• PERCEPTOR

• Dr. ACHINT JUNEJA

• PRESENTED BY-
• PRIYANKA
 INTRODUCTION
 HISTORY
 ANDREW’S SYSTEM
 ROTH’S 5 YEAR EVALUATION
 ROTH’S 17 YEAR EVALUATION
 RATIONALS OF ROTH SETUP

 ROTH CONCEPT OF SELECTION OF

TREATMENT MECHANICS
 ARCH FORMS: ROTH TRU ARCH
 RX MECHANICS
UNLOCKING Of THE DENTETION
WORKING PHASE
FINISHING PHASE
 CONCLUSION
 REFERENCES
 Sir Edward Angle
introduced the
Edgewise appliance
which was a revolution
in the field of clinical
orthodontics.

Next Gigantic leap;

Andrews in 1970
revolutionized this
Edgewise to Preadjusted
Edgewise appliance.
 ROTH MBT
1 2 3
 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.

 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.
 He did extensive work in Andrews SWA and
published two articles namely-
 1. Five year clinical evaluation of Andrews SW
appliance.(1976 jco)

 2. The SW appliance 17 years later (1987 jco).

 He started designing his own prescription as a
clinical trial and error evaluation that
lasted severed 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.
 THE ROTH Rx

In 1979, Roth

introduced a bracket

setup containing

modifications of the tip,

torque, rotations and

in out movement of the

Ronald H. Roth Andrews standard setup

brackets.
 The ROTH
approach
Attempts to translate Tipping of teeth is
teeth throughout allowed, by using
treatment without round wires in the
ever tipping teeth. initial phase of the
This leads to the
treatment.
necessity of utilizing The attempt is to
sliding mechanics and
number of different keep the tipping to
series of brackets to a minimum.
solve the problem. “GNATHOLOGICA
“ANATOMICAL L STANDPOINT”.
STANDPOINT’”
- what made roth to modify Andrews SW
appliance

1. Inventory problem-To treat different cases

clinicians were to buy band kits for all Andrews sets and
series. They are very extensive inventory on the self.
Also, changing anything about the appliances would be
prohibitively expensive.

[Link] loss -When mesially angulated brackets

are placed on the posterior teeth, the teeth tend to tip
mesially and migrate forward that resulted is anchorage
loss.

3. Problem in finishing - To achieve desired tooth

positions with the standard SWA, it was necessary to
finish the mechanotherapy phase of treatment by
 Upper Posteriors Prescriptions

5° 2° 2° 0° 0°

2° 2° 2° -1° -1° -1°

°

SWA with 2º for upper Roth with 0º for upper

premolars premolars
Roth's rationale for his bracket set up.
•The purpose of the Roth setup was to provide over
corrected tooth positions prior to appliance removal
that would allow the teeth in most instances to settle to
what was found is non orthodontic normals studied by
Andrews.

•With the appliance is 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
•Play or tipping freedom - Due to the play between the
archwire and bracket, the delivered tip, torque and
rotations forces are less than the designated amount
“built in” the slot which need over correction to
compensates for play.
•The curve of Spee will return or deepen after appliance
removal.
•Teeth adjacent to an extraction site will tend to rotate
and tip towards the extraction site.
•As teeth in the buccal segments settle they will rotate
and tip mesially, so if they are overcorrected and slightly
tipped distally, they will tend to settle better than teeth
that are already mesially inclined.
•As band spaces close, there is a corresponding loss of
torque of the anterior teeth.
ROTATION CORRECTION OVER CORRECTION
 MBT

Second generation. Third generation.

Used wide arch form Used ovoid. Tapered,

square arch form.
Pleasant aesthetic.
Light continuous forces.
Stability of
Anchorage control
treatment depends
[Link] forces
of good functional
[Link] tip
occlusion.
[Link]
TMJ problem less in
[Link]
good occlusion
ROTH CONCEPT OF SELECTION OF
TREATMENT MECHANICS

Thorough diagnosis

Establishing treatment goals

Dynamic treatment planning

The traditional method of selecting treatment
mechanics, based on the Angle's classification of
malocclusion, is inadequate.

Treatment mechanics should be selected by the

set of conditions that exist along with the
parameters that are placed on the situation.
(The treatment mechanics must be tailored to the
individual situation and the individual facial type).
•In diagnosis and treatment planning, it is necessary to
diagnose the case from a mandibular position of centric
relation, if one wish to treat centric relation occlusion.

•One must utilize a specific set of criteria for a functional

occlusion goal throughout diagnosis, treatment planning,
and retention

•One must have records. (Standard orthodontic models

and cephalometric centric relation head films) taken in
centric relation as well, if any significant centric
discrepancy exists in a particular case
 CO - CR discrepancy

The neuromuscular positioning of the mandible will

accommodate to existing occlusal discrepancies and hide
the true nature of malocclusion

So a REPOSITIONING SPLINT should be

fabricated
•To get the patient's mandible into centric and

•To make the true discrepancy apparent.

Once the discrepancies are apparent, one should make a

treatment plan to deal with all of the discrepancies
present in the case and not just one to cover only those
 TREATMENT MECHANIC

•Those that are used Those that are used

on for the more
dolichofacial types
normal to
brachyfacial types.
TREATMENT MECHANIC SELECTIONS - FACTORS TO
BE CONSIDERED.

•The facial type of an individuals.

•Reactions of various facial types to the proposed

treatment.

•How much growth remains and in which direction the

mandible can be expected to grow and what means must

be taken to alter the direction of this growth - favourably
with treatment mechanics.

•Effect of treatment mechanics on the patient's soft tissue

profile.
TO PLAN AND TO SELECT APPROPRIATE
TREATMENT MECHANICS, ROTH UTILIZED.

•An adjusted head film tracing from centric

(habitual) occlusion to centric relation.

•Ricketts VTO and

•The five position superimposition

•Jarabak analysis

.
 The five position superimposition is utilised to
quantify
•The amount of growth needed to correct the jaw
relationship.
•The amount of orthopedic changes or jaw relationship
changes necessary to correct the dental arch
relationship and
•The extent of tooth movement allowable or desirable
both anteroposteriorly and vertically of the anterior and
posterior teeth in each arch.
Jarabak analysis
For qualitative assessment of the facial type and its
probable response to the various kinds of treatment
mechanics and growth.

The most important measurementsare

•The anterior to posterior face height ratio,

•The tendency of the individual facial type

to rotate clockwise or counter clockwise

during growth, and
•a response to certain treatment mechanics
 Treatment goals
1. Pleasing facial esthetics, evaluated by soft tissue
and skeletal measurements cephalometrically.
2. Molar relation and tooth alignment, evaluated by
Angle's description of anatomical occlusion.
3. Functional occlusion, evaluated gnathologically on
an articulator.
4. Stability of postreatment tooth positions and
alignment.
5. Comfort, efficiency, and longevity of the dentition,
supporting structures, and the temporomandibular
joints.
ROTH'S ORTHODONTIC TREATMENT GOALS FOR AN
IDEAL FUNCTIONAL OCCIUSION
.
I- Centric occlusion or
maximum interuspation of
the teeth should occur
with the mandible in
centric relation, in which
they condyles are
centered transversersy
and seated against the
articulator disks at the
posterosuperior slopes of
the eminence
This centric relation occlusion should have three point
contact of the opposing centric cusps in their respective
fossae.

II- Mutually protective occlusion

Occlusal force during closure should be of equal
magnitude for all posterior teeth and the stress should be
directed along the long axes of the teeth and the lower
incisors should not be in contact with the lingual surface
of upper incisors and should have a clearance of 0.005
inch
(by transmitting all the occlusal
forces, the centric stops of the
posterior teeth will protect the
 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 No stress
of the lower cuspids and resultant
lower anterior crowding, and/or
labial movement of the maxillary
cuspids and affects post treatment
stability.
Canine guidance / canine rise- In lateral excursions
the maxillary
cuspids should act as guiding inclines to disclude the
teeth on
the balancing or non-functioning side and to disclude the
teeth on
the working or functioning side after approximately .5mm
of group contact.
balancing working
R L
In a "mutually protective" occlusion

•The anterior teeth protect the posterior teeth from

lateral stress during protrusive movement and

The posterior teeth protect the anterior teeth from lateral

stress during closure into centric relation occlusion

•So in a mutually protective occlusion, the mandible can

execute its total range or envelope of motion without
interference from the teeth and

During closure the teeth will direct and maintain centricity

of the condyles in the fossae
III -Tooth-to-two-teeth or cusp-embrasure occlusion

During maximum intercuspation, there should should be

Tooth-to-two-teeth or cusp-embrasure occlusion between
the upper and lower teeth, because this make the lateral
and protrusive movements with proper cuspid and incisor
contact.
IV- Tooth structure, tooth position
and occlusal form should correlate
perfectly with mandibular border
movements, including the Bennett
movement and immediate side shift.
ROTH'S ORTHODONTIC TREATMENT GOAL FOR AN
IDEAL STATIC OCCLUSION.

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".
 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.
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.
 Bracket positioning with Roth set up
The bracket placement vary slightly from the
position advocated by Andrews, thus a flat, unbent,
rectangular, full sized wire can be used as the finishing
wire rather than one with reverse and compensating
curve.
Reference point – Andrews FA point
The point on the facial axis that
separates the gingival half of the
clinical crown from the occlusal half.
The key in determining the bracket height is the canine
and premolars (second premolars is an extraction case).
Ideally the center of the bracket should be placed at
the maximum convexity of the crowns of the posterior
teeth. In a teeth with average height of gingival
attachment, the maximum convexity of the teeth will be
 Molars(upper/lower)
From the buccal From the occlusal

MB

Both the right and left bands should be checked to ensure

 Premolars(upper/lower)
From the buccal From the occlusal

Upper premolar bracket placement is the most variable

because of tooth size. The most common error is not
placing the bracket gingival enough, especially on smaller
 Upper and lower Canine
From the buccal From the occlusal
Upper and lower incisors
 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.
. 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.
 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,

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.
 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 facebow to the 6 years

molar
 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.
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
•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.
 Phase I treatment
•Helical loop archwires, Jarabak fashion made from
0.016”
Elgiloy green wire(crowing) or
0.015” braided archwire(routinely)
or
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
 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.
At the end of space closure

Double keyhole loop wire mechanics

Replaced by

0.018x0.025” blue elgiloy incorporating exaggerated R &

C curve with special torque adjustments(to offset the the
undesirable effect produced by R & C curves) to provide

•Rapid root paralleling

•Leveling of Curve of spee &

•Maxillary incisors lingual root torque

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.
 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

 Over over jet
bite

0.005”
2.5 mm 2.5 mm
•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.
•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
 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

•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 the of the occlusal plane.
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”
 REFERENCES
•Treatment mechanics for the straight wire appliance-
RONALD H. ROTH

•orthodontics - current principles and techniques- Thomas

M. Graber, Brainerd F. Swain
•Treatment concepts using the fully preadjusted three-
dimensional appliance- RONALD H. ROTH
•Orthodontics- current principles and techniquesThomas
M. Graber, Robert L. Vanarsdall
•Five year clinical evaluation of the Andrews S-W
appliance- Roth
•The straight wire appliance 17 years later- Roth

•Functional occlusion for orthodontics-Roth-part I II III

IV
•Straight wire design strategies - five year clinical