Post on 31-Mar-2015
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.
The bends incorporated in the wire are :
* 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
The bends incorporated in the wire are:
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"
The bends incorporated in the wire are:
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"
The bends incorporated in the wire are:
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
The bends incorporated in the wire are :
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"
The bends incorporated in the wire are :
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”
The bends incorporated in the wire are:
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
The bends incorporated in the wire are :
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
.018" Maxillary Levelling Wire
.018" 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
.016" Maxillary Levelling Wire
.016" Mandibular Levelling Wire
.020" Maxillary Levelling Wire
.020" Mandibular Levelling Wire
.021"x .028" Maxillary Stabilizing Wire
.019"x .025" Mandibular Anchorage Wire
.019"x.025" Maxillary Distal En Masse Wire
.021"x.028" Mandibular Stabilizing Wire
.021"x .028" Maxillary Artistic Positioning Wire
.021"x .028" Mandibular Artistic Positioning Wire
Class III Malocclusion
Name: Date:
GRADE SIGNATURE
.016" Maxillary Levelling Wire
.016" Mandibular Levelling Wire
.018" Maxillary Levelling Wire
.018" Mandibular Levelling Wire .019"x.025” Mesial En Masse Wire
.021"x.028" Mandibular Stabilizing Wire
.021"x .028" Maxillary Artistic Positioning Wire
.021"x .028" Mandibular Artistic Positioning 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