Orthodontics Posts

An innovative prosthetic-guided Orthodontic technique: case series
Fabio Cozzolino Anna Mariniello Roberto Sorrentino Marcello Sacchetta

Restoration of a lower incisor periodontal health by means of a selected radicular torque control using a fixed lingual orthodontic: case report
Matteo Beretta Nunzio Cirulli Aldo Macchi

i-TTR brackets: A new type of lingual brackets
Aldo Macchi Nunzio Cirulli Matteo Beretta Anna Nidoli Anna Mariniello

A new technique for restoring prosthetic space in implant region: a case report
Fabio Cozzolino Anna Mariniello

Straumann implant with bone regeneration (GBR) by using Bio-Gide And Bio–Oss
Fabio Cozzolino Giuseppe Cozzolino Anna Mariniello

Micro-screws in Orthodontics – clinical problems
Fabio Cozzolino Anna Mariniello

An innovative prosthetic-guided Orthodontic technique: case series

An innovative prosthetic-guided Orthodontic technique: case series




A new technique of prosthetic dental abutment movement with individualized fixed resin provisory crowns and resilient material is proposed. Two clinical cases with 4 years of follow up will be showed.

Clinical case 1

A man 26 years old came to our observation, previously treated in the maxillary arch with an incongruous fixed prosthetic therapy, a full arch, after a traumatic event. It was necessary the avulsion of tooth 21 and were prepared dental abutments from tooth 15 to tooth 25 to realize the bridge.

protesi fissa incongrua

This prosthetic therapy appeared aesthetically incongruous because of the shape and colours aberrations of the crowns. In addition to these aesthetic problems, because of which there was the patient request of a new rehabilitation, it appeared a periodontal suffering with probing depth between 4 and 5 mm. Instead satisfactory and compatible with a good periodontal health were the other teeth conditions.
The patient had the tooth 12 agenesis, a tooth 53 persistence and a mesial shift of tooth 13. X-rays showed previously incongruous endodontic therapies on teeth 11, 13 e 22 with cronical periapical diseases.
The clinical examination showed also a vertical bone minus of tooth 53 and an advanced root resorption state of this tooth.

Restoration of a lower incisor periodontal health by means of a selected radicular torque control using a fixed lingual orthodontic: case report

Restoration of a lower incisor periodontal health by means of a selected radicular torque control using a fixed lingual orthodontic: case report




A 25 years old girl previously treated with a fixed orthodontic appliance, has come to the chairside examination becouse of the gum vestibular resorption on tooth 41, with a sensibility increase and the diffucult to keep a good domiciliar oral igyene.

The clinical exam showed a severe gum resorption of this tooth with a buccal movement of the rooth and a traumatic contact with the antagonist because of the extrusion.

There was also a fixed contention in the lower arch from 3.2 to 4.2 that was damaged and repaired a lot of time and because of an inadeguate bonding procedure has became an active retainer. This exerted a couple of forces that generated an incontrolled radicular buccal torque of tooth 4.1.

The treatment provided the removal of the old retainer, a professional oral hygiene and the application of a fixed lingual appliance by means of self ligating i-TT? brackets from 3.4 to 4.4. The purpose was to levell teeth, to remove the traumatic contact, to correct the radicular torque of 4.1 and to re-establish a parodontal health to let a better domicialiar oral hygiene (Figg: 01-05).

i-TTR brackets: A new type of lingual brackets

i-TTR brackets: A new type of lingual brackets




A new type of lingual brackets.


The interesting toward esthetic Orthodontics, since the beginning of application of the first lingual brackets in 1978 by Fujta and Craven Kurz, in the last few years has growth. Patient’s request for orthodontic treatment and the need of an invisible therapy have became more and more frequent. Invisible orthodontics developed to answer to this demands, such as the lingual orthodontic in which brackets are applied on the lingual surface of the teeth.

The i-TTR brackets gave a great contribution to the lingual orthodontics. This brackets coming out from an idea and project of the Professor Aldo Macchi and realized by Rocky Mountain Orthdontics company® (Novaxa) allow to control precise the tree movements of tip, torque and rotation.

The name i-TTR is referred to the possibility of modular control, and from this the acronym, T orque, T ip e R otation.

The i-TTR is a non Edgewise low friction lingual bracket.

It presents two self ligating slots for the insertion of round wires and a rectangular central tube for the insertion of auxiliary sectionals, either for the anchorage or for the active orthodontic movement.

i-TTRlingual brackets


Bindings are not necessary to the insertion and the disconnection of the wire and it is possible to control completely the movement of a singular tooth or of a group of teeth, already in the first phase of treatment with a round wire without insert a rectangular wire.

The bracket is able to work either with low friction or in controlled friction modality, it depends on the section and the number of wires inserted.

The use of these brackets is very simple because there is the same brackets’ design for all the teeth and its application is mistake proof: occlusal and gingival profiles are the same. The molar bracket is not a tube but are used two brackets. It is possible to change the distance of these brackets in relation to the anatomical variability of tooth lingual surface, for a better patient’s comfort and to reduce the thickness of the composite resin.

A new technique for restoring prosthetic space in implant region: a case report

A new technique for restoring prosthetic space in implant region: a case report




In planning treatment of a prosthetic-implant patient, to obtain a propitious prognosis of a long term rehabilitation, a multi-discipline approach is elementary. However, in some cases, despite the commitment to realize an ideal treatment plan, it may happen to face up with an inadequate space when prosthetic procedures start.

Such a likelihood may be due to an occlusive stability lack, erroneously not corrected at the beginning of the treatment, or to the limited compliance of the patient who often does not respect periodical recalls established by the dentist. If there is not a correct occlusive mechanism or adequate space keepers, dental elements near the edentus saddle can carry versions of few mms which bring to significant prosthetic difficulties. In extreme cases, it may be impossible to associate implant-prosthetic components because of an inadequate occlusive space to access the implant neck.

For these cases, by taking advantage of the implant (bone-integrated, it is a steady anchor point and so it cannot move from its position), we created a technique to move dental elements. This idea was born by observing the spaces created mesially and distally to the molars using elastic divisors to insert bands in orthodontics. This technique permits to solve simply problems of space recovery in a non invasive way. It determines an orthodontic movement of uncontrolled inclination suitable for the resolution of these dental inclinations.

Case report

Patient S.R., a 32 year old male, was successfully treated by surgical implant therapy in the 16 area, in order to replace a dental element previously avulsed. A careful analysis of the spaces was carried out during treatment planning to introduce fixture in a prosthetic position optimally guided. Regardless, the patient missed periodical controls and returned 2 years after implant surgery. A mesial version of the element n. 17 was promptly highlighted (fig.1- 2) created during that time period.

Space recovery

Room recovery

This mesial version invalidated the restoring treatment plan, making necessary the distalization of the crown of the element n.17, in order to re-open correctly the prosthetic space. However, the patient refused both the realization of an inlay on the element n.17, necessary to recover at least a part of this space by changing the mesial profile of the tooth, and the traditional orthodontic therapy. Therefore, we proceed to screw a full implant abutment (fig 3) which was intra orally prepared to improve thicknesses in a mesial-distal and occlusive way, necessary to make a final prosthetic manufactured product (fig 4-5-6).

Straumann implant with bone regeneration (GBR) by using Bio-Gide And Bio–Oss

Straumann implant with bone regeneration (GBR) by using Bio-Gide And Bio–Oss






The present case report is aimed at presenting an implant treatment associated with both a simultaneous guided bone regeneration (GBR) and an orthodontic therapy. The complexity of the case required the use of a resorbable Bio-Gide membrane and a bone graft made up of autogenous bone together with Bio-Oss. Simultaneously, an esthetic orthodontic therapy was performed by means of ceramic brackets and miniscrews at the maxillary arch and using an invisible bracketless approach by means of preactivated retainers at the mandibular arch.

It is worth remembering that the type of membrane is a critical factor for the success of bone augmentation procedures. Nowadays, it is widely accepted that only non resorbable Gore-Tex membranes can guarantee a predictable result in complex bone reconstructions. Adequately stabilized resorbable membranes can be considered a viable alternative only in easier clinical cases and in the presence of a good regenerative potential. In order to properly stabilize resorbable membranes, nowadays resorbable pins are available (Resor Pin, Geistlich); differently, operative tips may be adopted, just like the use of membrane strips opportunely cut, as proposed by Prof. Massimo Simion, or creating a hole in the membrane so a sto stabilize it around the implant neck.

As to this clinical case, the patients lamented recurrent abscesses in region 14. First canine and molar class on both sides with a deep bite and mandibular crowding were evidenced.

Straumann implant with guided bone regeneration (GBR) with Bio-gide and Bio-oss
Bio oss

A vertical radicular fracture of tooth 14 was noticed. Such tooth had been previously restored by means of a metal cast post and a metal-ceramic crown; consequently, the extraction of tooth 14 was compulsory.

In order to solve the orthodontic problems, buccal ceramic brackets were used at the maxillary arch together with mini-screws to make the opening of the deep bite faster. On the contrary, pre-activated retainers were used at the mandibular arch, in order to expand the intercanine distance and to line up the anterior mandibular teeth.

Mini screw
Orthodontic screw
Active retainer
Orthodontic retainer

The choice of using brackets at the maxillary arch was due to the necessity of maintain a provisional resin shell in region 14. Such shell was fastened to the orthodontic wire by means of a metal ligature. In order to control the rotation of the resin shell, a continue ligature from tooth 13 to tooth 15 was made alternating the rotation spin mesially and distally to the provisional shell.

As we can also see in further cases in the present blog, to date it is preferable to avoid such a problem in the absence of teeth using rigid orthodontic wires lingually to fasten provisional crowns, so as to perform a bracketless lingual orthodontic therapy also in such cases.

Micro-screws in Orthodontics – clinical problems

Micro-screws in Orthodontics – clinical problems



The use of micro-screws in orthodontic anchorage is becoming more and more frequent in both vestibular and lingual techniques with brackets, and in more aesthetic and comfortable techniques without brackets.

Micro-screw insertion should be considered a surgical procedure as erroneous handling of the bone can easily lead to an inflammatory reaction around the screws and incorrect positioning can lead to their loosening.

Thus, in an attempt to make things clearer and to answer questions we have been asked by many of our colleagues, we can make a list of the problems that can be encountered and also share our experience in solving them.

The main problems which we can encounter when inserting a micro-screw are:

  1. Premature loosening of the micro-screw;
  2. An inflammatory reaction around the micro-screw with subsequent expulsion of the latter and the simultaneous loss of a small quantity of bone mass around the micro-screw;
  3. Micro-screw breakage;
  4. Periodontal damage when we “touch” the dental element with the micro-screw;
  5. Damage to anatomical structures close to the insertion site (vascular, neural and maxillary sinus);
  6. Decubitus ulcer on the alveolar mucosa and buccal mucosa, which often develops, above all, in the inferior dental arch.