Tip edge /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.

Indian dental academy provides dental crown &

Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit

www.indiandentalacademy.com ,or call
0091-9248678078

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Tip edge /certified fixed orthodontic courses by Indian dental academy

  1. 1. Tip-edge INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com www.indiandentalacademy.com
  2. 2. Tip-edge www.indiandentalacademy.com
  3. 3. • It is difficult to imagine that there was a period in orthodontics before the invention of the brackets. Yet this was the situation when Angle developed and perfected treatment procedures with his ‘E’arch which expanded the dental arches but provided no axial tooth control. www.indiandentalacademy.com
  4. 4. www.indiandentalacademy.com
  5. 5. • The pin and tube appliance introduced by Angle in 1910,overcame the weak point in his E arch---lack of axial control but permitted only limited mesio distal crown displacement and difficulty in arch wire placement. www.indiandentalacademy.com
  6. 6. • These two shortcomings were overcame by development of the Ribbon arch appliance by ingenious removal of portion of the tube and separation of the pin from the arch wire. www.indiandentalacademy.com
  7. 7. www.indiandentalacademy.com
  8. 8. • However these appliance also required frequent soldering to prevent the mesiodistal tipping. www.indiandentalacademy.com
  9. 9. • A solution to all these problems was offered by Angle(1925) in his latest and best orthodontic mechanism which were referred initially as ‘‘open face or tie brackets’’ and presently referred to as edgewise appliance or bracket. www.indiandentalacademy.com
  10. 10. • The high degree of control afforded by the edgewise bracket provides a sense of security and each tooth is always under complete mesio-distal tip control. • However due to increased control, teeth are restricted by the brackets ,not only from tipping independently in undesired directions, but also from tipping in desired directions. www.indiandentalacademy.com
  11. 11. • In comparison ,the ribbon arch type brackets presently used in the Begg technique permit mesiodistal tipping but are relatively demanding on the operator. Gingivally facing slots complicate arch wire placement and the range of mesiodistal tipping is so great that it must be continually monitored. • It seems obvious that an ideal appliance might combine the best of both while eliminating or at least minimizing the disadvantages of each. www.indiandentalacademy.com
  12. 12. • Combination brackets were developed but were not accepted readily by those familiar with either technique as it was neither an “Edgewise” nor a “Begg” bracket. So a solution may lie in a modification of either the ribbon arch or edgewise bracket. www.indiandentalacademy.com
  13. 13. • Alexander Sved in 1937 removed all mesiodistal angular control from the arch wire slot but the bracket never became popular ,because it had completely lost its “edge”. www.indiandentalacademy.com
  14. 14. MODIFICATION OF THE EDGEWISE MECHANISM • Expanding the arch wire slot • Elastomeric ligature for mesiodistal control • Torquing flaps www.indiandentalacademy.com
  15. 15. • On the basis of desirability of mesial or distal crown tipping for each tooth and the apparent advantage of Begg tooth movement KESLING have developed an edgewise type bracket with a unique arch wire slot .(Am.J.Orthod.1988) www.indiandentalacademy.com
  16. 16. • The slot has diagonally opposed surfaces that permit initial crown tipping which is controlled in both direction and degree. Since this bracket permits tipping yet also provides edgewise control, it was referred as the Tipedge bracket. www.indiandentalacademy.com
  17. 17. Expanding the arch wire slot Tip-edge bracket for maxillary right canine. Internal components of the "propellor" slot include: A and A, crown tipping control surfaces; B and B, root uprighting control surfaces; C, vertical and torque control ridges or pivots; D, rotational control surface. www.indiandentalacademy.com
  18. 18. Elastomeric ligature for mesiodistal control • An unique elastomeric ligature was developed for the tip-edge bracket that can provide mesiodistal angular control and was referred as tip-edge ring. www.indiandentalacademy.com
  19. 19. • Stretching the resilient ring into place around the bracket and arch wire generates the forces that continuously act to tip or to upright the tooth mesiodistally. www.indiandentalacademy.com
  20. 20. • These forces are partially created by lingually facing projections (B) on the lingual surface of the ring that are wedged between the arch wire and the bracket. • A crossbar (A) in the center of the ring affords additional power and prevents it from twisting during the placement. www.indiandentalacademy.com
  21. 21. • It also facilitates orientation during placement to ensure desired results and is possible to influence or maintain either crown tipping or root uprighting according to ring’s orientation to the bracket and arch wire. www.indiandentalacademy.com
  22. 22. Torquing flaps • To facilitate the retraction of anterior teeth or mesial movement of the anchor molars depending on needs of each case, it is necessary to permit the free sliding of the arch wire through relatively larger molar tubes (safety valves) but buccolingual torque control is lost. www.indiandentalacademy.com
  23. 23. • So Kesling developed torquing flaps that can be bent 90 degree to cover the mesial ends of 0.036 inch round molar tubes. • These flaps eliminates the need for double tubes and permit the use of straight arch wire (round or rectangular) and automatically provide predetermined buccolingual torque control. www.indiandentalacademy.com
  24. 24. The generous sized vertical slots in Tip – Edge brackets make possible the use of many auxiliaries throughout treatment. • • • • These auxiliaries are Power pins Rotating springs Side winder springs www.indiandentalacademy.com
  25. 25. • Power pins are means to accept elastomerics or rotating springs for rapid, physiological rotation. • These can be inserted into the vertical slot from the incisal or gingival on any bracket at any time. www.indiandentalacademy.com
  26. 26. Rotating springs • Rotations are corrected using rotating springs inserted through the vertical slots of the brackets. • These are over corrected whenever possible and held in these positions throughout treatment www.indiandentalacademy.com
  27. 27. www.indiandentalacademy.com
  28. 28. Mesio –distal uprighting springs • They are available in both standard and side winder versions and are made of .014 inch Australian wire • Side winder Uprighting springs are mesial or distal uprighting springs with power coils that are concentric with the desired axis of root uprighting. www.indiandentalacademy.com
  29. 29. • With the Side-Winder, the center of the power coil is concentric with the center of the bracket (the desired axis of uprighting) and the resulting force vectors are vertical at the contact points with adjacent teeth. • This would seem to maximize the desired distal root positioning and minimize mesial displacement of the crown. www.indiandentalacademy.com
  30. 30. • However, when the center of the power coil is gingival to the desired axis (standard uprighting spring), the vectors of force at the level of the arch wire would tend to move the crown mesially to open space distally and/or apply undue pressure to the lateral incisor www.indiandentalacademy.com
  31. 31. • Side winder springs have several advantages over standard springs • Improve both esthetics and hygiene. • Offer a choice of insertion from either the occlusal or gingival aspect • Appear to be more efficient than standard springs. www.indiandentalacademy.com
  32. 32. Concept and function of tip-edge • The tip-edge concept is to provide an edgewise type bracket that is familiar to all orthodontists can be used to treat all the malocclusions through differential tooth movement. • This is accomplished by maintaining everything that is positively associated with an edgewise bracket ,especially the labially facing arch wire slot and tie wings, while removing the one thing that prevents mesiodistal crown tipping— diagonally opposed corners of the slot itself. www.indiandentalacademy.com
  33. 33. Inter-bracket distance • The forces delivered to the teeth from arch wire is inversely proportional to the distance between the brackets –inter bracket distance. in other words , wider the brackets shorter the distance, greater the force. • To eliminate this problem the orthodontists have recently elected to use undersize or super elastic NiTi wire which makes the tip and torque control impractical for use. www.indiandentalacademy.com
  34. 34. • The tip edge arch wire slot completely eliminates problems caused by interbracket distances. • Initially when using round arch wires the cut corners of the slot prevent binding from tipped teeth. as treatment progresses and crown are tipped toward their final position in the dental arch slot size have increased. which permits passive engagement of full size rectangular wire with zero flexing www.indiandentalacademy.com
  35. 35. • each tooth will have either one point or no contact with the arch wire. therefore interbracket distance is in effect from molar tube to molar tube— 100% • Because of 100% inter tube distance the molars are the only teeth that feel the corrective torque forces which are extremely light and more than appropriate. www.indiandentalacademy.com
  36. 36. Bite-opening • Most malocclusions require bite opening ,which involves the intrusion of incisor teeth. If each tooth is free to intrude along its own path of least resistance, desired bite opening can accomplished relatively rapidly and with the lightest of the force—approx. 5 gram per tooth. www.indiandentalacademy.com
  37. 37. • Conventional edgewise slots prevents this free root movement and when teeth are tipped mesially or distally , can even cause lateral movements of the roots to further complicate the intrusion. www.indiandentalacademy.com
  38. 38. • Tip-edge arch wire slot with their one point contacts with the arch wire prevent the creation of such lateral pressure on the root surface and permit the root to intrude in unhindered fashion. www.indiandentalacademy.com
  39. 39. • Because of one point contact it is possible to open the deepest of anterior bites without the need of extra oral forces. • The principles of differential forces and mechanics are applied through high tensile ,steel arch wire, light inter maxillary elastics and to some extent, the force of mastication. • Intrusive forces are generated from properly bent 0.016 inch high tensile stainless steel arch wire. www.indiandentalacademy.com
  40. 40. •The amount of force applied to the anterior teeth is directly related to the passive distance (25mm) between the arch wire and the anterior bracket slots which is determined by the degree of bite opening bends in the arch wire mesial to anchor molar tubes and mesial inclination of the molars themselves. www.indiandentalacademy.com
  41. 41. www.indiandentalacademy.com
  42. 42. • Bicuspids are never engaged until the bite is open, so that all intrusive forces will be concentrated on cuspids and incisors. • The key to desired bite opening lies in the continual use of light (2oz) elastics and the highest tensile,0.016 inch arch wire with proper bite opening bends. www.indiandentalacademy.com
  43. 43. • A 25 mm displacement results in a approx.1.5oz(42g m) of depressive force on the six anterior teeth when the wire is engaged into the brackets. www.indiandentalacademy.com
  44. 44. •Two class II elastics (2oz each) pull the max. arch wire halfway toward the anterior the brackets. the 12-13 mm of travel remaining to the bracket slots generates approx.1 oz(28gm) of depression. www.indiandentalacademy.com
  45. 45. www.indiandentalacademy.com
  46. 46. Variable arch wire slot • tip-edge bracket slots are designed to permit crown tipping in one direction but they also, in effect, become larger as the teeth tip. • Of course, the slot do not physically change, but their interior geometry is such that, relative to the plane of the straight wire, the vertical dimension within the slot continuously increases with each degree of distal crown tipping www.indiandentalacademy.com
  47. 47. • The effective vertical dimension of the tipedge bracket slot increases as the tooth tips. this eliminates binding and facilitates placement of arch wires with larger cross sections and /or third order (torque) discrepancy. www.indiandentalacademy.com
  48. 48. www.indiandentalacademy.com
  49. 49. advantages • No binding • Ease of stepping up in arch wire size • No unwanted mesial or distal root movement • No need to use nickel titanium or memory wires to avoid discomfort and /or accidental debonding in case of edgewise brackets. www.indiandentalacademy.com
  50. 50. Retraction and space closure without loss of vertical control www.indiandentalacademy.com
  51. 51. • With the conventional edgewise brackets retraction of anterior teeth especially canines results in binding and friction with only a few degree of distal crown tipping • Continued retraction and tipping can result in incisal deflection of the arch wire itself which may extrude the lateral and central incisors and lead to deepening of the bite and more gingival display.. www.indiandentalacademy.com
  52. 52. • Retraction with dynamic tipedge brackets slots result in zero binding at the same degree of tipping and continued retraction and tipping occurs without any flexing of the wire. www.indiandentalacademy.com
  53. 53. Differential anchorage • The problem of anchorage preservation remains universal regardless of the orthodontic technique used. • Simple anchorage is provided by the teeth that are free to tip in response to force application; stationary anchorage occurs with teeth that can move only bodily. • Differential anchorage is the strategic application of stationary anchorage units against simple anchorage units. www.indiandentalacademy.com
  54. 54. • Although the lack of mesiodistal control with Angle’s ribbon arch bracket was considered a drawback by many including Angle himself, the freedom of the tooth to tip actually improved anchorage control by pitting simple against the stationary anchorage. Unfortunately, there were no efficient means to upright the tipped teeth at that time. www.indiandentalacademy.com
  55. 55. • The edgewise bracket eliminated the simple anchorage potential of the anterior teeth. • Tweed and others applied differential anchorage concept with the edgewise appliance by using a series of arch wire with tip-back bends in buccal segments there by enhancing anterior retraction as well as anchorage preservation. www.indiandentalacademy.com
  56. 56. Straight wire mechanics “TOE HOLD” EFFECT www.indiandentalacademy.com
  57. 57. • In preangulated appliance ,the anterior segment shows reverse anchorage effect due to decrease in efficiency of bodily tooth repositioning. • It happens because the tooth has to move in their final axial inclinations which is determined by tip and torque already incorporated in the brackets. • This effect increases the anchorage potential of the anterior segment.-- “toe hold effect” www.indiandentalacademy.com
  58. 58. • Regardless of the bracket used , the natural tendency of the teeth in response to horizontal forces is to tip. • With edgewise brackets , this tipping creates couples that deflect the anterior portion of the archwire incisally. The deflection is even greater with straightwire appliances because of their preangulated cuspid and pretorqued incisor bracket slots (toe hold effect). www.indiandentalacademy.com
  59. 59. • In extraction treatment, this arch wire deflection results in a reverse curve of spee in the upper arch and an accentuated curve of spee in the lower arch, which restricts the ability to open a deep anterior overbite without extra-oral forces. • The same adverse vertical deflection occurs, although to a lesser extent , during non extraction treatment whenever an attempt is made to retract either arch. www.indiandentalacademy.com
  60. 60. • Attempting to control the vertical deflection of the arch wire can make treatment overly complex, requiring functional appliance, multiple arch wires, headgears, and /or orthognathic surgery. www.indiandentalacademy.com
  61. 61. • The differential straight arch technique (DSAT) (Kesling Am.J.Orthod.1988) eliminates the complex mechanics of conventional techniques and offer these advantages:• Uses only 4 straight round wire or 6 if rectangular arch wires are used in finishing stages. • Less need for functional appliances, extra-oral forces, or orthognathic surgery. • Shorter treatment time • Maximum inter-bracket distance www.indiandentalacademy.com
  62. 62. • This is made possible by the tip-edge bracket’s arch-wire slot, which allows crown tipping only in one predetermined direction. • The system uses differential anchorage for major tooth movements, reserving the straightwire concept for final finishing only. www.indiandentalacademy.com
  63. 63. www.indiandentalacademy.com
  64. 64. • In non-extraction class II treatment, the tip-edge bracket’s unidirectional limitation of tooth movement inhibits mesial movement of the mandibular dentition. • However the crowns of the max. teeth can simultaneously tip distally toward a class www.indiandentalacademy.com I occlusion.
  65. 65. www.indiandentalacademy.com
  66. 66. Stages in differential straight arch technique www.indiandentalacademy.com
  67. 67. • Treatment is divided into 3 stages STAGE I STAGE II STAGE III Each stage features a distinct set of treatment goals that must be achieved before moving on to the next . Specific arch wires and auxiliaries are employed during each stage. Mixing the goals or the use of improper arch wire or auxiliaries can lead to excessive anchorage loss, and compromised control of the vertical dimension www.indiandentalacademy.com
  68. 68. Stage I • In contrast to conventional edgewise techniques, which tend to approach correction of each aspect of a malocclusion sequentially, Stage One of the DSAT initiates treatment by addressing the correction of all major aspects simultaneously. • The goals for stage I each listed in order of importance are:www.indiandentalacademy.com
  69. 69. • (1)-Open or close the bite to an edge to edge incisal relationship while correcting any anteroposterior discrepancy. • (2)-correct anterior crowding, rotations or spacing. • (3)-correct posterior cross bite • Duration of stage 1-- -6 weeks to six months, depending upon the malocclusion. www.indiandentalacademy.com
  70. 70. Correcting Anterior Overbite: Correction of anterior deep bite allows full expression of any potential mandibular growth in correction of a Class II malocclusion.  Stage one arch wires are formed from 0.016” high tensile stainless steel wire.  In extraction treatment, arch wires are generally straight ( no vertical loops) with bite opening bends placed several millimeters mesial to the molar tube. This allows distal sliding of the arch wire as retraction of anterior teeth occurs.  www.indiandentalacademy.com
  71. 71. • During non extraction treatment some means must be provided to preserve space for the premolars, which are not engaged until after anterior overbite correction. • This can be accomplished by placing the plastic tubings over the arch wires between the canine bracket and the molar tubes or stop bends mesial to the molar tube. www.indiandentalacademy.com
  72. 72. • When anterior open bite or edge to edge incisal relationship exists at the start of treatment, the maxillary arch wire is kept straight. • Very mild bite opening bends are placed in mandibular arch (5-10°), serving only to prevent the molars from tipping mesially in response to application of Class II elastics (if overjet correction is required.) www.indiandentalacademy.com
  73. 73. www.indiandentalacademy.com
  74. 74. www.indiandentalacademy.com
  75. 75. Proper use of Class II elastics (1-2 oz. On each side) in conjunction with properly modified high tensile stainless steel wires will correct severe anterior overbites within 4-6 months of treatment. precaution: Use of excessive elastic force , or use of overly resilient wires may worsen the deep bite rather than improve it. www.indiandentalacademy.com
  76. 76. • Vertical control is one of the problems occasionally encountered in Straight wire treatment. • Two cases, Helen Taylor (AO 2003 Feb )one with deep overbite and one with anterior openbite, demonstrate the use of a Tip-Edge stage-1 wire to enhance vertical control in conjunction with Straight wire brackets and super elastic main arch wires.`` www.indiandentalacademy.com
  77. 77. • With tip edge brackets using a super elastic wire as the main wire throughout the majority of treatment, forces are kept light and canine teeth are able to translate bodily distally with minimum anchorage loss. • With the additional control afforded by the auxiliary wire, no tipping into extraction sites is seen despite the flexibility of the main arch wire. www.indiandentalacademy.com
  78. 78. Over jet / under jet correction • Accomplished simultaneously along with anterior vertical discrepancies through use of either Class II or III elastics depending on incisor relationships. • Over jet or under jet in absence of anterior overbite can be corrected with horizontal (Class I) elastics if space is available in the arch for retraction. • Advantages:• Eliminates possibility of molar extrusion. • Particularly important in high angle or anterior open bite cases. www.indiandentalacademy.com
  79. 79. • If patient incompliance is encountered with the use of class II or class III elastics, an Outrigger appliance is placed to encourage elastic wear. • This appliance provides an effective means of ensuring elastic wear. If elastics are not worn the hooks extend labially into uncomfortable positions, when elastics are engaged the hooks swing incisally into much comfortable position. www.indiandentalacademy.com
  80. 80. www.indiandentalacademy.com
  81. 81. Force vector of intrusion and retraction mechanics www.indiandentalacademy.com
  82. 82. • The force vectors involved in bite opening and anterior retraction during differential tooth movement in class II div I malocclusion have been described by Hocevar. • The independent force vectors produced by the arch wire and class II elastics were shown to combine into a single resultant vector that intrudes and retracts the max. anterior teeth. www.indiandentalacademy.com
  83. 83. • The precise manner in which these occurs is dependent on the path of the resultant vector in relation to the center of resistance of each tooth www.indiandentalacademy.com
  84. 84. • However while using differential straight arch technique, there is no need to predetermine the force vectors or the individual center of rotation for anterior teeth. • Any tendency for max. or mand.flaring is automatically checked because of bent given distal to the molar tubes. So any tendency for incisors crown to flare labially will be checked by the anchor molar themselves. www.indiandentalacademy.com
  85. 85. Anterior Alignment • When space is available distal to the canines, anterior alignment is achieved by using elastomeric ties to the arch wire through the vertical slots of the Tip Edge brackets. • The Tip Edge archwire slot allows adjacent teeth to simply tip out of the way as lingually displaced teeth are www.indiandentalacademy.com brought into position.
  86. 86. • When moderate to severe crowding is present at start of non extraction treatment, vertical loops are placed in the anterior segments of .016 inch arch wires. www.indiandentalacademy.com
  87. 87. Stage II www.indiandentalacademy.com
  88. 88. • Primary goal is the closing of posterior spaces. • It is the shortest of the three stages of Tip Edge treatment, usually completed in 2 to 3 appointments. • Patient is instructed to wear light (1.5-2 oz) Class II or Class III elastics as needed to maintain desired anterior tooth relationships. www.indiandentalacademy.com
  89. 89. • Goals of Stage Two: 1. Close remaining posterior spaces. 2. Correct or maintain dental midlines. 3. Correct posterior cross bites. 4. Achieve Class I molar relation 5. Over rotate severely rotated premolars. 6. Level anchor molars. 7. Maintain all corrections achieved in Stage One. www.indiandentalacademy.com
  90. 90. • Far less arch wire manipulation is required during stage II because the arch wire serve only to maintain the vertical and lateral corrections achieved during stage I. • To provide maximum control, round arch wires(o.022inch)high tensile stainless steel are placed in both max. and mand. arches. www.indiandentalacademy.com
  91. 91. • In mild to moderate anchorage cases, the arch wires are engaged through the occlusal rectangular molar tubes during Stage II. • This levels the premolars and molars early , easing the transition to Stage III www.indiandentalacademy.com
  92. 92. •In maximum anchorage cases, where friction within the molar tube is of concern, it is preferred to insert the arch wires through larger diameter gingival round tubes. www.indiandentalacademy.com
  93. 93. Automatic Canine Rotational Control During Retraction. www.indiandentalacademy.com
  94. 94. • With the Differential Straight Arch Technique, no canine rotation problem occurs during space closure. • This is because forces are applied not to the labial surfaces, but at the contact point with lateral incisors, which are moved distally along with centrals by the arch wire. www.indiandentalacademy.com
  95. 95. Stage II breaking mechanics • Some time abundant space is present in the mandibular arch, due to cogenital missing teeth, microdontia or extraction in border line cases . • In such cases over retraction of the anteriors is not desired. www.indiandentalacademy.com
  96. 96. • Application of mechanical brakes, (Sidewinder springs) on premolars, canines and incisors, in conjunction with . 022” round wire or 0.0215x0.028 inch rectangular wire turn them into a larger anchor unit that can drag the posterior teeth forward using strong horizontal force(6-8 oz). www.indiandentalacademy.com
  97. 97. Stage III • Goal:• Upright the roots of all the teeth to ideal mesio-distal and labiolingual inclinations. • Maintain all the corrections achieved in the first two stages. • It is the longest stage of the treatment. • Non-extraction case -6 months and extraction cases-9-12 months www.indiandentalacademy.com
  98. 98. • The same 0.022 inch arch wire used during stage II or full size 0.0215-0.028 inch rectangular wire are used during this stage. • Stage III auxiliaries:--all individual tooth movement are accomplished using these auxiliaries. Side winder uprighting spring Torquing auxiliaries www.indiandentalacademy.com Clock wise Counterclock wise
  99. 99. • Torquing of maxillary incisor roots are done by nickel titanium torque bars. These are curved ribbon arch sections of 0.022 -0.018 inch dimensions with 30 degree of torque. • These auxiliaries are virtually invisible when in place because they are present directly behind the arch wire. www.indiandentalacademy.com
  100. 100. • For use of Torque Bars, special Deep Groove Brackets are used on the maxillary central incisors. • These feature conventional preadjusted Edgewise arch wire slots cast into the bottom of Tip Edge arch wire slots. • A cap fills the Deep Groove in Stages One and Two. This is removed at beginning of Stage Three , and a Torque bar ligated tightly lingual to the round base arch wire www.indiandentalacademy.com
  101. 101. A. Standard Tip-Edge bracket. B. "Deep Groove" version for maxillary incisors, featuring conventional edgewise slot that is filled with special cap to keep arch wire in outer slot during Stages I and II. C. Cap is removed for Stage III and deep groove used to engage nickel titanium torquing auxiliary under main arch wire. www.indiandentalacademy.com
  102. 102. • For torquing of individual teeth, an Individual Root Torquing Auxiliary is used. • These are often used with Ceramic Tip Edge brackets, which do not have the Deep groove feature. www.indiandentalacademy.com
  103. 103. • Significant anchorage strain only occurs during uprighting and torquing. • However at this point in treatment the occlusion is class I with no spacing and ideal overjet and overbite relationships. • This allows for excellent control of anchorage with no need for extra oral reinforcement. www.indiandentalacademy.com
  104. 104. finishing Rectangular arch wire approach Round wire approach www.indiandentalacademy.com
  105. 105. • Round Wire Approach: • Reserved for severe A-P skeletal discrepancies, as they permit maxillary and/or mandibular teeth to assume compensating labiolingual inclinations. • Also used when patient does not need molar torque or selective labiolingual root positioning of canines or mandibular incisors. • In such cases, torque to maxillary incisors could be provided by Torque bars. www.indiandentalacademy.com
  106. 106. • The relatively heavy forces from uprighting springs and torquing auxiliaries are applied to the teeth only after all teeth are in proximal contact, or contiguous. When the crowns of teeth are inclined distally, these reciprocal forces will reinforce anchorage as the teeth are initially urged distally against the anchor molars during the early phase of uprighting. • Kesling refers to this as Contiguously Reciprocal Uprighting. www.indiandentalacademy.com
  107. 107. Rectangular arch wire approach • Their practicality in Stage Three was demonstrated by Richard Parkhouse. • Strongest indications are: Generalized and individual torquing requirements, such as for molars, canines, mandibular incisors. • Molar torque is nearly impossible to achieve with round wire. • Placement of Sidewinder springs on all other teeth in conjunction with rectangular wire, automatically torques them. • For full torque expression, full size rectangular wires, . 0215 x. 028 ” are used. www.indiandentalacademy.com
  108. 108. Recent advances— tip-edge PLUS bracket (JCO Feb 2006) • The traditional procedure for treating class I crowded cases requires the application of force to create spaces before a flexible wire can be inserted for alignment. • Conventional appliances need extra ligatures to be used over the main arch wire however which adds chair time. www.indiandentalacademy.com
  109. 109. • Tip edge PLUS brackets offers a way to use overlay mechanics with reduced friction by combining two slots -standard tip –edge slot which can accommodate a wire as large as .022 -.028 inch and a hidden deep tunnel which accepts wire as large as .018 inch. • The space opening and alignment can be performed simultaneously thus reducing the treatment time. www.indiandentalacademy.com
  110. 110. www.indiandentalacademy.com
  111. 111. Use of tip edge PLUS bracket in class II and class III nonextraction treatment (JCO July 2006) • In conventional non extraction treatment, using elastics for anchorage, it is difficult to maintain the incisor position. the most common solution in edgewise mechanics has been to place a full size arch wire as early in the treatment as possible which makes the leveling and alignment difficult. • Overlay mechanics can efficiently resolve this problem but it is often unaesthetic. www.indiandentalacademy.com
  112. 112. www.indiandentalacademy.com
  113. 113. EFFICIENCY IN BONE DEFECT CASES (JCO, 1998 Feb ) www.indiandentalacademy.com
  114. 114. • Patients with repaired alveolar clefts can be difficult to treat orthodontically. • In cleft lip and palate cases with inadequate grafting, the average 2nd- and 3rd-order bracket prescriptions in Preadjusted appliances may be particularly inappropriate. www.indiandentalacademy.com
  115. 115. The Tip-Edge appliance has several advantages in these situations • Selective 2nd-order tipping is possible, and further control can be gained by “power-tipping” with auxiliary springs. • Although a range of tipping movements are possible, extreme tipping is prevented by the “self-limiting” bracket prescription. • The bracket torque prescription can be circumvented by the use of round wires, or applied progressively using rectangular wires and auxiliary springs. www.indiandentalacademy.com
  116. 116. Mesial tipping of maxillary left canine, with limited alveolar bone mesial to canine root. After controlled mesial root uprighting with Tip-Edge bracket and Side-Winder spring. www.indiandentalacademy.com
  117. 117. conclusion • By addressing the limitations of edgewise appliance from a fresh perspective—identifying the bracket slot as the source of anchorage problems-the Tip-edge concept produced the first edgewise appliance to allow the use of differential tooth movement, without sacrificing the precise finishing of edgewise therapy. • Major tooth repositioning and apical base correction can be accomplished with simplified mechanics and very light intra oral forces. www.indiandentalacademy.com
  118. 118. • The tip-edge appliance may not be the most popular appliance today but it has certainly provided an opportunity to both Begg and Edgewise practitioners to come closer, to a common more versatile appliance system. www.indiandentalacademy.com
  119. 119. • References:---1.Kesling P.C.-:Dynamics of the Tip-Edge bracket, Am.J.Orthod. 1989.vol.96,page:16-28, 2.Kesling CK. -The Tip Edge concept: eliminating unnecessary anchorage strain.J Clin Orthod1992 March;vol.XXXVI.NO.3:Page.165-178. 3.Kaku J, Arimoto H, Sinohara N, Greenfield R.-- Use of Tip Edge Brackets to reduce posterior anchorage requirements after molar distalization.-- J Clin Orthod 2004;38; 320-324. www.indiandentalacademy.com
  120. 120. 4.Kesling CK.------A simplified means of engaging the outrigger appliance-JCO2006 March.vol;XL.NO.3.page.150-151 5.Kim YH.-- Anterior openbite malocclusion: nature, diagnosis and treatment by means of multiloop edgewise archwire technique. Angle Orthod. 1987;vol. 57:page,290–321. 6.Kesling PC, Rocke RT, Kesling CK.-Treatment with Tip-Edge brackets and differential tooth movement. --Am J Orthod Dentofacial Orthop. 1991; 99: page.387– 402. www.indiandentalacademy.com
  121. 121. 7. Begg PR, Kesling PC. --The differential force method of orthodontic treatment. --Am J Orthod. 1977;vol. 71:page.1–39. 8.Greenfield R.--- Simultaneous torquing and intrusion auxiliary.- J Clin Orthod. 1993; vol.27, page:305–318. 9.TM Graber, RL Vanarsdall Jr--Orthodontics:Current Principles and techniques.-- 3rd edn, Mosby, 2000. Page.721-748. www.indiandentalacademy.com
  122. 122. 10.Galicia-Ramos, Killiany D, Kesling PC. --A Comparison of Standard Edgewise, Preadjusted Edgewise,and Tip-Edge in Class II Extraction Treatment.-- J Clin Orthod 2001;35:page.145-53. 11.Helen Taylor ---- Use of a Tip-Edge Stage-1 Wire to Enhance Vertical Control During Straight Wire Treatment: Two Case Reports--The Angle Orthodontist: 2003 Feb -Vol. 73, No. 1, page. 93–99. www.indiandentalacademy.com
  123. 123. 12.Kesling CK—Differential anchorage and the edgewise appliance—JCO 1989 June. vol— XXIII,No.6,page;402-409. 13.ROBBIE LAWSON, --Use of Tip-Edge Brackets in Patients with Repaired Alveolar Clefts-- JCO, 1998 Feb vol .XXXII ,no.2 page (84 - 88): 14.Praveen Mishra, Ashima Valiathan—Fixed orthodontic techniques-J Nep Med Assoc.1995 Oct-Dec,VOL.33,PAGE.391-397. www.indiandentalacademy.com
  124. 124. 15.John K. Kaku ----Overlay mechanics with the tip edge PLUS bracket—JCO 2006 Feb ,Vol. page-81-82. 16.Kesling,P.C.:Expanding the horizons of the edgewise arch wire slot, Am.J.Orthod 1988 July; vol.94;page:26-37 17.Jayne E. Harrison---Early experience with the tip-edge appliance.—BJO1998 Feb Vol.25,no-1,page-1-9. www.indiandentalacademy.com
  125. 125. 18.Lawrence P, Fine H, Cisneros G.-- Canine retraction: A comparison of two preadjusted bracket systems. --AJODO 1996August,vol;110,no-2,page: 191-196. 19.Shelton C, Cisneros G, Nelson S. --Decreased treatment time due to changes in technique and practice philosophy. --AJO-DO 1994,Dec; vol106,page:654-57. 20.Parkhouse R, Parkhouse P. --The Tip Edge torquing mechanism: a mathematical validation.-AJO DO 2001june,vol;119:page.632-639. www.indiandentalacademy.com
  126. 126. 21.Rocke RT. Employing Tip-Edge brackets on canines to simplify straight-wire mechanics. AJO DO 1994;106:341-50. 22.Jiuxiang Lin et al-- Lower Second Molar Extraction in Correction of Severe Skeletal Class III Malocclusion --The Angle Orthodontist: 2006 Feb ,Vol .76, No. 2, page. 217–225. 23. John K. Kaku ----Overlay mechanics with the tip edge PLUS bracket part-2 —JCO 2006 JULY.vol.XL,no.7 page.436-444. www.indiandentalacademy.com
  127. 127. Thank you For more details please visit www.indiandentalacademy.com www.indiandentalacademy.com

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