Alignment and Leveling of teeth is usually the fundamental and the most important objective of orthodontics during initial phase of fixed orthodontic treatment.

1. LEVELINGand ALIGNING
Presented by – Pranshu Mathur JR 2
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2. 2

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4. CONTENTS
4

5. 1. Introduction
2. Definitions
3. Objectives
4. Goals of 1st phase of
treatment
5. Key points in leveling
and aligning
6. Factors affecting
 Archwire material
Archwire requirements
 Size of archwire
 Interbracket distance
7. Properties of initial
alignment archwire
8. Wires used in leveling
and alignment
9. Aligning in different
philosophies
 Edgewise
 Beggs
 Straight wire appliance
 Roth prescription
 MBT
 Self ligating
 Lingual appliances
 Clear aligners
10.Clinical considerations
in aligning
 Alignment in crowding
 Alignment in non extraction cases
 Alignment in premolar extraction
 Alignment in cross bites
 Alignment in midline diastema
 Alignment in tooth rotations
 Alignment in tipped teeth
11.Leveling
 Leveling by extrusion
 Bite plate effect
 Levelling by intrusion
12.Anchorage control in
leveling and aligning
13.Conclusion
14.References
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6. INTRODUCTION
6

7. ◦Alignment and Leveling of teeth is usually the fundamental
and the most important objective of orthodontics during
initial phase of fixed orthodontic treatment.
◦The idea of dividing comprehensive treatment into stages
was emphasized by Raymond Begg.
◦The 3 major stages are –
1. Alignment and leveling
2. Correction of Molar relationship and Space closure
3. Finishing and detailing
7

8. DEFINITIONS
Leveling is the process in which incisal edge of the
anterior teeth and the buccal cusp of posterior teeth
are placed on the same horizontal plane.
Alignment is the lining up of teeth of an arch in order
to achieve normal contact point relationship
8

9. McLaughlin, Bennet, Trevisi (MBT) in their book Systemized
Orthodontic Treatment defined tooth leveling and aligning
as –
“The tooth movements needed to achieve passive
engagement of a steel rectangular wire of 0.019/0.025
dimension and of suitable arch form, into a correctly placed
preadjusted 0.022 bracket system.”
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10. ◦ This process can be performed by the means of different techniques and
sometime with surgical procedure in more severe cases.
◦ In almost all patients of malocclusion, some of the teeth are malaligned.
◦ The great majority have either excessive overbite, combination of excessive
curve of Spee in mandibular arch and absent or reverse curve of Spee in
upper arch or anterior open bite with excessive curve of Spee in maxilla and
little or none in the lower arch.
◦ Initial leveling and aligning of teeth has been simplified by the increased
availability and use of wires with low deflection rates and shape memory 10

11. OBJECTIVES
Short term objectives (Proffit)
In the initial months of treatment, the objective is to achieve
proper aligning and leveling by passive engagement of a
rectangular wire.
Long term objectives
Towards the end of treatment, the objective is to achieve an
ideal dentition, displaying six keys of normal occlusion, and
the dentition properly positioned within the facial profile.
11

12. GOALS OF THE 1ST PHASE OF
TREATMENT
◦ Alignment.
◦ Anteroposterior position of incisors.
◦ Arch form of the dental arches.
◦ Vertical discrepancies by leveling out the arches.
12

13. ◦For proper alignment, it is necessary not only to –
1. Bring malposed teeth into the arch but also to specify and control
the anteroposterior position of incisor as well as posterior teeth.
2. The width of the arch posteriorly and the form of dental arches.
◦In leveling the arch, leveling occurs by
1. Elongation of posterior teeth
2. Intrusion of incisors.
3. Combination of both
13

14. KEY POINTS IN LEVELING & ALIGNING
◦ Forces should be kept as light as possible.
◦ Sagittal, vertical & lateral anchorage needs should be identified for each case.
◦ Lacebacks & bend backs to be used in the initial stages to avoid unwanted
tooth movements.
◦ Posterior segments should supported with a head gear/ TPA in maximum
anchorage cases. 14

15. FACTORS AFFECTING
◦Leveling and aligning depends upon the following
factors –
Archwire material
Size of the archwire
Interbracket distance
15

16. 1. Archwire Materials
◦ Titanium based wires- NiTi and TMA (Titanium Molybdenum Alloy/ ß-
Titanium) offers better combination of springiness and strength.
◦ Nickel Titanium (NiTi) wires are better than TMA as they are springier and
stronger. They have low load deflection rate.
◦ If Stainless Steel wire is used in this stage – multistranded wires or wires
with loops can be used.
◦ Gravina (2013) in a RCT showed that the NiTi and multistranded steel wires showed
greater aligning capacity when compared with stainless steel wires.
16

17. Archwire Requirement
To bring teeth into alignment, a combination of labiolingual and mesiodistal
tipping by an archwire is needed but root movement usually is not.
1. For initial alignment of malpositioned teeth, flexible arch wire that should
provide light, continuous force of approx. 50 gms to provide efficient
tipping tooth movements.
◦ Reitan (1985) observed that light forces is necessary because hyalinization of
periodontal ligament and consequent delay in tooth movement occur when forces
greater than 70 gm are applied.
◦ Burstone and Groves (1961) observed optimum rate of tipping tooth movement
occurred when 50-70 gms force was applied.
17

18. 2. Arch wire should freely move within the brackets. For mesiodistal sliding
along an archwire, atleast 2 mil clearance between arch wire and brackets
is needed.
3. A tightly fitting resilient rectangular archwire for initial alignment is almost
always undesirable because not only is it resistant to sliding but wire
produces back and forth movement of root apices as the teeth moves into
alignment.
4. Springiness in arch wire is required when crowding to be atleast
reasonably symmetric otherwise arch form will be lost.
◦ If only one tooth is crowded out of the line or an impacted tooth has to brought into
alignment – a rigid archwire is needed so the arch form is maintained.
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19. 5. Coaxial superelastic NiTi wire is also used for
alignment as initial wire. It has got central core
wire with 5 outer wires wrapped around.it
increases resiliency and flexibility.
◦ It applies light continuous force.
◦ Degree of alignment with coaxial superelastic NiTi is
greater than with single stranded superelastic NiTi in
severe lower anterior crowding case.
◦ Multiple strands of NiTi used to deliver lighter force
which is stronger and has better resistance to fracture.
◦ Rajesh Reddy et al (2016) concluded that the activation and deactivation
forces were higher for nickel-titanium followed by copper-nickel titanium
and co-axial wires.
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20. 2. Size of Archwire
◦Changing the diameter of a wire greatly affects its properties for
initial aligning and leveling.
◦Strength changes as a cubic function of the ratio of 2 cross
sections. Range is directly proportional.
◦Effects of doubling the diameter
◦ Strength (2d/d)3 - Increases by 8 times
◦ Springiness (d/2d)4 - Decreases by 16 times
◦ Range (d/2d) - Decreases by ½ 20

21. 21

22. ◦As the wire size increases strength increases
rapidly and springiness decreases.
◦The smallest diameter wire of adequate
strength can be used for leveling and aligning.
◦Multistranded wires are composed of number
of thin wire sections coiled around each other
to provide round or rectangular cross section.
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23. 3. Interbracket distance
◦The relationship between the distance between the brackets,
strength, springiness and range is given by the following formulae.
◦Effects of doubling the length
◦ Strength (1/2 L) - Decreases by ½
◦ Springiness (L3) – Increases by 8 times
◦ Range (L2)– Increases by 4 times.
◦The width of bracket is an important factor, the wider the individual
brackets the smaller the inter bracket span.
23

24. NARROW BRACKETS
INTER BRACKET SPAN INCREASES
INCREASE IN THE LENGTH OF THE WIRE
INCREASED FLEXIBILITY
DECREASED FORCES
24

25. PROPERTIES OF INITIAL ALIGNMENT
ARCHWIRE
1. Excellent strength
2. Excellent springiness
3. Long range of action
4. Low stiffness
5. Good formability
6. Ideal shape memory
7. Low friction
8. Superelasticity
9. Biocompatible
10. Non allergic
25

26. WIRES USED IN LEVELING AND
ALIGNMENT
◦ Stainless steel wires.
- Multiloop Archwire
◦ Australian arch wires.
- Supreme Plus
◦ TMA wire
◦ Elgiloy wires
◦ Coaxial wires.
◦ Titanium alloys:-
- Nickle titanium alloy
- Copper Nickle Titanium alloy
◦ Braided / Twisted wires.
◦ Esthetic wires
◦ Composite /optical glass wires.
◦ CNA wires
26

27. ALIGNING IN
DIFFERENT
PHILOSOPHIES
27

28. EDGEWISE TECHNIQUE
◦ Dr. E. H. Angle in 1926 introduced his last and greatest contribution –
Edgewise Technique. He used the following in this technique –
◦ Fully banded technique-gold bands, soldered soft brackets
◦ Flat ideal arch wire to provide normal occlusion
◦ Original arch was of .022 X .028 gold wire
◦ If space had to be made, loops are bent onto main arch wire
◦ If space closure required, spurs were soldered on the arch wire and jigs were used
◦ Use of round wires in the initial stages.
◦ Gold was replaced by a more rigid alloy.
◦ Charles Tweed graduated from Angle’s course in 1928 and practiced and
improvised the technique from 1928 till 1970.
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29. Maxillary arch –
• Multiple loop 0.016" SS arch wire
• 0.020" arch wires
• Bent in tie back stop loops
• Vertical loops 5mm in length, bent mesial & distal to both maxillary
lateral incisors.
• Arch wire made in ideal form
• First order, second order bends
• Anti-rotation bends
• Artistic bends in incisal area.
• Curve of Spee
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30. Mandibular –
• Multiple loop 0.016" SS arch wire
• Bent in tie back stop loops
• Vertical loops between cuspids and 1 premolars on either side
• Tip-back bends
• Terminal molars anti-rotation bends
• Vertical loops, L loops
• Leveling with 0.018” Arch wire
• Molar stops, First order bends,
Second order bends
• Reverse curve of Spee
• Tie back loops
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31. BEGGS PHILOSOPHY
◦ In 1929, Dr. Raymond Beggs began using 0.20” round platinized gold, rather than
rectangular arch wire.
◦ In 1931 he started using 0.18” round stainless steel wire, bending now popular
vertical loops and intermaxillary hooks right into arch wires.
◦ In 1956, he introduced his treatment technique known as Begg’s Philosophy.
◦ Basic Begg’s movements -
• Incisor intrusion
• Tipping
• Root movements
In Stage I –
o Open the anterior bite
o Eliminate anterior crowding
o Close anterior spaces
o Over correct the cuspids and bicuspids
o Over correct the mesiodistal relationship of
the buccal segment 31

32. Beggs uses-
• Round austenitic SS – heat treated and cold drawn.
• Combination of resiliency and flexibility.
• Adequate stiffness for bite opening.
• 0.016” special AJW – principal wire of Stage I.
• 0.018” special – Molar extraction cases
• 0.014” special – rotating springs.
• Offset bends in the labial segment
• Bayonet bends act to hold the teeth in positions of overcorrection during treatment.
• Cuspid Curve
• Labial curvature in cuspid area – incorporated to avoid lingual tipping of canines.
• Narrow arches requiring expansion, cuspid offset given.
• Anchorage bends / Tip back bends.
32

33. ANDREW’S STRAIGHT WIRE
APPLIANCE
◦ Dr. Lawrence Andrews introduced Straight Wire Appliance in 1970, based
on 120 non orthodontic normal cases.
◦ He used this data to design
◦ These were the first generation preadjusted brackets.
◦ He recommended a wide range of brackets.
He incorporated tip and torque into the brackets.
For extraction cases, anti-tip, anti-rotation, and power arms for control space closure.
Three sets of incisor brackets with varying degrees of torque. a bracket system.
◦ For anchorage, he used TPA (maxillary arch) and lingual arch (mandibular
arch)
33

34. ROTH’S PRESCIPTION
◦ Dr. Ronald Roth introduced his bracket system (second generation preadjusted
appliance) in 1979 after working on Andrew’s SWA.
◦ He introduced a bracket setup containing modifications of the tip, torque,
rotations and in out movement of the Andrews standard setup brackets.
◦ The major difference between the Andrew’s philosophy and Roth approach to the
use of straight wire appliance has to do with the manner in which the teeth are
moved and not necessarily the desired end result or the result attained.
◦ In the Roth’s approach, tipping of teeth is allowed, by using round wires in the
initial phase of the treatment.
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35. ◦ Phase I treatment
◦ Helical loop archwires, Jarabak fashion made from
◦ 0.016” Elgiloy green wire(crowding)
or
◦ 0.015” braided archwire(routinely)
or
◦ Nitinol(severe rotation)
◦ 0.019” braided wire
◦ 0.018”Australian special plus (finalisation of any stubborn rotation)
◦ 0.019” square blue Elgiloy utility arches are used in case of intrusion of
incisor teeth.
◦ For anchorage, he used TPA, Headgear, Facebow and Lingual arch.
35

36. MBTTM PRESCRIPTION
◦ This third generation preadjusted appliance was introduced by Dr.
Richard P. McLaughlin, Dr. John C. Bennett and Dr. Hugo J. Trevisi
from 1997-2003.
◦ They redesigned the bracket system and again changed the tip and
torque values.
◦ Nitinol wires are used for initial leveling and aligning – 0.015”
Multistranded, 0.0175” Multistranded, 0.014”, 0.016” or 0.016” HANT
wires are used.
36

37. SEQUENCE A
◦0.015” multistranded
◦0.0175” multistranded
◦0.014” NiTi
◦0.016” NiTi
◦0.018” SS
◦0.020” SS
◦0.019” x 0.025” SS
◦0.014” round SS
Wire Sequence Used In MBT
37

38. SEQUENCE B
◦0.016” HANT
◦0.019” x 0.025”
HANT
◦0.019” x 0.025” SS
◦0.014” SS
38

39. ◦Anteroposterior control
◦ Lacebacks for Canines
◦ Bendbacks at Molars
◦For anchorage control
◦ Headgear and Palatal bar in maxillary arch and
◦ Lingual arch and Class III elastics with headgear in mandibular arch
are used.
39

40. SELF LIGATING BRACKETS
Main Advantage of self ligating brackets –
1. Full archwire engagement.
2. Low friction between brackets and archwire.
3. Less chair time assistance is needed.
4. Faster archwire removal and placement.
◦ Combination of low friction and secure archwire engagement is useful for
aligning very irregular teeth.
◦ With low friction the wire is able to slide through the brackets of the rotated
teeth resulting in rapid de-crowding.
◦ Full engagement results in full control while sliding teeth along the archwire.
40

41. LINGUAL APPLIANCE
◦ In 1976,the 1st generation of lingual brackets were
produced by Ormco and developed by Kurz and
co-workers.
◦ The lingual appliance most widely used today is
generation VII appliance, developed by Ormco.
◦ They have a horizontal slot and are offered in either an 0.018” or 0.020” slot
size.
◦ Multiple molar attachments are there including a tube, a twin bracket and a
hinge cap or terminal sheath.
41

42. ◦ All brackets have a gingival ball hook which facilitates elastic ligature
placement, rotation control and placement of intra and inter maxillary
elastic. Ideal archwire has a mushroom shape.
◦ Compensating bends are made. First order bends between cuspid and
bicuspid are made at right angles.
◦ First and second order bends contacting the teeth or bracket can act
as stops and result in expansion force as arch wire length is gained
through alignment.
Archwires used –
0.016 NiTi wire (1st initial wire)
0.016 Special Plus (2nd initial wire)
0.017/025 TMA (Intermediate wire)
42

43. CLEAR ALIGNERS
◦ Clear aligners are an alternative to traditional braces
and were designed to help guide teeth into their
proper position. It uses a gradual force to control the
tooth movements but without metal wires or brackets.
◦ Attachments are bonded on the tooth which helps in controlling tooth movement.
◦ Kassas et al (2013) reported that the clear aligner system is effective in leveling and
aligning arches in mild and moderate cases and in correcting buccolingual
inclinations effectively, however, it is not sufficient for providing ideal occlusal
contacts. The deterioration in occlusal contacts is caused by the thickness of
aligners, which interferes with the settling of the occlusal plane.
43

44. CLINICAL
CONSIDERATIONS
IN ALIGNING
44

45. ALIGNMENT IN CROWDING
◦Crowding is a common kind of malocclusion.
◦It can be
◦ Symmetric crowding
◦ Asymmetric crowding
◦ Superelastic NiTi wire is an ideal choice for initial alignment as it has
flat load deflection rate.
◦ It has good range of action so does not generate excessive force.
45

46. Symmetric Crowding
◦ Crowded arch alignment requires opening
space.
◦ Two ways to open the space –
• When additional arch length is required, stops are
useful in front of molar tube so that archwire is
proud (slightly advanced from crowded incisors). Stops on the archwire should hold it to
slightly in advance position.
• Use of compressed coil spring to open space for crowded incisors.
◦ When superelastic wires tied into malaligned dental arches, they have tendency
to travel around the arch as the patient chew.
46

47. Asymmetric Crowding
◦ Impacted canine, buccally placed canine, palatally
blocked lateral incisors are examples of
asymmetric crowding.
◦ Superelastic wire segment or braided/Multistranded
wires tied beneath the bracket is used to bring the
tooth into position, while arch form was maintained
as it gives light force.
◦ Result is efficient movement of displaced tooth with excellent preservation of
arch wire form –
◦ Two advantages of using superelastic wire auxillary wire to rigid steel wire –
◦ 1. Control of the tendency to distort arch form
◦ 2. Light force against the tooth to be moved
47

48. ALIGNMENT IN NON EXTRACTION
CASES
◦ Alignment in non extraction case require increase in arch length,
moving incisor from molars.
◦ One way to accomplish is to crimp a stop on the wire at molar tube so
that it holds the wire in advanced position.
◦ After that also if more arch length is needed additional stops is given.
◦ To expand arch, broad arch form is used which causes transverse
expansion in premolar area which will again help in alignment.
◦ To generate space we can place coil spring over A-NiTi archwire must
be free to slide forward.
48

49. ALIGNMENT IN PREMOLAR
EXTRACTION
◦ In patient with severe crowding, extraction of premolar is required so
that canine could be retracted to the premolar extraction space to gain
the enough space to align the incisors.
◦ In extreme crowding, its better to retract canine independently before
placing attachments on incisors.
◦ In moderate crowding, the canine is tipped distally and alignment of
incisors is done. This is done by NiTi archwire coupled with NiTi
springs from first molar to tip the canine.
◦ Lacebacks should be given from the last bonded molar to the canine
to prevent mesial tipping of canine.
49

50. 50

51. CROSSBITE CORRECTION
◦ANTERIOR CROSS BITE
◦ Early correction of crossbite has always been given more importance
because early correction will prevent further complications.
◦ Correction of mild anterior crossbite (one or 2 displaced teeth) or posterior
crossbite is done in first stage of treatment.
◦ Methods suggested for simple anterior cross bite correction –
1. Tongue blade therapy
2. Lower inclined plane
3. Hawley’s retainer with auxilliary springs
4. Labial and lingual archwires
51

52. ◦ Correction of crossbite requires first opening enough space then
bringing the displaced tooth or teeth across the occlusion into proper
position.
◦ Correction of this becomes difficult because of occlusal interference.
◦ Bite plate can be given temporarily to separate the posterior teeth and
create space to allow anterior teeth to move.
52

53. ◦POSTERIOR CROSS BITE
Correction of posterior crossbite
has following approaches –
1. Heavy labial expansion arch
2. Expansion lingual arch
3. Cross elastics
4. Transpalatal arch
5. Quad Helix
53

54. MIDLINE DIASTEMA
◦Etiologic factors like supernumerary tooth (mesiodens), cyst,
tumour if any is removed.
◦Habits like tongue thrusting and digit sucking are intercepted
using habit breaking appliance like cribs, spurs, etc.
◦The major cause of midline diastema is due to the presence
of thick, fibrous, papillary or papillary penetrating labial
frenum.
It usually requires surgical removal.
54

55. Midline Diastema can be treated with removable or fixed
appliance -
Removable appliances
◦Hawley’s appliance
incorporating 2 finger
springs distal to central
incisor.
◦Labial bows (split labial
bows)
55

56. Fixed appliances
◦ Elastic chain can be used between the two
central incisors.
◦ A closed coil spring between central
incisors.
◦ M shaped springs incorporating 3 helices
can be inserted into the two central incisor
brackets.
◦ Omega loop
56

57. TOOTH ROTATION
◦Tooth rotation, is defined as mesiolingual or distolingual
interalveolar displacement of the tooth around its longitudinal
axis.
◦Rotated teeth can be corrected by removable, semifixed or fixed
appliance depending upon the severity of rotation.
◦The various methods for the correction of tooth rotation like –
Removable plate with Z- spring
Modified Removable Plate
Whip Spring
57

58. Derotation can be done by number
of ways with fixed appliances
1. By engaging NiTi archwire into
bracket slot. Because of its superelastic
nature and creating 1st order couple as it
regains its original shape.
2. Off centred brackets bring slight over
correction of rotations. It exerts greater
pull force on the side having maximum
rotation.
3. Rotation wedge brings over correction
by exerting push force.
58

59. 4. Palatal/lingual attachments
helps in engaging force from
lingual side, thus couple force can
be applied
5. Ligature rotation tie onto the
arch wire acts by applying a
couple of force to bring
derotation. Elastic thread can also
be used in the same way.
6. Rotation spring can also be
used as in Beggs technique.
7. Whip device 59

60. TIPPED TEETH
◦A tipped mandibular molar is a frequent situation among orthodontic
patients, which usually occurs after premature loss of adjacent teeth
leading to the inclination of the molars.
◦In excessive inclination, overeruption of the antagonist molar, premature
contacts, and occlusal interferences impede prosthetic restoration.
◦Several orthodontic approaches are suggested for mandibular molar
uprighting, such as Australian uprighting spring, cantilever spring,
prefabricated Sander spring, helical uprighting spring, NiTi coil spring,
push spring appliance are few of the currently available options
60

61. METHOD
1. The auxiliary uprighting helix wire
2. Loops
3. Compressed coil spring
4. Reversed loop
5. Lingual auxillaries
61

62. LEVELING
62

63. ◦ Leveling is the procedure in which the molar and premolar
are brought to same plane as incisors.
◦Leveling can be accomplished with continuous archwires,
simply by placing an exaggerated Curve of Spee in the
maxillary archwire and reverse Curve of Spee in mandibular
archwire.
◦It can be brought about by either Intrusion or Extrusion.
63

64. Levelling By Extrusion
The correction of deep overbite includes -
◦Posterior teeth : Extrusion.
Distal tipping
◦Incisors teeth : Proclination
Intrusion
◦A combination .
64

65. 65

66. ◦Intrusion of incisors is commonly indicated in pseudo deep
bite cases or the cases with increased anterior face height.
◦Extrusion of posterior teeth is commonly indicated in
patients with decreased lower anterior face height.
◦It is also indicated in true deep bite cases.
◦Extrusion of molars of an average of 1mm results in 2 to
2.5 mm of bite opening.
66

67. Leveling by extrusion 67

68. RCS , Bendback , CLASS III elastics
Effect of RCS and Bendback in round wire
Effect of RCS in round wire
68

69. Bite Plate Effect
Introducing the bite plate effect in deep bite cases is helpful in
the bite opening process in three ways :
It allows for early placement of brackets on lower incisors, which
begins their movement.
Anterior bite plates can produce an intrusive force on lower
incisors which limits any future extrusion of these teeth.
Anterior bite plates allow for the eruption, extrusion, and/or
uprighting of posterior teeth.
69

70. Anterior Bite plane
Direct bonding on palatal surface of anterior
teeth
Occlusal blocks on posterior teeth
70

71. Leveling By Intrusion
EXTRA ORAL INTRA ORAL
71

72. MULLIGAN’S METHOD UTILITY ARCH
BURSTONE INTRUSION ARCH
3 PIECE INTRUSION ARCH K SIR ARCH
72

73. ANCHORAGE CONTROL IN LEVELING
& ALIGNING
◦ Anchorage control in leveling and aligning is as critical as in other stages of
treatment.
◦ Leveling and aligning procedures causes certain unwanted tooth movements, and if
uncontrolled, the underlying malocclusion worsens, increasing the time and effort
needed later in treatment for example allowing over jet to increase during the opening
stages of class-II division 2 treatment.
◦ Anchorage control in leveling and aligning may be defined as the manoeuvres used to
restrict undesirable changes during the opening phase of treatment so that leveling
and aligning is achieved without key features of the malocclusion becoming worse.
73

74. Anchorage control in leveling and aligning
in 3 planes -
Horizontal (Antero – posterior) plane
◦Control of anterior segments
Lace-backs
Bend-back
◦Control of posterior segment
Upper arch – Head gear
Lower arch – Lingual arch, Class-III elastics
Lateral Plane:
◦ Maintaining upper and lower inter canine width
◦Correction of molar cross bite – RME, Quad Helix, TPA
74

75. Vertical plane :
◦ Incisor vertical –
By not engaging incisor brackets when
canines have negative tip.
Utility arch
◦ Molar vertical control :
Upper 2nd molar banding to be
avoided
Expansion, if required, should be
achieved by bodily movement of
posterior teeth.
TPA should be 2-3 mm away from the
palate
Only high pull or combination pull
headgear to be used.
Posterior bite plane.
75

76. CONCLUSION
Achieving the first stage of
treatment successfully by applying
proper mechanics will result in
good and effective outcomes in the
later stages of orthodontic
treatment.
76

77. REFERNCES
77
• Gravins et al. Clinical Evaluation of Dental Alignment and Leveling With Three
Different Types of Orthodontic Wires Dental Press J Orthod 2013;18(6):31-7
• Reddy RK et al Forces in initial archwires during leveling and aligning: An in
vitro study. J Int Soc Prev Community Dent. 2016 Sep-Oct;6(5):410-416.
• Contemporary Orthodontics – William R. Proffit, 5th edition, 2018
• Orthodontics – Diagnosis and management of malocclusion and dentofacial
deformities – O. P. Kharbanda, 3rd edition, 2019
• Systemized Orthodontic Treatment – McLaughlin, Bennet Trevisi, 2003
• Textbook of orthodontics – T. M . Graber
• Clinical orthodontics – Tweeds
• Straight wire appliance – Andrews
• Orthodontic theory and technique – Beggs