Esthetic orthodontics /certified fixed orthodontic courses by Indian dental academy

ESTHETIC ORTHODONTICS

INDIAN DENTAL ACADEMY
Leader in continuing dental education
www.indiandentalacademy.com



Orthodontic patients – their demand



development of appliances
acceptable aesthetic for the patient
adequate technical performance for the clinician


Tooth Colored
Mini
Plastic
Ceramic
Hybrid


Tooth Colored


Early attempts to coat metal brackets with
a tooth colored coating were unsuccessful
due to failure of the coating to adhere and
its translucence.


Mini Brackets


There was a firm trend towards the development
of smaller stainless steel brackets.



Although these generally provide the technical
performance required by the orthodontist, they
offer little aesthetic advantage over conventionally
sized appliances.


Plastic Brackets



Introduced during 1970s
Initially – unfilled polycarbonate brackets
Disadvantage – Creep deformation

– Deteriorate in appearance
– Friction


Polycarbonate brackets (1990s)
Ceramic-reinforced
Fiberglass-reinforced
Metal slot-reinforced


Ceramic Brackets


An attempt to improve esthetics while
maintaining bracket strength has resulted
recently in the development of a ceramic
bracket.



Alumina
Monocrystalline
Polycrystalline



Zirconia

Ceramic Brackets


Single-crystal alumina – most translucent



Poly-crystal alumina – less than singlecrystal



Zirconia – inferior esthetics
Greater opacity, yellowish tint


MONOCRYSTALLINE CERAMIC BRACKET
Starfire
Inspire

POLYCRYSTALLINE ALUMINA CERAMIC BRACKETS
MXi (TP ORTHODONTICS)


Hybrid Brackets


Two or more polymers



These have properties intermediate
between those of the constituents



Materials should be so chosen that the
property of one constituent improves
the deficient property of others


68
68


Epoxy-coated
Optiflex


Esthetic Arch wires

Coated Arch wires

Composite Arch wires

(elastomeric poly-tetra-fluorethylene emulsion)

(Optiflex)


Epoxy Coated Wires


Epoxy coated tooth-colored arch wires with
a NiTi (superelastic) or stainless steel core.



Advantages:
Superior wear resistance and color stability
Retains superelastic qualities
More natural looking than white coatings


Optiflex


Optiflex is a new orthodontic arch wire designed
to combine unique mechanical properties with a
highly esthetic appearance.



Made of clear optical fiber, it comprises three
layers
1.
2.
3.

A silicon dioxide core that provides the force for moving
teeth.
A silicon resin middle layer that protects the core from
moisture and adds strength.
A stain-resistant nylon outer layer that prevents damage
to the wire and further increases its strength.


Essix


Essix retainers are clear, thin cuspid-to-cuspid
appliances appliances that snap into place and are
retained, without clasps, by the many natural
undercuts gingival to the anterior contact points.



They are fabricated from .030" Essix plastic sheet,
which is reduced to .015" during thermoforming.




Additionally, tooth movement is possible in
all planes of space.



Two types of space that must be evident
for tooth movement with Essix appliances
are
space within the appliance and
space within the dentition




Methods of applying force in the Essix
System:
1. Spot-thermo forming
2. Mounding




Spot Thermo-forming

96
96




Mounding


SPACE CLOSURE

104
104


Invisalign


Was the brainchild of Zia Chishti and Kelsey Wirth,
graduate students in Stanford University's MBA program.



Kelsey Wirth had traditional braces in high school, which she
reportedly hated whereas Zia Chishti had finished adult
treatment with traditional braces, and now wore a clear
plastic retainer.
He noticed that if he did not wear his retainer for a few days,
his teeth shifted slightly -- but the plastic retainer soon
moved his teeth back the desired position.





Together they started Align Technologies in April 1997 and
with the help of a handful of forward thinking orthodontists,
they applied 3-D computer imaging graphics and created the
Invisalign method.

Steps
Step 1 - Diagnosis and Treatment Plan
Step 2 - Polyvinylsiloxane Impressions and
Bite Registration
Step 3 - The Digitization Process
Step 4 - ClinCheck
Step 5 -Manufacture of Appliances


Indications







mild spacing (1 - 3 mm),
moderate spacing (4 - 6 mm),
mild crowding (1- 3 mm),
moderate crowding (4 - 6 mm),
narrow arches that are dental in origin (4 6 mm),
as well as patients who have relapsed
following conventional orthodontic
treatment

Fiber-Reinforced Composites


Long-fiber composites can be used as
adjuncts for active tooth movement




The FRC rope or strip is cut to length, and
the protective transparent foil is gently
removed.



The tooth is prepared for bonding with the
conventional polishing and etching.



The FRC is placed in position and
contoured to the tooth, then light-cured to
form an effective connecting bar.

Clinical Use of FRC


Retainers




Kesling Positioner
Invisible Retainers
Essix Retainer


Lingual Orthodontics


History


During the early 1970’s, Dr.Craven Kurz, an orthodontist,
then Assistant Professor of occlusion and gnathology at the
UCLA School of dentistry found his private orthodontic
practice to be increasingly dominated by adult patients.



A particular patient who was an employee of playboy, bunny
club, presented to his practice requesting treatment.
Because of her public position, she refused metal or plastic
labial appliances on esthetic grounds.



From her demand for an appliance that did not show, the
concept of a lingually bonded appliance was born.



List of difficulties encountered during the
development of the lingual appliance:
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.

Tissue Irritation and speech difficulties
Gingival Impingement
Occlusal Interference
Appliance Control
Base pad Adaptation
Appliance placement and bonding
Appliance Prescription
Wire placement
Ligation
Attachments



Generation 1
Ormco manufactured the

first Kurz lingual appliance.
Flat maxillary occlusal bite
plane from canine to
canine.
Lower incisor & PM
brackets were low profile &
half round.
No hooks on any brackets.




Generation 2
Hooks were added to

all canine brackets




Generation 3
Hooks were added to

all anterior & PM
brackets.
The first molar had
bracket with internal
hook.
The second molar had
terminal sheath without
hook




Generation 4
Low profile anterior inclined plane in central

& lateral incisor. Hooks were optional based
on treatment needs & hygiene concerns




Generation 5
Increased labial

torque in the maxillary
anterior region.
Canine had an
inclined plane with
bibevelled.
Hooks were optional.




Generation 6
Maxillary inclined plane is square in shape.

Hooks available in all brackets & are
elongated.TPA attachment is optional.
 Hinge cap available for molar brackets.




Generation 7
Maxillary anterior inclined plane is heart shaped

with short hooks. Premolar brackets were
widened mesiodistally for better angulation &
rotational control. Molar brackets with hinge cap
or terminal sheath




Advantages
Intrusion of anterior teeth
Maxillary arch expansion
Combining mandibular repositioning

therapy with orthodontic movements
Distalization of maxillary molars


Leader in continuing dental
education


Esthetic orthodontics /certified fixed orthodontic courses by Indian dental academy

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