Join me for part 1 of Adith’s lecture looking at the vertical dimension in orthodontics and its management.

Part 1 looks at 3 cases with vertical management through TADs, TPAs and a re-visit of the management of the Curve of Spee.

1st case TADs for extraction of 4s case

· Without TADs can result in ‘bowing effect’ – extrusion of incisors and molars.

· TAD placed between the upper 5- 6 root

o Direct retraction of the labial segment to the TAD

o Ligature wire from TAD to archwire 5-6 region, to prevent molar extrusion

2nd case low TPA

o ‘Low’ TPA =  5mm clearance from the palate

o Tongue presses on TPA resulting in intrusive force to molars

o Swallow 800/day = 500gm intermittent force

o Not enough force to intrude, but enough to provide vertical anchorage (i.e. prevent molar extrusion)

3rd case Curve of Spee

1. High angle =  Weak muscles = COS levels with posterior eruption.

§ Tailored COS treatment = Intrude the incisors

2. Low angle  = Strong muscles = COS levels with anterior proclination (due to posterior teeth prevented from erupting with strong muscles)

§ Tailored COS treatment = extrusion of posterior teeth

One piece intrusion arch

o TAD in upper 1-1 region and in 5-6 region

o Sectional 19x25ss archwire in upper 2-2 brackets

1. Powerchain from archwire to anterior TAD

Three piece intrusion arch

o TAD in upper 1-1 region and in 5-6 region, with ligature wire from TAD to archwire in 5-6 region

o Sectional archwire in upper 2-2 brackets with distal hooks, as well as sectional wire 3-6

o Intrusion:

o Powerchain from archwire to anterior TAD

o Powerchain from distal hooks (distal to U2s) to TAD U5-6 region

Retention tip for anterior intrusion

o Leave TAD between upper anterior teeth

o Lingual button in VFR

o Patient wears light elastic 2Oz from labial TAD over the incisal edge and VFR to the lingual button

References

Venugopal, A., Manzano, P. and Rengalakshmi, S., 2020. A Novel Temporary Anchorage Device Aided Sectional Mechanics for Simultaneous Orthodontic Retraction and Intrusion. Case Reports in Dentistry, 2020.

Venugopal, A., 2020. Interarch traction for impacted canines. APOS Trends in Orthodontics, 10(1), pp.60-61.

Venugopal, A., Manzano, P., Arnold, J., Ludwig, B. and Vaid, N.R., 2020. Treating a severe iatrogenic gingival exposure and lip incompetence–a challenge worthwhile. International orthodontics.