The bimetric system

Fred F. Schudy, D.D.S., and George F. Schudy, D.D.S., M.S.

Houston, Texas

T he “hi-metric system” of the edgewise mechanism is a technique which

uses bracket slots of two different sizes in the same mouth. On the upper and
lower incisors and canines, 0.016 inch brackets are used, and 0.022 inch brackets
are used on the upper and lower premolars and first molars (except when the
first molars are terminal teeth). When an 0.016 by 0.02.2 inch wire is used and
a 90-degree twist is made distal to the canines, the wire will then fill all brackets
(Figs. 1, 3, and 3). Thus, in the anterior section the treatment wire is “edge-
wise,” and in the posterior sections it is a “ribbon.”
Use of the 0.022 inch dimension of the wire both horizontally and vertically,
depending on the need in different phases of treatment, necessitates the use of
a two-way buccal tube on the molar (Fig. 4). This tube will receive either
dimension of the wire vertically or horizontally without allowing it to turn in
the tube.
The edgewise mechanism was first presented by Edward H. Angle in 1925,
and it has since played a major role in the progress of the specialty of ortho-
dontics. The entire profession owes a debt of gratitude to Angle for his total
contributions to dentistry. Forerunners to this mechanism, also developed by
Angle, were (1) the expansion arch (E arch), (2) the pin-and-tube mechanism,
and (3) the ribbon arch. Many men, notably Strang, Name, Steiner, and Tweed,
hare made important contributions to the application of the edgewise mechanism.
In the past, the size of the bracket slot has been changed, the width of the
bracket has been changed, the number of brackets per tooth has been changed,
the shape of the tie wings has been changed, and rotating levers, both fixed
and removable, have been added. Torquing springs, uprighting springs, and
a wide variety of loops have been used. None of these alterations has changed
the basic mechanical nature of the mechanism.
As far as can be determined, the bimetric system represents the first basic
change in the edgewise mechanism since it was originally developed 50 years
ago. Three unique features-(l) the use of 0.016 and 0.022 inch bracket slots

Presented at the seventy-fourth annual meeting of the American Association of

Orthodontists, Houston, Texas, May 19 to 23, 1974.

57
58 Xchudy ad Nch,udy

Fig. 1. Upper and lower arches with twists incorporated (approximately 90 degrees]. The
incisor and canine bands have 0.016 inch brackets. The premolars and lower first molars
have 0.022 inch brackets. The 0.016 inch dimension of the wire fills the anterior brackets
and the 0.022 inch dimension fills the posterior brackets.
Fig. 2. A magnification of a twist (approximately 90 degrees) between a lower right
canine and a first premolar. The 0.016 inch dimension is horizontal and the 0.022 inch
dimension is vertical.

on the same patient, (2) the use of a go-degree twist in a wire to fill slots of
two different sizes with the samr wire, and (3) a two-way buccal tube which
receives a rectangular wire both horizontally and vertically without turning-
make up a system which is basically different from anp changes which have
been made in the past (Figs. 1 to 4). When we propose these basic mechanical
changes, it is with a spirit of humility and deep appreciation for the man who
originated the device.
The rationale for these changes is reasonable and logical. To best control
the correct movement of the anterior teeth, we do not need strength or rigidity;
instead, we need resiliency. For the posterior teeth, resiliency is not as important,
but a given amount of strength and rigidity is required to resist and counteract
the force of occlusion. By placing the 0.016 inch dimension vertically in the
anterior portion of the dental arches, we have a resilient, gentle. and effective
 The bimetric system 59

Fig. 3. An 0.016 by 0.022 inch wire with a 90-degree twist. The twist is magnified.

.006”

Fig. 4. Five different designs of two-way tubes, all of which will receive an 0.016 by
0.022 inch wire, either vertically or horizontally, without turning.

torquing force. When the wire is twisted go-degrees distal to the canines and
the 0.022 inch dimension is placed vertically, the maximum strength of the wire
is utilized. In other words, we can almost “have our cake and eat it too” and
enjoy the “best of two worlds.77
The act of twisting the wire 90 degrees work hardens it and makes it stronger
in the twisted area. The twist is usually not used until the last few months of
treatment. Prior to this time there is 6/1000 “play” in the premolar and first
molar brackets. This play between the bracket and wire greatly facilitates level-
ing and bracket engagement; it also is much more gentle and acceptable to the
patient. This makes treatment much more tension-free for both patient and
orthodontist,
Since its inception, orthodontics has carried on a perpetual search for the
most ideal mechanism for the correction of malocclusion. This search is going
on at the present time and will, no doubt, continue perennially. It has been,
for the most part, a pragmatic approach. All mechanisms and procedures have
 been testctl in clinical practice. \Vc tend to accept t,liosc mechanisms am1 systems
in which the advantages outweigh t,hc (lisadrantagcs ant1 to rcjed thosr in which
the disadvantages outweigh the atlvalltagcs. Since KC will never fin11 ;I tcc~hniquc~
that is completely idcal, we must rely on the 011c t,hat has the most ~Itl~illlt~l#S
as related t>o its tlisadvantagcs and t,hc one that is in best accord with biologic
requirements.
The evolution of ideas and philosophies regarding mechanical devices for
the correction of malocclusion has, to :I great cxtcnt, rrntcrctl around the nlanner
of attachment between the treatment wire and the hands on the teeth. Early in
this century, only “tipping” appliances w’crc nsrtl. Then t,hc pill-alltl-tuhc
appliance was dcvcloped. This mechanism had complct,c control over the teeth,
hut it was so precise and technically exacting that it was too unwieldy ant1 was
discarded. Later, the ribbon arch, also an appliancac with rigid c,ontrol, was
developed, used for a few >-cars, and then tliscarcletl. In 1935, the cdgcwisr
mechanism was presented, ant1 it has been in wide use down to the prcscnt time.
This appliance, like the pin-anti-tube applianc~c, also has rigid control over the
teeth by means of a close fit between the treatment wire and the teeth. Thus, it
was Angle’s endeavor to establish complctc control over the teeth by having a
precise relationship hctwcen the wire ant1 the attachment on thr band. Such a
precise relationship has hecn the goal of most men performing superior ort,ho-
dontic treatment. It is now appropriate to discuss ;I i’cw important trcatmcnt
principles in relation to the bimctric system.

The principle of precision fit

The principle of “precision fit” hct,nwm the treatment wire and the bracket
on the hand represents the most effcctivc, most efficacious means of moving teeth
in clinical orthodontics. Treatment techniques which depart, -from this principle
introduce palliation and empiricism in proportion to the extent of the departure
from the principle. In other words, as WC depart, from this principle, procedures
become hit and miss instead of scicntifi~.
By using the precision fit principle. we automatic*all,v control groups of teeth
as a single unit. The six anterior teeth become one unit, and each posterior
segment becomes a unit. Thus, the twenty-eight units IIOW bcc~omc just sis
units. Most of the second- and t,hircl-orclcr hcnds arc matlc bctwccn thcsc six
groups of teeth. When all bantls llavc l~rn corrretly pla~tl and thr brackets
are c*orrectly angulatcd, an ahsolutc minimum of bends in the arch wires is
required within the six units rcprcscnting t,hc six groups of teeth. SpcGfically,
very few bends arc required in the arch wires for individual teeth ill the upper
and lower anterior segments of the clental arches.

Filling the bracket slot

One of the greatest drawbacks of the 0.022 inc.11 slot, is the rigidity of the
wire which is used with it. To eliminate t,his undcsirablc rigidity, many use the
0.019 by 0.025 inch wire in the 0.022 inch slot. This is unsound bccausc the
lack of control requires too much individual torquing.
 Th.e bimetric system 61

To take full advantage of the “precision fit” principle, it is absolutely neces-

sary to fill the bracket with wire. This we have always done. When we used
the 0.022 inch slot, the finishing wire was 0.0215 by 0.025 inch; when we used
the 0.018 inch slot the finishing wire was 0.018 by 0.025 inch; and now the
0.016 inch slot is completely filled with an 0.016 by 0.022 inch wire. It makes
better scnsc to use small slot ant1 fill it rather t,lian to use a large slot and
il

partially fill it.

In recclrt years the trend has been toward smaller treatment wires. For those
who have rejected the edgewise mechanism hccausc of the rigidity of the wire,
the bimctric system should cause them to reconsider the merits of the edgewise
appliance. The bimctrie system takes advantage of the merits of lighter wires
while retaining the advantage of heavier wires. Xany men have introduced
variations in an attempt to make the edgewise mechanism serve a dual purpose.
Examples of such dualism arc the universal appliance and the multiphase
appliance. However, the dualism ‘afforded by the bimetric system is by far
the simplest and easiest to apply. For those who are already oriented toward
lighter wires, this system should bc attractive.
Failure to fill the bracket with wire results in the expenditure of needless
effort and time. This effort takes the form of repeated removal of the arches
to place individual torque and “artistic bends.” When only a point contact
between wire and bracket is used, finishing becomes so difficult that clinicians
usually resort to positioners after band removal. When we use 0.016 inch
brackets, properly angulatc them, and USC0.016 by 0.022 inch wire as a finishing
arch, a minimum amount of effort is needed to complete treatment. From the
point in treatment when space closure is complete to band removal, usually
only one arch wire and very few arch removals are required. When brackets
arc not angulated and when there is an appreciable amount of play between
the wire and the bracket, it then becomes necessary to do a major amount of
torquing for individual teeth and a major amount of arch bending to effect
artistic positioning of the anterior teeth. This requires many arch removals
and bccomcs time consuming. As a result, only orthodontists with superior skill
arc able to finish casts well. This system requires a minimum amount of work
for superior results.
Interbracket space

The distance from the bracket on one tooth to the bracket on an adjacent
tooth is an important consideration. It has significant implications in terms of
(1) patient discomfort, (2) exactness of placing hooks on arch wires, (3) esact-
1~s of position, (1) exactness of placing bends in the arch wire, (5)
loop

number of round arches required, (6) length of time round arches must be used,
(7) size o-l’ first rectangular arch, (8) case of seating torque, (9) amount of
torque which can be used, (10) ease of getting correct arch form, (11) effective-
IICSS of torqnc, (12) total number of times arches must bc removed, (13) time
rcquircd to tic in the arches, ant1 (14) total time spent in treating the case.
When double brackets are used on small teeth, there is hardly enough room
62 Schudy rind Sch.udy 3 1)i. J. Orthod.
.Iclnuary 1975

Black )
Vellow *
Red -

06 Red

Fig. 5. Diagram of a loop arch. The anterior loops are used for head gear attachments
as well as for intermaxillary elastics. These may be preformed.
Fig. 6. Small, medium, and large preformed arches along with an arch meter with
matching color calibrations. The arches are preformed with both tie-back loops and
anterior loops which are used for head gear attachments or for intermaxillary elastics.
Fig. 7. An arch meter for determining arch length. Color calibrations match the color
markings on the preformed arches.

beside solder joints to grasp the wire for seating purposes. The greatest possible
distance between brackets is required in order to have treatment relate most
favorably to all of the above considerations.
As a result of lecturing in almost all parts of the United States and also as
a result of receiving many transfer cases from all parts of the country, we
have observed that twin brackets seem to be used much more t,han single
brackets. If this observation is correct, then it would seem that twin brackets
must be the best from the standpoint of the way they relate to basic, fundamental
principles of treatment. The facts do not come out quite that way. So far as
we know, nearly all schools teach the use of twin brackets. Perhaps a high
percentage of orthodontists have never had the opportunity to use single
brackets.
Twin brackets have some advantages which are quite convenient; however,
these advantages are not of great importance. Lips can tolerate these brackets
without an arch wire. This is often convenient and sometimes time saving. Twin
 The bimetric system 63

Fig. 8. A straight or directional-pull head gear.

Fig. 9. Side view of head gear.

brackets affect rotations quite effectively. Thus, in the first 2 to 3 months of

treatment twin brackets serve the orthodontist quite well. After the rotation
phase is over, and when the real bearing-down problems are being grappled
with, the disadvantages begin to show up. In other words, “after the honeymoon
is over” the glamour wears off. Those who use twin brackets seem to be unknow-
ingly “going for the short pull.” They are trading an early advantage for a later
and larger disadvantage. In other words, they are doing their work the hard
way but are. not aware of it. Most orthodontists have never tried single brackets
and do not know that they offer a “whole new world.”
It must be expressly understood that the bimetric system can be used with
all edgewise brackets, regardless of width and regardless of whether they are
twin or single brackets. The only requirement is that the anterior brackets must
be 0.016 inch and the posterior brackets must be 0.022 inch. This unique system
can be used with complete success with either angulated brackets or non-
angulated brackets. It must be kept in mind that it is completely versatile and
can be used with all edgewise brackets and most techniques. Other features of
the bimetric system are shown in Figs. 5 to 9 and 32 to 35.
This system was developed for the use of single-width (0.05 inch) brackets
with Steiner double rotating levers (Fig. 10). As stated earlier, the wide inter-
bracket space provided for by the use of these narrow brackets offers many
advantages.
If one prefers double brackets, they too can be used with good success. They
may have one possible advantage. The shorter distances between the brackets
of adjacent posterior teeth help to add vertical strength to resist the force of
occlusion. However, their use would at the same time necessitate more arch
removals to complete leveling.
The use of double brackets would definitely have disadvantages, especially
in the anterior segment, just as 0.022 or 0.018 inch slots have disadrant,agcs.
However, the 0.016 inch slot will minimize any disatlrantage imposetl 1)~. the
use of double brackets. These disadvantages are (1) delay in getting to the
first rectangular arch and thereby slowing treatment progress, (2) slower
t’orquing progress, (3) need for greater exactness in hook and loop placemrnt,
(4) the requirement of greater exactness in placin g the 90-dcgrec twist distal to
canines, and (5) greater difficulty in prc~fabricating arch wires. The use of 0.016
inch brackets will minimize these disadvantages and, by the same token, mill
maximize most of the advantages.

Angulation of brackets

Holdaway deserves credit for first proposing the angulation of braekcts on

bands to effect proper inclinations of teeth (Fig. 10). Logic immediately tells
us that this is a fundamentally sound concept. Also, it is the simplest and least
time-consuming method of achieving desired tooth inclinations. For the past 20
years we have used angulated brackets on almost all teeth that require angula-
tion and have found this procedure not only satisfactory but quite indispensable.
However, the use of angulated brackets does lead to complications in the
daily routine of practice. Since it requires a right and a left band for every
tooth in the mouth, the inventory is immediately doubled. This can lead to
confusion when one is dealing with untrained personnel. It is not at all difficult
to inadvertently place a right band on a left tooth. The result, of course, is
a disaster, and a new band is required at some later date. Greater angulation is
needed on premolars in extraction cases than in nonextraction cases. Also,
greater angulation is needed on second premolars when first premolars have
been removed than on first premolars when second premolars have been removed.
Furthermore, the angulation must be in opposite directions on the two teeth
under the above circumstances. These possible complications map be partially
the cause of the fact that a very small minority of orthodontist,s bother to
angulate their brackets. Once one has become accustomed to angulating brackets
and has observed the difference in finished cases, he could never go back to
unangulated brackets.
The discussion of angulation between colleagues has become rather careless
and often conveys misleading information. Before a given number of degrees
of angulation can be evaluated and have meaning, we must always state (1)
whether we are speaking of single (0.05 inch) or twin brackets and (2) whether
we intend to fill the bracket with wire. The wider the bracket, the less angulation
is needed to achieve a given tooth inclination. The tighter the fit between wire
and bracket, the less angulation is needed to achieve a given inclination of the
tooth. This must always be kept in mind so that we will not mislead others.
Principles of tooth rotation

Historically, methods of rotating teeth have been discussed and studied by

orthodontists. It is generally agreed that bands must be placed on teeth to
rotate them most effectively. It is also generally agreed that severe rotations
need both a “push and a pull.” That is, they need a mesial force on one side
and a distal force on the other side.
 The bimetric system 65

After bands have been placed, there are several options for affecting the
desired rotation. In the early years of the “edgewise era,” rotation was achieved
by the use of eyelets soldered to the bands. Tying wire ligatures through the
eyelets and around the arch wire created a fulcrum at the site of the bracket
which caused the tooth to rotate. Removable springs map bc attached to the
bracket at one end and to the arch wire at the other end. This is an effective
method of rotation. Another simple and effective method is the LXX of rubber
or plastic elastics. These may be used along the circumference of the arch 011
either the labial or the lingual side, or they may pull from the lingual through
the interproximal area to the arch wire.
Another widely used method is the LISC of twin brackets, that is, two identical
brackets on the same tooth. When one of these brackets is tied on a rotated
tooth, the other one acts as a fulcrum around which the tooth is made to rotate.
Still another widely used method is the use of free-ended levers attached to the
bands. These levers arc used in connection with single brackets, and they may
be made of rigid metal or flexible metal. Rigid levers must be used with small,
flexible arch wires. Flcxiblc lcvcrs ma>- be used with either flexible or rigid
arches. If overrotation is desired, double levers will effect this tooth movement
by the activation of one lever.
There is no one best method of rotating teeth. Circumstances will dictate the
simplest and most effective method for any given tooth. Rotation is generally
not one of the difficult aspects of treatment. Actually, there is no point in
belaboring the act of rotating teeth. It is a relatively simple procedure which
may be performed in several ways. While rotations are rather easily achieved
and are usually finished early in treatment, holding these rotations during the
rest of the treatment is sometimes not so easy. Thus, providing for the holding
of rotations of teeth after they have been rotated is a more important aspect
of the treatment than the actual rotations themselves. When two rotating levers
are placed on every band, rotated teeth arc automatically held in their positions
throughout the rest of the treatment by merely tying to the brackets (Fig. 10).
In the bimetric system we LXX single brackets with two levers, and after the
teeth have been rotated we can forget rotations for the rest of the treatment.
Use of auxiliary attachments

There is a wide variation among orthodontists in the use of auxiliary attach-

ments in connection with the edgewise appliance. Some enjoy rotating, retract-
ing, and uprighting attachments, and they try to dream up as many as possible.
We dislike these attachments and feel encumbered by them. A precision-fit
appliance, such as the edgewise mechanism, does not require any auxiliaries
except a vertical loop plus some form of elastic force from either rubber or
plastic. These two auxiliary forces are about all that we ever use.
When uprighting springs are needed, it generally means that one or more
teeth have gott,en somewhat out of control. If this is true, then the procedure
is a recovery process which generally adds treatment time. Rotating attachments
are not needed if each band contains two rotating levers.
The need for torquing auxiliaries is usually an indication that the sequence
of treatment has gotten out of control and, in this sense, it becomes a recovery
66 Schudy iwd Rchudy

measure ant1 will definitely (Iclay treatment. Torquing attaehmcnts art’ not
needed with the 0.016 inch slot and the 0.016 hv O.W!, inch wire. In fact, 011th
has to he very careful to not overtorque when using the narrow 0.016 inch
bracket. Frequently, we find ourselves removing some of the torque from the
upper anterior segment,.
Basically, WC believe that most orthotlont,ists woultl prcl’cr a simple strcam-
lined approach without encumbering auxiliaries. Tf this is true, then we must
teach them that this is possible. We must show them that it is not only possible
but that it requires less work, is less t,ime consuming for t,he orthodontist,
requires less treatment time, is less complicated, requires less digital skill, am1
is much easier on and more acceptable to t,he patient.

Size and hardness of treatment wire

The ideal wire to bc used for the correction of malocclusion would be one
with maximum resiliency and, at the same time, maximum strength. Un-
fortunately, this is not possible. The next best is a wire which has ample strength
and as much resiliency as possible.
Then the question arises, what shall be the size of the rectangular wire to
best meet the necessary requirements? When Angle developed the edgewise ap-
pliance, only gold alloy wires were available and he found that 0.022 bp 0.025
inch wire was needed to give adequate strength. Later, stainless steel wires
were made available, and the added strength of steel over gold made it possible
to reduce the size of the wire from 0.022 by 0.025 inch to 0.018 by 0.025 inch
and still maintain adequate strength.
As we contemplate wire size, there is a basic principle which must always
be kept in mind. This principle has to do with the ratio between t,he size and
the hardness of the wire. As the size of the wire is reduced., the hardness must
be increased to perform a given task. Of course, there are limits of both size
and hardness which must be recognized. Then, it becomes a question of just how
small the wire can be and still be strong enough to resist the force of occlusion.
To answer this question, we must resort to the pragmatic approach; WC must
tr,v it. Otherwise, we will never know. This we have done with the 0.016 inch
bracket, having treated more than 300 cases with the bimetric system.
The rationale for using 0.016 ineh brackets on anterior teeth and 0.022 inch
brackets on the posterior teeth is to have maximum resiliency in the anterior
segment and, at the same time, adequate strength in the posterior segment. It
makes good scnsc to utilize the full potential of the wire both in the anterior
and posterior segments. N’hen we do this by the use of a go-degree twist (Figs.
1, 2, and 3), the 0.016 by 0.022 inch wire becomes fully adequate in strength
and ideal in resiliency.

The pretorqued bracket

There are a number of treatment principles which must be considered

as we try to decide whether torque should be placed in the wire or in the
bracket.
First, we must decide whether we will work with a close fit between the
 The bimetric system 67

bracket and the wire or whether we will have a loose fit between these two
parts. If we decide that we like a loose fit, then we must decide just how loose.
The size of the bracket slot is an important consideration. If the slot is 0.022
inch, an 0.019 inch wire will provide ample strength and still give 0.003 inch
of play between wire and bracket. If the slot is 0.018 inch, then an 0.016 inch
wire may provide ample strength and still give 0.002 inch of play in the bracket.
However, if the slot is 0.016 inch we cannot work with a loose fit because then
the wire must of necessity be about 0.014 inch. Thus, it becomes obvious that
as we reduce the size of the slot, we must more nearly fill the bracket with wire
in all phases of treatment. Actually, when the slot is 0.016 inch, there is no
disadvantage in having a. close tolerance in the anterior section in any phase
of treatment. However, if tolerance is desired we can use 0.015 by 0.019.
The pretorqued bracket may be disadvantageous in the early phase of treat-
ment. For example, in a nonextraction case we first move the maxillary molars
distally, but we do not wish immediately to start moving the apices of the
maxillary incisors lingually. If the incisor brackets are pretorqued, then we
must (1) reduce the anterior section of the wire by grinding or (2) make
compensating bends to “detorque” the wire. It is only after the molars and
premolars have been moved distally that we have need for torque in the anterior
teeth. If we fill the slots of torqued brackets at the beginning of treatment, we
immediately begin to strain our molar anchorage. This, in turn, will call for
more extraoral anchorage.
It may also make extraction cases out of nonextraction cases. Then it becomes
obvious that the only way that we can advisedly use torqued brackets without
making compensating bends is to use a sufficiently large slot so that we can have
enough tolerance to prevent the torque from taking effect. Then this would
require either an 0.018 inch or an 0.022 inch slot. When 0.016 inch slots are
used in the anterior brackets, torquing is one of the smallest problems in the
treatment of malocclusion. The use of pretorqued brackets in the early phases
of treatment, when torque may be a disadvantage (as in maximum anchorage
cases), just to have their torquing effect toward the end of treatment does not
seem to be necessary in the bimetric system.
Placing torque in premolar and molar brackets in the bimetric system would
not seem to impose any disadvantages. By the same token, however, there may
not be any particular advantages. After all, when the go-degree twist is placed,
it must be checked and possibly adjusted for each tooth. One might as well
coordinate it with untorqued brackets. It is a physical impossibilit,y to use just
one degree of torque for each tooth and have it correct for all cases. This is
because of (1) variation in the slope of the buceal surfaces of the posterior teeth
and (2) difference in occlusogingival positions of bands in different ca,ses and
with different orthodontists.

Head gears

Extraoral forces have been used as a means of mechanical therapy for many
years. During the early part of this century, Calvin Case advocated the use of
head gears. Today they are being used by most orthodontists who use the edge-
68 Xchudy and Xchudy Am. J. Orthod.
.JanuarlJ 197,5

Fig. 10. The bimetric system appliance showing an 0.015 by 0.019 inch arch wire with
head gear loops. All brackets are angulated except the upper premolars.
Fig. 11. Head gear hooks locked into loops.
Fig. 12. Higher magnification of the head gear hook and loop into which it attaches.
This hook will not become dislodged during sleep.

wise technique. The bimetric system is completely adaptable to all types of

head gear (Figs. 10 to 15).
It can be stated categorically that it is a physical impossibility to correct
malocclusion properly without the use of extraoral forces. Why? Because there
is an equal force on each end of any elastic force within the mouth. On one end
it will be accomplishing a desired result. On the other end it m~sy be causing a
most undesirable result.
Since it is an undisputable fact that extraoral forces arc necessary for good
clinical practicse, then we have only to select the correct type for- any given
problem. This is not easy. The tendency is to select a head gear that is most
acceptable to the patient and that is the simplest and easiest to fabricate and
apply. It takes character and deep convictions, based on much knowledge and
understanding, to ovcreome the patient’s resistance and use the correct head
gear for a particular problem. A high percentage of orthodontists use only
cervical-pull face-bows in all cases. Yet they wonder why there are so many
open-bites and why frequently the Class II condition partially returns after
treatment. They also wonder why they cannot achieve harmony between centric
relation and centric occlusion.
Cervical face-bows should seldom, if ever, be used on patients with any of
the following characteristics : (1) open-bite tendencies, (2) muscle strain, (3)
Volume 67 The bimetric system 69
Number1

fig. 13. Diagram of three different designs of loops.

Fig. 14. Diagram of a head gear hook locked into a loop on an arch wire.
Fig. 15. Diagram of right and left head gear hooks and a magnification of the end.
These hooks will not become dislodged during sleep.

relatively short lips, (4) a “gummy” smile, (5) excessive relative AKS-to-&
distance, (6) flat, worn cusps, (7) large occlusomandibular plane angle, (8)
large palatomandibular plane angle, (9) large Frankfort-mandibular plane
angle, (10) large SN-mandibular plane angle, and (11) large gonial angle.
Cervical face-bow head gears apply particularly well to patients with char-
acteristics opposite the above.
A reasonable estimate would be that 75 per cent of our patients have at
least one of these characteristics. If this percentage can be accepted, then it
becomes obvious that this type of cxtraoral force should be worn by only about
25 per cent of our patients.
The effects of head gears have been extensively studied and reported. Three
things are important: (I) t,he direction of the force, (2) the amount and dura-
tion of the force, and (3) the point of application. The amount and direction
of force arc now pretty well untlcrstootl, so they will not bc cliscWW~t1hi&W.
7’hc pint of crpplicutimr . SO far as c~0Uld hC tlttcmlilrcvl, 110 01X(’ IlilScwrllc
forth with a set of scientific rmions, :I l~iltiOll~l~, (‘018giving impoi-tancv to tlrc‘
point of application to the maxillary arclr. It makes illot nI’ (liffcrcWo0 whctllc~l
t)llc force is applied to the ;~ilttTior cntl or the postc~rior cllltl 01’ 111~cltvltal ;Iwh.
A number of st,udies have shown that when :I force is applied in a dorsal dircc-
tion to the maxillary first mnlars, it tends to tip thr palatal plane clown in
front,.“’ ” This is true regardless of whether the forcc~ is ;lppliecI in a horizontal
direction, toward the top of the head, or towa rtl t,hc neck. ,\long with this
tipping of the palatal plancl, thr incisors usually* mov(~ clownwartl from lhis
plane more than cl0 the molars. Also, they tend to gi*ow clnwii nicw than in
natural growth. Tf these reactions arc not tlcsirctl in any given patient. then
the head gear should not hc applied to t,he molars.
When a head gear is applied to the incisor region, pulling to the top of the
head, it tends to intrude the incisors and inhibit the downward growth of the
anterior nasal spine. When such a force is applied parallel to the maxillary
occlusal plane, it inhibits the forwartl growth of the nasal spine; pos49y the
downward growth of this struet,ure, anal the forward and downward growth of
the incisor teeth. When extraoral forcc~ is applied to the anterior end of the
maxillary denture, it does not, seem to have any appreciable effect vertically on
the palatal he or on the maxillary molar teeth.
Thus, it becomes nbvious that extraoral force attaehcd to the incisor region
and pulling parallel to 01’ ahnvc the otclusal plane will rr7)Hnaf )IcI’fJr have an
adverse effect cm t,llc dentofacial cmnplcu. Tt, is also just as obvious that a face-
bow attached to the molars pulling from the neck vctry frequently will produce
cffccts that arc adverse. These atlversc cff&ts many times are readily detectable,
hut mnre frequcntlp they arc subtle and escape t,hc untrained, undiscerning.
uninfnrmcl eye. They take the form 01’ ( 1) a short upper lip, (2) a long face,
(3) muscle strain, (1) slight or (not so slight) open-bite, (5) a “gummy” smile,
(6) incisors slightly “tucked” in, (7) Class II c*ontlition partially corrected,
(8) ntclusal plane tippet1 dnwl in flmt (with relation to 8X), and/or (9)
lack of harmony bctwccn ccntrie relation and centric occlusion. Then it becomes
a question of cnnvinGng orthodontists an(l making them understand t,hat many
of the things they dislike about their treatetl casts are siclc effec*ts of c*crvical
fare-l~ows.
In the cnrrcction of a Class II, Division 1 maloc~elusion, just whether the
palatal plane tips tlownward an(l whether the maxillary incisors move down-
ward and backwartl from the anterior nasal spine has an important efftrt on
the tlifficulty of correcting the overjet. Also, thcsc same considerations will have
a very important effect on the beauty of the smile and muscular function.
Tlcss forwarcl growth of the mandible is required to resolve the nvcrjet if
the anterior portion of the maxilla and/or the maxillary incisors rnol-c down-
warcl and backwartl. Tn this scnsc, it would be dcsirablc to tip the palatal plane
tlownwartl and backward and to move the incisors downward and backward if
it were not for the nnfarorablc esthetic effects. Since this t,ypc of tooth move-
ment carries with it, undesirable side effects, it should not be done if it can be
 The bimetric system 71

Fig. 16. Treatment record of a boy aged 13 to 15 years. A, Before and after tracings
superimposed on S-N. Et, Diagram of the maxilla showing the bending of the alveolar
process. C, Maxilla registered on the cementoenamel (unction with the labial and lingual
cortical surfaces parallel to further depict the bending of the alveolar process. D,
Mandible showing the vertical behavior of the teeth. Other points of interest are (1)
great amount of posterior movement of maxillary incisors, (2) intrusion of maxillary
incisors, (3) increase in anterior dental height, (4) chin movement straight downward,
and (5) overbite change from 11 mm. to 1 mm.

avoided. Instead, it is much better to hold the incisors up and back with a
variable-pull head gear to the arch wire (directed slightly above the occlusal
plane) and wait for the growth of the condyles to carry the mandible forward.
If this does not happen, there is still time to move the upper incisors downward
and backward.
When the palatal plane and the maxillary incisors move down and back, they
will ultimately overtake and approximate the lower incisors if enough condylar
growth has occurred to merely offset vertical facial growth and thereby cause
the lower incisors to move straight downward, rather than downward and
72 Xchudy and Xchudy

llyr.. &no.

-- - 14yrs.

Fig. 17. Case 1. Tracings of a second-premolar-extraction case. Starting when the patient
was 7 years of age, two different orthodontists in two different states planned an ex-
tensive serial extraction program for this patient. The plan called for the ultimate ex-
traction of four first premolars. Our treatment involved moving the lower incisors 4 mm.
forward from the 8 year 9 month position to the 11 year 6 month position and then
waiting for teeth to erupt. After eruption of teeth, the four second premolars were ex-
tracted, and during treatment the incisors moved back to the 14-year position. (See
facial photographs, casts, and intraoral photographs in Figs. 18 and 19.)

backward. The ideal condition, of course, would be more than minimal condylar
growth, enough to move the incisors forward, thus obviating the need for so
much downward and backward movement of the maxillary incisors. When we
speak of the tipping of the palatal plane, we must understand exactly what
happens anatomically. Fe must not think of the palatal plane as a rigid bar,
which is suggested by the way it is depicted. Instead, it must be thought of as
a structure which bends when subjected to physical forces. It is composed of
two parts-a posterior rind an anterior part-which join in the region of the
anterior palatine foramen. This region becomes an area of cleavage, allowing
the anterior portion along with the nasal spine to bend with the alveolar process.
 The bimetric system 73

Fig. 18. Case 1. Pretreatment and posttreatment photographs. (See tracings, casts, and
intraoral photographs in Figs. 17 and 19.)

In the example of a treated case shown in Fig. 16, if the mandible had not
grown forward or downward, then it would have been necessary to move the
maxillary incisors 8 mm. posteriorly. This would not have been physically
possible, as there was not enough bone on the lingual aspect into which they
could have been moved. The condyles grew just enough to match the vertical
growth of the face but not enough to move the mandibular incisors forward.
This caused these incisors to move straight downward. The overjet was corrected
entirely by the downward and backward movement of the maxillary incisor
teeth. The apices moved mostly through the bone, while the crowns moved mostly
with the bone. The apices moved about 5 mm. through the bone and about 2 or
3 mm. by the bending of the palatal plane. The crowns moved about 2 mm. by
the bending of the anterior portion of the base of the maxilla and 6 mm. by
the bending of the alveolar process. All of these anatomic changes are illustrated
by superimposition.
Although moving the maxillary incisors downward away from the anterior
 74 Schudy and S&w&j

Fig. 19. Case 1. A to E, Pretreatment and posttreatment plaster casts of patient shown
in Figs. 17 and 18. F, G, and H, Posttreatment intraoral photographs.

nasal spine and tipping the palatal plant downward a Il(I t)i~c~l<\~a~tl
helps cowwt
the overjet, this should not be tlone if it can 1~ avoided. Thus, NY’ ha~x:
pointed up an important physical as well as biologic~ prineiplc which pertains
to the correction of ovcrjet and the selection of the correct head gear.
Treatment

For the past 15 years the senior autllor has appcarctl on many orthodontic
programs in all parts of the United States and in se\-cral foreign countries. 111
all of thcsc presentations, the discussions have been confined to facial growth,
diagnosis, and treatment (Figs. 17 to 31). We have never dealt with the “how
Volume 67 The bimetric system 75
Number 1

------llyrs.7mo.

- l4yn.lOmo.

- - - 17yr.smo.

Fig. 20. Case 2. Growth and treatment record of a malocclusion characterized by a deep
bite (8 mm.) The growth study began at 8 years 7 months. A, Pretreatment and post-
treatment record. B, Posttreatment record. C, Behavior of lower incisor during growth and
treatment. Note how apices and B point migrated lingually during growth. D, Behavior
of lower incisor during treatment.

to do.” Colleagues have suggested that we may have been remiss in not discuss-
ing technique.
After many years of using technical procedures and principles very similar
to those we use today, we have come to believe that they should be shared with
others. Through the years we have received a large number of patients trans-
ferred from other orthodontists all over the United States. The wide variety of
technical approaches which have been observed has provided an opportunity for
comparison with our own. As a result of these observations, we have had a
growing conviction that our technical procedures, by comparison, are simple,
effective, and time saving. This is what has prompted us to endure the enormous
amount of work necessary to document the bimctric system completely.
General pitfalls of orthookltic treatment. There are three basic mistakes which
are commonly made in treatment. First, there is the tendency to move the mandib-
ular incisors too far lingually to satisfy an accepted analysis or as a result of a
Fig. 21. Case 2. Pretreatment and posttreatment photographs. (See tracings, casts, and
intraoral photographs in Figs. 20 and 22.1

poor estimate of anchorage needs. An analysis, howercr valid, may not fit a
particular case under consideration. “Discretion is the better part of valor,”
and it is usually better to “shade it on the safe side.” We must be sure we are
not moving the lower incisors too far lingually. Once the mandibular incisors
have been moved too far lingually, c&her bodily or by tipping, t,here is a very
poor chance of recovery. This may result in poor facial esthetics. Mso, it may
cause extreme difficulty in correction of the Class II condition and failure to
achieve harmony between centric relation and centric occlusion. Thus, too much
lingual movement of mandibular incisors is a dangerous pitfall and may be a
very serious mistake. To avoid this pitfall, we must try to be sure t.hat the over-
jet can be resolved by lingual moremcnt of the maxillary incisors plus forward
growth of the mandible. Another treatment measure which may avoid this com-
mon mistake is nonextraction treatment or the extraction of second premolars
instead of first premolars.
Volume 67 The bimetric system 77
Number 1

Fig. 22. Case 2. A to E, Pretreatment and posttreatment plaster casts of patient shown
in Figs. 20 and 21. F, G, and H, Posttreatmen: intraoral photographs.

The second basic pitfall is first preparing anchorage in the mandibular arch
before moving the maxillary molars distally when this tooth movement is needed.
This particularly applies to nonextraction treatment. The act of leveling and
preparing anchorage in the mandibular arch as a first phase of treatment usually
increases the overjet, and this may more than offset the advantage of the an-
chorage which has just been prepared. Also, after the maxillary arch has been
subjected to Class III elastics for several months it is often extremely difficult
to move the maxillary incisors lingually. The act of moving these teeth labially
and “jiggling” them often seems to increase the difficulty of moving them
78 Schudy and Schudy

wyr..*mno.

----c- wyrr..mm.

Fig. 23. Case 3. Treatment record of a four-second-premolar-extraction case. Note that

the upper right first premolar is abnormally small. Also note that, despite the presence
of 6 mm. of crowding of the lower incisors and the use of lower sectional arches, the
lower incisors moved lingually 2.5 mm.

lingually. To avoid this pitfall, it is best to first move the maxillary molars
distally into a Class I relationship, hold the added arch length if any, secure
arch form, affect rotations, and execute torque before using the maxillary arch
to aid in the anchorage preparation of the mandibular arch.
The third pitfall to be avoided is planning too much use of Class II elastics.
It is unwise to plan to correct a full Class II condition with Class II elastics.
Such a plan of treatment is predicated on the premise that the condyles will grow
sufficiently to resolve the problem. This is a dangerous premise. It is much safer
to partially resolve the anteroposterior problem early in treatment with extra-
oral anchorage and plan to complete it with Class II elastics. Sometimes we are
forced to use more Class 11 elastic than we plan, but this is quite different from
planning too much in the beginning. Thus, when we anticipate more condylar
growth than the patient is destined to receive, we will not be able to avoid a dual
bite.
Volume 67 The bimetric system 79
Number 1

Fig. 24. Case. 3. Pretreatment and posttreatment photographs. (See tracings, casts, and
intraoral photographs in Figs. 23 and 25.)

Levelilzg. To correct an exaggerated occlusal curve of the mandibular arch,

the incisal edges, cusps, and/or marginal ridges must be brought into a straight
line anteroposteriorly, that is, brought to a common level. This can be done in
one of three ways: (1) the incisors and canines can be intruded to the level of
the premolars and molars, (2’) the molars and premolars can be moved up to the
level of the incisors, or (3) there can be a combination of intrusion of incisors
and occlusal movement of molars and premolars. Just which of these three ways
of leveling should be used is one of the most fundamental and important con-
siderations in the practice of orthodontics.
For many years we have been trying to convince orthodontists of some basic
truths in regard to this question. These basic truths have been discovered through
hundreds of hours of both documented and undocumented studies. The truth is
that in most cases molars and premolars should be moved up to the level of
the incisors if possible. Unfortunately, this is not always possible, but it still
should be attempted.
For many years it was reasoned that to best produce leveling it was necessary
to use the largest wire that the bracket would accomodate. From the standpoint
80 SchudzJ and Schudy

Fig. 25. Case 3. A to E, Pretreatment and posttreatment plaster casts of patient shown in
Figs. 23 and 24. F, G, and H, Posttreatment intraoral photographs.

of strength to resist the biting force this was correct, but the importance of
friction was overlooked. Especially in a nonextraction case with a severe occlusal
curve, and with all teeth in proximal contact, the brackets must slide along the
wire before it is physically possible for the teeth to reach a common level. The
larger the wire for a given bracket size, the greater the friction. This principle
that brackets must slide on a wire before leveling can take place is true, because
the distance from second molar to incisor increases during the leveling process.
The above explanation accounts for the rapid leveling with the bimetric system.
During leveling and before the go-degree twist, there is 0.006 inch of play be-
 The bimetric system 81

- 15Yrr.6no.

---- 17yrs.lOmo.

Fig. 26. Case 4. A severely closed bite further complicated by a broken central incisor
and a small lateral incisor. This made it impossible to achieve a correct midline. The
overbite was 10 mm., and the lower incisors were contacting the maxillary gingival
tissue. This case was selected to show that the bimetric system is capable of correcting
such problems.

tween the wire and the bracket. This play permits the teeth to slide along the
wire and allows the leveling process to take place rapidly.
A given size of wire does not have the same “leveling power” in all bracket
sizes. As an example, an 0.016 by 0.022 inch wire (with the 0.016 inch vertically)
used in an 0.022 inch bracket levels much better than the same wire in an 0.016
inch bracket. This is due to at least two reasons. First, friction prevents the
brackets from sliding along the wire and allowing the proximal contacts from
changing vertically. Also, this friction helps the occlusal force to “beat” the wire
down and eliminate its resiliency. Second, when leveling with a close fit between
bracket and wire, it is impossible to transmit to the teeth more than a small
portion of the resiliency which is placed in the wire, because the act of seating
the wire into the brackets causes it to take a partial set. This slows the leveling
process and necessitates from two to four times as many arch removals as when
 82 Schudy and Schudy

Fig. 27. Case 4. Pretreatment and posttreatment photographs. (See tracings, casts, and
intraoral photographs in Figs. 26 and 28.)

the 0.022 inch slot is used. This same principle would apply when an 0.0215 inch
wire is used in an 0.022 inch slot.
Friction. The effects of friction with a precision-fit appliance is a very real
disadvantage which must be dealt with. The more narrow the bracket, the
greater the friction and the greater the resistance that will be offered when a
tooth is sliding along a wire. The wider the bracket, the better a tooth will slide
on the wire. Traditionally, in our practice, we have used vertical loops for space
closure, so that friction has never been a problem. For many years in almost all
first-premolar-extraction cases we have retracted the maxillary incisors and
canines as a unit. For those who like to retract maxillary canines as single units,
friction becomes a problem, especially with narrow brackets. To counteract this
friction, a tipping spring has been developed (Figs. 32 to 35). This spring is
made of an 0.016 by 0.016 inch wire and attaches to the rotating levers. This
Volunie 67 The bimetric system 83
Number1

fig. 28. Case 4. A to E, pretreatment and posttreatment plaster casts of patient shown
in Figs. 26 and 27, F, G, and H, posttreatment intraoral photographs.

spring can be attached to both the Steiner bracket and the Lewis bracket. By
applying this spring to the canine tooth, reducing the wire in the canine area
and then applying an elastic thread, this tooth can be moved bodily distally
almost free of friction.
The 1atera.l control of molars. Many orthodontists avoid the 0.018 or 0.016
inch slot for fear of “buccal rolling” of the terminal teeth. If this undesirable
tooth movement occurs, it is because of insufficient torque and “toe in” early
enough in the treatment period. The best cure is prevention.
During the 8-year period in which we used the 0.022 inch bracket, buccal
rolling was a small problem. During the next 15 years in which we used the
84 Schudy and Schudy

Fig. 29. Case 5. A case treated without removing premolars. It was characterized by
crowding of upper and lower incisors along with considerable anteroposteriar discrepancy
of the iaws. Note that the lower incisors moved lingually and upward during treatment.

0.018 inch bracket, buccal rolling was also a small problem. Now, it is also a
small problem with the 0.016 inch bracket. It is not a serious problem and only
careful attention is required to prevent it.
Since labial arches arc attached to the buccal sides of molars, and since these
teeth are wider than other teeth, this places the attachment farther away from
the centroid of the tooth. Thus, when a gingival force is applied, the crown
tends to move or tip labially. This must be compensated for by lingual crown
torque. Obviously, the larger and more rigid the treatment wire, the easier this
can be controlled. However, it can be controlled just as well with the 0.016 by
0.022 inch wire if early precautions are observed. A maxillary lingual arch is
recommended to control the molars if trouble with arch width is anticipated.
The mandibular molars can be controlled, in turn, with cross-bite elastics. Masil-
lary lingual arches are not routinely used for this purpose in our office, but they
are helpful in certain instances.
Volume
Number
67
1
The bimetric system 85

Fig. 30. Case 5. Pretreatment and posttreatment photographs. [See tracings, casts, and
intraoral photographs in Figs. 29 and 31.)

The Icse of torsion forces. When the brackets on all teeth are filled with the
arch wire, one must have full knowledge of torquing principles. He must be able
to determine the exact amount of torque present in every tooth and, more
particularly, just how to eliminate unwanted torque.
A surprising observation is that so many orthodontists use only a “hit-and-
miss” method for checking torque in arch wires. Anyone who uses the edgewise
mechanism should have a precise, scientific method for measuring the torque in
all teeth or segments of teeth. Many try to complete cases with 0.003 or 0.004
inch of play bctwecn the wire and bracket. Perhaps some of these orthodontists
work with so much play because of an inadequate method of checking torque.
For the past 25 years we have checked torque by inverting the arch and
placing it in the molar tube, allowing the other end to project out of the mouth
and ext.end along the side of the face. By noting the distance that the free end
extends below or above the level of the occlusal plane, one can determine the
86 Xchuciy and S&U&J

Fig. 31. Case 5. A to E, Pretreatment and posttreatment plaster casts of patient shown
in Figs. 29 and 30. F, G, and H, Posttreatment intraoral photographs.

exact amount of torque. This same process is repeated all around the mouth on
all.teeth.
Before an arch wire is placed, cvcry tooth should be checked for torque or
lack of it. This is done by first checking the left central incisor by inverting the
arch wire and placing it into the left central incisor bracket and noting the level
of the free ends which are extending forward out of the mouth. If the ends lie
on the level of the occlusal plane, the left central incisor is passive and this tooth
will receive no torsion force when the arch wire is ligated into place. If the free
ends lie gingival to the occlusal plane, there is labial root torque on the left
central incisor. If the free ends lie incisal to the occlusal plane, there is lingual
Volume
Number
67
1
The bimetric system 87

Fig. 32. Two views of an antifriction spring. This spring prevents friction as a tooth is
being moved with an elastic thread.

Fig. 33. Antifriction spring in place for distal canine movement. The canine moved
bodily 5 mm. in 3 months.

root torque on the left central incisor. This will be true of both the lower and
upper incisors. This same procedure is repeated with the lateral incisors, the
canines, premolars, first molars, and, finally, the second molars. In routine prac-
tice, it is not always necessary to check central and lateral incisors, but it is
nearly always necessary to check canines and molars for torque. One must always
start checking torque in the anterior portion of the arch, rather than at the
terminal molar. This is because all torque bends affect all teeth distal to the bend.
The sectional arch.. In 1948 the senior author visited the late Harry Bull in
his office for the purpose of learning about the use of sectional arches. Dr. Bull
very graciously took the time to explain how to fabricate and use them. He also
informed us of their scientific rationale. Since then we have used them routinely
with complete success (Figs. 32 and 33).
Many orthodontists are afraid of them because their logic tells them that
88 Schudy and Xchudy Am. J. Orthod.
January 19 7 5

Fig. 34. Sectional arches for both second-premolar-extraction cases and first-premolar-
extraction cases.

Fig. 35. Angulation of brackets. The first premolar bracket is angulated 3 degrees
distogingivally. The second premolar bracket is angulated 6 degrees mesiogingivally.
The canine is angulated 5 degrees distogingivally.

these arches offer very little anchorage and they will allow lower molars to move
forward more than the canines move distally. Sectional arches will utilize the
full anchorage potential of the molar teeth to which they are attached. If there
is little resistance in a molar tooth, then a sectional arch will cause this tooth
to move forward rapidly. If there is a great deal of resistance in a molar tooth,
then a sectional arch will cause this tooth to move forward very slowly. If there
is a great deal of resistance to forward movement, a molar will resist stubbornly
and will cause the canine or premolar to move most of the width of the extraction
space.
Which molar teeth offer this desired resistance? Which molar teeth serve well
with sectional arches? Which ones do not? Maxillary molars offer very little
resistance to forward movement and are a very poor risk for sectional arches. We
never use sectional arches to retract upper canines. If they are used, they must
be backed up with a head gear. On the other hand, lower molars offer a tre-
mendous amount of resistance to forward movement and serve well as sectional arch
attachments. Why is this true? What is the biologic explanation for this phenome-
non? Since the mandible “outgrows” the maxilla, this differential resistance is
necessary to prevent trauma to the periodontal tissues. In the terminal growth
 The bimetric system 89

period it is not uncommon to see 4 to 6 mm. of forward growth of the mandible

while the maxilla grows very little or none. This difere?ltial awhorage phetlomenon.
allows the maxillary teeth to move through the bone and the mandibular teeth
to remain stationary with relation to their base. When we become informed on
how the jaws grow, then it is not hard to see why sectional arches are efficacious
for the low arch and unsatisfactory for the upper teeth.
While lower molars as a whole offer much more anchorage than the upper
molars, it must be understood that some of them have much less anchorage in
them than others. How can you tell just which molars offer desired anchorage?
The answer is that you cannot. However, we do have some clues. In general,
persons with deep bites and short faces have lower molars with maximum an-
chorage. In general, persons with long faces and high alveolar bone growth
have lower molars with minimum anchorage. It must be remembered that there
are many exceptions to this general rule.
Aside from the fact that sectional arches are the easiest to use, the simplest,
and the least time consuming, they hare another advantage which is far more
important. They allow the discerning orthodontist the opportunity of achieving
what his best judgment dictates instead of accepting whatever he happens to get
(Fig. 34). There is a rather precise anteroposterior position which lower incisors
must occupy if optimum facial esthetics is to be achieved. To accomplish this
desired position, extraction spaces on the lower arch must be closed very carefully
and skillfully, care being taken to see that each tooth adjacent to a space mores
an exact amount. This must be controlled accurately.
By banding only the teeth near the extraction spaces, learing the incisors and
canines or just the incisors unhanded, we leave an undisturbed group of teeth to
act as an index or a home base to tell us just which teeth are moving where.
Having two free ends of an arch section within one posterior segment of teeth is
tremendously important for precise tooth movement. It aids in the use of good
clinical judgment because it isolates a small group of teeth from the entire dental
arch. This small group can he dealt with as one entity free of any encumbrance
which the total arch might impose. For example, if we have extracted lower first
premolars and arc closing the spaces with sectional arches to the first molars,
having left the incisors unhanded, and spaces begin to appear mesial to the
canines, we know immediately that the incisors will move lingually later. Now,
if our analysis calls for the incisors llot to more lingually, then we know that WC
must slow down and apply weak Class II elastics from the closing loop (not the
molar hook) during the rest of the space closure. TVe also know that WC usually
will want the upper arch stopped against the molars during this phase of treat-
ment.
When lower second premolars are extracted, the sectional arches include only
the first molars and first premolars. The second molars, canines, and incisors are
not banded. Let us consider the treatment of a case which has 2 mm. of crowding
on each side at the site of the canines. The incisors arc in good alignment. As the
extraction spaces are being closed, we notice that 3 mm. of space has opened up
mesial to the first premolars on each side and there is still 3 mm. of second pre-
molars space. As we planned our treatment, we decided that the incisors should
9Cl Xchudy and Schudy

,)mt move linguallp. When we see 3 mm. of space on each side mcsial to the first
premolars and there was only 2 mm. of crowding on each side in the beginning,
we know immediately that we are getting into trouble. At this point we do not
activate the sectional arches but, instead, we start weak Class II elastics from the
closing loop (not from the molar hook). For the rest of thr space closure we go
slowly and never permit more than 2 mm. of space to occur mesial to the bi-
cuspids. On the other hand, if the molar is observed to he moving forward too
much (which is rare) then a Class III elastic is applied. Thus, the very nature
of a sectional arch makes it possible to know exactly which teeth are moving how
much at all times. When all teeth arc banded, precise tooth movement is camou-
flaged and one cannot tell just which teeth are moving until it is too late.
l’he biologic rrrtiowrrle for the action of sccfimnl rrrches. When a sectional arch
is activated 1 mm. the crowns of the teeth adjacent to the extraction space move
almost 1 mm. within a few hours, but the apices of these teeth move slightly
away from the extraction space during this time. Then 3 or -l weeks is required
for the apices of the roots to move 1 mm. to catch up with the crowns. If the loop
is again activated in a week the roots will not move at all. but they tend to move
in the wrong direction. If the loops continue to be activated too often, the root
ends never have a chance to move at all and the teeth bccomc tipped. A common
mistake is to look into the mouth and SW a spacr half closed and assume that
good progress has been madr without stoppin g to obscrvc whcthcr the root apices
hare also moved. Regardless of how mnch the crowns have moved, if the root
ends have not moved, no progress has been made. Tn fact, the treatment has
retrogressed.
As a result of going too fast, that is, activating either too much or too often,
the root ends never have a chance to move because most of the time the force is
in the wrong direction on the apices. Srctional arches should almost never be
activated more than 1 mm. cvcry 3 weeks. The secret of success is to go very
slow1.v. Tt has been our obscrration that cstraction spaces close vcrv rapidly in
the masilla but very slowly in the mandible. The ratio is probably two to one.
The reason for this is cliffercntial anchorage mentioned above.

The bimctric system has been introduced to orthodontics for the first t,ime. It
is a new system of the cdgcwise mechanism in which 0.016 inch brackets are
used on the anterior teeth and 0.022 inch brackets on the posterior teeth. Bp
making a 90-degree t,wist in an 0.016 b,v 0.022 inch arch wire, it is possible to fill
all brackets. To use the 0.022 inch dimension both horizontally and vertically
in the posterior region, a special tube is required. This tube, a newcomer to
orthodontics, receives both dimensions vertically and horizontally and will not
allow the wire to turn.
This system gives maximum torquing qualities for the anterior teeth and
maximum strength of the wire in the posterior region by turning the 0.022 inch
dimension vertically. The 0.006 inch play between the brackets and wire in the
posterior regions in the early phases of treatment affords rapid leveling.
The smaller wires used are much easier and simpler to use, require less
 The bim.etric system 91

digital skill, save time and shorten treatment time, are much easier on the pa-
tient, and make possible a tension-free experience for both patient and ortho-
dontist.
We have used this technique exclusively for the past 4 years and have
finished more than 300 cases. This system holds great promise for the future.
REFERENCES
1. Angle, Edward H.: The treatment of malocclusion of the teeth, Philadelphia, 1907, S. S.
White Dental Manufacturing Company.
2. Barton, John J.: The high-pull head gear versus cervical traction: A cephalometric com-
porkon, AM. J. ORT~OD. 62: 517, 1972.
3. Sproule, Wm. K.: Dento-facial changes produced by extraoral cervical traction of the
maxilla of the .Macnou m&ttn: A histologic and serial cephalometric study, University of
Washington, 196X.
4. S~chudy, George I?.: A longitudim~l cephalometric study of posttreatment craniofacial
growth : 1 ts implient,ions in orthodontic treatment, AX J. ORTI~O~. 65: 39, 1974.

6615 Cameron St. (77006)

THE JOURNAL 60 YEARS AGO

January, 1915

In this issue of the Journal appears an abstract of the paper read by Dr. Charles H. Mayo,
of Rochester, Minnesota, before the Section on Stomatology of the American Medical
Association at the June meeting in Atlantic City.
In this paper Dr. Mayo makes the statement that in the future more than in the past
society is going to demand orthodontic services. Human efficiency, to a great extent,
depends upon a well-regulated digestive system, and such a system is dependent upon
sound teeth and as nearly perfect occlusion as is possible to obtain. Society is going to
wield the “big stick,” as Dr. Mayo puts it, to such an extent that orthodontic work will
become the necessity of the future.
Dr. Mayo believes that the day is not far distant when orthodontia will become one of
the most important specialties of either medicine or dentistry. He looks for great advance-
ment in this science, as a result of which childlife is going to be much benefited. (Martin
Dewey: Editorial: Dr. Charles H. Mayo’s Opinion, p. 41.)