ADJUNCTS
IN
SWA
INDIAN DENTAL ACADEMY
Leader in continuing dental education
www.indiandentalacademy.com

www.indiandentala...
LIST OF CONTENTS
INTRODUCTION
HISTORY & DEVELOPMENT

LINGUAL STRAIGHT WIRE APPLAINCE
HEADGEARS
UTILITY
RETRACTION & INTRUS...
INTRODUCTION

DEVELOPMENT OF STRAIGHT WIRE
ORTHODONTIC APPLIANCES
Early fixed appliances
Late 1800s
Edward Angle
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EARLY FIXED APPLIANCES

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DEvELOPmENT OF FIXED
APPLIANCES
Standard Edgewise appliance
Early 1900s

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DEvELOPmENT OF
STRAIGHT WIRE APPLIANCES
Pre-adjusted edgewise appliance
1970s
Refined manufacturing process with
“built-in...
BANDED APPLIANCES

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BONDED APPLIANCES

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PRE-ADjUSTED EDGEWISE
APPLIANCE OR THE
STRAIGHT WIRE APPLIANCE
Larry Andrews - studied normal
occlusion and individual too...
PRE-ADjUSTED EDGEWISE
APPLIANCE
First order / in-out - Horizontal plane
Second order / tip - Mesio-distal
angulation
Third...
FIRST ORDER OR IN-OUT

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PRE-ADjUSTED EDGEWISE
APPLIANCE
First order / in-out - Horizontal plane
Second order / tip - Mesio-distal
angulation
Third...
SECOND ORDER OR TIP

4

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PRE-ADjUSTED EDGEWISE
APPLIANCE
First order / in-out - Horizontal plane
Second order / tip - Mesio-distal
angulation
Third...
THIRD ORDER OR TORqUE

4

To “Torque” is the least efficient
tooth movement using orthodontic
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...
CERAmIC APPLIANCES

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SELF LIGATING APPLIANCE

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COmPONENTS OF THE FIXED
APPLIANCE
Bands
Molar Tubes
Brackets
Buccal Tubes
Arch Wires
Auxiliaries: Elastomeric products, Co...
POSTERIOR ATTACHmENTS
MOLAR TUBES

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COmPONENTS OF THE FIXED
APPLIANCE
Bands
Molar Tubes
Brackets
Arch Wires
Auxiliaries: Elastomeric products, Coil
springs, L...
ANTERIOR ATTACHmENTS
Brackets

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COmPONENTS OF THE FIXED
APPLIANCE
Bands
Molar Tubes
Brackets
Arch Wires
Auxiliaries: Elastomeric products, Coil
springs, L...
ARCH WIRES
Maxillary and mandibular
Size and cross-section of wires vary
Material varies eg. Nickel Titanium alloy
(NiTi),...
TAPERED ARCH FORm

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SqUARE ARCH FORm

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OvOID ARCH FORm

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UPPER ARCH FORM
SUPERIMPOSITIONS

LOWER ARCH FORM
SUPERIMPOSITIONS

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COmPONENTS OF THE FIXED
APPLIANCE
Bands
Molar Tubes
Brackets
Arch Wires
Auxiliaries:

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LINGUAL STRAIGHT WIRE
APPLIANCE (LSW)

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EASE OF FLOSSING AND
PROXImAL SLICING

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ROTATIONAL CORRECTION

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LATEST IN LSW

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EXTRA ORAL FORCES - HEAD GEAR

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DISTALIzATION USING
HEADGEARS


Very efficient



Reciprocal forces are not transmitted to other teeth



Molar movemen...
Biomechanics of Headgears:


C Res



Moments

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HIGH PULL HEADGEAR
Produces intrusive &
Posterior direction
of pull
Long face class II
patients with high
MPA
Force throug...
STRAIGHT PULL
HEADGEAR


Class II Malocclusion with
no vertical problems



Prevent anterior migration
of maxillary teet...
CERvICAL HEADGEAR
Short face Class II
maxillary protrusive
cases with low MPA
& Deepbites
Extrusive &
distalizing effect

...
UNILATERAL mOLAR
DISTALIzATION WITH
UNILATERAL FACE BOWS

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COIL SPRING

Closed or open coil springs
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SEPARATE CANINE
RETRACTION

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ROOT TORQUING
AUXILLARY

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HELICAL SPRING FOR ENMASSE ROOT MOVEMENT

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INTRUSION IN PEA
INTRUSION ARCH WIRES
Intrusion can be accomplished in two ways with
intrusion arches.
1. With continuous ...
UTILITY ARCH (2X4 APPLIANCE)
This auxiliary archwire was developed and refined by
Ricketts for bioprogressive therapy.
The...
CINCHING
dISTALLY

TIP-bACk
bENd

GAbLE
bENd
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MATERIAL FOR UTILITY
ARCH
Blue elgiloy of 0.016" x 0.016"
0.016" x 0.022”
Dimension in an 0.022" slot.
A utility arch can ...
It produces 60-100 gms on the lower incisors for
intrusion.
The overall effect is intrusion and possible torquing
of the l...
RETRACTION UTILITY ARCH
Retraction and intrusion
of the incisors by
incorporating loops in the
archwire anterior to the
an...
RETRACTION
&
INTRUSION

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T-LOOP POSITION ANd ANCHORAGE CONTROL

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MOdIFIEd "T" LOOP
ARCHwIRE

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MUSHROOM LOOP

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k- SIR APPLIANCE
The K-SIR (Kalra
Simultaneous Intrusion
and Retraction)
archwire is a
modification of the
segmented loop
...
90° bends placed in archwire at level of Uloops.
Centered 90° V-bend creates two equal and
opposite moments (red) that cou...
Archwire with off-center 60° V-bend placed
about 2mm distal to U-loop.
Off-center V-bend creates greater moment
on molar, ...
20° antirotation bends placed in archwire just
distal to U-loops.

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Trial activation performed on each loop.
Archwire after trial activation.
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Neutral position of loop determined with
mesial and distal legs extended
horizontally. In neutral position, loop is
3.5mm ...
K-SIR archwire in place prior to cinching back.
First molar and second premolar are
connected by segment of .019"x .025" T...
INTRUSION
Intrusion refers to the apical movement of the
geometric center of the root (centroid) in
respect to the occlusa...
ABSOLUTE INTRUSION

RELATIVE INTRUSION
The difference between relative and
apparent is that when the vertical growth of th...
bURSTONE’S INTRUSION SPRING

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By Burstone,
These springs are made of 0.017”x
0.025” TMA wire. The upper and
lower arches have to be leveled
and aligned ...
CONTINUOUS INTRUSION
ARCH

The basic mechanism for intrusion consists of
three parts:
1. The posterior anchorage unit.
2. ...
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bURSTONE’S THREE PIECE
INTRUSION ARCH

The basic mechanism for intrusion consists of
three parts:
1. The posterior anchora...
The anterior segment is bent gingivally
distal to the laterals and then bent
horizontally creating a step of
approximately...
The intrusion cantilevers are made from
0.017" X 0.025" TMA wire.
The wire is first bent gingivally mesial
to the molar tu...
The anterior segment which is extended till
the distal end of the canine bracket, i.e., 2-3
mm distal to the center of res...
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THE CONNECTICUT INTRUSION ARCH

The CIA is fabricated from a nickel titanium
alloy. It incorporates the characteristics of...
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The maxillary and mandibular versions have anterior
dimensions of 34mm and 28mm, respectively.
In most cases, the wire is ...
MECHANICS

The CTA’s basic mechanism for force delivery
is a V bend lies just anterior to the molar
brackets.
When the arc...
Incisor intrusion requires 50g of force
directed apically along the center of
resistance.
A pure intrusion arch would have...
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REVERSE CURVE NITI

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When a reverse curve NiTi wire is introduced
with the concept that two equal and opposite
moments will be produced as it i...
EXTRUSION
The Extrusion Arch
1. The extrusion arch is a term coined to describe the
reverse action of already existing and...
EXTRUSION ARCH

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INdIvIdUAl TOOTH
dISTRACTION
Miniature tooth-borne distractor

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SPRINGS

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EXTRUSION OF PAlATAllY IMPACTEd
CUSPIdS
(Fig. 1). Materials needed are a Kobayashi hook, a
split rectangular extraoral hoo...
FACIAllY BONdEd lINGUAl ClEAT FOR
EXTRUSION OF AN ECTOPIC CANINE

The cleat is oriented vertically and bonded
to the facia...
PAlATAllY IMPACTEd CUSPIdS wITH
THE EXTRUSION SPRING ARM
a rectangular stainless steel tube with inside
dimensions the sam...
A UNIvERSAl RETRACTION SPRING
available in right and left
versions, is a prefabricated,
highly standardized, stainless
ste...
wAvE SPRING
NITI SPRING
MORE
COMFORTABLE
ONLY 4MM IN
LEN GTH WHEN
PASSIVE

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TPA & lINGUAl ARCHES

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PASSIvE FIXEd APPlIANCES

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lOwER "w"-SHAPE ARCH

Lower "W"-shape arch can expand cuspid width. A. Passive arch. B. After engagement.

Lingual chain e...
TPA wITH TMA SPRINGS

For aligning impacted cuspids, .018" × .025" tubes with .017" × .025" TMA
springs can be soldered to...
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A. For both rotation and expansion .021 x .025 TMA is used with arch parallel
to brackets. B. Engagement requires 1st-orde...
IMPlANTS

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IMPlANTS

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dISTAlIZATION
MAGNETS

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dISTAlIZATION OF MOlARS
wITH REPEllING
MAGNETS GIANEllEY ETAl JCO 1988
Anchorage – Modified
Nance appliance
Wire extending...
Distalization of Molars with
Repelling Magnets


Incisor brackets – passive
sectional wire- maintain incisor
alignment

...
MOlAR dISTAlIZATION
wITH SUPERElASTIC NITI
wIRE GIANEllY JCO 1992


100gm Neosentalloy upper
archwire



3 markings



...
MOlAR dISTAlIZATION
wITH SUPERElASTIC NITI
wIRE
Case report :


12 yr / F



Unilateral class II



Class II against up...
NICkEl TITANIUM dOUBlE-lOOP SYSTEM FOR SIMUlTANEOUS
dISTAlIZATION OF FIRST ANd SECONd MOlARS

Mandibular molars
and 2nd pr...
After 5months- overcorrected

Sectional NiTi archwires – crimp stops
Mesial and distal to 2nd premolar
5mm distal to 2nd m...
AdvANTAGES
Minimal patient co-operation
Ideal for simultaneous distalization
Anchorage easily controlled , without need fo...
k -lOOP
By Kalra in 1995
The appliance consists of a K-loop to
provide the forces and moments and
Nance button to resist a...
K-loop made of .017”x.025”TMA wire with
each loop 8mm long and 1.5mm wide

Legs of appliance bent down 200

www.indiandent...
Wire marked at mesial of molar tube distal of
premolar bracket

Bend placed 1 mm distal to distal mark and 1 mm
mesial to ...
K-loop in place with 2mm activation

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Activation sequence
Open loop 1mm at (1); Open loop
1mm at (2); Open at (3) to regain
the 200 bent of mesial and distal
le...
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PENdUlUM APPlIANCE
Indications
Distalization of upper first molars
before eruption of second molars.

Contra-indications.
...
2. PENdUlUM APPlIANCE
Byloff and Darendeliler (1997) and Byloff et al., 1997
showed that the appliance moved molars distal...
JAMES J. HIlGERS,JCO 1992



Nance button



.032 TMA springs



Broad swinging arc
(Pendulum) of force from
midline of...
Fabrication :
Pendulum springs consist of
1.
Recurved molar insertion
wire
2.
Horizontal adjustment loop
3.
Closed helix
4...
Preactivation and placement:


Springs bent parallel to midline of the
palate



Molar bands cemented



Anterior porti...


Nance button- extend to about 5mm
from teeth



Anterior retention loops fixed on
model, later soldered to bicuspid
ba...
PENdUlUM APPlIANCE
Pend-X
Jack-screw-One-quarter turn
every 3 days

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PENdUlUM

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Distal jet appliance
alDo carano, Mauro testa
jco 1996



Fixed lingual appliance

Appliance design :
 Wire extending fr...
Distal jet applaiance
alDo carano, Mauro testa
jco 1996
Reactivation- sliding clamp
closer to first molar
After distalizat...
Distal jet appliance
Advantages :
Bodily movement
Easy insertion
Well tolerated
Esthetic
Unilateral, Bilateral
Permits sim...
Open Coil Jig
3
1.

Heavy round wire

2.

Light wire

3.

Fixed Sheath

4.

Hook

5.

Sliding Sheath

6.

4

Open coil spr...
lokar

A similar mechanism, called the Lokar
distalizing appliance, has been developed
by Ormco Corporation. It has report...
lokar Molar Distalizing
appliance
A- Inserts into molar attachment with a rectangular wire
B- Compression spring
C- Slidin...
lokar Molar Distalizing
appliance
Nance button
Can be used in conjunction with complete edgewise
appliance
With headgear
E...
sectional jig appliance
Sumit ,o.p..kharbanda and
hari prakesh ajodo (1998).
A modified nance
appliance ,soldered to both
...
The mean distal movement of first
molar was 2.78 mm
The rate of movement per month was
0.86mm/momth
Their was increases ov...
First class appliance For
rapiD Molar
Distalization
Forniti et al ( ajodo 2004)
The appliance consists of
bands on 2 nd pr...
In just 2.4 months ,4mm of distal
movement with 4.6 o tipping occurred .
Increase overjet of 1.2mm ,and mesial
movement of...
Mini –Distalizing
appliance
One of the recent
versions of molar
distalization
Both distalization
with expansion
occurs.
ww...
As proper case
selection is ideal
for success with
any appliance .
MDA should only be
used in strong
muscular patients
whe...
intraoral BoDily
Molar Distalizer

Ahmet and korkmaz
(Ajodo jan 2000)
The Nance button
was covered palatal
aspect of incis...
The spring has 2
components
1 the distalizer
section of the
spring applied a
crown tipping
force
2 the up righting
section...
BiMetric systeM For Molar
Distalization (WDa)
Dr.Wilson-Tandem yoke
with bimetric arches for
molar distalization (EJO
JUNE...


Coil spring- between molar
tube & the yoke



5/16 “Elastics- 12 hours a
day



The Omega adjustable
stop –to modify ...
FixeD piston appliance
- greenFielD


.036 “ tubing- soldered to
biccuspids



.030 “ ss wires- first molars



Nance b...
ManDiBular Molars
With
skeletal anchorage

The anchor plates are made of
pure titanium plates are placed
behind the second...
Extraction
of 3 rd
molars
A- single
molar
distalizatio
n
B- en masse
distalizatio
n

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MoDiFieD Frozat appliance

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elastics

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intraoral elastics

1) CL I elastics or horizontal elastics

or intramaxillary elastics or intraarch elastics:-

The force...
2) CL II Elastics / intermaxillary
elastics / interarch elastics
The force recommended is 1 ½ to 2
½ oz. in non extraction...
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3)

Class III elastics
Recommended force is ¼” elastic
with 3 ½ oz

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4)

Anterior Elastics.
(Force-1 to 2oz.)

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5] Cross Bite Elastics
Force recommended is 5-7 ounce

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6) Cross Palate Elastics

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7) Diagonal
elastics)

Elastics

(Midline

Force used is 1 ½ to 2 ½ ounces.

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8) Open Bite Elastics
These are used for the correction
of open bite. It can be carried
out by a vertical elastic,
triangu...
9]

Box Elastics
Force used

¼” 6 oz or 3/16” 6 oz.

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10)Triangular Elastics
Elastics
used.

of

1/8”

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3

½

oz

is
11) Vertical Elastics (Spaghetti)
Force used is 3 ½ oz.

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12]

M and W Elastics
Force is ¾” 2 ounce.

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conclusion

There are a plethora of appliances
available in the market today, each
telling its own advantages, but as a
cl...
reFerences
JCO Volume 1985 Sep(664 - 665): Technique Clinic
Extrusion of Palatally Impacted Cuspids - DR. CHARLES
E. MEYER...
thank you
www.indiandentalacademy.com
Leader in continuing dental education

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Adjuncts in swa /certified fixed orthodontic courses by Indian dental academy

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The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.


Indian dental academy has a unique training program & curriculum that provides students with exceptional clinical skills and enabling them to return to their office with high level confidence and start treating patients

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Adjuncts in swa /certified fixed orthodontic courses by Indian dental academy

  1. 1. ADJUNCTS IN SWA INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com www.indiandentalacademy.com
  2. 2. LIST OF CONTENTS INTRODUCTION HISTORY & DEVELOPMENT LINGUAL STRAIGHT WIRE APPLAINCE HEADGEARS UTILITY RETRACTION & INTRUSION EXTRUSION SPRINGS TPA & LINGUAL ARCHES IMPLANTS DISTALIZATION INTRAORAL ELASTICS CONCLUSION REFERENCES www.indiandentalacademy.com
  3. 3. INTRODUCTION DEVELOPMENT OF STRAIGHT WIRE ORTHODONTIC APPLIANCES Early fixed appliances Late 1800s Edward Angle www.indiandentalacademy.com
  4. 4. EARLY FIXED APPLIANCES www.indiandentalacademy.com
  5. 5. DEvELOPmENT OF FIXED APPLIANCES Standard Edgewise appliance Early 1900s www.indiandentalacademy.com
  6. 6. DEvELOPmENT OF STRAIGHT WIRE APPLIANCES Pre-adjusted edgewise appliance 1970s Refined manufacturing process with “built-in” adjustments specific for each tooth Advances in material sciences made attachment much smaller www.indiandentalacademy.com
  7. 7. BANDED APPLIANCES www.indiandentalacademy.com
  8. 8. BONDED APPLIANCES www.indiandentalacademy.com
  9. 9. PRE-ADjUSTED EDGEWISE APPLIANCE OR THE STRAIGHT WIRE APPLIANCE Larry Andrews - studied normal occlusion and individual tooth positions Developed prescriptions for individual tooth position Elements of “ideal” tooth position are built into the appliance Minimizing active “wire manipulation” The Straight Wire Concept www.indiandentalacademy.com
  10. 10. PRE-ADjUSTED EDGEWISE APPLIANCE First order / in-out - Horizontal plane Second order / tip - Mesio-distal angulation Third order / torque - Labio-lingual angulation 3 - Dimensional control of tooth position www.indiandentalacademy.com
  11. 11. FIRST ORDER OR IN-OUT www.indiandentalacademy.com
  12. 12. PRE-ADjUSTED EDGEWISE APPLIANCE First order / in-out - Horizontal plane Second order / tip - Mesio-distal angulation Third order / torque - Labio-lingual angulation www.indiandentalacademy.com
  13. 13. SECOND ORDER OR TIP 4 www.indiandentalacademy.com
  14. 14. PRE-ADjUSTED EDGEWISE APPLIANCE First order / in-out - Horizontal plane Second order / tip - Mesio-distal angulation Third order / torque - Labio-lingual angulation www.indiandentalacademy.com
  15. 15. THIRD ORDER OR TORqUE 4 To “Torque” is the least efficient tooth movement using orthodontic www.indiandentalacademy.com appliances
  16. 16. CERAmIC APPLIANCES www.indiandentalacademy.com
  17. 17. SELF LIGATING APPLIANCE www.indiandentalacademy.com
  18. 18. COmPONENTS OF THE FIXED APPLIANCE Bands Molar Tubes Brackets Buccal Tubes Arch Wires Auxiliaries: Elastomeric products, Coil springs, Lingual arches, Extra-oral appliances www.indiandentalacademy.com
  19. 19. POSTERIOR ATTACHmENTS MOLAR TUBES www.indiandentalacademy.com
  20. 20. COmPONENTS OF THE FIXED APPLIANCE Bands Molar Tubes Brackets Arch Wires Auxiliaries: Elastomeric products, Coil springs, Lingual arches, Extra-oral appliances www.indiandentalacademy.com
  21. 21. ANTERIOR ATTACHmENTS Brackets www.indiandentalacademy.com
  22. 22. COmPONENTS OF THE FIXED APPLIANCE Bands Molar Tubes Brackets Arch Wires Auxiliaries: Elastomeric products, Coil springs, Lingual arches, Extra-oral appliances www.indiandentalacademy.com
  23. 23. ARCH WIRES Maxillary and mandibular Size and cross-section of wires vary Material varies eg. Nickel Titanium alloy (NiTi), Titanium Molybdenum Alloy (TMA), Stainless Steel www.indiandentalacademy.com
  24. 24. TAPERED ARCH FORm www.indiandentalacademy.com
  25. 25. SqUARE ARCH FORm www.indiandentalacademy.com
  26. 26. OvOID ARCH FORm www.indiandentalacademy.com
  27. 27. UPPER ARCH FORM SUPERIMPOSITIONS LOWER ARCH FORM SUPERIMPOSITIONS www.indiandentalacademy.com
  28. 28. COmPONENTS OF THE FIXED APPLIANCE Bands Molar Tubes Brackets Arch Wires Auxiliaries: www.indiandentalacademy.com
  29. 29. LINGUAL STRAIGHT WIRE APPLIANCE (LSW) www.indiandentalacademy.com
  30. 30. www.indiandentalacademy.com
  31. 31. EASE OF FLOSSING AND PROXImAL SLICING www.indiandentalacademy.com
  32. 32. ROTATIONAL CORRECTION www.indiandentalacademy.com
  33. 33. LATEST IN LSW www.indiandentalacademy.com
  34. 34. EXTRA ORAL FORCES - HEAD GEAR www.indiandentalacademy.com
  35. 35. DISTALIzATION USING HEADGEARS  Very efficient  Reciprocal forces are not transmitted to other teeth  Molar movements depends on direction of force in relation to the C Res of the molar & magnitude of force www.indiandentalacademy.com
  36. 36. Biomechanics of Headgears:  C Res  Moments www.indiandentalacademy.com
  37. 37. HIGH PULL HEADGEAR Produces intrusive & Posterior direction of pull Long face class II patients with high MPA Force through c res – Intrusion & distal movement of molar Adv-effective, no reciprocal forces 6-8 months – class www.indiandentalacademy.com Disadv- Patient compliance II-classI
  38. 38. STRAIGHT PULL HEADGEAR  Class II Malocclusion with no vertical problems  Prevent anterior migration of maxillary teeth, translate them posteriorly  Buccal force to molar Expansion of inner bow www.indiandentalacademy.com
  39. 39. CERvICAL HEADGEAR Short face Class II maxillary protrusive cases with low MPA & Deepbites Extrusive & distalizing effect www.indiandentalacademy.com
  40. 40. UNILATERAL mOLAR DISTALIzATION WITH UNILATERAL FACE BOWS www.indiandentalacademy.com
  41. 41. COIL SPRING Closed or open coil springs www.indiandentalacademy.com
  42. 42. SEPARATE CANINE RETRACTION www.indiandentalacademy.com
  43. 43. ROOT TORQUING AUXILLARY www.indiandentalacademy.com
  44. 44. HELICAL SPRING FOR ENMASSE ROOT MOVEMENT www.indiandentalacademy.com
  45. 45. INTRUSION IN PEA INTRUSION ARCH WIRES Intrusion can be accomplished in two ways with intrusion arches. 1. With continuous archwire that bypasses the premolars and canine teeth. 2. With segmented base archwire. So that there is no connection along the arch between the anterior and posterior segments and an auxiliary depressing arch. www.indiandentalacademy.com
  46. 46. UTILITY ARCH (2X4 APPLIANCE) This auxiliary archwire was developed and refined by Ricketts for bioprogressive therapy. The utility arch engages only two molars and the four incisors. It is commonly known as a 2 X 4 appliance. MOLAR SEGMENT INCISAL SEGMENT VESTIbULAR SEGMENT ANTERIOR VERTICAL SEGMENT POSTERIOR VERTICAL SEGMENT www.indiandentalacademy.com
  47. 47. CINCHING dISTALLY TIP-bACk bENd GAbLE bENd www.indiandentalacademy.com
  48. 48. MATERIAL FOR UTILITY ARCH Blue elgiloy of 0.016" x 0.016" 0.016" x 0.022” Dimension in an 0.022" slot. A utility arch can even be made with 0.014" or 0.018" round wires. www.indiandentalacademy.com
  49. 49. It produces 60-100 gms on the lower incisors for intrusion. The overall effect is intrusion and possible torquing of the lower incisors as well as tipping back of the molars. Retraction can be achieved by grasping the end of the molar segment with a Weingart plier distal to the molar tube and then turning this segment gingivally after pulling the wire posteriorly through the tube. This type of activation prevents proclination of the lower incisors during intrusion www.indiandentalacademy.com
  50. 50. RETRACTION UTILITY ARCH Retraction and intrusion of the incisors by incorporating loops in the archwire anterior to the anterior vestibular segment. Retraction and intrusion can be produced by activating the retraction arch in a similar fashion previously described of the intrusion utility arch. The incorporation of the loop into the design allows for a longer range of activation. www.indiandentalacademy.com
  51. 51. RETRACTION & INTRUSION www.indiandentalacademy.com
  52. 52. T-LOOP POSITION ANd ANCHORAGE CONTROL www.indiandentalacademy.com
  53. 53. www.indiandentalacademy.com
  54. 54. www.indiandentalacademy.com
  55. 55. MOdIFIEd "T" LOOP ARCHwIRE www.indiandentalacademy.com
  56. 56. MUSHROOM LOOP www.indiandentalacademy.com
  57. 57. k- SIR APPLIANCE The K-SIR (Kalra Simultaneous Intrusion and Retraction) archwire is a modification of the segmented loop mechanics of Burstone and Nanda K-SIR archwire: . 019“x.025" TMA archwire with closed Uloops 7mm long and 2mm wide. www.indiandentalacademy.com
  58. 58. 90° bends placed in archwire at level of Uloops. Centered 90° V-bend creates two equal and opposite moments (red) that counter tipping moments (green) produced by activation www.indiandentalacademy.com forces.
  59. 59. Archwire with off-center 60° V-bend placed about 2mm distal to U-loop. Off-center V-bend creates greater moment on molar, increasing molar anchorage and intrusion of anterior teeth. www.indiandentalacademy.com
  60. 60. 20° antirotation bends placed in archwire just distal to U-loops. www.indiandentalacademy.com
  61. 61. Trial activation performed on each loop. Archwire after trial activation. www.indiandentalacademy.com
  62. 62. Neutral position of loop determined with mesial and distal legs extended horizontally. In neutral position, loop is 3.5mm rather than 2mm wide. www.indiandentalacademy.com
  63. 63. K-SIR archwire in place prior to cinching back. First molar and second premolar are connected by segment of .019"x .025" TMA wire. Archwire cinched back to activate loop about 3mm, so that mesial and distal legs are barely separated. www.indiandentalacademy.com
  64. 64. INTRUSION Intrusion refers to the apical movement of the geometric center of the root (centroid) in respect to the occlusal plane or plane based on the long axis of the tooth. True intrusion is achieved by moving the root apices of the anteriors closer to the bony base. Relative intrusion is achieved by keeping them where they are, while the mandible grows and the posterior teeth erupt. Apparent intrusion is achieved by extrusion of the posterior teeth www.indiandentalacademy.com
  65. 65. ABSOLUTE INTRUSION RELATIVE INTRUSION The difference between relative and apparent is that when the vertical growth of the ramus compensates for the increase in molar height ; that is when the mandibular plane angle is maintained APPARENT INTRUSION If mandibular plane angle increases and if the mandible rotates backwards and downwards www.indiandentalacademy.com
  66. 66. bURSTONE’S INTRUSION SPRING www.indiandentalacademy.com
  67. 67. By Burstone, These springs are made of 0.017”x 0.025” TMA wire. The upper and lower arches have to be leveled and aligned and a rigid stainless steel wire, preferably 0.017”x 0.025” dimension is engaged. Anchor is reinforced by TPA and lingual holding arch www.indiandentalacademy.com
  68. 68. CONTINUOUS INTRUSION ARCH The basic mechanism for intrusion consists of three parts: 1. The posterior anchorage unit. 2. The anterior segment. 3. The intrusion arch itself. Initial alignment of anterior teeth is not necessary when performing intrusion. The intrusion arch itself is fabricated from 0.017" x 0.025" TMA or 0.016" x 0.022" TMA. www.indiandentalacademy.com
  69. 69. www.indiandentalacademy.com
  70. 70. bURSTONE’S THREE PIECE INTRUSION ARCH The basic mechanism for intrusion consists of three parts: 1. The posterior anchorage unit. 2. The anterior segment. 3. The intrusion spring itself. www.indiandentalacademy.com
  71. 71. The anterior segment is bent gingivally distal to the laterals and then bent horizontally creating a step of approximately 3mm. The distal part extends posteriorly to the distal end of the canine bracket where it is formed into a hook. The anterior segment should be made of 0.021”x0.025” stainless steel wire to prevent side effects created by bending of the wire during force application. www.indiandentalacademy.com
  72. 72. The intrusion cantilevers are made from 0.017" X 0.025" TMA wire. The wire is first bent gingivally mesial to the molar tube and then a helix is formed. On the mesial end the cantilever, hook is bent through which the intrusion force can be applied to the anterior segment. The cantilever is then activated by the making a bend mesial to the helix at the molar tube, and then cinched back. www.indiandentalacademy.com
  73. 73. The anterior segment which is extended till the distal end of the canine bracket, i.e., 2-3 mm distal to the center of resistance of the anterior segment of teeth allows distal placement of the intrusive force, which is desired in a case of flared incisors. A small distal force can be added by placing an elastomeric chain extending form the molars to the anterior segment of wire on each side. This force facilitate simultaneous intrusion and retraction by redirecting the force parallel to the incisor long axis. www.indiandentalacademy.com
  74. 74. www.indiandentalacademy.com
  75. 75. THE CONNECTICUT INTRUSION ARCH The CIA is fabricated from a nickel titanium alloy. It incorporates the characteristics of utility arch as well as those of the conventional intrusion arch. Two wire size are available 0.016” x 0.022” and 0.17” x 0.25”. www.indiandentalacademy.com
  76. 76. www.indiandentalacademy.com
  77. 77. The maxillary and mandibular versions have anterior dimensions of 34mm and 28mm, respectively. In most cases, the wire is not directly ligated into the bracket slots. The bypass, located distal to the lateral incisors, is available in two different lengths to accommodate for www.indiandentalacademy.com extraction, nonextraction, and mixed dentition cases.
  78. 78. MECHANICS The CTA’s basic mechanism for force delivery is a V bend lies just anterior to the molar brackets. When the arch is activated, a simple force system results, consisting of a vertical force in the anterior region and a moment in the posterior region. www.indiandentalacademy.com
  79. 79. Incisor intrusion requires 50g of force directed apically along the center of resistance. A pure intrusion arch would have a point contact at the incisors. The CTA’s point of force application is anterior to the center of resistance, which will flare the incisors. A tight cinch-back—a sharp bend distal to the molar tube, preventing forward slippage of the wire—will prevent incisor flaring during intrusion and produce some retraction of the incisors during www.indiandentalacademy.com molar tipback.
  80. 80. www.indiandentalacademy.com
  81. 81. REVERSE CURVE NITI www.indiandentalacademy.com
  82. 82. When a reverse curve NiTi wire is introduced with the concept that two equal and opposite moments will be produced as it is two couple system. If the moments are not equal, as the system to come into equilibrium vertical forces are created. Extrusion in the posteriors and intrusion in the anterior will take place www.indiandentalacademy.com
  83. 83. EXTRUSION The Extrusion Arch 1. The extrusion arch is a term coined to describe the reverse action of already existing and well established intrusion arch. 2. Anterior open bite can be addressed with arch wire mechanics using asymmetrical V bends in the wire. 3. Wire used is 1. 16 x 22 SS or 17 X25 TMA with 900 offset bend at the molar. 2. Extrusive force of 100 gms for 4 incisors. www.indiandentalacademy.com
  84. 84. EXTRUSION ARCH www.indiandentalacademy.com
  85. 85. www.indiandentalacademy.com
  86. 86. INdIvIdUAl TOOTH dISTRACTION Miniature tooth-borne distractor www.indiandentalacademy.com
  87. 87. www.indiandentalacademy.com
  88. 88. SPRINGS www.indiandentalacademy.com
  89. 89. EXTRUSION OF PAlATAllY IMPACTEd CUSPIdS (Fig. 1). Materials needed are a Kobayashi hook, a split rectangular extraoral hook, and a specially bent .018" wire two helices, perpendicular to each other and about 1/8" apart; mesial and distal legs should extend about 1" past the helices. (Fig. 2). Ligate the Kobayashi hook to the cuspid bracket before bonding the bracket to the exposed cuspid. Place a rectangular stabilizing wire in the arch. Crimp the extraoral hook, angulated labially and gingivally, onto the rectangular stabilizing archwire opposite the cuspid to be extruded (Fig. 3 Place the distal helix of the .018" wire, rotated toward the occlusal surface, over the extraoral hook). (Fig. 4 Ligate the distal leg of the wire to the brackets over the stabilizing archwire). Adjust the mesial leg to produce the desired amount and direction of extrusive force. (Fig. 5).Ligate the mesial leg to the Kobayashi hook with a round elastic www.indiandentalacademy.com
  90. 90. FACIAllY BONdEd lINGUAl ClEAT FOR EXTRUSION OF AN ECTOPIC CANINE The cleat is oriented vertically and bonded to the facial surface of the ectopic tooth. An archwire is placed above one wing of the cleat to extrude the tooth (Fig. 2). A light, 1/8", 2oz elastic can be extended from the cleat to the lower arch to aid in the eruption (Fig. 3). The elastic also minimizes the negative effects of reciprocal anchorage mechanics, which tend to intrude the other maxillary teeth—particularly those closest to the ectopic tooth. The tooth can be extruded farther than with traditional bracketing because the superior wing of the cleat, where the archwire lies, is immediately adjacent to the gingiva (Fig. 4). Extrusion typically takes three to four weeks www.indiandentalacademy.com
  91. 91. PAlATAllY IMPACTEd CUSPIdS wITH THE EXTRUSION SPRING ARM a rectangular stainless steel tube with inside dimensions the same as the archwire on which it is to be mounted (.016" ´ .022" or . 018" ´ .025"). A resilient wire is wrapped counterclockwise around the tube (Fig. 1). The end of the wire has a small loop for threading the elastomeric ligature that will activate the spring. After bonding an eyelet to the exposed impacted tooth. Slide the spring onto the archwire (Fig. 2), and adjust the direction and amount of force by bending the spring arm. To activate the Extrusion Spring Arm, thread an elastomeric ligature through the eyelet on the impacted cuspid and then through the loop at the end of the spring arm. Draw the spring to the eyelet with finger pressure (Fig. 3), and tie the ligature. Monitor the patient closely to ensure proper healing and to track the amount of www.indiandentalacademy.com extrusion.
  92. 92. A UNIvERSAl RETRACTION SPRING available in right and left versions, is a prefabricated, highly standardized, stainless steel retraction spring that is adjustable to fit both .018" and .022" SLOT. designed for controlled retraction of either canines or upper incisors. No clinical alteration of the spring is needed, and the force system produced is independent of interbracket distance. The spring is precalibrated to deliver predictable moment-toforce ratios in three planes of space. www.indiandentalacademy.com
  93. 93. wAvE SPRING NITI SPRING MORE COMFORTABLE ONLY 4MM IN LEN GTH WHEN PASSIVE www.indiandentalacademy.com
  94. 94. TPA & lINGUAl ARCHES www.indiandentalacademy.com
  95. 95. PASSIvE FIXEd APPlIANCES www.indiandentalacademy.com
  96. 96. lOwER "w"-SHAPE ARCH Lower "W"-shape arch can expand cuspid width. A. Passive arch. B. After engagement. Lingual chain elastic tips cuspid distally and rotates cuspid distobuccally. Stabilizing lingual arch can be used in conjunction with continuous buccal arch. www.indiandentalacademy.com
  97. 97. TPA wITH TMA SPRINGS For aligning impacted cuspids, .018" × .025" tubes with .017" × .025" TMA springs can be soldered to stainless steel TPA. www.indiandentalacademy.com
  98. 98. www.indiandentalacademy.com
  99. 99. A. For both rotation and expansion .021 x .025 TMA is used with arch parallel to brackets. B. Engagement requires 1st-order moments. For expansion without rotation,.032" x .032" arch is flared buccally. B. Engagement does not require 1st order moments. www.indiandentalacademy.com
  100. 100. IMPlANTS www.indiandentalacademy.com
  101. 101. IMPlANTS www.indiandentalacademy.com
  102. 102. www.indiandentalacademy.com
  103. 103. www.indiandentalacademy.com
  104. 104. dISTAlIZATION MAGNETS www.indiandentalacademy.com
  105. 105. dISTAlIZATION OF MOlARS wITH REPEllING MAGNETS GIANEllEY ETAl JCO 1988 Anchorage – Modified Nance appliance Wire extending from 1st premolars Acrylic button anteriorly contacting the incisors Auxillary wire with a loop at its end soldered - premolars bands www.indiandentalacademy.com
  106. 106. Distalization of Molars with Repelling Magnets  Incisor brackets – passive sectional wire- maintain incisor alignment  Repelling surfaces of magnets brought into contact by passing an .014 ligature through the loop, then tying back a washer anterior to the magnets  Force- 200-225 gms , dropped as space opened  3mm in 7 weeks  Anchor loss – 1mm www.indiandentalacademy.com
  107. 107. MOlAR dISTAlIZATION wITH SUPERElASTIC NITI wIRE GIANEllY JCO 1992  100gm Neosentalloy upper archwire  3 markings  Stops crimped, hook added  Insert wire such that posterior stop abuts mesial end of molar tube, anterior stop abuts distal of premolar  Anchorage reinforced by class II, or Nance appliance www.indiandentalacademy.com
  108. 108. MOlAR dISTAlIZATION wITH SUPERElASTIC NITI wIRE Case report :  12 yr / F  Unilateral class II  Class II against upper 1st premolar  Overcorrected- 4 months www.indiandentalacademy.com
  109. 109. NICkEl TITANIUM dOUBlE-lOOP SYSTEM FOR SIMUlTANEOUS dISTAlIZATION OF FIRST ANd SECONd MOlARS Mandibular molars and 2nd premolars banded, other teeth bonded Lip bumper- prevent extrusion Maxillary molars and bicuspids – banded, aligned 80 gm Neosentalloy – maxillary archwire placed – marked Distal to 1st premolar 5mm distal to 1st molar tube Stops crimped on www.indiandentalacademy.com markings
  110. 110. After 5months- overcorrected Sectional NiTi archwires – crimp stops Mesial and distal to 2nd premolar 5mm distal to 2nd molar tube Uprighting springs on 1st bicuspids Class II elastics www.indiandentalacademy.com Simultaneous, bodily movement
  111. 111. AdvANTAGES Minimal patient co-operation Ideal for simultaneous distalization Anchorage easily controlled , without need for TPA/Nance Due to streching of transeptal fibres, 1st molars can be distalized using lighter 80 gm force www.indiandentalacademy.com
  112. 112. k -lOOP By Kalra in 1995 The appliance consists of a K-loop to provide the forces and moments and Nance button to resist anchorage www.indiandentalacademy.com
  113. 113. K-loop made of .017”x.025”TMA wire with each loop 8mm long and 1.5mm wide Legs of appliance bent down 200 www.indiandentalacademy.com
  114. 114. Wire marked at mesial of molar tube distal of premolar bracket Bend placed 1 mm distal to distal mark and 1 mm mesial to mesial mark. Stop should be well defined and about 1.5mm long www.indiandentalacademy.com
  115. 115. K-loop in place with 2mm activation www.indiandentalacademy.com
  116. 116. Activation sequence Open loop 1mm at (1); Open loop 1mm at (2); Open at (3) to regain the 200 bent of mesial and distal legs www.indiandentalacademy.com
  117. 117. www.indiandentalacademy.com
  118. 118. PENdUlUM APPlIANCE Indications Distalization of upper first molars before eruption of second molars. Contra-indications. Lack of teeth anterior to the first molars to retain the appliance. www.indiandentalacademy.com Upper second molars have erupted.
  119. 119. 2. PENdUlUM APPlIANCE Byloff and Darendeliler (1997) and Byloff et al., 1997 showed that the appliance moved molars distally without creating bite opening, but the molars did tend to tip. Ghosh and Nanda (1996) also found that the pendulum appliance is a reliable method for distalizing maxillary molars at the expense of moderate anchorage loss.. Hilgers (1992) reports that when the appliance is placed before the eruption of the second molars, two-thirds of the tooth movement is molar distalization, one-third is experienced as forward www.indiandentalacademy.com shift of the anchor bicuspids and oppsite occurred if 2 nd molars erupted
  120. 120. JAMES J. HIlGERS,JCO 1992  Nance button  .032 TMA springs  Broad swinging arc (Pendulum) of force from midline of palate to upper molars www.indiandentalacademy.com
  121. 121. Fabrication : Pendulum springs consist of 1. Recurved molar insertion wire 2. Horizontal adjustment loop 3. Closed helix 4. Loop for retention in acrylic button Springs- close to center of Nance button Anterior portion- retentionocclusally bonded rests - Band upper 1st premolars, solder retaining wire to the bands www.indiandentalacademy.com
  122. 122. Preactivation and placement:  Springs bent parallel to midline of the palate  Molar bands cemented  Anterior portion of appliance later cemented  Pendulum spring brought forward & engaged in lingual sheath  As molar distalizes, moves on an arc towards midline- counteracted – opening horizontal loop www.indiandentalacademy.com
  123. 123.  Nance button- extend to about 5mm from teeth  Anterior retention loops fixed on model, later soldered to bicuspid bands  Acrylic pressed against the palatal vault  Pendulum springs inserted www.indiandentalacademy.com
  124. 124. PENdUlUM APPlIANCE Pend-X Jack-screw-One-quarter turn every 3 days www.indiandentalacademy.com
  125. 125. PENdUlUM www.indiandentalacademy.com
  126. 126. Distal jet appliance alDo carano, Mauro testa jco 1996  Fixed lingual appliance Appliance design :  Wire extending from acrylic through tube ends in a bayonet bend-inserted into lingual sheath  Coil spring  Clamp  Anchor wire to 2nd premolar www.indiandentalacademy.com
  127. 127. Distal jet applaiance alDo carano, Mauro testa jco 1996 Reactivation- sliding clamp closer to first molar After distalization – - clamp-spring assemblyacrylic, - premolar arms cut off. www.indiandentalacademy.com
  128. 128. Distal jet appliance Advantages : Bodily movement Easy insertion Well tolerated Esthetic Unilateral, Bilateral Permits simultaneous use of full bonded appliances www.indiandentalacademy.com
  129. 129. Open Coil Jig 3 1. Heavy round wire 2. Light wire 3. Fixed Sheath 4. Hook 5. Sliding Sheath 6. 4 Open coil spring 6 5 1 2 www.indiandentalacademy.com
  130. 130. lokar A similar mechanism, called the Lokar distalizing appliance, has been developed by Ormco Corporation. It has reported advantages of ease of insertion and ligation. To date, no published clinical trials have emerged on either of these appliances. www.indiandentalacademy.com
  131. 131. lokar Molar Distalizing appliance A- Inserts into molar attachment with a rectangular wire B- Compression spring C- Sliding sleeve D- Groove E- Flat guiding bar F- Round posterior guiding bar G- Immovable posterior sleeve www.indiandentalacademy.com
  132. 132. lokar Molar Distalizing appliance Nance button Can be used in conjunction with complete edgewise appliance With headgear Easy insertion, activation www.indiandentalacademy.com
  133. 133. sectional jig appliance Sumit ,o.p..kharbanda and hari prakesh ajodo (1998). A modified nance appliance ,soldered to both the 1 st and 2 nd premolars bands used for anchorage control The niti coil which exerts 70-75 grams of force over a compression of 1 to 5 mm . The sectional jig assembly was inserted posteriorly into double buccal tubes of www.indiandentalacademy.com first molars.
  134. 134. The mean distal movement of first molar was 2.78 mm The rate of movement per month was 0.86mm/momth Their was increases overjet of 1mm and 2.6 degree mesial tiping of 2 nd premolar. But their was distal tipping and clockwise rotation of molar www.indiandentalacademy.com
  135. 135. First class appliance For rapiD Molar Distalization Forniti et al ( ajodo 2004) The appliance consists of bands on 2 nd premolar and molar. A Nance palatal used for anchorage . On buccal side a 10mm long screws with 4 holes for activation . The patient were told to activate each vestibular screw a quarter turn in a counter clockwise direction www.indiandentalacademy.com once daily (o.1mm).
  136. 136. In just 2.4 months ,4mm of distal movement with 4.6 o tipping occurred . Increase overjet of 1.2mm ,and mesial movement of second premolars of 1.7mm with 2.2 o of mesial tipping www.indiandentalacademy.com
  137. 137. Mini –Distalizing appliance One of the recent versions of molar distalization Both distalization with expansion occurs. www.indiandentalacademy.com
  138. 138. As proper case selection is ideal for success with any appliance . MDA should only be used in strong muscular patients where growth and subsequent mechanics can compensate for transient open bite that results from expansion and RMD. www.indiandentalacademy.com
  139. 139. intraoral BoDily Molar Distalizer Ahmet and korkmaz (Ajodo jan 2000) The Nance button was covered palatal aspect of incisors and functioned as as anterior bite plan to disclude the posterior teeth . The spring is made up of 0.032x 0.032 TMA wire www.indiandentalacademy.com
  140. 140. The spring has 2 components 1 the distalizer section of the spring applied a crown tipping force 2 the up righting section applies up righting force to the first molars Distal tipping and extrusion of molars were not www.indiandentalacademy.com statically
  141. 141. BiMetric systeM For Molar Distalization (WDa) Dr.Wilson-Tandem yoke with bimetric arches for molar distalization (EJO JUNE 2000) Anteir segment made of 0.022’’and posterior 0.040’’. Before distalizing a TPA used to align the molars www.indiandentalacademy.com
  142. 142.  Coil spring- between molar tube & the yoke  5/16 “Elastics- 12 hours a day  The Omega adjustable stop –to modify & control arch length  .061 Omega loop  Coil springs & intermaxillary hooks. www.indiandentalacademy.com
  143. 143. FixeD piston appliance - greenFielD  .036 “ tubing- soldered to biccuspids  .030 “ ss wires- first molars  Nance button  NiTi coil www.indiandentalacademy.com
  144. 144. ManDiBular Molars With skeletal anchorage The anchor plates are made of pure titanium plates are placed behind the second molars at the anterior border of the mandibular ramus . Implantation was performed under local anesthesia and the titanium plates were secured with pure titanium screws The diameter and the length of the monocortical screws 2 and 5 www.indiandentalacademy.com
  145. 145. Extraction of 3 rd molars A- single molar distalizatio n B- en masse distalizatio n www.indiandentalacademy.com
  146. 146. MoDiFieD Frozat appliance www.indiandentalacademy.com
  147. 147. elastics www.indiandentalacademy.com
  148. 148. intraoral elastics 1) CL I elastics or horizontal elastics or intramaxillary elastics or intraarch elastics:- The force recommended is 1 ½ to 2 ½ oz for non extraction cases and 2 to 4 oz. in extraction cases. www.indiandentalacademy.com
  149. 149. 2) CL II Elastics / intermaxillary elastics / interarch elastics The force recommended is 1 ½ to 2 ½ oz. in non extraction case and 2 to 4 in extraction cases. www.indiandentalacademy.com
  150. 150. www.indiandentalacademy.com
  151. 151. 3) Class III elastics Recommended force is ¼” elastic with 3 ½ oz www.indiandentalacademy.com
  152. 152. 4) Anterior Elastics. (Force-1 to 2oz.) www.indiandentalacademy.com
  153. 153. 5] Cross Bite Elastics Force recommended is 5-7 ounce www.indiandentalacademy.com
  154. 154. 6) Cross Palate Elastics www.indiandentalacademy.com
  155. 155. 7) Diagonal elastics) Elastics (Midline Force used is 1 ½ to 2 ½ ounces. www.indiandentalacademy.com
  156. 156. 8) Open Bite Elastics These are used for the correction of open bite. It can be carried out by a vertical elastic, triangular or box elastic. Vertical elastic runs between the upper and lower brackets of each tooth www.indiandentalacademy.com
  157. 157. 9] Box Elastics Force used ¼” 6 oz or 3/16” 6 oz. www.indiandentalacademy.com
  158. 158. 10)Triangular Elastics Elastics used. of 1/8” www.indiandentalacademy.com 3 ½ oz is
  159. 159. 11) Vertical Elastics (Spaghetti) Force used is 3 ½ oz. www.indiandentalacademy.com
  160. 160. 12] M and W Elastics Force is ¾” 2 ounce. www.indiandentalacademy.com
  161. 161. conclusion There are a plethora of appliances available in the market today, each telling its own advantages, but as a clinician its our duty to access each individual case and decide which one is most suitable. www.indiandentalacademy.com
  162. 162. reFerences JCO Volume 1985 Sep(664 - 665): Technique Clinic Extrusion of Palatally Impacted Cuspids - DR. CHARLES E. MEYERS, LTC, DC, U JCO Volume 1995 Sep(579 - 579): Clinical Aid: Facially Bonded Lingual Cleat for Extrusion of an Ectopic Canine DONALD J. RINCHUSE, DMD, MS, MDS, P JCO Volume 1995 Nov(709 - 712): Treatment of Palatally Impacted Cuspids with the Extrusion Spring Arm SALLY J. TERRY, MARK E. THOMSON, D JCO Volume 1998 Apr(255 - 260): Nickel Titanium Double-Loop System for Simultaneous Distalization of First and Second Molars ALDO GIANCOTTI, DDS, M. JCO Volume 1998 Apr(255 - 260): Nickel Titanium Double-Loop System for Simultaneous Distalization ALDO GIANCOTTI, DDS, MS,PAOLA COZZA, MD, DDS, MS JCO Volume 1994 Apr(222 - 242): A Universal www.indiandentalacademy.com Retraction Spring - POUL GJESSING, D
  163. 163. thank you www.indiandentalacademy.com Leader in continuing dental education www.indiandentalacademy.com

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