Differential straight arch technique. /certified fixed orthodontic courses by Indian dental academy

The Differential Straight Arch Technique

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

 Introduction
 Development

of the Tip Edge Bracket.
 Design Considerations of the Tip Edge
Bracket
 The Differential Straight Arch Technique
 Studies with the Differential Straight Arch
Technique
 Conclusion
 References.

Introduction:
 The

Edgewise mechanism with conventional, static
archwire slots is the most popular appliance in the
world today.
 However, the Edgewise bracket, which Edward Angle
presented to orthodontics as “the latest and best”, 2
years before his death, reflects the non-extraction
philosophy that he espoused in the later years of his
career.
 It has no provisions to facilitate space closure in
posterior segments, and its archwire slot also restricts
antero-posterior correction of dental arches, compared
to its precursor, the ribbon arch.

 Angle

spent the last years of his life, attempting to
perfect the Edgewise mechanism
 He suggested the use of second order bends in the
archwire, to tip crowns distally.


 Subsequent

changes in the edgewise bracket such as
wider, twin brackets and preadjusted archwire slots
have increased and refined the level of tooth control.
 However, they also produce an active strain on
anchorage even before any attempt is made to
retract teeth.
 This stationary or "reverse" anchorage is the result
of holding the roots of all teeth to be moved at distal
inclinations throughout treatment.
 Simple leveling with preadjusted brackets can
cause undesirable mesial movement of an entire
arch.

Development of the Tip Edge Bracket
 An

early attempt to modify the Edgewise bracket was made
by Alexander Sved, who removed all mesiodistal angular
control from the arch wire slot in 1937.

 The

bracket never became popular, no doubt because it had
completely lost its "edge."

 In

1968, Peter.C.Kesling,
concluded that differential tooth
movement (crown tipping
followed by controlled root
uprighting) requires that each
tooth tip freely, either mesially
or distally, not in both
directions.

In his famous article, “Expanding the Horizons of the
Edgewise archwire slot” AJO-DO 1988, he introduced a
slot that had diagonally opposed surfaces that would
permit initial crown tipping, controlled in both direction
and degree, and final Edgewise torque and tip control
with straight wires.www.indiandentalacademy.com

. A, Edgewise bracket with conventional arch wire slot.

B, Diagonally opposed corners of the slot are chamfered to
permit mesiodistal tipping in predetermined direction. C,
Tip-edge bracket slot has ability to control desired tip angle
through horizontal surfaces and torque from a rectangular
wire between central ridges or pivots.

Parts of the Tip Edge bracket
Tip-edge bracket for
maxillary right canine.
Internal components of
the "propellor" slot
include: A and A, crown
tipping control surfaces;
B and B, root uprighting
control surfaces; C,
vertical and torque
control ridges or pivots;
D, rotational control
surface.

 Central

ridges and uprighting surfaces of the
archwire slot are also preangulated to provide
final labial or lingual crown torque, with a
straight rectangular wire.
 The slot is designed so that initial second order
changes, (mesio distal crown tipping) can be
carried out in the presence of a straight, round
archwire and powered by light intra-oral
forces- elastics or coil springs.
 Forces for subsequent root uprighting, tip
and/or torque are generated by auxiliaries, not
by flexing of the archwires.



Design Considerations of the Tip Edge
bracket:
Elimination of undesired torque forces to promote
rapid bite opening and prevent midline discrepancy
The absence of directly opposed parallel surfaces in the
arch wire slot reduces or eliminates the action of
undesired mesial or distal root torquing forces
during overbite correction.
Such root torque frequently occurs when continuous,
straight arch wires (even though relatively small and
round in cross section) are initially engaged into
conventional edgewise slots.

Tip-edge bracket on upper anterior tooth eliminates couples permitting
relatively rapid depression and overbite correction with light, arch wire force
(0.20 oz [6 gm] per tooth). B, Conventional edgewise bracket on same
tooth. Engagement of arch wire creates undesired torque force that can
interfere with bite opening and cause a dental midline discrepancy

 The

central ridges of the arch wire slot
provide pivot points for the arch wire that
enhance free crown tipping and diminish
lateral root apex displacement .

 Therefore,

Tip-edge brackets permit
anterior teeth to depress under light arch
wire forces, which results in relatively rapid
bite opening and subsequent correction of
anteroposterior discrepancies through
predetermined crown tipping.

The central ridges (CRs) provide upper and lower pivot
points between the arch wire and slot. This unique feature
in a horizontally facing slot permits full engagement of the
arch wire on a tipped tooth with little or no vertical
deflection.

One hundred percent inter-bracket
distance
Tip-edge bracket is the first edgewisetype bracket to provide automatic
mesiodistal tip control and 100%
interbracket distance.
 If malposed teeth are tipped mesiodistally, at
different levels or rotated, interbracket distances
become extremely important.
 Even if a small round arch wire is used, the force
couples and associated torque influences created
often are detrimental to attaining treatment
objectives.
 The


 Neither

ribbon-arch nor edgewise brackets can
provide 100% interbracket distances for
malpositions in both the vertical and horizontal
planes.
 However, the Tip-edge bracket, with its propeller
shaped arch wire slot, can provide 100%
interbracket distance in both planes.
 A 0.016-inch round wire usually can fully engage
the slot on each anterior tooth without deflection.
This is due to both slot design (chamfered corners)
and dimension (0.022 inch).
 The central ridges provide one-point vertical
contact with the arch wire and the horizontally
facing slot provides 100% interbracket distance in
that plane.

Initial use of 0.016-inch round arch wire in 0.022-inch Tip-edge
bracket slot creates a 36° tipping range that permits arch wire
engagement in most cases. This feature in a horizontally facing slot
provides effective 100% inter bracket distance in both the vertical
(A) and horizontal (B) planes.

Slot design automatically permits
tipping or holds tooth upright to
create anchorage

tipping and root
 The diagonally opposed crown
uprighting control surfaces of the arch wire slot
determine whether a tooth tips toward its ultimate
position or remains upright to serve as an
anchorage unit according to the needs of the case
and the direction of the applied force.
 Another unique feature of the slot design is that
the same set of brackets functions properly to
correct Class I, II, or III malocclusions.

 Tip-edge

arch wire slots also permit the retraction
of both dental arches as would be required in a
Class I bimaxillary malocclusion with generalized
spacing.
 For nonextraction correction of Class II or III
malocclusions, the same brackets permit retraction
of the malposed teeth of one dental arch while
enhancing anchorage in the other.
 When full-sized arch wires are engaged in each
bracket of a Class II malocclusion, the lower teeth
can act as one large anchorage unit by resisting
mesial tipping from Class II intermaxillary
elastics.
 Simultaneously the upper teeth freely tip distally
for correction of the overjet and other Class II
relationships

 In

a Class III malocclusion, the application of Class III
intermaxillary elastics automatically reverses these
mechanics and retracts the lower dental arch while
simultaneously restricting mesial movement of upper
premolars and canines.
 Whether a tooth tips freely or serves as an anchorage
unit is determined by the cross section of the arch wire,
direction of force application, and the design of its Tipedge arch wire slot.
 Dental arches can be repositioned with light forces (2
oz) and differential tooth movement and still maintain
final control over the torque and tip angulations of each
tooth.
 Total three-dimensional control is not a constant but an
option and is used only when required— usually near
the end of treatment.

Retraction and/or space closure using
light forces with minimal arch wire
deflection
 The

arch wire slot of the Tip-edge bracket permits
closure of extraction spaces or retraction of entire
dental arches through tipping and subsequent
uprighting with little or no vertical arch wire
deflection.
 When Tip-edge brackets are used, only 2 oz per
quadrant is required to retract six, eight, or even
ten teeth in cases featuring extraction of first or
second premolars or first permanent molars



Tip-edge bracket permits retraction by distal tipping of the
canine with little or no flexing of the wire. B, Retracting
the same tooth with a standard edgewise bracket can
actually result in distal crown tipping and simultaneously
cause flexing of the arch wire and extrusion of anterior
teeth. Relatively heavy forces normally used can also
displace anchor molars.

 The

ability of Tip-edge brackets to retract teeth
and close extraction spaces without arch wire
deflection can be illustrated by the "treatment" of
a Class II malocclusion featuring extraction of the
four first premolars.
 The same set of brackets is used on the six upper
and lower anterior teeth as is used for
nonextraction treatment.
 However, the chamfers of the arch wire slots in
the second premolar brackets are reversed to
permit mesial rather than distal crown tipping.
 This permits the closure of extraction spaces
through tipping from light forces but provides for
control of final crown uprighting from springs

 Differential

tooth movement (crown tipping
followed by root uprighting) normally does not
subject anchor molars to forces sufficient to
initiate their mesial movement until spaces are
closed.
 At that point, they are restrained from moving
mesially through the contiguity (proximal contact)
of all teeth mesial to them and the reciprocal
forces of mesial root uprighting— contiguously
reciprocal uprighting.


Bracket design provides increase in
slot size with mesial or distal tipping
 The

chamfers or tipping surfaces of the arch
wire slot are extended beyond one another.
 Because of this, the slot automatically
increases in width relative to the
arch wire as the tooth tips mesially or
distally

Maxillary right canine bracket and arch wire. A, Slot dimension is 0.022 inch
when uprighting surfaces are parallel with the arch wire. B, Slot can increase
to 0.027 inch when distal tipping of canine occurs. This permits changing
from 0.016 to 0.022-inch arch wires with no deflection

 This

is one of the most beneficial (yet least
obvious) features of the Tip-edge bracket arch
wire slot since it can facilitate placement of both
initial 0.016-inch arch wires and subsequent larger
wires— up to 0.022 inch in diameter.
 It also provides varying degrees of control ranging
from initial one-point contact with a round wire to
final, predetermined torque and tip angulations for
each tooth with a rectangular wire.


Slot design can cause automatic
shift from tipping to bodily movement
 The

arch wire slot of a Tip-edge bracket can
stop mesial or distal crown tipping at a
predetermined inclination and concurrently
increase the anchorage potential of a tooth.



This automatic shift from tipping to bodily
movement is an example of programmed
differential mechanics at work.

 In

malocclusions with excessive spaces, such as
those caused by congenitally missing or relatively
small teeth, this feature prevents over retraction of
anterior teeth.



Once the 25° crown tipping surfaces of canine
brackets strike the arch wire, tooth movement
automatically becomes bodily and is slowed
proportionately.



If the other anterior teeth tip distally to their
bracket limits (20°), the combined resistance
values may then exceed those of the anchor molars
and, with continued and/or increased forces, the
molars will begin to move mesially.

 On

the other hand, in first premolar extraction
situations, anchor teeth (first molars) may for
various reasons move forward excessively.
 The crowns of second premolars then can become
mesially tipped to the limits of their slots with
tipping surfaces then striking the arch wire.
 Subsequently, further mesial movement of these
premolars must be bodily and the premolars can
become anchor teeth themselves to help support
the molars.

Side-Winder springs for concentrically
powered uprighting.

distal uprighting springs with
 Side-Winders are mesial or
power coils that are concentric with the desired axis of
root uprighting.
 Have several advantages over standard springs with
their gingivally positioned coils.
 Improve both esthetics and hygiene.
 Offer a choice of insertion from either the occlusal or
gingival aspect
 Appear to be more efficient than standard springs.





With the Side-Winder, the
center of the power coil is
concentric with the center of
the bracket (the desired axis
of uprighting) and the
resulting force vectors are
vertical at the contact points
with adjacent teeth.
This would seem to
maximize the desired distal
root positioning and minimize
mesial displacement of the
crown.

 However,

when the center
of the power coil is gingival
to the desired axis (standard
uprighting spring), the
vectors of force at the level
of the arch wire would tend
to move the crown mesially
to open space distally
and/or apply undue pressure
to the lateral incisor

yyyy

Labial or lingual torque from a rectangular
wire with the Tip-edge bracket
 The

Tip-edge bracket slot can deliver torque force to
the tooth through contact of its central ridges and/or
root-uprighting surfaces with the flat upper and
lower surfaces of a rectangular wire.
 While receiving labial or lingual torque force from a
rectangular wire, the mesiodistal inclination of the
tooth must be controlled by an uprighting spring or
an elastomeric Tip-edge ring.
 The root will then tend to move along a compound
curve created by the wire and the spring or ring.

 The

arch wire slot can function also as a "shock
absorber" to cushion the high levels of torque and
mesiodistal uprighting force usually associated
with the insertion of full-sized square or
rectangular arch wires into standard edgewise arch
wire slots.

 If

the crown of an anterior tooth is tipped distally
and lingually, the design of the Tip-edge slot
allows arch wire engagement with little or no
vertical (second order) flexing.
 The arch wire slot also will be larger than the
cross section of the wire, thus permitting
engagement with less torsional (third order)
flexing of the wire and, therefore, less torque
force.
 After the upper and lower surfaces of the arch wire
and the uprighting surfaces of the slot reach full
contact and alignment, the crown is maintained at
these predetermined tip and torque angles with a
Tip-edge ring.

The hammock effect
 When

a ligature, either steel or elastomeric, is used to
retain an arch wire in a Tip-edge bracket, a
"hammock effect" is created that tends to
parallel the arch wire with the gingival and
occlusal edges of the tie wing tips.


 This

could influence mesial or distal crown
inclination.

 The

"hammock effect" from conventional
elastomeric rings that normally are used as
ligatures is relatively light and clinically
insignificant.

 Tooth

crowns are able to tip distally or mesially to
the full range allowed by their arch wire slots from
light elastic or arch wire forces in the presence of
such rings.

 Steel

ligatures usually are used only to reduce
friction and facilitate sliding of teeth along the
arch wires. They are tied loosely, which also
reduces or eliminates the hammock effect to
permit mesial or distal tipping.
 A large (0.012 inch or more), tightly tied steel
ligature could inhibit tipping and might be used to
stabilize or enhance the anchorage potential in a
particular tooth.
 When a tooth is at its final position near the end of
treatment, an elastomeric Tip-edge ring normally
is used to maintain the desired crown tip.

Mesiodistal angular control from a
Tip-edge elastomeric ring






A Tip-edge elastomeric
ring can effectively
control the mesiodistal
inclination of a tooth.
The resilient crossbar
and lugs wedge between
the arch wire and the
tipping surfaces of the
slot.
The tooth is urged
gently toward, or held
in, its final tip
angulation with the arch
wire


Differential Straight Arch Technique
 The

Differential Straight Arch Technique takes
full advantage of the Tip Edge brackets.
 Treatment is divided into 3 stages.
 Specific archwires and auxiliaries are employed
during each stage.

Stage One:
 In

contrast to conventional edgewise techniques,
which tend to approach correction of each aspect
of a malocclusion sequentially, Stage One of the
DSAT initiates treatment by addressing the
correction of all major aspects simultaneously.

 This

includes existing over or under jets, crowding
or spacing, and anterior deep or open bites.

 Stage

One is the only stage of the DSAT in which
archwires are used to directly generate tooth
moving forces-especially for anterior alignment
and bite opening.
Goals of Stage One:
Vertical correcton of deep/open bite.
Horizontal correction of anterior over or
underjet.
Align anterior teeth to eliminate crowding or
spacing.

 Correcting

Anterior Overbite:
Correction of anterior deep bite allows full
expression of any potential mandibular growth in
correction of a Class II malocclusion.
Stage one archwires are formed from 0.016” high
tensile stainless steel wire.
In extraction treatment, archwires are generally
straight ( no vertical loops) with bite opening
bends placed several millimeters mesial to the
molar tube.
This allows distal sliding of the archwire as
retraction of anterior teeth occurs.

Bite opening bends are placed to the degree that
the anterior portion of the archwire lies in the
deepest part of the muco-buccal fold when
passive.
It is important that the premolars not be bracketed
and engaged at the start of treatment, as this
dissipates the intrusive forces of the bite opening
bends and turns them into molar tip back bends.
Proper use of Class II elastics (1-2 oz. On each
side) in conjunction with properly modified high
tensile stainless steel wires will correct severe
anterior overbites within 4-6 months of treatment.
Note: Use of excessive elastic force , or use of
overly resilient wires may worsen the deep bite
rather than improve it.

Bite-opening bends displace anterior portions of 0.016 inch
Australian arch wires gingivally to reduce anterior
overbite.)

Initial 0.016-inch arch
wires (Extra Special
Plus grade of stainless
steel by A.J. Wilcock)
and 0.018-inch coaxial
alignment auxiliaries
and light (1.5 oz) Class ll
elastics. Ribbon archtype brackets on
canines were used for
traction only.


anterior open bite or edge to edge
incisal relationship exists at the start of
treatment, the maxillary archwire is kept
straight.
 Very mild bite opening bends are placed in
mandibular arch (5-10°), serving only to
prevent the molars from tipping mesially in
response to application of Class II elastics
(if overjet correction is required.)
 When


Correcting overjet or underjet
 Accomplished simultaneously along with anterior

vertical discrepancies through use of either Class
II or III elastics depending on incisor
relationships.
 Overjet or underjet in absence of anterior
overbitecan be corrected with horizontal (Class I)
elastics if space is available in the arch for
retraction.
 Eliminates possibility of molar extrusion.
 Particularly important in high angle or anterior
open bite cases.

 In

patients who do not show compliance with
elastics wear, an Outrigger appliance may be
placed.
 This features two hooks that extend labially when
the elastics are not worn, providing an
uncomfortable but not painful reminder that
elastics are not in place.
Note: during Stage one , the resultant vector that
intrudes and retracts the maxillary anteriors, may
have a tendency to cause labial flaring of incisors.
The ends of the wire are bent distal to the molar
tube to prevent this. This is an example of
differential tooth movement- pitting teeth that can
only move bodily, against those free to tip.

Anterior Alignment:
 When

space is available
distal to the canines,
anterior alignment is
achieved by using
elastomeric ties to the
archwire through the
vertical slots of the Tip
Edge brackets.
 The Tip Edge archwire
slot allows adjacent teeth
to simply tip out of the
way as lingually
displaced teeth are
brought into position.

 When

moderate to severe crowding is present at
start of non extarction treatment, vertical loops are
placed in the anterior segments of 016 inch
archwires.


 Rotations

are corrected using rotating springs
inserted through the vertical slots of the brackets.
 These are over corrected whenever possible and
held in these positions throughout treatment


Stage Two
Primary

goal is the closing of posterior

spaces.
It is the shortest of the three stages of
Tip Edge treatment, usually completed
in 2 to 3 appointments.
Patient is instructed to wear light (1.52 oz) Class II or Class III elastics as
needed to maintain desired anterior
tooth relationships.



Goals of Stage Two:

1.

Close remaining posterior spaces.
Correct or maintain dental midlines.
Correct posterior crossbites.
Achieve Class I molar relation
Over rotate severely rotated premolars.
Level anchor molars.
Maintain all corrections achieved in Stage
One.

2.
3.
4.
5.
6.
7.


Stage Two Mechanics:
 For

maximum control, 022 inch round steel
wires are placed in both arches, with mild
bite opening sweeps in case of prior deep
anterior overbite.

 In

mild to moderate anchorage cases, the
archwires are engaged through the occlusal
rectangular molar tubes during Stage II.

 This

levels the premolars and molars early ,
easing the transition to Stage III.

 In

maximum anchorage cases, where
friction within the molar tube is of concern,
it is preferred to insert the archwires
through larger diameter gingival round
tubes.

Stage

Two

Automatic Canine Rotational
Control During Retraction.
 With

the Differential Straight Arch
Technique, no canine rotation problem
occurs during space closure.
 This is because forces are applied not to the
labial surfaces, but at the contact point with
lateral incisors, which are moved distally
along with centrals by the archwire.

Braking mechanics in Stage Two
 In

cases where abundant space is present in the
mandibular arch, over retraction of the anteriors is
not desired.
 Application of mechanical brakes, (Sidewinder
springs on premolars, canines and incisors, in
conjunction with 022” round wire or 0215x028
rectangular wire) prevents unrestricted lingual or
distal crown tipping of anteriors.
 Relatively heavy (6-8 oz) horizontal force are
applied between anterior resistance unit and
posterior teeth.

Stage Three
 The

goal of Stage three is to bring all teeth to their
final, desired axial inclinations either palatally /
labially or mesio distally.
 Generally takes 9-12 months for extraction cases,
and 6 months for non extraction cases.
 All mesio distal uprighting and labial/lingual
torquing is accomplished by forces generated from
auxiliaries.
 Wire used is either 022” round wire from Stage
Two, or full size 0215x 028 rectangular wire.

 Torquing

as well as mesio-distal uprighting are
self limiting.
 Patient can go for 3 to 4 months or longer between
adjustments, without any adverse effects.
 Uprighting

auxiliaries:
Side Winder Springs are employed for
mesiodistal uprighting.

Torquing Auxiliaries:
Most commonly used torquing auxiliaries are the
nickel titanium Torque Bars which are curved
ribbon arch sections of 022 x 028 ” Nickel
titanium formed with 20 or 30 degrees torque.

Rectangular torquing auxiliary. Cross section through
auxiliary illustrates built-in 20° of torque. Auxiliary placed
lingual to main 0.022-inch round arch wire, which provides

 For

use of Torque Bars, special Deep
Groove Brackets are used on the maxillary
central incisors.
 These feature conventional preadjusted
Edgewise archwire slots cast into the
bottom of Tip Edge archwire slots.
 A cap fills the Deep Groove in Stages One
and Two. This is removed at beginning of
Stage Three , and a Torque bar ligated
tightly lingual to the round base archwire.

A. Standard Tip-Edge bracket. B. "Deep Groove"
version for maxillary incisors, featuring conventional
edgewise slot that is filled with special cap to keep
archwire in outer slot during Stages I and II. C. Cap
is removed for Stage III and deep groove used to
engage nickel titanium torquing auxiliary under main
archwire.




For torquing of individual teeth, an Individual Root
Torquing Auxiliary is used.
These are often used with Ceramic Tip Edge brackets,
which do not have the Deep groove feature.


Stage three Anchorage control:
 Unique

aspect of Tip Edge technique is the
ability to control timing of anchorage strain.

 This

occurs only during Stage Three when
occlusion is already in Class I and there is
no spacing mesial to the anchor molars.

 The

relatively heavy forces from uprighting
springs and torquing auxiliaries are applied
to the teeth only after all teeth are in
proximal contact, or contiguous.

 When

the crowns of teeth are inclined
distally, these reciprocal forces will
reinforce anchorage as the teeth are initially
urged distally against the anchor molars
during the early phase of uprighting.
refers to this as Contiguously
Reciprocal Uprighting.

 Kesling


Round wire or rectangular wire for
finishing?
 Round

Wire Approach:
 Reseved for severe A-P skeletal discrepancies, as
they permit maxillary and/or mandibular teeth to
assume compensating labiolingual inclinations.
 Also used when patient does not need molar
torque or selective labiolingual root positioning of
canines or mandibular incisors.
 In such cases, torque to maxillary incisors could
be provided by Torque bars.

Rectangular Wire
 Their

practicality in Stage Three was
demonstrated by Richard Parkhouse.
 Strongest indications are: Generalized and
individual torquing requirements, such as for
molars, canines, mandibular incisors.
 Molar torque is nearly impossible to achieve with
round wire.
 Placement of Sidewinder springs on all other teeth
in conjunction with rectangular wire,
automatically torques them.
 For full torque expression, full size rectangular
wires, 0215 x 028 ” are used.

Studies using the Differential Straight
Arch Technique.
 Canine

retraction: A comparison of two preadjusted
bracket systems.
Lawrence P. Lotzof, Howard A. Fine, George J. Cisneros.
(AJODO 1996).
The purpose of this study was to compare the time
required to retract canine teeth by using two different
preadjusted bracket systems (Tip-Edge, TP Orthodontics,
LaPorte, Ind., versus A-Company straight wire, Johnson
and Johnson, San Diego, Calif.) in a human sample.
Anchorage loss as a result of this movement was also
evaluated.

 All

patients required the removal of first
premolars in one or both arches as a part of their
orthodontic treatment.
 Each subject received two different brackets
placed on opposite canine teeth within the same
arch.
 There was no statistically significant difference in
the rates of canine retraction.
 The mean anchorage loss was 1.71 mm for the
Tip-Edge bracket, and 2.33 mm for the straight
wire bracket.

 Clarence

E. Shelton, Jr., DDS, George J. Cisneros,
Stanley E. Nelson and Paul Watkins. ( AJO DO
1994) compared the treatment time in Class I non
extraction cases between 28 cases treated with the
Begg technique and 25 cases with the Tip-Edge
appliance.
 The average treatment time for the Tip-Edge
group was 12.80 months versus 20.89 months for
the Begg group.
 The Tip-Edge appliance may thus reduce
treatment time in Class I nonextraction therapy


Employing Tip-Edge brackets on canines to simplify
straight-wire mechanics.R.T.Rocke AJO-DO 1994
 The

author reported two premolar extraction cases
in which Straight Wire brackets were used in
conjunction with Tip Edge brackets only on the
canines.
 The canines were retracted by tipping backwards
followed by uprighting with Sidewinder springs.
 The advantage was that there was no deflection of
the archwire during canine retraction and no
resulting deepening of the bite.

Comparison of Standard Edgewise, Preadjusted Edgewise
and Tip Edge in Class II extraction treatment. Ramos,
Killiany, Kesling. JCO 2001
The efficiency of these three appliances was
retrospectively evaluated in the treatment of 105
similar malocclusions by 8 experienced
orthodontists.
Treatment time was significantly different
among the three groups,with standard edgewise
patients treated in a mean 31.1 months,TipEdgepatients in 27.1 months, and preadjusted
edge -wise patients in 26.0 months.


Tip-Edge patients had the fewest appointments
(19.4),followed by preadjusted (27.6)and standard
edgewise (33.9) patients.
The number of arch wire changes was also
significantly different,with the preadjusted group
showing the most changes (a total of 12wires), the
standard edgewise group next (10wires),and the
Tip-Edge group the least (7 wires).
Also Headgear wear was not required in the Tip
Edge cases.

Kaku etal ( J Clin Orthod 2004) reported the
use of Tip Edge brackets in a case following
molar distalization with Greenfield Molar
Distalizer, in order to allow the anterior
teeth to tip back and close the spaces
without taxing molar anchorage.
In addition, the anterior teeth were not
forced to come forward during leveling and
aligning due to absence of opposing
moments acting on them.
This further reduced the anchorage
requirements.

Conclusion
 The

use of Tip Edge brackets in conjunction with
the Differential Straight Arch Technique, provides
the orthodontist with the advantages gained by
free initial crown tipping, as well as the final
luxury of automatically achieving predetermined
tip and torque angles.
 The use of light gentle forces results in kind
treatment of the teeth as well as less taxation of
anchorage.

References










Kesling,P.C.:Expanding the horizons of the edgewise arch
wire slot,Am.J.Orthod 1988;94:26-37,
Kesling,P.C.:Dynamics of the Tip-Edge bracket,
Am.J.Orthod. 1989.96:16-28,
Kesling PC, Rocke RT, Kesling CK. Treatment with Tip
Edge brackets and differential tooth movement.AJO DO
1991; 99: 387-401.
Kesling CK. The Tip Edge concept: eliminating
unnecessary anchorage strain.J Clin Orthod 1992;26:165178.
Rocke RT. Employing Tip-Edge brackets on canines to
simplify straight-wire mechanics. AJO DO 1994;106:34150.
Shelton C, Cisneros G, Nelson S. Decreased treatment
time due to changes in technique and practice philosophy.
AJO-DO 1994; 106:654-57.











Lotzof L, Fine H, Cisneros G. Canine retraction: A
comparison of two preadjusted bracket systems. AJODO
1996;110: 191-196.
Galicia-Ramos, Killiany D, Kesling PC. A Comparison
of Standard Edgewise, Preadjusted Edgewise,and
Tip-Edge in Class II Extraction Treatment. J Clin
Orthod 2001;35:145-53.
Parkhouse R, Parkhouse P. The Tip Edge torquing
mechanism: a mathematical validation.AJO DO
2001;119:632-639.
Kaku J, Arimoto H, Sinohara N, Greenfield R. Use of Tip
Edge Brackets to reduce posterior anchorage requirements
after molar distalization. J Clin Orthod 2004;38; 320-324.
Orthodontics:Current Principles and techniques. Ed.TM
Graber, RLVanarsdall Jr, 3rd edn, Mosby, 2000. Pp.721748.

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