Beruflich Dokumente
Kultur Dokumente
D. C. D. - D. S. O. - D. U. O.
OPTIMIZATION of
orthodontic ELASTICS
Edited by
GAC International
MICHEL LANGLADE
D. C. D. - D. S. O. - D. U. O.
OPTIMIZATION of
orthodontic ELASTICS
Edited by
January 2000
DIAGNOSTIC ORTHODONTIQUE
Prface Ruel W. BENCH
768 Pages - 552 Photos - 1981.
THERAPEUTIQUE ORTHODONTIQUE
Prface Robert M. RICKETTS
3rd Edition - 1986
OPTIMISATION TRANSVERSALE
DES OCCLUSIONS CROISEES UNILATERALES POSTERIEURE
Prface Rudolf SLAVICEK
384 Pages - 349 Photos - 1996
French editor:
MALOINE
27, rue de lEcole de Mdecine
75006 Paris FRANCE
Tl.: (33) 01.43.25.60.45
Fax: (33) 01.46.34.05.89
Italian editor:
S. T. D. EDIZIONI INTERNAZIONALI
Via Capecelatro 75
20 148 Milano ITALIA
Tl.: (39) 02 - 404.43.21
Fax: (39) 03 - 036.15 27
TABLE OF CONTENTS
CHAPTER I: Definitions..............................................................
p1
Definitions
Presentation of orthodontic elastics
Elastics force use
p5
p7
Classification
Clinical statement
Force delivery
Classification of forces
Basis for prescribed pressures
Anchorage
p 20
p 32
p 53
Definition
Disposition
Biomechanics of Class II elastics
Class II elastics effects with continuous archwires
Class II elastics indications
Clinical applications of Class II elastics
Clinical problems with Class II elastics
TMD and Class II elastics
Pain and Class II elastics
Orthognatics and Class II elastics
Influence of the archwire and hooked point
Bioprogressive torque Class II elastics
The Class II molar extrusion elastic
How to diminish the extrusion component force
The split positioner
p 83
Definition
Disposition
Biomechanics of Class III elastics
Class III elastics effects on continuous archwires
Indication of Class III elastics
Clinical applications of Class III elastics
Clinical problems with Class III elastics
TMD and Class III elastics
Pain and Class III elastics
Orthognatics and Class III elastics
p 97
p 128
p 159
CONCLUSION............................................................................
p 178
BIBLIOGRAPHY........................................................................
p 180
CHAPITER I
Definitions
CHAPTER I: Definitions
DEFINITIONS
ELASTICITY:
It is the property of a material to return to its original form.
ELASTIC MATERIAL:
Presents usually 3 properties:
1 - a distorsion not going beyond its limit of elasticity
2 - physically homogeneous
3 - isotrop, giving the same force in any direction ( see Fig I. 1 ).
LIMIT OF ELASTICITY:
It is the amount of forced distorsion without deterioration and loss of elasticity .
ELASTOMERS
General term encompassing materials returning to their original dimensions immediately after
substantial distorsion. Under this term are:
- natural rubber or latex coming from hevea trees
- synthetic rubber polymers such as styren butadien rubber, butyl, polyisopren,
polybutadien, ethylpropylen, teflons, hypalon, silicons.
1
CHAPTER I: Definitions
colour coding
first name
sports
countries
animals
plants
fruit
toys
objects
Some Ortho manufacturers have even proposed mint flavoured elastics in order to improve
patient compliance in elastic wear.
Orthodontic elastics can be designated as:
- intraoral
- extraoral
ADVANTAGE OF ELASTICS:
placed and removed by the patient
discarded after worn out
no activation required by the orthodontist
effect increased by mandibular movements ( mastication, phonation )
can be changed upon prescription one, two, three times a day or even worn at night.
DISADVANTAGE OF ELASTICS:
The orthodontist must be aware of:
deterioration and loss of elasticity:
Any elastic worn in mouth is affected by:
PH of oral environment
saliva
2
CHAPTER I: Definitions
dental plaque
time
foods and drinks.
moisture absorption makes the elastic swollen and odoriferous.
non odor free when worn after 24 hours.
unpredictably variable forces exerted if the prescription is not well explained and
controlled.
the exerted force is not constant and depends on patient compliance
elastics can be placed incorrectly, upsetting biomechanic effects of the appliance.
patient motivation.
The more the rubber elastic is worn, the less the elasticity memory stays, as E. HIXON 4 et. al.
have demonstrated ( see Fig I.2 ).
It means that in clinical uses, elastics must be changed regularly according to the orthodontists prescription.
Fig I.2: Percentage of elastic force lost in mouth from E. HIXON 5 et. al.
A. J. O. Vol 57 N 5. p 481 1970.
3
CHAPTER I: Definitions
Fig I.3: To check the elastic forces the Orthodontist can use CORREX or DONTRIX gauges.
4
CHAPITER II
1728:
1756:
1803:
1839:
1841:
1892:
1904:
1907:
1948:
1958:
1963:
F. CELLIER introduced for the first time the Chin Cup Fround with
rubber bandages.
Calvin CASE was the first to use intermaxillary elastic forces to correct malocclusions.
Charles TWEED initiated the Class III elastic use to reinforce the
anchorage preparation of Class II malocclusion before using Class II
elastics.
1965:
1964-1970:
1972:
1973-1996:
Michel LANGLADE developed the clinical applications of elastic forces in different situations such as occlusal elastics or controlateral
crossbite elastics, proposing biomechanics comparison in clinical
uses.
Elastomers
Intraoral Elastics
Only pure, natural latex is used in producing GAC elastics. Precise wall thickness and predictable forces
are consistent characteristics of our full line of elastics. Our Travel Pack recognition system makes it fun
and easy for patients to remember the correct size and force. In addition to size and force designation,
each smudge-proof bag has a landmark, symbol, or activity associated with a specific country. Each pack of
GAC intraoral elastics contains a bright white placer to help patients properly and easily use their elastics.
EXTRAORAL
INTRAORAL
Inside
Light
Diameter Red /1.8oz
3mm
(1/8)
4mm
(3/16)
6mm
(1/4)
8mm
(5/16)
10mm
(3/8)
12mm
(1/2)
14mm
(9/16)
16mm
(5/8)
18mm
(11/16)
11-100-03
Australia
11-100-04
Holland
11-100-06
China
11-100-08
Canada
11-100-10
England
Medium
Heavy
Super Heavy
XH
XXH
Green/2.7oz
Blue/4oz
Black/6oz
Brown/6oz
Black/8oz
11-101-03
Germany
11-101-04
Mexico
11-101-06
USA
11-101-08
Italy
11-101-10
Spain
11-102-03
India
11-102-04
Switzerland
11-102-06
Japan
11-102-08
Scandinavia
11-102-10
France
11-103-04
Thailand
11-103-06
Korea
11-103-08
So. America
11-100-16
Ireland
11-104-08
Greece
11-104-10
Greece
11-104-12
Greece
11-104-14
Greece
11-104-16
Greece
11-104-18
Greece
11-105-04
Africa
11-105-06
Kenya
11-105-08
Argentina
11-105-10
Peru
Light, Medium, Heavy, and SH are packaged in boxes of 50 zip lock bags of 100 elastics. XH and XXH are
packaged in boxes of 25 zip lock bags of 50 elastics.
Light
Medium
Heavy
Super Heavy
Red/1.8oz.
Green/2.7oz.
Blue/4oz.
Black/6oz.
1/8"
3/16"
1/4"
5/16"
3/8"
5/8"
11-201-03 / Panama
11-200-06
11-200-08
11-200-10
11-200-16
/
/
/
/
11-201-04 / Belgium
Philippines 11-201-06 / Russia
Singapore 11-201-08 / Indonesia
Malaysia
11-201-10 / Finland
Guatemala
11-202-03 / Columbia
11-202-04 / Brazil
11-203-04 / So. Africa
11-202-06 / Chile
11-203-06 / Saudi Arabia
11-202-08 / Luxembourg 11-203-08 / Hungary
CHAPITER III
ELASTIC
DISPOSITION
ELASTIC
CLASSIFICATION
MOVEMENT
FORCE
INDICATION
COUNTER
INDICATION
Space closure
Distal movement
Mesial movement
Tipping
Extrusion
Intrusion
NO
Dental and
Class I
Monomaxillary
Contraction
horizontal
vertical
transversal
Class II
Distal max
Mesial mandible
Skeletal
Regular
Class II
Closing
Distal max
Open bite
Class II
Extrusion
Mesial mandible
Class II
Monomandibular
ELASTIC
CLASSIFICATION
Class III
Mesial max
INDICATION
Class II and
Distal mandible
Skeletal
Class III
Extrusion
COUNTER
INDICATION
Dental and
Regular
MOVEMENT
FORCE
Closing
Short closing
Dental
Class II and
Distal mandible
Deep bite
Class III
Mesial max
Class III
Open bite
Class II and
Class III
deep bite
Extrusion
Class III
ELASTIC
DISPOSITION
ELASTIC
DISPOSITION
ELASTIC
CLASSIFICATION
MOVEMENT
FORCE
INDICATION
COUNTER
INDICATION
Oblique pull
Midline correction
Skeletal
extrusion
canine relationship
open bite
Oblique pull
Midline
extrusion
shift correction
Oblique pull
extrusion
with
of one side
midline shift
Class II
and
Class III
9
Diagonal
Oblique
Anterior
Triangular
Deep bite ?
Anterior
ELASTIC
CLASSIFICATION
MOVEMENT
FORCE
Posterior
Distal max
triangular
Mesial mandible
10
Anterior
deep bite
Class II
Extrusive
Dental
Extrusion
COUNTER
INDICATION
Dental
Class II
INDICATION
Open bite
Deep bite
U shape
force
open bite
Contraction
Anterior
Dental
and
rectangular
Deep bite
open bite
extrusion
ELASTIC
DISPOSITION
ELASTIC
DISPOSITION
ELASTIC
CLASSIFICATION
MOVEMENT
FORCE
INDICATION
Intermaxillary
Extrusive
Vertical
COUNTER
INDICATION
Open bite
vertical elastic
force
extrusion
11
Vertical
+
elastic
Open bite
extrusion
light contraction
Vertical extrusion
W and M
Extrusive
Skeletal
to
elastic
force
open bite
squeeze the bite
Extrusive force
Delta
ELASTIC
CLASSIFICATION
MOVEMENT
FORCE
Accordion
Contraction
++++
INDICATION
COUNTER
INDICATION
Open bite
Skeletal
with
Extrusion
++++
elastic
12
Posterior
Mesial max
open bite
spaces to close
Deep bite
Skeletal
triangular
Distal mandible
dental
open bite
Class III
Extrusion
Homolateral
Class III
Edge to edge
Transversal force +
cross bite
Skeletal
cross bite
Extrusion + + +
elastic
open bite
degree 1
ELASTIC
DISPOSITION
ELASTIC
DISPOSITION
ELASTIC
CLASSIFICATION
MOVEMENT
FORCE
INDICATION
COUNTER
INDICATION
Horizontal transversal
force
+ + + +
Degree 2 to 3
Skeletal
Extrusion
cross bite
open bite
Controlateral
cross bite
elastic
Tranversal
ectopic tooth
occlusal elastic
contraction
position
Combined
elastics
CR
Individual clinical
Objective
13
Too buccal
O shape
CLINICAL STATEMENT
Name:
N:
Date:
A / TRANSVERSAL:
RIGHT
Crossbite
NORMAL
Crossbite
LEFT
Maxillary
Maxillary
Mandible
Mandible
B / VERTICAL:
3SD 2SD 1SD
Class :
Deep bite
Open bite
Skeletal
Dental
Grade by 1 SD, 2 SD, 3 SD . Use an arrow for tendency
C / SAGITTAL:
Right
A
N
C
H
O
R
A
G
E
Right
yes
no
Loose
yes
no
Maxilla
yes
no
Mini
yes
no
yes
no
Mean
yes
no
yes
no
Maxi
yes
no
yes
no
Maxi
yes
no
Mandible
14
Left
yes
no
Mean
yes
no
yes
no
Mini
yes
no
yes
no
Loose
yes
no
A
N
C
H
O
Left
R
A
G
E
FORCE DELIVERY
Force application plays a strategic influence on orthodontic movement by means of
wires and elastic rubber bands.
Histologicaly optimum orthodontic movement had been related to an intact vascular supply.
An optimum force should not exceed the capillary blood pressure ( 20 to 25 gm/cm2 ).
If forces are above this level, clinical observations demonstrate possible ligament strangulation and sometimes root resorption.
Many authors had concluded that one of the major factors, if not the principal, governing bone resorption during tooth movement is the presence of an intact vascular system.
Z. DAVIDOVITCH 3 had proposed intermittent forces as more suitable because their duration
would not be sufficient to produce anoxic destruction of the ligament.
According to this author, osteoclasts, which were stimulated to function by the force application, would continue to resorb bone for a brief period of time mobilizing the necessary bone
removing cells.
Sunburst Elastics
GACs Sunburst Elastics are made from the finest quality
latex. They are clean-cut, durable, hygienic, and made with
regulation coloring. Available in a wide range of sizes and
force values, Sunburst provides the precise degree of
required control with a continuous force. Like our regular intraoral elastics, Sunburst is packaged with a bright white placer
in each bag for easier use and greater patient cooperation.
Colors are randomly assorted and are not available in specific
colors. Sold in boxes of 50 zip bags, 100 elastics per bag.
Description
2.7 oz.
4.0 oz.
6.0 oz.
3/16"
11-001-04
11-002-04
11-003-04
Catalog Number
1/4"
5/16"
11-001-06
11-002-06
11-003-06
11-001-08
11-002-08
11-003-08
Elastics Racks
Our aluminum anodized elastics rack is durable, light weight,
and has holes for mounting on a wall. Holds four boxes of GAC
elastics.
Aluminum Elastics Rack
15
97-300-30
CLASSIFICATION OF FORCES
O
R
T
H
O
D
O
N
T
I
C
O
R
OUNCES
GRAMS
FORCE
0.5
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
32
48
14.17
28.35
56.6
84.9
113.2
141.5
169.8
198.1
226.4
254.7
283.0
311.3
339.6
367.9
396.2
424.5
453.6
907.2
1360.8
very
light
Table III.1
16
O
R
light
T
H
O
D
O
medium
N
T
I
C
heavy
very
heavy
O
R
1.20
.55
.75
.75
.40
.50
Total
4.15 cm2
Necessary
force
180
85
110
115
60
75
Total
635 g.
Necessary
force
Root surface
175
1.10
90
.60
90
.60
115
.75
40
.25
40
Total
635 g.
.25
Total
3.55 g.
The size of enface root surface exposed to sagittal movement is measured in square centimeters. Every tooth can be evaluated as to the necessary force based on its root surface involved.
That means, on average, a force of:
635 g. in maxilla
550 g. in mandible
to move all of the teeth.
With friction, continuous archwires used with ceramic bracketts, its easy to understand that
heavy forces may be needed to move teeth.
In order to use lighter forces, a frictionless biomechanic system may be advised with segmented archwires.
Doing so, orthodontic movement with elastic forces should be faster and more efficient.
17
Maxilla
forces
Mandible
forces
1.05
1.35
.50
.50
.70
.65
.70
155
105
95
140
205
135
105
155
75
50
60
90
75
50
60
90
105
70
70
105
100
65
50
75
105
70
50
75
.95
1.05
.60
.60
.70
.50
.50
Table III.3
Maxilla
forces
Mandible
forces
.70
.80
.30
.30
.45
.30
.40
105
70
95
140
120
80
105
155
45
30
60
90
45
30
60
90
65
45
70
105
45
30
50
75
60
40
50
75
.95
1.05
.60
.60
.70
.50
.50
Table III.4
18
ANCHORAGE
STATIC
DYNAMIC
FIXED
MOBILE
RIGID
DIFFERENTIAL
WITH
FRICTION
>
FRICTION
LESS
CONTINUOUS
ARCHWIRES
SEGMENTED
ARCHWIRES
MEASURABLE
NON MEASURABLE
MECHANIC
BIOLOGIC
ABSOLUTE
COOPERATION
WITH OR
WITHOUT
COOPERATION
HEAVY
FORCES
LIGHT FORCES
Table III.5
19
CHAPITER IV
2 Explain
3 Explain
20
Fig IV.I
21
Bring back your worn out elastics at each visit , said R. BEGG 27, as a good way to educate a recalcitrant patient.
22
L. A.
CALIFORNIA
In order to brush your teeth and your gums correctly, remove the elastics and put them back on
immediately after brushing.
Always have some extra elastics in your pocket
to use in the event of breakage.
Fig IV. 2: Example of an elastic worn around two upper incisors with initial diastema. The
elastic went up in the gingiva with periodontal damage.
Fig IV.3: Clinical example of an exaggerated movement given by Class II elastics changing a
Class II in Class III.
24
Fig IV.4: Example of a misunderstood prescription of elastics. To correct the Class II canine
we need a closing Class II elastic.
Fig IV.5: A supply of elastics on the watch of a well motivated patient. During school hours,
elastics can be changed.
25
Skeletal Class II
Skeletal Class I
Dental Class II
Dental Class I
Be carefull:
Badly or incorrectly hooked elastics may change
biomechanics effects and complicate the treatment.
28
29
16 to 20 hours
Very important:
Remember to bring your appliance to any appointment
to give us a chance to properly adjust it.
30
W Th
Sat
W Th
Sat
...
Please score how many hours you have worn your headgear per 24 hours
Name:
Adress:
Elastics Placers
Our bright white Elastics Placer helps patients properly place their elastics, and the easier it is for them
to do, the greater the patient cooperation. Available
in bags of 100.
Description
Elastics Placers
31
Catalog Number
11-999-99
CHAPITER V
1 - Definition
The Class I elastic can be a chain, a rubber band, a ring or a thread placed on a single
arch and having a vertical or a horizontal force movement.
The Class I elastic has a reciprocical biomechanic action in a straight line
2 - Disposition
The Class I elastic can be placed:
one tooth to another tooth
one tooth in opposite way as a couple of forces
one tooth to an archwire, a loop
one point to another point of the archwire
one tooth to an auxilary appliance such as Quad Helix, a palatal bar, a bite
plate etc...
The Class I elastic is a monomaxillary or monomandibular elastic which can be used with
other elastics in the same time.
STABLE force
>
MOBILE force
That means, for example, that if you have, as in Fig V.8, to move distally a 41 and to close a
diastema, an elastic thread ligature around 42 and 41 will move both equally in the space. To
move distally the 41 you should placed the thread elastic on two or more teeth or thru the utility helix to keep the stable force higher than the mobile one.
32
Fig V.2:
Buccal upper incisor tipping for
adult in typical Class II.2.
The elastic thread is tied on a .045
wire.
Fig V.3:
Intrusion of a molar or cuspid with
a thread elastic, tied on utility arch.
Fig V.4:
Intrusion of lower incisors in adult,
with a thread elastic, on a R.
BENCH lower arch.
34
Fig V.5: Class I elastic ligature used to rotate and bring forward the left lateral incisor in the
opened space by the M utility.
Fig V.6: Class I elastic to slide backward the right lower lateral incisor. The elastic is changed 3 times a day.
35
Fig V.7: Example of elastic ligatures tied to rotate the 24 with an opposing force couple.
Fig V.8: Example of a Class I elastic ligature thru an utility Helix to close a lower incisor
diastema in moving distally the 41.
36
Fig V.9: Example of Class I elastic chain and ligature to rotate a canine and an upper first
premolar with a force couple.
Fig V.10: Example of Class I elastics on a bite plate to correct a midline deviation and close
diastemas.
37
Fig V.11: Example of a tongue thruster who had reopened a diastema after a treatment. Class
I elastic is placed on a bite plate.
38
Fig V.13: Class I elastic ligature tied on the 4T4 to close the lower diastema. The patient
was already in retention.
Fig V.14: Result obtained with the Class I cross elastic and lower elastic ligature. Permanent
retention with Ribbond was made.
39
Fig V.15: Example of space reopened after treatment. The patient does not want to have braces any more.
Fig V.16: A bonded hook is made distal to the upper lateral incisor.
40
Fig V.17: An upper bite plate with an O occlusal elastic is worn to close the diastema.
Fig V.18: Detail of the O occlusal elastic used to close the diastema.
41
Fig V.19: Frontal view showing the diastema closure with the O elastic.
Fig V.20: The bonded hook is removed and the upper incisors are splinted with a ribbond
wire.
42
Fig V.21: Class I elastics used on a crossway on a bite plate ( intraoral view ) for space closing.
Fig V.22: Class I elastics used on a crossway on a bite plate for space closing.
43
Fig V.23: A: A Class I elastic on maxillary arch to retract the upper canine can certainly move
it backward, but a slight forward movement of the upper molar can be seen if M1
is not anchored by an auxilary such as a palatal bar, a headgear...
B: A Class I elastic on maxillary arch anchored on the second molar is a better
anchorage than can achieve a retraction of the upper canine.
C: A Class I elastic used simultaneously on maxilla and mandible moves forward
the upper molar with the lower during the retraction of the upper canine.
45
Fig V.24: D: The association of a maxillary Class I with a Class II elastic moves forward
slightly the maxillary molar when the lower goes forward
E: The association of a bimaxillary Class I elastic with a Class II one moves the
molar forward and the upper canine backward.
F: The association of a maxillary Class I with a short Class II allows retraction of
the upper canine without moving the upper molar. Then the lower molar can be
brought forward without losing maxillary anchorage.
46
7 - Elastomeric chains
Polyurethane chain elastics are commonly used in daily orthodontics as Class I elastics.
They are made by Ortho manufacturers in:
- long filament chain
- short filament chain
- closed loop chain.
Elastomeric chains are mainly used for intra arch tooth movement and for spaces closing,
because placement and removal requires little chairtime and no patient cooperation.
More than 50 studies had been done on elastomeric chains; a consensus of clinicians may be
summarized as follow:
a permanent deformation may result after extension of plastic module
the degradation of force is increased over time
the force exerted is unpredictable and inconstant
the configuration of chain affects the behaviour of the force
after 3 weeks, the residual force is generally about 5 %.
oral environment ( such as PH, light, saliva, drinks, foods, dental plaque ) has been
associated with degradation of the polyurethane elastomer
extension or prestretching has been advocated before inserting the chains
the elastomeric chains must be kept in a container and protected from light.
47
The longer the chains filament, the lower the initial force
As with any system in Orthodontics, Class I elastics may give complications such as:
- abnormal tipping
- exaggerated rotation
- exaggerated extrusion
- anchorage lost
- minor or insufficient displacement...
Since more and more practitioners are using straight wires, some of them have undesirable
effects in using a continuous elastic chain on too light archwire < 0.016.
48
Fig V.26: Occlusal elastic placed on upper canine to correct a retarded occlusal contact function. The light contraction is usually obtained in a week.
Fig V.27: Correction of a too buccal position of first upper bicuspids with an occlusal elastic.
50
Fig V.28: Clinical example of the application of an occlusal elastic worn on the lower molar
which became too buccal.
This kind of O elastic is worn during night only and for a short time ( 2 to 3 weeks ) to
correct the lower buccal cross bite degree 2 (see text ).
Chain segmentation:
[R Molar - R canine] [incisors] [L canine - L Molar]
Elastics Placers
Our bright white Elastics Placer helps patients properly place their elastics, and the easier it is for them
to do, the greater the patient cooperation. Available
in bags of 100.
Description
Elastics Placers
51
Catalog Number
11-999-99
Fig V.29: Clinical example of bilateral buccal upper canine corrected with cross O shape
elastics.
52
CHAPITER VI
1 - Definition
Class II elastics are intermaxillary elastics placed on the maxilla anteriorly, and on the
mandible posteriorly.
2 - Disposition
Class II elastics may be placed differently on:
the mandibular arch posteriorly buccally, lingually or simultaneously from:
different teeth M2, M1, Pm2, Pm1
distal to a molar tube
a hook
a loop
a JARABAK or KAYABASHI ligature tie
a buccal hook coming from a lingual arch
a bite plate with a distal hook.
the maxillary arch anteriorly from:
a sectional archwire
a Class II utility arch
a continuous archwire with anterior loop
a sliding hook
a JARABAK or KAYABASHI ligature tie
a bracket hook
a Jig
a Class II headgear
a reciprocal archwire 0.45 with hooks
a reciprocal Mini Chin Cup.
Centric occlusion
Opening 10 mm
Opening 25 mm
Fig VI.1: Biomechanic influence of mouth opening on Class II elastic force ( see text ).
54
With a mouth open 25 m/m, which can happen when the patient is speaking, smiling or yawning, the elastic force can be again increased to 190 grams. But this force cannot be constant
and is going to decrease with time, in the saliva.
This maximum force occasionally exerted has again different effects upon:
- the maxillary arch
The vertical component of extrusion force is: 190 X sin 38.5 = 118.3 g.
The horizontal distalizing force is: 190 X cos 38.5 = 148.7 g.
- the mandibular arch
The horizontal forward force is: 190 X cos 52.5 = 115.7 g.
The vertical component of extrusion force is: 190 X sin 52.5 = 150.7 g.
From those figures, it is now easy to notice that by opening of the mouth from 10 to 25
m/m, the forward mandibular force drops down from 131 to 115.7 g.That means it decreased
about 10% despite the patient opened his mouth more. Notice also that the extrusive mandibular force went from 91.8 to 150.7 g. That means it increased 64% !
From this biomechanic explanation, the clinician must understand that the use of Class II intermaxillary elastics has to take into account the facial type in order to avoid a facial pattern
aggravation.
During day:
Intermaxillary elastics have a vertical component of extrusion that is
much more significant than the horizontal component.
During night
Intermaxillary elastics have an equivalent
vertical and horizontal component.
55
Fig VI.2: Facial type influence with Class II elastic use and consequences on the antero
superior occlusal plane when using continuous archwires. ( See text ).
56
Fig VI.3:
Ch. TWEEDs Class II elastics are
worn on continuous arches (with tip
back) and headgear.
Fig VI.4:
F. SHUDYs Class II elastics are
placed on three points in a closing
way with High Pull Headgear to
control anterior occlusal plane and
reinforce maxillary anchorage.
Fig VI.5:
R. ROTHs Class II elastics are
short and used with headgear according to the facial type.
57
Fig VI.6:
The R. RICKETTSs bioprogressive
technique. Class II elastic on sectional maxillary archwire.
Fig VI.7:
R. RICKETTSs utility arch with
Class II hook for maximum anchorage.
Fig VI.8:
J. PHILIPPEs circummandibular
arch to protract the mandibular
arch. Unfortunately, when the
patient opens his mouth, the Class I
elastic becomes a Class II with
extrusion consequences.
58
Fig VI.9: Example of a Class II elastic placed on a sliding hook to compress a spring for minor
distalization.
Fig VI.10: Example of a Class II elastic placed on a sliding Jig to correct a molar relationship.
60
Fig VI.11: Example of a Class II elastic placed on a Class II utility arch to correct a midline
shift.
Fig VI.12: Example of a Class II elastic placed on a contraction utility arch to correct an upper
incisor protrusion and close anterior spaces.
61
Fig VI.13: Example of a Class II elastic placed on a continuous archwires.This kind of intermaxillary elastic has an extrusion component on the occlusal plane ( see text ).
Fig VI.14: Clinical case of one Class II elastic placed on the upper sectional to settle the canine relationship and one other Class II elastic placed on the contraction utility archwire to help
the incisor retraction and torque.
62
Fig VI.15: Clinical example of a Class II canine relationship associated with a Class I molar
relationship before treatment.
Fig VI.16: After treatment of a Class II elastic placed on a sectional maxillary arch.
63
Fig VI.17: Example of clinical dental Class II 1 deep bite before treatment. Notice the canine
Class II relationship.
Fig VI.18: After 3 months the canine relationship had been corrected with a Class II elastic
worn on a reciprocal maxillary arch.
64
Remember:
65
66
67
There are other biomechanic systems that could be used such as segmented arches with utility
arch etc; but the principle remains mainly the same.
69
WITH FRICTION
FRICTIONLESS
Fig VI.19: Influence of biomechanic archwires systems and the hooked point of the Class II
elastics ( see text ).
70
Fig VI.20: Biomechanics of Progressive Torque with the RICKETTSs utility arch.
The Class II elastic pulls downward and backward the anterior loop which raises the anterior
segment of the arch increasing progressively the torque with the contraction. A bodily movement of the upper incisors is the result. See text.
71
Fig VI.21: Clinical example of Class II elastics placed on a Class II utility maxillary archwire
and a sectional to correct Class II molar and canine relationship on one side.
Fig VI.22: Clinical example of Class II elastic on right side to correct a midline deviation and
help to close the space between upper canine and lateral incisor.
72
Fig VI.23: Clinical example of U shape anterior elastic to close the bite. Notice the controlateral crossbite elastic to move the first bicuspid palatally.
Fig VI.24: Clinical example of closing Class II elastics to help closing the bite. Notice the
extrusion Class I elastic placed from right to left hook of the lateral maxillary sectional archwires.
73
In using:
molar M2 banding
Class II headgear
.045 reciprocal arch
reciprocal mini chin cup.
Before RETRACTION,
the more vertical the upper incisors are, the more TORQUE is needed.
74
Fig VI.26:
Class II molar extrusion elastic indicated in deep bite cases.
75
Fig VI.29:
A, B, C,
Class II 1
malocclusion
before
treatment.
77
Fig VI.30:
D, E, F,
After
correction
with Class II
elastics placed
on an . 045
upper
reciprocal
arch.
78
Fig VI.31: Example of oblique and Class II elastics to correct midline shift with a segmented
frictionless mechanism.
79
Fig VI.32: Example of a Class II elastic headgear with anterior welded hooks opened anteriorly.
Fig VI.33: Intraoral example of unilateral Class II elastic headgear for midline shift and
Class II correction.
80
Fig VI.34:
M. LANGLADEs reciprocal
maxillary arch used with a Class II
elastic on a .016 X .022 lower utility
arch.
Fig VI.35:
With a maxillary sectional arch and
a LANGLADEs reciprocal arch the
patient can wear two Class II elastics on each side.
Fig VI.36:
With the same system we can add a
LANGLADEs reciprocal mini chin
cup to reinforce the Class II effect
according the degree of difficulty of
the clinical case (3 X 100 g. force on
each side mandibular protraction
effect ).
See Chapter IX.
81
Fig VI.37: KAPRELIAN K 2 P . A split elastic positioner, worn with Class II elastics, during
home hours and sleeping.
82
CHAPITER VII
1 - Definition
Class III elastics are intermaxillary elastics placed posteriorly on the maxillary arch
and anteriorly on mandibular arch.
2 - Disposition
According to the clinical problem, Class III elastics may be placed:
Posteriorly
buccally
palatally to help expansion
buccally and palatally to increase the force
from the distal part of the archwire ( Fig VII.4 )
from a molar hook ( Fig VII.5 )
before the maxillary molar, even from Pm2 or Pm1
from a Class III headgear
from a bite plate distal upper hook.
Anteriorly
a loop on archwire
a JARABAK or KOBAYASHI ligature
from a Class III bite plate with anterior hooks and inclined plane to
help to jump the bite ( see Fig VII.6 ).
Centric
occlusion
Opening
10 mm
Opening
25 mm
Fig VII.2: Influence of conventional Class III elastics on the occlusal plane tilting when
using continuous archwires ( see text ).
85
Fig VII.3: Influence of conventional Class III elastic forces with facial type and consequences
on the vertical component of extrusion, when using continuous archwires. See text.
86
87
Camouflage with posterior mandibular rotation in Class III squeletal pattern depends on:
growth potential (use Long Range growth Forecast )
dental overbite
collapsed labial esthetics ( see Table VII.1 )
88
CHILDREN
ADULTS
GROWTH
POTENTIAL
LONG
RANGE
FORECAST
CANINE
FUNCTION
NO
GROWTH
limited by
POSTERIOR
ROTATION
DENTAL
OVERBITE
NOSE
LABIAL
ANGLE
T.M.J.
VERTICAL
DIMENSION
89
LABIAL
ESTHETICS
Fig VII.4: Conventional Class III elastic placed behind the upper molar. A high component
of extrusion exists on the occlusal plane.
Fig VII.5: Regular Class III elastic placed on maxillary mesial molar hook. The extrusion
component force still exists.
90
Fig VII.6: Example of Class III elastics placed on behind the maxillary molar posteriorly and
on anterior hook of a lower inclined bite plate in order to bring forward the upper arch and
jump the bite.
91
Fig VII.8: In this Class III, almost edge to edge incisor relationship, the vertical sense is critical and must not be opened. The posterior wedge must be kept.
Fig VII.9: Notice that the arch is segmented behind the 14th, and the patient is wearing a closing short Class III elastic to jump the bite.
92
The deeper the overbite, the better the prognosis in Class III malocclusions.
94
In orthognatics cases:
Extrude teeth on an unitarianly way in order to avoid moving bone fragments.
TONGUE INTERPOSITION,
vertical intermaxillary elastics can be
LINGUALLY placed on
cleat lugs, bonded buttons,
to provide an
ANTI-TONGUE SCREEN.
95
Centric occlusion
Opening 10 mm
Opening 25 mm
Fig VII.10: Triangular Class III biomechanics with a _, light elastic in 10 cm opened mouth.
We have:
at the maxilla: an extrusion force of 119.1 g.
a forward force of 32 g.
at the mandible: an extrusion force of 115.1 g.
a backward force of 44.3 g.
96
CHAPITER VIII
Particular
Intermaxillary Elastics
2 - THE
U SHAPE ELASTIC
The U shape elastic has a contraction and extrusion effect on only one arch. So it can
be used with a segmented arch to the antagonist arch and can be used in U shape or upside
down ( see Fig VIII.1 ).
Most of the time, this elastic is used anteriorly, but it can also be used posteriorly.
4 - THE
V SHAPE ELASTIC
This elastic has a vertical component of extrusion without a light contraction. It can be
worn to bring a tooth on the occlusal plane in a V shape or upside down according to the clinical need.
5 - THE
M OR W SHAPE ELASTICS
These elastics are used for extruding a group of teeth in order to squeeze the bite in an
effective closing way. Heavy elastic up to 300 g. may be used ( see Fig VIII.3 and 4 ).
Fig VIII.1: Example of the U shape vertical closure elastic on segmented arch.
98
Fig VIII.2: From R. M. RICKETTS and al. Bioprogressive Therapy. RMO Editor. 1979
99
Fig VIII.3: Example of M and W elastics to close the bite faster than locking up the maxillary teeth in a straight wire.
Fig VIII.4: Two weeks later, the bite is closed with the M and W vertical elastics.
100
Fig VIII.5: Clinical example of a squeeze of the bite with M and W shape elastics ( see text ).
Fig VIII.6: Post surgery TMJ patient wearing a splint with lateral rectangular elastics to
extrude lower molar and first bicuspid.
101
Fig VIII.7: Example of an upside down V elastic to bring down a right upper canine instead of
locking it up with a straight wire.
9 - SQUEEZE ELASTICS
In some borderline surgery open bite cases, R. M. RICKETTS 2 had advocated heavy
elastics forces ranging from 800 to 1500 g. to close the bite (see Fig VIII.5 ).
Those elastics are worn 24 hours a day, and changed three times during two weeks, to obtain
the bite closure.
MAXILLA:
UB3 = upper buccal 3 cross bite
UB2 = upper buccal 2 cross bite
UEE1 = upper edge to edge 1
UL2 = upper lingual 2 cross bite
UL3 = upper lingual 3 cross bite
MANDIBLE:
LB3 = lower buccal 3 cross bite
LB2 = lower buccal 2 cross bite
LEE1 = lower edge to edge 1
LL2 = lower lingual 2 cross bite
LL3 = lower lingual 3 cross bite
103
Table VIII.1
International Classification of
posterior unilateral cross bite:
Grade the pathologic situation
according to the unwedging cusp:
1 - for edge to edge
2 - for one cusp
3 - for the jump of the bite
Fig VIII.8: Differential posterior cross bite occlusion diagnosis must distinguish
A - a dental malocclusion
B - a narrow maxilla
C - a mandibular latero deviation ( functional shift ).
105
106
Occlusion
Open 30 mm
H
O
M
O
In closed
mouth
occlusion
F = 90 g.
L
A
T
E
R
A
L
Fh transversal:
54.3 g.
Fv extrusion:
171.7 g.
In mandible
In maxilla
C
O
N
T
R
O
L
A
T
E
R
A
L
In closed
mouth
occlusion
F = 120 g.
Fh transversal:
273.3 g.
Fv extrusion:
115.38 g.
In mandible
108
Fig VIII.11:
Short vertical elastics have a tendency to narrow the transversal
dimension
Fig VIII.12:
GRUMMONS double cross bite
used for molar extrusion in TMD
patients to unload the condyle.
109
N12
6 Male
6 Female
Average age: 10.9 years
Transverse unwedging
4.91 mm
Transverse unwedging
5.58 mm
Range from 3 to 6 mm
Range from 3 to 7 mm
Treatment time
267.25 days
Treatment time
60.33 days
Table VIII.3: Comparison of Unilateral posterior cross bite correction from M. LANGLADE. Foundation for
Orthodontic Research 1990.
Fig VIII.13: Use of a controlateral cross bite elastic to correct a right maxillary buccal degree
2 with a unilateral contraction Quadhelix. The elastic is reinforcing the stable force and
helping to increase the moving force.
Fig VIII.14: The controlateral cross bite elastic has a double action on the unilateral movement of the Quadhelix by:
1 - increasing the molar anchorage on the right side
2 - increasing the expansion force of the Quadhelix with a transversal elastic helping to
jump the left molar bite ( mobile force ).
111
Fig VIII.15: Controlateral cross bite elastic used to correct a lingual maxillary molar degree
2 with a unilateral expansion Quadhelix.
In DISTRACTION OSTEOGENESIS,
the practitioner can use all biomechanic principles
in order to correct maxillo mandibular anomalies using
intermaxillary elastics such as:
U
N
I
L
A
T
E
R
A
L
112
B
I
L
A
T
E
R
A
L
Fig VIII.16: Example of buccally ectopic canines with anterior open bite.
Fig VIII.17: A cross controlateral elastic is going to palatally move each canine in a week.
113
Fig VIII.18: One week later the bite is closed and the upper canines are settled transversally
and vertically ( see Fig VIII.16 and 17 ).
Fig VIII.19: Example of a controlateral elastic helping the correction of a cross bite degree
two with a unilateral Quadhelix force.
114
Fig VIII.20: The palatal ramp unilateraly on a bite plate can be used to guide the mandible in
functional shifts:
A - without occlusal plate
B - with bilateral bite plate
C - with unilateral bite plate.
Controlateral or intermaxillary elastics can be placed to help the midline shift correction.
115
117
N: Normal:
Check CR
A:
2) Use Class III elastic on opposite side to the
Mdb shift ?
3) Unilateral Mdb maximum anchorage on
opposite side Mdb shift.
4) Unilateral Mdb stripping opposite to Mdb
shift ?
5) Combination ?
B:
2) Mx extraction on opposite to midline
deviation, and also
3) Maxi anchorage.
4) Class I elastic on opposite side to midline
deviation.
5) Unilateral Mx stripping on opposite midline
deviation.
C:
2) Mx extraction on opposite midline deviation.
3) Unilateral arch advance on side of midline
deviation.
4) Class III elastic on opposite to Mdb shift
(anterior diagonal + vertical).
5) Cross stripping ?
D:
2) Mx and Mdb unilateral extractions on side of
Mdb shift.
3) Class II elastics on Mdb deviation side.
4) Unilateral stripping on opposite midline
deviation.
119
E:
2) Mdb extraction on Mdb side shift ?
3) Class III elastic on opposite side of Mdb
shift.
4) Unilateral Mdb arch maximum anchorage.
5) Stripping and/or combination of above.
F:
2) Unilateral Mx and Mdb extraction on side
of Mdle shift.
3) Class II elastic ( anterior or diagonal ) on
Mdb side shift.
4) Unilateral Mx maximum anchorage opposite
to Mx midline deviation.
5) Stripping and/or combination.
G:
2) Cross extractions 14 / 34.
3) Cross maximum anchorage.
4) Anterior diagonal elastic and/or Class II
elastic on opposite side of Mdb shift.
5) Stripping and/or combination.
H:
2) Mx unilateral extraction on opposite side
of Mdb shift.
3) Latero vertical and/or Class I elastics.
4) Unilateral stripping on opposite side Mdb
shift.
5) Stripping
120
121
Fig VIII.23:
D: Inclined convergent:
bite plate
segmentation of archwires
unilateral triangular elastics
Class II / III elastics
E: Unilateral convergent:
unilateral bite plate
unilateral rectangular elastics
Fig VIII.23:
123
In the growing patient, treatment for the fractured condylar, either unilateral or bilateral, is
usually a conventional functional appliance.
In the adult case, elastics may be a part of an orthodontic treatment such as:
In any case, the elastics are worn for two to three months and progress can be checked with
Xrays.
125
Fig VIII. 26: ELASTICS AND BILATERAL CONDYLAR FRACTURES ( see text ).
bilateral posterior bite plate to help the condylar distraction for healing.
anterior segmented archwires with
anterior vertical elastics.
127
CHAPITER IX
128
129
Fig IX. 1: The same malocclusion can be seen in different facial types. A different extra oral
pull must be appropriate to it.
130
Long
Medium
Short
High
Horizontal
Low
tion
rac
wt
Lo
131
Long
Medium
Short
High
Low
132
gh
Hi
c
tra
n
tio
Long
Mediu
Short
High
Horiz.
Low
133
134
FORCE
SYSTEM
GENERAL
RANGE OF
FACIAL TYPE
TIME
INCREMENTS
IN HOURS
FORCE
DELIVERED
IN GRAMS
1 - Cervical headgear
Mesofacial
through
brachyfacial
12 - 14
Long term
400 +
2 - Cervical headgear
and 2 X 4 lower
Mesofacial
through
brachyfacial
12 - 14
Long term
400 +
3 - Combination
headgear
Mesofacial
through
dolichofacial
12 - 14
Long term
1000 +
4 - Combination and
2 X 4 upper
Mesofacial
through
dolichofacial
20 +
Short term
1000 +
GENERALIZED
RESPONSE
From R.M. RICKETTS et. al. Bioprogressive Therapy. Book 1. R.M. 1979.
Elastics Racks
Our aluminum anodized elastics rack is durable, light weight,
and has holes for mounting on a wall. Holds four boxes of GAC
elastics.
Aluminum Elastics Rack
135
97-300-30
Fig IX. 7: Clinical example of a Class II malocclusion corrected with only a Class I headgear elastic. Correction of canine relationship and incisor protrusion had been obtained at the
same time (see text ).
137
138
Fig IX. 8: Example of a Class III elastic headgear. Notice the welded hook mesial to the
upper molar, on which the closing Class III elastic is placed ( see text ).
Fig IX. 9: Typical Class III elastic headgear. The Class III elastic force has no influence on
posterior occlusal plane ( see text ).
139
Fig IX.11
Fig IX.12
141
Disposition:
This appliance is used to protract forward the retruded maxilla from:
a welded buccal hook on a labio lingual wire cemented on the first premolars and
first molars.
the distal maxillary archwire.
The advised force:
According to different clinicians, heavy elastics can range from 1000 to 2000 g.
Whatever the protraction force is, it should be:
parallel to the occlusal plane
20 upward as DELAIRE and VERDON suggested, or
20 downward as T. ITOH and S. J. CHACONAS 49 et. al. proposed.
The resulting effect ( see Fig IX.13 to15 ) is an extrusion of the posterior palatal plane,
a counter clockwise rotation of the occlusal plane, and a backward mandibular rotation.
The effect:
The facial mask effect is accompanied by:
at the maxillary level:
a limited advancement of point A from 1 to 3 mm maximum, with a downward
descent
a downward and forward movement of posterior palatal spine ( see Fig IX.15 ).
For every forward millimeter of the point A, the posterior palatal plane goes
downward 4 mm.
an upper molar extrusion of 5 mm for 1 mm of point A advancement.
at the mandibular level with a postero anterior traction with a chin support it gives:
a posterior condylar compression more or less tolerated which creates an
alleviation attempt by the digastric muscle with
a posterior rotation of the mandible
an aggravation of prognathic growth tendencies of the mandible in the growing
patient.
143
Instead of a choice in uncertain future, the orthodontist must use a RICKETTSs Long
Range Growth Forecast to begin with the end in mind .
If you have a 7 year old patient with anterior cross bite, how can you make a decision at present time, if you ignore the final growth pattern of this patient ? Are you going to treat him
immediately with a facial mask ? By orthopedics or with Class III elastics ? And run for a useless jump of the bite during many years to finally use surgery to treat him ?
In orthodontics, profits and winnings, as losses and relapses, are not given by the diagnosis only, but also by the prognosis.
After your decision, you may suffer the consequences of your treatment, if you have no image
of the final growth pattern ( see Table IX. 1 ).
In using the long range growth forecast, you can predict:
the convexity
the mandibular corpus length
the mandible in the face
the esthetic profile
with the three prognosis key factors:
1 - Long Range Growth Forecast
2 - anterior overbite
3 - collapsed lower facial height.
You may use dental compensation or dental camouflage in some Class III cases, as D.
WOODSIDE 59 or P. TURLEY 60 had shown ( see Table VII. 1 ).
144
Fig IX. 13: The facial mask use has a triple chain reaction:
A - a lowering down of posterior palatal plane with a DOWNWARD and forward
maxillary dental arch advancement.
B - a posterior condylar loading which unlatch by reflex track.
C - a posterior mandibular rotation allowing a sagittal increase of prognathic growth.
Please remember that it is the vertical sense in TMJ that gives opportunity to the mandible to
grow SAGITTALLY.
145
Fig IX. 14: According to R. M. RICKETTS 2, the maxillary growth is much more vertical
posterior than anterior. This natural phenomenon must be taken into account in the facial mask
use.
Fig IX. 15: Any kind of facial mask pull always involves a downward movement of the
posterior palatal plane, increasing the vertical sense with consequences on mandibular
overgrowth.
146
SKELETAL
CLASS I
Pseudo Class III
SKELETAL
CLASS III
True Class III
Functional shift
CLASS III
dental
skeletal
Borderline
Elastics correction
Extractions
Surgery
The face mask produces orthodontic instead of orthopedic effect in most of the cases.
Dental and skeletal relapse will happen due to continued mandibular growth .
JONG HIN 58 et. al. 1993.
In Class III, the deeper the overbite, the better the prognosis.
147
Fig IX. 17: R. NANDA reverse headgear with a mesial molar hook for a Class III elastic to
reinforce postero anterior maxilla protraction.
Fig IX. 18: R. NANDA reverse headgear worn in mouth with complementary Class III elastics
on a lower Class III hooked bite plate.
149
Fig IX. 19 B: The NANDA postero anterior headgear is worn with a HICKHAM Chin Cup to
bring forward the maxilla.
150
Fig IX. 20: The HICKHAM chin cup for maxillary protraction.
Fig IX. 21: The HICKHAM chin cup for maxillary protraction is worn with postero anterior
intra and extra oral elastics placed on a head cup.
151
This appliance is most effective for its reciprocal effect allowing use two, three, or even four
intermaxillary Class II elastics.
Usually the reciprocal mini chin cup is worn during a short time ( from two to five months ),
even in adults cases.
154
Fig IX. 23: The LANGLADEs prefabricated maxillary reciprocal arch which is worn 24
hours a day with Class II elastics using a bumper effect. See text.
Fig IX. 24: The LANGLADEs prefabricated reciprocal mini chin cup which goes in the lateral tubes of the maxillary reciprocal arch which can be used with two to three Class II elastics
and a postero anterior Class I elastic.
This appliance is very effective and easily worn by adults.
155
Fig IX.25: Clinical example of dental Class II malocclusion with a retruded mandibular arch
corrected in three months with a Reciprocal Mini Chin Cup. Notice the sagittal and vertical
overcorrection ( before and after ).
156
157
Fig IX.26 : The two piece corrector from G. EGANHOUSE 57 is constructed with a sliding
guide and worn with closing Class III elastics and Chin Cup.
From J. C. O. Vol. XXXI. N 4. pages 246 - 250. 1997.
158
CHAPITER X
Rationale for
Elastics Prescription
159
Refer to the skeletal pattern and to the Long Range Growth Forecast.
Look at the occlusal bite. If you have an edge to edge incisor relationship your
priority will be to close the bite absolutely; so in that case you must use closing
elastics and/or eventually extractions.
2 - Observe the transversal sense afterwards:
Look at the centric occlusion:
Is it a normal occlusion relationship ?
How are the median lines ? Is there a midline shift ? Which one must be
corrected ?
Do you have a cross bite ? If yes, what is the degree of the cross bite 1, 2, or
degree 3 ?
Do you need an expansion on one side ?
Do you need a contraction on one side ?
Do you need cross bite elastics ? Closing elastics ?
Do you need a bite plate to jump the bite ?
For example, a lingual crossbite relationship of a maxillary canine may be corrected in placing
on the Class II elastic palatally to correct in the same time the transversal and sagittal sense.
A midline shift clinical case can suggest increasing the Class II elastic force on one side by:
changing three times the elastic on one side and only one time per day the other side or,
using a closing elastic force on one side and a regular one on the other side or,
using a heavy elastic on one side and a lighter on the other.
Right
A
N
C
H
O
R
A
G
E
Maxilla
yes
no
Loose
yes
no
yes
no
Mini
yes
no
yes
no
Mean
yes
no
Right
yes
no
Maxi
yes
no
yes
no
Maxi
yes
no
Left
yes
no
Mean
yes
no
yes
no
Mini
yes
no
Mandible
yes
no
Loose
yes
no
A
N
C
H
O
R
A
G
E
Left
yes
no
no
asymmetric...
mean
minimum
4 - Needed cooperation:
maximum
In using arrows on the chart and after determining the needed anchorage on each side of the
maxilla, the archwires may be chosen with the elastics forces which must be used to reach
clinical goals.
161
C: Lay down the problem ! Come up with the objectives to reach. Use arrows:
162
CLINICAL EXAMPLE
A - Observe this dysfunctional patient with a painful left TMJ ( Fig X. 1A ):
- on right side she has a Class II lingual degree 2 cross bite and a Class II canine
relationship.
- a midline shift of 3 mm with an edge to edge incisor relationship.
- on left side she has an open bite with a Class III canine relationship.
C - Solution ( Fig X. 1B ):
on right side, a triangular Class II cross bite elastic is going to correct the Class II and
jump the bite.
anteriorly a closing Class III elastic is going to correct the midline shift, bring forward
the left upper canine, and close the bite !
on left side, we are keeping the posterior wedge so we dont need any elastic.
D - After 8 weeks ( Fig X. 1C ):
The correct prescription of elastics corrected the majority of the malocclusion and the patient
is pain free.
163
Fig X. 1
164
QA -
QB -
QC -
QD -
QUIZ A
A - Observe Fig X. 2A, 2B, 2C ):
John has three missing teeth: 12 - 22 and 23.
- on right side notice the Class II canine relationship: well have to open the lateral
upper incisor space for a future implant.
- anteriorly we have an open bite tendency edge to edge with a 2 mm maxillary midline
shift.
- on left side 22 and 23 are missing and we have a Class II edge to edge position of the
first bicuspid, we would like to use for canine function. We also need to keep a space
for the upper left incisor implant.
B - Let us write down the problem:
To increase elastics efficiency, we could also use closing elastics in this case... but we dont
need too much overbite with future implants.
166
Fig X. 2
QUIZ A
167
Fig X. 3
SOLUTION A
168
QUIZ B
A - Observe ( Fig X. 4A, 4B, 4C ):
Jeromes clinical problem:
- on right side we have a 2 mm Class II canine relationship.
- anteriorly, the mandibular midline shift is off 2 mm on the left.
- on left side we are in Class II canine and premolar relationship.
B - Let us write down the problem:
Notice that one elastic is placed the utility Class II and the other on the left sectional, so
we have a maximum anchorage on that side, which is also going to correct the mandibular
midline !
169
Fig X. 4
QUIZ B
170
Fig X. 5
SOLUTION B
171
QUIZ C
A - Observe ( Fig X. 6A, 6B, 6C ):
Look at Sophies clinical problem:
- on right side, we are in Class I molar and premolar, but with a mesial space in front of
the first bicuspid, the right upper canine is in total Class II relationship.
- anteriorly, there is a distal diastema to the upper right lateral incisor; a maxillary
midline deviation of 4 mm.
- on left side, we have a maxillary ectopic canine, however in Class I, because the upper
left incisor is edge to edge with the lower left canine.
B - Let us write down the problem:
172
Fig X. 6
QUIZ C
173
Fig X. 7
SOLUTION C
174
QUIZ D
A - Observe ( Fig X. 8A, 8B, 8C ):
Sylvains clinical problem:
- on right side, the upper right canine is missing, and we would like to use the first
bicuspid for canine function.
- anteriorly, we have a light open bite, with a light midline maxillary deviation of 2 mm
and an upper incisor protrusion.
- on left side, we have a Class II canine tendency.
175
Fig X. 8
QUIZ D
176
Fig X. 9
SOLUTION D
177
CONCLUSION
Your patient tells you: Please use frictionless and light mechanics
to increase efficiency and comfort .
178
179
BIBLIOGRAPHY
1 - BURSTONE C. J. - PRYPUTNIEWICZ R. J.
Holographic determination of center of rotation produced by orthodontic forces
A. J. O. Vol 77 p 396 - 409. 1980
3 - DAVIDOVITCH Z.
Molecular orthodontic movement
Conferences series Paris. 1995
6 - QUINN R. S. - YOSHIKAWA K.
A reassessment of force magnitude in orthodontics
A. J. O. Vol 88 n 5 p 252 - 260. 1985
8 - TUN A. W. - KIYAK H. A.
Psychological influences on the timing of orthodontic treatment
A. J. O. D. O. Vol 113 n 1 p 29 - 39. 1998
10 - NANDA R. S. - KIERL M. J.
Prediction of cooperation in orthodontic treatment
A. J. O. D. O. Vol 102 n 1 p 15 - 21. 1992
11 - EL MANGOURY N. H.
Orthodontic cooperation
A. J. O. Vol 78 n 5 p 604 - 622. 1981
12 - DI MATTEO - DINICOLA
Achieving patient compliance
New York Pergamon Press Editor 1982
180
15 - DE GENOVA D. C. and al
Force degradation of orthodontic elastomeric chains - a product comparison study
A. J. O. Vol 87 n 5 p 377 - 384. 1985
16 - KILLIANY D. - DUPLESSIS J.
Relaxation of elastomeric chains
J. C. O. Vol 19 p 592 - 593. 1985
18 - WONG A. K.
Orthodontic elastic materials
Angle orthodontic Vol 46 p 196 205. 1976
22 - HOCEVAR R. A.
Orthodontic force systems: Technical refinements for increased efficiency
A. J. O. Vol 81 n 1 p 1 - 11. 1982
23 - TWEED C.
Clinical Orthodontics
C. V. Mosby Editor St Louis. 1966
24 - PEARSON L. E.
Vertical control in treatment of patients having backward rotational growth tendancies
Angle Orthodontic Vol 48 p 132 - 140. 1978
25 - KAPRELIAN G and B.
The split elastic positioner
Clinical Table Denver A. A. O. 1996
26 - PHILIPPE J.
Mechanical analysis of Class II elastics
J. C. O. Vol 79 n 6 p 367 - 372. 1995
27 - BEGG P. R.
Begg orthodontic theory and technique
W. B. Saunders Co Editor Philadelphia. 1965
181
28 - ROTH R.
Finishing orthodontics
Transactions of inter ortho conference Munich. 1979
29 - GRUMMONS D.
Orthodontics for the TMJ / TMD patient
Wright and Co publishers p 139, 168 - 169, 175 - 176, 226 - 231. Arizona. 1994
30 - ZIEGLER P. - INGERVALL B.
A clinical study of maxillary canine retraction with a retraction spring and with sliding mechanics
A. J. O. Vol 95 n 1 p 99 - 106. 1989
33 - LANGLADE M.
LArc Moustache
Therapeutique Orthodontique 3rd Edition Chapter XI p 247 - 297 Maloine Editor Paris. 1986
34 - LANGLADE M.
Comparative study of retrusive mandibular dental malocclusion correction
Soc. Italiana di Ortho. SIDO. 1997
35 - LANGLADE M.
The Reciprocal Mini Chin Cap
A. A. O. Denver conference. 1996
37 - JERROLD L. - LOWENSTEIN L. J.
The midline: diagnosis and treatment
A. J. O. Vol 97 n 6 p 453 - 462. 1990
39 - LANGLADE M.
Principes thrapeutiques de locclusion croise unilatrale
Optimisation transversale Chapter XI Maloine Editor Paris. 1996
41 - NANDA R.
Protraction of maxilla in rhesus monkeys by controlled extra oral forces
A. J. O. Vol 74 p 121 - 141. 1978
182
43 - JACOBSON A.
A key to the understanding of extra oral forces
A. J. O. Vol 75 p 361 - 386. 1979
47 - GRABER L. W.
Chin cup therapy for mandibular prognathism
A. J. O. Vol 72 p 23 - 41. 1977
48 - SHUDY F.
The rotation of the mandible resulting from growth: its implications in orthodontic treatment
Angle orthodontic Vol 91 p 183 - 192. 1965
51 - NANDA R.
Biomechanical and clinical considerations of a modified protraction headgear
A. J. O. Vol 78 p 125 - 139. 1980
53 - HICKHAM J.
Maxillary protraction therapy: diagnosis and treatment
J. C. O. Vol 25 n 2 p 102 - 113. 1991
54 - JIN J. - LIN J. J.
Differential diagnosis and management of anterior crossbite
3rd Edition. 99 Chung Shan N rd Tapei Taiwan. September 1995
183
57 - EGANHOUSE G.
Two piece corrector for Class III skeletal and dental malocclusions
J. C. O. Vol 31 n 4 p 246 - 250. 1997
59 - WOODSIDE D.
Interception in non surgical Class III cases
A. A. O. Meeting conference. 1991
60 - TURLEY P.
Treatment of skeletal deep bite associated with mandibular or maxillary defiencies
A. A. O. Conference. Ontario meeting. 1993
61 - DOYLE W.
Class III treatment for 2 or 4 year old
Foundation for orthodontic research. Hershey. 1997
62 - DELAIRE J. - VERDON
La croissance maxillaire: dductions thrapeutiques
Trans Euro Ortho Society p 82 - 102. 1972
184
This book provides a comprehensive detailed description of orthodontic elastic usage. A compendium of possibilities heretofore never been
collectively presented.
Prof. Ram S. NANDA - DDS - MS - PhD
Chairman of departement of Orthodontics
University of Oklahoma