Dr. Varun Grover

INDIAN DENTAL ACADEMY
Leader in continuing dental education
www.indiandentalacademy.com

www.indiandenta...
Introduction
 Goals

of orthodontic treatment

End of treatment
 Desire

for esthetics during
treatment

 Lingual

orth...
Search for absolute esthetics
 Advancement

in orthodontics

 Pinching

of the bands
 Direct bonding (Miura – 1971)
 P...
Search for absolute esthetics
 Bands

on all teeth

www.indiandentalacademy.com
Search for absolute esthetics
 Metallic

display

www.indiandentalacademy.com
Search for absolute esthetics


Ceramic brackets – relatively esthetic

www.indiandentalacademy.com
Search for absolute esthetics
 Lingual

brackets

www.indiandentalacademy.com
Search for absolute esthetics
 Good

fortune of orthodontist

Reduced cost
Lower arch – judge the progress
Reduced demand...
Historic perspective
 John Farrar
 Mershon –

– lingual removable arch (1889)

LRA with finger springs

 Owen Oliver
 ...
Historic perspective
 Nance

button
 TPA – Robert Goshgarian
 Lingual arch - Wilson

Note – supplement labial orthodont...
LO – As a complete system
 Vision of
 Craven
 Kinya

2 key innovators

Kurz – USA

Fujita – Japan
Kanagawa uni.

www.in...
LO – As a complete system
 Fujita

system -1971
 Advantages
Lip injury
Lip relation
Retention
Little anchorage loss
Brac...
LO – As a complete system
 Fujita

system -1971
 Disadvantages
Longer duration
Speech difficulties
Initial discomfort
Or...
LO – As a complete system
 Key

features – Fujita system
 Slots facing occlusally

Easy insertion and removal
Prevents d...
LO – As a complete system
 Grooves

for insertion of lockpins

Mesiodistally
 Auxilliary

grooves

www.indiandentalacade...
LO – As a complete system
 Multiple

slots – Less publicized
 Ant. And Pm bracket – 3 slots
Occlusal
Lingual
vertical
 ...
LO – As a complete system
 Do

lingual appliances hampers speech???

 Sample

– 1 patient

 Class

I crowding
 All 4s ...
LO – As a complete system
A

and O – no effect

www.indiandentalacademy.com
LO – As a complete system
 I,

E, U – disturbed on 1st
and 4th day
 Normal by 6th day
 S,

T, R and L – affected
 Cons...
Craven kurz
 Ormco
 1976 – introduced

lingual app
 Slots facing palatally
 Worked as a part of LTF (1990)
Scholz Gorm...
Craven kurz
 1976 – 1st

generation of
lingual brackets
Larger profile
Crude prescription
 1990 – 7th generation
Low pro...
Craven kurz
 Slot

size – 018
 Greatest innovation

Addition of bite plane
 Shearing

forces

www.indiandentalacademy.c...
Lingual brackets
 Mx

anterior brackets

Built in bite plane
Propping open the bite
Adv in deep bite cases

www.indianden...
Lingual brackets
 Mand

anterior brackets
Ball hook extends away from the tissue
Ease in maintaining oral hygiene

www.in...
Lingual brackets
 Bicuspid

brackets - wider
Better rotational and tip control
More uniform interbracket width
Ball hooks...
Lingual brackets
 Molar

brackets – variety
 Twin bracket
recommended when both 1st and 2nd molars are bonded
Twin brack...
Lingual brackets
 Hinge

cap

Latest
Ideal attachment for terminal tooth
Hinge cap tool

www.indiandentalacademy.com
Lingual brackets
 Terminal

tube

Used initially
Crown height is less

www.indiandentalacademy.com
Lingual instruments
 Lingual

utility plier
 Ligature cutter
 Curved mosquito hemostat
 Small distal end cutter
 Ling...
Lingual Begg brackets
 Fujita

and Craven kurz

Edgewise slot
 Stephen

Paige – 1982
 Begg appliance suits well to LO

...
Lingual Begg brackets
 Vertical slot
 Use

of round arch wires

 No built
 TP

facing occlusally

in tip and torque

–...
Lingual Begg brackets
 Anatomic considerations

Difficult to position the bracket
 Interbracket

arch wires

distance – ...
Lingual Begg brackets
 Low

profile lingual Begg bracket

Difficult to close the open bite
 Plastic

buttons on labial s...
Lingual Begg brackets

www.indiandentalacademy.com
Lingual Begg brackets
 Lockpins

– softer and thinner (014)

 Seated – using

a two hand instrument
Wire tucker

 Weing...
Lingual Begg mechanics
 Low

angle cases – favorable md rotation
 High angle cases
Smith (1986 )- HPHG
Cash and Blackwoo...
Lingual Begg mechanics
 Lingual

archforms – Mushroom shaped
Key hole shaped
 Bicuspid offset
 Molar offset
 Anchor be...
Lingual Begg mechanics
 Stage 1

archwires
 No crowding - 016ss
 Addition of

vertical loops
 Smaller diameter archwir...
Lingual Begg mechanics
 Stage II

archwires – 018, 020
 Stage III archwires – 020
Torquing auxiliaries
Uprighting spring...
Lingual Begg mechanics
 Lingual root

torque for upper incisors

www.indiandentalacademy.com
Lingual Begg mechanics
 Labial root

 Lingual

torque of upper lateral incisors

root torque of the canines

www.indiand...
Lingual Begg mechanics
 Uprighting springs
 Stage III

– Mesiodistal root movement
 Braking mechanics – stage II
 010 ...
Conceal system
 Thomas

Creekmore (AJODO 1989)
 Unitek, Monrovia, California
 Advantages
Facial tooth surfaces are not ...
Conceal system
 An



acceptable LOA must include following key elements

Align
Apparatus to position the brackets prec...
Conceal system





Accurate indirect bonding system
Preformed arches
Specifically designed pliers
Torquing keys

www....
Conceal system
 Slots

opens occlusally

 The

first 1mm of the molar tube
opens to the occlusal aspect

 Direct

guida...
Conceal system
 Design of

Pm and molar bracket

Occlusal tie wings projecting mesially and distally
Mesial and distal un...
Conceal system
 Conceal brackets

Unitwin bracket

are designed around the

Centered slot concept
Single bracket without ...
Conceal system
 Each

conceal bracket has 3 different slot widths

www.indiandentalacademy.com
Conceal system
 Tip

control in an occlusally inserting system is
analogous to rotational control in labial system

 Rot...
www.indiandentalacademy.com
Conceal system
 The width

of the slot for rotation – 0.070 inch

 Analogous
 Torque

to tip control in the labial syst...
Conceal system
 Play
 Maximum arch

www.indiandentalacademy.com

wire size
Conceal system – slot machine
 Lingual

surfaces – irregular
 Labiolingual thickness
 Slot machine
 Holds the lingual ...
Patient selection
 Adults
 Missing

teeth
 Complex restorative needs
 Periodontal problems

www.indiandentalacademy.co...
Patient selection
 Possible speech
 Absolute

difficulty – 2 to 4 wks

need for perfect speech

 Tongue irritation
 Op...
Patient selection
 Deep

bite cases are ideal for LO
 Short clinical crown height – relative CI
 Initial practitioners
...
Patient selection
 Deep

bite

Vs

 Open

bite

 Brachycephalic

 Dolichocephic

 Euryprosopic

 Leptoprosopic

 Bi...
Patient selection
 Biomechanical differences

 For

normally inclined or proclined upper incisors,
intrusive forces for ...
Patient selection
 For

retroclined anteriors

Advancing loops in initial archwires
www.indiandentalacademy.com
Patient selection
 Effects

of vertical extrusive forces
 Labial appliance – extrusion

Labial root torque
 Lingual

ap...
Patient selection
 Effects

in antero-posterior relation
 Lingual appliances

Vertical opening
Md rotation
Induce Class ...
Patient selection
 Contraindications
 Short

clinical crowns
 Unresolved periodontal problems
 Mutilated posterior occ...
Patient selection
 Effects

in transverse dimension

 LA –

expansive nature coupled by posterior
disclusion

 Mesiobuc...
Bracket placement
 Indirect

bonding
 Why not direct bonding???
Access
Irregular lingual surface
Variation in lingual to...
Bracket placement
 Methods

of bonding

 TARG

– Torque Angulation Reference Guide
 CLASS – Custom Lingual Appliance Se...
Bracket placement - CLASS
 Scott

huge
Ideal set up is created
Brackets placed
All planes of space considered
Custom brac...
Bracket placement - CLASS
 Brackets transferred

to the original cast

Another indirect bonding tray is fabricated
Ideal ...
Bracket placement - CLASS
 Steps
 Precise

impressions
 Wax bite
 Articulate the casts
 Fill the prescription
 Immob...
Bracket placement - CLASS
 Prescription form

www.indiandentalacademy.com
Bracket placement - CLASS
 Ideal set

up
2nd molars and single incisor in each arch

Teeth act as reference
Class I canin...
Bracket placement - CLASS
 Filling

the prescription

www.indiandentalacademy.com
Bracket placement - CLASS

www.indiandentalacademy.com
Bracket placement - CLASS
 Transfer

trays
 Sectioning of the trays

Preference – Vinyl
www.indiandentalacademy.com
Bracket placement - CLASS

www.indiandentalacademy.com
Bracket placement - CLASS
Arch width
Maintain
Widen
Constrict

Lower occlusal plane
Flat
Maintain
Deep

Overbite
Ideal
Inc...
Bracket placement - CLASS

www.indiandentalacademy.com
Bracket placement - TARG
Dev by Ormco, 1984
Bracket placed with respect to horizontal reference plane
Labial reference gau...
Bracket placement - TARG
 Advantages
 Accurate and

quantified 2 dimensional system
 Accurate positioning of bracket wi...
Bracket placement - BEST
 Bonding
 Fillion,

with Equalized Specific Thickness

1987

 Overcomes

the disadvantage of T...
Bracket placement – Hiro system
 Modified

CLASS technique
 Introduced by HIRO
 Improved by Takemoto and Scuzzo

www.in...
Clinical bonding
 Lingual

side of the arch

Moisture contamination
Calculus deposition
Pre bonding scaling
Use of antisa...
Clinical bonding
 If

it is desirable to bond one arch
 Mandibular arch
 Special considerations
Porcelain restoration
P...
Clinical bonding
 Bonding materials
2

part sealant – Maxi cure

 Filled

paste – EXCEL, Reliance orthodontic product

...
Clinical bonding
 Steps
 Isolation
 Etching
 10

min before bonding, apply conditioner on exposed
adhesive material on...
Thank you
For more details please visit
www.indiandentalacademy.com

www.indiandentalacademy.com
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lingual orthodontics courses in india /certified fixed orthodontic courses by Indian dental academy

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The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.

Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078

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lingual orthodontics courses in india /certified fixed orthodontic courses by Indian dental academy

  1. 1. Dr. Varun Grover INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com www.indiandentalacademy.com
  2. 2. Introduction  Goals of orthodontic treatment End of treatment  Desire for esthetics during treatment  Lingual orthodontics www.indiandentalacademy.com
  3. 3. Search for absolute esthetics  Advancement in orthodontics  Pinching of the bands  Direct bonding (Miura – 1971)  Plastic and ceramic brackets  Lingual brackets www.indiandentalacademy.com
  4. 4. Search for absolute esthetics  Bands on all teeth www.indiandentalacademy.com
  5. 5. Search for absolute esthetics  Metallic display www.indiandentalacademy.com
  6. 6. Search for absolute esthetics  Ceramic brackets – relatively esthetic www.indiandentalacademy.com
  7. 7. Search for absolute esthetics  Lingual brackets www.indiandentalacademy.com
  8. 8. Search for absolute esthetics  Good fortune of orthodontist Reduced cost Lower arch – judge the progress Reduced demands on the practitioner www.indiandentalacademy.com
  9. 9. Historic perspective  John Farrar  Mershon – – lingual removable arch (1889) LRA with finger springs  Owen Oliver  Crozat – Labiolingual app app www.indiandentalacademy.com
  10. 10. Historic perspective  Nance button  TPA – Robert Goshgarian  Lingual arch - Wilson Note – supplement labial orthodontics www.indiandentalacademy.com
  11. 11. LO – As a complete system  Vision of  Craven  Kinya 2 key innovators Kurz – USA Fujita – Japan Kanagawa uni. www.indiandentalacademy.com 1970s
  12. 12. LO – As a complete system  Fujita system -1971  Advantages Lip injury Lip relation Retention Little anchorage loss Brackets placed close to the functional line for forces to pass through C res. www.indiandentalacademy.com
  13. 13. LO – As a complete system  Fujita system -1971  Disadvantages Longer duration Speech difficulties Initial discomfort Oral hygiene  AJO 1979 – LO with Mushroom shaped archwires www.indiandentalacademy.com
  14. 14. LO – As a complete system  Key features – Fujita system  Slots facing occlusally Easy insertion and removal Prevents deformation www.indiandentalacademy.com
  15. 15. LO – As a complete system  Grooves for insertion of lockpins Mesiodistally  Auxilliary grooves www.indiandentalacademy.com Occlusogingivally
  16. 16. LO – As a complete system  Multiple slots – Less publicized  Ant. And Pm bracket – 3 slots Occlusal Lingual vertical  Molar bracket – 5 slots 1 occlusal 2 lingual 2 vertical www.indiandentalacademy.com Tandem wire mechanics
  17. 17. LO – As a complete system  Do lingual appliances hampers speech???  Sample – 1 patient  Class I crowding  All 4s extraction  Pronunciation of vowels  Real time third octave analyzer www.indiandentalacademy.com
  18. 18. LO – As a complete system A and O – no effect www.indiandentalacademy.com
  19. 19. LO – As a complete system  I, E, U – disturbed on 1st and 4th day  Normal by 6th day  S, T, R and L – affected  Consonants were not studied www.indiandentalacademy.com
  20. 20. Craven kurz  Ormco  1976 – introduced lingual app  Slots facing palatally  Worked as a part of LTF (1990) Scholz Gorman Kelly Alexander Smith Artun Greekmore www.indiandentalacademy.com
  21. 21. Craven kurz  1976 – 1st generation of lingual brackets Larger profile Crude prescription  1990 – 7th generation Low profile Refined prescription Mx bite plane – heart shaped, smaller hooks Inc width of Pm brackets Variety of molar brackets www.indiandentalacademy.com
  22. 22. Craven kurz  Slot size – 018  Greatest innovation Addition of bite plane  Shearing forces www.indiandentalacademy.com Compressive forces
  23. 23. Lingual brackets  Mx anterior brackets Built in bite plane Propping open the bite Adv in deep bite cases www.indiandentalacademy.com
  24. 24. Lingual brackets  Mand anterior brackets Ball hook extends away from the tissue Ease in maintaining oral hygiene www.indiandentalacademy.com
  25. 25. Lingual brackets  Bicuspid brackets - wider Better rotational and tip control More uniform interbracket width Ball hooks – shortened and flattened www.indiandentalacademy.com
  26. 26. Lingual brackets  Molar brackets – variety  Twin bracket recommended when both 1st and 2nd molars are bonded Twin bracket with auxiliary tube www.indiandentalacademy.com
  27. 27. Lingual brackets  Hinge cap Latest Ideal attachment for terminal tooth Hinge cap tool www.indiandentalacademy.com
  28. 28. Lingual brackets  Terminal tube Used initially Crown height is less www.indiandentalacademy.com
  29. 29. Lingual instruments  Lingual utility plier  Ligature cutter  Curved mosquito hemostat  Small distal end cutter  Lingual bracket remover  Hinge cap opening tool www.indiandentalacademy.com
  30. 30. Lingual Begg brackets  Fujita and Craven kurz Edgewise slot  Stephen Paige – 1982  Begg appliance suits well to LO www.indiandentalacademy.com
  31. 31. Lingual Begg brackets  Vertical slot  Use of round arch wires  No built  TP facing occlusally in tip and torque – (256 – 500) labial Begg bracket www.indiandentalacademy.com
  32. 32. Lingual Begg brackets  Anatomic considerations Difficult to position the bracket  Interbracket arch wires distance – precise measurement of the www.indiandentalacademy.com
  33. 33. Lingual Begg brackets  Low profile lingual Begg bracket Difficult to close the open bite  Plastic buttons on labial surfaces – assist lingual app www.indiandentalacademy.com
  34. 34. Lingual Begg brackets www.indiandentalacademy.com
  35. 35. Lingual Begg brackets  Lockpins – softer and thinner (014)  Seated – using a two hand instrument Wire tucker  Weingart plier www.indiandentalacademy.com
  36. 36. Lingual Begg mechanics  Low angle cases – favorable md rotation  High angle cases Smith (1986 )- HPHG Cash and Blackwood (1991) – JJ Jenner (1995) – Post bite plane Convenient surface for mastication Prevents molar extrusion www.indiandentalacademy.com
  37. 37. Lingual Begg mechanics  Lingual archforms – Mushroom shaped Key hole shaped  Bicuspid offset  Molar offset  Anchor bends  Distal ends  Elastics www.indiandentalacademy.com
  38. 38. Lingual Begg mechanics  Stage 1 archwires  No crowding - 016ss  Addition of vertical loops  Smaller diameter archwires  Niti or Cu Niti wires  Elastics – stiffer wires www.indiandentalacademy.com
  39. 39. Lingual Begg mechanics  Stage II archwires – 018, 020  Stage III archwires – 020 Torquing auxiliaries Uprighting springs www.indiandentalacademy.com
  40. 40. Lingual Begg mechanics  Lingual root torque for upper incisors www.indiandentalacademy.com
  41. 41. Lingual Begg mechanics  Labial root  Lingual torque of upper lateral incisors root torque of the canines www.indiandentalacademy.com
  42. 42. Lingual Begg mechanics  Uprighting springs  Stage III – Mesiodistal root movement  Braking mechanics – stage II  010 mini springs www.indiandentalacademy.com
  43. 43. Conceal system  Thomas Creekmore (AJODO 1989)  Unitek, Monrovia, California  Advantages Facial tooth surfaces are not damaged Facial gingival tissues health The position of the teeth can be precisely seen Drape of the lips – not distorted invisible www.indiandentalacademy.com
  44. 44. Conceal system  An   acceptable LOA must include following key elements Align Apparatus to position the brackets precisely www.indiandentalacademy.com
  45. 45. Conceal system     Accurate indirect bonding system Preformed arches Specifically designed pliers Torquing keys www.indiandentalacademy.com
  46. 46. Conceal system  Slots opens occlusally  The first 1mm of the molar tube opens to the occlusal aspect  Direct guidance for insertion  Easier to insert stiffer archwires  Eliminates the need of double over ties www.indiandentalacademy.com
  47. 47. Conceal system  Design of Pm and molar bracket Occlusal tie wings projecting mesially and distally Mesial and distal undercuts II base of the slot Changes the direction of ligature pull – 90 www.indiandentalacademy.com
  48. 48. Conceal system  Conceal brackets Unitwin bracket are designed around the Centered slot concept Single bracket without tie wings Centre of a 0.045 inch twin bracket Maximum interbracket distance for optimum tip and torque Twin tie wings – rotational control www.indiandentalacademy.com
  49. 49. Conceal system  Each conceal bracket has 3 different slot widths www.indiandentalacademy.com
  50. 50. Conceal system  Tip control in an occlusally inserting system is analogous to rotational control in labial system  Rotational control – length of the lever arm – 0.100 inch  Slot width – 0.100 inch  Excellent control in the tipping plane www.indiandentalacademy.com
  51. 51. www.indiandentalacademy.com
  52. 52. Conceal system  The width of the slot for rotation – 0.070 inch  Analogous  Torque to tip control in the labial system control is same for both the systems  Width of the slot for torque – 0.035 inch www.indiandentalacademy.com
  53. 53. Conceal system  Play  Maximum arch www.indiandentalacademy.com wire size
  54. 54. Conceal system – slot machine  Lingual surfaces – irregular  Labiolingual thickness  Slot machine  Holds the lingual bracket by its slot, which is oriented to the labial surface of each tooth for Torque, tip, rotation, height and labiolingual thickness  Bracket is bonded on the model – gap is filled  Customized base www.indiandentalacademy.com
  55. 55. Patient selection  Adults  Missing teeth  Complex restorative needs  Periodontal problems www.indiandentalacademy.com
  56. 56. Patient selection  Possible speech  Absolute difficulty – 2 to 4 wks need for perfect speech  Tongue irritation  Opening up of  Oral the spaces hygiene considerations  Initial weight loss www.indiandentalacademy.com
  57. 57. Patient selection  Deep bite cases are ideal for LO  Short clinical crown height – relative CI  Initial practitioners Non Xn Deep bite Mild crowding Upper palatal lower labial app Low anchorage demands Unilateral Xn cases www.indiandentalacademy.com
  58. 58. Patient selection  Deep bite Vs  Open bite  Brachycephalic  Dolichocephic  Euryprosopic  Leptoprosopic  Bite plane  Difficult effect  Favorable Md rotation www.indiandentalacademy.com cases  Cross elatics
  59. 59. Patient selection  Biomechanical differences  For normally inclined or proclined upper incisors, intrusive forces for lingual app are closer to Cres www.indiandentalacademy.com
  60. 60. Patient selection  For retroclined anteriors Advancing loops in initial archwires www.indiandentalacademy.com
  61. 61. Patient selection  Effects of vertical extrusive forces  Labial appliance – extrusion Labial root torque  Lingual app – incisors are inclined more than 20 º to the occlusal plane www.indiandentalacademy.com
  62. 62. Patient selection  Effects in antero-posterior relation  Lingual appliances Vertical opening Md rotation Induce Class II tendency Vertical bowing effect www.indiandentalacademy.com
  63. 63. Patient selection  Contraindications  Short clinical crowns  Unresolved periodontal problems  Mutilated posterior occlusion  High angle cases  Severe class II discrepancy with acute TMJ problems www.indiandentalacademy.com
  64. 64. Patient selection  Effects in transverse dimension  LA – expansive nature coupled by posterior disclusion  Mesiobuccal  Transverse molar rotation – space closure bowing effect www.indiandentalacademy.com
  65. 65. Bracket placement  Indirect bonding  Why not direct bonding??? Access Irregular lingual surface Variation in lingual tooth morphology  Customized resin beneath the brackets www.indiandentalacademy.com
  66. 66. Bracket placement  Methods of bonding  TARG – Torque Angulation Reference Guide  CLASS – Custom Lingual Appliance Set up Service  Fillion LIBS  Slot machine  Hiro system  Ray set system www.indiandentalacademy.com
  67. 67. Bracket placement - CLASS  Scott huge Ideal set up is created Brackets placed All planes of space considered Custom bracket bases www.indiandentalacademy.com
  68. 68. Bracket placement - CLASS  Brackets transferred to the original cast Another indirect bonding tray is fabricated Ideal set up – patients motivation www.indiandentalacademy.com
  69. 69. Bracket placement - CLASS  Steps  Precise impressions  Wax bite  Articulate the casts  Fill the prescription  Immobilization of the teeth is a must www.indiandentalacademy.com
  70. 70. Bracket placement - CLASS  Prescription form www.indiandentalacademy.com
  71. 71. Bracket placement - CLASS  Ideal set up 2nd molars and single incisor in each arch Teeth act as reference Class I canine and molar Establish adequate tip Torque Eliminate rotations Tight contacts www.indiandentalacademy.com
  72. 72. Bracket placement - CLASS  Filling the prescription www.indiandentalacademy.com
  73. 73. Bracket placement - CLASS www.indiandentalacademy.com
  74. 74. Bracket placement - CLASS  Transfer trays  Sectioning of the trays Preference – Vinyl www.indiandentalacademy.com
  75. 75. Bracket placement - CLASS www.indiandentalacademy.com
  76. 76. Bracket placement - CLASS Arch width Maintain Widen Constrict Lower occlusal plane Flat Maintain Deep Overbite Ideal Increased Decreased Overjet Ideal Increased Decreased www.indiandentalacademy.com
  77. 77. Bracket placement - CLASS www.indiandentalacademy.com
  78. 78. Bracket placement - TARG Dev by Ormco, 1984 Bracket placed with respect to horizontal reference plane Labial reference gauge to orient the bracket The orientation allows preprogramming www.indiandentalacademy.com
  79. 79. Bracket placement - TARG  Advantages  Accurate and quantified 2 dimensional system  Accurate positioning of bracket without cutting the tooth and placing it in wax  Disadvantages  Labiolingual thickness – not considered www.indiandentalacademy.com
  80. 80. Bracket placement - BEST  Bonding  Fillion, with Equalized Specific Thickness 1987  Overcomes the disadvantage of TARG  A caliper is added  Direct working on the malocclusion cast www.indiandentalacademy.com
  81. 81. Bracket placement – Hiro system  Modified CLASS technique  Introduced by HIRO  Improved by Takemoto and Scuzzo www.indiandentalacademy.com
  82. 82. Clinical bonding  Lingual side of the arch Moisture contamination Calculus deposition Pre bonding scaling Use of antisailogouges Probanthine – 15 mg 45 min prior to bonding www.indiandentalacademy.com
  83. 83. Clinical bonding  If it is desirable to bond one arch  Mandibular arch  Special considerations Porcelain restoration Presence of aluminium – HF acid Composite bondable surface Gold crowns Large amalgam fillings www.indiandentalacademy.com
  84. 84. Clinical bonding  Bonding materials 2 part sealant – Maxi cure  Filled paste – EXCEL, Reliance orthodontic product  Light cure adhesives  Bracket side – tooth side adhesive www.indiandentalacademy.com
  85. 85. Clinical bonding  Steps  Isolation  Etching  10 min before bonding, apply conditioner on exposed adhesive material on bracket base  Mix the bonding material  Place the trays www.indiandentalacademy.com
  86. 86. Thank you For more details please visit www.indiandentalacademy.com www.indiandentalacademy.com

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