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1© Dr. Franco Bruno and
The MULTI ApplianceUser GuideDr. Franco Bruno -- ARONA
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© Dr. Franco Bruno and
INDEX¡ Introduction
¡ The Multi Appliances¡ Multi-S®
¡ Multi-T®& T2¡ Multi-P®& P2¡ Multi DB¡ Multi-TB®
¡ Indication
¡ Contraindications
¡ Diagnostic Tools
¡ Management Tools
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INTRODUCTIONWhat’s a Multi Appliance?
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The Multi Appliances¡ The Multi appliances are pre-formed elastodontic orthodontic devices
made in medical silicon
¡ They can be used as¡ an elasto removable appliance for straightening the teeth¡ as a functional appliance for correcting skeletal class 2 problems¡ as a myofunctional appliance for muscles and tongue education
¡ The advantage is that is possible to make the 3 things in the same time.
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The Multi System¡The Multi Appliances are an integrated system of appliances that allow the orthodontists to choose the ideal appliance according to the age and the malocclusion of the patients
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Multis’ Main Features¡ Silicone
¡ Monobloc
¡ Buccal Shield
¡ Inner Protection
¡ Stabilization Line
¡ Holes
¡ Teeth Tracks
¡ Bite Plane
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Pre-Formed¡ No Impressions Needed
¡ Ready to Use
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Silicone¡ NO Allergies
¡ Easy to Clean and Sanitize
¡ Modifiable
¡ Mechanical Predictable
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Monoblock¡ Acts on the upper and lower teeth in the same time
¡ The patient has to keep the mouth closed
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Protrusion¡ Open and advanced mandibular position
¡ TMJ Unlocking
¡ Class 2 Correction
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Buccal Shields¡ Perioral muscles stretch
¡ Class 2 correction
¡ Mouth Breathing correction
¡ Habits correction
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Inner Protection¡ Tongue Reeducation
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Stabilization Line¡ Stabilize the Appliance
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Holes¡ Breathing
¡ Increase the elasticity in the anterior part of the bite for a better deepbite correction
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Teeth Tracks¡ Breathing
¡ Increase the elasticity in the anterior part of the bite for a better deepbite correction
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Soft Bite-Plane¡ Self-Adapting
¡ TMJ protection
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The Multi SystemOnly 5 Appliances
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The Multi-S®
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1 SIZE
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The Multi-S®(ECXS)
¡ Age: from 4 to 7 y.o.
¡ Teeth Guidance: upper and lover incisors
¡ Soft Silicon
¡ Indications¡ Deciduous Teeth¡ Early Mix Dentition¡ Early Lower Crowding¡ DeepBite in Deciduous¡ Thumb Sucking
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1 SIZE
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The Multi-T
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1 SIZE
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The Multi-T® (ECXT)
¡ Age: from 8 to 12 y.o.
¡ Teeth Guidance: upper and lover incisors + canines
¡ Indications¡ Early and Late Mix Dentition¡ Lower Crowding¡ DeepBite¡ Class 2¡ Thumb Sucking¡ Tongue Reeducation
1 SIZE
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Multi-T2 (ECXT2)¡ Extended molar region¡ Optimized overjet correction¡ Enlarged upper and lower labial shields¡ Improved lip bumper shape
1 SIZE
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The Multi-T2
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1 SIZE
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The Multi-T® (ECXT2)
¡ Age: from 8 to 12 y.o.
¡ Teeth Guidance: upper and lover incisors + canines
¡ Extended molar region
¡ Optimized overjet correction
¡ Enlarged upper and lower labial shields
¡ Improved lip bumper shape
1 SIZE
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The Multi-P®& P2
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The Multi-P25
Short 10Short 15Short 20Short 25Short 30
Short 20Short 25Short 30
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The Multi-P2 26
Low/High 35Low/High 40Low/High 45Low/High 50Low/High 55Low/High 60Low/High 65Low/High 70
Short & LONG
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Special Ruler (ECXPSIZER for Multi-P®)
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(XPSIZER for Multi-P2)
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How to use the ruler¡ Measures the perimeter of the upper incisors
¡ Indicates the corresponding size
¡ In case of crowding use 1 or 2 size more
¡ In case of diastemas use 1 size smaller
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Fit Multi-P or P2 on the patientand check that the teeth sit properly in the guides
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Multi-P® Selection
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Place the elevated marker between the left maxillary lateral incisor and canine.
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Multi-P® Selection
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Read the scale between the right maxillary lateral incisor and the mesial surface of the canine
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Multi-P® Usage
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If you don’t need distalizing forces: the canine’s cusp has to stay in the middle of the slot
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Multi-P® Usage
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In crowded cases: the canine cusp has to be ½ mm mesial for pushing it distally
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Multi-P® Usage
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If the canine is out of the guide the appliance does not drive the teeth properly
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The Multi-DB
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The Multi-DB¡ Age: from 11 to 14 y.o.
¡ Teeth Guidance: upper and lower incisors, canines, first premolar
¡ Incisal Reinforcement for DeepBite
¡ Indications¡ Late Mix Dentition¡ Permanent Teeth¡ Class 2¡ DeepBite¡ OpenBite
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2 LengthsSizes
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Multi-DB Low Volume¡ Normofacial Patients
¡ Brachifacial Patients
¡ 16 Sizes
¡ 2 lengths: short and long
¡ Incisal reinforcement for Deepbite
Short SizeXPNLS35R 35XPNLS40R 40XPNLS45R 45XPNLS50R 50XPNLS55R 55XPNLS60R 60XPNLS65R 65XPNLS70R 70
Long SizeXPNLL35R 35XPNLL40R 40XPNLL45R 45XPNLL50R 50XPNLL55R 55XPNLL60R 60XPNLL65R 65XPNLL70R 70
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The Multi-TB®
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The Multi-TB® (ECXPSIZER)
¡ Age: 8 y.o. and older
¡ Use with Braces
¡ Teeth Guidance: NO
¡ Indications¡ Deep Bite¡ Tongue Trust¡ Class 2 1 SIZE
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Indications
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Treatment Time¡ From 9 to 18 months¡ Crowding: 8 – 10 months¡ Deep-Bite: 8 – 12 months¡ Class 2: 12 – 18 months
¡ Minimum wear: night-time plus 2 hours / day
¡ Ideal wear: 14 hours / day
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Indications¡ Multi Appliances corrects overbite around of 0.5
mm/month
¡ Multi-S® corrects overjet around 0.3 mm/month
¡ Multi-T®& T2 and Multi-P®& P2 corrects overjet around 0.5 mm/month
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Drawbacks¡ Are not recommended for patients with a history of
severe TMJ problems
¡ Multi-T®& T2/ Multi-P®& P2 : are not recommended for cases with undeveloped root apices in the incisal segments (use Multi-S)
¡ Are not recommended in cases of congenitally missing incisors, extra or impacted permanent teeth
¡ Are not recommended in cases with more than 4 mm. of incisal diastema of the upper incisors
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Drawbacks¡ Are not recommended in cases with severely tapered
or square shaped arch forms or super large archform (ovoid)
¡ Are not recommended if there is less than 3 mm of free protrusion starting from the teeth to teeth position
¡ Are not recommended in cases with forward condile position
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Tip & TricsClinical Use
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Expansion Arch
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Expansion Arch47
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Buttons
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Pushing Button
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Pushing Button with Root Control
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Rotation Button
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Tipping Button
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Torque Button
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How to modify the appliance
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Drill Suggestion
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BIOPERM : ECS3226
POLYFIX : ECS3371
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Drill Suggestion
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Grinding caps : ECM1003
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How to add Silicon¡ 3 STEPS¡ Roughen The Appliance¡ Treat with Ethanol for 1 minute¡ RMBond® (J00256) or Odontosil
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Diagnostic ToolsCephalometrics for the Functional Therapy
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Simplified Harvold Analysis
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Angle of Convexity
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Norms: 20° ± 3°
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Harvold Triangle
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HarvoldNorms
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giovedì 8 novembre 12
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McNamara Vertical
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Norm at 9 years :
Point A: +2 ± 2 mmPogonion: -6 ± 2 mm
Adults
Male:Point A: +1 ± 1 mm
Pogonion: -1 ± 2 mm
Female:Point A: +0 ± 1 mm
Pogonion: -2 ± 2 mm
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Interincisal Angle
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Norms: 130° ± 5°
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Occlusal planeto the radicular maxillomandibularplane
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Norms: 87° ± 3°
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L1 to Dental Plane
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Norms: +1 mm ± 2 mm
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Subnasal Vertical
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Soft Point A: 0 ± 2 mm
Upper Lip: +2 ± 2 mm
Soft Pogonion: -4 ± 2 mm
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Management Tools
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First Month69
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From Month # 270