Orthodontic fixed appliance including basics,every component of fixed appliance, applied part is also included. Thank you.....

2.  Introduction
 Optimum orthodontic force
 Changes following application of mild forces
 Changes following application of extreme forces
 Tooth movements possible using fixed appliance
 Types of appliance
 Components of fixed appliance
1. Active components
2. Passive components
 Method of fixing attachment on the teeth
1. Banding
2. Bonding

3.  Fixed appliance technique
 Edgewise Appliance
A. Levelling and Alignment
B. Overbite Reduction
C. Overjet Reduction and space Closure
D. Final Tooth position
E. Debonding and Retention
 Begg appliance
 Preadjusted Edgewise Appliance
 Tip-Edge Technique

4.  Appliance that are fixed or fitted onto the teeth by the
operator and cannot be removed by patient is known as
fixed appliance.
 Removable appliance are capable of only tipping type of
movement, but fixed appliance can bring various type of
tooth movements including bodily movement, Tipping,
Rotation, Intrusion, Extrusion.
 Oral hygiene maintenance becomes more difficult for
patient in fixed orthodontic treatment and this is the most
important disadvantages of a fixed appliance.

5.  Definition: Optimum orthodontic forces is one which moves
tooth most rapidly in the desired direction, with the least
possible damage to tissue and with minimum patient
discomfort.
 It is equivalent to the capillary pulse pressure that is 20-26
gm/ sq cm of root surface area.

6.  When a force is applied to a tooth, areas of pressure and
tension are produced.
1. Changes on pressure side:
 The periodontal ligament in a direction of tooth movement
gets compressed to almost 1/3rd of its original position.
 Osteoclast is the bone resorbing cells that line up along
the socket wall on pressure side.
 When forces applied within the physiologic limit the
resorption seen on the alveolar plate this kind of
resorption is called frontal resorption.

7. 1. Changes seen on tension side:
 The area of tooth opposite to the direction of force is
called as tension side.
 On application of force periodontal membrane on the
tension side get stretched.
 Raised vascularity causes mobilization of cells such as
fibroblast and osteoblast in this area.
 Due to this traction osteoid is laid down by osteoblast in
the periodontal ligament and calcified bone forms woven
bone.

9.  Whenever extreme forces are applied to teeth, its results in
crushing or total compression of periodontal ligament and
occlusion of blood vessels and leads to hyalinization.
 In this case bone can not resorb in frontal portion ,it resorb
in the adjacent to marrow spaces and below the alveolar
plates this type of resorption is known as undermining
resorption.
 Periodontal ligaments gets over stretched on tension side
and leads to tearing of blood vessels and ischemia.

10.  The various tooth movements possible using fixed
appliance are:
1) Tipping
2) Bodily movement
3) Torquing
4) Uprighting
5) Rotations
6) Extrusion and Intrusion

11. 1) Tipping:
 It is a simplest type of tooth movement.
 Where single force is applied to the crown which, results in
movement of crown in the direction of force and root in the
opposite direction.
 Force needed is about 50 – 75 gm.

12. 1) Controlled tipping:
 In controlled tipping centre of rotation
is at apex.
 Crown moves in one direction and here is
negligible or minimal movement of root
2) Uncontrolled tipping:
 This kind of tipping occurs with centre of
rotation is in apical area and very close to
the centre of resistance
 Due to this crown moves in one direction
and root moves in opposite direction.

13.  Translation of the teeth takes place when the crown and
the root of the tooth move in same direction i.e. horizontal
linear direction.
 Here centre of rotation is at infinity. Force needed is about 100 – 150 gm

14.  Movement of root without movement of crown is called as
torque.
 Root movement or torque is
achieved by keeping the crown
of tooth stationary and applying a
movement and force to move only
the root.
 Hare centre of rotation is at
incisal edge.

15.  In some malocclusion axial
inclination is seen in the crowns.
Those teeth will be tipped abnormally
in mesiodistal direction and root
tipped in opposite direction.
 Tipping of these roots back to its
acceptable position is known as
uprighting.

16.  Rotation are labial or lingual movements of tooth around its
long axis.
 Pure rotation requires a couple of forces. Force needed is about 50 – 100 gm.

17.  Extrusion is bodily displacement of tooth along its long
axis in an occlusal direction.
 Force needed is about 50 gm.

18.  Intrusion is the bodily displacement of tooth along long
axis of tooth in apical direction.
 It require least amount of force i.e. 15 – 25 gm.

19. TYPES OF APPLIANCE:
TYPES OF ORTHODONTIC
APPLIANCE
Removable Fixed
Active
Removable + Fixed
Passive Active Passive

20. DEFINITION:
Fixed Appliances are devices or equipment's that
are attached to the teeth, cannot be removed by the patient
and are capable of causing tooth movement.

21.  Fixed Appliances are indicated when precise tooth
movements are required
 Correction of mild to moderate skeletal discrepancies
 Correction of rotation
 Overbite reduction by intrusion of incisors
 Multiple tooth movements required in one arch
 Active closure of spaces: extraction spaces/hypodontia

22. ACTIVE COMPONENTS
 Separator
 Arch wire
 Elastics
 Springs

24.  Orthodontic separators commonly known as spacers
 They are made up from rubber bands or metal.
 Spacers are placed between the molars at the second
orthodontic appointment, before molar bands are applied.

25. Purpose:
 Spacers are usually used to create spaces in between
teeth before placement of braces.
 They are usually rubber, but sometimes they can be metal.
 Smetimes very painful, they are usually in place for 1 to 2
weeks.
 Spacers can also cause toothache and gum pain because
of the constant pressure against the teeth.

26. How to apply the separator ?
 Special orthodontic tools are used to stretch or open the
rubber bands, depending on crowding.
 If the jaw is crowded, the spacers may cause intense and
constant pain due to the tooth movement.

27. How to remove separator?
 Spacers may also fall out on their own without being
removed by the patient by picking or eating sticky foods.
 Sometimes, a dentist may use a spacer that is similar to a
metal spacer, but is removable.
 The spacers are taken out about a week before placing the
braces.

28.  An orthodontic arch wire is a wire in similar shape of the
alveolar or dental arch that can be used with dental braces
as a source of force in correcting irregularities in the
position of the teeth.
 Orthodontic arch wires may be fabricated from several
alloys, most commonly stainless steel, nickel-titanium alloy
(NiTi), and beta-titanium alloy (composed of titanium and
molybdenum)

30. Based on material used:
1. Gold and Gold alloys
2. Stainless steel
3. Nickel Titanium alloys
4. Beta titanium
5. Cobalt chromium nickel alloys
6. Optiflex arch wire
Based on cross section:
A. Round
B. Square
C. Rectangle
D. Twisted
E. Coaxial

31. Ideal requirement of orthodontic wire:
 Spring back: It increases range of action.
 Stiffness: It provide ability to provide lower and a more constant
forces over time.
 Formability: Orthodontic wire should exhibit high formability so as to
bend the arch wire into desired configuration.
 Resilience: Orthodontic wire should exhibit high resilience so as to
increase the working range of appliance.
 Biocompatibility: Orthodontic wire should exhibit resistance to
tarnish and corrosion and should be non-toxic.
 Joinability: Orthodontic wire should exhibit the property of soldering
and welding.

32.  Elastics are made of latex rubber and are available in various
diameter.
 The force applied by these elastic depends on its diameter.

33. Applications of elastic:
Class I elastics: They are intra arch elastics stretched
between the molars and anterior. They are generally used
for closer of space and retraction of teeth.

34. Class II elastics: They are intermaxillary elastics stretched
between the lower molars and upper anterior. They are
used in the treatment of class II malocclusion. They bring
reduction of upper anterior proclination and mesial
movement of lower molars.

35. Class III elastics: It is intermaxillary elastics stretched
between the upper molar and lower anterior. They are used
in class III malocclusion to bring mesial movement of upper
teeth and retraction of lower anterior.

36. Cross bite elastics: It is Intermaxillary elastics used to treat
molar cross bite. They extend between the palatal surface
of the upper molar and buccal surface of lower molar.

37. Box elastics: This form of elastic used to correct anterior
open bites and open bite gets corrected by forced eruption
of upper and lower anterior.

38. It is used to bring about various tooth movement.
Types of spring:
Uprighting springs: This type of spring move the root in
mesial or distal direction.

39. Open coil springs: This type of spring that are compressed
between two teeth to open up space between them.

40. Closed coil springs: They are stretched between teeth to
close space.

41. PASSIVE COMPONENTS OF FIXED
APPLIANCE

42. 1) Bands:
 It helps in fixing the various attachments on to the teeth.
 The are made of from soft stainless steel.
 The attachments like molar tube and brackets are
soldered or welded on to the band and band will be
cemented around the teeth.
 Prefabricated band are also available. The use of these
bands reduces the chair side time by eliminating tedious
procedure like pinching.

44. 2) Brackets
 Brackets acts as handles to transmit the force from the active
component to the teeth.
 Brackets have one or more slots that accept the arch wire.
Types of brackets:
1. Edgewise brackets:
2. Ribbon arch brackets:
3. Weldable and bondable brackets:
4. Metallic brackets:
5. Ceramic brackets:
6. Plastic brackets:

45. 1) Edgewise type of bracket: (The bracket with rectangular
slot facing labially)
 Bracket used in Edgewise and straight wire technique
have a horizontal slot facing labially.
 They accept wires of
rectangular cross section.
 These bracket provide
greater control over tooth
movement and do not permit
tipping of tooth.

46. 2) Ribbon arch brackets: (The bracket with vertical slot
facing occlusal or gingival direction)
 The slot is narrow mesio-distally.
 This type of brackets usually
receive round wire to bring
tipping of tooth labio-lingual
as well as mesio-distal direction.
 It is used in Begg-fixed appliance.

47. 3) Weldable and bondable brackets:
 Those brackets are welded over the
band are called weldable bracket.
 Those bracket directly bonded over
the enamel are called bondable brackets.
 Bondable bracket has a meshwork or grooves to help in
interlocking with the adhesives.

48. 4) Metallic brackets:
 Mostly in use
Advantages of metallic brackets:
 They can be recycled
 They can be sterilized
 They resist deformation and fracture
 They exhibit the least friction at the wire bracket interface.
 They are not expensive
Disadvantages of metallic brackets:
 They are aesthetically not pleasing.
 The can corrode and cause staining of teeth.

49. 5) Ceramic brackets:
 Introduced in 1980’s
 They are made up from aluminium oxide or zirconium oxide
Advantages of Ceramic brackets:
 They are dimensionally stable
 They are durable and resist staining in the oral
environment
Disadvantages of Ceramic brackets:
 The are very brittle
 To compensate their brittleness, their size is increased
which tends to increase their bulk

50. Ceramic brackets
Metallic
brackets

51. 5) Plastic brackets:
 Made up from Polycarbonate
 Introduced to improve the aesthetic value of appliance
 Available in tooth colored or transparent forms
Disadvantages of Plastic brackets:
 They tend to become discoloured due to smoking and
coffee etc.
 They having poor dimensional stability.
 Their slots tend to distort.

52. 2) Molar tube / Buccal tube:
 Buccal tube can be weldable on to the bands or they can
be bondable directly to the teeth.
 Buccal tube can be round or rectangular.
 The buccal tube sometimes have double or triple tubes.
These additional tubes for additional wires.

53. 2) Accessories:
1) Lock pins
 It is small pins that are used to secure the arch wire into
the bracket with vertical slot such as ribbon arch
brackets.
 It is usually made of brass

54. 2) Ligature wire
 They are soft stainless steel wire of 0.009 to 0.011 inches
in diameter and are used to secure the arch wire to the
bracket and it is known as ligation
 Ligation is necessary in edgewise type of brackets
because it have labially facing slot
 Elastic ligature can also used to secure wire into the
brackets

55. 1) Banding:
 Banding involves the use of thin stainless steel strips
called bands that are pinched tightly around the teeth and
then cemented to the teeth.
 The stainless steel tape is available in different width and
thickness to suit different teeth.
 The molar band material is wider and stiffer
 Anterior band material is thinner and narrower.

56.  Indications for banding
Banding is preferred over bonding in case of
posterior teeth the Banded attachment are better
capable of resisting occlusion forces than bonded
attachment.
It is preferable to band a tooth that requires buccal
as well as lingual attachments.
Bands are better likely to resist heavy forces as in
the case of extra oral devices such as headgear.

57.  Although it is not possible to Bond attachments on teeth
that have porcelain or gold restorations on crowns, banding
is preferred in these case.
 It is preferable to band teeth that show recurrent breakage
of the bonded attachments due to bond failure.
 It is preferable to use Banded attachments whenever they
are likely to connect the opposing dentition when the jaws
are closed.

58. Steps in banding:
1. Separation of teeth
2. Selection of band material
3. Pinching of the band
4. Fixing the attachments
5. Cementation of band

59. Separation of teeth
 Due to the presence of tight inter-dental contact between
the teeth, it may not be possible to force the band through
contact point.
 Hence tight contact should be broken with the help of
separator prior to band adaptation.
Selection of band material
 Based on which tooth is being banded, the band material of
appropriate thickness and width is selected.

60. Pinching of the band
 Band material of adequate length is taken and two end are
welded together and band is now passed through the
separated interdental contact around the teeth to be
Banded using band pinching pliers.
 The band is tightly drawn around the tooth to form a ring
the neck of the band is spot welded to retain the tight fit
the excess band material is then cut off and the end are
adapted close to the band.

61.  The bend portion is spot welded and the gingival margins of the band
are trimmed to conform the contour of the gingival margin.
 The weld spots and rough margin are then smoothened and polish.

62. Fixing the attachment
 Once the band pinching is completed the appropriate
attachments are fixed on to the band.
 The attachments include brackets for the anterior teeth
and buccal or molar tube for the posterior teeth
 The attachments are fixed to the band by spot welding by
soldering.

63. Cementation of the band
 The final step involves cementation of the band around the tooth.
 The inner surface of the band is rough in order to add retention.

64.  A well pinched band is one that has adequate retention
even without the use of cement but Cementation is
required to eliminate the space between the band and
tooth into which cariogenic material may seep.
 cements that can be used includes zinc polycarboxylate,
zinc phosphate, glass ionomer cement etc

66. Band thickness in inches Band width in inches
Incisor 0.003 0.125
Canine 0.003 0.150
Premolar 0.004 0.150
Molar 0.005
0.006
0.180
Band sizes

67.  Causes of band failure
1. Patient factors
 Eating hard and sticky food
 Bruxism
 Use of phenolic mouthwashes
 Biting nails chewing pen or pencil
2. Dentist factor
 Poor moisture control
 Insufficient etch time
 Application of high force to engage the arch wire.

68. 2) Bonding:
 The method of fixing attachments directly over the enamel
using adhesive resins is called bonding
 Introduced by buonocore. [ in 1955 ]

69. Advantages of bonding
 It is aesthetically superior.
 It is faster to Bond than to pinch band around the teeth.
 It enables maintenance of better oral hygiene.
 It is possible to Bond on teeth that have aberrant shape or
form.
 It is easier to Bond than band in case of partially erupted
and fracture teeth.
 The risk of caries under band is eliminated.
 Interproximal areas are accessible for restoration and
proximal stripping.

70. Disadvantages of bonding
 Bonded attachments are weaker than Banded attachments.
 Bonding involves etching of enamel with an acid which may
lead to enamel loss and an increased risk of
demineralization.
 Chances of enamel fracture can occur during the
debonding.

71. Steps in bonding:
1. Teeth which are to be bonded cleaned with the help of
pumice and brush to remove plaque.
After cleaning teeth are washed and dried.
During bonding procedure adequate moisture control
should be maintained with the help of saliva ejector and
cotton rolls.

72. 2. 35-50% phosphoric acid in gel or liquid form is used to
etch enamel.
This etching is done for 45-60 seconds after that etchant
is washed of with water.
Teeth are then dried and sealant is applied onto the
etched enamel surface.

73. 3. Adequate amount of bonding adhesive is placed on the
base of brackets, then bracket is placed on the tooth
Excessive adhesive is removed by using scaler.

74. FIXED APPLIANCE TECHNIQUES
1. Edgewise appliance
2. Begg appliance or light force
technique or differential technique
3. Preadjusted Edgewise Appliance or
Straight Wire appliance
4. Tip Edge technique

75.  Introduced by EH Angle in 1928
 It utilizes both rectangular slot
brackets as well as rectangular wire
 Rectangular wire in rectangular
slot able to control tooth movement
in all the tree planes of space

76.  Angle devised a metal bracket having rectangular slot with
0.022’’ * 0.028’’ dimension facing labially. The slot
receive rectangular wire of 0.022’’ * 0.028’’
 Rectangular wire is inserted into bracket slot in such way
that the narrower dimension is placed oclusogingivally and
the larger dimension extends depth wise labiolingually into
the slot.
 This mode of incretion is called edgewise hence this
technique is known as Edgewise technique.

78. Levelling and Alignment:
 This is the major objective during the early stage of
treatment
 In this all the teeth are brought in same vertical and
horizontal planes of space. Any rotation, crowding,
intrusion and extrusion are corrected in this stage.
 It is achieved by round Ni-Ti wire or stainless steel wire
which apply gentle forces without distortion.
 This is followed by sequentially increasing diameter of wire
from 0.012’’ to 0.020’’ or 0.016’’ * 0.016’’ to 0.018’’ * 0.018’’
square wire

79. Overbite reduction:
 Deep bite are corrected by intrusion of the anterior or
extrusion of posterior teeth
 That depends upon the number of factors such as skeletal
and dental growth pattern of individual, lip configuration
and inter-occlusal clearance.

80.  Incisors can be intruded by using intrusion utility arches, with
incorporating anchor bends in wire and arch wires with reverse Spee
in the mandiblular and curve of spee in maxillary arch.
 Posterior extrusion can be achieved by use of bite planes and
vertical elastics.
 In some cases headgears may be used.

81. Overjet reduction and space closer:
 It is necessary to establish normal relationship between
the upper and lower arches.
 There are two types of mechanisms used for anterior
retraction.
1. Friction or sliding mechanisms:
2. Frictionless or loop mechanisms:

82. 1. Friction or sliding mechanisms:
 After proper alignment of the bracket [teeth], arch wire
easily slides through the buccal tube.
 Rectangular stainless steel wire with 0.18’’ * 0.025’’ or
0.019’’ * 0.025’’ dimension are used for the purpose of
anterior retraction.

83.  Hocks are soldered on the arch wire either mesial or distal to the
canine.
 Sometimes elastic, either fixed or removable and NiTi coil springs
can be used.

 This result in retraction of anterior teeth by arch wire sliding through
the slot of the posterior brackets and buccal tube.

84. 2. Frictionless or loop mechanisms:
 This is based on the spring and loop design incorporated
into the main arch wire.
 The spring can be modulated for anterior retraction or
posterior protraction depending upon the anchorage need
of patient.
 Various design of loop are available such as T-loop, Omega
loop, key hole loop, tear drop loop, mush-room loop etc.

86. Final tooth position:
 The final phase involves finishing and occlusal detailing .
 During this phase of treatment smaller diameter wires are
used in the initial phases such as 0.016’’ stainless steel
wires as they are more flexible and allow precise finishing.
Debonding and Refraction:
 Once the occlusion is settled, the appliance is debonded.
This is followed by appropriate retention.

87.  Introduced by Raymond Begg.
 Begg modified the angles ribbon arch technique and
introduced begg light wire differential force technique.
 Tipping rather than bodily movement .
Begg appliance technique is carried out in three different
stages.

88. 1. Stage one:
 It is concern with alignment, correction of crowding,
rotation, closer of anterior spaces and achiving
edge-to-edge anterior bite . The bite is open in order
to reduce the overjet
 Usually 0.016’’ stainless steel round arch wire that
will be plane or with loops is used.
 Intermaxillary elastics are used in this stage

89. 2. Stage two:
 The remaining extraction spaces are closed in this stage
 Usually 0.018’’ stainless steel round arch wire is used.
 Both intermaxillary and intramaxillary elastics is used.
3. Final stage:
 Uprighting and torquing is carried out in this stage to
achieve normal axial inclination of teeth.
 Usually 0.020’’ stainless steel round arch wire is used.
 Uprighting springs also used in this stage.

91.  Introduced by Lawrence F Andrews in 1970.
 It is the a modification of the edgewise appliance and it is
based on the Andrews six keys to normal occlusion.

92.  Bracket have rectangular slots similar to standard edgewise bracket.
 The first-order, Second-order and Third-order components are built in
the bracket itself. So it eliminates the need of wire to have any
complex bending as required in standard edgewise appliance. Hence
it is called preadjusted appliance

94. Tip-Edge Technique:
 It was introduced by Peter C. Kesling.
 This is the combination technique which utilises the
advantages of both the edgewise and begg appliance.
 The bracket design has both vertical and horizontal slot.
 It can create rapid opening of bite as well as reduced
treatment time and at the same there is good control over
tooth movements.

95.  Advances in orthodontic brackets:
Ceramic Bracket:
• Ceramic brackets were introduced in the 1970’s
• All currently available ceramic brackets are composed of
aluminium oxide in two forms i.e. polycrystalline or
monocrystalline, depending on their method of fabrication.
Plastic Bracket:
• Plastic brackets were marketed in the early 1980’s. Initially
constructed from acrylic and later by polycarbonate.

96. Self-ligating Bracket:
 A self-ligating bracket is a ligature less system with a mechanical
device built-in to close-off the bracket slot.
 Secure engagement of the main arch wire into bracket may be
produced by a clip mechanism replacing the stainless steel or
elastomeric ligature.
Features of Self-ligating bracket
1. Speed brackets:
 Earlier brackets had clips which
could too easily be displaced or distorted.
 These drawbacks have been taken care into
these bracket.

97. 2. Activa brackets:
 Activa brackets had a rotating slide, which therefore gave a concave
inner radius to the labial surface of the slot.
 These increased slot depth reduced the labio-lingual alignment
efficiency. The bracket is wider than the average bracket.
 Tie-wings were absent and a different bonding base made bracket
positioning more difficult.

98. 3. Time 2 bracket:
 The time 2 bracket has a clip that rotates into position around the
gingival tie wing and rotates towards the occlusal rather than the
gingival wall of the slot.

99. 4. DAMON SL Brackets:
 Damon SL brackets had a slide that wrapped around the labial face of
the bracket.
 The slides sometimes opened inadvertently and they were prone to
breakage

100. 5. DAMON 2 Brackets:
 Introduced to overcome the imperfections of Damon SL.
 Damon 2 brackets are almost completely free from inadvertent slide
opening or slide breakage.
 However, the brackets were not immediately and consistently very
easy to open.

101. 6. DAMON 3 and DAMON 3MX Brackets:
 Damon 3 and Damon 3MX brackets have a different location and
action of the retaining spring, and this has produced a very easy and
secure mechanism for opening and closing.
 Damon 3 brackets have three significant problems: a high rate of
bond failure, separation of metal from reinforced resin components,
and fractured tie wings.

102. 7. Basis of Butterfly system:
 The Butterfly System is based on low-profile pre-adjusted bracket
that features a vertical slot.
 The vertical slot permit the addition of a variety of auxiliaries.
 Hook or T-pins for elastics can be added to the vertical slot during
treatment whenever they are needed.
 A further enhancement to patient comfort and aesthetics is derived
from the reduced profile or thickness of the bracket.

103. 1. Emoyers, handbook of orthodontics 4h edition, year book medical
publisher, inc 1988
2. Profit, Contemporary orthodontics, Elsevier India 3ed 2000.
3. Begg PR, KeslingPC, begg orthodontic theory and technique, St
Louis Mosby 1985
4. Kesling PC, Tip-edge guide and diffren. Stratight arch technique
1988
5. Andrew LF. Straight wire appliance explaned and compared. J clin
orthod 1976;10:174-95

104. THANK YOU