Part 1

Bioprogressive Therapy
www.indiandentalacademy.com

 Introduction
 Principles of BPT.
 Diagnosis and treatment planning.
 Role of orthopedics.
 Forces used in BPT.
 Development of the utility arch.
 Mixed dentition treatment.

 Brackets & Prescriptions
 Class II div I
 Class II div II
 Mechanics for extraction cases.
 Finishing and retention.

Introduction
 Bioprogressive therapy was developed from a
background of edgewise technique as well as
begg technique.
 Rickett’s describes three phases of:
 Primary edgewise
 Secondary edgewise
 Tertiary edgewise.
 Quaternary edgewise

Introduction
 It accepts as its mission the treatment of the
total face rather than the narrower objective
of the teeth and the occlusion.
 Takes advantages of biological progressions
including growth, development ,function and
directs them to normalize it.

Introduction
 Management
umbrella

Principles of the

Principles of the
 BPT has been developed in an attempt to
communicate an understanding of
mechanical procedures in developing a
treatment plan, appliance selection specific to
individual type.
 Ten Principles.

Principles of the
 The use of a systems approach to diagnosis
and treatment by the application of the VTO
in planning treatment, evaluating anchorage
and monitoring results.
 Torque control throughout treatment.

Principles of the
 Keep the roots in vascular trabecular
bone.
 Place roots against dense cortical bone.
 Torque to remodel cortical bone.
 Torque position teeth in final occlusion.

Principles of the
 Muscular and cortical anchorage.
different types of muscular pattern in
different individuals.
 Movement of any teeth in any direction with
proper application of pressure
it is designed to respect the supporting
structures and size of the root of individual teeth-

Principles of the
 Orthopedic alteration
-anticipates and plans for this in treating younger children.
 Treat the overbite before the overjet.
-incisor intrusion as best choice
-stability of results
-prevent interference

Principles of the
 Sectional arch treatment- arches are broken
into segments.
-allow lighter continuous force
-more efficient root control.
-supplements maxillary orthopedic alteration.
- reduces friction and binding.
 Concept of overtreatment
- to overcome muscular forces.
- root movements for stability.

Principles of the
- To overcome orthopedic rebound
- To allow settling in retention
 Unlocking of malocclusion in progressive
sequence of treatment in order to establish or
restore more normal function .
-functional influence
- orthopedic alteration.
- arch form-length
- tooth movement.

Principles of the
 Efficiency in treatment with quality results
utilizing a concept of pre fabrication.
-allows the clinician to direct energies in diagnosis and planning
and efficient appliance therapy.

Diagnosis and Treatment
Planning

Visual treatment objectives
 VTO is a cephalometric tracing representing
the changes that are expected (desired)
during the treatment.
 It includes expected growth, any growth
changes induced by the treatment, and any
repositioning of the teeth from orthodontic
tooth movement.

1. Is like a blueprint used in building a house.
2. Visual plan to forecast normal and to
anticipate influence of treatment.
3. In establishing individual objectives.
4. Helps in developing a alternate treatment
plan.
5. Helps to evaluate treatment progress.
6. Valuable tool for the orthodontist’s self
improvement.

 Steps-
1. Ba-Na plane
2. Construction of the
new mandible
position .(mandibular
rotation)

3. Construction of the
new maxillary
position
4. Position of the
dentition.

5. Final soft tissue
profile.

Superimpositions area’s
1. The chin
2. The maxilla
3. The teeth in the mandible
4. The teeth in the maxilla
5. The facial profile

 The first superimposition
(Basion-Nasion at CC Point)
establishes Evaluation Area
1
 Amount of growth of the chin
 Any change in chin in an
opening or closing direction
that may result from our
mechanics.

 The second superimposition
area (Basion-Nasion at
Nasion) establishes
Evaluation Area 2 to show
 Any change in the maxilla
(Point A).
 The Basion-Nasion-Point A
Angle does not change in
normal growth.

 The third superimposition area (Corpus Axis
at PM) establishes Evaluation Area 3 and
Evaluation Area 4,
 Together evaluate any changes that take
place in the mandibular denture. In normal
growth, the lower denture remains constant
with the APO Plane

 In Evaluation Area 3-
lower incisors.
 In Evaluation Area 4-
lower molars

 The fourth superimposition area (Palate at
ANS) establishes Evaluation Area 5 and
Evaluation Area 6,
 Which together evaluate any changes that
take place in the maxillary denture

 In Evaluation Area 5, the
upper molars
 In Evaluation Area 6, we
evaluate the upper incisors

 5th Superimposition
Area (esthetic plane at
the crossing of the
occlusal plane)
 Area 7 with which we
evaluate the soft tissue
profile

Role Of Orthopedics

Orthopedics in BPT
 Any manipulation that alters the normal
growth of the dentofacial complex in either
direction or amount.
 Concept of differential treatment in Class II
malocclusion.

Orthopedics in BPT
 Thorough analysis of facial and dental
characteristics –facial growth type.
 More emphasis on cervical or combination
headgear.

Orthopedics in BPT

Generalized orthopedic response
with Cervical Headgear alone-
 Maxilla responds in a
more predictable
manner.

Generalized orthopedic response
 Mandibular response – depends on the
musculature.
- weak musculature
- strong musculature

Generalized orthodontic response
 Upper molars-extrusion of upper molars.
 Upper incisors-tip lingually
 Lower molars-upright and move distally
 Lower incisors-tip labially

The Reverse Response

Expansive Response
 In Class II –ant. Part of the maxilla is
generally tapered –lingual crossbite.
 Two basic expansive phenomenon are
occur-
1. Anatomic configuration of maxillary
complex.

Expansive Response

Expansive Response
2. From mechanical point ,progressive
widening of the alveolar base is
accomplished by widening of inner bow.
- Reciprocal expansion of lower arch.
- Preventing impacted second molar.

Mechanical application
1. Force level- 400gms
Intermittent wear –several advantages
-heavy forces result in hylanization.
-rebound allows in stability.
-more growth occurs at nite.
- Patient acceptance.

Mechanical application
3. Outer bow length and position
- Rigid outer bow.
- At the ala of the nose.
4. Expansion and rotation.
- Flexible inner bow , 2 cm of expansion.
5. Freedom of movement of maxilla

Forces Used In

Forces Used In
 The orthodontic movement of teeth occurs as
a result of the biological response and the
physiological reaction to the forces applied by
our mechanical procedures.
 Brian Lee, following the work of Storey and
Smith, measured the surface of the root being
exposed to movement— called the enface
surface of the root.

Forces Used In
 He, proposed 200 grams per sq cm of enface
root surface exposed to movement as the
optimum pressure to be applied in efficient
tooth movement.
 Bioprogressive Therapy's evaluation of the
applied forces suggests 100 gms per sq cm
of enface or exposed root surface as
optimum.

Forces Used In
Rating scale for the intrusion
of teeth measures the greatest
cross section
of the tooth surface in cm2.
Required forces are shown at
150 and 100 gms/ cm2 Lower
incisors show .20cm2 of
enface root surface, while
upper incisors show .40cm2.

Forces Used In
 Thurow has shown that
a force of 650 grams is
produced in deflecting
an .018 round chrome
wire 3mm across a
span of ½-inch
(13mm) .When a steel
wire is used, the force is
almost doubled to over
1000 grams.

Forces Used In
 Control of force:
1. Use of long lever
arm.

Forces Used In
2. Use of loops to increase the length
of the wire.

Forces Used In
 Cortical Anchorage: The concept of cortical
bone anchorage implies that, to anchor a
tooth, its roots are placed in proximity to the
dense cortical bone under a heavy force that
will further squeeze out the already limited
blood supply and thus anchor the tooth.
 Since each tooth is supported by cortical
bone, an understanding of this bony structure
and support is necessary.

Forces Used In
 Lower incisors and
cuspids:

Forces Used In
 Lower bicuspids and molars
lower molar anchorage –
the lingual cusps are kept
down (roots expanded and
torqued buccally)

Forces Used In
Upper incisors and canines

Forces Used In
 Upper molars and
bicuspids:
 The upper molars
are supported at the
base of the key
ridge of the
zygomatic process.

Forces Used In
 Muscular
Anchorage:

Forces Used In
In summary :
 Size of the root surface involved.
 Amount of force applied.
 Cortical bone support.
 Muscular support –facial type.

Utility and Sectional arches

Development of the utility arch
 Full banded edge
wise setup-most
efficient method
 In order to avoid
forward movement
of incisors, wire
ends were cinched
back

 Class III elastics
 It was long felt that
incisor intrusion as
an medium for
levelling the spee
was an impossibility.

 Ricketts tried to utilize the supposedly
immutable lower incisors as an anchor unit to
hold the posteriors in upright position, during
cuspid retraction.
 This lead to the development of step down
base arch wire/Rickett’s lower utility arch

Roles and functions of
the lower utility arch
 Position of the lower
molar to allow for
Cortical Anchorage:

 Manipulation and Alignment of the lower
incisor segments.
 Treated as a segment- different movements.
 Different planes of space.
 Ideal force levels.

 Stabilization of the lower arch, Allowing
segmental treatment of the buccal segments.
 Directing movements towards the final
position.
 Early maintenance of molar anchorage.

 Physiologic roles of the lower utility arch.
 Reaching or activator effect-removing contact
of LI from palatal or incisal occlusion.
 Helps in the headgear therapy.
 Bite before jet.
 Dictates the final arch form.

 Overtreatment
 Edge to edge bite.
 Freeing the buccal segments for unimpeded
correction of Class II
 Role in mixed dentition
 Resolve arch length problems.

1. Uprighting of the lower
molars.
Root movement-2mm
Crown movement-2mm
2. Advancement of the
lower incisors
1mm incisor movement
2mm arch length

3. Expansion in the buccal segment.
4. Saving the “E” space.
The author believes -with the utility arch slow,
delibrate and functional type of expansion
occurs-non extraction

Fabrication of the utility arch

Intra oral activation

Physiologic Vs Mechanical
Response
 Tip back applied to lower
molar-30° to 40 °.
 Extraction cases-definite
distal rotation must be
placed .

Response
 30° to 45° buccal
root torque applied
to the lower molar

Response

Response
 Long lever arm
applied to lower
incisors.
 75 gms of intrusive
force.(0.16 x 0.16)

Modifications of the Utility Arch
 Expansion utility
arch
 Force :
1mm= 85 gm
2mm=140 gm
3mm=205 gm

 Contraction utility arch
 Force:
1mm=50 gm
2mm =150 gm
3mm=230 gm

 Utility arch with T or
L Horizontal loop

 Contraction or
advancing utility
arch

Treatment in the Mixed
Dentition Phase

Bioprogressive Mixed
Dentition Treatment
 Four basic objectives-
1. Resolve functional problems.
2. Resolve arch length discrepancy.
3. Correct vertical problems.
4. Correct overjet problems.

Resolve functional problems
 Anything that disturbs the growth, health and
function of the TMJ complex.
 In 1950’s Ricketts –used body section x rays
(laminagrphy)

 Lack of rough surface , excessive thickening

 Submento-vertex
analysis
- Individual condylar
inclinations and
width.

 Nine general categories-
1. Cross mouth interferences.
2. Anterior crossbite.
3. Open bite.
4. Excessive range of function.
5. Distal displacement.

6. Loss of posterior support.
7. Habits.
8. Breathing and airway problems.
9. True Class III Growth pattern.

Resolve Arch
Length Discrepancy
 This is accomplished
by three ways-
1. Lateral expansion of
the molars.
- Depends on the
inclination of the
posterior teeth.

Resolve Arch
Length Discrepancy
Arch length gained is result slow natural
expansive response created by muscles

Resolve Arch
Length Discrepancy
 Expansion primarily by
change in axial inclination :
- Rickett’s quad helix or W
arch
- .040 blue elgiloy wire.

Resolve Arch
Length Discrepancy
 With 1cm expansion in the upper molars –
anterior segment are expanded 3cm overall.
 Long term functional expansion for atleast a
year or more for stable and demonstrable
changes to occur in the lower arch.

Resolve Arch
Length Discrepancy
Modifications of the Quad Helix

Resolve Arch
Length Discrepancy
 Expansion by mid palatal dysfunction:
- Hass type or modified Nance type expansion
appliance.

Resolve Arch
Length Discrepancy
2. Advancement of forward movement of the
lower molars:
- If the VTO and physiologic factors warrant.
- 1mm forward movement of LI yields 2mm of
arch length.

Resolve Arch
Length Discrepancy
3. Uprighting and /or distal movement of the
lower molars:
- Accomplished by utility arch.
- 2 mm per side can be gained by uprighting.

Correct Vertical/Overjet
Problems
 This is done after functional and arch length
corrections are achieved.
 Six basic approaches are used for the first
phase of non extraction treatment.

Problems
1. Orthopedic problems-
In case where good alignment of lower arch exists and Class
II is on account of Max.protrusion.
2. Orthopedic problems with lower arch
therapy-
with maxillary protrusion but incisors and molars in deep bite
or need advancement.

Problems
3. Orthopedic problems –Enhanced maxillary
movement.
where maxillary reduction is required but growth pattern does
not suggest a cervical pull head gear.
4. Combination orthopedic /orthodontic
problems
Initially started with utility and headgear.

Problems
5. Orthopedic problems with minor incisor
interferences.
- Upper utility arch with headgear.
6. Orthodontic problems alone.
- Upper utility arch with Class II elastics.

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