Varix simplex

DEPT OF ORTHODONTICS& DENTOFACIAL
ORTHOPAEDICS
PEOPLES DENTAL ACADEMY
BHOPAL(M.P)
– PRESENTED BY
– DR BHAGWAT R. KAPSE
– FINAL YRS PG STUDENT
The Alexander
Orthodontic
Philosophy
VERIX SIMPLEX1/16/2015 1

FROM TWEED TO VARI-
SIMPLEX
 0.022 bracket slot
 Treatment in
mandibular arch
Uprighting mand. 1st
molars
 Uprighting lower
incisors
Non-extraction
treatment Cervical
facebow VERIX SIMPLEX1/16/2015 2

The Alexander Orthodontic
Philosophy
• VARI -Variety of bracket types
• SIMPLEX -Concept of keeping all aspects
of the treatment as simple as possible
• (KISS principle –keep it simple, sir)
DISCIPLINE -Orthodontist must be
knowledgeable & regular in follow-up

APPLIANCE DESIGN (1978)
• Vari-simplex brackets –
• 0.018 SLOT
• Pre-torqued,
• Pre-angulated and exhibit specified bracket
base thickness to reflect in/out
considerations

APPLIANCE DESIGN
• Factors determining the design of the
VSD appliance -
1. Sizes & shapes of the teeth
2. Accessibility of tooth
3. Patient comfort
4. Bracket wing breakages

APPLIANCE DESIGN
• 5 factors which define bracket system
• - bracket types, placement positions,
angulations, torques, and in/outs
• Advantages
• -Fewer wire bends are made
• -Quality control is improved
• -Treatment times are shortened
• -Fewer wire changes are required

BRACKET TYPES
 Twin brackets
• (Mini diamond brackets)
 Rhomboid shape
 Inter-bracket width
Rotational control
Torquing ability
 Smooth & less irritable

APPLIANCE DESIGN
 Lang brackets (Dr. Howard Lang)
 Round surfaced teeth
 Teeth at corners of the mouth
 (Max. & Mand. Cuspids)
• WEDGE SHAPED IN PROFILE

APPLIANCE DESIGN
Lewis or Steiner

APPLIANCE DESIGN
Advantages of Lang brackets over twin
brackets
 Twin brackets on canines reduce inter
bracket distance
 Full bracket engagement is difficult

APPLIANCE DESIGN

Lewis bracket
• Large round surfaced teeth that are not at
the corners of the mouth

APPLIANCE DESIGN
• Useful in rotated teeth

APPLIANCE DESIGN
• Other attachments
• Twin bracket with convertible sheath on
first molars
• Distal offset -150 in upper tube
• - 50 in lower tube
• Single buccal tubes on second molars.

BRACKET POSITION
• Bicuspid bracket height (X) is the key to position all brackets
• MAXILLARYARCH
• CI – X
• LI - X - 0.5
• C - X + 0.5
• BC - X
• FM - X - 0.5
• SM - X -1.0
• MANDIBULAR ARCH
• CI - X - 0.5
• LI - X - 0.5
• C - X + 0.5
• BC - X
• FM - X – 0.5

BRACKET ANGULATION
(Tip or second order bends)

BRACKET TORQUE ( Third order bends )

Bracket IN / OUT ( First order bends)
• MAXILLARYARCH
• CI – Standard
• LI – Thick
• C & BC – Thin
• MOLARS – Thinnest
• MANDIBULAR ARCH
• CI, LI, & C – Thick
• BC - Thin M - Thinnest

EXTRA-ORAL FORCES
• Milwaukee brace therapy
• Kloehnn cervical headgear
• RETRACTOR
• (Dr.Fred Schudy)

EXTRA-ORAL FORCES

EXTRA-ORAL FORCES
• Indications for use
• The choice of the appliance is determined by
the amount of horizontal mandibular growth
expected
• Cervical facebow SN-MP < 370
• Combination facebow SN-MP 370 to 410
• High pull facebow Sn-mp > 420

EXTRA-ORAL FORCES
• Effects on 3 dimensions
• Sagittal dimension
• Vertical dimension
• Transverse dimension
• Anchorage control

Components of a Facebow system
• Molar tubes - gingivally to move molar
bodily - occlusally for orthopedic correction
• Adv; easy to insert the inner bow easy to
clean facilitates the use of omega loops

Components of a Facebow system The
outer bow

Components of a Facebow system The
inner bow

EXTRA-ORAL FORCES
• Retractor system parameters
• Force Initially -8 ounces of force
• Next -16 ounces of forces
• Time
• ANB is 30 or less -during sleep
• 3 to 50 -10hours /night
• > 50 -14hours /day or more

EXTRA-ORAL FORCES
Patient cooperation
 Checking neck / head strap
 Checking molar tubes
 Checking molar mobility

EXTRA-ORAL FORCES
• Orthopedic and Orthodontic forces
• For orthodontic forces
• -anterior attachments
• For orthopedic forces
• -headgear tubes -maxillary arch should be
bonded or banded -tie backs

Effects on SNA

EXTRA-ORAL FORCES
• Molar Distalization
• How far a maxillary molar be distalized using
a retractor ?
• Position of second and third molars

USE OF ELASTICS
• Adverse effects
• Loss of anterior torque
• Mandibular incisor advancement
• Extrusion of mandibular molars
• Occlusal plane tipping
• Used on finishing wires Continuous wear

Use of elastics - specifications

• Use of elastics- Class II elastics

Use of elastics- Class II elastics
• Proper timing is critical
• Not used to open the bite
• Class II elastics can keep the mandible in
fossa
• Skeletal growth
• Used to burn anchorage

Use of elastics-
• Class III elastics
• INDICATIONS
• An anterior dental crossbite Mandibular arch
crowding

• Use of elastics-
• More vertical vector than class II elastics
Distal position of condyle

Use of elastics
• -Mid line elastics
• ½ “ , 6 ounce elastics
• 24hrs / day
• During finishing stages

Use of elastics –
• Box elastics
• Worn during the final stages of the treatment to
improve interdigitation 3/16” ,
• 6 ounce Anterior box elastics –to increase the
overbite

Use of elastics -
• Box elastics
• Lateral boxes improve the cuspid function

Use of elastics -
• Box elastics Buccal boxes help to settle the
posterior occlusion Close the posterior open
bite

Use of elastics
• Triangular elastics
• Crossbite elastics

Use of elastics
• –up and down elastics
• Finishing elastics ‘W’ with a tail in class II
cases ‘M’ with a tail in class III cases

Use of elastics
• Extra-oral elastics ½”,
• 14-16 ounce Coil springs

The use of arch wires VSD does not
rely on wire bending
• Closing loops
• Omega loops
• Other bends ( step-up or step-down and
individual torque bends)
• Third order bends

The use of arch wires
• Tying back of orthodontic wires
• Active tie-back (0.014 ligature wire)
• 1. Consolidate the arch when extra-oral force
is being applied
• 2. Used after closing extraction spaces

• Initial archwires in the maxillary arch 0.0175
multi-stranded
• Respond wire or 0.016 NiTi ( flexible & less
force on the teeth)
• Next visit – 0.016 SS round wire

• Initial archwires in the mandibular arch
Depends upon the torque requirements 0.017
X 0.025 multi-stranded D-Rect wire in
noncrowded arch
• 0.016 X 0.022 D-Rect wire crowding cases

• Intermediate to final archwires
• MAXILLARY
• TMA wire is used when slight rotations are
present ( 0.0175, 0.016 X 0.022 and 0.017 X
0.025 )
• MANDIBULAR
• 0.016 X 0.022 and 0.0175 TMA or SS

• In extraction case
• Retraction is done with 0.018 X 0.025 SS
closing loop wire in max. arch

use of arch wires
• In extraction case 0.016 X 0.022 SS closing
loop
• In deep bite cases

• Finishing wire in all cases in both arches is an
0.017 X 0.025 SS ( 5 months )
• Heat treating To maintain bends

The use of arch wires –
• Arch forms For upper arch

The use of arch wires -
• Arch forms Lower arch forms ( Dr. Garland
McElvain ) ‘U’ shaped ‘V’ shaped

Non extraction treatment
• Each orthodontic problem should be diagnosed
as non-extraction whenever possible .
• Fuller and esthetic smile
• Good posterior occlusion

Non extraction treatment –Borderline
cases
• Bonding does not require inter-dental space
• Inter-proximal reduction
• -50 torque in lower anteriors and –60
angulation in lower first molars
• Advent of rectangular flexible arch-wires
• Patient co-operation

Non extraction treatment
• Slenderizing (inter-proximal stripping)
• ½ mm per tooth can be reduced Dome stripper
Diamond disk

Non extraction treatment -
• Class II Div 1 Maxillary arch
• 1. Placing brackets on the mandibular
anteriors cause occlusal interferences
• 2. Biteplate in deep bite cases
• 3. Original mand. Arch form can be
maintained longer
• 4. More time is allowed for mand. Second
molar to erupt.

Non extraction treatment -
• Class II Div 2 Conversion of div 2 as div 1
Biteplate after

Case reports

Case reports Class II Div II

Extraction treatment
• Indications for bicuspid extractions
• Cases with extreme arch length discrepancy
• Cases with bimaxillary alveolar protrusion .

Extraction treatment -
• DRIFTODONTICS

Extraction treatment
• Arch wire sequence in Class II Div 1
MAXILLARYARCH
 More crowding than non-extraction cases
 -leveling & aligning with flexible wires -
Interference with tip of max. cuspid
 -cuspid retraction on 0.016 round SS wire ( 4-
6 months )
 Power chain –250-300gms of force

Extraction treatment -
Class II Div 1
Space closure on 0.018 X 0.025 closing loop
( 0.016 X 0.023 in the posterior region )
1mm activation
Gable bend in deep bite ( 20-300 angle )
 Finishing wire 0.017 X 0.025 SS

Extraction treatment - Class II
Div 1
• MANDIBULAR ARCH
• Driftodontics of 4 to 6 months
• Anterior retraction with 0.016 X 0.022 SS
loop ( 6 anteriors together –4 months )
• 400 gable bend in deep bite cases
• Finishing wire 0.017 X 0.025 SS

Finishing & retention
procedures
• The problem of retention must be solved during
treatment or it will not be solved at all
• -Dr. Fred Schudy
• Pleasing balance, correct occlusion, healthy
tissues, long term stability
• -Dr. Tweed
• Objectives of VSD
1. -quality results
2. -non-extraction treatment
3. -teeth placed in ideal positions

Finishing & retention
procedures
• When does retention begin ?
1. Ideal occlusion
2. No CO-CR discrepancy
3. Normal Overjet & overbite
4. Artistic positioning of anteriors Spread out
lower incisor roots
5. Correct torque of upper & lower incisors

• Finishing & retention procedures

Finishing & retention procedures
• 7. Lower inter canine width must be
maintained
• 8.Lower first molar should be upright
• 9.Habits should have been eliminated
• 10.Midlines should coincide
• 11. Correct arch form
• 12.Correct curve of Spee

The count-down to retention
• Appointment 1 - sectioning of wires and
finishing elastics
• Appointment 2 (3 wks later ) - occlusal check
and final adjustments, and possible sectioning
of the opposing arch wire
• Appointment 3 (3 wks later ) - fixed appliance
removal Appointment 4 (2 days later ) -
seating of the retainers

• Appointment 1
• Arch wire sectioning
• Deep overbite/Class II -lower arch wire is
sectioned Open bite/Class III -upper arch wire
is sectioned

• Normal bite Either or both arch wires

• Appointment 2 (3 wks later )
• Max.molar bands are removed
• Patients are asked to chew sugarless gum
Elastics –night wear Tooth shaping

• The count-down to retention
• Appointment 3 (3 wks later )
• o Complete appliance removal
• o Inter-proximal stripping
• o Impressions for final models
• o 3rd molars are considered
• Appointment 4 (2 days later ) Retainers

Retention
• Maxillary retainer
• -Wraparound retainer

Retention
• Mandibular retainer
• 0.0215 multi-stranded wire

Retention
• 0.036”
• BANDED /BONDED

• Special problems
• Equilibration
• Spacing
• 5/16”, 31/2 ounce

References
• Technique and treatment with light-wire edgewise
appliances (volume I and II) - J.R.JARABAK
• THE ALEXANDER DISCIPLINE Contemporary Concepts
and Philosophies - R.G.”WICK” ALEXANDER
J.A.FAZZEL
• Face Bow Correction Of Skeletal II Discrepancies in the
Alexander Discipline -C. D Alexander
• The Alexander Discipline Appliance Design and
Construction -M.Alan.Bagden
• Seminars in Orthodontics, Vol 7, No 2 (June), 2001
• Finishing and Retention Procedures in the Alexander
Discipline -Tucker Haltom J M. Alexander
•

Varix simplex

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