CHOICE OF WIRES FOR STAGE THREERECTANGULAR

For Molar Or PremolarTorque.

To Eliminate The Need ForAn Anterior TorquingAuxiliary.

For Automatic CanineTorque.

To Align MandibularAnterior Roots.

For Maximum Vertical AndHorizontal Control.

With Ceramic Brackets,When Central And LateralIncisors Require Torque.

ROUND

For Treatment Simplicity(Fewer Archwires) WhenThere Are Minimal TorqueRequirements.

When Compensating AnteriorInclinations In SevereSkeletal Discrepancies.

For Maximum Torque Rates:A. Torque Bar.B. Looped Auxiliary.C. IRT (Individual Root

Torquing Auxiliary).

With Ceramic Brackets,When Only The CentralIncisors Require Torque.

SUMMER 1998

Published Quarterly In The USA

APPLIANCE UPDATES — Q’S & A’S — CASE REPORTS — COURSE / LECTURE NEWS — REVIEWS

®

FOR TIP-EDGE TODAY SUBSCRIPTION, COURSE INFORMATION AND PATIENT REFERRALS CALL 1-800-TIP-EDGE

DR. RASHID CHAMDA OF BLOEMFONTEIN,SOUTH AFRICA, SECOND FROM LEFT,AND MEMBERS OF THE KESLING ANDROCKE GROUP DURING TIP-EDGECOURSE NOVEMBER, 1997, PAGE 5.

EDGELINES

COVER STORY

DR. RICHARD PARKHOUSE DEMON-STRATES DIRECT BONDING DURINGRECENT COURSE IN THE PHILIPPINES,PAGE 6.

Rectangular or Round Wire In Stage ThreeBy Peter C. Kesling, D.D.S., Sc.D.

Please see COVER STORY next page

When approaching the end ofstage two in the DifferentialStraight-Arch® Technique, onehas to make the decision whetherto finish the case with round orr e c t a n g u l a rarchwires. Con-tinuing withround wires cansimplify treat-ment for the op-erator—no needfor more arch-wires. In othercases the use ofr e c t a n g u l a rarchwires canprovide auto-matic torque toall teeth that re-quire it, from ananchor molar toa lingually posi-tioned mandi-bular lateralincisor.

A recent survey of officesusing Tip-Edge brackets indi-cates varying preferences aroundthe globe from 18% round and82% rectangular in Great Brit-ain to 50% each in the UnitedStates. Choices are affected byprevious appliances—Begg orEdgewise—and length of timesince last Tip-Edge course. Thetrend is definitely away fromround wires and toward rectan-gular. However, there remainindications and advantages foreach.Indications for RoundArchwires

In severe anteroposterior skel-etal discrepancies, round arch-

Figure 1. Round wire stage three withmaxillary torque bar in Deep Grooves.Side-Winder springs on maxillary lat-eral incisors can be removed in oneor two visits as bar settles into DeepGrooves.

GreatBritain

Europe

USA

Japan

5050505050

5050505050

8282828282

2626262626

7474747474

7878787878

1818181818

2222222222

Data based on survey of orthodontistsusing Tip-Edge brackets and the D.S.A.T.

PERCENT OF CASES FINISHED WITHPERCENT OF CASES FINISHED WITHPERCENT OF CASES FINISHED WITHPERCENT OF CASES FINISHED WITHPERCENT OF CASES FINISHED WITHRECTANGULARRECTANGULARRECTANGULARRECTANGULARRECTANGULAR OROROROROR ROUNDROUNDROUNDROUNDROUND WIRESWIRESWIRESWIRESWIRES

RECTANGULAR ORROUND?

Reasons for select-ing round or rect-angular wires forfinishing are dis-

cussed in de-tail. CoverStory, Page 1.

ACCELERATEDTORQUINGAn IndividualRoot Torquing(IRT) auxiliaryis used to accel-erate the torque rateof a single tooth,Page 4.

COVERING THE BASESIN TRAINING CAMP

Custom instrumenttray covers fa-

c i l i t a t eT i p - E d g et r ea tmen t

at graduatestudent pro-

grams, Page 4.

wires may be the wires of choicefor stage three. During stages oneand two they permit the maxil-lary and/or mandibular anteriorteeth to assume compensating la-

biolingual inclinations. Subse-quent anterior torque adjustmentsare often unnecessary—even con-traindicated. Rectangular arch-wires would demand third orderfine tuning—an unnecessary com-plication to treatment.

Round archwires would also bethe obvious choice when the pa-tient does not require molartorque or selective labiolingualroot positioning of canines ormandibular incisors. The require-ments of stage three would thenbe limited to mesiodistal rootuprighting and/or group torquingof maxillary incisors. Side-Winder springs provide the up-righting forces and anteriorauxiliaries, the torque. With this

scenario the choice of torquingauxiliary might reflect theoperator’s background. Thosewith Begg in their blood mayprefer a looped auxiliary, those

with edgewise—a Torque Bar formaximum aes-thetics, Figure 1.

Torque Barsrequire DeepGrooves in thecentral and lat-eral incisorbrackets. How-ever, this combi-nation alsoeliminates theneed for Side-Winder springson the centralincisors and of-ten the lateralincisors as well.Deep Grooves

are also helpful when torquing

with two or four looped auxil-iaries—more activation (force)is achieved as the base sections

Pg 2 COVER STORY — Q’s & A’s

COVER STORY

Rectangular or Round . . . Continued from page 1

Figure 3. Buccal offsets are requiredin round archwires to compensate forhorizontal play within the tubes.

Figure 2. Torque force from torquespur is increased if auxiliary is placedin Deep Groove.

of the auxiliary are held closerto the teeth, Figure 2.

The only disadvantage ofTorque Bars and looped auxilia-ries is that they are not self-lim-iting and overtorque could occur.However, this may be offset bythe fact that they provide themost rapid rate of root torque—3 to 4 degrees a month, with theTorque Bars being the fastest.

When only the maxillary cen-tral incisors require torque andthe brackets are ceramic, a roundarchwire would be indicated.Individual Root Torquing (IRT)auxiliaries, which are nearly in-visible, could be used to torquethe central incisors. The roundarchwire enhances such thirdorder movement, as the ligaturesdo not have to “flow” over theedges of the archwire as the toothtorques.

Some may consider that fin-ishing with round archwires sim-plifies treatment—two lessarchwires. However, if teethother than the maxillary anteri-ors require torque, this couldprove “round wise and rectan-gular foolish.”

Finally, to achieve and main-tain proper rotational positionsof the anchor molars with roundwires, it is necessary to placemolar offsets to compensate forthe horizontal play within the oc-clusal .022" x .028" molar tubesand the .022" archwires,Figure 3.

Indications For RectangularArchwires

Generalized and individualtorquing requirements are thestrongest indications for utilizing

rectangular archwires in stagethree. These would include thetorquing of molars, canines and/or mandibular incisors. If roundarchwires were used, each ofthese needs would have to beaddressed separately and one, i.e.molar torque, would be nearlyimpossible to accomplish.

When zero degree, full-sizerectangular archwires are insertedinto the occlusal tubes, the mo-lars will automatically betorqued, as necessary. The forcesdelivered to the molars from the.0215" x .028" rectangular arch-wires are extremely light andlong-lasting. This is because the“interbracket” distance is actu-ally from molar to molar—notbetween each individual tooth inthe arch, Figure 4.

The simple placement of Side-Winder springs on all other teethwill not only result in theircrowns uprighting mesiodistally,but their roots torquing labially

or lingually without any con-scious, specific “instructions”from the operator.

The second order power de-livered by the Side-Windersprings is translated into thirdorder movements by the internalgeometry of the Tip-Edge slot.The resulting torque forces arephysiologic and automaticallystop when the teeth have reachedpredetermined inclinations. Eachtooth is torqued without disturb-ing its neighbors along the arch.Such a means of torquing is aluxury afforded by no other ap-pliance and results in beautifullytorqued canines and the auto-matic alignment of labiolinguallydisplaced anterior tooth root api-ces (especially mandibular) formaximum posttreatment stability,Figure 5.

Ceramic brackets are anotherindication for rectangular arch-wires when the maxillary centraland lateral incisors require

Q’s and A’sQ. I have been noticing teeth rotating during stage three. Do

you have any suggestions?Surrey, U.K.

A. We assume the teeth that are rotating are being uprighted bySide-Winder springs. If these springs are deformed when placed orsubsequently by the patient, their activation coils may be deflectedlabially. This would change their action from mesiodistal towardrotational.

Remember to always insert the springs from the incisal, so theircoils will be forced against the bracket (not away) by occlusal forces.

It is important to place the elastomeric ligatures in the propersequence; before regular Side-Winders and after/over invisible Side-Winders. For maximum control, ligatures should be replaced afterthree months and be of the highest quality. Molded ligatures seem tohave more strength than those cut from tubing, which provide lesscontrol.

Q. I have a patient whose maxillary lateral incisors were origi-nally palatally displaced. In order to quickly torque their rootslabially I plan to use two IRT’s (Individual Root Torquing Auxilia-ries). Should I cross their tails at the midline or run each distally?

Hershey, Pennsylvania

70 to 80 mm of Intertube Distance

Figure 4. Tip-Edge brackets create an effective “interbracket” distance betweentubes, not brackets. This is because the brackets’ slots enlarge and becomeineffective in the second and third orders.

A. To avoid having to contain three wires in the central incisorand canine archwire slots, the IRT tails should go distally, endingbetween the premolar and first molar. Remember the legs that passthrough the vertical slots can also influence mesiodistal inclinationsas desired.

Q. After I changed from a .016" to a .022" round archwire, aspace developed between the maxillary central incisors in one month.What is the cause?

Bacolod, Philippines

A. If the case originally had anterior crowding and the first pre-molars were removed, the teeth may have been in the late stages ofunraveling when you changed archwires. This involves not only ro-tations and labiolingual corrections of the central and lateral incisorsbut distal tipping of the canines as well. In the absence of cuspid tiesin extraction cases the momentum of such alignment can result inanterior spacing. The change in archwires may have been only coin-cidental. This is assuming the intermaxillary circles of the new .022"wire were not pressing on the mesial of the canine brackets—whichcould also cause spacing.

COVER STORY — CASE REPORT Pg 3

CASE REPORT

J.W. ........................... Female, 22 YearsClass II, Division 1Extractions .............................. U66, L88Archwires Used .................... 6 (4U, 2L)Treatment Time .................... 23 MonthsRetention ................................ Perfector®

Cephalometric Changes:Start-Dotted Finish-Solid

1 A-Po +2.0 mm +1.5 mmWits +1.0 mm .0 mmSN-MP 42.0o 41.0o

SNA 82.0o 79.0o

SNB 75.0o 79.0o

ANB 7.0o 5.0o

1-SN 98.0o 86.5o

Rectangular or Round . . . Continued from page 2

Figure 6. Stage three with .0215" x.028" archwires. Horizontal elastic clos-ing residual posterior space while alltorquing and uprighting accomplishedwith Side-Winder springs.

torquing. A Torque Bar, the mostaesthetic means of torquing fourincisors, cannot be consideredsince ceramic brackets do nothave Deep Grooves. A fourlooped auxiliary in conjunctionwith a round archwire may notbe appreciated by a patient whochose ceramics for the “invisiblelook.” Therefore, torque viaSide-Winders and a rectangulararchwire would be indicated,Figure 6.

Rectangular archwires .0215"x .028" provide more verticaland horizontal control than .022"round archwires. This is due totheir increased cross sections and

can be appreciated by their rela-tive degrees of stiffness—248 forrectangular and 115 for round.1

They would be preferred tomaintain bite opening in deepbite cases during incisor torqu-ing and to hold expansion—

while simultaneously moving theroots of posterior teeth buccallyto enhance posttreatment stabil-ity.

In summation, the chart onpage 1 lists the indications foreither round or rectangular arch-wires for finishing.

It seems quite obvious thatrectangular archwires would pro-vide the most controlled and au-tomatic stage three, but as withall else in orthodontics, thewhims and preferences ofeach individual operator willprevail.References1. Thurow R. Personal correspondenceMarch 1998.

This 21 year old female exhibited a full step Class II malocclusion with9 mm of overjet and slight spacing in both maxillary and mandibularanterior segments. The position of the mandibular incisors, 2 mm aheadof the A-Po line, coupled with the spacing contraindicated the extractionof teeth in the mandibular arch. Both maxillary third molars were presentand well positioned for successful eruption. The maxillary first, and man-dibular third, molars were extracted prior to starting treatment.

Stainless steel (high tensile) archwireswith mild bite opening bends and lightClass II elastics. Pre-stretched E-Linksfrom maxillary wire circles to secondmolars.

Maxillary .022" archwire, Side-Windersprings as brakes on canines and pre-molars. Mandibular .016" archwire en-gages premolars for pre-stage three.

Stage three with .0215” x .028” arch-wires. Horizontal elastic closing residualposterior space while all torquing anduprighting accomplished with Side-Winder springs.

Vertical SlotVideo

A new 16-minute video hasjust been released explaining theversatility of vertical slots. Be-ginning with the first verticalslots in Angle’s ribbon archbrackets of 1915, it follows theirevolution to becoming essentialcomponents of today’s preadjust-ed edgewise brackets.

Uses of vertical slots from thebeginning of treatment, to aid indirect bonding, to final torquingand tipping are graphically dem-onstrated.

The application of variousauxiliaries designed to fit withinvertical slots and the resultingtooth movements are shownthrough computer animation. Theconcepts of recovering losttorque with conventional arch-wire slots and full range torqu-ing with Tip-Edge archwire slotsare fully demonstrated.101-946 NTSC (United States)101-947 SECAM101-948 PAL

Figure 5A-C. A) Pretreatment mandibular cast showing severe lingual displacement of lateral incisors. Initial alignment ofthe crowns with round wire leaves such teeth labially inclined with their roots relatively undisturbed. B) Rectangular archwireand Side-Winder springs on mandibular lateral incisors automatically torque their roots labially. C) Posttreatment cast showslateral incisors have been torqued to same axial inclinations as central incisors.

BEFORE AFTER

A B C

IRT’s Helpful to Accelerate TorquingPg 4 TECHNIQUE TIP

When using rectangular arch-wires during stage three of Tip-Edge treatment, an individualtooth may, on occasion, be foundto be torquing slower than others.In this situation an IRT (IndividualRoot Torquing) auxiliary can beused to accelerate the torquing ofthe desired tooth. To accomplishthis a 90-degree bend is placed inthe IRT at the junction of the tailof the auxiliary and the u-shapedportion which engages the verti-cal slot of the bracket, Figure 1.

This allows for the engagementand ligation of the auxiliary over,rather than under, the base arch-wire. Since the placement of thisbend also creates a “right” or“left” auxiliary, it should be modi-fied in such a way that the tail of

the auxiliary will extend distallyfrom the bracket to which it isengaged.

The use of an IRT with rectan-gular archwires delivers torquingforces through two distinct ac-tions. The arm of the auxiliaryinserted in the vertical slot deliv-ers torque in the same manner aswhen used with round wires.When employed with rectangulararchwires, torque is also generatedthrough the mesiodistal upright-ing force delivered by the IRT.As the tooth uprights, the Tip-Edge archwire slot closes tightlyagainst the flat surfaces of therectangular archwire.

IRT’s accelerate the torque rateduring rectangular stage three dueto the combined effects of thisuprighting component of force(stronger than that produced bySide-Winder uprighting springs)and the application of direct torqu-ing force from within the bracket’svertical slot.

The effectiveness of IRT’s usedwith rectangular archwires is wellillustrated through intraoral pho-tographs taken during treatment ofthe patient featured in this issue’scase report. During stage three the

Figure 2. IRT engaged over rectan-gular archwire to accelerate torque ratefor maxillary right central incisor.

Figure 3. After 12 weeks maxillaryright central incisor torqued to matchbuccolingual inclination of adjacentcentral incisor.

maxillary right central incisor,which had been endodonticallytreated prior to orthodontic treat-ment, was torquing more slowlythan the adjacent central incisor.To enhance the rate of torque forthis tooth, a modified IRT was in-serted through the vertical slotfrom the incisal and engaged overthe rectangular archwire, Figure 2.

Two appointments later (12weeks) the axial inclination of themaxillary right central incisor ap-proximated that of the adjacent leftcentral incisor, Figure 3.

Two IRT’s can be used in tan-dem with rectangular archwires

Figure 1. A) Original IRT. B) IRTmodified to allow engagement overbase archwire. Ninety degree bend isplaced between tail and segment ofauxiliary that is engaged in vertical slot.

B

Awith their tails extending distallyto accelerate torquing of both cen-tral incisors during stage three ifdesired. Maximum braking forcescould be achieved using this ap-proach to protract posterior teeth.

The torquing effectiveness ofconventional edgewise archwireslots might also be enhanced us-ing IRT’s. This would occurthrough their direct torquing ac-tion as well as with their ability tofully upright the teeth mesiodis-tally, which eliminates the “slop”that exists between full sizerectangular archwires and arch-wire slots due to manufacturingtolerances.

Tray Covers Designed To Facilitate Checking Tip-EdgePatients In Graduate Orthodontic Programs

Custom tray covers help or-ganize and prepare graduate stu-dents to efficiently care forTip-Edge patients. Each instru-ment required, including pliers,4 ounce tension gauge, anneal-ing torch and Straight Shooter isoutlined and identified.

When the students have “allthe bases covered,” no time islost looking for instrumentsasked for by the clinical instruc-tors. The instructors’ time is alsobetter utilized. They can quicklyreach for and pick up an instru-ment to demonstrate a particularpoint.

Labiobuccal drawing in cen-ter depicts all teeth and attach-

ments. This aids in illustratingthe insertion of auxiliaries as wellas the design and placement ofsectional wires for the eruptionof impacted canines, anterioralignment or correction of sec-ond molar crossbites.

Clinic Guidelines are listed inthe lower right hand corner.These include reminders to havethe patient’s teeth clean, elasticsin place and the original modelsreadily available for review.

Original artwork is availablefrom TP Orthodontics at nocharge. Ordinary placemats canthen easily be printed atlocal “quick” print shops.Call 1-800-TIP-EDGE.

REVIEWS — COURSE / LECTURE NEWS Pg 5

Kesling and Rocke Group Gives TwoGraduate Student Tip-Edge Courses

The second course, February 27th & 28th, 1998, brought 45 par-ticipants to the Orthodontic Center. Practicing orthodontists as well asstudents and faculty members from the following universities were inattendance: Boston University, Indiana University, Montefiore Medi-cal Center, State University of New York at Buffalo, University ofMedicine & Dentistry of New Jersey, University of Tennessee and theUniversity of Western Ontario.The first course was held November 14th and 15th, 1997 at the

Orthodontic Center in Westville, Indiana. Fifty-two graduate studentsand faculty members from the following universities participated:Case Western Reserve, Columbia, Montefiore Medical Center, SaintLouis University, State University of New York at Stony Brook,University of Mexico and the University of Missouri at Kansas City.

Seven practicing orthodontists also attended. For some it was theirfirst introduction to Tip-Edge brackets and the Differential Straight-Arch Technique. To others it served as a refresher. Instructors for thiscourse were members of the Kesling and Rocke Orthodontic Group.

During the February course Drs. Peterand Chris Kesling review a treated casewith Drs. Igor and Marina Yelistratov fromKhabarovsk, Far East Russia. Igor plansto implement the Tip-Edge technique atthe University of Khabarovsk. Dr. DoyleBaldridge (right) of Shreveport, Louisi-ana has given courses in Khabarovskand was instrumental in the Yelistratovsvisiting the Center.

Tip-Edge Paper in IndiaDr. B.N. Sunilkumar, post graduate in Faculty of Orthodontics,

KLES Institute of Dental Sciences Karnataka, India presented“Merging philosophies, expanding horizons—DSAT” at the 32ndIndian Orthodontic Conference held in Goa October 16th-18th, 1997.

In his presentation he elaborated on the appliance evolution,history, treatment with Tip-Edge brackets and their introduction to

India with the help of eightwell-documented casestreated with the DifferentialStraight-Arch Technique.

His scientific paper wasselected from a total of 84papers submitted for presen-tation during the Orthodon-tic Congress in Goa, India.

Tip-Edge Articles Published“Early Experiences with the Tip-Edge Appliance”Jayne E. Harrison, B.D.S., F.D.S., M.Orth., M.Dent.Sci.British Journal of Orthodontics, February 1998

In this article, which in essence is two case reports, Dr. Harrisonrelates her experiences in first being trained in the “Straight WireAppliance” and then in Tip-Edge at the Glan Clwyd Hospital, Walesby Dr. R. Parkhouse.

The first case report is of a 14-year-old girl with an extreme dentaland skeletal Class II malocclusion. The thirty months of treatment,which involved the extraction of the maxillary first and mandibularsecond premolars, is well documented by color intraoral photos andcephalometric information. The final occlusion and lip balance areexcellent though the latter somewhat overtaken by unexpected growthof nose and chin.

The second patient was also female, age 12½ but had a Class IIImalocclusion with a bilateral crossbite. Treatment included extrac-tion of the maxillary and mandibular second premolars and expan-sion of the maxillary arch with a quad-helix appliance. Again, colorintraoral photographs clearly show the progress of differential toothmovement through the three stages of treatment.

Side-Winder springs were used as brakes in stage two and then, inconjunction with passive .0215" x .028" wires, to provide the powerrequired for all individual tooth uprighting and torque. The results,achieved in 25 months, are excellent and camouflage the Class IIIskeletal base relationship. Such changes would not have been sorelatively easy to obtain without the benefits afforded by differentialtooth movement. This well written article is yet another to add to thegrowing evidence of the benefits to be gained from the preadjustedyet permissive Tip-Edge archwire slot.

“Tip-Edge: Differential Forces and Variable Anchorage Control”Dr. Georges Mauran, Professor a la Chirurgie Dentaire - Montpellier, FranceDr. Helene Mauran-Plas, Dento-Faciale C.E.C.S.M.O. - Montpellier, FranceDr. Frederic Plas, Dento-Faciale C.E.C.S.M.O. - Montpellier, FranceInformations Orthodontiques - Vol. 2 No. 1

This article covers the development of the Tip-Edge archwire slotand the advantages it offers. The application of forces from arch-wires, elastics and auxiliaries in each stage of treatment are clearlyexplained by text and illustrations. The successful nonextraction treat-ment of a Class II Division 1 malocclusion is covered in detail throughplaster casts, x-rays, cephalometric tracings and facial photographs.

This well organized article should do much to promote the under-standing and appreciation for Tip-Edge brackets and the DifferentialStraight-Arch Technique to all French speaking orthodontists.

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Pg 6 COURSE / LECTURE NEWS

Dr. Parkhouse “Bonds” withPhilippine Orthodontists

On February 12th and 13th Dr. Richard Parkhouse of Clwyd, Wales,U.K. gave a Tip-Edge course in Manila. In spite of the devaluationof Philippine currency that occurred before the course, attendanceand interest was high with over fifty orthodontists attending.

A vast number of the participants were women and several thoughtDr. Parkhouse resembled James Bond. Because of this he kept theirattention, especially through the intricacies of Side-Winder torquing.Rachel Parkhouse accompanied her husband and helped keep his feeton the ground. The course ended on a high note with requests for arefresher next year.

Dr. Parkhouse, center, with participants during February 1998 Tip-Edge Course inManila, Philippines.

Belgium’s 4th Tip-Edge CourseChateau du Lac, outside Brussels, proved an idyllic location for

Belgium’s fourth Tip-Edge Course, conducted by Dr. RichardParkhouse in November, 1997. The 23 participants reflected the widevariety of techniques practiced on the European continent, with pre-vious Begg and straight wire orthodontists represented. The two daysof lectures and typodonts proved intensive and enthusiastically re-ceived, capably supported by TP’s exclusive Sales Representative toBelgium, Mr. Werner Bervoets.

Shirley Stanley, TP Orthodontics’ Senior Director of International Sales, and Dr.Parkhouse (front row left) and members of Belgium Tip-Edge course. Photo takenat the Chateau du Lac near Brussels.