The 1926 Congress: Then and now

Abstract

From the foregoing discussions, it may be recognized that a new, lighter, and sequential order of force applications is recommended. Accordingly, in order for the clinician to apply the new technique with the intelligence, he must realize that many biologic factors form the fundamental criteria of its application. We have attempted to examine these factors and place them in their appropriate hierarchy of significance.While edgewise was the background, sufficient departure from traditional edgewise therapy has been made to warrant a new label, “bioprogressive therapy.” It was so named because of the practice of progressive banding and a planned progression of events in sequential order. Eight steps usually form the frame of reference. Ironically, it can be applied in the very young and in the very old.It is difficult to appreciate these views and practices in the beginning because the method may be difficult to envision on the typodont or as simply a laboratory mechanical exercise due to the fact that cortical bone, growth, and muscle are not present in an artificial medium. In order to fully apply the recommendations of the proponents of this method, mechanical forecasting, physiologic forecasting, and growth forecasting principles are all employed. Even as a simple mechanical regime, however, it rates with or better than any other current multibanded method as a practical and efficient clinical procedure.Size 0.016 by 0.016 inch blue Elgiloy wire is commonly but not exclusively used. Loops or forms are bent in the wire for lighter and more continuous pressures on teeth to be moved. Soldering of auxiliaries has been eliminated, as well as the heat treating of wires. The 0.016 by 0.016 inch to 0.016 by 0.022 inch yellow Elgiloy is used for detailing near the end of treatment. The 0.018 by 0.022 inch is the largest wire employed, and it is used for spanning distances between teeth in the progressive debanding phases.Anchor teeth are stabilized against cortical bone; hence, cortical anchorage. In order to position and control the teeth behind or away from cortical bone or against or away from muscle or to intrude into or extrude away from the bony alveolus, three-plane control is utilized. A limited use of round wire is employed with this technique except for specific isolated conditions in which there is a place for tipping or simple alignment and rotation of teeth. We try to avoid leveling with round wires, for reasons that have been explained. Used as a triple-control technique, the bioprogressive method excels in proper overtreatment and for delivery of anchorage.A continuous arch is broken up into segments or sections so that movements in desired planes of space are not complicated and anchorage can be shifted in favor of the desired move.The technique usually involves orthopedic correction, particularly in the maxilla, when such corrections are needed. When this technique is combined with the activator or mandibular posturing devices, an application can be made to provide an anchorage approach to include growth and maxillary and mandibular orthopedics.57Muscle anchorage definitely is considered in anchorage planning and utilized in its fullest application, even to posttreatment rebound.The leveling of the arch by the extrusion of the premolars is considered to be contraindicated. Thus, intrusion of anterior teeth, either upper or lower, is a practiced art with a bioprogressive technique.With this approach, a tremendously wide range of flexibility is possible, and overtreatment is the byword. This flexibility permits the clinician to overcome tooth-size discrepancies, as overtreatment of a part of the arch can easily be attained.The light square wire allows the clinician a wide range of intraoral adjustments. This procedure reduces the clinician's chair time, is much less painful and trying to the patient, and at the same time provides even greater control in the strictest sense of the word. This is an art to be learned by the individual clinician.Another virtue of the “progressive” approach to treatment is particularly thought provoking: absolute standardization is not appealing and is not the aim. Rather, a body of principles has been developed. In depth diagnosis, prognosis, and designing are advocated for the patient, depending upon his particular individual needs. The orthodontist is still in command because anchorage preparation, differences in extraction and nonextraction, and various arch-form differences make absolute straight wire misleading.Visual objective “designing” with cephalometrics as a reference for planning is strongly recommended, although “intuitive planning” is practiced with this method as well as others. In applying specific progressive therapy to its greatest potential, however, the biologic and mechanical principles are put together cephalometrically for each individual patient only after his unique personal requirements are determined. In this manner, the philosophy and science of orthodontics can be practiced with the spirit of the artist.