Alexanders vari simplex discipline

1. VARI SIMPLEX DISCIPLINE
[ALEXANDER DISCIPLINE]
R.G. “WICK” ALEXANDER 1978.

2. ‘VARI’ Twin, Lang ,Lewis.
‘SIMPLEX’ KISS Principle
‘DISCIPLINE’ Edgewise mechanics

3. TWEED VARI SIMPLEX
• Anchorage preservation
• .022 Slot.
• Treat mandibular arch first.
DRIFTODONTICS.
• Uprighting the mandibular first molars
6 degree tip

4. • Upright lower incisor.
• Headgear.
RETRACTOR.
• Non extraction
Tweed concept
and
Contemporary developments
QUALITY RESULTS

5. Key Objective
Patient ends up with the face proportionately
balanced and consistent with his skeletal pattern .
The treatment should be completed in the stipulated
time with a satisfied patient, parent and doctor

6. Unique Concepts.
1.First Straight wire type –
Different designs of brackets in the same
case, depending on the type of teeth.
The – 5 degree lower anterior torque is
different from other appliances.
2. Only 2 to 3 arch wires to be changed

7. 3. Bracket design and bracket effectiveness
does not dictate the treatment technique.
4. Rectangular multistranded arch wires

8. DIAGNOSIS AND TREATMENT PLANNING
.
Patient information
Diagnostic Chart
Patient records
Cephalometrics , patient
examination
Treatment planning
Financial records

9. I.Patient history

10. I. Patient examination.
II. Diagnostic records.
1) Intra oral and Panoramic radiographs.
2)Study models.
3)Facial photographs

11. 4)Cephalometric Analysis.
a) General skeletal pattern.
b)Tooth position.

12. Critical Factor in diagnosis
Lower Incisor Position.
1.Incisor mandibular plane angle.
2.Holdaway Ratio.
3.Lower incisor to A-Pog

13. Treatment Plan.
Two steps:
1.Determine the desired position of the
mandibular incisor.
2.Determine the treatment needed to position
the maxilla and maxillary dentition over the
desired mandibular arch position.

14. Objective of Treatment:
1.Incisors upright over the basal bone .
2.Cuspids not expanded.
3.Level curve of spee.
4.Non extraction therapy .

15. VARI-SIMPLEX DESIGN
Brackets are
• Pretorqued
• Preangulated
• Built in In / Out
[Pioneered by IVAN LEE and LARY ANDREWS]
Different bracket design on particular teeth in the arch,but
the system of brackets for each pt is identical.

16. IMPORTANT FACTORS IN DETERMINING
THE DESIGN OF THE V.S.APPLIANCE
1. Shape and Size of the tooth.
Mesiodistal width and curvature.
2. Accessibility.
3. Patient comfort and frequency of bracket wing
breakage.

17. Factors Related To The Brackets
1. Bracket selection
2. Bracket placement
3. Bracket angulation
4. Bracket torque
5. In / Out

18. BRACKET SELECTION
TWIN BRACKETS
• Large ,flat surfaced teeth.
• Mini Diamond brackets.
• Accessibility
• Additional hooks .

19. •Inter bracket distance.
•Patient comfort.
•Full archwire engagement.

20. LANG BRACKETS
Dr.Howard Lang
• Round surfaced teeth at the
corners
• Single bracket with a flat
rotational wing.

21. • Wire deformation

22. LANG BRACKETS
•Complete arch wire
engagement.
•Increased inter bracket
width
Wedge shaped in
profile

23. LEWIS BRACKETS
• Large round surfaced teeth and
small flat surfaced teeth.
• Single bracket with fixed
rotation wing –built in labial
curvature

24. LEWIS BRACKETS
• Wedge shaped in profile
• Excellent inter bracket width.

25. • Facilitates correction of severely rotated teeth.
Activation

26. OTHER ATTACHMENTS
•Twin bracket with a Convertible sheath .
•Head gear tubes placed occlusally*.
•15 degree offset –upper first molar .
5 degree – mandibular first molar.
•Ball hooks .

27. OTHER ATTACHMENTS
• Single buccal tubes second molars
• 6 degree distal offset built in the lower second
molar.
• Lingual hooks on all molar bands.
Appliance does not dictate the treatment technique

28. Bracket height
• Bicuspid bracket height [x] key

29. Bracket angulation
• Ideal axial inclination.
Roots parallel Crown in most esthetic
&functional position.
DIAMOND BRACKET
VERTICAL LINES PARALLEL TO THE
LONG AXIS OF THE TOOTH

31. 1 st
Bicuspid Extraction

32. Dr Dwayne Trammell
BAYLOR UNIVERSITY
• Laminographic x- ray of the molars
• 3 months
• Superimposition showed
Root tips moved
anteriorly by , 0.5
mm
Crowns tipped distally on
an average of 1mm
• 2 mm of arch length

33. BRACKET TORQUE DEVELOPED
Finishing rectangular wires of 50 cases

34. • - 30
torque maxillary cuspids
• No torque mandibular second molar tube
• - 50
lingual crown torque mandibular incisors

35. DR. TRAMELL
• Class II non extraction cases
• 0.017’’ x .025’’ D RECT MULTISTRANDED -
3 MONTHS
• Superimposition showed incisal edges moved
lingually by less than 0.5mm
• Root apices moved labially on an average of 1mm
• Main aim Hold the incisors in its
original position

36. Bracket in – out

37. EXTRA-ORAL FORCES
‘RETRACTOR’ Dr.Fred Schudy
Sagittal
Control Vertical
Transverse
Skeletal Dental

38. Three different type of retractors
1. Cervical traction
• Force vector -10 degrees
• SN- MP- < 37 degrees

39. 2. Combination pull
• Force vector 30 degrees
• SN- MP 37 to 41 degrees

40. 3. High pull retractor
• Force vector 60 to 70 degrees
• SN-MP > 42 degrees

41. Components of a facebow system
1. Molar buccal tubes.*

42. 2. Inner bow
Adjustments in six
directions
• Bucco-lingually
• Superio- inferiorly
• Anterio - posteriorly

43. 3. Outer bow

44. • 4. Retractor system

45. Retractor force
• 8 ounces
• 16 ounces
Time worn
Depending on severity of A-P discrepancy
• ANB – 3 7-8 HOURS
• ANB – 3- 5 10 HOURS
• ANB - > 10 14 HOURS
Orthodontic vs Orthopedic force

46. Class III Extra oral forces
• Face masks
• Vertical pull chin
cup
• Reverse headgear

47. Co-operation*
Successful treatment Growth
Arch consolidation

48. Elastics in Vari – simplex
discipline
• To align the maxillary dentition with the
mandibular dentition and correcting an
centric occlusion / centric relation
discrepancy.
• Correction of cross bite and midline
• Finalize the occlusion
3 to 6 ounces

49. Elastic Specifications
• Class II - ¼ “, 6 oz

50. • Class III - ¼” , 3 ½ oz

51. • Midline elastics – ¼ “ , 6 oz

52. Box elastics
• Anterior box elastics – 3/16“ 6 oz

53. Box elastics
• Lateral box • Buccal box

54. • Trapezoid elastics – ¼ “ , 6 oz

55. • Triangular elastics
1/8 ”, 3 ½ oz

56. • Cross bite elastics
– 3/16 “ , 6 oz

57. • Finishing elastics – [ UP AND DOWN]
¾ “ , 2 oz

58. M with
tail
W with tail

59. • Head gear
elastics
• Coil springs
½ “, 140z

60. Non-Extraction Treatment
Photographs
Learning Experiences
Case Record
BORDERLINE CASES
Fifty percent of cases Treated
Non

61. Borderline Non extraction
• Negative torque on the lower incisors
bracket
• Negative tip on the lower molar bracket
• Flexible D RECT wire initial
• Bonding instead of banding
• Ability to perform selective interproximal
reduction

62. MAXILLARY ARCH. Bonding and Banding
First Wire
• Multistrandard spiral round archwire
• Retractor
Second Wire
• 0.016 ss with omega stops.
Space closure with power chains.
Third final wire
• 0.017 x 0.025 ss rectangular

63. MANDIBULAR ARCH
First wire
 0.017 x 0.025 multistranded rectangular wire
 Slenderizing followed by 0.016 x 0.022 D-Rect
 0.016 Ni ti and class III elastics
Second wire
 0.016 x 0.022 ss with omega
Third wire
 0.017 x0.025 ss

64. CLASS II DIV 2
 0.0175 Multistranded or Ni ti
 0.016 ss wire
 Bite blocks
 Mandibular arch- Initial round wires
- 0.016 x 0.022 ss finishing wires
- Invert bracket or zero degree torque
DEEP BITE CASES
• Bite plate.
• Cervical retractor

65. CLASS III CASES
• Start treatment in both arches.
• Early use of class III elastics.
• Extra oral forces.
OPEN BITE
• Bracket positioning.
• Extra oral forces

66. Extraction Treatment
Indications:
1. Severe mandibular arch length discrepancy.
2. Severe bimaxillary protrusion.
•25 percent*

67. Advantages of delaying treatment in
the mandibular arch:
1.Physiologic drifting. ‘DRIFTODONTICS’

68. 2. No interference for retraction of
maxillary canines .
3. Additional time for second molars to
erupt.

69. STANDARD CLASS II DIV 1
MAXILLA
Initial wire -
0.0175 Respond multistranded
or 0.017” –0.025”D-Rect rectangular
braided arch wire
Second archwire- Canine retraction.
0.016 ss round with omega stops .
0.016 –0.022ss closing loop arch wire .

70. Third archwire -
• Incisor retraction.
• 0.018-0.025 ss closing loop archwire*
• Loop activation –1mm per four weeks.
• Excellent torque control.

71. Final finishing arch wire
• 0.017-0.025 ss wire.

72. MANDIBLE:
4 to 6 months of Driftodontics
Initial wire
Multi-stranded .0175 respond.
or 0.016 Ni-ti
or 0.017 –0.025 D-rect.
Second wire
0.016 ss wire .

73. Third archwire
• 0.016-0.022ss closing loop archwire.
Final finishing arch wire
• 0.017-0.025 ss archwire.

74. RETENTION IN VSD
Criteria for completion of treatment.
1. Centric relation and Centric occlusion
should coincide.
2. ClassI Cuspid relation.
3. Mand intercuspid width.
4. Interincisal angle with proper torque.
5. Normal ant overbite and overjet.

75. 6. Normal buccal overjet.
7. Levelled upper and lower arches .
8. Rotations eliminated and all Spaces closed
9. Roots parallel near extraction.
10. Good cuspid interdigitation.

76. COUNT DOWN TO
RETENTION
6 WEEKS - Active treatment to Retention.
Posterior settling --- Sectioning the arch wire.
1. Mandibular arch wire - Class II deep bite
2. Maxillary arch wire - Class III open
bite
3. Both the arches - Class I

77. Band removal appointment
¾” ,2 oz

78. Retainer design and fabrication

79. PRINCIPLES OF THE
ALEXANDER DISCIPLINE
1. ‘AS A MAN THINKETH’
JAMES ALLEN
EFFORTS = RESULTS

80. 2. Dr .Hans Selye ‘Altruistic Egoism’
3. KISS Principle .
4. Plan your work .
Accurate Diagnosis and Treatment Planning
5. Goals for stability.

81. 6.Specific bracket design.
7.Bracket positioning.
8.Face bow for Orthopedic correction .
9.Proven Arch form design and Arch wire
force system .

82. 10.Consolidate arches.
11.Complete bracket engagement.
12.Level the arches.
13.Progressing into finishing archwires .

83. References
• The Alexander Discipline – R.G. “Wick”
Alexander
• JCO June 1983
• Seminars in Orthodontics – Vol 7 June
2001