Roth philosophy /certified fixed orthodontic courses by Indian dental academy

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


IN MEMORIAM
• Ronald H. Roth, 1933-2005
• Valued the importance of Larry Andrews Straightwire-appliance concepts

• “Roth philosophy”
• Functional diagnosis and correction of malocclusion
to a properly functioning occlusion

• Harmonious functioning of the
Temporomandibular joints
• Earliest users of interactive self-ligation
• Dr Ronald H. Roth died on January 24, 2005. His
passing came quickly from an aggressive form of
cancer


CONTENTS
•
•
•
•

INTRODUCTION – ROTH
ROTH PHILOSOPHY
FUNCTIONAL OCCLUSION PART( 1 – 4 )
TEMPOROMANDIBULAR PAIN – DYSFUNCTION
AND OCCLUSAL RELATIONSHIPS
• CLINICAL EVALUATION OF ADREWS STRAIGHT
WIRE APPLIANCE
• CONCLUSION
• REFERENCES

INTRODUCTION
• Ronald H. Roth, [1933-2005] – “ the Roth
Prescription “ – “ Roth Philosophy. “ – chief
contributions by Dr. Roth included an everpresent insistence on the functional diagnosis
and correction of malocclusion to a properly
functioning occlusion with a harmoniously
functioning temporo mandibular joint.
• He was among the first to recognize the value of
Larry Andrews straight wire appliance concepts.
He was among the earliest users of self –
ligation.

GOALS
• FACIAL ESTHETICS
• DENTAL ESTHETICS

• FUNCTIONAL OCCLUSION
• PERIODONTAL HEALTH
• STABILITY

ROTH’S APPRAISAL OF
ANDREWS SWA
• In 1968, Dr Roth introduced to Dr Lawrence F
Andrews of San Diego, California who had
developed - STRAIGHT WIRE APPLIANCE
• The Andrews concept was built on his study of a
collection of 120 non-orthodontic normals.


ANDREW’S PRESCRIPTION
 ANGULATION
Maxillary
•
•
•
•
•

5° Central incisor
9°Lateral incisor
11° Canine
2° Premolars
5° Molars

Mandibular
•
•
•

2° Incisors
5° Canines
2° Premolars and Molars


 INCLINATION

Maxillary
•
•
•
•

7° Central incisor
3° Lateral incisor
-7° Canine, Premolars
-9° Molars

Mandibular
•
•
•
•
•
•

-1° Incisors
-11° Canines
-17° First premolars
-22° Second premolars
-30° First molar
-35° Second molar

 PROMINENCE

Maxillary
•
•
•
•
•

2.9mm-Molars
2.4mm-Premolars
2.5mm-Canines
1.65mm-Lateral incisor
2.1mm-Central incisor

Mandibular
•
•
•
•

2.5mm-Molars
2.35mm-Premolars
1.9mm-Canines
1.2mm-Incisors

 OFFSET
Maxillary
•

10° molar

Mandibular
•

No offset
Curve of spee ranged from flat to 2.5mm deep


ADVANTAGES OF SWA
•
•
•
•
•
•

EASE OF ARCH WIRE CONSTRUCTION
NO NEED FOR INTER – BRACKET SPAN
EASE OF ARCH WIRE PLACEMENT
LESS ROUND TRIPPING
BETTER CONTROL OF TOOTH POSITIONS
CONSISTENT RESULT


•
•
•
•

PATIENT COMFORT –
EASE OF LIGATION –
BRACKET IDENTIFICATION
EASIER, MORE ACCURATE BRACKET PLACEMENT
All treatment were subjected to Andrew‟s „
“six keys to normal occlusion”


Molar Relation

Improper molar
relation

Improved molar
relation

More improved
molar relation

Proper molar
relation


Crown angulation (TIP)


Crown Inclination (Torque)


No Rotations


Tight Contacts


Curve Of Spee


• Dr Roth’s concept of idealized tooth positions to
achieve centric relation closure, mutually
protected occlusion and elimination of excursive
interferences came very close indeed to Dr
Andrew’s concept – thus he incorporated ‘ The
six keys to Normal occlusion with mandible in
gnathologic centric relation ‘.


• The rearmost, uppermost and midmost
relationship of the mandible to the cranium
(after stuart).
• To satisfy both orthodontic and gnathologic
requirements,Dr Roth came up with the –
FUCTIONAL OCCLUSION FOR ORTHODONTIST


FUNCTIONAL OCCLUSION FOR
ORTHODONTIST
• WHY FUNCTIONAL OCCLUSION?

• ROLE OF EQUILIBRATION


Roth’s Treatment Objectives
Pleasing Facial Esthetics
Molar Relation and Tooth Alignment
Functional Occlusion
Stability of Post Treatment Tooth Positions and
Alignment
Comfort,
Efficiency
and
Longevity
of
Dentition, Supporting Structures/ TMJ


HARMONY OF OCCLUSION
• Ideal relationship of condyles
• Border movements

• Centric contacts
• Instrumentation


CENTRIC RELATION (CR)

• Dr Roth
• Williamson
• Stuart


Examination
• Manipulation of mandible into clinical CENTRIC
RELATION
• FIRST CENTRIC CONTACT
• TMJ palpation for sounds
• Musculature examined for tenderness
• Inspection of occlusion


OCCLUSAL INTERFERENCES
SIGNS AND SYMPTOMS :
 Occlusal wear
 Excessive tooth mobility
 TMJ sounds
 Limitation of opening
 Myofascial pain
 Contracture of mandibular musculature
 Tongue thrust swallow

• In terms of patient’s reactions to occlusal
interferences, there are three categories of
patients –
1. Those with symptomatology
2. Those that are either psychologically and/or
physically predisposed to developing a problem
3. Those that are neither symptomatic nor
predisposed to developing symptoms


• OCCLUSAL INTERFERENCES TEND TO MAKE
TEETH AND JAWS A FOCUS FOR VENTING
PSYCHOLOGICAL STRESS


DIAGNOSIS AND TREATMENT
PLANNING

Bilaterally balanced occlusion

Unilaterally balanced occlusion

Mutually protected occlusion

Orthodontic models
Splints

Mounting in an articulator

Template

TMJ Tomograms

Normal condyle fossa relationship


THE REPOSITIONING SPLINT
• PURPOSE
 Is to enable the operator to find ‘ true ‘ centric
i.e. stable/comfortable.
 To test the patient’s response to change in the
occlusion prior to any occlusal therapy
 To see if the mandibular centric relation position
can be stabilized
EUGENE DYER popularized the use and called it
a CRANIOMANDIBULAR ORTHOPEDIC APPLIANCE

• USES
 Symptomatic patient
 Difficult to manipulate the mandible/ not easy
 Alleviation of pain – dysfunction symptoms
 Allows remodelling of the joints if there have been
some previous degenerative changes


• OBJECTIVE
 It is to seat the condyles in the most superior
position possible on every visit, and to adjust the
occlusal surface of the splint to achieve
maximum intercuspation at this position of the
mandible at the most closed vertical dimension
obtainable


• The MANDIBULAR POSTURAL CHANGES during
splint therapy are –
1. Changes due to relaxation of the musculature
that postures the mandible incorrectly due to
muscle contracture or spasms
2. Changes due to elimination of intracapsular
inflammatory fluid
3. Changes due to remodelling or recontouring of
the bony parts of the joints

CONSTRUCTION
1. Accurate stone model.

2. Base trimmed to approximately
5mm at the thinnest point


3. With model in vacuum former , a 0.080“ clear resin
sheet is heated until it sags approximately ¾"

4. While vacuum is still on, tightly adapt the
resin to the interproximals and occlusal
anatomy of the teeth


5. With the acetate marking pen, mark the
separation line

6. Acrylic trim bur


7. With the acrylic trim bur, follow the
separation line cutting through the resin shell

8. Cut under the teeth with the bur. This
allow the teeth to be fractured from the rest
of the model, so that the resin shell can be
separated from the model without fracturing
or distorting the shell


10. A carbide bur for the
9. Pry with a lab knife to fracture the
model and separate the teeth from the
model base

straight hand - piece is used to
trim the resin and finish the
acrylic used in the fabrication
of the splint.


11. Trim and smooth the margins

12. No. 2 and/or a No. 4 round bur is used in
the straight hand - piece to remove internal
interferences. An indicator paste such as P. I. P
may be helpful.


13.

Mix acrylic in a dappen dish

14. Moisten it with monomer


15.

Fill lingual interproximals with acrylic

16.
Moisten index finger with saliva


17.
18.
Manipulation
mandible

Smooth the acrylic
on
lingual
and
occlusal

of

19.

The procedure


21.
20

Maintenance of anterior stop

Mandible tapped into CR

Mandible guided into CR

Marking by mandibular cuspids

Mark cuspid excursion by cusp
tips

Grind contact in the posterior

Remove excess acrylic

Posterior clearance seen

Condyles upward and backward

Click observed

3 days on the splint with only
anterior support

Mandibular posterior teeth In
simultaneous
www.indiandentalacademy.com contact

Occlusal markings

Protrusive guidance

Incisors
0.0005”

clear

in

CR

CR Contacts

by

Excursions checked with mylar
marking

Establishment
of
protected occlusion

Resin left over
anterior teeth

mutually

incisal

edges

Completed splint


of

0.0005” shim in CR

0.0005” shim in
CR

Right lateral excursion

Centric relation, lateral
protrusive excursion

excursion

and

• Adjustment schedule
• Wearing of splint


GNATHOLOGICAL PRINCIPLES
• Instrumentation is needed to get the patient’s
neuromuscular mechanism out of the way, so
that we can see how the patient would close and
move if there were no teeth interfering with the
movement pattern that TMJ’s can execute.
• 3D effect of mandibular movement and closure
can be studied and relate the joint – dictated
movement / closure patterns to occlusion.


STUART PANTOGRAPHIC RECORDER

DENAR ARTICULATOR


• OBJECTIVES
 To obtain a stable CR of mandible and no actual
contact of the anterior teeth in centric closure
(.0005” clearance)
 Harmonious glide path of anterior teeth working
against each other to separate the posterior
teeth immediately, but gently, as soon as the
mandible moves out of centric closure


IMMEDIATE SIDE SHIFT OF MANDIBLE


• The cuspids should be the main gliding includes
on lateral excursion and the 6 maxillary anteriors
teeth should articulate with the 6 mandibular
anterior teeth / the mandibular bicuspids so that
protrusive load is spread over 14 teeth.
• Mutually protective occlusion


MUTUALLY PROTECTED OCCLUSAL SCHEME

EXCURSIVE OCCLUSAL SCHEME

INSUFFICIENT TORQUE

STEEP ANTERIOR LIFT

INSUFFICIENT GLIDE PATH IN PROTRUSIVE


IDEAL TOOTH POSITIONING
•
•
•
•
•

PROPER INDIVIDUAL TOOTH POSITIONING
CENTRIC RELATION OF MANDIBLE
COORDINATION OF ARCH FORM AND WIDTH
CONTROL OF VERTICAL DIMENSION
ANTEROPOSTERIOR CORRECTION BETWEEN
MAXILLA AND MANDIBLE
• CLINICAL AWARENESS OF EXCURSIVE
INTERFERENCES


INDIVIDUAL TOOTH POSITIONING


TREATMENT PRIORITIES
1.
2.
3.
4.
5.
6.
7.
8.

Correction of cross bites
Reduction of jaw relationship
Elimination of crowding
Establishment of space for severely malposed
teeth
Space consolidation of the lower arch
Levelling of the curve of spee
Finishing of the lower arch
Establishment of desired molar / buccal
segment relationship

9. Consolidation of maxillary space / retraction
and / or intrusion of maxillary anteriors
10. Artistic positioning / torque of maxillary
anteriors, to allow them to occupy sufficient
space to encase the lower arch / still maintain
functional overbite
11. Overcorrection of buccal segments, curve o /
spee, rotations and root positions at extraction
sites
12. Final detailing of tooth positions

CONTROL OF VERTICAL
DIMENSION / THE MOLAR
FULCRUM
 Avoid extrusion of posterior teeth and increase
excess vertical alveolar growth

 MOLAR FULCRUM is the problem in attempting
to treat Orthodontically to centric relation


When the fulcrum has been created, one of two
things occurs:
1. Appearance of an anterior open bite through
the bicuspids - tongue – thrust swallow
2. Clicking of TMJ’s / tightness or stiffness of the
mandibular musculature, usually associated
with pain or discomfort of any combination of
mandibular muscles.

• OVERCORRECTION
Overcorrection of anteroposterior relationship of
arches is done with
 Headgear,
 Short class II elastics- 3 months
Discontinue for 3-4 weeks
Wires changed to braided rectangular wires

FINISHING IN CR
•
•
•
•
•

Correction of anteroposterior jaw relationships
Elimination of molar fulcrum
Coordination of arch form and width
Levelling of curve of spee
Checking centric deflection


GNATHOLOGICAL TOOTH
POSITIONER
Final seating / finishing of occlusion is obtained
with a GNATHOLOGICAL TOOTH POSITIONER
PURPOSE: is to move the occlusion closer to CR
than it was at the time of debanding. This may
seat the occlusion into CR and retain it there
The positioner is also used to aid in providing a
better anterior guidance and posterior disclusion
upon mandibular movement

• OBJECTIVE
It is to be able to place the appliance over the
patient’s maxillary teeth and hinge the patient’s
mandible on the centric relation arc into the
lower position of the appliance, and have the
teeth seat into the sockets without the necessity
of the mandible moving forward off to the CR
arc

• REQUIREMENTS
 Proper treatment
 Anatomical articulator
 The mounting
 The setup
 The processing
 The material
 Construction technique

MOUNTING

Centric registration

Gnatho positioner on skull

Processed Positioner on Articulator


CONSTRUCTION TECHNIQUE


AFTER DEBANDING


TEMPORARY RETAINERS


GNATHOPOSITIONER INTRAORALLY

3 DAYS LATER

COPYPLAST RETAINERS


ROTH PRESCRIPTION
ANDREWS STRAIGHT WIRE APPLIANCE
DISADVANTAGES:
• Heavy forces
• Roller coaster effect
• Anchorage control
• Inventory problem
• Need for reverse curves and compensating
curves

THE ROTH PRESCRIPTION
• ROTH PRESCRIPTION OF THE ANDREWS
APPLIANCE
 ANTERIOR BRACKETS, placed more incisally
 TRU-ARCH
 AUXILLIARY ATTACHMENTS
 ADDITIONAL HOOKS


TRU ARCH


MAXILLARY PRESCRIPTION
• INCISORS: 5⁰ more than normal INCLINATION
• CANINES: Less negative torque
2⁰ more distal tip
2⁰ rotation to the mesial
UPPER BUCCAL SEGMENTS

• BICUSPIDS: Rotated 2⁰ mesially
• MOLARS: 14⁰ distal rotation
14⁰ buccal root torque

• 0⁰ upper molar rotation-in two upper bicuspids
extraction cases

• ‘Super Torque’ anteriors


MANDIBULAR PRESCRIPTION
• INCISOR BRACKETS
• CANINES: 7⁰ mesial tip
2⁰ distal rotation

• PREMOLARS / MOLARS: Entire segment
3⁰ distal tip from normal
4⁰ distal rotation

• TORQUE remains normal


ARCH WIRES
 Flat - incisors upper/lower
 Curve - cuspids and bicuspids
 Curve gently towards the distal through the
entire buccal leg
 The most prominent point in the front curvature
of the arch is the first bicuspid; the most
prominent and widest point in either arch is at
the mesiobuccal cusps of the first molars
 Anterior Guidance
 Lee and Lundeen’s work

ROOT POSITIONS
 Overcorrection in the appliance / some in the
arch form


The amount of overcorrection never expressed
intraorally for the following reasons • There is an angle of deflection between the
bracket slot / arch wire
• The force values drop so low that they are below
the values needed to more the teeth
• The teeth tend to relapse back to their original
positions

APPLIANCE CONFIGURATION

•
•
•


SINGLE WING BRACKETS
SIAMESE BRACKETS
BRACKETS- smaller
CASTED POWER ARMS


APPLIANCE CONFIGURATION
• Brackets welded to special bands
 Coined bases / flexible mesh pads

 Brazed micromesh

Esthetics and patient comfort


• LATER VERSIONS
 ‘ L ‘ shaped hooks were made by blocking out
part of the molds when making the plastic
patterns for attachment of elastics
 TWIN BRACKETS


ATTRACT BRACKETS

SAPPHIRE BRACKETS


TREATMENT TIME
•




ADVANTAGES
Decrease in treatment time
Better tooth positioning
The performed arch wires allows full bracket
engagement / expression efficiently and gently
as in case of 0.0215" x 0.028“ sentinol wire
 Heavy steel wires- 0.021” x .O25” Level slot line up


• Heavy steel wires placed without using pliers
because by the time the teeth are well enough
aligned to place such a large wire, the bracket
slots are aligned in both height and torque with
automatic in/out – ‘LEVEL SLOT LINEUP’ – allows
the use of heavy wires without having to resort
to heavy forces


CONCLUSION
• 30 Years-MBT introduced in 1972
• Appliances do not achieve ideal tooth positions INACCURATE BRACKET PLACEMENT
 VARIATIONS IN TOOTH STRUCTURE
 ANCHORAGE REQUIREMENTS


REFERENCES
• Roth,RH.: Five Year Clinical evaluation of
Andrews Sraight wire
appliance,J.clin.orthod.10:836-850,1976.


Thank you
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Roth philosophy /certified fixed orthodontic courses by Indian dental academy

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