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This patient initially came to the office for OJW for weight loss. When I told her I was confident I could treat her inter-dental spacing at the same time she was more than willing to proceed. Here you see I have placed the brackets on the upper and lower dentition in proper position for orthodontic treatment, and placed the first arch wire (.016 NiTi). You will note the brass pins I have placed  to fasten the arch wire to the canines and premolars in order to facilitate placement of the OJW wiring (See below).

 

                                     Left side

Anterior view showing the use of Cosmetic braces on the upper and lower dentition.

Here I have placed a lower .016 NiTi and wired the right and left using the typical OJW wiring configuration. The patient is wired so that the lower jaw can move 1.5mm-2.0mm in all directions

Here you  can see the typical "figure 8' OJW wiring configuration on the right side

Left side view.

SPECIAL NOTE

This case is unique not only because the orthodontic treatment and OJW treatment modalities are combined, but because the author is using .009 stainless steel wire for the first time. Typically I would have used a .014 dead-soft stainless steel wire. If  this wire keeps its integrity for a reasonable number of weeks it will be used in the future. I did order .010 dead-soft wire for future use in the belief that it will be effective to ligate the arches and and have even more durability than the .009 stainless steel ligature wire used here.

SPECIAL NOTE cont.

 On July 18, Iris returned to the office. The .009 stainless steel wire had stayed intact. However, some brackets had detached and the wire just fell off. I rebonded the brackets (5) and rewired Iris with .012. dead soft wire. (See below.) at the same time I changed her upper and lower arches to .018niti/.016 niti. I added power chain to cont upper and anterior space closure.

 

  Visit of July 18:  note the use of .012, deadsoft wire to to wire the jaws apart (about 2mm).  The orthodontic treatment is progressing nicely as well.

See Iris's next visit to the office  8/10/07

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11/1/2007  Front view showing OJW in place with power chain on the lower teeth only in order to pull back the lower front teeth. When they are back I will begin retracting the upper front teeth.  The OJW in no way impairs the movement of the teeth. 11/1/2007  It's easier to see the "power chain" pulling back the  lower front teeth in this photo. The power chain is attached from  the 4th lower tooth to the hook I bent into the wire just in front of the lower eye tooth. it's difficult for the untrained eye to see it.

12/8/2007 Iris has 35 lost pounds. This photo demonstrates that at the start of wiring (upper right second premolar), it is prudent to leave some excess of wire (note the excess of wire between the upper right 2nd premolar and the lower right premolar). You can use the excess to adjust the final tension of the wrap of the wires. DO NO FORGET IF THE CASE WERE ONLY JAW WIRING YOU COULD FEED THE WIRES THROUGH THE VERTICAL SLOTS.

The instrument I use to begin twisting the wire to create the "pigtail" is called a back locking hemostat or (Mathieu needle holder. I provide every patient with one of them. Here I am showing that I take hold of the wire at about 10 mm from bracket of the lower right canine. It take between 6 and 9 twists to begin getting sufficient tautness to prevent the wire from slipping over the brass hook that I am using. I am using the brass hook only because it is an orthodontic case and the archwire precludes me from using  the slot of the bracket.

 

Sometimes I first make a pigtail at the outer half of the wire as shown here. Then I continue twisting the wire until I can see that the twists have reached the bracket. Then I begin carefully twisting 1/2 to 1.5 turns more to achieve a tautness of the wire that allows the lower jaw to move about 2mm in all directions and sufficiently tight to prevent the wire from slipping over the brass pin. Leave 1/8"h -1/4" of pigtail and tuck it away. There should be visible about 2'' of interocclusal space.

 

Note that the OJW wire pigtail is tucked away in front and most of the original excess slack in the rear has been used up in the act of adjusting the wire to allow the desired movement of the mandible. One must do the figure 8 wiring to allow the maximum amount of interocclusal opening within the limitations of the attachment hooks or slots of the bracket being used. balance the tautness of the wire so as to avoid but not so excessive as to overflow the hooks the wire was wrapped around.   

 

May 15, 2008

May 15, 2008