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leveling will almost always flare the mandibular incisors labially.8,9 On the other hand, proponents of the
continuous-arch treatment philosophy contend that premolar and molar extrusions represent stable occlusal
changes, whereas mandidular incisor intrusion is an
unstable movement that will almost certainly relapse in
time.6,7,10-16
Cephalometric studies undertaken to compare the
sectional and continuous arch leveling methods report
that both the Ricketts4 and the modified Tweed5 techniques successfully correct deep overbites. At the same
time, a comparative study of these 2 approaches to
orthodontic treatment found that they result in similar
mandibular incisor positions.17
In support of the contention that it is important to
level an excessive COS, Andrews18 noted that the
occlusal planes of nonorthodontically treated normal
occlusions tend to be level. He associated a COS with
postorthodontic treatment relapse and concluded that,
even though not all normal occlusions have flat planes
of occlusion, this should be an orthodontic treatment
goal. Because of the tendency for the COS to return
after orthodontic treatment, other authors in support of
Andrews point of view suggest that it should be an aim
of orthodontic treatment to establish a level occlusal
plane.19,20
Several authors commented on the amount and
363
age at T1
age at T2
age at T3
treatment time (T2-T1)
fixed retention time
postretention time (T3-T2)
Time
12
14
26
2
3
11
y
y
y
y
y
y
6 mo
11 mo
4 mo
5 mo
4 mo
5 mo
type of occlusal relapse after orthodontic treatment.3,12,17,21-30 In general, these studies noted increases in overjet, overbite, and mandibular incisor
crowding along with decreases in arch length and arch
width. Although postorthodontic relapse was studied in
some detail, relatively little is known about the longterm stability of leveling the COS and how the different
methods of arch leveling relate to its subsequent relapse.
The primary purpose of this investigation was to
determine radiographically the long-term effectiveness
of the Alexander discipline (continuous archwire technique) in leveling the COS in Class II Division 1
deep-bite nonextraction patients. We also report on
some relevant cephalometric changes that take place
during arch leveling with the continuous archwire
technique. The cephalometric data obtained were used
to determine whether a COS that was leveled remains
stable in the long term.
MATERIAL AND METHODS
Table II.
T2
T3
Measurement
Mean
SD
Mean
SD
Mean
SD
2.47
38.89
32.50
29.16
94.85
1.18
22.81
82.03
76.87
5.16
66.21
31.23
17.76
13.47
8.00
20.00
78.89
26.29
109.24
19.18
134.27
84.95
0.69
3.02
2.76
2.14
5.43
1.98
5.16
3.33
3.34
1.60
2.91
4.35
3.31
3.18
2.89
4.15
6.29
2.46
9.31
8.27
13.56
4.10
0.19
39.42
35.31
31.47
95.68
0.34
24.18
79.39
77.21
2.18
67.26
32.21
14.77
17.44
8.95
22.73
81.00
26.87
111.23
22.68
130.53
78.53
0.31
2.94
3.01
2.81
6.93
1.51
4.82
4.08
3.75
1.76
3.36
5.54
2.94
4.58
3.35
2.52
6.24
2.84
5.30
4.25
7.02
5.60
0.69
41.08
36.31
32.70
94.50
0.24
23.15
79.76
77.76
2.00
66.92
31.65
14.58
17.06
8.23
23.97
83.11
28.29
111.97
23.68
131.35
80.40
0.64
3.27
3.18
3.20
5.80
2.04
4.94
4.14
3.91
2.25
3.77
6.30
3.63
4.23
3.04
2.84
6.27
3.10
7.87
5.74
7.98
6.05
Perp, Perpendicular.
Table III.
Posttreatment changes
(T2-T3)
Total change
(T1-T3)
Measurement
Mean
SD
Mean
SD
Mean
SD
2.50
0.53
2.81
2.31
0.87
1.26
0.61
0.82
1.51
1.37
2.65
0.34
2.98
0.52
1.05
0.98
2.98
3.90
0.95
2.73
2.11
0.58
1.98
3.50
3.70
6.42
0.77
1.60
1.69
2.28
0.49
1.66
1.00
1.23
0.66
0.00
0.23
1.18
0.10
1.03
0.37
0.55
0.18
0.06
0.34
0.56
0.19
0.32
0.73
1.24
2.11
1.42
0.74
1.00
0.82
1.87
0.69
2.30
2.00
2.38
1.78
2.19
3.81
3.53
0.21
1.26
0.84
0.35
1.41
0.34
2.27
0.89
3.16
0.59
0.71
0.42
3.18
3.58
0.23
3.97
4.23
2.00
2.73
4.50
2.92
4.55
0.74
2.37
2.15
2.24
6.08
1.57
4.81
2.17
1.29
1.55
1.86
1.34
2.43
3.09
3.83
1.91
2.85
5.32
1.99
9.29
8.09
11.37
3.04
5.21
1.31
4.21
2.23
1.34
2.06
1.45
1.33
2.44
2.56
3.14
1.64
1.59
5.40
1.79
5.22
3.92
6.55
4.63
3.91
1.57
4.35
2.51
1.58
2.34
1.95
1.73
2.75
3.22
3.18
1.78
2.56
5.67
2.20
9.00
7.24
10.28
5.37
Perp, Perpendicular.
Table IV.
Measurements
COS
L1 perp to MP
L4 perp to MP
L6 perp to MP
L1 perp to MP, growth
L4 perp to MP, growth
L6 perp to MP, growth
L1 to MP
L1 to A-Po line
L1 to NB
SN-MP
Y-axis
OP-MP
SN-OP
SN-PP
ANB angle
T1 vs T2
P
P
P
P
P
P
P
P
P
P
P
P
P
P
P
P
.0001
.0742
.0001
.0001
.0052
.0001
.1482
.4569
.0001
.1227
.0316
.0001
.0001
.0001
.0095
.0001
T2 vs T3
P
P
P
P
P
P
P
P
P
P
P
P
P
P
P
P
.0004
.0004
.0093
.007
.0001
.0627
.0001
.2181
.6829
.1822
.2072
.1651
.5151
.6769
.0198
.6357
Perp, Perpendicular.
After treatment, the incisors retroclined a mean distance of 0.10 mm relative to the A-Po line, resulting
in an overall (T3) mean proclination of 1.41 mm
(SD, 1.57 mm). A negative value for the measurement
represents lingual movement of the tip of the tooth.
There was a statistically significant difference between
the T1 and T2 measurements (P .0001) (Table IV).
DISCUSSION
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