The Roth Prescription

Functional Occlusion
Roths treatment mechanics

Functional Occlusion
Increasing awareness and fear
Roths interests
Belief that functional dynamics of occlusion imp. for
stability
To prove that no harm was being done to his pts.
To disprove that PM extractions could cause TMD

The Roth Rx

Dr. Punit Thawani

Functional Occlusion
Equilibration
Time consuming and difficult
Only possible if there are minor problems
Jaws had to have stable relation i.e.. after growth.
More important to straighten teeth better.

The Roth Rx

Dr. Punit Thawani

Functional Occlusion
SIX KEYS of Occlusion, with the mandible in
CENTRIC RELATION

The Roth Rx

Dr. Punit Thawani

Functional Occlusion
The condyles should be seated superior and
anterior in the fossae against the articular disks
and the distal slope of the articular eminence,
and centered transversely.
Electromyographic study by Williamson

The Roth Rx

Dr. Punit Thawani

Functional Occlusion

Incisors in Class I occlusion

4 mm overbite
2-3mm overjet at incisors
1mm overjet at canines
U Canine cusp tip below occl. plane at level of
contact point b/w L3 & 4/5
U canine, slightly mesial axial incliation, so that it
touches disto incisal slope of L canine
The Roth Rx

Dr. Punit Thawani

Functional Occlusion

The Roth Rx

Dr. Punit Thawani

Functional Occlusion
Signs that mand. is not in centric

Occlusal wear
Excessive tooth mobility
TMJ sounds
Limitation of mouth opening
Myofacial pain
Tightness of mandibular musculature

The Roth Rx

Dr. Punit Thawani

Functional Occlusion
Important to diagnose a patient from centric
Guide mandible into centric, and check for first
tooth contact
Articulator mounting may be necessary.
Splint therapy may be needed.

The Roth Rx

Dr. Punit Thawani

Functional Occlusion
Once mandible is stabilized in centric, Rx
planning can begin.
If large difference, ceph should be taken in
centric, or adjusted accodingly.
Jarabak ceph analysis and Ricketts VTO

The Roth Rx

Dr. Punit Thawani

Functional Occlusion
Anatomic articulator mounting/SAM articulator

The Roth Rx

Dr. Punit Thawani

Functional Occlusion
CO

CR

CR after equilibration of cast

The Roth Rx

Dr. Punit Thawani

Functional Occlusion

Repositioning of the mandible on the tracing

The Roth Rx

Dr. Punit Thawani

Gnathological Objectives
3 parts
1. On normal closure in centric relation
2. Protrusive movement
3. Lateral movement

The Roth Rx

Dr. Punit Thawani

Gnathological Objectives
On closure in centric
Class I occlusion at centric
Simultaneous contact of all posterior teeth with
force directed down the long axis of the posterior
teeth
0.005 clearance of anteriors

CO = CR
The Roth Rx

Dr. Punit Thawani

Gnathological Objectives
Protrusive movement.
Anteriors must gently
disocclude postriors
Sufficient overjet and bite
Occlusion U 6 ant with L
ant and 1st PM
14 teeth bear the stress

Mutually protected
occlusion
The Roth Rx

Dr. Punit Thawani

Gnathological Objectives
On lateral excursions
Cuspids main guiding
inclines
U canine cusp tips ride
on disto-incisal incline of
L canine.
All other teeth lifted out of
occlusion
Cuspid Guidance
The Roth Rx

Dr. Punit Thawani

The Roth Prescription

Too many brackets in Andrews prescription
Translation friction
Roth did not translate teeth
Overcorrection
Wanted 1 prescription for all his patients.

The Roth Rx

Dr. Punit Thawani

The Roth Prescription

5o more torque in upper incisors,
Less torque in upper canines
2o more tip in canines
2o anti-rotation in canines and PMs
Upright posterior segments
Over-correction of U molar offset and torque
The Roth Rx

Dr. Punit Thawani

The Roth Prescription

Lower posteriors
3o distal tip
Distal rotation

The Roth Rx

Dr. Punit Thawani

The Roth Prescription

Also available
Molar tubes with no upper molar offset
Super torque anterior brackets
Canines with 0o tip

The Roth Rx

Dr. Punit Thawani

The Roth Prescription

Tooth

II molar I Molar

II PM

I PM

Canine

Lateral

Central

Maxillary

5/-9
(10o
offset)

5/-9
(10o
offset)

2/-7

2/-7

11/-7

9/8

5/12

Mand.

2/-35
4o offset

2/-35
4o offset

2/-22

2/-17

5/-11

2/-1

2/-1

The Roth Rx

Dr. Punit Thawani

The Roth Prescription

Bracket placement as advocated by Andrews
except
Upper anteriors and lower incisors bonded more
incisally
Lower canines bonded slightly more gingivally

The Roth Rx

Dr. Punit Thawani

The Roth Prescription

Archform Tru Arch
Flatter anteriorly
Sharp curve in Canine PM
region
Gentle curve at post. legs.

The Roth Rx

Dr. Punit Thawani

The Roth Prescription

Roth

Andrews

The Roth Rx

Dr. Punit Thawani

The Roth Prescription

Large amount of overcorrection because
1. Brackets do not express themselves play
2. Before complete expression force levels drop
3. Tendency of teeth to relapse

The Roth Rx

Dr. Punit Thawani

The Roth Prescription

Roths treatment mechanics

Treatment Objectives
1. Correction of Crossbites
2. Correction of jaw relations
3. Eliminate severe crowding
4. Create space in the arch for severely
malposed/impaced teeth
5. Alignment of teeth in the individual arches

The Roth Rx

Dr. Punit Thawani

Treatment Objectives
6. Begin space closure
7. Finish the lower arch
8. Achieve class I relationship of the buccal
segments
9. Retract and intrude maxillary anterior teeth.
10. finishing and detailing

The Roth Rx

Dr. Punit Thawani

Treatment Mechanics
3 phases
1. Unlocking phase
2. Working phase
3. Finishing phase

The Roth Rx

Dr. Punit Thawani

Unlocking Phase
Major corrections
Cross bites
Severely malposed teeth

Use of RME, Quadhelix, Bimetric arches, Utility

arches
Jarabak style loops in light wire
Braided wires

The Roth Rx

Dr. Punit Thawani

Unlocking Phase

Jarabak light wire loops

The Roth Rx

Dr. Punit Thawani

Unlocking Phase
Main objective
Gross corrections
Aligment with flexible wires so that heavier
wires can be used later

The Roth Rx

Dr. Punit Thawani

Working phase
Closure of extraction site
Correct a-p jaw relation and
dental relation
Intrusion, if required
Space closure with double
keyhole loop
Usu 19x26 mil rounded edge
rectangular wire
The Roth Rx

Dr. Punit Thawani

Working phase
Double keyhole loop
Space closure with 1 wire
Medium between tipping and translation
Permit either ant. retraction or post. protraction
Control of canine rotation
Used as elastic hooks.

The Roth Rx

Dr. Punit Thawani

Working phase
Asher face bow for retracting anteriors en
masse. 12 15 oz of force for upper ant.

The Roth Rx

Dr. Punit Thawani

Working phase

The Roth Rx

Dr. Punit Thawani

Working phase
Upper wire with gable bend distal to canine and
COS
To protract posteriors cinch back keyhole loops
discontinue Headgear

The Roth Rx

Dr. Punit Thawani

Working phase
Some tipping occurs after space closure
18x25 blue Elgiloy - COS
0.018 steel
16 x 22 yellow Elgiloy 2 turn helix

The Roth Rx

Dr. Punit Thawani

Working phase

The Roth Rx

Dr. Punit Thawani

Working phase
After uprighting
21 x 25 ss wire with only archform and no COS
Occationally 22 x 28 ss wire

The Roth Rx

Dr. Punit Thawani

Working phase
High angle cases
Avoid heavy wires max use of Nitinol and TMA and
braided wires
Space closure on 0.016 SS wire
Uprighting with 19x25 TMA/Nitinol/braided wire

The Roth Rx

Dr. Punit Thawani

Working phase
Bimax cases
Initial space closure with 0.018 or 0.020 wire with
double keyhole loops
Once teeth are upright intrude with Utility arch
Continue space closure with 19x26 double keyhole
loops and Asher face bow

The Roth Rx

Dr. Punit Thawani

Working phase
Maximum retraction and torque control
21 x 25 SS or Elgiloy double keyhole loops
Maximum torque control
Reduce posterior ends

The Roth Rx

Dr. Punit Thawani

Finishing Phase
Place full sized wires and let brackets express
Drop to braided settling elastics
Short Class IIs - minimum extrusion.?

The Roth Rx

Dr. Punit Thawani

Case report Bimax.

The Roth Rx

Dr. Punit Thawani

Pretreatment

The Roth Rx

Dr. Punit Thawani

Retraction

The Roth Rx

Dr. Punit Thawani

After Space Closure

The Roth Rx

Dr. Punit Thawani

Post Treatment

The Roth Rx

Dr. Punit Thawani

Post Treatment

The Roth Rx

Dr. Punit Thawani

Anchorage considerations
Factors that result in mesial migration of molars

Heavy wires for leveling COS

Attempts to gain rapid alignment with heavy

wires

Uprighting distally tipped canines

Lingual root torque of max. incisors

Arch expansion with labial archwire

Retracting extremely procumbent anterior teeth

The Roth Rx

Dr. Punit Thawani

Anchorage considerations
Procumbent teeth offer a lot of anchorage
One teeth are upright, they retract easily.
Space closure can be done on any wire, as long
as it is done slowly.

The Roth Rx

Dr. Punit Thawani

Anchorage considerations
Initial alignment on light wires
0.015 Coaxial wire then 0.017/0.019 Coaxial wire
Heavier wires (esp with COS tend to procline teeth)

For leveling COS where do incisors need to be?

Intrusion with - 19 square Utility arch
Then go to continuous wire

The Roth Rx

Dr. Punit Thawani

Minimal use of HG
1. Leveling on light wires usually Coaxial
2. If procumbent incisors upright with HG
6-8 weeks with HG then reciprocal space closure

3. Band 2nd molars from the beginning

4. Intrude the incisors to level the COS

The Roth Rx

Dr. Punit Thawani

Expansion with archwire

The Roth Rx

Dr. Punit Thawani

Expansion with the Quadhelix

Quadhelix can be used to correct molar rotation
Mild buccal expansion
Buccinator mechanism and buccal musculature
retract the 1st molars ----- ???
Truncated cone effect - used in Crozat appliance

The Roth Rx

Dr. Punit Thawani

Minimal use of HG

0.015 Coaxial
0.019 Coaxial

The Roth Rx

Dr. Punit Thawani

Minimal use of HG

0.020 double keyhole loops

Extends up to 1st molar

19x26 double keyhole loops

The Roth Rx

Dr. Punit Thawani

Minimal use of HG

Deep COS by end of Space Closure

19 x 19 Utility arch
Incisor intrusion 3 months
Intrusion of canine
1 month

The Roth Rx

Dr. Punit Thawani

Minimal use of HG

Braided wire for alignment

21x25 NiTi then SS

The Roth Rx

Dr. Punit Thawani

Upper arch
Upper arch treatment slightly behind the lower
arch
When lower arch is in 21 x 25 SS and upper in
braided start short Class II elastics
Go to 21 x 25 SS in upper continue elastics
Settling with 21 x 25 braided wire.

The Roth Rx

Dr. Punit Thawani

 Mandible is in centric importance to TMJ

Incorporation of different mechanics
Use of HG to anterior teeth for minimal amount
of time
Light wires for initial alignment, to prevent
proclination of incisors
The Roth Rx

Dr. Punit Thawani

References
Orthodontics Current Principles and
Techniques
Graber and Swain

Orthodontics Current Principles and

Techniques
Graber and Vanarsdall

The Straight-Wire Appliance - 17 Years Later

Roth JCO Sep 1987

The Roth Rx

Dr. Punit Thawani