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Fixed orthodontic appliances


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Fixed orthodontic appliances

  2. 2. • It’s a division of orthodontic appliance systems. • They are fixed on the teeth surfaces. • These appliances can't be adjusted or removed by the patient.
  3. 3. INDICATION OF FIXED ORTHODONTIC APPLIANCES: 1-Correction of Intrusion/extrusion of teeth
  4. 4. 2-Correction of mild to moderate skeletal discrepancies. 3- Closure of extraction spaces ,or spaces due to hypodontia, to ensure a good contact between teeth.
  5. 5. 4- Overbite / overjet reduction . 5-Multiple tooth movement .
  6. 6. 6-Correction of rotations .
  7. 7. CONTRA-INDICATION OF FIXED ORTHODONTIC APPLIANCES • 1. Poorly motivated patient : The patient should understand that his/her cooperation will be required throughout treatment.
  8. 8. 2. Bad Oral Hygiene Patients with poor oral hygiene are more likely to suffer from periodontal diseases.
  9. 9. • 3. Severe Skeletal problems : Malocclusions that are skeletal in nature or otherwise beyond the scope of orthodontics should not be attempted.
  10. 10. • 4. Appropriate training of operator Only orthodontists are qualified to carry out the treatment using the fixed orthodontic appliances.
  11. 11. ADVANTAGES OF FIXED ORTHODONTIC APPLIANCES: • 1. Precise control of tooth movement : it is possible to move individual teeth in the three planes of space to achieve perfect alignment of teeth both inter and intra arch. • 2. Multiple tooth movements are possible: Individual teeth can be moved in all the three planes of space at the same time , for example a tooth can be intruded as well as retracted. Also, different teeth can be moved in different directions at the same time, i.e. while one tooth is being derotated another can be retracted.
  12. 12. • 3. Patient cooperation is reduced in comparison to removable appliance wear . • 4. More comfortable to the patient than removable and myofunctional appliances . • 5. Some tooth movement can't be produced by removable or myofunctional appliances such as root bodily movement .
  13. 13. DISADVANTAGES OF FIXED ORTHODONTIC APPLIANCES: • 1. Oral hygiene requirement : Oral hygiene maintenance becomes more difficult. Food debris tend to accumulate around the attachments and their removal becomes difficult.
  14. 14. • 2. Esthetics : Fixed appliances are generally made of metal that might not be esthetically acceptable to the patient. The advent of the lingual technique and tooth-colored brackets (made of ceramic/composites/fiber glass) has helped overcome this disadvantage to a large extent.
  15. 15. • 3. Special training for operator: Only orthodontists are trained to handle and monitor these appliances. • 4. Increased cost of treatment Fixed orthodontic appliances are costly as compared to removable appliances. The attachments used with these appliances are expensive and hence, the cost of the treatment goes up.
  16. 16. • 5. Increased chair side time Since the appliance is fixed, and cannot be removed from the patient’s mouth, hence, all adjustments have to be made in the patient’s mouth by the operator. This increases the chair side time. • 6. Anchorage control is more difficult as compared to removable appliances. • 7. Treatment monitoring is more difficult. The patient has to be recalled at regular intervals for appliance adjustments/reactivations. Long-term monitoring is essential to achieve stable results.
  17. 17. COMPONENTS OF FIXED ORTHODONTIC APPLIANCES : • A- Bands. • B- Brackets. • C- Archwires. • D- Auxillaries such as elastics , coils spring , lingual wire .
  18. 18. Bands : These are rings encircling the tooth to which buccal, or lingual attachments are soldered or welded. Brackets: Many types of brackets were introduced over the years, to get better biomechanical properties, better esthetic appearance, better biocompatibility with oral hygiene and less demineralization.
  19. 19. Brackets can be classified into: Standard edgewise bracket system (zero torque & angulation ) Pre-adjusted bracket system Begg brackets system(the only bracket system with vertical slot) Self ligation brackets ( no need to use elastics ) Tip edge brackets (the corners is removed from the conventional edgewise slot )
  20. 20. ARCHWIRES • Archwires are made of variable materials and dimensions. Originally archwires were made from gold alloy but because it is expensive, the stainless steel alloy becomes the material of choice. • Recently a super-elastic and flexible wire is introduced, made from Nickel - titanium alloy .
  21. 21. • Archwires are available in different cross section shape and dimensions a) Round archwire. b) Square archwire . c) Rectangular archwire
  22. 22. Another Classification is according to arch form : 1- Oval. 2- Taper. 3- Wide.
  23. 23. And Finally it can be classified according to the material that are made from: • Metal – Gold, Stainless steel : it is the most corrosion resistant when in direct contact with biological fluid. • Titanium, Nickel : Lighter and more flexible than the SS arch wire • Plastics & Cermaic : which is more esthetically acceptable
  24. 24. Auxillaries • These are used in conjunction with archwires to produce tooth movement. 1. Elastic separators are used to create spaces between two adjust teeth before banding.
  25. 25. 2. Palatal arches can be utilized to reinforce the anchorage, to achieve expansion or de-rotation of molars.
  26. 26. 3. Coil springs : either opening or closing, which made from stainless steel or nickel titanium alloys, also used to move teeth along the archwire.
  27. 27. ORTHODONTIC BONDING AND BANDING TECHNIQUES • Banding : The method of fixing attachments by welding them to a metal band which are then cemented to the teeth with polycarboxylate cement.  Indications of Banding 1. Teeth with excessive occlusal forces 2. Teeth that have large metal restorations ( weak ) or metal prosthesis. 3. When a headgear or cemented palatal arch needs to be used. 4. Failure of bonded attachment. 5. Teeth with short clinical crown Bands must be placed accurately and the teeth have to be separated from adjacent tooth contacts by using a separator around the contact area.
  28. 28. • Bonding : Is the method in which Brackets are fixed to the teeth directly with a composite resin after acid-etching of enamel surface, and chemical or light cured resins are generally used • Unlike banding, there is no need for separation.
  29. 29. • Bonding procedure has several advantages over banding 1-More esthetic. 2-Less caries and gingival plaque. 3-Less discomfort. 4-Used on partially erupted teeth. 5-Teeth separation not required. 6-Detachment is more easily. 7-No spaces remain after treatment.
  30. 30. • Direct bonding : In which direct attachment of orthodontic appliances to etched teeth using chemically and light cure adhesives. • It is most popular due to its simplicity and reliability.
  31. 31. • Indirect bonding : In this technique, the brackets were first positioned on study casts with water soluble adhesive and then transferred to the mouth with a custom tray. The advantage of this technique is more precise location of brackets that is possible in the laboratory.
  32. 32. EXPANSION BY FIXED APPLIANCES Quadhelix appliance • Very efficient fixed slow expansion appliance. • produce an anterior and posterior expansion. • made of 1 mm stainless steel wire and attached to the teeth by bands cemented to the molars. Hyrax (rapid expansion screw) • gives posterior expansion. • It is designed to open mid-palatal suture and expand the upper arch by producing skeletal expansion. • It is used in early teens before the suture fuses.
  33. 33. Treatment with fixed appliance can be divided into four phases: 1. Alignment phase : • Crowding And Rotation Are Rapidly Dealt With To Allow Placement Of More Rigid Archwires. 2. Working Phase : • Horizontal And Vertical Dento-alveolar Correction Are Made. 3. Finishing phase : • Tooth position is carefully detailed to achieve best esthetic and functional result. 4. Retention phase : • The fixed appliance is removed and retainers are fitted. • The retainers are worn full time for 4-6 months then at night-time for 4-6 months. • The retainers usually are removable appliances so they can then be gradually withdrawn to ensure teeth stability.
  34. 34. ALTERNATIVE ORTHODONTIC APPLIANCES • Lingual appliances Brackets bonded to the lingualpalatal surfaces of the teeth and specially configured arch wires are used. The main advantage is esthetic. While the disadvantages are uncomfortable to the patient and difficult to adjust. • Clear aligner therapy Aligners used as devices for treatment of the mildly displaced teeth into their correct positions . The main advantage is esthetic because it is invisible or minimally visible.