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MORNING

TORQUE IN
ORTHODONTICS

Introduction
Proper buccolingual inclination of anterior and

posterior teeth is essential to provide better


esthetic, stability and functional occlusal
relationship. With Edgewise appliance Torque or
buccolingual inclination was achieved by third
order bends placed in arch wire. With Begg
appliance inclination was achieved with
auxiliaries. But today, majority of orthodontic
brackets are pretorqued, so there is no need to
give third order bend in the arch wire.

But in reality it is not so. So many factors affects

the torque expression. It may be biological factors


or mechanical factors. Moreover if the
orthodontist does not have an understanding of
torque, many adverse tooth movements will
result, making orthodontic treatment more
difficult and treatment results less desirable

Definition
Torque being more related to engineering

terms is defined as

The force system transmitted by and


through a structural or machine member,
capable of producing pure rotational
displacement about the longitudinal axis.

In Orthodontics, as stated by Dr. EARMAN D.

RAUCH:

Torque is the force that enable the


orthodontist to control the axial inclination of the
teeth and to place them in the harmonizing
positions that are so desirable for a nicely
finished results. Torque is the force that gives the
operator control over the movement of the roots
of the teeth.

Torque is a force that assists him to bring about


a
desirable change of point A & B which in turn
helps to bring about desirable facial changes in his
patients.

BIOMECHANICS OF TORQUE
Torque or root movement of a tooth is achieved by

keeping the crowns stationary and applying a moment to


force only to the root.
This basic concept is better understood if the role of
moment to force ratio is known.
The centre of rotation of a tooth is at the incisal edge in
case of root movement.
The M/F ratio should at least be 12:1 to achieve root
movement.
According to Dr. Ravindra Nanda
M/F ratio of 5:1 causes UNCONTROLLED TIPPING
M/F ratio of 7:1 causes CONTROLLED TIPPING
M/F ratio of 10:1 causes TRANSLATION
M/F ratio of 12:1 causes ROOT MOVEMET

Proffit has stated that the perhaps simplest way


to determine how a tooth will move is to
consider the ratio between moment created
when force is applied to crown (MF) and
counterbalancing moment generated by a
couple within the bracket (MC).

MC/MF = 0 results in PURE TIPPING


MC/MF < 1 results in CONTROLLED
TIPPING
MC/MF = 1 results in TRANSLATION
MC/MF >1 results in TORQUE

When a rectangular wire is twisted and


inserted into the slot, the opposite sides of the
wire contacts the slot which creates a couple
and generates a moment large enough for
root movement

Torque
WHY.?
WHEN.?
& HOW?

why torque is necessary ?


To bring about labiolingual movement of
the teeth
To retain the teeth in the cortical bone
To avoid relapse
To give a natural finish to the dentition

When.....?
When there is uncontrolled tipping of the

crown
In third order bends of finishing and artistic
positioning in a pre adjusted edgewise system.
In pre surgical and post surgical phases for
the precise placement for axial inclination of
teeth
As a device to augment anchorage demands
of that particular situation.

How..?
Torque can be done both in fixed and removable

machanotherapies
Torque in fixed appliance can be employed in
different ways
1. By giving a twist in an arch wire
commonly used in edgewise techniques
2. Torque exerted by the bracket itself
Pre adjusted edgewise appliance
3. By use of torquing auxiliary
- widely used in Beggs technique and edgewise
technique.

ARMAMENTARIUM:

METHODS OF
TORQUING IN
VARIOUS APPLIANCE
MECHANICS

EDGEWISE
MACHANOTHERAPY :
The edgewise arch appliance is the last
of many contributions of Dr.EDWARD H.
ANGLE and was introduced to the
profession by one of his last students,
Dr.ALLAN G. BROADIE in 1929. It is an
exacting appliance requiring the thorough
understanding and skill manipulation.
This technique offers excellent controls in
the labiolingual, mesiodistal and vertical
dimension

The classification of tooth movement


associated with edgewise appliance seem to
be based upon the type of movements
rather than direction.
i.
Movement of the First order
ii. Movement of the Second order
iii. Movement of the third order
We will see here movement of the Third
Order
Before we go into it we will have quick view
over glossary

Passive torque torque for proper placement of

the wire
Active torque for active tooth movement
Progressive torque- increase of the torque value
progressively as we go posteriorly in the dentition
Torque force is named according to the action

upon the tooth crown.


1. Lingual torque

2. Labial or buccal torque

1. Labial Torque: Labial Torque or Buccal


torque will tip the crown of the tooth
labially or buccally and the roots lingually
2. Lingual torque: Lingual root torque will
tip the crown of the tooth lingually and the
roots labially or buccally
19

TH IRD O RD ER M O VEM EN TS :
It is defined as the difference in
inclination of the facial plane of crown at its
mid point in an ideal occlusion.
The third order bends better known as
torque are placed in the arch wire to effect
buccolingual or labiolingual root and crown
movements in a single tooth or a group of
teeth

Torque requirem ents in m axillary and


m andibular arch w ire

For ideal axial inclinations, there should be

lingual root torque in both maxillary and


mandibular anterior teeth.
The arch wire should have lingual crown
torque in the mandibular posterior teeth and to
ensure good occlusion canine do not require
any torque.

Anterior torque
The basic criteria is

that the wire must fill


the bracket i.e.. the
diagonal dimensions of
the wire must exceed
the occlusogingival
width of the bracket
slot in order to
maintain the twist
activation.

To place lingual root

torque in the maxillary


anterior region ,pliers
should be held mesial to
v bend and mesial part
of the wire should be
bent in gingival
direction with
thumb.the pliers are
moved in slight step
towards the midline
being bent in a gingival
direction with
thumb.the entire arch
has a lingual root
torque now.

To remove lingual

root torque from


posterior legs the
arch wire should
be held just distal
to v bend with
another plier
mesial to v bend
the distal leg
should be twisted
in incisal direction
until the omega
loop or stop is
again vertical.

To check the torque

the arch wire when


placed in central
and lateral brackets
the distal legs
should be near the
gingiva.

If the orthodontist

expects to move
the anterior teeth
bodily in a lingual
direction then
labial torque of
the incisal
segment is
increased until the
arch wire lies 6 to
8 mm. gingival to
the buccal tube
when the operator
tests for labial

Posterior
torque
Continuous

Progressive

Continuous
posterior torque

Progressive Posterior Root Torque

Brodie first called attention to

the fact that, in order to have


mass torque action in the buccal
segment, progressive torque is
necessary; otherwise, when the
wire is inserted in the bracket of
the cuspid tooth, the bracket
removes the torque action from
the teeth distal to the cuspid
tooth, and the wire lies passive in
the brackets of each succeeding
tooth until the cuspid tooth
movement has been accomplished.

TORQUE
IN THE

PRE ADJUSTED
EDGEWISE
APPLIANCE

PRE ADJUSTED EDGEWISE


APPLIANCE:
Until the mind 1970s most fixed appliance therapy
was carried out using the standard Edgewise bracket,
either in a single or twin from having a 900 bracket
base and brackets slot angulation.
The Major disadvantage resulted from this treatment
are;
1. Arch wire bending is time consuming and tedious.
The short comings of the bracket system and the
extreme skill required of the orthodontists resulted in
many under treated cases and the results are
appeared artificial

Molars were not in true CL-I relationship.


Upper incisor are under torqued . So the
resulting occlusion had the appearance of a
nice orthodontic result rather that a
pleasing natural dentition.
And also the
long term stability of tooth adjustment was
compromised by failing to establish ideal
tooth relationships.

Against this background Dr.Lawrence


F.Andrews developed the straight wire
appliance which became widely available in
the mid 1970s.
It was hailed by the
clinicians as a radical step forward offering
the dual advantages of less wire bending,
coupled with an improved quality of the
finished cases

TORQUE IN FACE VS TORQUE IN BASE

Torque in base was an important issue with the 1st and 2nd generation
PEA brackets because level slot line up was not possible with brackets
designed with torque in the face.
Torque in base ,as said by Andrews, is a pre requisite for a fully
programmed appliance.
Albert H Owen (1980) conducted a study comparing Roth
prescription and Vari Simplex Discipline. He concluded that while
torque in base had a strong theoretical basis, its effectiveness is
greatly influenced by clinicians success in accurately placing
brackets.

Torque in base
means that
bracket stem is
parallel and
coincides with
long axis of
bracket slot
The torque in face,
slot is cut at an
angle to the
bracket stem. The

UNDESIRABLE EFFECTS OF HAVING TORQUE IN THE


FACE:

Bracket having torque in the face


affects the final vertical positioning
of tooth.
ii) Level slot line up is not possible.
iii) Bracket wings could bend or
distort under various forces of
ligation.
i)

Torque in the bracket base allows


flexibility of design. It enhances
bracket strength and other features
such as depth of the wing and labio

Modern bracket systems


including MBT system have
been developed using CAD
CAM tech. Brackets may be
finished with torque in the
base ( full size or clear) or
combination of torque in base
or face ( mid size) with
absolutely no difference in

Crown inclination is determined by the


resulting angle between a line 90 degrees
to the occlusal plane and a line tangent
to the middle of the labial or buccal
clinical crown.
43

TORQUE NORMS IN VARIOUS


PRESCRIPTIONS
ANDREWS STRAIGHT WIRE APPLIANCE (SWA)

Considered as the first generation of PEA


This appliance was constructed on the basis of a
collection of 120 non orthodontic models selected on
the basis of occlusions that could not be anatomically
improved upon with orthodontic therapy.
The average values from the non orthodontic normal
sample were used to construct a hybrid edgewise
appliance in which all three dimensions for tooth
positioning for each tooth was built directly into the
bracket.

Average crown inclination in SWA :


-9

-9

-7

-7

-7

+3

+7

-35

-30

-22

-17

-11

-1

-1

Upper

Lower

Maxillary incisors have a positive inclination


Mandibular incisors have a slight negative inclination
Upper canines and premolars are negative and quite
similar.
Inclination of the maxillary first and second molars are
also similar and negative.
Inclinations for the mandibular teeth are progressively
more negative from the incisors to the molars.

ROTH PHILOSOPHY

Roth selected brackets from Andrews SWA set up and developed the
Roth treatment and prescription.
These were made available in 1976 and they are considered as the
second generation of PEA.
The three main reasons for the Roth prescription were as follows:

To reduce the need for a large and expensive inventory


where one set of brackets could be used for a wide variety of
cases
Anchorage Loss: Roth believed that mesially angulated
brackets on posterior teeth tend to tip the teeth mesially and
let them migrate forward resulting in possible anchor loss.
Over Correction : Roth propagated a therapy goal in which
at the end of treatment all teeth were positioned slightly
overcorrected and from which the would most likely settle
into a non orthodontic normal position.

TORQUE SPECIFICATIONS
-14

-14

-7

-7

-2

+8

+12

-35

-30

-22

-17

-11

-1

-1

Upper

Lower

Compared to SWA in the upper arch


The incisor torque is increased (5)
Canine torque is decreased (5)
The molar buccal root torque is increased (5)
The lower arch values are similar to the SWA.

Super Torque Series


Extra torque incorporated from canine to canine in the
following case scenarios:
Two upper first premolar extraction cases
Also used in Class II div 2 cases and in any cases that
require 6mm or more upper anterior retraction

MBT PHILOSOPHY

Mclaughlin, Bennett and Trevisi


redesigned the entire standard bracket
system to complement their proven
treatment philosophy and to overcome
the inadequacies of SWA.
They re-examined Andrews original
findings and took into account of
additional research input from
Japanese sources
This 3rd generation bracket system is
designed for use with light continuous
forces, lacebacks,bendbacks and
sliding mechanics.

TORQUE SPECIFICATIONS
-14

-14

-7

-7

-7
0
+7

+10

+17

-10

-20

-17

-12

-6
0
+6

-6

-6

Upper

Lower

INCISOR TORQUE
Palatal root torque of the upper incisors and labial root torque
for the lower incisors were increased compared to previous
generations due to :
Inefficiency of PEA brackets in delivering torque.
In class II cases, class II elastics can cause torque to be lost on
upper incisors and lower incisors can get flared.
In class I cases, correct incisor torque helps to achieve good
anterior tooth fit.
In class III cases correct torque helps to compensate for mild
class III dental bases

CANINE TORQUE
Upper canines:
Torque in the upper canines are necessary because they
are key elements in a mutually protected occlusion.
The goal is to deliver ideal tip and torque to the canines so
that they can fulfill their role in lateral excursions and
have a small amount of freedom in maximum
intercuspation.
MBT uses two canine brackets for three torque options
( +7, 0, -7 )
Lower Canines:
Original SWA torque in canine is not satisfactory because
-11 tends to leave lower canine roots too prominent in
some cases.
MBT uses two canine brackets for three options
(+6 , 0 ,-6 )

SELECTION OF CANINE TORQUE OPTIONS


1. ARCH FORMS
Well developed arches and substantial tooth
movement not required
Upper Canine: -7
Lower Canine: -6
In cases of ovoid arch forms
Upper Canine: 0
Lower Canine: 0
In cases of narrow (tapered) arch
Upper Canine: +7
Lower Canine: +6
2. CANINE PROMINENCE
-7 in the upper arch or -6 in lower arch
canine torques are normally not correct
if the patient has prominent canines or canine
gingival recession at start of treatment, in these
cases bracket with 0 or +7 /+6 should be used.

3. EXTRACTION DECISION:
0 brackets tend to maintain canine roots in the cancellous bone
making tip control of roots easier.
4. OVERBITE:
In some Class II div 2cases, there is a requirement to move lower
canine roots labially and also centre the roots in bone. This is more
easily achieved if 0 or +6 lower canine torque is used.
5. RAPID PALATAL EXPANSION CASES
RPE of upper arch creates a secondary widening of the lower arch.
There are torque changes associated with this. Values of 0 or +6
brackets are recommended to assist in the favourable change.
6. AGENESIS OF UPPER LATERAL INCISORS
If one or both lateral incisors are missing, a decision may be made to
close spaces and bring canines mesially. It is helpful to invert -7
upper canine 180 , thus changing the torque to +7 with the tip
remaining the same.

UPPER PREMOLAR AND MOLAR TORQUE


Upper premolar value of -7 has proven to be satisfactory
in clinical use and the authors continue to work with it.
For upper molars, -9 of original SWA has proven to be
inadequate. They prefer -14 as it gives better control on
palatal cusps and prevents the cusps from hanging down

LOWER PREMOLAR AND MOLAR TORQUE


Many orthodontic cases have narrow
maxillary arches with lower arches
showing compensatory narrowing.
These cases normally require buccal
crown torque of lower premolars and
molars.
The original SWA first molar torque (-30
) and 2nd molar torque (-35 ) allowed
rolling in of the lower molars.

WHY SO MUCH OF VARIATION IN TORQUE


IN PEA???

VARIABILITY OF TORQUE IN PEA


Torque prescription varies from 7 for the
maxillary central incisor in the SWA to 17 in
MBT and 22 in Bioprogressive Rx.
This lack of uniformity may be attributed to :
The value that the developer chose as the
average normal inclination of the tooth surface.
The expected play in the bracket between the
arch wire and the slot.
Position of the bracket on tooth surface. The
appliance meant to be placed rather gingivally
have different torque values than one placed
incisally.
AJO DO 2004; 125:323-28

VARIABLES AFFECTING TORQUE IN PEA:

Variation in the shape of individual tooth


Play of the arch wire
Variations in bracket placement
Manufacture errors in brackets and wires
Mode of ligation

AJO DO 2004; 125:323-28

1.VARIATION IN THE SHAPE OF INDIVIDUAL


TEETH:
Theoretically for these brackets to apply torque
implied by prescription, they should be
positioned at the same point at which average
torque values were first obtained - L.A point.
With basic morphologic differences in the
individual
tooth
shape
and
different
recommended bracket placement charts of
various prescriptions, clinicians donot use the
L.A. point and therefore torque applied to tooth
varies from prescription. AJO DO 1989; 96:312-09

2.PLAY OF THE ARCH WIRE


Filling the bracket slot by incrementally
increasing the wire cross section has been the
basic sequence of therapeutic protocols.
Inevitably, a fraction of torque that is built
into the bracket remains unexpressed owing to
play or 3rd order clearance or slop.
Inability in full expression of built in torque in
PEA is perhaps one of its biggest
shortcomings. The average play values vary
with different clinicians and researchers.

3. VARIATIONS IN BRACKET PLACEMENT


With PEA brackets, the position of brackets on crown
determines the tooths final tip, torque, height and rotation.
Poorly positioned brackets result in poorly positioned teeth
and necessitate many more arch wire adjustments.
This can lead to an increase in treatment time or final
occlusion that is less than ideal.
Errors in the vertical dimension can alter the torque values
built into the appliance
Meyer and Nelson stated that the mandibular 1st premolar
has the greatest occlusogingival curvature of any tooth and
that a 3 mm displacement of the bracket results in a 10
alteration in applied torque
In addition thickness of composite and cement material
under brackets and tubes may be another factor that changes
the effective torque AJO DO 1978; 73:485-90
AJO DO 2001; 119:76-80

4. VARIABILITY OF ACTUAL vs REPORTED TORQUE

Manufacturing of brackets allows for an acceptable


variation in their size and characteristics including
dimensional accuracy and torque consistency.
Wires and slots cannot be made precisely every time.
Manufacturing tolerances result in 0.018 slots ranging
from 0.017 to 0.019 whereas 0.022 slots ranging
from 0.021 to 0.023
Bracket manufacturing process involving casting,
injection moulding etc. can affect the accuracy of
prescribed torque values.
Various bracket slot manufacturing defects such as
incorporation of metal particles in the slot, enlargement
of the slot or decrease in the wire cross section can
prevent the full engagement of the wire into the bracket
slot which affects the torque expression. AJO DO 1993; 104:8

Other means taken to prevent the undesirable


event is the rounding and bevelling the edges of
both arch wire and slot. This makes insertion of
wire easier
In a study done by William Brantley et al (1984),
it was found that in 0.022 slot the 0.019 x 0.025
Titanium wire produced a play of 22 as
compared to 12 in stainless steel.
They concluded that edge bevel is expected to be
a critical factor for actual torque expression by
specific round or rectangular wire. So increase in
edge bevel means increase in play.

5. MODE OF LIGATION
A source of torque control loss is force relaxation in elastomeric
ligatures. Elastomeric ligatures have shown a force degradation
pattern characterized by initial decrease of nearly 40 % in the
first 24 hrs. Thus the engagement of the wire to slot is flexible
and incomplete resulting in further reduced expression of the
already compromised torque.
The use of steel ligatures has been found to diminish slot wire
clearance.
So as a bottom line, a clinician might actually require
more torque than incorporated into the currently
available PEA and alternatively sufficient activation
should be applied to arch wires to compensate for play,
various manufacturing defects and clinical procedures
which counteract the expression of torque built into the
bracket.

TORQUE CONTROL IN VARIOUS


TREATMENT STEPS
LEVELING AND ALIGNING

Contrary to popular belief torque is not expressed only in


rectangular SS wires.
Flexibility of the rectangular HANT wires allows early
placement and this allows easier torque control than was
possible when only steel wires were available

BITE OPENING CURVES AND TORQUE

In majority of the cases after rectangular stainless steel


wires have been in place for 4-6 weeks, arches are
normally aligned and adequate bite opening would have
taken place if 2nd molars were banded , if this is not so
then bite opening curves can be placed in rectangular
steel wires
Placing bite opening curves in the
upper arch wire increases palatal
root torque to upper incisors.
This is beneficial in majority of
cases and it is usually unnecessary
to add any additional torque
bends.
When a reverse curve is placed in
the lower rectangular wire result
is proclination of lower incisors.
This generally is not indicated.
Thus before placement of bite
opening curves in lower wire
approximately 10 to 15 of labial
root torque can be added

SPACE CLOSURE AND TORQUE


All research evidence shows the de merits of using Ni Ti
coil springs for more rapid space closure. If space is closed
too rapidly, incisor torque is lost and requires several
months to regain the lost torque.
Loss of torque control results in upper incisors being too
upright at the end of space closure with spaces distal to the
canines and a consequent unaesthetic appearance.
Also rapid mesial movement of the upper molars can allow
the palatal cusps to hang down resulting in functional
interferences.
Rapid movement of the lower molars causes Rolling in of
molars.

According to Raymond
Siatkowski (1999) there
is an average torque loss
of 5 in the retraction of
1.3mm in maxillary arch
and 1.2mm in the
mandibular arch.
This means that there is
an average of 15 torque
loss for 4mm of retraction.

TORQUE IN FINISHING AND DETAILING


Torque in maxillary incisors is critical in establishing an
aesthetic smile line, proper anterior guidance and a solid
Class I relationship.
Under torqued incisors deprive the dental arch of space.
It has been shown that for every 5 of anterior inclination
1mm of arch length is generated.Under torqued posterior
segment has a constricting effect on the maxillary arch.
(BJO 1999;26:97-102)
A major finishing consideration in the horizontal plane is
co ordination of tooth fit in the anterior and posterior
areas. Any discrepancy in the tip, torque or tooth size can
affect tooth fit.

Providing adequate incisor torque


Torque control is the weakness of PEA . Three factors
responsible are.
1. Area of torque application
Approximately 1mm segment of rectangular steel wire
is placed in a bracket slot of about the same
dimension.
This segment is required to carry out rather difficult
tooth movement which involves moving an entire
portion of root through alveolar bone.
2. Play between arch wire and slot.
3. Upper and Lower anterior torque need of different
patients vary greatly.
So,there is a need to place additional palatal root torque in
upper incisors and labial root torque in the lower

Providing adequate posterior torque

Though the MBT bracket system has been provided with


additional buccal root torque compared to SWA, extra
buccal root torque needs to be added to posterior segments
of upper arch wire in certain cases.
To provide adequate buccal root torque in the upper arch,
it is also important to have a wide enough maxilla.
If the maxilla is not wide enough, then buccal cortical
plates will not allow for incorporation of appropriate
amount of buccal root torque. This in turn leads to palatal
cusps that create interferences during labial excursions
and compromises to functional occlusion.
This need to be evaluated carefully at the beginning of
treatment

0.018 or 0.022 slot?


The earliest slotted bracket appliances relied on precious
metal wires for activation. Gold wires were efficient and
resilient in the first standardized slot size : the 0.022 inch.
In the 1930s stainless steel alloys were introduced and
orthodontists soon replaced gold alloys with cheaper SS
wires despite the realization that steel wires were less
flexible than the equivalent sizes in gold.
Clinicians in the 1950s began employing smaller sized
wires in the 0.022 inch slot. The mood was now right for a
downsizing of edgewise slot dimension from 0.022 to 0.018
to allow light forces with SS.
Some edgewise folks switched, some did not! Indeed the
slot size dichotomy persists even today: 0.018 or 0.022!?

TORQUE EXPRESSION : 0.018 Vs 0.022 SLOT


The 0.018 brackets usually has 0.017 x 0.025 as
working wire which has a slop of 6. Thus theoretically
torque expression in the 0.018 slot maybe better than in
an 0.022 slot.
But the 0.018 slot has a host of other short comings:
i) Torque prescription for the 0.018 slot tends to be more
conservative.
ii) There is an obvious limitation in choice of wires and
treatment mechanics employed.
iii) They are not efficient in sliding mechanics since the
0.017 x 0.025 wire does not have sufficient clearance
and can be deflected . Loop mechanics has its own side
effects of excessive forces and operator errors.

In the 0.022 slot, the slop of 10 with a 0.019x0.025 arch


wire must be counteracted by adding torque (10 - 15 ) into
the arch wire for utilizing complete built in prescription.
In PEA the 0.022 slot is preferred because of the following
advantages:
During leveling and aligning, these slots have definite
advantage in choice of alignment wires.
0.022 slots are designed for sliding mechanics which is
proven to be more efficient in space closure.
As adjunct with PEA, ( fixed functional, orthopedic
forces, surgical cases) we require stiff, full size arch
wires to avoid deflection. Thus 0.022 slots are more
efficient.

DOES ONE PRESCRIPTION APPLY TO ALL?

Factors such as age, sex, ethnic group are important in making


a proper orthodontic treatment plan. Another important factor
is the facial growth pattern and its general clinical
characteristics.
Faciolingual inclinations in PEA are relative to the occlusal
plane. Occlusal planes are oriented differently in head when
extreme variations in vertical growth proportionally occurs.
Use of any PEA will orient the dentition to an occlusal plane
that is different in different growth patterns
High angle skeletal patterns: upright maxillary incisors and
increased buccal inclination of posterior teeth
Low angle skeletal pattern: More proclined maxillary incisors
related to the SN plane and increased lingual inclination of the
posterior teeth.
AJO DO 1993; 104:8-20

AJO DO 1990; 98:422-9

VARYING FACES .. VARYING


TORQUE!!!!!!

Finishing protocols in torque should be


decided by the orthodontist and not left to
the appliance used!!

Torque in BEGGS
MECHANOTHERAPY

BEGGS MECHANOTHERAPY :
The torquing in BEGG is testimonial to the genius
Dr.BEGG, both with regards to its concept and the
designs. The special feature of BEGG appliance in
separating the tooth moving forces from the arch
wire forces gives at a unique advantage. Various
torquing auxiliaries developed Dr.BEGG the
1.
Spur design having 2,4 and 6 pairs
2.
Mouse-strap for lingual root torque
3.
Udder arch for labial root torque
4.
Reciprocal lateral torquing auxiliary
5.
Reverse torquing auxiliary
6.
KITCHTON torquing auxiliary
Single root torquing auxiliary developed Dr.Kesling

RECENT ADVANCES - Refined BEGG


1.
2.

Reciprocal torquing auxiliary (SPEC) Design


Reverse torquing auxiliary for controlling the
roots of the canine of the premolar by Franciskus
Tan in November 1987.
3.
Buccal root torque and upper molars
4.
Labial root torque only in the lateral incisors
5.
MAA Auxiliary by Mollenhauer

TO R Q U IN G A U X ILIA RY W ITH
SP U R S

Action of the torquing auxiliary


1.

The auxiliary bent into a small circle,


when fixed in the mouth, is spread out along
the wider anterior curvature of the arch wire.
The lingual torquing effect is an account of two
factors.
a. Firstly, the vertical plane in which the
torquing auxiliary orients when fitted on two
central incisors, is changed to a horizontal
plane of arch wire when fully tied to it.

b. Secondly, when the torquing auxiliary


is opened to a larger arc of anterior
portion of the arch wire it rolls inwards.

Both the effects, force the tips of the


spurs to press in a lingual direction
against the gingival portion of the
crown. Reciprocally the inter spur
spans of the auxiliary tend to lift away
in the labial direction.
THUS A
FORCE COUPLE IS CREATED. The
labial forces are resisted by the bracket
slots and the base arch wire to which
the auxiliary is tied. Thus accentuating
the action of lingual root moving forces

ABO U T TH E SPU R
1. The Auxiliary should be constructed
in 0.012 premium plus wire (preferable pulse
straightened) unlike in 0.014 or 0.016 special
plus wire which were previously used.

2. The length of the spur does affect the


force produced. A short spur will produce
much greater force that will drop rapidly
when the teeth start getting torqued, as
against a longer spur that produces a gentler
and more constant force.

The length of the spur should be kept at


about 5 mm; but it should be varied
depending on the clinical crown height,
leaving it about 1 mm short of the gum to
facilitate proper hygiene

3. Inclination of the spurs to the


horizontal (occlusal) plane is kept 00. In other
words, the activation is 100%.
4. The distal leg of every spur is kept
slightly shorter by about 0.5 mm, so that the
distal leg does not project incisally to the main
arch wire on tying

5. Activation of the spur


a. The inter-spur span is curved as recommended
by Dr.Kesling

b. Kept straight as shown in Swains


chapter

c. Angulated midway as in BEGG

d. As recommended by Dr.Jayade normally


size of the old 50 paise coin

The force generated by the auxiliary increase


with decrease in the diameter in the circle and
vice-versa

Two of the modification commonly required in the


spur design torquing auxiliary are as follows.
a. Reverse labial torque on one or both the lateral
incisors : Boxes at right angle to the plane of the
spurs are made to lie at the incisal area of the lateral
incisor(s). Crossover bends are made on either side of
the lateral incisor bracket to permit the auxiliary to
pass over the base wire, similar to the bends
described in the section on the MAA
Torquing boxes on the canines for lingual root
torque : Instead of making spurs for the canines,
boxes can be provided. The ends of this auxiliary
need not extend beyond the canine area

MOLLENHAUERS ALIGNING AUXILIARY


(MAA) AND ITS MODIFICATIONS
MAA auxiliary was developed by Dr.
MOLLENHAUER and it was given the
name as An Aligning Auxiliary for Ribbon
Arch Brackets. The MAA, attempts root
control from the very beginning, of the
treatment without significantly affecting
the anchorage and overbite correction.
This has become possible by using a
combination of a stiff base arch wire made
from 0.018 Premium plus, and ultra light
root moving forces from the MAA made
from the 0.009 Supreme grade wire

Requirements for use of the MAA


Mollenhauer has enumerated the requirements
as
1. It must generate very light root moving forces.
Therefore, the wire size must not exceed 0.009.
2. For the same reason, when reciprocal torque is
required on adjacent teeth, the adjacent rectangles
must not diverge by more than 45 degrees.
3. At the same time, the auxiliary must be able to
resist deformation. Hence, it must be made in a
highly resilient wire viz. Supreme grade (preferable
pulse straightened)

4. The base wire should be able to resist the


vertical and transverse reactive forces
from the MAA. Therefore, it must be
made in 0.018 Premium Plus wire.
5. In Mollenhauers application, the MAA is
always engaged first and the main wire is
engaged piggyback. The rectangles for
lingual root torque lift away from the
tooth surface, which are held down with
the help of pins, thus indirectly
transmitting the torquing action throug h
the pins to the brackets onto the teeth.

Therefore, he recommends the thickest possible


lock or hook pins (such as the pins for Ceramaflex
brackets)

Advantages of the MAA


According to Molenhauer, the advantages of MAA

are :

1. Efficacy in intrusion and advantages retraction of the


anterior teeth,
2. Efficiency in rapid bodily alignment of the anterior teeth
using gentle forces
3. Stable results.
4. Reciprocability of torquing forces on the in standing
laterals or palatally placed canines.

5. Periodontal advantages in such cases,

because the gingival dehiscence associated with


prolonged labial root torquing of such teeth
during the 3rd stage is eliminated.

6.

A short stage III, because the early root


control minimizes (uncontrolled) root tipping
in the opposite direction

7.

Possibility of growing cortical bone at the A


and B points

VARIO US APPLICATIO N S O F TH E M AA
1. Originally, the MAA was introduced for bodily

alignment of crowded teeth. The looped arch wire like


effect (expansion + de rotation + vertical leveling) was
combined with lingual and / or labial root torque

VARIO US APPLICATIO N S O F TH E M AA
2. By bending more positive torque into the

MAA, it can be used after the stage I as a braking


mechanism.

Mollenhauer strongly recommends applying


labial root torque on the lower incisors in growing
brachyfacial cases, to prevent their roots from
lingualizing (which can happen due to intrusive
forces and due to contraction of trans-septal
fibers in extraction cases). This helps in a better
profile control. The MAA can be used for labial
root torque on the upper incisors in Class III
cases

3. In later writings, Mollenhauer described

use of the same auxiliary for controlling the


mesio-distal root positions from the beginning.
He called this application MAA-tip.
A
ligature wire tied to the auxiliary and to the
pin transfers the tipping effect to the tooth.

4.

Modification can be used for reciprocal root


torque

O ther boxed Auxiliaries


Mini versions of MAA ranging from 0.009 to
0.012 and curvatures facing incisally facing
incisally or gingivally, for labial or lingual root
control respectively. They are employed on two or
more number of anterior teeth in either or both the
arches. The force exerted by the boxes is varied, as
per the individual requirement, by varying the
diameter of the wire from which the auxiliary is
made, size of the boxes and acuteness of
the curvature.

Obviously, the auxiliaries generating


lighter forces are employed in the first and
second stages of treatment, while those
generating higher forces are meant for the
third stage and sometimes in the second
stage as a breaking mechanics
a. Two boxes on the upper central incisors
for lingual root torque after the teeth are
aligned

b. Two boxes on the in standing upper or


lower lateral incisors for labial root torque.

Jenner auxiliary two boxes on the


upper or lower canines with very
prominent roots. That is made up of
0.012 wire. Lingual root torque exerted
by the boxes reduces the prominence to
facilitate anterior retraction

d. SPEC design Reciprocal


torquing auxiliary it is employed when
two adjacent teeth require root torque in
opposite directions. One such example is
an in standing lateral incisor needing labial
root torque and the adjacent canine
needing lingual root torque. This auxiliary
is made of lighter 0.009 or 0.010 could be
used for controlling the root movements
during the first and second stages.
If needed in stage three it should be
made of 0.012.The box on the tooth
requiring labial root torque is placed incisal
to main wire, while the box on the other
tooth requiring lingual root torque sits
piggyback on the main wire .hence a
crossover bend is required between the

Som e other torquing auxiliary


designs
a. Single root torquing auxiliary proposed by
Dr.Kesling. This is a very useful design for
any tooth (excepting the molars) requiring
torque in the labial or the lingual direction.
It is particularly indicated on an UPPER
PREMOLAR , which needs buccal root
torque.
To
eliminate
the
cuspal
interference from its hanging palatal cusp.
It is convenient to place the long arm of
the auxiliary piggy back over the main
arch wire. Since the main arch wire may
not be untied it could also lie occlusal to
the base arch wire in the slot as well. The
long arm should extend to three to four
adjacent teeth when engaged in the

The long arm always faces mesially for the


premolar teeth. Depending on how the curvature is
pointing before the auxiliary is tied, the torque
generated will have lingual (palatal) or buccal root
moving effect.
For example, the auxiliary fitted with its convexity
facing upwards will have a buccal root torquing
effect on the upper premolars, but the effect will be
for lingual root torque on the lowers, and viceversa. The effect is transmitted by the vertical
extension of the auxiliary through the bracket pillar
onto the tooth; The long arm could face either
mesially or distally on the anterior teeth, and
action will depend on how the curvature of the long
arm relates to the base arch wire. This auxiliary is
made up of 0.012 size Premium Plus wire. The
force generated by it can be varied by changing
acuity of the curvature. More acute greater is the
force generated.

b. Reverse torquing auxiliary for controlling the roots

of canines or premolars proposed by Dr.Franciskus


Tan It was described for the labial root
movement of a palatally impacted maxillary
canine, whose crown has been aligned but the root
is still placed palatally and needs labial root torque.
If required for lingual root torque in other
situations it is simply inverted well on the
premolars made up of 0.012 P+ wire conjunction
with a 0.018 or 0.020 inserted in the molar tube
from the distal end. An offset is placed in the
auxiliary to bypass the main wire rotated by 1800
for activating it

c. Buccal root torque on the molars When


the upper molar crowns roll buccally
because of a lack of control during the
third stage, their roots must be torqued
buccally to lift their palatal hanging
cusps. It is made in 0.014 size and is
fitted in the round molar tubes alongside
the main arch wire. It has boot design
occlusal extensions on the molars, and it
is inserted from the mesial end of the
molar tubes. The boot portion is twisted
lingually and given a toe in, and the whole
auxiliary is suitable contracted.
The
auxiliary need not be engaged in other
brackets.
It can be ligated to the main
wire at 2-3 places on either side

d. Labial root torque only on the lateral incisors

This is made up of 0.012 size wire, and is placed


with the convexity of the auxiliary facing
gingivally. The auxiliary is engaged first in the
incisor brackets, and the main wire is then
engaged piggyback. The boxes extend labially on
the incisal area of the crowns. This design is
often required on the lower incisors in those cases
where the central incisors and the canines are
placed normally, and hence do not require
reciprocal lingual root torque

e. UDDER ARCH - The udder arch is made up of

0.16 S.S.wire. The vertical loops of the auxiliary


can be opened or closed as needed to assume
accurate fit. The distal ends of the auxiliary is tied
to the lower cuspid bracket. The vertical loops are
slipped behind the main arch wire and the
auxiliary is tided to one or two brackets to prevent
dislodgement. It is very easy to insert and remove.
This is used for the reverse torquing of the
mandibular incisors.

f. Kitchton torquing auxiliary - It is used


for applying torque force on the anterior teeth.
Kitchton auxiliary can be used with Begg,
edgewise and removable appliances. It is
made up of 0.016 Australian wire. Coils in the
midline assume gentle, and continuous torque
force and also provide means of attachment to
the main arch wire.
It is of two types :
1) Small
2) Large

* Small auxiliary delivers gentle lingual root torque


to the central incisors only. It can be used with
the Hawleys retainer for additional root torque.
Large auxiliary can deliver greater force to
the central incisor and can be adjusted to deliver
torquing force to the central and lateral incisors.
It an also be used with Hawley retainer for
additional root torque

Mouse trap
Mouse trap design is very efficient but
involves more time patience and skill

Torque in Tip-Edge
Appliance

Tip-Edge Appliance:
Kesling introduced these concepts in 1986. Tip
edge brackets are produced by removal of diagonally
opposed corners from edgewise slot to permit either
mesial or distal tip.

This was a preadjusted bracket slot.


MAX Torque 12 8 -4 -7 -7
MAD Torque -1 -1 -11 20 -20

12

In Tip Edge concepts, inclination of teeth except


anchor tooth are normally not controlled until
the final finishing stage. But exception for
earlier axial control would be
To correct Midline Discrepancy.
For effective Anchorage control
To prevent excess Tipping
During stageIII depends upon the necessity of
torquing action, Round wire ( 0.022 inch ) or
Rectangular wires ( 0.0215 * 0.028 inch ) are
used.
12

Round wire approach: (0.022 inch wire)


Patients who doesnot requires molar torque
Selective labiolingual root position of the tooth
In severe AP discrepancy to maintain the
compensating labiolingual inclinations.

Side-winder springs

12

Niti torquing Bars: They are formed in 18*22


with 30 torque.

They are invisible when placed in the slot because

it lies behind the main arch wire.


Characteristic of Tip edge bracket was presence of
Deep groove in the slot. During Stage 1 and 2 a cap fills
the deep groove. At the beginning of stage 3, the cap is
removed and torquing bar is ligated tightly in to the
deep groove under the round wire.
12

Standard Tip Edge

Grooved Edgewise Cap closed

Cap opened in stage 3

Kesling Root torquing Auxiliary: Individual root

torquing was effectively achieved except for molars.


It is made up of 0.016SS wire.

When inserted incisal, it delivers palatal root torque.


When inserted gingival, it delivers labial root torque.
In ceramic brackets because of the lack of Deep
groove in the slot, this auxiliary is effectively used.
12

Rectangular wire approach: (0.0215*0.028 )

Patients who required molar torque, canine and


mandibular incisor are candidate for rectangular
wire approach.

Deep bite
During stageI and stageII, as crowns are tipped to
the final position of the dental arches, Slot size will
also get increased. This permits passive engagement
of full size rectangular arch wire. Each tooth will
have either one point or no contact with the arch
wire. So the interbracket distance is from molar to
molar which yields light and long lasting torquing
forces

Torquing Features of Tip edge:

SELECTIVITY
LIMITATION
PHYSIOLOGIC

Advantages of this system: AJO 1998 Parkhouse

Independent torquing: Because the Side-Winder


springs do not cause clinically detectable twisting of the
heavy base arch wire, unwanted secondary torque
reactions to adjacent teeth are eliminated.
Light forces: An auxiliary spring is less likely to
generate excessive torque forces than an activated
rectangular arch wire.
13

Long activation span: Reactivation of the SideWinder spring is not normally found to be necessary.
However, additional activation may be required near
the completion of treatment, for a precise definition of
finishing torque angulation.
.

Single arch wire: All torquing can be accomplished


using one rectangular arch wire in each arch.
Adjustment of the arch wire is normally not required.
No lost torque: Because the bracket closes into
complete approximation with the arch wire, the exact
prescription is expressed without compensation being
necessary for free play.
13

Vari Simplex
Discipline:
0.018 inch SS slot was used instead of 0.022 inch SS
slot to have a better control of torque.
Bracket Torque was formulated after measuring
torque found in rectangular arch wire in finished 50
cases.
Max +14 +7 3 7 7 10 -10
Mand 5 5 7 11 17 22 -27
In Alexander Discipline Diamond Twin brackets were
used for upper incisors, Lang brackets for canine, Lewis
brackets for Premolars and mandibular incisors which
adds advantage of increased interbracket distance.

13

Diamond Twin Bracket

Lang Bracket

Lewis Bracket

13

Rectangular multistranded arch wire was used


from initial point of treatment itself.
-3 Torque in maxillary canine compared to 7
to +7 in Andrewss prescription eliminate the
need for adjusting torque through wire bending
during treatment.
-5 Lower incisors torque prevents labial
flaring of incisors.
When omega loop was used in mandibular 2 nd
molar, to prevent gingival impingement bend
was placed in the wire which automatically
incorporates torque. So additional torque was
not necessary in 2nd molar. .

13

B io-progressive therapy
The Standard Bioprogressive appliance was introduced in 1962.

Dental reaction to continuous arch wire


Max 22 14 7 0 0 -10 -10
Mand 0 0 7 0 -14 -22 -32
13

This system was based on sectional arch treatment


in which the buccal segments are handled
separately from the incisors for better torque
control. It includes all cases whether nonextraction, or extraction treatment.
Torque control throughout treatment is one of
the basic principle of this technique. The Full
Torque Bioprogressive appliance adds additional
torque to the original Standard Bioprogressive
setup to over torque the tooth at the time of band
removal to settle in to functional occlusion.
13

In this technique the lower first molar is


rotated disto-lingually, tipped distally, expanded,
and torqued (buccal root torque) so that the roots
come to lie beneath the adjacent buccal cortical
bone. This is called as cortical anchorage. This
is an area that exhibits a greater bone density
because of the external oblique line of the
mandible and decreased vascularity. By placing
the roots of the lower first molar adjacent to the
more dense cortical bone, anchorage is believed to
be enhanced, thereby minimizing movement of
the molar teeth. So Torque value of 27 in molar is
used.

13

Upper buccal segment should have 10 of buccal


root torque to compensate for the occlusogingival
curvature of the crowns of these teeth.
The lower molar cannot differentiate between
buccal root and lingual crown torque ,when a 45
buccal root torque is placed on the distal legs of
the utility arch. The only way that buccal root
torque can be expressed by buccal movement of
the root and stabilization of the crown is by
expansion of the arch. This is not only for cortical
bone support to the lower molar (anchorage) but
also for regulating or allowing normal arch width.
13

Utility arch is designed to avoid contact on


cortical bone on the lingual surface of the lower
incisor roots during their intrusion by placing 15-20
buccal root torque
Cuspid Torque: +70
There is a mechanical tendency to detorque the
upper cuspids as they are retracted in extraction
cases. Because the dense cortical plate surrounding
the upper cuspids is particularly corrugated
(especially in adults), it is difficult to retract the
cuspids without impacting the root on the labial
plate. It is mechanically more efficient to keep the
root of the cuspid in the cortical trough when moving
it distally when using +70 torque. .
13

Parkhouse in AJO 1998 evaluated


bioproggresive therapy and tweed appliance result and
stability after 5 years of post retention. The result
showed both cause molar extrusion and are stable.
Incisor intrusion was more and clinically significant in
bioprogressive theraphy
Elizabeth and Bernard AJO 1998 done a
comparative study of anchorage in bioprogressive
versus standard edgewise treatment in Class II
correction with Class II Elastics and showed cortical
anchorage did not resist the side effects of Class II
elastics more effectively than standard edgewise
anchorage preparation.
14

Torque control in lingual


orthodontics

Torque controlin lingual


orthodontics
Decreased arch radius, decreased interbracket

distance, compound lingual geometry, highly


variable tooth morphology, and limited access and
visibility all combine to make accurate torque
control exceedingly difficult with a lingual
appliance.
Early torque control becomes more important with
lingual brackets, because minor differences in
labiolingual long axis inclinations of the incisors will
show up as apparent height differences.
It can be disconcerting when a patient complains
that incisor alignment is getting worse,

The TARG (Torque and

Angulation Reference
Guide) instrumentation is
designed to transfer bracket
prescriptions from the more
reliable labial surfaces of
each tooth to the lingual at
a given bracket height.
This is in effect a method of
doing a diagnostic set-up
without sectioning the
model, and it allows the
laboratory technician to set
customized torque and
angulations for each
individual prescription.
.

For example, a Class II, division 2 case

requiring additional torque in the


maxillary anteriors is so noted on the
prescription.
The technician then "dials" in the
prescribed torque on the TARG, locating
the lingual bracket at an increased torque
angle from the averaged bracket values.
The fit of the lingual bracket base is then
compensated for with the Advance
adhesive.

Torquing of maxillary

and mandibular
anterior teeth requires
special consideration.
The first is the use of a
torquing auxiliary like
the ones used in
conventional Begg
mechanotherapy where
the application of force
on the tooth is at the
incisal edge.

The second is the use of a

torqued ribbon arch. It


provides approximately 45
degrees of torque for the
mandibular anterior teeth
and 30 degrees for the
maxillary anterior teeth.
When the ribbon arch
passes the cuspid-bicuspid
inset, it will naturally
transition to approximately
90 degrees for the buccal
segments.

Beta titanium, stainless steel, and Elgiloy

rectangular wire may also be very useful for


this purpose.
Hocevar has stated that the use of the
ribbon arch is effective for torquing of
maxillary anterior teeth, and it has the
advantage of being more gentle in the
buccolingual directions, a very important
advantage with lingual orthodontic
treatment.

Torquing With Removable


Appliances

Torquing W ith Rem ovable


Appliances
Many simple malocclusions can be treated with

removable appliances; but, since removable


appliances are only capable of tipping crowns, it
has not been possible to torque roots, particularly
in cases with spacing of anterior teeth. In these
cases, spaces can be closed effectively with
removable appliances, but the anterior teeth have
labial root prominence at the end of treatment.
To avoid this problem and the need for a fixed
appliance to correct it, a new technique was
developed for root tipping of anterior teeth with
removable appliances

A removable appliance is

constructed in a conventional
manner, with Adams clasps on first
permanent molars and triangular
clasps between first and second
premolars, for additional anchorage
and to combat leverage in the
anterior region.

The labial bow was made

with 0.7mm Dentaurum


wire. After curing the
plastic, the midline of the
labial bow was marked
with a fine file. A small
(0.6mm) wire lug was
soldered gingivally to
this mark, taking care
not to anneal the labial
wire.

A torquing spring of 0.4mm

spring wire was constructed by


winding the wire
Winding must be started from the
central lug. The finished loops are
lingually inclined. The distal ends
of the loops are not soldered or
welded to the labial bow. Force is
generated from the central lug,
which resists the activation of the
loops.
When the appliance is placed in
the mouth, the loops exert
pressure on the cervical third of
the crown. The tip of the crown is
prevented from coming labially by
the labial bow. Thus, movement is
restricted to lingual root tipping.

Torque considerations in adults


A routine torque by conventional edgewise arches

is not always the recommended method.


In the anterior region of the adult teeth the lingual
and labial cortical plates are frequently thin and
dense. if the movement of the teeth is not
performed carefully the apices of the teeth may be
forced against the dense alveolar bone with the
shortening of the root as result of resorption.
A second important point is that the center of
resistance varies with alveolar bone height. The
movement of teeth in adults with alveolar bone loss
will be different than in adolescents.

A thin arch is preferable for torque

movement in adults.
Light wire torque may also lead to root
resorption if the force is acting for a long
period.
In order to avoid root resorption the best
technical solution would be to apply light
torquing forces that acts interruptedly
over a fairly short distance.

CEPHALOMETRIC NORMS FOR TORQUE

With the advent of ceph head films many ceph analyses were
developed in an attempt to more objectively define the direction of
treatment.
Dental and skeletal normals were established for general populations
in certain analyses such as Tweed, Downs, Steiners etc
Problems associated with these:
i) Assumption was made that if dental and skeletal values were
normal
face would also be normal.
ii) Normals were obtained from patient samples with
malocclusions.
iii) Position of dentition was related to cranial base structures
which showed significant variability of position in patients with
more severe facial disharmony.
Arnett and Bergman (1993) drew attention to shortcomings of the
cranial base for facial planning with their two part paper.
Arnett et al (1999) suggested a method of STCA and STCP. This
new analysis was based on the true vertical line (TVL).

Incisor torque norms acc. To Dr Arnett


Upper Incisor
F: 57 2.5 M: 58 3

Lower Incisor
F: 64 3.2 M: 64 4

Why use maxillary and mandibular OP??


Incisor measurements to distant landmarks such an Sella Nasion, FH
plane , A-Po line may produce misleading measurements.
Mandibular and palatal planes themselves are altered by surgical
procedures so these are not good references for surgical cases.