Professional Documents
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N.MOTHI KRISHNA
I MDS
DEPARTMENT OF ORTHODONTICS
CONTENTS
• INTRODUCTION
• MANAGEMENT UMBRELLA
• PRINCIPLES
• V.T.O
• ORTHOPAEDICS IN BIOPROGRESSIVE THERAPHY
• FORCES USED IN BIOPROGRESSIVE THERAPHY
• UTILITY AND SECTIONAL ARCHES
• BIOPROGRESSIVE IN MIXED DENTITION TREATMENT
• MECHANICAL SEQUENCE FOR MIXED DENTITION
• MECHANICAL SEQUENCE FOR CLASS II DIV I & DIV II
• FINISHING AND RETENTION
INTRODUCTION
• Bioprogressive theraphy developed from Edgewise
technique also contain some elements of light wire
technique.
-Primary
-Secondary
-Teritary
• Other research talks on advantage of light forces in
contrast to heavy forces(1950).
• 1950 - Robert Murray Ricketts.
• BPT accepts as its mission the treatment of the total face rather than narrower
objective of the teeth or the occlusion.
• The initiation of this series with a discussion of management at the begining rather
than at the end.
• Dr Ricketts states that management is a unique skill; it is the ability to get other
people to work with you and for you, to accomplish common objectives.
• In an orthodontic practice, getting the subordinates to work with you and for you is
to treat the patient to happy ending, and to manage the patient so that he gives full
cooperation in his treatment.
As per Dr Ricketts
management system for
orthodontists should include
the following three things;
7. The orthodontists needs better communication with patient’s parents, dentists and
the public.
8. Time is one of our most valuable asses. It is reason in itself to become involved in
a total management process.
The system which Ricketts used is the Lewis A. Allen Management System,
which is based on a simple formula to plan organize, lead and control.
In order to help overcome the tendency for relapse, provisions for the
post-treatment rebound as well as post-treatment growth changes need to
be appreciated and planned for anticipated post-treatment adjustments:
1. Ba-Na plane
2. Construction of the new mandible position (mandibular rotation)
3. Construction of the new maxillary position
4. Position of the dentition.
5. Final soft tissue profile.
The first superimposition (Basion-Nasion at CC Point)
establishes Evaluation Area 1
Amount of growth of the chin.
Any change in chin in an opening or closing direction that
may result from our mechanics.
• When an archwire is ligated across short spans, very high forces can result
that are much above the optimum levels.In order to lessen the applied force,
the concept of long lever arm is applied. By placing more wire between the
teeth the applied force is lowered and the length of time of activation is
increased.
• For this purpose, Bioprogressive mechanics incorporate more wire in its loop
design, thus producing lighter forces that are more continuous in their action.
Simple loop designs incorporate more wire between teeth and reduce the amount of force
applied.
Compound loop designs use combination of simple loops and add additional wire to further reduce
the amount of force, while making it more continuous. Also, these loops can be compressed during
activation.
Concept of cortical bone anchorage
• The concept of cortical bone anchorage implies that, to anchor a
tooth, its roots are placed near the dense cortical bone under a
heavy force that will further squeeze out the already limited blood
supply and restrict the physiologic bone remodeling in this area.
• On the other hand, in order to move a tooth, a route should be
followed through the less dense trabecular bone where under a
light force a generous blood supply can be maintained that will
produce the physiologic osteoclastic reaction of bone resorption
needed for movement.
Teeth in the mandible.
• During lower incisor retraction, the incisor roots should be moved through
the cortical bone using even lighter, more continuous forces. This allows
for remodeling of the bone.
• During lower cuspid retraction also, the roots must be moved through the
trough of trabecular bone.
Lower 2nd Bicuspids and Molars:
These teeth are supported by the cortical bone on their
buccal surface.
Lower molars are anchored by expanding and torquing
their roots buccally into the buccal cortical bone.
Teeth in the maxilla.
• The nasal, orbital, oral and sinus cavities of the maxilla are lined with
cortical bone that gives them support.
• The roots of the maxillary teeth lie adjacent to these cavities and are
influenced by the cortical bone lining them.
• The maxillary teeth are supported within the alveolar process with cortical
bone on the palatal surface as well as along the facial surfaces.
• The maxilla supports four cavities – orbital, nasal, oral and sinus cavities.
The cortical bone support in the maxilla surrounds these cavities as well
as the alveolar process containing the teeth.g the facial surface.
Maxillary Incisors.
-These are intruded along their long axis into the broadest area of the alveolar
process.
-Utility arch mechanics for intrusion first advances the crowns and locates the
root tip away from the interference of the labial cortical bone.
Maxillary Cuspids.
-These should be moved around the corner during their alignment and retraction,
and their movement should be contained within the trough of trabecular bone.
-Excessive tipping can expose the root tip through the buccal cortical bone, thus
making uprighting and torquing alignment extremely difficult.
Maxillary Bicuspids and Molars.
-The bicuspids are supported in the alveolar process between the buccal
and lingual cortical plates.
-The roots of the 2nd bicuspids and molars are often involved with the cortical
bone lining the floor of the maxillary sinus. Thus, intrusion of these teeth
should be done using light and continuous forces.
-The roots of the maxillary molars are anchored by expanding and rotating
them into the buccal cortical bone.
• Round arch segments were laced from the lower molars and premolars to
the lower incisors as the canines were retracted.
• They noted that not only were the buccal segments maintained in an
upright position, but the lower incisors intruded with this light, continuous
pressure.
Following early maintenance of anchorage at the molars and proper positioning of the
lower incisors, separate rotations and leveling can occur in the buccal segment teeth –
especially the canines – without disturbing the idealized location of the other segments.
The utility arch allows incisor alignment and molar control during the
transient dentition by stepping around the deciduous buccal occlusion.
Thus, arches can be leveled out without depending upon extrusion of the
buccal segment teeth.
• This is done after functional and arch length corrections are achieved.
• Includes different approaches are used for the first phase of non
extraction treatment.
1. Orthopedic problems-
- In cases where good alignment of lower arch exists and Class II is on
account of Max.protrusion.
• Sequence:
Lower Incisor intrusion.
Lower Cuspid intrusion.
Alignment of the lower buccal segment.
Alignment of the upper buccal segment.
Segmental correction of Class II with elastics.
Upper incisor alignment and intrusion.
• Upper arch –orthopedic reduction of the maxilla.
• Lower arch-treatment starts with levelling the spee.-
utility arch
• Lower stabilizing utility arch-after initial
purpose of the utility arch is accomplished
–it no longer serves as an efficient function
• 16 x 22 stabilizing arch is placed
a) Consolidation section
b) Stabilizing section
• Segmental correction with Class II elastics:
Three detrimental effects:
1. Skidding effect.
2. Tendency for a deep bite.
3. Difficult to overcorrect buccal segment.
• Tractions Sections-
Gable bend distal to canine.
Rotation bend in the anterior portion.
Molar bayonet bend
Functions –
1. Counteract downward backward pull
2. Stabilizing function in the upper buccal segment.
• Upper incisors alignment and Intrusion
Upper incisors are aligned before placement with light round
wires.
16 X 22 utility arch is placed.
• Amount of pressure:
125-160 gms
16 x 22
Stabilization of the molars:
Quad helix
TPA
Stab. sections
2.Intrusion of lower incisors:
16 x 16 utility arch.
65-75 gms.
This is followed by cuspid intrusion.