tip edge technique by almuzian

University of Glasgow

Tip Edge appliance

Personal notes

Mohammed Almuzian

1/1/2013

.

Contents

Introduction...........................................................................................................2

Indication...............................................................................................................2

Advantages............................................................................................................2

Disadvantages........................................................................................................3

Design....................................................................................................................3

Treatment stages....................................................................................................5

Stage I: Anterior segments.................................................................................5

Stage II: Close residual Spaces..........................................................................6

Objectives...........................................................................................................6

Mechanics..........................................................................................................7

Stage III: Root Uprighting.................................................................................7

Tip - Edge Plus......................................................................................................8

Design................................................................................................................8

Mechanics..........................................................................................................8

Table illustrating anchorage differences between tip edge and straight wire

appliances..............................................................................................................9

Mohammed Almuzian, University of Glasgow, 2013 Page 1

Tip-Edge

Introduction

Developed by Kesling and first described in AJO 1988.

Indication

1. Class II camouflage

2. Significant anchorage demand

3. Significant Increased overjet,

4. Significant deep OB

5. Class II molar relationship

6. Significant Presence of crowding.

Advantages

1. Increased inter-bracket span because of the reduced bracket size MD

2. Little need for HG

3. Less anchorage demand because

Differential force theory,

Less expression of the tip during the first stage of treatment

Light force

Round wire with reduced friction during the first stage of treatment

4. Precision in finishing

5. TE bracket can be used with SW in case of Proclined or retroclined canines


Disadvantages

1. Expensive

2. Extraction philosophy

3. Reliant on elastic wear

4. Poor rotational control

5. Profile dishing

6. High risk of root resorption

7. Risk of PD damages

8. Complex in stage III specially the old TE system because each bracket requires

an auxiliary spring to deliver its final prescription.

9. Increased friction in later stages

Design

A. The tip edge bracket

1. Basically it is a modified straight wire bracket

2. Removed two diagonally opposite corners from

rectangular archwire slot which allow the bracket to tip

up to 25° either mesially or distally. It is a ‘dynamic’

slot because:

Unique feature that the slot increases its vertical archwire space from 0.022 to

0.028 inches as the tooth tips

When the vertical slot is then closed down by the auxiliary against a rectangular

archwire, it produces a three-dimensional precision finish.

Also the it reduce the friction during the first stage of treatment


3. Lateral extensions or wings on the bracket provide good rotational control of

tooth position

4. Vertical slot lingual to main archwire slot (auxillaries)

5. Double buccal tubes:

Preadjusted convertible straight wire tube (.022x.028)

Gingival round tube (0.036 diameter)

B. Auxiliaries

1. Sidewinder

0.014” high tensile stainless steel.

Coils alongside the archwire, over bracket face.

Generates mesio-distal root movement as well as

torque correction with rectangular wires. The

torque correction occur mainly by the

rectangular AW fitting in the slot but the side

winder act to closely fitting the AW so it act

indirectly to correct the torque.

2. Power Pin

Soft stainless steel.

Traction hook fitted into vertical slot.

Retained by bending occlusally projecting tail 90 degrees.

3. TE elastic ring

Tip-edge rings (elastomeric tie rings with

crossbars and lingually facing lugs) provide


both arch wire attachment and mesial or distal tip control by filling the

chamfered wedge area. This is called “hammock ‘effect”

These rings are normally used only in the final stage of treatment to maintain the

crown uprighting achieved with springs.

Also ligature steel can produce “hammock ‘effect” as shown in the figure down.

4. Rotating Spring

0.014 inch high tensile stainless steel.

Useful for recapturing a rotation that occurred during treatment.

Place ligature first then spring

Treatment stages

Stage I: Anterior segments

Objectives:

1. Initial alignment of upper/lower anterior segments

2. Closure of anterior spaces

3. Correction of increased overjet or reverse Overjet


4. Correction of increased overbite or AOB

5. Work towards arch coordination

Stage 1 Mechanics

1. Place upper and lower 0.016 SS base archwires and gently engage those teeth

that you can.

2. Severely displaced teeth can be engaged with elastic thread passed through the

vertical slot.

3. Leave off the premolars.

4. Place gentle anchor bends in front of the molars, placing the base archwire in the

gingival slot. These bends reciprocally intrude incisors by the idea of ‘’dig in

heels’.

5. Use Class II elastics (60g only) from circles on the upper archwire to the lower

6’s.

6. Braking: If unwanted proclination of lower incisors during overbite reduction,

utilized ‘reverse Side-Winder springs’

Stage II: Close residual Spaces

Objectives

1. Maintain Stage I corrections

2. Continue crossbite correction

3. Continue correcting centre lines

4. Close residual spaces (either by retracting the labial segments or protracting

buccal segments)


5. Derotate & level 6’s

Mechanics

1. The archwire size is increased to 0.020” round SS.

2. Class one elastic by using E-links between the circles on the archwire to the

hooks on the 6’s.

3. Maintain Class II elastics as required to keep the upper and lower incisors in

gentle contact.

4. To protract the buccal segments rather than retract the labial segments

sidewinders (brake) can be placed on the canines.

5. In view of a centreline discrepancy consider using unilateral sidewinders.

6. At the end of Stage II, de-rotation of the molars is done with a 1mm buccal

offset and 10 degrees of lingual toe-in between the premolar and molar.

Stage III: Root Uprighting

Objectives:

1. Maintain Stage I/II changes

2. Correct torque and Tip

3. Detailing & finishing

Mechanics

0.0215” x 0.028” stainless steel base wire.

Using Side Winder springs or piggy back 014 or 016 NiTi in TE plus

Maintain the space closure using ligatures from crimpable hooks to the hook on

the molars.


Use Class II elastics to maintain light contact between the upper and lower

incisors.

Tip - Edge Plus

Developed by Parkhouse in 2008

Design

1. Two slots: Both 0.020 inch round internal dimension.

Vertical slot for auxiliaries

Horizontally slot for a light flexible wire to replace

Side–Winder.

2. Main archwire slot size 0.0215x 0.028

Mechanics

1. In clinical use, both Tip-Edge and Plus remain identical

throughout the first two stages

2. Side-Winder ‘brake’, may be useful for increasing anterior anchorage, when the

operator chooses, or for correcting centrelines.

3. Placement of the distal end of the auxiliary wire relative to the molar depends on

the extraction pattern. If a first premolar has been extracted, the second premolar

will require mesial root uprighting. This will be aided by placing the distal end

of the deep tunnel wire in the gingivally placed round molar tube and vice versa.

Table illustrating anchorage differences between tip edge and

straight wire appliances

Feature TIP EDGE STRAIGHT WIRE

Stages of

treatment

Stage I Anchorage preparation


Reduce overjet

Open &/or close bite

Close anterior spaces

Overcorrect rotations

Correct X bites

Correct molar relation

STAGE II

Maintain stage 1 objectives

Close posterior spaces

PRE STAGE III

Braking

Fully engage premolars

Correct molar rotations

STAGE III

Uprighting and torque

Finishing

RETENTION

Level and align

Overbite control

Overjet reduction

Space closure

Detailing and finishing

Retention

Concept Differential movement

techniques (eg Begg and Tip

Teeth are moved bodily to

correct malocclusion.


Edge)

Bracket design Modified straight wire

bracket

Rectangular slot with

heavy binding effects

Wires Majority high tensile round

stainless steel with low

friction,

Spaces closed on

rectangular wire, high

friction

Force

magnitude

Light ~60gm continuous Heavy intermittent eg

during frequent archwire,

powerchain changes

Elastics Very light Relatively heavier

Extractions More frequently required Less frequently required

Anchorage Low anchorage strain High anchorage strain

Timing of

anchorage

Late (Stage III)

Correcting and uprighting

mechanics defer anchorage

strain until stage III by

which time extraction spaces

have closed. At this time the

malocclusion is essentially

class I requiring only final

uprighting and torquing

From outset of treatment

Need for Very rarely needed Frequently needed


headgear,

functional,

TPA / Nance /

lingual arch

Premolars Not bonded up until stage II

to reduce friction

posteriorly.

Minimum archwire binding

Bonded up from day 1

Risk of archwire binding

Bite opening tip back / anchor bends Best with rectangular wires

Space closure Light on anchorage as

spaces have already closed

by this time

Heavy on anchorage

Uprighting

mechanics

Using sidewinders in stage

III

Early in treatment

Finishing Ease of use and precision

later in treatment – As seen

in Edgewise system.

Good finishing in EW


tip edge technique by almuzian

Health & Medicine

tip edge bracket

tip edge

te bracket

tipedge introduction

rectangular archwire

final stage of treatment

bracket face

distal tip control