Vertical control in swa, intrusion mechanics /fixed orthodontic courses /certified fixed orthodontic courses by Indian dental academy

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Vertical control in swa, intrusion mechanics /fixed orthodontic courses /certified fixed orthodontic courses by Indian dental academy

  1. 1. Vertical control in SWA, Intrusion Mechanics and Utility arches www.indiandentalacademy.com
  2. 2. INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com www.indiandentalacademy.com
  3. 3. Introduction Overbite – mm measurement / % - overlap of the mandibular incisors by the max. incisors. 50% overbite – deep overbite. Overbite control – closely related to arch leveling process. Occurs after levelling & aligning of individual teeth. www.indiandentalacademy.com
  4. 4. Vertical control – management of  Deep Bite &  Open Bite. Deep bite – 2 types: True. Pseudo. True – infra eruption of post. teeth. Pseudo – supra eruption of ant. teeth. www.indiandentalacademy.com
  5. 5. Development of Deep bite: Ant. teeth – erupt – until contact made with –  Opposing ant. teeth.  Soft tissue of the palate.  Tongue inhibits – eruption. Class II or III MO – facilitates - / reversed overjet  over eruption of ant. teeth.  Unrestricted eruption – lower 2nd molars – Cl II deepening of curve of spee in post. part. www.indiandentalacademy.com
  6. 6. Correction – various tooth movts: Eruption or extrusion of post. teeth. Distal tipping of post.teeth. Proclination of incisors. Intrusion of incisors. Combination www.indiandentalacademy.com
  7. 7. Eruption / extrusion of post. teeth. Stable process – accompanies vert. facial dev. Contributing factor – bite opening – deep bite patients. vertical facial ht. – growing patients – accommodates extrusion of post. teeth during ortho trt.  Not stable – adults – low mand. plane angles. Musculature – resists extrusion.  High angle cases – weak musculature – stable results. Permanent opening of mand. plane - undesired www.indiandentalacademy.com
  8. 8. Distal tipping of post. teeth. Stable process – growing patients. Low angle adult cases – not stable. High angle cases – stable – to be avoided. Proclination of incisors. Proclination – retroclined incisors  in ant. region. Lower arch – LI crowns – proclined. Upper arch – crown proclination & root torque control. www.indiandentalacademy.com
  9. 9. Intrusion of anterior teeth. Not normally reqd in growing patients. Face grows vertically – restricting the normal eruption of ant. teeth – allow bite to open. Adult cases – musculature resists post. changes. :. bite opening in adults – proclination of incisors Intrusion. www.indiandentalacademy.com
  10. 10. Advantages:  Controlling VD – by preventing post. eruption – mandible rotate closed / prevented opening.  No encroachment – inter occlusal space – Stability.  Prevention of post. eruption during growth – AB to OP reln. Improved. Eg. Sk Cl II not worsened by post. extrsn & rotn. www.indiandentalacademy.com
  11. 11. Principles of ant. intrusion.  Use of optimal magnitude of forces & delivery with low LDR springs.  Use of point contacts in ant. region ( statically determinant system)  Position of force – selection of the point of application of force with respect to CR.  Selective intrusion based on ant. tooth geometry.  Control – reactive units – post. Anchorage unit.  Inhibition – erupn. of post. teeth. www.indiandentalacademy.com
  12. 12. Controlling force magnitude & constancy: Lowest force – capable of intrsn. – used. Heavy forces – 2 effects.   in rate of root resorption.  On the anchorage unit – Maxilla – Extrusion & steepening of the occl. plane. Mandible – flattening. Moment – intrsn arch - anchorage unit. Due to dist from incisors to molars. www.indiandentalacademy.com
  13. 13.  Force constancy – low load defln. rate spring. Lose less force / mm deactivation. More accurate upon activation than high LDR spring.  Ant. single point contact. Intrusion arch – not directly placed into brackets. Tied to ant. segments – 2 points of contact. . www.indiandentalacademy.com
  14. 14. Advantages. If placed into br.  torque to ant. segment. Labial root torque -  intr. force. Lingual root torque -  intr. force on ant. segment. Force system statically determinant. Clinician precisely know the force system involved. Telescoping of trt. Br. – used for initial alignment segments + intrusion. www.indiandentalacademy.com
  15. 15. Point of force application. Intrusive force  CR  intrusion , no labial or lingual rotn. of the tooth. Patients with procumbent incisors – intrusive force – farther from CR –  moment   lingual root movt. Management: Retract Apply ant. – upright axial incln.- intrude. vertical force – lingual to CR. www.indiandentalacademy.com
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  18. 18.  Selective intrusion. Indescriminate levelling – continous arch or sectional wire – undesirable side effects. Decision which teeth to intrude – Intelligent trt. planning & accomplishing – creative use of mech. In Cl II div. 2 – CI intruded > LI. www.indiandentalacademy.com
  19. 19. Indiscriminate levelling – LI extrusion. Moments – roots – converge mesially. Proper mech. – intrude CI to proper reln. with LI, then include LI & continue intrusion. www.indiandentalacademy.com
  20. 20. Control of reactive units. Best method – control of anchorage unit -  forces. Effect – moment produced – intrusive force. Large due to long moment arm. 2 side effects:  Plane of occln. of buccal segment altered.  Due to equal & opp. extrusive force – buccal segments. www.indiandentalacademy.com
  21. 21.  Plane of occln. maxilla – steepens. mandible – flattens. To minimize –  Intrsn forces.  Teeth in the anchorage unit. Retract as much as possible initially -  length of moment arm Occipital head gear – force directed ant. to C.R – post. anchorage unit. www.indiandentalacademy.com
  22. 22.  Equal & Opp. extrusive force. Force – acting at aux. tube of molar – Buccal to CR of molar/ buccal segment. Moment  tip buccal segments lingually roots moving buccally. Prevented by Lingual arch – maintains axial inclins. & arch width. Fabricated width of intrn. arch less critical. www.indiandentalacademy.com
  23. 23. Avoiding extrusive mechanics. Patients – genuine intrusion Cl II or Cl III elastics, Cervical headgear – high outer bows to max. arch – to be avoided. Canine root – mesioangular incln. Placement of continuous archwires – extrude incisors – canine root moves distally. Solution: Bypass the canine with continuous arch & Perform separate canine movement. www.indiandentalacademy.com
  24. 24. Methods to correct deep bite.  Bite plates.  Utility arches.  Reverse curve Niti / SS.  Burstone intrusive arch.  Kalra SIR, appliance. www.indiandentalacademy.com
  25. 25. Utility Arches. Designed – Robert M. Ricketts – early 1950’s. Originally designed for enhancing anchorage during canine retraction. History: Continuous archwires ( flat or reverse curve of spee) - Levelling & aligning – Ant. flared out PM overerupted. Molars uprighted or tipped back. Class III elastics & head gear used to prevent. www.indiandentalacademy.com
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  27. 27. Canine retraction with sectional wires – Molars & PM’s tipped mesially. Canines tipped distally & extruded. 1950's Robert Ricketts - counteract the tipping in the buccal segments - utilizing - immutable lower incisors as an anchor unit, Round arch segments - laced from the lower molars and PM’s to the lower incisors. www.indiandentalacademy.com
  28. 28. Buccal segments maintained in an upright position, lower incisors intruded with this light, continuous pressure. Development - Step-down base arch, or Ricketts' Lower Utility Arch. Double tube with no torque – designed. Sp. Blue Elgiloy wires – 0.016” x 0.016” Force generated – 100 gms –four incisors. www.indiandentalacademy.com
  29. 29. Design And Function:  Extremely functional design. Molar section – 2-3 mm beyond the molar tube Stepped down 3- 5mm – bypass the PM & Canine. Stepped up 2-3 mm distal to the LI br. Follows the contour of the ant. segment. www.indiandentalacademy.com
  30. 30. Ant. segment – labial root torque – 10 - 15°. Molar segment – buccal root torque. - tip back of 30 - 45°. Toe in – molar segment – extraction cases. Expansion – 2 cm – on each side. www.indiandentalacademy.com
  31. 31. Effect on Molars.  Tends to upright the molars.  Crowns tip distally, rots move mesially  Tip back bend – straight distalizing force – distolingual rotn. Effect on Incisors.  Continous arch – flaring of the anteriors.  Crowns – mesially, roots – lingualy, hit against cortical bone. Labial root torque – prevents this.  Most effective force - intrusion - // to long axis. www.indiandentalacademy.com
  32. 32. www.indiandentalacademy.com
  33. 33. Function & roles of the Utility arch.  Used to position the lower molars – snable them to use cortical anchorage.  Loss of proprioception – incisal occlsn. – mandible relocates – Cl II corrections.  Torque placed – incisors & molars – helps to define ideal archform.  Possible to treat ant. & post. segemnts simultaneously to overcorrection. www.indiandentalacademy.com
  34. 34.  It helps to maintain arch length, increase/ decrease it Uprighting the molars. Advancement of the lower incisors Expansion of the buccal segments. Saving “E” spce. www.indiandentalacademy.com
  35. 35. Fabrication  0.016x 0.016 Blue Elgiloy wire used.  Wire not heat trtd. When arch is formed.  Step 1. vertical step down – 10 mm from the end – 3 – 5mm height. Horizontal section – 3mm distal to the LI br.- step up bend  Step 2. bent horizontally. Slight inward angle – 10 - 15°. Ant. arch form swept into the wire.  Step 3. opp side completed. Buccal segment gently contoured & buccal bridges flared www.indiandentalacademy.com
  36. 36.  1 cm expansion on each side.  Distal leg twisted buccally. Places labial root torque & prevents gingival impingement of the distal vertical legs.  Incisors intruded - 45° tip back – molar section. Final arch form – Well contoured ant. segment with labial root torque. Flared buccal segments. Post. legs // to each other, 45° buccal root torque. Tip back – uprights molars & gains space. www.indiandentalacademy.com
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  38. 38. Classification: Passive utility arch: Stabilisation or space maintainence. Mixedentition – hold space – transitional period. Permanent den.- maintain anchorage. Intrusive utility arch. Sizes of wire used in max. arch 0.018 slot – 0.016 x0.022 0.022 slot – 0.018 or 0.019 square wires. www.indiandentalacademy.com
  39. 39. Retraction Utility arch To achieve retraction & intrusion. Loops into archwire – ant. vertical step Greater range of retrcn. Mainly used in the maxilla. Protraction Utility arch. Proclining & intruding upper and lower incisors – Class II div 2. Post. step flush with molar tube. Loop distal to the ant. vertical step & occlusal to the horizontal segment. www.indiandentalacademy.com
  40. 40. Tip back Springs ( Intrusion Springs ). Originally proposed – Burstone Upper & lower arches –levelled & aligned – rigid SS wire – 0.017 x 0.025. Used when true intrusion requd.  Growing patients with forward growth rotation.  Deep curve of spee in the lower arch.  Deep overbite – extrusion of the incisors.  Steep natural plane of occln. www.indiandentalacademy.com
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  42. 42. Anchor molars reinforced. TPA – upper, Lingual arch – Lower. Intrusion spring – With helix –SS – 0.017 x 0.025 Without helix – TMA – 0.017 x 0.025. Fabrication: Wire bent gingivally mesial to the molar tube . Helix formed. www.indiandentalacademy.com
  43. 43. Mesial end bent into a hook. Engaged distal to the LI. When passive – mesial end – height of mucobuccal fold. Three Piece Intrusion Arch. Consists of the following parts.  Post. anchorage unit.  Ant. segment with post. extension.  Intrusion Cantilevers. www.indiandentalacademy.com
  44. 44. Fabrication:  Anterior segment – bent gingivally – distal to the laterals.  Then bent horizontally – step of 3 mm.  Distal part – distal end of canine br. – formed into a hook.  Ant. segment – 0.021 x 0.025 SS wire – prevent side effects – bending the wire during force aplcn. www.indiandentalacademy.com
  45. 45.  Intrusion Cantilever – 0.017 x 0.025 TMA.  Bent gingivally mesial to the molar tube & helix formed.  Mesial end of cantilever – bent into a hook. Activation:  Bend mesial to the helix at the molar tube.  Passively – ant. end lies – vestibule.  End brought down and engaged – horizontal portion of the ant. segment. www.indiandentalacademy.com
  46. 46. www.indiandentalacademy.com
  47. 47. Further distal placement of the force – lateral to the LI. Resultant forces – CR of ant. teeth. E chain – attached to hook – simultaneous intrusion & retraction. www.indiandentalacademy.com
  48. 48. Canine Intrusion. Difficult to intrude six ant. teeth. High foce levels requd.- large moments – undesirable changes in the axial incln. of post.teeth. Achieved in 2 ways: Cantilever form aux. tube of molar tied to the canine br – point contact. 0.017 x 0.025 TMA wire used. Problem – labial flaring. During cuspid retraction – applying more β moment ( post.) than α ( ant. ) moment. www.indiandentalacademy.com
  49. 49. K – SIR archwire. Appliance for simultaneous intrusion & retrcn. Of six teeth – should control:  Magnitude of forces & moments.  Moment to force ratio.  Constancy of forces & moments.  Friction. Kalra Simultaneous intrusion & retraction archwire – modifn. of segmented loop mech. of Burstone & Nanda. www.indiandentalacademy.com
  50. 50. Continuous 0.019 x 0.025TMA wire with closed 7mm x 2 mm U loops at the extn. site. For bodily movement & prevent tipping - 90° V bend – at the level of each U loop. V bend when centred – counter the moments – activation forces of the clodong loops. 60° V bend – post to the center of inter br. dist. – increased clockwise moment – molarAugments molar anchorage & intrsn. of ant. teeth. www.indiandentalacademy.com
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  52. 52. Activation: Trial activation – outside the mouth – releases stress built on bending the wire. Neutral position – U loop – 3.5 mm wide. Activated – 3mm. Mesial & distal legs – barely apart. Control of Reactive forces: Keep forces to a min. Add teeth to the anchorage unit. High pull head gear. www.indiandentalacademy.com
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  54. 54. Intrusive force – 125 g. Advantages: Simplicity of design. Easy to fabricate Comfortable to the patient. Low forces, Low LDR. Activation – 8 week period. Shortens trt. time. Unsightly space distal to laterals avoided. www.indiandentalacademy.com
  55. 55. Open Bite: Non extn. Trt. Preferred. Some cases – extn. – to allow for eruption & retroclination of incisors.  Upper & lower arches – crowding & protrusion – upper & lower PM extn.  1st PM extn. – molars > 3-4mm class II.  Br.placement – 0.5mm more gingival than normal.  Early second molar banding – avoided.  Class II or III elastics – to PM’s than Molars. Short elastics minimize extrusion. www.indiandentalacademy.com
  56. 56. Thank you www.indiandentalacademy.com Leader in continuing dental education www.indiandentalacademy.com

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