www.indiandentalacademy.com
INDIAN DENTAL ACADEMY
Leader in continuing dental education
www.indiandentalacademy.com
www.indiandentalacademy.com
www.indiandentalacademy.com
INTRODUCTION
ALIGNMENT ARCH WIRES
ALIGNMENT IN
Symmetric crowding
Premolar extraction cases
Non extraction cases
As...
www.indiandentalacademy.com
THE PRINCIPLES IN CHOICE OF
LEVELING AND ALIGNING WIRES
ROUND WIRE V/S RECTANGULAR WIRE
FREEDOM OF MOVEMENT OF ARCH WIRE
P...
THE SUBSTITUTION SEQUENCE

Traditional wires
0.015 Multistrand
0.017 Multistrand
0.014 S.S.
0.016 S.S
0.018 S.S
0.020 S.S....
KEY POINTS IN LEVELING & ALIGNING
Forces should be kept as light as possible.
Sagittal, vertical & lateral anchorage needs...
VARIABLES IN SELECTING APPROPRIATE
ARCH WIRES
ARCH

SIZE

WIRE MATERIAL

OF THE WIRE

DISTANCE

BETWEEN ATTACHMENTS

ww...
ALIGNMENT OF SYMMEYRIC CROWDING
WITH EDGE WISE APPLIANCE.
The flat load deflection curve of super elastic Niti makes ideal...
ALIGNMENT IN NON EXTRACTION CASES

FLARING OF ANTERIORS
DISTALIZATION OF MOLARS

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ALIGNMENT OF ASYMMETRIC CROWDING
WITH THE EDGE WISE APPLIANCE
Continuous Niti wire – Distortion of arch form.

www.indiand...
ALIGNMENT IN PREMOLAR EXTRACTION
CASES
DRAG LOOP –STONER
ACTIVE LACE BACK
NITI OPEN COIL SPRING

www.indiandentalacademy.c...
ALIGNMENT WITH BEGG’S TECHNIQUE

0.016 Australian wires with loops used for alignment.
Niti wires – loss of control of mol...
SPECIAL PROBLEMS IN ALIGNMENT
1. CROSS BITE CORRECTION
ANTERIOR CROSS BITE
POSTERIOR CROSS BITE

www.indiandentalacademy.c...
SPECIAL PROBLEMS IN ALIGNMENT
2. IMPACTED/UNERUPTED TEETH
•SURGICAL EXPOSURE
•ATTACHMENT TO THE TOOTH
•ORTHODONTIC MECHANI...
SPECIAL PROBLEMS IN ALIGNMENT
3.DIASTEMA CLOSURE
Maxillary midline diastema is complicated by insertion of
labial frenum i...
LEVELING
It includes correction of DEEP BITE & OPEN BITE

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DEEP BITE
DEVELOPMENT OF DEEP BITE

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DEEP BITE
CORRECTION OF DEEP BITE
•ERUPTION/EXTRUTION OF POSTERIORS
•DISTAL TIPPING OF POSTERIOR TEETH
•PROCLINATION OF IN...
DISTAL TIPPING OF POSTERIOR TEETH

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ERUPTION/EXTRUSION OF POSTERIOR
TEETH

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EXTRUSION AND RELATIVE INTRUSION
18 SLOT NARROW BRACKET
22 SLOT WIDER BRACKET

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PROCLINATION OF UPPER AND
LOWER ANTERIORS

Indication:
 This can be done only if the
soft tissue profile permits it or
in...
INTRUTION OF ANTERIOR TEETH
•CONTINUOUS INTRUSION ARCH
•THREE PIECE INTRUSION ARCH
•UTILITY ARCH

www.indiandentalacademy....
TIP BACK SPRINGS
Indications
Growing patients with forward rotations.
Deep Curve of Spee in the lower arch.
Deep over bite...
UTILITY ARCH
1. MATERIAL AND DIMENSIONS OF WIRE
2. SALIENT FEATURES OF UTILITY ARCH
3. TYPES
•PASSIVE UTILITY ARCH
•INTRUS...
THREE PIECE INTRUSION ARCH
IT CONSISTS OF FOLLOWING PARTS
1. THE POSTERIOR ANCHORAGE UNIT
2. ANTERIOR SEGMENT WITH POSTERI...
BITE PLATE EFFECT
IT IS USEFUL IN 3 WAYS
ALLOWS EARLY PLACEMENT OF BRACKET ON
LOWER INCISORS.
INTRUSIVE FORCE ON LOWER ANT...
CORRECTION OF DEEP BITE

Importance of second molar.
Torque issues.
Anteroposterior issues and elastics.
Lighter forces du...
ROLLER COASTER EFFECT

www.indiandentalacademy.com
ANTERIOR OPEN BITE
1.
2.
3.
4.

ETIOLOGY
CLINICAL FEATURES
EARLY MANAGEMENT
MANAGEMENT DURING FULL ORTHODONTIC
TREATMENT

...
ANCHORAGE CONTROL IN THE PRE ADJUSTED EDGEWISE
APPLIANCE
BENNET AND McLAUGHLIN CONSIDER ANCHORAGE
IN THREE PLANES OF SPACE...
EXTRA ORAL ANCHORAGE
CLASSIFICATION OF HEAD GEARS
1. ACCORDING TO POINT OF ORIGIN
•CERVICAL-ANCHORAGE FROM NAPE OF NECK
•O...
HEAD GEAR

Occipital

Combi

Occlusal
plane
Cervical
www.indiandentalacademy.com
HEAD GEAR
The line of traction or direction of pull can be changed by
Varying either :
Length of outer bow.
Angulation bet...
HEAD GEAR
High pull head gear

Combi-pull head gear

www.indiandentalacademy.com
HEAD GEAR

This diagram shows the theoretical effect of variations in the length
of the outer arm of the headgear bow.
www...
HEAD GEAR
FORCE AND DURATION OF WEAR
MARCOTTE
200gm/side in MIXED DENTITION
500gm/side in PERMANENT DENTION
18-20 hrs/day
...
CONTROL OF ANCHORAGE IN HORIZANTAL
PLANE
CONTROL OF ANTERIOR SEGMENTS
LACE BACK
BEND BACK
ROLLER COASTER EFFECT

www.india...
CONTROL OF ANCHORAGE IN HORIZANTAL
PLANE
1.53mm

1.4mm

1.0mm

1.76mm

No laceback

Laceback

The work of Robinson confirm...
CONTROL OF ANCHORAGE IN HORIZANTAL
PLANE
BEND BACKS

www.indiandentalacademy.com
CONTROL OF ANCHORAGE IN HORIZANTAL
PLANE
CONTROL OF POSTERIOR SEGMENT
ANCHORAGE REQUIREMENT IS MORE IN THE
MAXILLA THAN MA...
CONTROL OF ANCHORAGE IN VERTICAL PLANE

1.VERTICAL CONTROL OF ANTERIOR SEGMENT
2.VERTICAL CONTROL OF MOLAR SEGMENT
•TPA
•P...
CONTROL OF ANCHORAGE IN VERTICAL PLANE
VERTICAL CONTROL OF ANTERIOR SEGMENT

The tip which is built into the anterior brac...
CONTROL OF ANCHORAGE IN VERTICAL PLANE
VERTICAL CONTROL OF ANTERIOR SEGMENT

High labial canines may be loosely tied to th...
CONTROL OF ANCHORAGE IN VERTICAL PLANE
VERTICAL CONTROL OF MOLAR SEGMENT

If the upper palatal bar is placed 2 mm away fro...
ANCHORAGE CONTROL IN TRANSVERSE PLANE
MAINTAINING EXPANSION PROCEDURE
MAINTAINING INTER CANINE WIDTH

Ideal
arch form
Expa...
RE LEVELING PROCEDURES

NEWLY ERUPTED TOOTH
IMPROPER BRACKET PLACEMENT
BANDING OF SECOND MOLAR

www.indiandentalacademy.co...
www.indiandentalacademy.com
1. BURSTONE C.J. MECHANICS OF SEGMENTED ARCH
TECHNIQUE. Angle Orthod .36:99-120,1966.
2. WILLIAM R PROFFIT, HENRY W FIELDS...
www.indiandentalacademy.com
www.indiandentalacademy.com
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Levelling and aligning 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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Levelling and aligning in orthodontics /certified fixed orthodontic courses by Indian dental academy

  1. 1. www.indiandentalacademy.com
  2. 2. INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com www.indiandentalacademy.com
  3. 3. www.indiandentalacademy.com
  4. 4. INTRODUCTION ALIGNMENT ARCH WIRES ALIGNMENT IN Symmetric crowding Premolar extraction cases Non extraction cases Asymmetric crowding Begg technique SPECIAL PROBLEMS IN ALIGNMENT LEVELING CONTROL OF ANCHORAGE IN 3 PLANES CONCLUSION REFERENCES www.indiandentalacademy.com
  5. 5. www.indiandentalacademy.com
  6. 6. THE PRINCIPLES IN CHOICE OF LEVELING AND ALIGNING WIRES ROUND WIRE V/S RECTANGULAR WIRE FREEDOM OF MOVEMENT OF ARCH WIRE PROPERTIES OF ALIGNMENT ARCH WIRES TYPES OF ALIGNING WIRES ARCH WIRE SEQUENCING •TRADITIONAL WIRES •HEAT ACTIVATED WIRES KEY POINTS IN LEVELING AND ALIGNING www.indiandentalacademy.com
  7. 7. THE SUBSTITUTION SEQUENCE Traditional wires 0.015 Multistrand 0.017 Multistrand 0.014 S.S. 0.016 S.S 0.018 S.S 0.020 S.S. 0.0195 x 0.025 S.S Heat activated wires 0.016 Thermal Niti 0.0195X0.025 Thermal Niti 0.0195 x 0.025 S.S www.indiandentalacademy.com
  8. 8. KEY POINTS IN LEVELING & ALIGNING Forces should be kept as light as possible. Sagittal, vertical & lateral anchorage needs should be identified for each case. Lacebacks & bend backs to be used in the initial stages to avoid unwanted tooth movements. Posterior segments should supported with a head gear/ TPA in maximum anchorage cases. www.indiandentalacademy.com
  9. 9. VARIABLES IN SELECTING APPROPRIATE ARCH WIRES ARCH SIZE WIRE MATERIAL OF THE WIRE DISTANCE BETWEEN ATTACHMENTS www.indiandentalacademy.com
  10. 10. ALIGNMENT OF SYMMEYRIC CROWDING WITH EDGE WISE APPLIANCE. The flat load deflection curve of super elastic Niti makes ideal for initial alignment when the degree of crowding is similar on two sides of arch. www.indiandentalacademy.com
  11. 11. ALIGNMENT IN NON EXTRACTION CASES FLARING OF ANTERIORS DISTALIZATION OF MOLARS www.indiandentalacademy.com
  12. 12. ALIGNMENT OF ASYMMETRIC CROWDING WITH THE EDGE WISE APPLIANCE Continuous Niti wire – Distortion of arch form. www.indiandentalacademy.com
  13. 13. ALIGNMENT IN PREMOLAR EXTRACTION CASES DRAG LOOP –STONER ACTIVE LACE BACK NITI OPEN COIL SPRING www.indiandentalacademy.com
  14. 14. ALIGNMENT WITH BEGG’S TECHNIQUE 0.016 Australian wires with loops used for alignment. Niti wires – loss of control of molar position. The modern alternative – Dual flex wire. www.indiandentalacademy.com
  15. 15. SPECIAL PROBLEMS IN ALIGNMENT 1. CROSS BITE CORRECTION ANTERIOR CROSS BITE POSTERIOR CROSS BITE www.indiandentalacademy.com
  16. 16. SPECIAL PROBLEMS IN ALIGNMENT 2. IMPACTED/UNERUPTED TEETH •SURGICAL EXPOSURE •ATTACHMENT TO THE TOOTH •ORTHODONTIC MECHANICS www.indiandentalacademy.com
  17. 17. SPECIAL PROBLEMS IN ALIGNMENT 3.DIASTEMA CLOSURE Maxillary midline diastema is complicated by insertion of labial frenum into a notch in the alveolar bone. Mild midline diastema is closed before frenectomy. Large midline diastema partially closed before frenectomy and completely closed after surgery. Delay in orthodontic treatment after surgery results in scar formation. www.indiandentalacademy.com
  18. 18. LEVELING It includes correction of DEEP BITE & OPEN BITE www.indiandentalacademy.com
  19. 19. DEEP BITE DEVELOPMENT OF DEEP BITE www.indiandentalacademy.com
  20. 20. DEEP BITE CORRECTION OF DEEP BITE •ERUPTION/EXTRUTION OF POSTERIORS •DISTAL TIPPING OF POSTERIOR TEETH •PROCLINATION OF INCISORS •INTRUSION OF INCISORS •A COMBINATION OF ABOVE www.indiandentalacademy.com
  21. 21. DISTAL TIPPING OF POSTERIOR TEETH www.indiandentalacademy.com
  22. 22. ERUPTION/EXTRUSION OF POSTERIOR TEETH www.indiandentalacademy.com
  23. 23. EXTRUSION AND RELATIVE INTRUSION 18 SLOT NARROW BRACKET 22 SLOT WIDER BRACKET www.indiandentalacademy.com
  24. 24. PROCLINATION OF UPPER AND LOWER ANTERIORS Indication:  This can be done only if the soft tissue profile permits it or in cases with retroclined anteriors. Methods:  Not using lacebacks and bend backs.  Use of open coil spring between retroclined teeth and posterior teeth. www.indiandentalacademy.com
  25. 25. INTRUTION OF ANTERIOR TEETH •CONTINUOUS INTRUSION ARCH •THREE PIECE INTRUSION ARCH •UTILITY ARCH www.indiandentalacademy.com
  26. 26. TIP BACK SPRINGS Indications Growing patients with forward rotations. Deep Curve of Spee in the lower arch. Deep over bite due to extrusion of incisors. www.indiandentalacademy.com
  27. 27. UTILITY ARCH 1. MATERIAL AND DIMENSIONS OF WIRE 2. SALIENT FEATURES OF UTILITY ARCH 3. TYPES •PASSIVE UTILITY ARCH •INTRUSION UTILITY ARCH •RETRUSION UTILITY ARCH •PROTRUSION UTILITY ARCH www.indiandentalacademy.com
  28. 28. THREE PIECE INTRUSION ARCH IT CONSISTS OF FOLLOWING PARTS 1. THE POSTERIOR ANCHORAGE UNIT 2. ANTERIOR SEGMENT WITH POSTERIOR EXTENSION 3. INTRUSION CANTILEVERS www.indiandentalacademy.com
  29. 29. BITE PLATE EFFECT IT IS USEFUL IN 3 WAYS ALLOWS EARLY PLACEMENT OF BRACKET ON LOWER INCISORS. INTRUSIVE FORCE ON LOWER ANTERIORS. ALLOWS EXTRUSION/ERUPTION/UPRIGHTING OF POSTERIOR TEETH. www.indiandentalacademy.com
  30. 30. CORRECTION OF DEEP BITE Importance of second molar. Torque issues. Anteroposterior issues and elastics. Lighter forces during leveling and aligning- roller coaster effect www.indiandentalacademy.com
  31. 31. ROLLER COASTER EFFECT www.indiandentalacademy.com
  32. 32. ANTERIOR OPEN BITE 1. 2. 3. 4. ETIOLOGY CLINICAL FEATURES EARLY MANAGEMENT MANAGEMENT DURING FULL ORTHODONTIC TREATMENT This patient had an asymmetrical dental anterior open bite, which was related to right thumb sucking activity. Anterior open bites of this type are often not difficult to correct, provided the digit sucking is discontinued. www.indiandentalacademy.com
  33. 33. ANCHORAGE CONTROL IN THE PRE ADJUSTED EDGEWISE APPLIANCE BENNET AND McLAUGHLIN CONSIDER ANCHORAGE IN THREE PLANES OF SPACE 1. HORIZANTAL ANCHORAGE 2. VERTICAL ANCHORAGE 3. TRANSVERSE ANCHORAGE ANCHORAGE IS CLASSIFIED AS 1. EXTRA ORAL-HEADGEAR AND FACE MASK 2. INTRA ORAL-LACE BACK, TPA, LINGUAl ARCH. LIP BUMPER etc. www.indiandentalacademy.com
  34. 34. EXTRA ORAL ANCHORAGE CLASSIFICATION OF HEAD GEARS 1. ACCORDING TO POINT OF ORIGIN •CERVICAL-ANCHORAGE FROM NAPE OF NECK •OCCIPITAL-ANCHORAGE FROM BACK OF HEAD •PARIETAL-ANCHORAGE FROM UPPER PART OF HEAD 2. HIGH PULL HEAD GEAR CERVICAL PULL COMBI PULL www.indiandentalacademy.com
  35. 35. HEAD GEAR Occipital Combi Occlusal plane Cervical www.indiandentalacademy.com
  36. 36. HEAD GEAR The line of traction or direction of pull can be changed by Varying either : Length of outer bow. Angulation between outer and inner bow. Cervical pull head gear maxilla www.indiandentalacademy.com
  37. 37. HEAD GEAR High pull head gear Combi-pull head gear www.indiandentalacademy.com
  38. 38. HEAD GEAR This diagram shows the theoretical effect of variations in the length of the outer arm of the headgear bow. www.indiandentalacademy.com
  39. 39. HEAD GEAR FORCE AND DURATION OF WEAR MARCOTTE 200gm/side in MIXED DENTITION 500gm/side in PERMANENT DENTION 18-20 hrs/day MCLAUGHLIN 150-250 gm/side for OCCIPITAL 100-150 gm/side for CERVICAL PULL www.indiandentalacademy.com
  40. 40. CONTROL OF ANCHORAGE IN HORIZANTAL PLANE CONTROL OF ANTERIOR SEGMENTS LACE BACK BEND BACK ROLLER COASTER EFFECT www.indiandentalacademy.com
  41. 41. CONTROL OF ANCHORAGE IN HORIZANTAL PLANE 1.53mm 1.4mm 1.0mm 1.76mm No laceback Laceback The work of Robinson confirms that lower canine lacebacks have a beneficial effect in controlling proclination of lower incisors. Without lacebacks, on average the lower incisor moved forwards 1.4 mm. In contrast, with lacebacks in place, the lower incisors moved 1.0 mm distally. www.indiandentalacademy.com
  42. 42. CONTROL OF ANCHORAGE IN HORIZANTAL PLANE BEND BACKS www.indiandentalacademy.com
  43. 43. CONTROL OF ANCHORAGE IN HORIZANTAL PLANE CONTROL OF POSTERIOR SEGMENT ANCHORAGE REQUIREMENT IS MORE IN THE MAXILLA THAN MANDIBLE CONTROL OF ANCHORAGE IN UPPER ARCH CONTROL OF ANCHORAGE IN LOWER ARCH Headgear www.indiandentalacademy.com Head gear in combination with class III elastic.
  44. 44. CONTROL OF ANCHORAGE IN VERTICAL PLANE 1.VERTICAL CONTROL OF ANTERIOR SEGMENT 2.VERTICAL CONTROL OF MOLAR SEGMENT •TPA •POSTERIOR BITE BLOCK •HEAD GEAR www.indiandentalacademy.com
  45. 45. CONTROL OF ANCHORAGE IN VERTICAL PLANE VERTICAL CONTROL OF ANTERIOR SEGMENT The tip which is built into the anterior brackets of the preadjusted appliance system gives a tendency to temporary increases in overbite early in treatment. If the canines are distally tipped in the starting malocclusion, then the bite-deepening effect is greater. www.indiandentalacademy.com
  46. 46. CONTROL OF ANCHORAGE IN VERTICAL PLANE VERTICAL CONTROL OF ANTERIOR SEGMENT High labial canines may be loosely tied to the .015 multistrand or .016 HANT wire in the early stages of treatment. If the starting archwire is fully engaged in the canine bracket slot, it can produce unwanted tooth movements in the adjacent www.indiandentalacademy.com lateral incisor and premolar regions.
  47. 47. CONTROL OF ANCHORAGE IN VERTICAL PLANE VERTICAL CONTROL OF MOLAR SEGMENT If the upper palatal bar is placed 2 mm away from the palate, tongue forces can assist in vertical control of the molars. www.indiandentalacademy.com
  48. 48. ANCHORAGE CONTROL IN TRANSVERSE PLANE MAINTAINING EXPANSION PROCEDURE MAINTAINING INTER CANINE WIDTH Ideal arch form Expanded archwire Upper molar expansion should be carried out by bodily movement rather than tipping. Minimal molar crossbites can be corrected using rectangular steel wires which www.indiandentalacademy.com are slightly expanded from the normal form and which carry buccal root torque.
  49. 49. RE LEVELING PROCEDURES NEWLY ERUPTED TOOTH IMPROPER BRACKET PLACEMENT BANDING OF SECOND MOLAR www.indiandentalacademy.com
  50. 50. www.indiandentalacademy.com
  51. 51. 1. BURSTONE C.J. MECHANICS OF SEGMENTED ARCH TECHNIQUE. Angle Orthod .36:99-120,1966. 2. WILLIAM R PROFFIT, HENRY W FIELDS. CONTEMPORARY ORTHODONTICS. 3. JAMES A Mc NAMARA. UTILITY ARCHES J. Clin. Orthod. 20:452-56:1986. 4. BENNETT JC Mc LAUGHLIN RP:MANAGEMENT OF DEEP OVER BITE WITH P.E.A. J. Clin.Orthod.24:684-96,1990. 5. RICHARD P McLAUGHLIN, JOHN C BENNET & HUGO J TREVISI – SYSTEMIZED ORTHODONTIC TREATMENT MECHANICS. www.indiandentalacademy.com
  52. 52. www.indiandentalacademy.com
  53. 53. www.indiandentalacademy.com

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