Tip edge technique by almuzian

1. UNIVERSITY OF GLASGOW
Tip Edge appliance
Personal notes
Mohammed Almuzian
1/1/2013
.

2. Mohammed Almuzian, University of Glasgow, 2013 Page 1
Contents
Introduction....................................................................................................2
Indication .......................................................................................................2
Advantages.....................................................................................................2
Disadvantages.................................................................................................3
Design............................................................................................................3
Treatment stages .............................................................................................5
Stage I: Anterior segments............................................................................5
Stage II: Close residual Spaces .....................................................................6
Objectives....................................................................................................6
Mechanics ...................................................................................................7
Stage III: Root Uprighting............................................................................7
Tip - Edge Plus ...............................................................................................8
Design.........................................................................................................8
Mechanics ...................................................................................................8
Table illustrating anchorage differences between tip edge and straight wire
appliances.......................................................................................................9

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Tip-Edge
Introduction
Developed by Kesling and first described in AJO 1988.
Indication
1. Class II camouflage
2. Significant anchorage demand
3. Significant Increased overjet,
4. Significant deep OB
5. Class II molar relationship
6. Significant Presence of crowding.
Advantages
1. Increased inter-bracket span because of the reduced bracket size MD
2. Little need for HG
3. Less anchorage demand because
 Differential force theory,
 Less expression of the tip during the first stage of treatment
 Light force
 Round wire with reduced friction during the first stage of treatment
4. Precision in finishing
5. TE bracket can be used with SW in caseof Proclined or retroclined canines

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Disadvantages
1. Expensive
2. Extraction philosophy
3. Reliant on elastic wear
4. Poorrotational control
5. Profile dishing
6. High risk of root resorption
7. Risk of PD damages
8. Complex in stage III specially the old TE system because each bracket requires
an auxiliary spring to deliver its final prescription.
9. Increased friction in later stages
Design
A. The tip edge bracket
1. Basically it is a modified straight wire bracket
2. Removed two diagonally oppositecorners from
rectangular archwire slot which allow the bracket to
tip up to 25° either mesially or distally. It is a
‘dynamic’ slot because:
 Unique feature that the slot increases its vertical archwire spacefrom 0.022 to
0.028 inches as the tooth tips
 When the vertical slot is then closed down by the auxiliary against a rectangular
archwire, it produces a three-dimensional precision finish.

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 Also the it reduce the friction during the first stage of treatment
3. Lateral extensions or wings on the bracket provide good rotational control of
tooth position
4. Vertical slot lingual to main archwire slot (auxillaries)
5. Double buccaltubes:
 Preadjusted convertible straight wire tube (.022x.028)
 Gingival round tube (0.036 diameter)
B. Auxiliaries
1. Sidewinder
 0.014” high tensile stainless steel.
 Coils alongside the archwire, over bracket face.
 Generates mesio-distal root movement as well as
torque correction with rectangular wires. The
torque correction occurmainly by the
rectangular AW fitting in the slot but the side
winder act to closely fitting the AW so it act
indirectly to correct the torque.
2. PowerPin
 Soft stainless steel.
 Traction hook fitted into vertical slot.
 Retained by bending occlusally projecting tail 90 degrees.
3. TE elastic ring

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 Tip-edge rings (elastomeric tie rings with crossbars and lingually facing lugs)
provide both arch wire attachment and mesial or distal
tip control by filling the chamfered wedge area. This is
called “hammock ‘effect”
 These rings are normally used only in the final stage of
treatment to maintain the crown uprighting achieved
with springs.
 Also ligature steel can produce“hammock ‘effect” as shown in the figure down.
4. Rotating Spring
 0.014 inch high tensile stainless steel.
 Useful for recapturing a rotation that occurred during treatment.
 Place ligature first then spring
Treatmentstages
Stage I: Anterior segments
Objectives:
1. Initial alignment of upper/lower anterior segments

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2. Closure of anterior spaces
3. Correction of increased overjet or reverse Overjet
4. Correction of increased overbite or AOB
5. Work towards arch coordination
Stage 1 Mechanics
1. Place upper and lower 0.016 SS base archwires and gently engage those teeth
that you can.
2. Severely displaced teeth can be engaged with elastic thread passed through the
vertical slot.
3. Leave off the premolars.
4. Place gentle anchor bends in front of the molars, placing the base archwire in the
gingival slot. These bends reciprocally intrude incisors by the idea of ‘’dig in
heels’.
5. Use Class II elastics (60g only) from circles on the upper archwire to the lower
6’s.
6. Braking: If unwanted proclination of lower incisors during overbite reduction,
utilized ‘reverse Side-Winder springs’
Stage II: Close residualSpaces
Objectives
1. Maintain Stage I corrections
2. Continue crossbitecorrection

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3. Continue correcting centre lines
4. Close residual spaces (either by retracting the labial segments or protracting
buccalsegments)
5. Derotate & level 6’s
Mechanics
1. The archwire size is increased to 0.020”round SS.
2. Class one elastic by using E-links between the circles on the archwire to the
hooks on the 6’s.
3. Maintain Class II elastics as required to keep the upper and lower incisors in
gentle contact.
4. To protract the buccalsegments rather than retract the labial segments
sidewinders (brake) can be placed on the canines.
5. In view of a centreline discrepancy considerusing unilateral sidewinders.
6. At the end of Stage II, de-rotation of the molars is done with a 1mm buccal
offset and 10 degrees of lingual toe-in between the premolar and molar.
Stage III: RootUprighting
Objectives:
1. Maintain Stage I/II changes
2. Correct torque and Tip
3. Detailing & finishing
Mechanics

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 0.0215” x 0.028” stainless steel base wire.
 Using Side Winder springs or piggy back 014 or 016 NiTi in TE plus
 Maintain the spaceclosure using ligatures from crimpable hooks to the hook on
the molars.
 Use Class II elastics to maintain light contactbetween the upper and lower
incisors.
Tip - Edge Plus
 Developed by Parkhouse in 2008
Design
1. Two slots: Both 0.020 inch round internal dimension.
 Vertical slot for auxiliaries
 Horizontally slot for a light flexible wire to replace
Side–Winder.
2. Main archwire slot size 0.0215x 0.028
Mechanics
1. In clinical use, both Tip-Edge and Plus remain identical
throughout the first two stages
2. Side-Winder ‘brake’, may be useful for increasing anterior anchorage, when the
operator chooses, orfor correcting centrelines.
3. Placement of the distal end of the auxiliary wire relative to the molar depends on
the extraction pattern. If a first premolar has been extracted, the second premolar
will require mesial rootuprighting. This will be aided by placing the distal end
of the deep tunnel wire in the gingivally placed round molar tube and vice versa.

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Table illustrating anchorage differences betweentip edge and
straight wire appliances
Feature TIP EDGE STRAIGHT WIRE
Stages of
treatment
Stage I
Reduce overjet
Open &/or close bite
Close anteriorspaces
Overcorrectrotations
CorrectX bites
Correctmolar relation
STAGE II
Maintain stage 1 objectives
Close posteriorspaces
PRE STAGE III
Braking
Fully engage premolars
Correctmolar rotations
STAGE III
Uprighting and torque
Anchorage preparation
Level and align
Overbite control
Overjet reduction
Space closure
Detailing and finishing
Retention

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Finishing
RETENTION
Concept Differential movement
techniques (eg Begg and Tip
Edge)
Teethare moved bodily to
correctmalocclusion.
Bracketdesign Modified straight wire
bracket
Rectangularslotwith
heavy binding effects
Wires Majority high tensile round
stainless steelwith low
friction,
Spaces closedon
rectangularwire, high
friction
Force
magnitude
Light ~60gmcontinuous Heavy intermittent eg
during frequent archwire,
powerchainchanges
Elastics Very light Relatively heavier
Extractions More frequently required Less frequently required
Anchorage Low anchorage strain High anchorage strain
Timing of
anchorage
Late (Stage III)
Correcting and uprighting
mechanics defer anchorage
strain until stage III by
which time extraction spaces
From outset of treatment

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have closed. At this time the
malocclusionis essentially
class I requiring only final
uprighting and torquing
Needfor
headgear,
functional,
TPA / Nance /
lingual arch
Very rarely needed Frequently needed
Premolars Not bonded up until stage II
to reduce friction
posteriorly.
Minimum archwire binding
Bonded up from day 1
Risk of archwire binding
Bite opening tip back / anchor bends Bestwith rectangularwires
Space closure Light on anchorage as
spaces have alreadyclosed
by this time
Heavy on anchorage
Uprighting
mechanics
Using sidewinders in stage
III
Early in treatment
Finishing Ease ofuse and precision
later in treatment – As seen
in Edgewise system.
Goodfinishing in EW

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