Journal of Clinical Orthodonics

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PEARLS

Extraction Letter

CARLOS MARTINS COELHO FILHO, DDS, MSD

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A patient is often anxious to start orthodontic treatment before it is possible to write a consultation letter to his general dentist. On such occasions, if extractions are needed, this form is useful. It is filled out at the consultation appointment and hand-delivered to the dentist by the patient. The dentist then has written verification of the teeth to be extracted, with no possibility of misunderstanding and no need for an embarrassing phone call to ask "which teeth am I supposed to remove?" We have these forms padded, and of course, we keep a copy.

Thanks to Dr. Jack Green, Jr., of Myrtle Beach, South Carolina, for contributing this Pearl.If you have a Pearl to share with your colleagues, send it to Dr. Jerry Clark, 409 Parkway, Greensboro, NC 27401.

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Fig. 1 Mandibular Protraction Appliance No. 1 with stops placed in mandibular archwire distal to cuspids.

Fig. 2 Small loop bent at right angle to end of .032" stainless steel wire.

Fig. 3 Appliance length measured from mesial of maxillary tube to mandibular archwire stop with mandible in proper protruded position.

Fig. 4 Small right-angle loop bent in opposite direction into other end of .032" stainless steel wire.

Fig. 5 Circles closed with plier after appliance placement.

Fig. 6 A. Appliance slides distally along mandibular archwire and mesially along maxillary archwire upon opening. B. Buccal offset in lower archwire to allow clearance for sliding.

Fig. 7 MPA No. 2 made with right-angle circles in two pieces of .032" stainless steel wire.

Fig. 8 Coil of .024" stainless steel wire slipped over one wire.

Fig. 9 One end of each wire inserted through other wire's loop.

Fig. 10 Travel of each wire limited by wire coil.

Fig. 11 Improper relationship of wires is prevented by coil.

Fig. 12 Maxillary archwire has occlusally directed circles against molar tubes; mandibular archwire has occlusal circles 2-3mm distal to each cuspid.

Fig. 13 Measurement between mesial surface of maxillary molar tube and mandibular circle.

Fig. 14 Appliance length transferred to wire assembly; attachment loops bent in wire ends for maxillary and mandibular occlusal circles.

Fig. 15 Attachment loops inserted into archwire circles and squeezed closed.

Fig. 16 Patient before and after placement of MPA No. 2.

Fig. 17A Case 1. A. 11-year-old female before treatment.

Fig. 17BCD Case 1. B. After placement of MPA No. 1. C. After 22 months of treatment. D. Three years and 10 months after debonding.

Fig. 17EFGH Case 1. E. Before treatment. F. After 22 months of treatment. G. Three years and 10 months after debonding. H. Superimposition of pretreatment (black) and post-retention (red) tracings.

Fig. 18AB Case 2. A. 12-year-old male before treatment. B. After placement of MPA No. 1.

Fig. 18CD Case 2. C. After 16 months of treatment. D. 22 months after debonding.

Fig. 18EFGH Case 2. E. Before treatment. F. After 16 months of treatment. G. 22 months after debonding. H. Superimposition of pretreatment (black) and post-retention (red) tracings.

Fig. 19AB Case 3. A. 12-year-old male before treatment. B. After placement of MPA No. 1.

Fig. 19CD Case 3. C. After 18 months of treatment. D. Three years after debonding.

Fig. 19EFGH Case 3. E. Before treatment. F. After 18 months of treatment. H. Superimposition of pretreatment (black) and post-retention (red) tracings.

Fig. 20AB Case 4. A. 11-year-old female before treatment. B. After 21 months of treatment.

Fig. 20C Case 4. C. Three years and seven months after debonding.

Fig. 20DEFG Case 4. D. Before treatment. E. After 21 months of treatment. F. Three years and seven months after debonding. G. Superimposition of pretreatment (black) and post-retention (red) tracings.

CARLOS MARTINS COELHO FILHO, DDS, MSD

Dr. Filho is in the private practice of orthodontics at Rua do Alecrim, 415, sala 111, 65010-040 Sao Luis, Maranhao, Brazil.

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