contemporary fixed orthodontics
TRANSCRIPT
8/15/2017 1haPPy Smile
“The eyes sees only what the mind is prepared to comprehend”
Seminar submitted to DEPARTMENT OF ORTHODONTICS
Seminar submitted by SACHIN SUNNY OTTAFINAL YEAR PART 1
FIXED ORTHODONTIC
APPLIANCES
8/15/2017 2haPPy Smile
From the history…Most of the early appliance were of removable
type.Actually , they were modified dentures. Early fixed appliance were usually crude metal bands that were ligated to teeth with brass or silver wire. They were outstanding for their inefficiency & their ability to trap food.So KINGSLEY,ANGLE & CASE realised that for any effective tooth movement,some means must be devised to control individual teeth.This led to the development of attachments that were soldered on modified crowns or bands…!
8/15/2017 3haPPy Smile
What Are Fixed Appliances?
Appliances that are fixed or fitted on to the
teeth by the operator & cannot be removed by
the patient at will.
They are very versatile and can be used to
treat most
malocclusions.
8/15/2017 4haPPy Smile
ADVANTAGES:
1.Orthodondist need not depend on patient cooperation on timely wear.
2.Any type of tooth movements are possible.
3.Multiple tooth movements possible simultaneously.
DISADVANTAGES:
1.Oral hygiene maintenance
2.Time consuming to fix and adjust
3.Damaged appliance deliver mis-directed forces
4.Regular visits
5.Expensive
6.Esthetically not pleasing
8/15/2017 5haPPy Smile
Tooth movements possible
TIPPING –crown moves in direction of force
BODILY MOVEMENT – equal movement
TORQUING – root in lingual direction
UPRIGHTING – mesio distal movement
ROTATIONS – rotation around long axis
EXTRUSION
INTRUSION
8/15/2017 6haPPy Smile
UPRIGHTING ROTATION
INTRUSION EXTRUSION
8/15/2017 7haPPy Smile
OPTIMUM ORTHODONTICFORCE
The force that produce maximum tooth
movement in the desired direction with
minimum damage to supporting tissue &
without any discomfort to patient.
It should be in range of 20-26gm/cm sq of
root surface
It should not occlude blood vessels in PDL.
8/15/2017 8haPPy Smile
8/15/2017 9haPPy Smile
8/15/2017 10haPPy Smile
Fixing attachment to teeth
BANDING
Technique of fixing attachments to band
is referred as BANDING.
Uses thin stainless steel strips called
bands that are wrapped around teeth &
cemented to teeth.
Posterior bands are wider & stiffer
where anterior band is thinner &
narrower.
8/15/2017 11haPPy Smile
8/15/2017 12haPPy Smile
Indications for banding:
1.Posterior teeth which receive heavy Occlusal force & moisture control is required.
2.Teeth that require buccal & lingual attachments
3.Teeth with short clinical crowns
Steps in banding:
1.Separation of teeth – using elastomeric rings(doughnut),separating springs(1 week),Keslings separator.
2.Selection of band material,thickness & width
3.Band placed around tooth & pinched
4.Spot weld
5.Fixing the attachments
6.Cementation 8/15/2017 13haPPy Smile
8/15/2017 14haPPy Smile
BONDING The method of fixing the attachment directly over
the enamel using adhesive resin
Advantage over banding: enhance esthetics & oral hygiene maintenance.
PRETREATMENT OF ENAMEL BEFORE BONDING:
1.Etching the enamel enhance surface energy
2.Etching enhance porosity & hence greater bond strength.
ADVANTAGES:
1.Esthetics
2.Faster to bond
3.Better oral hygiene
4.Risk of caries under loose bands are eliminated
8/15/2017 15haPPy Smile
8/15/2017 16haPPy Smile
DISADVANTAGES:
1.Weaker than banded attachments
2.Etching increases risk of demineralisation
3.Enamel fracture can occur during debonding
TYPES OF BONDING:
1.Direct bonding :direct attachment of bracket to pretreated teeth.
2.Indirect bonding: bonding with the help of transfer tray
DIRECT BONDING
1.Cleaning – pumice & bristle brush
2.Moisture control – saliva ejectors & cotton rolls. Methantheline 50mg per 45kg bdy wt 15 min before bonding.
8/15/2017 17haPPy Smile
8/15/2017 18haPPy Smile
8/15/2017 19haPPy Smile
3.Enamel pretreatment – 30-50% phosphoric acid (gel or liquid) for 15-30 sec. appearance of etched enamel is “matte,dull,whitish & lightly frosted”
4.Sealant application
5.Bonding – using bonding material (bis-GMA).Light cure adhesives also used.Excessiveadhesive material removed using scaler.
INDIRECT BONDING
1.Brackets are positioned & applied over the model
2.Transfer tray (thermoplastic sheet or silicone putty) is adapted over the model to incorporate bracket.
8/15/2017 20haPPy Smile
3.Bonding resin applied to mesh side of bracket
4.Tooth surface is pretreated
5.Bonding tray is positioned over patient `s
mouth
6.Light cured
ADVANATAGES:
1.Accurate placement of brackets
2.Clinical chair side time reduced
8/15/2017 21haPPy Smile
8/15/2017 22haPPy Smile
8/15/2017 23haPPy Smile
8/15/2017 24haPPy Smile
8/15/2017 25haPPy Smile
Components of fixed appliances
ACTIVE COMPONENTS
1.Arch wire
2.Springs
3.Elastics
4.Separators
PASSIVE COMPONENTS
1.Bands
2.Brackets
3.Buccal tubes
4.Lingual attachments
5.Lock pins
6.Ligature wire
8/15/2017 26haPPy Smile
8/15/2017 27haPPy Smile
8/15/2017 28haPPy Smile
bands Help to fix attachments to teeth.
Made of soft stainless steel
Preformed bands or custom made bands are
available
Inner surface has matt finish to aid in
retention of cement.
8/15/2017 29haPPy Smile
BRACKETS Handles of attachment to tooth that transmit
force from active component (arch wire)
Classification:
1.Based on material
Metallic & Ceramic
2.Based on attachment
to tooth
Weldable & Bondable
3.Based on mode of securing arch wire
Self ligating & that require ligation
4.Based on technique
Edgewise , Ribbon arch , Tip edge type
8/15/2017 30haPPy Smile
8/15/2017 31haPPy Smile
EDGEWISE : have a
horizontal slot labially.
They accept wires of rectangular
cross section.
Greater control over tooth.
RIBBON ARCH: have vertical slots facing
occlusal or gingival direction.Used
with round wires.Permit tipping of
teeth in labiolingual & mesiodistal
direction.Used in Beggs appliance.
8/15/2017 32haPPy Smile
WELDABLE & BONDABLE BRACKETS
METALLIC BRACKETS:
recycled,sretilized,resist deformation,least
friction at wire-bracket interface.Not
esthetically pleasing.
8/15/2017 33haPPy Smile
CERAMIC BRACKETS: aluminium oxide or
zirconium oxide.Dimensionally stable,durable
& resist staining.They are very brittle &
exhibit greater friction at wire-bracket
interface.
8/15/2017 34haPPy Smile
PLASTIC BRACKETS: improve esthetic
value.They tend to discolor & offer poor
dimensional stability.Very high friction.
SELF LIGATING BRACKETS: have inbulit
metal labial face that can be opened & closed
to secure arch wire.Exhibit very low friction
8/15/2017 35haPPy Smile
EVOLUTION OF
BRACKETS
8/15/2017 36haPPy Smile
BUCCAL TUBES Attachment generally used in
molars(molar tube)
They are weldable or bondable
Round or Rectangular in cross section
Single , Double & Triple.
8/15/2017 37haPPy Smile
Lingual attachment
Attachments to be fixed lingually.
Used to engage elastics.
Lingual cleats Lingual buttons
Eyelets
Ball end hook
8/15/2017 38haPPy Smile
Ligature wire To secure arch wire to
bracket(ligation) in edge wise brackets.
Stainless steel wire of
0.009-0.011 inch diameter
Lock pins Small pins to secure arch wire
to ribbon arch bracket.
Made of brass
8/15/2017 39haPPy Smile
Arch wire Gold wires replaced by stainless steel wires due to high
cost & mechanical inefficiency
Titanium wires also used due to high elastic properties.
Ideal requirements:
1.Spring back-how far deflected without permanent
deformation
2.Stiffness-low stiffness apply low constant force over time
3.Formability-be high to bend in any configuration
4.Resilience-amount of force wire can withstand without
deformation.
5.Biocompatability
6.Joinability
7.Friction-very low
8/15/2017 40haPPy Smile
Gold & gold alloys: low spring back & high cost
Stainless steel:18-8 stainless steel
Nitinol :high spring back, high working range &
low stiffness.Cannot be soldered or welded.
Beta tiatnium: T.M.A wires.High range of action &
spring back.High formability & can be welded.
Elgiloy : cobalt chromium nickel alloys
Optiflex arch wires: made of clear optical fibre &
hence highly esthetic.High resilience.Cannot
accept sharp bends.
Multistranded arch wire:made of number of
thinner wires.Increased flexibility.
Arch form termed as “Parabolic Shaped”8/15/2017 41haPPy Smile
Elastics & elastomerics
ELASTICS
Latex rubber
Force delivered depend on diameter of
elastics
Color coded
8/15/2017 42haPPy Smile
Applications:
1.Class 1 elastics: intra arch
elastics.Used for space closure &
retraction of teeth.
8/15/2017 43haPPy Smile
2.Class 2 elastics :inter maxillary elastics
stretched between lower molars &upper
anteriors.Used in treatment of class II
malocclussion.
8/15/2017 44haPPy Smile
3.Class 3 elastics:intermaxillary elastics
stretched between upper molars & lower
anteriors.Used in treatment of class III
malocclusion.
8/15/2017 45haPPy Smile
4.Cross bite elastics:to treat molar cross
bite.Extend between palatal surface of
upper molars & buccal surface of lower
molars or vice versa.
8/15/2017 46haPPy Smile
5.Box elastics:treat anterior open
bite.elastic is stretched between upper &
lower anteriors like a box.Forced
eruption of upper & lower anteriors.
8/15/2017 47haPPy Smile
ELASTIC CHAINS (E-CHAINS)
Elastics available as long chains of interconnected rings
Made of synthetic polyurethene
material
Used in closure of space between
teeth.
ELASTIC THREAD
Made of core of latex rubber surrounded by woven silk
Tied around two teeth for space closure or to derotate a tooth.
ELASTIC MODULE
Two elastic rings separated by variable distance
Used for space closure & derotation of tooth
8/15/2017 48haPPy Smile
ELASTIC
THREAD
ELASTIC
MODULE
8/15/2017 49haPPy Smile
LIGATING RINGS
To secure arch wire to bracket
Available in various colors
Alternative to ligature wires.
Springs Uprighting spring:move root in mesial or
distal direction
Torquing springs:move root in lingual or palatal direction
Open coil spring:coil compressed between two teeth to open space between them
Closed coil spring:stretched between two teeth to close space.
8/15/2017 50haPPy Smile
UPRIGHTING
SPRINGS
TORQUING
SPRINGS
8/15/2017 51haPPy Smile
CLOSED COIL
SPRING
OPEN COIL
SPRING
8/15/2017 52haPPy Smile
separators To open up a gap in interdental area for easy
banding & patient comfort.
BRASS WIRE SEPARATOR
0.5-0.6mm diameter brass wire
RING SEPARATOR
Elastic rings passed via contact using applicator
DUMBBELL SEPARATORS
Dumbbell shaped elastic stretched into contact
Stretched separator tries to regain original length hence indirectly separates the teeth.
KESLING`S SPRING SEPARATOR
Have a coil & two arms- shorter arm passed below contact while longer arm rests above the contact.
8/15/2017 53haPPy Smile
8/15/2017 54haPPy Smile
8/15/2017 55haPPy Smile
8/15/2017 56haPPy Smile
E-ARCH Expansion arch by Angle
Had bands on molars with an expansion arch
threaded to buccal aspect of molar bands
Individual teeth were ligated to expansion arch
Deliver only heavy interrupted force
8/15/2017 57haPPy Smile
PIN & TUBE APPLIANCE Consist of bands with vertical tubes placed
on all teeth. Arch wire carried soldered pins
inserted into vertical tubes
Tooth movement achieved by altering
placement of pins.
Require high precision & skill
8/15/2017 58haPPy Smile
EDGEWISE APPLIANCE
“Metal bracket having rectangular slot facing
labially received a rectangular arch wire “
It enabled control of tooth movement in all
three plane of space
Angle`s last contribution
It incorporated FIRST , SECOND & THIRD
ORDER BENDS.
8/15/2017 59haPPy Smile
8/15/2017 60haPPy Smile
Comprises of lateral inset,canine offset & molar offset
Correct buccolingual position by moving the roots
8/15/2017 61haPPy Smile
8/15/2017 62haPPy Smile
8/15/2017 63haPPy Smile
8/15/2017 64haPPy Smile
Advantages:
1.Ability to move teeth in all three planes
of space
2.Bodily movement of teeth possible
3.Good control
Disadvantages:
1.Need to apply heavy force
2.Need for complex wire bending
3.Increased friction
4.Difficult to open deep bites
8/15/2017 65haPPy Smile
RIBBON ARCH APPLIANCE
First appliance to use a true bracket having
vertical slot facing occlusaly
Used archwires with good spring qualities
Poor control of root position
Used rectangular wires than round wires
Enabled rotation control,bucco lingual &
incisogingival tooth movement
8/15/2017 66haPPy Smile
BEGG APPLIANCE
Concept of differential force & tipping of teeth
rather than bodily movement
Modification of ribbon arch appliance
Treatment is under 3 stages:
1.Alignment, correction of crowding, rotation
correction, closure of anterior space &
achieving an edge to edge anterior bite.
2.Closure of extraction space & maintenance
3.Root Uprighting & torquing
8/15/2017 67haPPy Smile
Advantages:
1.Use of light continuous force over
physiological limits
2.Do not strain the anchorage
3.Minimal friction
4.Extra oral force not required to conserve
anchorage.
8/15/2017 68haPPy Smile
8/15/2017 69haPPy Smile
STRAIGHT WIRE APPLIANCE
Pre adjusted edgewise appliance
Programmed brackets to eliminate the
complex bends.
Bodily movement of tooth achieved
Stages of treatment:
1.Initilal aligning & leveling of arch with
crowding correction.
2.Space closure & establish class I molar
relation with normal over jet
3.Finishing & detailing
8/15/2017 70haPPy Smile
By passing the bends..
1.First order bends – varying the thickness of
base of bracket
2.Second order bends – angulating bracket
base or bracket slot
3.Third order bends – inclined bracket slots
8/15/2017 71haPPy Smile
BAKERS ANCHORAGE Use of inter maxillary rubber bands
Adjust the teeth by pitting the upper arch
against lower arch
Used in class II & class III malocclussion
cases
8/15/2017 72haPPy Smile
LINGUAL ORTHODONTICS Technique involving placement of bracket &
other attachments on lingual surface of teeth.
Appliance not visible & hence donot affect esthetics(Invisible orthodontics)
Begg`s & edgewise principle can be incorporated
Indications:
1.Mild incisor crowding with anterior deep bite
2.Long & uniform lingual tooth
surface without fillings,crowns or
bridges
3.Good gingival & periodontal
health8/15/2017 73haPPy Smile
Drawbacks:
1.Difficult to place bracket in lingual aspect
2.Tooth control not very effective
3.Limited scope for complex problems
4.Difficult in short crowns
5.Expensive
Indirect bonding is
mandatory due to
difficult visualization &
bracket height.
Moisture control is difficult.
8/15/2017 74haPPy Smile
TIP EDGE APPLIANCE
Combine advantages of straight wire & begg
appliance
Initial stage: Tip edge bracket allow tipping of
tooth(round arch wire)
Final stage: Better degree of control over
tooth (rectangular arch wire)
8/15/2017 75haPPy Smile
Stages of treatment
Leveling & alignment
Overbite reduction
Overjet reduction
Space closure
Final tooth positioning
8/15/2017 76haPPy Smile
8/15/2017 77haPPy Smile
1.LEVELING & ALIGNMENT
In vertical & horizontal planes
All rotations are corrected
2.OVERBITE REDUCTION??
By intrusion of anteriors or extrusion of
posteriors depending on skeletal growth
pattern,lip configuration & inter occlusal
clearance
Intrusion of anteriors – intrusion utility arches &
arch wires with anti curve of spee in mandibular
& exaggerated curve of spee in maxillary arch .
Posterior extrusion – bite planes & vertical
elastics
8/15/2017 78haPPy Smile
OVERBITE CORRECTION8/15/2017 79haPPy Smile
3.OVERJET REDUCTION & SPACE CLOSURE
To obtain class 1 canine relation
Close any residual space occurred due to extraction
Mechanics of anterior retraction :
1. Friction or sliding mechanism - aligned brackets allow wire to slide through posterior bracket slots. Thick rectangular stainless steel wires are used
2. Friction less or loop mechanics – Depends on spring and loop design for anterior retraction or posterior protraction depending upon anchorage need . Various loops are T loop ,Omega loop , Key hole loop and Tear drop loop
8/15/2017 80haPPy Smile
KEY HOLE LOOP
8/15/2017 81haPPy Smile
En mass retraction – Entire anterior segment is
retracted
Canine retarction followed by incisal retraction –
Enhances posterior anchorage control during
space closure
4.FINAL TOOTH POSITIONING
Finishing and occlusal detailing
Smaller diameter wire ( 0.016inch stainless steel
or rectangular beta titanium) is used
Minor arch wire bends in 1st 2nd or 3rd order may
be used
Vertical settling elastics is used for settling of
occlusion 8/15/2017 82haPPy Smile
FINAL STAGE
8/15/2017 83haPPy Smile
DEBONDING
removal of orthodontic attacthment and adhesive resins .
To restore the surface of teeth as closely as possible to pre traetment conditions
Metal brackets debonded using twin beak debonding plier and brackets are cut off at tooth bonding base interface
Thermal debonding csn be done when barcketsare exposed to heat source (softening of adhesive)
Laser debonding
Ceramic brackets debonded by lifting the brackets of using bracket removing plier ??
8/15/2017 84haPPy Smile
8/15/2017 85haPPy Smile
Residual adhesive is removed using burs and
contra angle hand piece
Dome shaped tungsten carbide burs at
30000rpms using light painting stokes can
remove adhesive
Ultra fine diamond burs
Teeth is polished with prophylaxis paste
8/15/2017 86haPPy Smile
Tungsten Carbide bur used for cleaning of adhesive
8/15/2017 87haPPy Smile
EXTRACTION IN CONJUGATION WITH
ORTHODONTIC THERAPY
Teeth returned to their original positions of
malocclusions after the retaining appliance were
removed
In such case removal of one or more teeth made
the problem of correction much easier
Removal of first cuspids permit the normal
occlusion with greater ease and post treatment
stability
It was an antagonism with Angle’s followers .
8/15/2017 88haPPy Smile
FIXED FUNCTIOAL APPLIANCES Functional appliances that are fitted on teeth by
the orthodontist and cannot be removed at will by the patient
Non compliance class II correctors
Advantages:
1. 24 hours usage
2. smaller size
3. better adapted to functional movements
4. overall treatment time is reduced
Classified as : 1 . Flexible fixed functional apliance ( FFFA) 2. Rigid fixed functional appliances (RFFA)
8/15/2017 89haPPy Smile
FFFA Inter maxillary torsion coils of fixed springs
Allows greater movements of mandible
Elasticity and flexibility
Disadvantages : fracture of appliance, tendency to chew the appliance ,mucosal ulceration of springs
Uses : class II div 1 and 2 , class 3 malocclusions
Example : Jasper jumper ,Klapper super spring ,Churro jumper
8/15/2017 90haPPy Smile
8/15/2017 91haPPy Smile
8/15/2017 92haPPy Smile
RFFA Advantages : after fixing appliance ,do not
permit the patient to close the centric
relation which creates 24 hours stimulus
for mandibular growth
Examples : herbest appliance,
cantilevered bite jumper ,MALU herbst
appliance ( mandibular advancement
locking unit), flip lock herbst appliance
8/15/2017 93haPPy Smile
8/15/2017 94haPPy Smile
Problems during orthodontic treatment
1.Caries & decalcification
2.Deformed bands
8/15/2017 95haPPy Smile
3.Soft tissue problems
Ulcerations
Inflammation & enlargement of gingival
papillae
Recession
8/15/2017 96haPPy Smile
Care your teeth during
treatment!!1.Orthodontic brushes
8/15/2017 97haPPy Smile
2.Digital gum massage
3.Interdental stimulation
4.Waterpik
8/15/2017 98haPPy Smile
With the help of….
Graber`s textbook of orthodontics-Sridhar Premkumar (4th edtn)
Contemporary orthodondics-William.R. Proffit (4th edtn)
Orthodontics the art & science-Bhalajhi
Orthodontics exam preparatory manual for undergraduates-Sridhar Premkumar(2nd edtn)
8/15/2017 99haPPy Smile
8/15/2017 100haPPy Smile
“ONCE YOU LEART TO
QUIT, IT BECOMES A
HABIT”