The Herbst appliance has been used routinely in the specialty of orthodontics for nearly 40 years. Over this time, many design variations have been utilized. One of the recent designs is the AdvanSync 2 appliance, manufactured by Ormco. The AdvanSync 2 appliance is smaller than the conventional Herbst appliances and allows the clinician to place braces on all the permanent teeth forward of the first molars. In the case presented, the patient presented with a skeletal Class II, division 2 malocclusion. Facially, it was determined that mandibular advancement would be advantageous for ideal facial esthetics. The result of treatment utilizing the Damon System braces and the AdvanSync 2 Class II corrector was an excellent outcome both dentally and in regard to facial esthetics.

Aims The aim of the study was to determine the validity and reliability of Peer Assessment Rating (PAR) index score derived from digital and plaster models of the same patient. Subjects And Methods Thirty orthodontic plaster study models were digitalized using the 3Shape R700™ Orthodontic 3D scanner. PAR Index scoring was carried out on both the plaster and digital models by one independent examiner calibrated in the PAR Index. The measurements were repeated at a second sitting. Measurements were made on plaster models with the PAR Index ruler and on digital models with the 3Shape OrthoAnalyzer™ software. Statistical Analysis Used Bland-Altman plots were used to test for validity and intraexaminer reliability. Results For PAR Index score, overjet and overbite component scores, 28 out of 30 measurements were within 95% limits of agreement. Other components of the PAR Index score had all points within 95% limits of agreement. For intraexaminer reliability, digital models had 28 out of 30 measurements and plaster models had 27 out of 30 measurements that were within 95% limits of agreement. Conclusions Digital models are a clinically acceptable alternative to plaster models in the measurement of the PAR Index. Improvement in software design is necessary to attain greater agreement in the measurement of the overjet and overbite components of the PAR index score between plaster and digital models.

This Experts Corner discusses five principles that I wish I had known sooner as a younger orthodontist. I will discuss my philosophies on progress records, banding second molars, premolar extractions, conservative Phase I treatment, and the importance of humility. While I am certain these principles were taught during my residency, I did not fully understand them until I struggled in private practice. I share them in hopes that others can learn from my experiences.

Objective The objective of this study was to determine the effect of cortical piezo-puncture (CPP) on maximum insertion torque (MIT), maximum removal torque (MRT), and maximum axial load (MAL) during the insertion of self-drilling miniscrew implants (MSI), in an experimental model with proximal epiphysis of bovine tibia. Materials And Methods A comparative study was conducted using two groups of 20 self-drilling MSI inserted in intact bone (control group) and in bone with previous CPP (experimental group). MIT, MRT, and MAL of the 20 mini implants of each group were measured. Using SPSS software, Student’s t-test was applied to compare MIT and MRT and the U-test Mann–Whitney test was applied to compare MAL in both groups as well as Pearson and Spearman correlation. Results In the experimental group, average values of 12.85 (±4,32) Newton x centimeters (Ncm), 13.7 (±4,54) Ncm, and 22,474 (±895,95) gF for MIT, MRT, and MAL were found, respectively. In the control group, average values found for MIT, MRT, and MAL were 20.2 (±4,7) Ncm, 22.3 (±5,17) Ncm, and 4688,7 (±320,18) gF, respectively. Statistically significant differences were observed in MIT, MRT, and MAL between control and experimental groups (P < 0,001). Conclusions CPP before insertion of orthodontic MSI in bovine tibia significantly reduces MIT, MRT, and MAL.

Introduction In the last decade, anchorage control with mini-implants has gained enormous credibility in maintaining orthodontic anchorage. Resonance frequency analysis (RFA) has proven to be an adequate method to measure the stability of these mini-implants because of its non-invasiveness and contactless measurement method. Materials And Method Tomas and S.K surgical mini-implants were tested. For this purpose custom fabricated attachment was fabricated to attach the smart peg on orthodontic mini-implant head, and 45 mini-implants were inserted in fresh swine pelvic bone in the density matched sites to that of most common sites where mini-implants are placed in human mandible. Mini-implants of two different lengths with diameter constant were also placed to assess the effect of length on primary stability. Results The mean ISQ of Group 1 (Tomas 10 mm) was 55.53±3.39 while that of Group 2 (S.K Surgical 10mm) was 56.63±3.48 and that of Group 3(S.K Surgical 8 mm) was 55.90±3.48. Difference among the groups were not statistically significant when ANOVA test was used (P >0.05). Conclusion The resonance frequency analysis is applicable to comparatively assess the primary stability of orthodontic mini-implants. There was no difference in primary stability of Tomas and S.K Surgical mini-implant and primary stability was not affected by the length of the mini-implant.

Class III malocclusions are considered to be one of the most difficult problems to treat. Due to the significant number of patients with Class III malocclusion who cannot undergo orthognathic surgery for different reasons, we have proposed an alternative treatment that we have called surgically assisted rapid palatal expansion (SARPE) + temporary anchorage devices (TADs) which allows solving mild and moderate Class III malocclusion combined with maxillary compression, obtaining acceptable esthetic and functional results. We present a case report of an adult female with skeletal Class III malocclusion with compression in the maxillary and mandibular asymmetry, who was treated with SARPE + TADs. The result is acceptable in terms of occlusion function, esthetic of the smile, and facial esthetics.

21-year-old female presented with chief complaints of crooked teeth, canine impaction, deep bite, and “gummy smile” (excessive maxillary gingival exposure when smiling). Increased facial convexity (15.5°), increased lower facial height (56%), and incompetent protrusive lips (E-line to upper left 2 mm, E-line to lower left 2 mm) were associated with a severe Class II malocclusion (nearly a full cusp bilaterally). There was 7.5 mm of overjet, 100% anterior deepbite, and a left posterior buccal crossbite. Cephalometrics revealed a skeletal discrepancy due to a protrusive maxilla and a retrusive mandible (SNA 85°, SNB 78°, and ANB 7°). Cone-beam computed tomography imaging revealed a palatally impacted right maxillary canine (UR3) near to the adjacent lateral incisor (UR2). The retained right primary canine (URc) was extracted. A simplified open-window technique was utilized to surgically expose its impacted successor. A maxillary anterior mini-screw provided anchorage to align the UR3 in its correct anatomical position. Nonextraction treatment with a passive self-ligating fixed appliance was indicated to align and level both arches. Anchorage provided by infrazygomatic crest bone screws, and maxillary anterior miniscrews were used for the correction of Class II malocclusion and gummy smile. To achieve more esthetic crown lengths in the maxillary anterior segment, gingivectomy was performed with a diode laser 2 months after fixed appliances were removed. This challenging skeletal Class II malocclusion with a Discrepancy Index of 38 was treated in 32 months to excellent outcomes: Cast-radiograph evaluation score of 25 and an pink and white dental esthetic score of 2. All facial and dental corrections were stable at the 6 months follow-up evaluation (Int J Orthod Implantol 2017;48:24-46). Republished with permission from: Ariel Wong, Chang CH, Roberts WE. Conservative Management of Skeletal Class II Malocclusion with Gummy Smile, Deep Bite, and a Palatally Impacted Maxillary Canine. Int J Orthod Implantol 2017;48:24-46.

The aim of this article is to introduce a faster and even simpler method where the patient can readily visualize the treatment outcome than the currently available methods. This article demonstrates how PowerPoint software can be used to generate instant virtual treatment outcomes (IVTOs) at the chairside using the patient’s digital photographs. The generated two-dimensional skeletal and dental IVTO provides the necessary communication aid in patient motivation and education. Furthermore, it serves as making a tremendous leap forward, toward informed consent.

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