Recent advances inSelf ligating brackets


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Recent advances inSelf ligating brackets

  1. 1. Self Ligating brackets
  2. 2. contents Introduction. History of self ligating brackets. Classification. Difference between Self ligating and Conventional brackets Active versus passive self ligating clips. Advantages and Disadvantages of self ligating brackets. Features of self ligating system. Different types of self ligating brackets. Clinical tips using self ligating brackets. Conclusion. 2 Dr Ravikanth Lakkakula
  3. 3. The dawn of 21st century in orthodontics has been accompanied by significant developments such as emergence profile , golden proportions, altered active and passive eruption, biological width have become important diagnostic considerations. Recent studies on arch length management in mixed dentition have helped clarify ideal time to begin treatment in. Self ligation is “the future of Orthodontics” – Proffit also confirms this by calling self-ligation – the future of orthodontics. Over the years, the basic design of orthodontic brackets has evolved dramatically - Angle’s edgewise bracket,Twin bracket, Pre torqued/Pre angulated and Self ligating brackets. INTRODUCTION 3 Dr Ravikanth Lakkakula
  4. 4. Selfligating brackets are ligatureless bracket systems that have a mechanical device built into the bracket to close off the edgewise slot.The cap holds the arch wire in the bracket slot and replaces the steel/elastomeric ligature.With the selfligating brackets, the moveable fourth wall of the bracket is used to convert the slot into a tube. 4 Dr Ravikanth Lakkakula
  5. 5. These brackets, referred to as “low-friction” brackets with utilizing lighter forces to move teeth because there is much less friction in the system to overcome (Harradine, 2003, 2008). Self-Ligating brackets allow the orthodontist to choose the type of wire and ideal force levels that will be most efficient in the early stages of a patient’s treatment, most notably for leveling and aligning, as well as correcting rotations. The design of the self-ligating brackets is based on the principle that the force used to reposition teeth , should not overwhelm the specialized tissues surrounding and supporting the teeth (Harradine, 2003, 2008) 5 Dr Ravikanth Lakkakula
  6. 6. The concept of Self ligating brackets was not new to orthodontics. It was existing for surprisingly long time in orthodontics , Russell lock edgewise attachment being described by Dr. Jacob stolzenberg in 1935. Newer designs of these bracket have continued to appear even today. This continued popularity of self ligating brackets has attracted more than a small percentage of brackets manufacturers, sales and users. 6 Dr Ravikanth Lakkakula
  7. 7. Light forces are the key to self-ligation. Proponents suggest that low force, low-friction systems allow teeth to travel to their physiologic position because they do not overpower the musculature or compromise the periodontal tissues. Philosophy of self-ligating bracket proponents 7 Dr Ravikanth Lakkakula
  8. 8. Ischemia is not induced in the surrounding periodontal tissues because the forces generated by the small dimension, arch wires are too low to completely occlude the periodontal vascular supply. Heavy forces on teeth cause hyalinization in the periodontal ligament space which brings tooth movement to a halt. 8 Dr Ravikanth Lakkakula
  9. 9. Self-ligating brackets place enough force on the teeth to stimulate tooth movement without completely disrupting the vascular supply and therefore, tooth movement is more effective and physiologic.The final position of the teeth after treatment with the self-ligating bracket systems is determined by the balanced interplay between the oral musculature and periodontal tissues and not by heavy orthodontic forces. Moreover, the design in passive self-ligating bracket also enables teeth to move in the path of least resistance.When the gate is in its closed position, the bracket essentially becomes a tube in which the flexible nickel-titanium arch wire can move freely. 9 Dr Ravikanth Lakkakula
  10. 10. By greatly reducing the amount of friction with passive self-ligating brackets, low force arch wires can work to peak expression and stimulate teeth to move in a more biologically compatible method . Teeth movement is also more efficient when they are allowed to move individually and passive self-ligating brackets offer more freedom for teeth to move to their natural position even though they are still interconnected because the arch wire is never tightly engaged with the bracket slot (Damon, 1998). 10 Dr Ravikanth Lakkakula
  11. 11. History of self ligating brackets 11 Dr Ravikanth Lakkakula
  12. 12. Year Bracket Acti/passive avail Mechanism Picture 1935 Russell Lock active No Circular thread opening 1972 Ormco Edgelok passive No Rigid sliding clip 1980 Forestadent Mobil-Lock passive No Rigid rotational disk 12 Dr Ravikanth Lakkakula
  13. 13. Year Bracket Acti/passi avail Mechanism Picture 1980 Strite Industries SPEED Active Yes Flexible spring clip 1986 “A” Company Activa passive No Rigid rotational arm 13 Dr Ravikanth Lakkakula
  14. 14. Year Bracket Acti/passi avail Mechanism Picture 1996 AdentaTime passive Yes Rigid rotational arm 1996 “A” Company Damon SL passive Yes Solid indented slide 1998 Ormco TwinLock passive No Solid labial slider 14 Dr Ravikanth Lakkakula
  15. 15. Year Bracket Acti/passi avail Mechanism Picture 2000 Ormco/“A” Co. Damon 2 passive Yes Solid indented slide 2000 GAC In- Ovation Active Yes Flexible spring clip 2001 Gestenco Oyster passive Yes Unique snap-on cap 15 Dr Ravikanth Lakkakula
  16. 16. Year Bracket Acti/passi Avail Mechanism Picture 2002 Forestadent Philippe lingual bracket passive Yes Flexible tie wing 16 Dr Ravikanth Lakkakula
  17. 17. Year Bracket Acti/passi avail Mechanism Picture 2002 GAC In- Ovation R active Yes Flexible spring clip 2002 Adenta Evolution LT passive Yes Rotating flexible type clip 2004 Ultradent OPAL Passive Yes Flexible hinge 17 Dr Ravikanth Lakkakula
  18. 18. Year Bracket Acti/passi avail Mechanism Picture 2004 Ormco Damon 3 passive Yes Rigid solid slide 2004 3 M Unitek SmartClip Passive /active Yes Mesial and distally placed Flexible clips 2005 Ormco Damon 3 MX passive Yes Rigid solid slide 18 Dr Ravikanth Lakkakula
  19. 19. Year Bracket Acti/passi avail Mechanism Picture 2006 Ultradent OPAL metal Active /passive Yes Flexible Hinge 2006 Forestadent Quick passive Yes Snap flexible spring 2006 Lancer Praxis Glide passive Yes Removable multiplanar clip 19 Dr Ravikanth Lakkakula
  20. 20. Year Bracket Acti/passi avail Mechanism Picture 2006 GAC system C passive Yes Flexible clip 2006 GAC inovation L passive Yes Flexible clip 2006 GAC innovation C passive Yes Flexible clip 20 Dr Ravikanth Lakkakula
  21. 21. Year Bracket Acti/passi avail Mechanism Picture 2007 3m unitek clarity SL Active / passive Yes Flexible clip 2007 American Orthodontics vision LP passive Yes Flexible clip 2007 Dentauraum discovery passive Yes Flexible lid 21 Dr Ravikanth Lakkakula
  22. 22. Year Bracket Acti/passi avail Mechanism Picture 2009 Ormco Damon Q passive Yes Flexible sliding clip 2009 Ormco Damon aesthetic passive Yes Flexible sliding clip 2009 Smartclip sl3 Active/passi ve yes Mesial and distal flexible clips 22 Dr Ravikanth Lakkakula
  23. 23. CLASSIFICATION On the Basis of Action of Clip or Slide Two types of self - ligating brackets have been developed, active and passive. These terms refer to the mode in which they interact with the arch wire. The active type has a spring clip that encroaches on the slot from the labial/buccal aspect and presses against the arch wire providing an active seating force on the arch wire and ensuring engagement such as In-Ovation (GAC International) , SPEED ( Strite Industries) and Time brackets (Adenta). 23 Dr Ravikanth Lakkakula
  24. 24. In the passive type , the clip does not press against the arch wire. Instead, these brackets use a rigid door or latch to entrap the arch wire providing more room for the arch wire such as Damon (Ormco/”A”Company), SmartClip (3M Unitek, USA) and Oyster ESL (Gestenco International). 24 Dr Ravikanth Lakkakula
  25. 25. Active clip Passive clip Spring clip pressing against the arch wire. System of ligation remains away from arch wire. Active clips reduce the slot size in horizontal dimension.The gingival wall is smaller than occlusal wall.This may have an effect on full 3D Expression. The slot size remains unaffected . passive clips in Damon has a slide that opens and closes vertically on facial surface and Smart Clip has Nickel-titanium clips on either side of tie wings to capture the wire. 25 Dr Ravikanth Lakkakula
  26. 26. On the Basis of Design Selfligating brackets may be of single or twin bracket design. Single SelfLigating Bracket Systems (Interactive single bracket): Based on single edgewise bracket, single self ligating bracket systems used successfully hygienic, non –degrading and nonbinding arch wire engagement while they simultaneously maintained a mild seating force on active arch wires for complete tooth control and optimal time efficiency. Ex: Edgelok, Speed,Activa etc. SiameseTwin Self Ligating Bracket Systems (Interactive twin bracket): The synthesis of the distinct functional characteristics of the interactive single philosophy with the preadjusted Siamese twin form has created the new art and science of Interactive SiameseTwins. Interactive-twins are designed to be independent of conventional elastomeric or metal ligation to achieve relatively low-friction and offers better rotational and torque control. Ex: Time,Twin Lock, Damon System etc. 26 Dr Ravikanth Lakkakula
  27. 27. According to position of clip : 1. cap type. 2. clip type. 3.clamp type. 27 Dr Ravikanth Lakkakula
  28. 28. Difference between self ligating and conventional brackets 28 Dr Ravikanth Lakkakula
  29. 29. Self - ligation Conventional Esthetics Some designs permits significant miniaturization Limited miniaturization Force level Permits use of lighter forces Requires heavier level force Force density Light initial force Higher initial force Friction Predictable, very low Stainless steel : high Elastomeric very high Infection control Significantly reduced risk of precutaneous injury Increased risk of precutaneous injury Instrumentation Fewer instruments are required during arch wire change Many instruments are required during arch wire change Ligation Movable, integral part creates outer fourth wall Stainless steel or elastomeric ligatures Ligation stability Retains original throughout treatment Loses initial shape and tightness Office visits Shorter, less frequent visits Longer, more frequent visits Oral hygiene Wingless designs easy to clean Difficulty to treat food straps Patient comfort Only slight discomfort with wire changes Teeth usually sore after ligation Sliding mechanics Ideally situated for tooth translation slow Treatment time Overall treatment reduced by about four Longer, especially in extraction29 Dr Ravikanth Lakkakula
  30. 30. Active Clip vs. Passive Slide Self-ligating Systems Self-ligating brackets come in a variety of designs from different manufacturers. Overall these designs can be categorized as either active or passive designs.Active and passive systems have been introduced to allow for more efficient sliding mechanisms to reduce the force and increase the rate of tooth movement(Pandis, 2010).This has been a topic of controversy because most of the original claims were published by the manufacturer and not evidence-based. 30 Dr Ravikanth Lakkakula
  31. 31. Active Clip Designs Active clip designs such as the SPEED bracket have an element in the bracket that depresses and makes contact with the arch wire when the wire is engaged (Pandis, 2010). In many designs nickel-titanium is used to exert force onto the wire when it is engaged. In reality active systems are a mix of both passive and conventional systems. This means they have low friction in small round archwires when there is room in the slot to allow for easy sliding of the archwire. As the wire size increases, the spring clip engages the wire and causes the bracket to act similar to a conventional bracket. This allows for more three-dimensional control expressed in larger arch wire. 31 Dr Ravikanth Lakkakula
  32. 32. In addition, these spring clips will exert their own force upon the arch wire giving a greater and longer activation range. Smaller arch wires that do not completely fill the bracket slot can still exert more control. Arguments against use of the spring clips on active brackets are that they change the direction of force in a less desirable direction.This can result in unwanted side effects on the tooth and can throw off finite finishing movements. 32 Dr Ravikanth Lakkakula
  33. 33. Passive Slide Designs As opposed to active clip designs, passive slide designs do not have an “Active” element that exerts force on the wire when the bracket door is closed. Instead, passive slide designs have a “door” that closes around the wire effectively making a tube. Ideally there would be no pressure exerted upon the arch wire , although this is likely possible only when the tooth is in ideal alignment. Passive slide brackets are used when the orthodontist inserts a smaller wire to create less friction early on in treatment, which is very good for freedom of movement (Harradine,2006). 33 Dr Ravikanth Lakkakula
  34. 34. The advantage of a passive slide system is the extremely low level of friction , while the disadvantage is that many practitioners feel there is a lack of finite control during the finishing stages. The same large bracket slot that provides low friction levels during initial stages of treatment diminish “slot-fill” and therefore control of tip and torque on the tooth is compromised in later stages of treatment. During the initial stages of treatment, low friction is advantageous. In the middle and final stages of treatment, low friction is a disadvantage (Roth, 2005). 34 Dr Ravikanth Lakkakula
  35. 35. Advantages of self ligating brackets 1. More certain full arch wire engagement. 2.Low friction between bracket and arch wire. 3.Less chair side assistance and faster arch wire removal and ligation. 4. Reduced overall treatment time. 5. Self-ligation reduces the risk of percutaneous injuries and potential transmission of HBV, HCV, or HIV for both the orthodontist and the staff . 6. Self ligating brackets can also be superior to conventional appliances in treating patients with complications such as hemophilia , swollen gingival tissue due to persistent mouth breathing. 7. More efficient treatment (fewer appointments and increased intervals between appointments). Advantages and disadvantages of self ligating brackets 35 Dr Ravikanth Lakkakula
  36. 36. Disadvantage of self ligating brackets 1.High cost compare to conventional bracket. 2. Because of their low friction design, some practitioners feel they have trouble expressing the minor tooth movements necessary to finish cases (Harradine,2006). 3.The increased size of self ligating brackets can also cause occlusal interferences, particularly in the lower anterior position. There is a lack of evidence to support these claims (Pandis, 2010). 36 Dr Ravikanth Lakkakula
  37. 37. Features of self ligating system 37 Dr Ravikanth Lakkakula
  38. 38. Properties of an Ideal Ligation System Ligation should: 1.Be secure and robust. 2.Ensure full bracket engagement of the archwire. 3. Exhibit low friction between bracket and archwire. 4.Be quick and easy to use. 5.Permit high friction when desired. 6.Permit easy attachment of elastic chain. 7.Assist good oral hygiene. 8.Be comfortable for the patient. 38 Dr Ravikanth Lakkakula
  39. 39. Limitations of Conventional Ligation 1.Failure to provide and to maintain full arch wire engagement. 2.High friction. 3.For elastomerics, the force (and therefore tooth control) decays and they are sometimes lost. 4.Potential impediment to oral hygiene. 5.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. It is easy to find examples of the deficiencies of conventional ligation, but clinicians have become accustomed to tolerating these shortcomings. 39 Dr Ravikanth Lakkakula
  40. 40. 1. Archflow Archflow describes both flow mechanics of the self ligating bracket along the archwire and the distal drift of the initial archwire itself. Tooth distalization with conventional twin systems have referred to it as “sliding” or “walking back”. But severe deflections of the archwire in conventional twin brackets with metal ligation follow a more erratic, zigzag pattern that increases resistance. Features of self ligating brackets 40 Dr Ravikanth Lakkakula
  41. 41. Distal movement of the self ligating bracket can be compared to a flowing liquid. The bracket and arch wire move in union because of the arm and arch wire deflections, which are constantly changing position and also the smoother, undulating shapes of the smaller and more flexible arch wire deflections also contribute to the flow mechanics. This produces significantly less friction than circumferential elastomeric chain or metal ligatures around the four tie wings, which is often used for arch wire engagement. 41 Dr Ravikanth Lakkakula
  42. 42. Thus Self ligating brackets produce a freer distal flow, making initial autorotations less restricted and distal drift of the teeth more efficient. The distally moving archwire in self ligating brackets has a water- wheel effect on the lightly contacting brackets .This accurate distal drift, as compared to the inconsistent distal drift with conventional twin brackets, is especially evident in rotated teeth near extraction spaces. 42 Dr Ravikanth Lakkakula
  43. 43. 2.Acculock. The precision arm accurately locks the arch wire within the dimensions of the slot in an “all or nothing” pattern. This secure robust ligation is very resistant to indent loss of ligation .This is a primary factor contributing to the improvement in controlled tooth movement over conventional ligation. In metal ligation or elastomeric modules engagement, after initial movement of the tooth the displaced archwire will catch the labial edges of the slot and leads to reduced control. Thus full archwire engagement in selfligating brackets maximizes the potential long range of action of modulus wire. 43 Dr Ravikanth Lakkakula
  44. 44. 3.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 light, continuous force of the active clips and early rotation control. 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. 44 Dr Ravikanth Lakkakula
  45. 45. With passive self ligating brackets , rotation control is efficiently achieved only by using larger rectangular archwires. The recommended archwire sequence is 0.014" nickel titanium, 0.016" X 0.025" thermally activated nickel titanium, 0.019" x0.025" stainless steel. In some passive systems (Activa) require changes in certain prescriptions (Roth, for example) and expanded archforms because of the archwire not being seated in the base of the slot. If the archwire is not fully seated, the teeth cannot move toward the final archform. 45 Dr Ravikanth Lakkakula
  46. 46. 4.Arch Flexibility In both active and passive self ligating brackets, the low friction of the resilient and flexible stainless steel precision arms reduces interbracket archwire deflections, resulting in free , biocompatible three- dimensional tooth movements and accurate distal drift. The narrowest arm and the smallest bracket body provides additional archwire flexibility . Increased force in metal ligation produces moderate friction from seating causes undesirably large archwire deflection moments (which often cause bond failures) and archwire binding with resultant patient discomfort. 46 Dr Ravikanth Lakkakula
  47. 47. 5.Anchorage Conservation 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. Lower net force deflects arch wire less and facilitate release of binding force between arch wire and bracket, enhancing sliding of bracket along the arch wire. The high friction of conventional twin brackets with repeated elastomeric or metal ligation eventually controls tooth movement, but resists flow mechanics and thus taxes anchorage. Brackets with shoulders that lift ligatures away from large round archwires have near-zero friction and avoid straining anchorage, but can compromise tooth control. 47 Dr Ravikanth Lakkakula
  48. 48. 6.Asepsis The four tie-wing undercuts are also left open for the self-cleansing effects of salivary fluids. The precision arm is integrated into the bracket body, thus contributing to the prevention of enamel discoloration and gingival inflammation. Conventional ligatures retain plaque, calculus and food debris external to the bracket body. 48 Dr Ravikanth Lakkakula
  49. 49. 7. Comfortable for the patient In 1990,Rolf major showed Patients bonded with self ligating brackets invariably reports the brackets are smoother and wings do not seems to sticks in to the cheeks and lips, which reduces the risk of skin perforation and possible infection. Even though Elastomers are good wire ligature requires careful tuckering into the ends to avoid soft tissue trauma and can occasionally be displaced between appointments and cause discomfort. This mechanisms project an image of clean, precise, punctual treatment. Reduction in bracket profile further adds esthetics. 49 Dr Ravikanth Lakkakula
  50. 50. 8.Adaptation The Flexible archwire is not bound by ligatures so the vertical elastics over the open tie wings will work with the low-friction, to provide excellent dental adaptation and ideal occlusal interdigitation. The muscles of mastication will further assist through chewing and swallowing, since the finally, flexible archwire is not bound by ligatures. 50 Dr Ravikanth Lakkakula
  51. 51. 9. Patient Acceptance a) Frequency of visit The ability to ensure full and secure wire engagement of modern, low modulus wires make an of the interval between appointments even up to 10 Weeks b) Duration of visit Berger showed , stainless steel : 6-7 minutes, Elatomeric Modules : 2 minutes Self ligating : less than 1 minutes(Speed least to damon most) In 1990,Maijer & Smith showed that with conventional edgewise brackets requires an average of 10 minutes for archwire removal and replacement, and six minutes for the orthodontist's adjustments.Assuming that the average patient takes five minutes to arrive and depart, a total of 21 minutes has been used. On the other hand, the average self-ligating case would take 14 minutes. 51 Dr Ravikanth Lakkakula
  52. 52. In 1990,Smith showed that anterior self ligating brackets were four times as fast in removing and placing arch wire than the other operator with edgewise brackets. In 1994 , Shivapuja and Berger showed that overall 12 minutes added time for both archwire removal and placement in conventional method compared to self ligating system(speed). In 1996,Harridine showed using the selfligating brackets frees an additional seven minutes of the appointment for positive reinforcement of proper oral hygiene, headgear, lip bumpers or elastic wear, discussion of progress or Simply communicating with the patient. Another possibility is that two patients with selfligating brackets could be scheduled in the time of one conventional half-hour arch change appointment. 52 Dr Ravikanth Lakkakula
  53. 53. 10. FRICTION Friction is defined as a force that retards or resists the relative motion of two objects in contact, and its direction is tangential to the common boundary of the two surfaces in contact. Static friction is the force needed to start movement kinetic friction is the force needed to maintain movement once started. In orthodontic sliding mechanics, friction is determined by the type of archwire, the type of bracket and the method of ligation. 53 Dr Ravikanth Lakkakula
  54. 54. Frank and Nikolai(1980) describes Friction is related to applied force which is influenced by the degree of tension of ligature engaging arch wire in bracket and co-efficient of friction between ligature and arch wire materials. Schumacher et al (1990 ) describes friction is determined mostly by method of ligation rather than dimension of arch wire. Proffit-1993 describes Due to appliance inefficiency, friction and kinematics of tooth movements , it becomes extremely difficult to determine and control the magnitude of force received by an individual tooth. 54 Dr Ravikanth Lakkakula
  55. 55. In active Selfligating system, friction is produced as a result of the clip pressing against the arch wire. These brackets have greater torque control without unduly increasing the friction. In the passive selfligating system, there is no actual contact of the clip with the arch wire, The full bracket expression is achieved only when higher dimensional wires are used. The active selfligating bracket produced 216 times more the friction of a passive self ligating bracket. 55 Dr Ravikanth Lakkakula
  56. 56. In 1998Voudouris measured the friction produced by three types of conventional twin brackets compared to three self ligating brackets: one active (Sigma) and two passive (Damon SL I and TwinLock).When 0.016,0.018,0.020,0.019 x0.025 Niti, and Stainless Steel wires were drawn through the bracket, a) As the diameter of arch wire increases, friction increases. b)A conventional twin ligated with elastomeric rings produced 388 to 609 times more . Conventional twins with metal ligatures were found to have friction values more than 300 times those of passive self ligating brackets. The active self ligating bracket produced 216 times the friction of a passive self ligating bracket. 56 Dr Ravikanth Lakkakula
  57. 57. In 1998, Damon showed in 0.022 slot 0.019 x 0.025 wire is preferable.This will free an 0.03 inch clearance , provided with lesser friction and better tooth control. In 1998 Rupali kapur showed that 0.17N for 0.014 Niti, 2.15N for 0.019 x0.025 SS in conventional brackets. 0.01N for for 0.014 Niti,0.75N for 0.019x0.025 SS inTime brackets 0.01N for for 0.014 Niti,0.07N for 0.019x0.025 SS in DamonSL brackets Distance between spring clip and bracket base forTime 0.018 inch and Speed bracket is 0.016inch. When arch wire used are lesser than this dimension ,there will not as much difference in friction between the brackets. 57 Dr Ravikanth Lakkakula
  58. 58. SEM study showed, smoother surface of Damon bracket was due to metal injection moulding , which lowers kinetic friction than conventional brackets. In 1998 Pizzoni showed minitwin >speed >Damon regarding kinetic friction. In 1998Thomas showed preadjusted edgewise >Tip edge> Damon regarding kinetic friction. 58 Dr Ravikanth Lakkakula
  59. 59. In1994 Shivapuja and Berger showed when force is applied away from the center of resistance tooth will tip until the wire touches the corner of the brackets. This will be applicable to both self ligating and conventional brackets.Thus second order angulation affects more than the type of ligation. This was also shown by Loftus in1999 that most of the studies uses a fixed base medium. But normal tooth movement will be as stated by Shivapuja and berger. Both of them showed that no difference between conventional and self ligating brackets regarding friction. 59 Dr Ravikanth Lakkakula
  60. 60. In 2003, Vittorio and sfondrini showed Friction of Esthetic Self ligating brackets is comparable to conventional Selfligating brackets and coventional brackets shoe less friction than Ceramic Brackets. For esthetic reasons this bracket is used as an alternative to ceramic Brackets. 60 Dr Ravikanth Lakkakula
  61. 61. Different types of self ligating brackets 61 Dr Ravikanth Lakkakula
  62. 62. Russel lock edgewise attachment First Self-ligating brackets were introduced in the mid-1930s in the form of the Russell attachment by Newyork orthodontic pioneer Dr. Stolzenberg . The bracket had a flat-head screw seated snugly in a circular, threaded opening in the face of the bracket that allows for quick and Simple arch wire changes. Horizontal screw could be loosened or tightened with a small watch repair screw driver to obtain the desired tooth movement. 62 Dr Ravikanth Lakkakula
  63. 63. Loosening the screw made the system passive and allowed bodily translation on a round wire while tightening it made it active and provided root torquing on a square or a rectangular wire. Advantages The bracket system was more comfortable for the patient and shorter office visits and shorter treatment time . Perhaps because Dr. Stolzenberg was ahead of his time, the concept of self-ligating brackets fell more or less into obscurity until the early 1970s. 63 Dr Ravikanth Lakkakula
  64. 64. Edgelock bracket The first modern passive self ligating bracket (Edgelok- Ormco ) was introduced in the early 1970’s which had a round body with a rigid labial sliding cap . A special opening tool was used to move the slide occlusally for arch wire insertion.When the cap was closed over the arch wire with Finger Pressure, the bracket slot was converted to a tube.The rigidity of this outer fourth wall rendered the bracket “passive” in its interplay with the arch wire. 64 Dr Ravikanth Lakkakula
  65. 65. Advantage 1.Adequate strength. 2.Smothness to tissues. 3.Low profile. 4.Automatic locking and unlocking. 5.Reliable action and complete control in all planes of space. Disadvantage 1. Imprecise in their ability to control tooth movement. 2. Only available prewelded to preformed bands or band strips. 65 Dr Ravikanth Lakkakula
  66. 66. Mobilock bracket In 1974,Dr. Franz Sander developed Mobil-lock Brackets(Forestadent , Germany) which had a rigid Semicircular labial disk, which was turned with a screwdriver to close and open covering part of the labial surface of the slot.The wire could be tightly or loosely engaged by the degree of rotation of the cam. 66 Dr Ravikanth Lakkakula
  67. 67. As with the Edgelok the passive outer wall transformed the bracket slot into a tube that loosely contained the arch wire. Clockwise rotation eccentric cam, resulting in the variable slot (0016-0.022- inch in the occluso gingival direction), which may be adjusted by the use of a key which is constructed with a 'ratchet‘ system such that the arch wire is engaged only up to a certain pressure, after which the ratchet will slide. Perhaps because of the simultaneous introduction of elastomeric ligatures, however, neither the Edgelok nor the Mobil-lock gained much of a following. 67 Dr Ravikanth Lakkakula
  68. 68. 1.Open position. 2. Free-sliding, where the depth of the slot is 0.022-inch and permits maximum play of the arch wire. 3. Further turning of the cam leads to gradual engagement of the arch wire up to the point of locking the arch wire, it is possible to regulate the amount of torque and tip transmission to the tooth. Disadvantage 1.Narrowness of the labial face of the slot gave very poor rotational control , to the extent that upper incisor brackets were given twin cams to increase the effective bracket width. 2. Difficulty of access to open and close premolar brackets with the straight screwdriver. Advantage 68 Dr Ravikanth Lakkakula
  69. 69. Speed bracket SPEED is a fully preadjusted miniaturized edgewise appliance that uses a superelastic nickel titanium , introduced in 1980 by Herbst Hanson(Orec company). This appliance offered in a full range of popular torque prescriptions. 69 Dr Ravikanth Lakkakula
  70. 70. SPEED brackets are similar in appearance, they are specifically designed for each individual tooth. Each attachment consists of upto Five components. 1.Multislotted bracket body. 2.Permanently installed super elastic nickel titanium spring clip. 3.An in-out adapter. 4.An Integral Mushroom Hook . 5. Micro-Retentive Mesh bonding base. 70 Dr Ravikanth Lakkakula
  71. 71. Bracket body The SPEED appliance uses a narrow, single bracket body. The body design is a narrow form for the incisors, but the slightly wider posterior body which features a miniaturized mushroom-shaped hook that neatly projects from the distal-gingival of each bracket body. The precision machined bracket body is multislotted in design with the three main horizontal slots. 1.A pre torqued arch wire slot : The arch wire slot is available in either 0.018 x 0.025 inch or 0.022 x 0.028 inch and can accommodate round, rectangular, square, or SPEED shaped arch wires. 71 Dr Ravikanth Lakkakula
  72. 72. 2.An auxiliary slot : The 0.016-inch x 0.016 inch square auxiliary slot which may house secondary archwire . It runs parallel to the main arch wire slot both occlusally and gingivally. Auxilliary slot remains as a tube even when spring clip is in open position . 3.A spring retainer slot : The spring retainer slot has been incorporated into the SPEED body design to house the recurved tip of the spring clip. This slot is made deep enough and shaped with an outer lip to securely house the spring clip during the most severely of transient stresses. 72 Dr Ravikanth Lakkakula
  73. 73. The SPEED bracket had a curved, flexible “Super-Elastic Spring Clip” that wraps Occlusogingivally around a miniaturized bracket body .The clip is moved occlusally using either a universal scaler at the gingival aspect of the bracket body or a curved explorer inserted into the labial window to permit archwire placement, then seated gingivally with finger pressure. The labial arm of the Spring Clip, which forms the flexible fourth wall of the bracket slot, not only constrains the archwire, but interacts with the archwire.This sets the SPEED system apart from all other currently Available self-ligating brackets as the only “active” design. Spring clip 73 Dr Ravikanth Lakkakula
  74. 74. The Spring Clip, through elastic deflection, gently imparts a light, continuous level of force on the archwire, resulting in precise and controlled tooth movement. Hanson describes this as the “homing action of the spring” - the ability of the SPEED bracket to reorient itself three-dimensionally until the arch wire is fully seated in the slot.Any subsequent rotation, tipping or torquing, during tooth movement of any kind, results in a labial deflection of the spring that reactivates this homing behavior. 74 Dr Ravikanth Lakkakula
  75. 75. In-out adaptor : SPEED adaptor features both an angular and a translational dimension. This unique characteristic ensures the creation of an exceptionally smooth arch form that is achieved through a progressive “ ramp-like” effect of the in-out adaptor.The transition to a more rigid construction of each adaptor has permitted further appliance miniaturization while increasing bond strength by more than 300%. Foil Mesh Pad Each SPEED attachment features a foil mesh bonding pad with complex asymmetric curvatures.These, combined with the miniaturized dimensions of each mesh pad, ensure ideal bracket to tooth adaptation. Furthermore, the recent change in size of the brazed foil mesh from a fine 100 gauge to a more coarse 60 gauge has further enhanced the bond strength of the SPEED attachment.75 Dr Ravikanth Lakkakula
  76. 76. Bracket base since the bracket base is smaller ,to avoid bond failure sintered porous metal coating is used on the base. It consist of irregular microscopic stainless steel particles fused together and to the bracket base to create network of pores for a strong adhesive grips. Narrow bracket increase the span of arch wire between the teeth for greater torquing and rotation efficiency. Mushroom hook The advent of the recently designed SPEED bracket with a 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. 76 Dr Ravikanth Lakkakula
  77. 77. 1.Highly flexible nickel titanium spring clip provides precise 3-D tooth control. 2. Minimal friction during sliding mechanics. 3. Extended range of activation due to energy stored in spring clip. 4. Large interbracket span. 5. Spring clip will not fatigue or plastically deform under normal treatment conditions. 6. Horizontal auxiliary slot enhances segmental mechanics. Benefits for the patient include: 1.Smooth, rounded, easy for all patients to clean. 2.Miniaturized, wingless design with low profile improves patient comfort. 3. Esthetically appealing - polished appearance with clean design lines. Advantages 77 Dr Ravikanth Lakkakula
  78. 78. 1.Try to treat without extractions in any case that has the necessary potential except include extremely crowded cases or where other mitigating circumstances, such as soft tissue profile or incisor angulations. Not only is this nonextraction approach advantageous for the patient, but the orthodontist benefits by having to spend less time managing the compensatory extraction mechanics and more time managing the more predictable reaction to light forces. 2. If extractions necessary, extract 2nd bicuspids to minimize any reduction in prominence of dentition. Treatment Philosophy When Using SPEED 78 Dr Ravikanth Lakkakula
  79. 79. 3. Preliminary functional appliances as necessary to favorably alter jaw growth if possible. 4.Use intraoral distalization instead of headgear. 5.Expand arches that have failed to develop to their full potential. 6. In patients that exhibit lots of gingival tissue, intrude upper anterior teeth. 7.Correct tooth rotations to ideal alignment without overcorrection rely on IPR and circumferential Supracrestal fiberotomies to enhance retention. 8.Overcorrect Class II/III where strong tendency for relapse occurs. 79 Dr Ravikanth Lakkakula
  80. 80. Arch wires—Selection and Use SPEED appliance design greatly simplifies and enhances arch wire selection and effectiveness. SPEED’s wide inter bracket span, predictably light frictional drag and full control with even the most undersized arch wires maximizes efficiencies of tooth movement while ensuring excellence in finishing. Although SPEED’s edgewise slot will accommodate virtually any size or configuration of arch wire, experienced SPEED users have found that the selected arch wires outlined herein most fully exploit SPEED’s unique benefits.These are recommended for best results and include Super cable , Hills Dual-Geometry and SPEED finishing arch wires 80 Dr Ravikanth Lakkakula
  81. 81. SPEED Supercable wire SPEED Super cable is a super elastic nickel titanium coaxial archwire consisting of Seven strands of wire wrapped with a “long pitch” and is available in 0.016, 0.018 and 0.020.With one-third the force of a solid 0.016 nickel titanium archwire it offers unmatched low force levels . As an initial aligning and levelling arch wire, Super cable may be Fully engaged without plastic deformation due to its unique construction and Super elastic properties . In such instances, the supporting tissues experience near optimum force levels, which translate into minimal or no patient discomfort.81 Dr Ravikanth Lakkakula
  82. 82. Hills Dual-Geometry Arch wire This arch wire has been designed to maximize sliding mechanics in the posterior segments via its round posterior portion while maintaining anterior incisor crown torque with its square anterior portion . Made from ultra-high tensile-strength stainless steel , the Hills wire provides the stiffness needed to prevent undesirable side effects during tooth translation.The Hills wire is manufactured in two sizes—0.018 X 0.018 anterior with 0.018 round posterior and 0.021 X 0.021 anterior with 0.020 round posterior. 82 Dr Ravikanth Lakkakula
  83. 83. SPEED Finishing Archwires The bevelled labial-gingival shape of “SPEED” finishing arch wires encourages full expression of the interaction between the super elastic spring clip , the arch wire and the arch wire slot .Any deviation of the bracket position relative to the wire, results in deflection of the spring clip, which stores appropriate energy for recovery. This energy is gently released through precise three-dimensional tooth positioning. In addition, this quarter round archwire shape facilitates wire insertion and spring clip closure.These wires are manufactured intwo sizes: 0.017 X 0.022 and 0.020 X 0.025 dimensions. 83 Dr Ravikanth Lakkakula
  84. 84. 84 Dr Ravikanth Lakkakula
  85. 85. Activa bracket In 1986, Dr. Erwin Pletcher developed Activa bracket(“A ”company). Activa bracket had an inflexible, curved arm that rotates occluso gingivally around the cylindrical bracket body. The arch wire is retained by a resilient clip that rotates into a retaining groove gingival to the arch wire, positioning two straps labial to the wire and creating a bracket that is very similar mechanically to a molar tube with twin channel caps. The clips can be opened and shut with a wide range of commonly used hand instruments including ligature tuckers, flat plastics and Mitchell's trimmers. All brackets have vertical slots behind the arch wire channel. vertical slots 85 Dr Ravikanth Lakkakula
  86. 86. Advantages of vertical slot : Vertical slot is a useful feature in a bracket withoutTie wings.T- shaped locking pins are a preformed auxiliary used in the slot for 1. Closure of diastema withT pins and elastic chain. 2. Ligature connection of palatal canine to buccal sectional wire 3. Rotating spring used to overrotate a canine. Disadvantage Higher bond failure rate 1.Operators who are new to these brackets tend to fail to fully seat them on the teeth. 2.Bases are slightly smaller than with most brackets. 3.The absence of tie-wings means that a smaller percentage of the bracket base is attached to overlying bracket and this may possibly lead to less rigidity of the bracket base and easier distortion of the base and consequent bond failure under external loading forces86 Dr Ravikanth Lakkakula
  87. 87. Less convenient with power chain When closing multiple spaces, elastic chain must either be placed behind arch wire orT-shaped locking pins must be placed in several brackets. Neither of these is a big problem, but tie-wings are more convenient in this instance. Unfamiliarity and difficulties during bracket placement Tie-wings are useful holding points for tweezers and their absence dictates minor changes in bracket placement technique.Also, the very different shape and the unfamiliar aligning tags on the bases require close concentration if errors of bracket placement are to be avoided.This particularly applies to the angulation of canine Brackets. 87 Dr Ravikanth Lakkakula
  88. 88. Breakage of arch wire retaining clips Clip breakage mainly occurs when excessive force was given to engage an stiffer wire. If a clip break, it is possible to replace it with a new clip without the need to remove and replace the bracket. Separate clips are supplied for this purpose. Placing a new clip in the circumstance is a slightly awkward , fractional enlargement of the radius of the circular portion of the clip (with light-wire pliers) before pressing it onto the bracket eases placement. 88 Dr Ravikanth Lakkakula
  89. 89. Time bracket In 1994 Dr.WolfgangHeiser , developed theTime bracket which is similar in appearance to the SPEED bracket , but its design and mode of action are significantly different.It is the first one-piece self-ligating system, was developed using CAD/CAM technology. It is described as hybrid self ligating bracket. Time features a rigid, curved arm that wraps occlusogingivally around the labial aspect of the bracket body.TheTime bracket can be opened either with a dental probe or with its special instrument. It is used to pivot the arm gingivally into the slot-open position or occlusally into the slot-closed position. 89 Dr Ravikanth Lakkakula
  90. 90. The time bracket has a clip that rotates into position around the gingival tie wing and rotates towards the occlusal rather then the gingival wall of the slot .The spring clip opens far enough for a wire to be inserted, but the opening is limited by a stop between the clip and the bracket body. Resistance will be felt when the full opening is reached, opening the clip any farther could deform it enough that it would have to be replaced. If necessary, the spring clip can be removed by over-opening it or by sliding it mesially or distally.This will allow the bracket to be used with conventional ligatures . 90 Dr Ravikanth Lakkakula
  91. 91. Advantages 1.Designed to be both passive(minimal force and friction in early stage of treatment) and active(torque and rotational control in middle and finishing stage), Controlled torque and rotations, Easy to open throughout treatment and more hygienic for Patients. 2. Its small mesio-distal width enables it to be placed in the most severely Crowded lower anterior cases. 3.A simple to open-close clip mechanism for ease of wire changes . 4. The capacity to achieve finishing details in a controlled manner in all three planes of space. Because of its intrinsic simplicity of design, only a short description of the Time bracket is necessary to augment the figures presented.91 Dr Ravikanth Lakkakula
  92. 92. Damon bracket These brackets are introduced in 1996 by Dwight Damon. Damon SL 1 It had a slide, which moved vertically on the labial Surface of an otherwise fairly conventional twin tie-wing bracket.The slide clicked into a positive open or shut position and opened in a downward direction in both jaws to give a full view of the slot. A tiny U-shaped wire spring lay under the slide and clicked into the two labial 'bulges' on the slide to provide positive open and shut positions.These brackets were a major Step forward, but suffered two irritating problems; (1)the slides sometimes opened inadvertently and (2) they were prone to Breakage. 92 Dr Ravikanth Lakkakula
  93. 93. Disadvantages of Damon SL 1 bracket 1. Inadvertent slide opening. 2. Loss of slide. breakage of slide due to work hardening of slide corner. Excessive opening will cause the slide to pass beyond the stop provided by the underlying U – shaped wire. 93 Dr Ravikanth Lakkakula
  94. 94. The imperfections in the Damon SL brackets led to the development of Damon 2 brackets(2000yr) which retain the same vertical slide action and U-shaped spring to control opening and closing, but place the slide within the shelter of the tie-wings . Combined with the metal injection moulding manufacture, which permits closer tolerances, these developments have almost completely eliminated inadvertent slide opening or slide breakage. Although special and excellent slide-opening tools are provided with these brackets, they can after some practice be easily opened and closed with conventional light-wire pliers in combination with the Cool-Tool archwire- seating implement. Damon 2 bracket 94 Dr Ravikanth Lakkakula
  95. 95. Opening closing : there are three components to handling arch wires with self ligation – locating the arch wire in slot, closing the slide or clip and opening the slide or clip. In order to close and open the doors or clips easily , it is necessary to be able to see clearly whether the arch wire is fully seated or not. It is strongly recommended that operators work under mild magnification (1.5 to 3 times) in order to visualize the relation between arch wire and the slot. Nuview’s Voroscope MXL has excellent magnification with rechargable LED light (slight bluish white)used for this purpose. 95 Dr Ravikanth Lakkakula
  96. 96. Advantage of damon 2 bracket . 1.Reduce the overall size of the bracket and hence the larger inter- bracket span produces lower forces. 2.Slide opens away from the clinician, allowing clear visibility into the Slot. 96 Dr Ravikanth Lakkakula
  97. 97. Damon 3 brackets(2004 yr) These brackets have three major changes from previous damon brackets. 1. A tooth colored composite resin base and upper tie wing reduces the visual impact of the bracket. 2. A completely new vertically placed chair shaped clip behind the slide. This has produced a slide which is extremely easy and consistent to open and close. The slide is closed with finger pressure and has a positive tactile and audible signal when fully closed. 3. It is opened with a special opening tool resembling a modified blunt dental probe. The technique is to slide the point of the tool down the V - shaped ramp on the front of the slide until it engages in the small hole at the base of the slide , pressing inwards while continuing to press downwards release the clip. 4. A rhombodial shape of the bracket and slide which facilitates bracket siting. 97 Dr Ravikanth Lakkakula
  98. 98. Advantage of damon 3 bracket 1.Combination of clear material and stainless steel provides the aesthetic. Remarkably easy-to-use slide mechanism makes wire changes a snap. Disadvantages 1.High rate of bond failure. 2.separation of metal from reinforced resin components . 3. Fracture of tie wings. 98 Dr Ravikanth Lakkakula
  99. 99. Damon MX brackets(2005) These brackets are all metal and have essentially the same mechanism as D3 with further refinements. They are designed to be fully compatible with D3.They have a vertical slot behind the arch wire slot into which prefabricated click in auxiliary hooks can be added to any brackets as required. Advantage 1.Easy-to-use slide mechanism. 2.Ultra-smooth self-ligation contours and rounded edges for maximum bracket . 3. Patient comfort and improved hygiene. 4. Contoured base design for strong, reliable bond retention. 99 Dr Ravikanth Lakkakula
  100. 100. Twinlock bracket In 1998, Dr. JimWildman DevelopedTwinLock bracket . Its flat, rectangular slide, housed between the tie wings of an edgewise twin brackets. Passive Slides is moved occlusally into the slot-open position with a universal scaler. It is moved gingivally with finger pressure to entrap the arch wire in a passive configuration. 100 Dr Ravikanth Lakkakula
  101. 101. Advantages 1.Quicker Treatment and reduced chair time, fewer emergencies, available with Advanced bonding base in orthodontics. (Optimesh XRT). 2.Additional benefits include improved hygiene and patient comfort, smooth and clean labial surface. Disadvantage 1.Mobility of the slide during opening and closing outdated its commercial success. 101 Dr Ravikanth Lakkakula
  102. 102. GAC - Inovation bracket These brackets are introduced by Micheal CAlpern in 2000. These are very similar to speed brackets in concept and design, but are of 1.Twin configuration . 2. Bracket manufactured with metal injection moulding. 3.V –Tool(Tweezer ) is used for opening the clip. 4. Active clip which is made from cobalt chromium alloy is highly resistant to fracture. 5. Slot Blocker: It prevents archwire from escaping from the bracket and enhancesTorque Expression. 6. Horizontal Slot :This Slot runs through the occlusal wings which can be used for Rotation and uprighting springs or Segmental wire . 7. Super mesh Base: This houses a wide mesh over a tight mesh which enhances retention. 102 Dr Ravikanth Lakkakula
  103. 103. Innovation – The standard In-ovation bracket . Innovation R -These brackets are narrow in width than inovation brackets. This adds advantage of their use in lower anteriors. partially erupted tooth, small tooth, impacted tooth. Innovation C - Esthetic innovation brackets. Innovation L MTM - indirect bonding of anterior teeth (3-3) with these lingual braces. Innovation L - lingual innovation braces. 103 Dr Ravikanth Lakkakula
  104. 104. 104 Dr Ravikanth Lakkakula
  105. 105. These brackets are similar to the SPEED brackets in conception and design, but are of a twin configuration .They are a good, robust design, and no breakage of the clips has been personally experimented or reported. Some relatively minor disadvantages in bracket handling are apparent. 1. some brackets are hard to open. This is unpredictable, but more common in the lower arch where the gingival end of the spring clip is difficult to visualize. Excess composite to the gingival of lower brackets can be hard to see and may hinder opening. 2. These brackets are extremely easy to close before the archwire is in position and the downward direction of closure makes this more likely in the lower arch. 3. The security of closure of the flexible clip can be overcome by some rectangular Niti wires, which can cause spontaneous opening of the clip. Lastly, it is possible as with the Damon bracket105 Dr Ravikanth Lakkakula
  106. 106. slides to incompletely open the clip and discover the need for the final Fraction of opening though difficulty with removing a thicker arch wire. These minor reservations may well be reduced by further bracket development. In 2002, smaller brackets for the anterior teeth became available called the In-Ovation R (Reduced). This narrower width is very welcome in terms of greater inter-bracket span In-Ovation brackets have an active clip. There is the invasion of the slot by the clip and the consequent differential height of the gingival and occlusal bracket walls, the former being considerably less than the nominal slot depth. 106 Dr Ravikanth Lakkakula
  107. 107. Gestenco Oyster brackets This is the first translucent self ligating Bracket which was introduced in 2001. The Oyster bracket is semi-translucent polycorbonate bracket and is made from strong, fiber glass reinforced composite polymer that resists discoloring. Use of Super elastic and Beta arch wires exclusively is strongly recommended. The unique snap-on cap allows arch wires to be placed easily Since the cap is convertible, it can be removed if necessary and the bracket will function as a regular twin. Mushroom Hook is present for auxiliary attachment. Disadvantage: 1.High friction that is equivalent to Conventional stainless steel brackets, So not used now. 107 Dr Ravikanth Lakkakula
  108. 108. Adenta Evolution brackets It is developed by Dr. Hatto Loidl and C. Schendell (2001). Unlike many other self ligating brackets that only lock closed and no longer play a role, the Adenta self ligating lingual bracket was designed with non- locking rotating clip resulting in unique flexibility . Programed to hold even a non-seated wire securely with just the right amount of pressure, continuously pushing the archwire to the base of the bracket slot. This constant pressure produces the torque, angulation and in- out control required to finish your cases quickly and efficiently. Slot for horizontal arch wire insertion in the front and unique milled truly Onepiece bracket design. Smooth round edges providing highest patient comfort and oral Hygiene. Self-ligating clip is used as a bite plane accelerating bite opening. 108 Dr Ravikanth Lakkakula
  109. 109. Philippe lingual self ligating bracket Philippe passive self ligating bracket developed (forestadent) byAldo Macchi(2002) . Philippe 2D self-ligating lingual brackets providing 2-dimensional control, were suggested for the correction of simple malocclusions, such as minor crowding or spacing with the lingual technique. The main advantage of the Philippe brackets is their low profile and their comfort to the patients.They are suitable for simple cases that do not require 3-dimensional control since they have no slot. 109 Dr Ravikanth Lakkakula
  110. 110. These brackets can be bonded directly to the lingual surface of the tooth These brackets have no slot, they include small wings welded to the brackets base. Four types of Philippe brackets are available standard medium twin, a narrow single-wing bracket for lower incisors, a large twin and a three-wing bracket. Bracket wings used to secure the archwire to slot, are opened with Haideman spatula and closed with weingart plier. 110 Single wing triple wing Standard medium Large twin Dr Ravikanth Lakkakula
  111. 111. The Forestadent 3DTorque-Lingual self-ligating brackets have the similar flat design as the Philippe 2D self-ligating brackets, but have avertical slot for 3-dimensional control.The verticalopening of the slot provides fast and Easy archwire insertion . The archwire is used like a ribbon-arch, with the widest edge of the wire lying against the tooth surface; therefore the buccolingual slot dimension is smaller than the occlusogingival slot dimension and the bracket is relatively flat, with a low profile.The low profile of the brackets improves patient comfort and address a major problem of the lingual technique. 111 Dr Ravikanth Lakkakula
  112. 112. The archwire is secured in the slot by small wings that can be pushed or opened like the wings of the Philippe 2D self-ligating lingual brackets. By pushing the wings against the bracket’s base, and over the archwire with Weingart utility pliers, the archwire is secured in the slot.A thin spatula placed between the wings and the base of the bracket is used for opening the bracket for archwire replacement. The brackets are designed with 45° of torque for all the upper and lower incisors, and with 0° of torque for all the bicuspids and molars. Individual prescription and adaptation of the bracket base for each tooth, for each case, according to the requirements of the orthodontist is done. In the laboratory by an indirect bracket positioning technique based on a lingual setup and bracket positioner, using specially designed jigs to hold the brackets. 112 Dr Ravikanth Lakkakula
  113. 113. Opal brackets It is a completely non metallic bracket, designed and developed (ultradent) by Dr.Norbert Abels(2004). Entirely nonmetallic (resin)Bracket function as an effective slot and Flexible enough in hinge area to open and close.the opal design is rather ingenious in this respect but care must be taken not to fatigue fracture the hinge part of the bracket by repeated full opening of the cap. The brackets like most resins , are perhaps best suited for short course of treatment where these problems are longevity are less of issue. There are no tie wings , so elastic chain is placed in prior to closing the cap. 113 Dr Ravikanth Lakkakula
  114. 114. Smart clip It is introduced and developed (3M Unitek)by Gary L.Weinberger in 2004. It consists of two nickel titanium clips i.e., mesial and distal tie wings that open and close through elastic deformation of the material when the arch wire exerts a force on the clip.The bracket contains no moving door or latch. The feature of no moving doors or latches can eliminate problems such as sticking, spontaneous opening, or plaque build-up that are associated with other types of self ligating brackets. 114 Dr Ravikanth Lakkakula
  115. 115. Opal metal bracket It is a hybrid self ligating bracket consist of metal and ceramic componets. 1.Polymer snap - on door for easy and fast closing or opening - also protects in trauma situations. 2.Ceramic body for strength and secure bonding – slim design with low profile. 3.CentredT hook for elastics and fits all NiTi chains. 4.Both passive and active. 5.Stainless steel hinge. 6.Metal insert for reduced wire- friction. 7.Radius in base for easier de-bonding. 8.FDI notation in base for easy identification 115 Dr Ravikanth Lakkakula
  116. 116. Forestadent quick It is developed by Dr.Bjorn ludwig(2006). It available both active (bioquick)and passive (biopassive) . Externally passive brackets differentiated from active by a vertical marks on metal ligature wing. It consist of snap flexible spring , is opened with probe from the gingival end. Optimised ,anatomically positioned base prevents rocking of the bracket When it is pressed on the tooth. 116 Dr Ravikanth Lakkakula
  117. 117. Lancer praxis glide It is developed by Dr. Robert Lokar and team of Lancer Orthodontic engineers is truly an innovative low friction hybrid twin system, are manufactured using the latest robotic Technology. Praxis Glide is a proven torque-in-the base twin bracket, with a removable multiplanar clip. PraxisTSTM bracket is the latest mid aesthetic appliance now offered by LANCER. 117 Dr Ravikanth Lakkakula
  118. 118. Features 1.Open Lumen bracket, passive at the first stage of treatment. 2.Total control using a ligature over the clip 3.Anatomical design for each tooth (11 different bracket shapes) 4.Easy positioning (avoiding any repositioning of the bracket) 5.Low profile, smooth and ergonomic, optimal comfort for the patient 6.Rapid leveling and alignment. 118 Dr Ravikanth Lakkakula
  119. 119. Smart Clarity SL bracket(2007) It is ceramic version of smartclip bracket with improved clip forces. 119 Dr Ravikanth Lakkakula
  120. 120. Vision LP It is passive ,low prifile self ligating bracket, available in high ,standard and low torque prescriptions. TheVision LP clip was easy to open with a simple rotation of the Vision LP instrument. Closing is a gentle "click" with a fingernail or the instrument. It has Strong, Durable Clip , the interplay between the keeper notch in the bracket and the carefully heat treated, nickel titanium clip givesVision LP the ability to hold up to 9 pounds of outward wire force more than enough to contain heavily torqued or rotated wires.However, the unique design of the clip's hinge action requires only light, comfortable opening forces during wire Changes. Vision LP opening tool 120 Dr Ravikanth Lakkakula
  121. 121. Brackets with sliding gates or spring clips can trap bio-debris and build up calculus in their opening mechanisms, making them difficult to open.Vision LP brackets with Flip ClipTM technology solve this common problem by eliminating narrow clip tracks and rotating open instead of sliding. Toothbrushes cannot reach the recesses of the metal on metal sliding tracks (shown above in red) of other clip designs. Over the course of treatment, biodebris can build up and make the clips increasingly difficult to open.Vision LP clips have only very small contact points, which are located on the face of the bracket where they are scrubbed clean every time the patient brushes. 121 Dr Ravikanth Lakkakula
  122. 122. Discovery brackets It is developed by dentauram in 2007 using CAD – CAM technology. Features 1.Best therapy results with minimal size for aesthetic treatment. 2.high degree of user convenience due to easy locking mechanism 3.Improved, flexible lid stop keeps the lid open for quick, smooth archwire change. 4.New opening mechanism in the direction of force guarantees numerous perfect opening and closing operations. 5.Revised bracket geometry to ensure that the lids always open straight. This prevents buckling of the lid. 6.Super smooth surfaces provide excellent intraoral comfort for the Patient. 7. FDI notation on the base ensures easy assignment to each tooth.122 Dr Ravikanth Lakkakula
  123. 123. Damon Q(2009) These are the latest version of Damon system, sliding mechanism is designed to be easier , more secure and more comfortable to the patient when opened and closed and immune to the effects of calculus accumulation. These brackets also smaller in all dimensions than their predecessors and space has been found for horizontal as well as vertical slot. Spintec cool – opening tool 123 Dr Ravikanth Lakkakula
  124. 124. 124 Dr Ravikanth Lakkakula
  125. 125. Damon Aesthetic(2009) The new Damon Clear bracket is a translucent passive self-ligation bracket with no metal insert.The bracket’s completely clear design is Intended to meet patients expectations for aesthetics, while its robust construction meets clinicians’ needs for functionality and strength. The fully aesthetic bracket body and slide are made of sturdy polycrystalline alumina (PCA), an inert material impervious to staining or discoloration. The slide of the SL bracket constitutes a fourth wall, which creates a passive lumen to hold the arch wire in place with low ligation force while facilitating rotational control. A nickel-titanium (Ni-Ti) spring mechanism maintains the slide in the open and closed positions and keeps the slide from separating from the bracket body. 125 Dr Ravikanth Lakkakula
  126. 126. Smart clip SL3(2009) It is similar to Smartclip bracket, difference is less clip force reduction. Also available in adhesive precoated system with flouride release property. FamiliarTwinWing design allows for treatment flexibility and selective bracket or tie-wing ligation, increasing inter-bracket width when Needed. 126 Dr Ravikanth Lakkakula
  127. 127. Archwire insertion is done with finger pressure and removal done with disengagement tool has two hooks to engage the wire, and its central part holds over the buccal surface of the mesial and distal wings. By means of pressing the handles together, the wire disengages from the bracket slot. 127 Dr Ravikanth Lakkakula
  128. 128. 128 Dr Ravikanth Lakkakula
  129. 129. TandemArchwires Significant results have been seen in correcting rotations and creating levelling and alignment when using tandem arch wires with 3M Self LigatingAppliances 1.To correct rotations and level and align teeth early in treatment, the goal is to engage arch wires that fill the horizontal plane and have a low unloading force. 2. Using two flexible round arch wires in tandem fills both the horizontal and vertical planes of the bracket slot - They correct and manage rotations while correcting vertical discrepancies. 3.The tandem arch wire should be inserted directly on top of the initial arch wire used in treatment - No need to disengage the initial archwire,which saves chair time. 129 Dr Ravikanth Lakkakula
  130. 130. Tandem archwire combination Tandem arch wire combinations depend on the slot size and degree of rotational deflection. In most cases, the .018 slot option will be the .014/.014 and the.022 slot will be the .014/.016 combination. 130 Dr Ravikanth Lakkakula
  131. 131. Advantages of SmartClip SL3 Brackets Reduction in friction, which results in more efficient sliding mechanics than traditionally ligated brackets. Improvement in oral hygiene with an open slot and elimination of ligature Ties. Reduced chair-time for archwire removal and insertion. No plaque entrapment in sliding mechanism and bracket slot. Ability to ligate on an as-needed basis. Treatment flexibility of twin tie-wing design. 131 Dr Ravikanth Lakkakula
  132. 132. Clinical tips when using self ligating brackets 1.Aids to arch wire engagement - It is important to engage the wire fully in the bracket before the clip closure, rather than simultaneously attempt to close and engage the wire. 2. Wire can be held in place with different tools, Special pliers and tools have been recommended both for closing as well as opening bracket clips by different manufacturers. 3. Self Brackets use pushing force rather than pulling force while engaging the arch wire. 4. In badly rotated teeth, it is advisable to first close the clip and than thread the arch wire i.e. to first convert it to a molar tube. 5.Prevent wire pokes: Low friction allows easy sliding of wire through brackets. It is necessary to turn the ends of wire securely. 6.V shaped notches in arch wire or stops also are recommended.132 Dr Ravikanth Lakkakula
  133. 133. Currently available self-ligating brackets offer the very valuable combination of extremely low friction and secure full bracket engagement and they are sufficiently robust and user friendly to deliver most of the potential advantages of this type of bracket. The core advantages of self-ligation are now established and readily available. These developments offer the possibility of a significant reduction in average treatment times and maybe also in anchorage requirements, particularly in cases requiring large tooth movements. Evidence of better treatment effectiveness exists but is incomplete. While further refinements are desirable and further studies essential, current brackets appear able to deliver measurable benefit with good robustness and ease of use. Conclusion 133 Dr Ravikanth Lakkakula