TYPHODONT EXERCISE

STANDARD EDGEWISE APPLIANCE

Under guidance of:

Presented by: Dr. Anil K Chandna
Dr. Resham Irshad Dr. D.K. Agarwal
PG Ist year Dr. Preeti Bhattacharya
Dept of Orthodontics & Dentofacial Dr. Ankur Gupta
Orthopeadics Dr. Ravi Bhandari
Dr. Shivani Singh

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BONVIL HAWLEY CHART for IDEAL
ARCH FORM
 FIRST ORDER BENDS
• IN & OUT Bends
• Bucco-lingual / Labio lingual bends
• Rotational movement.

• First order bends are:

- Lateral inset
-Canine eminence
-Molar offset
 SECOND ORDER BENDS
• Also called, Tip or Angulation
• Used to tip posterior teeth
• Tip back or Tip forward bends
• Bends in Occluso-gingival direction to maintain final angulation of
teeth.

TIP BACK Bends: to convert step bends into distal tipping bends.
-Distal leg of V bend is lengthened & entire posterior segment of
arch wire distal to V bends is bent 300 upwards
 THIRD ORDER BENDS
• Changes position of the root.
• used to obtain axial changes in bucco lingual or labiolingual root & crown
axis on one or more teeth.

BUCCAL / PALATAL BUCCAL / PALATAL

TORQUE
ROOT TORQUE CROWN TORQUE
 TORQUE

ACTIVE PASSIVE

CONTINOUS PROGRESSIVE
ARTISTIC POSITIONING BENDS

• given in the incisal area.

• To provide the ideal angulation of these teeth
 TREATMENT PHASES

1.Non extraction 2.After the first phase,

treatment of Class II all First Premolars are
condition extracted to correct the
↓ protusive condition
leading to Bimaxillary
Protrusion
 Round arch wires
.016- multiple loops for
rotation corrections
01 Levelling of the occlusal replaced by .018
plane, then .020inch continous ideal
gaining good arch form arch wire to level occlusal
correction of all rotations plane and gain ideal arch form

Anchorage Preparation

02 Third Degree Anchorage Preparation in the

mandibular arch, and breaking down
unfavourable
anchorage in maxillary arch
03 Distal En masse movement of the maxillary teeth

04 Detailed Tooth positioning preparatory to

retention will not be necessary since, upon
completion of step 3, all four premolars will
be removed and treatment of bimaxillary
protrusion will begun
LEVELLING
SET 1, MAXILLARY
Multiple loop .016 wire is fabricated as follows:
 Bent In, Tie back stop loops are are made in arch wire to
maintain arch length.
 Vertical loops, 5mm length bent mesial and distal to both maxillary
lateral incisors.
 Ideal arch form is made
 Tip Back bends, to prevent forward tipping of buccal segments of
teeth.
 Anti rotational bends made in terminal areas of arch wires
 Mild curve of spee
 Distal rotation ties made on right and left lateral incisors,& mesial
rotation on right and left central incisors
SET 1, MANDIBULAR
Multiple loop .016 wire is fabricated as follows:
 Bent In , Tie back stop loops are are made in arch wire to maintain arch
length.
 Vertical loops located between cuspid and first premolars
 Distal legs are made 5mm long and mesial 4 mm, to elevate premolars
and depress cuspids and incisors, and located such that to correct the
distal rotations of cuspids
 Arch wire is made in ideal form
 Tip back bends to prevent mesial tipping of teeth.
 Terminal molar anti rotation bends are also incorporated
 Arch wire is ligated
 Distal rotation ties made on both cuspid teeth
After 4 weeks, all rotations in both arches have been corrected.
Both maxillary and mandibular 0.018 round continous arch wires are
placed.
These are used to
-continue leveling of curve of spee
-gain ideal arch form
-further alignment of teeth.
SET 2, MAXILLARY
 A maxillary .020 inch continous ideal arch wire is made with
bent in stop loops to main arch length.
 Incisal curvature is flattened
 Mild second order bends in buccal segments to prevent mesial
tipping of teeth.
 Terminal molar tip back bends are twice in degree as are bends
in cuspid and premolar areas
 Artistic bends in incisal area→ to slightly incline crowns of
incisors towards mesial line.
SET 2, MANDIBULAR
 Bent in molar tie back stop loops are bent in wire → to maintain arch
length
 Cordinated tip back bends made in arch wire, with accentuated molar
tip back bends.
 Arch wire is offset occlusally 1mm, between cuspids and first pre
molars to elevate first premolars and depress cuspid and incisors.
 A reverse curve of spee is bent in arch wire.
 Arch wire ligated at terminal molars to prevent mesial migration of
arch wires.

At this point, correction of all irregularities has been completed,

arch form and bracket alignment established,
and second step is started.
ANCHORAGE
PREPARATION
SET 3, MAXILLARY
 An ideal .0215 by .0275 inch maxillary stabilizing arch wire is
constructed.
 Tie back loops to maintain exact arch length.
 Mild second order bends in buccal segments → to prevent mesial
tipping of teeth when class III intermaxillary forces is used.
 Terminal molar tip back bends ar made twice severe as the other
second order bends.
 A curve of spee is bent into arch wire
 Hooks for intermediate headgear are soldered to the a wire.
SET 3, MANDIBULAR
 A mandibular .020 by .026 inch ideal working arch wire is made .
 Bent in stop loops made to maintain arch length.
 Mild second order bends are made.
 Tip back bends on terminal molars are made twice as severe as other
second order bends
 Brass hooks for class III intermaxillary elastics use are soldered
between cuspid and lateral incisor bracket.
 Arch length increased slightly to create tension on terminal molars.
 Both wires are checked for cordination.
The sequence of ligation in mandibular arch wire is as follows:
1) Four incisors
2) Right and left cuspids
3) Right and left first pre molars
4) Right and left second pre molars

Terminal molars are not tied

Reason for this ligation sequence: arch length had been slightly
increased, and transmit force equally on terminal molars to start
thedistal tipping action.
The patient is instructed to wear INTERMEDIATE type headgear a
minimum of 14 hours per day.

The pull of headgear is high up.

Force exerted by headgear is twice that exerted by the No.6 inter

maxillary elastic.

Elastics are replaced by fresh ones at morning and at night.

This part is beginning step in anchorage preparation.

At the next month visit, both arch wires are removed & mandibular
second order bends are increased.

Both arch wires are checked for cordination.

This phase of treatment usually completes in 4 to 6 months.

Treatment is continued until third degree anchorage has been prepared.

After this, treatment mechanincs are reversed, the mandibular arch wire
will become the holding arch wire units.
DISTAL EN MASSE
MOVEMENT OF
TEETH
SET 4, MAXILLARY
 A new .0215 by .0275 inch ideal maxillary arch wire is made.
 All necessary primary, secondary and torque bends are incorporated
into new arch wire.
 After heat treating, it is reduced distal to the lateral incisor bracket
areas to .020 by .026 dimensions.
 Bent in molar stop loops and intermaxillary brass hooks for
intermediate headgear use are made in the wire.
 Arch wire is made passive in incisal area.
 As treatment progresses, the degree of second order bends are slightly
increased.
 The amount of labial/ lingual root torque is determined by using new
lateral cephalogram.
SET 4, MANDIBULAR
 The .020 by .026 inch mandibular working arch wire is replaced by .
0215 by .0275 inch stabilizing arch wire.
 Second order bends are made
 Wire passive in mandibular incisor area
 Cordinated with the new maxillary arch wire
 During this, close inspection of mandibular teeth is important. The
slightest movement of mandibular terminal molars will require
increase in the distal tipping bends.
 If bite has a tendency to open, second order bends should be checked
and corrected.
 spurs soldered gingivally on boththe arch wires between CI adn LI for
up and down elastic use.
it will prevent depression of mandibular incisors and alteration of
occlusal plane.
When the Class II treatment concluded after 9 months, the angular
measurements drawn on cephalogram were compared to those at the
beginning.
FMA: 280 FMA: 290
IMPA: 1010 IMPA: 1010
FMIA: 510 FMIA: 500
ANB: 60 ANB: 50

Although there are no signicant chnages in the triangle but,

a) the deep mandibular curve spee is corrected.
b) deep bite is corrected
c) Maxillary and mandibular first molars uprighted and tipped
distally.
d) Molar relation changed to Class I
e) Patient now has Class I bimaxillary protrusion.
Thank you