lingual & esthetic orthodontics

21
Lingual & Esthetic Orthodontics Edited by Rafi Romano Associate editors: Silvia Geron and Pablo Echarri London, Berlin, Chicago, Tokyo, Barcelona, Beijing, Istanbul, Milan, Moscow, New Delhi, Paris, Prague, São Paulo, Seoul and Warsaw

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Page 1: Lingual & Esthetic Orthodontics

Lingual & Esthetic Orthodontics

Edited by Rafi RomanoAssociate editors: Silvia Geron and Pablo Echarri

London, Berlin, Chicago, Tokyo, Barcelona, Beijing, Istanbul, Milan,

Moscow, New Delhi, Paris, Prague, São Paulo, Seoul and Warsaw

Page 2: Lingual & Esthetic Orthodontics
Page 3: Lingual & Esthetic Orthodontics

v

Lingual & Esthetic Orthodontics

Introduction and Acknowledgments ix

Section I: The Lingual Appliance: Brackets, Wires and Accessories 1

Chapter 1 Development of the In-Ovation L Bracket from GAC 3Carlos F. Navarro, Marco A. Navarro, Jorge A. Villanueva

Chapter 2 New Horizons in 2D Lingual Orthodontics 15Vittorio Cacciafesta

Chapter 3 The Stealth System, Today and in the Future 29Antonio Veneziani (with the cooperation of Paolo Morandotti)

Chapter 4 magic®: Treatment Efficiency Meets Patient Comfort 41Rubens Demicheri

Chapter 5 ORG Lingual Brackets 67Rafi Romano and Silvia Geron

Chapter 6 STb: The Light Lingual System 73Luca Lombardo

Chapter 7 The Phantom Bracket: Lingual Self-ligation and Esthetics 87Thomas W. Örtendahl

Chapter 8 Lingual Orthodontic Cases Treated with Original Hiro Brackets 95Toshiaki Hiro

Contents

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vi Contents

Lingual & Esthetic Orthodontics

Chapter 9 Self-ligation and Traditional Ligation in Lingual Orthodontics: Pros and Cons 125Alfredo Gilbert

Chapter 10 Customized Brackets and Archwires for Lingual Orthodontic Treatment 147Rafi Romano

Chapter 11 3D Interactive Treatment Planning and Patient-Specific Appliances 157Craig A. Andreiko

Chapter 12 The Manufacturing Process for LingualJet 167Pascal Baron, Christophe Gualano, Laurent Sempe, Ari Sciacca, and Geoffrey Hall

Chapter 13 Self-ligating Brackets in Lingual Orthodontics 181Hatto Loidl

Chapter 14 The Evolution Bracket: Clinical Experience 193Manabu Nakagawa

Chapter 15 Instruments Used in Lingual Orthodontics 199Victoria Burdess

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viiContents

Lingual & Esthetic Orthodontics

Section II: Updated Laboratory and Simulation Techniques 207

Chapter 16 Digital Advancements in Lingual Orthodontics and Laboratory Procedures 209Ari Sciacca

Chapter 17 Orapix System in Lingual Orthodontics 219Carla Maria Melleiro Gimenez

Chapter 18 Indirect Bonding Technique in Lingual Orthodontics: The Hiro System 239Toshiaki Hiro

Chapter 19 In-house Lingual Bracket Transfer Systems 255Alfredo Gilbert

Chapter 20 A Modified Hiro System Within a Laboratory Sequence 275Peter Taylor

Chapter 21 Lingual Plain-Wire Appliance System 289Hee-Moon Kyung

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viii Contents

Lingual & Esthetic Orthodontics

Section III: Mechanics: from Alignment to Finishing 307

Chapter 22 Tooth-Size Discrepancies and Stripping 309Carlos F. Navarro, Marco A. Navarro, Jorge A. Villanueva

Chapter 23 How to Control the Vertical Dimension with Lingual Orthodontics 325Silvia Geron

Chapter 24 Theoretical Analysis of Maxillary Incisor Movement due to Anteroposterior Force: Labial vs Lingual 349Tamar Brosh

Chapter 25 Interdisciplinary Treatment with Lingual Orthodontics 361Asif Chatoo

Chapter 26 Combining Lingual Orthodontics With Surgery 379Joan-Pau Marcó

Chapter 27 The Customized Hiro Transfer System 399Hatto Loidl

Chapter 28 Microimplant Anchorage in Lingual Orthodontic Treatment 407Hee-Moon Kyung

Chapter 29 Microimplants and Lingual Orthodontics 427Pablo Echarri

Chapter 30 Lingual Orthodontics in a Multidisciplinary Practice 461Laura Buso Frost

Chapter 31 Finishing with Lingual Orthodontics 489Silvia Geron

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ixContents

Lingual & Esthetic Orthodontics

Section IV: Tips and Tricks in Lingual Treatment 509

Chapter 32 Paradigms in Lingual Orthodontics 511Julia Harfin

Chapter 33 Problems, Their Solutions, and Some Clinical Tips 529Henrique Valdetaro

Chapter 34 Clinical Considerations for the Establishment of Facial Balance and Harmony 563Toru Inami

Chapter 35 Aluminum Oxide: To Use or Not To Use? 581Rita Thurler

Chapter 36 Speech and Language Therapy: The Key to Functional Control and Relapse Avoidance in Lingual Orthodontic Treatments 593Diana Grandi

Chapter 37 Rotated Teeth in Lingual Orthodontics: Problems and Solutions 609Silvia Geron and Rafi Romano

Chapter 38 It’s All in Your Hands: Food for Thought 617Federico I. Marconi Jr.

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x Contents

Lingual & Esthetic Orthodontics

Section V: Clear and Esthetic Appliances 631

Chapter 39 Invisalign: Effective and Accurate Treatment of a Variety of Malocclusions 633Willy Z. Dayan

Chapter 40 Lingual Orthodontics in Class II and Class III Malocclusions: The Microimplant-Supported Pendulum and Mechanics 649Lorenzo Favero and Vittorio Favero

Chapter 41 Clear Aligner: Its Application and Combined Treatment with Lingual Brackets 663TaeWeon Kim

Section VI: Future of Lingual Orthodontics 677

Chapter 42 Future of the Lingual Orthodontics Technique 679Rafi Romano

Index 685

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xi

Lingual & Esthetic Orthodontics

Introduction and Acknowledgments

Introduction and AcknowledgmentsAlthough only just over a decade has passed since our first lingual book (Lingual Orthodontics, B.C. Decker, 1998), myriad changes have occurred in lingual orthodontic techniques: numerous new brackets have been presented by various companies, including individualized computerized techniques; laboratory techniques have been upgraded and protocols are more detailed and simple; and biomechanics have been thoroughly investigated. As a result, lingual orthodontics has gained popularity and become part of the daily routine in many clinics.

At the same time, a different esthetic option has emerged: clear aligners (Invisalign and the like). This has challenged practitioners to ascertain the true advantages of the lingual technique over other esthetic alternatives. The demand for esthetic treatment is constantly growing – a trend that will doubtless continue. Yet, the lingual technique still consti-tutes only a niche and lingual practitioners are still an exclusive group, meeting each other at the few meetings held worldwide.

Although research and information on the lingual technique is still deficient, this book presents probably the most up-to-date information available to the clinician. It covers not just a specific bracket or a specific technique, but the entire scope of options and information available.

Thirty-four of the best clinicians from around the world, who practice lingual orthodontics on a daily basis, have contributed their experiential knowledge in the most objective, noncommercial manner. The book does not aim to direct the orthodontist toward a specific treat-ment modality, but rather to review innovations in the technique and to serve as a reference source, which to date has unfortunately been lacking for the lingual clinician.

The book has been written and edited in a very short period of time, to render it as up-to-date as possible. Being free of commercial

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xii

Lingual & Esthetic Orthodontics

Introduction and Acknowledgments

constraints, I believe the book presents orthodontists with the broadest perspective and range of updates on the lingual technique.

On a personal note, my lingual practice began soon after I com-pleted my postgraduate programme. I was advised by a good friend in France to adopt this unique esthetic technique, and with his help I met Dr Didier Fillion, who then was already one of the gurus of the technique. Dr Fillion’s enthusiasm and exclusive dedication to lingual treatment inspired me and was one of the major reasons for editing my first textbook.

Over the years, I have gained numerous personal friends within this field of orthodontics, many of whom gladly accepted my invitation to contribute to this textbook. I thank them most sincerely and pro-foundly for their commitment and motivation. Special thanks go to my associate editors, Dr Silvia Geron and Dr Pablo Echarri.

I am deeply grateful to Quintessence Publishing, especially to the publisher Dr H. W. Haase and his son, Mr C. W. Haase, for their con-tinued support. This is my third book to be published by Quintessence, and I have also been appointed Editor-in-Chief of ORTHODONTICS: The Art and Practice of Dentofacial Enhancement (formerly WJO) by Quintessence Publishing.

I thank my personal assistant, Evelyn Rosenberg, and last but not least my beloved family: my father, Dr Albert Romano, also a dentist, who inspired me and followed my developing career; my wife, Michal; and our four children, Emily, Lee-Ann, Illy, and Adam.

Rafi Romano, DMD, MSC

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ICarlos F. Navarro

Marco A. NavarroJorge A. VillanuevaVittorio Cacciafesta Antonio VenezianiRubens Demicheri

Rafi RomanoSilvia Geron

Luca LombardoThomas W. Örtendahl

Toshiaki HiroAlfredo Gilbert

Craig A. AndreikoPascal Baron

Christophe GualanoLaurent Sempe

Ari SciaccaGeoffrey Hall

Hatto LoidlManabu Nakagawa

Victoria Burdess

The Lingual Appliance:

Brackets, Wires and Accessories

Page 12: Lingual & Esthetic Orthodontics

78 Luca Lombardo

The Lingual Appliance:Brackets, Wires and

Accessories

Social Six Treatment

The so-called Social Six treatment is a clinical procedure proposed by Scuzzo and Takemoto for the correction of all malocclusions with slight to moderate crowding or diastemata limited to the anterior portion of the maxillary and mandibular dentition. This is an invisible treat-ment, which necessitates no patient collaboration and limited chair-side time; patient comfort is favored due to the use of small brackets (STbs) attached only to incisors and canines and, in a small number of cases, the first premolars.

Social Six generally involves the use of round, very light wires; it cannot be used in cases requiring torque control of one or more den-tal elements. Thus, the bracket positioning in this technique does not require complex laboratory procedures, and can therefore be performed by the orthodontist directly on the malocclusion model of the patient (simplified indirect bonding). Bracket transfer is then carried out by means of transfer masks; Scuzzo and Takemoto suggest that this is per-formed using thermoplastic glue to optimize precision.

The first archwire to be positioned must be very resilient (0.012 or 0.013-inch Ni-Ti or copper-nickel-titanium (Cu-Ni-Ti)) to ensure light forces and rapid dental movements, and will remain in place for a period of 5–16 weeks. If necessary, posttreatment finishing can be carried out using a more rigid wire (0.016-inch Ni-Ti or TMA (beta-titanium)).

Figures 6-4 to 6-11 illustrate a case of Class I dental malocclusion with maxillary and mandibular diastemata treated via Social Six with STb brackets. Figures 6-4 to 6-6 show the pretreatment situation.

After an initial phase of tooth alignment using a 0.012-inch Ni-Ti archwire (Fig 6-7), spaces were closed using elastic chains on a more rigid 0.016-inch TMA archwire (Fig 6-8). Figures 6-9 to 6-11 show intraoral and extraoral images after treatment.

ca b

Fig 6-4 (a to c) Case 1: Extraoral initial photographs.

Page 13: Lingual & Esthetic Orthodontics

79STb: The Light Lingual System

The Lingual Appliance:Brackets, Wires and Accessories

Fig 6-5 (a to e) Case 1: Intraoral initial photos.

ca b

ed

a

b

Fig 6-6 (a, b) Case 1: Orthopantomogram and lateral cephalogram before treatment.

Fig 6-8 (a, b) Case 1: Space closure. ba

Fig 6-7 (a, b) Case 1: Tooth alignment using a 0.012-inch Ni-Ti archwire. ba

Page 14: Lingual & Esthetic Orthodontics

228 Carla Gimenez

Updated Laboratory and Simulation

Techniques

4. Virtual bracket positioningOnce the virtual setup is completed in the software library, the selection of virtual lingual brackets is processed. All brackets will initially appear in the same virtual plane, parallel to the occlusal plane (Fig 17-15), and will be moved as a group to arrange the composition according to conventional bracket placement (mushroom archwire) (Fig 17-16) or lingual straight archwire (without in-out bend) (Fig 17-17). It is then possible to move each bracket individually to refine bracket positioning (Figs 17-18 and 17-19).

The brackets can be moved vertically to find the ideal height, with lateral movements providing the ideal inclination, and in the sagittal plane to achieve the shortest distance between the bracket base and the enamel surface to obtain the smallest resin pads possible (Fig 17-20). The program

Fig 17-13 (left) Anterior view of the dental arches in occlusion and the contact points – collision test.

Fig 17-14 (right) Posterior view of the dental arches in occlusion and the contact points – collision test.

Fig 17-15 (left) Bracket pos-itioning on the virtual setup.

Fig 17-16 (right) Bracket pos-itioning for a mushroom archwire.

Fig 17-17 (left) Bracket pos-itioning for a straight archwire.

Fig 17-18 (right) Adjustment for bracket positioning in a 3D view.

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229Orapix System in Lingual Orthodontics

Updated Laboratory and Simulation Techniques

makes it possible to check whether the lingual brackets respect the teeth limits and whether there are any interferences when the maxillary and man-dibular arches are in occlusion (Fig 17-21) and adjustments can be made.

When mushroom archwires are used, the incisor brackets are rela-tively far from the lingual surfaces because their positions depend on the thickness of the canines (Fig 17-22). In the lingual straight-wire technique, the position of the incisor brackets no longer depends on canine thickness. The incisor brackets are placed with the maximum possible contact with the lingual surfaces (Fig 17-23). To eliminate the bends between canine and premolar, the canine brackets must be placed in rotation (Fig 17-24) (distal offset); likewise, to eliminate the bends between premolar and molar, the second premolar brackets must sometimes be slightly in rotation (according to the thickness of the first molars).

Fig 17-19 (left) 3D bracket individualization.

Fig 17-20 (right) The resin pad can be minimized by adjusting the bracket positioning.

Fig 17-21 (left) Checking bracket positioning with the arches in occlusion.

Fig 17-22 (right) Clinical view showing resin pad sizes for incisor brackets with a mushroom archwire.

Fig 17-23 (left) Clinical view showing resin pad sizes for incisor brackets with a straight archwire.

Fig 17-24 (right) Canine brack-et in slight rotation for straight-wire technique.

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456 Pablo Echarri

Mechanics: from Alignment

to Finishing

Fig 29-84 Molar intrusion.

Fig 29-85 Detailing and finish-ing.

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457Microimplants and Lingual Orthodontics

Mechanics: from Alignment to Finishing

Deep-bite cases

For the treatment of deep-bite cases with the intrusion of the incisors, the following is the protocol23:1. Indirect bonding of the lingual brackets and tubes to all maxillary

and mandibular teeth.2. A 0.016-inch Ni-Ti archwire for alignment and leveling and a

0.0175 × 0.0175-inch TMA archwire for torque control (Fig 29-86).3. Insert a microimplant between the roots of the central and lateral

incisors in the labial side and bond labial ceramic or plastic buttons onto the labial surface of the upper incisors (Figs 29-87 and 29-88).

4. Intrusion of the upper incisors, using elastic chain or light elastics (3.5 oz and 1/8 inch) from the microimplants to the labial buttons (Fig 29-89)

5. Detailing and finishing with a 0.016-inch stainless steel or TMA archwire (Fig 29-90).

ConclusionMicroimplants enable more effective mechanics, which facilitates labial and lingual orthodontics and therefore reduces the treatment time.

Fig 29-86 Lingual brackets and labial buttons.

Page 18: Lingual & Esthetic Orthodontics

566 Toru Inami

Tips and Tricks in Lingual Treatment

4 measurements of the Tweed analysis and 4 measurements of the Powell analysis (Fig 34-2).

ResultsMean values of the pretreatment and posttreatment cephalometric measurements of the two groups were compared and tested for statistical significance (Table 34-1).1. Many subjects in the straight group had maxillary protrusion with

protrusive A point, while there was a greater proportion of the high-angle and Class II malocclusions with retrognathic mandibles in the convex group.

2. ANB angle was successfully reduced in the straight group, while ANB angle reduction was difficult in the convex group.

3. It was possible to retract point A, but very difficult to advance point B in both groups.

4. There were no significant changes in FMA or SN-M angle in either group, indicating that the mandibular plane angle was main-tained without opening during lingual treatment.

Summary of the StudyClass II malocclusions can be categorized into two clinical types, accord-ing to the profile changes obtained with treatment:• straight type with profile improvement: Class II malocclusion due

to maxillary protrusion with protrusive A point

Fig 34-2 (a) Powell cephalometric analysis. (b) Steiner and Tweed cephalometric analysis.

Powell Analysis

mentocervical:80~95°

nasolabial:90~120°

nasomental:120~132°

nasofrontal: 115~130°

nasofacial: 30~40°

Steiner Analysis • Tweed Analysis

FMA

U lip to E line

L lip to E line

L1 to NB

Po to NBGo–Gn to SN

Occl. to SN

U–1 to NA

U1 to L1

SNASNBANBSND

SE SL

FMIA Z angle

IMPAa b

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567Clinical Considerations for the Establishment of Facial Balance and Harmony

Tips and Tricks in Lingual Treatment

• convex type without profile improvement: Class II malocclusion due to a retrognathic mandible (particularly with a high-angle, dolichofacial pattern).

The following clinical criteria for achieving facial balance and harmony should be considered in planning lingual orthodontic treatment.• Clinical criterion 1: A proper interincisal angle should be estab-

lished by adequately uprighting madibular incisors, which neces-sitates the application of good lingual root torque to the maxillary incisors to prevent them from rabbiting.

Straight group Convex group

Pre-Tx Pre-Post significance

Post-Tx Pre-Tx Pre-Post significance

Post-Tx

Pre S-C significance

Post S-C significance

SNA 85.4 0.008** 84.6 82.3 0.006** 81.6 0.013* 0.017*SNB 79.8 0.356 79.7 75.4 0.149 75.1 0.001** 0.001**ANB 5.6 **0.001 4.9 7.0 0.084 6.5 0.071 0.033*SND 76.5 0.245 76.6 71.5 0.200 71.3 0.001** 0.000**U1 to NA (mm) 7.2 0.000** 3.7 8.0 0.000** 3.4 0.256 0.381U1 to NA (degrees) 27.7 0.000** 15.6 30.8 0.000** 14.2 0.170 0.284L1 to NB (mm) 9.6 0.000** 6.9 13.5 0.000** 9.2 0.001** 0.001**L1 to NB (degrees) 31.7 0.009** 27.9 39.6 0.001** 29.0 0.008** 0.332Po to NB 0.3 0.001** 1.3 –1.5 0.048* –1.3 0.008** 0.001**Po & L1 to NB 9.3 0.000** 5.6 15.0 0.000** 10.5 0.001** 0.000**U1 to L1 115.0 0.000** 131.7 102.7 0.000** 130.4 0.014* 0.353Occl to SN 17.0 0.021* 18.1 20.4 0.021* 22.5 0.064 0.027*Go-Gn to SN 37.5 0.462 37.6 46.5 0.069 47.0 0.001** 0.000**SL (mm) 46.3 0.152 46.3 36.7 0.062 35.9 0.006** 0.001**SE (mm) 19.6 0.133 19.3 19.8 0.005** 19.4 0.448 0.499U-lip to E-line 1.2 0.000** –2.3 4.5 0.000** 1.5 0.000** 0.000**L-lip to E-line 3.6 0.000** –0.3 7.6 0.000** 3.7 0.001** 0.000**FMA 32.3 0.457 32.3 39.3 0.102 39.8 0.002** 0.001**FMIA 53.3 0.011* 57.4 42.8 0.001** 53.0 0.002** 0.039*IMPA 94.4 0.013* 90.3 97.9 0.001** 87.1 0.166 0.153Nasofrontal 137 0.293 136.3 135.2 0.158 133.6 0.176 0.112Nasofacial 33.7 0.5 33.7 38.3 0.268 38.0 0.000** 0.001**Nasomental 129.2 0.254 129.7 124.0 0.181 124.7 0.005** 0.007**Mentocervical 95.5 0.043* 91.2 99.5 0.043* 95.9 0.178 0.143Nasolabial 98.4 0.004** 107.2 106.2 0.003** 113.5 0.061 0.035*

Student t-test, * P < 0.05 ; **P < 0.01.

Table 34-1 Results. The official approval of mean value and significant difference

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640 Willy Z. Dayan

Clear and Esthetic Appliances

images for a successful case of leveling of curve of Spee and deep bite with Invisalign, with no refinements or auxiliary treatment.

The ClinCheck treatment plan (Fig 39-10) to create this leveling and room for restorations (Fig 39-11) was specified with overcorrection, just as would be the case with an accentuated reverse-curve archwire.

The experienced Invisalign clinician learns to think of the white surfaces of the teeth (or edges of attachments) as the force application surfaces and not necessarily as teeth positions in some types of move-ments.

Treatment of Class II MalocclusionClass II correction is a very common challenge faced by clinical ortho-dontists. Class II correction for the nongrowing or adult patient poses an even more complex set of clinical obstacles. Clinicians are encouraged to not alter their Class II treatment philosophy. Instead, clinicians should use Invisalign as a tool in their armamentarium. The treatment of Class II malocclusion in an adult is illustrated below. The author’s philoso-phy is to approach the case with a technique to first correct the Class II molar relationship, and then later to correct the crowding and deep bite elements of the case. This has been the approach used for many cases. Clinicians may choose to distalize molars with other appliances, such as the Distal Jet™, Pendulum, T Rex™, Frog™, Celtin™, or Carriere™. All these appliances can be incorporated into Invisalign treatment. The clinician sets up the case using the appliance(s) of choice and then incor-porates Invisalign to help obtain individual ideal treatment goals. The advantage of continuing to treat cases in the same way the clinician has in the past is that the only element that has changed is the Invisalign tool. This allows the clinician to compare the effectiveness of Invisalign with his or her previous experiences.

The case illustrated in Fig 39-12 is a typical Class II adult case that was corrected with Invisalign. Treatment began with a maxillary remov-able appliance (distalization screws) with adjunct anchorage provided by

Fig 39-11 (right) Clinical result of ClinCheck overcorrection ordered in Fig 39-10.

Fig 39-10 (left) ClinCheck with overcorrection of deep anterior overbite.

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641Invisalign: Effective and Accurate Treatment of a Variety of Malocclusions

Clear and Esthetic Appliances

Class II elastics (supported by a mandibular vacuum-formed retainer), as shown in Figs 39-13 and 39-14.

Once the maxillary molars were distalized, Invisalign could be used to sequentially distalize the premolars and then the anterior teeth, thus decreasing the overjet and correcting the dental Class II malocclusion. Note that with braces, patients use Class II elastics to avoid anchorage loss during this second phase of correction; this is also the case with Invisalign, where Class II elastics are used from the mesial aspect of the maxillary canines to bonded buttons on the mandibular second molars (Fig 39-15; however note that this figure shows a different case, to demonstrate the use of elastics with Invisalign).

Fig 39-12 (a, b) Before treat-ment of Class II, division 2, mal-occlusion.

Fig 39-14 (right) Class II elas-tics to lower buttons with lower Essix retainer.

Fig 39-13 (left) Maxillary removable appliance to distalize molars.

a b

Fig 39-15 (a, b) Class II elastics to lower buttons during Invisalign.

a b