Bioprogressive therapy /certified fixed orthodontic courses by Indian dental academy

Bioprogressive Therapy


Part III

www.indiandentalacademy.com

1

Mechanics Sequence for
Class II Div II


2

Mechanics For Class II Div II
Three treatment
possibilities:
1. Distalizing the
upper arch.
2. Advancing the lower
arch.
3. A reciprocal
movement.



3

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.

4



Quad helix or W
arch


5

1.

Advancement, torque control, and intrusion
of the upper incisors.

X Principle of bite before jet
 Jet is created followed by intrusion.
16x22 utility arch


6


Directional control

7

Amount of pressure:
 125-160 gms
 16 x 22
 Stabilization of the
molars:
Quad helix
TPA
Stab. sections



8






Intrusion of lower incisors:
16 x 16 utility arch.
65-75 gms.
This is followed by cuspid intrusion.


9



1.

Advancement
of the lower
denture:
Utility arch with
4 helical loops


10

2.

Using three
vertical loops:


11

Alignment of the buccal
segment:
a) Stabilizing section
3.


12

If buccal segment
are not aligned


“T” sections



Twistoflex wire



Cable wire


13

4.

Consolidation of
the maxillary
incisors:


14



Idealization and
arches and finishing


15

Pentamorphic Arch Forms

16

Finishing and Retention


17





“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.


18







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

19



20



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.


21



Initial stage of retention :



First six weeks following appliance removal



Retainers inserted-designed not to hold but to
guide the teeth in settling.


22

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

23

Lower arch:
 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.



24






Stabilizing stage of retention:
First year following active treatment.
Lower retainer is kept in place and upper is
worn most of the time.


25

Bioprogressive Simplified
James J. Hilgers
Jco 1987-part 1-4


26







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”.

27

Visual Treatment Objective




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

28



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

29

Occlusal Paralleling Instrument




Arch length deficiency is
one of the most critical
aspects of diagnosis.
One of the most
accurate measuring
devices is the
mandibular occlusal xray


30

Diagnostic procedures
Grades the patient asA- enthusiastic
B- average
C- resistant
 Patient assurance about headgear usage.



31

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

32

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.


33

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.

34

Appliance design

The key to a Class I buccal segment is the
proper positioning of the lower first molars

35

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.


36

Linear Dynamic System
C.I

Max
Man
d

L.I

Canin
e

22/5
-1/0

14/8 7/10
-1/0 7/5

1st
pm

2nd
pm

1st
2nd
molar molar

-7/0 -7/0 -10/0 -10/0
-11/0 -17/0 -27/5 -27/5


37

Basic principles






Treatment of overbite before overjet.
Sectional arch mechanics
Progressive unlocking of malocclusion
Cortical and muscular anchorage
Torque control throughout treatment.


38

Extraction Therapy







Initiation
Cuspid retraction and uprighting.
Transition and final cuspid space
closure.
Consolidation.
Idealization

39

Extraction Therapy





Initiation
Lower arch-utility arch
- band 2nd molars.
Upper arch - TPA
-headgear
-utility
-2nd molars

40

Extraction Therapy


-

Cuspid retraction and uprighting
Angulation of the cuspid
Mesially tipped-1/3 of the extraction space


41

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)


42

Extraction Therapy



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.


43

Extraction Therapy



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.

44


45

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



46

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.


47


48

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”



49

Non extraction therapy





Initiation.
Transition.
Traction.
Idealization.


50

Synopsis Non Extraction
Therapy






Initiation –
Orthopedic appliances.
Base arches to set up the
anchorage.
Overlay wires.


51

Therapy







Transition
After leveling and
aligning of the arches.
Correct rotation and
spacing
Resilient arches.


52

Therapy







Traction
Lower arch set up –to
allow Class II elastics.
Upper buccal segments
are leveled
Traction sections in
upper arch


53

Therapy





Idealization
Final arches used to
achieve arch
coordination.
Use of light round wires.


54


55


56


57


58


59


60


61


62


63

Thank
you

Leader in continuing dental education


64

Bioprogressive therapy /certified fixed orthodontic courses by Indian dental academy

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