dental, biomechanics , medical, bpt , bioprogressive therapy , dentistry, bpt, orthodontics, journal,

1. BIOPROGRESSIVE
THERAPY
Done by
Prince 2nd yr. pg.

2. CONTENTS
Introduction
The management umbrella
Principles of BPT.
Visual treatment objective.
The use of superimposition areas to
establish treatment design.
Role of orthopedics.
Forces used in BPT.
Development of the utility and sectional
arches.
Mixed dentition treatment.

3. Brackets & Prescriptions
Mechanics sequence for Class II div I
Mechanics sequence for Class II div II
Mechanics for extraction cases.
Finishing procedures and retention.

4. INTRODUCTION
 Biology means characteristic life processes and phenomena of living
organisms, progression means the act of moving forward toward a goal.
 Dr.Robert Murray rickets was responsible for the development of this
approach to orthodontic care
 Dr.ricketts orthodontic philosophy and therapy involves a broad concept of
total treatment, rather than a sequence of technical and mechanical steps
which is referred to as BIO-PROGRESSIVE THERAPY.

5. JCO -1978
key article published in 12 part

6. MANAGEMENT UMBRELLA :
Quality
Quantity
Effectiveness
1. TECHNICAL SYSTEM CANNOT FUNCTION EFFICIENTLY UNLESS THEY
OPERATE UNDER THE TOTAL MANAGEMENT SYSTEM OR UMBRELLA.
2. A MANAGEMENT SYSTEM FOR ORTHODONTIST WOULD INCLUDE
THE FOLLOWING THERE THINGS

7. The system we use is the
Lewis. A. management system
which is based on a simple
formula to plan, organize, lead
and control.

8. 1.FORECASTING
2.DEVELOPING OBJECTIVES
3.PROGRAMMING
4.SCHEDULING
5.BUDGETING
THE FIVE FUNCTIONS INVOLVED IN PLANNING

9. DIAGNOSIS AND TREATMENT
PLANNING

10. 1.IDEAL FUNCTIONAL OCCLUSION
2. PHYSIOLOGICAL STABILITY OF OUR RESULTS.
3. TOTAL FACIAL BALANCE.
THERE ARE THREE MAJOR OBJECTIVES OF ORTHODONTIC TREATMENT:

11. SYSTEMS ARE NECESSARY TO
DEVELOP THE POLICIES AND
PROCEDURES
WE WILL NOW BRIEFLY OUTLINE
THE STEPS OF DIAGNOSTIC AND
TREATMENT DESIGN SYSTEM
DIAGNOSTIC PROGRAMMING ?

12. Step I — Clinical examination of the patient
Step II — Describe the malocclusion
Step III — Describe the face
Step IV — Describe the functional requirements such as evaluation of
nasopharyngeal airway , musculature , soft tissue , habits .
Step V — Construct the V.T.O. so that can develop 5 superimposition areas:
DIAGNOSTIC PROGRAMMING

13. Step VI— Superimposition areas. The superimposition areas from our V.T.O
give us the individual objectives for a case.
Step VII— From these superimposition areas We can develop the areas of
evaluation to establish the treatment mechanics:

14. Step VIII — Appliance Evaluation. when we are think of any auxiliary or fixed
appliance,
we like to think of it in four areas:
1. Function
2. Fabrication
3. Placement
4. Activation
Step IX— Sequence of mechanics.
Step X— Time schedule.
Step XI—setting a budget

15. PRINCIPLES OF THE BIOPROGRESSIVE THERAPY

16. 10 PRINCIPLES OF THE BIO PROGRESSIVE THERAPY
1. The use of systematic approach to diagnosis and treatment
2. Torque control throughout the treatment
3. Muscular and cortical bone anchorage
4. Movement of all teeth in any direction with the application of pressure
5. Orthopedic alteration
6. Treat the overbite before the over jet
7. Sectional arch therapy
8. Concept of overtreatment
9. Unlocking the malocclusion in a progressive sequence of treatment
10. Efficiency in treatment with a concept of prefabrication of appliances

17. VISUAL TREATMENT OBJECTIVE

18. VISUAL TREATMENT OBJECTIVE
 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.
 This treatment forecast, developed by Ricketts and called a Visual
Treatment Objective by Holdaway allows the orthodontist to
visualize the changes that should occur and to prescribe the
necessary treatment to cause it to happen.

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

20. RICKETTS STEP BY STEP GROWTH PREDICTION:
1.the cranial base prediction
2. the mandibular growth prediction
3. the maxillary growth prediction
4. the occlusal plane position
5. the location of the dentition
6. the soft tissue of the face

21. VISUAL TREATMENT OBJECTIVES
STEPS-
Cranial base prediction:
 Trace Ba-Na plane (nasion and
basion grow 1mm per year for 2
year of estimated treatment time)

22. Mandibular growth prediction:
Construction of the
new mandible position
starts with rotation of
mandible.

23. VISUAL TREATMENT OBJECTIVES
OTHER STEPS INVOLVED ARE,
 Construction of the new maxillary
position
 Position of the dentition.
 Finally soft tissue profile.

24. 1. CHANGES DUE TO NORMAL
GROWTH AND CHANGES
DUE TO VARIOUS
TREATMENT MECHANICS
ARE DIFFERENT
2. SO IT IS NECESSARY TO
UNDERSTAND THE
RESPONSE OF HIS
INDIVIDUAL SKELETAL AND
FACIAL STRUCTURES TO
VARIOUS TREATMENT
MECHANICS.

25. DESCRIBING THE FACE:
There are 3 basic facial patterns:
1. MESOFACIAL - AVERAGE FACIAL PATTERN;
2. BRACHYFACIAL - HORIZONTAL GROWTH PATTERN
3. DOLICHOFACIAL - VERTICAL GROWTH PATTERN

26. FIVE ANGLES ARE USED TO DESCRIBE THE FACE:
1.The Facial Axis Angle: gives us the direction of growth of chin
2. Facial Angle: It is a facial depth indicator
3. Mandibular Plane Angle:
High MPA-skeletal open bite is due to the mandible.
Low MPA – skeletal deep bite is due to mandible
4. Lower Facial Height: - the divergence of the oral cavity.
5. Mandibular Arc: - square growing or an obtuse growing mandible.

27. SUPERIMPOSITIONS AREA’S
In order to establish treatment design superimposition of areas is
necessary
5 superimposition areas are used to evaluate the face in the following
order:
1. The chin
2. The maxilla
3. The teeth in the mandible
4. The teeth in the maxilla
5. The facial profile
Take VTO and superimpose it in the five superimposition areas to
establish your individual objectives.

28.  The FIRST SUPERIMPOSITION
Area 1 we evaluate ,(BA-NA At CC Pt)
1. Amount of growth of the chin
2. Any change in chin in an opening or
closing direction
The SECOND SUPERIMPOSITION
Area 2.
 The Basion-Nasion-Point A Angle does
not change in normal growth.
Therefore change is due to the effect of
our mechanics.

29. These are the maximum ranges of Point A change with
various mechanics:

30.  The THIRD SUPERIMPOSITION AREA (Palate at
ANS) establishes Evaluation Area 3 and Evaluation
Area 4
 In Evaluation Area 3, evaluate lower incisors.
 In Evaluation Area 4 evaluate the lower molars.

31.  The FOURTH SUPERIMPOSITION AREA
( PALATE TO ANS )
 Evaluation Area 5 and Area 6
 In Evaluation Area 5, the upper molars are evaluated
 In Evaluation Area 6, we evaluate the upper incisors
5TH SUPERIMPOSITION AREA (esthetic plane at the
crossing of the occlusal plane)
 Area 7 which evaluate the soft tissue profile.

32. ROLE OF ORTHOPEDICS

33. ORTHOPEDICS IN BPT
 Any manipulation that alters the normal growth of the dentofacial
complex in either direction or amount.
 It develops thorough analysis of facial and dental characteristics –
facial growth type.
 It works on the concept of differential treatment in Class II
malocclusion.
 It emphasis more on cervical or combination headgear.

34. CREVICAL HEADGEAR:
FIRST INTRODUCED BY , KLOEHN IN 1947
IT IS THE MOST COMMONLY USED FACE BOW IN CLINICAL PRACTICE , TYPICALLY IT IS
USED IN GROWING PATIENTS WITH DECREASED VERTICAL DIMENSION
COMPOSED OF THREE BASIC PARTS
1)MOLAR BANDS AND TUBES
2)INNER BOW AND OUTER BOW SOLDERED
3)NECK STRAP
THE EXTRAORAL PULL IS GENERALLY APPLIED BILATERALLY
FOR THREE MAIN REASONS
1)AS A RESTRAINING FORCE
2)AS A RETRACTING FORCE
3)AS A SUUPPLEMENTARY FORCE.

35. GENERALIZED ORTHOPEDIC RESPONSE WITH CERVICAL
HEADGEAR ALONE
 Maxilla responds in a predictable manner.
 mandible is highly variable
 Mandibular response – depends on the
musculature.
- weak musculature
- strong musculature
 Upper molars-extrusion of upper molars.
 Upper incisors-tip lingually
 Lower molars-upright and move distally
 Lower incisors-tip labially

36. THE REVERSE RESPONSE:
 In Those Cases Where A Cervical
Headgear Is Utilized In Combination
With A Lower Utility Arch,
 The Orthopedic Response In The
Maxillae Will Result In The Classical
Rotational Response.
 The Intermittent Extrusion Of Upper
Molar, In Conjunction With The Strong
Muscular Pattern, Results In
Stabilizing The Entire Lower Dentition.
 This Action Is Referred To As Reverse
Response

37. EXPANSIVE RESPONSES WITH HEADGEARS:
This expensive process provides for several distinct considerations
 RECIPROCAL EXPANSION OF THE LOWER ARCH as the upper
arch form slowly changes a natural widening of the lower arch occurs.
PREVENTING IMPACTED SECOND MOLAR When the upper first
molar is translated distally without expansion, the incline planes of that
tooth start to reciprocally constrict the lower molars, carrying them
lingual.

38. The palatine bone (B) forms an outward bevel between the maxillary
tuberosity and the sphenoid bone (C). When the maxilla is compressed
distally, it moves down the outward bevel (D), and a natural expansion
occurs in the upper arch.

39. Mechanical application
Differentiation Between Orthopedic and Orthodontic Movements
1.Force level
2.Intermittent wear –several advantages
-heavy forces result in hylanization.
-rebound results in stability in the mandible.
-more growth occurs at night.
- Patient acceptance.
3. Outer bow length and position
4.Expansion and rotation.
5.Freedom of movement of maxilla

40. FORCES USED IN
BIOPROGRESSIVE THERAPY

41. FORCES USED IN BIOPROGRESSIVE THERAPY
 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.

42.  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.

44. CONTROL OF FORCE:
1. Use of long lever arm.
Shorter distances generates greater
forces when more wire is incorporated
the force will proportionally reduces.

45. 2. USE OF LOOPS TO INCREASE THE LENGTH OF
THE WIRE.

46. 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.

47. UPPER INCISORS AND CANINES:
Upper incisor intrusion should avoid the cortical bone and move into the
broadest area of the alveolar process. the crowns must be tipped forward
(root tipped back) before intrusion. A force of approximately 40 grams to
each tooth is necessary for their efficient intrusion.

48. Lower incisors and
cuspids:
are supported on the lingual by
cortical bone of the planum
alveolar.
LOWER BICUSPIDS AND MOLARS:
1. The lower bicuspids and molars are supported from the
buccal by the cortical bone
2. To anchor the lower molars , the roots are expanded and
torqued into this denser avascular cortical bone.

49. During the early stages of maxillary
cuspid retraction, lingual string
should be avoided, because it will
cause tipping around the lingual
cortical bone of the alveolar
process.

50. MUSCULATURE ANCHORAGE:
The musculature is strong and characterized by the deep
bite, low mandibular plane, brachyfacial type, the teeth
demonstrate a "natural anchorage".
The lower face height angle is an angular reflection of the
musculature function between the upper and lower jaws.
While the mandibular arc angle describes the internal
structure of the mandible and its function.

51. UTILITY AND SECTIONAL ARCHES

52. DEVELOPMENT OF THE UTILITY ARCH:
In 1950’s Robert Ricketts and others attempted to counteract the tipping
that occurred in the buccal segment s in extraction cases by utilizing the
supposedly immutable lower incisors as an anchor unit .
This lead to the development of step down base arch wire / Rickett’s
lower utility arch

53. ROLES AND FUNCTIONS OF LOWER UTILITY ARCH
1. Position of the lower molar to allow for cortical anchorage
2. Manipulation and alignment of the lower incisor segment
3. Stabilization of the lower arch, allowing segmental treatment of the buccal
segments
4. Physiological roles of the lower utility arches
5. Over treatment
6. Role in mixed dentition
7. Arch length control

54. PHYSIOLOGICAL VS. MECHANICAL
RESPONSES
it is important to understand the biological Or
physiological response that occur when activation
Of tip back torque and expansion are applied to the
lower molars And to lower incisors.
1. 30º to 45º Tip-back applied to the lower molars
2. 30º to 45º buccal toot torque applied to the
lower molar
3. Long liver arms applied to the lower incisors
4. 75grams of intrusive force applied to the lower
incisors

55. Modifications of the Utility Arch
Ricketts has described 4types
Expansion utility arch
Contraction utility arch
Utility arch with T or L Horizontal loop
Contraction and advancing utility arch

57. CONTRACTION UTILITY ARCH
IT CONSIST OF A VERTICAL LOOP PLACED ALONG THE BUCCAL
BRIDGE HAS THE FACILITY OF BEING ADJUSTED INTRAORALLY TO
EXPAND OR CONTRACT THE ARCH .
WHEN PLACED OPPOSITE TO THE LOWER CUSPIDS , IT IS USEFUL IN
THEIR INTRUSION BY TIEING ELASTIC LIGATIONS TO THE CUSPID
BRACKET.
THE LOOP IS PLACED FORWARD OF THE ANTERIOR OR VERTICAL
STEP WHEN THE INCISORS TO BE RETRACTED .
THE LOOP AT THE LOWER CORNER OF THE VERTICAL STEP IS
PLACED FORWARD OR AHEAD OF THE STEP , WHEN THE INCISORS
ARE TO BE RETRACTED . THIS EXERTS A FORCE TO RETRACT THE
INCISORS IN A CONTRACTION ARCH.

59. Treatment in the Mixed Dentition Phase

60. FOUR BASIC OBJECTIVES OF EARLY
TREATMENT :
1. Resolve functional problems.
2. Resolve arch length discrepancy.
3. Correct vertical problems.
4. Correct over jet problems.
The practical definition of a functional
problem is anything that disturbs the growth ,
health and function of the temporomandibular
joint complex.
Cross mouth
interference,
Distal displacement,
Loss of posterior
support,
Habits,
Breathing and airway
problem,
true class III growth
pattern.

61. RESOLVE ARCH LENGTH DISCREPANCY:
arch length gain in lower lower arch occour in 3 ways:
1.Lateral expansion of the lower buccal segments
 Expansion primarily by change in axial inclination
 Expansion by midpalatal dysjunction
2.Advancement or forward movement of the lower incisors
(1mm forward movement of Lower incisors yields 2mm of arch
length)
3.Uprighting and/or distal movement of the molars
(2mm per side can be gained by up righting)

62. MECHANICS SEQUENCE
FOR EXTRACTION
TREATMENT

63. The mechanics prescribed to accomplish the specific objectives are
selected from eight areas of evaluation that show:
1.The present location of the jaws and teeth
2.Where they would be without treatment
3.And where they need to be moved to reach the proposed objectives

64.  Stabilization of upper and lower molar anchorage
 Retraction and up righting of cuspids with sectional arch mechanics
 Retraction and consolidation of upper and lower incisors
 Continuous arches for details of ideal and finishing occlusion.
The extraction sequences in bio progressive therapy can be
Organized into four general procedures.

65. MECHANICS SEQUENCE FOR
CLASS II DIV I

66. 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.

67. LOWER INCISOR INTRUSION &LOWER CUSPID
INTRUSION.
 Lower arch-treatment starts with levelling the spee-utility
arch
 A glance at the VTO elucidates weather the incisor need
to be intruded or advanced or retracted .in most cases to
achieve the level of the functioning buccal occlusion
incisors and canine needs to be intruded.

68. ALIGNMENT OF THE LOWER BUCCAL
SEGMENT STARTS:
The arches typically used for alignment
are
.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.

69. SEGMENTAL CORRECTION WITH CLASS II ELASTICS:
 Three detrimental effects:
1. Skidding effect.
2. Tendency for a deep bite.
3. Difficult to over correct buccal segment.
Tractions Sections
Gable bend distal to canine.
Rotation bend in the anterior portion.
Molar bayonet bend
Functions
Counteract downward backward pull
Stabilizing function in the upper buccal segment.

70. 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
 Its necessary to Over treat in order to overcorrect the
buccal segments in effect be a -2mm step between
cuspid and incisor bracket
 The most frequently used arch used to accomplish
this 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 at least 2 months.
Light round wires finishing

71. MECHANICS SEQUENCE
FOR CLASS II DIV II

72. MECHANICS FOR CLASS II DIV II
Three treatment possibilities:
1. Distalizing the upper arch.
2. Advancing the lower arch.
3. A reciprocal movement.

73. SIX FUNCTIONS NECESSARY IN TREATING CLASS2 DIV2
MALOCCLUSIONS, WHICH ARE GENERAL CONSIDERATIONS
FOR EVALUATING THE MECHANICS SEQUENCE
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.

74. ADVANCEMENT, TORQUE CONTROL, AND INTRUSION OF
THE UPPER INCISORS.
One of the principles of bpt is to correct overbite before
over jet but this is not true generally so its necessary to
create over jet first and then correct overbite.
Over Jet is created followed by intrusion.
16x22 utility arch

75. Directional control

76.  Amount of pressure:
125-160 gm. is needed for
intrusion of upper incisors
16 x 22 nitinol utility arch is
used
Maxillary incisor intrusion
causes tipping effect on
maxillary molars so they should
be stabilized.

 Stabilization of the molars:
Quad helix
TPA
Stab. sections

77. Intrusion of lower incisors:
16 x 16 utility arch.
65-75 gm.
This is followed by cuspid intrusion.
 The VTO will find out if you have to advance the
lower incisors and or the lower denture if advancing
the lower incisors is necessary .it can be done by
 Utility arch with 4 helical loops
or Using three vertical loops

78. ALIGNMENT OF THE BUCCAL
SEGMENT:
Involves three types of basic
section:
A) Stabilizing section
B)Consolidation section
C)Traction section
If buccal segment are not aligned
 “T” sections
 Twistoflex wire
 Cable wire

79. Consolidation of the maxillary incisors
Idealization of arches and
Finishing
16*16 or 16*22 blue elgiloy

80. Finishing and Retention

81. 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.

82. FUNCTION INFLUENCES FINISHING AND RETENTION
 The proper location and function of the condyle in the
temporomandibular joint is essential to the health and stability of
the occlusion
 A normal airway which effects the basic respiratory process and
influences the tongue posture and function is important to the
stability of the denture
 Lip function and its variations have an influence upon the incisor
alignment and stability.
 The buccal and facial musculature along with the muscles of
mastication, which are reflected in the facial type as described by
cephalometrics is important.

83. Three Separate Phases of Retention
1)Initial stage
2)Stabilizing stage
3)Long term retention.

84. The Initial Stage of Retention
The teeth are "turned loose" to erupt along their normal eruptive paths
Retainers inserted at this initial phase to assist in guiding this settling process.

85. The Stabilizing Stage of Retention
 Ongoing phase over the first year following active treatment where
 sutural adjustment
 trans septal fibers
 functioning occlusion
 muscle physiology need to be considered in supporting new
occlusion.
 During this period lower fixed retainer is kept in place
 The upper retainer is worn most of the time.
 Following the 1st year, if the functioning occlusion remains stable,
the retainer is worn only part time, during sleeping .

86. LONG TIME RETENTION
 Long time retention needs to consider late growth changes and other
influences that will continue to affect the alignment of the teeth.
 The lower incisor stability was dependent upon facial type and lip function.
Slight settling changes of the teeth will continue throughout life. They are
functioning in the dynamics of living bone and certain changes are to be
expected.
 Some extremes of facial pattern and muscle function will require semi-
permanent long term retention if ideal alignment is to be maintained.

87. OCCLUSAL CHECK LIST IN FINISHING
An occlusal check list including eight areas in each arch
is used in establishing the ideal finishing arch
configuration and individualized tooth rotation in our
over treated orthodontic finishing occlusion.

88. MAXILLARY ARCH
1. Width across first and second molars.
2. Distal rotation of first molar so that line drawn through
disto buccal and mesio lingual cusps points to the
distal third of the opposite side cuspid .
3. Mesial offset (large) on molar.
4. Mesial rotation of lingual cusp of first bicuspid to seat in
distal fossa of lower first bicuspid.
5. Premolar offset (2-3mm) to avoid first area of prematurity.
6. Cuspid brought into contact with lower cuspid and premolar to establish cuspid rise.
7. Lateral left labial (until retainer) to allow overtreatment of
buccal segments; then tucked in.
8. Smooth arc across incisors.

89. MANDIBULAR ARCH
1. Arch width across second molars.
2. Distal of first molar rotated lingually until the distobuccal cusp
approximates mesial sluiceway on second molar.
3. Large buccal offset at mesial of first molar.
4. Check inter-bicuspid width for necessary expansion.
5. Proper buccal arch form and contour.
6. Premolar offset to bring it in contact with distal lingual
incline of upper canine (2-3mm).
7. Mesial of cuspid tucked slightly behind lateral incisor
distal of the cuspid buccal.
8. Over-rotation of incisors; smooth arc.

90. RELATED ARTICLES

91. AJO - 1976

92. IT IS A TWO PART ARTICLE ,
PART 1- DEALS WITH THEROITICAL BACKGROUND , LOGIC OF DEVELOPMENT
OF BAND ,BRACKET AND BONDING DESIGN
PART -2 DEALS WITH ACTIVATING MECHANISMS AND DEV. OF PREFORMED
ARCHES OR MODULES FITTING TOGETHER FOR THE THERAPY
THERORITICAL BACKGROUND:
DEVELOPED FROM EDWISE APPLAINCE TECHNIQUE DESCRIBED BY ANGLE 1925
HAS THREE TYPES
1)PRIMARY EDWISE
2)SECONDARY EDGEWISE
3)TERTIARY EDGEWISE
ALL OF THESE FORMED A BACKGROUND FOR BIOPROGRESSIVE METHOD.

93. BIOPROGRESSIVE THERAPY
➜ This technique was introduced by Dr. Robert Ricketts and Dr. Ruel Bench " in
1950
➜ Combined contemporary edgewise mechanics with solid diagnostic principles and
an innovative approach to sectional mechanics
BRACKET MODIFICATION BY RICKETTS
➜ Increased mechanical efficiency was desired over the staple, used in the original
edgewise, for rotation correction.
➜ Ricketts designed a wide-flanged easy-tie 0.018" x 0.030" Siamese bracket for:
➜ 1. Ease of ligating
➜ 2. Uprighting access
➜ 3. Flexibility of the elastic attachment
 Extra ligating area
 Special .018 x .030 slot dimension
slot permit dual wire
 Auxillary wire may be used
 This design was an evolution from
the original Steiner design and the
narrow slot was developed in
consultation with Steiner and Lang.
 The bracket could be fabricated on
bands or bonded directly

94. DEVELOPMENT OF THE BIOPROGRESSIVE SET-UPS:
There are three combinations of the bioprogressive set-up which use
the basic bioprogressive percepts:
 STANDARD BIOPROGRESSIVE:
 FULL TORQUE BIOPROGRESSIVE
 TRIPLE CONTROL BIOPROGRESSIVE:
STANDARD FULL TORQUE TRIPLE CONTROL
 torque was built into the
brackets of the upper central
and lateral incisors as well as
all four cuspids.
 The torquing of the lower
buccal segment and step
bends in the arch for the
premolars and molars were
relegated in the arch wires
 torque combinations were
developed for the lower premolars
and molars.
 Rotation tubes were placed on
lower molars.
 Lateral step bends were needed,
and even the bends were already
placed in the preformed
archwires.
 All torque requirements were
eliminated from the wire except
for the variations needed.
 First-order activations were
avoided because of the need for
bulking-up of the brackets, the
danger of esthetic and hygienic
complications, and the need to
prevent lever action against the
band itself
 combines the first order offset bends
with the second order tip, and the
third order torque, to present the
complete "triple control”
 all the canine brackets were raised
to produce the buccal step for the
first premolars
 molar needs to be stepped bucally
from the second molars and in order
to obviate the step in the wire, the
second premolar was raised so that
it will be aligned lingually
 This allows a continuous arch to be
used as the final ideal finishing arch.
With the Triple Control appliance,
the finishing archwire does not
require the offsets or torque, since
they are now built into the appliance

100. Rickets 1 2 3 4 5 6 7
Tip 0 8 15 0 0 0 0
Torque 24 14 7 0 0 0 0
Rickets 1 2 3 4 5 6 7
Tip 0 0 0 5 0 5 5
Torque 0 0 7 0 14 22 22
BIOPROGRESSIVE PRESCRIPTION FOR TRIPLE CONTROL
Rotation:
i) Ligation to eyelet, when simple bracket used.
ii) Figure of eight ligature ties for reciprocal
rotation.
iii) With Siamese bracket as
a) Band cemented slightly off centre: tying of any
one bracket.
b) One bracket can be filled with elastic or
squashed.
c) Reciprocal ties d) Lingual cleats for counter
movement.

101. PART 2 OF THE ARTICLE AIMS AT EXPLAINING THE ACTIVATING MECHANISMS ,
TREATMENT PRINCIPLES AND SOME FUNDAMENTAL ASPECTS OF PLANNING ANCHORAGE
ARCH SIZE WERE ORGANISED IN BIOPROGRESSIVE SYSTEM
IN ORDER TO SELECT AN ARCH WIRE FOR THE INDIVIDUAL PATIENT, A MEASUREMENT IS MADE
FROM THE DISTAL MARGIN OF THE LATERAL INCISOR TO THE SAME POINT ON THE OPPOSITE
SIDE AND CONVERTED TO A NUMBERED ARCH.
The standard wires preformed to accompany the preformed bands and prefabricated
assemblies. These wires come in various sizes, and the millimeter reading is
that which is measured between the distal aspects of the two lateral incisors in the
typical patient. The utility, the double delta, the closed helix, the ideal, and the finishing
arches are common sequences employed.

102. Throughout the evolution of edgewise therapy the
edgewise arch took on various
forms, starting with Angle in 1929
(A), described by Wright in Anderson’s textbook in
the 1930’s
(B), by Tweed in his textbook and practice in the 1940’s
and 1950’s
(C), the bioprogressive forms as described by Ricketts in
the 1960’s and 1970’s
(D). The conventional patterns are fashioned following the
trifocal elliptical principle of Brader

103. PREFABRICATED SECTIONS:
MAXILLARY AND MAND. CANINE RETRACTOR
IDEAL BUCCAL SECTION
HORIZONTAL HELIX ETC….
OTHER AUXILIARIES IN PREFABRICATION AND
PREFORMING PROCEDURES: (FIG. 26)
THE LASER-WELDED AND PLASTIC-COVERED FACE-BOW.
QUAD HELIX APPLAINCE
BUMPER OR BUCCAL BAR
LINGUAL RETAINER BAR.

104. QUAD HELIX APPLAINCE :
IT IS INTRODUCED BY RICKETTS IN 1975
W-ARCH WAS ITS FORERUNNER .
INDICATIONS :
1. ALL CROSSBITES NEEDING UPPER ARCH EXPANSION
2. CROWDING CASES NEEDING MILD EXPANSION
3. CLASS 2 CASES NEEDING MOLAR DISTAL ROTATION
4. CLASS 3 CASES WITH CONSTRICTED MAXILLARY ARCH
5. TOUNGUE THRUSTING CASES
6. CLEFT LP AND PALATE CONDITIONS EARLY TREATMENT

105. 2003
2003
1998

106. CONCLUSION:
articles on treatment sequences demonstrated approach to accomplishing the
objectives proposed in the Visual Treatment Objective.
Sections on mixed dentition, extraction, Class II Division 1 and Class II Division 2
non extraction, and orthopedic alteration detailed the mechanics of these common
treatment problems.
Bioprogressive Therapy approaches an in-depth analysis of the basic
malocclusion, the underlying morphology with its functional variations, then
attempts to treat them to as normal a function and esthetic relationship as is
possible for the long range health and stability of the denture.
Each case is approached individually because of its individual morphology,
physiology and malocclusion and the prescribed treatment sequence is selected
to accomplish quality results with efficiency.

107. References:
1)Textbook of bioprogressive therapy – rickets
2)Bioprogressive Therapy and Diagnostics-2003
Martina MikπiE, Mladen claj ,Senka MeπtroviE ,Department of Orthodontics ,School of
Dental Medicine.
University .of Zagreb
3)Cervical Headgear Usage and the Bio progressive Orthodontic Philosophy-Semin Orthod
1998
Charles T. Pavlick, Jr
4)Bioprogressive therapy – as an answer to orthodontic needs AJO- 1976
rickets part 1 and part 2.
BIBILIOGRAPHY::