Vari simplex /certified fixed orthodontic courses by Indian dental academy

VARI-SIMPLEX

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INDIAN DENTAL ACADEMY
Leader in continuing dental education


- Introduction
- Concept and Appliance design
-Diagnosis and treatment planning
-The concept
* Bracket selection
*Bracket height
*Bracket angulation
*Bracket torque
*Bracket in and out
*Archwire selection and sequence
-Non Extraction treatment
-Maxillary and mandibular arches
-Extraoral force application
Sameer

- Extraction treatment
- Maxillary and Mandibular arches
-Elastic wear
-Palatal and lingual arches
-Expansion Appliances
- Retention
Sujala


INTRODUCTION
Richard G. Wick Alexander
He designed an appliance to deliver excellent treatment
results in a simple organized way.
His main concern is simplicity, to encourage
cooperation, comfort and control.
His major goals are
- High quality results
- Patient comfort
- Reduced chair side time


He developed an appliance called the VariSimplex Discipline. “Vari” refers to the variety of
bracket types used. “Simplex” relates to the KISS
Principle (Keep It Simple, Sir).
Archwire fabrication is simplified, with first-,
second-, and third-order bends placed in the bracket
instead of the archwire.
Simpler archwires afford fewer
changes, and easier ligation and activation.


archwire

Treatment philosophy retains three fundamentals of the
Tweed technique:
1. Anchorage preparation (uprighting mandibular first
molars)
2. Positioning of mandibular incisors over basal bone.
3. Orthopedic alteration with headgear.

Key Objectives:
The key objective is to treat the case so that the
patient ends up with the face proportionately
balanced, consistent with his skeletal pattern. He
believe in non-extraction therapy whenever possible.

Diagnosis and Treatment Planning:
Determine the desired position of the mandibular
incisors, and then determine the treatment needed to
position the maxilla and maxillary dentition over the
desired mandibular arch position.
• Incisors upright over basal bone
• Cuspids not expanded
• Curve of spee level
• Non-extraction therapy whenever possible


His approach to diagnosis include Age: Patient’s age will determine whether we think in
terms of mixed dentition early treatment, full treatment
during adolescence, or adult treatment. The other
factors can be categorized according to the diagnostic
records taken to study the three tissues (facial,
skeletal, dental) in their three dimensions (vertical,
transverse, sagittal).
•Intraoral and/or panoramic x-rays
• Study models
• Facial photographs
• Cephalometric appraisal


The concept of the Vari Simplex Discipline:1. The size and shape of the teeth, especially the
mesiodistal width and curvature.
These affect interbracket width, which, in turn,
affects the ability to rotate the teeth and level the
arch without using vertical springs, multiloops, or
extra arch wires.
The system evolved around five factors related
to brackets: bracket selection, bracket height,
bracket angulation, bracket torque and bracket inout.

Bracket Selection:
Each tooth has a particular bracket that is most effective.
1. Twin Brackets:

Twin brackets (Diamond brackets) are used on large,
flat-surfaced teeth – maxillary central and lateral incisors.
The diamond bracket is designed so that all the
horizontal lines are placed parallel to the incisal edge of
the tooth, and the rhomboid design makes it possible to
align the vertical lines parallel to the long axis of the
tooth.

The flat surfaces of maxillary centrals and laterals
permit full arch wire engagement in the twin brackets. Twin
brackets on the incisors allow 5-6mm of interbracket width,
which is sufficient for flexibility, rotational control, and
torquing ability.
As the maxillary lateral incisors erupt, they frequently
remain high relative to the normal position of the centrals,
presenting a significant incisogingival interbracket
discrepancy.
Twin brackets on these teeth provide additional tie
wings for easy initial wire placement, whereas the rotation
wing of a single-width bracket might cause interference with
the archwire.
Twin brackets are smooth and minimize irritation of
labial tissue.

2. Lang Brackets:
Lang brackets were invented by Dr. Howard Lang.
These brackets are used with the Diamond design on large,
round-surfaced teeth at the corners of the arch – maxillary
and mandibular cuspids.

The single bracket allows for easy ligation and
increased interbracket width. The wing can easily be
activated for rotational control.
In extraction cases, the cuspids can be retracted on
round wire with very little tipping or rotation.

3. Lewis Brackets:
Lewis brackets are used on large, round-surfaced
teeth that are not at the curve of the arch – maxillary
and mandibular bicuspids – and on small, flat-surfaced
teeth – mandibular incisors.

The Lewis bracket is a fixed-wing single bracket,
which produces sufficient interbracket width.


The wings provide maximum rotational control
and can be activated for additional rotation.
An additional benefit offered by the single
bracket with wings is that, on a tooth that is badly
rotated, the wing in the direction of the rotation can be
removed. The bracket can then be positioned properly,
remaining wing serving to rotate the tooth into proper
position.


Other Attachments:
Twin brackets with a convertible sheath are used
on maxillary and mandibular first molars, which are
usually banded. The convertible sheath is easily
removed when second molars are banded, converting
the attachment to a bracket.


Headgear tubes are placed occlusally on the
maxillary first molars.

This position makes it easier to see and to use
them; it minimizes food traps, oral hygiene problems,
and gingival impingement; and it eliminates blockage
when omega stops are used.
Single buccal tubes are used on maxillary and
mandibular second molars, and lingual hooks are
placed on all molar bands.

Bracket Height:
Each bracket is placed at a predetermined
position on each tooth relative to the other teeth.
Placing a bracket higher or lower affects the
amount of torque and angulation, and the
incisogingival position of the tooth.
The bracket height will vary to fit the clinical
crowns.
Bicuspid bracket height is the key. Its normal
height is 4.mm.


Bracket Height:
Maxillary Arch:
Centrals
X
Laterals
X – 0.5mm
Cuspids
X + 0.5mm
Bicuspids
X
1st Molars
X – 0.5 mm
2nd Molars
X – 1.0 mm
Mandibular Arch:
Centrals
X – 0.5mm
Laterals
X – 0.5 mm
Cuspids
X + 0.5mm

Bicuspids
1st Molars

X
X – 0.5 mm

Brackets have to be positioned in the center of
the tooth mesiodistally, so that the rotating wings will
be able to function properly.

On a severely rotated tooth, the interfering wing
can be removed to enable the bracket to be placed in
the center of the tooth.


Bracket Angulation:
This allows the roots to be parallel to each other and
the crowns to be placed in their most esthetic and functional
positions.
The horizontal incisal and gingival portions of the
bracket are parallel to the incisal edge and the vertical
portions are parallel to the long axis of the crown.
Bracket Angulations:
Banding
Bonding
(Incisal edge reference)
(Long axis reference)
Maxillary Arch
Centrals
3°
5
Laterals
6
8
Cuspids
6
10
Bicuspids and
Molars
0 www.indiandentalacademy.com 0

Mandibular Arch:
Centrals

2

2

Laterals

2

2

Cuspids

6

6

Bicuspids

0

0

1st Molars

-6

-6

2nd molars

0

0


Bracket Torques:
In 1978 torques is moved from arch wire into the
bracket so that the best results are achieved when an
0.017”, 0.025” archwire is used to fill the 0.018” bracket
slots.
Bracket Torques:
Maxillary Arch
Centrals
14
Laterals
7
Cuspids
-3
Bicuspids -7
Molars
-10


Mandibular Arch:
Incisors
-5
Cusids
-7
1st Bicuspids -11
2nd Bicuspids -17
1st Molars
-22
2nd molars
0 or -27
No torque is placed in the mandibular second molar
tubes, because of omega stops. As the omega is bent out to
avoid impingment on gingival tissue and to create less of a
food trap, torque is automatically placed into the second
molar.
The most important difference is -5o of lingual crown
torque or labial root torque in the mandibular incisors.

Bracket In Out (First Order Bends):
The fifth component of the Vari-Simplex Discipline is
bracket in-out. The appliance incorporates a system of
interrelated, compensating bracket base thicknesses to
replace the usual first-order bends or offsets.
Archwire Selection and Sequence:
Bracket is only a “handle” placed on the tooth. Proper
archwire selection and sequence will allow the discipline to
deliver the desired results.
The first step, in most cases, is the elimination of
rotations. This is done by the newer, flexible, more resilient
wires – multistranded round and rectangular TMA and
Nitinol.

Leveling and space closure are accomplished next,
usually with rectangular wire – TMA or stainless steel.
The last step – final leveling and arch form – are
always performed with stainless steel wire.

The usual selection of archwires includes:
A. Non-extraction:
1. Multistrand 0.017” x 0.025” D-Rect (mandibular arch) and
0.0175” Respond (maxillary arch).
2. 0.016” SS round or an 0.016” x 0.022” SS rectangular
wire may be used for further eliminate rotations.
3. 0.017” x 0.025” SS ideal finishing archwire

B. Extraction:
1. Maxillary arch
a) Multistrand 0.0175” Respond or 0.017” x 0.025” DRect
b) 0.016” round SS wire for retracting cuspids
c) 0.018” x 0.025” SS with closing loops to retract four
anteriors
d) 0.017” x 0.025” SS finishing archwire
2. Mandibular Arch:
a) Multistrand 0.0175” Respond or 0.017” x 0.025” DRect
b) 0.016” round SS archwire or 0.017” x 0.025” D-Rect
c) 0.016” x 0.022” SS closing loop archwire
d) 0.017” x 0.025” SS finishing archwire

NON EXTRACTION TREATMENT

The total time needed to complete mandibular
arch treatment is perhaps as little as six months in a
non-extraction case. In addition, one of the big
problems on a Class II case is moving a Class II canine
to a Class I relationship when the mandibular arch is
banded.
Bracket interference can create canine attrition,
loose bonds, and retardation of tooth movement. For
these reasons, mandibular arch is rarely banded until
class I canine relationship is achieved.


Maxillary Arch:
Non-extraction
maxillary arch.

treatment

begins

with

the

The incisors, cuspids and first bicuspids are
bonded, and the second bicuspids and first molars are
banded.
After the appliances are in place, a multistranded,
spiral, round archwire is inserted. After 2 weeks the
patient is given an extra oral appliance (retractor).
At the third appointment, rotations are tied, and
the retractor is adjusted. An 0.016” round wire with
omega stops mesial to the terminal tubes is placed, so
that the arch wire can be tied back.

In case of close bite, enough excess curve of spee is
placed in the archwire to enhance the opening of the bite. It
is extremely important to tie this archwire back.
There are three ways of tying back – the traditional
omega stop, power chain or ligature wire from molar to
molar, and bending the archwire at an angle distal to the
molar tube.
Tying back the arch wire is used to consolidate the
arch to convert the arch from several units to a single unit. It
is necessary for the arch to be in one unit for the extraoral
forces to act orthopedically instead of dentally, and intraoral
elastic forces must act on the arch and not on individual
teeth.

The Omega stop, placed 1-2 mm mesial to the
buccal tube, enables placement of an active tieback force
on the archwire.
After all the rotations have been eliminated, all
spaces have been closed, and the arch is beginning to
level, the round wire is removed, and the third and final
archwire – an 0.17” x 0.025” rectangular stainless steel
finishig archwire is placed.
If the bite is still closed at this stage, a bite plate is
used so that the mandibular anteriors occlude on the bite
plate and free the occlusion.
This will improve the effectiveness of the maxilary
archwire, and the allow the posterior teeth to begin erupting
into a more level position.

The pressure of the mandibular anterior teeth on the
bite plate will tend to depress them. This will begin to open
the bite and level the mandibular arch before it is bonded
and banded.

Mandibular Arch:
After the final archwire is placed in the maxillary arch,
separators are inserted between the mandibular posterior
teeth, and the mandibular arch is bonded and banded two
weeks later.
Bonding/ banding on the mandibular arch is delayed
in a non-extraction case www.indiandentalacademy.com

1. It will avoid interference of mandibular brackets with
maxillary teeth.
2. As the maxillary arch improves, the mandibular curve of
Spee improves naturally.
3. If a bite plate is needed, it fits better and is more
comfortable after the maxillary arch has been properly
aligned.
4. Total time needed to treat the mandibular arch is 6-9
months.
5. It allows more time for the mandibular second molars to
erupt.


The mandibular arch is the key to non-extraction
treatment with the Vari-Simplex Discipline. There are five
primary reasons for our ability to control the advancement
of the mandibular anteriors:
1. Bonding eliminates the need for interproximal band space.
2. A -5 degree torque on the mandibular incisors resists
anterior flaring of these teeth.
3. The use of 0.017” x 0.025” D-Rect multistranded, braided
archwire permits torque control in the anterior segment with
the initial archwire.
4. A -6 degree tip on the mandibular first molars allows distal
movement of the molar crowns, which can create additional
arch length.
5. With bonding, selective interproximal enamel reduction is
possible.

In non-extraction cases but crowding of the
mandibular arch may prevent unravelin and uprighting of
the lower anteriors. Then class III mechanics should be
considered.
If Class III elastics are worn to the mandibular arch,
the extrusive force of the elastics on the maxillary first
molars should be considered. In a close bite case, some
molar extrusion may be desired to help open the bite.
In the case of an open bite or a higher SN-MP angle,
a high-pull force is added to the facebow during Class III
mechanics to prevent molar extrusion. The high-pull force
should be initiated before placement of the first mandibular
wire.

The term “slenderizing” is used, rather than
“stripping”, for the selective interproximal reduction of the
enamel. (Dr. Moody Alexander)
The D-Rect wire in the mandibular arch is left until
the anterior rotations have almost been eliminated. If all
rotations cannot be eliminated, an 0.017” x 0.025” D-Rect
wire with an 0.016” x 0.022” TMA or stainless steel archwire
is followed.
The next wire is an 0.017” x 0.025” stainless steel
finishing archwire. Extra oral forces have continued
throughout, and a class I molar relationship should be
achieved.
Class II mechanics are not initiated until finishing
archwires are in place.

Extra Oral Force Application:
The best results are achieved with a facebow
attached to the maxillary first molars. Patient acceptance
and cooperation are better, so successful orthopedic results
are achieved.
The facebow offers better control of the posterior
transverse dimension, so that palatal arches are not
necessary in the normally growing patient.
The bow stops anterior to the ears, so that it will not
interfere with the ears when a high-pull is used.
With an angle of SN to mandibular plane of 35
degree or less – cervical-pull neckstrap; 36-42 degree, a
combination pull; and greater than 42 degree, a high pull.

Outer bow should be parallel to the occlusal plane
and the inner bow. When the patient closes, the lips should
seal just behind the junction of the two bows without
impingement on the lips.
Depending on the diagnosis, the patient will wear the
retractor 8-14 hours per day.
If the patient’s ANB is 5 degree or more, the retractor
is worn 14 or more hours a day. If the ANB is 3-5 degree,
retractor wear can be reduced to 12 hours. If the ANB is
less than 3 degree, the retractor is worn at night only, 8
hours a day.


References
The Vari-Simplex Discipline, Part 1: Concept and appliance design, J.
Clin. Orthod. 1976.
Clin. Orthod. 1976.
Clin. Orthod. 1976.
Clin. Orthod. 1976.
Clin. Orthod. 1976.
The Alexander Discipline: Contemporary Concepts and Philosophies
Orthodontics—State of the Art; Essence of the Science - L.W. Graber


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Leader in continuing dental education


Vari simplex /certified fixed orthodontic courses by Indian dental academy

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