Vari simplex /certified fixed orthodontic courses by Indian dental academy


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Vari simplex /certified fixed orthodontic courses by Indian dental academy

  2. 2. INDIAN DENTAL ACADEMY Leader in continuing dental education
  3. 3. - Introduction - Concept and Appliance design -Diagnosis and treatment planning -The concept * Bracket selection *Bracket height *Bracket angulation *Bracket torque *Bracket in and out *Archwire selection and sequence -Non Extraction treatment -Maxillary and mandibular arches -Extraoral force application Sameer
  4. 4. - Extraction treatment - Maxillary and Mandibular arches -Elastic wear -Palatal and lingual arches -Expansion Appliances - Retention Sujala
  5. 5. INTRODUCTION Richard G. Wick Alexander He designed an appliance to deliver excellent treatment results in a simple organized way. His main concern is simplicity, to encourage cooperation, comfort and control. His major goals are - High quality results - Patient comfort - Reduced chair side time
  6. 6. He developed an appliance called the VariSimplex Discipline. “Vari” refers to the variety of bracket types used. “Simplex” relates to the KISS Principle (Keep It Simple, Sir). Archwire fabrication is simplified, with first-, second-, and third-order bends placed in the bracket instead of the archwire. Simpler archwires afford fewer changes, and easier ligation and activation. archwire
  7. 7. Treatment philosophy retains three fundamentals of the Tweed technique: 1. Anchorage preparation (uprighting mandibular first molars) 2. Positioning of mandibular incisors over basal bone. 3. Orthopedic alteration with headgear. Key Objectives: The key objective is to treat the case so that the patient ends up with the face proportionately balanced, consistent with his skeletal pattern. He believe in non-extraction therapy whenever possible.
  8. 8. Diagnosis and Treatment Planning: Determine the desired position of the mandibular incisors, and then determine the treatment needed to position the maxilla and maxillary dentition over the desired mandibular arch position. • Incisors upright over basal bone • Cuspids not expanded • Curve of spee level • Non-extraction therapy whenever possible
  9. 9. His approach to diagnosis include Age: Patient’s age will determine whether we think in terms of mixed dentition early treatment, full treatment during adolescence, or adult treatment. The other factors can be categorized according to the diagnostic records taken to study the three tissues (facial, skeletal, dental) in their three dimensions (vertical, transverse, sagittal). •Intraoral and/or panoramic x-rays • Study models • Facial photographs • Cephalometric appraisal
  10. 10. The concept of the Vari Simplex Discipline:1. The size and shape of the teeth, especially the mesiodistal width and curvature. These affect interbracket width, which, in turn, affects the ability to rotate the teeth and level the arch without using vertical springs, multiloops, or extra arch wires. The system evolved around five factors related to brackets: bracket selection, bracket height, bracket angulation, bracket torque and bracket inout.
  11. 11. Bracket Selection: Each tooth has a particular bracket that is most effective. 1. Twin Brackets: Twin brackets (Diamond brackets) are used on large, flat-surfaced teeth – maxillary central and lateral incisors. The diamond bracket is designed so that all the horizontal lines are placed parallel to the incisal edge of the tooth, and the rhomboid design makes it possible to align the vertical lines parallel to the long axis of the tooth.
  12. 12. The flat surfaces of maxillary centrals and laterals permit full arch wire engagement in the twin brackets. Twin brackets on the incisors allow 5-6mm of interbracket width, which is sufficient for flexibility, rotational control, and torquing ability. As the maxillary lateral incisors erupt, they frequently remain high relative to the normal position of the centrals, presenting a significant incisogingival interbracket discrepancy. Twin brackets on these teeth provide additional tie wings for easy initial wire placement, whereas the rotation wing of a single-width bracket might cause interference with the archwire. Twin brackets are smooth and minimize irritation of labial tissue.
  13. 13. 2. Lang Brackets: Lang brackets were invented by Dr. Howard Lang. These brackets are used with the Diamond design on large, round-surfaced teeth at the corners of the arch – maxillary and mandibular cuspids. The single bracket allows for easy ligation and increased interbracket width. The wing can easily be activated for rotational control. In extraction cases, the cuspids can be retracted on round wire with very little tipping or rotation.
  14. 14. 3. Lewis Brackets: Lewis brackets are used on large, round-surfaced teeth that are not at the curve of the arch – maxillary and mandibular bicuspids – and on small, flat-surfaced teeth – mandibular incisors. The Lewis bracket is a fixed-wing single bracket, which produces sufficient interbracket width.
  15. 15. The wings provide maximum rotational control and can be activated for additional rotation. An additional benefit offered by the single bracket with wings is that, on a tooth that is badly rotated, the wing in the direction of the rotation can be removed. The bracket can then be positioned properly, remaining wing serving to rotate the tooth into proper position.
  16. 16. Other Attachments: Twin brackets with a convertible sheath are used on maxillary and mandibular first molars, which are usually banded. The convertible sheath is easily removed when second molars are banded, converting the attachment to a bracket.
  17. 17. Headgear tubes are placed occlusally on the maxillary first molars. This position makes it easier to see and to use them; it minimizes food traps, oral hygiene problems, and gingival impingement; and it eliminates blockage when omega stops are used. Single buccal tubes are used on maxillary and mandibular second molars, and lingual hooks are placed on all molar bands.
  18. 18. Bracket Height: Each bracket is placed at a predetermined position on each tooth relative to the other teeth. Placing a bracket higher or lower affects the amount of torque and angulation, and the incisogingival position of the tooth. The bracket height will vary to fit the clinical crowns. Bicuspid bracket height is the key. Its normal height is
  19. 19. Bracket Height: Maxillary Arch: Centrals X Laterals X – 0.5mm Cuspids X + 0.5mm Bicuspids X 1st Molars X – 0.5 mm 2nd Molars X – 1.0 mm Mandibular Arch: Centrals X – 0.5mm Laterals X – 0.5 mm Cuspids X + 0.5mm Bicuspids 1st Molars X X – 0.5 mm
  20. 20. Brackets have to be positioned in the center of the tooth mesiodistally, so that the rotating wings will be able to function properly. On a severely rotated tooth, the interfering wing can be removed to enable the bracket to be placed in the center of the tooth.
  21. 21. Bracket Angulation: This allows the roots to be parallel to each other and the crowns to be placed in their most esthetic and functional positions. The horizontal incisal and gingival portions of the bracket are parallel to the incisal edge and the vertical portions are parallel to the long axis of the crown. Bracket Angulations: Banding Bonding (Incisal edge reference) (Long axis reference) Maxillary Arch Centrals 3° 5 Laterals 6 8 Cuspids 6 10 Bicuspids and Molars 0 0
  22. 22. Mandibular Arch: Centrals 2 2 Laterals 2 2 Cuspids 6 6 Bicuspids 0 0 1st Molars -6 -6 2nd molars 0 0
  23. 23. Bracket Torques: In 1978 torques is moved from arch wire into the bracket so that the best results are achieved when an 0.017”, 0.025” archwire is used to fill the 0.018” bracket slots. Bracket Torques: Maxillary Arch Centrals 14 Laterals 7 Cuspids -3 Bicuspids -7 Molars -10
  24. 24. Mandibular Arch: Incisors -5 Cusids -7 1st Bicuspids -11 2nd Bicuspids -17 1st Molars -22 2nd molars 0 or -27 No torque is placed in the mandibular second molar tubes, because of omega stops. As the omega is bent out to avoid impingment on gingival tissue and to create less of a food trap, torque is automatically placed into the second molar. The most important difference is -5o of lingual crown torque or labial root torque in the mandibular incisors.
  25. 25. Bracket In Out (First Order Bends): The fifth component of the Vari-Simplex Discipline is bracket in-out. The appliance incorporates a system of interrelated, compensating bracket base thicknesses to replace the usual first-order bends or offsets. Archwire Selection and Sequence: Bracket is only a “handle” placed on the tooth. Proper archwire selection and sequence will allow the discipline to deliver the desired results. The first step, in most cases, is the elimination of rotations. This is done by the newer, flexible, more resilient wires – multistranded round and rectangular TMA and Nitinol.
  26. 26. Leveling and space closure are accomplished next, usually with rectangular wire – TMA or stainless steel. The last step – final leveling and arch form – are always performed with stainless steel wire. The usual selection of archwires includes: A. Non-extraction: 1. Multistrand 0.017” x 0.025” D-Rect (mandibular arch) and 0.0175” Respond (maxillary arch). 2. 0.016” SS round or an 0.016” x 0.022” SS rectangular wire may be used for further eliminate rotations. 3. 0.017” x 0.025” SS ideal finishing archwire
  27. 27. B. Extraction: 1. Maxillary arch a) Multistrand 0.0175” Respond or 0.017” x 0.025” DRect b) 0.016” round SS wire for retracting cuspids c) 0.018” x 0.025” SS with closing loops to retract four anteriors d) 0.017” x 0.025” SS finishing archwire 2. Mandibular Arch: a) Multistrand 0.0175” Respond or 0.017” x 0.025” DRect b) 0.016” round SS archwire or 0.017” x 0.025” D-Rect c) 0.016” x 0.022” SS closing loop archwire d) 0.017” x 0.025” SS finishing archwire
  28. 28. NON EXTRACTION TREATMENT The total time needed to complete mandibular arch treatment is perhaps as little as six months in a non-extraction case. In addition, one of the big problems on a Class II case is moving a Class II canine to a Class I relationship when the mandibular arch is banded. Bracket interference can create canine attrition, loose bonds, and retardation of tooth movement. For these reasons, mandibular arch is rarely banded until class I canine relationship is achieved.
  29. 29. Maxillary Arch: Non-extraction maxillary arch. treatment begins with the The incisors, cuspids and first bicuspids are bonded, and the second bicuspids and first molars are banded. After the appliances are in place, a multistranded, spiral, round archwire is inserted. After 2 weeks the patient is given an extra oral appliance (retractor). At the third appointment, rotations are tied, and the retractor is adjusted. An 0.016” round wire with omega stops mesial to the terminal tubes is placed, so that the arch wire can be tied back.
  30. 30. In case of close bite, enough excess curve of spee is placed in the archwire to enhance the opening of the bite. It is extremely important to tie this archwire back. There are three ways of tying back – the traditional omega stop, power chain or ligature wire from molar to molar, and bending the archwire at an angle distal to the molar tube. Tying back the arch wire is used to consolidate the arch to convert the arch from several units to a single unit. It is necessary for the arch to be in one unit for the extraoral forces to act orthopedically instead of dentally, and intraoral elastic forces must act on the arch and not on individual teeth.
  31. 31. The Omega stop, placed 1-2 mm mesial to the buccal tube, enables placement of an active tieback force on the archwire. After all the rotations have been eliminated, all spaces have been closed, and the arch is beginning to level, the round wire is removed, and the third and final archwire – an 0.17” x 0.025” rectangular stainless steel finishig archwire is placed. If the bite is still closed at this stage, a bite plate is used so that the mandibular anteriors occlude on the bite plate and free the occlusion. This will improve the effectiveness of the maxilary archwire, and the allow the posterior teeth to begin erupting into a more level position.
  32. 32. The pressure of the mandibular anterior teeth on the bite plate will tend to depress them. This will begin to open the bite and level the mandibular arch before it is bonded and banded. Mandibular Arch: After the final archwire is placed in the maxillary arch, separators are inserted between the mandibular posterior teeth, and the mandibular arch is bonded and banded two weeks later. Bonding/ banding on the mandibular arch is delayed in a non-extraction case
  33. 33. 1. It will avoid interference of mandibular brackets with maxillary teeth. 2. As the maxillary arch improves, the mandibular curve of Spee improves naturally. 3. If a bite plate is needed, it fits better and is more comfortable after the maxillary arch has been properly aligned. 4. Total time needed to treat the mandibular arch is 6-9 months. 5. It allows more time for the mandibular second molars to erupt.
  34. 34. The mandibular arch is the key to non-extraction treatment with the Vari-Simplex Discipline. There are five primary reasons for our ability to control the advancement of the mandibular anteriors: 1. Bonding eliminates the need for interproximal band space. 2. A -5 degree torque on the mandibular incisors resists anterior flaring of these teeth. 3. The use of 0.017” x 0.025” D-Rect multistranded, braided archwire permits torque control in the anterior segment with the initial archwire. 4. A -6 degree tip on the mandibular first molars allows distal movement of the molar crowns, which can create additional arch length. 5. With bonding, selective interproximal enamel reduction is possible.
  35. 35. In non-extraction cases but crowding of the mandibular arch may prevent unravelin and uprighting of the lower anteriors. Then class III mechanics should be considered. If Class III elastics are worn to the mandibular arch, the extrusive force of the elastics on the maxillary first molars should be considered. In a close bite case, some molar extrusion may be desired to help open the bite. In the case of an open bite or a higher SN-MP angle, a high-pull force is added to the facebow during Class III mechanics to prevent molar extrusion. The high-pull force should be initiated before placement of the first mandibular wire.
  36. 36. The term “slenderizing” is used, rather than “stripping”, for the selective interproximal reduction of the enamel. (Dr. Moody Alexander) The D-Rect wire in the mandibular arch is left until the anterior rotations have almost been eliminated. If all rotations cannot be eliminated, an 0.017” x 0.025” D-Rect wire with an 0.016” x 0.022” TMA or stainless steel archwire is followed. The next wire is an 0.017” x 0.025” stainless steel finishing archwire. Extra oral forces have continued throughout, and a class I molar relationship should be achieved. Class II mechanics are not initiated until finishing archwires are in place.
  37. 37. Extra Oral Force Application: The best results are achieved with a facebow attached to the maxillary first molars. Patient acceptance and cooperation are better, so successful orthopedic results are achieved. The facebow offers better control of the posterior transverse dimension, so that palatal arches are not necessary in the normally growing patient. The bow stops anterior to the ears, so that it will not interfere with the ears when a high-pull is used. With an angle of SN to mandibular plane of 35 degree or less – cervical-pull neckstrap; 36-42 degree, a combination pull; and greater than 42 degree, a high pull.
  38. 38. Outer bow should be parallel to the occlusal plane and the inner bow. When the patient closes, the lips should seal just behind the junction of the two bows without impingement on the lips. Depending on the diagnosis, the patient will wear the retractor 8-14 hours per day. If the patient’s ANB is 5 degree or more, the retractor is worn 14 or more hours a day. If the ANB is 3-5 degree, retractor wear can be reduced to 12 hours. If the ANB is less than 3 degree, the retractor is worn at night only, 8 hours a day.
  39. 39. References The Vari-Simplex Discipline, Part 1: Concept and appliance design, J. Clin. Orthod. 1976. The Vari-Simplex Discipline, Part 2: Concept and appliance design, J. Clin. Orthod. 1976. The Vari-Simplex Discipline, Part 3: Concept and appliance design, J. Clin. Orthod. 1976. The Vari-Simplex Discipline, Part 4: Concept and appliance design, J. Clin. Orthod. 1976. The Vari-Simplex Discipline, Part 5: Concept and appliance design, J. Clin. Orthod. 1976. The Alexander Discipline: Contemporary Concepts and Philosophies Orthodontics—State of the Art; Essence of the Science - L.W. Graber
  40. 40. Thank you Leader in continuing dental education