Self ligating brackets /certified fixed orthodontic courses by Indian dental academy


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Self ligating brackets /certified fixed orthodontic courses by Indian dental academy

  1. 1. SELF LIGATING BRACKETS INDIAN DENTAL ACADEMY Leader in continuing dental education
  4. 4. INTRODUCTION: A truly efficient orthodontic Edward angle’s edgewise appliance introduced (1928) represented the culmination of years of work and many variations in orthodontic appliance design.   appliance must provide superior predictability and control. The appliance must enhance, and not inhibit treatment progress.
  5. 5.     The appliance must also be aesthetically pleasing, and must enable good oral hygine. The twin edgewise bracket is a passive appliance that independently is unable to effect and control tooth movement because it relies on a ligature to secure it to the arch wire. The inherent limitation imposed by this bracketligature- arch wire relationship ultimately compromises the clinical efficiency of the appliance. The self- ligating brackets transcends the limitations imposed on design by providing treatment efficiency and precise tooth movement
  6. 6. SELF- LIGATING BRACKETS: ACTIVE VERSUS PASSIVE. Passive and Active •Passive brackets use a rigid, movable component to entrap the arch wire. •Tooth control by passive bracket is determined solely by the fit between bracket slot and the arch wire.
  7. 7. Active brackets:    Active brackets use a flexible component to entrap the arch wire. This constrains the arch wire in the arch wire slot and has the ability to store and subsequently release energy through elastic deflection. A self – ligating bracket : “a bracket, which utilizes a permanently installed, moveable component to entrap the arch wire.”
  9. 9. HISTORICAL PERSPECTIVE:    The first patent for a self-ligating attachment, the Boyd band bracket, was filed by Charles. E. Boyd (1933). Later James. W. Ford filed a patent for the Ford lock design, which was manufactured by the Dee Gold company of Chicago, Illinois. This bracket was reintroduced by his son William F. Ford.(1951),but it was primarily marketed for Johnson twin wire technique.
  10. 10. Boyd band bracket
  11. 11.    The Edgelok bracket was the first self-ligating bracket designed to enjoy any sort of commercial success. (1971) Another design was found in 1980’s called Mobil – Lock. Both were passive brackets that achieved limited acceptance in orthodontic community. In the mid 1970’s an entirely new generation of self-ligating appliance began, one that was active not passive, G.H. Hanson’s SPEED appliance was a revolutionary step in orthodontic bracket design.
  12. 12. Edgelok bracket Mobil-lock bracket SPEED bracket
  13. 13.   In (1986) the obsolete self ligating Activa bracket designed by E. Pletcher, also offered an alternative to conventional ligation. Some deficiencies, such as the ease with which the patient could open the bracket, and the excessive mesiodistal width, led to its commercial demise. The next self-ligating design, the Time bracket entered the market place in 1995. This is largely a passive self-ligating mechanism.
  14. 14. Activa bracket Time bracket
  15. 15.  One year later in 1996,the Damon bracket was introduced, named the Damon SL I. This design was passive, and because of problems with the bulky slide and limited tooth control, its commercial life span was short.  The Twinlock bracket was A.J. Wildman’s second endeavor, after Edgelok bracket.  The Twin lock bracket was modified slightly and renamed as Damon II bracket. The bracket is now named as Damon 2 bracket.
  16. 16. Damon SL 1 bracket Twinlock bracket Damon 2 bracket
  17. 17.  In (2004) a passive, hybrid composite- metal bracket, the Damon 3 bracket was found.  The introduction of In - Ovation bracket in 2000 was an attempt, similar to the Damon design. The Elgiloy spring clip renders the In – ovation an active self-ligating appliance.
  18. 18. Damon 3 bracket In-Ovation-R bracket
  19. 19. Comparison of self- ligated and ligated brackets: Ligation stability Ligation Force level Friction Sliding mechanism Office visits Treatment time Esthetics Patient comfort Oral hygiene Infection control Instruments Staff
  20. 20. Benefits of self-ligating brackets:    Self-ligating brackets result in greater patient comfort, shorter treatment time, reduced chair time, and greater precision and control of tooth translation. Self-ligating bracket design permit the use of lighter force levels and impart lower frictional forces compared with ligated brackets. Friction during tooth translation is reduced significantly, due to elimination of steel or elastic ligatures.
  21. 21.   Self-ligating brackets has been reported to reduce the risk of percutaneous injury and the potential for transmission of hepatitis B virus, hepatitis c virus, or human immunodeficiency virus for the orthodontist and the support staff, self-ligation decreases the possibility of soft tissue laceration and infection from the cut end of ligature ties. The elimination of tie – wings and other type of food traps on some self-ligating bracket designs significantly elevates the hygiene level of all patents.
  22. 22. BRACKET PLACEMENT:   Care must be taken to position the miniaturized SPEED brackets as accuratly as possible to enhance the action of the spring clip in tooth positioning. few key points to assist accurate bracket placement: The curved spring portion of the SPEED bracket should be positioned occlusally in both arches.
  23. 23.    The upper brackets are positioned to conform to an arch wire plane compatible with brackets placed as far gingivally as possible on the typically short clinical crowns. Use of single SPEED brackets on the upper molars has significant advantages: Rotation control offered by the spring clip creates a superb molar rotation. Longer span between molar brackets provides for more efficient use of compression coil springs for molar distalization.
  24. 24.  Use of a bracket on the terminal molars enables rapid arch wire changes, in situations where the ends of arch wire have been cinched back.  To avoid occlusal interference problems on the lower first and second molars, use of miniaturized mandibular tubes rather brackets is recommended.
  25. 25. THE SPEED SYSTEM: Introduction of vastly improved arch wires, the evolution of the preadjusted appliances, and the perfecting of the various bonding techniques stands out as major milestones in the advancement of the art and science of the clinical orthodontics.  A new edgewise appliance was developed for introduction to our profession, to facilitate arch wire changes and to permit the application of corrective forces. 
  26. 26.    More than 600 patients have undergone treatment with this new appliance. The acronym SPEED has been chosen to identify the appliance and the system of treatment which is continuing to evolve with its use. The name is derived from the descriptive terms Spring-loaded, Precision, Edgewise, Energy, and Delivery, all of which describe the design. The main component of the appliance are, mutilated bracket body, a spring clip, and a foil- mesh bonding bases.
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  28. 28.     The spring clip: Highly resilient spring clips are formed from a high tensile 17-7 precipitationhardening 0.005 by 0.006 inch stainless steel strip. This has a short labial arm joined to a longer lingual arm by an 0.025 inch. After forming and prior to assembly, the springs are precipitation hardened for 1 hour at 900 degree. The bonding bases: The bonding pads are just wide enough for a secure laser seam weld to each bracket flange.
  29. 29. Labial, mesial and distal edges of each pad are parallel to one another and angulated relative to the occlusal edge required by the type of the tooth to which it has been assigned.  All pads requiring mesiodistal curvature are bent about a central axis parallel to their mesial and distal edges.  Bracket-spring assembly: The spring clip is mounted on the bracket body, and when the spring is in the slot-closed position, its arms are held apart to reduce their angle. 
  30. 30.    Mounting the spring on the bracket body in the slot-closed position converts the arch wire slot into a trapezoidal tube having three rigid walls an elastic inclined labial wall. Welding the bracket-spring assembly to its bonding base transforms the vertical lingual slot into a lingual arm of the clip in a closetolerance fit. Operation of the SPEED bracket: The spring is opened by approximately 10 ½ ounces of occlusally directed force to the gingival edge.
  31. 31.    Once the gingival edge of its labial arm has passed over the short ledge immediately occlusal to the arch wire slot, the spring appears to jump the rest of the way into its parked-open position by itself. The spring clip can be returned to the slotclosed position by application of a light gingivally directed force. During insertion, an arch wire must be held all the way into the slot, at least until the labial arm of the spring clip has trapped it.
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  33. 33.     • The SPEED appliance has been designed for precise rotational control about three axes: The occlusogingival axis (rotation). The labiolingual axis (tipping). The mesiodistal axis (torque). Rotational control about the occlusogingival axis: The bracket and the entrapped arch wire bear a relationship to one another, where only least amount of elastic strain imparts to the spring clip. No rotation of the bracket around the occlusogingival axis away from this position is possible without additional elastic deformation of the spring.
  34. 34. • The spring clip is holding the arch wire captive and is subjecting it to a 15 degree counterclockwise bend The arch wire is deflecting the labial arm of the spring clip labially and distally and also giving it a clockwise twist. Rotational control about the faciolingual axis: The effectiveness of an edgewise appliance in controlling tooth tipping is dependent on the size of the arch wire and bracket slot used. A tight fit between the arch wire and the bracket slots can cause excessive frictional binding.
  35. 35. • The SPEED appliance permits improved control over tipping movements, a higher degree of constancy of light force, and a reduction in the frictional resistance to sliding movements. Rotational control about the mesiodistal axis: (torque control ) – The SPEED appliance is designed for a high degree of control over labiolingual tooth tipping, similar to all edgewise appliance.
  36. 36. TECHNIQUE  Clinical experiences taught some points when using the SPEED appliance: The curved portion of the bracket should be directed toward the occlusal in both arches so that the spring which wraps over it will always be to move into the slot-open position. Lower brackets should be positioned far enough gingivally to avoid even the lightest occlusal interference.
  37. 37. Unless overrotation are required, each bracket should be centered on the middle lobe of the tooth, with its mesiodistal slot axis parallel to a tangent drawn to the lobes curvature at its midline. Because of their small size and individualized compound curvature, SPEED bracket bases require very little fitting. Accurate placement of brackets is aided by bearing in mind that the occlusal edge of each bonding pad is parallel to the arch wire slot. An excellent instrument for opening and closing the bracket spring clips is a Silverman PD-1 band pusher and director.
  38. 38. ARCHWIRE HOOKS FOR THE SPEED SYSTEM:   The SPEED Arch Wire Hook permits the use of interarch or intra-arch elastics with any size or shape of arch wire. The hook consists of a tapered, split inner male component that rests, by a friction fit, inside a slightly less tapered outer female collar. The SPEED Arch Wire Hook has three major advantage: It will never move or creep along the arch-wire, as the male and the female.components are squeezed together.
  39. 39. B A
  40. 40.  Its load and lock process is extremely simple and fast. The hook saves chair time. It was specifically designed to provide a secure method of applying force to a wire of any material. Technique: Seat the arch wire in the open SPEED bracket slots. The preassembled positions of the inner and outer components help align the split portion of the inner sleeve with the outer hook. Be sure that the hook assembly of the outer female component is facing in the desired direction for elastic traction.
  41. 41.    Rotate the outer sleeve with the hook to the desired bucolingual position, using a fine ligature director, while holding the SPEED hook in the marked on the arch wire. With gentle, but firm, plier pressure, guide and then squeeze the tapered, split inner male component into the outer female component, without disturbing the archwire hook. The technique described above is a simple, quick and highly accurate means of adding a SPEED hook to any arch wire. No laborious soldering is required.
  42. 42. SUPERCABLE AND THE SPEED SYSTEM:   Round and rectangular multistranded cables such as Wildcat and Respond have been wildly used, but are still limited by the mechanical properties of the stainless steel. In 1985, Burstone and colleagues reported on a new superelastic Chinese nickel titanium wire with a spring back 50% greater than nitinol and 400% greater than stainless steel.
  43. 43.  In 1993, Hanson combined the mechanical advantages of multistrand cables with the material properties of superelastic wires to create a superelastic nickel titanium coaxial wire, called the Supercable. The resulting loading and the unloading forces were measured by the Instron machine.  It was found that both .016” and .018” Supercable wires exerted only 36-70% of the force of .014” solid nickel titanium wires. 
  44. 44. CLINICAL USE OF SUPERCABLE:    Most clinically significant finding was that the . 016” and the .018” Supercable wires were the only , that tested at less than 100g of un loading force over a deflection range of 1-3mm. Supercable thus demonstrates optimum orthodontic forces for the periodontium. As directed by Reitan and Rygh (1986). It also offers the clinician the advantage of engaging a relatively large arch wire at the start of the treatment.
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  46. 46. Supercable offers the following advantages when combined with SPEED bracket system: .Minimal patient discomfort. Improved treatment efficiency.  Simplified mechanotherapy. Elimination of arch wire bending. More effective and efficient control of rotational, tipping, and leveling mechanics. No evidence of anchorage loss Minimum patient discomfort.
  47. 47. DISADVANTAGES: • Tendency of the wire to fray if not cut with sharp instrument. • Tendency of the arch wire to break and unravel in extraction spaces. • Inability to accommodate bends, steps or helices. • Tendency of the wire ends to migrate distally, and occasionally irritate soft tissues.
  48. 48. THE DAMON BRACKET:    The Damon system achieves the biologically induced tooth moving force, by means of a passive, virtually friction free, self-locking fixed appliance that maximizes the full potential of today’s high-tech arch wires. The clinical results indicate that clinicians can maintain most complete dentitions, even in severely crowded arches, by using very light-force, high-tech arch wires in the passive Damon appliance that alter the balance of forces among the lips, tongue, and muscles of the face. The author refers this phenomenon as “physiologically determined” tooth positioning.
  49. 49. Early observations of Damon system:  Dwright H. Damon first started using this new passive tube tecnology in the mid 1990’s, it became obvious that alveolar bone, tissue, and teeth responded differently from those treated with conventional high-force mechanics. The system offers minimal negative impact on the arch form when aligning severely malpositioned teeth. With this tube technology and lowforce, low-friction mechanics, adverse effects like intrusion and flaring are minimized or eliminated.
  50. 50. The appropriate force and wire-to-lumen ratio produces a frankle-type arch-widening effect in the posterior, while lower canine width stays approximately same. The orbicularis oris and mentalis muscles create a lip bumper effect, which minimizes anterior movement of the incisors. In cases treated with nonextraction, as it widens in the posterior, the tongue usually lifts and moves forward, creating a new force equilibrium between it and the lips and muscles of the face. In bimaxillary protrusive cases treated through extraction therapy, treatment mechanics are simplified greatly with the lip bumper or headgear effect of the facial muscles minimizing the demand on posterior anchorage.
  51. 51. FORCE MANAGEMENT: The means of achieving extremely light-force mechanics: (a passive tube)    The author has spent nearly 20 years carefully evaluating the rationale for his clinical mechnics. One of the earliest tube systems, the twin-wire capand-channel appliance, possessed some of the attributes of current self-locking systems. Unitek introduced an appliance in 1966, its Snap Ring appliance, that was not self ligating, but simulated the concept.
  52. 52.    A later example was the edgelok bracket which was introduced in the late 1960s,was the first “true self-ligating tube-type appliance.” It was comfortable and had a positive-seating mechanism. Another major advancement of that era was the SPEED appliance (an active self-ligating appliance). Here arch wire changing chair time reduced to as little as 25% of that of conventional twin bracket. George Anderson introduced the space-age nickel-titanium wires.
  53. 53.     Maximizing treatment results, requires a passive selflocking appliance (tube) combined with careful selection of arch wires and timing. The Damon bracket meets these demands to meet the optimal force range that stimulates cellular activity without blood flow in the periodontium. Using extremely light forces in passive tube: Using scanning microscopy, Carl Sandstedt (1904) discovered the different responses of tissue to heavy and light orthodontic forces. The Damon system, when properly applied provides patients with the physiological improvement.
  54. 54.
  55. 55.  Light wires acting in almost friction-free environment in the Damon tube appear to correct the functional imbalance and allow the alveolar process to create new arch form.  Moving teeth with high-tech arch wires in passive self-locking tubes generates a healthy alveolar bone and periodontium support that is not as susceptible to relapse.
  56. 56. Damon system appliance:     The preadjusted Damon appliance is available in 0.022”and 0.018” slots. This appliance when used with the recommended arch wire, allows faster, unrestricted tooth movement and a more comfortable patient. Opening the slide in the latest D3 version is done by a opening tool, whereas closing is by finger pressure . Mechanics is based on achieving the following two clinical properties: high-force mechanics should not be used during any phase of treatment, and work with the orofacial musculature.
  57. 57. THE IN-OVATION BRACKET :  THE IN-OVATION BRACKET IS THE WORK OF DIFFERENT PERSONS- Andrews, Roth, and Voudouris. This bracket has created a revolution in time saving for the patient and the orthodontist. CONCEPT OF THE IN-OVATION BRACKET:  This bracket is a true straight wire appliance.  The bracket base is contoured occlusogingivally or incisogingivally and mesiodistally.  Rotation, in-out, and torque are built into the bracket base. 
  58. 58. ADVANTAGES OF INOVATION OVER OTHER SELF LIGATING SYSTEMS:       True fully adjusted three-dimensional appliance. Accurate Roth prescription. Interactive closing spring. No breakage of lock mechanism. Total torque control with no compromise result. Rapid, dependable opening and closing mechanism for arch wire change.
  59. 59. COMPARISON TO OTHER BRACKETS:    Currently, the Damon bracket is the only selfligating straight wire bracket, but the lock mechanism is passive rather than interactive. The interactive closing clip mechanism minimizes friction in the early stages of treatment, when low friction is advantages. The two major problems of passive selfligating brackets are: Inability to control torque and the breakage of the lock mechanism.
  60. 60.
  61. 61. .
  62. 62.  The Smart clip” self – ligation appliance system revolutionizes self-ligation. An integral nikel-titanium clip permits easy and simple arch wire insertion and removable, yet holds the arch wire with a pre-programmed force that avoids unintentional disengagement.  The Smart clip bracket also features a similar twin bracket design and the MBT system prescription.
  63. 63.  Choose either the APC” II adhesive coated appliance system or the APC” plus system with color change adhesive for greater efficiency. These features , exclusively together with Smart clip appliance system combine to bring unmatched efficiencies and more predictable outcomes of orthodontic treatment.
  64. 64. A Comparative study of conventional ligation and self-ligating bracket system:  With the introduction of the Edgelok bracket in 1972, the SPEED system in 1980, and the Activa in 1986, reported a significant reduction in the level of friction, in addition to shorter treatment time and chair time, when compared with conventional bracket system.  A greater demand is placed on the doctor-staff time to maintain the same level of efficiency in the patient care.
  65. 65.     The sample consisted of five different types of o.o22 X o.o28 inch brackets. Each brackets were mounted on a acrylic cylinder and an 0.018 inch arch wire was ligated into each bracket slot. Frictional force was calculated using the universal testing instrument. The results showed no statistical difference in the force values to initiate wire movement for the Activa, Edgelok, SPEED, and the twin bracket with the metal tie.
  66. 66.  The use of the elastomeric power module revealed a higher level of mean frictional resistance of 3.07 ounces with the SPEED bracket system when compared with Activa bracket system (12.64 ounces) or the Edgelok bracket system (1.42 ounces.  The time involved to open the self-ligating brackets illustrated a significant decrease in time when compared with the conventional ligation method.
  67. 67. Time Savings with Self-ligating brackets:   Despite a wide range of protective techniques for sterilization and infection control, orthodontists are still exposed to infectious hazards. The possibility of puncture wounds from ligatures raises the question whether to use ligatures. Self-ligating brackets were introduced in 1970s and include the SPEED appliance and Mobilok and Quicklok brackets.
  68. 68.     Using the self-ligating brackets frees an additional few minutes of the appointment for positive reinforcement of proper oral hygiene. Two patients of self-ligating can be scheduled in the time of one conventional half-hour arch change appointment. Manufactures of self-ligating brackets have always emphasized the advantages of improved esthetics and comfort. The reduced chair time is another significant advantage of the self-ligating brackets – whether the time is used to schedule more patients, or increase practice efficiency.
  69. 69. A prospective survey of percutaneous injuries in orthodontists:   Last two decades has seen an increaseed awareness of occupational injury, and a dramatic increase in HIV patients and Hepatitis B has been an lethal consequences to the health care provider. A stratified random sample of practicing orthodontists were used, 2800 orthodontists were used to complete the survey.
  70. 70.    The results of this study indicate that the orthodontists have a rate of percutaneous injury that is low in relation to most other generalists and specialist in dentistry. The largest number of injuries was associated with the manupulation of the arch wires, although burs, scalers, explorers, and rotary disks were also involved. The majority of the percutaneous injury occurred during arch wire changes were to the index finger and thumb.
  71. 71. Conclusion : As more orthodontic practices embrace the concept of self-ligation. It is becoming apparent that stainless steel and elastomeric ligatures will eventually be as out dated as full banding is today. Considering the advantages of selfligating brackets for the clinician, staff and patient, they may well become the “conventional” appliance systems of the 21st century.
  72. 72. REFERENCES:  GRABER, VANASDAL – ORTHODONTIC PRINCIPLES : 2004  Dr. G. Herbert Hanson :- The SPEED system: A report on the development of a new edgewise appliance; AJO : 1980 Vol 78.  Jeffrey L. Berger : The influence of the SPEED bracket’s selfligating design on force levels in tooth movement: A comparative in vitro study; AJO-DO : 1990 vol 97.  Jeffrey L. Berger : The SPEED appliance :A 14- year update on this unique self-ligating orthodontic mechanism; AJO-DO march 1994: vol 3.
  73. 73.     Robert A. Bagramian, James A. McNamara : A prospective survay of percutaneous injury in othodontists; AJO-DO december 1998 : vol 114. Rolf Maijer, and Dennis C. Smith : Time saving with self-ligating brackets; JCO january 1990: vol 24. Prasanna Kumar Shivapuja, and Jeff Berger : AJODO november 1994; vol 106. Susan Thomas, Martyn Sherriff, and David Birnie : A comparative in vitro study of the frictional characteristics of two types of self-ligating brackets and two types of pre-adjusted edgewise brackets tied with elastomeric ligatures; EJO 1998 : vol 20.
  74. 74.   Jeff Berger: Self-ligation in the year 2000; JCO February 2000: vol 34. G. B. Read-Ward, and S. P. Jones: A comparison of self-ligating and conventional orthodontic bracket system; BJO 1997: vol 24.
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