Edgewise Sequential Directional Force Technology Levern Merrifield Introduction Dr. Angle introduced the original edgewise appliance, and Dr. Tweed, his most brilliant student, dedicated his professional career to utilizing the appliance and developing a philosophy of treatment that would satisfy his orthodontic objectives. After working many years with Dr. Tweed, I, along with many colleagues, began evolving new techniques, utilizing clinical research, improved orthodontic materials, performance testing, and years of orthodontic experience. This evolution has resulted in some very interesting and exciting concepts in clinical orthodontics that have merged into advanced technology that is simple, practical, efficient and gives such a consistently higher quality of service that I predict this technology will be too impressive to be ignored. This technology started years ago with a modification to the Tweed technique that I named “the directional force technique”. Our study group seriously studied all the auxiliaries and their effect upon the denture and its environment. Our goal was to achieve optimal denture repositioning with precise directional force control by utilizing the edgewise bracket, the archwires, and the proper auxiliary force. One of the features of the technique in an extraction case was the immediate retraction of the cuspids distally into the extraction space as leveling and rotation correction was being accomplished. This was done by applying J hook directionally oriented headgear force individually to each cuspid. This achieved the cuspid movement and simultaneously stopped the mesial migration of the incisors as the mal-occlusion leveled.Many orthodontists accepted this one feature of the technique as the only modification and assumed they were treating with the technique if they placed a headgear force against the cuspids. This is certainly not true, and I would like to define the directional force technique as “a group of force systems utilizing directional control to precisely position the teeth in both arches so that they are in optimum harmony with their environment’. Serious clinical research and experience has given us new insight and certain clinical concepts such as the many differences between the maxillary and mandibular dentures in the malocclusion, in treatment objectives, and in treatment responses. These differences demand individualized procedures for each arch through many of the areas of treatment. I will describe this new technology and some of the other underlying concepts. The technique is based on a philosophy and an appliance. The philosophy was conceived originally by Dr. Tweed, and my colleagues and I have spent many years defining and enhancing this concept The appliance is a basic tool for achieving our orthodontic goals. It is most ctitical and must have certain characteristics. These are simplicity, efficiency and comfort. It must be hygienic, esthetic and above all, have a very wide range of versatility. This is most critical, otherwise we will severely limit our clinical capability. The appliance of choice can be identified as “the edgewise appliance”. It consists of bands that carry single, double width brackets on the six anterior teeth, intermediate single width brackets on the bicuspids, twin brackets on the first molars and a heavy edgewise tube with a mesial hook on the second molars. The bands also have attached lingual hooks on the molars and cleats on the bicuspids and cuspids. These increase versatility, and they are especially necessary in activating 23rd order bends. Each of the brackets and tubes are placed so that the slots are at right angles to the long axis of the tooth and precisely positioned in relation to the incisal edges of the anteriors and the cusps of the posteriors. There are no tips, no slants, nor any variation in thickness in bracket or slot. The dimension of the slot and tube is 022 x .028. The basic appliance just described is the only edgewise appliance available which offers the range of control and versatility that allows individualized tooth positioning for maximum environmental harmony. Sequential Banding The application of the appliance to the patient is important. It is a concept of sequential banding in which the 2nd molars, the 2nd bicuspids, the cuspids, and the central incisors are initially banded. This procedure has several advantages. It is less traumatic to the patient. It is easier and less time consuming for the orthodontist. However, its most important advantage is that it allows much greater efficiency in the action of the arch wire during the first months of treatment. It also allows better monitoring of the progress. Sequential banding as described gives the arch wire much longer interbracket length and power storage and can accomplish one's objective more rapidly. It obviously gives the orthodontist the opportunity to apply a wire of larger dimension less subject to occlusal or bracket engagement distortion. After the teeth that are initially banded respond to the forces of the arch wire and auxiliaries, additional teeth are banded in sequence so that the forces can individually be most efficient.The maxillary Ist molars are banded after one appointment. The mandibular Ist molars are banded after the second appointment and the lateral bands are placed at either the 3rd or 4th appointment depending upon the progress of the treatment. The concept of sequential tooth movement is central to our new technology and replaces concepts of enmasse movements which caused jamming, binding, and many undesirable reactions to our forces. The Arch Wires Itis appropriate that I explain the arch wire selection. Only resilient edgewise arch wire is used. The dimensions of the wire are .017 x .022, .018 x .025, .019 x .025, 020 x 025, and .0215 x .028. These wires give a great range of versatility with the .022 x .028 bracket and allows the sequential application of forces as needed for various treatment objectives. I have eliminated the need for arch wire reduction, except in one stage of treatment, and this improves accuracy and consistency. Many cases can be treated with 3 mandibular arch wires and 3 or 4 maxillary arch wires. Our objective is to enhance tooth movement and control with the proper edgewise wire. The Auxiliaries The auxiliaries routinely used are elastics and directionally oriented headgear. Primarily, the high pull and the straight pull J hook headgear furnish the extra-oral force in a directional manner. Most techniques are described by listing a number of steps in treatment. 1 would like to vary from this procedure by listing the various systems of forces used in achieving certain objectives as treatment progresses.The Force System Of Denture Preparation Denture preparation would include all the initial steps that prepare a malocclusion for correction. These include: . leveling, 2. individual tooth alignment, 3. cuspid retraction, and 4. initial preparation of the terminal molars for stress resis ance. These systems of forces are best illustrated by line drawings, pertinent elements of the system in the mandibular arch is a .018 x .025 arch wire with bent in loop stops, incisal curvature, malocclusion arch width with the bent in loop stops flush with the molar tubes. The distal portion of the arch wire which lies in the molar tube is adjusted to effect a 15° distortion with the long axis of the terminal molar. The degree of bend in the wire is determined by an initial "read out" of the malocclusion. Here it is -10°. For instance, if the lower terminal molar is inclined mesially 10°, the bend would be 5° in severity. If the terminal molar were upright in its original position the bend would be 15°. This bend is downward in the mandibular arch and must be related to the original position of the molar. An exaggerated 2nd bicuspid offset bend is placed just mesial to the bicuspid bracket. This guides the cuspids between the cortical plates as they retract. In addition to the 018 x .025 wire, a high pull J hook headgear is fitted so that the eyelets of the J hook slide over the arch wire and apply force mesial to the cuspid brackets. This force supports the anterior segment of the arch wire and prevents vertical and mesial displacement of the incisors. The terminal molar, the 2nd bicuspid and the cuspid are primarily affected by this system the first month. The terminal molars are uprighting, the 2nd bicuspids are leveling and the cuspids are retracting and uprighting into the extraction spaces. The key is the highly resilient .018 x .025 edgewise arch wire which maintains archwidth, resists occlusal stress, and achieves a second order force on the terminal molar. The terminal molar will upright to 0° from -10°, and the cuspid will retract 1 1/2 mm into the extraction space the Ist month. The .018 x .025 wire is removed, recontoured, and an additional 10° of distal tip is placed in the terminal molar area. The wire is retied, and during the 2nd month the terminal molars tip distally 5° - 8°, the 2nd bicuspids level, the cuspids retract an additional 1 1/2 mm, and the central incisors are maintained. The unbanded teeth also respond positively as space develops. The laterals migrate to better alignment and the Ist molars upright. The .018 x .025 arch wire is removed at the 3rd appointment and again recontoured to remove occlusal distortion. The 2nd molar area receives an additional 5° of tip and now has 20° of distal tip. The first molar is now easily banded and the wire is religated. The high pull headgear force continues mesial to the cuspid bracket, and the cuspids will retract an additional mm into the extraction space. The terminal molars will have a read-out of 10 distal tip, there will be a slight space distal to the Ist molar. At the next appointment the lateral incisors are banded, the .018 x .025 edgewise arch wire is recontoured, the 20° tip in the terminal molar is maintained, and an alastic chain is placed from the 2nd bicuspid to the cuspid. The 2nd molar, the Ist molar, and the 2nd bicuspid are securely ligated together, and all remaining teeth are ligated with individual ties. After four months, this sequential application of forces and banding, using the same .018 x .025 edgewise arch wire and high pull headgear, should have the mandibular teeth level with good bracket engagement. The terminal molars should be tipped distally to approximately 15° to the bracket plane. The extraction space should be approximately 1 1/2 mm, and the arch form should be very good.This force system should be continued until the cuspid is retracted to its desired position and all initial objectives of denture preparation have been achieved. The maxillary teeth are also sequentially banded, and the initial arch wire for this force system is a highly resilient .017 x .022 edgewise arch wire. This wire is excellent for maxillary denture preparation and can be of smaller dimension because it does not have to withstand distortion from occlusal stresses. It is maintaining the distal axial inclination of the 2nd molars and maintaining rather than eliminating the Curve of Spee.The arch wire is contoured with incisal curvature and malocclusion arch width with a slight Curve of Spee. The terminal molar area has a 30° distal tip. There is an exaggerated 2nd bicuspid offset bend just mesial to the bicuspid bracket. The high pull directional force J hook headgear is applied to the arch wire mesial to the cuspid brackets and is worn 12 hours each day. In one month the maxillary terminal molar inclination will have been slightly enhanced with some intrusion of these teeth, the 2nd bicuspids will begin uprighting and the cuspids will upright and retract about 1 1/2 mm into the extraction space. The central incisors will have an intrusive force applied. At the next appointment the .017 x .022 wire is removed, recontoured, and the Ist molar bands are fitted. The wire is religated and headgear wear is continued. One should expect about 11/2 mm of cuspid retraction utilizing the headgear at this time. At the next adjustment, the .017 x .022 maxillary arch wire is removed, the wire is checked, all distortions and expansion corrected, and the wire is reinserted. ‘An alastic chain is placed from the cuspid to the 2nd bicuspid and a continuous ligature is used from the terminal molar to the 2nd bicuspid, all other ligations are single ties with good bracket engagement. The high pull headgear and the alastic 7chain will enhance cuspid retraction. At this adjustment or the following one the lateral incisors are banded and bracket engagement is accomplished. Sequential banding and sequential force application has now been fully implemented, and this system of force is continued until the maxillary cuspids are fully retracted or in a strong Class I relationship. At this point let me digress for a moment to explain the basic premises which make necessary certain elements of the following force systems. A careful study of the action, the interaction, and the reaction of teeth to bends in the arch wire should make one realize that this knowledge is critical. It is basic and fundamental and drastically affects our clinical results. These same actions, interactions, and reactions occur when the arch wires are straight and the brackets are distorted. Second order bends in the mandibular arch posterior segment are very antagonistic to the teeth in the anterior segment. Without excellent directional control and a careful application of these 2nd order forces in a sequential manner, all control of these teeth will be lost. The anterior teeth cannot support the simultaneous tipping of the posterior teeth, and I have concluded that anchorage preparation with Class III elastics as previously taught is unsound. The directional force is not high enough to support the intrusive force on the anteriors, and the elastics do not activate the tips properly. Another area of unsoundness is the placement of compensating bends on the initial arch wire before compensation is needed. Only after tipping should the bends have compensation. Second order bends in the mandibular arch wire posterior segment also affect the 3rd order position of the lower anterior teeth in a negative manner. These teeth generally require lingual crown torque, and posterior tipping bends give labialcrown torque to the incisors. This must be given careful consideration in arch fabrication and force application. In the maxillary arch 2nd order bends in the posterior segments are generally desirable or complimentary to the teeth in the anterior segment. The reaction to the lipping forces intrudes these incisors and gives a lingual root torque effect. These are positive or complimentary to our objectives. Third order bend reaction in the mandibular arch wire is complimentary to all the teeth if properly placed. Our objective is some degree of lingual crown torque on all these teeth, Therefore the posterior and anterior segments work together in action, reaction, and interaction. Conversely, 3rd order bends in the maxillary arch wire are antagonistic. The anterior segment needs lingual root torque and the posterior segment needs some lingual crown torque. It would not be wise to incorporate active torque force in both segments with opposite actions simultaneously. It would be prudent to apply active 3rd order bends sequentially and in only one direction in the maxillary arch at any given time. First order bends action and reaction effects expansion or contraction. These actions are most easily monitored and are usually used to move individual teeth. The interaction can affect the 3rd order position of the teeth if expansionary forces are used. Labial crown torque must be controlled with counterforce. Denture Correction - Mandibular Arch When the lower denture preparation objectives have been attained, the system of forces are altered to achieve our next series of objectives. These can be called denture correction. They are: (1) Retraction and the up-righting of the lower incisors to their most ideal positions.2) Completion of space closure, and (3) positioning the teeth in the mid-arch and posterior areas into axial inclinations that will allow final coordination with the maxillary teeth for normal functional occlusion. The elements of the force systems used are an .019 x .025 edgewise arch that has ideal 1st order bends, closed vertical loops just distal to the lateral incisors, and bent in loop stops just distal to the distal brackets on the Ist molars. The distal leg is adjusted to prevent elevation of the 2nd molar. The wire has 7° of lingual crown torque in the incisal area and has passive 3rd order bends in the rest of the wire. 3rd order bends are complimentary in the lower arch wire as they consist of varying degrees of lingual crown torque. The 2nd order bends are only placed on the terminal molars, and with the precision arch chart 20° of distal tip is incorporated in this area. Vertical spurs are soldered gingivally between the central and lateral incisors. It is very essential to have a read-out before the arch wire is inserted. This read-out should be recorded for the 7’s, the 6's, and the 5's. The arch wire is heat treated and polished without reduction. The arch wire is activated by ligating from the terminal molar to the bent in loop stop and cinching the closed vertical loop open 1 mm at each adjustment. Further activation is achieved by applying a high pull headgear with J hooks to the vertical spurs between the centrals and laterals. (The J hook is adjusted by bending the eyelet so that its lumen is horizontal.) The eyelet is bent upward 45° and then the shank is bent downward 90 °. The high pull directional force places a force that is 40° above the occlusal plane. This force overcomes the intrusive force on the incisors which is a reaction to the 20° distal tip in the terminal molar, and the remaining headgear force is distal and allows uprighting and retraction to occur very rapidly. 10The 20° distal tip in the terminal molars maintains these teeth when the vertical loop is activated and actually tips them distally when the vertical loop is closed. By supporting the arch wire with ten teeth and the high pull headgear, the two terminal molars will maintain an anchorage prepared position. About 5° of additional distal tipping of these terminal molars should occur. This system is used until the incisors are correctly uprighted and all space is removed. A headfilm is necessary for monitoring incisal position. If more than one wire is required, the 2nd wire has the vertical loops distal to the cuspids and the vertical spurs for the high pull headgear are distal to the lower laterals. The headgear is worn to the lower arch 10 hours each day. The maxillary force system for denture correction, anterior retraction, space closure, and initial posterior denture positioning is very similar. However, the arch wire is a resilient edgewise .020 x .025. The vertical loops are placed just distal to the lateral incisors. The bent in loop stops are adjacent to the distal bracket of the Ist molars and carefully adjusted to not extrude the terminal molars. The wire has ideal first order bends, and again a read-out of the posterior teeth is absolutely essential. This is recorded and referred to at each appointment. It is also used to determine the severity of the distal tip in the 2nd molar area. The read-out will determine the passive tip. If 20° , make 25° for a 5° effect. A curve of spee is placed on the Ist molar and 2nd bicuspid. This will allow excellent resistance to mesial molar movement when the vertical loop is activated. When the loop closes, the high pull headgear force will enhance the position of the posterior teeth. Third order bends are more critical in the maxillary force system because they are antagonistic in the maxillary arch. The anteriors should have passive lingual root torque, and the posteriors up to the 2nd molar should have passive lingual crown torque. The 2nd molar should carry 5° of active lingual crown torque. The "1arch wire has soldered headgear hooks distal and gingival to the central incisors and the high pull headgear used to retract the maxillary cuspids is adjusted by closing the eyelet and recontouring the bow of the J hooks. This high pull headgear with 30° of intrusive force gives direction and activation to the system of forces incorporated into the arch wire. The arch wire is heat treated and polished with no reduction. Both high pull headgears are worn simultaneously on the upper and lower arches, but the number of hours of wearing of each will vary with each malocclusion. The directional control becomes more vital with the severity of the malocclusion. This maxillary force system is continued until anterior retraction is complete. Finish of Upper Retraction It is important to note that both the mandibular and maxillary force systems are totally independent of each other. No Class Ill elastics or stabilizing arches are necessary. The maxillary arch force system is incorporated one month behind the mandibular arch system. Anterior retraction, space closure, and initial denture preparation is being accomplished in both arches simultaneously. This should eliminate at least 4 mos. of treatment time. 10-2 System Mandibular Arch Although this entire technique is based on sequential tooth movement, the key is the 10-2 anchorage system in the lower arch. The concept is that the arch wire has an active portion affecting only 2 teeth, and the remaining portion is passive, thus the 10 remaining teeth act as a stabilizing or anchorage unit as the 2 teeth are 12tipped. This allows a quick controlled response without serious reaction. This system is further supported and activated by the high pull headgear worn on anterior vertical spurs. With this system of sequential anchorage it is absolutely essential that there be no pretipped brackets in the lower arch. When all spaces are closed and the incisors have been retracted, the mandibular .019 x .025 arch wire is removed, and a read-out is made on the terminal molars. It should show a 15° distal inclination from the previous force system; the Ist molars should be 0°- 3°; and the 2nd bicuspid should be 0°- 5°. At this time the second step of sequential anchorage, 10-2-6, is incorporated. Using the same wire a distal tip of 10° is placed in the Ist molar area, and compensating bends are carefully fashioned just mesial to the bent-in-loop stops. These bends must compensate for the distally inclined 2nd molars and leave the wire in the Ist molar areas at a 10° bias when laid across the twin brackets. The 2nd molars are now a part of the 10 stabilizing units, and the Ist molars are the two units receiving the action of the directional forces. For ideal response, the high pull headgear is still applied to the vertical spurs anteriorly. After | month the arch wire is removed, and a read-out should show +5° to +8° distal inclination of the Ist molars, the 2nd molars should read-out +15°, and the 2nd bicuspids 0°. The 3rd and final step of this procedure is to place a distal tip of 5° severity in the 2nd bicuspid area. Measure on the precision arch chart, and place compensating bends just mesial to the mesial bracket of the Ist molars. These bends must allow the wire in the 2nd bicuspid areas to be on a bias to the bicuspid bracket when the wire is seated in the 2nd molar tubes and the 1st molar brackets. These compensating bends must be most carefully checked. This wire is ligated in place and again the high pull headgear is worn to the vertical spurs. Sleeping hours will usually be sufficient. At this point the Ist and 2nd molars and the 6 anterior teeth are a part of the 10 stabilizing units and the 2 bicuspids are 13the recipients of the 10-2-5 directional force system. A read-out at the end of one month should show a distal axial inclination of +15° in the 2nd molars, +5° to +8° in the Ist molar area and 0° to +5° in the 2nd bicuspid area. A lateral headfilm should also show the lower incisor position to be slightly enhanced. If originally positioned at 88° they should be now at 85°. (note) If more distal positioning of the lower teeth were necessary, it would require jigs and the straight pull headgear or Class III elastics to accomplish. Maxillary Arch On the maxillary arch the necessary posterior denture positioning should have been either maintained or accomplished with the previous two force systems. The position of these teeth can be confirmed with a read-out and should be +20° for the 2nd molar, +10° for the Ist molar and +5° for the 2nd bicuspid. The occlusal relationship at this time will be such that the 2nd molars are discluded as is the distal cusp of the Ist molar. If the read-out does not show these values, the same .020 x .025 edgewise arch is removed and adjusted utilizing the 10-2 system. Maxillary posterior denture positioning is accomplished as the mandibular posterior teeth are being positioned with the 10-2 system of sequential anchorage preparation. Denture correction will now be complete for the Class I occlusions. For the cases with end-on or Class II occlusions a new system of forces must be used to complete denture correction. A careful study of the cusp relationships will determine the next step. If the cuspal relationship is nearly Class I or just slightly end-on, make a new maxillary arch wire using .0215 x .028 resilient edgewise wire. It will have ideal arch form with Ist order bends, passive 3rd order bends in the 14posterior segment, and slightly enhanced lingual root torque in the anterior segment. The 2nd order bends in the posterior segment are also increased by further exaggeration of the curve of spee, this wire is heat treated and the legs distal to the laterals are reduced 2 minutes and then the entire wire is polished. Hooks are soldered gingivally distal to the centrals for the high pull headgear. Seat and ligate the arch wire being careful to secure complete bracket engagement. Do not ligate the terminal molars. At the end of mandibular sequential anchorage preparation, a new mandibular stabilizing arch is fabricated using .0215 x .028 resilient edgewise wire. All the first, second and third order bends are incorporated. It is important the bent- in-loop stop are flush against the molar tubes. The wire is heat treated and polished, then spurs are soldered gingivally just distal to the lateral incisors. The wire is seated and ligated, and the terminal molar is cinched tightly to the bent-in-loop stop. Place up and down elastics from the gingival spurs distal to the laterals on the mandibular arch and over the high pull headgear hooks between the centrals and laterals on the maxillary arch. Place Class Il elastics from the hooks on the mesial of the lower 2nd molar tubes and to the Class II hooks soldered on the maxillary arch wire. Six to eight ounces of force should be used, and the elastics should be worn continuously. The maxillary high pull J hook headgear should be worn 14 hours each day. (Note 1) If for any reason the Class II elastics are not indicated on the lower arch, a straight pull ] hook headgear can be used by attaching it to the Class II hooks on the maxillary arch and wearing it along with the high pull headgear. (Note 2) It must be assumed that a careful diagnosis utilizing total space analysis has been used and posterior space is available for maxillary distal en masse movements. Two to three months using this force system should accomplish a slightly overtreated Class T occlusion. 15If the cuspal relation at the end of the previous step was end-on or Class II it will be necessary to use another system of directional forces. Class Il Force System It is absolutely necessary at this time to make a final diagnostic decision based on the ANB relationship and the maxillary posterior space analysis as well as patient cooperation, If the maxillary 3rd molars are missing, or if the ANB is 5° or less and the patient is cooperative, the system to be described will accomplish the best result. If these 3rd molars are present and are anywhere near eruption, they should be removed to facilitate maxillary denture distal movement. If the ANB relationship is 5° to 8° with a Class II cusp relationship and the patient is cooperative, the extraction of the maxillary 2nd molars will be the most advantageous. If the ANB is above 8° or the patient's motivation is questionable, or both, then either the Ist molars should be removed or surgical correction is indicated Facial balance and harmony after correction should also be carefully considered in this decision. The mandibular arch wire is the same as previously described. it is seated, cinched, and ligated for maximum stability. The maxillary arch wire is modified by incorporating closed bulbous loops just flush with the mesial of the molar tubes. This wire is identical to the previous wire in all other areas. High pull headgear hooks are soldered distal to the central incisors gingivally. 16There are Class II hooks soldered occlusally distal to the lateral incisors. The closed bulbous loops are opened about 1 1/2 mm on each side and the arch wire is ligated in place. Class II elastics with 6 oz. of force are worn from the hook on the lower 2nd molar tubes to the Class If hooks on the maxillary arch wire. Up and down elastics are worn from the spurs on the lower arch over the high pull headgear hooks on the maxillary arch wire, and finally the high pull headgear is worn on these maxillary hooks. This force system is continued for one month to sequentially move the 2nd molars distally. At the next appointment, the lower arch is retied and recinched, and the upper arch is removed so that the bulbous loops can be opened further. The wire is reseated, and sliding jigs are fabricated and placed so that the distal eyelets contact the mesial bracket of the upper Ist molars and the mesial eyelets are midway between the cuspid and bicuspid brackets. The mesial eyelet has an extension for a Class II elastic. At this time Class Il elastics with 6 oz. of force are worn 24 hours each day from the hook on the lower 2nd molar tube to the sliding jig and a 2nd elastic of 6-8 oz. of force is worn from the lower molar hook to the Class II hook on the maxillary arch wire. In addition an anterior up and down elastic is worn 24 hours each day along with a high pull headgear to the upper arch wire 14 hours daily. This is a very efficient force system with excellent directional control. It is sequential in that the maxillary 2nd molars, the maxillary Ist molars, and the rest of the maxillary denture are receiving individual distalizing forces. Four months of wear with reactivation monthly should position the posterior teeth in an overtreated Class 1 occlusion. This system will not strain the mandibular denture if the up and down elastics are worn and there is sufficient space available in the maxillary posterior segment. 17After Class II overcorrection, a new maxillary arch wire may be needed with a vertical loop distal to the cuspids, Class II hooks and the same anterior forces are used to retract the anteriors and correct the overjet. This Class I force should be milder, 4 - 6 02., and carefully controlled lingual root torque on the incisors is necessary. Denture Completion The last phase of treatment can be identified as denture completion. It consists of very precise and varied systems of forces. These forces are based on a very critical study of the arrangement of each tooth in each arch. The relationship of one arch to the other and the relationship of the arches to their entire environment is also studied. Read-outs should be made, and necessary 2nd and 3rd order adjustments placed in the arch wires. A progress headfilm and tracing can determine final lower incisor position, as well as any minor control of the palatal,occlusal, and mandibular planes that may be needed. The accurate tracing will also indicate the amount of lingual root torque necessary for the maxillary incisors. Visual clinical study can determine the lip line, maxillary incisor relationship and the amount of cusp seating and artistic positioning of the incisors. One should consider denture completion as “mini” treatment of the malocclusion, and repeat whichever systems of forces are necessary and then when the original malocclusion is overcorrected, add final artistic positioning bends and cusp seating forces that give detail and quality to the overcorrection. Selective band removal will facilitate cusp seating and band space removal. Over all, 4 to 6 months in these ideal arches undergoing “mini” treatment and precision finalizing will add quality, individuality, and stability to the final result. 18Denture Recovery When all bands are removed and retainors are placed, the most critical phase of malocclusion correction occurs. I would like to refer to this period as the recovery period and the forces involved are those of the surrounding environment, primarily the muscles and the peridontium. I strongly believe that if our corrective procedures barely achieve normal relationships of the teeth there will be inevitable relapse. Any change will be away from ideal toward malocclusion. Denture recovery based on a concept of overcorrection of the major problems of the malocclusion is predicated on clinical experience and clinical research which indicates that certain tooth and denture changes effected during treatment will tend to revert toward their original position - that as in overbite and rotation correction approximately one-half of the change is lost in subsequent “settling”. The overcorrection to a disclusion of the 2nd molar and the distal cusp of the Ist molar and the distal axial inclination of these teeth in both dentures removes any possibility of prematurity or trauma. It frees the tempro-mandibular joint to function normally, and in recovery function settles these teeth into their most efficient, healthy, and stable positions. One should never strive for the ideal final result at the end of treatment. This should occur after all mechanics are discontinued and uninhibited function and all other environmental influences active in the recovery period stabilizes and finalizes the position of the teeth in both the maxilla and mandible, A recent thesis submitted by Dr. Cooper Sandusky of The University of Tennessee was a study of nearly 100 cases treated by Dr. Tweed and 3 of his colleagues in which records were made 10 to 20 years post treatment. These records were carefully analyzed. All of these cases were treated with the Tweed philosophy of 19overtreatment and respect for the original dimensions of the denture and showed excellent stability after full recovery. Conclusion I hope these concepts and this technology has been interesting and | invite and challenge you to join our crusade for improving our clinical skills, our knowledge, and the quality of service rendered to our patients. This is our finest hour. We have at our finger tips treatment procedures that will, with discipline and concern, produce a clinical result we could only hope for in the past. Our future is bright. 20