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TIP EDGE ORTHODONTICSSTAGE III
Dr. Onkar Khot
1
Objectives
Correction of torque and tip angles for each tooth individually
Attainment of optimum facial profile compatible with stability
Maintaining class I occlusion
Final detailing
2
Conventional torquing
-Fixed vertical slot dimension.
-19 x 25”
-Active torque- rectangular archwire
Conflicting requirements(rectangular wire provide torque at the same time offer 3dimensional stability)
3
How does Tip-edge torque?
Torque escape’- actively torqued rect wire –reopen the vertical slot dimension, second order root movement than torque
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How does Tip-edge torque?
a)Initial engagement of rectangular wireb)side winder begins to close vertical spacec)final tip and Torque achieved simultaneously when slot closes
5
How does Tip-edge torque?
-Side winder can recover 14 deg of torque from either direction-Tip and torque- self limiting according to prescription of bracket.-Overcorrection of tip permitted(since 0215”fractionally smaller than 022”)-zero torque discrepancy between bracket and archwire after sidewinder has fully expressed
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Points to note
-Sidewinder oriented to the side- untip the tooth irrespective of direction of torque
-Two-point contact- tip and torque are unalterably related
-Inadequate tip correction will lead to inadequate torque
-Force values – decline from 60g to 20g at the apex
-No less than .0215 x .028– torquing platform
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Stage III archwires
Choice of archwires
Arch width
Identifying the land marks
Archform
Traction hooks
Preparation of arch ends
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Stage III archwires
-Only one size0215” X 028”
-Archwidth- 2mm expanded at molars
-5° lingual toe-in so as to enter pre angulated molar tube at an equivalent angle to straight-wire archform
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Stage III
Traction hooks
Crimped midway between laterals and canines,hooks pointing gingivally.accept elasomerics from either side
Protruding distal archwire ends are thinned and annealed
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Stage III – setting the torques
How to read the torque
Torque in
Reduced overbite cases
Increased overbite cases
Pretorqued archwires
Checking the torque
Skeletal class III cases
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How to read the torque
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Torque-increased overbite cases
Vertical bite sweep
(reverse curve of spee)
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Pretorqued archwires
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Small amount of anterior archwire intrusion is all that needed to retain previous deepbite
Small amount of palatal root torque added to upper anterior segment by elevating the tails of archwire
Checking torque/wiping the sweep
15
Stage III fitting the archwires
Testing molar torque
Cinch backs
Side-winders and elastomeric modules
Removing the archwires
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Testing molar torque
Only molars-torque from beginning Torque discrepancy between zero torque archwire and 2nd molar tube
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Cinch backs
Cinching back to allow small ingress of space
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Sidewinders and elastomeric modules
Sidewinders point mesially except 2nd
premolars in 1st premolar Xn
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Degree of activation
Canines and premolars- tip correction.Excess activation- loss of anchorage
Full activation appropriate for incisorsApprox 45 deg enough on canines
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Removal of archwires
Rotating plier forwards along long axis of wire will walk wire mesially out without discomfort to the patient
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Stage III checks
How to admit extra space
Hyperactivation of side-winders
Causes of inadequate torque
22
Stage III checks
-Progress of the tip and the torque
tipedge has fully expressed when its occlusal and gingival tiewings have become parallel to rectangular archwire
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Stage III checks
-Available space in the arch
Tight contacts or anterior rotations indicate inadequate space during uprighting
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Stage III checks
-Unwanted space- Activation of side-winders- Interarch relationship-The vertical relationship-Molar width-2nd molars -Profile considerations
classII check elastics useful aid in maintaining overbite reduction or molar occlusion
25
‘Hyper activation’ of side-winders
Flattening of small section of coil with lightwire plierwhich effectively expand them
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Causes of inadequate torque
-Incorrect bracket-Misangled bracket-Incorrect archwire-Incorrect bonding position-Incomplete bracket engagement-Wire ligatures-Tight contact points-Slack side-winders-Incorrect torque in archwire
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Precision finishing
Picking up second molars
Occlusal seating
Braided rectangular arches
Titanium-niobium archwires
Sectioning the main archwire
Crossbite cases
Positioners
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Precision finishing
-Self-limited precision finishing-Previously unnoticed errors come to light-Stage III(easier to correct in his stage without stepping down the archwire)-occlusal seating-Second molars
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Picking up second molars
-Until late stage IIIObstructive – unwanted friction.022 x .028” molar tubes
Preliminary alignment- late stage III by means of sectional devise given by Dr. Tom Rocke.016”s.s runs through gingival tiewing and mesially with occlusal inclined loop
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Vertical elastics can be engaged to a combination of molarhooks and gingivally inserted lockpins
Occlusal seating
Braided rectangular archesTitanium-niobium archwires
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Sectioning the main archwirearchwire distal to canine is sectioned,premolars and molars recquire tying with criss cross
ligature to prevent spacing
Extrude buccal cusps, leaving palatal cusps unseated
32
Positioners
No finishing wiresPre-Fit PositionersDiff sizes- Extraction and non-extraction
Dis Adv-Individual tooth size discrepancy,noncompliant patient
Tooth positioner as settling aid may take upto 6weeks33
The non-compliant patient
Outrigger hooks
Case selection for Outriggers
Advantages of Outriggers
Limitations of outriggers
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The non-compliant patient
Whatever one puts in is directly proportional to the gains in tern
Advantages of TipEdge
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Dr. Christopher kesling
Outrigger appliance
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Outrigger appliance
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Outrigger applianceused with rect archwire
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Outrigger appliance
Patient compliance in the advantage
Limitations
Anterior spacing
Adequate supply of elastics
Part time wear is impossible
Long term fatigue fracture of hooks
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In the future..!!
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Tip-edge plus
Stage III root movements – heat activated NiTi auxiliary arch wiresidewinders- ‘spring free stage III’
Improved aesthetics,oral hygiene and patient comfort
41
The addition of a horizontal tunnel permits mesiodistal uprighting and torquing from the power of a small, round, super-elastic auxiliary wire-eliminates the need for individual uprighting springs and torquing auxiliaries
42
CONCLUSION
Tip Edge appliance may no be the most popular appliance today but it has certainly provided an opportunity to both begg and edgewise practitioners to come closer to a common versatile appliance system.
43
Reference
Tip – edge Orthodontics by Richard Parkhouse, 2005 reprint
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