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Edge wise technique 1 /certified fixed orthodontic courses by Indian dental academy


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The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.

Edge wise technique 1 /certified fixed orthodontic courses by Indian dental academy

  1. 1. The Edgewise appliance-evolution & technique
  2. 2. INDIAN DENTAL ACADEMY Leader in continuing dental education
  3. 3. Contents :Evolution / Historical perspective 1) Bandelette appliance 2) Angle’s E–arch 3) Pin &Tube appliance 4) Ribbon arch appliance 5) Edgewise appliance Attachments Modification of edgewise brackets Evolution of buccal tube Bracket placement &angulation
  4. 4. Evolution of the technique -Primary edgewise -Secondary edgewise -Tertiary edgewise Tweed’s philosophy of treatment Growth trends Diagnostic facial triangle Cephalogram or headplate correction Treatment objectives Anchorage preparation Ideal arch form Three orders of tooth movement General plan of treatment Merrifield’s modification
  5. 5. Evolution of appliance First attempt at tooth movement in1728 by a French physician Pierre Fauchard Bandalette appliance-crude alignment of teeth by expansion of the dental arches Disadvantage : lacked stability no effective means of firmly fixing it in position
  6. 6. 1841-Schange introduced screw force 1849-Dwinelle developed jack screw 1871-Magil introduced dental cements to attach bands on teeth 1866-Kingsley advocated the use of extraoral forces No attempt was made to correct malocclusion by placing teeth in a stable soft tissue environment Angle believed that teeth when moved into their correct occlusal relationship, stability would be assumed.
  7. 7. The E arch appliance(1880) First typical orthodontic fixed appliance Rigid framework –Molar bands with heavy labial arch wire soldered to them, Teeth tied to it by means of brass ligature wire Crown movement & simple anchorage Teeth were expanded into normal occlusion
  8. 8. 4 different designs: Basic E-arch  Ribbed E-arch  E-arch without threaded ends that fit into molar sheaths, used with an attached ball for high pull head gear in the incisor area  E-arch with hooks for intermaxillary elastics Also had maxillo mandibular growth guidance Disadvantages :1) correction of axial inclination could not be accomplished 2)long term retention was required 
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  10. 10. The Pin &Tube appliance(1912) Ideal arch of E-arch was not there Arches were altered as tooth movement carried out progressing towards ideal archform Bands with tubes soldered on it Pins soldered on the archwire & made to fit into tube perfectly Change position of pin ,solder it again on archwire to a different position & fit into the tube again Disadvantage:difficult to solder & unsolder pins time consuming
  11. 11. Ribbon arch appliance (1915) To overcome disadvantage of pin & tube Brackets with vertical slot introduced Archwire initially confirmed to malocclusion ,held in place by brass pins Rectangular wire with longer dimension vertical Overcame 2 major problems: 1) archwire placement 2) M-D movement of teeth Teeth were free to move along the archwire like strings of beads
  12. 12. Teeth could tip M-D, even with lockpins Angle devised cleats to be soldered to archwire to contact the sides of the bracket Held the teeth upright, but necessitates soldering new cleats at different locations Disadvantage:-relatively poor root control -mesial & distal tipping bends could not be incorporated -enmass movement of teeth in an anteroposterior direction was not easy
  13. 13. The Edgewise appliance(1925) Solution to all problems –latest & best in orthodontic mechanism Changed the form of bracket located the slot in the center & placed it in a horizontal plane instead of a vertical Bracket wide mesio-distally Rectangular slot for rectangular archwire .022x.028 slot size, same size wire Archwire inserted in narrowest dimension -EDGEWISE Initially called open face or tie brackets Archwire held with brass ligature & S-S ligature later
  14. 14. Types of headgear used High pull :- intrusion of maxillary incisors increase the lingual root torque used with cl.II elastics Intermediate pull headgear :- distalise maxillary dentition when bite is not deep hold the maxilla during anchorage preparation Low pull headgear :- open bite case support mandibular dental arch in older patients The Kloehn cervical gear :- growth trend is type A or C restricting the maxillary growth so that the mandible can catch up
  15. 15. ATTACHMENTS Evolution of edgewise brackets Original bracket – soft gold , .022 x .028 inch slot 1)Single width brackets original bracket .050 inch wide & soldered to the gold band material archwire rests on bottom of bracket slot instead of the band ineffective for tooth rotation because of the narrow width Angle devised gold eyelets to be soldered on bands
  16. 16. 2)Twin brackets - two brackets on one base -“Siamese twin brackets” by Swain - space between two brackets was .050 inch (equal to width of one bracket ) Main advantage : - ability to effect tooth rotations without using auxiliaries Available in different widths: Extra wide  Standard  Intermediate  Junior
  17. 17. 3)Curved base twin bracket curved bases to confirm to the curvatures of the canines & premolars Advantages of twin brackets : Offers a positive control Disadvantages: increased width decreases the inter bracket span, thus decreasing the resiliency
  18. 18. 4)Lewis bracket Developed by Lewis in 1950. To overcome the problem of efficient tooth rotation. He soldered auxillary rotation arms that abutted against the bracket itself, thus, offered a lever arm to deflect the archwire & rotate the tooth. One piece bracket with integral rotation wings These wings do not interfere with occlusogingival deflections of archwire & do not decrease the interbracket span
  19. 19. 5)Curved base Lewis bracket Curved base confirms to the canine, premolar surface Wings lie close to the tooth throughout their length ,so less trapping of food
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  22. 22. 6)Vertical slot Lewis bracket Incorporation of .020 x .020 inch vertical slot Possible to use uprighting spring to correct axial inclinations if needed Advantages of Lewis brackets: 1) complete rotational control 2)do not reduce the interbracket span
  23. 23. 7) Steiner bracket Given by Cecil C Steiner in 1931 Incorporated flexible rotation arms & so did not rely on the resiliency of the archwire for tooth rotation Introduced tie wings for ease of ligation 8)Broussard bracket Designed by Garford Broussard for use in the Broussard technique Addition of a 0.0185 x 0.046 inch vertical slot to accept a doubled 0.018 inch auxillary wire
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  28. 28. Evolution of edgewise buccal tube Original appliance had .022x .028 inch gold or nickel silver tubing soldered to the molar band Length –3/16 or ¼ inch Notched distal ends - to facilitate a tie back ligature Hook – gingival to buccal tubes, soldered on the bands for placement of elastics Inconel tube - gold buccal tubes were discarded Stamped buccal tube with welding flanges or Inconel tube which could be soldered to the band
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  30. 30. Combination buccal tubes Incorporates a round tube for insertion of a face bow Fairly close tolerances must be maintained between archwire & tube for effective transmission of torque to the tooth Triple buccal tube additional rectangular tube for auxillary sectional & base archwire
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  34. 34. Bracket & tube placement Angle - “goal of correct bracket & tube placement is to produce an ideal occlusion at the end of treatment with flat, straight, ideal archwires Tweed advocates – millimeter measurement from bracket slot to the incisal edge UPPER ARCH Centrals –4.5 Laterals –4.0 Canines –5.0 Premolars-4.5 Molars –3.5 LOWER ARCH Anteriors-4.0 Canines-4.5 Premolars-5.0 Molars-4.0
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  36. 36. Bracket angulation Brackets –parallel to the long axis of the tooth Holdaway (1952) described three uses for bracket angulation a) as an aid in paralleling roots adjacent to extraction spaces b) as a method of setting up posterior anchorage units into tipped back or anchorage prepared positions c) as a means of obtaining correct axial inclinations or artistic positioning
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  39. 39. Armamentarium
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  53. 53. Ligature locking and tying plier in place and ready for tying
  54. 54. Evolution of technique Primary edgewise *as described by Angle in 1929 *fully banded technique-gold bands ,soldered soft brackets *flat ideal arch wire -to provide normal occlusion *original arch was of .022 X .028 inch gold wire *to be adapted passively to all malocclusion *if space had to be made, loops are soldered onto main arch *if space closure required, spurs & tie backs used *involves all the teeth to be brought under control so, treatment should be initiated after eruption of canine & premolar
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  56. 56. Angle stated that "malocclusion must be treated as though the denture is a self-sustaining, self maintaining unit and all parts of denture exerting or sustaining forces must be perfectly balanced” 1) fully normal proximal contact relations of teeth 2) normal cusp & inclined plane relation 3) normal upright axial position & relation of teeth this is essential if the teeth are to balance with the muscles & sustain the forces of occlusion
  57. 57. Angle introduced the bracket 2 yrs. before his death. Proposed nonextraction treatment for all malocclusion Expansion of the dentition – method of teeth alignment Muscular balance was upset, teeth were moved to an unstable positions-------high frequency of relapse Little attention to establishment of anchorage
  58. 58. Secondary edgewise *to avoid the making archwires passive *use of round wires in the initial stages *gold was replaced by a more rigid alloy *frequency of extractions increased *bands with prewelded brackets *in 1940s round .045in.tubes were also soldered on the upper molars for a face bow
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  60. 60. Tertiary edgewise or Tweed’s edgewise *stressed on the importance of anchorage preparation *advocated the use of cl. III elastics & extraoral traction *vigorous forces were now employed *space closure was done by simple vertical or horizontal open loops bent into the archwire or by push coil tie -backs
  61. 61. Leader in continuing dental education