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MBT system in orthodontics /certified fixed orthodontic courses by Indian dental academy


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MBT system in orthodontics /certified fixed orthodontic courses by Indian dental academy

  2. 2.
  3. 3.  Orthodontic treatment mechanics are determined by four elements--bracket positioning-bracket selection-archwire selection-force levels
  4. 4. WORK OF ANDREWSFirst Generation The original SWA was introduced by Andrews in 1972 and it had the features of Siamese edgewise bracket. He recommended a wide range of brackets - For extraction cases,canine brackets with anti-tip,anti- rotation, and power arms -Three sets of incisor brackets with varying degrees of torque for different clinical situation.
  5. 5. WORK OF ROTHSecond Generation To avoid inventory difficulties of a multiple bracket system, ROTH recommended a single appliance system to manage both extraction and non-extraction cases. The appliance prescriptions developed by Andrews and Roth were based on the treatment mechanics used in their practice.
  6. 6. WORK OF McLAUGHLIN,BENNETTAND TREVISI Third Generation The MBT has been developed from the combined clinical experience of the authors for more than 70 years. It also introduced additional research input from Japanese sources to update the scientific input. It is designed ideally to work with sliding mechanics,with light continuous forces, lacebacks and bendbacks.
  7. 7. Following elements make up the MBT treatmentphilosophy Bracket selection, versatility of bracket system, accuracy of bracket positioning, light continuous forces, 0.022 versus 0.018 slot, anchorage control, group movement, use of three arch forms, one size of rectangular steel wire, archwire hooks, methods of archwire ligation, awareness of tooth size discrepancies, persistence in finishing.
  8. 8. The MBT Bracket System The MBT bracket system is based on a more balanced mix of science,tradition and experience. It is a bracket system for use with light continuous forces, lacebacks and bendbacks It is designed ideally to work with sliding mechanics.
  9. 9. EXCLUSIVE MBTAPPLIANCE FEATURES. Reduced anterior tip. Upper bicuspid brackets with 0 0 tip. Lower bicuspid brackets with 2 0 tip. Additional palatal root torque for upper incisors and additional labial root torque for lower incisors. Upper cuspid brackets with the normal –70 torque or 00 torque.
  10. 10.  Upper molar brackets with additional 50 buccal root torque. Progressive buccal crown torque in lower cuspids and lower buccal segments. Optional upper second bicuspid brackets with an additional 0.5mm of in-out compensation. Three bracket types,Clarity Aesthetic Brackets, Victory Series brackets, and Unitek Full Size Twin Brackets,all available with APC Adhesive Coating.
  11. 11. Design features of a modern bracketsystem  Range of brackets - Standard size metal brackets. - Mid-size metal brackets. -Esthetic brackets.  Improved i.d system Laser numbering of standard size metal brackets.  Rhomboidal shape Reduces bulk and assists accuracy of bracket placement.
  12. 12.
  13. 13.  Drawing of original SWA bracket.  Dots (upper) and dashes (lower) were used for i.d
  14. 14.  Drawing of MBT brackets.  Standard size brackets have a rhomboidal form and numerical
  15. 15. VERSATILITY Seven areasOptions for palatally placed upper lateral incisors(-10*)Three torque options for upper canine(-7,0,+7)Three torque options for lower canine(-6,0,+6)Interchangeable lower incisor bracketsInterchangeable upper premolar bracketsUse of upper second molar tubes in first molars in non-HG casesUse of lower second molar tubes for upper first and second molar of opposite sides when finishing cases to class II molar relationship.
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  18. 18. Horizontal bracket placementerrors  If brackets are placed to the mesial or distal of the vertical long axis of the clinical crown,improper tooth rotation can occur.
  19. 19. Axial or paralleling errors  These will occur if the bracket wings do not straddle the vertical long axis of the crown in a parallel manner.  Such errors lead to improper crown tip.
  20. 20. Thickness errors.  Excess bonding agent beneath the bracket base can cause thickness and rotational errors.  Can be eliminated by pressing the bracket against the tooth.
  21. 21. Vertical errors  Vertical errors in bracket placement are caused by placing brackets gingival or incisalocclusal to the center of the clinical crown.
  22. 22. Gingival Concern.  Partially erupted tooth.  It is difficult to visualize the center of the clinical crown on partially erupted teeth,when treating young patients.
  23. 23. Gingival Inflammation Gingival inflammation causes foreshortening,effectivelyreducing the length of the clinical crowns.  Top:Healthy gingivae.  Bottom :The same case with inflamed gingivae in the upper right quadrant.
  24. 24. Teeth with palatally or linguallydisplaced roots.  Individual teeth with lingually displaced roots can produce short clinical crowns.
  25. 25. Teeth with facially displacedroots.  Individual teeth with facially displaced roots can produce long clinical crowns.
  26. 26. Incisal or Occlusal concerns.  Incisal crown fractures or tooth wear make it difficult to visualize the center of the clinical crown.
  27. 27. Crowns with long taperedbuccal cusps  Cuspids with tapered clinical crowns often do not have adequate contact with the opposing teeth.
  28. 28. Axial/paralleling variation The tip position of the lateral incisor brackets was varied to help root paralleling. In this case a lower incisor has been extracted and root paralleling has been helped by changing axial positions of adjacent brackets.
  29. 29. Tip specificationANTERIOR TIP Reduced anterior tip wasincorporated into the applianceto conform to Andrews originalresearch,and to dramaticallyreduce the anchorage needs ofeach case.
  30. 30. Incisor Tip Cuspid Tip Upper Upper Lower Lower Upper Lower Central Lateral Central LateralMBT 4.0° 8.0° 0° 0° 8.0° 3.0°Versatile+Original 5.0° 9.0° 2.0° 2.0° 11.0° 5.0°SWA3
  31. 31. Upper tip considerations The authors prefer a 00 tip bracket,with the band seated parallel to the buccal cusps.This gives 50 tip. If a 50 bracket is used,the band must be seated more gingivally at the mesial. If a 50 bracket is used,and the band is seated parallel to the buccal cusps,this will result in an effective 100 tip on the molar.
  32. 32. Lower Bicuspid Tip Lower Molar Tip Lower First Lower Lower First Lower Second SecondMBT Versatile+ 2.0° 2.0° 0° 0°Original SWA 2.0° 2.0° 2.0° 2.0°
  33. 33. UPPER POSTERIOR TIP Upper bicuspid brackets are provided with 00 tip to keep these teeth in a more upright position . Upper molar brackets are provided with 00 tip, which when placed parallel to the occlusal plane,introduces 50 tip into the upper molars.
  34. 34. LOWER POSTERIOR TIPLower posterior tip in the first andsecond bicuspid brackets is maintainedat 20, to slightly incline these teethforward.For the lower first and second molars,00 tipped brackets are provided, whichwhen placed parallel to the occlusalplane,introduces 20 of tip to theseteeth.
  35. 35. Bicuspid Tip Molar Tip Upper First Upper Upper First Upper Second SecondMBT Versatile+ 0° 0° 0° 0°Original SWA 2.0° 2.0° 5.0° 5.0°
  36. 36.  Torque in base-the CAD factor Using CAD it is possible to program the computer to create the correct relationship between the mid-point on the tooth and the slot base,as with traditional torque-in-base. Refinement of bracket base design It is incorporated to increase strength and help plaque control in difficult areas.
  37. 37. In-out specification It is 100% fully expressed. In upper premolars an alternative bracket which is 0.5mm thicker than normal,is used. This is helpful in obtaining good alignment of marginal ridges in cases with small upper second premolars.
  38. 38. In-out modifications.  An upper second bicuspid bracket with an additional 0.5mm of in-out compensation is provided for the common situation in which upper second bicuspids are smaller than upper first bicuspids.
  39. 39. Torque specification INCISOR TORQUEUpper incisor brackets are provided with additional palatal root torque;while lowerincisor brackets are provided withadditional labial root torque.This adjustment aids in the correction ofthe most common torque problemsoccurring in the incisor areas.
  40. 40. Upper central incisor torque  Increased palatal root torque for upper centrals.
  41. 41. Upper lateral incisor torque  Increased palatal root torque for upper lateral incisors.
  42. 42. Lower incisor torque  Increased labial root torque for lower incisors.
  43. 43.  Upper canine torque.  Available in –70 ,00 , +70 , torque.  The 00 and +70 options are for cases with narrow maxillary bone form andor prominent canine roots,and are often used with archwires in the tapered
  44. 44. Upper Cuspid ,bicuspid and molartorque . • Upper cuspid and bicuspid brackets are provided with the normal -70 of torque.Upper molar brackets are provided withan additional 50 of buccal root torque (-90to -140 ) to reduce palatal cuspinterferences with these teeth.
  45. 45. Incisor Torque Incisor Torque Upper Central Upper Lower Lower Lateral Central LateralMBT Versatile+ 17.0° 10.0° -6.0° -6.0°Original SWA 7.0° 3.0° -1.0° -1.0°
  46. 46. Palatally positioned lateralincisors. It is important to create adequate space before attempting to move palatally placed incisors. It is beneficial to invert the bracket on instanding lateral incisors,giving –100 torque.
  47. 47. Arch form considerations forstability and esthetics.  Bonwill and Hawley in 1905,suggested the geometric method of constructing the ideal arch form. - The lower six anterior teeth lie along a circle whose radius equaled their combined widths. -From this circle an equilateral triangle is created,the base of which represented the condylar width. -Premolars and molars should lie along these extended lines.
  48. 48. Traditional edgewise wire bending and Boone arch
  49. 49. Brader Archform
  50. 50.  The Catenary curve is formed by extending a chain from two fixed points.  Many of the tapered arch forms provided by orthodontic manufactures today are based on Catenary
  51. 51.  In 1907 Angle- - The form of line from the premolars and molars should resemble a parabolic curve. -He proposed the need for natural curvature in molar region. In 1934 Chuck- -Noted variation in arch form –square, oval, tapering. -The premolar region should be wider than canines to prevent excessive expansion of the canines.
  52. 52.  In 1963 Boone – -Superimposed Bonwill-Hawley arch form on a millimeter grid and used Angles method for construction. -Thus Bonwill-Hawley arch form is used as a template in edgewise. Braun et al,1998 -Reported that the human arch form could be represented by a complex mathematical formula,known as the Beta function. -This was calculated by entering measurements of dental landmarks on orthodontic models into a computer curve- fitting program.
  53. 53. Selection of Archformi. Arch form template are placed on lower study models. -The inter-canine width is evaluated.ii.If buccal uprighting is needed in the lower arch, a wider arch form is selected.
  54. 54. In 70% of cases buccal uprighting will result in lower anterior relapse.Cases in which buccal uprighting will be stable include- (a) Cases in which maxillary expansion is indicated. (b)Deep bite cases such as Class II /2 cases.iii.Contour and width in the lower posterior segment is estimated but this can be easily customized.
  55. 55. MBT ARCH FORM The three basic arch forms are tapered, square and ovoid. When superimposed they vary mainly in inter- canine width,giving a range of approximately 6mm. Inter-molar widths are similar ,but the molar areas can be widened or narrowed as needed,by easy wire bending.
  56. 56. ARCH FORMS - MBT
  57. 57. THE TAPERED ARCH FORM  Indicated for patients with narrow ,tapered arch form and gingival recession in canine and premolar regions.  Cases undergoing single arch treatment,in this way no expansion of treated arch occurs.
  58. 58. THE SQUARE ARCH FORM Indicated in cases with broad arch form. Cases that require buccal uprighting of the lower posterior segments and expansion of the upper arch. After over-expansion has been achieved ,it may be beneficial to change to the ovoid arch form in the later stages of treatment.
  59. 59. THE OVOID ARCH FORM It is the most preferred arch form. The ovoid arch form has proved to be good, reliable arch form for high percentage of cases treated with PAE Treated cases have shown good stability, with minimal amounts of post-treatment relapse.
  60. 60. The four components of archformi. ANTERIOR CURVATURE Based on inter-canine width. Its shape becomes more tapered when inter-canine width is narrow and more square when inter-canine width is wide.ii. INTER-CANINE WIDTH This appears to be the most critical aspect of arch form,because significant relapse occurs if this dimension is changed.
  61. 61.  POSTERIOR CURVATURE In the posterior area a gradual curvature between canine and second molars are preferred. INTER-MOLAR WIDTH Treatment changes in this dimension is more stable. Arch form in the inter-molar region can be widened or narrowed,depending on the needs of the case.
  62. 62. Relapse tendency after changingarch form. Riedel in 1969,postulated that arch form, in the mandibular arch,cannot be permanently altered during appliance therapy. Similar research was done by Shapiro, Gardner, Felton,De La Cruz and Burke suggesting that changes in inter-molar width seem to be more stable than those of inter- canine width.
  63. 63. TREATMENT MECHANICS Anchorage control Leveling and aligning Overbite control Overjet reduction Space closure Finishing
  64. 64. Anchorage control during leveling andaligning The tooth movements needed to achieve passive engagement of a plain, rectangular archwire of 0.019/0.025 dimension, having standard archform, into a correctly placed preadjusted 0.022 bracket system. The manoeuvres 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.
  65. 65.  Recognizing the anchorage needs of a case Mistakes in tooth leveling and aligning in the early years Reduced anchorage needs Control in three planes:- -horizontal -vertical -laterally
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  67. 67.
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  69. 69. OVERBITE CONTROL Development of overbite
  70. 70. Tooth movements for bite opening Extrusion of posterior teeth Distal tipping of posterior teeth Proclination of incisors Intrusion of anterior teeth Combination of two or more of the above tooth movements.
  71. 71. NON-EXTRACTION TREATMENT Initial archwire placement Bite-plate effect Importance of second molars Torque issues Bite opening curves Elastics
  72. 72. OVERJET REDUCTION Mesial movement of lower incisors Distal movement of upper incisors Distalizing or limiting the forward growth of the maxilla Mesial movement of the mandible due toa) forward mandibular growth rotation orb) limiting posterior dental and skeletal vertical dvelopment.
  73. 73. SPACE CLOSURE Closing loop archwires Sliding mechanics with heavy forces Elastic chain Sliding mechanics with light continous forces (recommended):-archwiressoldered hookspassive tiebacksactive tiebacks using elastomeric modulesforce levels
  74. 74.  Trampoline effect Type one active tieback(distal module)
  75. 75.  Type two active tieback(mesial module)
  76. 76.  Active tiebacks using a NiTi coil spring
  77. 77. Obstacles to space closure Inadequate leveling Damaged brackets Incorrect force levels Interference from opposing tooth Soft tissue resistance
  78. 78. FINISHING During the closing stages of treatment attention needs to be given to the following considerations:- Horizontal Vertical Transverse Dynamic Cephalometric and esthetic.
  79. 79. In 1976,Dougherty described 17 factors that should be considered during finishing:- Correction and overcorrection of the A-P jaw relationship Establishing the correct tip Establishing correct torque Co-ordinating arch width and form Establishing correct posterior crown torque Establishing marginal ridge relationship and contact points Correction of midline discrepancies Establishing interdigitation of teeth Checking cephalometric objectives Checking the parallelism of roots Maintaining the closure of all spaces Evaluating facial and profile esthetics Checking for TMJ dysfunctions Checking functional movements Correction of habits
  80. 80. Horizontal Coordination of tooth fit-anterior and posterior areas. Establishing correct tip of anterior and posterior teeth Management of tooth size discrepancies Controlling rotations Maintaining the closure of al spaces Horizontal overcorrection
  81. 81. Vertical Correct crown length,marginal ridge relationships,and contact points Final management of the curve of Spee -low angle cases -high angle cases Vertical overcorrection-deep bite -open bite
  82. 82. Transverse Arch form Archwire coordination Establishing posterior torque Transverse overcorrection
  83. 83. Dynamic Establishing centric relation and checking functional movements Checking for temporomandibular joint dysfunction
  84. 84. Cephalometric and esthetic Progress headfilms should be taken halfway through orthodontic treatment to determine how the skeletal, dental and soft tissue components are being managed. Final ceph radiograph 3-4 months before debanding Factors considered- Soft tissue profile, antero-posterior positionof the incisors, torque of incisors, changes in the mandibular plane, degree to which vertical development of patient occurred or restricted and success in correcting the horizontal,skeletal,and dental components Evaluation involves superimposition of progress
  85. 85. Settling 0.014 or 0.016 round HANT wires used Vertical triangular elastics
  86. 86.  Variations:- Cuspid labially placed, diastemas, extraction cases, expansion cases, severe class II malocclusion. Settling may take longer than 6 weeks,it is beneficial to leave lower rectangular steel wire to maintain the arch form. When only three weeks treatment remaining, a normal lower 0.014 steel or 0.016 heat activated can be placed.
  87. 87. FINISHING TO ABO REQUIREMENTS In July 2000, the ABO came out with revised requirements and a grading system for dental casts and panoramic radiographs.The ABO places emphasis on self assessment of seven features of dental casts.These include:- tooth alignment Marginal ridges buccolingual inclination occlusal relationships occlusal contacts overjet interproximal contacts
  88. 88. Appliance removal and retention Bracket and band removal Removal of remaining cement and bonding agents Placement of positioners Retainers-bonded and removable