Elastics in orthodontics /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.

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

  1. 1. LASTICS IN ORTHODONTICS www.indiandentalacademy.com
  2. 2. INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com www.indiandentalacademy.com
  6. 6. INTRODUCTION  Elastics and Elastomeric are routinely used as a active component of orthodontic therapy. Elastics have been a valuable adjunct of any orthodontic treatment for many years. There use, combined with good patient cooperation, provides the clinician with the ability to correct both Antero-posterior and vertical discrepancies. www.indiandentalacademy.com
  7. 7.  Both natural rubber and synthetic elastomers are widely used in orthodontic therapy. Naturally produced latex elastics are used in the Begg technique to provide intermaxillary traction and intramaxillary forces. Synthetic elastomeric materials in the form of chains find their greatest application with edgewise mechanics where they are used to move the teeth along the arch wire. www.indiandentalacademy.com
  8. 8.  The links of chain fit firmly under the wings of an edgewise bracket so that chain elastomers also serve to replace metal as the ligating force that holds the arch wire to the teeth. Since they are so positively located on the brackets it is usual for the chains to remain in situ until replaced by the orthodontist at the next visit of the patient. This routine differs from that usually followed for latex elastics, which are changed by the patient every one or two days. www.indiandentalacademy.com
  9. 9. The use practice values is of latex predicted given by the elastics on force in clinical extension manufactures for different sizes of elastics. The standard force index employed by suppliers indicates that at three times the original lumen size, elastics will exert the force stated on the package. From a clinician view it would be mandatory not only to know the clinical aspect of these elastics but also their basic www.indiandentalacademy.com properties, in order to extract the most out of
  10. 10. TERMINOLOGY  Force : It is defined as an act upon a body that changes or tends to change the state of rest, or the motion of that body. Though defined in units of Newtons it is usually measured in units of grams or ounce.  Elastic : Is defined as the ability to return to its original length or shape after being stretched www.indiandentalacademy.com
  11. 11.  Elasticity : The property of a substance that enables it to change its length, volume or shape in direct response to a force affecting such a change and recover its original form upon the removal of the force.  Elastic limit : The elastic limit is the maximum stress which a material can endure without undergoing permanent deformation www.indiandentalacademy.com
  12. 12.  Elastic Modulus or Modulus of Elasticity : When a material is stressed it is usually found that the stress is usually proportional to the strain, so their ratio is constant. In other words the material deforms linearly and elastically. This can be represented by the expression E = stress/strain.  Resilience : [stored or spring energy] Resilience represents the energy storage capacity of a wire. It is stressed not to exceed it proportional limit www.indiandentalacademy.com
  13. 13.  Plasticity : It is the property of any substance by which the material can be molded into various forms and then hardened for commercial use.  Relaxation : It is defined as decrease in force value carried or transmitted over time with the element maintained in a fixed activated state of constant strain.  Vulcanization : The process of heating sulphur-rubber mixtures is known as vulcanization. 1 ounce www.indiandentalacademy.com (oz) =
  14. 14. HISTORY OF ELASTICS AND ELASTOMERICS    Elastomer is a general term that encompasses materials that, after substantial deformation, rapidly return to their original dimensions. Natural rubber -the first known elastomer, used by the ancient Incan and Mayan civilizations. It had limited use because of its unfavorable temperature behavior and water absorption properties. With the advent of vulcanization by Charles Goodyear in 1839, uses for natural rubber greatly increased. Early advocates of using natural latex rubber in orthodontics were Baker, Case and Angle. www.indiandentalacademy.com
  15. 15. Natural Rubber  When the early European explorers came to Central and South America, they saw the Indians playing with bouncing balls made of rubber.  The South American Indians called the rubber tree cahuchu , weeping wood. The drops of latex oozing from the bark made them think of big white tears.  In 1770, the English chemist Joseph Priestley discovered that the materials could be used as an eraser to rub out pencil marks. From this use we get the name rubber. www.indiandentalacademy.com
  16. 16. A French man JMA Strange in 1841 claimed that he used a rubber attached to some hooks on the appliance surrounding the molars for retention.  John Tomes in 1848 used the elastics springs with metal plates. www.indiandentalacademy.com
  17. 17.  Celvin Case discussed the use of intermaxillary elastics at the Columbia Dental Congress. However in 1893 Henry A Baker was credited with, originating the use of intermaxillary elastics with rubber bands and named it as Baker Anchorage . . Angle in1902 described the technique before the New York institute of Stomatology. www.indiandentalacademy.com
  18. 18. Synthetic Rubber  Synthetic rubber polymers developed from petrochemicals in the 1920’s have a weak molecular attraction consisting of primary and secondary bonds.  Elastomeric chains were introduced to dental profession in the 1960’s and have become integral part of orthodontic practice. They are used to generate light continuous forces. They are inexpensive, relatively hygienic, easily applied and required no patient cooperation.  From here and there have been numerous advances in manufacturing process which have let to a significant importance in their properties, with this there has been greater application of these elastics in clinics in variety of uses. www.indiandentalacademy.com
  19. 19. PROPERTIES OF ELASTICS AND ELASTOMERICS  Rubber is one of our most interesting and most important raw materials. Natural rubber comes from the juice of a tree. Synthetic rubber is made from chemicals.  Rubber is especially useful for several reasons: it holds air  keeps out the moisture  does not readily conduct electricity .  But its chief importance to us is that it is elastic. www.indiandentalacademy.com
  20. 20. Natural Rubber  Chemical analysis shows that about 30 to 35 percent of latex consists of pure rubber, water makes up another 60 to 65 percent. The remainder consists of small amount of other materials such as resins, proteins, sugar and mineral matter. Latex spoils easily and must therefore be processed into crude rubber as soon as possible after it has been tapped.This is done by separating the natural rubber in the latex from water and other materials. About 99 percent of all natural rubber comes from the latex of Hevea brasiliensis . This is the tree that we call the rubber tree. www.indiandentalacademy.com
  21. 21.  In 1860, another Englishman, Greville Williams, heated some rubber and obtained a colourless liquid that he called isoperene. Each isoperene molecule contains five carbon atoms and eight hydrogen atoms (C5H8). The atom in the isoperene molecules always forms a definite pattern. Four of the carbon atoms form a chain. The fifth carbon atom branches off from one of the carbons in the chain. Three hydrogen atoms surround the fifth carbon atom to form a methyl group. : www.indiandentalacademy.com
  22. 22. The following chemical symbols show the arrangement of the five carbon and eight hydrogen atoms in the isoperene molecule H (Methyl Group) H C H H H H C=C C=C (Chain) H H In natural rubber thousands of tiny isoperene molecules link together in a giant, chainlike molecule, the rubber molecule. www.indiandentalacademy.com
  23. 23. www.indiandentalacademy.com
  24. 24.  Natural rubber has many unsaturated carbon atoms. Oxygen atoms from the air gradually attach themselves to these carbon atoms. This breaks down the rubber polymers so that the rubber becomes brittle or soft and loses elasticity. The addition of antioxidants during compounding prevents this action.  Scientists have not discovered all the answers to the chemistry of rubber. For example, they once believed that sulphur atoms attached themselves to unsaturated carbon atoms during vulcanization. But the sulphur reaction that makes rubber hard now seems more complicated than this. In many other ways, the chemistry of natural rubber remains mystery. www.indiandentalacademy.com
  25. 25. Synthetic rubber  Rubber like materials which are made from chemicals were called synthetic rubbers because they were intended as substitutes for natural rubber. Chemists use the word elastomer for any substances, including rubber, which stretches easily to several times its length, and returns to its original shape.  Manufacturers group synthetic rubbers into two classes: General-purpose and special-purpose. www.indiandentalacademy.com
  26. 26.  General rubbers: purpose synthetic The most important general purpose rubber is styrene-butadiene rubber (SBR). It usually consists of about three parts butadiene and one part styrene. Butadiene, a gas, is made from petroleum. It must be compressed or condensed into liquid form for use in making rubber. Styrene is a liquid made from coal tar or petroleum. Special purpose rubbers: Contact with petrol, oils, sunlight and air harms natural rubber. Special-purpose synthetic rubbers resist these “enemies” better than natural rubber or SBR do. Also some of these special-purpose rubbers have www.indiandentalacademy.com
  27. 27. www.indiandentalacademy.com
  28. 28.  Special-purpose rubbers include  butyl rubber  cispolyisoperene rubber  neoprene rubber  nitrile rubber  polysulphide rubbers  polyurethane rubbers  silicon rubber  ethylene-propylene rubbers  fluorocarbon www.indiandentalacademy.com rubbers 
  29. 29.  Most of the elastics currently used in orthodontics are made up of polyurethane.  Polyurethane rubbers resist heat and withstand remarkable stresses and pressures.. Polyurethane foams come dense to light. The ingredients of polyurethane rubbers include ethylene, propylene, glycols, adipic acid, and di-isocyanates.  It has got an excellent strength and resistance to abrasion when compared with natural rubber. They tend to permanently distort, following long periods of time in the mouth and often lose their elastic properties. This is mainly used for elastic ligatures. www.indiandentalacademy.com
  30. 30. CLASSIFICATION OF ELASTICS Elastics can be classified in many ways. According to the material, their availability, there uses and force. www.indiandentalacademy.com
  31. 31. ACCORDING TO THE MATERIAL Latex Elastics: These are made up of natural rubber materials, obtained from plants, the chemical structure of natural rubber is 1, 4 polyisoprene. Synthetic elastics: These are polyurethane rubber contains urethane linkage. This is synthesized by extending a polyester or a polyether glycol or polyhydrocarbon with a diisocynate. These are mainly used for elastic ligatures. www.indiandentalacademy.com
  32. 32. ACCORDING TO THE AVAILABILITY Different makers have different sizes and force, and the colour coding and the name is also different. www.indiandentalacademy.com
  33. 33. COLOUR DIAMETER FORCE INCH MM GRAMS OUNCE WHITE 1/8 3.2 56.8 2.0 RED 3/16 4.6 99.4 3.5 GREY 3/16 4.6 127.8 4.5 BLUE 1/ 4 6.4 99.4 3.5 ORANGE 1/ 4 6.4 127.8 4.5 YELLOW 5/16 7.9 56.8 2.0 GREEN 5/16 7.9 99.4 3.5 TAN 5/16 7.9 127.8 4.5 PINK 3/8 9.5 99.4 3.5 LAVENDER 3/8 127.8 4.5 www.indiandentalacademy.com 9.5
  34. 34. H E A V Y . E L A S T I C S DIAMETER FORCE INCH MM GRAMS OUNCE 3/16 4.6 56.8 2.0 5/16 7.9 95.4 3.5 3/16 4.6 113.6 4.0 5/16 7.9 170.4 6.0 5/16 7.9 227.2 8.0 www.indiandentalacademy.com
  35. 35. www.indiandentalacademy.com
  36. 36.  ACCORDING TO THE USES. 1) Intra oral 2) Extra oral www.indiandentalacademy.com
  37. 37. INTRAORAL ELASTICS 1) CL I elastics or horizontal elastics or intramaxillary elastics or intra-arch elastics:- •These extend with in each arch. • This is used for the space closure and to a certain extent; it can open the bite also. • It is placed from the molar tube to the intramaxillary hook of canine of the same side of the same arch. www.indiandentalacademy.com
  38. 38. The force recommended is 1 ½ to 2 ½ oz for non extraction cases and 2 to 4 oz. in extraction cases. . www.indiandentalacademy.com
  39. 39. 2) CL II Elastics / intermaxillary elastics / interarch elastics This is extended from the lower molar teeth to upper cuspid which is placed from lower molar tube to the upper intermaxillary hook of the same side. They are primarily used to cause Antero-posterior tooth changes that aid in obtaining CL I cuspid relationship from a CL II relationship www.indiandentalacademy.com
  40. 40. www.indiandentalacademy.com
  41. 41. If the lower second molar are banded it is best to extend the elastic from the second molar to the upper cuspid if they are to be used for over two months of treatment. If the elastics are used for 2 to 6 weeks only, then one may extend them from the lower first molar to upper cuspid teeth. This treatment regimen minimizes the side effects from the use of elastics (extrusion of the lower posterior teeth and labial tipping of the lower anterior teeth, lowering of anterior occlusal plain and the creation of gummy smile). If any temporoma dibular joint discomfort occurs elastic should be discontinued at least temporarily. . www.indiandentalacademy.com
  42. 42. In CL II elastics we can observe some following important features:1. Light but direct force applied to both mandible and maxilla to stimulate maxillary retardation and mandibular growth. Negative side effects such as loss of maxillary anterior torque can take place if elastic are used early in treatment. 2. Mandibular incisor advancement, especially with arch wire of low stiffness and lingual tipping of maxillary anteriors. 3. Extrusion of mandibular molars. 4. Occlusal plane tipping. 5. It may exaggerate the increased lower anterior facial height. www.indiandentalacademy.com
  43. 43. The force recommended is 1 ½ to 2 ½ oz. in non extraction case and 2 to 4 in extraction cases www.indiandentalacademy.com
  44. 44. 3) Class III elastics • Class III elastics are exact opposite of the class II’s. • They extended from upper molar to the lower cuspid. • It is used in the treatment of CL III malocclusions. • In some CL II cases also it is used to relieve edge relationship of the anteriors. • It is attached from the maxillary molar to mandibular lateral incisor or canine. • They promote extrusion of upper posterior teeth and upper anteriors, along with lingual tipping of the lower anteriors. www.indiandentalacademy.com
  45. 45. www.indiandentalacademy.com
  46. 46. 1. 2. 3. 4. Indications: To avoid advance maxillary dentition and or retract the mandibular dentition. To correct anterior cross bite. Mandibular crowding in a non extraction case in which it is desired to eliminate the crowding without advancing the mandibular incisor appreciably. In deep bite, low angle, crowded case early use of c1 III elastics will allow the bite open. www.indiandentalacademy.com
  47. 47. Recommended force is ¼” elastic with 3 ½ oz www.indiandentalacademy.com
  48. 48. 4.ANTERIOR ELASTICS: 1. It is used to improve the over bite relationship of incisor teeth. 2. Open bite up to 2mm may be corrected with these elastics. 3. They may extend from the lower lateral incisor to the upper laterals or central incisor teeth or from the lower cuspid to the upper laterals. 4. It is used in conjunction with a plain arch wire for closing spaces between anterior teeth. It produces a reciprocal free tipping of anterior crowns, which closes the spaces. www.indiandentalacademy.com
  49. 49. Anterior Elastics. (Force-1 to 2oz.) www.indiandentalacademy.com
  50. 50. 5) Zigzag Elastics Aras A et al 2001 they have done pilot study of “The effect of zig zag elastics in the treatment of CL II div 1 malocclusion subjects with hypo and hyper divergent growth pattern”. The conclusion of this study can be summarized as follows.  Zig zag elastics thus was used in the last stage of fixed appliance treatment of CL II malocclusion in growing patient were effective in the correction of molar relationship. Establishing a good intercuspation as well as improving sagittal skeletal relationship. www.indiandentalacademy.com
  51. 51. Force recommended is 2.5 oz. www.indiandentalacademy.com
  52. 52. 6] Cross Bite Elastics •This is indicated in unilateral and bilateral cross bites, to expand and upright lower molars which have tipped lingually. • It is placed between the lingual aspect of the lingually placed molar and the buccal aspect of the opposing tooth. www.indiandentalacademy.com
  53. 53. Force recommended is 5-7 ounce www.indiandentalacademy.com
  54. 54. 7) Cross Palate Elastics •This is to correct the undesired expansion of the upper molars, during third stage. • This is placed between the lingual aspects of the upper molars. • Upper molar expansion during the 3rd stage is usually bilateral, the cross palate elastics is appropriate because the force it exerts in pulling one molar lingually is equal and opposite to the force it exerts in pulling the other lingually. www.indiandentalacademy.com
  55. 55. 8) Diagonal elastics) Elastics (Midline Force used is 1 ½ to 2 ½ ounces. www.indiandentalacademy.com
  56. 56. 9) Open Bite Elastics  These are used for the correction of open bite.  It can be carried out by a vertical elastic, triangular or box elastic.  Vertical elastic runs between the upper and lower brackets of each tooth. www.indiandentalacademy.com
  57. 57. 10.Box elastics •Box elastics have a box shape configuration and can be used in variety of situations to promote tooth extrusion and improve intercuspation. •Most commonly, they include the upper cuspid and lateral incisor to the lower first bicuspid and cuspid(CL II vector) or to the lower cuspid and lateral incisors(CL III vector). • All bicuspid teeth of one side can be extruded as well. •These are used to correct the open bite or to decrease the anterior open bite. www.indiandentalacademy.com
  58. 58. Box Elastics Force used ¼” 6 oz. 6 oz or 3/16” www.indiandentalacademy.com
  59. 59. 11.Triangular elastics: •Triangular elastics aid in the improvement of CL I cuspid intercuspation and • increase the over bite relationship anteriorly by closing open bite in the range of 0.5 to 1.5 mm. • They extended from upper cuspid to the lower cuspid and first bicuspid teeth. • It is used for similar reasons of box elastics, but including only 3 teeth www.indiandentalacademy.com
  60. 60. Triangular Elastics Elastics of 1/8” 3 ½ oz is used. www.indiandentalacademy.com
  61. 61. 12)Vertical Elastics(Spaghetti) •This is useful in is 3 ½ there is Force used whom oz. difficulty in closing the bite, whether anteriorly or posteriorly. • This type of elastic is contraindicated in malocclusions that were originally characterized by a deep bite www.indiandentalacademy.com
  62. 62. 13] M and W Elastics Force is ¾” 2 ounce. •In an open bite or c1 III tendency some amount curve of spee should have been placed in the lower arch. Therefore some curve should be placed in the upper arch as well. • The arch wire is sectioned distal to laterals or cuspids and up and down elastics ( “M” with a tail) are worn. • In class I case M or W without a tail is used. The upper and lower arch wire is sectioned in which the teeth to be extruded. •In class II vector ‘W’ with a tail is given. www.indiandentalacademy.com
  63. 63. 14.Lingual elastics  This can be used as a supplement or a counter balancing agent to buccal elastic force, there by increasing the efficiency of force distribution.  Lingualy tipped lower molars can be uprighted by the use of class II elastics attached between to lingual hook of the lower molar and intermaxillary hook of upper arch wire on the same side.  Lingual elastics can be used as a substitute for buccal elastics like CL I and CL II elastics, provided the arch wire should be tied back to the cuspid bracket. www.indiandentalacademy.com
  64. 64. Lingual Elastics www.indiandentalacademy.com
  65. 65. 15) Check Elastics Check elastics can provide a potent mechanism for overbite reduction, causing extrusion of maxillary and mandibular molars and counteracting the tendency of the anchor bends to tip the molars distally plus aiding incisor intrusion. www.indiandentalacademy.com
  66. 66. 16] Sling Shot Elastics( Molar distalizing) Two hook on buccal and lingual side of the molar to be incorporated in the acrylic plate to hold the elastic. The elastic is stretched at the mesial aspect of molar to distalize it. www.indiandentalacademy.com
  67. 67. 17)Elastics appliance     in removable Elastics in conjunction with the removal appliance are used for the movement of single and groups of teeth, and for intermaxillary traction. It can be used to move impacted canine to proper place along with the Hawley appliance. The use of elastics in moving the canine distally along with screw appliances. The acrylic plates covering the premolars and molars and tuberosities for bodily anchorage. www.indiandentalacademy.com
  68. 68. www.indiandentalacademy.com
  69. 69. 18) Other elastics : Asymmetrical elastics: They are usually CL II on one side and CL III on other side. They are used to correct dental asymmetries. If a significant dental midline deviation is present (2mm or more), an anterior elastic from upper lateral to the lower contralateral lateral incisor should also be used. Finishing elastics: Are used at the end of the treatment for final posterior settling. www.indiandentalacademy.com Force recommended ¾” or 2 oz
  70. 70. ACCORDING FORCE High TO THE Pull Ranges from 1/8” (3.2mm) to 3/8” (9.53mm). It gives 71 gm force (2 ½ oz) Medium Pull Ranges from 1/8” (3.2mm) 3/8” (9.53 mm) it gives 128gm or 4 ½ oz force. Heavy pull Ranges from1/8”(3.2mm) 3/8”(9.53 mm) It gives 184gm or 6 1/2oz force. www.indiandentalacademy.com
  71. 71. Elastic separators Elastic separators Dumbell separator www.indiandentalacademy.com
  72. 72. TYPES OF ELASTICS INTRA ORAL ELASTICS: It can be of light, medium or heavy www.indiandentalacademy.com
  73. 73. EXTRA ORAL ELASTICS : Heavy elastics and plastic chain are used with the head gear www.indiandentalacademy.com
  74. 74. E-LINK : It is used as intermaxillary class II and class III applications. It is available in different lengths www.indiandentalacademy.com
  75. 75. LIG-A-RING: It is used for individual ligation of the tooth. It can be used in place of conventional ligature ties in straight wire therapy and for cuspid ties in Begg. It is of 1.5 – 2 mm in diameter. www.indiandentalacademy.com
  76. 76. TIP EDGE RINGS: It can control and hold the desired degree of mesiodistal inclination. The cross bar can give up-righting forces. www.indiandentalacademy.com
  77. 77. E-CHAIN: It is used for continuous ligation and consolidation etc. It is available in 3 types. Small (continuous) Medium (short) Large (long) www.indiandentalacademy.com
  78. 78. POWER THREAD: LIGATURE) (ELASTIC This is polyurethane thread, used for rotating, extruding, losing minor spacing and to consolidate www.indiandentalacademy.com
  79. 79. ELAST -O CHAIN: It is used for consolidation of arches. It gives a light continuous traction force. www.indiandentalacademy.com
  80. 80. ELASTIC THREAD: This is an elastic ligature covered with silk or nylon. The nylon fibers is there to resist the unravelling and protect the latex core. It is available in 3 types. It is used for rotation correction, traction etc, both with fixed and removable appliance. Light Medium Heavy www.indiandentalacademy.com
  81. 81. SEPARATING RINGS: It gives a continuous force during contact opening. .Small – used in anterior region .Large – used in posterior region www.indiandentalacademy.com
  82. 82. ROTATION WEDGES : It acts as a fulcrum between wire and bracket to correct the rotation. It is ligated to the tie wing of the bracket. www.indiandentalacademy.com
  83. 83. PLASTIC CHAIN: It is used extraoraly along with head gear, for the orthopedic correction using heavy forces. www.indiandentalacademy.com
  84. 84. ANALYSIS OF ELASTIC FORCE  Force produced by elastics on a tooth or teeth depends on its magnitude. The stress produced depends on the site of application, distribution through the periodontal ligament and direction, length, diameter and contour of root, alveolar process, tooth rotation and health, age and above all the co-operation of the patient www.indiandentalacademy.com
  85. 85.  CL I elastic traction is judiciously combined with strong anchor bend. Deliberate consideration of anchorage conservation is essential, because the resultant of the retractive and intrusive forces that lies distant to the maxillary molars will induce adverse movements or anchorage loss of the maxillary molars.  Intermaxillary elastic force exerts pressure on the incisor in a vertical direction bringing them into supraocclusion or accentuating supraocclusion already present. Tilting of anchor teeth may also occur. www.indiandentalacademy.com
  86. 86.  The amount of light force exerted by the elastic is at an optimal level to tip the anterior crowns backward but a minimal level to move the lower molars forward bodily. Elastic force received by the molars and anteriors are equal and opposite, the resistance is not equal. So the crown tipping is relatively rapid and bodily movements are slow.  A continuous force can bring about rapid intrusive movement. Each anterior tooth will intrude by a force as light as 20 to 30 gms. The light force produces very short hyalinizations periods and the anterior teeth will be intruded quite rapidly. www.indiandentalacademy.com
  87. 87. FORCE DEGRADATION  Relaxation is defined as a decrease in force value carried or transmitted over time with the element maintained in a fixed activated state of constant strain.  The force decay under constant force application to latex elastic, polymer chains and tied loops showed that the greatest amount of force decay occurred during the first three hours in water bath. The force remained relatively the same throughout the rest of the period. www.indiandentalacademy.com
  88. 88.  K.A. Russell et al 2001 conducted the study on the assessment of mechanical properties of latex and non latex orthodontic elastics.  So there are few general conclusions that can be drawn and applied clinically to all elastic types. Although all of elastics met the Australian standard for breaking force there was trend towards non latex elastics having lower breaking force than the latex elastics www.indiandentalacademy.com
  89. 89.  After an exhaustive review of the literature regarding elastomeric chain, it can be said that most marketed elastomeric chains generally loses 50% to 70% of their initial force during the first day of load application. At the end of three weeks they retained only 30 to 40% of original force www.indiandentalacademy.com
  90. 90. ELASTIC ERRORS Latex allergy : Allergies to the latex proteins are increasing which has implication for dental practitioners because latex is ubiquitous in dental environment. K. A. Russel 2001 - reaction to the latex materials have become more prevalent and better recognized- since 1988 adoption of universal precautions. Only 3 reports have been cited in the literature relating latex allergies to orthodontic treatment. 2 of these studies related the allergic reactions to use of latex gloves, and 3rd report related to the development of stomatitis with acute swellings and erythematous buccal lesions to the use of orthodontic elastics www.indiandentalacademy.com
  91. 91. Staining of elastics Elastomeric materials do stain from certain food such as mustard. The attempt to solve this problem by masking with metallic colour inclusions reduces the strength and elasticity. It is because of the difference in the resilient properties. A study regarding staining in 1990 by Kenneth K. K. Lew divided into 3 categories. No staining: - With coco cola presumably most colorless food stuffs. Gradual staining: - With chocolate drink, red wine, tomato ketchup. Rapid staining: - With coffee and tea. www.indiandentalacademy.com
  92. 92. STORAGE According to the manufactures the orthodontic elastics should be stored in the refrigerator, because increased atmospheric temperature for a long period will decrease the strength. Keeping in refrigerator (cool and dry) will give long shelf life. www.indiandentalacademy.com
  93. 93. PRE STRETCHING OF ELASTICS Allen. K. Wong suggested in 1976 that the elastomeric materials need to pr-stretched 1/3rd of their length to pre stress the molecular polymer chain. This procedure will increase the length of a material. If the material is over stretched a slow set will occur but will go back to original state in time. If the material is over stretched to near breaking point, over and over again permanent plastic deformation will occur.  These means that the initial force may come to an effect during an pre stretched process. So when it is in use it will give more stable force. www.indiandentalacademy.com
  94. 94. FLUORIDE RELEASE FROM ORTHODONTIC ELASTIC CHAIN Plaque accumulation around the fixed orthodontic appliance will cause dental and periodontal decease.  Decalcification can be avoided by mechanical removal of plaque or by topical fluoride application or with a mechanical sealant layer  Controlled fluoride release device (CFRD) have been in use since 1980’s. in such device a copolymer membrane allows a reservoir of fluoride ions to migrate into oral environment rate. www.indiandentalacademy.com
  95. 95. www.indiandentalacademy.com
  96. 96. The study was designed to a stannous fluoride release from a fluoride impregnated elastic power chain. The delivery of stannous fluoride by means of power chain would presumably reduce count and inhibit demineralization. (An average of 0.025mg of fluoride is necessary for reminerilization). But this protection is only temporary and of a continued exposure needs, the elastic should be replaced at weekly intervals. The force degradation property will be higher with the fluorinated elastic chain. www.indiandentalacademy.com
  97. 97. ELASTIC LIGATURES Vs WIRE LIGATURES  Elastic ligature may be a substitute for the wire ligatures in most situations.  Elastic ligatures will give an easy work to the doctor and since no sharp ends it will be more acceptable by the patient.  In rotation control, higher force levels than elastomeric materials is required. The brackets in rotation cases the partial engagement of the arch wire will be difficult with elastic ligature, so in these cases wire ligature are advised. www.indiandentalacademy.com
  98. 98. When the sliding of a bracket on the arch wire is needed, it is advisable to use elastic ligature because of its smoothness. The strength and inflexibility of wire ligatures may also provide more secured ligation. The relatively low strength of the elastic ligature is its major disadvantage. Ligature wire can transfer elastic force from arch wire to tooth and for holding the engagement of the arch wire in the bracket. www.indiandentalacademy.com
  99. 99. COIL SPRINGS Vs ELASTICS  To overcome the drawbacks of elastomeric material, Andrew L. Souis in 1994 conducted a study NiTi coil springs and elastics.  This study shows the following:- NiTi coil springs have been shown to produce a constant force over varying length with no decay. - NiTi coil spring produced nearly twice rapid a rate of tooth movement as conventional elastics. - No patient co-operation needed. - Coil springs can stretch as much as 500% with out permanent deformation.  The force delivered is 90 to 100gm. www.indiandentalacademy.com
  100. 100. ORTHODONTIST’S PART IN PATIENT WEARING ELASTICS  Educate the patient to wear the elastics continuously except while brushing and replacing. Occasionally there may be some exceptions.  Instruct the patient carefully where the elastics are to be attached and have him to do so before you.  Every visit check whether the patient is wearing elastics, properly or not.  Make sure that the patient can place his elastics easily and that they remain in place. www.indiandentalacademy.com
  101. 101. Check whether the hooks, pins, tubes, cleats are easily accessible and remove all sharp edges that may cause breakage of elastics. Caution the patient not to allow the lower jaw to come forward in response to the pulling force exerted by CL II elastics. Be sure that the patient closes in the proper retruded position. It is most important to impress upon the patient and the parents, that if there is any difficulty in wearing elastics it should be informed to your office immediately. www.indiandentalacademy.com
  102. 102. Dispense sufficient amount of elastics required till the next visit. Do not increase elastic force for a patient who shows unsatisfactory progress, before making sure that he is actually wearing the elastics already prescribed. www.indiandentalacademy.com
  103. 103. ARMAMENTARIUM Dontrix Gauge :It is used to determine proper size elastic for each application by measuring the force. Measuring range is 28gm – 450gm. www.indiandentalacademy.com
  104. 104. Stress Gauge (correx Gauge):The measuring range is 25-250gm or 100500gms or 200 – 1000 gm. www.indiandentalacademy.com
  105. 105. Elastic separator placing pliers:Pliers with the limit for excess expansion. Rounded beak protects patient’s soft tissue. It can be used with large and small rings www.indiandentalacademy.com
  106. 106. Mathieu Forceps :It is used for placing all types of elastomers. It has got a slip free grasping and quick release ratchets for fast operation. Twirl on ligature :It is used for placing elastomeric modules and can be preloaded. www.indiandentalacademy.com
  107. 107. Module remover Double ended instrument for removing modules from the bracket. Mosquito forces Having curved delicate serrated tips for applying modules www.indiandentalacademy.com
  108. 108. Orthodontic wrench It is a double ended plastic instrument for the use of attaching and elastics by patient himself Elastic positioner modules www.indiandentalacademy.com for power
  109. 109. CONCLUSION  To put it in a nut shell elastics is a prime consideration in orthodontics.  Elastics are one of the most versatile material available to the orthodontist.  Its an invaluable tool of the orthodontist armamentarium.  An orthodontist who does not exploit these materials to the fullest is not doing justice to the patient. As a matter of fact I would think that it is all but not impossible to practice in this branch of dentistry without this material. www.indiandentalacademy.com
  110. 110. T H A N K Y O U www.indiandentalacademy.com
  111. 111.         REFERENCES: Bishara Samir E. and Anderson George F., “A comparison of time re: lated forces between plastic alastics”. Angle Orthod. 1970; 40; 319-328. Brantley William A.“Effects of pre-stretching on force degradation characteristics of plastic modules”. Angle Orthod. 1979; 49; 37-43. Bruno W Kwapis and John E. Knox. “Extrusion of teeth by elastics”. J Am Dent Assoc.1972; 84; 629 – 630. David L. Baty, “Force delivery property of colored elastomeric modules”. Am J Orthod Dentofac Orthop., 1994; 106; 40-46. David L. Baty, “ Synthetic Elastomeric chains a Literature Review” Am J Orthod Dentofac Orthop.1994:105:536-42. Dermaut L. R. and Breeden L. “The effects of CL II elastic force on a dry skull measured by hylographic interferometry.” Am J Orthod. 1981; 79; 297-304. Fletcher G.G.T. “The Begg appliance and technique. www.indiandentalacademy.com London: Wright PSG: 1981.
  112. 112. Frank G. “Contact stomatitis resulting from the use of orthodontic rubber elastics”. J Am Dent Assoc. 1974; 88; 1030-1031.  Alexander R.G., “ The Alexander discipline”. USA; Ormco Corporation;1986.  Anthony D. , Viazi S., “Atlas Of Orthodontics- Principles and clinical application” W. B Saunders Company, 1993  Aras. A et al “The zig zag elastics in the CL II div 1 malocclusion. Subject with hypo and hyper divergent growth pattern, a pilot study , Eur J orthod.: 2001; 23; 393-402.  Asbell M. B., “A brief history of orthodontist”. Am J Orthod Dentofac Orthop. 1990; 98; 176-182, 206-213..  Begg P. R. and Peter C. Kessling; “The Begg Orthodontic theory and technique”; London; W. B. Saunders Co; 1977.  Bell Walter R., “A study of applied force as related to the use of elastics and coil springs. Angle Orthod. 1951; 21; 151-154.  Bertl Wolfgang. H. and Droschl Helmut, “Forces produced by orthodontic elastics as a function of time and distance extended. Eur J  Orthod. 1986; 8; 198-201. www.indiandentalacademy.com
  113. 113.   Graber T.M. and Swain B.F., “Current orthodontic concepts and techniques”. second edition. Toronto; W.B. Sounders company; 1975. Graber T. M and Bedrich Neuman, “Removable orthodontic appliances”, second edition London; W.B. sounders company; 1984. •Joseph V.P. “Fluoride release from orthodontic elastic chain”. J.Clin Orthod. 1993; 26; 101-105. •Kenneth K.K Lew, “Staining of clear elastomeric modules from certain-foods”. J.Clin Orthod. 1990; 24; 472-474. •Sonis. Andrew L. “comparison of NiTi coil springs Vs elastics in canine retraction”. J.Clin Orthod. 1994; 28; 293 – 295. •Taloumis Louis et al; “Instructions for wearing elastics”; J. Clin Orthod; 1995 ; 25; 49;. www.indiandentalacademy.com
  114. 114. Thank you www.indiandentalacademy.com Leader in continuing dental education www.indiandentalacademy.com