preadjusted edgewise appliance
TRANSCRIPT
PRE ADJUSTED PRE ADJUSTED EDGEWISE APPLIANCEEDGEWISE APPLIANCE
Guided by:Dr. Suresh KanganeDr. Anand AmbekarDr. Pravinkumar Marure Dr. Yatishkumar JoshiDr. Chaitanya Khanapure
Presented by:Khushbu Agrawal
CONTENT
• History and evolution of fixed appliances• Straight wire concept and evolution
– Evolution of SWA– Concept of SWA– Need for a new appliance
• Design features of fully programmed brackets • Transition of standard edgewise to pre-adjusted
edgewise
2
HISTORY AND EVOLUTION OF FIXED APPLIANCES
EDWARD ANGLE (1855-1930)
• E-Arch (1907)
Contemporary orthodontics by William Profitt, 5th edi.
3
• Pin and Tube appliance (1912)
• Ribbon arch appliance (1915)
• Edgewise appliance (1926)
Contemporary orthodontics by William Profitt, 5th edi.
4
OTHER EARLY FIXED APPLIANCES:
•Labiolingual appliance
•Twin wire appliance
•Begg’s appliance
Contemporary orthodontics by William Profitt, 5th edi.
5
STRAIGHT WIRE
CONCEPT AND
EVOLUTION
6STRAIGHT WIRE: The concept and appliance by Lawrence F Andrews. 1989
EVOLUTION OF SWA
7STRAIGHT WIRE: The concept and appliance by Lawrence F Andrews. 1989
8
• Torqued slots for upper and lower incisors
• Angulated brackets and tubes to effect tipping movements
• Importance of bracket placement parallel to LACC• Angulated brackets on teeth adjacent to extraction
sites to aid root paralleling
• Raised brackets base of lateral incisor by 0.016 inch
STRAIGHT WIRE: The concept and appliance by Lawrence F Andrews. 1989
Evolution of SWA…
9
• Increased tip and torque for overcorrection
• Tip and Torqued brackets • Building treatment into appliance
• Straight wire appliance
• Vari-Simplex Discipline
STRAIGHT WIRE: The concept and appliance by Lawrence F Andrews. 1989
Evolution of SWA…
10
• Introduced Slot machine
• Introduced Elan and Orthos system
Evolution of SWA…
STRAIGHT WIRE: The concept and appliance by Lawrence F Andrews. 1989
11
CONCEPT OF SWA
STRAIGHT WIRE: The concept and appliance by Lawrence F Andrews. 1989
Study 1 : Examination of post-treatment occlusion
12
• Began in 1960
• Asses static occlusion
• American Board of Orthodontics, EH Angles
Society, Tweed Foundation
• Post-treatment casts
13
Examination of post-treatment occlusion…
STRAIGHT WIRE: The concept and appliance by Lawrence F Andrews. 1989
• Consistent features:
1. Incisors were not rotated
2. No crossbite / overjet
3. Class I molar relationship
14
Examination of post-treatment occlusion…
STRAIGHT WIRE: The concept and appliance by Lawrence F Andrews. 1989
• Variations in result:1. Articulations of occlusal surface not proper2. Long axis of teeth on either site of extraction site
not parallel3. Inclinations and angulations varied among
patients treated with different orthodontists 4. Second molar not included in treatment5. Interdental spaces existed frequently6. No intraoral models or oral photographs 7. No standardization as to whether dental casts
were registered in centric occlusion or centric relation
15STRAIGHT WIRE: The concept and appliance by Lawrence F Andrews. 1989
16
Study 2:Naturally occurring optimal occlusion
Lawrence F. Andrews noted that too many post treated models had
obvious inadequacies, despite the acceptable molar relationships as
described by Angle.
17*Lawrence Andrews, The six keys to optimal occlusion. AJODO 1972(296-309)
• 120 non-orthodontic normal models were collected between 1960-1964.
• Models selected were of teeth which –– Had never had orthodontic treatment – Were straight and pleasing in appearance – Had a bite which looked generally correct – According to author would not benefit from
orthodontic treatment
18*Lawrence Andrews, The six keys to optimal occlusion. AJODO 1972(296-309)
19
Study 3:The six keys to optimal
occlusion
*Lawrence Andrews, The six keys to optimal occlusion. AJODO 1972(296-309)
SOME IMPORTANT TERMINOLOGIES
1] ANDREW’S PLANE The surface or plane on which the mid transverse plane of every crown in an arch will fall when teeth are optimally positioned.
20STRAIGHT WIRE: The concept and appliance by Lawrence F Andrews. 1989
Six keys to optimal occlusion…
2] CLINICAL CROWNThe amount of crown that can be seen intraorally or with a study cast
21STRAIGHT WIRE: The concept and appliance by Lawrence F Andrews. 1989
Six keys to optimal occlusion…
3] FACIAL AXIS OF CLINICAL CROWN (FACC)For all the teeth except molars, the most prominent portion of the central lobe on the facial surface of each crown For molars, buccal groove that separates the 2 large facial cusps.
22STRAIGHT WIRE: The concept and appliance by Lawrence F Andrews. 1989
Six keys to optimal occlusion…
4] FACIAL AXIS POINT (FA POINT) The point on the facial axis that separates the gingival half of the clinical crown from the occlusal half
23STRAIGHT WIRE: The concept and appliance by Lawrence F Andrews. 1989
Six keys to optimal occlusion…
• TOOTH CLASS – A group of teeth having similar shape and
function– E.g. incisors, canines, premolars, molars
• TOOTH TYPE– Subordinate category within a class of teeth– E.g. first mandibular premolars, second
mandibular premolars
24STRAIGHT WIRE: The concept and appliance by Lawrence F Andrews. 1989
Six keys to optimal occlusion…
Key I: Interarch Relationships1) As explained by Angle, the mesiobuccal cusp of permanent maxillary first molar occludes in the groove between mesial and middle buccal cusps of the permanent mandibular first molar
2) The distal marginal ridge of the maxillary first molar occludes with the mesial marginal ridge of the mandibular second molar
25*Lawrence Andrews, The six keys to optimal occlusion. AJODO 1972(296-309)
Six keys to optimal occlusion…
3) The mesiolingual cusp of maxillary first molar occludes in the central fossa of the mandibular first molar
4) The buccal cusps of the premolars have a cusp embrasure relationship with the mandibular premolars
5) The lingual cusps of maxillary premolars have a cusp-fossa relationship with the mandibular premolars
26*Lawrence Andrews, The six keys to optimal occlusion. AJODO 1972(296-309)
Six keys to optimal occlusion…
6)The maxillary canine has a cusp-embrasure relationship with the mandibular canine and first premolar. The tip of its cusp is slightly mesial to the embrasure
7) The maxillary incisors overlap the mandibular incisors, and the midlines of the arches match
27*Lawrence Andrews, The six keys to optimal occlusion. AJODO 1972(296-309)
Six keys to optimal occlusion…
Key II: Crown Angulation
• All crowns in the sample essentially have a ‘positive angulations’ that is, gingival portion is distal to incisal portion of crown
• All crowns of each tooth type are similar in amount of angulations
29*Lawrence Andrews, The six keys to optimal occlusion. AJODO 1972(296-309)
Six keys to optimal occlusion…
Key III: Crown Inclination
• Labiolingual or Buccolingual inclination
• Maxillary incisors – positive• Progressively negative from
maxillary canines to second molars
• Progressive negative inclination for mandibular incisors to second molars
30*Lawrence Andrews, The six keys to optimal occlusion. AJODO 1972(296-309)
Six keys to optimal occlusion…
Clinical implication of Key II and III :
• The wagon wheel effect:– For every 4 degrees of
lingual crown torque there is 1 degree of mesial convergence of the gingival portion of central and lateral crowns, that makes a ratio of 4:1
31*Lawrence Andrews, The six keys to optimal occlusion. AJODO 1972(296-309)
Six keys to optimal occlusion…
• The teeth should be free of undesirable rotations
• Example of problem: rotated molars would occupy more space
Key IV: Rotations
32*Lawrence Andrews, The six keys to optimal occlusion. AJODO 1972(296-309)
Six keys to optimal occlusion…
• The contact points should be tight (no spaces)• Exceptions: genuine toot-size discrepancies
Key V: Tight Contacts
33*Lawrence Andrews, The six keys to optimal occlusion. AJODO 1972(296-309)
Six keys to optimal occlusion…
• The planes of occlusion ranged from flat to slight curve of Spee (concave)
• Andrew believed that a flat plane should be the treatment goal as a form of overtreatment since there is a natural tendency for the curve of Spee to deepen with time.
Key VI: Occlusal Plane
34*Lawrence Andrews, The six keys to optimal occlusion. AJODO 1972(296-309)
Six keys to optimal occlusion…
35
Study 4:Crown measurement in 120 samples by Andrews
• After determining the 6 keys of occlusions Andrew made certain measurements in the non orthodontic models which helped in the development of the first fully programmed appliance
STRAIGHT WIRE: The concept and appliance by Lawrence F Andrews. 1989
36
• The measurements made were: – Bracket area– Vertical contour– Angulation– Inclination– Maxillary molar offset– Horizontal contour– Facial prominence– Curve of spee
37STRAIGHT WIRE: The concept and appliance by Lawrence F Andrews. 1989
Measurements by Andrews…
38STRAIGHT WIRE: The concept and appliance by Lawrence F Andrews. 1989
Measurements by Andrews…
39STRAIGHT WIRE: The concept and appliance by Lawrence F Andrews. 1989
Measurements by Andrews…
The average findings for the maxillary teeth are:
1) Angulation:
STRAIGHT WIRE: The concept and appliance by Lawrence F Andrews. 1989
40
Measurements by Andrews…
2) Inclination:
41STRAIGHT WIRE: The concept and appliance by Lawrence F Andrews. 1989
Measurements by Andrews…
3) Maxillary molar offset:
42STRAIGHT WIRE: The concept and appliance by Lawrence F Andrews. 1989
Measurements by Andrews…
4) Crown prominence:
43STRAIGHT WIRE: The concept and appliance by Lawrence F Andrews. 1989
Measurements by Andrews…
The average findings for the mandibular teeth are:
1) Angulation:
STRAIGHT WIRE: The concept and appliance by Lawrence F Andrews. 1989
44
Measurements by Andrews…
2) Inclination:
45STRAIGHT WIRE: The concept and appliance by Lawrence F Andrews. 1989
Measurements by Andrews…
3) Crown prominence:
46STRAIGHT WIRE: The concept and appliance by Lawrence F Andrews. 1989
Measurements by Andrews…
4) No offset was needed for mandibular molar because the middle & mesiobuccal cusps are equal in prominence.
5) The curve of Spee ranged from flat to 2.5 mm deep
47STRAIGHT WIRE: The concept and appliance by Lawrence F Andrews. 1989
Measurements by Andrews…
• This study revealed consistencies in the position, morphology & relative facial prominence for the crown of each tooth type with an arch except for incisor inclination.
• The differences in the incisor inclination were attributed to interjaw disharmony.
• Thus special considerations must be given in the bracket design to correlate the inclination of incisors with interjaw relationship.
48STRAIGHT WIRE: The concept and appliance by Lawrence F Andrews. 1989
Measurements by Andrews…
49
Study 5:Comparison between study models and treated casts
• After making the measurements, Andrew compared the 120 non-orthodontic models with the treated 1150 models.– That is best in nature vs best in treatment
• Comparison were made particularly in relation to the 6 keys of optimal occlusion:
50STRAIGHT WIRE: The concept and appliance by Lawrence F Andrews. 1989
Comparison between study models and treated casts…
KEY I - Inter-arch relationship:
• In 80% of the treated models, distal marginal ridge of maxillary I molar did not occlude with mesial marginal ridge of mandibular II molar.
• Premolars and canines did not have cusp-embrasure relationship.
51STRAIGHT WIRE: The concept and appliance by Lawrence F Andrews. 1989
Comparison between study models and treated casts…
KEY II - Angulation: • In 91 % of the treated models, crowns had one or
more teeth whose angulation differed from those of optimal sample.
52
KEY III - Inclination:
Inter incisal FACC – • In optimal- more than 180 degrees in 78%• In treated - Less than 180 degrees in 81.5%
STRAIGHT WIRE: The concept and appliance by Lawrence F Andrews. 1989
Comparison between study models and treated casts…
KEY IV - Rotation: Rotations were evident in 67% of post treated cases.
KEY V - Tight contacts: Spaces were seen in 43% of post treatment casts.
KEY VI - Curve of Spee: More than 2.5 mm in 56% of post treatment casts.
53STRAIGHT WIRE: The concept and appliance by Lawrence F Andrews. 1989
Comparison between study models and treated casts…
• These evidence showed that only few post treatment results met the six key standards.
• So a quarter century of research done by Andrew, devoted to naturally optimal & treated occlusions has yielded not only the six keys, but also several principles fundamental to the concept of fully programmed appliance.
54STRAIGHT WIRE: The concept and appliance by Lawrence F Andrews. 1989
Comparison between study models and treated casts…
Summary of principles• Each normal tooth type is similar in shape from one
individual to another.
• The size of normal crowns within a dentition has no effect on their optimal angulation, inclination or prominence of their facial surface.
• Most individuals have normal teeth regardless of whether their occlusion is flawed or optimal.
55STRAIGHT WIRE: The concept and appliance by Lawrence F Andrews. 1989
Comparison between study models and treated casts…
• Jaws must be normal & correctly related to permit the teeth to be correctly positioned & related.
• Dentitions with normal teeth and in jaws that are or can be correctly related can be brought to optimal occlusal standards.
56STRAIGHT WIRE: The concept and appliance by Lawrence F Andrews. 1989
Comparison between study models and treated casts…
NEED FOR A NEW APPLIANCE
• The edgewise appliance designed by Angle is "Non programmed" because of the bilaterally symmetric design.
• If located on the FA point & the FACC & used with unbent archwire, the brackets would cause the Inclination of the facial plane of each crown to be at 90 degrees to occlusal plane,
• The occlusogingival positions of each crown to be irregular,
• All crowns to have equal facial prominence & angulation of the FACC of each crown to be at 90 degree to the occlusal plane.
58
Need for a new appliance…
The major shortcomings of edgewise appliance are:
1. Bracket bases are perpendicular to bracket stem2. Bracket bases are not contoured occlusogingivally3. Slots are not angulated4. Bracket stems are of equal faciolingual thickness 5. Maxillary molar offset not built in6. Bracket siting techniques are unsatisfactory
59STRAIGHT WIRE: The concept and appliance by Lawrence F Andrews. 1989
Need for a new appliance…
1] Bracket bases are perpendicular to bracket stem
• Can cause problems for the slot inclination and occlusogingival position.
60STRAIGHT WIRE: The concept and appliance by Lawrence F Andrews. 1989
Need for a new appliance…
• The effect when the brackets are aligned with unbent arch wire.
61STRAIGHT WIRE: The concept and appliance by Lawrence F Andrews. 1989
Need for a new appliance…
2] Bases not contoured occlusogingivally:
• Can unintentionally cause rocking of bracket occlusally or gingivally.
62STRAIGHT WIRE: The concept and appliance by Lawrence F Andrews. 1989
Need for a new appliance…
• There will be irregular slot siting in each arch caused by vertically flat based brackets.
63STRAIGHT WIRE: The concept and appliance by Lawrence F Andrews. 1989
Need for a new appliance…
• This diagram shows the effect of the irregularly placed brackets.
64STRAIGHT WIRE: The concept and appliance by Lawrence F Andrews. 1989
Need for a new appliance…
3] Slots are not angulated:
• The bracket slots of the edgewise brackets are non angulated.
65STRAIGHT WIRE: The concept and appliance by Lawrence F Andrews. 1989
Need for a new appliance…
• When the vertical components of the brackets are sited parallel to FACC & base point sited at FA point, the angle of the slot vary to many different angulation
66STRAIGHT WIRE: The concept and appliance by Lawrence F Andrews. 1989
Need for a new appliance…
• This diagram shows the effects when the brackets are placed without slot angulation
67STRAIGHT WIRE: The concept and appliance by Lawrence F Andrews. 1989
Need for a new appliance…
4.Stems of equal prominence:
• Distance between bracket base & center of slot is same in each brackets.
68STRAIGHT WIRE: The concept and appliance by Lawrence F Andrews. 1989
Need for a new appliance…
• Therefore when the brackets are placed they become as irregular in the facial prominence as the crown
69STRAIGHT WIRE: The concept and appliance by Lawrence F Andrews. 1989
Need for a new appliance…
• With the unbent archwire the facial surface of each crown becomes equidistant from the embrasure line, which is undesirable.
70STRAIGHT WIRE: The concept and appliance by Lawrence F Andrews. 1989
Need for a new appliance…
5.Maxillary molar offset not built in:
• The midsagittal plane of the slot is angular to the mid sagittal plane of the crown.
• Rotational effect of the molars
71STRAIGHT WIRE: The concept and appliance by Lawrence F Andrews. 1989
Need for a new appliance…
6. Unsatisfactory bracket sitting techniques:
• Most of the authors & practitioners seldom agree about which landmarks are best for bracket siting
• Each requires a different wire bending
72STRAIGHT WIRE: The concept and appliance by Lawrence F Andrews. 1989
Need for a new appliance…
• Tweed – specified number of mm from cusp tip or
incisal edge
• Saltzman – middle third of clinical crown
• Holdsway – altered according to malocclusion,
open bite or deepbite
• Jaraback – determined by the shape of crown
• Lindquist – relative to height of marginal ridges
for posterior teeth 73
STRAIGHT WIRE: The concept and appliance by Lawrence F Andrews. 1989
Need for a new appliance…
74
DESIGN FEATURES OF
FULLY PROGRAMMED
BRACKETS
75STRAIGHT WIRE: The concept and appliance by Lawrence F Andrews. 1989
DESIGN FEATURES OF FULLY PROGRAMMED BRACKETS…
1] Slot sitting features
• Midtransverse plane: Feature 1: Midtransverse plane of slot, stem, crown must be same
76STRAIGHT WIRE: The concept and appliance by Lawrence F Andrews. 1989
DESIGN FEATURES OF FULLY PROGRAMMED BRACKETS…
• Midtransverse plane: Feature 2: Base must have same inclination as of facial plane of crown
77STRAIGHT WIRE: The concept and appliance by Lawrence F Andrews. 1989
DESIGN FEATURES OF FULLY PROGRAMMED BRACKETS…
• Midtransverse plane: Feature 3: Contoured occlusogingivally
78STRAIGHT WIRE: The concept and appliance by Lawrence F Andrews. 1989
DESIGN FEATURES OF FULLY PROGRAMMED BRACKETS…
• Midsaggital plane: Feature 4: Midsaggital plane of slot, stem, crown must be same
79STRAIGHT WIRE: The concept and appliance by Lawrence F Andrews. 1989
DESIGN FEATURES OF FULLY PROGRAMMED BRACKETS…
• Midsaggital plane: Feature 5: Vertical components designed to be parallel to each other
80STRAIGHT WIRE: The concept and appliance by Lawrence F Andrews. 1989
DESIGN FEATURES OF FULLY PROGRAMMED BRACKETS…
• Midsaggital plane: Feature 6: Base contoured mesiodistally
81STRAIGHT WIRE: The concept and appliance by Lawrence F Andrews. 1989
DESIGN FEATURES OF FULLY PROGRAMMED BRACKETS…
• Midsagittal plane: Feature 7: The vertical components of the bracket should be parallel to one another
82STRAIGHT WIRE: The concept and appliance by Lawrence F Andrews. 1989
DESIGN FEATURES OF FULLY PROGRAMMED BRACKETS…
• Midfrontal plane: Feature 8: All slot points within an arch must have same distance between them and crown embrasure lines
83STRAIGHT WIRE: The concept and appliance by Lawrence F Andrews. 1989
DESIGN FEATURES OF FULLY PROGRAMMED BRACKETS…
• Gingival tie wings on posterior brackets extend further laterally
84
2] Convenience features
STRAIGHT WIRE: The concept and appliance by Lawrence F Andrews. 1989
DESIGN FEATURES OF FULLY PROGRAMMED BRACKETS…
• Facial surfaces of incisor and canine brackets parallel their bases
• This feature is incorporated for Lip comfort
85STRAIGHT WIRE: The concept and appliance by Lawrence F Andrews. 1989
DESIGN FEATURES OF FULLY PROGRAMMED BRACKETS…
• Power arms
• Hooks
• Facebow tubes
• Utility tubes
• Rotation wings
86
3] Auxiliary features
STRAIGHT WIRE: The concept and appliance by Lawrence F Andrews. 1989
DESIGN FEATURES OF FULLY PROGRAMMED BRACKETS…
87
ADVANTAGES AND
DISADVANTAGES OF SWA
ADVANTAGES
1.Ease of archwire construction
2.No need for interbracket span
3.Less round tripping
4.Better control of tooth positions
5.Consistent result in shorter treatment time
6.Patient comfort
88STRAIGHT WIRE: The concept and appliance by Lawrence F Andrews. 1989
7. Complete space closure with one set of archwires
8. Ease of ligation
9. Ease of bracket identification
10. Easier more accurate bracket placement
11. Precise control on premolar and molar torque
13. Precise finishing control in all 3 planes
89STRAIGHT WIRE: The concept and appliance by Lawrence F Andrews. 1989
DISADVANTAGES
1.Individual variations in facial surface curvature
2.Consistent LA point is questionable
3.Different skeletal types have different inclines of
occlusal planes
4.No specification regarding placement of bracket
from manufacturers
90STRAIGHT WIRE: The concept and appliance by Lawrence F Andrews. 1989
91
TRANSITION FROM
STANDARD EDGEWISE TO
PREADJUSTED EDGEWISE
APPLIANCE
• The mechanical treatment of most orthodontic cases can be divided into six stages:
1. Anchorage control
2. Leveling and aligning
3. Overbite control
4. Overjet reduction
5. Space closure
6. Finishing 92
STRAIGHT WIRE: The concept and appliance by Lawrence F Andrews. 1989
TRANSITION FROM STANDARD EDGEWISE TO PEA…
1] Anchorage Control • Increased tendency for incisors and cuspids to tip
forward• To manage:
– Omega loop stops and molar ties– Palatal bars and headgears – Lingual arches class III elastics – Archwire bend behind distally banded molar
93STRAIGHT WIRE: The concept and appliance by Lawrence F Andrews. 1989
TRANSITION FROM STANDARD EDGEWISE TO PEA…
2] Leveling and aligningFactor 1: •To prevent anterior teeth forward tipping•Need to prevent mesial tipping as well as retracting cuspid into extraction sitesFactor 2: •Need for overcorrection at the end of treatment
94STRAIGHT WIRE: The concept and appliance by Lawrence F Andrews. 1989
TRANSITION FROM STANDARD EDGEWISE TO PEA…
• To avoid this problems:1. Lacebacks
95
1
STRAIGHT WIRE: The concept and appliance by Lawrence F Andrews. 1989
TRANSITION FROM STANDARD EDGEWISE TO PEA…
• To avoid this problems:2. Bendbacks
96STRAIGHT WIRE: The concept and appliance by Lawrence F Andrews. 1989
TRANSITION FROM STANDARD EDGEWISE TO PEA…
3] Overbite and overjet reduction
• Distally tipped cuspids
• Caused mesial aspect of bracket to be more incisal
causing extrusive effect on incisors
• Causing bite deepening
97STRAIGHT WIRE: The concept and appliance by Lawrence F Andrews. 1989
TRANSITION FROM STANDARD EDGEWISE TO PEA…
To manage:
•Do not bond incisors
•Upright cuspid root first by lacebacks and then
engage incisors •Also, lower second molar banding as early as possible
98STRAIGHT WIRE: The concept and appliance by Lawrence F Andrews. 1989
TRANSITION FROM STANDARD EDGEWISE TO PEA…
4] Space closure
• Standard edgewise: Closing loop arches
• PEA: Hooks placed in anterior section of straight
arches and elastics or spring forces tied from
molar brackets
99STRAIGHT WIRE: The concept and appliance by Lawrence F Andrews. 1989
TRANSITION FROM STANDARD EDGEWISE TO PEA…
5] Finishing
• More accurate the appliance, less time and effort
required during finishing
• Necessary to place archwire bends to compensate
for tooth shape and size, improper bracket
positioning
100STRAIGHT WIRE: The concept and appliance by Lawrence F Andrews. 1989
TRANSITION FROM STANDARD EDGEWISE TO PEA…
101
CLASSIFICATION OF
PREADJUSTED EDGEWISE
APPLIANCE
102STRAIGHT WIRE: The concept and appliance by Lawrence F Andrews. 1989
TORQUE IN BASE
103
LA pointLA pointSlot pointSlot point
Base pointBase point
104STRAIGHT WIRE: The concept and appliance by Lawrence F Andrews. 1989
105
VARIOUS APPLIANCE
PRESCRIPTIONS
Bracket prescription: Incisors through premolars
106Contemporary orthodontics by William Profitt, 5th edi.
107
Bracket prescription: Incisors through premolars
Contemporary orthodontics by William Profitt, 5th edi.
Molar bracket/tube prescription
108Contemporary orthodontics by William Profitt, 5th edi.
• Variable appliance prescriptions1. SWA2. Roth 3. MBT4. Ricketts: Bioprogressive therapy5. Alexander’s principles6. Viasis Bioefficient brackets7. Bidimensional systems8. The Butterfly system 9. SEBA/ Protorque system10. Self-ligating system
• Conclusion• References
109
CONTENT
Straight wire appliance
• Lawrence Andrew, Father of Preadjusted bracket system (1972)
110
SWA tip
SWA tip
2º 2º 5º 2º 2º
2º 2º 11º 9º 5º
Tip values STRAIGHT WIRE: The concept and appliance by Lawrence F Andrews. 1989
Torque values 111
Lateralincisors
Centralincisors
3º 7º
-1º -1ºOriginal SWA
Lateralincisors
Centralincisors
10º 17º
-6º -6ºRecommended torqueOriginal SWA
-9º
-35º
-30º
-22º
-17º
-11º
STRAIGHT WIRE: The concept and appliance by Lawrence F Andrews. 1989
SWA…
Roth precription
• 1976, the second generation brackets• Need to place compensating curves and reverse
curves• Overcorrect malocclusion• Full size archwires • Hooks were added
112Roth, R.H.: Treatment Mechanics for SWA in Orthodontics: Current principles and techniques. JCO 1985
113
Roth tip
Roth tip
0º 0º 7º 0º 0º
0º 0º 9º 9º 5º
Tip values
Roth, R.H.: Treatment Mechanics for SWA in Orthodontics: Current principles and techniques. JCO 1985
ROTH Prescription…
114
Molars Premolars Canines Lateralincisors
Centralincisors
-11º
0º0º
-17º
-22º
-30º-30º
-14º-14º
-7º -7º
-2º 8º 12º
Torque values
Roth, R.H.: Treatment Mechanics for SWA in Orthodontics: Current principles and techniques. JCO 1985
ROTH Prescription…
MBT PRESCRIPTION
• McLaughlin, Benett and Trevisi (1997)• The third generation brackets• Versatility• Light archwire forces• Lacebacks and Bendbacks for early anchorage
control
115Systemized orthodontic treatment mechanics by McLaughlin, Bennett and Trevisi 2001
116
5º 5º 0º 0º 8º 8º 4º
2º 2º 2º
2º 3º 0º 0º
Tip values
Systemized orthodontic treatment mechanics by McLaughlin, Bennett and Trevisi 2001
MBT Prescription…
117
Molars Premolars Canines Lateralincisors
Centralincisors
+6º 0º -6º
-6º-6º
-10º
-20º
-17º-12º
-14º-14º
-7º -7º
+7º 0º -7º 10º(-10º) 17º
Torque values
Systemized orthodontic treatment mechanics by McLaughlin, Bennett and Trevisi 2001
MBT Prescription…
Ricketts: bioprogressive therapy
• Robert Murray Ricketts (1976)• “Bio” – technology with biology• “Progressive” – treatment sequence
118The textbook of The Bioprogressive therapy by Robert Ricketts
• In 1970’s, two principle bracket designs available were:1. Rotation arms2. Twin – Siamese type – or dual bracket
• Ricketts experimentally moved from rectangular slot to 016 square box
• Return to 019 x 025 slot• Standardize 018 x 025 slot• Ricketts went to 0185 x 030 slot
119The textbook of The Bioprogressive therapy by Robert Ricketts
Ricketts Bioprogressive therapy…
RICKETTS BRACKET DESIGN
1] Deep slot– Permits two light arches to be employed at once – Chamfer or bevel at the box entrance to
facilitate wire seating– More accurate distance for torque grooves to be
placed
120The textbook of The Bioprogressive therapy by Robert Ricketts
Ricketts Bioprogressive therapy…
2] Wide incisal-gingival wing– Easy access for tie wires– Even a single wing of once bracket can be used
as eyelet– Auxiliary wire can be placed underneath the
wing– Rubber elastic traction– Accessibility for cement removal under the
wings
121The textbook of The Bioprogressive therapy by Robert Ricketts
Ricketts Bioprogressive therapy…
3] Softer material– Permits closing of bracket for rotation with
later reopening for finishing– Doesn’t fracture or chip teeth easily during
interferences– Can be pinched close around narrow wires for
absolute wire engagement
122The textbook of The Bioprogressive therapy by Robert Ricketts
Ricketts Bioprogressive therapy…
123
0º 0º 0º 0º 5º 8º 0º
0º 0º 0º
0º 15º 0º 0º
Tip values
The textbook of The Bioprogressive therapy by Robert Ricketts
Ricketts Bioprogressive therapy…
124
Molars Premolars Canines Lateralincisors
Centralincisors
7º
0º0º
0º
0º
22º0º
0º0º
0º 0º
7º 14º 22º
Torque values
The textbook of The Bioprogressive therapy by Robert Ricketts
Ricketts Bioprogressive therapy…
• 1980’s Ricketts and Gugnio: 3 sets of brackets 1. Proversion – Class II div 2, deep bites2. Neutroversion – Class I openbite or deepbite 3. Retroversion – Class II div 1 and uprighting
upper incisors
• Now-a-days – “Utility arch” from Bioprogressive technique
• Made from 016 x 016 blue elgiloy• Vertical discrepancies treated prior to horizontal
125The textbook of The Bioprogressive therapy by Robert Ricketts
Ricketts Bioprogressive therapy…
The ALEXANDER’S discipline
• Vari-simplex discipline (1978)– Variety of brackets– KISS principle– Knowledgeable orthodontist
• Esthetically pleasant face with stability of treatment and a balanced occlusion.
126The 20 Principles of the Alexander Discipline by R.G. Wick Alexander. 2008
127The 20 Principles of the Alexander Discipline by R.G. Wick Alexander. 2008
The Alexander’s Discipline…
VIASIS bioefficient brackets
• Bioefficient therapy (1995)• By Anthony Viasis• New superelastic A-NiTi wires• Multifunctional single brackets
129Anthony Viasis. Bioefficient therapy. JCO 1995 Sept.:552-68
1] Conformity to crown anatomy and crown outline
130Anthony Viasis. Bioefficient therapy. JCO 1995 Sept.:552-68
Viasis brackets…
2] Ease of use
131Anthony Viasis. Bioefficient therapy. JCO 1995 Sept.:552-68
Viasis brackets…
3] Minimum friction
132Anthony Viasis. Bioefficient therapy. JCO 1995 Sept.:552-68
Viasis brackets…
4] Tip control
133Anthony Viasis. Bioefficient therapy. JCO 1995 Sept.:552-68
Viasis brackets…
5] Rotation control
134Anthony Viasis. Bioefficient therapy. JCO 1995 Sept.:552-68
Viasis brackets…
6] Vertical slot
135Anthony Viasis. Bioefficient therapy. JCO 1995 Sept.:552-68
Viasis brackets…
7] High anterior torque
136Anthony Viasis. Bioefficient therapy. JCO 1995 Sept.:552-68
Viasis brackets…
BIDIMENSIONAL SYSTEMs
1] BIMETRIC SYSTEM
•Schudy and Schudy (1975)•016 slots on anteriors•022 slots on posteriors•022 x 016 SS wire with a 900 twist distal to canines
137Vipul K S, Bidimensional Technique: A Topical Review. Int J Dentistry Oral Sci. 2015 2(6), 94-
96.
2] BIDIMENSIONAL EDGEWISE SYSTEM
•Dr. Gianelly (1985)•Non-preadjusted 022 x 028 slot brackets for all the teeth•0.016”x0.022” archwire is used with a 900 twist distal to the lateral incisors•‘‘Bidimensional-wire’’ technique
138Vipul K S, Bidimensional Technique: A Topical Review. Int J Dentistry Oral Sci. 2015 2(6), 94-
96.
3] BIDIMENSIONAL SLOT SYSTEM
•Dr. Gianelly (2000)•018 slot on centrals and laterals •022 slot on canines and posteriors•Anteriors – “tight fit” – three dimensional control•Posteriors – “loose fit” – sliding mechanics
139Vipul K S, Bidimensional Technique: A Topical Review. Int J Dentistry Oral Sci. 2015 2(6), 94-
96.
THE BUTTERFLY YSTEM
• S. Jay Bowman in 2003• Features:
– new low profile brackets, – miniature twin-wing design, – rounded tie wings, and – elimination of standard hooks
140S. Jay Bowman. The Butterfly System. JCO 2004: 274-87
• Feature 1: Versatile vertical slot
141S. Jay Bowman. The Butterfly System. JCO 2004: 274-87
Removable T-Pins or hook pins can be placed through vertical slots of any brackets when needed, eliminating integral bracket hooks
The Butterfly system…
142S. Jay Bowman. The Butterfly System. JCO 2004: 274-87
Vertical or “sling” tie: stainless steel ligature placed through
vertical slot and around archwire for severely displaced teeth
Compliance Spring used with round stainless steel archwire and intermaxillary elastics to provide
labial root torque
The Butterfly system…
143S. Jay Bowman. The Butterfly System. JCO 2004: 274-87
U-Turn square-wire rotating spring
Power Arm limits tipping when used with elastics, chains, or nickel
titanium coil springs
Traditional Begg’s uprighting spring
The Butterfly system…
• Feature 2: Progressive posterior torque
144S. Jay Bowman. The Butterfly System. JCO 2004: 274-87
The Butterfly system…
145S. Jay Bowman. The Butterfly System. JCO 2004: 274-87
Inappropriate posterior torque causes excessive curve of Wilson Increased maxillary posterior torque
(–14°) and reduced mandibular posterior torque (–10°) to improve
intercuspation and posterior overjet, flatten curve of Wilson, and reduce
interferences
The Butterfly system…
• Feature 3: Reversible second premolar brackets
146S. Jay Bowman. The Butterfly System. JCO 2004: 274-87
Zero or negative angulation in second premolar bracket
promotes improper intercuspation in
nonextraction cases
Butterfly System second premolar brackets (+3° tip) improve posterior marginal
ridge adaptation in nonextraction treatment
The Butterfly system…
147S. Jay Bowman. The Butterfly System. JCO 2004: 274-87
Zero or positive angulation in second premolar brackets promotes improper root
angulation during space closure
Butterfly System’s reversible second premolar brackets.
The Butterfly system…
148
Butterfly System second premolar brackets placed on first premolars to improve root paralleling during space
closure after extraction of second premolars
The Butterfly system…
• Feature 4: Progressive mandibular anterior tip
149S. Jay Bowman. The Butterfly System. JCO 2004: 274-87
The Butterfly system…
• Feature 5: Angulated first molar attachments
150S. Jay Bowman. The Butterfly System. JCO 2004: 274-87
The Butterfly system…
Prominent distobuccal cusps result when first molar bands are fitted to marginal ridges
instead of placing molar attachments parallel to
buccal cusps.
A. Butterfly System molar attachments have –6° angulation to account for differences in first molar marginal ridges.
B. When Butterfly System first molar bands are fitted to marginal ridges, tube angulation keeps buccal cusps parallel
to occlusal plane.
• Feature 6: Preventive mandibular anterior torque
151S. Jay Bowman. The Butterfly System. JCO 2004: 274-87
• Feature 7: Conservative anterior torque
The Butterfly system…
• Feature 8: Improvement in overjet
152S. Jay Bowman. The Butterfly System. JCO 2004: 274-87
The Butterfly system…
• Feature 9: Bonding pad attachments
153S. Jay Bowman. The Butterfly System. JCO 2004: 274-87
The Butterfly system…
SEBA/protorque SYSTEM
• Sugiyama Evidence Based Asian prescription • Dr. Raymond Sugiyama and Dr. Mauricio
Gonzalez• Todays PEA – derived from Caucasian norms• Dr. Sugiyama studied the significant differences in
the dental anatomy and cephalometric measurements between Caucasians and Asians
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CEPHALOMETRIC COMPARISONS
Asians Caucasians Differences1.U1-SN = 107.5° 104.2° +3.3°2.U1-FH = 114.0° 109.6° +4.4°3.L1-MP = 95.2° 91.2° +4.0°4.L1-APo = 4.5mm 1.0mm +3.5mm5.L1-APo = 26.2° 22.0° +4.2°6.U1-L1 = 124.4° 134.0° -9.6°
7.Higher torque and lower angulation – keep the teeth in the middle of the basal bone during orthodontic movement – lessening the chance for root resorption
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SEBA System…
• He concluded –1. Asian teeth are wider mesio-distally and have
less angulation 2. The upper and lower incisors of Asian teeth are
more proclined, in relation to basal bone3. The interincisal angle is significantly less for
Asians
• Higher torque and lower angulation – keep the teeth in the middle of the basal bone during orthodontic movement – lessening the chance for root resorption.
156
SEBA System…
0º 0º 9º
º 2º 2º
157
0º 0º 9º 6º 3º
2º 2º 5º 0º 0º
Tip values
SEBA System…
158
Molars Premolars Canines Lateralincisors
Centralincisors
-5º
3º3º
-12º
-17º
-6º -6º
8º 18º 24º
Torque values
SEBA System…
SELF-LIGATING BRACKETS
• Dr. Dwight Damon (1998)• Low friction brackets• Active and passive types
159Contemporary orthodontics by William Profitt, 5th edi.
160
4º 4º 5º 4º 2º
2º 2º 5º 9º 5º
Tip values
Contemporary orthodontics by William Profitt, 5th edi.
Self-ligating brackets…
161
Molars Premolars Canines Lateralincisors
Centralincisors
-6º
-6º-6º
-12º
-17º
-28º-10º
-14º-18º
-11º -11º
7º 6º 15º
Torque values
Self-ligating brackets…
CONCLUSION
• A variety of PEA prescription are available in the market now-a-days.
• No single appliance however can be used to achieve ideal treatment results.
• The success of orthodontic treatment still depends on clinicians knowledge and willingness to do the wire bending as and when needed.
162
conclusion
REFERENCES• Contemporary orthodontics by William Profitt, 5th Edition• STRAIGHT WIRE: The concept and appliance by Lawrence F
Andrews. 1989• Roth, R.H.: Treatment Mechanics for SWA in orthodontics: Current
principles and techniques. JCO 1985• Anthony Viasis. Bioefficient therapy. JCO 1995 Sept.:552-68• Systemized orthodontic treatment mechanics by McLaughlin, Bennett
and Trevisi 2001• S. Jay Bowman. The Butterfly System. JCO 2004: 274-87• Vipul K S, Bidimensional Technique: A Topical Review. Int J Dentistry
Oral Sci. 2015 2(6), 94-96.• The Bioprogressive therapy by Robert Ricketts • Smartclip Self-ligating appliance system by Hugo Trevisi 2007
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references
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