VARI SIMPLEX DISCIPLINE [ALEXANDER DISCIPLINE]

R.G. “WICK” ALEXANDER 1978.

‘VARI’ Twin, Lang ,Lewis.

‘SIMPLEX’ KISS Principle

‘DISCIPLINE’ Edgewise mechanics

TWEED VARI SIMPLEX • Anchorage preservation

• .022 Slot.

• Treat mandibular arch first. DRIFTODONTICS.

• Uprighting the mandibular first molars 6 degree tip

• Upright lower incisor.

• Headgear. RETRACTOR.

• Non extraction Tweed concept and Contemporary developments

QUALITY RESULTS

Key Objective

Patient ends up with the face proportionately

balanced and consistent with his skeletal pattern .

The treatment should be completed in the stipulated

time with a satisfied patient, parent and doctor

Unique Concepts.

1.First Straight wire type –

Different designs of brackets in the same case, depending on the type of teeth.

The – 5 degree lower anterior torque is

different from other appliances.

2. Only 2 to 3 arch wires to be changed

3. Bracket design and bracket effectiveness

does not dictate the treatment technique.

4. Rectangular multistranded arch wires

DIAGNOSIS AND TREATMENT PLANNING

.

Patient information Diagnostic Chart

Patient records

Cephalometrics , patient examination

Treatment planning

Financial records

I.Patient history

I. Patient examination.II. Diagnostic records. 1) Intra oral and Panoramic radiographs. 2)Study models. 3)Facial photographs

4)Cephalometric Analysis.

a) General skeletal pattern.

b)Tooth position.

Critical Factor in diagnosis

Lower Incisor Position.

1.Incisor mandibular plane angle.

2.Holdaway Ratio.

3.Lower incisor to A-Pog

Treatment Plan.Two steps:1.Determine the desired position of the

mandibular incisor.2.Determine the treatment needed to position the maxilla and maxillary dentition over the

desired mandibular arch position.

Objective of Treatment:

1.Incisors upright over the basal bone .

2.Cuspids not expanded.

3.Level curve of spee.

4.Non extraction therapy .

VARI-SIMPLEX DESIGNBrackets are

• Pretorqued

• Preangulated

• Built in In / Out

[Pioneered by IVAN LEE and LARY ANDREWS]

Different bracket design on particular teeth in the arch,but

the system of brackets for each pt is identical.

IMPORTANT FACTORS IN DETERMINING THE DESIGN OF THE V.S.APPLIANCE

1. Shape and Size of the tooth. Mesiodistal width and curvature.

2. Accessibility.

3. Patient comfort and frequency of bracket wing breakage.

Factors Related To The Brackets

1. Bracket selection2. Bracket placement3. Bracket angulation4. Bracket torque5. In / Out

BRACKET SELECTION

TWIN BRACKETS• Large ,flat surfaced teeth.• Mini Diamond brackets.• Accessibility• Additional hooks .

•Inter bracket distance.

•Patient comfort.

•Full archwire engagement.

LANG BRACKETS Dr.Howard Lang

• Round surfaced teeth at the corners

• Single bracket with a flat rotational wing.

• Wire deformation

LANG BRACKETS

•Complete arch wire engagement.

•Increased inter bracket width

Wedge shaped in profile

LEWIS BRACKETS

• Large round surfaced teeth and

small flat surfaced teeth.

• Single bracket with fixed

rotation wing –built in labial

curvature

LEWIS BRACKETS• Wedge shaped in profile

• Excellent inter bracket width.

• Facilitates correction of severely rotated teeth.

Activation

OTHER ATTACHMENTS

•Twin bracket with a Convertible sheath .

•Head gear tubes placed occlusally*.

•15 degree offset –upper first molar .

5 degree – mandibular first molar.

•Ball hooks .

OTHER ATTACHMENTS

• Single buccal tubes second molars

• 6 degree distal offset built in the lower second

molar.

• Lingual hooks on all molar bands.

Appliance does not dictate the treatment technique

Bracket height• Bicuspid bracket height [x] key

Bracket angulation

• Ideal axial inclination.

Roots parallel Crown in most esthetic &functional position.

DIAMOND BRACKET

VERTICAL LINES PARALLEL TO THE LONG AXIS OF THE TOOTH

1 st Bicuspid Extraction

Dr Dwayne TrammellBAYLOR UNIVERSITY

• Laminographic x- ray of the molars• 3 months • Superimposition showed

Root tips moved anteriorly by , 0.5 mm

Crowns tipped distally on an average of 1mm

• 2 mm of arch length

BRACKET TORQUE DEVELOPED

Finishing rectangular wires of 50 cases

• - 30 torque maxillary cuspids

• No torque mandibular second molar tube

• - 50 lingual crown torque mandibular incisors

DR. TRAMELL • Class II non extraction cases• 0.017’’ x .025’’ D RECT MULTISTRANDED -

3 MONTHS

• Superimposition showed incisal edges moved lingually by less than 0.5mm

• Root apices moved labially on an average of 1mm

• Main aim Hold the incisors in its original position

Bracket in – out

EXTRA-ORAL FORCES

‘RETRACTOR’ Dr.Fred Schudy

SagittalControl Vertical

Transverse

Skeletal Dental

Three different type of retractors 1. Cervical traction

• Force vector -10 degrees• SN- MP- < 37 degrees

2. Combination pull • Force vector 30 degrees• SN- MP 37 to 41 degrees

3. High pull retractor

• Force vector 60 to 70 degrees• SN-MP > 42 degrees

Components of a facebow system

1. Molar buccal tubes.*

2. Inner bow

Adjustments in six directions

• Bucco-lingually

• Superio- inferiorly

• Anterio - posteriorly

3. Outer bow

• 4. Retractor system

Retractor force• 8 ounces• 16 ounces

Time worn Depending on severity of A-P discrepancy

• ANB – 3 7-8 HOURS• ANB – 3- 5 10 HOURS • ANB - > 10 14 HOURS

Orthodontic vs Orthopedic force

Class III Extra oral forces• Face masks

• Vertical pull chin cup

• Reverse headgear

Co-operation*Successful treatment Growth

Arch consolidation

Elastics in Vari – simplex discipline

• To align the maxillary dentition with the mandibular dentition and correcting an centric occlusion / centric relation discrepancy.

• Correction of cross bite and midline

• Finalize the occlusion

3 to 6 ounces

Elastic Specifications

• Class II - ¼ “, 6 oz

• Class III - ¼” , 3 ½ oz

• Midline elastics – ¼ “ , 6 oz

Box elastics• Anterior box elastics – 3/16“ 6 oz

Box elastics

• Lateral box • Buccal box

• Trapezoid elastics – ¼ “ , 6 oz

• Triangular elastics1/8 ”, 3 ½ oz

• Cross bite elastics – 3/16 “ , 6 oz

• Finishing elastics – [ UP AND DOWN] ¾ “ , 2 oz

M with tail

W with tail

• Head gear elastics

• Coil springs

½ “, 140z

Non-Extraction Treatment

PhotographsLearning Experiences

Case Record

BORDERLINE CASES

Fifty percent of cases Treated Non

extraction

Borderline Non extraction

• Negative torque on the lower incisors bracket

• Negative tip on the lower molar bracket• Flexible D RECT wire initial• Bonding instead of banding • Ability to perform selective interproximal

reduction

MAXILLARY ARCH. Bonding and Banding

First Wire• Multistrandard spiral round archwire

• Retractor

Second Wire• 0.016 ss with omega stops.

Space closure with power chains.

Third final wire• 0.017 x 0.025 ss rectangular

MANDIBULAR ARCH

First wire 0.017 x 0.025 multistranded rectangular wire Slenderizing followed by 0.016 x 0.022 D-Rect 0.016 Ni ti and class III elastics

Second wire 0.016 x 0.022 ss with omega

Third wire 0.017 x0.025 ss

CLASS II DIV 2 0.0175 Multistranded or Ni ti 0.016 ss wire Bite blocks Mandibular arch- Initial round wires

- 0.016 x 0.022 ss finishing wires

- Invert bracket or zero degree torque

DEEP BITE CASES• Bite plate.

• Cervical retractor

CLASS III CASES• Start treatment in both arches.

• Early use of class III elastics.

• Extra oral forces.

OPEN BITE• Bracket positioning.

• Extra oral forces

Extraction Treatment

Indications:

1. Severe mandibular arch length discrepancy.

2. Severe bimaxillary protrusion.

•25 percent*

Advantages of delaying treatment in

the mandibular arch:

1.Physiologic drifting. ‘DRIFTODONTICS’

2. No interference for retraction of

maxillary canines .

3. Additional time for second molars to

erupt.

STANDARD CLASS II DIV 1MAXILLA

Initial wire - 0.0175 Respond multistranded

or 0.017” –0.025”D-Rect rectangular braided arch wire

Second archwire- Canine retraction.0.016 ss round with omega stops .0.016 –0.022ss closing loop arch wire .

Third archwire -

• Incisor retraction.

• 0.018-0.025 ss closing loop archwire*

• Loop activation –1mm per four weeks.

• Excellent torque control.

Final finishing arch wire

• 0.017-0.025 ss wire.

MANDIBLE:

4 to 6 months of Driftodontics

Initial wire

Multi-stranded .0175 respond.

or 0.016 Ni-ti

or 0.017 –0.025 D-rect.

Second wire

0.016 ss wire .

Third archwire• 0.016-0.022ss closing loop archwire.

Final finishing arch wire • 0.017-0.025 ss archwire.

RETENTION IN VSD

Criteria for completion of treatment.

1. Centric relation and Centric occlusion should coincide.

2. ClassI Cuspid relation.

3. Mand intercuspid width.

4. Interincisal angle with proper torque.

5. Normal ant overbite and overjet.

6. Normal buccal overjet.

7. Levelled upper and lower arches .

8. Rotations eliminated and all Spaces closed

9. Roots parallel near extraction.

10. Good cuspid interdigitation.

COUNT DOWN TO RETENTION

6 WEEKS - Active treatment to Retention.

Posterior settling --- Sectioning the arch wire.

1. Mandibular arch wire - Class II deep bite

2. Maxillary arch wire - Class III open bite

3. Both the arches - Class I

• FINALIZE THE OCCLUSION

Band removal appointment

¾” ,2 oz

Retainer design and fabrication

PRINCIPLES OF THE ALEXANDER DISCIPLINE

1. ‘AS A MAN THINKETH’JAMES

ALLEN EFFORTS = RESULTS

2. Dr .Hans Selye ‘Altruistic Egoism’

3. KISS Principle .

4. Plan your work .

Accurate Diagnosis and Treatment Planning

5. Goals for stability.

6.Specific bracket design.

7.Bracket positioning.

8.Face bow for Orthopedic correction .

9.Proven Arch form design and Arch wire

force system .

10.Consolidate arches.

11.Complete bracket engagement.

12.Level the arches.

13.Progressing into finishing archwires .

References

• The Alexander Discipline – R.G. “Wick” Alexander

• JCO June 1983• Seminars in Orthodontics – Vol 7 June

2001