Bioprogressive therapy

1,625 views

Published on

Published in: Education
0 Comments
5 Likes
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total views
1,625
On SlideShare
0
From Embeds
0
Number of Embeds
6
Actions
Shares
0
Downloads
25
Comments
0
Likes
5
Embeds 0
No embeds

No notes for slide

Bioprogressive therapy

  1. 1. Bioprogressive Therapy INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com www.indiandentalacademy.com
  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. www.indiandentalacademy.com
  3. 3.      Brackets & Prescriptions Class II div I Class II div II Mechanics for extraction cases. Finishing and retention. www.indiandentalacademy.com
  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 www.indiandentalacademy.com
  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. www.indiandentalacademy.com
  6. 6. Introduction  Management umbrella www.indiandentalacademy.com
  7. 7. Principles of the Bioprogressive Therapy www.indiandentalacademy.com
  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. www.indiandentalacademy.com
  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. www.indiandentalacademy.com
  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. www.indiandentalacademy.com
  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- www.indiandentalacademy.com
  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 www.indiandentalacademy.com
  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. www.indiandentalacademy.com
  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. www.indiandentalacademy.com
  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. www.indiandentalacademy.com
  16. 16. Diagnosis and Treatment Planning www.indiandentalacademy.com
  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. www.indiandentalacademy.com
  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. www.indiandentalacademy.com
  19. 19. Visual treatment objectives  Steps- 1. Ba-Na plane 2. Construction of the new mandible position .(mandibular rotation) www.indiandentalacademy.com
  20. 20. Visual treatment objectives 3. 4. Construction of the new maxillary position Position of the dentition. www.indiandentalacademy.com
  21. 21. Visual treatment objectives 5. Final soft tissue profile. www.indiandentalacademy.com
  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 www.indiandentalacademy.com
  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. www.indiandentalacademy.com
  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. www.indiandentalacademy.com
  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 www.indiandentalacademy.com
  26. 26. Superimpositions area’s   In Evaluation Area 3lower incisors. In Evaluation Area 4lower molars www.indiandentalacademy.com
  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 www.indiandentalacademy.com
  28. 28. Superimpositions area’s   In Evaluation Area 5, the upper molars In Evaluation Area 6, we evaluate the upper incisors www.indiandentalacademy.com
  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 www.indiandentalacademy.com
  30. 30. Role Of Orthopedics www.indiandentalacademy.com
  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. www.indiandentalacademy.com
  32. 32. Orthopedics in BPT   Thorough analysis of facial and dental characteristics –facial growth type. More emphasis on cervical or combination headgear. www.indiandentalacademy.com
  33. 33. Orthopedics in BPT www.indiandentalacademy.com
  34. 34. Generalized orthopedic response with Cervical Headgear alone Maxilla responds in a more predictable manner. www.indiandentalacademy.com
  35. 35. Generalized orthopedic response with Cervical Headgear alone Mandibular response – depends on the musculature. - weak musculature - strong musculature www.indiandentalacademy.com
  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 www.indiandentalacademy.com
  37. 37. The Reverse Response www.indiandentalacademy.com
  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. www.indiandentalacademy.com
  39. 39. Expansive Response www.indiandentalacademy.com
  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. www.indiandentalacademy.com
  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. www.indiandentalacademy.com
  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. www.indiandentalacademy.com
  43. 43. Forces Used In Bioprogressive Therapy www.indiandentalacademy.com
  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. www.indiandentalacademy.com
  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. www.indiandentalacademy.com
  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. www.indiandentalacademy.com
  47. 47. Forces Used In Bioprogressive Therapy www.indiandentalacademy.com
  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. www.indiandentalacademy.com
  49. 49. Forces Used In Bioprogressive Therapy  1. Control of force: Use of long lever arm. www.indiandentalacademy.com
  50. 50. Forces Used In Bioprogressive Therapy 2. Use of loops to increase the length of the wire. www.indiandentalacademy.com
  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. www.indiandentalacademy.com
  52. 52. Forces Used In Bioprogressive Therapy www.indiandentalacademy.com
  53. 53. Forces Used In Bioprogressive Therapy  Lower incisors and cuspids: www.indiandentalacademy.com
  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) www.indiandentalacademy.com
  55. 55. Forces Used In Bioprogressive Therapy Upper incisors and canines www.indiandentalacademy.com
  56. 56. Forces Used In Bioprogressive Therapy www.indiandentalacademy.com
  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. www.indiandentalacademy.com
  58. 58. Forces Used In Bioprogressive Therapy  Muscular Anchorage: www.indiandentalacademy.com
  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. www.indiandentalacademy.com
  60. 60. Utility and Sectional arches www.indiandentalacademy.com
  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 www.indiandentalacademy.com
  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. www.indiandentalacademy.com
  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 www.indiandentalacademy.com
  64. 64. Roles and functions of the lower utility arch  Position of the lower molar to allow for Cortical Anchorage: www.indiandentalacademy.com
  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. www.indiandentalacademy.com
  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. www.indiandentalacademy.com
  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. www.indiandentalacademy.com
  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. www.indiandentalacademy.com
  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 www.indiandentalacademy.com
  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 www.indiandentalacademy.com
  71. 71. Fabrication of the utility arch www.indiandentalacademy.com
  72. 72. Fabrication of the utility arch www.indiandentalacademy.com
  73. 73. Intra oral activation www.indiandentalacademy.com
  74. 74. Physiologic Vs Mechanical Response   Tip back applied to lower molar-30° to 40 °. Extraction cases-definite distal rotation must be placed . www.indiandentalacademy.com
  75. 75. Physiologic Vs Mechanical Response  30° to 45° buccal root torque applied to the lower molar www.indiandentalacademy.com
  76. 76. Physiologic Vs Mechanical Response www.indiandentalacademy.com
  77. 77. Physiologic Vs Mechanical Response   Long lever arm applied to lower incisors. 75 gms of intrusive force.(0.16 x 0.16) www.indiandentalacademy.com
  78. 78. Modifications of the Utility Arch   Expansion utility arch Force : 1mm= 85 gm 2mm=140 gm 3mm=205 gm www.indiandentalacademy.com
  79. 79. Modifications of the Utility Arch   Contraction utility arch Force: 1mm=50 gm 2mm =150 gm 3mm=230 gm www.indiandentalacademy.com
  80. 80. Modifications of the Utility Arch  Utility arch with T or L Horizontal loop www.indiandentalacademy.com
  81. 81. Modifications of the Utility Arch  Contraction or advancing utility arch www.indiandentalacademy.com
  82. 82. Treatment in the Mixed Dentition Phase www.indiandentalacademy.com
  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. www.indiandentalacademy.com
  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) www.indiandentalacademy.com
  85. 85. Resolve functional problems  Lack of rough surface , excessive thickening www.indiandentalacademy.com
  86. 86. Resolve functional problems Submento-vertex analysis - Individual condylar inclinations and width.  www.indiandentalacademy.com
  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. www.indiandentalacademy.com
  88. 88. Resolve functional problems 6. 7. 8. 9. Loss of posterior support. Habits. Breathing and airway problems. True Class III Growth pattern. www.indiandentalacademy.com
  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. www.indiandentalacademy.com
  90. 90. Resolve Arch Length Discrepancy Arch length gained is result slow natural expansive response created by muscles www.indiandentalacademy.com
  91. 91. Resolve Arch Length Discrepancy  Expansion primarily by change in axial inclination : - Rickett’s quad helix or W arch - .040 blue elgiloy wire. www.indiandentalacademy.com
  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. www.indiandentalacademy.com
  93. 93. Resolve Arch Length Discrepancy Modifications of the Quad Helix www.indiandentalacademy.com
  94. 94. Resolve Arch Length Discrepancy  Expansion by mid palatal dysfunction: - Hass type or modified Nance type expansion appliance. www.indiandentalacademy.com
  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. www.indiandentalacademy.com
  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. www.indiandentalacademy.com
  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. www.indiandentalacademy.com
  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. www.indiandentalacademy.com
  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 . www.indiandentalacademy.com
  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. www.indiandentalacademy.com
  101. 101. Thank you For more details please visit www.indiandentalacademy.com www.indiandentalacademy.com

×