www.indiandentalacademy.com
INDIAN DENTAL ACADEMY
Leader in continuing dental education
www.indiandentalacademy.com
LEVELING AND ALIGNING IN PREADJUSTED APPLIANCE
INTRODUCTION
 Leveling and aligning is the fundamental objectives of
ortho...
WIRES USED IN LEVELING AND ALIGNING
Stainless steel wires
Australian stainless steel wires
Cobalt-chromium (Elgioy)
Beta-t...
STAINLESS STEEL WIRES
Stainless steel wires used in orthodontics, consist of 18%
chromium and 8% Nickel with austenitic ty...
AUSTRALIAN STAINLESS STEEL WIRES
The Australian stainless steel wires was produced A.J.Willcock
according to specification...
4. Special plus with orange label
5. Premium with blue label
6. Premium plus with blue label
7. Supreme with lavender labe...
COBALT CHROMIUM ALLOY WIRES
This alloy is colour coded according to their resiliency
1. Blue elgiloy
2. Yellow elgiloy
3. ...
NICKEL TITANIUM ALLOY WIRES (NiTiNol)
 Invented in 1960 by William f. Buehler
 At novel ordanance laboratory (Nol) in si...
NiTiNol have to remarkable properties
1. Shape memory
2. Super elasticity
M-niti
After considerable experimentation, nitin...
In late 1980s, new nickel titanium wires with an active austenitic
grain structure appeared.
These wires exhibit the other...
BETA TITANIUM (TMA)
In the early 1980s, after Nitinol but before A-niti, a quite
different Titanium alloy, Beta titanium w...
MULTI STANDARD/ CO-AXIAL STAINLESS STEEL WIRES
The wires available in
1. Round
2. Rectangular
3. Square in cross section
A...
COMPOSITE PLASTICS
Optiflex is a composite structure formed by top coating optical
glass fibres (which are pure silicon di...
LEVELING AND ALIGNING
Definition
The tooth movements needed to achieve passive engagement of a
plain, rectangular arch wir...
THE OBJECTIVE OF LEVELING AND ALIGNING
The objective in leveling and aligning can be divided into
1. Short term objectives...
Any attempt to rush the achievement of short term objectives by
taking short cuts and using heavy forces, cause unwanted c...
THE PRINCIPLES IN THE CHOICE OF LEVELING AND
ALIGNING WIRES
1. The initial arch wires for alignment should provide light
c...
ARCH WIRE MATERIALS
The wires used for initial alignment purpose require a
combination of excellent strength, springiness ...
SIZE OF THE WIRES
Changing the diameter of a wire greatly affects its properties for
initial leveling and aligning the sma...
DISTANCE BETWEEN THE BRACKETS
As the distance increases between the point of attachment of a
beam, strength decreases rapi...
LEVELING AND ALIGNING ARCH WIRE SEQUENCE
ARCH WIRE SEQUENCE FOR .018” SLOT BRACKETS
Selection of initial alignment wires
T...
MULTISTANDARD WIRES
Its excellent properties, .0175” multistandard stainless steel wire
is too large for effective use .01...
NICKEL TITANIUM WIRES
In contrast to steel wires that tend to be too stiff and not strong
enough for good alignment.
niti ...
STAINLESS STEEL WIRES WITH LOOPS
Excellent performance in alignment also can be obtain by using
.014” or .016” stainless s...
ARCH WIRE SEQUENCE FOR .022” SLOT
MULTISTANDARD WIRES
With a .022” slot, there is optimum clearance for .0175” twisted
arc...
NICKEL TITANIUM WIRES
Both .016” and .018” diameter NiTi can be used initial arch wires
with .022” slot brackets.
.018” M-...
STAINLESS STEEL WIRE WITH LOOPS
.014” stainless steel wires usually the best choice.
But .016” stainless steel wires can a...
3. .014” stainless steel round wires
4. .016” stainless steel round wires
5. .018” stainless steel round wires
6. .020” st...
Anchorage control in the PEA system is very important, because
of the features built in the appliances, which tend to proc...
Horizontal plane
Anchorage control means limiting the mesial movement of the
posterior segments while encouraging distal m...
Control of anchorage in the horizontal plane
Anchorage control in the horizontal plane includes the
achievement of the cor...
Anterior control of anterior segments
The first difference between the standard edge wise appliance and
the PEA is the ten...
To eliminate or minimize this effect by connecting anterior
segments to the posterior segments with elastic forces.
In the...
This “ROLLER COASTER” effect is minimized by Andrews and
later by ROTH.
They introduce features into the bracket system to...
BENNET and MC LAUGHLIN took a different root,
They introduce lace backs to reduce or minimize this side effects.
The lace ...
WALKING CANINES
www.indiandentalacademy.com
BEND BACKS
Bending the arch wire immediately behind the most distally
banded posterior tooth is called chinching.
It serve...
IN SUMMERY
The primary methods of anterior anchorage control during
leveling and aligning include:
Using lace backs to min...
ANCHORAGE CONTROL IN THE UPPER POSTERIOR
SEGMENT
In certain cases it may be necessary to limit or prevent the
posterior se...
Because of these factors, extra oral force normally the most
effective way to provide posterior anchorage control in the u...
The length of the outer bow of the head gear is important to avoid
unwanted molar tipping.
www.indiandentalacademy.com
A secondary method of anchorage support in the upper posterior
segments is palatal bar.
This is normally placed when the u...
ANCHORAGE CONTROL OF POSTERIOR SEGMENTS IN
LOWER ARCH
When extra anchorage support is needed in the lower posterior
segmen...
ANCHORAGE CONTROL IN VERTICAL PLANE
There are two important areas of anchorage control in the vertical
plane
Incisor contr...
This effects avoided either by not initially bracketing the incisor
(or) by not tying the arch wire into the incisor brack...
It is important to avoid early arch wire engagement of high label
canines.
So that unwanted vertical movements of lateral ...
MOLAR VERTICAL CONTROL
The following methods of vertical molar control can be
considered when treating higher angle cases....
3. If palatal bars are used, they are designed to lie away from the
palate by approximately 2mm. So that the tongue can ex...
ANCHORAGE CONTROL IN THE LATERAL PLANE
Anchorage control in the lateral (or) transverse plane involves the
maintenance exp...
MOLAR CROSS BITE
Care should be needed to avoid arbitrary correction of molar cross
bite by tipping movement
This allows e...
Whenever possible molar cross by should be corrected by bodily
movement.
Minimal molar cross bite can be corrected effecti...
SPECIAL PROBLEMS DURING LEVELING AND
ALIGNING
1. Deep overbite correction
2. Cross bite correction
3. Rotation
Deep Overbi...
True deep bites is mostly due to infra eruption of the posterior
teeth.
Pseudo deep bite due to supra eruption of anterior...
EXTRUSION AND UPRIGHTING OF POSTERIOR TEETH
This method is indicated in
1. A patient with horizontal growth pattern
2. Gro...
Including second molar arch set up
Engaging arch wires with an exaggerated curve of spee in the
upper and reverse curve of...
INCREASE THE INCLINATION OF ANTERIORS
This procedure should be employed in the patient who has normal
skeletal pattern but...
INTRUSION OF ANTERIOR TEETH
Indicated in
1. Vertical skeletal growth pattern
2. Pseudo overbite
This is accomplished by
1....
When a round wire with a reverse curve of spee is engaged in the
lower arch to level the curve or spee, it produces mild d...
SALIENT FEATURES OF UTILITY ARCH
www.indiandentalacademy.com
TYPES OF UTILITY ARCHES
1. Passive utility arch
2. Intrusion utility arch
3. Retrusion utility arch
4. Protrusion utility ...
Intrusion utility arch
Retrusion utility arch
Protrusion utility arch
www.indiandentalacademy.com
TIPBACK SPRINGS (INTRUSION SPRINGS)
Originally proposed by Burstone, these springs are made of
0.017” x 0.025” TMA wire.
T...
THREE PIECE INTRUSION ARCH
This consist of following parts :
1. Posterior anchorage unit
2. The anterior segment with post...
ROTATION CORRECTION
It is defined as perversion of the tooth around its long axis or any
parallel axis.
Correction of bila...
An alternate way to obtained equal and opposite moments to
derotate molars is to use a high pull head gear with an occlusa...
CORRECTION OF UNILATERAL MOLAR ROTATION
Unilateral activation is incorporated into the horizontal tab of the
transpalatal ...
CROSS BITE CORRECTION
It is defined as cross bite as an abnormal buccal, labial or lingual
relationship of a tooth or teet...
For more details please visit
www.indiandentalacademy.com
www.indiandentalacademy.com
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Levelling and aligning in Pre Adjusted edge wise technique in orthodontics /certified fixed orthodontic courses by Indian dental academy

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Levelling and aligning in Pre Adjusted edge wise technique in orthodontics /certified fixed orthodontic courses by Indian dental academy

  1. 1. www.indiandentalacademy.com INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com
  2. 2. LEVELING AND ALIGNING IN PREADJUSTED APPLIANCE INTRODUCTION  Leveling and aligning is the fundamental objectives of orthodontics during the initial phase of treatment.  In most technique this stage is required before correction of major aspect of the malocculusion, such as overjet reduction (or) space closure and PEA is no exception to this.  The great majority also have either excessive overbite, resulting from some combination of excessive curve of spee in the lower arch and absent in upper arch.  A minority of cases have an anterior open bite caused by excessive curve of spee in upper arch offset in lower arch.  Therefore the purpose of this initial phase of treatment in PEA is to bring the teeth into alignment and correct the vertical discrepancy by leveling out of the arch. www.indiandentalacademy.com
  3. 3. WIRES USED IN LEVELING AND ALIGNING Stainless steel wires Australian stainless steel wires Cobalt-chromium (Elgioy) Beta-titanium (TMA) A-niti M-niti Coaxial wires Braided wires Composite plastics/optical glass www.indiandentalacademy.com
  4. 4. STAINLESS STEEL WIRES Stainless steel wires used in orthodontics, consist of 18% chromium and 8% Nickel with austenitic type of steel. It has tarnish and corrosion resistance due to passivating effect of chromium. The property of stainless steel wires can be controlled reasonably wide range by varying the amount of cold working and annealing during manufacture. This steel is softened by annealing and hardened by cold working. Fully annealed stainless steel wires of soft and highly formable. www.indiandentalacademy.com
  5. 5. AUSTRALIAN STAINLESS STEEL WIRES The Australian stainless steel wires was produced A.J.Willcock according to specifications. Specified by Dr. Begg, Without which as Dr. Begg, himself says “The Begg Technique would not have developed”. It has ultra high tensile austenitic stainless steel wire. It comes in different resiliencies. This wires are graded and colour coded depending on the resiliency. 1. Regular with white label. 2. Regular plus with green label 3. Special grade with black label www.indiandentalacademy.com
  6. 6. 4. Special plus with orange label 5. Premium with blue label 6. Premium plus with blue label 7. Supreme with lavender label The regular grade is least and premium grade is the most resilient of all the wires. For leveling and aligning special plus and above the wires are used. www.indiandentalacademy.com
  7. 7. COBALT CHROMIUM ALLOY WIRES This alloy is colour coded according to their resiliency 1. Blue elgiloy 2. Yellow elgiloy 3. Green elgiloy 4. Red elgiloy Blue being the least resilient and red being more resilient. A distinct advantage with these wires is that they can be heat treated, so increase the resiliency. Therefore, the clinicians can place accurate bend with easy in preheat treatment wires. After preheat treatment the same wire obtained better spring back properties www.indiandentalacademy.com
  8. 8. NICKEL TITANIUM ALLOY WIRES (NiTiNol)  Invented in 1960 by William f. Buehler  At novel ordanance laboratory (Nol) in silver springs. Now called navel surface weapon centre.  Acronym of elements - Ni – Nickel Ti – Titanium Nol - Origin INTRODUCTION TO ORTHODONTICS Introduced by George Anderson in 1971. Clinical use started 1972. Marketed by unitek. www.indiandentalacademy.com
  9. 9. NiTiNol have to remarkable properties 1. Shape memory 2. Super elasticity M-niti After considerable experimentation, nitinol was marketed in the late 1970s for orthodontic use in stabilized martensitic form. It is exceptionally springiness and quite strong but has poor formability. The family of stabilized martensitic alloys now commercially available are reffered as M-niti. www.indiandentalacademy.com
  10. 10. In late 1980s, new nickel titanium wires with an active austenitic grain structure appeared. These wires exhibit the other remarkable property of NiTi alloy- super elasticity. It is reffered as A-niti The wire has spring back 4-4 times that of comparable stainless steel wire and 1.6 times of NiTiNol. At 80% activation average stiffness of NiTi is 73% that of stainless steel and 36% that of NiTiNol. The load deformation rate at small activation is considerably higher that of large activation. Highly suitable wire if large deflection and low stiffness required. A-niti www.indiandentalacademy.com
  11. 11. BETA TITANIUM (TMA) In the early 1980s, after Nitinol but before A-niti, a quite different Titanium alloy, Beta titanium was introduced into orthodontics. It offers highly desirable combination of strength and springiness as well as reasonably good formability. This is excellent choice of auxiliary springs and intermediate and finishing arch wires. Its property is intermediate between stainless steel and M-niti. www.indiandentalacademy.com
  12. 12. MULTI STANDARD/ CO-AXIAL STAINLESS STEEL WIRES The wires available in 1. Round 2. Rectangular 3. Square in cross section According to studies conducted by Kusy & Barrow in 1982. Brided wires have elastic properties similar to nitinol. It can be used as a suitable to nitinol considering the cost of the later. www.indiandentalacademy.com
  13. 13. COMPOSITE PLASTICS Optiflex is a composite structure formed by top coating optical glass fibres (which are pure silicon dioxide) with a hot melt adhesive and a nylon skin. Its advantages are light forces for initial alignment and excellent esthetics. www.indiandentalacademy.com
  14. 14. LEVELING AND ALIGNING Definition The tooth movements needed to achieve passive engagement of a plain, rectangular arch wire of .019/.025 dimension, having standard arch form into correctly placed preadjusted .022” bracket system. In case of 0.018” bracket system the dimension of arch wire should be 0.016/0.022. www.indiandentalacademy.com
  15. 15. THE OBJECTIVE OF LEVELING AND ALIGNING The objective in leveling and aligning can be divided into 1. Short term objectives 2. Long term objectives Short Term Objectives In the opening months of treatment, will be to achieve proper leveling and aligning into passive rectangular wire. Long Term Objectives To be achieved by the end of the treatment, will be to achieve an ideal dentition, showing in the six keys to normal occlusion, and with the dentition properly positioned in the facial profile. www.indiandentalacademy.com
  16. 16. Any attempt to rush the achievement of short term objectives by taking short cuts and using heavy forces, cause unwanted changes to the take place. These make achievement of long term objectives more time consuming and difficult. So we have choose carefully about the leveling and aligning wires. If we choose properly, it will safely and smoothly take as to both our short term and long term goals. www.indiandentalacademy.com
  17. 17. THE PRINCIPLES IN THE CHOICE OF LEVELING AND ALIGNING WIRES 1. The initial arch wires for alignment should provide light continuous force to produce the most efficient tipping tooth movement. 2. The arch wire should move freely, with minimal binding, within the bracket slot. 3. Sliding teeth along an arch wire requires atleast 0.002” of clearance and 0.004” would be ideal. 4. During initial alignment, it is better to position the crowns than to cause root displacement. Although a highly resilient wire such as 0.017” x 0.025” A-niti could be used during this stage it is not advisable because it will create unnecessary and desirable root movements which delay the alignment process and possibility of root resorption.www.indiandentalacademy.com
  18. 18. ARCH WIRE MATERIALS The wires used for initial alignment purpose require a combination of excellent strength, springiness and long range of action. Ideally there should be an a almost flat-load deflection curve with the wire delivering about 50gm of force of almost any degree of deflection. The titanium based arch wire both NiTi and TMA offer a better combination of strength and springiness than stainless steel wires. The NiTi wires are particularly useful in first stage of treatment, remarkably flat load deflection curve of A-niti make it the wire of choice for leveling and aligning. www.indiandentalacademy.com
  19. 19. SIZE OF THE WIRES Changing the diameter of a wire greatly affects its properties for initial leveling and aligning the smallest diameter wire that has adequate strength would be proffered. When the diameter of wire is doubled, 1. The strength increases by 8 times. 2. The springiness decreases by 16 times. 3. Range decrease by half. www.indiandentalacademy.com
  20. 20. DISTANCE BETWEEN THE BRACKETS As the distance increases between the point of attachment of a beam, strength decreases rapidly while springiness increases even more rapidly. The bit of the bracket is an important factor. The wider the individual bracket, the smaller the interbracket span. So gaining increased springiness and the range of action, withiout sacrifying too much strength. www.indiandentalacademy.com
  21. 21. LEVELING AND ALIGNING ARCH WIRE SEQUENCE ARCH WIRE SEQUENCE FOR .018” SLOT BRACKETS Selection of initial alignment wires The principle that there should be .002” of clearance for initial wires means that .016” round wire is the largest that should be considered for initial alignment in the .018” slot. The three major possibilities for alignment arches are 1. Multi standard stainless steel wires 2. Nickel titanium wires 3. Single standard steel wires www.indiandentalacademy.com
  22. 22. MULTISTANDARD WIRES Its excellent properties, .0175” multistandard stainless steel wire is too large for effective use .018” slot bracket. The difficulty of sliding the teeth along with .0175” wires in .018” slot brackets is compounded irregular surface of the twisted strands, which can be bind against the corner of brackets. A .015” wire gives adequate clearance but its physical properties are inferior, so this wire is can be eliminated as impractical. www.indiandentalacademy.com
  23. 23. NICKEL TITANIUM WIRES In contrast to steel wires that tend to be too stiff and not strong enough for good alignment. niti wires have outstanding properties of springiness and range and also good strength. M-niti does provide good formability. In clinical practice, it has tendency to break and permanently distorted if stressed to the same extent. A-niti wires of the same diameter of .016” can have different force deflection curve, with these wires, the appropriate choice for initial alignment is the wire delivers 50 gms along its unloading curve. The great advantage is that the wire will deliver this optimum force over a large range.www.indiandentalacademy.com
  24. 24. STAINLESS STEEL WIRES WITH LOOPS Excellent performance in alignment also can be obtain by using .014” or .016” stainless steel wires incorporating loops if necessary. The primary indication choosing loop in a .014” steel wires, when the arch is well aligned except at one spot, where the tooth badly mal positioned tooth, there is risk for distorting arch form. In such situation arch wire should be reasonably stiff except at the spot where springiness needed and loops will produced just that effect. .014” stainless steel wire used to align the teeth further. After a lapse of 1-6 weeks .016” round stainless steel wire is ligated. Finally .016” x .022” stainless steel wire is ligated to complete the phase of leveling and aligning.www.indiandentalacademy.com
  25. 25. ARCH WIRE SEQUENCE FOR .022” SLOT MULTISTANDARD WIRES With a .022” slot, there is optimum clearance for .0175” twisted arch wires and this wires can be excellent choice of initial alignment arch wire, if mal aligned is not severe. Although .0195” twisted wire also would fit well within the bracket slot but this wire is undesirably stiffer. .0195 co-axial wire has similar springiness that of .0175” twisted wire, and is better choice if some reason a large diameter wire is desired. Because coaxial wires cost more than twisted wires. www.indiandentalacademy.com
  26. 26. NICKEL TITANIUM WIRES Both .016” and .018” diameter NiTi can be used initial arch wires with .022” slot brackets. .018” M-niti undesirably stiffer and should be avoided. A-niti is readily available in .016” diameter. Although there will be .008” clearance within the brackets with such wires does not cause clinical problems. Since the stiffness of .0175” twisted wires and .016” NiTi wires is quite similar at small deflections. It make good economic sense to use the twisted wires initially .022” slot. When the teeth reasonably well aligned initially and use .016” NiTi when greater range needed. www.indiandentalacademy.com
  27. 27. STAINLESS STEEL WIRE WITH LOOPS .014” stainless steel wires usually the best choice. But .016” stainless steel wires can also be used. But the wire fits better in .022” slot, but its greater stiffness requires more complex loop design. Once the initial alignment is achieved, the diameter of wire progressively increased to .016”, .018”, .020” round wires. And finally .0195” x .025” rectangular stainless steel wire is placed to complete the leveling and aligning. BENNET and MC LAUGHLIN advice the following sequence of arch wire in .022” slot. 1. .015” twist flex 2. .0175” twist flex www.indiandentalacademy.com
  28. 28. 3. .014” stainless steel round wires 4. .016” stainless steel round wires 5. .018” stainless steel round wires 6. .020” stainless steel round wires 7. .019” x .025” rectangular stainless steel wire The exact sequence of arch wire varies with the complexity of mal occlusion. In difficult cases a particular size may be maintained for more than one month. In initial cases, it is often possible to skip a wire size. BENNET and MC LAUGHLIN did not discourage the use of NiTi wires, he says the NiTi wires disadvantages The cost, the flexibility, difficulty to place bend backwww.indiandentalacademy.com
  29. 29. Anchorage control in the PEA system is very important, because of the features built in the appliances, which tend to proclaine the teeth. During the leveling and aligning will have the following meaning The maoeuvers used to restrict undesirable changes during the opening phase of treatment, so that leveling and aligning is achieved without key features of the malocclusion becoming worse. BENNET and MC LAUGHLIN emphases the need to consider anchorage in all the three plane of space 1. Horizontal plane 2. Vertical plane 3. Transverse plane (Lateral) ANCHORAGE CONTROL DURING LEVELING AND ALIGNING IN PEA www.indiandentalacademy.com
  30. 30. Horizontal plane Anchorage control means limiting the mesial movement of the posterior segments while encouraging distal movement of the anterior segments. When the posterior mesialize and the anterior procline, anchorage is being lost in the horizontal plane. Vertical plane Vertical anchorage control involve the limitation of the vertical skeletal and dental development in the posterior segments and the limitation of the vertical eruption of (or) even intrusion of the anterior segments. Transverse (Lateral) anchorage control It comprises maintenance of expansion procedure, primarily in the upper arch, and the avoidance of tipping (or) extrusion of posterior teeth during expansion.www.indiandentalacademy.com
  31. 31. Control of anchorage in the horizontal plane Anchorage control in the horizontal plane includes the achievement of the correct antero posterior position of the teeth at the end of the treatment. It often involves limiting the mesial movement of the posterior teeth while encouraging the distal movement of the anterior teeth. This can be divided into 1. Anchorage control of anterior segments 2. Anchorage control of posterior segment www.indiandentalacademy.com
  32. 32. Anterior control of anterior segments The first difference between the standard edge wise appliance and the PEA is the tendency for the anterior teeth to incline forwards during the initial phase of leveling and aligning. This result from the tip built in the anterior brackets which is more in the upper arch compared to the lower arch. www.indiandentalacademy.com
  33. 33. To eliminate or minimize this effect by connecting anterior segments to the posterior segments with elastic forces. In the elastic force were greater than the leveling force of the arch wire, there was tendency for anterior teeth to tip and rotate distally, and increasing the curve of spee, deepening the bite. This phenomenon is known as “ROLLER COASTER”. This was particularly evident in first premolar extraction cases. www.indiandentalacademy.com
  34. 34. This “ROLLER COASTER” effect is minimized by Andrews and later by ROTH. They introduce features into the bracket system to prevent unwanted changes. 1. Extra torque was built into incisor bracket 2. Anti tip, antirotation features built into canine, premolar and molar brackets. 3. Power arms were added to some brackets to bring the forces closer to the centre of resistance of each tooth. www.indiandentalacademy.com
  35. 35. BENNET and MC LAUGHLIN took a different root, They introduce lace backs to reduce or minimize this side effects. The lace backs are constructed by 0.009” (or) 0.0010” ligature wires and tied in figure of eight fashion. They extend from the most distally banded molars to the canine in all quardrants and have proven effective in controlling the canine during leveling and aligning. The lace back prevent the cuspids from the tipping forward and can also be used for distalizing (or ) retracting the canines. www.indiandentalacademy.com
  36. 36. WALKING CANINES www.indiandentalacademy.com
  37. 37. BEND BACKS Bending the arch wire immediately behind the most distally banded posterior tooth is called chinching. It serves to minimize forward tipping of incisors. www.indiandentalacademy.com
  38. 38. IN SUMMERY The primary methods of anterior anchorage control during leveling and aligning include: Using lace backs to minimize the forward tipping of the canines and effectively retract them when indicated. 1. Using bend backs to minimize forward tipping of incisors. www.indiandentalacademy.com
  39. 39. ANCHORAGE CONTROL IN THE UPPER POSTERIOR SEGMENT In certain cases it may be necessary to limit or prevent the posterior segment from moving forward, maintain their position, (or) even distalize them. Posterior anchorage requirements normally greater upper arch than in lower arch. Because of the following reason. 1.The upper anterior segments has longer than lower. 2.The upper anterior brackets have greater amount of built in tip. 3.The upper incisors require more torque control and bodily movement than lower arch. 4.The upper molar usually move mesially more readily than the lower arch www.indiandentalacademy.com
  40. 40. Because of these factors, extra oral force normally the most effective way to provide posterior anchorage control in the upper arch. BENNET and MC LAUGHLIN favour a combination of head gear (occipital and cervical pull). The force levels used for combination of head gears are 150 – 250gms. Keeping the force directed slightly above the occulusal plane and minimize the tendency for vertical extrusion of the upper posterior teeth, while simultaneously allowing effective distalization of molar. www.indiandentalacademy.com
  41. 41. The length of the outer bow of the head gear is important to avoid unwanted molar tipping. www.indiandentalacademy.com
  42. 42. A secondary method of anchorage support in the upper posterior segments is palatal bar. This is normally placed when the upper molars has been properly rotated and or situated c-1 molar relation. The palatal bar can be constructed of heavy .045” (or) .051” round wire, extending from molar to molar with a loop placed in the middle of the palate and the arch wire above (2mm) from the roof of the palate and its soldered to the molar hook. www.indiandentalacademy.com
  43. 43. ANCHORAGE CONTROL OF POSTERIOR SEGMENTS IN LOWER ARCH When extra anchorage support is needed in the lower posterior segments, we can use 1. Lingual arch 2. C-111 elastics 3. Lip bumper www.indiandentalacademy.com
  44. 44. ANCHORAGE CONTROL IN VERTICAL PLANE There are two important areas of anchorage control in the vertical plane Incisor control In PEA produce a transitional deepening of anterior over bike during leveling and aligning. Mainly due to tip of the canine brackets. If canines are tipped distally, the mesial aspect of the canine bracket slot. Directed in the occlusal direction. www.indiandentalacademy.com
  45. 45. This effects avoided either by not initially bracketing the incisor (or) by not tying the arch wire into the incisor bracket, until the canine roots have been uprighted and moved distally under control of lace back. www.indiandentalacademy.com
  46. 46. It is important to avoid early arch wire engagement of high label canines. So that unwanted vertical movements of lateral incisors and premolar does not occur. www.indiandentalacademy.com
  47. 47. MOLAR VERTICAL CONTROL The following methods of vertical molar control can be considered when treating higher angle cases. 1.Early banding of the second molar is to be avoided if banded, the tube has to be positioned more occulusally to prevent extrusion 2.If the upper first molar require expansion, an attempt is made to achieve bodily movement rather than tipping, to avoid extrusion of palatal cusps. It is accomplished by fixed expanded. www.indiandentalacademy.com
  48. 48. 3. If palatal bars are used, they are designed to lie away from the palate by approximately 2mm. So that the tongue can exert a vertical intrusive effect on these teeth. 4. In some cases upper and lower posterior by plate in the molar region is helpful to minimize extrusion of molars. www.indiandentalacademy.com
  49. 49. ANCHORAGE CONTROL IN THE LATERAL PLANE Anchorage control in the lateral (or) transverse plane involves the maintenance expansion procedure mainly upper arch, and to avoidance of tipping and extrusion of the posterior teeth during the expansion phase. MAINTAINING INTERCANINE WIDTH During the treatment, the intercanine width should not be altered to a great extent. Expansion of the arches should be controlled to prevent relapse and care should be taken to ensure that crowding is not relieved by uncontrolled expansion of the upper and lower arch. www.indiandentalacademy.com
  50. 50. MOLAR CROSS BITE Care should be needed to avoid arbitrary correction of molar cross bite by tipping movement This allows extrusion of palatal cusp and unwanted opening of the mandibular plane angle in the treatment of high angle cases. www.indiandentalacademy.com
  51. 51. Whenever possible molar cross by should be corrected by bodily movement. Minimal molar cross bite can be corrected effectively by expanding the arch wire. www.indiandentalacademy.com
  52. 52. SPECIAL PROBLEMS DURING LEVELING AND ALIGNING 1. Deep overbite correction 2. Cross bite correction 3. Rotation Deep Overbite Moderate deep bite cases get corrected as a result of routine leveling and aligning procedure. Severe deep bite cases require different corrective procedure. Types of Deep Overbite 1. True deep overbite 2. Pseudo deep overbite www.indiandentalacademy.com
  53. 53. True deep bites is mostly due to infra eruption of the posterior teeth. Pseudo deep bite due to supra eruption of anterior teeth. Corruption of deep overbite is accomplished by various tooth movements 1. Extrusion of posterior teeth 2. Uprighting of posterior teeth 3. Increasing the inclination of incisors 4. Intrusion of anterior teeth www.indiandentalacademy.com
  54. 54. EXTRUSION AND UPRIGHTING OF POSTERIOR TEETH This method is indicated in 1. A patient with horizontal growth pattern 2. Growing individuals 3. True deep overbite cases This method is accomplished by 1. Anterior bite plane- which allows the posterior teeth to supra erupt thereby opening of the bite www.indiandentalacademy.com
  55. 55. Including second molar arch set up Engaging arch wires with an exaggerated curve of spee in the upper and reverse curve of spee in the lower. www.indiandentalacademy.com
  56. 56. INCREASE THE INCLINATION OF ANTERIORS This procedure should be employed in the patient who has normal skeletal pattern but dentally retroclined (or) crowded anteriors. This can be achieved in PEA by not giving either lace back or bend back. www.indiandentalacademy.com
  57. 57. INTRUSION OF ANTERIOR TEETH Indicated in 1. Vertical skeletal growth pattern 2. Pseudo overbite This is accomplished by 1. Utility arches 2. Burstone’s segmental arch mechanics Utility arches The utility arch has multiple uses in various orthodontic treatment. This auxiliary arch wire was developed according to the biomechanical principles described by Burstone and refined by Ricketts for bioprogressive therapy www.indiandentalacademy.com
  58. 58. When a round wire with a reverse curve of spee is engaged in the lower arch to level the curve or spee, it produces mild distal tipping uprighting of the molars, extrusion of the premolars and flaring of the incisors. In order to restrict this unwanted tooth movements true intrusion of the incisors is required. Blue elgiloy of 0.016” x or 0.016” or 0.016” x 0.022” dimension in an 0.022” slot is material for fabrication of utility arches. Utility arch can even be made with 0.014” or 0.018” round wires. www.indiandentalacademy.com
  59. 59. SALIENT FEATURES OF UTILITY ARCH www.indiandentalacademy.com
  60. 60. TYPES OF UTILITY ARCHES 1. Passive utility arch 2. Intrusion utility arch 3. Retrusion utility arch 4. Protrusion utility arch Passive utility arch It can be used for stabilization (or) as a space maintainer. It is ideal in the mixed dentition as it permits the eruption of canine and premolars www.indiandentalacademy.com
  61. 61. Intrusion utility arch Retrusion utility arch Protrusion utility arch www.indiandentalacademy.com
  62. 62. TIPBACK SPRINGS (INTRUSION SPRINGS) Originally proposed by Burstone, these springs are made of 0.017” x 0.025” TMA wire. The springs are indicated in 1. Growing patient with forward growth rotation. 2. Very deep curve of spee in the lower arch. 3. Pseudo deep bite cases. www.indiandentalacademy.com
  63. 63. THREE PIECE INTRUSION ARCH This consist of following parts : 1. Posterior anchorage unit 2. The anterior segment with posterior extension 3. Intrusion cantilevers www.indiandentalacademy.com
  64. 64. ROTATION CORRECTION It is defined as perversion of the tooth around its long axis or any parallel axis. Correction of bilateral molar rotations To correct bilaterally rotated molars (mesial-in, distal out rotation) two equal and opposite moments are applied to the molars. www.indiandentalacademy.com
  65. 65. An alternate way to obtained equal and opposite moments to derotate molars is to use a high pull head gear with an occlusal insertion of the inner bow in the buccal tubes on the molar bands. The force of high pull head gear is directed through the center of resistance of maxillary first molar. The distal force applied through the buccal tube of the molars buccal to the center of resistance and creates a moment that tends to rotate the molars mesial out. www.indiandentalacademy.com
  66. 66. CORRECTION OF UNILATERAL MOLAR ROTATION Unilateral activation is incorporated into the horizontal tab of the transpalatal arch.. The opposite molar will experience a tip back moment. If such side effects or not desirable, it is necessary to place 0.017” x 0.025” ss wire from right maxillary molar to the left second premolar for anchorage purpose. www.indiandentalacademy.com
  67. 67. CROSS BITE CORRECTION It is defined as cross bite as an abnormal buccal, labial or lingual relationship of a tooth or teeth of maxilla, the mandible, or both, when the arches are in occlusion. It is corrected by 1. Transpalatal arch 2. Quad-helix 3. Cross elastics 4. Heavy labial expansion arch 5. Expansion screws to move one or two teeth 6. pendulum appliance with screw www.indiandentalacademy.com
  68. 68. For more details please visit www.indiandentalacademy.com www.indiandentalacademy.com

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