Auxilleries /certified fixed orthodontic courses by Indian dental academy

INDIAN DENTAL ACADEMY
Leader in continuing dental education
www.indiandentalacademy.com

Mollenhauer’s Aligning Auxiliary (MAA)Mollenhauer’s Aligning Auxiliary (MAA)
In the classic Begg philosophy crown tipping & rootIn the classic Begg philosophy crown tipping & root
movements- totally bifurcated, becausemovements- totally bifurcated, because
– Root movement in early stages- loss of anchorageRoot movement in early stages- loss of anchorage
– Lingual root tip of incisor – extrusion of incisor and biteLingual root tip of incisor – extrusion of incisor and bite
deepeningdeepening

– MAA attempts root control from the veryMAA attempts root control from the very
beginning without significantly affectingbeginning without significantly affecting
anchorage & intrusionanchorage & intrusion
– This is possible by using stiff base wireThis is possible by using stiff base wire
(0.018” premium plus) & ultra light force(0.018” premium plus) & ultra light force
from MAA (0.009” supreme).from MAA (0.009” supreme).

• Development of MAADevelopment of MAA
Mollenhauer –rectangles made in 0.010 “ wire forMollenhauer –rectangles made in 0.010 “ wire for
reciprocal torque on adjacent incisors (SPECS)reciprocal torque on adjacent incisors (SPECS) tootoo
heavy forceheavy force
In 1984, on request of Mollenhauer , A. J. Wilcock madeIn 1984, on request of Mollenhauer , A. J. Wilcock made
0.009” supreme wire0.009” supreme wire
Initially he used it similar to niti or co-axial wire.Initially he used it similar to niti or co-axial wire.
Later boxed aux. namedLater boxed aux. namedwww.indiandentalacademy.com

• Requirements of MAARequirements of MAA
– Must generate very light root moving forcesMust generate very light root moving forces
– when reciprocal torque is required with the adjacentwhen reciprocal torque is required with the adjacent
rectangle must not diverge by more than 45rectangle must not diverge by more than 4500
– Auxiliary should resist deformation (resilient supremeAuxiliary should resist deformation (resilient supreme
grade pulse straighten wire)grade pulse straighten wire)
– Base wire should be able to resist vertical and transverseBase wire should be able to resist vertical and transverse
reactive forces from MAAreactive forces from MAA

For lingual root torqueFor lingual root torque
Mollenhauer engaged MAAMollenhauer engaged MAA
first & base arch wire piggyfirst & base arch wire piggy
backback
but rectangles lift away frombut rectangles lift away from
the tooth surface. So,the tooth surface. So,
Thickest possible pinsThickest possible pins
(ceramaflex) used.(ceramaflex) used.

ADVANTAGES OF MAAADVANTAGES OF MAA
– simultaneous intrusion and retraction of incisorssimultaneous intrusion and retraction of incisors
– of rapid bodily alignment of anterior teeth with gentleof rapid bodily alignment of anterior teeth with gentle
forcesforces
– Stable resultsStable results
– Reciprocablility of torquing forces on instanding lateralsReciprocablility of torquing forces on instanding laterals
or palatally placed canines.or palatally placed canines.
– Periodontal advantages – gingival dehiscences associatedPeriodontal advantages – gingival dehiscences associated
with prolonged labial root torquing is eliminatedwith prolonged labial root torquing is eliminated

– Short stage threeShort stage three
– Possibility of growing cortical bone at point A & point B.Possibility of growing cortical bone at point A & point B.
Various applications of MAAVarious applications of MAA
– bodily alignment of crowded teethbodily alignment of crowded teeth
– To apply labial root torque on lower incisors in growingTo apply labial root torque on lower incisors in growing
brachyfacial cases.brachyfacial cases.
– Can also be used for labial root torque on upper incisorsCan also be used for labial root torque on upper incisors
in class III cases.in class III cases.

– By bending more +ve Torque as a brakingBy bending more +ve Torque as a braking
mechanismmechanism
– For controlling mesio-distal tipping (MAAFor controlling mesio-distal tipping (MAA
tip)tip)

Modification of MAAModification of MAA
– With available pins holding down the boxes forWith available pins holding down the boxes for
lingual root torque was difficult. So, torquing actionlingual root torque was difficult. So, torquing action
of MAA is directly applied on gingival surface ofof MAA is directly applied on gingival surface of
teeth. For this base wire is engaged first and MAA isteeth. For this base wire is engaged first and MAA is
engaged piggy back.engaged piggy back.

– When reciprocal root torque is required onWhen reciprocal root torque is required on
adjacent teeth the concerned box rides overadjacent teeth the concerned box rides over
the main arch wire with a cross over band andthe main arch wire with a cross over band and
pressed against the incisor surface of thepressed against the incisor surface of the
crowncrown

• Braking auxiliariesBraking auxiliaries –– in minimum anchorage casesin minimum anchorage cases
where extractions were performed there is need towhere extractions were performed there is need to
prevent the anterior from over retracting. This can beprevent the anterior from over retracting. This can be
done bydone by
– Passive uprighting springsPassive uprighting springs
(made in 0.018” wire)(made in 0.018” wire)

Single root torquing AuxiliarySingle root torquing Auxiliary (kesling)(kesling)
• Useful for any tooth except molarUseful for any tooth except molar
• Made from 0.012” premium plus wireMade from 0.012” premium plus wire
buccal palatalbuccal palatal

Universal Torquing AuxiliaryUniversal Torquing Auxiliary (JACK PERLOW JCO 1973)(JACK PERLOW JCO 1973)
can be usedcan be used
• on extraction and non-extraction cases;on extraction and non-extraction cases;
• on upper and lower teeth;on upper and lower teeth;
• on centrals or laterals;on centrals or laterals;
• for labial or lingual torque.for labial or lingual torque.
• on .020 round wire in a Begg techniqueon .020 round wire in a Begg technique
• on edgewise wireon edgewise wire
• on a Hawley retainer. ( .012 wire), since a heavier auxiliaryon a Hawley retainer. ( .012 wire), since a heavier auxiliary
will dislodge the retainer.will dislodge the retainer.

Reverse torquing aux. for controlling the roots of caninesReverse torquing aux. for controlling the roots of canines
and premolarsand premolars (Tan, JCO, 1987)(Tan, JCO, 1987)
• Made from.014" wire in conjunction with an .018" or .Made from.014" wire in conjunction with an .018" or .
020" main archwire,020" main archwire,
• effective to perform an extensive labial canine rooteffective to perform an extensive labial canine root
movement to produce a canine eminence.movement to produce a canine eminence.
• For palatally impacted canines which require labial rootFor palatally impacted canines which require labial root
torque.torque.

Buccal root torque on molarsBuccal root torque on molars
during third stageduring third stage if molar crown rolled buccally roots needif molar crown rolled buccally roots need
torquetorque
0.014’ wire,0.014’ wire,
boot design,boot design,
twisted lingually & toe intwisted lingually & toe in

Finishing Wires in Begg Trt.Finishing Wires in Begg Trt.
Round Finishing WiresRound Finishing Wires
• 0.020”,0.018” premium grade0.020”,0.018” premium grade
• 0.020” sectional wire (with settling elastics)0.020” sectional wire (with settling elastics)
Rectangular wiresRectangular wires
• 0.022” x 0.018” ribbon (alpha titanium)0.022” x 0.018” ribbon (alpha titanium)
• 0.019” x 0.025” (blue elgiloy)0.019” x 0.025” (blue elgiloy)
• 0.020” Sq. (alpha titanium)0.020” Sq. (alpha titanium) mollenhauermollenhauer

Round wires (Fabrication)Round wires (Fabrication)
• 0.020” normally0.020” normally
• 0.018” vertical movement req.0.018” vertical movement req.
• 0.020” sectional closing open bites0.020” sectional closing open bites
• Often req. to continue aux.Often req. to continue aux.
• Ach wire fabricated according to individual arch formAch wire fabricated according to individual arch form

First Order BendsFirst Order Bends
Upper archUpper arch
• To tuck in lateral incisorsTo tuck in lateral incisors
• Canine offset (diff. in lab.lin. Thickness of U-2 &U- 3)Canine offset (diff. in lab.lin. Thickness of U-2 &U- 3)
• Offset between premolars and molars (to compensate for diff.Offset between premolars and molars (to compensate for diff.
in buccal contour)in buccal contour)
• Toe in bend for 1Toe in bend for 1stst
& 2& 2ndnd
molars for good class I molar (notmolars for good class I molar (not
req. for cases finished in class II)req. for cases finished in class II)
• Flat segment between U-3 & U-6Flat segment between U-3 & U-6

Lower archLower arch
• To tuck L – 3(minimize relapse of lower crowding)To tuck L – 3(minimize relapse of lower crowding)
• diff. in thickness of L-3 & L-2 pushes L-3 slig. Ling.diff. in thickness of L-3 & L-2 pushes L-3 slig. Ling.
without offset (no offset in well alig. Or mild crowdingwithout offset (no offset in well alig. Or mild crowding
cases)cases)
• in severely crowded cases inset between L-2 & L-3 andin severely crowded cases inset between L-2 & L-3 and
offset between L-3 & adj. premolaroffset between L-3 & adj. premolar
• Offset between premolars and molarsOffset between premolars and molars

Second order BendsSecond order Bends
• If necessary to intrude U-2 vertical stepIf necessary to intrude U-2 vertical step
• Mild occlusal (tip down) bend in U molar region (slig. Mesial ang. OfMild occlusal (tip down) bend in U molar region (slig. Mesial ang. Of
U-6 for seating its D.B cusp against M.B cusp of L-7U-6 for seating its D.B cusp against M.B cusp of L-7
• A slig. Distal tip of L-6 for proper fit against U-6 takes place its ownA slig. Distal tip of L-6 for proper fit against U-6 takes place its own
(AB)(AB)
• Continue uprighting spring on U-3 so cusp tip occlude with distalContinue uprighting spring on U-3 so cusp tip occlude with distal
half of lab. surface of L-3half of lab. surface of L-3
Third order CorrectionThird order Correction
• Over correct all teeth 10-15% in 3Over correct all teeth 10-15% in 3rdrd
stage if not possible during 3stage if not possible during 3rdrd
stage continue stage III aux.stage continue stage III aux.

Rectangular wiresRectangular wires
• Dr. Mollenhauer suggested and popularized rectangularDr. Mollenhauer suggested and popularized rectangular
wires for finishingwires for finishing
• The original tech. consisted in converting the round tubes byThe original tech. consisted in converting the round tubes by
crimping using a template into ribbon tubescrimping using a template into ribbon tubes..
• He recommended use of 0.020” sq. or 0.018” x0.022” alphaHe recommended use of 0.020” sq. or 0.018” x0.022” alpha
titanium wiretitanium wire
Adv. of rectangular wiresAdv. of rectangular wires
• Bucco-lingual root torque particularly for post. Seg. Eff.Bucco-lingual root torque particularly for post. Seg. Eff.
AppliedApplied

• Extent of overcorrection can be reducedExtent of overcorrection can be reduced
• Individual tooth positions in terms of in out, rotations andIndividual tooth positions in terms of in out, rotations and
overcorrection easily establishedovercorrection easily established
• Root & crown movements are stabilizedRoot & crown movements are stabilized
• Arch form, arch coordination & occlusal relationships can beArch form, arch coordination & occlusal relationships can be
fine tunedfine tuned
• Retention is likely to be more stableRetention is likely to be more stable
• Gnathological/functional occlusal relationships can achieveGnathological/functional occlusal relationships can achieve
betterbetter
• Stabilizing wires for orthognathic surgeryStabilizing wires for orthognathic surgery
• Debonding & debanding easier (less mobile teeth)Debonding & debanding easier (less mobile teeth)www.indiandentalacademy.com

The strap upThe strap up
• Combination tubesCombination tubes Consist of gingival round tubeConsist of gingival round tube
0.036”diametre x 6.2mm long & rectangular (ribbon)0.036”diametre x 6.2mm long & rectangular (ribbon)
occlusal tube 0.025”x 0.018” dia x 5.5 mm long it has 6ºocclusal tube 0.025”x 0.018” dia x 5.5 mm long it has 6º
offsetoffset
• Second molars can be banded withSecond molars can be banded with
this tube or only ribbon tubesthis tube or only ribbon tubes
• good Quality Begg Brackets (thick walled)good Quality Begg Brackets (thick walled)

Wire SelectionWire Selection (directly related to modulus of elasticity)(directly related to modulus of elasticity)
• Based upon-Based upon- cases that req. only passive torque &cases that req. only passive torque &
stabilizationstabilization (0.020”sq. or 0.018” x 0.022’ alpha titanium)(0.020”sq. or 0.018” x 0.022’ alpha titanium)
• cases that req. active torque (ss or elgiloy alloy)cases that req. active torque (ss or elgiloy alloy)
Alpha TiAlpha Ti has modulus of elasticity intermediate to ss & TMA .has modulus of elasticity intermediate to ss & TMA .
• It has adv .of intraoral adjustmentIt has adv .of intraoral adjustment
• shows ↑ in str. in oral cavity due to absorption of H ions but itshows ↑ in str. in oral cavity due to absorption of H ions but it
become brittle (due to vanadium content) in 6 weeks ofbecome brittle (due to vanadium content) in 6 weeks of
insertion.insertion.

Incorporation of torqueIncorporation of torque
• Best wayBest way in ant. Segment with 0.022” torquing turretin ant. Segment with 0.022” torquing turret
(permit 20º torque) either torque or reverse torque(permit 20º torque) either torque or reverse torque
• Individualized torque – Rose torquing plier.Individualized torque – Rose torquing plier.
• General rule 15º and 25º buccal root torque in U & L pos.General rule 15º and 25º buccal root torque in U & L pos.
respectivelyrespectively
• First and second order bends are placed as in round wiresFirst and second order bends are placed as in round wires

Fabrication and placement of arch wireFabrication and placement of arch wire
• A st. length of app. 8” of .018 x.022 wireA st. length of app. 8” of .018 x.022 wire
• Placed in turret so that middle of wire coincides withPlaced in turret so that middle of wire coincides with
centre mark on turretcentre mark on turret
• Turret is given firm & brisk turn for arch formTurret is given firm & brisk turn for arch form
• 11stst
& 2& 2ndnd
order bends place with Tweed plierorder bends place with Tweed plier
• Individual torque when req.– Rose torquing plier.Individual torque when req.– Rose torquing plier.
• Place the arch wire in slots and pin them securely withPlace the arch wire in slots and pin them securely withwww.indiandentalacademy.com

Checklist on finishingChecklist on finishing
• Establish all the Andrews keys of normal occlusionEstablish all the Andrews keys of normal occlusion
• Midline should coincideMidline should coincide
• Cheek occlusion in centric positionCheek occlusion in centric position
• Cheek occlusion in functional movementsCheek occlusion in functional movements
• Cheek for excellent interdigitation, where needed sectionCheek for excellent interdigitation, where needed section
archwire & place W or M elastics to settle the teetharchwire & place W or M elastics to settle the teeth
• Overcorrection generally not req. or at most 10½ /10Overcorrection generally not req. or at most 10½ /10
overcorrectionovercorrection www.indiandentalacademy.com

Thank youThank you
For more details please visitFor more details please visit
www.indiandentalacademy.comwww.indiandentalacademy.com

Auxilleries /certified fixed orthodontic courses by Indian dental academy

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