Composite rectangular loop - blocked out U2's

Composite rectangular loop - blocked out U2's was created by anne_chanly

Clinical Discussion - May 2023:
Records: April 13, 2023

15 years old, Hispanic female.

• Presented with a chief complaint of poorly aligned teeth, she is especially concerned about the position of upper lateral incisors
• We treatment planned a non-extraction comprehensive orthodontic treatment
• Treatment plan
  • Step 1: TPA to expand U6s and derotate 
  • Step 2: Large rectangular loop U4s and 5s
    • Expand U4-5-6's, more of a rotation than expansion
    • U3's already buccal, so don't expand them
    • IPR also needed in area of U3s-U6's, ~1mm per side

   

 

    

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Replied by Giorgio_Fiorelli on topic Composite rectangular loop - blocked out U2's

Ann, I think posting in this way is a great start! 
The images below are just to try the system myself.

 

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Replied by anne_chanly on topic Composite rectangular loop - blocked out U2's

Sounds good, I will continue posting and correcting this one. Thanks for your help. Anne

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Replied by anne_chanly on topic Composite rectangular loop - blocked out U2's

Clinical Discussion - Oct 2023:
Records: Sept 29, 2023

• Findings since May 2023:
  • Expansion seen on L6's from LLA (0.36 TMA)
  • Expansion seen on U6's and U4-5's from HS arch (0.36 TMA) and large rectangular loops (17X25 TMA)
  • Some space creation seen for U2's, still insufficient amount to bring U2's into arch
• Recommendations from Clinical discussion Oct 2023: Need to increase OJ and keep U1's forward, 2 options:
  • Option 1 - U-shaped vertical loop with notch b/t U1's
    • Extrusive component
    • Notch in loop prevents sliding
  • Option 2 - Using TPA (0.36") with 2 cantilevers, 70-80g per side to bring U1-1 forward and transversally
    • Transversal force will cancel each other out so that you only have forward movement
    • Remember to add extension to the segmental wire in order to allow for hook on cantilevers to travel distally over time
    • If extrusive component is not placed in vertical loop wire then vertical elastics can replace this force

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Replied by anne_chanly on topic Composite rectangular loop - blocked out U2's

Clinical Discussion - May 2024:
Records: May 4, 2024 

Findings;

• Additional upper expansion seen on upper
• Additional lower expansion and uprighting on lower
• Additional space made for U2's
• Expansion with Bite plate used to continue lower expansion and to keep patient of occlusion in order to allow U2's to have crossbite correction

Recommendations from Clinical Discussion May 2024 - Need to continue transversal expansion

• Don't use power chain to bring U2's forward, it is less control of root movement
  • Use composite rectangular loop instead - Upper  2-1-1-2 (17X25 TMA and 18 TMA)
    • Framework from U3-3 with bypass of U2's
    • Vertical brackets on U2's (vertical slot)
• IPR UL2
• Correct rotation of LL4 with rectangular loop
• Continue transversal expansion 
  • Take measurements: intermolar, premolar, and canine widths
• Ck for need for IPR of lower anteriors
• In the posterior, the U-shaped loop extension should be a step up instead of a step down in order to allow easier oral hygiene and less chance of occlusion interferences

 

 

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