Bio progressive therapy

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Published on March 21, 2014

Author: indiandentalacademy

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INDIAN DENTAL ACADEMY: 1 INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com www.indiandentalacademy.com Bioprogressive Therapy PowerPoint Presentation: 2 Part II www.indiandentalacademy.com PowerPoint Presentation: 3 Utility arch. Mixed dentition treatment Brackets & Prescriptions Class II div I Class II div II Mechanics for extraction cases. Finishing and retention. www.indiandentalacademy.com Roles and functions of the lower utility arch: 4 Roles and functions of the lower utility arch Position of the lower molar to allow for Cortical Anchorage Manipulation and Alignment of the lower incisor segments. Allowing segmental treatment of the buccal segments Physiologic roles of the lower utility arch. Role in mixed dentition www.indiandentalacademy.com Fabrication of the utility arch: 5 Fabrication of the utility arch www.indiandentalacademy.com Physiologic Vs Mechanical Response: 6 Physiologic Vs Mechanical Response Tip back applied to lower molar-30° to 40 °. No toe-in in non extraction utility. Extraction cases-definite distal rotation must be placed . www.indiandentalacademy.com Physiologic Vs Mechanical Response: 7 Physiologic Vs Mechanical Response 30° to 45° buccal root torque applied to the lower molar www.indiandentalacademy.com Physiologic Vs Mechanical Response: 8 Physiologic Vs Mechanical Response www.indiandentalacademy.com Physiologic Vs Mechanical Response: 9 Physiologic Vs Mechanical Response Long lever arm applied to lower incisors. 75 gms of intrusive force.(0.16 x 0.16). Labial root torque. www.indiandentalacademy.com Modifications of the Utility Arch: 10 Modifications of the Utility Arch Expansion utility arch Force : 1mm= 85 gm 2mm=140 gm 3mm=205 gm www.indiandentalacademy.com Modifications of the Utility Arch: 11 Modifications of the Utility Arch Contraction utility arch Force: 1mm=50 gm 2mm =150 gm 3mm=230 gm www.indiandentalacademy.com Modifications of the Utility Arch: 12 Modifications of the Utility Arch Utility arch with T or L Horizontal loop www.indiandentalacademy.com Modifications of the Utility Arch: 13 Modifications of the Utility Arch Contraction or advancing utility arch www.indiandentalacademy.com Treatment in the Mixed Dentition Phase: 14 Treatment in the Mixed Dentition Phase www.indiandentalacademy.com Bioprogressive Mixed Dentition Treatment : 15 Bioprogressive Mixed Dentition Treatment Four basic objectives- Resolve functional problems. Resolve arch length discrepancy. Correct vertical problems. Correct overjet problems. www.indiandentalacademy.com Resolve functional problems : 16 Resolve functional problems Anything that disturbs the growth, health and function of the TMJ complex. In 1950’s Ricketts –used body section x rays (laminagrphy) www.indiandentalacademy.com Resolve functional problems: 17 Resolve functional problems Lack of rough surface , excessive thickening www.indiandentalacademy.com Resolve functional problems: 18 Resolve functional problems Submento-vertex analysis - Individual condylar inclinations and width. www.indiandentalacademy.com Resolve functional problems: 19 Resolve functional problems Nine general categories- Cross mouth interferences. Anterior crossbite. Open bite. Excessive range of function. Distal displacement. www.indiandentalacademy.com Resolve functional problems: 20 Resolve functional problems Loss of posterior support. Habits. Breathing and airway problems. True Class III Growth pattern. www.indiandentalacademy.com Resolve Arch Length Discrepancy : 21 Resolve Arch Length Discrepancy This is accomplished by three ways- Lateral expansion of the molars. - Depends on the inclination of the posterior teeth. www.indiandentalacademy.com Resolve Arch Length Discrepancy: 22 Resolve Arch Length Discrepancy Expansion primarily by change in axial inclination : - Rickett’s quad helix - .040 blue elgiloy wire. www.indiandentalacademy.com Resolve Arch Length Discrepancy: 23 Resolve Arch Length Discrepancy With 1cm expansion in the upper molars –anterior segment are expanded 3cm overall. Long term functional expansion for atleast a year or more for stable and demonstrable changes to occur in the lower arch. www.indiandentalacademy.com Resolve Arch Length Discrepancy: 24 Resolve Arch Length Discrepancy Arch length gained is result slow natural expansive response created by muscles www.indiandentalacademy.com Resolve Arch Length Discrepancy: 25 Resolve Arch Length Discrepancy Modifications of the Quad Helix www.indiandentalacademy.com Resolve Arch Length Discrepancy: 26 Resolve Arch Length Discrepancy Expansion by mid palatal dysfunction: - Hass type or modified Nance type expansion appliance. www.indiandentalacademy.com Resolve Arch Length Discrepancy: 27 Resolve Arch Length Discrepancy Advancement or forward movement of the lower molars: If the VTO and physiologic factors warrant. Expansion utility arch. 1mm forward movement of LI yields 2mm of arch length. www.indiandentalacademy.com Resolve Arch Length Discrepancy: 28 Resolve Arch Length Discrepancy Uprighting and /or distal movement of the lower molars: - Accomplished by utility arch. - 2 mm per side can be gained by uprighting. www.indiandentalacademy.com Correct Vertical/Overjet Problems: 29 Correct Vertical/Overjet Problems This is done after functional and arch length corrections are achieved. Includes different approaches are used for the first phase of non extraction treatment. www.indiandentalacademy.com Correct Vertical/Overjet Problems: 30 Correct Vertical/Overjet Problems Orthopedic problems- In case where good alignment of lower arch exists and Class II is on account of Max.protrusion. Orthopedic problems with lower arch therapy- - with maxillary protrusion but incisors and molars in deep bite or need advancement. www.indiandentalacademy.com Correct Vertical/Overjet Problems: 31 Correct Vertical/Overjet Problems Orthopedic problems with minor incisor interferences. - Upper utility arch with headgear . Orthodontic problems alone. - Upper utility arch with Class II elastics . www.indiandentalacademy.com Development of the Bioprogressive Brackets : 32 Development of the Bioprogressive Brackets www.indiandentalacademy.com Brackets : 33 Brackets Siamese twin bracket on all the teeth. Slot size-.022 changed to .018 www.indiandentalacademy.com Brackets : 34 Brackets Slot size-.0185 x .030 Use of two light arches Permits a champer or bevel. Allows for a lever access. Adequate distance for the torque grooves. www.indiandentalacademy.com Development of Brackets: 35 Development of Brackets Rickett’s Standard Bioprogressive. Rickett’s Full Torque Bioprogressive. Triple Control Bioprogressive. www.indiandentalacademy.com Development of Brackets: 36 Development of Brackets Rickett’s Standard Bioprogressive. These were the first set of brackets which available.(1960) Banding was done on all the teeth. Line of occlusion –through the contact points. www.indiandentalacademy.com Development of Brackets: 37 Development of Brackets Trend of building in treatment in the appliance. (angulations) The original design had 5° for all the canines and 8° for the upper lateral incisors and 5° for the lower first molar Torque was present only in-upper incisors, laterals and canines. www.indiandentalacademy.com Development of Brackets: 38 Development of Brackets www.indiandentalacademy.com Development of Brackets: 39 Development of Brackets Rickett’s Full Torque Bioprogressive. Torque was build in the lower molars and pre molars. Brackets were placed with 5 angulation. 12 rotation was also built in the tube. www.indiandentalacademy.com Development of Brackets: 40 Development of Brackets www.indiandentalacademy.com Development of Brackets: 41 Development of Brackets Triple control Bioprogressive. Raised bases Triple tube for upper molars Breakaway convertible lower molar tube. Direct bonding base/contoured. Slots cut at an angle www.indiandentalacademy.com Development of Brackets: 42 Development of Brackets www.indiandentalacademy.com Development of Brackets: 43 Development of Brackets www.indiandentalacademy.com Mechanics Sequence for Extraction Treatment: 44 Mechanics Sequence for Extraction Treatment www.indiandentalacademy.com Extraction Mechanics: 45 Extraction Mechanics Four general procedures : 1 Stabilization of upper and lower molar anchorage. 2 Retraction and uprighting of cuspids with sectional arch mechanics. 3 Retraction and consolidation of upper and lower incisors. 4 Continuous arches for details of ideal and finishing occlusion. www.indiandentalacademy.com Extraction Mechanics: 46 Extraction Mechanics 1. Stabilization of upper and lower molar anchorage: Maximum upper molar anchorage . Nance arch with modifications. Headgear . www.indiandentalacademy.com Extraction Mechanics: 47 Extraction Mechanics b) Moderate upper molar anchorage : Palatal bar. Quad helix. Upper utility arch. www.indiandentalacademy.com PowerPoint Presentation: 48 c) Minimum upper molar anchorage: Vertical closing loop. Double delta loop. www.indiandentalacademy.com Extraction Mechanics: 49 Extraction Mechanics Maximum lower molar anchorage: Lower utility arch-four mechanical adjustments. www.indiandentalacademy.com Extraction Mechanics: 50 Extraction Mechanics Moderate lower molar anchorage: Lower utility with adjustments . www.indiandentalacademy.com Extraction Mechanics: 51 Extraction Mechanics Minimum lower molar anchorage: Eliminate the four mechanical factors. Round wires may be used. www.indiandentalacademy.com Extraction Mechanics: 52 Extraction Mechanics 2. Retraction and uprighting of cuspids with sectional arch mechanics. Cuspids need to be kept in the narrow trough of trabecular bone and avoid the severe tipping or displacement The activation of the cuspid retraction springs should produce 100 to 150 grams of force www.indiandentalacademy.com Extraction Mechanics: 53 Extraction Mechanics www.indiandentalacademy.com Extraction Mechanics: 54 Extraction Mechanics Intrusion www.indiandentalacademy.com Extraction Mechanics: 55 Extraction Mechanics Root uprighting www.indiandentalacademy.com Extraction Mechanics: 56 Extraction Mechanics Rotation www.indiandentalacademy.com Extraction Mechanics: 57 Extraction Mechanics 3. Retraction and consolidation of upper and lower incisors. Lower incisors: Very light continuous forces (150 grams) Contraction utility Double delta retraction loops www.indiandentalacademy.com Extraction Mechanics: 58 Extraction Mechanics www.indiandentalacademy.com Extraction Mechanics: 59 Extraction Mechanics Upper Incisors : Regular contraction utility. Upside down vertical closing loop. Double delta loop. www.indiandentalacademy.com Extraction Mechanics: 60 Extraction Mechanics www.indiandentalacademy.com Extraction Mechanics: 61 Extraction Mechanics www.indiandentalacademy.com Mechanics Sequence for Class II Div I: 62 Mechanics Sequence for Class II Div I www.indiandentalacademy.com Mechanics For Class II Div I: 63 Mechanics For Class II Div I Sequence: Lower Incisor intrusion. Lower Cuspid intrusion. Alignment of the lower buccal segment. Alignment of the upper buccal segment. Segmental correction of Class II with elastics. Upper incisor alignment and intrusion. www.indiandentalacademy.com Mechanics For Class II Div I: 64 Mechanics For Class II Div I Upper arch –orthopedic reduction of the maxilla. Lower arch-treatment starts with levelling the spee.-utility arch www.indiandentalacademy.com Mechanics For Class II Div I: 65 Mechanics For Class II Div I www.indiandentalacademy.com Mechanics For Class II Div I: 66 Mechanics For Class II Div I Lower stabilizing utility arch-after initial purpose of the utility arch is accomplished –it no longer serves as an efficient function 16 x 22 stabilizing arch is placed www.indiandentalacademy.com Mechanics For Class II Div I: 67 Mechanics For Class II Div I www.indiandentalacademy.com Mechanics For Class II Div I: 68 Mechanics For Class II Div I Alignment of the lower buccal segment starts: .015 or .0175 Twistoflex .012,.014 of 018 wires 16x 16 triple T section .016 or.018 nitinol www.indiandentalacademy.com Mechanics For Class II Div I: 69 Mechanics For Class II Div I Upper arch alignment: Incisors are not included. Upper molars starts Distalizing-opening spaces in the buccal segment. www.indiandentalacademy.com Mechanics For Class II Div I: 70 Mechanics For Class II Div I a) Consolidation section b) Stabilizing section www.indiandentalacademy.com Mechanics For Class II Div I: 71 Mechanics For Class II Div I Segmental correction with Class II elastics: Three detrimental effects: Skidding effect. Tendency for a deep bite. Difficult to overcorrect buccal segment. www.indiandentalacademy.com Mechanics For Class II Div I: 72 Mechanics For Class II Div I Tractions Sections- Gable bend distal to canine. Rotation bend in the anterior portion. Molar bayonet bend www.indiandentalacademy.com Mechanics For Class II Div I: 73 Mechanics For Class II Div I Functions – Counteract downward backward pull Stabilizing function in the upper buccal segment. www.indiandentalacademy.com Mechanics For Class II Div I: 74 Mechanics For Class II Div I Upper incisors alignment and Intrusion Upper incisors are aligned before placement with light round wires. 16 X 22 utility arch is placed www.indiandentalacademy.com Mechanics For Class II Div I: 75 Mechanics For Class II Div I Consolidation of Upper Incisors Retraction of the upper incisors . Over treatment -2mm Closing utility/upside down closing arch/vertical helical arch. www.indiandentalacademy.com Mechanics For Class II Div I: 76 Mechanics For Class II Div I Idealization of arches and finishing. 16 or 17 square,16 x 22 or 17 x 25 nitinol. Class II elastics to be discontinued atleast 2 months. Light round wires finishing www.indiandentalacademy.com Mechanics Sequence for Class II Div II : 77 Mechanics Sequence for Class II Div II www.indiandentalacademy.com Mechanics For Class II Div II: 78 Mechanics For Class II Div II Three treatment possibilities: 1. Distalizing the upper arch. 2. Advancing the lower arch. 3. A reciprocal movement. www.indiandentalacademy.com Mechanics For Class II Div II: 79 Mechanics For Class II Div II 1. Advancement, torque control, and intrusion of the upper incisors. 2. Intrusion of the lower incisors and cuspids. 3. Alignment of the buccal segments and Class II correction. 4. Consolidation of the upper incisors. 5. Idealizing the arches. 6. Finishing. www.indiandentalacademy.com Mechanics For Class II Div II: 80 Mechanics For Class II Div II Quad helix or W arch www.indiandentalacademy.com Mechanics For Class II Div II: 81 Mechanics For Class II Div II Advancement, torque control, and intrusion of the upper incisors. X Principle of bite before jet Jet is created followed by intrusion. 16x22 utility arch www.indiandentalacademy.com Mechanics For Class II Div II: 82 Mechanics For Class II Div II Directional control www.indiandentalacademy.com Mechanics For Class II Div II: 83 Mechanics For Class II Div II Amount of pressure: 125-160 gms 16 x 22 Stabilization of the molars: Quad helix TPA Stab. sections www.indiandentalacademy.com Mechanics For Class II Div II: 84 Mechanics For Class II Div II Intrusion of lower incisors: 16 x 16 utility arch. 65-75 gms. This is followed by cuspid intrusion. www.indiandentalacademy.com Mechanics For Class II Div II: 85 Mechanics For Class II Div II Advancement of the lower denture: Utility arch with 4 helical loops www.indiandentalacademy.com Mechanics For Class II Div II: 86 Mechanics For Class II Div II Using three vertical loops: www.indiandentalacademy.com Mechanics For Class II Div II: 87 Mechanics For Class II Div II Alignment of the buccal segment: a) Stabilizing section www.indiandentalacademy.com Mechanics For Class II Div II: 88 Mechanics For Class II Div II If buccal segment are not aligned “T” sections Twistoflex wire Cable wire www.indiandentalacademy.com Mechanics For Class II Div II: 89 Mechanics For Class II Div II Consolidation of the maxillary incisors: www.indiandentalacademy.com Mechanics For Class II Div II: 90 Mechanics For Class II Div II Idealization and arches and finishing www.indiandentalacademy.com PowerPoint Presentation: 91 Pentamorphic Arch Forms www.indiandentalacademy.com Finishing and Retention : 92 Finishing and Retention www.indiandentalacademy.com Finishing and Retention: 93 Finishing and Retention “Begin with the end in mind”. Every orthodontist has a visual picture in his mind of the ideal occlusion into which the teeth should fit and mesh in the final finished occlusion. www.indiandentalacademy.com Finishing and Retention: 94 Finishing and Retention Bioprogressive proposes the concept overtreatment…. No clinician can position teeth as delicately as the functioning incline plane and cusp action can accomplish naturally when it is adequately set up to operate correctly. Allow natural function to guide the teeth into the best functioning occlusion for each individual www.indiandentalacademy.com Finishing and Retention: 95 Finishing and Retention www.indiandentalacademy.com Finishing and Retention: 96 Finishing and Retention Two phases of retention: Guiding changes during initial adjustments. Supporting bony sutural and muscular accommodations to changing environment and considering long range influences. www.indiandentalacademy.com Finishing and Retention: 97 Finishing and Retention Initial stage of retention : First six weeks following appliance removal Retainers inserted-designed not to hold but to guide the teeth in settling. www.indiandentalacademy.com Finishing and Retention: 98 Finishing and Retention Labial frame of typical upper retainer (Ricketts) passes between the lateral and cuspid and has a distal loop at each end to tuck in the distal of the expanded overtreated upper cuspid www.indiandentalacademy.com Finishing and Retention: 99 Finishing and Retention Lower arch: Fixed first bicuspid retainer is placed. -maintain cross arch bicuspid width. -lower cuspid freedom of adjustment against upper occlusion. -maintain lower incisor alignment and rotation correction. www.indiandentalacademy.com Finishing and Retention: 100 Finishing and Retention Stabilizing stage of retention: First year following active treatment. Lower retainer is kept in place and upper is worn most of the time. www.indiandentalacademy.com PowerPoint Presentation: www.indiandentalacademy.com 101 Thank you www.indiandentalacademy.com Leader in continuing dental education

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