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MBT SYSTEM

STRAIGHT WIRE TECHNIQUE




          INDIAN DENTAL ACADEMY
   Leader in Continuing Dental Education
    www.indiandentalacademy.com




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 Orthodontic  treatment mechanics are
  determined by four elements-
-bracket positioning
-bracket selection
-archwire selection
-force levels


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WORK OF ANDREWS
First Generation

  The original SWA was introduced by Andrews in 1972
  and it had the features of Siamese edgewise bracket.

  He recommended a wide range of brackets
       - For extraction cases,canine brackets with anti-tip,anti-
    rotation, and power arms
       -Three sets of incisor brackets with varying degrees of
    torque for different clinical situation.




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WORK OF ROTH
Second Generation
   To avoid inventory difficulties of a multiple
    bracket system, ROTH recommended a
    single appliance system to manage both
    extraction and non-extraction cases.
   The appliance prescriptions developed by
    Andrews and Roth were based on the
    treatment mechanics used in their practice.



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WORK OF McLAUGHLIN,BENNETT
AND TREVISI
  Third Generation

   The MBT has been developed from the
    combined clinical experience of the authors for
    more than 70 years.
   It also introduced additional research input from
    Japanese sources to update the scientific input.
   It is designed ideally to work with sliding
    mechanics,with light continuous forces,
    lacebacks and bendbacks.
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Following elements make up the MBT treatment
philosophy

   Bracket selection, versatility of bracket
  system, accuracy of bracket positioning, light
  continuous forces, 0.022 versus 0.018 slot,
  anchorage control, group movement, use of
  three arch forms, one size of rectangular
  steel wire, archwire hooks, methods of
  archwire ligation, awareness of tooth size
  discrepancies, persistence in finishing.


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The MBT Bracket System

 The   MBT bracket system is based on a
  more balanced mix of science,tradition
  and experience.
 It is a bracket system for use with light
  continuous forces, lacebacks and
  bendbacks
 It is designed ideally to work with sliding
  mechanics.

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EXCLUSIVE MBT
APPLIANCE FEATURES.
 Reduced    anterior tip.
 Upper bicuspid brackets with 0 0 tip.
 Lower bicuspid brackets with 2 0 tip.
 Additional palatal root torque for upper
  incisors and additional labial root torque
  for lower incisors.
 Upper cuspid brackets with the normal
   –70 torque or 00 torque.
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   Upper molar brackets with additional 50
    buccal root torque.
   Progressive buccal crown torque in lower
    cuspids and lower buccal segments.
   Optional upper second bicuspid brackets with
    an additional 0.5mm of in-out compensation.
    Three bracket types,Clarity Aesthetic
    Brackets, Victory Series brackets, and Unitek
    Full Size Twin Brackets,all available with APC
    Adhesive Coating.
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Design features of a modern bracket
system

      Range of brackets
         - Standard size metal brackets.
         - Mid-size metal brackets.
          -Esthetic brackets.
      Improved i.d system
           Laser numbering of standard size metal
            brackets.
      Rhomboidal shape
          Reduces bulk and assists accuracy of bracket
          placement.
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   Drawing of original
                SWA bracket.
               Dots (upper) and
                dashes (lower) were
                used for i.d
                purposes.



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   Drawing of MBT
                        brackets.
                       Standard size
                        brackets have a
                        rhomboidal form
                        and numerical
                        i.d.system.



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VERSATILITY
   Seven areas
Options for palatally placed upper lateral incisors(-10*)
Three torque options for upper canine(-7,0,+7)
Three torque options for lower canine(-6,0,+6)
Interchangeable lower incisor brackets
Interchangeable upper premolar brackets
Use of upper second molar tubes in first molars in non-HG
   cases
Use of lower second molar tubes for upper first and second
   molar of opposite sides when finishing cases to class II
   molar relationship.

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Horizontal bracket placement
errors
                      If brackets are
                       placed to the mesial
                       or distal of the
                       vertical long axis of
                       the clinical
                       crown,improper
                       tooth rotation can
                       occur.

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Axial or paralleling errors

                                 These will occur if
                                  the bracket wings do
                                  not straddle the
                                  vertical long axis of
                                  the crown in a
                                  parallel manner.
                                 Such errors lead to
                                  improper crown tip.


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Thickness errors.
                           Excess bonding
                            agent beneath the
                            bracket base can
                            cause thickness and
                            rotational errors.
                           Can be eliminated
                            by pressing the
                            bracket against the
                            tooth.
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Vertical errors
                            Vertical errors in
                             bracket placement
                             are caused by
                             placing brackets
                             gingival or
                             incisalocclusal to
                             the center of the
                             clinical crown.


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Gingival Concern.

                         Partially erupted tooth.
                         It is difficult to visualize
                          the center of the
                          clinical crown on
                          partially erupted
                          teeth,when treating
                          young patients.


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Gingival Inflammation
  Gingival inflammation causes foreshortening,effectively
reducing the length of the clinical crowns.

                                 Top:Healthy gingivae.
                                 Bottom :The same
                                  case with inflamed
                                  gingivae in the upper
                                  right quadrant.



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Teeth with palatally or lingually
displaced roots.

                      Individual teeth with
                       lingually displaced
                       roots can produce
                       short clinical
                       crowns.



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Teeth with facially displaced
roots.

                        Individual teeth with
                         facially displaced
                         roots can produce
                         long clinical crowns.




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Incisal or Occlusal concerns.
                                       Incisal crown
                                        fractures or
                                        tooth wear
                                        make it difficult
                                        to visualize the
                                        center of the
                                        clinical crown.



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Crowns with long tapered
buccal cusps

                               Cuspids with
                                tapered clinical
                                crowns often do
                                not have adequate
                                contact with the
                                opposing teeth.



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Axial/paralleling variation

                 The tip position of the lateral
                 incisor brackets was varied to
                 help root paralleling.


                 In this case a lower incisor has been
                 extracted and root paralleling has
                 been helped by changing axial
                 positions of adjacent brackets.


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Tip specification
ANTERIOR TIP
     Reduced anterior tip was
incorporated into the appliance
to conform to Andrews original
research,and to dramatically
reduce the anchorage needs of
each case. www.indiandentalacademy.com
Incisor Tip                   Cuspid Tip

             Upper     Upper     Lower     Lower       Upper   Lower
             Central   Lateral   Central   Lateral

MBT           4.0°      8.0°       0°        0°        8.0°    3.0°
Versatile+
Original      5.0°      9.0°      2.0°       2.0°      11.0°   5.0°
SWA3




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Upper tip considerations
        The authors prefer a 00 tip bracket,with
        the band seated parallel to the buccal
        cusps.This gives 50 tip.

         If a 50 bracket is used,the band must be
          seated more gingivally at the mesial.

        If a 50 bracket is used,and the band is
        seated parallel to the buccal cusps,this
         will result in an effective 100 tip on the
         molar.
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Lower Bicuspid Tip              Lower Molar Tip

                 Lower First    Lower          Lower First   Lower
                                Second                       Second

MBT Versatile+      2.0°         2.0°              0°          0°

Original SWA        2.0°         2.0°             2.0°        2.0°




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UPPER POSTERIOR TIP
 Upper  bicuspid brackets are
 provided with 00 tip to keep these
 teeth in a more upright position .
 Upper molar brackets are provided
 with 00 tip, which when placed
 parallel to the occlusal
 plane,introduces 50 tip into the upper
 molars.
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LOWER POSTERIOR TIP
Lower    posterior tip in the first and
second bicuspid brackets is maintained
at 20, to slightly incline these teeth
forward.
For   the lower first and second molars,
00 tipped brackets are provided, which
when placed parallel to the occlusal
plane,introduces 20 of tip to these
teeth.
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Bicuspid Tip                   Molar Tip

                 Upper First    Upper       Upper First     Upper
                                Second                      Second

MBT Versatile+       0°           0°            0°               0°

Original SWA        2.0°          2.0°          5.0°         5.0°




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 Torque   in base-the CAD factor
      Using CAD it is possible to program the
 computer to create the correct relationship
 between the mid-point on the tooth and the
 slot base,as with traditional torque-in-base.

 Refinement    of bracket base design
     It is incorporated to increase strength and
 help plaque control in difficult areas.



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In-out specification

 It is 100% fully expressed.
 In upper premolars an alternative
  bracket which is 0.5mm thicker than
  normal,is used.
 This is helpful in obtaining good
  alignment of marginal ridges in cases
  with small upper second premolars.

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In-out modifications.

                      An upper second bicuspid
                       bracket with an additional
                       0.5mm of in-out
                       compensation is provided
                       for the common situation
                       in which upper second
                       bicuspids are smaller than
                       upper first bicuspids.




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Torque specification

  INCISOR TORQUE
Upper incisor brackets are provided with
  additional palatal root torque;while lower
incisor brackets are provided with
additional labial root torque.
This adjustment aids in the correction of
the most common torque problems
occurring in the incisor areas.

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Upper central incisor torque


                    Increased
                      palatal root
                      torque for upper
                      centrals.



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Upper lateral incisor torque

                    Increased
                      palatal root
                      torque for
                      upper lateral
                      incisors.

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Lower incisor torque

                  Increased
                    labial root
                    torque for
                    lower
                    incisors.

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   Upper canine torque.
               Available in –70 ,00 ,
                 +70 , torque.
               The 00 and +70 options
                are for cases with
                narrow maxillary bone
                form andor prominent
                canine roots,and are
                often used with
                archwires in the
                tapered form.


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Upper Cuspid ,bicuspid and molar

torque   .
     • Upper cuspid and bicuspid
       brackets are provided with the
       normal -70 of torque.
Upper   molar brackets are provided with
an additional 50 of buccal root torque (-90
to -140 ) to reduce palatal cusp
interferences with these teeth.
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Incisor Torque               Incisor Torque

                 Upper Central    Upper          Lower       Lower
                                  Lateral        Central     Lateral
MBT Versatile+       17.0°         10.0°          -6.0°       -6.0°

Original SWA         7.0°          3.0°           -1.0°       -1.0°




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Palatally positioned lateral
incisors.
                It is important to create adequate
                space before attempting to move
                palatally placed incisors.



                It is beneficial to invert the
                bracket on instanding lateral
                incisors,giving –100 torque.
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Arch form considerations for
stability and esthetics.
    Bonwill and Hawley in 1905,suggested the
     geometric method of constructing the ideal
     arch form.
          - The lower six anterior teeth lie along a
     circle whose radius equaled their combined
     widths.
           -From this circle an equilateral triangle is
     created,the base of which represented the
     condylar width.
           -Premolars and molars should lie along
     these extended lines.
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Traditional
                    edgewise wire
                    bending and
                    Boone arch form.




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Brader Archform




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   The Catenary curve is
                formed by extending a
                chain from two fixed
                points.
               Many of the tapered
                arch forms provided by
                orthodontic
                manufactures today are
                based on Catenary
                curve.




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 In 1907 Angle-
    - The form of line from the premolars and
  molars should resemble a parabolic curve.
     -He proposed the need for natural
  curvature in molar region.
 In   1934 Chuck-
     -Noted variation in arch form –square,
  oval, tapering.
    -The premolar region should be wider than
  canines to prevent excessive expansion of
  the canines.


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 In   1963 Boone –
         -Superimposed Bonwill-Hawley arch
  form on a millimeter grid and used Angles
  method for construction.
        -Thus Bonwill-Hawley arch form is used
  as a template in edgewise.
 Braun   et al,1998
       -Reported that the human arch form could
  be represented by a complex mathematical
  formula,known as the Beta function.
       -This was calculated by entering
  measurements of dental landmarks on
  orthodontic models into a computer curve-
  fitting program.
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Selection of Archform

i. Arch form template are placed on lower
  study models.
    -The inter-canine width is evaluated.

ii.If buccal uprighting is needed in the lower
   arch, a wider arch form is selected.


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In 70% of cases buccal uprighting will result in
  lower anterior relapse.
Cases in which buccal uprighting will be stable
  include-
        (a) Cases in which maxillary expansion is
  indicated.
    (b)Deep bite cases such as Class II /2 cases.

iii.Contour and width in the lower posterior
   segment is estimated but this can be easily
   customized.


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MBT ARCH FORM
   The three basic arch forms are tapered,
    square and ovoid.
   When superimposed they vary mainly in inter-
    canine width,giving a range of approximately
    6mm.
   Inter-molar widths are similar ,but the molar
    areas can be widened or narrowed as
    needed,by easy wire bending.


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ARCH FORMS - MBT




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THE TAPERED ARCH FORM
  Indicated for patients with narrow
   ,tapered arch form and gingival
   recession in canine and premolar
   regions.
  Cases undergoing single arch
   treatment,in this way no expansion of
   treated arch occurs.

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THE SQUARE ARCH FORM
 Indicated in cases with broad arch form.
 Cases that require buccal uprighting of
  the lower posterior segments and
  expansion of the upper arch.
 After over-expansion has been
  achieved ,it may be beneficial to
  change to the ovoid arch form in the
  later stages of treatment.

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THE OVOID ARCH FORM
   It is the most preferred arch form. The ovoid
    arch form has proved to be good, reliable
    arch form for high percentage of cases
    treated with PAE

   Treated cases have shown good stability,
    with minimal amounts of post-treatment
    relapse.


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The four components of archform

i.    ANTERIOR CURVATURE

           Based on inter-canine width. Its shape
      becomes more tapered when inter-canine
      width is narrow and more square when
      inter-canine width is wide.

ii.   INTER-CANINE WIDTH
           This appears to be the most critical
      aspect of arch form,because significant
      relapse occurs if this dimension is changed.

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    POSTERIOR CURVATURE
      In the posterior area a gradual curvature
    between canine and second molars are
    preferred.

    INTER-MOLAR WIDTH
        Treatment changes in this dimension is
    more stable.
          Arch form in the inter-molar region can
    be widened or narrowed,depending on the
    needs of the case.

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Relapse tendency after changing
arch form.
   Riedel in 1969,postulated that arch form, in
    the mandibular arch,cannot be permanently
    altered during appliance therapy.
   Similar research was done by Shapiro,
    Gardner, Felton,De La Cruz and Burke
    suggesting that changes in inter-molar width
    seem to be more stable than those of inter-
    canine width.

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TREATMENT MECHANICS

 Anchorage  control
 Leveling and aligning
 Overbite control
 Overjet reduction
 Space closure
 Finishing


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Anchorage control during leveling and
aligning

   The tooth movements needed to achieve
    passive engagement of a plain, rectangular
    archwire of 0.019/0.025 dimension, having
    standard archform, into a correctly placed
    preadjusted 0.022 bracket system.
   The manoeuvres used to restrict undesirable
    changes during the opening phase of
    treatment, so that leveling and aligning is
    achieved without key features of the
    malocclusion becoming worse.
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 Recognizing   the anchorage needs of a
  case
 Mistakes in tooth leveling and aligning in
  the early years
 Reduced anchorage needs
 Control in three planes:-

          -horizontal
          -vertical
          -laterally


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OVERBITE CONTROL
 Development of overbite




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Tooth movements for bite opening

 Extrusion  of posterior teeth
 Distal tipping of posterior teeth
 Proclination of incisors
 Intrusion of anterior teeth
 Combination of two or more of the
  above tooth movements.



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NON-EXTRACTION TREATMENT


   Initial archwire
    placement
   Bite-plate effect
   Importance of
    second molars
   Torque issues
   Bite opening curves
   Elastics

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OVERJET REDUCTION

 Mesial  movement of lower incisors
 Distal movement of upper incisors
 Distalizing or limiting the forward growth of
  the maxilla
 Mesial movement of the mandible due to

a) forward mandibular growth rotation or
b) limiting posterior dental and skeletal
  vertical dvelopment.
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SPACE CLOSURE

   Closing loop archwires
   Sliding mechanics with heavy forces
   Elastic chain
   Sliding mechanics with light continous forces
    (recommended):-
archwires
soldered hooks
passive tiebacks
active tiebacks using elastomeric modules
force levels
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   Trampoline effect
   Type one active
    tieback(distal
    module)




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   Type two active
    tieback(mesial
    module)




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   Active tiebacks
    using a NiTi coil
    spring




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Obstacles to space closure

 Inadequate   leveling
 Damaged brackets
 Incorrect force levels
 Interference from opposing tooth
 Soft tissue resistance




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FINISHING

 During the closing stages of treatment
 attention needs to be given to the
 following considerations:-
  Horizontal
  Vertical
  Transverse
   Dynamic
   Cephalometric and esthetic.
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In 1976,Dougherty described 17 factors that should be
   considered during finishing:-
 Correction and overcorrection of the A-P jaw relationship
 Establishing the correct tip
 Establishing correct torque
 Co-ordinating arch width and form
 Establishing correct posterior crown torque
 Establishing marginal ridge relationship and contact
    points
   Correction of midline discrepancies
   Establishing interdigitation of teeth
   Checking cephalometric objectives
   Checking the parallelism of roots
   Maintaining the closure of all spaces
   Evaluating facial and profile esthetics
   Checking for TMJ dysfunctions
   Checking functional movements
   Correction of habits
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Horizontal
 Coordination  of tooth fit-anterior and
  posterior areas.
 Establishing correct tip of anterior and
  posterior teeth
 Management of tooth size discrepancies
 Controlling rotations
 Maintaining the closure of al spaces
 Horizontal overcorrection

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Vertical

 Correct   crown length,marginal ridge
  relationships,and contact points
 Final management of the curve of Spee
         -low angle cases
        -high angle cases
 Vertical overcorrection-deep bite

                        -open bite
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Transverse

 Arch form
 Archwire coordination
 Establishing posterior torque
 Transverse overcorrection




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Dynamic

 Establishing
             centric relation and
 checking functional movements



 Checking for temporomandibular joint
 dysfunction


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Cephalometric and esthetic
   Progress headfilms should be taken halfway through
    orthodontic treatment to determine how the skeletal,
    dental and soft tissue components are being managed.
   Final ceph radiograph 3-4 months before debanding
   Factors considered-
    Soft tissue profile, antero-posterior positionof the
    incisors, torque of incisors, changes in the mandibular
    plane, degree to which vertical development of patient
    occurred or restricted and success in correcting the
    horizontal,skeletal,and dental components
   Evaluation involves superimposition of progress


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Settling

   0.014 or 0.016
    round HANT wires
    used
   Vertical triangular
    elastics




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 Variations:-
 Cuspid labially placed, diastemas,
 extraction cases, expansion cases, severe
 class II malocclusion.
 Settling may take longer than 6 weeks,it is
 beneficial to leave lower rectangular steel
 wire to maintain the arch form.
      When only three weeks treatment
 remaining, a normal lower 0.014 steel or
 0.016 heat activated can be placed.


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FINISHING TO ABO REQUIREMENTS
   In July 2000, the ABO came out with revised
    requirements and a grading system for dental casts and
    panoramic radiographs.The ABO places emphasis on
    self assessment of seven features of dental casts.These
    include:-
        tooth alignment
        Marginal ridges
        buccolingual inclination
        occlusal relationships
        occlusal contacts
        overjet
        interproximal contacts
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Appliance removal and retention

 Bracket and band removal
 Removal of remaining cement and
  bonding agents
 Placement of positioners
 Retainers-bonded and removable




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THANK YOU


INDIAN DENTAL ACADEMY
www.indiandentalacademy.com




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MBT system in orthodontics /certified fixed orthodontic courses by Indian dental academy

  • 1. MBT SYSTEM STRAIGHT WIRE TECHNIQUE INDIAN DENTAL ACADEMY Leader in Continuing Dental Education www.indiandentalacademy.com www.indiandentalacademy.com
  • 3.  Orthodontic treatment mechanics are determined by four elements- -bracket positioning -bracket selection -archwire selection -force levels www.indiandentalacademy.com
  • 4. WORK OF ANDREWS First Generation The original SWA was introduced by Andrews in 1972 and it had the features of Siamese edgewise bracket. He recommended a wide range of brackets - For extraction cases,canine brackets with anti-tip,anti- rotation, and power arms -Three sets of incisor brackets with varying degrees of torque for different clinical situation. www.indiandentalacademy.com
  • 5. WORK OF ROTH Second Generation  To avoid inventory difficulties of a multiple bracket system, ROTH recommended a single appliance system to manage both extraction and non-extraction cases.  The appliance prescriptions developed by Andrews and Roth were based on the treatment mechanics used in their practice. www.indiandentalacademy.com
  • 6. WORK OF McLAUGHLIN,BENNETT AND TREVISI Third Generation  The MBT has been developed from the combined clinical experience of the authors for more than 70 years.  It also introduced additional research input from Japanese sources to update the scientific input.  It is designed ideally to work with sliding mechanics,with light continuous forces, lacebacks and bendbacks. www.indiandentalacademy.com
  • 7. Following elements make up the MBT treatment philosophy Bracket selection, versatility of bracket system, accuracy of bracket positioning, light continuous forces, 0.022 versus 0.018 slot, anchorage control, group movement, use of three arch forms, one size of rectangular steel wire, archwire hooks, methods of archwire ligation, awareness of tooth size discrepancies, persistence in finishing. www.indiandentalacademy.com
  • 8. The MBT Bracket System  The MBT bracket system is based on a more balanced mix of science,tradition and experience.  It is a bracket system for use with light continuous forces, lacebacks and bendbacks  It is designed ideally to work with sliding mechanics. www.indiandentalacademy.com
  • 9. EXCLUSIVE MBT APPLIANCE FEATURES.  Reduced anterior tip.  Upper bicuspid brackets with 0 0 tip.  Lower bicuspid brackets with 2 0 tip.  Additional palatal root torque for upper incisors and additional labial root torque for lower incisors.  Upper cuspid brackets with the normal –70 torque or 00 torque. www.indiandentalacademy.com
  • 10. Upper molar brackets with additional 50 buccal root torque.  Progressive buccal crown torque in lower cuspids and lower buccal segments.  Optional upper second bicuspid brackets with an additional 0.5mm of in-out compensation.  Three bracket types,Clarity Aesthetic Brackets, Victory Series brackets, and Unitek Full Size Twin Brackets,all available with APC Adhesive Coating. www.indiandentalacademy.com
  • 11. Design features of a modern bracket system  Range of brackets - Standard size metal brackets. - Mid-size metal brackets. -Esthetic brackets.  Improved i.d system Laser numbering of standard size metal brackets.  Rhomboidal shape Reduces bulk and assists accuracy of bracket placement. www.indiandentalacademy.com
  • 13. Drawing of original SWA bracket.  Dots (upper) and dashes (lower) were used for i.d purposes. www.indiandentalacademy.com
  • 14. Drawing of MBT brackets.  Standard size brackets have a rhomboidal form and numerical i.d.system. www.indiandentalacademy.com
  • 15. VERSATILITY  Seven areas Options for palatally placed upper lateral incisors(-10*) Three torque options for upper canine(-7,0,+7) Three torque options for lower canine(-6,0,+6) Interchangeable lower incisor brackets Interchangeable upper premolar brackets Use of upper second molar tubes in first molars in non-HG cases Use of lower second molar tubes for upper first and second molar of opposite sides when finishing cases to class II molar relationship. www.indiandentalacademy.com
  • 18. Horizontal bracket placement errors  If brackets are placed to the mesial or distal of the vertical long axis of the clinical crown,improper tooth rotation can occur. www.indiandentalacademy.com
  • 19. Axial or paralleling errors  These will occur if the bracket wings do not straddle the vertical long axis of the crown in a parallel manner.  Such errors lead to improper crown tip. www.indiandentalacademy.com
  • 20. Thickness errors.  Excess bonding agent beneath the bracket base can cause thickness and rotational errors.  Can be eliminated by pressing the bracket against the tooth. www.indiandentalacademy.com
  • 21. Vertical errors  Vertical errors in bracket placement are caused by placing brackets gingival or incisalocclusal to the center of the clinical crown. www.indiandentalacademy.com
  • 22. Gingival Concern.  Partially erupted tooth.  It is difficult to visualize the center of the clinical crown on partially erupted teeth,when treating young patients. www.indiandentalacademy.com
  • 23. Gingival Inflammation Gingival inflammation causes foreshortening,effectively reducing the length of the clinical crowns.  Top:Healthy gingivae.  Bottom :The same case with inflamed gingivae in the upper right quadrant. www.indiandentalacademy.com
  • 24. Teeth with palatally or lingually displaced roots.  Individual teeth with lingually displaced roots can produce short clinical crowns. www.indiandentalacademy.com
  • 25. Teeth with facially displaced roots.  Individual teeth with facially displaced roots can produce long clinical crowns. www.indiandentalacademy.com
  • 26. Incisal or Occlusal concerns.  Incisal crown fractures or tooth wear make it difficult to visualize the center of the clinical crown. www.indiandentalacademy.com
  • 27. Crowns with long tapered buccal cusps  Cuspids with tapered clinical crowns often do not have adequate contact with the opposing teeth. www.indiandentalacademy.com
  • 28. Axial/paralleling variation The tip position of the lateral incisor brackets was varied to help root paralleling. In this case a lower incisor has been extracted and root paralleling has been helped by changing axial positions of adjacent brackets. www.indiandentalacademy.com
  • 29. Tip specification ANTERIOR TIP Reduced anterior tip was incorporated into the appliance to conform to Andrews original research,and to dramatically reduce the anchorage needs of each case. www.indiandentalacademy.com
  • 30. Incisor Tip Cuspid Tip Upper Upper Lower Lower Upper Lower Central Lateral Central Lateral MBT 4.0° 8.0° 0° 0° 8.0° 3.0° Versatile+ Original 5.0° 9.0° 2.0° 2.0° 11.0° 5.0° SWA3 www.indiandentalacademy.com
  • 31. Upper tip considerations The authors prefer a 00 tip bracket,with the band seated parallel to the buccal cusps.This gives 50 tip. If a 50 bracket is used,the band must be seated more gingivally at the mesial. If a 50 bracket is used,and the band is seated parallel to the buccal cusps,this will result in an effective 100 tip on the molar. www.indiandentalacademy.com
  • 32. Lower Bicuspid Tip Lower Molar Tip Lower First Lower Lower First Lower Second Second MBT Versatile+ 2.0° 2.0° 0° 0° Original SWA 2.0° 2.0° 2.0° 2.0° www.indiandentalacademy.com
  • 33. UPPER POSTERIOR TIP Upper bicuspid brackets are provided with 00 tip to keep these teeth in a more upright position . Upper molar brackets are provided with 00 tip, which when placed parallel to the occlusal plane,introduces 50 tip into the upper molars. www.indiandentalacademy.com
  • 34. LOWER POSTERIOR TIP Lower posterior tip in the first and second bicuspid brackets is maintained at 20, to slightly incline these teeth forward. For the lower first and second molars, 00 tipped brackets are provided, which when placed parallel to the occlusal plane,introduces 20 of tip to these teeth. www.indiandentalacademy.com
  • 35. Bicuspid Tip Molar Tip Upper First Upper Upper First Upper Second Second MBT Versatile+ 0° 0° 0° 0° Original SWA 2.0° 2.0° 5.0° 5.0° www.indiandentalacademy.com
  • 36.  Torque in base-the CAD factor Using CAD it is possible to program the computer to create the correct relationship between the mid-point on the tooth and the slot base,as with traditional torque-in-base.  Refinement of bracket base design It is incorporated to increase strength and help plaque control in difficult areas. www.indiandentalacademy.com
  • 37. In-out specification  It is 100% fully expressed.  In upper premolars an alternative bracket which is 0.5mm thicker than normal,is used.  This is helpful in obtaining good alignment of marginal ridges in cases with small upper second premolars. www.indiandentalacademy.com
  • 38. In-out modifications.  An upper second bicuspid bracket with an additional 0.5mm of in-out compensation is provided for the common situation in which upper second bicuspids are smaller than upper first bicuspids. www.indiandentalacademy.com
  • 39. Torque specification INCISOR TORQUE Upper incisor brackets are provided with additional palatal root torque;while lower incisor brackets are provided with additional labial root torque. This adjustment aids in the correction of the most common torque problems occurring in the incisor areas. www.indiandentalacademy.com
  • 40. Upper central incisor torque  Increased palatal root torque for upper centrals. www.indiandentalacademy.com
  • 41. Upper lateral incisor torque  Increased palatal root torque for upper lateral incisors. www.indiandentalacademy.com
  • 42. Lower incisor torque  Increased labial root torque for lower incisors. www.indiandentalacademy.com
  • 43. Upper canine torque.  Available in –70 ,00 , +70 , torque.  The 00 and +70 options are for cases with narrow maxillary bone form andor prominent canine roots,and are often used with archwires in the tapered form. www.indiandentalacademy.com
  • 44. Upper Cuspid ,bicuspid and molar torque . • Upper cuspid and bicuspid brackets are provided with the normal -70 of torque. Upper molar brackets are provided with an additional 50 of buccal root torque (-90 to -140 ) to reduce palatal cusp interferences with these teeth. www.indiandentalacademy.com
  • 45. Incisor Torque Incisor Torque Upper Central Upper Lower Lower Lateral Central Lateral MBT Versatile+ 17.0° 10.0° -6.0° -6.0° Original SWA 7.0° 3.0° -1.0° -1.0° www.indiandentalacademy.com
  • 46. Palatally positioned lateral incisors. It is important to create adequate space before attempting to move palatally placed incisors. It is beneficial to invert the bracket on instanding lateral incisors,giving –100 torque. www.indiandentalacademy.com
  • 47. Arch form considerations for stability and esthetics.  Bonwill and Hawley in 1905,suggested the geometric method of constructing the ideal arch form. - The lower six anterior teeth lie along a circle whose radius equaled their combined widths. -From this circle an equilateral triangle is created,the base of which represented the condylar width. -Premolars and molars should lie along these extended lines. www.indiandentalacademy.com
  • 48. Traditional edgewise wire bending and Boone arch form. www.indiandentalacademy.com
  • 49. Brader Archform www.indiandentalacademy.com
  • 50. The Catenary curve is formed by extending a chain from two fixed points.  Many of the tapered arch forms provided by orthodontic manufactures today are based on Catenary curve. www.indiandentalacademy.com
  • 51.  In 1907 Angle- - The form of line from the premolars and molars should resemble a parabolic curve. -He proposed the need for natural curvature in molar region.  In 1934 Chuck- -Noted variation in arch form –square, oval, tapering. -The premolar region should be wider than canines to prevent excessive expansion of the canines. www.indiandentalacademy.com
  • 52.  In 1963 Boone – -Superimposed Bonwill-Hawley arch form on a millimeter grid and used Angles method for construction. -Thus Bonwill-Hawley arch form is used as a template in edgewise.  Braun et al,1998 -Reported that the human arch form could be represented by a complex mathematical formula,known as the Beta function. -This was calculated by entering measurements of dental landmarks on orthodontic models into a computer curve- fitting program. www.indiandentalacademy.com
  • 53. Selection of Archform i. Arch form template are placed on lower study models. -The inter-canine width is evaluated. ii.If buccal uprighting is needed in the lower arch, a wider arch form is selected. www.indiandentalacademy.com
  • 54. In 70% of cases buccal uprighting will result in lower anterior relapse. Cases in which buccal uprighting will be stable include- (a) Cases in which maxillary expansion is indicated. (b)Deep bite cases such as Class II /2 cases. iii.Contour and width in the lower posterior segment is estimated but this can be easily customized. www.indiandentalacademy.com
  • 55. MBT ARCH FORM  The three basic arch forms are tapered, square and ovoid.  When superimposed they vary mainly in inter- canine width,giving a range of approximately 6mm.  Inter-molar widths are similar ,but the molar areas can be widened or narrowed as needed,by easy wire bending. www.indiandentalacademy.com
  • 56. ARCH FORMS - MBT www.indiandentalacademy.com
  • 57. THE TAPERED ARCH FORM  Indicated for patients with narrow ,tapered arch form and gingival recession in canine and premolar regions.  Cases undergoing single arch treatment,in this way no expansion of treated arch occurs. www.indiandentalacademy.com
  • 58. THE SQUARE ARCH FORM  Indicated in cases with broad arch form.  Cases that require buccal uprighting of the lower posterior segments and expansion of the upper arch.  After over-expansion has been achieved ,it may be beneficial to change to the ovoid arch form in the later stages of treatment. www.indiandentalacademy.com
  • 59. THE OVOID ARCH FORM  It is the most preferred arch form. The ovoid arch form has proved to be good, reliable arch form for high percentage of cases treated with PAE  Treated cases have shown good stability, with minimal amounts of post-treatment relapse. www.indiandentalacademy.com
  • 60. The four components of archform i. ANTERIOR CURVATURE Based on inter-canine width. Its shape becomes more tapered when inter-canine width is narrow and more square when inter-canine width is wide. ii. INTER-CANINE WIDTH This appears to be the most critical aspect of arch form,because significant relapse occurs if this dimension is changed. www.indiandentalacademy.com
  • 61. POSTERIOR CURVATURE In the posterior area a gradual curvature between canine and second molars are preferred.  INTER-MOLAR WIDTH Treatment changes in this dimension is more stable. Arch form in the inter-molar region can be widened or narrowed,depending on the needs of the case. www.indiandentalacademy.com
  • 62. Relapse tendency after changing arch form.  Riedel in 1969,postulated that arch form, in the mandibular arch,cannot be permanently altered during appliance therapy.  Similar research was done by Shapiro, Gardner, Felton,De La Cruz and Burke suggesting that changes in inter-molar width seem to be more stable than those of inter- canine width. www.indiandentalacademy.com
  • 63. TREATMENT MECHANICS  Anchorage control  Leveling and aligning  Overbite control  Overjet reduction  Space closure  Finishing www.indiandentalacademy.com
  • 64. Anchorage control during leveling and aligning  The tooth movements needed to achieve passive engagement of a plain, rectangular archwire of 0.019/0.025 dimension, having standard archform, into a correctly placed preadjusted 0.022 bracket system.  The manoeuvres used to restrict undesirable changes during the opening phase of treatment, so that leveling and aligning is achieved without key features of the malocclusion becoming worse. www.indiandentalacademy.com
  • 65.  Recognizing the anchorage needs of a case  Mistakes in tooth leveling and aligning in the early years  Reduced anchorage needs  Control in three planes:- -horizontal -vertical -laterally www.indiandentalacademy.com
  • 69. OVERBITE CONTROL  Development of overbite www.indiandentalacademy.com
  • 70. Tooth movements for bite opening  Extrusion of posterior teeth  Distal tipping of posterior teeth  Proclination of incisors  Intrusion of anterior teeth  Combination of two or more of the above tooth movements. www.indiandentalacademy.com
  • 71. NON-EXTRACTION TREATMENT  Initial archwire placement  Bite-plate effect  Importance of second molars  Torque issues  Bite opening curves  Elastics www.indiandentalacademy.com
  • 72. OVERJET REDUCTION  Mesial movement of lower incisors  Distal movement of upper incisors  Distalizing or limiting the forward growth of the maxilla  Mesial movement of the mandible due to a) forward mandibular growth rotation or b) limiting posterior dental and skeletal vertical dvelopment. www.indiandentalacademy.com
  • 73. SPACE CLOSURE  Closing loop archwires  Sliding mechanics with heavy forces  Elastic chain  Sliding mechanics with light continous forces (recommended):- archwires soldered hooks passive tiebacks active tiebacks using elastomeric modules force levels www.indiandentalacademy.com
  • 74. Trampoline effect  Type one active tieback(distal module) www.indiandentalacademy.com
  • 75. Type two active tieback(mesial module) www.indiandentalacademy.com
  • 76. Active tiebacks using a NiTi coil spring www.indiandentalacademy.com
  • 77. Obstacles to space closure  Inadequate leveling  Damaged brackets  Incorrect force levels  Interference from opposing tooth  Soft tissue resistance www.indiandentalacademy.com
  • 78. FINISHING  During the closing stages of treatment attention needs to be given to the following considerations:- Horizontal Vertical Transverse Dynamic Cephalometric and esthetic. www.indiandentalacademy.com
  • 79. In 1976,Dougherty described 17 factors that should be considered during finishing:-  Correction and overcorrection of the A-P jaw relationship  Establishing the correct tip  Establishing correct torque  Co-ordinating arch width and form  Establishing correct posterior crown torque  Establishing marginal ridge relationship and contact points  Correction of midline discrepancies  Establishing interdigitation of teeth  Checking cephalometric objectives  Checking the parallelism of roots  Maintaining the closure of all spaces  Evaluating facial and profile esthetics  Checking for TMJ dysfunctions  Checking functional movements  Correction of habits www.indiandentalacademy.com
  • 80. Horizontal  Coordination of tooth fit-anterior and posterior areas.  Establishing correct tip of anterior and posterior teeth  Management of tooth size discrepancies  Controlling rotations  Maintaining the closure of al spaces  Horizontal overcorrection www.indiandentalacademy.com
  • 81. Vertical  Correct crown length,marginal ridge relationships,and contact points  Final management of the curve of Spee  -low angle cases -high angle cases  Vertical overcorrection-deep bite -open bite www.indiandentalacademy.com
  • 82. Transverse  Arch form  Archwire coordination  Establishing posterior torque  Transverse overcorrection www.indiandentalacademy.com
  • 83. Dynamic  Establishing centric relation and checking functional movements  Checking for temporomandibular joint dysfunction www.indiandentalacademy.com
  • 84. Cephalometric and esthetic  Progress headfilms should be taken halfway through orthodontic treatment to determine how the skeletal, dental and soft tissue components are being managed.  Final ceph radiograph 3-4 months before debanding  Factors considered- Soft tissue profile, antero-posterior positionof the incisors, torque of incisors, changes in the mandibular plane, degree to which vertical development of patient occurred or restricted and success in correcting the horizontal,skeletal,and dental components  Evaluation involves superimposition of progress www.indiandentalacademy.com
  • 85. Settling  0.014 or 0.016 round HANT wires used  Vertical triangular elastics www.indiandentalacademy.com
  • 86.  Variations:- Cuspid labially placed, diastemas, extraction cases, expansion cases, severe class II malocclusion. Settling may take longer than 6 weeks,it is beneficial to leave lower rectangular steel wire to maintain the arch form. When only three weeks treatment remaining, a normal lower 0.014 steel or 0.016 heat activated can be placed. www.indiandentalacademy.com
  • 87. FINISHING TO ABO REQUIREMENTS  In July 2000, the ABO came out with revised requirements and a grading system for dental casts and panoramic radiographs.The ABO places emphasis on self assessment of seven features of dental casts.These include:- tooth alignment Marginal ridges buccolingual inclination occlusal relationships occlusal contacts overjet interproximal contacts www.indiandentalacademy.com
  • 88. Appliance removal and retention  Bracket and band removal  Removal of remaining cement and bonding agents  Placement of positioners  Retainers-bonded and removable www.indiandentalacademy.com
  • 89. THANK YOU INDIAN DENTAL ACADEMY www.indiandentalacademy.com www.indiandentalacademy.com