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Standard Edgewise 2.6.2020
Standard Edgewise 2.6.2020
TECHNIQUE
Presented by:
Dr. Nikita Gupta
JR-II
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
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
Treatment initiated after eruption of canines & premolars
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 dimension
maxillary working wire.
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
malocclusion. Tweed used 0.0215×0.028 rectangular
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, torque or variations in thickness are present 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
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
A radiographic comparison of apical root resorption after
orthodontic treatment with a standard edgewise & a straight-
wire edgewise technique
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
Outcome of MBT and Standard Edgewise Techniques in
Treating Class I Malocclusion
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