Professional Documents
Culture Documents
Bioprogressive Therapy
OUTLINE
About Dr. Ricketts
The Bioprogressive philosophy
Evolution of the Bioprogressive therapy
10 Principles of Bio-Progressive Therapy
Different type of Bracket design & Buccal tube used in
Bioprogressive Therapy
o Brackets with rotation arm
o Siamese type or dual bracket
o Some other variations in bracket design
o Factors in Molar tube & Auxiliary design
Mechanics
o Utility arch- Evolution, fabrication and its uses
Sectional arch treatment
Sequence of mechanics:
o Stabilization of upper and lower molar anchorage
Retraction and uprighting of cuspids with sectional arch
mechanics
o Retraction and consolidation of upper and lower incisors
o Continuous arches for details of ideal and finishing occlusion
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Bioprogressive Therapy
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Bioprogressive Therapy
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Bioprogressive Therapy
Utilizing the growth studies of Bjork, Moss, Scott, Petrovic and others
to develop a computer generated method of predicting growth (Long
Range Forecasting);
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Bioprogressive Therapy
Bioprogressive Philosophy11:
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Bioprogressive Therapy
Mission – To treat the total face rather than the narrower objective of
teeth or the occlusion.
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Bioprogressive Therapy
2. The tongue interacts with the lips in all functions such as mastication,
speech, and deglutition and even in tonicity at physiological rest.
3. Lip and tongue function is read from the cephalometric X- ray film.
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Bioprogressive Therapy
to the chin (E- line), the lower lip is closer to the line than the upper, the lips
are smooth in contour and the mouth is closed with no strain.
The use of round wires in the leveling stage in cases with deep bite led
to protrusive dentitions.
Even in some cases where extractions were carried out for lower
incisor stability, imbrication developed post treatment.
To avoid these problems, some modifications were made in the full banded
edgewise technique:
2. The use of complicated second order bends were not used in the
treatment of Class II malocclusion. Straight arches with sliding hooks
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Bioprogressive Therapy
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Bioprogressive Therapy
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Bioprogressive Therapy
To plan properly for the change that will occur, the clinician must
understand the present condition, anticipate growth and know the
specific effect of his orthodontic- orthopedic treatment.
For this purpose the VTO is like a blueprint or design of the final
results. Thus VTO allows the clinician to evaluate the inter
relationship of the various changing parts as they affect each other in
the proposed adjustment………
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Bioprogressive Therapy
We must consider the inter- relationships, first with the chin and its
effect upon the maxilla, then their combined effect on the lower molar, then
the effect of lower molar change on the upper molar, upper incisor and the
soft tissue profile.
The above seven areas of evaluation are used to determine the major
moves needed to accomplish the forecast objectives and to design treatment
with a priority sequence for quality results and maximum efficiency.
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Bioprogressive Therapy
The edgewise bracket slot - .018" x .030" is used in order to keep the
bracket and wire size smaller, but still have torque control available through
the various stages of treatment.
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Bioprogressive Therapy
Muscular Anchorage
It was seen that those facial types, which exhibit stronger musculature,
are characterized by deep bite, lower mandibular plane angle and
brachyfacial structure. While those which exhibit weak musculature are
characterized by high mandibular plane angle, vertical growth pattern, open
bite and dolichofacial structure.
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Bioprogressive Therapy
Teeth move slowly through the cortical bone due to more dense and
laminated pattern and limited blood supply. Tooth movement is further
delayed when excess force against the cortical bone can press off the blood
supply and thus limit physiologic tooth movement.
The key factor to the rate at which tooth movement will occur, is the
blood supply that sustains the physiological action that takes place within
the bone itself. The force that is too heavy causes ischemia and tooth
movement is delayed. Any appliance that delivers light continuous force is
the most effective for optimum tooth movement.
0.016" X 0.016" chrome alloy arch wires have been found to apply
light continuous forces required. Thus bio- progressive therapy is designed
to respect the supporting bony structure and size of the roots of individual
teeth.
5) Orthopedic Alteration
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Bioprogressive Therapy
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Bioprogressive Therapy
It reduces the binding and friction of brackets as they slide along the
archwire.
8) Concept of Overtreatment
For example,
For example,
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Bioprogressive Therapy
For example,
In class II cases the rebound effect, which closes the bite and
rotates the chin forward will help in class II correction and therefore it
is beneficial.
For example,
For example,
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Bioprogressive Therapy
One must pay attention to the fine details that are necessary to render
service of the highest quality.
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Bioprogressive Therapy
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Bioprogressive Therapy
Advantages:
Advantages:
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Bioprogressive Therapy
Distributes force.
Dr.Cecil Steiner and Dr. Lang suggested 0.016" x 0.016" slot, which
was later, changed to 0.019" x 0.025" slot.
Dr. Ivan Lee used torque slot, to get rid of Third order bends.
Dr. Reed used bracket angulations to reduce need for second order
bends.
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Bioprogressive Therapy
c) Softer material:
the wings
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Bioprogressive Therapy
The upper molar band should be driven down to the distal marginal
ridge.
Buccal extension of the distal aspect of the tube with a 120 rotation.
50 tip.
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Bioprogressive Therapy
MECHANICS
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Bioprogressive Therapy
But as the Curve of Spee in the round arches expressed itself, the roots
of lower incisors were thrown against the dense lingual cortical bone,
which acted as an anchor leading to the same forward movement of
the incisors, and forward movement of the lower molars.
When even the smallest continuous round arches are tied into place
for leveling, an expansive movement is placed on the buccal segment
teeth which tips them up and out to unfavourable axial inclinations.
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Bioprogressive Therapy
The lower incisors, often brought forward during the leveling must
be roundtripped in their retractive movement.
Round arch segments were laced from the lower molars and bicuspids
to the lower incisors as the cuspids were retracted.
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Bioprogressive Therapy
Due to the fact that dense cortical bone supports the lower molar on
the buccal and the relative position of the erupted or erupting lower
second molar, a tip-back applied singularly to the lower molars will
upright these teeth bringing their roots mesially (the lower molar will
tip around a center of resistance near the top of its mesial root) and the
crown distally.
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Bioprogressive Therapy
Buccal root torque is required to position the roots against the buccal
cortical plate for anchorage enhancement.
When a 45° buccal root torque is placed on the distal legs of the utility
arch, the amount of movement of the root to the buccal is
proportionate to the amount of movement of the crown to the lingual.
The only way that buccal root torque can be expressed by buccal
movement of the root and stabilization of the crown is by expansion
of the arch.
Both for enhancing the cortical bone support to the lower molar
(anchorage), and for regulating or allowing normal arch width, it is
important that the distal legs of the utility arch be generously
expanded prior to placement in the mouth.
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Bioprogressive Therapy
Along with the intrusion of the lower incisors, there is a labial tipping
which occurs.
In most cases, a slight labial root torque (5° to 10°) will free the apex
of the lower incisor teeth from the lingual cortical plate and allow its
intrusion without labial flaring.
The mandibular utility arch is best fabricated from .016 ´x .016 Blue
Elgiloy wire in order to create a lever system that will deliver a
continuous force to the lower incisors in the range of 50 to 75 grams.
The arch is stepped down at the molar, lies in the buccal vestibule, and
is stepped back up at the incisors to avoid interference from the forces
of occlusion that would distort it.
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Bioprogressive Therapy
1) Step Height
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Bioprogressive Therapy
The vertical step height in the lower utility arch is from 3mm to 5mm.
The only function of the vertical step is to bring the malleable .016 ´ x
.016 Blue Elgiloy wire out of the occlusion to avoid deformation with
functional movements.
The wire is bent back up at the mark made distal to the lower lateral
incisor bracket and, at this point, , rather than being bent straight
down and maintained in the same plane of space the wire is bent at a
slight inward angle (in the same direction as the curvature of the
mouth).
When the wire is bent gently inward 10° to 15°, labial root torque is
being applied to the anterior portion of the utility arch. Holding the
wire at the anterior vertical step, the anterior arch form is then
contoured by sweeping the anterior portion of the arch between the
forefinger and the thumb.
The left side of the utility arch, having been completed, is laced over
the lower incisors and a mark made 2mm to 3mm distal to the
opposite lateral incisor bracket.
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Bioprogressive Therapy
Again, a 3mm to 5mm step is made on the right side of the arch.
By measuring the span on the right side, either in the mouth or from
the previously measured left side, the last vertical step is made at the
mesial of the opposite side first molar.
The buccal bridges are then gently contoured with the fingers or with
a contouring plier, to account for the gentle curvature of the arch
along the buccal segment where the utility arch will lie.
The anterior (torqued) segment of the utility arch is then held with a
How plier and the buccal bridges flared to the buccal.
This will allow the buccal portion of the utility arch to avoid tissue
impingement as the anterior portion of the arch moves gingivally and
will also start to place some of the buccal root torque at the lower
molars.
At the same time, holding the anterior vertical leg of the utility arch,
the buccal bridges are generously expanded to assure that a buccal
root movement will be applied to the lower molars, rather than a
lingual crown movement.
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Bioprogressive Therapy
Proper activations in the distal legs of the utility arch are placed in
order to maintain torque control, to begin to align the lower incisors,
and to upright the lower molars.
Care should be taken to make sure the proper amount of torque has
been placed as well as buccal flaring of the bridge and the vertical
steps to avoid tissue impingement.
The activation to intrude the lower incisors and upright the lower
molars (tip-back) is placed by holding the posterior vertical step with
the How plier at its last bend. The posterior legs are then tipped back
approximately 45° and are symmetrically aligned parallel to each
other.
When the lower molar is uprighted, it will also rotate distally, so that
placement of a distal rotation bend in the nonextraction utility arch
will quite often overrotate the lower first molar. This is very
individual, however, and is dictated by the needs of each particular
case.
The anterior arch form is tightly contoured to the lower incisor teeth.
This will allow the lower incisors, especially the lower lateral incisors,
to intrude without advancing their crowns (thereby throwing the roots
into the lingual planum alveolare and preventing easy intrusion).
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Bioprogressive Therapy
anchorage (by virtue of the reverse torque) and allow the lower incisor
roots to avoid the cortical bone at their apices.
The buccal bridges are flared to avoid tissue impingement and are
expanded liberally in order to avoid lingual crown movement of the
lower molars.
The posterior legs are parallel to each other, and 45° buccal root
torque has been placed to maintain the buccal cortical support in the
lower molar region.
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Bioprogressive Therapy
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Bioprogressive Therapy
5) Overtreatment
7) Arch length control: Increase in arch length can be brought about by:
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Bioprogressive Therapy
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Bioprogressive Therapy
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Bioprogressive Therapy
The modification to the Nance lingual arch, with the plastic button
against the rugae region of the palate, is the addition of a distal loop
on the mesial lingual of the upper molar bands, which allows the
molar teeth to be expanded and rotated more easily.
o The third value is the distal rotation of the molar crowns for
final positioning in the finishing occlusion. The finishing
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Bioprogressive Therapy
Moderate upper molar anchorage may not need to hold the upper molar
completely stable, but will allow it to be advanced forward up to half of the
extraction space during the treatment procedure.
A distal looped lingual arch or a palatal bar without the plastic button
support will stabilize the molar and give moderate anchorage support.
Minimum upper molar anchorage may occur in a case in which the upper
molar needs to be advanced the whole distance of the extraction space or
even more.
Class III extraction treatment usually calls for upper second bicuspid
extraction with advancement of the upper molar. Since upper molar
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Bioprogressive Therapy
A vertical closing loop or double delta loop will assist in its forward
closure.
Thus, the moderate anchorage concepts are used in the strong muscle
patterns and the more maximum anchorage concepts in the vertical
pattern where the musculature gives least support.
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Bioprogressive Therapy
o Buccal root torque that places the roots against the cortical
support to limit their movement. Up to 45° of buccal root
torque is placed in .016x .016 Elgiloy wire.
Moderate lower molar anchorage modifies the lower utility arch mechanics
to allow the molar to come forward during cuspid and incisor retraction.
A contraction utility arch stepped ahead of the molar tube modifies the
four components of molar anchorage and utilizes the incisor retraction
force to advance the molar.
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Bioprogressive Therapy
Round wire in the molar tube may be used to eliminate the binding
and torquing to the molar and thereby reduce the anchorage.
Elastic string adds the continuous force needed when advancing the
lower molar.
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Bioprogressive Therapy
In the lower arch, the planum alveolare on the lingual supports the
cuspid.
In the upper arch, the cortical bone on the lingual palatal surface of
the alveolar process supports the cuspid lingually.
Severe tipping of the cuspids which allows the root tip to move
forward will complicate its retraction. The cuspids need to be kept in
the narrow trough of trabecular bone and avoid the severe tipping or
displacement into the cortical bone.
Extreme 90° gable and 90° offset antirotation bends are placed before
the springs are placed and activated for the cuspid retraction.
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Bioprogressive Therapy
Tipping may occur when the retraction forces have been too high, in
excess of 150 grams.
While the cuspids are being retracted with sectional retraction springs,
the upper and lower incisors can be aligned and either intruded or
extruded for better overbite control before their retraction.
Upper and lower utility arches which span from the gingival tube of a
double tube on the molar to the incisors are effective in producing the
light continuous forces for incisor intrusion and alignment.
In the cases where the treatment objective shows little need for incisor
intrusion, the utility arch would require very little tipback bend, but
can still be stopped against the molar tube with the other three
activations for molar anchorage.
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Bioprogressive Therapy
Lower Incisor:
Lower incisor retraction must respect the cortical bony support on the
lingual planum alveolare as the teeth are being retracted.
Heavy forces will anchor the roots against movement and produce
tipping and extrusion of the incisors. The contraction utility is used in
lower incisor retraction. Its construction and activation allow light
activation forces and limited extrusion because of the molar tipback
loop.
Upper Incisor:
The torque is applied through the long lever arm and loop on the
utility arch from the molar.
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Bioprogressive Therapy
Ideal and finishing arch mechanics are consistent with the basic
principles of occlusion.
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Bioprogressive Therapy
Mandibular Arch
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Bioprogressive Therapy
Maxillary Arch
6. Upper cuspid brought into contact with lower cuspid and premolar to
establish cuspid rise.
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Bioprogressive Therapy
The upper laterals, all cuspids, and the lower molars have also had
angulation or tip placed in the brackets.
This setup, along with the offsets and torque placed in the archwire,
was designed to accomplish the objectives of overtreated orthodontic
occlusion.
The torque that is placed in the archwire also gives the added control
that is required during the various basic treatment movements before
the final continuous arches and finishing details are considered.
Rotation was also placed in the lower first and second molars of the
Full Torque Bioprogressive appliance.
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Bioprogressive Therapy
With the Triple Control appliance, the finishing archwire does not
require the offsets or torque, since they are now built into the
appliance.
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Bioprogressive Therapy
Angulation Inclination
Tooth
( Tip ) ( Torque )
Maxillary
Canine 50 70
First premolar 00 00
Second premolar 00 00
First molar 00 00
Second molar 00 00
Mandibular
Central incisor 00 00
Lateral incisor 00 00
Canine 50 70
First premolar 00 00
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