Multiband technics.

Dr. Kaán Miklós

SEMMELWEIS EGYETEM

Gyermekfogászati és

Fogszabályozási Klinika

Multiband technikák

• Multiban-multibond appliance is usually

the 2. part of the orthodontic treatment

• Multibond is used in permanent denture

12-13

• Multibond is the only appliance which is

able for the perfect alignment and bodily

movement (torque, angulation)

Early orthodontic treatment

(interceptív orthodontics, orthodontic

prevention)

• 1. phase of the orthodontic treatment:

- in mixed dentition

traetment of serious sceletal problems (in intensive growing, developmental period)

- we can avoid the irreversible deformation of the denture

- a nem kívánatos kompenzáló mechanizmusok kiiktatása

- We solve a lot of local anomaly (crossbites, diasthema medianum, space

maintening)

- less extraction and less surgery after early orthodontic treatment

- less relapse after early orthodontic treatment

- good psichological effect

-

4

Multiband technics in the XX.

century

• -1902. Angle: E- arch

• -1911. Angle: Pin and tube appl.

• -1916. Angle: Ribbon arch appl.

• -1928. Angle: Standard edgewise

• Edgewise technic Angle , Tweed

• Light wire technic Begg

• Bioprogressive technic Rickett Straight-wire technic Andrews

Angle Expansion arch (E arch) 1907

E arch with hooks

Rigid gold wire

Teeth were connected to the arch

with metal ligatures (injury of the

marginal gingiva !!)

Heavy forces

Pin and tube appliance 1913 (Angle)

Metal bands, vertical tubes , good labiolingual movement

The pin was connected to the gold wire

Rigid gold wire

Heavy foerces

Ribbon arch 1915 (Angle)

New bracket with vertical slot

and „ribbon arch” (gold).

Ribbon arch type bracket

Edgewise appliance 1928 (Angle)

Előnyei:

•Good movement controll

•Bodily movement !!

Hátrányai:

•Lot of bending (in-out, torque,

angulation)

•Expensive - gold

•Horizontal slot instead of vertical slot

•Edgewise wire =rectangular wire

Edgewise bracket (Angle)

1. 0.022”x0.028”

horizontal slot

2. Standard edgewise system

Development of the appliances

Angle

készülékek

Tweed

Standard Edgewise

Begg

Light wire technika

Ricketts

Bioprogresszív technika

Andrews

Straight-wire technika

He was not satisfied with Angle’ conception

(nonextraction treatment, face esthetic)

1941- „basal bon” conception

Charles H. Tweed

1895- 1970

TWEED EDGEWISE

APPLIANCE

Strategy of Tweed

1In this slide I summarized the 7 main ideas and the results

of his new concept. Actually, he was the first one who

realised the importance of the facial aesthetics. He also

modernised the orthodontic diagnoses. He was the first

one who used the cephalometrics in the clinical practice.

He introduced new treatment concepts: for example the

serial extraction.

.

Anchorage control first the canine distalisation and the

front togeder

Three different kind of bending

In-out Angulatio Torque

Begg light wire, multiloop technic

Begg’s bracket

Vertical loop

Begg technic

(multiloop technic)

Three main type of tooth movement in Begg mechanics:

Ausztralian wire (Begg), Round cross section 0,016

1. Intrusion, extrusion

2. Tilting, rotation

3. „Multiloop” appliance

Difficult, copmlicated technic with lot of loops

RICKETTS BIOPROGRESSiV

THERAPY (1965)

• Utility wire

• Loops

• Szectional wires (not for the whole arch)

• Quad-helix

• Ricketts examined patient’s actual

development and it influences the treatment

plan and the

Robert Murray Ricketts

0.018” slot (Ricketts )

Stainless steel wire instead of gold

Elgiloy wire (Ricketts )

• Material:

Cobalt(40%)

Crom(20%) Fe(15,81%)

Ni(0,15%),

Mo (7%),

Mn(2%),

Beryllium(0,04%)

C (15%),

• A special kind of

stainless steel (softer)

Utility wire (Ricketts )

• . We use the arch for both vertical

and sagittal corrections.

Sectional wire (Ricketts )

Intermaxillary anchorage

The utility arch with the sectional one. In this situation

the sectional arch is for the distalisation of the canine.

The utility arch treats the incisors.

The same way as Begg also Ricketts

used loops for space closure

• Upper retraktor loop

• Lower retractor loop

• Delta loop

„T” loopok

• To rotate the premolars

• Leveling of Spee curve

Ricketts quad-helix

• Expansion in

mixed and

permanent

denture

I. case

• Angle III. class

• Narrow upper arch

(quad-helix)

• Anterior crossbite

• (utility arch)

Sectional wire to distalise the canine

and

utility arch for the correction of the

anterior crossbite

Direkt ragasztott bracket

End of the treatment

New material: Nickel-titánium

ANDREWS - STRAIGHT-WIRE

Appliance

• Andrews’ „six keys”

• Triple-Control bracket

• Nickel–titanium wires

• 5 stages in the treatment

Lawrence F. Andrews

Andrews „six keys”

1. Szabályos moláris és szemfog viszony

2. Mesio-distal korona inklináció (angulatio) a bracketekben

3. Labio-lingual korona inklináció (torque) a bracketekben

4. Rotáció mentes fogazat

5. Feszes kontaktpontok

6. Lapos Spee görbe

Triple control brackets (Andrews)

• Angulatio

• Torque

• In-Out (Distal offset)

Standard edgewise system - Straight-wire system

An ideal wire has to be bended to reach the optimal position

of each tooth

Torque – third order bend

Angulation – second order bend

In-out – first order bend

Different arch forms

Normal Long and

narrow

Long and

wide Ovális Oval and

long

Stages of the treatment(Andrews)

• Leveling

• Leading phase

• Contraction phase

• Final, correction phase

• Retention

1. Leveling phase - alignment

Alignment – leveling phase

Torque

Angulation

1. Leveling phase - alignment

• Leveling of the

vertical

discrepansies of

the dental arches

is also necessary

Pl: Spee-Curve Rectangular niti wires are also used at the

end of the leveling phase

anti Spee wire

The leveling phase is succesfull is there is enough

space in the arch The treatment of the sceletal (transversal, sagittal etc.) anomalies should

be treated in the late mixed dentition

( durin intensive develeopment)

1. Expansion:: hyrax (sceletal effect), quad-helix,

transzpalatal bar

2. Distalisation of the first molar: headger, pendulum,

distal-jet

3. Extraction: most frequently premolars

4. Stripping

Possibilities for space gaining:

1. Leveling phase – alignment

archwires: round wires:

, • (0,012 inch NiTi or TMA) 0,014 inch NiTi or TMA

• 0,016 inch NiTi or TMA, (0,016 Stainless steel

wire)

rectangular wires

• 0,016 x 0,016 NiTi or 0,016 x 0,016 braided wire

(SS)

• 0,016 x0,022 NiTi 0,016x 0,022 braided wire

(SS)

1. Leveling phase – alignment

Archwires:

Twist-felx or coaxial wire (stainless steel) -weak round wires

Braided wire- stainless steel

Utility arch

(for correction phase)

stainless steele wire

0,016x0,022 SS

4. Correction phase to solve the problems (gaps, rotation, axis correction)

5. Retention

2. Leading phase – the move the canines,

premolars, molars to the finel position

and to proper occlusion

Wires: stainless steel : 0,016x0,016

0,016x0,022

The only function of the rigid wire : leading,

Splinting the teeth

BODILY MOVEMENT !!

The crown and the root are moving

together

2. Leading phase –

movement of the lateral teeth

Bodily movement: the crown and

the root move together

Wire: rectangular stainless steel

Leading phase

• Distalisation of the canines

(fe: after extractions)

• To reach the correct occlusal

units between the canines,

premolars, molars

• 0,16x0,16 vagy 0,16x0,22

stainless steel

II. class, four premolar extraction

Leading phase

2. Leading phase: movement of the canines, premolars,

molars

The function of teh archwires: leading of the teeth (as a rigid splint)

Forces for the tooth movement

Elastic chain

Nikkel-titánium spring (for space closure)

Tight metal ligature

Intermaxillary elastics

Intermaxilláry elastics:

Intramaxillary tooth movement

Intermaxillary elastics for the correction of II. III. class anomalies

Distalisation of the canine

Treatment of the II. class anomaly

The wires prohibit the tilting and the rotation

Tight metal ligatures

Loop for space closure (less friction)

ANCHORAGE !!

Nance appliance

Orthodontic implants

Transzpalatal bar

Headger

3. Contraction phase

adjustment of the incisors

3Contraction phase

The incisors are moved together, in one block

All the dimension are determined (vertical, sagittal)

3. Contraction phase

adjustment of the incisors

Loops between the canine

and the lateral incisor

Elastic chain Intermaxilláry elastics

Wit working arch

Intermaxilláry elastics

4. Final, correction phase

To solve the rest problems: small

gaps, small rotations

We want to reach the perfect occlusal

units

At the end of the treatment

0,17x0,22; 0,17x0,25 stainless steel

wire is necessary to utilise the the

torque, angulation, in-out values

4. Correction phase

To harmonise the occlusion

Proper tooth axis

Correction of assimetry

Retention phase

To keep the result

5. Retention

MIT HASZNÁLUNK MANAPSÁG?

• Angle diagnosztikai rendszerét

• Cephalometriai analízist – Hasund, Ricketts, Steiner, Mcnamara

• Nickel titánium íveket

• Rozsdamentes acélíveket

• Loopokat, ívhajlításokat

• Intermaxilláris gumihúzásokat

• Utility ívet – Ricketts

• Triple kontrol bracketeket - Andrews

• Straight wire technikát – Andrews

Köszönöm a megtisztelő

figyelmet