Plan: Incognito™ Appliance System Treatment Plan: Clarity™ ADVANCED Ceramic Brackets (1)

5A 5B 5C 6A 6B 6C

5D 5E 5F 6D 6E 6F

5G 5H 5I 6G 6H 6I

Figure 5A-I: Incognito Appliance System photos.

™
Figure 6A-I: Clarity ADVANCED Ceramic Brackets (1) photos.
™

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Orthodontic Perspectives Innova

Treatment Plan: Clarity™ ADVANCED Ceramic Brackets (2) Mid-Treatment

7A 7B 7C 8A 8B 8C

7D 7E 7F 8D 8E 8F

7G 7H 7I 8G 8H 8I

Figure 7A-I: Clarity ADVANCED Ceramic Brackets (2) photos.

™

8J

Figure 8A-J: Mid-treatment photos.

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Orthodontic Perspectives Innova

Retention Initial vs. Final

9A 9B 9C

10A 10B

Figure 10A-B: Initial vs. final photos.

9D 9E 9F

9G 9H 9I

Figure 9A-I: Retention photos. 11A 11B

Figure 11A-B: Initial vs. final photos.

12A 12B

Figure 12A-B: Initial vs. final photos.

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Orthodontic Perspectives Innova

Doctor's Notes
1. Notice that the mandibular arch was bonded 3 months after the upper Incognito
appliance was bonded. In this way, we benefit from the bite opening effect of
the lingual braces without having to bond occlusal or anterior bite openers.
2. Note that this case was finished on stainless steel wires (SS) in both arches,
as this is the arch wire material that is recommended to close spaces with
the Incognito appliance. As for the lower arch, stainless steel was used to
reproduce the arch form from the Incognito set-up as shown in the Unitek™
Treatment Management Portal | TMP.
3. Good torque expression with the combination of Incognito™ Hidden Braces/
Clarity ADVANCED Ceramic Brackets with APC™ Flash-Free Adhesive
appliances.

Case photos provided by Dr. Patrice Pellerin.

13A 13B

Figure 13A-B: Initial vs. final photos.

14A 14B

Figure 14A-B: Initial vs. final photos.

3M, APC, Clarity, Incognito, MBT, and Unitek are trademarks of 3M.
Used under license in Canada. © 3M 2016. All rights reserved.

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Orthodontic Perspectives Innova

3M Health Care Academy

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SmartClip™ SL3 Self-Ligating Appliance:

A Case for Orthodontic Treatment Efficiency

Dr. Moe Razavi

Dr. Moe Razavi received his dental training at Case Western He served as the orthodontist for the Cleveland Browns, and is currently
Reserve University – DDS (‘02), orthodontic certificate (‘05), and a member of the clinical staff at the University of Alberta. Dr. Razavi is a
MSD (‘05). Upon completion of his orthodontic training, he was diplomate of the American Board of Orthodontists, a Fellow of the Royal
invited to join the department as an assistant clinical professor, College of Dentists in Canada, and an ad hoc reviewer for the American
where he founded and directed the Skeletal Anchorage Clinic, Journal of Orthodontics, and the Journal of Clinical Orthodontics.
and has integrated various TAD systems into the training program. Dr. Razavi maintains a private practice in Ottawa, Canada.

Introduction Diagnosis and Treatment Plan

In the current marketplace, orthodontists are no longer just competing for potential A 13-year-old female presented with the chief complaint of “eye teeth have not
patients with other orthodontists, but also, numerous dentists who have been come in.” Clinical examination revealed Class I malocclusion with impacting and
coached by dental practice management experts to avoid referrals of patients from blocked out maxillary right and left canine teeth, an increased overbite, and mild
their offices. In such a competitive landscape, orthodontists can no longer afford maxillary and mandibular tooth-size-arch-length discrepancy (Figure 1A-J). A
to provide their patients with inefficient orthodontic treatment that often takes large midline maxillary diastema was present, with a heavy frenum. Cephalometric
analysis revealed well-balanced skeletal relationship with retroclined maxillary
two to three years, with monthly visits to “tighten” the braces as perceived by the
and mandibular incisor teeth. Comprehensive orthodontic treatment using fixed
patients. As experts in the field, we need to arm ourselves with treatment tools that
appliances was presented. In order to allow for efficient treatment progression,
allow for efficient and effective orthodontic treatment means to obtain the desired
it was advised to use a soft tissue laser to expose the maxillary right and left
treatment results, in a shorter period of time, with fewer adjustment appointments. canine teeth, as well as to remove the frenum to avoid future recurrence of the
The following case report demonstrates combining the SmartClip™ SL3 Self-Ligating maxillary diastema.
Appliance, with the use of a soft-tissue laser to provide effective and efficient
treatment in an adolescent patient.

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Orthodontic Perspectives Innova

Treatment Progress
Fixed appliances (.022✕.028 SmartClip™ SL3 Self-Ligating brackets) were
bonded and leveling and aligning was initiated. To assist with the improvement
of the inclination of the maxillary and mandibular incisors, Variable Prescription
Orthodontic (VPO) high-torque prescription was used in this specific case. The
passive self-ligating appliances offered the advantage of reduced friction which
often occurs during guided eruption of high canine teeth when ligated brackets are
used. An initial aligning wire of .014 SE Nitinol was used immediately after initial
bonding, and upon return of the patient for the first adjustment appointment, a
1A 1B 1C combination of .014/.016 SE Nitinol Tandem wires were used. Open coil springs
were placed to increase the space for the eruption of the maxillary canines, and
a light chain module was used to reduce the size of the diastema (Figure 2). Once
sufficient space was created for the eruption of the canine teeth, the tips of these
teeth erupted into the oral cavity (Figure 3). In order to improve treatment efficiency

1D 1E

2 3
1F 1G 1H Figure 2 Figure 3

and allow for ideal bracket placement, a soft-tissue laser was used to expose
adequate clinical crown space, and the maxillary canine brackets were placed with
ideal bracket positioning. Tandem wire mechanics were used to guide the canine
teeth into the arch. The .014 SE Nitinol wire was used to engage the canine brackets,
while the .016 SE Nitinol wire was used in conjunction with passive Nitinol open
coil springs to maintain the spaces for the eruption of the canines (Figure 4A-C).

1I 1J

Figure 1A-J
4A 4B 4C

Figure 4A-C

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Orthodontic Perspectives Innova

5A 5B 5C

Figure 5A-C

As the canine teeth moved further into the arch, both tandem wires were engaged
6A 6B 6C
in the canine brackets for final leveling and alignment (Figure 5A-C). Wires were
sequenced next to .019✕.025 Heat-Activated Nitinol wires, before a mid-treatment
panorex was taken to assess root position. Occlusion was detailed with the final
working wires of .019✕.025 Beta Titanium, and intermaxillary elastics. A fixed
mandibular retainer was placed prior to the debond appointment, and removal of
the maxillary frenum was achieved using a soft-tissue laser.

Treatment Results and Conclusions

The patient was seen for a total of 10 appointments during the 14.5-month active
treatment period. Post treatment records revealed a Class I molar relationship 6D 6E
with ideal overjet and overbite (Figure 6A-J). It was recommended to have the
gingival margins of the maxillary incisors assessed one year after removal of the
appliances for a possible gingival contouring to obtain optimal smile esthetics.
However, at a subsequent retainer check appointment, the gingival inflammation
had subsided and a gingivectomy was not deemed necessary (Figure 7A-H).
A cephalometric superimposition indicated improved incisor inclination of the
6F 6G 6H
maxillary and mandibular incisor teeth. The use of VPO high-torque prescription
allowed us to achieve this treatment goal in a relatively short treatment time, as the
increased torque value accounts for the “slop” in the system and the loss of torque
during routine orthodontic treatment as we rarely finish in a full-size .021✕.025
wire (Figure 8). The increased torque value of the brackets utilized allowed us to
finish with our .019✕.025 wire, while obtaining the desired treatment torque
values without the need for additional detailing bends and resulting increased
treatment time.
In today’s competitive orthodontic landscape, patients want speedy treatment
options. However, we should not provide expedient treatment in exchange for a
reduction of treatment quality. Instead, we should aim to utilize the tools that allow
for esthetic and functional treatment results, in an effective and efficient manner.
This case is an example of using the SmartClip SL3 Self-Ligating Appliance, 6I 6J
combined with Variable Prescription Orthodontics and soft-tissue lasers to provide Figure 6A-J
the patient with a smile that will last a lifetime.

18
Orthodontic Perspectives Innova

7A 7B 7C

8
7D 7E
Figure 8

Case photos provided by Dr. Moe Razavi.

7F 7G 7H

Figure 7A-H

3M and SmartClip are trademarks of 3M. Used under license in Canada.

© 3M 2016. All rights reserved.

19
Orthodontic Perspectives Innova

3M Health Care Academy

SM

Eight Keys for Successful and Efficient Treatment

with SmartClip™ and Clarity™ SL Appliances
2006- Examiner in phase II board examinations in Orthodontics, the Israel
Dr. Gilad Har-Zion Dental Association.
Dr. Gilad Har-Zion received a D.M.D. in 1992, and the MSc. Dr. Har-Zion has been practicing with the MBT™ Appliance System since 2000,
(Magna cum laude), Specialist in Orthodontics in 2001 from and the SmartClip™ and Clarity™ SL Self-Ligating Systems since 2004. Current
Hebrew University, Jerusalem. research includes friction in self-ligating brackets as well as clinical phenomena
associated with various self-ligating systems.
1999- Private and public practices – Orthodontics.
Dr. Har-Zion has lectured and presented posters in Israel, Europe and in USA,
2000- Instructor in graduate course in Orthodontics, Hebrew and has published several scientific articles in peer-reviewed Orthodontic
University, Jerusalem, Israel journals. He serves as a reviewer for several international orthodontic journals.
2008- Member of the committee for board examinations in Memberships include: Israel Dental Association, Israel Orthodontic Society,
Orthodontics, the Israel Dental Association. Israel Forum of Lingual Orthodontics, European Orthodontic Society, World
Federation of Orthodontists and the American Association of Orthodontists.

The transition to SmartClip™ SL3 Self-Ligating Brackets and/or Clarity™ SL Don’t use your old archwires
Self-Ligating Brackets can be challenging to the clinician who is only experienced with the SmartClip™ and Clarity™ SL
with conventional brackets. This is because the addition of the two Nitinol clips to Appliances
the familiar twin bracket design not only omits the usage of elastic modules and/or It is highly recommended to use the
metal ligatures, it in fact creates a completely different appliance system. In many archwires which were specially designed
aspects, this appliance has different characteristics when compared to conventional and developed for use with these
appliances. Therefore, the aim of this article is to clarify some of the differences systems (Figure 1). These specialized
between the systems and to supply clinicians with several guidelines which will archwires significantly differ from
enable them to deliver successful and efficient treatment with these appliances. the archwires used with conventional
bracket systems.
Don’t change your diagnostic regimens or treatment plans!
SmartClip and Clarity SL brackets form marvelous appliance systems. Yet, there Firstly, the initial archwires are more
is no magic in them. Using these brackets will not turn an extraction case into a elastic and exert weaker levels of force.
non-extraction case since they cannot create space in the arch out of nowhere. This is due to the fact that SmartClip 1
Furthermore, these appliances will not eliminate the usage of expanders, and Clarity SL are binary brackets in
nature1. This means that there are only Figure 1: 3M special archwires for
headgear or functional appliances. So, if your case dictates any of the above, SmartClip™/Clarity™ SL Appliances.
two possible positions of the archwire
do not hesitate to employ it.
relative to the bracket. The archwire
can either be outside the lumen of
20
Orthodontic Perspectives Innova

the bracket or it can be clipped and be contained by the lumen of the bracket. In
other words, unlike conventional brackets, it is not possible to only half engage
the archwire to the bracket. Consequently, in order to enable clipping of the initial
archwires into SmartClip/Clarity SL brackets bonded to malaligned teeth, and to
prevent spontaneous disengagement of the clipped archwire, the initial archwires
must be very soft and elastic. In addition, due to the fact that frictional resistance
is very low in SmartClip and Clarity SL appliances, smaller force levels are needed
to overcome the frictional resistance within the system. Hence, the specialized
archwires apply weaker forces in comparison with their conventional members.
3 4A 4B
Secondly, many of the initial and intermediate archwires developed for these
systems include a built-in stop (Figure 2). This is to prevent the archwire from sliding Figure 3: In SmartClip™/ Figure 4A: A conventional rectangular archwire impinges
to one side of the bracket system while disengaging from the distal attachment on Clarity™ SL Brackets, a small against the Nitinol clips due to lack of parallelism with the
diameter archwire is slot of the bracket. Figure 4B: In order to be inserted into the
the opposite side (“snaking”). A phenomenon which is very common with SmartClip
not forced into the bottom bracket a conventional rectangular archwire must be torqued
and Clarity SL appliances owing to the minute frictional resistance in these systems. of the slot. parallel to the slot of the bracket.

And finally, hybrid archwires can be of great help in these systems. Hybrid archwires
are rectangular archwires in which the corners have been rounded. They were designed
specifically in order to eliminate the difficulty of engaging rectangular archwires into
a SmartClip/Clarity SL bracket. The problem with conventional rectangular archwires
is that, unless the archwire is aligned almost parallel with the bracket slot, it will be
stuck against the Nitinol clips which will prevent the insertion of the archwire into the
bracket (Figure 4A-B). Owing to their rounded corners, there is less need to align hybrid
archwires parallel to the bracket slot so they are much easier to engage.

Don’t try to implement your former archwire sequence with these appliances
It is much better to use one of the recommended archwire sequences.1,2 Cases must
2 be started using thin soft round archwires. It is well known that every archwire
bracket combination has a critical contact angle for binding (Ǿ) in the vertical
Figure 2: A central stop on an archwire in order to prevent “snaking.”
(occluso-gingival) dimension.3,4 However, due to the fact that in SmartClip/Clarity
SL brackets the locking mechanism is relatively rigid they also have a critical
Thirdly, some of the specialized archwires have unique dimensions (i.e. contact angle for binding in the horizontal (bucco-lingua) dimension.5,6 In order to
0.014"✕0.025"; 0.016"✕0.025"). The rationale is that when a small diameter archwire avoid binding and enable quick and efficient leveling and alignment these critical
is inserted into a SmartClip/Clarity SL bracket it is not forced into the bottom of the contact angles must not be exceeded. One of the ways to accomplish that is by
slot as in conventional ligation. Hence, a leeway is created between the archwire starting cases with thin soft round archwires. It also implies that Burstone’s concept
and the lumen of the bracket (Figure 3). This leeway enables several degrees of play of “variable-modulus orthodontics”7 (i.e. starting cases with soft thick rectangular
in this archwire-bracket combination and therefore prevents complete rotational archwires which are later replaced by stiffer archwires with the same dimensions), is
control. Consequently, it is necessary to fill the depth of the slot by increasing the not applicable for SmartClip/Clarity SL appliances. This is because thick rectangular
wire size in the bucco-lingual dimension. archwires will instantly exceed the critical contact angles and thus
significantly slow down the velocity of tooth movement.

21
Orthodontic Perspectives Innova

As mentioned before, complete correction of the initial rotations with small round Don’t apply the same old interappointment intervals
archwires is not possible with SmartClip/Clarity SL appliances. Consequently, in As a matter of fact, it is highly advisable not to use a constant interappointment
order to finish the leveling and alignment stage it is necessary to fill the depth of interval at all!
the slot. It can be achieved either by increasing the wire size or by inserting another
small diameter archwire on top of the first one thus almost completely filling the slot Ideal and fast expression of archwires within SmartClip/Clarity SL brackets is
in the bucco-lingual dimension; a technique coined the tandem archwire technique8 guaranteed owing to the clips. This is due to the fact that unlike elastic modules, the
(Figure 5). This archwire combination enhances rotational control. In addition, it Nitinol clips do not degenerate with time. Thus, when an archwire is inserted into
provides better horizontal and vertical control of teeth position (Figure 6A-C). the brackets the tooth will move until the archwire fully expresses itself. Hence, in
comparison with conventional appliances some of the interappointment intervals
should be lengthened because there is no need to call the patient for replacing
decaying elastic modules, tightening metal ligatures etc. On the other hand,
since the level of friction in the system is very low, archwires express themselves
much faster and so in certain situations the interval between appointments can
be shortened.

The bottom line is that, in order to deliver an efficient and speedy treatment, the
clinician must be able to evaluate how much time it is going to take for a specific
archwire to fully express itself in a certain situation.
5 Figure 5: Two small diameter archwires fill the horizontal
dimension of a SmartClip™/Clarity™ SL Bracket. Don’t clip the initial archwire in both the clips when teeth are severely
malaligned
As SmartClip and Clarity SL Brackets are the only twin self-ligating brackets, it is
possible to engage the initial archwire in only one of the clips of brackets which
are bonded to severely malaligned teeth (Figure 7). Thus, increasing inter-bracket
span and archwire flexibility while reducing the contact angles in the vertical and
horizontal dimensions.9

6A 6B 6C

Figure 6A: The initial mal-occlusion. Figure 6B: Six weeks after bonding and engaging a NiTi
16 archwire residual rotation of the lower left lateral incisor still persists. Figure 6C: Four weeks
after engaging a NiTi 14 archwire on top of the NiTi 16 archwire (“tandem technique”) the rotation
is corrected.

Owing to the minute frictional resistance in the system ß Titanium archwires are
capable of delivering all the necessary forces and moments which are required in
order to finish a case. Thus, stainless steel archwires are redundant in most non-
extraction cases. Figure 7: After bonding, a NiTi 14 archwire
7 is clipped only to one clip in severely
malaligned teeth.

22
Orthodontic Perspectives Innova

When engaging thick NiTi and stainless steel archwire make sure that
they are completely engaged in all the clips
As mentioned before, unlike conventional brackets, partial engagement of the
archwire relative to SmartClip/Clarity SL bracket slot is not possible. For that
reason, thick archwires which are not fully clipped will be pressed against the Nitinol
clip which will then function as a very effective rotation wedge and will cause the
tooth to rotate! (Figure 8) This rotation is very hard to correct in the advanced stages
of treatment as thick archwires are usually too stiff to be inserted into the bracket
slot of a rotated tooth. So, the clinician is compelled to regress to a smaller archwire 9A 9B 9C
in order to pick up the rotated tooth while unnecessarily elongating treatment time. Figure 9A: When spaces are closed using a continuous elastic chain a constricting force is
Therefore, it is of utmost importance not to dismiss the patient before checking and created upon the dental arch. Figure 9B: In the anterior area this force tends to pull the incisors
double-checking that the thick archwire is fully clipped throughout the arch! in a distal direction. Figure 9C: As a result the archwire is forced against the Nitinol clips.

Figure 8: An upper left lateral incisor which 10A 10B 10C

rotated because the mesial clip of the bracket
8 was not completely clipped in the former Figure 10A: The beginning of the space closure stage. The spaces were closed with a
appointment! continuous elastic chain which was placed under a S.S. 19✕25 archwire. Figure 10B: 9 weeks
into the space closure stage. Loss of torque control of the incisors is obvious.
Figure 10C: 19 weeks into the space closure stage. The incisors are still loosing torque.
During space closure the incisors must be tied to the archwire in order to
maintain torque control
torque control it is imperative to push the archwire into the depth of the slot of the
Some clinicians using SmartClip/Clarity SL appliances try to reduce the friction
anterior brackets. That can be achieved by adding elastic modules or a metal ligature
throughout the space closing stage employing different tactics. Two of these
over the archwire in the anterior brackets (Figure 11). Another possible way is to close
strategies include placing an elastic chain under the archwire or tying the anterior six
spaces utilizing posted stainless steel archwires in combination with an elastic chain/
teeth with a “figure of 8” metal ligature under the archwire followed by connecting
Nitinol spring/tie back between the distal molar and the post (Figure 12A-B). Such a
an elastic chain/Nitinol spring/tie back between the distal molar and the hook of the
system combines a low friction retraction force together with an anterior component
canine bracket. The trouble with the above method is that while the spaces are being
of force which pushes the archwire into the depth of the slot of the anterior brackets.
closed, the archwire is being pushed away from the bottom of the slot (Figure 9A-C),
In this manner, closing spaces and controlling torque is achieved at the same time.
so a great deal of torque is being lost! (Figure 10A-C) As a result, in order to maintain

23
Orthodontic Perspectives Innova

In the initial stages of treatment, elastic modules/metal ligatures can be utilized in

order to loosely tie a very remote tooth to the archwire just like with conventional
brackets. In addition, elastic chains can be connected to the brackets and used as an
adjunct to derotate severely rotated teeth.

As the treatment advances, it is highly recommended to secure teeth that were

extremely rotated initially with an elastic module/metal ligature in order to prevent
disengagement from the archwire and rapid relapse of the rotation.

Following the aforementioned keys can certainly help the astute clinician avoid
Figure 11: During space closure a stainless some of the most common mistakes which are so prevalent with the transition from
11 steel ligature is tied over the archwire in order
to push it against the bottom of the slot.
conventional appliances to SmartClip and/or Clarity SL appliances. It will also help
him exploit the many advantages which these unique systems offer.

Acknowledgment: The author would like to thank Dr. Ziva M.L. Lurie for her help
with the manuscript.
Case photos provided by Dr. Gilad Har-Zion.

References
1. Sondhi A.; Smart Things to Know About the SmartClip™ Self-Ligating Appliance System.
Orthod. Perspec. 2007; 14: 4-9.
2. Weinberger GL.; An Optimized Treatment Protocol (OTP) for the SmartClip™ Self-Ligating
Appliance System. 3M Unitek. 2007; 10-12.
12A 12B 3. Kusy RP, Whitley JQ.; Assessment of Second-Order Clearances Between Orthodontic
Archwires and Bracket Slots via the Critical Contact Angle for Binding. Angle Orthod. 1999;
Figure 12A-B: Space closure technique utilizing a posted S.S. 19✕25 archwire. 69: 71-80.
4. Thorstenson GA.; SmartClip™ Self-Ligating Brackets Frictional Study. Orthod. Perspec.
2005; 12: 8-11.
5. Reznikov N, Har-Zion G, Barkana I, Abed Y, Redlich M.; Influence of Friction Resistance
on Expression of Superelastic Properties of Initial NiTi Wires in “Reduced Friction” and
Using ligatures and/or elastic modules can be very beneficial on Conventional Bracket Systems. J. Dental Biom. 2010; 613142.
certain occasions 6. Reznikov N, Har-Zion G, Barkana I, Abed Y, Redlich M.; Measurement of Friction Forces
Thanks to their familiar twin design both SmartClip and Clarity SL brackets possess Between Stainless Steel Wires and “Reduced Friction” Self-Ligating Brackets. Am. J. Orthod.
the “active on demand” feature. In other words, these passive self-ligating brackets Dentofacial Orthop. 2010; 138: 330-338.
7. Burstone CJ.; Variable-Modulus Orthodontics. Am. J. Orthod. 1981; 80: 1-16.
can be easily activated by tying an elastic module/metal ligature.1 That aspect can 8. Rodrigue C.; The Tandem Archwire Technique: Enhanced Rotational Control with
be very useful in clinical situations which demand precise control of teeth positions, 3M™ Self-ligating Appliances. Orthod. Perspec. 2008; 15: 3-5.
namely the finishing stages. 9. Har-Zion G.; Self-Ligation: A Clinician’s point of View. Am. J. Orthod. Dentofacial Orthop.
2009; 136: 756-757.
Elastic modules/metal ligatures can also be selectively used when engaging thin
archwires with SmartClip/Clarity SL appliances in order to push the archwire into
the depth of the slot to achieve/maintain alignment on these archwires, which do
not fill the horizontal dimension of the bracket.

3M, Clarity, and SmartClip are trademarks of 3M. Used under license in Canada.
© 3M 2016. All rights reserved.

24
Orthodontic Perspectives Innova

3M Health Care Academy

SM

This case is a sample of the cases

Class I contained in the newly published

Clarity™ ADVANCED Ceramic
Bracket Case Overview booklet.
Crooked teeth, crowding, midline discrepancy To view the complete publication,
visit [Link]/ortho and follow the
links to the Clarity ADVANCED
Brackets page.

Dr. Patrice Pellerin

Dr. Pellerin received his post graduate Certificate in Orthodontics He is referred to by his peers as the grandfather of the completely aesthetic
in 1991 from the University of Montreal. Before orthodontics, he practice. He has lectured worldwide to share his practice philosophy of highest
practiced general dentistry for four years after earning his dental aesthetics without compromise to accomplish treatment. Dr. Pellerin also
degree from the University of Montreal in 1985. Since 1991, he has currently teaches lingual and aesthetic orthodontics to the residents at the
maintained a solo private practice in Lachine, Quebec. In 1998, University of Montreal and University of Winnipeg. He has been an active member
Dr. Pellerin converted his practice to a fully aesthetic practice. of the 3M Unitek Advisory Committee for Aesthetic Appliances since 2003, as
well as a 3M Advocate for the use of aesthetic appliances since 2004.

Patient • Bonding charts: Upper MBT System open bite 4.5 mm/Lower MBT System
Female (M.D.L.); 20 years, 3 months open bite 4.5 mm
• Use of a half bracket2 on LL1
Patient's Main Concern • Light Class II elastics to correct the Class II relation
Crooked lower front teeth, and too long and too forward upper front teeth
• Indirect Bonding Double Clear Tray Technique
X-ray Findings
• Complete permanent dentition Treatment 12 months (April 2013 – April 2014)
• Pneumatized maxillary sinuses
• Evidence of formation of wisdom teeth 14 SE3 (5s), 16x22 SE (4s), 17x25 Classic4 (26s),
Mx April 2013 Indirect
16x16 SE (4s), 17x25 Classic to the end
*Patient should have removed earrings before X-ray
14 SE (13s), 18 SE (6s), 16x22 SE (11s), 17x25 Classic
Dental Analysis Md April 2013 Indirect
(7s), 16x16 SE (5s), 17x25 Classic to the end
• Class I with a light Class II relationship on the left side
• Light to moderate crowding in both arches # of visits 13

• Midline discrepancy Emergencies 05

• Narrow upper jaw
Retention
Treatment Plan • Fixed lingual wires 0.018 TMA
• Upper/Lower – Clarity™ ADVANCED Ceramic Brackets 0.018 slot –
MBT™ System prescription (APCFF1) • Upper canine to canine/Lower first bicuspid to first bicuspid

25
Orthodontic Perspectives Innova

Initial

3A 3B 3C

Figure 1: Initial X-ray.

Cephalometric Analysis
SNA (°) 82.4 82.0 3.5 0.1
SNB (°) 76.6 80.9 3.4 -1.3 *
ANB (°) 5.7 1.6 1.5 2.7 **

Maxillary Depth (FH-NA) (°) 91.4 90.0 3.0 0.5 3D 3E 3F

Facial Angle (FH-NPo) (°) 86.5 88.6 3.0 -0.7
FMA (MP-FH) (°) 27.9 23.9 4.5 0.9 Figure 3A-F: Initial dental analysis.
UFH:LFH, Upper (N-ANS/N-Gn) (%) 43.3 45.0 1.0 -1.7 *

U-Incisor Protrusion (U1-APo) (mm) 2.2 6.0 2.2 -1.7 *

U1 – Palatal Plane (°) 104.0 110.0 5.0 -1.2 *
L1 Protrusion (L1-APo) (mm) -1.0 2.7 1.7 -2.2 **
IMPA (L1-MP) (°) 91.2 95.0 7.0 -0.5
Interincisal Angle (U1-L1) (°) 136.2 130.0 5.0 1.2 *

Upper Lip to E-Plane (mm) -4.9 -6.0 2.0 0.5

Lower Lip to E-Plane (mm) -2.2 -2.0 2.0 -0.1
Nasolabial Angle (Col-Sn-UL) (°) 124.9 102.0 8.0 2.9 **

Maxillary length (ANS-PNS) (mm) 51.2 51.6 4.3 -0.1

2 Mandibular length (Go-Gn) (mm) 73.1 65.9 5.5 1.3 *
Facial Convexity (G'–Sn-Po') (°) 160.9 154.0 5.6 1.2 *
Figure 2: Initial cephalometric
Wits Appraisal (mm) 3.6 -1.0 1.0 4.6 ****
analysis.
SUMMARY ANALYSIS
Class II Molar Relationship
Skeletal Class II (A-Po)
Skeletal Class II (ANB)
Retrusive Mandible (Pg-N)

Table 1: Cephalometric analysis.

26
Orthodontic Perspectives Innova

Initial Clarity™ ADVANCED Ceramic Brackets – Half Brackets

5A 5B
4A 4B 4C Figure 5A-B

4E

4D 4F

6A 6B 6C

4G 4H 4I

Figure 4A-I: Initial photos.

6D 6E 6F

6G 6H 6I

Figure 6A-I

27
Orthodontic Perspectives Innova

Mid-Treatment Retention

7A 7B 7C 8A 8B 8C

8E
7D 7E 7F 8D 8F

7G 7H 7I 8G 8H 8I

Figure 8A-I: Retention photos.

7J

Figure 7A-J: Mid-treatment photos.

28
Orthodontic Perspectives Innova

Initial vs. Final Doctor's Notes

1. APCFF denotes APC™ Flash-Free Adhesive Coated Appliance
2. If a severe rotation doesn’t allow you to position a normal bracket in the proper
position on the tooth, one may choose to first open the space with coil or use an
eyelet or buttons. Once the rotation is corrected and there is access, a regular
bracket can be positioned.
My preference is to take advantage of a feature unique to all the brackets in
the Clarity™ brand bracket family: a pre-serrated bracket base that facilitates
consistent and easy debonding. This feature enables the clinician to cut the
Clarity bracket in two, allowing access to proper bracket positioning (“LA”
point) with torque and angulation control (always depending of the bracket you
are using - in this case, a lower anterior bracket with MBT™ Appliance System
prescription has no angulation). To do so, simply use a sharp pin and ligature
cutter to easily create a smaller bracket with the correct torque and angulation.
The reason to use a “sharp” pin and ligature cutter is not to cut the bracket
9A 9B (they are pre-serrated), but rather to cut the non-woven mat in the case of
Figure 9A-B: Initial vs. final photos. Clarity™ ADVANCED Brackets with APC™ Flash-Free Adhesive, or the metal slot
in the case of a Clarity™ SL Self-Ligating Bracket.
3. SE denotes NiTi Super Elastic wire
4. Classic denotes NiTi Classic wire
5. Using APC™ Flash-Free Adhesive with indirect bonding, no bond failures or
emergency appointments during treatment.

Case photos provided by Dr. Patrice Pellerin.

10A 10B

Figure 10A-B: Initial vs. final photos.

3M, APC, Clarity, and MBT are trademarks of 3M. Used under license in Canada.
© 3M 2016. All rights reserved.

29
Orthodontic Perspectives Innova

3M Health Care Academy

SM

This case is a sample of the cases

Class II contained in the newly published

Clarity™ ADVANCED Ceramic

Aesthetic Treatment with Clarity™ ADVANCED Ceramic Brackets

Bracket Case Overview booklet.
To view the complete publication,

Patient Experienced Failure in Treatment with Aligners visit [Link]/ortho and follow the
links to the Clarity ADVANCED
Brackets page.

Dr. Anoop Sondhi

Dr. Anoop Sondhi received his dental degree from the Indiana practice. Since 1988, he has been in full-time private practice in Indianapolis, and
University School of Dentistry, and his post-graduate certificate and continues to be a Visiting Professor for several graduate programs in Orthodontics.
M.S. in Orthodontics from the University of Illinois in 1977. Following He has presented seminars and continuing education courses to several dental and
his graduation, he was on the graduate faculty of the Department Orthodontic organizations in the United States, and has been invited to give courses
of Orthodontics at Indiana University. During his full-time academic in Canada, Central America, South America, Europe, Asia, South Africa, Australia
appointment at Indiana University, he maintained a part-time private and New Zealand.

Patient • Molar tube set atypically to upright tooth #19

Female; 28 years, 10 months • Class II elastics on the right side for Class II correction
• Indirect Bonding with Sondhi™ Rapid Set Indirect Bonding System
Patient's Main Concern
• No emergency appointments
Inability to bite posterior teeth together, midline discrepancy. Previous treatment
with Invisalign® was unsuccessful.
Treatment 13 months (March 2014 – April 2015)
X-ray Findings
• Complete permanent dentition .016 Nitinol SE .016x.022
Mx 4/16/14 Indirect
• Third molars have been extracted Nitinol .016x.022 SS
• Atypical root morphology noted on teeth #18, 19, 30 and 31 .016 Nitinol SE .016x.022
Md 4/16/14 Indirect
Nitinol.016x.022 SS
Dental Analysis
• Asymmetric Class II Division 1 malocclusion # of visits 6

• Right side half cusp Class II Emergencies 0

• Left side Class I Total Treatment Time 11 months
• Severe midline discrepancy
• Bilateral posterior open bite
Retention
Treatment Plan • Maxillary and mandibular .040 Essix® Retainers
• Upper/Lower Clarity™ ADVANCED Ceramic Brackets .018 slot –
Variable Prescription
30
Orthodontic Perspectives Innova

Initial

3A 3B 3C

Figure 1: Initial X-ray.

Initial Analysis
Skeletal Measurements
Convexity (NA-APo) (9) 3.4 4.9 3.0 -0.5 3D 3E 3F
Facial Angle (FH-NPo) (°) 93.8 88.6 3.0 1.7 *
SNA (°) 83.8 82.0 3.5 0.5 Figure 3A-F: Initial dental analysis.
SNB (°) 81.3 80.9 3.4 0.1
ANB (°) 2.5 1.6 1.5 0.6
Palatal-Mand Angle (PP-MP) (°) 20.0 25.0 6.0 -0.8
Y-Axis (SGn-SN) (°) 64.5 67.0 5.5 -0.5

Dental Measurements
Occ Plane to FH (°) -2.6 -11.0 2.0 4.2 ****
IMPA (L1-MP) (°) 93.5 95.0 7.0 -0.2
Wits Appraisal (mm) -0.5 -1.0 1.0 0.5

Table 1: Initial analysis.

Figure 2: Initial cephalometric

analysis.

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Orthodontic Perspectives Innova

Initial Mid-Treatment

4A 4B 4C 5A 5B

5C 5D 5E

Figure 5A-E: Mid-treatment photos.

4D 4E

4F 4G 4H

Figure 4A-H: Initial photos.

32
Orthodontic Perspectives Innova

Final Initial and Final Comparison

6A 6B 6C

9A 9B

Figure 9A-B: Initial vs. final photos.

6D 6E

6F 6G 6H
10A 10B
Figure 6A-H: Final photos.
Figure 10A-B: Initial vs. final photos.

Doctor's Notes
This case report demonstrates that adult patients who may not be particularly
good candidates for aligner therapy are extremely receptive to the new generation
of esthetic brackets.

Case photos provided by Dr. Anoop Sondhi.

7 8

Figure 7: Final X-ray. Figure 8: Final cephalometric

analysis.
3M, Clarity, and Sondhi are trademarks of 3M. Used under license in Canada.
All other trademarks are property of their respective owners.
© 3M 2016. All rights reserved.

33
Orthodontic Perspectives Innova

3M Health Care Academy

SM

This case is a sample of the cases

Class III contained in the newly published

Clarity™ ADVANCED Ceramic
Bracket Case Overview booklet.
Missing teeth, tight teeth, Class III cuspid relationship To view the complete publication,
visit [Link]/ortho and follow the
links to the Clarity ADVANCED
Brackets page.

Dr. Patrice Pellerin

Dr. Pellerin received his post graduate Certificate in Orthodontics He is referred to by his peers as the grandfather of the completely aesthetic
in 1991 from the University of Montreal. Before orthodontics, he practice. He has lectured worldwide to share his practice philosophy of highest
practiced general dentistry for four years after earning his dental aesthetics without compromise to accomplish treatment. Dr. Pellerin also
degree from the University of Montreal in 1985. Since 1991, he has currently teaches lingual and aesthetic orthodontics to the residents at the
maintained a solo private practice in Lachine, Quebec. In 1998, University of Montreal and University of Winnipeg. He has been an active member
Dr. Pellerin converted his practice to a fully aesthetic practice. of the 3M Unitek Advisory Committee for Aesthetic Appliances since 2003, as
well as a 3M Advocate for the use of aesthetic appliances since 2004.

Patient Treatment Plan

Male (S.A.); 36 years, 11 months • Upper – Clarity™ ADVANCED Ceramic Brackets 0.018 slot – MBT™ System
prescription (APC™ Flash-Free Adhesive)
Patient's Main Concern • Indirect bonding using bonding open bite charts 4.5 mm
Had extraction of teeth in the upper jaw as a teenager, teeth are very tight, do some • Extraction of LL5, LR5
more teeth need to be removed? • Sectional direct bonding (second molar to first bicuspid) using bonding open
bite charts 5 mm, with active tie back retraction
X-ray Findings
• Permanent dentition • When the space is adequate direct bonding lower cuspid to cuspid with open
bite charts 5 mm
• Missing two upper bicuspids (UR4, UL4?)
• Class III and vertical elastic mechanics
• Wisdom teeth erupted
• Reassess the vertical relationship and patient comfort with the wisdom teeth
• Pneumatized maxillary sinuses
• Condylar irregularity (left), and asymmetrical
Treatment 27 months (October 2012 – January 2015)
Dental Analysis 14 SE (7s), 16x16 SE (6s), 16x22 SE (6s), 17x25 Classic
• Class II molar relationship, Class III cuspid relationship Mx October 2012 Indirect
(25s), 16x22 SE (5s) 17x25 Classic to the end
• Inadequate OJ/OB (end to end relation)
16x16 SE (6s), 17x25 Classic (12s), 16x16 SE (14s),
• Missing two upper bicuspids Md December 2012 Direct
14 (12s), 16x16 (12s), 17x25 Classic to the end
• Crossbite of teeth UR6, UR2, UL2
# of visits 24
• Dental crowding (-6 mm upper arch, -10 mm lower arch)
• Weak attached gingiva, UR6, UL6, LL5 Emergencies 0

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Retention Initial
• Fixed lingual wires 0.018 TMA
• Upper canine to canine/lower first bicuspid to first bicuspid
• Lower Essix retainer nighttime use only

3A 3B 3C

Figure 1: Initial X-ray.

3D 3E 3F
Cephalometric Analysis
SNA (°) 81.5 82.0 3.5 -0.1 Figure 3A-F: Initial dental analysis.
SNB (°) 78.6 80.9 3.4 -0.7
ANB (°) 2.9 1.6 1.5 0.9

Maxillary Depth (FH-NA) (°) 94.1 90.0 3.0 1.4 *

Facial Angle (FH-NPo) (°) 91.0 89.6 3.0 0.5
FMA (MP-FH) (°) 24.5 22.9 4.5 0.4
UFH:LFH, Upper (N-ANS/N-Gn) (%) 42.4 45.0 1.0 -2.6 **

U-Incisor Protrusion (U1-APo) (mm) 2.9 6.0 2.2 -1.4 *

U1 – Palatal Plane (°) 117.7 110.0 5.0 1.5 *
L1 Protrusion (L1-APo) (mm) 1.2 2.7 1.7 -0.9
IMPA (L1-MP) (°) 87.9 95.0 7.0 -1.0 *
Interincisal Angle (U1-L1) (°) 130.9 130.0 5.0 0.2

Upper Lip to E-Plane (mm) -8.9 -8.0 2.0 -0.4

Lower Lip to E-Plane (mm) -3.8 -2.0 2.0 -0.9
Nasolabial Angle (Col-Sn-UL) (°) 113.1 102.0 8.0 1.4 *

Maxillary Length (ANS-PNS) (mm) 50.2 51.6 4.3 -0.3

2 Mandibular Length (Go-Gn) (mm) 73.4 65.9 5.5 1.4 *
Facial Convexity (G'-Sn-Po') (°) 169.2 154.0 5.6 2.7 **
Figure 2: Initial cephalometric Wits Appraisal (mm) -0.2 -1.0 1.0 0.8
analysis. SUMMARY ANALYSIS
Class I Molar Relationship
Skeletal Class II (A-Po)
Skeletal Class I (ANB)
Protrusive Maxilla (A-N)

Table 1: Cephalometric analysis.

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Initial Treatment Plan (1)

4A 4B 4C 5A 5B 5C

4E 5E

4D 4F 5D 5F

4G 4H 4I 5G 5H 5I

Figure 4A-I: Initial photos. Figure 5A-I: Treatment plan (1) photos.

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Orthodontic Perspectives Innova

Treatment Plan (2) Mid-Treatment

6A 6B 6C 7A 7B 7C

6E 7E

6D 6F 7D 7F

6G 6H 6I 7G 7H 7I

Figure 6A-I: Treatment plan (2) photos.

7J

Figure 7A-J: Mid-treatment photos.

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Active Tie-Back Retraction Retention

8A 9A 9B 9C

9E

9D 9F

8B

9G 9H 9I

Figure 9A-I: Retention photos.

8C

Figure 8A-C: Active tie-back retraction photos.

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Initial and Final Comparison Doctor's Notes

1. The retraction is completed using some of the mechanical concepts from
Dr. Burstone’s segmented arch technique, controlling the side effects, but with a
modern twist. You don’t have to reinvent the wheel. Stick to basic biomechanics
and you will always have control, or at least you will know what to expect.

Case photos provided by Dr. Patrice Pellerin.

10A 10B

Figure 10A-B: Initial vs. final photos.

11A 11B

Figure 11A-B: Initial vs. final photos.

3M, APC, Clarity, and MBT are trademarks of 3M. Used under license in Canada.
All other trademarks are property of their respective owners.
© 3M 2016. All rights reserved.

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3
3M Oral Care 3M Canada 3M, “3M Science. Applied to Life.”, APC, AlastiK, Clarity, Forsus, Incognito,
2510 Conway Avenue MBT, SmartClip, Sondhi, Unitek, and Victory Series are trademarks of 3M.
Health Care Division
3M Health Care Academy is a service mark of 3M. Used under license in
St. Paul, MN 55144-1000 USA 300 Tartan Dr.
Canada. All other trademarks are property of their respective holders.
Phone 1-800-423-4588 London, ON N5V 4M9 Canada
© 3M 2016. All rights reserved.
Web [Link]/ortho Phone 1-800-443-1661 70-2021-5283-4 1605