SUMMER 1996

EDGELINES

© 1996 Two Swan Advertising Agency

TIP-EDGE GRAPHIC

Published Quarterly In The USA

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

®

The Tip-Edge bracket, asdeveloped by Kesling1,2 in 1986,has proven to be a highly effi-cient tooth-moving appliancein its purest form. Tooth move-ment can be accomplished us-ing lighter forces, fewer arch-wires and simpler mechanicsthan with other techniques.Torquing and uprighting of in-dividual teeth are accomplishedin the last stage of treatmentwith .0215" x .028" rectangulararchwires and Side-Windersprings. Side-Winder springsprovide the force to torque themaxillary incisors on zero de-gree rectangular wires. Thesesprings will position individualteeth into their final positions asdetermined by bracket prescrip-tion.

For those who wish to limitmaxillary incisor tipping, it ispossible to combine Tip-Edgewith conventional straight wirebrackets.3 This modification willallow for more torque controlin the earlier stages of treatment.Preadjusted, Straight-Edge®

brackets (Figure 1A), are placedon the maxillary central and lat-eral incisors and, optionally, onmandibular central incisors. Tip-Edge brackets (Figure 1B), areplaced on the remaining teeth.Early in treatment if maxillaryincisors are protrusive, roundarchwires are used for retraction.When the axial inclination onthe incisors is corrected, rectan-gular archwires are placed. Inextraction cases, space closureis continued with a rectangular

Figure 2.

Figure 5.

When maxillary incisortorque is estimated to be nearlycorrect, a rectangular archwireis placed in the maxillary archand space closure is continued.When the extraction spaces areclosed, a mandibular rectangu-lar archwire is placed and Side-Winder springs are added to allteeth needing uprighting (Fig-ure 3). The appliance contin-ues to torque and upright teethwithout archwire modification.Figure 4 shows treatment near-ing completion and at applianceremoval (Figure 5).

Patient 2The second patient was

missing mandibular secondpremolars. The treatment planwas to extract the mandibularsecond deciduous molars andmaxillary second premolars.Attempt would be made toclose spaces from the rear.Straight-Edge brackets were

Figure 4.

Figure 3.

Figure 1. Straight-Edge brackets (A) arecombined with Tip-Edge brackets (B).

A B

archwire in the maxillary archduring Stage II. In nonextractioncases, the rectangular archwirewould usually be used for a fin-ishing wire.

Patient 1The patient, a bimaxillary

protrusion case treated with theextraction of four first premolars,is started with .016" (Wilcock)archwires and light (2 oz.)Class II elastics. Straight-Edgebrackets are placed on maxillarycentral and lateral incisors andmandibular central incisors. Tip-Edge brackets were placed on allothers (Figure 2).

DR. PARKHOUSE ANSWERS STUDENT’SQUESTION DURING TYPODONT SESSION INBOURNEMOUTH (PAGE 4).

DRS. P. KESLING, MAURICIO BALLESTEROS,SUSIE RIVAS, TOM ROCKE AND EDUARDOAGUILAR IN MEXICO CITY (PAGE 4).

The day Tippy first learned that a sec-ond order force (log falling) can resultin third order torque.

COVER STORY

Combining Tip-Edge With ConventionalStraight Wire Brackets—An Alternative Approach

By: R. Thomas Rocke, D.D.S., M.S.

C a n T i p -E d g e b ecompatiblewith con-v e n t i o n a lb r a c k e t s ?Advantagesand disadvantages are pointedout in Cover Story, Page 1.

Please see COVER STORY next page

COMPATIBILITY?

Intrusion mayresult in rootsmoving me-

s ia l ly orl a b i a l l y .Q’s & A’s,Page 2.

NEW EDITION:A new, up-to-d a t e a n d e x -p a n d e d T h i r dEdition of theTip-Edge Guide©is now available,Page 3.

LOWER ANTERIORSSCOOT THEIR ROOTS:

Pg 2 COVER STORY — QUESTIONS & ANSWERS

COVER STORY — Combining Tip-Edge... Continued from page 1

Figure 6.

placed on the maxillary incisorsand Tip-Edge on the rest.

After leveling with .016"archwires, .022" round arch-wires were placed with Side-Winder braking springs onthe canines and first premolarsto limit their tipping and pro-mote space closure by mesialmovement of the molars. E-Links® (E-5) provide space clos-ing force (Figure 6).

When maxillary incisortorque was judged to be nearlycorrect, rectangular wires wereplaced and space closure anduprighting were continued (Fig-ure 7). A braided .021" x .025"archwire with vertical elastics was

Figure 7. Figure 8. Figure 9.

nonextraction. Straight-Edgebrackets were placed on maxil-lary and mandibular incisorsand Tip-Edge brackets on caninesand premolars. Bite opening,leveling and Class II correctionwere accomplished with .016"archwires and 2 oz. Class II elas-tics. No headgear was used. Atthis time, premolars were brack-eted and leveled (Figure 11). Pro-ceeding to a full size maxillaryrectangular archwire at this timewould be difficult and painfulfor the patient since the maxillaryincisors needed more torque andthe maxillary lateral incisors weretipped slightly to the distal.Therefore, a maxillary .022" arch-

wire with a 30 degree nickel tita-nium Torque Bar were initiallyplaced (Figure 12). When themaxillary incisor torque was im-proved, rectangular wires wereplaced to finish the treatment(Figure 13), and the result asshown in Figure 14.

The advantages and disad-vantages of combining conven-tional edgewise and Tip-Edgebrackets:Advantages:1. Control of tip and torque of

maxillary incisors through-out treatment.

2. Side-Winder springs arenot needed on maxillarycentral and lateral incisors

for torquing and uprighting.3. Without Side-Winder springs,

esthetics are improved.Disadvantages:1. Bite opening procedures in

Stage I may be slowed dueto lack of one point contacton the maxillary incisors.

2. Anchorage may be compro-mised during space closuredue to bodily retraction ofmaxillary incisors.

3. It may be difficult to gofrom .016" to full size rect-angular wires if the maxil-lary lateral incisors aretipped and/or if the maxil-lary incisors need torque.

4. Torquing the teeth by flex-ing rectangular archwiremay deepen the overbite.

5. Patient discomfort.It is left to the reader to

evaluate the advantages anddisadvantages of combiningconventional, preadjusted andTip-Edge brackets.

References1. Kesling PC. Expanding the horizons of the

edgewise archwire slot. Am J OrthodDentofac Orthop 1988;94:26-37.

2. Kesling PC. Dynamics of the Tip-Edgebracket. Am J Orthod Dentofac Orthop1989;96:16-25.

3. Rocke RT. Employing Tip-Edge bracketson canines to simplify straight-wire me-chanics. Am J Orthod Dentofac Orthop1994;106:341-350.Figure 13.

Figure 11.

Figure 14.

Figure 12.Figure 10.

used to finalize the occlusion(Figure 8), the result is shown inFigure 9.

Patient 3The third patient exhibited

a severe Class II, Division 2(Figure 10), and was treated

Q’s and A’sQ. I have noticed that sometimes a midline shift appears in the

early months of my Rectangular Stage Three patients. It does notseem to be related to mesiodistal crown tipping. What is the causeof this?

ST. LOUIS, MISSOURI

A. Slight midline discrepancies such as this are usually due touncoordinated or improperly placed archwires. The relatively stiff.0215" x .028" archwires are able to warp the dental arches to causemidline shifts and/or posterior crossbites. Placement of preformedarchwires with their midlines off center can result in midline shifts.Be sure the marks on the archwires are located exactly between thecentral incisors when crimping the intermaxillary hooks. This willthen ensure that the forms of the archwires are coordinated withthose of the dental arches.

Q. I am hitting problems in Stage I of Tip-Edge treatment whenthe first premolars have been extracted. The lower labial segmentseems to be retroclining excessively. What is the cause and solution?

NORTH HUMBERSIDE, U.K.A. If the mandibular anterior teeth are slightly retroclined at

the beginning of treatment and intrusive forces are applied from anarchwire, their roots will tend to move further labially and/or me-sially. This phenomenon is referred to as “root scooting” and usuallyis no problem.

Normally such malocclusions (with lingually tipping anteriorteeth) are treated nonextraction which would prevent the caninecrowns from readily tipping distally to aggravate the situation.

The application of Side-Winder springs (in the braking mode)with mild activation would help prevent or at least stabilize the situ-ation. However, the correction of labial and mesial root tip displace-ment should be left until the final stage. At that time such axialdiscrepancies can automatically be taken care of easily by the simpleapplication of the appropriate Side-Winder springs in conjunctionwith a passive .0215" x .028" mandibular archwire.

REVIEW — TECHNIQUE TIP — CASE REPORT Pg 3

CASE REPORT

T.H. .............................. Female, 13 YearsClass II, Division IExtractions ..................... UL2, UR4, L55Archwires Used ..................... 6 (3U, 3L)Adjustments ......... 14, Time: 20 MonthsRetention ..... Upper & Lower Retainers

Cephalometric Changes:Start-Dotted Finish-Solid–

1-APo +2.0 mm +3.0 mmWits +5.5 mm +0.5 mmSN-MP 47.5o 45.0o

ANB 8.0o 5.0o

SNA 76.0o 73.5o

SNB 68.0o 68.5o

–1-SN 94.0o 98.5o

A 13-year-old female presented for treatment with a Class II, Division 1malocclusion. The maxillary left lateral incisor had erupted palatally. Becauseof anticipated problems with retention, this left lateral, the maxillary right firstpremolar and mandibular second premolars, were extracted. Straight-Edgebrackets were placed on the maxillary four anterior teeth and mandibularcentral incisors. Tip-Edge brackets were bonded on all remaining teeth.

Stainless steel .016" (AJ Wilcock)archwires with bite opening bendsand 2 oz. Class II elastics to correctthe overjet and Class II relationship.

Beginning of Stage III with .022"maxillary archwire and 30 degreeTorque Bar. Flat .0215" x .028" man-dibular archwire with Side-Windersprings for torquing and uprighting.

When the incisors were adequatelytorqued, a maxillary .0215" x .028"steel archwire replaced the .022"archwire. Torquing and uprighting bySide-Winder springs continues.

Easier Placement of IRTA’sIRTA’s deliver either labial or palatal/lingual root torque to in-

dividual teeth depending on the direction from which they are in-serted into the vertical slot. If inserted from the gingival, they generatelabial root torquing forces, if inserted from the incisal, they deliverpalatal/lingual root torquing forces.

To engage conventional IRTA’s, the torquing arm is first in-serted into the vertical slot. The tail of the auxiliary is then ligatedunder the archwire into the archwire slots of the brackets on adjacentteeth. This manner of engagement requires partial disassembly of theappliance and loosening of the archwire to slip the tail under thearchwire.

Through a slight modification of the IRTA it is possible to engagethese auxiliaries so that they lay over, instead of under, the base archwire(Figure 1). The modification is easily made by placing a 90 degreebend at the bend between the u-shaped portion and the tail of theauxiliary. When bent in this manner, the auxiliary crosses over the frontof the bracket rather than alongside the bracket under the base archwire(Figure 2). After inserting the torquing arm into the vertical slot, the tailcan be ligated over the archwire on the adjacent teeth (auxiliary shouldextend through at least two adjacent teeth).

Figure 1. A) Conventional IRTA lies inone plane. Auxiliary is engaged underbase archwire after insertion in toothrequiring torque. B) By bending torquingarm of auxiliary at a 90° angle fromplane of auxiliary tail the auxiliary canbe engaged over the base archwire.

Figure 2. Modified auxiliary engagedin maxillary right central incisor bracket.Note that torquing arm of auxiliarycrosses over the face of the bracketrather than alongside the bracketunder the archwire.

New Third Edition of Tip-Edge GuideNow Available

The Third Edition of the Tip-EdgeGuide by Dr. Peter Kesling was recentlyreleased by Two Swan Advertising. Ithas been completely revised and greatlyexpanded as compared to the First(1988) and Second (1990) Editions.

Its 234 pages are divided into fivesections. Together they provide themost complete compilation of infor-mation relating to the Tip-Edge arch-wire slot, the Differential Straight-Arch® technique and related subjectsboth current and historical.

The first section explains the concept behind the Tip-Edge bracketand its unique dynamic archwire slot. It also reveals the excitingpossibilities of the Differential Straight-Arch technique.

The second details Tip-Edge attachments including brackets andmolar tubes as well as those instruments used with the technique.

The third covers the three distinct stages of treatment in detail.Also included is a diagnostic regime keyed to the versatility of thetechnique and case reports to verify the effectiveness of both.

The fourth is a reference section which includes reprints of ar-ticles by the author that are not readily available, a review of attritionalocclusion and a biography of Dr. P.R. Begg. It was Begg who intro-duced the concept of differential tooth movement which the Tip-Edge bracket now makes possible with an edgewise appliance.

Section five includes a glossary of terms unique to Tip-Edgebrackets and the Differential Straight-Arch technique, which alsoserves as an index, plus a bibliography of related articles listed bothby subjects and authors.

To order: 100-110 Tip-Edge Guide $43.95 U.S.

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Mexican Tip-Edge Society CelebratesFirst Anniversary

January 14, 1996, marked the first anniversary of the foundingof the Mexican Tip-Edge Society with Dr. Mauricio Ballesteros pre-siding.

Tip-Edge is increasing in popularity in Mexico with 110 mem-bers attending the meeting in Mexico City. Guest speakers were Drs.Peter Kesling and Thomas Rocke. Dr. Kesling spoke about Drs.Edward Angle and Calvin Case and gave an historical account ofbracket development.

Dr. Rocke spoke about the use of rectangular archwires with theTip-Edge appliance and also presented a three-day Tip-Edge courseto 23 participants prior to the Society meeting.

Dr. Kesling, interpreter Dr. Azucena Rivas and Dr. Rocke with course participantsand faculty. Photo taken at Hotel Plaza, Mexico City.

Tip-Edge Course in Bournemouth, EnglandA Tip-Edge Course was held in Bournemouth, England in Sep-

tember of 1995 in conjunction with the British Orthodontic SocietyMeeting. Dr. Parkhouse of Glan Clwyd Hospital, Wales, and Dr.Richardson of Belfast, Ireland, instructed. There were approximately45 attendees.

Dr. Richardson of Queen’s University is one of the first profes-sors to have graduate orthodontic students treat patients with Tip-Edge brackets and the Differential Straight-Arch technique.

Drs. Richardson (second from left) and Parkhouse (center) with the members ofthe Tip-Edge course in Bournemouth, England.