THE APPLICATION OF THE EDGEWISE ARCH MECHANISM

TO THE TWEED PHILOSOPHY IN ORTHODONTICS

B. L. HERZBERG, D.D.S., M.D.S., CHICAGO, ILL.

T HIS paper will deal with mechanics per se and will differ in that respect
from a paper read by me before the Central Section of the American As-
sociation of Orthodontists at Cedar Rapids, Iowa, in November, 195O.l In that
paper not only was the Tweed philosophy treated at some length, but diagnosis
and the method of making one were given considerable space. In addition a
mass of material was presented to show the results of treatment, both from
the point of view of favorably changed tooth and jaw relationships and favor-
able changes in facial balance or esthetics, each as a justification of the therapy
employed.
In another paper published in The Portnightly Review of the Chicago Dental
Society and titled “Facial Esthetics in Relation to Orthodontic Treatment,“*
I delve into material that may also properly be considered as preliminary to
this paper and therein, too, make an effort to point to the criteria for the de-
velopment of better facial balance and esthetics through orthodontic treat-
ment. Further, the aims of orthodontic therapy are discussed at some length
and are listed as (1) the best in facial esthetics, (2) the best in function, (3)
the best in health of all of the structures involved, and (4) the best in stability.
It was also carefully pointed out that in therapy, since it was desirable to
maintain or place lower incisor teeth over base, it would be necessary to estab-
lish and maintain mandibular anchorage in the course of treatment, and in this
paper every effort will be made to stress this point.
The paper on mechanics referred to previously herein was profusely illus-
trated with photographs of appliances taken directly in the patients’ mouths,
while the present thesis will be illustrated with photographs of appliances in
the mouths of patients and supplemented by line drawings. In this way I hope
to convey more clearly the action of the various components of the appliances
and to depict more clearly the actual assemblage of the appliance.
We, therefore, should at this time take up the basic assemblage or fabrica-
tion of the edgewise arch mechanism. The first step must, of necessity, be the
fabrication and the placing of the individual bands. This is elementary, of
course, but the correct fitting, seating, and cementation of bands will eliminate
many wasted hours later on in the course of treatment and will reduce to a
minimum the hazards of tooth decalcification and decay provided we start with a
fully restored dentition completely free of caries. It might be well at this time to
point out that the proper tools or instruments are essential in the work we are
to do, and they may and do facilitate our progress and make easier our task.
Presented at the Fall Meeting of the Northeastern Society of Orthodontists, Philadelphia,
Pa., Nov. 13, 1951.
 EDGEWISE ARCH MECHANISM AND TWEED PHILOSOPHY 507

Bands are pinched directly on the various teeth in the mouth, using Angle
band-forming pliers, No. 155 right and left and No. 155s right and left. The
bands are so placed in the pliers (Fig. 1) that pressure upon the handles of the
instrument compresses the band material around the tooth to fit it snugly
(Fig. 2) and then, by a rotating motion of the pliers, both mesiodistally and
incisogingivally, and with more pressure on the plier handles, the band mate-
rial is more closely adapted to the tooth. Since we at our office use stainless
steel band material, we cut off one end of the tail at the marking made by the
band-forming pliers and the other end about 1 mm. beyond the marking and
make a lapped welded joint directly on the mark. For lower incisors we use
band material of 0.003 inch thickness by 0.125 inch width; for upper incisors,
cuspids, and premolars the material is 0.004 inch by 0.150 inch; and for molars
material is 0.005 inch by 0.180 inch in width. For most cuspids, contoured
bands are used with the brackets set as closely as possible to the incisal edge.
All bands carry edgewise brackets centrally placed prior to pinching the band
material around the tooth. The last molar band carries a 0.022 inch by 0.028
inch buccal tube and where second molars are banded, the first molars carry
a wide edgewise bracket. Some lower first molars are banded with contoured
bands, and when these are used the brackets are soldered after fitting. When
satisfactory cuspid bands cannot be placed, cast cuspid bands are fabricated
and the brackets are placed after fitting. May1 at this point digress to explain
that the process of forming the band around the tooth we designate as pinch-
ing, and the step of adapting the band to the tooth after it has been welded we
consider fitting. Up to this point the only difference that I can note in this
technique as opposed to one using precious metal banding material would be
in the welding step, as opposed to a soldering step; and in soldering a butt
joint may be preferable. All incisor bands are pinched on the lingual, pre-
molar bands are pinched on the buccal, as are lower molars except when lower
contoured molar bands are used ; then they are pinched on the lingual. Upper
molars are pinched on the lingual. Whenever possible second molars are
banded.
In fitting the bands to the teeth, we drive our bands to place with a Hol-
lenbeck automatic gold foil condenser. Frequently, we may have to stretch
the bands to set them to the desired position. Starting with either the upper
or lower first premolar, the band is driven and adapted to the tooth. All oc-
clusal overhang is removed with a large stone. The band is reseated with the
bracket in its correct or best position on the buccal surface, and at that time
the bracket location, as related to the buccal cusp, is measured with Starrett
dividers adapted for this purpose by shortening one leg of the dividers. The
instrument for this purpose was first suggested to me by Dr. Harry Bull of
Jersey City. All I did was to add a male attachment to the short leg that
would not only fit into the bracket slot but would also be adapted to the
bracket wings (Fig. 3). This seemed to me to be a bit more exact.
The dividers are now set and are used for the bracket and buccal tube
positions on all of the buccal teeth in that arch. Hooks are soldered on the
mesio-buccal-gingival aspect of the last mandibular molar bands, to receive
508 B. L. HERZBERG

Class II elastics. This position avoids rotation of the anchor molar when using
elastics. We like to place our incisor brackets incisally to the point that the
bracket position as such would tend to depress the incisors. both upper and
lower. On the lower incisors all brackets are set at the same distance from
the incisal edge, but on the upper incisors t,he lateral incisor brackets are SO
set a,s to finish the case with those teeth a little shorter than the central in-
cisors. When the upper incisors are fitted, they are driven to place and bracket
positions checked. The lingual surfaces of these bands are now adapted to
the lingual contour of these teeth with ball burnishers, after which solder is
flowed into this contoured area to strengthen these bands so that the tremen-
dous functional stress against these bands would not dislodge them (Fig. 4).
This very valuable step, reducing to a minimum the need for recementation of
upper incisor bands and practically eliminating not only the fear of, but also
the actual occurrence of, white decalcification on the lingual or labial surfaces
of upper incisors, was also suggested to me by Dr. Hull. Molar bands are fitted
by driving the band well down so that whenever possible the band fits slightly
under the free margin of the gum tissue. The bands are contoured to the lin-
gual and bucca,l grooves of the teeth and all occlusal excess is removed with a
large stone. This is also done with mesial and distal excess on cuspicl and in-
cisor bands. Now that the bands are fitted a mesial and a distal staple are
placed on all bands except the molar bands tha.t carry the buccal tubes. When
staples cannot be placed as usual they may be soldered on the lingual SUP-
face. Failure to place staples as suggested frequently results in many hours
of extra work. Tf an office is well orga.nized and has a good laboratory tech-
nician there is little reason why the soldering of brackets and staples to the
bands and the welding of bands cannot be delegated to others. After staples
have been soldered and the bands polished, the bands are once again a,djusted
to the teeth and then cemented (E’ig. 5). It is needless to say, of course, that
throughout the band-forming and cementation procedure adequate separation
must be present. It is not necessary to advise concerning the number of bands
to be cemented at one time or with one mix. At,tention is merely directed to
the fa,ct that careless cementation procedures could easily make ineffective a
very careful band technique.
For the purpose of clarity it might be well at this time to consider arch
bending technique. All of our full arches are formed to conform to the origi-
Fig. l.-The armamentarium for pinching edgewise bracket bands, showing at the toy
contoured molar band.fo!lowed by molar band, both 0.005 by 0.180 inch.; premolar band, 0.094
;zc;.150 inch; lower mc!sor pand, 0.003 by 0.026 inch: contoured cuspld band, 0.004 by 0.150
There are four phers m the set: right and left convex, No. 155, and a right and left
con&ye, No. 1555. A plier with a band in place ready to be pinched around the tooth.
Fig. 2.-A, A premolar band being pinched from the buccal with a bracket shown on
the lingual. The No. 1555 pliers are used for premoiars. B, A lower incisor being pinched
on the lingual. The No. 155 plier is used for all bands other than for premolars.
Fig. 3.-The modifled Starrett dividers being used to measure bracket and band position
on the teeth. .
Fig. 4.-Soldered reinforcement shown on the lingual of the upper incisors.
Fig. 5.-Completed edgewise bracket band assemblage showing mesial and distal staples
on all bands except on the last molar bands which carry 0.022 by 0.028 inch buccal tubes.
Note hook on last mandibular molar band at the mesiogingival buccal aspect to receive elasacs.
Fig. B.-Arch farmers showing the manner in which arch is set into groove for forming.
Fig. i’.-Arch adapted to lower model in malocclusion without expansion.
Fig. 8.-Small round arch, 0.016 inch, used to start a case in limbering up process.
Fig. 9.-The method of tying a rotation, flrst through the staple and then around the
bracket to keep the rotating action continuous over a longer period of time.
EDGEWISE ARCH MECHANISM BND TWEED PHILOSOPHY 509
510 B. L. HERZBERG

nal malocclusion, for in our orthodontic procedures there is no place for expan-
sion as such, except in crossbite cases, either anterior or posterior, or for in-
dividual teeth that are obviously in lingual position. Arches in the edgewise
technique are of various sizes, viz., 0.01.6, 0.018, 0.020, 0.022, and 0.021 by 0.025
inch and 0.022 by 0.028 inch. All of the arches are stainless steel. The arches
are fabricated on a turret arch former with grooves to t,ake any of the pre-
viously mentioned arches (Fig. 6). The arch form is definitely adapted to the
malocclusion (Fig. 7). The formin g is done by starting with the largest por-
tion of the turret and coming down to the smaller forms until the correct gen-
eral shape is achieved. Final bending is clone with fingers or pliers. Stops or
tiebacks are usually fashioned directly in the arch material with pliers, but
may be soldered by using brass wire of about 0.020 inch diameter as the stop
material. This is done when space is short for a formed stop, but care must
be taken in soldering not to heat the arch wire and render it useless. All arch
wires are bent wit.h a tip back for the molar sheaths to initiate the uprighting
or tipping back of the most distal teeth. Lingual bends are usually placed on
the last banded molar teeth. Arch wires are now heat-treated at 850’ F. for
three or more minutes, then allowed to cool in air, and are polished by sub-
mersing in acid. Deviation in arch forms from this point on will be treated in
the various steps in therapy as bhey OCCIIT.
Tweed has aptly said that if we as orthodontists know our goal, we will
he able to devise a means for attaining it.R Those who follow the Tweed philos-
ophy and use the edgewise arch mechanism have a definite plan or routine to
follow in therapy.4 If the lower incisors are not over base they must be placed
t,here in treatment; if they are over base, they must be so maintained. If more
mandibular anchorage is desirable or required, these teeth along with all the
lower cuspids and buccal teeth must be tipped back, the buccal segments dis-
t,ally and the labial teeth lingually. The problem may be very simply stated
and be almost all embracing by putting it as follows: The mandibular incisors
in treatment must be placed and/or held relatively upright over the mandibu-
lar base. All other mandibular teeth must be placed in correct proximal con-
tact to adjacent teeth and in the correct axial inclination to the basal bone
and to each other. The maxillary teeth then must be occluded with the man-
dibular teeth and must also be in correct axial inclination to their base. All
this must be done without expansion except as previously stated in cross-bites.
If in treatment the lower incisors cannot be placed upright to base without
expansion, then dental units must be removed so that the mandibular incisors
may be correctly positioned. In extraction cases four first premolars are the
units of choice to be removed, but this choice is tempered by conditions as
t,hey exist in the patient’s mouth, examples of which are teeth that have large
fillings, are badly decayed, are pulpless, or malformed, or that are disadvan-
tageously positioned for movement. It might be called to your attention that
I, as well as many others, notably Charles H. Tweed, have pointed out that
usually (although not always) the more the lower incisors are set lingually, the
more is facial esthetics improved. This applies definitely to patients with
large Frankfort-mandibular plane angles,5 and immediately draws attention
to the limitations of orthodontic treatment.
 EDGEWISE ARCH MECHANISM AND TWEED PHILOSOPHY 511

With the above preliminary steps covered, and with the above comment
as to aims and goals of treatment, and with the limitations as above imposed
upon our ability to upright lower incisors over base, we are prepared to pro-
ceed with treatment and will select first the nonextraction case.
We have cemented edgewise bracket bands on all the teeth with a mesial
and distal staple on all the bands except the last molar bands which carry the
rectangular buccal tubes. The second molars have been banded if possible.
The steps now follow each other according to a plan.
An 0.016 inch arch wire is placed in each dental arch and they conform
to the malocclusion. A tip back is placed for the last tooth on each side in
each arch (Fig. 8). A slight lingual tip is placed at both ends of the arches.
Spaces are gathered up by cinching up the arches; therefore, the tiebacks must
be anterior to the buccal tubes. After a limbering up process and after bracket
engagement is attained, the same procedures are followed with 0.018 inch and
0.020 inch arches; and now in addition to cinching to close spaces, rotations
are ironed out by ligating through the correct staple on the rotated tooth;
first, to the arch which is thus caused to spring and then drawing the ligation
ligature through the bracket wings to keep it active for a long period and to
keep the ligature from slipping (Fig. 9). All this time, the insertion of the
larger arches, all formed to the malocclusion and even slightly contracted to
avoid expansion, continues to level the occlusal curve. This reduces the an-
terior overbite. Any arch wire conformed to the tooth arch when seated into
the flat slot of the edgewise brackets on the incisors and then ligated tends to
expand that arch in the buccal segments. Therefore, the arch is frequently
contracted before being seated.
The last and largest-sized arches placed are 0.021 inch by 0.025 inch and
by this time rotations should be corrected, the curve of Spee and the overbite
reduced, and in most instances the spaces closed (Fig. 10). In difficult rota-
tions the rotating bar is used (Fig. 11) and made of 0.018 inch arch material.
Now if a Class II condition exists, tip back bends are placed in both arches
which are now rectangular, 0.021 inch by 0.025 inch. A tip back is placed at
about the center of each interbracket space all the way forward to and in-
cluding the space between the cuspids and lateral incisors. These bends are
made by holding a 442 or a 142 plier on the interbracket mark, made with a
file, scissors, or white pencil, and if in the maxillary arch, by bending the distal
segment up with the thumb or fingers and the mesial segment down (Fig. 12).
Both segments should be parallel. The plier is now moved forward to the next
mark, the wire bending process repeated,’ and now we have three segments
all of which should be parallel and offset the same degree. This process is con-
tinued until the last interbracket mark is worked over; then the same steps
are followed through on the other side of the arch. The distal tip back is
increased now slightly over the others and tiebacks are placed snugly to the
upper buccal tubes if no spaces exist in the maxillary arch, and slightly for-
ward to the tubes if there is some spacing (Fig. 13). Note here that in none
of the arches were lateral incisor inserts placed, for I in my study of excellent
512 B. IA. HERZBERG

nontreated dentitions have not observed that the lateral incisors are lingual]?
placed, but on the contrary their lahial surfaces are in the same curvat,ure
as are those of the central incisors. This upper arch is now tied in with eo-
ordinated torque, i.e., with the in&al segment, of the arch as it seats int,o the
brackets parallel to the tip backs in t,he buccal segment. The arch is tied in
and tied back snugly to create a unit of anchorage. Rooks have been placetl
between the upper cuspids a,nd incisors t,o receive extraoral force to augment
the anchorage in the upper arch as (‘(lass I IT elastics are used (F’igs. 14 and 15).
The lower arch is treated as is the maxillary arch in placing of tip back
bends, except as the 132 plier is held on the distal interbracket space, the distal
segment is bent down and the mesial segment up, and so, until all t,he bends
are made on both sides. The tip backs in the mandibular arch, however, are
greater than those in the opposite arch and again, too, the last tip back is some-
what exaggerated. Class IT1 hooks are placed between the lateral incisor and
cuspid bracket to receive (*lass II1 elastics. The ineisal segment here, as above.
should he parallel to the buccal tip backs, but, tar the beginner or the tin&l
the incisal segment may be rounded if the operator fears that the mandibular
incisor roots may he torqued too far labially. This arch is not tied back but
the stops are definitely against the buccal tubes to prevent buckling of COIL-
t,act,s in the lower arch. Now, the pabient wearing Class 1IL elastics constantly ;
the mandibular buccal and incisal segments are set back until the molars, pre-
molars, and cuspids are leaning distally and the incisors are leaning lingually.
The patients are instructed during this period to use extraoral force on the
maxillary arch all night long and as much more time as possible, to augment
the resist,ance in the maxillary arch. At subsequent sittings, if need he, the
t,ip backs in the lower arch are increased but the stops are kept against the
buccal tubes. The upper tip backs also may be increased slightly and tied
back more tightly to keep the anchorage from giving way even though sup-
plemented by extraoral force. As tip back bends are increased it may be
necessary to make new arches so that they may be seated int,o bracket engage-
ment. When the mandibular teeth are advantageously placed to resist Class
II elastics, mandibular anchorage has been established and we are ready for
Class II mechanics.
In Class II mechanics we use the same arches where possible, increasing
the bends slightly in the mandibular arch and more drastically in the maxil-
lary arch, and now tying the lower arch back tightly to create a unit of an-
chorage. The maxillary arch is not now tied back but the stops are against the
Fig. lO.-Rectangular arches in place with spaces closed and overbite reduced,
Fig. Il.-A, Type of rotating lever ready to be tied in and activated; used in difficult
rotations. B, Schematic drawing of rotating lever showing how lever is bent to At under
wings of bracket of tooth to be rotated.
Fig. 12.-Placing tip backs in tte arch with No. 142 or No. 442 plier using thumb an,1
flrst Anger to make bend.
Fig. 13.-Arch with tip backs incorporated showing accentuated bend at the end of arch.
Fig. 14.-A, Class III mechanics in use. tip backs in lower arch. Tip backs in the
upper arch and the arch tied back tightly. Note upper right cuspid cast band. Also note
hooks on upper arch to receive extraoral force. B, Schematic drawing of Class III me-
chanics. Note depression offsets for the incisor teeth in both upper and lower arches.
Fig. 15.-A, Extraoral force used with Class III mechanics. B, Anterior view of A.
Note that the plastic tube shown in the illustration has been replaced by an elastic fabric
cervical band.
EDGEWISE ARCH MECHANISM AND TWEED PHILOSOPHY 513

Figs. 10-15. (For legends, me opposite page.)

514 B. L. HERZBERG

molar tubes to prevent contact breaks in that arch. Here, as before, in the
opposite arch, the timid may round the in&al segment of the upper arch if
they fear the roots may become too prominent in the incisal segment. Class I1
elastics are worn continuously, extraoral force is discontinued, and as need
be the upper tip backs may be increased (Fig. 16). The offset in the arches,
between the cuspids and lateral incisors, tends to open up the bite. The tip
backs in general also tend to do this. Class II elastics are worn until the mesio-
distal cuspal remtionship is slightly orrrtreated and the incisors are about end
to end.
If at this time a tooth midline discrepancy exists with a unilateral disto-
elusion, then the mesiodistal and the midline discrepancies are adjusted by the
use of Class 11 elastics on the side of distoclusion and Class III elastics 011 the
opposite side of the dental arches” (Fig. 17). The incisors are carried to about
end to end as in treating Class II conditions. The teeth are then checked foi
rotations and axial inclinations, elastics are removed, and the teet,h are al-
lowed to settle. If they settle well and do not relapse, provision is made t,o
remove the appliance and place retainers. If the teeth do not settle well,
hooks are placed on both arches at advantageous locations and the cusps are
seated with vertical elastics (Fig. 18). In finishing, a few bands may be rc-
moved and the arches cinched to close band spaces, but I find that band spaces
usually close uneventfully when the appliances are removed.
The treatment of extraction cases differs only in the closure of spaces at?
the site of extractions and then the closure of the incisor spacings created by
the movement of the cuspids distally into the premolar spaces. When all the
spaces are closed the same procedures that ha,ve been enumerated in the non-
extraction cases are followed. I will, for treatment purposes, recognize two
types of extraction cases, viz. (I) crowded cases, the usual example of which
a.re t,he locked-out cuspid cases, and (2) all others. In the first group the four
first memolars are extracted and upper and lower fixed lingual arches (Fig.
19) are placed until the cuspids and/or other crowded teeth assume the best
positions they may under the lingual arch management. Then either they art’
ready for full band and arch mana,gement as in nonextraction cases or they
require space closure techniques which we will ta.ke up at this time.
Fig. l&-A, Class II mechanics used after establishing mandibular anchorage. B, Sche-
matic drawing of Class II mechanics. Note depression offsets in both arches for incisor teeth.
Fig. 17.-A, Shift elastics; Class III on one skle, Class II on the other side to arljust s
midline discrepancy. B, Schematic drawing of A.
Fig. 18.-Vertical elastics to seat cusps.
Fig. lg.-Fixed lingual arches used in crowded extraction cases to allow cuspids to erupt
and move distally. This device taxes anchorage to a minimum.
Fig. 20.-A, Sectional arches with tip back bends tied into distal staple of a meslally
tipped cuspid in an extraction case to upright the cuspid. B, Schematic drawing OP A. Nofe
stop against buccal tube and tied in. Activation is from distal cuspid staple to eyelet at the
mesial end of vertical loop.
Fig. 21.-A, Sectional arch without tip backs, seated in cuspid bracket by means of liga-
ture through distal cuspid staple then to cuspid bracket. this to prevent rotation of cuspid as
it moves distally. The loop is activated from the stop anterior to the buccal tube by a ligature
tied around the distal of the buccal tube. B, Schematic drawing of A.
Fig. 22.-Cuspid-to-cuspid coil for moving cuspids distally. The text of the paper has
these arches rectangular with tip backs and securely tied in. This type of coil is now being
used with a round 0.020 inch arch without tip backs and not tied back. The lip action lieeps
the coil active. IJsing coils in this manner appears to strain anchorage less than when arches
are tied in. This method of using coils to retract cuspids was suggested by George Englert.
Fig. 23.---Ceils against stops to move cuspids distally.
EDGEWISE ARCH MECHANISM AND TWEED PHILOSOPHY 515

Figs. 16-23. (For legends, see opposite page.)

516 B. 1,. HERZBERC;

As in crowded cases, so in the second group, four first premolars are IY-
moved and bands are placed on all t,he buccal teeth and the cuspids. Vu11
arches may be used to a.lign the brackets, but as soon as possible provision is
made to carry the cuspid distally into the extraction spaces. This may be done
in several ways.
First, by means of sectional arches. If the cuspid is tipped mesially thr
sectional arch carries tip backs, is tied back securely, and is activated from
the loop through the distal staple on the cuspid band (Fig. 20). If and when
the cuspids are relatively upright, a mashed or Hull loop is used. In the use
of this arch the procedures suggested by Harry Bull are followed. No tip
backs, as such, are placed in t,hese sectional arches but the short lever, anterior
to the loop that engages the cuspid bracket, is tipped gingivally to the bracket
so that as it is seated the long arm distal t,o the loop becomes one large tip
back, when the short anterior lever is raised occlusally to be seated. Desides
the mashed loop there is incorporated in the sectional arches a small bend just
anterior to the cuspid bracket to keep t,he arch secure, and a tieback anterior
to the buccal tube to allow for activation. The arch is so bent that it seats
readily in the brackets and at the same time is contoured lingually in the cus-
pid area to keep those teeth from tipping la.bially (Fig. 21). These sectional
arches are tied in to the cuspid brackets t,hrough the distal staple and thcll
sround the bracket wings, to keep the cuspids from undesirable rotations.
Then the tiebacks are cinched to the hooks on the molar bands below and to
the dista,l of the buccal tubes above, opening the mashed loop a small amount.
Then the arch is seated in the brackets of the first molars and second premolars
to complete the ligating sequence. At subsequent sittings (in our office, three
weeks) the loops are reactivated, always being careful that the arm engaging
the cuspid bracket is bent gingivally. RectRngular arch material is used for
these sectionals. The process is continued to the point where the cuspids are
relatively upright and when ample space is present to upright the lower in-
cisors to base or, if need be, even to tip them lingually to base. In the step
just described there is no question that the posterior teeth move forward and
that is usually what is desired. When, however, all the extraction space is
needed and even that may not be adequate, then our techniques are usually
found wanting and our ingenuity is taxed to the utmost. To the degree that
the posterior teeth can be kept from coming forward, will our results reflect
the finest in orthodontic efforts.
Second, cuspicls are carried distally by means of full coil springs from
cuspid to cuspid in each arch using rectangular arches 0.021 inch by 0.025
Fig. 24.-A, Acrylic plate with finger springs to move cuspids distally. B, Schematic
drawing of A. (From Paul D. Lewis. f
Fig. 25.-A, Double vertical loops to close anterior spaces. R, Schematic drawing of A.
When rectangular arches are used it is well to round the incisal segment.
Fig. 26.-A, Gabled roof arch used to parallel roots in space closure cases. B, Schematic
drawing of A
Fig. 27.-Oriented cephalometric lateral x-rays of four first premolar extraction cases
showing relative tooth and jaw relations at the following stages of treatment:
1. Upper left, At the beginning of treatment.
2. Upper right, After. retraction of cuspids.
3. Lower left, After Class III mechanics and establishment of mandibular anchorage.
4. Lamer center, After Class II mechanics.
5. Lower right, After completion of case.
EDGEWISE ARCH JIECHAXISJI ASD TWEED 1’HlLOSOPHY 517

Figs. 24-27. (For legends, see opposite page.)

 518 B. L. HERZBERG

inch, with small tip backs in the bnccal segments (Fig. 22), and tied back
securely. In this procedure the anterior teeth are not banded.’ As the cuspids
go distally small coil sections are added to continue to exert force against the
cuspids.
Third, cuspids are carried distally by means of short coils activated be-
tween stops on the labial of the edgewise arch and the cuspid brackets on each
side in each arch (Fig. 23). The activation is continued here, too, by adding
small sections of coils to continue the distal movement of the cuspids. Tip
backs are also used in t,his arch to enhance anchorage and the arch is tied back

Fig. 28.-Nonextraction case, treated in accordance with methods outlined in article.

securely. The greatest advantage of’ this short coil technique is that extraoral
anchorage or force can be added easily t,o help keep the buccal teeth from
moving anteriorly.
Fourth, upper cuspids are moved distally by means of upper acrylic
Hawley plates with finger springs fabricated to move the upper cuspids to
an upright position (Fig. 24).8 When the cuspids have been uprighted the
teeth must be banded and one of the above three procedures followed through.
 EDGEWISE ARCH MECHANISM AND TWEED PHILOSOPHY 519

When the goal in the step of moving the cuspids distally is attained then
all the incisor teeth are banded and full arches are placed to get bracket en-
gagement. Full arches of 0.016 , 0.018, 0.020, 0.022 inch or 0.021 by 0.025 inch
may be used in this step, followed by full arches, usually rectangular, with
a vertical mashed loop on both sides just distal to the cuspids (Fig. 25). Tie-
backs are placed anterior to, and away from, the buccal sheaths and hooks
may be placed between the cuspid and lateral brackets to receive extraoral
anchorage or force. In the buccal segment of this arch tip backs are placed.

Fig. 29.-Extrac:ion case, treated in accordance with methods outlined in article. Note
UDright position df lower incisors at completion of treatment. Note reduction of lip protrusion
at c&npIetion of treatment.

The sequence of tying this arch in is as follows: first, the incisors and cuspids,
then the tiebacks to activate the loops, and then the buccal teeth. During this
time, whenever arches are tied in, consideration is given to the reduction of
rotations. When all spaces are closed the case is ready for the establishment
of mandibular anchorage with Class III mechanics and extraoral force on the
maxillary teeth, followed by Class II mechanics, cusp seating with vertical
elastics, atid all other steps as used in the nonextraction cases. At times spaces
520 B. L. HERZBERG

are closed in conjunction with Class II I and Class 11 mechanics. We attempt

to finish our orthodontic treatment with end-to-end incisal relationships, not
knowing just where the anterior overbite should be, but knowing full well that
each case will settle and the’overbite will stay the same 01’ will increase a little
or a, great deal. Beyond this we have little or no control over the anterior
overbite. Infrequently, the anterior overbite even reduces. We are careful
t,o eliminate rotations and correct axial inclinations as we see them. When
necessary if roots are divergent, adjacent to the extraction spaces, gabletl IYJOC
arches, as suggested by Dr. Bull, are used to parallel these roots (Fig. 26).
We try to seat OLN cusl~s rather precisely, and, above all, we try to finish OUJ
cases with the lower incisors relatively upright to base. The above details
in treatment n-e attempt to attain because we are convinced that our cases
thus finished, through our humble efforts, are at least on the road toward the
best in health for all the structures involved, the best in function, the best in
stability, and the best in facial esthetics.
I will now show the cephalometric lateral head x-ray records of an ex-
traction case (four first premolars) (Fig. 2’7) to show the relative tooth and
jaw relationships at various stages:
1. At the beginning of treatment.
2. After retraction of cuspids.
3. After Class III mechanics ant1 establishment of mandibular anchorage.
4. After Class II mechanics.
5. After completion of case.
Two cases will be presented from among hundreds, one nonextraction
(Fig. 28) and the other extraction (four first premolars) (Fig. 29) to present
merely a sample of the results attainable from day to day by a great number
of orthodontists who follow the Tweed teachings in orthodontics.
Again the thought is presented, as it has been by many others before me,
notably, Calvin Case, George Grieve, Charles II. Tweed, L. B. Higley, and
others, that our specialty is not that of the tooth straightener but rather that
of the dentofacial orthopedist.
REFERESCES

1. Herzberg, B. L.: The Mechanical Therapy Employed in Following the Tweed Philosophy
in Orthodontics, AM. J. ORTHODONTICS 38: 237, 1952.
2. Herzberg, B. L.: Facial Esthetics in Relation to Orthodontic Treatment, Fort. Rev.
Chicago D. Sot. 31: 7-15, 22-35, 1951.
3. Tweed, Charles H.: History of the Evolution of the Tweed Philosophy. Unpublished.
In the syllabus presented to the Charles H. Tweed Foundation for Orthodontie
Research at Tucson, Ariz., in 1959.
1. Herzberg, B. L.: The Mechanical Therapy Employed in Following the Tweed Philosophy
in Orthodontics, AM. J. ORTHOI~NTICS 38: 237, 1952.
5. Tweed, Charles H.: Frankfort Mandibular Plane Angle, AM. J. ORTHODONTICS ANI,
ORAL SURG. 32: 175-220, 1946.
6. Abelson, Josephine M.: A New Method of Treating Unilateral Posterior Occlusion,
Class II, Division 1, Subdivision, AM. J. ORTHODONTICS AND ORAL SURG. 30: 31-39,
1944.
7. Fraser, Emery J.: Case Report Angle Orthodontist 16: 103-106, 1946.
8. Lewis, Paul D.: Vertical Dimension, AM. J. ORTHODONTICS 37: 527, 1951.
7200 EXCHANGE AVE.