1. Comprehensive orthodontic treatment involves repositioning nearly all teeth to achieve an ideal occlusion. It is ideally done during adolescence when permanent teeth have erupted but growth remains.
2. Treatment involves 4 stages - alignment and leveling, correction of molar relationship and space closure, finishing, and retention.
3. The first stage, alignment and leveling, aims to align teeth and correct vertical discrepancies. This is done using round nickel-titanium wires which apply light continuous forces.
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This Presentation tells 4th Stage of Comprehensive Orthodontic Treatment in Orthodontics, Retention, which is used to Prevent Relapse after Orthodontic Treatment.
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This Presentation tells 4th Stage of Comprehensive Orthodontic Treatment in Orthodontics, Retention, which is used to Prevent Relapse after Orthodontic Treatment.
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Maxillomandibular elastics (or intermaxillary elastics) are commonly used because of their simplicity; however, a lack of understanding of their force system can lead to many serious problems.
Elastics are usually classified by the direction of the force (eg, Class II or Class III elastics).
Sometimes force magnitude is considered, but point of force application is left out. Therefore, many different types of Class II elastics can be applied. There are short or long elastics.
Often too many elastics are used when a single resultant elastic at the correct location would work better. However, sometimes more than a single elastic is needed when the attachment point is not directly accessible.
All maxillomandibular elastics and their actions should be analyzed in three dimensions.
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Maxillomandibular elastics (or intermaxillary elastics) are commonly used because of their simplicity; however, a lack of understanding of their force system can lead to many serious problems.
Elastics are usually classified by the direction of the force (eg, Class II or Class III elastics).
Sometimes force magnitude is considered, but point of force application is left out. Therefore, many different types of Class II elastics can be applied. There are short or long elastics.
Often too many elastics are used when a single resultant elastic at the correct location would work better. However, sometimes more than a single elastic is needed when the attachment point is not directly accessible.
All maxillomandibular elastics and their actions should be analyzed in three dimensions.
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Leveling and Alignment in Preadjusted Edgewise Appliance
The purpose of this initial phase of treatment in the PEA appliance is to
• bring the teeth into alignment and
• correct vertical discrepancies (like deep overbite and open bite) by leveling out the arches.
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The Begg light-wire appliance remains unique in the history of orthodontic innovation. Whereas many current self-ligating bracket appliances purport to be low friction or friction free, it is the Begg appliance that best exemplifies low friction, free sliding mechanics.
By creating only a single point of contact between the bracket and the arch-wire Dr Begg was able to greatly decrease resistance to sliding, both by reducing friction between the bracket and the arch-wire and virtually eliminating the binding of the arch-wire in the bracket slot, as is seen in all horizontal slot brackets.
Begg’s bracket design allowed teeth to freely tip mesially and distally as well as lingually and labially. This often gave teeth the appearance of being over tipped during treatment and required considerable diligence by Begg practitioners to keep tooth movement under control.
This freedom of tooth movement allowed unprecedented correction of large overbites and overjets to an edge-to-edge position and rapid closure of extraction spaces by initially tipping the adjacent teeth into the extraction site and uprighting the teeth afterwards.
Individual tooth root correction was managed by the use of fine springs that were designed, and often individually crafted to upright, torque and rotate teeth into their correct positions once the position of tooth crowns had been established.
One key advantage of the appliance set up was the use of light elastic forces for the correction of anterior overbites and overjets. All anchorage could be established intra-orally without headgear, without the need for ancillary appliances such as trans-palatal arches, or needing to set up molar anchorage prior to treatment, as Dr Tweed advocated.
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Definition: The ideal tooth extraction is painless removal of the whole tooth or tooth root with minimal trauma to the investing tissues so that the wound heals uneventfully and no post operative prosthetic problem is created.
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in Orthodontics, Torque is a vital ingredient in the achievement of optimal esthetics, function and health of teeth and surrounding tissues, as also in stability of the treatment results
Introduction
Historical Perspectives
Creation of tip-edge
Tip –edge concepts
Bonding and setting up
Treatment stages
Stage I
Stage II
Torque in tip-edge
Stage III
Advantages
Disadvantages
Case reports
Articles
Conclusion
References
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Similar to Comprehensive Orthodontic Treatment in the Early Permanent Dentition (20)
a Topic from Chapter 9 of Proffitt's Orthodontics Edition 6, including the Mechanical Principles in Orthodontics.
In this Slide terminology of Biomechanics in Orthodontics is defined along with effects of wide & narrow bracket, with brief description of Moment & Couple used in Orthodontic Tooth Movement.
Notes made in my Final Year of Bachelor in Dental Surgery from Subject Oral & Maxillofacial Surgery. In this i have mentioned the 8 principles which are used in the treatment & prevention of odontogenic infection which are most common in dental practice. This documents is for professional dental undergraduates studying in their 4th year of BDS or DDS.
A Topic from Subject of Maxillofacial Trauma written in my Final Year of Dentistry.
This Chapter is Clinical Based Review of Mandible Fracture, one of the most common fractures of Face during Road Traffic Accident.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
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TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
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The Gram stain is a fundamental technique in microbiology used to classify bacteria based on their cell wall structure. It provides a quick and simple method to distinguish between Gram-positive and Gram-negative bacteria, which have different susceptibilities to antibiotics
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Comprehensive Orthodontic Treatment in the Early Permanent Dentition
1. Comprehensive Orthodontic
Treatment In The Early Permanent
Dentition
Section 6
S A R A N G S U R E S H H O T C H A N D A N IS A R A N G S U R E S H H O T C H A N D A N I
2. Introduction Comprehensive
Orthodontic Treatment
• Definition; It is process in which patient’s occlusion is made as ideal
as possible by repositioning all or nearly all teeth.
• Ideal time for Comprehensive Orthodontic Treatment; (When to
Perform Comprehensive Orthodontic Treatment)
• Adolescence – when permanent teeth just erupted.
• Some vertical & antero posterior growth of the jaw remains.
• Social adjustment to orthodontic treatment is no great problem
SARANG SURESH HOTCHANDANI 2
3. Introduction Comprehensive
Orthodontic Treatment
• During comprehensive treatment complete fixed appliance consists
of brackets is used.
• Comprehensive orthodontic treatment consists of following 4
stages; - this concept was given by Raymond Begg
• Alignment & Levelling
• Correction of Molar Relationship & Space Closure
• Finishing
• Retention
SARANG SURESH HOTCHANDANI 3
5. Goals of 1st Stage of Treatment
• The goal of 1st phase of comprehensive treatment is to bring teeth
into alignment & correct vertical discrepancy by levelling out arches.
• PROPER ALIGNMENT OF TEETH CAN BE ACHIEVED BY;
• Bring malposed teeth into arch
• Control the antero posterior position of incisors, width of arches posteriorly,
form of dental arches.
SARANG SURESH HOTCHANDANI 5
6. Goals of 1st Stage of Treatment
• LEVELLING OF ARCHES
CAN OCCUR BY;
• Elongation of posterior
teeth
• Intrusion of incisors
• Combination of two.
• Excessive overbite results from;
• Excessive curve of spee in lower
arch.
• Absent or reverse curve of spee in
upper arch.
• Anterior open bite results from;
• Excessive curve of spee in upper
arch
• Little or no curve of spee in lower
arch
SARANG SURESH HOTCHANDANI 6
8. PRINCIPLES IN THE CHOICE OF
ALIGNMENT ARCHES
•During alignment phase, only
combination of labio – lingual & mesio
– distal tipping of teeth is needed.
• Root movement during alignment phase is not needed.
(Reason mentioned in notes)
SARANG SURESH HOTCHANDANI 8
9. Principles in the Choice of
Alignment Arches
Continuous force of 50g needed for alignmentContinuous force of 50g needed for alignment
2 – 4 mil of space b/w archwire & bracket slot for tipping2 – 4 mil of space b/w archwire & bracket slot for tipping
Round NiTi wire for alignment are preferredRound NiTi wire for alignment are preferred
• Rigid wire with auxiliary wire for Asymmetric Crowding
Springier Wire for Symmetric CrowdingSpringier Wire for Symmetric Crowding
SARANG SURESH HOTCHANDANI 9
10. PRINCIPLES IN THE CHOICE OF
ALIGNMENT ARCHES
• Archwires in alignment
phase should provide
continuous force of
approx. 50 gm for
tipping.
• Avoid heavy force during
alignment phase
• There should be 2 – 4 mil of space
b/w archwire & bracket.
• 14 – 16 mil wire will be placed in 18 mil
bracket. OR
• 16 – 18 mil wire will be placed in 22 mil
bracket.
• The reason of creating space b/w bracket &
archwire is that archwire should be able to
move freely during tipping for alignment.
SARANG SURESH HOTCHANDANI 10
11. PRINCIPLES IN THE CHOICE OF
ALIGNMENT ARCHES
• Always use ROUND NiTi for
alignment phase.
• Why Rectangular NiTi wires are not
Used during Alignment?
• Tight fit in bracket cause resistance to
sliding.
• Produces back & forth movement
of root apices during alignment.
• Increases root resorption
• Slow the alignment process
A. Round Wire
B. Rectangular Wire
SARANG SURESH HOTCHANDANI 11
12. PRINCIPLES IN THE CHOICE OF
ALIGNMENT ARCHES
• Springier wire will be used for alignment of Symmetric Crowding.
• Symmetric Crowding; degree of crowding is similar on two sides of arch.
• While in asymmetric crowding, springier wire will distort the arch form
during alignment.
• Asymmetric Crowding; all or nearly all crowding on one side of arch. e.g. impacted
canine, single displaced tooth.
• Here in this condition Rigid archwire will be needed on normal side & to prevent the
distortion of arch form while springy archwire is needed for crowding side.
SARANG SURESH HOTCHANDANI 12
13. Use of an auxiliary super elastic wire
for incisor alignment in a patient with
asymmetric crowding.
A. Crowding expressed largely as
displacement of one lower lateral
incisor in an adult with periodontal
bone loss for whom light force was
particularly important.
B and C, After space was opened for
the right lateral incisor, a super elastic
wire segment tied beneath the
brackets was used to bring the lateral
incisor into position, while arch form
was maintained by a heavier archwire
in the bracket slots.
D. Alignment completed. This
approach allows use of optimal force
on the tooth to be moved and
distributes the reaction force over the
rest of the teeth in the arch
SARANG SURESH HOTCHANDANI 13
14. P RO P E R T IES O F
A L I G N M ENT A RCH W IR ES
• Wire for initial alignment phase
should have;
• High strength
• High springiness
• High range
• Deliver about 50gm of
force
•Ideal archwire material
for INITIAL ALIGNMENT
is A – NiTi wire
SARANG SURESH HOTCHANDANI 14
15. A L I G N MENT O F S Y M M E T RI C
C ROW D I NG
• Super elastic NiTi is ideal for initial
alignment in symmetric crowding.
• Alignment requires opening space for
teeth that are crowded in the arch.
• Spaces can be created with following 2
ways
• Folded stops
• Hold the archwire slightly advanced
relative to crowded incisors
• Compressed Coil Springs
SARANG SURESH HOTCHANDANI 15
17. Travelling of
Archwire
• One problem with super elastic wires for
initial alignment is their tendency to
“travel” so that the wire slips around to
one side, protruding distally from the
molar tube on one side and slipping out of
the tube on the other.
• The most effective way to prevent travel is to
• tightly crimp a split tube segment onto the wire
between two adjacent brackets.
• The location of the crimped stop, here between the left
central and lateral incisors, is not critical.
• dimple in the midline to prevent the archwire
from sliding excessively.
SARANG SURESH HOTCHANDANI 17
18. This panoramic radiograph shows archwire travel to the point that on one side it
penetrated into the ramus, almost to the depth of an inferior alveolar block injection
(interestingly, the patient reported only mild discomfort).
SARANG SURESH HOTCHANDANI 18
19. Alignment in
pre-molar extraction space
• Patients with sever crowding of anterior teeth sometimes require
extraction of premolar to gain space for alignment of incisors.
• After this extraction, canine is retracted by one of two methods;
• Independent retraction of canine followed by alignment of incisors
• Simultaneous distal tipping of canine along with alignment of incisors
• A NiTi coil spring for canine retraction
• A NiTi archwire for incisor alignment
SARANG SURESH HOTCHANDANI 19
20. Alignment in
pre-molar extraction space
(Independent Method)
When anchorage is critical for retraction of canines to
allow alignment of incisors, bone screws placed in the
alveolar process between the molar and premolar
roots are the most effective way to obtain the
necessary space.
A. The anchorage can be direct, with an elastomeric
chain or NiTi spring from the bone screw
providing the force to retract the canines or
B. indirect, with an attachment from the bone screw
to the first molar to keep those teeth from moving
forward when an attachment from the posterior
teeth is used to retract the canine.
Direct Method
Indirect Method
SARANG SURESH HOTCHANDANI 20
21. Alignment in
pre-molar extraction space
(Simultaneous
Method)
Alignment of severely crowded lower
incisors with the super elastic
equivalent of the original
“drag loop.”
a) Occlusal view prior to treatment.
b) Canine retraction with super
elastic coil springs that provide 75
gm of force, and alignment of
incisors with a super elastic NiTi
wire that incorporates an
accentuated reverse curve of Spee
and delivers 50 gm.
c) and D, Completion of canine retraction
and incisor alignment after 5 months of
treatment.
SARANG SURESH HOTCHANDANI 21
23. Individual Teeth into Anterior
Cross bite
• Correction of a dental anterior cross bite, as
in this young adult, requires
• opening enough space for the displaced teeth
followed by
• attempting to move it facially into arch form.
• At that point, a biteplate to obtain vertical
clearance often is required because;
• patient can bite on the bracket placed on displaced tooth
so for preventing this, posterior teeth are separated
temporarily
• Occlusal interference prevents the facial movement of that
displaced tooth SARANG SURESH HOTCHANDANI 23
24. Transverse Maxillary Expansion by
Opening the Mid Palatal Suture
• Widening of maxilla by opening mid palatal suture is easy in
young age, but it becomes difficult in as the patient become
older.
• Patient who require opening of mid palatal suture will also
need extraction of premolar.
• Expansion is done 1st after that extraction or alignment of teeth is
performed.
• Because 1st premolar teeth are useful for anchorage & lateral expansion.
SARANG SURESH HOTCHANDANI 24
25. Transverse Maxillary Expansion by
Opening the Mid Palatal Suture
• If the maxillary width is normal, expansion should be avoided.
• It should be used for correcting skeletal cross bite.
• After the age of 15 or in older patients, maxillary expansion by opening mid
palatal suture should be achieved with Rapid Activation of expansion screw
(2 turns initially & 2 turns per day until suture opens) – 10 – 20 pounds of
force is applied.
• Patient will feel pop apart
• If the suture at this age with rapid expansion does not open within 2 – 3 days, surgical
expansion is only possibility after that.
• Slow activation in this age will produce only dental expansion.
SARANG SURESH HOTCHANDANI 25
26. Transverse Maxillary Expansion by
Opening the Mid Palatal Suture
• There are two appliance for this transverse maxillary expansion;
• Bonded expander
• Banded expander
• Bonded Expander
• Indicated in patients with excessive anterior face height.
• Does not cause downward & backward rotation of mandible.
• Banded Expander
• Mostly given in patient with short anterior face height
• Cause downward & backward rotation of mandible resulting long face.
Normal Face Height Persons can be given
any of two expanders
Normal Face Height Persons can be given
any of two expanders
SARANG SURESH HOTCHANDANI 26
27. Transverse Maxillary Expansion by
Opening the Mid Palatal Suture
Banded Expander Bonded Expander
SARANG SURESH HOTCHANDANI 27
28. Correction of Dental Posterior
Cross Bites
• 3 methods of correcting less sever dental cross bite;
•Heavy labial expansion arch
•Inner bow Face bow in case of headgear wearer
•Expansion lingual arch
•Cross elastics
SARANG SURESH HOTCHANDANI 28
29. Heavy Labial Expansion Arch
• A heavy labial archwire (usually 36 or 40
mil steel) placed in the headgear tubes on
first molars can be used for a small amount
of expansion and to maintain arch width
after palatal suture opening while the
teeth are being aligned.
• This is more compatible with fixed
appliance treatment than a removable
retainer and does not depend on patient
cooperation.
SARANG SURESH HOTCHANDANI 29
30. Trans Palatal
Lingual Arch
If anchorage is of no
concern, highly
flexible lingual arch
like quad helix
design is used to
correct dental cross
bite.
SARANG SURESH HOTCHANDANI 30
31. Trans Palatal Lingual Arch
•If expansion & anchorage both are needed, the
choices are;
•36 mil steel wire with adjustment loop
•Use of 32 x 32 TMA or Steel wire
SARANG SURESH HOTCHANDANI 31
32. A and B, Mandibular stabilizing lingual
arch. It is easier to insert a heavy lingual
arch of this type from the distal of a
horizontal tube on the first molar bands.
Note that the lingual arch is contoured
away from the incisors, so that it does not
interfere with aligning and retracting them.
C and D, A maxillary lingual arch can be
active, typically to rotate the maxillary
molars, or passive for stabilization. An
active lingual arch can be placed in a
horizontal tube or ligated into a special
bracket on the molars, as shown here.
Ligation into a bracket makes it easier to
remove and adjust the lingual arch, but
over time, gingival overgrowth can make
re-ligation difficult
SARANG SURESH HOTCHANDANI 32
33. Cross Elastics
• They run from lingual or upper
molar to the buccal of lower molar.
• Cause extrusion of teeth and
downward & backward rotation of
mandible.
SARANG SURESH HOTCHANDANI 33
36. Surgical Exposure
• Before surgery to expose the tooth, it precise position should be
known. It can be obtained by on of the following radiographs;
• CBCT (Small Field of View)
• Vertical Parallax Method
• Combination of OPG & Occlusal View.
• Lateral Cone Shift Method
• Multiple Periapical Views.
SARANG SURESH HOTCHANDANI 36
37. Surgical Exposure
• When exposure of impacted tooth is planned, it is important for tooth to
erupt through attached gingiva no through alveolar mucosa.
• If an impacted canine is on the labial, removing tissue to expose the crown for
bonding an attachment can be done conveniently with a diode laser.
• If the unerupted tooth is more apically positioned, a flap should be reflected
from the crest of alveolus and sustured.
SARANG SURESH HOTCHANDANI 37
38. Surgical Exposure
A
B
C
A. The permanent canine was slow to erupt. Probing showed that exposure of 4 mm of the crown could be done
without violating the biologic width of the attachment apparatus.
B. Immediately after crown exposure with a laser.
C. The tooth brought to the occlusal level with a super elastic wire, ready for placement of a bracket in ideal
position.
SARANG SURESH HOTCHANDANI 38
39. Method of Attachment
• Best approaches are;
•Bonding of button or hook to
which gold chain is tied and
extending into mouth.
• Other approaches;
• Placement of pin in a hole prepared in crown.
• Wire ligature around crown instead of gold chain.
• Results in loss of PDL support.
• Increases chances of ankyloses
SARANG SURESH HOTCHANDANI 39
40. Mechanical Approaches for
Aligning Impacted Tooth
• Orthodontic traction to move an unerupted tooth away from other
permanent tooth roots & then toward the line of arch should begin
ASAP after surgery.
• Brackets should be applied to other teeth before surgery so that force
can be applied immediately.
• If it is not possible, then force should be given within 2 – 3 weeks post
surgically.
• The reason for pre-surgical bracket is to create space for that impacted tooth
to erupt into arch.
SARANG SURESH HOTCHANDANI 40
41. Mechanical Approaches for
Aligning Impacted Tooth
• As we know impacted tooth is example of
asymmetric crowding, so for that purpose;
•At least 18 mil steel rectangular
wire should be in place as heavy
stabilizing wire followed by
auxiliary A NiTi wire for moving
impacted tooth.
SARANG SURESH HOTCHANDANI 41
42. A. For this patient with palatally positioned
bilateral impacted maxillary canines, a
soldered lingual arch has been placed for
better anchorage control; a heavy labial
archwire is in place after space for the
canines has been opened; and an auxiliary A-
NiTi wire is tied to attachments (preferably, a
segment of gold chain) that were bonded to
the canines at the time they were exposed.
B. Progress in the same patient, with the A-NiTi
auxiliary now placed over a button that was bonded
on the facial surface of the canine after it was
brought down enough to allow this.
C. When the tooth has elongated enough, the button is
replaced with a standard canine bracket and
alignment is complete.
D. A vertical spring bent into a 14 mil steel archwire is
an alternative approach to bring down an impacted
canine. The spring is a loop of wire that faces
downward before activation and is rotated 90
degrees for attachment to the impacted tooth or
teeth. This method is effective but less efficient than
using a super elastic auxiliary wire.
SARANG SURESH HOTCHANDANI 42
43. Unerupted/Impacted Lower 2nd
Molar Alignment
• Impaction of lower 2nd molar usually develops during
orthodontic treatment.
• Mesial tipping of lower 2nd molar instead of eruption occurs when
mesial marginal ridge of lower 2nd molar catches against the distal
surface of 1st molar or on the edge of 1st molar band.
• Lower Molar distalization also increase the chances of
impaction of lower 2nd molar.
SARANG SURESH HOTCHANDANI 43
44. Unerupted/Impacted Lower 2nd
Molar Alignment
• Correction of an impacted 2nd molar require tipping the
tooth posteriorly & uprighting it.
• This can be achieved by;
•Use of separators
•Use orthodontic force by arch wire
•Surgical uprightening
SARANG SURESH HOTCHANDANI 44
45. Unerupted/Impacted Lower 2nd Molar Alignment
– with SEPARATORS
• For a second molar that is caught on the edge of a first
molar band, a simpler approach is uprighting achieved
with a 20 mil brass wire OR SEPARATORS tightened
around the contact.
• Usually it is necessary to anesthetize the area to place a
separator of this type.
• Uprighting and distal movement obtained with the
brass wire separator. A spring clip (one type is sold as
the Arkansas de-impaction spring) can be used in the
same way, but both brass wire and spring clips are
effective only for minimal molar uprighting.
SARANG SURESH HOTCHANDANI 45
46. Unerupted/Impacted Lower 2nd Molar Alignment
– with Ortho WIRES
When a second molar is banded or bonded relatively late in treatment, often
it is desirable to align it with a flexible wire while retaining a heavier archwire
in the remainder of the arch.
Repositioning a maxillary second molar, using a
straight segment of rectangular A-NiTi wire
that fits into the auxiliary tube on the first molar
and the tube for the main archwire on the second
molar.
SARANG SURESH HOTCHANDANI 46
47. Unerupted/Impacted Lower 2nd Molar Alignment
– with Ortho WIRES
In both arches, after the repositioning, a continuous archwire can extend to
the second molar.
Repositioning a mandibular second molar, using a
segment of steel wire with a loop that extends
from the auxiliary tube on the first molar.
SARANG SURESH HOTCHANDANI 47
48. Surgical Uprighting
Surgical uprighting of impacted mandibular second molars sometimes is the
easiest way to deal with severe impactions.
A, Age 12, prior to loss of the second primary molars, with the permanent
second molars tipped mesially against the first molars. Teeth in this position
often upright spontaneously when the first molars drift mesially after the
primary molars are lost.
B, Age 14, severe impaction one year after the beginning
of orthodontic treatment.
C, Age 14, after surgical uprighting of the second molars, which are rotated
around their root apex into the space created by third molar
extraction. Loss of pulp vitality
usually does not occur when this is
done.
D, Age 16, after completion of
orthodontic treatment. Note the
excellent fill-in of bone between
the first and second molars
A
B
C D
SARANG SURESH HOTCHANDANI 48
50. Management of Midline
Diastema
•If midline diastema is due to high Frenum; frenectomy
should always be performed after closing the space
orthodontically.
•Treatment starts with; aligning the teeth together by
figure 8 wire ligature before frenectomy followed by
removal of Frenum & placement of bonded retainer as
shown in figure.
SARANG SURESH HOTCHANDANI 50
51. A. Facial appearance, showing the protruding maxillary incisors caught on the lower lip.
B. Intraoral view before treatment.
C. Teeth aligned and held tightly together with a figure-8 wire ligature, before frenectomy.
D. Appearance immediately after frenectomy, using the conservative technique advocated
by Edwards in which a simple incision is used to allow access to the interdental area,
the fibrous connection to the bone is removed, and the frenal attachment is sutured at a
higher level.
E. Facial appearance 2 years after completion of treatment.
F. Intraoral view 2 years after treatment.
G. Bonded retainer, made with .0175 steel twist wire. It is important for the wire to
be flexible enough to allow some displacement of the incisors in function—a
rigid wire is much more likely to break loose.
Management of a maxillary midline diastema.
A
B
C
D
E
F
F
SARANG SURESH HOTCHANDANI 51
53. Levelling
There are three possible ways to level a lower arch with
an excessive curve of Spee:
A. ABSOLUTE INTRUSION
B. RELATIVE INTRUSION, achieved by preventing
eruption of the incisors while growth provides
vertical space into which the posterior teeth erupt;
and
C. EXTRUSION of posterior teeth, which causes the
mandible to rotate down and back in the absence of
growth.
• Note that the difference between B and C is whether
the mandible rotates downward. This is determined by
whether the ramus grows longer while the tooth
movement is occurring.
SARANG SURESH HOTCHANDANI 53
54. Curve of Spee
Excessive Curve of Spee
Flat Curve of
SpeeReverse Curve
of Spee
EXCESSIVE CURVE OF SPEE; restrict the amount
of space available for upper teeth results in
crowding.
FLAT CURVE OF SPEE; most receptive for normal
occlusion. (the mandibular curve of spee should
not be deeper than 1.5 mm)
REVERSE CURVE OF SPEE;
creates excessive space in
upper jaw
SARANG SURESH HOTCHANDANI 54
55. Levelling by Extrusion
(Relative Intrusion)
• After initial alignment by A NiTi wire, arch wire is changed for Levelling.
• Resilient & springy arch wire is needed for alignment while,
• Stiffer Wire Is Needed For Levelling.
• The choice of wire for levelling depends on the bracket used;
• Either the bracket is 18 slot size or 22 slot size.
• The wire which is placed for levelling after removal of alignment wire should have
following features if the levelling is to performed by Relative Intrusion method;
• Excessive curve of spee in maxillary archwire
• Reverse curve of spee in mandibular archwireSARANG SURESH HOTCHANDANI 55
57. 18 Slot, Narrow Br acket
Here the 2nd wire for levelling phase in this bracket is
almost always
16 MIL STAINLESS STEEL ROUND Wire
with excessive curve of spee in upper arch & reverse
curve of spee in lower arch.
SARANG SURESH HOTCHANDANI 57
58. 18 Slot, Narrow Br acket
•In some patient, particularly in non extraction treatment of
older patients who have little or non remaining growth will
need an archwire heavier than 16 mil (probably 17 – 18 mil).
•However, in them instead of using of heavy wire, we can add
auxiliary leveling arch wire of 17 x 25 mil TMA or Steel
Rectangular wire.
• This auxiliary arch wire inserts into tubes beneath the 16 mil base
arch
SARANG SURESH HOTCHANDANI 58
59. 18 Slot, Narrow Br acket
A, Auxiliary leveling wire prior to and after activation (B) by tying it beneath a continuous mandibular
archwire.
The appropriate force in this instance is approximately 150 gm, and the expected action is leveling by
extruding the premolars rather than intruding the incisors.
For absolute intrusion, light force (approximately 10 gm per tooth) is necessary.
This requires use of archwire segments and an auxiliary intrusion arch.
A B
SARANG SURESH HOTCHANDANI 59
60. 18 Slot, Narrow Br acket
(C)Intrusion arch prior to and after activation (D) by bending it downward and tying it to the
segment to be intruded.
The force delivered by the intrusion arch can be measured easily when it is brought down to the
level at which it will be tied
SARANG SURESH HOTCHANDANI 60
61. 18 Slot, Narrow Br acket
(E)Auxiliary leveling arches for extrusion in the maxillary arch and
(F) for incisor-canine intrusion in the mandibular arch.
Note that the mandibular base arch is segmented, creating a separate incisor segment, while a continuous archwire is in place
in the maxillary arch and the auxiliary leveling arch is tied into the anterior brackets on top of it.
Intrusion requires a segmented base arch and a light intrusive force (here, with six mandibular incisors in the anterior
segment, approximately 50 gm would be used). Extrusion can be done with a segmented or continuous base archwire, using
about 50 gm/tooth in the segmented to be extruded.SARANG SURESH HOTCHANDANI 61
62. 22 – Slot WIDER BRACKET
• Initial alignment wire – A NiTi wire
• Wire for Levelling in 22 Slot Bracket
• Initially 16 mil steel wire with reverse or accentuated
curve of spee
• Later 18 mil round steel wire to complete levelling.
• No 20 mil or auxiliary wire needed.
SARANG SURESH HOTCHANDANI 62
63. NOTE !!
Never use Rectangular base wire in levelling phase.
Never use excessive curve of spee wire in mandible.
• Curve will cause torque on incisor roots lingually.
• Rectangular wire would be acceptable in upper arch if
lingual torqueing of upper incisors is needed.
SARANG SURESH HOTCHANDANI 63
64. Levelling by INTRUSION
• The key to successful intrusion is Light Continuous Force
Directed Towards Apex.
• Avoid Pitting intrusion of one tooth against extrusion of its
neighbor.
• TWO METHODS of Levelling by Intrusion
• Bypass Arches Method
• Segmented Arches Method
SARANG SURESH HOTCHANDANI 64
65. Bypass Arches Method
• In this
Continuous Archwire That Bypasses The Premolar (& Frequently
Canine) Teeth is used
• This method is most useful for
Patients Who Have Some Growth (Mixed Or Early Permanent
Dentition).
• Mechanism of Action - Bypass Arch Method;
• Uprighting & Distal Tipping Of The Molar, Pitted Against
Intrusion Of Incisors.
SARANG SURESH HOTCHANDANI 65
66. Diagrammatic Representation of Bypass Method
• Diagrammatic representation of the forces for a leveling arch that bypasses the premolars, with an anchor
bend mesial to the molars.
• A force system is created that elongates the molars and intrudes the incisors.
• The wire tends to slide posteriorly through the molar tubes, tipping the incisors distally at the expense of
bodily mesial movement of the molars.
• An archwire of this design is used in the first stage of Begg treatment but also can be used in edgewise
systems.
• A long span from the molars to the incisors is essential.SARANG SURESH HOTCHANDANI 66
67. Mechanical Arrangements
Bypass Arches M e t hod
There are 3 Techniques available by which we can intrude the teeth for
levelling with Bypass Method
1ST STAGE OF BEGG TECHNIQUE; bodily movements of anchor molars
were pitted against tipping of movement of anterior teeth.
Here premolar teeth were bypassed & loose tie was made to canine.
2 X 4 EDGEWISE APPLIANCE; only 2 molars & 4 incisors included in appliance
RICKETT’S UTILITY ARCH
Produce complex mechanical system that is difficult to control, that’s why utility
arches are now replaced by segmented arch approach as mentioned in next slides
SARANG SURESH HOTCHANDANI 67
68. 2x4 Edgewise Appliance
A and B, The long span of a 2 × 4 appliance makes it possible to create the light force necessary for
incisor intrusion and also makes it possible to create unwanted side effects. The 2 × 4 appliance is
best described as deceptively simple.
When incisor intrusion is desired before other permanent teeth can be incorporated into the
appliance, a trans palatal lingual arch for additional anchorage is a good idea.
SARANG SURESH HOTCHANDANI 68
70. Bypass Arches Method
• Success of bypass method depend on KEEPING FORCES LIGHT.
• These light forces can be achieved by;
• USING SMALL DIAMETER WIRE
• Weather bracket is 18 Or 22 Slot, Wire Heavier Than 16 Mil Should Not Be
Used. – size of bracket slot is irrelevant
• Ricketts used 16 x 16 cobalt chromium wire for his utility arches.
• IN MODERN UTILITY ARCHES; 16 X 22 BETA TITANIUM rectangular wire is used.
• USING LONG SPAN B/W INCISORS & 1ST MOLAR.
SARANG SURESH HOTCHANDANI 70
71. Bypass Arches M e t hod
( W E AK N ES S)
• Only 1st molar is available for anchorage which results extrusion of this
tooth which compromises the intrusion the anterior teeth.
• This extrusion is not a major problem in growth patients with good facial pattern.
• However, molar extrusion should be avoided in non growing patients with poor facial
pattern.
• Intrusive force against incisors is applied anterior to the center of resistance
and therefore INCISORS TEND TO TIP FORWARD as they intrude.
SARANG SURESH HOTCHANDANI 71
72. A. When the incisor segment is viewed from a lateral perspective, the center of resistance (X) is lingual to the point at
which an archwire attaches to the teeth. For this reason, the incisors tend to tip forward when an intrusive force is
placed at the central incisor brackets.
B. Tying an intrusion arch distal to the midline (for instance, between the lateral incisor and canine, as shown here) moves
the line of force more posteriorly and therefore closer to the center of resistance. This diminishes or eliminates the
moment that causes facial tipping of the teeth as they intrude.
C. Intrusion arch tied in the midline as only the central incisors are intruded, so that the incisors will tip facially as they
intrude.
D. In the same patient later, an intrusion arch now is tied between the central and lateral incisors to intrude all four incisors
while reducing the amount of facial tipping.
SARANG SURESH HOTCHANDANI 72
73. Bypass Arches M e t hod
( W E AK N ES S)
• This forward tipping of incisors can be prevented by;
• Anchor bend at the molar in bypass arch creating closing effect that restrains forward
movement of incisors.
• Activation of utility arch like closing loop.
SARANG SURESH HOTCHANDANI 73
74. Segmented Arch Method
• Developed by Burstone.
• In this approaches brackets are placed on all teeth.
• Here for intrusion of anterior teeth, posterior segment are
stabilized & point of force application against anterior teeth
is controlled.
SARANG SURESH HOTCHANDANI 74
75. Segmented Arch Method
• Posterior teeth are stabilized for better control of anchorage. Which can be
achieved by;
• Placing full dimension archwire into bracket slots of 2nd premolar, 1st molar
& 2nd molar on both sides of arches which act as single segment.
• After that both sides are connected by a heavy lingual arch made either 36 mil
round or 32 x 32 rectangular stainless steel wire.
• A resilient anterior segmental wire is used to align the incisors while the
posterior segments are being stabilized.
• Wire for ANTERIOR TEETH; BRAIDED RECTANGULAR WIRE OR
RECTANGULAR TMA
SARANG SURESH HOTCHANDANI 75
76. Segmented Arch Method
• For intrusion, an auxiliary arch placed in auxiliary tube on the 1st molar is used to
apply intrusive force against anterior segment.
• This arch should Always Be Rectangular so that it does not twist in tube, and
made from either one mentioned below.
• 18 x 25 steel wire with 2 ½ turn helix
• 17 x 25 or 19 x 25 TMA wire without helix
• Preformed M – NiTi
• This wire should be
placed gingival to
incisors & apply
light force of 10 gm
per tooth.
SARANG SURESH HOTCHANDANI 76
77. S e g m e n t e d A r c h M e t h o d
M e t h o d s t o R e d u c e F o r w a r d
I n c i s o r s T i p p i n g
• Two strategies available;
• Similar to bypass arches, a space closing force
can be created by tying the auxiliary arch back
against posterior segments.
• Change the point of force against incisors.
• Tying an intrusion arch distal to the midline
(for instance, between the lateral incisor and canine,
as shown here) moves the line of force more
posteriorly
and therefore closer to the center of resistance.
This diminishes or eliminates the moment that causes
facial tipping of the teeth as they intrude.
SARANG SURESH HOTCHANDANI 77
78. Levelling by INTRUSION
•Although both act by intrusion of incisor with
extrusion & distal tipping of posterior segments.
But;
•With segmented arch technique; 4x as much
incisor intrusion as molar extrusion in non growing
adults is possible. WHILE
•The ratio of anterior intrusion to posterior
extrusion is much less favorable with bypass
technique. SARANG SURESH HOTCHANDANI 78
79. The KEY is T ying Auxiliary
Archwire where Intrusion
is required.
•It is quite possible to intrude asymmetrically;
•Only adjusting the teeth that are placed in
stabilizing & intrusion segments and tying the
auxiliary intrusion arch where intrusion is required.
SARANG SURESH HOTCHANDANI 79
80. A. In this adult patient, the maxillary left
central and lateral incisors and
particularly the canine had super
erupted. Asymmetric intrusion of those
teeth was needed.
B. An auxiliary intrusion arch delivering
about 30 gm was tied to the elongated
canine, while preliminary alignment
with an A-NiTi wire was employed. The
result was leveling of the maxillary arch
with a component of intrusion on the
elongated side. Asymmetric intrusion
can be accomplished either by
asymmetric activation of an intrusion
arch that spans from one first molar to
the other or by use of a cantilever
intrusion arch on one side only.
SARANG SURESH HOTCHANDANI 80
81. Summary
of 1st Stage of Treatment
• The arches should be level
• Teeth should be aligned to the point that rectangular steel archwires
can be placed without excessive curve & without generating
excessive force.
• The duration of 1st stage of Tx. Is determined by severity of both
horizontal & vertical component of initial malocclusion.
SARANG SURESH HOTCHANDANI 81
82. THE END
Final Year BDS, Bibi Aseefa Dental College, SMBBMU, Larkana, Sindh, PAKISTAN
Email: hotchandanisarang@gmail.com
Twitter: www.twitter.com/fetusdentista
SARANG SURESH HOTCHANDANI 82