Orthodontic alignment phase of pre-adjusted fixed appliance part 2 is discussed

1. Orthodontic alignment
phase of pre-adjusted fixed
appliance
part 2
Prof dr Maher fouda
Mansoura Egypt

2. No single arch form is
unique to any of the
Angle’s class
of malocclusion but it
is the frequency of a
particular arch
form that varies
among Angle’s
classification groups.

3. Arch Form
For over a century,
there has been a
persistent search for
the ideal arch form for
human dentition.
Changes
to arch form during
treatment may result
in instability and
subsequent relapse,
which can contradict
this
search for the ideal
arch form.

4. Arch Form
There is an awareness
that a great deal of
variation exists from one
human
arch form to another. With
this in mind, 3M provides
three distinct arch forms
that reconcile the
variation
in anterior curvature,
inter-cuspid width, inter-
molar width and the
curvature from the cuspid
to the
second molars.

5. Treatment should
be directed toward
maintaining the
arch form
presented by the
malocclusion as
much as possible.
Arch Form, Particularly the
Mandibular Arch,
Cannot Be Permanently
Altered with Appliance
Therapy
(a) Pretreatment mandibular occlusal view. (b) Five months:
driftodontics. (c) Ten months. Second archwire: 0.016 × 0.022-
inch SS closing loops. (d) Twelve months. Third archwire:
0.017 × 0.025-inch SS finishing. Second molars banded.

6. In a clinical situation,
orthodontists should select
the most appropriate
archwire for the patient
arch form and treatment
plan to align and level the
teeth. This step is
sometimes neglected as
the orthodontists might
assume that light NiTi
archwires will not alter
archwidth.
Maxillary archforms. (A) Narrow.
(B) Ovoid. (C) Square
Selecting the
archwire on
the
pretreatment
model

7. Preserving the arch
form also affects
stability of the
treatment results. The
intercanine width of
each patient is
determined by
muscular balance, and
any unintended
expansion in this
region could cause
instability 1: intermolar width; 2: intercanine
width; 3: molar
depth; 4: canine depth.

8. It is generally
advised to
maintain the
patient arch
form during fixed
orthodontic
treatment.
Orthodontic
archwires play a
significant role in
expansion of the
dental arch. The determination of arch form
with software analyze

9. This is more
important during
the use of
nickel titanium
(NiTi) archwires, as
these wires are not
easily customizable
and may contribute
to arch form
development
during early
stages of
treatment. Different arch forms of cases of malocclusion

10. Pre-
formed NiTi
archwires are
available in various
shapes
and sizes, and their
average intercanine
width could
exceed the natural
mandibular
intercanine width by
almost 6 mm.
NiTi arch wire used for
alignment and leveling.

11. Thus, it is
important to
select prefabri-
cated NiTi
archwires that
are similar to the
patient arch
form to minimize
changes and
reduce possible
relapse.
Template
with
maxillary
and
mandibular
arch forms

12. The therapeutic
arch form should
be de-
signed by
considering the
original arch
form of the
patient and
treatment
objectives.
Ricketts pentamorphic arch form template

13. Most orthodontists
selected archwires
subjectively by visual
assessment of the
adaptation of the
archwires to the facial
axis or facial surface of
the teeth, incisal edges
and cusp tips, or the
facial portion of the
proximal contacts.
Contoured nickel-
titanium arch
superimposed on a
model.
G&H STANDARD FORM
ARCHFORM CLEAR TEMPLATES

15. Archform analysis
The maxillary arch
width in the premolar
and molar regions
should be assessed to
determine, if it is
narrow, normal or
broad. These values
depend on the
combined mesiodistal
widths of the four
upper incisors (SI).

16. Archform analysis
The values thus obtained
indicate the ideal values of
premolar and molar
widths. The actual
measured values of the
interpremolar (mesial
occlusal pit of first
premolars on either side)
and intermolar (mesial
occlusal pit of first molar
on either side) widths are
compared to the ideal
values to conclude
whether the arch is
narrow, normal or broad.

17. Nitinol Heat-Activated
is a thermally activated
super-elastic archwire.
It
is the easiest of Nitinol
wires to engage, and it
delivers light
continuous
forces that effectively
move teeth with
minimal discomfort to
the patient.
Archwires that are used during the first phase
of alignment of teeth

18. Nitinol Heat-Activated
• Can be cooled or
chilled resulting in a
softer, more pliable
wire for
easy engagement
• Provides light
continuous forces
• Force activation
occurs around body
temperature
• Available in square
sizes making it
excellent for early
torque control

19. Unitek™ Nitinol Super-
Elastic Archwire
Nitinol Super-
Elastic is easy to
engage and
maintains
light continuous
forces with a range
between Nitinol
Heat-Activated and
Nitinol Classic. *Hybrid **Dimpled
Nickel Titanium Dimpled ArchWire

20. Unitek™ Nitinol Super-
Elastic Archwire
• Provides light
continuous
forces
• Easy
engagement
characteristics
• Good early
torque control

21. Superelastic NiTi 0.014-
inch during initial
alignment orthodontic
stage, before and after
bracket engagement.
Note
the degree of
misalignment that the
wire can tolerate due to
superelastic properties.

22. Unitek™ Nitinol
Classic Archwire
3M
pioneered
nickel-
titanium as
an improved
alternative
to stainless
steel in
1977.
DuraForm® NiTi Dimpled Archwires

23. • Long working range
• 40% the forces of
stainless steel
This “Classic”
archwire
continues to provide
the linear elasticity
and bendability of
high strength
steel and the elastic
working range
and lighter forces
that only a
nickeltitanium
can deliver.

24. wire progression for improved
efficiency in your treatment plans.

25. Multi-Strand Archwire
Unitek™ Coaxial Wire
• Five (5) tempered wires
wrapped around a core
wire
• Light force
• Highly flexible – easy to
engage
• Excellent initial wire
• One form for both U/L
arches
• Ends do not unravel
when cut

26. There is evidence
showing that multi-
stranded superelastic
NiTi wires can produce
greater tooth movement
than single-strand
superelastic NiTi when
used as the first
archwire in a fixed
(“train track”) brace.
Pearson ® 6-strand Coaxial Archwire - Standard
Excellent for initial leveling and aligning when
teeth are severely misaligned. Great flexibility
and super smooth silky finish means less
resistance and lower friction when engaged in
bracket slot!

27. The use of multi-
strand stainless
steel vs superelastic
NiTi does not have
a noticeable
difference in the
pain experienced
by the wearer.
Morelli Orthodontic Wire Twist Flex (3 strand)

28. Due to the gentle nature
of the wire, round
stranded wires are
traditionally used in
early treatment to
correct misaligned teeth.
Stranded wires apply a
low force level over a
given span with minor to
moderate deformation
depending on the
severity of the
malocclusion.
The wire is flat and
is excellent for the
fabrication of
Lingual Retainers

29. Rectangular
stranded wires are
typically used in
transitional
applications
to align and detail
occlusions
effectively with
comparatively
lower force than
solid stainless steel
archwires
TruForce Stainless Steel 8-Strand Braided Archwire
•Stable for finishing and holding
•Type 304 stainless steelSmooth bright finish
•Does not unravel when cut
•Etched midline

30. Unitek™ Stainless Steel Straight Lengths
By 1950s stainless
steel alloys were used
for most orthodontic
wires
• The most popular
wires because:
E Low cost
E Excellent
formability
E Can be soldered
and welded

31. Tooth-Colored Nickel
Titanium Archwires
• Durable
epoxy coating
• Stain
resistant •
Midline
marked •
Available in
stainless steel
Tooth-colored archwires
are ink midline-marked
(black upper, red lower) for
symmetrical identification.
A cotton swab dipped in
isopropyl alcohol will
remove the majority of the
ink after placement if
desired.

32. Bioforce Arch wires
• It produces a
gradient of force
levels
• It applies gentle and
low forces to the
anterior teeth
• It applies
increasingly higher
forces across
the posterior and
plateauing at the
molars

33. In
contemporary
treatment,
overbite
reduction is
increasingly
undertaken in
tandem
with
alignment.
Treatment sequence was performed with sequence of rounds
archwires (both NiTi and stainless steel) until 0.020’’ stainless
steel with reverse and accentuated curve of Spee
2017 Contemporary Clinical Dentistry

34. Initial orthodontic
alignment requires high
degrees of wire flexibility
permitting
engagement of grossly
displaced and irregular
teeth, particularly with
limited inter-bracket
span in the lower anterior
region and in areas of
significant crowding.

35. Firstly, a fixed tongue crib appliance was given to the
patient for six months . After 6 months, the case was
strapped up with 0.022 slot brackets of MBT
prescription. Maxillary left upper first premolar was
extracted. Both arches were bracketed, and the wire was
placed in the sequence of 0.016 Nickel-Titanium super
elastic round wires for the alignment of the teeth
followed by 0.018 stainless steel wire.
Non Surgical Management of a Mutilated Skeletal Class II
Malocclusion with an Open Bite: A Case Report
Int J Dent Med Res | MAR- APR 2015 | VOL 1 | ISSUE 6
Case report

36. Pre-treatment extraoral and intraoral photographs
Non Surgical Management of a
Mutilated Skeletal Class II
Malocclusion with an Open
Bite: A Case Report
Case report

37. During the leveling and aligning stage, a vertical
holding appliance consisting of an acrylic button
in the trans-palatal arch was given in the
maxillary molars to control the extrusion of the
maxillary molars. The round wires were followed by
0.019x.0.025 stainless steel wires for initial torque
control and better alignment. Then the cantilever
mechanics were used on the left side of the
maxillary incisors to shift the midline to the left
side.
Case report

38. Case report

39. A segmental 0.019 x 0.025 stainless steel was
placed in the maxillary incisors during use of
segmental cantilever mechanics. After the
correction of the maxillary dental midline, a
0.018 stainless steel wire with vertical helices
was placed, and simultaneous Class II elastics
were given for the closure of the spaces in the
maxillary arch. After 16 months of treatment,
the extraction spaces were closed, maxillary
dental midline was corrected, proper overjet
and overbite were established. The finishing
and detailing took another 2 months.
Case report

40. Non Surgical Management of a
Mutilated Skeletal Class II
Malocclusion with an Open Bite: A
Case Report
Case report

41. Alignment and
levelling of
maxillary and
mandibular
arches before
the initiation
of retraction
mechanics.
Case report

42. Alignment is usually undertaken
over a period of approximately 6
months pending
on the pre-existing space
conditions and involves
progression from low-dimension
round (0.012- or 0.014-in.) Nickel-
Titanium (NiTi) to larger dimension
round
(0.016-, 0.018- and 0.020-in.) and
square or rectangular (0.020 ×
0.020-,
0.017 × 0.025-, 0.018 × 0.025- and
0.019 × 0.025-in.) NiTi wires.
Case report

43. Archwires may
be held in place
using
elastomerics,
stainless steel
ligatures or
inbuilt
mechanisms
with self-ligating
systems.

44. Conventional
modes of ligation,
however, are
limited in relation
to efficiency of
handling, plastic
deformation,
discoloration,
plaque
accumulation and
friction.

45. Self-ligating
brackets have
been
developed in
an attempt to
address these
shortcomings.

46. Stainless steel ligatures
may
also be used in areas of
significant rotation or
displacement and when
active mechanics
are in use to promote
rotational correction
during alignment and
indeed to limit
unwanted rotations during
sliding mechanics and
space closure.

47. Initial Wire Placement and
Engagement: Practical Steps
The wire is initially
cut to length with
distal end cutters
using the study
model as a
reference and
centred using a
midline indicator .
Distal end cutter
A midline
identifier (circled) on an
upper 0.014-inch NiTi wire

48. A small distal
excess (3–7 mm) is
advisable to allow for
wire cinching and
possibly for
additional
length in order to
compensate for wire
deflection with
engagement of
displaced and
crowded teeth.

49. Round wires
are
introduced
using fingers
to thread into
the molar
tubes
initially.
An initial
alignment NiTi
wire
inserted through
the
molar tubes
using fingers
only. A
Weingarts may
be
helpful in the
presence of
significantly
rotated
molars or with
larger
dimension wires

50. A pliers (e.g.
Weingarts)
may be used to
direct this but
is often not
required for
narrow
dimension
wires.
Ricketts pantamor-
phic arch form
templates, ovoid,
tapered (V-shaped),
and
square (U-shaped)
forms

51. A mosquito forceps is
used with the tips
enclosing one edge of
the elastomeric
while leaving the
lumen exposed
permitting a secure
grip and engagement
of the
undercuts of tie-
wings.
A range of elastomerics. (a) The beaks of
the mosquito forceps should not encroach
on the central lumen
(b) to allow positive engagement of bracket
undercuts

52. Ligation may be
commenced in the
anterior region to
stabilise the wire
initially.
Ormolasts are
typically used
engaging all four
tie-wings
sequentially in an O-
configuration.
(a–e) Sequential placement of an ormolast in an ‘O’-
configuration on the maxillary central
incisor

53. It is advisable to
engage a gingival
tie-wing initially
before
proceeding to
both occlusal tie-
wings and finally
the remaining
gingival wing. (a–e) Sequential placement of an ormolast in an ‘O’-
configuration on the maxillary central
incisor

54. Ligature Tucker

55. Partial ligation,
figure-of-eight
ties and use of
stainless steel
ties
can be
considered with
more displaced
or rotated teeth.
(a–h) Placement of an ormolast in a figure-of-eight
configuration following initial prestretching

56. Partial ligation, figure-of-eight ties

57. Care is taken to
tie and cut the
ligature at
right angles to the
attachment to
avoid introduction
of shear forces
which might
predispose
to attachment
failure
Placement of a stainless steel ligature.

58. Placement of a stainless steel ligature.

59. Pre-stretching
of elastomeric
makes the
ormolast
slightly more
lax
permitting the
degree of
stretch
required to
allow figure-of-
eight
formation.

60. Chang suggested
100% prestretching in clinical
applications to reduce
the initial force.
Some
studies have recommended
prestretching orthodontic
synthetic elastomeric chains
before use.
Wong found in his studies that
elastomeric materials should be
pre-stretched one third of their length
to stress the molecular polymer
chain, thus increasing the strength of
the material.

62. Pre-stretching
of elastomeric
makes the
ormolast
slightly more
lax
permitting the
degree of
stretch
required to
allow figure-
of-eight
formation.

63. Partial ligation
is likely to
inhibit
progression to
a significantly
larger wire at
the subsequent
visit.

64. More complete
ligation,
however,
promotes
better
alignment of
the slots and
therefore
wire
progression.

65. This is,
however, not
always
realistic in
view of the
degree of
displacement
or rotation.

66. Stainless steel
ligatures offer
potential
advantages with
lower resistance
to sliding than
elastomerics
and less force
decay making
wire ligation
more
assured.

68. A
B

69. Metal ties may
also be used in
areas of
significant wire
displacement. It is
helpful to bend
the ligature at
approx. 90° to
assist with
placement .

70. The ligatures
should ideally be
tied at 90° to the
plane of the
bracket as shear
forces
on the bracket
risk debonding
during
tightening.

71. Similarly, the
ligature
cutters can be held
parallel to the
bracket with a wire
tail of approx. 3
mm, which
can be tucked
occlusally with a
wire tucker in order
to promote optimal
gingival
health .

72. Firm ligation
is advised
when
stainless
steel
ligatures are
used;

73. It is important,
however, that these
are not over-
tightened as this
risks irreversible
surface change to
the archwire
including notching,
which may in turn
inhibit tooth
movement.

74. An initial 0.014-
in. NiTi wire has
been ligated in
this arch with
significant
palatal
displacement of
the maxillary
right lateral
incisor.
Engagement of a displaced
maxillary lateral incisor. In this
instance, there is sufficient
space to align the lateral incisor

75. For ease of
ligation,
the most
displaced
tooth (UR2)
is ligated
initially . as such, sliding mechanics
would be unnecessary

76. This tooth can be
included in the
appliance at this stage
as there is adequate
space to allow for
alignment.
Where inadequate
space exists, sliding
mechanics and space
redistribution
are advisable. All
teeth have been ligated
fully in this case.

77. Partial ligation
can be considered
where excessive wire
deflection occurs as
this risks excessive
forces and attachment
debonding. Moreover,
excessive deformation
may lead to the
superelastic properties
of the wire being
exceeded.

78. Lacebacks
have been
placed
bilaterally from
canine to first
molar .
Placement of a laceback ligature

79. Lacebacks
have been
placed
bilaterally
from
canine to
first molar .

80. Lacebacks
have been
placed
bilaterally
from
canine to
first molar.

81. It is helpful
to tie the
wire off
after initial
engagement
of the molar
hook .

82. Tie-wings
of premolar
and canine
brackets
should be
engaged
positively to
ensure
the laceback is
secure .

83. At subsequent
visits,
lacebacks are
likely to
become lax as
the canines
move distally
and molars in a
mesial
direction.

84. The laceback
may be left in
place, while the
arch wire is
removed and
can be activated
simply by
twisting the wire
with an explorer
tip .
Reactivation of
a laceback using an
explorer tip. This does not
necessitate removal and
replacement of the wire

85. Lacebacks
are fabricated
from 0.09″ to
0.10″
stainless
steel wire
spanning the
first molars
to canines.

86. They represent a means
of controlling the
anteroposterior
position of the incisors
during the initial
alignment phase by
limiting
forward movement of the
canine crowns while the
mesial tip prescription of
the canine teeth is
expressed.

87. Lacebacks
are of
potential
value in
extraction
cases or
spaced
arches.

88. Orthodontic
extractions may
promote more
stable relief of
crowding by
generating space
to limit or avoid
unwanted
advancement of
the anterior
segments.
Lace-backs for distal movement of
canines following extraction of first
premolars.

89. The mesial
angulation in-built
in canine brackets
predisposes to
forward
movement of the
incisors in
conjunction with
alleviation of
crowding
during the initial
alignment phase.
Andrews/Roth/MBT tip values

90. While the incisors may be
moved posteriorly
later in treatment,
particularly during space
closure, reciprocal
movement
of this nature (‘round
tripping’) is considered
undesirable predisposing to
root
resorption, periodontal
attachment loss and more
prolonged treatment.
Leveling and alignment phase

91. Lacebacks
may be
particularly
useful
where the
canines are
upright or
distally
angulated
at the
outset,
A crowded Class I malocclusion with
buccally displaced maxillary left
canine
with an associated midline shift to
the left side (a–d). An initial 0.014-in.
NiTi aligning wire was
placed with lacebacks from canine to
first molar (e–h). These assisted in
achieving alignment with
some distal movement of the canines
(i–k) prior to definitive space closure
in rectangular stainless
steel wires

92. as in these
cases,
significant
mesial crown
movement
is likely to be
accompanied
by
advancement
of the
incisors.
Lacebacks not
only inhibit
forward canine
movement, but
they are an
effective way of
distalizing the
canines. This
occurs because
the lacebacks tip
the canines at
the gingival
aspect of the
alveolar crest.

93. Canine
retraction: In
extraction
patients, the
canines
were retracted
on round wires
using elastic
chains.

94. Canine retraction:
Without the
overcorrection of
additional gable bends,
teeth tended to tip and
rotate into the extraction
sites
when the chains were
overstretched, with
associated
bite deepening .
the 'roller
coaster' effect
developing in
an early
treatment w i t h
the original
SWA. The
unwanted
deepening of
the overbite
was due t o
excess force
and the use of
elastic
retraction
mechanics.

95. The gable or V-Bend
intrusion mechanics had
been known in
literature, long time ago.
Bendistal and Omni
Pliers only could insert
V-bend in super elastic
wires and
employed their light and
consistent forces to
simplify teeth intrusion
for the first time.
The V-Bend Mechanics On Niti Wires

96. V-BENDS OF
BENDISTAL AND
OMNI PLIERS in NiTi
archwires, allow
applying their light
forces systems in
vertical direction that
simplify
teeth intrusion, and
easily correct the
most challenging
malocclusions.

97. A: illustrates mandibular dental arches
after alignment, with the preformed
NiTi archwire (in black) tied in place.
The blue colored line shows the shape
of the wires after receiving the
permanent inverted V-bend behind the
canines. B: Shows the activated tied in
NiTi archwire (in light green) being tied
after it intrudes the most distant
anterior and posterior teeth. C: Shows
the mechanical effects on mandibular
dental arch before and after
illustrations superimposed

98. Lacebacks are effective
because they don't produce
continual forces. The space is
created, then they stop
working until they are re-
activated. This light,
intermittent force is
probably the reason the
molars are unaffected. Also,
the heavier forces produced
by chain will cause teeth to
tip into the extraction sites.
Lacebacks do not cause this
worsening of the
malocclusion

99. Teeth tended to tip and
rotate into the
extraction
sites when the chains
were overstretched,
with associated
bite deepening. This
was frequently seen
and
became known as the
“roller coaster” effect.

100. Lacebacks are
placed in a
passive
configuration
and are
typically
intermittently
activated
during
occlusal
contact.
Passive figure-eight ligature
wires, called “lace-
backs,” were placed from the
first molars to the canines
before archwire placement. It was
important to avoid
overtightening them

101. While many
clinicians
routinely use
lacebacks to
control incisor
position during
orthodontic
alignment, they
have
not met with
universal
approval.
Canine retraction with Active
laceback ligature

102. Disadvantages of
laceback use may
include
loss of anchorage
posteriorly manifesting
as mesial migration and
tipping of
first permanent molars,
potential for plaque
stagnation and limited
additional
chairside time and
complexity.
Passive figure-eight ligature wires,
called “lacebacks,” were placed from
the first molars to the canines before
archwire placement. It was important
to avoid overtightening them

103. Moreover, clinical trials
have confirmed that
control of incisor
position comes at the
expense of anchorage
loss in the molar
region (Irvine et al. 2004).
As such, they remain
useful in terms of
alignment
but are unlikely to alter
the anchorage balance
appreciably.
With lacebacks, the periodontal space was
compressed with minor tipping. The archwire was
then placed and had adequate time (4-6 weeks)
to upright the roots. The lacebacks were adjusted
at 4- to 6-week intervals to take up any slack.
0.014" NiTi SE
arch and
laceback to
guide distally
the canines
during
crowding res
olution. In
this phase the
friction occurs
especially in
the area of
the anterior
teeth.

104. Duration of
Alignment
The initial alignment
phase typically
spans up to 6
months but may
obviously
be more prolonged
in cases with severe
rotations, crowding
and tooth
displacements.
(a–e) A crowded lower arch (a). A decision was made
to treat this without extraction
allowing advancement of the mandibular incisors. The
initial aligning wires were not cinched to
allow for arch lengthening. The attachments on the
rotated LL3 and LL5 were not fully ligated in
0.014-in. NiTi (b); this wire was therefore retied before
progressing to rectangular NiTi with complete
wire engagement (c). The mandibular second molars
were subsequently bonded (d), and
ultimately complete alignment is achieved (e)

105. The latter, in
particular, may
necessitate
extractions and
sliding
mechanics with
space
redistribution
prior to inclusion
of all
anterior teeth
within the
appliance.
During initial
alignment, .014"
and .016" round
nickel titanium
archwires were
inserted into the
−25° tipback tubes .
Distal canine
movement occurred
without laceback
ties, and initial
upper alignment
was achieved in six
months . Only
minor upper-molar
tipback was
observed.

106. Numerous studies
investigating the effect of
wire and bracket type on
the duration of alignment
have been undertaken,
with
less than 8 months
usually required prior to
engagement of 0.019 ×
0.025-in.
stainless steel wires in
extraction cases (Scott
et al. 2008).
The complex
force systems
resulting from the
severely
angulated
mandibular left
first premolar,
even with a light
Ni-Ti continuous
archwire, is
demonstrated
clinically by the
adverse changes
in tooth
positions.

107. Little difference has
been observed in terms of alignment
efficiency with competing wires
(Pandis
et al. 2009) or bracket designs (Scott
et al. 2008). Notwithstanding this, NiTi
alloys tend to be preferred to
stainless steel alternatives (including
multistrand
and multiloop designs, which
incorporate increased wire length to
enhance flexibility)
in view of simplicity and resistance to
permanent deformation.

108. Edgewise 0.022 x 0.028-in
orthodontic brack-
ets were placed in the maxillary
arch, except for
teeth #11 and 22 (maloccluded).
Treatment be -
gan with Twist-flex 0.015-in
steel archwire placed
for initial alignment and
leveling. Subsequently,
0.012, 0.014, 0.016 and 0.018-in
stainless steel arch-
wires were progressively
installed every 30 days, with
omega loops mesially adjusted
to the first molars.
Case report

109. The omega loops were
adjusted in 0.05 mm on each
side on every orthodontic
visit, increasing arch cir -
cumference and length, and,
as a result, establishing
mild and continuous
protrusion of incisors with ex-
pansion of the arches.
Case report

110. Once the 0.018-in
steel wire had been
installed,
open springs were
compressed
between teeth #11
and 22 to create
space between
them. At this point,
orthodontic
appliance was
installed on these
teeth
Case report

111. the 0.018” arch and the bonded
appliances. At this
stage, maxillary incisors were
slightly protruded,
thus providing enough space to
correct the maloc-
clusion . By the time the 0.020”
stainless steel
wire was installed, the incisors had
been satisfactory
protruded, thus providing enough
mesiodistal space
for buccal inclination of #11 and #22
.
Buccal traction of maloccluded
teeth was per-
formed with mild-force
elastomeric chains between
Case report

112. After maloccluded teeth were
corrected, the
appliances of #11 e #22 were
replaced and a new
0.014” stainless steel wire was
installed for teeth
alignment and leveling.
Subsequently, 0.016, 0.018,
0.020-in and 0.019 x 0.025-in
stainless steel wires
were progressively installed for
individual torque
control and treatment
finishing.
Case report

113. The maxillary and mandibular teeth
were
bonded with 0,022-inch MBT
brackets (Ortho
Technology). The treatment was
started using 0.012,
0.014, 0.016, 0.016 x 0.016, and
0.016 x 0.022 NiTi
in both arches.
After leveling and aligning were done, the
next treatment was enamel stripping in
central and
lateral upper incisor. Space closing was
done with
power chain and stainless steel wire
0.016 x 0.022.
Finishing and detailing were used
stainless steel wire
0.016 x 0.022 and 0.017 x 0.025 both
arches with
elastic.
Case report

114. Orthodontic tooth movement is initiated with 0.022 slot MBT
bracket system in both the arches. 0.016 NiTi was the initial
wire, followed 0.017 × 0.025 NiTi, 0.019 × 0.025 NiTi, 0.019 ×
0.025 SS. In the maxillary arch premolars and canines
retracted separate followed by upper anterior retraction. In
the mandibular arch, en masse retraction was carried out.
Case report

115. Complete bonding & banding in both
maxillary and mandibular arch was done,
using MBT0.022X0.028”slot. Initially a 0.012”
NiTi wire was used which was followed by
0.014 , 0.016”, 0.018”, 0.020” Niti archwires
following sequence A of MBT. After 6 months
of alignment and leveling NiTi round wires
were discontinued. Retraction and closure of
existing spaces was then started by use of
0.019” x 0.025” rectangular NiTi followed by
0.019” x 0.025” rectangular stainless steel
wires. Reverse curve of spee in the lower arch
and exaggerated curve of spee in the upper
arch was incorporated in the heavy archwires
to prevent the excessive bite deepening
during retraction process
Case report

116. The maxillary and
mandibular first molars
were banded. The
maxillary and mandibular
teeth were bonded with
0,022-inch Roth brackets
(Ortho Technology).
Treatment was started
using 0.012” NiTi , 0.014”
NiTi, 0.016” NiTi, then
0.018” NiTi in both arches.
Case report

117. The maxillary and mandibular 1st
premolar of right side was first extracted.
Complete bonding & banding in both
maxillary and mandibular arch was done,
using Pre-adjusted Edgewise bracket
system. Initially a 0.012” NiTi wire was
used which was followed by 0.014 , 0.016”,
0.018”, 0.020” Nitiarchwires following
sequence A of MBT. After 6 months of
alignment and leveling NiTi round wires
were discontinued. Retraction and closure
of spaces was then started by use of
0.019” x 0.025” rectangular NiTi followed
by 0.019” x 0.025” rectangular stainless
steel wires.
Case report

118. Treatment was started
using 0.016” NiTi in both
arches,
which was followed by
0.018” NiTi 0.019 × 0.025”
NiTi. Finally, a 0.019” ×
0.025” stainless steel
wire was placed as a
working arch wire.
Leveling
and alignment were
completed in 5 months.

119. The treatment was initiated with a
banding and bonding procedure using
modified bidimen-
sional preadjusted edgewise brackets,
0.018-inch slots in
the incisors and canines, and 0.022-inch
slots in the premo-
lars and molars (3M Unitek, Monrovia,
CA, USA). Roth
prescription was combined with
cementation of the quad
helix appliance. Leveling and alignment
were achieved with
a straight wire technique which was
used in the following
sequence: 0.012′′ Niti, 0.014′′ Niti,
0.016′′ Niti, and 0:016
× 0:025′′ Niti followed by 0:018 ×
0:022′′ SS wire

120. 0.022 x 0.028” slot MBT
appliance was used
in this case. Posterior
leveling and aligning
was initially
done with round 0.014
and 0.016 Niti wires.
0.018SS
archwire was used to
make the Mulligan’s
bypass arch.
It was placed from
canine to molars
bilaterally
bypassing incisors.

121. E-chain was placed
from the molar
tube to canine hook
with the force of 100g .
Individual canine
retraction is carried
about for 4
months and the
anteriors were allowed
to decrowd itself
with driftodontics .

122. Meanwhile In upper arch,
canine was pulled
down with segmental wire.
After the canine retraction
in lower arch the anteriors
were engaged with
continuous archwire. E-
chain was used for
anterior
space closure.

123. correction, 19x25 SS
archwire was placed to co-
ordinate the
arches.0.021x0.025”
braided SS was placed
for finishing and detailing.
Removable circumferential
retainer and fixed retainer
were given for retention.
The
total treatment time was 20
months.
After space closure
and midline