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In-Ovation® R & C InteractiveSelf-Ligating Orthodontic BracketsLow Friction Self-Ligating Brackets with High Prescription Control
White Paper byDr. Luis Nelson Núñez
Luis Nelson Núñez, DDSDr. Núñez graduated from the University of the Eastern Republic of Uruguay in 1996. He taught as an assistant professor at the Orthodontic and Dento-facial Orthopaedic Department at the same University for 10 years. He has taken several postgraduate courses at UDELAR, given by instructors within the Orthodontics Department and visiting faculty. He completed the CCO 1 Uruguay course at the Roth Williams Center for functional occlusion, given by Drs. Ronald Roth, Robert Williams, Anka Sapunar, and national instructors. He is currently Director of the Dentsply GAC International Continuous Orthodontics Education Program for Latin America. He is a member of the Uruguayan Dental Association, the Latin American Orthodontists Association, and the World Federation of Orthodontists. He has given numerous conferences and short courses at the national and international levels. He owns a private practice in Montevideo, Uruguay.
Private practice in Magariños Cervantes 1363 ap. 104, Montevideo – Uruguay.Tel. fax: 598 (2) 628 5654E-mail: [email protected]: www.clinicadeortodoncia.com.uy
Dr. Núñez Biography . . . . . . . . . . . . . . . . . . . . .
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Description and Characteristics of In-Ovation R . . . . . . 1
Description and Characteristics of In-Ovation C . . . . . . 2
Concepts of Friction and Archwires Used . . . . . . . . . 3
Archwires Used . . . . . . . . . . . . . . . . . . . . . . . .4
Concepts of Superleastic Archwires . . . . . . . . . . . . 5
Friction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
Anchorage . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
Clinical Case . . . . . . . . . . . . . . . . . . . . . . . . .7-11
Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . 10
List of Products in the in-Ovation System . . . . . . . . 12
References . . . . . . . . . . . . . . . . . . . . . . . . . . 13
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(active), by in my opinion, interac-tive more appropriately represents this category. Passive brackets are those in which the closing clip never pressurizes or pushes the archwire towards the end of the slot; the clip may be rigid or flexible. Interactive brackets utilize clips that are able to flex and interact with archwires to correct the teeth’s position. The clip on an interactive bracket fits inside the slot and pushes the archwires towards the base of the slot.
In-Ovation RIn-Ovation R (reduced size) surged in 2002. Designed by Dr. John Voudouris with the help of Dr. Ron Roth*, it is a True Straight Wire twin bracket with a cobalt chromium interactive clip that turns it into a self-ligating bracket. In order to really be a Straight Wire bracket, it must be prepared via MIM or molten metal. This
IntroductionSince the beginning of the edgewise archwire technique in 1915 Dr. Angle designed a bracket with a pin going through the gingival and incisal flange, thus closing the slot. A few years later, in the 1930’s, a bracket designed by Dr. Stolzemberg was released, and new designs followed in the 1970’s, however they were not popular due to lack of clinical and commercial success. The self-ligating brackets boom surged again in the 1990’s with the appearance of Time in 1994, Damon SL in 1996, and Twinlock in 1998.
It could be said that this time self-ligating brackets became another of the big advances or paradigms of our discipline. Self-li-gation is typically categorized into two types, passive or interactive. Some believe in a third category
In-Ovation® R & C Interactive Self-Ligating Orthodontic BracketsLow Friction Self-Ligating Brackets with High Prescription ControlDr. Luis Nelson Núñez
Fig. 1: In-Ovation R
Clip opensfrom gingival to incisal or occlusal.
Fig. 2: In-Ovation R
Mesial, distal and incisal/occlusal beveled slot. These beveled walls are veryeffective avoiding possible binding and notching of the archwire.
The gingival wall is .0185” deep in its mesial and distal extremities, the centre has bigger depth. The incisal wall is .028” deep.
In the centre the gingival wall shows the slotblocker This provides the correct depth in order to take advantage of thefinal archwires presence and express theprescription torque.
allows for all required attributes of a True Straight Wire bracket to be present:• Compound Contour Base (me-
sial-distal and gingival-occlusal contours)
• Torque in base (not in the slot)• Proper in/out and anti-rotation• Level slot alignment at the con-
clusion of appliance therapy
Characteristics:• CO-CR metallic clip Twin brack-
et, able to twist and interact with the archwire
• MIM manufactured• Torque in base• .022”x.028” or .018”x.025” slot• Base Rx* prescription and many
more• It is BioInteractive• Single mesh base• Identification on the base and
distal gingival wing• Laser welded hooks• Excellent surface finish
*Dentsply Sirona Orthodontics Base Rx has prescription values that are equivalent to the Roth prescription. ROTH is a registered trademark of Roth Licensing, LLC. All rights reserved.
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Fig. 3: In-Ovation R
PASSIVE
Fig. 3 - In this view it is possible to see the torque in base of In-Ovation R. This type of torque is extremely important for the self-ligating brackets considering that once leveled and aligned the slots must be parallel with the other slots without difference in angulations.
It shows the functioning of the bracket and clip in different archwire sections. From left to right we see passive, expressive
EXPRESSIVE
ACTIVE
and active. These images clearly illustrate why it is referred to as interactive technology. The clip conforms (interacts) to different shapes and sizes of the archwire, tooth position, and moment in treatment.
Opening and closing the clip on In-Ovation R brackets requires a simple gingival to occlusal motion. There are a number of instruments available to open a clip. My prefer-ence is the Engage-R.
The clip opens easily when pressure is applied occlusally to the V notched clip at the gingival side of the bracket, using the Engage-R or similar instrument.
If unable to access the gingival V notched clip you can also utilize the Opin-R notch on the facial surface of the clip by applying gentle pressure occlusally with a mini scaler.
The clip can be closed with an instrument, or simple finger pressure on the incisal curve.
The primary method for opening and closing the clip is the V notched clip.
In-Ovation CIn-Ovation C is an Injection Molded (IM) produced polycrystalline ceramic twin bracket. It is translu-cent, thus enabling blending with the tooth color on which it is attached. (Fig. 4)
Characteristics: • Torque-in-base, compound con-
tour base• Rhodium covered cobalt chro-
mium clip that makes the metal shine whitish and opaque
• 100% mechanical macro-re-tention base at the sides and a frame on all the peripheral that goes over the tooth, preventing marginal infiltration and facili-tating removal. It has no silane.
• Mesial and distal rounded hooks that make the bracket more re-sistant
• Tooth specific colorimetric Ova-tion identification
• Mesial, distal and incisal beveled slot just like in In-Ovation R
Fig. 4: In-Ovation C
Opened Clip
Macro-retention at the sides
Removal bevel
Little ball to open the clip
3Fig. 5
At the end of 2007, superelastic Sentalloy® and BioForce® rhodium-covered archwires were launched in the market. These, just like In-Ovation C clips, are whitish and opaque, preventing light reflection and boosting aesthetics. They are called Sentalloy and BioForce High Esthetic. These archwires offer big advantage over conventional aesthetics with epoxy resin or Teflon cover as they are not changed by buccal conditions.
To remove this ceramic bracket, the ODG-346 RT plier is recommended. To use, place the debonding instrument in the debonding channels, occlusal gingivally and squeeze. Torquing of bracket is not indicated in debonding procedure. (Fig. 5)
The sharp pliers’ edges will thus be placed at the tooth-bracket interface, having previously removed excess resin with a multi-edge drill. Tweezers can be placed in mesio-distal, gingival–occlusal, or diagonal direction, as it suits the professional.
Clinical Suggestions:• The necessary composite to at-
tach these metallic single mesh or ceramic brackets must be
orthodontic, in other words, it must have adequate consisten-cy and fluency to penetrate the retention and at the same time allow placing the bracket on the face of the tooth without sliding. GAC recommends NeoBond® by GAC.
• Bond the In-Ovation R brackets with the clip closed. This way, 3 references should coincide with the tooth longitudinal axis; the gingival notch of the clip, the vertical line at the gingival part of the base and the vertical line at the incisal part of the base. In-Ovation C brackets can be at-tached with the clip opened in order to rely on the colored rub-ber bar references in the slots and make for more accurate placement.
• Avoid excess composite to the gingival and incisal so as not to impede the opening of the clip.
• Once attached, it is not recom-mended to open with an ex-plorer from the face of the clip because it can be permanently deformed if the force is exces-sive. This method should be re-served for cases only where the notch is inaccessible due to gin-gival inflammation.
• Ensure the wire is properly seat-ed in the slot before closing the clip.
• Like all self-ligating brackets, its action will be limited if the pa-tient does not maintain good oral hygiene. Scaling or etching may be utilized to clear up clip functionality in these cases.
Concepts of Friction and Archwires UsedWhen talking about self-ligating brackets we immediately think of the low archwire sliding resistance
inside the slot. Thus they have low archwire - bracket friction coefficient which provides many treatment advantages. Friction reduction is enabled by three factors: alloys that integrate brackets and archwires, the lack of need for elastomeric or steel ligatures, and a more gentle archwire path when there is overcrowding without causing permanent deformity and greater inter bracket distance that may act in favor or against as we shall see.
Each of these factors deserves to be studied in depth. When we speak of alloys that integrate the bracket and archwire, we know that the lower friction coeffi-cient occurs between two good quality steel alloys. In-Ovation R and C clips are both made from cobalt chromium. These are more flexible alloys than the 18-8 conventional steel archwires, that allow flexing for displacement towards the outside in the case of a lingualized teeth for example, transversally flexing in rotation cases and allowing deformation in different shapes depending on teeth malposition. The clips that participate in the correction of dental malpositions tend to pull the archwire towards the slot end while the arch tends to escape from it in order to recover its initial austenitic shape and thus both opposite forces and synergic action correct overcrowding. IT IS TRUE that in being a clip that participates in correction, it slightly increases friction with the archwire, being this much lower than that of conventional brackets ligated with elastomer, BUT always maintaining tridimensional control
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Fig. 6: Conventional and eight ligation.
Fig. 7b: Interactive self ligating bracket
Photo by Dr. Celestino Nobrega
Fig. 7a: Conventional ligation
of the tooth on the bone, unlike passive brackets that have less friction and also less control.
With regards to elastomers, these, depending on quality, lose elasticity at between 10 and 20 days and are colonized by bacterial plaque as days go by. In order to solve the elastic ligature loss of tension, they can be ligated as 8 instead of in a circle, which increases friction even more, as seen in Fig. 6. Being tight to start with, they press the archwire against the slot and considerably increase sliding resistance, not needing this auxiliary, by itself is a big advantage. (Fig. 7a) The elasto-meric ligation, and even more so the metallic ligation, can cause permanent archwire deformation in severe overcrowding cases due to exceeding alloy elastic limit. With the use of In-Ovation R and C, this problem does not occur because the clips deform flex, allowing the archwire path to be less crooked. (Fig. 7b)
A bracket’s mesio-distal width must be at most half of the tooth’s width. Narrow brackets generate less friction due to the smaller slot path, but compromise the
sliding mechanism, the tip and rotations control. Therefore, in the apparatus selection for your patients you should consider width since a narrow bracket may cause deficiencies. In-Ovation R is a small twin bracket that, thanks to its interactive clip, helps eliminate these problems, providing very good tridimensional control. According to several studies, the In-Ovation R clip has shown to have the most success in settling the arch compared to other similar brackets. (Studies by Dr. Nobrega, São Pablo, Brazil)
Distance between brackets is another one of the previously mentioned elements that can reduce the force transmitted to the teeth. With the archwire span being bigger between brackets, it will cause more flexibility and will decrease the force intensity. BUT in cases of very badly placed teeth on the bone, with a more narrow bracket, the arch deflection inside the slot will be bigger and the bracket slot edges will be in more intense contact with the arch (binding and/or notching), thus increasing friction and eventually the force to be transferred. (Fig. 8)
Another of the interesting attributes of self-ligating brackets is the reduction in treatment length. In order to enjoy this advantage the clinician must acknowledge the bracket attributes, the prescription it uses and the sequence of arches to be used. It is a fact that small and constant forces are more physio-logical, reabsorption in pressure areas will be direct or frontal and dental movements will be faster and more physiological.
Since it is not necessary to frequently change elastomers, appointment intervals can be extended. If the Orthodontist has established a certain treatment plan in accordance with a correct diagnosis, patients can be seen in fewer overall appointments, booking visits every 8 weeks on average. In-Ovation R and C are best utilized when given the opportunity to work over time. It is important to allow adequate time for each archwire and for the whole prescription to work.
Archwires UsedRegarding archwires, most orthodontists use as the last archwire, a .019”x.025” in
5
Fig. 8 Fig. 9
.022”x.028” bracket, which is why the prescription cannot be fulfilled. Drs. Andrews and Roth always sustained the importance of utilizing full size archwires in order to fully benefit from the appliance. It is a fact that the better the dental positions achieved the better the post treatment stability.
Not only the torque is insuffi-cient when finishing with smaller archwires at slots in passive brackets but so are the tip, the in & out, leveling and alignment as shown in Fig. 9. Many colleagues maintain that when finishing with these full size archwires, even the smallest bracket placement errors exposed, therefore needing repositioning. This is why it is critical to take the time up front to make sure brackets are precisely placed and positioning is accurate.
Passive self-ligating systems had to develop special dimension archwires to work, considering that since there is always a certain play between archwires and brackets, it is very difficult to achieve correct dental positions. Measurements like .016”x.022” had to be replaced by .016”x.025”, in order to have bigger depth in the
slot, with .002” still remaining to be filled. Studies made by NYU (New York University), found that a .019”x.025” archwire in a .022”x.027” slot with passive clip, creates a 7.2° angle (Fig. 10). This angle is even bigger if the archwire edges are rounded, as manufac-tured by various companies for the archwire insertion to be easier.
The main concept of passive systems with heat activated archwires is to move teeth with small forces and place them in a neutral zone, between the buccal forces and the tongue force in accordance with concepts developed many years ago by Dr. Frankel. In order to reduce forces there needs to be that play between the bracket and the archwire. This is also why higher torques are utilized in passive systems; in order to correct the different malocclusions, thus solving the archwires inability to fill the slots and fully express the prescription.
This does not occur with interac-tive clips brackets like In-Ovation R and C since once the archwire exceeds .0185” depth, the clip settles it towards the slot end
Fig. 10
.019”x.025” archwire in .022”x.028” slot
Provided by Dr. Celestino Nobrega
to finish leveling alignment and providing more torque. As we keep advancing on the archwire sequence, we can use an archwire like the .022”x.018” BioForce, designed exclusively for In-Ova-tion R and C in order to vertically fill the slot and not be touched by the clip. With this archwire we advance in the treatment, taking advantage of the low archwire-bracket friction. (Fig. 11)
When arriving to the final archwires like .021”x.025” or .0215”x.028”, all alterations have been corrected in the three space directions. In this
.022”x.018” BioForce archwire.
Fig. 11
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Low friction causes the force transmitted to the tooth to be smaller. The use of super elastic arches also works to release small and practically constant forces. These two factors cause dental movement to be more physiological, the force moment exercised in each case to be smaller, osseous reab-sorption to be frontal, and dental sliding to be faster with fewer inclinations.
Fig. 12: In-Ovation R
delicate termination stage friction is a determining factor for the archwires to remain in place, work, and fulfill the chosen prescription. In other words, this interactive bracket system benefits from the archwire-bracket friction to fulfill the prescription, unlike passive systems.
For every particular case and depending on various elements like biotype, malocclusion, periodontal biotype, the presence or absence of temporomandibular dysfunctions, periodontal health etc., the archwire’s sequence will be determined. At the end of this white paper you will find, some possible archwire’s sequences divided according to malocclu-sions and to my concepts. Remember these charts are only a guide for the reader and not an absolute or unchangeable way of treating your patients.
Sentalloy®The name “Super Elastic Nickel Titanium Alloy”, means exactly what it states. They are the latest NiTi archwires generation. Unlike conventional NiTi they have a memory shape that is activated with the presence of buccal stress and temperature, about 37.5ºC/98.6ºF. Its initial Austenitic phase is characterized by the presence of cubical alloy crystals and striking clinical malleability that increases when the archwire is cooled down. When inserting these archwires in brackets, the alloy changes to martensitic stage with hexagonally shaped crystals which under higher temperature start recovering their initial shape with low and practically constant forces, correcting the teeth positions.
BioForce is a unique archwire in the market. It is a square or rectangular Neo Sentalloy with sectorial heat treatment that as a result produces an archwire with three different forces depending on the archwire region. Like its name insinuates, it provides the ideal biological force for each dental group. In the front sector it releases light force for the incisors group, intermediate force for the canines and bicuspids and heavier load for the molars.
BioForce provides leveling, alignment, rotation correction, and at the same time, it provides torque, tip and in & out since it comes only in quadrangular and rectangular sections. It is an archwire that simplifies the overall archwire sequence. It behaves like three different arches according to the sector, at the front it finishes leveling, aligning etc. and in lateral and back sectors prepares anchorage, expressing the distal offset of molars and premolars.
In-Ovation R and C interaction with these archwires ensures low forces, less disturbance, faster movement and correct use of the system’s advantages.
FrictionThis element’s management is essential for self-ligating brackets. Depending on the movements you want to make, it is possible to set a sequence for them to be carried out. In most cases and especially in patients with well toned or high toned peribuccal musculature we know that the initial archwires force (like that of .014” Sentalloy) will not exceed the lips pressure. In these types of patients you can expect frontal overcrowding
correction and archwire distal sliding without the anchorage becoming loose. The ample space that these first archwires count within the slots facilitates distal sliding of these last.
One of Base Rx* prescription characteristics is the cortical anchorage at molars and premolars level through distal offset incorporated in molar tubes and premolars’ brackets. In cases of frontal overcrowding and bicuspids extraction, once the appliance is installed and all teeth are ligated, each of them will be distally placed through the reciprocal forces applied on the neighbors, thus closing the extraction space without need for canines’ retroligation or lace backs. When archwires are used
*Dentsply Sirona Orthodontics Base Rx has prescription values that are equivalent to the Roth prescription. ROTH is a registered trademark of Roth Licensing, LLC. All rights reserved.
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Fig. 13
Resistance Centre
Force application point. A force moment is produced.
in good timing and shape there should be no loss of anchorage, nor anterior sector protrusion.
In the case of a Class II 2nd division with big incisors’ verticalization we must manage friction differ-ently. Ligating premolars with elastomers or placing crimpable stops or composite caps on the archwire prevents this archwire’s distal sliding due to which, all its energy will be used on the front sector and the incisors group will turn vestibular. Something similar can be implemented in Class III cases for dental malpositions (not skeletal).
Differential friction is also very useful for deviant dental midlines. We block the archwire slide on the deviation side and allow the archwire to work on the side we want the mid line to move to. When every archwire, even if rectangular, exhausts its working capacity, it will transversally slide inside the slots, appearing at one or other molar tubes distal, lacerating
the patient’s cheek. This is the time to advance the archwire. For this reason it is important to place crimpable stops or composite caps on archwires that will stop them sliding from side to side without interfering with overcrowding correction and spaces management.
AnchorageAnchorage is provided by those anatomic structures that are opposed to orthodontic movements. Using conventional brackets with elastic ligatures increases archwire-bracket friction too much, which is why higher forces should be used to move teeth, that may lead to defeating the anchorage capacity of the pieces in which we anchor and suffer unwanted movements.
Unlike conventional brackets, with self-ligating brackets the archwire-bracket friction coefficient is much smaller, which is why the forces to move teeth do not need to be so high. Since the forces to
be used are smaller, not so many auxiliary elements or procedures will be needed to strengthen the anchorage.
The use of Sentalloy coil springs is recommended for the closure of spaces after extractions. Being manufactured with different loads, we know with what force we are working, unlike what happens with elastic chains. In these cases is recommended the use of 150 to 200 gr. coil springs, depending on the patient’s anatomic characteristics.
The use of micro implants, mini screws, ortho implants, TADs, etc. is very useful when combined with self ligating brackets. We know that these devices provide what is considered absolute anchorage since they will not move at the application of force. Through them it is possible to intrude, extrude, verticalize, re-enforce anchorage, help space closure and many more applications.
Sentalloy coils mini screws
Elastic chain mini screw
Molar Sentalloy coil spring
Canine Sentalloy coil spring
Fig. 14
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CLINICAL CASEDiagnostic - Male patient, 30 years old with straight retracted profile, Class I skeletal and Mesofacial Biotype. In maximum intercuspation shows Class I molar and canine and on the way to centric occlusion shows contacts between 17 and 47. Increased overbite, verticalization of central incisors (153.9° interincisor angle) and 8mm lower cramming.
Quadrangular dental arches with lateral sectors compression and light Bolton discrepancy in favor of lower sectors, showing upper lateral incisors with microdontia. Occlusal plane fallen to the right.
Treatment plan1. Aligning, leveling and
derotating.2. Preparing prescription
anchorage, dental arches conformation and applying torque to the front sectors.
3. Coordinating archwires among them.
4. Achieving the best occlusal adjustment with the apparatus. Occlusal equilibration after appliance removal.
Summary of Arches Used: .014” Sentalloy, .018” x .018” BioForce,.019” x .025” Neo Sentalloy, .021” x .025” Neo Sentalloy, .0215” x .028” Neo Sentalloy, .021” x .025” & .021” x .025” braided.
All objectives planned at the start of the treatment were fulfilled in this patient. The change in the soft tissue is notable at the lips level, after correcting dental malpositions.
9
Treatment Evolution
.014” 8 weeks upper Sentalloy archwire until correcting incisors position and being able to place lower ceramic brackets.
.018”x.018” BioForce upper archwire and .014” lower Sentalloy archwire with elastomers at the 2nds. Lower premolars, preventing the archwire to distally slide and work more on the front sector, providing positive torque to verticalized incisors.
.021”x .025” upper and lower steelarchwires to finish settling the teeth in their places in alveolar processes. Afterwards, braided upper and lower multifibre steel archwires of the same caliber and 1/8” 6 oz intermaxillary elastics are used for 8 to 12 weeks to achieve occlusal settling and transition toward removal.
.0215”x .028” Neo Sentalloy upper Arch with Sentalloy coils compressed at the distal of laterals to reconstruct and solve inter arch dental discrepancy and .019”x.025 Neo Sentalloy lower archwire to continue lower arch leveling. Up to now no elastics, nor lacebacks ligatures have been used on the canines.
10
Removed appliance. Fixed upper and lower retention from the notedmalposition of incisors that the patient showed.
do not mean having to change diagnostic method. In some cases working with these forces may stimulate (though it is not scientifically shown) new osseous formation and thus obtaining more space for overcrowding correction through expansion. But something must remain clear; it is that if dental material is propor-tionally bigger than the bone, the necessary extractions must be made in order not to finish the treatment with teeth outside the bone, or many other periodontal complications.
When selecting a self-ligating bracket it is important to know
its working details, inter-relation with archwires, and how it must be processed in accordance with prescription.
In-Ovation R and C are two excellent products that will greatly facilitate your daily work. The time benefit you gain from longer appointment intervals can free up your schedule and change the way you practice. Whether it is using that time to accommodate extra case starts, investing more time in the marketing elements of your practice, or freeing up your schedule for more personal time, the choice is yours.
Conclusions In-Ovation R and C two interac-tive, self-ligating brackets that integrate with advanced archwires resulting in a system that ensures a very low archwire-bracket friction coefficient with very good tridimensional tooth control.
If you are currently using the Base Rx* prescription these In-Ova-tion System does not change your current treatment protocol. Simply keeping in mind some of the previously mentioned sugges-tions, the cases will be solved faster and with less disturbance. Additionally, In-Ovation R and C
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Patients treated withIn-Ovation R and C
Adult male patient with a lower dentoalveolar discrepancy of 12 mm and a bi-protrusive profile. Treatment included extraction of 4 premolars and a supernumerarytooth mesial and apical to 34.
Patients treated withIn-Ovation R
An adult female with periodontal alterations and temporomandib-ular dysfunctions. Compromise treatment without extractions and small forces..
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List of Product in the In-Ovation System Reference
In-Ovation R Base Rx bracket set .022” with hooks on 3, 4 and 5 KIT89-055-24
In-Ovation C Base Rx bracket set .022” with hooks on 3, 4 and 5 KIT100-532-11
Sentalloy archwires .014” MD upper 02-511-112 lower 02-511-612
Sentalloy archwires .014” MD Hi Aesthetic upper 02-711-112 lower 02-711-612
Sentalloy archwires .016” MD upper 02-511-122 lower 02-511-622
BioForce archwires .018” x .018” MD upper 02-528-042 lower 02-528-542
BioForce archwires .018” x .018” MD High Aesthetic upper 02-728-042 lower 02-728-542
Bioforce archwires .022” x .018” MD upper 02-528-092 lower 02-528-592
BioForce archwires .019” x .025” MD upper 02-528-062 lower 02-528-562
Steel archwires .019” x .025” MD upper 03-925-632 lower 03-925-642
Steel archwires .021” x .025” MD upper 03-125-632 lower 03-125-642
Braided archwires .019” x .025” MD upper 03-925-43 lower 03-925-44
Braided archwires .021” x .025” MD upper 03-125-43 lower 03-125-44
Adhesive tubes .022” Base Rx Upper right 1st molar 68-162-83 Upper left 1st molar 68-262-83 Lower right 1st molar 68-362-86 Lower left 1st molar 68-462-86
Upper right 2nd molar 68-172-80 Upper left 2nd molar 68-272-80 Lower right 2nd molar 68-372-80 Lower left 2nd molar 68-472-80
Fiji 1/8” intermaxillary elastics 6 ounces 11-103-03
*Dentsply Sirona Orthodontics Base Rx has prescription values that are equivalent to the Roth prescription. ROTH is a registered trademark of Roth Licensing, LLC. All rights reserved.
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References
John C. Voudouris, DDS (Hons), DORTH, MSC. Interactive edgewise mechanisms: Form and function comparison with conventional edgewise brackets. American Journal of Orthodontics and Dentofacial Orthopedics Volume 111, No. 2, 119 – 140.
Textbook “Orthodontics: Current principles and Techniques. Mosby, 2005. The In-Ovation bracket for fully adjusted appliances. Ronald H. Roth, Anka Sapunar, Robert C. Franz.
Textbook “El Tratamiento Ortodóncico con Arco Recto”. Drs. Jorge Gregoret, Elisa Tuber and Horacio Escobar. NM Ediciones, 2003.
John C. Voudouris, DDS. Seven clinical principles of interactive Twin Mechanisms. Journal of Clinical Orthodontics. Vol XXXI No. 1, 55 – 65.
Daniel J. Rinchuse, Donald J. Rinchuse, and Rupali Kapur-Wadhwa. Orthodontic appliance design. American Journal of Orthodontics and Dentofacial Orthopedics. Volume 131. No. 1, 76 -82.
Sandra P. Henao, BS; Robert P. Kusy, BS, MS, PhD. Evaluation of the frictional resistance of conven-tional and self – ligating bracket designs using standardized archwires and dental typodonts. Angle Orthodontist, Vol 74, No. 2, 2004, 202-211.
N.W.T. Harradine. Current products and practices. Self-ligating brackets: where are we now? Journal of Orthodontics, Vol 30, 2003, 262-273.
Proffit WR, Fields HW Jr. Contem-porary Orthodontics. 3rd ed. St. Louis: Mosby; 2000.Andrews LF. Six keys to normal occlusion. Am J Orthod 1972; 62: 296-309.
Thorstenson GA, Kusy RP. Comparison of resistance to sliding between different SL brackets with second order angulation in the dry and saliva states. American Journal of Orthodontics and Dentofacial Orthopedics 2002; 121: 472-82.
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ofAf
ter t
his p
erio
d th
ere
is th
e ris
k O
nce
the
misp
ositi
ons h
ave
been
cor
rect
edLe
vele
d an
d al
igne
d1°
.014
" Sen
tallo
y O
rTh
e in
itial
arc
h se
ctio
n de
pend
scr
owdi
ng.
6 to
8 w
eeks
*of
dev
elop
ing
dias
tem
as a
nd lo
sing
anch
orag
eTh
e ar
ch w
ants
to sl
ide
from
side
to si
deIN
TERA
CTIV
Eon
the
skel
etal
bio
type
, per
iodo
ntal
hea
lth
Dist
al d
uplic
ity o
f the
es
peci
ally
with
the
arch
es o
f big
gest
sect
ion
Adva
nce
the
sequ
ence
as s
oon
as p
ossib
le.0
16" S
enta
lloy
and
the
patie
nt's
crow
ding
gra
de.
2nd
Mol
ars i
s not
nec
essa
ry.
OPT
ION
ALPe
rfor
m st
rippi
ng if
nec
essa
ry.
Use
diff
eren
tial f
rictio
nby
pla
cing
ela
stom
ers o
r cap
s.
STAG
E 2
2°.0
18"x
.018
" Bio
forc
eIN
TERA
CTIV
EAp
plyi
ng to
rque
and
fini
shin
g co
rrec
ting
mal
posit
ions
.Fo
r dev
iatin
g m
idlin
es6
to 1
0 w
eeks
*RE
-ATT
ACH
BADL
Y PL
ACED
BRA
CKET
SW
hen
both
arc
hes a
re p
ract
ical
lyPr
epar
ing
anch
orag
e in
mol
ars
cent
er h
alf o
f the
arc
h w
ithBe
car
eful
with
the
incl
inat
ion
of th
e ca
nine
s,pa
ralle
l and
the
inse
rtio
n of
Ar
rang
ing
arch
es, t
orqu
e Ar
rang
ing
arch
es.
the
max
illar
y or
face
mid
line.
thes
e di
rect
ly in
fluen
ce fr
ont t
eeth
st
eel a
rche
s is p
ossib
le.
and
anch
orag
eFo
r exp
ansio
n w
ith sm
all l
oads
, m
ovem
ent w
hen
plac
edpr
epar
atio
nw
e le
t the
m w
ork
for a
long
er ti
me.
in th
e ap
para
tus.
The
mol
ars'
posit
ion
dict
ates
the
corr
ectio
n in
pre
mol
ars.
019"
x.02
5" B
iofo
rce
ACTI
VEIf
unab
le to
fini
sh le
velin
g an
dFo
r sm
all c
ross
ing
bite
s,4
to 1
0 w
eeks
Whe
n fin
ishin
g th
e le
velin
g an
dO
PTIO
NAL
alig
ning
in b
raqu
ifaci
al p
atie
nts.
shor
t ela
stic
s may
hel
p.Be
car
eful
with
the
torq
ue a
nd th
e bu
ccal
al
igni
ng.
osse
ous b
ase.
STAG
E 3
3°01
9"x
025"
stee
l AC
TIVE
In th
is st
age
we
mus
t fin
ish c
oord
inat
ing
INDI
VIDU
ALIZ
ING
ARC
HES
8 to
12
wee
ksW
ork
Stag
ede
ntal
arc
hes a
nd c
orre
ctin
g al
lAd
just
able
hoo
ks c
an b
e pl
aced
Whe
n de
ntal
pos
ition
s hav
e be
en c
orre
cted
al
tera
tions
with
in th
e 3
dire
ctio
ns o
f spa
ce.
in th
e ar
ch to
clo
seon
ly se
ttlin
g th
e oc
clus
ion
021"
x025
" ste
elAC
TIVE
Coor
dina
ting
arch
es.
dist
emas
or c
orre
ct li
ght c
lass
es II
, III
8 to
12
wee
ksBe
car
eful
with
pat
ient
s of s
kinn
y re
mai
ns.
OPT
ION
ALan
d de
viat
ing
mid
lines
.pe
riodo
ntal
bio
type
and
/or A
TM d
isord
ers
Rem
ove
band
s and
att
ach
tube
s.ST
AGE
4O
nce
the
occl
usio
n is
corr
ectly
sett
led,
4°01
9"x0
25" b
raid
edAC
TIVE
Slow
ly re
cove
ring
Usin
g sh
ort e
last
ics o
f 8
to 1
2 w
eeks
Use
the
sam
e siz
ew
ithou
t int
erfe
renc
es o
r pre
mat
ure
Term
inat
ion
dent
al in
divi
dual
ity.
occl
usal
sett
ling
as th
e la
st st
eel a
rch
used
.co
ntac
ts d
urin
g th
e fu
nctio
ning
and
with
02
1"x0
25" b
raid
edAC
TIVE
Occ
lusio
n se
ttle
men
t.Fi
ji - 1
/8 6
oz.
Ital
y 5/
16" M
ediu
m o
r 8
to 1
2 w
eeks
Cut t
he a
rch
outs
ide
the
mou
th w
ith
corr
ect d
ento
-gin
giva
l aes
thet
ics,
it is
O
PTIO
NAL
Scan
dina
via
5/16
" He
avy
for
wel
l sha
rpen
ed p
liers
, in
orde
r not
to fr
ay.
time
to re
mov
e th
e ap
para
tus.
devi
atin
g m
idlin
es.
*D e
pend
s on
the
resp
onse
to th
e pa
tient
's de
ntal
mov
emen
t. Al
low
ing
the
arch
to e
xhau
st it
s wor
king
pot
entia
l in
orde
r to
adva
nce
the
sequ
ence
.
15CLAS
S II
FIRS
T D
IVIS
ION
WIT
H EX
TRAC
TIO
N O
F U
PPER
PRE
MO
LARS
TRE
ATED
WIT
H IN
-OVA
TIO
N R
OR
CST
AGE
ARCH
TO
BE
USE
DCL
IPG
OAL
TIPS
DURA
TIO
NW
ARN
ING
STI
ME
TO A
DVAN
CE
STAG
E 1
Plac
e ca
ps o
n th
e ar
ch th
at d
o no
tpr
even
t the
cor
rect
ion
ofEx
trac
t pre
mol
ars b
efor
e at
tach
ing
brac
kets
..0
12" S
enta
lloy
crow
ding
.O
PTIO
NAL
PASS
IVE
Leve
ling,
alig
ning
and
rota
tion.
Dist
al d
uplic
ity o
f the
At
tach
bra
cket
s to
all t
eeth
Whe
n th
e m
ispos
ition
s hav
e be
en c
orre
cted
Leve
led
and
alig
ned
1°.0
14" S
enta
lloy
Or
The
initi
al a
rch
sect
ion
depe
nds
2nd
Mol
ars i
s not
nec
essa
ry.
6 to
8 w
eeks
*an
d pa
ss th
e ar
ch th
roug
h al
l the
bra
cket
s,th
e ar
ch w
ill sl
ide
from
side
to si
de.
.016
" Sen
tallo
yIN
TERA
CTIV
Eon
the
skel
etal
bio
type
, per
iodo
ntal
hea
lth
Retr
o-lig
atio
n up
to th
e ca
nine
sin
ord
er fo
r the
reci
proc
al fo
rces
Adva
nce
the
sequ
ence
as s
oon
as p
ossib
leO
PTIO
NAL
and
the
patie
nt's
crow
ding
gra
de.
is no
t nec
essa
ry.
to c
orre
ct th
e cr
owdi
ng a
nd to
Use
diff
eren
tial f
rictio
nst
art c
losin
g th
e ex
trac
tion
by p
laci
ng e
last
omer
s or c
aps.
sp
aces
.Th
e ar
ch m
ust r
un in
dist
ance
in o
rder
toco
rrec
t fro
ntal
cro
wdi
ng.
STAG
E 2
2°.0
18"x
.018
" Bio
forc
eIN
TERA
CTIV
EAp
plyi
ng to
rque
, fin
ishin
g co
rrec
ting
mal
posit
ions
and
For d
evia
ting
mid
lines
6 to
10
wee
ks*
Re-a
ttac
h Ba
dly
Plac
ed B
rack
ets
quic
kly
prep
arin
g an
chor
age
in m
olar
s for
the
cent
er h
alf o
f the
arc
h w
ithDo
not
leav
e th
is ar
ch in
the
mou
th lo
ng e
noug
hre
trus
ion
of th
e fr
ont o
nes.
th
e m
axill
ary
or fa
ce m
idlin
e.to
nee
d le
velin
g, a
ligni
ng a
nd ro
tatio
nAr
rang
ing
arch
es, t
orqu
e So
me
light
ela
stic
inte
rmax
illar
yAd
vanc
e w
ith th
e se
quen
ce a
s soo
n as
Whe
n bo
th a
rche
s are
pra
ctic
ally
and
anch
orag
eca
n al
so b
e us
ed.
poss
ible
.pa
ralle
l and
the
inse
rtio
n of
pr
epar
atio
nst
eel a
rche
s is p
ossib
le.
019"
x.02
5" B
iofo
rce
ACTI
VEIf
unab
le to
fini
sh le
velin
g an
d al
igni
ng.
Mor
e lo
ad c
an b
e us
ed if
nec
essa
ry4
to 1
0 w
eeks
Do n
ot c
lose
spac
es w
ith th
is ar
ch.
OPT
ION
AL02
2"x0
28" B
iofo
rce,
019"
x025
" Neo
sent
allo
y or
021
"x02
5"N
eose
ntal
loy
STAG
E 3
3°01
9"x
025"
stee
l AC
TIVE
Fina
l alig
ning
and
leve
ling
for t
he sl
idin
g.IN
DIVI
DUAL
IZIN
G A
RCHE
S4
wee
ks b
efor
eCl
osur
e of
ext
ract
ion
spac
es.
Roun
d ar
ches
to re
duce
fric
tion
orst
artin
g to
Man
agin
g th
e ne
ed fo
r anc
hora
ge to
cho
ose
Wor
k St
age
018"
X018
" ste
elIN
TERA
CTIV
E(0
18"x
018"
ss) S
peci
al fo
r slid
ing
teet
h in
the
arch
.us
e 01
8"x0
18" s
teel
.cl
ose.
the
clos
ure
mec
hani
cs.*
**W
hen
dent
al p
ositi
ons h
ave
been
cor
rect
edO
PTIO
NAL
usin
g lo
w fo
rce.
Plac
e ad
just
able
hoo
ks in
the
arch
es.
Use
low
fric
tion
of th
e ap
para
tus.
and
the
extr
actio
n sp
aces
Coor
dina
ting
arch
es.
Use
150
or 2
00 g
rs. S
enta
lloy
coils
ha
ve b
een
clos
ed.
021"
x025
" ste
elAC
TIVE
Issu
ing
the
pres
crip
tion
in p
atie
nts t
hat
plac
ed o
n m
olar
8
wee
ks p
ost
Ensu
re th
e sp
ace
clos
ure
with
met
alO
PTIO
NAL
allo
w u
sing
this
arch
cal
iber
.6,
7 o
r with
min
iscre
w.
spac
e cl
osur
e.lig
atio
n up
to 4
wee
ks a
fter
clo
sure
,Re
mov
e ba
nds a
nd a
ttac
h tu
bes.
to a
llow
radi
cula
r rec
over
y.ST
AGE
4O
nce
the
occl
usio
n is
corr
ectly
sett
led,
4°01
9"x0
25" b
raid
edAC
TIVE
Slow
ly re
cove
ring
dent
al
Usin
g sh
ort e
last
ics o
f8
to 1
2 w
eeks
Use
the
sam
e siz
ew
ithou
t int
erfe
renc
es o
r pre
mat
ure
Term
inat
ion
indi
vidu
ality
.oc
clus
al se
ttlin
gas
the
last
stee
l arc
h us
ed.
cont
acts
dur
ing
the
func
tioni
ng a
nd w
ith
021"
x025
" bra
ided
ACTI
VEO
cclu
sion
sett
lem
ent.
Fiji
- 1/8
6 o
z.Cu
t the
arc
h ou
tsid
e th
e m
outh
with
co
rrec
t den
to-g
ingi
val a
esth
etic
s, it
is
OPT
ION
ALw
ell s
harp
ened
plie
rs, i
n or
der n
ot to
fray
.tim
e to
rem
ove
the
appa
ratu
s.
* De
pend
s on
the
resp
onse
to th
e pa
tient
's de
ntal
mov
emen
t. Al
low
ing
the
arch
to e
xhau
st it
s wor
king
pot
entia
l in
orde
r to
adva
nce
the
sequ
ence
.**
Ste
el a
rch
018"
x018
" is
a v
ery
good
arc
h fo
r slid
ing.
It is
pos
sibl
e to
use
it a
fter
a 0
19"x
025"
stee
l arc
h.
***
Refe
r to
spac
e cl
osin
g m
etho
ds o
n pa
ge 1
3.
16 LIG
HT C
LASS
II 2
A. D
IVIS
ION
WIT
HOU
T EX
TRAC
TIO
NS
TREA
TED
WIT
H IN
-OVA
TIO
N R
Or C
STAG
EAR
CH T
O B
E U
SED
CLIP
GO
ALTI
PSDU
RATI
ON
WAR
NIN
GS
TIM
E TO
ADV
ANCE
STAG
E 1
Plac
e ca
ps o
n th
e ar
ch th
at w
ill n
otLe
velin
g, a
ligni
ng a
nd ro
tatio
n.al
low
it sl
idin
g in
dist
ance
U
pon
impr
ovem
ent o
f the
situ
atio
n of
1°.0
14" S
enta
lloy
PASS
IVE
The
initi
al a
rch
sect
ion
depe
nds
and
appl
y th
e co
rrec
tion
In c
ases
of o
verb
ite it
is p
ossib
leup
per f
ront
teet
h.Le
vele
d an
d al
igne
d.0
16" S
enta
lloy
Or
on th
e sk
elet
al b
ioty
pe, p
erio
dont
al h
ealth
to
the
fron
t sec
tor.
6 to
8 w
eeks
*to
pla
ce in
cisa
l cap
s on
uppe
rAd
vanc
e to
qua
dran
gula
r sec
tion
arch
esO
PTIO
NAL
INTE
RACT
IVE
and
the
patie
nt's
crow
ding
gra
de.
Do n
ot d
uplic
ate
arch
in d
istan
ce o
f the
2nd
cent
rals
pala
tine.
as so
on a
s pos
sible
in o
rder
to g
ive
torq
ue to
mol
ars.
Be c
aref
ul w
ith lo
wer
cer
amic
s bra
cket
s.th
e fr
ont t
eeth
.In
gen
eral
this
mal
occl
usio
n is
follo
wed
by o
verb
ite a
nd B
raqu
ifaci
al B
ioty
pe.
Use
the
diffe
rent
ial f
rictio
n
STAG
E 2
For d
evia
ting
mid
lines
2°.0
18"x
.018
" Bio
forc
eIN
TERA
CTIV
EAp
plyi
ng to
rque
, fin
ishin
g co
rrec
tion
of m
alpo
sitio
ns
cent
er h
alf o
f the
arc
h w
ith6
to 1
0 w
eeks
*RE
-ATT
ACH
BADL
Y PL
ACED
BRA
CKET
San
d pr
epar
ing
anch
orag
e in
mol
ars.
the
max
illar
y or
face
mid
line.
Be c
aref
ul w
ith th
e in
clin
atio
n of
the
cani
nes,
Arra
ngin
g ar
ches
and
impr
ovin
g th
e ov
erbi
te.
For e
xpan
sion
with
smal
l loa
dsth
ese
dire
ctly
influ
ence
on
the
Arra
ngin
g ar
ches
, tor
que
leav
e it
wor
k fo
r lon
ger.
fron
t tee
th m
ovem
ent w
hen
plac
edW
hen
both
arc
hes a
re p
ract
ical
lyan
d an
chor
age
in th
e ap
para
tus.
para
llel a
nd th
e in
sert
ion
of
prep
arat
ion
.019
"x.0
25" B
iofo
rce
ACTI
VEIn
cas
e of
not
bei
ng a
ble
to fi
nish
leve
ling
and
If ne
cess
ary
mor
e lo
ad c
an b
e4
to 1
0 w
eeks
*st
eel a
rche
s is p
ossib
le.
OPT
ION
ALal
igni
ng d
ue to
pat
ient
's Bi
otyp
e.us
ed 0
22"x
028"
Bio
forc
e,Th
e bi
te c
an b
e op
ened
in th
e fr
ont s
ectio
n01
9"x0
25" N
eose
ntal
loy
or 0
21"x
025"
by p
ositi
ve to
rque
. Eva
luat
e th
e br
acke
tsN
eose
ntal
loy
posit
ioni
ng.
.019
"x.0
25" R
etra
nol
ACTI
VEIn
trud
ing
fron
tals,
redu
cing
Spe
e cu
rve,
app
lyin
g It
is po
ssib
le to
use
low
er re
vers
e cu
rve
4 to
10
wee
ks*
INFE
RIO
R O
PTIO
NAL
posit
ive
torq
ue to
fron
t tee
th.
arch
.ST
AGE
33°
.019
"x .0
25" s
teel
AC
TIVE
Corr
ectin
g al
l misp
ositi
ons a
nd c
orre
ctin
gIN
DIVI
DUAL
IZIN
G AR
CHES
8 to
12
wee
ksW
ork
Stag
ecl
ass I
I.Pl
acin
g ho
oks o
n th
e ar
ches
.Ev
alua
te th
e pr
esen
ce o
f upp
er 3
rd m
olar
sW
hen
dent
al p
ositi
ons h
ave
been
cor
rect
ed.0
18"X
.018
" ste
el**
INTE
RACT
IVE
Dist
al u
pper
den
tal a
rch
clas
s II a
nd th
e ov
erbi
teO
PTIO
NAL
Coor
dina
ting
arch
es.
with
coi
ls, m
inisc
rew
s and
/or
Use
low
fric
tion
of th
e ap
para
tus.
have
bee
n co
rrec
ted.
.021
"x.0
25" s
teel
ACTI
VEin
term
axill
ar 1
/8 o
r 3/1
6" h
eavy
ela
stic
s.8
to 1
2 w
eeks
OPT
ION
ALRe
mov
e ba
nds a
nd a
ttac
h tu
bes.
STAG
E 4
Onc
e co
rrec
tly se
ttle
d th
e oc
clus
ion,
4°.0
19"x
.025
" bra
ided
ACTI
VESl
owly
reco
verin
g de
ntal
U
sing
shor
t ela
stic
s of
8 to
12
wee
ksU
se th
e sa
me
size
with
out i
nter
fere
nces
or p
rem
atur
eTe
rmin
atio
nin
divi
dual
ity.
occl
usal
sett
ling
as th
e la
st st
eel a
rch
used
.co
ntac
ts d
urin
g th
e fu
nctio
ning
and
with
.0
21"x
.025
" bra
ided
ACTI
VEO
cclu
sion
sett
lem
ent.
Fiji
- 1/8
6 o
z.Cu
t the
arc
h ou
tsid
e th
e m
outh
with
co
rrec
t den
to-g
ingi
val a
esth
etic
s, it
is
OPT
ION
ALw
ell s
harp
ened
plie
rs, i
n or
der n
ot to
fray
.tim
e to
rem
ove
the
appa
ratu
s
* De
pend
s on
the
resp
onse
to th
e pa
tient
's de
ntal
mov
emen
t. Al
low
ing
the
arch
to e
xhau
st it
s wor
king
pot
entia
l in
orde
r to
adva
nce
the
sequ
ence
.**
Ste
el a
rch
018"
x018
", is
a v
ery
good
arc
h fo
r slid
ing.
It is
pos
sibl
e to
use
it a
fter
a 0
19"x
025"
stee
l arc
h.
17CLAS
S II
2A. C
OM
PLET
E D
IVIS
ION
WIT
H EX
TRAC
TIO
NS
TREA
TED
WIT
H IN
-OVA
TIO
N R
Or C
STAG
EAR
CH T
O B
E U
SED
CLIP
GO
ALTI
PSDU
RATI
ON
WAR
NIN
GS
TIM
E TO
ADV
ANCE
STAG
E 1
Aim
ing
fron
tal c
orre
ctio
n bu
t not
Leve
ling,
alig
ning
and
rota
tion.
prev
entin
g di
stal
mov
emen
t of t
heIn
cas
es o
f ove
rbite
it is
pos
sible
Upo
n im
prov
emen
t of t
he si
tuat
ion
of1°
.014
" Sen
tallo
y PA
SSIV
ETh
e in
itial
arc
h se
ctio
n de
pend
sfr
ont t
eeth
to c
lose
the
to p
lace
inci
sal c
aps o
n up
per
uppe
r fro
nt te
eth.
Leve
led
and
alig
ned
.016
" Sen
tallo
yO
r on
the
skel
etal
bio
type
, per
iodo
ntal
hea
lth
extr
actio
n sp
ace.
6 to
8 w
eeks
*ce
ntra
ls pa
latin
e or
mou
ntin
g th
e up
per
Adva
nce
to q
uadr
angu
lar s
ectio
n ar
ches
OPT
ION
ALIN
TERA
CTIV
Ean
d th
e pa
tient
's cr
owdi
ng g
rade
.Di
stal
dup
licity
of t
he
appa
ratu
s and
wai
ting
the
plac
e fo
r the
bot
tom
as so
on a
s pos
sible
in o
rder
to g
ive
torq
ue to
2nd
Mol
ars i
s not
nec
essa
ry.
appa
ratu
s.th
e fr
ont t
eeth
.In
gen
eral
this
mal
occl
usio
n is
follo
wed
Cons
ider
ing
that
the
corr
ectio
n is
mad
eBe
car
eful
with
low
er c
eram
ics b
rack
ets
by o
verb
ite a
nd B
raqu
ifaci
al B
ioty
pe.
clas
s II 2
a. is
tran
sfor
med
in c
lass
II 1
a.
STAG
E 2
For d
evia
ting
mid
lines
2°.0
18"x
.018
" Bio
forc
eIN
TERA
CTIV
EAp
plyi
ng to
rque
, fin
ishin
g co
rrec
tion
of m
alpo
sitio
ns
cent
er h
alf o
f the
arc
h w
ith6
to 1
0 w
eeks
*RE
-ATT
ACH
BADL
Y PL
ACED
BRA
CKET
San
d pr
epar
ing
anch
orag
e in
mol
ars.
the
max
illar
y or
face
mid
line.
Be c
aref
ul w
ith th
e in
clin
atio
n of
the
cani
nes,
Arra
ngin
g ar
ches
and
impr
ovin
g th
e ov
erbi
te.
For e
xpan
sion
with
smal
l loa
ds10
to 1
2 w
eeks
thes
e di
rect
ly in
fluen
ce o
n th
eW
hen
both
arc
hes a
re p
ract
ical
lyAr
rang
ing
arch
es, t
orqu
e le
t it w
ork
for l
onge
r.fr
ont t
eeth
mov
emen
t whe
n pl
aced
para
llel a
nd th
e in
sert
ion
of
and
anch
orag
ein
the
appa
ratu
s.st
eel a
rche
s is p
ossib
le.
prep
arat
ion
.019
"x.0
25" B
iofo
rce
ACTI
VEIn
cas
e of
not
bei
ng a
ble
to fi
nish
leve
ling
and
If ne
cess
ary
mor
e lo
ad c
an b
e4
to 1
0 w
eeks
*Th
e bi
te c
an b
e op
ened
in th
e fr
ont s
ectio
nO
PTIO
NAL
alig
ning
.us
ed 0
22"x
028"
Bio
forc
e,by
the
posit
ive
torq
ue.
019"
x025
" Neo
sent
allo
y o
021"
x025
"N
eose
ntal
loy
Eval
uate
the
brac
kets
pos
ition
ing.
.019
"X.0
25" R
etra
nol
ACTI
VEIn
trud
ing
fron
tals,
redu
cing
Spe
e cu
rve,
app
lyin
g It
is po
ssib
le to
use
low
er re
vers
e cu
rve
INFE
RIO
R O
PTIO
NAL
posit
ive
torq
ue to
fron
t tee
th.
arch
.ST
AGE
33°
019"
x 02
5" st
eel
ACTI
VEFi
nal a
ligni
ng a
nd le
velin
g fo
r the
slid
ing.
INDI
VIDU
ALIZ
ING
ARC
HES
4 w
eeks
bef
ore
Clos
ure
of e
xtra
ctio
n sp
aces
.Ro
und
arch
es to
redu
ce fr
ictio
n or
star
ting
toM
anag
ing
the
need
for a
ncho
rage
to c
hoos
eW
ork
Stag
e01
8"X0
18" s
teel
INTE
RACT
IVE
(018
"x01
8"ss
) Spe
cial
for s
lidin
g te
eth
plac
e ad
just
able
hoo
ks in
the
arch
es.
clos
e.th
e cl
osur
e m
echa
nics
.***
Whe
n de
ntal
pos
ition
s hav
e be
en c
orre
cted
OPT
ION
ALin
the
arch
.U
se 1
50 o
r 200
grs
. Sen
tallo
y co
ils
Use
low
fric
tion
of th
e ap
para
tus.
and
extr
actio
n sp
aces
hav
e be
enCo
ordi
natin
g ar
ches
.pl
aced
on
mol
ar
clos
ed.
021"
x025
" ste
elAC
TIVE
Issu
ing
the
pres
crip
tion
for p
atie
nts t
hat
6, 7
or w
ith m
inisc
rew
.8
wee
ks p
ost
Ensu
re th
e sp
ace
clos
ure
with
met
alO
PTIO
NAL
allo
w u
sing
this
arch
cal
iber
.Re
mov
e ba
nds a
nd a
ttac
h tu
bes.
spac
e cl
osur
e.lig
atio
n up
to 4
wee
ks a
fter
clo
sure
,to
allo
w ra
dicu
lar r
ecov
ery.
STAG
E 4
Onc
e co
rrec
tly se
ttle
d th
e oc
clus
ion,
4°.0
19"x
.025
" bra
ided
ACTI
VESl
owly
reco
verin
g de
ntal
U
sing
shor
t ela
stic
s of
8 to
12
wee
ksU
se th
e sa
me
size
with
out i
nter
fere
nces
or p
rem
atur
eTe
rmin
atio
nin
divi
dual
ity.
occl
usal
sett
ling
as th
e la
st st
eel a
rch
used
.co
ntac
ts d
urin
g th
e fu
nctio
ning
and
with
.0
21"x
.025
" bra
ided
ACTI
VEO
cclu
sion
sett
lem
ent.
Fiji
- 1/8
6 o
z.Cu
t the
arc
h ou
tsid
e th
e m
outh
with
co
rrec
t den
to-g
ingi
val a
esth
etic
s, it
is
OPT
ION
ALw
ell s
harp
ened
plie
rs, i
n or
der n
ot to
fray
.tim
e to
rem
ove
the
appa
ratu
s
* De
pend
s on
the
resp
onse
to th
e pa
tient
's de
ntal
mov
emen
t. Al
low
ing
the
arch
to e
xhau
st it
s wor
king
pot
entia
l in
orde
r to
adva
nce
the
sequ
ence
.**
Ste
el a
rch
018"
x018
", is
a v
ery
good
arc
h fo
r slid
ing.
It is
pos
sibl
e to
use
it a
fter
a 0
19"x
025"
stee
l arc
h.
***
Refe
r to
spac
e cl
osin
g m
etho
ds o
n pa
ge 1
3.
18
CLAS
S III
DEN
TAL
ALVE
OLU
S W
ITHO
UT
OR
WIT
H LI
GHT
SKE
LETA
L CO
MPR
OM
ISE
STAG
EAR
CH T
O B
E U
SED
CLIP
GO
ALTI
PSDU
RATI
ON
WAR
NIN
GS
TIM
E TO
ADV
ANCE
STAG
E 1
Plac
ing
caps
in u
pper
bac
k ar
eas
to p
rotr
ude
the
fron
t tee
th.
.012
" Sen
tallo
yPA
SSIV
ELe
velin
g, a
ligni
ng a
nd ro
tatio
n.It
is po
ssib
le to
let w
ork
the
uppe
r arc
hW
hen
the
misp
ositi
ons h
ave
been
cor
rect
edO
PTIO
NAL
Or
The
initi
al a
rch
sect
ion
depe
nds
Low
er st
rippi
ng if
nec
essa
ry.
6 to
8 w
eeks
*fo
r lon
ger t
han
the
low
er. I
n th
e up
per p
art i
s th
e ar
ch w
ill sl
ide
from
side
to si
de.
Leve
led
and
alig
ned
1°.0
14" S
enta
lloy
INTE
RACT
IVE
on th
e sk
elet
al b
ioty
pe, p
erio
dont
al h
ealth
re
quire
d ex
pans
ion
and
prot
rusio
n, o
n th
e bo
ttom
Adva
nce
the
sequ
ence
as s
oon
as p
ossib
le.0
16" S
enta
lloy
and
the
patie
nt's
crow
ding
gra
de.
Not
pro
trud
ing
low
er fr
ont t
eeth
. The
low
erco
rrec
tion
with
out e
xpan
sion
or p
rotr
usio
n.O
PTIO
NAL
arch
mus
t not
exc
eed
.020
" in
orde
rno
t to
give
low
er fr
ont p
ositi
ve to
rque
.
STAG
E 2
2°.0
18"x
.018
" Bio
forc
eIN
TERA
CTIV
EAp
plyi
ng to
rque
, fin
ishin
g co
rrec
tion
of m
alpo
sitio
ns.
For d
evia
ting
mid
lines
10 to
12
wee
ksRE
-ATT
ACH
BADL
Y PL
ACED
BRA
CKET
SW
hen
both
arc
hes a
re p
ract
ical
lyU
PPER
Leav
ing
to w
ork
to a
chie
ve e
xpan
sion
with
smal
l loa
d.ce
nter
hal
f of t
he a
rch
with
para
llel a
nd th
e in
sert
ion
of
Arra
ngin
g ar
ches
, tor
que
Coor
dina
ting
arch
es.
the
max
illar
y or
face
mid
line.
stee
l arc
hes i
s pos
sible
.an
d an
chor
age
2°.0
18"x
.020
" Sen
tallo
ySh
ould
not
app
ly lo
wer
pos
itive
torq
uepr
epar
atio
nLO
WER
019"
x.02
5" B
iofo
rce
ACTI
VEIn
cas
e of
not
bei
ng a
ble
to fi
nish
leve
ling
and
For s
mal
l cro
ssin
g bi
tes,
6 to
8 w
eeks
Be c
aref
ul w
ith th
e to
rque
and
the
bucc
al
Whe
n fin
ishin
g th
e le
velin
g an
dU
PPER
OPT
ION
ALal
igni
ng.
shor
t ela
stic
s can
hel
p.os
seou
s bas
e.al
igni
ng.
STAG
E 3
3°01
9"x
025"
stee
l AC
TIVE
In th
is st
age
we
mus
t fin
ish c
oord
inat
ing
INDI
VIDU
ALIZ
ING
ARC
HES
8 to
12
wee
ksRe
solv
ing
poss
ible
upp
er d
iast
emas
Wor
k St
age
UPP
ERde
ntal
arc
hes a
nd c
orre
ctin
g al
lAd
just
able
hoo
ks c
an b
e pl
aced
gene
rate
d w
ith e
xpan
sion.
Whe
n de
ntal
pos
ition
s hav
e be
en c
orre
cted
al
tera
tions
in th
e 3
sens
es o
f spa
ce.
on th
e ar
ch to
cor
rect
ligh
ton
ly se
ttlin
g th
e oc
clus
ion
3°.0
20" s
teel
AC
TIVE
Cons
olid
atin
g lo
wer
pos
ition
s.cl
ases
III a
nd d
evia
ting
mid
lines
.8
to 1
2 w
eeks
rem
ains
.LO
WER
021"
x025
" ste
elAC
TIVE
Rem
ove
band
s and
att
ach
tube
s.8
to 1
2 w
eeks
Be c
aref
ul w
ith p
atie
nts o
f ski
nny
OPT
ION
ALpe
riodo
ntal
bio
type
and
/or A
TM d
isord
ers
STAG
E 4
4°01
9"x0
25" b
raid
edAC
TIVE
Onc
e co
rrec
tly se
ttle
d th
e oc
clus
ion,
UPP
ERSl
owly
reco
verin
g de
ntal
U
sing
shor
t ela
stic
s of
8 to
12
wee
ksU
se th
e sa
me
size
with
out i
nter
fere
nces
or p
rem
atur
eTe
rmin
atio
n4°
.021
5" c
oaxi
alAC
TIVE
indi
vidu
ality
.oc
clus
al se
ttlin
gas
the
last
stee
l arc
h us
ed.
cont
acts
dur
ing
the
func
tioni
ng a
nd w
ith
LOW
ERO
cclu
sion
sett
lem
ent.
Fiji
- 1/8
6 o
z. It
aly
5/16
" Med
ium
or
8 to
12
wee
ksCu
t the
arc
h ou
tsid
e th
e m
outh
with
co
rrec
t den
to-g
ingi
val a
esth
etic
s, it
is
021"
x025
" bra
ided
ACTI
VESc
andi
navi
a 5/
16"
Heav
y fo
rw
ell s
harp
ened
plie
rs, i
n or
der n
ot to
fray
.tim
e to
rem
ove
the
appa
ratu
s.U
PPER
OPT
ION
ALde
viat
ing
mid
lines
.
* De
pend
s on
the
resp
onse
to th
e pa
tient
's de
ntal
mov
emen
t. Al
low
ing
the
arch
to e
xhau
st it
s wor
king
pot
entia
l in
orde
r to
adva
nce
the
sequ
ence
.
19CLAS
S I W
ITH
OPE
N B
ITE
DEN
TAL
ALVE
OLU
S W
ITH
EXTR
ACTI
ON
OF
4 O
F TH
E 2n
d M
OLA
RSST
AGE
MET
HOD
TO U
SECL
IPG
OAL
TIPS
DURA
TIO
NPR
ECAU
TIO
NS
TIM
E TO
ADV
ANCE
STAG
E 1
Plac
e ca
ps o
n th
e ar
ch th
at d
o no
tin
terr
upt t
he c
orre
ctio
n of
Carr
y ou
t the
ext
ract
ion
of m
olar
s.0
12" S
enta
lloy
cram
min
g. T
he c
ram
min
g m
ust
befo
re a
ttac
hing
the
appa
ratu
s, in
cas
es o
f lig
htO
PTIO
NAL
PASS
IVE
Leve
ling,
alig
ning
and
rota
tion.
be c
orre
cted
tow
ards
the
fron
t, if
crow
ding
, or l
ater
in c
ases
Whe
n th
e m
ispos
ition
s hav
e be
en c
orre
cted
Leve
led
and
Alig
ned
1°.0
14" S
enta
lloy
Or
The
initi
al a
rch
sect
ion
depe
nds
the
soft
pro
file
allo
ws i
t and
not
at t
he6
to 8
wee
ks*
whe
n cr
owdi
ng is
seve
re.
the
arch
will
slid
e fr
om si
de to
side
..0
16" S
enta
lloy
INTE
RACT
IVE
on th
e sk
elet
al b
ioty
pe, p
erio
dont
al h
ealth
ex
pens
e of
the
extr
actio
n sit
e.At
tach
bra
cket
s to
all t
eeth
Adva
nce
the
sequ
ence
as s
oon
as p
ossib
leO
PTIO
NAL
and
the
patie
nt's
crow
ding
gra
de.
Eval
uate
the
right
mom
ent f
or th
e1
mm
mor
e to
war
ds g
ingi
val t
o he
lp c
lose
extr
actio
ns in
ord
er to
cou
nt o
nth
e bi
te.
the
extr
actio
n sp
ace
to a
lign
Cons
erve
the
extr
actio
n sp
ace
for
mol
ars a
nd c
lose
the
bite
.th
e m
esia
l mov
e of
the
mol
ars.
Use
diff
eren
tial f
rictio
n.
STAG
E 2
2°.0
18"x
.018
" Bio
forc
eIN
TERA
CTIV
EAp
plyi
ng to
rque
, fin
ishin
g co
rrec
tion
of m
alpo
sitio
ns a
nd F
or d
evia
ting
mid
lines
6 to
10
wee
ks*
RE-A
TTAC
H BA
DLY
PLAC
ED B
RACK
ETS
aim
ing
not t
o in
cur r
otat
ion
in th
e m
olar
s,
cent
er h
alf o
f the
arc
h w
ithDo
not
leav
e th
is ar
ch in
the
mou
th lo
ng e
noug
hto
mak
e m
ore
thei
r alig
nmen
t eas
ier.
the
max
illar
y or
face
mid
line.
to n
eed
leve
ling,
alig
ning
and
rota
tion
Arra
ngin
g ar
ches
, tor
que
Som
e lig
ht e
last
ic in
term
axill
ary
Adva
nce
with
the
sequ
ence
as s
oon
asW
hen
both
arc
hes a
re p
ract
ical
lyan
d an
chor
age
can
also
be
used
.po
ssib
le.
para
llel a
nd th
e in
sert
ion
prep
arat
ion
Dist
anci
ng o
f pre
mol
ars a
ndof
stee
l arc
hes i
s pos
sible
.M
ore
load
can
be
used
if n
eces
sary
appa
ritio
n of
dist
emas
may
occ
ur.
019"
x.02
5" B
iofo
rce
ACTI
VEIn
cas
e of
not
bei
ng a
ble
to fi
nish
leve
ling
and
used
022
"x02
8" B
iofo
rce,
4 to
10
wee
ksDo
not
clo
se sp
aces
with
this
arch
.O
PTIO
NAL
alig
ning
.01
9"x0
25" N
eose
ntal
loy
or 0
21"x
025"
Neo
sent
allo
yST
AGE
33°
019"
x 02
5" st
eel
ACTI
VEFi
nal a
ligni
ng a
nd le
velin
g fo
r the
slid
ing.
INDI
VIDU
ALIZ
NG
ARC
HES
4 w
eeks
bef
ore
Clos
ure
of e
xtra
ctio
n sp
aces
.Ro
und
arch
es .0
19"x
.025
" to
redu
cest
artin
g to
Man
agin
g th
e ne
ed fo
r anc
hora
ge to
cho
ose
Wor
k st
age
018"
X018
" ste
elIN
TERA
CTIV
E(0
18"x
018"
ss) S
peci
al fo
r slid
ing
teet
h in
the
arch
.fr
ictio
n an
d m
aint
ain
fron
tal t
orqu
e.cl
ose.
the
clos
ure
mec
hani
cs.*
**W
hen
dent
al p
ositi
ons h
ave
been
cor
rect
edO
PTIO
NAL
usin
g lo
w fo
rce.
Plac
e ad
just
able
hoo
ks in
the
arch
es.
Use
low
fric
tion
of th
e ap
para
tus.
and
the
extr
actio
n sp
aces
Coor
dina
ting
arch
es.
Use
150
or 2
00 g
rs. S
enta
lloy
coils
ha
ve b
een
clos
ed, c
orre
ct02
1"x0
25" s
teel
ACTI
VEIs
suin
g th
e pr
escr
iptio
n in
pat
ient
s tha
tpl
aced
on
mol
ar 6
.8
wee
ks p
ost
Ensu
re th
e sp
ace
clos
ure
with
met
alov
erbi
te is
ach
ieve
d.O
PTIO
NAL
allo
w u
sing
this
arch
cal
iber
.Re
mov
e ba
nds a
nd a
ttac
h tu
bes.
spac
e cl
osur
e.lig
atio
n up
to 4
wee
ks a
fter
clo
sure
,Fi
nish
clo
sing
with
ela
stic
cha
in.
to a
llow
radi
cula
r rec
over
y.ST
AGE
4O
nce
corr
ectly
sett
led
the
occl
usio
n,4°
019"
x025
" bra
ided
ACTI
VESl
owly
reco
verin
g de
ntal
U
sing
shor
t ela
stic
s of
8 to
12
wee
ksU
se th
e sa
me
size
with
out i
nter
fere
nces
or p
rem
atur
eTe
rmin
atio
nin
divi
dual
ity.
occl
usal
sett
ling
as th
e la
st st
eel a
rch
used
.co
ntac
ts d
urin
g th
e fu
nctio
ning
and
with
02
1"x0
25" b
raid
edAC
TIVE
Occ
lusio
n se
ttle
men
t.Fi
ji - 1
/8 6
oz.
Cut t
he a
rch
outs
ide
the
mou
th w
ith
corr
ect d
ento
-gin
giva
l aes
thet
ics,
it is
O
PTIO
NAL
wel
l sha
rpen
ed p
liers
, in
orde
r not
to fr
ay.
time
to re
mov
e th
e ap
para
tus
* De
pend
s on
the
resp
onse
to th
e pa
tient
's de
ntal
mov
emen
t. Al
low
ing
the
arch
to e
xhau
st it
s wor
king
pot
entia
l in
orde
r to
adva
nce
the
sequ
ence
.**
Ste
el a
rch
018"
x018
" is
a v
ery
good
arc
h fo
r slid
ing.
It is
pos
sibl
e to
use
it a
fter
a 0
19"x
025"
stee
l arc
h.
***
Refe
r to
spac
e cl
osin
g m
etho
ds o
n pa
ge 1
3.
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