Aligning and leveling in pea2

ComprehensiveComprehensive treatment mechanicstreatment mechanics
with preadjusted appliances involves 3with preadjusted appliances involves 3
stagesstages
ALIGNING AND LEVELINGALIGNING AND LEVELING
RETRACTIONRETRACTION
SETTLINGSETTLING
www.indiandentalacademy.comwww.indiandentalacademy.com

The tooth movement needed to achieveThe tooth movement needed to achieve
passive engagement of a plain,passive engagement of a plain,
rectangular archwire of 0.019 X 0.025rectangular archwire of 0.019 X 0.025
dimension, having standard arch form,dimension, having standard arch form,
into a correctly placed 0.022 bracketinto a correctly placed 0.022 bracket
systemsystem
(Mc Laughlin(Mc Laughlin & Bennet)& Bennet)

OBJECTIVESOBJECTIVES
Short term objectivesShort term objectives (proffit)(proffit)
In the initialIn the initial months of treatment, themonths of treatment, the
objective is to achieve proper aligning and leveling byobjective is to achieve proper aligning and leveling by
passive engagement of a rectangular wire.passive engagement of a rectangular wire.
Long term objectivesLong term objectives
Towards the end of treatment, the objective isTowards the end of treatment, the objective is
to achieve an ideal dentition, displaying six keys ofto achieve an ideal dentition, displaying six keys of
normal occlusion, and the dentition properlynormal occlusion, and the dentition properly
positioned within the facial profile.positioned within the facial profile.

Goals of first level of treatmentGoals of first level of treatment (proffit)(proffit)
The goals of aligning and leveling are toThe goals of aligning and leveling are to
bring the teeth into alignment and correct thebring the teeth into alignment and correct the
vertical discrepancies by leveling out thevertical discrepancies by leveling out the
arches.arches.

The goals of alignment areThe goals of alignment are ………………………………………………
1.1. Bringing out the malaligned teeth intoBringing out the malaligned teeth into
position.position.
2.2. Control of anterio-posterior position ofControl of anterio-posterior position of
incisors.incisors.
3.3. Control of anchorage in all three planes.Control of anchorage in all three planes.
4.4. To maintain the width of archesTo maintain the width of arches
posteriorly.posteriorly.
5.5. To maintain the form of dental archesTo maintain the form of dental arches

ETIOLOGY OF MALALIGNMENTETIOLOGY OF MALALIGNMENT (proffit)(proffit)
Deviation in path of eruptionDeviation in path of eruption
In almost all cases with malalignedIn almost all cases with malaligned
teeth, the apices will be closer to itsteeth, the apices will be closer to its
normal position, because malalignmentnormal position, because malalignment
almost develops as eruption path isalmost develops as eruption path is
deviated.deviated.
Crown movement is necessary, rootCrown movement is necessary, root
movement not usually requiredmovement not usually requiredwww.indiandentalacademy.comwww.indiandentalacademy.com

Roots in normal
position
Crowns are abnormally
situated
Deviated path of
eruption
Malalignment or
malocclusion

Cleft casesCleft cases
In cases of cleft surgery theIn cases of cleft surgery the
malalignment frequently seen ismalalignment frequently seen is
stereotyped and is due to thestereotyped and is due to the
displacementdisplacement of a part of tissue whichof a part of tissue which
tends to move the growing tooth bud astends to move the growing tooth bud as
a whole.a whole.

Muscle forcesMuscle forces
a)a) Normal casesNormal cases
Severe tipping from lip pressureSevere tipping from lip pressure
usually displaces maxillary centralusually displaces maxillary central
incisors inincisors in class II div 2.class II div 2.
b) due to abnormalb) due to abnormal Buccinator activityBuccinator activity,,
the upper arch may be constricted andthe upper arch may be constricted and
results in crowding and proclinationresults in crowding and proclination

 Definition.Definition.
 Principles of aligning.Principles of aligning.
 Properties of archwires.Properties of archwires.
 Archwire selection.Archwire selection.
 Alignment in various clinical situation.Alignment in various clinical situation.
 LevelingLeveling
 Methods of levelingMethods of leveling
 RelevelingReleveling
 Intrusion archesIntrusion arches
 Alignment in different treatment mechanics.Alignment in different treatment mechanics.
 ConclusionConclusion

““Tooth movements needed toTooth movements needed to
achieve passive engagement of aachieve passive engagement of a
steel rectangular wire, withoutsteel rectangular wire, without
exaggerated curve and withoutexaggerated curve and without
generating excessive forces”generating excessive forces”
proffitproffit

Principles of aligningPrinciples of aligning
Initial archwires for alignment
should produce a light force of 50 gms
to produce effective tipping.
Heavy forces should be avoided.
Whatever the slot size, the wire
should be loosely ligated to the
bracket.An archwire tied loosely is 4
times springier than a firmly attached
one.
proffit

 For better alignment, the clearanceFor better alignment, the clearance
between the archwire and the bracketbetween the archwire and the bracket
should be sufficient enough to provideshould be sufficient enough to provide
free frictionless sliding.free frictionless sliding.
 There should be at least 2-4 milThere should be at least 2-4 mil
clearance between bracket slot and wireclearance between bracket slot and wire..
 For 0.018 slot aligning wire should beFor 0.018 slot aligning wire should be
0.014”-0.016”.0.014”-0.016”.
 For 0.022 slot, 0.016-0.018 “ wire shouldFor 0.022 slot, 0.016-0.018 “ wire should
be used.be used.
CLEARENCE IN BRACKET SLOT
proffit

ROUND v/s RECTANGULAR WIRE
proffit
ROUND RECTANGULAR
Undesirable root movement
Slower alignment
More damaging
Crown tipped to normal position
No undesirable root movement
Faster derotations

When using springier archwire, theWhen using springier archwire, the
crowding should be reasonablycrowding should be reasonably
symmetric.symmetric.
Principles of aligningPrinciples of aligning
If one or more tooth is out of arch or
in an impacted tooth, base archwire
maintains its rigidity, where as
auxiliary wire with springness is used

Properties of ideal alignment arch wireProperties of ideal alignment arch wire
STRENGTH
SPRINGINESS
LONG RANGE OF
ACTION
FLAT LOAD
DEFLECTION CURVE

Maximum force a wire can deliver
D►2D STRENGTH x 8STRENGTH
SPRINGINESS
RANGE
Area under stress strain curve out
of proportional limit
D►2D SPRINGINESS x 1/16
Distance that a wire can bend
before plastic deformation
D►2D RANGE x 1/2
FLAT LOAD
DEFLECTION CURVE
Property of an archwire to
withstand deformation for a
greater loadwww.indiandentalacademy.comwww.indiandentalacademy.com

Variables in the selection ofVariables in the selection of
aligning arch wiresaligning arch wires
ARCHWIRE
MATERIAL
WIRE
SIZE
INTERBRACKET
SPAN

ARCHWIRE MATERIALARCHWIRE MATERIAL
 The wire should produce only light continuousThe wire should produce only light continuous
forceforce
 SteelSteel MULTISTRANDED OR MULTI LOOPS, supremeMULTISTRANDED OR MULTI LOOPS, supreme
 Beta titanium and NiTiBeta titanium and NiTi strength andstrength and
springinessspringiness
 NiTiNiTi more springness and strength at smallmore springness and strength at small
cross sections, flat load deflection curvecross sections, flat load deflection curve

 Cu NiTiCu NiTi (Rohit Sachdeva and Suchio Miyasaki 1994(Rohit Sachdeva and Suchio Miyasaki 1994 ))
 Cu NiTi have reduced energy lossCu NiTi have reduced energy loss
 precise phase transformationprecise phase transformation
temperature-15,27,35,40temperature-15,27,35,40°°CC
 20% less loading force when compared20% less loading force when compared
with NiTiwith NiTi

WIRE SIZEWIRE SIZE
Force deflection curves of 16 mil A-NiTi
with force delivery of 50,100,150gms
SIZE OF CLEARENCE IN
THE WIRE BRACKET SLOT
M-NiTi, TMA, steel wires – wire size is of great
concern
FOR INITIAL ALIGNMENT -----STRONGER WIRE IN
SMALLEST DIAMETER IS BEST
MULTISTRANDED STAINLESS STEEL ----- INCREASED
STRENGTH WITHOUT CHANGE IN SPRINGINESS

DIAMETER
INCREASES
STRENGTH
INCREASES
DIAMETER
DECREASES
SPRINGINESS
INCREASES

INTEBRACKET SPANINTEBRACKET SPAN
As the distance between the point of
attachment of a beam increases strength
decreases and springiness increases. The
bracket width determines the beam length
when continuous wire are used

INTER BRACKET SPAN INCREASES
INCREASE IN THE LENGTH OF
THE WIRE
INCREASED FLEXIBILITY
DECREASED FORCES
POINT OF ATTACHMENT OF
BEAM INCREASES
MORE
MECHANICAL
EFFICENCY
NARROW BRACKETS

Anchorage considerationsAnchorage considerations
““The manoeuvres used to restrictThe manoeuvres used to restrict
undesirable changes during the openingundesirable changes during the opening
phase of treatment, so leveling and aligningphase of treatment, so leveling and aligning
is achieved without key features ofis achieved without key features of
malocclusion becoming worse.malocclusion becoming worse.
(Mc Laughlin & Bennet MBT)(Mc Laughlin & Bennet MBT)

Principles of anchorage controlPrinciples of anchorage control
Anchorage is critical during the initialAnchorage is critical during the initial
phase and it is essential to control thephase and it is essential to control the
undesirable tooth movement in all threeundesirable tooth movement in all three
dimensionsdimensions
There is a need to minimize the factorsThere is a need to minimize the factors
which threaten anchorage & whichwhich threaten anchorage & which
produce unwanted tooth movements.produce unwanted tooth movements.

Anchorage control in horizontal planeAnchorage control in horizontal plane
Control of anterior segment
There is a tendency for anterior teeth to
incline forward during the initial phase of leveling
and aligning when using preadjusted edgewise.
This is due to the inbuilt tip in the bracket design.
Earlier this effect was minimized or eliminated by
connecting anterior and posterior segment with
elastics. www.indiandentalacademy.comwww.indiandentalacademy.com

 The tooth next to the extraction space hasThe tooth next to the extraction space has
the greatest tendency to tip into thethe greatest tendency to tip into the
extraction space during space closureextraction space during space closure
 To negate this effect, a counter moment inTo negate this effect, a counter moment in
the form of mesial crown tip is built into thethe form of mesial crown tip is built into the
anterior brackets with the maximum on theanterior brackets with the maximum on the
caninecanine

Roth mechanics
TIP VALUES
11 22 33 44 55 66 77
UpperUpper 5º5º 9º9º 13º13º 0º0º 0º0º 0º0º 0º0º
LowerLower 2º2º 2º2º 7º7º -1º-1º -1º-1º -1º-1º -1º-1º

11 22 33 44 55
UpperUpper 4º4º 8º8º 8º 0º0º 0º0º
LowerLower 0º0º 0º0º 3º 2º2º 2º2º
TIP VALUES MBT mechanics

 0.010 or 0.009 ligature wires which extend from0.010 or 0.009 ligature wires which extend from
most distally banded molars to canine in all fourmost distally banded molars to canine in all four
quadrants. It prevents canine from tippingquadrants. It prevents canine from tipping
forward, and when necessary, can be used toforward, and when necessary, can be used to
distalize canine also without causing tipping.distalize canine also without causing tipping.
 Bend the archwire behind most distally bandedBend the archwire behind most distally banded
posterior teeth to minimize forward tipping ofposterior teeth to minimize forward tipping of
incisorsincisors
MBT Mechanics

Effect of lace backEffect of lace back (Robinson S N 1989)(Robinson S N 1989)
57 premolar extraction cases57 premolar extraction cases
 Prevent canines from forward tippingPrevent canines from forward tipping
 Distalizing canines.Distalizing canines.
 Controlling lower anterior proclination.Controlling lower anterior proclination.
1.4mm 1mm

To prevent the upper posterior segment toTo prevent the upper posterior segment to
move distally or prevent them from movingmove distally or prevent them from moving
mesially, to allow the anterior segment to bemesially, to allow the anterior segment to be
properly positioned in the face.properly positioned in the face.
Control of posterior segment (upper)Control of posterior segment (upper)
PALATAL BARPALATAL BAR HEAD GEARHEAD GEAR

 Soldered lingual arch is required in late mixedSoldered lingual arch is required in late mixed
dentition period to avoid the mesial drifting ofdentition period to avoid the mesial drifting of
molars into the leeway space.molars into the leeway space.
 Class III elastics can be worn to Kobayashi tieClass III elastics can be worn to Kobayashi tie
wires in the lower canine region with head gear.wires in the lower canine region with head gear.
The class III elastics should be worn after 0.016The class III elastics should be worn after 0.016
round wires, to prevent extrusion of anteriors.round wires, to prevent extrusion of anteriors.
Control of posterior segment (lower)Control of posterior segment (lower)

Anchorage control in Transverse planeAnchorage control in Transverse plane
 Intercanine width should be maintained almostIntercanine width should be maintained almost
same from the onset to the end of treatment tosame from the onset to the end of treatment to
ensure stability, both in upper and lower arches.ensure stability, both in upper and lower arches.
 Molar cross bites should be corrected only byMolar cross bites should be corrected only by
bodily movement. Tipping will cause the palatalbodily movement. Tipping will cause the palatal
cusp to extrude causing bite openingcusp to extrude causing bite opening

Arch formsArch forms
 3 arch forms – tapered, ovoid and square3 arch forms – tapered, ovoid and square
 Arch form should be preserved till the end of treatmentArch form should be preserved till the end of treatment
 The arch wires used in the alignment stage are resilientThe arch wires used in the alignment stage are resilient
and need not be shaped, but from the beginning the archand need not be shaped, but from the beginning the arch
form should reflect each individual arch formform should reflect each individual arch form
 Due to the increased resiliency of the initial aligning archDue to the increased resiliency of the initial aligning arch
wire – loss of arch form particularly in severe crowding orwire – loss of arch form particularly in severe crowding or
asymmetric crowding is a common observation.asymmetric crowding is a common observation.

Anchorage control in vertical planeAnchorage control in vertical plane
Control of incisors
If the canine is tipped distally, before starting
treatment, the archwire will lay incisaly to the
incisor bracket. If we engage the archwire into
the bracket, it will tend to deepen the bite

Vertical control of molarsVertical control of molars
 Second molars are not initially banded,Second molars are not initially banded,
in high angle cases, to avoid extrusionin high angle cases, to avoid extrusion..
 if expansion of upper arch is required,if expansion of upper arch is required,
an fixed expander with head gear isan fixed expander with head gear is
advised to achieve bodily movementadvised to achieve bodily movement
 To get a vertical intrusive effect onTo get a vertical intrusive effect on
molars, the palatal bar is placed 2 mmmolars, the palatal bar is placed 2 mm
away from tissueaway from tissue..www.indiandentalacademy.comwww.indiandentalacademy.com

 A combi-pull or a high pull head gear isA combi-pull or a high pull head gear is
advised in high angle casesadvised in high angle cases..
 Upper or lower molar bite planes can beUpper or lower molar bite planes can be
given to avoid molar extrusion.given to avoid molar extrusion.

ALIGNMENT IN SYMMETRIC CROWDINGALIGNMENT IN SYMMETRIC CROWDING
 Initial alignment can be done by tying a 0.016” or 0.014”Initial alignment can be done by tying a 0.016” or 0.014”
A-NiTi /Cu NiTi that delivers about 50gms into theA-NiTi /Cu NiTi that delivers about 50gms into the
bracket of all teeth.bracket of all teeth.
proffitproffit
DisadvantagesDisadvantages
Traveling’Traveling’ of the wire.of the wire.
PreventionPrevention
Crimping of archwireCrimping of archwire..

 AA triple stranded 0.0175” multistrandedtriple stranded 0.0175” multistranded
stainless steelstainless steel can be used.can be used.
 DisadvantagesDisadvantages
 Patient discomfort due to variable force levels.Patient discomfort due to variable force levels.
 Multistranded stainless steel wires should beMultistranded stainless steel wires should be
recontoured and retied on each visit.recontoured and retied on each visit.

Alignment in premolar extraction situation.Alignment in premolar extraction situation.
o In case of extreme crowdingIn case of extreme crowding 
individual canine retractionindividual canine retraction  moremore
strain on anchorage.strain on anchorage.
o In less crowding cases,In less crowding cases,  tip thetip the
canines and align incisorscanines and align incisors
simultaneously.simultaneously.

Alignment in nonextraction situation.Alignment in nonextraction situation.
When multistranded wires are used theWhen multistranded wires are used the
easiest way is to bend a loop mesial toeasiest way is to bend a loop mesial to
molar tube, so that wire is held justmolar tube, so that wire is held just
anterior to the incisors before tying it. Inanterior to the incisors before tying it. In
next visits this loop is opened, until thenext visits this loop is opened, until the
teeth will come into alignmentteeth will come into alignment..

When using superelastic NiTi, the procedureWhen using superelastic NiTi, the procedure
is to crimp a stop on the wire at the molaris to crimp a stop on the wire at the molar
tube, so that it holds the wire in front oftube, so that it holds the wire in front of
incisors. Additional stops can be slipped intoincisors. Additional stops can be slipped into
position, without even removing the arch inposition, without even removing the arch in
later visitslater visits..

ALIGNMENT IN ASYMMETRIC CROWDINGALIGNMENT IN ASYMMETRIC CROWDING
 Archwire requirementsArchwire requirements
 rigidity, in the area where the teeth are alreadyrigidity, in the area where the teeth are already
alignedaligned
 Springness in crowded areaSpringness in crowded area
 When superelastic NiTi is placed as aWhen superelastic NiTi is placed as a
continuous wire in crowded arch or in ancontinuous wire in crowded arch or in an
impacted canine, the adjacent teeth will alsoimpacted canine, the adjacent teeth will also
have the same effect as the malaligned toothhave the same effect as the malaligned tooth..www.indiandentalacademy.comwww.indiandentalacademy.com

 Earlier this was corrected with the use of 0.014” orEarlier this was corrected with the use of 0.014” or
0.016” stainless steel wire with incorporated loops in the0.016” stainless steel wire with incorporated loops in the
area of crowding.area of crowding.
 It is easy to add a small diameter superelastic wire as anIt is easy to add a small diameter superelastic wire as an
auxiliary spring, so that a stiffer archwire is tied in to allauxiliary spring, so that a stiffer archwire is tied in to all
teeth except all areas which are malalignedteeth except all areas which are malaligned

Cross biteCross bite
 In the first stage of treatment, it isIn the first stage of treatment, it is
important to correct mild anterior orimportant to correct mild anterior or
posterior cross bites.posterior cross bites.
 Correction of cross bite requires opening ofCorrection of cross bite requires opening of
enough space for the displaced teeth to beenough space for the displaced teeth to be
brought forward into proper position. But thebrought forward into proper position. But the
occlusal force tends to push each other andocclusal force tends to push each other and
the archwire force pulls them together..the archwire force pulls them together..

 Hence before aligning, it is necessary toHence before aligning, it is necessary to
open the bite using a posterior biteopen the bite using a posterior bite
plane and create vertical spaceplane and create vertical space
necessary to move the tooth forwardnecessary to move the tooth forward

Skeletal cross biteSkeletal cross bite
The arch expansion should be carried
out as the first step before premolar
extraction
Palatal expansion appliance
Opening of midpalatal suture –
4000 -9000 gms force for 2 weeks –
retention for 3-4 months

 When the maxillary teeth move transversely,When the maxillary teeth move transversely,
some amount of extrusion takes place, or, evensome amount of extrusion takes place, or, even
cuspal interference will cause mandible to rotatecuspal interference will cause mandible to rotate
downward and backwards. this is advantageousdownward and backwards. this is advantageous
in deepbite cases and in class III tendencyin deepbite cases and in class III tendency
patients.patients.
 When used in long face patients bite blockWhen used in long face patients bite block
should be added to the bonded expander toshould be added to the bonded expander to
overcome this problem.overcome this problem.

Dental cross biteDental cross bite
Dental cross bite in permanent dentitionDental cross bite in permanent dentition
 In patients with molar tipped linguallyIn patients with molar tipped lingually, a heavy, a heavy
labial expansion arch / expanded inner bow oflabial expansion arch / expanded inner bow of
head gear is used.head gear is used.
 Expansion transpalatal archExpansion transpalatal arch made of 0.036”made of 0.036”
steel wires, with an adjacent loop.steel wires, with an adjacent loop.
 Cross elasticsCross elastics from lingual of upper molar tofrom lingual of upper molar to
buccal of the lower molar .buccal of the lower molar . But extrusion ofBut extrusion of
posteriors is an expected disadvantageposteriors is an expected disadvantage..

Impacted or unerupted teethImpacted or unerupted teeth
Correction of impacted can be discussed
under following headings
Surgical exposure
Attachment to the teeth
Orthodontic mechanics

 Surgical exposureSurgical exposure
A tooth always should erupt throughA tooth always should erupt through
attached gingiva. If the impactedattached gingiva. If the impacted
tooth is placed more labially intooth is placed more labially in
relation with the maxillary alveolarrelation with the maxillary alveolar
process, the flap should be reflectedprocess, the flap should be reflected
from the crest of the alveolarfrom the crest of the alveolar
process. OTHERWISE, the tissue willprocess. OTHERWISE, the tissue will
strip away from the crown, leaving anstrip away from the crown, leaving an
unsightly and periodontallyunsightly and periodontally
compromised tooth.compromised tooth.

 Orthodontic mechanicsOrthodontic mechanics
Alignment of other teeth and space forAlignment of other teeth and space for
impacted tooth should be created beforeimpacted tooth should be created before
the surgical exposure, so that a heavythe surgical exposure, so that a heavy
stabilizing wire can be in position at thestabilizing wire can be in position at the
time of surgery.time of surgery.
It is always better to use an
auxiliary NiTi, overlaid on a
stabilizing arch, as we are
using in asymmetric arch.
NiTi attached directly to the
malpositioned canine

DiastemaDiastema
 Accompanied with thick fibrous tissueAccompanied with thick fibrous tissue
inserted into the alveolar bone. Stableinserted into the alveolar bone. Stable
correction attained only by frenectomy.correction attained only by frenectomy.
 The frenectomy should never be carried outThe frenectomy should never be carried out
before orthodontic correction, as scar tissuebefore orthodontic correction, as scar tissue
forms between the teeth, and will delay theforms between the teeth, and will delay the
space closure.space closure.
 Loops should be avoided in space closure, asLoops should be avoided in space closure, as
the height will irritate the frenum.the height will irritate the frenum.www.indiandentalacademy.comwww.indiandentalacademy.com

 In severe diastema, surgery can beIn severe diastema, surgery can be
done after partial closure of space. Thedone after partial closure of space. The
remaining space can be closed soonremaining space can be closed soon
after surgery. when this is done,after surgery. when this is done,
healing occurs together with spacehealing occurs together with space
closure, and the scar will stabilize theclosure, and the scar will stabilize the
teeth in correct position.teeth in correct position.
 If frenectomy is not necessary, as inIf frenectomy is not necessary, as in
simple cases, only the fibroussimple cases, only the fibrous
connection to the bone is removedconnection to the bone is removed
(frenotomy)(frenotomy) www.indiandentalacademy.comwww.indiandentalacademy.com

Instanding tooth without sufficient
space for the tooth to come into
alignment
When continuous arch wire is placed
Due to lack of space, the crown is
unable to come into alignment
Crown movement does not occur, but the
root moves in the opposite direction
In standing toothIn standing tooth

Two Stage AlignmentTwo Stage Alignment
In Standing LateralIn Standing Lateral
Initial alignment with 016 round NiTiInitial alignment with 016 round NiTi
Initial alignment of the remaining teethInitial alignment of the remaining teeth
Change to 016 round SS wire with open coil springsChange to 016 round SS wire with open coil springs
Create space for the instanding toothCreate space for the instanding tooth
Further alignment with 016 round NiTiFurther alignment with 016 round NiTi
Create space greater than the mesiodistal diameter of the
instanding tooth
{Do not bond the in standing tooth or engage the continuous wire}
Aligned Lateral IncisorAligned Lateral Incisor

INITIAL alignment with 0.016 NiTi0.016 ss wire with open coil spring
Ligature ties

 No distortion of the arch formNo distortion of the arch form
 Light forcesLight forces
 Reciprocal forces is distributed over all the restReciprocal forces is distributed over all the rest
of the teeth through the rigid base arch wireof the teeth through the rigid base arch wire
 No strain on anchorageNo strain on anchorage
 No adverse effect on the torque of the instandingNo adverse effect on the torque of the instanding
toothtooth
ADVANTAGES

Unfavorable canines.Unfavorable canines.
In distally tilted canines, it is advisable to leave the
brackets off the incisors (or the archwire disengaged)
until the cuspid roots can be distalized and the cuspid
bracket slots are more parallel to the occlusal plane.
DISTALLY PLACED CROWN
MESIALLY PLACED ROOT

Favourable canineFavourable canine
 The canine root is distal to the crown.The canine root is distal to the crown.
 The root is in an ideal position.The root is in an ideal position.
 Only the crown needs to be moved moreOnly the crown needs to be moved more
than the root which is more easier.than the root which is more easier.www.indiandentalacademy.comwww.indiandentalacademy.com

Highly placed caninesHighly placed canines
If continuous wire tied into the highlyIf continuous wire tied into the highly
placed canine, the lateral incisor andplaced canine, the lateral incisor and
premolar would tip into the canine spacepremolar would tip into the canine space

LEVELINGLEVELING
Leveling is the procedure inLeveling is the procedure in
which the molar and premolar arewhich the molar and premolar are
brought to same plane as incisorsbrought to same plane as incisors..

LEVELING
ALIGNING
RETRACTION
SETTLING
0.5mm incisally in the
anteriors
0.5 mm gingivally in
posteriors
Leveling can also be partially corrected by altering the bracket
position.
Deep bite
www.indiandentalacademy.com

 If adequate leveling is not achieved beforeIf adequate leveling is not achieved before
space closure, it will result inspace closure, it will result in ANCHORANCHOR
LOSSLOSS
 In presence of severe crowding it is betterIn presence of severe crowding it is better
to align first with a resilient wire and doto align first with a resilient wire and do
leveling as a next stepleveling as a next step

LEVELING BY EXTRUSIONLEVELING BY EXTRUSION
 Leveling by extrusion is achieved byLeveling by extrusion is achieved by
means of placing a maxillary wire withmeans of placing a maxillary wire with
exaggerated curve of spee and a lowerexaggerated curve of spee and a lower
archwire with reverse curve of speearchwire with reverse curve of spee
usually with a continuous stiffer wire.usually with a continuous stiffer wire.
 Achieved by supra eruption of posteriors.Achieved by supra eruption of posteriors.

Effect of reverse curve in round wireEffect of reverse curve in round wire
REVERSE CURVE OF SPEE

REVERSE CURVE OF SPEE AND BENDBACK

REVERSE CURVE OF SPEE, BENDBACK,CLASS III ELASTICS

LEVELING BY INTRUSIONLEVELING BY INTRUSION
 Achieved by light continuous force passingAchieved by light continuous force passing
through the apex of the tooth.through the apex of the tooth.
 When a tooth is planned to intrude, care shouldWhen a tooth is planned to intrude, care should
be taken not to extrude the neighboring teeth,be taken not to extrude the neighboring teeth,
causing pitting intrusion.causing pitting intrusion.
This can be achieved by two methodsThis can be achieved by two methods
 BYPASS ARCHES-BYPASS ARCHES- continuous wire that bypassescontinuous wire that bypasses
premolars and canines.premolars and canines.
 SEGMENTED BASE ARCHWIRES-SEGMENTED BASE ARCHWIRES- segmented wiressegmented wires
and depressing auxiliary wire.and depressing auxiliary wire.

Leveling techniquesLeveling techniques
 Extra oral proceduresExtra oral procedures
Head gearsHead gears
High pullHigh pull
Cervical pullCervical pull
Combination pullCombination pull
J hookJ hook
 Intra oral includesIntra oral includes
 Burstone intrusionBurstone intrusion
archarch
 Utility archesUtility arches
 Three piece intrusionThree piece intrusion
 Connecticut archConnecticut arch
 K SIR archK SIR arch
Extra oral / intra oral techniqueExtra oral / intra oral technique

BYPASS ARCHESBYPASS ARCHES
 Advised in patients before growth cessation.Advised in patients before growth cessation.
 Uprighting and distal tipping of molars withUprighting and distal tipping of molars with
intrusion of anteriors takes place.intrusion of anteriors takes place.
 Example – Utility arches of Ricketts andExample – Utility arches of Ricketts and
McNamaraMcNamara

Mulligan’s methodMulligan’s method (JCO 1980)(JCO 1980)
Using a 16 mil steel wire with an anchorUsing a 16 mil steel wire with an anchor
bend similar to beggs technique in hisbend similar to beggs technique in his
“2 X 4” appliance“2 X 4” appliance

Rickett’s utility archRickett’s utility arch
 Rickets utility arch is characterized by stepRickets utility arch is characterized by step
down bends between first molar and lateraldown bends between first molar and lateral
incisor, so less chance of wire distortion byincisor, so less chance of wire distortion by
occlusal force.occlusal force.
 The arch is made of 16X16 blue elgiloyThe arch is made of 16X16 blue elgiloy
wire in an 18” slot.wire in an 18” slot.
 Today 16x22 beta titanium is preferredToday 16x22 beta titanium is preferred

Disadvantages of bypass archesDisadvantages of bypass arches
Only first molar will available for anchorage, causes itsOnly first molar will available for anchorage, causes its
extrusion. In non growing patients, it’s a major concern. Toextrusion. In non growing patients, it’s a major concern. To
increase the anchorage, there are two methodsincrease the anchorage, there are two methods
 Use of high pull head gear, along with bypassUse of high pull head gear, along with bypass
arches.arches.
 Inclusion of second molar and second premolar inInclusion of second molar and second premolar in
the posterior segmentthe posterior segment..
 The intrusive force against incisors is applied anterior toThe intrusive force against incisors is applied anterior to
the center of resistance this will tend to tip the incisorsthe center of resistance this will tend to tip the incisors
forward, particularly in extraction cases. This can beforward, particularly in extraction cases. This can be
corrected by the inclusion of torque in the wire.corrected by the inclusion of torque in the wire.

SEGMENTED INTRUSION ARCHESSEGMENTED INTRUSION ARCHES
This approach depends on establishing stabilized
posterior segment and controlling the point of force
application against anteriors.
The right and left posterior segment are stabilized using
rigid wires, the anterior segment is also stablized
A heavy lingual arch wire of 0.036” or 32 X 32 s/s wire
connects right and left posterior segments making the
posterior segment a single unit.
An intrusion base arch is used to level the anteriors,
while the posteriors are stabilized.www.indiandentalacademy.comwww.indiandentalacademy.com

Burstone intrusion arch

RELEVELINGRELEVELING
 When newly erupted teeth are includedWhen newly erupted teeth are included
 When brackets or bands are reattachedWhen brackets or bands are reattached
due to breakage or incorrect positioningdue to breakage or incorrect positioning
 It is better to reposition brackets than toIt is better to reposition brackets than to
make archwire bends throughoutmake archwire bends throughout
treatmenttreatment

0.016 Green Elgiloy0.016 Green Elgiloy 0.015 Respond0.015 Respond 0.019 Respond0.019 Respond
 0.018 Australian special plus0.018 Australian special plus 0.019 square blue0.019 square blue
Elgiloy (if VTO calls for incisor extrusion)Elgiloy (if VTO calls for incisor extrusion)
In cases of bimaxillary protrusion, the initial wire will beIn cases of bimaxillary protrusion, the initial wire will be
0.018 special plus Australian wire followed by 0.0200.018 special plus Australian wire followed by 0.020
double keyhole loop archwires in which the Asher facedouble keyhole loop archwires in which the Asher face
bows to retract the anterior teeth to a more uprightbows to retract the anterior teeth to a more upright
position.position.
Banding of the 2Banding of the 2ndnd
molars.molars.

Hass type appliance.Hass type appliance. initial aligninginitial aligning
Quad helix.Quad helix. expansionexpansion
Goshgarian type TPA or a lingual arch.Goshgarian type TPA or a lingual arch. anchorageanchorage
Occipital pull head gear or face bow.Occipital pull head gear or face bow. anchorageanchorage
Wilson biometric arch or a Utility arch.Wilson biometric arch or a Utility arch. mixed dentionmixed dention
If the crowding is more than 5mm helical loopedIf the crowding is more than 5mm helical looped
archwires, Jarabak fashion made inarchwires, Jarabak fashion made in 0.016 green0.016 green
ElgiloyElgiloy is preferredis preferred

.015 .0175 .014 .016 .018 .020
.016 HANT .014.019X.025.019X.025 HANT
Aligning and leveling wires used in MBT mechanics

Banding of second molarBanding of second molar
In low angle, deep bite cases banding of
second molars in most beneficial in bite
opening and leveling of curve of spee.
This provides an excellent lever arm or the
extrusion of premolars and the intrusion of
incisors, and hence helps in bite opening

Bite planeBite plane
 They are used for leveling of the arches inThey are used for leveling of the arches in
the specified clinical situationsthe specified clinical situations

Nonextraction casesNonextraction cases
Multistranded .017" X.025" D-RectMultistranded .017" X.025" D-Rect
(mandibular arch) and .0175" Respond(mandibular arch) and .0175" Respond
(maxillary arch to promote anterior(maxillary arch to promote anterior
dental advancement)dental advancement)
Occasionally, an .016" SS round or an .Occasionally, an .016" SS round or an .
016"X.022" s/s rectangular wire may be016"X.022" s/s rectangular wire may be
used to eliminate rotationsused to eliminate rotations
.017" ´ .025" s/s ideal finishing archwire.017" ´ .025" s/s ideal finishing archwirewww.indiandentalacademy.comwww.indiandentalacademy.com

Extraction casesExtraction cases
 Maxillary ArchMaxillary Arch
Multistrand .0175" Respond / .017" X .025" D-RectMultistrand .0175" Respond / .017" X .025" D-Rect
.016" round SS.016" round SS wire for retracting cuspidswire for retracting cuspids
.018" X.025" SS with closing loops to retract four.018" X.025" SS with closing loops to retract four
anteriors (reduce archwire posteriorly)anteriors (reduce archwire posteriorly)
.017" X .025" SS finishing archwire.017" X .025" SS finishing archwire
 Mandibular ArchMandibular Arch
Multistrand .0175" Respond / .017" X .025" D-RectMultistrand .0175" Respond / .017" X .025" D-Rect
.016" round SS archwire or .017" X .025" D-Rect.016" round SS archwire or .017" X .025" D-Rect
.016" X.022" SS closing loop archwire.016" X.022" SS closing loop archwire
.017" X .025" SS finishing archwire.017" X .025" SS finishing archwire

At the end of treatment the arches should be well
aligned and leveled to the point that rectangular
steel wires can be placed without a exaggerated
curve and without generating excessive forces. It is
expected that appropriate goals for each patient be
stated and treatment techniques should be designed
to achieve the goals !!!!!!

o Earlier Stoner’s “Drag loop”. This loop in theEarlier Stoner’s “Drag loop”. This loop in the
extraction site is gabled sharply andextraction site is gabled sharply and
activated, producing a space closing forceactivated, producing a space closing force
with an antitip moment in the posteriors. Aswith an antitip moment in the posteriors. As
the activated distal loop closes, the mesialthe activated distal loop closes, the mesial
loop opens, allowing the canine to tip back andloop opens, allowing the canine to tip back and
the incisors to align.the incisors to align.
o A-NiTi archwire with exaggerated reverseA-NiTi archwire with exaggerated reverse
curve of spee and A-NiTi coil springscurve of spee and A-NiTi coil springs..

Traction applied with ligature
wire or elastic chain attached to
stiff base arch wire
A special alignment spring (ballista
spring) either soldered to heavy wire
or bend into a light archwire can also
be used. Jacoby AJO 1979
Auxiliary spring soldered to
the base arch wire

18 slot narrow bracket v/s 22 slot wider brackets18 slot narrow bracket v/s 22 slot wider brackets
16 mil stainless steel wire followed by 0.018” round wire16 mil stainless steel wire followed by 0.018” round wire
is used for leveling. In some cases, we need to continueis used for leveling. In some cases, we need to continue
with 0.020” wire or an auxiliary wire, to achievewith 0.020” wire or an auxiliary wire, to achieve
complete leveling.complete leveling.
0.018” slot
An 0.018” or 0.016” NiTi can be
used in cooperative patients.
An auxiliary wire of 17X25 TMA or
steel inserted in the auxiliary tube of
molar, and tied beneath the 0.016”
base arch wire can also be used.
0.022” slot

Care should be taken, when rectangular wire is usedCare should be taken, when rectangular wire is used
for leveling, either with 18 slot or with 22 slot. Whenfor leveling, either with 18 slot or with 22 slot. When
using a rectangular wire with exaggerated curve inusing a rectangular wire with exaggerated curve in
the wire, it creates torque in the wire that causes thethe wire, it creates torque in the wire that causes the
roots to move palatally. It must be avoided in theroots to move palatally. It must be avoided in the
lower arch. Therefore wire should be leveled beforelower arch. Therefore wire should be leveled before
placing in the lower arch.placing in the lower arch.

For the intrusion of anteriors, auxiliaryFor the intrusion of anteriors, auxiliary
depressing arch made of 18X25 s/s with a 2 ½depressing arch made of 18X25 s/s with a 2 ½
turn helix or 19/25 TMA or a preformed NiTi isturn helix or 19/25 TMA or a preformed NiTi is
inserted in the auxiliary tube. This depressinginserted in the auxiliary tube. This depressing
arch lies gingival to incisor bracket, when it’sarch lies gingival to incisor bracket, when it’s
passive. When it is tied beneath into the bracket,passive. When it is tied beneath into the bracket,
it produces a light intrusive force of 10-15 gmsit produces a light intrusive force of 10-15 gms
per tooth, depending on the root size.per tooth, depending on the root size.

 As the anteriors are intruded, there is always aAs the anteriors are intruded, there is always a
tendency for the teeth to be move forward. This cantendency for the teeth to be move forward. This can
be prevented by two methods,.be prevented by two methods,.
1.1. A space closing force can be created by tying theA space closing force can be created by tying the
depressing arch back against the posteriordepressing arch back against the posterior
segments.segments.
2.2. Vary the force of application against the incisorVary the force of application against the incisor
segment. This can be achieved by tying the auxiliarysegment. This can be achieved by tying the auxiliary
wire distal to midline, ie, between the central incisorwire distal to midline, ie, between the central incisor
and the laterals or distal to the laterals. Thisand the laterals or distal to the laterals. This
prevents tipping of incisor segment without causingprevents tipping of incisor segment without causing
anchorage strain.anchorage strain.

Aligning and leveling in pea2

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