2. Seminar submitted to
DEPARTMENT OF
ORTHODONTICS
Seminar submitted by
SACHIN SUNNY OTTA
FINAL YEAR PART 1
FIXED ORTHODONTIC
APPLIANCES
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3. From the history…
Most of the early appliance were of removable
type.Actually , they were modified dentures.
Early fixed appliance were usually crude
metal bands that were ligated to teeth with
brass or silver wire. They were outstanding
for their inefficiency & their ability to trap
food.So KINGSLEY,ANGLE & CASE
realised that for any effective tooth
movement,some means must be devised to
control individual teeth.This led to the
development of attachments that were
soldered on modified crowns or bands…!
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4. What Are Fixed Appliances?
Appliances that are fixed or fitted on to the
teeth by the operator & cannot be removed by
the patient at will.
They are very versatile and can be used to
treat most
malocclusions.
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5. ADVANTAGES:
1.Orthodondist need not depend on patient
cooperation on timely wear.
2.Any type of tooth movements are possible.
3.Multiple tooth movements possible
simultaneously.
DISADVANTAGES:
1.Oral hygiene maintenance
2.Time consuming to fix and adjust
3.Damaged appliance deliver mis-directed forces
4.Regular visits
5.Expensive
6.Esthetically not pleasing
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6. Tooth movements possible
TIPPING –crown moves in direction of force
BODILY MOVEMENT – equal movement
TORQUING – root in lingual direction
UPRIGHTING – mesio distal movement
ROTATIONS – rotation around long axis
EXTRUSION
INTRUSION
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8. OPTIMUM ORTHODONTICFORCE
The force that produce maximum tooth
movement in the desired direction with
minimum damage to supporting tissue &
without any discomfort to patient.
It should be in range of 20-26gm/cm sq of
root surface
It should not occlude blood vessels in PDL.
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11. Fixing attachment to teeth
BANDING
Technique of fixing attachments to band
is referred as BANDING.
Uses thin stainless steel strips called
bands that are wrapped around teeth &
cemented to teeth.
Posterior bands are wider & stiffer
where anterior band is thinner &
narrower.
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13. Indications for banding:
1.Posterior teeth which receive heavy Occlusal
force & moisture control is required.
2.Teeth that require buccal & lingual attachments
3.Teeth with short clinical crowns
Steps in banding:
1.Separation of teeth – using elastomeric
rings(doughnut),separating springs(1
week),Keslings separator.
2.Selection of band material,thickness & width
3.Band placed around tooth & pinched
4.Spot weld
5.Fixing the attachments
6.Cementation
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15. BONDING
The method of fixing the attachment directly over
the enamel using adhesive resin
Advantage over banding: enhance esthetics & oral
hygiene maintenance.
PRETREATMENT OF ENAMEL BEFORE
BONDING:
1.Etching the enamel enhance surface energy
2.Etching enhance porosity & hence greater bond
strength.
ADVANTAGES:
1.Esthetics
2.Faster to bond
3.Better oral hygiene
4.Risk of caries under loose bands are eliminated
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17. DISADVANTAGES:
1.Weaker than banded attachments
2.Etching increases risk of demineralisation
3.Enamel fracture can occur during debonding
TYPES OF BONDING:
1.Direct bonding :direct attachment of bracket to
pretreated teeth.
2.Indirect bonding: bonding with the help of
transfer tray
DIRECT BONDING
1.Cleaning – pumice & bristle brush
2.Moisture control – saliva ejectors & cotton rolls.
Methantheline 50mg per 45kg bdy wt 15 min
before bonding.
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20. 3.Enamel pretreatment – 30-50% phosphoric acid
(gel or liquid) for 15-30 sec. appearance of
etched enamel is “matte,dull,whitish & lightly
frosted”
4.Sealant application
5.Bonding – using bonding material (bis-
GMA).Light cure adhesives also used.Excessive
adhesive material removed using scaler.
INDIRECT BONDING
1.Brackets are positioned & applied over the
model
2.Transfer tray (thermoplastic sheet or silicone
putty) is adapted over the model to incorporate
bracket.
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21. 3.Bonding resin applied to mesh side of bracket
4.Tooth surface is pretreated
5.Bonding tray is positioned over patient `s
mouth
6.Light cured
ADVANATAGES:
1.Accurate placement of brackets
2.Clinical chair side time reduced
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29. bands
Help to fix attachments to teeth.
Made of soft stainless steel
Preformed bands or custom made bands are
available
Inner surface has matt finish to aid in
retention of cement.
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30. BRACKETS
Handles of attachment to tooth that transmit
force from active component (arch wire)
Classification:
1.Based on material
Metallic & Ceramic
2.Based on attachment
to tooth
Weldable & Bondable
3.Based on mode of securing arch wire
Self ligating & that require ligation
4.Based on technique
Edgewise , Ribbon arch , Tip edge type
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32. EDGEWISE : have a
horizontal slot labially.
They accept wires of rectangular
cross section.
Greater control over tooth.
RIBBON ARCH: have vertical slots facing
occlusal or gingival direction.Used
with round wires.Permit tipping of
teeth in labiolingual & mesiodistal
direction.Used in Beggs appliance.
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34. CERAMIC BRACKETS: aluminium oxide or
zirconium oxide.Dimensionally stable,durable
& resist staining.They are very brittle &
exhibit greater friction at wire-bracket
interface.
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35. PLASTIC BRACKETS: improve esthetic
value.They tend to discolor & offer poor
dimensional stability.Very high friction.
SELF LIGATING BRACKETS: have inbulit
metal labial face that can be opened & closed
to secure arch wire.Exhibit very low friction
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37. BUCCAL TUBES
Attachment generally used in
molars(molar tube)
They are weldable or bondable
Round or Rectangular in cross section
Single , Double & Triple.
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38. Lingual attachment
Attachments to be fixed lingually.
Used to engage elastics.
Lingual cleats Lingual buttons
Eyelets
Ball end hook
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39. Ligature wire
To secure arch wire to
bracket(ligation) in edge wise brackets.
Stainless steel wire of
0.009-0.011 inch diameter
Lock pins
Small pins to secure arch wire
to ribbon arch bracket.
Made of brass
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40. Arch wire
Gold wires replaced by stainless steel wires due to high
cost & mechanical inefficiency
Titanium wires also used due to high elastic properties.
Ideal requirements:
1.Spring back-how far deflected without permanent
deformation
2.Stiffness-low stiffness apply low constant force over time
3.Formability-be high to bend in any configuration
4.Resilience-amount of force wire can withstand without
deformation.
5.Biocompatability
6.Joinability
7.Friction-very low
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41. Gold & gold alloys: low spring back & high cost
Stainless steel:18-8 stainless steel
Nitinol :high spring back, high working range &
low stiffness.Cannot be soldered or welded.
Beta tiatnium: T.M.A wires.High range of action &
spring back.High formability & can be welded.
Elgiloy : cobalt chromium nickel alloys
Optiflex arch wires: made of clear optical fibre &
hence highly esthetic.High resilience.Cannot
accept sharp bends.
Multistranded arch wire:made of number of
thinner wires.Increased flexibility.
Arch form termed as “Parabolic Shaped”
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44. 2.Class 2 elastics :inter maxillary elastics
stretched between lower molars &upper
anteriors.Used in treatment of class II
malocclussion.
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45. 3.Class 3 elastics:intermaxillary elastics
stretched between upper molars & lower
anteriors.Used in treatment of class III
malocclusion.
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46. 4.Cross bite elastics:to treat molar cross
bite.Extend between palatal surface of
upper molars & buccal surface of lower
molars or vice versa.
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47. 5.Box elastics:treat anterior open
bite.elastic is stretched between upper &
lower anteriors like a box.Forced
eruption of upper & lower anteriors.
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48. ELASTIC CHAINS (E-CHAINS)
Elastics available as long chains of interconnected
rings
Made of synthetic polyurethene
material
Used in closure of space between
teeth.
ELASTIC THREAD
Made of core of latex rubber surrounded by woven
silk
Tied around two teeth for space closure or to
derotate a tooth.
ELASTIC MODULE
Two elastic rings separated by variable distance
Used for space closure & derotation of tooth
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50. LIGATING RINGS
To secure arch wire to bracket
Available in various colors
Alternative to ligature wires.
Springs
Uprighting spring:move root in mesial or
distal direction
Torquing springs:move root in lingual or
palatal direction
Open coil spring:coil compressed
between two teeth to open space
between them
Closed coil spring:stretched between
two teeth to close space.
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53. separators
To open up a gap in interdental area for easy
banding & patient comfort.
BRASS WIRE SEPARATOR
0.5-0.6mm diameter brass wire
RING SEPARATOR
Elastic rings passed via contact using applicator
DUMBBELL SEPARATORS
Dumbbell shaped elastic stretched into contact
Stretched separator tries to regain original
length hence indirectly separates the teeth.
KESLING`S SPRING SEPARATOR
Have a coil & two arms- shorter arm passed
below contact while longer arm rests above the
contact.
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57. E-ARCH
Expansion arch by Angle
Had bands on molars with an expansion arch
threaded to buccal aspect of molar bands
Individual teeth were ligated to expansion arch
Deliver only heavy interrupted force
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58. PIN & TUBE APPLIANCE
Consist of bands with vertical tubes placed
on all teeth. Arch wire carried soldered pins
inserted into vertical tubes
Tooth movement achieved by altering
placement of pins.
Require high precision & skill
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59. EDGEWISE APPLIANCE
“Metal bracket having rectangular slot facing
labially received a rectangular arch wire “
It enabled control of tooth movement in all
three plane of space
Angle`s last contribution
It incorporated FIRST , SECOND & THIRD
ORDER BENDS.
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65. Advantages:
1.Ability to move teeth in all three planes
of space
2.Bodily movement of teeth possible
3.Good control
Disadvantages:
1.Need to apply heavy force
2.Need for complex wire bending
3.Increased friction
4.Difficult to open deep bites
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66. RIBBON ARCH APPLIANCE
First appliance to use a true bracket having
vertical slot facing occlusaly
Used archwires with good spring qualities
Poor control of root position
Used rectangular wires than round wires
Enabled rotation control,bucco lingual &
incisogingival tooth movement
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67. BEGG APPLIANCE
Concept of differential force & tipping of teeth
rather than bodily movement
Modification of ribbon arch appliance
Treatment is under 3 stages:
1.Alignment, correction of crowding, rotation
correction, closure of anterior space &
achieving an edge to edge anterior bite.
2.Closure of extraction space & maintenance
3.Root Uprighting & torquing
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68. Advantages:
1.Use of light continuous force over
physiological limits
2.Do not strain the anchorage
3.Minimal friction
4.Extra oral force not required to conserve
anchorage.
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70. STRAIGHT WIRE APPLIANCE
Pre adjusted edgewise appliance
Programmed brackets to eliminate the
complex bends.
Bodily movement of tooth achieved
Stages of treatment:
1.Initilal aligning & leveling of arch with
crowding correction.
2.Space closure & establish class I molar
relation with normal over jet
3.Finishing & detailing
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71. By passing the bends..
1.First order bends – varying the thickness of
base of bracket
2.Second order bends – angulating bracket
base or bracket slot
3.Third order bends – inclined bracket slots
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72. BAKERS ANCHORAGE
Use of inter maxillary rubber bands
Adjust the teeth by pitting the upper arch
against lower arch
Used in class II & class III malocclussion
cases
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73. LINGUAL ORTHODONTICS
Technique involving placement of bracket &
other attachments on lingual surface of
teeth.
Appliance not visible & hence donot affect
esthetics(Invisible orthodontics)
Begg`s & edgewise principle can be
incorporated
Indications:
1.Mild incisor crowding with anterior deep bite
2.Long & uniform lingual tooth
surface without fillings,crowns or
bridges
3.Good gingival & periodontal
health
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74. Drawbacks:
1.Difficult to place bracket in lingual aspect
2.Tooth control not very effective
3.Limited scope for complex problems
4.Difficult in short crowns
5.Expensive
Indirect bonding is
mandatory due to
difficult visualization &
bracket height.
Moisture control is difficult.
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75. TIP EDGE APPLIANCE
Combine advantages of straight wire & begg
appliance
Initial stage: Tip edge bracket allow tipping of
tooth(round arch wire)
Final stage: Better degree of control over
tooth (rectangular arch wire)
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76. Stages of treatment
Leveling & alignment
Overbite reduction
Overjet reduction
Space closure
Final tooth positioning
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78. 1.LEVELING & ALIGNMENT
In vertical & horizontal planes
All rotations are corrected
2.OVERBITE REDUCTION??
By intrusion of anteriors or extrusion of
posteriors depending on skeletal growth
pattern,lip configuration & inter occlusal
clearance
Intrusion of anteriors – intrusion utility arches &
arch wires with anti curve of spee in mandibular
& exaggerated curve of spee in maxillary arch .
Posterior extrusion – bite planes & vertical
elastics
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80. 3.OVERJET REDUCTION & SPACE CLOSURE
To obtain class 1 canine relation
Close any residual space occurred due to
extraction
Mechanics of anterior retraction :
1. Friction or sliding mechanism - aligned brackets
allow wire to slide through posterior bracket
slots. Thick rectangular stainless steel wires are
used
2. Friction less or loop mechanics – Depends on
spring and loop design for anterior retraction or
posterior protraction depending upon anchorage
need . Various loops are T loop ,Omega loop ,
Key hole loop and Tear drop loop
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82. En mass retraction – Entire anterior segment is
retracted
Canine retarction followed by incisal retraction –
Enhances posterior anchorage control during
space closure
4.FINAL TOOTH POSITIONING
Finishing and occlusal detailing
Smaller diameter wire ( 0.016inch stainless steel
or rectangular beta titanium) is used
Minor arch wire bends in 1st 2nd or 3rd order may
be used
Vertical settling elastics is used for settling of
occlusion
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84. DEBONDING
removal of orthodontic attacthment and
adhesive resins .
To restore the surface of teeth as closely as
possible to pre traetment conditions
Metal brackets debonded using twin beak
debonding plier and brackets are cut off at tooth
bonding base interface
Thermal debonding csn be done when barckets
are exposed to heat source (softening of
adhesive)
Laser debonding
Ceramic brackets debonded by lifting the
brackets of using bracket removing plier ??
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86. Residual adhesive is removed using burs and
contra angle hand piece
Dome shaped tungsten carbide burs at
30000rpms using light painting stokes can
remove adhesive
Ultra fine diamond burs
Teeth is polished with prophylaxis paste
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88. EXTRACTION IN CONJUGATION WITH
ORTHODONTIC THERAPY
Teeth returned to their original positions of
malocclusions after the retaining appliance were
removed
In such case removal of one or more teeth made
the problem of correction much easier
Removal of first cuspids permit the normal
occlusion with greater ease and post treatment
stability
It was an antagonism with Angle’s followers .
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89. FIXED FUNCTIOAL APPLIANCES
Functional appliances that are fitted on teeth by
the orthodontist and cannot be removed at will
by the patient
Non compliance class II correctors
Advantages:
1. 24 hours usage
2. smaller size
3. better adapted to functional movements
4. overall treatment time is reduced
Classified as : 1 . Flexible fixed functional
apliance ( FFFA) 2. Rigid fixed functional
appliances (RFFA)
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90. FFFA
Inter maxillary torsion coils of fixed springs
Allows greater movements of mandible
Elasticity and flexibility
Disadvantages : fracture of appliance,
tendency to chew the appliance ,mucosal
ulceration of springs
Uses : class II div 1 and 2 , class 3
malocclusions
Example : Jasper jumper ,Klapper super
spring ,Churro jumper
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