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BIOPROGRESSIVE THERAPY
Part II
www.indiandentalacademy.com

UTILITY AND SECTIONAL ARCHES
MIXED DENTITION TREATMENT
MECHANICS SEQUENCE FOR EXTRACTION CASES

UTILITY AND SECTIONAL ARCHES
 Utility arch is one of the most recognizable entity of bio.prog
therapy. .
It is a catalyst which ties together all the different types of
mechanotherapy.
 Contemporary, orthodontic approaches have assumed that the most
efficient method of effecting rotations ,leveraging curve of spee in
the intial phase of treatment is through light continuous round arches

Response To Round Reverse Curve of Spee Arch wire

Step Down Base Arch Or Ricketts Lower Utility Arch

Step Down Base Arch Or Ricketts Lower Utility Arch
FUNCTIONS
1. Position lower molar to allow for cortical bone anchorage
cortical bone extension of the external oblique ridge is the
normal supportive buttress.
Lower Utility Arch

2. Manipulation and alignment of the lower incisors segment
• Lower incisors and buccal segment are in two different planes
so, lower incisors respond well when treated as an individual unit.
•Lower utility arch can intrude or extrude or hold lower
incisors in the initial phase of therapy.
•By alteration of design it is possible to advance or retract the
lower incisors.

3. Stabilization of the lower arch allowing segmental treatment
of Buccal segments
• Separate Rotations and levelling can be done in lower arch
• Lower incisors can be intruded in their own plane of space
prior to intruding canine

4 Physiological Role
By removing lower incisors from palatal occlusion
Loss of proprioception in the incisor region
Mandible reacts by reaching forward
Causing “Activator” or Reaching effect allows mandible to
move forward

5 Overtreatment
With continuous wire ,it is difficult to over treat buccal segments
until upper and lower incisors are brought to an end to end relation
6 Role in mixed dentition
7 Arch length control
• Uprighting of molar
• Advancement of lower incisors
• Expansion in the buccal segment
• Saving of E space

PHYSIOLOGICAL VS MECHANICAL RESPONSE
1.30-45 degree tip back applied to lower molars
2 30-45 degree buccal root torque applied to lower molar
3 Long lever arm applied to lower incisors
4 75 gms of intrusive force applied to lower incisors

FABRICATION OF MANDIBULAR UTILITY
1. Vertical steps and Buccal bridge formation
2. Placement of labial root torque in anterior section wire
3. Finishing the opposite site
4. Contouring the buccal bridges
5. Activation of distal leg
6. Final arch form
Lower Utility Arch

MIXED DENTITION TREATMENT

MIXED DENTITION TREATMENT
• Early treatment poses the universal enigma.
• Is the early intervention worth the time ?
• Most of us are coerced into early intervention of problems because
of somewhat overstated concept of “Interception Vs Correction”
•Anything the orthodontist would do
Even the decision not to treat – should be preventive

Objectives Of Early Treatment
A.Resolve functional problems
Anything that disturbs the growth , health and function of the
temporomandibular joint complex.
or
Anything that jeopardizes the normal direction of growth in
the individual case
B. Resolve the arch length discrepancy
So that the borderline cases can be managed without extractions .

C.Correct vertical problems
Deep bite or Open bite , “Bite before Jet”
D.Correct overjet problems
To create an acceptable maxillomandibular balance , by
combination of orthopedic – orthodontic movements

A.Resolve functional problems
Dolichofacial growth pattern
Condyles grow in upward and backward direction
Other growth patterns
Condyles grow in upward and forward direction.

Nine general categories of functional problems can be detected
on radiographs and laminagraph
1. Cross mouth interferences
2. Anterior cross bite
3. Open bite
4. Excessive range of function
5. Distal dispalcement
6. Loss of posterior support
7. Finger sucking / Lip sucking / Tongue thrusting
8. Breathing and airways problems
9. True class III

1.Cross mouth interferences
• Cross mouth interferences should be removed ,
• If constriction of maxilla is problem than bilateral expansion
should be done
2. Anterior cross bite
• Check for true class III
• If case of anterior interference than alignment of one or more
teeth is done

3. Open bite
•Evaluate airway for possible tonsillectomy or adenoidectomy
•Orthopedically expand the maxilla ,to improve tongue space
•Early alleviation of severe anterior crowding to allow incisors to
erupt
•Evaluate tongue size ,posture and tongue thrusting pattern
4. Excessive range of function
• Seen in extreme maxillary prognathism cases
• Intiate headgear therapy

5. Distal displacement
• Caused by vertical inclination of upper and lower incisors ,
especially evidenced in class II div 2 case.
• Demonstrate pain in TMJ, may show crepitation, tinnitus , early
loss of mobility.
• Clinical factors to be avoided is the early removal of lower cuspid
causing crowding and deep bite .
• Treatment is the long term , gentle class II elastics to protract the
mandible and extrude the buccal segment
• Avoid extractions to assure proper vertical support

6.Loss of posterior support
• Causes distal displacement and pain
• If multiple extractions are advised than replacement of teeth in
a retainer is important.
7. Finger sucking / Lip sucking / Tongue thrusting
Alleviate the habit and correct crossbite

8. Breathing and airways problems
Tonsillectomy or adenoidectomy , with orthodontic therapy to
increase the airway
9. True class III
• Maxillary advancement and expansion in cases of maxillary
deficiency
•Chin cup or face mask therapy

B. Resolve the arch length discrepancy
So that the borderline cases can be managed without
Extractions.
•Expansion
•Forward movement of lower incisors
•Uprighting or Distal movement of molars
C/D. Correction of overbite / overjet problems
Orthopedics (Headgear) and/ or Orthodontics (Utility arch)

MECHANICS SEQUENCE FOR
EXTRACTION CASES

MECHANICS SEQUENCE FOR EXTRACTION CASES
 Treatment plan and sequence of mechanical procedures are
planned in progressive stages that will unlock the malocclusion
and establish a more normal function.
 As many malocclusion have developed in such abnormal
environment that they may never have enjoyed a normal development.
 Draw V.T.O that includes changes that are expected with
1. Normal growth
2. Orthopedic alteration
3. Alignment of teeth
4. Functional and soft tissue changes

Sectional arch treatment
Breaking up arches into various segments during treatment ,
we are able to evaluate all three planes of space
• Anterio posterior movement
• Vertical movement
• Buccolingual movement
Incisor movements and canine retraction can be best handled on
sectional arch in order to respect the supporting structures and avoid
the complication of full arch mechanics.

EXTRACTION MECHANICS
Sequence can be best ordered into four General procedure
1. Stablization 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.Stablization of upper and lower molar anchorage
UPPER MOLAR ANCHORAGE
A. Maximum upper molar anchorage
Nance lingual arch with plastic button against rugae region of the
palate, in addition to the distal loop on the mesial lingual of the
upper molar , which allows the molar teeth to be expanded and
rotated

Expansion and Rotation of upper molar present advantages as
1 Expansion places the molar roots out under the zygomatic process
where cortical bone support resist change and thus anchors and limits
their movement.
2 Molars , placed in distal rotation tend to resist the forward mesial
pull as the cuspids are being retracted on sectional springs
3 Distal rotation of molar crown help for final positioning in
finishing occlusion .

B. Moderate upper molar anchorage
May not need to hold the upper molar completely stable ,
but will allow it to be advanced forward up to half of the extraction
space during the treatment procedure
• A distal looped lingual arch or a palatal bar without the plastic button
support
• Upper utility arch during cuspid retraction

C. Minimum upper molar anchorage
where the upper molar needs to be advanced the whole distance
of the extraction space .
• Class III elastics
• Double delta loop

Lower molar anchorage
More moderate anchorage concepts in the strong muscle
patterns and more maximum anchorage concepts in the vertical
pattern where the musculature gives weak support.
A. Maximum lower molar anchorage
Lower utility arch with
1. 45 deg buccal root torque
2. Buccal expansion of 10mm to support buccal torque
3. Tip back 30 – 40 deg
4. Distal molar rotation of 30-45 deg

B. Moderate lower molar anchorage
Contraction utility arch with stepped ahead of the molar tube
modifies the four components of molar anchorage.
C. Minimum lower molar anchorage
• Four anchoring factors
Torque , Tip back , Expansion and Rotation are reduced.
• Round wire in the molar tube may be used to eliminate the binding
and torquing to the molar and thereby reduce the anchorage.

2. Retraction and uprighting of cuspids with sectional
arch mechanics
Sectional arch treatment gives better results as
• Efficient force application
• Canine is located in the corner of the arch so need to be kept in the
narrow trough of trabecular bone, which is difficult with continuous
wire.

Springs are used
• To prevent the tipping and rotation , extreme 90 deg gable bend
and 90 deg offset antirotation bend are placed before the spring is
placed.
• Activation should produce 100 –150 gm of force.
•Only 2-3mm of activation is done.

3.Retraction and consolidation of upper and lower incisors
Lower incisor
• Retraction must respect the cortical bone support on the lingual
planum alveolare
•Very light continuous force of 150gm need to be applied so that
cortical bone can be remodeled

•Heavy forces will anchor the roots against movement and
produce tipping and extrusion of incisors
• Contraction utility is used for lower incisor retraction
• Double delta loop retraction loop used produces more extrusion
of incisors and is used where incisor bite closure is desirable

Upper incisor
•Remove the nance lingual arch to allow the alveolar process to
remodel.
• Torque has to be maintained, upper incisors are torqued till the long
axis parallel to facial axis.
•This allows for incisor alignment that is individualized to the facial
type.
• Torque control begins by treating the overbite with incisor intrusion
before retraction or overjet correction.

• Contaction utility arch can be used for retraction.
• Where additional torque is required a torquing contraction utility
arch is used.
• When little or no torque is required then use round wires.
• Double delta in open bite cases.

4. Continuous arches for details of ideal and finishing occlusion
• Continuous wire and Multistranded wires
• Finishing arches are placed in final 2 weeks of active treatment
the bands have been removed from buccal occlusion in order that
band space closure can allow finer details in occlusion

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