Introduction How straight is a straight wire appliance?
When this question is asked to the orthodontists, it will produce varied responses. Some clinicians readily accept the straight wire concept and appliance, as being both scientifically sound and clinically acceptable, other clinicians question the concept itself and criticize the appliance but considering all factors preadjusted systems have provided great benefit to orthodontics in all stages of treatment, no matter what the original malocclusion, a rectangular finishing arch wire in a preadjusted system always require some 1 st, 2nd and 3rd order bends to precisely position the teeth. One can not simply place an ideal rectangular arch wire in a straight wire appliance, and assume that ideal positions of each tooth will result. Essentially every patient varies in teeth morphology and bracket positioned. Will require some adjustment in the final rectangular arch wire. The actual amount of finishing and detailing in any given case may be increased by any of the following; 1. Variation in the shape and size of the patient’s teeth preadjusted to the average measurements used for the preadjusted appliance. 2. Inaccuracies or shortcoming in appliance design relative to its measurement goal. 3. Inaccuracies in appliance placement relative to the design of the appliance. 4. Failure to allow sufficient time for the bracket system to express itself. As in many other aspect of dentistry for e.g. a denture will not be better than a primary impression or an only will not be better than a crown preparation an obturation will not be better than a root canal preparation. If all other factors remain equal in a pure preadjusted system a finishing and detailing will not be better than a bracket placement, so if we consider, a straight wire system purly straight then the effectiveness of the straight wire appliance depends on perfect bracket placement. However practically this axiom is impossible hence I believe that in preadjusted system finishing is the beginning of the end so lots start with the end. The six keys to normal occlusion Andrews discussed six significant characteristics observed in a study of120 casts of non-orthodontic patients with normal occlusion. These constants will be referred to as the “six keys to normal occlusion”. The six keys to normal occlusion contribute individually and collectively to the total scheme of occlusion and, therefore, are viewed as essential to successful orthodontic treatment. Key I Molar relationship
The first of the six keys is molar relationship. The non-orthodontic normal models consistently demonstrated that the distal surface of the distobuccal cusp of the upper first permanent molar occlude with the mesial surface of the mesiobuccal cusp of the lower second molar. Therefore, one must question the sufficiency of the traditional description of normal molar relationship. It is possible for the mesiobuccal cusp of the upper first permanent molar to occlude in the groove between the mesial and middle cusps of the lower first permanent molar (as sought by Angle) while leaving a situation unreceptive to normal occlusion. The closer the distal surface of the distobuccal cusp of the upper first permanent molar approaches the mesial surface of the mesiobuccal cusp of the lower second molar, the better the opportunity for normal occlusion. Key II Crown angulation The gingival portion of the long axes of all crowns was more distal than the incisal portion. The crown tip is expressed in degrees, plus or minus. The degree of crown tip is the angle between the long axis of the crown (as viewed from the labial or buccal surface) and a line bearing 90 degree from the occlusal plane. A “plus reading” is awarded when the gingival portion of the long axis of the crown is distal to the incisal portion. A “minus reading” is assigned when the gingival portion of the long axis of the crown is mesial to the incisal portion. Normal occlusion is dependent upon proper distal crown tip, especially of the upper anterior teeth since they have the longest crowns. Let us consider that a rectangle occupies a wider space when tipped than when upright . Thus, the degree of tip of incisors, for example, determines the amount of mesiodistal space they consume and, therefore, has a considerable effect on posterior occlusion as well as anterior esthetics. Key III Crown inclination The third key to normal occlusion is crown inclination. Crown inclination is expressed in plus or minus degrees, representing the angle formed by a line which bears 90 degrees to the occlusal plane and a line that is tangent to the bracket site (which is in the middle of the labial or buccal long axis of the clinical crown, as viewed from the mesial or distal. A plus reading is given if the gingival portion of the tangent line (or of the crown) is lingual to the incisal portion. A minus reading is recorded when the gingival portion of the tangent line. Anterior crown inclination Upper and lower anterior crown inclinations are intrieately complementary and significantly affect overbite and posterior occlusion. The upper posterior crowns are forward of their normal position when the upper anterior crowns are insufficiently inclined. Even when the upper posterior teeth are in proper occlusion with the lower posterior teeth, undesirable spaces will result somewhere between the anterior and posterior teeth, if the inclination of the
are progressively in error. Key VI occlusion plane The planes of occlusion found on the non-orthodontic normal models ranged from flat to slight curves of Spee. A deep curve of Spee results in a more contained area for the upper teeth.
.anterior crowns is not sufficient. The remaining upper teeth. In broad sense. Three is a tendency for the plane of occlusion to deepen after treatment. An ideal occlusion which is healthy and functionally satisfactory 2. in treated cases. 1. Posterior crown inclination upper The pattern of upper posterior crown inclination was consistent in the nonorthodontics normal models. A progressively greater “minus” crown inclination existed from the lower canines through the lower second molars. is often incorrectly blamed on tooth size discrepancy. making normal occlusion impossible. allowing excessive space for each tooth to be intercuspally placed A brief note on three main orthodontic goals. Intercuspation of teeth is best when the plane of occlusion is relatively flat. A minus crown inclination existed in each crown form the upper canine through the upper second molar. A reverse curve of Spee is an extreme of overtreatment. Only the upper first premolar is properly intercuspally placed. anterior and posterior to the first premolar. Ideal facial esthetics 3. the 3 major goals of orthodontic treatment are. Key V tight contacts The fifth key is that the contact points should be tight (no spaces). This space. Key IV Rotations The fourth key to normal occlusion is that the teeth should be free of undesirable rotations. Ideal stability of results An ideal occlusion which is healthy and functionally satisfactory. Posterior crown inclination The lower posterior crown inclination pattern also was consistent among all the non-orthodontic normal models.
Generally it is impossible to maximize all three goals. In fact. at the expense of the others.
. However esthetic standard cannot be rigidly formulated and not all irregularities of teeth are esthetically unsatisfactory. Guiding inclines. Buccal inclines of the lingual cusp of the mandibular posterior teeth. 5. and on the community in which he lives. depends on the attitude of the patient himself. one can compromise facial esthetic.There is no evidence. 3. 4. Where as positioning the teeth to produce ideal facial esthetics may result in less than optimal occlusion and stability. but a normal occlusion to have proper function should have certain property. to attempts to achieve an absolutely ideal dental occlusion. What is acceptable. The end result of the orthodontic treatment to bring about an occlusion which is healthy and functionally satisfactory should have following quality. The guiding inclines are the planes of occlusal ridges that determine the path of the supporting cusp during normal lateral and protrusive excursions. For example for some people a mild element of bimaxillary proclination is attractive while for other it is unacceptable and is considered to be a justification for orthodontic treatment. Aesthetically satisfactory The majority of the patients seek orthodontic treatment for esthetic reasons. it may be associated with instability after treatment in the same way effort to achieve the most stable result after orthodontic treatment. One way to deal with this of course is to emphasize one of the goals. They are lingual incline of the buccal cusp of the maxillary posterior and lingual inclines of the maxillary anterior teeth. that minor irregularities of teeth or of arch relationship are harmful to the health of dentition. A perfect occlusion is generally regarded as esthetically ideal. Correlation between centric occlusion and centric relation. may necessitate compromise in both facial esthetic and occlusion. Absence of any occlusal interference between centric relation and centric occlusion. However. The term normal implies a situation commonly found in the absence of disease and physiological adaptive range. Functional stability means that impact of full intercuspidation closure be in the long axis of all posterior teeth. The occlusion guidance in various excursion should be on the working rather then on balancing side. Stability The natural occlusion before orthodontic treatment is stable in planing orthodontic treatment to any change in position of the teeth must be another position of stability. 6. In the early twentieth century angle solved this problem by focusing solely on the occlusion and declaring that facial esthetics and stability would take care of themselves. Stable jaw relationship when the teeth make contact in centric relation. 1. 2. unfortunately they did not.
the crowns tend to bunch up and a fixed lower retainer is usually needed to prevent post treatment relapse. and the apices of the lower lateral incisors must be spread more than those of the central incisors. Second key The lower incisor apices should be spread distally to the crowns more than is generally considered appropriate. If this happens. to gain acceptable esthetic and stability. those of greatest important to the patients should be favoured. relapse and crowding will occur. Use of the mandibular plane might indicate that the apex is not sufficiently distal to the crown. should be used as a positioning guide. even if their roots are spread and the incisal edges are on the A-P line or 1mm in front of it. Some times ideal occlusion must be altered by extraction or otherwise. When the lower incisor roots are left convergent. This is the optimum position for lower incisor stability. First key The incisal edge of the lower incisor should be placed on the A-P line or 1mm in front of it. When the retainer is removed. Lower incisors that are overly proclined in treatment – beyond one standard deviation – can only be maintained in such an untenable position with a fixed retainer. The occlusal plane. or even parallel. Elimination of lower retention The frequency with which lower retainers are used after treatment to prevent lower incisor or cuspid collapse suggests there is little understanding of how to avoid these post treatment events. 5Distal
. Appliance control is required to achieve optimal position of the lower incisor consistently at the end of treatment. Third key The apex of the lower cuspid should be positioned distal to the crown. the incisors will move lingually and become crowded. Such a circumstance could occur when there are highly divergent occlusal and mandibular planes in a steep mandibular plane angle case. It also creates optimum balance of soft tissues in the lower third of the face for all the variations in apical base differences within the normal range. If the lower incisor is advanced too far beyond the A-P line.As important as dental occlusion is it is not the most important consideration for all patients. (Raleigh Williams) has introduced six treatment keys which have emerged as essential if lower retention is to be eliminated. when in fact it is if the occlusal plane is used. several steps can be taken during fixed appliance treatment to eliminate the need for retention in the lower dentition. However. In general if all of three major goals of orthodontic treatment cannot be reached. the lower incisors crowd up. rather than the mandibular plane. This angulation of the lower cuspid is important in creating post treatment incisor stability because it reduces the tendency of the cuspid crown to tip forward into the incisor area.
To torque the lower cuspid apex buccally. Otherwise. a Begg clinician can use a simple auxiliary. Even if a lower cuspid with abnormal lingual position of the apex were supported for many years with a fixed retainer. rounded. the combined variation can be 36O. from 11O to 47O. the crown would eventually move lingually when the restraint was removed. which are small. Straightwire systems agree within 4-6 of inclination of the lower cuspids to the occlusal plane. the contact areas between the incisor crowns move upward toward the anatomical contact points. This is extremely important because of its influence on post treatment stability. If the apex of the lower cuspid is lingual to the crown at the end of treatment. Spreading the apices of the lower incisor roots distally causes a strong reciprocal tendency for the crowns to move mesially. Fourth key All four lower incisor apices must be in the same labiolingual plane. and the degree to which it occurs will affect lower incisor post treatment stability. There is a bewildering range of lower cuspid buccal root torque in straightwire edgewire brackets. the forces of occlusion can more easily move the crown lingually toward the space reserved for the lower incisors because of these functional pressures plus a natural tendency for the crown to upright over its root apex. The displacement forces are considerably augmented by the increasing width of the lower incisor crown toward the incisal edge and contact point. This results in a reverse movement of the apices linguolabially.
. the slightest amount of continuous mesial pressure can cause various degrees of collapse in the lower incisor segment. small contact points. This means that provision for the additional space must be made during the spreading process. All sort of occlusal forces await their chance to exert lingual pressure on the lower cuspid crown. there is a tendency for these contact points to displace each other labiolingually. Variations in crown slopes to which the variously torqued brackets are attached compound the dilemma. a total variation of 18O. as the roots are spread. Lower incisors that have sustained no proximal wear have round. Between the lower right and left cuspids. labiolingual apical displacement of the lower incisors will tend to occur. An edgewise clinician can place the appropriate torque in the rectangular wire. which are accentuated if the apices have been spread for stability. Consequently.inclination the lower cuspid should be a standard treatment object and is easily accomplished with the Begg or any straightwire technique. Moreover. Fifth key The lower cuspid root apex must be positioned slightly buccal to the crown apex. Because of the strong mesial pressure. and near the incisal edge. Sixth key The lower incisors should be slenderized as needed after treatment.
The suggestions made for treatment therapy to correct the malposition of the maxillary first permanent molar are. This may be accomplished in a multiband technique by banding the mandibular second molars and placing its attachment as far occlusally as is possible. This extension may be adjusted to correct the supraversion of the second molar to the first molar.Flattening lower incisor contact points by slenderizing or stripping creates flat contact surfaces that help resist labiolingual crown displacement. Some post treatment situations do not seem to have a detrimental effect on lower incisor stability. With these basic factors in mind. more than one slenderizing session may be necessary to bring the tooth mass into harmony with the jaw size and to eliminate the need for lower incisor retention. and another is prodigious mandibular growth that carries incisors forward against the upper incisors and tips them out. When the mandibular second molar is not sufficiently erupted to be banded.
. When the buccal attachment on the maxillary molar band placed toward the mesial angle of the tooth. the favourable distolingual rotation of the buccal cusps will be accomplished with a minimum number of compensating bends in the arch wire. Occasionally. This treatment also helps eliminate the need for lower incisors retention. and axial alignment. It is necessary to eliminate the supraversion of the mandibular second permanent molar. If the post treatment dentition displays pressure signs by developing irregularities among the incisors reduction of incisor width by slenderizing can be the answer. Proper positioning of maxillary first molars The normal position of the maxillary first permanent molar has been described with some detail concerning its cusp relation. Usually only minimal tooth structure has to be removed if the root apices have been adequately spread. A straight arch wire placed into this attachment will accomplish the mesial axial inclination. the buccal attachment should be placed on the band at such an angle that its mesial edge is directed toward the incisal. Experience has shown that neither of these requires the protection of a lower retainer. an extension may be soldered to the lingual arch and adapted to rest on the occlusal surface of the second molar. One is the depth of the overbite. may be simplified by following a few suggestions in appliance therapy. When the band for this tooth is formed parallel with the tips of the buccal cusps. The orientation of the maxillary first permanent molar into normal occlusion. The attachment on the buccal of the maxillary first molar may be placed in such a position that mesial axial inclination will be accomplished with a minimum number of compensating bends in the arch wire. the orthodontist needs to deviate from them in a major or minor degree as warranted by the case under treatment.
A. Checking for T. Establishing a relatively flat plane of occlusion Root paralleling at extraction sites
. Checking functional movement. 1. 7. c.J. 2. 10. Placement of the buccal attachment to accomplish proper rotation. Establishing correct posterior crown torque. 13. Excessive overbite Anterior openbite
6. Correction of rotations and over correction where need. Placement of buccal attachment to accomplish proper mesial inclination. 11. B. 9. Root paralleling at extraction sites. 5. Correction of midline discrepancies. 4. 17. Factors which should be considered during finishing and detailing – problems and remedies. b. Correction and over correction of the A-P jaw relationship. Depressing of the mandibular second molar. dysfunctions such as clicking and locking. Establishing correct tip of the upper and lower anterior teeth. Tooth size discrepancies. 14. 15.M. 12. Co-ordinating arch width and arch form. Determining if all habits have been corrected.a. Establishing marginal ridge relationships and contact points. 3. Correction of vertical relationship. Maintaining the closure of all spaces. Checking cephalometric objectives. 16. Evaluating facial and profile esthetics.
18. Establishing correct torque of the upper and lower anterior teeth. 8.
Colin Ress for paralleling at Extraction Sites is as follows: If extraction space has been closed too fast. to prevent the extraction site from reopening during finishing. paralleling the roots becomes even more difficult. and some degree of root paralleling is often necessary. Either the teeth must be tied together at the extraction site.025 steel wire is undesirably stiff. A similar box loop archwire can be used with the . These wires are flexible enough to engage narrow brackets even if a moderate degree of tipping has occurred. Occasionally. a severely tipped canine tooth will be encountered.017 x .022 bracket is much too stiff to produce the needed root up righting moment. With inaccurate bracket placement. this loop can also be used to obtain a last bit of space closure. the best choice is usually a box loop in . there are two options: (1) bending a loop into a rectangular archwire to provide the desired flrxibility or (2) using a auxiliary root uprighting spring. this is the preferred approach. In this situation.During space colours with the edgewire appliances. there is usually even less need for root paralleling as a finishing procedure than with narrow brackets and closing loop archwires. a bets titanium or even a nickel steel archwire to obtain final positioning. To enhance 9
. 025 wire (the smallest size that will not twist in an . the typical finishing archwire is either 017 x . If a greater degree of tipping has occurred.018 x . In .016 x . At the same time that the root of the canine tooth is being positioned distally. 017 x . With wider .018 appliance. Even a .022 or . preventing the crowns from tipping together.022 appliance. If proper moment to force ratios have been used. Another method which has been introduced by L.025 wire. make a gable bend directly over the extraction site with a Tweed loop forming plier.025 brackets on the canines and premolars and with the use of sliding rather than loop mechanics. Little if any root paralleling will be necessary as a finishing procedure.022 or . It is usually a goal of treatment to produce bodily tooth movement during space closure. If teeth do tip even slightly into the extraction space. Use figure eight metal ligatures on the adjacent teeth to counteract the crown separating tendency of the bend and consequent reopening of the extraction site. and this effect is important to remember.22 x .022 edgewise. With the 018 appliance. made from . the crowns of the canines and first premolars tend to tip toward each other. A root paralleling moment is a crown separating moment in edgewise just as it is in Begg. To correct more severe tipping. or the entire archwire tied back against the molars (Fig. a more flexible full dimension rectangular archwire is needed. and the archwire will generate the necessary root paralleling moments. 21).019 x . In such a case. however.022 bracket). and a longer range of action is needed than can be delivered by even the most flexible continuous archwire. A rectangular beta titanium wire is an excellent choice of root paralleling is needed. The alternative is to by pass the tipped canine with a rectangular base arch and use an auxiliary root uprighting spring extending from the auxiliary tube on the first molar and tied into the canine bracket. a full dimension steel archwire in a . On the other hand.025 steel. it is likely that at least a small amount of tipping will occur in some patients. With the .
regardless of the appliance system. but the total anchorage required for a given anteroposterior correction is about the same for all appliances. The tip and torque built into the anterior brackets of these appliances create a greater demand for anchorage. Overcorrection of the Class II case is the greatest challenge in this area. growth prediction is difficult. These will exert a purely extrusive force on that tooth and an insignificant intrusive force with distal root tip on the adjacent teeth. However. Make identical clockwise bends. If corrected only to the desired and position. causing excessive distal root tip. directed toward the tooth to be moved. along with a slight extrusive and mesial root tipping effect on the second bicuspid and a slight intrusive and mesial root tipping effect on the cuspid. place the archwire under the canine and premolar brackets to level the arch. These patients benefit from overcorrection to an edge to edge position and maintenance of that position with night time Class II elastics for six to eight weeks.
. This will result in a pure tipping movement of the first bicuspid. such as peg shape lateral incisors. Other Class II cases have a Class III growth tendency in retention and clearly would not benefit from overcorrection in the finishing stage. place bends on either side of the tooth. New brackets can then be bonded.the root paralleling action of the gable bend. After the roots are parallel in three or four months. 2. place another bends mesial to the premolar and distal to the canine. are present. the mesial marginal ridge of the first bicuspid may be more gingival than the distal marginal ridge. Even if the arch has been levelled. Wire bending will occur in only two situations. making treatment much more efficient. If a bracket has been bonded slightly too far incisally on one tooth compared to adjacent teeth. for the most part. followed by settling into an ideal Class I relationship. many Class II cases will show a relapse of overjet and a deepening of the bite. 1. particularly in the upper arch. Correction and over correction of the A-P jaw relationship Considerations of anteroposterior skeletal and dental corrections are. not specific to preadjusted systems. When irregularly shaped anterior teeth. When brackets are improperly placed relative to the vertical reference lines of the anterior teeth (although it is much easier to reposition the brackets than to place unnecessary bends in the anterior segments of both archwires). with the rounded tip of a jarabak plier on either side of the tooth. Establishing correct tip of the upper and lower anterior teeth The tip built into the face of preadjusted bracket eliminates the need for 2nd order bends in the anterior segments.
In addition. when torque is frequently lost in the upper anterior segment while the lower incisors are angulated forward. i.. It can be particularly helpful in patients with Class II division 2 malocclusion whose maxillary central incisors are severely tipped lingually and require a long distance of torquing movement. One torquing auxiliary deserves special mention: the burstone torquing arch. With the .022 brackets (provided the brackets have torque built in). the wire slides through the bracket slots far more efficiently. on the other hand.e. The most common examples is during overjet correction of the moderate to severe Class II case. while the lateral incisors need little if any torque.017 or .019 wire in a . For this reason. even in the . It is equally effective with the . that the finishing archwire will have a minimum dimension of .022 appliance.017 wire in an . Two factors determine the amount of torque that will be expressed by any rectangular archwire in a rectangular slot: the inclination of the bracket slot relative to the archwire.022 bracket as with an . tipping of incisors can be largely prevented during retraction and space closure. lingual root torque as a finishing procedure may be required. it is assumed that the rectangular archwires used for finishing will fit tightly in the bracket slot.022 edgewise appliance have almost disappeared from contemporary use. Therefore. further reducing any need for auxiliary arches). 3. it is often necessary to adjust the torque in the upper and lower anterior segments at various stages of treatment with a preadjusted appliance.022 appliance. allowing effective use of sliding mechanics for space closure. some brackets may have extra built in torque to compensate for rectangular finishing archwires that will have more clearance. it may be necessary to compensate by adding lingual root torque to the upper anterior teeth and labial root torque to the lower anteriors.018. Such compensatory bends should be placed early in the space closure and overjet correction phase. Torque will not be expressed to the same extent with a . full dimension nickel titanium or bets titanium arch wires can be used to torque incisors with .018 or . Because of the long lever arm. The anterior torquing needs of patients vary so widely that no single set of bracket torque values can meet the needs of all the cases seen in an orthodontic practice. to avoid having to re establish lost torque during the finishing stage. The difference amounts to several degrees of torque.018 appliance. this is the most effective torquing auxiliary for use with the edgewise appliance. Without anterior archwire bends. 11
. establishing correct torque of the upper and lower anterior teeth If protruding incisors tipped while they were being retracted.There is also a mechanical advantage to built in tip in cases of anterior spacing. it is important to know what finishing wires were intended in any given straight arch appliance. Obviously. and the tightness of the fit between the archwire and the bracket. With the . torquing auxillaries for the . In this situation. One of the great virtues of pretorqued brackets is that.022 appliance.018 bracket.
The greater the desired vertical change in incisor position. An excessive curve of Spee with relative elongation of the lower incisors may still be the cause of overbite. no change in the vertical position of incisors will be needed during the finishing stage of treatment. the simples approach may be cut this archwire distal to the lateral incisors and install an auxiliary intrusion arch. A less effective alternative is . It is important to remember that when an auxiliary intrusion arch is used. but either situation may occur. Correction of vertical relationships If the first two stages of treatment have gone smoothly. and elongating these teeth is usually undesirable. the base arch should be a relatively small round wire.For full expression of the torque built into brackets in the . Small corrections during finishing usually do not require placing a lingual arch. if an auxiliary depressing arch is added to a continuous base archwire. As a general rule. if the patient is still growing and relative rather than absolute intrusion would be satisfactory. At this stage. a stabilizing transpalatal lingual arch may be needed to maintain control of transverse relationships and prevent excessive distal tipping of the maxillary molars. A solid . If the open bite results12 from
. the more important it will be to have stabilizing lingual arch in place. it is important to analyze the source of the difficulty if an anterior open bite persists at the finishing stage of treatment. a light round continuous archwire with an accentuated curve of Spee (. the problem is often slight elongation of the maxillary incisors. If so. anterior open bite is more likely to be a problem than residual excessive overbite. an auxiliary intrusion arch is the preferred solution. Excessive overbite Before attempting to correct excess overbite at the finishing stage of treatment. and particularly to observe the vertical relationship between the maxillary lip and maxillary incisor.021 x 0.016 or . and an auxiliary arch added to it.
Anterior open bite As with deep bite. Only rarely is a persistent open bite caused by lack of eruption of the upper incisors. taking advantage of the greater resilience of this modern material.018) can be placed. but by this stage of treatment. while if the base arch is segmented. and vice versa. the segments should be rectangular wire. Alternatively.022 edgewise appliance.25 braided rectangular steel wire. If a rectangular finishing archwire is already in place. it is better to use an .025 steel wire cannot be recommended because of its stiffness and the resulting extremely high forces and short range of action.021 x – 025 beta titanium arch wire for finishing.021 x . it is important to carefully assess why the problem exists.
A relatively common problem at the finishing stage of treatment is a discrepancy in the midlines of the dental arches. and treatment decisions will have to be made in the light of camouflage versus surgical correction. High pull headgear to the upper molars is the best approach if excessive vertical development of the posterior maxilla is the basic problem. The preferred approach is to place a light round wire (. while retaining a full dimension rectangular archwire in the upper. Minor midline discrepancies at the finishing stage are no great problem. If carried to an extreme. Correction of midline discrepancies Most minor midline discrepancies of 3mm or less can be easily corrected with rectangular wires in the finishing stage (greater discrepancies require attention earlier in treatment). Fortunately. it is preferable to replace a heavy rectangular lower archwire with a lighter round wire before using anterior vertical elastics. Posterior marginal ridge discrepancies. with a slight curve of spee and any necessary vertical steps to correct marginal ridge discrepancies.excessive eruption of posterior teeth.018) in the lower arch. Although coincident dental midlines are an important component of midline discrepancy will be reflected in how the posterior teeth fit together – it is undesirable esthetically to displace the maxillary midline. midline 13
. correcting it at the finishing stage can be extremely difficult. Elongating anterior teeth in this way. it is important to establish as clearly as possible exactly where the discrepancy arises. Because of the stiffness of the rectangular archwire futile to use vertical elastics without altering the form of the archwires to provide a curve of spee in the lower arch. Moreover. Light elastic force is then used to elongate the lower incisors and close the open bite. which may also contribute to the open bite. or an asymmetric. creating aslight curve of spee. should be eliminated with small vertical steps in the archwires. this condition can result either from a preexisting midline discrepancy that was not completely resolved at an earlier stage of treatment. and this treatment will have to be continued until growth is nearly complete. a mild open bite at the finishing stage of treatment is usually caused by an excessively level lower arch. however.016 or . but it is quite difficult to correct large discrepancies after extraction spaces have been closed and occlusal relationships have been nearly established. of course. This condition is managed best by elongating the lower but not the upper incisors. whether from a poor growth pattern or improper use of interarch elastics. bringing it around to meet a displaced mandibular midline. A correct maxillary midline is important for good facial esthetics. If no severe problems with the pattern of facial growth exist. Closure of spaces within the arch. usually well into the retention period. is no substitute for controlling posterior vertical development. this will reintroduce overjet and produce an esthetically uneacceptable relationship even if proper occlusion is achieved. If a midline discrepancy results from a skeletal asymmetry. As with any discrepancy at the finishing stage. while a small displacement of the mandibular midline creates no esthetic difficulty. it may be impossible to correct it orthodontically.
a unilateral elastic is usually tolerated reasonably well by the patient. Usually. However. the entire maxillary arch is slightly displaced transversely relative to the mandibular arch so that with the teeth in occlusion. In this circumstances.018 round wire. to bring the midlines together. 1. A single Class II elastic on one side only. Correction again would involve posterior cross elastics. This can arise easily if a slight discrepancy in the transverse position of posterior teeth is present. There are five methods of elastic wear for specific situations. This approach should be reserved for small discrepancies. and a mild Class II relationship still exists on that side. 2. for cases with the corresponding dental relationships. Prolonged use of Class II or III elastics during the finishing stage of treatment should be avoided. If a midline discrepancy is more from displacement of mandibular than maxillary teeth. for cases with a bilateral Class II component. the midline can often be corrected by using asymmetric Class II (or Class III) elastic force. but in a parallel pattern. and it is important to carefully observe and control any expansion of the lower molar while a Class II elastic is worn against a light archwire. can facilitate correction with a unilateral Class II elastic. The correction in this instance. but a brief period of interarch elastic force is often necessary to obtain final positioning of teeth. while retaining a full dimension rectangular arch in the upper arch. 3. if one side is totally corrected while the other is not. the difference in stability with rectangular versus round wires can be used to help in correcting the situation. An important consideration in dealing with midline discrepancies is the possibility of a mandibular shift contributing to the discrepancy.
. replacing the rectangular mandibular finishing arch with an . but there is a lateral shift to reach that position. As a general rule.016 or . If the maxillary midline is correct while the mandibular midline deviates slightly toward one side. Occasionally. obviously. A single Class II elastic on one side and a double class II elastic on the other. it is more effective to use Class II or III elastics bilaterally with heavier force on one side than to place a unilateral elastic. Class III elastics on one side and Class II elastics on the other. must include some force system (usually careful coordination of the maxillary and mandibular archwires. a slight narrow maxillary right posterior segment can lead to a shift of the mandible to the left on final closure. For instance. creating the midline discrepancy. when the overjet results in a slight Class II relationship on that side and the opposite side is in a Class I position. perhaps reinforced by a posterior cross elastic) to alter the transverse arch relationships. the midline discrepancy is accompanied by a mild class II or III relationship on one side. relationships are excellent.discrepancies in the finishing stage are not usually that severe and are caused only by lateral displacements of maxillary or mandibular teeth. or vice versa. It is also possible to combine a Class II or Class III elastic on one side with a diagonal elastic anteriorly.
When the problem is tooth size deficiency. Co-ordinating arch wire widths and form Upper and lower arch wires should be co-ordinated from the early stages of treatment through to the rectangular wire stage. This can be treated by using cross elastic in canine areas and by canting the arch wire in the opposite direction to the arch asymmetry. The archwires should be tied back while these elastics are worn so that the wires do not slide around the arch. This procedure allows direct observation of the occlusal relationships before the final tooth size adjustments are made. 5. Reduction of interproximal enamel (stripping) is the usual strategy to compensate for discrepancies caused by excess tooth size. This will help eliminate unwanted and trouble some cross bite in the finishing stages. This can be done by narrowing or widening the arch wire at the beginning of the treatment. and only with rectangular archwires. but many of the steps to deal with these problems are taken in the finishing stage of treatment. Tooth size discrepancies Tooth size discrepancy problems must be taken into account when treatment is planned initially. One of the advantages of a bonded appliance is that interproximal enamel can be removed at any time. Addition of composite resins to small teeth is an excellent way to compensate for tooth size problems. when that side is in a class III position and the opposite side has a class I dental relationship. An anterior cross elastic. it is necessary to leave space between some teeth. but final stripping can be deferred until the finishing stage. Archwire canting and elastic wire will often help correction of anterior asymmetries even before the finishing stages of treatment. A single Class III elastic on one side only. With some asymmetry cases the patients’ arch form may show distortion in the anterior segment particularly in the canine area. Having a small space distal to the lateral incisor is usually esthetically and functionally acceptable. most of the enamel reduction should be done initially. Asymmetrical elastics should be used for a minimum period of time. because of their tendency to cant the occlusal plane. Most arch width discrepancies can be fully corrected by the time rectangular wire stage has been reached. which may or may not ultimately be closed by restorations. It is better to add small amounts of resin on both sides of a small15tooth
. when the discrepancy occurs primarily I the anteiror segments. and is often the best plan for small incisors. causing unwanted space opening and distortion of the archform. When stripping of enamel is part of the original treatment plan.4. Tooth size deficiency problems are often caused by small maxillary lateral incisors.
.014” round wire can be used to step any improperly positioned brackets.than a large amount on one side. These adjustments require third order bends in the finishing archwires. while slightly excessive torque can partially compensate for small upper incisors. It is also possible to compensate by slightly tipping teeth. Nevertheless there is often a tendency for upper palatal cusps to be situated below the occlusal plane. requiring posterior buccal root torque to be placed in rectangular finishing wires. A . and at the next appointment these brackets can be repositioned with a heavier archwire and virtually no loss of treatment time. However such wire bending would not be acceptable for a preadjusted appliance designed to accommodate the maximum percentage of patient. Incorrect bracket height becomes apparent early in the leveling and aligning stages of treatment. but not until soft tissue inflammation has been resolved. To a limited extent. Establishing correct posterior crown torque Correct posterior crown torque is essential in preventing posterior interferences and allowing for the seating of centric cusps. During finishing. The torque built in to posterior or brackets eliminate the need for archwise bonds in most situations. More generalized small deficiencies can be masked by altering incisor position in any of several ways. For example upper central incisors bracket were frequently placed 5mm above the incisal edge at the tooth. Establishing marginal ridge relationships and contact points Marginal ridge relationships are mainly determined by bracket heights during the finishing stages of treatment. The composite buildups should be done as soon as possible after the patient is in retention. segments of coil spring are usually placed on the finishing archwire to precisely position the small tooth. In the lower arch first and second molars can show undesirable lingual tipping and it may be necessary to and bucccal crown torque to the rectangular arch wires in the lower molar regions. torque of the upper incisors can be used to compensate: leaving the incisors slightly more upright makes them take up less room relative to the lower arch and can be used to mask large upper incisors. McLaughl in and Bennett are found it effective to reposition brackets as early as possible. When the patients teeth were large the bracket was placed more incisally when compared to a patient with small teeth the 1st 2nd 3rd order bonds placed in standard edge wise archwires could compensate for the variation in bracket position. depending on the individual circumstances. A more reliable guideline is the center of the clinical crown as described by Andrews which provides a consistent bracket position regardless of tooth size. The most common method of measuring bracket heights with the standard edgewise appliance involved measuring a specific distance from the incisor or occlusal surface of each tooth. so that time is not wasted stepping archwires or repositioning brackets during the finishing stage. or by finishing the orthodontic treatment with mildly excessive overbite or overjet.
Make a 2nd order bend in the existing archwire. with an . changes in the occlusal plane. It is prefarable to take final cephalometric headfilms three or four months before debonding. 1. Carefully monitor the amount of activation in the wire at the next appointment. since it is usually necessary to return to a smaller archwire to pick up the previously unbracketed teeth. by using passive tiebacks in the finishing stage. Maintaining the closure of all spaces It is important that space closure be maintained particularly in extraction cases. other brackets can repositioned as necessary at the same appointment. and wait four to eight weeks. 3. Checking cephalometric objectives Progress headfilms should be taken about halfway through treatment to allow time for reassessment of anchorage and possible changes in the division of treatment time. when dropping to a smaller archwire for relevelling or picking up previously unerupted teeth. rather than after completion of treatment. in which if a bracket placement error is detected early enough for instance. bond a new bracket in the ideal position. Instead of removing the archwire.022” archwire in an . and placing a new multistranded or nickel titanium wire. If the cephalogram is taken before debonding.016” x . minor tooth position correction can still be made. Otherwise. The next large archwire can usually be used. spaces frequently open during finishing and must be reclosed. since the bent archwire will have been in place for at least eight weeks. and the success of the case. For example. but it provides no practical advantage to the patient. It is also beneficial in extraction cases. 2. Taking a headfilm at the end of treatment may be important for the orthodontists education and for evaluating the success or failure of the treatment. Important factors to evaluate with progress and final cephalometric x-rays include the antero posterior position of the incisors.016” x . the incisor angulations. the following technique can be used. Superimposition of the progress and final x-rays on the pretreatment x-ray will help determine the orthodontic change that has occurred. rebonding the bracket. when newly erupted teeth such as second molars are bracketed or banded.There are other times in treatment when brackets can be repositioned to save time during finishing and detailing. using an unbent archwire as a guide.018” slot – the problem can be corrected fairly quickly without round tripping. Colin Ress. to use “lacebacks” from molars to cuspids until the rectangular wire is resumed. Once the tooth has the correct mesiodistal inclination. the extent to which vertical development has occurred or been restricted. Another method has been introduced by L.
Central incisors longer than laterals. Obtuse nasolabial angle All three are attributable primarily to a lack of torque in the upper incisors. Such treatment often involves a short phase of splint therapy and physical therapy. No mesial tip in incisors Both of these esthetically and functionally undesirable axial inclinations are routinely avoided with the ample mesial tip in all straight wire appliance upper and lower anterior brackets. 4. 9. until the symptoms are eliminated. then joint function can often be re-established without permanent damage. The orthodontic look: By Roth 1. No mesial tip in cuspids 5. 6. A projection of esthetic goals should be made as part of the treatment plan the facial and profile esthetics can then be monitored clinically. Occlusal plane across upper anterior curved downward at the midline. for example) is used and sufficient time (usually 3 months) is allowed for the “built-in” torque to express itself. as well as with progress and final cephalometric x-rays. (b) thin or weak arch wires with no anterior reverse curve to assure “even and equal” intrusion of the upper incisors.025 inch. and (c) prolonged use of Class II elastics. It is elastics while managing the TMJ problem. If problems are managed before the development of true internal derangement. 18
. Document any evidence of TMJ dysfunction prior to treatment. 7. this dentofacial problem can be avoided. we recommend that the clinician: 1. Premaxilla elongated downward from class II elastics. Straight upper lip 3.Evaluating facial and profile esthetics Esthetic evaluation is an ongoing process during all stages of orthodontic treatment. and inform the patient that such symptoms exist. If a wire that “fills the slot” (0.021 x 0. concurrent with the orthodontic treatment. However. Monitor the patient for symptoms of TMJ dysfunction during treatment. Lots of gum tissue a “gummy” smile
This group is attributable to the following: (a) faulty bracket placement that positions the upper centrals longer than the upper laterals. Flattened profile 2. 2. Checking for TMJ dysfunctions such as clicking and locking TMJ dysfunction is a broad subject whose full discussion would be beyond the scope of this seminar. 8. Roth brackets for upper centrals and laterals have 12 and 8 degrees respectively.
Finally. A forward or retruded condyle can be corrected during the finishing stages. as well as two to three months before debonding. if a patient shows an anterior skid with a corresponding anterior condylar position. It is important that the lower eight most anterior teeth make contact with the upper six most anterior teeth during protrusive movements. Monitor the patient for symptoms of TMJ dysfunction during retention. airway size increases and 19
. if the condyle is in a reasonably concentric position with no clinical evidence of an anterior skid. the patient should be checked for interferences during protrusive movements and lateral excursions. This can be done by ceasing the use of Class II elastics and headgear or by using Class III elastics. Second molars should normally be banded to prevent interferences in this critical area during lateral excursions. It is generally accepted that orthodontic patients benefit from the establishment of a sited and reasonably concentric condylar position. the patient should experience cuspid rise with slight anterior contact and disclusion of posterior teeth on both the working and balancing sides. This normally requires a slight widening of the archform in the bicuspid area so that the mesial of the lower bluspids contacts the distal of the upper cuspids.
Checking functional movements Before debonding. is helpful in detecting irregularities within the joint and in evaluating the clinical position of the condyle.3. we can provide the structural environment that will best withstand stressful forces. because as the patient grows. the headgear or class II elastics can be continued until the anterior skid is eliminated and the condyle seats in the fossa. in conjunction with minor changes in anteroposterior and vertical jaw position. which will allow for normal TMJ development and function after orthodontic treatment. the patient can be debonding and left in that position. Determining if all habits have been corrected Habits such as tongue thrusting will usually have been corrected before the finishing stage is reached. While we cannot predict physical or emotional stress. It is especially important in cases that show a developing Class III tendency. For example. a slight amount of anterior skid can be provided so that the condyle is more centered. 35). if a patient has a significantly posterior condyle with no evidence of an anterior skid (Fig. In lateral excursions. Taking tomographic x-rays before treatment. Conversely. Preadjusted appliances are helpful because they provide for anterior and posterio torque adjustment. which is critical in establishing an ideal functional occlusion.
particularly if force levels are kept low.the tongue can assume a more posterior position. according to Andrews. It is helpful to have the study models near the treatment area so that pre existing rotations can be evaluated and slightly overcorrected during finishing. Any remaining rotations can be corrected during finishing by one of three methods. particularly in extraction cases. include the proper fit curve of Spee is left in the lower arch. Fiberotomics can then be scheduled either just before debonding or after the tissue has had time to heal once appliances have been removed. because most deep bites tend to relapse. as the dental environmental that supported the habit is improved orthodontically. the tongue and lip musculature adapt to the improved environment and normal function begins to occur. 2. A note should be made in the patient’s record of any severe rotations before treatment. 1. for example. Steiner rotation wedges – these are useful because they can be placed after the archwire is in position. Deep bite cases also benefit from overcorrection of the curve of Spee. 3. Lingual elastics – we have found this the most effective method. If the occlusal planes are not leveled before finishing and detailing. In addition. Also. since the lower teeth occupy less room than the opposing upper teeth.
Establishing a relatively flat plane of occlusion Reasons for completing cases to a relatively flat occlusal plane. the archwires will not slide easily through the bracket slots during space closure with sliding mechanics. Rubber rotation wedges under the rectangular archwire. Patients with severe habits should be referred for myofunctional therapy early in treatment or even before treatment. This overcorrection helps minimize relapse. it is not uncommon for a 20
. Final settling of teeth At the conclusion of Class II or III correction. We have observed that about 80 percent of tongue thrust habits correct themselves before the finishing stage. Correction of rotations and overcorrection where needed Most rotations will have been eliminated before the finishing stages. there is a tendency toward increased overjet. particularly if interarch elastics have been used. the teeth tend to rebonded back toward their initial position despite the presence of rectangular archwires.
and the rebounded from use should be allowed to express itself. 2. therefore. After the bands and brackets have been removed with the use of tooth positioners. There are 3 ways to settle the occlusion. 1. to hold some teeth slightly out of occlusion. anterior deep bite patient. the teeth should be taken to an end – to – end incisor relationship. By replacing the rectangular arch wires at the very end of treatment with light round arches 0. These light round arch wire must include any 1st or 2nd order bend in rectangular arch wire. the teeth should brought into a solid occlusal relationship without heavy archwires present. with both overjet and overbite totally eliminated. Interarch elastics and headgear should be discontinued. 2.018 in to a 22 slot to provide freedom for movement of the teeth to find their own occlusal level. 3. no matter how carefully made. before the headgear or elastic forces are discontinued. Because of the rebound after Class II or III treatment. appropriately called “settling” since its purpose is bring all teeth into a solid occlusal relationship before the patient is placed in retention. These considerations lead to formulation of two rules in finishing treatment: 1.016 in 18 slot 0. 4 to 8 weeks before the orthodontic appliances are removed. As a final step in treatment. With laced posterior vertical elastics after removing the posterior segments of the arch wires. providing some latitude for the teeth to rebound or settle into the proper relationship. In a typical class II. It is unnecessary for patient to wear light posterior vertical elastic during this setting but they can be used if needed these light arches will quickly settle the teeth into final occlusal and should remain in place for only a few weeks at most the disadvantage of undersized round wires at the end of treatment is that some freedom of movement for settling of posterior teeth is desired but precise control of anterior teeth is lost as well.016 or 0. The final step of finishing. Replacing rectangular wires with light round arch wires at a very end of the treatment was the original method recommended by tweed in the year 1940. Similar over correction is needed for other problem. It was not until the 1980 that orthodontist realized the advantage of removing only the posterior part of the rectangular finishing wire leaving the anterior segment (typically canine to canine or 1st premolar to 1st premolar and sign the lace elastic to bring the posterior teeth in to tight occlusion.full – dimension rectangular archwire. This method sacrifices a 21
. it is important to slightly overcorrect the occlusal relationships.
It may also be necessary to reposition brackets at this point. The maxillary wire is cut 3mm distal to each lateral incisor bracket.2 elastic is strated over the upper and lower second molars. If the teeth have settled properly after two to four weeks. The posterior sections are discarded. This step is critical. because teeth will not settle against interferences. The upper second molar is not included. the patient then wears the elastic at night only for three more weeks. Both are removed and sectioned. the mandibular wire 3mm distal to each canine bracket.
. a ¾”. For a Class II pull. the patient can return to heavier archwires for additional finishing. “K” ties are placed distogingivally on the upper and lower centrals.large degree of control of the posterior cross bite for the majority of patients who had well aligned posterior teeth from the beginning however this is a remarkably simple and effective way to settle the teeth into their final occlusion. tell them the appliances come off in six weeks if they follow instructions then keep your word.014” round sectional wire from lateral incisor to lateral incisor. If the teeth are into correctly positioned. A elastic begun on the left side will end on the maxillary right central incisor and mandibular left central incisor. If teeth fit properly after three weeks. At the beginning of the sequence. the bands and brackets are removed at the end of six weeks. and the sequence is repeated to the maxillary central incisor on the opposite side of the midline. This is accompanied by vertical triangular elastics. because of the degree of refinement it produce. 202 elastic is started over the lower second and upper first molar. because it signals the end of treatment. but normally any repositioning should have been done earlier in treatment. 2. “0” ties are placed on the upper and lower lateral and lower canines. Elastics should be worn day night for three weeks. Both are bent lingually on the ends to avoid irritation. maxillary and mandibular arches carry ideal finishing wires. a ¾”. McLaughlin and Bennett using a lower 0. If you want to establish credibility with your patients. The elastic is twisted between each pair of teeth and ends on the central incisors on opposite sides of the midlines. stretching across the midline. For a Class III pull. His finishing procedure is a six week sequence of controlled settling that has been most gratifying to the authors. the brackets should be ground down. Michael Steffen (1987) has introduced a method for final settling of the occlusion by use of the five cent tooth positioner. and for the patients. The elastic is twisted and engaged over the next two teeth. If all goes planned. If the maxillary buccal cusps are striking mandibular bracket at this time. and the anterior sections are replaced. then the patient can be scheduled for debonding.014” round archwire and a upper 0.
Maxillary anterior bands are removed from the labial surface with an anterior bands removing plier while tightly fitted mandibular anteriors band usually must be slit with an cutting plier to make it possible to take them off. With metal brackets applying cutting plier to the base of the brackets so that the bracket bends has disadvantage of destroying the bracket which otherwise could be reased but this is safest method enamel damage from debonding metal bracket as compare as ceramic bracket is rare. For the lower posterior teeth the band removing plier is applied first on buccal and then an lingual side.
. These will happen because the ceramic brackets have little or no ability to deform. They are either intact or broken. It also is easy to fracture a ceramic bracket while attempting to remove it. Removal of bands and bonded attachments Removal of the bands is accomplished by simply breaking the cement attachment and then lifting the band off the tooth.Another advantage to letting a case settle without rectangular archwires is that the patient can establish an individual archform. resin so that the bracket can be removed with lower force. 2. In addition. There are three approaches to these debonding problems. within certain limits. Grind away the bracket rather than attempting to break them loose. 1. The archform used in treatment may be slightly wider or narrower than the patient’s archform. and the settling phase allows correction of minor variations. 3. Bonded brackets must be removed without damaging the enamel surface this is done by creating a fracture within bonding material or between brackets and the resin and then removing the residual resin from the enamel surface. For upper molars and premolars teeth a bond removing plier is first in lingual side then buccal surface is elevated by the plier. retainers will fit more properly after settling than if they immediately follow rectangular wires. Modify the interface between the bracket and the bonding resin to increase the chance that when force is applied the failure will occurs between the brackets and bonding materials. The hand scaler can no longer be considered desirable for the removal of heavily filled resins as it produce deep gouges in the enamel. The best result is using a carbide but at moderate speeds in dental hand piece. Use heat to soften the bonding. Study has show that the risk of pulpal damage and patients discomfort is minimal when electrothermal instrument used for ceramic bracket cement left on the teeth after debonding can be removed easily by scaling but residual bonding resin is more difficult to remove.
b. Tooth positioner has two advantages a. The positioner is fabricated by either a hard rubber or soft plastic material which their inherent elasticity to move the teeth slightly to their final position. This indirect approach allows individual tooth positioner to be adjusted with considerable precision bringing each tooth to a desired final relationship.Positioners for finishing An alternative to segmental elastic or light round arch wires for final settling is a rubber or plastic tooth posterior. Indications i. Disadvantages of tooth positioner 1. Good patient cooperation is essential. Settling with positioner tend to increase the overbite as compare to light elastics. All erupted teeth should be included in the positioner to prevent supraeruption. 3. A gingival condition with more than the usual degree of inflammation and swelling at the end of active orthodontics. It not only position the teeth but also massage the gingiva. This stimulation is an excellent way to promote a rapid return to normal gingival contour. Which is almost always at least slightly inflamed and swollen after comprehensive treatment. 2. ii. It allows the fixed appliance to be removed somewhat more quickly (some finishing could have been done with the final arch wires can be left to the positioner). An open bite tendency so that settling by mild depression rather than elongation of posterior teeth is needed. Require a considerable amount of laboratory fabrication time and therefore they are expensive. This is a disadvantages for patients who originally had deep bite and advantages if the initial problem was an anterior open bite. A positioner does not maintain the correction at rotracted teeth so minor rotation may recur. A positioner is most effective if it is placed immediately after removal of fixed appliance. Normally it is fabricated 4-6 week before removing appliance taking impression of the teeth and a registration of occlusal relationship and then resetting the teeth in the laboratory incorporating minor changes in position of each tooth to produce appropriate settling.
. 4. As part of laboratory procedures bonds and brackets are trimmed away any band space is closed.
These changes are not attributed to tooth movement alone. Class III. Special finishing procedure to avoid relapses A. iv. Beyond that time if the positioner is continue it serving as a retainer rather than a finishing device and as general rule. in a patient with a class II open bite growth pattern). and so are relapse in that sense. Control of unfavourable growth B. For patients with skeletal problem who have undergone orthodontic treatment. ii. Control of soft tissue rebound i. this “active retention” takes one of two forms. however. Since the amount of the tooth movement by positioner incline rapidly after a few days of use in excellent schedule is to remove the orthodontic appliance clean the teeth and apply a fluoride treatments and place the positioner immediately asking the patients to wear it as nearly full time as possible for the first two days after. It is more accurate to say that their control requires a continuation of active treatment than to describe this treatment as specific procedures to prevent relapse. That positioners are working hopefully or playfully. but to the pattern of skeletal growth. The rather appropriate option is to use a functional appliance rather than a conventional retainer after the completion of fixed appliance therapy. or open bite pattern contribute to a return of the original problem. for instance. As general rule a tooth positioner in a cooperative patient will produce any changes. deep bite.Contra indications i. ii. iii. Severe malalignment Severe rotated teeth Deep bite tendency An uncooperative patient
Timing Patient should wear the positioners at least 4 hours during the day and during sleep. Over treatment Adjunctive periodontal surgery
Control of unfavourable growth Changes resulting from continued growth in a Class II. Positioners are not good retainers as there is an old says. One possibility is to continue extraoral force in conjunction with orthodontic retainers (high-pull) headgear at night. Control of soft tissue rebound
. which is capable within 3 weeks. That it can be worn on the usual night 4 hours daily schedule.
Before the force system is released. Over treatment so that any rebound will only bring the teeth back to their proper position. Correction of Class II or Class III malocclusion after discontinuation of elastic or headgear. It is logical to position them overcorrected at the end of the treatment only a small degree of over treatment is compatible with precise finishing of orthodontic case. Over treatment Since it can be anticipated that teeth will rebound slightly toward their previous position after orthodontic treatment. In fact if supracrestal fibres are sectioned and allowed to seal while the teeth are held in proper position relapse caused by gingival elasticity is greatly reduced.A major reason for retention is to hold the teeth until soft tissue remodeling can take place. Where as relapse due to unfavourable growth appear after several month. Cross bite correction Whatever the mechanism used to correct cross bite it should be over correct by 1-2mm. It can be expected that the teeth will rebound 1-2mm. Sectioning of supracrestal fibres can be carried out by two methods
. If the pull of this fibres could be eliminated a major cause of relapse of previously irregular and rotated tooth should be eliminated. Adjunctive periodontal surgery. In some cases permanent retention is required to maintain the desired relationship. There are two ways to deal with rebounding. To reduce rebound from elastic fibres in the gingiva. As a general rule as teeth are moved in to a new position these fibres tend to strech and they remodle very slowly. So this degree of over treatment is required the rebound from the forces used forces used for Class II or Class III correction occur within 3-4 week. Irregular and rotated teeth The over correction of irregular and rotated tooth should be during 1 st and 2nd stages. But maintaining of those over correction during finishing stage by adjusting the wings of single brackets or by pinching shut one of a paire of twin bracket is necessary. 2. Adjunctive periodontal surgery A major cause of rebound after orthodontic treatment is the network of elastic supra crestal gingival fibres. 1. a.
2nd and 3rd order bends. Experience has demonstrated that sectioning the gingival fibres is an effective method to control rotational relapse but does not control. Conclusion The real value of the preadjusted appliance become apparent in finishing stage. secondly an improper bracket placement and need for over correction make any one of the order bend compulsory. wherever we need it. then we have to put a little bend in the arch wire. The built in tip torque and in-out allowed the orthodontists to spend less time treating the appliance with 1st. In the same way preadjusted bracket will take you most of the way. So if the tip torque and in-out compensation built in to the appliance is accurately suited to the patient dentition. It is important to hold the teeth in good alignment while gingival heating occurs. This is because the appliances prescriptions are based on averages. Never the less the misconception developed that no wire bending is required at all with the new preadjusted system. The margin to 12mm below the height of bone buccally and lingually this method called as papilla – dividing procedure. 2. Since clinically this cannot be the case and ultimately we have to think of tooth position rather than bracket position and it is the result that is important and not the processes. 27
. As Andrews once said. The first method originally developed by EDWARD’s is called circumferential supracrestal fibrotomy (CSF). The fine turning still relies on the ability of the orthodontic to bend wire. but. The tendency for crowded incisors to again become irregular. Although it is true that very little bending is needed during initial stages of treatment but bending the wire to produce the proper tooth position during finishing stage is part of the game. as treatment proceeds toward completion there should be only minimal wire bending required to complete the treatment. The more accurate the appliance the less time and effort is required during finishing stage. you don’t walk all the way. Another method is to make an incision in the centre of each gingival papilla sparing the margin but separating the papillary from just below. if you go on a long journy. they cannot possibly account for all the variation of the tooth size and morphology. Neither the CSF nor the papilla – dividing procedure should be done until malaligned teeth have been corrected and held in their new position for several month so this surgery is done toward the end of the finishing phase of treatment. you flay most of the way and then take taxi and walk the final hundred yards. This means that surgery should be done either a few weeks before removal of orthodontic appliance or if it is performed at the same time the appliance is removed a retainer must be inserted almost immediately.1. torque height. in-out if they are not what we have to want. Therefore we should not really care what the position in term of axial inclination.