Edge wise technique 1 /certified fixed orthodontic courses by Indian dental academy

The Edgewise The Edgewise appliance-evolution & appliance-evolution &

techniquetechnique

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INDIAN DENTAL ACADEMY

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Contents :-

Evolution / Historical perspective

1) Bandelette appliance

2) Angle’s E–arch

3) Pin &Tube appliance

4) Ribbon arch appliance

5) Edgewise appliance

Attachments

Modification of edgewise brackets

Evolution of buccal tube

Bracket placement &angulation


Evolution of the technique -Primary edgewise -Secondary edgewise -Tertiary edgewise Tweed’s philosophy of treatmentGrowth trendsDiagnostic facial triangle Cephalogram or headplate correctionTreatment objectivesAnchorage preparationIdeal arch formThree orders of tooth movementGeneral plan of treatmentMerrifield’s modification


Evolution of applianceFirst attempt at tooth movement in1728 by a French physician

Pierre Fauchard

Bandalette appliance-crude alignment of teeth by expansion of the dental arches

Disadvantage : lacked stability

no effective means of firmly fixing it in position


1841-Schange introduced screw force

1849-Dwinelle developed jack screw

1871-Magil introduced dental cements to attach bands on teeth

1866-Kingsley advocated the use of extraoral forces

No attempt was made to correct malocclusion by placing teeth

in a stable soft tissue environment

Angle believed that teeth when moved into their correct

occlusal relationship, stability would be assumed.


The E arch appliance(1880)

First typical orthodontic fixed appliance

Rigid framework –Molar bands with heavy labial arch wire soldered to them,

Teeth tied to it by means of brass ligature wire

Crown movement & simple anchorage

Teeth were expanded into normal occlusion


4 different designs:

Basic E-arch Ribbed E-arch E-arch without threaded ends that fit into molar sheaths,

used with an attached ball for high pull head gear in the incisor area

E-arch with hooks for intermaxillary elastics Also had maxillo mandibular growth guidanceDisadvantages :1) correction of axial inclination could not be accomplished 2)long term retention was required



The Pin &Tube appliance(1912)

Ideal arch of E-arch was not there Arches were altered as tooth

movement carried out progressing towards ideal archform

Bands with tubes soldered on it Pins soldered on the archwire &

made to fit into tube perfectlyChange position of pin ,solder it

again on archwire to a different position & fit into the tube again

Disadvantage:difficult to solder & unsolder pins time consuming


Ribbon arch appliance (1915)

To overcome disadvantage of pin & tube

Brackets with vertical slot introduced Archwire initially confirmed to

malocclusion ,held in place by brass pins

Rectangular wire with longer dimension vertical

Overcame 2 major problems: 1) archwire placement 2) M-D movement of teeth

Teeth were free to move along the

archwire like strings of beadswww.indiandentalacademy.com

Teeth could tip M-D, even with lockpins

Angle devised cleats to be soldered to archwire to contact the sides of the bracket

Held the teeth upright, but necessitates soldering new cleats at different locations

Disadvantage:-relatively poor root control

-mesial & distal tipping bends could not

be incorporated

-enmass movement of teeth in an antero-

posterior direction was not easy


The Edgewise appliance(1925)

Solution to all problems –latest & best in orthodontic mechanism

Changed the form of bracket located the slot in the center & placed it in a horizontal plane instead of a verticalBracket wide mesio-distally Rectangular slot for rectangular archwire .022x.028 slot size, same size wire Archwire inserted in narrowest

dimension -EDGEWISE Initially called open face or tie bracketsArchwire held with brass ligature & S-S

ligature later www.indiandentalacademy.com

Types of headgear used

High pull :- intrusion of maxillary incisors increase the lingual root torque used with cl.II elasticsIntermediate pull headgear :- distalise maxillary dentition when bite is not deep hold the maxilla during anchorage preparation Low pull headgear :- open bite case support mandibular dental arch in older patientsThe Kloehn cervical gear :- growth trend is type A or C restricting the maxillary growth so that the mandible can catch up


ATTACHMENTSEvolution of edgewise

brackets Original bracket – soft gold , .022

x .028 inch slot 1)Single width brackets original bracket .050 inch

wide & soldered to the gold band material

archwire rests on bottom of bracket slot instead of the band

ineffective for tooth rotation because of the narrow width

Angle devised gold eyelets to be soldered on bands


2)Twin brackets- two brackets on one base -“Siamese twin brackets” by Swain - space between two brackets was .050 inch (equal to width of one

bracket )Main advantage :- ability to effect tooth rotations without using auxiliaries Available in different widths:- Extra wide Standard Intermediate Junior


3)Curved base twin bracket

curved bases to confirm to the curvatures of the canines & premolars

Advantages of twin brackets :

Offers a positive control

Disadvantages:

increased width decreases the inter bracket span, thus decreasing the resiliency


4)Lewis bracketDeveloped by Lewis in 1950.To overcome the problem of

efficient tooth rotation.He soldered auxillary rotation

arms that abutted against the bracket itself, thus, offered a lever arm to deflect the archwire & rotate the tooth.

One piece bracket with integral rotation wings

These wings do not interfere with occlusogingival deflections of archwire & do not decrease the interbracket span


5)Curved base Lewis bracket

Curved base confirms to the canine, premolar surface

Wings lie close to the tooth throughout their length ,so less trapping of food




6)Vertical slot Lewis bracket Incorporation of .020 x .020 inch vertical slot Possible to use uprighting spring to correct axial inclinations if

neededAdvantages of Lewis brackets: 1) complete rotational control 2)do not reduce the interbracket span


7) Steiner bracket

Given by Cecil C Steiner in 1931

Incorporated flexible rotation arms & so did not rely on the resiliency of the archwire for tooth rotation

Introduced tie wings for ease of ligation

8)Broussard bracket

Designed by Garford Broussard for use in the Broussard technique

Addition of a 0.0185 x 0.046 inch vertical slot to accept a doubled 0.018 inch auxillary wire






Evolution of edgewise buccal tube

Original appliance had .022x .028 inch gold or nickel silver tubing soldered to the molar band

Length –3/16 or ¼ inch

Notched distal ends - to facilitate a tie back ligature

Hook – gingival to buccal tubes, soldered on the bands for placement of elastics

Inconel tube - gold buccal tubes were discarded

Stamped buccal tube with welding flanges or

Inconel tube which could be soldered to the band



Combination buccal tubes Incorporates a round tube for

insertion of a face bow Fairly close tolerances must be

maintained between archwire & tube for effective transmission of torque to the tooth

Triple buccal tube additional rectangular tube for

auxillary sectional & base archwire





Bracket & tube placement

Angle - “goal of correct bracket & tube placement is to produce an ideal occlusion at the end of treatment with flat, straight, ideal archwires

Tweed advocates – millimeter measurement from bracket slot to the incisal edge

UPPER ARCH LOWER ARCH

Centrals –4.5 Anteriors-4.0Laterals –4.0 Canines-4.5 Canines –5.0 Premolars-5.0Premolars-4.5 Molars-4.0Molars –3.5



Bracket angulation

Brackets –parallel to the long axis of the tooth

Holdaway (1952) described three uses for bracket angulation

a) as an aid in paralleling roots adjacent to extraction spaces

b) as a method of setting up posterior anchorage units into tipped back or anchorage prepared positions

c) as a means of obtaining correct axial inclinations or artistic positioning




Armamentarium















Ligature locking and tying plier in place and ready for tying


Evolution of technique� Primary edgewise� � *as described by Angle in 1929� *fully banded technique-gold bands ,soldered soft brackets� *flat ideal arch wire -to provide normal occlusion� *original arch was of .022 X .028 inch gold wire� *to be adapted passively to all malocclusion� *if space had to be made, loops are soldered onto main arch� *if space closure required, spurs & tie backs used� *involves all the teeth to be brought under control so,

treatment should be initiated after eruption of canine & premolar



� Angle stated that "malocclusion must be treated as though the denture is a self-sustaining, self maintaining unit and all parts of denture exerting or sustaining forces must be perfectly balanced”

� 1) fully normal proximal contact relations of teeth� 2) normal cusp & inclined plane relation � 3) normal upright axial position & relation of teeth � this is essential if the teeth are to balance� with the muscles & sustain the forces of � occlusion


Angle introduced the bracket 2 yrs. before his death.Proposed nonextraction treatment for all malocclusion Expansion of the dentition – method of teeth alignmentMuscular balance was upset, teeth were moved to an unstable

positions-------high frequency of relapse Little attention to establishment of anchorage


� Secondary edgewise

� *to avoid the making archwires passive � *use of round wires in the initial stages� *gold was replaced by a more rigid alloy� *frequency of extractions increased� *bands with prewelded brackets � *in 1940s round .045in.tubes were also soldered on � the upper molars for a face bow



� Tertiary edgewise or Tweed’s edgewise

� *stressed on the importance of anchorage � preparation � *advocated the use of cl. III elastics & extraoral � traction� *vigorous forces were now employed� *space closure was done by simple vertical or � horizontal open loops bent into the archwire or by � push coil tie -backs


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Edge wise technique 1 /certified fixed orthodontic courses by Indian dental academy