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WICK ALEXANDER TECNIQUE
OF PRE-ADJUSTED
EDGEWISE APPLIANCE
Extraction treatment
Retention
Conclusion

www.indiandentalacad...
Maxillary arch
Separators placed
2 weeks later maxillary arch bonded and
banded
Initial archwire -.0175”Respond or .017...
-4-5weeks later -.016” ss round wire is
placed with omega stops 1-2 mm anterior
to the molar tubes.
-canine retraction is ...
Next 3-5 appointments
Powerchain replaced and retractor adjusted.
Canine retraction normally takes 3 appointments
In cl...
Canine may have tendency to tip and rotate
during retraction
Ligate the canine bracket completely to the .016”
wire .
L...
Why retract canines individually rather than
retract all 6 teeth as a unit
1]Less posterior
anchorage lost-patient
cooper...
.018”x.025”ss closing loop archwire placed.
Portion of archwire distal to loop reduced in the
anodic polisher.
Activate...
Patient seen every 4-5 weeks and loops
are activated.
Space closure in 6-8 months.
.017”x.025”ss –with ideal arch form ...
Mandibular Arch
Advantages of delay in banding the mandibular
arch in extraction cases –
1]allows physiological drifting ...
.0175” Respond multistranded wire or .017”x .
0125” D-Rect rectangular braided archwire is
placed.
.016”ss with omega st...
After all the spaces are closed .017” x.025”ss
with omega stops
If arch not adequately level after 1-2 months –
reverse ...
Critical to manipulate patient’s mandible.
Necessary to adjust the archwires.

www.indiandentalacademy.com
Elastic wear
Class III elastics are worn early in the
treatment
to prevent advancement of mandibular
incisors, to advanc...
Class II elastics are worn during last few
months of treatment
Final maxillary and mandibular stabilizing arch
wires .01...
At this time proper torques have been
established and stabilized with heavy
wires so prevents unwanted
maxillary anterior ...
Midline elastic used in conjunction with
class II or Class III elastic to achieve the
desired correction.
Triangular ela...
ELASTIC SIZES
 Class II
1/4"
 Midline
1/4"
 Class lIl 1/4"
1/2oz
 Up-and-down
6oz
or
3/16"
 Cross bite 3/16"
 Finish...
PALATAL AD LINGUAL ARCHES
-Nance palatal arch to hold the anterior and
posterior teeth in place as the canine drift
into t...
EXPANSION APPLIANCES
Rapid palatal expansion –jack screw
turned every 12 hr or every 24 hrs.
Slow palatal expansion with...
Arch form
Initial multistranded archwire has no archform
.016” ss is contoured and placed in the mouth
to see if it conf...
•Dr Garland McKelvain ,1981-reported on arch
forms used with this discipline in an
unpublished thesis written when he was ...
Conclusions:
1]average maxillary arch design had very little SD from all
those examined.
2]of mandibular arches studied ,a...
RETENTION
GOALS:
1]close band spaces
2]maintain proper anterior torque
3]obtain correct interdigitation
4]control ove...
Countdown to retention
Patient’s teeth have been properly
positioned ,
-centric relation is achieved
-roots at extraction...
POSTERIOR SETTLING TECHNIQUE
Archwire [usually mandibular]is cut
between right and left canines and
premolars.
Posterior...
www.indiandentalacademy.com
Patient is instructed to wear elastics 24 hrs per
day for 3 weeks.
In open bite cases patient is instructed to
discontin...
BAND OR BOND REMOVAL
FIRST APPOINTMENT
All bonds except on the 4 man incisors
are removed ,and the premolar and
second m...
instructions given 1)to wear elastics ;
2)facebow; 3)to chew sugarless gum

www.indiandentalacademy.com
MAXILLARY RETAINER
•.036’ wire is formed to fit closely to the anterior teeth with a
loop in each canine region.
•2nd mola...
MANDIBULAR RETAINER
•.036” lingual wire adapted 1 mm below the incisal edge
of the anterior teeth and than soldered to the...
SECOND APPOINTMENT
Within next 1-5days remaining brackets
and bands are removed
Plate adjusted until it is out of contac...
FULL BAND REMOVAL
FIRST APPOINTMENT
All bands are removed and patients are given
instructions
1]wear one ¾” ,2 oz elast...
SECOND APPOINTMENT

Impressions are taken for fabrication of
retainers
If band spaces are closed, instructed to
disconti...
THIRD APPOINTMENT
Retainers are delivered
next appointment [4-6 weeks later ]retainer is
adjustment is done

www.indianden...
-4-5 months after appliance removal patient
instructed to wear elastics at night
-patient is seen annually until decision ...
VARIATIONS IN PROCEDURE

MANDIBULAR INCISOR PROBLEMS
1]Severe discrepancy ,mandibular incisors slightly
advanced----impre...
MAXILLARY INCISOR PROBLEMS
1]Band spaces are larger---5/16”,31/2 oz elastic

worn around the involved anterior teeth near ...
MISCELLANEOUS PROBLEMS
-poorly placed maxillary canine---3/4”,2oz
elastic
-Buccolingual relationship problem---3/16”,6
oz ...
Conclusion
If the mandibular arch is
properly positioned –the arch level
with the incisors not tipped
f orward , the mola...
Thank you
www.indiandentalacademy.com
Leader in continuing dental education

www.indiandentalacademy.com
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wick alexander technique of pre adjusted edgewise appliance /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
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wick alexander technique of pre adjusted edgewise appliance /certified fixed orthodontic courses by Indian dental academy

  1. 1. WICK ALEXANDER TECNIQUE OF PRE-ADJUSTED EDGEWISE APPLIANCE Extraction treatment Retention Conclusion www.indiandentalacademy.com
  2. 2. Maxillary arch Separators placed 2 weeks later maxillary arch bonded and banded Initial archwire -.0175”Respond or .017”.025” D-Rect braided wire is tied with o- ring Treatment started in max arch and allow the mandibular arch to drift for 6 to 8 months [except in class III or bimaxillary protrusion cases] 2 weeks later –rotations are tied with steel ligature wire and cervical facebow is seated. www.indiandentalacademy.com
  3. 3. -4-5weeks later -.016” ss round wire is placed with omega stops 1-2 mm anterior to the molar tubes. -canine retraction is initiated with a threeunit segment of power chain II. -retractor adjusted to prevent mesial movement of molars www.indiandentalacademy.com
  4. 4. Next 3-5 appointments Powerchain replaced and retractor adjusted. Canine retraction normally takes 3 appointments In closed bite cases treatment in mandibular arch started as soon as canines are in class I  If the bite is not closed incisor retraction is initiated prior to proceeding to mandibular arch. www.indiandentalacademy.com
  5. 5. Canine may have tendency to tip and rotate during retraction Ligate the canine bracket completely to the .016” wire . Lang bracket activated to complete rotation 1 appointment to accomplish complete uprighting and elimination of rotation www.indiandentalacademy.com
  6. 6. Why retract canines individually rather than retract all 6 teeth as a unit 1]Less posterior anchorage lost-patient cooperative in wearing extraoral appliance. 2]no concern for cuspal interference . 3]torque in max incisors more easily controlled. www.indiandentalacademy.com
  7. 7. .018”x.025”ss closing loop archwire placed. Portion of archwire distal to loop reduced in the anodic polisher. Activated by placing plier on the archwire distal to the molar tube ,pushing it distally 1-2mm to open the closing loop,and bending the end 45 degrees gingivally to produce a stop. www.indiandentalacademy.com
  8. 8. Patient seen every 4-5 weeks and loops are activated. Space closure in 6-8 months. .017”x.025”ss –with ideal arch form and omega stops www.indiandentalacademy.com
  9. 9. Mandibular Arch Advantages of delay in banding the mandibular arch in extraction cases – 1]allows physiological drifting of anteriors. 2]little posterior anchorage is lost since max molars are being held distally. 3]no interference and or attrition on the cusp tips from the mandibular canine bracket 4]time for the second molars to erupt more fully . 5]time to complete mandibular arch treatment is 9-12 months. www.indiandentalacademy.com
  10. 10. .0175” Respond multistranded wire or .017”x . 0125” D-Rect rectangular braided archwire is placed. .016”ss with omega stops 1-2mm anterior to the molar tubes stops not used if small amount of extraction space remains  if too much space .016” x.022” ss closing archwire is given Space closure takes 2-6 months. Amount of extraoral force depends on the molar relationship. www.indiandentalacademy.com
  11. 11. After all the spaces are closed .017” x.025”ss with omega stops If arch not adequately level after 1-2 months – reverse curve of spee is placed in it . Detailed finishing takes 3-6 months . Brackets are activated to finalize rotations. Midline class II and class III corrections are made with elastics. www.indiandentalacademy.com
  12. 12. Critical to manipulate patient’s mandible. Necessary to adjust the archwires. www.indiandentalacademy.com
  13. 13. Elastic wear Class III elastics are worn early in the treatment to prevent advancement of mandibular incisors, to advance max dentition or retract mandibular dentition] and to correct anterior dental crossbite To prevent molar extrusion vertical high pull facebow is given www.indiandentalacademy.com
  14. 14. Class II elastics are worn during last few months of treatment Final maxillary and mandibular stabilizing arch wires .017x.025 ss are fully engaged and have been in mouth at least 1 month before class II elastics are initiated www.indiandentalacademy.com
  15. 15. At this time proper torques have been established and stabilized with heavy wires so prevents unwanted maxillary anterior retraction or mandibular anterior advancement. www.indiandentalacademy.com
  16. 16. Midline elastic used in conjunction with class II or Class III elastic to achieve the desired correction. Triangular elastic-are attached to three teeth .The main concentration of force is at the apex of the triangle Cross elastics-lingual lugs on molar bands Anterior and posterior up –and –down elastics [zig-zag ]worn to finalize cuspal interdigitation. www.indiandentalacademy.com
  17. 17. ELASTIC SIZES  Class II 1/4"  Midline 1/4"  Class lIl 1/4" 1/2oz  Up-and-down 6oz or 3/16"  Cross bite 3/16"  Finishing 3/4" 6oz 6oz 3– 1/4" 6oz 6oz 2oz www.indiandentalacademy.com
  18. 18. PALATAL AD LINGUAL ARCHES -Nance palatal arch to hold the anterior and posterior teeth in place as the canine drift into their position. -transpalatal arch with a Goshgarian design used in high angle cases . -Lingual holding appliance in mandibular arch www.indiandentalacademy.com
  19. 19. EXPANSION APPLIANCES Rapid palatal expansion –jack screw turned every 12 hr or every 24 hrs. Slow palatal expansion with quad helix appliance in younger patients. www.indiandentalacademy.com
  20. 20. Arch form Initial multistranded archwire has no archform .016” ss is contoured and placed in the mouth to see if it conforms to the patient’s arch form .017”x.0 25” finishing mandibular archwire is contoured to fit patients original models After this archwire in place for sometime the maxillary archwire is contoured to fit the mandibular teeth. www.indiandentalacademy.com
  21. 21. •Dr Garland McKelvain ,1981-reported on arch forms used with this discipline in an unpublished thesis written when he was a graduate student. 102 maxillary and mandibular .017” .25” archwires from well treated cases He made copies of the final archwire used on those cases ,drew perpendicular lines down the middle of the arch forms,and measured across the arches at certain intervals. www.indiandentalacademy.com
  22. 22. Conclusions: 1]average maxillary arch design had very little SD from all those examined. 2]of mandibular arches studied ,all could be related to one of the 2 mandibular designs with very little SD 3]Compared to the subsample the arch forms appeared to be same as the master sample form. 4]compared to the original pretreatment models with appliances placed ,there appeared to be no change in the shape. 5]comparing arches to the Par ,Brader ,and Boone forms ,there was a significant difference in shape. www.indiandentalacademy.com
  23. 23. RETENTION GOALS: 1]close band spaces 2]maintain proper anterior torque 3]obtain correct interdigitation 4]control overjet and overbite relationships 5]maintain class I molar relationships 6]design retainers www.indiandentalacademy.com
  24. 24. Countdown to retention Patient’s teeth have been properly positioned , -centric relation is achieved -roots at extraction sites parallel -mandibular canine width not expanded -proper buccal and labial torque -normal overjet and overbite -class I canine relation www.indiandentalacademy.com
  25. 25. POSTERIOR SETTLING TECHNIQUE Archwire [usually mandibular]is cut between right and left canines and premolars. Posterior archwire is removed Patient is instructed to wear series of elastics. www.indiandentalacademy.com
  26. 26. www.indiandentalacademy.com
  27. 27. Patient is instructed to wear elastics 24 hrs per day for 3 weeks. In open bite cases patient is instructed to discontinue before appliance removal www.indiandentalacademy.com
  28. 28. BAND OR BOND REMOVAL FIRST APPOINTMENT All bonds except on the 4 man incisors are removed ,and the premolar and second molar bands are removed ,leaving only the 4 molars banded . Mandibular canine bands are fitted and impressions are taken and archwire is retied. www.indiandentalacademy.com
  29. 29. instructions given 1)to wear elastics ; 2)facebow; 3)to chew sugarless gum www.indiandentalacademy.com
  30. 30. MAXILLARY RETAINER •.036’ wire is formed to fit closely to the anterior teeth with a loop in each canine region. •2nd molar if too far buccally-------and mandibular 2 nd molar in normal position than the tooth will move into normal position •Acrylic bite plane with full palatal coverage • 3 mm diameter hole is placed in the center of palatal area to help control tpngue position www.indiandentalacademy.com
  31. 31. MANDIBULAR RETAINER •.036” lingual wire adapted 1 mm below the incisal edge of the anterior teeth and than soldered to the canine bands •Elastic lugs are spot welded to the distobuccal surface of the bands. •Bonded retainer can also be given www.indiandentalacademy.com
  32. 32. SECOND APPOINTMENT Within next 1-5days remaining brackets and bands are removed Plate adjusted until it is out of contact with the mandibular incisors www.indiandentalacademy.com
  33. 33. FULL BAND REMOVAL FIRST APPOINTMENT All bands are removed and patients are given instructions 1]wear one ¾” ,2 oz elastic 24 hrs a day from buccal tube of the maxillary 1 st molar to the buccal tube of the opposite 1 st molar 2]wear one ¾”,2 oz elastic at night on the mandibular arch 3]wear facebow to the maxillary 1st molar 4]chew sugarless gum www.indiandentalacademy.com
  34. 34. SECOND APPOINTMENT Impressions are taken for fabrication of retainers If band spaces are closed, instructed to discontinue wearing the elastics www.indiandentalacademy.com
  35. 35. THIRD APPOINTMENT Retainers are delivered next appointment [4-6 weeks later ]retainer is adjustment is done www.indiandentalacademy.com
  36. 36. -4-5 months after appliance removal patient instructed to wear elastics at night -patient is seen annually until decision is made on future of 3 rd molar -mandibular retainer removed at 17to 20 yrs. www.indiandentalacademy.com
  37. 37. VARIATIONS IN PROCEDURE MANDIBULAR INCISOR PROBLEMS 1]Severe discrepancy ,mandibular incisors slightly advanced----impression for 3-3 retainer taken same day bands are removed 2]Incisors slightly rotated or become crowded between appointments----appliance is placed by making the patient to bit on the band seating instrument positioned on lingual wire 3]Incisors rotated with interproximal spacing ---1/4”,2oz elastics worn from hook to hook labially. 4]rotation after retainer is cemented---retainer www.indiandentalacademy.com removed and recemented after slenderization
  38. 38. MAXILLARY INCISOR PROBLEMS 1]Band spaces are larger---5/16”,31/2 oz elastic worn around the involved anterior teeth near the incisal edges 2]Open extraction spaces. 5/16”,6 oz elastic Mandibular arch -1st molar band not removed +canine to canine retainer given +3/4”,2 oz elastic worn www.indiandentalacademy.com
  39. 39. MISCELLANEOUS PROBLEMS -poorly placed maxillary canine---3/4”,2oz elastic -Buccolingual relationship problem---3/16”,6 oz crossbite elastics on 1st molars -maxillary 2nd molar erupting buccally---.020” wire soldered to .036”labial wire +bend to contour buccal surface of 2nd molar and is activated. www.indiandentalacademy.com
  40. 40. Conclusion If the mandibular arch is properly positioned –the arch level with the incisors not tipped f orward , the molars uprighted , and the canines not appreciably expanded –and the maxillary teeth interdigitate with the mandibular teeth in good centric relation , signif icant relapse is limited. www.indiandentalacademy.com
  41. 41. Thank you www.indiandentalacademy.com Leader in continuing dental education www.indiandentalacademy.com

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