Canine retraction in pre adjusted edgewise technique /certified fixed orthodo...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078
Canine retraction in pre adjusted edgewise technique /certified fixed orthodo...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
This slide gives you a detailed description of History
,Bone screws,Maxillary infra-zygomatic bone crest anatomy,Dimensions of IZC,Indications of IZC,Sites of placing IZC Screws,Mini-screw insertion in IZ crest of maxilla,Biological limitation for placement of IZC for distalization,General guidelines for placing IZC,Post operative care,Failures of IZC
Retraction mechanics in swa 2 /certified fixed orthodontic courses by Indian ...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
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.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
This slide gives you a detailed description of History
,Bone screws,Maxillary infra-zygomatic bone crest anatomy,Dimensions of IZC,Indications of IZC,Sites of placing IZC Screws,Mini-screw insertion in IZ crest of maxilla,Biological limitation for placement of IZC for distalization,General guidelines for placing IZC,Post operative care,Failures of IZC
Retraction mechanics in swa 2 /certified fixed orthodontic courses by Indian ...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
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.
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.
Alignment and Leveling of teeth is usually the fundamental and the most important objective of orthodontics during initial phase of fixed orthodontic treatment.
Tip edge /certified fixed orthodontic courses by Indian dental academy Indian dental academy
The Indian Dental Academy is the Leader in
continuing dental education , training dentists
in all aspects of dentistry and offering a wide
range of dental certified courses in different
formats.
Indian dental academy provides dental crown &
Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit
www.indiandentalacademy.com ,or call
0091-9248678078
Different Types of Dental Wiring Techniques
Essig’s wiring
Gilmer’s wiring
Risdon’s wiring
Ivy eyelet wiring
Armamentarium for Wiring
Presterilized 26-G stainless steel wire
Two needle holders or wire holders.
Wire cutters.
Essig’s wiringUsed to stabilize dentoalveolar fractures.
Steps:
The luxated teeth should be pushed back into their sockets.
The wire is passed around the neck or the chosen teeth,
One end going from buccal to lingual and other end going lingual to buccal in each interdental space of teeth And the wires are brought together and twisted and cut short to be tucked into interdental space .
The additional small wires are passed interdentally around these base
wires to secure them tightly beyond the cingulum.
The individual interdental wires are also twisted, cut and adjusted in the interdental spaces.
Gilmer’s wiring
It is direct wiring method of intermaxillary fixation.
Att least one tooth anterior and one posterior to the fracture should be available for wiring to assure proper stabilization.
Steps :
stainless steel wire is passed around the neck of the chosen tooth. Both the ends are brought out on the buccal surface and manually twisted keeping the twists close to the tooth.
Final twisting is completed by grasping both the ends with a wire holder.
CONTENTS
INTRODUCTION
TERMINOLOGIES
REQUIREMENTS OF MAJOR CONNECTORS
FUNCTIONS OF MAJOR CONNECTORS
NOMENCLATURE
TYPES OF MAJOR CONNECTORS
CONTENTS
MAXILLARY MAJOR CONNECTORS
SUMMARY
REVIEW OF LITERATURE
REFERENCES
INTRODUCTION
When a prosthesis that can be removed from the mouth is used, the prosthesis must extend to both sides of the arch.
This enables transfer of functional forces of occlusion from the denture base to all supporting teeth and tissues within an arch for optimum stability.
It is through this cross-arch tooth contact, which occurs at some distance from the functional force, that optimum resistance can be achieved
This is most effectively accomplished when a rigid major connector joins the portion of the prosthesis receiving the function to selected regions throughout the arch.
A major connector combines all other components of an RPD so that the partial denture acts as one unit.
Thus, functional loads can be distributed to all abutment teeth, and cross-arch stabilization can be provided.
In addition, in distal extension RPDs, forces can be distributed between both the abutment teeth and the mucosa by unification of the direct retainers with the denture base.
TERMINOLOGIES
MAJOR CONNECTOR- GPT 9
The part of a removable partial denture that joins the components on one side of the arch to those on the opposite side.
CROSS-ARCH STABILIZATION :
Resistance against dislodging or rotational forces obtained by using a partial removable dental prosthesis design that uses natural teeth on the opposite side of the dental arch from the edentulous space to assist in stabilization
REQUIREMENTS
To function effectively and minimize potentially damaging effects, all major connectors must
1. Be rigid
2. Provide vertical support and protect the soft tissues
3. Provide a means for obtaining indirect retention where indicated
4. Provide a means for placement of one or more denture bases
5. Promote patient comfort
RIGIDITY
PROVIDE VERTICAL SUPPORT AND PROTECT THE SOFT TISSUES
The second fundamental requirement of a major connector is that it must not permit impingement upon the free gingival margins of the remaining teeth.
The marginal gingivae are highly vascular and susceptible to injury from sustained pressure.
For this reason, care should be exercised during the design and fabrication of removable partial dentures.
In the maxillary arch, the borders of a major connector should be located at least 6 mm from the free gingival margins.
The borders should run parallel to the gingival margins of the remaining teeth.
If the gingival margins must be crossed, they should be crossed at right angles to minimize coverage of the delicate marginal tissues
Where the major connector crosses a gingival margin, relief (le, space) must be provided between the metal and soft tissues.
If relief is not provided, inflammation of the soft tissues will result.
PROVIDE A MEANS FOR OBTAINING INDIRECT RETENTION WHERE INDICATED
It is important to note that
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
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
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
Similar to comprehensive orthodonic treatment (20)
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
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
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
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
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
CDSCO and Phamacovigilance {Regulatory body in India}NEHA GUPTA
The Central Drugs Standard Control Organization (CDSCO) is India's national regulatory body for pharmaceuticals and medical devices. Operating under the Directorate General of Health Services, Ministry of Health & Family Welfare, Government of India, the CDSCO is responsible for approving new drugs, conducting clinical trials, setting standards for drugs, controlling the quality of imported drugs, and coordinating the activities of State Drug Control Organizations by providing expert advice.
Pharmacovigilance, on the other hand, is the science and activities related to the detection, assessment, understanding, and prevention of adverse effects or any other drug-related problems. The primary aim of pharmacovigilance is to ensure the safety and efficacy of medicines, thereby protecting public health.
In India, pharmacovigilance activities are monitored by the Pharmacovigilance Programme of India (PvPI), which works closely with CDSCO to collect, analyze, and act upon data regarding adverse drug reactions (ADRs). Together, they play a critical role in ensuring that the benefits of drugs outweigh their risks, maintaining high standards of patient safety, and promoting the rational use of medicines.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
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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
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Title: Sense of Taste
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 structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
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
3. Contents
• Introducton
• Adjustment of individual Tooth Positions
• Correction of Vertical Incisor Relationships
• Final "Settling" of Teeth
• Positioners for Finishing
• Special Finishing Procedures to Avoid Relapse
• Micro-esthetics procedures in finishing
4. Introduction
• Comprehensive orthodontic treatment implies an effort to make the patient’s
occlusion as ideal as possible, repositioning all or nearly all the teeth in the
process.
• The idea of dividing treatment into stages was emphasized by Raymond Begg.
• These major stages of comprehensive treatment are:
alignment and leveling,
correction of molar relationship and space closure, and
finishing.
5. End result of second stage
The teeth should be well aligned
Extraction spaces should be closed
Tooth roots should be reasonably parallel
The teeth in the buccal segments should be in a normal Class I
relationship.
In the Begg technique, major root movements of both anterior and
posterior teeth still remained at the end of Stage 2, to obtain root
paralleling at extraction sites and proper torque and axial inclination
of tipped incisors.
6. Objective of stage 3
Much less treatment
remains
Minor versions of these same
root movements
Marginal ridges level
Obtain precise in-out
positions of teeth within the
arches
Overcome any discrepancies
produced by errors in either
bracket placement or
appliance prescription.
Vertical relationship of
incisors (either correcting
moderately excessive
overbite or closing a mild
anterior open bite).
7. The sequence of arch wire
(1)The most efficient arch
wires should be used, so as
to minimize clinical
adjustments and chair time;
and
(2)It is necessary to fill the
bracket slot in the finishing
stage with appropriately
flexible wires to take full
advantage of the modern
appliance.
12. Wireselection
• With the 18-slot appliance, the typical finishing archwire is either 17
x 22 or 17 x 25 steel.
• These wires are flexible enough to engage narrow brackets even if
mild tipping has occurred, and the archwire will generate the
necessary root paralleling moments.
• If a greater degree of tipping has occurred, a more flexible full-
dimension rectangular archwire is needed.
• To correct more severe tipping, a beta-titanium (beta-Ti) or even a
nickel- titanium (M-NiTi) 17 x25 wire might be needed initially, with a
steel archwire used for final expression of torque.
13. • With wider 22-slot if teeth have tipped even slightly into the
extraction space or if other root-positioning is needed, even
undersized steel archwires ( I9 x 25 steel) are much too stiff.
• A 21 x 25 beta-Ti wire is the best choice for a finishing archwire under
most circumstances and if significant root positioning is needed, 21 x
25 M-NiTi should be used first.
• The great advantage of A-NiTi is its very flat load-deflection curve,
which gives it a large range.
• In the finishing stage, however, appropriate stiffness at relatively
small deflections, rather than range, is the primary consideration .
14. • A-NiTi wires may deliver less force than their M-NiTi counterpart.
• M-NiTi almost always is the better choice for rectangular nickel-
titanium wires.
• Occasionally, a severely tipped tooth will be encountered and a
longer range of action is needed. This may indicate using a
rectangular A-NiTi wire initially, then M-NiTi.
15. • A root-paralleling moment is a crown-separating moment in edgewise technique
just as it is in Begg or any other technique.
• Either the teeth must be tied together or the entire archwire must be tied back
against the molars to prevent spaces from opening.
• Not only extraction sites, but also maxillary incisors must be protected against
this complication.
• When a full-dimension rectangular wire is placed in the maxillary arch, spaces are
likely to open between the incisors in non-extraction as well as extraction cases.
• Tying the maxillary incisors together, which can be done conveniently with a
segment of elastomeric chain from the mesial bracket of one upper lateral incisor
across to the mesial bracket of the other, is necessary during finishing.
16. Torque
• Lingual root torque of incisors
• Buccal root torque of premolars and molars
17. Lingual root torque of incisors
• If protruding incisors tipped lingually while they were being retracted, Iingual
root torque as a finishing procedure may be required.
• In the Begg technique, the incisors are deliberately tipped back during the
second stage of treatment, and lingual root torque is a routine part of the
third stage of treatment.
• Like root paralleling, this is accomplished with an auxiliary appliance that fits
over the main or base archwire.
• The torquing auxiliary is a "piggyback arch" that the labial surface of the
incisors near the gingival margin, creates the necessary couple with a
moment arm of 4 to 5 mm.
• The auxillary arch is bent into a tight circle initially, exerts force against the
roots of the teeth as it is partially straightened out to normal arch form.
18. Burstone torqueing arch
• Class ll division2 cases where maxillary central incisors need a large amount of torque.
• The torqueing auxiliary is full dimension steel wire (21x25 or 17 x 25,in 22 or 18-slot
brackets respectively) that fits in the brackets only on the incisors.
• It can be used only on the centrals or on the centrals and laterals.
• The base rectangular archwire extends forward from the molars through the canine or
lateral incisor brackets, then steps down and rests against the labial surface of the teeth
to be torqued.
• When the torqueing auxiliary is passive, its long posterior arms are up in the buccal
vestibule.
• lt is activated by pulling the arms down and hooking them beneath the base archwire
mesial to the first molar.
• The segment of the base arch that rests against the labial surface of the central incisors
prevents the crowns from going forward, and the result is efficient lingual root torque.
19. • Because of the long lever arm, this is the most effective torquing
auxiliary for use with the edgewise appliance.
• It is equally effective with the l8- or 22-slot appliance.
• If all four incisors need considerable torque, a wire spanning from the
molar auxiliary tube to the incisors, with a V-bend so that the incisor
segment receives the greater moment, is a highly efficient approach.
20. Class II elastic
• A torquing force to move the roots lingually is also a force to move
the crowns labially.
• In a typical patient with a Class II malocclusion, anchorage is required
to maintain overjet correction while upper incisor roots are torqued
lingually.
• For that reason, Class II elastics are likely to be necessary when active
torque is needed during the final stage of Class II treatment.
21. Factor determining amount
of torque expression
• Torsional stiffness of wire
• Inclination of bracket slot relative to
archwire
• Tightness of fit b/w archwire &
bracket
• With the l8-slot appliance a, 17 x25
steel archwire has excellent properties
in torsion, and torque with this archwire
is entirely feasible.
22. (-)ve torque of canine &
premolar
Affect smile
Arch expansionBuccal crown torque
Buccal root torque of premolars and molars
23. Correction of Vertical Incisor Relationships
Excessive
overbite
Incisor
display
Anterior face
height
Anterior
openbite
Lip vs upper
incisor
relation
Anterior face
height
24. • If intrusion is indicated and a rectangular finishing archwire is already in place,
the simplest approach is to cut this archwire distal to the lateral incisors and
install an auxiliary intrusion arch.
• When a maxillary auxiliary intrusion arch is used, a stabilizing transpalatal lingual
arch may be needed to maintain control of transverse relationships and prevent
excessive distal tipping of the maxillary molars.
• The greater the desired vertical change in incisor position, the more important it
will be to have a stabilizing lingual arch in place, and vice versa.
• Small corrections during finishing usually do not require placing a lingual arch.
• Alternatively, if slight elongation of the posterior teeth is indicated, step bends in
a flexible archwire would be satisfactory.
• The intermediate arch wire before the final torqueing archwire is the one for
implementation of these step bends (17 x 25 TMA with the l8-slot appliance, 17 x
25 M-NiTi with the 22-slot appliance).
25. Methods of settling of teeth
Replacing rectangular wire at the very end
of t/t with light round arches that provide
some freedom for movement of the teeth
& using light vertical elastics to bring teeth
together.
Using laced posterior vertical
elastics after removing posterior
segment of the archwires
After the bands & brackets
have been removed, using a
tooth positioner
26. Control of rebound and posturing
Rebound vs
posturing
•Rebound is a 1 to 2 mm phenomenon ;posturing can
lead to 4 to 5 mm relapse.
Overcorrection
•After class II or III correction, particularly if interarch elastics have been used, the teeth tend to
rebound back towards their initial position despite the presence of rectangular archwires.
•Because of this, it is important to slightly overcorrect the occlusal relationships.
Guideline for
finishing treatment
when interarch
elastics
•When an appropriate degree of overcorrection has been achieved, the force used with the
elastics should be decreased & continued full time for another appointment interval.
•Interarch elastics should be discontinued,4-8 weeks before the orthodontic appliances are
removed, so that changes due to rebound or posturing can be observed.
•If the occlusion is stable, the teeth should be brought into a solid occlusal relationship without
heavy archwires present.
27. Removal of Bands
• Removal of band is accomplished by
breaking the cement attachment & then
lifting the band off the tooth .
• For upper molar & premolars, band
removing instrument is placed first on lingual
then buccal surface.
• For lower posterior sequence of force is just
reversed: band remover is applied first on
buccal, then the lingual surface.
28. Debonding
• Done by creating a fracture within resin bonding material or between the
bracket & resin and then removing the residual resin from enamel surface.
• For metal brackets-safest method is to apply cutting plier to the base of
bracket, so that bracket bends. This method has disadvantage of bracket
destruction so cant be reused.
• Ceramic bracket have little or no ability to deform. So shearing stress are
applied to the bracket to remove it, which is alarmingly large. This leads to
more chance of enamel damage.
29. Approaches
for
debonding
ceramic
bracket
Modify interface (chemical
bonding) between bracket
and bonding resin to
increase the chance that
when force is applied, the
failure will occur between
the bracket and the bonding
material.
Heat to soften the bonding
resin, so that bracket can be
removed by lower force –
electrochemical or laser
instrument
Modify the bracket-metal
slot in ceramic bracket.
30. Timing:
4-6 week
before the
planned
removal
of
appliance
Lab
procedure
trim band
&
brackets-
include all
erupted
teeth-
bring each
tooth into
desired
final
relationshi
p
Advantage
early
removal of
appliance
gingival
massage,
open bite
tendency
Disadvant
age
expensive,
increase
overbite,
not
maintain
rotated
teeth,
pt.coopera
tion
Contraindi
cation
severe
malalignm
ent &
rotated
teeth,
deep bite
tendency,
uncoopera
tive
patient
Schedule
Full time
wear for
first 2
days,
At least 4
hrs during
day &
during
sleep,
Produce
changes
within 2-3
weeks
Positioners for finishing
32. Control of Unfavorable growth
• Changes resulting from continued growth in a Class II, Class III, deep
bite or open bite pattern contribute to a return of the original
malocclusion, and so are relapse in that sense.
• For patients with skeletal problems who have undergone orthodontic
treatment "active retention" takes one of two forms.
• One possibility is to continue extraoral force in conjunction with
orthodontic retainers (high-pull headgear at night in a patient with a
Class II open bite growth pattern).
• The other appropriate option is to use a functional appliance rather
than a conventional retainer after the completion of fixed appliance
therapy.
33. Control of Soft Tissue Rebound
• A major reason for retention is to hold the teeth until soft tissue
remodeling can take place.
• There are two ways to deal with this phenomenon:
(1) overtreatment, so that any rebound will only bring the teeth back
to their proper position, and
(2) adjunctive periodontal surgery to reduce rebound from elastic
fibers in the gingiva.
34. Overtreatment
Correction of Class II or Class III Malocclusion
• After headgear or elastics have been discontinued, it can be expected that
the teeth will rebound I to 2 mm relatively quickly.
• Especially when elastics are used, the patient should be taken to a slightly
overcorrected position, and elastics discontinued for 3-4 weeks to allow
rebound to occur, before appliances are removed.
• Particularly when a patient has been wearing Class II elastics, he or she may
begin to posture the mandible forward, so that the malocclusion looks
more corrected than it really is.
35. • For this reason it is important to allow a period of time without
elastics before ending active treatment, to be sure that the patient
really has been corrected and is not just posturing.
• The best plan is to reduce the force on Class II elastics when the
apparently correct degree of overcorrection has been achieved but
maintain them full-time for 3-4 weeks, then wear them just at night
for another appointment period, and finally discontinue them
completely for at least 4 weeks before removing the appliances.
36. Crossbite Correction
• Whatever the mechanism used to correct crossbite, it should
be overcorrected by at least I to 2 mm before the force
system is released.
• If the crossbite is corrected during the first stage of
treatment, the overcorrection will gradually be lost during
succeeding phases of treatment, but this should improve
stability when transverse relationships are established
precisely during the finishing phase.
37. Irregular and Rotated Teeth
• It is wise to hold the teeth in a slightly overcorrected
position for at least a few months, during the end of the first
stage of treatment and the second stage.
• As a general rule, however, it is not wise to build this
overcorrection into rectangular finishing archwires.
• Maintaining an over rotated position can be done by
adjusting the wings of single brackets, or by pinching shut
one of a pair of twin brackets.
• Rotated teeth should be maintained in an overcorrected
position as long as possible.
38. • A major cause of rebound after orthodontic treatment is the network
of elastic supracrestal gingival fibers.
• As teeth are moved to a new position, these fibers tend to stretch,
and they remodel very slowly.
• If the supracrestal fibers are sectioned and allowed to heal while the
teeth are held in the proper position, relapse caused by gingival
elasticity is greatly reduced.
• It can be carried out by either of two approaches. (circumferential
supracrestal fibrotomy & papilla dividing procedure)
Adjunctive periodontal surgery
39. Circumferential supracrestal fibrotomy
• Originally developed by Edwards
• After infiltration with a local anesthetic, the procedure consists of
inserting the sharp point of a fine blade into the gingival sulcus down
to the crest of alveolar bone.
• Cuts are made interproximally on each side of a rotated tooth and
along the labial and lingual gingival margins unless, as is often the
case, the labial or lingual gingiva is quite thin, in which case this part
of the circumferential cut is omitted.
• No periodontal pack is necessary and there is only minor discomfort
after the procedure.
40. Papilla dividing procedure
• Incision in the center of each gingival papilla, sparing the margin but separating
the papilla from just below the margin to 1 to 2mm below the height of the bone
buccally and lingually.
• This modification is said to reduce the possibility that the height of the gingival
attachment will be reduced after the surgery, and it is particularly indicated for
esthetically sensitive areas( i.e., the maxillary incisor region).
• Nevertheless, there is little if any risk of gingival recession with the original CSF
procedure unless cuts are made across thin labial or lingual tissues.
41. • Neither the CSF nor the papilla-dividing procedure should be done
until malaligned teeth have been corrected and held in their new
position for several months, so this surgery is always done toward
the end of the finishing phase of treatment.
• It is important to hold the teeth in good alignment while gingival
healing occurs.
• The surgery should be done a few weeks before removal of the
orthodontic appliance
• If it is performed at the same time the appliance is removed, a
retainer must be inserted almost immediately.
42. • An advantage of the papilla-dividing procedure may be that it is
easier to perform with the orthodontic appliance still in place.
• The only problem with placing a retainer immediately after the
surgery is that it may be difficult to keep the retainer from contacting
soft tissue in a sore area.
• Experience has demonstrated that sectioning the gingival fibers is an
effective method to control rotational relapse but does not control
the tendency for crowded incisors to again become irregular.
• The primary indication for gingival surgery therefore is a tooth or
teeth that were severely rotated. This surgery is not indicated for
patients with crowding without rotations.
43. Micro-esthetics procedures in finishing
Recontouring the gingiva to improve tooth proportion and display-
Height-width ratios of the teeth are affected by the extent to which gingiva
covers the upper part of the crown.
Reshaping the teeth for enhanced esthetics-Enamel recontouring should
not be done until after the initial phase of orthodontic alignment because, if a
tooth rotation is corrected, the perception of its width is changed while the
height is not, giving a misleading height-width ratio.
• After alignment, reshaping of the teeth can be carried out as desired but should
be completed before the end of the finishing stage of treatment.
45. Ref:-Sarver DM; Enameloplasty and esthetic finishing in orthodontics – identification and treatment of microesthetic
features in orthodontics part – 1; J Esthet Rstor Dent 23:296-302,2011
46.
47. Steps for enameloplasty to improve smile appearance
Establish height Address the width
Check the length
of the connector
Round the
line angle
Close the space created by
interproximal
enameloplasty
Create & refine
embrasures
Polish to finish
Ref:-Sarver DM; Enameloplasty and esthetic finishing in orthodontics – identification and treatment of microesthetic
features in orthodontics part – 1; J Esthet Rstor Dent 23:296-302,2011
48. References
• Contemporary orthodontics,5th edition
• Sarver DM; Enameloplasty and esthetic finishing in orthodontics –
identification and treatment of microesthetic features in
orthodontics part – 1; J Esthet Rstor Dent 23:296-302,2011
Editor's Notes
Bolton
The auxillary arch is bent into a tight circle initially,exerts force against the roots of the teeth as it is partially straightened out to normal arch form
Settling is the final step of bringing tooth into occlusion.