edgewise

1. The Edgewise Appliance
Presented by – Dr. Priyal Billaiya

2. Contents
• Introduction
• History
• Edward Angle
• Angle’s Philosophy
• E Arch Appliance
• Pin and Tube Appliance
• Ribbon Arch Appliance
• Edgewise Appliance
• Instruments
• Brackets
• Molar Tubes
• Banding

3. • Arches
• Loops
• After edgewise
• Charles Henry Tweed
• Tweed Philosophy
• Lester Levern Merrifield
• Tweed Merrifield Edgewise
• References

4. The Edgewise arch mechanism was Edward
H. Angle’s last and greatest contribution to
orthodontics, after a lifetime devoted to
development of orthodontic appliances.

5. Etienne Bourdet
• First record of recommending serial extraction (1757)
• Extracting premolars to relieve crowding
• Lingual orthodontics
Pierre Fauchard (18th Century)
• Horseshoe-shaped strip of precious metal to which
the teeth were ligated
• Basis for Angle’s E-arch
Orthodontics in 3 millennia. Chapter 1:Antiquity to the mid-19thcentury.Norman Wahl. (Am J Orthod Dentofacial Orthop.2005;127:255-9)

6. Schangé Appliance(1841)
A marked improvement in the anchorage, in the
form of a skeleton crib attachment to the molars
Harris’s Appliance(1850)
• change of metal (nickel silver)
• modification of form and proportions
Treatment of malocclusion of the teeth : Angle's system / by Edward H. Angle(1907)

7. • Victor H. Jackson
• Wire crib in 1887 (patterned much after the design of Schange)
• A number of finger springs for tooth movement were soldered
• “Jackson System,” opening the door to what some have
called the “Age of Systems.”
• Fixed retention and fiberotomy
William E. Walker
• Who used precious metals
Crozat
• Modified Walker’s device and introduced it in 1919.
• For many years, the “Crozat technique” was one of the most popular in use
Orthodontics in 3 millennia. Chapter 5: The American Board of Orthodontics, Albert Ketcham, and early 20th-century appliances.Am J Orthod Dentofacial Orthop 2005;128:535-40

8. Edward Hartley
Angle
1855 – 1930

9. A Biographical Portrait of Edward Hartley Angle, the First Specialist in Orthodontics, Part 1-Sheldon Peck.Angle Orthod. 2009;79:1021–1027

10. Orthodontics in 3 millennia. Chapter 2: Entering the modern era.Norman Wash.AmJOrthod Dentofacial Orthop 2005;127:510-5).

11. Frederick B. Noyes, his friend since 1892 and a former student, put it this
way:
‘‘When he presented a paper before a society and someone
assailed his ideas with elaborate quotations from the
literature and citing of authorities, he could not argue. All
he could do was to cuss at them, and call them God damn
fools, who they probably were, and they
didn’t like it.’’
Angle Orthod. 2009;79:1021–1027

12. ANGLE’S PHILOSOPHY
five points or 'landmarks'
A, D, D', E and E‘
It will be noted that there is a straight line from
the center of the labial
ridges of the cuspids, D, D', to the center of the
mesiolabial ridges of the first
molars, E, £'. This line is always straight,
regardless of the degree or form of the
curve of the anterior part of the dental arch or
of the lateral width between either
the cuspids or the molars."
he area of the lateral incisor

13. He believed that an orthodontic appliance must have Five properties:
1. Simplicity
2. Stability
3. Efficiency
4. Delicacy
5. Inconspicuousness

14. • First design of Angle
• Consisted of bands only on the first molars
• Wire ligatures tied to a heavy archwire
• Each end of the wire was threaded, and a small nut
was placed on the threaded portion to advance it.
• E-arch could only tip teeth
E arch Appliance (1900)
Orthodontics in 3 millennia. Chapter 5: The American Board of Orthodontics, Albert Ketcham, and early 20th-centuryappliances.Norman Wahl. Am J Orthod Dentofacial Orthop 2005;128:535-40

15. Plain arch E
Treatment of malocclusion of the teeth : Angle's system / by Edward H. Angle(1907
Ribbed expansion arch E

16. • Strong headed pins soldered to their screw-heads.
• Designed for the treatment of fractures of the maxilla
Plain used both in regulation and in retention
• Smooth-bore tubes soldered to their sides into which the ends of the
arches and the extension flanges of the nuts accurately fit.
• X bands are for premolars and the D bands for molars.‘
Treatment of malocclusion of the teeth : Angle's system / by Edward H. Angle(1907)
Adjustable Clamp Bands

17. • Placing bands on other teeth
• vertical tube on each tooth into which a pin, soldered to the
archwire, was placed
• Repositioned the pins
• Could not control the tooth roots because of the round
archwires
• Special instructions
• Expense and time
Pin and Tube Appliance (1910)
Dr. Edward H. Angle's Pin and Tube Appliance. Current Orthodontic Literature

18. • Modified the bracket
• Open occlusally
• Rectangular arch fitted closely into a
machined bracket
• .022 x 036-in gold, held firmly with pins
• small enough to have good spring qualities
• lacked premolar control
Ribbon Arch Appliance(1916)
How, why, and when was the edgewise appliance born? Julien Philippe.J Dentofacial Anom Orthod 2008;11:68-74

19. To overcome the drawbacks of the ribbon arch, in 1925, Angle reoriented the slot from vertical to
horizontal and inserted a rectangular wire “edgewise”— with its greater dimension perpendicular to
the long axis of the teeth. Rather than being held with lock pins, which often broke and defied
removal, the archwire was tied in place with steel ligatures.
The archwire was of .022 x 028-in gold
The edgewise appliance was the first bracket able to move teeth in all 3 planes simultaneously
It soon became the most popular appliance in the United States
Orthodontics in 3 millennia. Chapter 5: The American Board of Orthodontics, Albert Ketcham, and early 20th-century appliances.Norman Wahl.Am J Orthod Dentofacial Orthop 2005;128:535-40
THE EDGEWISE APPLIANCE (1928)

20. Parts of the
Mechanism
ANGLE.--THE LATEST AND BEST IN ORTHODONTIC MECHANISM 1147

21. Soldering Pliers
Band Forming Pliers
WireCutter
Regulating Pliers

22. Scissors
How Pliers
Hand Mallet
Band Driver

23. Wrenches Lane Blowpipe

24. Brackets

25. Original Edgewise Bracket
•Soft gold, soldered to gold band material
•Bracket slot 0.022 x 0.028 inch
•Bracket slot was readily deformed by the forces of occlusion and by tying
ligature wires to the bracket
Single Width Bracket
• designed to overcome the problem of tooth rotation.
Soldered gold eyelets was placed in the bands.
• Ligature wire tied from eyelet to the archwire
Orthodontics current principles & techniques

26. Double width /Posterior bracket
• Approximately twice as wide as single
width bracket (0.1 in)
• Designed for use on molar teeth, but has been practically
used on all tooth.
Orthodontics current principles & techniques

27. Twin Bracket
• Two edgewise brackets joined on a common base
• Named “Siamese twin brackets” by Swain, the originator of the idea.
Orthodontics current principles & techniques

28. Curved base twin bracket
• Base of twin bracket was curved to confirm to
the curvatures of canine and premolars
• Auxiliary eyelet tie was not required for
rotation
• Greater control of axial inclination
• Decreased interbracket span
•Decreased amount of activation of closing loops
Orthodontics current principles & techniques

29. Lewis Bracket
Original Lewis bracket consists of soldered auxiliary rotation arms or wings
abutted against the bracket itself and thus offered a lever arm to deflect the
archwire and rotate the tooth.
Present Lewis bracket is a one piece rotational bracket with integral rotational
wing
• 100% of desired rotation is easy to obtain
• No interference with activation of closing loops, second order bends
and other archwire fabrications
• Size of the bracket hindered use in many
situations
• Food trapping around the wings
Orthodontics current principles & techniques

30. Modifications of Lewis Bracket
• Curved base Lewis bracket
•Vertical slot Lewis bracket
Consists of 0.020x0.020 in vertical slot , making possible the use of
uprighting spring to correct axial inclination
A modification of the Lewis bracket, designed by Howard M. Lang (1914-
94),3 uses straight arms with a hole to increase flexibility and for ligature
tying

31. Broussard Bracket
• Garford Broussard
• A conventional bracket with a closed, rectangular, vertical
slot 0.018” X 0.046” which is formed when the
bracket is welded onto the band material
Clinical applications of the Broussard auxiliary edgewise bracket. Am J Orthod.1964.

32. Steiner Bracket
• This bracket incorporated flexible rotation arms which
afforded a rotational effect
• Easy to tie
• It works satisfactorily as long as the flexible arms do not take on
a permanent deformation.
Orthodontics current principles & techniques

33. Buccal Tubes
Orthodontics current principles & techniques

34. Banding

35. Technique and treatment with the edgewise appliance.

36. Treatment of malocclusion of the teeth. Angle EH

37. Treatment of malocclusion of the teeth. Angle EH

38. Treatment of malocclusion of the teeth. Angle EH

39. Arches

40. Pliers for bending round wires
A Angle wire-bending pliers No. 139
used to hold the wire while it is bent around
one beak with the fingers
B Triple-beak clasp-adjusting pliers.
C & D Pliers for bending and forming loops,
especially in small-diameter wires.
B,C & D will produce a bend by merely
closing on the wire; greater bends are made
by continuing the bend with the fingers or by
successive small bends
Treatment of malocclusion of the teeth. Angle EH

41. Instruments for bending rectangular wires
A, B, D, & E torque keys with slotted
ends machined to engage the flat sides of the wire
securely.
C Arch former with slots machined around the
circumference to fit different thicknesses of
rectangular wire.
F Angle pliers No. 142, with a groove in the lower
beak which provides a secure grip on the wire.
Treatment of malocclusion of the teeth. Angle EH

42. Labial curvature of the incisor segment

43. • The second bends - sharp bends at the cuspid prominences
• made with the small end of the arch former, with the fingers, or with a pair of pliers.

44. • The last bends - subtle adjustments at the
lateral incisor and molar
• made with the No. 142 or three-point clasp-
adjusting pliers

45. • Purpose:- To contour the arch wire to the buccal surfaces of teeth, which
vary in their labio-lingual thickness and do not conform to an arch.
• The extent of each bends is dictated by the labio-lingual thickness of
individual teeth so that a smooth curve of incisors and canines on their
lingual surface can be achieved.
• In and Out bends
• Bucco-lingual / Labio-lingual
FIRST ORDER BENDS

46. Compensations for first order bends
• For molars
offset position of molar tubes is necessary
at least 10-degree offset
• The offset for lower first molar should be 5-7 degree
• while that for second molar should be at least as large as for the upper molar

47. SECOND ORDER BENDS
• Bends in the occluso-gingival direction to maintain the final angulation
of teeth.
• In the incisal area, second order bends (artistic bends) provide the ideal
angulation to these teeth.
• In posterior region, second order bends maintain the distal tipping of the
pre-molars and molars

48. Compensation for second order bend
• Contemporary Edgewise brackets have a built in tip
• Angulation of brackets
• A distal tip for upper first molar is also needed to produce good
interdigitation of the posterior teeth

49. THIRD ORDER BENDS
• Torsional bends along the long axis of the rectangular arch wire are called third order
bends or torque.
• Buccal (Labial) / Palatal (Lingual) root torque.
• Buccal (Labial) / Palatal (Lingual) crown torque
Active torque
Torque in an arch wire is said to be active when it is capable of affecting a
torque movement of teeth in a segment.
Passive torque
A passive torque in an arch wire is said to be present when the torque in it
does NOT produce torque movement on full engagement of the wire. The
purpose of the passive torque is to maintain the already achieved torque

50. PART II

51. LOOPS

53. Space-holding loops.
• The loop between the first molar and the first
bicuspid
• shown is passive, merely holding space for the
second bicuspid.
• level where it might be easily deformed by occlusion.
Molar Stop loop
shows a different form of space-holding loop ahead of
the molar
tube. This loop, in combination with a similar loop on
the opposite side, will
hold arch length from molar to molar. This form of
stop loop also has the ad-
vantage of adjustability, in both mesiodistal and
buccolingual directions

54. .
• The long horizontal segments add vertical adjustability, so that this loop is capable of moving the
tooth in any direction.
• Mesiodistal movements can be carried out for space opening or closing is formed so that the vertical
arms or other arch stops engage brackets in the proper way.
• activated to move the left central incisor labially and inferiorly, with no mesiodistal action
Box loops.

55. • .The delta is actually half of a box loop, distorted so
that it can be fitted into a single interproximal space.
• This can be very useful where limited vertical
correction is required in combination with other
movements.
Delta loop

56. These versatile loops serve as stops to maintain or adjust
intercuspid width, as points of adjustment for vertical and
horizontal relationships between cuspid and lateral
incisor, and as hooks for elastics.
The upper hook in the illustration is positioned so that the arch
wire is free to slide distally through the cuspid bracket, closing
anterior spaces. The lower hook is against the cuspid bracket,
maintaining anterior arch length.
Rubber elastics can be extended from these hooks distally to the
molar tubes either arch to close spaces or to correct intermaxillary
discrepancies (or both)
Boot hooks

57. Horizontal loops.
• A variation on the boot-hook loop is shown
• Here it is used to gain vertical adaptability for
correction of the bi-cuspid.
• Note the long horizontal arms.
Torqueing loops.
• they serve merely as vertical extensions of the
arch wire which engage the gingival region of the
crown to move the root lingually.
• Elastic action comesalmost entirely from torsion
in the arch wire, not from the loop itself

58. Ligation

59. After Edgewise

60. Retaining devices are used as temporary aids to support and guide teeth to their normal, balanced
relationships
Rubber Positioner
This has two distinct advantages over the rigid retainer:
• It is made to a cast on which the final spaces have been corrected, so that it will not tend to
maintain these spaces.
• It is not worn during the day, so there is no interference with normal occlusion and tongue function.
Acrylic Retainers
Acrylic appliances, usually plates, are also useful in maintaining corrected relationships, especially arch
length and retraction of upper anterior teeth
Retainers must be worn until the musculature reaches a condition of balance with the dentition.

61. Third Molars
Third molars should be observed, and extractions should be ordered if indicated.
The End of Treatment
• Orthodontic treatment cannot be considered complete until all of the adult dentition is in
position and gives evidence of reasonable future stability.
• Our goal must always be a normal, healthy adult dentition, not merely a temporary glossing over
of the most obvious esthetic defects.

62. DRAWBACKS
• Angle’s edgewise philosophy incorporated the non-extraction protocol
• Anteroposterior correction difficult to accomplish.
• Proclination of anterior teeth was common

63. “I have finished my work, it is as perfect as I can make it”

64. Thank You

65. References
• Technique and treatment with the edgewise appliance. Thurow, Raymond C.
• Treatment of malocclusion of the teeth. Angle EH.
• Orthodontics: Current Principles and Techniques. T.M. Graber,B.F. Swain.
• Contemporary Orthodontics, 5th Edition. William R. Proffit, Henry W. Fields & David M. Sarver
• Orthodontics, Current Principles and Techniques.5th Edition. Graber, Vanarsdall & Vig.
• A Biographical Portrait of Edward Hartley Angle, the First Specialist in Orthodontics, Part 1.Sheldon
Peck. (Angle Orthod. 2009;79:1021–1027.)

66. • Angle EH. The latest and best in Orthodontic Mechanism. Dental Cosmos1928;70:1143-56.
• Angle EH. The latest and best in Orthodontic Mechanism. Dental Cosmos1929;71:164-74.
• Angle EH. The latest and best in Orthodontic Mechanism. Dental Cosmos1929;72:260-70.
• Angle EH. The latest and best in Orthodontic Mechanism. Dental Cosmos1929;73:409-21
• Dr. Edward H. Angle's Pin and Tube Appliance. Current Orthodontic Literature.
• Classification of Malocclusion. Edward H. Angle. The Dental Cosmos.
• History & Evolution of Edgewise Orthodontics. Rjeev Kumar Mishra.

67. • Orthodontics in 3 millennia. Chapter 1:Antiquity to the mid-19century.Norman Wahl. Am J Orthod
Dentofacial Orthop 2005;127:255-9).
• Orthodontics in 3 millennia. Chapter 2: Entering the modern era. Norman Wahl. (Am J Orthod
Dentofacial Orthop 2005;127:510-5).
• Orthodontics in 3 millennia. Chapter 5: The American Board of Orthodontics, Albert Ketcham, and
early 20th-century appliances.Norman Wahl. (Am J Orthod Dentofacial Orthop 2005;128:535-40)
• Charles H. Tweed, 1895-1970.James L. Vaden.Cookeville,Tenn.(Am J Orthod Dentofacial Orthop
2015;147:S171-9)
• In Memoriam. Lester Levern Merrifield, Feb 1, 1921 to Jan 15, 2000. Am J Orthod Dent Orthop
;117(4).
• The profile line as an aid in critically evaluating facial esthetics. Levern Merrifield.(Thesis-ABO)