Tip edge

BY
Dr. GEJO JOHNS B.D.S , M.D.S
1
Dr.GEJO JOHNS

 Introduction
 Historical Perspectives
 Differential tooth movement
 Dynamics of Tip -Edge
 Auxiliaries
 Bonding and setting up
 Stage I
 Setting up stage I
 Stage I checks
 Department studies
 References
2Dr. GEJO JOHNS

 The Tip-Edge (TP Orthodontics Inc ,La Porte Indiana, USA) bracket was invented by
Dr Peter Kesling to introduce differential tooth movement within an edgewise based
bracket system
 Tip-edge combines an initial degree of tooth tipping, which greatly facilitates tooth
movement prior to edgewise precision finishing
3Dr.GEJO JOHNS

 The ‘Edgewise’ bracket, which he invented as long ago as 1925, has been the
main stay of fixed appliance practice ever since
 Angle himself appreciated that tooth movement was facilitated by allowing a
tooth to tip.
 He had no means of subsequent root up righting
 He adopted his well known non-extraction treatment doctrine, to which his
edgewise bracket was best suited.
 Although a large number of his results, as history shows, proved to be unstable
4
Dr.GEJO JOHNS

 Concept of extractions in search of greater stability in crowded or
severe discrepancy cases.
 Dr Raymond Begg was notable in evolving a different bracket system.
 Begg bracket was itself a modification of Angle’s earlier ‘Ribbon arch’
bracket.
 Allowing teeth to tip freely during the initial stages of tooth translation.
 Begg introduce an entirely new sequence of tooth movement , first
tipping the crown into their correct positions before uprightening the
roots
5Dr.GEJO JOHNS

Straight-wire’ bracket system.
This was a direct development of the edgewise design, and
introduced the concept of a preadjusted appliance.
Incorporating in–out adjustments and finishing angulations of tip and
torque into the bracket itself.
Second order beautifying bends” required to achieve correct mesio-
distal root angulations
6
Dr.GEJO JOHNS

Moving teeth apex-first generates maximum anchorage resistance.
Secondly, the control of third order torque is primitive
The torque prescription ‘written in’ to each bracket may not be achieved
in clinical practice, due to the 10 degree of torque slop present when
using .019 x.025 inch arch wire on .022 x .028 inch bracket slot
7Dr.GEJO JOHNS

 The tip edge brackets has been designed to provide
 All the benefits and advantages of differential tooth movement plus
predetermined degree of final crown tip and torque
 The face of the edge wise bracket has been changed to permit free crown
tipping followed by controlled root uprightening
8Dr.GEJO JOHNS

 The modification of the bracket by removing two diagonally opposed corners from the rectangular
arch wire slot
9Dr. GEJO JOHNS

Essentially, differential tooth movement makes the translation of teeth into
their finishing positions so much easier, employing only very light forces.
Reduction of large overjets.
The attainment of Class I buccal segment occlusion is greatly simplified.
Consuming little anchorage, while the correction of overjets and increased
overbites early in treatment.
Shorter overall treatment times
12Dr.GEJO JOHNS

 Tip-Edge is capable of delivering its finishing prescription more
accurately than conventional brackets, without the need of torque
adjustments in the arch wire.
This is because , at the conclusion of treatment , zero tolerance is
achieved between brackets and rectangular arch wire
13Dr.GEJO JOHNS

While it is commonly believed that the superior treatment ability of
Tip-Edge is shown most convincingly in Class II division 1 and
Class II division 2 cases, its flexibility of treatment is appropriate to
all malocclusion types
14Dr.GEJO JOHNS

 The arch wire slot is .022” x .028”
 The geometry of the bracket, in which the mesio-distal width of the tip-limiting
surfaces slightly exceeds the width of the finishing surfaces
 Finishing surfaces therefore extend less than halfway across the face of the bracket,
and are at no point directly opposed
15Dr.GEJO JOHNS

 Lateral extensions (wings) on the bracket provide maximum rotational control even
when the teeth is tipped , therefore the bracket body can be narrowed for maximum
esthetics
 Each bracket has vertical slot to accept rotating or uprightening springs, power pins
 The slot is .020” x .020” square with both the gingival and incisal edge chamfered to
facilitate the insertion of auxiliaries
16Dr.GEJO JOHNS

 Horizontally facing slots facilitates arch wire engagement especially on rotated
teeth.
 Elastomeric ties act as cushion, increases patient comfort and decrease bond
failure.
 In-Out compensations eliminates need of molar offset.
 Better finishing due to three dimensional control
17Dr.GEJO JOHNS

 Malocclusion include teeth that are adversely tipped mesially or distally .
 The engagement of initial straight wire into original edge wise slots in brackets of
these teeth can interfere with retraction , bite opening , patient discomfort and bond
failure and extrusion of adjacent teeth
18Dr.GEJO JOHNS

‘roller coaster’ effect.
Because differential tooth movement
leaves the apex behind crown retraction
carries no vertical consequences ,
19Dr.GEJO JOHNS

 The primary design feature of the “propellers” arch wire is to permit crown tipping in
one direction followed by controlled root uprightening.
 It also provide ease of arch wire engagement
 Propeller arch wire slot permit initial passive engagement of .016” arch wire in slots
on malpositioned teeth , they facilitate (even permit) changing from .016” to
.022”round arch wire during treatment
20Dr.GEJO JOHNS

Arrow on the occlusal
wing indicates the
direction of crown
tipping
Circle indents
designate maxillary
bracket , triangular
mandibular brackets
24Dr.GEJO JOHNS

 Combining the advantages of both straight wire and beggs, Tip-
Edge employs double buccal tubes.
 Comprise of pre-adjusted straight wire rectangular tube of
.022x.028 inches which is convertible and a gingivally placed
round tube of .036 inch internal diameter.
 The rectangular tubes are of Easy-Out design with the posterior
lumen slightly flared occlusal , this facilitates arch-wire removal
when a cinch back has been used
28Dr.GEJO JOHNS

 Tip edge rings are designed to retain the arch wire and prevent mesial or distal
tipping
 Used to hold teeth upright during stage III . Not used during stage I and II
30Dr.GEJO JOHNS

 Elastomeric E-Links modules are used for rotating individual teeth or
closing intra-arch spaces
 They provide gentle, continuous force over long periods of time without
breakage
31Dr. GEJO JOHNS

The Side-Winder
Power Pin
Rotating Spring
32Dr.GEJO JOHNS

 Generates mesio-distal root movement.
 well proven to produce torque correction as well
 014 inch high tensile stainless steel wire
 The Side-Winder was a significant improvement
over the original Beggs type up righting spring,
which carried its coils gingivally
33Dr.GEJO JOHNS

 The side winder has undergone considerable development.
 Original versions were retained in the vertical slot by bending the protruding gingival
tails 90 degree which makes them fiddlesome to remove.
 These invisible side-winders is not strictly invisible but has several advantages
1. Retained in position by elastomeric rings , in addition to its own spring pressure which
enable the modules to be changed if necessary
2. The bulky hook has been eliminated , the spring has wide range of activation
35Dr.GEJO JOHNS

• Side winders come in clockwise and counter- clockwise
formats
• An upper right canine requiring distal root correction will
need a counter-clockwise spring, while uprighting a
lower right canine root distally will require a clockwise
rotation
• Side-Winder springs should always be inserted from the
occlusal and never gingivally
38Dr .GEJO JOHNS

Side-
Winders
should only
be used with
stainless
steel arches
steel
ligature ties
and Side-
Winders do
not mix
39
Dr. GEJO JOHNS

BEGGS TECHNIQUE TIP EDGE TECHNIQUE
Coil -gingivally Coil along side of arch wire over bracket face
Inserted from gingival direction Inserted occlusally
Carries coils along side of bracket face
40
Dr.GEJO JOHNS

•These are traction hooks that
can be fitted in the vertical slot
•Made of soft stainless steel
41Dr.GEJO JOHNS

The commonest instance will be if a ligature or a bracket has detached from a previously rotated
tooth
43Dr. GEJO JOHNS

A. The bracket is wire ligated , crossing the archwire only at the side of contact. B. a counter-clockwise spring is inserted
from gingival C. pointing the arm of the spring directly away from the tooth bend to produce a leg gingivally . D. hooking the
arm around the arch wire will now ‘wind up’the spring and activate a counter clockwise rotation
44
Dr. GEJO JOHNS

Variable
anchorage
Light
forces
Root
uprighting
45Dr. GEJO JOHNS

Striking feature of differential tooth movement ìncludes total
anchorage requirements, and duration of treatment, seem
significantly less than with straight-wire or edgewise systems,
particularly in difficult cases
Controversies still remain
46Dr.GEJO JOHNS

Induce a distal
root force
48Dr.GEJO JOHNS

 It is fundamental to differential tooth movement that all forces should be light.
 Heavier forces, as will be familiar to users of edgewise type appliances, are
unnecessary and likely to be harmful
 Not only will posterior anchorage be strained, but the periodontal ligament could be
put at risk
 Differential tooth movement naturally implies a differential periodontal response
49Dr.GEJO JOHNS

In edgewise and straight-wire appliance correction of
mesio-distal crown tip by engaging the bracket with active
arch-wire provoke extrusion of adjacent teeth
50Dr.GEJO JOHNS

In Tip-Edge recovery is by light and progressive action of
auxiliary springs while vertical arch stability is maintained by
a relatively heavy archwire
51Dr. GEJO JOHNS

 From Rx-1 to the ‘Plus’ bracket
 The bracket face
 Frictional resistance
 Bite opening
 The Plus base
54Dr.GEJO JOHNS

Dr Peter Kesling’s original aim was to make differential tooth movement
possible within an edgewise type bracket face
Single straight-wire bracket minus two diametrically
opposed wedges = Tip-Edge!
Resulted in a bracket that enabled the crown to tip in a
predetermined direction, whereas with an archwire of full vertical
thickness, it would resist tipping in the reverse direction.
55Dr. GEJO JOHNS

 Introduced in 2003
 conventional tie wings
 small circular markers at the disto-gingival tie wings of
the maxillary anterior brackets
 placed triangular markings for the mandibular anteriors
 The opposing central ridges provide vertical control until
final finishing and are also the points at which torque is
imparted
 The laterally extended surface lingual to the main
archwire preserves rotational control throughout the range
of tip permitted by the bracket.
 Broader base also provides for a longer deep tunnel, for
more effective uprighting later in treatment
57Dr.GEJO JOHNS

• During the initial decrowding or overjet reduction the crown will tip distally
into a corrected Class I relationship.
• The amount of distal crown tip will be limited by the tip-limiting surface
59Dr.GEJO JOHNS

• A passive rectangular archwire is fitted and an auxiliary Nickel–titanium archwire is
threaded through the deep tunnels
• Uprighting action of the auxiliary archwire will become self-limited by the approximation of
the finishing surfaces above and below the main archwire
60Dr.GEJO JOHNS

 Each bracket requires an auxiliary in the final stage in order to deliver a three
dimensional root correction
 Innovation of a horizontal ‘deep tunnel’in the bracket base completely eliminates
Side-Winder springs.
 Clinically this is a much easier process and less prone to error, with obvious benefits
to the patient in terms of aesthetics and comfort.
 Plus brackets are metal injection molded.
61Dr. GEJO JOHNS

Special brackets were prepared with labial access ‘deep grooves’ cut deep to the main archwire slot,
into which a nickel–titanium wire could be fitted to power the desired mesio-distal uprighting
62Dr.GEJO JOHNS

 The deep tunnel runs ‘east–west’ through the base and intersects the vertical slot almost
at right angles, describing a plus sign – which is how Plus got its name
Why is it called as TIPEDGE PLUS
63Dr.GEJO JOHNS

 It will induce a second order torque force, ‘untipping’ the root in the appropriate
direction
 when used in conjunction with a rigid rectangular main archwire. All bracketed teeth
will thus be torqued and tipped concurrently, just as they were with Side-Winders
64Dr.GEJO JOHNS

 Since the Tip-Edge appliance is preadjusted, with a torque and tip
prescription incorporated in each attachment
 It follows that it should be set up just like any other straight-wire appliance
72Dr. GEJO JOHNS

 Mid-crown position is therefore recommended
for routine bonding
 Each bracket should be aligned with its vertical
axis parallel with the long axis of the tooth
 Height of the bracket should be at the vertical
mid-point of the fully erupted clinical crown
73Dr. GEJO JOHNS

 Rationale behind a mid-crown bonding position is that the middle point of the crown is
generally the point of greatest convexity on the curvature of the labial surface
 Placing a pretorqued bracket further gingivally will decrease the torque prescription, while
placing it too incisally will increase the torque
75
Dr. GEJO JOHNS

 With Tip-Edge, the use of bonded first molar tubes is contraindicated.
 This is because the withdrawal of the rectangular archwires at the end of
Stage III is likely to cause bond failure. The extra security of molar bands is
therefore recommended
77Dr.GEJO JOHNS

 STAGE I
 STAGE II
 STAGE III
81Dr. GEJO JOHNS

 Alignment of upper and lower anterior segments.
 Closure of anterior spaces.
 Correction of increased overjet or reverse overjet.
 Correction of increased overbite or anterior open bite.
 Work toward buccal segment crossbite correction.
82Dr. GEJO JOHNS

All about the anterior segments, which should be aligned, and any
incisor spacing closed.
Eliminating overjets, reverse overjets, increased overbites or anterior
open bites
.016 inch high tensile stainless steel
Nickel–titanium auxiliary ‘under arches’ are frequently employed
in the initial treatment visit, to assist in the alignment of instanding or
rotated teeth
6-9 months of duration for class II cases
83Dr. GEJO JOHNS

• .016 inch round high tensile stainless steel is the ideal archwire for Stage I, in
both arches
84Dr. GEJO JOHNS

 Correct positioning of the anchor bends should be
approximately 2 mm in front of the molar tubes in both
arches.
 The anchor bends not only boost the anchorage available
from the first molars, but also exert vertical control.
 where there is little or no overbite reduction required, the
bends can be minimal: just enough to prevent the lower
molars tipping mesially.
 Anchor bends should be used in the round molar tubes,
with the premolars omitted from the appliance
85Dr. GEJO JOHNS

 To ‘roll’ circle distally (A), will
 require counter-clockwise rotation. First, unravel the
anterior section the desired amount using a light wire
plier
 (B) before winding up the
 posterior section to restore the horizontal
 (C).Doing it in this sequence
 involves only a single section of wire between the plier
beaks throughout.
86Dr.GEJO JOHNS

• considerable amount of clinical time can be saved by using
preformed archwires
• These are size graded according to the distance in
millimetres between the cuspid circles,
87Dr.GEJO JOHNS

usually of .014 inch diameter, has the task
of aligning instanding anterior teeth, and
can usually be discarded at the first or
second adjustment visit
This sectional auxiliary should extend 3
mm distal to the canine brackets.
88Dr.GEJO JOHNS

 The auxiliary under arch goes in first,
ligated to the instanding or rotated teeth
 With this in place, the tail of the main
arch can be offered to the entrance of
the round molar tube on one side
89Dr.GEJO JOHNS

 invented by Dr
Peter Kesling,
is ideally suited
to Tip-Edge
91
Dr. GEJO JOHNS

 This serves two purposes:
1 .The canines are prevented from unwanted further distal migration, . So
that the anterior segment will not become spaced;
2 The archwire is stabilized laterally, and cannot swing from side to side.
93Dr.GEJO JOHNS

 An incorrect cuspid tie. The
elastic ligature lies beneath the
archwire at the mesial
 The figure-of-eight ‘Swiss Twist
94Dr. GEJO JOHNS

 Elastomeric ‘E-Links’
95Dr. GEJO JOHNS

• Two millimetres of archwire should be left protruding distal to the lower molar tubes to
accept the Class II elastics
• Cinching the lower archwire ends tightly to the gingival is wrong. If the first molar tips
distally due to the anchor bend, it will drag the lower labial segment lingually
97Dr.GEJO JOHNS

 The patient is given two packets of elastics, one to be used for routine
replacement every night before bed time, the other to be carried with them
wherever they go, for instant replacement in the event of loss or breakage
98Dr.GEJO JOHNS

The routine
adjustment
interval
throughout
Stage I is 6
weeks.
Measure
the
overjet.
Observe
the
overbite.
Molar
widths.
Check the
cuspid
circles
Siting of
anchor
bends.
Distal arch
ends.
Reassess
the elastic
tension.
99Dr.GEJO JOHNS

 Tip edge guide and the differential straight arch technique , 2nd edition-
Peter.C. Kesling, DDS
 Tip edge orthodontics and the plus bracket -2nd edition – Richard parkhouse
 Parkhouse RC. Current products and practice: Tip-Edge Plus. Journal of
Orthodontics 2007; 34:59–68.
 Kesling PC. Expanding the horizons of the edgewise arch wire slot.
American Journal of Orthodontics 1988; 94:26–37.
 Kesling PC. Dynamics of the Tip-Edge bracket. American Journal of
Orthodontics 1989; 96:16–28.
 TP orthodontics catalog
102Dr. GEJO JOHNS

Tip edge

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