Bioprogressive therapy /certified fixed orthodontic courses by Indian dental academy

www.indiandentalacademy.com
INDIAN DENTAL ACADEMY
Leader in continuing dental education

Contents
• Introduction.
• Principles of Bioprogressive therapy.
• Visual treatment objective.
• Phasing and staging.
• Orthopedics in Bioprogressive therapy.
• Forces used in Bioprogressive therapy.
• Sectional and utility arches.
• Synopsis of extraction and non-extraction treatment
mechanics.
• Development of Bioprogressive therapy.
• Conclusion www.indiandentalacademy.com

Bioprogressive therapy is not strictly an
orthodontic technique but, more importantly, it
encompasses a total orthodontic philosophy.
Bioprogressive therapy accepts as its mission
the treatment of the total face rather than the
narrower objective of the teeth or occlusion.
Dr. Robert Murray Ricketts was the man
responsible for the development of this
approach to orthodontic care.

Bioprogressive therapy takes advantage of
biological progressions including growth,
development and function, and directs them in a
fashion that normalizes function and enhances
esthetic effect.

During its genesis, more than 100 verified and
corroborated principles were formulated in
support of the Bioprogressive therapy. These
principles were divided into the following four
“sciences”:
1. Social – this group of principles covers
aspects of sociology, patient motivation,
psychology, patient management and
aesthetics.
2. Biological – risk factors and relapse fall within
this domain.

3. Clinical – any record taken, any measurement
recorded and any value judgement decision
made on a living patient falls within the clinical
area.
4. Mechanical - myofunctional therapy, behavioral
modification or awareness training an
correction of nasal and oral functions are all
components of the Bioprogressive technique.

Principles of Bioprogressive
Therapy

#1 The use of a systems approach to
diagnosis and treatment by the
application of the visual treatment
objective in planning treatment,
evaluating anchorage and
monitoring results.
A planned systematic approach is followed in
constructing a cephalometric setup in order to
anticipate those changes expected in an
individual patient. For this, an understanding of
the present condition, the expected growth and
the specific effect of the orthodontic-orthopaedic
is essential. www.indiandentalacademy.com

#2 Torque control throughout
treatment.
Bioprogressive therapy suggests that
movement of teeth can be more efficient and
various treatment procedures more effectively
carried out when control of the direction of root
movements is available.
Four treatment situations where torque control
of root movement is necessary:
1. Keep roots in vascular trabecular bone – for
efficient movement. During tooth movements
such as incisor intrusion or cuspid retraction,
torque control allows steering the roots away
from the denser, thicker cortical bone, and
through the less dense vascular trabecular

The lower incisors are supported by the lingual cortical
bone and require buccal root torque for their efficient
intrusion through the trabecular bone.

2. Place roots against dense cortical bone - for
anchorage.
3. Torque to remodel cortical bone - certain tooth
movements often require that the roots be
moved into dense, less vascular cortical bone
structure. Such movements include incisor
retraction, upper incisor root torquing, impacted
upper canine and forward movement of lower
molars to close spaces created by missing or
extracted teeth.
4. Torque used to position teeth in final occlusion
details - for proper function and better stability.

The lower molars are anchored by expanding their roots
into the more dense cortical bone.

#3 Muscular and cortical bone
anchorage.
Muscular anchorage
Stabilizing the teeth against the horizontal movements
and vertical (extrusive) forces produced by a cervical
headgear to the upper molars, as well as the effect of
Class II elastics on lower molars is countered by the
posterior muscles of mastication, mainly the masseter
and temporalis.
Brachyfacial types, characterized by deep bites and
low mandibular planes exhibit stronger musculature, and
are better able to overcome the adverse orthodontic
treatment forces that tend to open the bite and rotate the
mandible, when compared to their dolicofacialwww.indiandentalacademy.com

Cortical bone anchorage
The cortical bone is dense and laminated,
with a very limited blood supply. Due to this,
tooth movement through this bone is slower.
Bioprogressive therapy advocates the
application of excessive force against the
cortical bone to press out the blood supply and
further limit the tooth movement through this
bone, thus increasing the anchorage potential.

• Lower molar anchorage is enhanced by
expanding the molar roots into the cortical bone
on their buccal surface. Excessive buccal root
torque and expansion is placed in the archwires
for this.
• The upper molar is adjacent to the zygomatic
ridge, the maxillary sinus and the cortical bone
shelves of the alveolar process. The heavy
forces of the orthopedic headgear expand the
roots into the cortical bone. For this, the inner
bow of the headgear is expanded 5-10mm.
before placement.

#4 Movement of any tooth in any
direction with the proper application
of pressure.
• The key factor to the rate at which tooth
movement occurs is the blood supply to the
bone. Thus, forces that effect the blood supply
and cellular physiology determine the tooth
movement. Heavy forces cause ischemia of the
blood supply to an area, thereby decreasing
tooth movement.
• Density of supportive bone also influences rate
of tooth movement – movement through the
dense, less vascular cortical bone requires even
lighter forces to ensure a continuous blood
supply. www.indiandentalacademy.com

• The most efficient force for tooth movement is
based upon the size of the root surface of the
tooth to be moved, called the enface root
surface or the portion of the root that is in the
direction of movement.
• Bioprogressive therapy suggests that 100gms.
of force per square centimeter of enface
root surface is optimum for efficient tooth
movement.

#5 Orthopedic alteration.
Bioprogressive therapy subscribes to,
anticipates and plans for orthopedic change as
part of its treatment procedures. This changes
the relationship of the basic supporting jaw
structure, in contrast to localized tooth
movement in the alveolar process.
Use of headgears to alter the position of
maxilla and lateral forces for separating and
widening the mid-palatal suture are examples of
the orthopedic alterations achieved.

#6 Treat the overbite before the overjet.
• Incisor overbite can be corrected by two
methods:
1. Extrusion of posterior teeth – increases lower
facial height by mandibular rotation.
2. Intrusion of upper or lower incisor teeth – little
or no rotation.
• Vertical facial patterns respond best to
extrusion of posterior teeth for overbite
correction. However, this further increases the
already excessive lower anterior face height,
thus compounding lip strain.www.indiandentalacademy.com

• On the other hand, the short anterior vertical
facial height type with low mandibular plane
would benefit best from molar extrusion, but their
strong musculature resists this type of
movement.
• Due to these considerations, incisor intrusion is
considered the treatment of choice for overbite
correction.

• By treating the incisor overbite before the
overjet, incisor interference is avoided and the
posterior teeth remain in their normal stable
vertical occlusion established by the
musculature.
• Incisor intrusion is achieved using a spanning
arch called a utility arch.

#7 Sectional arch treatment.
This is a basic treatment procedure of
Bioprogressive therapy in which the arches are
broken into sections or segments in order that
the application of force in direction and amount
will be of more benefit in the efficient
movements of the teeth.

Benefits of the sectional arch treatment:
1. It allows lighter continuous forces to be
directed to the individual teeth.
2. More effective root control in the basic tooth
movements.
3. It supplements maxillary orthopedic alteration.
4. It reduces the binding and friction of the
brackets as they slide along the archwire.

#8 Concept of overtreatment.
In order to help overcome the tendency for
relapse, provisions for the post-treatment
rebound as well as post-treatment growth
changes need to be appreciated and planned
for.

Four areas where overtreatment may help
compensate for the anticipated post-treatment
adjustments:
1. To overcome muscular forces against the tooth
surfaces – the muscular influences of the
tongue, lips and cheeks against the surfaces of
the teeth require overtreatment to compensate
for the post-treatment changes, resulting due
to the continued influence of these muscles as
they adapt to the new occlusion.
2. Root movements needed for stability –
overtreatment may be necessary in cases
involving correction of incisor deep overbite by
intrusion and torquing, paralleling of roots of
teeth adjacent to extraction sites and de-
rotation of severely rotated teeth.www.indiandentalacademy.com

3. To overcome orthopedic rebound –
overtreatment is done in anticipation of the
rebound of the orthopedic changes, when the
heavy restrictive forces involved in these
movements are lessened or eliminated.
4. To allow settling in retention – overtreatment of
the individual teeth within the arches allows
them to “settle” into a functioning occlusion.

#9 Unlocking the malocclusion in a
progressive sequence of treatment in
order to establish or restore more
normal function.
Bioprogressive therapy suggests that many
malocclusions are a result of abnormal function.
The present malocclusion, while stable under
the present abnormal function, may never have
had the opportunity for normal development.

Abnormal function
Abnormal development

Bioprogressive therapy proposes treatment
sequences that progressively unlock the
malocclusion in order to restore or establish a
more normal environment that will allow a more
normal function to occur.

#10 Efficiency in treatment with
quality results utilizing a concept of
pre-fabrication of appliances.
Bioprogressive therapy uses appliances ready-
made for clinical application. This allows the
clinician to direct his energy in the details of their
application, rather than their construction.

Visual Treatment Objective
Visual treatment objective (VTO) is a visual
plan to forecast the normal growth of the patient
and the anticipated influences of treatment, to
establish the individual objectives that are
desired for that patient.

Advantages of the visual treatment objective:
• Permits the development of alternative
treatment plans.
• It serves as a visual goal against which
treatment progress can be measured and
monitored.
• Permits the orthodontist to set his goals in
advance and compare them with the results at
the end of treatment. Identification of the
discrepancies between goals and results provide
him with an idea of the areas in which his
treatment could be improved.www.indiandentalacademy.com

Phasing and Staging in
Bioprogressive Therapy

• PHASING
The timing of orthodontic treatment is termed
phasing.
It can be divided into four types according to when
it is begun in relationship to one of four stages in
dental development.

Preventive (3 – 6 years)
Interceptive (7 – 10 years)
Corrective (11 – 13 years ♀)
Rehabilitative (11 – 13 years ♂)
Bioprogressive Straight wire
Four phases in dental development

• STAGING
A significant difference between traditional
and Bioprogressive orthodontic techniques deals
with not when to, but how to start treatment.
Bioprogressive therapy aims first at
accomplishing orthopedic correction, controlled
arch length increase and deep bite correction by
anterior tooth intrusion.
This treatment order, also called staging,
establishes order and increases treatment
efficiency.

Stages and steps involved in the Bioprogressive
treatment sequence
Stage Steps
Commencement 1. Awareness training
2. Early treatment
3. Intra-arch correction
Continuation 4. Inter-arch correction
Consolidation 5. Integration and torquing
6. Idealization and coordination
Completion 7. Finishing and overtreatment
8. retention and stabilization

Orthopedics in Bioprogressive
Therapy

By definition, orthopedics implies any
manipulation that alters the skeletal system and
associated motor organs.
In the growing child, orthopedic alteration
would be any manipulation which would change
the normal growth of the dentofacial complex in
either direction or amount.

• Orthopedic alteration is a major tenet of
Bioprogressive therapy.
• Prior to the defined orthodontic movements to
create the ideal occlusion, an acceptable
symmetry between the upper and lower jaws is
needed to allow the ultimate framework upon
which an esthetic, functional and stable
occlusion can be built.
• This is achieved through the use of cervical or
combination headgear.

Generalized orthopedic response
with cervical headgear.
When a vector of force is
applied below the center of
resistance of the maxilla
(located near the apex of the
pterygomaxillary fissure), a
rotational orthopedic effect
is seen in the maxilla. The
maxillary complex rotates in
a clockwise direction and all
points on the maxilla appear
to arc in a concentric
fashion.

• This maxillary rotation results in:
- reduction in maxillary protrusion.
- downward canting of the palatal plane.
- the nasal bone pivots downward and backward
at the frontonasal suture.

• The mandible shows a variable orthopedic
response.
• In weak muscular growth patterns, i.e.
dolicofacial patterns, the extrusion of both the
maxillary molar and maxilla causes:
- a reciprocal clockwise rotation of the mandible.
- opening of the facial axis and mandibular plane.
- a diminishing effect on forward chin posture.

• In normal and strong muscular growth patterns,
i.e. brachyfacial patterns, mild mandibular
rotation may occur, but the amount of maxillary
response compensates for this mandibular
rotation by 3 to 4 times.

• The net effect is that:
- In weak muscular growth patterns, the extrusive
effects of cervical headgear of cervical headgear
result in a negative response in the mandible
(i.e. orthopedic in nature).
- In strong muscular growth patterns, the extrusive
forces of cervical headgear are seen as
responses in the dentition (i.e. orthodontic in
nature).

Generalized orthodontic response
with cervical headgear.
• The downward and backward force of the
cervical headgear intermittently extrudes the
upper molars and carries them distally.
• The upper incisors tip lingually from the apex.
This occurs when the overjet has been reduced
enough for the lower lip to close over the upper
incisors, causing a functional retraction of these
teeth.

• The lower molars upright and move distally, as
they are carried by the incline planes of the
upper molars.
• The lower incisors tip labially as they are free of
the restrictive effect of the lower lip. The tongue
starts to dominate the labial positioning of these
teeth.

The Reverse Response
• When a cervical headgear is combined with a
lower utility arch, the maxilla shows the classical
orthopedic response.
• However, the mandible shows a response
different from the usual:
- The mandibular plane and facial axis are
stabilized in normal and dolicofacial types.
- In brachyfacial types, the mandible rotates in a
counterclockwise direction, resulting in closure of
lower face height, mandibular plane and facial
axis. www.indiandentalacademy.com

When the upper molar is extruded and distalized intermittently,
its inclined planes upright and distalize the lower molar. This is
accentuated by the tipback in the utility arch and the labial root
torque at the lower incisor. The vertical pull of the masseter and
pterygoid muscles stabilizes lower molar eruption and limits
upper molar eruption.
The net result is a limited eruption/intrusion of the lower molar
and a distal movement of the lower incisor, with concomitant
changes in the occlusal plane.

Soft tissue esthetic changes.
With normal growth, the
soft tissue nose grows
concentrically approx.
1mm. per year at the tip.
Following headgear
therapy, the nose crosses
over at the bridge,
lengthens vertically and
the upward cant to the
nares is tipped down to a
more horizontal position.

Forces used in
Bioprogressive Therapy

• Bioprogressive therapy suggests that an applied
force of 100gms. per square centimeter of
enface or exposed root surface area is optimum
for tooth movement.
• When an archwire is ligated across short spans,
very high forces can result that are much above
the optimum levels.
Loop design for force controlLoop design for force control

• In order to lessen the applied force, the concept
of long lever arm is applied. By placing more
wire between the teeth the applied force is
lowered and the length of time of activation is
increased.
• For this purpose, Bioprogressive mechanics
incorporate more wire in its loop design, thus
producing lighter forces that are more
continuous in their action.

Simple loop designs incorporate more wire between
teeth and reduce the amount of force applied.

Compound loop designs use combination of simple
loops and add additional wire to further reduce the
amount of force, while making it more continuous.
Also, these loops can be compressed during
activation.

Concept of cortical bone anchorageConcept of cortical bone anchorage
• The concept of cortical bone anchorage implies
that, to anchor a tooth, its roots are placed near
the dense cortical bone under a heavy force that
will further squeeze out the already limited blood
supply and restrict the physiologic bone
remodeling in this area.
• On the other hand, in order to move a tooth, a
route should be followed through the less dense
trabecular bone where under a light force a
generous blood supply can be maintained that
will produce the physiologic osteoclastic reaction
of bone resorption needed for movement.www.indiandentalacademy.com

Teeth in the mandible.
The mandible has cortical bone support
running along its length. The cortical bone
structure forms around its tubular shape and
extends to the alveolar, coronoid and condylar
processes.

Lower incisors –
Cuspids – First
Bicuspids.
• These teeth are
supported on the
lingual by the cortical
bone of the planum
alveolar.

• During lower incisor intrusion, their roots should be
moved buccally, away from the lingual cortical
plate. For this, a utility arch, applying a buccal root
torque of 15° - 20° is used. This applies a force of
80 grams on the incisors (round leveling wires
apply 300 grams of force and tip the incisor roots
into the cortical bone).
• During lower incisor retraction, the incisor roots
should be moved through the cortical bone using
even lighter, more continuous forces. This alows
for remodeling of the bone.

• During lower cuspid
retraction also, the
roots must be moved
through the trough of
trabecular bone.

Lower 2nd
Bicuspids
and Molars.
• These teeth are
supported by the
cortical bone on their
buccal surface.
• Lower molars are
anchored by
expanding and
torquing their roots
buccally into the
buccal cortical bone.www.indiandentalacademy.com

Teeth in the maxilla.
• The nasal, orbital, oral and sinus cavities of the
maxilla are lined with cortical bone that gives
them support.
• The roots of the maxillary teeth lie adjacent to
these cavities and are influenced by the cortical
bone lining them.
• The maxillary teeth are supported within the
alveolar process with cortical bone on the palatal
surface as well as along the facial surface.

The maxilla supports four cavities – orbital, nasal, oral and
sinus cavities. The cortical bone support in the maxilla
surrounds these cavities as well as the alveolar process
containing the teeth.

Maxillary Incisors.
• These are intruded along their long axis into the
broadest area of the alveolar process.
• Utility arch mechanics for intrusion first
advances the crowns and locates the root tip
way from the interference of the labial cortical
bone.

Maxillary Cuspids.
• These should be moved around the corner
during their alignment and retraction, and their
movement should be contained within the trough
of trabecular bone.
• Excessive tipping can expose the root tip
through the buccal cortical bone, thus making
uprighting and torquing alignment extremely
difficult.

Maxillary Bicuspids and Molars.
• The bicuspids are supported in the alveolar
process between the buccal and lingual cortical
plates.
• The roots of the 2nd
bicuspids and molars are
often involved with the cortical bone lining the
floor of the maxillary sinus. Thus, intrusion of
these teeth should be done using light and
continuous forces.

• The roots of the maxillary molars are anchored
by expanding and rotating them into the buccal
cortical bone.
• Headgear therapy that applies heavy forces
(>500gms), expands the molars into the cortical
bone where they become “anchored”.

Muscular Anchorage.Muscular Anchorage.
• In cases where the musculature is strong as
characterized by deep bite, low mandibular
plane, brachyfacial type, the teeth demonstrate
a “natural anchorage”.
• In the open bite, vertical dolicofacial patterns,
the musculature is weaker and less able to
overcome the molar-extruding and bite-opening
effect of treatment mechanics. Thus, anchorage
enhancement is required in these cases.

• To summarize, for efficient tooth movement,
Bioprogressive therapy suggests consideration
of the following:
1. Size of root surface involved.
2. Amount of force applied.
3. Cortical bone support.
4. Muscular support – reflected by the facial type.

The Utility and Sectional
Arches in Bioprogressive
therapy mechanics

Historical perspective
• Contemporary edgewise orthodontic approaches
assume that the most efficient method of
effecting rotations and leveling the deep curve of
Spee in the initial phase of treatment is through
the use of a series of light, continuous round
arches.
• However, the use of these arches results in
some detrimental responses, to counteract
which several distinct moves have been
developed.

• Dental reactions to
continuous round wire
with reverse curve of
Spee.
with reverse curve of
Spee and tieback.
with Class III elastics and
hi-pull facebow.

• Late in the 1950’s, Robert Ricketts and others
attempted to counteract the tipping that occurred
in the buccal segments in extraction cases by
utilizing the lower incisors as an anchor unit to
hold the lower second premolars and molars
upright in the retraction process.
• Round arch segments were laced from the lower
molars and premolars to the lower incisors as
the canines were retracted.

• They noted that not only were the buccal
segments maintained in an upright position, but
the lower incisors intruded with this light,
continuous pressure.
• This led to the development of what is now
classically described as the step-down base
arch, or Ricketts’ Lower Utility Arch.

Roles and Functions of the lower
utility arch.
I. Position of the lower molar to allow for
cortical bone anchorage.
Following uprighting of the lower first molars,
the mesial root of the lower molar should be
palpable in its ideal axial inclination following
utility arch therapy.

Support of dense cortical bone and its normal
relationship to lower buccal segment teeth.

II. Manipulation and alignment of the lower
incisors segment.
When treated as a segment, the four lower
inisors are manipulated from the lower molar
to align and either hold, intrude or extrude
these teeth in the initial phases of therapy.
Also, by altering the design of the lower utility
arch, the lower incisors can be advanced or
retracted without disturbing or depending
upon the canines and premolars.

III. Stabilization of the lower arch, allowing
segmental treatment of the buccal segments.
Following early maintenance of anchorage at the
molars and proper positioning of the lower
incisors, separate rotations and leveling can
occur in the buccal segment teeth – especially
the canines – without disturbing the idealized
location of the other segments.

IV. Physiological roles of the lower utility arch.
Intrusion of the lower incisor segment results tin
disclusion in the anterior segment. This leads to:
• Prevention of interferences that commonly
retard the easy movement of the dentition.
• Loss of proprioception in the incisor region. The
mandible reacts to this by reaching forward to
search out proprioceptive output. This
“activator” or “reaching” effect allows a
muscular response that can be benefial in
correction of Class II malocclusion.
• Creates space for the maxilla which is moving
downward and backward, under the influence of
headgear therapy. This helps to close the
overjet. www.indiandentalacademy.com

V. Overtreatment.
By treating the incisors and buccal segments as
separate entities, it is possible to treat the
overbite (by intrusion of upper and lower
incisors) at the same time that the buccal
segment teeth are being corrected.
Thus, it is not necessary to tie the overbite
control to the overjet control.

VI. Role in mixed dentition.
The utility arch allows incisor alignment and
molar control during the transient dentition by
stepping around the deciduous buccal occlusion.
Thus, arches can be leveled out without
depending upon extrusion of the buccal segment
teeth.

VII. Arch length control.
The lower utility arch serves as a determinant of
arch length maintained, gained or lost by:
1. Uprighting the lower molar.
2. Advancement of the lower incisors.
3. Expansion in the buccal sement teeth.
4. Saving “E” space.

I.) 30° to 45° tip-back applied to the lower molars.
A tip-back applied to the lower molars uprights
these teeth by bringing their roots mesially
and the crown distally.
In extraction cases where there is both a mesial
and uprighting component of force a distal
rotation must be placed to avoid mesial
rotation of the molars.
However in non-extraction, cases a distal rotation
applied to the lower molar causes an over-
rotation of these teeth.www.indiandentalacademy.com

II.) 30° to 45° buccal root torque applied to the
lower molar.
Both for enhancing the cortical bone support to the
lower molar and for regulating normal arch
width, the distal legs of the utility arch can be
expanded prior to placement in the mouth.
III.) Long lever arm applied to the lower incisors.
If there is 0° torque at the lower incisors when a
long lever arm works at the lower molars, then
as the arch intrudes, there is a slow progressive
change to place a lingual root torque.

IV.) 75 grams of intrusive force applied to the lower
incisors.
The mandibular utility arch is best fabricated from
0.016x0.016 Blue Elgiloy wire in order to create
a lever system that will deliver a continuous
force to the lower incisors in the range of 50 to
75 grams.

Synopsis of extraction and
non-extraction treatment

• Extraction therapy can be divided into five
phases, each designed to achieve a specific
goal.
I. Initiation.
- The utility arch is not used to align the lower
incisors, but instead to open the bite during
initial cuspid retraction and control torque in
the incisor and molar regions.
- Lower arch anchorage is increased by engaging
the lower second molars in the arch early in
treatment.
Extraction treatment using Bioprogressive
mechanics

- In the upper arch, anchorage is gained by one
or more of four methods:
1. Use of transpalatal bar.
2. Use of headgear.
3. Use of upper utility arch.
4. Engaging the upper second molars in the arch
using an overlay wire.

II. Cuspid Retraction and Uprighting.
- Retraction across the first one-third of the
extraction sites can be started with Class I
elastics from lower molar to lower cuspid
with no archwire other than the lower utility
arch. The remaining two-thirds of the
extraction site is closed with rigid overlay
wires.
- Cuspid retraction with a sectional arch is
more feasible in the upper arch.

III. Transition and Final Cuspid Space Closure.
Transition arches made of flexible edgewise wires
(Ni-Ti, TMA) are used to complete the cuspid
retraction.
IV. Consolidation.
A heat-treated .016" x .016" helical continuous
closing arch is used to retract the incisors.

V. Idealization.
After consolidation of the incisors, rigid
edgewise ideal coordinated arches are placed to
achieve ideal interarch symmetry, to allow the
pretorqued and preangulated brackets to
express themselves completely, and to complete
buccal segment overcorrection.

Non-extraction treatment using Bioprogressive
mechanics
There are four stages of non-extraction therapy,
and within each stage certain archwires are
selected to achieve objectives.
I. Initiation
• Orthopedic appliances (headgear, bionator,
etc.) are used when indicated.

• Base or utility arches are placed to set up
anchorage, gain or reduce arch length, and
open the bite— beginning in the lower arch in
Class II, division 1 and in the upper arch in Class
II, division 2.
• Overlay wires level and align the buccal
segments and begin to create complete arch
integrity.

II. Transition.
• After leveling and alignment of the upper and
lower arches, there are usually small rotation,
space, and leveling problems that must be
resolved before placing a stiff stainless steel
edgewise arch.
• Transition arches are typically resilient
edgewise wires that continue the leveling
process, but also begin to define arch form and
characteristics of the idealization stage.

III. Traction.
• The lower arch is set up with sufficient
anchorage to allow placement of Class II
elastics, which are used in most cases to treat or
overcorrect the buccal segments.
• Before elastics are worn, upper buccal segments
are leveled and aligned with sectional arches.
• Traction sections are placed in the upper arch to
allow for segmental correction with Class II
elastics.

IV. Idealization.
• These are the final arches used to achieve arch
coordination and ideal orthodontic occlusion.
The smallest possible edgewise wires are used.
• Light round wires may be used at the end of
treatment to help seat the occlusion.

Development of Bioprogressive
Therapy

Ricketts’ Bioprogressive technique was
developed from a background of Angle’s
edgewise technique, as well as incorporating
some advantageous characteristics of Begg’s
inverse ribbon arch technique. But, in addition,
several new features were combined to make it
a flexible, full-control technique in which very
light to very heavy forces could be applied on
selection by the operator.
This made it the most versatile and appealing
technique to be devised for clinical orthodontics.

Standard Bioprogressive Appliance
• Used since 1962.
• “Second-order” movement was built in by
angulating the bracket.
- All four canines, lower molar tubes and brackets
angulated at 5°.
- Maxillary lateral incisor brackets were angulated
at 8°.
- Brackets for all other teeth were given no
angulation (0°).
• Lingual root torque was built into the brackets
of upper central incisors (22°), upper laterals
(14°) and all canines (7°).

Angulation values in Ricketts’ StandardAngulation values in Ricketts’ Standard
BioprogressiveBioprogressive

Lingual root torque:
22° in upper central
incisors
14° in upper lateral
incisors
7° in cuspids

22° torque in upper central
incisors
7° torque in canines

Ricketts’ Standard Bioprogressive

Full Torque Bioprogressive Appliance
• In this, additional torque was added to the
Standard Bioprogressive appliance, by placing
torque in the lower second premolars (14°) and
the lower first and second molars (22°).
• A 12° rotation was added to the tube and
brackets on the lower first molar.

12° rotation in lower
molar tube
22° torque in lower
second premolar and
molars www.indiandentalacademy.com

Ricketts’ Full Torque Bioprogressive

Triple – Control Bioprogressive
The Triple-Control
Bioprogressive appliance now
combines the offset first-order
bends with the second-order tip,
and the third-order torque, to
present the complete “triple-
control” needed to place the
teeth in all three planes of
space to accomplish the
necessary movements to reach
the objective of the overtreated
orthodontic occlusion.

Features of the Triple-Control appliance.
• Raised brackets were placed on certain teeth in
order to step these teeth inward or to set the
adjacent teeth outward.
• Triple tubes were designed for rotation on the
upper molar (15°).
• Breakaway convertible lower molar tubes were
designed that made it easier to band the lower
second molar and convert the occlusal molar
tube to a bracket.

Breakaway convertible
molar tube
Second molar tube with 32°
torque, 6° rotation & 5°
angulation
Occlusal offset in upper
second molar tube

• A lower second molar tube was developed with
32° torque, 6° rotation and 5° angulation.
• An upper second molar band and tube were
designed. The upper rectangular tube was to be
placed 1.75mm. below the level of the first molar
tube. This allowed the upper molar to be
positioned with the non-bent wire.
• Penta-Morphic Arches - five arch forms were
identified, which were to be selected for
individual patients by technical methods.

Penta-Morphic Archeswww.indiandentalacademy.com

Ricketts’ Triple – Control Bioprogressive

Zero Base Bioprogressive
Developed by Gugino, the Zero Base logic
system adds an organizational capability to the
Bioprogressive philosophy.
Under this system, treatment planning is
based on the degree of difficulty of each of a
series of diagnostic elements. This aproach
results in treatment plans that are individualized
according to the specific needs of each patient.www.indiandentalacademy.com

The term zero base originated from the bell-
shaped statistical curve of distribution of a
sample of normal data.
• The peak of the bell-shaped curve represents
the neutral position or zero base.
• Those patients with less deviant, or mesofacial
morphology represent the middle two-thirds of
the population.
• The further a given patient deviates from the
zero base of facial type, the more difficult
the treatment is likely to become.

A representation of a normal distribution, bell-
shaped curve. www.indiandentalacademy.com

Zero Base Diagnosis

The 10 mechanical principles of the Zero Base
Bioprogressive philosophy

Conclusion
The Bioprogressive philosophy, embracing
early treatment, was developed for greater
efficiency in orthodontic treatment.
The ultimate objectives of this philosophy are
to work in harmony with growth, to achieve
permenent orthopedic changes, and to set the
stage for lifelong enjoyment, in every sense of
one of nature’s miracles – the natural dentition.

References
1. Ricketts RM. Bioprogressive therapy as an
answer to orthodontic needs – part I. Am J
Orthod. 1976; 70: 241-268.
2. Ricketts RM. Bioprogressive therapy as an
answer to orthodontic needs – part II. Am J
Orthod. 1976; 70: 359-397.
3. Ricketts RM, Bench RW, Gugino CF, Hilgers
JJ, Schulhof RJ. Bioprogressive therapy.
Rocky Mountain Orthodontics, 1980.

4. Ricketts RM. A principle of arcial growth of the
mandible. Angle Orthod. 1972; 42: 368-386.
5. Hilgers JJ. Sep(618 - 627): Bioprogressive
simplified Part 1- Diagnosis and treatment
planning. J Clin Orthod. 1987; 9: 618-627.
6. Hilgers JJ. Bioprogressive simplified - Part 3 -
Nonextraction therapy. J Clin Orthod. 1987; 11:
794-804.
7. Hilgers JJ. Bioprogressive simplified - Part 4 -
Extraction therapy. J Clin Orthod. 1987; 12: 857-
890.

8. Bench RW, Gugino CF, Hilgers JJ.
Bioprogressive therapy Part 2: Principles of the
Bioprogressive therapy. J Clin Orthod. 1977; 11:
661-682.
Bioprogressive therapy Part 3: Visual treatment
objective or VTO. J Clin Orthod. 1977; 11: 744-
763.
Bioprogressive therapy Part 4: the use of
superimposition areas to establish treatment
design. J Clin Orthod. 1977; 11: 820-838.

11. Ricketts RM. The wisdom of the
Bioprogressive philosophy. Semin Orthod 1998;
4: 201-209.
12. Sellke TA. Zero Base Bioprogressive:
Unlocking the door to the future. Semin Orthod
1998; 4: 210-218.
13. Ricketts RM. The influence of orthodontic
treatment on facial growth and development.
Angle Orthod. 1960; 30: 103-131.

14. Ricketts RM. Esthetics, environment and the
law of lip relation. Am J Orthod. 1968; 54:272-
289.
15. Pavlick CT. Cervical headgear usage and the
Bioprogressive prthodontic philosophy. Semin
Orthod. 1998; 4: 219-230.
16. Gugino CF, Dus I. Unlocking orthodontic
malocclusion: an interplay between form and
function. Semin Orthod. 1998; 4: 246-257.

Thank you
For more details please visit

Bioprogressive therapy /certified fixed orthodontic courses by Indian dental academy

Recomendados

Recomendados

Mais conteúdo relacionado

Mais procurados

Mais procurados (20)

Semelhante a Bioprogressive therapy /certified fixed orthodontic courses by Indian dental academy

Semelhante a Bioprogressive therapy /certified fixed orthodontic courses by Indian dental academy (20)

Mais de Indian dental academy

Mais de Indian dental academy (20)

Último

Último (20)

Bioprogressive therapy /certified fixed orthodontic courses by Indian dental academy