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INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com

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      

Introduction Principles of BPT. Diagnosis and treatment planning. Role of orthopedics. Forces used in BPT. Development of the utility arch. Mixed dentition treatment. www.indiandentalacademy.com


    

Brackets & Prescriptions Class II div I Class II div II Mechanics for extraction cases. Finishing and retention.

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Introduction 

    

Bioprogressive therapy was developed from a background of edgewise technique as well as begg technique. Rickett’s describes three phases of: Primary edgewise Secondary edgewise Tertiary edgewise. Quaternary edgewise www.indiandentalacademy.com


Introduction ď Ž

It accepts as its mission the treatment of the total face rather than the narrower objective of the teeth and the occlusion.

ď Ž

Takes advantages of biological progressions including growth, development ,function and directs them to normalize it. www.indiandentalacademy.com


Introduction ď Ž

Management umbrella

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Principles of the Bioprogressive Therapy

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Principles of the Bioprogressive Therapy ď Ž

ď Ž

BPT has been developed in an attempt to communicate an understanding of mechanical procedures in developing a treatment plan, appliance selection specific to individual type.

Ten Principles.

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Principles of the Bioprogressive Therapy ď Ž

The use of a systems approach to diagnosis and treatment by the application of the VTO in planning treatment, evaluating anchorage and monitoring results.

ď Ž

Torque control throughout treatment.

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Principles of the Bioprogressive Therapy 

  

Keep the roots in vascular trabecular bone. Place roots against dense cortical bone. Torque to remodel cortical bone. Torque position teeth in final occlusion.

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Principles of the Bioprogressive Therapy ď Ž

Muscular and cortical anchorage. different types of muscular pattern in different individuals.

ď Ž

Movement of any teeth in any direction with proper application of pressure it is designed to respect the supporting structures and size of the root of individual teeth

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Principles of the Bioprogressive Therapy ď Ž

Orthopedic alteration -anticipates and plans for this in treating younger children.

ď Ž

Treat the overbite before the overjet. -incisor intrusion as best choice -stability of results -prevent interference

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Principles of the Bioprogressive Therapy ď Ž

Sectional arch treatment- arches are broken into segments. -allow lighter continuous force -more efficient root control. -supplements maxillary orthopedic alteration. - reduces friction and binding.

ď Ž

Concept of overtreatment - to overcome muscular forces. - root movements for stability.

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Principles of the Bioprogressive Therapy - To overcome orthopedic rebound - To allow settling in retention ď Ž

Unlocking of malocclusion in progressive sequence of treatment in order to establish or restore more normal function . -functional influence

- orthopedic alteration. - arch form-length - tooth movement.

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Principles of the Bioprogressive Therapy ď Ž

Efficiency in treatment with quality results utilizing a concept of pre fabrication. -allows the clinician to direct energies in diagnosis and planning and efficient appliance therapy.

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Diagnosis and Treatment Planning

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Visual treatment objectives ď Ž

ď Ž

VTO is a cephalometric tracing representing the changes that are expected (desired) during the treatment. It includes expected growth, any growth changes induced by the treatment, and any repositioning of the teeth from orthodontic tooth movement.

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Visual treatment objectives 1. 2.

3. 4.

5. 6.

Is like a blueprint used in building a house. Visual plan to forecast normal and to anticipate influence of treatment. In establishing individual objectives. Helps in developing an alternate treatment plan. Helps to evaluate treatment progress. Valuable tool for the orthodontist’s self improvement. www.indiandentalacademy.com


Visual treatment objectives ď Ž

Steps-

1.

Ba-Na plane

2.

Construction of the new mandible position .(mandibular rotation) www.indiandentalacademy.com


Visual treatment objectives 3.

4.

Construction of the new maxillary position

Position of the dentition.

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Visual treatment objectives 5.

Final soft tissue profile.

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Superimpositions area’s 1. 2. 3. 4. 5.

The The The The The

chin maxilla teeth in the mandible teeth in the maxilla facial profile

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Superimpositions area’s 

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. www.indiandentalacademy.com


Superimpositions area’s 

The second superimposition area (Basion-Nasion at Nasion) establishes Evaluation Area 2 to show Any change in the maxilla (Point A). The Basion-Nasion-Point A Angle does not change in normal growth.

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Superimpositions area’s 

The third superimposition area (Corpus Axis at PM) establishes Evaluation Area 3 and Evaluation Area 4, Together evaluate any changes that take place in the mandibular denture. In normal growth, the lower denture remains constant with the APO Plane

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Superimpositions area’s 

In Evaluation Area 3lower incisors.

In Evaluation Area 4lower molars

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Superimpositions area’s 

The fourth superimposition area (Palate at ANS) establishes Evaluation Area 5 and Evaluation Area 6, Which together evaluate any changes that take place in the maxillary denture

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Superimpositions area’s 

In Evaluation Area 5, the upper molars

In Evaluation Area 6, we evaluate the upper incisors

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Superimpositions area’s 

5th Superimposition Area (esthetic plane at the crossing of the occlusal plane)

Area 7 with which we evaluate the soft tissue profile

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Role Of Orthopedics

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Orthopedics in BPT ď Ž

Any manipulation that alters the normal growth of the dentofacial complex in either direction or amount.

ď Ž

Concept of differential treatment in Class II malocclusion. www.indiandentalacademy.com


Orthopedics in BPT 

Thorough analysis of facial and dental characteristics –facial growth type.

More emphasis on cervical or combination headgear.

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Orthopedics in BPT

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Generalized orthopedic response with Cervical Headgear aloneď Ž

Maxilla responds in a more predictable manner.

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Generalized orthopedic response with Cervical Headgear aloneď Ž

Mandibular response – depends on the musculature. - weak musculature - strong musculature

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Generalized orthodontic response with Cervical Headgear alone   

Upper molars-extrusion of upper molars. Upper incisors-tip lingually Lower molars-upright and move distally Lower incisors-tip labially

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The Reverse Response

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Expansive Response 

In Class II –ant. Part of the maxilla is generally tapered –lingual crossbite.

Two basic expansive phenomenon are occurAnatomic configuration of maxillary complex.

1.

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Expansive Response

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Expansive Response 2.

From mechanical point ,progressive widening of the alveolar base is accomplished by widening of inner bow.

-

Reciprocal expansion of lower arch.

-

Preventing impacted second molar.

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Mechanical application 1.

Force level- 400gms

Intermittent wear –several advantages -heavy forces result in hylanization. -rebound allows in stability. -more growth occurs at nite. - Patient acceptance. www.indiandentalacademy.com


Mechanical application 3.

-

Outer bow length and position Rigid outer bow. At the ala of the nose.

-

Expansion and rotation. Flexible inner bow , 2 cm of expansion.

5.

Freedom of movement of maxilla

4.

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Forces Used In Bioprogressive Therapy

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Forces Used In Bioprogressive Therapy 

The orthodontic movement of teeth occurs as a result of the biological response and the physiological reaction to the forces applied by our mechanical procedures.

Brian Lee, following the work of Storey and Smith, measured the surface of the root being exposed to movement— called the enface surface of the root. www.indiandentalacademy.com


Forces Used In Bioprogressive Therapy ď Ž

He, proposed 200 grams per sq cm of enface root surface exposed to movement as the optimum pressure to be applied in efficient tooth movement.

ď Ž

Bioprogressive Therapy's evaluation of the applied forces suggests 100 gms per sq cm of enface or exposed root surface as optimum. www.indiandentalacademy.com


Forces Used In Bioprogressive Therapy Rating scale for the intrusion of teeth measures the greatest cross section of the tooth surface in cm2. Required forces are shown at 150 and 100 gms/ cm2 Lower incisors show .20cm2 of enface root surface, while upper incisors show .40cm2.

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Forces Used In Bioprogressive Therapy

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Forces Used In Bioprogressive Therapy ď Ž

Thurow has shown that a force of 650 grams is produced in deflecting an .018 round chrome wire 3mm across a span of ½-inch (13mm) .When a steel wire is used, the force is almost doubled to over 1000 grams. www.indiandentalacademy.com


Forces Used In Bioprogressive Therapy ď Ž 1.

Control of force: Use of long lever arm.

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Forces Used In Bioprogressive Therapy 2.

Use of loops to increase the length of the wire.

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Forces Used In Bioprogressive Therapy ď Ž

Cortical Anchorage: The concept of cortical bone anchorage implies that, to anchor a tooth, its roots are placed in proximity to the dense cortical bone under a heavy force that will further squeeze out the already limited blood supply and thus anchor the tooth.

ď Ž

Since each tooth is supported by cortical bone, an understanding of this bony structure and support is necessary. www.indiandentalacademy.com


Forces Used In Bioprogressive Therapy

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Forces Used In Bioprogressive Therapy ď Ž

Lower incisors and cuspids:

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Forces Used In Bioprogressive Therapy ď Ž

Lower bicuspids and molars

lower molar anchorage – the lingual cusps are kept down (roots expanded and torqued buccally)

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Forces Used In Bioprogressive Therapy Upper incisors and canines

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Forces Used In Bioprogressive Therapy

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Forces Used In Bioprogressive Therapy ď Ž

Upper molars and bicuspids:

ď Ž

The upper molars are supported at the base of the key ridge of the zygomatic process. www.indiandentalacademy.com


Forces Used In Bioprogressive Therapy ď Ž

Muscular Anchorage:

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Forces Used In Bioprogressive Therapy    

In summary : Size of the root surface involved. Amount of force applied. Cortical bone support. Muscular support –facial type.

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Utility and Sectional arches

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Development of the utility arch ď Ž

ď Ž

Full banded edge wise setup-most efficient method In order to avoid forward movement of incisors, wire ends were cinched back www.indiandentalacademy.com


Development of the utility arch ď Ž

Class III elastics

ď Ž

It was long felt that incisor intrusion as an medium for levelling the spee was an impossibility. www.indiandentalacademy.com


Development of the utility arch 

Ricketts tried to utilize the supposedly immutable lower incisors as an anchor unit to hold the posteriors in upright position, during cuspid retraction. This lead to the development of step down base arch wire/Rickett’s lower utility arch

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Roles and functions of the lower utility arch 

Position of the lower molar to allow for Cortical Anchorage:

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Roles and functions of the lower utility arch 

  

Manipulation and Alignment of the lower incisor segments. Treated as a segment- different movements. Different planes of space. Ideal force levels.

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Roles and functions of the lower utility arch 

Stabilization of the lower arch, Allowing segmental treatment of the buccal segments.

Directing movements towards the final position.

Early maintenance of molar anchorage.

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Roles and functions of the lower utility arch  

  

Physiologic roles of the lower utility arch. Reaching or activator effect-removing contact of LI from palatal or incisal occlusion. Helps in the headgear therapy. Bite before jet. Dictates the final arch form.

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Roles and functions of the lower utility arch  Overtreatment  Edge to edge bite.  Freeing the buccal segments for unimpeded correction of Class II  Role in mixed dentition 

Resolve arch length problems.

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Roles and functions of the lower utility arch 1.

2.

Uprighting of the lower molars. Root movement-2mm Crown movement-2mm Advancement of the lower incisors 1mm incisor movement 2mm arch length www.indiandentalacademy.com


Roles and functions of the lower utility arch 3. 4.

Expansion in the buccal segment. Saving the “E� space.

The author believes -with the utility arch slow, delibrate and functional type of expansion occurs-non extraction

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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 www.indiandentalacademy.com


Fabrication of the utility arch

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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 . www.indiandentalacademy.com


Physiologic Vs Mechanical Response 

30° to 45° buccal root torque applied to the lower molar

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Physiologic Vs Mechanical Response

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Physiologic Vs Mechanical Response 

Long lever arm applied to lower incisors. 75 gms of intrusive force.(0.16 x 0.16). Labial root torque.

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Modifications of the Utility Arch ď Ž

ď Ž

Expansion utility arch Force : 1mm= 85 gm 2mm=140 gm 3mm=205 gm

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Modifications of the Utility Arch ď Ž ď Ž

Contraction utility arch Force: 1mm=50 gm 2mm =150 gm 3mm=230 gm

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Modifications of the Utility Arch ď Ž

Utility arch with T or L Horizontal loop

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Modifications of the Utility Arch ď Ž

Contraction or advancing utility arch

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Treatment in the Mixed Dentition Phase

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Bioprogressive Mixed Dentition Treatment ď Ž

1. 2. 3. 4.

Four basic objectivesResolve functional problems. Resolve arch length discrepancy. Correct vertical problems. Correct overjet problems.

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Resolve functional problems 

Anything that disturbs the growth, health and function of the TMJ complex.

In 1950’s Ricketts –used body section x rays (laminagrphy)

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Resolve functional problems ď Ž

Lack of rough surface , excessive thickening

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Resolve functional problems Submento-vertex analysis - Individual condylar inclinations and width. ď Ž

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Resolve functional problems ď Ž 1. 2. 3. 4. 5.

Nine general categoriesCross mouth interferences. Anterior crossbite. Open bite. Excessive range of function. Distal displacement.

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Resolve functional problems 6. 7. 8. 9.

Loss of posterior support. Habits. Breathing and airway problems. True Class III Growth pattern.

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Resolve Arch Length Discrepancy ď Ž

1.

-

This is accomplished by three waysLateral expansion of the molars. Depends on the inclination of the posterior teeth.

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Resolve Arch Length Discrepancy ď Ž

Expansion primarily by change in axial inclination : - Rickett’s quad helix - .040 blue elgiloy wire.

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Resolve Arch Length Discrepancy 

With 1cm expansion in the upper molars – anterior segment are expanded 3cm overall.

Long term functional expansion for atleast a year or more for stable and demonstrable changes to occur in the lower arch.

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Resolve Arch Length Discrepancy Arch length gained is result slow natural expansive response created by muscles

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Resolve Arch Length Discrepancy

Modifications of the Quad Helix www.indiandentalacademy.com


Resolve Arch Length Discrepancy ď Ž

Expansion by mid palatal dysfunction:

- Hass type or modified Nance type expansion appliance.

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Resolve Arch Length Discrepancy 2.

-

Advancement or forward movement of the lower incisors: If the VTO and physiologic factors warrant. Expansion utility arch. 1mm forward movement of LI yields 2mm of arch length.

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Resolve Arch Length Discrepancy 3.

Uprighting and /or distal movement of the lower molars:

- Accomplished by utility arch. - 2 mm per side can be gained by uprighting.

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Correct Vertical/Overjet Problems ď Ž

This is done after functional and arch length corrections are achieved.

ď Ž

Includes different approaches are used for the first phase of non extraction treatment.

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Correct Vertical/Overjet Problems 1. -

2.

-

Orthopedic problemsIn cases where good alignment of lower arch exists and Class II is on account of Max.protrusion.

Orthopedic problems with lower arch therapywith maxillary protrusion but incisors and molars in deep bite or need advancement.

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Correct Vertical/Overjet Problems 3.

-

Orthopedic problems with minor incisor interferences. Upper utility arch with headgear

.

4.

Orthodontic problems alone.

-

Upper utility arch with Class II elastics

.

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Development of the Bioprogressive Brackets

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Brackets ď Ž

ď Ž

Siamese twin bracket on all the teeth. Slot size-.022 changed to .018

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Brackets ď Ž 1. 2. 3. 4.

Slot size-.0185 x .030 Use of two light arches Permits a champer or bevel. Allows for a lever access. Adequate distance for the torque grooves.

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Development of Brackets 1. 2. 3.

Rickett’s Standard Bioprogressive. Rickett’s Full Torque Bioprogressive. Triple Control Bioprogressive.

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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.

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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.

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Development of Brackets

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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.

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Development of Brackets

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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

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Development of Brackets

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Development of Brackets

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Mechanics Sequence for Extraction Treatment

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Extraction Mechanics ď Ž

1 2 3 4

Four general procedures : Stabilization of upper and lower molar anchorage. Retraction and uprighting of cuspids with sectional arch mechanics. Retraction and consolidation of upper and lower incisors. Continuous arches for details of ideal and finishing occlusion. www.indiandentalacademy.com


Extraction Mechanics 1. Stabilization of upper

a)

ďƒź

ďƒź

and lower molar anchorage: Maximum upper molar anchorage. Nance arch with modifications. Headgear .

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Extraction Mechanics b) Moderate upper molar anchorage:  Palatal bar.  Quad helix.  Upper utility arch.

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c) Minimum upper molar anchorage: ďƒź Vertical closing loop. ďƒź Double delta loop.

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Extraction Mechanics ď Ž

ďƒź

Maximum lower molar anchorage: Lower utility arch-four mechanical adjustments.

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Extraction Mechanics ď Ž

ďƒź

Moderate lower molar anchorage: Lower utility with adjustments.

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Extraction Mechanics 

Minimum lower molar anchorage: Eliminate the four mechanical factors. Round wires may be used.

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Extraction Mechanics 2.

Retraction and uprighting of cuspids with sectional arch mechanics.

ď Ž

Cuspids need to be kept in the narrow trough of trabecular bone and avoid the severe tipping or displacement

ď Ž

The activation of the cuspid retraction springs should produce 100 to 150 grams of force www.indiandentalacademy.com


Extraction Mechanics

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Extraction Mechanics ď Ž

Intrusion

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Extraction Mechanics ď Ž

Root uprighting

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Extraction Mechanics ď Ž

Rotation

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Extraction Mechanics 3. Retraction and consolidation of upper and lower incisors. Lower incisors:  Very light continuous forces (150 grams)  Contraction utility  Double delta retraction loops

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Extraction Mechanics

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Extraction Mechanics  

Upper Incisors: Regular contraction utility. Upside down vertical closing loop. Double delta loop.

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Extraction Mechanics

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Extraction Mechanics

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Mechanics Sequence for Class II Div I

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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. www.indiandentalacademy.com


Mechanics For Class II Div I 

Upper arch –orthopedic reduction of the maxilla. Lower arch-treatment starts with levelling the spee.-utility arch

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Mechanics For Class II Div I

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Mechanics For Class II Div I 

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

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Mechanics For Class II Div I

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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

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Mechanics For Class II Div I 

Upper arch alignment: Incisors are not included. Upper molars starts Distalizing-opening spaces in the buccal segment. www.indiandentalacademy.com


Mechanics For Class II Div I a) Consolidation section

b) Stabilizing section

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Mechanics For Class II Div I ď Ž ďƒź 1. 2. 3.

Segmental correction with Class II elastics: Three detrimental effects: Skidding effect. Tendency for a deep bite. Difficult to overcorrect buccal segment.

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Mechanics For Class II Div I  

Tractions SectionsGable bend distal to canine. Rotation bend in the anterior portion. Molar bayonet bend

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Mechanics For Class II Div I  1.

2.

Functions – Counteract downward backward pull Stabilizing function in the upper buccal segment.

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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

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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. www.indiandentalacademy.com


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 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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Linear Dynamic System JCO October -1987

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Linear Dynamic System   

Original malocclusion Ideal orthodontic tooth position. Anticipated rebound and required overcorrection.

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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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Mandibular 1st molar

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Maxillary 1st molar

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1. Morphology requires some offset for a linear archwire. 2. Archwire leads away from the tooth mesiodistally, and the tube's built-in rotation must be neutral to allow proper rotation. 3. Most Class II cases have mesially rotated upper first molars that require 4. Mechanics in Class II and III cases often involve forces that rotate the upper molar mesiolingually.

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Second molars

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Mandibular 2nd pre molars

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Mandibular 1st pre molars

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Mandibular canine

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the lower cuspid contact should be no more than . 5mm lingual to the lower lateral incisor,

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Mandibular incisors

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Maxillary 2nd premolars

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Maxillary Canines

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Maxillary incisors

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First. the initial area of interference when distally overcorrecting the upper buccal segments is the upper lateral incisors to maintain a good contact point with the upper cuspid, the upper lateral incisor bracket should be slightly thicker than the upper cuspid bracket www.indiandentalacademy.com


www.indiandentalacademy.com Leader in continuing dental education

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Bioprogressive therapy/ dental implant courses by Indian dental academy