Typho word doc

BASIC BENDS IN EDGEWISE WIRE BENDING

A) PRIMARY OR FIRST ORDER BENDS

* Placed in the horizontal plane

* The wire should lie tangent to the glass slab after bending the first order bends as

torquing bends, which are placed in bucco-lingual or labio-lingual root and teeth or groups of

teeth.

Types of first order bends :

Upper Arch

1) Lateral inset

2) Canine offset

3) Molar offset

Lower Arch

1) Canine offset

2) Premolar offset

3) Molar offset

B) SECONDARY OR SECOND ORDER BENDS

*Bends are placed in the vertical plane

* Used to tip teeth in the buccal segments of both dental arches either mesially or

distally for anchorage requirements

Types of second order bends : Upper and Lower Arches

1) V bend - Used to attach headgear hooks

Division between anterior and posterior torque

2) Tip back bends mesial to the 2nd premolar bracket

3) Tip back bends mesial to the 1st molar bracket

4) Tip back bends mesial to the 2nd molar bracket

5) Artistic positioning bends

TERTIARY OR THIRD ORDER BENDS

Known as torquing bends , which are placed in the archwire to effect buco-lingual or

labiolingual root and crown movements in single teeth or groups of teeth.

It is the twist in the wire in the horizontal plane.

The types of 3rd order bends are :

Upper Arch

1) Anteriorly: Lingual root torque.

2) Posteriorly: Lingual root torque

Lower Arch

1) Anteriorly: Lingual root torque

2) Posteriorly: Buccal root torque

3) Progressive torque for posterior segment

To be effective, torque must be of such severity that when the wire is placed in the

bracket it must be seated with either a torquing key or a pair of pliers.

CLASS I BI-MAXILLARY PROTRUSION TREATMENT

The wire bending steps for the bi-maxillary protrusion treatment

Type of Anchorage requirement: Grade III

Use of kloehn headgear - 6-8 Ounces of force with 12-14 hours of

wear per day

FIRST SET OF ARCH WIRES: LEVELING OF MANDIBULAR ARCH

Wire used: .016" round multiple loop archwire

Types of bend incorporated in the wire are:

i) Omega loops - 1 mm anterior to the 2nd molar buccal tubes. The distal leg should be

higher than the mesial leg.

ii) Tear drop shaped closed loops at the extraction spaces.

The distal leg should be 5 mm in length, and the mesial leg should be 4 mm in length.

iii) Vertical loop in contact with the mesial aspect of the cuspid bracket.

Height of the loop : 5 mm

Width of the loop: 1.5 mm

The distal leg should be 1 mm higher than the mesial leg

iv) Multiple loops

Height - Should not exceed 5 mm

Width - 1.5 mm

Number of loops - 3

Both the mesial and distal legs should be of equal length.

v) Sufficient degree of second order bends to prevent the teeth in the posterior buccal

segments from tipping forwards should also be incorporated into the arch wire.

vi) After arch wire fabrication, omega loops should be 1 mm anterior to the 2nd molar

tubes The distal legs of the loops between cuspids and lateral incisors should be in

contact with the mesial surface of the cuspid brackets. The arch wire from cuspid

bracket to cuspid bracket should be passive

vii) Anti-rotation bends in the terminal molar areas are given to prevent mesial rotation

of these teeth. Toe in bends are given mesial to the 2nd molar bracket.

FIRST SET OF WIRES: MAXILLARY ARCH

This step involves the reversal of mechanical procedures, break down of unfavorable

anchorage in the maxillary arch. and starting to reduce the procumbancy of the maxillary

incisors.

MAXILLARY ARCH WIRE & - LEVELING OF MAXILLARY ARCH

Wire used: .016" round multiple loop wire

The bends incorporated in the wire are :

a) Omega loops - 2 mm mesial to the molar tube

b) Tear drop shaped closed loops bent in the extraction spaces

with its distal leg higher than the mesial leg by 1 mm.

c) Vertical loops in contact with the mesial aspect of the cuspid bracket.

d) Multiple loops

No. of loops : 3

Height of loop : 5 mm or less

Width between the two legs : 1 mm

e) Second order bends (tip back bends) of sufficient degree to prevent the teeth from

tipping forward

f) Toe in bends are made mesial to the 2nd molar to prevent rotation of the molar

Elastics used : Class II elastics with 4-6 ounces of force to prevent labial flaring of the

incisors.

SECOND SET OF ARCH WIRES: MAXILLARY AND MANDIBULAR

After the initial decrowding with the .016" round multiple loop arch wire, an .018"

continuous arch wire is used for further alignment and decrowding.

Bends given in the .018" round wire are:

* Omega loops flush to the molar tubes

* Tear drop shaped loops in the extraction space

* Vertical loops between the lateral incisor and canine bracket in contact with the canine

bracket

* Height: 5 mm

* The distal leg should be higher than the mesial leg by 1 mm

* Anteriorly, continuous arch wire (without vertical loops)

* second order bends (tip back bends)

Mesial to the 2nd premolar bracket

Mesial to the 1st molar bracket

Mesial to the 2nd molar bracket

*Molar toe in

THIRD SET OF ARCH WIRES - MANDIBULAR ANCHORAGE

PREPARATION

Wire used : .019" x .025" stainless steel rectangular wire

* Bent as ideal in the form as conditions will allow and carries no stops or attachments.


* Long tip-back bend$ mesial to the ~econd premolar, the first molar and the second

molar

* Mandibular jigs are fabricated

Wire used : .019" x .025"

The distal eye of the jig should be in contact with the second premolar bracket

and the mesial eye of the jig should be exactly 1.5 mm anterior to the mesial eye

of the jig should be exactly 1.5 mm anterior to the cuspid bracket.

*Utility of the jig :For the attachment of Class III elastics : for bringing about distal

tip back of the posterior teeth

Elastic force : Class III elastic force of 4-6 ounces.

Headgear force : Kloehn headgear with 8-12 ounces of force.

Degree of Anchorage Preparation in the lower arch

First degree anchorage preparation :

* Uprighting the 1st and 2nd molars

* Done in Class III and Class II malocclusions

Second degree anchorage preparation :

* Slight distal tipping of the terminal molars

*Done in Class II division 1 malocclusion

Third degree anchorage preparation :

* Severe distal tipping of the terminal molars with the distal marginal ridge of the 2nd

molar under the gingival tissue

* Done in Class I bi-dental protrusion malocclusion

THIRD SET OF ARCH WIRES - MAXILLARY STABILIZING WIRE

Reversal of mechanics using the maxillary dental arch supported by the headgear pull

as anchorage. for retraction of the mandibular cuspids and then the mandibular

incisors.

Wire used: .0215" x .0275" stabilizing arch wire fabricated in ideal form

The bends incorporated in the wire are:

a) Second order bends to maintain the teeth in the prepared anchorage positions

b) Curve of Spee incorporated into the wire

c) Soldered stops 1 mm mesial to the molar tubes

d) Headgear hooks soldered on the V-bends between the lateral incisor and the canine

e) During final ligation of the arch wire, all the four maxillary incisors are ligated

together to prevent their migration.

FOURTH SET OF ARCH WIRES:

MANDIBULAR ARCH WIRE - CUSPID RETRACTION ARCH WIRE

Wire used: .019" x .025" ideal-working arch


1) Sufficient amount of tip back bends to maintain teeth in the prepared anchorage

position

2) Method of retraction : by use of open coil

Length of the open coil : 1 1/4 times the distance between the brackets of the lateral

incisor and the canine

3) Molar stops soldered 1 mm mesial to the molar tubes

4) Intermaxillary hooks are soldered between the central and the lateral incisor brackets

Method of ligation

1) All the four incisors are ligated together to prevent their migration along the arch

2) After tying the cuspid bracket to the arch wire, the open coil is activated by tying it

back to the 2nd bicuspid bracket

3) The second bicuspid bracket and mesial bracket of the 1st molar are ligated

together

4) The distal bracket of the 1st molar is ligated to the molar stop

The distal bodily movement of the mandibular cuspids is a slow procedure. The distal

movement is continued until the cuspids have been moved within 0.5 mm of the 2nd

bicuspid tooth

Elastic wear: Class II inter-maxillary elastics on both the sides. 4-6 ounces of force for

24 hours a day.

Headgear: Maxillary Kloehn headgear with 14 ounces of force is worn for 12-14 hours

a day to counteract the Class III elastic force

Maxillary stabilizing archwire -------continued

FIFTH SET OF ARCHWIRE

MANDIBULAR ARCH WIRE: COMPLETE RETRACTION OF THE MANDIBULAR

INCISORS

Wire used: .019" x .025"


a) Vertical closed loops are bent 1 mm mesial to the cuspid bracket. Distal leg of the

vertical loop should be 1 mm higher than the mesial leg.

b) Second order bends to maintain the position of the teeth.

c) Soldered stops 1 mm distal to the 1st molar bracket.

d) Inter-maxillary hooks are soldered gingivally on the archwire on the V-bend between

lateral incisor and the canine.

e)The amount of mandibular incisor torque whether labial root torque or lingual root

torque is decided after studying the lateral cephalogram.

Method of activation of the wire:

Tie back the molar stop to the molar tube. The loop is opened 1 mm of every

activation

Maxillary Stabilizing Arch Wire -- Continued

SIXTH SET OF ARCH WIRES

MANDIBULAR ARCH - STABILIZING MANDIBULAR ARCH WIRE

Wire used: .0215" x .0275"


a) Tip back bends of sufficient degree to preserve the prepared anchorage

b) Molar stops - 1 mm mesial to the molar tubes

c) Intermaxillary hooks are soldered between the central the lateral incisors.

These are headgear hooks used for cervical headgear which is used in conjunction

with Class II elastics.

Method of ligation :

1) All the four incisors are ligated together followed by first molar and second bicuspids

on both sides.

2) The arch wire is then gently ligated to the cuspid bracket.

Elastic wear

Class II inter maxillary force is continued until the inclination of the maxillary incisors

becomes normal. Space ciosUt2 with a vertical loop arch wire should not be continued

After normal inclinations of the maxillary incisors have been attained as there is less,

torque control in this wire.

MAXILLARY ANCHORAGE PREPARATION

Wire used: .0215" x .0275". in ideal arch form


a)Tip back bends made mesial to the 2nd. Premolar to the 1st molar and to the 2nd molar

(1/4 mm)

b) This wire carries no stops or soldered, attachments

c) Torque - Lingual crown torque is given to prevent the incisor from flaring

d) Jigs are made of wirE size .019" x .025"

The distal eye of tHE jig should contact the 2nd premolar bracket. and the mesial eye

of the jig should lie 1.5 mm

mesial to the cuspid bracket

Elastics used :

Class II elastics - 4-5 ounces of force 24 hours a day

Headgear

Cervical pull headgear with 12-14 ounces of force for 14 - 16 hours day

SEVENTH SET OF ARCHWIRE

MAXILLARY ARCH WIRE- COMPLETE RETRACTION OF THE MAXILLARY

CUSPIDS

Wire used: .019" x .025"


a) Second order bends of sufficient degree to maintain the prepared anchorage position of

the teeth

b) stops soldered 1 mm mesial to the molar tubes

c) Inter-maxillary hooks soldered between the central and lateral inciSor brackets

Method of retraction

By the use of open coils 1 1/2 times the distance between the lateral and the canine

bracket.

Method of ligation :

1) All the four incisors are ligated together to prevent their migration

2) After ligation of the cuspid bracket, the open coil is activated by tying it back to the

2nd bicuspid bracket.

3) The mesial bracket of the 1st molar and the 2nd bicuspid bracket are ligated.

4) The distal bracket of the 1st molar is now tied to the molar stop mesial to the 2nd

molar tube.

Frequency of activation: Coils should not be reactivated more often than once every 3

to 6 weeks, and they are never totally activated.

Elastics used: Class II elastics 4-6 ounces of force for 24 hours a day

Headgear used: Cervical headgear worn for 12 to 14 hours a day with 10-14 ounces of

force

Mandibular Stabilizing Wire: Continued

EIGHT SET OF ARCHWIRE

MAXILLARY ARCHWIRE: RETRACTION OF THE MAXIARY INCISORS

Wire used: .019”x.025”


a) A distinct curve of Spee is incorporated into both legs of the arch wire

b) Tie back bends are made mesial to the 2nd bicuspid brackets mesial to the 1st molar

and mesial to the 2nd molar. It is also made 1.5 mm anterior to the cuspid brackets.

c) Lingual root torque (anterior segment) is incorporated into the wire

d) Headgear hooks should be soldered occlusally on the wire between central incisor and

the lateral incisor brackets for the high pull headgear.

e) Intermaxillary hooks soldered in the V-bends between the lateral incisor and

canine for elastic wear.

f) Half inch long open coils are threaded on each leg of the archwire.

g) Stops are then soldered to the arch wire 1.5 mm anterior to both the 2nd bicuspid

brackets.

Method of ligation

a) The cuspid and 2nd bicuspid brackets are ligated together to of the spaced between

them.

b) The incisors are ligated to the arch wire.

c) The open coils are compressed against the stops 2.5 mm mesial to the 2nd bicuspid

brackets. This ligature is then tied to the 2nd bicuspid bracket.

d)The mesial bracket of the 1st molar and the 2nd bicuspid bracket ligated together.

e)The second molar tubes are ligated to the distal bracket of the 1st molar

Headgear wear :

The highpull headgear attached to the hooks located between the central and lateral

incisor- brackets.

Duration of wear: Not less than 14 hours a day

Elastic wear : Class II elastics are worn for 24 hours a day with 4-6 ounces of force.

NINTH SET OF ARCH WIRES

MAXILLARY ARCH WIRE: ROOT PARALLELING

Wire used: .0215" x .0275" multiple loop arch wire

Purpose of the wire:

1). Root paralleling of the cuspid and bicuspid teeth

2) Artistic positioning of the incisors

3) Seating the teeth in the buccal segments

4) Torquing root apices


a) Vertical closed loop is bent into the arch wire at the contact point between the

first molar and the second bicuspid.

Distal leg = 5 mm ; Mesial leg = 4 mm

b) A second closed loop is bent at the contact point between the 2nd bicuspid and

the cuspid tooth.

Distal leg = 5 mm ; Mesial leg = 4 mm

c) Molar stops are soldered 0.5 mm mesial to the molar tubes. d) Distinct curve of

Spee is incorporated into the arch wire.

e) Lingual root torque is placed into the incisal segment of the arch wire to

maintain the normal axial inclinations of the maxillary incisors.

MANDIBULAR ARCH WIRE: ROOT PARALLELING

Wire used: .0215X .0275

Bends incorporated in the wire are:

a) Vertical closed loops at the contact point between the 1st molar and the 2nd

bicuspid; and between the 2nd bicuspid and the cuspid tooth.

b) Distal leg of the vertical closed loop is 5 mm and the mesial leg is 4 mm.

c) stops are soldered 0.5 mm mesial to the mesial end of the tube

d) Torque is given depending on whether to maintain root apices in their original

position or move them back.

e) Second order bends of sufficient degree to maintain the mandibular molars in

upright position.

Headgear wear

Cervical pull headgear is worn to prevent mesial displacement of the mandibular

denture.

Elastic wear :

Up and down elastics are attached to the anterior maxillary loop and both

mandibular loops to form a triangle.

TENTH SET OF ARCH WIRES

MAXILLARY ARCH WIRE: ARTISTIC

POSITIONING

.

Wire used: .021 x .028

1) Grasp arch wire legs with the plier pointing away from you.

2) Approach arch wire from the lingual side, straddling mark between central

incisor and with the forefinger of the left hand press downward an equal amount

on both left and right sides of the arch wire.

3) Slide the holding plier to the mark between the left central and lateral incisors

straddling the mark.

4) Now bend up with the thumb of the left hand on mesial side of the arch wire

and down with forefinger on distal end an equal amount.

5) Repeat on the opposite side.

MANDIBULAR ARCH WIRE: ARTISTIC

POSITIONING

Wire used: .021" x .028"

1) Approach the wire from the lingual side, straddling median line with the plier

with round beak on the occlusal surface of the wire.

2) Press up on the arch wire on both right and left sides to the degree you wish the

central incisors to toe in towards the medial line.

3) Slide holding plier to left along arch wire and straddling mark between central

and lateral incisors.

4) With the forefinger of the left hand on median line bend down and with thumb

press upwards distal to holding plier.

5) Slide the holding plier to left, straddle mark between the central and the lateral

incisors and press down on the mesial side and upward with the thumb on the

distal side.

TREATMENT OF CLASS II NON-EXTRACTION

MALOCCLUSION

STEP 1: leveling. Correction of all rotations, closing of slight spacing in the

incisal area

SET 1: MANDIBULAR ARCH WIRE

a) Bent-in tie back stops are placed 0.5 mm anterior to the

molar tubes.

b) Bent-in vertical loops are placed between cuspids and first bicuspids on

either side. The distal leg of the loop is 5 mm

long and the mesial leg is 4 mm long, to start the elevation of the first

bicuspid teeth as well as depressing the cuspids and incisor teeth. Because

of the minor nature of any rotations, space closure can be started as one

of the initial movements.

c) The arch wire is made ideal in form

d) Distal tip-back bends are bent into the arch wire to be effective on all

teeth in the buccal segments to prevent mesial tipping of these teeth.

Terminal molar anti-rotation bends are very important.

e) The arch wire is ligated to the teeth and activated a total of 1 mm.

SET 1: MAXILLARY ARCH WIRE

Highly resilient .016" arch wire fabricated as follows

a) Bent-in tie-back stops are placed 1.5 mm mesial to the molar

tube.

b) Vertical loops 5 mm in length are bent into the arch wire mesial and

distal to the cuspid teeth in both right and left legs of the arch wire.

These loops are located at the contact points. The loops are slightly

bulbous gingivally with their legs in contact incisally.

c) The arch wire is made ideal in form with anti-rotation bends

in'the terminal molar area.

d) Tip-back bends are incorporated into the arch wire in the buccal segments

to prevent mesial tipping of these teeth.

e) An accentuated curve of Spee is bent into the arch wire.

f) The arch wire is ligated to the teeth and activated 1 mm on each side.

g) The patient is dismissed for four weeks.

SET 2: MANDIBULAR ARCHWIRE

Highly resilient .020” continuous ideal archwire is made to continue the leveling of

the curve of spee and complete the correction of all rotations. It is made as follows:

a) Bent in molar tie back stops to maintain arch length

b) Coordinated tip back bends are bent into the arch wire with accentuated

molar tip back bends

c) The archwire is off-set occlusally 1mm between the cuspid and first cuspid area to

elevate the first bicuspid and depress the cuspids and incisors. When correctly fabricated, a

curve of spee will have been bent into the archwire.

d) Ligate the archwire lightly to the terminal molars. The balance ties are optional

SET 2 : MAXILLARY ARCH WIRE

a) Tie-back loops are bent into each leg of the arch wire 0.5 mm mesial to

the molar tube.

b)The ideally formed arch wire is flattened somewhat at the incisal segment.

c) Mild second order bends are bent into the buccal segments and artistic

bends are bent in the incisal area of the arch wire. The terminal molar tip

back bend is twice as great in degree as the previous second order bends.

d) The curve of Spee is increased in degree by wiping action of the fingers

along the legs of the archwire.

e) Prior to inserting the arch wire, a .007" ligature is laced under the wings

of the brackets of the four incisor teeth to prevent the opening of spaces.

f)The arch wire is ligated to place, tying it to the terminal molar to prevent

mesial migration of the arch wire.

g) The patient is dismissed for four weeks.

STEP 2: MANDIBULAR ANCHORAGE PREPARATION

SET 3 : MAXILLARY STABILIZING ARCH WIRE

An ideal maxillary stabilizing arch wire is constructed. It is equipped with headgear

hooks, and tie back loop stops located 0.5 mm anterior to the molar tubes.

a). The archwire has mild second order bends, and as accentuated curve of

spee. The terminal molar tip back bends are approximately twice as severe as

the other second order bends

b)The arch wire is made passive in the incisal segment.

SET 3: MANDIBULAR ANCHORAGE PREPARATION ARCH WIRE

a) A mandibular ideal working arch wire is fabricated. Into this arch wire are

incorporated bent-in stop loops to maintain arch length and mild coordinated

second order bends.

b) The tip-back bends on the terminal molars are twice as severe as the other

second order bends in this arch wire. Brass hooks for Class III intermaxillary

elastic wear are soldered incisally to the arch wire.

c) The arch width is inspected in the mouth to check the coordination of all

second order bends. It is also checked for undesirable torque.

d) Arch length is slightly increased to create tension on the terminal molars

e).Both- maxillary and mandibular arch wires are checked for arch breadth and

coordination by superimposing the maxillary arch wire over the mandibular.

The arch wires are ligated to the patient's teeth in the following manner:

A) Maxillary arch wire

i) Ligate the four incisors first.

ii) Then ligate each of the teeth in the buccal segments from the cuspids back to and

including the mesial bracket on the first molar.

iii) The last tie is made from the terminal molar to tie-back loop to the distal

bracket of the first molar.

B) Mandibular arch wire

i) Tie in all four incisors first;. then ligate the cuspids on either side; next, ligate

the first bicuspids on either side; ligate the second bicuspids on either side; and

last, ligate the first permanent molars

ii) Do not tie the terminal molars to the arch wire. The reason for this sequence

of ligating the mandibular arch wire is that arch length has been slightly

increased and it is our desire to transmit force equally on the terminal molars to

start their distal tipping action.

iii) The patient is instructed to wear the Fisher type of headgear with the pull as

high up as the lobes of the ear will permit, for a minimum of 14 hours per day.

The distal force exerted by the headgear should not be less than twice the pull

exerted by the No.6 elastic, 6-8 ounces.

iv) The patient is instructed to wear No.6 intermaxillary elastics on either side

during the day and two No.6 elastics on either side during the time the headgear

is worn.

v) The elastics must be worn at all times - day and night, except when eating

and brushing the teeth. In addition, the elastics are replaced every night and

morning.

vi) Thus we have begun the second phase of treatment which is anchorage

preparation.

vii) When the patient returns for the next visit, the mouth is checked carefully. If

the maxillary terminal molars show no mobility and the teeth seem to be holding

nicely, this arch wire is not changed. If otherwise, it is removed and the second

order bends are slightly increased, particularly the terminal molar bends.

viii)In the mandibular working arch, all the second order bends are increased as

need be. The arch wire is polished in the lathe and replaced in the mouth after

increasing the, tip-back on the terminal molars. Keeping the arch wire wide in

the terminal area to prevent lingual rolling by Class III action of the elastics.

ix) The maxillary stabilizing arch wire is coordinated with the new mandibular arch

wire by referring back to the models and coordinating the maxillary arch wire over

the mandibular. The arch wires are ligated to place and the action continued until

anchorage preparation has been completed. At this time, a lateral cephalogram

should be made to check inclinations of the teeth in the buccal segments, particularly

the terminal molars, and also to check whether or not displaced mandibular incisor

root apices are giving a false IMPA reading.

STEP 4: DISTAL ENMASSE MOVEMENT OF THE MAXILLARY DENTURE

Treatment mechanics must now be reversed. The mandibular arch must now become the

anchorage or holding arch wire unit.

A) Mandibular arch wire: .

i) The .019" x .025" mandibular arch wire is replaced by an .0215" x .0275" stabilizing arch

wi""e. Into this new arch wire, second order bends must be made that are identical to those

that were fashioned into the .019" x .025" arch wire used during anchorage preparation.

The new wire must be passive in the mandibular incisal area.

ii) It is made ideal in form, checked on the original malocclusion for cuspid and molar

breadths, carefully examined for adverse torque, heat treated, polished for 10 seconds in the

anodic polisher and set aside until it can be coordinated with thenew maxillary arch

wire, the fabrication of which is now described.

B) Maxillary arch wire

i) The maxillary .0215" x .0275" arch wire is made ideal in form. All necessary primary,

secondary and torque bends are incorporated into the arch wire. It is then heat treated and

reduced distal to the lateral incisors in the anodic polisher to working arch dimensions

of .019" x .025".

ii) It has been found expedient to maintaSn the .0215" x .0275" caliber of the arch wire in

the maxillary incisal area to control torque in this area, so that at the completion of

treatment, the maxillary incisor teetth inclinations will be within normal range and not

retruded.

iii) In case of the slightest mobility in the terminal molars, the dist~l tip-back bend is

increased and a slight amount of progressive lingual crown torque is incorporated into the

legs of the arch wire.

iv) Also, during this period of treatment the section of the arch wires, both maxillary and

mandibular between the cuspids and first bicuspids, should be altered and lengthened in

such a manner as to elongate all four first bicuspid teeth and depress all four cuspid teeth.

as well as both maxillary and mandibular incisors. By doing so, an excessive overbite

condition will be aligned when treatment is terminated.

v) Occasionally during this third step in treatment, the bite will have a tendency to open.

Two things can cause this undesirable movement; lack of patient cooperation in wearing

the intermaxillary elastics as directed, or and more probably the placing of step-up bends

rather than tip-back bends in the arch wire.

vi) Whatever the cause, check the second order bends in each arch wire and solder gingival

spurs on each of the arch wires, between central and lateral incisors and instruct the patient

to wear up and down elastics in conjunction with the Class II intermaxillary elastics. When

the bite begins to open! the forces within the arch ~ire are being directed upwards and

downw!rds rather than posteriorly. The up and down elastics counteract the depressing

forces and the result is usually the distal movement of the maxillary denture.

vii) When the enmasse movement of the maxillary teeth have been completed andchecked

for permanency of positions by discontinuance of both headgear and intermaxillary pull

for atleast two weeks, another lateral cephalogram is taken to check tooth inclination and

tooth apices prior to beginning the final phase of treatment.

STEP 4: ARTISTIC POSITIONING OF TEETH PRIOR TO RETENTION

i) Two new arch wires of .0215" x .0275" are fabricated ideal in form with particular

emphasis not to exceed normal cuspid breadth.These arch wires are carefully

coordinated one to the other so far as breadth is concerned. Each carries bent

in stop loops maintaining arch length. Each have bent into them second order or

tip-back bends and torque identical in degree to the arch wire they are to replace.

These arch wires are then heat treated and reduces in the anodic distal to the lateral

incisor brackets to a dimension of approximately .019" x .025". The caliber of these

arch wires in the incisor segments remain .0215" x .0275" for torquing forces, if they

are necessary.

ii) Prior to soldering gingival spurs on either leg of each of the arch wires, the

curve of spee in the maxillary arch wire should be increased. The mandibular arch

wire should be altered so that it has a reverse curve of Spee. The spurs for up and

down elastic wear should be placed on the respective arch wires so that in

addition to up and downpull, the elastic pull is also slightly Class II in nature.

iii) The maxillary arch wire also carries .032 II hooks for headgear or further

intermaxillary elastic usage, if they are necessary. It is advisable to have the patient

wear the up and down elastics as much as possible in conjunction with light Class II

intermaxillary elastics.

iv) No attempt should be made to reduce the severity of the second order bends

during this phase of treatment. However. careful attention should be given to the

artistic positioning bends in the incisal segments.

v) The maxillary central incisors should toe-in slightly towards the median lne as

should the lateral incisors. In addition, the lateral incisors should be

approximately be 0.5mm shorter than the centrals. The mandibular central and

lateral incisors should be of equal height, but incline gracefully towards the

midline.

TREATMENT OF CLASS III MALOCCLUSION

STEP 1: LEVELING

Leveling and the correction of all rotations with a series of round arch wires, the first of

which is:

SET 1: MAXILLAY AND MANDIBULAR

The mandibular .016" multiple loop arch wire is constructed to start narrowing the too wide

mandibular arch.

The maxillary .016". arch wire is expanded and arch length increased to eliminate

cuspid crowding. These arch wires are replaced at the second visit by ideally

formed continuous .018" arch wires.

SET 2: MAXILLARY AND MANDIBULAR

A mandibular .018" ideal arch wire is made. Arch length is maintained by bent-in

stop loops. The stop loops must be of such a size that they become an attachment

for cross-bite elastic wear. The arch wire is constricted 0.5 inch in the molar area.

A maxillary .018" ideal arch wire is made. Arch length increased or maintained as

required. It is expanded 0.5 inch the molar area.

The patient is instructed to wear strong cross-bite elastics the lingual hook on the

maxillary first molar to the stop mesial to the mandibular second molar tube.

STEP 2: MESIAL ENMASSE MOVEMENT OF TEETH

SET 3: MAXILLARY WIRE:

i) A maxillary ideal working arch wire .019" x .025" is fabricated.

ii) The arc wire is expanded 0.5 inch in the molar area. Progressive lingual crown

torque is incorporated into both legs of the arc wire from the cuspid to terminal

molar. To be effective the torquing bends must be very pronounced due to

the .019" x ..025" dimensions of the archwire.

iii) Tip forward bends, which are the direct opposite of tip-back bends are

incorporated into this arch wire, from cuspid to terminal molar. This arch wire

requires no molar stops.

iv) The arch wire is ligated to the teeth and class III intermaxillary elastic force is

applied to move the maxillary denture forwards.

v) During this procedure, cross-bite elastics are worn from the lingual hooks

soldered to the first bicuspid and molar bands to gingival spurs soldered to the

stabilizing mandibular arch wire between first and second bicuspids and first and

second molars.

vi) The mesial movement of the maxillary denture is continued until the condition

seems to be over-treated. At this time, both arch wires are removed from the

mouth. Off-set bends are made in each arch wire. These off-set bends are made

between cuspid and lateral incisors in both arch wires. The nature of the bands in

each arch are such that the incisal segments are elongated to develop a deep

overbite. When these wires are correctly bend, the mandibular arch wire will have

the appearance of a deep curve of Spee and the maxillary arch wire a reverse

curve of Spee.

vii) Spurs for up and down elastic pull are soldered gingivally to both arch wires

in the area of the arch wire between the central and lateral incisors. Light Class III

intermaxillary traction is continued with up and down elastic pull in the incisal

areas to seat the cusps. When the cusps have been seated and an overbite of atleast

one half the length of the mandibular clinical crown has been attained, the case is

ready for its final adjustment prior to retention. This adjustment concerns the

correction of the abnormal buccolingual axial inclinations of the teeth in the

buccal segments.

viii)Both arch wires are ligated to the teeth by means of torquing keys and ligature

tying pliers. Small but powerful cross-bite elastics are engaged to the lingual

hooks previously soldered to the maxillary first bicuspid and first terminal molar

bands. The other ends of the cross-bite elastics are attached to the spurs soldered

to the gingival surface of the mandibular arch wire between first and second

bicuspids and between first and second molars.

STEP 4: ARTISTIC POSITIONING

SET 4: MANDIBULAR

i) A mandibular ideal stabilizing arch wire is made. It is made passive in the incisal

area and passive mesio-distally in the buccal areas because we want no tipping of these

teeth.

ii) Progressive lingual root torque in placed in both legs of the arch wire. Stops are

soldered to the arch wire to maintain arch length and for tie-back purposes. The stops

must be long enough gingivally to accommodate the cross-bite elastics.

iii) Additional stops are soldered gingivally on the arch wire between the first and

second bicuspid teeth to accommodate additional cross-bite elastics. These additional

cross-bite elastics are worn from the hooks soldered to the lingual surface of the

maxillary first bicuspid band to the stop on the mandibular arch wire between first and

second bicuspids. In addition, intermaxillary hooks are also soldered to the gingival

surface of the wire between lateral incisor and cuspid.

iv) The arch wire is constructed in the molar area atleast 0.5 inch. This arch wire

should be passive mesio-distally with no second order bends. The only force in the arch

wire is torque in the buccal segments. The terminal molars are tied to the arch wire to

prevent their movement and enhances anchorage.

SET 4: MAXILLARY

i) The mandibular stabilizing arch wire used in set 5 arch wires.

ii) The new maxillary ideal arch wire of .0215" x .0275" dimensions is now made. Into

this arch wire are bent step forward bends in the buccal segments and offset bends

between lateral incisor and cuspid identical in degree to those that were incorporated

into the working arch wire that is being replaced. Pronounced progressive lingual

crown torque or buccal root torque is incorporated into both legs of the arc wire from

cuspid to terminal molar. To be effective, the degree of torque must be such that a

torquing key or pliers must be used to seat the arch wire in the bracket slots. The arch

wire should be made passive in the incisal segment. Spurs should be soldered to the

new arch wire in the identical positions as those attachments carried by the replaced

working arch wire.

iii) The maxillary arch wire is bent so that it is considerably wider than the ideal, about

0.5 inch. Inspite of the fact that the considerable expansion is placed in the arch wire, it

is nullified by torque in the arch wire, which will be expending its energy in moving

the roots of the teeth buccally and lingually.

iv) The mandibular arch wire is carefully checked to make certain that the progressive

lingual root torque is of such a nature and magnitude as to move the roots of the teeth

in

the buccal segments lingually and their crowns buccally, when it is ligated to the teeth.

This arch wire is reduced in breadth by 0.5 inch.

EVALUATION

TYPODONT GRADING SHEET

Ideal Arches Name: Date:

GRADE SIGNATURE

First Order Bends Maxillary Mandibular

Second Order Bends Maxillary Mandibular

Third Order Bends Maxillary Mandibular

Class I Bimaxillary Protrusion

Name: Date:

GRADE SIGNATURE

.016" Maxillary Levelling Wire

.016" Mandibular Levelling Wire



.021"x .028" Maxillary Stabilizing Wire

.019"x .025" Mandibular Anchorage Wire

.019"x .025" Mandibular Canine Retraction

.019"x .025" Mandibular Anterior Retraction

.019"x .025" Maxillary Anchorage Wire

.021"x.028" Mandibular Stabilizing Wire

.019"x .025" Maxillary Canine Retraction Wire .019"x .025" Maxillary Anterior Retraction Wire

.019"x .025" Maxillary Root Paralleling Wire

.019"x .025" Mandibular Root Paralleling" Wire

.021"x .028" Maxillary Artistic Positioning Wire

.021"x .028" Mandibular Artistic Positioning Wire

Class II Division 1 Malocclusion

Name: Date:

GRADE SIGNATURE





.021"x .028" Maxillary Stabilizing Wire

.019"x .025" Mandibular Anchorage Wire

.019"x.025" Maxillary Distal En Masse Wire




Class III Malocclusion

Name: Date:

GRADE SIGNATURE




.018" Mandibular Levelling Wire .019"x.025” Mesial En Masse Wire




RECOMMENDED READINGS

BOOKS: 01 Athenasiou Orthodontic cephalometry 02 Bennett &

McLaughlinOrthodontic management of dentition with the preadjusted appliance

03 Clark Twin block functional therapy 04 Enlow Essentials of facial growth 05 Gardiner, Leighton,

Luffingham.Ashima Valiathan

Orthodontics for dental students

06 Graber & Swain Current orthodontic concept and technique 07 Graber & Vanarsdal Orthodontics-current principles and technique 08 Jacobson Radiographic cephalometry 09 Melson Controversies in orthodontics 10 Moyers Handbook of orthodontics 11 Nanda Biomechanics in clinicalorthodontics 12 Nikolai Bioengineering analysis of orthodontic mechanics 13 Graber, Petrovic &

RakosiDentofacial orthopedics with functional appliances

14 Proffit Contemporary 15 Tweed Clinical orthodontics Vol.1 & 2 16 Ricketts Bioprogressive therapy 17 Salzman Practice of orthodontics Vol.1& 2 18 Michael Riolo Textbook of orthodontics

JOURNALS:1. American Journal of Orthodontics and Dentofacial Orthopedics2. Angle Orthodontics3. Journal of Orthodontics4. Journal of Clinical Orthodontics5. European Journal of Orthodontics6. Seminars in Orthodontics7. Journal of Indian Orthodontic Society.8. World Journal of orthodontics9. Australian Orthodontic Journal

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