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PROCEDURES MANUAL

THE FARRELLBENT WIRESYSTEM (BWS)™

developed by Dr. Chris Farrell (BDS Sydney University)

Arch development combined withsimultaneous myofunctional training inthe late mixed or permanent dentition.

BWS

Contact us for a FREE instructional video on theFARRELL BENT WIRE / TRAINER System.

Enquire about courses in your area onMYOFUNCTIONAL / ORTHODONTIC TREATMENT

All enquiries to:

MYOFUNCTIONAL RESEARCH CO.PO Box 14 Helensvale Qld 4212 AUSTRALIA

Tel: +61 7 55735 999 Fax: +61 7 55736 333

Email: info@myoresearch.com

Internet: www.myoresearch.com

CONTENTS:

Introduction2 - 3

BWSFabrication4 - 5

Inserting theBWS6 - 7

PatientInstructions8 - 9

AdjustmentVisits10 - 11

Important12

Materials andInstrumentsChecklist13

E U R O P E • U S A • A U S T R A L I A

465BWS:02/03 ENG_H © 2003 Copyright MYOFUNCTIONAL RESEARCH CO.

INTRODUCTION

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THE FARRELL BENT WIRE SYSTEM (BWS)PROCEDURE MANUAL

The Farrell “BENT WIRE SYSTEM”,BWS, has been developed in responseto the need for combined myofunctionaland orthodontic/orthopaedic treatment.

One of the important phases ofOrthodontic treatment is archdevelopment. Although controversystill exists whether to expand or extractto gain space, there is a clear indicationfor arch development in many cases.

A study of the appliances used for this purpose reveals they are mostlydetrimental to correct function and encroach on tongue space. This is just onereason why poor results are often obtained. Multi-banded appliances are alsopoor tools in obtaining significant arch development. Extraction of permanentteeth is therefore the only option, even though the research shows the resultsare no more stable.

The TRAINER system was developed for correction of the underlyingmyofunctional habits, which are the cause of many orthodontic problems.Before, during and after treatment, the soft tissue dysfunction can be treatedwith the pre-orthodontic TRAINER, the TRAINER for Braces and the TRAINERfor finishing. Correction of tongue position and function plus mode of breathinghas a major positive effect on dental and facial development. However, virtuallyall arch development appliances encroach on tongue space and tend to makemyofunctional problems worse.

See NOTE 1 (page 12): “Why you should never use maxillary applianceswith acrylic in the palate.”

There is a need to combine arch developmentwith simultaneous myofunctional training inthe late mixed or permanent dentitionThe Trainer system combined with the Farrell Bent Wire System are usedfor simultaneous arch development and treatment of myofunctional habits.

It can totally replace existing Phase I treatment. This dual treatment approachgives substantial arch development with very light forces from a simple andinexpensive, fixed appliance.

No palatal bar is needed, eliminating the speech and functional problems ofthe common acrylic and quad helix appliances. It is can also be integrated withmulti-banded appliances.

The Farrell“BENT WIRE

SYSTEM”,BWS, has been

developed inresponse to the

need forcombined

myofunctionaland

orthodontic/orthopaedic

treatment

Correction of tongueposition and function

plus mode ofbreathing has a major

positive effect ondental and facial

development

Bent WireAppliance

Upper (FF1)

BWS

INTRODUCTION

3

Stability is greatly improved due to the use of the TRAINER to correct tongueposition and function, plus mode of breathing. In fact the technique dependson the use of the TRAINER system for its effectiveness.Because the BENT WIRE SYSTEM is a fixed appliance, the complianceproblems of phase one-type appliances are eliminated. The patient enjoysnormal speech and no visible appliance during the day. The children like thesystem particularly for this reason.

There's no need for laboratory construction of the BWS - it can be performedentirely "in office" without need for a laboratory technician. Each appliancetakes less than five minutes to make and the components are inexpensive andreadily available. This also means breakages can be rapidly and inexpensivelyrectified while the patient is still in the chair.

SeamlessIntegration withMulti-bandedappliances

The BENT WIRE SYSTEMcan be combined with fixedbrackets and the T4B™TRAINER for BRACES,a l l o w i n g a s e a m l e s sin tegra t ion f rom archd e v e l o p m e n t , i n t ofull fixed brackets, whilecontinuing myofunctionaltraining.

SeamlessIntegration

withMulti-banded

appliances

Stability is greatlyimproved due to the

use of the TRAINER tocorrect tongue

position and function,plus mode of

breathing

BWS

Archdevelopment

after 7 monthsusing

BWS/TRAINER

THE BENT WIRE SYSTEM (BWS) FABRICATION

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The Bent Wire System (BWS) FabricationThere is no requirement for laboratory construction. (See BWS video)

There is norequirement for

laboratoryconstruction

Only compensate for badly misaligned teeth (photo shows appropriatecompensation bend).

Mark a point at the distal of the canine. At this point form an 'S' bend aroundthe premolars or deciduous first molars using hollow jaw pliers.

BWS

Cut off 10cm of 0.7 stainless steel wire. Mark the centerline on the wire. First,bend the anterior section to the ideal arch shape between the distal edges ofthe upper canines.

THE BENT WIRE SYSTEM (BWS) FABRICATION

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Mark a point 2-3 mm from the top of the distal part of the loop. Using three-jaw pliers make a near 90º bend forward, then using bird-beak pliers create atight 180-degree reverse bend back to the distal. This makes a loop to attacha ligature.

The distal end that engages the tube in the molar band should be stepped up1-2mm from the mesial part of the loop.

Cut off the ends exactly to the length of the molar tube - that is 6mm.

CompletedBWS-FF1on model

BWS

Mark a point between second premolar or second deciduous molar and the firstpermanent molar. Using loop-bending pliers, form a loop of 5-7mm wide. Anglethe loop to clear soft tissue - 25 degrees upper, 10 degrees for the lower. Allbends should be single plane.

CompletedBWS-FF1on model

INSERTING THE BWS

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Remove the BWA, place two Begg premolar brackets in bracket holders withwire slot directed towards the gingival.

Etch the lingual of premolars and bond the Begg brackets with arch wire slotto the gingival.

Alternately a composite ledge can be made on the premolars. This is preferredif the deciduous first molar is present.

For extra retention or for more force on an in-standing anterior tooth, use ananterior Begg bracket, a button or composite on that tooth.

BWS

After one week's preparation with separating elastics, select the appropriate sizemolar band. Ensure the molar band is a very firm fit and not too big, becausethere's considerably more torque on the molar band than for regular arch wire.

Weld a Farrell spec tube to the centre of the lingual section of the selectedband or use pre-welded bands with correct BWA tubes.

Cement the band with glass ionomer cement.

Next place the BWA into the tubes and check for correct fit and activation.Correct the angles of the distal ends so there is no active torque on the molars.There should be no active lateral arch expansion in the appliance.

Inter-molar width of the BWA should be the same as at the molar tubes. Thisis because there sufficient lateral expansive force once the loops are activated.

Check that the loops are clear of the soft tissue.

Inserting the BWS

Activation at the loops should be no more than one to two millimetersinitially and subsequently every two-to-three weeks.

INSERTING THE BWS

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BWS

Open the loops bilaterally with Adams pliers at the base of the loop and placea compensating bend at the start of the loop to keep the distal end in line withthe BWA body. Adjust the distal end angle to obtain some intrusive force onthe upper anterior only.

Fit the upper BWA - FF1 on this visit and the lower one in four to eight weeks.This interval will minimise discomfort for the patient.

The BWA is held in place using a ligature from the distal of the tube to theligature loop of the wire. This is put in place using mosquito forceps. Thelarger 1.3mm ligatures are best.

Check again for anyirritation and particularlyanywhere the BWAencroaches on the softtissue. It's important to beaware that any part of theBWA 0.7mm wire canpotentially ulcerate thegingiva and can becomesubmerged in a few weeksas the gingiva grows overthe BWA.

PATIENT INSTRUCTIONS

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You should warn the patient they will experience irritation around the molarbands and sensitivity in the first few days particularly. But this normallysubsides within a week.

Issue one soft T4K, orif second molars arepresent, the T4B

Remind the patient that theTRAINER must be used one hour aday plus overnight while sleeping.Direct the patient to begin using theT4K or T4B immediately.

The first adjustment appointment takes place after two weeks. At this appointmentensure that the BWA is not encroaching on the gingival areas anywhere beforeremoving.

Remove the ligatures with a probe. Remove the BWA with pliers. Check fortooth movement and arch development.

Activate loops 1-2mm per side using Adams pliers and decompensate the bend.This is the only adjustment. Do not activate laterally. Straighten out anteriorcompensating bends progressively if present.

Replace the BWA.

Check TRAINER USEReinforce its importance.

The concept of the BWS is toprogressively regain arch size andtrain the tongue to its correct position.

The effect of correction of tongueposition assists in the skeletaldevelopment of the upper arch.Stopping tongue thrust and reverseswallowing with The TRAINERassists correction of the loweranterior arch form.

BWS

Patient Instructions

T4B™

PATIENT INSTRUCTIONS

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Subsequent visits should be scheduled for every three to four weeks. At thesevisits question the patient about the previous adjustment and how long theteeth were sensitive.

This will guide you regarding the degree of activation.

The teeth should remain sensitive for no more than two days after eachadjustment visit. Continue the adjustment process as described, but if sensitivitypersists for more than two days after adjustments, decrease the amount ofadjustment.

You will notice that for the first few weeks of treatment there isn't a lot ofmovement. After the first few weeks tooth movement tends to accelerate, sodon't be tempted to increase the adjustment amount by more than 1-2 mm perside.

The fabrication of the lower BWA is the same.

Fit lower BWA (FF2) after 4-8 weeks using the previous fitting procedures.Use composite or anterior Begg brackets on the anteriors if the premolars areof insufficient crown length.

Some distalisation of the molars will occur as well as some tipping. Althoughthis is normal, do not let it become excessive and adjust accordingly.

Also adjust the BWA to fine-tune tooth movement and arch shape. Removethe BWA for 3-4 weeks if tipping becomes excessive.

Continue with TRAINER only in this time.

At each visit check for improvement in myofunctional habits and alwaysreinforce TRAINER use. See the TRAINER video for the information on this.Compare photos and Soft Tissue Dynamic Analysis.

During visits, always remind the patient and their parent that daily useof the TRAINER is essential for the system to work effectively.

If the patient is not usingthe T4K as directed do notactivate the BENT WIRESYSTEM fully and tellthem this will more thandouble the treatment timeand risk an unstable resultwith long retention time.The TRAINER manualhas more information onthis.

Don't be tempted to try to expand the molars using the BWA. Inter-molardistance will widen due to the reciprocal forces on the anteriors. Straighteningout the 'S' bend bilaterally half-to one-millimeter per adjustment with an Adamsplier can actively expand the premolar area. Again, this arch widening tendsto occur as a reciprocal action in any case.

After achieving good dental alignmentand arch development - which shouldtake no more than six to eight monthsper arch the harder TRAINER can beimplemented for further correction ofdental alignment.

Alternately full fixed appliances canbe implemented with the Trainer forBraces -T4B™.

This continues the myofunctionaltraining with orthodontic treatment.

Usually the BWA can be removedafter the brackets are on. However theBWA can be replaced at any time torefine the inter-molar widths.

ADJUSTMENT VISITS

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BWS

Adjustment Visits

ADJUSTMENT VISITS

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Many cases can be treated without brackets by use of the harder trainers forfinal dental alignment. Further mandibular translation can be achieved usingthe T4F™ Trainer for finishing.

The T4F™, T4U™ Multifunctional Appliance or T4A™ Trainer for Alignmentcan all be used as retainers at the de-band stage,depending on the stability ofthe case.

Always ensure BWA is clear of soft tissue to prevent submerging beforerequirement for surgical removal.

Avoid excessive adjustment, as theBWA appears to move teeth slightlyexponentially and you'll besurprised how easy it is to gain spacewithout opening the bite.

Resist the concept that crowding isassociated with lack of arch widthand remember that most crowdingcases are due to a combination ofmyofunctional problems andflattening or vee-ing of anterior archform.

As with the Biobloc philosophy, theupper anterior will be placed in a moreforward and upward position. Thisproduces a decrease of the Indicatorline. Some molar distalisation andwidening occurs as a natural sideeffect. No longer is there a need forheadgear. This is a favourable effectin early Class II correction asrecommended by Ricketts.

BWS

T4A™

T4F™

Cross Section of dual-moulded T4F showsrigid inner core surrounded by customisableEVA outer material

IMPORTANT

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IMPORTANT

Always ensure that the T4K™ or T4B™ are worn daily in conjunction withthe BWA program. This is how bony development is achieved without theuse of acrylic and expansion screws. If the TRAINERS are not worn, slowdown the adjustment or remove BWA for a period of time.

Remember that the purpose of the FARRELL BENT WIRE SYSTEMis to achieve both arch development and myofunctional trainingsimultaneously.

This dual effect provides a powerful tool in correcting any malocclusion,resulting in considerably less treatment time, less requirement for extractions,no more open bites. It’s also ideal for regaining lost C space to avoid premolarextractions. And because it has no visual or functional disadvantages the BENTWIRE and TRAINER SYSTEM achieves far greater compliance - it’s themost user-friendly appliance available.

To be effective, orthodontic treatment must address the underlyingmyofunctional problems causing the orthodontic disorder. That’s why theFARRELL BENT WIRE SYSTEM and the TRAINER System weredeveloped - to meet the need for combined myofunctional and orthodonticor orthopaedic treatment.

See the BWS video for a selection of cases showing the power of the BWSsystem. As treating function and form simultaneously produces outstandingnon - extraction results. All you are doing is correcting arch form and gettingfunction back to normal.

NOTE 1: Why you should never use maxillary appliances with acrylic inthe palate.

The famous Harvold studies in the 1960’s through to the 1980’s on primates performed twobasic operations:

1. Plugged the noses to produce mouth breathing animals, and2. Placed acrylic blocks in the palatal vault.

Both scenarios PRODUCED malocclusions and changed (myo) functional characteristics.The malocclusion is primarily caused in both cases by lowering tongue position. John Mewwould call it a change in mandibular posture. However, all acrylic appliances including hisBiobloc system, simulate this very same effect while supposedly trying to CORRECT themalocclusion. Popular translatory appliances like the Clark Twin Block with acrylic in boththe palatal vault and on the occlusal surface are the ultimate in producing a malocclusion bylowering tongue posture, encouraging tongue thrusting through the open anterior space,perpetuating mouth breathing and preventing lip seal. A case of the dog chasing its tail. Thisexplains the rapid relapse experienced in many of these cases. So don’t use any of these. Thisis why the BWA was developed. It is also noteworthy that appliances like the Crozat and theALF plus Quad-helix are going in the right direction, but still maintain palatal wires whichinterfere with tongue posture. All are more expensive and complex than the BWA.

Remember thatthe purpose of

the FARRELLBENT WIRE

SYSTEM is toachieve both

archdevelopment

ANDmyofunctional

trainingsimultaneously

All you aredoing is

correcting archform and

getting functionback to normal

BWS

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What is needed to make the BWS

� Check box to order

Materials� 0.7mm low nickel wire Leone Biosteel 0.7mm - .028” wire (C0401-07)� Molar band set - Leone or any preferred.� Kit of assorted sizes prewelded with Leone Farrell Spec tubes tubes and brackets.� 1.0 & 0.8mm buccal tubes - Leone Farrell Spec tubes� Begg brackets (premolar) wide base. TP (256-354).

Instruments� Hollow Jaw Pliers - Leone P1155-00� Loop Bendering Pliers - Leone P1165-00� Weingart Pliers - Leone P1823-00 / Ortho Organisers 200-303� Elastic Separating Pliers - Leone P1141-00� Wire Cutters Leone - P1099-00� Adams Pliers - Leone P1174-00� Bird Beak Pliers - Leone P1815-00� Band Seating Instrument - Ortho Organisers 200-319� Band Removing Pliers - Leone P1836-00� Bracket Holder - Ortho Organisers 200-319� Bracket Removing Pliers (Straight) - Leone P18329-00� Mosquito Forceps - Leone P1088-00� Ligatures - Leone 1.3mm K6360-13� Fuji IX Glass Ionomer Cement� Light cured flowable composite or any bracket bonding kit.� Rocky Mountain Welder. (optional)� Other

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BWS

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