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Levelling and aligning in orthodontics /certified fixed orthodontic courses by Indian dental academy
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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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  • 1. www.indiandentalacademy.com
  • 2. INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com www.indiandentalacademy.com
  • 3. www.indiandentalacademy.com
  • 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. www.indiandentalacademy.com
  • 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. 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. 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. VARIABLES IN SELECTING APPROPRIATE ARCH WIRES ARCH SIZE WIRE MATERIAL OF THE WIRE DISTANCE BETWEEN ATTACHMENTS www.indiandentalacademy.com
  • 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. ALIGNMENT IN NON EXTRACTION CASES FLARING OF ANTERIORS DISTALIZATION OF MOLARS www.indiandentalacademy.com
  • 12. ALIGNMENT OF ASYMMETRIC CROWDING WITH THE EDGE WISE APPLIANCE Continuous Niti wire – Distortion of arch form. www.indiandentalacademy.com
  • 13. ALIGNMENT IN PREMOLAR EXTRACTION CASES DRAG LOOP –STONER ACTIVE LACE BACK NITI OPEN COIL SPRING www.indiandentalacademy.com
  • 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. SPECIAL PROBLEMS IN ALIGNMENT 1. CROSS BITE CORRECTION ANTERIOR CROSS BITE POSTERIOR CROSS BITE www.indiandentalacademy.com
  • 16. SPECIAL PROBLEMS IN ALIGNMENT 2. IMPACTED/UNERUPTED TEETH •SURGICAL EXPOSURE •ATTACHMENT TO THE TOOTH •ORTHODONTIC MECHANICS www.indiandentalacademy.com
  • 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. LEVELING It includes correction of DEEP BITE & OPEN BITE www.indiandentalacademy.com
  • 19. DEEP BITE DEVELOPMENT OF DEEP BITE www.indiandentalacademy.com
  • 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. DISTAL TIPPING OF POSTERIOR TEETH www.indiandentalacademy.com
  • 22. ERUPTION/EXTRUSION OF POSTERIOR TEETH www.indiandentalacademy.com
  • 23. EXTRUSION AND RELATIVE INTRUSION 18 SLOT NARROW BRACKET 22 SLOT WIDER BRACKET www.indiandentalacademy.com
  • 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. INTRUTION OF ANTERIOR TEETH •CONTINUOUS INTRUSION ARCH •THREE PIECE INTRUSION ARCH •UTILITY ARCH www.indiandentalacademy.com
  • 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. 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. 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. 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. 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. ROLLER COASTER EFFECT www.indiandentalacademy.com
  • 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. 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. 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. HEAD GEAR Occipital Combi Occlusal plane Cervical www.indiandentalacademy.com
  • 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. HEAD GEAR High pull head gear Combi-pull head gear www.indiandentalacademy.com
  • 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. 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. CONTROL OF ANCHORAGE IN HORIZANTAL PLANE CONTROL OF ANTERIOR SEGMENTS LACE BACK BEND BACK ROLLER COASTER EFFECT www.indiandentalacademy.com
  • 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. CONTROL OF ANCHORAGE IN HORIZANTAL PLANE BEND BACKS www.indiandentalacademy.com
  • 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. 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. 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. 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. 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. 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. RE LEVELING PROCEDURES NEWLY ERUPTED TOOTH IMPROPER BRACKET PLACEMENT BANDING OF SECOND MOLAR www.indiandentalacademy.com
  • 50. www.indiandentalacademy.com
  • 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. www.indiandentalacademy.com
  • 53. www.indiandentalacademy.com