This document discusses several methods for distalizing maxillary and mandibular molars, including removable appliances, fixed appliances, and surgical techniques. For maxillary molars, common removable appliances discussed are the Cetlin appliance, acrylic cervical occipital appliance, and a removable appliance using screws and springs to simultaneously distalize and expand the arch. Fixed appliances can use coils or TMA to distalize molars. For mandibular molars, it is more difficult and extraoral appliances are rarely used; common intraoral options include lip bumpers and lingual arches. Surgical extraction of impacted teeth may also be required to create space for molar distalization.
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 document provides an outline for a lecture on alignment and leveling in orthodontic treatment. It defines alignment and leveling and discusses the goals of the initial treatment stage. Ideal properties for initial aligning archwires are described. Common wires used for alignment like stainless steel, titanium alloys, coaxial wires and others are explained. The document also covers anchorage control, consequences of mechanotherapy, and approaches to specific cases involving crowding, extractions, crossbites and impacted teeth.
Comparison of The Roth prescription,Alexander prescription & MBT prescription...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.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
Edge wise appliance /certified fixed orthodontic courses by Indian dental aca...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.
This document discusses various techniques for positioning orthodontic brackets, including:
1. Standardized methods that use gauges to measure from tooth edges.
2. Andrews' FACC method which uses the central lobe of each tooth crown.
3. Individualized positioning that varies torque, angulation, and position for each tooth.
4. Progressive positioning by Pitts which places brackets more gingivally from posterior to anterior.
It also discusses bracket positioning considerations and modifications for specific tooth anomalies, malocclusions, and treatment plans.
Space closure by frictionless mechanics 2 /certified fixed orthodontic course...Indian dental academy
This document discusses various methods for space closure during orthodontic treatment. It begins by stating that space closure is dictated by treatment objectives and can be achieved through different mechanisms. The goals for any space closure method are then outlined, including differential tooth movement control and producing an optimal biological response. Key determinants of space closure like the amount of crowding, anchorage, and tooth inclinations are also discussed. The document then goes on to compare sliding/friction mechanics versus loop/frictionless mechanics. It provides details on considerations for various anchorage situations and techniques for individual canine retraction. In summary, the document provides an overview of factors to consider for space closure and compares different mechanical approaches.
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 document provides an outline for a lecture on alignment and leveling in orthodontic treatment. It defines alignment and leveling and discusses the goals of the initial treatment stage. Ideal properties for initial aligning archwires are described. Common wires used for alignment like stainless steel, titanium alloys, coaxial wires and others are explained. The document also covers anchorage control, consequences of mechanotherapy, and approaches to specific cases involving crowding, extractions, crossbites and impacted teeth.
Comparison of The Roth prescription,Alexander prescription & MBT prescription...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.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
Edge wise appliance /certified fixed orthodontic courses by Indian dental aca...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.
This document discusses various techniques for positioning orthodontic brackets, including:
1. Standardized methods that use gauges to measure from tooth edges.
2. Andrews' FACC method which uses the central lobe of each tooth crown.
3. Individualized positioning that varies torque, angulation, and position for each tooth.
4. Progressive positioning by Pitts which places brackets more gingivally from posterior to anterior.
It also discusses bracket positioning considerations and modifications for specific tooth anomalies, malocclusions, and treatment plans.
Space closure by frictionless mechanics 2 /certified fixed orthodontic course...Indian dental academy
This document discusses various methods for space closure during orthodontic treatment. It begins by stating that space closure is dictated by treatment objectives and can be achieved through different mechanisms. The goals for any space closure method are then outlined, including differential tooth movement control and producing an optimal biological response. Key determinants of space closure like the amount of crowding, anchorage, and tooth inclinations are also discussed. The document then goes on to compare sliding/friction mechanics versus loop/frictionless mechanics. It provides details on considerations for various anchorage situations and techniques for individual canine retraction. In summary, the document provides an overview of factors to consider for space closure and compares different mechanical approaches.
Anchorage in beggs technique /certified fixed orthodontic courses by Indian d...Indian dental academy
Welcome to 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 has a unique training program & curriculum that provides students with exceptional clinical skills and enabling them to return to their office with high level confidence and start treating patients
State of the art comprehensive training-Faculty of world wide repute &Very affordable.
The document provides an overview of the Tip-edge bracket system created by Dr. Peter Kesling in 1986. It was designed to allow for differential tooth movement by removing corners from conventional edgewise brackets. This allows the crown to tip into place before final torque and positioning. The system uses light forces and a sequence of 3 stages to align, level and torque teeth into the desired positions. A variety of auxiliaries like sidewinders and power pins are used throughout treatment to control individual tooth movements. The Tip-edge bracket is intended to provide controlled three dimensional tooth positioning with light continuous forces.
Loops in orthodontics /certified fixed orthodontic courses by Indian dental ...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.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
00919248678078
Leveling and aligning is the first stage of comprehensive orthodontic treatment. The goals are to bring teeth into alignment and correct vertical discrepancies. This involves tipping teeth into position through light continuous forces of around 50 grams delivered by round or superelastic nickel titanium wires. Maintaining proper anchorage through devices like lacebacks and bendbacks is important. Special challenges like crossbites, impacted teeth, and spacing issues are addressed. Leveling can be achieved through extrusion of posteriors, intrusion of anteriors, or a combination of movements.
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 document discusses the management of low angle cases (skeletal deep bites). It covers the etiology, which can include hereditary factors and horizontal growth patterns. Clinical features include a short square face, upper teeth hidden behind the lips, and decreased interlabial distance. Diagnostic features include decreased facial angles and a horizontal growth pattern seen on cephalograms. Management options discussed include removable appliances, growth modification, magnets, fixed appliances, implants, lingual appliances, Invisalign, and surgery. Stability and retention are also addressed.
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 document discusses various types of intrusion arches used in orthodontics to correct deep overbites. It begins by defining intrusion and describing the biomechanics and principles involved. It then covers 9 specific intrusion arch designs: 1) Rickett's Utility Arch 2) Tipback Springs 3) Burstone's Continuous Intrusion Arch 4) Burstone's Three Piece Intrusion Arch 5) K-SIR 6) Connecticut Intrusion Arch 7) PG Retraction Spring 8) Translation Arch 9) Lingual Arch for intruding lower incisors. For each type, it provides details on materials, design, and mechanics of intrusion.
Modification of twin block functional applianceMaher Fouda
This document discusses the Twin Block appliance, which was originally developed by Clarke. It remains a widely used functional appliance for treating Class II malocclusions. The Twin Block consists of separate upper and lower acrylic appliances connected by occlusal blocks. It works by forcing the mandible into a protrusive position during jaw closure. The document describes the standard Twin Block design and various modifications that have been made, including the addition of expansion screws, torquing springs, and bite jumping screws to allow for gradual advancement. Advantages include comfort, aesthetics, and improved patient compliance compared to fixed appliances. The Twin Block is effective at correcting Class II malocclusions in a rapid manner.
This document provides an overview of orthodontic treatment mechanics using the McLaughlin, Bennett and Trevisi (MBT) bracket system. It discusses the history and development of the MBT system, variations in appliance specifications including bracket selection and torque specifications. It also covers important aspects of treatment including bracket positioning, arch forms, anchorage control, archwire sequences and finishing the case.
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.
Dr. William Roth
Introduction
The Roth Rx
Reasons For Modification
Treatment Philosophy
Treatment Goals
Roth Rationale
Selection Of Treatment Mechanics
Roth Set-up
Sequencing Of Treatment Objectives
Treatment Mechanics
Anchorage Considerations
Detailing Of Tooth Position
Advantages
Comparisons
Conclusions
The pendulum appliance uses acrylic and springs to deliver continuous force from the palate to the upper molars, producing distal movement without affecting other teeth. It is fabricated with acrylic covering springs that extend to molar bands. Springs are activated in 3-week intervals to monitor distalization over 4 months before stabilizing molars. The appliance effectively treats Class II malocclusions without extractions through distal molar movement.
This document discusses the third and final stage of comprehensive orthodontic treatment called "finishing". It defines finishing as correcting prior errors and detailing the case. The document outlines the goals of finishing which include enhancing aesthetics, individual tooth positioning, occlusion, and stability. It describes the standards used by the American Board of Orthodontics for grading case finishing. The document provides details on techniques for correcting tooth alignment, angulation, rotation, and achieving proper gingival levels and tooth sizes during the finishing stage.
Biomechanics of molar distalization appliance /certified fixed orthodontic c...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
1. The document discusses various methods of conserving anchorage in fixed orthodontic appliances, including Nance buttons, transpalatal arches, lingual arches, and extraoral appliances.
2. Nance buttons provide anchorage by resting on the hard palate and resisting unwanted tooth movement during anterior retraction. Transpalatal arches connect the right and left molars to resist mesial molar migration.
3. Lingual arches in the lower arch function similarly to transpalatal arches in the upper arch. Extraoral appliances derive anchorage from outside the oral cavity, such as from the neck or face, to reinforce anchorage and achieve tooth movement.
This document discusses various methods and appliances for distalizing maxillary molars, including removable and fixed options. Removable appliances discussed include extraoral traction using headgear as well as removable appliances with finger springs or sliding jigs. Fixed appliances discussed include intramaxillary devices like Wilson's 3D appliance as well as intermaxillary appliances like Herbst or Jasper Jumper. Factors like the presence of second molars, skeletal pattern, and growth prognosis must be considered when determining whether molar distalization is indicated.
Proper bracket placement is important for optimal orthodontic treatment outcomes. Brackets should be placed according to the facial axis of the clinical crown and the facial axis point to ensure proper positioning relative to the facial axis of occlusion. The mesiodistal position of brackets varies slightly between tooth types, and should be placed at the mid-developmental ridge for most accurate positioning. Correct axial positioning of brackets parallel to the long axis of the clinical crown is important to express the proper tip built into pre-adjusted brackets.
Andrew’s straight wire appliance /certified fixed orthodontic courses by Indi...Indian dental academy
Welcome to 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 has a unique training program & curriculum that provides students with exceptional clinical skills and enabling them to return to their office with high level confidence and start treating patients
State of the art comprehensive training-Faculty of world wide repute &Very affordable.
Anchorage in beggs technique /certified fixed orthodontic courses by Indian d...Indian dental academy
Welcome to 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 has a unique training program & curriculum that provides students with exceptional clinical skills and enabling them to return to their office with high level confidence and start treating patients
State of the art comprehensive training-Faculty of world wide repute &Very affordable.
The document provides an overview of the Tip-edge bracket system created by Dr. Peter Kesling in 1986. It was designed to allow for differential tooth movement by removing corners from conventional edgewise brackets. This allows the crown to tip into place before final torque and positioning. The system uses light forces and a sequence of 3 stages to align, level and torque teeth into the desired positions. A variety of auxiliaries like sidewinders and power pins are used throughout treatment to control individual tooth movements. The Tip-edge bracket is intended to provide controlled three dimensional tooth positioning with light continuous forces.
Loops in orthodontics /certified fixed orthodontic courses by Indian dental ...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.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
00919248678078
Leveling and aligning is the first stage of comprehensive orthodontic treatment. The goals are to bring teeth into alignment and correct vertical discrepancies. This involves tipping teeth into position through light continuous forces of around 50 grams delivered by round or superelastic nickel titanium wires. Maintaining proper anchorage through devices like lacebacks and bendbacks is important. Special challenges like crossbites, impacted teeth, and spacing issues are addressed. Leveling can be achieved through extrusion of posteriors, intrusion of anteriors, or a combination of movements.
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 document discusses the management of low angle cases (skeletal deep bites). It covers the etiology, which can include hereditary factors and horizontal growth patterns. Clinical features include a short square face, upper teeth hidden behind the lips, and decreased interlabial distance. Diagnostic features include decreased facial angles and a horizontal growth pattern seen on cephalograms. Management options discussed include removable appliances, growth modification, magnets, fixed appliances, implants, lingual appliances, Invisalign, and surgery. Stability and retention are also addressed.
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 document discusses various types of intrusion arches used in orthodontics to correct deep overbites. It begins by defining intrusion and describing the biomechanics and principles involved. It then covers 9 specific intrusion arch designs: 1) Rickett's Utility Arch 2) Tipback Springs 3) Burstone's Continuous Intrusion Arch 4) Burstone's Three Piece Intrusion Arch 5) K-SIR 6) Connecticut Intrusion Arch 7) PG Retraction Spring 8) Translation Arch 9) Lingual Arch for intruding lower incisors. For each type, it provides details on materials, design, and mechanics of intrusion.
Modification of twin block functional applianceMaher Fouda
This document discusses the Twin Block appliance, which was originally developed by Clarke. It remains a widely used functional appliance for treating Class II malocclusions. The Twin Block consists of separate upper and lower acrylic appliances connected by occlusal blocks. It works by forcing the mandible into a protrusive position during jaw closure. The document describes the standard Twin Block design and various modifications that have been made, including the addition of expansion screws, torquing springs, and bite jumping screws to allow for gradual advancement. Advantages include comfort, aesthetics, and improved patient compliance compared to fixed appliances. The Twin Block is effective at correcting Class II malocclusions in a rapid manner.
This document provides an overview of orthodontic treatment mechanics using the McLaughlin, Bennett and Trevisi (MBT) bracket system. It discusses the history and development of the MBT system, variations in appliance specifications including bracket selection and torque specifications. It also covers important aspects of treatment including bracket positioning, arch forms, anchorage control, archwire sequences and finishing the case.
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.
Dr. William Roth
Introduction
The Roth Rx
Reasons For Modification
Treatment Philosophy
Treatment Goals
Roth Rationale
Selection Of Treatment Mechanics
Roth Set-up
Sequencing Of Treatment Objectives
Treatment Mechanics
Anchorage Considerations
Detailing Of Tooth Position
Advantages
Comparisons
Conclusions
The pendulum appliance uses acrylic and springs to deliver continuous force from the palate to the upper molars, producing distal movement without affecting other teeth. It is fabricated with acrylic covering springs that extend to molar bands. Springs are activated in 3-week intervals to monitor distalization over 4 months before stabilizing molars. The appliance effectively treats Class II malocclusions without extractions through distal molar movement.
This document discusses the third and final stage of comprehensive orthodontic treatment called "finishing". It defines finishing as correcting prior errors and detailing the case. The document outlines the goals of finishing which include enhancing aesthetics, individual tooth positioning, occlusion, and stability. It describes the standards used by the American Board of Orthodontics for grading case finishing. The document provides details on techniques for correcting tooth alignment, angulation, rotation, and achieving proper gingival levels and tooth sizes during the finishing stage.
Biomechanics of molar distalization appliance /certified fixed orthodontic c...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
1. The document discusses various methods of conserving anchorage in fixed orthodontic appliances, including Nance buttons, transpalatal arches, lingual arches, and extraoral appliances.
2. Nance buttons provide anchorage by resting on the hard palate and resisting unwanted tooth movement during anterior retraction. Transpalatal arches connect the right and left molars to resist mesial molar migration.
3. Lingual arches in the lower arch function similarly to transpalatal arches in the upper arch. Extraoral appliances derive anchorage from outside the oral cavity, such as from the neck or face, to reinforce anchorage and achieve tooth movement.
This document discusses various methods and appliances for distalizing maxillary molars, including removable and fixed options. Removable appliances discussed include extraoral traction using headgear as well as removable appliances with finger springs or sliding jigs. Fixed appliances discussed include intramaxillary devices like Wilson's 3D appliance as well as intermaxillary appliances like Herbst or Jasper Jumper. Factors like the presence of second molars, skeletal pattern, and growth prognosis must be considered when determining whether molar distalization is indicated.
Proper bracket placement is important for optimal orthodontic treatment outcomes. Brackets should be placed according to the facial axis of the clinical crown and the facial axis point to ensure proper positioning relative to the facial axis of occlusion. The mesiodistal position of brackets varies slightly between tooth types, and should be placed at the mid-developmental ridge for most accurate positioning. Correct axial positioning of brackets parallel to the long axis of the clinical crown is important to express the proper tip built into pre-adjusted brackets.
Andrew’s straight wire appliance /certified fixed orthodontic courses by Indi...Indian dental academy
Welcome to 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 has a unique training program & curriculum that provides students with exceptional clinical skills and enabling them to return to their office with high level confidence and start treating patients
State of the art comprehensive training-Faculty of world wide repute &Very affordable.
This document provides information about extraoral appliances in orthodontics:
- It discusses the history, types, uses, complications, safety considerations, and factors affecting the force of extraoral appliances.
- Extraoral appliances have specific uses in orthodontic biomechanics for anchorage, dental movement, and modifying growth.
- Clinicians should be familiar with the clinical indications, potential problems, and how to avoid problems when using appliances like headgear.
biomechanics of open bite closure by incisor extrusionMaher Fouda
This document discusses various techniques for treating anterior open bites in orthodontics. It begins by noting that while deep bites are commonly treated using intrusion mechanics, open bites have received less attention despite being a common problem. Techniques discussed include incisor extrusion using vertical elastics, extractions to allow incisor eruption/retroclination, and appliances like tongue cribs. Challenges with reliability and patient compliance with vertical elastic use are also addressed. The document provides details on biomechanics, appliances, and cases.
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
Molar distalisation /certified fixed orthodontic courses by Indian dental aca...Indian dental academy
This document discusses current trends in molar distalization. It begins by explaining that orthodontic treatment philosophies now aim to avoid extractions and rely less on patient cooperation, leading to development of various appliances for distalizing maxillary molars. Removable appliances include headgear and finger springs, while fixed appliances include intra- and intermaxillary devices like pendulums, magnets, and coils. Factors like second molar eruption and skeletal patterns influence distalization. A proper diagnosis is needed to determine if distalization is indicated based on growth prognosis and sagittal relationships. Contraindications include high mandibular planes and open bites.
The Twin Block Appliance is a functional orthodontic appliance consisting of upper and lower removable bite blocks used to correct Class II malocclusions by repositioning the mandible forward through inclined occlusal planes which provide proprioceptive stimulus for bone growth; it was developed in the 1980s as an improvement on previous functional appliances and provides numerous orthodontic, dental, skeletal, soft tissue and airway benefits when worn as directed.
This document discusses the diagnosis and treatment of posterior crossbites. It begins by outlining the potential issues caused by untreated crossbites, including compensatory changes, skeletal asymmetries, and soft tissue and dental modifications. It then describes the clinical examination and diagnostic records needed to properly assess a crossbite. This includes studying models, radiographs, and examining for mandibular shifts. The document concludes by detailing various appliance options for treating crossbites, including removable expanders, lip bumpers, and fixed rapid palatal expanders, emphasizing the need for an appropriate diagnosis and treatment plan.
Seminar non extraction class ii by mahadiamahad saad
This document discusses non-extraction treatment for Class II malocclusions. It provides an overview of treatment modalities for distalizing maxillary molars without extractions, including:
- Headgear, which applies cervical traction to retract molars. Early treatment with headgear during transitional dentition can correct Class II relationships.
- Vertical holding appliances, which apply intrusive and distal forces to distalize molars without extractions.
- Transpalatal arches, which can derotate maxillary molars before distal movement with auxiliary springs and cervical headgear.
Careful patient selection and consideration of facial type and remaining growth is important for successful non-extraction treatment. Early treatment and compliance with appliances
This document describes a case study of using titanium screw anchorage to successfully treat a 31-year-old female patient with a severe anterior open bite of 7 mm. Mini screws were implanted in the maxilla and mandible to provide anchorage for intruding the upper and lower first molars by 3 mm each over 19 months of active treatment. This led to a counterclockwise rotation of the mandible which corrected the open bite and improved her retrognathic facial profile. The results suggest titanium screws are useful for intruding molars and treating anterior open bites in adult patients.
This document provides information about molar distalization, including:
- Molar distalization involves moving molars backwards to correct malocclusions.
- Various appliances can be used for molar distalization, including headgear, K-loops, and pendulum appliances.
- Treatment planning for molar distalization generally involves two phases - a space gaining phase followed by a consolidation phase to achieve ideal occlusion.
This document discusses various orthodontic treatment plans and appliances. It begins by discussing treatment planning for different malocclusions like Class I, Class II, deep bite, open bite, crossbite and crowding. It then discusses different types of fixed and removable appliances used in orthodontic treatment like PEA appliance, lingual appliances, functional appliances and orthopedic appliances. The document also discusses considerations for extraction patterns and different anchorage devices and mechanics used for deep bite correction.
Introduction
History
Indications and contraindications
Timing of distalization
Second molar extraction
Mandibular molar distalization
Rickett’s criterion
Classification and various distalization appliances
References
This document summarizes different techniques for molar distalization including headgear, pendulum appliances, distal jet, keles slider, and magnets. Molar distalization is used to treat class II malocclusions by moving the maxillary molars distally. Key points discussed include indications such as tooth-size discrepancies, contraindications like severe protrusion, and factors that influence distalization like eruption of other molars. The document compares techniques and provides details on designs, mechanics, anchorage, and effects of various appliances.
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
Impacted lower and upper 3rd molar lecturememoalawad
This document summarizes the surgical procedures and considerations for extracting impacted third molars. It describes the different types of impactions - mesioangular, vertical, horizontal, and distoangular - and the techniques for removing each, such as sectioning the tooth and removing bone. Potential complications are outlined, including bleeding, swelling, trismus, pain, infection, root fracture, and alveolar osteitis. Methods to prevent and treat complications are provided, such as the use of antibiotics, steroids, irrigation, and dressings. Surgical success depends on factors like impaction depth and the surgeon's experience.
Techniques for anchorage control in lingual orthodonticsParag Deshmukh
various techniques used in lingual orthodontics for anchorage control are described here.. and various cases of lingual orthodontics in which different techniques were used for anchorage control are discussed here..
Lip bumper, quad helix, tongue crib,Tpa,Nance by Dr.Saurav Mishrasaurav mishra
This document discusses the lip bumper, quad helix, and tongue crib appliances. It provides details on the design, indications, and mechanisms of these appliances. The quad helix appliance is described as having anterior and posterior helical loops to provide a wide range of continuous, controlled force during maxillary expansion. Its fan-like sweeping action can buccally expand and distally rotate the maxillary molars. Indications for the quad helix include correcting crossbites through upper arch expansion and mild class II malocclusions requiring upper arch widening and molar rotation. Complications and clinical management are also briefly covered.
This document discusses several orthodontic appliances including the Nance appliance, transpalatal arch, quad helix, lip bumper, and tongue crib. It provides details on the design, indications, mechanisms of action, advantages and disadvantages of each appliance. The document is intended as an educational guide for orthodontic residents, as it is presented by several orthodontists and covers the key aspects of these common fixed functional appliances.
1) Space regainers are appliances used to regain space lost due to drifting of teeth after primary teeth are lost. They can be either fixed or removable.
2) Common causes of space loss include caries of primary molars which allows permanent molars to tip mesially. Space regainers work to distalize permanent molars and correct shifted teeth.
3) Various space regainer designs are discussed, including removable appliances with helical springs and fixed appliances using loop springs, jackscrews, and headgear. The document provides details on indications and mechanics of different space regainer options.
selection of preformed archwires during the alignment stage of preadjusted or...Maher Fouda
This document discusses orthodontic archwire selection during the alignment stage of treatment with preadjusted appliances. It provides details on different types of archwires used for alignment including multi-strand stainless steel, conventional and superelastic nickel-titanium (NiTi), and heat-activated NiTi wires. Superelastic NiTi wires are preferred for alignment due to their low stiffness, high springback, and ability to deliver nearly constant light forces during tooth movement. The document discusses various archwire sequences used during alignment and leveling, noting that there is no set sequence but heat-activated NiTi can replace multiple stainless steel wires to reduce visits and discomfort.
The document discusses orthodontic initial alignment. It defines alignment as moving teeth into their correct positions in relation to the planned dental arch form. Initial alignment uses thin, flexible round archwires to move tooth crowns horizontally into better positions, as root positions are often closer to correct. It describes using progressively thicker archwires as alignment improves. Factors like bypassing severely displaced teeth, using reinforcement sleeves, and avoiding excessive forces are discussed to optimize initial tooth movement.
This document discusses various techniques for orthodontic tooth alignment and leveling. It begins by outlining the stages of the straight wire technique. It then provides details on objectives and techniques for the initial alignment and leveling stage, including:
- Aligning tooth brackets to allow progression to stiffer archwires
- Placing brackets slightly off-center to aid in correcting tooth rotations
- Techniques for aligning high or impacted canine teeth, such as auxiliary wires or springs
- Using archwire sleeves or bypass arches to protect crowded incisors from unwanted movement
- Achieving curve of spee flattening mostly through proclination of mandibular incisors
The document emphasizes using lighter arch
Moment-to-Force Ratios and Controlling RootNew Microsoft PowerPoint Presentat...Maher Fouda
1. Moment-to-force ratios describe the relationship between an applied orthodontic force and the counterbalancing moment, or rotational force, required to control tooth movement.
2. Altering the ratio of the moment of an applied force to the moment generated by a force couple at the bracket allows for different types of tooth movement, from simple tipping to controlled tipping to bodily movement.
3. Achieving the desired tooth movement depends on manipulating these moments such that their ratio results in the desired movement, whether that be tipping, controlled tipping, or translation without rotation.
The document discusses orthodontic bracket prescriptions, including:
1) Early edgewise brackets required wire bends to control tooth movement, while contemporary brackets have built-in prescriptions for in-out, tip, and torque adjustments.
2) Lawrence Andrews introduced the pre-adjusted edgewise appliance with customized brackets programmed for specific tooth control without wire bends.
3) Later prescriptions like Roth and MBT incorporated changes like more torque in upper incisors to compensate for bracket limitations, while individual adaptations are often needed for specific cases.
This document discusses orthodontic controlled space closure using fixed appliances. It describes a case where the maxillary and mandibular first premolars were extracted and all teeth were bonded with pre-adjusted edgewise brackets. Initial alignment took 4 months. Space closure involved retracting the anterior teeth with a continuous tear drop loop activated over months until the extraction space was closed after 9 months. It discusses principles and objectives of space closure, including maintaining the desired occlusal and aesthetic outcomes through controlled tooth movement.
1. Retention is required after active orthodontic tooth movement to allow tissues to remodel and support teeth in their new positions.
2. Several factors can cause relapse, including residual forces in the periodontium and gingiva as they remodel over 3-6 months, forces from muscles and occlusion, and ongoing facial growth.
3. The type of original malocclusion, treatment performed, and a patient's growth pattern inform the appropriate retention plan, which may include removable or fixed retainers worn long-term to stabilize results.
The document discusses bracket variations that can be used to optimize tooth positioning for different malocclusion types. Specifically, it describes how inverting the bracket on an upper lateral incisor that is palatally displaced can provide beneficial labial root torque to help align the crown and root. Inverting the bracket changes the torque prescription from +10 degrees to -10 degrees, facilitating labial movement of the root during treatment. Careful selection and positioning of brackets can simplify treatment of localized anomalies.
Andrew identified 6 keys to normal occlusion based on a study of non-orthodontic models. The 6 keys are:
1. Proper molar relationship between the upper first molar and lower second molar.
2. Positive crown angulation for all teeth.
3. Negative crown inclination for most teeth, except upper front teeth.
4. Teeth should be free from undesirable rotations.
5. Tight contact points between all teeth.
6. An occlusal plane that is relatively flat, rather than a deep or reverse curve of Spee.
When these 6 keys are present, it results in optimal intercuspation and occlusion. Deviations
MBT wire sequence during orthodontic alignment and levelingMaher Fouda
This document discusses different archwire sequences used during tooth leveling and aligning. It begins by describing a case where a non-extraction approach was used with .016 HANT wires for initial alignment. After 3 months, rectangular HANT wires were placed, followed by .019/.025 stainless steel wires after 6 months to help correct the occlusion. The document then provides historical background on archwires and discusses the introduction of nickel-titanium wires as substitutes for steel wires during initial alignment. Heat-activated nickel-titanium wires are described as being able to replace 3 traditional stainless steel wires. Recommendations are provided on when stainless steel wires are still preferable to heat-activated wires.
This document discusses arch form in orthodontic treatment. It notes that while custom archwires were traditionally used, preadjusted appliances assumed one arch form could fit all patients. However, some customization is still needed. The document examines stability of arch form changes after treatment and notes expansion, especially of lower intercanine width, often relapses. It recommends using tapered, square, and ovoid arch forms to balance efficiency and accuracy for individual patients.
Orthodontic alignment phase of pre-adjusted fixed appliance ...Maher Fouda
1. The document discusses the orthodontic alignment phase when using pre-adjusted fixed appliances. It begins by describing how the original edgewise appliance required wire bending to position each tooth, whereas pre-adjusted brackets incorporate each tooth's final position.
2. It then explains how pre-adjusted brackets achieve three-dimensional control of each tooth's position by varying bracket base thickness, slot angulation, and base contour. Various archwire sequences and techniques used during initial alignment are also described.
3. The summary concludes by noting that efficient initial alignment is important for simplifying future treatment and is typically achieved using light nickel-titanium or steel wires until adequate alignment is reached.
Hazards of swallowing orthodontic appliancesMaher Fouda
The document discusses the clinical examination process for orthodontic patients, including assessing risks of foreign body aspiration or ingestion. A thorough examination involves obtaining medical history, conducting extra-oral and intra-oral exams, and taking radiographs. It is important to evaluate predisposing factors that could increase risks, such as medications, medical conditions, or behaviors. Symptoms may vary depending on the location of any foreign objects in the airway, esophagus, or gastrointestinal tract. Proper patient positioning and emergency procedures should be followed to address any potential complications.
This document provides an overview of functional appliances used in orthodontic treatment. It begins with an introduction to functional appliances and their use in guiding natural forces to correct morphological abnormalities. It then covers classifications of functional appliances, how cephalometric analysis is used to assess patients, and descriptions of common appliances like the activator, bionator, and twin-block. The document discusses how functional appliances can correct Class II and III malocclusions by influencing facial growth. In under 3 sentences.
This document discusses deep bite, including its definition, types, etiology, diagnosis, factors, and treatment. A deep bite is defined as excessive vertical overlap of the upper and lower incisors. It can be true, caused by infraocclusion of posterior teeth, or pseudo, with normal posterior eruption. Causes include genetic, acquired, and muscular factors. Diagnosis involves clinical exams, casts, radiographs, and cephalograms. Treatment aims to correct the underlying occlusion and may involve bite planes, fixed appliances, or intrusion/extrusion of teeth to reduce the overbite. Bite ramps are an effective option to help correct a deep bite over time through posterior development.
1. Orthodontic tooth movement occurs through remodeling of the alveolar bone in response to prolonged mechanical forces on teeth. Bone resorbs on the pressure side and forms on the tension side of the periodontal ligament.
2. Physiologic tooth movements include eruption, drift, and minor movements during mastication. Eruption occurs through growth of the root and forces from the periodontal ligament.
3. When forces are within physiologic limits, tooth movement occurs through frontal resorption on the pressure side and bone formation on the tension side. Excessive forces cause hyalinization and undermining resorption.
This document discusses the classification, etiology, clinical features, and assessment of Class II malocclusions. It describes two main types of Class II malocclusions - Division 1 where the upper anteriors are proclined, and Division 2 where the upper anteriors are retroclined. Class II Division 1 is often due to a skeletal Class II pattern or habits that procline the upper incisors. Class II Division 2 can be associated with a mild skeletal Class II or reduced lower facial height. A thorough assessment of skeletal patterns, soft tissues, dental factors, growth potential, and likelihood of stability is needed to determine the appropriate treatment approach.
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2. Introduction
Treatment of Class II malocclusions frequently
requires distalization of maxillary molars into a Class
I relationship. A variety of treatment modalities
have been suggested, including those that are
heavily dependent on patient compliance such as
extraoral traction, removable appliances with finger
springs,Wilson arches, and sliding jigs with Class II
intermaxillary elastics) The techniques that rely
less on patient cooperation include repelling
magnets, transpalatal arches, compressed coil
springs, and the Herbst appliance.
American Journal of Orthodontics and Dentofacial Orthopedics December 1996
3. Gaining space in the mandible is more difficult
than in the maxilla. Extraoral appliances are
seldom attached to the mandibular molars
because of the pressure they place on the
condyles. The most commonly used intraoral
appliances are lip bumpers, lingual arches, and
removable appliances with screws or springs
(which depend on patient compliance for their
success ).
JCO/SEPTEMBER 2000
4. Other than the third molars and maxillary
canines, the mandibular second premolars have
the highest percentage of impaction. One of the
major causes is early extraction of the deciduous
predecessor, which can cause a mesial drift and
tilt of the molars that impedes the eruption of
the second premolar.
5. Placing an open-coil spring on the archwire
between the first molar and the first premolar is
the technique most commonly used to move the
migrated molars back to their original positions
and create enough space for the impacted tooth to
erupt. To prevent a reactive mesial drift of the
anterior teeth, however, the upper arch must be
anchored with a headgear and intermaxillary
Class III elastics.
6. Third molar angulation during and
after treatment in relation to
Impaction
It is suggested that premolar extraction therapy
has a favourable effect on maxillary third molar
angulation, while changes in mandibular third molar
angulation during treatment may be similar in
patients treated with and without premolar
extractions. The findings also indicate that distal
tipping of the maxillary third molars during active
treatment, more than 30 degrees of distal
angulation, and any mesial angulation relative to the
occlusal plane at the end of treatment, are risk
factors for subsequent impaction
European Journal of Orthodontics 27 (2005) 590–596
7. • In addition, mandibular third molars
angulated more than 40 degrees mesially
relative to the occlusal plane at the end of
treatment may be at increased risk of
impaction. Changes in third molar angulation
from one direction to another may be
common in both arches during the fi nal
stages of root development, and less than 50
per cent of erupted third molars assume an
ideal angulation in the dental arch.
European Journal of Orthodontics 27 (2005) 590–596
8. THIRD MOLARS Extraction
Third molars that have erupted or are close to
erupting tend to impede the distal movement of the
first and second molars. For this reason, they are
removed when possible. However, the decision to
extract these teeth has important strategy implications.
If third molars are removed, molar distal movement to
gain the space to resolve the malocclusion is virtually
mandatory because maxillary premolar extraction is no
longer tenable as it would involve extracting four teeth
in the same arch.
Gianelly -American Journal of Orthodontics and Dentofacial Orthopedics July 1998
9. After third molars have been extracted and
progress is inadequate when moving both first and
second molars posteriorly at the same time, the
procedure is changed and the molars are moved in
sequential manner as described; second molar
distal movement is followed by first molar distal
movement. The gain in safety compensates for the
increased time necessary to complete molar distal
movement.
Gianelly -American Journal of Orthodontics and Dentofacial Orthopedics July 1998
11. Using Removable Appliances
• RESISTANCE TO TOOTH MOVEMENT
(ANCHORAGE), 2
Distal movement of a buccal segment
Following extraction of an upper second molar
the first molar and both premolars of that side
may be moved distally, three teeth moving
against an anchorage of nine teeth. The labially
displaced canine is not included in either part
of the appliance.
12. An Atlas of Removable Orthodontic Appliances Second edition GORDON C. DICKSON &ALBERT E. WHEATLY
13. DIST AL MOVEMENT OF BUCCAL
SEGMENT (SCHWARZ)
Distal movement of an upper buccal segment after
extraction of the second molar can be accomplished
by means of the appliance illustrated. A hard metal
screw is placed with its long axis parallel to the line
of the segment to be moved and to the occlusal
plane. A short, steep inclined plane is incorporated
to assist anchorage by applying some forward
pressure to the lower incisors (Inset). A spur or half-
clasp on the left lateral incisor prevents this tooth
drifting distally.
An Atlas of Removable Orthodontic Appliances Second edition GORDON C. DICKSON &ALBERT E. WHEATLY
14. Rate of activation
The screw is turned at the rate of one quarter-turn per week.
Construction
Screw: Hard metal (stainless steel) with guide pin
Spur:O.6mm stainless steel wire
Retention: Adams clasps on 64/46
Baseplate: Full palate with anterior inclined plane, divided by
two cuts, one across the screw and the other exactly
parallel with the buccal segment to be moved and with the
long axis of the screw
An Atlas of Removable Orthodontic Appliances Second edition GORDON C. DICKSON &ALBERT E. WHEATLY
15. An Atlas of Removable Orthodontic Appliances Second edition GORDON C. DICKSON &ALBERT E. WHEATLY
16. Cetlin appliance
Distalization Treatment:
Several different treatment modalities may be employed
to distalize the posterior dentition. Possibilities include
removable appliances such as a modified Cetlin appliance.
This type of appliance has a high acceptance among adult
patients because it facilitates good oral hygiene and allows
adaptation to lingual appliance during the initial phase. The
removable Cetlin appliance is constructed from 2 Adams
clasps on the first premolars, distalizing springs on the
second premolars and on the first molars, distalizing screws
between the first and second premolars, and an anterior
bite plane. The appliance does not include any metal clasps
from cuspid to cuspid due to esthetic consideration.
18. Acrylic cervical occipital (ACCO)
This appliance consists of an acrylic palatal
section (1 mm bite plate) to disclude the
posterior teeth, modified Adams clasps on the
first premolars, a labial bow across the incisors
for retention, finger springs against the mesial
aspects of the first molars for molar distalization
in association with an extraoral traction . With
the combined use of ACCO and headgear, molars
can be moved distally in a more bodily fashion.
The finger springs move the crowns, and the
headgear moves the roots .
Sfondrini et al. Upper molar distalization Orthod Craniofacial Res 5, 2002/114–126
19. Acrylic cervical occipital (ACCO)
Sfondrini et al. Upper molar distalization Orthod Craniofacial Res 5, 2002/114–126
20. A Removable Class II Appliance
for Simultaneous Distalization
and Expansion
Treatment of a case of Class II malocclusion
with maxillary arch constriction and anterior
crowding generally involves expanding the arch,
distalizing the molars, and aligning the anterior
teeth.This article introduces a removable
appliance that can simultaneously correct a
Vshaped upper archform and move the upper
molars distally.
JCO/OCTOBER 2005
21. Removable appliance for simultaneous molar
distalization and maxillary expansion.
JCO/OCTOBER 2005
22. The acrylic plate of the appliance is fabricated with
occlusal coverage to maintain anchorage, prevent
occlusal interferences, and control the vertical
dimension and molar tipping. Mechanical retention is
provided by Adams clasps on the first molars and
finger springs on the premolars. A Bertoni multiple-
sector palatal screw is embedded in the acrylic at the
level of the contact points of the first molars and
second premolars, bisecting the midpalatal raphe.
Placing the screw in this position and sectioning the
acrylic plate into three parts makes it possible to
simultaneously move the molars distally and expand
the anterior archform.
JCO/OCTOBER 2005
23. For distalization, the screw is activated in a
sagittal direction once a day during the first two
weeks. For expansion, a transverse activation is
begun in the second week with a quarter-rotation
per day. In the third week, both activations should
be reduced to every other day until the molars
have reached a Class I relationship and sufficient
expansion has been achieved. The appliance
should then be left in place for passive retention,
of about half the duration of the expansion.
JCO/OCTOBER 2005
24. 13-year-old male Class II patient with retruded upper lateral incisors and canines in
supraversion before treatment.
Patient after 24 months of treatment with removable and fixed appliances.
27. A. Beginning of treatment with unilateral
molar distalization splint. B. After three
months of treatment. C. Distal movement
achieved in three months.
28. Using Extra-oral Traction
The use of headgear for the distal movement of
maxillary molar teeth has probably been the most
frequently used adjunct to fixed appliance
therapy over the last fifty years. Headgear was
originally described by pioneers such as Farrar,
Goddard and Kingsley and further modified by
Angle in 1888. The use of cervical headgear
increased in the1950s following the work of Kloehn.
It is still widely used today, however, there is a
perception that when possible, clinicians today
may be seeking and using other alternative options.
29. Dental Effect
Headgear being a tooth-borne appliance, produces
certain dental effects along with a skeletal change.
Headgears usually cause distalization of the maxillary
molars. Along with this, extrusion or intrusion of the
molar may also be seen if the extraoral attachment is
cervical or Occipital respectively. In most skeletal Class
II problems a cervical headgear is not desired as the
extrusion of the maxillary molar caused by the
inferiorly directed force which causes downward and
backward mandibular rotation, thus worsening the
problem.
30. (A) Standard face bow, (B) Loop style face bow, (C) Loop style, short outer bow
(A)
(B)
(C)
31. Distal movement of buccal segments with
the "en masse" removable appliance
upper removable appliances to which an Interlandi
headgear was attached through a face-bow . At the
first visit the removable appliance only was fitted with
instructions for it to be worn full time, including
meals. Not until this had been achieved was the
headgear added. The short outer bow was angled
slightly upward to permit application of the extraoral
force through the center of resistance of the first
molar to minimize tipping of the dentition. A force of
200 to 300 gm per side was applied, and the children
were requested to wear their headgear every night
and for a few hours in the evening as well. A diary was
to be kept so that the clinician could check on
progress. American Journal of Orthodontics and Dentofacial Orthopedics Orlon et aL 243 Volume 109, No, 3
32. Interlandi headgear with safety cord. Relatively short outer bow runs parallel to occlusal
plane and direction of force follows this line. B, Close-up of nylon safety cord and deepened
slots in C-piece of Interlandi headgear. Cord is tailored individually for each patient and the knot
is tucked away on inner side of C-piece. C, Close-up of terminal portion of face-bow and molar
buccal tube. Bow is stopped with Z-shaped vertical bend, fabricated in vertical plane. Terminal 3
mm of bow have been crimped slightly to help prevent accidental dislodging of face-bow.
33. American Journal of Orthodontics and Dentofacial Orthopedics Orlon et aL 243 Volume 109, No, 3
34. A, Most standard en masse upper removable appliance design: Adams clasps on upper first
molars and first premolars with headgear tubes taped and soldered to bridges of molar clasps.
L-shaped rests are contoured to lie in palatal and mesioocclusal fissures of upper first molars.
Midline screw provides requisite expansion and baseplate is saddled and finished in heat cured
acrylic. B,Appliance with double clasps on upper left and right first molars and second
premolars and headgear tubes on molar portion only of double clasps. T-shaped occlusal rests,
emerging from acrylic distal to upper second premolars, are provided by modified cross clasps.
Acrylic-trimmed palatal to upper first premolars prevents these teeth from being expanded. C,
Appliance with double clasps on upper right and left first and second premolars and headgear
tubes opposite upper second premolars. T-shaped occlusal rests are used. Distopalatally 0.028-
inch self-supporting springs engage upper right and left first and second molars to move these
teeth buccally. D, Appliance clasped on upper canines and first molars. Occlusal rests engage in
distal fossae of first molars and do not extend over oblique ridge. clasps, 0.032 inch (0.8 mm); all
double clasps, 0.032 inch
35. American Journal of Orthodontics and Dentofacial Orthopedics Orlon et aL 243 Volume 109, No, 3
36. A,En masse upper removable appliance with acrylic
extended forward and built up into flat anterior biteplane.
(See tooth indentations.) Acrylic, trimmed to even curve, has
allowed spontaneous alignment of upper right central incisor
and left canine. B, Occlusal view of upper arch showing buccal
exclusion of upper canines, C, Same patient as in B after
buccal segment retraction. Recurved palatal wire is adjusted
to move upper lateral incisors labially and then maintain
upper incisor position. Marked spontaneous alignment of
upper canines is seen. Wire must be adjusted away from
upper right canine for further improvement to occur.
37. American Journal of Orthodontics and Dentofacial Orthopedics Orlon et aL 243 Volume 109, No, 3
38. A, En masse appliance to encourage closure of anterior open bite.
Acrylic covers occlusal surfaces of all buccal segment teeth. Standard
clasping but "flying" EOT tubes are processed into acrylic. This
headgear tube position facilitates buccal segment intrusion. Upper
and lower incisors are free to erupt, but lower posteriors are
inhibited, encouraging upward and forward hinging of mandible and
closure of open bite. B, High-pull headgear attached to short outer
bow to apply intrusive mechanics described in AY C, Standard design
en masse appliance with self-supporting 0.028-inch wire spurs
engaging mesial to upper right lateral and upper left central incisors.
As screw is opened, these teeth are moved laterally. D, Appliance
shown in C after 3.5 months of expansion. Upper labial segment
crowding is alleviated, with sufficient space for upper right central
incisor, which already shows some spontaneous alignment (cf, C).
39. The en masse removable appliance,
modified according to individual patient
requirements and with a detachable face-bow,
is an effective method of distalizing the buccal
segments.
American Journal of Orthodontics and Dentofacial Orthopedics Orlon et aL 243 Volume 109, No, 3
40. The molar distalizing bow (MDB)
The molar distalizing bow (MDB) guarantees
controlled distal movement of the molars. It is
easy to handle, can be removed at any time and
can be worn almost full time. Since there is no
extra-oral force, there are no unphysiological
effects on the cervical spine and neck muscles or
on the molars to be moved. Furthermore, there
is no risk of injury by wearing the appliance.
Modifications of the basic appliance broaden the
range of applications.
N. JECKEL AND T. RAKOSI European Journal of Orthodontics 13(1991)41-46
41. Shape and function of the MDB
The appliance consists of an 0.8-1.5-mm thick
thermoplastic splint extending into the buccal
sulcus (Fig. 1). The distalizing bow fits into the
anterior slot (Fig. 1). The ends of the bow fit to
conventional headgear tubes on the molars to be
distalized (Fig. 1). The force can be generated either
by coil springs around the bow or by loops within
the bow itself (Fig. 2a). The amount of distal
movement can be regulated with adjust- able stops
(Fig. 2a). In its inactive state the central section of
the MDB lies approximately 2 mm in front of and
1.5 mm above the anterior slot (Fig. 2b).
42. To activate the appliance the central section of
the bow must be fitted in the anterior slot by
manual pressure against the elastic resistance of
the springs or loops so that the force generated
Is transmitted to the molar tubes. The molar
tubes must be in the same plane as the anterior
slot or just above it.
43. (a) Spring—elastic distalizing
elements: pressure spring
around the bow (top): and
double-looped bow (bottom)
with adjustable stops, (b) The
narrow middle section of the
passive bow is approximately
2.0 mm in front of and 1.5 mm
above the anterior-vestibular
groove anchorage.
44. Lateral view of simultaneous molar distalization with the MDB in
maxilla and mandible
45. Plaster model with border between attached and buccal mucosa drawn in to define the
limb of the splint. The splint completely covers the hard palate.
46. Springs and Wires
Perhaps the simplest, cheapest, and oldest of
these devices is the compressed-coil spring.
Gianelly and colleagues recommended placing
nickel titanium coil springs on .016" × .022"
stainless steel sectional wires from first
premolar to first molar. When compressed, each
coil produces approximately 100g of force to
move the molar distally along the wire.
47. Ni–Ti coil springs
• Gianelly et al. have developed another distalization
system consisting of 100 g Ni–Ti superelastic coil
springs placed on a passive 0.016” · 0.022” wire
between first molar and first premolar. In addition, a
Nance-type appliance is cemented onto the first
premolars. To enhance anchorage further, an 0.018”
uprighting spring is placed in the vertical slot of the
premolar bracket, directing the crown distally ,and
Class II elastics are used. Because the line of force
action lies occlusally and buccally in respect to the
centre of resistance of the molar, we would expect the
molar to be distally tipped and rotated. These side-
effects have been confirmed by Pieringer et al, who
reported a distal-crown tipping of maxillary molars
and a buccal tipping of the maxillary incisors in all the
patients treated with such appliance.
Orthod Craniofacial Res 5, 2002/114–126
58. Wilson bimetric distalizing arch (BDA)
system
It consists of a buccal upper arch with an open
coil spring pushing against the first molar bands.
Patient co-operation with Class II intermaxillary
elastics is required to prevent advancement of the
maxillary incisors. Anchorage in the lower arch is
reinforced by means of a 3-D lower lingual arch
contacting the cingulae of the incisors and
attached to the lingual of the mandibular first
molars. If maximum anchorage is required, a full
fixed appliance can be bonded on the lower arch.
Sfondrini et al. Upper molar distalization Orthod Craniofacial Res 5, 2002/114–126
59. Wilson Bimetric Distalizing Arch and lower full-fixed bonded appliance.
Sfondrini et al. Upper molar distalization Orthod Craniofacial Res 5, 2002/114–126
60. Pendulum
It consists of a Nance button that incorporates four
occlusal rests that are bonded either to the deciduous
molars or to the first and second bicuspids. An alternative
method is to solder retaining wires to bands on
the maxillary first bicuspids. Two TMA 0.032” springs
inserted into an 0.036” lingual sheath on the maxillary
molar bands are used as active elements for molar
distalization. The springs are mounted as close to the
centre and distal edge of the button as possible to
produce a broad, swinging arc (or pendulum) of force
62. Each spring consists of a closed helix, an
omegashaped adjustable horizontal loop for molar
expansion and prevention of the cross-bite following
the palatal movement of the molar . The force is
applied occlusally in respect to the centre of resistance
of the molar. Therefore, the molars are not distalized in
a bodily fashion, but distal tipping is expected. If
expansion of the maxillary arch is indicated, then a
midline screw is added to the appliance (Pend-X). An
alternative is a fixed rapid palatal expander that
incorporates the rotation and distalization components
of the Pendulum appliance
63. Distal-Jet
Carano and Testa described the design and use of this appliance.
Bilateral tubes of 0.036” internal diameter are attached to an
acrylic Nance button. A Ni–Ti coil spring and a screw clamp are slid
over each tube. The wire from the acrylic ends in a bayonet bend
and inserts into a palatal sheath on the molar band. An anchor
wire from the Nance button is soldered to the bands on the first or
second premolars. The Distal-Jet is reactivated by sliding the clamp
closer to the first molar once a month. The force acts close to the
centre of resistance of the molars , thus, we would expect less
molar tipping and a better bodily movement compared with other
intraoral distalizing devices. The force, however, is applied
palatally. Therefore, the rotational control of the molars during
distalization is quite difficult and, once distalized, the mesial
rotation is a common finding.
66. First class
It consists of vestibular and palatal components.
Screws are soldered on the buccal sides of the first
molar bands, occlusal to the single tubes. Split rings
welded to the second premolar bands control the
vestibular screws. In the palatal aspect the appliance is
much like a modified Nance button, but it is wider and
has a butterfly shape for added stability and support.
Ni–Ti coil springs are fully compressed between the
bicuspid joints and the tubes on the first molars.
67. FCA
After completion of molar distalization,
applianceis transformed into modified Nance
holding arch
69. The Greenfield Lingual Distalizer
• The Greenfield Molar Distalizer (GMD),
introduced in March 1995,1 is a fixed appliance
with buccal and lingual pistons on each side .
Placing the pistons at the gingival level reduces
the distance of the applied force from the
center of resistance of the molar , minimizing
the crown-tipping moments that are seen with
other distalizers. Thus, the GMD produces
bodily molar movement with almost no tipping
JCO/SEPTEMBER 2005
70. Original Greenfield Molar Distalizer
(GMD),
with parallel buccal and lingual pistons
banded to first premolars and first
permanent molars.
2Pistons placed at gingival level to avoid
crown-tipping moments.
JCO/SEPTEMBER 2005
71. A. 2mm split-ring stops placed every eight weeks for reactivation. B. Stop held with
contra-angle optical plier. C. Stop squeezed over mesial end of piston. D. Compression
of superelastic nickel titanium opencoil spring, producing activation of about 50g.
72. A. New Greenfield Lingual Distalizer (GLD), with Twin Piston Modules on lingual
side only. B. Occlusal piston is at gingival level, as in original GMD, but palatal
piston is at least 5mm deeper in palatal vault.
Components of Twin Piston Module: .030"
stainless steel wire assembly and .036" sleeve,
each with .045" stainless steel extension;
superelastic nickel titanium open-coil springs
with .055“ internal diameter.
73. Magnet Force System ™
This molar distalizer ties into the molar bracket
and bicuspid brackets to generate force. The
polarity of the magnets is reversed so they push
against each other with enough force to move
molars distally.
Using Repelling Magnets
74. Nickel-titanium Coil Springs and Repelling
Magnets: a Comparison of Two Different
Intra-oral Molar Distalization Techniques
75. Appliance design:
A modified Nance appliance soldered to the upper first
premolars was used, as described by Gianelly et al. (1988).
With this design, it was possible to observe any movement
of the second premolars. Prefabricated magnetic devices
(Medical Magnetics, Inc., Ramsey, N.J U.S.A.) were used on
the upper right quadrant These produced 225 g of
repelling force, when the magnets were in tight contact .
Nickel-titanium (Ortho. Organizer Inc. U.S.A.) open coil
springs size 0·014x 0·037-inch, were used on the left only.
In order to select the appropriate length of coil spring to
produce 225 g of force in each case, an intraoral gauge
was used. Coil springs were used (Ortho Organizer Inc.
U.S.A.) only on the right side of the patients .
76. For the activation procedure, the repelling surfaces of
the magnets were brought into contact by passing an
0·014 ligature wire through the loop on the auxiliary
wire then tying back a washer anterior to the magnets
(Fig. 1). Magnets were re-activated every week as
recommended by Gianelly et al. (1989) in order to
standardize the force level. Coil springs were activated
every month by adding a piece of a tubing (of equal
length to the amount of molar distalization) onto the
archwire at the end of the spring.
77.
78. Frontal clinical view of midline discrepancy when magnet therapy began.
Right and left lateral views with repelling magnets in position.
American Journal of Orthodontics and Dentofacial Orthopedics November 1995
79. A and B, Upper and lower occlusal views 7 weeks after magnet distalization. Maxillary Nance now retains
distalized left molars and distal retraction of left second premolar was started. Lingual arch wire in
mandible will be extended distally to retain distalized lower right molar. Lower right magnets are still in
position. C, Anterior view, showing upper and lower midline correction, with Class II elastics on left and
Class Ill elastics on right.
80. Bondemark et al. , comparing repelling magnets
vs. superelastic Ni–Ti coil springs in the distalization
of maxillary molars, found, after 6 months of
treatment, that superelastic coils were more
ef?cient than repelling magnets. This can be
explained by the differential decrease of force in
the two systems. The open coils produce a more
constant force, while the magnet forces drop rather
quickly with increased distance between the poles
as a result of physical properties. These results
were confirmed by the work of Erverdi et al.
Orthod Craniofacial Res 5, 2002/114–126
81. (a,b) Biomechanical force system produced by repelling magnets -sagittal and occlusal view .
Orthod Craniofacial Res 5, 2002/114–126
82. Jones Jig
The Jones Jig is an open Ni–Ti coil spring
delivering 70–75 g of force, over a compression
range of 1–5 mm, to the molars (39). A modified
Nance appliance is attached to the upper first
or second premolars, or the second deciduous
molars. Because the line of force action lies
occlusally and buccally in respect to the centre
of resistance of the molar , we would expect
the molars to be distally tipped and rotated,
whereas the premolars to be mesially tipped.
The reports of other authors have
corroborated these side-effects
85. (a,b) Biomechanical force system produced by the Jones Jig –sagittal (a)
and occlusal view (b).
Jones Jig
86. The Lokar Distalizer
Dr. Bob Lokar designed an appliance with
one thing in mind – simplicity. His Distalizer
works with any common labial fixed
appliance; and it works very well for mixed
dentition cases. The Lokar Distalizer is tied
easily into position with ligature wire. It is
similar in functionality to other labial or
lingual non-compliant distalizing systems,
however the Lokar Distalizer is encompassed
in one convenient, streamlined unit
87.
88. Details for use
In using the Lokar Distalizing Appliance, 1st molars are
usually banded, but they can also be bonded. Banding
molars allows for the use of an EZ lingual arch to control
the molars during distalization (ie: expansion, rotation and
translation).
ANCHORAGE: If used with full fixed appliances, a
banded or bonded Nance can be used from the 2nd
molars. In the case of mixed dentition a bonded Nance is
recommended. If full fixed appliances are used, another
anchorage option is to ligate a full-size wire from 2nd
bicuspid to 2nd bicuspid. Dr. Lokar prefers to bond the
entire lower arch, as well as ligate a full size wire and
instruct the patient to use class II elastics.
89. The Sliding Jig
It is more efficient to direct the distal force
generated by a Class III elastic directly against
the molar tooth using a sliding jig. This
auxiliary may be used either on the first or
second molar tooth.
ORTHODONTIC PEARLS 2004
90. The auxiliary should be constructed using a
relatively stiff wire, such as 0.457x0.635 mm
(0.018x0.025 inch) or round 0.508 mm (0.020
inch). The design will vary depending on the
molar buccal attachment.
91. Banded or bonded single buccal tube/
edgewise bracket
In cases where the buccal tube is less than
0.914 mm (0.036 inch) in diameter or where an
edgewise bracket is being used instead of a
buccal tube.
ORTHODONTIC PEARLS 2004
92. Construction (Figure a b)
• Bend an eyelet with a vertical post approximately 3 mm (0.12 inch) in
height.
• Bend the horizontal arm at right angles to the plane of the eyelet.
• Place the eyelet hard up against the mesial of the molar tube or
bracket with the horizontal arm extending mesially.
• Mark the horizontal arm at least 3 mm (0.12inch) mesial to the canine
bracket or as close to the distal of the lateral bracket as possible,
remove from the mouth.
• At this point, bend the wire up at right angles to the horizontal
section in the same direction (gingival) and plane as the vertical post of
the eyelet.
• At a height of 3 mm (0.12 inch) bend the wire (towards the dental
arch as opposed to the cheek) a full 180° to create a U-loop in the
same plane as the eyelet with the long arm now extending incisally.
• Measure approximately 4 mm (0.16 inch) on this descending arm
then bend a mesially facing hook.
ORTHODONTIC PEARLS 2004
93.
94. Placement
• Slip the distal end of the main archwire out of the buccal tube.
• Thread the distal end of the archwire through the eyelet of the sliding jig.
• Replace the distal end of the archwire into the buccal tube.
• From the gingival, slip the anterior hook of the sliding jig over the archwire
in an incisal direction. In a few cases it may be necessary to
temporarily untie the lateral and canine brackets for this procedure.
• Once the anterior hook is in place, use a Howe or Weingart pliers to
squeeze closed the gingival U-loop. This should prevent the hook from
slipping up gingivally.
• The patient should now be able to attach a Class II elastic to the incisally
and anteriorly facing hook.
• Check that the hook does not impinge on the cheek or gingiva.
ORTHODONTIC PEARLS 2004
95. Banded or bonded double and/or
triple buccal tubes
Construction
• Bend a 3 mm (0.12 inch) vertical offset in an occlusal
direction.
• Place the distal end into one of the tubes not
holding the main arch.
• Slide the vertical offset up against the mesial of
the buccal tube.
• Mark and construct the anterior section as
described above.
ORTHODONTIC PEARLS 2004
96.
97. Placement
With this design it is not necessary to disengage the
distal end of the main arch.
• Slide the distal end of the auxiliary into the free buccal
tube.
• Slip the anterior section into place as described
above.
• Make sure the distal extension of the jig is long
enough to prevent the jig from sliding out of the molar
tube.
ORTHODONTIC PEARLS 2004
98. Banded or bonded single round buccal
tube
The internal diameter of the buccal tube
is 0.914 mm (0.036 inch) or greater. The
design and fitting is the same as for the
double buccal tube (Figure 2). However, the
sliding jig wire size must not be greater
than 0.508 mm (0.020 inch) in order to fit
into the tube together with a 0.406 mm
(0.016 inch) main archwire. The combined
size of the sliding jig and the main archwire
cannot exceed 0.914 mm (0.036 inch).
99. Banded or bonded buccal tube with a
vertical slot
Construction
• The wire size of the jig must match the size of
the vertical slot of 0.457 mm (0.018 inch).
• Bend a 3 mm (0.12 inch) vertical post at right
angles to the main section.
• Slip the post into the vertical slot.
• Mark and construct the anterior section as
described above.
ORTHODONTIC PEARLS 2004
100.
101. Placement
If the gingival margin of the band or tube is hard up
against the gingival soft tissues or if there is gingival
in?ammation or hypertrophy, this design is unsuitable.
However, provided there is adequate space
between the gingival edge of the buccal tube and the
soft tissue gingival margin, then from the occlusal
aspect insert the vertical post of the sliding jig into
the vertical slot of the buccal tube.
• With a ‘bird beak’ pliers grip the end of the post
protruding through the vertical slot of the buccal and
bend it horizontally.
• Slip the anterior section into place as described
above.
102. Advantages of the sliding jig
• It can be easily constructed at the chair-side.
• It can be added to the current fixed appliance
without having to remove or modify any
component of the existing appliance.
Disadvantage of the sliding jig
• It requires the use of Class II elastics,which
are in turn, dependent on patient compliance
and anchorage considerations.
ORTHODONTIC PEARLS 2004
103. K-Loop Molar Distalizing Appliance ™
Developed in Consultation with Dr . Varun Kalra
Used to distalize molars in a more bodily fashion as
the special V-bend in the K-Loop moves both the
crown and root distally. Made of CNA Beta III
Titanium, the K-Loop produces gentle continuous
forces for efficient and effective tooth movement.
104. Activation:
Step 1: Insert K-Loop into first molar tube and first
premolar bracket. Place a mark just mesial to the
molar tube and distal to the premolar bracket.
Step 2: Place 2.0mm high step bend 2.0mm distal to
the molar mark and 2.0mm mesial to the premolar
mark.
Step 3: Insert K-Loop in place and ligate into premolar
bracket. Place a cinch back bend mesial to the
premolar bracket as shown.
107. A-The Herbst Appliance
The Herbst appliance, developed more than a
century ago, was designed to “jump the bite” of
Class II patients. Reintroduced by Pancherz in the
late 1970s, the modern Herbst appliance
incorporated thick bands on the maxillary first
molars, connected to bands on the mandibular
first premolars by a rigid plunger-in-tube system
that forced the lower jaw into a forward position
during closure. Subsequent banded designs have
incorporated bands on the lower first molars as
well.
JCO/JANUARY 2008 Berkman, Haerian, and McNamara
110. in the maxillary posterior segments. The upper
molars may be distalized as much as 5-6mm if the
maxillary molars are connected directly and solely
to the Herbst without any intra-arch consolidation,
as would occur with a rapid palatal expander
or full edgewise appliances. When the appliance is
used during comprehensive edgewise orthodontic
treatment, maxillary molar movement generally is
much less, in the range of 1-3mm.
JCO/JANUARY 2008 Berkman, Haerian, and McNamara
111. Pushing forces exerted by Herbst telescoping mechanism
JCO/JANUARY 2008 Berkman, Haerian, and McNamara
112. B-The Jasper Jumper and
Related Appliances
In 1987, J.J. Jasper developed and patented the
Jasper Jumper , which featured a stainless steel
compression spring housed in a polyurethane
sheath.33 The Jasper Jumper was viewed by the
inventor as a modification of the Herbst “bite-
jumping” mechanism that would permit greater
freedom of mandibular movement . The
compression module, which is available in multiple
lengths, may be anchored to the main archwire,
attached directly to teeth, or connected with various
jig modifications
114. The Jasper Jumper is flexible, and in fact
obtains its force-generating potential from its
flexibility. Because the appliance bends, it is
activated when the patient’s mandible is
elevated from an open position. This activation,
a build-up of internal stress, is released
continuously during periods of mandibular
closure or near-closure.The appliance is
designed to deliver approximately 60-250g of
force
116. Cope et al. described the orthopaedic and
orthodontic changes associated with the Jasper
Jumper therapy. They showed that the majority
of action was the result of dental, rather than
skeletal change, although the maxilla underwent
significant posterior displacement and the
mandible backward rotation. The maxillary
molars underwent significant distal tipping and
relative intrusion, of greater magnitude than
found with the Herbst. The mandibular incisors
underwent significant uncontrolled buccal tipping
and intrusion.
Orthod Craniofacial Res 5, 2002/114–126
117. The Forsus Spring and Forsus Fatigue
Resistant Device (FRD), The Adjustable Bite
Corrector, The Eureka Spring, SUS ; appliances
that are conceptually similar to the Jasper
Jumper but hardier.
Forsus Fatigue Resistant Device
118. C-Mandibular Anterior
Repositioning Appliance
Another increasingly popular appliance for
correction of Class II malocclusion is the
Mandibular Anterior Repositioning Appliance
(MARA), a fixed device fabricated on stainless steel
crowns that commonly are placed over the
maxillary and mandibular first permanent molars .
Reintroduced in its present form in 1991 by Drs.
Douglas Toll (Germany) and James Eckhart (United
States), it is indicated for use throughout the late
mixed dentition and into adulthood.
119. The MARA’s extension arms prevent the patient
from closing in a natural Class II relationship,
requiring mandibular hyperpropulsion to achieve
intercuspation. The MARA is classified as a
functional appliance in part because it causes
forward repositioning of the lower jaw for the
duration of its use.
Mandibular Anterior Repositioning Appli ance
120. S
The MARA has been reported to have effects
generally similar to those of the Herbst
appliance, with a few exceptions. Whereas
maxillary molar intrusion is a characteristic
feature of the Herbst,this finding has not been
reported with the MARA.the dental changes
are due mainly to maxillary molar distalization,
which accounts for about 77% of the total
dental correction, with the remaining 23% due
to mesial mandibular molar movement.
123. The most prevalent device used to distalize
lower molars was the lip bumper. Next most
popular were compressed nickel titanium coil
springs, which were usually used in conjunction
with some mechanism to control flaring of the
anterior teeth.To a much lesser extent, were tip-
back auxiliary springs, miniscrews, and Class III
elastics. Lower second molars were sometimes
extracted prior to distalization of the lower first
molars.
JOHN J. SHERIDAN 2007 JCO VOLUME XLI NUMBER 8
124. Removable appliances
Sagittal Appliance
This is a removable appliance with a screw
incorporated for the distalization of the first
permanent molars (Fig.). The anchorage is gained
by the remaining teeth anterior to the first
permanent molars. Retention clasps are used to
hold the appliance in place. The activation of the
screw causes the molars to be pushed distally.
126. Sagittal Appliance
The intraoral appliances take anchorage from
the palate and the anteriorly placed premolars.
By pitting more root surface area and/ or the
rugae region of the palate these appliances are
able to minimize the proclining effect of the
reciprocal forces generated while distalizing the
molars. Here also the efficiency of the
appliances is more before the eruption of the
second permanent molars.
127. Headgear Therapy to Distalize Molars
Four molar bands are placed, the upper molars
receive the KGR, and the lower molars via .045
buccal tubes provide attachment for an .022“arch
wire supporting sliding hooks via open coil springs.
The arch is ligated to the incisors and stopped at
the canine area. The coil springs are activated
periodically by extending them. ClassIII elastics are
worn only when the headgear is worn.
Andrew J. Haas Semin Orthod 2000;6: 79-90.)
128. Andrew J. Haas Semin Orthod 2000;6: 79-90.)
The appliance for maintaining buccal teeth ,in space while the
corpus of the mandible advances growth.
129. The changes on a simulated wax set-up occurring in 14 months using growth to create
space in the anteroposterior and transverse dimensions
Andrew J. Haas Semin Orthod 2000;6: 79-90.)
130. Lower Molar Distalization with
the Unilateral Frozat Appliance
This article describes an alternative treat-
ment, using an asymmetrically activated lingual
arch, that allows an intersegmental correction of
the malocclusion. A rigid and passive buccal wire
segment provides sufficient anchorage without
the need for special patient cooperation.
JCO/DECEMBER 2004
131. Fig. Passive unilateral Frozat appliance on patient’s cast. B. Lingual arch activated at anchor
molar band with three-prong plier. C. Antirotation bend placed in lingual arch at target molar
band. D. Appliance activated with about 200g of force.
132. Unilateral Frozat Appliance
A modification of the Frozat (fixed Crozat) appliance initially
developed by Mayes, the unilateral Frozat appliance consists
of two molar bands soldered to an .038" Blue Elgiloy* or
.040“ stainless steel wire (Fig. 1A). The wire is fabricated on
the patient’s setup cast with lingual steps bent mesial to the
molars and the distance from the alveolar process kept as
constant as possible in the anterior segment. On the anchor
side the lingual arch is bent into an occlusal U-loop distal to
the solder point on the molar band, then curved around to
form the lingual arm of the appliance. Care must be taken to
ensure that this arm is in contact with the lingual surfaces of
all the anchor teeth, and that the wire segment inserted
buccally on these teeth is as rigid and passive as possible. The
lingual arm and the segmental archwire combine to form one
large, multiroot anchor unit, as described by Bench with
regard to the Quad Helix.
133. The unilateral Frozat appliance is activated by using
an Aderer three-prong plier to make a 1st order
bend on the anchor side of the lingual arch, near
the molar band (Fig. 1B). An antirotation bend must
then be placed in the lingual arch in the region of
the molar to be distalized (Fig.1C). This activation
eliminates the risk of any contact between the
molar root and the lingual cortical bone, so that the
desired distalization takes place in the cancellous
bone. Before placing the appliance in the mouth, a
distalizing force of about 180-200g should be
verified on the cast(Fig. 1D).
134.
135. The appliance must be inserted with caution to
preserve the activation and prevent distortion of
the bands. We recommend first inserting the molar
band on the anchor side and then extending the
appliance along the lingual surfaces of the teeth
until the molar band on the distalization side can
be cemented without difficulty. If necessary, the
unilateral Frozat appliance can be extraorally
reactivated and recemented at later appointments.
139. Figures a to d. Example from patient group 3.Occlusal views of the lower dental arch plus
de-tails from the panoramic radiographs (region:tooth 35) before and after lingual arch
appliance therapy. Anchorage by means of the lingual arm of the appliance, a sectional
archwire made of 0.016 0.022 stainless steel, and a lip bumper.
140. Mandibular Molar Distalization
with the Franzulum Appliance
This article presents a new device, based on the
Pendulum, that can distalize mandibular molars
without the drawbacks of other appliances.
Byloff, Darendeliler, and Stoff JCO/SEPTEMBER 2000
141. Appliance Design :
The Franzulum Appliance’s anterior anchorage
unit is an acrylic button, positioned lingually and
inferiorly to the mandibular anterior teeth, and
extending from the mandibular left canine to the
mandibular right canine (Fig. 1A). The acrylic
should be at least 5mm wide to avoid mucosal
trauma and to dissipate the reactive force
produced by the distalizing components. Rests
on the canines and first premolars are made
from .032" stainless steel wire. Tubes between
the second premolars and first molars receive the
active components.
143. The posterior distalizing unit uses nickel
titanium coil springs,about 18mm in length, which
apply an initial force of 100-120g per side. A J-
shaped wire passing through each coil (Fig. 1B) is
inserted into the corresponding tube of the
anchorage unit (Fig. 1C); the recurved posterior
portion of the wire is engaged in the lingual sheath
of the mandibular first molar band (Fig. 1D). The
anchorage unit is bonded with composite resin to
the canines and first premolars. The J-shaped
distalizing unit is then ligated to the lingual sheaths
of the molar bands, compressing the coil springs.
Thus, the active part of the appliance runs lingually
at a level close to the center of resistance of the
molar, to produce an almost pure bodily movement.
144.
145. Essix-based molar distalization
appliance
The laboratory technique The fabrication
sequence for the Essix-based molar distalization
appliance is described on a demonstration case as
follows: - A polyvinyl siloxane or an accurate
alginate impression must be taken to encompass
the complete dentition and one-third of the
alveolus. A working cast is obtained from quality
die stone. To increase the efficiency of
thermoforming, the long axis of the incisors should
be perpendicular to the base of the cast and
ideally, the cast should only be about 2 cm high.
146.
147. -Vacuum a 0.040-inch (1 mm) sheet of Essix type
A plastic over the prepared model, remove
from the vacuum machine and allow it to cool.
Do not cut off the excess plastic around the
model (Figure 1).
- Place expansion screws (Dentaurum) just mesial
to the molars, while the Essix appliance is on
the model (Figure 2).
- To keep the orthodontic acrylic (to be added to
the Essix plastic) minimal in the buccal sections,
box out the vestibular aspects with baseplate
wax. Apply the orthodontic acrylic only to the
lingual side of the appliance (Figure 3).
148.
149. - Cut away the plastic with a wheel saw and
remove the appliance from the model after
polymerization. Trim the lingual border of
appliance in the same manner as a conventional
removable appliance. However, the Essix plate
must be extended 3–4 mm onto the gingivae on
the buccal side. On the working cast, remove the
sections of the appliance covering the occlusal
surfaces of erupting teeth. Finalize the fabrication
by polishing (Figure 4a–c).
150.
151.
152. Effect of lip bumpers(LB) on
mandibular arch dimensions
153. In this systematic review, we discussed the effects
of LB treatment. The key question was “what are the
effects of the LB on mandibular arch dimensions in
adolescents compared with untreated patients?”
Our results showed increases in arch dimensions
that in- cluded an increase in arch length. This was
attributed to incisor proclination, distalization, and
distal tipping of the molars. There were also
increases in arch width and intercanine and
deciduous intermolar or premolar distances. The
long-term stability of the effects of the LB need to
be elucidated.
Hashish and Mostafa(Cairo) American Journal of Orthodontics and Dentofacial OrthopedicsJanuary 2009
154.
155. CD Distalizer
C.D. Distalizer is a fixed orthodontic appliance
used to distalize molars on either the upper or
lower arch.Patients and doctors have had good
acceptance due to its easy wear and adjustability.
Developed by Dr. Peter Ching, this fixed
appliance can be used in either unilateral or
bilateral configurations and allow doctors to gain
up to 1 m of molar distalization per month.
Website: www.johnsdental.com
157. Contents:
The appliance consists of an anterior segment,
banding the first bicuspids, with a Nance button
and lingual arch wire to act as anchorage. Vertical
tubes are soldered to the buccal surface of the first
bicuspid bands. A .036 wire, with a 5 mm tube, is
placed on the molar band and then inserted into
the vertical tube on the bicuspid band. A small
bend is made in the .036 wire, at the gingival, to
hold the wire in place. The end is heat-treated for
ease of bending.
158. Adjustments:
At each patient visit, approximately every
three to four weeks, the Gurin lock is loosened
and pushed distally to compress the coil
spring. When the spring is compressed, the
lock is tightened to keep the coil spring
activated. Repeat this procedure at each
patient visit until the molars are in their
desired position.
159. Wilson Lingual Arch
3D Lingual Arch
Sophisticated Lingual Arch engineering. Vertical insertion, with a
friction lock provides maximum anchorage and permits multiple
auxiliary functions not possible with horizontal insertion. Twin vertical
posts provide molar control, torque and rotations that are
geometrically predictable.
The diamond loop design of the 3D Activator has dynamic three
dimensional force mechanics and multidirectional movement
possibilities with predictable forces. It has a lingual offset to avoid
mucosa compression. There are five angles in the activator that can
be adjusted slightly to give geometric predictable force vectors. Force
is dissipated 100%, resulting in a rapid controlled movement. The
resilience of the Activator produces the force.
Measurement is from mesial post to mesial post.
162. Jackscrew Regainer
Adjustable turn-nuts on threaded wire facilitates
bodily space opening.Bilateral design shown for
maximum cross-arch anchorage. Device may be
designed unilaterally.
164. Group Distal Movement of Teeth Using Microscrew
Implant Anchorage
Angle Orthodontist, Vol 75, No 4, 2005
165. CASE REPORT-1
Directional force treatment for an adult with
Class III malocclusion and open bite
Lima and Lima American Journal of Orthodontics and Dentofacial Orthopedics June 2006
166.
167. TREATMENT PROGRESS
The proposed orthodontic treatment involved
fixed appliances in both arches, extraction of the
mandibular third molars, and the patient’s
cooperation using a J-hook headgear. A .022 .028-
in standard edgewise appliance was placed. The
main objective of the initial mechanics was to use
rectangular archwires for the distal movement of
the mand with the second molars. A loop in a
.019x .026-in archwire was bent flush against the
second molar tubes and activated with a high-pull
headgear with J-hooks, worn 10 to 12 hours per
day, and by hooks soldered mesial to the canines.
After alignment and leveling of the maxillary
teeth, a .019 .026-in archwire supported Class III
elastics and vertical anterior elastics at night.
168. Distal movement of mandibular second molars with loop mesial to
mandibular second molars and high-pull J-hook headgear in spurs
soldered at anterior region.
169. After distal movement of the mandibular
second molars, the J-hooks and high-pull
headgear were used to distalize the first molars .
The mandibular molars were tied together to
support the distal movement of the premolars
with elastomeric chains . The mandibular canines
were also distalized with the directional force of
the J-hook.
170. Distal position of mandibular second molars and jigs for distal movement of mandibular
first molars with high pull J-hook headgear.
171. Distal movement of mandibular second premolars with elastomeric chains and
canines with J-hooks, and retraction of mandibular incisors.
172. A new archwire, .019X .026-in with closing loops distal
to the lateral incisors, was used to retract the mandibular
incisors. The directional force mechanics were performed
in steps, and the overbite and crossbite were corrected
by the counterclockwise rotation of the mandible and
distal movement of the teeth. After Class I molar and
canine relationships were attained, .215X.275-in
coordinated archwires were placed, and vertical right and
left elastics were used to finish the occlusion . Active
treatment time was 28 months. The teeth were retained
with a maxillary removable Hawley appliance and a fixed
lingual arch from canine to canine. The 3-year
postretention records show the stability of the occlusion,
despite the need for continuous mandibular lingual
retention.
175. Treatment progress
Two C-implants were implanted in the interdental
spaces between the upper second premolars and
first molars. After incision of the mucosal area,
drilling was carried out at 1500 rpm of drill speed
and 15 Ncm of drill pressure with profuse irrigation
with isotonic saline solution. The 1.5-mm diameter
guide drill (Carl Martin, GmbH, Solingen, Germany)
was selected when drilling to depth in cortical bone.
176. The screw part was placed clockwise into the
prepared site using internal and external sterile
saline cooling .After an 8-week healing period,
the head part of C-implant was assembled into
the screw part by lightly tapping with a small
mallet 1 to 2 times. Immediate loading is
possible, mainly in areas where dense bone is
located and where primary stability can be
achieved .
177.
178. Treatment was initiated with the leveling and
distalization of the lower posterior dentition.
Because of the patient’s dental and skeletal
problems, no bonds were placed on the maxillary
anterior and right posterior teeth. However ,
brackets were placed on the upper left posterior
teeth, followed by the placement of a segmented
0.022 0.028 inch preadjusted arch wire appliance
for intrusion of the upper left second molar . The
lower third molars were all
179. upper left second molar . The lower third molars
were all removed. The patient was instructed to
wear Class III elastics as long as possible to move the
lower dentition distally. The missing lower anterior
space was almost completely regained after 12
months of active tooth movement . The fixed
appliances were removed, and a tooth positioner
was used for 1 month for finishing. The retention
was provided by an upper fixed retainer and
removable lower Hawley retainer .