Advances in orthodontics /certified fixed orthodontic courses by Indian dental academy


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Advances in orthodontics /certified fixed orthodontic courses by Indian dental academy

  1. 1. Advances in Or thodontics INDIAN DENTAL ACADEMY  Leader in continuing dental education 
  2. 2.    Introduction History of Orthodontics Advances In Orthodontic Materials     Brackets Arch wires Bonding materials Alternative force delivery systems     Recent Orthodontic Appliances Biomechanical Principles Changing Esthetic Concepts Conclusion
  4. 4. INTRODUCTION  Every generation of man, admires his own wisdom, skill, science, art & progress;
  5. 5.  It calls its own whatever it has learnt from men of former days, & counts the few improvements which have had their birth in its own time as triumphs & distinctions which elevates it above the past.
  6. 6.  Advances in orthodontics has made possible a constant improvement in the quality of orthodontic treatment over a period of last two centuries, ultimately benefiting the patient.
  7. 7. An analysis of the various dimensions of orthodontic advancement reveals two important truths: 1. 2. The biologic problem have remained singularly unchanged. Advancement in orthodontic material and their cascading effect on appliance design and treatment strategies has added new solution to old problems.
  8. 8.  This area has been greatly taken advantage by the manufacturers & the engineer orthodontist, who due to their basic knowledge of the materials have introduced newer and more efficient orthodontic appliances.
  9. 9.  Every important science must be correlated to another.  Similarly dentistry has borrowed from many different disciplines and specialties.  Engineering is only one of them.
  10. 10.  The profession of dentistry 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.
  11. 11.  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.
  12. 12. The Tooth    Teeth exist in a dual environment, partly inside the body and partly out. The external part is called “crown”. The internal part consist of the “root” and the supporting structures, the periodontal ligament. PDL Root Crown
  13. 13. Division in Dentistry Working division in dentistry is based on the area of their function, such as  Operative dentistry  Endodontics  Prosthodontics  Periodontics  Orthodontics  Oral Surgery
  14. 14. Operative dentistry   Is responsible for the preservation of the crowns of the teeth. These are the working ends that are seen in the mouth, exposed to a wide variety of chemical, bacterial and mechanical hazards.
  15. 15. Endodontics  Endodontics treats the pulp (the living part of the tooth mostly by replacement) along with related diseases of the periapical tissues. Pulp
  16. 16. Prosthodontics  Replaces missing crowns, with or without support from remaining teeth.
  17. 17. Periodontics   Periodontics bridges the gap between the tooth and its environment. The central responsibility is the periodontal membrane that attaches tooth to bone.
  18. 18. Orthodontics   Orthodontic therapy is accomplished by manipulating the external environment of the crown to stimulate changes in the internal environment that will alter tooth positions. He is concerned with the dental environment.
  19. 19. Oral Surgery  Most of you must be familiar with this branch of dentistry.
  20. 20. History of Orthodontics
  21. 21.  Although we can hide our political and religious beliefs or our IQ with silence,
  22. 22.  camouflage many physical shortcomings with clothing,
  23. 23.  we generally appearance. cannot hide our facial
  24. 24.  The face especially the mouth, is visible in most social interactions.
  25. 25.  It has been argued that disfiguring malocclusion is a physical handicap because it limits a person’s employment, career advancement, social stereotype, and marriage opportunities.
  26. 26.  “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” Moyers
  27. 27. Pierre Fauchard (1728)  “Bandelette” plates used to “straighten” teeth by tying them to crude metal plates with brass or silver wire.
  28. 28.  Farrar’s appliance
  29. 29.  Dr Angle’s appliances, 1887 using cemented bands, retraction screws, soldered attachments
  30. 30.  Dr Angle’s E (expansion) arch appliance.
  31. 31. Advances in Brackets (design) Pin & Tube Ribbon arch Edgewise Begg Pre-Adjusted Edgewise
  32. 32. Advances in Brackets (design) Pin & Tube Ribbon arch Edgewise Begg Pre-Adjusted Edgewise
  33. 33. Advances in Brackets (design) Pin & Tube Ribbon arch Edgewise Begg Pre-Adjusted Edgewise
  34. 34. Advances in Brackets (design) Pin & Tube Ribbon arch Edgewise Begg Pre-Adjusted Edgewise
  35. 35. Advances in Brackets (design) Pin & Tube Ribbon arch Edgewise Begg Pre-Adjusted Edgewise
  36. 36. Advances in Orthodontic Materials Brackets  Arch wires  Bonding materials Alternative force delivery systems  
  38. 38. Brackets    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. Bracket Arch wire Bonding material
  39. 39. Advances in Brackets (materials) Stainless Steel Esthetics Allergic reaction to Nickel Polycarbonate Titanium Nickel free SS Magnetic Brackets Ceramics
  40. 40. Stainless 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. 2. 3. Milling Sintering Metal injection moulding
  41. 41. Titanium Brackets   Current concept about heavy metal poisoning and their biologic effects led to banning the use of nickel releasing alloys in European countries. Therefore, Titanium based bracket were developed.
  42. 42. Ceramic Brackets  Demand for esthetics in treatment.  Modifications include: 1. 2. 3. 4. Mini sized steel brackets, Lingual orthodontics Poly carbonate brackets Ceramic brackets (1987).
  43. 43.  With ceramic brackets, unlike traditional stainless steel braces, your smile will not look 'metallic.' In addition, ceramic brackets are designed so that they won't stain or discolor over long periods of time.
  44. 44. Classification of ceramic brackets  Crystal structure 1. 2.  Mono-crystalline Poly-crystalline Materials 1. 2. Zirconia Alumina
  45. 45. Lingual Orthodontics
  46. 46. Arch wires  They generate the required forces and moments to bring about tooth movement.
  47. 47. Advances in Arch wires Precious alloy Gold + Copper + Platinum + Palladium Stainless Steel & Cobalt Chromium alloy Better strength and Springiness with Corrosion Resistance Nickel Titanium alloy Developed for the space program 1. Shape memory 2. Super elasticity Copper NiTi alloy Heat activated NiTi wires Beta Titanium alloy Alfa Titanium alloy (Titanium Molybdenum alloy) (Titanium + Aluminium + Vanadium) Ion Implantation To improve surface properties of the TMA wires
  48. 48. Precious alloy     Before the 1950s Nothing else would tolerate intraoral conditions But gold alone was too soft Therefore used as alloy: Gold Copper Platinum Palladium
  49. 49. Stainless Steel   Increase in price of precious metals Introduction to: Stainless Steel (18:8 ss) Cobalt chromium alloy   Resistance to corrosion due to high chromium content. Properties depends on 1. 2. Cold working & Anealing during manufacturing.
  50. 50. Nickel Titanium (NiTi) alloy    The 1st titanium alloy introduced in orthodontics = Nitinol (Nickel Titanium Naval Ordnance Laboratory) It was developed for space program. Properties: 1. 2. 3. 4. 5. Shape memory Super elasticity Superior spring back Light continuous force Long range of action
  51. 51.  Types: Stabilized Martensitic NiTi Active Austenitic NiTi Thermally activated NiTi Copper NiTi Chinese NiTi Japanese NiTi
  52. 52. Advances in Arch wires Esthetic Arch wires Coated Arch wires Composite Arch wires (elastomeric poly-tetra-fluorethylene emulsion) (Optiflex)
  53. 53. Bonding Materials  The brackets are attached to a tooth surface with the help of bonding materials.
  54. 54. Advances in Arch wires Composite Resins Chemical Cure Single paste system Two paste system Light cure U.V. light Visible light Laser cure
  55. 55. Alternative force delivery systems
  56. 56. Advances in Orthodontic Appliances
  57. 57. Removable appliances  Coffin Spring 1869  Bertoni expansion screw 2000
  58. 58.
  59. 59. Retention Plates
  60. 60.
  61. 61. Functional Appliances
  62. 62. Fixed Functional Appliances
  63. 63. Extra-oral anchorage
  64. 64. Biomechanical Approach to Growth Principles  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.
  65. 65.  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.
  66. 66. Traditional use of Biomechanical Concept
  67. 67.
  68. 68. Chinese Foot
  69. 69.
  70. 70. Lip –Tongue-cheek System
  71. 71. Functional Deviation (Maxillary Constriction)
  72. 72. Environmental (Habits or Trauma)
  73. 73. Muscle Dysfunction  Loss of part of musculature (unknown cause or birth injury or damage to the motor nerve).
  74. 74. Muscle Weakness  Muscular dystrophy / Cerebral palsy / Muscle weakness syndromes.
  75. 75. Functions of the Jaws
  76. 76. Mechanical Principles in Jaws Functioning
  77. 77.  Thus understanding of the fundamentals of mechanics must be the starting point for understanding orthodontics.
  78. 78.  The principles of force analysis are the basic tools of the mechanical engineer, & their application is universal.
  79. 79.  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
  80. 80.  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.
  81. 81. Bioengineered Human of Future
  82. 82. CONCLUSION   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 .
  83. 83.  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.
  84. 84.  We should make a sincere effort to lay an enduring foundation for a robust and a lasting co-operation between the specialities for the sake of providing excellent care for our patients.
  85. 85.  We should be open to criticisms and update ourselves. We should be careful not to get entangled in dogmatic philosophies and treatment approaches.
  86. 86.  Let us work together to usher in a new era of integrated multidisciplinary treatment philosophy.
  87. 87.  I would like to leave you with an inspirational saying “Coming together is a beginning Keeping together is progress Growing together is success”.
  88. 88. T hank You !
  89. 89. Golden Proportions (Divine Proportion) Rickett’s 1982
  90. 90. Bracket positioning simulation & Computerized wire bending
  91. 91. CAD/CAM Fabrication of occlusal splint for orthognathic surgery  Laser scanning of the cast  Image of cast on monitor
  92. 92.  Images of study casts and facial skeleton combined for simulation
  93. 93.  Sagittal split ramus osteotomy simulated on a 3-D image
  94. 94.  Contact areas of occlusal splint drawn from computer image of study cast  Finished 3d image of occlusal splint
  95. 95.  Occlusal splint polymerized by Laser Lithography Unit
  96. 96. Thank you  Leader in continuing dental education 