A treatment method for orthodontic /certified fixed orthodontic courses by Indian dental academy

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Class II Correction
• Headgears/ Class II elastics –Patient Compliance
• Implants becoming popular
• Xtn of First molars – Williams (1976)
• Williams R. Single arch extraction—upper first molars or what to do
when nonextraction treatment fails. Am J Orthod 1979;76:376–393.
• Williams R, Hosila FJ. The effect of different extraction sites upon incisor
retraction. Am J Orthod 1976;69:388–410.

Technique
• 3 stages
– Class II Correction
– Space Closure & Torque

– Detailing & Finishing


Phase 1: Class II Correction


Maxilla
• The second molars are banded -7-mm buccal tubes and palatal

sheaths – palatal bar
– increase anchorage
– correct eventual rotations and transversal malpositions

• Extraction of First Molar – healing period of three weeks
• Low-friction brackets - Begg light wire brackets

• Maxillary premolars not bonded

Beginning of Class II correction


The Archwire
• 0.016-in premium plus pull straightened Australian wire (Wilcock,

Whittlesea, Australia)
• If the maxillary anterior teeth cannot easily be attached to the
archwire, this is completed after space is created by distal

movement of the maxillary canines
• Anchor bends – 5mm mesial of the second molar tubes prevents
mesial tipping of these teeth

• degree of bends depends on the desired amount of bite opening

• canines are fixed with stainless steel high hat lock pins

• occlusal part - partially bent mesially - hook for the
horizontal elastics (5/16 in, 2.6 oz),
• attached - buccal hooks on the maxillary second molar bands
• patient is instructed to replace the elastics only once per
week
• elastics should run inside the anchor bends in the main arch
– prevent irritation to gingiva


If second molars move too quickly
• horizontal elastics - replaced by Class II elastics (5/16 in,
2.6o)


Completion of Class II correction; a Class I
canine and premolar inter-digitation is realized


Phase II : Space Closure & Torque


• modified with offset bends, anchor bends, and vertical

offsets between second molars and second premolars
• Depending on the required bite opening, v-bends between
both premolars and premolars and canines are added
• alignment of the maxillary premolars takes approximately
one month, after which the 0.016-in archwire is replaced by
a 0.018-in premium plus archwire


Individual adjustments
• to correct the relation of maxillary central and lateral

incisors in conjunction with the smile line - form of the
maxillary arch is adapted to the form of the original arch
• An individual two-spur torque auxilliary of 0.014-in regular

wire (Wilcock, Whittlesea, Australia) ending distally of the
maxillary canine brackets is applied
• Aside from the torque effect, this spring has the tendency to

protrude the maxillary anterior teeth.

• adverse effect is eliminated by horizontal traction in the

lateral regions
• If extensive torque is required and rest spaces are small, the
palatal bar between the maxillary second molars is
maintained. In the opposite situation, the bar is temporarily
removed.


Beginning of space closure and torque; the
maxillary premolars are bonded and the
maxillary 0.016-in archwire is adjusted.


• If extensive torque is required and rest spaces are small, the
palatal bar between the maxillary second molars is
maintained
• In the opposite situation, the bar is temporarily removed


A 0.018-in maxillary archwire in combination
with a 0.014-in torquing auxilliary, uprighting
and horizontal tractions; the palatal bar can be
temporarily removed


• The patients are seen at intervals of six to eight weeks

• The closing of the lateral spaces and torque action must be
balanced
• Orthodontists have to observe the progress and decide
about individual adaptations in the use of horizontal
tractions, uprighting springs, and eventual wear of Class II
elastics.


Mandible
• In case of the eventual wear of Class II elastics, the

mandibular archwire shape is expanded to compensate for
lingual tipping of the mandibular molars
• When indicated, individual uprighting springs are placed in
the vertical slots


Phase III : Detailing & Finishing


• In the final phase of treatment, adjustments are made in the

archwires for detailed finishing and the palatal bar is
reinserted when indicated
• Each tooth can be uprighted independently by placement of
springs, taking into account the adverse effects of the
uprighting springs that all point into the same direction and
causing a mesial directed tendency


Space closure, torque, and uprighting are
complete


Retention
• means of fixed retainers

• To prevent vereruption of the mandibular second molars,
local retention wires are bonded buccally between the
mandibular first and second molars
• These sectionals are removed when the maxillary third
molars are in occlusal contact with the mandibular second
molars


The bonded wire between the mandibular first and
second molars is removed after settling in of the
maxillary third molar.


Beginning of treatment


Beginning of Class II correction after extraction
of the maxillary first molars


Beginning of space closure and torque; the
maxillary premolars are bonded, and the
maxillary 0.016-in archwire is adjusted


A 0.018-in maxillary archwire with a 0.014-in
torquing auxilliary


Completion of treatment


Five years post treatment


Discussion


Conclusion
Extraction of maxillary first molars, followed by fixed
appliance treatment with low-friction brackets with thin
round wires and a palatal bar, is an effective and efficient
treatment modality for Class II Division 1 malocclusions,
especially for less compliant patients.


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A treatment method for orthodontic /certified fixed orthodontic courses by Indian dental academy

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