Tweed merrifield /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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Tweed merrifield /certified fixed orthodontic courses by Indian dental academy

  1. 1. TWEED- MERRIFIELD EDGEWISE PHILOSOPHY INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com www.indiandentalacademy.com
  2. 2. CONTENTS  HISTORY OF EVOLUTION  ANGLE’S PHILOSOPHY  TWEED PHILOSOPHY  TWEED – MERRIFIELD PHILOSOPHY  APPLICATION OF PHILOSOPHY INTO PRACTICE  CONCLUSION www.indiandentalacademy.com
  3. 3. ANGLE- TWEED- MERRIFIELD LEGACY www.indiandentalacademy.com
  4. 4. EDWARD HARTLEY ANGLE www.indiandentalacademy.com
  5. 5. www.indiandentalacademy.com
  6. 6. E ARCH APPLIANCE www.indiandentalacademy.com
  7. 7. PIN AND TUBE APPLIANCE www.indiandentalacademy.com
  8. 8. RIBBON ARCH APPLIANCE www.indiandentalacademy.com
  9. 9. EDGEWISE APPLIANCE www.indiandentalacademy.com
  10. 10. EDGEWISE OPENFACE TIE BRACKETS www.indiandentalacademy.com
  11. 11. EVOLUTION OF THE EDGEWISE CONCEPT www.indiandentalacademy.com
  12. 12. ANGLE’S CONCEPT OF AN APPLIANCE SIMPLE- PUSH, PULL, ROTATIONS  STABLE - FIXED TO TEETH  EFFICIENT- PROVIDE ANCHORAGE  DELICATE - ACCEPTED BY TISSUES  INCONSPICUOUS - ESTHETIC  www.indiandentalacademy.com
  13. 13. THE RIBBON ARCH WAS NOT CAPABLE OF AN EN MASSE TOOTH MOVEMENT. HENCE THIS BECAME HIS MOTIVATION. THE EDGEWISE BRACKET CAME INTO EXISTENCE IN 1925.THE BRACKET SLOT WAS PLACED HORIZONTALLY WITH A RECTANGULAR SLOT HAVING A .022 BY .028 INCH DIMENSION. www.indiandentalacademy.com
  14. 14. THE ARCHWIRE WAS HELD IN POSITION FIRST BY A BRASS LIGATURE AND LATER BY DELICATE STAINLESS STEEL LIGATURE.THE ARCHWIRE WAS GOLD ARCHWIRE. THE NEW DESIGN PROVIDED MORE ACCURACY AND A MORE EFFICIENT TORQUING MECHANISM. www.indiandentalacademy.com
  15. 15. ANGLE’S EDGEWISE PHILOSOPHY INCORPORATED THE NON-EXTRACTION PROTOCOL THEREFORE CLOSING OF SPACES IN THE POSTERIOR SEGMENTS WAS A PROBLEM. ANTEROPOSTERIOR CORRECTION DIFFICULT TO ACCOMPLISH. PROCLINATION OF ANTERIOR TEETH WAS COMMON. CROWNS TENDED TO TIP MESIALLY. www.indiandentalacademy.com
  16. 16. ANGLE SUGGESTED THAT AS LONG AS THE APPLIANCE WAS UTILISED TO ITS MAXIMUM POTENTIAL……. MILD PROCLINATION IS INEVITABLE AND SHOULD NOT BE A CAUSE OF DISTRESS. ANTERO POSTERIOR PROBLEMS COULD BE RECTIFIED BY TIPPING THE CROWNS DISTALLY. www.indiandentalacademy.com
  17. 17. ANGLE FOUND A CAPABLE MAN IN CHARLES TWEED TO CONTINUE WHERE HE HAD LEFT . HENCE THE LEGACY OF THE EDGEWISE APPLIANCE PASSED OVER FROM ANGLE TO TWEED WITH THESE LAST WORDS.. ‘ I HAVE FINISHED MY WORK,IT IS AS PERFECT AS I CAN MAKE IT.’ www.indiandentalacademy.com
  18. 18. TWEED PHILOSOPHY www.indiandentalacademy.com
  19. 19. CHARLES H.TWEED www.indiandentalacademy.com
  20. 20. TWEED WOULD OVER THE COURSE OF TIME REVOLUTIONISE EDGEWISE PHILOSOPHY IN A MOST RADICAL WAY. ALTHOUGH INITIALLY CALLED THE ‘TRAITOR OF ANGLE’, BY HIS ADVOCACY OF FIRST PREMOLAR EXTRACTIONS WHICH WAS DEEMED A HERESY BACK THEN…….. www.indiandentalacademy.com
  21. 21. HE BECAME A LEGACY FOR ALL TO FOLLOW WITH HIS CONCEPT OF:  EXTRACTIONS  UPRIGHTING OF TEETH OVER BASAL BONE.  APPLICATION OF CEPHALOMETRICS.  DIAGNOSTIC FACIAL TRIANGLE.  ANCHORAGE PREPARATION.  SERIAL EXTRACTION IN MIXED DENTITION.  GROWTH TRENDS www.indiandentalacademy.com
  22. 22. DIAGNOSTIC FACIAL TRIANGLE www.indiandentalacademy.com
  23. 23. FOUR ESSENTIAL ANGLES CONSIDERED FRANKFORT MANDIBULAR PLANE ANGLE OR FMA ( 25 DEGREES)  MANDIBULAR INCISOR PLANE ANGLE OR IMPA ( 90 DEGREES)  FRANKFORT MANDIBULAR INCISOR ANGLE OR FMIA (65 DEGREES)  POINT A – NASION – POINT B OR ANB( O TO 5 DEGREES)  www.indiandentalacademy.com
  24. 24. ANCHORAGE PREPARATION FIRST DEGREE ANCHORAGE PREPARATION ANCHORAGE PREPARATION NOT CRITICAL WHEN ANB RANGES FROM 0 TO 4 DEGREES AND FACIAL ESTHETICS IS GOOD. TERMINAL MANDIBULAR MOLARS MUST BE JUST UPRIGHT TO PREVENT ELONGATION BY CLASS II ELASTICS. www.indiandentalacademy.com
  25. 25. SECOND DEGREE ANCHORAGE PREPARATION ANCHORAGE PREPARATION NECESSARY AS ANB IS ABOVE 4.5 DEGREES AND FACIAL ESTHETICS NOT GOOD. DISTAL RIDGE OF TERMINAL MOLARS MUST BE TIPPED TO GUM LEVEL AND DIRECTION OF CLASS II ELASTICS MUST BE GREATER THAN 90 DEGREES SO AS TO FURTHER DEPRESS IT. www.indiandentalacademy.com
  26. 26. THIRD DEGREE OR TOTAL ANCHORAGE PREPARATION ANB NOT GREATER THAN 5 DEGREES AND BIMAXILLARY PROTRUSION. DISTAL TIPPING OF TERMINAL SECOND MOLARS TO BELOW GUM LEVEL.FIRST MOLARS AND SECOND PREMOLARS ALSO DISTALLY TIPPED TO AUGMENT ANCHORAGE. www.indiandentalacademy.com
  27. 27. GROWTH TRENDS TYPE A GROWTH TREND  CHARACTERISED BY MIDDLE AND LOWER FACE GROWING DOWNWARD IN UNISON WITH NO CHANGE IN ANB.  IF ANB NOT MORE THAN 4.5 DEGREES,NO TREATMENT INDICATED. www.indiandentalacademy.com
  28. 28. TYPE A SUBDIVISION MOLAR RELATIONSHIP CLASS II WITH ANB GREATER THAN 4.5 DEGREES.  RESTRAIN MAXILLARY GROWTH WITH KLOEHN HEADGEAR .  PROGNOSIS IS GOOD.  TREATMENT COMPLETED IN 15 TO 21 MONTHS.  www.indiandentalacademy.com
  29. 29. TYPE B GROWTH TREND  ANB 6 TO 12 DEGREES  MIDDLE FACIAL HEIGHT GROWTH FASTER THAN LOWER FACIAL HEIGHT.  PROGNOSIS POOR.  ALL FOUR FIRST PREMOLAR EXTRACTION AND KLOEHN HEADGEAR  TREATMENT TIME 36 TO 42 MONTHS. www.indiandentalacademy.com
  30. 30. TYPE C GROWTH TREND  LOWER FACE GROWS FASTER THAN MIDDLE FACE.  MANDIBULAR INCISOR LINGUAL TIPPING OR MAXILLARY INCISOR LABIAL FLARING CAN OCCUR.  CUSPID TO CUSPID LINGUAL BAR WITH MAXILLARY RETAINER GIVEN.  PROGNOSIS EXCELLENT  TREATMENT TIME 10 TO 15 MONTHS. www.indiandentalacademy.com
  31. 31. TYPE C SUBDIVISON  WHEN GROWTH IS PREDOMINANTLY HORIZONTAL WITH A DECREASED FMA ANGLE.  LITTLE VERTICAL GROWTH OCCURS. www.indiandentalacademy.com
  32. 32. HIS PHILOSOPHY INCORPORATED:  POSITION AND ARRANGE TEETH FOR MAXIMAL FACIAL AND DENTAL ESTHETICS AND FUNCTIONAL EFFICIENCY.  HEALTH OF TEETH,JAWS,JOINTS,SURROUNDING TISSUES MUST BE MAINTAINED.  STABLITY  HARMONISE CORRECTION OF NORMAL GROWTH PROCESSES. www.indiandentalacademy.com
  33. 33.  MAXIMISE COMPENSATION FOR LESS THAN NORMAL GROWTH PATTERNS.  POSITION THE DENTITION SO THAT IT IS IN A CONTINUAL STATE OF HARMONY WITH ITS ENVIRONMENT. www.indiandentalacademy.com
  34. 34. DRAWBACKS OF THE TWEED PHILOSOPHY www.indiandentalacademy.com
  35. 35.  HE CONCENTRATED ON THE ANTEROPOSTERIOR AND VERTICAL TREND OF GROWTH ON THE BASIS OF WHICH HE FORMULATED THE GROWTH TRENDS.  EN MASSE TOOTH MOVEMENT DID NOT NECESSARILY TRANSLATE INTO PRECISON AND CONTROL. www.indiandentalacademy.com
  36. 36.  MANDIBULAR ANCHORAGE WAS PREPARED WITH CLASS III ELASTICS AND WITH ALL COMPENSATION BENDS PLACED IN ARCH WIRE AT ONE TIME RESULTING IN LABIALLY FLARED AND INTRUDED MANDIBULAR INCISORS AS A SEQUELAE. www.indiandentalacademy.com
  37. 37. TWEED NAMED LEVERN MERRIFIELD AS HIS SUCCESSOR TO GUIDE THE RAPIDLY EXPANDING AND SUCCESSFUL TWEED STUDY COURSE IN TUCSON , ARIZONA. THE PITFALLS OF THE TWEED PHILOSOPHY WHERE TO BE RECTIFIED BY HIM AND WAS SUBSEQUENTLY KNOWN AS THE ‘ TWEED-MERRIFIELD PHILOSOPHY’ www.indiandentalacademy.com
  38. 38. TWEED- MERRIFIELD PHILOSOPHY www.indiandentalacademy.com
  39. 39. LEVERN MERRIFIELD www.indiandentalacademy.com
  40. 40. MERRIFIELD INTRODUCED THE TWEED MERRIFIELD PHILOSOPHY BY ADDING A SEVENTH OBJECTIVE  ALL CLINICAL OBJECTIVES MUST BE PURSUED IN AN ETHICAL ,MORAL AND COMPASSIONATE MANNER WITH AN OVER RIDING CONCERN FOR THE PUBLIC’S WELFARE. www.indiandentalacademy.com
  41. 41. THE TWEED MERRIFIELD IS BASED ON FOUR FUNDAMENTAL PILLARS OR PREMISES. THEY ARE: AN ANTERIOR LIMIT EXISTS.THE TEETH MUST NOT BE PLACED FORWARD OF BASAL BONE.  A POSTERIOR LIMIT EXISTS.  A LATERAL LIMIT EXISTS. ANY POSITION BEYOND THIS RESULTS IN A RELAPSE.  A VERTICAL LIMIT EXISTS. FACIAL BALANCE AND HARMONY CAN BE LOST AS RESULT.  www.indiandentalacademy.com
  42. 42. BROAD PARAMETERS OF THE TWEEDMERRIFIELD PHILOSOPHY INCLUDE:  ASSESSING THE DIMENSIONS OF THE LOWER FACE.  TOTAL SPACE ANALYSIS.  ASSESSING AREAS OF SKELETAL,FACIAL AND DENTAL DISHARMONY.  DIRECTIONAL CONTROL DURING TREATMENT www.indiandentalacademy.com
  43. 43.  SEQUENTIAL TOOTH MOVEMENT.  SEQUENTIAL MANDIBULAR ANCHORAGE PREPARATION. www.indiandentalacademy.com
  44. 44. DIFFERENTIAL DIAGNOSIS  FACIAL DISHARMONIES  DENTAL DISHARMONIES  CRANIAL DISHARMONIES  ENVIRONMENTAL DISHARMONIES www.indiandentalacademy.com
  45. 45. FACIAL DISHARMONIES THREE FUNDAMENTAL FACTORS INFLUENCE FACIAL BALANCE:  POSITONS OF TEETH  SKELETAL PATTERN  SOFT TISSUE THICKNESS www.indiandentalacademy.com
  46. 46.  TOOTH POSITON PLAYS A FUNDAMENTAL ROLE IN FACIAL BALANCE.  MAXILLARY INCISOR POSITION IS DIRECTLY RELATED TO POSITION OF MANDIBULAR INCISORS. THIS CAN BE DIAGNOSED BY EQUATING THE UPPER LIP MEASUREMENT TO THAT OF THE LOWER CHIN. www.indiandentalacademy.com
  47. 47. UPPER LIP THICKNESS IS MEASURED FROM THE GREATEST CURVATURE OF THE LABIAL SURFACE OF THE CENTRAL INCISOR TO VERMILION BORDER OF UPPER LIP. TOTAL CHIN THICKNESS IS MEASURED HORIZONTALLY FROM NB LINE EXTENDED TO SOFT TISSUE POGONION. www.indiandentalacademy.com
  48. 48. UPPER LIP = TOTAL CHIN www.indiandentalacademy.com
  49. 49. TWO ANGLES ARE USED TO QUANTIFY FACIAL BALANCE: Z ANGLE IDEALLY THE Z LINE MUST BE TANGENT TO THE CHIN AND THE VERMILION BORDER OF BOTH LIPS AND SHOULD BISECT THE NOSE.IT SHOULD PROCEED TO JOIN THE FRANKFORT PLANE AT AN ANGLE OF 75 TO 78 DEGREES. www.indiandentalacademy.com
  50. 50. FMIA ANGLE THE FMIA SHOULD CORRESPOND TO AN ANGLE OF 65 DEGREES . www.indiandentalacademy.com
  51. 51. A BALANCED FACE CORRESPONDING TO Z ANGLE AND FMIA ANGLE www.indiandentalacademy.com
  52. 52. CRANIAL DISHARMONIES THE FOLLOWING READINGS WERE TAKEN INTO ACCOUNT TO ASSESS CRANIAL DISHARMONIES :  SNA : 80- 84 DEGREES  SNB : 78- 82 DEGREES  ANB : 1- 5 DEGREES  AO- BO : 0-4 MM www.indiandentalacademy.com
  53. 53.  OCCLUSAL PLANE TO FRANKFORT HORIZONTAL PLANE : 8- 12 DEGREES  FACIAL HEIGHT INDEX PFH X 100 = 69% OF AFH. AFH A RANGE OF 65 TO 75% WAS FOUND TO BE ACCEPTABLE. www.indiandentalacademy.com
  54. 54. FACIAL HEIGHT CHANGE RATIO: FACIAL HEIGHT CHANGE WAS ASSESSED DURING THE COURSE OF TREATMENT. A RATIO OF TWO TIMES AS MUCH PFH INCREASE THAN AFH INCREASE DURING TREATMENT WAS IDEAL FOR CORRECTION OF CLASS II DIV 1 AND DENTOALVEOLAR PROTRUSIONS. www.indiandentalacademy.com
  55. 55. www.indiandentalacademy.com
  56. 56. DENTAL DISHARMONIES TOTAL SPACE ANALYSIS DIVIDED INTO THREE PARTS:  ANTERIOR  MIDARCH  POSTERIOR www.indiandentalacademy.com
  57. 57. ANTERIOR SPACE ANALYSIS MEASUREMENT TAKEN FROM MANDIBULAR CANINE TO CANINE.ALSO MESIODISTAL DIAMETER OF SIX ANTERIOR TEETH TAKEN. THE DIFFERENCE GIVES IDEA OF SURPLUS OR DEFICIT.  LATERAL HEAD FILM DISCREPANCY TAKEN INTO ACCOUNT.IT IS THE AMOUNT OF SPACE REQUIRED TO POSITION THE MANDIBULAR INCISORS FOR FACIAL BALANCE.  TOTAL CHIN THICKNESS MUST EQUAL UPPER LIP THICKNESS.HENCE SOFT TISSUE BALANCE OBTAINED.  www.indiandentalacademy.com
  58. 58. THUS THE SUM OF ANTERIOR TOOTH ARCH SURPLUS OR DEFICIT,LATERAL HEADFILM DISCREPANCY AND SOFT TISSUE IMBALANCE IS COMBINED TO ESTIMATE THE ANTERIOR DISCREPANCY. EACH OF THE VALUES IS ASSIGNED A DIFFICULTY FACTOR. www.indiandentalacademy.com
  59. 59. MIDARCH SPACE ANALYSIS  INCLUDES MANDIBULAR FIRST MOLARS AND FIRST AND SECOND PREMOLARS.  AVAILABLE MIDARCH SPACE: DISTAL OF CANINE TO DISTAL OF FIRST MOLAR.TO THIS ADD THE SPACE REQUIRED TO LEVEL THE CURVE OF SPEE. www.indiandentalacademy.com
  60. 60.  OCCLUSAL DISHARMONY: ARTICULATE THE CASTS AND USE MAXILLARY FIRST PREMOLAR AS REFERENCE.MEASURE MESIALLY OR DISTALLY FROM BUCCAL CUSP OF MAXILLARY FIRST PREMOLAR TO EMBRASURE BETWEEN MANDIBULAR FIRST AND SECOND PREMOLARS.MEASUREMENT DONE ON BOTH SIDES AND AVERAGED.THE AVERAGED VALUE IS THEN DOUBLED AND ADDED TO MIDARCH DIFFICULTY. www.indiandentalacademy.com
  61. 61. POSTERIOR SPACE ANALYSIS MEASURED FROM THE DISTAL OF MANDIBULAR FIRST MOLAR TO ANTERIOR BORDER OF RAMUS ALONG THE OCCLUSAL PLANE. THIS MEASUREMENT MUST TAKE INTO CONSIDERATION THE AGE AND GENDER OF THE PATIENT AS WELL. www.indiandentalacademy.com
  62. 62. VARIABLES TO BE TAKEN INTO ACCOUNT WHEN ASSESSING POSTERIOR SPACE ARE:  RATE OF MESIO-OCCLUSAL MIGRATION OF MANDIBULAR FIRST MOLAR.  RATE OF RESORPTION OF ANTERIOR BORDER OF RAMUS.  TIME OF CESSATION OF MOLAR MIGRATION. www.indiandentalacademy.com
  63. 63.  TIME OF CESSATION OF RAMUS RESORPTION.  GENDER  AGE. www.indiandentalacademy.com
  64. 64. APPLICATION OF PHILOSOPHY INTO PRACTICE www.indiandentalacademy.com
  65. 65. THE TWEED MERRIFIELD APPLIANCE IS ESSENTIALLY CONSISTS OF .022 EDGEWISE SLOTS WITH  DOUBLE WIDTH BRACKETS ON THE SIX ANTERIOR TEETH.  INTERMEDIATE SINGLE WIDTH BRACKETS ON PREMOLARS.  TWIN BRACKETS ON THE FIRST MOLARS.  .022 TUBES WITH MESIAL HOOKS ON THE SECOND MOLARS. www.indiandentalacademy.com
  66. 66. TWEED MERRIFIELD EDGEWISE APPLIANCE www.indiandentalacademy.com
  67. 67.  TWEED INITALLY USED 12 SETS OF ARCHWIRES.MERRIFIELD REDUCED IT TO FOUR TO FIVE SETS OF ARCH WIRES THE DIMENSIONS OF WIRE COMMONLY USED WERE :  .017X .022  .018X .025  .019X .025  .020X .025  .021X .028 www.indiandentalacademy.com
  68. 68. FIVE CONCEPTS OF TREATMENT PHILOSOPHY  SEQUENTIAL BANDING OR BONDING.  SEQUENTIAL TOOTH MOVEMENT.  SEQUENTIAL MANDIBULAR ANCHORAGE PREPARATION.  DIRECTIONAL FORCE APPLICATION.  PROPER TIMING OF TREATMENT. www.indiandentalacademy.com
  69. 69. SEQUENTIAL BANDING OR BONDING THE TERMINAL MOLARS ARE BANDED,THE SECOND PREMOLARS AND CANINES.INCISORS CAN BE EITHER BANDED OR BONDED. ADVANTAGES :  LESS TRAUMATIC TO PATIENT.  EASIER AND LESS TIME CONSUMING FOR THE ORTHODONTIST www.indiandentalacademy.com
  70. 70. LONGER INTERBRACKET LENGTH FOR THE ARCHWIRE.HENCE CREATES A POWER STORAGE IN THE WIRE THAT ACCOMPLISHES THE OBJECTIVES RAPIDLY.  ORTHODONTIST CAN INSERT A WIRE OF LARGER DIMENSION THAT IS LESS SUBJECT TO BRACKET ENGAGEMENT DISTORTION.  MAXILLARY MOLARS ARE BANDED AFTER ONE MONTH.THE MANDIBULAR MOLARS AFTER SECOND VISIT.LATER LATERAL INCISORS CAN BE BANDED OR BONDED DEPENDING ON PROGRESS. www.indiandentalacademy.com
  71. 71. www.indiandentalacademy.com
  72. 72. www.indiandentalacademy.com
  73. 73. SEQUENTIAL TOOTH MOVEMENT  EN MASSE TOOTH MOVEMENT NOT DONE.  TEETH MOVED INDIVIDUALLY OR IN SMALL UNITS. ADVANTAGES :  MORE RAPID TOOTH MOVEMENT.  MORE PRECISION INVOLVED. www.indiandentalacademy.com
  74. 74. SEQUENTIAL MANDIBULAR ANCHORAGE PREPARATION INSTEAD OF CLASS III ELASTICS TWEED OPTED FOR HIGH PULL GEAR FOR ANCHORAGE PREPARATION.  THE 10-2 SYSTEM WAS INCORPORATED TO BETTER AUGMENT ANCHORAGE. TEN TEETH WERE USED AS ANCHORS TO TIP TWO TEETH. ADVANTAGE:  NO LABIAL FLARING OF MANDIBULAR INCISORS.  NO INTRUSION.  www.indiandentalacademy.com
  75. 75. DIRECTIONAL FORCES THIS CONCEPT LED TO THE EVOLUTION OF MERRIFIELD’S ‘ SEQUENTIAL DIRECTIONAL FORCE TECHNOLOGY’ DIRECTIONAL FORCES ARE DEFINED AS CONTROLLED FORCES WHICH PLACE THE TEETH IN THE MOST HARMONIOUS RELATIONSHIP WITH THEIR ENVIRONMENT. www.indiandentalacademy.com
  76. 76. THE RESULTANT VECTOR OF ALL FORCE SYSTEMS MUST BE UPWARD AND FORWARD SO THAT THE OPPURTUNITY TFOR FAVOURABLE SKELETAL CHANGE IS ENHANCED.  SUCH A SYSTEM REAUIRES THAT THE MANDIBULAR INCISOR BE UPRIGHT OVER THE BASAL BONE SO THAT THE MAXILLARY INCISOR CAN BE MOVED DISTALLY AND SUPERIORLY.  FOR THIS TO BE A REALITY, VERTICAL CONTROL IS CRITICAL.  www.indiandentalacademy.com
  77. 77. SEQUENTIAL DIRECTIONAL FORCE www.indiandentalacademy.com
  78. 78. TIMING OF TREATMENT TREATMENT MUST BE INITIATED AT A TIME WHEN THE TREATMENT OBJECTIVES CAN BE READILY ACCOMPLISHED.  INTERCEPTIVE TREATMENT IN MIXED DENTITION  SERIAL EXTRACTIONS IN MIXED DENTITION  WAITING FOR SECOND MOLAR ERUPTION DIAGNOSTIC DISCRETION IS PARAMOUNT. www.indiandentalacademy.com
  79. 79. INCORPORATION OF FORCE SYSTEMS INTO THE PHILOSOPHY www.indiandentalacademy.com
  80. 80. FIRST ORDER BENDS www.indiandentalacademy.com
  81. 81.  THESE BENDS PROVIDE FOR BUCCOLINGUAL MOVEMENTS OF TEETH  BENDS ARE INCORPORATED IN THE HORIZONTAL PLANE .  THESE BENDS PROVIDE FOR EXPANSION OR CONTRACTION OF THE ARCH AS THE NEED ARISES. www.indiandentalacademy.com
  82. 82. www.indiandentalacademy.com
  83. 83. SECOND ORDER BENDS www.indiandentalacademy.com
  84. 84. THESE BENDS PROVIDE FOR MESIO-DISTAL TIPPING OF TEETH AS AND WHEN REQUIRED.  BENDS ARE INCORPORATED IN THE ARCH WIRE IN THE VERTICAL PLANE AS TIP- BACK BENDS.  BENDS MADE IN THE POSTERIOR SEGMENT OF THE MANDIBULAR ARCH ARE ANTAGONISTIC TO ANTERIOR TEETH  LABIAL FLARING AND INTRUSION ARE THE SEQUELAE IF ALL BENDS ARE PLACED AT ONE GO.  www.indiandentalacademy.com
  85. 85.  SECOND ORDER BENDS MADE IN THE POSTERIOR SEGMENT OF THE MAXILLARY ARCH ARE COMPLIMENTARY TO THAT OF ANTERIOR SEGMENT.  INTRUSION AND LINGUAL ROOT TORQUE OCCUR ON THE MAXILLARY INCISORS . www.indiandentalacademy.com
  86. 86. www.indiandentalacademy.com
  87. 87. THIRD ORDER BENDS www.indiandentalacademy.com
  88. 88.  THIRD ORDER BENDS ARE GIVEN TO EFFECT ROOT TORQUE,BE IT BUCCAL OR LINGUAL.  TWO RIBBON ARCH PLIERS ARE UTILISED.ONE TO HOLD THE WIRE.THE OTHER TO INCORPORATE THE DESIRED TORQUE.  IN THE MANDIBULAR ARCH,INCORPORATION OF TORQUE IS COMPLIMENTARY TO THE ANTERIOR AND POSTERIOR SEGMENTS www.indiandentalacademy.com
  89. 89.  IN THE MAXILLARY ARCH,THIRD ORDER BENDS PROVE TO BE ANTAGONISTIC AS LITTLE OR NO TORQUE IS REQUIRED IN THE ANTERIOR SEGMENT AND HENCE ANY TORQUE IN THIS REGION IS UNDESIRABLE WHEN TORQUE GIVEN IN POSTERIOR SEGMENTS.  THEREFORE ACTIVE THIRD ORDER BENDS ARE GIVEN IN POSTERIOR SEGMENTS SEQUENTIALLY AND ONLY IN ONE DIRECTION AT ANY GIVEN TIME. www.indiandentalacademy.com
  90. 90. www.indiandentalacademy.com
  91. 91. www.indiandentalacademy.com
  92. 92. FORCE SYSTEMS  DENTURE PREPARATION  DENTURE CORRECTION  DENTURE COMPLETION  DENTURE RECOVERY www.indiandentalacademy.com
  93. 93. DENTURE PREPARATION OBJECTIVES  LEVELING  INDIVIDUAL TOOTH MOVEMENT AND ROTATION CORRECTION  RETRACTION OF BOTH MAXILLARY AND MANDIBULAR CANINES.  PREPARATION OF TERMINAL MOLARS FOR STRESS RESISTANCE. www.indiandentalacademy.com
  94. 94.  THIS STAGE REQUIRES APPROXIMATELY SIX MONTHS.  .017X.022 MAXILLARY ARCH WIRE.  .018X.025 MANDIBULAR ARCH WIRE.  LOOP STOPS MUST BE FLUSH WITH THE SECOND MOLAR TUBES.  MANDIBULAR SECOND MOLAR RECEIVES A 15 DEGREE EFFECTIVE DISTAL TIP.  MAXILLARY SECOND MOLAR RECEIVES 5 DEGREE DISTAL TIP FROM WIRE DISTAL TO LOOP. www.indiandentalacademy.com
  95. 95.  HIGH PULL HEADGEAR INCORPORATED TO RETRACT THE CANINES. ADVERSE EFFECT: CANINES TEND TO EXPAND OUT OF THE ALVEOLAR TROUGH AS THEY GET RETRACTED. REMEDY: PLACE A SECOND PREMOLAR OFFSET BEND MESIAL TO SECOND PREMOLAR BRACKET.  AS CANINES RETRACT AND ARCHES LEVEL,LATERAL INCISORS CAN BE BANDED OR BONDED. www.indiandentalacademy.com
  96. 96.  POWER CHAIN FORCE CAN BE USED TO AID RETRACTION OF CANINES. AT END OF DENTURE PREPARATION  ALL DENTITION MUST BE FULLY BRACKETED AND LEVELLED.  CANINES SHOULD BE RETRACTED.  ALL ROTATIONS CORRECTED.  MANDIBULAR TERMINAL MOLARS MUST BE TIPPED TO TERMINAL ANCHORAGE POSITION. www.indiandentalacademy.com
  97. 97. www.indiandentalacademy.com
  98. 98. www.indiandentalacademy.com
  99. 99. www.indiandentalacademy.com
  100. 100. DENTURE CORRECTION  CONTINUATION OF SEQUENTIAL MANDIBULAR ANCHORAGE PREPARATION.  THE CLASS II FORCE SYSTEM. www.indiandentalacademy.com
  101. 101. SPACES CLOSED WITH MAXILLARY AND MANDIBULAR CLOSING LOOPS SUPPORTED BY J HOOK HEADGEAR ATTACHED TO HOOKS SOLDERED BETWEEN MAXILLARY AND MANDIBULAR CENTRAL INCISORS. ARCH WIRE CHANGES  MAXILLARY: .020X.025 WITH 6.5MM VERTICAL LOOPS.  MANDIBULAR: .019X.025 WITH 6MM VERTICAL LOOPS. www.indiandentalacademy.com
  102. 102.  LOOP STOPS IMMEDIATELY DISTAL TO BRACKETS OF FIRST MOLARS.  LOOP STOP IN MANDIBULAR ARCHWIRE INCORPORATES COMPENSATION TO MAINTAIN 15 DEGREE MOLAR TIP. www.indiandentalacademy.com
  103. 103. END OBJECTIVES PRIOR TO MANDIBULAR ANCHORAGE PREPARATION WOULD BE :  OBTAIN SPACE CLOSURE IN BOTH ARCHES.  MAINTAIN CURVE OF OCCLUSION IN MAXILLARY ARCH.  LEVEL MANDIBULAR ARCH.  MAINTAIN 15 DEGREE DISTAL TIP OF SECOND MOLAR. www.indiandentalacademy.com
  104. 104. www.indiandentalacademy.com
  105. 105. www.indiandentalacademy.com
  106. 106. SEQUENTIAL MANDIBULAR ARCH PREPARATION  EMPLOYS A 10-2 ANCHORAGE SYSTEM. ADVANTAGES:  QUICK CONTROLLED RESPONSE  SUPPORTED BY HIGH PULL HEAD GEAR WORN ON VERTICAL SPURS SOLDERED DISTAL TO MANDIBULAR LATERAL INCISORS. www.indiandentalacademy.com
  107. 107. AFTER CHECKING THAT :  THE MANDIBULAR ARCH IS LEVEL.  THE SECOND MOLARSARE TIPPED TO A 15 DEGREE ANGULATION. A READOUT IS OBTAINED WHEREBY THE MANDIBULAR ARCHWIRE IS REMOVED AND A PLAIN ARCHWIRE IS INSERTED INTO THE SECOND MOLAR TUBE AND A READOUT IS OBTAINED. www.indiandentalacademy.com
  108. 108. READ OUT www.indiandentalacademy.com
  109. 109. THE SECOND STEP OF SEQUENTIAL MANDIBULAR PREPARATION IS NOW INITIATED.  ANOTHER .O19X .025 ARCHWIRE IS FABRICATED WITH LOOP STOPS BENT FLUSH AGAINST SECOND MOLAR TUBES.  HEADGEAR HOOKS SOLDERED DISTAL TO LATERAL INCISORS. www.indiandentalacademy.com
  110. 110. 10 DEGREE DISTAL TIP PLACED 1MM MESIAL TO FIRST PREMOLAR BRACKETS.  A COMPENSATING BEND PLACED TO MAINTAIN 15 DEGREE TIP AT TERMINAL MOLAR.  THUS ARCHWIRE IS PASSIVE TO SECOND MOLAR AND CROSSES FIRST MOLAR AT A 10 DEGREE ANGLE.  THE SECOND MOLAR BECOME PART OF STABILISING UNIT.FIRST MOLAR IS THE RECIPIENT OF DIRECTIONAL FORCES.  FOR IDEAL RESPONSE A HIGH PULL HEADGEAR APPLIED TO ANTERIOR VERTICAL SPURS.  www.indiandentalacademy.com
  111. 111. FIRST MOLAR READOUT- +5 TO + 8 DEGREE SECOND MOLAR MAINTAIN 15 DEGREES www.indiandentalacademy.com
  112. 112. THE THIRD AND FINAL STEP OF MANDIBULAR ANCHORAGE PREPARATION IS INITIATED.  A 5 DEGREE DISTAL TIP PLACED MESIAL TO SECOND PREMOLAR BRACKETS.  COMPENSATING BEND PLACED IN EMBRASURE BETWEEN SECOND PREMOLAR AND FIRST MOLAR.  AGAIN ARCH WIRE IS AT ANGULATION TO SECOND PREMOLAR BRACKET. www.indiandentalacademy.com
  113. 113.  HEAD GEAR IS WORN TO VERTICAL SPURS.  THE SECOND PREMOLARS NOW BECOME THE RECIPIENTS OF THE 10-2 SYSTEM.  AT THE END READOUT MUST SHOW:  SECOND MOLARS AT 15 DEGREE  FIRST MOLARS AT 5 TO 8 DEGREE  SECOND PREMOLARS AT 0 TO 3 DEGREE . www.indiandentalacademy.com
  114. 114. www.indiandentalacademy.com
  115. 115. END OBJECTIVES OF TREATMENT OF CLASS I MALOCCLUSION ARE:  COMPLETE SPACE CLOSURE IN BOTH ARCHES.  SEQUENTIAL ANCHORAGE PREPARATION IN MANDIBULAR ARCH.  ENHANCED CURVE OF OCCLUSION IN THE MAXILLARY ARCH.  CLASS I INTERCUSPATION OF CANINES AND PREMOLARS. www.indiandentalacademy.com
  116. 116.  MESIOBUCCAL CUSP OF MAXILLARY FIRST MOLAR SHOULD FIT INTO MESIOBUCCAL GROOVE OF MANDIBULAR FIRST MOLAR.  THE DISTAL CUSPS OF THESE TEETH SHOULD BE DISCLUDED AS THOSE OF SECOND MOLARS. www.indiandentalacademy.com
  117. 117. CLASS II FORCE SYSTEM APPLICABLE FOR CASES WITH AN END-ON OR FULL STEP CLASS II RELATIONSHIP OF THE BUCCAL SEGMENTS. CORRECTIONS WILL BE BASED ON:  ANB RELATIONSHIP  MAXILLARY POSTERIOR SPACE ANALYSIS  PATIENT COOPERATION. www.indiandentalacademy.com
  118. 118. GUIDELINES FOLLOWED IN TREATING  IF ANB <5 DEGREE AND MAXILLARY THIRD MOLARS MISSING, CLASS II FORCE SYSTEMS WORK BEST WITH A COOPERATIVE PATIENT.  ANB IS 5 TO 8 DEGREES,CLASS II CUSP RELATIONSHIP,COOPERATIVE PATIENT. EXTRACTION OF SECOND MOLARS IS ADVANTAGEOUS.THE FORCE SYSTEM WILL THEN DISTALIZE THE MAXILLARY ARCH IN EXTRACTION SPACE. www.indiandentalacademy.com
  119. 119.  ANB > 10 DEGREES ,PATIENT COMPLIANCE IS QUESTIONABLE,FIRST MOLAR REMOVAL OR SURGICAL CORRECTION SHOULD BE CONSIDERED. ARCHWIRES MAXILLARY : .020X.025 WITH CLOSED BULBOUS LOOPS BENT FLUSH AGAINST THE SECOND MOLAR TUBES. MANDIBULAR: .021X.028 STABILISING ARCHWIRE WITH LOOP STOP 0.5 MM SHORT OF MOLAR TUBE. www.indiandentalacademy.com
  120. 120. www.indiandentalacademy.com
  121. 121. CLASS II FORCE SYSTEM www.indiandentalacademy.com
  122. 122. AFTER THE FORCE SYSTEM IS EMPLOYED FOR A MONTH OR SO  THE BULBOUS LOOPS ARE ACTIVATED AGAIN TO 1 MM.  .030 SLIDING JIGS ARE FABRICATED AND PLACED ON MAXILLARY ARCHWIRE SUCH THAT DISTAL EYELET CONTACTS MESIAL BRACKET OF MAXILLARY FIRST MOLARS AND THE MESIAL EYELETS ARE MIDWAY BETWEEN CANINE AND PREMOLAR BRACKETS. www.indiandentalacademy.com
  123. 123. www.indiandentalacademy.com
  124. 124. AFTER FOUR MONTHS OF TREATMENT WITH MONTHLY REACTIVATION, AN OVER TREATED CLASS I RELATIONSHIP IS ACHIEVED.  REFABRICATE MAXILLARY ARCH WIRE WITH 6.5 MM CLOSING LOOPS DISTAL TO LATERAL INCISORS. CLOSING LOOPS OPENED 1MM PER VISIT.  CLASS II FORCES REDUCED TO 4 TO 6 OZ.ANTERIOR ELASTICS AND HEADGEAR TO BE USED IN CONJUNCTION WITH ELASTICS. www.indiandentalacademy.com
  125. 125. www.indiandentalacademy.com
  126. 126. www.indiandentalacademy.com
  127. 127. DENTURE COMPLETION MAXILLARY AND MANDIBULAR ARCHWIRES PROGRESSED TO .021X .O28.  LIGHT CLASS II ELASTICS MAINTAINED  CRITICAL STUDY OF INDIVIDUAL TOOTH ARRANGEMENT AS WELL AS INTER ARCH RELATIONS DONE.  PROGRESS CEPHALOGRAM AND TRACINGS DONE TO EVALUATE FINAL MANDIBULAR INCISOR POSITIONS AND MINOR CONTROL OF PALATAL,OCCLUSAL AND MANDIBULAR PLANES.  www.indiandentalacademy.com
  128. 128.  TRACINGS WOULD ALSO REVEAL REQUREMENT OF LINGUAL ROOT TORQUE IN MAXILLARY INCISORS.  FORCE SYSTEMS ARE REPEATED IF ORTHODONTIST NOT SATISFIED.  AFTER OVER CORRECTION,FINAL ARTISTIC BENDS AND CUSP SEATING FORCES GIVEN TO PROVIDE QUALITY AND DETAIL. www.indiandentalacademy.com
  129. 129. www.indiandentalacademy.com
  130. 130. END OBJECTIVES      INCISORS MUST BE ALIGNED. OCCLUSION OVERTREATED TO CLASS I RELATIONSHIP. ANTERIOR TEETH MUST BE EDGE TO EDGE. MAXILLARY CANINE AND PREMOLARS MUST LOCK TIGHTLY INTO CLASS I RELATIONSHIP. MESIOBUCCAL CUSP OF MAXILLARY FIRST MOLAR MUST OCCLUDE IN THE MESIOBUCCAL GROOVE OF MANDIBULAR FIRST MOLAR. www.indiandentalacademy.com
  131. 131.  DISTAL CUSPS OF FIRST AND SECOND MOLARS MUST BE OUT OF OCCLUSION.  ALL SPACES MUST BE CLOSED TIGHT FROM SECOND PREMOLARS FORWARD. www.indiandentalacademy.com
  132. 132. www.indiandentalacademy.com
  133. 133. DENTURE RECOVERY ALL TREATMENT MECHANICS ARE DISCONTINUED TO ENABLE IDEAL RESULTS.  ALL BANDS EXCEPT FOR CANINES AND FIRST MOLARS ARE REMOVED.  FIRST MOLARS LIGATED TO CANINES IN UPPER AND LOWERARCHES.  CANINES LIGATED TO EACH OTHER IN MANDIBULAR ARCH.  FOR THE MAXILLARY ARCH ,POWER CHAINS GIVEN FOR CANINES.  www.indiandentalacademy.com
  134. 134.  AFTER SEVEN DAYS, REMAINING BANDS REMOVED AND RETAINERS PLACED.  RECOVERY OCCURS DURING THIS PERIOD WHEN FUNCTION SETTLES THE TEETH INTO THEIR MOST EFFICIENT ,HEALTHY AND STABLE POSITIONS. www.indiandentalacademy.com
  135. 135. www.indiandentalacademy.com
  136. 136. CONCLUSION ‘ NOTHING WORTHWHILE EVER DEPARTS’ IT FIRMLY STOOD THE TEST OF TIME. MODIFICATIONS WERE MADE FROM TIME TO TIME.BUT THE APPLIANCE REMAINED WHILE OTHERS VANISHED BENEATH THE SANDS OF TIME. www.indiandentalacademy.com
  137. 137. THANK YOU www.indiandentalacademy.com
  138. 138. REFERENCES GRABER AND VANARSDALL 2ND AND 3RD EDITIONS  CLINICAL ORTHODONTICS – CHARLES TWEED  AJO 31: 74-103,1945 PHILOSOPHY OF ORTHODONTIC TREATMENT ,TWEED  ANGLE 1936,208 & 256 PART 1 AND 2 PRINCIPLES OF ORTHODONTIC TREATMENT,TWEED  AJO 52(11):804-832,1966 THE PROFILE LINE AS AN AID IN CRITICALLY EVALUATING FACIAL ESTHETICS, MERRIFIELD  www.indiandentalacademy.com
  139. 139. www.indiandentalacademy.com

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