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ortho the international C.E. magazine of orthodontics

08 I I C.E. article_ Combination Technique months to achieve results. This third phase included detailed positioning, proper uprighting and ideal axial inclinations of all teeth. The Combination Tech- niquewasexcellentfortreatingextractioncasesand difficult malocclusions, as well as being very capable of obtaining outstanding results in non-extraction cases. During Stage III (edgewise), the rectangular arch- wire (Fig. 4a–4c) was used to achieve ideal arch form anddetailedaxialpositioningofboththecrownsand rootsofallteeth.Thisincluded:(a)rootparallelingof teeth adjacent to the extraction areas, (b) uprighting of molar teeth, (c) artistic positioning of the incisor segments,(d)continuedoverbitecorrectionifneces- sary, (e) final closing of residual extraction spaces, and (f) lingual root torque for labial axial inclination of the maxillary incisors. Torquingauxiliary During the correction of many severe malocclu- sions,themaxillaryincisorsrequiredroottorqueasa resultoflingualcrowntipping.Inordertoaccomplish incisorroottorquing,anauxiliarywirewasemployed similar to that used by Dr. Begg during Stage III. The torquing auxiliary (Fig. 5) was an 0.014 wire constructed with two loops in the same plane as the archwire, which when snapped into the insert pins placed the loops onto the maxillary central incisors slightly sub-gingival. After snapping the torquing auxiliary into the insert pins anteriorly (Fig. 6), it was cinched behind the molar tubes posteriorly. Thistorquingauxiliarywasusedinadditiontothe main edgewise wire, which had been ligated into the horizontal slot of the widely spaced twin edgewise bracket to carry out the desired objectives of Stage III as well as providing anchorage and stability dur- ing the torquing procedure. The torquing auxiliary forcesproducedapproximatelyonedegreeoflingual rootmovementpermonth.Thiswassubstantiatedby cephalometric and visual examination. _Example of the Combination Technique in a severe malocclusion Treatment of a Class II, Division I severe maxillary protrusion and deep overbite is shown, using maxil- laryfirstandmandibularsecondbicuspidextractions (Fig. 7a–7j). Incisor coverage biteplate (Fig. 8a–8c) was re- quired as a preliminary step as a result of the severe ortho2_2012 Fig. 6Fig. 5 Fig. 4a Fig. 4b Fig. 4c Fig. 7a Fig. 7b Fig. 7c Fig. 7d