Rmeric11 l1stitut1 for Biapro1ressive Ed1catian

THE IUISDOffl Of SECTIOURL fflECHRnlCS

co pg right 1998

bg Or. Robert m. Ricketts

 THE WISDOM OF
SECTIONAL MECHANICS:
INTERMAXILLARY TRACTION
IN NON-EXTRACTION THERAPY

Robert Murray Ricketts, D.D.S., M.S.

Director, American Institute for Bioprogressive Education

Professor of Orthodontics, Loma Linda University
Professor, Department of Orthodontics, U ,C.L.A.
Hon. Professor of Orthodontics, University of Illinois
Visiting Professor of Orthodontics,
Padmashree Dr. D.Y.Patal Dental College,
Bombay, India
© 1997 American Institute for Bioprogressive Education
Scottsdale, Arizona

and

Ricketts Research Library and Learning Center

Loma Linda University
Loma Linda, California
 THE WISDOM OF SECTIONAL MECHANICS:
INTERMAXILLARY TRACTION IN
NON-EXTRACTION THERAPY

By Robert M. Ricketts, D.D.S., M.S.

CHAPTER ONE: THE TRADITIONAL PROBLEMS IN MAXILLO­

MANDIBULAR MECHiLNICS
Introduction
Evolution to Full Banding and Interrnaxillary Traction
Techniques
The Ribbon Technique
The Theory of the Edgewise Bracket and
Other Full-Banded Techniques
Orthopedics and Edgewise Philosophy
Mandibular Stimulation
Maxillary Change
The Results of the Edgewise Practice
The Alteration of The Original Edgewise Theory
Secondary Edgewise
Cephalometric Findings
Did Fully-banded Techniques Promulgate The
Doctrine of Limitation?
Summary

CHAPTER TWO: STUDIES LEADING TO SECTIONAL THERAPY

Introduction
Segmentation
Sectionalization
Unitization
Experiments - Leading to Sectioning
Arch Sectioning, Cortical Anchorage, and TMJ Protection
Early Problems With Sectionals
A Primary Straight Section
The Utility Arch and the Utility Section
Push Coil Added
 Drift-odontics
Shielding Effect
Orthopedics and Sectional Mechanics
Cortical Clearance for the Upper Canine
Finishing and Detailing
Eighteen Advantages of Sectional Mechanics
Summary

CHAPTER THREE: THE THEORY OF INTERMAXILLARY ELASTICS

Introduction
Rating of Elastics
Use and Indication for Elastics
Clinical Guides
Indications
A Proposal for Numbering (1976)
Recommendations
Working Hypotheses
No. I-· Distances Standardized
No. 2 -· Vector Analysis
No. 3 -· Decay Rate
No. 4 -- Root Mass Calculations
Studies and Resulting Recommendations for Use
Application
Factors in Actual Clinical Experience
For Patient Education
Summary
Do's and Don'ts with Intermaxillary Traction

CHAPTER FOUR: STEP-BY-STEP TECHNIQUE FOR APPLICATION

OF SECTIONAL MECHANICS
Introduction
Root-Rating Scales
Armamentarium and Application
Wire Material
Brackets and Tubes
Prescription for the Upper Section
The Lower Prescription
Anchorage in the Lower
 Routine Adjustments of the Lower Utility Arch
Torque
Rotation
Tip-back
Expansion
Discussion of Utility Therapy
Torque on the Lower Incisors
Lateral Incisor Spacing
The Full Lower Arch Engagement
Premolar Prescription
The Upper Sectional Utility
Critical Bends in the Upper Utility Section
Sectional Arch Modifications
Simple Anterior Sections
Sectional Variations and Options
Review
Sections To Move Molars Distally First
To Review
Vector Analysis
The Upper Utility Arch - The Ultimate in Segmentation
Intrusion and Palatal Torque of Upper Incisors
Upper Bracket Prescriptions
Incisors
Premolars
The Upper Second Molar
Other Applications of Sectional Mechanics
Nasal Asymmetry Correction
The Canine Twist
Nasal Aperture and Cleft Palate Cases
Sectioning of the Lower Arch
Class III Mechanics
Crossbite Correction
Integration Mechanics
Summary
Do's and Don'ts for Sectional Mechanics

CHAPTER FIVE: GENERAL SUMMARY

General Principles of Sectional Mechanics
Deciduous Arch
Interceptive Dentition
Full Dentition
Anterior Sectioning
Finishing
 THE WISDOM OF SECTIONAL MECHANICS:
INTERMAXILLARY TRACTION IN
NON-EXTRACTION THERAPY

CHAPTER ONE
THE TRADITIONAL PROBLEMS
IN MAXILLO-MANDIBULAR MECHANICS

INTRODUCTION

Evolution to Full Banding and Intermaxillary Traction

In order to understand the application of intermaxillary elastics it would be
well to see things from their beginning. Angle laid claim to being the first person to
use a force from one arch to the other by means of a rubber elastic. However, he used
it from the lower to an impacted canine on the upper, apparently thinking that an
availability of movement of a single tooth was all that was possible. But Angle gave
ample credit to Baker, just before the tum of the century, for the demonstration that
intermaxillary elastics could indeed correct arch relationships.

The introduction of intermaxillary elastics had a profound effect on

orthodontics because it opened up a new possibility of arch correction. Prior to that
time, orthodontists had attempted to practice "bite jumping" with mandibular
propulsion as the chief method for correcting Class II malocclusion. When that
didn't work for Class II correction they resorted to extraction of upper first premolars
for the purpose of gaining space to retract the upper anterior segment. Anterior
retraction was frequently done with extraoral traction without the thought of molar
correction with that modality (Fig. 1-1).

With the demonstration of anchorage from the lower to the upper, and with
the use of elastics, Angle changed his opinion from extraction to non-extraction which
was to be manifested in his teachings in his career thereafter (Fig. 1-2). From
illustrations in Angle's publications it appeared that the elastics were (1) tied in and
(2) possibly employed with a magnitude of 300 to 400 grams per side. Angle
demonstrated that molar correction with intermaxillary elastics could be achieved in
three months with the use of the E-arch technique.

1
 ,.,°',
I

\\ '�..,,,
'\ ....'
\

\ \
'. \.

A B

D.

Fig. 1-1 A and B: Angle was the first to apply interrnaxill ary elastics to single teeth.
C and D: Angle's "bite jumper" as the only method for arch correction at the time.
E, F, and G: Angle's original extraction method for Class II.
 c

G
Fig. 1-2 A and B: Elastics (Baker anchorage 1898) applied to E arches (1900).
C: "Depression" demonstrated with the "Ribbon arch" (1916).
D and E: Examples of elastics with 2 x 2, 2 x 4, and 2 x 6.
F and G: The sliding yoke of Calvin Case (1921 ).
 In 1921 Calvin Case described a yoke to be placed over the arch labial wire in
order to administer intermaxillary traction with action directed initially on the first
molar (see Fig. 1-2). This could be likened to a sliding section along the arch wire but
still engaged a continuous wire as a base.

TECHNIQUES

The Ribbon Technique

The modern version of a ribbon philosophy is candidly referred to as "two by
four" (2 X 4) techniques. This implies the banding of two molars and the bracketing
of four incisors (Fig. 1-3). The anchoring of the lower molars beneath the buccal
plate (cortical anchorage) together with the depression on the incisors from tip-backs
on the molars is not too different from the old practices with the ribbon philosophy,
particularly in the mixed dentition. Unfortunately because patients treated with
Ribbon appliance technique were not studied cephalometrically, that technique was
frowned upon by Edgewise practitioners and ridiculed as being outmoded.

The Theory of the Edgewise Bracket and Other Full-Banded Techniques

· The "Ribbon" bracket lacked control of tooth angulation. The "Edgewise"
bracket provided mesio-distal angulation control as well as torque. With the switch
to the Edgewise bracket there also occurred a change in philosophy. The new
philosophy held that rather than becoming engaged in earlier treatment the most
practical course to follow for a patient would be to wait until all the permanent
teeth were available and manipulate all of them simultaneously and quickly.
Because bands were employed the procedure of putting a strap around the teeth with
a band, and around the arch with an arch wire, was candidly referred to as "the strap­
up". As the Begg treatment still proposes, interrnaxillary elastics were to be applied
immediately at the time of the placement of the first arch wires.

These first Edgewise techniques prescribed that the arches were to be leveled
and spaces to be created for alignment of teeth within the arch. At the same time the
lower arch was to be used as an anchor to move the complete upper arch distally for
Class II malocclusions. Fifteen Edgewise patients treated in 1948 were analyzed by
computer composites. Elastics were used in these patients, following six months of
"anchorage preparation" in the lower arch (Fig. 1-4).

The theories and practices of Edgewise were also developed prior to the
advent of the use of Cephalometrics as a tool to analyze the changes. The
practices were good theoretically but practically they failed, and history shows they

2
 Class II Low-convexity
Utility -elast1cs
Tl N 15 +
Age 11.25

55

126

Class II Low-con·
T2 N 15
Age 14.42 -t

Fig. 1-3 T l and T2 composites of patients corrected vvith Utility Arches. The same could
perhaps have been done vvith the Ribbon. B: The Four Position analysis:
 \

""" - --... - --.... --... -

-..
'\

'\

B: The Four Position analysis: note (I) chin

dosed, (2) maxilla reduced, (3) upper molar held and incisor intruded, (4) lower incisor
intruded; little anchorage loss.
 Standard Edgewise 1948
Tl Age 11.40
N=15 +

13.5

T2 Edgewise-Elastics

Age 13.50

N=15

Fig. l-4A
Edgewise in 1948: composites of group of patients with Tl beginning and T2 at
retention. Compare to Fig. 1-3. Note mean opening of facial Axis and facial height
even after 6 months of "anchorage preparation".
 T1 11.40
AGE
T2 13.50

Rotation

"' � • - .. I

..__
. . .�
'
·,
'

EDGEWISE

Extrusion

Fig. l-4B (I) Opening chin rotation, (2) limited orthopedics, (3) continued forward molar incisor
position.
(4) loss of lower anchorage.
led to a plethora of e\.rtractions.

ORTHOPEDICS AND EDGEWISE PHILOSOPHY

Mandibular Stimulation
It would appear from the literature that E. H. Angle, during the development
of the Edgewise mechanism at the latter part of his career, was of the opinion that the
growth of the mandible could be controlled. Stimulation of growth under the
influence of posturing or by the pull with elastics was alleged to be a potential source
of correction.

Careful cephalometric analysis in patients treated in the 1970s with elastics in

the range of 240 grams or more per side revealed that the basic mandibular structure
could indeed be modified in its short-term growth pattern when forces of a high
magnitude were induced (Fig. 1-5). However, it was further found that subsequently,
with natural development, the mandible would return to its predicted size and form.

It would therefore appear that any attempt to increase the amount of

mandibular growth by ordinary orthodontic means -- whether it be Herbst,
mandibular posturing or intermaxillary elastics -- has not been demonstrated in
long term (Fig. 1-6). In the end there was remodelling of the maxilla through
function and tooth movements accomplished.

Maxillary Change
The foregoing circumstances -- which appear to be factual -- leave the clinician
with the conclusion that true orthopedic modification (skeletal alteration) lies within
the maxillary complex in the long term. After all, change of the maxillary teeth was
the original objective with the Edgewise mechanism. Second order bends were
theorized, consisting of a series of tip-back bends combined with step bends, to be
activated by elastic traction from the lower arch. The second order bends were to be
activated by a depressing bend on the incisor segment which would first be
manifested against the upper lateral incisor. A hook was soldered onto the
rectangular arch and the elastics were placed mesial to the canine. This original
theory held that by a series of tip-backs, the apices of the roots could be used as an
anchor, to assist in the distallization of the upper arch as a whole unit (see Fig. 1-4).

The Results of the Edgewise Practice

In some patients the Edgewise theory worked satisfactorily, especially in

3
 Utility A&B Elastics
300 grams per side

R.V. Q Tl
13- 2 Yr.

9 mos;
\

R.V.
T2
®
13-11 Yr.

Fig. 1-5
"Orthope dics with Elastics!" A thirteen-year-old femal e wore two elastics bilaterally to
te st cortical anchorage of molars off Utility Arch e s only. Note that change s in 9
months' time included palatal alte ration and opening of Corpus-Condyle Axis. Patient
was another 9 months in finishing.
Dr. Kurt Faltin Sample

Bionator Treatment
Tl
�
.. .-�---···· f
Class II Age 9.8 Yr.
+ :
o· - - - �---· : : :;, ....---. - - - - - - - -- :�·;:!
N:50
I .,. , . t
I , I
I ., ' . . I

:
t ,, I
,, , :
: 92/94:
21 CJ
f I

,•'89/ :
''
68/60
I
'
I
'.
'
\
'
.
I
I
I

,,
I

.... 31/
I

,, •
I
'
I
I
'
•

'
I

..... .... .. .. . . :-
,_.,. :-:.- .. ,. ___ _
46 ,nt-z l
' ' I

'-
'' I '

' 126/119

Before
I
I
I

+:
.
! 22/24

··- ··-- ---··--·--

---
FACIAL PATTERN: MESOFACIAL
ff FACTORS �FD NORM CLINICAL
Int.,rlncleel Angle
Conve><ity
124.9
6.8
dg
mm
118.B
7.5
dg
mm
DEVIATION
1.0
-0.6
•
Lower Facial Height 44.8 dg 47 .0 dg -0.6
A6 Moler Po•ltion to PTV 16.2 mm 12.B mm
mm mm
0.0
Bl to A-Po Plane 1.0 3 0 -0.9
Bl Incllnatlon to A-Po
Feela I Depth
21.1 dg 26.0 dg
dg
-1.2 •
06.8 dg BB .4 -0.S
Facial Ax is 08.9 dg 09.0 dg 0.0
Ma><illery Depth 92.6 dg 93.S dg -0.3
Mandibular Plene to Fl-I 22.4 dg 23.6 dg -0.2
M1rnd ibu I ar Arc 30.7 dg 29.6 dg 0.3
Total Facial Height 60.0 60.0 dg
tlg
-��

Fig. 1-6 [Courtesy of Dr. Kurt Faltin]

A: TI composite of 50 patients before Bionator treatment (age 9.8 years).
 MAND AL FORECAST .

FALT IN CASES

Without Treatment

GR OWTH 6.3Yrs.

N:50 · Cutoff 16.1 Yr.

21'(; Faltin
29 Q ACTUAL 18.2 Yr.

Fig. 1-6 B: Forecast without treatment of the N=50 patients seen in Tl (A).
 K. Faltin Sample
Bionator

Class II Treated T2
N=50

.C

58/60 ....
3 4i'34
.• .•
..
•
\
\

.•.
•,
-�--------. - - . - . -
I I

. -- -+-=�--.----1-
I
- I
I I
I • • I
I

,•,
46/'47 .,•
'kI >
129/127
' .,
I
I

\ I

Long Range ,
.,'• ,
- .. � � :
'�� ... �i ,
•

\\�;
I

I • •
I
I
I '
•
I \

' .
I \
I \

+: \ I

20/20 ... ... .. ,

....... /
Actual 18.2 Yr ..

ff FACTORS MEASUlB> NORM CL!Nl CAL

VALUE OEVIAT! UN
Interinci9al Angle 128.9 dg 127.0 dg 0.3
Conve><lty 3.e mm 2.9 mm 0.3
Lower F•cial Height 46.1 dg 47.0 dg -0.2
A6 Moler Po9itlon to PTV 22.3 mm 21.0 mm 0.4
Bl to A-Po Plane 2.5 mm 3.0 mm -0.2
Bl Inclination t;o A-Po 24.5 dg 26.0 dg -0.4
Fac i a I Depth 8B.8 dg 91. l dg -0.7
Faci•I A>< is 89.1 dg 89.0 dg 0.0
Maxi I lary Depth 92.1 dg 93.5 pQ -0.5
Mandibtilar Plane t;o FH 20.2 dg 19.5 dg 0 .1
Mandibular Arc 33.9 d dg 0.1
-'k"t-, ·1
33.7
Total Facial Height 57.9 dg 60.0 dg

Processed 2/19/93
Fig. 1-6 C: T2 long-range composites of patients seen in A, at age 18.2 -- essentially 10 years
later.
 .,
S h o rt
9 2 /94
M A N DIB L E ,.,-4 . • • - . • . • • . - - • - - - • - • - • - -- -- - - -- - - · - - - - - · - · - ·- +-- -· - - · - ·
()
I

. . . I

and
I
8 9 /91 !
..
I
I
I

H EIG HT

D
A

Forecast to T2

9 2 /9-4

8 9 /91

.. •.

.,I

.
I
I

·,
PROFILE and · T E E T H

I
..L'
B

Fig. I-6 D: T2 comparisons on the mandible (A) and Facial Plane (B). Note the changes were
in the teeth and slight rotation of the mandible. No stimulation of mandibular
growth is suggested in long ranged (in this sample and six other samples of posturing
methods.
patients with brachyfacial patterns. These were conditions in which the lower arch
could be moved forward in keeping with correction for a retruded lower denture on a
good mandible, and in short faces in which the mandible could be rotated open.

However, findings in which the early technique was used soon began to
demonstrate, as Tweed declared in 1 936, that the face began to look "horsey" (or
long) and the upper anterior teeth were extruded despite the fulfillment of the
technique as was prescribed. Therefore, the results in the average patient, or the
patient with more of a dolichofacial pattern to start with, were often unacceptable in
terms of esthetics and also stability (Fig. 1 -7 A and B) .

On a practical basis, the average Class II has a 6 mm. discord. In the course of
treatment if the mandible is opened 4° , the condition to be treated is 1 50% worsened,
or a 9 mm. correction is necess ary. If, in addition, space is procured for premolars
and canines in the lower arch by a 3 mm. distal movement of the lower molar, then
there is a 200% increase in the amount of movement required for the Class II
correction. If the pattern is retrognathic the situation is even worse (Fig. 1 -8) .

In this analogy, with mandibular rotation uncontrolled, it can be readily

understood why clinicians opted for extraction.

THE ALTERATION OF THE ORIGINAL EDGEWISE THEORY

By I 940 two answers to the aforementioned clinical results were made. One
was by Tweed, the other by Brodie. Tweed, in the interests of preventing the
protrusion of the lower denture, prescribed extraction as the solution. He sustained
the idea of second-order bends and further applied tip-back/second-order bends to the
lower arch in the attempt to gain "toe-hold" anchorage. These actions were rigorous
by previous standards, but in the name of esthetics became popular for producing or
preserving a "chin button".

Brodie, on the other hand, advocated taking at least six months to "set up
anchorage" in the lower arch. Intermaxillary traction was delayed until the arch
levelling process had been completed and the teeth had been rotated into alignment.
Brodie further suggested that the six-months period also would utilize growth as an
assistant to the treatment. He further recommended that "lighter elastics" be used.
Both leaders advocated waiting for all the teeth to be present before the mechanics
were to be applied.

4
 MESO FACIAL

. BRAC HYFACIAL
D OLICHOFACIAL

Fig. l-7A Variation of the Facial Axis in a random sample of 50 Class II patients ( 1 948). Note
Mesofacial (typical 92°) with 1 2° to 13° variation from it on each side for Dolichofacial
(open) 79° and Brachyfacial (dosed) 1 04°.
 E X T R E M E S IN CLASS II
'
\

Ba

Gn

M a i n d i f f e r e n c e is
i n t h e m a n d i b le

Fig. l -7B A: Extremes compared on Facial Axis at Cc. Note the similarity of the cranial base and
Palatal plane, but differences in the angle BaNA (or maxillary protrusion).
B: Variation in bend of the body-rarnus as viewed in 1 948 from mandibular plane at
antegonial Point (extension of condyle plane) .
 .J. --

N OR M AL

Change in 2 Yr.

-1- --

1.0 mm.

r
6.0 mm.

Aids Class
Worsens Class II I
CLOSING
O PENING
H e lp s C lass III
o
C ancels Growth -a

Fig. 1 -8 Mean growth on a 90° Facial Axis carries the lower molar forward 3 mm. in two years.
Three degrees of rotation of the mandible cancels out gro� . Three degrees of closing
doubles the forward movement of the molar. Hence deep bite treated by premolar
extrusion worsens Class II.
 Brodie, for the "Primary Edgewise" technique, taught ( 1) to start with a gold
.022" X .028" wire adapted to the malocclusion of both arches, (2) slowly
straightening the wire, and (3) lengthening the wire with washers from a stop in front
of the molar, until arch length and arch levelling and alignment had been attained.
After this preliminary arch correction, or six to nine months after the "strap-up", the
second-order bends were placed and intermaxillary elastics were applied (see Fig. 1-4).

However, even with the slower technique, there was still a "tipping" of the
occlusal plane as a result of elastic pull. With the plane changed there was also
described a "dumping" of the lower incisors. Despite the attempts to intrude the
upper anterior teeth with a curved arch wire, the overall traction of the intermaxillary
elastics dominated. The upper incisors still extruded and the mandible rotated open
unfavorably. Theoretically, the incisors were to be intruded, and the lower incisors
were to be depressed, but premolar extrusion in both arches contributed to the
mandibular rotation.

Secondary Edgewise
Because adaptation of a rectangular arch wire was difficult and time­
consuming, clinical orthodontists preferred the use of round wires for the levelling
process together with the gaining of arch length for crowding correction. But levelling
of a deep bite with round wires tipped the lower incisors forward. There developed
consequently a practice to tie back the lower arch by means of a ligature around a
helix loop on the round . 0 l 611 wire anterior to the molar. This was used hopefully to
prevent the lower incisor from displacing forward. Graduation from .0 16" to .018" to
.020" round steel wire was taught as a standard procedure with Edgewise users
(Fig. 1-9).

Ironically, however, with the heavy intrusive force that was used, and because
the lower canine was also extruded, the lower incisor tended not to be depressed with
a series of straight wires. A technique developed, therefore, to deliberately extrude
the premolars, often with vertical elastics, for the process of levelling the arch or
treating the deep bite.

Not surprisingly, the tie-back on the molar also extruded that tooth. This was
possibly augmented by the anatomical curve of the root itself (see Fig. 1-9). The
initial stages of treatment for arch length and levelling management, even with the
"preparation", taxed the anchorage of the lower arch.

A further problem recognized with round wire, or even rectangular without

care, was that at each time a'f6tation was tied there was a tendency to straighten

5
 P R OXIMAL A N .C H O RAGE.
Second ary Edgewis e (with round w ir e )
" " "v 0 · "
Wire graduation .0 1 6 " to . 0 1 8 t o · 0 2 0 t o . 02 1 5 ;,.. .-o

Auxillary

Tie-backs tend t o
rotate m olars
and lose a n c h o r a g e Extru d e p r e m o lars

First m ovemen t
is further e x trusi o n
B e f o r e intrusion i n d e ep b i t e
the c anine

Q.
must tip

i· , _
and
,.110. f l ar es molar s

t1/_
,,,:Ll, � fle xes
..;;,>, . '.
wi r e

<' , - ·
C. 't- Tying rotations

Fig. 1-9 S econdary Edgewis e :

A : Headg ear was often used o n molars . Not e the looped ti e -backs.
B: Shows round wir e levelling. Note looped tie-backs.
C: Each tied rotation tends to straighten the wir e and flare the molars.
out the arch wire. Thus the crovvns of the lower molars tended to be "rolled"
buccally. This position placed molar roots upright bucco-lingually or in poor
anchorage position even with toe-holding. This is contrary to the cortical anchorage
theory of anchorage preservation that is currently taught in Bioprogressive
philosophy.

Setting up lower anchorage with round wires for later Class II elastic traction
proved to be problematical. Many clinicians -- realizing the inadequacies of the
roundwire technique for preservation of anchorage -- turned to extraoral traction, first
cervical, and later high pull. Even yet, change in the occlusal plane was still a
problem. The tension of intermaxillary elastics off continuous wires still tended to
extrude the upper incisors. Tipping of the occlusal plane led to the torquing of lower
incisors lingually as much as 10 degrees.

CEPHALOMETRIC FINDINGS

In 1947 a protocol was established by the author for the objective of studying
the influence of intermaxillary traction on the mandibular condyle to determine
whether or not there was a growth influence induced by the techniques employed at
that time. Laminagraphs of the joints were tal(en at the beginning, during, and at the
end of treatment. In addition, in order to determine the change in position of the
chin, each time that joint X-rays were tal(en a headplate was also obtained. It was
estimated that the pull of the intermaxillary elastics at that time (in which India
rubber rather than latex rubber was used) was in the range of 100 to 150 grams per
side. With a vector diagram the vertical component was 50 grams. It was observed
that an extrusion of the upper incisors took place, together with an upward and
forward displacement of the lower molar (see Fig. 1-4). Tipping of the occlusal plane
was almost inevitable with the technique practiced.

Tipping of the plane was particularly noted to occur at the later stages of the
correction at the time when inter-incisal interferences developed. A sample of Class II
children treated non-extraction with the Edgewise techniques showed that the mean
behavior was a rotation of the chin on the Facial Axis of 3° to 4° . Some patients
opened as much as 7° on the Facial Axis as a result of the Class II treatment.

It was quite clear that the mandibular rotation, induced by lower molar
extrusion and upper incisor extrusion, occurred as the result of the technique. It was
iatrogenic and not due to vertical growth as was believed. When such severe
rotations were encountered the theory also was that the mandible would rebound or

6
the chin would return to its normal position. Research by Cornforth later revealed
that in one-third of the patients the rebound did not occur, but that vertical behavior
continued. The untoward event of mandibular rotation, studied in 1960 and several
times thereafter, has been theorized in some patients to produce a permanent growth
inhibiting effect. This is found particularly in the face that is already longer than
normal or in patients with an asthenic condyle, but can begin as a brachyfacial
pattern (Fig. 1-10-A,B,C).

Did Fully-banded Techniques Promulgate The Doctrine of Limitation?

In retrospect, it was the fully banded techniques, as employed, which gave rise
to the Doctrine of Limitation and ushered in the extraction philosophy. In both
Class I and Class II these techniques tended to produce protrusive results together
with increases in maxillo-mandibular height. Both of these iatrogenic conditions
produced greater lip strain and hence mentalis elevation particularly in all but
brachyfacial faces. Esthetics suffered. Answers were needed and were sought.

Observations of the techniques employed combined with the biologic theories

of the 1930s and 1940s had led to the assumption that tooth intrusion was difficult
at best, and that distal movement of upper molars was questionable. Loss of posterior
anchorage occurred when anterior teeth were retracted vigorously in both arches. The
orthodontist thus became conscious of keeping teeth over "the ridge". In order to
satisfy esthetic objectives an answer was found in extraction of premolars, as
advocated by Tweed and supported by Strang.

Because it was further believed that no skeletal change could be achieved, and
that the muscle pattern was inherited and could not be changed, arch expansion also
was criticized. An old idea was renewed; upper premolars must be extracted in Class
II and lower premolars be extracted in Class III. Some clinicians, on seeing the drama
of the results, swore off intennaxillary traction altogether and looked to other means
for arch correction.

SUMMARY

There are essentially six methods that are available for the correction of the
Class II arch relationships. However, only in recent decades have methods for control
of maxilla-mandibular relation come under scrutiny. The oldest technique (1850)
was mandibular posturing. When that did not seem feasible, or successful,
orthodontists resorted to extraction of only upper premolars and employed the upper
posterior segments to retract the upper anterior segment. Extraoral traction was

7
 � T.R. T. R .
9- 1 0 1 1 -9
Y EARS

A' B

T . R.
1 2- 1 0
1 4 -4

c D

Fig. 1 - l OA Patient Developing J oint Disease

A. Beginning - brachyfacial type face with deep bite and crowded lower arch. Note
normal head posture. B. First phase correction age 1 1 -9. Normal growth behavior as
the bite was opened by extrusion of teeth intentionally. (Note facial height increase
from 57° to 6 1 °, -4°). C. After retention and observation to age 1 2- 10, the facial axis
opened 2° and oral gnomon 4 more degrees (total 4 1 ° to 49° = 8°) . Note asthenic
condyle. D. Severe open bite witnessed with arrest of the vertical cbndylar growth.
(Note now a 5 1 ° lower face height. Note also the change in head posture.)
 T. R. T. R . 2 1.e YRS
1 5-6
L . L A M I N A O R A P H, R. LAMINAG R A P H

F
E

T.R.

2 1 -9
R

G H

Fig. 1 -I OB E. A second treatment consisted of premolar extraction, and the vertical increase
continued; Facial Axis 93 ° to 84°, Facial Height 5 7° to 68°, denture height 4 1 ° yo 54°.
(Note root resorption.) F. Tomograms show advanced degenerative joint disease on
right side and loss of superior joint space on left side. G. By age 2 1-9 a condition was
stabilized with loss of I 0° on Facial Axis, an increase of 1 2° in Facial Height angle, and
13° opening of lower face height. ( Note relaps e of open bite.) H. Frontal shows
narrow nasal cavity and asymmetrical mandible.
 T. R O p R!: 0 I c T I O N COMPARISOH

ARCIAL NORMAL PREDICTION

to 1 4 . 8 t o a c tu a l
2 1 .9

COMP ARISON

FOR

POSITION

Fig. 1 - l OC I. The normal forecast of the mandible typical to the pattern for female patient T.R.
J. Comparison of the actual to the forecast; shows undergrowth and warped form
typical of degenerative j oint condition. (Normal forecast is now diagnostic. )
K. The result in chin position opened 1 0° as seen in G. of Fig. 1 - I OB.
Undergrowth of condyle opened the facial axis.
employed for the upper anterior segment retraction in Class II and for lower anterior
retraction after lower premolar extraction in Class III.

The second method of correction ( 1 900) was the use of intermaxillary

traction. That technique, however, tended to extrude the lower molars and the
upper incisors. This produced esthetic and functional problems, as it was employed.

The other techniques for molar correction are not the subject of this present
discourse, but for complete understanding they consist of the use of extraoral
traction ( 1 936), most effectively and conveniently achieved with cervical traction
which was the third alternative.

The fourth method, which is in the end more limited, is the use of a back.­
action palatal appliance (or quad helix) ( 1 952) which rotates the upper molar
distally. The fifth method, which is experimental, is the use of implants ( 1 990) on
bone which act as an anykyosed non-movable base.

A sixth method for Class II is a long-term maintenance of upper arch position

and employing mandibular growth alone ( 1 950).

This chapter constitutes a statement of the clinical problems with the use of
intraoral elastic traction leading to the breaking up of the continuous arch wire. In
the effort to prevent or control mandibular rotation four modifications were made.
These were ( 1 ) by incisor intrusion with transformo anchorage, (2) by the use of
cortical bone anchorage of the lower molar to prevent extrusion, (3) by orthopedic
movement of the entire maxillary complex and (4) by brealdng up the continuous
arch, or the ideal arch, into sections. The next chapter will deal with these
developments.

8
 THE WISDOM OF SECTIONAL MECHANICS:
INTERMAXILLARY TRACTION IN
NON-EXTRACTION THERAPY

CHAPTER TWO
STUDIES LEADING TO SECTIONAL THERAPY

INTRODUCTION

In Chapter One certain problems vvith the application of intermaxillary elastics

off full arches were explained. It was found that the theory of second-order bends in
the upper buccal segment affected the end result very little.

In this chapter, the objective is to show that_ intermaxillary traction can be a

powerful ally for the contemporary clinician, particularly when used vvith the
provision. of cortical mandibular anchorage which is different from methods employed
previously. Traction is especially effective when combined vvith sectionalization of
the maxillary arch.

Before proceeding, however, certain definitions and proposals are suggested to

help prevent misunderstandings.

Segmentation
To malce a segment is to separate into parts or to divide into sections.
Marking off a portion of a circle, or of an arc, is an act of segmentation. Thus
orthodontists such as Burstone refer to the buccal segment or the anterior segment of
a dental arch. But, as vvi.11 be understood, for a reference herein, "segmented" in
orthodontics refers to a portion of the dental arch managed but still connected in
some way to the other portions (Fig. 2-1).

Sectionalization
To section means to cut or separate completely. It also is talcen to mean the
dividing into parts which may be used as separate units. Sectional mechanics means
management of segments as separated units (Fig. 2-2). Anchorage and forces required
vary vvith the sections.

9
 SE GMENTATION

2 x 6

or

s e g m e nt
or

Examples of S e gm ents

Fig. 2 - 1 Represents the idea o f segmentation and the theory of transformo anchorage
(transferring anchorage away from the proximal tooth in the arch).
 S E CTIONALS

Straight S ection
{bucc al)
- ·�'.

ty}J:
Helix Back Action

Double T

Si ng le T

S ta bilizing S e c tion

T rip l e T
Conca tin a ted
section .

Clos e d Helix
fig. 2-2 Represents the concept of sectioning ,vith portions of the arch employed to anchor
against other sections either within the same arch or with the opposite arch.
Unitization
A unit is any fixed quality that serves as a single entity. Parts joined together
are considered to be unitized. Single teeth are simple units. Two or more teeth
joined are compound units (Fig. 2-3). A section may also be referred to as a unit
when all the teeth within the section are moved together or employed for anchorage.

EXPERIMENTS -- LEADING TO SECTIONING

Studies of arch-to-arch elastic traction effects was started prior to 1950. The
first effort was to improve the levelling and space-opening process in the arches
without excessive tipping. A .021" X .021" gold wire was adapted instead of the .016"
round steel wire. A bent stop was made at the molar. The wire was then straightened
to the ideal arch stage. After upper levelling was accomplished, sliding hooks were
placed on the arch wire.

Sliding hooks and yokes had been employed by Case to aid in the movement
of the upper buccal segments backward with intermaxillary traction. The hooks were
soldered to a short section of gold tubing material. This sliding hook circumvented
the need for second-order bends. With that sliding procedure to the buccal teeth
space was opened mesial to the canine. In fact, this procedure produced a
segmentation of the arch, as the buccal teeth were separated from the incisors
(Fig. 2-4).

Thus a more secure reduction was achieved without inordinate tipping of the
molar. Yet the elastic pull off a continuous wire still produced an extrusion of the
upper anterior teeth. Incisor retraction was now needed. With straight wire
theory, practiced at the time, it meant the use of a tie-back or pull coil springs.
Inadequate anchorage for retraction tended to move the upper buccal section forward
again.

The smaller square gold wire invited the introduction of loops! The procedure
developed was to manage the upper anterior segment with loops while the buccal
segment was supported from lower Class II elastics from the lower arch.

ARCH SECTIONING, CORTICAL ANCHORAGE, AND TMJ PROTECTION

In 1953 the author privately developed the "Sectograph Cephalometer".

Prescribed X-ray sections through the joint confirmed the findings made previously

10
 U NITIZATIO N

Bi Helix
Qu a d Helix

B ack Action H elix

Uprighting Spring

Face B ow To Molar

Labial Bar
Finger Sp ring

Free End

Fig. 2-3 Examples of single units for a single tooth, or a group of teeth as a unit.
 S L I D I N G H O O K TE C HN I Q U E
s egmented t h e arch

A
to
3 0°

B to 7

Sliding H o o k technique
Fig. 2-4 A. Efforts to conserve lower anchorage led to sliding mechanics in 1 950. The occlusal
plane still tipped.
B. Elastics exert around a 1 5 ° lateral pull.
with Laminagraphy. The possibility of "jamming" of the condyle, originally thought
desirable, had been theorized later to be damaging. Condyle compression was found
to be consistent with over-rotation of the mandible which was caused by ( 1) arch
levelling followed by (2) extrusion of teeth with elastics, and (3) complications with
"incisor interference". Therefore, further clinical experiments were set up in an
attempt to prevent the extrusion of both lower molars and upper incisors.

In 1954, after the arches in a group of patients were levelled in the traditional
manner, anchorage in the lower was enhanced by "buccal root torque" rather
than distal tipping or "toe-holding". The buccal plate of compact bone, as used,
was called cortical anchorage. This technique was aimed at preventing lower molar
extrusion from the intraoral elastic traction (Fig. 2-5).

Stated succinctly, if the roots of teeth were to be guided within the walls of the
alveolus for ease of movement it stood to reason that placing roots against the plates
would increase anchorage! It was further reasoned that the anchorage odds should
be improved by moving only the upper buccal segments distally. By reducing the
number of teeth to move distally the anchorage demands on the lower would thus be
reduced. The ratio of root surfaces was changed to favor the movement of the upper
segment. After levelling of the upper teeth had been accomplished, the ideal arch
wire was "cut" mesial to the canine. Complete "sectional mechanics" was thus
born (Fig. 2-6; also, see Fig. 2-2).

Instead of the sliding hook, the mesial end of the buccal section was bent
inward to serve as a hook for the intermaxillary elastic (see Fig. 2-6). The distal
bracl<.ets of the siamese design were tied on the canine. It was observed that the
buccal segment moved backward with greater efficiency than than ever before
observed. Now, with ( I ) a reduction of the drag on the lower, (2) by avoiding the
incisors and (3) with cortical anchorage setup, a better preservation of anchorage in
the lower arch was quite evident. It meant that less extraction was necessary for
even better results. The initial results were quite encouraging although fiercely
rejected by traditionalists.

EARLY PROBLEMS WITH SECTIONALS

With sectioning it was discovered that there was still an extruding effect on
the upper canines. In addition, a flaring of the section in the buccal direction was
noted (Fig. 2-7). The movement of the canine, together with the first premolar, was
downward, backward and outward. The pull of the intermaxillary elastic was indeed

11
 C ORTICAL M O LAR A N C H O RA G E

ob lique
ridge �

Four Classic Moves

B
R o ta t i o n

Tipping
T o rq u i n g Expansion

Maintain Level of Premo lars

Fig. 2-5 A. Buccal root torque anchors the lower molars.

B. Four moves for the molar with the Utility Arch or square wire.
C . Objective i s to treat to the lower first premolar level.
 \Vas h e r T e c hn i q u e
Id eal a r c h
Sliding Hook 1 95 0 i

Pla n e s ti l l tipp e d

. P IN CUTTER ( 1 9 5 4)
S e c ti o n e d A r c h

Cortical Anchorage

Fig. 2-6 A. Sliding techniques still lost anchorage.

B. Wire was "cut" to conserve anchorage and introduce "sectional" therapy.
 ARCH S E CTIONED

u. ·
w - .J

"'-

A �4�¢�=��{D o w nward p ull

Section flared

Fig. 2-7 A. Straight sectioned arch is pulled downward.

B. Section flared outw ard ( around palatal root) as a result of elastics.
downward, but also outward. The flaring of the segment, became a matter of
inquiry.

The movement outward seemed to be more than would be expected with the
lateral pull of the elastic alone (estimated to be 20 to 25 grams). Analysis in
progressive models suggested that perhaps another factor to consider was the
rotational effect of the upper molar around its palatal root during retraction (see
Fig. 2-7).

The effort was therefore made to increase the gable bend for molar rotation at
each adjustment. This was combined with an increased curve on the upper segment
(or to sweep it upward) in order to prevent canine extrusion. This kept the canine
"tucked in" relative to the first premolar to some degree, but the entire unit still
displaced downward, backward, and outward (Fig. 2-8).

A PRIMARY STRAIGHT SECTION

It was obvious that in order to keep the canine from extruding and flaring,
proximal levering from the first premolar was not adequate. The next
experiment was to start without banding or bonding the premolars altogether. A
straight-wire section was placed from molar to canine (Fig. 2-9). The upper canine
received about 50 grams of intruding force calculated to cancel the extrusion effect
from the elastic.

This type of straight section required two stops. One stop was the bayonet­
rotation bend at the molar which also was made to push the canine inward. Also, a
distal tipping bend prevented the canine extrusion from the elastic pull. A second
stop was bent at the canine to prevent buccal crowding. The results of this method
caused further excitement. It occurred at the time the bracket slots were reduced
from . 022" to . 0 1 8" and also as full preformed bands were being developed in 1958.
Combined with the cortical anchorage on the lower (often later from a lower Utility
Arch alone) the technique changed the clinical result significantly (see Fig. 2-9).

THE UTILITY ARCH AND THE UTILITY SECTION

In 1960 the "Utility" arch was developed. The idea of its configuration was
four-fold (Fig. 2- 10). First, a "by-pass" wire was stepped gingivally, to protect the
wire from the forces of occlusion. Secondly, a loop action was provided. In effect it

12
 Utility S ection
S traight Arch Section Bend ends inwa r d

1 5 grams
to prevent flare
°
Torque 1 7 from elastics

Keep g a bl e b end
active for rotatio n

A Keep rotation on molars

to prevent flare of canine
Maintain Arch Type

Fig. 2-8 A. Straight section flared and tipped even with premolars engaged.
B. The study for the solution led to a Utility Section with specific actions for the
canine from the molar.
 S TRAIGHT S E C TION Distal root angula tion
·P alatal root torque
N o length ening
Intrusion
Needs stops

.A

Cortical anchorage

o r--off Utility Arch B

\t
B u c c al R o o t T o r q u e
Intrusion

Fig. 2-9 A. The straight section was stopped at the molar and canine.
B. Anchorage from the lower molar was adequate with the four moves seen in Fig. 2-5.
 utility arch
This is the basic arch in th is segmented
appliance: . 0 1 6 x .01 6 Blue E LG I LOY
T h re e p la n e c o ntrol of molar.
/

..,___
O p e n lo o p

� T h ree' p la n e c o ntro l of i n c is o rs

posterior vertical step

F l a r e d for s hielding molar section
/ buccal bridge section

MO LA R ACT I VATION
�
I / anterior vertical step
200 -300 molar rotation
300 buccal root torque
30° -45° tip back

progressive
buccal root
torque

Fig. 2- 1 0 The utility arch and segmented control of anterior teeth became standard procedure.
Its nomenclature is shown in this illustration.
was an open loop with a bridge between the ends which permitted an opening or
closing of buccal space. The third aspect of the design was that the lower molar could
be controlled to produce an anchorage from the buccal bone. This "by-pass" wire
form was applied in both upper and lower arches (see Fig. 2-8). The fourth
characteristic was that force was transferred from proximal teeth to a more distant
site. It has several variations (Fig. 2-11) A complete manual was prepared for Utility
Arch therapy.

It became obvious that a shortened gingivally stepped wire could be employed

as an upper buccal section. Thus the label "Utility Section" was invented. The
design consisted of an open loop with a bridge between the vertical steps. Opening of
the space between the molar and the canine provided a primary action on the
molar (Fig. 2-12). This Utility Section has been the basic method of choice since the
early 1970s (see Fig. 2-12). The mesial movement of the canine was prevented by
the pull of a 150-gram elastic. Once the molar movement was initiated the canine
was also corrected, together with the molar, by the elastic traction.

With these procedures accomplished still better results were obtained. The tip­
bacl(. in the molar was in the range of 15° to 20° which acted to intrude the canine.
A rotation on the molar was in the range of another 10° (to the original rotation tube
of 15°), which kept the canine from flaring. The canine received about 5° more
lingual root torque in addition to the 7 ° in the bracket, which also had 5° - 7° mesial
inclination. The opening of the loop was about one-half millimeter.

As another option, the Sectional Utility was made in a "Z" shape on either end
so that a further opening action could be enjoyed in the event of a crowded buccal
segment. The Z section is actually a delta loop with a bridge (see Fig. 2-12). The
opening designs permitted premolars to drift distally.

Push Coil Added

During the l 970s, lessons were learned from Dr. William Wilson with regard
to his bimetric arch. That labio-lingual type consisted of an additional push coil
spring, placed on the arch wire mesial to the molar. These were to be activated by a
sliding open loop for continuous action on the molar. This apparatus was shown to
be most effective, but the Class II elastic traction still tended to produce an extrusion
effect on the incisors. The extrusion had to be offset by a distal tipping of the molar.
But, incisors that were already protrusive would receive an even more protrusive
action in the event of non-compliance with the wearing of elastics.

In keeping with the sectional philosophy, a push-coil utility opening section

13
 U tili ty Arch V ari ations

Fig. 2- 1 1 Variations in Utility Arches:

A. Opening - expansion
B. Z- or S-shaped (for opening or closing)
C. Simple closing
D. C ompound closing
E. Lower aligning ( also serves as lip bumper , or shielding)
F. Upper aligning.
 S t a n d a r d u p p e r U t ility S e ct i o n

. 0 1 e"X. 0 1 e"

In t r u s i o n 5 0 g r a m s

Torque 17°
� Mesial Tip 1 0 °
Open 1 .5 mm.

3 0° Buccal root torque

Z U tility S e c tion

Fig. 2- 12 A. Details for use of Utility Section

B. A "Z" Utility Section
was designed, particularly for use in adult patients (Fig. 2-13). Once the molar
movement was started, and the biology was in operation, it was better to keep it
going with a continuous action as long as it was not excessive. This became another
favorite option.

Still another choice was either a Utility tvvin loop or even a dual helix loop to
further lighten the force and keep it more continuous. All were successful and could
be prefabricated for ready application in order to save chair time.

Drift-odontics
In the late I 940s it was demonstrated that redirection of premolars into a
distal path followed a distal movement of the upper molar with face bow therapy.
The distal path of eruption of the upper premolars freed space for the upper
permanent canines to erupt in a downward, backward, and outward direction with
the face bow employed with progressive rotation and expansion. At that time it was .
assumed that the premolars were being pulled by the transeptal fibers around the
necks of the teeth or were directed by a positive force moving them distally.
However, at the same time it was discovered that upper canines, in the event of early
removal of a permanent first premolar, would also change their direction and erupt in
a downward and backward direction. This could not be e...'Plained on the basis of a
pull of the transeptal fibers. It therefore was evident that teeth would either erupt
or drift in the lines of least resistance or where space was available.

In the lower arch, for instance, patients following the early loss of the first
permanent molar have been seen to exhibit a distal premolar drift, amazingly,
sometimes a distal movement bodily. On the growth arc this could be explained as
non-drift forward.

On a biologic basis these "forces of nature" now were put to work for the
patient's and operator's benefit with sectional or by-pass maneuvers. Rather than
using fixed mechanics, and worldng hard to move premolars backward, the drift of
the teeth was employed -- together with modification of the maxillary base itself. A
surprising amount of posterior movement of the upper premolars occurred
without direct attachments to them. The effect was free to both doctor and
patient!

Shielding Effect
Another factor in the Utility Arch, and the Utility Section, is that they
produce a certain amount of lip or cheek shielding. Earlier, plastic tubing was placed
over the buccal portion of the wire for fear of injury to soft tissue, but with experience

14
 Push -coil U t i l i t y Sect i o n

Push
C o il

or

B u c c al R o o t T o r q Off Utility B
ue

Fig. 2- 1 3 Details of the very effi cie

nt Push-coil Utility Section use
treatment "Without extrac d in nearly all adult Class II
tion.
and proper placement of the height of the buccal section, it was found that tubing
was not necessary (see Fig. 2-8). The placement of the Utility Arch or the Utility
Section in either arch also protects the gingiva. It protects against direct pressure
eschemia from the lip or the cheek, but in addition "buccal drift" of premolars in
some patients is striking (see Fig. 2- 1 1 ).

ORTHOPEDICS AND SECTIONAL MECHANICS

The virtual elimination of the damaging effects of excessive rotation of the

mandible in the treatment of either Class I or Class II was evident by 196 1.
Geometrically, in the average patient, for every one degree of opening rotation of the
mandible, without growth, produced a 0.75 mm. backvvard movement of the lower
molar. Therefore a 4° rotation of the facial axis would move the lower molar
backward 3 mm. (closer to the Pterygoid Vertical plane). This adds significantly to
the distance that the upper first molar would need to be moved backward in order to
obtain a solid Class I relationship. Thus a part of the "wisdom" of sectional
mechanics is the prevention of rotation by anterior intrusion.

However, with sectional mechanics there is, in addition, an opportunity for

minor orthopedic palatal widening and palatal tilting (Figs. 2- 14 and 2- 15).

CORTICAL CLEARANCE FOR THE UPPER CANINE

One hundred years ago Gilford described a problem of keeping teeth roots
within the buccal and labial plates of bone for ease of movement. In fact, he also
explained that whenever teeth were moved labiolingually or buccolingually the forces
should be exceedingly gentle. He was mindful of the plates of the alveolus which
carry the main load of support. If the canine root is first moved into the outer plate
as attempts are made for its retraction, it is resisted by the labial cortical bone. The
labial plate is more difficult to resorb and requires more anchorage than the
cancellous bone. The canine is guided within the alveolar trough (see Fig. 2-9 and
Fig. 2- 12).

This principle has long been well appreciated in the event of retraction of the
canine in extraction cases. It is also a principle that should be remembered in the
event of the distal movement of a whole buccal segment in the treatment of a Class
II. This movement is difficult because the molar must be widened at the same time.

15
 S E C TIONALS UTILITIES E LASTICS

Cl a s s II
L o w C o nv e xi ty
D E E P B ITE
N:2 2
A g e 1 0.5 Y r .
Tl Before

A 1 27

N:22
L o w C o nve x i t y
Age 1 3 .S Yr.

T2 Af t e r T r .

56

PROVERS ION

Fig. 2-14 A. T l beginning composite of 22 patients with Class II deep bite with
moderate convexity.
B. T2 after treatment 'With sectionals, utilities and elastics. [See Fig. 2-15
for detailed analysis.]
 S ECTIO NALS
N.:22
T l to T2

3 mm,

2 m m ..

Fig. 2-15 An analysis o f patients seen in Fi gure 2-14:

( I ) Closing of facial axis and mm . of growth.
(2) Slight orthopedics in maxilla.
(3) Distal molar , together with intrusion and retraction of the upper incisors.
(4) Intrusion and retraction of lower incisors. Compare to Figures 1-3 and 1-4.
 Therefore, the primary action of a segmental wire should also be to torque the
canine root lingually (see Fig. 2-12). It should be maintained there until the Class
II action has been completed. If a Push-coil Utility Section is used, the canine may
remain stationary, only later requiring retraction (see Fig. 2-15) (see also Fig. 2-13).

FINISHING AND DETAILING

With space opening mesial to the canine following the Utility Section, a canine
retraction section may need to be employed later for space closure after maximum
distal premolar drift (see Fig. 2-15).

The same principle obtains for moving the incisors backward after canine
retraction as in extraction therapy. The canine root is guided between the plates so
that posterior anchorage will not be overtaxed. A separate manual was prepared for
extraction techniques.

For bodily retraction of the incisors against the palatal plate an intrusive force
is needed, which is a total of 140 grams for all four incisors (Fig. 2-16; see also Fig.
2-1 l D). But retraction of each lateral tal<.es 20 grams and each central is 25 grams,
mald.ng a total of only 90 grams, or 3 oz., because of the palatal bone. Thus,
intrusion forces are 1 gram per mm. 2 and retraction forces are 0.5 gram per mm. 2

EIGHTEEN ADVANTAGES OF SECTIONAL MECHANICS

The advantages are listed which have resulted from the experiments and
developments with pressure application on a clinical basis.

One: When buccal sections are employed, with the Utility shape or gingival
offset provisions, the distal force is directed initially on the upper molar. This design
unlodcs the crowding in the buccal segment, a behavior which is in marked contrast
to placing a drag required if teeth of the whole arch are moved as a compound unit.
Theoretically, in order to move the whole upper arch bodily in the sagittal
plane, about 375 grams per side would be required. To move an upper molar
directly distally tal<.es an average of only about 120 grams. This is only one-third the
force needed when the premolars, canine and incisors on one side are added as in
traditional Edgewise practice (Fig. 2-17).

Two: By means of a buccal section and distallization of a canine and/or the

16
 INTR U D E R- R E T R A C T OR

�����'
Intrude 1 40 gm.

.A

or Retract 9 0 gm.

fo r t o r q ui n g

c
'' ''
T s ection for buccal regulation
or

- ---------��-------------------------
O p e n i n g U t i lity

Fig. 2- 1 6 The second stage, after sectional mechanics, i s incisor intrusion and retraction.
A. An appliance for gentle intrusive retraction. Activate 1 to 2 rrun. only.
B. Design for torquing roots palatally.
C. A triple "T'' section.
D. Utility for expansion.
molar, there is a lessening of demand for anchorage on the lower arch. When the
lower molar root, of the first or the second molar or both, is torqued buccally
underneath the buccal plate, each tooth alone can withstand an elastic pull of
150 grams. Therefore, for a lower Utility Arch (or a lower lingual arch with
sufficient buccal root torque) the elastic pull can be withstood without moving
forward or without being extruded. This is a major source of anchorage
preservation.

Three: The tip-back on the molar required to intrude the canine places a
natural second-order action on the molar, which may assist in its distal movement.
The tipping action can be achieved with less force than bodily movement and
therefore even less force is needed if tipping actions are prescribed. Later uprighting
requires continued force, however, particularly in adults.

Four: The distal movement of either the molar crown or a bodily movement
distally will permit natural distal drift of premolars. This change can be enjoyed
without direct appliance action.

Five: The buccal section is adjusted to intrude the canine approximately 50

grams. This will prevent the canine from extruding under the pull of the
intermaxillary elastics of 1 50 grams. Throughout the life of the treatment a vector
analysis suggested that about one-third of the horizontal pull (or 50 grams) is
resolved in the vertical direction. [This is analyzed in Chapter Three.] Therefore, an
intrusive force against the canine will offset that vertical vector (see Fig. 2- 1 2).

Six: This condition gives the clinician the opportunity to check compliance of
the patient. If the canine is observed to be intruded with the buccal section
activated, the operator will know that the patient has not worn the elastics. If the
upper canine is extruded then the operator will know that not enough intrusive force
has been activated, or that the patient may be sneaking and wearing two elastics in
the hope of getting things speeded up. Intrusive forces are rated at 1 gram per mm. 2
(Fig. 2- 1 8).

Seven: With a lingual root torque bracket of 7° for the upper canine, according
to the Ricketts prescription, some of the labial root tipping may be avoided. But even
that is frequently not enough. Another 5° to 7° is added when the lingual root torque
bracket is used. If a labial torque bracket is employed there needs to be
approximately a 20° lingual torquing of the canine for the efficiency of this procedure.

Eight: A third action on the canine will be of assistance to aid in the reciprocal

17
 SA GITTAL PLANE
ROOT RATIN G S CALE
mm
so

-.
I 20 55 75 7 .5 40

sq uare
�

' Ji
M ... D millime ter L· L

A
10 60 60 80 2 5 25

_···_
· · · · · · · · · · · · · ll
A CTIVATE
-----\i ·· � on l y 2 m m

··
·· ········· · ··· gg·.9.

_:::, U s e n o more than

1 5 0 grams
{00.---�� B t o tal

Fig. 2-17 Above: the enface mean sizes of roots in the line of sagittal movements in mm. The
one gram per i:nm.2 value applies to movement between the alveolar walls. For
anchorage the forces are increased two to four times and the plates are engaged. For
modification of the ridge the force is reduced to 0.5 grams per rrun. 2 Below: the
application demonstrated -- retraction sections exert 75 grams per mm. activation.
 INTRUSIVE
PRESSURES

70 00 30 3 0 45 .30 4 0
sq uare
millime ter
·� • • •• •
• • ••• • •
75 85 30 30 35 20 20

1 gram p er mm. 2

Fig. 2- 1 8 The mean calculations as a working value for one square mm. of enface root surface in
the vertical plane. Note molars can be intruded with 80 grams of continuous force
while lower incisors require only 20 grams or less.
action of the canine and the molar. For instance, the canine root most frequently
needs to be moved bodily and, together vvith its intrusion, its lingual torquing also
needs to have a distal inclination of the root or a mesial direction at the crown.
This angulation action can be of assistance in preventing molar extrusion, as
about 25 grams of intruding force can be applied reciprocally to the upper
molar. This may be subtle, but is of significance in a sectional mechanical regime
(see Fig. 2-12).

Nine: A fourth action on the canine is one of tucking the canine inward, again
in the action to prevent it from engaging the buccal plate. Therefore, another
reciprocal action is obtained. The upper molar is rotated from a force on the canine,
which puts a lingual or palatal pressure on the canine. A rotation of the upper molar
is necessary in the vast majority of patients. The rotational effect on the molar keeps
the canine from flaring. This yields the ultimate canine tuck-in that is produced by
Bioprogressivists.

Ten: One of the greatest hidden advantages of sectional mechanics is that it

permits treatment of a unilateral condition rather than the complication that
appears vvith the need for skewing of a straight wire with ordinary, traditional
mechanics. Quite frequently, or maybe even in the majority of patients, a situation
exists in which both sides may be Class II, but one side is worse than the other. This
suggests, therefore, that more elastic traction is needed on one side than the other. fn
this event, full-time use of elastics can be placed on one side and night-time wear only
on the other, or two elastics worn at night only on one side while one is worn on the
other, so that in the end the two sides vvill be symmetrical. This is an advantage
often lost sight of, and is particularly efficient and advantageous (see Fig. 2-4).

Eleven: By using a section, and vvith the prevention of e..'i.rusion of the

premolar or the canine, there is also an avoidance of the need for premolar extrusion.
As stated frequently, some patients yield to the increased curve in the arch, which
may account for the mandibular rotation. Stated again, opening rotation of the
mandible moves the chin backvvard and downward, taldng the lower molar vvith it
and increasing the problem of Class II (see Fig. 2-5).

Twelve: With the use of utility buccal sections, and vvith a triple tube on the
upper, a separate utility unit from the molar is employed to manage the upper
incisors. A straight section can replace the Utility Section. A complete Utility Arch
is employed to intrude and retract the upper incisors with a remarkably gentle force
that prevents incisor e..'i.rusion as a result of the pull of the elastic. Other types may
be preferred, such as a back action loop to a closing helix or "upside down torque"

18
(see Fig. 2- 16).
This was the first principle of Bioprogressivists, in iYhich the overbite is treated
before the overjet, or the teeth are intruded before they are retracted. When the
incisor roots are placed against the palatal shelf, which is tough, gnarled bone, the
theoretical ideal pressure is one-half gram per square millimeter of root surface
engaging the bone. Calculated for typical root size, this suggests that only about 25
grams is needed for each central incisor and about 20 grams is needed for each lateral
incisor (Fig. 2- 19). Therefore, the pressure should be gentle and it should be
continuous. This is the advantage of a .0 16" X .0 l 6 11 Utility Arch. It may be used
later or be employed concomitant with the use of buccal segments. The point is that
cortical bone modification takes time.

Thirteen: Sectional mechanics is also employed for Class I. It is the rare

Class I that, after levelling and attaining of arch length, does not require some Class
II mechanics. Therefore, sectional mechanics can be enjoyed in Class I cases. This is
particularly true in Class I extraction cases. Sectional mechanics is quite effective in
the treatment of Class II, and is used in patients in which the Class II is a dental
Class II and not a skeletal Class II. Even skeletal Class II conditions in adults are best
treated with sectional mechanics. Nothing can be accomplished with reduction of
high convexity short of surgery in the adult patient.
If sectional mechanics is used in Class Ills, then the sequences are reversed
from those of Class II.

Fourteen: Sectional mechanics can be used in the mixed dentition, or even in

the deciduous dentition. With the first molars banded in the mixed dentition, the
deciduous canines can receive a bonded bracket. But quite often in such patients the
operator may make a Utility Section and ligate the section to the neck of the
deciduous canine, so that action can be delivered against the first molar. After the
molar has been reduced, then Utility Arches can be placed on the upper and lower
incisors, and the overbite and overjet can be reduced, followed by intermaxillary
traction.

Fifteen: The Utility Arch simplifies mechanics. This permits management

problems to be grossly reduced in the very young. But the techniques are best
applied to the very old patient. In adults in particular, mindful of appliances that are
conspicuous, buccal segment mechanics can carry the patient well along into
treatment without yet employing any appliances that will be conspicuous. Sectional
mechanics becomes a marketing tool with the promise that appliances that are
conspicuous will not be employed for more than half the duration of a patient's
orthodontic experience (Fig. 2-20).

19
 B O NE ENGA GEMENT

A 1 gram per mm . 2

B For S c l e r osis X 2 o r X 3 grams

C For c orti c al ch a n g e 1 / 2 gr a m

B 200 300 1 50 2 to 3 grams

.c r 5 0 7 5 25 2 5 4 0 20 25 1 /2 gra m
A 105 1 3 5 5 0 5 0 7 0 40 50 6 5 7 0 1 .0 gram

A 100 1 05 60 60 70 25 25 50 50
c1 50 55 30 30 35 15 15
B 200 20 0 150

Fig. 2- 1 9 Transverse Root Ratings:

A. For movements in cancellous bone, 1 gram per mm. 2 is a standard reference.
B. Forces for anchorage 2 to 4 times the standard.
C . Buccal-Labial expansion 0.5 or 1/2 gram per mm.2 (for ridge modification).
 --------------------------------------------
Detailing S e c t i o n s

or

D U s e if m a j o r

T r i p l e O p e n ''T" C a t e n a t e d

E D o u b l e d e l t a i s p owerful

1 2 5 G ra m s p e r mm. i
Fig. 2-20 After Class II reduction several conditions may exist and may be exercised.
A. Closed helix. B . Double "T". C. Buccal section for stabilization.
D . Triple "T". E. Double delta.
 Sh..'teen: In patients with severely crowded anterior teeth, the buccal segments
can be reduced and the drift that is enjoyed by the premolars can be enjoyed by the
incisors. Once given space, after the buccal section is reduced, then the natural forces
of the tongue and the lips will initiate the undoing of the crowding and the correction
of rotations anteriorly. This is also part of the management scheme for all patients.

Seventeen: While no data is available, theoretically at least, sectional

mechanics can help widen the palate orthopedically in the young patient. Certainly if
there is a lateral pull great enough to displace the canines buccally, that pull is
transmitted to the mid-maxillary suture. While it may be subtle, this action -­
particularly in a young patient -- will assist in the production of nasal integrity. This
is an aspect that needs to be studied carefully, but at least in theory it is another
advantage. It should be borne in mind, therefore, that while sectional mechanics is
being used in the young patient, a tying together at the midline of the incisors
should be avoided.

Eighteen: The use of segmental mechanics reduces the need for extraoral
traction. Headgear, while successful in adult patients, is very time-consuming and
difficult for total management. Therefore, distal movement of the buccal segments
can be achieved with these mechanics in order to circumvent the need for extraoral
therapy in adult Class II cases.

SUMMARY

The evolution of segmented mechanics was described. It started with sliding

hooks and led to the sectioning of an ideal arch. It went on to the elimination of
banding of the premolars and the use of a straight section. It proceeded therefrom to
a Utility Section which provided much versatility. Where spring and opening force
were desired in the buccal segment, other options were developed. These were a
Push-coil Utility Section, a "Z" Utility, a Double-open Utility, or even a Double-open
Helix Utility.

Many secondary benefits accrued by way of shielding and by way of levering

control for gentle continuous forces to be operative. It has been shown statistically
that a use of sections and the use of Utility Arches in the lower have dramatically
changed the results from those achieved with original Edgewise mechanics.
Eighteen advantages were listed with regard to the use of sections. Probably
the differences between Straight Wire and Bioprogressive are more profoundly
demonstrated with regard to sectional mechanics than with any other single issue.

20
 THE WISDOM OF SECTIONAL MECHANICS:
INTERMAXILLARY TRACTION IN
NON-EXTRACTIOI'"� THERAPY

CHAPTER THREE
THE THEORY OF INTERMAXILLARY ELASTICS

INTRODUCTION

With the Bioprogressive method, intermaxillary elastics constitute a significant

modality. It is unfortunate that many clinicians became frightened about their use.
This fear probably dates back to the early Edgewise techniques when arch levelling
with round wires was followed by prolonged use of vigorous Class II elastics. That
practice resulted in a forward movement of the lower arch and a forward canting of
the occlusal plane and inordinate lower facial height increases.

But intermaxillary traction is acceptable for a number of reasons, and several

goals can be attained with its use. Quite often, however, those who do prescribe the
use of elastics do so with no particular rationale or force in mind. With the disparity
of use, some order is indicated for clinical application, particularly with the
sophistication now employed in Bioprogressive mechanics, especially sectional
mechanics, the subject of this manual.

With so many commercial types of elastics available and with the variety of
techniques under consideration, the whole issue of elastic force becomes complicated.
Some years ago a color-coded regime for elastics was initiated, but the area still lacked
order and direction. Although coloring the elastic band served for identification, no
exact prescriptions were made.

Rating of Elastics
A problem existed in that elastics are rated by a pull three times their
unstressed length. The rating of a certain elastic is not the pull exerted clinically,
because they may be stretched twice or four times their length. The stretch will vary
with the dysplasia of the malocclusion and the position in which they are attached.

21
 A clinical reference base is needed, to include:
1. A clarification of the indication of elastics and their effectiveness,
2. A simple numbering system,
3. Analysis of force values and nomenclature, and
4. Recommendations for the application of intermaxillary elastics with
clinical techniques.

USE AND INDICATION FOR ELASTICS

The orthodontist may assume that patient cooperation with elastics is a

"cinch". This, of course, is false. It appears that it is at least as difficult to obtain
compliance with intraoral elastics as with routine use of extraoral traction or the
wearing of an activator. Simply handing a package of elastics to the patient with
instructions does not mal(e treatment happen. The patient should be treated as a
total human being. Explanations are in order, and cooperation is mandatory for
success.

It is appreciated that too much force on teeth can produce local ischemia.
Biologic stasis can occur as cell-free areas can be produced in the periodontal
membrane at heavy pressure sites. Therefore, the force and duration of elastics
theoretically can influence the outcome or the result.

Clinical Guides
The first cephalometric studies in 1938 showed the effects of elastics on the
lower arch. Investigation by the author in 1948 revealed that the greatest lower
anchorage slippage occurred when the lower molars were extruded from their sockets.
The danger was not the horizontal pull, but rather the vertical pull.

Another important observation was that extrusion of the molar seemed to be

related to incisor interference. In Class II correction the downward and backward
force of the elastic on the upper anteriors pulled the incisors into occlusal contact,
preventing molar occlusal function, and thus weal(ening their vertical stability. A
significant feature of the Bioprogressive technique is to situate molar roots
underneath heavy cortical buccal plates and prevent their vertical displacement,
together with prevention of incisor interference.

Thus, a second important feature in Bioprogressive technique is the intrusion

of the lower incisors, the upper incisors, or both, in order to prevent incisor
interference during the intermaxillary correction. Molar vertical displacement is,

22
 MAL O C CLUSION from L O W E R M O L A R

6mm.

- 6 mm.

NORMAL CLASS II CLAS S III

6 mm.

A
6 mm.

H o lding

B
Growth and
arch f o r m o nly
E lastics 60 grams

Fig. 3-I A typical Class II has a + 6 mm. molar fault. Class III is present at -6 mm.
A. The deep bite Class II also has 6 mm.. extrusion of lower incisor.
B. By holding the upper with elastics, intmding the l ower incisor, and not rotating the
mandible, a correction can be made with excellent grovvth alone.
 M AND IBULAR C O R RE C T I O N
( 1 } L o w e r slippage
R o un d wire B
or Ca nt p l a n e ( 1 2 0 g:r . )
A (2) Growth p at t e rn
or
(3) Mand.. orthop e d ics
· {240 to 2 8 0 gr . )
or
{4) S u rg i c a l { a d u l t)

.R E C IP R O CAL C H A N G E
M inimal Prep� B
S e c tional A
B
(1 0 0 gr.)

M A X ILLARY R E DU C TION
Orthopedics A
c M a x i m u m p r e p. B
�--��...,______ S e c tional A
(2 0 0 g r .)
or
S urgical L e F o r t

Fig. 3-2 Hierarchy of correction.

A. Forward movement of lower arch and no upper molar change by one of four
methods.
B . Movement of both arches reciprocally.
C. Essentially full reduction of maxilla.
however, advantageous in Class III cases where overclosure is present initially.

Indications
The indications for elastics depend upon the timing of their application and
anchorage preparation. A hierarchy may exist from lightest to heaviest elastic force
applied. The typical discrepancy from nonnal ideal relations in Class II is 6 mm. It
becomes Class III when the upper molar is found 6 mm. behind the lower molar.

A. The time employed for holding of the arches while growth is taking
place -- lightest force (30-60 grams), minimal anchorage preparation,
worn at night only. It should be understood that 7% of Class II molar
conditions self-correct with growth and development, and that flat bite
plates can prevent inclined plane locking. (See Fig. 3-1).

B. The correction of Class II cases by forward movement of the

mandibular arch -- moderate force (90-120 grams), no preparation,
and round arch used in the lower; preparation to full bracket
engagement in the upper with a square or rectangular wire (Fig. 3-2).

C. The reciprocal correction of Class II cases -- moderate force (100

grams), minimal preparation in both arches, full time use and sectional
mechanics in the maxillary arch (see Fig. 3-2).

D. The correction of a Class II problem by maxillary arch retraction --

200 grams, lower preparation to cortical anchorage, full-time use;
sectional mechanics in the upper (see Fig. 3-2).

E. The correction of a Class II problem by maxillary and/or mandibular

orthopedic alteration -- heaviest force (300 grams each side) with
ma..'Dmum mandibular preparation. This moves the maxilla and bends
the mandible until inclined plane coupling occurs (see Fig. 3-2).

Does it not now appear that diagnosis is important and sophisticated planning
is indicated?

A Proposal for Numbering ( 1 9 7 6)

The most common type of elastic currently used is the latex type. Fixed spring
modules have been employed, but yielded no anchorage preservation success. This
was due to the amount and duration of the spring force.

23
 The latex types are manufactured in the same manner as the India n1bber
band. A n1bber tubing is prepared by a dipping process on a steel mandrel of varying
thickness: the more dips the thicker the tube. The elastic is then sliced from that
tubing in varying widths. Manufacturers refer to "light" and "heavy", depending on
wall thickness of the tubing. Four factors play a part in the quality and
characteristics: the size of the lumen of the tubing, the thickness of the wall, the
width of the cut, and the properties of the elastic material.

One factor which does seem to be common is the sizing, which has been
graduated in 1/16 inch. Thus, a graduation exists, such as: 1/8 or 2/16, 3/16; 1/4 or
4/1 6, 5/16; 3/8 or 6/16, 7/16; 1/2 or 8/16 are usual sizes. For simplification elastics
were labeled #3, #4, #5, #6, etc., referring to each sixteenth of an inch.

There is, however, another variance. It pertains to light, medium and heavy
elastics among six different manufacturers whose products were studied. These varied
to such an extreme that no correlation existed. A medium in one line was equal to a
light in another line. The problem of semantics in the field was very confusing as
studied in 1976.

Recommendations

Recommendation No. 1 : To adopt a simplified numbering system as a

better means of nomenclature. Orthodontists would be advised to convert to the
metric scale and calculate from the flattened round rubber elastic for a simplified and
more descriptive starting point. For example:
1/2" = 12.6 mm. 1/4" = 6.3 mm. 1/8" = 3.15 mm.
A common #5 elastic (5/16") would equal 7 . 8 75 (or 8) mm., and a #6 elastic (6/16")
would be 9.45 (or 9.5) mm.

Recommendation No. 2: To adopt one size of wall thickness (small enough

to fit under the wing of a bracket).

Recommendation No. 3: To vary only the length of the elastics in selection

for adjustment so that some order and idea of force can be appreciated clinically.
Certainly all standard treatment may not be the same, even though all were treated
"entirely with intermaxillary traction".

24
WORIQNG HYPOTHESES

No. I -- Distances Standardized

Distances for the typical expectancy in the malocclusion can be averaged out.
Distances were calculated, first by taking measurements from the mouths of several
patients. Secondly, by working with the Ricketts template, varieties of situation were
simulated. The following values are submitted for consideration:
In Class II buccal segments, non-extraction, a distance of about 35 mm.
presents from the distal of the tube on a lower first molar to the mesial of a siamese
bracket on the upper canine (Fig. 3-3).
If a hook is soldered mesial to the canine and the bucca! leeth are spaced, these
values would be higher accordingly, perhaps 40 mm. or even more. By the time the
buccal segment is corrected to Class I, the distance drops to about 25 mm. But a 1 0
mm. increase in distance can be added if the lower second molar is included (see
Fig. 3-3).
In Class II buccal segments treated with extraction, the same factors prevail at
the beginning, i.e., 35 mm. (and 45 mm. if second molars are banded). However,
with space closure plus Class II correction, the distances drop to 20 mm. to the first
molar. It is about 30 mm. if lower second molars are used. This is a dimensional
drop of 15 mm. and changes the force and direction of the same elastic effectively.

No. 2 -- Vector Analysis

According to vector analysis of force, in which vector diagrams are used, the
horizontal and vertical components can be calculated. Jarabal( described vector
analysis (Fig. 3-4). The calculation is made by taking the force used and estimating
the angle of the elastic as it crosses the occlusal plane and then multiplying by the
cosine of the angle for the horizontal and the sine of the angle for the vertical pull.
Broken into abstraction, it yields 90% of the force horizontally and about 33% the
force to be effective in the vertical (with a 20° angle of pull across the occlusal plane)
(see Fig. 3-4).
If the analysis is to be made in a direct coordinate with the Frankfort plane,
these values would change because the average occlusal plane tips dmvnward (at age
8) by about I 0°. Thus, a vertical component would be even greater than 1/3 if
analyzed from the Frankfort Horizontal plane of reference.
Near the end of treatment, the vertical pull is probably nearly 50% of the total
pull as the occlusal plane becomes canted downward more and more by the
displacement of the lower molars and the upper incisors with some techniques. This
may explain why the longer the elastics are employed, the more danger there will be
of loss of anchorage and lower facial height increase. Thus the old concept of
"chasing the chin".

25
 INITIAL

after reduct i o n

EXTRACTION

Fig. 3-3 Analysis of length of pull and direction in clinical situations.

 CLASS I I E LA ST I C
COND ITIONS PREVAI LING
AT C E N T R I C

U P W A R D FORCES, POS.
DIST AL FORCES, POS.

Cli n ical application of parallel strand elastic i n centric occlusion.

6
_ _ _ _ _ _ _ _ __ _ _ _ _ - _ _ _ _ ______,,) � ���
HOOK , 9
f
50
� } _ P LA N E O F M A X I LLA RY
ARCH WIRE
_

y
- -- - - - - - T_L ____ _

C O N D I T I O N S PREVA I L I N G AT
AN OPEN I N G O F 1 0m m .
Clinical appli cation of parallel strands at 10 mm. opening.

. . . '1
---
<(I ----- .. . .. II!!==);=� . .

=�;:=�:;:;;;:;:;:;;;:;;;;::;;;:;:;:;;,;a�
. '-----·�--
REFERENCE LINE
PLANE OF
A R C H W I RE

E LA S T I C 'FROM MOLAR
BUTTON TO S LI D I N G HOOK

Clinical application of a Class II elastic from the lingual button.

Fig. 3-4 [ Courtesy of J. J arabak. ]

Force analysis at 20° oblique pull with the mandible at rest.
 Therefore, the longer the span of the pull, theoretically, the less the vertical
pull. It is for this reason that the elastic is hooked as far distally as possible on
the molar, or around the arch wire. A mesial hook on the first molar running to the
mesial of a canine is less than 15 mm. distant and at about 30° even with the mouth
closed (see Fig. 3-3). Thus, the value of lower second molar anchorage is seen for
elastic directional effect. This is aside from the cortical anchorage when the second
molar becomes available at the pubertal age level.

No. 3 -- Decay Rate

The elastic pull of force of any known material has a decay rate with use. The
elastic placed at the chair is not the ultimate force applied. Any decay rate is a rough
estimate, due to control problems in eJs.'}Jeriments. In addition, with movement the
distances shorten. Therefore, values are estimates, depending upon the material and
the patient.
It makes a difference as to how long each set of elastics is worn in any material.
A gross estimate is that a latex elastic soalced in saliva will lose probably less than
10% of its pull in 24 hours. Jarabak, in his work, indicated that the ordinary India
rubber elastics dropped from 200 grams to 1 50 grams in 24 hours, a 1/4 loss. A drop
in force was noted in the first few seconds in his studies. Some types of rubber may
lose half the pull in a similar period. Begg suggested that with three to four days' use
of the same set of elastics, a force of 2 to 3 oz. was his objective in the elastic pull.
But that was estimated from the size of elastics in use. He started with much higher
forces. In one test patient (B.T.) wearing the same latex elastics for one full week,
only a 24% drop in traction was noted. Therefore, latex elastics probably need to be
changed only every four days at most, and perhaps only every week!

No. 4 -- Root Mass Calculations

The force values, for prescribed effect, were worked out as modified for
individual root mass variation.
An elastic pull of 250 grams on each side equals 500 grams on the totai
maxillary complex; also, it applies against the total lower arch. The patient can
tolerate this force very well in most cases. A 500-gram force also appears to approach
the level easily. Prolonged force of this magnitude can affect the palatal plane in
the young patient. A pull of 150 grams (5 oz.) decaying down to about 120 grams (4
oz.) per side seems to work for Class II correction on sectional arches.
Other factors enter into the problem, such as length of time worn, the
individual's pain threshhold, the physiologic rotation of the mandible, and the overall
discrepancy needing correction.
Therefore, a current worldng hypothesis is offered:
A. For orthodontic correction (tooth movement without skeletal change) apply

26
 1 50 g-rams on each side which, dropping to the 1 20-gram range over a 24-hour
pe1iod, less 1 0% (for vector analysis) , results in a 1 35-gram drop to 1 10- 105
grams of horizontal pull for use with a sectioned upper arch.
B. For orthopedic correction (skeletal change) , the force used is in the 500-gram
range. Thus, 250 grams (8 oz. ) is used on each side at initial placement to
compensate for the drop in force. As the force is continued, there is a more
dramatic pull downward on the palatal plane. (Please understand that a
tipping of the whole palatal plane may be desirable in open bite cases.)

STUDIES AND RESULTING RECOMMENDATIONS FOR USE

The recommendation was to vary the length of the elastic, but not the wall
thickness. The analysis of a recommended walled latex elastic was approximated in
the following manner:

As measured from the inside lumen of the elastic, as flattened

before tension, the following resulted:
No. 3 start at 6 mm.
No. 4 start at 8 mm.
No. 5 start at 1 0 mm.
No. 6 start at 1 2 mm.
No. 7 start at 1 4 mm.
No. 8 start at 1 6 mm.
Thus, each 1/16 increase in size of the tubing used for making the elastic
averages about 2 mm. difference in the passive length of a cut elastic.
Samples of each of the following elastics were stretched to 35 mm. (the length
needed for Class II correction) , and the following rounded-out results were obtained:
Elastic Start Pulled Results in Yield
to Stretch

No. 3 --­ 6 mm. to 35 rrun. = 2 9 mm. stretch -- yielded 480 gr ams ( 1 6 oz.)
No. 4 8 mm. to 35 mm. = 27 mm. stretch -- yielded 360 grams ( 1 2 oz.)
No. 5 1 0 mm. to 35 mm. = 25 mm. stretch -- yielded 240 grams ( 8 oz.)
No. 6 --­ 12 mm. to 35 mm. = 23 mm. stretch -- yielded 1 60 grams ( 4 oz.)
No. 7 14 mm. to 35 mm. = 2 1 mm. stretch -- yielded 80 grams ( 3 oz. )
Note: A No. 6 ( 12 mm. ) light elastic (thin-walled) when tested at 35 mm. length
yielded 2.5 oz., or about 75 grams.

27
Therefore, in chart form an approximate, but not absolute interpretation of Hook.es'
Law (stress = strain) on grams per mm. of stretch may be listed:

No. 3 ---- 480 grams/29 nm1. = 16.0 grams per mm. stretch
No. 4 ---- 360 grams/27 nm1. = 14.0 grams per nm1. stretch
No. 5 ---- 250 grams/25 mm. = l 0.0 grams per mm. stretch
No. 6 ---- 1 60 grams/23 mm. = 7.0 grams per mm. stretch
No. 7 ---- 80 grams/2 1 nm1. = 3.5 grams per mm. stretd1

Application
In calculating the elastic force needed for a typical Class II, the foregoing chart
shows the force proposed. Working backward for an orthopedic force, therefore, a
No. 4 elastic would yield 360 grams for each side. This is 720 grams total, less 20%
decay rate = 57 6 grams, less 10% vector analysis = 510, hence orthopedic in
capacity.

For a reciprocal action, depending on desire and without lower preparation, the
elastic choice would be 160 grams or No. 6 on each side. Working to hold the teeth
or arches only while growth is occurring, the force would be 80 grams; hence, a No. 7
would be the choice. This may also be put in chart f01m:

Light Moderately Medium Moderately Heavy

Light Heavy

1 . Holding 50

2 . Forward lvlovement of 150

mandibular teeth

3. Reciprocal 250

4. Backvvard Ivlovement of 400

maxillary teeth

5. Orthopedic 500+

28
Thus, in order to select a proper elastic and given a choice of favored elastic:
A. Calculate distance of span '(35 mm.)
B. Select force desired -- say, 250 grams
C. Select total stretch needed = 25 mm.
D. Divide by gram/mm. elastic rating
For example: A No. 5 rated at 10 gram/mm., therefore, is the elastic of choice.

Factors in Actual Clinical Experience

Direct translatory behavior is very difficult vvith intermaxillary traction.
Tipping of individual teeth is introduced, and tipping of the occlusal plane is likewise
produced as well as some alteration of the palatal and mandibular planes if care is not
exercised. It can be accomplished, however, due to the entrance of absence of pain
resistance of muscles (Figs. 3-5 and 3-6).

Successful elastic pull for correction of Class II is about 150 grams (or 5 oz.)
on each side. Calculated for decay rate, this is reduced to 135 grams; calculated for
vector analysis (90%), it results in about 120 grams of pull. The vertical pull is about
one-third that, or about 40 grams.

A challenging patient with a relatively long face and potential vertical growth
was analyzed. This male was treated solely vvith sectional elastics and finishing arches
(see Figs. 3-5 and 3-6). The answer to the riddle may lie in the fact that a tipping
force usually results. Consequently, the resistance is not parallel to the long axis of
the teeth but in oblique directions (Fig. 3-7). This changes their enface
presentation to bony resistance. Further, in Class II therapy the upper molar is
tipped backvvard by intruding forces for depression of upper incisors in sectional
mechanics, which may be activated by elastics off the lower Utility Arch.

In the permanent dentition, when Class II correction is desired by distal

movement of the upper arch, the whole arch is not fixed into one solid unit with
an ideal arch. The arch is divided as Utility Sections are employed. The upper molar
is tipped backward in second-order fashion by a depression force on the canine to
offset the elongating effect of the intermaxillary elastic. The premolars are simply left
to float and permitted to drift temporarily at this stage. The incisors are managed at
a second stage of elastic traction.

In some patients, particularly Class II, Division 2, with blocked out canines,

29
 ,..,
C .u . o"'
2-74
Age 1 1 .5

86

143

C.G. (f
2-7 7
Age 1 4. 5

137

Fig. 3-5 A. T l , a male patient Class II, deep bite in a long face.
B . T2, after treatment with elastics and sectional-segmented mechanics.
 C . G . 1 1 . 5 to 1 4 . 5

\ I
'- _ I

Fig. 3-6 Four-Position .Analysis of patient C.G.,

seen in Fig. 3-5.
1 . Note only slight opening
2. Note maxillary orthopedics.
3. Note direct distal movement of upper arch.
4. Note no anchorage loss and lower incisor intrusion.
 /
/
/
/

Fig. 3-7 A. The forces during distal movement of the upper buccal segment vvith elastics is
from an oblique direction.
B. Intruding force for the incisors also tips the molar distally.
C. Tipping is countered by a short buccal section when all four incisors are intruded.
needing much intrusion of the upper incisor, a double system is used: one to a
straight section to the premolars and a second to manage the incisors. A "Z" bend
,vill later receive the elastic (see Fig. 3-5). In some cases elastics have been applied to
both the buccal section and the upper "Z" utility. Therefore, the balance of force can
be shifted in favor of the lower. The anchorage resistance is enhanced effectively by
maldng sure the roots of the lower molar are flared buccally. This keeps the root of
the molar locked under the buccal cortical plate and prevents it being pulled obliquely
upward and forward during heavy Class II traction.

When handled correctly, the upper incisors can be moved directly backvvard or
even intruded, as intermaxillary elastics are used in the Bioprogressive technique (see
Chapter Two). This becomes a starting reference, and the details of buccal section
retraction, reciprocal retraction, and orthopedic intermaxillary retraction require more
discussion. Treatment with the use of intermaxillary traction will ultimately be made
more scientific if these principles are applied.

In some patients, even '\vith loss of lower anchorage vertically and '\vith high
pain threshold and strong musculature, the upper incisors may intrude, which will
cancel mandibular rotation.

There is even a factor, less studied, which suggests that slight molar extrusion
can invite vertical growth of the condyle and forward behavior of the chin.

For Patient Education

Almost all orthodontists use elastics in one form or another in the treatment of
malocclusions. The property of elasticity is one in which a substance tends to return
to its previous state after having been stretched or distorted. By taldng advantage of
the stretching of a small band of elastic material, the orthodontist can apply force to
the teeth in a precisely prescribed manner.

Elastics may be of several types. A plain India rubber band is employed for
extraoral force. A second type is the latex elastic for intraoral work. A third type of
elastic is the nylon thread in which a thin, light thread of nylon is wrapped around a
latex rubber elastic to increase its resiliency and support. The fourth type used is a
plastic elastic, which are made in small rings, or assembled in small chains. The
plastic may appear to be similar to the latex elastic, or it may be molded in various
colors.

An elastic running across the mouth from one side to the other is called a
"transverse" elastic. If the posterior teeth are in crossbite, then the elastic may be

30
applied from the outside of one to the inside of another; this is called a "criss-cross"
elastic. The author prefers these to be employed with sectional mechanics in one or
the other or both buccal segments. In the case of an open bite, "up-and-dovvn" or
vertical elastics are used to close the teeth together. One very important fact should
be emphasized: elastics must be carefully worn as prescribed.

There is one thing the patient must remember: the orthodontist cannot be
there to place the n1bber bands or elastics. He cannot wear them for the patient.
The best way to get teeth treated on time is to wear the elastics strictly as prescribed.
If they are tal<:.en off for eating, they can be placed around the finger as a reminder to
replace them in the mouth after eating. The patient should remember also that the
conection does not take place until they have been worn for some time. For this
reason, treatment cannot be approached in a casual or haphazard manner. There is a
conjecture, however, that -- as with extraoral traction -- if the patient wears the
elastics faithfully at night only and perhaps slightly stronger than typically prescribed,
the effect and result may be similar.

Orthodontic treatment is a rewarding experience, and contributes to a

beautiful face, a glamorous smile, security in oral health, and recognition of pleasure
by one's friends. Patients should remember that it's up to them, in the end.

SUMMARY
At the time of this writing intermaxillary elastics for maxillo-mandibular arch
conection have been employed for almost exactly a century. They have been
misused and abused, praised and derided, but have steadfastly remained a potent tool
for orthodontics. Elasticity in materials both plastic and metal is employed to apply
pressure.

This chapter has attempted to raise the level of science to the better
application of the art of orthodontics.

31
 DO 'S AND DON'TS WITH
INTERMAXILLARY ELASTIC TRACTION

1. DO learn to use elastics. Elastics are the most widely used

, for interrnaxillarv
modalitv , correction.

2. DON'T fear elastics.

3. DO understand that elastics are graded by the pull three times

their natural length.

4. DO believe that a particular strength will move teeth and that

higher levels can affect basal bones.

5. D O know that latex elastics can be employed for one whole

week without losing more than 25% of their pull.

6. DO use about 1 50 grams for Class II elastics off sections.

7. DO understand that the vertical pull over the treatment period

will average about one-third the oblique pull, while two-thirds is
horizontal.

8. DO comprehend the parallelograms of forces.

9. DO simplify elastics for better application. A short thin elastic

can exert the same force as a longer thick elastic.

1 0. DO t1y to use elastics about 1 mm. square wall thickness

graduated in lengths.

1 1. DO know that elastics are graduated in fractions of inches on

the inside lumen and can be reduced to a single number for
reference. Example: 1/8" = 2/1 6 = #2
3/1 6 = #3
1/4" = 4/1 6 = #4
5/1 6 = #5
3/8" = 6/1 6 = #6
1/2" = 8/1 6 = #8
5/8" = 1 0/ 1 6 = # I O

32
12. DO understand that the longer the distance between the ends
where the elastic is attached the more horizontal the pull.

13. DO know that hook extensions incisally on the upper arch will
make the pull more horizontal.

14. DO perceive that the vertical component tends to extrude teeth.

15. DO believe that a Utility Section can be activated 50 grams to

intn1de the upper canine to offset the vertical pull on the elastics,
which is 50 grams.

16. DON'T use elastics until lower molars are put in anchor
positions or are in torque position at the start unless anchorage
loss is desired.

17. DO use elastics off round wires and upright lower molars bucco­
lingually if you desire to move the lower arch forward.

18. DO produce incisor interference if occlusal plane tipping is

desired, but watch for joint involvement.

19. DO use about 100 grams of transverse pull for anterior sections
for midline conections.

20. DO understand that details of full-time light wear have not been
scientifically compared to night wear only, or double elastic night
wear only.

21. DO know that long faces have long alveolar processes and that
molars above the external oblique ridge are less stable for
intennaxillary conecti on.

22. DO, for true buccal crossbite and molar overbite, use the #3 criss­
cross across the occlusal surfaces continuously for molar intrusion
on buccal sections.

23. DON'T stop elastics until the condition is overtreated and the
 condyle is in physiologic centric.

24. DO use elastics for gathering space in the upper anterior while
holding buccal sections in the upper with Class II elastics at the
canine.

25. DO correct Class III with the same p1inciples as desc1ibed for
Class IL

2 6. DO use vertical elastics for open bite squeeze treatment.

27. DO use elastics off neck ties in appropriate situations.

34
 THE WISDOM OF SECTIONAL MECHANICS:
INTERMAXILLARY TRACTION IN
NON-EXTRACTION THERAPY

CHAPTER FOUR
STEP-BY-STEP TECHNIQUE FOR APPLICATION
OF SECTIONAL MECHANICS

INTRODUCTION

Sectional mechanics is complicated and difficult to teach. It becomes easy

through study and understanding. The present thesis alludes to the sectional
mechanics employed for non-extraction, although principles apply to extraction
treatment also. These principles may apply both to child patients for treatment of
the deciduous dentition, mixed dentitions, to adolescent patients, or on to adult
patients.

Sectional mechanics can be a starting procedure, employed as the first

modality, or it can be particularly useful near the end of treatment when finishing is
difficult. Be not ashamed to cut the ideal arch wire! The benefits of
sectionalizing and transformo anchorage can be enjoyed at any time. The author has
demonstrated cutting the straight wire to the dismay (but later the gratification) of
graduate students on the clinic floor of several universities. There comes a time for
"breala.ng up the straight wire". Both patient and clinician can benefit greatly by
" sectional" mechanics.

ROOT-RATING SCALES

The root-rating scales are described in Chapter Two (Figs. 2-15, 2-17 , 2-18).
Force values are referred to specifically here in order to explain the mala.ng of
adjustments with wires or the understanding of modules for the practicing of this
technique.

35
ARMAMENTARIUM AND APPLICATION

Wire Material
It was found that one vvire, the .0 1 6" X .0 1 6" blue Elgiloy, is all that is
necessary for the armamentarium. It is surprising how that square vvire can be
adapted for virtually every purpose. Each operator should learn the delivery capacity
and character of this square vvire (Fig. 4-1 ). When the cross-section of many
common-sized vvires is compared, there comes a rather shocking revelation (Fig. 4-2).

Ligation of the vvire into .01 8" brackets can be made vvith either a .009 or .0 1 0
ligating wire, or plastic "O ring" ties. The author has preferred ligature ties because of
hygiene and stability. Due to the critical nature of the security at the canine, the
operator might consider using a firm ligation vvire, particularly on this tooth. The
wire is tvvisted with a pin cutter. This, however, is a matter of preference.

Brackets and Tubes

For these sectional techniques the classic Ricketts bracket-tube formulations
are recommended as produced by RMO. The reasons for each prescription should be
understood. But the consummate operator will need to bend the wire to comply with
the principles (Fig. 4-3). No one straight-wire system vvill fit all types of teeth and all
types of normal relations. Bending is required, and loops lend efficiency, control and
range of motion and safety. There are a few which have become standard through
the last four decades.

Prescription for The Upper Buccal Section

The upper first molar band receives a "triple" tube (the .0 1 8" X .025 "double"
Edgewise tube and a gingival . 045" tube) as a standard for headgear or for a buccal
bar. The gingival placement of the headgear tube makes the Edgewise tubes more
accessible and places the force nearer to the root centroid. v,.11i.en the upper second
molar is employed the tube is offset to the occlusal so that a straight finishing wire
will develop the occlusal curve. All the three tubes are rotated 1 5° (Fig. 4-4).

The Lower Prescription

The lower first molar band has a double Edgewise tube in .01 8" dimension.
Both tubes are angled 5° , torqued 24°, and rotated 1 2 ° (Fig. 4-5) to the buccal surface
of the band.

The lower second molar is used when available, vvith a double tube torqued
34 , angled 5°, and rotated 6°. If desired, the two molars can be placed in tandem for
°

better leverage from the first molar. The tube on the second molar is .offset 2.0 mm.

36
 CAPACITY OF

. 0 1 6 �, x .0 1 6� 1

BLUE ELGILOY WIRE

Conclusion a bout 2 0 0 0 gram m m . o f moment

F ORCE
LENGTH OF BEND I N G

@ 40 mm + 5 0 g r a ms
@ 3 5m m + 6 0 gr a m s
+ 7 0 g r a ms
: 36mm

@ 30mm • F O R D O U B LE D E LT A

@ 2 5m m + 8 0 gra ms
@ 20mm + 1 00 g ra ms
·@ 1 0m m + 2 00 gra ms
@ Smm + 4 00 g ra ms
@ 4mm + 5 0 0 g ra ms
@ 3 rn m + 600 g r a ms

Values r o u n d e d off for c li n i c a l use

Fig. 4- 1 The blue (or yellow) .0 1 6" square wire (0.4 1 mm.2 ) is the standard. It offers three-plane
control. Note that at 3 mm. (the distance between two lower incisor brackets) it
supports 600 grams but at 40 mm. will support only 50 grams. The introduction of a
Double Delta loop at 36 mm. of wire reduces force in the wire from 500 grams to 50
grams! All loops need to be analyzed for length and force (see Fig. 4-3).
 C O MP A R ATIVE CROSS S E CTION O F WIRES

INCHES MILLIMETERS SQ . MM .

0 . 045 1 • 522 1 • 81 8

0 . 030 1 • 01 5 0 . 800

D . 022 x . 028 , 644 x , 937 0 . 603

D . 02 1 5 x . 02 5 . 624 x , 78 1 0 , 487

D . 02 1 x , 02 1 . 60 5 x . 60 5 0 , 36 6

D • 01 9 x • 01 9 . 527 x . 527 0 . 278

D , 01 6 x . 022 . 4 1 0 x . 644 0 . 2 64

D . 01 4 x , 023 . 322 x . 684 0 . 227

D O . 0 1 6 x . 01 6 , 41 0 x , 41 0 0 . 1 68

0 , 01 4 . 322 0 . 08 6

0 . 01 2 , 24 4 0 . 047

0 .0 1 0 .2 1 0 0 .0 2 5

Fig. 4-2 Th e cross-section of a wire and th e direction of its bend determine the major asp ect of
force delivered. Note the star at .0 1 6" X .0 1 6" wire to denote the standard size used.
 LOOP NOMENCLATURE

== � �
Gable
B a y o net Stop

/)) � rt2
Tie b a c k O pen B oot Open "T"

• 2
K e y h o le O mega
s-z
D e lta End stop
Q)

fOl
©1
�
©
:
O p e n h e li x
C lo s e d
H e lix B a c k a c t i o n h e lix

ij � �

C lo s e d h e lix C r o s s e d "T " Boot h e lix "L "

\�=

D o ub le d e lta D o uble closed h e lix Ex p a n s i o n h e lix

Fig. 4-3 Essentially all the bends recorrunended are shown. Loops may extend 4 to 6 rrun. in the
lower and more in the upper. Combinations are employed for variation.
 UPPER SET-UP for S ECTIONALS

R otatio n
T rip le tub e . 0 1 8 "X . 0 2 5 " 1 5°

Tuck-in

0.9 m m ..

oo + 70
oo + 70
0 .4 m m .. Torque
A n g le
R ais e

Tube o c c lu s a lw a rd
2 , Om m . �h=x:C��:;::3:=r=
S t.wire intrudes 2 n d ., molar

Fig. 4-4 Upper tube p ositions and torques, rotations and raises are demonstrated for sectional
set-ups.
 LOWER SET-UP for SEGM ENTS

0
D o ub le tubes . 0 1 s X . 0 2 5 ·
°

-5 0 -50

gin giva l/y

A n g u la t i o n
---- T o rque -------
-34 0 -2 4 0 - 1 4°

Can ine "Tu c k "

Fig. 4-5 Lower tooth angulation, height to marginal ridges, torques, rotations and raises are
demonstrated for principal teeth in sectional mechanics (except upper anteriors).
gingivally for development of the curve.

A Utility Arch in deep bite Class II, Division 1, is usually placed first on the
lower arch (.'>ee Fig. 4-5). For the lower incisors the standard straight bracket is
employed with a 0. 7 mm. raise. The lower laterals are angled about 2 ° (downward
on the mesial) for aid in intrusion and future finishing. The 0° torque on the lower
incisor places the long axis on average the ideal l 6° to the ocdusal plane. When
lower canines are engaged, usually later, the standard canine bracket is raised 0.9
mm. , is torqued 2°, and angled 2 ° (see Fig. 4-5).

ANCHORAGE IN THE LOWER

One of the primary problems with intermaxillary elastic traction in the past
was that dramatic anchorage loss in the lower arch was observed most when the
lower molar became extruded (see Fig. 1-4). This also tipped the lower incisor
forward. In 1954 it was found that sustaining the lower first molar with a significant
buccal root torque locked it under the cortical plate and supplied anchorage both
vertically as well as horizontally (see Fig. 2-14).

A management concern with anchorage in the lower arch deals with three other
factors. The first is arch form. If the lower arch remains narrowed, then the buccal
plate of the lower arch is not engaged as much for anchorage. So, by maintaining a
more rounded arch shape the bony anchorage of the lower arch may be enhanced.
Anchorage also is preserved by keeping proper torque on the lower buccal
segment. This includes the second premolar, if needed (see Fig. 4-5). When
available the second molar alone properly torqued can provide significant anchorage
from the buccal shelf. The external ridge is significant (see Fig. 4-5).

The second anchor, the lower lip, can be engaged for assistance. It was found
that a lip bumper, placed at the sulcus of the lower vestibule was strong enough to
move the lower molar distally. For further anchorage enhancement with a complete
arch or with a Utility Arch, a series of "T" loops may be used against the lower lip
(see Fig. 2-11).

The third anchorage factor, more major than often believed, is the prevention
of anterior functional interference. The significance of proprioception of the
anterior teeth was an unexpected finding with continuous wire therapy from studies
conducted in 1 948. Vertical growth also is a contributor to the correction of
overbite. Natural vertical growth should not be confused with physiologic auto-

37
rotation caused by interferences (Fig. 4-6).

There is always the factor of breathing and neurologic phenomenon. The main
issue is to maintain the height of the lower molar as a method of preservation of
the anchorage. The author prefers to keep the plane below Xi Point. The importance
of buccal root torque cannot be overstated (Fig. 4-7).

Routine Adjustments of the Lower Utility Arch

The four classic actions on the molar are demonstrated in Figure 4-8.

Torque
A built-in torque in the tube on the second molar is 34° and the first molar is
24° (see Fig. 4-5). For anchorage insurance another 10° to 15° may be added in
the wire. For the deciduous dentition the lower second primary molar is used as a
surprisingly good anchor tooth and receives a band with a 24° torque, the same as the
first permanent molar. In the mixed dentition the lower first permanent molar is
employed for anchorage.

When later the second permanent molar is available, anchorage is better from
it, because of the progressively thicker buccal shelf for each molar successively
posteriorly (see Fig. 4-5).

Rotation
In contrast to a 1 2° rotation on the first molar, a 6° rotation is used on the
lower second molar. The distal rotations for both molars are not enough to offset the
mesial pull of elastics (and/or chains for space closure) and therefore another 5° of
rotation is added in the Utility Arch (see Fig. 4-5). The rotations on all the molars
have been a matter of controversv.

Several factors need recognition: ( l ) Tie-backs are always needed sooner or

later, and they rotate molars forward, (2) molars are rotated forward in most cases of
malocclusion at the start, (3) space closure is required in all extraction cases, mainly
from the buccal, (4) intermaxillary elastics rotate molars (5) closing chains are more
powerful than realized, (6) molars over-rotated distally will self-correct, but under­
rotated will not, and (7) the locked Class I will not obtain without a place to seat the
upper molar disto-buccal cusp.

Tip-back
A distal tip-back on the molar tooth is beneficial for anchorage when combined
with the buccal root torque. It results naturally from the intrusive pressure of

38
HORIZONTAL DEVELOPMENT

50 APo to Occ. Pl. -5 °

S h ort lower f a c e height
(lips loose)
A Lower denture
c o mpensates forw ard

VERTICAL DEVELOPMENT

B APo to O c c . Pl. 2 0 °

70

Long face,
Lip ten sion
Class II and
hi g h co nv exity pushes incisors backward
makes c a ndidate (cr owds teeth)
f o r extraction.

Fig. 4-6 Variation in patterns. Note the natural tendency for the occlusal plane to cross Xi Point
(or below it).
A. A brachyfacial pattern.
B. A dolichofacial pattern. Note the difference in the position of the lower incisor
relative to the APo plane. Note that ,v:ith vertical rotation the lips tighten and in
horizontal growth become more flaccid.
 O CCLU SAL PLANE and PROTRUSION

Arch Depth
6 to 1 23. 5 mm.

' \

c )
High Occlusal Plane

Inc iso r

Fig. 4-7 A. Occlusal plane at Xi. Point and incisor height at Divine Incisal Point between A and
Pm Points ( 1.0 to 1. 6 1 8).
B. Lower occlusal plane holds the incisor upright.
C. High occlusal plane tips the incisor forward (when tied into a straight rectangular
or square arch). This perhaps is the reason recommended for incisor detorquing of
incisors by clinicians advocating high-pull headgear or Herbst therapy.
 CORTICAL ANCHORA G E
·Prep arations
q b li q u e
Utility arch ridg e �
or
" "
c ontrol wire
.
)
24° + 1 0 ° ':: 3 4 °

T o r q u in g

1 2° + 5 ° = 1 7° .

T o coun ter bucc al p u ll

R otation
2 n d 6 ° -1- 5 ° · = 1 1 °

1 0° + 5° = 1 5°
B prep aration
mechanics

Tipp in g

5 mm. @ s i d e

T o prevent c ro s s - b i t e

Expansion

Fig. 4-8 The four pertinent adjustments on the molar for the lower utility wire or lower Utility
Section are shmv:n.
anterior teeth for deep bite correction. A 10° to 15 ° tip-back is employed in the wire
in addition to the 5 ° already placed in the angulation of the tube. Distally,
overtipped molars \vill up1ight with development and function, but mesially inclined
molars seldom self-correct.

Expansion
The final adjustment in the Utility Arch is expansion. Without expansion, the
buccal root torque will often move the crowns lingually. An expansion of I cm. is
adequate (5 mm. each side).

The tip-back action -vvith the utility wire, locked downward on the distal of the
molar tubes, moves the molar crown distally and will retract the incisors.
Consequently, in the event of slight existing crowding and increasing need for space,
the Utility Arch is often opened up (or advanced) from the molars. When
advancement of the lower incisors is employed the molars tend to be pushed outward
and e:J\.'J)and naturally. Therefore, less expansion adjustment, if any, is necessary when
elongation of the arch and rotations are required (see Fig. 4-8).

Discussion of Utility Therapy

Torque on the Lower Incisors

Due to previous experiences with straight wire expansion, some operators will
feel inclined to torque the lower incisor crowns lingually (to prevent "dumping").
Also, high-pull headgear off the molars for Class II treatment will intrude upper
molars, which is followed often by eruption of the lower molars and a tipping of the
occlusal plane. Thus, the occlusal plane is tipped upward posteriorly and the lower
incisors are tipped forward relative to the other planes of reference. Said again, an
average 16° long axis of th� lower incisors to the buccal occlusal plane will result from
a 0° bracket, which is an ideal position. When the occlusal plane is tipped
excessively, a lingual crown torque may be required (see Fig. 4-7).

The answer to an upright lower incisor thus resides in the occlusal plane
management. The author, as a result, advocates a 0 ° torque in the lower incisor
brackets. Nor is the wire torqued except in special situations. Thus, with the height
of the lower molar controlled, the natural consequence with a non-torqued anterior
segment of the wire will be to upright the incisors if they are protruded, or to tip
them forward if they are retruded. In fact, with generous tip-back on the molar
and with cervical traction employed the lower incisors may often need labial
crown torque. The analysis of such facial types in Figure 4-7 leads to the conclusion
of keeping or producing an occlusal plane at Xi Point.

39
 Lateral Incisor Spacing
As the incisors are intruded, a distal flaring of the crowns of the lateral incisors
and sometimes all four incisors may be observed. This is often thought to be a fault,
and is bothersome to the operator. However, convergence of the roots into a smaller
part of the alveolus is an advantage for intrusion (see Fig. 4-5). Contraction of
the roots helps with avoidance of the cortical plate. Temporary flaring of incisors,
with both upper and lower intrusive utility therapy, is actually a favorable
behavior,and simple crossed "T" loops later will close the space quickly. A separate
manual has been prepared for Utility therapy alone.

The Full Lower Arch Engagement

After incisor intrusion with the Utility Arch, the canine is intruded with a light
nylon thread of only 35 grams. The objective is to place the canine and incisors at
the level of the first premolar. Formerly, "piggy-back" wires were employed, but if
the teeth are essentially levelled and rotated, then a . 016"2 straight wire is
appropriate. The author prefers a concatenated wire or section if major work is
needed in the buccal section for space, tipping, and rotations.

Premolar Prescription
The bracket on the upper and lower first premolar is raised 0.4 mm. and is 0°
torqued (see Figs. 4-4 and 4-5). The lower second premolar is raised 1.0 mm. and is
torqued 14° . No angulation is employed for any of the premolars. The lower second
premolar receives a band (not bonded because of the nature of the shear of chewing
in that location).

A 34° torque is used for the second molar, and a 6° rotation is employed; in
addition the tube is lowered 2 mm. more toward the gingiva on the band to help
develop the Curve of Spee. This also helps in the control of the anchorage supplied
by the second molar (see Fig. 4-4 and Fig. 4-5).

Thus, for anchorage a buccally root-torqued lower lingual can be employed

with only the first or the second molar. From the single molar with a bar the
anchorage and control can be graduated to the molar and the central incisors (2 X 2),
then to the four anteriors (2 X 4), to the molar and six lower front teeth (2 X 6), to a
full arch to the first molar, or to the full arch to include the second molar (Fig. 4-9).

40
 B U C C AL S E CTIO NS for CLASS II

Z Ut ilit y S e c ti o n
c

L I N G U A L R ET R A CTS

·-- . !IIIIIQ
- - --
-�

F ig. 4-9 A. The upper Utility Section with five actions.

B. The complete lower arch as anchorage (the lower Utility).
C. The "Z" Utility for opening.
D. Augmented with a second molar and buccal section adapted through tubes.
Below: Intraoral regulation is made ·with i-360 plier.
THE UPPER SECTIONAL UTILITY

Through the years experimentation was carried out vvith several types of buccal
sections. The standard type came to be the "offset section" or "Utility Section". For
its construction, a square . O l 6 11 Elgiloy was employed. The wire was stepped upward
4 mm. at the molar tube, measured forward to the canine bracket and then stepped
downward 4 mm. , from where it is bent forward and cut at about a 6 mm. Canine
length to be received into the .018"canine bracket (see Fig. 4-9). For better pressure
against the molar, a Z utility shape (open delta) can be used, and other designs might
be of interest.

Critical Bends in the Upper Utility Section

The Utility Section is adapted for rotations and leveling. The section is first
adapted and then five provisions are made (see Fig. 2-12).

(1) A 1 5 ° to 20° tip-back on the molar is used in order to supply 50 grams

of intrusive force on the canine, which will offset the vertical pull of the
elastic (see Fig. 4-9).

(2) A 1 5 ° rotational bend is maintained on the molar which places the

canine inward within the "cortical channel" . A 15° rotation tube is used,
but 10° may be added if necessary. This offsets the lateral vector of the
elastic from the wider lower molar. It also guards against lateral flaring
of the canine resulting from molar correction for Class II because, as the
molar moves distally, it rotates and may influence the section as a
whole. It also helps anchor the section, which encourages palatal
separation with bilateral intermaxillary elastics (see Fig. 4-9).

(3) For the canine an additional lingual root torque of about 1 0° is

placed even with the standard 7 ° akeady in the bracket. This keeps the
canine root guided within the cancellous bone which facilitates the distal
movement (see Fig. 4-9).

(4) An advancement of 1 to 1 .5 mm. (or to 100 grams) is made for the

canine. This insures a continuous distal force on the molar, until the
action is achieved. Elastics are applied on its placements.

(5) The tip-forward bend is placed on the canine crown. This, in effect,
keeps the canine from tipping distally, but also places a light intrusive
action on the up per molar.

41
 The resulting action of the Sectional Utility, plus the intermaxillary elastic
traction on the canine results in a concentration of pressure first on the molar! The
molar receives four movements; it is tipped backward, pushed backward, rotated, and
slightly intruded!

Care should be exercised to maintain the elastic force, else canine intrusion or
lingual movement and forward positioning will result.

SECTIONAL ARCH MODIFICATIONS

Simple Anterior Sections

Curved sections of a full arch have beeri used since the beginning for limited
local alignment of teeth. For spacing and rotations, either loops or push-coil springs
have been used with such sections. As a principle, the procurement of space (or
unlocking) precedes the attempt to rotate and align teeth. It is a well-known
experience that the tying in of any rotation tends to straighten out the wire.
Therefore, the teeth at the ends of a section tend to flare outward and rotate buccally,
or labially if rotations are tied. This is further magnified when arch lengthening is
attempted. For that reason, most orthodontists will intuitively go back to the molars
for heavier anchorage source at the ends of the wire. A simple section can thus be
problematic in application, and many orthodontists will intuitively try to employ as
many teeth as possible in the section. This idea, in fact, led to the concept of the
molar as "stationary anchorage" and ultimately to a whole unitized arch.

There is, however, a distinct place for anterior segments, particularly in the
treatment of resistant midline problems and in open or closed bites. The continuous
arch wire is prudently sectioned and the components are moved as units.

Sectional mechanics has a clear advantage in the treatment of the subdivision­

type malocclusion or in patients with significant asymmetry. The buccal segment of
the Class II side is first reduced with sectional mechanics. Then an anterior segment
is unitized and a transverse elastic is employed from the opposite lower canine area to
the upper lateral incisor area for the midline correction (Fig. 4- I O)(see Fig. 2-6).

As will be seen from the root-rating scales (see Fig. 2-19), a total of about 1 30
grams per anterior side, or 2 60 grams total, is required for transverse management of
the anterior segment. This accounts for the difficulty of midline correction! The
anterior teeth have often developed away from the correct midline of the face. The
teeth in the entire anterior section may be tipped to an uprighted state with second

42
 F OR ASYMMETR Y
righ t left
Class II STAGE 1
Class I

(elastics) =:uL �)
B
A � 3J9
.:;:x
Utility S ection S t raight S ection

STAGE 2

c an in e
lock

STAGE 3
Reconne c t
Transverse e las tics
(overtrea t)

Fig. 4- 1 0 Three sectionals for Class II asyrrunetry.

A. A Utility Section with unilateral elastics.
B . A straight section for alignment.
C. A labially torqued canine root for aid in anchorage for orthopedic action.
D. Anterior transverse elastics for correction and overtreatment of maxillary midline.
Note second-order help.
order bends, which reduces the amount of force needed from the elastic and the
entire segment can be actuated with second-order bends. Experience has shown, time
and time again, that if over-correction of the midline is not made there vvill be a
subtle midline relapse in the ultimate result. Over-correction of the midline is
mandatory (see Fig. 4-10).

Sectional Variations and Options

Review -- Figure 4-11

In review, the first move toward sectioning in 1954 was the cutting of the ideal
arch mesial to the canine (see Fig. 4-11-a). The premolars were therefore included in
a straight section. Shortly thereafter a push-coil was placed on a stopped section for
canine retraction or buccal space closure (b). Later the brackets on premolars were
not applied until Class II reduction (occasionally not at all), and a straight wire
section was placed (c). This required bent stops to be made mesial to the molar tube
and distal to the canine bracket. This was the forerunner of the common and most
used Utility Section (d).
After (1) having applied extraoral traction to the upper molars for arch
correction, or (2) utilizing removable posturing mechanics for reduction of the <:;lass
II, or (3) after having expanded the upper arch with a quad helix in order to create
arch length, a simple straight buccal section shown in © could be used with chain or
pull-coils.
In order to gain length and keep pressure applied on the molar, the Utility
Section was used, or a "Z" utility was employed to gain arch length. This is in
essence a delta loop with a bridge (e).
Uprighting sections were made for second molars in an open "T" section (f).
This was versatile and could be employed anywhere. As two were used, one tooth
could efficiently be controlled (g).
Another option to upright or gain wire material between two teeth was the
back-action helix (h) .
Probably the best and kindest buccal section, however, was the Push-coil
Utility Section (i). Space opening and primary distal movement of the molar with it
was remarkable.
A simple closing loop or section very much used and appreciated by the author
is the Crossed "T" (j). This loop is good because the plane of the wire is not offset.
The Double Delta section is popular with many clinicians, but it is powerful at
125 grams per mm. (k).
In order to lighten the contraction pressure and supply a more continuous
action, a simple loop section of some design is indicated. The closed helix (1) is often
seen in publications, but it is very strong and is not preferred as is the crossed "T".

43
 Sixt"e en Options in Sectionals

. 1

��. n \._,/

g
�· · ...

Fig. 4- 1 1 Sectional options for Class II reduction, for space opening, for space closure, for
levelling, for expansion and uprighting.
 Several years of measurement and e)..rperimentation led to the development of
Canine Retraction sections (m) and (n). These are discussed in the manual on
extraction therapy.
If more severe rotations of premolars were needed, a single "T", a double "T" or
even a triple "T" section was employed (o). Made in square .0 16" wire, it vvas
successful for alignment, rotation and torquing all at the same time. For opening
space for rotations, the T sections were as effective as any other design studied and
led to intraoral regulation which reduced arch changes.
Until the 1980s it was believed that tipping of the canines enhanced anchorage
preservation. After tipping, the "Horizontal Helix" boot loop section (p) was used for
canine root control. This ceased to be used when it was found that much too heavv
forces had been employed, and tipping was contraindicated.
Sections To Move Molars Distally First
As stated before, the molar distallizing sections are activated from the canine
which in tum is sustained by intermaxillary traction. The force of the elastic usually
is applied in the range of 125 to 150 grams. The idea of sections originally was to
relieve the anchorage requirements on the lower arch.
It should be reemphasized that the sectioning technique was found to be very
useful and productive in the latter stages of treatment when incisor interference was
experienced and over-treatment in the buccal segment was required. Straight buccal
segments were usually limited to one or two appointments.
In order to better control the canine against eJ...rtrusion and flaring, the
premolars are avoided so that "proximal" anchorage is prevented. 1 If the premolars
are bracketed, the utility wire is stepped upward above the level of the brackets
already in place.
In summary, five movements are placed if not already adequately provided in
the formulation of the tubes and the canine bracket (see Fig. 4-9). These are:

(1 ) An increased rotation of the molar in the range of 20° to 25 ° (with the

Ricketts prescription there is already a 15° to 20° rotation).
(2) A tip-back bend, usually in the range of 15°, on the first molar, in order
to produce a lift on the canine of 50 grams.
(3) A I 0° lingual torque added to the canine root (the Ricketts prescription
already supplies a 7° lingual torque).
(4) A 5 ° mesial rotation of the canine to offset the distal tendency of the

1
Proximal anchorage is a term used when one tooth is moved from adjacent or proximal
teeth. A tooth may actually be moved in the opposite direction to the one desired, thus "round
tripped". Transformo anchorage is that employed when, for instance, molars are employed to
move anterior teeth. The force is transferred away from a proximal tooth.

44
 pull of the elastic.
(5) A 5° - 7 ° added distal root angulation for the canine, which will help
maintain the canine in its desirable inclination, and also -- ironically -­
tend to have a slight intruding action on the upper molar.

The bends are made immediately mesial to the molar tube and at the
distal of the canine bracket. The 150-gram pull of the elastic will have about a
50-gram extruding effect on the canine. This is offset by the distal tip-back
on the first molar. Further, the increased rotation of the first molar will have a
lingualizing effect on the canine to prevent its flaring by the lateral pull of the
elastic from the lower molar. The normal upper inter-canine width is around
3 7 mm. and the lower molar is about 55 mm. (Thus a lateral pull of an
estimated 25 grams may result. ) All bends are activated intraorally! Pinching
of the wire with the i-360 RMO Ricketts plier is very effective.

Further Review
The configuration found was the push-coil Utility Section. This type was
selected primarily for adults where continuous action was most desirable. A 4 mm.
push-coil is employed mesial to the molar, and a looped Utility Section was
constnicted. In order to create a stop for the push coil a tight 2 mm. occlusal bend
was formed, and a vertical 6 mm. extension was made gingivally. This was
terminated in a round open loop and dropped down to a 4 mm.-high ordinary
anterior extension of the utility (see Figs. 4-8 and 4- 1 1 ).

It talces approximately 120 grams to bodily move an upper molar distally.

When the tipping force on the unbanded upper second molar is added (probably
around 30 - 40 grams) this would mean a force requirement of around 150 grams.
But because of the distal tip-back for an intruding effect on the canine to offset the
vertical pull of the elastic, the action results in a tipping force on the upper first
molar, and therefore a push of about 100 grams that, when sustained, proved to be
adequate.

Vector Analysis
A parallelogram vector force analysis using a 150-gram elastic revealed that
during the life of a correction about 100 grams of distallizing force was produced.
The force analysis, also in the transverse plane, would suggest about 25 grams of
lateral force to be present. At least it worked well with the Utility Section mechanical
arrangement! Drifting of the premolars distally is invited when the molar and canine
are moved.

45
 It should be understood that because the molar is tipped overtreatment of the
crown is accomplished. Later uprighting with continued elastics will effect a distal
movement of the roots of the upper molars. At this stage buccal spaces were created
and canine retraction was required.

The Utility Arch section, after being opened, was then contracted. A canine
retraction section was used in e:1.'traction cases when spaces were large (see Figs. 4-11
to 4-14). In particular, the upper second premolar may require a mesio-buccal
rotation. The tying of only the distal brackets in the siamese system was useful with
a closing section. The intermaxillary elastics were continued throughout the space­
closing stage.

T HE UPPER UTILITY ARCH -- THE ULTIMATE IN SEGMENTATION

After complete Class II, Division I , molar reduction, space is often present at
the incisors mesial to the canine. In Division 2, space may be created for alignment.
A simple upper Utility Arch was the first type considered to reduce the upper incisor
as a segment (Fig. 4-12-A). Tip-backs on the molars are applied in order to intrude
the upper incisors before or together with retraction. The upper Utility Arch to the
incisors was often employed earlier to help stabilize the molar while canine retraction
and buccal space closure is being conducted (Fig. 4-12-B). Intrusion of the upper
incisors is recommended before retracting in all but open bite conditions.

When the roots of the upper incisors are engaged against the palatal plate the
pressure recommended is one-half gram per square millimeter of root surface
(0.5 gram per mm. 2 ) . This means that the upper central need only about 25 grams
and the upper lateral should receive about 20 grams of force at the root. This light
pressure is to be maintained as continuously as possible (Fig. 4- 1 2-C)

Some operators prefer to use heavier wires for management of the upper
anterior segment. The .016 112 blue Elgiloy is on the margin of enough force to intrude
all four incisors at once. However, the larger wires may sclerose the bone
interproximally and also may produce more root resorption. Finally, with larger
wires the retraction force may easily preempt the torque required (Fig. 4-12-D).
Therefore, the author prefers the use of . 016" X . 0 l 6 11 blue Elgiloy without heat
treatment or hardening in the great majority of conditions (Fig. 4-12-E). The
author's favorite type is the light Intruder-Retractor (Fig. 4-12-F). It should be
remembered that loop forming tempers the vvire.

46
 A NT E R I O R S E G M E NT TE C H N I Q U E S

Fig. 4- 1 2 Varieties i n Management Options:

A. Classic utility
B. Intrusion utility
C. Double " L" (contraction)
D. Double delta (closing)
E. Inverted helix (torqued)
F. Intruder-retractor
Intrusion and Palatal Torque of Upper Incisors
If the intrusion, and light retraction,does not take place, the upper incisor will
be "rabbited" . In addition, root resorption may occur. Many clinicians fear relapse
into deep bite. However, if the . 0 l 6 11 2 blue Elgiloy wire is used with patience, lingual
torquing of the root all the way through the plate is possible (Fig. 4- 13)

Dr. C. Burstone places a straight section on the incisors and intrudes vvith a
continuous wire from the molar tied to the section between the centrals. This is
another option. Ricketts prefers to intrude by converging the roots and in gummy
smile situations augmenting intn1sion with a light anterior high pull as described by
Jarabak (see Fig. 4- 13).

To repeat, the palatal shelf behind the incisors is gnarled and tough. Heavy
force, producing sclerosis or hyalinization, inhibits the remodelling of bone. Llght
pressure at 0.5 gram per mm. 2 of root surface does the trick. The behavior seen in
three male patients was not witnessed with .02211 brackets and heavy wires without
root resorption. The . 0 l 6 11 square wire in soft Elgiloy is amazing in its delivery.

UPPER BRACKET PRESCRIPTIONS

Because many clinicians find difficulty in finishing, undertorquing is a common

problem. With regard to intrusion and torque, the formulation for the upper anterior
segment is reviewed. When upper lateral incisors are too small or too large,
angulation is a challenge.

Incisors
The upper central incisor receives a 22° torque with a 0. 7 raise, and a 2°-3°
inclination down on the distal (to be established by the operator). For the upper
lateral incisor, the torque is 14° and is prescribed according to tooth morphology
with an 8° angulation downward on the distal (also to be altered, depending on tooth
form and space available (Fig. 4- 14).

Pre molars
Mistalces in finishing at the premolars can lead to prematurization in function.
The upper first premolar is zero (0) angulation, zero (0) torque, and is raised
0.4 mm. In bonding of that tooth the bracket is placed slightly mesial to the
buccal center. The resulting disto-buccal rotation produces the proper articulation
of the lingual cusp in the distal fossa of the lower first premolar in finishing. It is
preferable that the buccal and lingual cusps of first premolars be in alignment with

47
 Movement
" "
with 0 1 6 x 0 16 B lue Elgiloy

G.C. if 2 6 .5 yr.
_ ccz" Utility Tl 1 1- 1 -69
T2 1 0-3-71

if 8.9
Classic
B.M. yr.
Utility
Tl 1-29-62
T2 1 1 -6-64

1 . 0 Cm.
Utility �;
, · R . M. n;f'
v 1 1 . 5 yr .
and T l 1 0-26-79
High pull T2 3 - 1 0- 8 1
c

Fig. 4-13 Three male patients with remarkable torque and intrusion of upper incisors.
A. Adult C lass II, Division 2 with the deepest bite possible.
B. Mixed dentition boy Class II, Division 2.
C. An eleven-year-old with very gummy smile re jected by an orthodontist who wanted
to wait and have a Lefort surgery conducted. Note intrusion along long axis one
cm. with upper Utility Arch augmented with light high-pull headgear (75 grams) at
night only.
 CLASSIC PRESCR IPTION

Raises -
50

.9

1 2°

Fig. 4- 1 4 The details of brackets prescribed for management of anchorage and overtreatrnent with
the Ricketts philosophy. Note the incisors, premolars, and second molars.
those of the opposite side; in other words, the four cusps are in a straight line.

The upper second premolar is zero (0) angulation and zero (0) torque with a
raise of 1.0 mm. (the same as that in the lower) but the lower is torqued 14°.

The Upper Second Molar

The upper second molar, to be banded when necessary, receives a tube which is
zero (0) torque, zero (0) angulation, is rotated 15°, similar to the first molar.
However, the Ricketts tube is located 2 mm. occlusalward on the band in order to
build in the nonnal Curve of Spee which lifts the molar buccal cusps at the time of
finishing (see Fig. 4-14).

OTHER APPLICATIONS OF SECTIONAL MECHANICS

Nasal Asymmetry Correction

Careful inspection of frontal headplates and photographs will often reveal a
nasal cavity asymmetry. Subdivision Class II and Class III are common. Asymmetry
of the two maxillae is classic in unilateral conditions.

It is believed that sectional mechanics can play a role in correction of unilateral

skeletal dysplasias in young patients. The reason for this theory is related to three
findings: (1) the palatal plane will tip with vigorous elastics 2° to 4°, (2) a central
diastema will develop during treatment when the anterior teeth are not connected
with an appliance, and (3) nasal cavity improvement has been verified in headplates.

The Canine Twist

vVhen the nasal cavity on one side needs to be moved downward some
variations in the buccal section may be practiced.

Theoretically, because the asymmetry developed at the sutures in the first

place, unilateral alteration of the suture can be expected. The canine now needs to be
anchored in order to move the basal bone. Instead of torquing the canine root
lingually it is now torqued buccally and expanded 5 ° (see Fig. 4-10). Thus, in this
twisted position, it is engaged in the cortical plate and will be more resistant to elastic
traction. Intraoral traction of 2 00 to 250 grams unilaterally will affect the maxillary
sutures. Complete restoration of symmetry may not be obtained, but facial
improvement will be accomplished.

It should be remembered that when orthopedic action is desired but no arch

48
wire is placed to hold the incisors or the two maxillae together.

Nasal Aperture and Cleft Palate Cases

One of the common esthetic and functional problems following cleft palate
surgery is the flaring of the nostril. This is due to the muscle attachments on the
margins of a much too vvide and posteriorly positioned perifom1 aperture. Two
procedures help in improving the skeletal situation. The first is sectional mechanics
with 300-gram Class III elastics in order to move the maxilla of the cleft side forward
to help close the cleft space from behind. In unilateral conditions the normal side
serves as a control.

The second approach is segmented mechanics combined with a unilateral pull

from a face mask or facial anchorage. This applies to bilateral and unilateral
conditions. Scar tissue can act as a fibrous ankylosis as severely scarred palates do
not move, and teeth alone move with facial or dental anchorage.

Sectioning of the Lower Arch

In conditions of asymmetry (see Fig. 4-10), and in conditions of severe open
bite or deep bite, the lower arch can be sectioned as well as the upper. This is
particularly appropriate for severe open bite. Vertical elastics to both upper and
lower anterior sections are often a method of choice to dose the incisor bite space.
As in deep bite, open bite is overtreated. After all, the Utility Arch itself is a
segmented technique when the four lower incisors are managed conjointly.

The same sequence and philosophy of technique can be used in the lower for
Class III as is used in the upper for Class II. All four lower incisors are tied together
as a unit. Extruding mechanics for open bite can be applied to the lower arch, as may
be practiced in the upper anteTior segment as well.

Class HI Mechanics
In practice, in experience with Caucasian patients, perhaps only 3-4% exhibit
Class III malocclusions. In the Oriental Class III malocclusions may constitute 50%
of a practice. Numerous clinicians have reported that the best long-term success is
found in Class III when treated in the mixed dentition phase or, even better, in the
deciduous phase. This is done in order to obtain orthopedic control of the maxilla
and to gain what is conjectured to be an influence on the development of the
mandible with alteration of function.

However, at the permanent dentition state, and desiring not to treat a patient
with surgery, the usual mechanics employed for the Class II is reversed for the Class

49
III (Fig. 4-15). In other words, the buccal Sectional Utility can be used in the lower
arch and Class III elastics employed from (1) an upper Quad Helix appliance, or (2)
from an upper Utility Arch or (3) from a fully engaged upper arch. This sectional
technique is employed successfully as an alternative to lower arch e},._'traction (see
Fig. 4-15) .

When tongue habits prevail and elastic traction is needed for aid in finishing,
any of a number of sections in the lower can be employed with and without loops.
Various wire configurations can be used for aid in acquiring unity in the management
of the malocclusion.

Cross-bite Correction
In young patients there is often a mandibular shift associated with lingual
cross-bite. Therefore, all unilateral cross-bites in the young are treated as bilateral.
Lingual cross-bites (the upper molar lingual to the lower) are often treated by some
form of maxillary expansion. In adults, however, the shift has been developmentally
compensated. Criss-cross elastics and segmentation are the best choice.

The greatest challenge is the buccal crossbite in adults, and when bilateral has
been referred to as a Brodie Syndrome. It must be remembered that in buccal cross­
bite the molar teeth are in supraocclusion. Therefore, intrusion is required. Only
80 grams is needed to intrude molars and about 30 grams for premolars. Buccal
cross-bites require upper teeth to be moved against the palate, and lower teeth against
the cortical plate buccally. In order to modify these outer plates about the same
amount of force is required as for intrusion. Therefore, the elastics are light but
continuous.

When the elastic is attached to the lingual of the lower and the buccal of the
upper it supplies an intrusive force (see Fig. 4-15).

INTEGRATION MECHANICS

After the deep Class II or Class I bite is opened by intrusion and after the
buccal segment has been corrected, the incisor segment is now overtreated toward an
end-to-end condition. At this, the Stage 3 in the therapy, the segments need to be
reconnected or integrated (Fig. 4-16). Care should be taken to ensure that the
canine is properly intruded before integration is practiced (space closure and
levelling). Looped configurations can be used for purposes of consolidation.

50
 T e ch n i qu e for Clas s I I I and C r o s s- b ite

E la s t i c s 1 8 0

U tility s e ct i o n c a n b e a p p li e d

30 t o 40 gr. I n t r u s i v e f o r c e r e c ip ro c a l

E la s t ic f o r c e 8 0 to 1 0 0 g r .

Fig. 4- 1 5 A. Class III can also be managed with sectional arches in the reverse of Class II.
B. Buccal cross-bites are best treated ·with intrusion from criss-cross elastics.
Note they depress or intrude molars.
 The double-delta is powerful ( 125 grams per mm.) and should not be
overstressed (Fig. 4-16). The upper posterior anchorage can be broken. But re­
extrusion of upper incisors may occur when too much force is used, and the canine
has not been intruded. This is often accomplished with a threaded elastic tied to the
canine. When careful levelling technique has bneen uised and 3 to 4 mm. of space
remains, a simple crossed "T" in .0162 ideal arch form can be employed (see Fig. 4-
16).

The open "T" or a series is excellent for final detailing. All these options
precede the ideal arch.

Stage 4 is the finishing in which overtreatment is prudent. The "boot loops"

have been found useful, and the upper is finally closed with elastics from the lower
rather than tie-backs in order to not move the upper molar forward again.

For some clinicians wishing to reject the sectioning idea there is a bit of final
irony. As they close up spaces and overtreat they will often employ the molars and
anterior teeth as a segment. Finally, as they retain they may use a fixed bonded
lingual to the incisors (4 teeth as a unit) or a bonded canine-to-canine (6 teeth as a
unit). The author has long preferred to use fixed retention to the lower eight anterior
teeth (premolar to premolar).

SUMMARY

There is some confusion regarding the semantics of segmented, sectionalized or

unitized mechanics. To mal<:.e a section is to cut the wire into parts. They all concern
moving a part of the arch independently.

A profound knowledge of mechanics is required to manage sectional therapy.

In fact, it frightens some clinicians, and perhaps it should! However, sectional
treatment --once mastered -- offers many benefits, both skeletal and dental, and alters
thinldng regarding the outlook of orthodontic possibility.

As a profound base, a knowledge of enface root surfaces presented for

movement (and anchorage) quite helpful. The .016" X .016" blue Elgiloy wire
capacity also needs to be appreciated. Loop forming is enjoyable, and leads to lighter,
more continuous and much more versatile practices. Root sizes, force delivery, and
prescription of tubes and brackets all fit together in a "system".

51
Stage 3 Consolidation P o o r c h o ic e
u n til l e v e l
Step 5

M ild - effective

To le vel a n d rotate

Step 6 Idealization

Fig. 4-16 After sectionals and segments the arch units need to be integrated or put back together.
A. Double delta
B . Crossed "T"
C. Open "T"
D. Ideal arch
E. Finishing arches. All are .0 1 6" X .0 16" wire.
 Sectional mechanics most often but not always goes hand in hand with
inte1maxillary elastic traction. With intraoral traction the use of cortical anchorage
and cortical avoidance are principal factors in management. The lower molar is often
the primary source of anchorage via a Utility Arch. Anchorage can be graduated to a
fully engaged lower arch and even augmented by lip pressure.

The upper buccal section mechanics started in 1954 went through several
modifications. More and more was gradually learned regarding forces and pressures.
Five distinct actions came to be applied to the canine, as described in detail. Four
movements were described for upper molars.

Several configurations of sections were described from simple straight sections

to Push-coil Utility units. Most of these are prefabricated for time efficiency at the
chair.

Follovving, or concomittant vvith, sections in the upper, the complete upper

Utility Arch was discussed as a part of segmented mechanics. Its relationship to
sectional or segmented therapy was described as a critical factor.

Other applications include sectioning of the lower arch for open bite, deep bite,
crossbite, and Class III. In addition, nasal asymmetry, orthopedic correction together
vvith management of segments in cleft palate were described.

Many orthodontists needlessly fear the sectional approach. Integration of the

sections or segments can be an easy task vvith several connecting modalities.

Finishing and retention are separate issues taken up in other manuals. It is

recommended that this teaching manual be reviewed several times.

Finally, a few Do's and Don'ts are offered as an aid in learning:

52
 DO'S AND DON'TS FOR
SECTIONAL MECHANICS

l. DO understand what is meant by sectional or segmented

philosophy: anchorage is the primary concern.

2. DO understand, as a basic, certain problems with "proximal"

anchorage.

3. DO employ the advantage and understand the place for "by­

pass" mechanics, which is different fromsectional therapy.

4. DO believe that Class II conditions can be corrected with

intermaxillary traction without undesirable forward displacement
of the lower arch.

5. DO recognize the processes of natural drift of premolars and

canines. Don't band or bracket upper or lower premolars until
the retraction stage is nearly complete.

6. DO employ the occlusal rectangular tube on the triple tube

assembly supplied by the Ricketts design.

7. DON'T forget the influence of one of the forces of occlusion:

the outer muscular walls of the denture.

8. DO use sectional mechanics for intermaxillary traction for any

patient with anchorage problems.

9. DO reactivate tip-back on the molar during Class II traction on

the section in order to intrude the canine and counter the vertical
pull of the elastics. Intra.oral regulation is efficient with the RMO
i-360 plier.

10. DO also reactivate, in the mouth, the rotation on the molar

during Class II traction in order to tuck the canines ingually to
prevent flare.

11. DO also maintain lingual root torque of the canine during Class
II traction in order to keep the root within the cancellous bone

53
 and away from the cortical plates.

12. DON'T, if anchorage is desired in the lower arch, use the Class
II elastic traction until the buccal plate anchorage can be
engaged by applying buccal root torque on the lower first and
second molars.

13. DO, when the lower second molar is available, use the
advantage of the heavier buccal plate anchorage for Class II
correction and later anterior sectional reduction.

14. DON'T attempt to employ headgear at the same time reduction

with elastics is made.

15. DON'T stop elastic traction until an overtreated condition is

established.

16. DO remember that when severe rotation of premolars is present,

lingual couplings are of advantage.

17. DO remember that when severe rotation plus angulation is

needed, the triple or quad "T" section can be of great service.

18. DON'T attempt to retract the incisor segment from buccal

segments just after having achieved a Class II correction.
Retraction mechanics are employed with separate mechanisms in
the more gingival rectangular molar tube assembly.

19. DON'T attempt full arch integration until anterior reduction is

accomplished.

20. DO use upside-down loops for effective movement if more

upper incisor lingual torque control is needed.

21. DON'T be afraid or ashamed to section the upper arch a second

time and reintrude anterior teeth to prevent incisor interference
in finishing.

22. DO remember that sectioning of the anterior segments can be

made for vertical elastics in open bites after Class I is achieved;

54
 however, in gummy smile cases lower sectioning only will e)..'trude
that segment primarily for the advantage.

23. DO remember that in Class III conditions lower arch

segmentation can also be employed to save surgery in some
patients.

24. DON'T worry about the appearance of disharmony of the

segments during the anchorage objective stage of therapy.

25. DO inform the patients regarding ex:pected behavior, so

objections can be avoided. Remind them of the tempora1y nature
of denture spacing and its purpose.

55
 THE VvISDOM OF SECTIONAL MECHANICS :
INTERMAXILLARY TRACTION IN
NON-EXTRACTION THERAPY

CHAPTER FIVE
GENERAL SUMMARY

" Sectional", "segmented", and "unitized" mechanics are often confused. For
purposes of semantics, "sectional mechanics" may be referred to as unconnected parts
of an arch or separated units. A part of a circle is a segment. Therefore, "segmented"
may be likened clinically to the management of a portion of the arch as an
independent unit but still connected in some manner to other segments. The Utility
Arch, for example, handles the incisors as a segmented unit. When single teeth are
managed the procedure is called "unitization", which may also include two or more
teeth employed as a unit for anchorage.

Unitization was commonly practiced by Angle on the first molars with the "E"
Arch. He also found it efficient to employ sectional mechanics in extraction
techniques; therefore sectional treatment is not new. Segmentation, or isoloating the
anterior teeth as a unit, was common with the Ribbon technique. Thus, in principle,
sectioning and segmenting is a legacy.

However, with the advent of the fully ban.ded (or bracketed) procedures there
also developed the adherence to an absolute continuous arch wire. Studies
revealed that theories regarding reactions were shmvn to be false. The literature in
fact suggests that the advent of the full simultaneous techniques served as the
forerunner of the Doctrine of Limitations which led to the "extraction theory". It was
not the Edgewise bracket which led to problems, but the unsightly results that were
produced with the theories and practices of its application that prevailed. Candidly,
it gave rise to almost an orthodontic "Dark Age", where clinicians -- dominated by the
restrictions imposed with the techniques -- also threw out early intervention.

By 1 950 something needed to be changed. The change started perhaps with

unitization of the upper molar with the "face bow" and e:,...'i.raoral traction (applied to
the molars only) . Ideas became modified with the use of lighter wire and "progressive
engagement". This was followed by the study of anchorage losses which led to

56
"brealdng up the continuous arch". At the same time, in 1 954, anchorage from the
lower molar was obtained from the thick buccal bony plate, which also changed the
procedures and the philosophy (see Chapter Two).

Sectioning was started by the author in 1954 also by cutting the Ideal Arch
wire after levelling and condensation had been achieved. From straight sections
"premolar by-pass" straight sections were developed. Then came, simultaneously, the
reduction of the bracket from . 022" to a . 018 slot. Utility Sections were then created.
With these, drift of premolars was utilized, and even greater possibilities were
recognized.

The understanding and management of the canine, in conjunction with the

molar, became the key to sectional mechanic� success. Five distinct moves were
recommended on the canine for the best operation when activated by intermaxillary
elastics. Thus, a renewed value of intermaxillary traction was set forth. The
development of root rating scales was a significant contribution although slow to be
recognized and applied as force ideas were reduced to the concept of pressure.

Eighteen advantages of sectional mechanics were described, starting with the

lessening of anchorage demand, and going on to attention paid to management of the
molar by tipping and rotation. The premolar drift tendency for both sagittal and
transverse benefits were pointed out. Three-dimensional management of the canine
was described as a most critical and perhaps most difficult aspect to teach.

One very significant advantage to sectional mechanics was shown to be for the
correction of asymmetry. Probably a hidden factor, not recognized for its immense
value, is the control of excessive mandibular rotation on excessive vertical increases by
means of sectional mechanics. Damaging mandibular rotation in Class II correction
was, in fact, the factor which led to the investigations of sectioning in the first place.

Sectional mechanics is not limited to a specific application but is applied to all

the classes of malocclusion and any situation where anchorage poses a potential
problem. Further, it is applied at all ages. Orthopedic changes and unilateral effects
in the maxilla with sectional mechanics needs further detailed study.

For the most complete understanding the logic of the "Classic Ricketts" tube
and bracket prescription should at least be considered by the student. In addition,
the step-by-step details of sectional and segmented application of pressures should be
learned -- if not to be used, at least to be understood in a transfer case. The
variations available for modifications of application mal(e clinical practice interesting

57
and exciting.

BIOLOGIC FOUNDATION

Beneath all the sectional mechanics is the foundation of biology. This pertains
to the goals of occlusal function, the management of growth, the capacity to elicit
orthopedic change and the pressure values on the teeth for consummate clinical
aptitude. It further includes the prevention of pain and the procurement of
maximum individual esthetics. It also involves psychologic factors.

While sectional mechanics is not mandatory for clinical practice, its

possibilities e1.'tend far beyond straight continuous wire capability. It is complicated,
but not too complicated for the training of a contemporary specialist, and its clinical
benefits overwhelmingly justify the effort to learn it.

GENERAL PRINCIPLES OF SECTIONAL MECHANICS

Sectional mechanics was developed for several reasons.

.... First and foremost, it became a practical approach to control mandibular

rotation.

Second, it was designed to change the ratio in anchorage units.

.... Third, it was developed to control the occlusal plane.

Fourth, it was a practice , particularly in adults, to stay away from bracketing

the upper anterior teeth as long as feasible for esthetic an.d psychologic reasons.

Fifth, sectioning offered certain orthopedic possibilities.

.... Sixth, it was a program for utilizing the biologic natural drift of the premolars.

Seventh, it provided a natural second order movement to the molar which

assisted in its movement.

Eighth, it could be used on either the first or second molar, depending upon
the condition.

58
 Ninth, it was aimed at first setting up the foundations of the denture
posteriorly.

Te:nih, it permitted forces of mastication to work for intrnsjve action on the

upper molars.

Eleventh, it protected the joint.

... Twelfth, it permitted the starting correction of Class II very soon, before arch
leveling and arch perfection was fully accomplished.

Deciduous Arch
Sectional mechanics and elastics are preferred in young patients with moderate
convexity or a straight profile in which no orthopedics is planned. Occasionally
moderate skeletal change is observed with intermaxillary elastics, however.

For Class II treatment, at the primary level, all the deciduous second molars
are banded. A .0 16" 2 (0.4 1 mm. 2 ) is adopted and stops are bent at the lower molars.
A rectangular . 0 16" X .022" wire is twisted 90° for a stop at the molar and is thus
adapted to the lower arch. Thus a "ribbon wire" or "flat wire" is fashioned to the
teeth. The deciduous canines are ligated to the arch. Tip-backs are made and the
lower molar is torqued buccally for anchorage preservation.

For the upper, a square . 0 16" section can be employed, stopped at the molar by
a bent stop. For Class II correction, a boot loop is constructed for the elastic
attachment and for slight opening to activate the molar first. The upper deciduous
canine is directly ligated to the section. A tip-back on the molar is used to intrude
the canine in order to offset the vertical pull of the elastic. An elastic force of about
100 grams is used. The upper buccal portion is overtreated at least 10-20%.

Thus sectional and unitized mechanics can be applied before age 6.

Interceptive Dentition
At this phase of development, the permanent lower incisors and first molars are
available. A standard lower Utility Arch is placed, and the lower incisors are intruded
to the level of the first deciduous molar. This is the key to occlusal plane height for
the individual. The buccal occlusal plane is often found to be precisely at the level of
Xi Point (Fig. 5- 1).

The upper first molar is banded and a Utility Section is ligated to the upper

59
Fig. 5- 1 Pm is located at crest of bone at the mental protuberance at point of start of rec�ss on
anterior contours. The centroid of ramus is selected at a common point by measuring
minirnum height and depth of ramus and was labeled Xi Point. The connect.ion of
these two points is called the Corpus Axis. The Occlusal Plane is drawn through the
plane of the buccal teeth and called the True Occlusal Plane.
canines. A gable mesial to the molar is placed to push the canine palatally and a tip­
back is employed. A force of about 125 grams is used for the elastic. If the bite is
deep, and the incisors in Division 2 position, the section is not used, but an upper
Utility Arch is placed to open the bite first. Elastics are then placed directly to the
Utility Arch wire. Be not afraid to use elastics more than 200 grams at this time.

Full Dentition
This technique applies to the young permanent dentition as early as age I O or
to the mature dentition as old as 70. It can be started with only Utility Arches in the
lower, or elastics can be delayed until arch perfection is reached. The upper molars
are banded, and a Ricketts bracket is placed on the canine in order to receive the
.016"2 section.

Several options are available in the sectional design for the upper. These vary
from a straight section with a bent stop at the molar to the Utility Section, the Z
Utility Section, or the Push-coil Utility Section. Elastics of 150 grams are employed
to reduce the buccal occlusion to a firm Class I. The Utility Arches follow, which in
turn are followed by straight wire.

Anterior Sectioning
Actually, a single tooth is a segment of the arch. Two teeth, three teeth, or
four teeth also constitute a section.

One common point of sectioning is, as suggested, mesial to the canine. This
separates the buccal from the anterior as the canine is managed with the side teeth.
This sectioning is accomplished on a unilateral basis in cases of asymmetry. When
midlines of the ante1ior teeth are not aligned a skewing movement of the entire arch
is difficult. However, if the arch is segmented, or broken up into parts, the
movements are much easier and the flow much better.

In midline problems, the buccal section needing attention is corrected first.

But, in addition, all four incisors are aligned in a straight curved section, and
transverse elastics are applied.

After the midline is over-corrected the segregation can now be integrated. This
is done also with a variety of modifications of Utility fom1s. Commonly, a double
Delta Delta, crossed "T" or horizontal loops, are applied as desired.

Sectioning can be done in either arch and is especially good for open bite
reduction.

60
 Sectioning is feared by many straight-wire advocates, but when it is mastered it
certainly lends greater efficiency and better results.

Finishing
Even after the ideal arch step in therapy, segmented principles have been
taught with Edgewise techniques since it started. Progressive band removal and
closing of all spaces is customary.

Therefore, the orthodontic specialist should have no apprehension concerning

sectionals or segmental mechanics. They mal,e orthodontics alive and interesting.
The traditional straight wire practitioner must overcome his fear when separate
units are being managed. Teeth are "out of control" when undesirable occurences are
witnessed. "Control" does not mean just teeth locked into a straight line, but
includes the behavior of the mandible and the whole face.

61
RmERICRn lnSTITUTE FOR BIOPROGRESSIVE EOUCRTIOn
9106 E. La Posada
Sc1ttsdale, RZ 85255
(480) 948-4799 fax (480) 443-8837
rricketts@adata .cam