Roth philosophy / cosmetic dentistry courses

THE ROTH PHILOSOPHY
www.indiandentalacademy.com

In 1968, R . H ROTH was introduced to Dr. L.F. ANDREWS of
San Diego
Roth started using straight wire appliance in his practice in 1970
when Andrews gave him the first set of prototype brackets.
After seeing the treatment progress of the first patient, he
purchased the first commercially available Andrews brackets and
started all his new cases with SWA.
By the mid 1973, he switched his entire practice over to the SWA
and rebonded all the patients who still had edgewise brackets.

• He did extensive work in Andrews Straight Wire
Appliance and designed his own prescription as a clinical
trial and error evaluation.
• Cases were evaluated by the use of Intra oral photograph
and Mounted models for tooth positions
– During treatment
– At the end of appliance therapy

According to him teeth tend to relapse back from which
they started, and if counter-tip, counter-rotation, counter-
torque, and leveling of the curve of Spee were applied to the
SWA in every possible direction, then it should be possible
to use primarily one prescription for most cases, and to
finish to an "END OF APPLIANCE THERAPY" goal in which all
tooth positions are slightly overcorrected and from which
the teeth will most likely settle into non-orthodontic normal
positions
So with the concept of overcorrection he designed his
comprehensive prescription using the available Andrews
extraction brackets.

THE ROTH Rx
In 1987, Roth introduced a
bracket setup containing
modifications of the tip,
torque, rotations and in out
movement of the Andrews
standard setup brackets.
Ronald H. Roth

The major difference between the Andrews philosophy and the Roth
approach to the use of the straight wire appliance has to do with the
manner in which the teeth are moved and not necessarily the desired end
result or the result attained.
ANDREWS attempts to translate teeth throughout treatment without
ever tipping teeth. This leads to the necessity of utilizing sliding
mechanics and number of different series of brackets to solve the
problem of translating teeth depending on how far the teeth must be
moved.
In the ROTH approach, tipping of teeth is allowed, by using round wires
in the initial phase of the treatment, but the attempt is to keep the tipping
to a minimum wherein it is not necessary to resort to complex mechanics
to do the uprighting.

Andrews' study was based purely upon anatomical measurements of
tooth positions on untreated normals.
According to him teeth should be positioned from an
“ANATOMICAL STANDPOINT’”
Roth’s occlusion study was based purely upon pantographically
recorded and mounted a large number of post-treatment orthodontic
cases on the Stuart articulator
According to him natural teeth should be positioned from a
“GNATHOLOGICAL STANDPOINT”

What Made Roth To Modify
Andrews Straight wire Appliance
• Inventory problem - To treat different cases clinicians were to
buy different kits for all Andrews sets and series. Also,
changing anything about the appliances would be prohibitively
expensive.
• Anchorage loss - When mesially angulated brackets are placed
on the posterior teeth, the teeth tend to tip mesially and migrate
forward that resulted in anchorage loss.
• Problem in finishing - To achieve desired tooth positions with
the standard SWA, it was necessary to finish the
mechanotherapy phase of treatment by placing compensating
curve in the upper and reverse curve in the lower arch wire.

Roth's rationale for his bracket set
up
• The purpose of the Roth setup was to provide over corrected
tooth positions prior to appliance removal that would allow
the teeth in most instances to settle to what was found is non
orthodontic normals studied by Andrews.
• After appliance removal no matter how well treated the
patient may be, the teeth will shift slightly from the positions
they occupied at the time the appliance were removed.

Changes brought about
• In Roth Prescription the anterior brackets were placed slightly
more incisal from Andrews
– to eliminate the need of placing compensating and reverse
curve in the finishing arch wires.
• Auxiliary attachments such as double and triple buccal tube for
headgears and lip bumpers and rectangular auxiliary tubes for
Burstone and Bioprogressive mechanics.
• Additional hooks on each bracket evolved for use of short Class
II or Class III elastics.

Maxillary arch
Central tip torque rotation
Andrews 5 7 0
Roth 5 12 0
Lateral 9 3 0
9 8 0
The 5° torque increase in torque improves
Esthetics by preventing flattened profile, straight upper lip and
obtuse nasiolabial angle.
Provide more space for lower anterior teeth, thereby aiding class I
Intercuspation and
Establish proper anterior guidance & prevent lateral stress in
posterior segments.

Upper canine
tip torque rotation
• Andrews 11 -7 0
• Roth 9 -2 2(mesial)
• Increased distal tip because they are being retracted in
most treatment.
• Less negative torque to offset the reciprocal effect of
building more positive torque into the incisors.

Buccal Segment
I&II PM tip torque rotation
(A) 2 -7 0
(R) 0 -7 2M
IM &IIM
(A) 5 -9 10
(R) 0 -14 14D
• Elimination of the mesial tip on all buccal segment teeth
strengthened anchorage control significantly.
• To offset mesial the rotation that accompanies distal
traction
• The distal rotation of mesiobuccal cusp with reciprocal
mesial rotation of mesio-lingual cusp due to which the
cusp to cusp relation is changed to class I molar relation.

LOWER ARCH
CENTRAL &LATERAL
tip torque rotation
(Andrews) 2 -1 0
(Roth) 2 -1 0
CANINE
(Andrews) 5 -11 0
(Roth) 7 -11 2D

I PM tip torque rotation
(A) 2 -17 0
(R) -1 -17 4D
II PM 2 -22 0
-1 -22 4D
I M 2 -30 0
-1 -30 4D
II M 2 -35 0
-1 -30 4D
• Because these teeth settle more mesially than the upper and
simultaneously rotate mesially thus necessitating extra distal
rotation
• No change in the torque – To establish proper functional occlusionwww.indiandentalacademy.com

ROTH TRU-ARCH FORM
• Roth Tru-Arch form was derived from his extensive
clinical testing and recording of jaw-movement patterns in
treated patients who were out of retention and had
remained stable.
• The Roth Tru-Arch form actually overcorrects the arch
width slightly.
• In the front part of the arch, the widest part is at the
bicuspids, not at the cuspids.

Tru-Arch Form
• The widest point in the entire arch is at the first
molars region, (mesiobuccal cusp of I molar) There are
arcs in the Arch form as follows:-
– A curve across the front
– A curve in cuspid-bicuspid area
– A uniform curve in the buccal
segment to allow for proper
rotational position of the buccal
segment teeth.

ROTH CONCEPT OF SELECTION OF TREATMENT
MECHANICS
Thorough diagnosis
Establishing treatment goals
Dynamic treatment planning

•In diagnosis and treatment planning, it is necessary to diagnose the case
from a mandibular position of centric relation, if one wish to treat
centric relation occlusion.
•One must utilize a specific set of criteria for a functional occlusion goal
throughout diagnosis, treatment planning, and retention
•One must have records. (Standard orthodontic models and
cephalometric centric relation head films) taken in centric relation as
well, if any significant centric discrepancy exists in a particular case

CO - CR discrepancy
The neuromuscular positioning of the mandible will accommodate to
existing occlusal discrepancies and hide the true nature of malocclusion
So a REPOSITIONING SPLINT should be fabricated
•To get the patient's mandible into centric relation and
•To make the true discrepancy apparent.
Once the discrepancies are apparent, one should make a treatment plan
to deal with all of the discrepancies present in the case and not just one
to cover only those discrepancies he can see intraorally.

TREATMENT MECHANIC SELECTIONS - FACTORS TO BE
CONSIDERED.
•The facial type of an individuals.
•Reactions of various facial types to the proposed treatment.
•How much growth remains and in which direction the mandible can be
expected to grow and what means must be taken to alter the direction of
this growth - favorably with treatment mechanics.
•Effect of treatment mechanics on the patient's soft tissue profile.

TO PLAN AND TO SELECT APPROPRIATE
TREATMENT MECHANICS, ROTH UTILIZED.
•An adjusted head film tracing from centric (habitual) occlusion to
centric relation.
•Ricketts VTO and
•The five position superimposition
•Jarabak analysis

Treatment goals
1. Pleasing facial esthetics, evaluated by soft tissue and skeletal
measurements cephalometrically.
2. Molar relation and tooth alignment, evaluated by Angle's
description of anatomical occlusion.
3. Functional occlusion, evaluated gnathologically on an articulator.
4. Stability of post treatment tooth positions and alignment.
5. Comfort, efficiency, and longevity of the dentition, supporting
structures, and the temporomandibular joints.

ROTH'S ORTHODONTIC TREATMENT GOALS FOR AN
IDEAL FUNCTIONAL OCCIUSION
.
I- Centric occlusion or
maximum Intercuspation of
the teeth should occur with
the mandible in centric
relation, in which condyles
are centered transversely
and seated against the
articulator disks at the
postero superior slopes of the
eminence.

This centric relation occlusion should have three point contact of the
opposing centric cusps in their respective fossae.
II- Mutually protective occlusion
Occlusal force during closure should be of equal magnitude for all
posterior teeth and the stress should be directed along the long axis of the
teeth and the lower incisors should not be in contact with the lingual
surface of upper incisors and should have a clearance of 0.0005 inch
(by transmitting all the occlusal
forces, the centric stops of the
posterior teeth will protect the
anterior teeth from lateral stress).

Anterior guidance / incisal guidance
In straight protrusion the anterior teeth should serve as a gentle glide
path to disoclude the posterior teeth very gently. To have such anterior
guidance, there should be minimal but sufficient anterior overbite.
In the absence of anterior guidance,
excessive lateral stress on the
cuspids may cause lingual movement
of the lower cuspids and resultant
lower anterior crowding, and/or
labial movement of the maxillary
cuspids and affects post treatment
stability.
No stress

Canine guidance / canine rise In lateral excursions the
maxillary cuspids should act as guiding inclines to disoclude the teeth on
the balancing or non-functioning side and to disoclude the teeth on the
working or functioning side after approximately .5mm of group contact.

In a "mutually protective" occlusion
•The anterior teeth protect the posterior teeth from lateral stress
during protrusive movement and
The posterior teeth protect the anterior teeth from lateral stress
during closure into centric relation occlusion.
•So in a mutually protective occlusion, the mandible can execute
its total range or envelope of motion without interference from
the teeth and
During closure the teeth will direct and maintain centricity of the
condyles in the fossae.

III Cusp - fossa occlusion
During maximum intercuspation, there should be Tooth-to-tooth or cusp-
embrasure occlusion between the upper and lower teeth, because this
make the lateral and protrusive movements with proper cuspid and
incisor contact.
IV- Tooth structure, tooth position
and occlusal form should correlate
perfectly with mandibular border
movements, including the Bennett
movement and immediate side shift.

ROTH SETUP
Roth setup is available in both 0.018 and 0.022 slot
Roth preferred 0.022 slot brackets because it offered more
advantages
•In terms of wire size selection,
•In terms of stabilizing arches as anchor units.
•For control of torque in the buccal segments, which is very important
from the standpoint of functional occlusion.

SEQUENCING OF TREATMENT OBJECTIVES
The sequence of the treatment should be based on the dictates of the
individual case. The sequence of treatment objectives are generally.
1. Eliminating cross bite
2. Correcting jaw relationship
3. Eliminating severe crowding creating space in the dental arches for
severely malposed, impacted or blocked teeth,
4. Aligning the teeth in the individual arches,
5. Beginning space consolidation

6. Finishing the lower arch
It is of utmost importance that the lower arch must be finished in the
correct position to act as a template to receive the upper teeth, so that the
upper teeth can be set to the lowers
7. Achieving class I relationship of buccal segment,
8. Retracting and as if necessary intruding maxillary anterior teeth.
9. Detailing and finalizing the tooth position and the occlusion.
In many instances a number of these steps will be combined and will be
occurring simultaneously.

THE THREE PHASES OF TREATING MALOCCLUSION INCLUDES
Phase I unlocking the malocclusion
Phase II Working phase.
Phase III Finalization or detailing of occlusion
•To initial phase of treatment usually entails the use of some of the
following appliances
•Split palate Hass - type appliance
•Quard helix
•Transpalatal bar and / or a lingual arch
•An occipital pull headgear or facebow to the 6 years molar
•Utility arch.

Anchorage consideration
Factors responsible for anchorage loss
1. Attempting to upright extremely distally tipped canines.
2. Pulling distally with posterior teeth against extremely procumbent
or labially inclined incisors.
3. Attempting to level the curve of Spee with a continuous wire
without the use of distal traction.
4. Attempting to do any of the first three tooth movements utilizing
either a stiff or a resilient wire.
5. Attempting to move lingually or torque the maxillary incisor roots.
6. Attempting to expand the mandibular arch with a labial arch wire.

some of the ways in which one can avoid using
extra oral traction or losing anchorage are
•The leveling process should be started with a small flexible wire.
The best for this purpose is the braided arch wire.
•When it is time to retract and upright lower anteriors that have been
in labial or procumbent position, they should be retracted initially
with an anterior facebow. In most instances 6 to 8 weeks of
headgear to the lower anterior segment is all that is needed to
upright the lower anterior teeth sufficiently that the remainder of the
space can be closed with reciprocal mechanics.

•Band the second molars at the outset of full dentition treatment and
use them for anchorage. It is much more difficult to displace the
buccal segments in the mandibular dental arch forward if the second
molars have been included as part of the anchorage unit.
•When leveling the curve of Spee, wherever possible a utility arch
should be used to intrude the incisors followed by canine by
Bioprogressive technique and then going to the flexible small wires to
gain bracket engagement and alignment of the entire arch and
gradually level the remainder of the curve of Spee.

Phase I treatment
•Helical loop archwire, Jarabak fashion made from 0.016”
Elgiloy green wire(crowing) or
0.015” braided archwire (routinely)
or
Nitinol (severe rotation)
• 0.019” braided wire
• 0.018”Australian special plus. (finalization of any stubborn
rotation)
•0.019” square blue Elgiloy utility arches are used in case of
intrusion of incisor teeth.www.indiandentalacademy.com

Second phase of treatment.
Anterior teeth are generally retracted en masse as a group of 6 second
molars are routinely banded at the outset of treatment in the permanent
dentition.
Double keyhole loop wire mechanics (0.019 x 0.026” round edge
rectangular)- In case of minimum and moderate anchorage cases-
Modified Asher facebow- used in cases that need maximum anchorage
and retraction.

At the end of space closure
Double keyhole loop wire mechanics
0.018x0.025” blue elgiloy incorporating exaggerated Reverse curve
with special torque adjustments(to offset the undesirable effect produced
by Reverse curve) to provide
•Rapid root paralleling
•Leveling of Curve of spee &
•Maxillary incisors lingual root torque
Replaced by

During extraction space closure, faster the space is closed, regardless of
wire size, the more tipping there will be into the extraction space.
So it is the force & rate at which the extraction space is closed
determines the type of tooth movement(tipping or bodily) and not the
dimension of the wire used.

FINISHING PHASE
. The final finishing phase of treatment require filling of the bracket slot
(0.022 x 0.025) to get full bracket expression.
Short class II or III elastics are used to create anteroposterior denture
adjustments.
DETAILING OF TOOTH POSITION
THE MANDIBULAR ARCH
Lower incisors
•The sequence of tooth positioning
begins with placing the lower incisors
teeth at or slightly lingual to the
cephalometric goal. (-1 to A-Pog)www.indiandentalacademy.com

over jetOver bite
2.5 mm 2.5 mm
0.0005”

•The four incisors teeth should have the roots divergent and roots
appears to be in the same plane of space when viewed from the superior
aspect.
•Lower cuspid crowns should have 5 degrees angulation with the incisal
tip 1mm higher than the incisal edge of, the lateral incisors And it should
have a slightly exaggerated mesial rotation on extraction cases.
•There should be overcorrection of root parallelism in the extraction site,
if extractions were done.

•Bicuspids and molars should be upright and should have slight distal
rotation.
•There should be no spaces, and the arch form should be symmetrical.
•The widest point of the mandibular arch should be the mesiobuccal
cusps of the maxillary I molars and the I bicuspid.
•The curve of Spee should be leveled.(because it return to a 1- 1.5mm
curve, at its deepest point, after appliance removal and settling of the
occlusion

MAXILLARY ARCH
In the upper arch, the first tooth to be placed properly in relation to
the lower arch should be the maxillary six-year molar.
The upper six-year molars should have sufficient distal rotation,
mesioaxial inclination, and buccal root torque, so as to fit with the
lower six-year molars, as described by Andrews
The maxillary twelve-year molar
The upper bicuspids
The upper anteriors

•The incisal edges of upper centrals and laterals should be almost at the
same level with no more than 0.5mm height differential approximately
•The widest point of the maxillary arch should be the mesiobuccal cusps
of the maxillary six-year molars.
•Cusp tip of the canine should be app 1-1.5mm incisally than the of the
occlusal plane.

ROTH’S CONCLUDING STATEMENT
“I have tried to present a philosophy of treatment with the
concept of overcorrection, based on the specific set of goals
stated at the outset, taking in to account existing conditions,
facial types, and reaction to treatment mechanics.
Naturally there are always exceptions to the way one
approaches treatment”

Bibliography
• Roth, R.H.: Five Year Clinical Evaluation of the Andrews Straight-Wire
Appliance, B. Journal. Orthod. 1976; 10:836-850,
• Roth, R.H.: The Straight Wire Appliance 17 years later, J. Clin. Orthod. 1987;
21:632-642,.
• Roth, R.H, Functional Occlusion for the Orthodontist - Part I; J. Clin. Orthod;
1981;32 - 51
• Roth, R.H, Functional Occlusion for the Orthodontist - Part II; J. Clin. Orthod;
1981;100 - 123
• Roth, R.H, Functional Occlusion for the Orthodontist - Part III; J. Clin. Orthod;
1981;174 - 198
• Roth, R.H, Functional Occlusion for the Orthodontist - Part IV; J. Clin. Orthod;
1981;246 - 265

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