The document discusses the use of an extrusion arch to correct an anterior open bite. It describes how an extrusion arch creates a one-couple force system, applying an extrusive force to the anterior teeth and an intrusive force plus tip-forward moment to the posterior anchorage. It notes that seating elastics are needed to control the unwanted tipping, and presents a case report where miniscrew anchorage was used instead to prevent tipping while the arch closed an open bite over multiple months.
biomechanics of space closure in orthodonticcs / fixed orthodontics coursesIndian 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.
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 document discusses the biomechanics of space closure in orthodontics. It covers key topics such as:
1) The center of resistance and how it varies for single and multi-rooted teeth based on root length and alveolar bone height.
2) The importance of understanding moment to force ratios (M/F ratios) in controlling the type of tooth movement, whether tipping, translation, or root movement.
3) Factors that determine tooth movement during space closure including the axial inclination of teeth, midline discrepancies, and vertical dimension control.
4) Methods of anchorage control including extraoral anchorage, intermaxillary elastics, and differential moment-to-
Orthodontic retraction biomechanics for space closure and distalization using...Vishnu Patel Ortho
Centre of Resistance Simulator is an Innovative Customized Orthodontic Appliance for Retraction of Protruded dentition especially proclined upper front Teeth.
Biomechanics of Extraction Space Closure with Sliding Mechanics has been elaborated mathematically using Equilibrium Force Diagram.
Comparatively Simple and Statically determinate Force system using the Centre of Resistance Simulator (CRS) has been described.
Vertical Anchorage Control has been challenging task in patients having Long Faces and high Mandibular Plane Angle (Vertical Growers). This concept of Simulating Centre of Resistance facilitates vertical Anchorage control during Extraction Space Closure without Temporary Anchorage Devices (Microimplants or Bone Screws). Judicious use of TADs is definitely required for En Masse Distalization cases and absolute Anchorage demanding extraction cases e.g. extreme long faces where maximum extraction space is to be utilized for Retraction of Anterior Teeth Segment.
Bodily Retraction of Upper Anterior Teeth without bite deepening and without Molars extrusion ( i.e.opening of Mandibular Plane Angle) is also possible with the concept.
This appliance may also be used in patients having lingual braces and clear aligners for improving outcome.
This Orthodontic Force System provides Frictionless and Loopless Retraction Mechanics for Extraction Space Closure.
Designing of the appliance on Cephalometric Tracing and then accordingly locating estimated Centre of Resistance on Models has been mentioned stepwise in the video.
Techno Savvy young Orthodontists can design and fabricate CRS by CAD-CAM using 3D designing softwares and DMLS 3D Printing.
Biomechanical explanation of each minute sense has been described in this video. Please watch and listen carefully from start to finish in one go.
I humbly request to all Orthodontists especially those affiliated with Institutes to explore the concept. I will be more than happy to be involved in such work.
Please feel free to contact me on vishvadental@gmail.com for detailed insight.
The document discusses occlusal considerations for implant-supported prostheses. It introduces various occlusal terminology and explores the significance of occlusion on osseointegrated implants. The document outlines the goals of implant protective occlusion (IPO), which aims to distribute occlusal forces appropriately to minimize stress on implants and surrounding bone. IPO principles include using thin articulating paper for initial adjustment, equalizing contacts under heavy bite forces, avoiding non-axial and offset loads, and designing the occlusion around the weakest component. The document also discusses factors like implant angulation, crown height, bone quality and the materials used for occlusal surfaces.
differences between natural tooth periodontium and implant bone connection, biomechanics of implants, implant protected occlusion , occlusal principles for single tooth implant prosthetics and implant supported prosthesis on edentulous arch, shortened arch concept, therapeutic occlusion
The document discusses the use of an extrusion arch to correct an anterior open bite. It describes how an extrusion arch creates a one-couple force system, applying an extrusive force to the anterior teeth and an intrusive force plus tip-forward moment to the posterior anchorage. It notes that seating elastics are needed to control the unwanted tipping, and presents a case report where miniscrew anchorage was used instead to prevent tipping while the arch closed an open bite over multiple months.
biomechanics of space closure in orthodonticcs / fixed orthodontics coursesIndian 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.
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 document discusses the biomechanics of space closure in orthodontics. It covers key topics such as:
1) The center of resistance and how it varies for single and multi-rooted teeth based on root length and alveolar bone height.
2) The importance of understanding moment to force ratios (M/F ratios) in controlling the type of tooth movement, whether tipping, translation, or root movement.
3) Factors that determine tooth movement during space closure including the axial inclination of teeth, midline discrepancies, and vertical dimension control.
4) Methods of anchorage control including extraoral anchorage, intermaxillary elastics, and differential moment-to-
Orthodontic retraction biomechanics for space closure and distalization using...Vishnu Patel Ortho
Centre of Resistance Simulator is an Innovative Customized Orthodontic Appliance for Retraction of Protruded dentition especially proclined upper front Teeth.
Biomechanics of Extraction Space Closure with Sliding Mechanics has been elaborated mathematically using Equilibrium Force Diagram.
Comparatively Simple and Statically determinate Force system using the Centre of Resistance Simulator (CRS) has been described.
Vertical Anchorage Control has been challenging task in patients having Long Faces and high Mandibular Plane Angle (Vertical Growers). This concept of Simulating Centre of Resistance facilitates vertical Anchorage control during Extraction Space Closure without Temporary Anchorage Devices (Microimplants or Bone Screws). Judicious use of TADs is definitely required for En Masse Distalization cases and absolute Anchorage demanding extraction cases e.g. extreme long faces where maximum extraction space is to be utilized for Retraction of Anterior Teeth Segment.
Bodily Retraction of Upper Anterior Teeth without bite deepening and without Molars extrusion ( i.e.opening of Mandibular Plane Angle) is also possible with the concept.
This appliance may also be used in patients having lingual braces and clear aligners for improving outcome.
This Orthodontic Force System provides Frictionless and Loopless Retraction Mechanics for Extraction Space Closure.
Designing of the appliance on Cephalometric Tracing and then accordingly locating estimated Centre of Resistance on Models has been mentioned stepwise in the video.
Techno Savvy young Orthodontists can design and fabricate CRS by CAD-CAM using 3D designing softwares and DMLS 3D Printing.
Biomechanical explanation of each minute sense has been described in this video. Please watch and listen carefully from start to finish in one go.
I humbly request to all Orthodontists especially those affiliated with Institutes to explore the concept. I will be more than happy to be involved in such work.
Please feel free to contact me on vishvadental@gmail.com for detailed insight.
The document discusses occlusal considerations for implant-supported prostheses. It introduces various occlusal terminology and explores the significance of occlusion on osseointegrated implants. The document outlines the goals of implant protective occlusion (IPO), which aims to distribute occlusal forces appropriately to minimize stress on implants and surrounding bone. IPO principles include using thin articulating paper for initial adjustment, equalizing contacts under heavy bite forces, avoiding non-axial and offset loads, and designing the occlusion around the weakest component. The document also discusses factors like implant angulation, crown height, bone quality and the materials used for occlusal surfaces.
differences between natural tooth periodontium and implant bone connection, biomechanics of implants, implant protected occlusion , occlusal principles for single tooth implant prosthetics and implant supported prosthesis on edentulous arch, shortened arch concept, therapeutic occlusion
This document discusses various factors to consider in the design of removable partial dentures (RPDs). It covers 10 key factors: 1) biomechanical considerations and forces acting on RPDs, 2) controlling stress through design, 3) direct and indirect retention methods, 4) clasp design, 5) splinting, 6) the denture base, 7) major and minor connectors, 8) rests, 9) stress equalization techniques, and 10) philosophies of RPD design including broad stress distribution. The goal of proper RPD design is to preserve remaining teeth and restore function while minimizing stress on abutment teeth and soft tissues.
Extrusion arches of Nanda by Dr Maher FoudaMaher Fouda
The document discusses the use of extrusion arches for correcting anterior open bites. It describes how extrusion arches work by inverting intrusion arch mechanics to apply an extrusive force on the anterior teeth. Extrusion arches can be used in non-compliant patients to correct open bites. Various modifications to extrusion arches are discussed, such as adding buccal segments or vertical elastics, to prevent unwanted tipping movements. Extrusion arches combined with vertical elastics are shown to successfully correct open bites while maintaining occlusion.
Biomechanics of extra alveolar mini-implantsAshok Kumar
1) Extra-alveolar mini-implants placed in the infrazygomatic crest and mandibular buccal shelf areas provide effective anchorage for orthodontic tooth movement and treatment of complex malocclusions.
2) These mini-implants allow en masse retraction of the entire maxillary or mandibular arch in a single step using statically determinate biomechanics.
3) Retraction forces generated rotate the dental arch, causing intrusion of posterior teeth and extrusion of anterior teeth, which can assist in treating open bites and sagittal discrepancies.
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..
This document discusses anchorage management in orthodontic treatment. It defines anchorage as resistance to unwanted tooth movement and describes how anchorage requirements should be assessed during treatment planning. Poor anchorage can result in non-ideal outcomes. Anchorage devices work by anchoring teeth or skeletal structures to resist unwanted movement. Factors like tooth movement type, extraction pattern, bone quality, growth, and compliance impact anchorage. Devices include intraoral and extraoral appliances like headgear, which provide maximum anchorage when used properly.
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 article reviews literature on fracture of dental implants and presents a case report. It finds that implant fracture is a rare but severe complication with multiple potential contributing factors. These include design flaws, poor fit of superstructures, excessive occlusal forces, location in high stress areas like the posterior mandible, small implant diameter, metal fatigue, and bone resorption around implants. The case report describes a titanium implant that fractured after 4 years due to metal fatigue, which was potentially caused by bone loss facilitated by leakage of toxic nickel ions from the implant's non-precious metal crown. This suggests corrosion and ion leakage should be considered a possible risk for late implant fractures.
The scope of fixed prosthodontics treatment can range from the restoration of a single tooth to the rehabilitation of the entire occlusion. Single teeth can be restored to full function, and improvement in
esthetics can be achieved. Missing teeth can be replaced with fixed prostheses that will improve patient comfort and masticatory ability, maintain the health and integrity of the dental arches, and, in many instances, elevate the patient’s self-image.
This document provides an overview of friction in orthodontics. It discusses how friction occurs at the bracket-archwire interface during tooth movement, and identifies it as a clinical challenge, particularly for sliding mechanics. It then examines numerous variables that can affect friction levels, including physical/mechanical factors related to archwire, bracket, and appliance properties, as well as biological factors. The document proposes that an understanding of friction is important for orthodontists to optimize treatment outcomes and efficiency. It also summarizes various methods used to study friction in vitro and the development of experimental models to better simulate clinical tooth movement. In conclusion, the document stresses the importance of controlling friction to prevent unwanted tooth movement and ensure efficient sliding mechanics.
Intrusion PEREPERD BY DR.ABDULGHANI ALMOHAYA ,ALHADDAD.pptxAbdulghaniAlmohaya
The document discusses intrusion, which refers to the apical movement of a tooth's geometric center in relation to the occlusal plane or the tooth's long axis. Intrusion can be used to correct deep overbites by moving anterior teeth vertically downward. True intrusion is achieved by applying a single intrusive force through the tooth's center of resistance. Several appliances can provide intrusive forces, including utility arches, tip-back springs, and segmented arches. Proper biomechanics must be followed, such as applying light, constant forces and positioning the force vector through the tooth's center of resistance and parallel to its long axis.
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.
1. Indirect retainers assist direct retainers in preventing displacement of the distal extension denture base by functioning through lever action on the opposite side of the fulcrum line. They are most commonly occlusal rests placed on premolars.
2. For indirect retention to be effective, it must be placed some distance from the fulcrum line, usually contacting multiple teeth. It helps stabilize the denture base and reduces stresses on abutment teeth.
3. Indirect retainers have auxiliary functions like preventing tilting of abutment teeth, stabilizing the major connector, and providing early indication of need to reline the denture. Their location and design depends on factors like arch, ab
Biomechancal principles in orthodontics /certified fixed orthodontic courses ...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
This document discusses occlusion in removable partial dentures. It outlines several types of occlusion including static and dynamic occlusion. Desirable occlusal contacts are bilateral contacts of posterior teeth in centric occlusion. Methods for establishing occlusion include direct apposition of casts if enough teeth remain, interocclusal records with posterior teeth, or using occlusal rims. The functionally generated path method can also be used to develop a dynamic occlusion record without an articulator. Proper occlusion is important for the success, comfort and longevity of removable partial dentures.
This document discusses various mechanical concepts relevant to orthodontics including forces, moments, couples, centers of resistance and rotation, and their applications. It begins by defining scalars, vectors, forces, and resultants. It then discusses centers of resistance, gravity, and rotation. Moment of force, couples, and torque are also defined. The document outlines Newton's laws and static equilibrium. It concludes by discussing force systems and their relationships to different types of tooth movement including tipping, translation, and rotation.
Biomechanical principles of orthodontics /certified fixed orthodontic courses...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
Thesis final /certified fixed orthodontic courses by Indian dental academy Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078
Osteoporosis - Definition , Evaluation and Management .pdfJim Jacob Roy
Osteoporosis is an increasing cause of morbidity among the elderly.
In this document , a brief outline of osteoporosis is given , including the risk factors of osteoporosis fractures , the indications for testing bone mineral density and the management of osteoporosis
This document discusses various factors to consider in the design of removable partial dentures (RPDs). It covers 10 key factors: 1) biomechanical considerations and forces acting on RPDs, 2) controlling stress through design, 3) direct and indirect retention methods, 4) clasp design, 5) splinting, 6) the denture base, 7) major and minor connectors, 8) rests, 9) stress equalization techniques, and 10) philosophies of RPD design including broad stress distribution. The goal of proper RPD design is to preserve remaining teeth and restore function while minimizing stress on abutment teeth and soft tissues.
Extrusion arches of Nanda by Dr Maher FoudaMaher Fouda
The document discusses the use of extrusion arches for correcting anterior open bites. It describes how extrusion arches work by inverting intrusion arch mechanics to apply an extrusive force on the anterior teeth. Extrusion arches can be used in non-compliant patients to correct open bites. Various modifications to extrusion arches are discussed, such as adding buccal segments or vertical elastics, to prevent unwanted tipping movements. Extrusion arches combined with vertical elastics are shown to successfully correct open bites while maintaining occlusion.
Biomechanics of extra alveolar mini-implantsAshok Kumar
1) Extra-alveolar mini-implants placed in the infrazygomatic crest and mandibular buccal shelf areas provide effective anchorage for orthodontic tooth movement and treatment of complex malocclusions.
2) These mini-implants allow en masse retraction of the entire maxillary or mandibular arch in a single step using statically determinate biomechanics.
3) Retraction forces generated rotate the dental arch, causing intrusion of posterior teeth and extrusion of anterior teeth, which can assist in treating open bites and sagittal discrepancies.
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..
This document discusses anchorage management in orthodontic treatment. It defines anchorage as resistance to unwanted tooth movement and describes how anchorage requirements should be assessed during treatment planning. Poor anchorage can result in non-ideal outcomes. Anchorage devices work by anchoring teeth or skeletal structures to resist unwanted movement. Factors like tooth movement type, extraction pattern, bone quality, growth, and compliance impact anchorage. Devices include intraoral and extraoral appliances like headgear, which provide maximum anchorage when used properly.
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 article reviews literature on fracture of dental implants and presents a case report. It finds that implant fracture is a rare but severe complication with multiple potential contributing factors. These include design flaws, poor fit of superstructures, excessive occlusal forces, location in high stress areas like the posterior mandible, small implant diameter, metal fatigue, and bone resorption around implants. The case report describes a titanium implant that fractured after 4 years due to metal fatigue, which was potentially caused by bone loss facilitated by leakage of toxic nickel ions from the implant's non-precious metal crown. This suggests corrosion and ion leakage should be considered a possible risk for late implant fractures.
The scope of fixed prosthodontics treatment can range from the restoration of a single tooth to the rehabilitation of the entire occlusion. Single teeth can be restored to full function, and improvement in
esthetics can be achieved. Missing teeth can be replaced with fixed prostheses that will improve patient comfort and masticatory ability, maintain the health and integrity of the dental arches, and, in many instances, elevate the patient’s self-image.
This document provides an overview of friction in orthodontics. It discusses how friction occurs at the bracket-archwire interface during tooth movement, and identifies it as a clinical challenge, particularly for sliding mechanics. It then examines numerous variables that can affect friction levels, including physical/mechanical factors related to archwire, bracket, and appliance properties, as well as biological factors. The document proposes that an understanding of friction is important for orthodontists to optimize treatment outcomes and efficiency. It also summarizes various methods used to study friction in vitro and the development of experimental models to better simulate clinical tooth movement. In conclusion, the document stresses the importance of controlling friction to prevent unwanted tooth movement and ensure efficient sliding mechanics.
Intrusion PEREPERD BY DR.ABDULGHANI ALMOHAYA ,ALHADDAD.pptxAbdulghaniAlmohaya
The document discusses intrusion, which refers to the apical movement of a tooth's geometric center in relation to the occlusal plane or the tooth's long axis. Intrusion can be used to correct deep overbites by moving anterior teeth vertically downward. True intrusion is achieved by applying a single intrusive force through the tooth's center of resistance. Several appliances can provide intrusive forces, including utility arches, tip-back springs, and segmented arches. Proper biomechanics must be followed, such as applying light, constant forces and positioning the force vector through the tooth's center of resistance and parallel to its long axis.
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.
1. Indirect retainers assist direct retainers in preventing displacement of the distal extension denture base by functioning through lever action on the opposite side of the fulcrum line. They are most commonly occlusal rests placed on premolars.
2. For indirect retention to be effective, it must be placed some distance from the fulcrum line, usually contacting multiple teeth. It helps stabilize the denture base and reduces stresses on abutment teeth.
3. Indirect retainers have auxiliary functions like preventing tilting of abutment teeth, stabilizing the major connector, and providing early indication of need to reline the denture. Their location and design depends on factors like arch, ab
Biomechancal principles in orthodontics /certified fixed orthodontic courses ...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
This document discusses occlusion in removable partial dentures. It outlines several types of occlusion including static and dynamic occlusion. Desirable occlusal contacts are bilateral contacts of posterior teeth in centric occlusion. Methods for establishing occlusion include direct apposition of casts if enough teeth remain, interocclusal records with posterior teeth, or using occlusal rims. The functionally generated path method can also be used to develop a dynamic occlusion record without an articulator. Proper occlusion is important for the success, comfort and longevity of removable partial dentures.
This document discusses various mechanical concepts relevant to orthodontics including forces, moments, couples, centers of resistance and rotation, and their applications. It begins by defining scalars, vectors, forces, and resultants. It then discusses centers of resistance, gravity, and rotation. Moment of force, couples, and torque are also defined. The document outlines Newton's laws and static equilibrium. It concludes by discussing force systems and their relationships to different types of tooth movement including tipping, translation, and rotation.
Biomechanical principles of orthodontics /certified fixed orthodontic courses...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
Thesis final /certified fixed orthodontic courses by Indian dental academy Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078
Similar to Segmented approach to simultaneous intrusion and space closure: Biomechanics of the three-piece base arch appliance.pdf (20)
Osteoporosis - Definition , Evaluation and Management .pdfJim Jacob Roy
Osteoporosis is an increasing cause of morbidity among the elderly.
In this document , a brief outline of osteoporosis is given , including the risk factors of osteoporosis fractures , the indications for testing bone mineral density and the management of osteoporosis
Hiranandani Hospital in Powai, Mumbai, is a premier healthcare institution that has been serving the community with exceptional medical care since its establishment. As a part of the renowned Hiranandani Group, the hospital is committed to delivering world-class healthcare services across a wide range of specialties, including kidney transplantation. With its state-of-the-art facilities, advanced medical technology, and a team of highly skilled healthcare professionals, Hiranandani Hospital has earned a reputation as a trusted name in the healthcare industry. The hospital's patient-centric approach, coupled with its focus on innovation and excellence, ensures that patients receive the highest standard of care in a compassionate and supportive environment.
One health condition that is becoming more common day by day is diabetes.
According to research conducted by the National Family Health Survey of India, diabetic cases show a projection which might increase to 10.4% by 2030.
Adhd Medication Shortage Uk - trinexpharmacy.comreignlana06
The UK is currently facing a Adhd Medication Shortage Uk, which has left many patients and their families grappling with uncertainty and frustration. ADHD, or Attention Deficit Hyperactivity Disorder, is a chronic condition that requires consistent medication to manage effectively. This shortage has highlighted the critical role these medications play in the daily lives of those affected by ADHD. Contact : +1 (747) 209 – 3649 E-mail : sales@trinexpharmacy.com
Our backs are like superheroes, holding us up and helping us move around. But sometimes, even superheroes can get hurt. That’s where slip discs come in.
Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
Histololgy of Female Reproductive System.pptxAyeshaZaid1
Dive into an in-depth exploration of the histological structure of female reproductive system with this comprehensive lecture. Presented by Dr. Ayesha Irfan, Assistant Professor of Anatomy, this presentation covers the Gross anatomy and functional histology of the female reproductive organs. Ideal for students, educators, and anyone interested in medical science, this lecture provides clear explanations, detailed diagrams, and valuable insights into female reproductive system. Enhance your knowledge and understanding of this essential aspect of human biology.
2. American Journal of Orthodontics and Dentofacial Orthopedics Shroff et al. 137
Volume 107, No, 2
continuous arch wire with tip back bends located
mesial to the first permanent molars may not
achieve intrusion because the full engagement of
the arch wire in the brackets of the anterior teeth
produces an undesirable force system. In these
cases, relative intrusion and flaring of the anterior
teeth are achieved, resulting in a modification of
the axial inclination of the anterior teeth that may
or may not be desirable.7
The selection of the point of application of the
intrusive force with respect to the center of resis-
tance of the anterior segment is important to pre-
cisely define the type of tooth movement that will
occur. True intrusion without axial inclination
change is obtained by directing the intrusive force
through the center of resistance of the anterior
teeth. Since displacement of the intrusive force
away from the center of resistance will result in
either flaring or uprighting of the incisors, careful
evaluation is necessary to monitor the axial incli-
nation of the anterior teeth during intrusion.8
In patients with proclined incisors, a continuous
intrusion arch tied at the midline cannot be used
because the force system generated tends to
worsen the axial inclination of the anterior teeth.
This is because the intrusive force is applied ante-
rior to the center of resistance of the incisors and
the moment consequently produced tends to fur-
ther flare the anterior teeth. One solution to this
problem is the use of distal extensions to the
anterior segment of wire where segmented intru-
sion springs can be hooked at a point where the
force acts at the estimated center of resistance of
the anterior segment.9
In many extraction cases the axial inclination of
flared anterior teeth is corrected first by retraction
of the incisors during initial space closure. When
no further retraction is possible because of the
presence of a deep bite and the reduction of the
overjet, intrusion is initiated to open the bite and
allow subsequent space closure. To achieve deep
overbite correction and close extraction spaces si-
multaneously,an appliance design needs to incor-
porate a variable point of application of the intru-
sive force, as well as a mechanism to direct the
intrusive force along the long axis of the anterior
teeth.
~NTRUSION- RETRACTION MECHANICS
The mechanism described here uses the prin-
ciples of the segmented arch technique.~° Seg-
mented arch mechanics uses different wire cross-
sections in a given arch rather than continuous
wires?~The advantage of using such an approach is
that it is possible to develop a precise and predict-
able force system between an anterior segment
(incisors) and a posterior segment (premolar and
molars) enabling pure intrusion of the anterior
teeth and control of their axial inclinations. Move-
ment of the posterior segment is also well con-
trolled. The appliance described enables the mag-
nitude of the moments and forces delivered to be
well controlled.12 Consequently, constant levels of
force can be maintained, and the moment to force
ratio (M/F) at the centers of resistance easily regu-
lated to produce the desired tooth movements.
Sometimes, intrusive forces on the upper ante-
rior teeth can be used to tip back the posterior
teeth while partially or completely correcting a
Class II buccal relationship. This article will em-
phasize the use of intrusive forces for retraction of
anterior teeth when intrusion is needed. The same
mechanism with higher forces can be used to tip
back buccal segments. If only anterior intrusion
and retraction is indicated, the following proce-
dures are generally followed.
After careful differential diagnosis and plan-
ning, treatment is initiated by aligning the teeth
included in the right and the left posterior seg-
ments. After satisfactory alignment of the premo-
lars and molars, passive segmented wires (0.017 x
0.025 stainless steel) are placed in the right and the
left posterior teeth for stabilization. A precision
stainless steel transpalatal arch (0.032 × 0.032)
placed passively between the first maxillary molars
consolidates the posterior unit now consisting of
right and left posterior teeth.13 Canines may be
retracted separately and incorporated into the buc-
cal segments14'~5 or left at their initial positions.
The anterior segment is aligned with a low stiffness
arch wire. The next stage of treatment will involve
the simultaneous intrusion and retraction of the
incisor segment. To design the appliance optimally
to obtain the desired force system, the position of
the center of resistance of the anterior teeth may
be estimated on a lateral cephalometric x-ray film.
In clinical situations where incisors are proclined,
the center of resistance of the anterior segment lies
further lingual to the incisors crowns.
A three-piece base arch is used to intrude the
anterior segment (Fig. 1). A heavy stainless steel
segment (0.018 x 0.025 or larger) with distal exten-
sions below the center of resistance of the anterior
teeth is placed passively in the anterior brackets.
The distal extensions end 2 to 3 mm distal to the
center of resistance of the anterior segment. The
intrusive force is applied with a 0.017 × 0.025
TMA tip-back spring (Ormco, Glendora, Calif.).
3. 138 Shroff et aL American Journal of Orthodontics and Dentofacial Orthopedics
February 1995
Fig, 1, Diagramaticrepresentation of three-piece base arch. The anterior segment extends 2 to 3 mm
distal to the center of resistance (CR) of the anterior teeth. Force acts through center of resistance.
Fig, 2. Diagram of three-piece base arch and Class I elastic
stretched from maxillary first permanent molar to distal exten-
sion of anterior segment. Class I elastics are needed to
redirect force parallel to the long axis of the incisor.
(The point of application of the intrusive force on
the distal extension of the anterior segment will be
discussed later.) The overall force system obtained
is an intrusive force anteriorly and an extrusive
force posteriorly associated with the tip back mo-
ment. The design of this appliance enables low-
friction sliding to occur along the distal extension
of the anterior segment during space closure (Fig.
2). The application of a light, distal force delivered
by a Class I elastic to the anterior segment is used
to alter the direction of the intrusive force on the
anterior segment. This appliance design allows the
application of the intrusive force to get true intru-
sion of the incisors along their long axes.
Fig. 3. A, Intrusive force through CR will intrude incisor along
line of action of this force. B, An intrusive force perpendicular
to the distal extension and through CR will have the same
effect as in A.
BIOMECHANICS
Anterior segment and direction of intrusive force
A number of different clinical situations may
arise and they should be thoroughly analyzed from
a biomechanical standpoint to determine the cor-
rect force system necessary to achieve the treat-
ment objectives.
An intrusive force perpendicular to the distal
extension of the anterior segment and applied
through the center of resistance of the anterior
teeth will intrude the incisor segment (Fig. 3). It is
possible to change the direction of the net intrusive
force by applying a small distal force. The line of
4. American Journal of Orthodonticsand Dentofacial Orthopedics Shroff et aL 139
Volume 107,No. 2
Fig. 4. A, Direction of net intrusive force through CR may be
changed by application of a small distal force. The resulting
intrusive force has a direction parallel to the long axis of the
incisor and is distal to CR. B, The net force can be directed
along the long axis of the incisor by applying the intrusive
force more anteriorly.
action of the resultant force will be lingual to the
center of resistance (Fig. 4, A) and a combination
of intrusion and tip back of the anterior teeth will
occur. Thus the line of action of the resultant force
can be made parallel to the long axis of the anterior
teeth if an appropriate distal force is combined
with a given intrusive force. To obtain a line of
action of the intrusive force through the center of
resistance and parallel to the long axis of the
incisors, the point of force application must be
more anterior and as close to the distal of the
lateral incisor bracket as possible (Fig. 4, B).
If the intrusive force is placed farther distally
and an appropriate small distal force is applied
(Fig. 5), intrusion and simultaneous retraction of
the anterior teeth occurs because of the tip back
(clockwise) moment created around the center of
resistance of the anterior segment consisting of
four incisors.
The distal force used in this intrusion retraction
system is of very low magnitude and is used to
redirect the line of action of the intrusive force.
One advantage of this system is the low magni-
tude of force applied on the reactive or anchorage
unit.
CLINICAL APPLICATIONS OF THE INTRUSION
RETRACTION MECHANICS
After treatment planning and developing treat-
ment objectives, the desired force system should be
determined with respect to the centers of resis-
Fig. 5. intrusive force can be directed along long axis of
anterior teeth and applied lingual to CR. The farther lingual the
force, the larger will be the moment acting to tip the incisors
lingually.
tance of the anterior and posterior segments. The
correct appliance design is chosen after careful
analysis of the clinical situation as discussed above.
Spacing or crowding among the incisors is usually
addressed early in treatment. When intrusion-
retraction mechanics are initiated, the anterior
teeth will intrude and tip back with progressive
space closure between the incisors and the canines.
Distal movement of the canines may occur as the
anterior segment contacts the canines. It is also
possible to retract the canines indMdually and to
include them in the buccal stabilizing segment of
wire before the initiation of intrusion-retraction
mechanics.
The force system generated on a molar is shown
in Fig. 6, A. A tip back moment is created during
intrusion of the anterior segment and will have a
typical value of 900 gm-mm for an intrusive force of
30 g and an interbracket distance of 30 mm. In Fig.
6, B, the force is redirected to be parallel to the
long axes of the incisors. Redirection and move-
ment of the intrusive force distally reduces the
moment on the buccal segment of teeth, and thus
reduces the tendency for its natural plane of occlu-
sion to steepen. Headgear is not usually required
for anchorage control, since a net tip back moment
is applied to the posterior segment. It is important
to monitor the anterior and posterior segments and
alter the force system if indicated. The resulting
force system can be modified by changing the
magnitudes and points of application of the intru-
sive and distal forces with respect to the center of
resistance of the anterior segment.
5. 140 Shroff et aL American Journal of Orthodontics and Dentofacial Orthopedics
February 1995
gl
ao turn -----"~1
gr
B
Fig. 6. Comparison of force system developed on molar with identical 30 gm intrusive forces. A,
Perpendicular to the occlusal plane. B, Parallel to the incisor long axis and lingual to CR. Note
reduction of the moment on the molar in B.
CASE REPORT
A 10-year, 9-month-old black female patient pre-
sented to the orthodontic clinic of UMAB Dental School
for treatment. The extraoral examination of the patient
showed good facial symmetry and a convex profile. Her
upper and lower lips were significantly procumbent with
respect to the soft tissue line Sn-Pg (subnasale-Pogo-
nion), and her interlabial gap was 9 mm at rest. She
presented with an acute nasolabial angle and a deep
labiomental fold.
Dentally, the patient displayed a Class II, Division 1
malocclusion in the late mixed dentition (Fig. 7). The
occlusogram confirmed 11 mm of spacing in the maxillary
arch. The anterior overjet was approximately 10 mm, and
the overbite was 65%, with palatal impingement. A deep
curve of Spee was present in the mandibular arch. The
patient had a Class II skeletal relationship primarily
because of a protrusive maxilla. The upper incisors were
labially tipped with respect to Frankfort horizontal, and
the lower incisors were in relatively normal position with
respect to the mandibular plane. The treatment objec-
tives included a reduction of the maxillary protrusion
both orthopedically and dentally, correction of the deep
overbite, and achievement of maxillary space closure.
Deep overbite was corrected by upper and lower incisor
intrusion. In the maxillary arch, rotation of the first
molars was achieved initially with a removable stainless
steel transpalatal arch. High-pull headgear wear was
initiated to correct the Class II occlusion and control the
vertical dimension. Simultaneous intrusion and retrac-
tion of the upper incisors was initiated after consolida-
tion of spaces in the maxillary arch between the lateral
and central incisors. Because of the proclination of the
maxillary incisors, a three-piece base arch was selected to
intrude them and a light distal force was applied to
redirect the intrusive force along their long axes.
As intrusion occurred, the incisors tipped back and
space closure was achieved simultaneously (Fig. 8). A
continuous intrusion arch tied to the central incisors
could not have been used in this situation because of the
proclined position of the upper incisors. The application
of an intrusive force anterior to the center of resistance
6. American Journal of Orthodontics and Dentofacial Orthopedics Shroff et aL 141
Volume 107, No. 2
Fig. 7. A, Intraoral view of occlusion: Frontal aspect. There is a 65% overbite with palatal impinge*
ment and an anterior overjet of 10 mm. B, Intraoral views of the occlusion, maxillary occlusal view.
The maxillary arch is symmetric with respect to the median Raphe and the soft tissue of the cheeks
and lips. The maxillary arch has 11 mm of spacing confirmed by the occlusogram. C and D, Intraoral
views of the right and left buccal occlusion showing a deep curve of Spee in the lower arch and a
Class II, Division 1 type of malocclusion in the late mixed dentition. The maxillary anterior teeth are
in tabioversion.
Fig. 8. A, Intraoral view of occlusion: Frontal aspect. After preliminary alignment of the molars and
premolars and separate retraction of the canines, a three-piece base arch was used to simulta-
neously intrude and retract the maxillary incisors. B and C, Intraoral views of the right and left buccal
occlusion: The tip back spring is carefully positioned and activated. The chain elastic is redirecting
the intrusive force along the long axes of the maxillary incisors.
7. 142 Shroff et al. American Journal of Orthodontics and Dentofacial Orthopedics
February 1995
Fig. 9. Intraoral views of finished occlusion: A, Frontal aspect. B, Maxillary occlusaq aspect. C,
Mandibular occlusal aspect. D and E, Right and left buccal aspects.
BEFORE
...... AFTER
Fig. 10. Superimposition of maxillary cephalometric tracings
before and after treatment showing movement of maxillary
incisors and molars during treatment. The intrusive force
applied on the maxillary incisors was redirected along their
long axis and simultaneous intrusion and space closure was
successfully achieved.
of the anterior segment would have flared the incisors
farther. The upper arch was finished with a continuous
arch wire (0.016 x 0.022 TMA). In the mandibular arch,
a removable lingual arch was placed, and intrusion of the
incisors was achieved with a continuous intrusion arch.
After the leveling of the curve of Spee, a continuous arch
wire (0.017 × 0.025 TMA) was used for finishing. The
three-piece base arch allowed precise control of the
delivered force system in the maxillary arch, since it was
possible to direct the intrusive force along the long axes
of the incisors and place it lingual to the center of
resistance. Maxillary and mandibular Hawley retainers
were delivered to the patient subsequent to debonding
(Fig. 9). A superimposition of maxillary cephalometric
tracings before and after treatment shows the movement
of the maxillary incisors and molars during treatment
(Fig. 10).
CONCLUSION
Deep overbite correction and space closure can
be simultaneously achieved with the three-piece
8. American Journal of Orthodonticsand Dentofacial Orthopedics Shroff et aL 143
Folume 107,No. 2
base arch intrusion mechanism in patients with
flared incisors. The force system delivered on the
anterior segment depends on the point of applica-
tion of the intrusive force and its direction. This
segmented approach to intrusion and retraction is
clinically advantageous because it allows simulta-
neous control of tooth movement in the vertical
and anteroposterior planes. The low load deflec-
tion rate of this appliance delivers a constant in-
trusive force, and the levels of force can be kept
low. The design of this appliance allows the clini-
cian to deliver a well-controlled, statically determi-
nate force system in which only minimal chairside
adjustments are required.
We extend our thanks to Mrs. Jo-Ann Walker for
preparing the manuscript.
REFERENCES
1. Burstone CA. Deep overbite correction by intrusion. AM J
ORTHOD 1977;72(1):1-22.
2. Burstone CJ, Baldwin JJ, Lawless DT. The application of
continuous force to orthodontics. Angle Orthod 1961;31:1-
14.
3. Burstone CA. The rationale of the segmented arch. AM J
ORTHOD 1962;48(11):805-21.
4. Burstone CJ. Mechanics of the segmental arch technique.
Angle Orthod 1966;36(2):99-120.
5. Dellinger EL. A histologic and cephalometric investigation
of premolar intrusion in the Macaca speciosa monkey. AM J
ORTHOD 1967;53:325-55.
6. Reitan K. Initial tissue behavior during apical root resorp-
tion. Angle Orthod 1974;44(1):68-82.
7. Begg PR, Kesling PC. Begg orthodontic theory and tech-
nique. Philadelphia: WB Saunders: 1977:203-14.
8. Smith RJ, Burstone CJ. Mechanics of tooth movement. AM
J ORTHOD 1984;85(4):294-307.
9. Romeo DA, Bnrstone CJ. Tip-back mechanics. AM J
ORTHOD 1977;72(4):414-21.
10. Bnrstone CJ. Applications of bioengineering to clinical
orthodontics. In: Graber TM, ed. Current orthodontic con-
cepts and techniques, I. 2rid ed. Philadelphia: WB Saunders,
1985.
11. Burstone CJ. Variable modulus orthodontics. AM J
ORTHOD 1981;80(1):1-16.
12. Burstone CJ, Koenig HA. Optimizing anterior and canine
retraction. AM J ORTHOD 1976;70:1-20.
13. Burstone CJ, Manhartsberger C. Precision lingual arches-
passive applications. J Clin Orthod 1988;22(7):444-51.
!4. Burstone CJ. The segmented arch approach to space clo-
sure. AM J ORTHOD 1982;82(5):361-78.
!5. Manhartsberger C, Morton J, Burstone CJ. Space closure in
adult patients using the segmented arch technique. Angle
Orthod 1989;59:205-10.
Reprint requests to:
Dr. Bhavna Shroff
Department of Orthodontics
University of Maryland Dental School
666 West Baltimore St.
Baltimore, MD 21201
AAO MEETING CALENDAR
1995 -- San Francisco, Calif., May 12 to 17, Moscone Convention Center
(International Orthodontic Congress)
1996 - Denver, Colo., May 11 to 15, Colorado Convention Center
1997 - Philadelphia, Pa., May 3 to 7, Philadelphia Convention Center
1998 - Dallas, Texas, May 16 to 20, Dallas Convention Center
1999 - San Diego, Calif., May 15 to 19, San Diego Convention Center
2000 - Chicago, II1., April 29 to May 3, McCormick Place Convention Center