Bpt part ii /certified fixed orthodontic courses by Indian dental academy

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Bioprogressive Therapy
Part II
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INDIAN DENTAL ACADEMY
Leader in continuing dental education

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 Utility arch.
 Mixed dentition treatment
 Brackets & Prescriptions
 Class II div I
 Class II div II
 Mechanics for extraction cases.
 Finishing and retention.

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Roles and functions of
the lower utility arch
 Position of the lower molar to allow for
Cortical Anchorage
 Manipulation and Alignment of the lower
incisor segments.
 Allowing segmental treatment of the buccal
segments
 Physiologic roles of the lower utility arch.
 Role in mixed dentition

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Fabrication of the utility arch

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Physiologic Vs Mechanical
Response
 Tip back applied to lower
molar-30° to 40 °.
 No toe-in in non
extraction utility.
 Extraction cases-definite
distal rotation must be
placed .

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Response
 30° to 45° buccal
root torque applied
to the lower molar

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Response

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Response
 Long lever arm
applied to lower
incisors.
 75 gms of intrusive
force.(0.16 x 0.16).
 Labial root torque.

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Modifications of the Utility Arch
 Expansion utility
arch
 Force :
1mm= 85 gm
2mm=140 gm
3mm=205 gm

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 Contraction utility arch
 Force:
1mm=50 gm
2mm =150 gm
3mm=230 gm

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 Utility arch with T or
L Horizontal loop

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 Contraction or
advancing utility
arch

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Treatment in the Mixed
Dentition Phase

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Bioprogressive Mixed
Dentition Treatment
 Four basic objectives-
1. Resolve functional problems.
2. Resolve arch length discrepancy.
3. Correct vertical problems.
4. Correct overjet problems.

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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)

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 Lack of rough surface , excessive thickening

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 Submento-vertex
analysis
- Individual condylar
inclinations and
width.

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 Nine general categories-
1. Cross mouth interferences.
2. Anterior crossbite.
3. Open bite.
4. Excessive range of function.
5. Distal displacement.

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6. Loss of posterior support.
7. Habits.
8. Breathing and airway problems.
9. True Class III Growth pattern.

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Resolve Arch
Length Discrepancy
 This is accomplished
by three ways-
1. Lateral expansion of
the molars.
- Depends on the
inclination of the
posterior teeth.

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Resolve Arch
Length Discrepancy
 Expansion primarily by
change in axial inclination :
- Rickett’s quad helix
- .040 blue elgiloy wire.

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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.

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Resolve Arch
Length Discrepancy
Arch length gained is result slow natural
expansive response created by muscles

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Resolve Arch
Length Discrepancy
Modifications of the Quad Helix

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Resolve Arch
Length Discrepancy
 Expansion by mid palatal dysfunction:
- Hass type or modified Nance type expansion
appliance.

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Resolve Arch
Length Discrepancy
2. Advancement or forward movement of the
lower molars:
- If the VTO and physiologic factors warrant.
- Expansion utility arch.
- 1mm forward movement of LI yields 2mm of
arch length.

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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.

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Correct Vertical/Overjet
Problems
 This is done after functional and arch length
corrections are achieved.
 Includes different approaches are used for
the first phase of non extraction treatment.

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Problems
1. Orthopedic problems-
- In case where good alignment of lower arch exists and Class
II is on account of Max.protrusion.
2. Orthopedic problems with lower arch
therapy-
- with maxillary protrusion but incisors and molars in deep bite
or need advancement.

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Problems
3. Orthopedic problems with minor incisor
interferences.
- Upper utility arch with headgear.
4. Orthodontic problems alone.
- Upper utility arch with Class II elastics.

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Development of the
Bioprogressive Brackets

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Brackets
 Siamese twin bracket
on all the teeth.
 Slot size-.022 changed
to .018

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Brackets
 Slot size-.0185 x .030
1. Use of two light arches
2. Permits a champer or bevel.
3. Allows for a lever access.
4. Adequate distance for the torque grooves.

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Development of Brackets
1. Rickett’s Standard Bioprogressive.
2. Rickett’s Full Torque Bioprogressive.
3. Triple Control Bioprogressive.

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1. Rickett’s Standard
Bioprogressive.
 These were the first set of
brackets which available.
(1960)
 Banding was done on all
the teeth.
 Line of occlusion –through
the contact points.

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 Trend of building in treatment in the
appliance. (angulations)
 The original design had 5° for all the canines
and 8° for the upper lateral incisors and 5° for
the lower first molar
 Torque was present only in-upper incisors,
laterals and canines.

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2. Rickett’s Full Torque Bioprogressive.
 Torque was build in the lower molars and
pre molars.
 Brackets were placed with 5 angulation.
 12 rotation was also built in the tube.

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3. Triple control Bioprogressive.
 Raised bases
 Triple tube for upper molars
 Breakaway convertible lower molar tube.
 Direct bonding base/contoured.
 Slots cut at an angle

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Mechanics Sequence for
Extraction Treatment

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Extraction Mechanics
 Four general procedures :
1 Stabilization of upper and lower molar
anchorage.
2 Retraction and uprighting of cuspids with
sectional arch mechanics.
3 Retraction and consolidation of upper and lower
incisors.
4 Continuous arches for details of ideal and
finishing occlusion.

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1. Stabilization of upper
and lower molar
anchorage:
a) Maximum upper
molar anchorage.
 Nance arch with
modifications.
 Headgear .

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b) Moderate upper molar
anchorage:
 Palatal bar.
 Quad helix.
 Upper utility arch.

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c) Minimum upper
molar anchorage:
 Vertical closing loop.
 Double delta loop.

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 Maximum lower molar
anchorage:
 Lower utility arch-four
mechanical
adjustments.

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 Moderate lower molar
anchorage:
 Lower utility with
adjustments.

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 Minimum lower molar
anchorage:
 Eliminate the four
mechanical factors.
 Round wires may be
used.

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2. Retraction and uprighting of cuspids with
sectional arch mechanics.
 Cuspids need to be kept in the narrow trough
of trabecular bone and avoid the severe
tipping or displacement
 The activation of the cuspid retraction springs
should produce 100 to 150 grams of force

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 Intrusion

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 Root uprighting

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 Rotation

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3. Retraction and consolidation of upper and
lower incisors.
Lower incisors:
 Very light continuous forces (150 grams)
 Contraction utility
 Double delta retraction loops

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 Upper Incisors:
 Regular contraction
utility.
 Upside down vertical
closing loop.
 Double delta loop.

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Class II Div I

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Mechanics For Class II Div I
 Sequence:
 Lower Incisor intrusion.
 Lower Cuspid intrusion.
 Alignment of the lower buccal segment.
 Alignment of the upper buccal segment.
 Segmental correction of Class II with elastics.
 Upper incisor alignment and intrusion.

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 Upper arch –orthopedic reduction of the
maxilla.
 Lower arch-treatment starts with levelling
the spee.-utility arch

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 Lower stabilizing utility arch-after initial
purpose of the utility arch is accomplished –it
no longer serves as an efficient function
 16 x 22 stabilizing arch is placed

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 Alignment of the lower
buccal segment starts:
 .015 or .0175
Twistoflex
 .012,.014 of 018 wires
 16x 16 triple T section
 .016 or.018 nitinol

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 Upper arch
alignment:
 Incisors are not
included.
 Upper molars starts
Distalizing-opening
spaces in the buccal
segment.

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a) Consolidation section
b) Stabilizing section

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 Segmental correction with Class II elastics:
 Three detrimental effects:
1. Skidding effect.
2. Tendency for a deep bite.
3. Difficult to overcorrect buccal segment.

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 Tractions Sections-
 Gable bend distal to
canine.
 Rotation bend in the
anterior portion.
 Molar bayonet bend

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 Functions –
1. Counteract downward backward
pull
2. Stabilizing function in the upper
buccal segment.

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 Upper incisors alignment
and Intrusion
 Upper incisors are
aligned before placement
with light round wires.
 16 X 22 utility arch is
placed

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 Consolidation of Upper
Incisors
 Retraction of the upper
incisors .
 Over treatment -2mm
 Closing utility/upside
down closing
arch/vertical helical
arch.

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 Idealization of
arches and finishing.
 16 or 17 square,16 x
22 or 17 x 25 nitinol.
 Class II elastics to
be discontinued
atleast 2 months.
 Light round wires
finishing

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Class II Div II

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Mechanics For Class II Div II
 Three treatment
possibilities:
1. Distalizing the
upper arch.
2. Advancing the lower
arch.
3. A reciprocal
movement.

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1. Advancement, torque control, and intrusion of
the upper incisors.
2. Intrusion of the lower incisors and cuspids.
3. Alignment of the buccal segments and Class
II correction.
4. Consolidation of the upper incisors.
5. Idealizing the arches.
6. Finishing.

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 Quad helix or W
arch

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1. Advancement, torque control, and intrusion
of the upper incisors.
X Principle of bite before jet
 Jet is created followed by intrusion.
16x22 utility arch

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Directional control

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 Amount of pressure:
 125-160 gms
 16 x 22
 Stabilization of the
molars:
Quad helix
TPA
Stab. sections

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 Intrusion of lower incisors:
 16 x 16 utility arch.
 65-75 gms.
 This is followed by cuspid intrusion.

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 Advancement
of the lower
denture:
1. Utility arch with
4 helical loops

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2. Using three
vertical loops:

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3. Alignment of the buccal
segment:
a) Stabilizing section

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If buccal segment
are not aligned
 “T” sections
 Twistoflex wire
 Cable wire

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4. Consolidation of
the maxillary
incisors:

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 Idealization and
arches and finishing

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Pentamorphic Arch Forms

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Finishing and Retention

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 “Begin with the end in
mind”.
 Every orthodontist has a
visual picture in his mind
of the ideal occlusion into
which the teeth should fit
and mesh in the final
finished occlusion.

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 Bioprogressive proposes the concept
overtreatment….
 No clinician can position teeth as delicately
as the functioning incline plane and cusp
action can accomplish naturally when it is
adequately set up to operate correctly.
 Allow natural function to guide the teeth into
the best functioning occlusion for each
individual

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 Two phases of retention:
1. Guiding changes during initial adjustments.
2. Supporting bony sutural and muscular
accommodations to changing environment
and considering long range influences.

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 Initial stage of retention :
 First six weeks following appliance removal
 Retainers inserted-designed not to hold but to
guide the teeth in settling.

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Labial frame of typical
upper retainer (Ricketts)
passes between the lateral
and cuspid and has a
distal loop at each end to
tuck in the distal of the
expanded overtreated
upper cuspid

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 Lower arch:
 Fixed first bicuspid retainer is placed.
-maintain cross arch bicuspid width.
-lower cuspid freedom of adjustment against
upper occlusion.
-maintain lower incisor alignment and rotation
correction.

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 Stabilizing stage of retention:
 First year following active treatment.
 Lower retainer is kept in place and upper is
worn most of the time.

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