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8/15/2017 1haPPy Smile
“The eyes sees only what the mind is prepared to comprehend”
Seminar submitted to
DEPARTMENT OF
ORTHODONTICS
Seminar submitted by
SACHIN SUNNY OTTA
FINAL YEAR PART 1
FIXED ORTHODONTIC
APPLIANCES
8/15/2017 2haPPy Smile
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…!
8/15/2017 3haPPy Smile
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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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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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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UPRIGHTING ROTATION
INTRUSION EXTRUSION
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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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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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 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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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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 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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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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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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Components of fixed appliances
 ACTIVE COMPONENTS
1.Arch wire
2.Springs
3.Elastics
4.Separators
 PASSIVE COMPONENTS
1.Bands
2.Brackets
3.Buccal tubes
4.Lingual attachments
5.Lock pins
6.Ligature wire
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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.
8/15/2017 29haPPy Smile
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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 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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 WELDABLE & BONDABLE BRACKETS
 METALLIC BRACKETS:
recycled,sretilized,resist deformation,least
friction at wire-bracket interface.Not
esthetically pleasing.
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 CERAMIC BRACKETS: aluminium oxide or
zirconium oxide.Dimensionally stable,durable
& resist staining.They are very brittle &
exhibit greater friction at wire-bracket
interface.
8/15/2017 34haPPy Smile
 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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EVOLUTION OF
BRACKETS
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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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Lingual attachment
 Attachments to be fixed lingually.
 Used to engage elastics.
 Lingual cleats Lingual buttons
Eyelets
Ball end hook
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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
8/15/2017 39haPPy Smile
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
8/15/2017 40haPPy Smile
 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”
8/15/2017 41haPPy Smile
Elastics & elastomerics
ELASTICS
 Latex rubber
 Force delivered depend on diameter of
elastics
 Color coded
8/15/2017 42haPPy Smile
Applications:
1.Class 1 elastics: intra arch
elastics.Used for space closure &
retraction of teeth.
8/15/2017 43haPPy Smile
2.Class 2 elastics :inter maxillary elastics
stretched between lower molars &upper
anteriors.Used in treatment of class II
malocclussion.
8/15/2017 44haPPy Smile
3.Class 3 elastics:intermaxillary elastics
stretched between upper molars & lower
anteriors.Used in treatment of class III
malocclusion.
8/15/2017 45haPPy Smile
 4.Cross bite elastics:to treat molar cross
bite.Extend between palatal surface of
upper molars & buccal surface of lower
molars or vice versa.
8/15/2017 46haPPy Smile
5.Box elastics:treat anterior open
bite.elastic is stretched between upper &
lower anteriors like a box.Forced
eruption of upper & lower anteriors.
8/15/2017 47haPPy Smile
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
8/15/2017 48haPPy Smile
ELASTIC
THREAD
ELASTIC
MODULE
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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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UPRIGHTING
SPRINGS
TORQUING
SPRINGS
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CLOSED
COIL
SPRING
OPEN
COIL
SPRING
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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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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
8/15/2017 57haPPy Smile
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
8/15/2017 58haPPy Smile
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.
8/15/2017 59haPPy Smile
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Comprises of lateral inset,canine offset & molar offset
Correct buccolingual position by moving the roots
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 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
8/15/2017 65haPPy Smile
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
8/15/2017 66haPPy Smile
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
8/15/2017 67haPPy Smile
 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.
8/15/2017 68haPPy Smile
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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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 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
8/15/2017 71haPPy Smile
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
8/15/2017 72haPPy Smile
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
8/15/2017 73haPPy Smile
 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.
8/15/2017 74haPPy Smile
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)
8/15/2017 75haPPy Smile
Stages of treatment
Leveling & alignment
Overbite reduction
Overjet reduction
Space closure
Final tooth positioning
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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
8/15/2017 78haPPy Smile
OVERBITE CORRECTION8/15/2017 79haPPy Smile
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
8/15/2017 80haPPy Smile
KEY HOLE LOOP
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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
8/15/2017 82haPPy Smile
FINAL STAGE
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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 ??
8/15/2017 84haPPy Smile
8/15/2017 85haPPy Smile
 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
8/15/2017 86haPPy Smile
Tungsten
Carbide bur
used for
cleaning of
adhesive
8/15/2017 87haPPy Smile
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 .
8/15/2017 88haPPy Smile
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)
8/15/2017 89haPPy Smile
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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RFFA
 Advantages : after fixing appliance ,do not
permit the patient to close the centric
relation which creates 24 hours stimulus
for mandibular growth
 Examples : herbest appliance,
cantilevered bite jumper ,MALU herbst
appliance ( mandibular advancement
locking unit), flip lock herbst appliance
8/15/2017 93haPPy Smile
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Problems during orthodontic treatment
1.Caries & decalcification
2.Deformed bands
8/15/2017 95haPPy Smile
3.Soft tissue problems
 Ulcerations
 Inflammation & enlargement of gingival
papillae
 Recession
8/15/2017 96haPPy Smile
Care your teeth during
treatment!!
1.Orthodontic brushes
8/15/2017 97haPPy Smile
2.Digital gum massage
3.Interdental stimulation
4.Waterpik
8/15/2017 98haPPy Smile
With the help of….
 Graber`s textbook of orthodontics-
Sridhar Premkumar (4th edtn)
 Contemporary orthodondics-William.R.
Proffit (4th edtn)
 Orthodontics the art & science-Bhalajhi
 Orthodontics exam preparatory manual
for undergraduates-Sridhar
Premkumar(2nd edtn)
8/15/2017 99haPPy Smile
8/15/2017 100haPPy Smile
“ONCE YOU LEART TO
QUIT, IT BECOMES A
HABIT”

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Contemporary Fixed Orthodontics

  • 1. 8/15/2017 1haPPy Smile “The eyes sees only what the mind is prepared to comprehend”
  • 2. Seminar submitted to DEPARTMENT OF ORTHODONTICS Seminar submitted by SACHIN SUNNY OTTA FINAL YEAR PART 1 FIXED ORTHODONTIC APPLIANCES 8/15/2017 2haPPy Smile
  • 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…! 8/15/2017 3haPPy Smile
  • 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. 8/15/2017 4haPPy Smile
  • 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 8/15/2017 5haPPy Smile
  • 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 8/15/2017 6haPPy Smile
  • 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. 8/15/2017 8haPPy Smile
  • 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. 8/15/2017 11haPPy Smile
  • 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 8/15/2017 13haPPy Smile
  • 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 8/15/2017 15haPPy Smile
  • 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. 8/15/2017 17haPPy Smile
  • 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. 8/15/2017 20haPPy Smile
  • 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 8/15/2017 21haPPy Smile
  • 26. Components of fixed appliances  ACTIVE COMPONENTS 1.Arch wire 2.Springs 3.Elastics 4.Separators  PASSIVE COMPONENTS 1.Bands 2.Brackets 3.Buccal tubes 4.Lingual attachments 5.Lock pins 6.Ligature wire 8/15/2017 26haPPy Smile
  • 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. 8/15/2017 29haPPy Smile
  • 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 8/15/2017 30haPPy Smile
  • 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. 8/15/2017 32haPPy Smile
  • 33.  WELDABLE & BONDABLE BRACKETS  METALLIC BRACKETS: recycled,sretilized,resist deformation,least friction at wire-bracket interface.Not esthetically pleasing. 8/15/2017 33haPPy Smile
  • 34.  CERAMIC BRACKETS: aluminium oxide or zirconium oxide.Dimensionally stable,durable & resist staining.They are very brittle & exhibit greater friction at wire-bracket interface. 8/15/2017 34haPPy Smile
  • 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 8/15/2017 35haPPy Smile
  • 37. BUCCAL TUBES  Attachment generally used in molars(molar tube)  They are weldable or bondable  Round or Rectangular in cross section  Single , Double & Triple. 8/15/2017 37haPPy Smile
  • 38. Lingual attachment  Attachments to be fixed lingually.  Used to engage elastics.  Lingual cleats Lingual buttons Eyelets Ball end hook 8/15/2017 38haPPy Smile
  • 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 8/15/2017 39haPPy Smile
  • 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 8/15/2017 40haPPy Smile
  • 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” 8/15/2017 41haPPy Smile
  • 42. Elastics & elastomerics ELASTICS  Latex rubber  Force delivered depend on diameter of elastics  Color coded 8/15/2017 42haPPy Smile
  • 43. Applications: 1.Class 1 elastics: intra arch elastics.Used for space closure & retraction of teeth. 8/15/2017 43haPPy Smile
  • 44. 2.Class 2 elastics :inter maxillary elastics stretched between lower molars &upper anteriors.Used in treatment of class II malocclussion. 8/15/2017 44haPPy Smile
  • 45. 3.Class 3 elastics:intermaxillary elastics stretched between upper molars & lower anteriors.Used in treatment of class III malocclusion. 8/15/2017 45haPPy Smile
  • 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. 8/15/2017 46haPPy Smile
  • 47. 5.Box elastics:treat anterior open bite.elastic is stretched between upper & lower anteriors like a box.Forced eruption of upper & lower anteriors. 8/15/2017 47haPPy Smile
  • 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 8/15/2017 48haPPy Smile
  • 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. 8/15/2017 50haPPy Smile
  • 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. 8/15/2017 53haPPy Smile
  • 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 8/15/2017 57haPPy Smile
  • 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 8/15/2017 58haPPy Smile
  • 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. 8/15/2017 59haPPy Smile
  • 61. Comprises of lateral inset,canine offset & molar offset Correct buccolingual position by moving the roots 8/15/2017 61haPPy Smile
  • 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 8/15/2017 65haPPy Smile
  • 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 8/15/2017 66haPPy Smile
  • 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 8/15/2017 67haPPy Smile
  • 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. 8/15/2017 68haPPy Smile
  • 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 8/15/2017 70haPPy Smile
  • 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 8/15/2017 71haPPy Smile
  • 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 8/15/2017 72haPPy Smile
  • 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 8/15/2017 73haPPy Smile
  • 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. 8/15/2017 74haPPy Smile
  • 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) 8/15/2017 75haPPy Smile
  • 76. Stages of treatment Leveling & alignment Overbite reduction Overjet reduction Space closure Final tooth positioning 8/15/2017 76haPPy Smile
  • 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 8/15/2017 78haPPy Smile
  • 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 8/15/2017 80haPPy Smile
  • 81. KEY HOLE LOOP 8/15/2017 81haPPy Smile
  • 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 8/15/2017 82haPPy Smile
  • 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 ?? 8/15/2017 84haPPy Smile
  • 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 8/15/2017 86haPPy Smile
  • 87. Tungsten Carbide bur used for cleaning of adhesive 8/15/2017 87haPPy Smile
  • 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 . 8/15/2017 88haPPy Smile
  • 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) 8/15/2017 89haPPy Smile
  • 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 8/15/2017 90haPPy Smile
  • 93. RFFA  Advantages : after fixing appliance ,do not permit the patient to close the centric relation which creates 24 hours stimulus for mandibular growth  Examples : herbest appliance, cantilevered bite jumper ,MALU herbst appliance ( mandibular advancement locking unit), flip lock herbst appliance 8/15/2017 93haPPy Smile
  • 95. Problems during orthodontic treatment 1.Caries & decalcification 2.Deformed bands 8/15/2017 95haPPy Smile
  • 96. 3.Soft tissue problems  Ulcerations  Inflammation & enlargement of gingival papillae  Recession 8/15/2017 96haPPy Smile
  • 97. Care your teeth during treatment!! 1.Orthodontic brushes 8/15/2017 97haPPy Smile
  • 98. 2.Digital gum massage 3.Interdental stimulation 4.Waterpik 8/15/2017 98haPPy Smile
  • 99. With the help of….  Graber`s textbook of orthodontics- Sridhar Premkumar (4th edtn)  Contemporary orthodondics-William.R. Proffit (4th edtn)  Orthodontics the art & science-Bhalajhi  Orthodontics exam preparatory manual for undergraduates-Sridhar Premkumar(2nd edtn) 8/15/2017 99haPPy Smile
  • 100. 8/15/2017 100haPPy Smile “ONCE YOU LEART TO QUIT, IT BECOMES A HABIT”