Case Lb

A female patient, 11.5 years old, with near average MM angle of 29 , slight Class Ml skeletal bases (ANB 1 ) and a deep bile. Lower incisors were retroclined and crowded. All permanent teeth were developing, and there was a possible supernumerary tooth in (he upper right third molar region. T he patient was informed that surgical uncovering of the upper canine crowns might be needed during treatment. It was planned to treat the case without extractions. Mid-sized brackets were placed with a...

Horizontal overcorrection

It is often necessary to consider horizontal overcorrection of Class II and Class III cases. During the finishing stages of treatment, it is important to fully correct the A P position of the dentition using methods such as Class II or (lass III elastics, or headgear, for example. After correction has been completed, then these methods of tooth movement can be discontinued or worn on a part-time basis. The patient may then be observed for a period of 6 to 8 weeks. If the case appears to be...

Vertical control of incisors

In day-to-day orthodontic practice, there is a need to open deep anterior bites and to close anterior open bites. The treatment mechanics for this were explained in the previous chapter. As well as attempting to achieve a normal anterior overbite, the clinician should not lose sight of the desirability of meeting goals for upper incisor exposure relative to the upper lip, as proposed by Arnett. I lowever, it needs to be borne in mind that the surgeon has a greater ability than the orthodontist...

The importance of second molars

In average- to low-angle deep-bite cases, the earliest possible banding or bonding of the second molars, especially the lower second molars, is most beneficial in bite opening. Inclusion of (he second molars provides an excellent lever arm for eruption or extrusion of the premolars and first molars, and assists in incisor intrusion (Fig. 6.13). In numerous cases, the authors have observed that complete bite opening and leveling of the curve of Spee in the lower arch is extremely difficult if...

Light forces during space closure

It is important to use light force levels during the stage of space closure. Heavy forces can cause the bile to deepen in two ways The canines can tip into the extraction sites causing archwire deflection and binding. The sliding mechanics then become ineffective, and the overbite deepens. Excessive force overpowers the incisor torque control of the rectangular wire (Fig. 6.23), particularly in the upper arch, causing distal tipping and bite deepening. A small amount of torque added to the...

Transverse overcorrection

Cases that show narrowing in the maxilla should be adequately overexpanded and held in the expanded position for an extended period of time. The maxilla can be expanded until the palatal cusps of the upper arch are in contact with the buccal cusps of the lower arch in the posterior segments (Fig. 10.16A). It is best to expand cases 1 or 2 years prior to full orthodontic treatment, and to maintain this expansion with a palatal bar. Then stability is normally assured. If expansion is carried out...

Favorable condylar repositioning of the mandible

In a few cases, the mandible may be positioned distally at the start of treatment, and then the condyles can be expected to reposition more mesially into a centered position, as treatment progresses. For example, in some Class 11 2 treatments, there is the chance of a small but favorable mesial movement of'B' point after the case has been converted to a Class 11 1 malocclusion (Fig. 7.34), although this is difficult to confirm with research evidence (Case DO, p. 212). Fig. 7.34 During the...

White spots

Decalcification spots on the teeth can be most disappointing to orthodontist, patient, parents, and referring dentist (Fig. 11.7). The finger is often pointed towards the orthodontist concerning the cause of the problem. While this is generally not the case, if the patient's attention to oral hygiene early in the treatment is poor, it is important to minimize this problem. A suggested protocol can be considered and explained to the patient, in letter form, pre-treatment. At the first visit that...

Mesial movement of upper incisors in Class II treatment

In Class II 2 cases, the upper incisors are typically too far back in the face. In the modern thinking, which is concerned more with the incisor position in the face, the Class II molar relationship (which Angle emphasized) is secondary to (he retroclined upper and lower incisors. During leveling and aligning of (he upper arch, the upper incisors move mesially, bringing them closer to the PIP, and the Angle's classification becomes Class 11 1. In adolescent treatment, this ensuing Class II l...

Mesial movement of upper incisors within the bone

During tooth leveling with the opening wires, there is a tendency for upper incisors to move mesially due to bracket tip, as previously discussed. In Class III cases, this is normally beneficial, and moves the upper incisors towards PIP. Likewise, at the rectangular HANI'and the rectangular steel wire stages, the A P expansion and torque effects tend to produce beneficial changes for most Class III cases. This can be further augmented by the use of Class III elastics. Because of these...

Case Al

The following case shows an example of a patient with a tapered arch form and prominent canine roots at the start of treatment. This 15.5-year-old female patient was Class I skeletally, with a high-angle vertical pattern. From the frontal aspect, she had a narrow facial appearance, with some mandibular asymmetry to the left. Lower incisors were retroclined at 78 to the mandibular plane to the mandibular plane and at APo -1 mm. The facial profile was pleasing and harmonious. Dentally, the...

Torque issues

There is a tendency to believe that torque is introduced into the dentition by rectangular wires only, but this is not so. During early leveling procedures with round wires, torque changes occur, especially among anterior teeth. These actually begin to produce favorable torque changes in the case, before placement of rectangular wires. The flexibility of 1 IAN'F wires allows for early placement. This allows earlier torque control than was possible when only steel wires were available....

Maintaining the closure of all spaces

It is important to keep spaces closed during the finishing stage of treatment, particularly in extraction cases. This can be accomplished with passive wire tiebacks (Fig. 10.10) when rectangular wires are in place, and with lacebacks from molars to cuspids when light wires are in use. In extraction cases, during the settling stage, figure-8 ligature wires (Fig. 10.11) should be placed across the extraction site to keep them closed. Also, in any other areas where space closure was somewhat...

Pip Components In Class Ii Treatment

For each case, it is necessary to set a PIP as a treatment goal which will result in the upper incisors having correct A P and vertical positioning, with appropriate torque. Each orthodontist will have a view about what the exact goals for the upper incisor position should be for a particular case, although there is likely to be broad consensus about the approximate treatment needs. It is beyond the scope of this text to discuss and define those goals in detail. However, general comments will...

References

1 Tweed, C H 1966 Clinical orthodontics. Mosby, St Louis 2 The 'A' Company Straight-Wire Appliance. An eight page descriptive brochure. 'A' Company, San Diego, CA, USA 3 Bennett J C, McLaughlin R P 1990 Controlled space closure with a preadjusted appliance system. Journal of Clinical Orthodontics 24 251-260 4 Samuels R H, Rudge S J, Mair L H 1993 A comparison of the rate of space closure using a nickel-titanium spring and an elastic module a clinical study. American Journal of Orthodontics and...

O

M Intraorally, the molars were half a unit Class II bilaterally. The O lower midline was 1 mm to the right. All permanent teeth were developing, and the two remaining upper primary second molars were about to be shed. The patient's arch form was assessed as being square. The case was treated on a non-extraction basis. Mid-sized metal brackets (p. 28) were used in this case because of the small tooth size, and the need to assist in maintaining good oral hygiene. Commencing upper and lower...

Coordination of tooth fit

A major finishing consideration in the horizontal plane is the G> coordination of tooth fit in the anterior and posterior areas. The authors find that the anterior and posterior teeth fit well, with little or no adjustment, in approximately 20 of cases > (Fig. 10.4). However, in approximately 60 of cases m (Fig. 10.4), as the finishing stage approaches, it becomes clear that the crowns of the upper anterior teeth do not occupy enough space, relative to the crowns of the lower anterior...

Removal of remaining cement and bonding agents

After detachment of all the bands and brackets, the remaining cement may be removed using scalers or band-removal pliers, and then high-speed flame-finishing burs, without a water spray. Teeth may be polished using conventional rubber cups and pumice or a proprietary polishing agent. In instances where there is considerable gingival enlargement at the time of appliance removal, part of the residual cement and bonding agent may be temporarily left on the teeth. After a month of good plaque...

Borderline surgical cases

In some cases with mandibular excess, the diagnosis will suggest that mandibular surgery may be needed. It is helpful to delay orthodontic treatment for such cases, if possible. T his will allow assessment of growth patterns, using regular cephalometric radiographs, so that a more informed surgical non-surgical decision can be reached. Some cases are clearly Class III surgical cases from the outset, and should not be treated until all growth has ceased. Timing will be agreed with the surgeon,...

Intrusion of anterior teeth

In the majority of treatments for growing patients, intrusion of anterior teeth is normally not required. As the face grows vertically, preventing or even restricting the normal eruption of these anterior teeth will essentially allow the bile to 'grow open' as posterior eruption, extrusion, and or distal tipping occur. This is not true in adult cases, where the musculature resists these posterior changes. Therefore, bite opening in adulls must be brought about by the proclination of incisors...

The anteroposterior component of PIP in Class II treatment

Traditionally in orthodontics the upper incisor A P position has been related to the APo line with a conventional cephalometric value of+6 mm (Fig. 7.10). The Arnett analysis relates upper incisor position to a true vertical line (TVL), and uses the term MXI-TVL, which is the linear measurement from the tip of the upper incisor to the true vertical line. The male upper central incisor tip is ideally -12 mm to the line and the female is at -9 mm (Fig. 7.11). Fig. 7.10 In traditional orthodontic...

Mesial movement of maxillary bone due to orthodontic treatment

In growing individuals who have maxillary deficiency, consideration can be given to treatment procedures which will encourage orthopedic change within the maxillary bone (Pig. 8.22). These can include rapid maxillary expansion, and the use of reverse headgear, but there is much controversy and uncertainty surrounding the effect and stability of this type of treatment. However, there is some evidence in the literature7 that favorable mesial change in the maxilla can be produced, thereby...

Case Tc

Male patient, aged 11.4 years, with a Class 1 skeletal relationship (ANB 3 ) and a slightly low-angle pattern (MM 23 ). He was slightly Class 11 dentally. This type of malocclusion is frequently seen. The incisor relationship was close to normal, although there was a midline discrepancy of 2 mm and a lack of space for erupting upper canines. The molar relationship was 3 mm Class II on the right and 2 mm Class II on the left. It was decided to treat to a square arch form. Radiographs showed all...

The vertical component of PIP in Class II treatment

The Arnett analysis quantifies the vertical positioning of upper incisors, and requires an overbite of 3mm, with upper incisor exposure being 4mm below the relaxed upper lip in males and 5mm in females (Fig. 7.14). Orthodontic cephalometry has not provided clear goals for vertical positioning of the upper incisors. The high lip-line is a contributor)' factor in Class 11 2 malocclusions, and there is an acknowledged need to procline and intrude upper incisors in such cases, to assist in...

Progressive appliance removal

In some situations, it may be decided to gradually remove the appliances, over two or more visits. If one arch requires a lot less treatment than the other, for example, then it may be logical to consider early appliance removal in that arch. In some longer treatments, the patient may be glad to be offered early removal of upper appliances, in return for agreeing to a few more months of lower arch treatment. Progressive appliance removal is recommended for adult treatments where bands are used,...

Biteopening curves

The authors prefer not to place bite-opening curves in round wires or to have such curves built into rectangular heat-activated wires. They accept the fact that such wires do not complete the leveling of the arches and the bite-opening process. In the great majority of cases alter rectangular stainless steel wires have been in place for 6 weeks, the arches are normally level and adequate bite opening has been achieved. If this is not so, then bite-opening curves can be placed into the...

Pip Components In Class Iii Treatment

For each Class III case, it is necessary to set a PIP as a treatment goal which will result in the upper incisors having correct antero-posterior and vertical positioning, with appropriate torque (Fig. 8.17). It is beyond the scope of this text to discuss and define precise goals. However, each orthodontist will have a view about where the upper incisor should be placed, and there should be broad consensus in most cases. As with Class II cases, before reaching a decision about a suitable goal,...

Limits to mesial movement of upper incisors

There are clear clinical limits which have to be observed when moving upper incisors mesially. Problems can develop in seemingly easy treatments, and the risks lie in two areas Fig. 8.20 Excessive proclination of upper incisors beyond 120 to the maxillary plane should be avoided as a general rule, although there is individual variation. Fig. 8.20 Excessive proclination of upper incisors beyond 120 to the maxillary plane should be avoided as a general rule, although there is individual...

Obstacles to space closure

In almost all cases, space closure is easy and proceeds uneventfully. Only rarely are problems encountered. If it appears that space is not closing as it should (about 1 mm per month typically), the spaces should be carefully measured at successive visits. If they are not reducing, or if wire is not appearing gradually from the distal of the molar tube, then possible obstacles should be evaluated before resorting to different mechanics Inadequate leveling. The working rectangular wires need to...

Mandibular prognathism or maxillary retrognathism

Early in Class 111 treatment planning, it is necessary to. decide whether the case has a prognathic mandible or a retrognathic maxilla, or a combination of these two possibilities. In many cases, this will be clear from visual examination of the patient and the radiographs. There are several methods of conventional cephalometric analysis to assess A P skeletal discrepancy. For example, SNA, SNB, and ANB can be compared with Michigan normals' for a male or female of the same age. This method has...

Labial bonded retainers

Fig. 11.10A and B This Class II 2 malocclusion was treated to achieve initial alignment over a 9 month period. conventional methods can be used for retention. In adolescent treatment, labial bonded retainers can be useful in a 'pause' phase, while awaiting eruption of more teeth (Fig. II. 10). Bonded labial retainers for upper incisors are increasingly being considered. This may be useful as a short-term measure for impatient adults, allowing earlier removal of brackets. After a few months with...

The Development Of Anterior Open Bite

Anterior open bite can develop as a result of genetic and or environmental factors. Environmental factors include finger and thumb habits (Fig. 6.24), tongue posturing and thrusting problems, and respiratory concerns related to conditions such as allergies, adenoids and tonsils, and mouth breathing. Genetic factors can contribute to anterior open bite in the following manner. If patients show an excess of anterior vertical facial growth relative to posterior vertical facial growth, they are...

Wwwallislamnet Problem

Fig. 5.30 Upper molar expansion should be carried out by bodily movement rather than tipping. Minimal molar crossbites can be corrected using rectangular steel wires which are slightly expanded from the normal form and which carry buccal root torque. Fig. 5.31 Teeth which are significantly out of the arch form should be left unbracketed until adequate space is provided for their movement and positioning. The above examples show space being created for lower canines (Case LB, p. 116) and upper...

Mesial movement of mandibular bone Class III growth

This is a major factor in the treatment and subsequent retention of Class III patients, especially males. As mentioned previously (p. 226), any case which appears to have substantially unfavorable Class III growth patterns should be carefully monitored before making a commitment to correction by orthodontic means alone. If a decision is made to treat the malocclusion with orthodontics alone, every patient should be informed of the unpredictable nature of Class 111 growth, and of the...

Distal movement of upper incisors in nonextraction cases without spacing

In some Class Il l cases, it may be decided that the treatment should be on a non-extraction basis, and that the upper buccal segments need to be moved distally, to allow subsequent retraction of the upper incisors toward PIP. If the movement is minimal (1-3 mm), first molar rotation solves most of the problem (Fig. 7.21). A headgear and sliding jig are helpful in this situation. I lowever, when the required movement is 3 mm or more, this becomes a challenging situation for the patient and...

Distal movement of mandibular bone distal repositioning

In many Class III cases, there is a mesial displacement of the mandible at the start of treatment. As treatment progresses, the mandible repositions distally, to a position with the condyles centered in the fossae. This favorable change can be predicted at the treatment planning stage, and is a useful adjunct to distal movement of the lower incisors within the facial complex. Fig. 8.25 In many Class III treatments, a mesial mandibular displacement is evident at the start of treatment. As the...

Space closure in maximum anchorage cases crowding

Most of the premolar extraction space is used to relieve crowding in these cases. This requires careful anchorage control early in treatment (Case Nl I, p. 266), but then the space closure stage is normally minimal, because (he available space has mainly been used to relieve crowding. Fig. 9.28 Reciprocal space closure. This is the method of choice in many cases. Fig. 9.28 Reciprocal space closure. This is the method of choice in many cases.

Vertical overcorrection deepbite and openbite cases

It is beneficial to introduce some overcorrection in deep-bite and open-bite cases. This process begins with initial bracket placement. Brackets on the anterior teeth can be placed 0.5 mm more gingival in open-bite cases and 0.5 mm more incisal in deep-bite cases (p. 65). This greatly assists in the overcorrection process. In deep-bite cases, leveling of the curve of Spee with flat steel rectangular archwires normally results in effective bite opening, provided the second molars are included....

Stage 1 setting a PIP for the upper incisors

What is the ideal position for the upper incisors in the face in terms of A P position, torque, and vertical positioning Can ideal upper incisor position be achieved If not, can an acceptable incisor position be achieved by orthodontics alone, or is it necessary to consider maxillary surgery In this way, a PIP is determined for the case. Fig. 7.6 At the start of treatment planning, it is necessary to determine a 'planned incisor position', or PIP, for the upper incisors. In some cases, the...

Sliding mechanics with heavy exedgewise forces

A wide range of treatment mechanics was evaluated during the 1970s, in the early days with the preadjusted bracket system. Attempts were made to apply traditional edgewise force levels (500-600 gm) to the new brackets. It was found that heavy space closure forces (for example using steel Pletcher springs on .018 .025 steel wires) caused unwanted tip, rotation, and torque changes (Figs 9.8-9.11). When these heavy forces were used for space closure, there was therefore a need for extra tip,...

Providing adequate incisor torque

Torque control is the weakness of the preadjusted appliance system, and any system which is based on the edgewise bracket. There are three factors, and because of these, there does not seem to be a single set of torque values that will solve the needs of all patients 1. Approximately a 1-mm segment of rectangular steel wire is placed in a bracket of about the same dimension. This is required to carry out a rather difficult tooth movement, which involves moving an entire portion of the root...

Archwire coordination

In all wire sizes, once the lower arch form has been established, the upper archwire needs to be coordinated to the lower archwire. In general, this is achieved by adjusting the upper archwire so that it is 3 mm wider anteriorly and posteriorly than the lower archwire. This helps to establish the correct 3 mm of overjet both anteriorly and posteriorly. Because of posterior torque considerations (see below), it may be beneficial in many cases to widen the upper arch in the posterior segments to...

Introduction The Need For Efficient Space Closure

Although space closure is sometimes needed in non-extraction cases, the subject is generally discussed relative to premolar extraction cases. Space closure is carried out in the same manner in both groups, and although the subject of orthodontic extractions has been controversial in the past, it is now accepted that extraction of four premolars is beneficial in some cases. The 7 mm of space provided in each quadrant may be used to benefit the patient in one or more of the following ways Relief...

Control of upper incisor torque

In June 2000, Fasllight presented a discussion on the facial 'tetragon' consisting of the following four angles Upper incisor to palatal plane Lower incisor to mandibular plane Maxillary mandibular plane angle (Fig. 7.22). Fig. 7.23 Triangle formed from the upper part of Fastlight's tetragon. Fig. 7.23 Triangle formed from the upper part of Fastlight's tetragon. Fig. 7.24 Triangle formed from the lower part of Fastlight's tetragon. The lower triangle has angles as follows Mandibular plane to...

Finishing To Abo Requirements

In July 2000, the American Board of Orthodontics (ABO) came out with revised requirements and a grading system for dental casts and panoramic radiographs.4 It is the authors' hope that this book will be helpful to readers wanting to reach ABO goals. T he ABO places emphasis on self assessment of seven features of dental casts. Interestingly, these seven criteria for cast evaluation quite closely match the finishing goals described in this chapter, and throughout the book. Progress models, taken...

Removable Retainers Conventional wire and acrylic

Wire and acrylic removable retainers can be useful in the conventional 'wrap-around' or Begg type, for maintaining space closure after extractions, or as a Hawley type in deep-bite cases (Figs 11.12A & B) where the upper retainer needs to carry a bite plane. Fig. 11.12A Acrylic Hawley retainers can be useful when Fig. 11.12B Hawley retainers can be constructed with a bite retaining deep bite cases. plane to assist in retention of deep-bite cases. Fig. 11.12A Acrylic Hawley retainers can be...

The Final Stage Of Finishing Settling The Case

Rectangular stainless steel working wires are required for overbite control, A P correction, and space closure, but they are somewhat restrictive for settling of the teeth in the closing stages of the treatment. Much lighter wires are therefore used. Typically, a .014 or .016 round 1IANT wire is used in the lower arch, coordinated to the IAF for the patient. In the upper arch, a .014 round sectional wire can be placed from lateral incisor to lateral incisor. These wires can be accompanied by...

Movement of lower incisors in the mandibular bone

The range of orthodontic tooth movement for lower incisors within the bony housing of the mandible is limited. Mesial bodily movement of lower incisors is normally not possible, due to the anatomy of the bone in the lower incisor area (Fig. 7.31). Therefore, any mesial movement of the lower incisor tips is mainly as a result of a change in torque (Fig. 7.32). A rule of thumb limit for this proclination is 100 to mandibular plane as set in the Class II mandibular triangle (p. 176). As these...

Alternative mechanics for spaces resistant to closure

In a few cases, it may be found that spaces are slow or difficult to close with the normal mechanics. If no obstacles to space closure are evident (see below), alternative mechanics may be considered. Tiebac.ks with two modules may help, or a looped archwire can be made. A useful alternative in difficult space-closure situations is the Hycon device from Edenta. This has been used successfully by one of the authors for 4 years in selected cases. The device consists of a centimeter segment of 21...

The Appliance Removal Appointment Bracket removal metal brackets

A debracketing instrument (3M Unitek 444-761) or old ligature cutters are used to remove metal brackets (Fig. 11.3). When using the debracketing instrument, if the archwires are held in place with tie wires, the brackets can be detached from the tooth surfaces without first taking out the archwires. The archwire may then be removed with the brackets attached to it (Fig. 11.4), avoiding the possibility of loose brackets in the mouth. When using old ligature cutters, archwires may be removed with...

Setting a PIP for the upper

This involves deciding what would be the ideal position for the upper incisors. Is this achievable If not, can orthodontic tooth movements be used to reach a position which is less than ideal, but acceptable Or will maxillary surgery be needed to reach an acceptable upper incisor position In this way, a PIP (planned incisor position) for the upper incisors can be established (Fig. 8.13). Fig. 8.13 The first stage in Class III treatment planning concerns upper incisor position. It is necessary...

Establishing posterior torque

Tads Torque Molars Root

Progressive buccal crown torque has been designed into the appliance system in the lower posterior segments, as described in Chapter 2 (p. 33), and this has been a significant improvement. When the rectangular stainless steel wire is placed in the brackets, the lower posterior segments move to an upright position, providing a relatively flat curve of Wilson (Fig. 10.14). This does have a slight widening tendency in the lower arch. However, if arch form is maintained relative to the basal bone...

Palatal bonded retainers

These are not used as frequently as lower lingual retainers, because of the potential for breakage due to occlusal contact, or contact during biting. However, they are essential to ensure good retention of many adult cases, because some patients experience persistent spacing (especially in the midline) or other upper incisor movements. The advantages of palatal bonded retention outweigh the potential risk of breakage in such cases. Before placement, the patient's overbite and overjet should be...

Space closure and sliding mechanics

Introduction - the need for efficient space closure 250 Methods of space closure 252 Closing loop archwires 252 Sliding mechanics with heavy (ex-edgewise) forces 252 Sliding mechanics with light forces 254 Alternative mechanics for spaces resistant to closure 258 Anchorage balance during space closure 260 Space closure in maximum anchorage cases - Space closure in maximum anchorage cases -protrusion 261 Space closure in minimum anchorage cases -'burning anchorage' 262 Case NH An adult first...

Checking for temporomandibular joint dysfunction

It is important to document any evidence of temporomandibular joint (I'M)) dysfunction prior to treatment, and inform the patient that the condition exists. Asymptomatic clicking is generally not treated prior to orthodontics, but monitored as treatment proceeds. If muscular imbalances and or pain exist, and centric relation cannot be accurately recorded, then a phase of splint therapy and physical therapy is indicated prior to orthodontics. After the patient has been stabilized, orthodontic...

Gnathological Treatment

1 Tweed C H 1966 Clinical orthodontics. Mosby, St Louis 10 2 Arnett G W, Jalic J S, Kim J et al 1999 Soft tissue cephalometric analysis diagnosis and treatment planning of dentofacial deformity. American Journal of Orthodontics and Dentofacial Orthopedics 11 116 239-253 3 Arnett G W, Bergman R T 1993 Facial keys to orthodontic diagnosis 12 and treatment planning - part I. American Journal of Orthodontics and Dentofacial Orthopedics 103 299-312 4 Arnett, G W, Bergman R T 1993 Facial keys to...

Distal movement of upper incisors in cases with upper anterior spacing

Some Class II l cases have upper incisors which are demonstrably too far forward in the face. If this is associated with anterior spacing, it is a relatively routine procedure to gather up the upper incisors and retract them into the available space. (The mechanics have been likened to using a piece of rope to gather up a group of marbles on a tablecloth ) Sliding mechanics are used, on a normal working steel rectangular wire, and active tiebacks achieve the necessary retraction and space...

Proclination of incisors

Numerous deep-bite cases present with retroclined incisors, and proclination of these teeth contributes to bite opening in the anterior area. In the lower arch, this generally consists of lower incisor crowns being proclined. In the upper arch, a combination of crown proclination and root torque control normally occurs, with roots moving distally in the bone (Fig. 6.7).

Distal tipping of posterior teeth

This is normally a stable process in the growing patient, as it is accommodated by the increase in vertical facial height. However, in most average- to low-angle adult cases, distal tipping of posterior teeth is not stable, because it will be followed by intrusion of these teeth to the original vertical dimension. This may not occur during orthodontic treatment but will normally follow shortly after, and can be a source of post-orthodontic relapse of the deep bite. In the adult high-angle...

Correct crown lengths marginal ridge relationships and contact points

Correction of vertical crown positions, marginal ridge relationships, and contact points should be completed during the rectangular I IANT stage of treatment. If this is not done, these corrections must be made during the finishing and detailing stage of treatment, shortly before bracket removal. This does not ensure stability of vertical tooth positions. It is much belter for stability to allow these relationships to be correct for 1 to 2 years before bracket removal. Correct bracket placement...

Distal movement and retraction of the lower incisors within the mandibular bone

In most non-surgical Class 111 treatments, it is helpful to retract and retrodine the lower incisors (Fig. 8.23). This can compensate for mild mandibular prognathism or mild maxillary retrognathism, and hence mask the underlying skeletal discrepancy. The anatomy of the mandibular bone in the lower incisor region places limits on what should be attempted. Retraction and retrod nation beyond a figure of approximately 80 to the mandibular plane (Fig. 8.24) is undesirable, because of the risk of...

Systemized orthodontic treatment mechanics

EDINBURGH LONDON NEW YORK PHILADELPHIA ST LOUIS SYDNEY TORONTO 2001 An imprint of Harcourt Publishers Limited Mosby International Ltd 2001 KM is a registered trademark of 1 Iarcourt Publishers Limited The right of Dr Richard P McLaughlin, Dr John C Bennett and Dr I lugo I Trevisi to be identified as authors of this work has been asserted by them in accordance with the Copyright, Designs and Patents Act 1988 All rights reserved. No part of this publication may be reproduced, stored in a...

The limitations of orthodontics

In some cases, it will become evident during treatment planning that there are major limiting features, such as skeletal disproportion, which cannot be resolved by orthodontics alone. It is important to identify such cases, and consider a surgical orthodontic solution in order to achieve an acceptable PIP. If there are major limiting features, it is normally better not to commence treatment on the basis of orthodontics alone. In such cases, there is a probability of adverse facial change, due...

Planned incisor position

Planned incisor position (PIP) may be defined as The intended end-of-treatment position for upper incisors. In some cases, the perceived ideal upper incisor position will be a realistic treatment goal, and can become the PIP for that case. In other cases, the ideal incisor position may not be a realistic goal, for various reasons. In such cases, the perceived ideal incisor position has to be adjusted to reflect the limiting features of the case, such as lack of cooperation or growth potential....

Creating the biteplate effect

There are four methods of creating the bite-plate effect 1. Appliances can be placed on the upper arch only, which allows for proclination of (he upper incisors (f ig. 6.1 OA). This frees (he lower incisors for placement of brackets. This technique is helpful in high-angle cases, because posterior extrusion is minimized. 2. Acrylic removable anterior bite plates can be placed (Fig. 6.1013). This is particularly helpful in low-angle deep-bite cases, because it encourages distal tipping,...

The posterior squeezing out effect of molar crowding

There has been discussion of posterior crowding as a factor in the development of Class 111 malocclusions.3 The theory suggests that a squeezing out effect can occur because of crowding in the molar regions, which can contribute to an anterior open-bite malocclusion in a mandible with poor vertical growth in the ramus area (Fig. 8.9). Alternatively, good ramus growth can lead to a Class III malocclusion. This concept is not well understood, and has not been fully investigated. However, some...

Arch leveling and overbite control

The development of deep overbite 131 The tooth movements of bite opening 132 Eruption extrusion of posterior teeth 132 Distal tipping of posterior teeth 133 Proclination of incisors 133 Intrusion of anterior teeth 133 Initial archwire placement 134 The bite-plate effect 134 Creating the bite-plate effect 135 The importance of second molars 136 Torque issues 136 Bite-opening curves 137 Antero-posterior issues and elastics 138 Spacing in non-extraction cases 138 Light forces during leveling and...

Space closure in minimum anchorage cases burning anchorage

These are cases where there is only mild crowding or protrusion, but where extraction of premolars is needed to achieve proper treatment goals. It is necessary to close remaining spaces mainly by mesial movement of molars, thereby increasing available space for third molars and protecting facial profile. Second premolars may be chosen for extraction in this type of case, and second molars are normally not banded or bracketed. The thinking behind this approach is based on the mathematical...

The torque component of PIP in Class II treatment

Traditionally in orthodontics upper incisor torque has been related to the maxillary plane, with a cephalometric value of 110 to 115 being a typical goal (Fig. 7.12). The Arnett analysis relates upper incisor torque to the maxillary occlusal plane, and lower incisor torque to the mandibular occlusal plane, with the male upper central incisor torque being ideally 58 and the female 57 (Fig. 7.13). More information on upper incisor torque is given on pages 174-176. Fig. 7.12 In traditional...

Arch form

Brader Arch Form

The search for the ideal arch form 72 Relapse tendency after changing arch form 72 Cases where expansion may be stable 72 Variation among human arch forms 73 Summary of the issues facing the clinician 73 The use of three arch forms 74 Recommended ratios 75 The tapered arch form 76 The square arch form 76 The ovoid arch form 76 Systemized management of arch form 77 Standardized versus customized wires 77 The use of clear templates at the start of treatment 77 Arch form control early in treatment...

Finishing the case

Establishing correct tip of the anterior and posterior teeth 283 Providing adequate incisor torque 284 Management of tooth size discrepancies 285 Maintaining the closure of all spaces 286 Correct crown lengths, marginal ridge relationships, and contact points 288 Final management of the curve of Spee 288 Vertical overcorrection - deep-bite and open-bite cases 289 Arch form 289 Archwire coordination 289 Establishing posterior torque 290 Transverse overcorrection 291 Establishing centric relation...

Case Nh

A 30-year-old male patient with severe anterior crowding on mild Class il dental bases (ANB 5 ). He had Class I buccal segments, and third molars had been previously There was a high-angle pattern (MM angle 35 ). Lower arch form was checked with transparent arch form cards, and assessed as approximately ovoid. The upper right central incisor was recorded at 12 mm to APo line and lower left central incisor at 5mm to APo line. It was decided that the treatment goal would be to retract and align...

Light forces during leveling and aligning

If premolars are extracted in deep-bite cases, it is normally to reduce anterior protrusion or eliminate anterior crowding, or a combination of the two. If there is anterior protrusion without crowding, it is possible to retract the anterior segments en masse. Alternatively, the canines can be retracted alone, followed by retraction of the incisors. If the latter decision is made, extreme care must be taken not to tip the cupids distally because this results in extrusion of the incisors and...

Is Lower Canine Braces Can Interchangeable For Uppers In Mbt System

Prominent Canine With Brace

Figs 2.43 and 2.44 Arch form is an important factor in selection of canine brackets in upper and lower arches. Fig. 2.45 A case with prominent canine roots at the start of treatment, where canine retraction was required. Accordingly, zero torque upper and lower canine brackets are in place to assist treatment mechanics. The -7 upper and -6 lower torque canine brackets are normally not correct if the patient has prominent canines, or canine gingival recession, at the start of treatment. Brackets...

The surgicalnonsurgical decision in Class III treatment

As with Class II treatment, it is important to recognize those Class III cases which have a major skeletal disproportion, either at the time of assessment, or where there is a probability of unfavorable growth. For such individuals, it will be necessary to consider a surgical orthodontic solution. Treatment on the basis of orthodontics alone should be delayed, or discarded as a possibility. The S'FCA of Arnett et al was discussed in Chapter 7 (p. 163). In the following theoretical consideration...

Anchorage control during tooth leveling and aligning

Headgear Cervical

Short-term versus long-term objectives 94 Principles of anchorage control 94 Treatment sequence to show leveling and aligning 95 Recognizing the anchorage needs of a case 96 Bimaxillary retrusion - a Class 11 2 example 97 Mistakes in tooth leveling and aligning in the early years 98 Reduced anchorage needs during tooth leveling and aligning 99 Antero-posterior anchorage support during tooth leveling and aligning 100 Lacebacks for A P canine control 100 Bendbacks for A P incisor control 102 A P...

The surgicalnonsurgical decision in Class II treatment

The soft tissue cephalometric analysis, or STCA, has been advocated by Arnett et al2-3,4 as an aid for orthodontists and surgeons in treatment planning. It recommends analysis using a true vertical line TVL through subnasale, with natural head posture. It may also be used to quantify favorable or unfavorable change in the profile after overjet reduction, and hence has an important potential role in post-treatment analysis and in research. The STCA includes normal values for many aspects of...

Bracket removal ceramic brackets

Ceramic Clarity brackets are removed using a different technique. Archwires need to be taken out first, and any excess bonding agent removed from around the brackets, using a high-speed flame-finishing bur Fig. 11.5 . Each bracket may then be collapsed by gripping it mesially and distally using band-seating pliers and squeezing Fig. i 1.6 . It can help the confidence of nervous patients, or those with slightly mobile teeth, if they use each anterior tooth in turn to firmly bite on to a cotton...

Management of anterior open bite during full orthodontic treatment

Short Class Elastics

Some general considerations for the management of anterior open bite during full-banded orthodontic treatment are included in this section. While non-extraction treatment is generally preferred in orthodontics, some open-bite cases may benefit from extractions, primarily to allow for eruption and retroclination of incisors. Some possibilities are as follows If the upper and lower arches show crowding and or protrusion, upper and lower bicuspid extractions can be considered. If the lower arch...

An overview of Class III treatment

Accurate record-taking - displacements 219 Mandibular prognathism or maxillary retrognathism 220 The timing of Class 111 treatment 220 The surgical non-surgical decision in Class III treatment 222 The posterior 'squeezing out' effect of molar crowding 224 The four-stage treatment planning process 226 Setting a PIP for the upper incisors 226 The lower incisors 226 The remaining upper teeth 227 The remaining lower teeth 227 PIP components in Class III treatment 228 Upper incisor movement in Class...

Closing loop archwires

Edward Angle favored a non-extraction approach to all cases and space closure mechanics were not normally needed. Later, however, closing loop archwires became part of traditional edgewise mechanics, as described by Tweed.' Each rectangular steel wire typically had four loops - two omega loops and two closing teardrop loops - and had to be individually made for each patient. There was a limited range of action before the omega loop came into contact with the molar tube. Closing loop archwires...

Identifying severe Class II cases

Orthodontics can be relied upon to achieve a good outcome for most patients with Class I or mild Class II skeletal bases. I Iowever, it is important to recognize those Class II cases which have a major skeletal disproportion at the time of assessment. For such individuals, it will be necessary to consider a surgical orthodontic solution Fig. 7.2 . Treatment on the basis of orthodontics alone should be discarded as a possibility, unless there is a real prospect, in a growing individual, of...

Bracket positioning and case setup

Upper First Premolar Extraction

The need for accuracy 57 Patient management 57 Thcor ' of bracket positioning - avoiding errors 59 Horizontal accuracy during bracket positioning 60 Vertical bracket positioning with gauges and charts 62 Recommended bracket-positioning chart 63 Individualized bracket-positioning charts 63 Upper molar bands - rapid maxillary expansion cases 66 Lower molar band placement 67 Direct bonding of brackets 68 Indirect bonding of brackets 69 Advantages of indirect bonding 69 Disadvantages of indirect...

Sliding mechanics with light forces

Pinzas Torque Idividual Ortodoncia

In 1990, a method of controlled space closure was described3 using sliding mechanics. This has proved effective and reliable for many years, and has seen widespread acceptance by-clinicians. The authors recommend the following technique Archwires. Rectangular 019 .025 steel wires 'working wires' Fig. 9.15 are recommended with the .022 slot, because this size of wire gives good overbite control while allowing free sliding through the buccal segments. Thinner wires tend to give less overbite and...

Appliance specifications variations and versatility

Maxillary Incisor Torque

Design features of a modern bracket system 28 Expression of in-out 31 Upper second premolars 31 Expression of torque 33 Incisor torque 34 Canine torque 36 Upper premolar and molar torque 37 Lower premolar and molar torque 38 The versatility of the bracket system 39 Palatally displaced upper lateral incisors 40 Three torque options for the upper canines 44 Three torque options for the lower canines 44 When should the three canine options be used 44 Interchangeable lower incisor brackets 48...

A brief history and overview of treatment mechanics

Mbt Torque Figure

Fundamentals of treatment mechanics 3 Bracket design Bracket positioning Archwire selection Force levels The work of Andrews 4 Wide range of brackets Center of the crown Various arch forms Heavy forces Roth brackets Center of the crown Wide arch form Articulators McLaughlin and Bennett 1975 to 1993 7 Mainly standard brackets Center of the crown Ovoid arch form The work of McLaughlin, Bennett, and Trevisi between 1993 and 1997 8 improved bracket positioning with gauges The work of McLaughlin,...

The concept of ideal incisor position in treatment planning

With the advent of improved orthodontic and surgical techniques, emphasis has shifted more toward the upper incisors as a starting point. Today, it is possible to base treatment planning on the position of the upper incisors, instead of using the molars or the lower incisors as a starting point. At the start of treatment planning, it is possible to envision an 'ideal' position for the upper incisors. For many cases, treatment mechanics can then be planned to position the incisors ideally, and...

Stage 2 the lower incisors

Is it possible to position the lower incisors in good relationship to the PIP for the upper incisors Can the required lower incisor position be achieved by orthodontics alone If not, it will be necessary to modify the PIP for he upper incisors which may not be feasible , accept a treatment goal with a less than ideal incisor relationship, or consider surgery to the mandible. Fig. 7.7 The second stage of treatment planning concerns the lower incisors, and how to position them in good...

Positioner construction

The technique for positioner construction is as follows Complete the case as well as possible through the settling stage. With brackets on, take two sets of upper and lower impressions. One set is used for a reference, and the second set is used for positioner construction. Take a face bow recording and a centric relation wax bite, followed by mounting of the case on an articulator. This is critical so that the axis of opening is correct and the positioner material between the teeth is the...

Stage 3 the remaining upper teeth

In the discussion on Class II treatment planning p. 167 , stage 3 of the process concerned the remaining lower teeth, followed by stage 4 - the remaining upper teeth. In Class III treatment planning the opposite applies. It is beneficial to evaluate the remaining upper teeth at stage 3. If upper premolar extractions are necessary usually second premolars then it is normally logical to extract lower first premolar, in a Class III case. However, if the upper arch can be treated without...

Space closure in maximum anchorage cases protrusion

Worn Postier Teeth

Space closure is important in these cases. Good anchorage control is needed at the space closure stage in order to achieve incisor retraction into the available extraction space. First premolars are normally chosen for extraction. Second molars are included in the set-up if possible. In this way, six anterior teeth are balanced against six larger posterior teeth, giving a theoretical advantage in anchorage balance Fig. 9.29 . Palatal bars and lingual arches may be used during the alignment...

Establishing correct tip of the anterior and posterior teeth

Tip is one of the strengths of the preadjusted appliance, especially when twin brackets with adequate width are used. Nearly full expression of the bracket tip is expressed with relatively little effort, and tip bends are normally not needed. With the standard edgewise appliance, however, second order tip bends were placed in the archwires for two reasons. First, to properly move teeth relative to the 0 of tip in the bracket and, second, to compensate for the heavy forces used to move teeth....