1. ORTHODONTIC
Fixed Appliances

2. Contents
Introduction to Fixed Appliances
Indications & Contraindications of Fixed Appliances
Difference b/w Fixed & Removable Appliances
Types of Fixed Appliances
Orthodontic Bends in Fixed Appliances
Components along with Placement Removal of Fixed Appliances
Prevention & Treatment of White Spots after Orthodontic Tx.
Problems with Fixed Appliances
Temporary Anchorage Devices

3. Orthodontic
Appliances
Fixed Orthodontic Appliances
Functional Orthodontic Appliance
Removable Orthodontic Appliances

4. Introduction to Fixed Appliances
These are orthodontic devices, which have attachments that are
fixed onto the tooth surface, and force are exerted on tooth via
these attachments using arch wires and other auxiliaries.
These appliances cannot be removed or activated by patient.

5. Indications of Fixed Appliances
▶ Correction of mild to
moderate skeletal
discrepancy.
▶ Intrusion/Extrusion of
teeth.
▶ Corrections of rotation.
▶ Overbite reduction by intrusion of
incisors.
▶ Multiple tooth movements
required in one arch.
▶ Active closure of extraction
space, or space due to
Hypodontia.

6. Contraindications of Fixed Appliances
Poorly motivated patient
Poor dental health
Extremely sever malocclusion requiring orthognathic surgery

7. Fixed V/S Removable Appliances
FIXED APPLIANCE REMOVABLE APPLIANCE
Precise 3 dimensional tooth movement Less precise control of tooth movement
Bodily tooth movement Tipping tooth movement only
Complex malocclusions can be treated Simple malocclusions only
High anchorage requirements Small anchorage requirements
Controlled space closure possible Space closure is difficult
Multiple tooth movements Few tooth movements
Can be used in upper or lower arch Retention in lower arch is poor
Simple to correct rotations More difficult to correct rotations
Oral hygiene can be problematic Can be removed for oral hygiene
Not dependent on patient’s compliance Depend on patient’s compliance
Long chair side time Short chair side time

8. Fixed Appliances
Contemporary fixed appliances are variations of Edge wise appliance system.
Straight wire appliance (law nence F Andrews)
Another system of fixed appliance is Begg appliance system.
It contains rectangular slot but does not use rectangular arch wire.
Currently Begg appliance system has been modified into Tip – Edge appliance
system.
Lingual orthodontic system by KURZ

9. Fixed
Appliances
Edgewise
Standard
Edgewise
Contemporary/Straight Edgewise
Begg
Appliance
Tip Edge
Appliance

10. Ribbon Arch ▶ It was made by Edward Angle.
▶ It contains vertically positioned
rectangular slots in which arch
wire of 10x20 gold wire was
placed into the vertical slots
and held with pins.
▶ It had poor control of root
position and does not
generated torque.

11. Edgewise
Angle modified that ribbon arch appliance,
in which he reoriented the slot from
vertical to horizontal and inserted a
rectangular wire rotated 90 degrees to
the orientation it had with ribbon arch,
thus the name edge wise.
The dimension in that slot were 22 x 28
mils & wire of 22 x 28 mil precious
metal was used.

12. Begg Appliance
It is a modification of ribbon arch appliance, in which Raymond
Begg modified following things in the appliance.
He replaced the precious metal ribbon arch with 16 mils round stainless
steel wire
He retained original ribbon arch bracket, but turned it upside down so
that the bracket pointed gingival rather occlusally.
He added auxiliary springs to the appliance for control of root position &
cause rotation in
tooth.

13. Advantages & Limitations of Begg Appliance
▶ Advantage of Begg Appliance
▶ Tipping movement
▶ Bite opening
▶ Friction was minimized
▶ Binding was minimized (mentioned in
chapter 9)
▶ Limitations of Begg Appliance
▶ Finishing
▶ Cumbersome Technique

14. Tip Edgewise Appliance
▶ It is a hybrid appliance having combination of Begg &
Edge wise
mechanics (straight wire mechanics of edge wise)
▶ It allows tipping of tooth in the initial stages of
treatment with round wires – Begg technique.
▶ In latter stages, rectangular wires are used for final tooth
positioning.

15. Contemporary
Edgewise
Appliances

16. Modernedgewise appliances are of
two types;
▶Standard/Original Edge wise appliance
system
▶Straight wire/ Contemporary edgewise
appliance system

17. STANDARD EDGEWISE APPLIANCE SYSTEM
▶ Rotation of tooth was controlled
by separate ligatures tied to the
eyelets soldered to the corners of
bands
▶ Bracket slot size was 22 x 18
▶ Same bracket on all teeth
▶ That’s why bends were given to
compensate for difference in
tooth anatomy.

18. Bends in Standard Edgewise
18
• 1st order bends/In-out bend/facio-lingual
bends
• 2nd order bends/tip bends/ artistic bend
• 3rd order bends/torque bends

19. 1st order Bend OR in – out
bend OR facio – lingual bends
▶ This bend was given to compensate for variation in the
contour of labial surface of individual teeth (differing tooth
width & buccolingual direction of teeth).
▶ These bends are given in horizontal or in the plane of arch
wire.
▶ Can be given in rectangular or round wire

20. 2nd order bend/ tip bends/ artistic positioning
bends
▶ These bends were given to achieve proper
mesiodistal root position or tilting of teeth.
▶ They are given in vertical plane
▶ Can be given in rectangular or round wire.

21. 3rd order bends/ torque bends
▶ These bends are given only in rectangular wire.
▶ These bends are made by twisting the wire and is inserted
into bracket slot so that is can exert Bucco lingual force on the
root apex.
▶ These bends were given for moving the roots facially or
lingually and also to avoid movement of properly positioned
teeth.

22. Orthodontic Bends
1st order bend
2nd order bend
3rd order bend

23. Straight wire Edge
Appliance

24. Straight wire edgewise appliance
▶ They are modern edgewise appliances
▶ In these appliance rotation is not controlled by
separate ligature but it is built in the bracket itself.
▶ Bracket slot size is available in two forms;
▶ 18 x 28 mills & 22 x 28 mill slot size.

25. Straight wire edgewise appliance
Different brackets for different teeth.
This thing eliminated the bends which were given in standard edgewise.
In these appliances no any 1st order bend is given, instead,
compensation for the contour of labial surface of teeth is built into
the base of bracket.
In straight arch wire appliances, positioning of root is accomplished
by proper
angulation of bracket or bracket slot.
This thing decreased the need for 2nd order bends.

26. Straight wire edgewise appliance
The bracket slots in the straight wire edgewise
appliances are inclined to compensate for proper
inclination of facial surface, so that’s why 3rd order
bends are not given.

27. Straight wire edgewise
appliance
Diagram (a) shows an edgewise
bracket with a 2nd order bend
placed in the arch wire to achieve
the desired movement of tip.
Diagram (b) shows a pre –
adjusted bracket with tip built into
the bracket slot.

28. Components of Fixed Appliances
Bands Bonds/ Brackets
Orthodontic Adhesive Auxiliaries
Arch wires

29. Orthodontic
Bands

30. Orthodontic Bands
▶ These are the rings which encircle the tooth & to which buccal
and/or lingual attachments are soldered or welded.
▶ Before acid etching technique, brackets were attached on bands
which are then cemented on tooth.
▶ They are not used now days except only on molar teeth.

31. Indications Where Brackets Are Still Applied On Bands
▶ Teeth that will receive heavy
intermittent force;
▶ maxillary 1st molar in which force is
applied via headgear
▶ Teeth that will need both labial
and lingual attachments
▶ Molar with both headgear and
lingual arch
tube.
▶ Isolated lingual bracket.
▶ Teeth with short clinical
crowns
▶ Teeth with extensive
restoration
▶ Bond strength is low on
restorations.
▶ De bonding from porcelain
damages its appearance.

32. Rules of
Banding & Bonding in Contemporary
Orthodontics
32

33. Steps in Placement of Orthodontic Bands
Separation
Fitting
Cementation

34. Separation
▶ Teeth must be separated before banding, because tight inter
proximal contacts make it impossible to properly seat a band.
▶ Principle of Separation; a device to force or wedge the teeth
apart is left in place long enough for initial tooth movement to
occur, so that the teeth are slightly separated by the
appointment at which bands are to be fitted.

35. Methods of Separation
▶Separating Springs
▶Elastomeric Separators /
doughnuts

36. Separating Springs
▶ They exert scissor action above and below the contact.
▶ Open the contact points within 1 week. Should not be placed more
than 1 week.
▶ Easier to tolerate.
▶ Disadvantages; these separators tend to become loose & fall out as
they accomplish their purpose.

37. Method of Separation with Steel
Separating Spring
A. The spring is grasped at the base.
B. The bent – over end of the longer leg is placed in lingual
embrasure, and the spring is pulled open so the shorter leg can
slip beneath the contact.
C. The spring in place, with the helix to the buccal.
D. The spring can be removed most easily by squeezing the helix,
forcing the legs
apart.

38. Method of Separation with Steel
Separating Spring

39. ELASTOMERIC SEPARATORS
(DOUGHNUTS)
▶ They surround the contact point & squeeze the teeth apart.
▶ More difficult to insert but they are retained for long time
without fall.
▶ Always use bright colored elastomeric separators
because they are radiolucent.
▶ They should be placed not more than 2 weeks.

40. Method of Separation with Elastomeric Ring
▶ the elastomeric ring is placed over the beaks of a special pliers and
stretched, then
▶ one side is snapped through the contact and the pliers slipped out so
that the doughnut now surrounds the contact; c,
▶ an alternative to the special pliers is two loops of dental floss,
placed so they can be used to stretch the ring.
▶ the dental floss is snapped through the contact and the doughnut is
pulled underneath the contact;
▶ the doughnut is pulled upward, and the doughnut is snapped into
position. at that point, the dental floss is removed.

41. Method of Separation with Elastomeric
Ring

42. Fitting the Bands
Maxillary molar band
placement
▶ placed initially by hand pressure
on the mesial & distal surfaces.
After placement
▶ pressure is applied on
mesiobuccal and
distolingual surfaces.
▶ Final seating is with heavy biting
force by patient on the
distolingual corner.
Mandibular molar band placement
▶ Seated initially with hand
pressure on proximal
surfaces and then with
▶ Heavy biting force along
the buccal but not lingual
margins.

43. Cementation of Molar Bands
▶ All interior surfaces of orthodontic band must be coated with cement
before it is placed.
▶ Place a gloved finger over the top of the band when it is carried to place,
to help in keeping cement on the gingival aspect of band.
▶ Cement Materials;
▶ Zinc phosphate
▶ GIC
▶ Resin modified GIC

44. Orthodontic Brackets

45. Brackets
▶They are appliances that are fixed to
crown & mediate forces applied by
the arch wire & auxiliaries on tooth.

46. Types of Brackets
MATERIALS
▶ Cast or metal injected molded
stainless steel brackets
▶ Titanium brackets
▶ Cobalt chromium brackets
▶ Ceramic brackets
DESIGN
▶ Edgewise bracket/ straight wire
▶ Light wire appliance brackets/tip edge
bracket
▶ Self-ligating brackets
▶ Lingualbrackets

47. Components of Brackets
• 18 x 18 or
22 X 18
Wings Slots
Base
Mesh

48. Bonding of Bracket
Bonding is based on the
mechanical locking of an adhesive
to irregularities in the enamel
surface of the tooth and to
mechanical locks formed in the
base of bracket.
Brackets are mechanically bonded
to tooth surface. Chemical bonded
is avoided because it will create
problems in debonding of bracket
▶ Bonding
Materials in
Orthodontics
▶ Light cured bis – GMA resin
▶ Self-cured or light cured
composites
▶ GIC
▶ Less decalcification because of
fluoride
release
▶ Less strength & greater
chance of loos brackets

49. Types of Bonding Bracket
DIRECT BONDING
▶ places the brackets on
the teeth individually
at the chairside; and
▶ Advantages; easier, faster,
less expensive
▶ Disadvantage; no proper
position of bracket
INDIRECT BONDING
▶ places the brackets on study
models in the laboratory and
these are transferred to the teeth
using a positioning tray. it is used
when placing lingual fixed
appliances.
▶ Advantages
▶ greater accuracy of bracket
positioning
▶ Disadvantage
▶ extra cost and time

50. 1)Cleaning the tooth
surface, to remove
any pellicle using a
slow hand piece and
prophy brush or
cup;
2)Acid-etching the
enamel surface
using 37%
unbuffered
phosphoric acid for
20 – 30 seconds;
4)Placing unfilled
primer on the
etched area of the
tooth;
5. Placing composite
resin on the
bracket base
6. Positioning the
bracket on the
tooth crown
7. Cleaning up
excess composite
from around the
bracket base
8. Curing the
composite, either
chemically or with a
blue light source
Steps in Direct Bonding of Bracket
3. Washing and drying
the tooth surface

52. INDIRECT
BONDING

53. • The teeth are isolated, etched, and a chemically cured two-paste resin is painted on the
etched enamel and the brackets. Then, the transfer trays are inserted. D, After the resin
has completely set, the trays are carefully removed, leaving the brackets bonded to the
teeth.
• After the brackets are cured in the ideal position, a transfer tray is formed from a vinyl
polysiloxane putty
• The trays are removed from the working cast after soaking in warm water
and trimmed
• Brackets are placed precisely as desired on a cast of the teeth and held in place with
a filled resin.

55. De Banding &
De Bonding

56. Removal of Molar Band
▶Distort the band with force which
will break the cement away from
band & tooth and remove it.

57. Removal of Bracket
When bracket is one of the following things happen;
▶ Breakage b/w cement & bracket (preferred)
▶ Breakage within the cement material itself
▶ Breakage b/w enamel surface & cement (least desired)
The safest way to remove metal bracket is to distort the bracket base, which cause
breakage b/w bracket & cement.
▶ This damages the bracket and it cannot be reused.
▶ ceramic brackets on removal damages the enamel because they break before
bend.

58. Prevention & T
reatment of Enamel
Decalcification/White Spots after
Orthodontic Tx.

59. Prevention
▶ Fluoridated water & fluoride containing toothpaste
▶0.05% neutral sodium fluoride rinse
▶ Caries Prone patient; fluoride varnish application at 6-
month interval
▶ Chlorhexidine mouthwash for 14 days.

60. Remineralization
Therapy
External Bleaching
Micro Abrasion
Veneers

61. Characteristics of Contemporary Brackets –
CERAMIC BRACKETS
▶ Durable, resist staining, dimensionally stable
▶ Types of ceramic bracket based on the material;
▶ Polycrystalline alumina
▶ Polycrystalline alumina with metal slot
▶ Monocrystalline alumina

62. Problems with Ceramic Brackets
▶ Fracture of bracket
▶ Friction within bracket slot
▶ Attrition on teeth contacting
the bracket
▶ That’s why mostly placed on
upper teeth only.
▶ Enamel damage on bracket
removal
▶ Chemical bonding which is
strong, mechanical bonding
difficult in ceramic bracket.
▶ Brittle, that’s why they are
made bulky and act as wide
bracket. (effects of wide
bracket learnt in 9th chapter)

63. Straight Wire Concept in Bracket
63

64. Straight Wire Concept inBracket
▶ Compensation for 1st order
bends;
▶ For anterior teeth and premolars,
changing the bracket thickness
eliminate in – out bends in anterior
portion of arch wire. But molar
tube on molar bend should be
offset position to prevent molar
rotation.

65. Straight Wire Concept in Bracket
▶ Because for good occlusion, the buccal surface of molar
must sit at an angle to line of occlusion.
▶ Mesio buccal cusp more prominent
▶ That’s why the tube on the molar band should be at least
10 degree offset for maxillary molar.
▶ On mandibular molar it should be 5 – 7 degrees.

66. Straight Wire Concept inBracket
▶ A distal inclination or tip of the maxillary
first molar is important for proper
posterior occlusal interdigitating. If the
mesiobuccal cusp occludes in the mesial
groove of the mandibular first molar,
creating an apparently ideal Class I
relationship, proper interdigitating of the
premolars still cannot be obtained if the
molar is positioned too upright
▶ Tipping the molar distally allows
the premolars to interdigitate
properly

67. Self Ligating Brackets
▶ In this ligatures are
not needed for
holding wire, but the
mechanism for
retention of wire is
built within the
brackets.
▶ Types of self – ligating
brackets;
▶ Springy latching cap
▶ Smart clip system
▶ Springy retaining clips
▶ Innovation system
▶ Speed system
▶ Rigid latching caps
▶ Damon system

68. Archwires

69. Orthodontic Archwires
▶ During initial alignment phase;
▶ NiTi wire
▶ Stainless steel wire
▶ Coaxial wire
▶ To complete the process of levelling, beginning of overbite
reduction, sliding of teeth along arch wire;
▶ Round Stainless steel wire
▶ Arch wires during the later stages of overbite reduction and for
space closure;
▶ Rectangular stainless steel wire

70. Orthodontic Archwires
▶ NiTi wire is ideal for aligning teeth during initial stages of Tx.
▶ However, for later stages, space closure & overbite reduction, NiTi cannot
be used.
▶ In the initial stages of treatment, a wire which is flexible with
good resistance to permanent deformation is desirable, so that
displaced teeth can be aligned without the application of
excessive forces.

71. Orthodontic Archwires
▶ Initial Alignment (minimum stiffness, maximum
range)
▶ Ni-Ti wire
▶ Multi-stranded wires
▶ Mid Treatment
▶ (Series of working wires with increasing stiffness and
reduced range)
▶ Finishing & Detailing
▶ (Maximum Stiffness, snuggly fit rectangular wire)

72. Auxiliaries

73. Auxiliaries
• ▶ Types of Auxiliaries;
• ▶Elastic bands
• ▶Wire ligatures
• ▶Intra oral elastics
• ▶Palatal or lingual
arches
• ▶Coiled springs
• ▶Powerchains
▶ They are used to apply active
forces for space opening or
closure.
▶ Elastic materials can be used for
intra-arch (intra-maxillary) space
closure, and springs constructed
from stainless steel or nickel
titanium can be used for space
opening.

74. Problems with Fixed Appliances
▶ Pain
▶ Tooth mobility
▶ Mucosal trauma
▶ Orthodontic wax can be used to cushion the wire
▶ Bracket failure
74

75. Temporary
Anchorage
Devices
• BONE
SCREWS
• MINIPLATES

76. Indications of bone screws
▶ Positioning of individual teeth:
▶ Missing teeth – lack of anchorage
▶ Impacted teeth
▶ Position of groups of teeth;
▶ Space closure
▶ Major incisor retraction
▶ Incisor retraction & intrusion
▶ Mesial movement
▶ Maxillary & mandibular posterior teeth
▶ Entire mandibular arch
▶ Intrusion of anterior or posterior but not both simultaneously

77. Indications of miniplates
▶ Positioning groups of teeth.
▶ Distalization of entire maxillary & mandibular arch.
▶ Intrusion of anterior & posterior teeth
▶ Growth modification.
▶ Class III elastics, maxillary deficient child.
▶ Restriction of vertical maxillary growth.