dr. kaán miklós• bioprogressive technic rickett straight-wire technic andrews . angle expansion...
TRANSCRIPT
Multiband technics.
Dr. Kaán Miklós
SEMMELWEIS EGYETEM
Gyermekfogászati és
Fogszabályozási Klinika
Multiband technikák
• Multiban-multibond appliance is usually
the 2. part of the orthodontic treatment
• Multibond is used in permanent denture
12-13
• Multibond is the only appliance which is
able for the perfect alignment and bodily
movement (torque, angulation)
Early orthodontic treatment
(interceptív orthodontics, orthodontic
prevention)
• 1. phase of the orthodontic treatment:
- in mixed dentition
traetment of serious sceletal problems (in intensive growing, developmental period)
- we can avoid the irreversible deformation of the denture
- a nem kívánatos kompenzáló mechanizmusok kiiktatása
- We solve a lot of local anomaly (crossbites, diasthema medianum, space
maintening)
- less extraction and less surgery after early orthodontic treatment
- less relapse after early orthodontic treatment
- good psichological effect
-
4
Multiband technics in the XX.
century
• -1902. Angle: E- arch
• -1911. Angle: Pin and tube appl.
• -1916. Angle: Ribbon arch appl.
• -1928. Angle: Standard edgewise
• Edgewise technic Angle , Tweed
• Light wire technic Begg
• Bioprogressive technic Rickett Straight-wire technic Andrews
Angle Expansion arch (E arch) 1907
E arch with hooks
Rigid gold wire
Teeth were connected to the arch
with metal ligatures (injury of the
marginal gingiva !!)
Heavy forces
Pin and tube appliance 1913 (Angle)
Metal bands, vertical tubes , good labiolingual movement
The pin was connected to the gold wire
Rigid gold wire
Heavy foerces
Ribbon arch 1915 (Angle)
New bracket with vertical slot
and „ribbon arch” (gold).
Ribbon arch type bracket
Edgewise appliance 1928 (Angle)
Előnyei:
•Good movement controll
•Bodily movement !!
Hátrányai:
•Lot of bending (in-out, torque,
angulation)
•Expensive - gold
•Horizontal slot instead of vertical slot
•Edgewise wire =rectangular wire
Edgewise bracket (Angle)
1. 0.022”x0.028”
horizontal slot
2. Standard edgewise system
Development of the appliances
Angle
készülékek
Tweed
Standard Edgewise
Begg
Light wire technika
Ricketts
Bioprogresszív technika
Andrews
Straight-wire technika
He was not satisfied with Angle’ conception
(nonextraction treatment, face esthetic)
1941- „basal bon” conception
Charles H. Tweed
1895- 1970
TWEED EDGEWISE
APPLIANCE
Strategy of Tweed
1In this slide I summarized the 7 main ideas and the results
of his new concept. Actually, he was the first one who
realised the importance of the facial aesthetics. He also
modernised the orthodontic diagnoses. He was the first
one who used the cephalometrics in the clinical practice.
He introduced new treatment concepts: for example the
serial extraction.
.
Anchorage control first the canine distalisation and the
front togeder
Three different kind of bending
In-out Angulatio Torque
Begg light wire, multiloop technic
Begg’s bracket
Vertical loop
Begg technic
(multiloop technic)
Three main type of tooth movement in Begg mechanics:
Ausztralian wire (Begg), Round cross section 0,016
1. Intrusion, extrusion
2. Tilting, rotation
3. „Multiloop” appliance
Difficult, copmlicated technic with lot of loops
RICKETTS BIOPROGRESSiV
THERAPY (1965)
• Utility wire
• Loops
• Szectional wires (not for the whole arch)
• Quad-helix
• Ricketts examined patient’s actual
development and it influences the treatment
plan and the
Robert Murray Ricketts
0.018” slot (Ricketts )
Stainless steel wire instead of gold
Elgiloy wire (Ricketts )
• Material:
Cobalt(40%)
Crom(20%) Fe(15,81%)
Ni(0,15%),
Mo (7%),
Mn(2%),
Beryllium(0,04%)
C (15%),
• A special kind of
stainless steel (softer)
Utility wire (Ricketts )
• . We use the arch for both vertical
and sagittal corrections.
Sectional wire (Ricketts )
Intermaxillary anchorage
The utility arch with the sectional one. In this situation
the sectional arch is for the distalisation of the canine.
The utility arch treats the incisors.
The same way as Begg also Ricketts
used loops for space closure
• Upper retraktor loop
• Lower retractor loop
• Delta loop
„T” loopok
• To rotate the premolars
• Leveling of Spee curve
Ricketts quad-helix
• Expansion in
mixed and
permanent
denture
I. case
• Angle III. class
• Narrow upper arch
(quad-helix)
• Anterior crossbite
• (utility arch)
Sectional wire to distalise the canine
and
utility arch for the correction of the
anterior crossbite
Direkt ragasztott bracket
End of the treatment
New material: Nickel-titánium
ANDREWS - STRAIGHT-WIRE
Appliance
• Andrews’ „six keys”
• Triple-Control bracket
• Nickel–titanium wires
• 5 stages in the treatment
Lawrence F. Andrews
Andrews „six keys”
1. Szabályos moláris és szemfog viszony
2. Mesio-distal korona inklináció (angulatio) a bracketekben
3. Labio-lingual korona inklináció (torque) a bracketekben
4. Rotáció mentes fogazat
5. Feszes kontaktpontok
6. Lapos Spee görbe
Triple control brackets (Andrews)
• Angulatio
• Torque
• In-Out (Distal offset)
Standard edgewise system - Straight-wire system
An ideal wire has to be bended to reach the optimal position
of each tooth
Torque – third order bend
Angulation – second order bend
In-out – first order bend
Different arch forms
Normal Long and
narrow
Long and
wide Ovális Oval and
long
Stages of the treatment(Andrews)
• Leveling
• Leading phase
• Contraction phase
• Final, correction phase
• Retention
1. Leveling phase - alignment
Alignment – leveling phase
Torque
Angulation
1. Leveling phase - alignment
• Leveling of the
vertical
discrepansies of
the dental arches
is also necessary
Pl: Spee-Curve Rectangular niti wires are also used at the
end of the leveling phase
anti Spee wire
The leveling phase is succesfull is there is enough
space in the arch The treatment of the sceletal (transversal, sagittal etc.) anomalies should
be treated in the late mixed dentition
( durin intensive develeopment)
1. Expansion:: hyrax (sceletal effect), quad-helix,
transzpalatal bar
2. Distalisation of the first molar: headger, pendulum,
distal-jet
3. Extraction: most frequently premolars
4. Stripping
Possibilities for space gaining:
1. Leveling phase – alignment
archwires: round wires:
, • (0,012 inch NiTi or TMA) 0,014 inch NiTi or TMA
• 0,016 inch NiTi or TMA, (0,016 Stainless steel
wire)
rectangular wires
• 0,016 x 0,016 NiTi or 0,016 x 0,016 braided wire
(SS)
• 0,016 x0,022 NiTi 0,016x 0,022 braided wire
(SS)
1. Leveling phase – alignment
Archwires:
Twist-felx or coaxial wire (stainless steel) -weak round wires
Braided wire- stainless steel
Utility arch
(for correction phase)
stainless steele wire
0,016x0,022 SS
4. Correction phase to solve the problems (gaps, rotation, axis correction)
5. Retention
2. Leading phase – the move the canines,
premolars, molars to the finel position
and to proper occlusion
Wires: stainless steel : 0,016x0,016
0,016x0,022
The only function of the rigid wire : leading,
Splinting the teeth
BODILY MOVEMENT !!
The crown and the root are moving
together
2. Leading phase –
movement of the lateral teeth
Bodily movement: the crown and
the root move together
Wire: rectangular stainless steel
Leading phase
• Distalisation of the canines
(fe: after extractions)
• To reach the correct occlusal
units between the canines,
premolars, molars
• 0,16x0,16 vagy 0,16x0,22
stainless steel
II. class, four premolar extraction
Leading phase
2. Leading phase: movement of the canines, premolars,
molars
The function of teh archwires: leading of the teeth (as a rigid splint)
Forces for the tooth movement
Elastic chain
Nikkel-titánium spring (for space closure)
Tight metal ligature
Intermaxillary elastics
Intermaxilláry elastics:
Intramaxillary tooth movement
Intermaxillary elastics for the correction of II. III. class anomalies
Distalisation of the canine
Treatment of the II. class anomaly
The wires prohibit the tilting and the rotation
Tight metal ligatures
Loop for space closure (less friction)
ANCHORAGE !!
Nance appliance
Orthodontic implants
Transzpalatal bar
Headger
3. Contraction phase
adjustment of the incisors
3Contraction phase
The incisors are moved together, in one block
All the dimension are determined (vertical, sagittal)
3. Contraction phase
adjustment of the incisors
Loops between the canine
and the lateral incisor
Elastic chain Intermaxilláry elastics
Wit working arch
Intermaxilláry elastics
4. Final, correction phase
To solve the rest problems: small
gaps, small rotations
We want to reach the perfect occlusal
units
At the end of the treatment
0,17x0,22; 0,17x0,25 stainless steel
wire is necessary to utilise the the
torque, angulation, in-out values
4. Correction phase
To harmonise the occlusion
Proper tooth axis
Correction of assimetry
Retention phase
To keep the result
5. Retention
MIT HASZNÁLUNK MANAPSÁG?
• Angle diagnosztikai rendszerét
• Cephalometriai analízist – Hasund, Ricketts, Steiner, Mcnamara
• Nickel titánium íveket
• Rozsdamentes acélíveket
• Loopokat, ívhajlításokat
• Intermaxilláris gumihúzásokat
• Utility ívet – Ricketts
• Triple kontrol bracketeket - Andrews
• Straight wire technikát – Andrews
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