Bioprogressive therapy (3) /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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Bioprogressive therapy (3) /certified fixed orthodontic courses by Indian dental academy

  1. 1. BIOPROGRESSIVE THERAPY INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com www.indiandentalacademy.com
  2. 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 www.indiandentalacademy.com
  3. 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 www.indiandentalacademy.com
  4. 4.  www.indiandentalacademy.com
  5. 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 www.indiandentalacademy.com
  6. 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 www.indiandentalacademy.com
  7. 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 www.indiandentalacademy.com
  8. 8.  Communication – parents , patients , dentists and public  Time  The umbrella system is also called the LEWIS.A.ALLEN MANAGEMENT SYSTEM www.indiandentalacademy.com
  9. 9. Factors of the system  Planning  Organization  Leading  controlling www.indiandentalacademy.com
  10. 10. Planning-functions  Forecasting  Developing objectives  Programming  Scheduling  Budgeting www.indiandentalacademy.com
  11. 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 www.indiandentalacademy.com
  12. 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 www.indiandentalacademy.com
  13. 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 www.indiandentalacademy.com
  14. 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 www.indiandentalacademy.com
  15. 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 www.indiandentalacademy.com
  16. 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 www.indiandentalacademy.com
  17. 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 www.indiandentalacademy.com
  18. 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 www.indiandentalacademy.com
  19. 19. change occurring from treatment alteration www.indiandentalacademy.com
  20. 20.  www.indiandentalacademy.com
  21. 21.  www.indiandentalacademy.com
  22. 22.  www.indiandentalacademy.com
  23. 23.  www.indiandentalacademy.com
  24. 24. www.indiandentalacademy.com
  25. 25. ORTHOPEDICS  Definition – orthopedics implies any manipulation that alters the skeletal system and associated motor organs  Method of evaluation by using the superimpositional areas www.indiandentalacademy.com
  26. 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 morewww.indiandentalacademy.com
  27. 27.  Sufficient maxillary overjet  Hyperactive lower lip  Restrictive vault space  Protrusive upper incisors www.indiandentalacademy.com
  28. 28. Classical responses  Generalized orthopedic response with cervical headgear alone: - direction of force - Rotational effect - Effect in dolichofacial and brachyfacial types www.indiandentalacademy.com
  29. 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 www.indiandentalacademy.com
  30. 30. MAXILLARY CENTER OF ROTATION www.indiandentalacademy.com
  31. 31. REVERSE RESPONSE www.indiandentalacademy.com
  32. 32.  www.indiandentalacademy.com
  33. 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 www.indiandentalacademy.com
  34. 34. Soft tissue changes  Normal growth  Growth following orthopedic alteration of the maxilla  Lip and chin changes  Tongue posture www.indiandentalacademy.com
  35. 35. SOFT TISSUE CHANGES www.indiandentalacademy.com
  36. 36. orthopedic vs orthodontic movement  Force differentiation: - magnitude - duration - site of application  Growth restrictive forces and rotational forces www.indiandentalacademy.com
  37. 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 www.indiandentalacademy.com
  38. 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 www.indiandentalacademy.com
  39. 39. - full arch therapy without freeing anterior occlusion-incisal trauma - full time cervical head gear therapy www.indiandentalacademy.com
  40. 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 www.indiandentalacademy.com
  41. 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 www.indiandentalacademy.com
  42. 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 www.indiandentalacademy.com
  43. 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 www.indiandentalacademy.com
  44. 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 www.indiandentalacademy.com
  45. 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: www.indiandentalacademy.com
  46. 46.  Vertical helical closing loop  Double vertical helical closing loop  Double delta closing loop  “L” loop crossed “T” closing loop  Double vertical helical extended  Crossed “T” closing loop www.indiandentalacademy.com
  47. 47. HELICAL AND VERTICAL OPEN LOOP www.indiandentalacademy.com
  48. 48. OPEN HORIZONTAL BOOT LOOP AND HORIZONTAL “T” OPEN LOOP www.indiandentalacademy.com
  49. 49. VERTICAL CLOSED HELIX LOOP AND DOUBLE DELTA CLOSING LOOP www.indiandentalacademy.com
  50. 50. DOUBLE VERTICAL CROSSED “T” CLOSING LOOP AND DOUBLE VERTICAL HELICAL CLOSING LOOP www.indiandentalacademy.com
  51. 51. DOUBLE CLOSED EXTENDED HELICAL LOOP www.indiandentalacademy.com
  52. 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 www.indiandentalacademy.com
  53. 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 www.indiandentalacademy.com
  54. 54.  DOUBLE DELTA RETRACTION LOOP  36 – 50 mm of wire  Produces 100 gm per mm of activation  Force more here due to less wire www.indiandentalacademy.com
  55. 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 www.indiandentalacademy.com
  56. 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 segmentwww.indiandentalacademy.com
  57. 57. SIDE VIEW www.indiandentalacademy.com
  58. 58. FRONT VIEW www.indiandentalacademy.com
  59. 59. TOP VIEW www.indiandentalacademy.com
  60. 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 www.indiandentalacademy.com
  61. 61. UPRIGHTING EFFECT OF UTILITY ARCH www.indiandentalacademy.com
  62. 62. c. expansion in the buccal segment d. saving “E” space www.indiandentalacademy.com
  63. 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 www.indiandentalacademy.com
  64. 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 www.indiandentalacademy.com
  65. 65. OVER CONTOURED BANDS www.indiandentalacademy.com
  66. 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 www.indiandentalacademy.com
  67. 67. HEIGHT OF CONTOUR www.indiandentalacademy.com
  68. 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- www.indiandentalacademy.com
  69. 69. Bracket with a connection between the two Dual bracket with welding flanges Brackets with soldered bars on the bands www.indiandentalacademy.com
  70. 70. HORIZONTAL SLOT BRACKET www.indiandentalacademy.com
  71. 71. STAPLE BRACKET www.indiandentalacademy.com
  72. 72. SINGLE MESIAL AND DISTAL BRACKETS www.indiandentalacademy.com
  73. 73. CONNECTION BRACKET www.indiandentalacademy.com
  74. 74. BRACKETS WITH SOLDERED BARS www.indiandentalacademy.com
  75. 75. ROTATION BRACKET www.indiandentalacademy.com
  76. 76.  LATER DEVELOPMENTS  Superior quality metals  Preformed bands  Improved methods of seating and adapting  Lighter forces  Angulation of bracketsS www.indiandentalacademy.com
  77. 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 www.indiandentalacademy.com
  78. 78. SLOT DIMENSIONS www.indiandentalacademy.com
  79. 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 www.indiandentalacademy.com
  80. 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 www.indiandentalacademy.com
  81. 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 uprightingwww.indiandentalacademy.com
  82. 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 www.indiandentalacademy.com
  83. 83. TWO LIGHT ARCHES ACCOMADATION www.indiandentalacademy.com
  84. 84. PLACEMENT UNDERNEATH THE WING www.indiandentalacademy.com
  85. 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 www.indiandentalacademy.com
  86. 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. www.indiandentalacademy.com
  87. 87. MAXILLARY ARCH TOOTH TORQUE TIP Central incisor + 22 degrees 0 degrees Lateral incisor + 14 degrees + 8 degrees Canine + 7 degrees + 5 degrees First premolar 0 degrees 0 degrees Second premolar 0 degrees 0 degrees Molar 0 degrees 0 degrees www.indiandentalacademy.com
  88. 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 www.indiandentalacademy.com
  89. 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 www.indiandentalacademy.com
  90. 90. OCCLUSAL APPEARANCE OF DISTOBUCCAL CUSP www.indiandentalacademy.com
  91. 91. IMAGINARY LINE www.indiandentalacademy.com
  92. 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 www.indiandentalacademy.com
  93. 93. THREE TUBE PLACEMENT www.indiandentalacademy.com
  94. 94. 10 TO 30 DEGREES TORQUE www.indiandentalacademy.com
  95. 95. DISTAL 12 DEGREES FOR LOWER MOLAR ROTATION www.indiandentalacademy.com
  96. 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 www.indiandentalacademy.com
  97. 97. 4. Accomplish our objective DIFFERENT OCCLUSAL CONCEPTS 1. Ideal occlusion 2. Normal occlusion 3. Reconstructed occlusion 4. Orthodontic finishing www.indiandentalacademy.com
  98. 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 www.indiandentalacademy.com
  99. 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 www.indiandentalacademy.com
  100. 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 www.indiandentalacademy.com
  101. 101. MANDIBULAR CHECK LIST www.indiandentalacademy.com
  102. 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 www.indiandentalacademy.com
  103. 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 www.indiandentalacademy.com
  104. 104. MAXILLARY CHECK LIST www.indiandentalacademy.com
  105. 105. 3 STAGES OF RETENTION  INITIAL STAGE  THE STABILIZING STAGE  POSITIONER USE IN BIOPROGRESSIVE THERAPY www.indiandentalacademy.com
  106. 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 www.indiandentalacademy.com
  107. 107.  Retraction and consolidation of the upper and lower incisors  Idealize arches  Finishing arches www.indiandentalacademy.com
  108. 108. BIOPROGRESSIVE THERAPY ,THE NATURAL THERAPY www.indiandentalacademy.com
  109. 109. www.indiandentalacademy.com Thank you For more details please visit www.indiandentalacademy.com

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