Cosmetic Orthodontics

Cosmetic
Orthodontics
www.indiandentalacademy.com

What is Aesthetics?
Aesthetics is purely and simply
the science of expression,expression
being itself so defined as to be Identical
with every form of Appreciation,Intuition
or Imaginative Synthesis.
“HENFREY”

How Far Have We Gone?
In Aesthetics!!
In Orthodontics!!!
We have gone as far as developing
materials which are tooth colored
or (Invisible)in..

1. Brackets
2. Wires
3. Rings or Chains
4. Auxiliaries
TOGETHER IN A HARMONY BETWEEN
“ function and esthetics ”

HISTORICAL PRESPECTIVE
FIXED APPLIANCES INTRODUCED IN 1800’s
BANDING OF ANTERIOR &POSTERIOR TEETH
BONDING OF ANTERIOR ATTACHMENTS

REDUCTION OF BRACKET SIZES
CERAMIC /COMPOSITE BRACKETS
COMPOSITE ARCHWIRES
LINGUAL ORTHODONTICS
INVISALIGN SYSTEM

ANTERIOR BAND1NG :

TWIN BRACKETS
MINI-TWIN BRACKETS

DESIGN VARIATIONS

TOOTH COLOURED BRACKETS
1. PLASTIC BRACKETS
introduced by NEUMAN (1969)
Acrylic, nylon, epoxies, polysulphones, polycarbonates
USED IN
a. Minimal torque situations
b.Treatment of short duration
STEEL SLOTED PLASTIC BRACKETS ----BEST SUITED

ADVANTAGES
1.Nontoxic
2.Easy fabrication
3.Good abrasion resistance
4.Good impact strength
5.No bad odour /distaste
DISADVANTAGES
1.Lack of strength
2.Wire - slot wear
3. Water absorption & degradation
3.Discoloration and staining
4.Poor dimensional stability

2.CERAMIC BRACKETS
 FULL CERAMIC BRACKETS
 CERAMIC BRACKETS WITH METAL INSERTS
Introduced by MICHEAL SWARTZ (1987)

Full ceramic brackets
With metal inserts

 MONOCRYSTALLINE /POLYCRYSTALLINE ALUMINA
( 2100`C )
 ZIRCONIA (1000`C )
------Made of 3D inorganic molecules
Extremely high hardness and compressive strength.
Both are highly biocompatible

BONDING OF CERAMIC BRACKETS TO ENAMEL:
1. Mechanical retention via indentation / undercuts
in base.
2. Chemical bonding with silane coupling agents.

DISADVANTAGES
* Fracture of brackets
* Friction within bracket slots
* Tooth wear on bracket contact
1. BRACKET FAILURE
2. BULK OF THE BRACKETS
3. SURFACE ROUGHNESS
4. INHIBITION OF POLYMERISATION
5. DEBONDING DIFFICULTIES
* ENAMEL DAMAGE
* Pulpal damagewww.indiandentalacademy.com

CASE SELECTION CRITERIA
1.Deep bite cases
2.Bruxism patients
3.Large restorations
4.Need for significant torque
5.Children
Ceramic brackets are contraindicated in

3.COMPOSITE BRACKETS
A Composite is a multiphase material brought about by
combining materials that differ in composition /form to
obtain specific characteristics and properties. The
constituents retain their identities and properties.
Can be simplified as ‘dispersion of fillers(particles /fibres
/whiskers ) in a binder or matrix (metals /ceramics /resins)’.
Reinforcement of polymer with ceramic metals –most common
combination in ORTHODONTICS

COMPOSITION
COMPOSITE PRECURSOR
-Plasma treated high strength Polyethylene fibers
REINFORCED WITH
1.Glass
2.Mineral filler
3.Metal
4.Ceramic liner
5.Metal liner
Manufactured by ‘INJECTION MOLDING TECHNIQUE’.

ADVANTAGES
1.SUPERIOR IMPACT RESISTANCE
2.INCREASED COMPRESSIVE STRENGTH
3.FATIGUE RESISTANCE
4.RESISTANCE TO DISCOLORATION
1.CREVICE CORROSION
2.DISINFECTION PROBLEMS
3.DIFFICULTY TO DETECT CRACKS
4.EXPENSIVE & CANNOT BE RECYCLED
DISADVANTAGES

ARCH WIRES-COSMETIC ADVANCES
1. Arch wires with plastic tubing coating
2. Marsenol
3. Lee-white
4. Composite archwires
5. Optiflex archwires
6. Fibre reinforced composite

ARCH WIRES WITH PLASTIC TUBING COATING :
DISADVANTAGES
Earliest to be introduced
1. Easy peeling off of the coating
2. Loss of friction control
Stainless steel arch wires were coated with plastics

MARSENOL:
E.T.E COATED NICKEL TITANIUM
It exhibits all the characteristics of NiTi . The coating is
adherent and is flexible,fracture resistant, delivers force
over long periods.
LEE WHITE:
STAINLESS STEEL NiTi bonded to EPOXY COATING
Coating is completely opaque, does not peel ,chip , stain
or discolor

COMPOSITE ARCH WIRES:
Made of S-2 glass fibres and acrylic resin.
Manufactured by 1. Photopulstration
2. Electromagnetic radiation
Translucent
Strong & Springy
Variable Stiffness
Dimensional Stability
Minimal Staining
ADVANTAGES

‘OPTIFLEX’ ARCH WIRES
Designed by Dr. Taloss
Composite of ceramic fiber-plastic-nylon.
Made of 3 layers:
1. Silicon dioxide core –force production
2. Silicon resin middle layer - protection
3. Nylon outer layer –stain resistance

ADVANTAGES
 Highly esthetic
 Stain resistant
 Light continuous force
 Greater flexibility and resiliency
 Low friction
 Corrosion resistance
 High biocompatibility
DISADVANTAGE
‘ No formability’

FIBRE REINFORCED COMPOSITE
Made of S GLASS FIBRES in a matrix of THERMOSET BIS-GMA
Available as –1.Rope type
2.Woven strip
3.Unidirectional strip

USES:
1.Retainers
2.After initial aligning can replace main arch wire
3. Any attachments can be directly bonded

LINGUAL ORTHODONTICS
“INVISIBLE BRACES”

CASE SELECTION CRITERIA
NON EXTRACTION CASES
1.Cl.I , Deep bite , mild crowding
2Cl..I , Deep bite , generalized spacing
3.Cl.II , Deep bite
4.Cl.II div.2 , mand. retrusion
5.Diastema closure
EXTRACTION CASES
1.Cl.I, low FMA , severe crowding
2.Cl.II with minimal crowding

ADVANTAGES
DISADVANTAGES
1. Decreased accessibility
2. Small interbracket span –freq. adjustments
3. Difficulty to perform complex movements
4. Speech distortion and tongue irritation
1. Totally invisible
2. Facial surfaces are not damaged
3. Lip contour not distorted

CASE REPORT
PRETREATMENT

DURING TREATMENT

POST TREATMENT

The invisible way to align teeth without braces,
using a series of clear removable aligners
INVISALIGN
 Invisible,
 Removable,
 Comfortable.
Invisalign also allows a person to view his own virtual
treatment plan, he can see how his teeth will look when
the treatment is complete.
ADVANTAGES

Invisalign is a high-volume, customized manufacturing
process by advanced computer technology
|
The Technology Behind Invisalign
Using advanced imaging technology, Invisalign
transforms the plaster models into a highly accurate 3-D
digital image.

A computerized movie - called ClinCheck- depicting
the movement of the teeth from the beginning to the final
position is created .
From the approved ClinCheck file, Invisalign uses laser scanning to
make a customised set of aligners , sent to the clinician .

CASE REPORT
BEFORE AFTER

RETAINERS
QCM RETAINER
ESSIX RETAINER FRC RETAINER

AUXILIARIES
Easy to tie ligatures Elastomeric modules
Rotation wedges

CONCLUSION
“An orthodontic patient smile is
no more a metallic smile”
It’s in our hands to keep in pace with the
recent advances in esthetic dentistry to meet
the increasing esthetic concern of the patient .

Brackets
Wires
Auxiliaries

ACKNOWLEDGEMENT
PRINCIPAL :
Dr. E . Munirathnam Naidu M.D.S
VICE PRINCIPAL AND HEAD OF THE DEPARTMENT:
Dr. P. Jaya Kumar M.D.S.
Staff Members And P.G. Students,
Meenakshi Ammal Dental College,
CHENNAI.

Cosmetic Orthodontics

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