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FIXED APPLIANCE

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ORTHODONTIC TREATMENT ,E-ARCH, EDGEWISE, METALIC BRACKETS, BEGG APPLIANCE(1920), STEPS IN BONDING , etc

A seminar conducted by Dr.Sayyida.N.K @ Government Dental College, Calicut

Published in: Health & Medicine, Business

FIXED APPLIANCE

  1. 1. SAYYIDA.N. K. 25TH BDS
  2. 2. There are two clear justification for orthodontic treatment; aesthetics and function.
  3. 3.  The goal of orthodontic treatment defined by Proffit(1993).  The creation of the best possible occlusal relationships ,with in the framework of acceptable facial aesthetics and stability of the end result.
  4. 4.  Relief of crowding  Correction of the rotational and apical displacement teeth.  Correction of interincisal relationship  Establishment of satisfactory buccal intercuspation.  A pleasing facial appearance.  A stable end result.
  5. 5.  Grossly misplaced teeth.  Lower arch treatment.  Space closure.  Incisor relationship correction.  Multiple tooth movement.
  6. 6.  Patient cooperation is dispensed with to a large extent in the use of fixed appliances.  It is possible to bring about various types of tooth movements.  Multiple tooth movements are possible simultaneously.  More precise tooth movements and detailing of occlusion is possible using fixed appliances.  Fixed appliances can be used to treat most malocclusion including very complicated one.  Fixed appliances offer better control over anchorage
  7. 7.  The most important one is oral hygiene maintenance becomes more difficult.  It is more time consuming to fix and adjust it is more expensive.  It requires special training of the operator.  Damaged appliances that apply misdirected forces can not be removed by the patient.  It is more conspicuous than removable.  Unless it is done by a skilled operator there is a greater possibility of producing adverse tooth movements.
  8. 8.  Bodily movement  Tipping of crown  Torquing  Mesio distal uprighting  Intrusion  Extrusion  Rotations
  9. 9. The fixed appliance used in contemporary orthodontics are based on Angles designs from the early 20th century. He developed four major appliance systems.
  10. 10.  E-arch in the late 1800s ,it depends on some sort of rigid frame work to which the teeth were tied so that they could be expanded to the arch form dictated by the appliance.  It can only tipping movement
  11. 11.  Pin and tube Pin and tube, Angle placed bands on other teeth and used a vertical tube on each tooth into which a soldered pin from a smaller arch wire was placed, tooth movement was accomplished by repositioning the individual pins at each appointment.  Ribbon arch Ribbon arch, he provide a vertically positioned rectangular slot behind the tube and a ribbon arch of 10x20 gold wire placed into the slot and held with pins. But it provide d poor control of root position.
  12. 12.  Angle reoriented the slot from vertical to horizontal and inserted a rectangular wire rotated 90 degrees to the orientation it had with the ribbon arch.  It allow excellent control of crown and root position in all three plane of space.
  13. 13.  Begg adapted in three forms  He replaced precious metal ribbon arch with stainless steel  He turned bracket up side down ,so the slot pointed gingivally.  Add auxillary springs for control of root position.
  14. 14. Andrews(1980) developed bracket modification for specific teeth, to eliminate the many repetitive bends in arch wire to compensate for differences in tooth anatomy.
  15. 15.  Two methods  Banding  bonding
  16. 16.  Involves use of thin stainless steel strips pinched tightly around the teeth and then cemented to the teeth. Preformed steel bands also available. Indications :-  Teeth that will receive heavy intermittent forces against the attachments.  Teeth that will need both labial and lingual attachments ,such as molar with headgear and lingual arch tubes.  Teeth with short clinical crowns.
  17. 17.  Selection of band materials  Separation of teeth  Pinching of bands  Fixing the attachments  Cementation of the bands
  18. 18.  The method of fixing attachments directly over the enamel using adhesive resins is called bonding.  Advantages  Aesthetically superior  Faster to bond than banding .  Maintenance of better oral hygiene.  Easier to bond partially erupted ,fractured tooth.  The risk of caries eliminated.  Inter proximal areas are available for proximal stripping.
  19. 19.  It is esthetically superior.  Faster to bind than to pinch bands around the teeth.  Maintenance of better oral hygiene.  Possible to bond on teeth that have aberrant shapes or forms.  Easier to bond in case of partially erupted and fractured teeth.  Interproximal areas are accessible for restoration and proximal stripping
  20. 20.  Weaker compared to banding.  Acid etching lead to enamel loss.  Chance of enamel fracture during de bonding.
  21. 21.  Materials used  For many years fixed appliance had been  fabricated entirely from stain less steel. But nickel is a potentially allergenic materials.  So titanium arch wires used since 1980  Titanium is hypoallergenic.  Material is more wettable so reduce failure rate in bonding.  More resilient than steel.  Non metallic materials used  Plastic materials  Ceramics
  22. 22.  Active components ▪ Arch wire ▪ Springs ▪ Elastics ▪ Separators  Passive components  Bands  Brackets  Buccal tubes  Lingual attachments  Lock pins  Ligature wire
  23. 23.  Bands are passive components that helps in fixing the various attachments on to the teeth. They are made of stainless steel and available in various sizes.
  24. 24.  Brackets act as handles to transmit the force from the active components to the teeth. Brackets have one or more slots that accept arch wire.  Different designs of brackets are available.  Edge wise type, horizontal slot. ▪ Ribbon arch type ,vertical slot. ▪ Bondable brackets ,mesh work seen under surface of bracket. ▪ Weldable bracket. ▪ Metallic bracket ,steel brackets are commonly used. ▪ Individually customized brackets also available nowadays.
  25. 25.  Advantages : ▪ They can be recycled. ▪ They can be sterilized. ▪ they resist deformation and fracture. ▪ They exhibit the least friction at the wire bracket interface. ▪ They are not very expensive.  Disadvantages : ▪ They are aesthetically not pleasing. ▪ Corrode and staining of teeth.
  26. 26.  Advantage :  They are dimensionally stable.  They are durable and resist staining.  Disadvantages  Very brittle and more chance for fracture.  Exhibit greater friction at the wire bracket interface.
  27. 27. Made of polycarbonate.  Advantage  Aesthetic value improved.  Disadvantages  They tend to discolor.  They offer poor dimensional stability.  The friction between plastic brackets and arch wire is high.
  28. 28.  Buccal tubes:  The attachment generally used on molars. It can be weldable and durable.  Lingual attachments  It mainly used for engaging elastics, examples cleat, button, eyelet.  Ligature wires  They are soft stainless steel wires of 0.009 to 0.011 inches diameter ,used to secure the arch wire to the bracket  Elastomeric nodule also used
  29. 29.  Lock pins They are small pins used to secure arch wire to brackets with vertical slots such as ribbon arch bracket. The lock pins are usually made of brass.
  30. 30. One of the component of fixed appliance. Early day gold arch wires are used later it replaced by stainless steel wire or Ti.  Ideal requirements :  High spring back property.  Low stiffness.  High formability and resilience.  Biocompatibility and environmental stability.  Joinability.  Least friction at the wire bracket interfere.  To increase efficiency preformed arch wires can be used in modern appliance.
  31. 31.  Based on material used  Gold and gold alloys.  Stainless steel.  Nickel titanium alloys.  Beta titanium.  Cobalt chromium nickel alloys.  Optiflex arch wires.  Based on cross section  Round  Square  Rectangular  multistranded
  32. 32. Elastics are used in orthodontics for a number of purposes such as closer of space, to correct open bites, treatment of cross bites and to correct inter-arch relationship. The elastic products used in orthodontics include simple elastics, elastic change, elastic thread and elastic modules.
  33. 33. The following sprigs are used :  Uprighting springs : They are springs that move the root in a mesial or distal direction.  Torquing springs : Which move the root in a lingual or parallel direction.  Open coil springs : They are springs that are compressed between two teeth to open up space between them.  Closed coil springs : They are stretched between teeth to close space.
  34. 34. These are used to break the right inter contact. The different types of separators available are : Brass wire separators Ring separators Dumbbell separators Kesling’s spring seperator
  35. 35.  Leveling and alignment  Over bite reduction : It should precede overjet reduction in order to have a smooth movement of teeth in the horizontal plane. Deep over bite are corrected by instruction of the anteriors or by extrusion of the posterior teeth.  Overjet reduction and space closure : There are two types of mechanisms used for anterior retraction.  Friction or sliding mechanics  Frictionless or loop mechanics  Final tooth positioning : During this phase of treatment smaller diameter wires such as .016 inches stainless steel or rectangular beta titanium are used as they are more flexible and allow precise finishing.
  36. 36. hishampasha@gmail.com

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