TIP EDGE ORTHODONTICSSTAGE III

Dr. Onkar Khot

1

Objectives

Correction of torque and tip angles for each tooth individually

Attainment of optimum facial profile compatible with stability

Maintaining class I occlusion

Final detailing

2

Conventional torquing

-Fixed vertical slot dimension.

-19 x 25”

-Active torque- rectangular archwire

Conflicting requirements(rectangular wire provide torque at the same time offer 3dimensional stability)

3

How does Tip-edge torque?

Torque escape’- actively torqued rect wire –reopen the vertical slot dimension, second order root movement than torque

4

How does Tip-edge torque?

a)Initial engagement of rectangular wireb)side winder begins to close vertical spacec)final tip and Torque achieved simultaneously when slot closes

5

How does Tip-edge torque?

-Side winder can recover 14 deg of torque from either direction-Tip and torque- self limiting according to prescription of bracket.-Overcorrection of tip permitted(since 0215”fractionally smaller than 022”)-zero torque discrepancy between bracket and archwire after sidewinder has fully expressed

6

Points to note

-Sidewinder oriented to the side- untip the tooth irrespective of direction of torque

-Two-point contact- tip and torque are unalterably related

-Inadequate tip correction will lead to inadequate torque

-Force values – decline from 60g to 20g at the apex

-No less than .0215 x .028– torquing platform

7

Stage III archwires

Choice of archwires

Arch width

Identifying the land marks

Archform

Traction hooks

Preparation of arch ends

8

Stage III archwires

-Only one size0215” X 028”

-Archwidth- 2mm expanded at molars

-5° lingual toe-in so as to enter pre angulated molar tube at an equivalent angle to straight-wire archform

9

Stage III

Traction hooks

Crimped midway between laterals and canines,hooks pointing gingivally.accept elasomerics from either side

Protruding distal archwire ends are thinned and annealed

10

Stage III – setting the torques

How to read the torque

Torque in

Reduced overbite cases

Increased overbite cases

Pretorqued archwires

Checking the torque

Skeletal class III cases

11

How to read the torque

12

Torque-increased overbite cases

Vertical bite sweep

(reverse curve of spee)

13

Pretorqued archwires

14

Small amount of anterior archwire intrusion is all that needed to retain previous deepbite

Small amount of palatal root torque added to upper anterior segment by elevating the tails of archwire

Checking torque/wiping the sweep

15

Stage III fitting the archwires

Testing molar torque

Cinch backs

Side-winders and elastomeric modules

Removing the archwires

16

Testing molar torque

Only molars-torque from beginning Torque discrepancy between zero torque archwire and 2nd molar tube

17

Cinch backs

Cinching back to allow small ingress of space

18

Sidewinders and elastomeric modules

Sidewinders point mesially except 2nd

premolars in 1st premolar Xn

19

Degree of activation

Canines and premolars- tip correction.Excess activation- loss of anchorage

Full activation appropriate for incisorsApprox 45 deg enough on canines

20

Removal of archwires

Rotating plier forwards along long axis of wire will walk wire mesially out without discomfort to the patient

21

Stage III checks

How to admit extra space

Hyperactivation of side-winders

Causes of inadequate torque

22

Stage III checks

-Progress of the tip and the torque

tipedge has fully expressed when its occlusal and gingival tiewings have become parallel to rectangular archwire

23

Stage III checks

-Available space in the arch

Tight contacts or anterior rotations indicate inadequate space during uprighting

24

Stage III checks

-Unwanted space- Activation of side-winders- Interarch relationship-The vertical relationship-Molar width-2nd molars -Profile considerations

classII check elastics useful aid in maintaining overbite reduction or molar occlusion

25

‘Hyper activation’ of side-winders

Flattening of small section of coil with lightwire plierwhich effectively expand them

26

Causes of inadequate torque

-Incorrect bracket-Misangled bracket-Incorrect archwire-Incorrect bonding position-Incomplete bracket engagement-Wire ligatures-Tight contact points-Slack side-winders-Incorrect torque in archwire

27

Precision finishing

Picking up second molars

Occlusal seating

Braided rectangular arches

Titanium-niobium archwires

Sectioning the main archwire

Crossbite cases

Positioners

28

Precision finishing

-Self-limited precision finishing-Previously unnoticed errors come to light-Stage III(easier to correct in his stage without stepping down the archwire)-occlusal seating-Second molars

29

Picking up second molars

-Until late stage IIIObstructive – unwanted friction.022 x .028” molar tubes

Preliminary alignment- late stage III by means of sectional devise given by Dr. Tom Rocke.016”s.s runs through gingival tiewing and mesially with occlusal inclined loop

30

Vertical elastics can be engaged to a combination of molarhooks and gingivally inserted lockpins

Occlusal seating

Braided rectangular archesTitanium-niobium archwires

31

Sectioning the main archwirearchwire distal to canine is sectioned,premolars and molars recquire tying with criss cross

ligature to prevent spacing

Extrude buccal cusps, leaving palatal cusps unseated

32

Positioners

No finishing wiresPre-Fit PositionersDiff sizes- Extraction and non-extraction

Dis Adv-Individual tooth size discrepancy,noncompliant patient

Tooth positioner as settling aid may take upto 6weeks33

The non-compliant patient

Outrigger hooks

Case selection for Outriggers

Advantages of Outriggers

Limitations of outriggers

34

The non-compliant patient

Whatever one puts in is directly proportional to the gains in tern

Advantages of TipEdge

35

Dr. Christopher kesling

Outrigger appliance

36

Outrigger appliance

37

Outrigger applianceused with rect archwire

38

Outrigger appliance

Patient compliance in the advantage

Limitations

Anterior spacing

Adequate supply of elastics

Part time wear is impossible

Long term fatigue fracture of hooks

39

In the future..!!

40

Tip-edge plus

Stage III root movements – heat activated NiTi auxiliary arch wiresidewinders- ‘spring free stage III’

Improved aesthetics,oral hygiene and patient comfort

41

The addition of a horizontal tunnel permits mesiodistal uprighting and torquing from the power of a small, round, super-elastic auxiliary wire-eliminates the need for individual uprighting springs and torquing auxiliaries

42

CONCLUSION

Tip Edge appliance may no be the most popular appliance today but it has certainly provided an opportunity to both begg and edgewise practitioners to come closer to a common versatile appliance system.

43

Reference

Tip – edge Orthodontics by Richard Parkhouse, 2005 reprint

44