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3. Introduction
Overbite – mm measurement / % - overlap of
the mandibular incisors by the max. incisors.
50% overbite – deep overbite.
Overbite control – closely related to arch
leveling process.
Occurs after levelling & aligning of
individual teeth.
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4. Vertical control – management of
Deep Bite &
Open Bite.
Deep bite – 2 types:
True.
Pseudo.
True – infra eruption of post. teeth.
Pseudo – supra eruption of ant. teeth.
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5. Development of Deep bite:
Ant. teeth – erupt – until contact made with –
Opposing ant. teeth.
Soft tissue of the palate.
Tongue inhibits – eruption.
Class II or III MO – facilitates - / reversed overjet
over eruption of ant. teeth.
Unrestricted eruption – lower 2nd molars – Cl II
deepening of curve of spee in post. part.
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6. Correction – various tooth movts:
Eruption or extrusion of post. teeth.
Distal tipping of post.teeth.
Proclination of incisors.
Intrusion of incisors.
Combination
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7. Eruption / extrusion of post. teeth.
Stable process – accompanies vert. facial dev.
Contributing factor – bite opening – deep bite patients.
vertical facial ht. – growing patients –
accommodates extrusion of post. teeth during ortho trt.
Not stable – adults – low mand. plane angles.
Musculature – resists extrusion.
High angle cases – weak musculature – stable results.
Permanent opening of mand. plane - undesired
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8. Distal tipping of post. teeth.
Stable process – growing patients.
Low angle adult cases – not stable.
High angle cases – stable – to be avoided.
Proclination of incisors.
Proclination – retroclined incisors in ant. region.
Lower arch – LI crowns – proclined.
Upper arch – crown proclination & root torque
control.
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9. Intrusion of anterior teeth.
Not normally reqd in growing patients.
Face grows vertically – restricting the normal
eruption of ant. teeth – allow bite to open.
Adult cases – musculature resists post. changes.
:. bite opening in adults –
proclination
of incisors
Intrusion.
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10. Advantages:
Controlling VD – by preventing post. eruption –
mandible rotate closed / prevented opening.
No encroachment – inter occlusal space – Stability.
Prevention of post. eruption during growth – AB to
OP reln. Improved.
Eg. Sk Cl II not worsened by post. extrsn & rotn.
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11. Principles of ant. intrusion.
Use of optimal magnitude of forces & delivery
with low LDR springs.
Use of point contacts in ant. region ( statically
determinant system)
Position of force – selection of the point of
application of force with respect to CR.
Selective intrusion based on ant. tooth geometry.
Control – reactive units – post. Anchorage unit.
Inhibition – erupn. of post. teeth.
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12. Controlling force magnitude & constancy:
Lowest force – capable of intrsn. – used.
Heavy forces – 2 effects.
in rate of root resorption.
On the anchorage unit –
Maxilla – Extrusion & steepening of the occl. plane.
Mandible – flattening.
Moment – intrsn arch - anchorage unit. Due to dist from
incisors to molars.
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13. Force constancy – low load defln. rate spring.
Lose less force / mm deactivation.
More accurate upon activation than high LDR spring.
Ant. single point contact.
Intrusion arch – not directly placed into brackets.
Tied to ant. segments – 2 points of contact.
.
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14. Advantages.
If placed into br. torque to ant. segment.
Labial root torque - intr. force.
Lingual root torque - intr. force on ant. segment.
Force system statically determinant.
Clinician precisely know the force system involved.
Telescoping of trt.
Br. – used for initial alignment segments + intrusion.
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15. Point of force application.
Intrusive force CR intrusion ,
no labial or lingual rotn. of the tooth.
Patients with procumbent incisors – intrusive force
–
farther from CR –
moment lingual root movt.
Management:
Retract
Apply
ant. – upright axial incln.- intrude.
vertical force – lingual to CR.
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18. Selective intrusion.
Indescriminate levelling –
continous arch or sectional wire – undesirable side
effects.
Decision which teeth to intrude – Intelligent trt.
planning & accomplishing – creative use of mech.
In Cl II div. 2 – CI intruded > LI.
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19. Indiscriminate levelling –
LI extrusion.
Moments – roots – converge
mesially.
Proper mech. – intrude CI to
proper reln. with LI, then include
LI & continue intrusion.
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20. Control of reactive units.
Best method – control of anchorage unit -
forces.
Effect – moment produced – intrusive force.
Large due to long moment arm.
2 side effects:
Plane of occln. of buccal segment altered.
Due to equal & opp. extrusive force – buccal
segments.
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21. Plane of occln.
maxilla – steepens.
mandible – flattens.
To minimize –
Intrsn forces.
Teeth in the anchorage unit.
Retract
as much as possible initially - length of
moment arm
Occipital
head gear – force directed ant. to C.R –
post. anchorage unit.
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22. Equal & Opp. extrusive force.
Force – acting at aux. tube of molar –
Buccal to CR of molar/ buccal segment.
Moment tip buccal segments lingually
roots moving buccally.
Prevented by
Lingual arch – maintains axial inclins. & arch width.
Fabricated width of intrn. arch less critical.
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23. Avoiding extrusive mechanics.
Patients – genuine intrusion Cl II or Cl III elastics,
Cervical headgear – high outer bows to max. arch –
to be avoided.
Canine root – mesioangular incln.
Placement of continuous archwires – extrude incisors –
canine root moves distally.
Solution:
Bypass the canine with continuous arch &
Perform separate canine movement.
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24. Methods to correct deep bite.
Bite plates.
Utility arches.
Reverse curve Niti / SS.
Burstone intrusive arch.
Kalra SIR, appliance.
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25. Utility Arches.
Designed – Robert M. Ricketts – early 1950’s.
Originally designed for enhancing anchorage during
canine retraction.
History:
Continuous archwires ( flat or reverse curve of spee)
- Levelling & aligning –
Ant. flared out
PM overerupted.
Molars uprighted or tipped back.
Class III elastics & head gear used to prevent.
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27. Canine retraction with sectional wires –
Molars & PM’s tipped mesially.
Canines tipped distally & extruded.
1950's Robert Ricketts - counteract the tipping in
the buccal segments - utilizing - immutable lower
incisors as an anchor unit,
Round arch segments - laced from the lower molars
and PM’s to the lower incisors.
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28. Buccal segments maintained in an upright
position,
lower incisors intruded with this light, continuous
pressure.
Development - Step-down base arch, or Ricketts'
Lower Utility Arch.
Double tube with no torque – designed.
Sp. Blue Elgiloy wires – 0.016” x 0.016”
Force generated – 100 gms –four incisors.
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29. Design And Function:
Extremely functional design.
Molar section – 2-3 mm beyond the molar tube
Stepped down 3- 5mm – bypass the PM & Canine.
Stepped up 2-3 mm distal to the LI br.
Follows the contour of the ant. segment.
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30. Ant. segment – labial root torque – 10 - 15°.
Molar segment – buccal root torque.
- tip back of 30 - 45°.
Toe in – molar segment – extraction cases.
Expansion – 2 cm – on each side.
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31. Effect on Molars.
Tends to upright the molars.
Crowns tip distally, rots move mesially
Tip back bend – straight distalizing force –
distolingual rotn.
Effect on Incisors.
Continous arch – flaring of the anteriors.
Crowns – mesially, roots – lingualy, hit against
cortical bone. Labial root torque – prevents this.
Most effective force - intrusion - // to long axis.
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33. Function & roles of the Utility arch.
Used to position the lower molars – snable them
to use cortical anchorage.
Loss of proprioception – incisal occlsn. –
mandible relocates – Cl II corrections.
Torque placed – incisors & molars – helps to
define ideal archform.
Possible to treat ant. & post. segemnts
simultaneously to overcorrection.
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34. It helps to maintain arch length, increase/
decrease it
Uprighting
the molars.
Advancement of the lower incisors
Expansion of the buccal segments.
Saving “E” spce.
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35. Fabrication
0.016x 0.016 Blue Elgiloy wire used.
Wire not heat trtd. When arch is formed.
Step 1. vertical step down – 10 mm from the end
– 3 – 5mm height. Horizontal section – 3mm
distal to the LI br.- step up bend
Step 2. bent horizontally. Slight inward angle –
10 - 15°. Ant. arch form swept into the wire.
Step 3. opp side completed. Buccal segment
gently contoured & buccal bridges flared
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36. 1 cm expansion on each side.
Distal leg twisted buccally. Places
labial root torque & prevents gingival
impingement of the distal vertical legs.
Incisors intruded - 45° tip back – molar
section.
Final arch form –
Well contoured ant. segment with labial root
torque.
Flared buccal segments.
Post. legs // to each other, 45° buccal root
torque.
Tip back – uprights molars & gains space.
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38. Classification:
Passive utility arch:
Stabilisation or space maintainence.
Mixedentition – hold space – transitional period.
Permanent den.- maintain anchorage.
Intrusive utility arch.
Sizes of wire used in max. arch
0.018 slot – 0.016 x0.022
0.022 slot – 0.018 or 0.019 square wires.
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39. Retraction Utility arch
To achieve retraction & intrusion.
Loops into archwire – ant. vertical step
Greater range of retrcn.
Mainly used in the maxilla.
Protraction Utility arch.
Proclining & intruding upper and lower incisors –
Class II div 2.
Post. step flush with molar tube. Loop distal to the
ant. vertical step & occlusal to the horizontal
segment.
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40. Tip back Springs ( Intrusion Springs ).
Originally proposed – Burstone
Upper & lower arches –levelled & aligned – rigid
SS wire – 0.017 x 0.025.
Used when true intrusion requd.
Growing patients with forward growth rotation.
Deep curve of spee in the lower arch.
Deep overbite – extrusion of the incisors.
Steep natural plane of occln.
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42. Anchor molars reinforced.
TPA – upper, Lingual arch – Lower.
Intrusion spring –
With helix –SS – 0.017 x 0.025
Without helix – TMA – 0.017 x 0.025.
Fabrication:
Wire bent gingivally mesial to the molar tube .
Helix formed.
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43. Mesial end bent into a hook.
Engaged distal to the LI.
When passive – mesial end – height of mucobuccal fold.
Three Piece Intrusion Arch.
Consists of the following parts.
Post. anchorage unit.
Ant. segment with post. extension.
Intrusion Cantilevers.
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44. Fabrication:
Anterior segment – bent gingivally – distal to the
laterals.
Then bent horizontally – step of 3 mm.
Distal part – distal end of canine br. – formed
into a hook.
Ant. segment – 0.021 x 0.025 SS wire – prevent
side effects – bending the wire during force
aplcn.
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45. Intrusion Cantilever – 0.017 x 0.025 TMA.
Bent gingivally mesial to the molar tube & helix
formed.
Mesial end of cantilever – bent into a hook.
Activation:
Bend mesial to the helix at the molar tube.
Passively – ant. end lies – vestibule.
End brought down and engaged – horizontal
portion of the ant. segment.
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47. Further distal placement of the force – lateral to
the LI.
Resultant forces – CR of ant. teeth.
E chain – attached to hook – simultaneous
intrusion & retraction.
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48. Canine Intrusion.
Difficult to intrude six ant. teeth.
High foce levels requd.- large moments –
undesirable changes in the axial incln. of
post.teeth.
Achieved in 2 ways:
Cantilever
form aux. tube of molar tied to the canine br –
point contact.
0.017 x 0.025 TMA wire used.
Problem – labial flaring.
During cuspid retraction – applying more β moment
( post.) than α ( ant. ) moment.
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49. K – SIR archwire.
Appliance for simultaneous intrusion & retrcn. Of
six teeth – should control:
Magnitude of forces & moments.
Moment to force ratio.
Constancy of forces & moments.
Friction.
Kalra Simultaneous intrusion & retraction
archwire – modifn. of segmented loop mech. of
Burstone & Nanda.
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50. Continuous 0.019 x 0.025TMA wire with closed
7mm x 2 mm U loops at the extn. site.
For bodily movement & prevent tipping - 90° V
bend – at the level of each U loop.
V bend when centred – counter the moments –
activation forces of the clodong loops.
60° V bend – post to the center of inter br. dist. –
increased clockwise moment – molarAugments molar anchorage & intrsn. of ant. teeth.
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52. Activation:
Trial activation – outside the mouth – releases
stress built on bending the wire.
Neutral position – U loop – 3.5 mm wide.
Activated – 3mm. Mesial & distal legs – barely
apart.
Control of Reactive forces:
Keep forces to a min.
Add teeth to the anchorage unit.
High pull head gear.
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54. Intrusive force – 125 g.
Advantages:
Simplicity of design.
Easy to fabricate
Comfortable to the patient.
Low forces, Low LDR.
Activation – 8 week period.
Shortens trt. time.
Unsightly space distal to laterals avoided.
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55. Open Bite:
Non extn. Trt. Preferred.
Some cases – extn. – to allow for eruption &
retroclination of incisors.
Upper & lower arches – crowding & protrusion –
upper & lower PM extn.
1st PM extn. – molars > 3-4mm class II.
Br.placement – 0.5mm more gingival than normal.
Early second molar banding – avoided.
Class II or III elastics – to PM’s than Molars. Short
elastics minimize extrusion.
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56. Thank you
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