Advance ortho

Advances inAdvances in
OrthodonticsOrthodontics

 Introduction
 History of Orthodontics
 Advances In
Orthodontic MaterialsMaterials
 BracketsBrackets
 Arch wiresArch wires
 Bonding materialsBonding materials
 Alternative forceAlternative force
delivery systemsdelivery systems
 Recent Orthodontic
AppliancesAppliances
 BiomechanicalBiomechanical
PrinciplesPrinciples
 Changing EstheticEsthetic
Concepts
 Conclusion
www.indiandentalacademy.com

INTRODUCTIONINTRODUCTION
 Every generation of man, admires hishis
own wisdom, skill, science, art &own wisdom, skill, science, art &
progress;progress;

 It calls its ownown whatever it has learnt
from men of former days, & counts
the few improvementsthe few improvements which have
had their birth in its own time as
triumphs & distinctions which
elevates it above the past.

 Advances in orthodontics has made
possible a constant improvementconstant improvement in
the quality of orthodontic treatment
over a period of last two centuries,
ultimately benefiting the patient.the patient.

An analysis of the various dimensions
of orthodontic advancement reveals
two important truths:
1.1. TheThe biologic problembiologic problem have remainedhave remained
singularly unchanged.singularly unchanged.
2.2. Advancement inAdvancement in orthodontic materialorthodontic material
and their cascading effect onand their cascading effect on
appliance design and treatmentappliance design and treatment
strategies has added new solution tostrategies has added new solution to
old problems.old problems.www.indiandentalacademy.com

 This area has been greatly taken
advantage by the manufacturersthe manufacturers &
the engineer orthodontist,the engineer orthodontist, who due to
their basic knowledge of the
materials have introduced newer and
more efficient orthodontic appliances.

 Every important science
must be correlated to
another.
 Similarly dentistry has
borrowed from many
different disciplines and
specialties.
 EngineeringEngineering is only one
of them.

 The profession of dentistrydentistry itself,
includes many disciplines, each
important in its own right in the
development and preservation of the
portal that admits all food and
sometimes the air that fuel the living
body.

 The interests of dentistry, as the name
implies, are centered on the teeth; but the
teeth are an integral part of a much larger
structure.

The ToothThe Tooth
 Teeth exist in a dualdual
environment,environment, partly inside
the body and partly out.
 The external part is called
“crown”.“crown”.
 The internal part consist
of the “root”“root” and the
supporting structures, thethe
periodontal ligament.periodontal ligament.
Crown
Root
PDL

Division in DentistryDivision in Dentistry
Working division in dentistry is based
on the area of their function, such as
 Operative dentistry
 Endodontics
 Prosthodontics
 Periodontics
 Orthodontics
 Oral Surgerywww.indiandentalacademy.com

Operative dentistryOperative dentistry
 Is responsible for the
preservation of thepreservation of the
crownscrowns of the teeth.
 These are the working
ends that are seen in the
mouth, exposed to a wide
variety of chemical,chemical,
bacterial and mechanicalbacterial and mechanical
hazards.hazards.

EndodonticsEndodontics
 Endodontics treats thethe
pulppulp (the living part of
the tooth mostly by
replacement) along
with related diseases
of the periapical
tissues.
Pulp

ProsthodonticsProsthodontics
 Replaces missingmissing
crowns,crowns, with or
without support
from remaining
teeth.

PeriodonticsPeriodontics
 Periodontics bridges the
gap between the tooth
and its environment.
 The central responsibility
is the periodontalthe periodontal
membranemembrane that attaches
tooth to bone.

OrthodonticsOrthodontics
 Orthodontic therapy is
accomplished by
manipulating thethe
external environmentexternal environment of
the crown to stimulate
changes in the internalthe internal
environmentenvironment that will
alter tooth positions.
 He is concerned with
the dental environment.dental environment.www.indiandentalacademy.com

Oral SurgeryOral Surgery
 Most of you
must be familiar
with this branch
of dentistry.

History of OrthodonticsHistory of Orthodontics

 Although we can hide our political and
religious beliefs or our IQ with silence,silence,

 camouflage many physical shortcomings
with clothing,clothing,

 we generally cannot hide our facialfacial
appearance.appearance.

 The face especially the mouth,the mouth, is visible in
most social interactions.

 It has been argued
that disfiguring mal-
occlusion is aa
physical handicapphysical handicap
because it limits a
person’s employment,
career advancement,
social stereotype, and
marriage
opportunities.

 “Treatment of the face is more than
moving teeth or cutting and rearranging
bones; it is even more than the sculpture
of living tissues noted earlier, for it often
involves serious alterations in the
personality and social interactions”
MoyersMoyers

Pierre Fauchard (1728)Pierre Fauchard (1728)
 “Bandelette” plates used to “straighten” teeth by
tying them to crude metal plates with brass or
silver wire.

 Farrar’s appliance

 Dr Angle’s appliances, 1887 using cemented
bands, retraction screws, soldered
attachments

 Dr Angle’s E (expansion) arch appliance.

Advances in Brackets (design)Advances in Brackets (design)
Ribbon archRibbon arch
EdgewiseEdgewise
BeggBegg
Pin & TubePin & Tube
Pre-AdjustedPre-Adjusted
EdgewiseEdgewise www.indiandentalacademy.com

Orthodontic MaterialsOrthodontic Materials
BracketsBrackets
Arch wiresArch wires
Bonding materialsBonding materials
Alternative force delivery systemsAlternative force delivery systems

ORTHODONTIC BRACKETSORTHODONTIC BRACKETS

BracketsBrackets
 A door handle allows us to open or close a
door.
 Similarly a bracket acts as a handle to a
tooth.
 We can push, pull or rotate a tooth with the
help of these attachments.
BracketBracket
Bonding materialBonding material
Arch wireArch wire

Advances in Brackets (materials)Advances in Brackets (materials)
Stainless SteelStainless Steel
Allergic reaction to NickelAllergic reaction to Nickel
PolycarbonatePolycarbonate
EstheticsEsthetics
Magnetic BracketsMagnetic Brackets
TitaniumTitanium
CeramicsCeramics
Nickel free SSNickel free SS

Stainless Steel BracketsStainless Steel Brackets
 Austenitic steel
 AISI = 303, 304, 316, 316L & 317L (L =
low carbon content)
 AISI series 630 SS called as
“precipitation hardening SS”, contains
very low chromium and nickel.
 Manufacturing techniques
1.1. MillingMilling
2.2. SinteringSintering
3.3. Metal injection mouldingMetal injection mouldingwww.indiandentalacademy.com

Titanium BracketsTitanium Brackets
 Current concept about heavy metalheavy metal
poisoningpoisoning and their biologic effects
led to banning the use of nickel
releasing alloys in European
countries.
 Therefore, TitaniumTitanium based bracket
were developed.

Ceramic BracketsCeramic Brackets
 Demand for esthetics in treatment.
 Modifications include:
1.1. Mini sized steel brackets,Mini sized steel brackets,
2.2. Lingual orthodonticsLingual orthodontics
3.3. Poly carbonate bracketsPoly carbonate brackets
4.4. Ceramic brackets (1987).Ceramic brackets (1987).www.indiandentalacademy.com

 With ceramic brackets, unlike traditional
stainless steel braces, your smile will notwill not
look 'metallic.'look 'metallic.' In addition, ceramic
brackets are designed so that they won't
stain or discolor over long periods of time.

Classification of ceramic brackets
 Crystal structure
1.1. Mono-crystallineMono-crystalline
2.2. Poly-crystallinePoly-crystalline
 Materials
1.1. ZirconiaZirconia
2.2. AluminaAluminawww.indiandentalacademy.com

Lingual OrthodonticsLingual Orthodontics

Arch wiresArch wires
 They generate the required
forces and moments to bring
about tooth movement.

Advances in Arch wiresAdvances in Arch wires
Stainless Steel & Cobalt Chromium alloyStainless Steel & Cobalt Chromium alloy
Better strength and Springiness with Corrosion ResistanceBetter strength and Springiness with Corrosion Resistance
Nickel Titanium alloyNickel Titanium alloy
Developed for the space programDeveloped for the space program
1.1. Shape memoryShape memory
2.2. Super elasticitySuper elasticity
Beta TitaniumBeta Titanium
alloyalloy
(Titanium Molybdenum(Titanium Molybdenum
alloy)alloy)
Copper NiTi alloyCopper NiTi alloy
Heat activated NiTi wiresHeat activated NiTi wires
Precious alloyPrecious alloy
Gold + Copper + Platinum + PalladiumGold + Copper + Platinum + Palladium
Alfa TitaniumAlfa Titanium
alloyalloy
(Titanium + Aluminium(Titanium + Aluminium
+ Vanadium)+ Vanadium)
Ion ImplantationIon Implantation
To improve surfaceTo improve surface
properties of the TMA wiresproperties of the TMA wireswww.indiandentalacademy.com

Precious alloyPrecious alloy
 Before the 1950s
 Nothing else would tolerate intraoral
conditions
 But gold alone was too soft
 Therefore used as alloy:
GoldGold
CopperCopper
PlatinumPlatinum
PalladiumPalladium www.indiandentalacademy.com

Stainless SteelStainless Steel
 Increase in price of precious metals
 Introduction to:
Stainless Steel (18:8 ss)Stainless Steel (18:8 ss)
Cobalt chromium alloyCobalt chromium alloy
 Resistance to corrosion due to highhigh
chromium content.chromium content.
 Properties depends on
1.1. Cold workingCold working &
2.2. AnealingAnealing during manufacturing.www.indiandentalacademy.com

Nickel Titanium (NiTi) alloyNickel Titanium (NiTi) alloy
 The 1st
titanium alloy introduced in
orthodontics = Nitinol (Nickel Titanium
Naval Ordnance Laboratory)
 It was developed for space program.
 Properties:
1.1. Shape memoryShape memory
2.2. Super elasticitySuper elasticity
3.3. Superior spring backSuperior spring back
4.4. Light continuous forceLight continuous force
5.5. Long range of actionLong range of actionwww.indiandentalacademy.com

 Types:
Stabilized Martensitic NiTiStabilized Martensitic NiTi
Active Austenitic NiTiActive Austenitic NiTi
Thermally activated NiTiThermally activated NiTi
Copper NiTiCopper NiTi
Chinese NiTiChinese NiTi
Japanese NiTiJapanese NiTi

Esthetic Arch wiresEsthetic Arch wires
Composite Arch wiresComposite Arch wires
(Optiflex)(Optiflex)
Coated Arch wiresCoated Arch wires
(elastomeric poly-tetra-fluor-(elastomeric poly-tetra-fluor-
ethylene emulsion)ethylene emulsion)

Bonding MaterialsBonding Materials
 The brackets are attached to a tooth
surface with the help of bonding
materials.

Composite ResinsComposite Resins
Light cureLight cureChemical CureChemical Cure
U.V.U.V.
lightlight
VisibleVisible
lightlight
LaserLaser
curecure
Single pasteSingle paste
systemsystem
Two pasteTwo paste
systemsystem

Alternative force delivery systemsAlternative force delivery systems

Orthodontic AppliancesOrthodontic Appliances

Removable appliancesRemovable appliances
 Coffin Spring 1869  Bertoni expansion
screw 2000

Retention PlatesRetention Plates

Functional AppliancesFunctional Appliances

Fixed Functional AppliancesFixed Functional Appliances

Extra-oral anchorageExtra-oral anchorage

Biomechanical Approach to GrowthBiomechanical Approach to Growth
PrinciplesPrinciples
 Orthodontic problems are the result of
mechanical forces, and their correction
depends on mechanical forces.
 The force systems in the face can form
or deform, and their conscious control
is a continuing challenge in
orthodontics.

 Altering the balance of forces can
arrest or reverse progressive
deformities during growth, and it can
correct many of their effects even in the
adult.

Traditional use of Biomechanical ConceptTraditional use of Biomechanical Concept

Chinese FootChinese Foot

Lip –Tongue-cheek SystemLip –Tongue-cheek System

Functional DeviationFunctional Deviation (Maxillary Constriction)(Maxillary Constriction)

Environmental (Habits or Trauma)Environmental (Habits or Trauma)

Muscle DysfunctionMuscle Dysfunction
 Loss of part of musculature (unknown cause or
birth injury or damage to the motor nerve).

Muscle WeaknessMuscle Weakness
 Muscular dystrophy / Cerebral palsy / Muscle
weakness syndromes.

Functions of the JawsFunctions of the Jaws

Mechanical Principles in Jaws FunctioningMechanical Principles in Jaws Functioning

 Thus understanding of the
fundamentals of mechanics must be
the starting point for understanding
orthodontics.

 The principles of force analysis are the
basic tools of the mechanical engineer,
& their application is universal.

 In applying them to oral environment,
one combines engineering with
dentistry, which requires a mixed
terminology that is partly foreign to
each discipline:
BIOLOGY
+
MECHANICS
________________________
BIO-MECHANICS

 Today we are about to enter a new era
where the genetic coding is becoming
part of daily diagnostic tool. May be
tomorrow we have to approach
dentofacial problems by means of
genetic alterations.

Bioengineered Human of FutureBioengineered Human of Future

CONCLUSIONCONCLUSION
 Hope you have become familiar with
the variety of problems, their correct
diagnosis and the best treatment
solution possible.
 Every case is a challenge requiring
versatile thinking and imagination
rather than opting for a dogmatic
conventional cook book approach .

 Our profession is at cross roads
now. We are at a critical point in
history where we should make
conscious decisions which will
determine the way the future unfolds.

 We should make a sincere effort to
lay an enduring foundation for a
robust and a lasting co-operation
between the specialitiesbetween the specialities for the sake
of providing excellent care for ourexcellent care for our
patients.patients.

 We should be open to criticisms and
update ourselves. We should be
careful not to get entangled in
dogmatic philosophies and treatment
approaches.

QuickTimeMovie

So! Where are we?So! Where are we?

 Let us work together to usher in a
new era of integrated multidisciplinary
treatment philosophy.

 I would like to leave you with an
inspirational saying
““Coming together is a beginningComing together is a beginning
Keeping together is progressKeeping together is progress
Growing together is success”.Growing together is success”.

Let’s Begin, Progress & Succeed!Let’s Begin, Progress & Succeed!

Golden Proportions (Divine Proportion)Golden Proportions (Divine Proportion)
Rickett’s 1982

Bracket positioning simulation &
Computerized wire bending

CAD/CAM FabricationCAD/CAM Fabrication
of occlusal splint for orthognathic surgeryof occlusal splint for orthognathic surgery
 Laser scanning
of the cast
 Image of cast on
monitor

 Images of study casts and facial
skeleton combined for simulation

 Sagittal split ramus osteotomy
simulated on a 3-D image

 Contact areas of
occlusal splint
drawn from
computer image of
study cast
 Finished 3d image
of occlusal splint

 Occlusal splint polymerized by
Laser Lithography UnitLaser Lithography Unit

Advance ortho

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