Advances in orthodontics /certified fixed orthodontic courses by Indian dental academy

Advances in
Or thodontics
INDIAN DENTAL ACADEMY


Leader in continuing dental education



www.indiandentalacademy.com





Introduction
History of Orthodontics
Advances In
Orthodontic Materials





Brackets
Arch wires
Bonding materials
Alternative force
delivery systems









Recent Orthodontic
Appliances
Biomechanical
Principles
Changing Esthetic
Concepts
Conclusion


INTRODUCTION


Every generation of man, admires his
own wisdom, skill, science, art &
progress;




It calls its own whatever it has learnt
from men of former days, & counts
the few improvements which have
had their birth in its own time as
triumphs
&
distinctions
which
elevates it above the past.




Advances in orthodontics has made
possible a constant improvement in
the quality of orthodontic treatment
over a period of last two centuries,
ultimately benefiting the patient.


An analysis of the various dimensions
of orthodontic advancement reveals
two important truths:
1.
2.

The biologic problem have remained
singularly unchanged.
Advancement in orthodontic material
and their cascading effect on
appliance design and treatment
strategies has added new solution to
old problems.



This area has been greatly taken
advantage by the manufacturers &
the engineer orthodontist, who due to
their basic knowledge of the
materials have introduced newer and
more efficient orthodontic appliances.


 Every

important science
must be correlated to
another.
 Similarly dentistry has
borrowed from many
different disciplines and
specialties.
 Engineering is only one
of them.



The profession of dentistry itself,
includes many disciplines, each
important in its own right in the
development and preservation of the
portal that admits all food and
sometimes the air that fuel the living
body.



The interests of dentistry, as the name
implies, are centered on the teeth; but the
teeth are an integral part of a much larger
structure.


The Tooth






Teeth exist in a dual
environment, partly inside
the body and partly out.
The external part is called
“crown”.
The internal part consist
of the “root” and the
supporting structures, the
periodontal ligament.

PDL
Root

Crown

Division in Dentistry
Working division in dentistry is based
on the area of their function, such as
 Operative dentistry
 Endodontics
 Prosthodontics
 Periodontics
 Orthodontics
 Oral Surgery

Operative dentistry




Is responsible for the
preservation
of
the
crowns of the teeth.
These are the working
ends that are seen in the
mouth, exposed to a wide
variety
of
chemical,
bacterial and mechanical
hazards.

Endodontics


Endodontics treats the
pulp (the living part of
the tooth mostly by
replacement)
along
with related diseases
of
the
periapical
tissues.

Pulp

Prosthodontics


Replaces missing
crowns, with or
without
support
from
remaining
teeth.


Periodontics




Periodontics bridges the
gap between the tooth
and its environment.
The central responsibility
is
the
periodontal
membrane that attaches
tooth to bone.

Orthodontics




Orthodontic therapy is
accomplished
by
manipulating
the
external environment of
the crown to stimulate
changes in the internal
environment that will
alter tooth positions.
He is concerned with
the dental environment.

Oral Surgery


Most of you
must be familiar
with this branch
of dentistry.




Although we can hide our political and
religious beliefs or our IQ with silence,




camouflage many physical shortcomings
with clothing,




we generally
appearance.

cannot

hide


our

facial



The face especially the mouth, is visible in
most social interactions.




It has been argued
that disfiguring malocclusion
is
a
physical
handicap
because it limits a
person’s employment,
career advancement,
social stereotype, and
marriage
opportunities.



“Treatment of the face is more than
moving teeth or cutting and rearranging
bones; it is even more than the sculpture
of living tissues noted earlier, for it often
involves serious alterations in the
personality and social interactions”
Moyers

Pierre Fauchard (1728)


“Bandelette” plates used to “straighten” teeth by
tying them to crude metal plates with brass or
silver wire.




Farrar’s appliance




Dr Angle’s appliances, 1887 using cemented
bands,
retraction
screws,
soldered
attachments




Dr Angle’s E (expansion) arch appliance.


Advances in Brackets (design)
Pin & Tube
Ribbon arch

Edgewise
Begg
Pre-Adjusted
Edgewise


Advances in
Orthodontic Materials
Brackets
 Arch wires
 Bonding materials
Alternative force delivery systems




ORTHODONTIC BRACKETS


Brackets






A door handle allows us to open or close a
door.
Similarly a bracket acts as a handle to a
tooth.
We can push, pull or rotate a tooth with the
help of these attachments.
Bracket
Arch wire

Bonding material

Advances in Brackets (materials)
Stainless Steel

Esthetics
Allergic reaction to Nickel
Polycarbonate
Titanium

Nickel free SS

Magnetic Brackets

Ceramics

Stainless Steel Brackets



Austenitic steel
AISI = 303, 304, 316, 316L & 317L (L = low
carbon content)





AISI series 630 SS called as
“precipitation hardening SS”, contains
very low chromium and nickel.
Manufacturing techniques
1.
2.
3.

Milling
Sintering
Metal injection moulding

Titanium Brackets




Current concept about heavy metal
poisoning and their biologic effects
led to banning the use of nickel
releasing alloys in
European
countries.
Therefore, Titanium based bracket
were developed.

Ceramic Brackets


Demand for esthetics in treatment.



Modifications include:
1.
2.
3.
4.

Mini sized steel brackets,
Lingual orthodontics
Poly carbonate brackets
Ceramic www.indiandentalacademy.com
brackets (1987).



With ceramic brackets, unlike traditional
stainless steel braces, your smile will not
look 'metallic.' In addition, ceramic
brackets are designed so that they won't
stain or discolor over long periods of time.


Classification of ceramic brackets
 Crystal structure
1.
2.



Mono-crystalline
Poly-crystalline

Materials
1.
2.

Zirconia
Alumina


Lingual Orthodontics


Arch wires
 They

generate the required
forces and moments to bring
about tooth movement.


Advances in Arch wires
Precious alloy
Gold + Copper + Platinum + Palladium

Stainless Steel & Cobalt Chromium alloy
Better strength and Springiness with Corrosion Resistance

Nickel Titanium alloy
Developed for the space program
1.
Shape memory
2.
Super elasticity

Copper NiTi alloy
Heat activated NiTi wires

Beta Titanium
alloy

Alfa Titanium
alloy

(Titanium Molybdenum
alloy)

(Titanium + Aluminium
+ Vanadium)

Ion Implantation
To improve surface
properties of the TMA wires

Precious alloy






Before the 1950s
Nothing else would tolerate intraoral
conditions
But gold alone was too soft
Therefore used as alloy:
Gold
Copper
Platinum
Palladium


Stainless Steel



Increase in price of precious metals
Introduction to:
Stainless Steel (18:8 ss)
Cobalt chromium alloy





Resistance to corrosion due to high
chromium content.
Properties depends on
1.
2.

Cold working &
Anealing during manufacturing.

Nickel Titanium (NiTi) alloy





The 1st titanium alloy introduced
in
orthodontics = Nitinol (Nickel Titanium
Naval Ordnance Laboratory)
It was developed for space program.
Properties:
1.
2.
3.
4.
5.

Shape memory
Super elasticity
Superior spring back
Light continuous force
Long range of action



Types:
Stabilized Martensitic NiTi
Active Austenitic NiTi
Thermally activated NiTi
Copper NiTi
Chinese NiTi
Japanese NiTi


Esthetic Arch wires

Coated Arch wires

Composite Arch wires

(elastomeric poly-tetra-fluorethylene emulsion)

(Optiflex)


Bonding Materials


The brackets are attached to a tooth
surface with the help of bonding
materials.


Composite Resins

Chemical Cure
Single paste
system

Two paste
system

Light cure
U.V.
light


Visible
light

Laser
cure

Alternative force delivery systems


Advances in
Orthodontic Appliances

Removable appliances


Coffin Spring 1869



Bertoni expansion
screw 2000


Retention Plates


Functional Appliances


Fixed Functional Appliances


Extra-oral anchorage


Biomechanical Approach to Growth
Principles
 Orthodontic

problems are the result of
mechanical forces, and their correction
depends on mechanical forces.
 The force systems in the face can form
or deform, and their conscious control
is
a
continuing
challenge
in
orthodontics.

 Altering

the balance of forces can
arrest
or
reverse
progressive
deformities during growth, and it can
correct many of their effects even in the
adult.


Traditional use of Biomechanical Concept


Chinese Foot


Lip –Tongue-cheek System


Functional Deviation (Maxillary Constriction)


Environmental (Habits or Trauma)


Muscle Dysfunction


Loss of part of musculature (unknown cause or
birth injury or damage to the motor nerve).


Muscle Weakness


Muscular dystrophy / Cerebral palsy / Muscle
weakness syndromes.


Functions of the Jaws


Mechanical Principles in Jaws Functioning


 Thus

understanding
of
the
fundamentals of mechanics must be
the starting point for understanding
orthodontics.


 The

principles of force analysis are the
basic tools of the mechanical engineer,
& their application is universal.


 In

applying them to oral environment,
one
combines
engineering
with
dentistry, which requires a mixed
terminology that is partly foreign to
each discipline:
BIOLOGY
+
MECHANICS
________________________

BIO-MECHANICS



Today we are about to enter a new era
where the genetic coding is becoming
part of daily diagnostic tool. May be
tomorrow we have to approach
dentofacial problems by means of
genetic alterations.


Bioengineered Human of Future


CONCLUSION




Hope you have become familiar with
the variety of problems, their correct
diagnosis and the best treatment
solution possible.
Every case is a challenge requiring
versatile thinking and imagination
rather than opting for a dogmatic
conventional cook book approach .



Our profession is at cross roads
now. We are at a critical point in
history where we should make
conscious decisions which will
determine the way the future unfolds.




We should make a sincere effort to
lay an enduring foundation for a
robust and a lasting co-operation
between the specialities for the sake
of providing excellent care for our
patients.




We should be open to criticisms and
update ourselves. We should be
careful not to get entangled in
dogmatic philosophies and treatment
approaches.




Let us work together to usher in a
new era of integrated multidisciplinary
treatment philosophy.




I would like to leave you with an
inspirational saying

“Coming together is a beginning
Keeping together is progress
Growing together is success”.

Golden Proportions (Divine Proportion)


Rickett’s 1982

Bracket positioning simulation &
Computerized wire bending


CAD/CAM Fabrication
of occlusal splint for orthognathic surgery


Laser scanning
of the cast



Image of cast on
monitor


 Images

of study casts and facial
skeleton combined for simulation




Sagittal split ramus osteotomy
simulated on a 3-D image




Contact areas of
occlusal
splint
drawn
from
computer image of
study cast



Finished 3d image
of occlusal splint


 Occlusal

splint polymerized by
Laser Lithography Unit


Thank

you

 Leader in continuing dental education



Advances in orthodontics /certified fixed orthodontic courses by Indian dental academy

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