VARI SIMPLEX DISCIPLINE

[ALEXANDER DISCIPLINE]

R.G. WICK ALEXANDER

1978.

VARI

SIMPLEX
DISCIPLINE

Twin, Lang ,Lewis.

KISS Principle
Edgewise mechanics

TWEED

VARI SIMPLEX

Anchorage preservation
.022 Slot.
Treat mandibular arch first.
DRIFTODONTICS.
Uprighting the mandibular first molars
6 degree tip

 Upright lower incisor.

Headgear.
RETRACTOR.
Non extraction

Tweed concept
and
Contemporary developments

QUALITY RESULTS

Key Objective
Patient ends up with the face proportionately
balanced and consistent with his skeletal pattern .
The treatment should be completed in the stipulated
time with a satisfied patient, parent and doctor

Unique Concepts.
1.First Straight wire type
Different designs of brackets in the same
case, depending on the type of teeth.
The 5 degree lower anterior torque is
different from other appliances.

2. Only 2 to 3 arch wires to be changed

3. Bracket design and bracket effectiveness

does not dictate the treatment technique.

4. Rectangular multistranded arch wires

DIAGNOSIS AND TREATMENT PLANNING

Diagnostic Chart
Patient information
Patient records

.
Cephalometrics , patient
examination

Treatment planning

Financial records

I.Patient history

I.
II.

Patient examination.
Diagnostic records.
1) Intra oral and Panoramic radiographs.
2)Study models.
3)Facial photographs

4)Cephalometric Analysis.
a) General skeletal pattern.
b)Tooth position.

Critical Factor in diagnosis

Lower Incisor Position.
1.Incisor mandibular plane angle.

2.Holdaway Ratio.

3.Lower incisor to A-Pog

Treatment Plan.
Two steps:
1.Determine the desired position of the
mandibular incisor.
2.Determine the treatment needed to position
the maxilla and maxillary dentition over the
desired mandibular arch position.

Objective of Treatment:
1.Incisors upright over the basal bone .
2.Cuspids not expanded.
3.Level curve of spee.
4.Non extraction therapy .

VARI-SIMPLEX DESIGN
Brackets are
Pretorqued
Preangulated
Built in In / Out
[Pioneered by IVAN LEE and LARY ANDREWS]
Different bracket design on particular teeth in the arch,but
the system of brackets for each pt is identical.

IMPORTANT FACTORS IN DETERMINING

THE DESIGN OF THE V.S.APPLIANCE
1. Shape and Size of the tooth.
Mesiodistal width and curvature.
2. Accessibility.
3. Patient comfort and frequency of bracket wing
breakage.

Factors Related To The Brackets

1.
2.
3.
4.
5.

Bracket selection
Bracket placement
Bracket angulation
Bracket torque
In / Out

BRACKET SELECTION
TWIN BRACKETS
Large ,flat surfaced teeth.
Mini Diamond brackets.
Accessibility
Additional hooks .

Inter bracket distance.

Patient comfort.
Full archwire engagement.

LANG BRACKETS
Dr.Howard Lang
Round surfaced teeth at the
corners
Single bracket with a flat
rotational wing.

Wire deformation

LANG BRACKETS
Complete arch wire
engagement.
Increased inter bracket
width

Wedge shaped in
profile

LEWIS BRACKETS
Large round surfaced teeth and
small flat surfaced teeth.
Single bracket with fixed
rotation wing built in
curvature

labial

LEWIS BRACKETS

Wedge shaped in profile

Excellent inter bracket width.

 Facilitates correction of severely rotated teeth.

Activation

OTHER ATTACHMENTS

Twin bracket with a Convertible sheath .

Head gear tubes placed occlusally*.
15 degree offset upper first molar .
5 degree mandibular first molar.
Ball hooks .

OTHER ATTACHMENTS
Single buccal tubes second molars
6 degree distal offset built in the lower second
molar.
Lingual hooks on all molar bands.

Appliance does not dictate the treatment technique

Bracket height
Bicuspid bracket height [x]

key

Bracket angulation
Ideal axial inclination.
Roots parallel

Crown in most esthetic

&functional position.

DIAMOND BRACKET
VERTICAL LINES PARALLEL TO THE
LONG AXIS OF THE TOOTH

1 st Bicuspid Extraction

Dr Dwayne Trammell
BAYLOR UNIVERSITY

Laminographic x- ray of the molars

3 months
Superimposition showed
Root tips moved
anteriorly by , 0.5
mm

2 mm of arch length

Crowns tipped distally on

an average of 1mm

BRACKET TORQUE DEVELOPED

Finishing rectangular wires of 50 cases

 - 30 torque

No torque

maxillary cuspids

mandibular second molar tube

- 50 lingual crown torque

mandibular incisors

DR. TRAMELL
Class II non extraction cases
0.017 x .025 D RECT MULTISTRANDED 3 MONTHS

Superimposition showed incisal edges moved

lingually by less than 0.5mm
Root apices moved labially on an average of 1mm
Main aim

Hold the incisors in its

original position

Bracket in out

EXTRA-ORAL FORCES
RETRACTOR

Control

Dr.Fred Schudy
Sagittal
Vertical
Transverse
Skeletal

Dental

Three different type of retractors

1. Cervical traction

Force vector -10 degrees

SN- MP- < 37 degrees

2. Combination

pull

Force vector 30 degrees

SN- MP
37 to 41 degrees

3. High pull retractor

Force vector 60 to 70 degrees

SN-MP > 42 degrees

Components of a facebow system

1. Molar buccal tubes.*

2. Inner bow
Adjustments in six
directions

Bucco-lingually

Superio- inferiorly

Anterio - posteriorly

3. Outer bow

 4. Retractor system

Retractor force
8 ounces
16 ounces
Time worn
Depending on severity of A-P discrepancy
ANB 3
7-8 HOURS
ANB 3- 5
10 HOURS
ANB - > 10
14 HOURS
Orthodontic vs Orthopedic force

Class III Extra oral forces

Face masks
Vertical pull chin cup
Reverse headgear

Successful treatment

Co-operation*
Growth
Arch consolidation

Elastics in Vari simplex

discipline
3 to 6 ounces
To align the maxillary dentition with the
mandibular dentition and correcting an
centric occlusion / centric relation
discrepancy.
Correction of cross bite and midline
Finalize the occlusion

Elastic Specifications
Class II - , 6 oz

 Class III - , 3 oz

 Midline elastics , 6 oz

Box elastics
Anterior box elastics 3/16 6 oz

Box elastics
Lateral box

Buccal box

 Trapezoid elastics , 6 oz

 Triangular elastics
1/8 , 3 oz

 Cross bite elastics

3/16 , 6 oz

 Finishing elastics
, 2 oz

[ UP AND DOWN]

M with
tail

W with tail

 Head gear
elastics

, 140z

Coil springs

Non-Extraction Treatment
Photographs
Learning Experiences
Case Record
BORDERLINE CASES
Fifty percent of cases

Treated
Non

Borderline

Non extraction

Negative torque on the lower incisors

bracket
Negative tip on the lower molar bracket
Flexible D RECT wire
initial
Bonding instead of banding
Ability to perform selective interproximal
reduction

MAXILLARY ARCH. Bonding and Banding

First Wire
Multistrandard spiral round archwire
Retractor
Second Wire
0.016 ss with omega stops.
Space closure with power chains.
Third final wire
0.017 x 0.025 ss rectangular

MANDIBULAR ARCH
First wire
0.017 x 0.025 multistranded rectangular wire
Slenderizing followed by 0.016 x 0.022 D-Rect
0.016 Ni ti and class III elastics
Second wire
0.016 x 0.022 ss with omega
Third wire
0.017 x0.025 ss

CLASS II DIV 2
0.0175 Multistranded or Ni ti
0.016 ss wire
Bite blocks
Mandibular arch- Initial round wires
- 0.016 x 0.022 ss finishing wires
- Invert bracket or zero degree torque
DEEP BITE CASES
Bite plate.
Cervical retractor

CLASS III CASES

Start treatment in both arches.
Early use of class III elastics.
Extra oral forces.
OPEN BITE
Bracket positioning.
Extra oral forces

Extraction Treatment
25 percent*
Indications:
1. Severe mandibular arch length discrepancy.
2. Severe bimaxillary protrusion.

Advantages of delaying treatment in

the mandibular arch:
1.Physiologic drifting. DRIFTODONTICS

2. No interference for retraction of

maxillary canines .

3. Additional time for second molars to

erupt.

STANDARD CLASS II DIV 1

MAXILLA
Initial wire 0.0175 Respond multistranded
or 0.017 0.025D-Rect rectangular
braided arch wire
Second archwire- Canine retraction.
0.016 ss round with omega stops .
0.016 0.022ss closing loop arch wire .

Third archwire Incisor retraction.

0.018-0.025 ss closing loop archwire*
Loop activation 1mm per four weeks.
Excellent torque control.

Final finishing arch wire

0.017-0.025 ss wire.

MANDIBLE:
4 to 6 months of Driftodontics
Initial wire
Multi-stranded .0175 respond.
or 0.016 Ni-ti
or 0.017 0.025 D-rect.
Second wire
0.016 ss wire .

Third archwire
0.016-0.022ss closing loop archwire.
Final finishing arch wire
0.017-0.025 ss archwire.

RETENTION IN VSD
Criteria for completion of treatment.
1. Centric relation and Centric occlusion
should coincide.
2. ClassI Cuspid relation.
3. Mand intercuspid width.
4. Interincisal angle with proper torque.
5. Normal ant overbite and overjet.

6. Normal buccal overjet.

7. Levelled upper and lower arches .
8. Rotations eliminated and all Spaces closed
9. Roots parallel near extraction.
10. Good cuspid interdigitation.

COUNT DOWN TO
RETENTION
6 WEEKS - Active treatment to Retention.
Posterior settling --- Sectioning the arch wire.
1. Mandibular arch wire - Class II deep bite
2. Maxillary arch wire

- Class III open bite

3. Both the arches

- Class I

FINALIZE THE OCCLUSION

Band removal appointment

,2 oz

Retainer design and fabrication

PRINCIPLES OF THE
ALEXANDER DISCIPLINE
1. AS A MAN THINKETH
JAMES ALLEN
EFFORTS = RESULTS

2. Dr .Hans Selye

Altruistic Egoism

3. KISS Principle .
4. Plan your work .
Accurate Diagnosis and Treatment Planning
5. Goals for stability.

6.Specific bracket design.

7.Bracket positioning.
8.Face bow for Orthopedic correction .
9.Proven Arch form design and Arch wire
force system .

10.Consolidate arches.
11.Complete bracket engagement.
12.Level the arches.
13.Progressing into finishing archwires .

References
The Alexander Discipline R.G. Wick
Alexander
JCO June 1983
Seminars in Orthodontics Vol 7 June 2001