Levelling and Aligning - Dr. Lokesh / Orthodontic Courses by Indian Dental Academy

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INDIAN DENTAL ACADEMY

Leader in continuing dental education
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INTRODUCTION

ALIGNMENT ARCH WIRES

ALIGNMENT IN
Symmetric crowding
Premolar extraction cases
Non extraction cases
Asymmetric crowding
Begg technique

SPECIAL PROBLEMS IN ALIGNMENT

LEVELING

CONTROL OF ANCHORAGE IN 3 PLANES

CONCLUSION

REFERENCES
THE PRINCIPLES IN CHOICE OF
LEVELING AND ALIGNING WIRES
ROUND WIRE V/S RECTANGULAR WIRE
FREEDOM OF MOVEMENT OF ARCH WIRE
P ROPERTIES OF ALIGNMENT ARCH WIRES
TYPES OF ALIGNING WIRES
ARCH WIRE SEQUENCING
TRADITIONAL WIRES
HEAT ACTIVATED WIRES
KEY POINTS IN LEVELING AND ALIGNING
Traditional wires Heat activated wires
0.015 Multistrand
0.016 Thermal Niti 0.017 Multistrand
0.014 S.S.
0.016 S.S
0.0195X0.025 Thermal Niti 0.018 S.S
0.020 S.S.
0.0195 x 0.025 S.S 0.0195 x 0.025 S.S
THE SUBSTITUTION SEQUENCE
Forces should be kept as light as possible.

Sagittal, vertical & lateral anchorage needs should
be identified for each case.

Lacebacks & bend backs to be used in the initial stages
to avoid unwanted tooth movements.

Posterior segments should supported with a head gear/ TPA
in maximum anchorage cases.
KEY POINTS IN LEVELING & ALIGNING
ARCH WIRE MATERIAL

SIZE OF THE WIRE

DISTANCE BETWEEN ATTACHMENTS
VARIABLES IN SELECTING APPROPRIATE
ARCH WIRES
ALIGNMENT OF SYMMEYRIC CROWDING
WITH EDGE WISE APPLIANCE.
The flat load deflection curve of super elastic Niti makes ideal
for initial alignment when the degree of crowding is similar on
two sides of arch.
ALIGNMENT IN NON EXTRACTION CASES
FLARING OF ANTERIORS

DISTALIZATION OF MOLARS
ALIGNMENT OF ASYMMETRIC CROWDING
WITH THE EDGE WISE APPLIANCE
Continuous Niti wire Distortion of arch form.
ALIGNMENT IN PREMOLAR EXTRACTION
CASES
DRAG LOOP STONER

ACTIVE LACE BACK

NITI OPEN COIL SPRING
ALIGNMENT WITH BEGGS TECHNIQUE
0.016 Australian wires with loops used for alignment.

Niti wires loss of control of molar position.

The modern alternative Dual flex wire.

1. CROSS BITE CORRECTION
ANTERIOR CROSS BITE

POSTERIOR CROSS BITE
2. IMPACTED/UNERUPTED TEETH
SURGICAL EXPOSURE
ATTACHMENT TO THE TOOTH
ORTHODONTIC MECHANICS
3.DIASTEMA CLOSURE
Maxillary midline diastema is complicated by insertion of
labial frenum into a notch in the alveolar bone.

Mild midline diastema is closed before frenectomy.

Large midline diastema partially closed before frenectomy and
completely closed after surgery.

Delay in orthodontic treatment after surgery results in scar
formation.
LEVELING

It includes correction of DEEP BITE & OPEN BITE
DEEP BITE
DEVELOPMENT OF DEEP BITE
CORRECTION OF DEEP BITE
ERUPTION/EXTRUTION OF POSTERIORS

DISTAL TIPPING OF POSTERIOR TEETH

PROCLINATION OF INCISORS

INTRUSION OF INCISORS

A COMBINATION OF ABOVE
DEEP BITE
DISTAL TIPPING OF POSTERIOR TEETH
ERUPTION/EXTRUSION OF POSTERIOR
TEETH
EXTRUSION AND RELATIVE INTRUSION
18 SLOT NARROW BRACKET
22 SLOT WIDER BRACKET
PROCLINATION OF UPPER AND
LOWER ANTERIORS
Indication:
This can be done only if the
soft tissue profile permits it or
in cases with retroclined
anteriors.

Methods:
Not using lacebacks and bend
backs.
Use of open coil spring
between retroclined teeth and
posterior teeth.
INTRUTION OF ANTERIOR TEETH
CONTINUOUS INTRUSION ARCH

THREE PIECE INTRUSION ARCH

UTILITY ARCH
TIP BACK SPRINGS
Indications

Growing patients with forward rotations.
Deep Curve of Spee in the lower arch.
Deep over bite due to extrusion of incisors.
UTILITY ARCH
1. MATERIAL AND DIMENSIONS OF WIRE
2. SALIENT FEATURES OF UTILITY ARCH
3. TYPES
PASSIVE UTILITY ARCH
INTRUSION UTILITY ARCH
RETRUSION UTILITY ARCH
PROTRUSION UTILITY ARCH
THREE PIECE INTRUSION ARCH
IT CONSISTS OF FOLLOWING PARTS
1. THE POSTERIOR ANCHORAGE UNIT
2. ANTERIOR SEGMENT WITH POSTERIOR EXTENSION
3. INTRUSION CANTILEVERS
BITE PLATE EFFECT
IT IS USEFUL IN 3 WAYS
ALLOWS EARLY PLACEMENT OF BRACKET ON
LOWER INCISORS.
INTRUSIVE FORCE ON LOWER ANTERIORS.
ALLOWS EXTRUSION/ERUPTION/UPRIGHTING OF
POSTERIOR TEETH.
Importance of second molar.
Torque issues.
Anteroposterior issues and elastics.
Lighter forces during leveling and
aligning- roller coaster effect
CORRECTION OF DEEP BITE
ROLLER COASTER EFFECT
ANTERIOR OPEN BITE
1. ETIOLOGY
2. CLINICAL FEATURES
3. EARLY MANAGEMENT
4. MANAGEMENT DURING FULL ORTHODONTIC
TREATMENT
This patient had an asymmetrical dental anterior open bite, which was related
to right thumb sucking activity. Anterior open bites of this type are often not difficult
to correct, provided the digit sucking is discontinued.
ANCHORAGE CONTROL IN THE PRE ADJUSTED EDGEWISE
APPLIANCE
BENNET AND McLAUGHLIN CONSIDER ANCHORAGE
IN THREE PLANES OF SPACE
1. HORIZANTAL ANCHORAGE
2. VERTICAL ANCHORAGE
3. TRANSVERSE ANCHORAGE
ANCHORAGE IS CLASSIFIED AS
1. EXTRA ORAL-HEADGEAR AND FACE MASK
2. INTRA ORAL-LACE BACK, TPA, LINGUAl ARCH.
LIP BUMPER etc.
EXTRA ORAL ANCHORAGE
CLASSIFICATION OF HEAD GEARS
1. ACCORDING TO POINT OF ORIGIN
CERVICAL-ANCHORAGE FROM NAPE OF NECK
OCCIPITAL-ANCHORAGE FROM BACK OF HEAD
PARIETAL-ANCHORAGE FROM UPPER PART OF HEAD
2. HIGH PULL HEAD GEAR
CERVICAL PULL
COMBI PULL
HEAD GEAR
Occipital
Combi
Cervical
Occlusal
plane
HEAD GEAR
The line of traction or direction of pull can be changed by
Varying either :
Length of outer bow.
Angulation between outer and inner bow.
Cervical pull head gear
maxilla
HEAD GEAR
High pull head gear
Combi-pull head gear
HEAD GEAR
This diagram shows the theoretical effect of variations in the length
of the outer arm of the headgear bow.
MARCOTTE
200gm/side in MIXED DENTITION
500gm/side in PERMANENT DENTION
18-20 hrs/day

MCLAUGHLIN
150-250 gm/side for OCCIPITAL
100-150 gm/side for CERVICAL PULL
HEAD GEAR
FORCE AND DURATION OF WEAR
CONTROL OF ANCHORAGE IN HORIZANTAL
PLANE
CONTROL OF ANTERIOR SEGMENTS
LACE BACK
BEND BACK
ROLLER COASTER EFFECT

The work of Robinson confirms that lower canine lacebacks have a beneficial
effect in controlling proclination of lower incisors. Without lacebacks, on average the
lower incisor moved forwards 1.4 mm. In contrast, with lacebacks in place, the lower
incisors moved 1.0 mm distally.
1.53mm 1.4mm
No laceback
1.76mm
1.0mm
Laceback
PLANE
PLANE
BEND BACKS
CONTROL OF POSTERIOR SEGMENT
ANCHORAGE REQUIREMENT IS MORE IN THE
MAXILLA THAN MANDIBLE
CONTROL OF ANCHORAGE IN UPPER ARCH
CONTROL OF ANCHORAGE IN LOWER ARCH

PLANE
Headgear
Head gear in combination with class III elastic.
CONTROL OF ANCHORAGE IN VERTICAL PLANE
1.VERTICAL CONTROL OF ANTERIOR SEGMENT

2.VERTICAL CONTROL OF MOLAR SEGMENT
TPA
POSTERIOR BITE BLOCK
HEAD GEAR
VERTICAL CONTROL OF ANTERIOR SEGMENT
The tip which is built into the anterior brackets of the preadjusted appliance
system gives a tendency to temporary increases in overbite early in treatment. If the
canines are distally tipped in the starting malocclusion, then the bite-deepening effect
is greater.
VERTICAL CONTROL OF ANTERIOR SEGMENT
High labial canines may be loosely tied to the .015 multistrand or .016
HANT wire in the early stages of treatment. If the starting archwire is fully engaged
in the canine bracket slot, it can produce unwanted tooth movements in the adjacent
lateral incisor and premolar regions.
VERTICAL CONTROL OF MOLAR SEGMENT
If the upper palatal bar is placed 2 mm away from the palate, tongue forces
can assist in vertical control of the molars.
ANCHORAGE CONTROL IN TRANSVERSE PLANE
MAINTAINING EXPANSION PROCEDURE
MAINTAINING INTER CANINE WIDTH
Upper molar expansion should be carried out by bodily movement rather than
tipping. Minimal molar crossbites can be corrected using rectangular steel wires which
are slightly expanded from the normal form and which carry buccal root torque.
Ideal
arch form
Expanded
archwire
RE LEVELING PROCEDURES
NEWLY ERUPTED TOOTH

IMPROPER BRACKET PLACEMENT

BANDING OF SECOND MOLAR
1. BURSTONE C.J. MECHANICS OF SEGMENTED ARCH
TECHNIQUE. Angle Orthod .36:99-120,1966.
2. WILLIAM R PROFFIT, HENRY W FIELDS. CONTEMPORARY
ORTHODONTICS.
3. JAMES A Mc NAMARA. UTILITY ARCHES
J. Clin. Orthod. 20:452-56:1986.
4. BENNETT JC Mc LAUGHLIN RP:MANAGEMENT OF DEEP
OVER BITE WITH P.E.A. J. Clin.Orthod.24:684-96,1990.
5. RICHARD P McLAUGHLIN, JOHN C BENNET &
HUGO J TREVISI SYSTEMIZED ORTHODONTIC
TREATMENT MECHANICS.
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