Professional Documents
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Torque in Orthodontics
Torque in Orthodontics
MORNING
TORQUE IN
ORTHODONTICS
Introduction
WHY……….?
WHEN…………….?
& HOW…………?
why torque is necessary ……?
To bring about labiolingual movement of
the teeth
To retain the teeth in the cortical bone
To avoid relapse
To give a natural finish to the dentition
When.....?
When there is uncontrolled tipping of the
crown
In third order bends of finishing and artistic
positioning in a pre adjusted edgewise system.
In pre surgical and post surgical phases for
the precise placement for axial inclination of
teeth
As a device to augment anchorage demands
of that particular situation.
How…..?
Torque can be done both in fixed and removable
machanotherapies
Torque in fixed appliance can be employed in
different ways
1. By giving a twist in an arch wire
– commonly used in edgewise techniques
2. Torque exerted by the bracket itself
– Pre adjusted edgewise appliance
3. By use of torquing auxiliary
- widely used in Beggs technique and edgewise
technique.
ARMAMENTARIUM:
METHODS OF
TORQUING IN
VARIOUS APPLIANCE
MECHANICS
EDGEWISE
MACHANOTHERAPY :
The edgewise arch appliance is the last
of many contributions of Dr.EDWARD H.
ANGLE and was introduced to the
profession by one of his last students,
Dr.ALLAN G. BROADIE in 1929. It is an
exacting appliance requiring the thorough
understanding and skill manipulation.
This technique offers excellent controls in
the labiolingual, mesiodistal and vertical
dimension
The classification of tooth movement
associated with edgewise appliance seem to
be based upon the type of movements
rather than direction.
i. Movement of the First order
ii. Movement of the Second order
iii. Movement of the third order
We will see here movement of the Third
Order
Continuous Progressive
Continuous
posterior torque
Progressive Posterior Root Torque
Brodie first called attention to the fact
that, in order to have mass torque action in
the buccal segment, progressive torque is
necessary; otherwise, when the wire is
inserted in the bracket of the cuspid tooth,
the bracket removes the torque action
from the teeth distal to the cuspid tooth,
and the wire lies passive in the brackets of
each succeeding tooth until the cuspid tooth
movement has been accomplished.
TORQUE
IN THE
PRE ADJUSTED
EDGEWISE
APPLIANCE
PRE ADJUSTED EDGEWISE
APPLIANCE:
Until the mind 1970’s most fixed appliance therapy
was carried out using the standard Edgewise bracket,
either in a single or twin from having a 900 bracket
base and brackets slot angulation.
The Major disadvantage resulted from this treatment
are;
1. Arch wire bending is time consuming and tedious.
The short comings of the bracket system and the
extreme skill required of the orthodontists resulted in
many under treated cases and the results are
appeared artificial
Molars were not in true CL-I relationship. Upper
incisor are under torqued . So the resulting
occlusion had the appearance of a ‘nice orthodontic
result’ rather that a pleasing natural dentition. And
also the long term stability of tooth adjustment was
compromised by failing to establish ideal tooth
relationships.
Against this background Dr.Lawrence F.Andrews
developed the straight wire appliance which
became widely available in the mid 1970’s. It was
hailed by the clinician’s as a radical step forward
offering the dual advantages of less wire bending,
coupled with an improved quality of the finished
cases
TORQUE IN FACE VS TORQUE IN BASE
Torque in base was an important issue with the 1st and 2nd generation PEA brackets
because level slot line up was not possible with brackets designed with torque in the
face.
Torque in base ,as said by Andrews, is a pre requisite for a fully programmed
appliance.
Albert H Owen (1980) conducted a study comparing Roth prescription and Vari
Simplex Discipline. He concluded that while torque in base had a strong theoretical
basis, its effectiveness is greatly influenced by clinician’s success in accurately placing
brackets.
Torque in base means
that bracket stem is
parallel and coincides
with long axis of bracket
slot
The torque in face, slot
is cut at an angle to the
bracket stem. The long
axis of slot does not
coincide with bracket
system.
UNDESIRABLE EFFECTS OF HAVING TORQUE IN THE
FACE:
i) Bracket having torque in the face affects the
final vertical positioning of tooth.
ii) Level slot line up is not possible.
iii) Bracket wings could bend or distort under
various forces of ligation.
7 6 5 4 3 2 1
-35 ° -30 ° -22 ° -17 ° -11 ° -1 ° -1 ° Lower
7 6 5 4 3 2 1
124
Round wire approach: (0.022 inch wire)
Patients who doesnot requires molar torque
Selective labiolingual root position of the tooth
In severe AP discrepancy to maintain the
compensating labiolingual inclinations.
Side-winder springs
125
Niti torquing Bars: They are formed in 18*22
with 30 torque.
132
Diamond Twin Bracket
Lang Bracket
Lewis Bracket
133
Rectangular multistranded arch wire was used
from initial point of treatment itself.
-3 Torque in maxillary canine compared to –7
to +7 in Andrews’s prescription eliminate the
need for adjusting torque through wire bending
during treatment.
-5 Lower incisors torque prevents labial
flaring of incisors.
When omega loop was used in mandibular 2nd
molar, to prevent gingival impingement bend
was placed in the wire which automatically
incorporates torque. So additional torque was
not necessary in 2nd molar. . 134
Bio-progressive therapy
The Standard Bioprogressive appliance was introduced in 1962.
135
This system was based on sectional arch treatment
in which the buccal segments are handled
separately from the incisors for better torque
control. It includes all cases whether non-
extraction, or extraction treatment.
Torque control throughout treatment is one of
the basic principle of this technique. The Full
Torque Bioprogressive appliance adds additional
torque to the original Standard Bioprogressive
setup to over torque the tooth at the time of band
removal to settle in to functional occlusion.
136
In this technique the lower first molar is
rotated disto-lingually, tipped distally, expanded,
and torqued (buccal root torque) so that the roots
come to lie beneath the adjacent buccal cortical
bone. This is called as “cortical anchorage.” This
is an area that exhibits a greater bone density
because of the external oblique line of the
mandible and decreased vascularity. By placing
the roots of the lower first molar adjacent to the
more dense cortical bone, anchorage is believed to
be enhanced, thereby minimizing movement of the
molar teeth. So Torque value of –27 in molar is
used. 137
Upper buccal segment should have 10° of buccal
root torque to compensate for the occlusogingival
curvature of the crowns of these teeth.
The lower molar cannot differentiate between
buccal root and lingual crown torque ,when a 45°
buccal root torque is placed on the distal legs of
the utility arch. The only way that buccal root
torque can be expressed by buccal movement of
the root and stabilization of the crown is by
expansion of the arch. This is not only for cortical
bone support to the lower molar (anchorage) but
also for regulating or allowing normal arch width.
138
Utility arch is designed to avoid contact on
cortical bone on the lingual surface of the lower
incisor roots during their intrusion by placing 15°-20°
buccal root torque
Cuspid Torque: +70
There is a mechanical tendency to detorque the
upper cuspids as they are retracted in extraction
cases. Because the dense cortical plate surrounding
the upper cuspids is particularly corrugated
(especially in adults), it is difficult to retract the
cuspids without impacting the root on the labial
plate. It is mechanically more efficient to keep the
root of the cuspid in the cortical trough when moving
it distally when using +70 torque. .
139
Parkhouse in AJO 1998 evaluated
bioproggresive therapy and tweed appliance result and
stability after 5 years of post retention. The result
showed both cause molar extrusion and are stable.
Incisor intrusion was more and clinically significant in
bioprogressive theraphy
Elizabeth and Bernard AJO 1998 done a
comparative study of anchorage in bioprogressive
versus standard edgewise treatment in Class II
correction with Class II Elastics and showed cortical
anchorage did not resist the side effects of Class II
elastics more effectively than standard edgewise
anchorage preparation.
140
Torque control in lingual
orthodontics
Torque control in lingual
orthodontics
Decreased arch radius, decreased interbracket
distance, compound lingual geometry, highly
variable tooth morphology, and limited access and
visibility all combine to make accurate torque
control exceedingly difficult with a lingual
appliance.
Early torque control becomes more important with
lingual brackets, because minor differences in
labiolingual long axis inclinations of the incisors will
show up as apparent height differences.
It can be disconcerting when a patient complains
that incisor alignment is getting worse,
The TARG (Torque and
Angulation Reference
Guide) instrumentation is
designed to transfer
bracket prescriptions from
the more reliable labial
surfaces of each tooth to the
lingual at a given bracket
height.
This is in effect a method of
doing a diagnostic set-up
without sectioning the
model, and it allows the
laboratory technician to set
customized torque and
angulations for each
individual prescription.
For example, a Class II, division 2 case
requiring additional torque in the
maxillary anteriors is so noted on the
prescription.
The technician then "dials" in the
prescribed torque on the TARG, locating
the lingual bracket at an increased torque
angle from the averaged bracket values.
The fit of the lingual bracket base is then
compensated for with the Advance
adhesive.
Torquing of maxillary
and mandibular
anterior teeth requires
special consideration.
The first is the use of a
torquing auxiliary like
the ones used in
conventional Begg
mechanotherapy where
the application of force
on the tooth is at the
incisal edge.
The second is the use of a
torqued ribbon arch. It
provides approximately 45
degrees of torque for the
mandibular anterior teeth
and 30 degrees for the
maxillary anterior teeth.
When the ribbon arch
passes the cuspid-bicuspid
inset, it will naturally
transition to approximately
90 degrees for the buccal
segments.
Beta titanium, stainless steel, and Elgiloy
rectangular wire may also be very useful for
this purpose.
Hocevar has stated that the use of the ribbon
arch is effective for torquing of maxillary
anterior teeth, and it has the advantage of
being more gentle in the buccolingual
directions, a very important advantage with
lingual orthodontic treatment.
Torquing With Removable
Appliances
Torquing With Removable
Appliances
Many simple malocclusions can be treated with
removable appliances; but, since removable
appliances are only capable of tipping crowns, it
has not been possible to torque roots, particularly
in cases with spacing of anterior teeth. In these
cases, spaces can be closed effectively with
removable appliances, but the anterior teeth have
labial root prominence at the end of treatment.
To avoid this problem and the need for a fixed
appliance to correct it, a new technique was
developed for root tipping of anterior teeth with
removable appliances
A removable appliance is constructed in a
conventional manner, with Adams clasps on
first permanent molars and triangular clasps
between first and second premolars, for
additional anchorage and to combat leverage
in the anterior region.
The labial bow was made
with 0.7mm Dentaurum
wire. After curing the
plastic, the midline of the
labial bow was marked
with a fine file. A small
(0.6mm) wire lug was
soldered gingivally to
this mark, taking care
not to anneal the labial
wire.
A torquing spring of 0.4mm
spring wire was constructed by
winding the wire
Winding must be started from the
central lug. The finished loops are
lingually inclined. The distal ends
of the loops are not soldered or
welded to the labial bow. Force is
generated from the central lug,
which resists the activation of the
loops.
When the appliance is placed in
the mouth, the loops exert
pressure on the cervical third of
the crown. The tip of the crown is
prevented from coming labially by
the labial bow. Thus, movement is
restricted to lingual root tipping.
Torque considerations in adults