Earl's Pearls: Favorites from the PCSO Bulletin
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Earl's Pearls - Earl Johnson, DDS
Bulletin
1. Turbo Torque for Second Molars (Winter 2004)
One of the most frustrating aspects of finishing a case is trying to torque upper second molars to a flat occlusal plane while in the final finishing stages. The finishing wire (high stiffness) can only be adjusted a little bit at each appointment, resulting in quite slow molar movement.
If you have an upper second molar that is badly flared to the buccal…Here is the trick for lingual crown torque to an upper second molar:
1. Use a square 18x18 or 21x21 Ni Ti arch wire.
2. Orient the plane of the arch wire so that it is vertical – 90° to the occlusal plane.
3. Put the top end of the wire in the second molar tube.
4. Rotate the plane of the arch wire toward the midline until it is parallel to the occlusal plane. Fit it into the brackets and the opposite terminal molar (that does not need torque correction).
5. Tie all the teeth to their brackets except the first molar mesial to the second molar being torqued. The arch wire should bypass the first molar tube or bracket to the buccal. Do not tie in the first molar. Skip it!
6. Let the torquing wire work at least six to eight weeks.
7. Once the torque has been corrected, remove the wire and tie it in normally to level the second bicuspid, first molar and second molar relationships.
Why does it work?
1. Skipping the first molar triples the inter-bracket distance mesial to the second molar tube. That reduces the torsional stiffness of the wire by a factor of 3, making it one-third the stiffness.
2. The wire activation is increased by 90°.
3. The net effect is that there is a gentle effective torquing force that has an extremely low unloading rate. It will work over a long time and distance.
Note: Both second molars can be torqued at the same time.
1. Arch wire goes directly from the second bicuspid to the second molar bypassing the first molar tube / bracket.
2. There is an additional 90° of twist (torque activation) in the wire between the bicuspid and second molar.
3. The arch wire is tied in securely into the second bicuspid bracket slot and all the other brackets in the arch.
2. Unilateral Molar Mover (Summer 2006)
Do you ever want to move an upper molar distally on just one side? Want to avoid a unilateral headgear? Want to be done in two to four months? Is the patient an adult? This is just the ticket!
I developed the original design idea while our study club was visiting with the late Dr. Robert Ricketts. This is a re-engineered version of his original concept. The appliance described below is 0.018 SS. You can use 0.020 SS as well; just adjust wire sizes accordingly.
Design idea
- Have a continuous light distal force to the first molar (.010 x .045 Elgiloy open coil spring activated 4-5mm.)
- Eliminate any torque forces on the molar. (Use a round wire sectional.)
- Prevent reciprocal forward movement of the cuspid. (Light unilateral Class II check elastic.)
- Use an undisturbed lower arch as anchorage. (Well-fitting lingual arch—nothing else is bonded/banded.)
- Eliminate any tipping, buccal flaring or extrusion of the cuspid. (A completely passive sectional works just fine—no compensation or avoidance bends needed.)
Hardware
- Band the first molar, bracket the cuspid with nothing on the bicuspids.
- A completely passive .018 round stainless sectional from the cuspid to the molar bypassing the bicuspids. The sectional is not cinched back.
- Well-adapted mandibular removable .030 lingual arches (must be able to fine tune the adaptation to lower anteriors).
- 3 ounce Class II elastic worn 24 hours a day. Heavier elastics tend to overpower and create problems.