Bio progressive therapy Mechanics For Class II Div II

Bioprogressive Therapy
Part III
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Mechanics Sequence for
Class II Div II

Mechanics For Class II Div II
 Three treatment
possibilities:
1. Distalizing the
upper arch.
2. Advancing the lower
arch.
3. A reciprocal
movement.

1. Advancement, torque control, and intrusion of
the upper incisors.
2. Intrusion of the lower incisors and cuspids.
3. Alignment of the buccal segments and Class
II correction.
4. Consolidation of the upper incisors.
5. Idealizing the arches.
6. Finishing.

 Quad helix or W
arch

1. Advancement, torque control, and intrusion
of the upper incisors.
X Principle of bite before jet
 Jet is created followed by intrusion.
16x22 utility arch

Directional control

 Amount of pressure:
 125-160 gms
 16 x 22
 Stabilization of the
molars:
Quad helix
TPA
Stab. sections

 Intrusion of lower incisors:
 16 x 16 utility arch.
 65-75 gms.
 This is followed by cuspid intrusion.

 Advancement
of the lower
denture:
1. Utility arch with
4 helical loops

2. Using three
vertical loops:

3. Alignment of the buccal
segment:
a) Stabilizing section

If buccal segment
are not aligned
 “T” sections
 Twistoflex wire
 Cable wire

4. Consolidation of
the maxillary
incisors:

 Idealization and
arches and finishing

Pentamorphic Arch Forms

Finishing and Retention

 “Begin with the end in
mind”.
 Every orthodontist has a
visual picture in his mind
of the ideal occlusion into
which the teeth should fit
and mesh in the final
finished occlusion.

 Bioprogressive proposes the concept
overtreatment….
 No clinician can position teeth as delicately
as the functioning incline plane and cusp
action can accomplish naturally when it is
adequately set up to operate correctly.
 Allow natural function to guide the teeth into
the best functioning occlusion for each
individual

 Two phases of retention:
1. Guiding changes during initial adjustments.
2. Supporting bony sutural and muscular
accommodations to changing environment
and considering long range influences.

 Initial stage of retention :
 First six weeks following appliance removal
 Retainers inserted-designed not to hold but to
guide the teeth in settling.

Labial frame of typical
upper retainer (Ricketts)
passes between the lateral
and cuspid and has a
distal loop at each end to
tuck in the distal of the
expanded overtreated
upper cuspid

 Lower arch:
 Fixed first bicuspid retainer is placed.
-maintain cross arch bicuspid width.
-lower cuspid freedom of adjustment against
upper occlusion.
-maintain lower incisor alignment and rotation
correction.

 Stabilizing stage of retention:
 First year following active treatment.
 Lower retainer is kept in place and upper is
worn most of the time.

Bioprogressive Simplified
James J. Hilgers
Jco 1987-part 1-4

 Translating orthodontic skills into a bona fide
delivery system is one of the most difficult tasks
faced by clinicians.
 The best orthodontic managers are able to
identify the necessary information and leave out
the extraneous.
 “After studying many treatment disciplines, I
chose the Bioprogressive approach because it
was flexible”.

Visual Treatment Objective
 Orthodontic movements are more significant
than growth changes
 The VTO leads the clinician toward a viable
treatment plan by organizing factors
The superimpositions that define the practical
part of the mechanical procedures

 An accurate
measurement of arch
length deficiency—
combined with the
clinician's judgment of
dental and facial
changes required— is
used in the simplified
VTO to produce a
reasonable treatment
goal

Occlusal Paralleling Instrument
 Arch length deficiency is
one of the most critical
aspects of diagnosis.
 One of the most
accurate measuring
devices is the
mandibular occlusal x-
ray

Diagnostic procedures
 Grades the patient as-
A- enthusiastic
B- average
C- resistant
 Patient assurance about headgear usage.

Appliance design
 End-of-treatment goals should be dynamic,
not based on statistical norms.
 This kind of overcorrected result can be
called an ideal orthodontic occlusion— one
that will settle after positioner treatment,
retention, and normal physiologic rebound
into an ideal occlusion and thereafter into a
normal occlusion

Appliance design
1. Type and severity of the original
malocclusion.
2. General approach to mechanics.
3. Size of the final arches.
4. Timing of torque control
5. Bracket placement and design.

Appliance design
 Linear Dynamic system designed by the
Ormco 1979.
 17-4 grade of stainless steel, which has more
than three times the yield strength of the
standard 303 grade
 30% smaller bracket that is stronger than its
full-size counterpart.
 20% size reduction in molar region.

Appliance design
The key to a Class I buccal segment is the
proper positioning of the lower first molars

Linear Dynamic System
 Ideal orthodontic tooth position.
 Anticipated rebound and required
overcorrection.
 Appliance design features that
contribute to patient comfort, clinical
simplicity, and optimum utility.

Linear Dynamic System
C.I L.I Canin
e
1st
pm
2nd
pm
1st
molar
2nd
molar
Max 22/5 14/8 7/10 -7/0 -7/0 -10/0 -10/0
Man
d
-1/0 -1/0 7/5 -11/0 -17/0 -27/5 -27/5

Basic principles
 Treatment of overbite before overjet.
 Sectional arch mechanics
 Progressive unlocking of malocclusion
 Cortical and muscular anchorage
 Torque control throughout treatment.

Extraction Therapy
 Initiation
 Cuspid retraction and uprighting.
 Transition and final cuspid space
closure.
 Consolidation.
 Idealization

Extraction Therapy
 Initiation
 Lower arch-utility arch
- band 2nd
molars.
 Upper arch - TPA
-headgear
-utility
-2nd
molars

Extraction Therapy
 Cuspid retraction and uprighting
 Angulation of the cuspid
- Mesially tipped-1/3 of the extraction space

Extraction Therapy
 Bicuspid and cuspid – initial overlay wire
followed by a simple helical loop.(0.16
NiTi)
 Remaining 2/3 – rigid overlay wire.(0.16
Wallaby)

Extraction Therapy
 Upper arch
 Upper arch-depends on the position of the
incisors
a) Good position-16 x16 vertical closing helical
loop.
b) Need to be engaged at the onset of the
treatment-0.16 round overlay wire.

Extraction Therapy
 Traction and final cuspid space closure
 Cuspids have almost retracted and bite has
opened sufficiently-traction arches are
placed.(17x 25 NiTi or TMA)
1. Allow final incisor alignment
2. Correct details of the arch form
3. Allow for final root paralleling ,torquing in
cuspid and bicuspid region.

Extraction Therapy
 Consolidation
 This is done achievement of good arch form.
 Lower retraction-1 or 2 month ahead.
-16 square helical continuous
closing arch.
 Upper retraction-
- if they are proclined with no torque
requirement -016 round wire

Extraction Therapy
-if in good relation-16 square or 16 x 22
closing loop
-if additional torque is needed –retraction utility
is used.
-if ant intrusion and post extrusion –combination
crossed “T” horizontal closing loop is used.

Extraction Therapy
 Idealization
 Rigid edgewise coordinated arches (17x25
PAR).
 Light round wires.(0.14 or 0.16 Wallaby)
X “Start with round wires, finish with edgewise”

Non extraction therapy
 Initiation.
 Transition.
 Traction.
 Idealization.

Synopsis Non Extraction
Therapy
 Initiation –
 Orthopedic appliances.
 Base arches to set up the
anchorage.
 Overlay wires.

Therapy
 Transition
 After leveling and
aligning of the arches.
 Correct rotation and
spacing
 Resilient arches.

Therapy
 Traction
 Lower arch set up –to
allow Class II elastics.
 Upper buccal segments
are leveled
 Traction sections in
upper arch

Therapy
 Idealization
 Final arches used to
achieve arch
coordination.
 Use of light round wires.

Bio progressive therapy Mechanics For Class II Div II

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Bio progressive therapy Mechanics For Class II Div II