Bioprogressive therapy


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Bioprogressive therapy

  1. 1. Bioprogressive Therapy INDIAN DENTAL ACADEMY Leader in continuing dental education
  2. 2.        Introduction Principles of BPT. Diagnosis and treatment planning. Role of orthopedics. Forces used in BPT. Development of the utility arch. Mixed dentition treatment.
  3. 3.      Brackets & Prescriptions Class II div I Class II div II Mechanics for extraction cases. Finishing and retention.
  4. 4. Introduction       Bioprogressive therapy was developed from a background of edgewise technique as well as begg technique. Rickett’s describes three phases of: Primary edgewise Secondary edgewise Tertiary edgewise. Quaternary edgewise
  5. 5. Introduction   It accepts as its mission the treatment of the total face rather than the narrower objective of the teeth and the occlusion. Takes advantages of biological progressions including growth, development ,function and directs them to normalize it.
  6. 6. Introduction  Management umbrella
  7. 7. Principles of the Bioprogressive Therapy
  8. 8. Principles of the Bioprogressive Therapy   BPT has been developed in an attempt to communicate an understanding of mechanical procedures in developing a treatment plan, appliance selection specific to individual type. Ten Principles.
  9. 9. Principles of the Bioprogressive Therapy   The use of a systems approach to diagnosis and treatment by the application of the VTO in planning treatment, evaluating anchorage and monitoring results. Torque control throughout treatment.
  10. 10. Principles of the Bioprogressive Therapy     Keep the roots in vascular trabecular bone. Place roots against dense cortical bone. Torque to remodel cortical bone. Torque position teeth in final occlusion.
  11. 11. Principles of the Bioprogressive Therapy  Muscular and cortical anchorage. different types of muscular pattern in different individuals.  Movement of any teeth in any direction with proper application of pressure it is designed to respect the supporting structures and size of the root of individual teeth-
  12. 12. Principles of the Bioprogressive Therapy  Orthopedic alteration -anticipates and plans for this in treating younger children.  Treat the overbite before the overjet. -incisor intrusion as best choice -stability of results -prevent interference
  13. 13. Principles of the Bioprogressive Therapy  Sectional arch treatment- arches are broken into segments. -allow lighter continuous force -more efficient root control. -supplements maxillary orthopedic alteration. - reduces friction and binding.  Concept of overtreatment - to overcome muscular forces. - root movements for stability.
  14. 14. Principles of the Bioprogressive Therapy - To overcome orthopedic rebound - To allow settling in retention  Unlocking of malocclusion in progressive sequence of treatment in order to establish or restore more normal function . -functional influence - orthopedic alteration. - arch form-length - tooth movement.
  15. 15. Principles of the Bioprogressive Therapy  Efficiency in treatment with quality results utilizing a concept of pre fabrication. -allows the clinician to direct energies in diagnosis and planning and efficient appliance therapy.
  16. 16. Diagnosis and Treatment Planning
  17. 17. Visual treatment objectives   VTO is a cephalometric tracing representing the changes that are expected (desired) during the treatment. It includes expected growth, any growth changes induced by the treatment, and any repositioning of the teeth from orthodontic tooth movement.
  18. 18. Visual treatment objectives 1. 2. 3. 4. 5. 6. Is like a blueprint used in building a house. Visual plan to forecast normal and to anticipate influence of treatment. In establishing individual objectives. Helps in developing a alternate treatment plan. Helps to evaluate treatment progress. Valuable tool for the orthodontist’s self improvement.
  19. 19. Visual treatment objectives  Steps- 1. Ba-Na plane 2. Construction of the new mandible position .(mandibular rotation)
  20. 20. Visual treatment objectives 3. 4. Construction of the new maxillary position Position of the dentition.
  21. 21. Visual treatment objectives 5. Final soft tissue profile.
  22. 22. Superimpositions area’s 1. 2. 3. 4. 5. The chin The maxilla The teeth in the mandible The teeth in the maxilla The facial profile
  23. 23. Superimpositions area’s    The first superimposition (Basion-Nasion at CC Point) establishes Evaluation Area 1 Amount of growth of the chin Any change in chin in an opening or closing direction that may result from our mechanics.
  24. 24. Superimpositions area’s    The second superimposition area (Basion-Nasion at Nasion) establishes Evaluation Area 2 to show Any change in the maxilla (Point A). The Basion-Nasion-Point A Angle does not change in normal growth.
  25. 25. Superimpositions area’s   The third superimposition area (Corpus Axis at PM) establishes Evaluation Area 3 and Evaluation Area 4, Together evaluate any changes that take place in the mandibular denture. In normal growth, the lower denture remains constant with the APO Plane
  26. 26. Superimpositions area’s   In Evaluation Area 3lower incisors. In Evaluation Area 4lower molars
  27. 27. Superimpositions area’s   The fourth superimposition area (Palate at ANS) establishes Evaluation Area 5 and Evaluation Area 6, Which together evaluate any changes that take place in the maxillary denture
  28. 28. Superimpositions area’s   In Evaluation Area 5, the upper molars In Evaluation Area 6, we evaluate the upper incisors
  29. 29. Superimpositions area’s   5th Superimposition Area (esthetic plane at the crossing of the occlusal plane) Area 7 with which we evaluate the soft tissue profile
  30. 30. Role Of Orthopedics
  31. 31. Orthopedics in BPT   Any manipulation that alters the normal growth of the dentofacial complex in either direction or amount. Concept of differential treatment in Class II malocclusion.
  32. 32. Orthopedics in BPT   Thorough analysis of facial and dental characteristics –facial growth type. More emphasis on cervical or combination headgear.
  33. 33. Orthopedics in BPT
  34. 34. Generalized orthopedic response with Cervical Headgear alone Maxilla responds in a more predictable manner.
  35. 35. Generalized orthopedic response with Cervical Headgear alone Mandibular response – depends on the musculature. - weak musculature - strong musculature
  36. 36. Generalized orthodontic response with Cervical Headgear alone    Upper molars-extrusion of upper molars. Upper incisors-tip lingually Lower molars-upright and move distally Lower incisors-tip labially
  37. 37. The Reverse Response
  38. 38. Expansive Response   1. In Class II –ant. Part of the maxilla is generally tapered –lingual crossbite. Two basic expansive phenomenon are occurAnatomic configuration of maxillary complex.
  39. 39. Expansive Response
  40. 40. Expansive Response 2. From mechanical point ,progressive widening of the alveolar base is accomplished by widening of inner bow. - Reciprocal expansion of lower arch. - Preventing impacted second molar.
  41. 41. Mechanical application 1. Force level- 400gms Intermittent wear –several advantages -heavy forces result in hylanization. -rebound allows in stability. -more growth occurs at nite. - Patient acceptance.
  42. 42. Mechanical application 3. - Outer bow length and position Rigid outer bow. At the ala of the nose. - Expansion and rotation. Flexible inner bow , 2 cm of expansion. 5. Freedom of movement of maxilla 4.
  43. 43. Forces Used In Bioprogressive Therapy
  44. 44. Forces Used In Bioprogressive Therapy   The orthodontic movement of teeth occurs as a result of the biological response and the physiological reaction to the forces applied by our mechanical procedures. Brian Lee, following the work of Storey and Smith, measured the surface of the root being exposed to movement— called the enface surface of the root.
  45. 45. Forces Used In Bioprogressive Therapy   He, proposed 200 grams per sq cm of enface root surface exposed to movement as the optimum pressure to be applied in efficient tooth movement. Bioprogressive Therapy's evaluation of the applied forces suggests 100 gms per sq cm of enface or exposed root surface as optimum.
  46. 46. Forces Used In Bioprogressive Therapy Rating scale for the intrusion of teeth measures the greatest cross section of the tooth surface in cm2. Required forces are shown at 150 and 100 gms/ cm2 Lower incisors show .20cm2 of enface root surface, while upper incisors show .40cm2.
  47. 47. Forces Used In Bioprogressive Therapy
  48. 48. Forces Used In Bioprogressive Therapy  Thurow has shown that a force of 650 grams is produced in deflecting an .018 round chrome wire 3mm across a span of ½-inch (13mm) .When a steel wire is used, the force is almost doubled to over 1000 grams.
  49. 49. Forces Used In Bioprogressive Therapy  1. Control of force: Use of long lever arm.
  50. 50. Forces Used In Bioprogressive Therapy 2. Use of loops to increase the length of the wire.
  51. 51. Forces Used In Bioprogressive Therapy   Cortical Anchorage: The concept of cortical bone anchorage implies that, to anchor a tooth, its roots are placed in proximity to the dense cortical bone under a heavy force that will further squeeze out the already limited blood supply and thus anchor the tooth. Since each tooth is supported by cortical bone, an understanding of this bony structure and support is necessary.
  52. 52. Forces Used In Bioprogressive Therapy
  53. 53. Forces Used In Bioprogressive Therapy  Lower incisors and cuspids:
  54. 54. Forces Used In Bioprogressive Therapy  Lower bicuspids and molars lower molar anchorage – the lingual cusps are kept down (roots expanded and torqued buccally)
  55. 55. Forces Used In Bioprogressive Therapy Upper incisors and canines
  56. 56. Forces Used In Bioprogressive Therapy
  57. 57. Forces Used In Bioprogressive Therapy   Upper molars and bicuspids: The upper molars are supported at the base of the key ridge of the zygomatic process.
  58. 58. Forces Used In Bioprogressive Therapy  Muscular Anchorage:
  59. 59. Forces Used In Bioprogressive Therapy     In summary : Size of the root surface involved. Amount of force applied. Cortical bone support. Muscular support –facial type.
  60. 60. Utility and Sectional arches
  61. 61. Development of the utility arch   Full banded edge wise setup-most efficient method In order to avoid forward movement of incisors, wire ends were cinched back
  62. 62. Development of the utility arch   Class III elastics It was long felt that incisor intrusion as an medium for levelling the spee was an impossibility.
  63. 63. Development of the utility arch   Ricketts tried to utilize the supposedly immutable lower incisors as an anchor unit to hold the posteriors in upright position, during cuspid retraction. This lead to the development of step down base arch wire/Rickett’s lower utility arch
  64. 64. Roles and functions of the lower utility arch  Position of the lower molar to allow for Cortical Anchorage:
  65. 65. Roles and functions of the lower utility arch     Manipulation and Alignment of the lower incisor segments. Treated as a segment- different movements. Different planes of space. Ideal force levels.
  66. 66. Roles and functions of the lower utility arch    Stabilization of the lower arch, Allowing segmental treatment of the buccal segments. Directing movements towards the final position. Early maintenance of molar anchorage.
  67. 67. Roles and functions of the lower utility arch      Physiologic roles of the lower utility arch. Reaching or activator effect-removing contact of LI from palatal or incisal occlusion. Helps in the headgear therapy. Bite before jet. Dictates the final arch form.
  68. 68. Roles and functions of the lower utility arch  Overtreatment  Edge to edge bite.  Freeing the buccal segments for unimpeded correction of Class II  Role in mixed dentition  Resolve arch length problems.
  69. 69. Roles and functions of the lower utility arch 1. 2. Uprighting of the lower molars. Root movement-2mm Crown movement-2mm Advancement of the lower incisors 1mm incisor movement 2mm arch length
  70. 70. Roles and functions of the lower utility arch 3. 4. Expansion in the buccal segment. Saving the “E” space. The author believes -with the utility arch slow, delibrate and functional type of expansion occurs-non extraction
  71. 71. Fabrication of the utility arch
  72. 72. Fabrication of the utility arch
  73. 73. Intra oral activation
  74. 74. Physiologic Vs Mechanical Response   Tip back applied to lower molar-30° to 40 °. Extraction cases-definite distal rotation must be placed .
  75. 75. Physiologic Vs Mechanical Response  30° to 45° buccal root torque applied to the lower molar
  76. 76. Physiologic Vs Mechanical Response
  77. 77. Physiologic Vs Mechanical Response   Long lever arm applied to lower incisors. 75 gms of intrusive force.(0.16 x 0.16)
  78. 78. Modifications of the Utility Arch   Expansion utility arch Force : 1mm= 85 gm 2mm=140 gm 3mm=205 gm
  79. 79. Modifications of the Utility Arch   Contraction utility arch Force: 1mm=50 gm 2mm =150 gm 3mm=230 gm
  80. 80. Modifications of the Utility Arch  Utility arch with T or L Horizontal loop
  81. 81. Modifications of the Utility Arch  Contraction or advancing utility arch
  82. 82. Treatment in the Mixed Dentition Phase
  83. 83. Bioprogressive Mixed Dentition Treatment  1. 2. 3. 4. Four basic objectivesResolve functional problems. Resolve arch length discrepancy. Correct vertical problems. Correct overjet problems.
  84. 84. Resolve functional problems   Anything that disturbs the growth, health and function of the TMJ complex. In 1950’s Ricketts –used body section x rays (laminagrphy)
  85. 85. Resolve functional problems  Lack of rough surface , excessive thickening
  86. 86. Resolve functional problems Submento-vertex analysis - Individual condylar inclinations and width. 
  87. 87. Resolve functional problems  1. 2. 3. 4. 5. Nine general categoriesCross mouth interferences. Anterior crossbite. Open bite. Excessive range of function. Distal displacement.
  88. 88. Resolve functional problems 6. 7. 8. 9. Loss of posterior support. Habits. Breathing and airway problems. True Class III Growth pattern.
  89. 89. Resolve Arch Length Discrepancy  1. - This is accomplished by three waysLateral expansion of the molars. Depends on the inclination of the posterior teeth.
  90. 90. Resolve Arch Length Discrepancy Arch length gained is result slow natural expansive response created by muscles
  91. 91. Resolve Arch Length Discrepancy  Expansion primarily by change in axial inclination : - Rickett’s quad helix or W arch - .040 blue elgiloy wire.
  92. 92. Resolve Arch Length Discrepancy   With 1cm expansion in the upper molars – anterior segment are expanded 3cm overall. Long term functional expansion for atleast a year or more for stable and demonstrable changes to occur in the lower arch.
  93. 93. Resolve Arch Length Discrepancy Modifications of the Quad Helix
  94. 94. Resolve Arch Length Discrepancy  Expansion by mid palatal dysfunction: - Hass type or modified Nance type expansion appliance.
  95. 95. Resolve Arch Length Discrepancy 2. - Advancement of forward movement of the lower molars: If the VTO and physiologic factors warrant. 1mm forward movement of LI yields 2mm of arch length.
  96. 96. Resolve Arch Length Discrepancy 3. Uprighting and /or distal movement of the lower molars: - Accomplished by utility arch. - 2 mm per side can be gained by uprighting.
  97. 97. Correct Vertical/Overjet Problems   This is done after functional and arch length corrections are achieved. Six basic approaches are used for the first phase of non extraction treatment.
  98. 98. Correct Vertical/Overjet Problems 1. Orthopedic problemsIn case where good alignment of lower arch exists and Class II is on account of Max.protrusion. 2. Orthopedic problems with lower arch therapywith maxillary protrusion but incisors and molars in deep bite or need advancement.
  99. 99. Correct Vertical/Overjet Problems 3. Orthopedic problems –Enhanced maxillary movement. where maxillary reduction is required but growth pattern does not suggest a cervical pull head gear 4. . Combination orthopedic /orthodontic problems Initially started with utility and headgear .
  100. 100. Correct Vertical/Overjet Problems Orthopedic problems with minor incisor interferences. - Upper utility arch with headgear. 6. Orthodontic problems alone. - Upper utility arch with Class II elastics. 5.
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