ORTHODONTIC-Gurkeerat Singh-Textbook of Orthodontics (2007)

Removable Orthodontic Appliances 443

Fig. 38.12P: Triangularclasp Fig. 38.12R: Crozat's clasp
Fig. 38.120: Ball-endclasp
a support for pressure sources and distributes the
reaction of these forces to the anchorage areas.

USES OF BASE PLATE

1. It incorporates both the retentive and active
components into a single functional unit.

2. It helps in anchorage and retention of the appliance
in the mouth.

3. It helps resist unwanted drift during tooth
movement.

4. It distributes the forces from the active components
over a large area.

5. It protects the palatal springs against distortion in
the mouth (Fig. 38.3B).

6. Bitie planes can be incorporated into the base plate
and used to treat specific problems.

THICKNESS OF BASE PLATE

Base plates should not be made unduly thick. It should
be of minimum thickness to be comfortable to the
patient. A single thickness of wax (1.5-2 mm) is suffi-
cient in upper base plates. Base plate should not be
thickened over a rea to embed the tags of the clasps
(Fig. 38.13B) if the base plate is thick it fills up the
mouth, interferes with speech and will not be tolerated
by the patient.

EXTENSION OF BASE PLATE

In maxillary arch, if too much of the palate is covered
by acrylic, it can produce nausea for the patient. This
problem can be minimized by extending the base plate

444 Textbook of Orthodontics

tiJI the distal of the first molar and slightly cutting it Fig. 38.130: Cross-section of a mandibular plate in the posterior
forward in the midline (Fig. 38.13C). This ensures area. The borders should be rounded (right). sharp (left).
adequate strength and gains maximum anchorage at Undercuts should be filled in (green)
the same time.

The lower base plate is not extended too deep to
avoid irritation to the sulcus and displacement by the
tongue. In case of a lingual undercut, the undercut
should be blocked before acrylization (Fig. 38.130) to

Fig. 38.13A: The acrylic base plate facilitate easy removal. The edges should be rounded
to avoid tissue injury (Fig. 38.130).

Modification of Base Plate

Bite platforms, whether anterior or posterior can be
incorporated into the base plate.

Anterior bite planes (Figs 38.13£ and 38.13F) are
required for overbite reduction and are made behind
the incisors and canines. The biteplane should be flat
and not inclined. This is to avoid proclining forces on
the mandibular incisor teeth. The thickness should be
sufficient to open the bi te in the premolar region by 4-
5 mm. As the overbite reduces, additional acrylic can
be added to raise the platform and continue overbite
reduction. Grooves can be provided in the anterior bite

Fig. 38.138: Cut section of maxillary base plate

Fig. 38.13C: 'U' shaped maxillary base plate Fig. 38.13E: A correctly executed flat anterior bite plane

Removable Orthodontic Appliances 445

Fig. 38.13F: Anterior bite-plane

plane to support the incisal tips of the mandibular Fig. 38.13G: For mandibular incisor edges
incisors (Fig. 38.13G). Also, the maxillary incisors may
be capped to prevent their supra-eruption or flaring
(Fig. 38.13H). It also aids in retention and increases
the anchorage potential of the appliance. An inclined
guide plane can also be provided as a modification of
the anterior bite plane (Fig. 38.131).This will cause the
patient to bite more forward as compared to normal
and may cause the mandible to grow forward. It can
also procline the mandibular incisors.

Posterior bite planes (Fig. 38.13J) are used mainly
when teeth have to be pushed over the bite. The height
of the platform should be sufficient enough to free the
teeth, that are to be moved, from occlusal interference
with the opposing teeth. It is better to adjust the
posterior bite planes to obliterate the freeway space
to aid compliance.

446 Textbook of Orthodontics

faster to fabricate. However, care must be exercised
to ensure that laboratory processing has eliminated
as much residual monomer as possible, which also
reduces the porosity in the appliance.

Fig. 38.13H: Anteriorbite plane with"capped" DELIVERY OF REMOVABLE APPLIANCE
maxillary incisor
At the time the appliance is to be delivered, a number
of things should be checked:
1. Prior to placing the appliance, clinician should

check for any minute pimples due to blow holes in
the cast that could irritate the mucosa and the free
edges should be rounded and smooth.
2. The base plate may need some trimming while
fitting the appliance in the mouth.
3. Once the appliance is inserted, check for the
position of the active and retentive components.
The wire components should not irritate/ impinge
on any soft tissues. Clasps should fit the teeth
accurately.
4. Show the patient in a mirror how to insert and
remove the appliance.
5. The patient should be called for a recall visit every
3 weeks.

INSTRUCTIONS TO THE PATIENT

Fig. 38.131: Schematicdrawingof an inclined The success of any removable appliance is certain if
anteriorguide plate the patient follows the instructions carefully. The
patient and parent should be adequately counseled
The material of choice for the framework is usually verbally and it should be reinforced with a written list
cold cure acrylic, although heat cure acrylic can also of 'do's and don'ts'.
be used. This is because it is easy to use and much 1. The patient should be shown in a mirror the

insertion and removal of the appliance. Insist that
the appliance be maneuvered by the bridges of the
clasp and not the labial bow or springs.
2. Patient should be instructed to wear the appliance
for 24 hours a day and to remove the appliance
only while brushing and also during contact sports
and swimming.
3. A high standard of oral hygiene should be insisted
upon to avoid the possibility of enamel decalcifica-
tion.
4. The patient should be instructed to clean the
appliance by brushing it with soap and water. Care
should be taken while cleaning so as not to bend/
distort any component.

Removable Orthodontic Appliances 447

•I

Fig. 38.13J: Posterior bite-plane

5. In case of pain or appliance damage, patient must COMMON FAILURES FOR
be told to report immediately to the clinic. NO TOOTH MOVEMENT

6. Patients having an appliance with screws should ANTEROPOSTERIOR MOVEMENT
be given instructions on how to activate the screw.
Reduction in Overjet
7. Patients should be instructed not to leave the appli-
ance out of the mouth for a long period of time as • Sometimes, upper incisors may not be retracted as
it enhances chances of it getting damaged or efficiently. The reason may be that acrylic has not
distorted. been removed behind the upper incisors.

8. Care should also be taken to keep the appliance • Another reason may be the presence of an overbite,
away from pet animals when the appliance is not which prevents incisor retraction.
being worn.

448 Textbook of Orthodontics

Proclination of upper anteriors Inadequate clearance food traps are not created which also increase the
of occlusion prevents teeth from moving anteriorly. incidence of caries.
ii. Soft tissue irritation can result if the appliance,
Vertical edges are sharp and not rounded off. There should
be no sharp nodules and the edges should be
The anterior /posterior bite planes should be of such a smooth to avoid soft tissue irritation and
height that they do not obliterate the freeway space. ulceration, Wire components can also cause irrita-
Thickness of the bite plane can be increased once tion, e.g. loop of the labial bow can cause vesti-
neurophysiological adaptation has taken place. If the bular irritation.
bite plane is too thick it will not be worn by the patient. lll. Excessive forces applied by the active components
Insufficient height of bite plane will not reduce the can sometimes cause pain or tenderness in the
overbite or, in case of posterior bite planes, will not teeth, Care should be taken to apply only the
eliminate occlusal interference. optimum amount of force,
iv. Excessive force can also result in tooth mobility,
Transverse Movement This can also occur in cases of traumatic occlusion.

Failure to activate the screw will lead to lack of FURTHER READING
expansion. Proper instructions should be given to the
patient and/or parents. In some cases, lower molars 1. Adams CP., The Design and Construction of Removable
also expand at the same rate as the upper molars Orthodontic Appliances, 4th edition? John Wright and
because of good intercuspation between the two. Sons, Ltd. Bristol 1970.
Clinically, no improvement of the crossbite is seen;
lower intermolar distance should be measured to 2. Badcock JH. The screw expansion plate. Trans. Brit. Soc.
identify this problem. Orthod pp 1911;3-8.

Patient Compliance 3. Banks PA, Carrnichael G. Modified arrow-head clasps for
removable bitepianes. J Clin Orthod 1998;32:377-78.
The success of any removable appliance is dependent
on patient compliance. Compliance can be improved 4. CrozatGB. Possibilities and use of removable labiolingual
by providing a good fitting, well-designed appliance spring appliances. .lnternat J Orthodontia 1920;6:1-7.
and giving clear instructions to the patient.
5. Graber TM, B Neumann. Removable Orthodontic
PROBLEMS ENCOUNTERED IN REMOVABLE Appliance, WB Saunders Co. Philadelphia, 1977.
APPLIANCE THERAPY
6. Locks A, Westphalcn CH, Ritter DE, Ribeiro GV, et al. A
i. Lack of oral hygiene maintenance will lead to new wraparound retainer design. J Clin Orthod
gingival inflammation and enamel hypoplasia. 2002;36:524-26.
Patient should be instructed to clean the appliance
as well as maintain the oral hygiene. Improper 7. Noar]H, Evans RD. Rare earth magnets in orthodontics:
cleaning of the teeth can also result in caries. an overview, Brit J Ortho 1999;26:29-37.
Appliance should be designed in such a way that
8. Nord CFL. Loose appliances in orthodontia. Dental
Cosmos 1928;70:681-87.

9. Schwarz AM, M Gratzinger. Removable Orthodontic
Appliances. WB Saunders Co, Philadelphia, 1966,

10. Tulley Wj, AC Camp bell. A Manual of Practical
Orthodontics. J Wright and Sons, Bristol, 1960.

11. Zachrisson BU. Bonding in orthodontics. In Graber TM,
Vanarsdall RL(Eds). Orthodontics: current principles and
techniques, ed 3, St Louis, Mosby.

Fixed Orthodontic
Appliances

Gurkeerat Slngh

• Introduction • Contraindications to fixed orthodontic appliances
• Advantages of fixed orthodontic appliances
• Disadvantages of fixed orthodontic appliances • Components of fixed orthodontic appliances

• Indications of fixed appliances o Active components

(1 Passive components

INTRODUCTION as retracted simultaneously. Also, different teeth
can be moved in different directions at the same
As the name suggests, fixed orthodontic appliances time, i.e. while one tooth is being derotated another
include orthodontic devices, which have attachments can be retracted, ete.
that are fixed on to the tooth surface, and forces are 3. Patient cooperation is reduced in comparison to
exerted via these attachments using arch wires and / removable appliance wear, but cannot be dis-
or other auxiliaries. The appliances cannot and should pensed with completely.
not be adjusted or removed by the patient.
DISADVANTAGES OF FIXED
With fixed orthodontic appliances the control over ORTHODONTIC APPLIANCES
treatment mechanics shifts more directly into the
clinicians hands and the patient is restricted to simply 1. Oral hygiene requirement Oral hygiene maintenance
maintaining the appliance and oral hygiene and may becomes more difficult. Food debris tend to
be changing certain force applying devices, e.g. accumulate around the attachments and their
elastics. Patient compliance is rarely a problem. The removal becomes difficult.
control achieved with fixed orthodontic appliance is
far greater as compared to removable appliances and 2. Esthetics Fixed appliances are generally made of
the teeth can be moved virtually in all the three planes metal that might not be esthetically acceptable to
of space. the patient. The advent of the lingual technique and
tooth-colored brackets (made of ceramic/ compo-
ADVANTAGES OF FIXED si tes / fiber glass) has helped overcome this
ORTHODONTIC APPLIANCES disadvantage to a large extent.

1. Precise tooth control is possible. The movement 3. Special training for operator Only orthodontists are
achieved is precise and makes it possible to move trained to handle and monitor these appliances.
individual teeth in the three planes of space to Special training is a must to achieve acceptable
achieve perfect alignment of teeth both inter and results.
intra arch.
4. increased cost of treatment Fixed orthodontic
2. Multiple tooth movements are possible. Individual appliances are costly as compared to removable
teeth can be moved in all the three planes of space appliances. The attachments used with these
simultaneously, i.e. a tooth can be intruded as well appliances are expensive and hence, the cost of the
treatment goes up.

450 Textbook of Orthodontics

5. Increased chair side time Since the appliance is fixed, which is within the preview of their curriculum and
and cannot be removed from the patient's mouth, should not try behaving as orthodontists without
hence, all adjustments have to be made in the undertaking proper training from a recognized
patient's mouth by the operator. This increases the institution.
chair side time. .
COMPONENTS OF FIXED
6. Anchorage control is more difficult as compared ORTHODONTIC APPLIANCES
to removable appliances.
The components which form any fixed orthodontic
7. Treatment monitoring is more difficult. The patient appliance system can be divided into two categories
has to be recalled at regular intervals for appliance depending upon their ability to generate forces:
adjustments/ reactivations. Long-term monitoring
is essential to achieve stable results.

INDICATIONS OF FIXED APPLIANCES ACTIVE COMPONENTS

Fixed orthodontic appliances are indicated whenever These include components which are capable of
multiple tooth movement is required, e.g. intrusion, generating tooth moving forces. These include:
derotation, controlled space closure at extraction sites, a. Separators
bodily movement, extrusion or torque control, etc. b. Archwires
c. Elastics
CONTRAINDICATIONS TO FIXED d. Elastomerics
ORTHODONTIC APPLIANCES e. Springs
f. Magnets

1. Poorly motivated patient The patient should under- Separators
stand that his/her cooperation will be required Separators are used to create spaces in between two
throughout treatment. The patient's responsibility adjacent teeth, generally for the purpose of banding
is not limited to maintaining good oral hygiene but them.
will also involve wearing elastics and/ or headgear
and keeping appointments at regular intervals, etc. Initially soft brass wires, wires of 0.5 or 0.6 mm
diameter were passed interdentally and twisted (Fig.
2. Poor dental health A patient, who does not maintain 39.1) to create space. These brass wire separators were
oral hygiene routinely, cannot be expected to painful, the force exerted was not controlled and the
maintain the stringent oral hygiene procedures twisted end often caused laceration injuries to the
required with fixed appliances in place. Careful buccal mucosa and/ or gingival (Fig. 39.2).
consideration should be given to the patient's perio-
dontal status as well. Patients with poor oral Fig. 39.1: Brass separators in place medial and
hygiene are more likely to suffer from periodontal distal to the maxillary left first molar
diseases.

3. Malocclusions beyond the scope of fixed orthodontic
appliances Malocclusions that are skeletal in nature
or otherwise beyond the scope of orthodontics
should not be attempted. If the patient refuses
surgical intervention as part of an orthodontic
treatment plan, he should be properly counseled
regarding its necessity rather than proposing
compromises and not achieving stable results.

4. Appropriate training of operator Only orthodontists
are qualified to impart treatment using the fixed
orthodontic appliances. Care should be taken by
students of dentistry, to only attempt something,

Fixed Orthodontic Appliances 451

Fig. 39.2: Laceration injurycaused because of loosening of Fig. 39.3A: The short arm of the separator is held in a
the twisted end of the brass separator Weingart plier

Kesslyillg separators These are made of 0.016" special Fig. 39.3B: The long, hooked arm is placed under the
plus Australian wire with he1ices at the closed end (Fig. contact point and the short arm is pulled laterally by the plier
39.3A). The open straight arm passes below the contact
(Figs 39.3B and C) sufficient space is created within 48
hours of application.

Ring separators These are small elastic rings (Fig. 39.4A)
that are stretched and passed through the interdental
contacts using the separator placing pliers (Figs 39.4B
and C) or using two pieces of dental floss (Fig. 39.4D).
The elastic materia I used to make these ring separators
can be either round or with edges. Round ring
separators are the most comfortable for the patient as
they fit snugly in the interdental region (Fig. 39.4£).
Separation takes about 7 days.

Dumb-bell separators These consists of a dumb-bell
shaped piece of elastic that is stretched and passed
through the contacts between adjacent teeth (Fig. 39.5).
The elastic of the separator constricts over time to
regain its original space and causes separation.

Archwires

Archwires are available of variable dimensions and Fig. 39.3C: The separator is rotated into positionwiththe long,
materials (discussed in detail in Chapter 30). Archwires hooked arm of the separator over the contact point and the
are available in the prefabricated mould. They may
be of various shapes depending upon the arch form short arm under the contact point
type (Fig. 39.6). The arch form closest to the patient
should be chosen unless some change is planned in
the arch width.

452 Textbook of Orthodontics

Fig. 39.4A: Elasticseparators. The lose ones have a rectangular Fig. 39.40: Placement of elastomeric separators using dental

cut section whereas the ones on the stick are round floss. Two pieces of floss are placed through the hole in the

center of the separator and are held one in each hand

Fig. 39.4B: The separator-placing plier

Fig. 39.4E: Snugly fittingelastic separators

Fig. 39.4C: Separator-placing plier with a separator Elastics
stretched on its beaks
Elastics (Fig. 39.7) can be of latex or non-latex material.
Non-latex elastics deteriorate less as compared to the
latex elastics in the oral environment.

Elastics are available in various strengths, which is
dependent upon their diameter and thickness. The
elastics are chosen according to the purpose of their
use. They may be color coded according to strength.

Elastics are used mainly in the following six ways.

Class I elastics These are intra-arch elastics placed
mainly between the molars and the anteriors in the
same arch (Fig. 39.8). They are used to close the

Fixed Orthodontic Appliances 453

Fig. 39.5: Dumbell separator

Fig. 39.6: Various arch forms

44 Textbook of Orthodontics

Fig. 39.7: The various elastics used in routine practice Class 11 elasties These are intermaxillary elastics
placed between the mandibular molars and maxillary
extraction spaces by retracting the anteriors (lighter anterior (Fig. 39.9). These elastics may be used to
force elastics) or protraction of posterior teeth (heavier produce intrusion of maxillary anterior (Begg therapy
force elastics). stage I) or decrease the over jet by retracting the
maxillary anterior.

Class HI elasties These are again intermaxillary
elastics placed between the maxillary molars and
mandibular anteriors (Fig. 39.10). These are generally
used in the treatment of Angles Class III rnalocclusions
to bring about the retraction of mandibular anteriors
and protraction of the maxillary molars.

Diagonal elasties These are worn generally for the
correction of midline deviations. The elastic is worn
across the anterior teeth diagonally (Fig. 39.11).

Fig. 39.8A: Class I elastics, the horizontally placed green Fig. 39.9: Class 11elastics are placed between the
elastics seen in the above photographs mandibular molars and the maxillary anteriors

Fig. 39.8B: Horizontal pink colored elastics are Class I elastic Fig. 39.10: Class III elastics

Fixed Orthodontic Appliances 455

maxillary and mandibular anteriors like a 'box',
causing the distal tipping of the maxillary anterior
and/or forced eruption of the maxillary and/or
mandibular anteriors.

Extraoral elastics These elastics are used in
conjunction with extraoral appliances like a face mask

Fig. 39.11: Diagonal elastic worn to correct the rnidline

Cross bite elastics These intermaxillary elastics are Fig. 39.14; Extra-oral elastics (arrows)
used to correct cross bites in the buccal segments (Fig.
39.12). Their placement is dependent upon the tooth (Fig. 39.14). Generally exert high forces (8 oz to 14 oz)
in cross bite, generally from the palatal surface of the
maxillary molars or premolars to the buccal of
mandibular molars or premolars. Small dimension
elaslics are used for this purpus~.

Box elastics These elastics are used to correct anterior
open bites (Fig. 39.13). They extend between the

Fig_ 39.12: Cross bite etastics Elastomerics
Fig. 39.13: Box elastic
Elastomerics are used in various forms along with
fixed orthodontic appliances. These are generally
made of synthetic polyeurythane materials. The
various forms of elastomerics used are:

Elastic chains More commonly referred to as E-chains.
These are mainly used for space closure (Fig. 39.15).
These "re available in three different strengths based
on the distance between the rings as continuous (Fig.
39.16A) or closed short (Fig. 39.16B) and long (Fig.
39.16C).

Elastic thread or cotton thread Made of special
elasticized cotton, it is used to exert forces, which are
used to correct derotations, consolidation of anterior
spacing (Fig. 39.17), etc.

Elastic ligatures These are used to secure the archwire
in edge wise or pre-adjusted edgewise brackets (Fig.
39.18A). These can be easily engaged under bracket
tie wings. They are available in various attractive
colors (Fig. 39.18B).

456 Textbook of Orthodontics

Fig. 39.15: E chain being used for space closure

Fig. 39.16A: Continuouselastic chain Fig. 39.17: Figureof 8 placement of the cottonthread
Fig. 39.16B: Closed or short elastic chain
Elastic modules or elastomeric links They are made
of two elastic rings separated by a variable distance.
They are available in variable sizes based on the
interring distance (Fig. 39.19). These are generally used
to closed spaces or for derotation of teeth.

Springs

Various types of springs are used as auxiliaries to
generate tooth moving forces. Springs are mainly used
for tooth uprighting and torguing in the Begg's
appliance therapy and the tip edge appliance. Springs
may be used to open spaces (open coil springs) or to
close spaces (closed coil springs). Springs used along
with the fixed orthodontic appliances are:

Fixed Orthodontic Appliances 457

0-<> o~-~o-

0-0 0>----<0-

Fig. 39.18A: Elastic ligatures holding the wire Fig. 39.19: (A) E-1 thru E-4 smaller sizes, (B) E-5 thru E-B
in the bracket slot larger sizes

• Uprighting springs
• Rotating springs
• Torquing springs
• Open coil springs
• Closed coil spring

Uprighting springs Generally made of 0,012" or 0.014"
Australian wire. They move the tooth root in a mesial
or distal direction (Fig. 39.20). The standard designed
spring can be used with the Begg and the Tip-edge
brackets whereas, the side-winder design was
especially made for use with the Tip-edge bracket.

Rotating springs Rotating springs, as the name
suggests, provide for a simple and effective means of
derotating teeth without the removal of the archwire.
These springs are used in the vertical slots of the Begg
and the Tip-edge bracket. They are capable of both
clockwise and counter clockwise movement
depending on their design (Fig. 39.21).

Torquing springs Torquing springs are usually made
of 0.012" or 0.014" Australian wire. They are capable
of moving the tooth roots in a labial or lingual/palatal
direction (Fig. 39.22). Force is generated when the

'N!!¥::jj,I.§ Fig. 39.20: Mesiodistal
uprighting springs

Fig. 39.18B: Elastic ligatures available in Fig. 39.21: Rotating -. ~ mrazI1D
various attractive colors springs

58 Textbook of Orthodontics

Fig. 39.22: Torquing spring used for buccolingual Fig. 39.23: Open coil spring in place
root movement

spring is deformed and engaged along the archwire.
Force is transmitted to the tooth crown by the spurs,
which contact the teeth.

Open coil springs Open coil springs are either made
of stainless steel or nickel titanium alloy. The force
exerted also, depends upon the diameter of the wire
of which the spring is made. The spring of appropriate
length is compressed between two or more teeth to
open up the space between its points of attachment
(Fig. 39.23).

Closed coil springs Closed coil springs can be made
of stainless steel or nickel titanium alloys. They are
used to close spaces. Once the spring is stretched and
attached at two ends, it tries to achieve its prefabricated
length by closing the ga p between its points of
attachment (Fig. 39.24).

Magnets

Magnets have been used along with the fixed Fig. 39.24: Closed coil spring stretched from the molar to
orthodontic appliances for the purpose of space canine bracket for the retraction of the canine
closure as welJ as regaining lost space. For the purpose
of space closure they are used in attraction mode and auxiliaries to the tooth or retaining other active
for rega ining lost space in repulsion mode. components of the appliances. These include:
A. Bands
Magnets used presently are: B. Brackets
• Samarium cobalt magnets-c-SrnCog and Sm2Co,7 C. Buccal tubes
• Neodymium iron boron magnets-e-Nd, Fe'4B D. Lingual attachments

PASSIVE COMPONENTS a. lingual buttons
b. lingual seating lugs
These are those components of the fixed appliances
which are not capable of generating tooth moving
forces but help in providing attachment for other

Fixed Orthodontic Appliances 459

c. lingual eyelets in cross-bite (Fig. 39.30). Banding might also be
d. lingual cleats employed in teeth that have large metal restorations
e. lingual sheaths (structurally weak) or having metal prosthesis/
f. lingual elastilugs crowns (bondings is difficult or weak).
g lingual ball hooks
E. Lock pins
F. Ligature wires

Bands Fig. 39.25A: The band material is welded at
the ends
These are metal attachments that are cemented to
ind ivid ual teeth and provide a place for attachment
of other auxiliaries like buccal tubes, lingual buttons,
etc. These auxiliaries can be either welded or soldered
to the bands.

Bands can be either custom fabricated for
individual teeth (Table 39.1 and Figs 39.25A to F) or
selected from the various sizes available commercially
for different teeth (Fig. 39.26).

Banding is preferred on teeth that are likely to
experience excessive forces, e.g. mandibular molar
(Figs 39.27A and B), mandibular premolars (Fig. 39.28),
maxillary second molars (Fig. 39.29) or anterior teeth

Table 39.1: Steps of banding Fig. 39.258: The band pusher is used to adapt
the band
Step I Separation of adjacent teeth can be ach..ieved using
separators for a duration of 2 to 7 days depending upon the Fig. 39.25C: The band is pinched using a band
separator used. pinching plier or a Howe plier

Step 11 Selection of band material is criticaL Thinner band
material1esser in width is used for anterior (0.010 x 3.80
mm) teeth and thicker band material broader in width is
used for premolars (0.12 x 4.55 mm) and molars (0.15 x 4.55
mm).

Step III Pinching the band-Band material of adequate
length is cut and welded at the ends (Fig. 39.25A). The band
is adapted around the teeth using a band pusher (Fig. 39.258)
and pinched using the band pinching pliers or a Howe pller
(Fig. 39.25C). The pinched band is removed from the tooth
and welded close to the pinched ends. Extra band material
is cut and bent in a distal direction and welded (Fig. 39.25D).
The margins are smoothered and gingivai contouring done
on the mesial and distal gingival margins using a dental
stone (Fig. 39.25E).

Step IV Fixing the attachments-Attachments can be welded
or soldered in place. Weld ing is more commonly performed
(Fig. 39.25F)

Step V Cementation of the band can be done using any of
the luting cements. Adequate moisture control is essential
during cementation. Excess cement can be removed using
an explorer after the initial set of the Juting cement.

460 Textbook of Orthodontics

Fig. 39.250: The extra band material is cut and Fig. 39.26: Commercially available molar bands
welded after bending it distally

Fig. 39.25E: The mesial and distal gingival
aspects are cantored

Fig. 39.27 A: Banded mandibular 1st molars

Fig. 39.25F: The tube or other attachment Fig. 39.278: Mandibular molars are the most frequently
are welded in place banded teeth

Fixed Orthodontic Appliances •
461
Fig. 39.28: Mandibularpre-molars might experience frequent
bonding failures and might require banding

Fig. 39.30: A mandibular incisor which was

in cross bite was banded

Fig. 39.29: Banded maxillary1st and 2nd maxillarymolar

Brackets

A bracket is defined as a device that projects horizontally to Fig. 39.31: A bracket has been welded to a band and cemented
support auxiliaries and is open on one side usually in the on the mandibuiar left canine (black arrow), the rest of the
vertical or horizontal, brackets have been bonded (white arrows)

Brackets are of various types depending upon the
technique used. They are discussed in detail along with
the individual fixed orthodontic appliances and the
chapter on orthodontic materials.

Brackets can either be welded to bands (Fig. 39.31),
which are then cemented to individual teeth or can be
bonded (Table 39,2 and Figs 39.32A to G). Bonding
has its own inherent advantages (Table 39.3) and
disadvantages (Table 39,4) over banding.

Buccal Tubes

Buccal tubes are horizontal hollow tubes, round, • Bondable-bonded directly to the tooth surface
rectangular or oval in shape, They are generally used (Fig, 39.33B)
on molars and help provide better th ree dimensional
control of these anchor teeth. They can be classified b. Classified according to lumen shape as
as: • Round (Fig. 39.34A)
a. Classification based on mode of attachment • Oval (Fig. 39.34B)
• Rectangular (Fig. 39.34C)
• Weldable-can be welded on-to bands (Fig.
39.33A) c. According to the number of tubes
• Single (Fig, 39.35A)

4162 Textbook of Orthodontics

Table 39.2: Steps in bonding Fig. 39.32C: Frosted appearance following etching

Step I Cleaning is done using water slurry of pumice with a
rubber cup or polishing brush (Fig. 39.32A)

Step II Moisture control is achieved using cheek and tongue
retractors in conjunction with cotton rolls and saliva ejectors

Step III Enamel conditioning is generally achieved using
27 percent phosphoric acid in gel on liquid form for 15 to 30
sec. (Fig. 39.32B). After which the etched surface is washed
and dried leaving behind a white frosty appearance (Fig.
39.32C)

Step IV Sealing agent is painted over the entire etched
enamel surface using a small form pellet on brush with a
single gingivo-incisal stroke (Fig. 39.320)

Step V A coat of sealant is also applied on the bracket base.
This is followed by a sufficient amount of composite being
spread on the bracket base. The bracket is accurately placed
under pressure into the tooth surface (Fig. 39.32E). Excess
flash is removed using a sickle scaler (Fig. 39.32F). Brackets
should appear distinct after bonding (Fig. 39.32G)

Fig. 39.320: Primer applied to the teeth

Fig. 39.32A: Cleaning done using pumice powder and
polishing brush

Fig. 39.32E: Bracket placed under pressure

Fig. 39.328: Etchant placed on the teeth Fig. 39.32F: Excess composite removed with a sickle
scaler

Fixed Orthodontic Appliances 463

Fig. 39.33A: Weldable molar tubes

Fig. 39.32G: Bonding of brackets completed

Table 39.3: Advantages of bonding over banding Fig. 39.336: Bondable molar tubes

1. Bonded attachments are esthetically superior • Begg tube (Figs 39.34A and B), round or oval
2. Ttis faster and simpler • Edgewise tube (Fig. 39.35B) rectangular 0° tip
3. It is more comfortable for the patient
4. Arch length is not increased and torque values
5. More precise bracket placement is possible • Preadjusted edgewise (Fig. 39.35C) rectangular
6. Oral hygiene procedures can be performed more easily
7. Proximal stripping can be performed with prescribed in-out, tip and torque values.
8. Composite build-ups can be done on the interproximal

areas
9. Inventory is reduced as various band sizes don't have to

be stored

10. Certain appliances like lingual appliance can only be
bonded

11. No band space is left after debonding
12. Caries or hypo-calcification is generally not a problem

with bonding

Table 39.4: Disadvantages of bonding over banding Lingual Attachments

1. A bonded attachment is weaker as compared to a These are accessory attachments other than brackets
cemented band and tubes which are placed on the lingual aspect of
teeth (bonded) or bands (welded). These include:
2. Rebonding is more complex as compared to re- a. Lingual buttons (Fig. 39.36) Buttons with variable
cementing of bands
shaped bases for attachment of elastics or
3. Debonding is more complex and time consuming than elastomerics. Flat base for centering on molars,
debanding curved for mesial or distal placement on molars or
extra-curved for use on premolars.
4. Bonding on the lingual aspect can be difficult at times b. Lingual seating lugs (Fig. 39.37) These help in seating
5. Bonding might not provide sufficient strength when of bands. Are flat for anteriors and molars and
curved for cuspids and bicuspids.
headgears, etc. are used i.e. auxiliaries which exert c. Lingual eyelets (Fig. 39.38) These are used to tie
large forces are used elastic threads or ligature wires. Hollow in the
6. Protection against interproximal caries is missing middle and welded on the two sides.
d. Lingual cleats (Fig. 39.39) These are again used for
• Double (Fig. 39.35B) used for auxiliary wires or attachment of elastics or elastomerics. Are welded
headgear

• Triple (Fig. 39.35C) three tubes-two rectan-
gular and one large round for headgear or lip
bumper.

d. Classified according to the technique

64 Textbook of Orthodontics

Fig. 39.34A: Round molar tube Fig. 39.358: Double molar tube (Edgewise),
Fig. 39.348: Oval molar tube the headgear tube is placed occlusally

Fig. 39.35C: Triple molar tube
(pre-adjusted edgewise)

Fig. 39.34C: Rectangular tube

Fig. 39.35A: Single molar tube (Pre-adjusted edgewise) Fig. 39.36: Bondable lingual buttons

Fixed Orthodontic Appliances 465

in the middle with the ends being open, are also
available with a mesh base for bonding.
e. Lingual sheaths (Fig. 39.40) These are used for
attaching accessories such as transpalatal arches,
Ni-Ti molar rotators and expanders.
f. Lingual elastilugs (Fig. 39.41) These are used for
attaching elastics and are available as curved for
posteriors and flat for anteriors. Both weldable and
bondable lugs are available.
g. Lingual ball hooks (Fig. 39.42) These are small balls
attached to a weldable flat arm. The offset can be
mesial or distal. They are used to attach elastics or
elastomeric chains/rings from the lingual aspect.

Lock Pins Fig. 39.39: Versatile precision cleats

Lock pins (Fig. 39.43 ) are either made of brass or soft
steel. These are used to hold the wire in bracket slots
in the Begg technique or accessories in the tip edge
techniq ue.

Fig. 39.37: Lingual seating lug welded to a premolar band Fig. 39.40: Lingual sheaths
Fig. 39.41: Elastilugs

Fig. 39.38: Easy-threading eyelets Fig. 39.42: Lingual ball hook

Textbook of Orthodontics

One-point High hat Double Hook Universal
safety pin safety pin safety pin T-pin
pin

Fig. 39.43: Lock pins Fig. 39.44B: Teeth ligated to prevent spaces opening up

Fig. 39.44A: Ligature wire used to hold the 3. Lazzara DJ. Lingual force on the Goshgarian palatal bar.
arch-wire in the bracket slot Unpublished Master's Thesis, Loyola University, Chicago,
1976.
Ligature Wires
4. Lisenby WC, Bowman SI. Accurate band positioning in
Ligature wires are soft stainless steel wires of 0.008 to impressions. I Clin Orthod 2002;36:500.
0.010 inch in diameter. These may be used to hold /
ligate the archwire in brackets (Fig. 39.44A) or to tie 5. Mandall NA, Millett DT, Mattick CR, Hickman L
segments of teeth together (Fig. 39.44B). Worthington HV, Macfarlane TV. Orthodontic adhesives:
a systematic review. I Orthod 2002;29:205-10.
FURTHER READING
6. McNamara [A. Ir Utility arches. I Clin Orthod 1986;20:252-
1. Angle EH. Treatment of malocclusions of the teeth. Angle's 56.
systcm (7th edn). The SS White Dental Manufacturing
Company Philadelphia, 1907:191. 7. Noar JH, Evens RD. Rare earth magnets in orthodontics:
an overview, Brit I Ortho 1999;26:29-37.
2. Hobson RS, Rugg-Gunn AI, Booth TA. Acid-etch patterns
on the buccal surface of human permanent teeth. Arch 8. Park DK. Australian uprighting spring for partially
Oral Binl 2002;47:407-12.
impacted second molars. J Clin Orthod 1999;33:404-405.
9. Ricketts RM, RW Bench, CF Gugino, JJ Hilgers, RI

Schulhoff. Bioprogressive Therapy Hocky Mountain
Orthodontics, Dcnvcr, 1979.
10. Root TL. The level anchorage system. In: Orthodocntics:
Current Principles and Techniques TM. Graber and BP
Swain (Eds). The CV Mosy Co. SI. Louis, 1985.
11. Ruth RH. Treatment mechanics for the straight wire

appliance. In: Orthodonctics: Current principles and
Techniques. TM Graber and BF Swain (Eds). The CV
Mosby Company, SI. Louis, 1985.
12. Roth RH. Treatment mechanics for the straight wire
appliance. In: Orthodontics: Current Principles and
Techniques. TM Graber and BF Swain (Eds). The CV
Mosby Company, SI. Louis, 1985.
13. Tweed CH. Clinical Orthodontics. The CV Mosby
Company, St. Louis 1966.
14. Wilson RC, WL Wilson. Enhanced Orthodontics. Rocky
Mountain Orthodontics. Denver, 1988.
15. Zachrlsson BU. Bonding in orthodontics. In Crubcr TM,
Vanarsdall RL(editors): Orthodontics: current principles
and techniques, ed 3, St Louis, Mosby.

• Introduction The Edgewise
• Treatment steps Appliance
• Bracket specifications
• Bracket position Gurkeerat Singh

• Archwire faorication
• First order bends
• Second order bends
• Third order bends

INTRODUCTION Fig. 40.2: Pin and tube appliance

The term" edgewise" refers to the method by which a
rectangular archwire is inserted into the bracket, i.e.
on edge. The edgewise appliance was introduced to
orthodontics in 1925 by Dr Edward H Angle.

Dr Angle's appliance design reflected his changing
need for individual tooth control and space require-
ment to achieve different treatment objectives. In 1907
he advocated the pretreatment extraction of teeth in
certain cases and designed an appliance to tip the
adjacent teeth into these spaces (Fig. 40.1). By 1910 he
became convinced that a full compliment of teeth was
essential and advocated expansion for gaining space.
His endeavor to achieve three dimensional tooth
controls led to the advent of the pin and tube appliance
(Fig. 40.2) the same year.

The pin and tube appliance was followed by the
ribbon arch (1915) (Fig. 40.3) and finally the "tie
bracket" and the edgewise appliance (Fig. 40.4) in the

Fig. 40.1: Appliancedesigned by EH Angle(1907) Fig. 40.3: Ribbonarch appliance

year 1925. The edgewise bracket proved to be far
superior to its predecessors and not only provided
three dimensional control of individual teeth but also
facilitated wire changes.

468 Textbook of Orthodontics

BRACKET SPECIFICATIONS

The edgewise bracket has a bracket slot measuring
0.022" x 0.028" with single or double tie-wings. The
slot projects horizontally from the base of the bracket
(Fig. 40.6). Both, bondable and weldable brackets are
available.

Fig. 40.4: Edgewiseappliance

Charles H Tweed joined case and others in Fig. 40.6: Edgewisebrackets
recommending extraction of teeth as means of gaining
space to correct malocclusions. Tweed can be credited
with establishing a method of closure of extraction
spaces in a proper sequential manner for optimum
results in orthodontic treatment.

TREATMENT STEPS BRACKET POSITION

Tweed used the diagnostic facial triangle (Fig. 40.5) The brackets on the maxillary centrals, laterals and
for diagnosis and treatment planning (discussed in the cuspids were placed 3.5, 3.0 and 4.5 mm, respectively
chapter on Cephalometries). He also advocated the from the incisal edge to the bracket base. The maxillary
concept of "anchorage preparation". Anchorage bicuspid brackets were placed 3.5 mm from the buccal
preparation was done to prevent the mandibular and cusp tips and the molar brackets/tubes were placed
maxillary molars from drifting anterioriy in response in the middle third of the crown. The mandibular
to the intermaxillary elastics used for retracting the incisor brackets were placed 2.5 mm from the incisal
anterior teeth. edges. The mandibular cuspid brackets were placed
3.5 mm from the incisal tips and the bicuspids 3.0 mm.
The mandibular molar tubes were placed in the middle
third of the crowns. All the brackets were centered
mesiodistall y on the buccal surfaces of the teeth.

ARCHWIRE FABRICATION

The basic arch wire is formed on an edgewise arch
former using the Ban will Hawley chart (Fig. 40.7). The
width of the archwire is primarily dictated by the inner
cuspid and the inner buccal segment width in the
original malocclusion. After the archwire width and
symmetry arc found to be satisfactory, first order,
second order and third order bends can be
incorporated.

Fig. 40.5: Cephalometrictracingwithplanes and FIRST ORDER BENDS
diagnosticangles
First order bends are those that are made in the hori-
zontal plane, i.e in-out bends. These are required to
make the wire to conform anatomically to the labial
and buccal contours of the teeth in a manner that

The Edgewise Appliance 469

arranges these teeth in the most ideal position in THIRD ORDER BENDS
respect to the inter-, intra-arch and underlying skeletal
structure (Figs 40.8A and B). Third order bends are torsion bends (Fig. 40.10) used
to tip the crowns or roots labially or lingually or
, 11 1=_':::_':::_'=_-==_ -= buccally.

Fig. 40.7: The 8onwill-Hawley chart The outline of treatment mechanics as proposed
by Tweed for the correction of bi-maxillary protraction
Figs 40.8A and B: First order bends and arch form. mal occlusion was:
(A) Maxillary. (8) Mandibular 1. Leveling of maxillary and mandibular arches - by

SECOND ORDER BENDS sequentially increasing the diameter of the wire
Second order bends are made in the vertical plane (Fig. used from /0.012" to 0.020" or 0.016" x 0.016" to
40.9) and are used for anchorage preparation or 0.018" x 0.018" square wires (Fig. 40.11).
uprightening teeth. They are also used for the paralle- 2. Space closure
ling of the roots, and elevation or depressing certain a. Maxillary and mandibular cuspid retraction-
teeth.
using open coil springs (Fig. 40.12) loops
headgears to augment anchorage.
b. Mandibular incisor retraction on 0.019" x 0.026"
archwires with closing loops (Fig. 40.13).
3. Mandibular anchorage preparation-using tip
back bends in the buccal segments on a 0.0195" x
0.026" wire (Fig. 40.14).
4. Maxillary Anterior Retraction-bodily retraction
with special helical closing loops in a 0.0215" x
0.0275" archwire (Fig. 40.15).
5. Final inter-digitation of the teeth in the buccal
segments and artistic positioning of the anteriors-i-
using decreased tip back bends, Class II and/or
vertical elastics for settling along with a high pull
headgear (Fig. 40.16).
Once the occlusion settles, the appliance can be
debanded. Debanding, is followed by a Hawley's type
retention appliance.
The technique though far advanced than any
previously known was complex and required the
clinician to be extremely dedicated and meticulous in
his/her wire bending. Patient cooperation in wearing
headgears was a must. Since the forces used were
heavy the incidence of patient discomfort and root
resorption were high.

Fig. 40.9: Second order bends Fig. 40.10: Third order bends, active torque.
(A) Lingual root torque. (8) Labial crown torque

470 Textbook of Orthodontics

Fig. 40.11: Maxillary and mandibular
dentitions after leveling

Fig. 40.14: Mandibular anchorage preparation

Fig. 40.12: Maxillary cuspid retraction Fig. 40.15: Maxillary anterior retraction
(using open coil springs)

Fig. 40.13: Mandibular incisors retraction Fig. 40.16: Final interdigitation and artistic positioning

The Edgewise Appliance 471

FURTHER READING treatises by various authors: operative and prosthetic
dentistry, vo!. 2, Philadelphia, 1886-87, Lea and Febiger
1. Angle EH. Orthodontia-ribbon arch mechanism and some pp 486-98.
new auxiliary instruments, Dental Cosmos, 1920;62:1157- 6. Lindquist JT. Edgewise appliance: Orthodontic current
76, 1279-94. principles and technique, edited by GraberTM, Swain BF,
St Louis, 1985, CV Mosby Company.
2. Angle EH. Some form of orthodontic mechanism and the 7. Moussa R,O'ReiUy MT, Close JM. Long-term stability of
reason for their introduction, dental Cosmos, 1916;58:969- rapid palatal expander treatment and edgewise
mechanotherapy. Am J Orthod Dentofacial Orthop
94. 1995;108:478-88.
3. Angle EH. The latest and best in orthodontic mechanisms, 8. Tweed CH. Clinical Orthodontics, CV Mosby Co., 1966.
9. Tweed CH. The diagnostic facial triangle in the control of
Dent Cosmos 1928;70:1143-58. treatment objectives, Am J Orthod 1969;55:651.
4. Angle EH. Treatment of malocclusion of the teeth, ed. 7, 10. Tweed CH. Treatment planning and therapy in the mixed
dentition, Am J Orthod 1963;49:900.
Philadelphia, 1907,Thee SS White Dental Manufacturing
Company.
5. Bonwill WGA. The geometrical and mechanical laws of
the articulation of human teeth- the anatomical articulator.
In Lltch WF, editor: The American system of dentistry in

The Begg

Appliance

• Introduction Gurkeerat Singh
• Components used in the 8egg technique
• Diagnosis in the 8egg technique
• Three stages of 8egg technique

INTRODUCTION

Or PR Begg introduced the Begg Appliance, to the Fig. 41.1A: Modified ribbon arch type bracket permits both free
profession in the 1950s. Or Begg's studies on the crown tipping and root movement from auxiliaries when desired
normal occlusion of man made him realize that the
teeth continuously migrate mesially and vertically to
compensate for attritions of their proximal and
occluso-incisal surfaces. Based on this premise, he
devised the light wire differential force technique.

The technique is designed such that it permits teeth
to move towards their anatomically correct positions
in the jaws under the influence of very light forces, as
would occur naturally in the presence of attrition. Or
Begg advocated the tipping of teeth crowns instead of
bodily movement, which were later uprighted, roots
paralleled and repositioning achieved. Dr Begg
modified the ribbon arch brackets and placed them
'upside down', allowing free tipping.

COMPONENTS USED IN THE BEGG TECHNIQUE Fig. 41.1 B: Frontal view of the Be99 bracket

MODIFIED RIBBON
ARCH BRACKETS (Figs 41.1A to F)

Brackets have a single vertical short, which faces
gingivally. The bases arc either flat or curved. The
brackets can be either welded to bands or directly
bonded to the teeth at predetermined distances from
incisal edges or cusp tips (Fig. 41,2A). They are usually
centered mesiodistally on the labial or buccal surfaces
of the teeth (Fig. 41,2B).

The Begg Appliance 473

Central Lateral Cuspid Bicuspid
4mm
4mm 31% mm 4% mm red

red blue yellow ((J

ri> LW ((J

Fig. 41.1C: Begg bracket, gingival view. C6G~lG ~
The vertical slot is visible
Central Lateral Cuspid Bicuspid
3Y2 mm 3'Y2 mm 4 mm 4 mm

blue blue red red

Fig. 41.2A: Standard positioning of brackets with jigs

Fig. 41.10: Begg bracket, occlusal view. Fig. 41.2B: Brackets are accurately bonded or banded at
The vertical slot is visible desired distances from incisal edges on cusp tips

One-point High hat Double Hook Universal
safety pin safety pin safety pin pin T-pin

Fig. 41.1E: Begg bracket, lateral view. Fig. 41.3: Various types of lock pins used with ribbon arch type
The archwire slot is well defined brackets. Each is designed to co-act with the archwire and
bracket in a different manner to provide the type of tooth
Fig. 41.1F: Bondable Begg brackets movement or control desired

LOCK PINS

Various types of lock pins (Fig. 41.3) made of brass or
stainless steel were designed to hold the wire in the
bracket slots. One point safety pin provides a single
point contact of the wire on the tooth surface aIJowing
free tipping, which is essential in stages Iand TTof the
Begg technique.

474 Textbook of Orthodontics

MOLAR TUBES

Molar tubes are either round (Fig. 41.4A) or flat-oval
(Fig 41.4B) in cross section. They can be either bonded
directly on the anchore molars or welded to bands that
are cemented to the molars. The bondable tube has a
mesh base (Fig. 41.5A), whereas the weldable tube has
a flat contoured metal flange base (Fig. 41.5B). The
mesh base is broader in comparison to the weldable

Fig. 41.5C: Comparison of the mesh (red arrow)
and flange bases (black arrow)

Figs 41.4A and S: (A) Round molar tube Fig. 41.6: Various diameters of the special
(weldable), (6) Oval molar tube (weldable)
plus Australian wire spools

base, for adequate bond strength (Fig. 41.5C). They
are designed to permit free mesiodistal sliding of the
archwire, which is necessary to permit the free disto-
lingual tipping of the anterior teeth from the forces
generated by the vertical loops and/or elastics,

ARCHWIRE

High tensile, high strength wires produced by AJ
Wilcock of Australia, were especially manufactured
for use in the Begg technique. Archwires are available
in various diameters and tempers (Fig. 41.6).

ELASTICS

Figs 41.5A and S: (A) Mesh base is provided for tubes that Latex or non-latex elastics of different diameters (Fig.
can be bonded. (6) Long flange is available on tubes that are 41.7) are used to apply forces of different magnitude

to be welded to metal bands depending upon the stage of treatment.

The Begg Appliance 475

••~
.~

Fig. 41.9: Uprightening springs

Fig. 41.7: The various elastics used

Occlusal - Activated

ROTATING SPRINGS Fig. 41.10: Torquing springs

Rotating springs, as the name suggests, provide for a engaged along the archwire. Force is transmitted to
simple and effective means of derotating teeth without the tooth crown by the spurs, which contact the teeth.
the removal of the archwire. These springs are used The number of spurs can be altered depending upon
in the vertical slots of the Begg bracket. They are the number of teeth to be torqued.
capable of both clockwise and counter-clockwise
movement depending on their design (Fig. 41.8). DIAGNOSIS IN THE BEGG TECHNIQUE

UPRIGHTENING SPRINGS Both the extraction and non-extraction treatments can
be carried out using this technique, depending upon
Uprightening springs are generally made of 0.012" or the space requirements.
0.014" Australian wire. They move the tooth root in a
mesial or distal direction (Fig. 41.9). The decision to extract is based upon:
1. Type of malocclusion
TORQUING SPRINGS 2. Severity of malocclusion
3. Treatment goals
Torquing springs are usually made of 0.012" or 0.014" 4. Age of the patient
Australian wire. They are capable of moving the tooth 5. Skeletal pattern of the patient
roots in a labial or lingual! palatal direction (Fig 41.10). 6. Anticipated anchor loss
Force is generated when the spring is deformed and 7. Anticipated patient cooperation
8. Ability and experience of the operator.

•• (.Il.l. THREE STAGES OF BEGG TECHNIQUE

Fig. 41.8: Rotating springs: Clockwise movement From a clinical standpoint, the Begg technique has
been divided into three treatment stages. The first two
stages involve crown tipping and the third stage is
restricted to root tipping .

OBJECTIVES OF STAGE I
1. Open (or close) the anterior overbite
2. Eliminate anterior crowding or spacing

476 Textbook of Orthodontics

3. Overcorrect rotated cuspids and bicuspids of the OBJECTIVES OF STAGE 11
4. Correct any posterior crossbites
5. Overcorrect any mesiodistal relationship Maintain all corrections achieved during the first stage
and close any remaining posterior spaces.
buccal segment.

Characteristic Archwires and Elastics of Stage I Characteristic Archwire and Elastics of Stage 11

Ni Ti (Fig. 41.11A) or looped initial archwires (Fig. Plain 0.018" archwire with pre-molar offsets and slight
41.118) are used for initial aligning. Shift to plain decrease in anchor bends. Class I horizonta I elastics
archwires as soon as possible (Fig. 41.11C). with class II elastics (Fig. 41.12) are used to close along
spaces.
Class II elastic of 2-2.5 oz force levels are used in
angles Class I or Class II malocclusion.

Fig. 41.11 A: Stage I 0.016" special plus Australian archwire (plain. not looped) in place with Class 11yellow elastics. Helices
are incorporated mesial to the canine brackets and anchor bends are kept 3-4 mm mesial to the molar tubes

Fig. 41.116: Stage 110.018" special plus Australian wire with pre-molar offsets. Class I blue and Class 11yeilow
stastlcs are also visible

Fig. 41.11 C: Stage I .016" special plus Australian archwire in place alows 41.11 A: initial alignment down using .016" NiTi wires

!--------------The-Begg Appliance 477

Fig. 41.12: Stage 11 0.018" special plus Australian wire with pre-molar offsets.
Class I blue and Class IIyellowelastics are also visible

Figs 41.13 A to C: Stage II1 0.020" special plus Australian wire in place with a two spur
torguing auxiliaryon the maxillarycentral incisors and uprighteningsprings on the maxillary
and mandibular lateral incisors, canines and pre-rnolars. Class 11elastics are also in place

OBJECTIVES OF STAGE III completed to perfection to achieve long-term stability
of results. As with all orthodontic corrections, the
All corrections achieved during stage I and stage II retention phase is mandatory following the comple-
are maintained and mechanics are undertaken to tion of the active treatment.
achieve desired axial inclination of all teeth.

Characteristic Archwire and Elastics of Stage III FURTHER READING

The 0.020" base archwire is used with molar offsets. 1. Begg PR, Kesling Pc. 8egg orthodontic theory and
Uprightening and torquing auxiliaries are engaged in technique, ed 3, Philadelphia, 1977,W.B.saunders.
the brackets to correct axial inclinations of individual
teeth. Light force Class II or Class III elastics might be 2. Begg PR. Differential force in orthodontic treatment, Am
made use of, as per requirement (Figs 41.13A to C). J Orthod 1956;42:481-510.

The Begg technique was the first to make use of 3. Begg PR. Stone Age man's dentition, Am J Ortho.
very light forces. It incorporated overcorrection of the 1954;40:298-312.
teeth as part of its treatment goal. This was done to
compensate for the natural tendency for relapse that 4. Cadman G R. A vade mecum for the Begg technique:
occurs when orthodontic appliances are removed. Technical principles, Am J Orthod, 1981;67:477-512.
Another outstanding feature of this technique is the
long-time duration of 4-6 weeks in between appoint- 5. FletcherGGT.The Beggappliance and technique, London.
ments. The technique is popular all over the world, John G. Wright, PsG [ne, 1982.
especially Asia and Australia. It is more economical
as compared to any other fixed orthodontic technique. 6. Graber TM, Swain B. Current Orthodontics Concepts and
Here, we find it pertinent to emphasize that the third Techniques" 2nd cd, W.BSaunders 1975.
stage of this technique is essential and should be
7. Graber TM, Swain BF. Orthodontics current principles and

techniques, St Louis, 1985,CV Mosby Company.
8. [ayade VP, Kakodkar S. Rotational control in the Begg

appliance, J Ind Orthod Soc, 1999;32(2):50-57.
9. Jayade VP. Refined Begg for modern times, 1st ed, 2001.
10. Singh Curkccrat, Shetty VS. Extraction space closure in

Stage11of Beggtechnique, J Ind Orthod Soc,1999;32(2):58-
64.

• Introduction The Pre-Adjusted
• Anchorage control Edgewise Appliance
• Leveling and aligning
Gurkeerat Singh

• Overbite control
• Overjet reduction and space closures
• Finishing and detailing

INTRODUCTION

Until the mid 1970s, the edgewise appliance had r
become the most popular fixed appliance in use in the
United States of America and most probably, the world Fig. 42.1A: Firstorder or in and out bends builtwiththe
over. bracket PEA base

The standard edgewise bracket, either in single or Fig. 42.1 B: Second order or mesiodistal tip incorporated into
twin form, having a 90° bracket base and bracket slot
angulations required meticulous archwire bending the bracket PEA
skills by the orthodontist to achieve adequate results.
The archwire bending increased the chair side time Fig. 42.1C: Thirdorder or torquingincorporatedintoto PEA
and, if not performed to perfection resulted in results bracket
that appeared 'artificial', failing to achieve ideal tooth
relationships compromising the long-term stability.

In 1972 Lawrence Andrews listed the ingredients
of occlusion which he considered essential to
accomplish the anatomical goal and achieve harmony
of occlusion as:
1. Molar relationship
2. Crown angulation
3. Crown inclination
4. Rotational control
5. Good proximal contact
6. Flat curve of Spee

In the edgewise bracket system, to achieve an ideal
alignment of teeth all the bends-first order (in and
out), second order (mesiodistal) and third order
(torguing) have to be built into the archwire by the
clinician. But as the name suggests, in the pre-adjusted
edgewise appliance (PEA) a11these are built into the
brackets or the appliance (Figs 42.1A to C).

The Pre-Adjusted Edgewise Appliance 479

Each PEA bracket has particular base thickness A: Torque in face B. Torque in bace
(Figs 42.1A and 42.2A) to compensate for the first order
bends (in-out bends). When a wire is engaged, the Figs 42.3Aand B: (A)Torque in face, (8) Torquein base
horizontal plane of the wire remains the same while
teeth align themselves labiolingually in ideal occlusion prescription for the PEA and called it the straight wire
(Fig. 42.2B). The slot of the bracket is angulated with appliance. In fact, Andrew created various
respect to the long axis of the tooth. This leads to the prescription based on the malocclusion, extractions
teeth being positioned in the ideal mesiodistal and the underlying skeletal structure of the patient.
angulation from the beginning of the treahnent. The He advocated the placement of brackets on the
torque (or the third order bend) is, either incorporated Andrew's plane, which is the plane or surface on which
by angulating the slot with respect to the base (Fig. the mid-transverse plane of every crown in an arch
42.3A) or by angulating the base of the bracket with will fall when the teeth are ideally positioned (Fig.
respect to the slot (Fig. 42.3B). When a rectangular wire 42.4).
is engaged in the slot, the torque values start
expressing themselves. Roth modified the tip and torque values of his
prescription (Table 42.1) making a series which was
Based on the "prescription" i.e. the in out, tip and common for extraction and non-extraction cases. He
torque values-various clinicians have brought out also modified the bracket placement as shown in
various PEA systems. Andrew proposed the first Figure 42.5.

Maxillary arch Mandibular arch When treating cases with the pre-adjusted
edgewise appliance, the management can be divided
Fig. 42.2A: Firstorder effects into six distinct yet overlapping stages as:
1. Anchorage control
2. Level ing and aligning
3. Overbite control
4. Overjet red uction
5. Space closures
6. Finishing and detailing

Fig. 42.2B: Positioningin PEA Fig. 42.4: Andrew'splane

480 Textbook of Orthodontics

Table 42.1: The tip and torque values of the Roth
prescription

Maxillary Torque Angulation/ Tip

Central incisor 12 5 Fig. 42.7: Nance palatal button in place
La teral incisor 89
-2 13
Canine -7 0
1st Pre-molar -7 0
2nd Pre-molar -14 0
1st Molar
Mandibular -1 2
Central incisor -1 2
Lateral incisor -11 7
Canine -17 0
1st Pre-molar -22 0
2nd Pre-molar -25 0
tst Molar

X.l.O X.0.5 ~~ X
X.0.5 X.0.5 X
X X X+0.5 X-0.5

X X X+0.5 X

Fig. 42.5: Bracket positioning values Fig. 42.8: Patient wearing a head-gear to prevent the
maxillary molars from drifting mesially

ANCHORAGE CONTROL LEVELlNG AND ALIGNING

Anchorage control can be achieved using intraoral Leveling and aligning is done with light continuous
means like transpalatal arches (Fig. 42.6) or Nance
palatal button (Fig. 42.7) etc. or extraoral means, e.g. force wires like, nickel titanium alloy wires sequen-
head gears (Fig. 42.8).
tially increasing in stiffness and diameter (Figs 42.9A

to C). .

Fig. 42.6: Transpalatal arch (TPA) in place. The TPA can be Figs 42.9A to C: (A) Round 0.014" diameter NiTi wire placed
soldered to the molar bands or be placed in the lingual sheaths for initial alignment, (B) As the alignment progresses the wire
that are welded on the molar bands. as shown here dimension and stiffness is increased, (C) Stainless steel base
archwire along with .016" NiTi wire to align upper central incisior

The Pre-Adjusted Edgewise Appliance 481

OVER BITE CONTROL

Overbite control is achieved using utility arches (Fig.
42.10) or wires with a reverse curve of Spee (Figs
42.11A to B[ii]). Molar extrusion might even be
achieved using headgears.

Fig. 42.10: Pre-treatment and during treatment photographs Fig. 42.11 B (ii): A rectanguiar (nickel titanium alloy) wire with
(with intrusion utility arch in place). Note the decrease in overbite a reverse curve of Spee incorporated in it, seen ligated in the
following the use of the utility arch midline

OVERJET REDUCTION AND SPACE CLOSURES

Overjet reduction and space closures are accomplished
with the help of elastics (Fig. 42.12) closed coil springs
(Fig. 42.13) or elastic modules (Fig. 42.14), or elastic
chains (Fig. 42.15) or loops incorporated into the arch
wire (Fig. 42.16).

Fig. 42.11A: A rectangular (nickel titanium alloy) wire with a Fig. 42.12: Elastics may be used to retract
reverse curve of Spee incorporated in it teeth or for closing residual spaces

Fig. 42.11 B (I): A rectangular (nickel titanium alloy) wire with a Fig. 42.13: Closed coil spring is stretched from
reverse curve of Spee incorporated in it seen passively placed the molar to the canine, for canine retraction
in accessory molar tubes

Textbook of Orthodontics

Fig. 42.14: Elastic module tied to the canine bracket using a Fig. 42.15: Elastic chain used for extraction space closure

ligature wire to retract the canine

Fig. 42.16: Loops incorporated in the archwire FINISHING AND DETAILING
for retraction and bite opening
Finishing and detailing involves the use of stiff
rectangular stainless steel wires with or without the
use of artistic bends.

The stages are sequential in their order, with the
effective management of one stage being a prerequisite
for the successful completion of the next stage. A case
treated with the appliance is presented with the pre-
treatment (Fig. 42.17), during (Figs 42.18A and B) and
post-treatment (Fig. 42.19) photographs.

A retention sequence follows, once all corrections
have been achieved to satisfaction. Retention
appliances are a must whatever the appliance chosen
for treatment (Retention appliances are discussed in detail

in Chapter on Retention and Relapse).

Fig. 42.17: Pre-treatment photographs

The Pre-Adjusted Edgewise Appliance 483

Fig. 42.18A: Initial alignment using the flexible NiTi wires

Fig. 42.188: Space closure and finishing is done using the stiffer stainless steel rectangular wires

484 Textbook of Orthodontics

Fig. 42.19: Post-treatment photographs

FURTHER READING 6. Bennett]E, Melaughlin RP. Controlled space closure with

1. Andrew LF. Straight wire appliance explained and pro-adjusted appliance systm, J Clin Orthod 1990;24:251-

compared. J Clm Othod 1976;10:174-95. 60.

2. Andrew LE Straight wire appliance origin, controvercy, 7. Dellinger EL. Scientific assessment of straight wire

commentary. J Clin Othod 1976;10:99-114. appliance, Am J Orthod Dentofacial Orthop 1978;73:290-

3. Andrews LF. Straight wire appliance Case histories, 9.
8. McLaughlin RP, Bennett Je. The transition from standard
Nonextraction treatment, J Clin Orthod 1976;10:283-303.
edgewise to prcadjusted appliance systems, J C1in Ortho
4. Andrews LF. Straight wire appliance, Extraction bracket
1989;23:142-53.
and classification of treatment, J Clin Orthod 1976;10:360-
9. Roth RH. Straight wire appliance 17 years later, J Clin
79.
Orthod 1987;21:632-42.
5. Andrews LF. Straight wire: the concept and appliance,
San Diego, 1989 LA Wells.

The Tip Edge
Appliance

Gurkeerat Slngh

• Introduction • Placement of tip edge attachments
• Tip edge bracket design
• Advantages of the tip edge brackets • Auxiliaries
• Treatment stages

INTRODUCTION archwires, therefore, the name Differential Straight-
Arch Technique.
With the .advent of the so called straight wire
technique, the clinicians who were practicing the Begg TIP EDGE BRACKET DESIGN
technique felt the need to reduce the amount of The tip edge bracket has basically been created by
precision wire bending and the need of the various removing the diagonally opposing corners of the
uprightening and torquing auxiliaries used with the conventional edgewise archwire slot (Fig. 43.1). In
technique. Also, the edgewise practitioners had by addition, rotational wings are provided along with a
now realized the advantages of light forces and vertical rectangular (0.20"x 0.20") slot to facilitate the
differential anchorage, i.e. segregation of forces used insertion of auxiliaries from either direction (Fig. 43.2).
to move the tooth crowns, by tipping, and root moving
forces. There was also a heightened awareness of the ADVANTAGES OF THE TIP EDGE BRACKETS
advantages of the rectangular wire finish which As compared to the Standard edgewise bracket-
provided the three-dimensional control of each eliminates the undesired couples and moments which
individual tooth.
Remove wedges
The advent of the tip edge bracket by Peter C from two opposite ends of
Kesling, was a step in this direction. This bracket
system provided a interlucor between the techniques. archwire slot
Accord ing to Peter C Kesling an ideal bracket should
have ~~ ~__ (,..J
• A labially facing wire slot
• Ease of ligation with elastomeric rings Fig. 43.1: (A)Diagonallyopposed corners of a conventional
• Provision for root torquing and mesiodistal
edgewise archwire slot were removed to create the basic tip
uprighting using auxiliaries
• First order (in-out) bends built into the bracket edge bracket. (6) Additionalrotationwingsand a verticalslot
• Predetermined tip and torque control should be
were provided
available.
Keeping the above in mind, Kesling designed the
tip edge bracket. It makes all the above possible and
permits differential tooth movement with straight

486 Textbook of Orthodontics

Fig. 43.2: Distaland incisalview of upper rightcanine bracket.

Vertical slot accepts many auxiliaries. Lateral extensions
provide rotational control

tt Fig. 43.4: Tip edge brackets are cast with built-in in/out
compensation to eliminatethe need forlateral.bicuspidor molar
-0 offsets

-
Figs 43.3A and B: (A) Conventionaledgewise bracket on upper
anterior tooth tipped at start of treatment. Undesired forces Figs 43.5A and B: (A) Horizontallyfacing archwire slot in tip-
(arrows) are created which interfere withbite opening. (6) Tip- edge bracket with a straight archwire when the tooth is
edge bracket on same tooth eliminatescouples to permitdesired rotated (6) Engaging the same archwire in a verticallyfacing
bite opening using light forces slot of ribbon arch type bracket produces excessive forces

were produced in the standard edgewise bracket Fig. 43.6: Elastomerics can be used for wire engagement
allowing light forces to be used for anterior retraction
and bite opening (Figs 43.3A and B). This results in PLACEMENT OF TIP EDGE ATTACHMENTS
diminished anchorage demands and increase in Tip edge brackets are bonded with sides parallel to
vertical control. In other word, extraoral anchorage is long axis of crown (Fig. 43.7) Bracket heights can be
accurately controlled by using positioning jigs (Fig.
generally not required. 43.8).

As compared to the Begg bracket-in-out compen- The brackets are centered mesiodistally (Fig. 43.9).
sation is built into the bracket (Fig. 43.4), hence molar The molar tubes (Fig. 43.10) are designed to keep
(or other) offsets which are normally required with the molars upright and yet permit free sliding of the
the ribbon arch bracket werc eliminated. arch wire. The round tubes have .036" inside diameters
and length of .250". The rectangular tube is at the same
Horizontally facing arch wire slots facilitate initial
archwire engagement, especially on rotated teeth (Figs
43.5A and Bl.

The preangulated archwire slot (Table 43.1) stops
free crown tipping at a predetermined angle and
simultaneously increases the anterior anchorage to
encourage the mesial movemen t of the posterior teeth.

The use of elastomerics (Fig. 43.6) is possible
throughout the treatment, which are easier to replace
and also more comfortable for the patient than lock
pms.

The Tip Edge Appliance 487

Table 43.1: Tip edge bracket archwire slot angulations (Slot size .022")

Crown tipping permissible Final crown tip Final root torque

Maxillary 20" <listal 5°
Central incisor 20° distal 9°
Lateral incisor 25° distal 11°
Canines 20° distal or mesial
First premolar 20° distal or mesial A"
Second premolar
0°

Mandibular 20° distal 2°
Central incisor 20° distal 5°
Lateral incisor 20" distal 5°
Canine 20° distal or mesial
First premolar 20° distal or mesial A"
Second premolar A"

Fig. 43.7: Tip edge brackets bonded with sides parallel to long
axes of crowns. Bracket heights can be accurately controlled
by using positioning jigs

Cd[) c;2D ~ ~ ~

2nd bicuspid 1st bicuspid Cuspid Lateral Central
3Y1: mm 4Y2 mm 4mm
blue 4 mm red 3'l'mm
yellow blue red
c5l c3J
Z)J lil ~
2nd bicuspid 1st bicuspid
4 mm red 4mmred' Cuspid Lateral Central
4 mm red 3Y:.t mm blue 3% mm blue

Fig. 43.8: Normal jig heights/colors Fig. 43.9: Brackets are centered mesiodistally on the labial
and buccal tooth surfaces

488 Textbook of Orthodontics

Fig. 43.10: Combination edgewise and round __
tube for lower left molar .. .
.

Figs 43.11A and S: Rotating springs: (A) Clockwise,
(B) Counter-clockwise

level as the archwire slots in the brackets on the Figs 43.12A and S: (A) Side-winder (B) Standard
prernolars. Fig. 43.13: Bi-Ievel pins

Molar tubes are placed parallel with the occlusal
surface of the anchor molars. The round .36" round
tubes are positioned gingivally to help prevent the
arch wire from being distorted from occlusal forces.

AUXILIARIES

Rotating Springs

Rotating springs are made of .014" Australian wire,
and are capable of causing clockwise (Fig. 43.11A) or
counter clockwise (Fig. 43.11B)rotation of teeth. These
can be inserted without removing the archwire.

Mesiodistal Uprighting Springs

These provide an optional means of uprighting
individual teeth mesiodistally. They are available in
both standard (Fig. 43.12A) and side-winder versions
(Fig. 43.128). They are made .014" Australian wire.

Si-level Pins

These can be used to capture auxiliaries behind the tie
wings of the tip edge brackets (Fig. 43.13).

Power Pins

Power pins (Fig. 43.14A) are used for engaging remov-
able elastics or fixed elastomerics. These can be
inserted into the vertical slot from the incisal or
gingival on any bracket at any time (Figs 43.14 B
and C).

The Tip Edge Appliance 489

Figs 43.14A to C: When power pin is (A) inserted from the gingival (B) the head is inclined labially,
when from the incisal (C) it leans lingually

Tip Edge Rings Fig. 43.15: Elastomeric tip edge ring retains arch
wire while preventing mesiodistal free tipping
These are designed to function exclusively with tip
edge brackets. They have lingually facing lugs which
wedge between the arch wire and the bracket and hold
the teeth upright during the finishing stages of the
treatment (Fig. 43.15).

TREATMENT STAGES

The basic treatment with differential straight arch
appliances is the same as with differential light wire
appliance (Figs 43.16A to F). The only difference being

Fig. 43.16A: Pretreatment photographs of an Angle's Class I case
Fig. 43.16B: Initial alignment using NiTi wires

490 Textbook of Orthodontics

Fig. 43.16C: Stage I. 0.016" special plus Australian wire in place with 2-2.5 oz Class 11 elastics

Fig. 43.160: Mediumforce Class I elastics used for retraction and extraction
space closure after achieving all objectives of Stage I

Fig. 43.16E: Round wire used for finishing along with uprightening and torquing auxiliaries

Fig. 43.16F: Case immediately followingdebanding

in the use of rectangular wires in the finishing or stage The tip edge appliance may not be the most popular
TV of this technique. All the objectives of stages T, Il appliance today but it has certainly provided an oppor-
and TII are the same and should be achieved before tunity to both Begg and edgeWise practitioners to come
proceeding to the next state of treatment. closer, to a common more versatile appliance system.

Sta ge TV a 11ows for precision finishing using FURTHER READING
rectangular wires. The rectangular wires mayor may
not be required depending upon the case, but the 1. Keelingrc. Expending the horizons of the edgewise arch
provision does exist for their use. Conventional stain-
less steel wires should be used, beginning with a 0.019" wire slot, Am J Orthod Dentofac Orthop, 1988;94:26-37.
x 0.025" size and progressing to 0.021"x 0.028" wire 2. Keeling Pc. Tip-edge Guide and the differential straight
for total control. These rectangular wires should pass
through rectangular molar tubes and are used with areh technique, 2 Swan Advertising Agency, 1988.
special tip edge elastomeric rings. 3. Keeling PC, Rocke RT, Lesling CK. Treatment with Tip-

Edge brackets and differential tooth movement, Am J
Orthod Dentofac Orthop 1991;99:387-401.

Lingual

Orthodontics

Gurkeerat Singh

• Introduction • Indications for lingual appliances

• History o The edgewise lingual appliance
• Difficultiesencountered and their solutions o The light wire lingual appliance

INTRODUCTION of his patients were public figures, esthetics became a
major concern. This led to the development of the
The lingual orthodontic appliances were conceived concept for the lingually bonded appliance. Or Kurz
with the simple objective of making orthodontic developed the first true lingual appliance, consisting
treatment esthetic. The concept of these appliances was of plastic Lee Fisher brackets bonded to the lingual
developed before the development of esthetic aspect of the anterior dentition and metal brackets
brackets-brackets made of plastic, composites and bonded to the lingual aspect of the posterior dentition.
ceramic, which matched the color of the tooth crowns. The plastic brackets were used for the inherent ease
Clinicians all over the world have tried to modify their of recontouring and reshaping them to avoid direct
appliances to match the changing demands of their contact with the opposing teeth.
patients. Dr Craven Kurz can be credited with the
development of an edgewise lingual appliance and Or Around the same time Or K Fujita of Japan pub-
K Fujita of Japan for the development of a light wire lished cases treated with his modification of the Begg
lingua I appliance. light wire appliance. He had bonded the Begg brackets
lingually and used the same Australian AJ Wiicock
HISTORY wires contoured to the lingua I aspect of the teeth. He
explained the arch form which resembled a mushroom
Even before the development of a true lingual (when viewed occluasally) and advocated the same
appliance the orthodontic material company Ormco basic steps as in the conventional Begg technique to
in conjunction with Or [im Wildman, had attempted be used with the Begg bracket with a modified base.
to develop a system to align the dentition using the
lingual approach. This system consisted of a pedicle Further research was carried out by individuals and
positioner, rather than a multibracketed system. groups of individuals associated together, with
Although innovative, the inherent limitations of this financial funding from the orthodontics manufactur-
system prevented it from gaining widespread ing companies. TI,e Lingual Task Force was set-up (by
popularity in the orthodontic community. the orthodontic material company Ormco) to develop
a commercially viable lingual appliance.
It was only in the early 1970s that Or Craven Kurz,
an assistant professor at UCLA School of Dentistry, The lingual appliance is the most esthetic ortho-
realized that a major portion of his private orthodontic dontic appliance. Along with this major advant-
practice was dominated by adult patients. Since many age that it has over other appliances the lingual
appliance had some inherent shortfalls (Table 44.1).

492 Textbook of Orthodontics

Table 44.1: Disadvantages of the initial lingual appliances

1. Indirect vision hampered accurate bracket placement
2. Occlusal interferences caused frequent bond failures

and at times restricted tooth movement
3. Speech distortion
4.. The sharp edges hurt/iaccrated the tongue
5. Gingival irritation due to plague accumulation
6. Increased chair-side time due to difficulty in

insertation and ligation of archwire

The most irritating problem associated with the initial Fig. 44.1: Lingual bracket with anterior bite plane
appliances was of frequent bond failures. The turning
point in the development of the appliance was the Fig. 44.2: Maxillary canine bracket preventing
addition of an anterior inclined plane as an integral mandibular canine retraction
part of the maxillary anterior brackets (Fig. 44.1). This
inclined plane converted the shearing forces produced shearing forces to a horizontal sea ting force helped
by the mandibular incisors, which caused the bond not only in reducing frequent bracket failures but also
failures, to compressive forces applied in an intrusive helped in bite opening and correcting teeth in cross
and labia I direction. This modification decreased the bite.
bond failures and also assisted in the initial bite Tissue Irritation and Speech Difficulties
opening. Brackets were redesigned with smooth exterior
surfaces and a low profile. This increased comfort
The Lingual Task Force pioneers Drs Kurz, Gorman allowed normal tongue activity: thereby preventing
and Smith were the first to conduct courses on the any significant speech impairment.
edgewise lingual appliance. Or Vince Kelly of
Oklahoma and Or. Steve Paige of Florida were the first
to start giving courses using a Begg appliance
lingually.

Or Oilier Fillion of France is the only orthodontist
to have restricted his practice to lingual orthodontics
exclusively. It would be pertinent to mention that the
first textbook on lingual orthodontics was published
by Dr Rafi Romano in 1998.

DIFFICULTIES ENCOUNTERED DURING THE
DEVELOPMENT OF LINGUAL ORTHODONTIC
THERAPY AND THEIR CURRENT SOLUTIONS

Bond Failures

The bracket base was better contoured and the Girigival Impingement
introduction of the indirect bonding technique helped
to reduce frequent bond failures. The bracket base was redesigned to be more self-
cleansing, it now extends more incisally and mesio-
Occlusal Interferences distally, providing adequate bond strength,
yet retaining hygienic qualities. Also, the bracket
Occlusal interferences restricted tooth movement hooks have been redesigned with a lower profile
beyond a certain limit (Fig. 44.2). An inclined or bite and are located several millimeters from the gingival
plane strategically placed to redirect the vertical margin.