Intrusion in orthodontics /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 provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078

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Intrusion in orthodontics /certified fixed orthodontic courses by Indian dental academy

  1. 1. ….post prandial stupor…. INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com www.indiandentalacademy.com
  2. 2. INTRODUCTION Overbite Deep bite Problems with deep bite www.indiandentalacademy.com
  3. 3. Overbite . . . Vertical overlap of the incisors Ref: W.R.Profitt & H.W.Fields; Contemporary Orthodontics;chap 1;pg 10 Lower incisors contact uppers at / above cingulum 1-2 mm Excessive overbite is deep overbite/deep bite www.indiandentalacademy.com
  4. 4. Deepbite . . . Skeletal Dental True Pseudo maxilla mandible Both Infraerupted molars Supraerupted incisors www.indiandentalacademy.com
  5. 5. Intrusion Arches Guided by Prof.Dr.K.Rajasigamani The Head Presented by anisha manjeni PG Student 26.04.2006 www.indiandentalacademy.com
  6. 6. Features Of Pseudo Deep Bite Small interocclusal space Excessive curve of spee Fully erupted molars Incisal margins of incisors beyond functional occlusal plane www.indiandentalacademy.com
  7. 7. Problems with Deepbite . . . trauma to soft tissues lower anterior attrition palatal – deep bite + excessive overjet lower labial – deep bite + reduced overjet lack of incisal guidance sensitivity www.indiandentalacademy.com
  8. 8. INTRUTION www.indiandentalacademy.com
  9. 9. apical movement of the geometric center of the root in respect to the occlusal plane / a plane based on the long axis of the tooth www.indiandentalacademy.com
  10. 10. Factors considered for Intrusion . . . Natural plane of occlusion Anterior esthetics Amount of attached gingiva in lower incisor region A-B discrepancy clinical crown height www.indiandentalacademy.com
  11. 11. Biomechanics involved . . . Intrusion force levels Control reactions of posteriors www.indiandentalacademy.com
  12. 12. INTRUSION FORCE MAX INCISOR MAND INCISOR CANINE 5 – 10 g 10 – 15 g 15 – 25 g Ref : Dermaut LR Vanden Bulcke MM AJO 89; 251-263;1986 www.indiandentalacademy.com
  13. 13. The III law of Newton action = reactionwww.indiandentalacademy.com
  14. 14. …just to warm up Mulligan’s illustrations www.indiandentalacademy.com
  15. 15. Ref: Thomas.F.Mulligan ; Common Sense Mechanics :chapter 1 ;CSM1982 Short long equal www.indiandentalacademy.com
  16. 16. Ref: Thomas.F.Mulligan ; Common Sense Mechanics :chapter 1 ;CSM1982 Short long equal www.indiandentalacademy.com
  17. 17. Ref: Thomas.F.Mulligan ; Common Sense Mechanics :chapter 1 ;CSM1982 Short long equal www.indiandentalacademy.com
  18. 18. Ref: Thomas.F.Mulligan ; Common Sense Mechanics :chapter 1 ;CSM1982 Short long equal www.indiandentalacademy.com
  19. 19. Intrusion arches www.indiandentalacademy.com
  20. 20. Intrusion arch gamut . . . Begg & its modifications Burstone’s 3 piece Ricketts’ utility arch Mulligan intrusion arch Connecticut KSIR www.indiandentalacademy.com
  21. 21. Begg www.indiandentalacademy.com
  22. 22. BEG G Arch wire material Delivers light force Heat treated SS Developed by A.J.Wilcock Round wire High resiliency with toughness Ref: Begg&Kesling ; Begg Orthodontic Theory & Technique;1977;W.B.Saunders;3rd edt www.indiandentalacademy.com
  23. 23. Arch Design Stage I archwire (0.016”) with intermaxillary hooks Anchorage bends are formed in the buccal segments First distal ends of arch wire are placed in molar tube The labial segments of the arch wire press against the mucolabial sulci Ref: Begg&Kesling ; Begg Orthodontic Theory & Technique;1977;W.B.Saunders;3rd edt www.indiandentalacademy.com
  24. 24. Arch Design The forces are not great enough to tip the crowns of molars distally & are optimal for depressing the six anterior teeth in their socket But it can resist the forward pull of the class II elastics - “tip back” action of anchor bend offers “toe hold” to molars Ref: Begg&Kesling ; Begg Orthodontic Theory & Technique;1977;W.B.Saunders;3rd edt www.indiandentalacademy.com
  25. 25. Begg stage I arch Anchor bend www.indiandentalacademy.com
  26. 26. Modifications of Begg www.indiandentalacademy.com
  27. 27. Jayad eShortcomings of conventional Begg Molar extrusion & little incisor intrusion Questionable efficacy in upper incisor intrusion Stereotype approach for all types of cases -Insufficient force from 0.016” upper archwire -45g from archwire ( intrusive component ) -30g from Cl II elastics ( extrusive component) -Net force is 15g for 3 teeth i.e.,5g for one tooth -Upper incisor inclination was not considered Ref: Vijay P.Jayade ; Refined Begg For Modern Times;Sep.2001;1st edt www.indiandentalacademy.com
  28. 28. Jayad eBite opening Excess proclination is corrected in substage I This is done to orient the forces close to CRES Proclined-intrusive force 45g;Cl II force 60g Improved inclination –intrusive force 60g;Cl II force 30g Upright –elastic force oblique with anterior downwards - achieves controlled tipping & active intrusion Ref: Vijay P.Jayade ; Refined Begg For Modern Times;Sep.2001;1st edt www.indiandentalacademy.com
  29. 29. Jayad eBite opening Methods of increasing intrusive force magnitude Methods of reducing elastic force Use of same elastics for a longer time Shift to road runner elastics (5/16”) Increase anchor bend of 0.016” from 30° to 50° After 2-3 visits use 0.018” with anchor bends Ref: Vijay P.Jayade ; Refined Begg For Modern Times;Sep.2001;1st edt www.indiandentalacademy.com
  30. 30. Jayad e Palatal elastics TPA fabricated with hooks They lie in line with lat.incisor Oval shaped wire soldered in the center This generates intrusive force by the tongue action Four brackets bonded on palatal aspect of incisors slots incisal – high hat pins on lat incisors Light elastics applied from TPA to lat incisor No elastics on buccal side Ref: Vijay P.Jayade ; Refined Begg For Modern Times;Sep.2001;1st edt www.indiandentalacademy.com
  31. 31. Jayad eMechanics of palatal elastics Ref: Vijay P.Jayade ; Refined Begg For Modern Times;Sep.2001;1st edt Neutralizes labially proclining component of the archwire Augments intrusive force of the archwire Cephalogram construction to estimate force levels www.indiandentalacademy.com
  32. 32. Construction of cephalogram Arch wire Palatal elastics Intrusiveforce Intrusive force magnitude Elastic force magnitude Ref: Vijay P.Jayade ; Refined Begg For Modern Times;Sep.2001;1st edt www.indiandentalacademy.com
  33. 33. A line is drawn at right angle to the span of the archwire at the bracket slot gives the direction of intrusive force These two forms the two sides of the parallelogram A line joining the bracket shadow to the CRES acts as hypotenuses This is extended to required length ( 1cm = 20g ) to denote a resultant of 60g The length of the 2 sides gives values of these 2 forces These forces can be obtained in the mouth by selecting a suitable elastic size and by manipulating the degree of anchor bends Construction of cephalogram Ref: Vijay P.Jayade ; Refined Begg For Modern Times; www.indiandentalacademy.com
  34. 34. Jyothindra Kumar Sections of rectangular wire of 0.018 X 0.025” are bent in the form of hooks Soldered on the buccal aspect of molars gingival to tube Elastics are engaged from these hooks to the cuspid circles Power arms Direction from class II to class I Ref: Vijay P.Jayade ; Refined Begg For Modern Times;Sep.2001;1st edt www.indiandentalacademy.com
  35. 35. Anchor bend modifications www.indiandentalacademy.com
  36. 36. Conventional anchor bend Placed 3mm mesial to molar tube Cause more intrusion of the upper canine & less intrusion of the incisors This is due to bowing of the arch wire in canine area Ref: Vijay P.Jayade ; Refined Begg For Modern Times;Sep.2001;1st edt www.indiandentalacademy.com
  37. 37. Gable bend Placed distal to canine Cause extrusion of canine & more intrusion of the incisors Ref: Vijay P.Jayade ; Refined Begg For Modern Times;Sep.2001;1st edt www.indiandentalacademy.com
  38. 38. Hocevar’s modification Bend placed on either side of canine Central incisors – intrusion lateral incisor- less extrusion canine – more extrusion Ref: Vijay P.Jayade ; Refined Begg For Modern Times;Sep.2001;1st edt www.indiandentalacademy.com
  39. 39. Kameda’s modification Simultaneous anchor bend & Gable bend Engaged on premolars Extrusion of premolars & canine Intrusion of canine Ref: Vijay P.Jayade ; Refined Begg For Modern Times;Sep.2001;1st edt www.indiandentalacademy.com
  40. 40. Jayade’s modification Mild gingival curve in the anterior section from mesial of cuspid circle on one side to the other It should lift the arch wire at the midpoint by 3mm over the brackets Ref: Vijay P.Jayade ; Refined Begg For Modern Times;Sep.2001;1st edt www.indiandentalacademy.com
  41. 41. Jayade’s modification The bend causes an inward tilting of the cuspid circles and the posterior sections Arch contouring plier is used to plane the cuspid circles Ref: Vijay P.Jayade ; Refined Begg For Modern Times;Sep.2001;1st edt www.indiandentalacademy.com
  42. 42. Jayade’s modification A vertical step-up bend of 4-5 mm height is placed 2-3mm mesila to molar tube Anchor bend is placed at the upper end of the step Step-up bend converges occlusally to avoid trauma to gingiva Ref: Vijay P.Jayade ; Refined Begg For Modern Times;Sep.2001;1st edt www.indiandentalacademy.com
  43. 43. Jayade’s modification The step-up bend applies intrusive force high above the occlusal plane The vertical step-up & the tip back intrude canine Anterior gingival curvature intrude incisors Ref: Vijay P.Jayade ; Refined Begg For Modern Times;Sep.2001;1st edt www.indiandentalacademy.com
  44. 44. Burstone www.indiandentalacademy.com
  45. 45. Ref: Charles R.Burstone; Deep overbite correction by intrusion; AJO 1977;Jul;1-22 BURSTON E segmented arch mechanics 3 parts a posterior anchorage unit an anterior segment an intrusive arch spring www.indiandentalacademy.com
  46. 46. Burstone’s intrusion arch Ref: Charles R.Burstone; Deep overbite correction by intrusion; AJO 1977;Jul;1-22 Posterior segment Anterior segment Intrusion spring www.indiandentalacademy.com
  47. 47. BSS Lingual arch High pull Head gear Posterior anchorage unit www.indiandentalacademy.com
  48. 48. Intrusive arch spring 0.018” x 0.022” / 0.018” x 0.025” SS 3mm helix wound 21/2 times & placed mesial to the aux. tube Incisal curvature lies gingival to the central incisors Gentle curvature increasing towards helix Ref: Charles R.Burstone; Deep overbite correction by intrusion; AJO 1977;Jul;1-22 BURSTON E www.indiandentalacademy.com
  49. 49. Six major principles of intrusion . . . Ref: Charles R.Burstone; Deep overbite correction by intrusion; AJO 1977;Jul;1-22 1.Force – less magnitude & constant 2.Anterior single point contacts 3.Point of force application & CRES 4.Selective intrusion based on anterior tooth geometry 5.Control over reactive units with post.anch.unit 6.Avoid extrusive mechanics BURSTON E www.indiandentalacademy.com
  50. 50. Principle 1 Force – less magnitude & constant Problems with increased force magnitude Decreased rate of intrusion Increased rate of root resorption Increased reciprocal vertical force on molars 100g recommended Ref: Charles R.Burstone; Deep overbite correction by intrusion; AJO 1977;Jul;1-22 www.indiandentalacademy.com
  51. 51. To achieve 100g of constant force . . . Low load deflection wire Helix - 2 ½ turns & 3m diameter Activated 16.5mm delivers 100g For 1mm intrusion change in force magnitude is 6g – relatively constant force achieved Long perpendicular distance from incisors to aux tube - Intrusion spring of 30 mm LLD of 6g/mm Ref: Charles R.Burstone; Deep overbite correction by intrusion; AJO 1977;Jul;1-22 www.indiandentalacademy.com
  52. 52. Force levels Upper Incisor 20 – 25 g Lower Incisor 5 - 10 g Canine 50 g 1mm deflection generates 6g force 100g needs 16.5 mm of deflection 25 25 25 25 100g www.indiandentalacademy.com
  53. 53. CRES 16.5 mm 1mm deflection generates 6g force Ref: Charles R.Burstone; Deep overbite correction by intrusion; AJO 1977;Jul;1-22 www.indiandentalacademy.com
  54. 54. Ref: Charles R.Burstone; Deep overbite correction by intrusion; AJO 1977;Jul;1-22 Arch wire engaged by considerable deflection www.indiandentalacademy.com
  55. 55. Principle 2 Anterior single point contacts Disadvantages of engaging IA in brackets Anterior torque labial root torque – intrusive force increased →anchor loss lingual root torque – intrusive force decreased/reversed Unwanted curvatures forms during activation Statically indeterminant force system Ref: Charles R.Burstone; Deep overbite correction by intrusion; AJO 1977;Jul;1-22 www.indiandentalacademy.com
  56. 56. Advantages of single point contacts Statically determinant force system Allows placement of series of anterior alignment arches Principle 2 Anterior single point contacts Ref: Charles R.Burstone; Deep overbite correction by intrusion; AJO 1977;Jul;1-22 www.indiandentalacademy.com
  57. 57. Principle 3 Point of force application (PFA) & CRES Intrusive force through the CRES does not produce any labial / lingual rotation of teeth. The CRES of the anterior segments lie at geometric centers of the roots of the incisors to be intruded Ref: Charles R.Burstone; Deep overbite correction by intrusion; AJO 1977;Jul;1-22 www.indiandentalacademy.com
  58. 58. Proclined Normal CRES +ve +ve PFA thru’ CRES Tie IA back Ref: Charles R.Burstone; Deep overbite correction by intrusion; AJO 1977;Jul;1-22 www.indiandentalacademy.com
  59. 59. Proclination Normal inclination PFA thru’ CRES Anterior segment with distal extension Sectional intrusive springs (L&F) IA tied back to prevent protrusion Ref: Charles R.Burstone; Deep overbite correction by intrusion; AJO 1977;Jul;1-22 www.indiandentalacademy.com
  60. 60. Principle 4 Selective intrusion This has to be considered in class II DivII & Div I cases with retroclined and extruded incisors Arch leveling should not be by extrusion of laterals but should rather be by intrusion of centrals ( class II Div II ) Arch leveling should not be by extrusion of canine but should rather be by intrusion of incisors ( Class II Div I )www.indiandentalacademy.com
  61. 61. Principle 5 Control of reactive units Reactive unit refers to the posterior unit Minimization of the force magnitude offers good control of posterior unit A large moment arm b/w ant. & post. demands additional control measures i.e,.max anchorage Ref: Charles R.Burstone; Deep overbite correction by intrusion; AJO 1977;Jul;1-22 www.indiandentalacademy.com
  62. 62. Posterior unit Why maximum anchorage? Side effects due to intrusion steepening of the occlusal plane extrusion of molars Ref: Charles R.Burstone; Deep overbite correction by intrusion; AJO 1977;Jul;1-22 www.indiandentalacademy.com
  63. 63. steepening of the occlusal plane Intrusive force moment M = F x D Distal tipping Exsisting OP Steepened OP www.indiandentalacademy.com
  64. 64. extrusion of molars Lingual tipping TPA Anchorage control transverse plane Strong consideration in vertical growth -ve moment-ve moment -ve moment-ve moment 0.036” SS www.indiandentalacademy.com
  65. 65. Posterior anchorage unit buccal stabilizing segment 0.018”x0.025” / 0.021”x0.025” transpalatal / lingual arch occipital headgear Distal tipping Extrusion Distal tipping & Extrusion Ref: Charles R.Burstone; Deep overbite correction by intrusion; AJO 1977;Jul;1-22 www.indiandentalacademy.com
  66. 66. Principle 6 Avoid extrusion mechanics Class II & Class III intermaxillary elastics Cervical head gear with outer bows placed high applied to maxillary arch Extrusive mechanics are . . Reverse curve of spee in the lower arch wire to extrude premolars Ref: Charles R.Burstone; Deep overbite correction by intrusion; AJO 1977;Jul;1-22www.indiandentalacademy.com
  67. 67. Distally tipped canine…..to be bypassed Extrusion Ref: Charles R.Burstone; Deep overbite correction by intrusion; AJO 1977;Jul;1-22 Principle 6 Avoid extrusion mechanics www.indiandentalacademy.com
  68. 68. Ricketts www.indiandentalacademy.com
  69. 69. Rickett s Utility arch . . . 0.016” X 0.016” / 0.022” blue elgiloy in 0.018 slot Design includes molar segment, posterior vertical segment, vestibular segment & anteiror vertical segment, incisal segment Ref: Ricketts R.M ;Bioprogressive Therapy US:Rocky Mountain.1980:183-199 www.indiandentalacademy.com
  70. 70. Rickett s Utility arch . . . Molar segment extends into the tube on the 1st / 2nd molar 30-45 degrees of molar rotation bend 45 degrees of buccal root torque 30-45 degrees of molar tipback bend Molar segment Ref: Ricketts R.M ;Bioprogressive Therapy US:Rocky Mountain.1980:183-199 www.indiandentalacademy.com
  71. 71. Rickett s Utility arch . . . Formed perpendicular to molar bend 3- 4 mm length in mandible & 4-5 mm in maxilla Posterior vertical segment Ref: Ricketts R.M ;Bioprogressive Therapy US:Rocky Mountain.1980:183-199 www.indiandentalacademy.com
  72. 72. Rickett s Utility arch . . . Formed by placing a right angled bend at the inferior part of posterior vertical segment Passes anteroinferiorly along the gingival margin Vestibular segment Ref: Ricketts R.M ;Bioprogressive Therapy US:Rocky Mountain.1980:183-199 www.indiandentalacademy.com
  73. 73. Rickett s Utility arch . . . 4-5mm height in mandible This can vary with individuals Anterior vertical segment 5-8mm height in mandible Ref: Ricketts R.M ;Bioprogressive Therapy US:Rocky Mountain.1980:183-199 www.indiandentalacademy.com
  74. 74. Rickett s Utility arch . . . A final 90 degree bend creates an incisal bend Incisal segment This lies passively in the brackets of anterior teeth Ref: Ricketts R.M ;Bioprogressive Therapy US:Rocky Mountain.1980:183-199 www.indiandentalacademy.com
  75. 75. Rickett s Utility arch . . . A final 90 degree bend creates an incisal bend Activation This lies passively in the brackets of anterior teeth Ref: Ricketts R.M ;Bioprogressive Therapy US:Rocky Mountain.1980:183-199 www.indiandentalacademy.com
  76. 76. Why blue Elgiloy? Elgiloy is a Co-Cr-Ni wire developed in 1950s by the Elgiloy corporation ( USA ) They are color coded by the manufacturer : Blue – soft Yellow – ductile Green – semi resilient Red - resilient Similar in composition but differ in wire processing Blue elgiloy is popular among orthodontists Rickett s Ref: WA.Brantley & Eliades ;Orhtodontic Materials;Thieme;Sttutgart NY 2001 www.indiandentalacademy.com
  77. 77. Plus points of blue Elgiloy Ease of manipulation – soft feel – low YS Force delivery and joining characters similar to SS Modulus of elasticity similar to SS Can be heat treated to increase its yield strength, resilience & modulus of elasticity Ref: WA.Brantley & Eliades ;Orhtodontic Materials;Thieme;Sttutgart NY 2001 www.indiandentalacademy.com
  78. 78. Mulligan www.indiandentalacademy.com
  79. 79. Mulliga n Ref: Graber & Vanarsdall ; Orthodontics current principle & techniques;768-771 Employs the “cantilever principle” Popularly described as “Diving Board Concept” 0.018” A.J.Wilcock SS wire Design includes a helix mesial to molar tube with an anchorage bend www.indiandentalacademy.com
  80. 80. How common sense avoids molar distal tipping? Arch wire tied securely to the molar tubes does not allow tip back bend to tip molar crown distally It brings out mesial root movement of molars instead This is advantageous as most of the class II malocclusion requires molar uprighting Crown movement precedes root movement Ref: Thomas F.Mulligan ; common sense mechanics 6;JCO 1980;Feb;98-103 www.indiandentalacademy.com
  81. 81. overlaywww.indiandentalacademy.com
  82. 82. KSIR www.indiandentalacademy.com
  83. 83. KSI R Introduced by Varun Kalra in 1998 Ref: Varun Kalra ; Simultaneous Intrusion & Retraction Of The Anterior Teeth; JCO 1998;Sep;535-540 KSIR – Kalra Simultaneous Intrusion & Retraction The mechanism is based on the space closure mechanics advocated by Burstone Easy fabrication,Easy adjustment, & Patient comfort www.indiandentalacademy.com
  84. 84. KSI R Continuous 0.019” X 0.025” TMA Ref: Varun Kalra ; Simultaneous Intrusion & Retraction Of The Anterior Teeth; JCO 1998;Sep;535-540 7mm X 2mm U-loops incorporated at extr. sites 3 bends 90° V-bend 60° V-bend 20° anti rotation bend www.indiandentalacademy.com
  85. 85. KSI R Ref: Varun Kalra ; Simultaneous Intrusion & Retraction Of The Anterior Teeth; JCO 1998;Sep;535-540 Why TMA ? Sufficient strength to resist distortion Excellent formability Titanium Molybdenum Alloy Delivers low forces compared to SS & CrCo Sufficient stiffness to generate moments Activated twice of SS without permament deformation www.indiandentalacademy.com
  86. 86. KSI R Ref: Varun Kalra ; Simultaneous Intrusion & Retraction Of The Anterior Teeth; JCO 1998;Sep;535-540 Why Loop ? Frictionless mechanics Space closure of extraction site Increases the span of wire - LLD www.indiandentalacademy.com
  87. 87. KSI R Ref: Varun Kalra ; Simultaneous Intrusion & Retraction Of The Anterior Teeth; Why bends ? Placed at the level of each U- Loop 90° V-bend . . . Centered b/w 1st molar & canine creates 2 equal and opposite moments This counters tipping movements caused by loop activation www.indiandentalacademy.com
  88. 88. 90° V-bend . . . www.indiandentalacademy.com
  89. 89. KSI R Ref: Varun Kalra ; Simultaneous Intrusion & Retraction Of The Anterior Teeth; Why bends ? 60° V-bend placed posterior to the center of interbracket distance 60° V-bend . . . Produces an increased clockwise moment on first molar This augments molar anchorage & incisor intrusion www.indiandentalacademy.com
  90. 90. 60° V-bend . . . www.indiandentalacademy.com
  91. 91. KSI R Ref: Varun Kalra ; Simultaneous Intrusion & Retraction Of The Anterior Teeth; JCO 1998;Sep;535-540 Why bends ? To prevent the buccal segments rolling mesillingually due to the force produced by the activation 20° antirotation bend . . . This bend is placed in the archwire just distal to each U-loop This augments molar anchorage & incisor intrusion www.indiandentalacademy.com
  92. 92. 20° antirotation bend . . . Ref: Varun Kalra ; Simultaneous Intrusion & Retraction Of The Anterior Teeth; JCO 1998;Sep;535-540 www.indiandentalacademy.com
  93. 93. Fabrication . . . Ref: Varun Kalra ; Simultaneous Intrusion & Retraction Of The Anterior Teeth; JCO 1998;Sep;535-540 www.indiandentalacademy.com
  94. 94. Done extraoral releases built stress severity of bends↓ Neutral position 3.5mm wide After trial activation Trial activation . . . Ref: Varun Kalra ; Simultaneous Intrusion & Retraction Of The Anterior Teeth; JCO 1998;Sep;535-540 www.indiandentalacademy.com
  95. 95. Insertion . . . Archwire is inserted in the auxillary tube of 1st molars Engaged in the six anterior brackets Activated about 3mm so that mesial & distal legs of loop are barely apart Premolars are bypassed for biomechanical purpose Ref: Varun Kalra ; Simultaneous Intrusion & Retraction Of The Anterior Teeth; JCO 1998;Sep;535-540 www.indiandentalacademy.com
  96. 96. When loops are first activated greater tipping moments are generated Mechanism of action . . . This cause controlled tipping of the teeth into extraction space As loops deactivate and forces decreases moment –to- force ratio will increase to cause bodily movement and then root movement Thus frequent reactivation not recommended ( once in 6-8 weeks until all space closed ) Arch wire left in place for 4-5 months Ref: Varun Kalra ; Simultaneous Intrusion & Retraction Of The Anterior Teeth; JCO 1998;Sep;535-540 www.indiandentalacademy.com
  97. 97. From the author’s gallery . . . Ref: Varun Kalra ; Simultaneous Intrusion & Retraction Of The Anterior Teeth; JCO 1998;Sep;535-540www.indiandentalacademy.com
  98. 98. Connecticut www.indiandentalacademy.com
  99. 99. Designed by Ravindra Nanda, Robert.M & Andrew.K Inmates of university of Connecticut health centre, Farmington Ref: Ravindra Nanda et al. The Connecticut Intrusion Arch JCO 1998 Dec 708-715 Connectic ut www.indiandentalacademy.com
  100. 100. Connectic ut Appliance design 0.016” X 0.022” / 0.017” x 0.022” NiTi Anterior dimensions max-34mm;mand-28mm UTLD molar tubes Auxillary tube 0.018”x0.025” TPA -added anchorage/maintain buccal width Ref: Ravindra Nanda et al. The Connecticut Intrusion Arch JCO 1998 Dec 708-715www.indiandentalacademy.com
  101. 101. DIMENSION Connectic ut Anterior dimension is the length of wire b/w bypasses &distal to lateral incisors Posterior dimension is the length of wire b/w each bypass & the tipback bend on the same side www.indiandentalacademy.com
  102. 102. Connectic ut Why NiTI? Shape memory Spring back Light continuous forces on large activations Low load deflection Reduced number of reactivations Ref: Ravindra Nanda et al. The Connecticut Intrusion Arch JCO 1998 Dec 708-715 www.indiandentalacademy.com
  103. 103. Connectic ut Mechanics Force is delivered from a calibrated V-bend 40-60g of force generated V-bend lies just anterior to the molar tubes Following activation intrusive force in the anterior & moment in posterior is generated Ref: Ravindra Nanda et al. The Connecticut Intrusion Arch JCO 1998 Dec 708-715 V - BEND www.indiandentalacademy.com
  104. 104. Connectic ut Mechanics 1mm of intrusion / month is achieved Molar side effects may be counteracted with head gear Ref: Ravindra Nanda et al. The Connecticut Intrusion Arch JCO 1998 Dec 708-715 Single point contacts with incisors Incisor flaring is avoided by tight cinch backs www.indiandentalacademy.com
  105. 105. Connectic ut Steps in use CTA is tried in to determine length Cut off excess wire protruding from the molar tubes leaving 3mm/side for cinch backs Ref: Ravindra Nanda et al. The Connecticut Intrusion Arch JCO 1998 Dec 708-715 A section of wire is inserted into incisor barckets Appropriated length of CTA is selected Insert posterior legs & tie anterior part at lateral incisor & between the central incisors www.indiandentalacademy.com
  106. 106. www.indiandentalacademy.com
  107. 107. From the author’s gallery . . . Ref: Ravindra Nanda et al. The Connecticut Intrusion Arch JCO 1998 Dec 708-715 www.indiandentalacademy.com
  108. 108. Comparison of intrusion arches Compared five intrusion arches Ref: DivakarKaranth & SurendraShetty;Comparative Study Of Various Intrusive Arches JIOS 2001;34:82-91 Anchorage bends Burstone’s intrusive arch without helix Burstone’s intrusive arch with helix Mulligan’s intrusive arch Ricketts intrusive utility arch 1 2 3 4 www.indiandentalacademy.com
  109. 109. Comparison of intrusion arches Concluded that…. Ref: DivakarKaranth & SurendraShetty;Comparative Study Of Various Intrusive Arches JIOS 2001;34:82-91 Anchorage bends exerted maximum force Burstone’s intrusive arch without helix Burstone’s intrusive arch with helix Mulligan’s intrusive arch Ricketts intrusive utility arch www.indiandentalacademy.com
  110. 110. Biologic hazards www.indiandentalacademy.com
  111. 111. Pulpal alterations like vacuolization of odontoblasts layer Nonvitality of pulp Apical root resorption –continuous heavy forces Adults Dens invaginatus, blunt root Risk factors Endodontically treated Incisors www.indiandentalacademy.com
  112. 112. Thank you. www.indiandentalacademy.com
  113. 113. www.indiandentalacademy.com
  114. 114. www.indiandentalacademy.com
  115. 115. www.indiandentalacademy.com
  116. 116. www.indiandentalacademy.com
  117. 117. www.indiandentalacademy.com
  118. 118. MOLAR TRIPLE TUBE HEAD GEAR T. ARCH WIRE T. AUX.T. .018” ×.025” Connectic ut www.indiandentalacademy.com
  119. 119. MAND MOLAR DOUBLE TUBE ARCH WIRE T. AUX.T. .018” ×.025”www.indiandentalacademy.com
  120. 120. www.indiandentalacademy.com
  121. 121. Proclined Retroclined CRES +ve -ve PFA thru’ CRES PFA thru’ CRES www.indiandentalacademy.com
  122. 122. www.indiandentalacademy.com
  123. 123. www.indiandentalacademy.com
  124. 124. www.indiandentalacademy.com Thank you For more details please visit www.indiandentalacademy.com

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