270

3
SECTION
BIOMECHANICS
OF THE
- THERAPY
BIOPROGRESSIVE
RO B E R TM . R I C K E T T SO , D S ,M S
RI J E L W.B E N C H ,D D S
CAF L F - G U G I N O ,D D S
J AM E SJ . H I L G E R S ,D D S

PABT 1 S E O UE NCEO F ME CHA NI CS IN

NON"EXTRACTION CLASSII. DIVISIONI
DE E PB rT ECA S E S. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . 2 7 3

PABT 2 S E O UE NCE IN
O F ME CHA NI CS
cLASS I EXTRACTTON CASES.....................................277

PART 3 VARIABLESEOUENCE OF IV]ECHAN ICS

IN CLASSII, DIVISIONI, VERTICALGROWTH
P AT T E RNWI T HA NT E RI O RO P E NB I T E
(E X T RA CT T O N) ...........................281

PART4 SEOUENCE OF MECHANICS IN

NON"EXTRACTION. CLASSII, DIVISIONII
DEE PB |T ECA S E S ......................289

PART5 TM A NDT B UL A
UTR t L t T Y A RCHE S. . . . . . . . . . . . . -. . . . . . . .. . . . . . . . 2 9 3

PART6 ANCHORAGEPLANNINGEXTRACTIONCASES...,,..299

PART7 TR T p L E -CO NT RO
B LT O P RO G RE S S I V E ' . . . . . . . . . . . .. . . . . . . . . . . 3 0 3

271
anoptionalapproach
sequenceof mechanicsin
non.extractionclass II, divisionI, deep bite cases

OR THOPEDIC CONV EXI TY Ea n dtl re !p p e r .i .)l ar qLq an{ip aceheadqei rr. Forcedi recron (hi p! , cervt . ator
, com b
R E DUCTIONBEGINN I NC n a tro n ld e p e fd e.t upon physol os c l a.ro6 ai d .ephai omerrineeds.
.
CIA SSII MOLAR CORRECTI O N Typi calhsadsears wor r
I2 to 1 4 h o ! 6 a day overan * rendecj pe.i odof rtmeto effeclorl hopedi ccorr ect ion.

Pro s re s i v ea c tl val i of.)l the l readgear

i o prod!cebuccate\pansi oiand dj sra rot al on of r he
u p p e rfi rs t mo l aBbV w den n! rhe i ni er bow dj rnensi on
and ncreasn! the otfs erm esat r o r he

B E GINNINGINCISOR Ba n d o w e rm ol ars6]6 an.tba.ttl b..d 21F1. ptace.016r.0j 6 bl ue E tstoy !1 t ly ar ch

O V EABITECORFECTI O N a c tl v a te dw i th 60 75 !ramsof forcero l nrrurterhe ow er i ncj sorsand!pr 9hr t he t ower, nola6.
B Y LOWERARCH L EVELI NC
T h e l o w s m o . r roorsarerofqLred bl ca ty i nro the dersecorri catboneof rhe exr er f €tobljqLr e
ri d g e j ' rg L racrow
l ntorq!e l s appl i edro rhe tow ertnc sorsro asssr n thei r i nlr uson.
Wl re nfl rtre r i n c sor:.rrusof i s rece$ary,bl i rhe ow er mo arsareatreadyup r t ght t, he 616
te e tha res l a b i l i zedby bandi ng/bondi ns
rhe ow er buccatseqmenr teertrand p act ; gan . 0i6 \
.0 1 6b !e E g o y st€bl i 2 f! sedi on .r rhe occ l sa mo ar rl be ro the fi rst bi cl spidi I he t ower
u t ty a r.h .a n then be mri nta red ro i ntrLrde the i nci sors
w j rho!r overti ppi nqt he m olar s.
U p p e rb u c c as egnrefl ares posti onedand preparedro receveC tasstretasti .s. Baf d/ bond
S O CCALSEGMENTS
A LIGNEO !!3 1 3 1 5 a n d p a.e l el e j nq and/orcl osi nqsecri ons
to ati snupperbi c!spi dsandc! spids O nce
a l g n n re n its a chl eved,..016 r 016 rracri onsecrj oni s p aced. The he€dgear i s of r encont in! ed
d !ri n g th i s p h rseol treai mert.
L o w e rb l c c a ! segments areai i !ned. Oncerhecorecr posi ttons
ol rhe l ow eri nciso6and m ot ar s
" re " . i F .,d n ' l a r" oi oi ,, . i
" " .0l b.
O _ o^- ..d, ./ q,. ,a. a pa. - a.
' 5 4 ,.o d , F" o o op ,o" d.
" 1" , oop r, 4 t:r,
",
ri 1

F i n a lro ta t o n a contro ol the l ow erbLrccaseqmenrs

sacr-ri evedby.seresof ar . hes( . 012,
.0 1 4 ,.O l 6 ,tw stafl ex," T i oops,erc.)thatoverayrhenabj i zi nsuri lryarch.
C assn e asticscan be starredro rhe !pper tr.ct on sectionro overcorrecrrhe C asstr

UP P ERINCISORCON TRO L The !pper jfclsors 21_lLU are banded/bo.r{:ledto prep.re for nrrusioi .nd revacr on ot rhese
t€ e th . An a n te ro. Ievel i ng
secton 1 ghr ro!nd or tw i stafl exw i fe, i s p acedto alisf andct ose
s p a c e sn rn e !p per ncrsorteetfr.
A .0 1 6 x .0 2 2u pperuti ry arch s pl acedro i nrruderheseteeth. The traci j onse. r onsar e
m a i ta i n e dto p reventoveni ppi hgol the nroare.nd C l assII €tastt.s€recontj . ued.
After ihe upper inc sors h.ve beenj.truded i]nd iorq!ed (.s necessary), consotdat on archesare
p l a c e d1 0 re tra cttheseteeth. U sLrs
l V , a si mpl e. osi ngul i t tV arch i s ptacedasa. ov€r t ayio t he
!p p e r rra c l o n secrons.
A l o w e ri d e € /arch s p acedassoonasl i na l eve n! and forari onaconrro oJ rh e ower bucca
s e s m e nte
t e i h s i i ni shed.The l ow ermo arstT7 arebanded.nd a gnedand i nregr aledinr o r he

I DE AL IZEARCHES l d e a c o o rd i n ated
.016 x .016bl ue E si toy ar.hesareptacedi n order1(ra l ow a m or enaiur al
a rc hto rm l .)d eveop. Theupperce.tral shave22o.rhe areratst4o.and| rec uspdsT. , jngual
ro o t to rq u ei n t he brackets.
The l ow ercLrspi dsa so have70 j ns!a roor i orqLr e.
V a r a ti o n l ro m l he . .ss ca dealarchesi s rhe l ackol c!spi d em .e,j cew i rh ext f . pr om ina. ce
o t rh e mo a r b ayonetol fsel s
Wh e rea rc hfo r m di cti ,tes,
heavi er016 x .022or .018 r 022 afchesmay be req! t r ed.

Pro s re s s v e d eb.fdnsofrfre!pperl nd o* * * r' ," " * H l * e . tow si or ba. d space

. o s !re i n a c o ftro ed manner. L oops-* l l ..018I .022 bl l e E gi toyoverrhe r€sjonof r he
c u s pd s a l o w tor cl os!.eof tre buc.a b.nd spa.e On y rhe oopsj n rhe ow erar char eacr i
vated The upper loop s Lrsedrs a lrook for t shr Ctasstretasrtcs.JhL:i, |ri owiil
s p a c el s .l o s e d forw ardto ma ntai ncorrecrnro ar cl spi d and i nci sorre ar onshp. Sl shr
m i d l i n ec o rre .ti onsc:n be made.r rhi sri me by !si n! X -crossetanj .s Tw o w e ekjnr er ual
a p p o ;n tm.rtsarescherl ul ed d!fi ng rh s I ni stri .{rpl !se.

213
treatmentsequenceof mechanics
NON EXTRACTIONCLASSI I . O I VI SI O NI - DEEPBI TE C A S E

U PPER:

Fir and cen,e.l olq bands. se ecr on or

headqear aftl torce/linre/dlreoon deFei
den i up o. trea nn eflneeds1V. TO . ) qr owr h
patlern,a.d anriciparedphv!

L O W EBI

Bard/bonrrrow€rnrola^ and incis.re. .016 x

016 b ue ELGIL OYlt i it y ar c h- des ioned ro
. t r u de /alsn lowe rin . ho^ and upr qht af d
posilion ower molare Dilierentlype utiliry
ar.hesmay be e eciedio advan.aorc.nsoli

B an d / b o n d 5 4 1 1 4 5 Se .r r o .so a .e d !o l€ ve
;.d .or s.ldar€ f€ lpper bu!.al seqments
Hea d g e a ri s o i i e . . o n t i n !€ d d !r in g ih is p h a e
ol t.eaim€nt. The upperbucc
b€ ng prepared 10 accept ClassII€ a$icsand
1o slatriliz€ aqainsl upper i.cisor lntr!si.n.

LO$ /E R l
T he.0 16r .O16blu eELG I LO Y ut ilt y ar . h
isr€activaledor rep aced. Once6 6 are
I' leaiVpo sito fed , th e m o a6ar e s abii2ed
aqainnove,r!D.o b\ bandno/ bondno
5?fl:25 and piaclqnab izi.q,&1ions
lrom 6 6 ih rou qh4 14 .W hent he c us plds . eed
i. t r usion ,ea ni. thre adh ght t y iied lr om
t he cu$ idslo a smal v er t lc aloop or t he

UPPER:
T he uFpe r e ve linq /.onoldat i. ns - "c t ions ar e
replac€dwith lraciion se.tio.s. A smal
clos.d h.rix .r qabe is in.orporared1o maii
lain disralr.o iripo .rhec ! s pi{ ls d! r in! c a$
ll ea sii.w€ ar Mo ar r olali. n ber ds and
li.s b cuspidoflens are inc u.led

LOW ER :
Alte. |re incisore and m!la6 tuve b.en
a iq. a l , o . O l 6 x 0 2 2 b u d EL GT L OY n a b
lizi.s !ri ily a.ch is placed to id€Jlize an.i
mdln r " n t o n ! € o n r o. A \e r .\o f p lq y.
Darr o o L e r r r a r c i F\ a .L p d p r l io p ffe lr
rorrl i . n s , s p a c e . l o s u rd , a n d e ve ti.q in ih e

214
 UPPER:

B atu /bo nL?l lll? pr ar Plr hr ound or - - - ^

iwislal r' a' L ef
ol6 ^ 0 22 b lue ELG LoY ut ! t r r ' r c n
p 3c<l to .trude/lorq!e !pper n' e6

LOWEN:

Low e ' d e a a f L h w t r e o l6 0 1 6 EL GIL o Y'

Cur . d q a b l € b r u s P d .ftsPt
Ln.;delr. tT7 b".dFLl ard in.!'!ofated n

UPPEB:

Ail€r upper i.cisotr are inlrud€dhorqued,

an r e r o r s F d . e s L o s d wlih o ve r a v 3 ( n -
O I 6 . Ol 6 b u c E L GIL OY a s u Ps d € d o wn
^ o r cr o n n q
c o s i n q L o o p a r c l r , d o lb e d e la

LOWER:

CL d $ I I e l a * n s t o I h € u p p € r r G' tio n !!tio l

ro n t l n u e d d u f n g u p p e r sp 6 ' e o su r _ a F r n a l
'
.relalkwo.ked o!t

U PP ER :

rr
U o o e r d e d a r . l p l "!€ d to a ' h € vc fin a ld '
r; r , a n d r o r q u € . h d r a .r e r istl

LO W EB:

c a $tr.a stics m l1. dt o ae. ni ex ir u! r nq

!pr€ r in cisors lld eeF bit e s t ll€iis t s ,
re turnro u riLiiva t c hes

216
threedimensional
molarcontrol

MAXILL AR YM OLA RS

._
\
/tF;-\ ..4'- S€qmenis a.d fu ir.hes

w'6 r . A d r L 5 r m e n t st o ih e ln ie r b o w o f
2 . lle lc al l oop5 i n a modi l i ed.ol l l n
sp r ins 1.040 E LG LOY or N o,4 90 d 3. A l sesmented and conl l no!sa rc h.
i h e h e a d ! € a r s h o u d in clld e p r o wke) allow mo ar roialion alons es requ /d mo ar bayo.er ofisel
qr,cssiv€expansion and di5ial ro wilh expansion ol lhe !pper bu. bends i i .fd€r to mai nrai n mo ar
t r t o n . f t h e u p p e r m o la 6 .

5 u/

"z' -g."'
5 . A.0 4 5 ro!nd arch w l re w th horl zo.a
"L loops a ows re.iorocal expanslon
f f i€ o
4. Ela$lc nrinq lanened ro lrr€ lins co.rraclion uprlqhii.q and roialion 6- Looped molar c a5p3iiom an acrY lc
!a rie clearsasslsrsin efleciins .l rhe lpper mo are. This arch mav be rerainer willessisr in proper moLar
igar€d to rhe lncisor brackels,

MANDIBUL ARMOLA RS

9. An !prighl .q action in lrre O'n€qa

Trre disial helca looped tired lower helcal looped ectlonal arch s al
7. A n a c t i v a i e d l o w € r u iiliy a r .h wlll lin q !a l arch ai l ow s expansl on.on- leclive in !prishllns owar molare.
a $ * i n o w e r m o a r u p r sh t.q , tJcli.n upri qhtl nq and rol al l on.d. Tl re 5al i o.al arch k tl ed o.l o l rre
roiaiion and blcca root ioque conlro , r r o lo l the ow er mol a6-

e: l*

--<'!4rl
Lru
-.\
v:
l'f#
E-=
l0_ E l a n l c r h . e a d t e d o n lo o r !.d e r ih e 12. CrDWn o.ke.j or un€tlpted mo aE
I nqL3ltie-cleais is€llecrive ir eve in! A Ia rge hori z.nt.l 'T D op l ..0TB can be upriqr,ied bv e!terded rrd!i.al
a n d r o i a r o n a l . . n to i.f th e lo we r .0 2 2 E LGILOY w i re i s Freacl i vat€d ooped sprlng sectlons a.livridd uider
Lprlqht and rolale ihe lowe. nro ar.

2l t)
 sequenceof mechanics
in classI extractioncases
OF THEUPPER
STABILIZATION A Bandthe upper mo ars6Li .nd p acea pre act vatedd sta looped fited
AND LOWEBMOLABANCHORAGE
A . l i l ati on to expandand di sta y rol rte the mol arcl s p !.ed n the Nance
h o dl ngarchbefore.em.ntati on. The N a.cehol d ng archremal nsin p ace
!nt ncl sorretracti ons beg!n.

B Ban.l lhe iowei nro ars3il and the ofrer n. s.,rsrlllz P1... a 016 x
O l 6bl LreE LGLOY l l i l i yarch The!1 ty :ni h l s a.t vatedw th l0" nio
a rri p ba.k 30" d stalrol arrol al or' r dnd3045" bl cca rootl orquet ost a
b l /e l he l ow ernrorrs and l evelthe ow e..r.h bv i .r.i sor i trl sl on asn'"ede{j

B a ndbi cl spl dsandcLrspi ds5-t3 b andpl ace 016 x.016 b !e ELG iioY
oa ll€ p r e-fabri cated retracton spri ngs.The secti onal
secti onal sprl ngsar egabled
"r-"o"t,o" "ra.oa
W ! T H S E CT I O N A LSP R IN G S 4 5o €nd a.tl vatedon y 2 to 3mm to preve.textr!si onand excess cuspid
tl ppi ngdurl ngrei ractl on.The total retracton for.e i o the c!spi d lnc ! ding
th e bLrccaspri ngsho!l d be kepi Lrnder 200 srams.

UP B I G HT I NGA N D AL IGN M EN TOF T he secton retracl i onspri ngsshoud be removedas soonas the cuspd
THE RE T RA CT EDC U S PID S crown in retracted,cont nued lcllon may calse a blccdl d sta rotationa
d i spacementol the cl sp d. S .ce sLtht cl sp d tl ppi nqmav o..!r due t o
the l i ght conti n!o!s actl onof i he retracton spri ngs,v€rl ous!pr ight ng
s p r ngsare I l stral edthat show l prl ghtl ns aFd paral el i ngof the cuspid
ro otsdependi nq on the l ndi vi du:lneedsot the parti cul arcase.E a st lct hr ead
may now be lsed and tied ingua y lrom -dl:. for rotat on co.trol.

RE T RA CT I O NA N D C O N SOL ID AT ION The lower inc sors .re retracted and conso ldated to the retracted
O F T HE UP P E RA N D L OW E RIN C IS O R S c L rspi dsand b!cca segments w l th a do!b e del tacl osng oop or a cont r sct ing
L jtll ty afchw hl chw i l retractand eve the anteri orsegment.
T h e N ancehol dl nqarch mLr$be removedal th€ ti me the l pper lncisor
re tracti onl s besun The upper nc sorscan b€ consol dE tedw i tl r the lse ot
doLrbe de ta oop or an ext€ ndeoc os ng
a contracti onl ti i ty or a stepped_up
o op to torq!€ the i nci sors.
F o r addi ti onall ncl sortorqueacti onduri nqthe retracl i onof i he !p per in
cisorsa vertlcal he ca closing oop is p acedlpside down d sta to the atera

IDE A LI Z E A RCH !S dealcoordi nat€dl l ghl .016 x.016 bl ue E LGILOY archesare plac€din
a more nal uralarchform. N o t or que
o rderto al l ow functi onto establ i sh
is plac€d ln the idea lpper arch sincethe upper centralshaw 22" the
L€terals140 , and the clspids 70 ingu. root torque.

Variation from the classicaldeal archesis the ack of cuspid emlnence.

Thesearches,how€ver,haveextra promlnent offsels ir the molar bavonet
b e ndsand mesl ato the bi cLspl ds to mai ntai nthei r w l dth.
E3 3 5
F I NI S HI NGA RC H E S Progressi debandl
ve ngo{ the l pper and Low erb!.car segmcnts5 313 5
a ow s for bandspa.ec osl re i n a.ontro ed manner.Ll oopson 018x
.0 22 b !e E Lc LoY overthe regon of the cl spl dsaLl owfor cl os lr eot t he
b!.cal bandspace.OnLythe oopsi n the l ow erarchare.cti vatedThe
lpper loop is lsed as a hook lor Lght Clas tr elastcs. Thus. the lower b3nd
spa.e is closedforward to ma ntal. corect moli:r cusp d and lncisor rela
l lonshi p.S l i ghtmi d ne.orrectoni canbe madeat th s i me l rv u sr ng
X..ross e ast cs Two week jntervalappointrf€ntsare scheduledd!rl.g
r hi sdet.l and l i ni shi .gphase

)l l
 treatmentsequenceof mechanics
CLASSI EXTRACTION CASE (SEMI MAXIMUM ANCHORAGECASE)

1 UPPER: P aceNan e ho ding ar c h,iabr c ar ed

ndk€cry Acrvlic button sizeot qlarier and
dista oops actilaied prior 1o
ettect mo ar rotarion The Nan.e applia.ce
may have to be activaleddlri.g subseque.t
ap po i.lmen tsto k* pt h€ ac r y lc blt on in. os
conta.l w th th. palale This can be dofr
inra ofally whh a three pronqp ier.

LOWER: 0 16 x .016 blu€ ELG I LO Y uiiit y

ar ch isacl vale dwir h 30%m o ar iiD bac k , 307"
dhral molar roiarion, a.d 30% 45% bucca
.oot lorque ro nabillze rhe I
l€velrh€ ower arch by ower i.cior .rr!s o.

2 U PPER: 0 16 x .0 16 b ue ELCI LO Y r et r a. r lon

ections F acedin conju.ctlon with Naf.e hol'l
nq arch Aciivaied by ci.ch back 2-3mm ro
provide iqht @ntinuous reiraction lorce io
c!spids Do nor over acrlvareretracro. €ctions
n order io avoid undu€ lippino and s!p€.
eruprion when clspids a.e lu y rel.acredro
aburme nlwh h b icu s pds . The nqua ebnic
threadtrom dhta of p to clspid.

IOWER: Place.Ol6 x . 016 blue ELG I LO Y

uti ry arch in sinsivalbucca tube ro intrlde
ower nciere a.d rorale, lpfiqhi, and st.biize
the lowe. mo are. The ev€riry ol the tip back
bend dlctatesihe amouni ol incier inirlslof,
wh ich h ay be min im a in Clas I m aloc c lus o. .
01 6 !.0 16 b lue ELG I LO Y r elr ac iionpc t ions
are placedin the occllel buccaliub€ and aci
vate d2 3 mm b y cln . h bac k . The ooFsol lhe
lower reiractlon*ctlons shoud b€ lnsideihe
ur lhy a rch . Re rrac lo. ec iiois ar e s abled
beforeplacemeniro.ounrer.uspid tippinq

3 UP P E R : A i i e r c ! s p id sa r e lu y r e r r a cr e d ,a n y
/\ /\

WryUJ
one ol s€veralmelrrods may be uli ized lo up
rq h i , n l r u d e , e l a v a r e ,a n d r o r a le r h e cu sp id
t*ih.A h o r i z o n r a h € lica o r "L " lo o p s{ r io n
alwi ! provide bo|r ve.tlca and hof zonial co.-
iro o l r h e c u s p i d . I n s tu a iio is wh e r e le ssI e xi
b I ly is reqliren, a s mpLe he lca loop n .
sra shl secrion lcuspid lntuders caf be a teren
t of t h s 9 ! r p o s e ) w i l pr o vid e e xce lle n r h o r izo n
ra c o n t r o l i n t h e u p r Oh t .q o f ih e .!sp d s
Liqht I ng!a!elanic thread is lsua y need€d to
ef i { t h e s a l r o r a i o n o t th 6 .u sp id .

LOW E F : C u s p l d u p r iq h i n q a .d r o ta r lo n r .i
ions 3re plac€d n the ower arch a so. l.rfa oral
ad j u s i m e n c a r e m a de in r h e !lin t a r ch 1 o
l!rther act var€ nir!5on and oler cone.i n
c is o r r o t a l l o n s . C l s p id b clsp d 9 a 1 o n is r €
qu n e d i n a l o l i h e c u sp id u p r lq h r in g se cr io n j
lo avo d spac nC . the exta.tl.n s res. L nsuaL
thread mav be t!rih€r used t..nhan.e bu.ca

218
 \,

\j
U P P E B : A l t e r c l sp d !p r lq r r i .q h a s b d e n a .n
eled, the Nance appl ance s removed The \,
l p p € r i n . i s o ^ a r e ih e . b a n d e d r n m € r .ta l o n
3 . d s p a . . q o l l h e se r e e lh d u e to lip a n d io '
que Press!r€, maY have alrea.l
t h p r p s e x c e s s i v €a n r e r io r d o wd ln q , d 0 1 6 x
. 0 1 6 b u e E L G I L OY m !liiL o o p r e le n ! r r cn
\ t L,-"r
be placed for o.e or iwo
'r3v
r iq.lhelpper n ciso E. A d o u b le d e r a r ciio .!
io. ar.h s lrren p a.cd lo reira.t a.d..nso
d a t e t h o i c i s o s w l th th € b lc.a lse q m e n t te € tl
I a d d l t o n a l l d r q !e .o n t.l
sdedow.lo..
s !4 1 u ir .d a n !p
l s a l!) co sin q l.o p a r ch wn .
'\:l
,)

s p l a . e d 5 0 t h 3 l Lo .p 3 .1 1 !a i.., r € n h a n .e

l O W E A : A . l . ! b e ld lr a r € i.a .il.n a r .i is
p ac€d ti r.lra.i aid eleLlhe owef in.ls.f, ,)
L l q r r t C a $ I J e l a n.s m a Y b e u -\_+-:./
f. miinta n the c a$ I b!.cal s0'l.r.ft irer
dlq raiion. Lowdr n.l$,r rui;-l.n 5ho! d be t
nined and mai.la ned sllqnilv drreadoi tr€
upper n.Gor retactlon..Avo'd over eci vir o^ \\
o f b o t h t h e u p p e ra id l.we r I
1 0 m a l n t " i n a n c h o r r c€ , r o r q u e co n if. a n d i'
p r e v e n i l l F p l n q . A lig h l co n lln !.u i lo r ce is
ded na rerra.r on wtr*.
\,-l
U P P E R : P l a c e . Ol6 r .0 1 6 b l!e EL GIL OY
d e o l a r c l r . D o f n ir e b u .ca o ts€ Gto r p r €
nrolaE afd overrolalion ol upper mo a6
Forai ons can a sd b€ oler.otrecled bv mea.s
ol ntra oral .r.h be.ds or ru!:l lqht e an '
t h r e a d . l l f u r t h e t ar .h to m o r lo r q !e .o n to r
hdeslred, iarger sized €.lsewie arches mav be
used. caretu ar.h io.m rvpa conideraiions
{round, ovoid, eic ) ii.ofporai€d ai l| 5$as!

L o W E R T P a . € 01 6 ! .0 1 6 b !e EL G L o Y
ldea drch. D€l niie bu..i ott'seb lor predio a(
a.d f rt and s..ond mo are. Labia 9.b e b€.d
or slep io k€ep car fes sliqhllv behlnd !itera
.c{r. A s o , L nq u r L cr o wn lo r q !e o i m o la r
p r o q r e s s v . l r o m d 5 ia o t.a n ln € wh e n se ' o ' d
m.lar is banded. a del I te otlsei a.d loe .

U P P E R : F o l l o w in q d € b a n d r u .l5 3 3 5 a
. 0 1 8 x . 0 2 2 b l u e EL G L OY clo sin s h o r zo ita l
" L ' a , . h l s p l a c e d . De f n ite 3 fii5 tic o r "b e a !r v"
bends incorporaled ro achleve s ghl ro.t d ver
qence ol boih ce.ta a.d ar€ra .. sots Llpp€r
ar.h nor acllvaled so ihar lpper molarear€ nol
d r a w n f o e a r d i n b a n d sp a ceclo su r e L q it
C assII elanics aPP l€d to a.h
o . o f b u . . a l s e q m € n t !e .lh

L O W E R : F o . w l .q d a b a n d in g o l5 3T-3 5
'
. 0 1 3 x . 0 2 2 b u e EL GIL OY . o sln g h o r lzo ila l
" L ' a r . h l s p a . e d . A.liva r e d I 2 m m l. tr r n q
ow€r bdcca seqmenis forwa.'l in ban'r spac'a
. oslre io achieve over coftat on of C assl
mo ar relation. L qhi ClassII e asli.s also rr€ p
1 o a c h i e v er h i s o ve r ..ft e cllo n . Pa tie n ls a r e
s€en at two week inlerva s at I
raln Droper c..fo in th€se llnishi.s naqes.
c a r e l u l a r l € . r i o . to m d ll.e a n d n c sr d e ta ll
n g i s i m p o n a n i a t r h E p o r n l.
 three dimensionatcuspidcontrol

a''. -tt4\"=:.
%**s
\

z
-
6
l
F
z
For .lr!si.is !l rhe ower (tr
p d s t o t h € er e o f ih e F r e vi!!5 B. A ishl e Jni .l hf.rd sl ed l rom
y nrrlded r.wef r.iso^ n b te r n e.usF d brJ.ke110 arnal n.he
o p e . . s a 0 1 6 x.!r Cb !e n rh. uti Ir ar.rr l mad! w rrr an c. Trre hori zontat her.a o.ped
E L G L O Y s e.io .a a r ch w r € n r ra ora be!d) Trri sa ow srrr€
vr rh a .15 delre. he .a i p br.l cu 5prdi o se.k ts ear €st ro!t..f rus oi a.d l pr qhl j i s as a nj n.
. D P i s ! 1 r , z e .l in .o n r u r .i o l n trus D n to the _.ve of i e D re! r.. oi i i sw i deranqe Jfd conr
o,r I t..ii's
'.rrtiden

l9
so'*l
z
tr
r
I

l
F
o F A 014 round heat i reded w n e
w rth a hel .a toop i s ockel
D. The h elicall.o pednr dqht s c t i E, Oolb t p er Ouad I oops !nder a {)yri I w i i s bfa.kel and
on a archin 0 16 x . 016 b us -.
are rsd 10 c.rred rotari ofs and sprui s !fder thd brack.r of i h e
EL GILOYw re wi I upr is hiand lprlqht nq prcact vaied up ro 45o
adra.e.i toolh. Th s q ve! r.. p
paraler the cuspidr.or where
ro.al roor para i e .q. The.row ns
smaI ra.gesor movem€nlare or the teelh h!st be ried roqerher

z
tr
F
EG. A I ngua elasiicthreadlrom tre
mo ar d n a I n ql r l hoor io nr e
mer. r .qua .usp d r.rai ng cteai
a low5 .o!.re r ro r aron. f bor h
mo arua.d cuspds. Al rs pr..al
rd rarois rn the b! . . a s eqm dnl H. Dou b l . h o , l z o n i a" T ' o . p 5 C u5p d .otar .na .onrrtr i s s!.
a re1e d w rh .q ual. as t . r r r eid ( . 01 6t . 0 1 5 E L G L O Y I o n e r . h p rmenl ed by a hor-..r. T,
s de o r r r r e . u s pd s a r er f i e . r i v € ardr rmj i.quJ
n e v e n ga n dr o l a to n a . o . r r D t .

2Al
AN OPTIONALAPPROACH
variablesequenceof mechanicsin classII,
divisionI verticalgrowthpatternwith
anterioropen bite (extraction)
616
STAAILI Z A T I O NO F 6 I6 F OF I ts a n dthe l pper rnol arsLl tA and p a.e a di re.t ona he.dgear(forcesdir €ct ed
ANCHO RA G EA ND M I N IMIZ A T IO N a b o v eth. occ Lrsap ane)l o el therdi sta dr ve.i d i ntnrdeor ho d .ga nst
OF VERT I CA L E RUP TION vertical er!]pt on the Lrppermolar teeth An lpper dlsta ooped Nanceho d ng
a rc ho r transpaata bar may be p aced n I e! of or l n conj uncti onw i l h t he
3J! cllre.tion.Lheadgearto stab lze the nro arsand slolv verticalerLrplion.
RETRAC T O N O F C U S P I D S 3 3
WIIH S ECTIONALSPR N G S
B a n d b l cca s€smenl teeth13l !5 andpace.016x.016bueE LG LOY
prelabricatedsectionalretracllon springs The springsare gab ed 450 each
l€! and actlvated2 3mm each4 weeks to prevent extruslon, avo d excess
tl p p l n g ,and mal nl an the c!spi d rootsaw ayfrom bl ccal corti calbone.
l f to n g !e thrl st i s present.b.nd !pper i n.i l soB21 l 2 andsol dertongle
s p u rsb e l rnd l ncl sorteethto ke€pthe t.rngl e i n the rl gae targei rone.

Band lower reerh 6EatTDa66 and place 0l 6 x .016 b LreELG|Loy con-

tra c ti onl ti l ty archto si abl i zel ow er mo ars..d retractl not l ntrl de) ower
1 o ,.1 1" o1_" i o r' i ,,d /. Lg- b-ro ot -
(1 5 " ) and t pback115i ). The mol arstepi s 3 4mm anterj or10the owerb! .
.a tl b e and s a.ti vated1 2mm by.i nch back

Pl a c e016 x .016bl ue E LGILoYprefabri .ated retractl onsecti onsacti vaied

2 3 m m erch4 w eekperi odi nto ful l abl tmenl w i th bl ccal 1€€th5T5 .

UPR IG HT I NGA ND A L IG N M EN T The sectiona .etractiof springssho! d be removedas soon as the clspid
OF RETRA CT E DCUS PID S c ro w n sarefLr y retra.tedS l ght ti ppi ngmay occl r due l o the l i ghtcont inu-
o u s a .ti on of the retracti onspri ngsl abol t 30" i s normal ).V arl ous!priqht ing
SLL] P P A GIN
D IFFE RE NT I A E L OW E R
s p r n g sareul i l i zedto !prl ght,rotat€,torque,andel i h€ri ntrudeor ext r ude
rto oo !.rL o -44d6d t.r .btroql | dpr' 6 rppp. o I -_I l
,q ^ r l,ot,r ddrl d
o^p i oo l sq,f to.16.6o f. J1 .
t o n i n gbuccaloc. l si on l t scrl ti cal to r€tardthe_l
verl
-" i calerupti onoi t he
, ^ t .ro tdc o od-.c Lp1c-o t" " taq ol a- " " ' ." ) bc

upon the l ncl sorposi ti onand anchor age

b ro u g h tfoMa.d sl ghtl y,dependi ng

Th€ upper incisor is retractedand consolidaredwlth either a double delta or

RETRACTIONAND CONSOLIOATION
u p s l d edow nvertl calhel l cacl osns oop arch. (Thei ncl sorsegmentl s slepp€d
OF THEUPPERAND LOWERINCISORS
d o w n 2-3mmto provl deextrusi vel orc€1othe upperanteri orsesment . )lt a
N a n c eh ol dl ngarchhasbeenul i l i zed,i t must b€ removedpri or to ncl sorr e_
rracllon whereasih€ transpaatal bar may be maintainedto he p stabi ize the
m o L atreeth. V €rti cale asi cs areadj !ncl i veto extrudl ngel therl he upp eror
dependi n!upo. th€ i ndi vi duaneedsof the case.
l o w e rl n ci sors,

Slncethe lower nc so6 havebeenconso idat€d slightly wlth the contraction

w l th ei l hera do!bl e de t a or
u ti ty a rch,spacecl osurecanbe accompl i shed
crossed"T" c osingarch.

281
 variablesequence of mechanics
inclasstr,
divisionI verticalgrowth
patternwith
anterior open bite (extraction),.on,,nu*,

SELECTIVEEXTRUSION
OF TEETH 1 1 h eanteri orl or posreri or) opef b re hasnot beenbroughr!nder conr r otby
TO CLOSEOPENBITE l n i s stage,setectrve extrl stonof reethi s underraken. c osedhortzon r al, , 1, ,
oop srches.re p acedyLiitha ser es of stepdowns from the posterior,,c osed,,
occrusronro rhe anterioror "op.n, occtlsion. verttcal e asrtcsfronr the srabi
c dl o^qd \d \: .rr" " , ..or..oa,p..l ri ..,
' .o, or,1.po , a, o.
l d e { r / ri ' l 6 otr o ro -o, F, ot r-o ooo \,
o n e nl edIn. . ass d recri '
oni f further.offed on of rhe mol arreta r ionis
.ecessary.The slep down archesare !r lized basica y afrer sp.ce c osurehas

ID E A LI Z EA RCH ES l d e alcoordl nateil il ghr .016 x 016 b ue E LGrLoyar.h€s arepta.edi n or der

O V E RCO F B E C I ER BIT E
OV to a low function ro estabish narur€ arch form fle upper certra s haveZ:"
th e l ateras l 40 andcl spi ds70 ti ng!atroot torq!e i n rhe brackei sThe
. t ower
c a n r nebracketshave70 l i ngua roor torqLre.

ln addit on, the upper lat€rat fcisor brackersare angulated80 for dista root
' o o r oabll q O' a1rr F dr o- .d. pt" " o ,t . dr h . o
r . r . r 95 d'.o106 " .F
- ! of th. ,op6 dl .pr o|oot . .tgh.oFl o oo^1b" o
^
mesar to the clspids of 1m.n witt increaseoverb 1e.onstsrenr wirh rhe over
t.e a t mentphl l osophy.

Va ri : ti of fi om rhe cl assi .ai dea archesi s the tackof cuspi demi nen ce
wir h
e x traproml nence of rhe mol arbayoneibends.

Either d€lra or afterior vertica/elasticsmay be useoar in s srageto s€ateither

ttre anterroror posteriorocc us on

FINI S HI NGA RC H E SA N D ..
--o q .pi . \FoFoard, go, rre.oo4 drdto^., br dt\Fqne,r, , l .
1t, t!
; t o^-
FINA L DE . E A N D IN G 'or ^or.e . ' o{ - aro ao....o- | rooo.a08.
u //^ bd1d
b t re E LGI ov o,. rher" g o. ot fi e , (ord5d to, to. Ll
,d b dd.p-" l i oo" -rore . d11
,. dhpt \ ot t:o do^r oe' l on.) b" p . d
re ro ro egro-'oi l | ra rpoe,"cr t- o.ti qc / " \t,,oothedr re-o. tper n.

Oniy the oops in the lower archare a.iivated. The Lpper toop is usedas a
fo o k for l ght cl assl l el asti csorctass detraetasttcsThus,th€ ow er band
spaceis closedfoMard to mai.rain corect motarcuspjd and incisorretatjon,
s l rl p Tw o w eek i fterva appoi ntmeftsareschedul ed duri rg th s fj ni s hing

Placementol retainersin open btte casesshoutdbe assoon after fjna de band-

ing as possibleto avold recurrenceof anrer or open orre.

242
 treatmentsequenceof mechanics
V A RIABL ESEOUENCEO F M ECHANI CSI N CLASSI I , DIV I S I O NI V E A T I C A LG A O WT HP A T T E R N
WIT H ANTEFIOB OPE NBI TE ( EXTRACTI O NI

{ UP P E F : P " ! e d n e r n r h e a d q e r r in . p o u ' r d .
I t f f . . r o d i . r , l l f ! p a n r fr ld r lo p r m o r ",:.
I t reJi m e n l o b l e c r i v e s m o a f ia b i za t .n a .d f'=---. I
felardai oi da v€ni- erupr or, p a.e Nan.e rr.td b\*-- qU/ \o
nq arc h . r t r a n ! D i a t a b a .,la b r .Jr e d in d tr e .ilV.
016 ! 0 1 6 b t u € E L c r L o y r e ir a .r io n { cr t.n s
! J . ed n . o n l ! n . r i l r f w i th !h 1 iN!a e .n .
lrrread r t u r m d i s l a l r . l . i . n o o p so l Na n c: to m e
s ia r. ra i i o . ! q . 1 . ! s p d b r n d p r o vd e 5 .o !fte r
p d s a n d m .3 ^
d!nnC retract on. Rllra.Jion secr ..s a.|vated
by . n. h b : . k 2 3 m m t o pr .v d e q h i .o .tin u .u s
r. r. e 1 ! r l e r 2 0 0 q r a m s ) r o .u sp ld s. tl to n O!€
rrabit s pf€sent, so dor t..E!e
n.6of lranrrsand sftt ba.d5 h qh s nOiv.|y.
LO WE R : . r : r l 6 ! 0 l 6 b ue EL cL o yco n r a .ti..
!t ty ar.h is a.J w r h 1 5 " m o lJr r ip b a ck
30y od s r a l m o . r r' a . rtaeidi o f 3 n d t5 4 5 0 b !..r r txn
lo| q! e. T h e s e v e r r y ! f i he n o la r J.iiva t o r d e
o. f ds up o . l h e . m o ! n t o f sip p a q e .t r ir d .w€ r
molar lomard .Jesfe.t The mo ar bend is 3 4mrn
ant er' o r i o t h € t o w e r b ! . . a r !te a r Nl th e h e ce s
rn t he. .r r f a c t i o n ! i i t i i y a r .h r r e a .iiva ta l I 2 tr r m
by c inc h b i . k . F e r r a . t i . n se ct o .s Jr e sa b 6 l b e
for€ F aceme.l r! counler spid i pp .q. L.we.
reeJ.r of oops n'ou d be .sid€ ol tbe hor 7.n
ta reg or re !1 iry af.lr.

ai UP P E B : A r t e , n i 5 p d 5 r r p r u I, r p ia .iF n Jn v
a o. e or F F E I m e r r d . m a y b e u r ze l r o u n
rqhl, f t r l d e , e t r l d e , r o r q !e ,.. r o r a ie r h .
. ls pid 1 e € r h . n o p e n b t e.a se 5 , th e c.F d h o r
z o. ra " L " o o p s € c i i o n a lwt lF ,r o vd e a n e !ir u

@@BP
s v ea. d u p f q n n q t o r . e o l th € .a n .e . I io e \.
t rls o. s n e e d q j , a 5 m p e h e t .d lo .p jn a
nraO hi s e c t i o n o r a n o p € n h o r tzo n r tr h e tx.r
'' L oo p . a . b e L r i l i z e d T o .s!e sp u ca r e m a tn
ra .€d !nti if.hor rerrad on is balun.
LO WER : C u s p i d u p r s r r i i.g a n d r .ia ii.f se .r i.is
o w € r a rcf a so . t 5 r sF o $ i
b 01. a l l n t h e { r 6 p d . b i . d 5 p id r e ? io n b y !s.q a
pis qy b 3 c k T w s t F l e r o r .0 1 4 r .!n d a r .h a n d
aux i iar y ! p r j s h t j . g s p r j . ss_ T h e .o .r ia d o n !ti.
rtv ..n be act vared ro f(trther relracr rhe ower

rt UPPEF : A l r e r . u s p d l p rq h r n q h a sb e cn a .h e !
r) €d and th€sp t€€rh hJle b€pn b'ouo Lrdodf .r.
dation a.d retiJdiof k
accomp shed. The Na..€ app iafce s remov€d
(th€ ranspatata bar nay be teir i.) ard the tn
. so6 rebandel wirhour to.sue sp!h. a doub e
oe t a r€ r r a c t i . n a r c h w i r h 1 2 m m se p d o wn r o
rhe anierior r€eth is pla.ed ro rei'act and exirude
rh€ inc i s o r ei o r h e k v € l o t th e b u c.a lse lm e n t )
leerrr. l a d d I ' o n d r o r q u eco n tr o tisd 6 n e l, dn
lps dedo w n l o d u s r y ) cto stn q o .p a r .h wir €
s p ac a l , a r d t h e s a m e s re p d o wn o J 1 2 m m is
in.orporatd. Thes€ consotdatior arches are
a. t iv ara l b y c i n c h b a c k 1 .2 m m .
LO W E R T S i n c e i h e l o w e r n .iso r e h a ve b e e n
part ra ry r e r a d e r w t h t h e u t ir y a r ch ,lin a
spa.e ctos!re d. be easi y hanl led wfth enh€r.
. rors ed " T ' o r d o u b e d e fta .o n so id a iio n a r ch
C a$ delia etasti.srrom ihe ower motar, over
rhe ! ppe r c o n s o i d a r j o n t oo p , a n d d o w n io th e
ower. on s o i d . r i o f o o p w q ive b o r h a c a $ r l
and a verticaL.omponent ot torceto a d in anle.i
or rerra . t i o n a R l e x t r ! s i o n. M in im ize d e h r e ta sr tc.
as they t€nd io sup€r €rupr the lower hotars un
r4s t h€v a r e w e l a n . h o r e d !.d e r th e b d cca co d

283
 UPPER: Alrer space closure has b€en achid€d,
ir isolre imes st .e.esary to €lrLdeanter or
le e l h i n r o o c c l u s o n. P a ce .0 t6 x .O1 6 5 r e p d o wn
arch whh closed horlzo.ial "L" oops in 2mm
veriica drops Jor each loop, C osel horizonta
oopswil compresswben eated n rhe brackeis
a n d w h e f u s € d i n co n ju n cr o n wir h a n ie r lo r v€ r i
celelastic IAVE's) areq!ite ellecl v€ . c osing

L O W E R T P i a c e , 0 16 x .0 1 6 b L e € L GL o y sia b
izing or idelarch. CLspid blc!spid uprighlinO
on b€ coftlnled w rh aux lary lpriqhr .q sprirus
acce.tuared bucca roor iorqle ro rhe dTd
molaE will h€ p prevent veriica erupiion ol rhese
t€€lh and i.desethe anchorage val!€ ol ihe

UPPER: Pla c€a .0 16 x . 016b ! € ELGLoY

ld€alarch.Defl.ileblcca ofiselslor pr€oola6
and oveFrorariono1 uppermo ar. tl ludhs arch
torm or lorqu€ conirol is d€sned,largers zed
edqdisearchesmay be used.Stepdown bends
lotrre upper rncisoEa.econrifu€d ro over cor
r{r the overbire.oeha ebnics, cta$ lt d€ ta
e asrcs,or afterlo. vefri.alelasiicsmay be ds€d
\-)

LOWEB: Con i n lew t h. 0l6 x 016or ar ger

brue ELGrLoyidea arch.seNnd noh6 7Tt
can be bandd ro alig.. Labla gab€ be.d or srep
io k€epc6ninessliqhrlybehindthe t6leratinciere.
Ale, irEla c.own lor qle pr Q r es iv €lr om d s

6 UPPEB: Forlowingde.bandnq or 31L!5 , a

-018 x.0 22 blu e ELc ' Loyc t os i. Ohof iz onial
"L" 6rch h placed.Definiie adisiic or "beaury"

*i
beMsare ifcofporaled r! achiev€stOht rool
drwrq€ncei. both rhe ce.iratard tar€rati.cko6.
Simplehelix plac€dan1€ror ro the molarwirh
15 q iipd own be rd wit s €r v €iollnher d€epen
th€ o v€ rbh e.Lig hrC h$ ildelt a € as iic sc anbe
appli€dro ach eveovercorectio. ol ihebuccal
oftlusion a.d overbile

LowER: Fo lowins debandi.s oi 5-:T:6 a

)
,Ol8 : .022 b !e ELc Lov ctosirs horjzonla )
''L" arch ls plac€d.lt s adivatel 1 ro 2mm io
brinslhe ower bu.a s€sme.tsforwardtnb6nd
odedton ol C as
I molar r€ ations.Patientsareeen ai rwoweek
ifrerlalsdurinq rhis rime io rointai. prop€rcof
trolin th6elinishin€ slages.lr is impo.tanrar
rhis poinr to p6y €refuIatrentio. ro midtifea.rl

244
treatmentprinciplesinvertical
growth patternswith anterioropenbite

D ir€cl i onalhe:dgear(occi pi l aland veni calpul l )

Nanceapp iance,or transpalatalbar
Utility archwllh buccalroot torque and contraction
L LIMITATION OF VERTICAL A v oi d i ntermaxi l l ary
€l asi i cs
EBUPIION OF POSTEBIOF
TEETH
Avoid lntermittent tooth interferencec
Edgsrlse or squar€wire to malntainconslanttorque control
Light continuousforces

Anterior bite closur€'ttep down" arch€sand segments

De ta ClassI elasllcs
II. EXTRUDEANTERI O RTE€TH
Anterior venica elastics
IN S€LECTED CAS€S
O!€rcorrectto deepblte in ali arches
Bandanteriorteeth cervic?lly

Extractlon with forward slippageof molars

L "1. etacri.-i r -at' o trdaa\ l l a.ve,.st,,
Tongu€applianc€on lower molars
III. TAKE IEEIH OIJT OF POSIEFIOi Avoid cortical anchorag€where slippageis desired
WEDGE Correct Classll by diffef€ntial slippaseand 1_ll1 extraction
blr ,
616 ot t 11
Molarextraclion

Tongue
lraining
Tongu€
spurson bands2l I 12
IV. CONTAOL AOVEFSE HABIT ,IN
Tonguespurson retainer

Gumchew;ns
V. NEUFOMUSCULARCON.IBOL T€mporalG andmass€ter clinchingexercises
Diet control{ch€wyfoods)

VI. MORPHOLOGICDISTURBANCES Expansion(directionalheads€aror W expanslon)

IINCREASENASA! AIRWAY}
Rotate maxilla inferiorjy in selectedcases(microfiino dysplasia)

V II. ORTHOSUiGI CALI NTEFVENTI O N

 treatmentprinciplesin verticalgrowthpatterns

Ve rt ic algr . ) i/ t hparte rn so c c u p y : d i s * 2 . N AN CEA P P LIA N C EOR TR A N S . 5. A V OID

C LOS IN GLOOP S- C os ng
rn. Veprace n conremporaryortho- PA L AT A L B A R , E i therthe N ance l oopsandspri ngs9abeas thev €r e
dontics. They are !fliversalty assLrmed h o l d i n ga r ch (l i xed)or rh€ rra.spatatal acr vared.
As the oops straighteno!t,
to b e . m ong t he m o s td i ffi c u tt c a s e to s bar (tixed or removable)w I ferard an extrusLve torcei s ptacedon adja. ent
tr-a ataf d S ener ally.a lu p o n a tt o f o u r vertrcaleruption of ql]l . Th. ad on
o rthodont i.ingenu i tyto a ri a tna s a ti s or the tongue i/r sw€l owing ptacesan
fa ctor yr es ! lt . A it ho L rg hi r i s v trtu a tty rn te rm rtt ent i rtrusi vefofce on rh' " 6. A V OID IN TE B MITTE N TTO O TH
possbre to set a speclfictrearrrent mo ars Both oJ rheseirpptiancescan IN TE B FE R E N C E -STraLrrn!tmir s
p l a f ior all v er t ic ag ro w e rsi,t i s p o s i b e !t i z e dto stabti zerhe motarreei h the abi l i tyof physol ogyro ho.l down
b l e to . lar if y pr inc ip teos f m e .h a n tc a (a f.h o ra geand prevenrtj ppi ng)and the o.cl l si on.P aI
and growth nThichwil , if fo towed, of ro r m o ra rr orari on(di sr.itooped). te€th.an fesul ti n € i ransj entop ef bile
fe r a n appr oac ht o a s p e c i fi cp ro b te m . w nr.n.an becomeper.fanenrl f t he
Evenk nowingt h€s ep ri n c i p te {v, e rti c a t * 3 . C ON T BA C TIONU TILTTYA R C H . occrusar
pariernsorten r€presentsome of our l fa!ma s conti nLred overa ong
T h e q u a d h el i xcoftracri onl ri i ty arch
rn o s tdr a. nat icf ailLr e s . a l l o w sfo r di fJerenri at stj ppaqe and/or
s ta b i l i tyo f rhe l ow ermotarsand rerra. 7. E D GE W IS EOR S OU A R EW IB E .
A b r ief des . r ipr iora fd v i s u a ti /a ti o o n f t o n o l th € l ow er i nci sors. B y ptaci ng Mai ni enance
pr n.iplas set forth on rhe preceeding the roots of the mo ar teeth of const!nttorq!e.on
into rhe trol preventsthe rol ing out, or wedg
pageare presenredhere. (, i usrraral) c o rti c a b l o neof the €xrernaobti que Inq,oi anteror teethov€r.ort ca
r dge,vertrcalerLrDtionof theset€e1h bona.B y purposel yanchori ngrh e pos
1 . DI A E CT I O NA LH EA D G E AB -
terior teeth in corrical bore and ma n
Ei th e ra high pu or .o n rb i n a ti o nh e a d
ta nrngthe €nt€ror reethj n the t r a
se a r{ his hpul and c e rv i c apt u t ) c a n b e 4 . AV O ID IN TE R MA X ILLA R Y bocutartrough,exrrusi oni s i mi red
!t 7ed ro e ther retard ve.tt.a erupt ELASTICS- nrermarii ary etastcs in th€ antero-posteriormovemeniof
o f o r d s r a dr lv ean d i n tru d erh e !p from the posteriorteeih have€ vert -
per mo ars 0rL6 . Short outer bows c.l torce vector which extrudesthese
(1 oth e m olar ) andf o .c € sa t o r a b o v e teeth and caf furrher open rhe pos
the occlusa p ane are recommended l e fi o r v e rtl cal di mensi on C tassI
€ l a s ti .sfro m 6fFsho!l d not be l tl
I zed lntil theseteerh are weli an-
c h o re di n b uccai corri fttbone

Tr..spa ata bar kemovabe) Conlraction !r iry ar.h

/-
/t)t il a
IAA IVE
:W W

Ginqiva batu inq (ant€rtoc) Srepdown arch€s& seciions

286
 16. N E U R OMU S C U LA FC ON TRO L'
8 . L I G HT CO NT T N U O U F SOB C E S. ' 1 2 . BA N D A N TERIOR TE pl E TH
ace B v encouragi ng constanl!ti l i za t lonoi
C E R V Ic A LLY -Thi s w i Ll an
l rl o * i r o' c ont inuo " sm o " e me n to t the m\.rsculat!re by chewrngsuga'ress.
teeth wlthoui excesslvepain Limiilng extrLrslveforce on anter or te€in even
rs pl aced chew ng gum, cl l nchl ngexercses ano
;;l n , whic h m ls ht ke e pth e p a ti e n t w h e n a s l rai ghtarch
.hew y foodsi n di et control ,par nour '
i ro m f or . ef ullv oc c l !d i n g ,l s l mp e ra tr€atment s n-rrnrm 2
1 3 . MOV E TE E TH OU T OF P OS TE R IORlng onhodontic can or o
." p,-d o rol A l and the musc!l at!re P n ys
W E O GE - 1..," I.or o
w a rd m o vementol the buccalteeth gi .al l y hel phol d dow n po$eriorver t i
'9;3i:i
. A NT E RI O R B I T E C L OS U R E O R
oowru- nncnes lttlo outof lhepaatomandib!ar plane
SEGM E NT S- B V Lt i l i z i n gth e p o s te ro r w e c l g e rrl l l hel p c osean anteri oropen
p - b r B/..od o-1 o o-' rorooo 17, IN C R E A S EN A S A L A IR WAY '
. ,o , o r\" . " ' 9 of l he uP P €rj aw . re m oval
ar d . l o o d q . I d e 610 rrv' v E xpansi on
^l r d r'.dd'1 " of l onsi l safd adenol ds,and ro r aton
or.o 6
^ ,4io fd" r - , 9, "d a r o'
"r "' o, , l"
r p d r r r i p _ a "I 6 ot the pal atel n mi crorhi fodvspasa
o" l o '
iot da ol a .d.rp -r'q ' "' d - 'o l d r
thefaciaaxisandmandbular w i l encourace bettertongu€posr r ion
iri' ihat cases,
"r1l* "i""*,1* "itrusion planecanbec oseddurlngtreatment and increaseihenasa alrwav Dlasno
ir,o,ta t" utt".ot"o sl sl s cri ti caL.smaxi l l arydvsjunct lon
* 1 0 . E LA S T I CSW I T H A V ER T IC A L .1 4 . T O N G U EA P P LIA N C E ON LOW . can worsenthe open blte
e l a s ti c s ER S. !\rh ereow er mol arsl i P page is
cOMP oNE NT_ I nte rma x i l l a ry 18. OR TH OS U R GIC A LIN TERVEN-
wi th a v er llc alc om p o n e nct a n a s s l s t d e s l re da, cri b rype tongueappl l ance s! r
lower TION - l n certal nexl remecases,
l n the dlf f €r ent lals p p a g eo f p o n e rl o r a lows lhe tongueto dragth€ q€rvon ei theri he maxi l l a,mandible,
molarsforward- This nrav or maY nol
l e et h,ex t r ls lonof a n t€ ri o rte e l h ,a n d ;. tonquei n conj Lrncti on w l th or iho
C l a s sll or C as sI I m o l a rc o rre .tL o n dontLcs,rs necessary'
* 1 5 . C ON TR OLOF A D V E R S EH A B IT
1 1 . OV E RCO RRE C TT O D EE PB IT E. PA T T ER N S_ Tongl e trarnrngexer
Sta biit y of t h€ f ini s h e d c a s c
e a n b € c i s e sth, !m b appl ances,tonguespurs
€ncouragedby ov€rcorrecton Into a o n u p p e ri nci sorbands,and rongLre
d e epblt e in allar c h e s . s p L rrs a n d t.rg€t areasntherei aLner
c a n h e p l n adverse habrtP atl erns.

F ix 6 l t h ! m b a P P r a n c€

28l
 SECTIONALIZEO
F E A T U R E SO F T H E L I G H T P R O G R E S S I VTEE C H N IOU E

elasticsconductin openbitecases

O EL T A C L A S S I I E LAST ICS
Cla$ ll € an cs or entql from the tower rotaft,
ov e r t h € u D p e r c u s p i d b r a cke is 1 o r . o sir ! kjo p ) ,
a.d vefi callv ro re lower clspd bra.k-"r Effec.
t lv e n C l a $ I m o t a r c o fte .iio n a .d € xtr !so i o t
fc s.re Ted€ncy ro ext.ld€

oEfTA CLASS t €IASTICS

Cra$ i I e a n i c s o r e n t El fr .m th e lp p e r n o a 6
! t ue r l f e w i n s s o t t h e o w.r .!5 tid b .a .k€ i1 .r
. k t rr . l . ! p l , a l < J v e r i.a y 1 o th e L p p € f ca . fc
bra.rers. Fff-o.t v. I C ass I i mo ar.orrect on
a. o e : t r l s o n d l l p p e ra n d io we r n .iso ^ . T e n
d€f c v t o e r t r u d e ! F p e r m o a E.

A NTERIORVEATIC AL ELASTI CS( AVE' S)

C lassll .rien tario i. An t er or ! €f t . at €las t ic s . r i
enld aro!or the lpper taierr .. sor brackeis
add .wn !nd €rth € m es iatbr 3. k er s ott he . w- "r
t irn b .uspid s.Espe c iat V ef f ec t iv ein ex r r ! s t on
. l an lero r t€e rhwirh . ul e: r r us ionor m . t a6.
SliqhrC ass v{tor aho.

ANT E f i I O R V E R T I C A! EL AST ICS { AVE' S)

C a$ | or enratio. Aiter o. ve/t ca el.ni cs
orie.red aro!nd r€ !Fpef clsp d bra.kers a.d
dow. ! n d € r i h € t o w e r a le r J in ci$ r b ,a cke r s
Es p€ . i a v e t l e . t i v e i n e\tr !s o i.f a n r e r io f te e r h
w lho u t e r t r l s o . o l m o a 6 S ig h r Cja $ | ll

V E RTICAf EIASTIC SW I THUPPERM O LAF

V€rlica elastc ffomd sta ot upp€r molar,ov€r

brr. lie rso f ate rati..is. r , anddowf io t ower
rarera inchor brackei.pr.vides J.rward no!e
rusion ol tncisots.
Erce tefr tor movi.g uppermolareolt ol p.neri

V E RT I C A L E L A S T I C S WIT H L OWER M OlAB

V edi.a e a s r i . f r o m d i s ra o l o we fm o a r ,u fd e r
o b r a .ke r so f u p p e r
Lai€ra ii', sor. Pro!id€slotuard movdmenl of
ower m o a r s a . d e x t u sio . o l ii.isG. e xce le n i
lor movl.9 lowe. mo a^ out of posieriorwedse

POSTERIOR OELTA ELASiICS

E as lic s o r e . t a j a r o ! n d ih e b r a cke co l th e
p.sterior reeih to seei iheb!.ca occt!sior
Can beorienteJ so as lo s ecrivery e!rlde
Can a s be or ented . a
Cla$ or C ass lr d .eciiof.
 sequenceof mechanics in
non.extractionclassI[, divisiontr deepbitecases
U P P E RI NCI S O R B a nd r. l rper n,o drsl l q.r.d the Lrpper.., s.rs ZLl !:..d p a. e a
ADV A NCE I v , I E NT
TO, ROUE 0 16 i 022 b ue E q oy l tl ty !r.h The !i l tv ar.h ml y i .. l de on y
AND I NT B US I O N th e centra n.i sorsor conta. horl zo.u " T ' l .i ops berw eenthe .ent r as
rfd arcral si l fecessarv. 125 150!r:ms n1tusve l or.e t.r the l o ur
!.p.i r n. sors w th appr.ri nri ,rey 15 o. mor-" mm.l anreror def l€c
to. U ppermol n.s.eedto l e sl i rbi zedw henuppe.Lti tyaf.h s! s. d
U seS e.r oi A r.l r H eadGear or L nql a A r.h to sl abii zc l hr nroar s

L OW E RI NCI S ORA N D B.nd the owe. molaB 6T6 :no lower ncison ZTt: . P are a .016 x
L OW E RCUS P I DI N T R U SION .016 b !e E l qi l oyLrt l ty ar.h a.tl l atedw i th 60 gr.msof for.e to l f r r lde
l h e l ovi er nci sorsand to l prl ghl the ow er mo are.
T ho ow er nrol anarea l ow edto l pr ght w l h m n mLrnrbl cca roo t t or que
a nd an.horage preparal ron.
After the lolver nc sorsare intrlded, band ihe ower cuspds :TJ . P are
a n i i trl d ng secional ar.h or an e !stl . str ng ti ed to. oop on the hor i
z o fti r se.t o. of the uti l i ty ar.h.

UPPER
AND LOWER A. Lower bLr..a rolal ons.otrected. Baid s.d45 anr:lcorect any rota
BUCCALSEGMENTS
ALIGNED ti ons byel tl rerro!.d :,rches..abe 1i tj rarch,orhorzonl al ql ad' T'
s e.ti onsasanauxl €ryarchtothe o\!cr l i i l i ty arch E astc i ga r ionr o
f!!a ti e c eatsar€ti ed 10 affectre.l proc! rotai on.
B. U pperbrccalsegrnents areposi ti ofed.B and 5431345and p a . e ! pper
b u..a secti onal ar.hesw l th .n ofi setfor the cl spi d a.d a strongbayonet
b endmesal to the upperrrol arsfor the C l a$ e.sti c eti ect.5/l 6 " heavy
e a sl .s arew orn 20 ho!rs a dav.

C O NS O LI DA T I ONO F A . C oni i n!e the ntr!si onof the !pper n. sorsl vi th af Lrpper
!t t V ir r ch
TH E UP P E RI NCISOR S !nti the nc sor deepovl r bl te i s cotrected1r]an end to e.d re a t ionshp

B . C onsol l d.tl on.l orqLi g and l eve i g of i he upperl nci sorsto l he pr ell
o l s y corected buccalsegmento.c usl onl s a.comFl i shed bV pl .c inga
s t €ppeddoub e dc ta retractl n!ar.h or w henmoretorquers needed,
th e upsl dedow . verti cahel ca l orqLi i n!€rch s pl a.ed

ID E A LI Z EA RCH E S d e. .oordl i ai €d.016 x.016 b ue E i gioy archesarepacodi norder t o

a l l owa morenatura archform to devel op-The upper.entrai shave22'
70 i nqua root tofq!e n the bra. kels.
th e l ai eral sl 4' and the cLrspl ds
T he ow erc!sp ds al sohave7" l i ng!al root torque. n.i sor torquet o 1250
i n ter-nci sorangl emay be neededfor st€bii ty-
V a ri €1i on
l rom the cl €ssl cal
l dealarchesi s the l ackof c!sp d emi nence
w i th extraproJnl nance of the mo ar bayonetoffsets.
!!h ere ar.h form di ctates,heavl er.016r .022 or .018x .022 archesm ay

Doo,d. .dddbor, oor -1ll11

FINI S HI NGA RCH ES
d l o^ ' o, od1d p" " l o." 1" o _ol"'" o^a" 1"-.*-",'
r.
L oops n .018 x .022 bi !e E l gl l oyoverthe r€gl onof the cuspds a low
for closLrreof the b!.cal bandspace.On y the oops in the ower arch ar€
acllvated.The upper oop is lsed asa hook for I ght C ass| | e ast cs. Thus,
the band spa.e is c osedforw.rd to malnta n correct molar clspld and
S l i ghim d l ne cofrecti ons
l n c sor rel ari onshi p. caf b€ madeat rl risr lm e
by !s ng X crosse astl.s.Two week lnterva appointmentsare sched!led
d ] ]rl ngth s t ni shi ngphas€.

2A-.)
 treatmentsequenceof mechanics
NON-EXTBACTI O NCLASSU,DI VI SI O Nt r , O EEPB I I E C A S E

Aand/bond rhe upper molarand i.cisoB. l.

UPPER: The upper inckoc are advanced, iorqued
a n d nr u d e d wh h a .0 1 6 x .0 1 6 . o r .0 1 6
x . 0 2 2 B u € Elsllo y Ullliiy Ar ch T h e
upper centrals may be advanced !o rhe
iare/6rposirionj then irr!de rhe cenrah
and raierarsat the same rime. The pos
ierior verticat nep sho!ld be aqainn the
m o r a r iu b e a s a sto p a q a in { in ch o r a d
!an.emenl. The anlertor section should
be def ected foBard smm of more. h
shourd be wet contolred. A ,,V,, in the
anlenor arch rorm willhetp keep ihis
conio!r. The upper mota6 are $abitjzed
asa,n{ t pprng w'th a ,016 x .016 se.-

\u)

Continue use ol utiliry arch lor iorque

a n d i n t!sio n co n lr o to fr h e u p p e . in cis
06. Band/bond ihe maxi ary cuspids
UPPER: a.d bicuspid! if nor previousty done.
Lever rhe bLccal sections wirh.,T,,sec
t i o n s o r "Pig q Vb a ck,,,a r o u n d wir e . I
leveling noi ne.essary, pt6ce a h.ction
t---J
s € c n o n a n d in n ia r € cr .IIe 6 sics { s/1 6 ,,

When adeq€re overjet occu6, band/

bdnd rhe lower incGo6 and mote(
P 6 c e a lo we r 0 1 6 . Ol6 Bu e Ea r r o !
U ' l ' t ! A( h w' th 6 0 7 s q ,a m s o i r o ;( e
i o r , n c 5 o 1 n 1 r L 5 o n a r d m o ta r u lr io h r
LOWER: nq. The b'cusp'ds 1.nd.u,D,d,l m;v r,.
b:nded/bonded and a nabitzrns s.ci,on
p r . c . d M o d tl.a ir o n j o l r h e b 6 n . u n t,ty
arch can be ptaced dependrns o. spEc,r,c
o b r e i v e s { v T o I Er a m p te M o d lca -
I'on or an advancins Ulitity Arch.

---..----l

Inrra Orar Uittity Arch aclivalionto con.

UPPER: rnu e
'n chas
rracnon
inr us ion. |l Cr .t r €t a$ic
r s or
not beentnitiaEd, starid

l\
*-4J

Ela*ic ihread tisatedirom the tower

cu sp idb ' . c r 4 r o a 5m a|] oop at onsr he \
ordge 3enon or rh. utilily Ar.h to f.-
cd'taie cuspidintrunon pta.e a or6 t
O2 2o r . O 16r . 0t 6 St 6br t , ng
z Unt hy
-.rv-,
LOWE
R: a(n to €nh.nce rorquecoorot. SE
orrz,ngsecl'on!ho!td b€ useddurida
cu sp idin r us ion. af r er c us Ddinf u.
sion ir necessrv.a ,,T sedion arch or
ts'sgyb€ck_. a Twislio:, or a Cable
wrc toaliqh the bu.catsesmenrs.
t"'\
290
 \.

F o ! r p o $ i b litie s o f m .xlla r y in ciso r

tVr
;')

1. T o r q ! i n q Utilh V Ar ch
2. c o n r a c r io n ' Utilily Ar ch
3. D o ! b l e De h a Ut lliy Afch \;
4. ConrinuoLs Double Delra
UPPER: Afte. bucca sect or! ar€ coiie.ted, one
ot the above arches s used for rorque
contfo , inrus on, conraction and evel
ins ol rhe nciso6. Pdster or vefiica
s t e p o r b a v o n e i b a n d sh o u d b e m e sia lto
seco.d bicuspid bracket toracr vaiion.
C o n t l n ! e C. tr e la $ lcs d u f in g in ciso r
c o n r o l . c .II e la n cs a r e wo .n io ia c
t o n s e c r i o n s ( n o t in . so r e ) .

P ace a nab liz nq Urlr ry Arch to ldeal

ze and mainta n tdrque conlrdl. Place
LO W E R : " p s s v b a c k " o f o ve r la y a r ch e sto f co n
rinued erteci or rorai on, space closLre
and levalinq of bucca sect ons. Place
! d e a l A r c h at !h is n a 9 e ir p o $ ib le .

lde a u pp era. c hw r e . 016t 016 or

.O16x.0 22 alue E s iloy , lladdniona
rorqueconioland arch lom is ne.ded,
u se.01 6x . 022 B ue Els ioy . I n s t and
UPPER: a rd Aiop ros r es ile,
ihe r ar r ar s abe
bends,bicuspidoftse!, and molar
b ayon esar ep ac ed. lr ! s inga t r ple

l d e a l l o w e r a r ch w r e .0 1 6 x .0 1 6 , .0 1 6 x
. 0 2 2 o r . 0 1 a x.0 2 2 B u e Elsio y. L a r e r a
sables, bicuspid ollset., a.d mdar bay
onea afe pla.ed Buccal roor rorque is
LOWEB: benr nro the deal arch dista io the li*t
bicuspids. lf !sing riple conrol a
nra sht w re with properar.h form

Fin shins and band sp6ce closur€ arch.

C l o s i n s " L " a r ch wn e .o l8 r .0 2 2 Bl!e Note: No liebek in th€ upper arch-
UPPEA: E l g i o V . N o r a .tva r e d . ll u sin g b o n d in g
lechniques, space closure arches would

Finhh ns and b6nd spaceclosur. arch.

C os ng horizoniar"L" arch wne .016 x
.0 22 Blu eEls ioy . Ac r iv ar ed1 ' 2m m .
5/1 6" Hea v yCla$t r elanic s20 hour e Nor.: Low€r.rch k acrivatedby lock
a day.Twoweek interuaLoppointmenrs.
It usinsb dn dins t ec hnlques s pac
, ec lo dGtal b.nd over lower molar t!b€.
surearcheswourd not be necessry.

291
 fabrication,activationand placementof the
quad helix appliance

F A B RI CA T I O N

M ADE OF .O3 A EL G

T h e O u a dH e ti xa p pi i afcei s a ti ngLrai
expansion a rc hc o n si sri ns
oi four heti cat
o o p sw h i c h w h e npropertyacti vated
p ro d u c ep re s s !rew hi ch expa.dsthe arch
and rotatesteeth as welt as influence
The hel i call oopedspri ngsareso con.
th e mi d ,p a l a ti nseu tur€i n an orrhopedj c
structedthar they a l ow expansion a!
they expressthemselves.
T h e O u a dH e l i x ti n guatarchi s avai l abte
[,fll
Btl
i n p re fo rme dE ts i to ychromea y .O3gor The di stall oopsextendbeyondrh e
mol arbandal l ow j ngmo ar rotationand
i t c a n b e ma d eo f No.4 gotdw i re_

A CT I V A T I O N ( IN IT IAL )
The i l l ustrati o.show sthe amo!nt
of excess acrl vari on
thar i s ptacedin
the l oopsbeforethe appti ance i s c em ent
ed. After it is cementedon one side it
tnen must be " sprung' i,nto ptaceas
the opposi temol arbandi ! cenen r ed.

Leavi ngi t srandi ngaw ayfrom the ing! al

surfaceof the bicuspidsand cuspids
al l ow sthe mol arrotati onto occu rpr ior
to expannonofthe buccatsegme nt s.
ACT I V A T I O N { IN T BA .O R AL )

Intraoralacti vati onof the OuadHet ix

appl i afcei nvol vest) adj ustments
ro
expandthe rnot6l sand 2) adi ustm ent s
that rotate the motar and expandthe

IV I O DI F I CA T t ON S

A N TE R IO R A N D P OS TE E IOF
E X P A N S ION
[4any mod'ficationsof the Ouad m o l a rrotati onor expansi on atonei s atsoaccompl i shedby a modi fi cat ionof
H elix applianc ar e eo s e fu i1 ) to a s s i sitn required,3) anteriorloopsand arms the Ouad Hetix lingual archas iltusrrated.
th e habitc or r { t ion o f th u m b s u c k i n g a l l o we xpansi on and rot;ti on of the
or tongue thrusting, 2) in caseswhere i n c i s o rs,4)The l ow erarchexpansi on is

292
 :"'":L,,,u.,.""",.,,
.*':i:L
@ n:*:?lJ""l
The utility archls the basicarchLrsed Techniqr.re
ln the LightProgressive lt ls termedthe utility arch
because it perforTns e numberof ro esand functlonsdueto the un qLlenessof ts basicdesign andtfre
manVmodificatlons lt allows.

/ ;'-^'**'*'*

SJO EVI EW

CONSTRUCTION OF THE
SPECIFICATIONS b) A l l ow sLseof segm.ftedar.h mLl h.ni csw t h . usp d r e
tra.ti on aganst an.horage oi al of the othert cet h
IV]ANO
IBULAR UTILITYARCH the ow erarchtor C l ass e.stl cs t o lpper
c) S tabi l l Tes
seamented or !tl Ll tv arches.
stzE o) ni l ow s rotat on ara a qnnrentof the te-"lh n t he b! . . a]
Th e m aidlb! lar Lrtil ty a rc h i s b e s tf.b rl c a i e dfro m .016 \
.0 16s ] le b ue E Lcl L o Y w re i n o rd e ri o .re a t€a forcesys
te 'n t hat del v er ea ro n l i .!o u s fo rc eth a t s i g h t e n oLrgh
lo PhysiolosicalRolesand Function
be ln the rangeof 50 to 75 grirn\. a) U ti i Tesm!s.! ar an.horage p bumper.
b) B u..a arnractsasa cheekrrl mper expar son or D! . . 4
DESIGN
Th e des lgnof t he m a n d i b ! a r !rt l ty a r.h s d c t.te d bv the c) A ci l vatorcl l ed by el l rr na1.! l he propl o . ept ! e nlNr
re q ! lr em ent tshat th e i g h l fo rc eb e d e i v e re dc o n t rn!o!sv fefencesto the
d) A l ow bcl ter b!...1 teci h eft4rtl onby rer r r oving l! f t t o.
Th e pr in. p e of t he o n g l e v e ra rm,l ro m th e n ro l aBto the
, app ic d 1 op ro d !.e th s e ffe c t T h e ma ndi b!l ar
i n c is or sis e) Corrcixsoverbitebelore overel t h , , s , i r vo d i fg I'i ci so r
u i ilit y ar c hls s t ep p e dd o w f ro a v o i di n te rl e re n ctronr
e i he
fo r c aso{ o. . Lr s io thn l l r/l I d i s to rti t. i ) Ll d nl a ns physl oo!l ..rch tor I I 0 r t h e i d v d l d i a .d 1

Th e bu. c a br dges e .1o n s fl .re d b !.c a l v to p re ventti ssl e

rr t at ion oppos lt cL h ev e rti c asl te p sa si h e a r.h a p proachcs Allows Role of Overtreatmentto FacilitateStability
th e t is s ueand asih -" .. s o r tc c l h a fe l n trd c d
a) A l ow scfd l o efd n. sor re at onsnp:s a n over r r $r
R O LESAN D FUNCIIONS nreni I deepbl i c overi .t.des
PositionMola6 for Cortical Anchorage bl Overtrei rment ol brc.a o..l L s on afd cl spid r e at on
a ) D nal lingualr o t.ti o r o f th e l o l l e r m o a rs J '". "
.) Ol ortreatnr€ftol rot.tl o.s l n bul r.!l o.1r! s|o' r
b ) Upr ight ingof t p p e do r ri $ l l l y i c i .e .l mo l .r s 'L: e
.) T or qlt s m o ! r r o o tsb !,..4 1y l n d e r th e o b l q u e rl dgcof fro!:rs .nd ri sorsart statri rcd

R ol e i n Mi xedD enti ti on
Ma nipulat ion and Al i s n m e n to f th e In c i s o rSe g ment r) A 016 r. sor a i l nnrentand n,. ar.ori ro ilr . g lr an
i, I p n" o
a ) ! nt r ls on or ex t r!s o n o l i h t l n . s o l 5to l h e tl el ot l he ', 1
b! . . a f ! nlt lo. .g o .c l L so n . b!u.. oc.rl sron.
the dcri i l LJoLs
b l A dv af . c ' nento r re tra c lo r o l th e l n .-i s o rsn e t her cr B ar.l l .g ol det.i dLrolse.ond
s ro ars aTe a lo$ ear iv
pans io.or - . r t ra c i i o rr.a s e s treatmertof deepb 1ei n.i s., ' rotr.frs
.l Lev eingaf d r o l rti o n a l.o n tro o l l l r. l l rd !d !. i n.i sor A ..xs herter oLvermolar 610 ctupiion beh nd the
L!r qhl eddcc dLrous mol au cTa
d l A x al n. lnat lo .i , .o .l ro l b y l rb a o r L n !l a l .row i lii"i"r,l;,t,rr o" o!v-"rsc.ona blf!nriil 5-Tl
w hdrde.i dl ol".,p1
s no aIs "t eTe .r. !!rr ghtell
A l l ow searl yrol .t ona .orrect on ol b Lrr sFds a''l '! s
Stabilizesthe Lower Arch, Allowing Additional B0!e3and oi dsdLr n.tthel rcfl pt ori
SegmentedArch Mechanics 1l nf sor.l anrfenli rndl ntn ( on .an b. r,: . o- p sher l
a l A lt s 1t )m . it . if a rc hs l a b i l l tyv h l e .a n l r.s a re r.tr!.l ed fr.m th. de.i at ol s ,nol ars-4 e . s!! ng $r I D- 'r . r af r r r t
and Dos lloneds .p a ra rey nrol arsl or ater bi rnor!1.

293
 fabrication,activation,placement
anduseof the mandibular utilityarch

1t"uri""tion
6. The (oftouri nq pl i er s l sed ro prod!.e a.tdtri o n..to.
tol r n l fe.nter or se.t or Thsp eri sel pe.rrt yL5eit jl
w heni rori ronl aloopsareoresenr

Th e F os t er i. rv' . r t l.a s te ps h o ud b e s ro p F e da g a i .srrhe

n rolart r le in . f . lc r to p re v e .rb e n d n g b y i h e l o n tesol
o .r Ls on. a. d lo. ifd t b e tte rmo i a ra n d rc i s o rm ol e

2 Th e anLer iorv er t ican e p s l ro Ld b e e tte n d e dfa r .n ol gh

l re y ondr he lat er . i n i :s o r b ra .k e rsro . l o w !n ra !. nl l
7 Ihe a.ter or seftl o. contoLrrs
Lorn l de.l anteror ar . h
a n da g' r nr entol t h e i n .i s o rs

E The si eppeddow f b!... br dgcse.r on hasd bu ( . 1 . o.

t: to| ]r l hl t stands.!i .VJromrh. a veo rs..d ar.r dsa
bunper .gi ri .stthc Lr!..i natornr!s. c and the .h eeks
n the ower vesl Lrle

3 T hc afte rior itrd p os t er ior v er ii. a s r et , ss ho! ld ont y b , "

S rf r r hrg h aid .alr b. iabr i. . t e. j wiLh ih, - bc alii o, d n ! y r - -

T he s 1cs ol tlre o s er ! t I t y af t lr es ar e des . r b& o y U r e 1l The b!..a1 bri d!. s..tl on s f:fe{l .} !i w rrl w l r e ho d
e. !rfr oi th . br...l . nd lm r c r l. r s e. t r ns , i . , 25 3 U ? 5 . na th-...ter or s/_i i or w i th,r i Jow . p rr
A narro w ilcxitrl-. ler la. i t ar . s r helr inr r a or l t r r e d s ! e
meni a.d sel.(_ to f ^ Sin. e t he s / . s ar r s t anda. , J , e t ! r ! i 0 B V fl .r ri ! tfr. rr..a trr dges{ rfri on.rrl reanl eriorler r
mNfts, the y e .d ttr . r r s elv est o I ' elabr c r r on. i ! step,the posl eri orvcrt.. st-api 5i so Il rrcd b ! . . a1 y
and c5tfb i shesthe 45" b!!ua roor torqLre rert! r. . t in
the Jro .r se.rtl or

I I A s i ght l rql al .row . ro' ,rLr ol 0. Lo5! .rr .e esla

b shedrf thN .rt-.ri orsc.r of rr rhe | fi e ri r. b!. . .
se{ rlo.s arc t .rea o!1, d l f I l !s| .l i ol N . !l

l 2 The.osi cr or ven.. srrf s l l rred trL..t ty ro.!o d t he

l h € s m a 1, , r er , Ln kn 9 0 l a !.0 1 6 !rr.,( | e s L al rsn trsl l e g .gi rrl ro rhe xo .r rl bc
l h e : n: h io|r i. t he rn tc r o r s e .r o n . D L r-" ro th . tl e i bi 1
l y ot t he ! r n. l er ! r i rc s ,o l e r.o n to L rri .! L € .o n 4 | . .-ps l l l The nro rr sed o. l h,rt€rr.nds i nto Lheqrol artLb - "sh: s
a45' b(,cr r.ot tort!e.:10: ro.15! dsr! i fS ! a r o
tat or !. th :l0r to 45! | F ba.k.

t5 I he aror l i di .al es the 30, ro 45! d sl al n,otarr or aton

p a.e! ri tl r. trro.r se.t on
activation
I h..rrow .ai .atesti r. ti p backol 30J ro45,,rlr ar s
p ..e| n the .ro ar se.t orrto cffc.t mo .r l pr gh l r g and

l 7 Th s posteri orvi .r/ ol the l ovrer!i ry.r.h oe4r o. s( r dies

l tro tol . ..1 l al o| that s presentd| e 10ri re!n qleness
l 4 Th e a' r ow ndi. at - " sth e b u ..a l ro o t to q !-p o t 4 5 1 rthat . i d.qra
rsp l a. er l . t he m o a r s e .t o . Th i sto rq u ei s e s ta i rl l shed 1 rl r ng of the b!..a Ir dge keepsthe vel l .a srepslr om
.!to ( r at r . a ly v r henth e b !.c a l b r d g es e .t o n s f a r e,l ' orai , .al .r rra.. | 6.. . , . . 6
l fd at the' o,.01 pl a.es
sametl nre, l orq!e I rh€ mo l r rwion.

294
 placement
t-- i-

20..21Thi sdemonnratesthe grcaterupri ghti ngeffectot a

a'q .,1 o l 'o I i1 o
" '"qd; "l o/"
1 8 . 19. Upon p ac e me not f th e ' a c t v :te d " o w e r u l I tv archi n th.t l s ti ppedratherthan aganst onetl rat s alr eadv! p
the lower rnolartubes,the anterlorsecllon wlll rest !t rl ght,and l he stral ght!! re.an be seated
w i t ho! t anv
t he bonor no f th e l a b i a ls ! c !s . \l h e n i t i s rai sedto the
50 75
ev c lof t he l n .i s o rb ra c k e l si,t s h o !!d n e a sLrre
gramsof force. This lorce is dir€ctedto lnrrLrl_atire tour 22. A sl l ghtI ngl al cfow n to(!e ol 00 to 50 i n t he ir nt er
lowerlnc iso rte € th . or sectionasssts in kcop rrgthe roots away the
i ngl a cori .a boneof the p anLrma veoar'romeanda lows
€ beter i rtrl s on of the nc sors.
coFFE.r \.s]f*],ig
\<v

l. or dert o allo v ri h e m o i a ri o !p rl g h t,l h e w i r e sho!l d

ex t endt hr oug hth e rn o l a rt!b e .n d s h o !l d n o t be bent
down d s t a t o th e l i rb e .T h k p re v e n tsth e c ro wnfrom
C aresho!l d be l aken to f arebl cca l y l he .nter r orver t l
Lr prght r ng.
ca neps. l f thk stepshoud becomei ntrudedl n io t he
The posteriorvertlcal step should not be advan.edahead tiss!€ at the cor.ers, care mun be laken dLrrng is ad
of the mo ar tlbe slnco t wl L b€ distoned bv ihe torces j Lrsrment so that i he mol ar.ontrol i s not al ter edor dis
of occ usionand deflect ihe mo ar iorque contro .

4 orroo""anduse
IMOLARS tNcr so Rs

(Disial Uprighting) l ntrl si onof the l ow erl ncl sors.o the l evelot th e t ! nct on
T he ! pr ight ng a c ti o na n dd s ta lti p p l rg o f th € l ow ermol ars l ng bl ccal occl uson i s one of th€ l sesand pur poses or lhe
is affected in the reciprocalactlon of ihe lower uti ltv arch mandi bul ar !11 ty arch.S l i ght l ng!aLcrow nto r q! e and
T hisalLows f or th e n ra l n te n .n coef th e E s p .ceand ncreas l i ghl conti nuo!sforcesarene.essary for i he r e Jf icientln
ed ar c h engt hl n th e b L rc .aol c c l !s i o na l o w i ngthe bi cl spi {l s

(@
(Distal Lingual Rotation)
Dis t a ingualro ta tl o no f th e l o w e rfl rs l m o l a rposl ti onsi t to
prop€r y receivea we rotaled upper molar and s a critica The lower lilllly arch a lows the ower nclsorsto be ad
f ac t or in pr op e rm o a r re l a i i o n s h i pt. i s a s oa vi l ai factor vancedor relractedby varlousmod flcatlonsto the !t lty
in t he f ln s hin go f th e b u c c a o c c l s i o n . arch ln the accomplishmentof varioLrs treatmeni obleclves.
l ntra oraladj l stmentsof th€ uti l l l y archal soasslsls
t hls

{Alisnment)
,o
{EuccalRoot Torque) Ovenappingor crowdlngof the lower inclsorscan be pro'
The blccal iorq!lng of the lower molar roots o!t Lrnderthe p€ay correctedand ld€a y a ignedas lhe lower lncjsorsare
' 1 p o o r q Jp oqp . d od< n o.prD r I il bei ngl ntrudedw i th the uti i ty arch.The modlf icalions to
mandib! ar anchorage.The ulilltr' arch, wlth ts manv roles the uti l i ty archby pl acement of hori zoni alL o r T loops
d1d lJ l' . or s d t. I d o a p l .h ,g tl i 5 i o o ". faci llates this
'novement
294
 intra.oraladjustments
f t r . or . ldiLs tn e n ts ,F !...1 l n rh e n ra n db !.r Lrti ty
ar , h. , ian[ e , , ] a d .!r i h . l o p l o r.ri n !p i e ro r.snr!l
t f r r eepr o r g t r e r !i !.r' i . .l trrt o f 3 rrl .i rre trr Lsrb-a
ex en:! ! . r n or l e r th l r fro p e r .1 rs o r 3 n d n ro a r .onrr.
s r . inr . . t d l mp ro o e rd d l rs l rn e .rs .:n e a s i t yd n.rrr ,/\- .\-N
lh. . pp r . . L on o l th e o r q n r rL r(L r.

'.."".^..".'-.
The rbove ocati ofsl .di c.re," !heretrrra orat,rdl |] sr
r-.nts or the .randi b!l arLt' l i ty an:l rsho!l d be ra! e
A : . ! r . . r a pri fl p c , .tr. o rrl !d i L rrr-..ts s ho! o .-" ,.' ' " o' ,| ' I
r ade e lf er pa r.l e o r p e ri re .d i r!l a rto rh e s e .1on rhar .fd D osl eri .rrv.rti ..l st-" ps
or rdj a.eft to them or
s ber ngr - alr r il a r_ pl,lh s !, l i E -.pth e r.ri o f i n the
r ar ' . I f n- . . n, !ri ro t d e i e .r rh r .ri ! :a ro r q!v

P l i erP l acement
l l nci sore)
Plie r Placeme nt( M olaB)
A ,J !al on I the i n.i sordrc. i s nratepd.tetto thc
Aii,.a llo. . th e t r r o. r lr er t 5 f n. . le f F t , . f . t . L i r l 1 r
L sor se.rtor or ti re I I anl cror !-a.tl i dtsr.p or 2) ihN
the fo ;r se.ro r ! t lr . r . . lll t hr ir Ds ier or , . . r r i i r . l ur.a br n!€ re\t rc rhesl ep
st.p o r 1 2r { l:j r lnt t o t o|r hebr . . r ! hr t it ge f h c
lll The F er nrl rstbe.otl i ed l rorn a di sta ti re.i i o l
orn er t.i b ..t !0 ! Lo r ir . . J ls t a y r oiar . . t r o r r 5 e . L u l order i . tre;raral c r. thei ]| tcf or sef .r.

IV]OLAR
ADJUSTIV]
ENT
1. PosteriorVertical Step 2. rvl ol arE nd of B uccalB ri dqe

niia. r a r f l L. 1 -p .l st! th E rn ! rr 5 ..t .. !l o . rtftl r-.

r i r ! . a L' 19 . Ih e i !.i t rs rn re .trs tr!! rt tret| + )t -

. 1. ! l! ' f er t ir d , !.r ..! ! to rh e r.,!r s e .r . j r !
. . . r r f ! s h t h s n l j !s tme .t rl rcrl e r I I rs t,ro m_.n trom
a F os r er or . l r . . i o r, to l )et-.rp rn .L ;r to rl r. d 3l .' frod!' :r n.re rro fr i i p bi r.k,rhrr i ..i sor .tl !s or l
r Dl. r or t r . v o! ! y u rf.d i n th e rro .r s c .t o rr A ' :l j l stme.t n the n,ol rh ..n trern.deI th th! rl ee
s]-ar-r toop p erorsma ttrr.eprorj up er Thea.tl L sr
..d16.16,1

/+ . ;::::::;ra\ rhi .h h3s:10"d strt ror.ro.

ffil- ,i;ti ; \,4o))l "",". Il wI oI h-a

ar-.as
oi adi l at o. l rr ' fosr effe.t !e
-..----/- d' (e- !. .tr verl .a srep,or
foster
2J i he b!..i hrnl gei . fr!rr of rhe r_rosr.rilor
efi i .a l

CRI T I CA L F E AT U R E SIN T H E D E SIGNAN D FA A R IC A TIONTH A T

A B E V I T A L T O IT S PR O P EBA C T IV AT IONA N O FU N C TIONA R E :
a . 30' t o 45! ti p b l i k i n rh e n rt!r s c .r o n l. Sl glrl 5i 10 l0i I n!r!.l iro\/n rorqle I the !|r.r or
b . 10' Lo45" d l n a l l i !u tu rr.ri o . I rtren ro r.rserIof
1 .. B !..a I ar i g of the r!{ a br l ge se.t of from r he. n
d . P os t . ior
r ! er i .rd s tc ps h o rk l b e s to p p e d .g . i .srrhe t.nor verti .alsi -.p,w h .h a so f arei the posr.fi or! er r
.al stepo.d .stabl i shes a 45! i oru!e n th-"nrotrrse. r t on
, " . i lr ! . r L1rwlr . s h o !k l e rru rd rh ro L rg h
th e n ro l artdre h A .ter or se.t on exrend_.rJ i l r cnol gh Fastth-" at er r l
d o( ir _0iL t o J p r g h t bra.kctto rl ow for r.l sor i r .qnn,c| r
296
intra.oraladjustment
INCISORADJUSTMENT
nlr a or a a d l u s tm e n ts to th e i n .l s o rs e cron shoud be i ri ci sorareal s madepara e to thc r. sor se clio.e r her
a j a" ,ro o on the I ) l nter or ve.l l calnep, or 2l rhe b!.. a br dge
t ir eb! . . a b r d g e l h e s e a d l u s tn e n l sto the !nl er or ," rorl " .
seft on shond tre nrird! para le to the anter or sect on. to advan.-" w l th l .b a .Joyrntorq!e, or to relr a. rwilh
'| |. r1 .. .--, o "il Io ro. .o
I r o, nt hc p o s te rl o r.lre i J o n . o rd e r1 0bc parare ro s a.t val edat th. mol arstep.
t h, 4c or i to u ro f th e .n t-a rl osr e .t o n A c ti vari onl n rhe

A . r i v d ti o no n a ftc r o r s tc p k e e p sactl v.ti onparale to

A ct l a t o f a o n g b !!c ! b ri d g cn e dranterl orsteDshou.l

. on re i r s i g h tl y l ro m b e h i d a n d be kept parai c to
ant e rl o rs e c ti o no f a r.l r.An te ri o rse.t on h.s contour
s o a c tl o nl s to th e te e tho i e a c hp artl c!l ars de

CROWN
TOROUEOB LABIALADVANCEIVENT C R OW NTOR A U EOR LIN GU A L R E TRACTI O N

AF

________%\
r
T o adv a n c e
th e i fc i s o rso r to e fi e c tl a b al crotvntorq!e,
the intra oral adllrslnrentsare madeas I lirstratedabove. To retrad the lnclsorsor to effect ingua crown
T he ar . h w re b e l n gd e fl e c te di n w a rda dv€nces the n.i sor torq!e, the intra ora adjlrstmertsare m.de as
t €€t h,ai d p l a c e sl a b i a c ro w nto rq u e . il ustratedabove.The arch wire belngdelle.ted
oLrtwardretractsthe n.isor ieeth, and pla.es
ngl arcro\!n l orque.
designmodifications
O F BASICUTILITY A RCHP RINCIP LE

IV I A ND
I B ULA R U T I L IT Y AR C H ES

t. ExpansionUtility Arches Use:Sarneasbaslc.except

movesincisorsfor1"/ard.Posteriorvertical st€p shoud
be agalr s tb u c c a ltu b e .
F or c e: lm m 8 5 s ra m s
2m m 1 4 0g ra ms
: mm 2 0 5 s ra m s
T he loop ls p a .e d i i s i d e o r b e h n d i h e a n teror vertca
st€pwfren the i.rcisors.reto be advanced.

Conrraction Utility Arche. Use: Uriliry Arch wlrh helica

r oopst o r e tra c ti n c i s o r " P o s te ro r s l e ps h oul dbe 5mm
or m ov eio rw a rdo f b u .c a l tu b e to a l o w fo rdi sl a move

F or c e: lm m 5 0 !ra m s
2r n m 1 5 0g r.m s
3m m 2 3 0 g ra m s
4m m 3 OOg ra m s
T he oop s p l a .e dfo rw a rdo f th e a n re ro r or verti cal
stepwhen the ln. sorsare to be r€lracred

The oop at ihe ovvarcorner of the vertical step is p aced

o r a, d o o 5 " d oo ' ,rrp r.I / 1 - l " .r or' o o-
'd ,d ..d -t 6.d. " ."
,,o.5 i ,
"

Utility Arch With T or L Horizontal Loops: To rotalc

and l€v e n .s o rs T h e h e g h to fth e h o ri /o r tal LorT
oopss hol l d b e k e p l b e tw ,.e n5 a n d 7 mn r n orderto
pr ev ef tt is s l e n t a ti o n n th e s ! .!s o f th e l ow erl i p

T he hor iz o n i a lo o p s. o w f e r b i i l y a n d f !l bracket
engageqreinolr a l g n m e .t..d n tru s i o n

Cont.action or Advanc'nsUnlity Arch: A .-' I c roop

p aceda ong the b!.cal brldge hasthe facl ity of belng
adlls t edin i r. o r. y to e rp a fd o r c o n tra .tthe !r.h
Whef p acedopposjtethe lovr'erclspl.ls. t is useTuln
. t ai a .i o . l . g , o ., .ort-" . p,1
- 9 -"

294
 anchorageplanningextractioncases

M O D I F IEDNAN C ELINGUA LA RCH

FORUPPERIVIOLAR ANCHORAGECONTROL

The originalNancelingualarchdesign
is from the palatalplastic
buttondirectly
to the lingualoi molarband.

ModifiedNancelingualarchhasa
distalloopdesigned for molarexpansionand
rotation. Largelingualbutton asnecessary
for addedstability.

Helicalloopin the modifiedNancelingual

archgivesadditionalrotationto the
molars,Molarattachment is on
mesiallingualsurfacefor furtherrotation

Helicalloopandlingualextentionin
modifiedNancelingualarchgivesadditional
molarrotationandbicuspidexpansaon.

ThemodifiedNancelinglalarchwith lingual
arch extentivesand loopsto the individual
teethallowsaddedaction.

[/]odifiedNancelingualarchwith
individualspringsfrom the palatal
plasticbuttonmayalsobe designed

299
L O WERM OLA RA NCHOB A G
E DE S I G N

MAXII\4UI\4
ANCHORAGE

1 . l\4olarHeld'Anterior Retracted
MaximumUtility Support
AgainstN4olarTube

2. l\4olarForward1/4 Way
lvloderareUtility Support
ForwardoI lMolarTube

3. MolarForward1/3 Way
[4inimumLJtilirySupport
Contraction
Utility

4. EqualClosureBack
lMolarTorque- LightAcrivation

5. EqualClosureForward
No l\,4olar
Torque- HeavyActivation

6. lMolarForward
No lvlolarTorque
WireRoundedin MolarTube

IV]
INII\4UM ANCHORAGE
UPPERMOLARANCHORAGEDESIGN

MAXII\4UI\4
ANCHORAGE

'1. NancePlasticButton
FollowedBy HeadGear

2. HeadGearDirectional

,)

3 . NancePlasticButton Alone
:t
N
Classl-noonhopedics

MODE RA TEA NCHO RA G E

1. OuadHelixExpansion
Arch
without plasiic button

2. UpperUtility Arch

Then
3. SectionalRetraction
AnteriorRetraction

MINIIMUM
A NCHO B A G E

I Reciprocal
Closure

2. Extractal! NlolarForward

301