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Alexanders vari simplex discipline

Alexanders vari simplex discipline

Alexanders vari simplex discipline

  1. 1. VARI SIMPLEX DISCIPLINE [ALEXANDER DISCIPLINE] R.G. “WICK” ALEXANDER 1978.
  2. 2. ‘VARI’ Twin, Lang ,Lewis. ‘SIMPLEX’ KISS Principle ‘DISCIPLINE’ Edgewise mechanics
  3. 3. TWEED VARI SIMPLEX • Anchorage preservation • .022 Slot. • Treat mandibular arch first. DRIFTODONTICS. • Uprighting the mandibular first molars 6 degree tip
  4. 4. • Upright lower incisor. • Headgear. RETRACTOR. • Non extraction Tweed concept and Contemporary developments QUALITY RESULTS
  5. 5. Key Objective Patient ends up with the face proportionately balanced and consistent with his skeletal pattern . The treatment should be completed in the stipulated time with a satisfied patient, parent and doctor
  6. 6. Unique Concepts. 1.First Straight wire type – Different designs of brackets in the same case, depending on the type of teeth. The – 5 degree lower anterior torque is different from other appliances. 2. Only 2 to 3 arch wires to be changed
  7. 7. 3. Bracket design and bracket effectiveness does not dictate the treatment technique. 4. Rectangular multistranded arch wires
  8. 8. DIAGNOSIS AND TREATMENT PLANNING . Patient information Diagnostic Chart Patient records Cephalometrics , patient examination Treatment planning Financial records
  9. 9. I.Patient history
  10. 10. I. Patient examination. II. Diagnostic records. 1) Intra oral and Panoramic radiographs. 2)Study models. 3)Facial photographs
  11. 11. 4)Cephalometric Analysis. a) General skeletal pattern. b)Tooth position.
  12. 12. Critical Factor in diagnosis Lower Incisor Position. 1.Incisor mandibular plane angle. 2.Holdaway Ratio. 3.Lower incisor to A-Pog
  13. 13. Treatment Plan. Two steps: 1.Determine the desired position of the mandibular incisor. 2.Determine the treatment needed to position the maxilla and maxillary dentition over the desired mandibular arch position.
  14. 14. Objective of Treatment: 1.Incisors upright over the basal bone . 2.Cuspids not expanded. 3.Level curve of spee. 4.Non extraction therapy .
  15. 15. VARI-SIMPLEX DESIGN Brackets are • Pretorqued • Preangulated • Built in In / Out [Pioneered by IVAN LEE and LARY ANDREWS] Different bracket design on particular teeth in the arch,but the system of brackets for each pt is identical.
  16. 16. IMPORTANT FACTORS IN DETERMINING THE DESIGN OF THE V.S.APPLIANCE 1. Shape and Size of the tooth. Mesiodistal width and curvature. 2. Accessibility. 3. Patient comfort and frequency of bracket wing breakage.
  17. 17. Factors Related To The Brackets 1. Bracket selection 2. Bracket placement 3. Bracket angulation 4. Bracket torque 5. In / Out
  18. 18. BRACKET SELECTION TWIN BRACKETS • Large ,flat surfaced teeth. • Mini Diamond brackets. • Accessibility • Additional hooks .
  19. 19. •Inter bracket distance. •Patient comfort. •Full archwire engagement.
  20. 20. LANG BRACKETS Dr.Howard Lang • Round surfaced teeth at the corners • Single bracket with a flat rotational wing.
  21. 21. • Wire deformation
  22. 22. LANG BRACKETS •Complete arch wire engagement. •Increased inter bracket width Wedge shaped in profile
  23. 23. LEWIS BRACKETS • Large round surfaced teeth and small flat surfaced teeth. • Single bracket with fixed rotation wing –built in labial curvature
  24. 24. LEWIS BRACKETS • Wedge shaped in profile • Excellent inter bracket width.
  25. 25. • Facilitates correction of severely rotated teeth. Activation
  26. 26. OTHER ATTACHMENTS •Twin bracket with a Convertible sheath . •Head gear tubes placed occlusally*. •15 degree offset –upper first molar . 5 degree – mandibular first molar. •Ball hooks .
  27. 27. OTHER ATTACHMENTS • Single buccal tubes second molars • 6 degree distal offset built in the lower second molar. • Lingual hooks on all molar bands. Appliance does not dictate the treatment technique
  28. 28. Bracket height • Bicuspid bracket height [x] key
  29. 29. Bracket angulation • Ideal axial inclination. Roots parallel Crown in most esthetic &functional position. DIAMOND BRACKET VERTICAL LINES PARALLEL TO THE LONG AXIS OF THE TOOTH
  30. 30. 1 st Bicuspid Extraction
  31. 31. Dr Dwayne Trammell BAYLOR UNIVERSITY • Laminographic x- ray of the molars • 3 months • Superimposition showed Root tips moved anteriorly by , 0.5 mm Crowns tipped distally on an average of 1mm • 2 mm of arch length
  32. 32. BRACKET TORQUE DEVELOPED Finishing rectangular wires of 50 cases
  33. 33. • - 30 torque maxillary cuspids • No torque mandibular second molar tube • - 50 lingual crown torque mandibular incisors
  34. 34. DR. TRAMELL • Class II non extraction cases • 0.017’’ x .025’’ D RECT MULTISTRANDED - 3 MONTHS • Superimposition showed incisal edges moved lingually by less than 0.5mm • Root apices moved labially on an average of 1mm • Main aim Hold the incisors in its original position
  35. 35. Bracket in – out
  36. 36. EXTRA-ORAL FORCES ‘RETRACTOR’ Dr.Fred Schudy Sagittal Control Vertical Transverse Skeletal Dental
  37. 37. Three different type of retractors 1. Cervical traction • Force vector -10 degrees • SN- MP- < 37 degrees
  38. 38. 2. Combination pull • Force vector 30 degrees • SN- MP 37 to 41 degrees
  39. 39. 3. High pull retractor • Force vector 60 to 70 degrees • SN-MP > 42 degrees
  40. 40. Components of a facebow system 1. Molar buccal tubes.*
  41. 41. 2. Inner bow Adjustments in six directions • Bucco-lingually • Superio- inferiorly • Anterio - posteriorly
  42. 42. 3. Outer bow
  43. 43. • 4. Retractor system
  44. 44. Retractor force • 8 ounces • 16 ounces Time worn Depending on severity of A-P discrepancy • ANB – 3 7-8 HOURS • ANB – 3- 5 10 HOURS • ANB - > 10 14 HOURS Orthodontic vs Orthopedic force
  45. 45. Class III Extra oral forces • Face masks • Vertical pull chin cup • Reverse headgear
  46. 46. Co-operation* Successful treatment Growth Arch consolidation
  47. 47. Elastics in Vari – simplex discipline • To align the maxillary dentition with the mandibular dentition and correcting an centric occlusion / centric relation discrepancy. • Correction of cross bite and midline • Finalize the occlusion 3 to 6 ounces
  48. 48. Elastic Specifications • Class II - ¼ “, 6 oz
  49. 49. • Class III - ¼” , 3 ½ oz
  50. 50. • Midline elastics – ¼ “ , 6 oz
  51. 51. Box elastics • Anterior box elastics – 3/16“ 6 oz
  52. 52. Box elastics • Lateral box • Buccal box
  53. 53. • Trapezoid elastics – ¼ “ , 6 oz
  54. 54. • Triangular elastics 1/8 ”, 3 ½ oz
  55. 55. • Cross bite elastics – 3/16 “ , 6 oz
  56. 56. • Finishing elastics – [ UP AND DOWN] ¾ “ , 2 oz
  57. 57. M with tail W with tail
  58. 58. • Head gear elastics • Coil springs ½ “, 140z
  59. 59. Non-Extraction Treatment Photographs Learning Experiences Case Record BORDERLINE CASES Fifty percent of cases Treated Non
  60. 60. Borderline Non extraction • Negative torque on the lower incisors bracket • Negative tip on the lower molar bracket • Flexible D RECT wire initial • Bonding instead of banding • Ability to perform selective interproximal reduction
  61. 61. MAXILLARY ARCH. Bonding and Banding First Wire • Multistrandard spiral round archwire • Retractor Second Wire • 0.016 ss with omega stops. Space closure with power chains. Third final wire • 0.017 x 0.025 ss rectangular
  62. 62. MANDIBULAR ARCH First wire  0.017 x 0.025 multistranded rectangular wire  Slenderizing followed by 0.016 x 0.022 D-Rect  0.016 Ni ti and class III elastics Second wire  0.016 x 0.022 ss with omega Third wire  0.017 x0.025 ss
  63. 63. CLASS II DIV 2  0.0175 Multistranded or Ni ti  0.016 ss wire  Bite blocks  Mandibular arch- Initial round wires - 0.016 x 0.022 ss finishing wires - Invert bracket or zero degree torque DEEP BITE CASES • Bite plate. • Cervical retractor
  64. 64. CLASS III CASES • Start treatment in both arches. • Early use of class III elastics. • Extra oral forces. OPEN BITE • Bracket positioning. • Extra oral forces
  65. 65. Extraction Treatment Indications: 1. Severe mandibular arch length discrepancy. 2. Severe bimaxillary protrusion. •25 percent*
  66. 66. Advantages of delaying treatment in the mandibular arch: 1.Physiologic drifting. ‘DRIFTODONTICS’
  67. 67. 2. No interference for retraction of maxillary canines . 3. Additional time for second molars to erupt.
  68. 68. STANDARD CLASS II DIV 1 MAXILLA Initial wire - 0.0175 Respond multistranded or 0.017” –0.025”D-Rect rectangular braided arch wire Second archwire- Canine retraction. 0.016 ss round with omega stops . 0.016 –0.022ss closing loop arch wire .
  69. 69. Third archwire - • Incisor retraction. • 0.018-0.025 ss closing loop archwire* • Loop activation –1mm per four weeks. • Excellent torque control.
  70. 70. Final finishing arch wire • 0.017-0.025 ss wire.
  71. 71. MANDIBLE: 4 to 6 months of Driftodontics Initial wire Multi-stranded .0175 respond. or 0.016 Ni-ti or 0.017 –0.025 D-rect. Second wire 0.016 ss wire .
  72. 72. Third archwire • 0.016-0.022ss closing loop archwire. Final finishing arch wire • 0.017-0.025 ss archwire.
  73. 73. RETENTION IN VSD Criteria for completion of treatment. 1. Centric relation and Centric occlusion should coincide. 2. ClassI Cuspid relation. 3. Mand intercuspid width. 4. Interincisal angle with proper torque. 5. Normal ant overbite and overjet.
  74. 74. 6. Normal buccal overjet. 7. Levelled upper and lower arches . 8. Rotations eliminated and all Spaces closed 9. Roots parallel near extraction. 10. Good cuspid interdigitation.
  75. 75. COUNT DOWN TO RETENTION 6 WEEKS - Active treatment to Retention. Posterior settling --- Sectioning the arch wire. 1. Mandibular arch wire - Class II deep bite 2. Maxillary arch wire - Class III open bite 3. Both the arches - Class I
  76. 76. Band removal appointment ¾” ,2 oz
  77. 77. Retainer design and fabrication
  78. 78. PRINCIPLES OF THE ALEXANDER DISCIPLINE 1. ‘AS A MAN THINKETH’ JAMES ALLEN EFFORTS = RESULTS
  79. 79. 2. Dr .Hans Selye ‘Altruistic Egoism’ 3. KISS Principle . 4. Plan your work . Accurate Diagnosis and Treatment Planning 5. Goals for stability.
  80. 80. 6.Specific bracket design. 7.Bracket positioning. 8.Face bow for Orthopedic correction . 9.Proven Arch form design and Arch wire force system .
  81. 81. 10.Consolidate arches. 11.Complete bracket engagement. 12.Level the arches. 13.Progressing into finishing archwires .
  82. 82. References • The Alexander Discipline – R.G. “Wick” Alexander • JCO June 1983 • Seminars in Orthodontics – Vol 7 June 2001

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