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PRESENTED BY
CHANDRIMA A SREEKUMAR
IIND YEAR PG
The Alexanders
The Alexander Discipline owes its name to two generations of the
Alexander family:
• Dr. R.G. "Wick" Alexander and his sons J. Moody and Chuck.
His dental degrees are from the University of Texas Dental Branch; the D.D.S. in
1962, and the M.S.D. in 1964. Dr. Alexander began the practice of orthodontics in
Arlington, Texas, in 1964.He is a Clinical Professor of Orthodontics at The
University of Texas, New York University, and Baylor College of Dentistry. Dr.
Alexander is recognized internationally for his innovation in orthodontic
procedures. He is well known for his work in designing the Alexander Discipline, a
system of Brackets placed on teeth, which is used by orthodontists around the
world.
The Alexanders
Effort = Results.
PRINCIPLE NUMBER 2
•based on another quote, "Sometimes when I consider
what tremendous consequences come from little things, I
am tempted to think, there are no little things.“
•Of all the little things that influence the outcome of
treatment, timing may be one of the most important
•Stage of growth
•Age
•Orthodontic diagnosis
•General rule = once patients have lost all primary teeth, with
the exception of the primary mandibular second molars
•This usually occurs when patients are about 11 to 12 years old
and experience a period of rapid growth.
PRINCIPLE NUMBER 3
1. bracket height,
2. bracket angulation, and
3. mesiodistalbracket position.
PRINCIPLE NUMBER 8
Exploit Growth to Obtain Predictable Orthopedic
Correction
Is to obtain predictable orthopedic correction by using
•a face bow,
•facemask,
•rapid palatal expansion,
•lip bumper,
•auxiliary appliances such as the transpalatal arch, the
Nance lingual arch, magnets, and distalizing mechanics.
PRINCIPLE NUMBER 9
Establish Ideal ArchForm
This principle discusses the use of a proven arch form
design and a contemporary arch wire force system.
Most patients are treated by using continuous arch wires
beginning with the maxillary arch.
• In a true deep bite case, the patient exhibits an excessive anterior overbite
and an excessive curve of Spee in the mandibular arch.
•The method of leveling the curve of Spee with the Alexander Discipline is by a
combination of mainly bicuspid extrusion, and minor incisor intrusion.
•The maxillary and mandibular arch forms have now been individually
finalized and the goal then is to get the maxillary and mandibular arches
coordinated.
•By establishing arch form and proper torque controls before using
intraoral elastics, the elastic forces act more orthopedically,
moving the entire arches without adversely affecting the teeth.
The exceptions to this rule include:
• the use of cross-bite elastics when necessary;
• Class III elastics may be used when the lower arch is
initially bonded to prevent flaring of the lower
incisors, and/or while closing lower extraction spaces
with a closing loop arch wire in maximum anchorage
situations
• Class II elastics may be used when closing lower
extraction spaces with a closing-loop arch wire to
move lower molars forward in minimum anchorage
situations.
In general, the use of elastics in the Alexander
Discipline system of biomechanics is divided into
three sequences:
1. Early in treatment
• C rossbite elastics
• Class 3 elastics after bonding of the mandibular arch
to prevent incisor flaring
2. Midtreatment
• Box elastics to help close open bites and/or level the
mandibular arches
• Class 2 elastics for minimum mandibular anchorage
in extraction cases
• Class 3 elastics to maximize mandibular anchorage in
extraction cases
3. Finishing archwires
• Class 2 elastics to achieve occlusion in centric relation
• Midline elastics with class 2 or class 3 elastics (never
combine midline and maxillomandibular elastics
because they can cant the occlusal plane)
• Box elastics to improve occlusion
• Finishing elastics
PRINCIPLE NUMBER 17
Use Nonextraction Treatment When Possible
•Principle number 17, in non extraction cases, recommends initiating
treatment in the upper arch and progressing into finishing arch wires as
soon as possible.
1985
1997
Generation 3: Alexander Signature appliance
Appliance Design
• Bracket selection.
•The first, and most important, advantage of the Alexander
Discipline is that the system is composed of a number of
bracket designs.
•The security of the system, and its mechanics, allows for
twin brackets on anterior maxillary teeth, single-wing Lang
brackets on all four cuspids, and single-wing Lewis brackets
on premolars and lower incisors.
BRACKET SELECTION
Advantages
• This allows for more efficient control of these teeth during the
leveling process and actually sets up anterior anchorage in those
situations where the mandibular posterior teeth are to be
protracted in the correction of Class II malocclusions.
•For a typical case the band must be placed, as always, with the
occlusal margin of the band parallel with the occlusal surface of
the molar at the marginal ridges.
•In open bite situations, care must be given to tip the distal
aspect of the band gingivally so that the mesial cusp is not
supererupted and the distal aspect is supported, which
minimizes the bite opening effect of the —6° tip of the bracket
placement.
TWIN BRACKETS
•Twin (Diamond) brackets (Ormco Corp) are used
on large, flat-surfaced teeth (namely, maxillary
central and lateral incisors).
•The flat surfaces of these teeth permit full arch
wire engagement in the twin brackets.
•Ball hooks for elastic placement are usually
placed on lateral incisor brackets.
•There is little trouble tying the wire into these
brackets because of their ease of accessibility, and
the brackets allow for 5 to 6 mm of interbracket
width, which is sufficient for flexibility, rotational
control, and torquing.
• These brackets are smooth and minimize
irritation on labial tissues
LANG BRACKETS
•Proper arch wire selection and sequence allows the vari-simplex discipline to
deliver results.
•The combination of greater interbracket width achieved with lewis and lang
brackets, improved resiliency of arch wires such as multi stranded and bet
titanium or nickel titanium wires and the vari simplex discipline itself have all
contributed to the reduction of time consuming arch wire changes.
ARCH WIRE SELECTION AND SEQUENCE
•Before selection of each arch wire, the doctor must identify the
intended purpose.
•Levelling and space closure are often primary goals of the next
wire. This is usually a rectangualr wire, either beta titanium or
stainless steel, depending on the specific need.
•The last step, final leveling and arch form finishing, is always
performed with stainless steel wire.
ARCH WIRE SELECTION AND SEQUENCE
Maxillary arch
•o.o175 multistranded
Mandibular arch
•o.o17X0.025 multistranded
Extraction cases
Maxillary arch
Extraction cases
Mandibular arch
When all the goals of the optimally treated patient are met and
fixed appliance removal time is approaching, four appointments
are made with specific objectives for each appointment.