TWEED- MERRIFIELD
APPLIANCE
www.indiandentalacademy.com
INDIAN DENTAL ACADEMY
Leader in continuing dental education
www.in...
INTRODUCTION
www.indiandentalacademy.com
www.indiandentalacademy.com
HISTORICAL PERSPECTIVE
DR.EDWARD HARTLY ANGLE –
FATHER OFORTHODONTICS
ANGLE SYSTEM-1887
ANGLE SCHOOL OF ORTHODONTIA-
1900
...
EVOLUTION OF ORTHODONTIC
APPLIANCES
•DR,PIERRE FAUCHARD-A FRENCH PHYSICIAN,1728
USED FLAT METAL STRIP PIERCED WITH HOLES
•...
•KINGSLEY.(1829-1913)-1861 –HEADGEAR
•COFFIN-1861-FLEXIBLE PIANO WIRE BRACKET ATTACHMENT
•TUCKER- BOSTON-1846-RUBBER ELAST...
www.indiandentalacademy.com
www.indiandentalacademy.com
www.indiandentalacademy.com
www.indiandentalacademy.com
www.indiandentalacademy.com
www.indiandentalacademy.com
THUS ANGLE CONCLUDED THAT BODILY MOVEMENT
OF TEETH WAS ESSENTIAL FOR STABLE RESULTS
DEVELOPED PIN AND TUBE APPLIANCE IN 19...
www.indiandentalacademy.com
DR.CHARLES TWEED
GRADUATED IN 1928-GEORGE HAHN -IMPROVISED EDGEWISE
HIS CONTRIBUTIONS TO ORTHODONTICS –SUMMARIESED AS –
•E...
DR.LEVERN MERRIFIELD
-1952- STUDENT OF DR. TWEED CONTINUE WORK ON EDGEWISE
CONTRIBUTIONS-
1. FUNDAMENTAL CONCEPTS OF “DIME...
www.indiandentalacademy.com
DIMENTIONS OF THE DENTURE-
• MESIAL
• DISTAL
• FACIAL
• LINGUAL
• INTRUSIVE
• EXTRUSIVE
ALLTHESE MOVEMENTSARE RESTRISTED B...
DIFFERENTIAL DIAGNOSIS
THE DETERMINATION OF A DISEASE FROM ITS SYMPTOMS, DATA OR TESTS
AND THE DECISIONS AND JUDGEMENTS MA...
THE SKELETAL PATTERN
1. ANGLE FMIA
2. ANGLE FMA
3. ANGLE IMPA
4. ANGLE SNA
5. ANGLE SNB
6. ANGLE ANB
7. AO-BO
8. OCCLUSAL ...
• RADZIMNSKI (1987), GEBECK AND MERRIFIELD (1989), ISSACSON
1981(1981),PEARSON(1978,1986) AND SCUDY(1973) DESCRIBED THE IM...
• POSTERIOR SPACE ANALYSIS
THE VARIABLES TO BE CONSIDERED:
• RATE OF MESIO –OCCLUSAL MIGRATIONSS OF MANDIBULAR 1ST
MOLAR
•...
A) SKELETAL DISHARMONIES
• HORIZONTAL CLASS II MALOCCLUSIONS
• HORIZONTAL CLASS III MALOCCLUSIONS
• VERTICAL DISHARMONIES-...
THE TWEED –MERRIFIELD EDGEWISE APPLIANCE
DIRECTIONAL FORCE TECHNIQUE
THIS ADVANCED EDGEWISE TECHNIQUE ALLOWS CONTRACSION, ...
TREATMENT WITH THE TWEED- MERRIFIELD EDGEWISE :APPLIANCE;
THERE ARE ESSENTIALLY5 CONCEPTS COMPOSING THE TREATMENT PHILOSOP...
• WIRE OF LARGER DIMENSION CAN BE USED
SEQUENTIAL ANDOR INDIVIDUAL TOOTH MOVEMENT:
IS NOT ENMASSE AS IN TWEED BUT IS SEQUE...
www.indiandentalacademy.com
www.indiandentalacademy.com
DIRECTIONAL FORCE
USE OF DIRECTIONAL FORCE SYSTEM IS THE HALLMARK OF TWEED –MERRIFIELD
EDGEWISE TREATMENT
DEFINITION-CONTR...
www.indiandentalacademy.com
www.indiandentalacademy.com
www.indiandentalacademy.com
www.indiandentalacademy.com
A) DENTURE PREPARATION:
THE BASIC OBJECTIVES
• LEVELLING
• INDIVIDUAL TOOTH ALIGNMENT AND ROTATION CORRRECTION
• CUSPID RE...
-DENTURE COMPLETION:
THE GOALS OF THIS ARE
1. REMOVE ANY FIRST ORDER ASYMMETRIES, EXPANSION OR LACK OF ARCH CO-
ORDINATION...
www.indiandentalacademy.com
www.indiandentalacademy.com
www.indiandentalacademy.com
• ANTERIOR TEETH MUST BE EDGE TO EDGE
• MAXILLARY CANINES AND 2ND PREMOLARS MUST BE LOCKED INTO A CLASS I
RELATIONSHIP
• M...
Thank you
For more details please visit
www.indiandentalacademy.com
www.indiandentalacademy.com
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Tweed Merrifield Appliance /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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Tweed Merrifield Appliance /certified fixed orthodontic courses by Indian dental academy

  1. 1. TWEED- MERRIFIELD APPLIANCE www.indiandentalacademy.com INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com
  2. 2. INTRODUCTION www.indiandentalacademy.com
  3. 3. www.indiandentalacademy.com
  4. 4. HISTORICAL PERSPECTIVE DR.EDWARD HARTLY ANGLE – FATHER OFORTHODONTICS ANGLE SYSTEM-1887 ANGLE SCHOOL OF ORTHODONTIA- 1900 www.indiandentalacademy.com
  5. 5. EVOLUTION OF ORTHODONTIC APPLIANCES •DR,PIERRE FAUCHARD-A FRENCH PHYSICIAN,1728 USED FLAT METAL STRIP PIERCED WITH HOLES •SCHANGE-FRENCHMAN,1841,INVENTED ADJUSTABLE CLAMP BONDWITH INTRODUCTION OF LINGUAL SCREW •DWINNELE-NEW YORK,1849 INVENTED THE REGULATING JACK SCREW •MAGILL OF ERIC, PENNSYLVANIA,1870, •THUS BY 1875,THE ORTHODONTIC APPLIANCES HAD AN ARCH WIRE, www.indiandentalacademy.com
  6. 6. •KINGSLEY.(1829-1913)-1861 –HEADGEAR •COFFIN-1861-FLEXIBLE PIANO WIRE BRACKET ATTACHMENT •TUCKER- BOSTON-1846-RUBBER ELASTICS •CASE AND BAKER –POPULARISED IT TO PROVIDE INTERMAXILARY FORCE INTERMAXILARY ANCHORAGE EDWARD ANGLE – A STANDARD ORTHODONTIC APPLIANCE MUST POCESSES 5BASIC PROPERTIES 1. SIMPLE 2. STABLE 3. EFFICIENT 4. DELICATE 5. INCONSPICUOUS FINALLY IN 1907 HE DEVELOPED THE “E-ARCH” www.indiandentalacademy.com
  7. 7. www.indiandentalacademy.com
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  10. 10. www.indiandentalacademy.com
  11. 11. www.indiandentalacademy.com
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  13. 13. THUS ANGLE CONCLUDED THAT BODILY MOVEMENT OF TEETH WAS ESSENTIAL FOR STABLE RESULTS DEVELOPED PIN AND TUBE APPLIANCE IN 1909 -THIS WAS DIFFICULT TO MANIPULATE THUS ANGLE DEVELOPED -RIBBON ARCHAPPLIANCE IN 1915 -THE EDGEWISE APPLIANCE ANGLE DESIGNEDTHE EDGEWISE BRACKETWIYH A HORIZONTAL SLOT OF 0.022”x 0.028”-THIS NEW DESIGN PROVIDED MORE ACCURACY AND EFFICIENT TORQUING HE DESIGNED THIS SYSTEM IN 1928- 2 YEARS BEFORE HIS DEATH . www.indiandentalacademy.com
  14. 14. www.indiandentalacademy.com
  15. 15. DR.CHARLES TWEED GRADUATED IN 1928-GEORGE HAHN -IMPROVISED EDGEWISE HIS CONTRIBUTIONS TO ORTHODONTICS –SUMMARIESED AS – •EMPHASISED THE 4 OBJECTIVESOF ORTHODONTIC TREATMENT WITH EMPHASIS AND CONCERN FOR FACIAL ESTHETICS •DEVELOPED THE CONCEPT O F UPRIGHTING TEETH OVER THE BASAL BONE WITH EMPHASIS ON MANDIBULAR INCISORS •MADE EXTRACTION OF TEETH FOR ORTHODONTIC CORRECTION ACCEPTABLE AND POPULARISED 1ST PREMOLAR EXTRACTIONS •ENHANCED THECLINICAL APPLICATION OF CEPHALOMETRICS •DEVELOPED THE DIAGNOSTIC FACIAL TRIANGLE •DEVELOPED THE CONCEPT OF ORDERLY TREATMENT AND INTRODUCED ANCHORAGE PREPARATION •DEVELOPED A PREORTHODONTIC PROGRAMME-SERIAL EXTRACTION . www.indiandentalacademy.com
  16. 16. DR.LEVERN MERRIFIELD -1952- STUDENT OF DR. TWEED CONTINUE WORK ON EDGEWISE CONTRIBUTIONS- 1. FUNDAMENTAL CONCEPTS OF “DIMENTIONS OF THEDENTURE” 2. THE DIFFERENSIAL DIAGNOSIS CONCEPTS OF- • DIMENTIONS OF THE LOWER FACE • TOTAL SPACE ANALYSIS GUIDLINES FOR SPACE MANAGEMENT- -FACILITATE MAX. ORTHODONTIC CORRECTION -DEFINE AREAS OF SKELETAL ,FACIAL AND DENTAL DISHARMONY 3 . THE TREATMENT CONCEPTS OF: • -DIRECTIONAL CONTROL DURING TREATMENT • SEQUENTIAL TEEETH MOVEMENT • SEQUENTIAL MANDIBULAR ANCHORAGE PREPRARATIONS • ORGANISATION OF TREATMENT INTO 4ORDERLY STEPS, WHICH HAVE SPECIFIC OBJECTIVES . www.indiandentalacademy.com
  17. 17. www.indiandentalacademy.com
  18. 18. DIMENTIONS OF THE DENTURE- • MESIAL • DISTAL • FACIAL • LINGUAL • INTRUSIVE • EXTRUSIVE ALLTHESE MOVEMENTSARE RESTRISTED BY BONE ,MUSCLE AND SOFT TISSUE WHICH EXERT INFLUENCE ON THE TEETH AND JAWS THERE ARE 4 BASIC DIMENTIONS IN THE PREMISES OF A DENTURE PREMISE 1 PREMISE II PREMISE III PREMISE IV . www.indiandentalacademy.com
  19. 19. DIFFERENTIAL DIAGNOSIS THE DETERMINATION OF A DISEASE FROM ITS SYMPTOMS, DATA OR TESTS AND THE DECISIONS AND JUDGEMENTS MADE PRIORTO TREATMENT MERRIFIELD’S DIAGNOSTIC PHILOSOPHY IS • RECOGNISE AND TREAT THE DIMENSION OF THE DENTURE • RECOGNISE THE DIMENSION S OF THE LOWER FACE AND TREAT h TO ACHIEVE • MAX FACIAL HARMONY AND BALANCE • RECOGNISE AND UNDERSTAND THE SKELETAL PATTERN • THE FACE . www.indiandentalacademy.com
  20. 20. THE SKELETAL PATTERN 1. ANGLE FMIA 2. ANGLE FMA 3. ANGLE IMPA 4. ANGLE SNA 5. ANGLE SNB 6. ANGLE ANB 7. AO-BO 8. OCCLUSAL PLANE 9. ‘Z’ANGLE 10. POSTERIOR FACIAL HEIGHT 11. ANTERIOR FACIAL HEIGHT 12. FACIAL HEIGHTINDEX 13. FACIAL HEIGHT CHANGE RATIO . www.indiandentalacademy.com
  21. 21. • RADZIMNSKI (1987), GEBECK AND MERRIFIELD (1989), ISSACSON 1981(1981),PEARSON(1978,1986) AND SCUDY(1973) DESCRIBED THE IMPORTANCE OF THE RELATIONSHIP BETWEEN CONTROL OFVERTICAL DIMENTION AND SUCCESSFUL TREATMENT OF CLASS II MALOCCLUSIONS • UNSUCCESSFUL TREATMENT RESULTS – INCREASE IN AFH • SUCCESSFUL TREATMENT RESULTS -2:1 RATIO OF INCREASE IN PFH TO AFH THE DENTITION: TOTAL SPACE ANALYSIS – • ANTERIOR • MID-ARCH • POSTERIOR ADVANTAGES OF THIS DIVISION • SIMPLICITY IN IDENTIFICATION OF SPACE DEFICIT / SURPLUS • ACCURACY IN DIFFERENTIAL DIAGNOSIS 1. ANTERIOR SPACE ANALYSIS- 2. MID-ARCH ANALYSIS – INVOLVES MANDIBULAR PREMOLARS AND 1ST MOLAR- 3. IMPORTANT AREA OF THE DENTURE – SHOWS INCLINED 1 ST MOLAR, ROTATIONS 4. SPACINGS, DEEP CURVE OF SPEE, CROSSBITES , MISSING TEETH,HABIT . www.indiandentalacademy.com
  22. 22. • POSTERIOR SPACE ANALYSIS THE VARIABLES TO BE CONSIDERED: • RATE OF MESIO –OCCLUSAL MIGRATIONSS OF MANDIBULAR 1ST MOLAR • RATE OF RESORPTION OF ANTERIOR BORDER OF RAMUS • TIME OF CESATION OF MOLAR MIGRATION • TIME OF CESATION OF RAMUS RESORPTION • SEX AND AGE DIAGNOSTIC SPACE MANAGEMENT GUIDELINES 1)TOTAL SPACE ANALYSIS- TOOTH – ARCH DISCREPANCIES A) ANTERIOR SURPLUS OR DEFICIT-SPACE MANAGEMENT B) MID ARCH SURPLUS OR DEFICIT- ANTERIOR DEFICITS OVERIDEMID-ARCH DEFICITS C) POSTERIOR SURPLUS OR DEFICITS . www.indiandentalacademy.com
  23. 23. A) SKELETAL DISHARMONIES • HORIZONTAL CLASS II MALOCCLUSIONS • HORIZONTAL CLASS III MALOCCLUSIONS • VERTICAL DISHARMONIES- OPEN BITES • VERTICAL DISHARMONIES- CLOSED BITES • FACIAL DISHARMONIES . www.indiandentalacademy.com
  24. 24. THE TWEED –MERRIFIELD EDGEWISE APPLIANCE DIRECTIONAL FORCE TECHNIQUE THIS ADVANCED EDGEWISE TECHNIQUE ALLOWS CONTRACSION, EXPANSION AND DIRECTIONAL CONTROL OF INDIVIDUAL OR GROUPS OF TEETH I .BRACKETS AND TUBES: ALL BRACKETS ARE 0.022 “ 6 ANT TEETH INTERMEDIATE SINGLE WIDTH BRACKETS ARE PLACED ON PREMOLAR BANDS, TWIN BRACKET ON 1ST MOLARSAND HEAVY EDGEWISE 0.022 TUBES WITH MESIAL HOOKS ON 2HD MOLARS. THE BANDS HAVE LINGUAL HOOKS ON MOLAR AND LINGUAL CLEATS ON PREMOLARS II. ARCHWIRES: 0.017”X 0.022” 0.018”X 0.025” 0.019”X 0.025” 0.020”X 0.025” 0.0215”X 0.025” III.FIRST, SECOND, AND THIRD ORDER BENDS AUXILLARIES . www.indiandentalacademy.com
  25. 25. TREATMENT WITH THE TWEED- MERRIFIELD EDGEWISE :APPLIANCE; THERE ARE ESSENTIALLY5 CONCEPTS COMPOSING THE TREATMENT PHILOSOPHY 1. SEQUENTIAL BANDING AND BONDING 2. SEQUENTIAL ANDOR INDIVIDUAL TOOTH MOVEMENT 3. SEQUENTIAL MANDIBULAR ANCHORAGE PREPARATION 4. DIRECTIONAL FORCESINCLUDING CONTROL OFVERTICAL DIMENSION, WHICH WILL ENHANCE MANDIBULAR RESPONSE 1. PROPER TIMING OF TREATMENT SEQUENTIAL BANDING AND BONDING: ADVANTAGES: • LESS TRAUMATIC TO THE PATIENT • EASIER AND LESS TIME CONSUMING FOR THE ORTHODONTIST • GREATER EFFICIENCY-GIVES THE ARCHWIRE MUCH LONGER INTERBRACKET LENGTH • THIS CREATES A POWER STORAGE THAT ACCOMPLISHES TREATMENT OBJECTIVES MOR RAPIDLY . www.indiandentalacademy.com
  26. 26. • WIRE OF LARGER DIMENSION CAN BE USED SEQUENTIAL ANDOR INDIVIDUAL TOOTH MOVEMENT: IS NOT ENMASSE AS IN TWEED BUT IS SEQUENTIAL SEQUENTIAL MANDIBULAR ANCHORAGE PREPARATION: THIS METHOD IS SEQUENTIAL, PRECISE, AND CONTROLLED . www.indiandentalacademy.com
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  29. 29. DIRECTIONAL FORCE USE OF DIRECTIONAL FORCE SYSTEM IS THE HALLMARK OF TWEED –MERRIFIELD EDGEWISE TREATMENT DEFINITION-CONTROLLED FORCES WHICH PLACE TEETH IN THE MOST HARMONIOUS RELATIONSHIP WITH THEIR ENVIRONMENT TIMING OF TREATMENT: SHOULD BE INITIATED AT A TIME WHEN TREATMENT OBJECTIVES CAN BE MORE READILY ACCOMPLISHED. THE STEPS OF TREATMENT: THIS TWEED –MERRIFIELD EDGEWISE DIRECTIONAL FORCE TREATMEBT CAN BE ORGANISED INTO 4 FORCE SYSTEMS • DENTURE PREPARATION • DENTURE CORRECTION • DENTURE COMPLETION • DENTURE RECOVERY . www.indiandentalacademy.com
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  34. 34. A) DENTURE PREPARATION: THE BASIC OBJECTIVES • LEVELLING • INDIVIDUAL TOOTH ALIGNMENT AND ROTATION CORRRECTION • CUSPID RETRACTION • INITIAL PREPARATION OF THE TERMINAL MOLARS FOR STRAIN RESISTANCE. . B) DENTURE CORRECTION: OBJECTIVES 1 .RETRACTION AND UPRIGHTING OF L-INCISORSTO THEIR PLANNED POSITIONS 2 COMPLETION OF SPACE CLOSURE 3 ACHIEVEMENT OF POSTERIOR AND MID-ARCH AXIAL INCLINATIONS THAT WILL PERMIT 4 PROPER FUNTIONAL CO-ORDINATION WITH THE MAXILLARY TEETH . www.indiandentalacademy.com
  35. 35. -DENTURE COMPLETION: THE GOALS OF THIS ARE 1. REMOVE ANY FIRST ORDER ASYMMETRIES, EXPANSION OR LACK OF ARCH CO- ORDINATION 2. CORRECT RESIDUAL ROTATIONS, LACK OF ROOT PARALLELISM, TORQUE DEFICIENCES AND SPACING 3. POSITION THE MAX. INCISORS WITH ARTISTIC BENDS 4. SEAT THE CUSPS WITH VERTICAL SPURS AND ELASTICS. AT THE END OF THIS STAGE THE FULL CHARACTERISTICS SHOULD BE READILY OBSERVED • INCISORS SHOULD BE ALIGNED • OCCLUSION MUST BE OVER TRAETED TO CLASS I RELATIONSHIP : . www.indiandentalacademy.com
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  39. 39. • ANTERIOR TEETH MUST BE EDGE TO EDGE • MAXILLARY CANINES AND 2ND PREMOLARS MUST BE LOCKED INTO A CLASS I RELATIONSHIP • M-B CUSP OFMAX 1ST MOLAR MUST OCCLUDE IN THE M-B GROOVE OF THE MAND 1ST MOLAR • DISTAL CUSPS OF THE 1ST AND 2ND MOLARS MUST BE OUT OF OCCLUSION • ALL SPACES MUST BE CLOSED TIGHTLY FROM 2ND PREMOLAR FORWARD. D) DENTURE RECOVERY: THIS IS THE FINAL PHASE OF TREATMENT. . www.indiandentalacademy.com
  40. 40. Thank you For more details please visit www.indiandentalacademy.com www.indiandentalacademy.com

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