Torque when, where, how?
Importance of torque
Biomechanics in torque
Torque expression in slot 0.018 and 0.022
Expression of torque
Mode of ligation and torque
Types of torque
- Passive
- Active
Factors affect torque
Torque with different appliances
Torque in base and face
Torque prescription in different techniques
Class II malocclusion and torque
Torque control in different treatment steps
Differential torque
Torque clearance
Intrusion and torque
Torque and intra-oral elastics
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Definition
Types of rotation
Etiology of rotation
Winging and counter winging rotation
Advantages of derotation
Biomechanics of rotation correction
Methods of correction rotation
Management of molar derotation
Retention of rotated tooth
Methods to prevent relapse
Active retention
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a Topic from Chapter 9 of Proffitt's Orthodontics Edition 6, including the Mechanical Principles in Orthodontics.
In this Slide terminology of Biomechanics in Orthodontics is defined along with effects of wide & narrow bracket, with brief description of Moment & Couple used in Orthodontic Tooth Movement.
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Extra-oral forces
And
Appliances
Prepared by:
Dr. Mohammed Alruby
Definition
Philosophy
History and development
Classification of extra-oral forces
Advantages of extra-oral forces
Disadvantages of extra-oral forces
Uses of extra-oral forces
Headgear
Appliance enhanced the action of headgear
Protraction appliances
Types of reversed headgear
Chin cup appliance
Orthopedic correction of class III
Orthopedic correction of open bite
Orthopedic correction of class II
Retention after orthopedic correction
Definition
It is a force derived from an extra-oral appliance that uses the forehead, the top of the head or the back of the neck as anchorage to apply forces to the dental or basal arch. It may be orthodontic force or orthopedic force to move the dentition, or restrict or redirect the growth respectively.
Philosophy:
The philosophy beyond the use of extra-oral force is based upon the old concept that, (the application of appreciable amount of force against the growing bone con modify or alter the direction of bone growth and consequently alter the shape and position of the bone
= the well-known best examples are the induced skull deformation in Colombia –India and feet deformation in Chinese girls
History and development:
Appliances resembling chin cups have been in use since the early 1800's. According to Graber, the early attempts with the chin cup were not successful because of incomplete knowledge of mandibular and facial growth, its use on non-growing patients, and an inadequate understanding of the forces generated by the chin cup.
1802: Cellier and Josef Fox in 1803, utilized chin caps in combination with bite blocks to correct the “underslung chin”
1866: Norman Kingsley introduced extra-oral head cap anchorage or force for maxillary distal movement
1880: Kingsley described an appliance that could influence the position of the dentition in upper jaw with the aid of extra-oral forces
1887: E.H.Angle recommended the use of occipital bandage in treatment of maxillary protrusion
1904: Jackson was first describing the facial mask
1892: headgear appliance was originally designed by Kingsley
1920: Angle and his followers were convinced that class II and class III elastics not only moved teeth but cause a significant skeletal changes: stimulate growth of one and restrain growth for the other so we not need to use any extra-oral force just wait until permanent dentition is completed
1923: Case recommend the use of extra-oral force against maxilla in treatment of class II and class I maxillary protrusion
1947: Kleohn, presented his treatment results with cervical neck strap, subsequent to this report, many other variation of the headgear appliance were presented
1960: Delaire facemask
Classification of extra-oral force appliances according to uses
The extra-oral pull is generally applied bilaterally, for three main purposes:
(1) as a restraining force
(2)
Effects of extra-oral appliances
And
Forces
Prepared by
Dr. Mohammed Alruby
Factors affect extra-oral force
Studies of maxillary protraction force
Results of extra-oral force
Effects of extra-oral appliances
The effects of extra-oral forces on dentofacial structure depend on the following factors:
- Direction of force
- Magnitude of force
- Duration of force
- Growth
- Patient cooperation
1- Direction of force:
Kloehn 1953, Gould 1975, Greenspan 1970, Merrifield and Cross 1970, and Worms et al 1973, all give an adequate description for the direction of force application and their effect on maxillary molar position, tipping, bodily, extrusion, intrusion movement
The direction of force should be adjusted according to the patient needs and objective of treatment as:
- When bodily movement is required, the force should pass through the center of resistance of molars (at the tri-furcation of roots) and the extra-oral tube should be placed gingivally as possible
- When bodily displacement of maxilla is required, the force should pass through the center of maxillary resistance (zygomatic bone)
- When extrusion of molars is required, (in case of deep bite) the force should pass below the center of resistance (below the level of occlusal plane)- cervical headgear is the best choice
- When intrusion is required (open bite cases) the force should pass above the level of occlusal plane
- In occipital headgear, the vector of force may pass through the center of resistance of 1st molar and thus causes: -------------- distal translation of 1st molar
- If the vector of force passes above the center of resistance causing:
a- Distal root torque
b- Mesial crown tipping
c- Intrusion of maxillary 1st molar ---- that, ----- closing the bite and same can occurs in the vertical or high pull headgear
== the direction of force can be determined by adjusting the outer bow in relation to the occlusal plane or center of resistance
== the best method for recording the force direction is the lateral cephalometric radiograph with the appliance in place, then the outer bow is adjusted in relation to the occlusal plane and the center of resistance of tooth or jaw
= in Kloehn’s face bow, the direction of force is 25 – 30 degree below the occlusal plane so that, the vector of force is far away from the center of resistance of 1st molars, thus cervical headgear causes distal tipping and extrusion of 1st molars and open bite
The direction of force depends upon the following variables:
I- Vertical position of the outer bow relative to the center of resistance:
= force applied by oblique headgear passing through the center of resistance will cause translation of the tooth and make intrusion at the same time
= force applied by oblique headgear passing above the occlusal plane
but below the center of resistance will cause:
a- Distal crown tipping, mesial root torque
b- Extrusion of mesial marginal ri
Characteristic of light
History
Laser physics and properties
Component of laser
Classification of laser
Biological effect of laser
Laser effect on dental tissues
Laser safety in dental practice
General application of laser
Personal protective equipment
Types of laser intensity in orthodontics
Uses of laser in orthodontics
Effect of laser in orthodontics
Introduction
History
Classification of maxillary fractured Lefort
Special consideration for orthognathic surgery
- Patient selection:
Age of patient
Assessment of patient motivation and expectation
The nature and severity of skeletal dysplasia
Systemic evaluation
- Patient evaluation:
(1) General evaluation
(2) Esthetic evaluation
(3) Functional evaluation
(4) Radiographic evaluation
a- Ceph ---
PA
Lateral: ------ soft and hard
b- Panorama
c- CBCT
d- Periapical
Protocol for basic orthognathic record collection
Treatment planning
- Time of treatment
- Objective of orthodontic treatment
Pre-surgical
Post-surgical
- Sequence of treatment:
Pre-surgical phase
Orthodontic in theatre
Post-surgical treatment
Surgery without orthodontics
Stability and clinical success
complications
Medical glossary
Prepared by:
Dr. Mohammed Alruby
Medical glossary
Aberrancy: occurring or developing away from the normal situation
Acantholysis: loss of coherence between epithelial cells due to degeneration of desmosomes (intercellular bridge) this will lead to the formation of intra-epithelial clefts, vesicle and bullae
Acanthosis: epithelial hyperplasia, mainly of the stratum spinosum, leading to increase thickness of the stratum granulosum due to increased number of cell layers of prickle cells
Achondroplasia: an autosomally inherited disorder characterized by abnormality of conversion cartilage into bone predominantly affecting the epiphyses of long bones, leading to retarded growth at the epiphyses and resulting in dwarfism with short extremities but normal trunk
Acidogenic: referring to organisms capable of producing acid
Aciduric: referring to organisms capable of surviving and metabolizing under highly acidic conditions
Acquired: a term used to describe a condition, habit or other characteristic which is not present at birth, which developed in the individuals by reaction to some environmental factor (to acquire is to obtain)
Agenesis: failure of formation leading to absence of a part or organ
Aglossia: failure of formation leading to absence of the tongue
Agnathia: absence of the jaw, usually the lower jaw, usually accompanied by approximation of the ears
Amyloid: pertaining of starch, having the characteristic of starch. A protein compound of albumin and chondroitin sulphate which resembles starch in appearance and may be pathologically deposited in certain tissues
Anaplasia: atypical differentiation or lack of differentiation of epithelial cells occurring in the malignant disease. Anaplastic cells have large, hyperchromatic, irregularly shaped nuclei and frequently show a typical mitosis.
Aneuploidy: an abnormal number of chromosomes in a nucleus. This usually arise from failure of paired chromosomes or sister chromatids to disjoin at anaphase of cell division
Aneurysm: circumscribed dilatation of an artery
Aneurysmal: relating to an aneurysm. The term applied to a type of cyst that produce bony expansion simulating the expansion of an artery produced by a vascular aneurysm
Angiogenesis: development of blood vessels
Angioma: a swelling or mass due to proliferation with or without dilatation of vascular channels
Anhydrosis: absence of sweating due to absence of sweat glands
Ankyloglossia: tongue tie, usually due to a short lingual frenum or one attached too near the tip of the tongue, may be due to failure of separation of tongue from the floor of the mouth during embryogenesis
Ankylosis: stiffening or fixation of a joint as a result of a disease process
Anodontia: absence of teeth
Anomaly: deviation from the normal, anything structurally unusual or irregular
Antigen: a substance that can induce an antibody response
Antimongoloid slant: an obliquity of the palpebral fissures laterally
Muscles
Part 3
Prepared by
DR. Mohammed Alruby
Development of oropharyngeal function
Neuromuscular regulation of jaw positions and functions
Muscles controlling mandibular postures
- Muscles of mastication
- Submandibular muscles
- Extensor and flexor muscles of neck
Positions of mandible
Some clinical implications
Development of oropharyngeal function
1- Prenatal maturation:
= During prenatal life, the neuromuscular system does not mature evenly, it is not accidentally that the orofacial region matures a head of limb region
= In human fetus, by about the 8 week, generalized uniform reflex movement of entire body can be elicited by tactile stimulation
Diffuse spontaneous movements in response to as yet unidentified stimuli have been observed as early as 9.5 weeks
Localized specific and more peripheral responses cannot be produced before 11 weeks, and at this time, stimulation of the nose-mouth region causes lateral body flexion
By 14 weeks, the movements have become much more individualized. Stimulation of the mouth area, the general bodily movements no longer are seen but instead facial and orbicular muscle response are produced
Stimulation of the upper lip causes the mouth to close and often deglutition occurs
Respiratory movements of the chest and abdomen are seen first at about 16 week
The gag reflex has been demonstrated in human fetus of 18.5 weeks. By 25v weeks, respiration is shallow but may support life for few hours
Stimulation of the mouth at 29 weeks’ menstrual age has elicited sucking through complete suckling and swallowing is not thought to be developed until at least 32 week
2- Neonatal oral functions:
a- The mouth as sensory instrument:
= At birth, the orofacial region is a very active perceptual system, the infant finds the mouth nipple = more tactile than the visual sensation
At birth, the tactile sense already is more highly developed in the lips and mouth than in the fingers
= The neonate’s slobbers, drools, chew his toe, sucks his thumb and discovers the gurgling sounds can be made with his mouth
= oral function of the neonate is guided primarily by local tactile stimuli, particularly those from the lips and anterior part of the tongue
= the posture’s of neonate’s tongue is between the gum pads and often for enough forward to rest between the lips, where it can perform its role of sensory guidance more easily
= the mouth of infant is used for many purpose, the perceptual functions of the tongue, lips, and facial skin are mingled with the sensory function of taste, smell and jaw position.
= the sensitivity of tongue and lips is greater than other area of the body and the sensory guidance for oral functioning, including jaw movements is from remarkably large area
b- Infant suckling and swallowing:
= Infant suckling and swallowing have been the subjects of much research due to the effectiveness of these activities is a good indication of the neurologic ma
Muscles
Part 2
Prepared by:
Dr. Mohammed Alruby
Muscle function and malocclusion
Muscle development and skull form in relation to function
Facial balance, muscle balance, and orthodontic therapy
EMG response of muscles
Myofunctional therapy
Basic concepts of neuromuscular physiology
Muscle function and malocclusion
Muscle function is a factor in shaping the dental arches and is important in maintaining the stability of the teeth following orthodontic treatment
Muscle fibers contract in response to change in electrical potential of its investing membrane, proprioceptors located in the muscles and the periodontal membrane make possible a high degree of accuracy in bringing the teeth in contact
Class II malocclusion:
The muscle function is usually normal in class I malocclusion with the exception of class I Openbite
In class I cases, the teeth are in state of balance with environmental force, although the actual measurements of tongue and lip forces showed that, they are not equal at any area during particular function
Class I openbite:
= Usually caused by thumb sucking, retained infantile tongue swallowing or both, the child begins with finger habits of sufficient intensity and duration to deform the maxillary anterior segment forcing the incisors labially and allowing the tongue to move farther in forward direction
= the tongue continues to thrust instead of entering the transitional phase, a large part of this activity may be compensatory or adaptive to produce anterior seal with lower lip during swallowing
=such activity accentuates the openbite, prevent complete eruption of incisors and increase the overjet to the extent that the lower lip may cushion behind the maxillary incisors during rest and functional movements
- The upper lip become more hypotonic
- The lower lip become hyperactive
- Chin puckering can see with each swallowing
= the hyperactive mentalis muscle, retroclined, imprecate and flatten the mandibular anterior segment
= the tongue drop downward and mouth breathing become a dominate pattern, as the tongue thrust forward, it elongates in shape thus alter the balance with buccinator mechanism resulting in:
- Collapse of posterior segment
- V-shaped palate
- Buccal cross bite
This occurs also as a result of molding effect of the tongue upon the hard palate
Mouth breathing:
Is the good explain for these changes a result of underdeveloped nasopharyngeal structures and subsequently maxillary deficiency
Class II division 1 malocclusion:
= In contrast to class I class II div 1 involve an abnormal muscle function from beginning
= As abnormal muscle function in class II div 1 is a compensatory or adaptive and is secondary to skeletal relationship
= Because of large overjet, there is lack of the lip seal during rest and various functions so, mouth breathing is developed
= Some individuals translate the mandible forward to effect lip seal and to improv
Muscles
Part 1
Prepare by
Dr. Mohammed Alruby
Histology of muscles
Physiology of muscles
Muscles development
Orofacial muscles
- Facial muscles
- Jaw muscles
- Portal muscles
Methods of studying muscles
Muscle changes during growth
Muscle function and facial development
Histology of muscles
The structural and functional unit of the muscles is the muscle fiber
Muscle fiber: elongated cylinder measure about 10 to 80 microns in thickness and from 1 to 15cm in length
= Each muscle fiber contains an acidophilic granular cytoplasm (sarcoplasm) that rich in:
Glycogen, mitochondria, Golgi apparatus, protein (actin, myosin, tropomyosin),
Large number of myofibrils (sarcostyles) which responsible for muscle contraction
= the muscle fiber is covered by thick membrane called (sarcolemma) and surrounded by CT called (endomysium)
= the muscle fibers are coalescing together to form bundles; each bundles are covered by C T septa called perimysium
= the muscle bundles are coalescing together to the whole muscle which is covered by CT fascia called epimysium, these CT contain: blood vessel, lymph vessel, and nerves, that firmly attach the muscle bundles to each other and attach the whole muscle to its tendon
= the myofibrils (sarcostyles)are the contractile units of the muscle, in skeletal muscle they are transversely striated due to presence of dark and light bands
The dark bands are formed of thick myosin filaments rich in Ca, the light bands are formed of thin actine filaments rich in water, there is a pale line in at the center of dark band called (Henesen’s disk), There is dark line at the center of light bands called (Krauses membrane) or Z line
The distance between the two lines called (sarcomere) which is a contraction unit of the muscle.
During the muscle contraction there the Sarcomere is shortened due to sliding of the light bands over the dark bans. The energy required for contraction is derived from transformation of ATP ------ ADP
Physiology of muscles:
Man has 639 muscles, composed of 6 billion muscle fibers, each fiber has 1000 fibrils, which means that there are 6000 billion fibrils at work at one of time or another.
Elasticity: muscle can be stretched behind its original length and return to the original shape after relaxation (normal muscle can be elongated about 6/10 of its length
Contractility: it is the ability of muscle to shorten its length under nerve impulse, this contraction is stimulated by acetyl choline, glycogen is partially oxidized to provides energy and lactic acid that carried away by blood stream
Excessive accumulation of lactic acid can produce fatigue
Isometric contraction: (stretching): the muscle is simply resisting the external forces without actual shortening
Isotonic contraction: there is an actual shortening of the muscle, the strength of isometric contraction is much greater than that of isotonic contraction as the stre
diagnostic aids part 3, photograph and radiograph.docxDr.Mohammed Alruby
Diagnostic Aids
Part 3
{Radiographs and Photographs}
{BMR and EMG}
Prepared by
Dr. Mohammed Alruby
Radiographs
Means: A procedure that uses a type of high-energy radiation called x-rays to take pictures of areas inside the body. X-rays pass through the body onto film or a computer, where the pictures are made
Types:
Intra-oral radiographs:
Periapical radiographs:
It is necessary for any orthodontic diagnosis for the following reasons:
The pattern and amount of root resorption of deciduous teeth
Presence or absence of permanent teeth, their size, shape, position and relative state of development
Congenital absence of teeth or presence of supernumerary teeth
Character of alveolar bone, lamina dura, and periodontal membrane
Morphology and inclination of permanent teeth roots
Pathological oral condition such as thickened periodontal membrane, periapical infection, root fractures, cysts, retained deciduous teeth
Abnormal path of eruption of permanent teeth
Malposition of individual as: rotation, which requires a larger space on the arch
Very useful in mixed dentition analysis
Recognition of exact position of impacted tooth by using method of parallax: that determine whether the unerupted tooth is located labially or palatally. Two periapical radiograph is taken with the film in the same position in each exposure, but the tube is moved in second exposure about 10cm. if the impacted tooth is moved in the same direction as the tube so the tooth is impacted palatally and the reverse is versa.
Bit-wing radiographs:
Is used mainly for detection of proximal cries, but it is of little value in orthodontic diagnosis
Occlusal film:
Occlusal projection is useful to locate the supernumerary teeth at the midline (mesiodens) and to determine accurately the position of impacted maxillary cuspids
Extra-oral radiographs:
Cephalometric radiographs:
Lateral cephalometric radiographs
PA cephalometric radiographs
Lateral oblique cephalogram:
The patient is directed by 45 degree and take the shot
Since dentofacial structure will be superimposed in the true lateral cephalometric projection, the lateral oblique direction is designed to gives a more accurate recording of the actual tooth position in either the left or right buccal segments depending on which side is approximately perpendicular to the central rays
The lateral oblique cephalogram combines most of advantages of the lateral views, intra-oral periapical survey and panoramic radiograph plus a standard cephalometric registration that makes possible measurements of bone size and eruptive movements so it is of particular size in analysis of developing dentition
Submental vertex cephalometric:
Is used to assess mandibular asymmetry in the transverse and anterior-posterior plane. It is an important aid in detecting asymmetry in the symphysis, body, ramus, and condyle of the mandible. In many cases of asymmetry, this view is important for evaluation of mandibular displacemen
Diagnostic Aids
{Study cast, Cast analysis}
Part (2)
Prepared by
Dr. Mohammed Alruby
Study cast
Definition: it is a positive replica of the teeth and their supporting structure, it should be reproducing accurately all the anatomical details of the teeth, alveolar process, mucobuccal folds, palate, frenal attachment as well as the exact relationship of the mandibular to the maxillary dental arch
Good models begin with good impression, orthodontic impression should displace the lips and cheeks, so that, the full depth of mucobuccal sulci is recorded. This over extension of impression is obtained by building up the tray periphery with wax or by using special orthodontic trays
The position of maximum intercuspation should be recorded by getting the patient to bite through softened wax, that is important for:
1- Recording the proper intercuspation specially in cases of poor occlusal fit due to extraction or tongue thrust. So it is wise to check the occlusion in the mouth and compare it to the occluded cast to insure that the model is correctly articulated
2- Trimming of the upper and lower cast together without change in occlusal relationship or fracture of teeth
Occlusal registration of wax bite:
= the position of maximum intercuspation as well as the centric relation must be registered
= a piece of soft wax large enough to cover the occlusal surface of maxillary teeth is shaped to the form of maxillary arch, then gently pressed against the maxillary teeth
= the patient instructed to relax and mandible is guided to most posterior and superior position of condyle within the glenoid fossa, while the teeth come into occlusion
= if there is shifting during closure due to cuspal interference, this mean that the occlusal position is not coincide with centric occlusal position, in this case, in this case two bites are taken one for usual occlusal position, and the other for centric occlusion
Ideal requirements of orthodontic study models:
1- They are symmetrical and pleasing to the eye and so that a symmetrical arch form can be readily recognized
2- The dental occlusion shows by setting the models on their backs
3- Clean, smooth, bubble free, with sharp angles where the cuts meet
4- Glossy in finish.
Trimming of study models:
There are two types of trimming:
a- Angle trimming:
The purpose of angle trimming is to added an appropriate proportional bases to the anatomical portion of dental casts which is important in:
- Registration of centric occlusion by having the posterior and lateral border of both casts on the same plane, so that cast may place on any side without change in its relationship
- Giving an idea about the relationship of the teeth to the alveolar process and basal bone
- Giving harmonizing appearance of the right and left sides of the cast which any a symmetry can be detected
- Detection of occlusion from any side, anterior as well as lateral sides
Principles:
1- The floor of the base is trimmed
diagnostic aids part 1 diagnosis, examination, BMR, EMG.docxDr.Mohammed Alruby
Introduction:
Proper treatment plane depends on prompt diagnosis, good clinician should have a bird’s eyes to first identify the problem and find its etiology
Definitions:
= Grabber and Rackosi: defined diagnosis as:
Recognition and systemic designation of anomalies, the practical synthesis of the finding, permitting therapy to be planned and identification to be determined
=a continuous evaluation process in orthodontics starting right from the first interaction with the patient continuing through different stages till end of treatment and course follow up visits
Goal of orthodontic diagnosis:
Is to produce a comprehensive description of the patient’s problem and then to synthesis the various elements of description into a rational problem list
Diagnostic aids:
Data required for orthodontic diagnosis are derived from routine essential diagnostic aids and also from supplemental aids when needed, Graber categorized the diagnostic aids into essential and supplemental aids
Essential:
- Case history
- Study models
- Certain radiographs: periapical, bite wing, panoramic radiograph
- Facial photographs
- Intra-oral photographs
Supplemental:
- Specialized radiographs: occlusal of maxilla and mandible, lateral cephalogram
- Hand &wrist radiograph
- Electromyography
- Endocrine test
- Basal metabolic rate
Case history:
Complete case history includes all the relevant information derived from the patient and parents and essential for planning
Personal details:
Name:
The patient’s name should be recorded for the purpose of identification and communications
Calling the patient by his/her name not only establishes a good report but also imparts confidence in the patient mind about treatment providers
In case of children, it might help to know their pet problems
Age:
= certain malocclusion occurring during growth period are transient and self-correcting
= growth modification procedures such as functional appliances can be carried out during growth periods
= surgical respective procedures such as orthognathic surgery are best carried out after cessation of growth
= chronological age is important for the maintaining of shedding and eruption time tables as well
Gender:
= recording gender of the patient is important for treatment planning, females are observed to precede males in growth related events such as onset of growth spurt, eruption of the teeth and onset of puberty
= gender may also have a bearing on patient’s compliance toward certain types of orthodontic treatment
Occupation and address:
Occupation of patient / or parents gives an idea about socioeconomic condition which might affect the selection of orthodontic appliances and can give an idea about awareness
Address of patient determine the sociality of the patient and this effect on the treatment because some countries have normally bi-maxillary protrusion and also determine the awareness of patient about treatment and oral hygiene
Patient behavior:
Behavior of patient depend on: patient
Smile: is the most pleasant and wanted expression by each one of us.
Smile: is amused facial expression with the corner of mouth turned up and exposed front teeth
Facial expression, postures of lips, occlusion and arrangement of teeth, buccal corridor, shape of teeth, gingival color, texture, contour and other several aspects constitute component of smile
Most of patients come to us to improve their smiles, the orthodontic studies stress on skeletal structure than soft tissue structure, and the smile still receives relatively little attention
Nature of smile:
1- Posed smile: voluntary, static, sustained, social smile not elicited by an emotion
2- Un-posed smile: spontaneous, involuntary, dynamic, natural, and not sustained characterized by greater lip elevation
Smile types: smile styles:
1- Commissures smile: the corner of the mouth turned upward called Monalisa smile
2- Cuspid smile: the upper lip is elevated, the entire lip rises like a window shade
3- Complex smile: the upper lip moves superiorly as in cuspid smile and lower lip moves inferiorly
Evaluation of posed smile:
variables Normal smile Not good smile
Smile arc Consonant Non consonant
Smile index Average Increased / decreased
Morley’s ratio 75 – 100% (normal) Disturbed
Buccal corridor Average Obliterated / excessive
Smile line Average High / low
Occlusal plane No canting Canting occlusal plane
Important definitions:
Smile arc:
the curvature formed by an imaginary line tangent to the incisal edges of the teeth, modified in varying degree of curvature in relationship to the lower lip
Range: from no curvature to an accentuated curvature was in relation to the lower lip, so quantification differed for each model
Buccal corridor:
the amount of dark space displayed between the facial surfaces of the posterior teeth and the corner of the mouth, calculated as the total dark space on both sides of the mouth as a percentage of the total smile width
Range: from 6% to 26.5 in approximately 0.5% increments
Maxillary gingival display or gummy smile:
The amount of gingival show above the central incisor crown and below the center of the upper lip. Negative number indicate gingival exposure. Positive number indicate tooth overlap by the lip
Range: from 1mm of gingival display (-1) to almost 7mm of tooth coverage for the female models, and approximately 2mm of gingival display (-2) to 6mm tooth coverage for male models
The variation between the models was due to differences in sizes and coordinating the images for different faces
Maxillary midline to face:
The relationship of maxillary dental midline (measured between the central incisors) to the midline of the face, defined by the center of the philtrum and the facial midline
Range: the maxillary midline was moved to the left of the face in approximately 0.25 mm increments. The right and left buccal corridor was maintained throughout the movement of the dentition. The maximum deviation show is 6mm
Maxillary to mandibular mid
orthodontic biology of tooth and supporting structure.docxDr.Mohammed Alruby
The goal is to examine the relationship between orthodontic biomechanics and the underlying biological process
When orthodontic force is applied to the crown of the tooth it is transmitted through the roots to the periodontal ligament and alveolar bone
Histology of supporting structure:
- Periodontal ligament
- Alveolar bone
I- Periodontal ligament:
A- Cellular component:
• Forming cells:
Osteoblast: bone forming cells
Fibroblast: PDL fibers forming cells
Cementoblast: in layer adjacent to the roots
• Resorptive cells:
Osteoblast: large cell rich acid phosphatase enzyme that demineralize the bone and disintegrate of organic matrix
Fibroblast: disintegrate fibers
Cementoblast: resorb cementum
• Progenitor cells: undifferentiated mesenchymal cells UMC: small cells with closed nucleus and little cytoplasm & monocytes
• Epithelial rest of malassez: arise as a result of breakdown of epithelial root sheath at the time of cementogesis
• Defensive cells: as macrophages & mast cells
B- Periodontal fibers:
1- Collagen fibers:
the main bulk of PDL fibers and found in 5 groups:
- Alveolar crest group: from cervix to alveolar crest
- Horizontal group: from cementum to bone horizontally
- Oblique group: the main attachment that run obliquely from cementum to bone in an apical direction
- Apical group: circumscribed the apex and responsible for resistance to rotation
- Inter-radicular group: inter-mediate plexus, observed midway between bone and root
- Supra-alveolar group:
Dento-gingival
Dento-periosteal
Transeptal
Circular
Alveolo-gingival
2- Oxytalan fibers:
Immediate elastic fibers that resist dissolution by acids unlike collagen
Run from cementum or bone to blood vessels
Play a role in supporting the blood vessels against distortion and compressive strain
c- Ground substances:
organic matrix surrounding the PDL elements, it is chemically composed of CHO linked with protein. CHO- protein complex commonly divided into two groups: proteoglycan and glycoprotein
ground substances of periodontal ligament is in a continuous state of remodeling process
d- Neurovascular elements:
myelinated: pain sensation
non-myelinated: blood vessels wall
PDL functions:
- Supportive
- Nutritive
- Remodeling
- Sensory
II- Alveolar bone:
= in human, marrow spaces are rare in the buccal and lingual plates, these spaces decreased with age
= wider spaces are lined with a layer of fenestrated compact bone when PDL fibers are anchor these fibers is called bundle bone
N: B:
= collagen turn over in PDL is higher 4 times than skin and 2 times than gingiva and this due to the forces in PDL is multi-directional takes vertical and horizontal component
= lake of marrow spaces implies that bone resorption takes more time so that the tooth movement in mesial and distal direction occur more than labial and lingual sides
= the resorptive cells increase as the marrow spaces increase
N: B:
The new deposited tissue during tooth migration have 3 stages:
Stage I osteoid:
is the pr
Successful infection prevention program
A successful infection prevention program depends on:
1-Developing standard operating procedures.
2- Evaluating practices and providing feedback to dental health care personnel (DHCP).
3- Routinely documenting adverse outcomes (e.g., occupational exposures to blood) and work-related illnesses in DHCP.
4- Monitoring health care associated infections in patients.
Standard Precautions
Standard Precautions: are the minimum infection prevention practices that apply to all patient care, regardless of suspected or confirmed infection status of the patient, in any setting where health care is delivered. These practices are designed to both protect DHCP and prevent DHCP from spreading infections among patients.
Standard Precautions include:
1- Hand hygiene.
2- Use of personal protective equipment (e.g., gloves, masks, eyewear).
3- Respiratory hygiene / cough etiquette.
4- Sharps safety.
5- Safe injection practices (i.e., aseptic technique for parenteral medications).
6- Sterile instruments and devices.
7- Clean and disinfected environmental surfaces.
Each element of Standard Precautions is described in the following sections. Education and training are critical elements of Standard Precautions, because they help DHCP make appropriate decisions and comply with recommended practices.
1- HAND HYGIENE:
1- Perform hand hygiene.
a. When hands are visibly soiled.
b. After bare hand touching of instruments, equipment, materials, and other objects likely to be contaminated by blood, saliva, or respiratory secretions.
C. Before and after treating each patient.
d. Before putting on gloves and again immediately after removing gloves.
2. Use soap and water when hands are visibly soiled (e.g., blood, body fluids); otherwise, an alcohol-based hand rub may be used.
2- PERSONAL PROTECTIVE EQUIPMENT (PPE):
1- Provide sufficient and appropriate PPE and ensure it is accessible to DHCP.
2- Educate all DHCP on proper selection and use of PPE.
3- Wear gloves whenever there is potential for contact with blood, body fluids, mucous membranes, non-intact skin or contaminated equipment.
a- Do not wear the same pair of gloves for the care of more than one patient.
b- Do not wash gloves. Gloves cannot be reused.
c- Perform hand hygiene immediately after removing gloves.
4- Wear protective clothing that covers skin and personal clothing during procedures or activities where contact with blood, saliva, or OPIM (other potential infectious materials) is anticipated.
5- Wear mouth, nose, and eye protection during procedures that are likely to generate splashes or spattering of blood or other body fluids.
6- Remove PPE before leaving the work area.
3- RESPIRATORY HYGIENE / COUGH ETIQUETTE:
1- Implement measures to contain respiratory secretions in patients and accompanying individuals who have signs and symptoms of a respiratory infection, beginning at point of entry to the facility and conti
The way to infection control in dental clinics
Introduction:
The unique nature of dental procedures, instrumentation and patient care settings require specific strategies directed to the prevention of transmission of diseases among dental health care workers and their patients.
Disease: impairment of normal functioning, manifested by signs and symptoms.
Infection: state produced by an infected agent in or on a suitable host, host may be or may not have signs or symptoms.
Carrier: individual harbors the agent but does not have symptoms (person can infect others).
Factors that allow or aid infection:
= The presence of pathogenic micro-organisms.
= There must be a portal of entry via which the organisms invade and colonize the susceptible host.
Medical history
A thorough medical history should be taken and up-dated at subsequent examinations. Medical history screening is essential in alerting the clinician to medical problems that could, in conjunction with dental treatment, adversely affect the patient.
Protective measures
Protection can be achieved by a combination of immunization procedures, use of barrier techniques and strict adherence to routine infection control procedures.
(a) Immunization:
All dental health care workers are advised to be immunized against HBV unless immunity from natural infection or previous immunization had been documented
(b) Protective coverings:
=Uniforms:
Uniforms should be changed regularly and whenever soiled. Gowns or aprons should be worn during procedures that are likely to cause spattering or splashing of blood.
=Hand protection:
Gloves must be worn for procedures involving contact with blood, saliva or mucous membrane. A new pair of gloves should be used for each patient.
If a gloves damaged, it must be replaced immediately. Hands should be washed thoroughly with a proprietary disinfectant liquid soap prior to and immediately after the use of gloves.
Disposable paper towels are recommended for drying of hands.
Any cuts o abrasions on the hands or wrists should be covered with adhesive waterproof dressings at all times.
=Protective glasses, masks or face shields Protective:
Glasses, masks or face shields should be worn by operators and close-support dental surgery assistants to protect the eyes against the spatter and aerosols which may occur during cavity preparation, scaling and the cleaning of instruments.
(c) Sharp instruments and needles:
Sharp instruments and needle should be handled with great care to prevent unintentional injury. Needles should never be recapped by using both hands indirect contact or by any other technique that involves moving the point of a used needle towards any part of the body. The needle can be recapped by laying the cap on the tray, placing the cap in a re-sheathing device or holding the cap with forceps before guiding the needle into the cap.
(d) First aid and inoculation injuries:
preventive and interceptive for general practitioners.docxDr.Mohammed Alruby
Scope of orthodontics
for general practitioner
Prepared by
Dr. M Alruby
Orthodontics: is a branch of science and art of dentistry dealing with prevention, interception, and correction of positional and dimensional dentofacial abnormalities.
Orthodontic treatment could be divided as follow:
1- Preventive orthodontic treatment.
2- Interceptive orthodontic treatment.
3- Corrective orthodontic treatment. a) Early corrective. b) late corrective.
4- Post. Treatment maintenance or retentive and follow up.
Preventive orthodontics:
It is defined as that phase of orthodontics employed to recognize and eliminate potential irregularities and malposition in the developing dentofacial complex. It is directed toward improving environmental conditions to permit future normal development
N: B: the child as a patient: children will accept orthodontic treatment if the purpose for treatment is explained in a simple terms that they can understand. Information concerning treatment aims and procedures should be given to the child without hesitation and under authority; neither gives him a great attention nor neglect him. Be familiar with the child and give him some sympathy.
Most children at preadolescent age are ready to accept orthodontic treatment if the orthodontist was able to establish a sympathetic relationship with the child. The child must not force to treatment but it is better to postpone treatment until the child feels the needs for treatment.
The adolescent patients: the 15 years old patient frequently consider himself as a man and must has a special management. Adolescent patient may deny that his teeth need correction and warning of the appliances. It is very important to know whether the patient came to the office alone, with friends or forced by his parents.
Preventive orthodontics is a long range approach and it is largely a responsibility of the general dentist. Many of the procedures are common in preventive and interceptive orthodontics but the timing are different.
Preventive procedures are undertaken in anticipation of development of a problem. Interception procedures are undertaken when the problem has already manifested. For extraction of supernumerary teeth before they cause displacement of other teeth is a preventive procedure, while their extraction after the signs of malocclusion have appeared is an interceptive procedure.
Preventive procedures:
A- Pre-dental preventive procedure ( parents education):
Instruct the mother to feed her baby from breast and if the baby to be feed by a bottle, the nipple should be long enough to rest on the anterior third of the tongue. It also should contain a small side opening instead of single large end hole, this allows the milk to flow on the dorsum of the tongue and prevent it from being squeezed directly into the pharynx, by this method the tongue is allowed to function properly during swallowing which is very important in general growth of the jaws, al
Orthodontic Diagnosis
For general practitioners
Prepared by Dr. M Alruby
Orthodontic diagnosis deals with recognition of the various characteristics of the malocclusion. It involves collection of data in a systematic manner to help in identifying the nature and cause of the problem. Comprehensive orthodontic diagnosis is established by use of certain clinical implements called diagnostic aids.
Consideration of general health, appearance and attitude:
The first step in any orthodontic examination is to form a general idea of patient's health status, physical appearance and attitude toward orthodontics.
Case history:
Case history involves eliciting and recording of relevant information from the patient and parents to aid in the overall diagnosis of the case. The information is gathered from the patient and parents.
Personal details:
Name: the patient's name should be recorded for the purpose of communication and identification. Most patients like being called by their name. Addressing the patient by his or her name has a beneficial psychological effect as well. In case of children it is wise to record their pet names.
Age: the patient's chronological age should be recorded. Age consideration helps in diagnosis as well as treatment planning. There are certain modalities that are best carried out during the growing age. Growth modification procedures using functional and orthopedic appliances are carried out during the growth period. Surgical respective procedure is best carried out after the cessation of growth.
** Dental age determination: can be determined by two different methods:
- Stage of eruption of teeth.
- Stage of tooth mineralization on radiograph.
Determination of the dental age from observation has been the only method available for long time. In certain cases however, the accuracy of the method is limited.
When determining the dental age radiographically according to the stage of germination, the degree of development of individual teeth is compared to a fixed scale.
** Skeletal age evaluation: assessment of the skeletal age is often made with the help of a hand radiograph which can be considered the biologic clock. For the analysis of skeletal maturity the stage of mineralization of the carpal bones must be determined thereafter the development of the metacarpal bones and phalanges should be evaluated. For the evaluation of the hand radiograph various indicators regarding the development and maturity are established which occur regularly in a definite sequence during skeletal development.
Sex: the patient sex should be recorded in the case history. This is important in planning treatment, as the timing of growth events such as growth spurts is different in males and females. Females usually precede males in onset of growth spurts, puberty and termination of growth.
Address and occupation: this help in evaluation of socio-economic status of the patients and parents. Some countries
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
1. 1
Torque in orthodontics Dr. Mohammed Alruby
Torque in Orthodontics
Prepared by
Dr. Mohammed Alruby
2. 2
Torque in orthodontics Dr. Mohammed Alruby
Torque when, where, how?
Importance of torque
Biomechanics in torque
Torque expression in slot 0.018 and 0.022
Expression of torque
Mode of ligation and torque
Types of torque
- Passive
- Active
Factors affect torque
Torque with different appliances
Torque in base and face
Torque prescription in different techniques
Class II malocclusion and torque
Torque control in different treatment steps
Differential torque
Torque clearance
Intrusion and torque
Torque and intra-oral elastics
3. 3
Torque in orthodontics Dr. Mohammed Alruby
as stated by Dr. EARMAN D. RAUCH: Torque is the force that enable the orthodontist to
control the axial inclination of the teeth and to place them in the harmonizing positions that are so
desirable for a nicely finished results.
Torque is the force that gives the operator control over the movement of the roots of the teeth.
Torque: movement of root of tooth with little or no movement of the crown in opposite direction
by applying couple of force at the same time
The center of rotation at incisal edge
WHY:
- To bring about labiolingual movement of the teeth
- To retain the teeth in the cortical bone
- To avoid relapse
- To give a natural finish to the dentition
WHEN:
- In third order bends of finishing and artistic positioning in a pre-adjusted edgewise system.
- In pre surgical and post-surgical phases for the precise placement for axial inclination of
teeth.
HOW:
Torque in fixed appliance can be employed in different ways
1- By giving a twist in an arch wire -------------– commonly used in edgewise techniques
2- Torque exerted by the bracket itself -------– Pre adjusted edgewise appliance
3- By use of torqueing auxiliary ---------------- widely used in Begg technique.
IMPORTANCE OF TORQUE:
- Effect on apical bases: One of the objective of orthodontic treatment is reorientation of
apical base relationship, maintaining good labial axial inclination of the upper incisors
Torque assists the orthodontist in bringing about a desirable change of points A and B,
thereafter the desirable facial changes.
- Effect on teeth: Proper bucco-lingual inclination of both posterior and anterior teeth is
considered important in providing stability and for proper occlusal relationship in
orthodontic treatment.
- Smile esthetics: Fullness of the smile should be sought through adjustment of the clinical
crown torque of the maxillary canines and premolars to their most esthetic appearance in
different face types.
- Torque and root resorption: Since the first comprehensive study on root resorption by
Ketcham, most investigations have confirmed that root resorption is common after
orthodontic treatment. In mature young teeth, adult patients and periodontally
compromised cases, a thin edgewise arch wire is preferred. The best technical solution to
avoid root resorption in light-wire technique would be to apply a light torqueing force
that acts interruptedly
N: B:
M = Fd:
With edgewise third order mechanics, rectangular wire engages a rectangular bracket to creates
a pair of equal and opposite parallel forces called couple
This couple has moment or tendency to rotated (M) and measured as magnitude of force (F) times
the distance between the forces (d)
4. 4
Torque in orthodontics Dr. Mohammed Alruby
Proffit:
Stated that the simplest way to determine how a tooth will move is by considering the ratio between
moment created when force is applied to crown (MF) and counter balancing moment generated by
couple within the bracket (Mc)
Bio-mechanics in torque:
1- Torque or root movement is achieved by keeping the crowns stationary and applying amount
of force acting on the root
2- The center of rotation of tooth is at the incisal edge of tooth movement
3- M / F ratio should be at least 12: 1 to achieve root movement
4- According to Nanda:
M / F = 5 / 1 -------- causing uncontrolled tipping
M / F = 7 / 1 ------- causes controlled tipping
M / F = 10 / 1 ------- causes translation
M / F = 12 / 1 ---------causes root torque
N: B:
When 100gm of force is applied to the tooth (bracket) and center of resistance is 10mm apical to
the bracket, will cause a moment of 1000gm. This force alone not cause root movement, to achieve
root movement at the level of bracket counter moment of 1200gm is applied through the center of
resistance of tooth
SO: M / F applied at the bracket is 1200 / 100 = 12: 1 -- , this will cause a distal force of 100gm
plus a moment to tip the crown mesially of 300gm –mm
By keeping the crown of tooth stationary and applying a counter moment will cause only root
movement
When M / F ratio applied, tooth appear to rotate around the crown, therefore the center of rotation
when the amount to force ratio is 12: 1 is at incisal edge or bracket of crown.
N: B:
= with no Mc (M / Mf = 0) the tooth rotated around the center of resistance (pure tipping)
= as the moment – to – force ration increases (0 > Mc / Mf > 1 ) the center of rotation is displaced
further and further away from the center of resistance ----- produce controlled tipping
= when (Mc / Mf =1), the center of displacement to infinity and bodily movement (translation)
occurs
= when (Mc / Mf is less than 1), so the center of rotation is displaced and the root apex will move
more than the crown that producing ---- root torque
5. 5
Torque in orthodontics Dr. Mohammed Alruby
Torque expression in 0.018 slot bracket versus 0.022 slot:
== 0.018 slot bracket usually has 0.017x0.025 stst wire as working wire which has slop of 6 degree
thus, theoretically torque expression in 0.018 slot may be better than 0.022 slot.
BUT: 0.018 slot has another shortcoming:
1- Torque prescription for 0.018 tends to be more conservative
2- There is an obvious limitation in a choice of wires and treatment mechanics employed
3- They are not efficient in sliding mechanics as 0.017x0.025 wire does not have sufficient
clearance and can be deflected
== in 0.022 slot bracket the slop is 10 degree with 0.019x0.025 arch wire must be counteracted
by adding 10 -15 degree to the arch wire for utilizing complete built in prescription
= in prescription edgewise appliance PEA 0.022 slot is preferred because:
1- During leveling and aligning, these slot have definite advantages in choice of alignment
wire
2- 0.022 slot are designed for sliding mechanics in which is proven to be more efficient in
space closure
3- For fixed functional appliances, orthopedic appliances, or in surgical cases need more stiff
wire, full size arch with to avoid deflection SO slot 0.022 is more efficient
Expression of torque:
= The area of torque application is small and depends on the twist effect of a relatively small size
wire, compared with the bulk of tooth
SO, the torque is not efficiently expressed by the Preadjusted appliance system, partly due to small
area of torque application
= In order to slide teeth, it is normal to use 0.019x0.025 stst wire in 0.022 slot because full thickness
wire prevent sliding, these wires has slop of about 10 degree depending on the tolerance in bracket
and wire manufacturing and amount of wire edge rounding
As a result of the relative inefficiency of pre-adjusted bracket in delivering torque, it was necessary
to build extra-torque into the incisors, molars, lower premolars bracket in order to meet clinical
goal with a minimum of wire bending
N: B:
Rectangular 0.019x0.025 stst wire in slot 0.022 can yield approximately 10 degree of torque loss.
The actual amount depends on variability in both wire and slot but the true torque achieved is less
than the value built in slot
Mode of ligation:
It is difficult to achieve torque control with elastomeric ligation; the use of steel ligation would be
effective in maintaining the arch wire in the slot to achieve good torque control
Types of torque:
A- Passive or harmonizing torque:
= Is that torque that incorporated into the rectangular arch wire to accommodate for position of
the tubes and or brackets on the buccal and labial surface of the teeth in edgewise system
= The buccal surface of bicuspids and molars are usually slopes with height of contour lying more
gingivally. This slope produces a degree of angulation of the molars tube and bicuspids brackets
So that, the distal portion of the arch wire must torque to fit the brackets and tubes passively
6. 6
Torque in orthodontics Dr. Mohammed Alruby
= on the other hand, if the rectangular arch wire is not torqued, it will forcibly fit the brackets and
tubes which induce bucco-lingual tooth movements that alter the bucco-lingual relation of
posterior teeth and may create a buccal cross bite.
Thus the passive or harmonizing torque is designed to maintain the proper bucco-lingual or labio-
lingual relationship of the teeth
Harmonizing torque is usually placed in both sides of the arch wire in the distal segment at the
inter-proximal space distal to the cuspid, since the buccal slopes of the bicuspids and molars
require this torque.
How to determine the amount of harmonizing torque?
1- Placing harmonizing torque in the arch wire between cuspid and bicuspid in the right side
2- Place the distal end of the right side of the arch in the right molars tube
3- Observe the relationship of the distal free end of the wire to the left molar tube
4- If the distal free end of the arch wire rest just opposite and on the same horizontal level as
the molar tube so, the proper torque is obtained
5- If the distal free end on left side rest gingival to left molar tube so the torque is insufficient
6- If the distal end on left side rest occlusal to the left molar tube so the torque is too much. in
the latter two cases, the torque should be adjusted
7- Repeat this procedure for the left side of arch wire
8- When both sides have the proper amount of harmonizing torque, the arch wire can be
inserted passively without altering the bucco-lingual relationship of these teeth. BUT now
the Preadjusted appliance systems eliminate the needs for such compensatory bends
B- Active torque:
Torque placed into the rectangular edgewise arch wire either to correct the axial inclination of the
teeth or as a part of anchorage preparation ((active buccal root thrust))
Types of active torque:
1- Active labial torque:
Torque incorporated in anterior segment of rectangular arch wire to correct the axial inclination
of anterior teeth
Usually named according to the direction in which the torque will act upon the crown of the tooth:
active labial torque will cause the crown to move labially and the root to move palatally. Some
investigators named it according to direction of root movement
If one wishes to restrict the labial crown movement, then couple of force is required, one force to
move the root palatally and the other to prevent labial movement of crown, SO pure movement is
obtained
This can be achieved by tying back the arch wire to the molars tube and use of class II elastics or
headgear to overcome the labial component of torque
This type of torque is used during intrusion and retraction of maxillary incisors to avoid flushing
of the root against the labial cortical plate which may causes root resorption or fenestration of the
labial bone.
7. 7
Torque in orthodontics Dr. Mohammed Alruby
In finishing stages:
Selective labial torque should be placed for each tooth to ensure final detailing of the teeth position,
for example, 22 degree for 1, 16 degree for 2 and 7 for 3 BUT, the pre-adjusted appliance provides
a pre-torqued and pre-angulated brackets that eliminates the needs for such difficult bends.
2- Progressive torque:
Torque incorporated into the buccal segment of the arch wire and utilized in the correction of
buccal cross bite
Starting just distal to the cuspid bracket, a series of bending 15 -20 degree are placed in the arch
wire at the interdental spaces between the teeth until 1st
molar.
The direction of bending is that direction for the desired crown movement as: buccal in maxilla
and lingual in mandible
The total degree of bending may reach 90 degree at the mesial surface of 2nd
molar but when the
arch wire is ligated, only 15 – 20 degree is received by each tooth
3- Active root thrust:
Active torque placed in the buccal segment of arch wire specially opposite to the mandibular 1st
molars to move or thrust the root ag arch wire specially opposite to the mandibular 1st
molars to
move or thrust the root against the buccal cortex as a form of anchorage re-enforcement
Factors affecting torque in orthodontics:
1- Shape of wire:
After levelling, rectangular wire is used that express the torque in the roots that tip in all three
planes of space
2- Size of wire:
Thicker wire has a greater ability to torque, 0.025 ----– than-- 0.022 ------ than-- 0.018 without
any twist in wire itself. There is a greater ability of torque in 0.017x 0.025 ------- than-- 0.017x0.022
3- Materials used:
Materials with low modulus of elasticity such as Nickel titanium (ni-ti) has reduced torque
expression when compared with sst wire {stst wire has 1.5 times torque expression than TMA},
{stst has 2.5 times torque expression than niti}
4- Bracket material:
The main fracture strength is much lesser in polycrystalline bracket when compared to
monocrystalline ceramic bracket
5- Mode of ligation:
The use of steel ligation wire is more successful than elastic ligation because the torque control
loss by the loosening of force of elastomeric ligation
6- Bracket height:
Bracket height on crown of tooth affect the torque and tip. Poorly positioned bracket will result in
imperfectly positioning of teeth and requires a much higher arch wire adaptation
7- Loop design:
The torsional stiffness of a looped wire can be distinguished by the two factors are the wire cross
section and the loop geometry.
Increase in the quantity of wire in the mesiodistal section of the loop and also increasing the
diameter of the apex will result in increase of loop ‘s torsional workability
8. 8
Torque in orthodontics Dr. Mohammed Alruby
N: B:
The classification of tooth movement associated with edgewise appliance seem to be based upon
the type of movements rather than direction.
1- Movement of the First order
2- Movement of the Second order
3- Movement of the third order ----------- We will see here movement of the Third Order
Torque with different techniques
1- Torque with removable appliance:
Different types of torquing springs can be used which are flexible, easy to construct, easily
positioned and adjusted. Bass (1975) has shown that it is possible to perform this movement by
pressure in a lingual direction at the gingival margin on the incisors using a double cantilever
spring while preventing lingual movement at the incisal edges using a Sved bite-plane
2- Torque with edgewise appliance:
= The Edgewise mechanics torques teeth buccally or lingually by placing an activated rectangular
wire in a rectangular bracket slot. However, the immediately adjacent teeth receive the equal and
opposite reciprocals, which are commonly disregarded. The consequence is a decrease in the
facio-lingual discrepancy between adjacent teeth.
= Twists in rectangular arch wires seem to be suitable only when reciprocal torque is needed on
the adjacent teeth, but one should be aware of high moments emerging in full-sized or nearly full-
sized stainless-steel arch wires.
= Torque control in finishing stages can be obtained by maintaining a proper moment / force ratio
during the time of retraction in extraction cases
= To overcome this, torqued slot brackets were introduced by manufacturers in the late 1950s or
early 1960s. This design eliminated the need for adding torque to the anterior portion of the upper
arch wire
3- Torque with Begg technique:
In Begg’s method, the reactions generated by the torquing auxiliaries spread through the
arch wire on to the entire arch, rather than pre-dominantly expressing on the adjacent teeth as in
edgewise appliance. Originally spurs were bent into the main maxillary arch wire which was made
from 0.016-inch arch wire material, to rest against the labial surfaces of the upper central and
lateral incisors. The torque force was relayed in a spiral manner along the main arch wire to the
anchor molars
9. 9
Torque in orthodontics Dr. Mohammed Alruby
Different types of torquing auxiliary:
1- The four-spur type auxiliary
The auxiliary is made from 0.012” Premium Plus wire. However, if only the central incisors
require the torque, an auxiliary with two spurs is used
2- Pre-wound torquing auxiliary/ rat-trap type auxiliary,
originally devised by Dr Begg in early 1950's. Regardless of
the size of wire used in its construction, it is simpler to apply
and has the potential to deliver a large force through a
greater range of movement than other types of incisor torquing auxiliaries
3- Kitchton’s torquing auxiliary was invented by Dr. John
Kitchton, is capable of exerting a great amount of force. It
can be made to include central and lateral incisors, or it
can be shortened to torque central incisors only
4- For any tooth requiring root torque in the labial or lingual direction,
single root-torquing auxiliary proposed by Kesling is a
very useful design. It is indicated in case of an upper
premolar, which needs buccal root torque to eliminate
cuspal interference from its hanging palatal cusp
10. 10
Torque in orthodontics Dr. Mohammed Alruby
5- Reciprocal torquing auxiliary (SPEC design) is used in
cases where two adjacent teeth require root torque in
opposite directions. The 'Spec' auxiliary could be used
for controlling the root movements during the first and
second stages if made in lighter 0.009" or 0.010" size
wires
6- Franciskus Tan described reverse torqueing auxiliary
for controlling the roots of canines or pre-molars
design in the 1987. It was reported for the labial root
movement of a palatally impacted maxillary canine,
whose crown has been aligned but the root is placed
palatally and requires labial root torque
7- Mollenhauer's aligning auxiliary (MAA) strives root control from the very beginning,
without notably affecting the anchorage and overbite correction, can be used in crowded
teeth. This is achieved by using a combination of a stiff base arch wire made from 0.018"
Premium plus, and ultra-light root moving forces from the MAA made from the 0.009"
supreme grade wire. It can be used after the stage I as the braking mechanism by adding
more positive torque into the MAA.
In growing brachyfacial cases, labial root torque on the lower incisors can be applied to
prevent lingual movement of their root.
Whereas, in controlling the mesiodistal root position, a ligature wire is tied to the auxiliary
and to the pin to transfer the tipping effect to the tooth
4-Torque prescriptions with edge wise appliance:
The Roth prescription:
Ronald Roth began to use the straight wire appliance in 1970 when Andrews gave him the first set
of high cost prototype brackets that were welded into pinched band material. Since these had
inventory problem and Anchorage loss, Roth in 1979 introduced a bracket setup with modified tip,
torque, rotations and in out movement of the Andrews standard setup brackets.
These second generation of pre-adjusted brackets had more torque in the maxillary incisors which
improves esthetics, provides more space for lower anterior teeth, and establishes proper anterior
guidance.
11. 11
Torque in orthodontics Dr. Mohammed Alruby
The Vari-simplex discipline:
This system was developed and introduced by Dr. R.G. Wick Alexander and is based on edgewise
philosophy. Here, ‘Vari’ refers to the variety of bracket types used (Twin, Lewis and Lang) and
‘Simplex’ refers to the principle of KISS (Keep it simple, sir)
The Bio-progressive system:
This was introduced by Dr. Robert Ricketts and Ruel Bench who combined contemporary
edgewise mechanics with solid diagnostic principles and a new approach to sectional mechanics
MBT bracket system:
= McLaughlin and Bennett worked with Trevisi to re-design the Straight Wire Appliance (SWA)
bracket system to complement their treatment philosophy and to overcome the perceived
inadequacies of the original SWA. They re-examined Andrews’ original findings and considered
additional research input from Japanese sources when designing the third generation of pre-
adjusted brackets namely, the MBT system.
= Due to the small area of torque application, the pre adjusted appliance system is relatively
inefficiency in delivering torque, it is therefore necessary to build in extra torque into the important
incisor and molar brackets to achieve the clinical goals with minimum of wire bending [
5- Torque in lingual technique:
Stephen Paige used two separate effective methods such as a torquing auxiliary and torqued ribbon
arch for torque control (Figure 11). A torquing auxiliary is similar to the auxiliary in conventional
Begg mechanotherapy. The application of force on the tooth is at the incisal edge [28]
6-Torque in self-ligating bracket:
= Badawi and coworkers studied the difference in third-order moments that can be delivered by
engaging 0.019 x 0.025-in stainless steel arch-wires to 2 active self-ligating brackets and 2 passive
self-ligating brackets.
= They concluded that as the active clip forces the wire into the bracket slot, the active self-ligating
brackets have better torque control.
= The amount of arch-wire bracket slop was comparatively less in active self-ligating brackets.
The passive self-ligating brackets produced lower moments at low torsion angles and produced
higher moments at high torsion that cannot be used clinically.
= Compared to passive self-ligating brackets, the active self-ligating brackets have greater
clinically applicable range of torque activation, higher expression of torque at clinically usable
torsion angles (0°-35°).
= Thomali et al evaluated the torque expression in active and passive self-ligating brackets and
concluded that there was minor difference in the torque expression of the two brackets. The torque
expression increased with increase in engagement angle and also with an increase in slot size
12. 12
Torque in orthodontics Dr. Mohammed Alruby
Torque expression in self-ligating bracket:
= active self-ligating bracket seems to have better torque control, direct result of their active clip
forcing the wire into the bracket slot
= the amount of arch wire bracket slop was considerably less for active self-ligating bracket than
passive self-ligating bracket
= the active self-ligating bracket expressed higher value than the passive self-ligating brackets at
clinically usable torsion angle (0 – 30 degree)
Torque in base versus torque in face:
= The torque in the base means that the bracket stem is parallel and coincides with the long axis
of the bracket slot. But, with the brackets having torque in the face the slot is cut at an angle to the
bracket stem, therefore their long axis does not coincide and are not parallel to each other
= When the center of the bracket base is placed on FA point the long axis of the bracket stem and
bracket slot both are parallel to and are in line with Andrew’s plane. But this is not possible with
brackets having torque in the face. Modern bracket systems MBT are developed using computer
aided machine the CAD-CAM system.
= This allows more flexibility of design, improved bracket strength. The brackets may be finished
with all torque in base and torque in face with absolute no difference in slot position
13. 13
Torque in orthodontics Dr. Mohammed Alruby
Torque prescription in different systems
a- Andrews Prescription:
Lawrence Andrews started the pre-adjusted appliance. In his study he evaluated the occlusion and
identified the six keys of occlusion by re-assessing all the previous orthodontic experiences. The
third key is described by the torque and was expressed by a bracket containing the angulation,
inclination and in-out of each tooth, interrelate with a straight-wire.
Andrews prescription
Upper inclination Lower inclination
Central +7 Central -6
Lateral +4 Lateral -6
Canine -7 Canine -11
1st
premolar -7 1st
premolar -17
2nd
premolar -7 2nd
premolar -22
1st
molar -11 1st
molar -30
b- Roth Prescription:
Roth condemn Andrews furnishing of brackets. According to Roth, a large inventory was difficult
to handle, so he proposed a new prescription called as the Straight Wire, in which a unique torque
value of the upper canines (11°), proposing to use the same brackets for extractions and non-
extraction cases.
Roth prescription
Upper inclination Lower inclination
Central 12 Central 0
Lateral 8 Lateral 0
Cuspid 0 Cuspid -11
1st
premolar -7 1st
premolar -17
2nd
premolar -7 2nd
premolar -22
1st
molar -7 1st
molar -30
c- THE BUTTERFLY SYSTEM:
= The butterfly system was introduced by Dr. Jay Bowman and Dr. Aldo Carano. In order to
correct the undesired effects produced, in this butterfly system progressive posterior torque was
incorporated.
= To improve the final buccolingual occlusion, the lower posterior torque is reduced while the
upper is increased by flattening the curve of Wilson, reducing inconsistency in posterior overjet,
and lowering the bulging of palatal cusps.
Butterfly prescription
Upper inclination Lower Inclination
Central 14 Central -5
Lateral 8 Lateral -5
Canine 0 Canine -3
1st
premolar -7 1st
premolar -7
2nd
premolar -8 2nd
premolar -9
14. 14
Torque in orthodontics Dr. Mohammed Alruby
d- MBT prescription:
MBT technique is the third-generation of Straight wire devices. McLaughling, Bennet and Trevisi
altered the prescriptions of Roth and Andrews, this alteration is due to the establishment of
sliding mechanics, SO that light forces could be used to close the extraction spaces.
MBT prescription
Upper Inclination Lower inclination
Central +17 Central -6
Lateral +10 Lateral -6
Canine 7 / -7 Canine 6 / -6
1st
premolar -7 1st
premolar -12
2nd
premolar -7 2nd
premolar -17
1st
molar -14 1st
molar -20
e- ALEXANDER’S THE VARI-SIMPLEX:
= An appliance called as the Vari-Simplex Discipline was introducing in the year 1977 by
Alexander
in which he introduced a system of brackets placed on teeth, employed by orthodontists all over
the world and he defines Vari-Simplex Discipline, in which there is specific bracket system
utilized in case treatment.
= Specific bracket designs are being made for individualized teeth. In this
prescription, mainly for non-extraction cases, allows controlled and efficient mandibular arch
levelling.
Alexander prescription
upper inclination lower inclination
Central 14 Central -5
Lateral 7 Lateral -5
Canine -3 Canine -7
1st
premolar -7 1st
premolar -11
2nd
premolar -7 2nd
premolar -17
1st
molar -10 1st
molar -22
f- Self-Ligating Brackets-DAMON System:
= The Damon philosophy assert for the lowest frictional resistance of any ligation system with the
idea of passive self-ligation technique.
= The concept of decreasing the friction allows the force to transfer from the arch wires to the
teeth and its supporting structures directly and without any force dissolution by the ligature system.
Self-ligating – Damon
Upper Inclination Lower inclination
Central 12 Central -1
Lateral 8 Lateral -1
Canine 0 Canine 0
1st
premolar -7 1st
premolar -12
2nd
premolar -7 2nd
premolar -17
1st
molar -18 1st
molar -28
15. 15
Torque in orthodontics Dr. Mohammed Alruby
Class II malocclusion and torque:
Torque of maxillary incisors is critical in establishing an esthetic smile line, proper anterior
guidance
= Buchin 1957 stated that, reduction of SNA is very desirable in cases with discrepancy in point A
and B and is attained by employing strong class II mechanics with anterior lingual root torque or
labial crown torque
= Bennet and Mclaughin showed, it is necessary to add lingual root torque to upper anterior arch
wire and labial root torque to the lower anterior in the arch wire early in space closure and
overcorrection in class II rather than attempting to re-establish proper torque that has been lost
= high torque brackets were used in the maxillary arch (22degree torque for U12) because the
upper incisors more prone to retroclination during retraction
= low torque brackets were chosen for the mandibular arch (-6 degree for L12) because negative
torque prescription in the lower incisors could counteract the side effect of anterior proclination
caused by class II elastics
Torque control in different treatment steps:
1- During leveling and alignment:
Torque is not expressed only on rectangular stst wire, flexibility of rectangular wires allows early
placement and this allows easier torque control than was possible when only steel wire was
available
2- During space closure:
Loss of torque control during space closure results in upper incisors is too upright at the end of
space closure with spaces distal to the canines and consequent unaesthetic appearance
== Rapid mesial movement of upper molars can allow the palatal cusp to hang down resulting in
functional interferences
== rapid movement mesially of lower molar cause rolling of the molars
Bite opening curve and torque:
Placing bite opening curve in upper arch wire increase the palatal root torque to upper incisors,
this beneficial in majority of cases and it is usually unnecessary to add any additional torque bends
When the reversed curve is placed in the lower arch result in proclination of lower incisors, this is
generally, thus therefore placement of bite opening curve in lower wire approximately 10 -15
degree of labial root torque can be added
Deferential torque:
When the arch wire with tip back bends is
tied into the brackets and tied at the molar
tubes different magnitude of moments is
produced which are referred as deferential torque
16. 16
Torque in orthodontics Dr. Mohammed Alruby
Torque clearance:
Is the amount of play between the bracket and arch wire which depends on the size of arch wire?
Arch wire inches stst Amount of play
0.016x0.022 16 – 18 degree
0.017x0.025 13 – 14 degree
0.019x0.025 6 – 8 degree
0.021x0.025 2 – 3 degree
Examples:
0.017 x0.025 stst wire in slot 0.022 has approximately 13 – 14 degree play assuming that the wire
is completely passive when retraction start
WHILE: 0.016 x 0.022 wire has greater amount of tipping and prolonged phase I , II of retraction
SO: if the anterior teeth are flared at the beginning, more tipping is required hence a thicker wire
will be of limited use, as the effective play will be lesser. If instead the teeth are upright and there
is need for more control on the incisors, a thicker wire should be the choice
Intrusion and torque control:
Utility arch for intrusion creates two-couple force system, the moment of which tend to tip the
incisors crown facially and the molar distally.
The facial tipping of incisors can be avoided by cinching or tying back the intrusion utility arch,
any force that tends to bring the anchor teeth mesially is undesirable.
Incorporating twist or torque bend in incisor segment is another way for controlling the tendency
of the teeth to tip facially or by using CTA wire which involves no wire bending and needs minimal
adjustment, so CTA is better for control of torque.
17. 17
Torque in orthodontics Dr. Mohammed Alruby
Bi-dimensional techniques: for strong torque control in extraction case:
Bi-dimensional slot technique in which pre-torqued 0.018 bracket slot are placed on incisors while
0.022 bracket slot placed on other teeth
When wire 0.018 x 0.022 stst wire is engaged, it is fully sized fit into the anterior bracket but leaves
clearance 0.004 inch within the buccal bracket
SO: in anterior segment can give almost play to the pre-torqued bracket while clearance at buccal
segment can facilitate the wire sliding in space closer
SO: BDS or BDW technique offer similar capacity for another torque control
Torque and intra-oral elastics:
1- Class II elastics:
Class II elastics is placed on anterior part of contraction utility arch has an effect of increasing
torque during the incisor backward movement
Class II elastics pulls downward and backward the anterior loop which raise the anterior segment
of the arch and increase the anterior torque progressively with the contraction
2- Class III elastics:
Application of class III elastics lead to biomechanics problem to resist the extrusion and lingual
tipping elastic force (to avoid gingival dehiscence)