Tip edge orthodontics stage III


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Tip edge orthodontics stage III

  2. 2. Objectives  Correction of torque and tip angles for each tooth individually  Attainment of optimum facial profile compatible with stability  Maintaining class I occlusion  Final detailing 2
  3. 3. Conventional torquing -Fixed vertical slot dimension. -19 x 25” -Active torque- rectangular archwire Conflicting requirements(rectangular wire provide torque at the same time offer 3dimensional stability) 3
  4. 4. How doesTip-edge torque? Torque escape’- actively torqued rect wire –reopen the vertical slot dimension, second order root movement than torque 4
  5. 5. How doesTip-edge torque? a)Initial engagement of rectangular wire b)side winder begins to close vertical space c)final tip andTorque achieved simultaneously when slot closes 5
  6. 6. How doesTip-edge torque? -Side winder can recover 14 deg of torque from either direction -Tip and torque- self limiting according to prescription of bracket. -Overcorrection of tip permitted(since 0215”fractionally smaller than 022”) -zero torque discrepancy between bracket and archwire after sidewinder has fully expressed 6
  7. 7. Points to note -Sidewinder oriented to the side- untip the tooth irrespective of direction of torque -Two-point contact- tip and torque are unalterably related -Inadequate tip correction will lead to inadequate torque -Force values – decline from 60g to 20g at the apex -No less than .0215 x .028– torquing platform 7
  8. 8. Stage III archwires  Choice of archwires  Arch width  Identifying the land marks  Archform  Traction hooks  Preparation of arch ends 8
  9. 9. Stage III archwires -Only one size0215” X 028” -Archwidth- 2mm expanded at molars -5° lingual toe-in so as to enter pre angulated molar tube at an equivalent angle to straight-wire archform 9
  10. 10. Stage III Traction hooks Crimped midway between laterals and canines,hooks pointing gingivally.accept elasomerics from either side Protruding distal archwire ends are thinned and annealed 10
  11. 11. Stage III – setting the torques  How to read the torque  Torque in  Reduced overbite cases  Increased overbite cases  Pretorqued archwires  Checking the torque  Skeletal class III cases 11
  12. 12. How to read the torque 12
  13. 13. Torque-increased overbite cases  Vertical bite sweep  (reverse curve of spee) 13
  14. 14. Pretorqued archwires 14
  15. 15. Small amount of anterior archwire intrusion is all that needed to retain previous deepbite Small amount of palatal root torque added to upper anterior segment by elevating the tails of archwire Checking torque/wiping the sweep 15
  16. 16. Stage III fitting the archwires  Testing molar torque  Cinch backs  Side-winders and elastomeric modules  Removing the archwires 16
  17. 17. Testing molar torque Only molars-torque from beginning Torque discrepancy between zero torque archwire and 2nd molar tube 17
  18. 18. Cinch backs Cinching back to allow small ingress of space 18
  19. 19. Sidewinders and elastomeric modules Sidewinders point mesially except 2nd premolars in 1st premolar Xn 19
  20. 20. Degree of activation Canines and premolars- tip correction. Excess activation- loss of anchorage Full activation appropriate for incisors Approx 45 deg enough on canines 20
  21. 21. Removal of archwires Rotating plier forwards along long axis of wire will walk wire mesially out without discomfort to the patient 21
  22. 22. Stage III checks  How to admit extra space  Hyperactivation of side-winders  Causes of inadequate torque 22
  23. 23. Stage III checks -Progress of the tip and the torque tipedge has fully expressed when its occlusal and gingival tiewings have become parallel to rectangular archwire 23
  24. 24. Stage III checks -Available space in the arch Tight contacts or anterior rotations indicate inadequate space during uprighting 24
  25. 25. Stage III checks -Unwanted space - Activation of side-winders - Interarch relationship -The vertical relationship -Molar width -2nd molars -Profile considerations classII check elastics useful aid in maintaining overbite reduction or molar occlusion 25
  26. 26. ‘Hyper activation’ of side-winders Flattening of small section of coil with lightwire plier which effectively expand them 26
  27. 27. Causes of inadequate torque -Incorrect bracket -Misangled bracket -Incorrect archwire -Incorrect bonding position -Incomplete bracket engagement -Wire ligatures -Tight contact points -Slack side-winders -Incorrect torque in archwire 27
  28. 28. Precision finishing  Picking up second molars  Occlusal seating  Braided rectangular arches  Titanium-niobium archwires  Sectioning the main archwire  Crossbite cases  Positioners 28
  29. 29. Precision finishing -Self-limited precision finishing -Previously unnoticed errors come to light -Stage III(easier to correct in his stage without stepping down the archwire) -occlusal seating -Second molars 29
  30. 30. Picking up second molars -Until late stage III Obstructive – unwanted friction .022 x .028” molar tubes Preliminary alignment- late stage III by means of sectional devise given by Dr.Tom Rocke.016”s.s runs through gingival tiewing and mesially with occlusal inclined loop 30
  31. 31. Vertical elastics can be engaged to a combination of molarhooks and gingivally inserted lockpins Occlusal seating Braided rectangular arches Titanium-niobium archwires 31
  32. 32. Sectioning the main archwire archwire distal to canine is sectioned,premolars and molars recquire tying with criss cross ligature to prevent spacing Extrude buccal cusps, leaving palatal cusps unseated 32
  33. 33. Positioners No finishing wires Pre-Fit Positioners Diff sizes- Extraction and non-extraction DisAdv-Individual tooth size discrepancy,non compliant patient Tooth positioner as settling aid may take upto 6weeks 33
  34. 34. The non-compliant patient  Outrigger hooks  Case selection for Outriggers  Advantages of Outriggers  Limitations of outriggers 34
  35. 35. The non-compliant patient  Whatever one puts in is directly proportional to the gains in tern  Advantages ofTipEdge 35
  36. 36. Dr. Christopher kesling Outrigger appliance 36
  37. 37. Outrigger appliance 37
  38. 38. Outrigger appliance used with rect archwire 38
  39. 39. Outrigger appliance  Patient compliance in the advantage  Limitations  Anterior spacing  Adequate supply of elastics  Part time wear is impossible  Long term fatigue fracture of hooks 39
  40. 40. In the future..!! 40
  41. 41. Tip-edge plus Stage III root movements – heat activated NiTi auxiliary arch wire sidewinders- ‘spring free stage III’ Improved aesthetics,oral hygiene and patient comfort 41
  42. 42. The addition of a horizontal tunnel permits mesiodistal uprighting and torquing from the power of a small, round, super-elastic auxiliary wire-eliminates the need for individual uprighting springs and torquing auxiliaries 42
  43. 43. CONCLUSION Tip Edge appliance may no 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 versatile appliance system. 43
  44. 44. Reference  Tip – edge Orthodontics by Richard Parkhouse, 2005 reprint 44