THE EFFECT OF INTERMAXILLARY ELASTICS IN ORTHODONTIC THERAPY
Cristina D. Bratu , Camelia Fleser , Florica Glavan REZUMAT
Elasticele ortodontice sunt utilizate în toate tipurile de anomalii, Clasa I, Clasa a II-a [i Clasa a III-a, [i în ocluzii deschise, având meritul de a suplimenta deplasarea mandibulei [i a nu necesita activ\ri repetate din partea ortodontului. Ele realizeaz\ deplas\ri orizontale, verticale, transversale, distaliz\ri, mezializ\ri ale mandibulei, extruzii dentare, închideri de spa]ii, corectarea liniei mediane, a rela]iei intercanine [i în\l]area ocluziei. Lucrarea de fa]\ î[i propune prezentarea câtorva aplica]ii ale elasticelor în optimizarea ortodontic\ în anomaliile de Clasa a II-a Angle [i ocluzia deschis\ fronto-bilateral\. Cuvinte cheie: for]e ortodontice, elastice intermaxilare clasa a II-a, anomalie dentomaxilar\ clasa II/1, ocluzie deschis\ fronto-bilateral\.
Orthodontic elastics are used in all kinds of malocclusions: Class I, Class II, Class III and open bite. Their aim is to increase the movement of the mandible, without the need of multipe activations by the orthodontist. Their effects are: horizontal, vertical, transersal movements, mandible distalizing and mesializing, dental extrusion, space closing, midline shift and intercanine relation correction, opening the bite. Our study will pesent some of the clinical applications of orthodontic elastics in Class II and fronto-bilateral openbite malocclusions. Key Words: intermaxillary Class II elastics, Class II/1 malocclusion, open bite, orthodontic forces.
Orthodontic treatment represents a major investment in the future dental health and appearance.1 Teeth move as a reaction to forces applied to them.2 In many cases, we use other teeth in the same jaw to give them resistance or anchorage, needed to provide the required forces.3 Most often, usually when several teeth need to move in the same direction, it is not possible to produce the change required using appliances anchored in just one jaw. During some phases of orthodontic treatment, elastics or rubber bands are used to move teeth or jaws, or sometimes both.4,5 By carefull treatment planning and controlling the strength, direction and duration of forces, we aim to keep our use of elastics and headgear to a minimum.
Department of Pediatric Dentistry and Orthodontics, Faculty of Dentistry, Victor Babes University of Medicine and Pharmacy Timisoara Correspondence to: Dr.Dana Cristina Bratu, Department of Pediatric Dentistry and Orthodontics, Revolutiei Blvd. 9, Tel. +40-256-491943 Email: firstname.lastname@example.org Received for publication: Nov. 05, 2003. Revised: Jul. 19, 2004.
In some cases a good treatment outcome will be impossible without a lot of work using elastics, headgear or both. The first known elastic was used by the Inca and Maya civilizations and was extracted from Hevea trees.2 Later, in 1728, Pierre Fouchard proposed to close anterior diastema with silk ligature.1 From this moment on the history of using elastics in orthodontics abounds in writers, culminating with Ricketts in 1970, which applyed the Bioprogressive segmented light square wire technique advising the closing elastics conduct in open bite cases. 2 Roth recommends short Class II intermaxillary elastics to help leveling the curve of Spee in association with extraoral forces. Langlade has the merit of developing clinical applications of elastic forces in different situations, proposing rules of biomechanics .6
MATERIAL AND METHOD
Intermaxillary Class II elastics are placed on the anterior maxilla and posterior mandible.6 We used intraoral elastics produced by GAC International Inc. NY USA, made from latex and available in different sizes and shapes. They are available in “light”, “medium”, “heavy” and “super heavy” types, each of
TMJ 2004, Vol. 54, No.4
mandibular arch advancement. dental distalization. Application of the elastics was different.6
In the maxillary arch. The class II elastics have different effects:6 a. Effect of Class II elastics is the maxillary distalizing. the force varies with different angulation of the Class II elastic and has different effects upon the maxillary and mandibular arches. mesial movement of the mandible. labial or lingual: distal to a molar tube. extrusion and downward movement of anterior occlusal plane. a Kobayashi wire ligature or a continuous archwire with anterior loop. forward movement of the entire mandibular arch. lateral extrusion. Each bag of GAC elastics contains a bright white placer for the patient. Class II elastic indications: Class II elastics may be used for main and secondary objectives in the following clinical situations: skeletal and/or dental Class II malocclusions.
1: Figure 1 Orthodontic elastics in different clinical situations
Elastics were inserted at the maxillary arch. M1. According to the orthodontist’s prescription. effects on the occlusal plane:lowering of the anterior occlusal plane. phonation). The lower facial height will depend on the wearing time and the amount of elastic force used. the patients were instructed to wear the elastics during night and day. At the mandibular arch. a hook or a loop.
Figure 2: Biomechanic influence of elastics in Class II anomalies
. Pm 1). a Kobayashi wire ligature. effects upon the mandibular arch: buccal tipping of lower incisors. presented a Class II/1 malocclusion. elastics were inserted posterior. depending on the clinical situation. We used classic. c. During daytime. the vertical component of extrusion is smaller than the horizontal component of distalizing. sagital correction of the Class II relationship. triangular and rectangular elastics. a Class II utility arch. effects on the facial patterns: forward movement of the chin. the horizontal component of advancement is smaller than the vertical force of extrusion. Pm 2. Effects of Class II elastics: mandible distalizing. In different clinical situations. effects upon the maxillary arch:upper incisors are more vertical. extrusion of the lower first molars. midline deviation correction.
Representative clinical cases Case 1 Patient S. their effect being increased by the functional movements (mastication. buccal tipping of retruded lower incisors. 6 intermaxillary elastics have an equivalent vertical and horizontal component.
Cristina D. forward movement of the mandible with a posterior rotation. After retraction of the frontal group and obtaining a functional overjet.6 They are recommended only after the correction of overbite and segmentation of the maxillary archwire.A. Bratu et al. mandibular advancement and closing the bite. This study was conducted on a number of 20 patients with Class II/1 and fronto-bilateral open bite anomalies. anchorage reinforcement.them performig a different force on the teeth. backward movement of the upper arch. With a mouth open of 10 mm during speech. d. they must be changed 1-2-3 times/day. anterior from a canine bracket hook. the patient wears Class II elastics. b. During the night. In the mandibular arch. backward movement of the upper incisors. bite opening (class II/2). different teeth (M2.6 intermaxillary elastics have a vertical component of extrusion that is much more significant than the horizontal component.
1. presented narrow upper arch and and bilateral canine ectopy. unwanted space opening or closing. Forte ortodontice. After 1 month after insertion.10 have found more pronounced vertical changes after elastic treatment. Rectangular elastics to close the open bite
Frontal elastics in rectangular shape produce:7 transversal changes. unwanted rotation or extrusion. horizontal and vertical equal forces which rearrange the oclussion in the finishing stage. occlusal and vertical stability of the canine. Vol. Ed. presented a fronto-bilateral open bite. we applied frontal rectangular elastics in order to close the bite. in order to obtain an optimal occlusion and a long time stability of the orthodontic results. In the final stage. Timisoara. Ed.
Figure 4. 1995.9. triangular elastics were applied. Clinical case and representation of Class II elastics
Case 2 Patient A. Bratu E. presented with a Class II/1 malocclusion. Glavan F. temporomandibular disorders. After alignment of the canines. upper and lower anterior group extrusion. mandibular rotation.10 After comparing the effects of Class II elastics and the fixed functional appliances such as Herbst. Glavan F. the elastic properties decrease with 30%. After solving the lateral occlusal problems. Rectangular elastics
Effects of lateral rectangular elastics: distalizing of the upper arch. the elastic properties may decrease or be lost.
TMJ 2004. with the condition of a carefull diagnosis and treatment planning. we applied rectangular intermaxillary elastics for occlusal setlling. No.4
Figure 5. et al. The disadvantages of intermaxillary elastics are minimal and the results are optimal.
Figure 3. advancement of the lower arch. 2. 2001. with the movement of the tooth along the bisector line direction. periodontal problems of the lower teeth. Case 3 Patient F. Clinical case with triangular elastics
Triangular elastics produce canine extrusion.
Our conclusion is that it would be advisable to use intermaxillary elastics in the finishing stage of orthodontic treatment.
Some clinical problems may appear even with careful clinical observation: 6 excessive or insufficient wearing. and after 3 hours. incorrect placement of the elastics by the patient. abnormal tipping. 2003. UMF Victor Babes. Ortodontie. and the presence of two oblic forces. elasticity was 50% off. other authors 8. Mirton. 3. with 40%.Case 4 Patient A. loss of anchorage.M. After 2 hours from the insertion of elastics6 in the oral cavity. Waldpress. Timisoara. Ed.
A pilot study. Bratu et al. et al. 5. 6. Am J Orthod Dentofacial Orthop 2000.and hyperdivergent growth patterns. Heo G. New York. Kersey ML. Nelson B. Bradley H.13(3):147-50.118(6):641-8 10. 2000. Skeletal and dental changes with nonextraction Begg mechanotherapy in patients with Class II Division 1 malocclusion.
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Cristina D. Class II correction-reducing patient compliance: a review of the available techniques. Langlade M. Hagg U. Rock WP.73(2):181-6. Hansen K. Reddy P. 7. Cinsar A. Eur J Orthod 2002. Kharbanda OP. Aras A. Fisher SE. Class II correction in patients treated with class II elastics and with fixed functional appliances: a comparative study.4.
8. A comparison of dynamic and static testing of latex and nonlatex orthodontic elastics. McSherry PF. The effect of zigzag elastics in the treatment of Class II division 1 malocclusion subjects with hypo. 9.27(3):219-25. Duggal R. Optimization of Orthodontic elastics. Am J Orthod Dentofacial Orthop 2000. J Orthod 2000. Wilosn HJ. Br J Orthod 1986. et al. Force reduction of orthodontic elastomeric chains after one month in the mouth. Glover KE.23(4):393-402. Angle Orthod 2003. GAC International Ed.