fudamentals of biomechanics and biomechanics of levelling and aligning(includes biomechanics of...
TRANSCRIPT
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Fundamentals of Biomechanics including Mechanics of Leveling
and Aligning
Dr. Meenakshi Vishwanath
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Contents
Introduction
Terms and definitions
Principles of biomechanics
One couple system
Two couple system
Leveling and aligning
-Begg and PAE systems
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Introduction
Mechanics-is the discipline that describes the effect of forces on bodies.
Biomechanics-study of mechanics as it affects the biologic systems.
Application of mechanics to the biology of tooth movement.
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Introduction
History
Studies concerning the biology of tooth
movement -1930’s
The study of mechanics and effect on
periodontium-1950’s
Various methods to study mechanics –
Laser holography, Photo-elasticity,
Complementary Strain Energy, F E M . .
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Introduction
Orthodontic tooth movement –Force on the teeth.
Knowledge of mechanical principles and governing forces- necessary for the control of orthodontic treatment.Basis of orthodontic treatment-clinical application of biomechanic concepts
Proper mechanical force system = medications Treatment success.
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Terms and definitions
Centre of Mass- All objects (finite) behave as if the entire mass is concentrated onto a single point.
Applicable in force - free stateBehaviour- Predictable if forces acting in relation to this point is known.
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Terms and definitions
Centre of Gravity- objects subject to gravitational force Cmass / Cg -“ Balance point”
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Terms and definitions
Centre of Resistance- analogous to the Cmass for restrained bodies.
Function of a body in a system of constraints-supporting tissues.
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Terms and definitions
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Terms and definitions
Cres depends on-1. Root length & Morphology2. Number of roots3. Level of alveolar bone support
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Terms and definitions
Various authors differ in the estimation of Cres.Methodology.For single rooted teeth-
At 50% of root length-Proffit,Nikolai
B/w 50%-33% of root length-Smith and
Burstone
At 33% of root length-Burstone
B/w 25%-33% of root length-Nanda
The Cres of facial bones, entire arches of teeth,
or segments can also be estimated
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Terms and definitions
Multirooted teeth-
Maxillary anterior dentiton Cres - maxillary anterior teeth-distal to lateral incisor-NandaIncorporation of lateral incisors-small distal shift,canines-significant distal movement-Burstone & Sachdeva
Mutirooted-close to bifurcation of the roots –Nanda
Trifurcation-Upper I molar- Worms, Isaacson and Speidel
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Terms and definitions
Cres of -maxilla-slightly inferior to orbitale-Nanda
Postero-superior ridge of the pterygomaxillary fissure registered on the median sagittal plane-Tanne et al
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Terms and definitions
Determination of the centers of resistance of all the individual teeth and groups of teeth using FEA.
Conclusions-1. Longer the root, the more apically placed was
the Cres.
2. The Cres of all teeth were slightly apical to the centroid of the teeth.
3. The Cres of Mand. Premolars lie at the same level, Cres of I Max. Premolar is more apical to that of the II premolar.
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Terms and definitions
4. The Cres of the maxillary and Mandibular molar lies at the tri/bifurcation respectively.
5. Intrusive forces on groups of teeth-Cres shifts posteriorly as more number of teeth were included in the segment.
6. For retractive forces on groups of teeth-Cres shifts coronally as more number of teeth were included in the segment.
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Terms and definitions
Precise location-not known, conceptual awareness needed.
Relationship of force systems to Cres of tooth-type of tooth movement
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Terms and definitions
Centre of Rotation- a point around which an object rotates.
-The geometric point about which no movement occurs
Point around which an object seems to have rotated as determined from its initial and final positions.
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Terms and definitions
Method for determining centre of rotation –
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Terms and definitions
Can be at any point ON or OFF the tooth
If there has been no rotation-infinity
If tooth has followed an irregular path-several centers of rotation
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Principles of biomechanics
Scalars and vectors
Force- vector
-a load applied to a object that will tend to move it to a different position in space
F=mass x acceleration Newtons or gm.mm/sec2
Orthodontics- (mm/s2 )-irrelevant
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Principles of biomechanics
1 Newton=101.937 grams (or) 1 gram=.oo981 N
1 Pound=16 Oz =.4536 Kg
1Oz =28.35 grams
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Principles of biomechanics
Direction and magnitude of force -
Origin/point of application
Magnitude Sense/Direction
Line of action
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Principles of biomechanics
Multiple vectors can be combined through vector additionSum of 2 or more vectors- Resultant
Resultant
Force 1
Force 2
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Principles of biomechanics
Different points of application-
Forces can be combined using the law of transmissibility of force.
“When considering the external effects of a force on a rigid body the force may be considered to have a point of application anywhere along its line of action”
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Principles of biomechanics
Resolving a force into vectors-
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Principles of biomechanics
Moment –Rotational tendency of a force that is not passing through the centre of resistance.
The magnitude of the moment=Force x lar distance of line of action (force) to
the Cres
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Principles of biomechanics
Unit - Gram millimeters (Newton millimeters)
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Principles of biomechanics
M=F x D
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Principles of biomechanics
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Principles of biomechanics
Important to distinguish between force and moment.“Cue ball concept”
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Principles of biomechanics
Couple –consists of two forces of equal magnitude, with parallel but non-collinear lines of action and opposite senses.
- Two equal and opposite parallel forces separated by a perpendicular distance.
-Applied moments
Pure rotation about the centre of resistance
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Principles of biomechanics
Magnitude of a couple=Mag.of 1 force x perpendicular dist b/w them Unit-Gram.mm
Translational effects cancel out each other
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Principles of biomechanics
Moment arm of a couple-
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Principles of biomechanics
Couples result in pure rotational movement regardless of where the couple is applied on the object.
50 x 10=-500gm-mm50x30=1500gm-mm
500gm-mm is negative Thus 1000gm-mm just as in
the previous case
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Principles of biomechanics
Clinically
Centre of rotation coincides with the centre of resistance.
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Principles of biomechanics
Forces indicated by-
Moments indicated by-
Moment of force-rotational tendency of a single force that does not pass though the Cres-(linear movement occurs)
Moment of couple-two forces that produce pure rotation (no linear movement)
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Principles of biomechanics
Application of force/couple usually is at the brackets
Predicting the type of tooth movement-determine the Equivalent force system at the of resistance.
Equivalent force system- Analysis that replaces the applied force at the bracket with its equivalent at the at the Cres
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Principles of biomechanics
The 2 extreme situations-Force exactly at the centre of resistance-only linear movement (translation).Forces that produce pure rotation.
All situations in between the two produce some translatory and some rotatory movements.
So what are the forces at the Cres and what type of tooth movement results?
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Principles of biomechanics
Determining the force system at the Cres
1. Place force vector at the Cres (maintain
magnitude and direction)
2. Calculate -moment of force
3. Place MF - centre of resistance
4. Applied moment placed at the Cres
5. The MF and applied moment added –net
moment
6. Resulting force - expected tooth movement
100gm
10mm
1000gmm1000gmm
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Principles of biomechanics
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Principles of biomechanics
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Principles of biomechanics
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Biomechanics
Bio-mechanics
Cmass /gravity/res
Centre of rotation
Forces and Moments
Couple
Moment of force/Moment of couple
Equivalent force system
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Principles of biomechanics
Equivalent force system- It is the forces at the centre of resistance that determine how teeth move.
The force system placed at the bracket is equated at the Cres to determine the tooth movement.
Helps in-Prediction of the tooth movement
Equivalent force system- Analysis that replaces the applied force at the bracket with its equivalent at the the Cres
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Principles of biomechanics
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Principles of biomechanics
Types of tooth movement-infinite variety but can be categorized into basic types
uncontrolled Tipping
controlled
Translation
Root movement
Rotation
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Principles of biomechanics
Each type of tooth movement is due to the variation in the amount of applied moment and force.
The ratio of the applied counter moment and the applied force experienced at the Cres is called the Moment- to- force ratio .
The M/F ratio of the applied force and moment determines the type of movement at the centre of rotation.Unit-millimeters
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Principles of biomechanics
Tipping- Greater movement of the crown than the root.
Centre of rotation-Apical to the Cres
Uncontrolled tipping Controlled tipping
Between Cres and root apex At the root apex
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Principles of biomechanics
Uncontrolled tipping- Simplest type of movement –often
undesirable.
Simple forces-chain elastics, intraoral-arch elastics, or coil springs used on a round wire.
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Principles of biomechanics
Non uniform stress generated
Maximum-root apex and crown
M/F =0:1 - 5:1(av.root lengths and 100% alveolar bone height)
Desirable-Cl II div 2 and Cl III patients with excessively upright incisors that need flaring & excessively flared Cl II div 1.
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Principles of biomechanics
Controlled tipping – Control or maintenance of the root apex
position.Desirable type of tooth movement.
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Principles of biomechanics
Stress at root apex is
minimal
Concentration of forces
at the cervical area-
timely tooth movement
Protrusive incisors
(Root apex in a good
position)
M/F=7:1
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Principles of biomechanics
Translation (bodily movement)- crown and root move the same distance in the same direction.
Centre of rotation-infinity
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Principles of biomechanics
For this type of tooth movement-Force-centre of resistanceForce applied at the bracket….
counter moment applied in such away that-equivalent force system at the Cres –pure force.
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Principles of biomechanics
M/F-10:1
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Principles of biomechanics
Root movement- crown is stationary -force and moment cause only root movement
Centre of rotation-incisal or bracketRequires a large moment-M/F ratio at or above 12:1
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Principles of biomechanics
Stress levels high at apex –significant amount of bone resorption required.Undermining resorption-slow momentAdvantageous-augments anchorage
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Principles of biomechanics
Clinically--Upright the incisors, correct the canine roots
after space closure.-crowns should be ligated to stop them from
moving-Lingual root movement of incisors-large forces
may cause a “Row –boat” effect
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Principles of biomechanics
Rotation –requires a
couple
No net force at the Cres
Clinically-rotated teeth.
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Principles of biomechanics
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Principles of biomechanics
True relevance of M/F ratio-Biologic variations in estimation of CresDifference in the M/F ratio of various tooth movements is small.Difference in opinion about precise M/F ratios
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Principles of biomechanics
The M/F ratio need not be taken as absolute-General principles are important-
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Principles of biomechanics
Static equilibrium-
Effort was put to achieve the equilibrium
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Principles of biomechanics
In orthodontics-equilibrium establishes itself
We do not have to achieve static equilibrium but recognize the forces and moments that have come into existence to establish the static state.
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Principles of biomechanics
Newton’s laws of motion-underlie the fundamental concept of mechanics.
1.Law of inertia
2.The law of acceleration
3.The law of action and reaction
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Principles of biomechanics
Application of these laws-orthodontics
Wire engaged into poorly aligned teeth-1st & 3rd laws
A more important application of Law of action and reaction is static equilibrium.
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Principles of biomechanics
Static equilibrium implies -At any point within a body, the sum of forces and moments acting on a body is zero.The analysis of equilibrium as applied to orthodontics can be stated as
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Principles of biomechanics
Sum of all vertical forces =0
Anterior intrusion-have to deal with-the balancing force-molar extrusion.
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Principles of biomechanics
Sum of all horizontal forces=0
Correction of unilateral crossbite-not possible with a single horizontal force
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Principles of biomechanics
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Principles of biomechanics
Moment acting around any point must = 0.
Forces produced to maintain static equilibrium
Magnitude of forces exactly –necessary to produce a counter rotation.
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Principles of biomechanics
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Equilibrium situations
Many appliances and bends placed in clinical
situations
Many situations –unequal forces and moments
develop.
“Additional forces”-develop to obtain
equilibrium
Determination of complete system in
equilibrium-side effects.
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Equilibrium situations
The forces and moments that determine a appliances equilibrium –must exist.
If not-Newton’s 2nd law-teeth will accelerate out of the mouth!
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Determinate Vs Indeterminate force systems
Force systems can be-
Statically determinate (One couple system) The forces and moments can readily be discerned, measured and evaluated.
Statically indeterminate (Two couple system) System is too complex for precisely measuring all forces and moments involved in equilibrium.
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Biomechanical classification of orthodontic appliances
Equal and opposite force system (No couple appliance system)
One couple appliance system
Two couple appliance system
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Force systems
Equal and opposite force system-No couple
Elastic band stretched between 2 points
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Statically determinate
One couple system- Simplest arrangement of an orthodontic force system.
Couple is created ay one end of the attachment –only force at the other.
One end –tube or bracket and point contact at the other.
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Statically determinate
The direction of moment clinically can be estimated –placing one end of the arch wire over but not inside the slot.The wire crosses the bracket at an angle.
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Statically determinate
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Statically determinate
Magnitude of forces-measurable
Force multiplied by the distance b/w bracket and point of attachment=moment-equal and opposite to Mc at bracket.
Magnitude of forces of couple at the bracket-divide the magnitude of Mc by the length of bracket.
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Statically determinate
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Statically determinate
High predictability of tooth movement.
Decreased need of appliance reactivation.
Side effects known
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Statically determinate
Applications of one couple systems-
Cantilever spring applications
Canine extrusion springs
Midline springs
Anterior intrusion arches
Anterior extrusion arches
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Statically Indeterminate
Two couple system-When the free end of the arch wire-inserted into a second bracket.
For the purpose of establishing the direction of associated equilibrium forces-sum of 2 successive 1 bracket systems
Couples-each of 2 brackets
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Statically Indeterminate
The entry of wire –not accurate estimate of direction of Mc
When wire placed over bracket-angle of entry determines-larger/smaller moment
The force systems-depend on wire geometry and bracket angulation relationships.
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Statically Indeterminate
Applications of two couple systems-
Utility arches
Upside-down Utility arches
Torquing arches
Upside-down torquing arches
Transverse activations
Segmented springs
Transpalatal/lingual arches
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Equilibrium situations
Description of Force system in 3 bracket – wire situations-
1. Off-Centre “V” bend
2. Centre “V” bend
3. Step Bend
4. Straight wire passed through non - aligned
brackets
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Equilibrium situations
Location of the centre of resistance-
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Equilibrium situations
Off-centered “V” bends (asymmetric bend relationship)
Creates unequal and opposite couples.
The net equilibrium forces-intrude one
unit, extrude the other.
Total magnitude of system-not certain,
relative magnitude can be determined.
The larger moment-indicates the direction
of equilibrium forces.
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Equilibrium situations
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Equilibrium situations
Magnitude of b-does not mean stronger extrusion –as the anchorage value of the tooth is more.
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Equilibrium situations
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Equilibrium situations
1/3rd the way along the inter bracket span-no moment on the distant tooth.
Closure than 1/3rd moment generated in the same direction.
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Equilibrium situations
Centered “V” bend Creates equal and opposite couples at the brackets.
The associated equilibrium forces at each bracket-equal and opposite – cancel each other out.
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Equilibrium situations
•The location of Cres has no effects on the reactions produced
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Equilibrium situations
Need not be half-way b/w the 2 groups of teeth
If 1 tooth is larger-equal and opposite moments require-bend to be placed closer to the larger tooth
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3_D wire will cause torsion and bending to occur.
FEM used-description of forces & couples along the global co-ordinates.
17 X 25 ss wire
MY1 ,MY2 & associated equilibriums-FZ1 & FZ2
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Equilibrium situations
2 opinions on location of Cres-
2 teeth as individual unitsA single unit -1 Cres
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Equilibrium situations
Step bends-
Creates 2 couples in the same direction-regardless of location between brackets.
Location of step bend-no effect on either magnitude of moments or equilibrium forces.
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Equilibrium situations
Forces generated are stronger than the off-centered “V” bend situation
If the Cres changes-similar effect of that seen in Off-centre “V” bend .
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Equilibrium situations
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Equilibrium situations
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Equilibrium situations
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Equilibrium situations
Straight wire placed in a non - aligned brackets-
Arch wire is placed in mouth-complicated set
of forces on each tooth
Simplest basic unit- two tooth segment of an
arch
Series of 2 tooth systems-forces can be found
along the arch.
Force systems in a ideal arch wire-Burstone &Koenig AJO-1974
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Equilibrium situations
The force system produced by a straight wire placed between two attachments-determined by defining the Wire-attachment geometry.
Interbracket axis-L-connects the 2 centers of attachmentθA & θB -angles of attachment –respect to interbracket axis
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Equilibrium situations
Six basic 2 tooth geometries –θA/ θB
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Relative force systems-
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Actual M/F ratios
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Actual M/F ratios
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Actual M/F ratios
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Actual M/F ratios
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Actual M/F ratios
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Actual M/F ratios
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Equilibrium situations
Dogma of ideal arch-wire is bent into a shape one would like the brackets to be found at the end of treatment –teeth move into that positions on the ideal arch.
Validity???
Rigid wire-acts as a mould.
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Equilibrium situations
Each segment of the arch wire (2 tooth) has different forces and moments generated.
Not under the control of orthodontist.
Sheer chance that desired force system would be produced!
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Equilibrium situations
Common sense application of mechanical principles.
Dealing with the biologic environment-variation in response - challenges the orthodontist.
Understanding of the appliance of choice and the various force systems.
Treat in a practical & realistic manner.
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Equilibrium situations
Visual inspection-Frequently used to determine the forces an arch wire will produce
May seem obvious-Faulty conclusions.
Determine the forces and moments
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Equilibrium situations
What force will be produced?On the molar? Extrusive . Intrusive. None.On the Cuspid? Extrusive. Intrusive. None.
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Equilibrium situations
What force will be produced?On the Central Incisor?On the Lateral Incisor?Extrusive. Intrusive. None.
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All figures described only 4 situations
Archwire bends-centre and off-centre
Can describe the force system by noting the location of the bend.
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Equilibrium situations
A Simple Rule.
Bend off center: short and long segment.
Short segment engaged –long segment point in direction of the force produced.
Short segment points in the opposite direction of the force.
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Equilibrium situations
Bend at center: no short or long segments- forces as cancel each other upon engagement leaving only pure moments.
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Fundamentals of Biomechanics including Mechanics of Leveling
and Aligning
Dr. Meenakshi Vishwanath
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Biomechanics of leveling and aligning-Introduction
Usually the first step –orthodontic treatment plan.
Division of treatment into stages-Begg, but
reasonably applicable to PAE.
3 major stages in comprehensive treatment plan-
1. Alignment and leveling
2. Correction of molar relation and space closure
3. Finishing
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Introduction
Goals of I phase of treatment-
To create a harmonious dental arch without irregularities
& Correct vertical discrepancies by leveling
out arches.
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Introduction
Leveling and aligning in PAE - synonymous with the stage I in Begg.
Proper alignment- one not only brings malposed teeth into the arch but- control antero-posterior positions, width of arches and form of dental arches.
Leveling-determine and control-extrusion of posterior teeth ,intrusion of anteriors or a specific combination of the 2.
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Introduction
Types of tooth movement-infinite variety but can be categorized into basic types
uncontrolled Tipping
controlled
Translation
Root movement
Rotation
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Introduction
Uncontrolled tipping-M/F =0:1 - 5:1
Controlled tipping –M/F=7:1
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Introduction
Translation (bodily movement)-M/F-10:1
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Introduction
Root movement-M/F ratio at or above 12:1
Rotation -
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Alignment
Though generally agreed- ‘Bite before Jet’- BUT treating cases of maligned arches alignment becomes important.
Once the teeth are aligned-all teeth can be intruded.
Alignment-create space for correcting crowded teeth or to close excess space if present.
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Alignment
Depending on individual treatment goals-all teeth aligned at the same time or some teeth excluded to avoid round - tripping.
Early alignment-corrections maintained for a
longer time biologic adaptation and enhanced
stability.
A combination of labiolingual and mesiodistal
tipping guided by an arch wire is needed.
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Principles in choice of alignment arches
Initial arch wires should provide-light continuous
force -50grams
Most often achieved- placing wires with low load
deflection rates and shape memory-
NiTi ,multistranded and small cross-sec SS wires.
Arch wires should freely slide within the brackets-
at least a 2mil clearance B/w arch wire and bracket.
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Principles in choice of alignment arches
• Wires should be loosely ligated
• Loosely ligated, so that it can slide through the brackets, it has ¼th the stiffness of a wire that is tightly ligated.
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Principles in choice of alignment arches
Rectangular wires –avoided -(root apices are
closure to the normal position).Better to tip the crowns into position during initial alignment.
Rectangular wire useful-torque expression right from start-root positions not favorable-
Instanding lateralsSoon after arch expansion
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Properties of alignment arch wires
Combination of strength, springiness and long range of action.
The variables in selecting appropriate arch wires for alignment-
Arch wire materialCross-sectionDistance between attachments
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Arch wire material
Titanium based wires – NiTi and TMA –offer better combination of springiness and strength.NiTi wires-better (springier and stronger) than TMA-preferred.Remarkably -Low-load deflection.
If steel is used in this stage-Multistranded wires or loops.
141
Size of wire
Strength changes as a cubic fn of the ratio of the 2 cross sections.Springiness-4th powerRange-direct proportion
As the wire size increases though strength increases rapidly, springiness decreases even more.
The smallest diameter wire (springy) of adequate strength can be used.
142
Size of wire
Multistanded wire- They are composed of specified numbers of thin wire sections coiled around each other to provide round or rectangular cross section
On bending - individual strands slip over each other , making bending easy.
Result - high elastic modulus wire behaving like a low stiffness wire
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Distance B/w attachments
Increase the length of the wire-Loops
Proportionate decrease in strength, but the stiffness will decrease as a cubic function
The width of bracket determines the beam length if a continuous wire is used.
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Arch wire -materials
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Space creation
In case of crowding , space required for alignment can be obtained in the following ways-
Proclination Canine distalizationArch expansionInterproximal reduction
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Aligning in Begg
Stage-I
SUB-STAGE I-A SUB-STAGE I-B
Objectives of substage I-A
1.Create space
2.Alingment of anterior teeth-Labio-lingual
displacements & rotations,anterior crossbites
3.Improve incisor inclination-+/- 10 ° of normal
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Aligning in Begg
4.Rotations ,bucco-lingual positions of molars-crossbites
5.Premolar rotations
6.Upper arch form corrected-0.016
Completion of substage I-A-full engagement of plain arch wire-intrusive -forces applied to all teeth.
Inclinations are improved-true intrusion & controlled tipping is achieved.
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Aligning in Begg
Alignment best carried out-flexible wires –low load deflection rate.
Easy engagementLight constant forces-long distancesPermit sliding
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Aligning in Begg
Multilooped archwire-though made of stiff wire-loops incorporated-anterior area
Disadvantages-Inadequate bite openingLabial flaring of incisorsLoss of control over molar positions & anchorageDifficulty in construction and adjustmentDifficulty in maintaining the arch form
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Aligning in Begg
Alignment without multilooped wires-0.016 –canine distalization-sliding along the arch wire.Flexible wires-steel base wire.
Thus –choice made between various sizes of steel, multistranded wires and NiTi-singly or combinations.
151
Aligning in Begg
Full length NiTi can be used- Highly placed canine-class II elastics (ultra light)-bite does not deepen as extrusive component of elastic is negated.Open bite situations
If bite already deep-and elastics given-combination of flexible and steel wire-(anchor bend is given )-can be used
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Aligning in Begg
If canine has to be distalized for space creation-the SS wire 0.014 or 0.016 is to be used.Minimal crowding-cuspid circle positions can be altered ;offset bends can be given in the wire-partially active.
More crowding-canines slide along the wire-elastics.
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Aligning in Begg
Rotational correction-bracket slot should be filled
Larger diameter NiTi are better
If small diameter steel used-Exaggerated horizontal offsets have to be given.
154
Aligning in Begg
Flexible sectionals are used-
Only after canine distalization and there is
sufficient space for decrowding.
NiTi,Co-ax or supreme wires used as-
sectionals with a base wire to prevent
adverse effects.
Base wires are given offsets to keep away
from brackets.
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Aligning in Begg
Anchorage considerations in stage IVery efficient control- sagittal direction-stationary anchorageAnchorage loss-heavy elastic forceAnchorage conserved-
TPAAnchor bendsStiff wires-molar stopsLip bumpers
156
Aligning in PAE
Pre adjusted edgewise system-
The tooth movement needed to achieve passive
engagement of a steel rectangular wire
of .019/.025 dimension and of suitable arch
form, into a correctly placed preadjusted .022
bracket system.
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Aligning in PAE
Anchorage control gains importance-
Successful alignment depends on recognizing unwanted tooth movements - occur early in the treatment –built in tip in the brackets.
Final treatment goal-kept in mind
Anchorage requirement changes-case to case-most cases do require some form
158
Aligning in PAE
Reduce anchorage needs-
Arch wire forces-very light
E-chains to be avoided
Lace backs to be given-restrict canine tipping-mainly used premolar extraction cases
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Aligning in PAE
Bendbacks for antro-posterior control
160
Aligning in PAE
Wire sequencing
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Aligning in PAE
Vertical control of incisors-built in tip-increases the overbite Canine distally tipped-extrusion of incisors
162
Biomechanics of aligning
Biomechanics-Continuous arch/Segmented arch
Special situations-Impacted canine Midline correctionDiastema closureMolar rotations
163
Biomechanics of aligning
Biomechanics in a continuous arch-
164
Biomechanics of aligning
165
Biomechanics of aligning
To avoid undesirable force-Bracket fewer teeth-sectional arch system
Segmented arch technique-
Concept-the arch is divided into segments
Better control and favorable force levels
Well defined units of teeth-anchorage and
movement segments clearly defined
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Biomechanics of aligning
In segmented mechanics-TPA/lingual arches used; stabalizing wire segments
Stabilization requires-most rigid wire-.022 edwiese slot preferred
21 x25 –anchor segments
167
Biomechanics of aligning
Segmented arch treatment-
Initial alignment within antero-posterior
segments
Once teeth within segments-aligned, each
treated as 1 large multi-rooted tooth
Creation of appropriate-anchorage and tooth
moving segment
Vertical correction and space closure with
differential movement of anterior& posterior
segments
Friction –almost avoided
168
Biomechanics of aligning
Vary the cross section of wire-Segmentation allows-use of different cross-sec wires at different locations in same arch.
169
Biomechanics of aligning
Special situations- AligningCanine extrusion spring- High facially placed
•Wire bent passive to
occlusal to canine
•Wire activated-2nd order
couple created
•Equilibrium forces
develop
170
If continuous wire were used-incisor intrusion-anterior open bite
171
Biomechanics of aligning
Effects extrusive force-Third order moment createdCanine-crown lingual ;root-facialForce passes facial to Cres
Wire inserted into the bracket-lingual root torque applied-side effect labial root torque on molar.
Statically indeterminate systemCare taken-no 2nd order activation at the canine
172
173
Biomechanics of aligning
Canine extrusion spring- Palatally placed
•Similar activation as previous situation
•Third order couple created at molar-passive TPA
174
Biomechanics of aligning
Palatal to facial canine movement
•1st order couple at molar tube
•Equilibrium forces-Facial canine movement
•TPA- molar
175
176
Biomechanics of aligning
Midline springs
•Wire lateral to incisors in direction in which movement required
•Force system-similar to previous situation
177
178
Biomechanics of aligning
Diastema closure
179
Biomechanics of aligning
Molar rotations-Transverse correctionsCan be done on a 2 x 2/4
2x6 –anterior segment –visualized as one large tooth.
Predominantly molar movement
180
Biomechanics of aligning
Symmetrical ‘V’ bends
Molar mesial- out rotations
Molar mesial- in rotations
181
Biomechanics of aligning
Moments-Bilateral toe-in
Canine -distal outMolar –mesial out
Anterior segment-large tooth-cancel each other
Increases arch perimeter
Correction of class II malocclusion
182
Biomechanics of aligning
Bilateral toe-outsMesial-in molar rotations
Correction of molar rotation
Decrease the arch perimeter
183
Biomechanics of aligning
Asymmertrical ‘V’ bends
Larger angle of entry-determines direction and not magnitude of equilibrium forces
Premolar should not be engaged
184
Biomechanics of aligning
185
Biomechanics of aligning
Molar mesial-out rotations-
Molar M-out rotations and intermolar expansion
186
Biomechanics of aligning
Molar mesial –in rotationsReversal of situations
Bilateral molar M-in rotations and constriction of inter molar width
187
Biomechanics of aligning
Molar constrictionBend-closure to canineLittle or no molar rotation
Constriction of intermolar width with minimum molar rotations are desired
188
Biomechanics of aligning
Molar expansion
Molar expansion-minimal rotations
189
Biomechanics of aligning
Step bends
Magnitude of the 2 M of couple need not be equal-but associated equilibrium forces are always equal
190
Biomechanics of aligning
Molar expansion-Toe-out
M-out rotations & enhanced expansive equilibrium forces.
191
Biomechanics of aligning
Molar constriction-Toe-in
M-out rotations and greater constrictive forces
192
Fundamentals of Biomechanics including Mechanics of Leveling
and Aligning
Dr. Meenakshi Vishwanath
193
Biomechanics of leveling-Introduction
Goals of I phase of treatment-
To create a harmonious dental arch without irregularities
& Correct vertical discrepancies by
leveling out arches.
194
Introduction
Overbite- vertical overlap of the incisors.
Lower incisal edges contact the lingual surface of the upper incisors at or above the cingulum.
Normal overbite-2-3mm
Deep bite-increased to more than 3mm -1oo% biteOpen bite-no vertical overlap of the teeth.
195
Introduction
Etiologic classification of deep bite-Developmental
Skeletal deep biteDentoalveolar deep bite –supraeruption of incisors (interocclusal clearance-small)-pseudo-deep bite
196
Introduction
Acquired deep bite-Lateral tongue thrust-infraocclusion of posterior teeth-large freeway space-class II div 2.-true deep bitePremature loss of deciduous teeth or early loss of permanent molarsWearing away of occlusal surface
197
Introduction
Etiologic considerations of open bite-Epigenetic factors-
Posture, morphology and size of tongueSkeletal growth pattern of maxilla and mandibleVertical relation of jaws
198
Introduction
Environmental factors-Abnormal respiration
199
Introduction
The development of vertical problems-The anterior teeth continue to erupt until contact is made with opposing anterior teeth.
If increased jet-continue to erupt-touch palate
200
Introduction
Stop erupting if mechanical obstruction-thumb/tongue restricts
Unrestricted eruption of lower 2nd permanent molar-posterior part of curve of spee.
201
Tooth movements of bite opening
Bite opening can mainly be done by-
Absolute intrusion
Relative intrusion
Extrusion of posterior teeth/distal tipping
Proclination of incisors
Combination
202
Tooth movements of bite opening
Criteria for the mode of bite opening-
Age of patient- amount of growth left
Growth pattern-horizontal/vertical
Incisor exposure at rest-
upper incisor exposure more than 2 - 3mm
Upper exposure normal-deep curve of
spee-lower incisor intrusion.
203
Tooth movements of bite opening
Tooth movements of bite opening-1.Absolute intrusion of incisors-
Required when hyperdivergent growth pattern
204
Tooth movements of bite opening
Adult patients-molar extrusion is not compensated by vertical ramal growth.
205
Tooth movements of bite opening2.Relative intrusion of incisors- kept where
they are, mandible grows and posterior teeth erupt.
Eruption of posterior teeth is a normal molar vertical change in a growing individual-stable
206
Tooth movements of bite opening
Increase in vertical face height-accommodates if any orthodontic extrusion occurs –leveling the COS, intermaxillary elastics
207
Tooth movements of bite opening3-a Extrusion of posterior teeth-not
compensated in adults-Low mandibular plane angle-not stable-musculature resists extrusionHigh angle cases-weaker musculature-teeth may remain stable-opening of the mandibular plane-undesirable
208
Tooth movements of bite opening3-b Distal tipping of posterior teeth-similar to
the previous situation
209
Tooth movements of bite opening 4.Proclination of incisors- retroclined incisors-
deep bite.
210
Tooth movements of bite opening
Combination of the above-Ex-Bite plate effect-Proclination
Incisor intrusion
Posterior extrusion
211
Tooth movements of bite opening
The importance of 2nd molars-Early banding esp. in low angle and deep bite cases.Inclusion of 2nd molars-lever for extrusion of premolars and assists molar intrusion.
212
Principles for intrusion
Burstone’s important principles for intrusion-
Light constant force
Single point of force application
Sequential intrusion
Good anchorage control
Analysis of forces and moments in each biomechanical situation
213
Leveling by intrusion
Bypass mechanics -
Begg bends and modifications
Cetlin’s intrusion arch
2x 4 mechanics
Utility arch
214
Leveling by intrusion
Segmented mechanics-
Burstone’s intrusion arch
3-piece intrusion arch
Connecticut intrusion arch
215
Leveling by extrusion (relative intrusion)Continuous arch-
COS
Kameda’s modification
Anchor curve
K-SIR archwire
216
Bypass Arches
Begg mechanics-Conventional Begg-mainly resulted in molar extrusion.
Heavy elastics and not so rigid base wires.
More emphasis –true incisor intrusion
Various methods of incisor intrusion and
different arch wire modifications for
improving efficacy of incisor intrusion.
217
Bypass Arches
Begg mechanics-
All 6 anteriors are intruded together -
Anchor bend
Anchor bend-
218
Bypass Arches
Round wire derives its bite opening force-anchor bend.Force passes labial to CresLabial flaring of incisors-undesirableClass II elastics
219
Bypass Arches
Class II elastics-horizontal and vertical component-
Vertical component-Dec the efficacy of intrusive force
Horizontal component-influences the net resulting force.
220
Bypass Arches
Interplay b/w intrusive force and retractive (elastic) force-Begg technique controls the vertical dimension- planned imbalance between archwire and elastic force.Optimal intrusive force-15-30 grams/upper incisor
221
Bypass Arches
Kesling –
Bite opening bends-1.5-1.2 oz –midlines
Class II extrusive force-I oz
Net intrusive force-0.5 oz
222
Bypass Arches
14 g for 3 teeth-below optimal force
Lower incisors-1.2 oz-30 grams
Upper incisors should receive -60-70 g net
force.
Class II elastic force-very light forces to be used (reqd for tipping)Yellow (5/16) or road runner (3/8)-5 g
223
Bypass Arches
Exact estimate of force value –not possible Higher intrusive archwire force and light extrusive forceArch wire size-table
224
Bypass Arches
Mollenhauer -0.18 ss (PP)-50°Severe tip of the anchor molars
Distal elastics –wire ends
Molar tubes on both 1st and 2nd molars-vertical anchorage -2 molars on either side
Bite opening curve
225
Bypass Arches
Direction of resultant force-Teeth move in direction of resultant-intrusive and elastic force.Resultant ideally - pass thro’ the Cres.
Resultant depends on -interplay B/w,
Magnitude of intrusive force (direction-constant)
226
Bypass Arches
Magnitude and direction of elastic force-
Different inclinations of anterior teeth-different combination of forces
227
Bypass Arches
Teeth - very proclined-low intrusive force & light class II-intrusion and retraction
As proclination decreases -increase amount of intrusive force-inc. bend /change wire
228
Bypass Arches
Change in vertical orientation becomes progressively smaller for same increments of inc. in intrusive force-Class II force-less magnitude
Class I-inclination improves (Reinforce anchorage)
229
Bypass Arches
Elastics from a higher point of attachment
Direct high pull headgear-inc in force level-damage the roots
230
Bypass Arches
Incisors-retroclined-no elastic force initially
231
Bypass Arches
Location of bite opening bends-different sites of bends-actions different
232
Bypass Arches
Conventional anchor bend-3mm mesial to molar tube-bowing of the archwire-more intrusion of upper canines
233
Bypass Arches
Gable bend-distal to canine-maintain intrusion-relative extrusion of canines
Hocevar’s modification-bend on either side of canine-only centrals intruded-canine and laterals extruded.
234
Bypass Arches
Modifications for uniform intrusion-6 anteriors-requiring significant amount of intrusion.
Gingival curve-Swain
235
Bypass Arches
Vertical step-up-augments intrusive action. Intrusive force applied higher –offsets extrusive action of gingival curve on canines-uniform intrusion 6 teeth
236
Bypass Arches
Cuspid circles –anterior incisal-prevents extrusion
237
Bypass Arches
Elastics from TPA (Palatal elastics) –Dr.JayadeDirection of elastic has to be changed.
Hooks soldered –line with lateral incisors.Oval shaped wire-soldered at the centre-lower from palate-neutralize extrusive component on molars.
238
Bypass Arches
Manipulating mechanics of palatal elastics-Neutralizes proclining effect of arch wireAugments intrusive force
239
Bypass Arches
Cephalogram used to find resultant-labially acting-intrusive force and palatal elastic (barium coated)
240
Bypass Arches
241
Bypass Arches
Power arms-Dr. Jyothindra kumar0.018 x 0.025 –hooks formed and soldered to the buccal aspect of upper molars
242
Bypass Arches
Cetlins‘s intrusion arches-Progressive /sequential intrusion-
243
Bypass Arches
Normally inclined incisors-Rectangular sectional on incisors
244
Bypass Arches
Intrusion arch tied to sectional wire-b/w central and lateralLight(2 oz) force-counter labial tipping
245
Bypass Arches
Labially inclined-PFA moved distallyRectangular-0.018x 0.025 inch/0.021 x 0.025Wire extended distally-2 helices bent-Rt. angles to intrusion arch
246
Bypass Arches
Helices=PFA-slightly in front of Cres.Light elastic force
247
Bypass Arches
Lingually inclined-PFA moved frontRigid rectangular -0.018 x 0.025/0.021 x 0.025-sectional on centrals
248
Bypass Arches
Wire bent forward and upward-hooks bentInserted into intrusion archLight elastic force
249
Bypass Arches
2 x 4 mechanics- 2 molars banded & 4 brackets on incisors.Analysis of the 2 x 4 appliance system-
Incisors considered as 1 unit -1 centre of resistance
Only molars and incisors bracketed-couples created and stored in the wires-larger with higher range than fully bracketed appliance system
250
Bypass Arches
The essence of activating a 2 x 4 –create and control moments and their equilibrium forces.2 x 4 –one couple
251
Bypass Arches
252
Bypass Arches
2 x 4 –two couple
253
Bypass Arches
254
Bypass ArchesMulligan’s 2 x 4 –can be used in the Begg set up-
Upper molars do not require tipping-helix bent into arch wire- 2-3mm mesialAnchor bend ,continuation of the helixNo cuspid circles required
‘Rowing effect’-moments at molars- retract incisors
255
Bypass Arches
256
Bypass Arches
Utility arches- one of the most versatile auxiliary arch wires-
Developed according to biomechanical principles described by Burstone and popularized by Ricketts.Originally developed-to level the curve of Spee.Through the incorporation of loops –performs more functions than intrusion.
Passive, intrusion, retraction, protraction utility
257
Bypass Arches
Basic components of utility arches-
Wire material- -blue elgiloy - in .018 slot .016 x .022- slot (maxilla) & .016 x .016-mandibular - in .022 slot-.019 x .019 Continuous rectangular steel wire-bypass mechanics
258
Bypass Arches
Intrusion utility-Stepped gingivally at the molars5mm space between anterior border of auxiliary tube and post. vertical segment.
259
Bypass Arches
Activation-2 waysBench (1988) –tip back bend in molar
Posterior tipping of molars seen
260
Bypass Arches
Gable bend-unwanted posterior tipping avoided
261
Bypass Arches
Similar to intrusion arch-biomechanics differ
Line of force in utility arch dictated by the location of the bracket-always be facialIn one couple-point contact-line of force varied.
Third order couple created-equilibrium forces modified
262
Bypass Arches
263
Bypass Arches
If torque introduced-
264
Bypass Arches
• Cinching back the wire-new horizontal system
•Molar root-mesially- Cres of moves mesially
•Lingual force at incisor brackets-restricts flaring •Lingual root movement
265
Fundamentals of Biomechanics including Mechanics of Leveling
and Aligning
Dr. Meenakshi Vishwanath
266
Tooth movements of bite opening
Bite opening can mainly be done by-
Absolute intrusion
Relative intrusion
Extrusion of posterior teeth/distal tipping
Proclination of incisors
Combination
267
Leveling by intrusion
Bypass mechanics -
Begg bends and modifications
Cetlin’s intrusion arch
2x 4 mechanics
Utility arch
268
Leveling by intrusion
Segmented mechanics-
Burstone’s intrusion arch
3-piece intrusion arch
Connecticut intrusion arch
269
Leveling by extrusion (relative intrusion)Continuous arch-
COS
Kameda’s modification
Anchor curve
Leveling by Extrusive mechanics
270
Segmented mechanics
Initial alignment within antero-posterior
segments
Once teeth within segments-aligned, each
treated as 1 large multi-rooted tooth
Creation of appropriate-anchorage and tooth
moving segment
Segmented arch technique not only has
advantages when aligning or space closure is
required; but produces genuine intrusion of
anterior teeth
271
Segmented mechanics
Burstone’s intrusion arch-
The basic mechanism for intrusion in segmented arch consists of 3 parts-
1. Posterior anchorage unit2. An anterior segment3. Intrusive arch spring
272
Segmented mechanics
Posterior teeth aligned and joined together-
buccal stabilizing unit –at least -0.018 x 0.018
(0.022).
Right and left segments joined together-TPA /
low lingual arch
273
Segmented mechanics
No need of continuous adjustments-single
multirooted tooth
To increase stability-0.018 x 0.025 or 0.021 x
0.025 can also be placed in the posterior
segment
Intrusive springs-auxiliary tube -.018 x .025
Standardized regardless of slot dimension of strap up
274
Segmented mechanics
The tooth to tooth adjustments are not made-only adjustments required - b/w auxiliary tube on molar and anterior segment.
275
Segmented mechanics
The intrusion arch-.018 x .025 –edgewise wire3mm helix wound - 2 ½ times placed mesial to auxiliary tube.
276
Segmented mechanics
Curvature –placed so that incisal portion lies gingival to incisors.Arch - tied to level of the incisorsIn order that arch length does not increase during activation-gentle curvature given
277
Segmented mechanics
Curvature –increases as one approaches the helixActivated wire-appears straightAs arch length decreases during intrusion-no labial flaring produced
278
Segmented mechanics
Intrusive spring is not directly engaged into the incisor bracketAn anterior alignment arch 0r anterior segment wire-in incisor bracketsIntrusive wire is placed either labially, incisally,or gingivally to the wire.
279
Segmented mechanics
280
Segmented mechanics
Canine intrusion spring-Canine is bypassed during intrusion-
100 grams / side required-intrusion of incisors and canines
If perpendicular distance-30mm-3000 gm.mm of moment on the posterior segment
Headgear required
281
Segmented mechanics
2 situations requiring separate canine intrusion-
Canine lies (bilaterally) occlusal to premolar Canines have not erupted symmetrically
Canine intrusion spring- .018 x.025-auxiliary tube
Labial flaring prevented-constructive force in the spring
282
Segmented mechanics
If molar auxiliary tube not available-most anterior premolar tube used
Canine root spring-simultaneously retract the root and intrude the canine
283
Segmented mechanics
Three piece intrusion (base) arch-
Simultaneous correction of deep bite correction and space closure in patients with flared incisors.
Intrusive force and its direction-effectively controlled.
Simultaneous control in vertical & anteroposterior planes
Low load deflection rate- constant force
Statically determinate force system
284
Segmented mechanics
Intrusion arch developed-True intrusion of either upper or lower anteriorsIn a case with flared incisors-continuous arch wire-worsens the axial inclinations of anterior teeth.
285
Segmented mechanics
1 solution-distal extensions
286
Segmented mechanics
Using segmented arch technique-precise and predictable force system
Pure intrusion and axial inclination control –anteriors
Well controlled moment-posteriors
Constant levels of force maintained
287
Segmented mechanics
Right and left buccal segments-aligned-.017 x .025 SS
TPA-.032 x.032 SS
Canines may be retracted separately –included in the buccal segments or left in initial positions
Anterior segment-aligned-low stiffness wire
288
Segmented mechanics
Assessment of location of Cres
Lateral cephalogram
4 incisors –usually estimated-half way b/w crest of alveolar bone and root apex of lateral incisor-sagittal plane
289
Segmented mechanics
The intrusion arch-.018 x .025 or .021 x .25 SS wire with distal extensions below Cres –placed passively-anterior bracketsDistal extensions-end 2-3 mm distal to Cres Anterior segment-stepped around the canines
290
Segmented mechanics
Bilateral tipback spring -.017 x.025 TMA
291
Segmented mechanics
Biomechanics Intrusive force – perpendicular to distal extension -through Cres intrude incisor segmentChange in the net intrusive force-small distal forceForce-lingual to CresLine of force-parallel to long axis
292
The force-lingual to Cres-combination of intrusion and tipback of anterior teethLine of action-made parallel-appropriate distal forceLine of action-through Cres-point of force application –anterior-close to distal end of lateral bracket.
293
Segmented mechanics
Intrusive force-placed distally-moment generated –tip back of anterior teethDistal force-low-redirect the intrusive force
294
Segmented mechanics
Clinical applications-
Simultaneous intrusion and tip back-space closed b/w canines and incisors.
Distal movement of canines-as anteriors retract
If canines-distalized first-included in buccal segment
295
Tip back moment –molar-900 gm.mm
296
Segmented mechanics
Redirection of force-reduces the moment on the molar
Headgear not required
297
Segmented mechanics
Resulting force system-modified by changing –magnitudes, point of application of intrusive and distal forces with respect to Cres.
298
Segmented mechanics
Connecticut intrusion arch- Ravindra Nanda et al
CTA-fabricated -NiTi alloyPreformed –appropriate bends2 wire sizes-.016 x .o22 & .017 x .025
299
Segmented mechanics
300
Segmented mechanics
Various applications-
Incisor intrusion
Class II molar correction
Incisor flaring
Correction of minor open bite
Correction of anterior occlusal cant
301
Segmented mechanics
Incisor intrusion-
50 grams
Slight differences in placement-alter force
system during activation
Spring gauges used
1mm-every 6 weeks
Headgear required
302
Segmented mechanics
Point contact-tying the intrusion arch
Excess flaring-tied at lateral incisors
Labial flaring prevented-tight cinch.
303
Segmented mechanics
Steps –how CTA is used for incisor intrusion-
1. Insert section of wire-incisor brackets
2. Choose appropriate CTA (long for non - extraction
or short for extraction/mixed dentition)
3. Cut-leaving 3mm/side –cinch back
4. Insert posterior legs into auxiliary tubes
5. Tie CTA to anterior segment at lateral incisors &
b/w centrals.
304
Segmented mechanics
305
Segmented mechanics
306
Segmented mechanics
Simultaneous class II molar correction-‘v’ bend –distal crownHigh-pull headgear –outer bow above Cres to upright the roots
307
Segmented mechanics
308
Segmented mechanics
Incisor flaring-Either full engagement into bracketNo cinch back
309
Segmented mechanics
Correction of open bite-CTA inserted upside downAnterior portion of wire-occlusal to incisorsExtrusion of incisorsMesial tipping moment-intrusive force –molarHigh pull headgear /inclusion of premolars-counter mesial tipping
310
Segmented mechanics
Correction of anterior occlusal cant-
Identify the offending teethTie only those teeth to be intruded/extrudedCant-tie only that side that needs to be corrected
311
Leveling by relative intrusion-Continuous arches
Bite opening curves-MBT-prefer not place in round or rectangular heat activated wiresPlaced only IF necessary after the SS rectangular wires have been in place for 6 weeks
312
Leveling by relative intrusion-Continuous arches
In upper-bite opening curve increases palatal root torque-beneficial
Sometimes additional torque-required
313
Leveling by relative intrusion-Continuous arches
Lower-bite opening curve-proclination of lower incisors10-15° of labial root torque to be addedNet effect-intrusive and retroclining force
314
Leveling by relative intrusion-Continuous arches
Anchor curve –Mollenhauer & Kameda’s design-
Canines and premolars-extruded
Laterals and centrals-progressive intrusion
315
Leveling by relative intrusion-Continuous arches
Extrusion-expresses fasterLeveling –more on account of extrusion
316
Leveling by relative intrusion-Continuous arches
Rocking chair NiTi
317
Leveling-posterior extrusion
In cases where deep bite leveled extrusive mechanics-extrusion arches are used. Two types
Type-I-lower arch –to level the curve of SpeeCotinuous/3 –piece extrusion arch is used
318
Leveling-posterior extrusion
Type-IIParallel extrusion of posteriors
Extrusion arch with cervical headgear
Anterior bite plate
319
Knowledge is the antidote to fear.
- Ralph Waldo Emerson
320
References
1. Refined Begg for modern times-V.P.Jayade2. Contemporary orthodontics - William.R.Proffit(3rd
ed.) 3. Dentofacial orthopaedics with functional
appliances-Thomas M.Graber, Thomas Rakosi, Alexandrer G.Petrovic.
4. Orthodontics – current principles and techniques- T.Graber, R.L.Vanarsdall -3rd ed
5.Systemized orthodontic treatment mechanics- McLaughlin, Bennett ,Trevisi
321
References
6. Orthodontic and orthopedic treatment in the mixed dentition-J.A. McNamara
7. Biomechanics in clinical orthodontics-Ravindra nanda
8. Biomechanics and esthetic strategies in orthodontics
9. Biomechanics in orthodontics- Michael R.Marcotte
10. Modern edgewise mechanics and the segmented arch technique- Charles J. Burstone
322
References
11.Force systems from an ideal arch. Burstone and Koenig – AJO march 1974;65:3; 270-289
12.Deep overbite correction by intrusion. Burstone- AJO 1977;73;1.1-22
13.Common sense mechanics. Thomas F Mulligan .JCO 1979,80. Article numbers- 1,2, 3,8,13
14.Mechanics of tooth movement- Richard Smith and Charles Burstone- AJO April 1984 85:4-294-306
323
References
15.Utility arches. James A Mc Namara 1986 JCO. 2o;7;455- 456
16.Equilibrium situations in bend force systems: Christian Demange - AJO 1990;98:333-9
17.The ground rules for arch wire design Robert Isaacson- Seminars in orthodontics,
vol 1,No1(March),1995
324
References
18.One couple orthodontic appliance systems Steven j. Lindauer- Seminars in orthodontics, vol
1,No1(March),1995
19.Two couple orthodontic appliance system A Two couple Intrusion Arch Moshe Davidovitch- Seminars in orthodontics, vol 1,No1(March),1995
2o. Two couple orthodontic appliance systems: Activations in the Transverse Dimension
Joe Rebellato- Seminars in orthodontics, vol 1,No1(March),1995
325
References
21.Activating a 2x4 appliance. Isaacson and Rubenstein – AO 1993;63;1. 17-24
22.Segmented approach to simultaneous intrusion and space closure: Biomachenics of the 3 piece base arch appliance. Bhavna Shroff, Lindauer, Burstone, Leiss. AJO 1995; 107;2;136-143
23.Simultaneous intrusion and retraction using e 3 piece base arch. Bhavna Shroff et al. AO 1997; 67;6; 455-4622
24.The Connecticut intrusion arch. Ravindra Nanda et al. JCO 1998. 32;12;708-715.
326
References
25.M.D.S dissertation- Determination of the centers of resistance of all the individual teeth and groups of teeth using FEA. -Dr. Sujana chava