wick alexander technique of pre adjusted edgewise appliance /certified fixed orthodontic courses by Indian dental academy

WICK ALEXANDER TECNIQUE
OF PRE-ADJUSTED
EDGEWISE APPLIANCE
Extraction treatment
Retention
Conclusion

www.indiandentalacademy.com

Maxillary arch
Separators placed
2 weeks later maxillary arch bonded and
banded
Initial archwire -.0175”Respond or .017”.025”
D-Rect braided wire is tied with o- ring
Treatment started in max arch and allow the
mandibular arch to drift for 6 to 8 months [except
in class III or bimaxillary protrusion cases]
2 weeks later –rotations are tied with steel
ligature wire and cervical facebow is seated.


-4-5weeks later -.016” ss round wire is
placed with omega stops 1-2 mm anterior
to the molar tubes.
-canine retraction is initiated with a threeunit segment of power chain II.
-retractor adjusted to prevent mesial
movement of molars


Next 3-5 appointments
Powerchain replaced and retractor adjusted.
Canine retraction normally takes 3 appointments
In closed bite cases treatment in mandibular
arch started as soon as canines are in class I

If the bite is not closed incisor retraction
is initiated prior to proceeding to mandibular
arch.

Canine may have tendency to tip and rotate
during retraction
Ligate the canine bracket completely to the .016”
wire .
Lang bracket activated to complete rotation
1 appointment to
accomplish complete
uprighting and
elimination of rotation


Why retract canines individually rather than
retract all 6 teeth as a unit
1]Less posterior
anchorage lost-patient
cooperative in wearing
extraoral appliance.
2]no concern for cuspal
interference .
3]torque in max incisors
more easily controlled.


.018”x.025”ss closing loop archwire placed.
Portion of archwire distal to loop reduced in the
anodic polisher.
Activated by placing plier on the archwire distal
to the molar tube ,pushing it distally 1-2mm to
open the closing loop,and bending the end 45
degrees gingivally to produce a stop.


Patient seen every 4-5 weeks and loops
are activated.
Space closure in 6-8 months.
.017”x.025”ss –with ideal arch form and
omega stops


Mandibular Arch
Advantages of delay in banding the mandibular
arch in extraction cases –
1]allows physiological drifting of anteriors.
2]little posterior anchorage is lost since max
molars are being held distally.
3]no interference and or attrition on the cusp tips
from the mandibular canine bracket
4]time for the second molars to erupt more fully .
5]time to complete mandibular arch treatment is
9-12 months.

.0175” Respond multistranded wire or .017”x .
0125” D-Rect rectangular braided archwire is
placed.
.016”ss with omega stops 1-2mm anterior to the
molar tubes
stops not used if small amount of extraction
space remains
 if too much space .016” x.022” ss closing
archwire is given
Space closure takes 2-6 months.
Amount of extraoral force depends on the molar
relationship.

After all the spaces are closed .017” x.025”ss
with omega stops
If arch not adequately level after 1-2 months –
reverse curve of spee is placed in it .
Detailed finishing takes 3-6 months .
Brackets are activated to finalize rotations.
Midline class II and class III corrections are
made with elastics.

Critical to manipulate patient’s mandible.
Necessary to adjust the archwires.


Elastic wear
Class III elastics are worn early in the
treatment
to prevent advancement of mandibular
incisors, to advance max dentition or
retract mandibular dentition] and to correct
anterior dental crossbite
To prevent molar extrusion vertical high
pull facebow is given

Class II elastics are worn during last few
months of treatment
Final maxillary and mandibular stabilizing arch
wires .017x.025 ss are fully engaged and have
been in mouth at least 1 month before class II
elastics are initiated


At this time proper torques have been
established and stabilized with heavy
wires so prevents unwanted
maxillary anterior retraction or
mandibular anterior advancement.


Midline elastic used in conjunction with
class II or Class III elastic to achieve the
desired correction.
Triangular elastic-are attached to three
teeth .The main concentration of force is
at the apex of the triangle
Cross elastics-lingual lugs on molar
bands
Anterior and posterior up –and –down
elastics [zig-zag ]worn to finalize cuspal
interdigitation.

ELASTIC SIZES
 Class II
1/4"
 Midline
1/4"
 Class lIl 1/4"
1/2oz
 Up-and-down
6oz
or
3/16"
 Cross bite 3/16"
 Finishing 3/4"

6oz
6oz
3–
1/4"

6oz
6oz
2oz

PALATAL AD LINGUAL ARCHES
-Nance palatal arch to hold the anterior and
posterior teeth in place as the canine drift
into their position.
-transpalatal arch with a Goshgarian
design used in high angle cases .
-Lingual holding appliance in mandibular
arch


EXPANSION APPLIANCES
Rapid palatal expansion –jack screw
turned every 12 hr or every 24 hrs.
Slow palatal expansion with quad helix
appliance in younger patients.


Arch form
Initial multistranded archwire has no archform
.016” ss is contoured and placed in the mouth
to see if it conforms to the patient’s arch form
.017”x.0 25” finishing mandibular archwire is
contoured to fit patients original models After
this archwire in place for sometime the maxillary
archwire is contoured to fit the mandibular teeth.


•Dr Garland McKelvain ,1981-reported on arch
forms used with this discipline in an
unpublished thesis written when he was a
graduate student.
102 maxillary and mandibular .017” .25”
archwires from well treated cases
He made copies of the final archwire used on
those cases ,drew perpendicular lines down the
middle of the arch forms,and measured across
the arches at certain intervals.


Conclusions:
1]average maxillary arch design had very little SD from all
those examined.
2]of mandibular arches studied ,all could be related to one
of the 2 mandibular designs with very little SD
3]Compared to the subsample the arch forms appeared to
be same as the master sample form.
4]compared to the original pretreatment models with
appliances placed ,there appeared to be no change in
the shape.
5]comparing arches to the Par ,Brader ,and Boone forms
,there was a significant difference in shape.


RETENTION
GOALS:
1]close band spaces
2]maintain proper anterior torque
3]obtain correct interdigitation
4]control overjet and overbite
relationships
5]maintain class I molar relationships
6]design retainers

Countdown to retention
Patient’s teeth have been properly
positioned ,
-centric relation is achieved
-roots at extraction sites parallel
-mandibular canine width not expanded
-proper buccal and labial torque
-normal overjet and overbite
-class I canine relation

POSTERIOR SETTLING TECHNIQUE
Archwire [usually mandibular]is cut
between right and left canines and
premolars.
Posterior archwire is removed
Patient is instructed to wear series of
elastics.


Patient is instructed to wear elastics 24 hrs per
day for 3 weeks.
In open bite cases patient is instructed to
discontinue before appliance removal


BAND OR BOND REMOVAL
FIRST APPOINTMENT
All bonds except on the 4 man incisors
are removed ,and the premolar and
second molar bands are removed ,leaving
only the 4 molars banded .
Mandibular canine bands are fitted and
impressions are taken and archwire is
retied.

instructions given 1)to wear elastics ;
2)facebow; 3)to chew sugarless gum


MAXILLARY RETAINER
•.036’ wire is formed to fit closely to the anterior teeth with a
loop in each canine region.
•2nd molar if too far buccally-------and mandibular 2 nd molar
in normal position than the tooth will move into normal
position
•Acrylic bite plane with full palatal
coverage
• 3 mm diameter hole is placed in
the center of palatal area to help
control tpngue position


MANDIBULAR RETAINER
•.036” lingual wire adapted 1 mm below the incisal edge
of the anterior teeth and than soldered to the canine
bands
•Elastic lugs are spot welded to the distobuccal surface
of the bands.
•Bonded retainer can also be given


SECOND APPOINTMENT
Within next 1-5days remaining brackets
and bands are removed
Plate adjusted until it is out of contact with
the mandibular incisors


FULL BAND REMOVAL
FIRST APPOINTMENT
All bands are removed and patients are given
instructions
1]wear one ¾” ,2 oz elastic 24 hrs a day from
buccal tube of the maxillary 1 st molar to the
buccal tube of the opposite 1 st molar
2]wear one ¾”,2 oz elastic at night on the
mandibular arch
3]wear facebow to the maxillary 1st molar
4]chew sugarless gum

SECOND APPOINTMENT

Impressions are taken for fabrication of
retainers
If band spaces are closed, instructed to
discontinue wearing the elastics


THIRD APPOINTMENT
Retainers are delivered
next appointment [4-6 weeks later ]retainer is
adjustment is done


-4-5 months after appliance removal patient
instructed to wear elastics at night
-patient is seen annually until decision is made on
future of 3 rd molar
-mandibular retainer removed at 17to 20 yrs.


VARIATIONS IN PROCEDURE

MANDIBULAR INCISOR PROBLEMS
1]Severe discrepancy ,mandibular incisors slightly
advanced----impression for 3-3 retainer taken same
day bands are removed

2]Incisors slightly rotated or become crowded
between appointments----appliance is placed by
making the patient to bit on the band seating
instrument positioned on lingual wire

3]Incisors rotated with interproximal spacing
---1/4”,2oz elastics worn from hook to hook labially.
4]rotation after retainer is cemented---retainer

removed and recemented after slenderization

MAXILLARY INCISOR PROBLEMS
1]Band spaces are larger---5/16”,31/2 oz elastic

worn around the involved anterior teeth near the
incisal edges
2]Open extraction spaces.

5/16”,6 oz elastic
Mandibular arch -1st molar band not removed
+canine to canine retainer given +3/4”,2
oz elastic worn

MISCELLANEOUS PROBLEMS
-poorly placed maxillary canine---3/4”,2oz
elastic
-Buccolingual relationship problem---3/16”,6
oz crossbite elastics on 1st molars
-maxillary 2nd molar erupting buccally---.020”
wire soldered to .036”labial wire +bend to
contour buccal surface of 2nd molar and is
activated.

Conclusion
If the mandibular arch is
properly positioned –the arch level
with the incisors not tipped
f orward , the molars uprighted
, and the canines not appreciably
expanded –and the maxillary
teeth interdigitate with the
mandibular teeth in good centric
relation , signif icant relapse is
limited.

Thank you
Leader in continuing dental education


wick alexander technique of pre adjusted edgewise appliance /certified fixed orthodontic courses by Indian dental academy

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wick alexander technique of pre adjusted edgewise appliance /certified fixed orthodontic courses by Indian dental academy