UNIVERSITY OF GLASGOW
Tip Edge appliance
Personal notes
Mohammed Almuzian
1/1/2013
.
Mohammed Almuzian, University of Glasgow, 2013 Page 1
Contents
Introduction..................................................
Mohammed Almuzian, University of Glasgow, 2013 Page 2
Tip-Edge
Introduction
Developed by Kesling and first described in AJ...
Mohammed Almuzian, University of Glasgow, 2013 Page 3
Disadvantages
1. Expensive
2. Extraction philosophy
3. Reliant on el...
Mohammed Almuzian, University of Glasgow, 2013 Page 4
 Also the it reduce the friction during the first stage of treatmen...
Mohammed Almuzian, University of Glasgow, 2013 Page 5
 Tip-edge rings (elastomeric tie rings with crossbars and lingually...
Mohammed Almuzian, University of Glasgow, 2013 Page 6
2. Closure of anterior spaces
3. Correction of increased overjet or ...
Mohammed Almuzian, University of Glasgow, 2013 Page 7
3. Continue correcting centre lines
4. Close residual spaces (either...
Mohammed Almuzian, University of Glasgow, 2013 Page 8
 0.0215” x 0.028” stainless steel base wire.
 Using Side Winder sp...
Mohammed Almuzian, University of Glasgow, 2013 Page 9
Table illustrating anchorage differences betweentip edge and
straigh...
Mohammed Almuzian, University of Glasgow, 2013 Page 10
Finishing
RETENTION
Concept Differential movement
techniques (eg Be...
Mohammed Almuzian, University of Glasgow, 2013 Page 11
have closed. At this time the
malocclusionis essentially
class I re...
Mohammed Almuzian, University of Glasgow, 2013 Page 12
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Tip edge technique by almuzian

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Tip edge technique by almuzian

  1. 1. UNIVERSITY OF GLASGOW Tip Edge appliance Personal notes Mohammed Almuzian 1/1/2013 .
  2. 2. Mohammed Almuzian, University of Glasgow, 2013 Page 1 Contents Introduction....................................................................................................2 Indication .......................................................................................................2 Advantages.....................................................................................................2 Disadvantages.................................................................................................3 Design............................................................................................................3 Treatment stages .............................................................................................5 Stage I: Anterior segments............................................................................5 Stage II: Close residual Spaces .....................................................................6 Objectives....................................................................................................6 Mechanics ...................................................................................................7 Stage III: Root Uprighting............................................................................7 Tip - Edge Plus ...............................................................................................8 Design.........................................................................................................8 Mechanics ...................................................................................................8 Table illustrating anchorage differences between tip edge and straight wire appliances.......................................................................................................9
  3. 3. Mohammed Almuzian, University of Glasgow, 2013 Page 2 Tip-Edge Introduction Developed by Kesling and first described in AJO 1988. Indication 1. Class II camouflage 2. Significant anchorage demand 3. Significant Increased overjet, 4. Significant deep OB 5. Class II molar relationship 6. Significant Presence of crowding. Advantages 1. Increased inter-bracket span because of the reduced bracket size MD 2. Little need for HG 3. Less anchorage demand because  Differential force theory,  Less expression of the tip during the first stage of treatment  Light force  Round wire with reduced friction during the first stage of treatment 4. Precision in finishing 5. TE bracket can be used with SW in caseof Proclined or retroclined canines
  4. 4. Mohammed Almuzian, University of Glasgow, 2013 Page 3 Disadvantages 1. Expensive 2. Extraction philosophy 3. Reliant on elastic wear 4. Poorrotational control 5. Profile dishing 6. High risk of root resorption 7. Risk of PD damages 8. Complex in stage III specially the old TE system because each bracket requires an auxiliary spring to deliver its final prescription. 9. Increased friction in later stages Design A. The tip edge bracket 1. Basically it is a modified straight wire bracket 2. Removed two diagonally oppositecorners from rectangular archwire slot which allow the bracket to tip up to 25° either mesially or distally. It is a ‘dynamic’ slot because:  Unique feature that the slot increases its vertical archwire spacefrom 0.022 to 0.028 inches as the tooth tips  When the vertical slot is then closed down by the auxiliary against a rectangular archwire, it produces a three-dimensional precision finish.
  5. 5. Mohammed Almuzian, University of Glasgow, 2013 Page 4  Also the it reduce the friction during the first stage of treatment 3. Lateral extensions or wings on the bracket provide good rotational control of tooth position 4. Vertical slot lingual to main archwire slot (auxillaries) 5. Double buccaltubes:  Preadjusted convertible straight wire tube (.022x.028)  Gingival round tube (0.036 diameter) B. Auxiliaries 1. Sidewinder  0.014” high tensile stainless steel.  Coils alongside the archwire, over bracket face.  Generates mesio-distal root movement as well as torque correction with rectangular wires. The torque correction occurmainly by the rectangular AW fitting in the slot but the side winder act to closely fitting the AW so it act indirectly to correct the torque. 2. PowerPin  Soft stainless steel.  Traction hook fitted into vertical slot.  Retained by bending occlusally projecting tail 90 degrees. 3. TE elastic ring
  6. 6. Mohammed Almuzian, University of Glasgow, 2013 Page 5  Tip-edge rings (elastomeric tie rings with crossbars and lingually facing lugs) provide both arch wire attachment and mesial or distal tip control by filling the chamfered wedge area. This is called “hammock ‘effect”  These rings are normally used only in the final stage of treatment to maintain the crown uprighting achieved with springs.  Also ligature steel can produce“hammock ‘effect” as shown in the figure down. 4. Rotating Spring  0.014 inch high tensile stainless steel.  Useful for recapturing a rotation that occurred during treatment.  Place ligature first then spring Treatmentstages Stage I: Anterior segments Objectives: 1. Initial alignment of upper/lower anterior segments
  7. 7. Mohammed Almuzian, University of Glasgow, 2013 Page 6 2. Closure of anterior spaces 3. Correction of increased overjet or reverse Overjet 4. Correction of increased overbite or AOB 5. Work towards arch coordination Stage 1 Mechanics 1. Place upper and lower 0.016 SS base archwires and gently engage those teeth that you can. 2. Severely displaced teeth can be engaged with elastic thread passed through the vertical slot. 3. Leave off the premolars. 4. Place gentle anchor bends in front of the molars, placing the base archwire in the gingival slot. These bends reciprocally intrude incisors by the idea of ‘’dig in heels’. 5. Use Class II elastics (60g only) from circles on the upper archwire to the lower 6’s. 6. Braking: If unwanted proclination of lower incisors during overbite reduction, utilized ‘reverse Side-Winder springs’ Stage II: Close residualSpaces Objectives 1. Maintain Stage I corrections 2. Continue crossbitecorrection
  8. 8. Mohammed Almuzian, University of Glasgow, 2013 Page 7 3. Continue correcting centre lines 4. Close residual spaces (either by retracting the labial segments or protracting buccalsegments) 5. Derotate & level 6’s Mechanics 1. The archwire size is increased to 0.020”round SS. 2. Class one elastic by using E-links between the circles on the archwire to the hooks on the 6’s. 3. Maintain Class II elastics as required to keep the upper and lower incisors in gentle contact. 4. To protract the buccalsegments rather than retract the labial segments sidewinders (brake) can be placed on the canines. 5. In view of a centreline discrepancy considerusing unilateral sidewinders. 6. At the end of Stage II, de-rotation of the molars is done with a 1mm buccal offset and 10 degrees of lingual toe-in between the premolar and molar. Stage III: RootUprighting Objectives: 1. Maintain Stage I/II changes 2. Correct torque and Tip 3. Detailing & finishing Mechanics
  9. 9. Mohammed Almuzian, University of Glasgow, 2013 Page 8  0.0215” x 0.028” stainless steel base wire.  Using Side Winder springs or piggy back 014 or 016 NiTi in TE plus  Maintain the spaceclosure using ligatures from crimpable hooks to the hook on the molars.  Use Class II elastics to maintain light contactbetween the upper and lower incisors. Tip - Edge Plus  Developed by Parkhouse in 2008 Design 1. Two slots: Both 0.020 inch round internal dimension.  Vertical slot for auxiliaries  Horizontally slot for a light flexible wire to replace Side–Winder. 2. Main archwire slot size 0.0215x 0.028 Mechanics 1. In clinical use, both Tip-Edge and Plus remain identical throughout the first two stages 2. Side-Winder ‘brake’, may be useful for increasing anterior anchorage, when the operator chooses, orfor correcting centrelines. 3. Placement of the distal end of the auxiliary wire relative to the molar depends on the extraction pattern. If a first premolar has been extracted, the second premolar will require mesial rootuprighting. This will be aided by placing the distal end of the deep tunnel wire in the gingivally placed round molar tube and vice versa.
  10. 10. Mohammed Almuzian, University of Glasgow, 2013 Page 9 Table illustrating anchorage differences betweentip edge and straight wire appliances Feature TIP EDGE STRAIGHT WIRE Stages of treatment Stage I Reduce overjet Open &/or close bite Close anteriorspaces Overcorrectrotations CorrectX bites Correctmolar relation STAGE II Maintain stage 1 objectives Close posteriorspaces PRE STAGE III Braking Fully engage premolars Correctmolar rotations STAGE III Uprighting and torque Anchorage preparation Level and align Overbite control Overjet reduction Space closure Detailing and finishing Retention
  11. 11. Mohammed Almuzian, University of Glasgow, 2013 Page 10 Finishing RETENTION Concept Differential movement techniques (eg Begg and Tip Edge) Teethare moved bodily to correctmalocclusion. Bracketdesign Modified straight wire bracket Rectangularslotwith heavy binding effects Wires Majority high tensile round stainless steelwith low friction, Spaces closedon rectangularwire, high friction Force magnitude Light ~60gmcontinuous Heavy intermittent eg during frequent archwire, powerchainchanges Elastics Very light Relatively heavier Extractions More frequently required Less frequently required Anchorage Low anchorage strain High anchorage strain Timing of anchorage Late (Stage III) Correcting and uprighting mechanics defer anchorage strain until stage III by which time extraction spaces From outset of treatment
  12. 12. Mohammed Almuzian, University of Glasgow, 2013 Page 11 have closed. At this time the malocclusionis essentially class I requiring only final uprighting and torquing Needfor headgear, functional, TPA / Nance / lingual arch Very rarely needed Frequently needed Premolars Not bonded up until stage II to reduce friction posteriorly. Minimum archwire binding Bonded up from day 1 Risk of archwire binding Bite opening tip back / anchor bends Bestwith rectangularwires Space closure Light on anchorage as spaces have alreadyclosed by this time Heavy on anchorage Uprighting mechanics Using sidewinders in stage III Early in treatment Finishing Ease ofuse and precision later in treatment – As seen in Edgewise system. Goodfinishing in EW
  13. 13. Mohammed Almuzian, University of Glasgow, 2013 Page 12

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