Edge wise technique 1 /certified fixed orthodontic courses by Indian dental academy

The Edgewise
appliance-evolution &
technique

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INDIAN DENTAL ACADEMY
Leader in continuing dental education



Contents :Evolution / Historical perspective
1) Bandelette appliance
2) Angle’s E–arch
3) Pin &Tube appliance
4) Ribbon arch appliance
5) Edgewise appliance
Attachments
Modification of edgewise brackets
Evolution of buccal tube
Bracket placement &angulation

Evolution of the technique
-Primary edgewise
-Secondary edgewise
-Tertiary edgewise
Tweed’s philosophy of treatment
Growth trends
Diagnostic facial triangle
Cephalogram or headplate correction
Treatment objectives
Anchorage preparation
Ideal arch form
Three orders of tooth movement
General plan of treatment
Merrifield’s modification

Evolution of appliance
First attempt at tooth movement in1728 by a French physician
Pierre Fauchard
Bandalette appliance-crude alignment of teeth by expansion
of the dental arches
Disadvantage : lacked stability
no effective means of firmly fixing it in position


1841-Schange introduced screw force
1849-Dwinelle developed jack screw
1871-Magil introduced dental cements to attach bands on teeth
1866-Kingsley advocated the use of extraoral forces
No attempt was made to correct malocclusion by placing teeth
in a stable soft tissue environment
Angle believed that teeth when moved into their correct
occlusal relationship, stability would be assumed.


The E arch appliance(1880)
First typical orthodontic fixed
appliance
Rigid framework –Molar bands
with heavy labial arch wire
soldered to them,
Teeth tied to it by means of
brass
ligature
wire
Crown movement & simple
anchorage
Teeth were expanded into normal
occlusion


4 different designs:
Basic E-arch
 Ribbed E-arch
 E-arch without threaded ends that fit into molar sheaths,
used with an attached ball for high pull head gear in the
incisor area
 E-arch with hooks for intermaxillary elastics
Also had maxillo mandibular growth
guidance
Disadvantages :1) correction of axial inclination could
not be accomplished
2)long term retention was required



The Pin &Tube
appliance(1912)
Ideal arch of E-arch was not there
Arches were altered as tooth
movement carried out
progressing towards ideal
archform
Bands with tubes soldered on it
Pins soldered on the archwire &
made to fit into tube perfectly
Change position of pin ,solder it
again on archwire to a different
position & fit into the tube
again
Disadvantage:difficult to solder
& unsolder pins
time consuming

Ribbon arch appliance (1915)
To overcome disadvantage of pin &
tube
Brackets with vertical slot introduced
Archwire initially confirmed to
malocclusion ,held in place by
brass pins
Rectangular wire with longer
dimension vertical
Overcame 2 major problems:
1) archwire placement
2) M-D movement of teeth
Teeth were free to move along the
archwire like strings of beads


Teeth could tip M-D, even with lockpins
Angle devised cleats to be soldered to archwire to contact the
sides of the bracket
Held the teeth upright, but necessitates soldering new cleats at
different locations
Disadvantage:-relatively poor root control
-mesial & distal tipping bends could not
be incorporated
-enmass movement of teeth in an anteroposterior direction was not easy


The Edgewise
appliance(1925)
Solution to all problems –latest & best
in orthodontic mechanism
Changed the form of bracket
located the slot in the center
& placed it in a horizontal
plane instead of a vertical
Bracket wide mesio-distally
Rectangular slot for rectangular archwire
.022x.028 slot size, same size wire
Archwire inserted in narrowest
dimension -EDGEWISE
Initially called open face or tie brackets
Archwire held with brass ligature & S-S
ligature later

Types of headgear used
High pull :- intrusion of maxillary incisors
increase the lingual root torque
used with cl.II elastics
Intermediate pull headgear :- distalise maxillary
dentition when bite is not deep
hold the maxilla during anchorage
preparation
Low pull headgear :- open bite case
support mandibular dental arch in
older patients
The Kloehn cervical gear :- growth trend is type A or C
restricting the maxillary growth so
that the mandible can catch up

ATTACHMENTS
Evolution of edgewise
brackets
Original bracket – soft gold , .022
x .028 inch slot
1)Single width brackets
original bracket .050 inch
wide & soldered to the gold band
material
archwire rests on bottom of
bracket slot instead of the band
ineffective for tooth rotation
because of the narrow width
Angle devised gold eyelets to
be soldered on bands

2)Twin brackets
- two brackets on one base
-“Siamese twin brackets” by Swain
- space between two brackets was
.050 inch (equal to width of one
bracket )
Main advantage :
- ability to effect tooth
rotations without using
auxiliaries
Available in different widths:
Extra wide

Standard

Intermediate

Junior

3)Curved base twin bracket
curved bases to confirm to the
curvatures of the canines &
premolars
Advantages of twin brackets :
Offers a positive control
Disadvantages:
increased width decreases the
inter bracket span, thus
decreasing the resiliency


4)Lewis bracket
Developed by Lewis in 1950.
To overcome the problem of
efficient tooth rotation.
He soldered auxillary rotation
arms that abutted against the
bracket itself, thus, offered a
lever arm to deflect the
archwire & rotate the tooth.
One piece bracket with integral
rotation wings
These wings do not interfere with
occlusogingival deflections of
archwire & do not decrease
the interbracket span

5)Curved base Lewis bracket
Curved base confirms to the
canine, premolar surface
Wings lie close to the tooth
throughout their length ,so
less trapping of food


6)Vertical slot Lewis bracket
Incorporation of .020 x .020 inch vertical slot
Possible to use uprighting spring to correct axial inclinations if
needed
Advantages of Lewis brackets:
1) complete rotational
control
2)do not reduce the
interbracket span


7) Steiner bracket
Given by Cecil C Steiner in 1931
Incorporated flexible rotation arms & so did not rely on the
resiliency of the archwire for tooth rotation
Introduced tie wings for ease of ligation
8)Broussard bracket
Designed by Garford Broussard for
use in the Broussard technique
Addition of a 0.0185 x 0.046 inch
vertical slot to accept a doubled
0.018 inch auxillary wire

Evolution of edgewise buccal tube
Original appliance had .022x .028 inch gold or nickel silver tubing
soldered to the molar band
Length –3/16 or ¼ inch
Notched distal ends - to facilitate a tie back ligature
Hook – gingival to buccal tubes, soldered on the bands for
placement of elastics
Inconel tube - gold buccal tubes were discarded
Stamped buccal tube with welding flanges or
Inconel tube which could be soldered to the band


Combination buccal tubes
Incorporates a round tube for
insertion of a face bow
Fairly close tolerances must be
maintained between archwire
& tube for effective
transmission of torque to the
tooth
Triple buccal tube
additional rectangular tube for
auxillary sectional & base
archwire


Bracket & tube placement
Angle - “goal of correct bracket & tube placement is to
produce an ideal occlusion at the end of treatment with flat,
straight, ideal archwires
Tweed advocates – millimeter measurement from bracket slot
to the incisal edge
UPPER ARCH
Centrals –4.5
Laterals –4.0
Canines –5.0
Premolars-4.5
Molars –3.5

LOWER ARCH
Anteriors-4.0
Canines-4.5
Premolars-5.0
Molars-4.0


Bracket angulation
Brackets –parallel to the long axis of the tooth
Holdaway (1952) described three uses for bracket angulation
a) as an aid in paralleling roots adjacent to extraction spaces
b) as a method of setting up posterior anchorage units into
tipped back or anchorage prepared positions
c) as a means of obtaining correct axial inclinations or artistic
positioning


Armamentarium


Ligature locking and tying plier in place and ready for tying


Evolution of technique
Primary edgewise
*as described by Angle in 1929
*fully banded technique-gold bands ,soldered soft brackets
*flat ideal arch wire -to provide normal occlusion
*original arch was of .022 X .028 inch gold wire
*to be adapted passively to all malocclusion
*if space had to be made, loops are soldered onto main arch
*if space closure required, spurs & tie backs used
*involves all the teeth to be brought under control so,
treatment should be initiated after eruption of canine &
premolar

Angle stated that "malocclusion must be treated as though
the denture is a self-sustaining, self maintaining unit and all
parts of denture exerting or sustaining forces must be
perfectly balanced”
1) fully normal proximal contact relations of teeth
2) normal cusp & inclined plane relation
3) normal upright axial position & relation of teeth
this is essential if the teeth are to balance
with the muscles & sustain the forces of
occlusion


Angle introduced the bracket 2 yrs. before his death.
Proposed nonextraction treatment for all malocclusion
Expansion of the dentition – method of teeth alignment
Muscular balance was upset, teeth were moved to an unstable
positions-------high frequency of relapse
Little attention to establishment of anchorage


Secondary edgewise
*to avoid the making archwires passive
*use of round wires in the initial stages
*gold was replaced by a more rigid alloy
*frequency of extractions increased
*bands with prewelded brackets
*in 1940s round .045in.tubes were also soldered on
the upper molars for a face bow


Tertiary edgewise or Tweed’s edgewise
*stressed on the importance of anchorage
preparation
*advocated the use of cl. III elastics & extraoral
traction
*vigorous forces were now employed
*space closure was done by simple vertical or
horizontal open loops bent into the archwire or by
push coil tie -backs


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Edge wise technique 1 /certified fixed orthodontic courses by Indian dental academy

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