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Simplifying the Complex Treatment of Malocclusions by Krista Houstoun, Associate Editor, Orthotown Magazine

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Orthotown Magazine sat down with Dr. Ronald Roncone to learn more about his revolutionary system, Roncone PhysioDynamicSystem(PDS), that’s based on long-time science.

What is your background in orthodontics?

Roncone: I have been an orthodontist for 43 years. I did my dental school and graduate work in neuroanatomy and muscle physiology simultaneously at Marquette University Dental and Medical School. My orthodontic residency was completed at Harvard School of Dental Medicine and Forsyth Dental Center where I received dual specialty certificates.

Tell us about The Roncone PhysioDynamicSystem.

Roncone: PDS is a six-step system which greatly simplifies the treatment of the vast majority of orthodontic malocclusions and does so while reducing the treatment time and the number of appointments required.

The explanation might be easiest to explain by listing the six steps of the Roncone PDS:

1. Control (relax) the muscles of the upper body. This does not mean using a pulsed machine to indicate a correct mandibular position. It means that before we can truly know what the malocclusion is to correct it, there must be good head posture and not one with the head in a forward position. We can obtain this correct posture with a combination of occlusal splints, ultrasound and ethyl chloride spray. It is not necessary to use splints in every case. Only about 20 percent of non-TMD patients require one.

2. Making the correct diagnosis. This certainly requires step one. However, over the years, I have identified 12 areas that are key in helping to make accurate diagnoses.
As an example, the first thing I look for on a panoramic view is the presence or absence of antegonial notching. If it is present, you must, in my opinion, get the masseter muscles to relax before placing orthodontic appliances. Frontal cephalograms are also key to demonstrate asymmetries. Another example would be the presence of very close cervical vertebrae on a lateral cephalogram. This to me indicates that the malocclusion is more Class II than what the patient presents with. CBCTs now show that this cervical curvature does not occur because of airway problems as has been previously thought.

3. Use a pre-adjusted appliance that routinely gets you closer to your treatment goal. In my case, I am obviously biased to the Roncone PDS Prescription. There are many pre-adjusted appliances available that have been developed by thoughtful and brilliant orthodontists. They all work! Over the years my goal was to simplify treatment with fewer appointments, fewer arch changes, fewer adjustments and fewer bracket changes. I believe that this has been accomplished. Self-ligation is key — not for quicker treatment, but for quicker appointments.

4. Ideal bracket placement. This is key. With all the technological advances that have been developed over the years, the vast majority of orthodontists still do not place brackets as precisely as they should. We mostly have looked for a millimeter number that we like. It doesn’t matter what we like. We must place the brackets where they belong for each individual patient because of all the variations in tooth size and anatomy. Dr. Rick McLaughlin was instrumental in spending a great deal of time and effort in emphasizing the importance of correct placement. We use indirect with individual tooth JSOP jigs to place brackets on patients. This is a greatly simplified twist on the Hiro method used in lingual orthodontics. I have used it in my office for almost 20 years.

5. Three simplified stages of treatment for the vast majority of patients. A single large .018 or double small .014s NiTi wires kept in place for six months over two 12-14 week appointment intervals. This stage 1 is the working stage. All rotations are corrected, Curve of Spee is corrected, archform is created, and significant root parallelism is achieved. Stage 2, if necessary, is a quality control stage. A .020x.020 rectangular HANT is placed to check on proper bracket placement. Incisal edges and marginal ridge height are checked after six weeks.

Stage 3 wires are the finishing wires. The upper arch is a .019x.025 PDS Beta Titanium wire with “P” loops for final aesthetic adjustment of the incisors or to achieve final anterior guidance. These adjustments, when necessary, can be easily done intraorally. The wires used in the PDS are titanium. It is rare that a stainless steel wire is ever used. The prescription is such that in a .022 slot, the finishing wire should be no larger than .019x.025. Anterior turbos made in the office out of clear Triad material are used routinely for a significant part of treatment to remove posterior occlusal interferences and significant muscular input. The full reasons for how and when we use the wires, prescription, auxiliaries, etc., are obviously beyond the scope of this interview.

6. The last step of the Roncone PDS is post-removal finishing. Various polishing burs and disks used for specific reasons. Impak positioners or Orchestrate aligners used for final settling are critical.



Can you discuss the science behind the idea?

Roncone: The science used as the basis for the PDS has always been available. However, it is a part of science and literature that has rarely been used, taught in orthodontic residency or presented in various courses. The basis for everything I do in orthodontics or TMD is muscular, neurological and anatomical. When a person moves the mandible forward, as most do, to get their teeth to fit better, a whole group of muscles are affected — posterior temporals, lateral pterygoids, masseters — but also the posterior cervicals, trapezii, etc. All these muscles will compensate so that there is now a forward head posture on a permanent basis. In order to find the true malocclusion or bite, the head posture must be changed by relaxing the muscles. Even single tooth minor prematurities cause muscular compensations. Additionally, there is significant evidence in the literature that shows what light and heavy forces are in terms of grams for efficient tooth movement. Based on using various types of NiTi wires since 1988, I am absolutely convinced that large diameter round wires or two smaller wires used together in a slot are well within optimum tooth moving forces and can perform multiple functions if left undisturbed for at least six months. Also, significant anatomical changes can occur when the mandible (condyles) is positioned inappropriately.



Where did this idea come from exactly?

Roncone: This idea came from a number of years of watching what I thought were well-treated cases not holding up as I thought they should. So far I have found 27 reasons for relapse. They are not what I originally thought they were. Many are related to function, archform, etc. But muscles always seem to be the main problem. Prescription also is a major cause of instability.

In what key ways does this system help orthodontists practice better?

Roncone: I believe this system will help orthodontists practice better in the following ways:
  1. There will be many fewer surprises after treatment has started.
  2. There will be fewer arch changes — two to three per arch for up to 90 percent of patients.
  3. Functional treatment can be completed for the vast majority of patients (80-90 percent) within seven appointments, including bonding and removal.
  4. Most treatment (80-90 percent) can be completed within 13-15 months.
  5. In addition to correcting malocclusions and smiles, the orthodontists can relieve a majority of headaches and upper body muscle problems. This will absolutely increase the patient’s quality of life.

I fully understand that most orthodontists reading this will be very skeptical. Some will think I am crazy, or a huckster. My reply would be, “try it, you’ll like it!”

How is the Roncone PDS more patient-centric?

Roncone: It reduces the number of appointments needed and the discomfort associated with the significant number of wire changes. Reducing treatment time and shorter appointment visits are very appealing to patients.

This is probably as good a time as any to give my opinion on self-ligation brackets versus traditional twin brackets. I do not believe that any self-ligation brackets are responsible for faster treatment, longer appointment intervals or fewer arch changes. In 1988, I began using long appointment intervals because the NiTi wires allowed this to occur if they were tied into each bracket fully with stainless steel ligatures. The same treatment time can be achieved with either type of bracket. However, if elastic modules are used to tie-in titanium wires, then the full potential of these initial wires is not possible and the patient must return for more frequent visits to change these modules. A few advantages of self-ligation are shorter visits and not needing to continually steel tie each tooth. In my experience, all NiTi wires are not equal in developing archform or correction rotations without taking a “set.” There are only two NiTi wires that are acceptable, with our PDS being one of them. It is also the only one with the correct archform.



Tell us about your relationship with Forestadent.

Roncone: While the basics of the Roncone PDS originated more than 25 years ago, wire force levels, PDS preformed beta titanium “P” loops, proper archform and the most updated versions of the Roncone prescription were just recently completed. All of these are manufactured and sold by Forestadent. Over the last 40 years of practice, I have been fortunate to have been a consultant and speaker for several companies. Orthodontics has changed drastically over the last five to 10 years. Most orthodontic companies have been purchased by mega dental companies with, in my opinion, non-orthodontic company cultures. Forestadent has been a major presence overseas. It is still a family company with an orthodontic culture. It seemed to be a perfect fi t for the things I wanted to accomplish in the remaining years of my orthodontic and teaching career. Its quality is superb, and the company still listens to ideas from consultants and has been incredibly supportive, just like the old days.

Can you speak a little of the JSOP course?

Roncone: The JSOP course covers everything about orthodontics including management, systems, enrolling patients, marketing, training, and clinical mechanics (the PDS). Part of the course includes many full-color manuals on every area of orthodontics.

How can orthodontists begin working with you, or learn more information?

Roncone: Orthodontists can take one of our in-office, yearlong courses by calling 800-758-5836 or (Canada/international) +1-760-630-5914 or by visiting RonconeROI.com. Current or future Forestadent customers may receive significant course discounts. For more information contact Karri Denny at 800-721-4940 ext. 132 or karrid@forestadentusa.com.

Orthotown Magazine
April 2024
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