Simplified Straight-Wire Technique

Messias Rodrigues


DENTAL PRESSE D I T O R A

Maringá

2011

2nd edition


Copyright© 2011 by Dental Press Editora

All rights for the Portuguese language reserved by Dental Press Publishing Ltd. This book or any part thereof may not be reproduced, stored in a retrieval system, or transmitted in any form or by means, electronic, mechanical,

photocopying, recording, or otherwise, without prior written permission of the publisher.

DENTAL PRESS INTERNATIONALAv. Euclides da Cunha, 1718 – Zona 05 - CEP 87015-180

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General CoordinationLaurindo Zanco Furquim

Teresa Rodrigues D’Aurea Furquim

Graphic Project and CoverJúnior Bianchi

Messias RodriguesCarlos Alexandre Venancio

EditionFernando Truculo Evangelista

Scientific IllustrationsCibele Santos

CollaborationRaul PectrovicKaren Woodiel

Rafael Eduardo HungElizabeth Gabriela Castellanos Mendez

Márcio CantarelliMargarida Matiko Shikida

RevisionLaudo Bernardes

Romilda Marins Corrêa

NormalizationMarlene Gonçalves Curty

English versionCristina Antunes

Mandarin versionDr. Dongliang Zhang

The Department of Orthodontics Beijing Stomatology Hospital affiliated to Capital University of Medical Science

Wangfujing Avenue Xi La Hu Tong No.11Dongcheng District, Beijing City, P.R China 100006

International data of Cataloguing-in-Publication (CIP)

R696 Rodrigues, Messias. Simplified straight-wire technique / Messias Rodrigues.

- Maringá : Dental Press, 2011. 556 p. : il.; color.

References: p. 545 ISBN 85-88020-35-1

1. Orthodontic. I. Title.

CDD 617.643

To my wife, Rosana, for her dedication, love and understanding in the moments I

was absent due to this paper.

To my children, André and Luísa,reason for my encouragement.

Whatever the force applied or the appliances used, the tooth always reacts

according to the biologic principles of physiology, and is sometimes modified by

the growing pattern.

Cyro Ribeiro de Moura

To Professor Cyro Moura, for his encouragement and guidance in my first orthodontic studies.

To Professors Gerval de Almeida and Sebastião Interlandi, for their confidence, support and example.

To the Ortholine Clinic staff, Márcio Cantarelli and my assistants, Beatriz, Andréia, Rosana and Fátima, for their constant dedication during years of group work.

To my colleague Margarida Shikida, for long days of contribution, organizing this material.

To the UNITAU Professorate, for the academic guidance.

To the Portuguese assistants – Antonio Figueiredo Machado, Maria João Almeida, Catherine Baptista Paulo –, for their dedication and friendship in divulging and teaching this proposal in Portugal.

To my colleagues Fernando Machado, Edmárcio Mafaciolli, Nelson Pavan and Rosana Vilella Chagas, for their assistance and loyalty.

To Cássia Campoy, for the encouragement since the first steps of this paper.

To my students, the reason of this Guide.

Since the first courses offered in Brazil, we felt the need to create an instrument to help students learn and develop. This

is how this guide was first idealized. Besides its main goal – Methodology of Simplified Straight-Wire Mechanics –, the

guide also intends to coordinate some current orthodontics knowledge in order to conscientiously apply them, taking the

most benefits such methodology may offer. Although it gathers many concepts by other authors, it intends to coordinate

readers’ knowledge with knowledge to be acquired in the future, in order to facilitate the correct diagnosis and its consequent

planning.

The author

SUMMARY

FOREWORD ........................................................................................................ 21

INTRODUCTION ................................................................................................ 23

CHAPTER 1

DEVELOPMENT OF SIMPLIFIED STRAIGHT-WIRE MECHANICS .......................................................................... 25 Using Tip-Edge brackets on canines in the Straight-Wire Mechanics The canine bracket Uprighting springs (Side-Winder) Retraction techniques Controlling posterior anchorage

CHAPTER 2

BIOMECHANICS OF THE SIMPLIFIED STRAIGHT-WIRE TECHNIqUE ......................................................................... 55 Notions of facial analysis Face proportions Vertical direction Sagittal direction Exposure of upper incisors Causes of gingival smile Clinical planning beginning with the soft tissue Clinical cases (diagnosis and planning)

CHAPTER 3

ASSEMBLy ............................................................................................................. 83 Choosing accessories Teeth separation Adapting bands Cementing bands Molar tubes Choosing brackets The Twin Tip-Edge bracket Esthetic brackets Bonding protocol Pliers

CHAPTER 4

PHASEI ................................................................................................................ 107 Alignment and leveling Leveling and alignment

CHAPTER 5

PHASE II ............................................................................................................. 119 Correction of overjet and overbite Australian type archwire Anchorage bend Class II elastics Elastics colors and force Premolar bonding in phase II First molar tubes Sliding movement Most common mistakes in the placement of archwire Leveling and alignment concomitant to bite opening and retractionCLINICAL CASE Rotation and uprighting springs Root uprighting springs (side-winder) Placement Activation Torque with tip-edge brackets Using rectangular archwire in phase II Diagram for archwires construction and coordination Initial visit – phase II Revision visit – phase II

CHAPTER 6

PHASE III ............................................................................................................ 171 Closure of spaces remaining from extractions Torque adjustment of the anterior teeth Uprighting canine roots Archwire in phase III Phase III with round archwire Phase III with rectangular archwire Diagram for archwires in phase III

CLINICAL CASE Bonding upper premolars in phase III Elastics for closing spaces E-link placement through vestibular and palatine Activation frequency CLINICAL CASE Phases II and III carried out simultaneouslyCLINICAL CASE Initial visit – phase II

CHAPTER 7

PHASE IV ............................................................................................................ 239 Leveking upper premolars and second molars Maintaining the goals achieved in previous phases Final torque adjustment of anterior teeth Installing the rectangular archwire Phase IV diagram Final mesiodistal adjustment of canine roots Initial visit – phase IV The four phases of the Simplified Straight-Wire Mechanics treatment

CHAPTER 8

TREATMENT MECHANICS WITHOUT ExTRACTIONS .............................. 259 Treatment of class II malocclusion without extraction The growth pattern Jarabak percentage Posterior cranial base and ramus height relationship Upper gonial angle Biomechanics Position of lower incisorsCLINICAL CASES

CHAPTER 9

ExTRACTION OF MOLARS .............................................................................. 327 Treatment with extraction of second molars Third molar conditions Orthodontic mechanics Appliance assembly Archwires and elasticsCLINICAL CASES

CHAPTER 10

ExTRACTIONS OF FIRST MOLARS ................................................................ 403 Clinical characteristics suggesting extraction of first molars Facial analysis Multi-restorations in molars Previous absence of one or more molars Early loss of one or two lower molars, provoking extrusion of the upper correspondent Extensive decays on teeth Simultaneous resolution of lack of space in both anterior And posterior sectors Problems in the endodontal treatment Significant deviation of the median line Severe overjet IndicationsCLINICAL CASES

CHAPTER 11

USING DOUBLE-KEy-HOLE ARCH IN THE SIMPLIFIED STRAIGHT-WIRE MECHANICS ........................................................................ 469 The retraction mechanics Retraction mechanics with Double-Key-Loop (DKL) Considerations on pre-adjusted brackets Characteristics Activation Anterior bite opening Activation magnitude Activation frequency Clinical protocol Leveling and alignment Caution regarding anchorage Clinical sequence ConclusionCLINICAL CASES

REFERENCES ...................................................................................................... 545

21


It is for me a great honor to introduce the present work by Professor Messias Rodrigues. From the time he was our student at the post-graduation program at the University of Taubaté, he showed remarkable intelligence, excellent performance and praise for the ethics. Owner of an unrestful and innovative mind, he managed to search at the inspired production of great leaders, such as Dr. Peter Kesling, Dr. Lawrence Andrews, Dr. Ronald Roth and Dr. S. Interlandi, a firm basis for the development of diagnosis and technique for orthodontic treatment, which represents one step forward for all of us.

The S t r a igh t -Wi r e S imp l i f i ed Technique he created represents a wise choice of a number of both mechanical and methodological courses leading to surprisingly good orthodontic results, within a short period of time, yet easy to understand and to appropriate by our

post-graduation students. No miracles, just extreme good sense. The author’s clinical experience, largely recognized, is collateral security, plenty of credibility.

Maintaining the anchorage, with resistance more dosed and controlled requirements – one major problem for orthodontists – allows for better average results, yet sustaining the benefits achieved. The teachings by Professor Messias represent today the most promising ways towards the commitment regarding the search for truth, simplicity and beauty, stability and harmony, yet with time saving in the field of the orthodontic mechanics.

I sincerely believe the words and images included in this work shall be worthy for the technical and scientific empowerment of the readers.

Gerval de Almeida

FOREWORD

23


Since 1925, when Dr. E. H. Angle presented the Edgewise bracket in the article under the title “Latest and best in Orthodontic Mechanism”, most therapy used until the mid of the 70’s was Edgwise technique (KESLING, 1989).

The practice required time and great ability from the operators, even the most experienced ones, and yet many results would present a number of deficiencies as to the torque of superior incisors and the correction of anteroposterior relationship. According to Bennett and McLaughlin (1998), the resulting occlusion looked like a “pleasant orthodontic result”, instead of presenting a natural-like dentition; and the stability of the teeth in the long term would be affected by the absence of the ideal dental relationships. Besides, in order to obtain retraction movement at the anterior teeth, special arches for space closure would embody second and third order bends for teeth repositioning, while reducing the stationary anchorage effort.

Aware of all those problems, Dr.

Lawrence F. Andrews developed the Straight-Wire appliance. No doubt this was the main advance in orthodontics since it was presented, by the mid of the 70’s. The orthodontists could finally set free from the difficult task of bend construction, as the new technique reduces the job stress, both for them and for the patients, and yet the quality of the cases could be improved.

Therefore, the Straight-Wire mechanics was developed in order to reduce such bends, making it easier to achieve good treatment results. However, the first results were disappointing, as some undesirable effects arose, such as the bite deepening leading to a Toe Hold effect, mainly caused by the canine slots.

All such effects take place because the Straight-Wire brackets incorporate to their basis and slots all the angulations and tri-dimensional torques ideal for the end of the treatment. Nevertheless, such tri-dimensional controls lead to excessive anchorage tension, thus making it difficult to move the tooth during the treatment.

INTRODUCTION

24

Messias Rodrigues

In order to solve these problems, Dr. Andrews applied extra torque on incisor brackets, as well as counter-tipping and counter-rotation characteristics to the canine, premolar and molar brackets. This procedure led the already high force levels to be increased, consequently requiring an increase to the posterior anchorage levels.

The treatment mechanics to be presented in this guide emerged precisely from an alternative idea for solving these problems,

turned up right at the initial phases of the treatment using both the edgewise arch and the straight-archwire techniques. The solution found was bonding Tip-Edge brackets on canines (TP Orthodontics, Inc.). This alternative proved to be efficient, as it avoids the undesirable effects of increasing the overbite, yet requiring less control over posterior anchorage. This method may be considered both simple and versatile, as the canine brackets interchange is the only alteration to the original technique.

Simplified Straight-Wire Technique

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