bio adaptive therapy presentation

Bio-Adaptive TherapyBio-Adaptive Therapy

A Breakthrough in Orthodontic Treatment

The Damon System is more than a new product – it’s an entirely new orthodontic concept.

The Damon System delivers ideal tooth position and improved

facial symmetry, usually without the need for rapid

palatal expansion, extraction, or surgery.

Three Pillars of Damon System Bio-Adaptive Therapy

Three Pillars of Damon System Bio-Adaptive Therapy

• Passive Self-Ligating Brackets –Low friction, improved comfort, better hygiene

• New Wire Technology –Lighter forces, fewer adjustments

• Minimally Invasive Mechanics –Far fewer extractions and the near-elimination of headgear or rapid palatal expansion

Q: Why are we talking about a new system?

• Twin sisters• Similar malocclusions• Comparison of extraction vs. nonextraction

Traditional ceph and model analysis suggests extractions to achieve “correct” tooth positioning and jaw relationships. The nonextraction case was the experimental case.

One was treated with extractions. One was treated with extractions. Which is which? Which is which?

Extracted Not Extracted

Q: Is conventional orthodontics serving the

needs of today’s patient?

““I wish I I wish I looked like looked like my sister.”my sister.”

Dr. Dwight Damon – the Pioneer in the Development of this

Treatment Approach

Dr. Dwight Damon – the Pioneer in the Development of this

Treatment Approach

“Most extractions are done to make space to eliminate crowding. But what about the face, the roots of the teeth, and the soft tissue? With the Damon

System, we use light forces to convert crowding into posterior arch width, yielding ideal tooth position AND

better facial aesthetics. There is also a growing body of evidence that this

approach yields less root resorption and a far better soft-tissue response.”

The following photosshould challenge every every

clinician to clinician to lower their clinical lower their clinical force mechanicsforce mechanics..

The following photosshould challenge every every

clinician to clinician to lower their clinical lower their clinical force mechanicsforce mechanics..

Force ManagementWhy light forces?


Q: What happens when roots are driven against the cortical plate with high forces?



Capillaries entering the foraminae of the cortical bone



Treatment goal:To achieve ideal tooth

position and facial harmony while keeping the

vascular intevascular integgritrityy of the of the alveolar cortical alveolar cortical pplatelate..

Treatment goal:To achieve ideal tooth

position and facial harmony while keeping the

vascular intevascular integgritrityy of the of the alveolar cortical alveolar cortical pplatelate..

“Optimum force levels for orthodontic tooth movement should be just high enough to stimulate cellular activity without completely occluding blood vessels in the periodontal ligament” – Dr. William Proffit

Thought leaders have talked for decades about how light forces would stimulate rapid tooth movement. However, conventional appliances forced clinicians to use far higher forces due to wire alloys and friction.

The new technology used in the Damon System now allows us to realize these goals.

Orthodontic Tooth Movement

Orthodontic Tooth Movement



Note the amount of blood flow in the PDL, and concentrated in the area of new bone deposition



Two Distinct Types of Pressure Side DynamicsTwo Distinct Types of Pressure Side Dynamics

1. Undermining Resorption – Response to Heavier Forces

2. Frontal Resorption – Response to Light Forces



Oxygen is the trigger mechanism for remodeling of the periodontium.

If vascularity is interrupted in the periodontal space, oxygen is no longer available and cellular activity is slowed or stopped.

Tooth Movement And Oxygen



“If the applied force is great enough to totally occlude blood vessels and cut off the blood supply, a hyalinized avascular necrotic area is formed. This area must revascularize before teeth start to move.”

– Dr. William Proffit

“If the applied force is great enough to totally occlude blood vessels and cut off the blood supply, a hyalinized avascular necrotic area is formed. This area must revascularize before teeth start to move.”

– Dr. William Proffit

Note how blood vessels are crushed in the necrotic PDL and how much bone must be eroded to cause movement with undermining resorption.

Pressure Side Traditional Heavy Forces



Pressure Side Characteristics of Light Forces



capillaries

“Light continuous forces ensure more-effective

tooth movement in areas with cortical bone or

bone with few marrow spaces. Use forces that

do notdo not interrupt the

vascular supply.”

– Rygh

Conventional forces with necrotic PDL

Low forces with vascular PDL



Time Course of Tooth Movement:Frontal vs. Undermining Resorption

Time Course of Tooth Movement:Frontal vs. Undermining Resorption



Light (Damon)

Heavy (conventional)

Friction Must Be Virtually Eliminated In Order To Achieve Lower,

Biologically Optimal Forces

Friction Must Be Virtually Eliminated In Order To Achieve Lower,

Biologically Optimal Forces

The Significance of Self-Ligating Bracket

Technology

New Low-Force, Low-Friction Orthodontic Therapy

New Low-Force, Low-Friction Orthodontic Therapy

Passive Self-Ligation vs. Traditional Active

Elastomeric Ligation

Older style braces require elastics to hold archwires in place.

Elastics are like

bungee cords –

they cause

and ,

making treatment

slower and less comfortable.

Damon System braces use a slide mechanism that eliminates the

friction and binding.

With the Damon

System, teeth

move more freely

and comfortably.

frictionpressure

Passive Self-Ligation

Friction ComparisonFriction Comparison

Conventional brackets with elastomerics produced 500 to 600 times more friction than Damon brackets.

Damon DifferencePassive self-ligation


A: By significantly reducing friction, now we can use “biologically“biologically sensible”sensible” forces with superior results

Q: Why is low friction so important?Q: Why is low friction so important?



Elastomerics and Hygiene• O-rings are extremely plaque retentive• Greatly increase the number of micro-organisms

attached to appliances during treatmentForsberg, et al, Ligature Wires and Elastomeric Rings: Two Methods of Ligation and Their Association with Microbial Colonization, Eur J

of Orth, pp416-20, Oct. 1991



What about other self-

ligating brackets?

Aren’t they all the same?

What about other self-

ligating brackets?

Aren’t they all the same?

Self-LigationSelf-Ligation

• Dr. Jacob Stolzberg developed the “Russell” attachment in the 1930s

• Dr. Jim Wildman developed the Edgelok bracket in 1971 – with limited commercial success

Self-ligation is not a new concept

SPEED®*

Self-LigationSelf-Ligation

Time®*

* Speed is a trademark of Speed Orthodontics. Time is a trademark of American Orthodontics.

Most Self-Ligating Brackets Feature ACTIVE Clip MechanismsMost Self-Ligating Brackets Feature ACTIVE Clip Mechanisms

• Wires are engaged or pressed into the bracket slot, producing greater FRICTION

• Larger wires are needed to overcome the friction = heavier forces

Damon DifferencePassive Self-Ligation


In-Ovation® “R”

Damon BracketsDamon Brackets

• Damon SL, 1996-1999

• Damon 2, 2001



20042005

Damon brackets have a slot with four solid Damon brackets have a slot with four solid walls to allow the wire to slide freely in walls to allow the wire to slide freely in

ALL PHASES OF TREATMENT ALL PHASES OF TREATMENT



Frictional Resistance Comparison

Frictional Resistance Comparison

Even other self-ligating brackets have significantly

more friction because they use an

active clip to keep the wire pressed into

the slot.

New Wire TechnologyNew Wire Technology

Enhancing the Clinical Benefits of Passive Self-

Ligation

Mechanical Principles in Orthodontic Force Control

Damon DifferenceHigh-Tech Archwires


• Very light forces• Faster tooth

movement• Far greater spring-

back properties• True heat activation



Treatment Time Comparison

Treatment Time Comparison

Compared with conventional treatment, the Damon System is proven to treat over 6 months faster on

average…with lighter forces!

Patient Comfort ComparisonPatient Comfort Comparison

Due to the lighter forces used in the Damon System,

patients experience far less discomfort.

Damon braces are

Traditional Braces

Smaller Comfortable FasterMore

Clinical CasesClinical Cases

Harnessing the Power of Low Force and Low Friction

M.J.14 yrs 6 mos

Initial

Class I severe crowding, deep bite, all cuspids blocked out.

Initial

Q: Why is thispatient so crowded?

Small jaws?

Q: Why is thispatient so crowded?

Small jaws?

Q: What is your treatmentplan for this case?

Extraction?

Q: What is your treatmentplan for this case?

Extraction?

Initial

What would extractions do to the profile of this patient?

What is your treatment plan for this case?

RPE? Surgery?

What is your treatment plan for this case?

RPE? Surgery?

2.5 Months1st appointment

5 Months2nd appointment

7.5 Months3rd appointment

12 Months5th appointment

Initial

Final14.5 Months

7th appointment

No extractions, RPE, headgear or surgery!

M.J.Final

14 months – 2 weeks7 appts upper5 appts lower

Initial16 years – 5 months

Class II, severe crowding, bilateral posterior crossbite

Treatment PlanningTreatment Planning

• Ceph numbers• Model analysis• Pano X-rays• Facial analysis• Impact of growth/aging• Vestibular bone density• Tongue position/airway• How light a wire do I need to stimulate

blood flow?

Initial

Initial – Tongue position?

Why is the upper so crowded?

Initial – Tongue position?

What is your treatment plan?

What is this patient going to What is this patient going to look like at 50 years of age?look like at 50 years of age?

Damon Mechanics Dramatically simplified approach

Damon Mechanics Dramatically simplified approach

• No palatal expanders

• No distalizers or headgear

• No anchorage preparation (TPAs, Nance buttons, etc.)

A.H.13 months

Light forces – no extractions, RPE

or surgery

13 months

13 monthsInitial

A.H.13 months

Light forces – no extractions, RPE

or surgery

Initial

Final

Final22 months

3 weeks

Final – 22 months 3 weeks

Initial

Final22 months

3 weeks

Initial Final

Note health of bone and tissue with tremendous alveolar change

Initial Final

Initial 1yr 3mo posttreatment

“…way more than straight teeth! I can

breathe through my nose and speak more

clearly.”

Retention 1 year 3 monthsRetention 1 year 3 months

Face-driven treatmentby converting anterior

crowding into posterior adaptation of bone, muscle,

and soft tissues

Face-driven treatmentby converting anterior

crowding into posterior adaptation of bone, muscle,

and soft tissues

Power of the TransversePower of the Transverse

• Low orthodontic forces do not “overpower” the lip musculature.

• Incisors are prevented from “dumping” forward.

• Teeth move laterally and distally.

Power of the Transverse

Power of the Transverse

Archwire adapted to initial and final arch form

Initial and final arch forms

Initial to final arch length increased 13 mm

Arch width accounts for space gained

Skepticism of Bio-Adaptive Therapy Treatment ResultsSkepticism of Bio-Adaptive Therapy Treatment Results

• Buccal tipping of posterior teeth?

• Compromising anterior labial bone support? Molar distalization?

• Pushing roots through buccal plate?

Q: Were anteriors flared to resolve crowding?

Composite

Note final position ofincisors in spite of extensiveanterior crowding

Q: Was the arch lengthened by molar distalization?

Distal of first molars to labial of incisors 37 mm

Distal of first molars to labial of incisors 38 mm

Q: Was transverse development achieved by tipping?

Width Initial Final ChangeCuspid 32 mm 34 mm 2 mm1st bicuspid 32.5 mm 40.5 mm 8 mm2nd bicuspid 37 mm 48 mm 11 mm1st Molar 44 mm 53 mm 9 mm

Initial Final (Note tremendous palatal change with minimal tipping)

First bicuspids changed 12 mmSecond bicuspids changed 11 mm

First molars changed 9 mm

Q: Have we blown teeth out of cortical bone?

The following CT scans have been provided courtesy of Dr. Damon

The following CT scans have been provided courtesy of Dr. Damon

Reading CT Scans

Maxillary Sagittal Mandibular Sagittal

Mandibular TranspalatalMaxillary Transpalatal

Tra

nsp

alat

al

horizontal

Upper first molars width change 9 mm

Upper CT scans 7 mos in retentionUpper CT scans 7 mos in retention

Note presence of bone on buccal and lingual sides of roots

Upper 2nd bicuspids width change 11 mm

Upper CT scans 7 mos posttreatmentUpper CT scans 7 mos posttreatment

Upper 1st bicuspids width change 12 mm

Upper CT scans 7 mos posttreatmentUpper CT scans 7 mos posttreatment

Change: Cuspids 2 mm, 1st Bicuspids 12 mm, 2nd Bicuspids 11 mm, Molars 9 mm

Mid-Face DevelopmentMid-Face Development

Change: Cuspids 2 mm, 1st Bicuspids 12 mm,

2nd Bicuspids 11 mm, Molars 9 mm

Change: Cuspids 2 mm, 1st Bicuspids 12 mm, 2nd Bicuspids 11 mm, Molars 9 mm

Width Initial Final ChangeCuspid 27 mm 27 mm 0 mm 1st bicuspid 34 mm 36.5 mm 2.5 mm 2nd bicuspid 40 mm 42 mm 2 mm 1st Molar 46.5 mm 47 mm .5 mm

Change: Cuspids 0 mm, 1st Bicuspids 2.5 mm, 2nd Bicuspids 2 mm, Molars .5 mm

Lower CT scans7 months post-treatment

Q: Can we achieve the same results with adults without surgery?

T.B.Initial

32 years – 9 months

Initial

Initial

What is your treatment plan?What is your treatment plan?

Initial

Q: Where does this patient’s tongue lay in the mouth?

Initial (Note depth of palate)

Initial

Q: In the palate, or….?

Initial

A: In the lower arch.

Initial

16 mos 2 wks8th Appt

12 mos 2 wks6th Appt

Initial 10 weeks1st Appt

7 months3rd Appt

Final

How can teeth move this rapidly? With such light forces?

Initial32 years – 9 months

Final18 Months – 2 weeks

10 appointments

Final 18 Months 2 weeks

10 Appointments

Initial Final

Composite

Width Initial Final ChangeCuspid 32 mm 34.5 mm 2.5 mm 1st bicuspid 35 mm 43.5 mm 8.5 mm 2nd bicuspid 41 mm 48 mm 7 mm 1st Molar 48 mm 52 mm 4 mm

Note change in shape of the palate –tongue can now move into balance

Initial Final

Q: Are we moving teeth through bone, or is the bone

adapting and moving with the teeth with these light forces?

1st Molars – 4 mm Transverse

Change: Cuspids 2.5 mm, 1st Bi’s 8 mm, 2nd Bi’s 7 mm, Molars 4 mm

16 months post-treatment

Q: Does this image change your thinking on what is possible?

2nd Bicuspids – 7 mm transverse


16 months post-treatment Roots are upright

in bone on both buccal and lingual side after significant transverse movement

1st Bicuspids – 8 mm transverse

Q: Does this image change your thinking on what is possible?



Change: Cuspids 2.5 mm, 1st Bi’s 8 mm,

2nd Bi’s 7 mm, Molars 4 mm

Observe the presence of bone onthe labial, buccal, and lingual of this adult


Evaluate bone and tissue contours6 months posttreatment

Note the presence of bone onthe labial, buccal, and lingual of this adult



Remember that the cuspids were out of the arch!

Evaluate tissue 6 months retention

Remember that the cuspids were out of the arch!

2 years 1 month

posttreatment

How Can Light Forces Cause Such a Dramatic

Adaptation of the Alveolar Bone?

How Can Light Forces Cause Such a Dramatic

Adaptation of the Alveolar Bone?

Insights Gained By Observing Naturally

Occurring Bodily Processes

Orthodontic Forces:How Low Can You Go?

Orthodontic Forces:How Low Can You Go?

4-2-03

Q: Can a 3rd Molar move distal 2/3 width of 2nd Molar in 2-3 months?

06-23-04

A: It can when there is a growing cyst.

Cyst growth exerts a fraction of the forces used in traditional orthodontics, yet it can move

teeth much more rapidly.

Cyst growth exerts a fraction of the forces used in traditional orthodontics, yet it can move

teeth much more rapidly.

How Much Can Alveolar Bone Move?

Note how cortical bone compensates for cyst growth

Once the cyst is removed, the alveolar bone moved back

Should this be a wakeup call to our concepts of force?

Q: If the muscles of the face and tongue are helping to determine arch form, will the arch forms of

all patients be different?

Standard Arch FormOne Size Fits All?

Standard Arch FormOne Size Fits All?

Customizing Arch Form For Each Patient

Customizing Arch Form For Each Patient

K.M. Final C.B. Final

Two people, two very different arch forms.Two people, two very different arch forms.

UPPERS

Q: Is there ever a time when you need to extract?

Face-Driven Treatment Planning

• Patient has very little crowding

• Bi-max protrusion

• Patient’s chief complaint is the protrusive nature of her profile.

• This is a case where extraction will help to establish an improved facial profile.

There is a time to extract

With the Damon System we “Extract for the face, not for the space.”

Light elastics and/or springs are used to close space

Low-friction Damon brackets allow spaces to be closed far more quickly and easily.

Treatment time: 21 months

• This technology must be used in all cases to see the true efficiency gains

• You never know who your best advocates will be

• If you know it is better for patients, how do you choose?

Selective Application vs.

All or None

Note posterior teeth tipped lingual – dark triangles

Mom only sees diastema

We could use brackets or aligners to make minor anterior corrections, but what about the facial impact?

A.M.Final

FinalNote change inarch form

Note change in mid-face support and smilevs. simple diastema closure

Initial Final

K.W. Initial

Initial

Initial

K.W. at 53 years 3 months

4 yrs 1 mo

post-treatmentNo night retentionfor 2 yrs

53 years 3 months 59 years 1 month

K.W. 59 years of age

“The interesting thing about the Damon System

isn’t just the quality of the cases, it’s the consistent

quality of the cases.”

– Damon user

Before

After

It’s More Than Just Straight Teeth.

It’s all about the face.

“As orthodontists we can do more for our patients, more quickly, and more comfortably than ever before.”

– Dwight Damon

• Extraordinary Results • Shorter Treatment Time • Fewer Appointments • Greater Comfort • Most Cases Treated

Without Extractions

For more information, visit www.damonbraces.com

http://www.damonbraces.com/

bio adaptive therapy presentation

Health & Medicine

conventional forces

light continuous forces

high forces

optimal forces

higher forces

sensible forces

ryghlow forces

new lowforce