Pacific Coast Society of Orthodontists Bulletin Summer 2020 - 49

Let's Talk About That

8. If using two-phase treatment, how do you retain between phases? I would retain this patient
for six to eight months by having her wear her
TBA every night. I would check the patient every
six weeks at this stage to ensure that the appliance is fitting well and that the overjet, overbite,
and first molars all settle into an ideal Class I
relationship.
9. If using two phases, how do you approach
Phase II? Phase II treatment for this patient would
likely involve a few months of full fixed edgewise
treatment (or possibly aligner wear) to detail the
occlusion, correct crowding, spacing, rotations,
etc.
10. What type of retention do you employ at
the end of treatment? My retention protocol for
this patient would include using a direct bonded
lingual retaining wire on the mandibular anterior
teeth, utilizing the V-looped design for ease of
flossing. For the upper arch, I would use a removable clear Essix-type retainer during the day for
the first six months after removal of the braces. In
addition, I would require the patient to wear removable upper and lower Hawley retainers every
night for at least two years.
In the event that I saw any relapse tendency in
the overjet and overbite in the retention phase,
I would construct a new TBA for the patient to
wear at night in lieu of the Hawley retainers.
11. What are the shortcomings or possible complications of the appliance you are using, and how
do you handle them? One of the shortcomings of
the TBA is that successful treatment is contingent on good patient cooperation. It has been my

Summer 2020    PCSO Bulletin	

personal experience that patient cooperation is
better in the younger, mixed dentition patients.
Getting the patient involved in the process by
allowing them to choose the acrylic color(s) for
their appliances and pick their favorite color of
sparkles seems to help engage the patient.
Also, when the appliance is initially inserted and
the patient sees how much better he or she looks
with their mandible advanced forward, that
patient is motivated to do whatever it takes to
correct their skeletal Class II deficiency. When
girls are 8 to 10 and boys are 9 to 11, they tend to
be more eager to wear a removable appliance,
especially if it spares them from having to wear
headgear and if it means greatly reduced time in
braces. Saving the patient from the discomfort
associated with braces, as well as taking away the
risk of decay and decalcification are good motivating reasons for the child to wear the TBA.
Another shortcoming of using the TBA is the need
for meticulous attention to detail in the design
and construction of the TBA. The appliance must
fit securely and comfortably. The orthodontist
must work with a top-notch lab or, better still,
have a well-trained lab technician in the office.
From time to time, the TBA must be reactivated. In my practice, this would involve about 30
minutes of lab time in my in-house lab while the
patient waits in the waiting room. I appreciate
that not every orthodontic office has the luxury
of an on-site, highly experienced technician to
do TBA activations, repair clasps, mend cracked
acrylic, etc. The orthodontist must be willing to
go through the learning curve to master the use
of the TBA and must also be passionate about
motivating the patients.

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Pacific Coast Society of Orthodontists Bulletin Summer 2020

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