Tip edge applaince 2 /certified fixed orthodontic courses by Indian dental academy

INDIAN DENTAL ACADEMY
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TIP EDGE APPLIANCE

In 1986, change in the edgewise slot is made with
the removal of diagonally opposed corners from the
conventional edgewise slot to permit either mesial or
distal crown tipping.


Such modifications of the slot could not have
been considered by ANGLE, because at that
time there were no mesiodistal uprighting
springs.

These springs were created by
DR BEGG in 1960, to upright teeth in
conjunction with ribbon arch type brackets.
Without such springs the Tip-Edge bracket
itself would not be practical.


VARIOUS ADVANTAGES OF TIP EDGE SLOT




Not only does it facilitate space opening or
closing, it also enhances retraction of the
buccal segments of one arch and
automatically, through intermaxillary
elastics, creates anchorage in the other.
Facilitates intrusion of teeth for anterior
bite opening.






Archwire slots, that open or close during
treatment, for maximum ease of archwire
changes and minimal patient discomfort.
The ability to torque and upright teeth from
forces generated by auxiliaries, which
leaves the stiffer arch wires relatively
undisturbed and provides stability and
molar control.




These new archwire slots have in / out
compensations and are preadjusted to
automatically achieve desired degrees of
crown tip and root torque with little or no
modifications to the arch wires themselves.


Because the arch wire slot permits initial
crown tipping mesially or distally and faces
horizontally, the slot and bracket are
termed TIP EDGE.

The technique, which take full
advantage of this slot and differential tooth
movement with straight archwire, is termed
the DIFFERENTIAL STRAIGHT-ARCH
TECHNIQUE (D S A T).


APPLIANCES
TIP EDGE BRACKETS
By removing predetermined, diagonally
opposed corners from the conventional
edgewise archwire slot, the Tip-Edge
bracket is created.
This permits the desired distal
crown tipping required for differential tooth
movement.
Preadjusted in three
dimensions the Tip-Edge slot permits the
use of straight arch wires in the majority of
cases, both extraction and non extraction.


The slot is designed so that initial second
order changes, mesiodistal crown tipping,
can be accomplished in the presence of a
straight round archwire and powered by
light intra oral forces---elastics and coil
springs.


Forces for subsequent root uprighting, tip
and/or torque are generated by auxiliaries
and not by flexing the arch wires.
This simplifies the treatment
through the use of “straight” arch wires
while providing increased range of root
movement, from physiologic forces with
maximum stability and comfort.


Brackets are available in single , twin and
ceramic forms.


Not only do the archwire slots permit initial crown tipping
but also they are preadjusted to provide the desired final
degrees of crown tip and torque.


MOLAR TUBES
To maximize the advantages inherent in
differential tooth movement, it is
advantageous to utilize relatively long and
loose fitting molar tubes in the early stages
of treatment and shorter , rectangular
tubes in the final stage.
Therefore tip-edge tubes are of double
configuration. The longer round tube is
positioned gingivally and the shorter
rectangular tubes occulasally.


ARCH WIRES


Initial arch wires are formed of high tensile
0.016 inch round stainless steel.
These wires will be able to
overcome anterior vertical force vectors
from class II or class III intermaxillary
elastics to permit simultaneous bite
opening and antero-posterior interarch
changes.






Arch wires of 0.014 inch or 0.016 inch Ni-Ti
can be used for initial alignment in class I
crowded cases.
Rectangular 0.0215 x 0.028 inch stainless
steel arch wires should be preferred for
final finishing.


AUXILLARIES
Due to generous size of the vertical slot in
T E bracket many auxiliaries are used
through out treatment.


Power pins for elastomerics.



Rotating springs.



Side winder springs.



Ni-ti torque bars.



Single tooth torquing auxiliaries

POWER PINS
Used to accept elastomerics or rotating springs for
rapid, physiologic rotation.


MESIO-DISTAL UPRIGHTING SPRINGS
OR SIDE WINDERS
They provide localized tip control of individual teeth
without arch wire modifications.
When finishing with rectangular arch
wires, they can produce the desired final axial
inclination for all teeth including torque.


Sectional wires of Ni-Ti are used for one or two
appointments for initial alignment or the eruption of
the impacted teeth.
When using round arch wires, anterior root torque can
be achieved by Ni-Ti Torque bars placed in deep
grooves of central and lateral incisor brackets.
The torquing of a single tooth is rapidly accomplished
with an Individual Root Torquing Auxiliary.


CONCEPT AND FUNCTION
The Tip-Edge concept is to provide an
edgwewise type bracket that is familiar to
all orthodontists and can be used in the
simplest manner to treat all malocclusions
through differential tooth movement.

This is accomplished by
maintaining everything that is positively
associated with an edgewise bracket, while
removing diagonally opposed corners of the
slot which prevents mesiodistal crown
tipping.


This than provides an edgewise bracket
that enhances rather than hinders bite
opening, class II or III correction and the
closing of posterior spaces.
Tip and torque control are
delayed until the end of the treatment and
than easily achieved utilizing root moving
forces that are relatively light, long lasting
and generated by auxiliaries and not by
flexing the main arch wire.


BITE OPENING
Most malocclusions require anterior bite
opening, which involves the intrusion of
incisor teeth. If each tooth is free to intrude
along its own path of least resistance,
desired bite opening can be accomplished
relatively rapidly and with the lightest of
forces--------approx 5 gm per tooth.


Conventional edgewise slots prevent this
free root movement and when teeth are
tipped mesially or distally can even cause
lateral movement of roots to further
complicate the intrusion.
Tip-edge archwire slots with
their one point contact with the archwire
prevents the creations of such lateral
pressures and permits the roots to intrude
in an unhindered fashion.


Because of this one point contact between
the archwire and the bracket slot, it is
possible to open the deepest of anterior
bites without the need for extra oral forces.
The principle of differential
forces and mechanics are applied through
high tensile stainless steel archwires(0.016
inch), light intermaxillary elastics and to
some extent, the forces of mastication.


RETRACTION AND SPACE CLOSURE
WITHOUT LOSS OF VERTICAL CONTROL
All teeth tend to tip distally as they are
retracted.
With conventional archwire slot it
first causes binding between the slots and
the wire and second, the incisal deflection
of arch wire itself especially in canine
region.
The central and lateral incisors
are than extruded which deepens the bite
or increases gingival display.


Because the
appropriate corners
have been removed
in Tip-edge
archwire slots,
there is no binding
and no deflection.


VARIABLE ANCHORAGE SLOT
Not only are Tip-edge archwire slots designed
to permit crown tipping in one direction but
they also become larger as the teeth tips.


The advantages gained by this increase in
archwire slot relative to arch wire include






No binding or archwire deflection during
retraction.
Ease of stepping up in archwire size.
No inadvertent mesial or distal root
movements






Ease of placing rectangular arch wires when
third order discrepancies exist between the
slots and the wires.
No need to use Ni-Ti or memory wires to
avoid discomfort and/or accidental
debonding.


ANCHORAGE CONSIDERATIONS
Extra oral anchorage is absolutely not
needed with DSAT with tip-edge brackets
as the forces are so light (2 oz) that
adequate anchorage can easily be found
within the mouth.


Binding, which normally occurs between
conventional edgewise slots and archwires
during space closure is nonexistent because
the corners of the slots which press against
the upper and lower surfaces of the
archwires during tipping and which causes
about 90% of the friction from an edgewise
appliance are gone.


Furthermore in the DSAT the archwires
move distally with the anterior teeth during
space closure and premolars are usually
not bracketed. So there is no sliding friction
between archwires and brackets or
ligatures to produce any additional strain
on anchorage.


The only source of sliding friction is within
the molar tubes and is at the absolute
minimum because the molars are held
upright, the tubes are relatively long, large
in diameter and of course, there is no
ligatures.


DIFFERENTIAL STRAIGHT ARCH
TECHNIQUE
The DSAT takes full advantage of TE
brackets. This makes possible the
successful treatment of even the most
severe of malocclusions with a minimal
number of appointments and archwires.
Treatment is divided into three
stages. Each stage features a distinct set of
treatment goals that must be achieved
before moving on to the next. Specific
archwires, elastics and auxillaries are used
for that particular stage and mixing them
will lead to undesirable results.

STAGE 1
This stage is the only stage of DSAT
treatment where arch wires are used to
directly generate tooth moving forces (
anterior alignment and bite opening ).
During the rest of the treatment they serve
to preserve the vertical and lateral
dimensions , while auxillaries are used to
produce all individual movement.


GOALS OF STAGE I






Vertical correction of deep or open anterior
bite.

Horizontal correction of anterior over or
under jet.
Align anterior teeth to eliminate crowding
or spacing


BITE OPENING MECHANICS
Opening the bite is the most important goal
of stage 1
The rapid correction of a deep
anterior overbite to an edge to edge incisal
relationship allows for the full expression of
any potential benefits of mandibular growth
in the correction of a class II malocclusion.


OVERJET/UNDERJET CORRECTION
The correction of overjet or underjet is
accomplished simultaneously along with
anterior vertical discrepancies.
It is accomplished through
the use of either class II or III elastics
depending on the incisar relationships.


ANTERIOR ALIGNMENT
When space is available distal to canines,
anterior alignment is achieved using
elastomeric ties to the archwire through the
vertical slots of the Tip-Edge brackets.

The Tip-edge archwire slots
allow adjacent teeth to simply tip out of the
way as the lingually displaced teeth are
brought into position.


When moderate to severe crowding is present
at the start of non extraction treatment,
vertical loops are employed in the anterior
segments of the 0.016 inch archwire.


Rotated teeth are corrected using rotating
springs inserted through the vertical slots
of the brackets.


These auxilaries are available in either
clockwise or counter clockwise versions.
The tooth is viewed from the occlusal to
determine the desired direction of rotation
and the corresponding spring is selected,
then engaged.
Rotations are overcorrected
whenever possible and held in these
positions throughout the treatment using
either overrotation brackets for incisors or
through mesiodistally offset bonding
positions on canines and premolars.

STAGE 2
Stage 2 is the shortest of the three stages
of Tip-Edge treatment usually being
completed in 2 to 3 appointments.
The primary goal of stage 2 is the
closing of posterior spaces.
In this other than horizontal
elastics to close spaces, class II or class III
elastics are given to maintain desires
anterior tooth relation.

GOALS OF STAGE II









Close remaining posterior spaces
Correct or maintain dental midline.
Correct posterior cross bite.
Achieve class I molar relations.
Over rotate severely rotated premolars.
Level anchor molars.
Maintain all corrections achieved during
stage I.

STAGE 2 MECHANICS AND
ARCHWIRES
Far less archwire manipulation is required
during stage 2 because the archwires serve
only to maintain the vertical and lateral
corrections achieved during stage 1.

High tensile, round 0.022
inch stainless steel wire should be used for
this.


In mild to moderate anchorage situations
the archwires are engaged through the
occlusal, rectangular molar tubes. This
levels the premolar brackets and molar
tubes early in treatment, easing the
transition to stage 3.
In maximum anchorage
situations where friction between the tubes
is more of a concern, it is preferred to
insert the archwires through the larger
diameter gingival round tubes.


STAGE 2 BRAKING MECHANICS
During stage 2 positive measures are
sometimes necessary to correct an
abundance of available space which can be
caused naturally by congenitally missing or
relatively small teeth or by extraction of
teeth in borderline extraction cases.
Whatever the reason,
corrective measures are required to
prevent overretraction of the anterior
teeth.


Through the application of mechanical
brakes (side winder springs on premolars,
canines and incisors, in conjunction with
0.022 inch round or 0.0215 x 0.028 inch
rectangular wire), anterior teeth are
prevented from further unrestricted distal
and/or lingual crown tipping.
Relatively heavy horizontal
forces (6-8 oz) are than applied between
these newly created anterior resistance
units and the posterior teeth.


STAGE 3
GOALS OF STAGE III




Achieve final axial inclination of all teeth.
Maintain all corrections achieved during
stages I and II.
This is the longest
stage of DSAT , usually taking about half
the total treatment time. Amount of time
varies , but in an extraction case anywhere
between 9-12 months.

All uprighting and torquing is accomplished
by auxillaries. The same stage II archwire
can be used in stage III.
All uprighting movements
are self limiting as each tooth reaches its
final mesiodistal inclination , the uprighting
surface of the tip edge arch wire slot
contacts the arch wire preventing over
uprighting.
When using rectangular arch
wire the torquing as well as uprighting is
self limiting


STAGE 3 AUXILIARIES
All individual tooth movements during stage 3 are
accomplished using auxiliaries. To produce
mesiodistal uprighting , side-winder springs are
employed.


These springs have several advantages over
conventional uprighting springs

 More efficient since coil located over wire.
 More esthetic and hygienic as it lies over
the bracket.


The labial surface of each tooth is evaluated
to determine which manner of uprighting is
desired, clockwise or counterclockwise.
Once it is determined, the
appropriate side-winder uprighting spring is
selected and engaged into the vertical slot
of the bracket.


Although side winder uprighting springs
can be inserted into the bracket from
either the gingival or incisal, they are
normally engaged from the incisal to
prevent coil distortion from occlusal forces.


TORQUING AUXILIARIES
Torquing of the maxillary incisor roots
palatally can be accomplished using one of
several types of torquing auxiliaries.
The most commonly
employed torquing auxiliaries are nickel
titanium Torque Bars.
These are curved ribbon
arch sections of 0.022 x 0.018 inch Ni Ti
formed with 30 degrees of torque. These
auxiliaries are invisible when in place
because they lie directly behind the main
arch wire.

For the successful use of Torque Bars with
the Tip-Edge appliance, special “deep
grove” brackets are used on the maxillary
incisors.

These brackets feature
conventional preadjusted edgewise
archwire slots cast into the bottom of the
Tip Edge archwire slots.


During stages 1 and 2, when a one point
contact between archwire and slot is
desired to facilitate bite opening and
retraction, a cap fills the deep groove.

At the beginning of stage 3
the cap is removed and the Torque Bar is
ligated tightly into the deep groove under
the round base archwire.


If torquing of an individual tooth is desired,
an Individual Root Torquing auxiliary (IRT)
is used.
This auxiliary can deliver palatal
or labial root torque depending upon the
direction from which it is engaged into the
brackets vertical slot. i.e. palatal root
torque if engaged incisally and labial root
torque ,if inserted gingivally.


ROUND OR RECTANGULAR WIRE IN
STAGE 3 ?
Continuing on round wire simplifies
treatment for the operator. Also when
molar torque is not required and torquing
of the anteriors is required then a round
wire with torque bar can be used along with
side winder springs.
If a 0.022 SS wire is used
in stage III then a molar offset and mild
bite opening curves should be incorporated
and if class II elastics are being used , the
lower arch wire width is increased by 2mm.

On the other hand generalized and
individual torquing requirements are the
strongest indications for utilizing
rectangular arch wires in stage III. That
would include torquing molars , canines
and incisors.
The other advantage
of rectangular stage III arch wire along
with side winder springs is that the 2nd
order power delivered by the springs is
translated by the internal geometry of the
tip edge bracket into third order moments.
The resulting forces are physiologic and
stop when the teeth have reached
predetermined inclination.

Tip edge applaince 2 /certified fixed orthodontic courses by Indian dental academy

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