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THREE PIECE INTRUSION ARCH - Simplified

- A C LINI CAL TIME AND MOTION STU DY
A u t h ors:
Na rayan Anjali, M.D.S.,
Sen ior Lecture r, M .R. Ambedkar D ental Coll ege

Joseph Sarojini, M .D.S.,
Professor, Oxford D ental College

Mo ha n K.A, M.D.S.,
Professor & H .D.D, M.R. Ambedkar De nta l Coll ege

Abstract The relationship of the maxil lary incisors to the upper lip line Is a critical factor that ensures a
pleasing appearance. In clinical practice, the patients presenting with proclined incisors which
are also erupted beyond the functional occlusal plane Is common. Simple retraction or distal
tipping of proclined incisors leads to further deepening of the bite and hence may not produce
the ideal result. In this study, an appliance that can simultaneously Intrude and retract incisors
i.e., the three piece Intrusion arch was analyzed In Its efficacy In producing simultaneous Intrusion
and retraction in ten patients, who presented with maxillary incisors that were proclined as well
as supra-erupted below the functiona l occlusal plane. Understa nding the blo-mechanlcs of a
system that produces simultaneous intrusion, retraction and translating the same Into an efficient
clinical appliance is important, for beginners. This article alms to simplify the concept with
clinical evidence which gives a concept of the time and efficiency of the appliance.
Key Words Simultaneous intrusion and retraction; three piece intrusion arch; time and motion study.

INTRODUCTION: 1 . A short he ight of th e philtrum o f the upper lip,
The new m ant ra in o rthodonti c practi ce is d iagn osis 2. V e rti cal ma x illary excess,
based on the analys is of soft ti ss ue as we ll as hard ti ssue 3. Excess ive cl ini ca l c row n he ig ht, severe ly proclined
paramete rs. Th e naso l abia l a n g le i s c rit ica l for an incisors
est heti ca ll y pl eas ing profile. Th e co ntour o f the lips 4. Under-torqued m axi ll ary inc i so rs or
.1 nd it s co mpetency as we l l as the re lationship of th e
5. Over- erupti on o f ma x i l lary inc iso rs.
maxi ll ary in c isors to the upper lip line is a c riti ca l fac to r
tha t en sures a pleaSi n g appea rance. During the smil e, In the past , leveling proced ures were bei n g d o ne by
the co nto ur of th e lower l i p sho uld co nform close ly to the injudicious use of continuou s arc h wi res, w hi ch
the incisa l edges o f the ma x illary anterior teeth . AI rest, led to th e extrusion of posterior teeth . The advent of
a n in cisor exp osure of 3 mm is co n sidered to be idea l. improved diagno si s h as evidence to show th a t
T he reaso ns for excessive incisor display at rest m ay d ep e nding o n th e g rowth p att e rn a nd the g rowth
be attr ibutabl e to the follow ing soft ti ss ue or hard ti ssu e potential of a pati ent, differe nt modalities of leve l i ng
disharm o n y i .e., shou ld b e instituted '.

Type of growth pattern G r owing pati en t Non - growin g patient

Average grower M o lar ex tru sio n I inc iso r intru sio n Tru e Incisor intru sion

H orizo ntal grower M o la r extru sion Mandibular Adva n cem ent And
Mol ar Extrusion

Vert ica l grower True Inc iso r intru sion Tru e Inc isor intrusion

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co n vex ity of the face. the fun c ti o na l occl u sa l p lane. w here in the intrusion a rc h was direct ly engaged re p o rted to the Department of O rth odo nt ics.on to th e d ista l extens io n of th e an te rior w ith spacing o r mild c rowd ing. A stu d y was desig ned to a nalyze th e efficacy of the They had fully erupted first a n d secon d molars. The intru si ve force compon ents Th e pat ient had class I or class II m a locclus io n s are en gaged .e. w h ich minimizes th e treatment side effects.Inte r-occl usa l sp ace. th e mome nt o f the fo rce Criteria for selection used: was in a c ounter cloc kwi se direction w hi c h res ulted in Th e p ati e nts were se lected suc h that th ey would labia l flaring of th e a nterior seg m ent as well . first premolar extract io n as we ll as non-extraction cases. Intrusion arches were fi rst d escribed by Burstone as a part of the segm ented arc h technique in 1977.. Treatment sequencing used: Th e cases se l ected we re both. thereby prov iding Th e p ati e nts had the upper incisal margins below a statica ll y dete rmin ate force sys te m . ensure deliveri n g growth pattern. A lime and motion study is one which bone trough in th e maxillary ante ri o r reg ion. In trusive 3. segm en t at a si n g le point b il atera ll y. w hi c h orth o d o nti c trea tme nt. very li g ht and con stant forces. three p iece intru sion arc h i n ac hi evi n g simulta neou s in trusio n a nd retra c ti o n of maxillary i nciso rs that are Al l th e p ati ents h ad a c urve of spee > 2 mm and proclined as we ll as supra-erupted below the functiona l The patients had sufficien t amount of a lveo lar occl u sa l p lan e. An essen ti a l featu re o f the intrusion arch is that it app li es force via a sing le pOint of contact with incisors MATERIALS & METHODS: the reb y m aking it a sta ti ca ll y dete rminate force system . Si mpl e rando mi zation was i s a frequ ent problem leads to d eepening of th e b ite not fol lowed a nd n o co ntro l g ro up was selected. m an y intru sio n arc hes have been described Sample Characteristics: Le. the use of a three pi ece intru sio n arc h 4 • The low load A ll pati ents se lected had an average or verti cal deflecti o n properti es of the TMA w ire. g rowth intru s i o n a rc h f o r sin g l e st e p intru sion a nd pattern of the patient and estimated growth rem ainin g retractio n of m axi ll ary incisors. To ana lyze w hethe r th e three p iece intru sion arc h tooth m ovem ents appea r to be m ost effecti ve with low ca n redu ce treatment durati o n by the si multaneous magnitude of forces of 1 2. are exce ll ent c riteri a that ca n b e employed to se lect th e crite ri a for l eve ling of the arc hes i. In the p ast. measures the rate of tooth movement in a stipulated period of time. M.. To eva lu ate th e a mount of retracti o n (in mm) of a nteri o r o r extru sio n of p osterior segm e nt.1 5gm s as suggested b y intrusion and retracti o n of incisors. 1. Co nnect ic ut intru sion arc h The present study was co ndu c ted o n ten p atients w ho etc.R .. a nd hence may prolong treatment time. intrusion of 2. To for mul ate a treatm ent protocol for correcti o n All the cases were started using MBT b racket system of d eep bite and p rocl ination using th e three piece wi th tripl e tubes o n m axi ll a ry mol ars and double 39 . i n to the brackets of the a nte rior segment th ereb y A mb e dkar D e ntal Co ll ege see kin g o rth odo nti c co n ve rtin g t h e force syste m into a stat i ca ll y trea tment. was that sin ce th e i ntru sive force was appli ed anterior to th e center of res istance. A n applia nce that ca n simultaneously intrude and retract i n cisors is Th e patients had p seudo d ento-alveola r deep bite in strume nta l in shorte nin g trea tm e nt duration . the Rickett's utility arc h. The samp le cons isted of six females and four indetermin ate o ne 3 • A n o th er pro bl em that was fo und m a l es w ith age ranging between 1 8-25 yea rs. Faber2. provided AIMS & OBJECTIVES: that they benefited fro m intru sion and ret racti o n The a ims of the presen t st udy were: of th eir m axi ll ary inci sors. the m ax ill ary i ncisors ac hi eved per unit time u si ng th e th ree pi ece intru sion a rc h . The due to supra erupti o n of upper in cisors> 3 mm sim ultaneous intru sion of the incisors a lo ng the ir long w ith proclin at ion upper anterior teeth and over j et ax is as we ll as thei r retraction ca n b e achi eved w ith > 4mm. b enefit f rom intru sio n a nd ret r act i o n of th e maxi ll ary incisors d urin g th e p rocess of th eir Retraction or d ista l tipping of procl ined in cisors.

l . 3 : Th e intru sive fo rce is accompanied wit h a appli cation of a mild di sta l force. T he premi se on w hi c h th e force application was b ased was that if in tru sion a long the lo n g ax is of th e tooth is required . A n intru si ve fo rce co unt er cl oc kwi se movem ent. a n g led downwa rd s to e nd 2-3 mm di sta l to th e 40 . ccphalostat (EC praline 00 m achin e) and center o f resistance of the a nteri or segmen t was loca ted. (F ig. th e ca nines were co n so lidated w ith th e rest of th e Fig.0 25" sta inl ess stee l w ire a nd two bil ate ral . Burstone and Lei ss 4 for the purpose 1. Lindauer.: illllcri or seg ment as wel l.019" x . --- The Three piece intrusion arch: The Three piece intru sion arc h was in trod uced in 1995 by Shroff. 7:26-33) Components of three piece intrusio n arch: - (Fig 5 . indi v idua l ca nin e retracti on was done in a ll cases using sliding m ec han ics w ith acti ve tie backs ex te nding fro m the hoo k o n the maxilla ry first m o la r tube to th e di stal hook of the maxil lary ca n i ne. Thi s cep ha logram was later o n u sed to compare th e resu lt s wi th th e p ost intru sion and re tra c ti o n cep ha l og ra m s. c hain to redirect th e intru sive fo rce a lo ng th e long A la teral ceph alogram was taken on a standardi zed axis of th e incisor.0 19" x .J. 2 : Three pi ece intru sion arc h w ith class I e last ic poster ior teeth b il atera ll y.:::=---. Pre a nd Post i ntru sio n cli ni ca l p hotograp hi c records were al so take n . 7.5. tu bes o n mandibula r m o l a r s a nd h ad a sl o t dirnen sio n o f . Aiter in itia l a lignment. A mi ld d istal fo rce a lo n g The reC iproca l effect is an ex tru sive fo rce and a d istal wit h the intrusive force res ults in the retrac ti o n of the tippi n g of the crow n of the m o la rs ( Burs tone c.0 1 7" x . After the individual ca nin e retracti on was ach ieved.022"x . The w ire was aga in bent to 90 degree Fi g. ~.4) The three pi ece intru sion arc h co n sisted o f an an terior segm e nt of . All the teeth including the seco nd molars were strapped up.028". 1 : Three pi ece in tru sion arc h w ith intru sive sl ightl y be low th e center of res istance and furth er force pa ss ing through th e centre of res i sta nce. Semin O rth od 200 1. Anterior segment: 1 t The ri g id ante ri o r seg m e nt consis ted of a .025" stai nl ess steel w ire from 3M U nite k p laced into th e brac kets of th e incisors a nd stepped up gi n giva ll y di sta l to th e br ac k e ts on th e l a te ral seg m e nt.025" TMA t ip bac k sprin gs.---+·'1 01 si mult a neous intru sio n a nd retraction of flared anterio r tee th as we ll as cor rect ion of th e ir ax i a l inclinations wi th good anc h o rage contro l. . lJ the intrusive force ca n be redi rected lin gu all y by th e Fig. 2 & 3) Biomechani cs of deep overbite correc ti o n . alone prod uces proclina tion.

T he hook s w hi c h indi ca te th e point of intru sive force appli ca tion were b e nt at ri g ht a n g les a nd c urved in wa rds a nd e n gaged on th e posteri o r exten sio n o f the ante rior segm ent at a p a int di stal to th e est i m ated p os i ti o n o f th e ce nte r of resistance of the anterior segm ent (i . Thi s sm all di sta l force directs the intru sive fo rce so its lin e of action i s ling ual and pa ra ll e l to th e long ax i s of the in cisors. A tip b ac k m o m e n t is Fi g .0 25" sta inl ess stee l w ire.019" x . 4 ).01 9" x . 5. Th e p os terior segmen ts: Th e p os t e ri o r seg m e nt s w e re c on so lid a t e d bil aterall y fro m canin e to seco nd m o lar using a p ass ive stabili z ing w ire of . ax is of th e teeth . 4. di sta l to the latera l in ciso r).01 7" x .9mm hard temper sta inless steel tran spal ata l a rc h (Fi g.e. The anter io r a ng led post eri o r ex ten sio n of the a nterior seg m ent segm ent w ill b e retracted as a res ult of sm a ll t ip a ll ows th e intru sive fo rce to be appli ed a lo n g th e b ac k m o m ent c rea ted . D istal fo rce compon ent (elastic c h ain ) : A n e lasti c c ha in is ex tend ed bil aterall y from th e m o lar hook to the p oste ri o r hook o f th e anteri o r segm ent. center o f res istance of the a nteri o r segm e nt. Th e generated o n the p osteri o r segm e n t.. 5. Fi g . Th ey were further co n so l id ated tra n sversely using a . 4 : An c horage preparati o n : D o uble tra n s pa latal arc h w ith rigid c on so lidati o n of th e p oste ri o r segm e nts usin g .3 : TMA intrusio n springs 41 . 2 : Ante ri o r segm e n t Th e bil atera l intru sion springs were made o f . Th e a nterior porti o n o f the ant eri o r segm ent wa s conto ured according to th e arc h fo rm . 2. Th e posteri o r exte nsio n s were ad apted suc h th at n o soft ti ss u e impingem ent wa s c reated 5 . Th e intrusion sp rings: Fi g .02 5 " TM A w ire. Th e tip b ac k b e nd s we re in c orpo rate d m es ia l to th e a u x ili ary tube o n the max illary first m o lars and th e springs w e re in serted into th e tube.025" stain less stee l.S : Compone nts o f the three Pi ece intru sio n a rc h Fig. 3.

B.Loo bo.9mm hard temper sta inl ess stee l in c i sors.01 9"x a nd di sta l ends o f the w ire were c ut suc h that 1 m m o f . Thi s info rmati o n was used clini ca ll y to estab li sh the p o int o f force appli ca ti o n durin g intru sio n m ech an ics. The cent er o f Fi g .chaio (Fig. 6 : Latera l cepha logram sh ow in g th e Cente r o f Th e assembl y was in serted and sec ured in pl ace and a resista nce of the anter ior segm e nt class J el asti c c h ain was en gaged to p rodu ce a m i ld 42 . Fig. abou t antcro-poster ior a nc ho rage.. res istance o f the fo ur inciso rs is u sua ll y estimated to b e ha l fway b etwee n th e c rest of th e a lveo lar bo ne and th e apex of th e latera l in cisor root in th e sagi tta l p lane6 .e. Fig. Th e two segm ents were 30 g m s of intru sive fo rce d e li vered per side i.o.4 : Latera l v iew of the Intru sio n spr i ngs Engagement of the three piece intrusion arch & force Anc horage Consideration: calibration: The p oster ior segmen ts of the m ax ill ary arch compri sing A ca li b rated Correx gauge was used to measure the of the ca ni ne.e.c. the intru sive fo rce must be p assed sl ightl y l i n gua l to the center o f res istance and a mi ld di stal com p o nent of fo rce mu st b e add ed to o ri e nt the force such th at the in tru sion occ urs a lo n g th e lo n g ax is of th e i ncisors. ex tendi ng from the p alata l shea th o f the m ax i l lary first and second m o lar to the opp os ite side and thi s p rov ided ancho rage i n the vert ica l pl ane. Location of the ce nter of resistance & determining the point of intrusive force a pplica tion: T he cen ter o f res istance of th e anteri o r segm ent was determined from the stand ard ized lateral ceph alogra m taken after ind ividu a l ca nine retracti o n .9).7).. After conso l ida ted firml y u si n g .0 10" sta inl ess stee l l iga ture th e intrusio n sp rings were inserted in th e a u xi l ia ry tu be wires and a pass ive stabi li z ing w ire segm e nt of . 7: M eas u r ing intru si ve force (30 g m s / side) The sm a ll di sta l fo rce appli ed u sin g th e e lastic c h ai n fro m the m ax ill ary m o lar hook to th e ante ri o r segm en t was a lso ca l ib rated.upoo the di sta o c e the sa m e a m o llDl of fo rce in~am s wasgmployed for the di sta l com po. Fo r retracting and intruding fl ared anter ior teeth .. f irst and seco n d m o lars were am o unt o f intrusive force b e in g appl ied (F ig. 5. a tota l co nnec t e d tr a n sve r se l y b y a sin g l e o r d o ubl e o f 6 0 g m s o f intru sive fo rce fo r th e fo ur m ax ill ary transpa l ata l arc h of . Th e d istance in m ill imeter between the 2 p o in ts were m eas ured usin g a ca l ib rated Vern ier Ca liper.ep-ending.th s ides after mild ly pre-stre tc hin&-J. D.he-eLasli. Th e am o unt of fo rce in eac h p osteri or segm e nt w hi c h offe red ad equ ate d e l ivered was m easured w ith a Co rrex gauge. Th i s red irecti o n o f the fo rce produ ces a cloc k wise m o m ent c rea ted around th e center o f resistance of the anteri o r segm ent an d results in retracti o n of the anterior teeth .o. premo lar.02 5" stainl ess steel were fro m 3 M Unitek was en gaged w i re w as pro j ectin g di sta ll y.

intru sion cepha logram to eva luate cep hal o m etri ca ll y the am o unt of intrusion that had been ac hi eved. post trea tment record s were taken . At th e end of th e phase of intru sion a nother latera l ce ph a l ogram was t ake n on th e sta nd a r dized cep h a l ostat a nd compare d t o th e pre.distal co mpone nt of th e force. Fig. 8 : Measuring dista nce between m ola r tube and distance between th e latera l in c isor a nd the ca nine was distal exten sio n of the ante rior segm e nt. The rate of intrusion was derived by dividing the m ea n amount of intrusion of the anteri or segm ent by the mean treatment Fig 10: M easuring sp ace u si ng V erni er Ca l iper time recorded in m ill imeter pe r m o nth . The am o unt of space present between the height of Conto ur of the distal surface of th e la tera l inc isor a nd th e m es ial surface of th e he ig h t of co ntour of th e ca n ine as m easured in millimeters u sing a ca librated Vernier Ca lipe r (Fig . force levels were eva luated at every visi t and the elastic c ha in rep laced o n occasions if th e force levels had decayed signifi ca n tl y. l 0 ). Any rec iprocal ex tru sion s of the posterior segment were a lso eva l uated b y comparing the p re and post intru sio n cepha lograms. 11 : Three pi ece intrusion arc h Assembled in place The patient was reca lied after every 4 weeks and the Fig. 9 : Corex gauge used to m eas ure force w hi c h the patient was reva l uated every 4 weeks. T he amount of spa ce present between the height of conto ur of the latera l incisor a nd the ca nin e was m easu red o n eve ry vis it using the ca librated Vernier Ca l ipe r. 43 . Treatment duration & treatme nt changes evaluati o n pro tocol : The mean trea tme nt duratio n was 6 month s during Fig. Me thods o f eva luating treatme nt c hanges: A total of five cep h alo m e tri c var i ab l es w hi c h represented th e trea tme nt c h anges were analyzed on pre a nd p os t trea tm e nt ceph alograms. m eas ured bilaterally u sing a Vernier Ca liper and the e l as t i c chain was c h a nged when re quired b y pre- stretc hing it fi rst to deliver the required force. The of the elastic c h ai n . At the en d of th e intrusio n and retraction ph ase.

PN S we re superimposed pa lata l pl ane. Lo ng axis of the m axi llary uppe r first m o lar Maxilla r y posterio r segment c hanges: U 6 VER = in m ill imeters represents th e p erpe ndi c ul ar Superimpositi o n t ec hniqu e distance between the m esiobu cca l cu sp tip of the upper Cephalometri c tracings were made o n pre and p os t first molar and th e p a latal plan e. M ax ill ary molar verti ca l m ovem ent . (palata l pl ane) and registered at ANS .U. Amount of incisor retraction 44 . Ma xi ll ary mol ar angu lar movem ent . ANG most pro m i ne nt cen tra l inci sor 4. VER = in millim eters represents th e pe rpendi c ul ar ANS T ip o f th e anter ior nasa l spine of the m axi lla d istan ce b etween th e in c i sa l ed ge of th e m ax ill ary PNS Tip o f th e posterior nasa l spin e o f the ma xi ll a cen tral inciso r and the pa lata l p la ne (X ax is). ANS . Ul . A IR . a ngu lar / IE T h e m os t in c isa l point on the c rown of the U . HOR 3. Fig. h o ri zontal / U . HI' Con struc ted hor i zonta l pl ane (iffl to S-N plane) to the perpe ndi c ul ar thro ug h nas io n to the co n stru c ted N.1 mm with a V erni er Ca lipe r. ANG = in degrees horizonta l plan e throug h Na si on rep resents the angle between th e lo ng axis o f the upper Long axis of the maxillary centra l in cisor centra l inc iso r and the pa lata l plane. 1.U b verti cal / IA Root apex of th e most promin ent m axi llary U. Ma x i ll a ry in c isor verti ca l movem en t U .. Th e position of Sta ti sti cal an al ys i s: the m ax ill ary molar was assessed to fin d o ut if intru sion an d retracti on of th e incisors a nd extru sion and an y 1 . U . VER c entral in c isor 5. a ngul ar / Mile M es iobu ccal c usp tip of ma x i ll ary first m o lar U fi ANG MBR Root apex of th e M esio bu cca l root o f the Maxillary anterior segm ent ch an ges: ma x ill ary first m ola r U . H O R N Nasion point = in mil l imeter represents the pe rpendi c ul ar distan c e b etween the incisal edges of the upper centra l in ciso rs. Pe r p e ndi c ular plan e to th e c ons tr u c t e d hori zon tal p lane (Na-) (Y axis). hori zo nta l and ver t ic a l m eas ure m en t was rn ad e to nea rest 0 . 2. 13 : Super imposi ti o n of th e pre & post Intru sion cep ha logram s on th e pa l ata l p la ne A ssessment o f treatment chan ges: All angul ar m eas urem ent ere m ad e to the nearest 0. 12 : Cep ha lo m et ri c landmarks U . U L. Ve rt ical / U . Th e followin g va ri abl es were m easured .Ut. M ax ill a r y in c i sor h o r izo nt a l mov e m e nt Fi g.5 11 . Ma x ill ary inci so r angular movem ent . Un ANG = represent s in tru sio n r e tr ac ti o n ce ph a lo g r a m s a nd we r e in degrees th e angl e fo rmed b y a line passing thro ug h supcrirnposed usin g positio n 3 of the Ri c kels 4 step the mesiobu ccal root apex of the first mol ar w ith the position anal ys i s7 . A ll Amount of anter ior intrusion di stal tipping of th e molars had occu rred. VER 2. U .

The d ata o btai ned were d e m onst rated in the tables and p lo tted was a nal yzed using descriptive statisti cs su c h as m ea n.38 7.2 1. Th e amount of tim e that occurred in the va ri ab le due to trea tment.2 0. 6 ± 11 9. r ' p 'value Rema rks Variable 1 29.095 mmlmonth .6 ± 4. The resu lt laken for space closure was a lso tabulated.14 mm/ m on th .752 mmlmonth.8 ± 5.6 .09°/month . Time t a ken for incisor intrusion a nd re tractio n . T 2-T1 .001 S 3. 5.97 ± 27. f ' p 'va lue Remarks Va ri able 4 1 25.56 Ta ble II A m o unt of i nc i sor r etraction (AIR) (millimet er s) Pre-treatmen t Post-trea tme nt D iffere nce ' t'va lu e d.3 ± 22 .3 ± 15.5 ± 6.96 Table III A m o unt of m o l a r ex trusi o n (AM E) (millimet ers) Pre-trea tment Post-trea tme nt Differen ce ' t'va l ue d.52 ± . The paired .9 S.00 1 S 6. The m ea n rate of a ngular c hange showing the di sta l crown tipping of max ill a ry first molar was .2 0. The mean rate of molar ext rusion was found to be . 12 Ta bl e IV D egree of i n ciso r ret ract ion (TI) (d egr ees) Pre-treatment Post-trea tment Difference ' t' value d.2 ± 94.3. r ' p ' va lue Remarks Variable 5 93. r 'p'va lue Remarks Variable 2 9. 1 9 < .36 9 < .5 ± 0.2 The m ea n rate mtrU Slo n In millimeters per month was 0. 1 6. TI Degree of i n cisal retraction as p a ired 't' lest.03 9 <0. f ' p 'va lue Rem ark s Va riable 3 2 1 .23°/ month 45 .14.4 ± .2 ± .4 ± -1.00 1 S 8.6 9 <0.4 9 <0.' lest at 5% leve l of signifi ca nce or The mentioned va riabl es were assessed (rom t h e 95 % co nfidence l imi t was used to m eas ure the c hanges ceph alo m e tri c m eas ure ments.7 4.1 7.9 3. TM D egree of molar dista l tipping RES ULTS: 6.001 HS 3..24 ± 27.001 HS 4. The average rate of ret raction (angula r) of ma xi ll a ry incisor measured in degrees was 1 . 1 7 ± 13. The data obtained were ana lyzed using the SPSS version X I.06 0. AME Amount of molar ext ru sio n standard devia ti on (S O ) and in ferential statistics such 4. in g raphs and were elicited below. Ta bl e I A m o unt o f incisor intrusio n (All) (M ea n valu e i n mill i m eter s) Pre-trea tm ent Post-t reatment Differen ce ' t'va lu e d.2 ± 1 1. The m ean rate of ret rac ti on was 0.7 Tab le V Degree of m o l ar di sta l c r own tipp ing (TM ) (d egrees) Pre-t reatment Post-trea tment Difference ' t'va lu e d.

thaI an o rthodo nti st has to overcome. No flari ng o f the teet h occurred in thi s study as the SUMMARY AND CONCLUSION: intrusion springs were no t engaged directl y into the Fro m the res ults o btai n ed in thi s study it was bra c ke t slo ts a nd a sing le po int o f fo rce appli ca ti o n concluded th at: was utili zed. a nd weak facia l m u scul ature the ca use of a m a loccl usio n is often a great c h all en ge th at could no t res ist the reacti o nary extru sive forces. The m ax imum a m o unt o f intru sion o f 3. The qu ality o f smil e Th e m ea n am o unt of extru sio n was . a m ea n va lu e of m ean va lu e of 2. intrusion m a ndibul ar pl ane ang le or a backwa rd rotati o n or th e mec hanics is idea ll y institu ted. The trea tme nt pro tocol fo rmul ated in thi s study for arch ext ract io n cases-the res idua l sp ace ca n be handl ed si multa neous intrusio n and retracti on was efficient and effective . The inclusio ns o f ca n ines bil atera ll y in to th e p os te rior seg m e nts h av e h e lp ed in reduci n g the Th e resu lt o f the present study is di scu ssed in terms of th e vario us pa ram eters i. The am o unt o f in cisor retracti o n (a ng ul ar as we ll addi ti o n of 1 5° of labi al ro ute to rque (Fin ishing a nd as linea r) wa s hi ghl y signifi ca nt stati sti ca ll y as well d eta iling of the occlusio n in th e MBT tec hn iques).DISCUSSION: Molar extrusion: Smi lin g is a soci al requirem e nt. m o lar ti p b ack a nd m o l ar extru sio n . Thi s a l so could h ave been study was 2 mm w h ich could b e attributed to presence minimi zed by th e u se o f a m o re ri g id sta inl ess steel of a reduced am o unt o f a lveo lar bo ne tro ug h in thi s stabili z ing w ire . The least va lue o bta ined in th is cl i ni ca ll y in signi fica nt. 2. Addi ng 15 ° -20 °p alata l route to rque to the upper 2. Th is achieved was considered h ighl y stati sti ca lly as well as va lu e w as co n side red stati sti ca ll y sig n i fi ca nt b ut is clini ca ll y sign ificant. Conseque ntl y. th e m ax ill a ry in cisors were intrude d to a o f the mol ars di sta ll y. Subsequ ent stu d ies m ay b e co ndu cted du e to the appli cat io n of the fo rce di sta l to the center w here compari son of the am o unt of intru sion ac hi eved of resi stance of the anteri o r segm ent a nd its redirecti o n w ith three pi ece intru sio n arc h a nd o th er m odified a lo ng the lo ng ax is of th e in cisors using a mi l d d ista l intrusi o n arc h es could b e m ad e.7 mm) seen in o ne pati e nt m ay be attr ibuted to her Deep bi te w hi c h is apt ly d esc ribed as a s ig n a nd no t verti ca l growth pattern. Whe n th e d eep But thi s amount o f extrusio n w as not large e no ugh to bil e is present in a pati ent w ith a verti ca l g ro wth p attern ca u se a ny clini ca ll y v i sible a m o un t o f inc rease in the with increased m ax illary inc isor di spl ay. Molar tip back: The rec iproca l co unte r cloc kw ise m o m ents generated In cisor intrusion: due to the intrusio n arc h normall y tend to tip the crowns In th is study.52 mm w h ich g rea tl y d e p e nd s o n th e a m o unt o f d is pl ay a nd tho ug h stati sti ca ll y sign ifi ca nt i s fo und to be cl in ica ll y protrusio n of m ax ill a ry incisor insignifi cant. Ske leta l a nc ho rage Incisor Retraction: d ev ices ca n be utili zed to reduce the reactio nary forces . In sing l e 1. m a ndible. In thi s stu d y. o n the poster ior segments were stati sti ca ll y sig n ificant. Th e amount o f in c isor intru sio n was stati st ica ll y as in c isors. In o ur study. inci sor intru sio n. Th e reason fo r ac hi eving suc h a mi sleading fi gures regarding th e net effect ive intru sio n Signifi ca nt am o unt of retracti o n in the stud y could be and retracti o n . Th e a m o unt o f intru sio n 1. Tho ug h the rec iproca l effects and d ue to th e low m agnitude o f forces u sed . force. any loss o f to rque o r t ipping of once th e lo ng ax is of the m ax ill ary inc isor was p ara ll e l th e in cisors. retra c tion. 46 . as clini ca ll y.2 degree. th e intru sive an d re trac ti ve clinica ll y signifi ca nt. 17mm w h ich was hi g hl y stati sti ca ll y as we ll as d e li very. palien!. b y:- 1. In a ll th e cases. wo uld h ave g i ven us to the facia l axis.e. thus minimizing th e counter cl oc kw ise moment th at tend s to fl are the anteri o r teeth .3 mm cou ld have been prod uced beca use o f the favorabl e In o ur stud y. incisor reci proca l effect of extru sio n o n th e bu cca l segm ents. In thi s stud y. if it did occ ur.73 mm . The m ax imum amo unt o f m o lar extru sio n (0.2 d egree m o lar t ip bac k was fo und to occur. we ll as cl ini call y hig hl y sig nifi ca nt. they w ere no t clini ca ll y sig nifi ca nt. retracti o n was terminated inciso r. th e average va lu e of retracti o n was Subseq uentl y they have been shown as uni ts for force 4 . we ac h ieved sign ifican t a m o unt s of amou nt of a lveo lar bone troug h ex isting in the p at ient intru si o n a nd retracti o n .. Str ip p ing and retracti o n o f the lower incisors w ith 3. p aram eters were assessed b ased o n the m ove m e nt of the incisa l edge of the m ax ill ary inciso rs rath er th an a Th e m ea n am o unt of angul ar retracti o n of incisors was m o re stabl e po int like th e centro id of th e m ax ill ary 6.

Th e m e.Po st Intr u s io n & Re tra c tio n 47 .} ll y i n sign i(it.1 eru p ted m. Case.1 plent y to an ortho don t ist.Intru sion & Re tra c ti o n Cephal o g r am .intru si o n & Re tra c ti o n Phot ogr a ph s r _ ~ . ~C _ · If .. h e n efit s . ..1 li sti c cx p ec I.1n c c .l te (I f i ntru sion was .. . PRE..l nt. s jg n i f i<':~l n t b u t <-li n icall y in signi iiLa nt. Ex tr<t c tion o f upp er first p re. ti c e oiter. • • .:l xi l l<t ry i n cisor"' .-L The . co" t eife<.]n r.e in tru " ion <)r( h for " i m u l l an eou s i n tru sion and re trac t ion of ma x il la ry i n c isors.. .:ll t' o f retra c t ion wa~ . ti ve }. rC. 1 Pre.:. th e in tegra tion o f w h ic h " ign i ii cill1t bu t cli n ic.' I . - Intra O ra l Ph o togr a phs a t th e time of Initia l Pl a c e m e nt O f Thr ee Pi e c e Intrusi o n A r c h ...1H stiL. i nt o th e ro ut in e u r th o d o nti c pr<l<. T he b eg in ner w il l k n ow the 6.SI11Ill / ll1onl h .} r ext ru sio n Wo"l S st.4 _ . Thl' three p iec e in tru sio n a rch is .l n r.l l1 y 7. T he .l sim p lc.1ck was sta tisti c il l l)..I : EXTRA ORAL.1 tiun s o f thi s ap p l i<tn <. Intra O r a l Ph o togr a ph s Po st Intru s ion & Re tra c tion Ex t r a O r a l Ph o togra ph s... 7S mlll / monl h.-~ - • . Fro nt a l V i ew La te ral Vi ew Pre..l u sion wi th supr.·.lver<tge grow th p"ttern a nd A n gle's Cla ss II D ivi sion I malou. c from t hi ~ stu d y.m o lars wa s (ollowed b y th e u st' o f th ree p ic(.11ll()llllt of lll o l ~lr d i s t ~l l ti p h..mel ti m e sav i ng <1 p pl i.INTRUS ION & RETRAC TION PHOTO G RAPH S Pati en t A p resent ed w it h a C la ss I I ske le ta l ba se .. '" . an . . T h e Ille.11ll0 un t 0 1 lllol.

...LlI .t (.1 Photographs ...1 .> .d....IL It IiOIlOI tht· upper 111''''' prt·1l11.Ind It'lidt tit II) 1)1 ILI. kl'lt.-l I Ihe lime of Initial Placement of Thr('c Piec e Intru sio n Ar<h ~. ...l. I ...lIH'tlll'" rn lnr <"'illl ..lf H·ldlulll IlVt .111e1. 01'.~ Intra oral photogra ph s ~ Po s t .II: EXTRA ORAL PRE.. .l .lon . .. II d l\.l1I-. ~ . l'IlI I . \V. 11I"'IlJll . .. ..IILlr\ 1111 I "()[-. r.1\\.UPI. IIl l ru-..INTRUSION AND RETRACTION PHOTOGRAPH S 1'..-111 I~ Plt·"I'llh·d \\ 1111 .hl· .ll1t'rl1 !l..lntru3ion & Retrus ion Ce phalog ram .. fronta l View lateral View Prc.1.) ... hul pn'-'l'nling \\l lh (1.".lIlg 1111' 1111"('(' pit..In h .II\ 11111'011'" u-..1.wing l\ngJl" ". . null.....l .." 111 nll ..111>.intrusion & Ret rac tion Pho tographs Inlra Or . to!lo\v(·d h .I I grow t h p. • )QC)c.II'IUpIl'd rll....... -~ - Pre. .\ mild <...Jlllh .Illtl -...hllll1 Il. ..11:..·S . { 1..intru s ion anel retraction Ex tra Ora l l) h()tograph s~ Po s t Intrusion & Retraction .. . .7 .. .. IIl~~ 1. . II ... ~ 1 nlol... ~ ~ •..l v('flit .. Case....-. "- .III.

Connectic ut..Post-Intrus ion a nd Re tractio n Extra Ora l Photographs . Intra O ra l Pre· intrusion & Retrac tion Ph otographs .M .M . "" '''#'~' ''' .. Ric h ard P M c laughlin. Burstone c. Semin Orthod 2001. Burstone c.. D . Burston e c.M. . D Co nt empo rary c ha nges from n atural g ro w th . Bursl o n e c. .: Biomec h anics o f d eep overbite correction. Benne tt . D .J. ---=- Intra O ra l Pho to graphs at th e time o f Initia l Placem e nt o f Three Piece Intrus io n Arc h ".: l ocat ion of the centers of resistance for anterior teeth force system s: A prospecti ve analysis of the treatment effects during retra c tio n u sing the laser re fl ection technique. 49 . Fro nta l Vie w Lateral Vie w Pre..J. Journa l of clini c orthodon tics Orthodontics.: A fou r-step m e thod to distingui sh ort hodo nti c 3. Am J of Ortho donti cs intru sion a rc h es. Non -extraction therapy was fo l lowed util i z ing three p iece intru sio n arch fo r simu ltaneous intrusion and retra c tion of m ax ill a ry incisors. 7:26-33.:.Intrusion & Re traction Cephalogra m >li: e ~ \ . Hugo J Trevisi ba se a rc h . 208-228..T .Post-Intrus ion and Re traction BIBLIOG RAPHY : 5. 1. . 3. Jo hn C. 4. Wi ll iam R.). Systemized O rthodonti c Treatment Mec hani cs. 't . Shroff S. 1 -77 7. Pg.120.. Dermaut 2. J.erupted m ax illary incisors. ~ '~I ~ -~~ . L. Th es i s. Faber Z. . . 36(2):99. Sa chdeva R.326-361 . Prof it . Angl e Orthod 1997..V.: The re la tio n ship o f tooth m ovement to mea sured loR . Simultaneou s i ntrusion and re traction using a three-piece 8. spac ing in the anterior region and supra . 6. l. Yoon W ...INTRUSION AND RETRACTION PHOTOGRAPHS Patient C presente d w ith class I ske leta l bases with a n average g rowth patte rn a nd h ad class I molar re lat io n. 1975. -- Intra Ora l Pho togra phs . Ph .. . Bulcke M .C. Ric ketts R. Linda urer 5. Case-III: EXTRA ORAL PRE..67(6):455-462. 9 1 : 375-84. University o f Orth o d Dento facial Orthop 1987. . : M ec h ani cs of segm ented arch tec hniqu e.S. Angle Orthod 1966.<1 Edition.

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