Alexander ortho /certified fixed orthodontic courses by Indian dental academy

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Welcome to Indian Dental Academy …

Welcome to Indian Dental Academy
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

State of the art comprehensive training-Faculty of world wide repute &Very affordable.

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  • 1. The Alexander Discipline INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com www.indiandentalacademy.com
  • 2. FROM TWEED TO VARI-SIMPLEX       0.022 bracket slot Treatment in mandibular arch Uprighting mand. 1st molars Uprighting lower incisors Non-extraction treatment Cervical facebow www.indiandentalacademy.com
  • 3. The Alexander Orthodontic Philosophy VARI -Variety of bracket types SIMPLEX -Concept of keeping all aspects of the treatment as simple as possible (KISS principle –keep it simple, sir) DISCIPLINE -Orthodontist must be knowledgeable & regular in follow-up www.indiandentalacademy.com
  • 4. APPLIANCE DESIGN (1978) Vari-simplex brackets –0.018 SLOT Pre-torqued, pre-angulated and exhibit specified bracket base thickness to reflect in/out considerations www.indiandentalacademy.com
  • 5. APPLIANCE DESIGN Factors determining the design of the VSD appliance  Sizes & shapes of the teeth  Accessibility of tooth  Patient comfort  Bracket wing breakages www.indiandentalacademy.com
  • 6. APPLIANCE DESIGN 5 factors which define bracket system - bracket types, placement positions, angulations, torques, and in/outs Advantages -Fewer wire bends are made -Quality control is improved -Treatment times are shortened -Fewer wire changes are required www.indiandentalacademy.com
  • 7. BRACKET TYPES Twin brackets (Mini diamond brackets) Rhomboid shape Inter-bracket width Rotational control Torquing ability Smooth & less irritable www.indiandentalacademy.com
  • 8. APPLIANCE DESIGN Lang brackets (Dr. Howard Lang)  Round surfaced teeth  Teeth at corners of the mouth (Max. & Mand. Cuspids) WEDGE SHAPED IN PROFILE www.indiandentalacademy.com
  • 9. APPLIANCE DESIGN  Lewis or Steiner www.indiandentalacademy.com
  • 10. APPLIANCE DESIGN Advantages of Lang brackets over twin brackets  Twin brackets on canines reduce inter bracket distance  Full bracket engagement is difficult www.indiandentalacademy.com
  • 11. APPLIANCE DESIGN www.indiandentalacademy.com
  • 12. APPLIANCE DESIGN Lewis bracket Large round surfaced teeth that are not at the corners of the mouth www.indiandentalacademy.com
  • 13. APPLIANCE DESIGN Useful in rotated teeth www.indiandentalacademy.com
  • 14. APPLIANCE DESIGN Other attachments Twin bracket with convertible sheath on first molars Distal offset -150 in upper tube - 50 in lower tube Single buccal tubes on second molars www.indiandentalacademy.com
  • 15. BRACKET POSITIION Bicuspid bracket height (X) is the key to position all brackets MAXILLARY ARCH CI - X LI - X - 0.5 C - X + 0.5 BC - X FM - X - 0.5 SM - X -1.0 MANDIBULAR ARCH CI - X - 0.5 LI - X - 0.5 C - X + 0.5 BC - X FM - X – 0.5 www.indiandentalacademy.com
  • 16. BRACKET ANGULATION (Tip or second order bends) www.indiandentalacademy.com
  • 17. BRACKET TORQUE ( Third order bends ) www.indiandentalacademy.com
  • 18. Bracket IN / OUT ( First order bends) MAXILLARY ARCH CI - Standard LI - Thick C & BC - Thin MOLARS - Thinnest MANDIBULAR ARCH CI, LI, & C - Thick BC - Thin M - Thinnest www.indiandentalacademy.com
  • 19. EXTRA-ORAL FORCES Milwaukee brace therapy Kloehnn cervical headgear RETRACTOR (Dr.Fred Schudy) www.indiandentalacademy.com
  • 20. EXTRA-ORAL FORCES www.indiandentalacademy.com
  • 21. EXTRA-ORAL FORCES Indications for use The choice of the appliance is determined by the amount of horizontal mandibular growth expected Cervical facebow SN-MP < 370 Combination facebow SN-MP 370 to 410 High pull facebow Sn-mp > 420 www.indiandentalacademy.com
  • 22. EXTRA-ORAL FORCES Effects on 3 dimensions Sagittal dimension  Vertical dimension  Transverse dimension   Anchorage control www.indiandentalacademy.com
  • 23. Components of a Facebow system Molar tubes - gingivally to move molar bodily - occlusally for orthopedic correction Adv; easy to insert the inner bow easy to clean facilitates the use of omega loops www.indiandentalacademy.com
  • 24. Components of a Facebow system The outer bow www.indiandentalacademy.com
  • 25. Components of a Facebow system The inner bow www.indiandentalacademy.com
  • 26. EXTRA-ORAL FORCES Retractor system parameters Force Initially -8 ounces of force Next -16 ounces of forces Time ANB is 30 or less -during sleep 3 to 50 -10hours /night > 50 -14hours /day or more www.indiandentalacademy.com
  • 27. EXTRA-ORAL FORCES Patient cooperation  Checking neck / head strap  Checking molar tubes  Checking molar mobility www.indiandentalacademy.com
  • 28. EXTRA-ORAL FORCES Orthopedic and Orthodontic forces For orthodontic forces -anterior attachments For orthopedic forces -headgear tubes -maxillary arch should be bonded or banded -tie backs www.indiandentalacademy.com
  • 29. Effects on SNA www.indiandentalacademy.com
  • 30. EXTRA-ORAL FORCES Molar Distalization How far a maxillary molar be distalized using a retractor ? Position of second and third molars www.indiandentalacademy.com
  • 31. USE OF ELASTICS Adverse effects  Loss of anterior torque  Mandibular incisor advancement  Extrusion of mandibular molars  Occlusal plane tipping Used on finishing wires Continuous wear www.indiandentalacademy.com
  • 32. Use of elastics - specifications www.indiandentalacademy.com
  • 33. Use of elastics - specifications www.indiandentalacademy.com
  • 34. Use of elastics- Class II elastics www.indiandentalacademy.com
  • 35. Use of elastics- Class II elastics  Proper timing is critical  Not used to open the bite  Class II elastics can keep the mandible in fossa  Skeletal growth  Used to burn anchorage www.indiandentalacademy.com
  • 36. Use of elastics- Class III elastics INDICATIONS An anterior dental crossbite Mandibular arch crowding www.indiandentalacademy.com
  • 37. Use of elastics- Class III elastics  More vertical vector than class II elastics  Distal position of condyle www.indiandentalacademy.com
  • 38. Use of elastics -Mid line elastics ½ “ , 6 ounce elastics  24hrs / day  During finishing stages www.indiandentalacademy.com
  • 39. Use of elastics – Box elastics Worn during the final stages of the treatment to improve interdigitation 3/16” , 6 ounce Anterior box elastics –to increase the overbite www.indiandentalacademy.com
  • 40. Use of elastics - Box elastics Lateral boxes improve the cuspid function www.indiandentalacademy.com
  • 41. Use of elastics - Box elastics Buccal boxes help to settle the posterior occlusion Close the posterior open bite www.indiandentalacademy.com
  • 42. Use of elastics Triangular elastics Crossbite elastics www.indiandentalacademy.com
  • 43. Use of elastics –up and down elastics Finishing elastics ‘W’ with a tail in class II cases ‘M’ with a tail in class III cases www.indiandentalacademy.com
  • 44. Use of elastics Extra-oral elastics ½”, 14-16 ounce Coil springs www.indiandentalacademy.com
  • 45. The use of arch wires VSD does not rely on wire bending  Closing loops  Omega loops  Other bends ( step-up or step-down and individual torque bends)  Third order bends www.indiandentalacademy.com
  • 46. The use of arch wires Tying back of orthodontic wires Active tie-back (0.014 ligature wire) 1. 2. Consolidate the arch when extra-oral force is being applied Used after closing extraction spaces www.indiandentalacademy.com
  • 47. The use of arch wires Initial archwires in the maxillary arch 0.0175 multi-stranded Respond wire or 0.016 NiTi ( flexible & less force on the teeth) Next visit – 0.016 SS round wire www.indiandentalacademy.com
  • 48. The use of arch wires Initial archwires in the mandibular arch Depends upon the torque requirements 0.017 X 0.025 multi-stranded D-Rect wire in noncrowded arch 0.016 X 0.022 D-Rect wire crowding cases www.indiandentalacademy.com
  • 49. The use of arch wires www.indiandentalacademy.com
  • 50. The use of arch wires Intermediate to final archwires MAXILLARY TMA wire is used when slight rotations are present ( 0.0175, 0.016 X 0.022 and 0.017 X 0.025 ) MANDIBULAR 0.016 X 0.022 and 0.0175 TMA or SS www.indiandentalacademy.com
  • 51. The use of arch wires In extraction case Retraction is done with 0.018 X 0.025 SS closing loop wire in max. arch www.indiandentalacademy.com
  • 52. The use of arch wires In extraction case 0.016 X 0.022 SS closing loop In deep bite cases www.indiandentalacademy.com
  • 53. The use of arch wires Finishing wire in all cases in both arches is an 0.017 X 0.025 SS ( 5 months ) Heat treating  To maintain bends www.indiandentalacademy.com
  • 54. The use of arch wires - Arch forms For upper arch www.indiandentalacademy.com
  • 55. The use of arch wires - Arch forms Lower arch forms ( Dr. Garland McElvain ) ‘U’ shaped ‘V’ shaped www.indiandentalacademy.com
  • 56. Non extraction treatment Each orthodontic problem should be diagnosed as non-extraction whenever possible  Fuller & esthetic smile  Good posterior occlusion www.indiandentalacademy.com
  • 57. Non extraction treatment –Borderline cases  Bonding does not require inter-dental space  Inter-proximal reduction  -50 torque in lower anteriors and –60 angulation in lower first molars  Advent of rectangular flexible arch-wires  Class III elastics Patient co-operation www.indiandentalacademy.com
  • 58. Non extraction treatment Slenderizing (inter-proximal stripping) ½ mm per tooth can be reduced Dome stripper Diamond disk www.indiandentalacademy.com
  • 59. Non extraction treatment -Class II Div 1 Maxillary arch 1. Placing brackets on the mandibular anteriors cause occlusal interferences 2. Biteplate in deep bite cases 3. Original mand. Arch form can be maintained longer 4. More time is allowed for mand. Second molar to erupt. www.indiandentalacademy.com
  • 60. Non extraction treatment - Class II Div 2 Conversion of div 2 as div 1 Biteplate after leveling www.indiandentalacademy.com
  • 61. Case reports Class II Div 1 www.indiandentalacademy.com
  • 62. Case reports www.indiandentalacademy.com
  • 63. www.indiandentalacademy.com
  • 64. Case reports –Class II div 2 www.indiandentalacademy.com
  • 65. Case reports www.indiandentalacademy.com
  • 66. www.indiandentalacademy.com
  • 67. Case reports www.indiandentalacademy.com
  • 68. www.indiandentalacademy.com
  • 69. Case reports www.indiandentalacademy.com
  • 70. www.indiandentalacademy.com
  • 71. Extraction treatment Indications for bicuspid extractions  Cases with extreme arch length discrepancy  Cases with bimaxillary alveolar protrusion www.indiandentalacademy.com
  • 72. Extraction treatment -DRIFTODONTICS www.indiandentalacademy.com
  • 73. Extraction treatment Arch wire sequence in Class II Div 1 MAXILLARY ARCH More crowding than non-extraction cases -leveling & aligning with flexible wires -Interference with tip of max. cuspid -cuspid retraction on 0.016 round SS wire ( 4-6 months ) Power chain –250-300gms of force www.indiandentalacademy.com
  • 74. Extraction treatment - Class II Div 1 Space closure on 0.018 X 0.025 closing loop ( 0.016 X 0.023 in the posterior region ) 1mm activation Gable bend in deep bite ( 20-300 angle ) Finishing wire 0.017 X 0.025 SS www.indiandentalacademy.com
  • 75. Extraction treatment - Class II Div 1 MANDIBULAR ARCH Driftodontics of 4 to 6 months Anterior retraction with 0.016 X 0.022 SS loop ( 6 anteriors together –4 months ) 400 gable bend in deep bite cases Finishing wire 0.017 X 0.025 SS www.indiandentalacademy.com
  • 76. Case reports www.indiandentalacademy.com
  • 77. www.indiandentalacademy.com
  • 78. Extraction treatment www.indiandentalacademy.com
  • 79. www.indiandentalacademy.com
  • 80. www.indiandentalacademy.com
  • 81. www.indiandentalacademy.com
  • 82. Finishing & retention procedures The problem of retention must be solved during treatment or it will not be solved at all -Dr. Fred Schudy Pleasing balance, correct occlusion, healthy tissues, long term stability -Dr. Tweed Objectives of VSD -quality results -non-extraction treatment -teeth placed in ideal positions www.indiandentalacademy.com
  • 83. Finishing & retention procedures When does retention begin ? 1. 2. 3. 4. 5. 6. Ideal occlusion No CO-CR discrepancy Normal Overjet & overbite Artistic positioning of anteriors Spread out lower incisor roots Correct torque of upper & lower incisors www.indiandentalacademy.com
  • 84. Finishing & retention procedures www.indiandentalacademy.com
  • 85. Finishing & retention procedures 7. 8. 9. 10. 11. 12. Lower inter canine width must be maintained Lower first molar should be upright Habits should have been eliminated Midlines should coincide Correct arch form Correct curve of Spee www.indiandentalacademy.com
  • 86. The count-down to retention Appointment 1 - sectioning of wires and finishing elastics Appointment 2 (3 wks later ) - occlusal check and final adjustments, and possible sectioning of the opposing arch wire Appointment 3 (3 wks later ) - fixed appliance removal Appointment 4 (2 days later ) -www.indiandentalacademy.com seating of the retainers
  • 87. The count-down to retention Appointment 1 Arch wire sectioning Deep overbite/Class II -lower arch wire is sectioned Open bite/Class III -upper arch wire is sectioned www.indiandentalacademy.com
  • 88. The count-down to retention Normal bite Either or both arch wires www.indiandentalacademy.com
  • 89. The count-down to retention Appointment 2 (3 wks later ) o o o o Max.molar bands are removed Patients are asked to chew sugarless gum Elastics –night wear Tooth shaping www.indiandentalacademy.com
  • 90. The count-down to retention Appointment 3 (3 wks later ) o Complete appliance removal o Inter-proximal stripping o Impressions for final models o 3rd molars are considered Appointment 4 (2 days later ) Retainers www.indiandentalacademy.com
  • 91. Retention Maxillary retainer -Wraparound retainer www.indiandentalacademy.com
  • 92. Retention Mandibular retainer 0.0215 multi-stranded wire www.indiandentalacademy.com
  • 93. Retention 0.036” BANDED BONDED www.indiandentalacademy.com
  • 94. Special problems Equilibration Spacing 5/16”, 31/2 ounce www.indiandentalacademy.com
  • 95. References  Technique and treatment with light-wire edgewise appliances (volume I and II) - J.R.JARABAK & J.A.FAZZEL  THE ALEXANDER DISCIPLINE Contemporary Concepts and Philosophies - R.G.”WICK” ALEXANDER www.indiandentalacademy.com
  • 96. References Seminars in Orthodontics, Vol 7, No 2 (June), 2001  The Alexander Discipline Appliance Design and Construction -M.Alan.Bagden  Face Bow Correction Of Skeletal II Discrepancies in the Alexander Discipline -C. D Alexander & J M. Alexander  Finishing and Retention Procedures in the Alexander Discipline -Tucker Haltom www.indiandentalacademy.com
  • 97. Thank you www.indiandentalacademy.com Leader in continuing dental education www.indiandentalacademy.com