3 indications for using lower fixed retainer

1) Maintenance of lower incisor position

2) Maintain diastema
3) Maintain pontic space

Name 2 active retainers

1) Spring-retainer (Clipon, Spring-retainer Hawley, Hawley with active labial

bow).
2) Modified functional retainer for a relapsed Class II condition.

Midline shift to right – right class III, left class II how do you correct?

Right side: class III elastics – 43 to 16

Left side: class II elastics – 23 to 36

Inclination of brackets relative to tooth for incisors and canines

Degrees Maxillary 8,8,4,4,8,8 Mandibular 3,0,0,0,0,3

3 indications for retention according to Profit (why ortho can be unstable)

1) Gingival and periodontal tissues are affected by orthodontic tooth movement and
require time for reorganization when the appliances are removed.

2) Changes produced by growth may alter the orthodontic treatment result.

3) Teeth may be inherently in an unstable position after treatment so the soft tissue
(lip pressure, tongue pressure, swallowing patterns, etc.) is constantly producing
relapse tendencies.

6 keys to occlusion

1) molar relationship
2) crown tip
3) crown torque
4) no rotations
5) tight proximal contacts
6) shallow or flat occlusal plane
 Removable Fixed
Rotations No Yes
Tipping Yes Yes
Torque No Yes
Fitting Quick Slower
Oral Hygiene Easy to clean Difficult to clean
Adjustment Quick Slower
Repairs/Convenience Difficult Simple
Patient Compliance Poor Good
Cost Inexpensive Expensive

Six stages of orthodontic treatment

1) anchorage control
2) levelling and aligning
3) overbite control
4) overjet reduction
5) space closure
6) finishing and detailing

List 5 ways of correcting deepbite

1) extrusion of the posterior teeth

2) uprighting of posterior teeth
3) increasing of the inclination of incisors
4) intrusion of anterior teeth
5) combination of above

3 problems you want to solve in leveling and alignment

1) Crossbite correction
2) Impacted or unerupted teeth
3) Diastema closure

Class II patient you decide to extract upper 4’s and lower 5’s. What anchorage is
needed in both arches

Maxillary arch – Maximum anchorage (retrocline incisors/hold molars)

Mandibular arch – Minimum anchorage (move molar forward)

Anchorage gain vs Anchorage loss

Anchorage loss - the situation where molars move forward in a sagittal plane.

Anchorage gain - describes the backward movement of incisors

Sliding vs Frictionless mechanics – which uses less force?

Frictionless system - we use a closing loop in both the .022 and .018 slots. The loop
should be fail safe. The ideal loop design therefore would produce a continuous, control
force designed to produce tooth movement at a rate of 1mm per month, but would not
include more than 2mm of range.

Sliding system - sliding the teeth along the arch wire to close the space. The most
effective method for space closure in sliding mechanics is to use a .019X.025 working
arch wire.

 Frictionless system uses less force

3 factors determining the speed and extent of tooth movement during sliding
mechanics
a) force applied
b) thickness of the arch
c) frictional resistance - a) sliding - b) binding

5 Inhibitors for sliding mechanics

1) Damaged brackets
2) Tissue factors (extraction sites)
3) Improper placement/alignment of brackets
4) Friction (first, second, third order)
5) Hard tissue interference (retained roots, ankylosis, bone sclerosis)

Finishing and detailing incorporates the following:

1) root paralleling at extraction sites
2) torque of incisors
3) correction of vertical relationships
4) midline discrepancies
5) tooth size discrepancies
6) "final settling" of teeth

2 rules of final settling and finishing

1) Elastics and headgear should be discontinued at least 4-8 weeks before deband, to
allow for rebound.
2) Teeth should be brought into a solid occlusal occlusal relationship without heavy
archwires present.

Define retention and relapse

Retention is maintaining newly moved teeth in position long enough to aid in
stabilizing their correction.

Relapse is a term applied to the loss of any correction achieved by ortho tx.
2 causes of relapse are:
1) the continued growth by a patient in an unfavourable pattern
2) tissue rebounds after the release of orthodontic force

When using the Edgewise appliance two factors are critical in torque of incisors:
1) inclination of the bracket slot relative to the arch wire
2) tightness of fit between the arch wire and the bracket

Heavy force/long duration Hours-days = cellular necrosis within bone (hyalinised) –

acellular layer - Undermining resorption

Tipping = 50-75g
Translation = 100-150g
Rotation = 50-100g
Extrusion = 50g
Intrusion = 15-25g

Ideal = light continuous force (fixed appliances)

Intermittent = force decays between adjustments (removable appliance springs)
Interrupted = Force only present when appliance worn (headgear) – optimal 14-16
hours/day – 450g/side for distal movement

Pulp – transient inflammatory response (can cause loss of vitality)

Root – some root resorption occurs usually repaired by cementum (loose 1-2mm of root
length)
Bone – loose ½-1mm of alveolar crest

Thinner and longer wires produce more deflection and lighter forces and work longer
periods before the force is exhausted extending the time necessary between
appointments

Thinner wires are more prone to damage by occlusal forces

Wire length can be increased by adding loops to the wire

Ideal wire – high strength, low stiffness, high range, high formability, weldable or
solderable, reasonable in cost

SS – rust resistance, weldable, good formability, high stiffness, low range

Multi strand wires – low stiffness, high range, poor formability, poor shape memory
NiTi – shape memory, super elasticity, high range, constant force, low stiffness, poor
formability, non-weldable