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Improving the predictability of aligner therapy with miniscrews. Benedict Wilmes. Episode 51. IOC 2020

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Hosted by
Farooq Ahmed

Advantages of aligners

  • Aesthetic Thai 2020
  • Less white spot lesions Peter 2019
  • Efficacy:
    • Good for distalising 1.5-2.2mm Simon Ravera
    • Poor expansion, mainly tipping Houle 2017
    • Poor space closure Papadimitriou 2019

 

Challenges with aligners

  • Bodily movement
    • Distalise 2mm+
    • Mesialise
    • Expansion

 

Can resolve challenges with aligners by incorporating TADs

 

TAD insertion

  • Location success Houfar 2015 / 2017
    • 98% success anterior palate
    • 71% success buccal
  • Anterior palate
    • ‘T’ zone – behind 3rd palatal rugae Wilmes 2016
    • Paramedian – more stable then mid palatal suture – Nienkemper 2013

 

2 stage protocol

  • TAD slider mechanics initially
  • Followed by aligner treatment for completion
  • Easier than 1 stage as synchronisation of aligner movement not required

 

1 stage protocol

  • Scan for aligners
  • Once inserted aligner, place distalisation slider
  • Requires synchronisation of distalisation with aligner movement

 

Distalisation

Clinical tips

  • Speed of distalisation
  • 6mm / months using slider – incorporate into aligner sequence
  • Bands with aligners do not fit well:
    • Use bonded tubes – wire with composite
    • Aligner scanned after insertion, or cut out of aligner
  • To deactivate appliance, ligature placed from slider to bonded tube

 

Mesialisation

Mesial slider Wilmes 2019

  • Clinical tips
  • Posterior attachment with bonded tubes and well as mid arch – premolar region

 

Expansion

  • 2 Screws anterior palate
  • BMX expander – pre-fabricated – no lab requirement, 6,8,10mm between holes and adaptable chairside (pre activation)
  • Slow expansion: as no risk of teeth tipping

 

Insertion of beni-slider

  • Laboratory fabrication or
  • Digitial design
  • Insertion guide
    • CADCAM design – insert TADs and RPE at the same time
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