Roth philosophy /certified fixed orthodontic courses by Indian dental academy

THE ROTH PHILOSOPHY
INDIAN DENTAL ACADEMY
Leader in continuing dental education
www.indiandentalacademy.com


In 1968, R . H ROTH was introduced to Dr. L.F. ANDREWS of
San Diego
Roth started using straight wire appliance in his practice in 1970
when Andrews gave him the first set of prototype brackets that
were welded into pinched band material and had been machined
at great expense.
After seeing the treatment progress of the first patient, he
purchased the first commercially available Andrews brackets and
started all his new cases with SWA.
By the mid 1973,he switched his entire practice over to the SWA
and rebonded all the patients who still had edgewise brackets.

He did extensive work in Andrews SWA and published two
articles namely
1.Five year clinical evaluation of Andrews SW appliance.(1976 jco)
2.The SW appliance 17 years later (1987 jco).
He started designing his own prescription as a clinical trial and
error evaluation that lasted severed years.
Cases were evaluated by the use of
•Intra oral photograph and
•Mounted models for tooth positions
During treatment and
At the end of appliance therapy

According to him teeth tend to relapse back from which they
started, and if counter-tip, counter-rotation, counter-torque, and
leveling of the curve of Spee were applied to the SWA in every
possible direction, then it should be possible to use primarily
one prescription for most cases, and to finish to an "END OF
APPLIANCE THERAPY"

goal in which all tooth positions are

slightly overcorrected and from which the teeth will most likely
settle into non-orthodontic normal positions

So with the concept of overcorrection he designed his comprehensive
prescription using the available Andrews extraction brackets.

THE ROTH Rx

In 1979, Roth introduced a
bracket setup containing
modifications of the tip,
torque, rotations and in out
movement of the Andrews
standard setup brackets.
Ronald H. Roth

The major difference between the Andrews philosophy and the
Roth approach to the use of the straight wire appliance has to do
with the manner in which the teeth are moved and not necessarily the
desired end result or the result attained.
ANDREWS attempts to translate teeth throughout treatment
without ever tipping teeth. This leads to the necessity of utilizing
sliding mechanics and number of different series of brackets to
solve the problem of translating teeth depending on how far the
teeth must be moved.
In the ROTH approach, tipping of teeth is allowed, by using
round wires in the initial phase of the treatment, but the attempt is
to keep the tipping to a minimum wherein it is not necessary to
resort to complex mechanics to do the uprighting

Andrews' occlusion study was based purely upon anatomical
measurements of tooth positions on untreated normals.
According to him teeth should be positioned from an
“ANATOMICAL STANDPOINT’”
Roth’s occlusion study was based purely upon pantographically
recorded and mounted a large number of post-treatment
orthodontic cases on the Stuart articulator
According to him natural teeth should be positioned from a
“GNATHOLOGICAL STANDPOINT”


Andrews SW appliance…..
Andrews collected 120 Non orthodontic models. He studied these
models anatomically and laid down his “six keys to normal
occlusion”
I MOLAR RELATION

IV ROTATIONS

II CROWN ANGULATION

V TIGHT CONTACTS

III CROWN INCLINATION

VI CURVE OF SPEE

•After determining the “six keys to normal occlusion” he made
certain measurements in the non orthodontic models which
helped him in the development of SWA
Andrews original standard straight wire brackets were designed
to treat only non extraction cases with an ANB differential of less
than 5º without the necessity of putting offset bends into the wire.

Then he introduced the extraction brackets which had counter tip
and counter rotations built in, to allow translation of teeth as much
as possible and to offset any relapse tendency.
Later he introduced different series and sets of brackets for
different combinations of extractions, and differentials, and
anchorage requirement
He developed a special classification of malocclusion and
prescribed various bracket series for treatment of each, to allow
translation of teeth without the need for bending offsets and also
to allow for over correction in view of relapse tendencies.

-

what made roth to modify Andrews SW appliance

Inventory problem-To treat different cases clinicians were to
buy band kits for all Andrews sets and series. They are very
extensive inventory on the self. Also, changing anything about
the appliances would be prohibitively expensive.
Anchorage loss -When mesially angulated brackets are placed
on the posterior teeth, the teeth tend to tip mesially and migrate
forward that resulted is anchorage loss.
Problem in finishing - To achieve desired tooth positions with
the standard SWA, it was necessary to finish the
mechanotherapy phase of treatment by placing compensating
and reverse curve in the upper and lower archwire.

Roth's rationale for his bracket set up.
The purpose of the Roth setup was to provide over corrected
tooth positions prior to appliance removal that would allow the
teeth in most instances to settle to what was found is non
orthodontic normals studied by Andrews.
•With the appliance in place, it is virtually impossible, because of
bracket interference, to position the teeth precisely into the
occlusion shown by the non orthodontic normal sample.
•After appliance removal no matter how well treated the patient
may be, the teeth will shift slightly from the positions they
occupied at the time the appliance were removed

•Play or tipping freedom - Due to the play between the archwire
and bracket, the delivered tip, torque and rotations forces are less
than the designated amount “built in” the slot which need over
correction to compensates for play.
•The curve of Spee will return or deepen after appliance removal.
•Teeth adjacent to an extraction site will tend to rotate and tip
towards the extraction site.
•As teeth in the buccal segments settle they will rotate and tip
mesially, so if they are overcorrected and slightly tipped distally,
they will tend to settle better than teeth that are already mesially
inclined.
•As band spaces close, there is a corresponding loss of torque of
the anterior teeth.

OVERCORRECTION
Extracted teeth with Roth Rx
SWA brackets, showing over
correction built in to the
brackets

Extracted teeth with Andrews
SWA brackets showing non –
orthodontic normal tooth
position.


ROTH CONCEPT OF SELECTION OF TREATMENT
MECHANICS
Thorough diagnosis
Establishing treatment goals

Dynamic treatment planning


The traditional method of selecting treatment mechanics,
based on the Angle's classification of malocclusion, is
inadequate.
Treatment mechanics should be selected by the set of
conditions that exist along with the parameters that are
placed on the situation. (The treatment mechanics must
be tailored to the individual situation and the individual
facial type).

•In diagnosis and treatment planning, it is necessary to diagnose
the case from a mandibular position of centric relation, if one
wish to treat centric relation occlusion.
•One must utilize a specific set of criteria for a functional
occlusion goal throughout diagnosis, treatment planning, and
retention
•One must have records. (Standard orthodontic models and
cephalometric centric relation head films) taken in centric relation
as well, if any significant centric discrepancy exists in a particular
case

CO - CR discrepancy
The neuromuscular positioning of the mandible will
accommodate to existing occlusal discrepancies and hide the true
nature of malocclusion
So a REPOSITIONING SPLINT should be fabricated
•To get the patient's mandible into centric and
•To make the true discrepancy apparent.
Once the discrepancies are apparent, one should make a treatment
plan to deal with all of the discrepancies present in the case and
not just one to cover only those discrepancies he can see
intraorally.

TREATMENT MECHANIC

•Those that are used on
normal to brachyfacial
types.

Those that are used for
the more dolichofacial
types


TREATMENT MECHANIC SELECTIONS - FACTORS TO BE
CONSIDERED.
•The facial type of an individuals.
•Reactions of various facial types to the proposed treatment.
•How much growth remains and in which direction the mandible
can be expected to grow and what means must be taken to alter
the direction of this growth - favourably with treatment
mechanics.
•Effect of treatment mechanics on the patient's soft tissue profile.


TO PLAN AND TO SELECT APPROPRIATE
TREATMENT MECHANICS, ROTH UTILIZED.
•An adjusted head film tracing from centric (habitual)
occlusion to centric relation.

•Ricketts VTO and
•The five position superimposition
•Jarabak analysis
.


The five position superimposition is utilised to quantify
•The amount of growth needed to correct the jaw relationship.
•The amount of orthopedic changes or jaw relationship changes
necessary to correct the dental arch relationship and
•The extent of tooth movement allowable or desirable both
anteroposteriorly and vertically of the anterior and posterior teeth
in each arch.


Jarabak analysis
For qualitative assessment of the facial type and its probable
response to the various kinds of treatment mechanics and growth.

The most important measurementsare
•The anterior to posterior face height ratio,
•The tendency of the individual facial type
to rotate clockwise or counter clockwise
during growth, and
•a response to certain treatment mechanics

Treatment goals
1. Pleasing facial esthetics, evaluated by soft tissue and skeletal
measurements cephalometrically.
2. Molar relation and tooth alignment, evaluated by Angle's
description of anatomical occlusion.
3. Functional occlusion, evaluated gnathologically on an
articulator.
4. Stability of postreatment tooth positions and alignment.
5. Comfort, efficiency, and longevity of the dentition,
supporting structures, and the temporomandibular joints.


ROTH'S ORTHODONTIC TREATMENT GOALS FOR AN
IDEAL FUNCTIONAL OCCIUSION
.

I-

Centric

maximum

or

occlusion
interuspation

of

the teeth should occur with
the

mandible

relation,

in

condyles
transversersy

in

centric

which
are
and

they

centered
seated

against the articulator disks at
the posterosuperior slopes of
the eminence

This centric relation occlusion should have three point contact of
the opposing centric cusps in their respective fossae.
II- Mutually protective occlusion
Occlusal force during closure should be of equal magnitude for all
posterior teeth and the stress should be directed along the long
axes of the teeth and the lower incisors should not be in contact
with the lingual surface of upper incisors and should have a
clearance of 0.005 inch
(by transmitting all the occlusal
forces, the centric stops of the
posterior teeth will protect the
anterior teeth from lateral stress).

Anterior guidance / incisal guidance
In straight protrusion the anterior teeth should serve as a gentle
glide path to disclude the posterior teeth very gently. To have
such anterior guidance, there should be minimal but sufficient
anterior overbite.
In the absence of anterior guidance,
excessive lateral stress on the
cuspids may cause lingual movement
of the lower cuspids and resultant
lower anterior crowding, and/or
labial movement of the maxillary
cuspids and affects post treatment
stability.


No stress

Canine guidance / canine rise In lateral excursions the maxillary
cuspids should act as guiding inclines to disclude the teeth on
the balancing or non-functioning side and to disclude the teeth on
the working or functioning side after approximately .5mm of
group contact.
balancing working
R
L


In a "mutually protective" occlusion
•The anterior teeth protect the posterior teeth from lateral stress
during protrusive movement and
The posterior teeth protect the anterior teeth from lateral stress
during closure into centric relation occlusion

•So in a mutually protective occlusion, the mandible can execute
its total range or envelope of motion without interference from
the teeth and
During closure the teeth will direct and maintain centricity of the
condyles in the fossae

III -Tooth-to-two-teeth or cusp-embrasure occlusion
During maximum intercuspation, there should should be Toothto-two-teeth or cusp-embrasure occlusion between the upper and
lower teeth, because this make the lateral and protrusive
movements with proper cuspid and incisor contact.
IV- Tooth structure, tooth position
and occlusal form should correlate
perfectly with mandibular border
movements, including the Bennett
movement and immediate side shift.


ROTH'S ORTHODONTIC TREATMENT GOAL FOR AN
IDEAL STATIC OCCLUSION.

In terms of tooth alignment, the goal primarily is one is
in very close harmony to that described by Andrews in
his "six keys to normal occlusion".


ROTH SETUP
Roth setup is available in both 0.018 and 0.022 slot
Roth preferred 0.022 slot brackets because it offered more
advantages
•In terms of wire size selection,
•In terms of stabilizing arches as anchor units and for
orthognathic surgery and
•For control of torque in the buccal segments, which is very
important from the standpoint of functional occlusion.

The Roth setup incorporated into it a member of hooks for
various types of elastic configuration and also double triple and
lip bumper tube for the use of auxillary wires and attachments.


Bracket positioning with Roth set up
The bracket placement vary slightly from the position
advocated by Andrews, thus a flat, unbent, rectangular, full sized
wire can be used as the finishing wire rather than one with
reverse and compensating curve.
Reference point – Andrews FA point
The point on the facial axis that
separates the gingival half of the
clinical crown from the occlusal half.
The key in determining the bracket height is the canine and
premolars (second premolars is an extraction case).
Ideally the center of the bracket should be placed at the
maximum convexity of the crowns of the posterior teeth. In a
teeth with average height of gingival attachment, the maximum
convexity of the teeth will be at the center of the clinical crown.

Molars(upper/lower)
From the buccal

From the occlusal

MB

Both the right and left bands should be checked to ensure that

Premolars(upper/lower)
From the buccal

From the occlusal

Upper premolar bracket placement is the most variable because of
tooth size. The most common error is not placing the bracket
gingival enough, especially on smaller sized teeth.

Upper and lower Canine
From the buccal

From the occlusal


Upper and lower incisors


Upper arch
Central

tip

torque

rotation

Andrews

5

7

0

Roth

5

12

0

9

3

0

9

8

0

Lateral

If it is increased the resultant axial is esthetically and functionally
undesirable
The 5° torque increase in torque improves
•Ethetics by preventing flattened profile, straight upper lip and
obtuse nasolabial angle.
•Provide more space for lower anterior teeth, thereby aiding
classI intercuspation and
•Establish proper anterior guidance & prevent lateral stress in
posterior segments

Upper canine
tip

torque

rotation

Andrews

11

-7

0

Roth

13

-2

4M(mesial)

•Increased because they are being retracted in most treatment.
•Less negative torque to offset the reciprocal effect of building
more positive torque into the incisors.


I&II PM

torque

rotation

(A)

2

-7

0

(R)

0

-7

2D

(A)

5

-9

10

(R)

IM &IIM

tip

0

-14

14D

• Elimination of the mesial tip on all buccal segment teeth
strengthened anchorage control significantly (but burning
anchorage can be difficult).
•To offset mesial the rotation that accompanies distal traction
•The distal rotation of mesiobuccal
cusp with reciprocal mesial rotation

MB

of mesiolingual cusp due to which

cusp

the cusp to cusp relation is changed
to class I molar relation.


LOWER ARCH
CENTRAL &LATERAL
tip

torque

rotation

(A)

2

-1

0

(R)

2

-1

0

(A)

5

-11

0

(R)

7

-11

2M

CANINE


I PM

tip

(A)

2

-17

0

(R)

-1

-17

4D

2

-22

0

-1

-22

4D

2

-30

0

-1

-30

4D

2

-35

0

-1

-30

4D

II PM

IM

II M

torque

rotation

•

Because these teeth settle more mesially than the upper and
simultaneously rotate mesially thus necessiating extra distal
roration

•

No change in the torque-To establish proper functional occlusion

ROTH TRU-ARCH FORM

Roth Tru-Arch form was derived from his extensive
clinical testing and recording of jaw-movement patterns
in treated patients who were out of retention and had
remained stable.


. The Roth Tru-Arch form actually overcorrects the arch width
slightly.
In the front part of the arch, the widest part is at the bicuspids, not
at the cuspids.
The widest point in the entire arch is at the first molars
region,(mesiobuccal cusp of I molar) There are actually five arcs in
the Arch
•A curve across the front
•A Curve in cuspid-bicuspid area
•A uniform curve in the buccal
segment to allow for proper
rotational position of the buccal
segment teeth.


SEQUENCING OF TREATMENT OBJECTIVES
The sequence of the treatment should be based on the dictates
of the individual case. The sequence of treatment objectives
are generally.
1. Eliminating cross bite
2. Correcting jaw relationship
3. Eliminating severe crowding creating space in the dental
arches for severely malposed, impacted or blocked teeth,
4. Aligning the teeth in the individual arches,
5. Beginning space consolidation

6. Finishing the lower arch
It is of utmost importance that the lower arch must be finished 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
7. Achieving class I relationship of buccal segment,
8. Retracting and as if necessary intruding maxillary arterior teeth.
9. Detailing and finalizing the tooth position and the occlusion.
In many instances a number of these steps will be combined and
will be occurring simultaneously.


THE THREE PHASES OF TREATING MALOCCLUSION INCLUDES

Phase I

unlocking the malocclusion

Phase II

Working phase.

Phase III

Finalization or detailing of occlusion

•To initial phase of treatment usually entails the use of some of
the following appliances
•Split palate Hass - type appliance
•Quard helix
•Transpalatal bar and / or a lingual arch
•An occipital pull headgear or facebow to the 6 years molar
•Utility arch.

Anchorage consideration
Factors responsible for anchorage loss
1. Attempting to upright extremely distally tipped canines.
2. Pulling distally with posterior teeth against extremely
procumbent or labially inclined incisors.
3. Attempting to level the curve of Spee with a continuous wire
without the use of distal traction.
4. Attempting to do any of the first three tooth movements
utilizing either a stiff or a resilient wire.
5. Attempting to move lingually or torque the maxillary incisor
roots.
6. Attempting to expand the mandibular arch with a labial
archwire.

some of the ways in which one can avoid using extra
oral traction or losing anchorage are
•The leveling process should be started with a small flexible wire.
The best for this purpose is the braided arch wire.
•When it is time to retract and upright lower anteriors that have
been in labial or procumbent position, they should be retracted
initially with an anterior facebow. In most instances 6 to 8 weeks
of headgear to the lower anterior segment is all that is needed to
upright the lower anterior teeth sufficiently that the remainder of
the space can be closed with reciprocal mechanics.


•Band the second molars at the outset of full dentition treatment
and use them for anchorage. It is much more difficult to displace
the buccal segments in the mandibular dental arch forward if the
second molars have been included as part of the anchorage unit.

•When leveling the curve of Spee, wherever possible a utility
arch should be used to intrude the incisors followed by canine by
Bioprogressive technique and then going to the flexible small
wires to gain bracket engagement and alignment of the entire arch
and gradually level the remainder of the curve of Spee.


Phase I treatment
•Helical loop archwires, Jarabak fashion made from 0.016”
Elgiloy green wire(crowing) or
0.015” braided archwire(routinely)
or
Nitinol(severe rotation)
•

0.019” braided wire

• 0.018”Australian special plus.(finalisation of any stuborn
rotation)
•0.019” square blue Elgiloy utility arches are used in case of
intrusion of incisor teeth.www.indiandentalacademy.com

Second phase of treatment.
Anterior teeth are generally retracted en masse as a group of 6
second molars are routinely banded at the outset of treatment in
the permanent dentition.
Double keyhole loop wire mechanics (0.019 x 0.026” round edge
rectangular)- In case of minimum and moderate anchorage casesModified Asher facebow- used in cases that need maximum
anchorage and retraction.


At the end of space closure
Double keyhole loop wire mechanics
Replaced by
0.018x0.025” blue elgiloy incorporating exaggerated R & C curve
with special torque adjustments(to offset the the undesirable effect
produced by R & C curves) to provide
•Rapid root paralleling
•Leveling of Curve of spee &
•Maxillary incisors lingual root torque

During extraction space closure, faster the space is
closed, regardless of wire size, the more tipping there
will be into the extraction space.

So it is the force & rate at which the extraction space is closed
determines the type of tooth movement(tipping or bodily) and
not the dimension of the wire used.


FINISHING PHASE
. The final finishing phase of treatment require filling of the
bracket slot (0.022 x 0.025) to get full bracket expression.
Short class II or III elastics are used to create anteroposterior
denture adjustments.

DETAILING OF TOOTH POSITION
THE MANDIBULAR ARCH
Lower incisors
•The sequence of tooth positioning
begins with placing the lower incisors
teeth at or slightly lingual to the
cephalometric goal. (-1 to A-Pog)

Over bite

   0.005”

over jet

   2.5 mm


     2.5 mm

•The four incisors teeth should have the roots divergent and
roots appears to be in the same plane of space when viewed from
the superior aspect.
•Lower cuspid crowns should have 5 degrees angulation with the
incisal tip 1mm higher than the incisal edge of, the lateral incisors
And it should have should have a slightly exaggerated mesial
rotation on extraction cases.
•There should be overcorrection of root parallelism in the
extraction site, if extractions were done.


•Bicuspids and molars should be upright and should have slight
distal rotation.
•There should be no spaces, and the arch form should be
symmetrical.
•The widest point of the mandibular arch should be the
mesiobuccal cusps of the maxillary Imolars and the I bicuspid.
•The curve of Spee should be leveled.(because it return to a 11.5mm curve, at its deepest point, after appliance removal and
settling of the occlusion


MAXILLARY ARCH
In the upper arch, the first tooth to be placed properly in relation
to the lower arch should be the maxillary six-year molar.
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 maxillary twelve-year molar
The upper bicuspids
The upper anteriors

•The incisal edges of upper centrals and laterals should be almost
at the same level with no more than 0.5mm height differential
approximately
•The widest point of the maxillary arch should be the
mesiobuccal cusps of the maxillary six-year molars.
•Cusp tip of the canine should be app 1-1.5mm incisally than the
of the occlusal plane.


ROTH’S CONCLUDING STATEMENT
“I have tried to present a philosophy of treatment with
the concept of overcorrection, based on the specific set
of goals stated at the outset, taking in to account existing
conditions, facial types, and reaction to treatment
mechanics.
Naturally there are always exceptions to the way one
approaches treatment”


REFERENCES

•Treatment mechanics for the straight wire appliance- RONALD H.
ROTH

•orthodontics - current principles and techniques- Thomas M.
Graber, Brainerd F. Swain
•Treatment concepts using the fully
dimensional appliance- RONALD H. ROTH

preadjusted

three-

•Orthodontics- current principles and techniquesThomas M.
Graber, Robert L. Vanarsdall
•Five year clinical evaluation of the Andrews S-W applianceRoth
•The straight wire appliance 17 years later- Roth
•Functional occlusion for orthodontics-Roth-part I II III IV
•Straight wire design strategies - five year clinical evaluation of
the Roth modification of www.indiandentalacademy.com
Andrew SW appliance-Lee W. Graber.

Thank you
For more details please visit


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