EDGEWISE

TECHNIQUE

Presented by:
K DHANUSHA
2ND MDS
 CONTENT

1. Introduction
2. History- Angle system
3. Edgewise appliance
4. Charles H. Tweed
5. Tweed philosophy
6. Facial types
7. Tweed diagnostic facial triangle
8. Levern Merrifield
9. Arch form
10.First, second & third order bends & their
interaction 11.Bracket & tube placement
12. Bracket angulation
13.Evolution of technique- primary, secondary & tertiary edgewise
14.Tweed-Merrifield edgewise appliance
15.Treatment with Tweed-Merrifield edgewise technique
16.Variations of appliance
17. Various studies
18.Conclusion

19.References
 INTRODUCTION

🠶Edgewise appliance- first described over 80 years ago

🠶Developed into a highly sophisticated technique to achieve

ideal orthodontic treatment results.

🠶Standard Edgewise technique will allow clinicians

to achieve a higher standard of treatment result.
HISTOR
Y
🠶Hippocrates- advocated theuse of a wooden spatula
to move teeth in crossbite into alignment.
🠶Pierre Fauchard (1678–1761) described a number
expansion devices to relieve of of the
arches. crowding dental
🠶Dwinelle (1849)- developed jack screw
🠶Magil (1871)- introduced dental cements to attach
bands on teeth
🠶NormanKingsley (1866)- advocated use of extraoral
forces.
ANGLE SYSTEM (1888):
🠶This system led to development of theedgewise
multibanded appliance- progenitor of all
appliances modern
🠶Edward Hartley Angle- after graduation from dental
school in 1878 & before introduction of Angle system in
1888
🠶Experienced many technical problems in patient treatment
🠶Believed an orthodontic appliance must have 5 properties:
1. Simplicity
2. Stability
3. Efficiency
4. Delicacy
5. Inconspicuousness
Angle designed a standard appliance- composed of specific
no. of basic components:
🠶Traction screws- A &B
🠶Attachment tubes- C&D
🠶Jackscrews-E&J
🠶Lever wires-L
🠶Band material-F&H
🠶Archwire-G
🠶Wrench-W
🠶Archwire lock-R
🠶These components mass produced- fulfilled all 5
properties
🠶Less difficulty & less time consuming
🠶Minimal pain & discomfort to patient
This universal application enabled practitioners to treat more
patients at a higher level of excellence & at less cost.
Beginning of Relationship among manufacturers,
suppliers & orthodontists
🠶Angle- first developed the E-arch (1905)-expansion
device but this was crude and could not position teeth
accurately.
🠶He then developed the pin and tube appliance which
consisted of vertical tubes soldered to bands on the teeth
and which engaged metal pins soldered to a labial
archwire- very good three-dimensional control over all the
teeth, but it was extremely difficult to adjust, as the pins
had to be re-soldered into new positions on the wire at
every visit.
🠶 The next stage of development was to file the vertical
tubes partially so that they were able to engage a
rectangular wire inserted ‘flatwise’ (i.e. the longest
dimension facing labially) –the ‘ribbon arch’, which was
an immediate improvement on the pin and tube appliance.
🠶finally, in 1928, Angle rotated the ribbon wire through 90
degrees and built the bracket around this – the ‘edgewise’
bracket, so called because the narrowest dimension of the
archwire was inserted into it ‘edgewise’.
🠶excellent three dimensional control over tooth position in
all planes of space & was much easier to use.
 THE EDGEWISE
APPLIANCE
🠶Angle changed the form of the brackets by locating the
slot in the center and placing it in a horizontal plane
instead of a vertical plane.
🠶Archwire was held in position first by a brass ligature &
later by a delicate stainless steel ligature.
🠶New edgewise bracket consisted of a rectangular box with
3 walls within the bracket, 0.022x0.028” in dimension.
🠶This new design provided more accuracy & thus a
more efficient torquing mechanism.
 CHARLES H. TWEED

🠶Angle along with the help of Tweed published an

article describing the appliance in Dental Cosmos.
🠶Tweed (in Arizona,Phoenix)– 1st pure edgewise speciality
practice in the United States.
🠶Angle urged tweed to:
1. Dedicate his life to development of edgewise appliance
2. Make every effort to establish orthodontics as a speciality
in dental profession
🠶In 1929, Arizona legislature passed 1st law – established
orthodontics as a speciality.
🠶Tweed- 1st certified specialist in the US.
🠶He published 1st article in the Angle Orthodontist in 1932-
titled “Reports of Cases Treated with Edgewise Arch
Mechanism”.
🠶Angle had a firm conviction- one must never extract teeth.
🠶Tweed found his results to be aesthetically unsatisfactory
& unstable- extracted four 1st premolar teeth
🠶In 1936, he published a paper on extraction of teeth for
orthodontic malocclusion correction.
 TWEED PHILOSOPHY

1. One of the prerequisites for normal occlusion is that the

mandibular incisors must be in correct relationship to the
basal bone and that a mathematical expression of the
relationship of the mandibular incisors to the mandibular
line in normal individuals is 90°, with a plus or minus
variation of 3°.
2. The principal direction in which the teeth move in
assuming positions of malocclusion is forward.
3. The growth of tooth-supporting bones and that of alveolar
bone is independent.
4.In the correction of malocclusion, it is rarely necessary to
move teeth mesially. Radial movement (expansion) is
secondary, and the primary movements of some or all of the
teeth in both arches are backward or distally.
5.If there is an excess of dental material over basal bone, it
may be necessary to extract teeth to permit the attainment of
the correct mandibular incisor positions.
6.Good esthetics, correct function & stability are a corollary
of the end result of malocclusion when treated and corrected
in accordance with the Tweed philosophy.
 FACIAL
TYPES
Tweed divided facial types into following types:
 TYPE A:
🠶 Maxilla & mandible show forward & downward growth
🠶 ANB angle remains same
🠶 Good prognosis
🠶 Treatment not indicated during mixed dentition if ANB angle does
not exceed 4.5°
 TYPE A SUBDIVISION:
🠶 ANB angle > 4.5 °
 TYPE B:
🠶Maxilla & mandible grow downward & forward with
maxilla growing more rapidly than mandible
🠶ANB≤4.5° - favorable prognosis
🠶Extraoral appliances should be used immediately
after extraction
 TYPE B SUBDIVISION:
🠶ANB is large & found to be increasing
🠶Undesirable growth trend
🠶Treatment long & difficult
 TYPE C:
🠶Maxilla & mandible grow downward & forward with
mandible growing more than maxilla
🠶ANB increasing
🠶Favorable growth & treatment is facilitated by growth
 TYPE C SUBDIVISION:
🠶Mandible grows more than maxilla butonly to a
little extent
TWEED’S DIAGNOSTIC FACIAL
TRIANGLE
🠶FMA- 25°, IMPA- 90°, FMIA- 65°
For successful treatment, aim should be to attain:
🠶FMIA of 70-75°( FMA=20°)
🠶FMIA of 65° (FMA= 30°)
🠶When FMA < 20°- FMIA should be > 70° & IMPA< 94°
🠶 Tweed showed that in well balanced faces- IMPA WAS 90±5°
🠶 For every degree that FMA was in excess of 25°, the IMPA would
have to be decreased by 1°.
Treatment objectives:
🠶 Facial balance & harmony
🠶 Stability of post treatment dentition
🠶 Healthy oral tissues
🠶 Efficient mastication
 LEVERN MERRIFIELD

🠶In 1970, L. Levern Merrifield of Ponca City, Oklahoma

became the Tweed Study Course Director.
🠶Levern Merrifield was determined to make the use of the
appliance more “efficient” while remaining true to
Tweed’s concepts of anchorage preparation with vertical
control during protrusion reduction.
🠶Merrifield introduced a totally new concept:
Edgewise Sequential Directional Force Technology.
🠶This system would “streamline” the use of Angle’s
invention — the edgewise appliance.
 ARCH FORM
🠶highly variable.
🠶earliest descriptions of an ideal arch form was the
Bonwill-Hawley arch form- Hawley (1905)
🠶The incisors and canines are aligned on the arc of a circle,
while the premolar and molar teeth are considered to lie
along a straight line radiating distally from the canines and
diverging outwards.
🠶This arch form was advocated by Charles Tweed in his
postgraduate edgewise courses.
🠶Edward Angle - parabola as the ideal arch form.
🠶Hechter - parabola best fitted arches in the upper and
lower outer and middle curves only, and did not fit so well
in the inner curves.
🠶The catenary curve was proposed by McConnail and Scher
based on the form that a chain takes when it is suspended
from two points.
🠶Rudge - found catenary curve to lie lingual to the premolar
regions and, when fitted to the premolar regions, tended to
overlap the incisal edge.
🠶Battagel- use of catenary curves and concluded that they
worked best only where the intercanine width was
relatively narrow.
🠶The current best arch form is considered to be the trifocal
ellipse (Brader), which fits arches in the premolar regions
and in the second and third molar area.
Isaacson and Williams give the following recommendations:
🠶 Lower arch –
• Maintain the labiolingual position of the lower incisors
• Gain space for decrowding by moving canines distally
• Maintain intercanine width
• Maintain intermolar width except when correcting a crossbite.
🠶 Upper arch –
• The AP position of the upper incisors will often need to
be changed.
• The position of the lower incisors will determine how far the
uppers need to be retracted.
• Offsets for canines and molars, insets for lateral incisors – the
first to satisfy function, the second for aesthetics.
In fabricating an Individualized archwire form
Attention must be paid to:
🠶Labiolingual position of lower incisors;
🠶Intercanine width;
🠶Degree of curvature of the labial segments;
🠶Intermolar width;
🠶Degree of crowding.
 FIRST, SECOND & THIRD ORDER BENDS
& THEIR INTERACTION
FIRST-ORDER BENDS:
🠶In-out & bucco-labial positioning
🠶Action & reaction of first order bends affect expansion &
contraction
🠶The actions are monitored easily
🠶Routinely used to move individual teeth
🠶Interaction of the bends can affect the third-order position
of the teeth if expansion forces are used.
SECOND ORDER BENDS:
🠶Tip- mesiodistal root positioning
🠶In posterior segment of mandibular arch are antagonistic
to the teeth in the anterior segment.
🠶Without excellent directional control & a careful
application of these second order forces in a sequential
manner- vertical control of anterior teeth will be lost.
🠶2nd order bends in the posterior segment of the mandibular
archwire also negatively affect the third order position of
mandibular anterior teeth.
🠶Teeth generally require lingual crown torque.
🠶Posterior tipping bends apply labial crown torque force to
incisors.
🠶In maxillary arch, 2nd order bends in posterior segments
are generally desirable/complementary to teeth in anterior
segment.
🠶The reaction to tipping forces intrudes themaxillary
incisors & gives lingual root torque effect to these teeth.
🠶This is generally positive/ complementary to treatment
objectives.
🠶According to Jones and Orton, should be no more than ‘a
ripple in the wire’.
THIRD ORDER BENDS:
🠶Torque- labiolingual root positioning
🠶3rd
order bend reaction in mandibular archwire is
complementary to all the teeth if properly placed.
🠶Objective is to have some degree of lingual crown torque
on all mandibular teeth.
🠶Posterior & anterior segments work together in action,
reaction & interaction.
In mandibular archwire, ideal 3rd order bends (lingual crown
torque) are:
🠶Incisors -7°
🠶Canines & first premolars -12°
🠶2nd premolars & molars -20°
🠶Conversely, 3rd order bends in the maxillary archwire are
antagonistic.
🠶Anterior segment needs no torque (0°)/ slight lingual root
torque
🠶Posterior segment needs lingual crown torque
🠶Canines & 1st premolars -7°
🠶2nd premolars & molars -12°
 BRACKET & TUBE PLACEMENT
🠶Angle’s goal of correct bracket & tube placement is to-
produce an ideal occlusion at the end of treatment with
flat, straight, ideal archwires.
🠶Tweed advocates- mm measurements from bracket slot to
incisal edge
UPPER ARCH LOWER ARCH
Central incisor 4.5 Central incisor 4
Lateral incisor 4 Lateral incisor 4
Canines 5 Canines 4.5
Premolars 4.5 Premolars 5
molars 3.5 molars 4
 BRACKET
ANGULATION
🠶Brackets- parallel to long axis of teeth
🠶Holdaway (1952) described 3 uses of bracket angulation:
1. As an aid in paralleling roots adjacent to extraction spaces
2. As a method of setting up posterior anchorage units
into tipped back/ anchorage prepared positions.
3. As a means of obtaining correct axial inclinations/ artistic
positioning.
 EVOLUTION OF TECHNIQUE

PRIMARY EDGEWISE
🠶 Angle (1929)
🠶 Fully banded technique- gold bands, soldered soft
brackets
🠶 Flat ideal arch wire- to provide normal occlusion
🠶 Original arch- 0.022x0.028” gold wire
🠶 Archwire adapted passively
🠶 Space had to be made- loops are soldered onto main arch
🠶 Space closure required- spurs & tie backs used
🠶 Involves all teeth to be brought under control
SECONDARY EDGEWISE
🠶To avoid making archwires passive
🠶Use of round wires in initial stages
🠶Gold replaced by more rigid alloy
🠶Frequency of extractions increased
🠶Bands with pre-welded brackets
🠶In 1940, round 0.045” tubes were soldered on upper
molars for a face bow
TERTIARY EDGEWISE/ TWEED’S EDGEWISE
🠶Importance of anchorage
🠶Use of class III elastics & extraoral traction
🠶Vigorous forces are now employed
🠶Space closure – simple vertical/ horizontal open loops bent
into archwire
Tweed essentially used Angle’s edgewise appliance in the following
manner. The steps were:
1.Leveling and alignment- series of round archwires-used
directionally controlled headgear applied to the canines to begin canine
retraction on these round archwires.
2. If teeth were extracted, mandibular extraction space closure was
accomplished after leveling and alignment. This was done with a 0.020
× 0.025 working archwire that had closing loops incorporated into
them.
3.Mandibular anchorage preparation- Tweed bent a stabilizing
archwire for the maxillary arch and a working archwire for the
mandibular arch. All mandibular second order bends were placed, at
one time, into the archwire.
To control these second order bends, Tweed used Class III elastics, an
intermediate headgear to the maxillary arch and vertical up and down
elastic force.
4. After en masse mandibular anchorage had been prepared, the
mandibular arch was stabilized with an 0.0215 × 0.028 archwire that
was continuously tied in the posterior segments.
 This stabilizing archwire was an exact “duplicate” of the previously
used working archwire, only larger.
 The maxillary archwire was changed to a smaller
maxillary working wire.
dimension
 Tweed then distalized the maxillary arch if the treatment was
nonextraction or retracted the maxillary anterior teeth if the patient
had extraction space mesial to the distalized maxillary canines.
 The patient generally wore Class II elastics, anterior
vertical elastics, and again, a headgear.
5. The final step was to finish the correction of the
Tweed used 0.0215×0.028 rectangular
malocclusion.
archwires with soldered spurs and vertical elastics to
effect the proper interdigitation of the teeth.
This treatment protocol, devised by Tweed, was
very effective. Patient cooperation was the key.
 TWEED-MERRIFIELD EDGEWISE
APPLIANCE
🠶Brackets & Tubes
🠶An appliance-
 instrument used to achieve orthodontic goals
 Certain characteristics: simplicity, efficiency & comfort
 Hygienic & aesthetic
 Wide range of versatility
Neutral 0.022 slot edgewise appliance consists of:
🠶Posterior bands & anterior mesh pads with single, double-
width 0.022 brackets on the six anterior teeth
🠶Intermediate single-width brackets on premolar bands
🠶Twin brackets on first molar bands
🠶Heavy edgewise 0.022 tubes with mesial hooks on second
molar bands
🠶All bands have lingual cleats attached
🠶Lingual cleats- increase versatility & necessary to correct
and control rotations.
🠶Brackets are positioned precisely in relation to the incisal
edges of anterior teeth & cusps of remaining teeth.
🠶No tip, torqueor variations in thickness arepresent
in bracket.
🠶Slot size of 0.022 allows clinician to use a multiplicity of
archwire dimensions.
🠶Archwires:
Resilient edgewise archwire is used with Tweed-
Merrifield 0.022” edgewise appliance.
Dimensions of wire commonly used:
🠶0.017x0.022
🠶0.018x0.025
🠶0.019x0.025
🠶0.020x0.025
🠶0.0215x0.028
🠶These wire dimensions give great range of versatility with
0.022x0.028 bracket slot & allow sequential application of
forces as needed for various treatment objectives.
🠶Objective is to enhance tooth movement & control
with the proper edgewise archwire at the appropriate time.
AUXILIARIES:
🠶Elastics
🠶directionally oriented headgear (high pull J hook
headgear)
 TREATMENT WITH THE TWEED-
MERRIFIELD EDGEWISE
APPLIANCE
🠶Using tweed’s treatment concepts as a foundation,
Merrifield developed force systems that simplify the use
of edgewise appliance.
🠶For example, Tweed used 12 sets of archwires which
reduced to 3 to 5 sets later.
🠶Merrifield’s sequential directional force technology-
simple, straightforward, fundamentally sound
🠶The key to quality treatment with the edgewise appliance
is the directionally controlled precision archwire
manipulation.
🠶The treatment philosophy includes 5 concepts:
1. Sequential appliance placement
2. Sequential/individual tooth movement/both
3. Sequential mandibular anchorage preparation
4. Directional forces (control of vertical
dimension to enhance a favorable mandible to
maxilla spatial change)
5. Proper timing of treatment
 SEQUENTIAL APPLIANCE
PLACEMENT
In a 1st premolar extraction patient,
🠶the 2nd molars & 2nd premolars- banded
🠶Initially, 1st molars are left unbanded
🠶Central & lateral incisors & canines- bonded
🠶Anterior malaligned teeth- notligated to archwire/
passively ligated
🠶Less traumatic to patient & easier & less time consuming
for orthodontist.
🠶This method allows much greater efficiency in the action
of archwire during 1st month of treatment because it gives
posterior segment of the archwire longer
much interbracket length.
🠶Length creates a powerstorage – more rapid molar
2nd movement
🠶Also, gives opportunity to an orthodontist to insert a wire
of larger dimension i.e. less subject to occlusal/ bracket
engagement distortion.
🠶After banded & bracketed teeth respond to forces
of archwire & auxiliaries, then 1st molars are banded.
🠶Max 1st molars banded after 1st appointment
🠶Mand 1st molars banded after 2nd appointment
 SEQUENTIAL TOOTH
MOVEMENT
🠶Sequential tooth movement is important.
🠶Not theen masse movement that was introduced by
Tweed.
🠶Individual teeth aremoved rapidly & with precision
because they are moved singly or in small units.
 SEQUENTIAL
MANDIBULAR
ANCHORAGE PREPARATION
🠶 Tweed- prepared mandibular anchorage with Class III elastics- all
compensatory bends were placed in archwire at 1 time.
🠶 Sequelae- labially flared & intruded mandibular incisors
🠶 Sequential mandibular anchorage preparation (MERRIFIELD):
🠶 System allowing mandibular anchorage to be prepared quickly and
easily by tipping only two teeth at a time to their anchorage prepared
position.
🠶 This system uses high pull headgear rather than Class III elastics for
support.
Controlled, sequential & precise movement.
🠶It is accomplished by using ten teeth as "anchorage units"
to tip two teeth- Merrifield "10-2" system.
 DIRECTIONAL FORCE

🠶Hallmark- use of directional force systems to move the

teeth.
🠶Directional forces - defined as controlled forces that place
the teeth in the most harmonious relationship with their
environment.
🠶It is crucial to employ a force system that controls the
mandibular posterior teeth and the maxillary anterior teeth.
🠶The resultant vector of
all forces should be
upward and forward
so that the opportunity
for a favorable skeletal
change is enhanced,
particularly during
dentoalveolar
protrusion Class
malocclusion II
correction.
🠶An upward and forward
force requires
system that mandibular
the
incisor be upright over
basal bone so that the
maxillary incisor can be
moved distally and
superiorly
.
🠶For the upward and forward force system to be a reality,
vertical control is crucial.
🠶To control the vertical dimension, the clinician must
control the mandibular plane, palatal plane and occlusal
plane.
🠶If point B drops down and back, the face becomes
lengthened, the mandibular incisor is tipped forward off
the basal bone and the maxillary incisor drops down and
back instead of being moved up and back.
🠶The unfortunate result is a patient with a lengthened face,
a gummy smile, incompetent lips, and a more recessive
chin.
 TIMING OF TREATMENT

🠶Integral part of the philosophy.

🠶Treatment should be initiatedat the time when treatment
objectives can be most readily accomplished.
🠶This may mean interceptive treatmentin the
mixed dentition, selected extractions in themixed
waiting
dentition,orfor second permanent eruption before
molar initiating active treatment.
🠶Diagnostic discretion is the determinant.
 STEPS OF TREATMENT

Tweed-Merrifield edgewise directional force treatment can

be organized into four distinct steps:
1. denture preparation
2. denture correction
3. denture completion
4. denture recovery
During each step of treatment, certain objectives must
be attained.
 DENTURE PREPARATION

🠶Denture preparation prepares the malocclusion

correction. for
🠶Objectives include the following:
1. Leveling
2. Individual tooth movement and rotation correction
3. Retraction of both maxillary and mandibular canines
4. Preparation of the terminal molars for stress resistance
 DENTURE PREPARATION
🠶 takes approximately 6 months.
🠶 The teeth of the original
malocclusion are sequentially
banded and bonded.
🠶 The mandibular second molar
receives an effective distal tip
of 15° from this initial
archwire.
🠶 In the maxillary arch, enough
tip is in the wire distal to the
loop to have an effective 5°
distal tip on the second molar.
🠶 A second premolar offset bend
mesial to the second premolar
bracket is in each archwire.
🠶 The third order bends in each
archwire are passive.
🠶 High pull J-hook headgear- to
retract both maxillary and
mandibular canines.
🠶 After 1st month of
treatment,
both archwires are removed, and
the terminal molar tip in
the
mandibular archwire is
increased maintain
to
effective 15° tip asthe
the tooth tips
distally.
🠶As the canines retract and the
arches are leveled, the lateral
incisors are ligated, and power
chain force to aid canine
retraction can be used.
🠶At the end of the denture
preparation stage of treatment
o the dentition should be
fully banded and level
o the canines should be
retracted
o all rotations should
be corrected
 DENTURE CORRECTION
🠶 Spaces are closed with maxillary
and mandibular closing loop archwires.
🠶 Vertical support to the maxillary arch -
J-hook headgear
🠶 Vertical support of the mandibular
anterior teeth - anterior vertical elastics.
🠶 The mandibular archwire is a 0.019 X
0.025 working archwire with 7mm
vertical loops distal to the lateral incisor
brackets.
🠶 The 0.020 X 0.025 maxillary archwire
has 7.5 mm vertical loops distal to the
lateral incisor brackets.
🠶The dentition is now ready
for mandibular anchorage
preparation.
🠶This step positions teeth in
the mandibular midarch and
posterior areas into axial
inclinations that will allow
final coordination with the
maxillary teeth for normal
functional occlusion.
Sequential mandibular anchorage preparation

🠶 sequential tooth movement.

🠶 The archwire produces an active force on only two teeth, while
remaining passive to the other teeth in the arch.
🠶 Therefore the remaining teeth act as stabilizing or anchorage units as
two teeth are tipped. -"10-2" (ten teeth versus two teeth) anchorage
system
🠶 The system is supported by high pull headgear worn on the anterior
vertical spurs, which are soldered distal to the mandibular central
incisors.
🠶 initiated during the denture preparation step of treatment by tipping
the second molar to a 15° distal inclination.
🠶 After the mandibular space is closed during the denture
correction step of treatment, the arch is checked to make sure
that it is level and that the second molars are tipped to a 15°
distal angulation- “Readout”
🠶 Now, second step of sequential mandibular anchorage
preparation, first molar anchorage, is initiated.
🠶 Another 0.019 X 0.025 in archwire with the loop
stops bent flush against the second molar tubes is fabricated.
🠶 First and third order bends are ideal.
🠶 Gingival hooks for high-pull J-hook headgear are soldered
distal to the central incisors.
🠶 The archwire is now passive to
the second molar and crosses the
twin brackets of the first molar at
a 10° bias.
🠶 The second molars are now part
of the 10 stabilizing units, and the
first molars are the two teeth
receive
that action of the
the
directional forces and the
archwire.
🠶 After 1 month, the archwire is
removed, and a readout should
show a +5° to +8° distal
inclination of the first molars.
🠶 The second molars should continue to
readout at + 15°.
🠶 The third and final step of sequential
mandibular anchorage preparation is
to place a 5° distal tip 1 mm mesial to
the second premolar brackets.
🠶 The archwire must be passive in the
brackets of the first molars and in the
second molar tubes.
🠶 It is ligated and again the high-pull
headgear is worn to the mandibular
headgear hooks.
🠶 Usually, headgear wear during
sleeping hours is effective.
🠶 During this step of anchorage preparation, the first and second
molars and the six anterior teeth are part of the 10 stabilizing units,
and the two premolars are the recipients of the "10-2" directional
force system.
🠶 At the end of mandibular anchorage preparation a readout will show
that
 the second molars have a distal axial inclination of 15°,
 the first molars have a distal axial inclination of 5° to 8°,
 second premolars have a distal axial inclination of 0° to 3°.
🠶 The denture correction step of treatment should now be complete for
the Class I malocclusion.
🠶 Objectives of the denture correction step are
1) complete space closure in both arches
2) sequential anchorage preparation in the mandibular arch
3) an enhanced curve of occlusion in the maxillary arch
4) a Class I intercuspation of the canines and premolars.
The mesiobuccal cusp of the maxillary first molar should fit into the
mesiobuccal groove of the mandibular first molar.
CLASS II FORCE SYSTEM
🠶For patients with an "end-on" or a full-step Class II dental
relationship of the buccal segments, a new system of forces
must be used to complete denture correction.
🠶A careful study of the cusp relationships will determine the
force system required.
It is necessary to make a final diagnostic decision for Class
II correction based on
1) the ANB relationship,
2) a maxillary posterior space analysis, and
3) patient cooperation.
The following guidelines are used:
1. If the maxillary third molars are missing, or if the ANB is 5° or less
and the patient is cooperative- will accomplish the best result. If
the third molars are present and are approaching eruption, they
should be removed to facilitate distal movement of the maxillary
teeth.
2. If a cooperative patient has
a) a mild Class II dental relationship,
b) a normal vertical skeletal pattern (FMA 28° or less),
c) an ANB of 5° to 8°, and
d)normally erupting maxillary third molars, the extraction of maxillary
second molars is most advantageous.
The force system is used to distalize the maxillary arch into the second
molar extraction space.
3. If
a) the ANB is greater than 10°
b) maxillary third molars are present, and/or
c) the patient's motivation is questionable, either the first molars
should be removed after maxillary and mandibular first premolar
extraction space closure, or surgical correction should be
considered.
🠶 Facial balance and harmony after correction should also be carefully
considered before making either decision.
🠶 The Class II force system cannot be used unless compliance
requirements are strictly followed by the patient.
🠶 If an attempt is made to use the Class II force system without
cooperation, the maxillary anterior teeth will be pushed forward off
the basal bone.
🠶 Patient cooperation must therefore be ensured before the use of the
Class II force system.
Orthodontic correction of the Class II dental relationship
🠶 At the end of sequential mandibular anchorage preparation, a mandibular
0.0215 X 0.028 stabilizing archwire is fabricated.
🠶 Ideal first, second, andthird order bends are incorporated into
the archwire.
🠶 Gingival spurs are soldered distal to the mandibular lateral incisors.
🠶 The wire is seated and ligated, and the terminal molar is cinched tightly
to the loop stop.
🠶 An 0.020 X 0.025 maxillary archwire with closed helical bulbous loops
bent flush against the second molar tubes is fabricated.
🠶 This archwire has ideal first and second order bends.
🠶 The molar segment has 7° of progressive lingual crown torque.
🠶 A gingival spur is attached to
thearchwire immediately distal to
the
maxillary second premolar bracket.
🠶 Gingival high pull headgear hooks are
soldered distal to the central incisors.
🠶 ClassII "lay on"hooks with a
gingival extension for anterior vertical
elastics are soldered distal to
lateral incisors.
the
🠶 The closed helical bulbous loops are
opened 1 mm on each side, and the
archwire is ligated in place.
🠶 Eight-ounce Class II elastics are worn
from the hooks on the mandibular
second molar tubes to the Class II
hooks on the maxillary archwire.
🠶 Anterior vertical elastics are worn from the spurs on the mandibular
archwire to the gingival extension hooks on the maxillary archwire.
🠶 The high-pull headgear is worn on the maxillary headgear hooks.
🠶 This force system is employed for approximately 1 month to
sequentially move the maxillary second molars distally.
🠶 At the next appointment themandibular archwire is removed and
checked and the helical bulbous loops are again activated 1 mm.
🠶 The activation of the maxillary archwire is repeated until the second
molars have a Class I dental relationship.
🠶Additionally, the Class II elastic is continuously worn
from the mandibular second molar hook to the Class II
hook on the maxillary archwire and an anterior vertical
elastic is worn 12 hours each day.
🠶The high-pull headgear is worn to the maxillary archwire
14 hours per day.
🠶This is a very efficient force system for first molar
distalization.
🠶 Four months of treatment with monthly reactivation should position
the posterior teeth in an overtreated Class I relationship.
🠶 This system will not strain the mandibular arch if the anterior
vertical elastics are worn and if sufficient space is available in the
maxillary posterior denture area.
🠶 After overcorrection of the Class II dental relationship of the
posterior teeth, a 0.020 X 0.025 maxillary archwire with 7 mm
closing loops distal to the lateral incisors is fabricated.
🠶 This archwire has ideal first, second, and third order bends. Gingival
headgear hooks are soldered distal to the central incisors.
🠶 The closing loops are opened 1 mm per visit by cinching the loop
stops to the molar tube.
🠶 The Class II force should be
milder- 4 to 6 oz instead of 6 to 8
oz.
🠶 The anterior vertical elastic and
the maxillary high-pull headgear
are used in conjunction with these
light Class II elastics.
🠶 After all the maxillary space is
closed, step of denture
the
correction has been completed,
and the dentition is ready for the
next step of treatment- denture
completion.
 DENTURE COMPLETION
🠶 Ideal first, second, and third order bends are
placed in the finishing mandibular and
maxillary 0.0215 X 0.028 resilient archwires.
🠶 The mandibular archwire duplicates the
anchorage preparation archwire used in a
Class I malocclusion or the previously used
mandibular stabilizing archwire if a Class II
force system was used.
🠶 The maxillary archwire has artistic bends
and hooks for the high-pull headgear,
anterior vertical elastics, and Class II
elastics.
🠶 Supplemental hooks for vertical elastics are
soldered as needed.
🠶 considered as "mini" treatment of the malocclusion- the orthodontist
repeats the systems of forces that are necessary until the original
malocclusion is overcorrected.
🠶 following characteristics should be readily observed:
1. The incisors must be aligned.
2. The occlusion must be overtreated to a Class I relationship.
3. The anterior teeth must be edge to edge.
4. The maxillary canines and second premolars must be locked tightly
into a Class I dental relationship.
5. The mesiobuccal cusp of the maxillary first molar must occlude in the
mesiobuccal groove of the mandibular first molar.
6. The distal cusps of the first molars as well as the second molars should
be out of occlusion.
7. All spaces must be closed tightly from the second premolars forward.
 DENTURE RECOVERY
🠶 The orthodontist should not strive for the ideal final result at the end
of treatment.
🠶 The ideal result will occur after all treatment mechanics
are discontinued and uninhibited function and other environmental
influences active in the posttreatment period stabilize and finalize
the position of the total dentition.
🠶 When all appliances are removed and the retainers are placed, the
most crucial "recovery" phase occurs.
🠶 During this recovery period, the forces involved are those of the
surrounding environment primarily the muscles & perioodontium.
🠶 Certain tooth and denture changes affected during treatment will
tend to revert toward their original position.
🠶This treatment occlusion- Tweed occlusion, but properly
identified as transitional occlusion, is characterized by
disclusion of the second molars and the distal cusps of the
first molars.
🠶This arrangement allows the muscles of mastication to
effect the greatest force on the "primary chewing table" in
the midarch area.
🠶The muscles of swallowing, expression, and mastication
are actively involved in determining the final stable,
esthetic relationship of the teeth, referred to as functional
occlusion.
🠶This concept of a transitional occlusion followed by a
period of recovery is based on the belief that each
individual's own oral environment will determine the
ultimate position of the dentition and that overtreatment
allows the patient the greatest opportunity for maximal
stability and functional efficiency.
 VARIATIONS OF THE APPLIANCE
1. Straight wire appliance (SWA) (1972)- Larry Andrews
2. Decrease in slot size from 0.022 to 0.018 inch & to 0.016
inch
ARTICLE
S
 A comparative study of anchorage in bioprogressive
versus standard edgewise treatment in class II correction
with intermaxillary elastic force

🠶 The purpose of this study was to evaluate the effectiveness of

cortical anchorage, by comparing two groups of patients with Class
II malocclusions that were treated successfully with Class II elastics.
🠶 Concluded that lower molar teeth extruded and moved mesially
equally in both groups. Although cortical anchorage did not retard
lower molar movement, it was no less effective in controlling molar
movement with a partial appliance than the fully banded standard
edgewise appliance.

Ellen EK, Schneider BJ, Sellke T. A comparative study of anchorage in bioprogressive versus standard edgewise
treatment in Class II correction with intermaxillary elastic force. Am J Orthod Dentofac Orthop. 1998;114(4):430-
 A radiographic comparison of apical root resorption after
orthodontic treatment with a standard edgewise & a straight-
wire edgewise technique

🠶 Aim: To compare the severity of apical root resorption occurring in

patients treated with a standard edgewise & a straight-wire edgewise
technique & to assess the influence of known risk factors on root
resorption incident to orthodontic treatment.
🠶 They concluded that there was significantly more apical root
resorption of both central incisors in the standard than in the
straight-wire edgewise group whereas no significant difference was
found for lateral incisors.

Mavragani M, Vergari A, Selliseth NJ, Bøe OE, Wisth PJ. A radiographic comparison of apical root resorption after
orthodontic treatment with a standard edgewise and a straight-wire edgewise technique. Eur J Orthod. 2000;22(6):665-
 Outcome of MBT and Standard Edgewise Techniques in
Treating Class I Malocclusion

🠶The aim of this study was to compare the treatment

outcome of Class I malocclusion patients treated by two
methods, including Standard Edgewise and MBT.
🠶Efficiency of two methods was favorable and post-
treatment ABO score in both groups had improved
significantly relative to pre-treatment.

Soltani M, Saedi B, Mohammadi Z. Outcome of MBT and Standard Edgewise Techniques in Treating Cl I
Malocclusion. Avicenna J Dent Res. 2018;4(2):127-31
The Effects of Different Bracket Types on Orthodontic Treatment
Evaluated with the Objective Grading System

🠶 The Objective Grading System created by the American Board of

Orthodontics (ABO) is one of the most reliable indices used to
evaluate treatment outcomes.
🠶 The aim was to determine the effects of using two different bracket
types on treatment outcomes by using the Objective Grading
System.
🠶 to the Objective Grading System, there are no
According significant differences between the orthodontic
treatment
statistically outcomes obtained using a standard edgewise or a
preadjusted Roth bracket.
Andryani S, Nazruddin N, Bahirrah S. The Effects of Different Bracket Types on Orthodontic Treatment
Evaluated with the Objective Grading System. Sci Dent J. 2019;3(1):9-16.
 CONCLUSION

🠶The standard edgewise appliance is as modern as

tomorrow and delivers a very high-quality treatment result
to each orthodontic patient.
🠶It was Angle’s greatest contribution to the specialty of
orthodontics.
🠶In today’s world of pre-adjusted appliances and temporary
anchorage devices, a knowledge of and appreciation for
the standard edgewise appliance is critical to patient care.
🠶The clinician must understand first, third, and second
order bends because no appliance is magic- no variation of
the standard appliance is magic.
🠶The “magic” lies in the proper treatment plan and in one’s
ability to use an appliance.
🠶Therefore, knowledge of how the standard appliance is
currently used is fundamental to the use of any of the
innumerable modifications that have been made to
Angle’s invention.
 REFERENCES
🠶 Graber LW, Vanarsdall RL, Vig KW, Huang GJ. Orthodontics-E-
Book: current principles
🠶 Proffit WR, Fields HW, Larson B, Sarver DM. Contemporary
orthodontics-e-book; principles and techniques. Elsevier Health
Sciences.
🠶 Vaden JL. A century of the edgewise appliance. APOS Trends
Orthod. 2015;5(6):239-49.
🠶 Andrews LF. The six keys to normal occlusion. Am J Orthod.
1972;62(3):296-309.
🠶 Andryani S, Nazruddin N, Bahirrah S. The Effects of Different
Bracket Types on Orthodontic Treatment Evaluated with the
Objective Grading System. Sci Dent J. 2019;3(1):9-16.
🠶 Greenstein AV. The tweed philosophy: An analysis. Am J
Orthod Oral Surg. 1943;29(9):527-40.
🠶 Ellen EK, Schneider BJ, Sellke T. A comparative study of anchorage
in bioprogressive versus standard edgewise treatment in Class II
correction with intermaxillary elastic force. Am J Orthod Dentofac
Orthop. 1998;114(4):430-6.
🠶 Holdaway RA. Bracket angulation as applied to the edgewise
appliance. Angle Orthod. 1952;22(4):227-36
🠶 Mavragani M, Vergari A, Selliseth NJ, Bøe OE, Wisth PJ. A
radiographic comparison of apical root resorption after orthodontic
treatment with a standard edgewise and a straight-wire edgewise
technique. Eur J Orthod. 2000;22(6):665-74.
🠶 McGuinness NJ. Standard edgewise technique and its relevance in
contemporary fixed appliance therapy part 1. Orthod Upd.
2010;3(3):76-80.
🠶 McGuinness NJ. Standard edgewise technique and its relevance in
contemporary fixed appliance therapy part 2. Orthod Upd.
2010;3(4):110-4.
🠶 McLaughlin RP, Bennett JC. Evolution of treatment mechanics and
contemporary appliance design in orthodontics: a 40-year
perspective. Am J Orthod Dentofac Orthop. 2015;147(6):654-62.
🠶 Soltani M, Saedi B, Mohammadi Z. Outcome of MBT and Standard
Edgewise Techniques in Treating Cl I Malocclusion. Avicenna J
Dent Res. 2018;4(2):127-31.
🠶 Terwilliger GH. The development of the edgewise arch mechanism
and its place in contemporary orthodontics. Am J Orthod Dentofac
Orthop. 1951;37(9):670-8.
🠶 Tweed CH. Clinical orthodontics. CV Mosby; 1966.
THANK
YOU