The aim is to introduce a new, miniaturised BiTurbo 2 device (BT2) as part of an overall, four-component system to treat severe, skeletal deep overbite malocclusion. Methods: Clinical applications of the first generation of BiTurbo (BT1) devices initially manufactured as one-piece were evaluated over a 2-year period in the private orthodontic clinic of Dr J. Voudouris. Improvements were implemented to develop a second generation BT2. The BT2 was manufactured by SIA Orthodontic Manufacturer, in Italy as a fourpiece unit including a body brazed to the bonding pad for greater flexibility, braze, for the separate curved bonding pad, and 80-gauge mesh for higher bond strength against lingual shearing forces. Two BT2s were positioned and bonded on the palatal aspects of the upper central incisors located at the incisal-third of the crowns. BT2s were the central device of a 4-component system to treat severe skeletal mandibular overclosure with deep overbite. The second component of the system included BT2s bonded simultaneously with a full Siamese twin, active self-ligating brackets to use the lower resistance in the appliance, shown in systematic review in vitro. The third component included new initial i-Arch wires with light forces that had a higher vertical dimension than horizontal dimension (for example .018 X .014”). This was used to improve moments of torque closer to the centre . of resistance at the upper and lower incisors with compensating curve in the upper archwires, while the lower arches incorporated reverse curve of Spee and where both facilitated mild incisor intrusion. The fourth component of the system included 2 vertical elastics at the buccal segments, in rhomboid-patterns from the upper canines and first molars to the lower first premolars and lower second molars. These were medium 1/4”, 4.5 oz elastics for moderate buccal segment extrusion in conjunction with the BT2s. Clinical Results: The ready-made metal BT2s were found to be highly efficient chairside and effective for Rapid Bite Correction (RBC). No clinically significant root resorption was not found that was possibly associated with the biocompatible forces applied. Conclusion: BiTurbos are recommended for rapid opening of overbites for a minimum of 6 months since they raise the vertical dimension automatically and reduce muscle hyperactivity to permit extrusion of the buccal segments into the excessive freeway space.
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