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1. ROTH PHILOSOPHY
INDIAN DENTAL ACADEMY
Leader in continuing dental education
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2. IN MEMORIAM
• Ronald H. Roth, 1933-2005
• Valued the importance of Larry Andrews Straightwire-appliance concepts
• “Roth philosophy”
• Functional diagnosis and correction of malocclusion
to a properly functioning occlusion
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3. • Harmonious functioning of the
Temporomandibular joints
• Earliest users of interactive self-ligation
• Dr Ronald H. Roth died on January 24, 2005. His
passing came quickly from an aggressive form of
cancer
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5. INTRODUCTION
• Ronald H. Roth, [1933-2005] – “ the Roth
Prescription “ – “ Roth Philosophy. “ – chief
contributions by Dr. Roth included an everpresent insistence on the functional diagnosis
and correction of malocclusion to a properly
functioning occlusion with a harmoniously
functioning temporo mandibular joint.
• He was among the first to recognize the value of
Larry Andrews straight wire appliance concepts.
He was among the earliest users of self –
ligation.
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7. ROTH’S APPRAISAL OF
ANDREWS SWA
• In 1968, Dr Roth introduced to Dr Lawrence F
Andrews of San Diego, California who had
developed - STRAIGHT WIRE APPLIANCE
• The Andrews concept was built on his study of a
collection of 120 non-orthodontic normals.
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12. ADVANTAGES OF SWA
•
•
•
•
•
•
EASE OF ARCH WIRE CONSTRUCTION
NO NEED FOR INTER – BRACKET SPAN
EASE OF ARCH WIRE PLACEMENT
LESS ROUND TRIPPING
BETTER CONTROL OF TOOTH POSITIONS
CONSISTENT RESULT
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13. •
•
•
•
PATIENT COMFORT –
EASE OF LIGATION –
BRACKET IDENTIFICATION
EASIER, MORE ACCURATE BRACKET PLACEMENT
All treatment were subjected to Andrew‟s „
“six keys to normal occlusion”
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20. • Dr Roth’s concept of idealized tooth positions to
achieve centric relation closure, mutually
protected occlusion and elimination of excursive
interferences came very close indeed to Dr
Andrew’s concept – thus he incorporated ‘ The
six keys to Normal occlusion with mandible in
gnathologic centric relation ‘.
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21. • The rearmost, uppermost and midmost
relationship of the mandible to the cranium
(after stuart).
• To satisfy both orthodontic and gnathologic
requirements,Dr Roth came up with the –
FUCTIONAL OCCLUSION FOR ORTHODONTIST
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26. Examination
• Manipulation of mandible into clinical CENTRIC
RELATION
• FIRST CENTRIC CONTACT
• TMJ palpation for sounds
• Musculature examined for tenderness
• Inspection of occlusion
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28. • In terms of patient’s reactions to occlusal
interferences, there are three categories of
patients –
1. Those with symptomatology
2. Those that are either psychologically and/or
physically predisposed to developing a problem
3. Those that are neither symptomatic nor
predisposed to developing symptoms
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29. • OCCLUSAL INTERFERENCES TEND TO MAKE
TEETH AND JAWS A FOCUS FOR VENTING
PSYCHOLOGICAL STRESS
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33. THE REPOSITIONING SPLINT
• PURPOSE
Is to enable the operator to find ‘ true ‘ centric
i.e. stable/comfortable.
To test the patient’s response to change in the
occlusion prior to any occlusal therapy
To see if the mandibular centric relation position
can be stabilized
EUGENE DYER popularized the use and called it
a CRANIOMANDIBULAR ORTHOPEDIC APPLIANCE
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34. • USES
Symptomatic patient
Difficult to manipulate the mandible/ not easy
Alleviation of pain – dysfunction symptoms
Allows remodelling of the joints if there have been
some previous degenerative changes
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35. • OBJECTIVE
It is to seat the condyles in the most superior
position possible on every visit, and to adjust the
occlusal surface of the splint to achieve
maximum intercuspation at this position of the
mandible at the most closed vertical dimension
obtainable
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36. • The MANDIBULAR POSTURAL CHANGES during
splint therapy are –
1. Changes due to relaxation of the musculature
that postures the mandible incorrectly due to
muscle contracture or spasms
2. Changes due to elimination of intracapsular
inflammatory fluid
3. Changes due to remodelling or recontouring of
the bony parts of the joints
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37. CONSTRUCTION
1. Accurate stone model.
2. Base trimmed to approximately
5mm at the thinnest point
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38. 3. With model in vacuum former , a 0.080“ clear resin
sheet is heated until it sags approximately ¾"
4. While vacuum is still on, tightly adapt the
resin to the interproximals and occlusal
anatomy of the teeth
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39. 5. With the acetate marking pen, mark the
separation line
6. Acrylic trim bur
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40. 7. With the acrylic trim bur, follow the
separation line cutting through the resin shell
8. Cut under the teeth with the bur. This
allow the teeth to be fractured from the rest
of the model, so that the resin shell can be
separated from the model without fracturing
or distorting the shell
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41. 10. A carbide bur for the
9. Pry with a lab knife to fracture the
model and separate the teeth from the
model base
straight hand - piece is used to
trim the resin and finish the
acrylic used in the fabrication
of the splint.
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42. 11. Trim and smooth the margins
12. No. 2 and/or a No. 4 round bur is used in
the straight hand - piece to remove internal
interferences. An indicator paste such as P. I. P
may be helpful.
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43. 13.
Mix acrylic in a dappen dish
14. Moisten it with monomer
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46. 21.
20
Maintenance of anterior stop
Mandible tapped into CR
Mandible guided into CR
Marking by mandibular cuspids
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47. Mark cuspid excursion by cusp
tips
Grind contact in the posterior
Remove excess acrylic
Posterior clearance seen
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48. Condyles upward and backward
Click observed
3 days on the splint with only
anterior support
Mandibular posterior teeth In
simultaneous
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50. Excursions checked with mylar
marking
Establishment
of
protected occlusion
Resin left over
anterior teeth
mutually
incisal
edges
Completed splint
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of
51. 0.0005” shim in CR
0.0005” shim in
CR
Right lateral excursion
Centric relation, lateral
protrusive excursion
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excursion
and
53. GNATHOLOGICAL PRINCIPLES
• Instrumentation is needed to get the patient’s
neuromuscular mechanism out of the way, so
that we can see how the patient would close and
move if there were no teeth interfering with the
movement pattern that TMJ’s can execute.
• 3D effect of mandibular movement and closure
can be studied and relate the joint – dictated
movement / closure patterns to occlusion.
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55. • OBJECTIVES
To obtain a stable CR of mandible and no actual
contact of the anterior teeth in centric closure
(.0005” clearance)
Harmonious glide path of anterior teeth working
against each other to separate the posterior
teeth immediately, but gently, as soon as the
mandible moves out of centric closure
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57. • The cuspids should be the main gliding includes
on lateral excursion and the 6 maxillary anteriors
teeth should articulate with the 6 mandibular
anterior teeth / the mandibular bicuspids so that
protrusive load is spread over 14 teeth.
• Mutually protective occlusion
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60. IDEAL TOOTH POSITIONING
•
•
•
•
•
PROPER INDIVIDUAL TOOTH POSITIONING
CENTRIC RELATION OF MANDIBLE
COORDINATION OF ARCH FORM AND WIDTH
CONTROL OF VERTICAL DIMENSION
ANTEROPOSTERIOR CORRECTION BETWEEN
MAXILLA AND MANDIBLE
• CLINICAL AWARENESS OF EXCURSIVE
INTERFERENCES
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62. TREATMENT PRIORITIES
1.
2.
3.
4.
5.
6.
7.
8.
Correction of cross bites
Reduction of jaw relationship
Elimination of crowding
Establishment of space for severely malposed
teeth
Space consolidation of the lower arch
Levelling of the curve of spee
Finishing of the lower arch
Establishment of desired molar / buccal
segment relationship
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63. 9. Consolidation of maxillary space / retraction
and / or intrusion of maxillary anteriors
10. Artistic positioning / torque of maxillary
anteriors, to allow them to occupy sufficient
space to encase the lower arch / still maintain
functional overbite
11. Overcorrection of buccal segments, curve o /
spee, rotations and root positions at extraction
sites
12. Final detailing of tooth positions
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64. CONTROL OF VERTICAL
DIMENSION / THE MOLAR
FULCRUM
Avoid extrusion of posterior teeth and increase
excess vertical alveolar growth
MOLAR FULCRUM is the problem in attempting
to treat Orthodontically to centric relation
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65. When the fulcrum has been created, one of two
things occurs:
1. Appearance of an anterior open bite through
the bicuspids - tongue – thrust swallow
2. Clicking of TMJ’s / tightness or stiffness of the
mandibular musculature, usually associated
with pain or discomfort of any combination of
mandibular muscles.
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66. • OVERCORRECTION
Overcorrection of anteroposterior relationship of
arches is done with
Headgear,
Short class II elastics- 3 months
Discontinue for 3-4 weeks
Wires changed to braided rectangular wires
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67. FINISHING IN CR
•
•
•
•
•
Correction of anteroposterior jaw relationships
Elimination of molar fulcrum
Coordination of arch form and width
Levelling of curve of spee
Checking centric deflection
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68. GNATHOLOGICAL TOOTH
POSITIONER
Final seating / finishing of occlusion is obtained
with a GNATHOLOGICAL TOOTH POSITIONER
PURPOSE: is to move the occlusion closer to CR
than it was at the time of debanding. This may
seat the occlusion into CR and retain it there
The positioner is also used to aid in providing a
better anterior guidance and posterior disclusion
upon mandibular movement
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69. • OBJECTIVE
It is to be able to place the appliance over the
patient’s maxillary teeth and hinge the patient’s
mandible on the centric relation arc into the
lower position of the appliance, and have the
teeth seat into the sockets without the necessity
of the mandible moving forward off to the CR
arc
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70. • REQUIREMENTS
Proper treatment
Anatomical articulator
The mounting
The setup
The processing
The material
Construction technique
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78. ROTH PRESCRIPTION
ANDREWS STRAIGHT WIRE APPLIANCE
DISADVANTAGES:
• Heavy forces
• Roller coaster effect
• Anchorage control
• Inventory problem
• Need for reverse curves and compensating
curves
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79. THE ROTH PRESCRIPTION
• ROTH PRESCRIPTION OF THE ANDREWS
APPLIANCE
ANTERIOR BRACKETS, placed more incisally
TRU-ARCH
AUXILLIARY ATTACHMENTS
ADDITIONAL HOOKS
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83. MANDIBULAR PRESCRIPTION
• INCISOR BRACKETS
• CANINES: 7⁰ mesial tip
2⁰ distal rotation
• PREMOLARS / MOLARS: Entire segment
3⁰ distal tip from normal
4⁰ distal rotation
• TORQUE remains normal
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84. ARCH WIRES
Flat - incisors upper/lower
Curve - cuspids and bicuspids
Curve gently towards the distal through the
entire buccal leg
The most prominent point in the front curvature
of the arch is the first bicuspid; the most
prominent and widest point in either arch is at
the mesiobuccal cusps of the first molars
Anterior Guidance
Lee and Lundeen’s work
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86. The amount of overcorrection never expressed
intraorally for the following reasons • There is an angle of deflection between the
bracket slot / arch wire
• The force values drop so low that they are below
the values needed to more the teeth
• The teeth tend to relapse back to their original
positions
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88. APPLIANCE CONFIGURATION
• Brackets welded to special bands
Coined bases / flexible mesh pads
Brazed micromesh
Esthetics and patient comfort
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89. • LATER VERSIONS
‘ L ‘ shaped hooks were made by blocking out
part of the molds when making the plastic
patterns for attachment of elastics
TWIN BRACKETS
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91. TREATMENT TIME
•
ADVANTAGES
Decrease in treatment time
Better tooth positioning
The performed arch wires allows full bracket
engagement / expression efficiently and gently
as in case of 0.0215" x 0.028“ sentinol wire
Heavy steel wires- 0.021” x .O25” Level slot line up
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92. • Heavy steel wires placed without using pliers
because by the time the teeth are well enough
aligned to place such a large wire, the bracket
slots are aligned in both height and torque with
automatic in/out – ‘LEVEL SLOT LINEUP’ – allows
the use of heavy wires without having to resort
to heavy forces
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93. CONCLUSION
• 30 Years-MBT introduced in 1972
• Appliances do not achieve ideal tooth positions INACCURATE BRACKET PLACEMENT
VARIATIONS IN TOOTH STRUCTURE
ANCHORAGE REQUIREMENTS
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94. REFERENCES
• Roth,RH.: Five Year Clinical evaluation of
Andrews Sraight wire
appliance,J.clin.orthod.10:836-850,1976.
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95. Thank you
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