Today I would like to break the series of theoretical post with a purely clinical one, sharing my first case with Insignia, the customized vestibular braces system that I chose for my practice - not that many alternatives are on the market as it’s the only one at present =)As with any new appliance that I use, I selected an easy case to start with
Today I would like to break the series of theoretical post with a purely clinical one, sharing my first case with Insignia, the customized vestibular braces system that I chose for my practice - not that many alternatives are on the market as it’s the only one at present =)As with any new appliance that I use, I selected an easy case to start with. The idea of selecting an easy case, is that I could easily find an alternative solution in case of failure of the new device. It’s a motto that my mentor, Dr Redento Peretta, thought me and I apply in any occasion where I’d like to test a new product (that is pretty often!).I present the case of this young patient that came to me for some minor crowding and a slightly increased overjet. She was the perfect patient on which to try with confidence this new customized bracket system.Initial photos and x-rays.
Setup. I planned:
Treatment progression. In light blue the months of therapy, in red numbers the appointments. The treatment lasted 11 months.Stock Damon .013 and .016 wires were used in the first 3 months. Thereafter only the customized arches from Insignia were used.
Progression. 3 months of treatment / 3rd appointment. The crossbite is corrected before the .014x.025 CuNiTi wires.
Progression. 5 months of treatment / 4th appointment. With .018x.025 CuNiTi arch coordination starts.
Progression. 8 months of treatment / 6th appointment. Working with CLII elastics
Progression. 11 months of treatment / 9th appointment ->Debonding
Final panoramic x-ray. It would have been better to take it before debonding to assess for the mesial tip of the root of 1.3 before debonding. The crown of the upper right canine did not allow to imagine that the root could have been that mesially tipped.May this be a limit of the library root that are manually linked to the crowns during the setup?Or just my first experience?
Final lateral x-ray and superimpositions. I was lucky that some residual growth was there during the period of treatment with braces and some CLII elastics. The overbite and overjet were diminished and matched to the planned values.
Final photos. The unpleasant increased overjet and the profile were corrected due to CLII elastics and residual growth. The smile was improved even if the 1.2 is showing a not ideal correction. A torque bend would have for sure been helpful.
Treatment sequence. The treatment finished into 11 months and 9 appointments.The first 7 months were spent into levelling and aligning. The .013 and .016 wires were CuNiTi Damon arch form stock wires. Wire customization is negligible during the first light wires. The cross-bite was corrected during the first 3 months with Chipmunk elastics (1/8" 3,5oz) before to install the .014x.025 CuNiTi. From rectangular wires on, the arch was customized according to the arch form that I approved in the setup.CLII correction started with stainless steel wire and was accomplished in three months with the help of Impala elastis (3/16" 6 oz).Rebracketing was necessary to adjust minor discrepancies before debonding.
Take home message. From my first Insignia case I learned that: