ROTH PRESCRIPTION OTHODONTICS AND DETOFACIAL ORTHOPEDICS.ppt

ROTH PRESCRIPTION OTHODONTICS AND DETOFACIAL ORTHOPEDIC

2. CONTENTS
HISTORY.
CONCEPT OF SELECTION OF TREATMENT MECHANICS.
APPLIANCE SELECTION
ROTH SET UP
ARCH FORM.
BRACKET POSITIONING.
SEQUENCING OF TREATMENT OBJECTIVES.
SEQUENCING OF FINISHING.
THREE PHASES OF TREATING MAL OCCLUSION.
ANCHORAGE CONSIDERATIONS
CONCLUSION.

3. HISTORY
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.

4. 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.

5. He did extensive work in Andrews SWA and published two articles
namely
1.Five year clinical evaluation of Andrews SW appliance.
(1976 J.C.O)
2.The SW appliance 17 years later (1987 J.C.O).

6. He started designing his own prescription as a clinical trial and error
evaluation that lasted several 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

7. THE ROTH TREATMENT
In 1979, Roth introduced a
bracket setup containing
modifications of the tip, torque,
rotations and in out movement of
the Andrews standard setup
brackets.

1933 - 2005

8. Difference between Andrews and the Roth
approach
ANDREWS
GNATHOLOGICAL
STAND POINT
ALLOWS TIPPING OF
TEETH
ROTH
ATTEMPTS TO
TRANSLATE TEETH
ANATOMICAL
STAND POINT

9. What made roth to modify Andrews SW appliance?
INVENTORY
ANCHORAGE LOSS
NEED FOR OVER
CORRECTION

10. INVENTORY
In andrews system different bracket values must be used, depending on how far a
tooth or a group of teeth is to be moved. The farther the teeth must be moved
the more counter tip and counter rotation should be placed in the brackets to
accomplish treatment by translation without offset wire bends.
To treat different cases if clinicians were to buy kits for all Andrews sets and series,
they would need an extensive and expensive inventory on the shelf.

11. ANCHORAGE LOSS
UPPER
LOWER
Upright position and over
rotation of the upper molars.
Upright position of the
upper premolars.
Upright positioning and
distal rotation of the lower
buccal segment.

12. NEED FOR OVER
CORRECTION
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

13. TREATMENT OBJECTIVES
The aims and objective of
treatment is to achieve
the best possible in each
of these separate areas

14. ROTHS TREATMENT GOAL
CEPHALO
METRICALLY
STATIC
OCCLUSION
FUNCTIONAL
OCCLUSION
RICKETTS CONCEPT
ANDREWS SIX KEYS
MUTUALLY PROTECTIVE
OCCLUSION

15. RICKETTS CONCEPT
Positioning of the lower dentition to the ideal
of +1 to the A Pog line and attempt to achieve the
best possible correction of jaw relationship.

16. ANDREWS SIX KEYS
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".

17. SELECTION OF TREATMENT MECHANICS
TOOTH
POSITIONING
FACIAL
ESTHETICS
FUNCTIONAL
OCCLUSION

18. TOOTH POSITIONING
The means to achieve the ideal tooth position must be visualized.
Are they to come about through,
A.TOOTH MOVEMENT – if so, how far and in which direction.
B.GROWTH – if so, how much growth is required.
C.ORTHOPEDIC CORRECTION of jaw relationship – if so, how much
orthopedic correction is required.
D.Any or all of the above means

19. FUNCTIONAL OCCLUSION
Functional occlusion refers to the occlusal contacts of the maxillary and
mandibular teeth during function, ie. During speech, mastication, and
swallowing.
Centric relation is defined as the relationship of the mandible to the maxilla with
properly aligned condyles and disc in the most superior against the eminentia

20. Centric occlusion is defined as the occlusion of opposing teeth when the
mandible is in centric relation, which may or may not coincide with maximum
intercuspation.
Maximum intercuspation is defined as the complete intercuspation of opposing
teeth independent of condylar position.

21. According to ROTH the two greatest causes of failure of occlusal treatment
are:
1. Failure to stabilize and then capture true centric relation prior to occlusal
therapy.
2. Failure to alter the occlusion with a high enough degree of precision to hold
centric and still clear on movement

22. ROTH uses a repositioning splint
1.To find "true" centric position.
2.To test the patient's response to change in the occlusion, prior to orthodontic
treatment.
3.To see if the mandibular centric relation position can be stabilized.

23. The patient will always close in a manner to gain intercusping of the
teeth. The neuromuscular protective mechanism will cause him to accommodate
his jaw position to the intercusping of the teeth. The purpose of an anatomical
articulator is to eliminate the patient's neuromuscular response to his existing
occlusion, so that we may see how his teeth relate when the jaw joints are
properly related to the fossae.
This is the basis for occlusal therapy and TMJ treatment. It is the
cornerstone of functional occlusion concepts.

24. The purpose of a repositioning splint is to eliminate the
neuromuscular accommodation of the mandibular position to the existing
occlusion, and place the condyles in the proper centric relation position in
the fossae.
BEFORE FITTING OF SPLINT AFTER FITTING OF SPLINT

25. Centric Closure and Anterior Guidance
In addition to centric closure, an anterior guide ramp is created to act as anterior
guidance to disclude the posterior teeth during movement out of centric.

26. The anterior guidance must be the gentlest slope possible that will
immediately disclude the posterior teeth. The ramp should have as many incisor
contacts as possible in straight protrusion and in lateroprotrusion. The cuspids
should be the main guiding inclines in lateral movements. The anterior teeth
should have 0.005" clearance from the ramp in centric closure.

27. Splint therapy must be continued until there has been no change in mandibular
positioning in centric relation for at least three months.
If symptoms cannot be relieved or stability attained with the splint, we will
usually not proceed with treatment. This eliminates many failures.

28. Gnathological Objectives:
The gnathological objectives are aimed at harmonizing the occlusal
morphology or natural tooth positions with closure of the mandible in centric
relation, and with border excursions of the mandible.
OBJECTIVE 1. To obtain a stable centric relation of the mandible and have the teeth
intercusp maximally at this mandibular position.

29. On full closure the posterior
teeth should have equal and even
contact of the centric cusps, the forces
being directed as nearly as possible
down the long axis, and the anterior
teeth should not be in contact, but
should have 0.005 inch of clearance

30. OBJECTIVE 2. To have a harmonious glide path of anterior teeth working against
each other to separate or disclude the posterior teeth immediately, as soon as the
mandible moves out of centric closure.
In this way, a "mutually protective" occlusal scheme is established, where
the anterior teeth protect the posterior teeth from lateral stress during movement
and the posterior teeth protect the anterior teeth from lateral stress during closure
into centric relation occlusion.

31. Excursive Occlusal Scheme
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. In addition, since the maxillary anterior teeth are retracted
in most cases, an improper anterior guidance in protrusive will tend to enhance
the chances of relapse of the maxillary anterior teeth labially.

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

33. 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

34. Fundamentals of programmed appliances
A. COMPOUND CONTOUR
The design of the appliance base must mirror the mesiodistal and occluso or inciso
– gingival curvature of the crown of each tooth type.

35. B. Torque in base.
A fundamental necessity for a programmed appliance is the torque in base.
This allows the slot point, the base point and the reference point on the tooth to
be on the same plane, a necessity for proper tooth positioning and level slot
alignment.

36.  IN \ OUT:
As a result of proper thickness relative to the adjacent bracket, in and out
bends (First order bends) are eliminated

37. D. Level slot:
When all the teeth reach their programmed positions, all four dimensions are
correct, allowing alignment , leveling, and parallelism of all the slots on all the
brackets around the arch.

38. 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.

39. 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.

40. Upper arch
Central tip torque rotation
Andrews 5 7 0
Roth 5 12 0
Lateral 9 3 0
9 8 0
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 class I
intercuspation and
•Establish proper anterior guidance & prevent lateral stress in posterior
segments

41. Upper canine
tip torque rotation
Andrews 11 -7 0
Roth 13 -2  
   
4M(mesial)
• Tip is 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.

42. I&II PM tip torque rotation
(A) 2 -7 0
(R) 0 -7 2D
IM &IIM (A) 5 -9 10
(R) 0 -14 14D
• Elimination of the mesial tip on all buccal segment teeth strengthened
anchorage control significantly.

43. LOWER ARGH
CENTRAL &LATERAL
tip torque rotation
(A) 2 -1 0
(R) 2 -1 0
CANINE
(A) 5 -11 0
(R) 7 -11 2M

44. I PM tip torque rotation
(A) 2 -17 0
(R) -1 -17 4D
II PM 2 -22 0
-1 -22 4D
I M 2 -30 0
-1 -30 4D
II M 2 -35 0
-1 -30 4D
•Because these teeth settle more mesially than the upper and
simultaneously rotate mesially thus necessiating extra distal
rotation
•No change in the torque-To establish proper functional occlusion

45. BRACKET PLACEMENT
According to ROTH, bracket should be placed in the middle of the
anatomical crowns occlusogingivally and incisogingivally with the exception of the
upper lateral incisors and six lower anteriors.
On the molars the buccal pit is the vertical center of the crown.
On bicuspids the vertical center is the vertical height of contour on the crown
long axis, and it is
The middle of the crown vertically on canines and incisors.

46. On the lower six anterior teeth ( canines and incisors) the bracket
should be placed 1mm incisal to the vertical center of the crown. This will give
a relatively flat curve of spee with appliances in place using a flat arch wire with
only arch form bend into it.

47. On the upper anteriors, the canine and the centrals incisor
bracket should be placed in the vertical center of the crown.
Vertically, the upper lateral incisor is placed 0.5 mm shorter than the upper
centrals.
This bracket positioning of the upper anteriors allows
approximately 3mm of overbite with the appliances in place and will settle to
4mm of overbite as desired after appliance removal.

48. IDEAL OCCLUSION AND FINISH OF
APPLIANCE THERAPY
BIO – ESTHETIC OCCLUSION – Put forward by
ROBERT . L. LEE.
The tooth form he advocates is that of normal human
tooth morphology in a class I arrangement. The condyles
should be seated superior and anterior in the fossae against
the disc and eminence and centered transversely.

49. With the condyles in this position the teeth should reach maximum intercuspation
in a cusp - embrassure relationship.
OVER BITE – 4mm
OVERJET – 2 – 3 mm

50. Canines – should extend below the plane of occlusion, so that their cusp tips
reach the level of the contact points between the lower canine and premolars.
There should be 1 mm overjet of the canines.
The upper canine should have a mesial axial inclination so that the cusp tips
occlude slightly forward in the embrassure between lower canine and
premolar for adequate canine guidance.

51. At the end of the appliance therapy,
1.The curve of spee should be levelled.
2. Incisor overbite should be 2 – 2.5 mm.
3. Posterior teeth should be upright and rotated distally( except for upper
premolars).
4. The torque of the lower segment should be ideal.
5. The upper molars should have slightly excessive root torque with a slightly
mesial overcorrection of root positions.

52. ROTH CAME UP WITH HIS OVATION BRACKET SYSTEM WITH
THESE OVERCORRECTION INCORPORATED INTO THE BRACKETS, SO
THAT THE TEETH CAN SETTLE INTO DESIRED FINAL POSITIONS

53. ROTH – OVATION SYSTEM
Ovation bracket system was manufactured by GAC International in ROTH
prescription.

54.  Ovation is a completely adjusted, four dimensional appliance system that
properly positions the teeth in at four levels:
1. In \ Out.
2. Angulation.
3. Torque.
4. Over correction.

55. Ovation is the first system that combines Metal injection Moulding
( MIM) and, Computer Numerated Controlled (CNC) milling.
MIM – Allows the smaller design with great strength and fully compound
contouring of the bases.
CNC – ensures truest slot in the industry.

56. VARIATIONS IN ROTH TREATMENT
SUPER TORQUE UPPER ANTERIOR
CANINE TO CANINE MODEL
THE ZERO TIP CANINE BRACKETS.

57. CONCEPT OF IN – OVATION BRACKET
The In – ovation bracket is the work of three different persons:
1. Andrews: who invented S W A.
2. Roth: whose prescription has consolidated over correction and anchorage
control into brackets.
3. Voudouris, who designed the self ligating interactive closing clip that is built
into the In – ovation bracket.

58. System R( In-Ovation series)
2001
Only self-ligating twin bracket with an active clip.
Two sizes-
Standard (1999)
Reduced width (2001)
Failure of clip is seldom-if failed modules can be used.
Standard bracket has additional slot for aligning displaced or ectopic
teeth.
Don’t use this in patients with calculus forming tendency.

59. ADVANTAGES OF INNOVATION OVER ALL OTHER
SELF – LIGATING BRACKETS
True fully adjusted 3 D appliance.
Accurate ROTH prescription.
No breakage of lock mechanism.
Total torque control with no compromise result.
Rapid, dependable, opening and closing mechanism for arch wire change.
0.022 – inch slot twin for best control of torque, rotation, and anchorage.

60. 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.

61. . 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.

62. 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

63. 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.

64. 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 face bow to the 6 years molar
•Utility arch.

65. 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.

66. 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. 

67. •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.

68. Phase I treatment
•Helical loop archwires, Jarabak fashion made from 0.016”
Elgiloy green wire(crowding more than5 mm) or
0.015” braided archwire(routinely) {Wild cat or Respond}
or
0.018 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.

69. 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 cases-
Modified Asher facebow- used in cases that need maximum anchorage
and retraction.

70. At the end of space closure
Double keyhole loop wire mechanics

0.018x0.025” blue elgiloy
This will provide:
Rapid root paralleling.
Leveling of Curve of spee &
Maxillary incisors lingual root torque
Replaced by

71. 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.

72. 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)

73. over jetOver bite
4 mm 2.5 mm
0.005”

74. •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.

75. •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 I molars and the I bicuspid.
•The curve of Spee should be leveled.(because it return to a 1- 1.5mm
curve, at its deepest point, after appliance removal and settling of the
occlusion

76. 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

77. •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 that of the
occlusal plane.

78. CONCLUSION
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”