Bpt 4

IO ROGRESSIVE HERAPY
www.indiandentalacademy.com

Contents
• The Management Umbrella
• Principles of Bioprogressive Therapy
• VTO
• Orthopedics in Bioprogressive Therapy
• Forces Used in Bioprogressive Therapy
• Triple - Control Bioprogressive
• Bioprogressive Mixed Dentition Treatment
• Finishing Procedures and Retention
•Conclusion www.indiandentalacademy.com

Introduction
• Dr. Robert Murray Rickets .
• It accepts as its mission the treatment of the total
face rather than the narrower objective of the teeth
and the occlusion.
• Takes advantages of biological progressions
including growth, development ,function and
directs them to normalize it.

Management Umbrella
Quality
Quantity
Effectiveness of Treatment
Primary goal
Practice
• Management System
• Leadership Evolution
Planning
Organizing
Leading
Controlling
Natural Leader
• Spontaneous
• Centric
• Specialized in tech work
• Centralizes decision making
• Control by inspection
Transitional Leader
• Organization proliferates
• Committees increase
• Assistants multiply
• Volume increase
• Profit falls
• Best people leaves
• No management successioni
Management Leadership
• Domination of group objectives
• Decentralized decisions making
• Logical action
• Control by exception

Planning
Forecast
Develop Objectives
Program
Scheduling
Budget
Diagnostic & Treatment Design
SystemDiagnostic Programme
Clinical Examination
Describe Malocclusion
Describe Face
Describe Functional Req.
• Evaluation of Airway
• Evaluation of Habits
• Evaluation of Soft Tissue
Construct V.T.O.
Superimposition Areas
Chin
Maxilla
Teeth in mandible and maxilla
Profile
Lower archwww.indiandentalacademy.com

Evaluation Areas
Chin
Maxilla
Lower incisor and molar
Upper incisor and molar
Soft tissue
Arch form
Appliance Evaluation
function
mechanical
Biological
• Facial type
• Musculature
• Cortical bone
Auxiliary Appl. SelectionHeadgear
Quadhelix
R.M.E
Bumper
Nance
Facemask
Plates
Activator

Select Fixed Mechanics
Vehicle
• Bands
• Direct bonding
Arch Wires
Sequence of Mechanics
Time Schedule
Budget

Principals Of Bioprogressive
Therapy
The Use of System Approach to Diagnose and Treatment by
Application of V.T.O
Torque Control Through Out Treatment
Muscular and Cortical Bone Anchorage
Movement of All Teeth in Any Direction With Proper
Application of Pressure
Orthopedic Alteration

Treat Overbite Before Overjet
Sectional Arch Therapy
Concept of Over treatment
Unlocking the Malocclusion in a Sequence of Treatment in
Order to Establish or Restore More Normal Function
Efficiency in Treatment With Quality Results Utilizing a
Concept of Prefabrication of Appliance

Torque Control Throughout TreatmentTorque Control Throughout Treatment
Importance of Torque
• Keep roots in vascular bone
• Anchorage
• Torque to model
• Position teeth in final occlusion

Muscular and Cortical Bone AnchorageMuscular and Cortical Bone Anchorage

Movement of All Teeth in Any Direction With ProperMovement of All Teeth in Any Direction With Proper
Application of PressureApplication of Pressure
• Work of Brian Lee
• Bpt Suggest
Orthopedic AlterationOrthopedic Alteration

Treat Overbite Before OverjetTreat Overbite Before Overjet
Sectional Arch TherapySectional Arch Therapy
• Lighter forces to individual teeth
• Effective root controlling
• Maxillary orthopedic alterations
• Reduces binding and friction

Concept of Over treatmentConcept of Over treatment
• To overcome muscular forces against tooth surface
• Root movements needed for stability
• To overcome orthopedic rebound
• To allow settling in retention

Unlocking the Malocclusion in a Sequence of Treatment in OrderUnlocking the Malocclusion in a Sequence of Treatment in Order
to Establish or Restore More Normal Functionto Establish or Restore More Normal Function
• Concept
• According to B.P.T
• 3 Areas of diagnosis
• Position of teeth
• Facial type
• Functional influence

Efficiency in Treatment With Quality Results Utilizing a ConceptEfficiency in Treatment With Quality Results Utilizing a Concept
of Prefabrication of Applianceof Prefabrication of Appliance
Efficiency
• Thorough understanding of mechanical procedures
• Effect of mechanics on underlying anatomy and physiology
• Failure will result in cook book
• Monitor and upgrade ones self.
Quality
• Considered from the beginning
• Finish in mind before starting the case
• To relieve burden of detailing Use prefabricated
appliance

VISUAL TREATMENT OBJECTIVE

1. Trace the nasion –basion
plane. Put a mark at point
CC.
2. Grow nasion 1mm/yr.
Treatment time – 2yrs.
3. Grow basion 1mm/yr for
2yrs.

Mandibular Growth Prediction - Rotation
Mechanics
1. Convexity reduction – Facial axis opens 1deg / 5mm.
2. Molar correction – Facial axis opens 1deg / 3mm.
3. Crossbite correction – Facial axis opens 1-11/2, recovers half the distance
4. Overbite correction – Facial axis opens 1deg / 4mm.
5. Facial pattern – Facial axis opens 1deg – dolichofacial ; 1deg closing in
brachyfacial www.indiandentalacademy.com

1. Superimpose at basion along
basion – nasion plane. Rotate
up at nasion – open bite and
down to close the bite using
DC as fulcrum.
2. Trace condylar axis coronoid
process and condyle.

1. On condylar axis, make mark
1mm / yr. Down from point
DC.
2. Slide mark up to the basion –
nasion plane along the
condylar axis. Extend the
condylar axis to XI point,
locating a new XI point.
3. With the old and new XI point
coinciding trace corpus axis,
extending it 2mm / yr.
Forward of old PM point.
4. Draw posterior border of the
ramus and the lower border of
the mandible. www.indiandentalacademy.com

1. Slide back along the corpus axis
superimpositioning at new and
old PM. Trace the symphysis
and draw in mandibular plane.
2. Construct facial plane from NA
to PO.
3. Construct facial axis from CC to
GN.

Maxillary Growth Prediction
1. To locate the “new” maxilla
within the face, superimpose
at nasion along the facial
plane and divide the distance
between “original” and “new”
mentons into third by drawing
two marks

1. To outline the body of the
maxilla superimpose mark #1
on the original menton along
the facial plane. Trace the
palate, exception of point A.

Maxillary Growth Prediction
Point A changes with various
mechanics
HG - -8mm
Class II – -3mm
Activator - -2mm
Torque - -1-2mm
Class III - +2-3mm
Facial mask - +2-4mm
1. Point A can be altered
distally with treatment. Place
according to orthopedic
problem and treatment
objective. For each mm of
distal movement, point A
will drop ½ mm
2. Construct new APO plane.www.indiandentalacademy.com

Occlusal Plane Position
1. Superimpose mark # 2 on original
menton and facial plane, then
parallel mandibular planes rotating
at menton. Construct occlusal
plane.

Lower Incisor
1. Superimpose on corpus axis at PM.
Place a dot representing the tip of
the lower incisor in the ideal
position to the new occlusal plane,
which is 1mm above the occlusal
plane and 1mm ahead of APO plane.
2. Aligning over the original incisor
outline or using a template, draw in
the lower incisor in the final position
as required by arch length. Angle is
22 deg at =1mm to occlusal plane,
but the angle increases 2 deg with
each mm of forward compromise.

Lower Molar
1. Without treatment the lower
molar will erupt directly upward
to the new occlusal plane. With
treatment 1mm of molar
movement equals 2mm of arch
length. Lower incisor moved
2mm in this case + 4mm of
leeway space. Therefore the
calculation allows us to move the
molar forward 4mm on each side.
2. Superimpose the lower molar on
the new occlusal plane at the
molar www.indiandentalacademy.com

Upper Molar
1. Trace the upper molar in good
class I position to the lower molar.
Use the old molar as template.

Upper Incisor
Place upper incisor in good
overbite – overjet position =
2mm; interincisal angle 130
deg.
1. Trace the upper incisor in its
proper relationship aligning
over the original incisor
using it as a template.

Soft Tissue – Nose
1. Superimpose at nasion along the
facial plane. Trace bridge of the
nose.
2. Superimpose at anterior nasal
spine (ANS) along the palatal
plane.
3. Move prediction “back” 1mm /
yr. Trace tip of nose fading into
bridge.

Soft Tissue – Pt. A and Upper
Lip
1. Superimpose along the
facial plane at the occlusal
plane. Divide the horizontal
distance between the
“original” and “new” upper
incisor tips into thirds by
using two marks.
2. Point A remains the same,
superimpose new and old
bony point A and make a
mark at soft tissue Point A.
3. Keeping the occlusal planes
parallel, superimpose mark
# 1 on the tip of the original
incisor (slide forward 2/3).
4. Trace upper lip connecting
with point A. www.indiandentalacademy.com

Lower Lip, Point B, Soft Tissue
Chin
1. Superimpose interincisal points
keeping occlusal planes
parallel. Trace lower lip and
soft tissue B point. The soft
tissue below lower lip remains
in the same relation to point B
as in the original tracing. Soft
tissue point B drops down as
lower lip recontours.

Completed V.T.O
1. Superimpose on the
symphysis and arrange the
soft tissue of the chin. It
should be evenly
distributed over the
symphysis.

ORTHOPEDICS IN BIOPROGRESSIVE
THERAPY
• Introduction
• Is There A Difference
• Evaluation Methods Normal Growth
Anticipated Growth
Mechanical
Response
Areas of Superimposition

ANALYSIS OF AN ORTHOPEDIC PROBLEM
Microrhino Dysplasia
General Characteristics 1. Upward Tilt Of Palate
2. Short Vertical Height Of Nose
3. Upward Cant Of Nares
4. High Convexity
5. Excessive Anterior Overjet
6. Abnormal Habits
7. Hypertonic Lower Lip
8. Retruded Lower Arch
9. Fractured Upper Incisors
10. Hypotonic Upper Lip
11. Blocked Upper Laterals
12. Mandible Unrelated

CLASSICAL RESPONSES WITH DIFFERENTIAL
HEADGEAR THERAPY ( CERVICAL HEADGEAR)
ORTHOPEDIC
RESPONSE
ORTHODONTIC
RESPONSE
REVERSE RESPONSE EXPANSIVE RESPONSE
SOFT
TISSUE RESPONSEwww.indiandentalacademy.com

GENERALIZED RESPONSE TO COMBINATION TYPE
HEADGEAR
• Usage
• Differentiation between
orthopedic and orthodontic
movements
• Force Amount
• Direction
• Force Duration
1. Sinus Development
2. Distal Root Tip
3. Sutural Freedom
Other Factors

Cervical Headgear Combination Headgear

Factors Causing Excessive Mandibular Rotations
Weak Muscular Pattern
Not Retarding Effective Eruption of Lower Molars
Severe Tipping of Upper Molars
Full Arch Therapy Without Freeing Anterior Occlusion

FORCES USED IN
BIOPROGRESSIVE THERAPY
• Physiology of Tooth Movement
Biological response to the forces applied to our
mechanical procedures

Force levels
• Work by Brian Lee following the work of Storey
and Smith
• According to bioprogressive therapy – 100gm cm2
• Control of force Work by Thurow

Support
Cortical Bone Support Muscular Support

UTILITY
ARCH

Response To Round Reverse Curve of Spee Arch wire
• Problem faced in the 1950’s
• Round arch segments
• Step down base arch formed

FUNCTIONS:
1. Position of the lower molar to allow for cortical
anchorage
2. Manipulation and alignment of the lower incisors
segment
3. Expansion in the buccal segment
4. Saving “E” space

SIDE VIEW

FRONT VIEW

StandardStandard ApplianceAppliance Full Torque Appliance

Triple BioprogressiveTriple Bioprogressive
ApplianceAppliance
Extraction
Series
Non-
Extraction
Series

MAXILLARY ARCH
TOOTH TORQUE TIP
Central incisor + 22 degrees 0 degrees
Lateral incisor + 14 degrees + 8 degrees
Canine + 7 degrees + 5 degrees
First premolar 0 degrees 0 degrees
Second
premolar
0 degrees 0 degrees
Molar 0 degrees 0 degreeswww.indiandentalacademy.com

MANDIBULAR ARCH
TOOTH TORQUE TIP
Central incisor 0 degrees 0 degrees
Lateral incisor 0 degrees 0 degrees
Canine +7 degrees +5 degrees
First premolar 0 degrees 0 degrees
Second
premolar
o degrees 0 degrees
Molar 0 degrees +5 degrees

FINISHING & RETENTION
• Commitment and Motivation
• Differing Occlusal Concepts
• Sectional Arch Treatment
• Prefabrication of Appliance
• Functional Influences
• Three Phase of Retention

Occlusal Check List for Lower
• Molar - upright , mesial slightly outward to accommodate distal
incline of upper first bicuspid.
• Bicuspid (2) - slightly depressed to seat the upper second
bicuspid.
• Bicuspid (1) – buccal to lower canine and should be well
elevated, mesial contact also buccal to canine.
• Lingual crown torque from bicuspid (2).
• Canine – position to produce smooth curve.
• Distal of lateral placed slightly labial to mesial of canine.
• Smooth curve of contacts of the incisors.

Finishing and Retention

Occlusal Check List for Upper
• Molar – well expanded to prevent collapse of arch later.
• Molar – upper molar rotation . Line should pass through canine.
• Bicuspid (2) – distal margin is well occlusal to marginal ridge of
upper first molar. Slightly inclined mesially.
• Bicuspid (1) – slightly distally inclined.
• Bicuspid (1) – offset buccally to cuspid to avoid area of premature
contact with lower first bicuspid.
• Canine – slight mesial rotation.
• Lateral – kept labially.
• Central – proper contact, midlines coincide with lower, level
incisal edges.

BIOPROGRESSIVE IN MIXED
DENTITION
Objectives of Early Treatment
Resolve Functional Problems
Resolve Arch Length Discrepancy
Correct Vertical Problems
Growth Concepts
Work by Bjork Moss
Moffett Ricketts

Traditional Growth Concept

Current Growth Concept

Laminagraphy
Functional Problems
• Cross Mouth Interference
• Anterior Crossbite
• Open Bite
• Excessive Range of function
• Distal Displacement
• Loss of Posterior Support
• Habits
• Airway problems
• True Class III Problems

Laminagraphic Norms for Condylar Position

Summary
• Orthopedic alteration, optimum orthodontic forces and
combination of mechanics were suggested that would
unlock the malocclusion in a progressive sequence in order
to establish more normal function for optimum health and
stability of the denture.
• Bioprogressive Therapy approaches an in-depth analysis of
the basic malocclusion, the underlying morphology with
its functional variations, then attempts to treat them to as
normal a function and esthetic relationship as is possible
for the long range health and stability of the denture.

References
• Ricketts , Bench, Hilgers. Bioprogressive therapy.
• C. Brian Preston, Jeff Kozlowski, and Bill Evans.
Adaptation of the Bioprogressive Philosophy to use
Brackets With .022" SlotsSemin Orthod 1998;4:238-245.
• James J Hilgers.Bioprogressive therapy simplified part 1-
Diagnosis and Treatment planning.JCO sep 1987( 618-
627).
The Linear Dynamic system.JCO oct 1987( 716-734).

References
• Dayse Uriasa; Fatima Ibrahim Abdel Mustafa.Anchorage
Control in Bioprogressive vs Straight-wire Treatment.
Angle Orthod 2005;75:987–992.
Non-extraction therapy.JCO Nov 1987( 794-804).
Extraction therapy.JCO Dec 1987( 857-870).

Bpt 4

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Bpt 4

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