Professional Documents
Culture Documents
2000 - Optimization of Orthodontic Elastics - Langlade
2000 - Optimization of Orthodontic Elastics - Langlade
D. C. D. - D. S. O. - D. U. O.
OPTIMIZATION of
orthodontic ELASTICS
OPTIMIZATION of
orthodontic ELASTICS
January 2000
From the same author:
CEPHALOMETRIE ORTHODONTIQUE
Préface Carl F. GUGINO
281 Pages - 202 Photos - 1978.
DIAGNOSTIC ORTHODONTIQUE
Préface Ruel W. BENCH
768 Pages - 552 Photos - 1981.
THERAPEUTIQUE ORTHODONTIQUE
Préface Robert M. RICKETTS
3rd Edition - 1986
OPTIMISATION TRANSVERSALE
DES OCCLUSIONS CROISEES UNILATERALES POSTERIEURE
Préface Rudolf SLAVICEK
384 Pages - 349 Photos - 1996
CHAPTER I: Definitions.............................................................. p1
• Definitions
• Presentation of orthodontic elastics
• Elastics force use
CONCLUSION............................................................................ p 178
BIBLIOGRAPHY........................................................................ p 180
CHAPITER I
Definitions
CHAPTER I: Definitions
DEFINITIONS
• ELASTICITY:
• ELASTIC MATERIAL:
• LIMIT OF ELASTICITY:
When an elastic force is applied to two identical solids ( for instance two central incisors ) the
moving force is identical and reciprocal.
• ELASTOMERS
General term encompassing materials returning to their original dimensions immediately after
substantial distorsion. Under this term are:
1
CHAPTER I: Definitions
For a long time rubber elastics have been offered to the Orthodontic community in:
- different sizes
- different shape forces giving a precise applied force.
They are presented in a plastic bag decorated with various symbols to help patients
recognize which elastic was received for the last prescription.
All elastics are sold in packages of 100 with a rapid zip and forces are indicated with:
Some Ortho manufacturers have even proposed mint flavoured elastics in order to improve
patient compliance in elastic wear.
To check the elastic forces, the orthodontist can use CORREX or DONTRIX gauges ( see
Fig I.3 ).
ADVANTAGE OF ELASTICS:
DISADVANTAGE OF ELASTICS:
2
CHAPTER I: Definitions
➩ dental plaque
➩ time
➩ foods and drinks.
• moisture absorption makes the elastic swollen and odoriferous.
• non odor free when worn after 24 hours.
• unpredictably variable forces exerted if the prescription is not well explained and
controlled.
• the exerted force is not constant and depends on patient compliance
• elastics can be placed incorrectly, upsetting biomechanic effects of the appliance.
• patient motivation.
The more the rubber elastic is worn, the less the elasticity memory stays, as E. HIXON 4 et. al.
have demonstrated ( see Fig I.2 ).
It means that in clinical uses, elastics must be changed regularly according to the orthodonti-
st’s prescription.
Fig I.2: Percentage of elastic force lost in mouth from E. HIXON 5 et. al.
A. J. O. Vol 57 N° 5. p 481 1970.
3
CHAPTER I: Definitions
1 - Friction
2 - Anterior torque
3 - Poor canine root control
4 - Excessive pressure
5 - Cooperation
Fig I.3: To check the elastic forces the Orthodontist can use CORREX or DONTRIX gauges.
4
CHAPITER II
The first known elastic was the natual rubber used by INCAN and MAYAN civilizations
extracted from Hevea trees.
☛ 1803: F. CELLIER introduced for the first time the “ Chin Cup Fround ” with
rubber bandages.
☛ 1892: Calvin CASE was the first to use intermaxillary elastic forces to cor-
rect malocclusions.
☛ 1948: Charles TWEED initiated the Class III elastic use to reinforce the
anchorage preparation of Class II malocclusion before using Class II
elastics.
☛ 1958: Fred SHUDY recommended short Class II elastics coming from the
upper first molar and in association with a high pull anterior extraoral
force in order to control the vertical sense.
5
CHAPTER II: History of Elastics Forces
☛ 1965: R. BEGG in his book “ Begg orthodontic theory and technique ” used
Class II elastics which were changed every five days.
6
Elastomers
Intraoral Elastics
Only pure, natural latex is used in producing GAC elastics. Precise wall thickness and predictable forces
are consistent characteristics of our full line of elastics. Our Travel Pack recognition system makes it fun
and easy for patients to remember the correct size and force. In addition to size and force designation,
each smudge-proof bag has a landmark, symbol, or activity associated with a specific country. Each pack of
GAC intraoral elastics contains a bright white placer to help patients properly and easily use their elastics.
INTRAORAL EXTRAORAL
Inside Light Medium Heavy Super Heavy XH XXH
Diameter Red /1.8oz Green/2.7oz Blue/4oz Black/6oz Brown/6oz Black/8oz
3mm 11-100-03 11-101-03 11-102-03
(1/8Ó) Australia Germany India
4mm 11-100-04 11-101-04 11-102-04 11-103-04 11-105-04
(3/16Ó) Holland Mexico Switzerland Thailand Africa
6mm 11-100-06 11-101-06 11-102-06 11-103-06 11-105-06
(1/4Ó) China USA Japan Korea Kenya
8mm 11-100-08 11-101-08 11-102-08 11-103-08 11-104-08 11-105-08
(5/16Ó) Canada Italy Scandinavia So. America Greece Argentina
10mm 11-100-10 11-101-10 11-102-10 11-104-10 11-105-10
(3/8Ó) England Spain France Greece Peru
12mm 11-104-12
(1/2Ó) Greece
14mm 11-104-14
(9/16Ó) Greece
16mm 11-100-16 11-104-16
(5/8Ó) Ireland Greece
18mm 11-104-18
(11/16Ó) Greece
Light, Medium, Heavy, and SH are packaged in boxes of 50 zip lock bags of 100 elastics. XH and XXH are
packaged in boxes of 25 zip lock bags of 50 elastics.
Class I
• Space closure
Monomaxillary Contraction
• Distal movement
• Mesial movement
• horizontal NO
• Tipping
• vertical
• Extrusion
• transversal
• Intrusion
Monomandibular
→
Regular Extrusion Class II Class II skeletal open bite
→ Mesial mandible
Class II Close the bite Class II Class II deep bite
CHAPTER III: Classification of Orthodontic Elastic Forces
ELASTIC ELASTIC MOVEMENT COUNTER
INDICATION
DISPOSITION CLASSIFICATION FORCE INDICATION
Dental and
Class III → Mesial max Class II and
Skeletal
→ Distal mandible
Class III
→
Extrusion Ø
Regular Skeletal open bite
( normal vertically )
→ Mesial max
8
→
Class III Extrusion Class III Skeletal open bite
→ Distal mandible
Class III Close the bite Class III deep bite
ELASTIC ELASTIC MOVEMENT COUNTER
INDICATION
DISPOSITION CLASSIFICATION FORCE INDICATION
Class II
Oblique pull Midline correction Skeletal
and
Diagonal
Triangular
of one side midline shift
CHAPTER III: Classification of Orthodontic Elastic Forces
ELASTIC ELASTIC MOVEMENT COUNTER
INDICATION
DISPOSITION CLASSIFICATION FORCE INDICATION
→
→
Class II Extrusion Class II
10
Deep bite
Contraction
Anterior Dental
Open bite
Delta Vertical
+ Open bite
elastic extrusion
light contraction
Vertical extrusion
W and M Extrusive Skeletal
to
Open bite
Contraction
Accordion Skeletal
++++
with
Extrusion
elastic open bite
++++
spaces to close
Skeletal
open bite
→
→
→
Class III Extrusion Class III
Controlateral
Horizontal transversal Degree 2 to 3 Skeletal
force
cross bite + + + +
O shape Tranversal
ectopic tooth
CLINICAL STATEMENT
A / TRANSVERSAL:
B / VERTICAL:
3SD 2SD 1SD 3SD 2SD 1SD
Class : Deep bite Normal Open bite
Skeletal
Dental
C / SAGITTAL:
FORCE DELIVERY
Force application plays a strategic influence on orthodontic movement by means of
wires and elastic rubber bands.
Histologicaly optimum orthodontic movement had been related to an intact vascular supply.
An optimum force should not exceed the capillary blood pressure ( 20 to 25 gm/cm2 ).
If forces are above this level, clinical observations demonstrate possible ligament strangula-
tion and sometimes root resorption.
Many authors had concluded that one of the major factors, if not the principal, gover-
ning bone resorption during tooth movement is the presence of an intact vascular system.
Z. DAVIDOVITCH 3 had proposed intermittent forces as more suitable because their duration
would not be sufficient to produce anoxic destruction of the ligament.
According to this author, osteoclasts, which were stimulated to function by the force applica-
tion, would continue to resorb bone for a brief period of time mobilizing the necessary bone
removing cells.
Sunburstª Elastics
GACÕs Sunburst Elastics are made from the finest quality
latex. They are clean-cut, durable, hygienic, and made with
regulation coloring. Available in a wide range of sizes and
force values, Sunburst provides the precise degree of
required control with a continuous force. Like our regular intra-
oral elastics, Sunburst is packaged with a bright white placer
in each bag for easier use and greater patient cooperation.
Colors are randomly assorted and are not available in specific
colors. Sold in boxes of 50 zip bags, 100 elastics per bag.
Catalog Number
Description 3/16" 1/4" 5/16"
2.7 oz. 11-001-04 11-001-06 11-001-08
4.0 oz. 11-002-04 11-002-06 11-002-08
6.0 oz. 11-003-04 11-003-06 11-003-08
Elastics Racks
Our aluminum anodized elastics rack is durable, light weight,
and has holes for mounting on a wall. Holds four boxes of GAC
elastics.
15
CHAPTER III: Classification of Orthodontic Elastic Forces
CLASSIFICATION OF FORCES
Table III.1
16
CHAPTER III: Classification of Orthodontic Elastic Forces
Necessary
force 180 85 110 115 60 75 Total
635 g.
Necessary Total
force 175 90 90 115 40 40 635 g.
Total
Root surface 1.10 .60 .60 .75 .25 .25 3.55 g.
The size of enface root surface exposed to sagittal movement is measured in square centime-
ters. Every tooth can be evaluated as to the necessary force based on its root surface involved.
With friction, continuous archwires used with ceramic bracketts, it’s easy to understand that
heavy forces may be needed to move teeth.
In order to use lighter forces, a frictionless biomechanic system may be advised with segmen-
ted archwires.
Doing so, orthodontic movement with elastic forces should be faster and more efficient.
17
CHAPTER III: Classification of Orthodontic Elastic Forces
Table III.3
Table III.4
18
CHAPTER III: Classification of Orthodontic Elastic Forces
ANCHORAGE
STATIC DYNAMIC
FIXED MOBILE
RIGID DIFFERENTIAL
WITH
FRICTION > LESS
FRICTION
CONTINUOUS SEGMENTED
ARCHWIRES ARCHWIRES
MECHANIC BIOLOGIC
ABSOLUTE WITH OR
WITHOUT
COOPERATION COOPERATION
HEAVY
FORCES LIGHT FORCES
Table III.5
19
CHAPITER IV
- Children under age of 10 years are more cooperative than older children.
1 Explain
2 Explain
3 Explain
20
CHAPTER IV: Elastics Wearing Motivation
➩ to maximize cooperation
➩ to avoid relapse.
Fig IV.I
21
CHAPTER IV: Elastics Wearing Motivation
2 - to explain why, when, and how to wear elastics (see Fig IV.3 ).
3 - to check that the patient understands well the message and is able to place
properly the prescribed elastics (see Fig IV.4 ).
4 - to keep an eye on motivation, ask to the patient to put on his elastics in front of
you.
∑ threats of complications:
➨ possibilities of extractions
➨ possibilities of surgery
“ Change them and wear them as indicated. Stay with your ela-
stics even if you have some discomfort particularly during the first
two days ( as with a new pair of shoes ) ”.
“ Remember that well worn elastics mean you are speeding your
treatment time ”.
“ Bring back your worn out elastics at each visit ”, said R. BEGG 27, as a good way to educa-
te a recalcitrant patient.
22
CHAPTER IV: Elastics Wearing Motivation
Dr. STRAIGHT
1057 Paradise Av. • Wear your elastics EXACTLY as has prescribed
L. A. on the back.
CALIFORNIA
23
CHAPTER IV: Elastics Wearing Motivation
Fig IV. 2: Example of an elastic worn around two upper incisors with initial diastema. The
elastic went up in the gingiva with periodontal damage.
Fig IV.3: Clinical example of an exaggerated movement given by Class II elastics changing a
Class II in Class III.
24
CHAPTER IV: Elastics Wearing Motivation
Fig IV.4: Example of a misunderstood prescription of elastics. To correct the Class II canine
we need a closing Class II elastic.
Fig IV.5: A supply of elastics on the watch of a well motivated patient. During school hours,
elastics can be changed.
25
CHAPTER IV: Elastics Wearing Motivation
During the course of a treatment the practitioner has to ask himself the following questions:
The appointment interval may be regulated according to the gravity of the malocclu-
sion. The more the sagittal Class II canine relationship is important the longer the intervals of
the first visits.
Generally, when starting the Class II discrepancy, the interval of the first two or three visits
may be every 8 weeks. Then in succession of interarch correction the interval may be 6 or even
4 weeks, according to the clinical exams. There is no absolute rule because the orthodontist
may slow down elastics wearing in prescribing them full time at the beginning and during
night time only at the end of correction (see Table IV.1 ).
Table IV.1
26
CHAPTER IV: Elastics Wearing Motivation
The Orthodontist may advise the patient to schedule his next visit only when the goal
will be reached.
For instance, if the patient has to wear a delta elastic to bring down an upper ectopic canine,
you can ask him or her to wear elastics until the canine contact with antagonists, and then call
for a new visit.
Some clinical cases have to be watched. Particulary some Class II discrepancies, who
are used to well wear their elastics, are sometimes able to go in an excessive Class III and even
with the caution of the Orthodontist.
Explain to the patient about the danger of undesirable movement.
Do not hesitate to reduce the interval of clinical visits or to reduce elastics wearing in an alter-
nate way-night time only or every other night for exemple.
Be carefull:
Badly or incorrectly hooked elastics may change
biomechanics effects and complicate the treatment.
27
CHAPTER IV: Elastics Wearing Motivation
• exaggerate rotation.
• parodontal problem, such as Class II worn too much, may give lower incisors
dehyscence.
1 - CR is a necessary treatment.
2 - Patient must be seated at 90°.
3 - In absence of pathology, CR is not static but a dynamic relationship.
4 - With muscle pathology, CR does not exist !
5 - 85 % of TMD’s are muscular problems.
6 - CO - CR discrepancies are the result of muscle pathology or internal derangement.
7 - Sliding CO - CR may change.
8 - When healthy, TMJ are flexible, adaptable and have the capacity to compensate.
9 - Think chronologicaly:
1 - muscles
2 - TMJ
3 - occlusion
4 - MRI
5 - articulators.
10 - Use deprogrammation splint, if pain exists.
11 - Use sagittal range of motion to detect dual bite.
12 - Screen TMD:
➩ pain ( dynamic vs static )
➩ functional restriction
➩ noise ? ?
➩ dyskinesia
➩ muscle tenderness.
13 - Choose pain reduction first ( ultrasounds, Tens, stress management, pharmacology).
14 - Instruct the patient.
15 - Patient’s eyes closed.
16 - Sting the soft palate with a probe.
17 - Ask the patient to swallow with the tongue placed on the soft palate sting.
18 - Stop the closing mouth at the first interdental contact.
19 - Check the CR occlusion.
20 - Use a Moyco wax bite to register CR.
28
CHAPTER IV: Elastics Wearing Motivation
4 - Mandibular dyskinesia.
5 - Increased noise:
- clicking
- ligament laxity
- crepitus.
7 - Teeth interferences:
- mobility
- dental pain
- parodontal problems.
14 - Excessive growth.
15 - Insufficient growth.
29
CHAPTER IV: Elastics Wearing Motivation
1 - Handle everything carefully, especially when removing or inserting the inner bow.
2 - Never try to pull the headgear off without first unhooking elastics or the strap which
is attached to the outer bow.
❒ 12 to 14 hours ❒ 16 to 20 hours
6 - Use your score card to keep record of the number of hours you are wearing your
appliance night and day.
7 - Recording the wearing hours allows your orthodontist to determine needed forces for
proper correction.
8 - To put on your headgear is quite simple in front of a mirror, or have someone help
you.
9 - Don’t twist or distort your inner or outer bow by playing with it.
10 - Please don’t wear your headgear during rough play, sports, cycling.... This could
result in injury to you.
Very important:
30
CHAPTER IV: Elastics Wearing Motivation
Please score how many hours you have worn your headgear per 24 hours
Name:
Adress:
Elastics Placers
Our bright white Elastics Placer helps patients prop-
erly place their elastics, and the easier it is for them
to do, the greater the patient cooperation. Available
in bags of 100.
31
CHAPITER V
1 - Definition
The Class I elastic can be a chain, a rubber band, a ring or a thread placed on a single
arch and having a vertical or a horizontal force movement.
The Class I elastic has a reciprocical biomechanic action in a straight line
2 - Disposition
The Class I elastic can be placed:
• one tooth to an auxilary appliance such as Quad Helix, a palatal bar, a bite
plate etc...
The Class I elastic is a monomaxillary or monomandibular elastic which can be used with
other elastics in the same time.
That means, for example, that if you have, as in Fig V.8, to move distally a 41 and to close a
diastema, an elastic thread ligature around 42 and 41 will move both equally in the space. To
move distally the 41 you should placed the thread elastic on two or more teeth or thru the uti-
lity helix to keep the stable force higher than the mobile one.
32
CHAPTER V: Class I Elastics Forces
33
CHAPTER V: Class I Elastics Forces
Fig V.2:
Buccal upper incisor tipping for
adult in typical Class II.2.
The elastic thread is tied on a .045
wire.
Fig V.3:
Intrusion of a molar or cuspid with
a thread elastic, tied on utility arch.
Fig V.4:
Intrusion of lower incisors in adult,
with a thread elastic, on a R.
BENCH lower arch.
34
CHAPTER V: Class I Elastics Forces
Fig V.5: Class I elastic ligature used to rotate and bring forward the left lateral incisor in the
opened space by the M utility.
Fig V.6: Class I elastic to slide backward the right lower lateral incisor. The elastic is chan-
ged 3 times a day.
35
CHAPTER V: Class I Elastics Forces
Fig V.7: Example of elastic ligatures tied to rotate the 24 with an opposing force couple.
Fig V.8: Example of a Class I elastic ligature thru an utility Helix to close a lower incisor
diastema in moving distally the 41.
36
CHAPTER V: Class I Elastics Forces
Fig V.9: Example of Class I elastic chain and ligature to rotate a canine and an upper first
premolar with a force couple.
Fig V.10: Example of Class I elastics on a bite plate to correct a midline deviation and close
diastemas.
37
CHAPTER V: Class I Elastics Forces
Fig V.11: Example of a tongue thruster who had reopened a diastema after a treatment. Class
I elastic is placed on a bite plate.
38
CHAPTER V: Class I Elastics Forces
Fig V.13: Class I elastic ligature tied on the 4T4 to close the lower diastema. The patient
was already in retention.
Fig V.14: Result obtained with the Class I cross elastic and lower elastic ligature. Permanent
retention with Ribbond was made.
39
CHAPTER V: Class I Elastics Forces
Fig V.15: Example of space reopened after treatment. The patient does not want to have bra-
ces any more.
Fig V.16: A bonded hook is made distal to the upper lateral incisor.
40
CHAPTER V: Class I Elastics Forces
Fig V.17: An upper bite plate with an “ O ” occlusal elastic is worn to close the diastema.
Fig V.18: Detail of the “ O ” occlusal elastic used to close the diastema.
41
CHAPTER V: Class I Elastics Forces
Fig V.19: Frontal view showing the diastema closure with the “ O ” elastic.
Fig V.20: The bonded hook is removed and the upper incisors are splinted with a ribbond
wire.
42
CHAPTER V: Class I Elastics Forces
Fig V.21: Class I elastics used on a crossway on a bite plate ( intraoral view ) for space clo-
sing.
Fig V.22: Class I elastics used on a crossway on a bite plate for space closing.
43
CHAPTER V: Class I Elastics Forces
➨ to use force couple maintaining the centroïd axis of a tooth during rotation control
In finishing and detailing occlusion, an elastic thread can be helpful to get an overcorrection
of a canine, a molar, etc.
44
CHAPTER V: Class I Elastics Forces
Fig V.23: A: A Class I elastic on maxillary arch to retract the upper canine can certainly move
it backward, but a slight forward movement of the upper molar can be seen if M1
is not anchored by an auxilary such as a palatal bar, a headgear...
B: A Class I elastic on maxillary arch anchored on the second molar is a better
anchorage than can achieve a retraction of the upper canine.
C: A Class I elastic used simultaneously on maxilla and mandible moves forward
the upper molar with the lower during the retraction of the upper canine.
45
CHAPTER V: Class I Elastics Forces
Fig V.24: D: The association of a maxillary Class I with a Class II elastic moves forward
slightly the maxillary molar when the lower goes forward
E: The association of a bimaxillary Class I elastic with a Class II one moves the
molar forward and the upper canine backward.
F: The association of a maxillary Class I with a short Class II allows retraction of
the upper canine without moving the upper molar. Then the lower molar can be
brought forward without losing maxillary anchorage.
46
CHAPTER V: Class I Elastics Forces
6 - ROTATION with one Class I or with force couple of two opposed Class I ( see Fig
V.9 ).
7 - Elastomeric chains
Polyurethane chain elastics are commonly used in daily orthodontics as Class I elastics.
They are made by Ortho manufacturers in:
Elastomeric chains are mainly used for intra arch tooth movement and for spaces closing,
because placement and removal requires little chairtime and no patient cooperation.
More than 50 studies had been done on elastomeric chains; a consensus of clinicians may be
summarized as follow:
• oral environment ( such as PH, light, saliva, drinks, foods, dental plaque ) has been
associated with degradation of the polyurethane elastomer
• the elastomeric chains must be kept in a container and protected from light.
47
CHAPTER V: Class I Elastics Forces
The longer the chain’s filament, the lower the initial force
As with any system in Orthodontics, Class I elastics may give complications such as:
- abnormal tipping
- exaggerated rotation
- exaggerated extrusion
- anchorage lost
- minor or insufficient displacement...
Since more and more practitioners are using straight wires, some of them have undesirable
effects in using a continuous elastic chain on too light archwire < 0.016.
48
CHAPTER V: Class I Elastics Forces
This elastic is placed occlusally on the maxillary or mandibular arch in order to correct:
• a buccal tooth position which is in buccal cross bite degree 1 or 2 (see Chapter VIII
Table VIII.1 ). Sometimes it may be a second molar.
• an arch asymmetry
• spaces or diastemas
• a lack of canine contact in maxillary arch ( see Fig V.26 ).
Biomechanically, the “ O ” shape elastic moves one tooth or a limited group of teeth
transversaly. That could be a canine, a premolar, or a molar. Usually, it can be worn on a sim-
ple way or in criss cross according the clinical objectives ( see Fig V.29 ).
49
CHAPTER V: Class I Elastics Forces
Fig V.26: Occlusal elastic placed on upper canine to correct a retarded occlusal contact func-
tion. The light contraction is usually obtained in a week.
Fig V.27: Correction of a too buccal position of first upper bicuspids with an occlusal elastic.
50
CHAPTER V: Class I Elastics Forces
Fig V.28: Clinical example of the application of an occlusal elastic worn on the lower molar
which became too buccal.
This kind of “ O ” elastic is worn during night only and for a short time ( 2 to 3 weeks ) to
correct the lower buccal cross bite degree 2 (see text ).
Chain segmentation:
[R Molar - R canine] [incisors] [L canine - L Molar]
Elastics Placers
Our bright white Elastics Placer helps patients prop-
erly place their elastics, and the easier it is for them
to do, the greater the patient cooperation. Available
in bags of 100.
51
CHAPTER V: Class I Elastics Forces
Fig V.29: Clinical example of bilateral buccal upper canine corrected with cross “ O ” shape
elastics.
52
CHAPITER VI
1 - Definition
Class II elastics are intermaxillary elastics placed on the maxilla anteriorly, and on the
mandible posteriorly.
2 - Disposition
Class II elastics may be placed differently on:
• a sectional archwire
• a Class II utility arch
• a continuous archwire with anterior loop
• a sliding hook
• a JARABAK or KAYABASHI ligature tie
• a bracket hook
• a Jig
• a Class II headgear
• a reciprocal archwire 0.45 with hooks
• a reciprocal Mini Chin Cup.
In occlusion, if this elastic makes a 20 degree angle with the upper continuous archwire and a
100 g force, the elastic effect has:
53
CHAPTER VI: Class II Elastics Forces
Centric occlusion
Opening 10 mm
Opening 25 mm
Fig VI.1: Biomechanic influence of mouth opening on Class II elastic force ( see text ).
54
CHAPTER VI: Class II Elastics Forces
• With a mouth open 10 m/m at the incisors level, the force varies with different angulation
of the Class II elastic and has different effects upon:
- on the mandible
The elastic has a 35 degree angulation with the lower archwire. So we have:
• With a mouth open 25 m/m, which can happen when the patient is speaking, smiling or yaw-
ning, the elastic force can be again increased to 190 grams. But this force cannot be constant
and is going to decrease with time, in the saliva.
This maximum force occasionally exerted has again different effects upon:
➩ The vertical component of extrusion force is: 190 X sin 38.5° = 118.3 g.
➩ The horizontal distalizing force is: 190 X cos 38.5° = 148.7 g.
From those figures, it is now easy to notice that by opening of the mouth from 10 to 25
m/m, the forward mandibular force drops down from 131 to 115.7 g.That means it decreased
about 10% despite the patient opened his mouth more. Notice also that the extrusive mandi-
bular force went from 91.8 to 150.7 g. That means it increased 64% !
From this biomechanic explanation, the clinician must understand that the use of Class II inter-
maxillary elastics has to take into account the facial type in order to avoid a facial pattern
aggravation.
During day:
Intermaxillary elastics have a vertical component of extrusion that is
much more significant than the horizontal component.
During night
Intermaxillary elastics have an equivalent
vertical and horizontal component.
55
CHAPTER VI: Class II Elastics Forces
Fig VI.2: Facial type influence with Class II elastic use and consequences on the antero
superior occlusal plane when using continuous archwires. ( See text ).
56
CHAPTER VI: Class II Elastics Forces
Fig VI.3:
Ch. TWEED’s Class II elastics are
worn on continuous arches (with tip
back) and headgear.
Fig VI.4:
F. SHUDY’s Class II elastics are
placed on three points in a closing
way with High Pull Headgear to
control anterior occlusal plane and
reinforce maxillary anchorage.
Fig VI.5:
R. ROTH’s Class II elastics are
short and used with headgear accor-
ding to the facial type.
57
CHAPTER VI: Class II Elastics Forces
Fig VI.6:
The R. RICKETTS’s bioprogressive
technique. Class II elastic on sectio-
nal maxillary archwire.
Fig VI.7:
R. RICKETTS’s utility arch with
Class II hook for maximum ancho-
rage.
Fig VI.8:
J. PHILIPPE’s circummandibular
arch to protract the mandibular
arch. Unfortunately, when the
patient opens his mouth, the Class I
elastic becomes a Class II with
extrusion consequences.
58
CHAPTER VI: Class II Elastics Forces
59
CHAPTER VI: Class II Elastics Forces
Fig VI.9: Example of a Class II elastic placed on a sliding hook to compress a spring for minor
distalization.
Fig VI.10: Example of a Class II elastic placed on a sliding Jig to correct a molar relationship.
60
CHAPTER VI: Class II Elastics Forces
Fig VI.11: Example of a Class II elastic placed on a Class II utility arch to correct a midline
shift.
Fig VI.12: Example of a Class II elastic placed on a contraction utility arch to correct an upper
incisor protrusion and close anterior spaces.
61
CHAPTER VI: Class II Elastics Forces
Fig VI.13: Example of a Class II elastic placed on a continuous archwires.This kind of inter-
maxillary elastic has an extrusion component on the occlusal plane ( see text ).
Fig VI.14: Clinical case of one Class II elastic placed on the upper sectional to settle the cani-
ne relationship and one other Class II elastic placed on the contraction utility archwire to help
the incisor retraction and torque.
62
CHAPTER VI: Class II Elastics Forces
Fig VI.15: Clinical example of a Class II canine relationship associated with a Class I molar
relationship before treatment.
Fig VI.16: After treatment of a Class II elastic placed on a sectional maxillary arch.
63
CHAPTER VI: Class II Elastics Forces
Fig VI.17: Example of clinical dental Class II 1 deep bite before treatment. Notice the canine
Class II relationship.
Fig VI.18: After 3 months the canine relationship had been corrected with a Class II elastic
worn on a reciprocal maxillary arch.
64
CHAPTER VI: Class II Elastics Forces
Any kind of elastics can be used whatever they are Class I postero anterior, regular
Class II or combined with different ones.
In case of dental open bite, closing Class II elastics are recommended to close the bite
(see Fig 24 ).
We must differentiate:
• vertically normal: where the Class II elastic has a light effect of posterior man-
dibular rotation.
• deep bite: the extrusion component of Class II can be used with the combination
of triangular Class II.
Remember:
➩ correct the overbite before the overjet
➩ level the curve of Spee before using the Class II elastic
➩ segment the maxillary arch.
In some cases, the bite plate can help to open the bite when using intermaxillary elastics.
• open bite: in those cases the use of Class II elastics must be avoided because
their effects increase the mandibular rotation even when using closing Class II.
It’s better to use Class I elastics associated with judicious extraction strategies
and/or surgery.
65
CHAPTER VI: Class II Elastics Forces
Some patients have worn Class II elastics for so long that they can develop a convenience bite
and cheat their Class II correction.
Before stopping Class II elastics check the centric relationship and look at the patient
occlusion.
66
CHAPTER VI: Class II Elastics Forces
For example, some Class II Div. 1 clinical patients may develop excessive buccal lower inci-
sors tipping and going on with Class II elastics, particularly in those with deep overbite, awa-
king the sleeping cat - PAIN- because the incisor contact with exaggerate use of Class II ela-
stics may give again a condylar compression.
In those kinds of clinical cases the mandibular tripod is very useful and allows intrusion of
lower incisors and/or upper incisors.
Then the segmentation of the splint may help the segmentation of archwires and may go on
with intermaxillary elastics.
Not every patient should have their vertical dimension of occlusion increased.
Some skeletal Class II micrognatia patients may have vertical deficiencies due to over-
closure in jaw position in closed mouth. A modest increase does not appear to be detrimental,
and addresses:
- molar tipping or rotation
- forwarding incisors
- intruding incisors
- advancing lower arch
- surgery.
Remember that an excessive thickness of the tripod beyond the freeway space or mandibular
postural position can lead to detrimental intrusion of the posterior teeth.
67
CHAPTER VI: Class II Elastics Forces
To make more comprehensive this notion, let us see the Fig VI.19 where we have a
dental Class II malocclusion with a locked second premolar.
➨ WITH FRICTION
In using a continuous archwire with an opened coil spring for Pm2 space, we can place
the Class II elastics as follows:
1 - behind the lower molar, which is going to be extruded and advanced with the whole man-
dibular arch without opening the Pm2 space.
2 - on the mesial hook of the lower molar which is going to be advanced without extrusion,
but without opening the Pm2 space.
3 - distal to Pm1 on a KOBAYASHI tied ligature. The Class II elastic is going to advance the
mesial part of the mandibular arch before the Pm2, with a friction system which is better than
Fig.VI.19 n° 1 or 2, but less efficient than Fig.VI.19 n° 6.
68
CHAPTER VI: Class II Elastics Forces
➨ FRICTIONLESS
Using an archwire with an activated M loop with tip back, we can place the Class II
elastic:
4 - behind the lower molar to advance the whole mandibular arch with less extrusion than in
Fig. n° 1.
5 - on the mesial hook of the lower molar to help the activation of the M loop and open the
Pm2 space and advance the mandibular arch with more efficiency than in Fig. n° 2.
6 - distal to Pm 1 on a KOBAYASHI tied ligature, the Class II elastic is going to help the M
loop to give a reciprocal effect in opening quickly the Pm2 space and advancing the mandi-
bular arch in a very efficient way.
There are other biomechanic systems that could be used such as segmented arches with utility
arch etc; but the principle remains mainly the same.
69
CHAPTER VI: Class II Elastics Forces
1 4
2 5
3 6
Fig VI.19: Influence of biomechanic archwires systems and the hooked point of the Class II
elastics ( see text ).
70
CHAPTER VI: Class II Elastics Forces
In fact, the Class II elastic pulls downward and backward the anterior loop which raises the
anterior segment of the arch and increases the anterior torque progressively with the contrac-
tion. This is a big difference between a continuous contraction arch and the RICKETTS’s seg-
mented technique.
Remember that when a continuous contraction arch is activated, the anterior occlusal plane
goes downward during the contraction. If you need to control it, you have to use a high pull
anterior headgear with good patient compliance.
This bioprogressive torque, in using Class II elastics, is a very innovative biomechanic system.
Fig VI.20: Biomechanics of Progressive Torque with the RICKETTS’s utility arch.
The Class II elastic pulls downward and backward the anterior loop which raises the anterior
segment of the arch increasing progressively the torque with the contraction. A bodily move-
ment of the upper incisors is the result. See text.
71
CHAPTER VI: Class II Elastics Forces
Fig VI.21: Clinical example of Class II elastics placed on a Class II utility maxillary archwire
and a sectional to correct Class II molar and canine relationship on one side.
Fig VI.22: Clinical example of Class II elastic on right side to correct a midline deviation and
help to close the space between upper canine and lateral incisor.
72
CHAPTER VI: Class II Elastics Forces
Fig VI.23: Clinical example of U shape anterior elastic to close the bite. Notice the controla-
teral crossbite elastic to move the first bicuspid palatally.
Fig VI.24: Clinical example of closing Class II elastics to help closing the bite. Notice the
extrusion Class I elastic placed from right to left hook of the lateral maxillary sectional arch-
wires.
73
CHAPTER VI: Class II Elastics Forces
The vertical component on the lower molar is between three to four times greater with the
check elastic according to R. HOCEVAR.
There are different means to diminish the extrusion force such as:
• more horizontal elastics with hooked point more posterior in the mandible and more
anterior for the maxilla.
In using:
➩ molar M2 banding
➩ Class II headgear
➩ .045 reciprocal arch
➩ reciprocal mini chin cup.
Before RETRACTION,
the more vertical the upper incisors are, the more TORQUE is needed.
74
CHAPTER VI: Class II Elastics Forces
Fig VI.26:
Class II molar extrusion elastic indi-
cated in deep bite cases.
75
CHAPTER VI: Class II Elastics Forces
76
CHAPTER VI: Class II Elastics Forces
Fig VI.29:
A, B, C,
Class II 1
malocclusion
before
treatment.
77
CHAPTER VI: Class II Elastics Forces
Fig VI.30:
D, E, F,
After
correction
with Class II
elastics placed
on an . 045
upper
reciprocal
arch.
78
CHAPTER VI: Class II Elastics Forces
Fig VI.31: Example of oblique and Class II elastics to correct midline shift with a segmented
frictionless mechanism.
79
CHAPTER VI: Class II Elastics Forces
Fig VI.32: Example of a Class II elastic headgear with anterior welded hooks opened ante-
riorly.
Fig VI.33: Intraoral example of unilateral Class II elastic headgear for midline shift and
Class II correction.
80
CHAPTER VI: Class II Elastics Forces
Fig VI.34:
M. LANGLADE’s reciprocal
maxillary arch used with a Class II
elastic on a .016 X .022 lower utility
arch.
Fig VI.35:
With a maxillary sectional arch and
a LANGLADE’s reciprocal arch the
patient can wear two Class II ela-
stics on each side.
Fig VI.36:
With the same system we can add a
LANGLADE’s reciprocal mini chin
cup to reinforce the Class II effect
according the degree of difficulty of
the clinical case (3 X 100 g. force on
each side → mandibular protraction
effect ).
See Chapter IX.
81
CHAPTER VI: Class II Elastics Forces
The advised force ranges from 100 to 150 g. depending on the prescription and the final
growth potential of the child.
Fig VI.37: KAPRELIAN “ K 2 P ”. A split elastic positioner, worn with Class II elastics, during
home hours and sleeping.
82
CHAPITER VII
1 - Definition
Class III elastics are intermaxillary elastics placed posteriorly on the maxillary arch
and anteriorly on mandibular arch.
2 - Disposition
According to the clinical problem, Class III elastics may be placed:
Posteriorly
• buccally
• palatally ➩ to help expansion
• buccally and palatally ➩ to increase the force
• from the distal part of the archwire ( Fig VII.4 )
• from a molar hook ( Fig VII.5 )
• before the maxillary molar, even from Pm2 or Pm1
• from a Class III headgear
• from a bite plate distal upper hook.
Anteriorly
• a loop on archwire
• a JARABAK or KOBAYASHI ligature
• from a Class III bite plate with anterior hooks and inclined plane to
help to jump the bite ( see Fig VII.6 ).
In occlusion, the elastic having a 20 degree angle with horizontal plane is developing:
➩ a vertical component force of 100 X sin 20° = 34.20 g.
➩ a horizontal component force which can be written 100 X cos 20° = 93.90 g.
In a mouth open 25 mm, the elastic force becomes 190 g. with a reciprocal action:
- on maxilla:
vertical component of 136.67 g.
horizontal component of 131.98 g.
- on the mandible:
horizontal component of 92.11 g.
vertical component of 166.17 g.
With those figures, it is easy to understand the effect of incisors elongation anteriorally and to
appreciate the vertical effect of such an elastic!
83
CHAPTER VII: Class III Elastics Forces
Centric
occlusion
Opening
10 mm
Opening
25 mm
84
CHAPTER VII: Class III Elastics Forces
Fig VII.2: Influence of conventional Class III elastics on the occlusal plane tilting when
using continuous archwires ( see text ).
85
CHAPTER VII: Class III Elastics Forces
Fig VII.3: Influence of conventional Class III elastic forces with facial type and consequences
on the vertical component of extrusion, when using continuous archwires. See text.
86
CHAPTER VII: Class III Elastics Forces
Influence of Class III elastics on occlusal plane tilting with continuous archwire:
When a regular Class III is placed distally to the upper molar and mesially to the lower
canine with continuous arches, the resulting force depends on the tilting of the occlusal plane
-in other words on the facial type:
- in a normal vertical dimension the resultant is a 50% forward movement of the maxilla of
applied Class III elastic ( see Fig VII.3A ) with an extrusion on upper molar and an extrusion
with lingual tipping of the lower incisors.
- the more the vertical dimension is increased ( see Fig VII.3B and C ), the less the mesial
movement of the upper molar from 33% to 25% with an increased extrusion worsening the
open bite.
So, it is very important to keep the posterior wedge in a patient with a potential borderline
open bite. Segment the arch behind the first upper premolar and use short closing Class III
elastics.
87
CHAPTER VII: Class III Elastics Forces
- dental overbite
In normal vertical cases, it becomes dangerous to open the bite with an extrude ful-
cruming maxillary molar which may increase T. M. J. tenderness.
Regular Class III elastics may increase patient mandibular growth ( see Chapter IX ).
For normal vertical Class III cases, it’s better to keep posterior wedges, if you want to treat
your patient orthodontically.
Evidently, for open bite skeletal Class III patterns, treatment should include surgery.
Finally the Class III elastics indications may include:
• dental Class III occlusal relationship with deep bite skeletal pattern
• mandibular incisors protrusion in which you need closing and retraction space
Camouflage with posterior mandibular rotation in Class III squeletal pattern depends on:
➩ dental overbite
88
CHAPTER VII: Class III Elastics Forces
CHILDREN ADULTS
GROWTH NO
POTENTIAL GROWTH
NOSE
LABIAL
ANGLE
89
CHAPTER VII: Class III Elastics Forces
Fig VII.4: Conventional Class III elastic placed behind the upper molar. A high component
of extrusion exists on the occlusal plane.
Fig VII.5: Regular Class III elastic placed on maxillary mesial molar hook. The extrusion
component force still exists.
90
CHAPTER VII: Class III Elastics Forces
Fig VII.6: Example of Class III elastics placed on behind the maxillary molar posteriorly and
on anterior hook of a lower inclined bite plate in order to bring forward the upper arch and
jump the bite.
91
CHAPTER VII: Class III Elastics Forces
Fig VII.8: In this Class III, almost edge to edge incisor relationship, the vertical sense is cri-
tical and must not be opened. The posterior wedge must be kept.
Fig VII.9: Notice that the arch is segmented behind the 14th, and the patient is wearing a clo-
sing short Class III elastic to jump the bite.
92
CHAPTER VII: Class III Elastics Forces
The deeper the overbite, the better the prognosis in Class III malocclusions.
• insufficient wearing
• excessive wearing
The distal lower tipping of the mandibular canine may increase the retroversion of
lower incisors, when using Class III elastics with light memory archwires.
For example, when a Class III elastic is placed on an 0.016 X 0.016 lower Niti or TMA, the
lower canine can be distally tipped, inducing an increased extrusion of lower incisors already
subject to the vertical component of extrusion of the Class III elastic.
93
CHAPTER VII: Class III Elastics Forces
For these patients, a splint may be recommended for control of the muscular hyperactivity
coming from the elastics use.
Class III elastics forces can be associated with postero anterior elastics in order to advance the
retruded maxilla.
94
CHAPTER VII: Class III Elastics Forces
• to avoid bone mobilization, even in rigid fixation cases, using light forces
In orthognatics cases:
Extrude teeth on an unitarianly way in order to avoid moving bone fragments.
TONGUE INTERPOSITION,
vertical intermaxillary elastics can be
LINGUALLY placed on
cleat lugs, bonded buttons,
to provide an
ANTI-TONGUE SCREEN.
95
CHAPTER VII: Class III Elastics Forces
Centric occlusion
Opening 10 mm
Opening 25 mm
Fig VII.10: Triangular Class III biomechanics with a _, light elastic in 10 cm opened mouth.
We have:
• at the maxilla: an extrusion force of 119.1 g.
a forward force of 32 g.
• at the mandible: an extrusion force of 115.1 g.
a backward force of 44.3 g.
96
CHAPITER VIII
Particular
Intermaxillary Elastics
CHAPTER VIII: Particular Intermaxillary Elastics
Many intermaxillary elastics may be used for a specific extrusion component associa-
ted in conjunction with others such as contraction, in a horizontal or vertical way.
Among them let us see:
This elastic has a rectangular shape adding a contraction and extrusion force movement
( see Fig VIII.10 ). It is well indicated for closing spaces and extruding a segment of the den-
tal arch. So it can be placed:
- posteriorly
- anteriorly
in order to close the bite and to close remaining spaces at both arches.
This elastic has a delta shape, a short triangle using a vertical component of extrusion
for a single ectopic tooth, most of the time an upper canine ( see Fig VIII.7 ).
They have the same purpose as the M or W ones, but they add a contraction compo-
nent that could be interesting for closing spaces when extruding a group of teeth ( see Fig
VIII.3 and 4 ).
This elastic has a triangular shape with a Class II orientation, indicated for its vertical
component of extrusion of deep bite Class II clinical cases.
97
CHAPTER VIII: Particular Intermaxillary Elastics
Fig VIII.1: Example of the U shape vertical closure elastic on segmented arch.
98
CHAPTER VIII: Particular Intermaxillary Elastics
Fig VIII.2: From R. M. RICKETTS and al. Bioprogressive Therapy. RMO Editor. 1979
99
CHAPTER VIII: Particular Intermaxillary Elastics
Fig VIII.3: Example of M and W elastics to close the bite faster than locking up the maxil-
lary teeth in a straight wire.
Fig VIII.4: Two weeks later, the bite is closed with the M and W vertical elastics.
100
CHAPTER VIII: Particular Intermaxillary Elastics
Fig VIII.5: Clinical example of a squeeze of the bite with M and W shape elastics ( see text ).
Fig VIII.6: Post surgery TMJ patient wearing a splint with lateral rectangular elastics to
extrude lower molar and first bicuspid.
101
CHAPTER VIII: Particular Intermaxillary Elastics
Fig VIII.7: Example of an upside down V elastic to bring down a right upper canine instead of
locking it up with a straight wire.
This kind of elastic has also a triangular shape used for its vertical component of extru-
sion of the posterior part of the maxillary arch as Class III sagittal correction of occlusion ( see
Chapter VII. Fig VII.10 ).
9 - SQUEEZE ELASTICS
In some borderline surgery open bite cases, R. M. RICKETTS 2 had advocated heavy
elastics forces ranging from 800 to 1500 g. to close the bite (see Fig VIII.5 ).
Those elastics are worn 24 hours a day, and changed three times during two weeks, to obtain
the bite closure.
But, before seeing their clinical application, we must look at a new international classification.
102
CHAPTER VIII: Particular Intermaxillary Elastics
Most authors have identified the unilateral posterior cross bite occlusion only in terms
of transversal relationship of the maxillary molar.
The term “ cross bite ” means an abnormal labio lingual, edge to edge or bucco lingual rela-
tionship of the antagonist teeth. This incomplete definition has caused some confusion since
apparent tooth relationships can hide underlying skeletal discrepancies sagittally and/or trans-
versely.
The reality of clinical and functional exams of patients, presenting a unilateral poste-
rior cross bite occlusion with three dimensional cephalometric analysis, axiography and study
models, has shown to M. LANGLADE that the lower molar can be affected in 19.36 % of
those cases in a sample of 280 orthodontic patients.
Since 1988, the author has used an international classification based on the responsible molar
( upper or lower ) with a figure 1, 2 or 3, expressing the transversal unwedging by degree of
difficulty:
- normal is 0
- 1 is edge to edge
- 2 is a one cusp unwedging
- 3 is the complete jump of the bite
Doing so, it is possible to establish the true pathologic situation which opens concre-
tely on the appropriate therapeutic solution.
For instance, all third degree cross bites must be corrected with a bite plate on the antagonist
arch.
MAXILLA:
UB3 = upper buccal 3 cross bite
UB2 = upper buccal 2 cross bite
UEE1 = upper edge to edge 1
UL2 = upper lingual 2 cross bite
UL3 = upper lingual 3 cross bite
MANDIBLE:
LB3 = lower buccal 3 cross bite
LB2 = lower buccal 2 cross bite
LEE1 = lower edge to edge 1
LL2 = lower lingual 2 cross bite
LL3 = lower lingual 3 cross bite
103
CHAPTER VIII: Particular Intermaxillary Elastics
Table VIII.1
International Classification of
posterior unilateral cross bite:
Grade the pathologic situation
according to the unwedging cusp:
1 - for edge to edge
2 - for one cusp
3 - for the jump of the bite
104
CHAPTER VIII: Particular Intermaxillary Elastics
Fig VIII.8: Differential posterior cross bite occlusion diagnosis must distinguish
A - a dental malocclusion
B - a narrow maxilla
C - a mandibular latero deviation ( functional shift ).
105
CHAPTER VIII: Particular Intermaxillary Elastics
Definition:
The homolateral cross bite elastic is usually used to jump the bite of a tooth or a group
of teeth. It is placed opposing teeth, for instance a palatal cleat lug of an upper molar in
lingual cross bite degree two, to the buccal hook of the lower molar of the same side (
or contrary ).
This kind of intermaxillary cross bite elastic can be used on any kind of tooth from the
palatal side to the buccal side or conversely.
Biomechanism:
The Biomechanism of a homolateral cross bite elastic may explain a clinical example of
such an elastic developing a 90 g. horizontal force in occlusion.
This elastic, as in Fig VIII. 9, gives a rotation moment written:
M = 90 X 16 = 1440 g.
If the distance of elastic insertion to the center of resistance is 16mm:
➩ the upper molar undergoes a palato buccal rotation
➩ the lower molar undergoes a bucco lingual rotation.
When the patient opens his mouth to 30 mm, the 90 g. force becomes a 180 g. If we
suppose that each molar has an 8 mm width and the jump of the bite is 4 mm, the elastic is
obliquely stretched exerting a force of rotation on each molar, which is decomposable in a
vertical and a horizontal force.
We have now a triangle with two known sides:
a = 30 mm
b = ( 8 + 4 ) = 12 mm
This oblique force exerted on each molar in inverted sense has moments which can be writ-
ten:
- for the horizontal force ➩ Mh = 54.3 X 16 = 868.8 g.mm
- for the vertical force ➩ Mv = 171.7 X 8 = 1573.6 g.mm
It is clear now that an intermaxillary homolateral cross bite elastic in an open mouth gives an
extrusive force three times greater than the original horizontal force.
This biomechanic demonstration shows that such elastics are to be avoided in open bite
cases.
106
CHAPTER VIII: Particular Intermaxillary Elastics
Occlusion
Open 30 mm
107
CHAPTER VIII: Particular Intermaxillary Elastics
Definition:
The controlateral cross bite elastic is an intermaxillary elastic placed on opposite sides
of dental arches; for example from a left upper molar buccally to a right lower molar, or
vice versa.
Biomechanics:
We can, for instance, use the same demonstration with a 130g. elastic force in a closed
mouth ( see Table VIII.2 ). If the patient opens his mouth again to 30 mm:
➩ the transversal force is 273 g.
➩ the vertical force is 115.38 g.
Now, we have a new situation with a horizontal force which is three times the extrusive one.
That means that the controlateral cross bite elastic is much more effective transversaly than
any other.
TABLE VIII.2
108
CHAPTER VIII: Particular Intermaxillary Elastics
Fig VIII.11:
Short vertical elastics have a ten-
dency to narrow the transversal
dimension
Fig VIII.12:
GRUMMONS double cross bite
used for molar extrusion in TMD
patients to unload the condyle.
109
CHAPTER VIII: Particular Intermaxillary Elastics
Clinical applications:
The clinical application of this kind of controlateral cross bite elastic suggests it is
helpful in various transverse corrections, more especially in posterior unilateral
crossbite situations.
In 1990, M. LANGLADE 39 did a comparative study on cross bite correction of unilateral pala-
tal upper molar in two degree cross bite wearing a Quadhelix with or without the help of a con-
trolateral cross bite elastic (see Table VIII.3 ).
The treatment time was shortened from approximately 270 to 60 days with the controlateral
elastic !
Table VIII.3: Comparison of Unilateral posterior cross bite correction from M. LANGLADE. Foundation for
Orthodontic Research 1990.
110
CHAPTER VIII: Particular Intermaxillary Elastics
Fig VIII.13: Use of a controlateral cross bite elastic to correct a right maxillary buccal degree
2 with a unilateral contraction Quadhelix. The elastic is reinforcing the stable force and
helping to increase the moving force.
Fig VIII.14: The controlateral cross bite elastic has a double action on the unilateral move-
ment of the Quadhelix by:
1 - increasing the molar anchorage on the right side
2 - increasing the expansion force of the Quadhelix with a transversal elastic helping to
jump the left molar bite ( mobile force ).
111
CHAPTER VIII: Particular Intermaxillary Elastics
Fig VIII.15: Controlateral cross bite elastic used to correct a lingual maxillary molar degree
2 with a unilateral expansion Quadhelix.
In DISTRACTION OSTEOGENESIS,
the practitioner can use all biomechanic principles
in order to correct maxillo mandibular anomalies using
intermaxillary elastics such as:
112
CHAPTER VIII: Particular Intermaxillary Elastics
Fig VIII.16: Example of buccally ectopic canines with anterior open bite.
Fig VIII.17: A cross controlateral elastic is going to palatally move each canine in a week.
113
CHAPTER VIII: Particular Intermaxillary Elastics
Fig VIII.18: One week later the bite is closed and the upper canines are settled transversally
and vertically ( see Fig VIII.16 and 17 ).
Fig VIII.19: Example of a controlateral elastic helping the correction of a cross bite degree
two with a unilateral Quadhelix force.
114
CHAPTER VIII: Particular Intermaxillary Elastics
Fig VIII.20: The palatal ramp unilateraly on a bite plate can be used to guide the mandible in
functional shifts:
A - without occlusal plate
B - with bilateral bite plate
C - with unilateral bite plate.
Controlateral or intermaxillary elastics can be placed to help the midline shift correction.
115
CHAPTER VIII: Particular Intermaxillary Elastics
It can be corrected with a Quadhelix developing unilateral force movement associated with an
homolateral or a controlateral cross bite elastic, according to the degree of difficulty (see Fig
VIII.13 to 15).
For example, you can have on one side a Class II changed one time a day and on the other side
a closing short Class II changed three times a day that means you have double force on that side.
Such as a Class II on right side and a Class III on left side. But you may have also a cross bite
and Class II elastics on the same side in an opposite one ( see Fig VIII.22 ).
It is very helpful to correct the dental midline deviation using frictionless forces associated
with intermaxillary elastics.
But one can also use a different arch form of the archwires in using the transversal loop.
Mandibular functional shifts can be corrected with the help of a guiding bite plate (see Fig
VIII.20) and controlateral cross bite or associated intermaxillary elastics.
Usually the cross bite elastic is placed in opposition to the side of mandibular shift (see Fig VIII.22)
116
CHAPTER VIII: Particular Intermaxillary Elastics
• vertically
• horizontally
• transversely
• sagittally.
Some practitioners are not well aware of the straight wire limitations to correcting such asym-
metric dental arch form.
Most of the time, the segmentation of archwires and/or the different arch form given
by a transversal loop associated with combined elastic forces may be the therapeutic solution
for those difficult clinical cases.
117
CHAPTER VIII: Particular Intermaxillary Elastics
N: Normal:
Check CR
118
CHAPTER VIII: Particular Intermaxillary Elastics
A:
2) Use Class III elastic on opposite side to the
Mdb shift ?
3) Unilateral Mdb maximum anchorage on
opposite side Mdb shift.
4) Unilateral Mdb stripping opposite to Mdb
shift ?
5) Combination ?
B:
2) Mx extraction on opposite to midline
deviation, and also
3) Maxi anchorage.
4) Class I elastic on opposite side to midline
deviation.
5) Unilateral Mx stripping on opposite midline
deviation.
C:
2) Mx extraction on opposite midline deviation.
3) Unilateral arch advance on side of midline
deviation.
4) Class III elastic on opposite to Mdb shift
(anterior diagonal + vertical).
5) Cross stripping ?
D:
2) Mx and Mdb unilateral extractions on side of
Mdb shift.
3) Class II elastics on Mdb deviation side.
4) Unilateral stripping on opposite midline
deviation.
119
CHAPTER VIII: Particular Intermaxillary Elastics
E:
2) Mdb extraction on Mdb side shift ?
3) Class III elastic on opposite side of Mdb
shift.
4) Unilateral Mdb arch maximum anchorage.
5) Stripping and/or combination of above.
F:
2) Unilateral Mx and Mdb extraction on side
of Mdle shift.
3) Class II elastic ( anterior or diagonal ) on
Mdb side shift.
4) Unilateral Mx maximum anchorage opposite
to Mx midline deviation.
5) Stripping and/or combination.
G:
2) Cross extractions 14 / 34.
3) Cross maximum anchorage.
4) Anterior diagonal elastic and/or Class II
elastic on opposite side of Mdb shift.
5) Stripping and/or combination.
H:
2) Mx unilateral extraction on opposite side
of Mdb shift.
3) Latero vertical and/or Class I elastics.
4) Unilateral stripping on opposite side Mdb
shift.
5) Stripping
120
CHAPTER VIII: Particular Intermaxillary Elastics
121
CHAPTER VIII: Particular Intermaxillary Elastics
A: Inclined divergent:
• segmentation of archwires
• triangular anterior elastics
Fig VIII.23:
CLASSIFICATION OF VERTICAL ASYMMETRY
OF ANTERIOR OCCLUSAL PLANE
122
CHAPTER VIII: Particular Intermaxillary Elastics
D: Inclined convergent:
• bite plate
• segmentation of archwires
• unilateral triangular elastics
• Class II / III elastics
E: Unilateral convergent:
• unilateral bite plate
• unilateral rectangular elastics
Fig VIII.23:
Elastics use and possibilities of correction
Check::
- Fronto facial / profile esthetics
- Frontal cephalometric analysis
- CR occlusal relationships.
123
CHAPTER VIII: Particular Intermaxillary Elastics
124
CHAPTER VIII: Particular Intermaxillary Elastics
In the growing patient, treatment for the fractured condylar, either unilateral or bilateral, is
usually a conventional functional appliance.
In the adult case, elastics may be a part of an orthodontic treatment such as:
where the condylar neck is anteromedialy displaced with an opening deflexion on the affected
side ( see Fig VIII. 25 ). The treatment should be:
● a unilateral bite plate on the controlateral fractured side, to help condylar distraction.
the mandible is rapidly rotating posteriorly with an anterior open bite and limited mouth ope-
ning ( see Fig VIII. 26 ). The treatment should be:
● a bilateral posterior bite plate to help the condylar distraction for healing.
In any case, the elastics are worn for two to three months and progress can be checked with
Xrays.
125
CHAPTER VIII: Particular Intermaxillary Elastics
126
CHAPTER VIII: Particular Intermaxillary Elastics
Fig VIII. 26: ELASTICS AND BILATERAL CONDYLAR FRACTURES ( see text ).
● bilateral posterior bite plate to help the condylar distraction for healing.
127
CHAPITER IX
13 - Don’t use E. O. F. in every Class II. With Long Range Growth Forecast, you may
choose to use:
- extractions
- activators
- surgery
15 - Do overcorrect
128
CHAPTER IX: Elastics and ExtraOral Forces
129
CHAPTER IX: Elastics and ExtraOral Forces
Fig IX. 1: The same malocclusion can be seen in different facial types. A different extra oral
pull must be appropriate to it.
130
CHAPTER IX: Elastics and ExtraOral Forces
High
Horizontal
Low
tion
rac
Lo wt
131
CHAPTER IX: Elastics and ExtraOral Forces
High
Low
132
CHAPTER IX: Elastics and ExtraOral Forces
Hi
gh
tra
c
tio
High
Horiz.
Low
133
CHAPTER IX: Elastics and ExtraOral Forces
134
CHAPTER IX: Elastics and ExtraOral Forces
From R.M. RICKETTS et. al. Bioprogressive Therapy. Book 1. R.M. 1979.
Elastics Racks
Our aluminum anodized elastics rack is durable, light weight,
and has holes for mounting on a wall. Holds four boxes of GAC
elastics.
135
CHAPTER IX: Elastics and ExtraOral Forces
In an incisors diastema condition, it is indicated to using this appliance, which allows to push
back and to close spaces ( see Fig IX. 7 ).
This appliance is able to correct a minor clinical problem of Class II canine relationship
without bonding the full arch, using only two molars bands.
136
CHAPTER IX: Elastics and ExtraOral Forces
Fig IX. 7: Clinical example of a Class II malocclusion corrected with only a Class I head-
gear elastic. Correction of canine relationship and incisor protrusion had been obtained at the
same time (see text ).
137
CHAPTER IX: Elastics and ExtraOral Forces
This appliance has a backward effect on the maxillary arch and a forward effect on the man-
dibular arch.
Usely, the Class II elastic headgear is worn at home during homework and sleeping hours.
Class II elastics are reinforcing the headgear effect on the maxilla and at the same time pro-
tracting the mandible.
This headgear has an inner bow with a welded hook, opened posteriorly, mesial to the molar
bayonet, allowing to place a Class III elastic ( see Fig IX. 8 and 9 ).
This welded hook avoids placing the elastic behind the upper molar, and abstaining from an
extrusion and a forward movement of the maxilla molar, as it is usually noticed with the regu-
lar Class III elastic wearing. The elastics are worn only when the headgear is worn.
• Non extraction biprotrusion where bite and space closure is obtained with a
maximum anchorage system using closing Class III elastic headgear.
• Biprotrusion with extraction where the closure of the bite must be done without
moving forward the maxillary molar.
138
CHAPTER IX: Elastics and ExtraOral Forces
Fig IX. 8: Example of a Class III elastic headgear. Notice the welded hook mesial to the
upper molar, on which the closing Class III elastic is placed ( see text ).
Fig IX. 9: Typical Class III elastic headgear. The Class III elastic force has no influence on
posterior occlusal plane ( see text ).
139
CHAPTER IX: Elastics and ExtraOral Forces
M. LANGLADE 33 proposed in 1973 the Whiskers headgear which is an extra oral bow in .045
round wire with two hooks coming under the maxillary archwire, between the central and the
lateral incisors ( see Fig IX.10 to 12).
This appliance may be used with 100 to 150 g. elastic force placed on helmet.
140
CHAPTER IX: Elastics and ExtraOral Forces
Fig IX.11
Fig IX.12
141
CHAPTER IX: Elastics and ExtraOral Forces
If the posterior support is always the first or the second molar, at the anterior level the sup-
port may be variable upon:
• of DELAIRE - VERDON 62
• of H. PETIT
• of D. GRUMMONS 29
• of R. NANDA 51.
As we are going to see, some of those appliances have an excessive extrusion component that
limits their clinical use.
It’s a .045 round wire thru the upper first molar which comes down in the lower buc-
cal part all around the mandibular arch; two welded hooks are at the canine level, opened ante-
riorly for postero anterior elastics from the first or second lower molar ( see Fig VI.8 ).
Unfortunately, when the patient opens the mouth, the Class I postero anterior elastic becomes
a Class II elastic force with a high clockwise movement of the maxillary molar.
It seems that this circummandibular arch should be recommended rather for retention of the
retruded lower incisor patients, especially those who have a strong mentalis muscle.
Proposed in 1904 by Victor Hugo JACKSON with metallic lamella framework for pro-
tracting the maxilla, then made fashionable by J. DELAIRE, the facial mask is a precious and
useful auxilary; but its indication is very limited.
Too many orthodontists, faced with an anterior cross bite, quickly choose the facial mask use,
thinking “ If it’s not good, it would not be bad for the profile concavity ”.
142
CHAPTER IX: Elastics and ExtraOral Forces
The action of the facial mask which supplies a vertical counter clockwise rotation of the upper
molar and palatal plane, what ever, high, horizontale, is known as the postero anterior pull.
Disposition:
This appliance is used to protract forward the retruded maxilla from:
➩ a welded buccal hook on a labio lingual wire cemented on the first premolars and
first molars.
The effect:
The facial mask effect is accompanied by:
➩ at the mandibular level with a postero anterior traction with a chin support it gives:
143
CHAPTER IX: Elastics and ExtraOral Forces
The use:
The facial mask use shows that the more the point A goes forward, the more the anterior
open bite increases. This alleviation tongue interposition reflex phenomenon is a
response of the muscular chains to the posterior condylar compression.
The TMJ by its numerous receptors is the regulation mechanism of the mandibular
growth.
By those facts, the facial mask use is much more limited than some authors had
declared.
Instead of a choice in uncertain future, the orthodontist must use a RICKETTS’s Long
Range Growth Forecast “ to begin with the end in mind ”.
If you have a 7 year old patient with anterior cross bite, how can you make a decision at pres-
ent time, if you ignore the final growth pattern of this patient ? Are you going to treat him
immediately with a facial mask ? By orthopedics or with Class III elastics ? And run for a use-
less jump of the bite during many years to finally use surgery to treat him ?
In orthodontics, profits and winnings, as losses and relapses, are not given by the dia-
gnosis only, but also by the prognosis.
After your decision, you may suffer the consequences of your treatment, if you have no image
of the final growth pattern ( see Table IX. 1 ).
• the convexity
• the mandibular corpus length
• the mandible in the face
• the esthetic profile
2 - anterior overbite
You may use dental compensation or dental camouflage in some Class III cases, as D.
WOODSIDE 59 or P. TURLEY 60 had shown ( see Table VII. 1 ).
144
CHAPTER IX: Elastics and ExtraOral Forces
Fig IX. 13: The facial mask use has a triple chain reaction:
A - a lowering down of posterior palatal plane with a DOWNWARD and forward
maxillary dental arch advancement.
B - a posterior condylar loading which unlatch by reflex track.
C - a posterior mandibular rotation allowing a sagittal increase of prognathic growth.
Please remember that it is the vertical sense in TMJ that gives opportunity to the mandible to
grow SAGITTALLY.
145
CHAPTER IX: Elastics and ExtraOral Forces
Fig IX. 14: According to R. M. RICKETTS 2, the maxillary growth is much more vertical
posterior than anterior. This natural phenomenon must be taken into account in the facial mask
use.
Fig IX. 15: Any kind of facial mask pull always involves a downward movement of the
posterior palatal plane, increasing the vertical sense with consequences on mandibular
overgrowth.
146
CHAPTER IX: Elastics and ExtraOral Forces
Table IX. 1
“ The face mask produces orthodontic instead of orthopedic effect in most of the cases.
Dental and skeletal relapse will happen due to continued mandibular growth ”.
JONG HIN 58 et. al. 1993.
• Use anterior bite 45° inclined plate, with Class III elastics.
In Class III, the deeper the overbite, the better the prognosis.
147
CHAPTER IX: Elastics and ExtraOral Forces
This is a modified face mask having a support from the forehead and cheeks instead of
the chin, allowing the maxilla or the mandible arch or both to be brought forward.
The author recommends a 12 hours wearing with 400 g. intra oral elastics on each side.
Because this face mask has no support on the mandible, there is no impact on the T. M. J.
With a hook welded in front of the molar, an intra oral Class III elastic can be added to increase
the maxilla protraction with:
148
CHAPTER IX: Elastics and ExtraOral Forces
Fig IX. 17: R. NANDA reverse headgear with a mesial molar hook for a Class III elastic to
reinforce postero anterior maxilla protraction.
Fig IX. 18: R. NANDA reverse headgear worn in mouth with complementary Class III elastics
on a lower Class III hooked bite plate.
149
CHAPTER IX: Elastics and ExtraOral Forces
Fig IX. 19 B: The NANDA postero anterior headgear is worn with a HICKHAM Chin Cup to
bring forward the maxilla.
150
CHAPTER IX: Elastics and ExtraOral Forces
Fig IX. 20: The HICKHAM chin cup for maxillary protraction.
Fig IX. 21: The HICKHAM chin cup for maxillary protraction is worn with postero anterior
intra and extra oral elastics placed on a head cup.
151
CHAPTER IX: Elastics and ExtraOral Forces
This chin cup has two vertical labial hooks for postero anterior elastics to protract the
maxilla or the dental mandibular arch ( see Fig IX.20 and 21 )
Unfortunately, this appliance must be worn with a headgear that is difficult to keep on the
head, even during sleeping hours.
This new appliance was invented by Dr M. LANGLADE in 1978 for the treatment of
dental Class II malocclusions.
Similar to an inner face bow, it is an .045 round wire inserted into maxillary molar
tubes. A vertical step goes under the upper lip, and two welded anterior hooks are used to
attach intermaxillary Class II elastics.
The arch can be worn 24 hours a day, and because it has a lip bumper and headgear effect,
along with Class II elastics, it can replace headgear during school hours and sometimes alto-
gether.
For a more severe malocclusion, the mini chin cup can be inserted in a welded .045
tube to the buccal sections of the reciprocal maxillary arch.
The chin cup has anterior hooks at the level of the labial commissure for attachment of poste-
ro anterior elastics from the mandibular molars.
It should be worn during homework and sleeping hours to increase the mandibular protraction
effect of the elastic force.
• Class II dental relationships in Class I skeletal patterns ( even with no growth potential)
• mandibular dental retrusion
• tipped back mandibular canines with or without mesial spacing
• borderline surgery cases
• microdontia with deep bite and spacing
• missing mandibular teeth that may cause a deepening of the bite.
When spaces must be closed in those two last indications, to correct the Class II dental rela-
tionship, some contradictory biomechanical movements come into play, with any technique
without a force coming from outside of the mouth.
152
CHAPTER IX: Elastics and ExtraOral Forces
153
CHAPTER IX: Elastics and ExtraOral Forces
This appliance is not cumbersome and may help to bring forward the retruded mandibular arch
and open the bite despite the spaces closing.
• appliance is prefabricated
• appliance of choice for rough cases with missing teeth, agenesia, or anodontia in
mandibular arch
This appliance is most effective for its reciprocal effect allowing use two, three, or even four
intermaxillary Class II elastics.
Usually the reciprocal mini chin cup is worn during a short time ( from two to five months ),
even in adults cases.
154
CHAPTER IX: Elastics and ExtraOral Forces
Fig IX. 23: The LANGLADE’s prefabricated maxillary reciprocal arch which is worn 24
hours a day with Class II elastics using a bumper effect. See text.
Fig IX. 24: The LANGLADE’s prefabricated reciprocal mini chin cup which goes in the late-
ral tubes of the maxillary reciprocal arch which can be used with two to three Class II elastics
and a postero anterior Class I elastic.
This appliance is very effective and easily worn by adults.
155
CHAPTER IX: Elastics and ExtraOral Forces
Fig IX.25: Clinical example of dental Class II malocclusion with a retruded mandibular arch
corrected in three months with a Reciprocal Mini Chin Cup. Notice the sagittal and vertical
overcorrection ( before and after ).
156
CHAPTER IX: Elastics and ExtraOral Forces
This appliance provides a retruding extra oral force used to posteriorly rotate the
mandible.
Indications:
It first requires a long range growth forecast to diagnose the risky true prognathic case,
in order to determine treatment effectiveness (see Table IX.1 ).
Use:
This appliance can be used:
Effects:
The wearing effects of orthopedic Class III chin cup are:
According to L. GRABER 47, who treated 30 Class III malocclusions in patients between 5 to
8 years during a three year period, his study provided strong support for the use of orthopedic
force mini chin cup appliance in the clinical management of young patients with moderate ske-
letal mandibular prognathism.
157
CHAPTER IX: Elastics and ExtraOral Forces
Fig IX.26 : The two piece corrector from G. EGANHOUSE 57 is constructed with a sliding
guide and worn with closing Class III elastics and Chin Cup.
From J. C. O. Vol. XXXI. N° 4. pages 246 - 250. 1997.
158
CHAPITER X
Rationale for
Elastics Prescription
CHAPTER X: Rationale for Elastics Prescrition
Even with the knowledge of all elastic possibilities, it is sometimes difficult for the cli-
nician to decide on the best elastic treatment.
It may be:
• to open the bite or,
The vertical dimension of skeletal pattern is the main factor to consider clinically. Remember
that all intermaxillary elastics have a tendency to increase the vertical dimension.
For instance, a Class II molar relationship can exist with an edge to edge that could be cor-
rected by placing the intermaxillary elastic buccally or palatally according to the transverse
problem.
159
CHAPTER X: Rationale for Elastics Prescrition
• How is the skeletal pattern ? Normal ? Open bite tendancy ? True open bite ?
Deep bite tendancy ? Or true deep bite tendancy ?
• What is the dental problem ?
= Do we have to close the bite ?
= Do we have to open the bite ?
• What kind of biomechanics are need to reach our goals ?
= continuous archwires ?
= segmented archwires ?
• Are we allowed to use intermaxillary elastics forces ? Or do we have to use
Class I or closing elastic forces ?
Refer to the skeletal pattern and to the Long Range Growth Forecast.
Look at the occlusal bite. If you have an edge to edge incisor relationship your
priority will be to close the bite absolutely; so in that case you must use closing
elastics and/or eventually extractions.
For example, a lingual crossbite relationship of a maxillary canine may be corrected in placing
on the Class II elastic palatally to correct in the same time the transversal and sagittal sense.
A midline shift clinical case can suggest increasing the Class II elastic force on one side by:
➩ changing three times the elastic on one side and only one time per day the other side or,
➩ using a closing elastic force on one side and a regular one on the other side or,
➩ using a heavy elastic on one side and a lighter on the other.
In good order:
1 - molar relationship
2 - canine relationship
3 - incisor relationship.
160
CHAPTER X: Rationale for Elastics Prescrition
❏ yes ❑ yes
❑ no ❑ no
❑ yes ❑ no ❑ asymmetric...
4 - Needed cooperation:
In using arrows on the chart and after determining the needed anchorage on each side of the
maxilla, the archwires may be chosen with the elastics forces which must be used to reach
clinical goals.
161
CHAPTER X: Rationale for Elastics Prescrition
C: Lay down the problem ! Come up with the objectives to reach. Use arrows:
162
CHAPTER X: Rationale for Elastics Prescrition
CLINICAL EXAMPLE
- on right side she has a Class II lingual degree 2 cross bite and a Class II canine
relationship.
- on left side she has an open bite with a Class III canine relationship.
C - Solution ( Fig X. 1B ):
• on right side, a triangular Class II cross bite elastic is going to correct the Class II and
jump the bite.
• anteriorly a closing Class III elastic is going to correct the midline shift, bring forward
the left upper canine, and close the bite !
• on left side, we are keeping the posterior wedge so we don’t need any elastic.
The correct prescription of elastics corrected the majority of the malocclusion and the patient
is pain free.
163
CHAPTER X: Rationale for Elastics Prescrition
Fig X. 1
164
CHAPTER X: Rationale for Elastics Prescrition
● QA -
● QB -
● QC -
● QD -
165
CHAPTER X: Rationale for Elastics Prescrition
QUIZ A
- on right side notice the Class II canine relationship: we’ll have to open the lateral
upper incisor space for a future implant.
- anteriorly we have an open bite tendency edge to edge with a 2 mm maxillary midline
shift.
- on left side 22 and 23 are missing and we have a Class II edge to edge position of the
first bicuspid, we would like to use for canine function. We also need to keep a space
for the upper left incisor implant.
• on right side, we need a maximum Class II anchorage with two Class II elastics, one
on the sectional arch, the other on the Class II utility arch.
• to correct the midline shift, we can add an oblique elastic worn during night.
• to bring forward the first left bicuspid, we need a Class III elastic which is also going
to help the midline shift correction.
To increase elastics efficiency, we could also use closing elastics in this case... but we don’t
need too much overbite with future implants.
166
CHAPTER X: Rationale for Elastics Prescrition
Fig X. 2
QUIZ A
167
CHAPTER X: Rationale for Elastics Prescrition
Fig X. 3
SOLUTION A
168
CHAPTER X: Rationale for Elastics Prescrition
QUIZ B
• on right side, a sectional with a Class II elastic placed the canine worn only at night.
• on left side, we’ll use a double Class II elastic worn 24 hours a day and changed three
times.
Notice that one elastic is placed the utility Class II and the other on the left sectional, so
we have a maximum anchorage on that side, which is also going to correct the mandibular
midline !
169
CHAPTER X: Rationale for Elastics Prescrition
Fig X. 4
QUIZ B
170
CHAPTER X: Rationale for Elastics Prescrition
Fig X. 5
SOLUTION B
171
CHAPTER X: Rationale for Elastics Prescrition
QUIZ C
- on right side, we are in Class I molar and premolar, but with a mesial space in front of
the first bicuspid, the right upper canine is in total Class II relationship.
- anteriorly, there is a distal diastema to the upper right lateral incisor; a maxillary
midline deviation of 4 mm.
- on left side, we have a maxillary ectopic canine, however in Class I, because the upper
left incisor is edge to edge with the lower left canine.
• on right side, a sectionnal retractor with a Class II elastic and a Class II utility arch with
again a Class II elastic, worn 24 hours a day and changed three times.
• notice that the utility arch is cut behind the left central for placing on oblique elastic
during sleeping hours.
• on left side, a sectional retractor with a Class II elastic worn 24 hours a day and chan-
ged three times is going to bring downward and backward the left upper canine.
172
CHAPTER X: Rationale for Elastics Prescrition
Fig X. 6
QUIZ C
173
CHAPTER X: Rationale for Elastics Prescrition
Fig X. 7
SOLUTION C
174
CHAPTER X: Rationale for Elastics Prescrition
QUIZ D
- on right side, the upper right canine is missing, and we would like to use the first
bicuspid for canine function.
- anteriorly, we have a light open bite, with a light midline maxillary deviation of 2 mm
and an upper incisor protrusion.
With straight wires we may use closing elastics; but with the frictionless segmented techni-
que we can use:
• on right side, an M loop to bring forward the first bicuspid; and a closing loop behind
the upper lateral incisor to contract the incisor protrusion.
• on left side, we can have a contraction utility arch wire to close the bite and to contract
the incisor protrusion with the help of a double Class II elastic, the second one placed on
the canine in order to correct the Class II tendency and close the distal diastema.
175
CHAPTER X: Rationale for Elastics Prescrition
Fig X. 8
QUIZ D
176
CHAPTER X: Rationale for Elastics Prescrition
Fig X. 9
SOLUTION D
177
CONCLUSION
1) In treating your patient, use a whole philosophy rather than a technique.
5) Set a long range visualization of treatment objectives (the short range VTO
is not enough ! ).
Your patient tells you: “ Please use frictionless and light mechanics
to increase efficiency and comfort ”.
178
11) Treat the overbite before the overjet.
13) Increase the ease and efficiency of tooth movement with segmented arch-
wires.
14) Diminish anchorage problems with the use of utility archwires which also
allow more cases to be treated on a non-extraction basis in recovering the
Lee way.
15) Use elastics forces carefully to get a mobile force without threatening
anchorage.
16) In the mixed dentition malocclusion, to get early canine function, use
provocation of sequences of teeth eruption ( E the first, D the second and C
the last ).
17) Use the ideal patient arch form according to the facial type.
18) Recognize the benefit of the segmented technique to get intraoral adjust-
ments and optimize elastic forces.
20) Use selective retention devices to maintain treatment results until the
patient reaches maturity.
179
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184
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