FALL 1994

EDGELINES

Published Quarterly In The USA

© 1994 Two Swan Advertising Agency

APPLIANCE UPDATES - Q’S & A’S - CASE REPORTS - TECHNIQUE TIPS - REVIEWS

Tip-Edge® Brackets Can BenefitAll Edgewise Techniques

Through Variable Anchorage ControlThe Tip-Edge bracket fea-

tures the first and only archwireslot that offers variable controllevels. It’s .022" archwire slotcan increase in size to .028" rela-tive to the archwire during re-traction yet close back down to.022" to facilitate final finishing.Variable control eliminates theexcessive anchorage strain andbite deepening that occurs dur-ing retraction with conventionaledgewise appliances. This inturn allows for far simpler treat-ment mechanics and much lessreliance on extraoral forces.1

Surprisingly, many orth-odontists are unaware of thisfeature and the manner in whichit can simplify all edgewise orth-odontic techniques. In his latesttext Proffit reiterates that theideal bracket “would provide avariable size archwire slot.”However, he laments that such abracket has not yet been devel-oped.2

Why variable anchoragecontrol levels?

With conventional edgewisearchwire slots, all teeth are rig-idly locked throughout treatmentat angulations that are only ben-eficial for final finishing. Thismakes anchorage managementunnecessarily difficult. Often theteeth requiring retraction offermore resistance to tooth move-ment (anchorage) than the de-sired anchorage units them-selves3. Although the difficul-ties encountered in retractingteeth with the edgewise appli-

Figure 1. The Tip-Edge bracket’s archwire slot is the first and only to actuallychange in size to facilitate tooth movements and finishing. During retractionthe archwire slot can open to .028" to facilitate the large amounts of toothmovement often required during this phase of treatment. After retraction hasbeen accomplished, the archwire slot closes down to .022" to provide the highlevel of three dimensional control required for final finishing. This feature offersdramatic benefits for all edgewise techniques.

ance are almost exclusivelyiatrogenic they have existed forso long (since the introductionof the edgewise archwire slot inthe 1920’s) that many orthodon-tists consider them to be an un-avoidable biological fact.

In reality, teeth will moveeasily and quickly in responseto very light forces if the artifi-cial constraints generated by theedgewise archwire slot are re-moved. Unrestrained teethreadily tip in response to mesio-distal and intrusive forces. His-torically, edgewise techniqueshave attempted to avoid tippingdue to a lack of an efficientmeans for uprighting.

Two features of the Tip-Edge archwire slot contribute toits overall ability to producevariable levels of control whenand where they are desired. Thefirst is the ability of the archwire

slot to increase in size relativeto the archwire as retraction pro-ceeds. The second is the vari-able anchorage potentials thatcan be generated— depending onthe direction of the forces ap-plied to each tooth.

Variable archwire slot sizeThe Tip-Edge archwire slot

is unique in that it actually in-creases in size in relation to thearchwire as the tooth tips duringretraction going from .022" to.028" (Figure 1). This not onlyfacilitates the large amount oftooth repositioning that is oftenrequired during retraction, butalso makes it far easier toprogress to larger archwires.With the Tip-Edge bracket treat-ment routinely progresses di-rectly from the initial .016"archwires to either .022" round

Continued on page 2

DR. MAURICIO BALLESTEROS INTRODUCESTIP-EDGE TO THE NATIONAL UNIVERSITYOF MEXICO DEPARTMENT OF ORTHO-DONTICS.

DR. BETNY SUMANTRI’S RECENT LEC-TURES ON TIP-EDGE WELL ATTENDED BYINDONESIAN ORTHODONTISTS.

0.022"

0.028"

TIP-EDGE GRAPHIC

SUPER TORQUEBARS:

Tippy’s Uncle Edger always has ahard time keeping up in the slidingfinish to their act.

VARIABLE ANCHOR-AGE BENEFITS ALL:

DEALING WITHCANINES:The prevention and cure ofcanines impacted due to loss

of archlength.Page 3.

Toothroots can“fly” through10° or more of torque with noadjustments required. Page 3.

Designof Tip-

Edge slot plususe of auxiliaries

varies the duration and degreeof anchorage. Cover story.

Pg 2 COVER STORY — QUESTIONS & ANSWERS

Q. Why not let the round archwires fall into the Deep Groovesof incisor brackets during the entire treatment? There would be no“antagonisms” between a round arch and a Deep Groove.

SARREGUEMINES, FRANCEA. If an archwire, even though it is round, were placed in Deep

Grooves, the incisors would not be able to tip distally. This wouldeliminate one of the greatest advantages of Tip-Edge brackets.

Studies of the differential movement of individual teeth and clini-cal observations clearly show that incisors must be free to tip distallyas well as labiolingually during retraction and bite opening. If they

Q’s and A’sare restrained from such movements, retraction and bite opening willrequire additional force (perhaps even extraoral) and take more time.Both would contribute, of course, to the unnecessary loss of anchor-age.

Incisors will even tip distally in nonextraction treatment – espe-cially during the opening of deep anterior overbites. In these casesit may be that the root apices are moving mesially more than thecrowns are moving distally. However, the result is the same – achange in the mesiodistal inclination of the teeth that could not occurif the archwire were in edgewise (Deep Groove) slots.

Tip-Edge Benefits AllContinued from page 1

Variable control levels: abeneficial concept for alltechniques.

There is an enormous dif-ference between an orthodonticbracket and the concept of anorthodontic technique. Manyorthodontists feel that only onebracket system can be used inconjunction with a specific tech-nique. However all edgewiseorthodontic techniques can ben-efit from the increased efficiencyand simplified treatment me-chanics offered by an improvedarchwire slot design.

The variable levels of con-trol offered by the Tip-Edgearchwire slot make any orth-odontic technique more efficient.Tweed tip-back retraction me-chanics can be induced withoutsecond order wire bending.Headgear forces will produceresults in half the time. Lipbumpers will also be more ef-fective. The problems of arch-

Figure 3 (A & B). Variable anchorage control sets up highly beneficial anchoragepotentials once Class II or III mechanics are initiated. A) During Class IItreatment the maxillary teeth are easily retracted through controlled and limitedtipping while the mandibular arch is limited to bodily tooth movement. B)DuringClass III treatment, the maxillary arch is limited to bodily movement while themandibular arch can be retracted through limited tipping to a Class I relationshipusing very light forces.

B

A

A B

8-10OUNCES

2OUNCES

Figure 2 (A & B). Example of a Tip-Edge bracket’s ability to differentiatebetween anchorage and free tipping— A) When force is from the distal, archwireslot design prohibits tipping— it becomes an anchor tooth. B) A relatively lightforce from the mesial of same tooth results in crown tipping to promote retractionand/or space closure.

or .0215 X .028" stabilizingarchwires for final uprightingand torquing. This feature al-lows for the correction of eventhe most severe malocclusionsusing only four “straight”archwires. Patient comfort isalso maximized when moving upto larger archwires and the prob-lem of bracket debonds wheninitially engaging larger arch-wires is virtually eliminated.

Variable anchoragepotential

With the Tip-Edge archwireslot, two distinct types of toothmovement are possible depend-ing on the direction of the forceapplied to each tooth. Whenmesially directed forces are de-livered, only bodily tooth move-ment can occur (with the ex-ception of second premolars infirst premolar extraction treat-ment). When distally directedforces are delivered, limited tip-ping of the teeth occurs (Figure2.). When light Class II or III

elastics are worn, highly benefi-cial anchorage relationships (im-balances) are automaticallygenerated between the dentalarch to be retracted and the oneto serve as anchorage.

During both extraction andnonextraction Class II treatment,the use of Class II elastics pitsbodily movement of the teeth inthe mandibular arch against con-trolled tipping of the entiremaxillary dental arch. Thusmandibular anchorage exceedsthe very light force levels re-quired to retract the maxillarydental arch in both extraction andnonextraction treatment. (Fig-ure 3a).

The Tip-Edge archwire slotsautomatically reverse their me-chanics when light Class III elas-tics are worn. Therefore duringClass III treatment, the maxillarydentition is limited to bodilymovement while the teeth in themandibular arch are free to tipdistally towards a Class I rela-tionship (Figure 3b).

wire deflection when retractingcanines are totally eliminated.

Was the “latest and best”orthodontic bracket developed in1925 never to be improvedupon? Definitely not. Anglespent the last years of his lifecontinuously modifying and im-proving the design of a succes-sion of orthodontic appliancesand brackets. Perhaps the timehas come to take the next step inthe evolution of the edgewise ap-pliance. A step towards an ap-pliance with a dynamic arch-wire slot that can facilitate re-traction and bite opening to thepoint that treatment mechanicsof all techniques can be radicallysimplified.References1Kesling, PC. Expanding the horizons of theedgewise archwire slot. Am J Orthod 1988;94:26-37.2Proffit, WR. Contemporary Orthodontics. 2nded. St. Louis, Missouri: C.V. Mosby, 1992.3Kesling, PC. Improving the final occlusionthrough selective premolar extractions. J ClinOrthod 1994; 28:84-92.

TECHNIQUE – APPLIANCE UPDATE – CASE REPORT Pg 3

New “Super” Torque Bars

Clinically, the increasedtorquing force of the .022" X.018" Torque Bars is immedi-ately apparent upon insertion.The procedure used to engage“Super” Torque Bars remains thesame as that used with originalTorque Bars.1 Due to their in-creased torquing effectiveness,these auxiliaries are usually onlyextended through the lateral in-cisors. This not only makesengagement easier but alsoserves to maintain the proper in/out relationship between themaxillary canines and lateral in-cisors. When properly engaged,Torque Bars produce an averageof 2 degrees of palatal roottorque per month.1Tip-Edge Today, Fall 1992.

To enhance their effective-ness, the cross-sectional dimen-sions of nickel titanium TorqueBars has been increased from.022" X .016" to .022" X .018"resulting in new stronger or “Su-per” Torque Bars. This signifi-cantly increases the active torqu-ing forces delivered by theseauxiliaries when used in conjunc-tion with Deep Groove Tip-Edgebrackets in two distinct ways.

The increased thickness ofthe new Torque Bars brings withit a corresponding increase instiffness and consequently theamount of torquing forces pro-duced. Their effectiveness isfurther increased since the twoouter corners of the auxiliary areshifted .002" outside of the DeepGroove archwire slot when fullyengaged. The corners which areslightly radiused due to manu-facturing tolerances, could con-tribute to rotation of the TorqueBar if located within the arch-wire slot. Moving them out ofthe slot improves Torque Bar“grip” by increasing the flat con-tact area between bar and theslot (Figure 1).

Figure 1.New “Super” nickeltitanium TorqueBars deliver moretorque due to in-creased thickness.The labial cornersof the auxilary ex-tend slightly out ofthe Deep Groovearchwire slot whichalso improves the

grip between auxiliary and archwireslot.

CASE REPORTAn 11-year-old female exhibited a Class II type malocclusion. The

mandibular first premolars lacked space for eruption and the maxillary canineswere completely blocked out. The maxillary left lateral incisor was in crossbiteand the midline was one tooth off. Due to the patient’s age and flatness of herprofile, nonextraction treatment with the Tip-Edge appliance was begun.

Initial archwires of .016" Wilcock wire.The maxillary has loops and a molarstop to create space for the blockedout canines and to move the maxil-lary lateral out of crossbite. A coilspring on the mandibular archwireopens space for the first premolar.

After space has been created, themaxillary canines are brought intoocclusion with an .016" nickel titaniumwire. Bumper-Sleeve® maintainsspace for the yet unbracketedmandibular premolars. J.W. .............................. Female, 11 Years

Class IINon-ExtractionArchwires Used ..................... 8 (5U, 3L)Adjustments .......... 19, Time: 25 MonthsRetention ............................... Positionette

Cephalometric Changes:Start - Dotted Finish-Solid

1-APo -3.0 mm +1.0 mmWits 0.0 mm -1.0 mmSN-MP 38.0o 40.0o

ANB 3.5o 2.0o

SNA 76.0o 73.0o

SNB 72.5o 71.0o

1-SN 86.0o 98.0o

.022" x .028" replace .016" maxillaryand mandibular archwires. Side-Winder springs on incisors andcanines torque and upright teeth toideal angulations. Note: Labial roottorque on the maxillary left lateral isautomatically accomplished.

Figure 2. Bracket relocated furthergingivally. Original .016" mandibulararchwire replaced to elevate canine.

Dealing With CaninesSometimes when canines are

quite pointed, use of jigs forbracket placement will not prop-erly locate the brackets on thecrowns. The height of contourand, therefore, mesial and distalcontact points will be located too

far gingivally causing the canineto become “impacted” betweenthe premolar and lateral incisor.(Figure 1).

To prevent this problem, itis best to reduce the canine tipswith a stone prior to bracketplacement.

If the problem occurs dur-ing treatment, the bracket shouldbe repositioned further gingivallyand elevated with a light arch-wire (Figure 2).

After proper leveling, thecanine tip can be recontoured ifnecessary. Good contacts be-tween the canine and adjacentteeth are then established (Fig-ure 3).

Figure 3. Mandibular canine isnow in good occlusion with propercontacts restored.

Figure 1. Mandibular canine iscrowded and out of occlusion due topoor bracket placement.

Pg 4 COURSE / LECTURE NEWS – REVIEWS

100 Center PlazaLaPorte, Indiana 46350

Comments on Nonextraction TreatmentAnd The Edgewise ApplianceBy Dr. Gordon Magnusson

Bulk Rate

U.S. Postage

PAIDLaPorte, Ind.

PERMIT NO. 79

The point made by Dr. Peter Kesling* that Dr. Angle may havepromoted nonextraction treatment because of limitations in his appli-ances is well taken. When I was using conventional edgewise brack-ets with static archwire slots, I was constantly frustrated with myinability to achieve good results in extraction cases!

Adjunctive to this premise, I feel that the popularity of secondmolar extraction therapy today is simply that by extracting secondmolars, which are located at the ends of the arch, the case thenbecomes, for all practical purposes, a nonextraction case. There is nobreak in the continuity of the dental arches. It can be hypothesizedthat those orthodontists who lack the skills to properly handle anextraction case and/or are handicapped by static archwire slots, maybe attracted to the second molar extraction treatment approach!

A second hypothesis could be made that those orthodontists whowish to run an assembly-line practice with assistants doing all thework within the mouth are attracted to nonextraction treatment (in-cluding the second molar extraction approach) as their assistants canplace a series of preformed archwires that require little, if any, per-sonal attention from the doctor.

What they don’t know, of course, is that the Tip-Edge bracketis the ultimate bracket for use in practices which utilize extensivedelegation of duties to assistants. For me and mine, however, I willcontinue to treat my patients with the Tip-Edge bracket myselfbecause...its more fun than I’ve ever had in 37 years of orthodontics!

*TIP-EDGE TODAY, Summer 1994, pg. 4.

Dr. Mauricio Ballesteros, chairman (center, first row), and residents of thedepartment of orthodontics of the National University of Mexico in Cuernavaca,Morelos. Dr. Ballesteros recently introduced the Tip-Edge Technique to thedepartment where it is now being used as the main orthodontic technique forthe treatment of patients by the residents.

A three day Tip-Edge course was presented this June by Dr. Andrew Richardson(fourth from right, kneeling) and Drs. Giuseppe and Regina Caponi in Bergamo,Italy. The course was filled to capacity with over 35 orthodontists from throughoutItaly in attendance. Dr. Richardson is professor of orthodontics at QueensUniversity of Belfast, Ireland.

For Subscription orCustomer Service

Call1-800-348-8856

219-785-2591Fax 219-324-3029

A specific problem encountered in each stageof treatment is demonstrated on these as-

sembled typodonts. Can you spot the prob-lems? (Answers on page 4.)

Stage III

Stage I Stage II

Special Feature: Tip-Edge Troubleshooting

Crimpable Hooks CanEliminate Bending Ends ofRectangular Archwires

When using full size rect-angular archwires during StageIII it can be difficult to removethe archwires for adjustments ifthe ends have been bent arounddistal to the molar tubes to pre-vent spaces from opening withinthe arch. TP’s new crimpablehooks provide a quick and easy

solution to this problem.Instead of leaving the ends

of the archwires wires long andannealing and bending them dis-tal to the molar tubes the endsof the rectangular wires thearchwires are simply cut offflush to the rectangular molartube. After Stage III has beenassembled the hook is crimpeddown upon the rectangular wiredirectly mesial to the molar tube.An elastomeric ligature tie isthen applied between the crimp-able hook and the molar hook tokeep spaces closed (figure 1).

Although crimpable hookscan sometimes slip along thewire TP’s hooks feature a pat-ented tungsten-carbide coatingon the crimping surfaces whichlocks them securely in place.Due to the small size of thesehooks it is highly recommendedthat special hook crimping pli-ers be used to carry them to themouth and lock them into place(figure 2).

Figure 1. Crimpable hooks areplaced just mesial to tubes and tiedback to molar hook with anelastomeric ligature tie or shortsection (two circles) of power chainor E-link. Ends of archwires can thenbe cut off flush at distal ends of tubes.

Troubleshooting answers: Stage I — Mixing of stages. During Stage Ihorizontal elastics are never used to correct the overjet or overbite. The onlyexception is during first molar extraction treatment. Stage II — Anchor bendspresent in .022" archwires. When using .022" archwires in Stage II or III onlyvery mild bite opening curves are used. Placing strong bends in these heavywires will tip the molars distally and roll them buccally. Stage III — Lower teethare not ligated to the archwire. All teeth must be tied to the archwire beforesidewinder springs are inserted and engaged.