Bioprogressive Therapy Part III INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com www.indiandentalacademy.com
Mechanics Sequence for Class II Div II
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Mechanics For Class II Div II Three treatment possibilities: 1. Distalizing the upper arch. 2. Advancing the lower arch. 3. A reciprocal movement. ď Ž
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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. www.indiandentalacademy.com
Mechanics For Class II Div II ď Ž
Quad helix or W arch
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Mechanics For Class II Div II 1.
Advancement, torque control, and intrusion of the upper incisors.
X Principle of bite before jet ďƒź Jet is created followed by intrusion. 16x22 utility arch
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Mechanics For Class II Div II
Directional control www.indiandentalacademy.com
Mechanics For Class II Div II Amount of pressure: 125-160 gms 16 x 22 Stabilization of the molars: Quad helix TPA Stab. sections
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Mechanics For Class II Div II
Intrusion of lower incisors: 16 x 16 utility arch. 65-75 gms. This is followed by cuspid intrusion.
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Mechanics For Class II Div II ď Ž
1.
Advancement of the lower denture: Utility arch with 4 helical loops
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Mechanics For Class II Div II 2.
Using three vertical loops:
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Mechanics For Class II Div II Alignment of the buccal segment: a) Stabilizing section 3.
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Mechanics For Class II Div II If buccal segment are not aligned
“T” sections
Twistoflex wire
Cable wire
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Mechanics For Class II Div II 4.
Consolidation of the maxillary incisors:
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Mechanics For Class II Div II ď Ž
Idealization and arches and finishing
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Pentamorphic Arch Forms www.indiandentalacademy.com
Finishing and Retention
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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.
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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 www.indiandentalacademy.com
Finishing and Retention
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Finishing and Retention ď Ž
Two phases of retention:
1.
Guiding changes during initial adjustments.
2.
Supporting bony sutural and muscular accommodations to changing environment and considering long range influences.
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Finishing and Retention
Initial stage of retention :
First six weeks following appliance removal
Retainers inserted-designed not to hold but to guide the teeth in settling.
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Finishing and Retention Labial frame of typical upper retainer (Ricketts) passes between the lateral and cuspid and has a distal loop at each end to tuck in the distal of the expanded overtreated upper cuspid
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Finishing and Retention Lower arch: ďƒź Fixed first bicuspid retainer is placed. -maintain cross arch bicuspid width. -lower cuspid freedom of adjustment against upper occlusion. -maintain lower incisor alignment and rotation correction. ď Ž
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Finishing and Retention
Stabilizing stage of retention:
First year following active treatment. Lower retainer is kept in place and upper is worn most of the time.
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Bioprogressive Simplified James J. Hilgers Jco 1987-part 1-4
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Translating orthodontic skills into a bona fide delivery system is one of the most difficult tasks faced by clinicians. The best orthodontic managers are able to identify the necessary information and leave out the extraneous. “After studying many treatment disciplines, I chose the Bioprogressive approach because it was flexible”. www.indiandentalacademy.com
Visual Treatment Objective ď Ž
ď Ž
Orthodontic movements are more significant than growth changes The VTO leads the clinician toward a viable treatment plan by organizing factors
The superimpositions that define the practical part of the mechanical procedures www.indiandentalacademy.com
An accurate measurement of arch length deficiency— combined with the clinician's judgment of dental and facial changes required— is used in the simplified VTO to produce a reasonable treatment goal www.indiandentalacademy.com
Occlusal Paralleling Instrument ď Ž
ď Ž
Arch length deficiency is one of the most critical aspects of diagnosis. One of the most accurate measuring devices is the mandibular occlusal xray
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Diagnostic procedures Grades the patient asA- enthusiastic B- average C- resistant ď Ž Patient assurance about headgear usage. ď Ž
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Appliance design
End-of-treatment goals should be dynamic, not based on statistical norms. This kind of overcorrected result can be called an ideal orthodontic occlusion— one that will settle after positioner treatment, retention, and normal physiologic rebound into an ideal occlusion and thereafter into a normal occlusion www.indiandentalacademy.com
Appliance design 1.
2. 3. 4. 5.
Type and severity of the original malocclusion. General approach to mechanics. Size of the final arches. Timing of torque control Bracket placement and design.
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Appliance design
Linear Dynamic system designed by the Ormco 1979. 17-4 grade of stainless steel, which has more than three times the yield strength of the standard 303 grade 30% smaller bracket that is stronger than its full-size counterpart. 20% size reduction in molar region. www.indiandentalacademy.com
Appliance design
The key to a Class I buccal segment is the proper positioning of the lower first molars www.indiandentalacademy.com
Linear Dynamic System
Ideal orthodontic tooth position. Anticipated rebound and required overcorrection. Appliance design features that contribute to patient comfort, clinical simplicity, and optimum utility.
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Linear Dynamic System C.I
Max
L.I
Canine 1st pm
22/5 14/8 7/10
Mand -1/0
-1/0 7/5
-7/0
2nd pm
1st 2nd molar molar
-7/0
-10/0 -10/0
-11/0 -17/0 -27/5 -27/5
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Basic principles
Treatment of overbite before overjet. Sectional arch mechanics Progressive unlocking of malocclusion Cortical and muscular anchorage Torque control throughout treatment.
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Extraction Therapy
Initiation Cuspid retraction and uprighting. Transition and final cuspid space closure. Consolidation. Idealization
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Extraction Therapy
Initiation Lower arch-utility arch - band 2nd molars. Upper arch - TPA -headgear -utility -2nd molars www.indiandentalacademy.com
Extraction Therapy -
Cuspid retraction and uprighting Angulation of the cuspid Mesially tipped-1/3 of the extraction space
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Extraction Therapy
Bicuspid and cuspid – initial overlay wire followed by a simple helical loop.(0.16 NiTi) Remaining 2/3 – rigid overlay wire.(0.16 Wallaby)
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Extraction Therapy ď Ž ďƒź
a)
b)
Upper arch Upper arch-depends on the position of the incisors Good position-16 x16 vertical closing helical loop. Need to be engaged at the onset of the treatment-0.16 round overlay wire.
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Extraction Therapy ď Ž ďƒź
1. 2. 3.
Traction and final cuspid space closure Cuspids have almost retracted and bite has opened sufficiently-traction arches are placed.(17x 25 NiTi or TMA) Allow final incisor alignment Correct details of the arch form Allow for final root paralleling ,torquing in cuspid and bicuspid region. www.indiandentalacademy.com
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Extraction Therapy Consolidation This is done achievement of good arch form. Lower retraction-1 or 2 month ahead. -16 square helical continuous closing arch. Upper retraction- if they are proclined with no torque requirement -016 round wire
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Extraction Therapy -if in good relation-16 square or 16 x 22
closing loop -if additional torque is needed –retraction utility is used. -if ant intrusion and post extrusion – combination crossed “T” horizontal closing loop is used.
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Extraction Therapy Idealization Rigid edgewise coordinated arches (17x25 PAR). Light round wires.(0.14 or 0.16 Wallaby) X “Start with round wires, finish with edgewise”
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Non extraction therapy
Initiation. Transition. Traction. Idealization.
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Synopsis Non Extraction Therapy
Initiation – Orthopedic appliances. Base arches to set up the anchorage. Overlay wires.
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Synopsis Non Extraction Therapy
Transition After leveling and aligning of the arches. Correct rotation and spacing Resilient arches.
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Synopsis Non Extraction Therapy
Traction Lower arch set up –to allow Class II elastics. Upper buccal segments are leveled Traction sections in upper arch
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Synopsis Non Extraction Therapy
Idealization Final arches used to achieve arch coordination. Use of light round wires.
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Thank You
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