Alexander Discipline in orthodontics course /certified fixed orthodontic courses by Indian dental academy

The Alexander Discipline

INDIAN DENTAL ACADEMY
Leader in continuing dental education

www.indiandentalacademy.com

FROM TWEED TO VARI-SIMPLEX
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0.022 bracket slot
Treatment in mandibular
arch
Uprighting mand. 1st molars
Uprighting lower incisors
Non-extraction treatment
Cervical facebow

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

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


APPLIANCE DESIGN
Factors determining the design of the VSD appliance
 Sizes

& shapes of the teeth
 Accessibility of tooth
 Patient comfort
 Bracket wing breakages


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

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

APPLIANCE DESIGN
Lang brackets
(Dr. Howard Lang)
 Round

surfaced teeth
 Teeth at corners of the
mouth (Max. & Mand. Cuspids)
WEDGE SHAPED IN PROFILE

APPLIANCE DESIGN
 Lewis

or Steiner


APPLIANCE DESIGN
Advantages of Lang brackets
over twin brackets
 Twin

brackets on canines
reduce inter bracket distance
 Full bracket engagement
is difficult

APPLIANCE DESIGN


APPLIANCE DESIGN

Lewis bracket

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

APPLIANCE DESIGN
Useful in rotated teeth


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

BRACKET POSITIION
Bicuspid bracket height (X) is the key to position
all brackets
MAXILLARY ARCH
CI
- X
LI
- X - 0.5
C - X + 0.5
BC - X
FM - X - 0.5
SM - X -1.0

MANDIBULAR ARCH
CI
- X - 0.5
LI
- X - 0.5
C
- X + 0.5
BC - X
FM - X – 0.5


BRACKET ANGULATION
(Tip or second order bends)


BRACKET TORQUE
( Third order bends )


Bracket IN / OUT ( First order bends)
MAXILLARY ARCH
CI
- Standard
LI
- Thick
C & BC
- Thin
MOLARS
- Thinnest

MANDIBULAR ARCH
CI, LI, & C
- Thick
BC - Thin
M - Thinnest


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


EXTRA-ORAL FORCES


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

EXTRA-ORAL FORCES
Effects on 3 dimensions
Sagittal dimension
 Vertical dimension
 Transverse dimension




Anchorage control

Components of a Facebow system
Molar tubes
- gingivally to move molar bodily
- occlusally for orthopedic correction

Adv; easy to insert the inner bow
easy to clean
facilitates the use of omega loops

The outer bow


The inner bow


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

EXTRA-ORAL FORCES
Patient cooperation
 Checking

neck / head strap
 Checking molar tubes
 Checking molar mobility


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

Effects on SNA


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


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

Use of elastics - specifications


Use of elastics- Class II elastics


Use of elastics- Class II elastics
 Proper

timing is critical
 Not used to open the bite
 Class II elastics can keep the mandible in fossa
 Skeletal growth
 Used to burn anchorage


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


Use of elastics- Class III elastics
 More

vertical vector than
class II elastics
 Distal position of condyle


Use of elastics -Mid line elastics
½

“ , 6 ounce elastics
 24hrs / day
 During finishing stages


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

Anterior box elastics
–to increase the overbite

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


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


Use of elastics
Triangular elastics

Crossbite elastics


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


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

Coil springs


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

Tying back of orthodontic wires
Active tie-back (0.014 ligature wire)
1.
2.

Consolidate the arch when extra-oral force is
being applied
Used after closing extraction spaces


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

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

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

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


In extraction case
0.016 X 0.022 SS closing loop
In deep bite cases


Finishing wire in all cases in both arches is an 0.017
X 0.025 SS ( 5 months )

Heat treating
 To

maintain bends


The use of arch wires - Arch forms
For upper arch


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


Non extraction treatment
Each orthodontic problem should be diagnosed as
non-extraction whenever possible
 Fuller

& esthetic smile
 Good posterior occlusion


–Borderline cases
 Bonding

does not require inter-dental space
 Inter-proximal reduction
 -50 torque in lower anteriors and –60 angulation in
lower first molars
 Advent of rectangular flexible arch-wires
 Class III elastics
Patient co-operation

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


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

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


Case reports Class II Div 1


Case reports


Case reports –Class II div 2


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


Extraction treatment -DRIFTODONTICS


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

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

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

Extraction treatment


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

When does retention begin ?
1.
2.
3.
4.
5.
6.

Ideal occlusion
No CO-CR discrepancy
Normal Overjet & overbite
Artistic positioning of anteriors
Spread out lower incisor roots
Correct torque of upper & lower incisors


7.
8.
9.
10.
11.
12.

Lower inter canine width must be maintained
Lower first molar should be upright
Habits should have been eliminated
Midlines should coincide
Correct arch form
Correct curve of Spee

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

Appointment 1
Arch wire sectioning

Deep overbite/Class II -lower arch wire is sectioned
Open bite/Class III -upper arch wire is sectioned


Normal bite
Either or both arch wires



o
o
o
o

Max.molar bands are removed
Patients are asked to chew sugarless gum
Elastics –night wear
Tooth shaping

o Complete appliance removal
o Inter-proximal stripping
o Impressions for final models
o 3rd molars are considered
Appointment 4 (2 days later )
Retainers

Retention
Maxillary retainer -Wraparound retainer


Retention
Mandibular retainer
0.0215 multi-stranded wire


Retention
0.036”
BANDED

BONDED


Special problems
Equilibration

Spacing
5/16”, 31/2 ounce

References

 Technique

and treatment with light-wire edgewise
appliances (volume I and II)
- J.R.JARABAK & J.A.FAZZEL

 THE

ALEXANDER DISCIPLINE
Contemporary Concepts and Philosophies
- R.G.”WICK” ALEXANDER

References
Seminars in Orthodontics, Vol 7, No 2 (June), 2001


The Alexander Discipline Appliance Design and
Construction
-M.Alan.Bagden



Face Bow Correction Of Skeletal II Discrepancies in the
Alexander Discipline
-C. D Alexander & J M. Alexander



Finishing and Retention Procedures in the Alexander
Discipline
-Tucker Haltom

Thank you
Leader in continuing dental education


Alexander Discipline in orthodontics course /certified fixed orthodontic courses by Indian dental academy

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