Professional Documents
Culture Documents
Part II
1
Utility arch.
Mixed dentition treatment
Brackets & Prescriptions
Class II div I
Class II div II
Mechanics for extraction cases.
Finishing and retention.
2
Roles and functions of
the lower utility arch
Position of the lower molar to allow for
Cortical Anchorage
Manipulation and Alignment of the lower
incisor segments.
Allowing segmental treatment of the buccal
segments
Physiologic roles of the lower utility arch.
Role in mixed dentition
3
Fabrication of the utility arch
4
Physiologic Vs Mechanical
Response
Tip back applied to lower
molar-30° to 40 °.
No toe-in in non
extraction utility.
Extraction cases-definite
distal rotation must be
placed .
5
Physiologic Vs Mechanical
Response
30° to 45° buccal
root torque applied
to the lower molar
6
Physiologic Vs Mechanical
Response
7
Physiologic Vs Mechanical
Response
Long lever arm
applied to lower
incisors.
75 gms of intrusive
force.(0.16 x 0.16).
Labial root torque.
8
Modifications of the Utility Arch
Expansion utility
arch
Force :
1mm= 85 gm
2mm=140 gm
3mm=205 gm
9
Modifications of the Utility Arch
Contraction utility arch
Force:
1mm=50 gm
2mm =150 gm
3mm=230 gm
10
Modifications of the Utility Arch
Utility arch with T or
L Horizontal loop
11
Modifications of the Utility Arch
Contraction or
advancing utility
arch
12
Treatment in the Mixed
Dentition Phase
13
Bioprogressive Mixed
Dentition Treatment
Four basic objectives-
14
Resolve functional problems
15
Resolve functional problems
Lack of rough surface , excessive thickening
16
Resolve functional problems
Submento-vertex
analysis
- Individual condylar
inclinations and
width.
17
Resolve functional problems
Nine general categories-
1. Cross mouth interferences.
2. Anterior crossbite.
3. Open bite.
4. Excessive range of function.
5. Distal displacement.
18
Resolve functional problems
6. Loss of posterior support.
7. Habits.
8. Breathing and airway problems.
9. True Class III Growth pattern.
19
Resolve Arch
Length Discrepancy
This is accomplished
by three ways-
1. Lateral expansion of
the molars.
- Depends on the
inclination of the
posterior teeth.
20
Resolve Arch
Length Discrepancy
Expansion primarily by
change in axial inclination :
21
Resolve Arch
Length Discrepancy
With 1cm expansion in the upper molars –
anterior segment are expanded 3cm overall.
22
Resolve Arch
Length Discrepancy
23
Resolve Arch
Length Discrepancy
24
Resolve Arch
Length Discrepancy
Expansion by mid palatal dysfunction:
25
Resolve Arch
Length Discrepancy
2. Advancement or forward movement of the
lower molars:
26
Resolve Arch
Length Discrepancy
3. Uprighting and /or distal movement of the
lower molars:
27
Correct Vertical/Overjet
Problems
This is done after functional and arch length
corrections are achieved.
28
Correct Vertical/Overjet
Problems
1. Orthopedic problems-
- In case where good alignment of lower arch exists and Class
II is on account of Max.protrusion.
29
Correct Vertical/Overjet
Problems
3. Orthopedic problems with minor incisor
interferences.
- Upper utility arch with headgear .
30
Development of the
Bioprogressive Brackets
31
Brackets
Siamese twin bracket
on all the teeth.
Slot size-.022 changed
to .018
32
Brackets
Slot size-.0185 x .030
1. Use of two light arches
2. Permits a champer or bevel.
3. Allows for a lever access.
4. Adequate distance for the torque grooves.
33
Development of Brackets
34
Development of Brackets
1. Rickett’s Standard
Bioprogressive.
These were the first set of
brackets which available.
(1960)
Banding was done on all
the teeth.
Line of occlusion –through
the contact points.
35
Development of Brackets
Trend of building in treatment in the
appliance. (angulations)
The original design had 5° for all the canines
and 8° for the upper lateral incisors and 5°
for the lower first molar
Torque was present only in-upper incisors,
laterals and canines.
36
Development of Brackets
37
Development of Brackets
2. Rickett’s Full Torque Bioprogressive.
Torque was build in the lower molars and
pre molars.
Brackets were placed with 5 angulation.
12 rotation was also built in the tube.
38
Development of Brackets
39
Development of Brackets
3. Triple control Bioprogressive.
Raised bases
Triple tube for upper molars
Breakaway convertible lower molar tube.
Direct bonding base/contoured.
Slots cut at an angle
40
Development of Brackets
41
Development of Brackets
42
Mechanics Sequence for
Extraction Treatment
43
Extraction Mechanics
Four general procedures :
1 Stabilization of upper and lower molar
anchorage.
2 Retraction and uprighting of cuspids with
sectional arch mechanics.
3 Retraction and consolidation of upper and lower
incisors.
4 Continuous arches for details of ideal and
finishing occlusion.
44
Extraction Mechanics
1. Stabilization of upper
and lower molar
anchorage:
a) Maximum upper
molar anchorage.
Nance arch with
modifications.
Headgear .
45
Extraction Mechanics
b) Moderate upper molar
anchorage:
Palatal bar.
Quad helix.
46
c) Minimum upper
molar anchorage:
Vertical closing loop.
47
Extraction Mechanics
Maximum lower molar
anchorage:
Lower utility arch-four
mechanical
adjustments.
48
Extraction Mechanics
Moderate lower molar
anchorage:
Lower utility with
adjustments.
49
Extraction Mechanics
Minimum lower molar
anchorage:
Eliminate the four
mechanical factors.
Round wires may be
used.
50
Extraction Mechanics
2. Retraction and uprighting of cuspids with
sectional arch mechanics.
51
Extraction Mechanics
52
Extraction Mechanics
Intrusion
53
Extraction Mechanics
Root uprighting
54
Extraction Mechanics
Rotation
55
Extraction Mechanics
3. Retraction and consolidation of upper and
lower incisors.
Lower incisors:
Very light continuous forces (150 grams)
Contraction utility
56
Extraction Mechanics
57
Extraction Mechanics
Upper Incisors:
Regular contraction
utility.
Upside down vertical
closing loop.
Double delta loop.
58
Extraction Mechanics
59
Extraction Mechanics
60
Mechanics Sequence for
Class II Div I
61
Mechanics For Class II Div I
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.
62
Mechanics For Class II Div I
Upper arch –orthopedic reduction of the
maxilla.
Lower arch-treatment starts with levelling
the spee.-utility arch
63
Mechanics For Class II Div I
64
Mechanics For Class II Div I
65
Mechanics For Class II Div I
66
Mechanics For Class II Div I
Alignment of the lower
buccal segment starts:
.015 or .0175
Twistoflex
.012,.014 of 018 wires
16x 16 triple T section
.016 or.018 nitinol
67
Mechanics For Class II Div I
Upper arch
alignment:
Incisors are not
included.
Upper molars starts
Distalizing-opening
spaces in the buccal
segment.
68
Mechanics For Class II Div I
a) Consolidation section
b) Stabilizing section
69
Mechanics For Class II Div I
Segmental correction with Class II elastics:
Three detrimental effects:
1. Skidding effect.
2. Tendency for a deep bite.
3. Difficult to overcorrect buccal segment.
70
Mechanics For Class II Div I
Tractions Sections-
Gable bend distal to
canine.
Rotation bend in the
anterior portion.
Molar bayonet bend
71
Mechanics For Class II Div I
Functions –
1. Counteract downward backward
pull
2. Stabilizing function in the upper
buccal segment.
72
Mechanics For Class II Div I
Upper incisors alignment
and Intrusion
Upper incisors are aligned
before placement with
light round wires.
16 X 22 utility arch is
placed
73
Mechanics For Class II Div I
Consolidation of Upper
Incisors
Retraction of the upper
incisors .
Over treatment -2mm
Closing utility/upside
down closing
arch/vertical helical
arch.
74
Mechanics For Class II Div I
Idealization of
arches and finishing.
16 or 17 square,16 x
22 or 17 x 25 nitinol.
Class II elastics to
be discontinued
atleast 2 months.
Light round wires
finishing
75
Mechanics Sequence for
Class II Div II
76
Mechanics For Class II Div II
Three treatment
possibilities:
1. Distalizing the
upper arch.
2. Advancing the lower
arch.
3. A reciprocal
movement.
77
Mechanics For Class II Div II
1. Advancement, torque control, and intrusion
of the upper incisors.
2. Intrusion of the lower incisors and cuspids.
3. Alignment of the buccal segments and Class
II correction.
4. Consolidation of the upper incisors.
5. Idealizing the arches.
6. Finishing.
78
Mechanics For Class II Div II
Quad helix or W
arch
79
Mechanics For Class II Div II
1. Advancement, torque control, and intrusion
of the upper incisors.
80
Mechanics For Class II Div II
Directional control
81
Mechanics For Class II Div II
Amount of pressure:
125-160 gms
16 x 22
Stabilization of the
molars:
Quad helix
TPA
Stab. sections
82
Mechanics For Class II Div II
Intrusion of lower incisors:
16 x 16 utility arch.
65-75 gms.
This is followed by cuspid intrusion.
83
Mechanics For Class II Div II
Advancement
of the lower
denture:
1. Utility arch
with 4 helical
loops
84
Mechanics For Class II Div II
2. Using three
vertical loops:
85
Mechanics For Class II Div II
3. Alignment of the buccal
segment:
a) Stabilizing section
86
Mechanics For Class II Div II
If buccal segment
are not aligned
“T” sections
Twistoflex wire
Cable wire
87
Mechanics For Class II Div II
4. Consolidation of
the maxillary
incisors:
88
Mechanics For Class II Div II
Idealization and
arches and finishing
89
Pentamorphic Arch Forms
90
Finishing and Retention
91
Finishing and Retention
“Begin with the end in
mind”.
Every orthodontist has a
visual picture in his mind
of the ideal occlusion into
which the teeth should fit
and mesh in the final
finished occlusion.
92
Finishing and Retention
Bioprogressive proposes the concept
overtreatment….
No clinician can position teeth as delicately as
the functioning incline plane and cusp action
can accomplish naturally when it is
adequately set up to operate correctly.
Allow natural function to guide the teeth into
the best functioning occlusion for each
individual
93
Finishing and Retention
94
Finishing and Retention
Two phases of retention:
95
Finishing and Retention
Initial stage of retention :
96
Finishing and Retention
97
Finishing and Retention
Lower arch:
Fixed first bicuspid retainer is placed.
98
Finishing and Retention
Stabilizing stage of retention:
99