Roth philosophy /certified fixed orthodontic courses by Indian dental academy

THE ROTH PHILOSOPHY

INDIAN DENTAL ACADEMY

Leader in continuing dental education www.indiandentalacademy.com

www.indiandentalacademy.com

In 1968, R . H ROTH was introduced to Dr. L.F.

ANDREWS of San Diego

Roth started using straight wire appliance in his practice

in 1970 when Andrews gave him the first set of prototype

brackets that were welded into pinched band material

and had been machined at great expense.

After seeing the treatment progress of the first patient, he

purchased the first commercially available Andrews

brackets and started all his new cases with SWA.

By the mid 1973,he switched his entire practice over to

the SWA and rebonded all the patients who still had

edgewise brackets.www.indiandentalacademy.com

He did extensive work in Andrews SWA and published two articles namely

1.Five year clinical evaluation of Andrews SW appliance.(1976 jco)

2.The SW appliance 17 years later (1987 jco).

He started designing his own prescription as a clinical trial and error evaluation that lasted severed years.

Cases were evaluated by the use of

•Intra oral photograph and

•Mounted models for tooth positions

During treatment and

At the end of appliance therapywww.indiandentalacademy.com

According to him teeth tend to relapse back from which

they started, and if counter-tip, counter-rotation,

counter-torque, and leveling of the curve of Spee were

applied to the SWA in every possible direction, then it

should be possible to use primarily one prescription for

most cases, and to finish to an "END OF APPLIANCE

THERAPY" goal in which all tooth positions are slightly

overcorrected and from which the teeth will most

likely settle into non-orthodontic normal positions

So with the concept of overcorrection he designed his

comprehensive prescription using the available

Andrews extraction brackets. www.indiandentalacademy.com

THE ROTH Rx

In 1979, Roth

introduced a bracket

setup containing

modifications of the tip,

torque, rotations and

in out movement of the

Andrews standard setup

brackets.

Ronald H. Roth


The major difference between the Andrews philosophy and the Roth approach to the use of the straight wire appliance has to do with the manner in which the teeth are moved and not necessarily the desired end result or the result attained.

ANDREWS attempts to translate teeth throughout treatment without ever tipping teeth. This leads to the necessity of utilizing sliding mechanics and number of different series of brackets to solve the problem of translating teeth depending on how far the teeth must be moved.

In the ROTH approach, tipping of teeth is allowed, by using round wires in the initial phase of the treatment, but the attempt is to keep the tipping to a minimum wherein it is not necessary to resort to complex mechanics to do the uprighting


Andrews' occlusion study was based purely upon anatomical measurements of tooth positions on untreated normals.

According to him teeth should be positioned from an “ANATOMICAL STANDPOINT’”

Roth’s occlusion study was based purely upon pantographically recorded and mounted a large number of post-treatment orthodontic cases on the Stuart articulator

According to him natural teeth should be positioned from a “GNATHOLOGICAL STANDPOINT”


Andrews SW appliance…..

Andrews collected 120 Non orthodontic models. He studied these models anatomically and laid down his “six keys to normal occlusion”

I MOLAR RELATION IV ROTATIONS

II CROWN ANGULATION V TIGHT CONTACTS

III CROWN INCLINATION VI CURVE OF SPEE

•After determining the “six keys to normal occlusion” he

made certain measurements in the non orthodontic

models which helped him in the development of SWA

Andrews original standard straight wire brackets were

designed to treat only non extraction cases with an ANB

differential of less than 5º without the necessity of putting

offset bends into the wire.


Then he introduced the extraction brackets which had

counter tip and counter rotations built in, to allow

translation of teeth as much as possible and to offset any

relapse tendency.

Later he introduced different series and sets of brackets

for different combinations of extractions, and differentials,

and anchorage requirement

He developed a special classification of malocclusion and

prescribed various bracket series for treatment of each, to

allow translation of teeth without the need for bending

offsets and also to allow for over correction in view of

relapse tendencies.www.indiandentalacademy.com

- what made roth to modify Andrews SW appliance

Inventory problem-To treat different cases clinicians were to buy band kits for all Andrews sets and series. They are very extensive inventory on the self. Also, changing anything about the appliances would be prohibitively expensive.

Anchorage loss -When mesially angulated brackets are placed on the posterior teeth, the teeth tend to tip mesially and migrate forward that resulted is anchorage loss.

Problem in finishing - To achieve desired tooth positions with the standard SWA, it was necessary to finish the mechanotherapy phase of treatment by placing compensating and reverse curve in the upper and lower archwire.


Roth's rationale for his bracket set up.

The purpose of the Roth setup was to provide over

corrected tooth positions prior to appliance removal that

would allow the teeth in most instances to settle to what

was found is non orthodontic normals studied by

Andrews.

•With the appliance in place, it is virtually impossible,

because of bracket interference, to position the teeth

precisely into the occlusion shown by the non orthodontic

normal sample.

•After appliance removal no matter how well treated the

patient may be, the teeth will shift slightly from the

positions they occupied at the time the appliance were

removed


•Play or tipping freedom - Due to the play between the archwire and bracket, the delivered tip, torque and rotations forces are less than the designated amount “built in” the slot which need over correction to compensates for play.

•The curve of Spee will return or deepen after appliance removal.

•Teeth adjacent to an extraction site will tend to rotate and tip towards the extraction site.

•As teeth in the buccal segments settle they will rotate and tip mesially, so if they are overcorrected and slightly tipped distally, they will tend to settle better than teeth that are already mesially inclined.

•As band spaces close, there is a corresponding loss of torque of the anterior teeth.www.indiandentalacademy.com

OVERCORRECTION

Extracted teeth with Roth Rx SWA brackets, showing over correction built in to the brackets

Extracted teeth with Andrews SWA brackets showing non – orthodontic normal tooth position.


ROTH CONCEPT OF SELECTION OF TREATMENT MECHANICS

Thorough diagnosis

Establishing treatment goals

Dynamic treatment planning


The traditional method of selecting treatment

mechanics, based on the Angle's classification of

malocclusion, is inadequate.

Treatment mechanics should be selected by the

set of conditions that exist along with the

parameters that are placed on the situation.

(The treatment mechanics must be tailored to the

individual situation and the individual facial type).


•In diagnosis and treatment planning, it is necessary to diagnose the case from a mandibular position of centric relation, if one wish to treat centric relation occlusion.

•One must utilize a specific set of criteria for a functional occlusion goal throughout diagnosis, treatment planning, and retention

•One must have records. (Standard orthodontic models and cephalometric centric relation head films) taken in centric relation as well, if any significant centric discrepancy exists in a particular case


CO - CR discrepancy

The neuromuscular positioning of the mandible will accommodate to existing occlusal discrepancies and hide the true nature of malocclusion

So a REPOSITIONING SPLINT should be fabricated

•To get the patient's mandible into centric and

•To make the true discrepancy apparent.

Once the discrepancies are apparent, one should make a treatment plan to deal with all of the discrepancies present in the case and not just one to cover only those discrepancies he can see intraorally.


•Those that are used on

normal to brachyfacial types.

Those that are used for the more dolichofacial types

TREATMENT MECHANIC


TREATMENT MECHANIC SELECTIONS - FACTORS TO BE CONSIDERED.

•The facial type of an individuals.

•Reactions of various facial types to the proposed

treatment.

•How much growth remains and in which direction the

mandible can be expected to grow and what means must

be taken to alter the direction of this growth - favourably

with treatment mechanics.

•Effect of treatment mechanics on the patient's soft

tissue profile.


TO PLAN AND TO SELECT APPROPRIATE TREATMENT MECHANICS, ROTH UTILIZED.

•An adjusted head film tracing from centric

(habitual) occlusion to centric relation.

•Ricketts VTO and

•The five position superimposition

•Jarabak analysis

.


The five position superimposition is utilised to quantify

•The amount of growth needed to correct the jaw relationship.

•The amount of orthopedic changes or jaw relationship changes necessary to correct the dental arch relationship and

•The extent of tooth movement allowable or desirable both anteroposteriorly and vertically of the anterior and posterior teeth in each arch.


Jarabak analysis

For qualitative assessment of the facial type and its probable response to the various kinds of treatment mechanics and growth.

The most important measurementsare

•The anterior to posterior face height ratio,

•The tendency of the individual facial type

to rotate clockwise or counter clockwise

during growth, and

•a response to certain treatment mechanics


Treatment goals

1. Pleasing facial esthetics, evaluated by soft tissue and skeletal measurements cephalometrically.

2. Molar relation and tooth alignment, evaluated by Angle's description of anatomical occlusion.

3. Functional occlusion, evaluated gnathologically on an articulator.

4. Stability of postreatment tooth positions and alignment.

5. Comfort, efficiency, and longevity of the dentition, supporting structures, and the temporomandibular joints.


ROTH'S ORTHODONTIC TREATMENT GOALS FOR AN IDEAL FUNCTIONAL OCCIUSION

.I- Centric occlusion or

maximum interuspation of

the teeth should occur

with the mandible in

centric relation, in which

they condyles are

centered transversersy

and seated against the

articulator disks at the

posterosuperior slopes of

the eminencewww.indiandentalacademy.com

This centric relation occlusion should have three point

contact of the opposing centric cusps in their respective

fossae.

II- Mutually protective occlusion

Occlusal force during closure should be of equal magnitude for all posterior teeth and the stress should be directed along the long axes of the teeth and the lower incisors should not be in contact with the lingual surface of upper incisors and should have a clearance of 0.005 inch

(by transmitting all the occlusal

forces, the centric stops of the

posterior teeth will protect the

anterior teeth from lateral stress).www.indiandentalacademy.com

Anterior guidance / incisal guidance

In straight protrusion the anterior teeth should serve as a gentle glide path to disclude the posterior teeth very gently. To have such anterior guidance, there should be minimal but sufficient anterior overbite.

In the absence of anterior guidance,

excessive lateral stress on the

cuspids may cause lingual movement

of the lower cuspids and resultant

lower anterior crowding, and/or

labial movement of the maxillary

cuspids and affects post treatment

stability.

No stress


Canine guidance / canine rise In lateral excursions the maxillary

cuspids should act as guiding inclines to disclude the teeth on

the balancing or non-functioning side and to disclude the teeth on

the working or functioning side after approximately .5mm of group contact.

balancing working

R L


In a "mutually protective" occlusion

•The anterior teeth protect the posterior teeth from

lateral stress during protrusive movement and

The posterior teeth protect the anterior teeth from lateral

stress during closure into centric relation occlusion

•So in a mutually protective occlusion, the mandible can

execute its total range or envelope of motion without

interference from the teeth and

During closure the teeth will direct and maintain centricity

of the condyles in the fossae


III -Tooth-to-two-teeth or cusp-embrasure occlusion

During maximum intercuspation, there should should be

Tooth-to-two-teeth or cusp-embrasure occlusion between

the upper and lower teeth, because this make the lateral

and protrusive movements with proper cuspid and incisor

contact.

IV- Tooth structure, tooth position

and occlusal form should correlate

perfectly with mandibular border

movements, including the Bennett

movement and immediate side shift.


ROTH'S ORTHODONTIC TREATMENT GOAL FOR AN

IDEAL STATIC OCCLUSION.

In terms of tooth alignment, the goal primarily is one is in very close harmony to that described by Andrews in his "six keys to normal occlusion".


ROTH SETUP

Roth setup is available in both 0.018 and 0.022 slot

Roth preferred 0.022 slot brackets because it offered

more advantages

•In terms of wire size selection,

•In terms of stabilizing arches as anchor units and for

orthognathic surgery and

•For control of torque in the buccal segments, which is

very important from the standpoint of functional

occlusion. www.indiandentalacademy.com

The Roth setup incorporated into it a member of hooks for various types of elastic configuration and also double triple and lip bumper tube for the use of auxillary wires and attachments.


Bracket positioning with Roth set up

The bracket placement vary slightly from the position advocated by Andrews, thus a flat, unbent, rectangular, full sized wire can be used as the finishing wire rather than one with reverse and compensating curve.

Reference point – Andrews FA point

The point on the facial axis that

separates the gingival half of the

clinical crown from the occlusal half.

The key in determining the bracket height is the canine and premolars (second premolars is an extraction case).

Ideally the center of the bracket should be placed at the maximum convexity of the crowns of the posterior teeth. In a teeth with average height of gingival attachment, the maximum convexity of the teeth will be at the center of the clinical crown.


Molars(upper/lower)

From the buccal From the occlusal

Both the right and left bands should be checked to ensure that they are in the same relative position on the crowns

M B


Premolars(upper/lower)


Upper premolar bracket placement is the most variable because of tooth size. The most common error is not placing the bracket gingival enough, especially on smaller sized teeth.


Upper and lower Canine



Upper and lower incisors


Upper arch

Central tip torque rotation

Andrews 5 7 0

Roth 5 12 0

Lateral 9 3 0

9 8 0

If it is increased the resultant axial is esthetically and functionally undesirable

The 5° torque increase in torque improves

•Ethetics by preventing flattened profile, straight upper lip and obtuse nasolabial angle.

•Provide more space for lower anterior teeth, thereby aiding classI intercuspation and

•Establish proper anterior guidance & prevent lateral stress in posterior segments


Upper canine

tip torque rotation

Andrews 11 -7 0

Roth 13 -2 4M(mesial)

•Increased because they are being retracted in most treatment.

•Less negative torque to offset the reciprocal effect of building more positive torque into the incisors.


I&II PM tip torque rotation

(A) 2 -7 0

(R) 0 -7 2D

IM &IIM (A) 5 -9 10

(R) 0 -14 14D

• Elimination of the mesial tip on all buccal segment teeth strengthened anchorage control significantly (but burning anchorage can be difficult).

•To offset mesial the rotation that accompanies distal traction

•The distal rotation of mesiobuccal

cusp with reciprocal mesial rotation M B

of mesiolingual cusp due to which cusp

the cusp to cusp relation is changed

to class I molar relation.


LOWER ARCH

CENTRAL &LATERAL

tip torque rotation

(A) 2 -1 0

(R) 2 -1 0

CANINE

(A) 5 -11 0

(R) 7 -11 2M


I PM tip torque rotation

(A) 2 -17 0

(R) -1 -17 4D

II PM 2 -22 0

-1 -22 4D

I M 2 -30 0

-1 -30 4D

II M 2 -35 0

-1 -30 4D

• Because these teeth settle more mesially than the upper and simultaneously rotate mesially thus necessiating extra distal roration

• No change in the torque-To establish proper functional occlusionwww.indiandentalacademy.com

ROTH TRU-ARCH FORM

Roth Tru-Arch form was derived from his

extensive clinical testing and recording of jaw-

movement patterns in treated patients who were

out of retention and had remained stable.


. The Roth Tru-Arch form actually overcorrects the arch width slightly.

In the front part of the arch, the widest part is at the bicuspids, not at the cuspids.

The widest point in the entire arch is at the first molars region,(mesiobuccal cusp of I molar) There are actually five arcs in the Arch

•A curve across the front

•A Curve in cuspid-bicuspid area

•A uniform curve in the buccal

segment to allow for proper

rotational position of the buccal

segment teeth.www.indiandentalacademy.com

SEQUENCING OF TREATMENT OBJECTIVES

The sequence of the treatment should be based on

the dictates of the individual case. The sequence of

treatment objectives are generally.

1. Eliminating cross bite

2. Correcting jaw relationship

3. Eliminating severe crowding creating space in the

dental arches for severely malposed, impacted or

blocked teeth,

4. Aligning the teeth in the individual arches,

5. Beginning space consolidation


6. Finishing the lower arch

It is of utmost importance that the lower arch must be finished in the correct position to act as a template to receive the upper teeth, so that the upper teeth can be set to the lowers

7. Achieving class I relationship of buccal segment,

8. Retracting and as if necessary intruding maxillary arterior teeth.

9. Detailing and finalizing the tooth position and the occlusion.

In many instances a number of these steps will be combined and will be occurring simultaneously. www.indiandentalacademy.com

THE THREE PHASES OF TREATING MALOCCLUSION

INCLUDES

Phase I unlocking the malocclusion

Phase II Working phase.

Phase III Finalization or detailing of occlusion

•To initial phase of treatment usually entails the use of some of the following appliances

•Split palate Hass - type appliance

•Quard helix

•Transpalatal bar and / or a lingual arch

•An occipital pull headgear or facebow to the 6 years molar

•Utility arch. www.indiandentalacademy.com

Anchorage consideration

Factors responsible for anchorage loss

1. Attempting to upright extremely distally tipped canines.

2. Pulling distally with posterior teeth against extremely procumbent or labially inclined incisors.

3. Attempting to level the curve of Spee with a continuous wire without the use of distal traction.

4. Attempting to do any of the first three tooth movements utilizing either a stiff or a resilient wire.

5. Attempting to move lingually or torque the maxillary incisor roots.

6. Attempting to expand the mandibular arch with a labial archwire.


some of the ways in which one can avoid using extra oral traction or losing anchorage are

•The leveling process should be started with a small

flexible wire. The best for this purpose is the braided arch

wire.

•When it is time to retract and upright lower anteriors

that have been in labial or procumbent position, they

should be retracted initially with an anterior facebow. In

most instances 6 to 8 weeks of headgear to the lower

anterior segment is all that is needed to upright the lower

anterior teeth sufficiently that the remainder of the space

can be closed with reciprocal mechanics. www.indiandentalacademy.com

•Band the second molars at the outset of full dentition

treatment and use them for anchorage. It is much more

difficult to displace the buccal segments in the

mandibular dental arch forward if the second molars have

been included as part of the anchorage unit.

•When leveling the curve of Spee, wherever possible a

utility arch should be used to intrude the incisors followed

by canine by Bioprogressive technique and then going to

the flexible small wires to gain bracket engagement and

alignment of the entire arch and gradually level the

remainder of the curve of Spee.


Phase I treatment

•Helical loop archwires, Jarabak fashion made from 0.016”

Elgiloy green wire(crowing) or

0.015” braided archwire(routinely)

or

Nitinol(severe rotation)

• 0.019” braided wire

• 0.018”Australian special plus.(finalisation of any stuborn rotation)

•0.019” square blue Elgiloy utility arches are used in case of intrusion of incisor teeth.


Second phase of treatment.

Anterior teeth are generally retracted en masse as a group of 6 second molars are routinely banded at the outset of treatment in the permanent dentition.

Double keyhole loop wire mechanics (0.019 x 0.026” round edge rectangular)- In case of minimum and moderate anchorage cases-

Modified Asher facebow- used in cases that need maximum anchorage and retraction.


At the end of space closure

Double keyhole loop wire mechanics

0.018x0.025” blue elgiloy incorporating exaggerated R &

C curve with special torque adjustments(to offset the the

undesirable effect produced by R & C curves) to provide

•Rapid root paralleling

•Leveling of Curve of spee &

•Maxillary incisors lingual root torque

Replaced by


During extraction space closure, faster the space is closed, regardless of wire size, the more tipping there will be into the extraction space.

So it is the force & rate at which the extraction space is closed determines the type of tooth movement(tipping or bodily) and not the dimension of the wire used.


FINISHING PHASE

. The final finishing phase of treatment require filling of the bracket slot (0.022 x 0.025) to get full bracket expression.

Short class II or III elastics are used to create anteroposterior denture adjustments.

DETAILING OF TOOTH POSITION

THE MANDIBULAR ARCH

Lower incisors

•The sequence of tooth positioning

begins with placing the lower incisors

teeth at or slightly lingual to the

cephalometric goal. (-1 to A-Pog)www.indiandentalacademy.com

over jetOver bite

2.5 mm 2.5 mm 0.005”


•The four incisors teeth should have the roots divergent and roots appears to be in the same plane of space when viewed from the superior aspect.

•Lower cuspid crowns should have 5 degrees angulation with the incisal tip 1mm higher than the incisal edge of, the lateral incisors And it should have should have a slightly exaggerated mesial rotation on extraction cases.

•There should be overcorrection of root parallelism in the extraction site, if extractions were done.


•Bicuspids and molars should be upright and should have slight distal rotation.

•There should be no spaces, and the arch form should be symmetrical.

•The widest point of the mandibular arch should be the mesiobuccal cusps of the maxillary Imolars and the I bicuspid.

•The curve of Spee should be leveled.(because it return to a 1- 1.5mm curve, at its deepest point, after appliance removal and settling of the occlusion


MAXILLARY ARCH

In the upper arch, the first tooth to be placed properly in relation to the lower arch should be the maxillary six-year molar.

The upper six-year molars should have sufficient distal rotation, mesioaxial inclination, and buccal root torque, so as to fit with the lower six-year molars, as described by Andrews

The maxillary twelve-year molar

The upper bicuspids

The upper anteriorswww.indiandentalacademy.com

•The incisal edges of upper centrals and laterals should

be almost at the same level with no more than 0.5mm

height differential approximately

•The widest point of the maxillary arch should be the

mesiobuccal cusps of the maxillary six-year molars.

•Cusp tip of the canine should be app 1-1.5mm incisally

than the of the occlusal plane.


ROTH’S CONCLUDING STATEMENT

“I have tried to present a philosophy of treatment with the concept of overcorrection, based on the specific set of goals stated at the outset, taking in to account existing conditions, facial types, and reaction to treatment mechanics.

Naturally there are always exceptions to the way one approaches treatment”


REFERENCES

•Treatment mechanics for the straight wire appliance- RONALD H. ROTH

•orthodontics - current principles and techniques- Thomas M. Graber, Brainerd F. Swain

•Treatment concepts using the fully preadjusted three-dimensional appliance- RONALD H. ROTH

•Orthodontics- current principles and techniquesThomas M. Graber, Robert L. Vanarsdall

•Five year clinical evaluation of the Andrews S-W appliance- Roth

•The straight wire appliance 17 years later- Roth

•Functional occlusion for orthodontics-Roth-part I II III IV

•Straight wire design strategies - five year clinical evaluation of the Roth modification of Andrew SW appliance-Lee W. Graber.


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Roth philosophy /certified fixed orthodontic courses by Indian dental academy