The Roth Prescription / Orthodontic Courses by Indian Dental Academy

Functional Occlusion
&
Roths treatment mechanics

INDIAN DENTAL ACADEMY

Leader in continuing dental education
www.indiandentalacademy.com


Pleasing facial esthetics, evaluated by soft tissue and
skeletal measurements cephalometrically.

Molar relation and tooth alignment, evaluated by
Angle's description of anatomical occlusion.

Functional occlusion, evaluated gnathologically on an
articulator.

Stability of post-treatment tooth positions and
alignment.

Comfort, efficiency, and longevity of the dentition,
supporting structures, and the temporomandibular
joints.

Roths :

Belief that functional dynamics of
occlusion is important for stability


The condyles should be centered transversely and
seated against the articular disks at the superior and
posterior slope of the articular eminences when the
teeth reach maximum intercuspation,

The anterior teeth should serve as a gentle glide path
to disoclude the posterior teeth but immediately upon
all movement away from full closure.

On full closure the posterior teeth should have equal &
even contact of centric cusps,

The forces being directed as nearly as possible down
their long axes ,

The anterior teeth should not actually be in contact
but should have 0.005 inch of clearance.
Three parts -
1. On normal closure in centric relation
2. Protrusive movement
3. Lateral movement

Class I occlusion at centric

Simultaneous contact of all posterior teeth with force
directed down the long axis of the posterior teeth

0.005 clearance of anteriors

CO = CR

Mandible is not in centric when.

Occlusal wear
Excessive tooth mobility
TMJ sounds
Limitation of mouth opening
Myofacial pain
Tightness of mandibular musculature

Anteriors must gently
disocclude posteriors
Sufficient overjet and bite
Occlusion U- 6 anteriors
with L-6 ant and 1
st
PMs
14 teeth bear the stress

Mutually protected
occlusion
Cuspids main guiding
inclines
U canine cusp tips ride on
disto-incisal incline of L
canine.
All other teeth lifted out of
occlusion

Cuspid Guidance

The distal surface of the distal marginal
ridge of the upper 1st permanent molar
contacts and occludes with the mesial
surface of the mesial marginal ridge of
the lower 2
nd
molar.

The mesio-buccal cusp of the upper 1st
permanent molar falls within the
groove between the mesial and middle
cusps of the lower 1
st
permanent molar.

The mesio-lingual cusp of the upper first
molar seats in the central fossa of the
lower 1
st
molar.


Crown inclination is the angle
between a line 90 degrees to
the occlusal plane and a line
tangent to the middle of the
labial or buccal clinical crown.

Anterior crowns central and lateral incisors: In upper
incisors the occlusal portion of the crown's labial surface is
labial to the gingival portion & in all other crowns the
occlusal portion of the labial or buccal surface is lingual to
the gingival portion.

In the nonorthodontic normal models the average inter-
incisal crown angle is 174 degrees.

Upper posterior crowns (cuspids - molars): Lingual crown
inclination is slightly more pronounced in the molars than
in cuspids and bicuspids.

Lower posterior crowns (cuspids -molars): Lingual
inclination progressively increases
In normally occluded teeth
the gingival portion of the
long axis of each crown is
distal to the occlusal
portion of that axis. The
degree of tip varies with
each tooth type.

Teeth should be free of undesirable
rotations.
Rotated molar or bicuspid occupies
more space than normally.
A rotated incisor can occupy less
space than normal.

Measured from the most
prominent-cusp of lower
second molar to the lower
central incisor.
A deep curve of Spee results
in a more confined area for
the upper teeth creating
spillage of upper teeth
mesially and distally.
A flat curve of Spee is most
receptive to normal occlusion.
A reverse curve of Spee
results in excessive room for
the upper teeth

Lower incisors at the cephalometric goal (+ 1 to A-Po);
for facial esthetics, for planning anchorage control,
and for selecting the most appropriate mechanics to
reach this goal.

Tips of the upper incisors 2-2.5mm below the lip
embrasure of the upper and lower lips, when the lips
are closed with no lip strain.

No more than 1 mm of attached gingiva showing upon
a full smile.

Approximately a 2.5mm overjet-overbite relationship
at the tip of the upper incisor in its relationship to the
lower incisor.

(The lower incisor would have .0005" clearance with
the lingual surface of the upper incisor, but the
articulating paper mark would occur 2.5mm gingival to
the incisal edge of the upper incisors.)

A level or nearly level occlusal plane, at the end of
appliance therapy that would return to a 1 to 1.5mm
curve, at its deepest point, after appliance removal and
settling of the occlusion.

A curve of Wilson that would allow seating of centric
cusps, but clearance upon excursions.
As much divergence as possible of the occlusal plane
from the angle of the eminence for excursive clearance.

Lower incisors aligned contact point-to-contact point
with the roots in the same plane, when observed from
the occlusal, and a mesioaxial inclination of 2 degrees.

Lower cuspid crowns angulated mesially 5 degrees,
with the incisal tip lmm higher than the incisal edge of
the lateral incisors.
{Note :The lower cuspids should have a slightly
exaggerated mesial rotation on extraction cases.}

The lower bicuspids should be uprighted 1 degree
from their normal mesial inclination and should have
a slight distal rotation (more so on an extraction case).
The contact point should be adjacent to the contact
point on the lower cuspid distal surface.

The lower molars should be uprighted 1 degree from
their normal 2-degree mesial inclination and should
have a slight distal rotation.

The lower buccal segment should have progressive
torque close to Andrews
'
measurements for
establishing the curve of Wilson, and there should be
no rotations or spaces.

The upper six-year molars should have sufficient distal
rotation, mesioaxial inclination, and buccal root
torque, so as to fit with the lower six-year molars, as
described by Andrews.

The same would follow for the upper second molars.
The torque requirement would be what is required for
the seating of the centric cusps, approximately 14
degrees torque and 0 degrees mesial inclination.

The upper bicuspids should be uprighted to 0 degrees
from their normal 2-degree mesial inclination, with no
rotation, except for some distal rotation in an
extraction case

The upper cuspid must have its contact points
adjacent to the contact points of the upper bicuspid
and lateral incisor, to establish proper length for
cuspid guidance. It should have 11 to 13 degrees of
mesial crown tip, and mesial rotation of 4 degrees, on
an extraction case..
The upper lateral and central incisors should be
almost equal in incisal edge length, with no more than
O.5mm height differential.

They should have 9 degrees and 5 degrees mesioaxial
inclination respectively, and there should be sufficient
torque so that the six upper anterior teeth can contact
the six lower anterior teeth and the upper cuspids can
lift off the lower bicuspids in a protrusive excursion.
There should be no rotations (other than those for
overcorrection) or spaces in the upper arch, and the
buccal segments from the cuspids distally should have
14 degrees nonprogressive buccal root torque.

The arch form should be a modified catenary curve
consisting of five separate radii
one for the front of the arch form,
one for each cuspid-bicuspid area and
one for each buccal segment from the
first bicuspid distally.

The widest point of the lower arch would be at the
mesiobuccal cusp of the mandibular first molars and
at the first bicuspids.
The widest point of the maxillary arch would be at the
mesiobuccal cusps of the first molars.

Correction of crossbites.
Reduction of jaw relationship (orthopedic correction).
Elimination of crowding.
Establishment of space for severely malposed teeth
Consolidation of the lower arch.
Levelling of the curve of Spee.
Finishing of the lower arch.

Overcorrection of buccal segments, curve of Spee,
rotations, and root positions at extraction sites

Establishment of the desired molar and buccal
segment relationship.

Consolidation of maxillary space and retraction and/or
intrusion of the maxillary anteriors.

Positioning and torque of maxillary anteriors, to allow
them to occupy sufficient space to encase the lower
arch and still maintain functional overbite.

Final detailing of tooth positions. (This should entail
only minor, rapidly executed movements such as
vertical height, minor rotation, and in-out).

It is of so importance that the lower
arch must be finished and in the
correct position to act as a template to
receive the upper teeth, so that the
upper teeth can be set to the lowers.
Each tooth must be considered individually, as the
position of each tooth affects the positions of all the
other teeth.

Regardless of the type of attachments, bracket
placement is of more importance in achieving a good
occlusal intercuspation.

Improperly placed brackets should be corrected at the
earliest possible time during the course of treatment
Twelve-year molars are the teeth most commonly
involved in occlusal interference .

It is therefore, important to see that these teeth are
placed in proper positions.

So it is important to band all 2
nd
molars.
Normally tipped incisors
occupy more space than those
that are straight up and down
Torqued incisors describe the
arc of a bigger circle than those
that are not and cuspids that
have their contact areas gingival
to the adjacent contact points of
the bicuspids and lateral
incisors may take up less space
in the arch than they ought to.

Rotations to the mesial cause upper molars to take up
too much space in the arch and cause the buccal
segments to fit more Class II.

Insufficient buccal root torque of upper molars makes
for balancing and centric interferences.

One of the greatest problems in attempting to treat
orthodontically to centric relation is that of avoiding
extrusion of the posterior teeth and encouraging excess
vertical alveolar growth, thus creating a molar fulcrum.
When the fulcrum has been created, one of two things
occurs:
1. Appearance of an anterior open bite through the bicuspids
and development of a tongue-thrust swallow.
2. No open bite, but clicking of the TMJ's and/or a tightness
or stiffness of the mandibular musculature, usually
associated with pain or discomfort of any combination of
mandibular muscles.
The fulcrum effect can
be observed on
cephalometric
laminagraphs showing
the condyles being
projected downward and
distally towards the
tympanic plates as the
teeth are closed into
habitual centric
occlusion

ROTHS PRESCRIPTION
AND
TREATMENT MECHANICS
Roth
Andrews
The use of straight wire appliance & the manner in
which teeth are moved.

Andrews attempted to translate teeth throughout
treatment without ever tipping teeth.

This leads to the necessity of utilizing sliding
mechanics & a number of different series of brackets
to solve the problem of translating teeth.
In the Roth approach, tipping of teeth is allowed but
the attempt is to keep it minimum so that no complex
mechanics requires to upright teeth.
Too many brackets in Andrews prescription
Translation friction
Overcorrection
One prescription for all his patients
Tooth II
molar
I Molar II PM I PM Canine Lateral Central
Maxilla 0/-14
(14
o

offset)
0/-14
(14
o

offset)
0/-7 0/-7 9/-2 9/8 5/12
Mand. 0/-30
4
o
offset
1/-30
4
o
offset
0/-22 0/-17 7/-11 0/0 0/0
Lower cuspid crowns angulated mesially 5 degrees,
with the incisal tip lmm higher than the incisal edge of
the lateral incisors.
{Note :The lower cuspids should have a slightly
exaggerated mesial rotation on extraction cases.}

The lower bicuspids should be uprighted 1 degree
from their normal mesial inclination and should have
a slight distal rotation (more so on an extraction case).
The contact point should be adjacent to the contact
point on the lower cuspid distal surface.


The upper bicuspids should be uprighted to 0 degrees
from their normal 2-degree mesial inclination, with no
rotation, except for some distal rotation in an
extraction case

The upper cuspid must have its contact points
adjacent to the contact points of the upper bicuspid
and lateral incisor, to establish proper length for
cuspid guidance. It should have 11 to 13 degrees of
mesial crown tip, and mesial rotation of 4 degrees, on
an extraction case..
5
o
more torque in upper incisors.
Less torque in upper canines.
2
o
more tip in canines.
2
o
anti-rotation in canines and PMs.
Upright posterior segments.
Over-correction of U molar offset and torque.

Lower posteriors
3
o
distal tip.
Distal rotation.
Molar tubes with no upper molar offset
Super torque anterior brackets
Canines with 0
o
tip

Bracket placement as advocated by Andrews FACC
except
Upper anteriors and lower incisors bonded more
incisally .
Lower canines bonded slightly more gingivally.
In addition, the maxillary central incisors should be
bracketed at equal height to lateral incisors.

Archform Truarch
Flatter anteriorly
Sharp curve in Canine PM
region
Gentle curve at posterior legs

Roths treatment mechanics
Ricketts VTO with the centric relation adjusted head
film tracing

Jarabak analysis
Repositioning of the mandible on
the tracing
Depend upon type treatment mechanics.

0.022 slot is better
Wire size selection
Control of torque in buccal segment
In terms of stabilizing arches as anchor units &
For orthognathic surgery.

1. Correction of Crossbites
2. Correction of jaw relations
3. Eliminate severe crowding
4. Create space in the arch for severely
malposed/impaced teeth
5. Alignment of teeth in the individual arches
6. Begin space closure
7. Finish the lower arch
8. Achieve class I relationship of the buccal segments
9. Retract and intrude maxillary anterior teeth.
10. finishing and detailing

3 phases
1. Unlocking phase
2. Working phase
3. Finishing phase
Major corrections
Cross bites
Severely malposed teeth

Use of RME, Quadhelix, Bimetric arches &
Utility arches.
Jarabak helical loops in light wire
Braided wires

Jarabak light wire helical loops
Main objective
Gross corrections
Alignment with flexible wires so that heavier wires
can be used later.

Closure of extraction site
Correct a-p jaw relation
& dental relation
Intrusion, if required.

Space closure with
Double keyhole loop
Introduced by John Parker.

19x26 mil rounded
edge rectangular wire

Double keyhole loop
Space closure with one wire
Medium between tipping and translation
Permit either anterior retraction or posterior
protraction.
Control of canine rotation
Used as elastic hooks.

Asher face bow for retracting anteriors en masse.
12 15 oz of force for upper anteriors.

Some tipping occurs after space closure
18x25 blue Elgiloy heat treated with COS
0.018 steel special plus
16 x 22 yellow Elgiloy 2 turn helix

0.018 steel special plus

18x25 blue Elgiloy heat treated with COS
16 x 22 yellow Elgiloy 2 turn helix

After uprighting
21 x 25 SS wire with only archform.
Occasionally 22 x 28 SS wire.

High angle cases
Avoid heavy wires max use of Nitinol and TMA and
braided wires
Space closure on 0.016 SS wire
Uprighting with 19x25 TMA/Nitinol/braided wire

Bimax cases
Initial space closure with 0.018 or 0.020 wire with
double keyhole loops
Once teeth are upright intrude with Utility arch
Continue space closure with 19x26 double keyhole loops
and Asher face bow

Maximum retraction and torque control
21 x 25 SS or Elgiloy double keyhole loops
Maximum torque control
Reduce posterior ends

Place full sized wires and let brackets express
Drop to braided settling elastics
Short Class IIs- minimum extrusion.

Factors that result in mesial migration of molars

Heavy wires for leveling COS
Attempts to gain rapid alignment with heavy wires
Uprighting distally tipped canines
Lingual root torque of max. incisors
Arch expansion with labial archwire
Retracting extremely procumbent anterior teeth

Procumbent teeth offer a lot of anchorage
Once teeth are upright, they retract easily.

Space closure can be done on any wire, as long as it is
done slowly.


Thank you

For more details please visit

The Roth Prescription / Orthodontic Courses by Indian Dental Academy

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

The Roth Prescription / Orthodontic Courses by Indian Dental Academy

Uploaded by

Copyright:

Available Formats

Functional Occlusion

You might also like