Elastic for Proper

Finishing of Occlusion
ELASTOMERS ;-
materials returningto their
original dimensions
immediately after substantial
distorsion.
Natural rubber or latex
Synthetic rubber polymers .
Orthodontic elastics :-
are rubber bands frequently used in the
field of orthodontics to correct different
types of malocclusions.

Finishing elastics :-
Are used at the end of the treatment for
final anterior & posterior settling.
١
 History of elastics
 the first known elastic was the natural rubber used by Incan and
Mayan civilisations extracted from hevea trees.

٣
 In Orthodontic
 The latex elastics have become integral
part of orthodontics after being first discussed
by Calvin Case in 1893 , but the credit goes to
Henry
Baker for the use of these elastics in
clinical practice to exert a class II inter-
maxillary forces .
 Calvin Case discussed the use of inter-
maxillary elastics at the Columbia Dental
Congress.
However Henry Baker is credited with
originating the use of inter-maxillary
elastics. ٤
• Angle in1902
described the
technique before the
New York institute.

• Classification of
malocclusions and the
use of corresponding
elastic forces.

o
 Henry Baker in 1893
• introduced the use of inter-maxillary elastics with the rubber bands, called as Baker anchorage .
• in 1903 published in the international dental journal an article entitled “ Treatment of protruding
and receding jaws by the use of inter-maxillary elastics
 Roles( benefits) of elastics
• One of the key elements of orthodontics treatment , which help adjust
the patient’s teeth to their correct position.
• Elastics are commonly used during orthodontic treatment and may be
applied to several different clinical situations.
 They are useful for :-
• Making space inter-proximally to facilitate placement of bands
•Ligating arch wires Closing space
•Aligning teeth into the arch De-rotating teeth
•Aligning displaced teeth Moving individual teeth
• Moving blocks of teeth
•Growth modification
Classification of
elastics
 A.According to material

Latex Synthetic
 B .According to lumen size
• 2/16’’= 3.18 mm
• 3/16’’ = 4.76 mm
• 4/16’’ = 6.35 mm
• 5/16’’ = 7.94 mm
• 6/16’’ = 9.5 mm
• 8/16’’ = 12.7 mm
• 10/16’’ = 15.8 mm
• 12/16’’ = 19.1 mm
 C.According to force values
• High Pull
Ranges from 1/8" (3.2mm) to 3/8" (9.53mm),It gives 71 gm
force (2 ½ oz).
• Medium Pull
Ranges from 1/8" (3.2mm) 3/8" (9.53 mm) it gives 128gm or
4 ½ oz force.
• Heavy pull
Ranges from1/8"(3.2mm) 3/8"(9.53 mm) It gives 184gm or 6
1/2oz force.
Does the
thickness make
a difference?
 D. According to the uses
1. Extra oral elastics 2. Intra oral elastics
 Intra-oral elastics
1. CL I elastics or horizontal elastics or intra-arch elastics
2. CL II Elastics / intermaxillary elastics
3. Class III elastics
4. Anterior elastics
5. Zigzag elastic
6. Cross bite elastics
7. Cross Palate Elastics
8. Diagonal elastics
9. Open bite elastics
10. Box elastics
11.Triangular elastics
12. Vertical Elastics
(spaghetti)
13. M and W elastics
14. Lingual elastics
15. Check elastics
16. Sling shot elastics
 E. Other elastics

Asymmetrical
Finishing elastics
elastics
Elastics Wearing
Motivation
 PATIENT COMPLIANCE WITH ELASTICS
• patient compliance is difficult to evaluate
before the treatment. However as a useful
predictor evaluation, some factors must be
taken in account:
 Girls are usually more cooperative than
boys.
 Of 10 studies relating gender to various
aspects of compliance, 5 reported that girls
were more cooperative, but 5 found no sex
difference.
 .Children under age of 10 years are more cooperative than older children

Personality is a better factor to consider for uncooperative patients,

PATIENT .characterized as being concerned with appearance

COMPLIANCE .Cooperation is not related to severity of the malocclusion

WITH ELASTICS
Embarrassment may be given as an excuse, forgetfulness, nuisance for
.low motivation or apathy

Pain is one of the most frequent reasons for not wearing intra oral or
extra oral rubber bands. Some patients will require more communication
.regarding the amount of discomfort and progressive elastic forces
 PATIENT COMPLIANCE WITH ELASTICS
• communication is essential

• So, three rules to keep in mind

1. Explain

2. Explain
 PATIENT COMPLIANCE WITH ELASTICS
Patient compliance is essential :
• to maximize cooperation
• to avoid headgear use, if possible
• to avoid mechanic problems
• to avoid relapse
Remember that the Motivation key is to dramatize any little problem
 Elastic Prescription

Elastics prescription
needs

a written to check that the to keep an eye on

prescription on a to explain why, patient understands motivation, ask to
motivation card to when, and how to well the message and the patient to put
reinforce the wear elastics is able to place on his elastics in
properly the
. message . prescribed elastics .front of you
 APPOINTMENT INTERVAL OF ELASTICS WEARERS
On a general basis, an appointment visit is subject to different
factors:

• Importance of movement to obtain

The appointment interval may be regulated according to the gravity of the

malocclusion. Generally, when starting the Class II discrepancy, the interval of the
first two or three visits may be every 8 weeks. Then in succession of interarch
correction the interval may be 6 or even 4 weeks, according to the clinical exams.
There is no absolute rule because the orthodontist may slow down elastics
wearing in prescribing them full time at the beginning and during night time only
at the end of correction
APPOINTMENT INTERVAL OF ELASTICS WEARERS

• The clinical goal to reach

The Orthodontist may advise the patient to schedule his next visit
only when the goal will be reached.

For instance, if the patient has to wear a delta elastic to bring down
an upper ectopic canine, you can ask him or her to wear elastics until
the canine contact with antagonists, and then call for a new visit.
 APPOINTMENT INTERVAL OF ELASTICS WEARERS

• In exaggerate correction risks

Some clinical cases have to be watched to avoid undesirable movement.

Risks of excessive elastics wear:

• an excessive correction ( a Class II becoming a Class III )

• an exaggerate tipping of lower or upper incisors ( backward/forward )
• anchorage lost
• undesirable extrusion / overbite
• exaggerate rotation
 LIMITATIONS AND WARNING SIGNAL OF ELASTICS
WEARING

• Muscular fatigue
• TMJ arthralgia
• Functional mandible limitation
• Improper incisor guidance:
open bite
overbite
• Teeth interferences:
Mobility
dental pain
periodontal problems
• Multiple root resorption ( extrusion / intrusion )
• Chronic respiratory problems ( apnea or sleep disorders )
• Chronic tongue interposition ( thumb sucker )
INTRAORAL
ELASTICS
Class I Elastics Forces
Definition
•-The Class I elastic can be a chain, a
rubber band, a ring or a thread placed
on a single arch and having a vertical or
a horizontal force movement.
• Also name
•CL l elastics or horzintal elastics or
intramaxillary elastics or
•intramaxillary-arch elastics
 Disposition
• one tooth to another tooth
• one tooth in
opposite way
couple of forces
• one tooth to an archwire, a loop
•one point to another point of
the archwire
• one tooth to an auxilary appliance
•such as Quad Helix, a palatal bar, a
bite plateDisposition
Indications
to rotate of a single tooth or reciprocal teeth➨

to achieve space closure➨

to use force couple maintaining the centroïd axis of a tooth during rotation control➨

to move a tooth which is difficult to tie in the archwire ➨

to intrude a tooth or a group of teeth (cuspid intrusion)➨

➨to extrude a tooth which is impacted or in ectopic position

 The force
recommended is

• 11/2 to 2 1/2 oz for non

extraction cases

• 2 to 4 oz in extraction
cases.
 •the Class I elastic has reciprocal action in
o f straight line.
i s
c c.
an sti
c h la . The force exerted depends on clinical
e Ie objectives, considering the STABLE force or
om ss
Bi Cla anchorage used and the MOBILE force to
a move the teeth.
 BUCCAL UPPER INCISOR TIPPING FOR ADULT IN TYPICAL CLASS
.II.2

INTRUSION OF A MOLAR OR CUSPID WITH A THREAD ELASTIC, TIED ON UTILITY

.ARCH
elastic ligatures tied to rotate Class I elastic ligature used to
the 24 with an rotate and bring forward the left
opposing force coupl lateral incisor in the opened space
by the M utility
Clinical problems with Class I elastic

Abnormal Exaggerated Exaggerated

.tipping .rotation .extrusion

Minor or
Anchorage
insufficient
.lost
displacement
The « O » shape occlusal elastic
•Elastic is placed occlusally on the maxillary or
mandibular arch in order to correct.
•The “O”shape occlusal elastic :
•➨must be worn during night only
•➨must be worn during a short time because of its
efficiency
•➨must be controlled every week
•Biomechanically, the “ O ” shape elastic moves one tooth or a limited
group of teeth transversaly. That could be a canine, a premolar, or a
molar. Usually, it can be worn on a simple way or in criss cross according
the clinical objectives.
ELASTOMERIC CHAINS
POLYURETHANE CHAIN
ELASTICS ARE COMMONLY
USED IN DAILY
ORTHODONTICS AS CLASS I
ELASTICS. THEY ARE MADE BY
ORTHO MANUFACTURERS IN

LONG FILAMENT CHAIN

SHORT FILAMENT CHAIN
- CLOSED LOOP CHAIN.
CLASS II ELASTICS
FORCES
 Definition
Class II elastics are intermaxillary elastics placed on the
.maxilla anteriorly, and on the mandible posteriorly
 Class II elastics effects with continuous archwires

Effects upon the maxillary arch ➨ Effects upon the ➨

mandibular arch
backward movement of the • entire mandibular arch is •
upper arch brought forward
extrusion and downward • the lower molar can be •
movement of anterior teeth extruded
.teeth are distallized •
 Biomechanics of a Class II elastic
Let us take an example of a Class II elastic placed on the distal buccal part of
.the lower archwire and on an anterior loop in front of the upper canine

In occlusion, if this elastic makes a 20 degree angle with the upper

:continuous archwire and a 100 g force, the elastic effect has

.a horizontal component force of: 100 X cos 20° = 93.90 g ➩

.a vertical component force of: 100 X sin 20° = 34.20 g ➩

Mouth open 10 m/m , the force varies with different angulation of the Class II
elastic and has different effects upon:
 the maxillary arch
➩ The vertical component of extrusion is: 160 X sin 29° = 77.60 g. because 29°
angulation with the upper arch
➩ The horizontal component of distalization is: 160 X cos 29° = 139.90 g.
 on the mandible
The elastic has a 35 degree angulation with the lower archwire.
➩ A forward component force of: 160 X cos 35° = 131 g.
➩ A vertical component of extrusion force which is: 160 X sin 35° = 91.8 g.
Biomechanics of a Class II elastic

 A Class II elastic inch, placed on the lower archwire and anterior loop,
can create an elastic effect when making a 20-degree angle with the
upper archwire and a 100 g force. This results in a horizontal
component force of 93.90 g and a vertical component force of 34.20 g
in occlusion.

 The force on the Class II elastic at a mouth open 10 m/m at the incisors
level varies with different angulations. The vertical component of
extrusion is 77.6s due to the elastic's 29° angulation with the upper
arch, and 129.9 for the horizontal component of distalization. On the
mandible, the elastic has a 35 degree angulation with the lower
archwire, resulting in a forward force of 131 g and a vertical force of
91.8g.
 LONG CLASS II ELASTICS: S H O RT C L A S S I I E L A S T I C S :

 greater length between attachment  shorter length between attachment

points on the upper and lower arches. points on the upper and lower arches.

 They provide a more extensive stretch  They provide a more localized force
stronger force over a longer distance and precise control of tooth movement

 . Long elastics are often used in cases is required

where a significant amount of  when the correction needed is more

correction is needed or when the minor.
malocclusion is more severe.  preferred for patient comfort
Watch out for lingual tipping
-extra torque on it
-expansion with wire
 Unilateral class II

Affected side: crossbite

Non affected side : scissor Non affected side open bite
bite
Short class II
 ANTERIOR POSITION

M A X I L L A : R O T AT I O N D R O P D O W N OVERBITE

M A N D I B L E : B O D I LY M O V E M E N T O N LY
 POSTERIOR POSITION

M A X I L L A : B O D I LY M O V E M E N T O N LY

M A N D I B L E : R O T AT I O N D R O P D O W N OVERBITE
 Class II elastics indications
skeletal and/or dental Class II malocclusions •

anchorage reinforcement •

backward movement of the upper incisors •

mandibular arch advancement •

bite opening /deep bite •

midline deviation correction •

.sometimes in Stabilization of treatment outcomes prevent relapse

 Clinical problems with Class II elastics
Compliance issues:( insufficient wearing) One of the most common problems with Class II
elastics which is impact the treatment outcomes and prolong the duration of treatment.

Overloading: (excessive wearing) Applying excessive force with Class II elastics can lead to
adverse effects such as root resorption, discomfort, and unwanted tooth movement. Orthodontists
must carefully monitor the force levels and adjust the prescription of elastics as needed to
minimize the risk of overloading.

Underloading

Unpredictable tooth movement biomechanic complication such as:

- space opening / space closing / anchorage lost / abnormal tipping / exaggerated rotation /
Soft tissue irritation: Class II elastics can sometimes cause irritation or discomfort to the soft tissues of the mouth,
including the cheeks, lips, and gums. This can occur if the elastics are improperly placed and cause parodontal problems
such as: lower incisors dehiscence - fenestration, etc..

Relapse: Failure to wear Class II elastics as prescribed or premature discontinuation of elastic therapy can
increase the risk of relapse

Temporomandibular joint (TMJ) discomfort:

Rarely, some patients may experience discomfort or exacerbation of temporomandibular joint (TMJ) symptoms
with the use of Class II elastics Orthodontists should closely monitor patients with Class II elastics for any signs
or symptoms of TMD, including jaw pain, muscle tenderness, clicking or popping sounds, or limited jaw
movement

depending on individual patient factors, including pre-existing TMJ health, occlusal stability, muscle function,
and joint morphology

If TMD symptoms arise or worsen during elastic therapy, adjustments to treatment may be necessary, such as
modifying the force levels, changing the direction of force, or discontinuing elastic wear temporarily.
SIZE, FORCE, AND WEAR TIME
 Pain and Class II elastics
•Some dysfunctional patients have difficulties tolerating intermaxillary
elastics, because of wearing may increase the tenderness and pain
• ◊ For this kind of patient a splint must be Recommended to control
muscular or articular pain resulting from the muscular hyperactivity
coming from the elastics use
 Orthognatics and Class II elastics
Surgerised orthognathics cases may be need some
Class II elastics for different reasons:
to maintain a good skeletal relationship during healing and «
.consolidating phase
.to overcorrect dental relationship «
.to correct midline deviation «
.to seat the canine occlusal relationship «
:The Class II elastics should be used
.to avoid bone mobilization, even in rigid fixation cases •
.to prefer short closing Class II elastics •
.to keep posterior wedges and avoid posterior mandibular rotation •
 Influence of the archwire and hooked
point
To make more comprehensive, we have a dental Class II malocclusion
.with a locked second premolar

:Different biomechanic systems could be used*

)WITH FRICTION(
In using a continuous archwire with an opened coil spring for Pm2 space, we can place
:the Class II elastics as follows
behind the lower molar, which is going to be extruded and advanced with the whole - 1
-man
.dibular arch without opening the Pm2 space
,on the mesial hook of the lower molar which is going to be advanced without extrusion - 2
.but without opening the Pm2 space
distal to Pm1 on a KOBAYASHI tied ligature. The Class II elastic is going to advance the - 3
. mesial part of the mandibular arch before the Pm2, with a friction system
 (FRICTIONLESS)
Using an archwire with an activated M loop with tip back, we can place the Class II
elastic:

4 - behind the lower molar to advance the whole mandibular arch with
less than in.
5 - on the mesial hook of the lower molar to help the activation of the M looextrusionp and open the Pm2
space and advance the mandibular arch with more efficiency than in °].
6 -distal to Pm 1 on a KOBAYASHI tied ligature,the Class II elastic is going to help the M
loop to give a reciprocal effect in opening quickly the Pm2 space and advancing the mandi-
bular arch in a very efficient way.

There are other biomechanic systems that could be used such as segmented arches with utility arch etc; but
the principle remains mainly the same
 1 4

2 5

3 6

WITH FRICTION FRICTIONLESS

ᵜ In LINGUAL TECHNIQUES all biomechanic principles remain
the same, except that elastics are placed on lingual side.
Class III elastics
 CLASS III ANTEROPOSTERIOR ELASTIC

• Class III elastics are intermaxillary elastics placed posteriorly on the

maxillary arch
• and anteriorly on mandibular arch
• Class III elastic has as main aim to move the upper teeth mesially
and the lower teeth distally, and it is very similar to the Class II elastic
regarding the anchorage preparation for use, wear time, force, and control
of side effects
It can be indicated in cases where it is desired to increase the loss of
anchorage in the upper arch or retraction in the lower arch when there are
diastemas or spaces created by extractions
 Anchorage preparation for class 3
• To distalize the entire lower arch associated with mesialization of
the entireupper arch, it is also necessary to prepare both arches
with
• 1. alignment and leveling up to rectangular steel wires, preferably
0.019 × 0.025-in.23,24 To control side effects
• 2. tip-back with step-up and accentuated toe-in bending can be
performed on
• the upper second molar to avoid mesial inclination, extrusion, and
rotation of this tooth that will serve as support for the elastic
 SIZE, FORCE, AND WEAR TIME
• Elastic sizes commonly used in the Class III direction are 1/4-in, 5/16-in, or 3/8-in medium force,
applying an average of 200gf on each side
• Initially,
• during the period we call the active phase, they should be ideally used for 24 h, being removed
only for food and hygiene.
• When the desired resultsare obtained,
• we move on to the retention phase that should last two months on average, using the same size
of elastic, but
• with light force and still for 24 hours a day.
• Finally,
• it is also possible to carry out the post-retention phase, as a guarantee of maintaining the results
obtained. At this stage, the light elastic should be used for 12 hours a day for one month
 Class III elastics effects on continuous archwires
:The use of Class III elastic has different effects

Effects upon maxillary arch

forward mesial tipping and extrusion of the first molar
light maxillary advancement
.buccal tipping of upper incisors

Effects upon mandibular arch

lower incisors extrusion
lower lingual tipping of lower incisor
.lower arch distalization

Effects upon occlusal plane

Class III elastics have a counterclockwise effect on the occlusal plane
.anteriorly and posteriorly
Effects upon facial type
backward rotation of the mandible
the chin goes downward and backward
the lower facial height is increased
Influence of Class III elastics on occlusal plan on Influence of Class III elastics on with facial
tilting type and consequences on the vertical
with continuous archwire component of extrustion
 Indications of Class III elastics
• In deep bite cases it is useful to:

protract the maxillary arch

procline maxillary incisors: bond them upside down to

advance Point A

use inclined 45° bite plate with Class III elastics

use brackets with buccal crown torque on lower incisors

to resist the extrusion and lingual tipping elastic force (to
.avoid gingiva dehyscence )
 Indications of Class III elastics
:In borderline or open bite cases it is useful to
segment the maxillary archwire behind the first upper
premolar
keep the posterior wedges
avoid increasing the vertical sense
use short closing anterior Class III elastics
 Orthognatics and Class III elastics
:Surgerised Class III cases may need some Class III elastics for different reasons
to maintain a good skeletal relationship healing and consolidating phase
to overcorrect dental relationships
to correct midline deviation
to seat the canine occlusal relationship

:Class III elastics should be used

to avoid bone mobilization, even in rigid fixation cases, using light forces •
to segment the antagonist arch to the surgerised one, if possible •
to prefer short closing Class III elastics •
to keep posterior wedges •
to control vertical dimension •
.to use segmented archwires instead of continuous ones with frictionless forces •
 Clinical problems with Class III elastics
:Many clinical problems may be observed even with careful clinical management such as
insufficient wearing •
excessive wearing •
parodontal problems such as lower incisors dehyscence •
.biomechanics problems like lingual tipping or excessive extrusion of lower incisors •

The distal lower tipping of the mandibular canine may increase the retroversion of
.lower incisors, when using Class III elastics with light memory archwires
For example, when a Class III elastic is placed on an 0.016 X 0.016 lower Niti or TMA, the
lower canine can be distally tipped, inducing an increased extrusion of lower incisors
already
.subject to the vertical component of extrusion of the Class III elastic
 Particular
Intermaxillaryarch elastics
 The rectangular elastic
• This elastics has a rectangular shape.
• It ‘s role is :
1. Adding a contraction force movement
2. extrusion of segment of dental arch.
3. closing spaces and placed anteriorly and
posteriorly in order to close the bite.
 The U-shape elastic
• It has a contraction and extrusion effect on only one arch , can be used with a
segmented arch to the antagonist arch and can be used in u shape or upside down
• It can be used anteriorly and posteriorly.
 THE DELTA ELASTIC
• Short triangle elastics using a vertical component for extrusion a
single ectopic tooth , mostly upper canine.
 The V shape elastic
• It is used to bring the tooth in occlusal plane in a v shape or upside down
according to the clinical need.
 The M OR W shape elastics
• It is used to extrude a
group of teeth in order
to squeeze the bite in an
effective closing way.
• Heavy elastics up to 300
g may be used.
 The cross bite elastics
• They are indicated in unilateral or bilateral crossbite cases.
• They are used for the purpose of straightening or
broadening the molar teeth that are bent towards the
lingual.
• They are used by extension from the oral side of the
lingualized tooth to the buccal face of the molar tooth on
the same side . It is recommended to apply these with a
force of 5–7 oz.
Diagonal elastics
They are used in midline adjustment.
They extend from the upper
intermaxillary hook to the
intermaxillary hook on the opposite
side.
. It is recommended to apply these
with a force of 1½ - 2½ oz.
 Open-bite closure elastics
• They are used to fix cases of open-bite.
They may be applied in a vertical ,
triangular or box manner .
• Vertical types are used in a way that they
extend from the bracket of each maxillary
tooth towards the bracket of the
mandibular teeth.
 Anterior elastics
• They regulate the overbite of the incisor teeth. In
treatment of closing open bite up to 2 millimeters,
they are used by extending from the mandibular
lateral teeth to the maxillary lateral teeth or vice
versa.
• It is recommended to use these following lingual
straightening or in adjusting overbite and with a
force of 1–2 oz.
 Lingual elastics
• They are used as a support or a force balancer against buccal elastic forces.
• It is asserted that this will increase the effectiveness of force distribution.
 ELASTICS IN CONDYLAR FRACTURES
• In the adult case, elastics may be a part of
an orthodontic treatment such as:
A / IN UNILATERAL CONDYLAR FRACTURE:
• a unilateral bite plate on the controlateral
fractured side, to help condylar distraction.
• segmented archwires on affected side with
• rectangular vertical elastics.
 B / IN BILATERAL CONDYLAR FRACTURE

• the mandible is rapidly rotating posteriorly with

an anterior open bite and limited mouth
opening. The treatment should be:
- a bilateral posterior bite plate to help the
condylar distraction for healing.
• anterior segmented archwires with
• anterior vertical elastics.
 Elastics and ExtraOral
Forces
Elastics are considered the force delivery system in many
extraoral appliances.
Commonly heavy elastics are used for orthopedic effect.
 Headgear
• Elastics were a key component of interlandi headgear:

• Recent headgear with self-release modules.

 Face mask appliance
• Elastics are stretched from intraoral appliance hooks
to extra oral rods.
• The following sequence of elastics is used:
(3/8" 8 oz.) 200 grams of force for the first few
weeks
(1/2" 14 oz.) 350 grams of force for 2 weeks,
(5/16" 14 oz.) (600 grams).
Chin cup appliance
 Elastics Force degradation
.The force decay under constant force application
The force dissipation is due to both hysteresis within the elastic, and the
.reduction in the distance between the two points of application of force
.The greatest amount of force decay occurred during the first three hour

.Initial force drop at the end of the first day (31% to 53%)

.The second force drop was reported by the end of the 7th day(37% to 61%)

.Third force drop by the end of the l5th day (58% to 63%)

.Fourth force drop at the end of the 21 days (65% to 75 %)

Elastic ligatures 

Elastic O ties are commonly used for arch wire ligation.

.Different patterns of ligation can be applied
 Elastic ligatures vs wire ligatures
• Elastic ligatures are easy to apply with no sharp ends and aesthatically more acceptable by
the patient.
• Stainless steel ligatures can be tied either too tight or too loose, depending on the technique
and needs of the clinician as during torque or during rotation prevention.
 Problems with elastics
Incorrect elastic
Allergies (latex Compliance
placement by the
.elastics) .(under/overuse)
.patient

Biological variability
and manufacturer
.differences
 Rationale for
Elastics Prescription
• Even with the knowledge of all elastic possibilities, it is
sometimes difficult for the clinician to decide on the best
elastic treatment.

• Separate the different clinical objectives:

- take notice of primary objective
- accept or refuse, for a while, the secondary objectives.
The primary objective: It may be:
• to open the bite or,
• to close the bite.

The secondary objectives:

They may be numerous choices for reaching selective secondary objectives.

For instance, a Class II molar relationship can exist with an edge to edge that
could be corrected by placing the intermaxillary elastic buccally or palatally
according to the transverse problem.
 BEFORE USING INTRA ORAL ELASTICS
1 - Consider the vertical dimension first:
• How is the skeletal pattern ? Normal ? Open bite tendancy ? True open bite ? Deep bite tendancy ? Or true deep bite tendancy ?
• What is the dental problem ?
= Do we have to close the bite ?
= Do we have to open the bite ?
• What kind of biomechanics are need to reach our goals ?
= continuous archwires ?
= segmented archwires ?
• Are we allowed to use intermaxillary elastics forces ? Or do we have to use Class I or closing elastic forces ?
2 - Observe the transversal sense afterwards:
Look at the centric occlusion:
• Is it a normal occlusion relationship ?
• How are the median lines ? Is there a midline shift ? Which one must be corrected ?
• Do you have a cross bite ?
• Do you need an expansion on one side ?
• Do you need a contraction on one side ?
• Do you need cross bite elastics ? Closing elastics ?
• Do you need a bite plate to jump the bite ?

For example, a lingual crossbite relationship of a maxillary canine may be corrected in placing on the Class II elastic
palatally to correct in the same time the transversal and sagittal sense.

A midline shift clinical case can suggest increasing the Class II elastic force on one side by:
➩ changing three times the elastic on one side and only one time per day the other side or,
➩ using a closing elastic force on one side and a regular one on the other side or,
➩ using a heavy elastic on one side and a lighter on the other.
:Correct sagittal relationship at last - 3

:In good order

I - molar relationship

II - canine relationship

.III - incisor relationship

HOW TO PRESCRIBE ELASTICS
A: Observe the B: Write down the occlusal
.malocclusion .chart

C: Lay down the D: Draw the needed

! problem :biomechanic archwires
A: Observe the malocclusion: B: Write down the occlusal chart:
C: Lay down the problem ! Come up with the objectives to reach. Use arrows:
D: Draw the needed biomechanic archwires: E: Draw elastic forces necessary to reach clinical goal:
 CLINICAL EXAMPLE
A - Observe this dysfunctional patient with a painful left
TMJ :

on right side she has a Class II lingual

cross bite and a Class II canine
relationship.
• a midline shift of 3 mm with an edge to
edge incisor relationship.
• on left side she has an open bite with a
Class III canine relationship.
B - Let us write down the problem:
 C - Solution
• on right side, a triangular Class II cross
bite elastic is going to correct the Class II
and jump the bite.
• anteriorly a closing Class III elastic is
going to correct the midline shift, bring
forward the left upper canine, and close
the bite !
• on left side, we are keeping the posterior
wedge so we don’t need any elastic.
 D - After 8 weeks

• The correct prescription

of elastics corrected the
majority of the
malocclusion and the
patient is pain free.
Thank you