Bioprogressive therapy /certified fixed orthodontic courses by Indian dental academy


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Bioprogressive therapy /certified fixed orthodontic courses by Indian dental academy

  1. 1. INDIAN DENTAL ACADEMY Leader in continuing dental education
  2. 2. Contents • Introduction. • Principles of Bioprogressive therapy. • Visual treatment objective. • Phasing and staging. • Orthopedics in Bioprogressive therapy. • Forces used in Bioprogressive therapy. • Sectional and utility arches. • Synopsis of extraction and non-extraction treatment mechanics. • Development of Bioprogressive therapy. • Conclusion
  3. 3. Bioprogressive therapy is not strictly an orthodontic technique but, more importantly, it encompasses a total orthodontic philosophy. Bioprogressive therapy accepts as its mission the treatment of the total face rather than the narrower objective of the teeth or occlusion. Dr. Robert Murray Ricketts was the man responsible for the development of this approach to orthodontic care.
  4. 4. Bioprogressive therapy takes advantage of biological progressions including growth, development and function, and directs them in a fashion that normalizes function and enhances esthetic effect.
  5. 5. During its genesis, more than 100 verified and corroborated principles were formulated in support of the Bioprogressive therapy. These principles were divided into the following four “sciences”: 1. Social – this group of principles covers aspects of sociology, patient motivation, psychology, patient management and aesthetics. 2. Biological – risk factors and relapse fall within this domain.
  6. 6. 3. Clinical – any record taken, any measurement recorded and any value judgement decision made on a living patient falls within the clinical area. 4. Mechanical - myofunctional therapy, behavioral modification or awareness training an correction of nasal and oral functions are all components of the Bioprogressive technique.
  7. 7. Principles of Bioprogressive Therapy
  8. 8. #1 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. A planned systematic approach is followed in constructing a cephalometric setup in order to anticipate those changes expected in an individual patient. For this, an understanding of the present condition, the expected growth and the specific effect of the orthodontic-orthopaedic is essential.
  9. 9. #2 Torque control throughout treatment. Bioprogressive therapy suggests that movement of teeth can be more efficient and various treatment procedures more effectively carried out when control of the direction of root movements is available. Four treatment situations where torque control of root movement is necessary: 1. Keep roots in vascular trabecular bone – for efficient movement. During tooth movements such as incisor intrusion or cuspid retraction, torque control allows steering the roots away from the denser, thicker cortical bone, and through the less dense vascular trabecular
  10. 10. The lower incisors are supported by the lingual cortical bone and require buccal root torque for their efficient intrusion through the trabecular bone.
  11. 11. 2. Place roots against dense cortical bone - for anchorage. 3. Torque to remodel cortical bone - certain tooth movements often require that the roots be moved into dense, less vascular cortical bone structure. Such movements include incisor retraction, upper incisor root torquing, impacted upper canine and forward movement of lower molars to close spaces created by missing or extracted teeth. 4. Torque used to position teeth in final occlusion details - for proper function and better stability.
  12. 12. The lower molars are anchored by expanding their roots into the more dense cortical bone.
  13. 13. #3 Muscular and cortical bone anchorage. Muscular anchorage Stabilizing the teeth against the horizontal movements and vertical (extrusive) forces produced by a cervical headgear to the upper molars, as well as the effect of Class II elastics on lower molars is countered by the posterior muscles of mastication, mainly the masseter and temporalis. Brachyfacial types, characterized by deep bites and low mandibular planes exhibit stronger musculature, and are better able to overcome the adverse orthodontic treatment forces that tend to open the bite and rotate the mandible, when compared to their
  14. 14. Cortical bone anchorage The cortical bone is dense and laminated, with a very limited blood supply. Due to this, tooth movement through this bone is slower. Bioprogressive therapy advocates the application of excessive force against the cortical bone to press out the blood supply and further limit the tooth movement through this bone, thus increasing the anchorage potential.
  15. 15. • Lower molar anchorage is enhanced by expanding the molar roots into the cortical bone on their buccal surface. Excessive buccal root torque and expansion is placed in the archwires for this. • The upper molar is adjacent to the zygomatic ridge, the maxillary sinus and the cortical bone shelves of the alveolar process. The heavy forces of the orthopedic headgear expand the roots into the cortical bone. For this, the inner bow of the headgear is expanded 5-10mm. before placement.
  16. 16. #4 Movement of any tooth in any direction with the proper application of pressure. • The key factor to the rate at which tooth movement occurs is the blood supply to the bone. Thus, forces that effect the blood supply and cellular physiology determine the tooth movement. Heavy forces cause ischemia of the blood supply to an area, thereby decreasing tooth movement. • Density of supportive bone also influences rate of tooth movement – movement through the dense, less vascular cortical bone requires even lighter forces to ensure a continuous blood supply.
  17. 17. • The most efficient force for tooth movement is based upon the size of the root surface of the tooth to be moved, called the enface root surface or the portion of the root that is in the direction of movement. • Bioprogressive therapy suggests that 100gms. of force per square centimeter of enface root surface is optimum for efficient tooth movement.
  18. 18. #5 Orthopedic alteration. Bioprogressive therapy subscribes to, anticipates and plans for orthopedic change as part of its treatment procedures. This changes the relationship of the basic supporting jaw structure, in contrast to localized tooth movement in the alveolar process. Use of headgears to alter the position of maxilla and lateral forces for separating and widening the mid-palatal suture are examples of the orthopedic alterations achieved.
  19. 19. #6 Treat the overbite before the overjet. • Incisor overbite can be corrected by two methods: 1. Extrusion of posterior teeth – increases lower facial height by mandibular rotation. 2. Intrusion of upper or lower incisor teeth – little or no rotation. • Vertical facial patterns respond best to extrusion of posterior teeth for overbite correction. However, this further increases the already excessive lower anterior face height, thus compounding lip
  20. 20. • On the other hand, the short anterior vertical facial height type with low mandibular plane would benefit best from molar extrusion, but their strong musculature resists this type of movement. • Due to these considerations, incisor intrusion is considered the treatment of choice for overbite correction.
  21. 21. • By treating the incisor overbite before the overjet, incisor interference is avoided and the posterior teeth remain in their normal stable vertical occlusion established by the musculature. • Incisor intrusion is achieved using a spanning arch called a utility arch.
  22. 22. #7 Sectional arch treatment. This is a basic treatment procedure of Bioprogressive therapy in which the arches are broken into sections or segments in order that the application of force in direction and amount will be of more benefit in the efficient movements of the teeth.
  23. 23. Benefits of the sectional arch treatment: 1. It allows lighter continuous forces to be directed to the individual teeth. 2. More effective root control in the basic tooth movements. 3. It supplements maxillary orthopedic alteration. 4. It reduces the binding and friction of the brackets as they slide along the archwire.
  24. 24. #8 Concept of overtreatment. In order to help overcome the tendency for relapse, provisions for the post-treatment rebound as well as post-treatment growth changes need to be appreciated and planned for.
  25. 25. Four areas where overtreatment may help compensate for the anticipated post-treatment adjustments: 1. To overcome muscular forces against the tooth surfaces – the muscular influences of the tongue, lips and cheeks against the surfaces of the teeth require overtreatment to compensate for the post-treatment changes, resulting due to the continued influence of these muscles as they adapt to the new occlusion. 2. Root movements needed for stability – overtreatment may be necessary in cases involving correction of incisor deep overbite by intrusion and torquing, paralleling of roots of teeth adjacent to extraction sites and de- rotation of severely rotated
  26. 26. 3. To overcome orthopedic rebound – overtreatment is done in anticipation of the rebound of the orthopedic changes, when the heavy restrictive forces involved in these movements are lessened or eliminated. 4. To allow settling in retention – overtreatment of the individual teeth within the arches allows them to “settle” into a functioning occlusion.
  27. 27. #9 Unlocking the malocclusion in a progressive sequence of treatment in order to establish or restore more normal function. Bioprogressive therapy suggests that many malocclusions are a result of abnormal function. The present malocclusion, while stable under the present abnormal function, may never have had the opportunity for normal development.
  28. 28. Abnormal function Abnormal development
  29. 29. Bioprogressive therapy proposes treatment sequences that progressively unlock the malocclusion in order to restore or establish a more normal environment that will allow a more normal function to occur.
  30. 30. #10 Efficiency in treatment with quality results utilizing a concept of pre-fabrication of appliances. Bioprogressive therapy uses appliances ready- made for clinical application. This allows the clinician to direct his energy in the details of their application, rather than their construction.
  31. 31. Visual Treatment Objective Visual treatment objective (VTO) is a visual plan to forecast the normal growth of the patient and the anticipated influences of treatment, to establish the individual objectives that are desired for that patient.
  32. 32. Advantages of the visual treatment objective: • Permits the development of alternative treatment plans. • It serves as a visual goal against which treatment progress can be measured and monitored. • Permits the orthodontist to set his goals in advance and compare them with the results at the end of treatment. Identification of the discrepancies between goals and results provide him with an idea of the areas in which his treatment could be
  33. 33. Phasing and Staging in Bioprogressive Therapy
  34. 34. • PHASING The timing of orthodontic treatment is termed phasing. It can be divided into four types according to when it is begun in relationship to one of four stages in dental development.
  35. 35. Preventive (3 – 6 years) Interceptive (7 – 10 years) Corrective (11 – 13 years ♀) Rehabilitative (11 – 13 years ♂) Bioprogressive Straight wire Four phases in dental development
  36. 36. • STAGING A significant difference between traditional and Bioprogressive orthodontic techniques deals with not when to, but how to start treatment. Bioprogressive therapy aims first at accomplishing orthopedic correction, controlled arch length increase and deep bite correction by anterior tooth intrusion. This treatment order, also called staging, establishes order and increases treatment efficiency.
  37. 37. Stages and steps involved in the Bioprogressive treatment sequence Stage Steps Commencement 1. Awareness training 2. Early treatment 3. Intra-arch correction Continuation 4. Inter-arch correction Consolidation 5. Integration and torquing 6. Idealization and coordination Completion 7. Finishing and overtreatment 8. retention and stabilization
  38. 38. Orthopedics in Bioprogressive Therapy
  39. 39. By definition, orthopedics implies any manipulation that alters the skeletal system and associated motor organs. In the growing child, orthopedic alteration would be any manipulation which would change the normal growth of the dentofacial complex in either direction or amount.
  40. 40. • Orthopedic alteration is a major tenet of Bioprogressive therapy. • Prior to the defined orthodontic movements to create the ideal occlusion, an acceptable symmetry between the upper and lower jaws is needed to allow the ultimate framework upon which an esthetic, functional and stable occlusion can be built. • This is achieved through the use of cervical or combination headgear.
  41. 41. Generalized orthopedic response with cervical headgear. When a vector of force is applied below the center of resistance of the maxilla (located near the apex of the pterygomaxillary fissure), a rotational orthopedic effect is seen in the maxilla. The maxillary complex rotates in a clockwise direction and all points on the maxilla appear to arc in a concentric fashion.
  42. 42. • This maxillary rotation results in: - reduction in maxillary protrusion. - downward canting of the palatal plane. - the nasal bone pivots downward and backward at the frontonasal suture.
  43. 43. • The mandible shows a variable orthopedic response. • In weak muscular growth patterns, i.e. dolicofacial patterns, the extrusion of both the maxillary molar and maxilla causes: - a reciprocal clockwise rotation of the mandible. - opening of the facial axis and mandibular plane. - a diminishing effect on forward chin posture.
  44. 44. • In normal and strong muscular growth patterns, i.e. brachyfacial patterns, mild mandibular rotation may occur, but the amount of maxillary response compensates for this mandibular rotation by 3 to 4 times.
  45. 45. • The net effect is that: - In weak muscular growth patterns, the extrusive effects of cervical headgear of cervical headgear result in a negative response in the mandible (i.e. orthopedic in nature). - In strong muscular growth patterns, the extrusive forces of cervical headgear are seen as responses in the dentition (i.e. orthodontic in nature).
  46. 46. Generalized orthodontic response with cervical headgear. • The downward and backward force of the cervical headgear intermittently extrudes the upper molars and carries them distally. • The upper incisors tip lingually from the apex. This occurs when the overjet has been reduced enough for the lower lip to close over the upper incisors, causing a functional retraction of these teeth.
  47. 47. • The lower molars upright and move distally, as they are carried by the incline planes of the upper molars. • The lower incisors tip labially as they are free of the restrictive effect of the lower lip. The tongue starts to dominate the labial positioning of these teeth.
  48. 48. The Reverse Response • When a cervical headgear is combined with a lower utility arch, the maxilla shows the classical orthopedic response. • However, the mandible shows a response different from the usual: - The mandibular plane and facial axis are stabilized in normal and dolicofacial types. - In brachyfacial types, the mandible rotates in a counterclockwise direction, resulting in closure of lower face height, mandibular plane and facial axis.
  49. 49. When the upper molar is extruded and distalized intermittently, its inclined planes upright and distalize the lower molar. This is accentuated by the tipback in the utility arch and the labial root torque at the lower incisor. The vertical pull of the masseter and pterygoid muscles stabilizes lower molar eruption and limits upper molar eruption. The net result is a limited eruption/intrusion of the lower molar and a distal movement of the lower incisor, with concomitant changes in the occlusal plane.
  50. 50. Soft tissue esthetic changes. With normal growth, the soft tissue nose grows concentrically approx. 1mm. per year at the tip. Following headgear therapy, the nose crosses over at the bridge, lengthens vertically and the upward cant to the nares is tipped down to a more horizontal position.
  51. 51. Forces used in Bioprogressive Therapy
  52. 52. • Bioprogressive therapy suggests that an applied force of 100gms. per square centimeter of enface or exposed root surface area is optimum for tooth movement. • When an archwire is ligated across short spans, very high forces can result that are much above the optimum levels. Loop design for force controlLoop design for force control
  53. 53. • In order to lessen the applied force, the concept of long lever arm is applied. By placing more wire between the teeth the applied force is lowered and the length of time of activation is increased. • For this purpose, Bioprogressive mechanics incorporate more wire in its loop design, thus producing lighter forces that are more continuous in their action.
  54. 54. Simple loop designs incorporate more wire between teeth and reduce the amount of force applied.
  55. 55. Compound loop designs use combination of simple loops and add additional wire to further reduce the amount of force, while making it more continuous. Also, these loops can be compressed during activation.
  56. 56. Concept of cortical bone anchorageConcept of cortical bone anchorage • The concept of cortical bone anchorage implies that, to anchor a tooth, its roots are placed near the dense cortical bone under a heavy force that will further squeeze out the already limited blood supply and restrict the physiologic bone remodeling in this area. • On the other hand, in order to move a tooth, a route should be followed through the less dense trabecular bone where under a light force a generous blood supply can be maintained that will produce the physiologic osteoclastic reaction of bone resorption needed for
  57. 57. Teeth in the mandible. The mandible has cortical bone support running along its length. The cortical bone structure forms around its tubular shape and extends to the alveolar, coronoid and condylar processes.
  58. 58. Lower incisors – Cuspids – First Bicuspids. • These teeth are supported on the lingual by the cortical bone of the planum alveolar.
  59. 59. • During lower incisor intrusion, their roots should be moved buccally, away from the lingual cortical plate. For this, a utility arch, applying a buccal root torque of 15° - 20° is used. This applies a force of 80 grams on the incisors (round leveling wires apply 300 grams of force and tip the incisor roots into the cortical bone). • During lower incisor retraction, the incisor roots should be moved through the cortical bone using even lighter, more continuous forces. This alows for remodeling of the bone.
  60. 60. • During lower cuspid retraction also, the roots must be moved through the trough of trabecular bone.
  61. 61. Lower 2nd Bicuspids and Molars. • These teeth are supported by the cortical bone on their buccal surface. • Lower molars are anchored by expanding and torquing their roots buccally into the buccal cortical
  62. 62. Teeth in the maxilla. • The nasal, orbital, oral and sinus cavities of the maxilla are lined with cortical bone that gives them support. • The roots of the maxillary teeth lie adjacent to these cavities and are influenced by the cortical bone lining them. • The maxillary teeth are supported within the alveolar process with cortical bone on the palatal surface as well as along the facial surface.
  63. 63. The maxilla supports four cavities – orbital, nasal, oral and sinus cavities. The cortical bone support in the maxilla surrounds these cavities as well as the alveolar process containing the teeth.
  64. 64. Maxillary Incisors. • These are intruded along their long axis into the broadest area of the alveolar process. • Utility arch mechanics for intrusion first advances the crowns and locates the root tip way from the interference of the labial cortical bone.
  65. 65. Maxillary Cuspids. • These should be moved around the corner during their alignment and retraction, and their movement should be contained within the trough of trabecular bone. • Excessive tipping can expose the root tip through the buccal cortical bone, thus making uprighting and torquing alignment extremely difficult.
  66. 66. Maxillary Bicuspids and Molars. • The bicuspids are supported in the alveolar process between the buccal and lingual cortical plates. • The roots of the 2nd bicuspids and molars are often involved with the cortical bone lining the floor of the maxillary sinus. Thus, intrusion of these teeth should be done using light and continuous forces.
  67. 67. • The roots of the maxillary molars are anchored by expanding and rotating them into the buccal cortical bone. • Headgear therapy that applies heavy forces (>500gms), expands the molars into the cortical bone where they become “anchored”.
  68. 68. Muscular Anchorage.Muscular Anchorage. • In cases where the musculature is strong as characterized by deep bite, low mandibular plane, brachyfacial type, the teeth demonstrate a “natural anchorage”. • In the open bite, vertical dolicofacial patterns, the musculature is weaker and less able to overcome the molar-extruding and bite-opening effect of treatment mechanics. Thus, anchorage enhancement is required in these cases.
  69. 69. • To summarize, for efficient tooth movement, Bioprogressive therapy suggests consideration of the following: 1. Size of root surface involved. 2. Amount of force applied. 3. Cortical bone support. 4. Muscular support – reflected by the facial type.
  70. 70. The Utility and Sectional Arches in Bioprogressive therapy mechanics
  71. 71. Historical perspective • Contemporary edgewise orthodontic approaches assume that the most efficient method of effecting rotations and leveling the deep curve of Spee in the initial phase of treatment is through the use of a series of light, continuous round arches. • However, the use of these arches results in some detrimental responses, to counteract which several distinct moves have been developed.
  72. 72. • Dental reactions to continuous round wire with reverse curve of Spee. • Dental reactions to continuous round wire with reverse curve of Spee and tieback. • Dental reactions to continuous round wire with Class III elastics and hi-pull facebow.
  73. 73. • Late in the 1950’s, Robert Ricketts and others attempted to counteract the tipping that occurred in the buccal segments in extraction cases by utilizing the lower incisors as an anchor unit to hold the lower second premolars and molars upright in the retraction process. • Round arch segments were laced from the lower molars and premolars to the lower incisors as the canines were retracted.
  74. 74. • They noted that not only were the buccal segments maintained in an upright position, but the lower incisors intruded with this light, continuous pressure. • This led to the development of what is now classically described as the step-down base arch, or Ricketts’ Lower Utility Arch.
  75. 75. Roles and Functions of the lower utility arch. I. Position of the lower molar to allow for cortical bone anchorage. Following uprighting of the lower first molars, the mesial root of the lower molar should be palpable in its ideal axial inclination following utility arch therapy.
  76. 76. Support of dense cortical bone and its normal relationship to lower buccal segment teeth.
  77. 77. II. Manipulation and alignment of the lower incisors segment. When treated as a segment, the four lower inisors are manipulated from the lower molar to align and either hold, intrude or extrude these teeth in the initial phases of therapy. Also, by altering the design of the lower utility arch, the lower incisors can be advanced or retracted without disturbing or depending upon the canines and premolars.
  78. 78. III. Stabilization of the lower arch, allowing segmental treatment of the buccal segments. Following early maintenance of anchorage at the molars and proper positioning of the lower incisors, separate rotations and leveling can occur in the buccal segment teeth – especially the canines – without disturbing the idealized location of the other segments.
  79. 79. IV. Physiological roles of the lower utility arch. Intrusion of the lower incisor segment results tin disclusion in the anterior segment. This leads to: • Prevention of interferences that commonly retard the easy movement of the dentition. • Loss of proprioception in the incisor region. The mandible reacts to this by reaching forward to search out proprioceptive output. This “activator” or “reaching” effect allows a muscular response that can be benefial in correction of Class II malocclusion. • Creates space for the maxilla which is moving downward and backward, under the influence of headgear therapy. This helps to close the overjet.
  80. 80. V. Overtreatment. By treating the incisors and buccal segments as separate entities, it is possible to treat the overbite (by intrusion of upper and lower incisors) at the same time that the buccal segment teeth are being corrected. Thus, it is not necessary to tie the overbite control to the overjet control.
  81. 81. VI. Role in mixed dentition. The utility arch allows incisor alignment and molar control during the transient dentition by stepping around the deciduous buccal occlusion. Thus, arches can be leveled out without depending upon extrusion of the buccal segment teeth.
  82. 82. VII. Arch length control. The lower utility arch serves as a determinant of arch length maintained, gained or lost by: 1. Uprighting the lower molar. 2. Advancement of the lower incisors. 3. Expansion in the buccal sement teeth. 4. Saving “E” space.
  83. 83. I.) 30° to 45° tip-back applied to the lower molars. A tip-back applied to the lower molars uprights these teeth by bringing their roots mesially and the crown distally. In extraction cases where there is both a mesial and uprighting component of force a distal rotation must be placed to avoid mesial rotation of the molars. However in non-extraction, cases a distal rotation applied to the lower molar causes an over- rotation of these
  84. 84. II.) 30° to 45° buccal root torque applied to the lower molar. Both for enhancing the cortical bone support to the lower molar and for regulating normal arch width, the distal legs of the utility arch can be expanded prior to placement in the mouth. III.) Long lever arm applied to the lower incisors. If there is 0° torque at the lower incisors when a long lever arm works at the lower molars, then as the arch intrudes, there is a slow progressive change to place a lingual root torque.
  85. 85. IV.) 75 grams of intrusive force applied to the lower incisors. The mandibular utility arch is best fabricated from 0.016x0.016 Blue Elgiloy wire in order to create a lever system that will deliver a continuous force to the lower incisors in the range of 50 to 75 grams.
  86. 86. Synopsis of extraction and non-extraction treatment
  87. 87. • Extraction therapy can be divided into five phases, each designed to achieve a specific goal. I. Initiation. - The utility arch is not used to align the lower incisors, but instead to open the bite during initial cuspid retraction and control torque in the incisor and molar regions. - Lower arch anchorage is increased by engaging the lower second molars in the arch early in treatment. Extraction treatment using Bioprogressive mechanics
  88. 88. - In the upper arch, anchorage is gained by one or more of four methods: 1. Use of transpalatal bar. 2. Use of headgear. 3. Use of upper utility arch. 4. Engaging the upper second molars in the arch using an overlay wire.
  89. 89. II. Cuspid Retraction and Uprighting. - Retraction across the first one-third of the extraction sites can be started with Class I elastics from lower molar to lower cuspid with no archwire other than the lower utility arch. The remaining two-thirds of the extraction site is closed with rigid overlay wires. - Cuspid retraction with a sectional arch is more feasible in the upper arch.
  90. 90. III. Transition and Final Cuspid Space Closure. Transition arches made of flexible edgewise wires (Ni-Ti, TMA) are used to complete the cuspid retraction. IV. Consolidation. A heat-treated .016" x .016" helical continuous closing arch is used to retract the incisors.
  91. 91. V. Idealization. After consolidation of the incisors, rigid edgewise ideal coordinated arches are placed to achieve ideal interarch symmetry, to allow the pretorqued and preangulated brackets to express themselves completely, and to complete buccal segment overcorrection.
  92. 92. Non-extraction treatment using Bioprogressive mechanics There are four stages of non-extraction therapy, and within each stage certain archwires are selected to achieve objectives. I. Initiation • Orthopedic appliances (headgear, bionator, etc.) are used when indicated.
  93. 93. • Base or utility arches are placed to set up anchorage, gain or reduce arch length, and open the bite— beginning in the lower arch in Class II, division 1 and in the upper arch in Class II, division 2. • Overlay wires level and align the buccal segments and begin to create complete arch integrity.
  94. 94. II. Transition. • After leveling and alignment of the upper and lower arches, there are usually small rotation, space, and leveling problems that must be resolved before placing a stiff stainless steel edgewise arch. • Transition arches are typically resilient edgewise wires that continue the leveling process, but also begin to define arch form and characteristics of the idealization stage.
  95. 95. III. Traction. • The lower arch is set up with sufficient anchorage to allow placement of Class II elastics, which are used in most cases to treat or overcorrect the buccal segments. • Before elastics are worn, upper buccal segments are leveled and aligned with sectional arches. • Traction sections are placed in the upper arch to allow for segmental correction with Class II elastics.
  96. 96. IV. Idealization. • These are the final arches used to achieve arch coordination and ideal orthodontic occlusion. The smallest possible edgewise wires are used. • Light round wires may be used at the end of treatment to help seat the occlusion.
  97. 97. Development of Bioprogressive Therapy
  98. 98. Ricketts’ Bioprogressive technique was developed from a background of Angle’s edgewise technique, as well as incorporating some advantageous characteristics of Begg’s inverse ribbon arch technique. But, in addition, several new features were combined to make it a flexible, full-control technique in which very light to very heavy forces could be applied on selection by the operator. This made it the most versatile and appealing technique to be devised for clinical orthodontics.
  99. 99. Standard Bioprogressive Appliance • Used since 1962. • “Second-order” movement was built in by angulating the bracket. - All four canines, lower molar tubes and brackets angulated at 5°. - Maxillary lateral incisor brackets were angulated at 8°. - Brackets for all other teeth were given no angulation (0°). • Lingual root torque was built into the brackets of upper central incisors (22°), upper laterals (14°) and all canines (7°).
  100. 100. Angulation values in Ricketts’ StandardAngulation values in Ricketts’ Standard BioprogressiveBioprogressive
  101. 101. Lingual root torque: 22° in upper central incisors 14° in upper lateral incisors 7° in cuspids
  102. 102. 22° torque in upper central incisors 7° torque in canines
  103. 103. Ricketts’ Standard Bioprogressive
  104. 104. Full Torque Bioprogressive Appliance • In this, additional torque was added to the Standard Bioprogressive appliance, by placing torque in the lower second premolars (14°) and the lower first and second molars (22°). • A 12° rotation was added to the tube and brackets on the lower first molar.
  105. 105. 12° rotation in lower molar tube 22° torque in lower second premolar and molars
  106. 106. Ricketts’ Full Torque Bioprogressive
  107. 107. Triple – Control Bioprogressive The Triple-Control Bioprogressive appliance now combines the offset first-order bends with the second-order tip, and the third-order torque, to present the complete “triple- control” needed to place the teeth in all three planes of space to accomplish the necessary movements to reach the objective of the overtreated orthodontic occlusion.
  108. 108. Features of the Triple-Control appliance. • Raised brackets were placed on certain teeth in order to step these teeth inward or to set the adjacent teeth outward. • Triple tubes were designed for rotation on the upper molar (15°). • Breakaway convertible lower molar tubes were designed that made it easier to band the lower second molar and convert the occlusal molar tube to a bracket.
  109. 109.
  110. 110. Breakaway convertible molar tube Second molar tube with 32° torque, 6° rotation & 5° angulation Occlusal offset in upper second molar tube
  111. 111. • A lower second molar tube was developed with 32° torque, 6° rotation and 5° angulation. • An upper second molar band and tube were designed. The upper rectangular tube was to be placed 1.75mm. below the level of the first molar tube. This allowed the upper molar to be positioned with the non-bent wire. • Penta-Morphic Arches - five arch forms were identified, which were to be selected for individual patients by technical methods.
  112. 112. Penta-Morphic
  113. 113. Ricketts’ Triple – Control Bioprogressive
  114. 114. Zero Base Bioprogressive Developed by Gugino, the Zero Base logic system adds an organizational capability to the Bioprogressive philosophy. Under this system, treatment planning is based on the degree of difficulty of each of a series of diagnostic elements. This aproach results in treatment plans that are individualized according to the specific needs of each
  115. 115. The term zero base originated from the bell- shaped statistical curve of distribution of a sample of normal data. • The peak of the bell-shaped curve represents the neutral position or zero base. • Those patients with less deviant, or mesofacial morphology represent the middle two-thirds of the population. • The further a given patient deviates from the zero base of facial type, the more difficult the treatment is likely to become.
  116. 116. A representation of a normal distribution, bell- shaped curve.
  117. 117. Zero Base Diagnosis
  118. 118.
  119. 119. The 10 mechanical principles of the Zero Base Bioprogressive philosophy
  120. 120. Conclusion The Bioprogressive philosophy, embracing early treatment, was developed for greater efficiency in orthodontic treatment. The ultimate objectives of this philosophy are to work in harmony with growth, to achieve permenent orthopedic changes, and to set the stage for lifelong enjoyment, in every sense of one of nature’s miracles – the natural dentition.
  121. 121. References 1. Ricketts RM. Bioprogressive therapy as an answer to orthodontic needs – part I. Am J Orthod. 1976; 70: 241-268. 2. Ricketts RM. Bioprogressive therapy as an answer to orthodontic needs – part II. Am J Orthod. 1976; 70: 359-397. 3. Ricketts RM, Bench RW, Gugino CF, Hilgers JJ, Schulhof RJ. Bioprogressive therapy. Rocky Mountain Orthodontics, 1980.
  122. 122. 4. Ricketts RM. A principle of arcial growth of the mandible. Angle Orthod. 1972; 42: 368-386. 5. Hilgers JJ. Sep(618 - 627): Bioprogressive simplified Part 1- Diagnosis and treatment planning. J Clin Orthod. 1987; 9: 618-627. 6. Hilgers JJ. Bioprogressive simplified - Part 3 - Nonextraction therapy. J Clin Orthod. 1987; 11: 794-804. 7. Hilgers JJ. Bioprogressive simplified - Part 4 - Extraction therapy. J Clin Orthod. 1987; 12: 857- 890.
  123. 123. 8. Bench RW, Gugino CF, Hilgers JJ. Bioprogressive therapy Part 2: Principles of the Bioprogressive therapy. J Clin Orthod. 1977; 11: 661-682. 9. Bench RW, Gugino CF, Hilgers JJ. Bioprogressive therapy Part 3: Visual treatment objective or VTO. J Clin Orthod. 1977; 11: 744- 763. 10. Bench RW, Gugino CF, Hilgers JJ. Bioprogressive therapy Part 4: the use of superimposition areas to establish treatment design. J Clin Orthod. 1977; 11: 820-838.
  124. 124. 11. Ricketts RM. The wisdom of the Bioprogressive philosophy. Semin Orthod 1998; 4: 201-209. 12. Sellke TA. Zero Base Bioprogressive: Unlocking the door to the future. Semin Orthod 1998; 4: 210-218. 13. Ricketts RM. The influence of orthodontic treatment on facial growth and development. Angle Orthod. 1960; 30: 103-131.
  125. 125. 14. Ricketts RM. Esthetics, environment and the law of lip relation. Am J Orthod. 1968; 54:272- 289. 15. Pavlick CT. Cervical headgear usage and the Bioprogressive prthodontic philosophy. Semin Orthod. 1998; 4: 219-230. 16. Gugino CF, Dus I. Unlocking orthodontic malocclusion: an interplay between form and function. Semin Orthod. 1998; 4: 246-257.
  126. 126. Thank you For more details please visit