The CCO System™

Dr. Juan Pablo Bosch de los Rios

Evolution of Clinical Orthodontics

2013
Connecting the Dots...

2013
Connecting the Dots...

2013
The CCO System integrates...
What is it..?
It is a orthodontic system based on three core
propositions:

Quality results
It is a orthodontic system based on three core
propositions:

Consistency
It is a orthodontic system based on three core
propositions:

Efficiency
Unparalleled Quality results

Consistency

Efficiency
 Complete Clinical Orthodontics
Young Adults Orthodontic
Early Treatment Treatment Orthognathic Surgery
Treatment
Adult Non-Extraction TMD Patients
Treatment Tx.
Teen
Orthodontics Extractions Tx. Periodontally
Compromise Patients

Corticotomies TADs

Efficient Consistent Quality

 Complete Clinical Orthodontics

Diagnosis Treatment Planning

Mechanics Patient Management

 The CCO System
Treatment Planning
Diagnosis

•Transverse Dimension.
•Ortho/Perio.
•Facial and Dental Esthetics.
•CBCT.
 The CCO System

Mechanics

•We understand the SWA.

•We understand Self-Ligation.
 The CCO System
System that Integrates
SWA

SS and Heat
ASL Brackets
Activated wires
 The CCO System

Mechanics

•We developed a very simple, accurate and effective

mechanics...to solve different types of malocclusions.
 The CCO System

Patient Management

•We have control over the cases.

•We know where we are...
•We know where we are heading.
 The CCO System
A system that...

•The vast majority of orthodontists can do it.

•The vast majority of orthodontists can learn it.
•The vast majority of orthodontists can afford it.
 The CCO System™
Review of Treatment Mechanics
 Evolution...New Technologies
Brackets

1900 2013
 Evolution...New Technologies
Wires
NiTi
1900 Stainless Steel Superelastic 2013

NiTi
“Memory” NiTi
Thermal elastic
Complete Clinical Orthodontics

System that Integrates

SWA

SL SS and Heat
Brackets Activated wires
Complete Clinical Orthodontics

Delivers with consistency

Quality
 Complete Clinical Orthodontics

Regardless of where you start...

Consistency

...the end is the same.

Case #
 A little bit of History
Knowing the pass...we can better appreciate
the present...and better visualize the future!
Straight-Wire Appliance

Specific
Tip, Torque and Offset
for each individual tooth

Lawrence F. Andrews
Introduced in 1970
 By 1976… Andrews Translation Brackets

12 brackets with overcorrections for tooth movement

Sliding mechanics using round .016” ss wires
 The Roth Rx. 80’s
Filling the slot - .021” x .025” ss to express Rx. values

•Increased torque upper incisors

•Increased tip upper canine
•Increased torque and offset of upper
molars
•Reduced tip of upper and lower
premolars and molars

“Extraction Rx”
 0˚ 0˚ 0˚
(5˚ M) (5˚ M) (2˚ M)

Anchorage
Upper and Lower
Molars and PM
Distal Tipping

(2˚ M) (2˚ M) (2˚ M)

-1˚ D -1˚ D -1˚ D

 0˚ 0˚ 0˚
(5˚ M) (5˚ M) (2˚ M)

Anchorage
Upper and Lower
Molars and PM
Distal Tipping

(2˚ M) (2˚ M) (2˚ M)

-1˚ D -1˚ D -1˚ D

 Charles H. Tweed
1940s’

Herbert A. Klontz,
Charles H. Tweed International Foundation Anchorage
Preparation
The MBT Technique 90’s

•Conventional Twin Brackets

•Lighter forces
•.019” x .025” ss biggest wire
•Removed overcorrections of some
teeth, added to others
Active SLB
21 st Century
Active SLB
 Active Clip
provides better
torque expression
 Torque expression of self-ligating brackets

Hisham M. Badawi, Roger W. Toogood, Jason P.R. Carey, Giseon Heo, and Paul W. Major
Edmonton, Alberta, Canada

Am J Orthod Dentofacial Orthop, May 2008

Torque Expression

SL Active Brackets SL Passive Brackets

In-Ovation (GAC) Wire Damon2 (Ormco)

Speed (Strite) .019 x .025 ss Smart Clip (3M Unitek)
 Torque expression of self-ligating brackets

Hisham M. Badawi, Roger W. Toogood, Jason P.R. Carey, Giseon Heo, and Paul W. Major
Edmonton, Alberta, Canada

Am J Orthod Dentofacial Orthop, May 2008

We conclude that active self-ligating brackets are

more effective in torque expression than passive self-
ligating brackets.
 Interactive vs. passive self-ligating brackets: Comparative
study of torque efficiency.
Gick MR, Nóbrega C, Benetti JJ, Jakob SR, Zucchi TU and Arsati F. Orthodontic Science and Practice. 2012; 5(17):37-46.

• .022” slot - lower second bicuspids.

• interactive In-Ovation RTM (GAC – USA).
• passive Damon MX3TM (Ormco – USA).

Stainless Steel
.017” X .025”
.018” X .025”
.019” X .025”
.021” X .025”
 Interactive vs. passive self-ligating brackets: Comparative
study of torque efficiency.
Gick MR, Nóbrega C, Benetti JJ, Jakob SR, Zucchi TU and Arsati F. Orthodontic Science and Practice. 2012; 5(17):37-46.

Damon Effective Effective

In-Ovation
MX3 torque torque
17” x 25” 0˚ 17” x 25” 17˚

18” x 25” 0˚ 18” x 25” 19˚

19” x 25” 5˚ 19” x 25” 22˚

21” x 25” 14˚ 21” x 25” 22˚

Problems with current versions of SWA/SLB

Countless “SWA” Rx available in the market, why??

None of the SWA Rx was made to fit an Active SLB.

Molar tubes are essentially passive, with a significant amount

of play, even in large size wires. Therefore, there is a lack of
control, specifically with torque.
 ™
CCO System
CCO Rx
 Active Passive

™
CCO System
CCO Rx
TUBES Controlling the Molars...

TIP TORQUE ROTATIONS

TUBES Too much play...

.019” x .025”ss .021” x .025”ss

TUBES Too much variability... All .022”slot

.023”
.024” .022”

.031”
.032” .028”
 Lack of Control
Specifically the 2nd Molars
Concept of Terminal tooth
 Lower Molars
roll Lingually

Upper Molars
roll Labially
 Lower Molars
roll Lingually

Upper Molars
roll Labially
Molars Inclination “Torque”
CCO Rx

-14˚/-20˚

-25˚/-20˚
Molars Offset
CCO Rx

4˚D 0˚ 14˚D
10˚D
Mesio-Distal width of Lower First Molars

Preventing excessive distal rotation of lower molars

Molars Distal Rotation / Arch Coordination
Molars Distal Rotation / Arch Coordination
Molars Distal Rotation / Arch Coordination
 Active Passive

™
CCO System
Incisor Inclination “Torque”
Class II elastics
Class II correctors (Forsus, Herbs, etc.)
Leveling the curve of Spee

Upright Upper Incisors

Procline Lower Incisors

Incisor Inclination “Torque”
CCO Rx
Andrews Roth MBT

7˚ 12˚ 17˚ 12˚

-6˚
-1˚ -1˚ -6˚
Upper Canine Tip Lower Canine Torque
10˚
13˚
CCO Rx -8˚
-11˚
 CCO Rx Improves Canine OB/OJ
X ✓
-2˚

-7˚

-8˚
-11˚
 Offset 0˚ 0˚ 2˚M 0˚ 10˚D 10˚D
Torque 12˚/7˚ 10˚/3˚ -7˚/0˚ -9˚ -14˚ -20˚
Tip
5˚ 9˚ 10˚ 0˚ 0˚ 0˚

CCO System™
CCO Rx

Tip 0˚ 3˚ 2˚ -1˚ -1˚ -1˚

Torque -6˚/-1˚ -8˚ -12˚ -17˚ -25˚ -20˚
Offset 0˚ 0˚ 0˚ 0˚ 0˚ 0˚
CCO System™
Bracket Placement
Bracket Placement
Bracket Placement
Bracket Placement
CEJ
Gingival Margin

Clinical Crown
not
Anatomical Crown

Incisal Edge (unworn)

Bracket Placement

Clinical Crown
1.5 mm less than
Anatomical Crown
Bracket Placement

FACC
Facial Axis of the Clinical
Crown
Bracket Placement

FA point
Bracket Placement

Bracket in correct place

Alignment

FA point Center of the Center of the

Bracket Base Bracket Slot
 A “true” SWA
has torque in the Base
 Correct Tube Placement

FACC FA point
The
buccal groove
Correct Tube Placement
Correct Tube Placement
 Alignment

FA point Center of the Tube Center of the

“Active”Base Bracket Slot
 Stages of Treatment
Mechanics
Stage1 Stage2 Stage3
Leveling and Aligning Working Stage Finishing Stage

Specific movements and specific GOALS to achieve

Specific archwires at each stage should be used to achieve the GOALS

 Stages of Treatment
Mechanics
Stage1 Stage2 Stage3
Leveling and Aligning Working Stage Finishing Stage
Stage 1 Mechanics

Leveling and Aligning

Teeth move individually.

Mainly crown movement.

Molars and Pm derotate and upright distally.

Stage 1 Mechanics

Leveling and Aligning

Incisors upright and some times even retract.

Start building posterior anchorage.

•Mainly round, small diameter, superelastic wires

(ideal thermoelastic).
Stage 1 Mechanics

Leveling and Aligning

Square or rectangular superelastic wires to completely

correct rotations.
Before going on Stage 2, check bracket position
(gross errors) and debond/rebond as indicated.
Reciprocal Anchorage
Lips
Reciprocal Anchorage
Lips
 0˚ 0˚ 0˚

-1˚D -1˚D -1˚D

 0˚ 0˚ 0˚

-1˚D -1˚D -1˚D

 Arch Wire Selection
Severe to Moderate
Stage1 Crowding

Type Size / Sequence

Sentalloy .014”

.018”
BioForce
.020” x .020”
 Arch Wire Selection
Stage1 Mild Crowding

Type Size / Sequence

Sentalloy
.018”

BioForce .020” x .020”

0.014” Sent. 3 months

8 months As the leveling and aligning

progresses:
Anterior teeth upright.
Extraction spaces are
reduced.
Archwire slides back.
 Stages of Treatment
Mechanics
Stage1 Stage2 Stage3
Leveling and Aligning Working Stage Finishing Stage
Stage 2 Mechanics

Working Stage

Movement of group of teeth in all planes of the space:

Sagittal, Vertical and Transverse.

OJ/OB correction.

Class II and III correction.

Stage 2 Mechanics

Working Stage

Close all remaining extraction spaces.

Finish leveling the occlusal plane.

Arch coordination.
Arch Coordination

Anterior OJ Posterior OJ
Arch Coordination

✓
 Leveling the
Occlusal Plane

In open bite cases

 Leveling the
Occlusal Plane
.014” Sentalloy
 .019” x .025” SS

Triangular Vertical 3/16” 6 oz elastics

 Leveling the
Occlusal Plane

In deep bite cases

 Leveling the
Occlusal Plane
.014” Sentalloy
 .019” x .025” SS Class II 3/16” 6 oz elastics

Lower archwire with Reverse Curve of Spee

.019” x .025” SS Class II 3/16” 6 oz elastics

Lower arch leveled

 Arch Wire Selection
Stage2 Non-extraction

Type Size / Sequence

SWss .019” x .025”

(BioForce .021” x .028”)

 Arch Wire Selection
Stage2 Extraction

Type Size / Sequence

SWss .019” x .025”

with Hooks .021” x .025”

Depends of Anchorage Requirement

Sentalloy Coil Spring
Medium Anchorage

Upper : .019” x .025”

Lower: .019” x .025”
Medium Anchorage

Upper : .019” x .025”

Lower: .019” x .025”
 Stages of Treatment
Mechanics
Stage1 Stage2 Stage3
Leveling and Aligning Working Stage Finishing Stage
Stage 3

Finishing Stage

Fine tuning the occlusion.

Check bracket position - Debond/Rebond as indicated

(minor corrections).
Stage 3

Finishing Stage

Short heavy (3/16” 6-8 oz) Class II, III or vertical

triangular elastics as indicated to achieve optimal

intercuspation
 Arch Wire Selection
Stage3 Finishing

Type Size / Sequence

Braided SS .021” x .025”

Back to the beginning...

The CCO System

What is it..?
 The CCO System

It is a orthodontic system that allows you to

achieve:

Quality results
Consistency
Efficiency
Thank you for your attention!!
Dr. Juan Pablo Bosch de los Rios