Orthodontic appliance /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.

Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call

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Orthodontic appliance /certified fixed orthodontic courses by Indian dental academy

  1. 1. INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com www.indiandentalacademy.co m
  2. 2. Removable Appliances Introduction:- • Definition:Orthodontic appliance are devices by means of which mild pressure may be applied to a tooth or group of teeth & their supporting structure so as to bring about necessary changes within the bone which will allow tooth movement. www.indiandentalacademy.co m
  3. 3. Classification:• Broadly classified into two groups Mechanical -removable -fixed Myofunctional -removable -fixed www.indiandentalacademy.co m
  4. 4. • Classification of removable appliances:1)According to Graber & Neumann:a) Active appliances-force within the appliance. b) Functional appliances-use muscular forces. 2)According to the function of removable appliances:- www.indiandentalacademy.co m
  5. 5. a)For buccal or labial movement: -Z spring -T spring b) For lingual movement: -Canine & premolar spring -Molar spring -Soldered auxillary spring c) For mesial & distal movement: -Finger spring -Expansion screw -Canine retractors www.indiandentalacademy.co m
  6. 6. d) Spring for expansion: -Coffin spring -Screw appliance e)Extrusion & intrusion of teeth: -Anterior bite plane -Posterior bite plane -Inclined plane f) Habit breaking appliances: -Tongue spikes,cribs for tongue thrust. -Lip bumper for lip sucking. -Oral screen for mouth breathing. www.indiandentalacademy.co m
  7. 7. g)According to attachment:i) Attachment at one end- Cantilever spring ii) Attachment at both end- Labial bow h)Number of arms in spring:i) Single cantilever- Finger spring ii) Double cantilever- Z spring i)According to the coil:i) Spring with coil- U shape canine retractor ii) Spring without coil- Helical coil canine retractor www.indiandentalacademy.co m
  8. 8. j)According to the placement:i)Buccal spring/Labial springHelical canine retractor ii)Palatal/Lingual springFinger spring, Z spring k)According to force applied:i)Push type-Labial wire of removable appliance ii)Pull type- Retraction ligature www.indiandentalacademy.co m
  9. 9. l)According to amount of pressure applied:-Heavy pressure -Light pressure m)According to mode of adhesion:-Bonding -Banding n)Functional/muscle motivating orthodontic appliance are divided into thre broad categories[Graber Neumann] Group I-Teeth supported appliance eg:Inclined planes,Oral sheilds Group II-Teeth/tissue supported appliance eg:Activator , Bionator www.indiandentalacademy.co m
  10. 10. Group III- Vestibular positioned appliance eg: Frankel functional regulator Oral screens o) Schwarz recognized the intimate relationship of force magnitude & tissue response & classified orthodontic force into four degrees of biological efficiency [Graber Neumann] i) First degree of efficiency: The orthodontic force in the first degree of efficiency are below the threshold of stimulation needed to activate orthodontic tooth movement or they are balanced by compensatory forces. www.indiandentalacademy.co eg: Frankel appliance m
  11. 11. ii) Second degree of efficiency: are that type of forces that are most favorable to achieve continuous tooth movement without root resorption. Resorption of alveolar bone in the pressure zone will happen at the same rate as deposition in the area of tension. iii) Third degree of efficiency: are that forces that can interrupt the blood circulation in the periodontal membrane. They are of medium strength 20-50 gm/cm. The tissue are not yet crushed. www.indiandentalacademy.co m
  12. 12. iv) Fourth degree of efficiency: are of such magnitude that the periosteal membrane is crushed between the root & alveolar bone in the area of greatest pressure. If continuous, the consequence is extensive necrosis of alveolar bone & root resorption. Irreparable may be caused to the tissue involved. www.indiandentalacademy.co m
  13. 13. Components:• In removable orthodontic appliancesI. Active components spring bows screws elastics II. Passive components clasp www.indiandentalacademy.co m
  14. 14. III. Base plate • In fixed orthodontic appliancesI. Active components seprators archwires elastics elastomerics springs magnets www.indiandentalacademy.co m
  15. 15. II. Passive components bands bracket buccal tubes lingual attachments →lingual buttons →lingual seating lugs →lingual eyelets →lingual cleats →lingual sheaths → lingual elastilugs →lingual ball hooks →lock pins →ligatures wires www.indiandentalacademy.co m
  16. 16. Ideal requirements • Biologic requirements • Mechanical requirements • Esthetic requirements • Hygienic requirements www.indiandentalacademy.co m
  17. 17. • Classification of spring: According to attachment:i) Attachment at one end- Cantilever spring ii) Attachment at both end- Labial bow Number of arms in spring:i) Single cantilever- Finger spring ii) Double cantilever- Z spring According to the coil:i) Spring with coil- U shape canine retractor ii) Spring without coil- Helical coil canine retractor www.indiandentalacademy.co m
  18. 18. Spring wrapped around heavy wire: eg: Apron spring. www.indiandentalacademy.co m
  19. 19. Removable orthodontic appliances • Active components * Springs i) Finger spring:-most important removable orthodontic appliances. -used for mesiodistal movement of the teeth. www.indiandentalacademy.co m
  20. 20. ii) Z spring:It is used for labial movement of incisors & correction of minor rotations. iii) T spring:It is used for the buccal movements of the premolars & canine. www.indiandentalacademy.co m
  21. 21. iv) Mattress spring:used for the correction of labial movement of the teeth in crossbite where sufficient space available for tooth movement. v) Helical coil spring:used to regain lost extraction space. www.indiandentalacademy.co m
  22. 22. vi) Coffin spring:Introduced by WALTER COFFIN in 1881. It is an omega shaped spring which helps to bring about arch expansion. www.indiandentalacademy.co m
  23. 23. vii) Canine retractors:#Buccal self supported canine – → It is made up of 0.7mm wire. It consists of active arm, helix of 3mm diameter & a retentive arm. Coil is placed distal to long axis of canine. → indicated in case where canine is buccally place & placed high in www.indiandentalacademy.co vestibule. m
  24. 24. #Palatal canine retractor:→Made up of 0.6mm stainless steel wire. It consists of active arm, helix coil,& a guiding arm. →It is indicated in case of palatally placed canine which required retraction. www.indiandentalacademy.co m
  25. 25. #Helical canine retractor:→Also called reverse loop canine retractor. Made up of 0.6mm wire. →It consist of active arm, retentive arm & coil of 3mm of diameter. →Activation done either by opening the coil by 2mm or by cutting 2mm of free end & readapt it around the canine. www.indiandentalacademy.co m
  26. 26. # U loop canine retractor:→Made up of 0.6-0.7mm round stainless steel wire.It consists of U loop, active arm & retentive arm. →U loop placed 2-3mm below the cervical margin. →It is used when minimum retraction (12mm)required. → It is easy in fabrication & less bulky. www.indiandentalacademy.co m
  27. 27. • Bows:i)Short labial bow:→Made up of 0.7mm round stainless steel wire.It is constructed in such a way that the bow contacts the most prominent labial surfaces of anterior teeth. →It is used for retention purpose as well as minor overjet reduction & anterior space closure. www.indiandentalacademy.co m
  28. 28. ii) Long labial bow:→It is just the modification of short labial bow. It extends from first premolar to first premolar of opposite side. iii)Split labial bow :→Modification of short labial bow. It is split in the middle.Effective in anterior retraction & closure of midline diastema. www.indiandentalacademy.co m
  29. 29. iv)Robert’s retractor:Made up of 0.5mm wire.It extends from labial surface of canine to canine instead of a regular loop it incorporates a 3mm internal diameter helix at the base of the loop.The distal arm of the loops are supported in softened stainless steel tubes of 0.5mm internal diameter. www.indiandentalacademy.co m
  30. 30. v) Reverse labial bow It’s the modification of conventional bow. In this there is a U loop & activation of the applianceis done by opening the loop. vi) Mills retractor:It’s also modification of conventional bow.It is used in patients with increased overjet.But due to it’s complex design & poor patient complience it is not widely used. www.indiandentalacademy.co m
  31. 31. vii)High labial bow with apron spring:It extends high in the vestibule. It is made up of thicker gauge wire & onto which thinner gauge of wire of 0.4mm wire is attached for the retraction of one or more upper anterior teeth. viii) Fitted labial bow:It adapts the contours of the labial surface of the teeth & used for retention purpose. www.indiandentalacademy.co m
  32. 32. • Screw:It’s active component of the removal appliance.It is activated by the patient by using a key.Mainly it can bring about three types of movements-Expansion of arch. -Movement of teeth or group of teeth in buccal or labial direction. - Movement of teeth or group of teeth in mesial or distal direction. www.indiandentalacademy.co m
  33. 33. • Advantage of screw over the spring:1) Easier to manage. 2) Less chair side time required. 3) Fewer tendencies to get dislodged ideal tooth movement is achieved by turning the screw a quarter turn every 3-7 days. www.indiandentalacademy.co m
  34. 34. • Elastics:-seldom used . -generally used for anterior retraction with labial bow. -Advantage :Aesthetically acceptable. -Disadvantage : can cause gingival trauma. :risk of arch form getting flattened. www.indiandentalacademy.co m
  35. 35. • Passive components Clasp: It is a retentive component of the removable appliance which helps in keeping the appliance in place & resist the displacement of the appliance. Mode of action: Clasps acts by engaging certain constricted areas of the teeth that are called undercuts www.indiandentalacademy.co m
  36. 36. • Two types of undercuts are found in natural dentition 1)Buccal & lingual undercuts“C”clasp & Jackson’s clasp. 2)Mesial & distal undercutsAdam’s clasp & Crozat clasp. • Requirement of the clasp 1)Should offer adequate retention. 2)Can use in partially & fully erupted teeth. 3)Easy to fabricate. 4)Should not apply active force. 5)Should not impinge soft tissue. 6)Should not interfere with normal www.indiandentalacademy.co occlusion. m
  37. 37. 1) Circumferential clasp: →also called Three quarter or C clasp. →Parts :-Circumferential retentive tip, interocclusal arm, retentive arm. →Advantages: i)Easy to fabricate. ii)Simple in design. →Disadvantage: Can not used in partially erupted teeth. www.indiandentalacademy.co m
  38. 38. 2)Jackson’s clasp: →Also called U clasp or Full clasp. →Advantage: -Easy to construct. -Offer adequate retention. →Disadvantage: -Inadequate retention in partially erupted teeth. www.indiandentalacademy.co m
  39. 39. 3) Adams clasp:-By C.P.Adams. -Also called as Liverpool clasp,Universal clasp,Modified arrowhead clasp. -Parts…Two arrowheads,Bridge,Two retentive arms. Advantagesi)Rigid & offer good retention. ii)Can used in partially erupted teeth. iii)Can give in permanent www.indiandentalacademy.co & deciduous teeth. m
  40. 40. • Modifications of Adams clasp:- www.indiandentalacademy.co m
  41. 41. 4)South end clasp-Used for retention purpose in anterior region. -The wire adapted on the cervical margin of both central incisors. 5)Triangular clasp-Small triangular shaped clasp between two adjacent posterior teeth & engages the proximal undercut. -Use: whenever additional retention needed. www.indiandentalacademy.co m
  42. 42. 6)Ball end claspThis appliance have a ball like structure on one end.This ball can be made with the help of silver solder. The ball engages the proximal undercut between two adjacent posterior teeth. Indication: Whenever additional retention is needed. www.indiandentalacademy.co m
  43. 43. 7)Crozat clasp-Resembles full clasp but an additional piece of wire soldered which engages in mesial & distal proximal undercut. 8)Schwartz clasp-Also called arrowhead clasp. -Engages in interproximal area between premolar & molar. -Provide adequate retention. www.indiandentalacademy.co m
  44. 44. • Disadvantage of Schwartz clasp:1)Need special arrowhead forming plier. 2)Occupies large amount of space in buccal vestibule. 3)Can injure inter dental soft tissue. 4)Difficult to fabricate & time consuming. www.indiandentalacademy.co m
  45. 45. • Base plate:-It is made up of cold cure acrylic resin. -The primary function of base plate is to incorporate all the components together as a functional unit. -Helps in anchoring the appliance in place. -Provide support to wire components. -Helps in distributing forces over a larger area. -It’s thickness should be 1.5-2 mm www.indiandentalacademy.co m
  46. 46. FIXED ORTHODONTIC APPLIANCES • Advantages:1)Precise tooth control is possible. 2)Multiple tooth movement is possible. 3)Patient co-operation is reduced. • Disadvantage:1)Difficult to maintain oral hygiene. 2)Unesthetic www.indiandentalacademy.co m
  47. 47. 3)Special training required. 4)Increased cost of treatment. 5)Increased chair side time. 6)Anchorage control is difficult. a) Active components: 1)Separatorsthey are used to create space between two adjacent teeth generally for the purpose of banding. www.indiandentalacademy.co m
  48. 48. i)Soft brass wires: -0.5-0.6mm diameter wire passed interdentally & twisted to create space. -Painful & can cause gingival trauma. ii)Ring separators: -Small elastic rings that are stretched & passed through interdental contacts with separator placing pliers. www.indiandentalacademy.co m
  49. 49. iii) Dumb-bell separators: - Dumb-bell shaped pieces of elastics that is stretched & passed through the contact between adjacent teeth. - The elastics of the separators constricts over a period of time to regain it’s original space & cause separation. www.indiandentalacademy.co m
  50. 50. 2)Elastics:-Can be of latex or no latex.Non latex deteriotes less than latex in oral environment. i) Class I elastics: It is used for closing the extraction space. ii) Class II elastics: These intermaxillary elastics are used to produce intrusion of maxillary anterior or decrease the overjet by retracting maxillary anterior teeth. www.indiandentalacademy.co m
  51. 51. iii) Class III elastics: Used in treatment of Class III malocclusion to bring about retraction of mandibular anterior & protraction of maxillary molars. iv)Diagonal elastics: For correction of midline deviations www.indiandentalacademy.co m
  52. 52. v)Cross bite elastics: Mainly to correct the cross bites in buccal segments. vi)Box elastics: -Used to correct the anterior open bite. -Causing distal tipping of maxillary anteriors &/or force eruption of maxillary &/or mandibular incisors. www.indiandentalacademy.co m
  53. 53. vii)Extraoral elastics: -Used in conjuction with the extraoral appliances like a face mask. -Generally exert high forces. www.indiandentalacademy.co m
  54. 54. 3) Elastomerics: Made up of synthetic polyurethane material i) Elastic chain: -Also called E chain. -Mainly used for space closure. ii) Elastic threads: -Made of specialized elasticized cotton. -Used to exert forces which are used to correct derotations & reduction of anterior spacing. www.indiandentalacademy.co m
  55. 55. iii) Elastic ligatures: -Used to secure the arch wire in edgewise or preadjusted edgewise bracket. -They can be easily engaged under the bracket wings. www.indiandentalacademy.co m
  56. 56. 4)Spring : These are used along with the fixed orthodontic appliances.They are i) Uprighting spring-Made up of 0.012-0.014” Australian wire. -Move tooth root in mesial or distal direction. -Standard spring used in Begg’s and Tip edgewise bracket -Side winder design made for Tip edge bracket. www.indiandentalacademy.co m
  57. 57. ii)Rotating spring: - Provide simple & effective means of derotating teeth without removal archwire. iii)Torquing spring: - Made of 0.012-0.014” Australian wire. -Capable of moving tooth roots in labial or lingual direction -Force is transmitted to the crown by spurs, which contact the teeth. www.indiandentalacademy.co m
  58. 58. iv)Open coil spring: -Made up of stainless steel wire or Ni-Ti wire. -Used for opening of the space. v) Closed coil spring: -Made up of stainless steel wire or Ni-Ti wire. -Used for closing of the space. www.indiandentalacademy.co m
  59. 59. 5) Magnets : Are used for opening or closing spaces. Normally used magnets are-Samarium cobalt magnets -Neodymium iron boron magnets 6) Archwires: i)According to the cross section -Round -Square -Rectagular www.indiandentalacademy.co m
  60. 60. 2) Based on the material constituent: -Gold -Stainless steel -Chrome cobalt -Nickel titanium -Beta titanium -Alpha titanium -Titanium niobium alloy -Multistranded wires -Composite wires -Optiflex wires www.indiandentalacademy.co m
  61. 61. 3)Based on diameter of wire: a) Round -0.08” -0.010” -0.012” -0.014” b) Square -0.16”x0.16” -0.17”x0.17” c) Rectangular -0.17x0.25” -0.17x0.28” www.indiandentalacademy.co m
  62. 62. 4) Based on microstructural arrangement: - Simple cubic - Face centered cubic - Body centered cubic i) Gold: Gold alloy is used prior to the 1930s.They were inert, biocompatible & enviromentally stable. www.indiandentalacademy.co m
  63. 63. • Composition: Gold – 15-65% Copper- 11-18% Silver- 10-25% Palladium – 5-10% Nickel – 1-2% Zinc – traces Advantageous properties:1) Extremely formable. 2) Strength can be increased by heat treatment as well as cold working. 3) Low modulus of elasticity. 4) Good environmental stability. 5) Excellent biocompatibility. www.indiandentalacademy.co m
  64. 64. Disadvantageous properties 1) Low yeild strength. 2) Low spring back. 3) High cost. ii) Stainless steel: Introduced by Wilkinson in 1929. Composition: Iron – 71% Chromium- 18% Nickel- 8% Carbon – Less than 0.2% Advantageous properties: 1) High stiffness. 2) High yield strength. www.indiandentalacademy.co m
  65. 65. 3)High resilience. 4)Good formability. 5)Good environment stability. 6)Adequate spring back. 7)Biocompatible 8)Corrosion resistance. 9)Economical. Disadvantageous properties 1)Lower spring back. 2)High modulus of elasticity. 3)Most frequent activation required to maintain same force level. iii)Chrome cobalt : Also known as Elgiloy. www.indiandentalacademy.co m
  66. 66. Composition : Cobalt- 40% Chromium- 20% Nickel- 15% Iron – 15.4% Molybdenum- 7% Manganese- 2% Beryllium- 0.4% Others – 0.05% The alloy is manufactured in four tempers depending on the amount of cold work. →Blue : Soft and easy to bend. →Yellow : Ductile →Green : Semi resilient →Red : Resilient www.indiandentalacademy.co m
  67. 67. Advantages: 1)Excellent tarnish & corrosion. 2)Good resistance to distortion. 3)Good resistance to fatigue. 4)Good formability. 5)Functionally remains active for longer duration. Disadvantages: 1)Has to be heat treated. 2)Soldering is demanding. 3)High modulus of elasticity cause higher forces to be delivered. iv) Nickel titanium: -Also called Nitinol. Develops in 1971. www.indiandentalacademy.co m
  68. 68. Composition: Nickel- 55% titanium- 45% Advantage: 1)High spring back. 2)High stored energy. 3)High elasticity. Disadvantage: 1)High friction as compared to stainless steel. 2)Low stiffness can’t be used at the completion stage of orthodontic treatment. 3)Fracture easily if bent over a sharp edge. www.indiandentalacademy.co m
  69. 69. 4)Limited bending is possible. 5)Can’t be welded or soldered. 6)Expensive. v) Beta titanium: Also called as TMA wire. In these wire BCC structure is found. Composition: Titanium- 79% Molybdenum- 11% Zirconium- 6% Tin -4% Advantage: 1) High spring back. 2) High formability. www.indiandentalacademy.co m
  70. 70. 3) Low modulus of elasticity. 4) Low load deflection rate. 5) Low stiffness . 6) Environmentally stable. 7) Excellent corrosion resistance. Disadvantages: 1) More friction than stainless steel. 2) Become brittle on overheating. vi)Alpha titanium: Composition: Titanium-90% Aluminium-6% Vanadium- 4% This is made up of closely packed hexagonal crystals. www.indiandentalacademy.co m
  71. 71. Vii) Titanium nobium alloy: -Less stiffness as compared to TMA wires. -Ideal as finishing wires. viii) Composite wires: -They are tooth colored wire which includes fiberglass & aramid. ix) Optiflex wires: -these are composed of silicon dioxide core which provides the force or resiliency to the wires. www.indiandentalacademy.co m
  72. 72. b)Passive appliance: i) Bands: These are the metal attachment that are cemented to individual teeth provide a place for attachment of other auxillaries like buccal tubes, lingual buttons, etc. They can be soldered or welded on band.Banding is preferred on tooth that are likely to experience excessive forces. ii) Brackets: A bracket is defined as a device that projects horizontally to support auxillaries & is open on one side usually in vertical & horizontal direction. www.indiandentalacademy.co m
  73. 73. Classification: 1) According to type of slota)Ribbon arch b)Edgewise 2) Based on mode of attachmenta)Weldable b)Bondable 3)Based on material used to fabricate the bracketa)Metallic b)Ceramic c)Plastic www.indiandentalacademy.co m
  74. 74. • Ribbon arch bracket: -vertical slot on gingival direction. -can bring about tipping of teeth in labiolingual & mesiodistal direction. - used in Beggs fixed appliance. www.indiandentalacademy.co m
  75. 75. • Edgewise bracket- -horizontal slot facing labially. -has rectangular slots and accepts rectangular cross section wire. • Weldable & bondable brackets- -bondable brackets bonded directly over the tooth.It has meshwork under the surface. -weldable brackets are welded over the band. www.indiandentalacademy.co m
  76. 76. • Mettalic Brackets: -made up of stainless steel. -most commonly used. Advantage: -they can be recycled. -can be sterilized. -resists deformation & fracture. -least friction at wire bracket interface. -not expensive Disadvantage: -esthetically not pleasing. -can corrode & staining of tooth www.indiandentalacademy.co m
  77. 77. • Ceramic Bracket: -introduce in 1980s. -made of aluminium oxide or zirconium oxide. Advantage-dimensionally stable. -durable & resists staining. -esthetically pleasing. Disadvantage-brittle. -exhibit greater friction at wire bracket interface. www.indiandentalacademy.co m
  78. 78. • Plastic brackets -made up of polycaronate or modified form of polycarbonate. -improves the esthetic value. Disadvantage: -Tends to discolour in patient who smoke. -Poor dimensional stability. -Slot tends to distort. -Friction between plastic brackets & metal arch wire is high. www.indiandentalacademy.co m
  79. 79. iii) Buccal tubes: These are horizontal hollow tubes which are used in molars. Classification: • Based on mode of attachment: -Weldable -Bondable • According to lumen shape: -Round -Oval -Rectagular www.indiandentalacademy.co m
  80. 80. • According to number of tubes: - Single - Double - Triple • According to the technique: -Begg tube -Edge wise www.indiandentalacademy.co -Preadjusted edgewise m
  81. 81. iv)Lingual attachments:• Lingual buttonFor attachment of elastics & elastomerics. • Lingual seating lugs:Helps in seating bands. Flat-Anterior & molar. Curved-Cuspid & bicuspid. • Lingual eyelets:Used to tie elastic threads or ligature wire. www.indiandentalacademy.co m
  82. 82. • Lingual cleatsUsed for attachments of elastic thread & ligature wire. • Lingual sheathsUsed for attaching accessories such as transpalatal arch. • Lingual elastilugsUsed for attaching elastics. Curved – for posteriors Flat – for anterior www.indiandentalacademy.co m
  83. 83. • Elastic ball hooks:- -Ball attach to weldable flat arm. -Offset can be mesial or distal. -Used to attach elastics or elastomeric chain from lingual aspect. • Lock pins:- -Made of brass or soft steel.-Used to hold the wire in bracket slot. • Ligature wire:- -Are soft stainless steel wire of 0.008-0.010”. -Used to hold or ligate the arch wire in bracket. www.indiandentalacademy.co m
  84. 84. FUNCTIONAL APPLIANCES • Also called Myofunctional appliance. • These appliance are used for growth modification procedure that are aimed at intercepting & treating jaw discrepancies. Myofunctional appliances Removable Fixed Activator, Bionator Herbst appliance Jasper jumper www.indiandentalacademy.co m
  85. 85. • Activator: By Anderson in 1908.  Also called Norwegian appliances. Components-Labial bow -Jack screw(Optinal in maxillary arch) -Acrylic portion Indication1)Class 2)Class 3)Class 4)Class 5)Class II Div 1 malocclusion II Div 2 malocclusion III malocclusion I openbite malocclusion I deep bite malocclusion www.indiandentalacademy.co m
  86. 86. Contraindication :1)Not used in correction of Class I problems. 2)In children with excess lower facial height. 3)Children with procumbent incisors. 4) Children with nasal stenosis. Advantage :1)It uses existing growth of jaws. 2)Minimum oral hygiene problem. 3)Interval between appointment is more. 4) Appointments are usually short. 5) More economical. www.indiandentalacademy.co m
  87. 87. Disadvantage:1)Require patient cooperation. 2)Can’t produce precise detailing & finishing of occlusion. 3)May produce moderate mandibular rotation. Mode of activation :The activator induces musculoskeletal adaptation by a new pattern of mandibular closure. This appliances fits loosely in the mouth. The patient has to move the mandible forward to engage the appliance. This results in stretching of elevator muscles of mastication which starts contracting thereby setting up a myotactic reflex. In addition to this myotactic reflex, a condylar adaptation by backward & upward growth occurs. www.indiandentalacademy.co m
  88. 88. • Bionator:-By Balters in 1950s. -Less bulky & elastic than activator. -3 types:  Standard bionator  Class III appliance  The open bite appliance 1. Standard Bionator -Used in treatment of Class II Div 1 & Class I malocclusion having narrow dental arch. www.indiandentalacademy.co m
  89. 89. 2)Class III appliances:Used in mandibular prognathism. The palatal arch is placed in opposite direction. The vestibular wire runs over the lower incisors instead of terminating at lower canines. 3)The open bite appliances:Used in open bite cases. The palatal & the vestibular arch wires same as standard appliance. The maxillary acrylic portion is modified so that even the anterior area is covered. www.indiandentalacademy.co m
  90. 90. • Indication:-Class II Div 1 malocclusion in the mixed dentition using standard bionator under following condition  Well aligned dental arches.  Function retrusion.  Mild to moderate dental discrepancy.  Evidence of labial tipping is seen. • Contraindication: Class II relation caused by maxillary prognathism.  Vertical growth pattern.  Labially tipped lower incisors. www.indiandentalacademy.co m
  91. 91. • Advantage:Less bulky. Can be worn full time except during meals. Appliance exert a constant influence on tongue & perioral muscle. Disadvantage:Difficulty in correctly managing it. www.indiandentalacademy.co m
  92. 92. • Frankel Appliance:-Developed by Prof. Rolf Frankel. -Also known as Functional regulator, Functional corrector, Oral gymnastic appliance. Principles1. 2. 3. 4. 5. Vestibular arena of operation. Sagittal correction via tooth borne maxillary anchorage. Differential eruption guidance. Minimal maxillary basal effect. Periosteal pull by buccal shields & pads. www.indiandentalacademy.co m
  93. 93. Types of functional regulators:FR 1- For treatment of Class I & Class II Div 1. 1a-Class I malocclusion where minor to moderate crowding is present. -Class I deep bite. 1b-Class II Div 1 malocclusion where overjet does not exceed 5mm. 1c-Class II Div1 malocclusion where overjet is more than 7mm. FR 2-ClassII Div 1 & 2. FR 3- Treatment of Class III. FR 4- treatment of open bite & bimaxillary protrusion. www.indiandentalacademy.co m
  94. 94. FR 5-Functional regulators that incorporate head gear. -indicated in long face patient having high mandibular plane angle & vertical maxillary excess. Parts of Frankel 1aAcrylic parts-2 vestibular screen -2 lip pads Wire parts-Palatal bow -Labial bow -Labial support wire. -Lingual bow www.indiandentalacademy.co -Canine loops m
  95. 95. Part of Frankel 1b Acrylic parts:-Vestibular screen -Lip pad -Lingual acrylic pad Wire components:-Palatal bow -Labial bow -Labial support bow -Lingual bow -Canine loops -Lower lingual spring www.indiandentalacademy.co m
  96. 96. Part of Frankel 1c Acrylic components:-Buccal shields are split horizontally & vertically into two parts -Lingual acrylic pads -Lip pads Wire components -Palatal bow -Labial bow -Labial support wire -Lingual bow - Canine loops www.indiandentalacademy.co m
  97. 97. • Parts of Frankel 2 -Most commonly used. Acrylic components Buccal shields Lip pads Lower lingual pad Wire component Palatal bow Labial bow Canine extensions Upper lingual wire Support wire for lip pads Lower lingual spring www.indiandentalacademy.co m
  98. 98. Part of Frankel 3 Acrylic components:Two upper lip pad(Tear drop shape) Lingual acrylic pad Lower lip pad Wire components:Palatal bow Labial bow Labial support wire Lingual bow Canine loop www.indiandentalacademy.co m
  99. 99. Parts of FR 4:-Same as FR 1&2 but lack of canine loops & protrusion bow (lingual stabilizing bow). -4 occlusal rests on maxillary first molar to prevent tipping of appliance. -Palatal bow is like FR 3 place distal to last molar. Parts of FR 5:-Have buccal tubes for the incorporation of head gear. • Twin block appliance:The twin block technique effectively combines inclined planes with intermaxillary & extraoral traction. The upper plate is retained by modified arrowhead clasp. The clasp can incorporate a tube for attachment of a face bow. Upper plate also have a jack screw in case of maxillary expansion. www.indiandentalacademy.co m
  100. 100. It consists of bite block that covers the palatal cusps of upper posterior teeth extending anteriorly till the mesial ridge of upper second premolar. The lower plate is retained by ballend clasp. The lower bite blocks extend distally upon the distal marginal ridge of second premolar. The lower molar are kept free to help in their eruption if needed. The upper & lower bite block interlock at 45°. www.indiandentalacademy.co m
  101. 101. • Herbst appliance:-Fixed functional appliance. -Popularized by Pancherz(1979). Indication-Dental Class II malocclusion. -Skeletal Class II mandibular deficiency. Contraindication-Dental & skeletal open bite. -Vertical growth with high maxillomandibular plane angle. -Excess lower facial height. -Case prone to root resorption. Disadvantage-Prone to breakage. -Lateral movement www.indiandentalacademy.co restricted. m
  102. 102. • Jasper jumper:Consists of two vinyl coated auxillary spring which are fitted to fully banded upper & lower fixed appliances. Indication – - ClassII malocclusion. - Deep bite with retroclined lower incisors. Contraindication :-Dental & skeletal open bite. -Minimum buccal vestibule space. -Vertical growth pattern with increased lower facial height. Disadvantage:www.indiandentalacademy.co Oral hygiene compromised. m
  103. 103. Orthopaedic Appliances • • • 1) Head gear Face mask Chin cup Head gear:- -Most commonly used. -Ideally indicated in patient with excessive horizontal growth of maxilla with or without vertical change along with some protrusion of maxillary teeth. -Most effective in prepubertal period. -Used for distalization of molars. www.indiandentalacademy.co m
  104. 104. Components1)Face bow 2)Force element 3)Head cap /Cervical strap  Face bow: i)Outer bow- made up of 1.5mm round stainless steel wire.This can be short, medium or long. ii)Inner bow- made up of 1.25mm round stainless steel wire & contoured around the dental arch and fixed in buccal tube which is fixed on maxillary first molar.Stop are placed to prevent sliding from tube. www.indiandentalacademy.co m
  105. 105. iii)The junction:It is a rigid joint of inner & outer bow. It is placed at the midline of bows.  Force element:It is the assembly which provide the force to bring about the desired effect. This may comprises of spring, elastics & any other stretchable material.  Head cap:Used for anchorage purpose. Principles of head gear: Centre of resistanceThe centre of resistance for a molar is usually at the midroot region. Force applied through centre of resistance cause bodily movement. -if force pass below it- distal tipping of crown. - if force pass above it- distal tipping of root. www.indiandentalacademy.co m
  106. 106.  Centre of resistance of maxilla:It is located above the roots of premolar teeth. Force passing through it – translation of maxilla in distal direction. Force passing above and below it- rotation of maxilla.  Point of origin of force:i) Cervical ii) Occipital iii) Combination www.indiandentalacademy.co m
  107. 107. • Typesi)Cervical: -Take anchorage from nape of neck. -Causes extrusion of molars. -Can move maxilla & maxillary dentition in distal direction. -Indicated in low madibular angle cases. ii)Occipital: -Take anchorage from back of head. -produce distal & superiorly directed force on maxillary dentition & maxilla. www.indiandentalacademy.co m
  108. 108. iii) Combination:Force exerted by both are equal & distal & slight upward force is exerted on maxillary dentition & maxilla. 2)Face mask:-Also called Reverse pull head gear or Protraction head gear. -By Hickham in 1972. -Parts i)Forehead cap ii)Metal frame iii)Chin cup -Used primarily for protraction of upper teeth or www.indiandentalacademy.co arch. m
  109. 109. Types of face mask:i)Delaire type of face mask ii)Tubinger type of face mask iii)Petit type mask www.indiandentalacademy.co m
  110. 110. • Chin cup:It is sometimes referred to is an extraoral orthopaedic device that covers the chin & is connected to a head gear. It is used to restrict the forward & downward growth of mandible. -Types : Occipital pull chin cup Vertical pull chin cup www.indiandentalacademy.co m
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