Bioprogressive therapy

Bioprogressive Therapy
www.indiandentalacademy.com

 Introduction
 Principles of BPT.
 Diagnosis and treatment planning.
 Role of orthopedics.
 Forces used in BPT.
 Development of the utility arch.
 Mixed dentition treatment.

 Brackets & Prescriptions
 Class II div I
 Class II div II
 Mechanics for extraction cases.
 Finishing and retention.

Introduction
 Bioprogressive therapy was developed from a
background of edgewise technique as well as
begg technique.
 Rickett’s describes three phases of:
 Primary edgewise
 Secondary edgewise
 Tertiary edgewise.
 Quaternary edgewise

Introduction
 It accepts as its mission the treatment of the
total face rather than the narrower objective
of the teeth and the occlusion.
 Takes advantages of biological progressions
including growth, development ,function and
directs them to normalize it.

Introduction
 Management
umbrella

Principles of the

Principles of the
 BPT has been developed in an attempt to
communicate an understanding of
mechanical procedures in developing a
treatment plan, appliance selection specific to
individual type.
 Ten Principles.

Principles of the
 The use of a systems approach to diagnosis
and treatment by the application of the VTO
in planning treatment, evaluating anchorage
and monitoring results.
 Torque control throughout treatment.

Principles of the
 Keep the roots in vascular trabecular
bone.
 Place roots against dense cortical bone.
 Torque to remodel cortical bone.
 Torque position teeth in final occlusion.

Principles of the
 Muscular and cortical anchorage.
different types of muscular pattern in
different individuals.
 Movement of any teeth in any direction with
proper application of pressure
it is designed to respect the supporting
structures and size of the root of individual teeth

Principles of the
 Orthopedic alteration
-anticipates and plans for this in treating younger children.
 Treat the overbite before the overjet.
-incisor intrusion as best choice
-stability of results
-prevent interference

Principles of the
 Sectional arch treatment- arches are broken
into segments.
-allow lighter continuous force
-more efficient root control.
-supplements maxillary orthopedic alteration.
- reduces friction and binding.
 Concept of overtreatment
- to overcome muscular forces.
- root movements for stability.

Principles of the
- To overcome orthopedic rebound
- To allow settling in retention
 Unlocking of malocclusion in progressive
sequence of treatment in order to establish or
restore more normal function .
-functional influence
- orthopedic alteration.
- arch form-length
- tooth movement.

Principles of the
 Efficiency in treatment with quality results
utilizing a concept of pre fabrication.
-allows the clinician to direct energies in diagnosis and planning
and efficient appliance therapy.

Diagnosis and Treatment
Planning

Visual treatment objectives
 VTO is a cephalometric tracing representing
the changes that are expected (desired)
during the treatment.
 It includes expected growth, any growth
changes induced by the treatment, and any
repositioning of the teeth from orthodontic
tooth movement.

1. Is like a blueprint used in building a house.
2. Visual plan to forecast normal and to
anticipate influence of treatment.
3. In establishing individual objectives.
4. Helps in developing an alternate treatment
plan.
5. Helps to evaluate treatment progress.
6. Valuable tool for the orthodontist’s self
improvement.

 Steps-
1. Ba-Na plane
2. Construction of the
new mandible
position .(mandibular
rotation)

3. Construction of the
new maxillary
position
4. Position of the
dentition.

5. Final soft tissue
profile.

Superimpositions area’s
1. The chin
2. The maxilla
3. The teeth in the mandible
4. The teeth in the maxilla
5. The facial profile

 The first superimposition
(Basion-Nasion at CC Point)
establishes Evaluation Area
1
 Amount of growth of the chin
 Any change in chin in an
opening or closing direction
that may result from our
mechanics.

 The second superimposition
area (Basion-Nasion at
Nasion) establishes
Evaluation Area 2 to show
 Any change in the maxilla
(Point A).
 The Basion-Nasion-Point A
Angle does not change in
normal growth.

 The third superimposition area (Corpus Axis
at PM) establishes Evaluation Area 3 and
Evaluation Area 4,
 Together evaluate any changes that take
place in the mandibular denture. In normal
growth, the lower denture remains constant
with the APO Plane

 In Evaluation Area 3-
lower incisors.
 In Evaluation Area 4-
lower molars

 The fourth superimposition area (Palate at
ANS) establishes Evaluation Area 5 and
Evaluation Area 6,
 Which together evaluate any changes that
take place in the maxillary denture

 In Evaluation Area 5, the
upper molars
 In Evaluation Area 6, we
evaluate the upper incisors

 5th Superimposition
Area (esthetic plane at
the crossing of the
occlusal plane)
 Area 7 with which we
evaluate the soft tissue
profile

Role Of Orthopedics

Orthopedics in BPT
 Any manipulation that alters the normal
growth of the dentofacial complex in either
direction or amount.
 Concept of differential treatment in Class II
malocclusion.

Orthopedics in BPT
 Thorough analysis of facial and dental
characteristics –facial growth type.
 More emphasis on cervical or combination
headgear.

Orthopedics in BPT

Generalized orthopedic response
with Cervical Headgear alone-
 Maxilla responds in a
more predictable
manner.

Generalized orthopedic response
 Mandibular response – depends on the
musculature.
- weak musculature
- strong musculature

Generalized orthodontic response
 Upper molars-extrusion of upper molars.
 Upper incisors-tip lingually
 Lower molars-upright and move distally
 Lower incisors-tip labially

The Reverse Response

Expansive Response
 In Class II –ant. Part of the maxilla is
generally tapered –lingual crossbite.
 Two basic expansive phenomenon are
occur-
1. Anatomic configuration of maxillary
complex.

Expansive Response

Expansive Response
2. From mechanical point ,progressive
widening of the alveolar base is
accomplished by widening of inner bow.
- Reciprocal expansion of lower arch.
- Preventing impacted second molar.

Mechanical application
1. Force level- 400gms
Intermittent wear –several advantages
-heavy forces result in hylanization.
-rebound allows in stability.
-more growth occurs at nite.
- Patient acceptance.

Mechanical application
3. Outer bow length and position
- Rigid outer bow.
- At the ala of the nose.
4. Expansion and rotation.
- Flexible inner bow , 2 cm of expansion.
5. Freedom of movement of maxilla

Forces Used In

Forces Used In
 The orthodontic movement of teeth occurs as
a result of the biological response and the
physiological reaction to the forces applied by
our mechanical procedures.
 Brian Lee, following the work of Storey and
Smith, measured the surface of the root being
exposed to movement— called the enface
surface of the root.

Forces Used In
 He, proposed 200 grams per sq cm of enface
root surface exposed to movement as the
optimum pressure to be applied in efficient
tooth movement.
 Bioprogressive Therapy's evaluation of the
applied forces suggests 100 gms per sq cm
of enface or exposed root surface as
optimum.

Forces Used In
Rating scale for the intrusion
of teeth measures the greatest
cross section
of the tooth surface in cm2.
Required forces are shown at
150 and 100 gms/ cm2 Lower
incisors show .20cm2 of
enface root surface, while
upper incisors show .40cm2.

Forces Used In
 Thurow has shown that
a force of 650 grams is
produced in deflecting
an .018 round chrome
wire 3mm across a
span of ½-inch
(13mm) .When a steel
wire is used, the force is
almost doubled to over
1000 grams.

Forces Used In
 Control of force:
1. Use of long lever
arm.

Forces Used In
2. Use of loops to increase the length
of the wire.

Forces Used In
 Cortical Anchorage: The concept of cortical
bone anchorage implies that, to anchor a
tooth, its roots are placed in proximity to the
dense cortical bone under a heavy force that
will further squeeze out the already limited
blood supply and thus anchor the tooth.
 Since each tooth is supported by cortical
bone, an understanding of this bony structure
and support is necessary.

Forces Used In
 Lower incisors and
cuspids:

Forces Used In
 Lower bicuspids and molars
lower molar anchorage –
the lingual cusps are kept
down (roots expanded and
torqued buccally)

Forces Used In
Upper incisors and canines

Forces Used In
 Upper molars and
bicuspids:
 The upper molars
are supported at the
base of the key
ridge of the
zygomatic process.

Forces Used In
 Muscular
Anchorage:

Forces Used In
In summary :
 Size of the root surface involved.
 Amount of force applied.
 Cortical bone support.
 Muscular support –facial type.

Utility and Sectional arches

Development of the utility arch
 Full banded edge
wise setup-most
efficient method
 In order to avoid
forward movement
of incisors, wire
ends were cinched
back

 Class III elastics
 It was long felt that
incisor intrusion as
an medium for
levelling the spee
was an impossibility.

 Ricketts tried to utilize the supposedly
immutable lower incisors as an anchor unit to
hold the posteriors in upright position, during
cuspid retraction.
 This lead to the development of step down
base arch wire/Rickett’s lower utility arch

Roles and functions of
the lower utility arch
 Position of the lower
molar to allow for
Cortical Anchorage:

 Manipulation and Alignment of the lower
incisor segments.
 Treated as a segment- different movements.
 Different planes of space.
 Ideal force levels.

 Stabilization of the lower arch, Allowing
segmental treatment of the buccal segments.
 Directing movements towards the final
position.
 Early maintenance of molar anchorage.

 Physiologic roles of the lower utility arch.
 Reaching or activator effect-removing contact
of LI from palatal or incisal occlusion.
 Helps in the headgear therapy.
 Bite before jet.
 Dictates the final arch form.

 Overtreatment
 Edge to edge bite.
 Freeing the buccal segments for unimpeded
correction of Class II
 Role in mixed dentition
 Resolve arch length problems.

1. Uprighting of the lower
molars.
Root movement-2mm
Crown movement-2mm
2. Advancement of the
lower incisors
1mm incisor movement
2mm arch length

3. Expansion in the buccal segment.
4. Saving the “E” space.
The author believes -with the utility arch slow,
delibrate and functional type of expansion
occurs-non extraction

 Position of the lower molar to allow for
Cortical Anchorage
 Manipulation and Alignment of the lower
incisor segments.
 Allowing segmental treatment of the buccal
segments
 Physiologic roles of the lower utility arch.
 Role in mixed dentition

Fabrication of the utility arch

Physiologic Vs Mechanical
Response
 Tip back applied to lower
molar-30° to 40 °.
 No toe-in in non
extraction utility.
 Extraction cases-definite
distal rotation must be
placed .

Response
 30° to 45° buccal
root torque applied
to the lower molar

Response

Response
 Long lever arm
applied to lower
incisors.
 75 gms of intrusive
force.(0.16 x 0.16).
 Labial root torque.

Modifications of the Utility Arch
 Expansion utility
arch
 Force :
1mm= 85 gm
2mm=140 gm
3mm=205 gm

 Contraction utility arch
 Force:
1mm=50 gm
2mm =150 gm
3mm=230 gm

 Utility arch with T or
L Horizontal loop

 Contraction or
advancing utility
arch

Treatment in the Mixed
Dentition Phase

Bioprogressive Mixed
Dentition Treatment
 Four basic objectives-
1. Resolve functional problems.
2. Resolve arch length discrepancy.
3. Correct vertical problems.
4. Correct overjet problems.

Resolve functional problems
 Anything that disturbs the growth, health and
function of the TMJ complex.
 In 1950’s Ricketts –used body section x rays
(laminagrphy)

 Lack of rough surface , excessive thickening

 Submento-vertex
analysis
- Individual condylar
inclinations and
width.

 Nine general categories-
1. Cross mouth interferences.
2. Anterior crossbite.
3. Open bite.
4. Excessive range of function.
5. Distal displacement.

6. Loss of posterior support.
7. Habits.
8. Breathing and airway problems.
9. True Class III Growth pattern.

Resolve Arch
Length Discrepancy
 This is accomplished
by three ways-
1. Lateral expansion of
the molars.
- Depends on the
inclination of the
posterior teeth.

Resolve Arch
Length Discrepancy
 Expansion primarily by
change in axial inclination :
- Rickett’s quad helix
- .040 blue elgiloy wire.

Resolve Arch
Length Discrepancy
 With 1cm expansion in the upper molars –
anterior segment are expanded 3cm overall.
 Long term functional expansion for atleast a
year or more for stable and demonstrable
changes to occur in the lower arch.

Resolve Arch
Length Discrepancy
Arch length gained is result slow natural
expansive response created by muscles

Resolve Arch
Length Discrepancy
Modifications of the Quad Helix

Resolve Arch
Length Discrepancy
 Expansion by mid palatal dysfunction:
- Hass type or modified Nance type expansion
appliance.

Resolve Arch
Length Discrepancy
2. Advancement or forward movement of the
lower incisors:
- If the VTO and physiologic factors warrant.
- Expansion utility arch.
- 1mm forward movement of LI yields 2mm of
arch length.

Resolve Arch
Length Discrepancy
3. Uprighting and /or distal movement of the
lower molars:
- Accomplished by utility arch.
- 2 mm per side can be gained by uprighting.

Correct Vertical/Overjet
Problems
 This is done after functional and arch length
corrections are achieved.
 Includes different approaches are used for
the first phase of non extraction treatment.

Problems
1. Orthopedic problems-
- In cases where good alignment of lower arch exists and Class
II is on account of Max.protrusion.
2. Orthopedic problems with lower arch
therapy-
- with maxillary protrusion but incisors and molars in deep bite
or need advancement.

Problems
3. Orthopedic problems with minor incisor
interferences.
- Upper utility arch with headgear.
4. Orthodontic problems alone.
- Upper utility arch with Class II elastics.

Development of the
Bioprogressive Brackets

Brackets
 Siamese twin bracket
on all the teeth.
 Slot size-.022 changed
to .018

Brackets
 Slot size-.0185 x .030
1. Use of two light arches
2. Permits a champer or bevel.
3. Allows for a lever access.
4. Adequate distance for the torque grooves.

Development of Brackets
1. Rickett’s Standard Bioprogressive.
2. Rickett’s Full Torque Bioprogressive.
3. Triple Control Bioprogressive.

1. Rickett’s Standard
Bioprogressive.
 These were the first set of
brackets which available.
(1960)
 Banding was done on all
the teeth.
 Line of occlusion –through
the contact points.

 Trend of building in treatment in the
appliance. (angulations)
 The original design had 5° for all the canines
and 8° for the upper lateral incisors and 5° for
the lower first molar
 Torque was present only in-upper incisors,
laterals and canines.

2. Rickett’s Full Torque Bioprogressive.
 Torque was build in the lower molars and
pre molars.
 Brackets were placed with 5 angulation.
 12 rotation was also built in the tube.

3. Triple control Bioprogressive.
 Raised bases
 Triple tube for upper molars
 Breakaway convertible lower molar tube.
 Direct bonding base/contoured.
 Slots cut at an angle

Mechanics Sequence for
Extraction Treatment

Extraction Mechanics
 Four general procedures :
1 Stabilization of upper and lower molar
anchorage.
2 Retraction and uprighting of cuspids with
sectional arch mechanics.
3 Retraction and consolidation of upper and lower
incisors.
4 Continuous arches for details of ideal and
finishing occlusion.

1. Stabilization of upper
and lower molar
anchorage:
a) Maximum upper
molar anchorage.
 Nance arch with
modifications.
 Headgear .

b) Moderate upper molar
anchorage:
 Palatal bar.
 Quad helix.
 Upper utility arch.

c) Minimum upper
molar anchorage:
 Vertical closing loop.
 Double delta loop.

 Maximum lower molar
anchorage:
 Lower utility arch-four
mechanical
adjustments.

 Moderate lower molar
anchorage:
 Lower utility with
adjustments.

 Minimum lower molar
anchorage:
 Eliminate the four
mechanical factors.
 Round wires may be
used.

2. Retraction and uprighting of cuspids with
sectional arch mechanics.
 Cuspids need to be kept in the narrow trough
of trabecular bone and avoid the severe
tipping or displacement
 The activation of the cuspid retraction springs
should produce 100 to 150 grams of force

 Intrusion

 Root uprighting

 Rotation

3. Retraction and consolidation of upper and
lower incisors.
Lower incisors:
 Very light continuous forces (150 grams)
 Contraction utility
 Double delta retraction loops

 Upper Incisors:
 Regular contraction
utility.
 Upside down vertical
closing loop.
 Double delta loop.

Class II Div I

Mechanics For Class II Div I
 Sequence:
 Lower Incisor intrusion.
 Lower Cuspid intrusion.
 Alignment of the lower buccal segment.
 Alignment of the upper buccal segment.
 Segmental correction of Class II with elastics.
 Upper incisor alignment and intrusion.

 Upper arch –orthopedic reduction of the
maxilla.
 Lower arch-treatment starts with levelling
the spee.-utility arch

 Lower stabilizing utility arch-after initial
purpose of the utility arch is accomplished –it
no longer serves as an efficient function
 16 x 22 stabilizing arch is placed

 Alignment of the lower
buccal segment starts:
 .015 or .0175
Twistoflex
 .012,.014 of 018 wires
 16x 16 triple T section
 .016 or.018 nitinol

 Upper arch
alignment:
 Incisors are not
included.
 Upper molars starts
Distalizing-opening
spaces in the buccal
segment.

a) Consolidation section
b) Stabilizing section

 Segmental correction with Class II elastics:
 Three detrimental effects:
1. Skidding effect.
2. Tendency for a deep bite.
3. Difficult to overcorrect buccal segment.

 Tractions Sections-
 Gable bend distal to
canine.
 Rotation bend in the
anterior portion.
 Molar bayonet bend

 Functions –
1. Counteract downward backward
pull
2. Stabilizing function in the upper
buccal segment.

 Upper incisors alignment
and Intrusion
 Upper incisors are
aligned before placement
with light round wires.
 16 X 22 utility arch is
placed

 Consolidation of Upper
Incisors
 Retraction of the upper
incisors .
 Over treatment -2mm
 Closing utility/upside
down closing
arch/vertical helical
arch.

 Idealization of
arches and finishing.
 16 or 17 square,16 x
22 or 17 x 25 nitinol.
 Class II elastics to
be discontinued
atleast 2 months.
 Light round wires
finishing

Class II Div II

Mechanics For Class II Div II
 Three treatment
possibilities:
1. Distalizing the
upper arch.
2. Advancing the lower
arch.
3. A reciprocal
movement.

1. Advancement, torque control, and intrusion of
the upper incisors.
2. Intrusion of the lower incisors and cuspids.
3. Alignment of the buccal segments and Class
II correction.
4. Consolidation of the upper incisors.
5. Idealizing the arches.
6. Finishing.

 Quad helix or W
arch

1. Advancement, torque control, and intrusion
of the upper incisors.
X Principle of bite before jet
 Jet is created followed by intrusion.
16x22 utility arch

Directional control

 Amount of pressure:
 125-160 gms
 16 x 22
 Stabilization of the
molars:
Quad helix
TPA
Stab. sections

 Intrusion of lower incisors:
 16 x 16 utility arch.
 65-75 gms.
 This is followed by cuspid intrusion.

 Advancement
of the lower
denture:
1. Utility arch with
4 helical loops

2. Using three
vertical loops:

3. Alignment of the buccal
segment:
a) Stabilizing section

If buccal segment
are not aligned
 “T” sections
 Twistoflex wire
 Cable wire

4. Consolidation of
the maxillary
incisors:

 Idealization and
arches and finishing

Pentamorphic Arch Forms

Finishing and Retention

 “Begin with the end in
mind”.
 Every orthodontist has a
visual picture in his mind
of the ideal occlusion into
which the teeth should fit
and mesh in the final
finished occlusion.

 Bioprogressive proposes the concept
overtreatment….
 No clinician can position teeth as delicately
as the functioning incline plane and cusp
action can accomplish naturally when it is
adequately set up to operate correctly.
 Allow natural function to guide the teeth into
the best functioning occlusion for each
individual

 Two phases of retention:
1. Guiding changes during initial adjustments.
2. Supporting bony sutural and muscular
accommodations to changing environment
and considering long range influences.

 Initial stage of retention :
 First six weeks following appliance removal
 Retainers inserted-designed not to hold but to
guide the teeth in settling.

Labial frame of typical
upper retainer (Ricketts)
passes between the lateral
and cuspid and has a
distal loop at each end to
tuck in the distal of the
expanded overtreated
upper cuspid

 Lower arch:
 Fixed first bicuspid retainer is placed.
-maintain cross arch bicuspid width.
-lower cuspid freedom of adjustment against
upper occlusion.
-maintain lower incisor alignment and rotation
correction.

 Stabilizing stage of retention:
 First year following active treatment.
 Lower retainer is kept in place and upper is
worn most of the time.

Bioprogressive Simplified
James J. Hilgers
Jco 1987-part 1-4

 Translating orthodontic skills into a bona fide
delivery system is one of the most difficult tasks
faced by clinicians.
 The best orthodontic managers are able to
identify the necessary information and leave out
the extraneous.
 “After studying many treatment disciplines, I
chose the Bioprogressive approach because it
was flexible”.

Visual Treatment Objective
 Orthodontic movements are more significant
than growth changes
 The VTO leads the clinician toward a viable
treatment plan by organizing factors
The superimpositions that define the practical
part of the mechanical procedures

 An accurate
measurement of arch
length deficiency—
combined with the
clinician's judgment of
dental and facial
changes required— is
used in the simplified
VTO to produce a
reasonable treatment
goal

Occlusal Paralleling Instrument
 Arch length deficiency is
one of the most critical
aspects of diagnosis.
 One of the most
accurate measuring
devices is the
mandibular occlusal x-
ray

Diagnostic procedures
 Grades the patient as-
A- enthusiastic
B- average
C- resistant
 Patient assurance about headgear usage.

Appliance design
 End-of-treatment goals should be dynamic,
not based on statistical norms.
 This kind of overcorrected result can be
called an ideal orthodontic occlusion— one
that will settle after positioner treatment,
retention, and normal physiologic rebound
into an ideal occlusion and thereafter into a
normal occlusion

Appliance design
1. Type and severity of the original
malocclusion.
2. General approach to mechanics.
3. Size of the final arches.
4. Timing of torque control
5. Bracket placement and design.

Appliance design
 Linear Dynamic system designed by the
Ormco 1979.
 17-4 grade of stainless steel, which has more
than three times the yield strength of the
standard 303 grade
 30% smaller bracket that is stronger than its
full-size counterpart.
 20% size reduction in molar region.

Appliance design
The key to a Class I buccal segment is the
proper positioning of the lower first molars

Linear Dynamic System
 Ideal orthodontic tooth position.
 Anticipated rebound and required
overcorrection.
 Appliance design features that
contribute to patient comfort, clinical
simplicity, and optimum utility.

C.I L.I Canin
e
1st
pm
2nd
pm
1st
molar
2nd
molar
Max 22/5 14/8 7/10 -7/0 -7/0 -10/0 -10/0
Man
d
-1/0 -1/0 7/5 -11/0 -17/0 -27/5 -27/5

Basic principles
 Treatment of overbite before overjet.
 Sectional arch mechanics
 Progressive unlocking of malocclusion
 Cortical and muscular anchorage
 Torque control throughout treatment.

Extraction Therapy
 Initiation
 Cuspid retraction and uprighting.
 Transition and final cuspid space
closure.
 Consolidation.
 Idealization

Extraction Therapy
 Initiation
 Lower arch-utility arch
- band 2nd
molars.
 Upper arch - TPA
-headgear
-utility
-2nd
molars

Extraction Therapy
 Cuspid retraction and uprighting
 Angulation of the cuspid
- Mesially tipped-1/3 of the extraction space

Extraction Therapy
 Bicuspid and cuspid – initial overlay wire
followed by a simple helical loop.(0.16
NiTi)
 Remaining 2/3 – rigid overlay wire.(0.16
Wallaby)

Extraction Therapy
 Upper arch
 Upper arch-depends on the position of the
incisors
a) Good position-16 x16 vertical closing helical
loop.
b) Need to be engaged at the onset of the
treatment-0.16 round overlay wire.

Extraction Therapy
 Traction and final cuspid space closure
 Cuspids have almost retracted and bite has
opened sufficiently-traction arches are
placed.(17x 25 NiTi or TMA)
1. Allow final incisor alignment
2. Correct details of the arch form
3. Allow for final root paralleling ,torquing in
cuspid and bicuspid region.

Extraction Therapy
 Consolidation
 This is done achievement of good arch form.
 Lower retraction-1 or 2 month ahead.
-16 square helical continuous
closing arch.
 Upper retraction-
- if they are proclined with no torque
requirement -016 round wire

Extraction Therapy
-if in good relation-16 square or 16 x 22
closing loop
-if additional torque is needed –retraction utility
is used.
-if ant intrusion and post extrusion –combination
crossed “T” horizontal closing loop is used.

Extraction Therapy
 Idealization
 Rigid edgewise coordinated arches (17x25
PAR).
 Light round wires.(0.14 or 0.16 Wallaby)
X “Start with round wires, finish with edgewise”

Non extraction therapy
 Initiation.
 Transition.
 Traction.
 Idealization.

Synopsis Non Extraction
Therapy
 Initiation –
 Orthopedic appliances.
 Base arches to set up the
anchorage.
 Overlay wires.

Therapy
 Transition
 After leveling and
aligning of the arches.
 Correct rotation and
spacing
 Resilient arches.

Therapy
 Traction
 Lower arch set up –to
allow Class II elastics.
 Upper buccal segments
are leveled
 Traction sections in
upper arch

Therapy
 Idealization
 Final arches used to
achieve arch
coordination.
 Use of light round wires.

JCO October -1987

 Original malocclusion
 Ideal orthodontic tooth position.
 Anticipated rebound and required
overcorrection.

C.I L.I Canin
e
1st
pm
2nd
pm
1st
molar
2nd
molar
Max 22/5 14/8 7/10 -7/0 -7/0 -10/0 -10/0
Man
d
-1/0 -1/0 7/5 -11/0 -17/0 -27/5 -27/5

Mandibular 1st
molar

Maxillary 1st
molar

1. Morphology requires some offset
for a linear archwire.
2. Archwire leads away from the tooth
mesiodistally, and the tube's built-in
rotation must be neutral to allow
proper rotation.
3. Most Class II cases have mesially
rotated upper first molars that
require
4. Mechanics in Class II and III cases
often involve forces that rotate the
upper molar mesiolingually.

Second molars

Mandibular 2nd
pre molars

Mandibular 1st
pre molars

Mandibular canine

the lower cuspid contact
should be no more than .
5mm lingual to the lower
lateral incisor,

Mandibular incisors

Maxillary 2nd
premolars

Maxillary Canines

Maxillary incisors

First. the initial area of interference when
distally overcorrecting the upper buccal
segments is the upper lateral incisors
to maintain a good contact point with the
upper cuspid, the upper lateral incisor bracket
should be slightly thicker than the upper
cuspid bracket www.indiandentalacademy.com

Bioprogressive therapy

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