Entrevista Dr. Benedict Wilmes

Desta vez, a entrevista da Mordida Aberta foi um pouco mais longe:  o Professor Benedict Wilmes teve a gentileza de nos responder a algumas perguntas. É uma boa introdução para o curso de pré-reunião de quinta-feira 4 de maio: Overcoming aligner limitations by using mini-implant borne-sliders and expanders. E para quem ainda não se inscreveu… um incentivo a fazê-lo.

Thank you, Professor Wilmes, for answering these few questions. You are a well-known Orthodontist and we have so much to learn from you. We hope that this short interview will arouse even more curiosity in our colleagues to assist your lecture in Lisbon.

In 2008, you published an article with D. Drescher in the JCO that was a worldwide premiere about the treatment of maxillary deficiency using mini-screws with interchangeable abutments. What made you conceive such a different solution? What made you switch to the insertion of TADS on the anterior palate?

Actually, we were quite unhappy with the standard treatment mechanics. In a maxillary transversal and sagittal deficiency, it never seemed to be super smart to use teeth as anchors to move bony structures. Dental side effects always occurred and the desired real orthopedic effects seemed to be very little in many cases.

Do you still use tooth-borne expansion for younger patients in an interceptive phase?


From what age do you think it’s safe to expand with a hybrid hyrax (if you still use them) or a BMX?

We don´t have enough evidence about the maximum ages yet. As a consequence, we need more good studies. From the clinical experiences, the maximum age for the BMX expander is 13 years, whereas the Hybrid Hyrax is used in our university also in adults (also in combination with SARPE).

In the treatment of Class III malocclusion with skeletal anchorage, do you believe that a rapid maxillary expansion prior to traction is needed even when there is no transverse discrepancy?

We know from many studies that RME and especially Alt-RAMEC helps to stimulate /loosen maxillary sutures and thus maxillary protraction is more efficient.

We have seen that in some cases where you placed the TADs right in the mid-sagittal suture, but in others you have placed them paramedian to the suture. What criteria are significant when choosing the best location for insertion, and do you have any concerns about placing mini-screws into the suture, especially in adolescent patients?

We changed our favorite insertion site over the last two decades from median (sutural) to a paramedian position.

Therefore, what are the most important details related to TADs insertion on the anterior palate?

We want to insert in an area with much available bone, thin soft tissue and no risk of damaging any important structures. This area is posterior form the palatal rugae and called T-Zone.

Since your TADs anchored distalizer for Class II correction applies forces on the palatal side of the molars, and a common characteristic of Class II malocclusions is a mesial rotation of the molars, how do you usually control this unwanted aspect?

To avoid rotation of the molars, the distalization appliance should be designed rigidly to avoid any bending of the guiding parts. If this crucial point is considered, molars are distalized like a train on a rail.

The Benefit system is a useful option for treatment of missing upper lateral incisors. In your lectures we have seen some different designs of molar mesialization appliances like the T-wire or Mesialsliders. How do you choose between them? 
The T-wire is an indirect anchorage mechanism, while the Mesialslider is direct anchorage. Both direct and indirect anchorage strategies have their pros and cons. But due to anchorage loss that might occur and stay undetected using indirect anchorage, I personally prefer direct anchorage and thus for upper space closure the Mesialslider. Another difference is that brackets are needed if the T-wire is used. On the other hand, the Mesialslider could and should be used without any brackets.

When you use the T-wire for indirect anchorage, do you mesialize all the maxillary teeth with just elastics chains from the anterior teeth?

Yes, I try to keep the mechanics as easy as possible and use elastic chains.

In a lot of cases, you combined the Beneslider system with Invisalign treatment. Can you describe better how to manage that? How can we use these appliances for anchorage after achieving the desired distalization of the molars?

Sure, the Beneslider should stay in place after distalization for molar anchorage. We can combine these two mechanics in a one-phase (simultaneous) or two-phase (consecutive) protocol.

Nowadays, what are the biggest challenges you face when treating a malocclusion with aligners? Which are your criteria for Invisalign indication? Do you overcorrect some movements?

I am a big fan of aligner treatment. However, aligner treatment can be very frustrating, especially if the compliance is too low, or if our treatment goals are not accomplished because of improper planning. We the see problems especially if roots should be moved for bodily space closure or expansion.

Do you still use conventional brackets, or did you switch totally to aligners?

I recommend aligners to all my patients. In difficult cases, I am using auxiliaries such as sliders, expanders, facemask etc. Of course, I still have some patients with fixed braces since not all patients want aligners.

We know that you have been a professional basketball player. Do you still practice?

Nowadays I am still active as a Basketball coach, especially in the summer in special camps. I like to share my love and enthusiasm for sport generally and of course especially for Basketball.

Finally, what do you consider to be the next paradigm that will emerge in orthodontics?

  1. Every orthodontist is speaking about direct printing of aligners. I think this a very interesting topic not because there is this so-called shape memory effect, but especially because you can design and print not just a layer with a certain thickness but design the aligners free style (e.g. like a functional appliance etc.). Only the sky is the limit…
  2. Improvements of the orthodontic software integrating AI will be another crucial game changer. An evidence-based chat GPT for orthodontic diagnosis and treatment planning / staging, that’s my vision.

Thank you very much Professor Wilmes for sharing your precious experience with us. We hope to see you soon in Lisbon.

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