INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com
Management umbrella Principles of the Bioprogressive therapy Visual treatment objective or V.T.O
BIOPROGRESSIVE THERAPY Developed by : Dr Robert Murray Ricketts
ď‚§ It takes advantage of biological progressions including growth, development and function and directs them in a fashion that normalizes function and enhances aesthetic effect. ď‚§It accepts as its mission the treatment of the total face rather than narrower objective of the teeth or occlusion. www.indiandentalacademy.com
Management umbrella Management of the total practice ultimately determines the degree of efficiency and effectiveness with which the orthodontist solves individual patient problems. Knowlegde of theory + skilled application of technique + administrative efficiency = Success Technical systems cannot function efficiently and have longevity unless they operate under a total management system or umbrella.
The management system should increase all of the following at same time :
A .Quality B .Quantity C . Effectiveness
Management umbrella PLANNING ORGANIZING LEADING CONTROLLING
- Normal growth
2.Deveolp Objectives - Indiviual treatment objective 3.Program
- Sequence of mechanics to achieve objectives
- Average time for mechanics to function
- Fee for case
PRINCIPLES OF THE BIOPROGRESSIVE THERAPY Ten principles have been developed in an attempt to communicate an understanding of the mechanical procedures that bio progressive therapy may use in developing a treatment plan , including appliance selection and application , specific to each individual patient.
1.The use of systems approach to diagnosis and treatment by application of the visual treatment objective in planning treatment , evaluating anchorage and monitoring results. In 2 year 70% of change is because of treatment and 30 % of change are due to growth V.T.O Allows orthodontist to visualize the changes that should occur and to prescribe the necessary treatment to cause it to happen.
Helps in understanding the interrelationship of various changing parts and the influence that one area has upon another. www.indiandentalacademy.com
Five areas of superimposition and analysis have been selected to evaluate the changes that have forecast to visualize the difference between the expected growth and proposed treatment alterations.
Seven areas of evaluation are used to determine the major moves needed to accomplish the forecast objective and to design treatment with a priority sequence for quality results and maximum efficiency
2. Torque control throughout treatment Most of techniques allow more freedom of movement of tooth by using round wires . Bio.prog therapy suggest that movement of teeth can be more efficient and various treatment procedures more effectively carried through when control of direction of root movement available. Four situation where torque control of root is necessary •
Keep roots in vascular trabecular bone during initial stages
• Place roots in dense cortical bone for anchorage • Torque to remodel cortical bone for U/L incisor retraction • Torque to position teeth in final occlusion www.indiandentalacademy.com
3.Muscular and cortical bone anchorage Anchorage here is considered in terms of stabilizing the molars and positioning teeth against movement during various stages of orthodontic treatment. â€˘ Upper arch â€“Masseter and Temporalis
Facial Type According to lower facial height angle
cortical bone anchorage cortical bone is more dense and laminated with very limited blood supply therefore the physiological process is delayed and tooth movement is slow . â€˘ U/L molar anchorage increased by Expansion â€˘Tooth movement can be enhanced by understanding the position of cortical bone .
4. Movement of all teeth in any direction with proper application of pressure. •Rate of tooth movement is dependent on blood supply that sustains the physiological action that takes place within bone •Brain lee ,suggested that the most efficient force for tooth movement is based upon the size of the root surface of the tooth to be moved which he called as enface root surface or the portion of root that is in the direction of tooth movement .
• He expressed this value as 200 gm/sq.cm of root surface area Bio prog therapy suggest as 100gm/sq.cm www.indiandentalacademy.com
â€˘Density of bone is also an influencing factor movement through cortical bone require even less forces.
.016 x .016 chrome alloy archwires ,with designs ,that allow more wire through spanning arches , sectional arches , or multiple loops have been found to apply light continuous forces
5.Orthopedic alteration Orthopedic forces changes the relationship of the basic supporting for jaw structure contrasted to tooth movement in localized area . It also affects areas associated with supporting structures like condyles of mandible and palatal plates of maxilla Ex ; Headgear , RME
â€˘ Headgear according to facial type www.indiandentalacademy.com
6. Treat the overbite before the overjet correction Most malocclusion , have a deep incisor bite relationship as in . class II div 1 and div 2 For stability in function and retention it is vital to correct deep bite so as to get proper overjet ,overbite and inter incisal relationship Methods of Deep bite correction â€“ A. Extrusion of posterior teeth (unstable)
B. Intrusion of anterior teeth Extrusion of Posterior teeth â€“ 1 Vertical growth pattern (increases anterior facial height)
2 Horizontal (resist molar extrusion)
•Bio .prog therapy considers incisor intrusion as treatment of choice
• If deep bite is not corrected before overjet correction ? Interference during retraction leads to limited occlusion and causes extrusion of posteriors
Spanning arch - Utility arch It stabilizes the buccal occlusion and apply light continous force for incisor intrusion www.indiandentalacademy.com
7. Sectional arch therapy In continuous arch the force and leveraging action to move malposed teeth comes primarily from the adjacent tooth along the arch and , because of the short span between their brackets , very heavy forces of a short duration are usually applied. In sectional arch treatment the arches are broken into sections or segments in order that the application of force in direction and amount will be of more benefit in efficient movements of the teeth.
Four benefits of sectional arch treatment
It allows lighter continuous forces to be directed to the individual teeth. utility intrusion arch , class II elastic , cuspid retraction
More effective root control in the basic tooth movement For intrusion â€“ Roots of lower incisor , Root of cuspid need separate torque www.indiandentalacademy.com
3. Supplements maxillary orthopedic alteration.
4 Reduces the binding and friction of the brackets along arch wire
8. Concept of overtreatment It is necessary for the clinician not only to appreciate the changes to bring the teeth into properly aligned functional occlusion , but to anticipate changes that follow when all the appliances are removed and post treatment adjustments begin to occur. Bio prog therapy suggest four areas where the concept of overtreatment may help : 1 To overcome the muscular forces against the tooth surfaces â€˘ â€˘ â€˘
Narrow upper arches, Anterior open bite , Upper anterior protrusion due to lip sucking. www.indiandentalacademy.com
2 Root movements needed for stability: Deep bite ,Paralleling of roots adjacent to extraction sites , Severe rotations 3
To overcome orthopedic rebound as heavy forces are eliminated , the basic supportive structures may rebound.
4 To allow settling in retention over treatment of the individual teeth within the arches allows them to settle into a functioning occlusion.
9. Unlocking the malocclusion in a progressive sequence of treatment in order to establish or restore more normal function 1 To describe the malocclusion and visualize the position of the teeth in terms of what functional influences have been responsible for their present form . 2 To describe the facial type and skeletal structure . 3 To describe the present abnormal functional influences upon dental arches , or the lack of abnormal development by default Ex: Upper arch expansion , Incisor protrusion correction, TMJ problems www.indiandentalacademy.com
10. Efficiency in treatment with quality results, utilizing a concept of prefabrication of appliances . Allows the clinician to direct his energies in details of appliance application, diagnosis and treatment planning.
VISUAL TREATMENT OBJECTIVE (V.T .O)
V.T.O “Blue print for building a house”
Its a visual plan to forecast the normal growth of the patient , so as to establish the individual objectives for that patient . Helps orthodontist to take advantage of growth . Valuable for orthodontist in self improvement.
www.indiandentalacademy.com Leader in continuing dental education