Selfligating brackets /certified fixed orthodontic courses by Indian dental academy


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Selfligating brackets /certified fixed orthodontic courses by Indian dental academy

  1. 1. LIGATING BRACKETS INDIAN DENTAL ACADEMY Leader in continuing dental education
  2. 2. SELF LIGATING BRACKETS • Introduction • Types of Self Ligating Brackets • Advantages of Self Ligating Brackets • Conclusion
  3. 3. INTRODUCTION    Self ligating Brackets are a Ligatureless bracket system that has a mechanical device built into the bracket to close off the slot. The concept of Self ligating brackets has been in existence since 1935 . Russell lock edgewise attachment was the first self ligating bracket and was described by Dr Jacob Stolzenberg in 1935. Newer designs of these brackets continue to appear even today.
  4. 4. Properties of an ideal ligation system The concept that brackets are ligated via tie-wings is so prevalent that it is worthwhile considering a list of ideal properties of any ligation system. Ligation should :  be secure and robust;  ensure full bracket engagement of the archwire;  exhibit low friction between bracket and archwire;  be quick and easy to use;  permit high friction when desired;  permit easy attachment of elastic chain;  assist good oral hygiene;  be comfortable for the patient.
  5. 5. DRAW BACKS OF CONVENTIONAL LIGATION  Failure to provide and to maintain full archwire engagement.  High friction.  For elastomerics, the force (and therefore tooth control) decays and they are sometimes lost.  Potential impediment to oral hygiene.  Wire ligation is very slow. Wire ties are secure, robust, enable full, partial or distant ligation, and have lower friction than elastomerics. Their largest drawback is the time required for ligation. Elastomerics are quick, but less good in every other respect. Neither method is ideal or nearly as good as a molar tube assembly, which is universally adopted as the ‘ligation’ of choice on posterior teeth.
  6. 6. Advantages of Self Ligating Brackets These advantages apply in principle to all selfligating brackets, although the different makes vary in their ability to deliver these advantages consistently in practice:  More certain full archwire engagement;  Low friction between bracket and archwire;  Less chairside assistance;  Faster archwire removal and ligation.
  7. 7. Self ligating brackets ACTIVE CLIPS PASSIVE SLIDES
  8. 8. ACTIVE CLIP BRACKETS Speed – Orec – 1980 Time - Adenta - 1994 EvolutionLT – Adenta – 2002 Inovation – GAC – 2000 Inovation – R – GAC –2002
  9. 9. PASSIVE SLIDES BRACKETS Edgelock – Ormco – 1972 Mobil lock – Forestadent – 1974 Activa – A company – 1986 Damon SL – A company - 1996 Twin lock – Ormco – 1998 Damon 2 - A company – 2000 Damon 3 – A company -200 Smart clip – 3M unitek
  10. 10. Russell Lock Edgewise Attachment First Self Ligating Bracket described by Dr. Jacob Stolzenberg Year 1935.It is an edgewise appliance. • Russell bracket had a flat head screw seated snugly in a circular, threaded opening in the face of the bracket
  11. 11. • Horizontal screw could be loosened or tightened with a small watch repair screw driver to obtain the desired tooth movement • Loosening allows bodily translation of round wire,whereas tightening facilitates root torquing with rectangular wire. • The flat lingual surface of this nut created a fourth wall to the arch wire slot and its variable position controlled arch wire activity
  12. 12. EDGE LOCK BRACKET First Passive Self Ligating Bracket described by Dr. Wild man in the Year 1972. • Edgelock bracket had a round body with a rigid labial sliding cap. A special opening tool was used to move the slide occlusally for archwire insertion. When the cap was closed over the archwire with finger pressure, the bracket slot was converted to a tube with in which the arch wire had total freedom of movement.
  13. 13. Mobil Lock Bracket • It is a Passive edgewise Self Ligating Bracket described by Dr. Franz Sander in the Year 1974. • Mobil lock bracket had a rigid Semicircular labial disk • A Special opening Tool was required to open and close the semicircular labial disk. • The passive outer wall transformed the bracket slot in to a tube that loosely contained the arch wire.
  14. 14. Evolution of self-ligating bracket designs depicting path of travel for outer (fourth) wall, view of a maxillary, left canine SPEED appliance.
  15. 15. SPEED bracket It is an Active Self ligating Bracket described by Dr. Hanson in the year 1975. Components of SPEED Bracket • Bracket body • Spring clip • In-out adaptor • Mesh pad
  16. 16. Bracket body • Single bracket body system • Body design is narrow for the Anteriors . • Body design slightly wider for the posteriors which features a miniaturized mushroom-shaped hook that neatly projects from the distalgingival of each bracket body. • Multislotted.
  17. 17. 1. Pre torqued arch wire slot • Arch wire slot is available in either 0.018 x 0.025 inch or 0.022 x 0.028 inch to accommodate round, rectangular,and SPEED shaped arch 2. Auxiliary slot wires • It is 0.016-inch square auxiliary slot • It runs parallel to the main arch wire slot occlusally. • Auxillary slot remains as a tube even when spring clip is in open position 3. Spring retainer slot • The spring retainer slot houses the recurved tip of the spring clip.
  18. 18. Spring clip a ) Roll-shaped, flexible spring clip b ) Highly resilient spring clip opens and closes in a vertical manner to permit arch wire removal and insertion c ) Shape of the clip eliminates any possibility of accidental arch wire release through the incorporation of a recurved tip. In-out adaptor Adaptor features both an angular and a translational dimension,Which ensures the creation of an exceptionally smooth arch form. Mesh pad Foil mesh bonding pad
  19. 19. Advantages of SPEED Bracket Size a ) It is 30% less in size of conventional PEA brackets. This smaller size adds ease to bond on small and partially erupted tooth b ) Esthetics Auxillary slot a ) Preformed hooks for use with elastics b ) Segmental arch wires c ) A ligature tie or elastomeric thread may be fed through the slot and then tied to the arch wire
  20. 20. Bracket Base It consists of sintered porous metal coating which is an irregular microscopic stainless steel particles fused together and to the bracket base to create network of pores for a strong adhesive grips which in turn increases the bond strength. Mushroom hook Mushroom hook permits the gingival positioning of the elastomeric power module and hence, the chances of frictional drag between the arch wire and the elastomeric power module become nonexistent.
  21. 21. Activa bracket It is Passive Self Ligating Bracket described by Erwin pletcher in theYear 1986 •Activa bracket had an inflexible, curved arm that rotated occlusogingivally around the cylindrical bracket body •The arch wire is retained by a resilient clip that rotates into a retaining groove.
  22. 22. • Clips can be opened and closed with a wide range of commonly used hand instruments including ligature directors, flat plastics, and Mitchell's trimmers • Vertical slots behind the arch wire channel. Advantages of vertical slot • T-shaped locking pins are used for Closure of diastema with T pins and elastic chain • Ligature connection of palatal canine to buccal sectional wire • Rotating spring used to overrotate a canine.
  23. 23. Disadvantages of Activa Brackets Higher bond failure rate Bases are slightly smaller than covventional brackets which lead to less rigidity of the bracket base and easier distortion of the base and consequent bond failure under external loading forces Less convenient with power chain When closing the multiple spaces, elastic chain must either be placed behind the arch wire or T-shaped locking pins must be placed in several brackets.
  24. 24. Difficulties during bracket placement Tie-wings are useful holding points for tweezers and their absence dictates minor changes in bracket placement technique especially with canine brackets Breakage of arch wire retaining clips Clip breakages are mainly due to the excessive force while trying to engage a stiffer arch wire . If a clip breaks, it is possible to replace it with a new clip without removing and replacing the bracket.
  25. 25. Time bracket Active Self Ligating Bracket described by Wolf Gang Heiser in the Year 1994 First one-piece self-ligating system with CAD/CAM computer technology Time bracket had a rigid curved arm that wraps occlusogingivally around t he labial aspect of bracket body
  26. 26. • Spring clip can be opened by dental probe • The spring clip can be removed by overopening it or by sliding it mesially or distally. Disadvantages of Time Brackets • Bracket base has microetched mechanical undercuts • With one piece bracket system,the distance between slot and base is increased which inturn reduced the inout values.This is more marked in lower incisor with reduction of prominence by 1/3
  27. 27. TwinLock bracket Is a Passive self ligating Bracket described by Jim Wildman in the Year 1998 Twin lock Bracket had flat, rectangular slide, housed between the tie wings of an edgewise twin bracket. Passive slide is moved occlusally into the slot open position with a universal scaler Passive slide is moved gingivally with finger pressure to entrap the archwire in a passive configuration.
  28. 28. Damon SL I bracket Is a Passive self ligating bracket described by Dwight Damon in the Year 1996. Damon I had a Flat rectangular slide outside the face of bracket, which straddled along the tie wings The slide clicked into a positive open or shut position and opened in a downwards direction in both jaws to give a full view of the slot. A tiny U – shaped wire spring lays under the slide to provide positive open and shut position
  29. 29. Disadvantage of DamonSL I Bracket • Inadvertent opening of the slide • Loss of Slide Can be due to Breakage of slide caused by work hardening of slide corners and also due to the overall length of the slide and the play in the slide/bracket contact. This permitted over-opening of the slide, which could pass beyond the stop provided by the underlying U-shaped wire.
  30. 30. Damon 2 bracket Is a Passive self ligating bracket introduced by Dr. Dwight Damon in the Year 2000. The imperfections in Damon brackets led to the development of Damon2 brackets.
  31. 31. These brackets retain the same vertical slide action and U-shaped spring to control opening and closing, but place the slide within the shelter of the tiewings. Combined with the metal injection moulding manufacture, which permits closer tolerances, these developments have almost completely eliminated inadvertent slide opening or slide breakage. Slides can be opened and closed with conventional light wire plier. Slide can be opened inferiorly in both arches in order to give an unobstructed view of the slot.
  32. 32. DAMON -3 1. A combination of clear material and stainless steel provides the aesthetics your patients will love. 2. Remarkably easy-to-use slide mechanism makes wire changes easier. 3. Ultra-smooth contours and rounded edges provide maximum comfort. 4. Slot with four solid walls facilitates fast low-friction tooth movement with maximum control. 5. High-retention mechanical bonding base assures strong, reliable bonding.
  33. 33. GAC IN – OVATION BRACKET Is a First twin bracket with active clip Micheal C Alpern in the Year 2002
  34. 34. • These are very similar to the SPEED bracket in conception and design, but are of a twin configuration Bracket manufactured with metal injection moulding • V – Tool(Tweezer ) is used for opening the clip • Active clip which is made from cobalt chromium alloy is highly resistant to fracture Slot Blocker : • Prevents archwire from escaping from the bracket • Torque Expression
  35. 35. Horizontal slot • This slot runs through the occlusal wings Super mesh base • This houses a wide mesh over a tighter mesh Disadvantages • Gingival end of the spring clip is difficult to open especially in the lower arch.
  36. 36. In-Ovation-R In-Ovation-R remains passive with small leveling wires, while it actively seats your finishing wires. In-Ovation-R's hook is smooth and rounded for enhanced function, aesthetics, and patient comfort. full rotational control with the clip's full span and slot blocker is possible. Easy to Open and Easy to Close. Functionality
  37. 37. Oyster Self Ligating Bracket First Translucent Self Ligating Bracket Year : 2003 • Strong,Fiberglass reinforced composite polymer • Cap can be removed and place back again • Mushroom hook for elastic attachment Disadvantage • Poor Dimensional Stability • Staining nature
  38. 38. PHILIPPE SELF LIGATING LINGUAL BRACKET Philippe Self ligating Brackets were introduced in the year 2002 • These brackets can be bonded directly to the lingual surface of the tooth • Bracket wings are opened with Haideman spatula • Brackets are closed with a Weingart utility plier .
  39. 39. Advantages • Post-treatment retention • Limited intrusion • Closure of minor spaces. • Correction of mild crowding • Alternative to conventional lingual brackets in cases that do not require 3rd - order tooth movements Disadvantages • These brackets do not have slots
  40. 40. SMART CLIP SELF LIGATING BRACKETS Has Twin bracket design that lets you keep your preferred treatment techniques.
  41. 41. Manufactured with MBT™ System Prescription and Engineered from nickel-titanium, which has an intrinsic memory for shape and force, the SmartClip™ Bracket self-ligating mechanism secures the archwire in place, yet is specially calibrated to release the archwire if forces exceed a predetermined level. This helps assure that force levels recommended for biocompatible tooth movement are not exceeded, therefore promoting efficient tooth movement with less patient discomfort. The integral clips permit easy and simple archwire
  42. 42. Properties of Self Ligating Brackets 1. LOW FRICTION  In orthodontic sliding mechanics, friction is determined by the type of archwire, the type of bracket and the method of ligation.  In active Self-ligating system, friction is produced as a result of the clip pressing against the archwire. These brackets have greater torque control without unduly increasing the friction.  In the passive self-ligating system, there is no actual contact of the clip with the archwire, The full bracket expression is achieved only when higher dimensional wires are used.
  43. 43. Very low friction with self-ligating brackets has been clearly demonstrated and quantified in work by various authors, for both Activa and Speed brackets, and Edgelok.  Voudouris has reported greatly reduced friction with Sigma and Interactwin prototypes and with Damon brackets. The friction is dramatically lower than for elastomeric rings with conventional brackets and seems to be an inherent characteristic of self-ligating brackets.  Thomas et al. confirmed extremely low friction with Damon brackets compared to both conventional pre-adjusted and also Tip-Edge brackets.  Kapur found dramatically lower friction with both stainless steel and nickel-titanium wires for Damon brackets compared to conventional brackets. With NiTi wires, the friction per bracket was 41 g with MiniTwin and conventional ligation and 15 g with Damon brackets; whilst with stainless steel wires, these values were 61 and only 3.6 g, respectively
  44. 44.  Pizzoni et al have reported that Damon brackets showed lower friction than Speed which in turn had less friction than conventional brackets stating that: ‘In the case of rectangular wires, the Damon bracket was significantly better than any of the other brackets and should be preferred if sliding mechanics is the technique of choice’.  Meling et al examining the effect of friction on wire stiffness concluded that each elastomeric placed in an ‘O’ configuration produces an average of 50 g of frictional force.  Ravnholt and Birte melsen in the year 1998 studied the frictional resistance of self ligating brackets and confirmed the low friction offered by self ligating brackets  In 2004 kusy and henao concluded that the self-ligating brackets performed better than the conventional brackets, more when coupled with smaller dimension archwires
  45. 45. 2. ACCULOCK The precision arm accurately locks the archwire within the dimensions of the slot in an “all or nothing Pattern a) Robust Ligation b) Controlled tooth movement 3. Archflow Archflow describes both flow mechanics of the self ligating bracket along the archwire and the distal drift of the archwire .
  46. 46. 4. Autoseat Active self ligating brackets : Automatic seating of either a round or a rectangular archwire in the base of the slot is responsible for the rotation and Torque control from early of the treatment. Passive self ligating brackets : Passive interaction is almost strictly a one-way force interchange . The archwire presses against the straight precision arm, which then reacts to the archwire force Rotation control is efficiently achieved only by using larger rectangular archwires.
  47. 47. 5. Arch Flexibility a) The low friction of the resilient and flexible stainless steel precision arms reduces inter bracket archwire deflections , resulting in freer, biocompatible three-dimensional tooth movements. b) The narrowest arm and the smallest bracket body, provide additional archwire flexibility.
  48. 48. 6. Anchorage Conservation a) The low friction of interactive brackets allows the application of consistent, light forces for efficient flow mechanics during retraction. This, in turn, reduces posterior anchorage loss b) Lower net force deflect archwire less and facilitate release of binding forces between the archwire and bracket,enhancing sliding of bracket along the archwire.
  49. 49. 7. Asepsis a) The four tie-wing undercuts are left open for the self-cleansing effects of salivary fluids. b) The precision arm is integrated into the bracket body, thus contributing to the prevention of enamel discoloration and gingival inflammation. 8.Comfortable for the patient Patients bonded with self ligating brackets invariably reported that the brackets were smoother and wings did not seem to stick into the cheeks and lips,which reduces the risk of skin perforation and possible infection . And also oral hygiene maintenance is easier than with conventional brckets.
  50. 50. 9.Less chair side time  In 1994 Shivapuja and Berger showed that 12 minutes added time for both archwire removal and placement in conventional method compared to self ligating system (speed)  In 1996,Harridine showed the self-ligating brackets frees an additional seven minutes of the appointment for positive reinforcement of proper oral hygiene, discussion of progress, or simply communicating with the patient.
  51. 51. 10.Patient Acceptance a) Frequency of visit The ability to ensure full and secure engagement of modern, low modulus wires make the interval between appointments even up to 10 weeks. b) Duration of visit More time is utilized for arch wire adjustment and change when conventional brackets are used compared to self ligating brackets
  52. 52. Clinical tips in using self Ligating Brackets  Aids in full archwire engagement with self ligating bracket  Opening and closing Clips / Slides  Prevention of wire pokes  Changing Treatment Mechanics
  53. 53. In cases where anchorage control is needed one can use passive and when anchorage control is less demanding, an active appliance can be used. • Active brackets are preferred in cases which require more tip and torque correction and thus aids in in a better finishing and detailing. • Additional torque should be added to the arch wire in passive self-ligating bracket, or larger dimension arch wire should be used,or expanded archform or design of the bracket should be changed with additional tip and torque values. •
  54. 54. Conclusion Self Ligating brackets thus offer valuable combinations of extremely low friction, secure full bracket engagement and reduction in duration of archwire ligation .These development offer the possibility of a significant reduction in average treatment time and also in anchorage requirements, particularly in cases requiring large tooth movements. While further refinements are desirable and further studies are essential, current brackets are able to deliver measurable benefit with good robustness and easy to use.
  55. 55. REFERENCES      Self-ligating brackets: where are we now? - by N. W. T. Harradine -Journal of Orthodontics, Vol. 30, No. 3, 262273, September 2003AJO-DO 1994 Mar (217-223): The SPEED appliance: A 14-year update on this unique selfligating orthodontic mechanism-Jeffrey L. Berger. JCO 1994 Oct (583-586): Replacement of the Spring Clip in the SPEED Appliance - JEFFREY L. BERGER. AJO-DO 1994 Nov (472-480): Conventional ligation versus self-ligation - Shivapuja and Berger Angle orthodontist 2004 ;74:202–211-Evaluation of the Frictional Resistance of Conventional and Self-ligating Bracket Designs Using Standardized Archwires and Dental Typodont-Sandra P. Henao, BSa; Robert P. Kusy.
  56. 56. REFERENCES EJO 1998 (283-291)-Frictional forces related to self ligating brackets-Luca Pizzoni, Gert Ravnholt and birte melsen.   B J O 1994; 21: 367–373 -Sims APT, Waters NE, Birnie DJ. A comparison of the forces required to produce tooth movement ex vivo through three types of preadjusted brackets when subjected to determined tip or torque values..  Berger JL. The influence of the SPEED bracket’s self-ligating design on force levels in tooth movement: a comparative in vitro study. AJO 1990; 97: 219–228.  Angle orthodontist 2005;75:828-832 - Friction of conventional and self-ligating brackets using a 10 brackets model.  Angle orthodontist 2004;74:816-824 -Frictional forces between lingual measured by a friction and archwires
  57. 57.  Voudouris JC. Interactive edgewise mechanisms: form and function comparison with conventional edgewise brackets. Am J Orthod Dentofac Orthop 1997; 111: 119–140.  Thomas S, Birnie DJ, Sherriff M. A comparative in vitro study of the frictional characteristics of two types of self ligating brackets and two types of preadjusted edgewise brackets tied with elastomeric ligatures. Eur J Orthod 1998; 20: 589–596.
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  62. 62. Thank you For more details please visit