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2. 2
Utility arch.
Mixed dentition treatment
Brackets & Prescriptions
Class II div I
Class II div II
Mechanics for extraction cases.
Finishing and retention.
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3. 3
Roles and functions of
the lower utility arch
Position of the lower molar to allow for
Cortical Anchorage
Manipulation and Alignment of the lower
incisor segments.
Allowing segmental treatment of the buccal
segments
Physiologic roles of the lower utility arch.
Role in mixed dentition
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5. 5
Physiologic Vs Mechanical
Response
Tip back applied to lower
molar-30° to 40 °.
No toe-in in non
extraction utility.
Extraction cases-definite
distal rotation must be
placed .
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8. 8
Physiologic Vs Mechanical
Response
Long lever arm
applied to lower
incisors.
75 gms of intrusive
force.(0.16 x 0.16).
Labial root torque.
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9. 9
Modifications of the Utility Arch
Expansion utility
arch
Force :
1mm= 85 gm
2mm=140 gm
3mm=205 gm
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15. 15
Resolve functional problems
Anything that disturbs the growth, health and
function of the TMJ complex.
In 1950’s Ricketts –used body section x rays
(laminagrphy)
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18. 18
Resolve functional problems
Nine general categories-
1. Cross mouth interferences.
2. Anterior crossbite.
3. Open bite.
4. Excessive range of function.
5. Distal displacement.
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19. 19
Resolve functional problems
6. Loss of posterior support.
7. Habits.
8. Breathing and airway problems.
9. True Class III Growth pattern.
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20. 20
Resolve Arch
Length Discrepancy
This is accomplished
by three ways-
1. Lateral expansion of
the molars.
- Depends on the
inclination of the
posterior teeth.
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21. 21
Resolve Arch
Length Discrepancy
Expansion primarily by
change in axial inclination :
- Rickett’s quad helix
- .040 blue elgiloy wire.
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22. 22
Resolve Arch
Length Discrepancy
With 1cm expansion in the upper molars –
anterior segment are expanded 3cm overall.
Long term functional expansion for atleast a
year or more for stable and demonstrable
changes to occur in the lower arch.
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25. 25
Resolve Arch
Length Discrepancy
Expansion by mid palatal dysfunction:
- Hass type or modified Nance type expansion
appliance.
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26. 26
Resolve Arch
Length Discrepancy
2. Advancement or forward movement of the
lower molars:
- If the VTO and physiologic factors warrant.
- Expansion utility arch.
- 1mm forward movement of LI yields 2mm of
arch length.
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27. 27
Resolve Arch
Length Discrepancy
3. Uprighting and /or distal movement of the
lower molars:
- Accomplished by utility arch.
- 2 mm per side can be gained by uprighting.
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28. 28
Correct Vertical/Overjet
Problems
This is done after functional and arch length
corrections are achieved.
Includes different approaches are used for
the first phase of non extraction treatment.
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29. 29
Correct Vertical/Overjet
Problems
1. Orthopedic problems-
- In case where good alignment of lower arch exists and Class
II is on account of Max.protrusion.
2. Orthopedic problems with lower arch
therapy-
- with maxillary protrusion but incisors and molars in deep bite
or need advancement.
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30. 30
Correct Vertical/Overjet
Problems
3. Orthopedic problems with minor incisor
interferences.
- Upper utility arch with headgear.
4. Orthodontic problems alone.
- Upper utility arch with Class II elastics.
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32. 32
Brackets
Siamese twin bracket
on all the teeth.
Slot size-.022 changed
to .018
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33. 33
Brackets
Slot size-.0185 x .030
1. Use of two light arches
2. Permits a champer or bevel.
3. Allows for a lever access.
4. Adequate distance for the torque grooves.
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34. 34
Development of Brackets
1. Rickett’s Standard Bioprogressive.
2. Rickett’s Full Torque Bioprogressive.
3. Triple Control Bioprogressive.
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35. 35
Development of Brackets
1. Rickett’s Standard
Bioprogressive.
These were the first set of
brackets which available.
(1960)
Banding was done on all
the teeth.
Line of occlusion –through
the contact points.
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36. 36
Development of Brackets
Trend of building in treatment in the
appliance. (angulations)
The original design had 5° for all the canines
and 8° for the upper lateral incisors and 5° for
the lower first molar
Torque was present only in-upper incisors,
laterals and canines.
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38. 38
Development of Brackets
2. Rickett’s Full Torque Bioprogressive.
Torque was build in the lower molars and
pre molars.
Brackets were placed with 5 angulation.
12 rotation was also built in the tube.
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40. 40
Development of Brackets
3. Triple control Bioprogressive.
Raised bases
Triple tube for upper molars
Breakaway convertible lower molar tube.
Direct bonding base/contoured.
Slots cut at an angle
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44. 44
Extraction Mechanics
Four general procedures :
1 Stabilization of upper and lower molar
anchorage.
2 Retraction and uprighting of cuspids with
sectional arch mechanics.
3 Retraction and consolidation of upper and lower
incisors.
4 Continuous arches for details of ideal and
finishing occlusion.
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45. 45
Extraction Mechanics
1. Stabilization of upper
and lower molar
anchorage:
a) Maximum upper
molar anchorage.
Nance arch with
modifications.
Headgear .
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50. 50
Extraction Mechanics
Minimum lower molar
anchorage:
Eliminate the four
mechanical factors.
Round wires may be
used.
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51. 51
Extraction Mechanics
2. Retraction and uprighting of cuspids with
sectional arch mechanics.
Cuspids need to be kept in the narrow trough
of trabecular bone and avoid the severe
tipping or displacement
The activation of the cuspid retraction springs
should produce 100 to 150 grams of force
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62. 62
Mechanics For Class II Div I
Sequence:
Lower Incisor intrusion.
Lower Cuspid intrusion.
Alignment of the lower buccal segment.
Alignment of the upper buccal segment.
Segmental correction of Class II with elastics.
Upper incisor alignment and intrusion.
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63. 63
Mechanics For Class II Div I
Upper arch –orthopedic reduction of the
maxilla.
Lower arch-treatment starts with levelling
the spee.-utility arch
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65. 65
Mechanics For Class II Div I
Lower stabilizing utility arch-after initial
purpose of the utility arch is accomplished –it
no longer serves as an efficient function
16 x 22 stabilizing arch is placed
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67. 67
Mechanics For Class II Div I
Alignment of the lower
buccal segment starts:
.015 or .0175
Twistoflex
.012,.014 of 018 wires
16x 16 triple T section
.016 or.018 nitinol
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68. 68
Mechanics For Class II Div I
Upper arch
alignment:
Incisors are not
included.
Upper molars starts
Distalizing-opening
spaces in the buccal
segment.
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69. 69
Mechanics For Class II Div I
a) Consolidation section
b) Stabilizing section
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70. 70
Mechanics For Class II Div I
Segmental correction with Class II elastics:
Three detrimental effects:
1. Skidding effect.
2. Tendency for a deep bite.
3. Difficult to overcorrect buccal segment.
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71. 71
Mechanics For Class II Div I
Tractions Sections-
Gable bend distal to
canine.
Rotation bend in the
anterior portion.
Molar bayonet bend
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72. 72
Mechanics For Class II Div I
Functions –
1. Counteract downward backward
pull
2. Stabilizing function in the upper
buccal segment.
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73. 73
Mechanics For Class II Div I
Upper incisors alignment
and Intrusion
Upper incisors are
aligned before placement
with light round wires.
16 X 22 utility arch is
placed
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74. 74
Mechanics For Class II Div I
Consolidation of Upper
Incisors
Retraction of the upper
incisors .
Over treatment -2mm
Closing utility/upside
down closing
arch/vertical helical
arch.
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75. 75
Mechanics For Class II Div I
Idealization of
arches and finishing.
16 or 17 square,16 x
22 or 17 x 25 nitinol.
Class II elastics to
be discontinued
atleast 2 months.
Light round wires
finishing
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77. 77
Mechanics For Class II Div II
Three treatment
possibilities:
1. Distalizing the
upper arch.
2. Advancing the lower
arch.
3. A reciprocal
movement.
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78. 78
Mechanics For Class II Div II
1. Advancement, torque control, and intrusion of
the upper incisors.
2. Intrusion of the lower incisors and cuspids.
3. Alignment of the buccal segments and Class
II correction.
4. Consolidation of the upper incisors.
5. Idealizing the arches.
6. Finishing.
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80. 80
Mechanics For Class II Div II
1. Advancement, torque control, and intrusion
of the upper incisors.
X Principle of bite before jet
Jet is created followed by intrusion.
16x22 utility arch
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82. 82
Mechanics For Class II Div II
Amount of pressure:
125-160 gms
16 x 22
Stabilization of the
molars:
Quad helix
TPA
Stab. sections
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83. 83
Mechanics For Class II Div II
Intrusion of lower incisors:
16 x 16 utility arch.
65-75 gms.
This is followed by cuspid intrusion.
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84. 84
Mechanics For Class II Div II
Advancement
of the lower
denture:
1. Utility arch with
4 helical loops
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85. 85
Mechanics For Class II Div II
2. Using three
vertical loops:
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86. 86
Mechanics For Class II Div II
3. Alignment of the buccal
segment:
a) Stabilizing section
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87. 87
Mechanics For Class II Div II
If buccal segment
are not aligned
“T” sections
Twistoflex wire
Cable wire
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88. 88
Mechanics For Class II Div II
4. Consolidation of
the maxillary
incisors:
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89. 89
Mechanics For Class II Div II
Idealization and
arches and finishing
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92. 92
Finishing and Retention
“Begin with the end in
mind”.
Every orthodontist has a
visual picture in his mind
of the ideal occlusion into
which the teeth should fit
and mesh in the final
finished occlusion.
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93. 93
Finishing and Retention
Bioprogressive proposes the concept
overtreatment….
No clinician can position teeth as delicately
as the functioning incline plane and cusp
action can accomplish naturally when it is
adequately set up to operate correctly.
Allow natural function to guide the teeth into
the best functioning occlusion for each
individual
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95. 95
Finishing and Retention
Two phases of retention:
1. Guiding changes during initial adjustments.
2. Supporting bony sutural and muscular
accommodations to changing environment
and considering long range influences.
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96. 96
Finishing and Retention
Initial stage of retention :
First six weeks following appliance removal
Retainers inserted-designed not to hold but to
guide the teeth in settling.
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97. 97
Finishing and Retention
Labial frame of typical
upper retainer (Ricketts)
passes between the lateral
and cuspid and has a
distal loop at each end to
tuck in the distal of the
expanded overtreated
upper cuspid
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98. 98
Finishing and Retention
Lower arch:
Fixed first bicuspid retainer is placed.
-maintain cross arch bicuspid width.
-lower cuspid freedom of adjustment against
upper occlusion.
-maintain lower incisor alignment and rotation
correction.
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99. 99
Finishing and Retention
Stabilizing stage of retention:
First year following active treatment.
Lower retainer is kept in place and upper is
worn most of the time.
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