Levelling and aligning in orthodontics /certified fixed orthodontic courses by Indian dental academy

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

INTRODUCTION
ALIGNMENT ARCH WIRES
ALIGNMENT IN
Symmetric crowding
Premolar extraction cases
Non extraction cases
Asymmetric crowding
Begg technique

SPECIAL PROBLEMS IN ALIGNMENT
LEVELING
CONTROL OF ANCHORAGE IN 3 PLANES
CONCLUSION
REFERENCES


THE PRINCIPLES IN CHOICE OF
LEVELING AND ALIGNING WIRES
ROUND WIRE V/S RECTANGULAR WIRE
FREEDOM OF MOVEMENT OF ARCH WIRE
PROPERTIES OF ALIGNMENT ARCH WIRES
TYPES OF ALIGNING WIRES
ARCH WIRE SEQUENCING
•TRADITIONAL WIRES
•HEAT ACTIVATED WIRES

KEY POINTS IN LEVELING AND ALIGNING

THE SUBSTITUTION SEQUENCE

Traditional wires
0.015 Multistrand
0.017 Multistrand
0.014 S.S.
0.016 S.S
0.018 S.S
0.020 S.S.
0.0195 x 0.025 S.S

Heat activated wires
0.016 Thermal Niti

0.0195X0.025 Thermal Niti
0.0195 x 0.025 S.S


KEY POINTS IN LEVELING & ALIGNING
Forces should be kept as light as possible.
Sagittal, vertical & lateral anchorage needs should
be identified for each case.
Lacebacks & bend backs to be used in the initial stages
to avoid unwanted tooth movements.
Posterior segments should supported with a head gear/ TPA
in maximum anchorage cases.


VARIABLES IN SELECTING APPROPRIATE
ARCH WIRES
ARCH

SIZE

WIRE MATERIAL

OF THE WIRE

DISTANCE

BETWEEN ATTACHMENTS


ALIGNMENT OF SYMMEYRIC CROWDING
WITH EDGE WISE APPLIANCE.
The flat load deflection curve of super elastic Niti makes ideal
for initial alignment when the degree of crowding is similar on
two sides of arch.


ALIGNMENT IN NON EXTRACTION CASES

FLARING OF ANTERIORS
DISTALIZATION OF MOLARS


ALIGNMENT OF ASYMMETRIC CROWDING
WITH THE EDGE WISE APPLIANCE
Continuous Niti wire – Distortion of arch form.


ALIGNMENT IN PREMOLAR EXTRACTION
CASES
DRAG LOOP –STONER
ACTIVE LACE BACK
NITI OPEN COIL SPRING


ALIGNMENT WITH BEGG’S TECHNIQUE

0.016 Australian wires with loops used for alignment.
Niti wires – loss of control of molar position.
The modern alternative – Dual flex wire.


SPECIAL PROBLEMS IN ALIGNMENT
1. CROSS BITE CORRECTION
ANTERIOR CROSS BITE
POSTERIOR CROSS BITE


2. IMPACTED/UNERUPTED TEETH
•SURGICAL EXPOSURE
•ATTACHMENT TO THE TOOTH
•ORTHODONTIC MECHANICS


3.DIASTEMA CLOSURE
Maxillary midline diastema is complicated by insertion of
labial frenum into a notch in the alveolar bone.
Mild midline diastema is closed before frenectomy.
Large midline diastema partially closed before frenectomy and
completely closed after surgery.
Delay in orthodontic treatment after surgery results in scar
formation.

LEVELING
It includes correction of DEEP BITE & OPEN BITE


DEEP BITE
DEVELOPMENT OF DEEP BITE


DEEP BITE
CORRECTION OF DEEP BITE
•ERUPTION/EXTRUTION OF POSTERIORS
•DISTAL TIPPING OF POSTERIOR TEETH
•PROCLINATION OF INCISORS
•INTRUSION OF INCISORS
•A COMBINATION OF ABOVE

DISTAL TIPPING OF POSTERIOR TEETH


ERUPTION/EXTRUSION OF POSTERIOR
TEETH


EXTRUSION AND RELATIVE INTRUSION
18 SLOT NARROW BRACKET
22 SLOT WIDER BRACKET


PROCLINATION OF UPPER AND
LOWER ANTERIORS

Indication:
 This can be done only if the
soft tissue profile permits it or
in cases with retroclined
anteriors.
Methods:
 Not using lacebacks and bend
backs.
 Use of open coil spring
between retroclined teeth and
posterior teeth.

INTRUTION OF ANTERIOR TEETH
•CONTINUOUS INTRUSION ARCH
•THREE PIECE INTRUSION ARCH
•UTILITY ARCH


TIP BACK SPRINGS
Indications
Growing patients with forward rotations.
Deep Curve of Spee in the lower arch.
Deep over bite due to extrusion of incisors.


UTILITY ARCH
1. MATERIAL AND DIMENSIONS OF WIRE
2. SALIENT FEATURES OF UTILITY ARCH
3. TYPES
•PASSIVE UTILITY ARCH
•INTRUSION UTILITY ARCH
•RETRUSION UTILITY ARCH
•PROTRUSION UTILITY ARCH


THREE PIECE INTRUSION ARCH
IT CONSISTS OF FOLLOWING PARTS
1. THE POSTERIOR ANCHORAGE UNIT
2. ANTERIOR SEGMENT WITH POSTERIOR EXTENSION
3. INTRUSION CANTILEVERS


BITE PLATE EFFECT
IT IS USEFUL IN 3 WAYS
ALLOWS EARLY PLACEMENT OF BRACKET ON
LOWER INCISORS.
INTRUSIVE FORCE ON LOWER ANTERIORS.
ALLOWS EXTRUSION/ERUPTION/UPRIGHTING OF
POSTERIOR TEETH.


CORRECTION OF DEEP BITE

Importance of second molar.
Torque issues.
Anteroposterior issues and elastics.
Lighter forces during leveling and
aligning- roller coaster effect


ROLLER COASTER EFFECT


ANTERIOR OPEN BITE
1.
2.
3.
4.

ETIOLOGY
CLINICAL FEATURES
EARLY MANAGEMENT
MANAGEMENT DURING FULL ORTHODONTIC
TREATMENT

This patient had an asymmetrical dental anterior open bite, which was related
to right thumb sucking activity. Anterior open bites of this type are often not difficult
to correct, provided the digit sucking is discontinued.

ANCHORAGE CONTROL IN THE PRE ADJUSTED EDGEWISE
APPLIANCE
BENNET AND McLAUGHLIN CONSIDER ANCHORAGE
IN THREE PLANES OF SPACE
1. HORIZANTAL ANCHORAGE
2. VERTICAL ANCHORAGE
3. TRANSVERSE ANCHORAGE
ANCHORAGE IS CLASSIFIED AS
1. EXTRA ORAL-HEADGEAR AND FACE MASK
2. INTRA ORAL-LACE BACK, TPA, LINGUAl ARCH.
LIP BUMPER etc.

EXTRA ORAL ANCHORAGE
CLASSIFICATION OF HEAD GEARS
1. ACCORDING TO POINT OF ORIGIN
•CERVICAL-ANCHORAGE FROM NAPE OF NECK
•OCCIPITAL-ANCHORAGE FROM BACK OF HEAD
•PARIETAL-ANCHORAGE FROM UPPER PART OF HEAD
2. HIGH PULL HEAD GEAR
CERVICAL PULL
COMBI PULL


HEAD GEAR

Occipital

Combi

Occlusal
plane
Cervical

HEAD GEAR
The line of traction or direction of pull can be changed by
Varying either :
Length of outer bow.
Angulation between outer and inner bow.
Cervical pull head gear

maxilla


HEAD GEAR
High pull head gear

Combi-pull head gear


HEAD GEAR

This diagram shows the theoretical effect of variations in the length
of the outer arm of the headgear bow.

HEAD GEAR
FORCE AND DURATION OF WEAR
MARCOTTE
200gm/side in MIXED DENTITION
500gm/side in PERMANENT DENTION
18-20 hrs/day
MCLAUGHLIN
150-250 gm/side for OCCIPITAL
100-150 gm/side for CERVICAL PULL


CONTROL OF ANCHORAGE IN HORIZANTAL
PLANE
CONTROL OF ANTERIOR SEGMENTS
LACE BACK
BEND BACK
ROLLER COASTER EFFECT


PLANE
1.53mm

1.4mm

1.0mm

1.76mm

No laceback

Laceback

The work of Robinson confirms that lower canine lacebacks have a beneficial
effect in controlling proclination of lower incisors. Without lacebacks, on average the
lower incisor moved forwards 1.4 mm. In contrast, with lacebacks in place, the lower
incisors moved 1.0 mm distally.

PLANE
BEND BACKS


PLANE
CONTROL OF POSTERIOR SEGMENT
ANCHORAGE REQUIREMENT IS MORE IN THE
MAXILLA THAN MANDIBLE
CONTROL OF ANCHORAGE IN UPPER ARCH
CONTROL OF ANCHORAGE IN LOWER ARCH

Headgear

Head gear in combination with class III elastic.

CONTROL OF ANCHORAGE IN VERTICAL PLANE

1.VERTICAL CONTROL OF ANTERIOR SEGMENT
2.VERTICAL CONTROL OF MOLAR SEGMENT
•TPA
•POSTERIOR BITE BLOCK
•HEAD GEAR


VERTICAL CONTROL OF ANTERIOR SEGMENT

The tip which is built into the anterior brackets of the preadjusted appliance
system gives a tendency to temporary increases in overbite early in treatment. If the
canines are distally tipped in the starting malocclusion, then the bite-deepening effect
is greater.

VERTICAL CONTROL OF ANTERIOR SEGMENT

High labial canines may be loosely tied to the .015 multistrand or .016
HANT wire in the early stages of treatment. If the starting archwire is fully engaged
in the canine bracket slot, it can produce unwanted tooth movements in the adjacent
lateral incisor and premolar regions.

VERTICAL CONTROL OF MOLAR SEGMENT

If the upper palatal bar is placed 2 mm away from the palate, tongue forces
can assist in vertical control of the molars.

ANCHORAGE CONTROL IN TRANSVERSE PLANE
MAINTAINING EXPANSION PROCEDURE
MAINTAINING INTER CANINE WIDTH

Ideal
arch form
Expanded
archwire

Upper molar expansion should be carried out by bodily movement rather than
tipping. Minimal molar crossbites can be corrected using rectangular steel wires which
are slightly expanded from the normal form and which carry buccal root torque.

RE LEVELING PROCEDURES

NEWLY ERUPTED TOOTH
IMPROPER BRACKET PLACEMENT
BANDING OF SECOND MOLAR


1. BURSTONE C.J. MECHANICS OF SEGMENTED ARCH
TECHNIQUE. Angle Orthod .36:99-120,1966.
2. WILLIAM R PROFFIT, HENRY W FIELDS. CONTEMPORARY
ORTHODONTICS.
3. JAMES A Mc NAMARA. UTILITY ARCHES
J. Clin. Orthod. 20:452-56:1986.
4. BENNETT JC Mc LAUGHLIN RP:MANAGEMENT OF DEEP
OVER BITE WITH P.E.A. J. Clin.Orthod.24:684-96,1990.
5. RICHARD P McLAUGHLIN, JOHN C BENNET &
HUGO J TREVISI – SYSTEMIZED ORTHODONTIC
TREATMENT MECHANICS.

Levelling and aligning in orthodontics /certified fixed orthodontic courses by Indian dental academy

Recommended

Recommended

More Related Content

What's hot

What's hot (20)

Viewers also liked

Viewers also liked (20)

Similar to Levelling and aligning in orthodontics /certified fixed orthodontic courses by Indian dental academy

Similar to Levelling and aligning in orthodontics /certified fixed orthodontic courses by Indian dental academy (20)

More from Indian dental academy

More from Indian dental academy (20)

Recently uploaded

Recently uploaded (20)

Levelling and aligning in orthodontics /certified fixed orthodontic courses by Indian dental academy