800.645.5530 | www.gacintl.

com
 Complete
Clinical Orthodontics
You are an active member of the orthodontic community, you’re
dedicated to practicing in the most efficient, effective and efficacious
way and you pride yourself on remaining up-to-date and informed on the
latest in orthodontics, yet you may be of the opinion that the last thing
we need is another technique!

As the founding father of Complete Clinical Orthodontics, I couldn’t

agree more.

This is exactly why Complete Clinical Orthodontics (CCO) represents

such a significant step forward in orthodontics. This is not a radical new
technique or technology, but a unique way to treat each and every case
to achieve the most successful clinical outcome for the individual patient.

By uniting the brightest minds and ideas in orthodontics (Angle, Tweed,

Ricketts, Andrews, Roth Alexander, McLaughlin and Damon to name a
“When I think about the future few) we’ve been able to impact control, predictability and efficiency for
of clinical orthodontics, I don’t all cases.
think of a new technological
discovery that will make us Unlike traditional orthodontic treatment where treatment strategies can
forget everything we have done vary on a visit-by-visit basis, the objective of the CCO™ System is to
in the past. I see an intelligent
emphasize goal-directed treatment that ends in a pre-visualized result.
integration of the best concepts
our predecessors gave us with This not only instills confidence in the practitioner for the patient, but it
the most efficient technologies leads to a more efficient and higher quality outcome.
we currently have.”
Ultimately the goal of the CCO System is to capitalize on the wealth
– Dr. Antonino Secchi of knowledge available to us as orthodontists, and to incorporate new
technology and proven concepts to achieve a higher level of efficiency.
Excellent treatment mechanics should allow the orthodontist to deliver
optimal treatment to the majority of his or her patients, and to do it in
the most efficient and simple way that maximizes an often-overlooked
commodity—TIME.

Part Art. Part Science. All Education.™

 Dr. Antonino Secchi
CCO Founder
USA

While Dr. Antonino Secchi is the most visible member of the CCO movement,
he views his role as more of curator or caretaker rather than founding father.
that’s because Dr. Secchi knows that, at its heart, the CCO is not the result
of any one individual. Instead, the CCO System is a blend of many minds and
the compilation of many schools of thought. Dr. Secchi views himself as the
architect who assembled all the individual parts. In finding unity in disparity,
the CCO System is able find a way to streamline treatment and enhance
clinical outcomes.

Dr. Secchi is Clinical Assistant Professor and Former Clinical Director of the Department of Orthodontics at the
University of Pennsylvania. He received his DMD, Certificate in Orthodontics, and a Master of Science in Oral
Biology from the University of Pennsylvania.

Dr. Secchi is a Diplomate of the American Board of Orthodontics and member of the Edward H. Angle Society
of Orthodontists. At the University of Pennsylvania, he has developed and implemented courses on Orthodontic
treatment Mechanics, Straight Wire Appliance Systems and Functional Occlusion in Orthodontics for postdoctoral
orthodontic residents.

Dr. Secchi’s research interests include the relationship between self-ligating appliances, friction and treatment
mechanics as-well-as orthodontics and functional occlusion. He has published in various dental and orthodontic
peer review journals. In 2005 he received the David C. Hamilton Orthodontic Research Award from the
Pennsylvania Association of Orthodontists (PAO) and in 2010, the Outstanding teacher Award from the
Department of Orthodontics of the University of Pennsylvania.

His passion for clinical orthodontic and commitment to education have made him a solicited lecturer at a national
and International level. In addition, he maintains an active orthodontic practice in Philadelphia, PA.

ROTH is not a trademark of DENTSPLY GAC Intl. nor does DENTSPLY GAC imply that it is endorsed in any way by Dr. Roth
 CCO Leadership
the CCO system is supported by a leadership team of well respected clinicians from around the world. An
interactive learning environment with advanced educational tools allows each course participant to have a unique
and informative learning experience. the system and philosophy are clearly demonstrated through real world clinical
application and results.

Dr. Jerry Clark Dr. Dan Fishel Dr. Julia Garcia-Baeza

CCO Leadership CCO Leadership CCO Leadership
USA USA Spain

Dr. Jerry Clark is a graduate of Dr. Daniel L. W. Fishel, DMD is dual- Dr. Baeza is a Diplomate of the
St. Louis University’s orthodontic specialty trained in orthodontics and American Board of Orthodontics
program and maintains a full-time periodontics. He completed his dental and member of the Spanish Society
orthodontic practice in Greensboro, training at the Harvard School of Dental of Orthodontics. She received her
north Carolina. He is also Founder Medicine and his residency training DMD from the University European of
and Partner in Bentson Clark & Copple at the University of Pennsylvania. Madrid, Spain; and her Certificate in
LLC, an orthodontic valuation and He practices in multiple locations in Orthodontics, and Master of Science
transition company, which provides a south central Pennsylvania, including in Oral Biology from the University
variety of services to buyers and sellers Harrisburg, york, and Hanover. He of Pennsylvania.
of orthodontic practices including: emphasizes educating his patients
practice valuation, partner location on the best treatments dentistry Dr. Baeza´s interest on research in
services, and provides assistance to has to offer, providing orthodontic, orthodontics appliances has taken
buyers and sellers with the negotiations periodontal, and dental implant her to enroll a PhD program at the
of practice sales and transitions. treatments that maximize dental health University Complutense of Madrid,
and longevity, as well as quality of life. Spain. She has published in various
Dr. Clark is also a much sought research and orthodontic journals and
after speaker on a variety of topics presented at the 2010 IADR meeting
including comprehensive programs in Barcelona.
on the business aspects of effectively
managing an orthodontic practice, Dr. Baeza´s devotion for clinical
practice transition information orthodontics and multidisciplinary work
and strategies, and he presents has made her to join an outstanding
comprehensive courses on achieving professional dental team in Madrid,
exceptional treatment results and in which “Passion for Excellence” is
optimizing treatment efficiency their main goal. She maintains her own
utilizing self-ligation. He has published orthodontics and multidisciplinary
numerous articles that have appeared private practice in Madrid.
in notable orthodontic publications.

Part Art. Part Science. All Education.

Dr. Andres Giraldo Dr. Sam King Dr. Isabell Mortalena
CCO Leadership CCO Leadership CCO Leadership
Colombia USA France

Dr. Andres Giraldo graduated as a After receiving his DDS at the Ohio Dr Mortalena received her DDS from
dentist at Universidad Autonoma de State University, he matriculated to the University of Bordeaux, France;
Manizales and made his postgraduate the University of Pennsylvania in her dual certificate in Orthodontics
studies as an orthodontist in Philadelphia. there he completed his and Periodontics, as well as her
Universidad Militar nueva Granada. He three year residency in orthodontics Master of Science in Oral Biology
has been the director of Universidad and received a Master of Science from the University of Pennsylvania.
Autonoma de Manizales’ orthodontics in Oral Biology. During this time, he She completed a two-year advanced
program for four years. He is the took additional training in facial and course in functional occlusion from the
director of the pre-clinic and clinic dental esthetics and function and Roth-Williams Center for Advanced
of CCO in Universidad Autonoma de completed the two year course at the Orthodontic Education. She also is a
Manizales’ orthodontics program. He Roth-Williams Advanced Education diplomate of the American Board
is member of Colombian Society of in Orthodontics Program. Upon of Orthodontics.
Orthodontics (SCO) and of AAO. graduation, Dr. King was offered
a position as an instructor at the Dr Mortalena’s research interests include
University of Pennsylvania where he the use of miniscrews-miniplates in
currently maintains a faculty position. Orthodontics, periodontally facilitated
He is a Diplomate of the American Orthodontics, surgical and orthodontic
Board of Orthodontics. management of impacted teeth and
multidisciplinary treatment.

She maintains a private Orthodontics-

Periodontics practice in Biarritz, France
with her husband, a board certified
periodontist who also graduated from
the University of Pennsylvania.
 CCO Leadership

Dr. Celestino Nobrega Dr. Luis Nunez Dr. Shalin Shah

CCO Leadership CCO Leadership
CCO Leadership
Uruguay
Brazil USA
DDS, University of the Uruguayan
Dr. Celestino nobrega is the director of Dr. Shah earned his Bachelor of
Republic, Uruguay, 1996. Former
ORtOGEO, an orthodontics school with Arts, Doctorate of Dental Medicine,
Assistant Professor, Department
over 20 years of experience bringing Certificate in Orthodontics, and Masters
of Orthodontics, Dental Faculty,
scientific research and cutting-edge of Science in Oral Biology from the
University of the Uruguayan Republic,
technology to professionals and University of Pennsylvania. During his
1997 - 2007. Graduated from two long
patients. He completed his general tenure at Penn, he learned to become
term orthodontics courses at the
dental training at Sao Paulo State a critical thinker through ten years
Uruguayan University. Graduated from
University, Brazil, his certificate in of research, he developed leadership
Roth / Williams long term course,
Orthodontics in Rio de Janeiro State experience as Chief Resident and
Catholic University, Uruguay. 2002 –
at Brazilian Dental Association and his President of Penn’s American Student
2004. Course taught by Drs. Ronald
Mastering of Dental Science in 1996. Dental Association, and discovered an
Roth, Robert Williams, Anka Sapunar
unwavering passion for orthodontics.
and assistants.

Dr. nobrega is an international speaker His passion for the profession led him
Member of ALADO (Latin American
and has presented his research in to earn additional certifications while
Orthodontists Association) and WFO.
countries like the United States, Canada, a resident, most notably becoming a
International lectures in Argentina,
Mexico, Dominican Republic, Venezuela, Diplomate of the American Board of
Brazil, Venezuela, Colombia, Perú,
Colombia, Ecuador, Uruguay, Chile, Orthodontics. Dr. Shah also developed
Ecuador y República Dominicana.
Brazil, Spain, Portugal, France, Italy, an interest in published orthodontic
DEntSPLy GAC Latin American
UAE and Lebanon. He is currently literature, and as a result, he accepted
Continuing Education Program in
leading a project of 19 biomechanical the position of Abstracts Editor for the
Orthodontics Director. new york
studies regarding the characteristics peer-reviewed journal, Orthodontic
University, Orthodontics short
of the interactive self-ligating system. Practice US. He is also on the faculty
programs for foreign doctors
the research is based on friction and at the University of Pennsylvania and
coordinator, along with Dr. Celstino
flexibility studies and the impact of low lectures nationally and internationally
nobrega, San Pablo - Brazil. Private
intensity laser and vibration therapy for Complete Clinical Orthodontics
practice in Montevideo - Uruguay.
during orthodontic treatment. and Roth-Williams Center for
Functional Occlusion.

Part Art. Part Science. All Education.

Dr. Raffaele Spena Dr. Ryan Tamburrino
CCO Leadership CCO Leadership
Italy USA

Dr. Raffaele Spena received his degree Dr. tamburrino grew up in Pittsburgh,
in Odontoiatria e Protesi Dentaria at and his tinkering and technical interests
the II Facoltà di Medicina e Chirurgia of during his early years led him to Duke
napoli, his Certificate in Orthodontics University where he received degrees in
at the Dental School of the University Biomedical Engineering and Mechanical
of Pennsylvania, Philadelphia and his Engineering/Materials Science.
degree of “Specialty in Orthodontics” Wanting to also to be involved in
at the University of Ferrara. He is a healthcare, he enrolled at the University
published author, an international of Pennsylvania where he received
speaker on the lecture circuit and his Doctorate of Dental Medicine and
Adjunct Clinical Professor at the was Chief Resident while obtaining his
Orthodontic Department of the Dental specialty Certificate in Orthodontics.
School of the University of Pennsylvania.
In addition to private practice, Dr.
A member of the American Association tamburrino is on the faculty at the
of Orthodontists, the Angle Society of University of Pennsylvania in the
Europe and the World Federation of Department of Orthodontics. Dr.
Orthodontists, Dr. Spena is currently tamburrino also lectures locally
involved in numerous research projects with various study groups, as well
including spreading from non-extraction as internationally/nationally with
treatment and the Periodontally the Complete Clinical Orthodontics
Facilitated Orthodontics. A resident of Course and Roth-Williams Center for
Italy, he currently practices orthodontics Functional Occlusion. He strongly
in the town of napoli. believes that it is important to teach
and to help raise the standard of care
for our community as well as for the
entire profession, and thoroughly
enjoys any opportunity to do so.
 Many Minds, One Comprehensive Mindset
Complete Clinical Orthodontics represents a philosophy that — when correctly applied — may enhance the
capabilities of appliances, improve treatment mechanics, and more importantly, produce better results. It literally
takes components of treatment and maximizes the benefits of each.

In the 1970’s the first Straight Wire Appliance (SWA) was introduced by Dr. Larry Andrews. this was the first
orthodontic appliance with all three dimensions for tooth position built into the bracket. Shortly after, a series of
additional brackets called “translation Brackets” were introduced to account for undesired tooth movement when
sliding teeth in extraction cases.

In the early 80s’, Ron Roth combined some of the Andrews Standard Rx values with some of the values found in the
translation Brackets to come out with the Roth Rx. Filling the slot with a large stainless steel archwire to express
the Rx was one of the premises of the Roth system.

In the early 90s’ McLaughlin, Bennett and trevisi modified the SWA Rx based on the fact that most orthodontists
would finish cases with a .019x.025 ss wire, which on a .022 slot could have up to 12˚ of play. they increased buccal
crown torque of maxillary incisors, reduced lingual crown torque of mandibular molars and increased lingual crown
torque of mandibular incisors.

Over the last decade, I have used different “versions” of the SWA, studying its concept and development and
collecting personal experiences as well as experiences from many clinicians. I have used different Self-Ligating
Brackets (SLBs), studied the theory behind them, used them in my own patients (today 100% of my practice is
Active SLB) and researched them in-vitro. Based on my clinical experience, I have come to the conclusion that
active SLBs have a lot to offer to facilitate and therefore improve the delivery of our treatment. However, based
on the different interaction between bracket and archwires due to the active clip, a “fine-tuning” of the Rx was
necessary. Introducing the CCO Rx.

today we have a more comprehensive understanding of biomechanics with pre-adjusted active self-ligating
appliances, effective and efficient early treatment, adult orthodontics with periodontal challenges and esthetic
considerations for each patient’s face and smile. the CCO System integrates the latest technological advancements
to best facilitate an effective new overarching treatment philosophy. What’s more, it uses time-tested treatment
planning strategies that stress 3D skeletal and dental diagnosis while integrating concepts from periodontics,
restorative dentistry, and oral surgery to provide a comprehensive treatment planning system to propel the
diagnostic scope of your entire practice to an even higher level.

this simple and efficient mechanical approach, combined with the state-of-the-art, active self-ligating appliance,
provides the necessary elements to consistently deliver exceptional results…..case after case.

Part Art. Part Science. All Education.

A Healthy Practice
We like to define a healthy practice of orthodontics, from a clinical standpoint, as a practice
where you can count the problem cases on one hand. We’ve all had the unpleasant experience of
losing sleep over “that case”. the case that refuses to go the way we want, and seems to confound
us at every step. It takes only a few of those cases to make your practice—and your life—miserable.
today, that can be avoided.

By combining the experience of over one hundred years of clinical orthodontics with the best technology
currently available, the CCO system is the answer to providing control, predictability, and efficiency for all cases.

Emphasis on Control
Controlling the variables of what we do in all aspects of our lives leads to productivity and predictability of results.
the CCO system commands total orthodontic control through a logical sequence to treatment – one that is easily
determined through planning and simulation – before ever initiating work on a patient. Unlike traditional orthodontic
treatment where treatment strategies can vary on a visit-by-visit basis, the objective of the CCO system emphasizes
goal-directed treatment towards a pre-visualized end result, thereby instilling confidence in both the practitioner
and the patient and leading to a more efficient and higher quality result.
 The Mechanics Behind the Movement
By integrating classic mechanics with modern, straight-wire active self-ligating
appliances, CCO shows you how to improve efficiency and control while achieving
predictable results.

the CCO mechanical system introduces a highly practical methodology to

diagnose and use straight wire active self-ligating brackets for efficient application
in all clinical situations.

the system leverages the basis of the straightwire appliance and how it integrates
with self-ligation to improve efficiency and control, while incorporating a new
appliance prescription to take full advantage of active self-ligating brackets.

the CCO Rx was developed to take full advantage of the bracket/archwire

interaction when using an active clip and to achieve optimal tooth position at the
end of treatment.

Rotational Control

the interactive capability together with the full slot clip coverage of the active
clip in the In-Ovation® brackets facilitates the correction of rotations within
the stage of leveling and aligning. the active clip also promotes complete
engagement of the wire into the slot. this avoids leaving small rotations
uncorrected as the wire sequence progresses. therefore, the CCO Rx removes
some of the offset overcorrection found in previous prescriptions.

Full Torque Expression

thanks to the active clip of the In-Ovation brackets, full torque expression
is achieved on a .019 x .025 ss wire. the interactive clip pushes the wire into
the slot. Research shows that on the In-Ovation brackets a .019 x .025 ss wire
can express the same amount of torque as a .021 x .025 Stainless Steel wire.*
therefore, some of the overcorrection implemented in previous Rx systems to
overcome the play between the bracket and a .019 x .025 ss wires, do not apply
when using the In-Ovation bracket. the CCO Rx removed these overcorrections.
*Dr. Celestino nobrega San Paulo Brazil - Comparative study of the movement of torque
induced by systems self ligation and conventional. Orthodontic Science and Practice,
2012; 5(17):37-46.

Part Art. Part Science. All Education.

Molar Control

Remember that it is the interaction between the bracket and the wire that
will transfer the values of tip, torque and offset to the teeth. tubes are passive
attachments. tubes are not able to transfer the values they have, specifically
torque, even if large wires are used. trouble correcting the curve of Wilson
of maxillary molars and excessive lingual crown torque of mandibular molars
are some of the problems commonly reported by many orthodontists.
therefore, the CCO Rx has a specific overcorrection for the maxillary and
mandibular first and second molars to achieve proper molar control on a
.019 x .025 ss archwire.

Incisors Control

It is very important for both esthetics and function to achieve optimal

torque of the maxillary and mandibular incisors. It affects lip support and
consequently facial esthetic as well as anterior coupling of the incisors and
therefore anterior guidance. It is sometimes difficult for the maxillary incisors
to achieve optimal torque due to the large amount of bone the roots must go
through, specifically in extraction cases as well as Class II Division II cases.

the inclination of the mandibular incisors is critical for both function and
stability. their position should be upright within the alveolar bone. Class
III camouflage, Class II mechanics and deep curve of Spee are specifically
challenging with regard of the upright position of mandibular incisors. the
CCO Rx combines proven values of torque for maxillary incisors that can be
fully expressed thanks to the active clip, with a slight overcorrection for the
mandibular incisors to achieve optimal control in a variety of clinical situations.

the CCO Rx is conveniently and progressively expressed throughout the

stages of treatment mechanics by using specific archwires at each stage.
the ultimate goal is to achieve optimal tooth position at the end of treatment,
even before the appliance is removed.
 CCO System Rx Highlights

the CCO System Rx works as a comprehensive

treatment protocol from second molar to
second molar.

the following identifies specific segments in

the arch where the CCO System Rx has adjusted
values to meet the clinical outcomes desired. the
transparent teeth in each illustration represents
typical tooth position from alternate prescriptions.
the solid tooth represents the adjusted values and
tooth position of the CCO System Rx.

1. U1: 12˚ Torque l U2: 10˚ Torque: these values are optimal if full expression of torque is
achieved. thanks to the active clip, full expression can be achieved on an .019 x .025 ss
wire. It is nOt necessary to increase/overcorrect these values.

2. L1/L2: -6˚ Torque, 0˚ Tip, 0˚ Offset: A small lingual crown

torque overcorrection has been shown to help keep
the incisors in an upright position when leveling and
aligning and through Class II correction. 0˚ tip and offset
makes all four incisor brackets interchangeable, facilitating
bracket inventory.

3. U3: 10˚ Tip: this value of 10˚ has the optimal angulation. the increased mesial
crown tip found in some prescriptions (13˚) has shown undesired distal tip of the
U3 root, frequently seen in x-rays. However, excessive up-righting (8˚ or less) could
compromise proper coupling with the L3 and could also leave spaces in the upper
arch that when closed, could prevent proper Class I relationship.

Part Art. Part Science. All Education.

4. L3: -8˚ Torque: In many cases where the width of the maxillary and mandibular
arches are normal, an excessive lingual crown torque (-11˚), found in some
prescriptions, makes proper coupling with the U3 difficult.

5. U4/U5: -9˚ Torque, 0˚ Tip, 0˚ Offset: Unique values are clinically insignificant, therefore
the same values have been chosen, making them interchangeable providing bracket
inventory flexibility.

6. L4: 2˚ Tip l L5: -1˚ Tip: Although this small difference of tip between the L4 and L5
will not be seen in non-extraction cases, it is significant in extraction cases to prevent
“dumping” of the premolar into the extraction space.

7. U6: -14˚ Torque l U7: -20˚ Torque: Increased lingual

crown torque, specifically for the second molar facilitates
the correction of the curve of Wilson and therefore arch
coordination, while minimizing the use of auxiliaries such
palatal bars, etc.

8. L6: -25˚ Torque l L7: -20˚ Torque: these values have been selected to facilitate
uprighting L6/L7 preventing them from rolling lingually.
 The CCO System Rx
Maxillary Arch

Tooth Torque Tip Offset

U1 12 5 0
U1 Low torque 7 5 0
U2 10 9 0
U2 Low torque 3 9 0
U3 Hook* -7 10 2M
U3 Low torque Hook* 0 10 2M
U4 • 5 -9 0 0
U4 • 5 Hook* -9 0 0
U6 Hook* -14 0 10D
U7 Hook* -20 0 10D

Mandibular Arch

Tooth Torque Tip Offset

L1 • 2 -6 0 0
L1 • 2 High torque -1 0 0
L3 Hook* -8 3 0
L4 -12 2 0
L4 Hook* -12 2 0
L5 -17 -1 0
L5 Hook* -17 -1 0
L6 Hook* -25 -1 0
L7 Hook* -20 -1 0
* All hooks are placed disto-gingivally. note: Values of torque, tip and offset refers to the crowns.
Positive values of torque and tip mean buccal while negative mean lingual. Offset values are indicated
as M (mesial) or D (distal).

Part Art. Part Science. All Education.

Wire Sequencing
Stage 1: Leveling and Aligning

Severe to Moderate Crowding

.022 Slot .018 Slot Time Goals
.014 Sentalloy®** .012 Sentalloy** 8-12 weeks Complete leveling and aligning
.018 Sentalloy .016 Sentalloy 8-12 weeks Correct all rotations
.020 x .020 Bioforce® .016 x .022 Bioforce 8-10 weeks Maintain or Upright incisors
Upright Pre Molars and Molars
** In cases of minor crowding, you can skip the .014 Sentalloy when using an .022 bracket or the .012 Sentalloy when
using an .018 bracket.

Stage 2: Working Stage

Non-Extraction
.022 Slot .018 Slot Time Goals
.021 x .028 Bioforce** .018 x .025 Bioforce** 6-8 weeks OJ/OB correction
.019 x .025 ss .018 x .022 ss 30-40 weeks Class II or III correction
Close all remaining spaces
Finish leveling the occlusal plane
Arch coordination
** In cases where the .020 x .020 Bioforce does not level and align the second molars enough to allow the placement of the
.019 x .025 ss, the use of the .021 x .028 Bioforce will correct this problem, so the stainless steel working wire can be used.

** In cases where the .016 x .022 Bioforce does not level and align the second molars enough to allow the placement of the
.018 x .022 ss, the use of the .018 x .025 Bioforce will correct this problem, so the stainless steel working wire can be used.

Extractions
.022 Slot .018 Slot Anchorage Goals

Close spaces by moving anterior

.019 x .025 ss with hooks .018 x .022 ss with hooks teeth backward approximately
Medium
Sentalloy coils 150 gr Sentalloy coils 150 gr the same amount as moving the
posterior teeth forward.

Close spaces by moving anterior

.019 x .025 ss with .018 x .022 ss with
teeth backward minimizing
hooks Sentalloy coils hooks Sentalloy coils Maximum
the movement of posterior
150-200 gr 150-200 gr
teeth forward.

Close spaces by moving posterior

.021 x .025 ss with .018 x .025 ss with
teeth forward minimizing
hooks Sentalloy coils hooks Sentalloy coils Minimum
the movement of anterior
150-200 gr 150-200 gr
teeth backward.

Use of inter-maxillary elastics at the Working Stage

Within the Working Stage for non-Extraction as well as for Extraction cases we use short 3/16” 4 or 6 oz.
in a Class II, III or triangular vertical fashion as indicated by the specific clinical situation.

Stage 3: Finishing Stage

.022 Slot .018 Slot Time Goals

Detail occlusion to achieve

.021 x .025 Braided .018 x .025 Braided 4-6 weeks
optimal intercuspation.

Use of inter-maxillary elastics at the Finishing Stage

Within the Finishing Stage we use short 3/16” 6 or 8 oz. in a Class II, III or triangular vertical fashion as
indicated by the specific clinical situation.
 Optimizing Treatment
the CCO System is designed to be an effective, efficient and practical way to achieve excellent results in a variety of clinical
situations when using straight wire self-ligating appliances. It’s an overarching orthodontic philosophy that can be applied to
every case. the following case studies will provide you with a sampling of the abilities of the CCO System in treating some
inherently challenging cases.

Wire Interaction
Figure A and B show a lateral view of an
extraction case at the beginning of Stage 1 with
an .014 Sentalloy® wire, and at the end of Stage 1
with an .020 x .020 Bioforce® wire.

notice how as the teeth level and align, the length

of the wire between canines and premolars
becomes smaller (red indicators). the extra wire
slides back and therefore it has to be clipped
at each visit. Anterior teeth upright and even Figure A. Figure B.
retract without losing anchorage. no elastics or
auxiliaries have been used.

Torque Control
Figure C and D show a lateral view of a Class II
deep bite case at the beginning of Stage 1 with
an .014 Sentalloy wire and at the end of Stage
2 with an .019 x .025 ss wire. Lower wire with
Reverse Curve of Spee, short Class II 3/16 6oz
have been used.

notice the change of torque of the maxillary

Figure C. Figure D.
central and lateral incisors (12˚/10˚).

Closing Space with Sentalloy Coil Springs

Figures E and F show a lateral view of an
extraction case at two different points during
Stage 2. the upper and lower show an .019 x
.025 ss wire with hooks.

notice how the space closed within a couple

of months of the Sentalloy coil spring being
activated.
Figure E. Figure F.

Part Art. Part Science. All Education.

Opening Space with Sentalloy Coil Springs
Figures G, H, I and J show a lateral view of a case
that presented with severe extrusion of maxillary Title Goes Here
first premolar and block out maxillary second
premolar due to early loss of primary teeth.
After leveling and aligning, a Sentalloy open coil
(Fig. I) was used to open space for the blocked
second premolar.
Figure G. Figure H.
Figures K, L, M and n show the occlusal view.

Figure I. Figure J. Figure K.

Figure L. Figure M. Figure n.

Post Treatment Stability

Figures O and P show a lateral view of an
extraction case at the beginning of Stage 1, the
end of Stage 3. Figure O. Figure P.

Figures Q and R show the finished case

right after treatment and 3 years in retention
respectively. the goal of the Finishing Stage is
to achieve an optimal occlusion before removing
the appliance and to create stability.

Figure Q. Figure R.
 Case Study 1
20 year-old female with an anterior open bite and a unilateral posterior crossbite.
Combination of In-Ovation ‘C’ and ‘R’ were used to level and align, flatten the
occlusal plane and coordinate the arches.

treatment duration: 15 months. • Case treated by Dr. Secchi

Initial intraoral photos showing the anterior open bite and posterior unilateral crossbite on the left side. notice how the
maxillary occlusal plane diverges from the mandibular occlusal plane.

In-Ovation ‘C’ appliance on the upper arch and ‘R’ on the lower arch. Photos show upper and lower .014” Sentalloy
initial archwires. Initial alignment was done in 6 months through a sequence of two archwires: .014” Sentalloy and
.020”x.020” Bioforce. no vertical elastics were used at this stage of treatment. Posterior crossbite was
corrected by coordinating the arches using a transpalatal bar.

Final .021” x .025” Braided archwire. At this final stage, vertical triangular elastics are used. notice how maxillary and
mandibular occlusal planes are now almost parallel.

Finished case. Class I molar and canine was achieved as well as good overjet and overbite. Both maxillary and mandibular
arches are coordinated to have an optimal overjet from second molar to second molar.

Part Art. Part Science. All Education.

 Case Study 2
12 year-old female with a deep bite, Class II canines and crowding.
In-Ovation ‘R’ appliance was used to level and align, parallel maxillary and
mandibular occlusal planes and provide optimal buccal crown torque to the
maxillary incisors. Short Class II elastics were used at the working stage.

treatment time: 25 months. • Case treated by Dr. Secchi

Initial intraoral photos showing the severity of the deep bite, right side buccal crossbite and Class II canines.
notice the lack of inclination of maxillary incisors. In order to level the mandibular occlusal plane, proper
inclination of maxillary incisors must be achieved.

In-Ovation ‘R’ appliance. Due to the severe deep bite upper arch was bonded first to level, align and procline upper incisors
to create space to level and align lower arch. Picture shows an .014” Sentalloy wire at the initial bonding.

Upper and lower .019” x .025” SS, lower arch with reverse curve of Spee and short Class II elastics. Parallelism of upper and
lower wire has been achieved. notice proper inclination of maxillary incisors and level curve of Spee.

Finished case. notice proper intercuspation, Class I molar and canine and proper overjet and overbite.
 Case Study 3
14 year-old male with a blocked canine, end-on molar relationship and midlines
off. In-Ovation ‘R’ appliance was used with extractions of maxillary first bicuspid
and mandibular second bicuspid. Minimum anchorage mechanics was used.

treatment time 20 months. • Case treated by Dr. Secchi

Initial intraoral photos showing maxillary right canine ectopically positioned, end-on molar and canine relationship and
maxillary midline off to patient’s right side.

Intraoral photos at the time the In-Ovation ‘R’ appliance was placed with an upper and lower .014” Sentalloy archwires.
Initial alignment was done in 7 months through a sequence of three archwires: .014” Sentalloy, .018” Sentalloy
and .020”x.020” Bioforce.

After spaces have been closed, arches have been coordinated and proper overjet and overbite have been achieved, upper and
lower .021” x .025” Braided finishing wires are used together with vertical triangular elastics for detailing and optimal coupling.

Finished case. Proper intercuspation, Class I molar and canine with proper overjet and overbite. Minimum anchorage
mechanics allowed maintaining maxillary and mandibular incisors inclination while protracting mandibular
molars to a Class I relationship.

Part Art. Part Science. All Education.

 Case Study 4
12 year-old female with a Class II malocclusion, increased Over-Jet and moderate
maxillary and mandibular crowding. Extraction of maxillary and mandibular
second premolars. Anchorage was managed with a combination of High Pull
Head Gear and short Class II elastics. In-Ovation ‘R’ appliance was used.

treatment time 30 months. • Case treated by Dr. Secchi

Initial photos showing an “end on” Class II malocclusion with maxillary and mandibular crowding as well as increased overjet.

Extraction of maxillary and mandibular second premolars. Photos showing initial bonding with an upper and lower
.014” Sentalloy archwires. Maxillary anchorage was managed by a combination of transpalatal bar and head gear.
Short Class II elastics were used at the working stage.

Spaces were closed, arches coordinated and Class I molar and canine achieved with proper overjet and overbite. Finishing
upper and lower .021” x .025” Braided are shown.

Finished case showing optimal intercuspation.

 Educational Support
the CCO System is taught through a series of interactive, hands-on courses. Small class sizes and advanced
educational tools allow each participant to have a unique and informative learning experience.

CCO Courses Explore:

• Biomechanics with pre-adjusted, active self-ligating appliances

• Effective and efficient early treatment

• Adult orthodontics with periodontal challenges

• tADs management

• Facial esthetics considerations for diagnosis and treatment planning

the CCO System is a comprehensive orthodontic system that addresses diagnosis, treatment planning and
treatment delivery in a single, inclusive approach. With curriculum that’s now taught in some of the most prestigious
institutions of learning around the world, the CCO System is shaping the way orthodontics is practiced. What’s
more, a comprehensive agenda of alumni classes is now being planned and will soon be made available both online
and in person. Led by some of the most-respected names in orthodontics, the current CCO Leadership team now
includes names like Dr. Julia Garcia-Baeza, Dr. Isabell Mortalena, Dr. Andres Giraldo, Dr. Jerry Clark, Dr. Luis nunez,
and Dr. Antonino Secchi to name but a few.

Part Art. Part Science. All Education.

Part Art. Part Science. All Education.

 Enhancing the Art and Science of Orthodontics
From esthetics perfection to essential care, orthodontics is about moving the
individual parts to perfect the collective whole. It’s why DENTSPLY GAC is
moving the field of orthodontics forward to deliver the highest in patient care.
From brackets, force-intuitive wires and highly efficient buccal tubes to bonding,
auxiliary appliances and innovative software programs, our mission is to help
you achieve rapid, optimal treatment results while streamlining your orthodontic
practice. To ask your GAC representative for more information, please call
800.645.5530, or visit www.gacintl.com.

2012 © DENTSPLY GAC International. All Rights Reserved. 0280-MM-120-057-03 Rev. 02

Part Art. Part Science. All Education.™

800.645.5530
www.gacintl.com