2016 Dental Press Journal of Orthodontics Dental Press J Orthod. 2016 Nov-Dec21(6):26-33 26An interview with [602567]

© 2016 Dental Press Journal of Orthodontics Dental Press J Orthod. 2016 Nov-Dec;21(6):26-33 26An interview with
How to cite this section: Wilmes B. An interview with Benedict Wilmes. Dental Press J Orthod. 2016 Nov-Dec;21(6):26-33.
DOI: http://dx.doi.org/10.1590/2177-6709.21.6.026-033.int Submitted: September 01, 2016 – Revised and accepted: September 13, 2016interview
It is a great pleasure to bring to the readers of Dental Press Journal of Orthodontics some of the clinical and scien-
ti/f_ic knowledge from this great German orthodontist: Prof. Dr. Benedict Wilmes. Dr. Wilmes was raised in Soest, a small village with 50,000 inhabitants in the middle of Germany. He attended Dental School in Muenster, a nice university city near Netherlands. He /f_irst received a post-graduate degree in Oral Surgery at the Department of Maxillofacial Surgery at University of Muenster, and subsequently he did a post-graduation in Orthodontics and Dentofacial Orthopedics at the University of Duesseldorf. Dr. Wilmes has published more than 100 articles and textbook chapters. His primary interest is in the area of non-compliant and invisible orthodontic treatment strate-gies (TADs, lingual Orthodontics and aligners). His favorite hobbies are sports and philosophy. He even was a professional basketball player for the 1st and 2nd divisions in Germany. Lastly, I would like to disclose my gratitude to the DPJO for the opportunity of this interview, to the professors who contributed with the questions, and espe-cially to Dr. Wilmes, who shared his experience and let us know a little more about his brilliant work. Vielen Dank!
Guilherme Thiesen – interview coordinator » Oral Surgery training, Department of Maxillofacial Surgery, University of Muenster,
Germany.
» Post-graduated in Orthodontics and Dentofacial Orthopedics, University of Duesseldorf, Germany.
» Professor, Department of Orthodontics, University of Duesseldorf, Germany.
» Visiting Associate Professor, University of Alabama at Birmingham, USA.
» First prize awarded of the German Orthodontic Society in 2007 and the First Prize of the European Orthodontic Society in 2009.
» Reviewer of numerous journals and has held more than 250 lectures and courses in 50 different countries all over the world.
DOI: http://dx.doi.org/10.1590/2177-6709.21.6.026-033.int
Benedict Wilmes

Wilmes B
© 2016 Dental Press Journal of Orthodontics Dental Press J Orthod. 2016 Nov-Dec;21(6):26-33 27interview
What are the advantages of the mechanics for up –
per-molar intrusion you have developed (Mouse-
trap Mechanics) compared with other conven-tional mechanics for molar intrusion? Is there a limitation for intrusion? If simultaneous intrusion of the first and second upper molars is needed, what variations in appliance design and/or force system do you use? Marcus Vinicius Neiva Nunes do Rego
The mostly used insertion site of miniscrews is in
the alveolar process. However, there are a number of disadvantages related to the insertion into the interra –
dicular area of the upper molars:
» There is o/f_ten insufficient space on the buccal as –
pect to insert a miniscrew safely between tooth roots.
1-3
» The periodontal structures may be damaged if the
miniscrew contacts the surface of a tooth root and the risk of failure of the miniscrew will be higher.
4,5
» The reduced interradicular area on the buccal al-
veolar process of the upper molars limits the placement of miniscrews to those with a small diameter.
6 However,
small diameters are associated with a higher risk of frac –
ture7 and failure.8-10
» Intrusive movement may be stopped and the root
surface may be damaged when a molar is moved direct –
ly against a mini-implant during intrusion.11,12» There is risk of penetration of the maxillary sinus
when a miniscrew is inserted into the posterior area of the upper alveolar process.
13
To minimise insertion risks, a prudent strategy is the
placement of miniscrews safely away from the roots and the teeth to be moved. The anterior palate provides for a suitable alternative insertion site where miniscrews with larger dimensions and higher stability
14,15 may be placed
in a region with a high bone quality, thin overlying so/f_t tissue and negligible risk of causing interference with nearby teeth.
16
To conclude: every strategy has pros and cons. Ad –
vantages of the Mousetrap are a safe insertion site for the Temporary Anchorage Devices (TADs) and a constant and predictable level and direction of forces (Figs/uni00A0 1/uni00A0 and/uni00A0 2). Disadvantage might be the bigger di –
mension of the appliance.
I don’t know if there is a limit of intrusion, we have
intruded some molars around 4-5 mm. However, the
risk of root resorption and the so/f_t tissue excess a/f_ter a distinctive intrusion have to be considered.
If more than one tooth in a quadrant is to be intrud –
ed, teeth can be coupled before intrusion. As an alterna –
tive, a two stage intrusion can be performed: 1) Intru –
sion of one molar; 2) Levelling and intrusion of adjacent teeth. Both strategies are possible.
Figure 1 – “Mousetrap” mechanics for upper molar intrusion using TADs in the
anterior palate. If the molars should be just intruded, the line of force must pass through the estimated center of resistance (CR). Figure 2 – “Mousetrap” mechanics for upper molar intrusion using TADs in the anterior palate in an open bite case.

© 2016 Dental Press Journal of Orthodontics Dental Press J Orthod. 2016 Nov-Dec;21(6):26-33 28interview
Figure 3 – Chairside adaptation of a Beneslider appliance. Due to prefabricated parts, impression and laboratory procedure are not needed. Since your TADs anchored distalizer for Class II
correction (named Beneslider) applies forces on the palatal surfaces of the molars, and a common characteristic of Class II malocclusions is a mesial rotation of the molars, how do you usually control this aspect? Guilherme Thiesen
From my point of view, there are three key points
to avoid molar tipping and rotation during distalization: 1)/uni00A0 a safe source of anchorage; 2) a rigid guiding wire (1.1 mm in the Beneslider) and 3) a rigid coupling with the
molars to be distalized. However, we see sometimes a little bit of rotation due to the little play using the molar sheath and the conventional Benetube (Fig 3). A more rigid cou –
pling from the Beneslider to the molars is obtained in the bonded Benetube (acc. to Dr. Banach, Fig 4).
You usually demonstrate in your lectures some dif –
ferent designs of molar mesialization appliances (T-wire, Mesialsliders, etc.). What are the clinical
differences between them? I mean, when do you indicate one or another? Ki Beom Kim
If the central incisors are in the correct posi –
tion (midline, torque and angulation is correct), a T-wire
17/uni00A0(Fig 5) can be bonded to the lingual surfaces
of the central incisors to apply an indirect anchorage with the goal of avoiding lingual tipping of the cen –
tral incisors during space closure.
17-19 As an alternative
to the T-wire (indirect anchorage), the Mesialslid-er
17,18 (Fig 6) as a direct anchorage device can be used.
The/uni00A0use of the T-wire leads to a very easy mechanics, but the Mesialslider has some advantages: 1) Since the incisors are not /f_ixed, a midline deviation and incor –
rect dental torque can be adjusted at the same time. 2)/uni00A0Brackets are not needed during the use of the Mesi –
alslider (and Beneslider), what makes this phase of the treatment much more comfortable for the patient.

Wilmes B
© 2016 Dental Press Journal of Orthodontics Dental Press J Orthod. 2016 Nov-Dec;21(6):26-33 29interview
On the AAO meeting held in Orlando in 2016, you
demonstrated a lot of cases in which you com –
bined the Beneslider system with Invisalign treat –
ment after that. Can you describe it better how to manage that? How can we use these appliances for anchorage after achieving the desired distalization of the molars? Guilherme Thiesen
In the US and in Europe, the use of aligners be -Figure 4 – If bands are not used, a Benetube according to Dr. Banach may be used.
Figure 5 – T-wire for indirect anchorage of the anterior dentition. Space closure
to the mesial was conducted. Figure 6 – Mesialslider for mesialization of the upper molars (direct anchorage).
came very popular over the last decade. At the Uni-
versity of Düsseldorf, we are following this two-step strategy: 1) Moving the upper molars (and premolars) with (Bene-) or Mesialsliders and 2) Taking an im –
pression and finishing the case with aligners.
20 I think
this is a great option for esthetic and non-compliant Orthodontics. In phase 2, we leave the Beneslider in place for anchorage purposes (Fig 7).

© 2016 Dental Press Journal of Orthodontics Dental Press J Orthod. 2016 Nov-Dec;21(6):26-33 30interview
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?
Guilherme Thiesen
I think that bodily sagittal movements and verti –
cal movements are very difficult with aligners. Thus, we can broaden the treatment opportunities by add –
ing TAD borne sliders for bodily movements or the “Mousetrap” for molar intrusion in the upper arch. If/uni00A0there is a difficult treatment task in the lower arch, I am still choosing fixed appliances.
Most of the miniscrews for your mechanics are
placed in the anterior palatal region. Some of them are inserted right at the midpalatal suture. Do you have any concerns about placing miniscrews into the suture especially in adolescent patients? Ki Beom Kim
The clinician has to differentiate between a median and
paramedian pattern of location of miniscrews. There is no difference in regards to the continued retention and stabil –
ity of miniscrews between median and paramedian inser –
tion, even among children and adolescents.
21,22 The/uni00A0possi-
bility of growth impairment due to the location of implants within the midpalatal suture was investigated by Asscher-ickx et al,
23 who inserted two dental implants (Straumann
palatal implant) in the suture of Beagle dogs and discussed a transversal growth inhibition of the maxilla. However, in this study, only one control animal was available and only one parameter was found to be different.
24 Secondly, the
transferability of /f_indings from this study to miniscrews is questionable, due to the greater diameter and the surface roughness of the dental implants. Clinical observations at our Institution have not revealed a tendency of impaired transversal growth of the maxilla. As such, the clinically relevant impairment of maxillary growth due to a median inserted miniscrew seems unlikely. Contrastingly, a me –
dian insertion is considered to be advantageous due to the profound reduction in risk of injury to the roots of the up –
per incisor teeth, during the insertion procedure.
Therefore, what are the most important details
related to TADs insertion on the anterior palate?
Jorge Faber
Very easy: Stay in the T-Zone posterior from the ru –
gae (green area, Fig 8). Avoid the posterior lateral area, due to lack of bone (red area, Fig 8).
A study you published in 2015
25, in which you com-
pared the classic maxillary protraction protocol
with another protocol using the Hybrid Hyrax ap-pliance (anchored on TADs placed in the palate), showed less forward movement of the maxilla and improvement of maxillomandibular relationship, if we compare your results with the findings report –
ed by Hugo De Clerk’s miniplate approach. What is the reason for this difference?
Marcus Vinicius Neiva Nunes do Rego
Mostly, it doesn’t make sense to compare these val –
ues from different studies. Maybe there are many rea –
sons for bias due to the different choice of patients in the different institutions etc. We need RCTs in the future to be able to compare these treatment approaches.
Figure 7 – Combination of the Beneslider and aligner: After distalization with
the Beneslider, aligners are used for finishing of the case. The Beneslider might stay in place passively for molar anchorage. Figure 8 – The T-Zone (green) is indicating the recommended insertion site for palatal TADs. In the posterior-lateral area (red) the available bone is very thin.

Wilmes B
© 2016 Dental Press Journal of Orthodontics Dental Press J Orthod. 2016 Nov-Dec;21(6):26-33 31interview
Figure 9 – Hybrid Hyrax with two TADs in the anterior palate for rapid maxillary
expansion and early Class III treatment.
Figure 13 – Principle of the Hybrid Hyrax-Men-toplate combination: The force is transferred to bony structures minimizing dental side effects. Hence, an extraoral device could be avoided. Figure 11 – TAD borne early Class III treatment: In-traoral elastics are attached to the Mentoplate and to the bands of the Hybrid Hyrax. Figure 12 – The Mentoplate is inserted in the men-tal area, with an outstanding bone quality. Inser-tion is possible at the best age for orthopedic treatment (before puberty, 8-10 years of age). Figure 10 – Principle of the Hybrid Hyrax facemask combination: The force is transferred to bony structures, minimizing dental side effects.
toplate and Hybrid Hyrax (Figs 11-13) compared to
the Bollard miniplates.
First of all, the Bollard miniplates cannot be inserted
before the lower canines are erupted (around 12 or 13 years old). As a consequence, the patient is, accord –
ing to many studies (eg. from Lorenzo Franchi
26), be-
yond the best age for an orthopedic Class III treatment. The/uni00A0Mentoplate can be inserted very early, our favorite age is around 8-9 years old.
Secondly, we are missing the “RPE-effect” and the
“Alt-RAMEC-effect” with stimulation of midface su –
tures for bigger maxillary protraction. We know that this stimulation results in more protraction of the maxilla.
26
Thirdly, the palatal TADs are less invasive and more
stable than upper miniplates since the failure rate of the palatal TADs is almost zero.
27 Clinically, we tried to be as less invasive as pos-
sible. That was the reason to use the Hybrid Hyrax with just two miniscrews instead of two miniplates for pure skeletal protraction of the maxilla without dental side effects (extrusion and mesial migration of the molars, Figs 9 and 10).
The Mentoplate is an innovative method for
Class/uni00A0 III treatment in growing patients. What are the main advantages of this technique in compari –
son to Hugo De Clerk’s miniplate approach?
Jorge Faber
First of all, I really admire Hugo De Clerk’s work.
From my point of view, he had many outstanding ideas and he is for sure one of my role-models. How –
ever, I think there are several advantages of the Men –

© 2016 Dental Press Journal of Orthodontics Dental Press J Orthod. 2016 Nov-Dec;21(6):26-33 32interview
Guilherme Thiesen
» Post-doctoral Fellow in Orthodontics, Center for Advanced Dental Education, Saint Louis University, Saint Louis, MO, USA.
» DDS, MSc and PhD in Orthodontics and Dentofacial Orthopedics (UFSC, PUCRS and ULBRA).
» Diplomate, Brazilian Board of Orthodontics and Dentofacial Orthopedics.
» Professor of Orthodontics, UNISUL, Santa Catarina, Brazil.
Marcus Vinícius Neiva Nunes do Rego» DDS, MSc and PhD in Orthodontics and Dentofacial Orthopedics (UFPI, PUCRS and SLMandic).
» Professor of Orthodontics, UNINOVAFAPI, Piauí, Brazil.
» Professor of the Postgraduate Orthodontic Program, UFPI, Piauí, Brazil.
» President of the Brazilian Association of Orthodontics, section Piauí (ABOR/PI).
Jorge Faber» Editor-in-chief, Journal of the World Federation of Orthodontists.
» Adjunct Professor of Orthodontics, University of Brasilia, Brazil.
» Former editor-in-chief, Dental Press Journal of Orthodontics.
» Board Certified, Brazilian Board of Orthodontics and Dentofacial Orthopedics.
» WFO fellow.
» Member of the Associação Brasileira de Ortodontia
(ABOR).
Ki Beom Kim» Associate Professor, Department of Orthodontics, Center for Advanced Dental Education, Saint Louis University, Saint Louis, MO, USA.
» DDS, MSD, PhD (Dankook University, South Korea and Vanderbilt University, Nashville, TN, USA).
» Diplomate, American Board of Orthodontics.
» Diplomate, American Board of Orofacial Pain.In the treatment of Class III malocclusion with skel –
etal anchorage, do you believe that a rapid maxil –
lary expansion prior to traction is needed even when there is no transverse discrepancy?
Marcus Vinicius Neiva Nunes do Rego
RME is not needed, but it improves the skel –
etal effects of the Class III therapy, especially using Alt-RAMEC (see previous question).
In some parts of the world, such as in Brazil, par –
ents tend to refuse procedures under general
anesthesia. At the same time, in growing Class III patients, miniplates are very often placed under general anesthesia. How well do European par –
ents accept this anesthetic protocol, and what is your point of view about the surgical risks and benefits of miniplate treatment in growing Class/uni00A0III patients? Jorge Faber
I think, there is not a big difference between par –
ents around the world. All parents want to do the best for their children. Of course, we have to talk about risks and bene/f_its for all our treatments and let the par –
ents and patients make the /f_inal decision. The risks of miniplates are very low if they are placed away from roots and nerves. This may be another advantage of the Mentoplate, it is inserted in a very safe area, away from the roots.
There are many case reports using the minis –
crews in the buccal shelf or retromolar region to
distalize the entire mandibular dentition to cor –
rect Class III malocclusions. What is your opin –
ion about this type of mechanics? Do you have any suggestions for Class III malocclusion with true prognathic mandible besides using minis –
crews or miniplates in the mandibular anterior area and infrazygomatic area? Ki Beom Kim
I don’t think that there are so many indications for
lower distalization, especially in Europe and the US. There is always the risk that there is no space distally, and therefore the distalization of the lower dentition will be a difficult task.

Wilmes B
© 2016 Dental Press Journal of Orthodontics Dental Press J Orthod. 2016 Nov-Dec;21(6):26-33 33interview
1. Ludwig B, Glasl B, Kinzinger GS, Lietz T, Lisson JA. Anatomical guidelines
for miniscrew insertion: Vestibular interradicular sites. J Clin Orthod. 2011 Mar;45(3):165-73.
2. Poggio PM, Incorvati C, Velo S, Carano A. “Safe zones”: a guide for miniscrew positioning in the maxillary and mandibular arch. Angle Orthod. 2006 Mar;76(2):191-7.
3. Kim SH, Yoon HG, Choi YS, Hwang EH, Kook YA, Nelson G. Evaluation of interdental space of the maxillary posterior area for orthodontic mini-implants with cone-beam computed tomography. Am J Orthod Dentofacial Orthop. 2009 May;135(5):635-41.
4. Miyawaki S, Koyama I, Inoue M, Mishima K, Sugahara T, Takano-Yamamoto T. Factors associated with the stability of titanium screws placed in the posterior region for orthodontic anchorage. Am J Orthod Dentofacial Orthop. 2003 Oct;124(4):373-8.
5. Chen YH, Chang HH, Chen YJ, Lee D, Chiang HH, Yao CC. Root contact during insertion of miniscrews for orthodontic anchorage increases the failure rate: An/uni00A0animal study. Clin Oral Implants Res. 2008 Jan;19(1):99-106.
6. Pan F, Kau CH, Zhou H, Souccar N. The anatomical evaluation of the dental arches using cone beam computed tomography – an investigation of the availability of bone for placement of mini-screws. Head Face Med. 2013 Apr 20;9:13.
7. Wilmes B, Panayotidis A, Drescher D. Fracture resistance of orthodontic mini-implants: a biomechanical in vitro study. Eur J Orthod. 2011 Aug;33(4):396-401.
8. Fritz U, Ehmer A, Diedrich P. Clinical suitability of titanium microscrews for orthodontic anchorage-preliminary experiences.J Orofac Orthop. 2004 Sept;65(5):410-8.
9. Wiechmann D, Meyer U, Büchter A. Success rate of mini- and micro-implants used for orthodontic anchorage: a prospective clinical study. Clin Oral Implants Res. 2007 Apr;18(2):263-7.
10. Tsaousidis G, Bauss O. Influence of insertion site on the failure rates of orthodontic miniscrews. J Orofac Orthop. 2008 Sept;69(5):349-56.
11. Kadioglu O, Büyükyilmaz T, Zachrisson BU, Maino BG. Contact damage to root surfaces of premolars touching miniscrews during orthodontic treatment. Am J Orthod Dentofacial Orthop. 2008 Sept;134(3):353-60.
12. Maino BG, Weiland F, Attanasi A, Zachrisson BU, Buyukyilmaz T. Root damage and repair after contact with miniscrews. J Clin Orthod. 2007 Dec;41(12):762-6; quiz 750.
13. Gracco A, Tracey S, Baciliero U. Miniscrew insertion and the maxillary sinus: an/uni00A0endoscopic evaluation. J Clin Orthod. 2010 July;44(7):439-43.REFERENCES
14. Wilmes B, Ottenstreuer S, Su YY, Drescher D. Impact of implant design on primary stability of orthodontic mini-implants. J Orofac Orthop. 2008 Jan;69(1):42-50.
15. Wilmes B, Drescher D. Impact of bone quality, implant type, and implantation site preparation on insertion torques of mini-implants used for orthodontic anchorage. Int J Oral Maxillofac Surg. 2011 July;40(7):697-703.
16. Ludwig B, Glasl B, Bowman SJ, Wilmes B, Kinzinger GS, Lisson JA. Anatomical guidelines for miniscrew insertion: palatal sites. J Clin Orthod. 2011 Aug;45(8):433-41; quiz 467.
17. Wilmes B, Drescher D. A miniscrew system with interchangeable abutments. J/uni00A0Clin Orthod. 2008 Oct;42(10):574-80; quiz 595.
18. Wilmes B, Drescher D, Nienkemper M. A miniplate system for improved stability of skeletal anchorage. J Clin Orthod. 2009 Aug;43(8):494-501.
19. Baumgaertel S. Maxillary molar movement with a new treatment auxiliary and palatal miniscrew anchorage. J Clin Orthod. 2008 Oct;42(10):587-9; quiz 596.
20. Wilmes B, Nienkemper M, Ludwig B, Kau CH, Pauls A, Drescher D. Esthetic Class/uni00A0II treatment with the Beneslider and aligners. J Clin Orthod. 2012 July;46(7):390-8; quiz 437.
21. Nienkemper M, Pauls A, Ludwig B, Drescher D. Stability of paramedian inserted palatal mini-implants at the initial healing period: a controlled clinical study. Clin/uni00A0Oral Implants Res. 2015 Aug;26(8):870-5.
22. Nienkemper M, Wilmes B, Pauls A, Drescher D. Mini-implant stability at the initial healing period: a clinical pilot study. Angle Orthod. 2014 Jan;84(1):127-33.
23. Asscherickx K, Hanssens JL, Wehrbein H, Sabzevar MM. Orthodontic anchorage implants inserted in the median palatal suture and normal transverse maxillary growth in growing dogs: a biometric and radiographic study. Angle Orthod. 2005 Sept;75(5):826-31.
24. Borsos G, Rudzki-Janson I, Stockmann P, Schlegel KA, Végh A. Immediate loading of palatal implants in still-growing patients: a prospective, comparative, clinical pilot study. J Orofac Orthop. 2008 July;69(4):297-308.
25. Ngan P, Wilmes B, Drescher D, Martin C, Weaver B, Gunel E. Comparison of two maxillary protraction protocols: tooth-borne versus bone-anchored protraction facemask treatment. Prog Orthod. 2015 Aug;16(26).
26. Masucci C, Franchi L, Giuntini V, Defraia E. Short-term effects of a modified Alt-RAMEC protocol for early treatment of Class III malocclusion: a controlled study. Orthod Craniofac Res. 2014 Nov;17(4):259-69.
27. Karagkiolidou A, Ludwig B, Pazera P, Gkantidis N, Pandis N, Katsaros C. Survival of palatal miniscrews used for orthodontic appliance anchorage: a retrospective cohort study. Am J Orthod Dentofacial Orthop. 2013 June;143(6):767-72.