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Bracket Positioning,
Sequence of Mechanics
in
Edgewise Mechanics
INDIAN DENTAL ACADEMY
Leader in continuing dental educati...
Bracket Positioning,
Sequence of Mechanics
in
Edgewise Mechanics
Dr. OP Kharbanda, AIIMS, New Delhi

www.indiandentalacade...
Basics of Edgewise

Dr. O. P. Kharbanda

All India Institute of Medical Sciences
opk15@hotmail.com, ompk@aiims.ac.in
www.i...
Contributors
Dr.
Dr.
Dr.
Dr.
Dr.
Dr.
Dr.

Ashok Jena,
Sandip Kumar,
Priyanka Kapoor,
Hari,
Neeraj Wadhawan,
Vishal Gupta,
...
Growth trends
– Type A growth trend
– Type B growth trend
– Type C growth trend

www.indiandentalacademy.com
Type A growth trend
• The middle and lower face are growing forward and
downward in unison, with no change in size of the ...
Type B growth trend
• Growth downward and forward with the middle face
growing forward more rapidly than the lower face
• ...
Type C growth trend
• Lower face is growing downward and forward more rapidly than
the middle face with a decreases in ANB...
Anchorage
• Tooth anchorage (Anchorage preparation)
• Anchorage savers

Anchorage preparation
• 1st degree
• 2nd degree
• ...
Dr. OP Kharbanda

www.indiandentalacademy.com

Anchorage savers
Bracket placement

• Precision bracket placement is essential for good leveling
and alignment.
• Indirect bonding showed b...
Bracket placement
Tweed: Mandibular arch:
• Bracket slot should be 3.5mm from incisal edge or cuspal tip
• On molars -Betw...
Bracket placement

Lindquist:

Upper arch

Lower arch

Central

4.5mm

4.0mm

Lateral

4.0mm

4.0mm

Canine

5.0mm

4.5mm
...
Computerized bonding

• Generating digital information defining the shape and
location of the malocclused tooth with respe...
Computerized bonding
• Calculating the placement position of an orthodontic
bracket on the malocclused tooth required in o...
ALIGNMENT & LEVELING
Goals of first phase
• Bring the teeth in alignment and correct vertical
discrepancies by leveling ou...
Loop mechanics
• A loop reduces force and increases range by adding wire
in inter-bracket span.
• A loop may be open or cl...
Clinical applications of loops
Movements Loop
Labial

- Double vertical- open

Lingual

- Double vertical- open

Elevation...
Clinical applications of loops
1. Mesial or distal movement (such as midline correction): double
vertical loop against bra...
Principles in the choice of alignment arches
• Initial arch wires for alignment should provide light, continuous
forces to...
Principles in the choice of alignment arches
• Rectangular wire particularly those with a tight fit within the bracket
slo...
www.indiandentalacademy.com
Dr. OP Kharbanda, AIIMS, New Delhi, Typo Photos Courtesy Dr. Hari PG student
Multiple loop arch wire (0.016”)

Molar tie back,Vertical loops, L loops

Upper

Lower
www.indiandentalacademy.com
Dr. OP ...
Multiple loop arch wire after ligation

www.indiandentalacademy.com
Dr. OP Kharbanda, AIIMS, New Delhi, Typo Photos Courte...
Multiple loop arch wire after movement

www.indiandentalacademy.com
Dr. OP Kharbanda, AIIMS, New Delhi, Typo Photos Courte...
Leveling with 0.016” Arch wire
Molar stops
First order bends
Second order bends

upper

lower
www.indiandentalacademy.com
...
0.016” Arch wire after ligation

www.indiandentalacademy.com
Dr. OP Kharbanda, AIIMS, New Delhi, Typo Photos Courtesy Dr. ...
0.016” Arch wire after movement

www.indiandentalacademy.com
Dr. OP Kharbanda, AIIMS, New Delhi, Typo Photos Courtesy Dr. ...
Leveling with 0.018” Arch wire

Molar stops, First order bends, Second order bends
Curve of spee- upper, Reverse curve of ...
Typical Upper and lower leveling wire
often used in Edgewise appliance just before
Insertion of the Edgewise wire.

Mild c...
Leveling with 0.020” Arch wire
• Molar stops
• First order bends
• Second order bends
• Curve of spee- upper
• Reverse cur...
Acknowledgement
Sincere thanks to all those staff , PG students, CMET Staff and all
others who have directly or indirectly...
Thank you
For more details please visit
www.indiandentalacademy.com

www.indiandentalacademy.com
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Leveling and alignment in edgewise technique /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.

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Leveling and alignment in edgewise technique /certified fixed orthodontic courses by Indian dental academy

  1. 1. Bracket Positioning, Sequence of Mechanics in Edgewise Mechanics INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com www.indiandentalacademy.com
  2. 2. Bracket Positioning, Sequence of Mechanics in Edgewise Mechanics Dr. OP Kharbanda, AIIMS, New Delhi www.indiandentalacademy.com
  3. 3. Basics of Edgewise Dr. O. P. Kharbanda All India Institute of Medical Sciences opk15@hotmail.com, ompk@aiims.ac.in www.indiandentalacademy.com
  4. 4. Contributors Dr. Dr. Dr. Dr. Dr. Dr. Dr. Ashok Jena, Sandip Kumar, Priyanka Kapoor, Hari, Neeraj Wadhawan, Vishal Gupta, Anand Pal Lohia www.indiandentalacademy.com
  5. 5. Growth trends – Type A growth trend – Type B growth trend – Type C growth trend www.indiandentalacademy.com
  6. 6. Type A growth trend • The middle and lower face are growing forward and downward in unison, with no change in size of the ANB • Growth is approximately equal in both the vertical and horizontal dimensions • Approximately 25 % of patients www.indiandentalacademy.com
  7. 7. Type B growth trend • Growth downward and forward with the middle face growing forward more rapidly than the lower face • Growth of the middle and lower face is predominantly in the vertical dimension in most instances • ANB reading 60 to 120 • If ANB is less than 40 prognosis is fair • If ANB is 70 to 120 prognosis is poor • Extraction of all four first premolar mandatory for patients with high ANB angle • Only about 15% patients www.indiandentalacademy.com
  8. 8. Type C growth trend • Lower face is growing downward and forward more rapidly than the middle face with a decreases in ANB angle • When FMA ranges upward from 200, growth is approximately equal in the vertical and horizontal dimensions • When FMA 200 or less, growth predominantly horizontal • When growth is virtually confined to the horizontal dimension with little vertical growth, the growth trend is classified as Type C subdivision. • 60% patients have Type C growth trend www.indiandentalacademy.com
  9. 9. Anchorage • Tooth anchorage (Anchorage preparation) • Anchorage savers Anchorage preparation • 1st degree • 2nd degree • 3rd degree Anchorage savers • • • • • Headgear or palatal bar Nance button Delayed extraction Lip bumpers Muscular pattern of low FMA cases www.indiandentalacademy.com
  10. 10. Dr. OP Kharbanda www.indiandentalacademy.com Anchorage savers
  11. 11. Bracket placement • Precision bracket placement is essential for good leveling and alignment. • Indirect bonding showed better bracket placement. (Koo, Chung, Vanarsdall, 1999) • Light cure bonding also showed better bracket placement than chemical cure. • Bonding with orthocad technology shows more accurate bracket positioning. www.indiandentalacademy.com
  12. 12. Bracket placement Tweed: Mandibular arch: • Bracket slot should be 3.5mm from incisal edge or cuspal tip • On molars -Between occlusal and middle third Maxillary arch: • Bracket slot 3.5mm from incisal edge of cuspal tip except on lateral incisor (3.0mm) www.indiandentalacademy.com Dr. OP Kharbanda, AIIMS, New Delhi, Typo Photos Courtesy Dr. Hari PG student
  13. 13. Bracket placement Lindquist: Upper arch Lower arch Central 4.5mm 4.0mm Lateral 4.0mm 4.0mm Canine 5.0mm 4.5mm Premolar 4.5mm 5.0mm Molar 3.5mm 4.0mm www.indiandentalacademy.com
  14. 14. Computerized bonding • Generating digital information defining the shape and location of the malocclused tooth with respect to the patient's jaw • Generating a mathematical model of the malocclused tooth as positioned in the jaw from the digitized information • Calculating the finish position in the jaw to which the malocclused tooth is to be moved from the digitized information www.indiandentalacademy.com
  15. 15. Computerized bonding • Calculating the placement position of an orthodontic bracket on the malocclused tooth required in order to move the malocclused tooth to its finish position by a preselected orthodontic treatment • A standard bracket is thereafter modified, if desired, individually for the patient, in view of the patient's physical deviations from the statistical averages. • The shape of a bracket positioning jig is calculated and formed www.indiandentalacademy.com
  16. 16. ALIGNMENT & LEVELING Goals of first phase • Bring the teeth in alignment and correct vertical discrepancies by leveling out the arches • Labiolingual discrepancies (crossbites) • Axial discrepancies (mesio-distal) • Correct rotations www.indiandentalacademy.com
  17. 17. Loop mechanics • A loop reduces force and increases range by adding wire in inter-bracket span. • A loop may be open or closed type. • Open loops are most efficiently activated through compression of the legs. • The force of any loop may be reduced by coiling the wire at the apex one or more times. • The force developed in loop or arch wire is transmitted to the tooth through the bracket attachment resulting tooth movement. www.indiandentalacademy.com
  18. 18. Clinical applications of loops Movements Loop Labial - Double vertical- open Lingual - Double vertical- open Elevation - Double horizontal or Box Depression - Double horizontal or Box Rotation - Double vertical- open or box Root tipping- Box or double horizontal Canine Retraction – Ricketts Spring Incisor Retraction T loops /double key hole loops www.indiandentalacademy.com
  19. 19. Clinical applications of loops 1. Mesial or distal movement (such as midline correction): double vertical loop against bracket or fixed to the contained section of the arch, activated by tying back or compression. Combination of open and closed vertical loops. 2. Space closure (contraction of the arch): closed vertical loop, tied back. 3. Space opening (expansion of the arch): open vertical loop, with stops. 4. Bite opening: T-loops mesial to the canine. Note that the arch wire in anterior section between the two loops should have reverse curve to transmit the pressure equally to all 4 incisors. www.indiandentalacademy.com
  20. 20. Principles in the choice of alignment arches • Initial arch wires for alignment should provide light, continuous forces to produce the most effective tooth movement. Heavy force in contrast should be avoided. • The arch wire should be able to move freely within the brackets. For mesiodistal sliding along an arch wire, at least 2 mil clearance between the arch wire and bracket is needed, and 4 mil clearances is desirable. www.indiandentalacademy.com
  21. 21. Principles in the choice of alignment arches • Rectangular wire particularly those with a tight fit within the bracket slot so that the position of the root apex could be affected, normally should be avoided. Cupper Ni Ti or BioForce are the exceptions. • Round wires are preferred for alignment. www.indiandentalacademy.com
  22. 22. www.indiandentalacademy.com Dr. OP Kharbanda, AIIMS, New Delhi, Typo Photos Courtesy Dr. Hari PG student
  23. 23. Multiple loop arch wire (0.016”) Molar tie back,Vertical loops, L loops Upper Lower www.indiandentalacademy.com Dr. OP Kharbanda, AIIMS, New Delhi, Typo Photos courtesy Dr.Hari PG student
  24. 24. Multiple loop arch wire after ligation www.indiandentalacademy.com Dr. OP Kharbanda, AIIMS, New Delhi, Typo Photos Courtesy Dr. Hari PG student
  25. 25. Multiple loop arch wire after movement www.indiandentalacademy.com Dr. OP Kharbanda, AIIMS, New Delhi, Typo Photos Courtesy Dr. Hari PG student
  26. 26. Leveling with 0.016” Arch wire Molar stops First order bends Second order bends upper lower www.indiandentalacademy.com Dr. OP Kharbanda, AIIMS, New Delhi, Typo Photos Courtesy Dr. Hari PG student
  27. 27. 0.016” Arch wire after ligation www.indiandentalacademy.com Dr. OP Kharbanda, AIIMS, New Delhi, Typo Photos Courtesy Dr. Hari PG student
  28. 28. 0.016” Arch wire after movement www.indiandentalacademy.com Dr. OP Kharbanda, AIIMS, New Delhi, Typo Photos Courtesy Dr. Hari PG student
  29. 29. Leveling with 0.018” Arch wire Molar stops, First order bends, Second order bends Curve of spee- upper, Reverse curve of spee- lower www.indiandentalacademy.com Dr. OP Kharbanda, AIIMS, New Delhi, Typo Photos Courtesy Dr. Hari PG student
  30. 30. Typical Upper and lower leveling wire often used in Edgewise appliance just before Insertion of the Edgewise wire. Mild curve of Spee With tip back bends and Molar stops Mild Reverse curve of Spee With tip back bends and molar www.indiandentalacademy.com stops Dr. OP Kharbanda, AIIMS, New Delhi, Typo Photos Courtesy Dr. Hari PG student
  31. 31. Leveling with 0.020” Arch wire • Molar stops • First order bends • Second order bends • Curve of spee- upper • Reverse curve of spee- lower www.indiandentalacademy.com
  32. 32. Acknowledgement Sincere thanks to all those staff , PG students, CMET Staff and all others who have directly or indirectly contributed to this presentation www.indiandentalacademy.com Dr. OP Kharbanda, AIIMS, New Delhi, Typo Photos Courtesy Dr. Hari PG student
  33. 33. Thank you For more details please visit www.indiandentalacademy.com www.indiandentalacademy.com

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