mechanical sequence for class 2 div 1 cases / orthodontic courses by indian dental academy

MECHANICS SEQUENCE FOR CLASSII DIVISION I CASES

INDIAN DENTAL ACADEMY

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Introduction-

• The bioprogressive therapy has long been thought of as sectionalized approach.

• When a full compliment of teeth is maintained,the possiblity of segmental approach to mechanics is greatly enhanced.

• It is important that basic principals of bioprogressive therap be adhered to both


• in treatment planning and in chairside decision making process.The universal concept of control must be altered slightly in mind of clinician to take into account the individual movements of teeth in different planes of space.


Thinking in terms of sectionalized approach.

• Not only are teeth within each arch considered to separate segments,requiring individual movements in their own plane of space,but the individual arches,themselves are to be considered as separate sections.It will be noted that for pure simlicity and efficiency of mechanics,each individual arch may be in completely different phase of treatment.


Sequence of mechanics (non-ex,classII div I Deep bite cases.

1)Upper- -selection of head gear lower- .016 x.OI6 blue elgiloy utility

arch,designed to align,intrude lower incisors.


2) UPPER

• band or bond canine and premolars.sections placed to level and consolidate the upper buccal segments.


Lower

• .O16x.O16 blue elgiloy is reactivated or replaced.

• When cuspid needs intrusion elastic thread is tied from cuspids to a small vertical loop of utility arch.


3)UPPER

• Upper levelling and consolidation sections are replaced with traction sections.

• A small closed helix or gable bend Is incorporated to maintain distal root tip.


LOWER

• After incisors and molars have aligned, .016x.022 blue elgiloy stablizing utility arch is placed.


4)UPPER

• Band or bond incisors• Place light round or

twistoflex anterior section to align incisors.

• .O16x.O22 utility arch is placed.


LOWER

• Lower ideal arch wire .O16x.O16 elgiloy.


5)UPPER

• Anterior spaces are closed with overlay arch-.O16x.O16 blue elgiloy is placed.


LOWER

• Class II elastics to the upper traction continued during upper space closure.


6)UPPER

• Upper ideal arch form is placed to achieve final arch form and torque characteristics in upper arch.


LOWER

• Class II elastics limited to avoid extruding upper incisors.


Mechanics sequence for class II div 2 Cases.

• The principles of bioprogressive therapy continue to be of extreme importance in treatment of class II div 2 malocclusions.the management process we use in order to individualize our mechanics and establish the sequence necessary for special case.


• Division 2 malocclussion are frequently present in brachyfacial patterns with resulting strong musculature. They generally have moderate to minimum convexity, but occasionally do have higher convexity resulting orthopedic problems.


• There are six functions necessary in treating in class2 div2 mallocclusions which are general considerations for evaluating the mechanics sequence:

1. Advancement ,torque control ,and intrusion of upper incissors.

2. Intrusion of lower incissors and cuspids.3. Allignment of buccal segments and class2

corrections.4. Consolidation of upper incissors.5. Idealizing the arches.6. Finishing.


TREATMENT SEQUENCE OF MECHANICS.NON EXTRACTION CLASSII DIV 2, DEEPBITE.

1. UPPER:• Band or bond the upper

incisors. The upper incisors are advanced , torqued and intruded with .016 x .016 blue elgiloy utility arch.

• The anterior section should be deflected forward 5mm or more.

• A”V” in the anterior arch for will help keep this contour.


2. UPPER

• Continue use of utility arch.

• Band or bond maxillary cuspids and bicuspids.

• Level the buccal sections with “T”sections or “piggyback”, a round wire.

• If leveling is not necessary place traction section and initiate class2 elastics.


LOWER

• Place lower .016 x .016 blue elgiloy utility arch with 65-75 gms of force.

• The bicuspids and cuspids are banded or bonded.


3 UPPER

• Intra oral utility arch activation to continue incisor intrusion.

• If class2 elastics has not been initiated,start at this time.


LOWER

• Elastic thread is ligated from lower cuspid.

• Place .016 x.022 stabilizing utility arch to enhance torque control. Stabilizing section should be used during cuspid intrusion.


4 UPPER

• After buccal segments are corrected torqing utility arch is used for torque control, intrusion, contraction and leveling of incisors.


LOWER

• Place a stabilizing utility arch to idealize and maintain torque control. Place piggyback or overlay arches for continued effect of rotation,space closure and leveling of buccal sections.


5 UPPER

• Ideal upper arch wire .016x.016 or .016x .022 blue elgiloy . In standered bioprogressive lateral gablebends, bicuspid offsets and molar bayonets are placed.


LOWER

• Ideal lower arch wire .016x.016, .016x.022 or .018x .022 blue elgiloy .

• Buccal root torque is bent into ideal arch distal to first bicuspids.


6 UPPER

• Finishing and band space closure arch is placed. Closing “L” arch wire .018x.022 blue elgiloy.

• If bonding techniques are used space closure arches would not be necessary.


LOWER

• Finishing and band space closure arch is placed. Closing horizontal “L”arch wire .016x.022 blue elgiloy. Activation of 1- 2 mm.

• 5/16’’ Heavy class2 elastics 20 hrs per day.

• Two week intervals appointments.


FINISHING PROCEDURES AND RETENTION.

• The finishing and retention procedure of the bioprogressive therapy are considered,from the beginning stages of treatment,as a part of the total scheme of treatment.

• One of greatest values of VTO is the establishing of specific end results from the beginning.


Basic boprogressive appliances

• Standard bioprogressive appliance has had torque in upper central and lateral incisors as well as all four cuspids.

• Full torque bioprogressive adds additional torque,by placing torque in lower 2nd bicuspids and lower ist and 2nd molars.this added torque is used in accomplishing the same objectives as the original standard appliance.


• Triple control bioprogressive appliance now combines offset first order bends with second order tip and the third order torque, to present the complete “triple control” needed to place teeth in all three planes of space to accomplish the necessary movements to reach the objective of the over treated orthodontic occlusion.


Occlusal check list in finishing

1. Intermolar width at lower 2nd molar,together with uprightness and rotation of that tooth.

2. Using 2nd molar as guide, is lower 1st molar contact at distal cucp.


3. Distal contact 2nd premolar. It would appear slightly depressed.

4. The lower 1st pm is very critical.it should appear to be buccal to canine.


5. Torque consideration from 2nd pm backward there is progressive lingual crown torque.

6. Pm offset is given to bring in contact with distal lingual incline of upper canine.


7. Mesial of cuspid is tucked slightly behind the lateral incisor,distal of cuspid buccal of 1st pm.

8. The incisors and canines are oriented to occlusal plane at about 14-16 deg.


UPPER ARCH FINISHING CHECK LIST.

1. 1st molar and 2nd molar width.

2. Upper molar rotation.3. This is considerd key of

finishing because lower 1st molar and the upper 1st molar must be correct before its proper position can be attained.


4. It should be parallel to occlusal plane buccolingually .it may also appear to be slightly distally inclined because mesial marginal ridge is broken and lower than distal marginal ridge.


5. In the upper arch is to consider the contour and over treatment of buccal occlusion.

6. Canine should be over treated in finishing stages of class 1 and class 11 malocclusion corrections.


7. A gingival step of1/2 to 2mm would be required to clear the longer cuspid in excursions of mandible.

8. Upper centrals contact are considred and midlines of the denture



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mechanical sequence for class 2 div 1 cases / orthodontic courses by indian dental academy

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