2. HISTORY
Bench , Gugino , Hilgers –1979
Extended seminars in this philosophy
Priorities of this new approach-keeping
with the forces of occlusion, growth and
nature
Main principle based on growth
3. THE MANAGEMENT
UMBRELLA
Mission – to treat the total face rather
than the narrower objective of teeth or
the occlusion.
Appropriate application of orthodontic
therapy
Primary concern of musculature
5. CONCEPT
Management in the beginning rather
than at the end
The methods of systems engineering,
operations and management science
and their applications
Ability to get other people to work with
you and for you
6. MANAGEMENT SYSTEMS-3
FACTORS
Quality – this would be the quality of
our result
Quantity – this would be the number of
patients that we treat
Effectiveness – this would be the
effectiveness of our treatment design
and office management
7. Basic premises
Satisfactory outcome
Practice effeciency
Initiation of true preventive procedures
for the future
An authority on occlusion ,including TMJ
function
Quantity but after quality
8. Communication – parents , patients ,
dentists and public
Time
The umbrella system is also called the
LEWIS.A.ALLEN MANAGEMENT SYSTEM
9. Factors of the system
Planning
Organization
Leading
controlling
11. PRINCIPLES
The use of a systems approach to
diagnosis and treatment by the
application of the visual treatment
objective in planning treatment,
evaluating anchorage and monitoring
results
Torque control
12. Muscular and cortical bone anchorage
Movement of any tooth in any direction
with proper application of pressure
Orthopedic alteration
Treat the overbite before the overjet
Sectional arch therapy
13. Concept of over treatment
Unlocking the malocclusion in a
progressive sequence of treatment in
order to establish or restore normal
function.
Efficiency in treatment with quality
results,utilizing a concept of
prefabrication of appliances
14. VTO
A blue print
A visual plan to forecast the normal
growth of the patient and the
anticipated influences of treatment,to
establish the individual objectives we
want to achieve for that patient
15. USE OF SUPERIMPOSITION
To forecast and draw up an effective
treatment design it is necessary:
- to understand individual patients basic
facial,skeletal and dental structures
- to understand response of his individual
skeletal and facial structures to various
treatment mechanics
16. - to understand his anticipated normal
growth in amount and direction in the
various areas of his face and jaws
TOOLS
- x-ray cephalometrics and tracings
Four objectives
- basic description of the cranial
structures
- Analysis of normal growth change
17. - A treatment design
- An evaluation of growth and treatment
results
11 factors of basic facial and skeletal
structures recorded from the tracings
1. Facial axis
2. Facial angle
3. Mandibular plane
4. Facial taper
5. Lower facial height
18. 5. Mandubular arc
6. Convexity of point A
7. Lower incisor to APO
8. Mandibular incisor inclination
9. Upper molar to PTV
10. Lower lip to E plane
Five areas of superimposition within
which seven areas of evaluation are
used to evaluate amount ,
direction,change in normal growth and
25. ORTHOPEDICS
Definition – orthopedics implies any
manipulation that alters the skeletal
system and associated motor organs
Method of evaluation by using the
superimpositional areas
26. Analysis of an orthopedic
problem
Bimler described the classical severe
convexity problem as a micro rhino
dysplasia(negative factor four)
Normally the palatal line is parallel or
slightly canted downward to the FH
plane.
In microrhino dysplasia –an
upward,outward tip with the ANS tipped
toward FH at least 4 degrees or more
28. Classical responses
Generalized orthopedic response with
cervical headgear alone:
- direction of force
- Rotational effect
- Effect in dolichofacial and brachyfacial
types
29. Generalized orthodontic response with
cervical headgear:
- downward and backward effect
- factors that dictate response
- effect on the upper and lower incisors
and lower molars
The reverse response:
- in combination with lower utility arch
- effect on the upper and lower molar
33. Expansive responses:
- the class 2 pose
- expansion of the midpalatal suture
Considerations for expansion
- reciprocal expansion of the lower arch
- preventing impacted second molars
34. Soft tissue changes
Normal growth
Growth following orthopedic alteration
of the maxilla
Lip and chin changes
Tongue posture
36. orthopedic vs orthodontic
movement
Force differentiation:
- magnitude
- duration
- site of application
Growth restrictive forces and rotational
forces
37. Nature of bone surrounding dentition
- sinus development
- distal root tip
- stacking factors
- sutural freedom
Mechanical application of cervical head
gear:
- force level
- intermittent wear
- outer bow length and position
38. - expansion , rotation
- freedom of movement of maxillae
Factors causing excessive mandibular
rotation(during cervical head gear
therapy)
- weak muscular pattern
- not retarding effective eruption of the
lower molars
- severe tipping of upper molars
39. - full arch therapy without freeing
anterior occlusion-incisal trauma
- full time cervical head gear therapy
40. FACTORS IN HEADGEAR TYPE SELECTION
Indicators for strong functional response
1.
2.
3.
4.
5.
Mandibular plane 25 degrees and under
Facial axis 90 degrees and above
Lower facial height 45 degrees and below
Mandibular arc 25 degrees and above
Condylar growth patternupward and forward
41. Forces in bioprogressive
therapy
Key factor in efficient tooth movement-
blood supply
Brian Lee – evaluated the optimum
force during cuspid retraction
Measured the surface of the root being
exposed and called it the enface surface
of the root
42. Proposed 200 gms/cm square of enface
root surface
Bioprogressive therapy suggests 100
gms / cm square of enface root surface
Utility arch mechanics for intrusion of
the lower incisors have shown efficient
intrusion with forces of 15 – 20 gms per
lower incisor
that is 0.2 cm square of cross section
root surface for each tooth
43. So 0.2 multiplied by 100 gms / cm
square would be equal to 20 gms / cm
square
Upper incisors root surface is twice as
large so 40 gms / tooth
CONTROL OF FORCES
Thurow has shown that a force of 650
gms is produced in deflecting an 0.018
round chrome wire 3mm across a span
of ½ inch
44. Whereas steel wire force is doubled to
over 1000 gms
Concept of long lever arm
Lighter continous force
The utility arch- spanning arch principle
Span in lower arch from molar to
incisors – 25 to 30 mm- produces 80
gms of force
45. Span in the upper arch is 35 to 40 mm
to produce 160 gms
LOOP DESIGN FOR FORCE CONTROL
Advantages
- amount of wire increased
- compression of wire during activation
Some Compound loops designed to
compress the wire are:
52. MANDIBULAR CUSPID RETRACTION
SPRING
Compound spring with a double vertical
helical closing loop
60mm of wire size 16 by 16 blue elgiloy
Produces 75 gms of force per mm of
activation
MAXILLARY CUSPID RETRACTION
SPRING
Double vertical helical extended crossed
53. “T” closing loop spring
70 mm of wire
Produces 50 gm per mm of activation
LOWER CONTRACTION UTILITY ARCH
Compound loop with an “L” loop and an
expanded crossed “T” loop
40 mm of wire
Produces 80 gm per mm of activation
54. DOUBLE DELTA RETRACTION LOOP
36 – 50 mm of wire
Produces 100 gm per mm of activation
Force more here due to less wire
55. THE UTILITY AND SECTIONAL
ARCHES
HISTORICAL PERSPECTIVE
The use of round arch wires initially
The reverse curve of spee wires
Class 3 elastics
Treatment in extraction and non
extraction cases
56. DEVELOPMENT OF THE UTILITY ARCH
Problem faced in the 1950’s
Round arch segments
Step down base arch formed
ROLES AND FUNCTIONS
1. Position of the lower molar to allow for
cortical anchorage
2. Manipulation and alignment of the
lower incisors segment
60. 3. Stabilization of the lower arch allowing
segmental treatment of the buccal
segments
4. Physiological roles of the lower utility
arch
5. Over treatment
6. Role in mixed dentition
7. Arch length control:
a. uprighting the lower molar
b. advancement of the lower incisors
63. PHYSIOLOGICAL vs MECHANICAL
RESPONSES
30 degrees to 45 degrees tip back
applied to the lower molars
30 to 45 degrees buccal root torque
applied to the lower molars
Long lever arms applied to the lower
incisors
75 gm of intrusive force applied to the
lower incisors
64. FEATURES OF
BIOPROGRESSIVE THERAPY
FACTORS IN BAND DESIGNING AND
BONDING
Limited pre shaping by manufacturer
Initial wide and bulky bands
Later thin strong and malleable bands
Light tapping required
Trained assistant ,nurse or student
66. Problem if over contoured
Produces the need for wider inter dental
spacing and needless crowding
Arch length and banding consideration
Canine bands more wider
Mandibular molar bands narrow
festooned,pre shaped
Maxillary bands provided with a notch
Undercuts recognized
Adapted to the height of contour
68. FACTORS IN BRACKET
DESIGN
Need for 3D control
Design by Edward H Angle
Initial gold wires of .022 by .028
Later round wires
TYPES OF BRACKETS USED
Bracket with staple
Placing of two single brackets mesially
and distally-
69. Bracket with a connection between the
two
Dual bracket with welding flanges
Brackets with soldered bars on the
bands
76. LATER DEVELOPMENTS
Superior quality metals
Preformed bands
Improved methods of seating and
adapting
Lighter forces
Angulation of bracketsS
77. Two principle bracket designs
1. Bracket with rotation arm
2. Siamese type or dual bracket
Dr.cecil steiner and Dr. Lang -.016
square box
Later on - .019 by .025 slot
Ricketts - .0185 with .030 depth
Dr.Ivan Lee – torque slot
Dr.Reed – bracket angulations
79. ADVANTAGES OF THE ROTATION
BRACKET AND THE SIAMESE BRACKET
ROTATION ARM BRACKET
- lighter force
- push or pull
- wide inter bracket distance
- less friction during sliding
- can be used as uprighting arms
- may take the place of a loop
80. - ease with straight wires
- decreased need for buccal or labial
contouring for band adaptation
SIAMESE TYPE
- yields positive control
- easy to keep clean
- more effective rotation
- provide greater wire purchase
- permits double tipping
- more efficient with light wire
81. - tying of only one wing of one bracket
for rotation
- bracket can be tied for counter rotation
- Crimping of one bracket provides a
lever in the event of over rotation
- permits exotic bends
- distributes force
- provides a lug for easier banding
- prevents wire distortion
- allows wire to be used as an uprighting
spring
82. - easier band removal
OTHER FACTORS OF BRACKET DESIGN
Deep slot ( .030 )
Permits two light arch wires to be
placed at once
Permits a bevel at the box entrance
Permits bracket profile to be raised
Provides more adequate distance for
torque grooves
85. Wide incisal gingival wing
- provides easy access for tie wires
- single wing of one wire can be used as
a staple
- permits auxiliary light wire to be placed
- used for rubber elastic traction
- provides accessibility for cement
removal under the wings
86. Softer material
- permits closing of the bracket for
rotation
- will not fracture or chip teeth
- can be pinched close around narrower
arches for absolute wire engagement.
88. MANDIBULAR ARCH
TOOTH TORQUE TIP
Central incisor 0 degrees 0 degrees
Lateral incisor 0 degrees 0 degrees
Canine +7 degrees +5 degrees
First premolar 0 degrees 0 degrees
Second
premolar
o degrees 0 degrees
Molar 0 degrees +5 degrees
89. FACTORS IN MOLAR TUBE
AND AUXILLARY DESIGN
Innovation of pre-attachment of tubes
Tube design for upper molar
- band should be driven down to the
distal marginal ridge
- gingivally placed head gear tube with a
middle round slot and an occlusal .022
by .028 edgewise rectangular slot
92. Tube design for lower molar
- buccal extension of the distal aspect of
the tube with a 12 degree rotation
- .018 by .025 twin tube type
- hook in the center for elastic traction
- 5 degree tip
96. FINISHING AND RETENTION
Stephen Covey- four main values,
when we “begin with the end in mind”
1. To know “where you intend to end
up”,you must know where you are
now
2. How to get from where you are now
to where you want to be
3. Mentally creating our desired outcome
97. 4. Accomplish our objective
DIFFERENT OCCLUSAL CONCEPTS
1. Ideal occlusion
2. Normal occlusion
3. Reconstructed occlusion
4. Orthodontic finishing
98. FUNCTION INFLUENCES FINISHING
AND RETENTION
Respect various elements of normal
physiology and function
Condyle location and function
Normal airway
Lip function
Buccal and facial musculature
99. FINISHING CHECK LIST
MANDIBULAR ARCH
1. Arch width across second molars
2. Distal of first molar rotated lingually
until the distobuccal cusp
approximates mesial sluiceway on
second molar
3. Large buccal offset at mesial of first
molar
100. 4. Check inter bicuspid width for
necessary expansion
5. Proper buccal arch form and contour
6. Premolar offset to bring it in contact
with distal lingual incline of upper
canine (2-3mm)
7. Mesial of cuspid tucked slightly behind
lateral incisor,distal of the cuspid
buccal
8. Over rotation of the incisors;smooth
arc
102. MAXILLARY CHECK LIST
1. Width across first and second
molars
2. Distal rotation of first molar so
that line drawn through
distobuccal and mesiolingual
cusp points to the distal third of
the opposite side cuspid
3. Mesial offset (large)on molar
4. Mesial rotation of lingual cusp of
first bicuspid to seat in distal
fossa of lower first bicuspid
103. 5. Premolar offset (2 –3 mm)to avoid
first area of pre maturity
6. Cuspid brought into contact with lower
cuspid and premolar to establish
cuspid rise
7. Lateral left labial to allow over
treatment of buccal segments;then
tucked in
8. Smooth arc across incisors
105. 3 STAGES OF RETENTION
INITIAL STAGE
THE STABILIZING STAGE
POSITIONER USE IN BIOPROGRESSIVE
THERAPY
106. CASE REPORT
SEQUENCE OF MECHANICS IN CLASS 1
EXTRACTION CASES
Stabilization of the upper and lower
molar anchorage
Retraction of cuspids with sectional
springs
Uprighting and alignment of the
retracted cuspids
107. Retraction and consolidation of the
upper and lower incisors
Idealize arches
Finishing arches
