This document discusses leveling and alignment in orthodontic treatment. It defines alignment as bringing malposed teeth into the arch form and leveling as bringing the molars and premolars into the same plane as the incisors. The document covers principles of alignment such as using light continuous forces from round wires to address one plane of tooth movement at a time. It also discusses variables in selecting alignment wires based on material, size and interbracket span. Special problems in alignment like crossbites and impacted teeth are addressed. The document concludes with discussions on leveling techniques including extrusion, intrusion, bypass arches and segmented archwires as well as anchorage control methods.

1. MBT- LEVELING
AND ALIGNMENT
Presented by :
Dr. Nabila Tahir
1

2. Contents
 Introduction
 Alignment
 Principles in the choice of alignment wires
 Properties of alignment archwires
 Variables in the selection of alignment archwires
 Special problems in alignment
 Alignment in different techniques
 Leveling
 Leveling in different techniques
 Anchorage control during alignment and leveling
 Exception to full bracket placement
2

3. 3
•Re-leveling
•Conclusion
•References

4. Introduction ORTHODONTIC
TREATMENT
1) Alignment
and leveling
2) Correction of molar
relationship & space
closure
3)Finishing
RAYMOND BEGG
4

5. DEFINITION
The tooth movements needed to achieve passive engagement
of a steel rectangular arch wire of 0.019” X 0.025”
dimension and of suitable arch form, into a correctly placed
preadjusted 0.022” bracket system.
5
•Systemized orthodontic treatment mechanics – McLaughlin Bennett Trevisi

6. Objectives
Short term
Achieve proper
leveling and
alignment into
passive
rectangular steel
wires
Long term
Achieve ideal
dentition
Achieve six keys
to normal
occlusion
With dentition
achieve properly
positioned facial
profile
6
•Systemized orthodontic treatment mechanics – McLaughlin Bennett Trevisi

7. Alignment
First orthodontic objective during
the initial stage of treatment.
ALIGNMENT
Bring malposed
teeth into arch
AP position
of incisors
Width of
posterior arch
Dental arch
form
Control
anchorage in
all 3 planes
7

8. PRINCIPLES
IN THE
CHOICE OF
ALIGNING
WIRES
1)Light continuous forces
2) Free movement of the archwire
3) Use round wire
4) Address one plane at a time
5) Excess crowding is present , create space
first
8
•Systemized orthodontic treatment mechanics – McLaughlin Bennett Trevisi

9. 1)Light continuous forces
2) Free movement of the archwire
9

10. Stanley and Braun mentioned one benefit of using the
rectangular archwire would be of prevention of flaring
of the incisors , due to in built labial root torque
The principle is that it is better to tip crowns to
position during initial alignment rather than
displacing root apices
3) Use round wire
10

11. 4) Address one plane at a time
5) Excess crowding is present , create
space first
11

12. Properties of
alignment
arch wires
 STRENGTH
 SPRINGINESS
 LONG RANGE OF ACTION
 FLAT LOAD DEFLECTION CURVE
 Providing 50gm force(optimum tipping force) for any degree of deflection
12

13. A- NiTi are the most efficient :-
 light forces provided over long range
 Low torsional strength so no root Torquing
 Flat load deflection curve
For super elastic wires the
manufacturers preparation not the
wire size determines force
delivery
13
•Wiiliam R Proffit textbook of comtemporary orthodontics Fifth edition

14. Variables in the
selection of
alignment arch
wires
 ARCHWIRE MATERIAL
 WIRE SIZE
 INTERBRACKET SPAN
14
•Wiiliam R Proffit textbook of comtemporary orthodontics Fifth edition

15.  The wire in reducing
order preference for
aligning severely
malaligned are
Archwire
material Wire Size
15
•Wiiliam R Proffit textbook of comtemporary orthodontics Fifth edition

16. If a beam is rigidly attached on both ends(last diagram) it is twice as strong
but only one fourth as springy as a beam of the same material and length
that can slide over the abutments (diagram 3)thus orthodontic property of
arch wire is affected based on how tightly or loosely it is tied
Inter bracket span
16
•Wiiliam R Proffit textbook of comtemporary orthodontics Fifth edition

17. Inter bracket
span
Increased inter bracket span
Increased springiness
Reduced force
Faster alignment
17

18. Wider brackets Narrow brackets
Decreased Increased
interbracket span interbracket span
Decreased wire Wire more flexible, less force
effectiveness and and more mechanical
less mechanical efficiency
efficiency
18

19. Alignment of
symmetric
crowding
Arch wire choices
Superelastic NiTi – ideal for initial alignment
19
•Wiiliam R Proffit textbook of comtemporary orthodontics Fifth edition

20. Problem with Superelastic NiTi
Crimp split tube segment to prevent
sliding excessively
20
•Wiiliam R Proffit textbook of comtemporary orthodontics Fifth edition

21. •Long range not necessary – 17.5 mil multistrand offers
properties at fraction of cost
•M-NiTi, co-axial wires or steel wires with loops – similar
performance to multistrand
21
•Wiiliam R Proffit textbook of comtemporary orthodontics Fifth edition

22. Alignment in
Non-
extraction
Requires increase in arch length
for alignment
Loop mesial to molar in
multistrand wire
Stop mesial to molar with
Superelastic wire to hold wire in
front of incisors
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•Wiiliam R Proffit textbook of comtemporary orthodontics Fifth edition

23. Alignment in
asymmetric
crowding
Alignment of single blocked out teeth
CuNiTi can be directly engaged in the
blocked out teeth
23
•Wiiliam R Proffit textbook of comtemporary orthodontics Fifth edition

24. 24

25. In highly placed canines
25

26. Consistent and Inconsistent force system
26
A, A maxillary second molar extruded with distal-crown tipping. Upon inserting a straight wire into the second molar tube
(black line) and placing a force to engage it to the other brackets (blue arrow), an intrusive (desired) force with a mesial-crown
tipping tendency (desired) is expected to occur. Because the estimated load system matches the one desired to correct the tooth,
the load system is called consistent. B, A maxillary second molar extruded with mesial-crown tipping. Upon inserting a
continuous arch into the second molar tube (black line) and placing a force to engage it to the other brackets (blue arrow), an
extrusive force (unwanted) with a distal-crown tipping tendency (desired) is expected to occur. Since the estimated load system
does not match the desired one to correct the second molar, the load system is termed inconsistent.
Shintcovsk et al Continuous arch and rectangular loops for the correction of consistent and inconsistent load systems in extruded and tipped maxillary second molars AJODO March 2018 Vol 153
Issue 3

27. Special
problems in
alignment
Cross bite correction
Individual teeth displaced into anterior cross bite
27
•Wiiliam R Proffit textbook of comtemporary orthodontics Fifth edition

28. Skeletal cross bite - Transverse maxillary expansion by opening mid palatal
suture - 10- 20 pounds force for 2 weeks – retention for 3-4 months
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•Wiiliam R Proffit textbook of comtemporary orthodontics Fifth edition

29. Dental cross bite –
1. Heavy labial expansion arch – Mulligan (JCO1979)
2. Inner bow of the face bow- expanded
3. Cross elastics
4. Expansion lingual arch
29
•Wiiliam R Proffit textbook of comtemporary orthodontics Fifth edition

30. 30
1) SURGICAL
EXPOSURE
2)ATTACHMENT
TO THE TOOTH
3)
MECHANICS
APPLIED
Impacted or unerupted tooth
Management includes :
•Wiiliam R Proffit textbook of comtemporary orthodontics Fifth edition

31. Surgical exposure
Attachment of the tooth
31
•Wiiliam R Proffit textbook of comtemporary orthodontics Fifth edition

32. Orthodontic mechanics to bring the tooth into arch
1. NiTi tied directly to attachment
2. Traction applied with ligature wire or elastic chain
attached to stiff base arch wire
32
•Wiiliam R Proffit textbook of comtemporary orthodontics Fifth edition

33. 3. Auxiliary spring soldered to the base arch wire
4. Vertical spring bent in 0.014 ss (ballista spring – Jacoby AJO 1979)
33

34. Management of impacted second molar
 Severely tipped teeth – auxiliary spring
NiTi from auxiliary tube on first molar to tube on the second molar
34

35. Align teeth before frenectomy
Then close space immediately after frenectomy
35
•Wiiliam R Proffit textbook of comtemporary orthodontics Fifth edition
Diastema closure

36. Alignment in
different
techniques
Alignment in straight wire appliance
 0.018” slot – 0.016” NiTi is the most suitable
 0.022”slot – 0.018” NiTi is desirable
36

37. Alignment in Vari Simplex discipline
.
37
In maxillary arch In mandibular arch

38. Alignment in MBT
 For severe crowding – multistrand wire is used.
 Normal recommended sequence for a 0.022” slot.
38

39. LEVELING
Leveling is defined as a procedure in which
the molar and premolar are brought to same plane
as incisors.
39

40. LEVELING
Leveling by
Extrusion
Leveling by
Intrusion
Combination of
the two
Leveling Vertical 40

41. Leveling by
extrusion
Involves supra eruption of molars and premolars
Accomplished with continuous arch wire
41
•Wiiliam R Proffit textbook of comtemporary orthodontics Fifth edition

42. Dental reactions to continuous round wire with reverse curve of
Spee.
42

43. Dental reactions to continuous round wire with reverse curve of
Spee and tieback.
43

44. Dental reaction to continuous round wire with Class III
elastics.
44

45. 45
Leveling by
intrusion
Bypass archwires Segmented archwires
Aligners having
attachments on
posterior teeth
•Wiiliam R Proffit textbook of comtemporary orthodontics Fifth edition

46.  Three different arrangements available
1. Mulligan common sense mechanics(JCO 1980
2. In amalgamated technique
46
Bypass archwires
•Wiiliam R Proffit textbook of comtemporary orthodontics Fifth edition

47.  Rickett’s utility arch
47
•Wiiliam R Proffit textbook of comtemporary orthodontics Fifth edition

48. 48
leveling in
Bioprogressive
therapy
Type A
leveling
Type B
leveling
Type C
leveling

49. Weakness of bypass arches
 Only first molar is available for anchorage – significant extrusion of 1st molar can occur
 Intrusive force applied anterior to the Cres- hence incisors tend to tip forward as they
intrude – undesirable in extraction cases
49
•Wiiliam R Proffit textbook of comtemporary orthodontics Fifth edition

50. 50
Segmented archwires - Developed by Burstone
•Wiiliam R Proffit textbook of comtemporary orthodontics Fifth edition

51. Connecticut intrusion arch –
Nanda, Marzban, Kuhlberg - JCO 1998
51

52. Intrusion force system consists of anterior intrusive force,
posterior extrusive force, and posterior tipback moment.
52

53. Force system created by CTA and high-pull headgear.
53

54.  Force system for incisor flaring. CTA is not cinched back, and can be
ligated directly into incisor brackets for maximum flaring.
54

55.  Force system for incisor extrusion, with CTA is inserted into molar
brackets upside down. Vertical forces shown are ideal for correction of
minor open bites.
55

56. Strategies used with segmented arches to prevent
forward movement of the incisors
56
•Wiiliam R Proffit textbook of comtemporary orthodontics Fifth edition

57. A space closing force can be created by tying the auxillary arch back
against the posterior segments
57

58. LEVELING IN
DIFFERENT
TECHNIQUES
Leveling in Vari simplex
discipline
58
Leveling in Roth

59. 59
Leveling in MBT

60. Importance of second molars
In low angle deep bite cases banding of second molars in most
beneficial in bite opening and leveling of curve of spee
60
•Systemized orthodontic treatment mechanics – McLaughlin Bennett Trevisi

61. 61
 The bite plate effect
•Systemized orthodontic treatment mechanics – McLaughlin Bennett Trevisi

62. Anchorage
control
during
aligning and
leveling
62
Principles of
anchorage
control
Reduction of
anchorage needs
Anchorage support
during aligning and
leveling
•Systemized orthodontic treatment mechanics – McLaughlin Bennett Trevisi

63. 63
Recognizing
anchorage
needs of a case
Class II div 1
example
Class III example
Bimaxillary
protrusion
example
•Systemized orthodontic treatment mechanics – McLaughlin Bennett Trevisi

64.  ANCHORAGE SUPPORT
In anteroposterior direction
64
1. Lacebacks
•Systemized orthodontic treatment mechanics – McLaughlin Bennett Trevisi

65. 65
2. Bendbacks
•Systemized orthodontic treatment mechanics – McLaughlin Bennett Trevisi

66. 66
3. Lingual arch
4. Class III elastics
and headgear
•Systemized orthodontic treatment mechanics – McLaughlin Bennett Trevisi

67. 67
5. Head gear for
upper molars
•Systemized orthodontic treatment mechanics – McLaughlin Bennett Trevisi

68. 1. Vertical control of incisors
68
•Systemized orthodontic treatment mechanics – McLaughlin Bennett Trevisi
Vertical anchorage control

69. 2. Vertical control of canines
In highly placed canines
69
•Systemized orthodontic treatment mechanics – McLaughlin Bennett Trevisi
High labial canines mat be loosely tied to the .015 multistranded or .016 HANT wire in early stages of
treatment . If the starting archwire is fully engaged in the canine bracket slot , it can produce unwanted tooth
movements in the adjacent lateral incisor and premolar regions.

70. 3. Vertical control of molars in high angle cases
70
•Systemized orthodontic treatment mechanics – McLaughlin Bennett Trevisi
If the upper palatal bar is placed 2 mm away from the palate, tongue forces can assist in
vertical control of the molars

71. Anchorage control in lateral plane
71
•Systemized orthodontic treatment mechanics – McLaughlin Bennett Trevisi
Upper molar expansion should be carried out by bodily
movement rather than tipping . Minimal molar crossbites
can be corrected using rectangular steel wire which are
slightly expanded from the normal form and which carry
buccal root torque.

72. 72
•Systemized orthodontic treatment mechanics – McLaughlin Bennett Trevisi
Exceptions of full bracket placement
 Cases with unerupted
teeth or teeth out of the
arch form
 High angle deep bite
cases

73. Re – leveling
procedures
73

74. CONCLUSION
74

75. References
75
•Wiiliam R Proffit textbook of comtemporary orthodontics Fifth edition
•Systemized orthodontic treatment mechanics – McLaughlin Bennett Trevisi
•Shintcovsk et al Continuous arch and rectangular loops for the correction of
consistent and inconsistent load systems in extruded and tipped maxillary
second molars AJODO March 2018 Vol 153 Issue 3
• Leveling and Aligning: Challenges and Solutions Bhavna Shroff and Steven
J. Lindauer Seminars in Orthodontics, Vol 7, No 1 (March), 2001

76. 76