This document provides a historical overview of orthodontic appliances, including Angle's edgewise appliance and Begg's ribbon arch appliance. It then introduces the Tip Edge bracket system, which was developed by Dr. Peter Kesling in 1986. The Tip Edge bracket allows for initial crown tipping followed by controlled root uprighting. This differential tooth movement requires lighter forces and reduces treatment time compared to conventional edgewise appliances. The document describes the design and mechanics of Tip Edge brackets, including their dynamic archwire slot, and explains how they facilitate techniques like variable anchorage and early bite opening.

2. TIP - EDGE
ORTHODONTICS AND
THE PLUS BRACKET
DR. ALBIN GEORGE

3. CONTENTS
• Historical Perspective
• Introduction
• Tip Edge Concepts
• Tip Edge Brackets
• Dynamics of Tip Edge
• Tip Edge Auxiliaries
• Treatment Stages
• Final Finishing
• Conclusion

4. HISTORICAL PERSPECTIVE
Dr. Edward Angle

5. Since the 1900 Angle introduced various appliances
:
• Angle’s E-arch
• Pin and Tube appliance(1910)
• Ribbon arch appliance (1915)
• Edgewise appliance(1925)

6.  Heavy forces during all tooth movements
 Difficulty in correcting Class II malocclusion
 Delayed bite opening
 ‘Round tripping’ of adjacent teeth during uprighting & torquing
{Reciprocal forces}
 More hungry on Anchorage
 No provisions to facilitate the closing of spaces in the posterior
segments.
 His best suggestion to tip crowns distally with the use of second
order bends in the archwire.

7. Dr.Raymond Begg

8. DR. P.R.BEGG, MODIFIED
RIBBON ARCH BRACKETS.
• Permitted free tipping followed by controlled uprighting
• Use of round wires
• Use of differential forces(2 oz)
• Demands on anchorage units was reduced
• However the vertically facing slot had the following limitations:
• Root recovery from extreme angles could be less than reliable, while
accurate molar control and buccal segment torque was denied by the
ability to use rectangular arch wires.
• No self limiting prescription finish and like edgewise a lot more
challenging in terms of wire bending.

9. STRAIGHT WIRE APPLIANCE
• 1970s Dr Lawrence Andrews introduced the Straight Wire
“bracket system”
• Concept of Preadjusted appliance- direct development of the
edgewise design.
• He incorporated in-out adjustments and finishing angulations of
tip and torque into the bracket system for individual tooth
positions.
• Relieved the Orthodontists of the necessity of all second order
beautifying bends and placing finishing torques.
• Subsequently alternate prescriptions appeared

10. • Limitations of conventional Straight Wire bracket
• Moving teeth apex first generates maximum
anchorage resistance
• Torque control - unwanted reciprocal and
unwanted torque reaction in adjacent teeth
• Full expression of torque not achieved- “torque
slop” due to play between bracket and arch wire

11. • It goes to the credit of Dr. Peter Kesling, a student of Dr.
Raymond Begg, to evolve the design of Tip Edge Bracket
System.
• The design and advantages of Tip Edge wire slot was
presented on 22nd Oct. 1986 by Dr. Peter Kesling with his
paper titled ‘Changing the face of Edgewise’

12. • Because of its initial TIPPING followed by EDGEWISE finishing
functions, he nicknamed the slot as “TIP EDGE”
•
• It is officially and more formally known as the “Differential straight arch
technique” though the nickname of “Tip edge” has been adopted
worldwide.
• Initial crown tipping followed by controlled root uprighting with straight
arch wires (differential tooth movement with straight arch wires).
• It converges the divergent philosophies of Begg and PEA into one
bracket system with no additional use of Extraoral anchorage.
• Richard Parkhouse in 2003, gave Tip-Edge Plus brackets, which
further builds on the Tip-Edge principle by deriving its tip and
torque forces from light nickel-titanium auxiliary archwires,
instead of the previously used Side-Winders.

14. SYNERGISITIC EFFECT
- Finer results and shorter treatment time is expected due to the
synergistic effect of forces and appliances working together in the
presence of a proper diagnosis.
- Synergistic Arch symbolizing the independence of various
components of the differential straight arch technique which,
when acting simultaneously ,result in changes greater than ,could
be expected if each were applied independently of the others

15. 1) A diagnosis and treatment plan that recognizes the
hereditary forces that cause the mesial migration and
vertical eruption of the tooth. Objectives include the over
correction of malrelationship of both teeth and jaw.
2) The simultaneous movement of all teeth. From the beginning
of treatment each tooth is directed towards its final position
in dental arch.
3) Total separation of root moving forces from archwire force,
during the final stage of treatment. Torquing auxiliaries and
individual uprighting springs are utilized for correct root
positioning.

16. 4) Application of proper elastic forces to create the desired differential
movement of teeth.Force should be so light that can be generated
and controlled completely intra orally.
5) Use of light ,round, continuous , hard and having highest quality
arch wires.
6) Use of molar attachments that prevents mesiodistal tipping and
yet permits the arch wires to slide mesiodistaly.
7)Use of attachments on all teeth, except anchor molars ,that controls
rotation, yet permits free tipping and free sliding along the archwires
in one direction.

17. TIP EDGE CONCEPTS
DIFFERENTIAL TOOTH MOVEMENT
• Contemporary fixed appliance work towards
finishing angulations from the outset of
treatment.
• This is because edgewise derived brackets, exert
mesio-distal second order root forces from the time
of first engagement with an archwire causing
bodily movement.
• Positioning a root apex towards the direction of
pull will generate resistance to tooth movement in
response to that force.

18. • Tip edge brackets are designed for differential
tooth movement.
• These brackets do not impart root-angulating
forces when an arch wire is engaged.
• Instead, the crown will be able to tip in the
direction of desired tooth movement, leaving the
root apex to trail behind.
• This simple free tipping requires far less force
and anchorage than moving the same tooth
bodily.
• This makes initial decrowding and reduction of
big overjets dramatically easy, as well as rapid.

19. • Root uprighting is done using various auxiliaries
to produce finishing root angulations.
• Whereas in Plus, a full auxiliary archwire in the
deep tunnels performs the same function.
• Tipping the crown first lends stability to the
subsequent root uprighting process, both by
establishing a strong interdigitation and by
bringing labial segments within the safety
of normal lip control.
• Hence anchorage requirements and duration of
treatment seem significantly less than with
straight wire or edgewise systems.

20. VARIABLE ANCHORAGE
• With differential tooth movement, root control of the brackted
teeth can be prescribed by the operator, rather than occurring
automatically from first archwire engagement.
• This can be simply done by the addition of an auxiliary (Side-
Winder) spring or springs.
• Auxiliary springs used in this way are known as ‘brakes’.
• It is also possible to use springs in an opposite mode in Stage I,
to induce lingual tipping of proclined lower incisors known as
‘Power Tipping’.
• This option is not possible with conventional brackets without
resort to more complicated add-ons such as lingual arches,
headgears or other anchorage reinforcements.

21. • When closing the residual extraction space with intramandibular
forces, the orthodontist can choose between retraction or
protraction.
• If the lingual movement of the labial segment is required this
will be readily be achieved simply by pitting bodily movement of
the first molars against the lower anteriors, all of which are free
to tip – the incisors lingually and the canines distally.

22. • Alternatively, if the labial segment
position is satisfactory, anterior
anchorage can be increased very
easily by adding auxiliary springs to
the canines.
• This will induce a distal root force to
both lower canines (effectively turning
these into straight wire units) which
will buttress the anterior segment
against retroclination, so long as the
space-closing forces are kept light.
• The result therefore will be
protraction.

23. LIGHT FORCES
• It is fundamental to differential tooth movement that all forces
should be light.
• A mere 50gms of intermaxillary elastic force bilaterally is quite
sufficient for the reduction of even large overjets.
• Differential tooth movement naturally implies a differential
periodontal response.
• Compared with moving a tooth bodily, when rate of periodontal
response will theoretically be uniform down the length of the root,
tipping a tooth will induce most root movement at the gingival,
diminishing towards the apex.
• The forces are therefore less evenly dissipated along the root. With
light forces, this will not present any hazard.

24. ROOT UPRIGHTING
• Edgewise & straight wire brackets offer
very poor recovery from tipped angulations.
• Correction of mesio-distal crown tip by
engaging the brackets with an active
archwire provokes major vertical
consequences with extrusion of adjacent
teeth.
• Use of power arms may facilitate the
uprighting process but the vertical
archwire deflections remain.

25. • In tip edge recovery is by the light and
progressive action of auxiliary springs.
• Principle is exactly the same with Plus,
uprighting with a light nickel-titanium
auxiliary archwire beneath an identical
main archwire.
• The vertical arch stability is maintained
by relatively heavy but passive archwire.

27. TIP EDGE BRACKETS
• To start the story at its very beginning in 1986,
the first Tip-Edge brackets came about by
means of a metal saw.
• The best inventions are frequently the
simplest.
• Diagonally opposite corners were removed by
Dr. Peter Kesling from the arch wire slot of a
0.22 inch straight wire bracket.
• This resulted in a bracket that enabled the
crown to tip in a predetermined direction,
whereas with an archwire of full vertical
thickness, it would resist tipping in reverse
direction.

28. • This was a logical design, since the direction of
tipping, in routine orthodontic cases, is easy to
predict.
• Distal crown tipping is the way bracketed teeth
will naturally want to incline the main
exception being 2nd premolar in first premolar
extraction cases.
• Other rare exceptions are where anterior teeth
are missing when if not restoring the spaces, a
canine may need to be moved mesially to
simulate a lateral incisor.
• The Tip-Edge bracket slot works well. Why
then, the arrival of the Plus bracket in 2003?

29. • Each Tip-Edge bracket requires an auxiliary in
the final stage in order to deliver a three
dimensional root correction.
• Clearly this was seen as a disincentive to using
Tip-Edge, particularly among straight wire and
edgewise orthodontists.
• The Plus bracket consists of Tip-Edge face
combined with a plus base. The specification and
geometry of the slot is identical.
• However, the innovation of a horizontal ‘deep
tunnel’ in the bracket base completely eliminates
Side-Winder springs during the final stage of
treatment, allowing torquing and tipping to be
powered by a light NI-Ti archwire.

30. • Clinically much easier, less prone to errors with
obvious benefits to patient in terms of aesthetics
and comfort.
• Unlike the Tip Edge brackets which are
manufactured by casting the Plus brackets are
metal injection molded. They are also available in
ceramic.
• Essentially the technique in Stage I & II is the
same.
• When setting up Stage III, the main rectangular
wires will be the same, but a single deep tunnel
wire in each arch is used instead of all the Side-
Winders.

31. • Bracket identification is by small
circular markers at the disto
gingival tie wings of the maxillary
anterior brackets and similarly
placed triangular markings on the
mandibular anteriors.
• The cut out surfaces of the archwire slot form
the tip limiting surfaces.
• The intact surfaces are therefore the finishing
surfaces.
• The point at which the tip limiting and
finishing surfaces meet constitute the central
ridge.
THE BRACKET FACE

32. • Slot size: 0.022”X0.028”
• Vertical slot: 0.020”x0.020”- to accept rotating
or up righting springs, power pins etc. Both
the gingival and incisal ends are
chamfered to facilitate the insertion
of auxiliaries from either
direction. (Funnel Shaped)
• Lateral extensions- for rotational control
hidden behind the arch wire –which is
esthetic.
• In and out compensation- eliminates the need
for lateral, bicuspid or molar offset
• Torque built in base

34. TYPES OF BRACKETS
Narrow metal
tip edge bracket
Twin metal tip
edge bracket
Narrow ceramic tip edge bracket

35. • Twin version of bracket - 018” or 022” slot size
• Known as “Freedom brackets”
• Disadvantages :
• Unaesthetic
• Extra bulk-occlusal interferences and
accidental debonds
• Mechanical disadvantage when Side Winder
springs are added.

36. TIP AND TORQUE PRESCRIPTIONS
• The preadjusted finishing prescription contained within the tip
edge bracket system is identical in principle to todays straight
wire systems.
• They compare most closely to Roth specifications.

38. DYNAMICS OF TIP EDGE
• DYNAMIC SLOT
• Unique feature to Tip edge brackets
• Arch wire slot increases its
vertical dimensions as the tooth
tips.
• Tipping of the tooth crown,
during initial translation, alters the axial
inclination between bracket and archwire,
progressively increasing the vertical space
available for the archwire from 0.022 to a
maximum of 0.028 inch

40. • Mesio-distal width of the tip-limiting
surfaces slightly exceeds the width of the
finishing surfaces.
• The finishing surfaces therefore extend less
than halfway across the face of the bracket,
and are at no point directly opposed.
• Therefore the central ridges, being slightly
offset either side of the mid-point, 'open up’
the vertical dimension of the as the bracket
tilts.
• This feature has great advantage like while
levelling & aligning it is possible to step up
from a .016 to a 0.22 inch SS archwire in a
single move.

41. VERTICAL REACTIONS DURING RETRACTION
• When canines are retracted using full arch mechanics with
edgewise or straight wire brackets there is tendency to produce
adverse vertical reaction, owing to bodily retraction of the tooth.
• This will tend to rotate the crown distally causing flexion in the
archwire, which will tend to extrude the labial segment and
intrude the buccal segments. This is called the roller coaster
effect.

42. • In Tip Edge the tooth movement leaves the apex behind, crown
retraction carries no vertical consequences. Hence vertical round
tripping of the anteriors is avoided.
• Vertical implications can occur later while the roots are uprighted.
But by this stage the patient will be in heavy achwires &
protected by an already established interarch relationship.

43. FRICTIONAL RESISTANCE
• Conventional bracket system involve a high friction between
brackets and archwire. This is because of apical resistance
generated when retracting a tooth bodily.
• In Tip edge this does not occur due to differential tooth movement
and also increase in vertical slot space or a dynamic slot.

44. BITE OPENING
• Early bite opening is one of the key reasons for reduced treatment
time, particularly in deep bite cases.
• Edgewise type brackets, used with full archwires are unable to
intrude incisor segments until the canine angulations are
corrected. This delays overjet reduction.

45. • A segmental arch approach can overcome this problem, but at the
added complexity.
• Segmental arches are never required with Tip-Edge and overbite
reduction can take place from the outset, irrespective of canine
angulation.

46. THE PLUS BASE
• Plus bracket incorporates a ‘deep tunnel’
which is unique in orthodontics.
• Idea germinated by author’s aim to dispense
Side-Winders in Stage III.
• A simple typhodont experiment was carried
out.
• The deep tunnel runs ‘east-west’ through
the base and intersects the vertical slot at
right angles, describing a plus sign.
• .020 inches in diameter with flared exits at
both ends.
• No labial or lingual access therefore, needs
to be threaded.

50. MOLAR TUBES
• Contains both rectangular and round tube
intended to combine advantages of both
straight wire and Begg modes of treatment.
• 2 types available - One comes with a
convertible rectangular buccal tube and tie-
wings so that the tube can become a bracket
when the buccal welded insert is peeled away.
This facilitates alignment of second molars.

51. • Rectangular tube of 0.022 * 0.028 inch which is
convertible and are of Easy Out design with posterior
inner lumen slightly flared towards the occlusal. This
facilitates arch wire removal when a cinch back has been
used.

52. • The other one is a non – convertible molar
tube since it carries no tie-wings, it has a
lower profile, which helps patient comfort
and reduces the chances of occlusal
interferences.
• Round tube of 0.036 inch internal
diameter & 0.250 inch length is placed
gingivally in the initial stages of
treatment in deep bite cases for bite
opening.
• Thereafter, all space closure and root
uprighting is carried out using
rectangular tubes.

53. • Mid crown position is recommended (Parkhouse)
• Bracket should be aligned with it’s vertical axis parallel with the
long axis of the tooth
• Midpoint of the crown mesio-distally.
• Height of the bracket should be at vertical midpoint of the fully
erupted clinical crown.
BRACKET PLACEMENT

54. • For accurate placement of the Tip-Edge bracket particularly on large
clinical crowns, they are supplied with the option of ‘plastic jigs’.
• Previously, the jigs were produced only in ‘L-shaped’ form, which
prescribes a fixed bonding height for each bracket from the incisal
edge or tip, as denoted by the color coding.
• Disadvantage – Measurement of the mid-crown point to the incisal
edge will vary according to the overall size of the crown.

55. • Recently, Universal Jigs have been introduced. These can easily be
aligned up the long axis of the tooth, while the mid-crown height
can be gauged by eye.
• Correct angulation up the long axis will result in the incisal tie
wing being parallel to the incisal edge of the crown.

56. • Middle point of the crown is generally the point of greatest
convexity on the curvature of the labial surface.
• Placing a pretorqued bracket further gingivally will decrease the
torque prescription. While placing it too incisally will increase
the torque.
• Reliance on L-shaped jigs frequently results in latter.
• Clinical experience shows that a true mid-crown position, as
opposed to a more incisal bonding position, significantly reduces
occlusal interference and hence cuts down on the number of
accidental debonds, particularly on lower canines and premolars.
Rationale Behind Mid-Crown Bonding

57. Incisal bonding position is contraindicated due to the following
reasons:
1. Prescribed torque value in the bracket base is effectively altered.
2. During overjet reduction, the amount of retroclination produced
during the initial tipping stage will be increased. This in turn will
require an increase in the amount of root uprighting in Stage III.
3. When auxiliary spring/deep tunnel wire uprights the root, during
Stage III it is placed at greater mechanical disadvantage if the
distance between the point of rotation and the root apex is
increased. This results in loss of efficiency.

58. PREMOLAR TIP EDGE
BRACKETS
• Identical tip and torque for 1st and 2nd premolars
• So, possible to have just 2 upper and 2 lower
bicuspid brackets.
• Can be switched from R to L side to provide
clockwise or counterclockwise crown tipping.

59. Identification of brackets
• Arrow – indicator for direction of
tipping
• Premolar jigs are modified
by the addition of a 90° angle
at the tip of the jig which
indicates the direction of
tipping.
• Origin from Queen’s University,
Belfast –called as “Irish jigs”

60. Tip edge brackets for first premolar extraction cases

61. Tip edge brackets for second premolar extraction
cases

62. Tip edge brackets for non extraction or
first molar extraction cases

63. MOLAR BANDS
• Use of bonded first molar tubes is contraindicated.
• Withdrawal of the rectangular archwires at the end of Stage III is
likely to cause bond failure.
• The rectangular buccal tubes should be aligned to the brackets, at
mid-crown height. The round tube will therefore sit towards
gingival margin.
• Second molars are not banded at the outset as they are
unnecessary to reinforce bite opening, contrary to straight wire
practice & merely adds friction.
• However, final alignment of second molars during finishing phase
is necessary.

64. ADVANTAGES OF TIP EDGE
BRACKETS
• Over conventional edgewise brackets
• Eliminates undesired force couples to promote rapid bite
opening and prevent midline discrepancies
• Anchorage problems are eliminated as space can be closed
with light forces and minimum wire deflection. This results in
diminished anchorage demands and increased vertical control.
• Permits free crown tipping followed by controlled uprighting
• Can reposition teeth with light forces and still maintain total
control over their final positions.

65. • Over Begg brackets
• Horizontally facing archwire slots facilitate initial archwire
engagement especially on rotated teeth. Elastomeric ties
provide a cushion or flexibility that enhances patient comfort
and reduces the chances for bond failure.
• In –out compensation eliminate the need for molar (or other)
offsets.
• Slot designs causes automotive shift from tipping to bodily
movement at the predetermined angle and increase anterior
anchorage to encourage mesial movement of posteriors –
“Programmed Differential Mechanics”
• Labio-lingual root torque from rectangular wires possible.

66. TREATMENT
• Treatment is divided into three stages
• Each stage features a distinct set of treatment goals that must be
achieved before moving on to the next.
• Specific arch wires and auxiliaries are employed during each
stage.
• Mixing the goals or the use of improper arch wires and auxiliaries
can lead to excessive anchorage loss, compromised control of the
vertical dimension, and other undesired complications.

67. TIP EDGE AUXILIARIES
• In early days, Tip-Edge was used with a host of different
auxiliaries, many of which were Begg derived and designed for
Orthodontists unfamiliar with rectangular wire.
• Apart from the Power Pin and the occasionally useful Rotating
Spring, the erstwhile Side Winder answered every need in terms
of root uprighting and torquing for Tip Edge users, it still does.
• With the invent of Plus bracket, even the Side-Winder has become
redundant during the final torquing and uprighting phase of
treatment, when virtually every bracket previously required a
spring to achieve its prescribed finish.
• A single Ni-Ti archwire running through the deep tunnel is
therefore the new auxiliary, which does the job formerly
undertaken by all the springs.

68. SIDE-WINDER
• Everyday “Work Horse” among Tip edge auxiliaries.
• Generates mesio distal root movement, when used in conjunction
with rectangular archwire produces torque correction.
• Made of 0.014 inch high tensile st steel.
• So called because it carries it coils along the archwire, over the
bracket face.

69. • Invisible side winder springs
• Wire of spring lies on archwire & brackets.
• Advantages
• Aesthetic
• Retained in position by the elastomeric
module, in addition to its own spring
pressure.
• Enables modules to be changed if
necessary during the root
uprighting process without removing springs.
• Since the bulky hook has been eliminated,
the spring arm has a wider range of
activation than was previously possible.

70. Direction of insertion
• Occlusal and not gingival
• Masticatory forces coming occlusally are deflected
harmlessly off the coils of a correctly inserted spring,
keeping these in close proximity to the bracket face.
• If inserted from gingival, occlusal forces might distort
them labially away from the bracket –spoils the
action of the spring as well as causes discomfort

71. • Side winders come in clock wise and counter clock wise formats.
• Selection of sidewinders spring is made solely on direction of second
order correction required, as seen from labial.
• Hence, an upper right canine requiring distal root correction will
need a counter-clockwise spring, while uprighting a lower right
canine root distally will require a clockwise spring.

72. Identification of spring
• Spring arm points in the direction towards which the occlusal tip will
rotate.
• Hold the spring in a plier, hook facing the operator, in which
direction does the hook curve?
• Starting from its free end, if the hook curves away in a clockwise
direction, it is a clockwise spring.

73. POWER PIN
• It is a traction hook that can be fitted in the
vertical slot.
• Most commonly used as hook for seating elastics
in final treatment visits.
• Made of soft stainless steel.
• Normally be inserted from the gingival side.

74. • Power pin is retained in the slot by bending the occlusally
projecting tail 90 degrees.
• This bend should be made in the opposite direction to the elastic
pull, since this avoids the possibility of a slackly turned pin doing
a U turn and being pulled out of the slot by the elastic.

75. • Head of the power pin is angled relative to the shaft.
• The pin should therefore be inserted with the head inclining away
from the tooth or gingival margin.
• Once fitted can be left in place for as long as required.
• When finished with, its removal is easy, by straightening the tail
and cutting it with ligature cutters.

76. • Power pin may be used when an individual tooth
requires retraction.
• Using an elastomeric to a power pin, instead of
directly to the bracket reduces the risk of
rotation.

77. ROTATING SPRING
• Made from 0.014 inch high tensile stainless steel.
• Used for recapturing a rotation that has recurred in
treatment, particularly if the patient is in a heavy archwire.
Eg:- Ligature or bracket has detached from a previously
rotated tooth.
• Inserted from gingival aspect to avoid occlusal interference.

79. Tip edge rings
• Elastomeric rings designed to function
with tip-edge brackets.
• Designed to retain archwire and
prevent mesial and distal tipping
during Stage III.
• Lingually facing lug on either end of
the crossbar wedge between the
archwire and the bracket to control
mesiodistal inclination of the tooth

80. TO BE CONTINUED

81. STAGE I

82. Stage I :Objectives
1. Alignment of upper and lower anterior segments
2. Closure of anterior spaces
3. Correction of increased overjet and reverse overjet.
4. Correction of increased overbite or anterior open bite
5. Work toward buccal segment cross bite correction

83. ANCHORAGE CONTROL
• Six upper anterior teeth by means of
Class II elastics are pitted against
two lower first molars, which are
maintained under bodily control by
the mesial apical influence of
anchorage bends in archwire.
• The Lower molars therefore ‘dig
their heels’ to resist the light mesial
pull of the elastics.(Tent Peg effect)
• Similarly upper anchorage bends
prevent mesial migration of the
upper molars, by imparting mesial
apical resistance.

84. • Elastic force is kept to a minimum, not exceeding 50 gms(2 ounces).
• Otherwise, the increased vertical component can overwhelm the
intrusive effect of the light maxillary archwire at the front, so
elongate the upper anterior segment as well as over-eruption of the
lower first molars.
• Using this pattern of anchorage control, the assistance of second
molars is unnecessary, either for overbite or overjet reduction.

85. Stage I base archwires
• 0.016 high tensile St-Steel wire (A . J Wilcock
Special plus ) is the Ideal Archwire.
• Has the necessary resilience to withstand
forces of occlusion, combined with the
flexibility required to align mild toot
irregularities.
• Suitable for bite opening, offering a good range
of action without excessive forces.
• Preformed wires – Bow Flex 0.016 archwires
• These are size graded according to the
distance in mm between the cuspid circles.

86. Intermaxillary Circles
1. Bent in a vertical plane or inclined
slightly labial.
2. Located mesial to canine bracket.
3. Anterior portion of the circle is labial
to the archwire to facilitate
engagement of distally directed ties or
elastics.
4. If labial segment is crowded, canines
need to drift distally, so circles placed
immediately mesial to the canine
brackets.
5. If incisors are spaced, mesial
movement of canines needed so circles
placed further mesially.

88. • Exert elevating effect on the molar tube, which may cause lingual
crown deflection.
• 5mm of expansion measured across molars.
• Twice the amount in difficult deepbite cases

89. Bite opening mechanics
• Anchor bends placed 2mm mesial to molar tubes.
• If reduced overbite or an open bite is present at the start of
the treatment, reduced degree of anchor bends are placed.
• Also depends upon the angulation of molars-if molars are
tipped mesially, reduced angulation required.
• Maximum vertical defection permitted (Low mandibular
deep bite cases) To the depth of the labial sulcus.
• Used in round molar tubes with the premolars omitted
from the arch wire.

90. THE AUXILIARY ARCH
• Niti underarch (.014inch diameter) used to align anterior teeth.
• In Plus users, this underarch wire runs through the main archwire
slots, never through the deep tunnels.
• Extends 3mm distal to canine bracket and turned 90 deg lingual for
patient comfort.

91. When a ligature (especially steel) is
used to retain the archwire a
“hammock effect” is created that tends
to parallel the archwire with the
gingival and occlusal edges of the tie
wing tips.
This could influence mesial /distal
inclinations.
Steel ligature when tied loosely
minimizes the hammock effect.
Elastomerics are preferred since they
are more flexible.
The Hammock Effect

92. Fitting the arches
 The Auxiliary underarch goes in first,
ligated to the instanding or rotated teeth.
 Then, the tail of the main arch goes into
the round molar tube.
 This leaves a straight section of main
archwire mesial to the canine bracket
with cuspid circle ready to be ligated.
 Once one canine is ligated, that side of
the archwire can be slid distally to its
correct position, whereupon the opposite
canine can be secured by same sequence.

93.  Secure the arch wire in position
and by pressing the trigger the
ring is released.
Straight Shooter Ligature Gun

94. Straight Shooter (ligature gun)
• Advantages
• Less time consuming.
• Places less pressure on the
tooth ,more comfortable for
the patient.

95. Cuspid ties
• Contraindicated while crowding exists in the anterior segment, as this
would impede the distal canine migration.
• However, once alignment is achieved it is mandatory to ligate each
canine bracket to its respective cuspid circle with an elastomeric
throughout Stage I.
1. Canines are prevented from further distal migration, so that anterior
segment space does not open up.
2. Archwire is stabilized laterally, and cannot swing from side to side.

96. • Simply engaging each tie wing and
cuspid circle direct, following archwire
insertion is wrong. This will result in
mesial rotation if the elastomeric is
under stretch.
• Because the elastomeric will find its way
beneath the archwire at the mesial of the
canine.
• Eliminate this risk by providing labial
archwire coverage at mesial n distal
ends.
• Achieved by threading an elastomeric
module on to the archwire from the back,
before fitting the archwire in mouth.
• Then following insertion of the archwire,
each module can be stretched around its
respective cuspid bracket.

97. • An alternative method is the ‘figure of
8’ known as ‘Swiss Twist’.
• Placed after archwire insertion.
• Easiest to engage the cuspid circles,
before twisting the elastomeric through
180 degrees and hooking it around the
tie wings.

98. E-links ( for anterior space
closure )
• Elastomeric links stamped from thermoset
material
• Less hydrophilic than thermoplastic
material
• Better force control than E-Chain.
• Available in graded lengths.
• E1to E4 smaller size with no tabs.
• E4 to larger sizes with tabs.
• E 9 size suitable.

99. • 2mm of archwire should be left protruding distal to the lower molar
tubes to accept Class II elastics.
• Bent 30 degrees to the lingual for patient comfort.
• Ends should not be cinched gingivally.
• Because any distal tipping of the molars in response to the anchor
bends will drag the archwire distally, causing retroclination of the
incisors.

100. Intermaxillary elastics
• Use of light Class II elastics (2 oz) / 50
gms.
• Worn full time from upper cuspid circles
to the distal ends of lower arch wire.
• There is a significant difference between
the vertical force vector produced by class
II elastics when worn to the distal –arch
end as opposed to the molar hook.
• Overbite reduction is more effective with a
more distal application of elastic to the
molar, which better resists distal crown
tip and encourages fuller expression of the
anchor bends to the anterior segment.

102. STAGE I
CHECKS

103. ROUTINE ADJUSTMENTS- 6 WEEKS
1. Measure the overjet: 3-4mm/visit
2. Observe the overbite
3. Molar width
4. Check the cuspid circles
5. Siting of anchor bends: 2-3mm
6. Distal arch ends
7. Distortion of the archwire
8. Reassess the elastic tension

104. POWER TIPPING
• Power Tipping is a way of resisting lower incisor proclination
during overbite reduction in extraction cases, or where buccal
segments are spaced.
• Also to upright incisors lingually over mandibular base with
minimal loss of anchorage.
• During over bite correction particularly where anterior
crowding present –risk of proclination in lowers.
• Less likely in Tip-Edge because the lower canines are free to tip
distally along the arch. Into available space.

105.  Intrusive force from an archwire within a labially placed
bracket acts along an axis that will be labial to the center of
rotation of a proclined incisor.

106. • Power tipping utilizes reverse side winders to induce distal crown
torque to lower canines.
• Hence distal traction, which uprights lower anterior segment
lingually.
• Its essential to ligate canine to cuspid circles, otherwise the canines
will retract without taking the lower incisors lingually, like a
locomotive leaving its train behind.
• Auxiliary springs –little ‘motors’ gently propelling crowns backwards
by distal rotations; as canine tied to the cuspid circles cause incisors
to tip lingually.

107. PROTRACTION ARCH
• Used in non extraction case where difficulty
is being experienced gaining precise
alignment of the lower incisors.
• Use is confined to mildly crowded
situations.
• Previously, the accepted method was to use
multi-looped stainless archwires with
vertical ‘goalposts’ to introduce local
flexibility.
• Difficult to keep clean and reduce control of
molar width and overbite reduction.
• Protraction arch is much simpler, more
comfortable and easier for the clinician to
manage.

109. • Fabricated from 0.016 inch high tensile SS
wire.
• Cuspid circles are placed 3mm distal to the
canine bracket.
• The circle faces gingivally.
• Protraction is activated by means of
elastomeric module stretched between each
canine bracket and the circle behind it.
• As the elastomeric contracts, the archwire
will be drawn forwards through the molar
tubes, making more wire available at the
front, allowing the incisors to align onto a
bigger curvature.

110. • Protraction arch works irrespective of
whether premolars are bonded or not.
• Adequate straight length of wire must be
available distal to each molar tube, ready to
be fed mesially.
• Distal end may be turned lingually for
patient comfort, but at an appropriate
distance from the distal of the tube.
• Cinching the archwire back thoughtlessly
will prevent its action completely.

111. PRE-STAGE II

112. Objectives
• Remove the 0.016 inch SS archwires.
• Bond and Aligning the premolars
• Remove the anchorage bends and replace them with vertical bite
sweeps, to retain the overbite correction previously gained.
• Reinsert the archwires into the rectangular molar tubes, which will
be used for remainder of the treatment.

113. • For lingually displaced premolar, elastic
thread can be tied through the vertical
bracket slots and out to the archwire.
• Rotated pre-molars can be corrected with
elastomeric E-links or chain.
• In case of mesial rotation, the elastomeric
can run from bracket to molar hook, while a
distal rotation will be handled in opposite
direction.
• Round Molar tubes are only used in Stage I.
• On no account should a Ni-Ti arch be used
to align premolars without the security of
SS main arch, as it would cause loss of
control such as relapse of overbite and
overjet.

114. STAGE II

115. Objectives
1. Closure of residual spaces.(Either by retraction or protraction)
2. Correction or maintain dental midlines.
3. Derotation of first molars.
4. Leveling of first molars.
5. Continuing cross bite correction.
6. Maintain all corrections achieved during stage I

116. Stage II archwires
• 0.020” high tensile St-Steel archwire.
• These are stiff enough to maintain vertical and horizontal
control during space closure, but are also sufficiently flexible for
derotation of the first molars.
• 0.022’’ SS archwire can be useful in certain conditions.(nearly
one-third greater stiffness than 0.020 inch wires)
1. In maxillary arch in crossbite cases, where maxillary buccal
segment expansion is required.
2. In first molar extraction cases, where the heavier archwire
offers better labio-lingual control of the second molars and
increased resistance to mesial tipping, particularly in
mandibular arch.

117. • Anchor bends are removed and bite sweeps are placed.
• In order to retain the overbite reduction gained during the first Stage.
• Reverse Curve of Spee – Lower Arch
• Increased Curve of Spee/Rocking Horse – Upper Arch
• Wiping in the vertical sweeps is best done with thumb and finger while
holding the archwire immediately distal to the circle in a light wire
plier.
• As for angle of sweep, a mm or two of active intrusion in the archwire
will generally be sufficient to retain a reduced overbite, as measured at
the midline.

118. Space Closure
• By E-links from buccal hook on the first
molar to cuspid circle
• Usually E-6 or E-5 is selected.
• Design of TIP EDGE bracket greatly
facilitates free sliding mechanics.
• No friction as compared to the conventional
brackets.
• Archwire itself will be moving distally as it
travels through the molar tubes.

119. APPLYING BRAKES
• Available space can be closed by
protraction of the posterior teeth
mesially.
• A gently active side winder placed
on canines to induce a distal root
movement.
• Increases anterior anchorage.
• Brakes can also be used to correct
a midline discrepancy.

120. MIDLINE CORRECTION
 In crowded cases, Midline is deviated towards crowded side.
 Resolve without intervention.
 Space closure on worst crowded side will be completed first,
whereupon the midline will drift across into the space remaining on
opposite side.

121.  If Midline is in correct position, where all space has closed on one side
but some space remains on the other.
 A protective brake should be placed on the canine spaced side to
prevent the labial segment from being pulled across.
 The remaining space will be closed by protraction.

122.  It is also possible to influence midlines from the front of the arch.
 Applying a Side-Winder to a mesially tipped central, or even a
lateral incisor, will induce a lateral movement across the segment
and influence the midline movement towards the opposite side,
particularly if supplemented by a brake to the canine behind it.

123. Derotation Of Molar
• During Stage II, a limited amount of first
molar rotation is expected.
• Because archwire of .020 inch runs within
0.028 molar tube, so that active space
closure will express this freeplay as a
small mesial rotation, as the molar slides
along the wire.
• 1mm Molar offset and 10°toe-in opposite
the interspace between the first molar and
premolar. for final visit of stage II.
• Initial stages no need to place these bends
as it increases friction.
• Distal wire annealed and turned gingivally
to prevent space recurring.

124. Leveling Of Molar
• Tipped back molars should be
leveled to allow the placement
of rectangular archwires
• Anti tip bend of 10° opposite to
premolar-molar contact point.
• Ensures seating of the distal
cusp of tipped molars
• Can be combined with offset
and toe-in.

125. STAGE II
CHECKS

126. Observe space closure
The distal archwire ends
Check molar widths
Labial segment position and inclination
Attention to center lines
Derotation of first molars
‘Untip” the first molars
Avoid over compression
Check the interarch relationship
ROUTINE ADJUSTMENTS- 6 WEEKS

127. • Historical Perspective
• Introduction
• Tip Edge Concepts
• Tip Edge Brackets
• Dynamics of Tip Edge
• Tip Edge Auxiliaries
• Treatment Stages
• Final Finishing
• Conclusion
TO BE CONTINUED…..

128. BASE MORPHOLOGY OF ORTHODONTIC
BRACKETS
Bonding mechanisms that have been identified for
Orthodontic brackets may be classified into three major
categories:
a) Mechanical retention employing large recesses.
b) Chemical adhesion facilitated by the use of a silane layer.
c) Micromechanical retention through the utilization of a
number of configurations, including protruding crystals,
grooves, a porous surface, and spherical glass particles.
(A) Mechanical retention
Large grooves are cut in the base of the bracket where the
edge angle is 90 to provide mechanical retention. Further, there
are crosscuts to prevent the bracket from sliding along the
undercut grooves.

129. (B) Chemical Retention
 The coupling agent -methacryloxypropyltrimethoxysilane
(-MPTS) has been used for promoting chemical adhesion
between surfaces.
 The -MPTS is hydrolysed to the corresponding silanol. A
limited number of silanol groups per silanol molecule are
hydrogen-bonded to the water layer adsorbed on the base
surface.
 Side chain silanols are condensed, establishing a siloxane
network that stabilizes the structure.
 Owing to the silanol orientation toward the bracket base,
methacrylate groups are placed in a configuration that favours
cross-linking with the methacrlate-based adhesive.

130. • Polycrystalline alumina brackets with a rough base
comprised of either randomly oriented sharp crystals or
spherical glass particles. These brackets provide only
micromechanical interlocking with the orthodontic adhesive.
•
(C) MICROMECHANICAL RETENTION
SEM Photomicrograph
of sharp crystals
Bright-field polarized-light photomicrograph
of spherical particles

133. STAGE III

134. Objectives:
1. Correction of torque and tip values for each tooth individually.
2. Attainment of optimum facial profile compatible with stability
3. Maintenance of Class I occlusion.
4. Final detailing.

136. • Tip-Edge bracket cannot be torqued by an
active archwire in the conventional manner.
• The intact upper and lower finishing
surfaces in each bracket are offset from one
another, and are therefore never directly
opposed.
• Insertion of an actively torqued rectangular
archwire will therefore elevate one finishing
surface and depress the other.
• In fact, the torquing effect in the archwire
will have dispersed, by increasing the
vertical dimension within Tip-Edge slot.
• The net result will be a relapse of root
uprighting in mesio-distal direction, rather
than any third order torque imparted to
root(Torque Escape).

137. • New and entirely original method of torque delivery, simultaneous with
tip correction.
• Relieves the rectangular wire of its double function.
• The heavy base archwire becomes a passive platform, preserving three-
dimensional rectangular control where necessary.
• Light auxiliary forces provide the flexibility to torque and tip each
bracket into conformity with the archwire.
• Originally with the Tip-Edge bracket, the Side Winder spring provided
the auxiliary force.
• The Plus bracket eliminates the Springs altogether.
• Uses a Niti auxiliary archwire, threaded through deep tunnels, beneath
the security of SS rectangular main archwire.

138. • During the first two stages of treatment, the
bracketed teeth being free to tip, opens the
vertical slot dimension from .022 to .028 inch.
• Even a small amount of mesial root or distal
crown tipping will open up the vertical
dimension, due to geometry of Tip-Edge bracket.
• At the onset of Stage III, therefore a .021*.028
inch SS rectangular archwire can be fitted
without any difficulty because each slot will be
comfortably in excess of the vertical dimension of
the archwire.
• No torque will therefore be imparted and
archwire won’t be deflected. In fact, only first
molars will be subject to torque control from the
onset of treatment.

139. • After some initial correction of tip, a point is
soon reached when further closing of the bracket
becomes obstructed by opposite corners of
rectangular archwire.
• A two point contact is established within the
bracket.
• Because the deep tunnel auxiliary archwire is
still active, these two points are attempting to
close down further, exert light pressure against
the archwire.
• Because the two pressure points are offset in
relation to the torque plane, a secondary
torquing couple is generated, which will induce
palatal root torque.

140. • As the torque begins to express, so further tip
correction progresses, the two-point contact
being maintained under light pressure, until
finally bracket becomes fully closed down to the
vertical dimension of the archwire.
• All torque and tip will have been fully expressed
with no residual ‘torque’.
• A maximally open incisor
bracket at onset of Stage III is
capable of accommodating 14
degree of torque discrepancy
in either direction, without
deflecting the archwire.

141. Anchorage Considerations
• Anchorage demands during root uprighting must be predicted by
taking a Cephalogram prior to Stage III and compared with pre-
treatment and against the final objectives.
• Because all adjacent teeth in each arch will be in contact
anchorage will no longer affect groups of teeth, but each arch as a
whole known as ‘Contiguous anchorage’.
• Therefore, anchorage sequelae may influence the interarch
relationship, which needs to be maintained in correction
throughout the root uprighting phase, as well as influencing the
facial profile.

143. Rectangular stage III wire
• 0.0215”X0.028” rectangular archwire
• Available in two formats - plain or
pretorqued
• Plain arches used for reduced overbite
and open bite cases.
• Pretorqued are used when bite sweeps
are used so that the resulting labial
crown torque is cancelled out, which
would cause incisor proclination.
• Also used for different reasons in
Class III cases, where a atypical
torque prescription may be
appropriate to the anterior segments
to maintain a positive overjet.

144. ARCH WIDTH
• Standard arch shape to be
used as starting point.
• Easier to expand a
rectangular arc, simply by
placing it on a flat surface and
widening the legs, rather than
trying to contract it, which
risks altering the torque.
• Initial expansion should be
about 2mm per side, across
the molars.

145. ARCHFORM
• Approximately, 5 degrees of lingual toe-in
should be placed opposite the mesial
molar contacts.
• This ensures that the archwire enters the
preangulated molar tubes at an
equivalent angle to straight-wire
archform.
• It will also restore archwire width across
the molars to its desired measurement,
while maintaining between 1 and 2 mm of
expansion across the premolars, yet
avoiding any increase in intercanine
width.

146. TRACTION HOOKS
• Should be crimped to the wire
midway between lateral incisor
and canine brackets.
• The hooks should always point
gingivally.
• T-shaped, therefore able to accept
elastics or elastomerics from either
direction.
• Seated from the buccal and need to
be crimped tightly.
• An internal tungsten coating
prevents slippage along the wire.

149. • The torque set in any part of the archwire can be easily visualized by
holding the prepared archwire within the beaks of a torquing plier,at
the point at which torque is assessed.

150. TORQUE IN INCREASED
OVERBITE CASES
• A zero torque archwire setting throughout will be the aim.
• However, where overbite reduction has been required in Stage I &
maintained with bite sweeps throughout Stage II, it follows that
vertical bite sweeps will be needed to maintain the reduced overbite
during the third stage also.
• This introduces complications since sweeping a vertical curvature
along the buccal segments will alter the torque setting at the front,
producing unwanted incisor proclination.
• Lingual crown torque required in anterior segment, to counteract the
labial crown torque produced by the bite sweeps, thereby restoring
zero torque to the lower incisors.

151. PRETORQUED ARCHWIRES
• 5 degree lingual crown torque in
maxillary.
• 8 degree lingual crown torque in
mandibular.
• Pretorqued archwires are identified by
their centreline markings.
• Maxillary – Single Mark
• Mandibular – Double Mark
• Markings are on the occlusal surface.
• To avoid accidental misfitting of an
archwire upside down, which would of
course reverse torque.

153. WIPING THE SWEEP
• The sweep comes first.
• Archwire to be held in a torquing
plier, mesial to hook, a vertical bite
sweep curvature stroked into
buccal segment with thumb and
finger.
• Reverse curve of spee in lower arch
& rocking horse in upper.
• Curvature should be along canine
and premolar regions but not
progressing into molar tubes.
• Amount of archwire intrusion at
front should normally be 1-2mm.

154. CHECKING THE TORQUE
• Firstly check the incisor segment,
by holding the wire at the midline,
to see if there is zero torque.
• Small torque adjustments can be
made gently deflecting the tails of
the archwire vertically with thumb
and finger, while holding the
centreline steady in a plier.

155. CLASS III CASES
• In mandibular arch, the
pretorqued archwire contains 8
degrees of lingual crown torque.
• Fitted without bite sweep it will
produce 8 degrees of retroclination.
• The only torque adjustments
required maybe to produce zero
torque in the buccal segments,
achieved by means of two pairs of
torquing pliers,either side of the
hooks.

156. • In Maxillary arch, requires inverted
thinking.
• This is because the pretorque set in the
archwire is lingual crown torque, and
retroclination is not what the upper
incisors need in a Class III case.
• To reverse the torque, flip the archwire
upside down. Hence, 5 degrees of
retroclination becomes 5 degrees of
proclination.
• An alternative approach for severe cases
would be to use mandibular archwire.
• It would require further expansion for
upper arch use but will give 8 degrees of
proclination.

157. THE MIDLINE APPROACH
• Original method proposed when the
Plus bracket was introduced.
• Recommended for newcomers.
• Since threading is easy to see from
the mesial of every bracket.
• Preformed Niti archwire is used.
• It should be cut to length before
threading, as there is no point
threading an excess of wire and then
having to cut.

160. THE DISTAL APPROACH
• Requires a straight length of Ni-Ti wire, without a preformed
curvature.
• Trying it across the archwire slots, the wire should be cut slightly
longer than the previous method.
• To allow the last 3mm of one end to be annealed and bent into a small
‘safety loop’.
• This will be the free end which will rest outside patient cheek.
• Unless using a mirror this process will be blind.

163. THE MOLAR TUBES
• If first premolar is extracted, the second
premolar will need mesial root uprighting.
Feeding the distal end of the auxiliary
archwire simply into the round molar tube
will do this naturally.
• If the premolar root needs uprighting the
other way it follows that the distal end of
the deep tunnel wire will need to be
deflected occlusally. There are two ways of
doing this.
• The first is simply to rest the arch end on
the occlusal surface of the molar double
tube. The ‘figure of 8’ retaining module is
pre-cautionary but generally unnecessary.

164. • However, Dr Christopher Kesling has since devised an alternative
and preferable method, by looping the free end of the wire occlusally
over the main archwire before inserting it into the safe haven of the
round buccal tube

165. TESTING FOR MOLAR TORQUE
• Before fitting the archwire, it is
important to assess whether there is
any torque discrepancy between the
archwire and the buccal tubes.
• Insert the distal end of the archwire
into the buccal tube on one side only,
keeping clear of the brackets and then
observing the height of the free distal
end on the opposite side, relative to its
buccal tube.
• Any height discrepancy will denote
the direction and extent of the torque
discrepancy in the molar engaged.

167. SIDE WINDERS
• Invisible Side Winders are fitted first,
the modules second.
• Inserted occlusally, arms will point
mesially.
• Degree of activation will vary
according to tooth and root movement
required.
• Side Winder will have to work harder
to produce a combination of tip and
torque.
• Incisors are most commonly the teeth
requiring both.

168. ‘HYPERACTIVATION’ OF
SIDE WINDERS
• Facilitate the delivery of final torque
prescription, also to increase bodily
control where required for anchorage
purposes.
• Activation cannot be increased by
bending the arm to open up the coils.
• Bcoz, leg of the spring crosses the arm
and coils occlusally, to protect them
and therefore prevents the leg from
being unwound to increase its
activation.

169. • Instead, the square beak of a light
plier should be placed within the coils,
the round beak on the outside.
• A single squeeze will flatten a small
section of coils, effectively expanding
them.
• The arm now actively presses against
the leg and would spring past it.
• Adjustment is done without removing
the spring.

170. STAGE III
CHECKS

171. Progress of Tip and Torque
Available space in the arch
Unwanted Space
Condition of the uprighting auxiliaries
Activation of Side-Winders
Interarch relationship
The vertical relationship
Molar widths
Second Molars
Profile Considerations
ROUTINE ADJUSTMENTS- 8 WEEKS

172. Incorrect bracket
Misangled bracket
Incorrect archwire
Incorrect bonding position
Incomplete bracket engagement
Wire Ligatures
Tight contact points
Underperforming uprighting auxiliary
Incorrect torque value in archwire
Late crown movements
Tipped Occlusal plane
CAUSES OF INADEQUATE TORQUE

173. • Use of rectangular wire during this stage.
• Beginning with 0.019”X0.025” ,then 0.021”X0.028” for total
tooth control.
• Rectangular wires should pass through the rectangular tube.
• Tip edge rings can maintain or even capture the tip angles in
all bracket slots.
PRECISION FINISHING

174. Second molar alignment
• 022" x 028" 2nd molar tubes used
• Preliminary alignment start
during late Stage III, by a simple
sectional device suggested by Dr
Tom Rocke.
• Straight 0.016" high tensile S-S
sectionals
• It runs through the channel of the
gingival tie wing of the first molar,
without being attached to it.
• Mesially ends with a small
occlusally inclined loop which
hooks over the main archwire

175. Occlusal seating
• Vertical elastics employed to a
combination of molar hooks &
gingivally inserted power pins,
which is worn at night only
• 0.019X0.025” braided archwire.

176.  At the conclusion of Stage III, when all
root uprighting is complete
 Cut rectangular archwire distal to
each canine
 Molars and premolars, canines tied
together with criss-cross ligature wire,
to prevent spacing.
 Anterior teeth space prevention done
by running an E-9 elastomeric E-link
from canine to canine.
 Light rhomboid elastics to allow
settling of buccal section.

177. Positioners
• Pre-Fit positioners come in
different sizes (for extraction
and non-extraction cases)
• Inappropriate for individual
tooth size discrepancie.s

178. OUTRIGGER HOOKS
• Invented by Dr. Christopher Kesling
for non-compliant patient.
• These remind the patient to replace
elastics.
• They do so by the simple method of
flicking out sideways whenever the
elastics are not attached.
• Each Outrigger appliance consists of
a pair of hooks, coiled at the end of an
interconnecting span.
• Made of 0.016 inch to reduce fatigue
breakage.

179. • Supplied preformed in a a range of
sizes.
• Sited between the lateral incisor and
canine brackets.
• Two ways of fitting Outrigger
appliance
1. Shared the main archwire slots &
was threaded from the back of the
archwire. But cannot be used with
cuspid circles.
2. Seating separately in occlusal tie-
wings of the upper central and
laterals with the help of ‘bilevel
pin’.

180. • Retains just like a Power Pin,
converts the tie-wings into a
horizontal channel in which the
Outrigger can easily rotate.
• So can be adjusted or changed
independently of main archwire.
• Amount of buccal spring can be
adjusted by altering the curvature of
the interconnecting wire.

182. LIMITATIONS
• In malocclusions with anterior crowding or excessive incisor spacing,
Outriggers will need to wait until six anterior teeth are aligned.
• The patient must carry an adequate supply of spare elastics at all
times, for immediate replacement in the event of breakage or loss.
• Part-time wear is impossible. A patient needs to report in at once, in
the event of a reversing overjet.
• Long-term fatigue fracture may occur.
• Renewal is therefore advised after 3 months in use.

184. CONCLUSION
• The tip edge bracket provides varying degrees of tooth control not
previously available in an edgewise type bracket.
• Control ranges from a simple one-point contact and 100%
interbracket distance with a round archwire to predetermined
control in three planes with rectangular arch wire and a Tip-Edge
ring.
• It also offers advantages over ribbon-arch (Begg) brackets
through ease of manipulation provided by the horizontally facing
slot plus predetermined limitation of initial crown tipping and
control of final root uprighting.

186. • In case of severely proclined incisors, the
intrusive force is 45 gms while Class II force is
60 gms.
• Resultant force passes little behind C.Res and
slightly diverging away from the long axes of
the teeth.
• Mainly reduces proclination but causes very
little intrusion.
• As inclination improves, the intrusive force is
increased to 60 gm while Class II force is
reduced to 30gms.
• This combination produces a resultant little
more vertically oriented, hence lies more
parallel to long axis and closer to C.Res.

187. • It brings about further correction
of inclination & some more
intrusion.
• Force is then gradually increased
to 90 gms.
• As incisors become more upright
the elastic application is changed
to an oblique direction.
• Class II to Class I orientation.
• Applying elastics from TPA in a
direction anteriorly pointing
downwards.