Pacific Coast Society of Orthodontists Bulletin Summer 2020 - 44

Let's Talk About That

Appointment 11: At 18 months, begin finishing
elastics. Section lower wire 3-3, no posterior
wire. Up and down zigzag elastics from upper
7 up and down ending on upper 2. Scan for
models for lingual bonded retainers.
Appointment 12: At 19 months, remove braces,
place lingual bonded retainers. Impressions
to use for quick-set models to fabricate Essix
retainers in both arches in house during
appointment. Deliver retainers.
7. What will your occlusal goal be? Class I.
8. If using a two-phase treatment, how do you
retain between phases? This would not be a
two-phase case for me, but if I had treated in the
mixed dentition around age seven or eight years,
I would place the upper and lower lingual holding
arches until full permanent dentition eruption
occurred.
9. If using two phases, how do you approach
Phase II? What appliances and auxiliaries do you
use? When Phase II comes along, if needed (about
66% in our office need a second phase), we offer
either braces or clear aligners to finish the case.
10. What type of retention do you employ at the
end of treatment? Maxillary and mandibular
bonded lingual retainers. Upper is a 2-2 made
with a multibraid 0.019 × 0.025-in SS wire. Lower
is 3-3, just bonded on the 3s with an 0.028-in
Elgiloy wire. We have patients wear clear Essix
retainers at night. Retention is lifetime.
11. What are the shortcomings or possible complications of the appliance you are using, and how
do you handle them? The AdvanSync appliance is
pretty robust for a Herbst appliance, but as with
any Herbst appliance, the crowns can become
dislodged or a screw that attaches the arms to
the crown could come loose. The key to minimizing loose crowns is proper fitting of the crowns
(make sure they "snap" over the height of contour
to give mechanical retention). This sometimes
requires reshaping of the gingival portion of the

44	

crown, crimping it inwards to "tighten" the fit
prior to cementing. In addition, we have tried
many cements, and I have found the Unitek Multi
Cure Glass Ionomer Cement to work extremely
well. For ensuring screws do not come loose, we
dip the screws in a product called Ceka Bond prior
to inserting the screw. It is essentially a medical-grade Loctite.
Dr. John Pobanz discusses the Forsus appliance
	
Dr. John Pobanz has
owned and operated
Pobanz Orthodontics in his
hometown of Ogden,
Utah, for 22 years. He
completed both his dental
and orthodontic specialty
training at the University
of Nebraska Medical
Center College of Dentistry. He is a diplomate of the American Board of
Orthodontics and a visiting volunteer clinical
instructor at the University of the Nevada Las
Vegas School of Dental Medicine. He and his wife,
Angela, a clinical psychologist, have four children
ranging in age from 11 to 25 and one grandchild.
1. When would the ideal time be to start treatment when using your appliance? Starting
treatment would depend on the patient's height
relative to her mother and older female siblings.
If she has started her period, I would aggressively
use the crossbow version of the Forsus appliance
to immediately achieve orthopedic expansion of
the maxilla as well as to advance the mandible to
ideal overjet upon delivery with or without maxillary brackets/archwire, then advance to −2-mm
overjet overcorrection and hold for a total of nine
months. I would use CBCT to check for condyle
centeredness in the fossa and then remove the
crossbow and bond the mandibular arch, level
and align, detail/coordinate.
If the patient has not started her period and the
window of growth is less urgent, I would follow
the protocol outlined below.

PCSO Bulletin    Summer 2020



Pacific Coast Society of Orthodontists Bulletin Summer 2020

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