MAA Final / Orthodontic Courses by Indian Dental Academy

MOLLENHAUERS ALIGNING
AUXILIARY (MAA)
AND ITS MODIFICATIONS

www.indiandentalacademy.com
During recent time, the Begg and
Edgewise philosophies are coming
closer to each other.
Light orthodontic forces

Mechanics of ( controlled ) tipping
followed by root movement
(Segmented edgewise)

Begg influence on edgewise
practice:

Edgewise influence on the Begg
practice

Root control from the beginning
( controlled tipping in the first
two stages which simplifies the
third stage mechanics)
Why clearcut division ( Crown tipping
followed by root movement ) in classic
Begg?

Because lingual root torque on
incisors antagonizes incisor
intrusion.
Lingual Root torque and distal
root uprighting tax anchorage.

MAA attempts root control from
stage-I without significantly
affecting intrusion and anchorage.

A major advance in Begg appliance
How ?
Base wire 0.018 Premium Plus ( for
intrusion, arch form control and
molar control)

MAA 0.009 Supreme ( Ultra fine
wire for ultra light root moving
forces).
1.Significant deviation from
classic Begg.

2. Enhanced treatment quality.

3. Shorter treatment time.
In this presentation, MAA as was
originally conceived by Dr.
Mollenhauer will be covered and
then the slightly modified way in
which we use it will be described.
Development
Precursor Specs in 0.010 wire.

Forces generated were relatively
high.
0.009 Supreme wire become available
in 1984.

Initially used as aligning wire (AOJ87)
then
as aligning rectangles- MAA (AOJ90)

Requirements
1) Ultra light root moving forces.
Hence
a.) 0.009 wire
b.) reciprocal torque not more than
45
0
.

2.) Yet, wire must be resilient to
resist deformation.

Hence supreme grade,preferably
pulse straightened.
3.) Strong base wire to resist the
vertical and transverse reactive forces.

Hence 0.018 Premium plus.
Requirements ( contd.)
Thickest possible lock pins or hook
pins (e.g. Ceramaflex pin) for
transmitting lingual root torque to
teeth ( since auxiliaries are kept
incisally for better hygiene).
ORIGINAL MAA FOR LINGUAL
ROOT TORQUE
Advantages of MAA according to
Mollenhauer:
1. Efficacy of intrusion and retraction.

2. Reciprocability of torque ( on
instanding 2s or palatally placed 3s.).
Hence periodontal benefits ( gingival
dehiscence prevented).

3.) Early root control with short stage III.

4.) Possibility of cortical bone growth
( at point A and point B).
Application of MAA:

1. Body alignment of crowded teeth by
combination of
a) Expansion + Crown alignment
(looped arch wire like effect)
&
b) Root torque.

Application of MAA ( contd..)
2.) After stage I as braking mechanics
( by bending more positive torque)
3.) For labial root torque on

a) Lower incisor in class II

b) Upper incisor in class III
(For cortical bone development)
4.) MAA- tip for controlling Mesio-
distal angulation of root apices in
stage I
( superior to light uprighting springs
for anchorage ?).

Application of MAA ( contd..)
Biomechanics of MAA
Class II or class I elastic force causes
uncontrolled tipping of U incisors
during stage I.
Sufficient counter moment must be
provided to obtain controlled tipping.
One way to provide such counter
moment is from the intrusive force of
the archwire.

Very light forces generated by MAA can
also provide torquing moments on the
teeth to counter the moment generated
by the class II or class I elastics, resulting
in controlled tipping

Biomechanics of MAA ( Contd..)
Lingual torquing couple of MAA is
additive to the moment generated by
intrusive force on incisors.
Both together, produce the required
M/F ratio.
Biomechanics of MAA ( Contd..)
For lower incisor intrusion during
stage I, MAA for labial root torque is
need to prevent proclination of lower
incisors.
PROCLINATION WITHOUT MAA
Moment resulting from intrusive
force diminishes in stage II.
Therefore MAA is must to provide
moment for controlled tipping.
UNCONTROLLED TIPPING WITHOUT MAA
ADDITIVE MOMENT
For retracting lower incisors in
stage II , MAA with lingual root
torque is needed for controlled
tipping ( like upper)

Thus lower incisors may need different
MAA for stage I & II.
Can MAA in 0.009 wire be used
for torquing the roots in stage III ?

NO.

Because for controlled root movements,
higher M/F ratios ( 12/1) is required .

But similar ( Boxed) design in
0.011wire can be use.
How our MAA application differs ?

a) Lingual torque delivered indirectly
through pin caused difficulties. (Of
course we did not try Ceramaflex
pins). Pin tails can rotate. Pins can
move up and down.

Hence MAA was modified to press
directly on incisal area for labial root
torque and gingival area for lingual
root torque.
Original MAA was always engaged
first in the brackets and base arch
wire was piggy back.
In our modification, when lingual
root torque is needed on all the teeth
or reciprocal root torque on some
teeth, base wire is engaged first and
the MAA is piggy back.

Original MAA for lingual root torque
Modification MAA for lingual root torque
Modifications for reciprocal root torque
When labial root torque is needed
on all teeth, we use the original
design and also place it first in the
bracket similar to original
application
MAA for labial root torque
For reciprocal root torque on some
teeth ,(e.g. in standing laterals), cross
over bends are made.
Since our experience with pins was
not favorable, we do not use MAA
tips.
MAA for expansion like multiloop
wire ?
May cause unpredictable action or
round tripping.

Hence we use MAA only for torque
control after crowns are aligned.
Steps in making the MAA
How to make cross over
bends.
Wire bent parallel to the boxes but
in opposite direction.
Then give another bend close to
the first bend but at right angle.
Complete the box. Make another
cross over.
Complete the blank.

Use of MAA or its variations in
Edgewise brackets
Substitution of braided rectangular
wire for MAA in order to reduce the
time and efforts involved in wire
bending.
Rectangular wires engaged before the base wire
Diameter Lateral Central Central Lateral
Of the wire Root Root Root Root
Stainless Steel
0.022 x 0.016 18 20.5 21 17.5
0.025 x 0.017 20 23 22.5 20
Braided Steel
0.022 x 0.016 11.5 14.5 14 11.5
0.025 x 0.017 13.5 16.5 16 14
0.025 x 0.018 15 18 18 15.5
0.025 x 0.019 16 19.5 20 16
NiTi
0.022 x 0.016 11 14 14 11
0.025 x 0.017 12.5 16 16 12.5
0.025 x 0.018 14 18.5 18 13.5
0.025 x 0.019 16.5 20 19.5 16.5
Br- NITI
0.025X0.017 11 12.5 12.5 11
Cu- NITI
0.025X0.017 14 16 16.5 14
0.025X0.019 15.5 18.5 18 15.5
.a Titanium
0.022X0.018 13.5 16 16 14
Four spur
0.12 pre
+
14 16 17 14
MAA 0.009
SUP
10.5 12.5 12.5 11
Torque bar
0.022 X0.018
11 12.5 13 11
The disadvantage of such an
application is that it cannot be used for
reciprocal torque on adjacent teeth.
Use Begg brackets with built in
torque (Kamedas design )?
In conclusion, it could be said that the
MAA and its modification have
proved a major advance in refining
the Begg mechanics.

The rectangular wire substitutes for
the MAA ( and the torquing
auxiliary) have made it possible to
apply them even in a busy practice.

THANK
YOU

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MAA Final / Orthodontic Courses by Indian Dental Academy

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MOLLENHAUERS ALIGNING

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