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Orthodontic Jaw Wiring: A protocol for General Dentists and Orthodontists

6/15/07 Photo-documentation of the first clinical trial combining simultaneously Orthodontic treatment with OJW from the every start.

(See the patient's medical dental chart entry below for this OJW office visit.)

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          The letter below is my response to all inquiries related to Orthodontic Jaw Wiring. Whoever takes the initial inquiry by phone must therefore obtain the email  address of the person calling. Most of  inquiries I receive typically come from email correspondence as a result of the wide spread broadcasting of the fact that I have placed my availability and willingness to do the OJW procedure on my web site. I make it prominently known to those who come to my office that I do OJW. Indeed I am proud to be a provider of this service.

 Ted Rothstein, DDS, PhD
Cosmetic Orthodontist for Adults and Children
American Association of Orthodontists

Founder OJW DPOJW Course.htm
35 Remsen St., Brooklyn, NY 11201
718 852 1551 Fx 718 852 1894
drted35@aol.com www.drted.com


Dear Would-be OJW patient: (In the photos below you will see the photo documentation of N. Mizrai and her significant other, Alex who kindly gave their permission to present her case.)

I know of only a few doctors who can/will provide the OJW service. I provide this service with pleasure and truly believe in it having provided it to many patients. If coming to my office in Brooklyn, New York is a consideration for you then please familiarize yourself with the information provided at:

http://www.drted.com/index.html.bak2/jaw_wiring.htm .  If you are still interested complete: The Informed Consent for OJW  and email it to me, and then download, complete and fax to me the two other documents requested on it. When I receive all three I will call you.  Complete the Informed Consent carefully.  Thank you for your inquiry.  Cordially, Dr. Ted
 

 Ps: Be sure to go to Directory/index of all OJW pages on this site and read items #2 and #102 and #103.
 

 

This photo may look like "orthodontic jaw wiring" BUT IT IS NOT. Indeed this orthodontic device utilizes elastics to actively make the upper and lower teeth "longer" so that they will are closer to each other.

Dr. Ted meets and greets the family upon their arrival from Seattle. more than likely this visit will be the their first and last visit to the office. So we have much work to get done...shall we dance? The basic rules for success and staying out of harms ways are reviewed: The daily caloric maximum in the liquid diet to lose about 2 pounds /wk; when and how to quickly (5-10 seconds) release and rewire the jaws for exercises and how to prevent any jaw joint stiffness; the correct apartness of the correctly of the wired jaws;  what to do if brackets detach. The role of the OJW's significant other; assurances that no harm has ever come to anybody that has had their jaws wired; a brief review of the about to done OJW procedure ( tell--show--do)

Here I am showing her my OJW training device. I use this device to teach how the jaw wiring is done. (See below.) The patient's OJW starting weight is recorded. Patient should be encouraged that a successful outcome is likely if the adhere to the regiment of the OJW protocol.

Here I am wearing the OJW simulator appliance to allow the person learning the wiring to do it in in-situ. Here I am looking at the panoramic I took then and there. In the course of your examination of the dentition, occlusion, periodontium and TMJ you will decide if their are any contraindications to your doing the OJW. You may have already spoken to his/her general dentist if they came from a long distance to your office. In this patient's case I learned for the first time that she had had four first premolars removed  so I used the first molars the the second premolars and the canines to do the OJW. Here I am introducing Alex to the method of wiring I usually use: It's like a waltz I say: one, two and three...four, four, five and six. for Alex this was a cake walk. This device is shown in some of the following photos.

Here Alex is putting the requisite 6th, 7th, or 8th twist in the pigtail using a back-locking hemostat. The demo device is fashioned to simulate the position of the brackets and right side of the teeth in the OJW wired position. Here Alex is finishing twisting the stainless steel jaw wiring material using the demo device I prepared for  them. See use of demo device Here I am wearing the device I invented to facilitate teaching the person who will do the jaw wiring under conditions that approximate the real mouth. See use of this unique OJW training device.

With the lip retractor in place all the teeth that are going to be bonded are etched: This is an ATYPICAL case because the molars are being used. More typical cases make use of the premolars and the canines. Clear braces used on the canines are a cosmetic enhancement that could easily be done. The author prefers metal, but on patient insistence, could provide clear brackets. The teeth are etched for one minute. A light-cure-method primer is painted on the teeth. In retrospect, I should have done only the upper arch first. The dentist should avoid painting deeply into the interproximals because you will seal the teeth together when you cure with the curing light. You should test with floss after curing to make sure you have not sealed the teeth together.

The brackets were coated with adhesive and positioned on the teeth: I positioned the top brackets about 1.5 mm  more distally leaning slightly distally to allow easier placement of the ligature wire. Here I am am simply taking an overall look to see if the brackets are properly positioned. At the the previous picture having assessed that the brackets were positioned correctly I then light cured them for three seconds and again checked their position. Having assured myself that all is well I now light-cure each bracket for 20 more seconds.

Do you remember the waltz? Here I am completing the "...and three" of the first part of the wiring : one, two and three. Here we have completed the waltz: Orthodontists  call this procedure of wiring "to figure eight: wire the teeth". Here the dentist is gather the wire at about the place he is going to seize it with the hemostat.

The wire is twisted between 5 and 8 times until the dentist achieves a tightness of the wire that permits the patient to move the jaw at least 1.5-2.0 mm in all directions, but so slack as to slip out of the bracket. Note the extra wire has been snipped away and the pig-tail tucked in to make the patient comfortable. Here, using a wire cutter to make a single snip to to remove the wire. Other methods the patient may use to remove the wire.

JUNE 7, 2007

 
Parting is such sweet sorrow. Bests wishes to N., her mom and her significant other.

SPECIAL NOTE:
The patient will leave your office with a kit that includes: a few spare brackets; A wire cutting instrument; a hemostat to twist the wire and a list a patient guide/reminders to achieve success and stay out of reach of harm's. See the guide.

 

 

Thursday, June 7, 2007

Clinical Notes: NM. Seattle, Washington,  Occ: Care-giver, Age 26, 5'2'' , 170 lbs (BMI 31.1),  Goal 110 pounds, Mildly active, willing to commit 6 months passionately to OJW. Expected weight loss: 45 pounds

 Examination of teeth, gums, all soft tissues, extent of movement of jaws, and TMJ (Temporo-Mandibular Joint) reveals that N. is in good health. Her medical and dental history indicated that she had no problems or issues contraindicating  treatment for compulsive overeating using OJW.  A routine panoramic X-ray was taken, which further showed that her teeth and TM joint were normal.  Her occlusion was tested with articulating paper in order to test for/locate any possible traumatic occlusion. None was noted. (The Temporo-Mandibular Joint (TMJ)) is a "ball and socket" joint. The "ball" is the top part of your lower jaw and is called the "condyle". You can feel them by putting your fingers just in front of your ears when opening and closing your mouth. N. was advised that in OJW the jaws are wired together but the teeth of the upper and lower jaw touch just barely, thus allowing about 1.0 mm of lower jaw movement in every direction. Consequently, no pressure is placed on the TM joint. She signed the informed consent for jaw wiring . She was provide an overview of the entire procedure and  was advised of the dangers she might encounter and how to avoid them. The informed consent and the FAQ's were reviewed and she signed the OJW Telephone memo indicating that she was aware of all aspects of the OJW treatment method for the control of compulsive overeating. "Begg" brackets were bonded on upper teeth 3,4, 6  and 11, 13, and 14 and lower teeth 30, 29, and 27 and 22, 20 and 19 and, 20 (this case is atypical because the molars were used).  The brackets were micro etched. The brackets were attached by the light curing method.

N. elected to have me teach her significant other (Alex) how to do the jaw wiring in the probable likelihood that she would not be returning to the office.   Alex was competent and confident at when doing the exercise to place the OJW.

The space between the teeth was checked for unimpeded passage of dental floss. The bracket slot was tested for blockage that might have occurred from stray adhesive. Finally, she was asked to put her teeth gently together and the wiring was done with "dead soft" .014 inch diameter stainless steel round wire.  N. observed the wiring technique and then cut out the wire as a practice procedure which she did with ease in about 5 seconds. She was then wired closed on the right and left sides so that she felt equally comfortable on both sides with about 1.0 mm of freedom to move in all directions.  After 5 weeks of being wired she would remove the wires for 5 days to exercise her TM joints. She was advised not to rewire if there was still any stiffness until the TM stiffness disappeared.  She was given a kit of supplies including a wire cutter and a wire twisting instrument. (Mathieu needle holder) She was given instructions on how to exercise her jaws  during the 5 days she would be released from the wires and advised re the possibility of the joint becoming more limited in motion over time (two fingers of opening rather than 3 fingers).  She was counseled to adhere to a 1350 calorie  low/no salt liquid diet.  She was advised to always carry the wire-cutter with him. Lacking a wire cutter a simple fork could accomplish the emergency removal of the wire. She was provided with instruments to assist in the removal and replacement of the wires including and (Mathieu needle holder). Although we knew that she would  be returning every five weeks to be rewired my staff and I taught her how to rewire himself, a task she was able to accomplish with remarkable ease.  Herein I advise her to weigh himself EVERYDAY and even better keep a graph of her weight loss 18"wide (each day) by 9" high (weight) and make an entry every day/week.  I encourage you both to read:the letter A.T. wrote  who spells out for you what her experience was like warts and all.

Ps.  The brackets were bonded on to the teeth differently than in all previous patients in that they "more inclined" rather than vertically placed on the surface of the teeth.  It seemed that this innovation was more suitably matched to the direction of the path of the wiring.

Paot Script to would-be providers of OJW:

I am confident that in time OJW will become a service that local dentists provide with pleasure in their own communities. I have no doubt that there will never cease to be members of the dental and medical community who look upon OJW with a jaundiced eye. I say offer the service, choose your patients carefully, do the OJW methodically and be responsive to patients needs.

Most of the compulsively overweight will applaud your efforts to help them and they will not hold it against you if they regain the weight. They do expect you would-be providers to see to it that no harm is coming to them because of the OJW.

You need to make sure their teeth, gums and jaw joints are not being harmed and to remove the appliance when they request it, and even before that if you think no benefit is being derived.